Primitive neuroectodermal tumors

The primitive neuroectodermal tumors (PNETs) of Hart and Earle constitute an important fraction of pediatric brain tumors that are clinically characterized by their aggressive behavior. In 1983, Rorke expanded the term “PNET” to include all small cell embryonal neoplasms of neuroectodermal origin, regardless of the location of the tumor. More recently, Dehner also proposed the terms “central” and “peripheral” PNETs, and the provocative concept of “PNET” has now come to encompass a diverse group of tumors in both the central and peripheral nervous systems. The acronym “PNET” has thus become a confusing and controversial term in the diagnosis and classification of pediatric embryonal tumors. We reviewed ten papers concerning the various aspects of PNETs.     

What Is Vitamin D Insufficiency? And Does It Matter?

The term nutrient “insufficiency,” as commonly used, refers to a nutritional status intermediate between classical, severe deficiency, and full normal. As both “deficiency” and “insufficiency” are causes of dysfunction and disease, there is no biological basis for a distinction between them. What is important to note is that, in the case of vitamin D, the preponderance of the evidence indicates that there is real, preventable disease in the range of vitamin D status values now labeled “insufficient.”     

“Turn downs” in aortic emergencies: Reassurance or uncertainty?

“Turn‐down” rate has been reported to have a significant influence on outcomes, and being turned down for an operation is associated with significant short‐term mortality risk. A study examining the impact of the pandemic on the “turn‐down” rates of acute aortic syndromes in the United Kingdom reported an overall “turn‐down” rate of  7.3% in the early part of the pandemic. This review examines the significance of “turn‐downs” in this setting and scrutinizes the adequacy of reporting this complex variable.     

Ergebnisqualität in der onkologischen Chirurgie

The term “quality” is a new buzzword used in connection with diagnostic and therapeutic activities. In the context of surgery, the term is usually restricted to the subdivision “quality of results.” The specific circumstances surrounding a patient threatened by a malignant tumor justify separate consideration of oncologic surgery. Upon scrutiny, the frequency with which the term quality of results is used is in stark contrast to the lack of distinct clarification of the parameters it covers and grave uncertainty in data collection. Since medical action is not identical to technical action, attention must be called to the limitations of this popular terminology, especially with regard to oncology.     

Shaping the subject of incontinence. Relating experience to knowledge

In this paper, we empirically analyse the role of experience and its relation to knowledge by working through a case study of a website for people with incontinence. The term “knowledge by experience” may be confusing if experience is framed as “situations someone has lived through” which then come to function as the foundation for experiential knowledge. Foundationalist framing of experiential knowledge leads to problems of “indistinctness”, “incontestability” and “authenticity” of experiential knowledge. The analysis shows how participants structure and process their experiences, for example by collecting, relating and reviewing individual moments and actively interpreting them. Not every experience counts as valid input for “knowledge”. We suggest that in relation to knowledge “experience” is better understood as “having experience with” rather than as “having lived through” something. Experience as “being experienced” is then not something that “grounds” experiential knowledge, but takes the shape of know-how, interpretive possibilities and skills that are not exclusively tied to a particular subject. Interpreting experiential knowledge like this specifies it as a form of practical knowledge that may be contested by (more) experienced others and can be transferred to others still trying to master skills. These skills may help in an attempt to shape experience in new ways.     

Shoulder arthroplasty in alkaptonuric arthropathy: a clinical case report and literature review

Alkaptonuria is a rare hereditary metabolic disease of autosomal recessive inheritance, resulting from deficiency of the enzyme homogentisic acid oxidase. The term “alkaptonuria” was first used in 1859 by Boedeker to describe a patient’s urinary reducing compound, and in 1866, Virchow coined the term “ochronosis” due to typical yellow pigmentation. Deposition of this pigment in articular cartilage leads to ochronotic arthropathy, the most incapacitating complication of alkaptonuria. We report a rare case of shoulder ochronotic arthritis, treated with total shoulder arthroplasty, achieving a successful long-term clinical and radiological outcomes.     

