Sublingual ranula: a closer look to its surgical management

Ranulas have been managed by various surgical methods, and the optimal treatment is still controversial. The aim of this study was to analyze a group of 124 surgically treated patients with intraoral ranula to assess 3 different methods: sublingual gland removal combined with the ranula excision, conventional marsupialization, and a variant of the marsupialization technique usually performed in our departments. Recurrence rate was 0% after radical treatment, 25.8% after marsupialization, and 12% after modified marsupialization. We suggest that conservative methods should always be considered as treatment of superficial oral ranulas. The modification of the conventional marsupialization by suturing the edges of the pseudocyst before unroofing of the lesion was demonstrated to be a useful technical strategy that simplifies and accelerates the surgical procedures and probably contributed to preventing recurrences.     

Evolution of psychological condition in caregivers of patients with disorders of consciousness: a longitudinal study

The aim of this study is to evaluate mood disorders and needs in caregivers of disorders of consciousness (DOC) patients during the admission to Neurorehabilitation Unit. A total of 80 caregivers was enrolled and divided in two groups (caregivers of vegetative state–VS patients and caregivers of minimally conscious state–MCS patients). Paired sample t tests were carried out to test differences between baseline observation (T0) and after 6 months (T1). Caregivers of VS patients showed an improvement between T0 and T1 especially, in vitality, mean health, Beck Depression Inventory (BDI-II), Spielberger State-Trait Anxiety Inventory-Y (STAI-Y), Prolonged Grief Disorder (PG 12) and Caregiver Needs Assessment (CNA). On the other hand, caregivers of MCS patients showed a significant improvement in: BDI II, STAI Y and CNA. These data confirmed that the presence of psychological problems, the quality of life and the psychological wellbeing of caregivers of DOC patients improved over the time.     

Evaluation of reproducibility of the MOCART score in patients with osteochondral lesions of the talus repaired using the autologous matrix-induced chondrogenesis technique

Purpose

To evaluate the applicability and reproducibility of magnetic resonance observation of cartilage repair tissue (MOCART) score for morphological evaluation of osteochondral lesions of the talus (OLT) repaired using autologous matrix-induced chondrogenesis (AMIC) technique.

Methods

Two radiologists (R1–R2) and two orthopaedists (O1–O2) independently reviewed 26 ankle MRIs performed on 13 patients (6 females; age: 38.9 ± 15.9, 14–63) with OLT repaired using AMIC. The MRIs were performed at 6 and 12 months from surgery. For inter/intra-observer agreement evaluation for each variable of the MOCART, we used Cohen’s kappa coefficient. Progression of MOCART between 6- and 12-month evaluation was assessed using the Wilcoxon test. The Spearman’s correlation coefficient was used to evaluate the correlation between baseline lesion size and MOCART.

Results

The inter-observer agreement between R1 and R2 ranged from poor (adhesions, k = 0.124) to almost perfect (subchondral bone, k = 0.866), between O1 and O2 from absent (effusion, k = ?0.190) to poor (surface, k = 0.172), and between R1 and O1 from absent (cartilage interface, k = ?0.324) to fair (signal intensity, k = 0.372). The intra-observer agreement of R1 ranged from poor (signal intensity, k = 0.031) to substantial (subchondral lamina, k = 0.677), while that of O1 from absent (subchondral bone, k = ?0.061) to substantial (surface, k = 0.663). There was a significant increase of MOCART between 6- and 12-month evaluation of R1 (Z = ?2.672; P = 0.008), R2 (Z = ?2.721; P = 0.007) and O1 (Z = ?3.034; P = 0.002). Conversely, the increase of MOCART of O2 was not significant (Z = ?1.665; P = 0.096). Inverse correlation between lesion size at baseline and MOCART was significant at 12-month evaluation (?0.726; P = 0.005).

Conclusion

MRI has an important role in the follow-up of surgical repaired OLT, but MOCART score does not seem to be sufficiently reproducible to be applied for this purpose.

     

The accumulation of vitrified oocytes is a strategy to increase the number of euploid available blastocysts for transfer after preimplantation genetic testing

Purpose

In a preimplantation genetic diagnosis for aneuploidy (PGD-A) program, the more embryos available for biopsy, consequently increases the chances of obtaining euploid embryos to transfer. The aim was to increase the number of viable euploid blastocysts in patients undergoing PGD-A using fresh oocytes together with previously accumulated vitrified oocytes.

Methods

Sixty-nine patients with normal ovarian reserve underwent PGD-A for repeated implantation failure or recurrent pregnancy loss indication. After several cycles of ovarian stimulation, 591 accumulated vitrified oocytes and 463 fresh oocytes were micro-injected with the same partner’s semen sample. PGD-A was completed on 134 blastocysts from vitrified/warmed oocytes and 130 blastocysts from fresh oocytes.

Results

A mean of 9.6% euploid blastocyst per micro-injected vitrified/warmed oocytes and 11.4% euploid blastocyst per micro-injected fresh oocyte were obtained (p?>?0.05). The euploidy and aneuploidy rates were comparable in blastocysts obtained from micro-injected vitrified/warmed oocytes and fresh oocytes (42.5 versus 40.8% and 57.5 versus 59.2%, p?>?0.05). Implantation rates of euploid blastocysts were comparable between the two sources of oocytes (56.0% from vitrified/warmed oocytes versus 60.9% from fresh oocytes, p?>?0.05).