Osteoporosis across chronic liver disease

Osteoporosis is a complication of chronic liver disease, with impact on morbidity, quality of life, and survival. The progress of medicine and the new therapies stretched the disease’s natural history and improved the survival of patients with liver disease. So, it is fundamental to make better the quality of life and to prevent complications. Metabolic bone disorders are common complications of chronic liver disease (CLD). Patients with CLD have an increased risk of bone fractures, with significant impact on morbidity, quality of life, and even on survival. Bone diseases, including osteomalacia, osteoporosis, and osteopenia, are frequently observed in many types of liver disease. The pathogenesis of damage and the mechanisms of bone loss are different in relation to the specific liver disease. The relevance of these conditions induced many authors to create a new nosographic entity known as “hepatic osteodystrophy”, although this term is rarely used anymore and it is now commonly referred to as osteopenia or osteoporosis associated with chronic liver disease. This review is based on the personal experiences of the authors and upon research done of the available literature on this subject matter. The authors searched the PubMed database for publications containing the term “liver disease” in combination with “bone disease”, “hepatic osteodistrophy”, “osteoporosis”, “osteopenia”, “osteomalacia”, and “fractures”. They selected publications from the past 10 years but did not exclude older seminal publications, especially for colestatic liver diseases. This review of literature shows that osteoporosis crosses all CLD. It is important to underline that the progress of medicine and the new therapies stretched the disease’s natural history and improved the survival of patients with CLD. It is fundamental to make better the quality of life and it is mandatory to prevent complications and in particular the osteoporotic ones, especially fractures.     

Neuroendocrine Neoplasms of the Head and Neck: Some Suggestions for the New WHO Classification of Head and Neck Tumors

As knowledge and understanding in pathology evolve, classifications and nomenclature also change to reflect those advances. The 2005 World Health Organization Classification of Head and Neck Tumours was a significant step towards diagnostic standardization of head and neck neuroendocrine carcinomas; however, in the last 10 years there have been new data supporting the recognition of “large cell neuroendocrine carcinoma” as a distinctive high grade carcinoma in the head and neck, a lesion not included in the 2005 Classification. In addition, the terms “middle ear adenoma” and “carcinoid tumor of middle ear” are still widely used to describe a neoplasm that is neither a pure adenoma nor a carcinoid tumor but a lesion with variable mixed exocrine and endocrine differentiation. Largely using the diagnostic criteria of the WHO classification of neuroendocrine carcinomas of the lung, we propose the terms “neuroendocrine carcinoma, grade 1”; “neuroendocrine carcinoma, grade 2”; “neuroendocrine carcinoma, grade 3, large cell type”; and “neuroendocrine carcinoma, grade 3, small cell type” for the classification of neuroendocrine carcinomas of the head and neck in a future WHO classification. In addition, we also proposed the term “mixed epithelial neuroendocrine tumor” of the middle ear as an alternative for “middle ear adenoma” and “carcinoid tumor of the middle ear”.     

Induction therapy in adult intestinal transplantation: reduced incidence of rejection with “2‐dose” alemtuzumab protocol

The incidence of early rejection after intestinal transplantation correlates with heightened risk of graft loss and mortality. Many different induction or pre‐conditioning protocols have been reported in the last 10 yr to improve outcomes; however, sepsis remains prevalent and diminishes long‐term results. We recently began a “2‐dose” alemtuzumab trial protocol – 15 mg at day 0 and 15 mg repeated on day 7 – with the hope of reducing our infection rate. We compared three different protocols used at our institution (daclizumab, conventional “4‐dose” alemtuzumab, and “2‐dose” alemtuzumab). There was a significantly lower rate of early rejection with the “2‐dose” alemtuzumab protocol in our study group of mainly (88%) intestinal grafts without accompanying liver engraftment with its protective immunologic effect. Sepsis remained low. Longer follow‐up will be required to evaluate the effects of this new protocol on longer‐term outcomes.     

Rapid Decline in Online Search Queries for Hip and Knee Arthroplasties Concurrent With the COVID-19 Pandemic

BackgroundIn response to the coronavirus disease 2019 (COVID-19) pandemic, US hospitals have canceled elective surgeries. This decline in total joint arthroplasty (TJA) revenue may place financial strain on hospitals. Our goal was to quantify the impact of COVID-19 on the public interest in elective TJA.MethodsThe Google Search Volume Index (GSVI) identified the terms “knee replacement,” “hip replacement,” and “orthopedic surgeon” as the most common to describe TJA. The term “elective surgery cancellation” was also analyzed. Weekly GSVI data were extracted between 04-01-2015 and 04-04-2020. Time series analysis was conducted and state GSVI values were compared with COVID-19 prevalence and unemployment claims.ResultsThe relative public interest in elective TJA has sharply declined since the WHO declaration of COVID-19 as a global pandemic. Between 03-01-2020 and 03-29-2020, the popularity of searches for “knee replacement”, “hip replacement,” and “orthopedic surgeon” dropped by 62.1%, 52.1%, and 44.3%, respectively. A concurrent spike was observed for the term “elective surgery cancellation.” California, New Hampshire, Maine, and Nevada showed a low relative rate for TJA searches, and the highest increase in unemployment claims.ConclusionThe onset of COVID-19 correlates with declining relative popularity of searches related to elective TJA. Higher volume of COVID-19 cases in certain states may correspond with lower relative search popularity, although this correlation remains unclear. These results portend the possibility of a decline in elective TJA case volume, further straining hospitals. Further research is required to inform stakeholders how best to proceed and determine any sustained effects from the current diminished relative interest in TJA.Level of EvidenceLevel III.     

Osseous Dysplasia with Gross Jaw Expansion: A Review of 18 Lesions

Fourteen cases with 18 grossly expansive lesions diagnosed over a period of 15 years as either “familial gigantiform cementoma” or “osseous dysplasia with jaw expansion” in an African population sample were reviewed. Eight lesions occurred in the anterior mandible, the maxilla was affected by four, three patients presented with more than one lesion and the most common associated pathologies were tooth displacement, conventional non expanding florid osseous dysplasia and simple bone cyst. No history of similar lesions in relatives of the diseased were recorded. The radiolucent fibrous component contained globular bone deposits and cellular osteoid with trabecular differentiation which matured into radiodense mineralized masses. Resorption of the cellular bone created cavities which are proposed to represent the early stage of simple bone cyst formation. It is recommended that “expansive osseous dysplasia” replace the out-dated term “familial gigantiform cementoma”. The differential diagnoses of expansive osseous dysplasias are discussed.     

Should we use platelet‐rich plasma as an adjunct therapy to treat “acute wounds,” “burns,” and “laser therapies”: A review and a proposal of a quality criteria checklist for further studies

Platelet‐rich plasma seems to help wound healing. The goal of this review is to determine if the adjunction of platelet‐rich plasma enhances the clinical outcome of acute wounds, burns, and laser therapies. A PubMed and Cochrane library search was performed by two reviewers with the senior author as a consultant. Medical Subject Headings search terms used were the following: [“Platelet‐rich plasma” OR “Platelet gel” OR “Platelet growth factor”] AND [“Acute wound” OR “Wound” OR “Burn” OR “Laser”]. We included controlled studies assessing the clinical outcome of acute wounds, burns, and laser therapies treated by platelet‐rich plasma. Nine randomized controlled studies, six prospective controlled studies, and two retrospective controlled studies were included. Regarding acute wounds, three randomized controlled trials found a statistical benefit regarding either the healing time, the return back to work time, the quality of life, or the pain and three prospective controlled studies found a statistical difference regarding the velocity of healing. Platelet‐rich plasma decreased the intensity or duration of erythema after laser therapy in four randomized studies. Regarding the long‐term outcome of laser therapies, two studies found a statistical benefit and two others did not. Platelet‐rich plasma accelerates acute wound healing and decreases erythema after laser therapies. Its use on burns has not been enough studied.     