Conclusions

Oocyte vitrification and warming do not generate aneuploidy in blastocysts. The number of viable euploid embryos for transfer can be increased by using accumulated vitrified oocytes together with fresh oocytes in ICSI.

Trial registration

NCT02820415 ClinicalTrials.gov

     

Pediatric Ovarian Torsion and its Recurrence: A Multicenter Study

Study Objective

To report results of a retrospective multicentric Italian survey concerning the management of pediatric ovarian torsion (OT) and its recurrence.

Erectile Function Outcome after Bilateral Nerve Sparing Radical Prostatectomy: Which Patients May Be Left Untreated?

IntroductionSeveral studies have shown that erectile function (EF) recovery in patients undergoing bilateral nerve sparing radical prostatectomy (BNSRP) improves significantly when phosphodiesterase type 5 inhibitors (PDE5) are administered following surgery.AimThe aim of this article was to identify patients who may recover EF after retropubic BNSRP (BNSRRP) without PDE5.MethodsWe included 293 patients treated with BNSRRP at a single center. Postoperative EF recovery was defined as an EF domain score of the International Index of Erectile Function (IIEF) ≥22. No patient received any treatment for postoperative erectile dysfunction (ED). Kaplan–Meier curves assessed time to EF recovery according to patient age, preoperative EF, and Charlson comorbidity index (CCI). Univariable and multivariable Cox regression models tested the association between predictors and EF recovery. Finally, the rate of EF recovery of untreated patients after BNSRP was compared with a subset of patients with similar preoperative characteristics but receiving PDE5.Main Outcome MeasureThe main outcome measure of this article was the IIEF‐EF domain score.ResultsOverall, 105/293 (35.8%) reached an IIEF‐EF ≥22 after a mean follow‐up of 26.8 months. At multivariable analyses, age, preoperative IIEF‐EF, and CCI achieved independent predictor status (all P ≤ 0.04). Patients <55 years had a 72.4% EF recovery rate compared with 30% of patients >70 years (P < 0.001). Similarly, preoperatively fully potent patients (IIEF‐EF ≥26) had a 56.6% chance of recovering EF after surgery compared with 18% of patients with severe ED before surgery (P < 0.001). The rate of EF recovery in untreated patients <55 years and with a pre‐op IIEF‐EF ≥22 was higher but did not differ significantly from comparable patients receiving PDE5 (P = 0.11).ConclusionsOverall, the rate of EF postoperative recovery in patients left untreated after surgery is modest (35.8%). Although younger patients with a good preoperative EF may experience good EF recovery rates even without any treatment, use of PDE5 after surgery further improved their functional outcomes. Therefore, a therapy for ED should be offered to all patients treated with BNSRP. Gallina A, Ferrari M, Suardi N, Capitanio U, Abdollah F, Tutolo M, Bianchi M, Saccà A, Salonia A, Rigatti P, Montorsi F, and Briganti A. Erectile function outcome after bilateral nerve sparing radical prostatectomy: Which patients may be left untreated? J Sex Med 2012;9:903–908.     

Clinical features, long-term follow-up and outcome of a large cohort of patients with Chronic Granulomatous Disease: an Italian multicenter study

A retrospective clinical and immunological survey was conducted in 60 patients with Chronic Granulomatous Disease. A prospective controlled non-randomized study of the efficacy of long-term IFNgamma treatment was carried out. The mean age at the time of diagnosis was 4.4 years; mean duration of follow-up was 10.4 years. Lung and skin infections were the most frequent manifestations both prior to diagnosis and during follow-up. Aspergillus species was the first cause of infection and of death in our cohort. The mortality rate was 13%. Long term prophylaxis with IFNgamma did not significantly change the rate of total infection per patient-year compared to controls (p=0.07). Our data provide clear evidence that protocols of continuing intensive surveillance and monitoring of compliance with anti-infective regimens may significantly improve the quality of life and long-term survival in patients with CGD. No evidence justifying long-term prophylaxis with IFNgamma was obtained.     

Perceptual load affects exogenous spatial orienting while working memory load does not

We examined whether or not increasing visual perceptual load or visual working memory (WM) load would affect the exogenous orienting of visuo-spatial attention, in order to assess whether or not exogenous orienting is genuinely automatic. In Experiment 1, we manipulated visual perceptual load by means of a central morphing shape that in some trials morphed into a particular target shape (a rectangle) that participants had to detect. In Experiment 2, the possibility that the presentation of any changing stimulus at fixation would eliminate exogenous orienting was ruled out, by presenting two alternating letters at fixation. In Experiment 3, we manipulated visual WM load by means of arrays consisting of three (low-load) or five (high-load) randomly located coloured squares. The participants had to remember these items in order to judge whether a cued square had been presented in the same or different colour at the end of each trial. In all the experiments, exogenous visuo-spatial attentional orienting was measured by means of an orthogonal spatial cuing task, in which the participants had to discriminate the elevation (up vs. down) of a visual target previously cued by a spatially nonpredictive visual cue. The results showed that increasing the perceptual load of the task eliminated the exogenous orienting of visuo-spatial attention. By contrast, increasing the WM load had no effect on spatial orienting. These results are discussed in terms of the light that they shed on claims regarding the automaticity of visuo-spatial exogenous orienting.