Refractory Heart Failure Dependent on Short‐Term Mechanical Circulatory Support: What Next? Heart Transplant or Long‐Term Ventricular Assist Device

Chronic heart failure is a progressive and eventually fatal illness. Although the disease cannot be cured and treatment is symptom oriented, most of the patients benefit from optimum medical treatment. Patients with rapid deterioration in chronic advanced heart failure refractory to medical treatment need inotropic support and may need intra‐aortic balloon pump to maintain circulatory support, which of course cannot be prolonged beyond a certain limit. The outcome of heart transplant and long‐term ventricular assist device (VAD) in such patients is poor. The short‐term mechanical circulatory support (MCS) offered to such patients not only provides effective circulatory support and stabilizes them hemodynamically, but also halts the ensuing or reverts the established end‐organ failure. As the name suggests, the short‐term MCS offers support for the short term, usually less than a month. Although some patients with acute heart failure experience recovery of myocardial function with short‐term MCS support, others become dependent. These patients, stabilized and “stuck” with short‐term MCS, can be “rescued” with long‐term VAD or heart transplantation. Both the procedures, when done in this special situation, have their inherent advantages, disadvantages, and complications and hence need the careful consideration about the choice of the procedure. We have tried to elucidate this situation by considering the advantages and disadvantages of both options.     

The effect of the metal-on-metal hip controversy on Internet search activity

The recall of the articular surface replacement (ASR) hip prosthesis in 2010 represents one of the most controversial areas in orthopaedic surgery in recent years. The aim of this study was to compare the impact of the metal-on-metal hip controversy on Internet search activity in four different regions and determine whether the number of related news reports affected Internet search activity. The Google Trends, Keywords and News applications were used to record the number of news articles and Internet search activity for the terms “hip recall”, “metal-on-metal hip” and “ASR hip” from October 2009 to October 2012 in the USA, the UK, Australia and Ireland. There was a large increase in search activity following the official recall in August 2010 in all countries. There was significantly greater search activity after the recall in Ireland compared with the UK for the search term “hip recall” (P = 0.004). For the term “metal-on-metal hip”, the UK had significantly more search activity (P = 0.0009). There was a positive correlation between the number of news stories in UK and Ireland with Internet search activity but not in the USA or Australia. Differences between countries affected by the same recall highlight the complex effects of the media on public awareness. The data demonstrates a window of opportunity prior to the official recall for the development of an awareness campaign to provide patients with accurate information.     

Remote peritentorial hemorrhage complicating supratentorial aneurysmal surgery: a report of three cases and literature review

We herein coin the term “remote peritentorial hemorrhage (RPTH)” and present three cases with “RPTH” after supratentorial aneurysmal surgeries, including two with remote cerebellar hemorrhage (RCH) and one with remote temporobasal hemorrhage. The RCH may result from rupture of the superior cerebellar veins due to excessive cerebrospinal fluid (CSF) loss. The mechanism behind the remote temporobasal hemorrhage may be similar to that of RCH. It can be explained by tearing of the temporobasal veins as a result of brain shift owing to intracranial hypotension stemming from intensive loss of CSF. As far as we know, this is the first report of such a bleeding pattern of probable venous origin. The results of this study could shed light on the “RPTH” physiopathology.     

Intestinal anastomosis: Description of a new technic

A comparison is made between the principles of exteriorization and direct anastomosis. The respective advantages and disadvantages of the Mikulicz-Paul procedure are given. The importance of preoperative preparation which forms the basis of modern colon surgery are briefly reviewed. Continued clinical experience is beginning to favor direct anastomosis; particularly, as we have begun to understand better the problems of intestinal obstruction and how to combat them effectively. It is suggested that the term “closed anastomosis” be substituted for “aseptic anastomosis.” A new technic of closed anastomosis is presented and its advantages outlined.     

Ultrasonography and stimulating perineural catheters for nerve blocks: a review of the evidence

Purpose: This narrative review summarizes the evidence derived from randomized controlled trials (RCTs) offering blinded assessment and sample size justification, in order to determine the benefits associated with adjunctive ultrasonography (US) and stimulating perineural catheters for nerve blocks. Source: The literature search for this review was conducted during the second week of December 2007 using the MEDLINE (January 1950 to November 2007) and EMBASE (January 1980 to November 2007) databases. For US-guided peripheral and neuraxial blocks, the following medical subject heading (MeSH) terms were searched: “nerve block”, “epidural anesthesia”, “epidural analgesia”, “epidural injection”, “epidural space”, “spinal anesthesia”, and “spinal injection”, the results were combined with “ultrasonography” (MeSH term) and “ultrasound” (key word). For stimulating perineural catheters, the following MeSH terms were cross referenced with the MeSH term, “nerve block”: “peripheral catheterization”, “indwelling catheterization”, “catheterization”, and keywords, “nerve catheter” and “continuous”. Subsequently, the result of this search was combined to “stimulating” (key word). Fifteen RCTs, offering blinded assessment and sample size justification, were retained for analysis. Principal findings: For axillary blocks, US guidance yields a higher success rate than a double-injection, transarterial and a triple-injection, neurostimulation-guided technique. Compared to a quadruple-stimulation technique, no major differences can be found. The addition of nerve stimulation to US guidance offers no clear benefits for axillary blocks. For femoral blocks, compared to neurostimulation, echoguidance is associated with a local anesthetic (LA) sparing effect (up to 42%). In children, US guidance yields a LA sparing effect and a longer duration of action for lower extremity nerve blocks. Compared to their blind counterparts, stimulating catheters seem to offer limited clinical benefits. Despite providing a sparing effect on LA and opioid consumption, stimulating catheters are not associated with a decrease in side effects or analgesia-related expenditures. Conclusions: Published reports of RCTs provide evidence to formulate limited recommendations regarding the use of adjunctive US and stimulating perineural catheters. Further well-designed and meticulously executed RCTs are warranted.     

烧伤临床营养新理念:从营养支持到营养治疗

For many years,the major concerns in the treatment of a major burn injury have always been shock resuscitation,infection control,and wound treatment,while nutrition has been considered as a subordinate concern.The concept of nutrition in the treatment of a major burn has been recognized as “nutrition support”,only with the purpose of restraining negative nitrogen balance through administration of energy and protein,in order to prevent malnutrition in patients with severe burn.In recent 10 years,however,increasing evidences have showed that optimal nutritional management could improve the outcome of severe burn patients.Now it is recognized that nutrition is not only to provide exogenous nutrients to improve nutritional status of the patients,but also to regulate celI metabolism,enhance cell activity,maintain and uphold the structure and function of the gastrointestinal mucosa,thus to improve patient's outcome.Therefore,the term of “nutrition support”seems to be far from comprehensiveness to reflect the purpose and the aim of this important treatment strategy.Medical literatures especially those in nutritional guidelines have begun to use the term of “nutrition therapy” instead of “ nutrition support”,which typifies the changes in nutritional concept,aim,means,and clinical evaluation.The aim of nutrition has changed from simply “providing nutritional substrate and improving nutritional status of patients” to “ regulating cell metabolism,maintaining organ structure and function,and ultimately improving outcome of patient”.Meanwhile,nutritional means has been more consummate,including special nutrients,hormones,and growth factors,in addition to use of conventional nutrients,in order to enhance therapeutic effect of nutrition in treatment of massive burn injury.Burn nutrition is no longer confined to maintenance of positive nitrogen balance,it should also consider the regulation of cell activity,metabolic status,immune and organ function.The purpose of the article is to analyze and discuss the important issues concerning nutrition therapy in treatment of burn injury,including risk screening,optimal energy supply and ratio of different nutritional ingredients,the choice of special nutrient,as well as the determination of optimal time for giving various nutritional supplements.