Supraorbital trans-eyebrow craniotomy and fluorescence-guided resection of fronto-basal high grade gliomas

Object

To determine the effectiveness of fluorescence-guided resection of fronto-basal high grade gliomas by using the supraorbital trans-eyebrow craniotomy.

Methods

We present a single-institution experience of 6 consecutive patients presenting high grade brain glioma located on the fronto-basal area that were operated through a supraorbital trans-eyebrow craniotomy. Previous to surgery all patients were administered 20 mg/kg of 5 aminolevulic acid so microscopic fluorescence-guided resection could be accomplished. Tumors were located on gyrus rectus (3 patients), medial orbital gyrus (2 patients), and anterior orbital gyrus (1 patient).

Results

Despite the narrow surgical corridor, fluorescence was useful in all cases. Fluorescence-guided resection allowed inclusion into the margins of resection of areas previously considered as normal under white light. Complete resection was obtained in 5 patients. No neurological postoperative new deficit was observed in this series. All six cases corresponded to glioblastoma. Only one case of superficial infection with delayed wound healing was reported as complication. All patients expressed a high level of satisfaction related to cosmetic result.

Conclusions

Fluorescence-guided resection of fronto-basal high grade gliomas can be successfully achieved through supraorbital trans-eyebrow craniotomy. Benefits of supraorbital craniotomy in the management of fronto-basal high grade gliomas as well as usefulness of fluorescence-guided resection through a very narrow corridor are exposed.     

Switching to duloxetine from selective serotonin reuptake inhibitors in non- or partial responders: Results from a Spanish sample

Objectives. To evaluate the efficacy and safety of switching from a selective serotonin reuptake inhibitor (SSRI) to duloxetine in non- or partial responders. Methods. This is a post-hoc analysis of the pooled data of the Spanish sample from an open-label, multicentre study. Additionally, a 6-month continuation safety phase was performed. Results. A total of 156 patients were switched to duloxetine from SSRIs. More than 83% completed the acute phase, of whom 75% went into the continuation phase. At baseline, the mean duration of SSRI treatment was 71.2 weeks and the HAM-D₁₇ mean score was 22.4. In the acute-phase, symptoms severity significantly improved after 10 weeks of duloxetine treatment as measured by mean change from baseline in HAM-D₁₇ total score (?10.5; P<0.001) and all secondary efficacy measures, including painful symptoms. Response (≥50% decrease in HAM-D₁₇ total score) and remission rates (HAM-D₁₇ total score ≤ 7) were 52.9 and 27.7%, respectively. The most common adverse events reported in both phases were headache (11.5% [acute]; 6.1% [continuation]) and nausea (6.4% [acute]; 5.1% [continuation]). Conclusions. In a population of Spanish SSRI non- and partial responders, switch to duloxetine was associated with significant improvement in emotional and painful symptoms of depression. Duloxetine was well tolerated and safe during both phases.     

The Influence of Implant Diameter on Its Survival: A Meta‐Analysis Based on Prospective Clinical Trials

Background: The use of narrow‐diameter implants has been proposed to restore small edentulous spans, thus avoiding extensive bone augmentation procedures and reducing the surgical complexity of implant rehabilitations. Although success rates of narrow‐diameter implants have already been analyzed in the literature, to the best of the authors’ knowledge, no meta‐analysis based on prospective and randomized controlled trials has been performed. The aim of this study is to analyze the survival rates of narrow‐diameter implants compared with standard or wide‐diameter implants. Methods: An electronic search from three databases and a hand search in implant‐related journals of studies published in English before September 1, 2012 were performed. Prospective human clinical studies with at least 10 implants and a follow‐up period of 1 year were included in the meta‐analysis. Implants were divided into two groups based on their diameters. Results: The initial search yielded 484 articles, of which 49 were evaluated in full text for eligibility. Finally, 16 studies were chosen and separated into two groups: 1) implants of diameter <3.3 mm (group 1) and 2) implants of diameter ≥3.3 mm (group 2). A meta‐analysis performed for groups 1 and 2 showed survival rates of 75% and 87%, respectively. Conclusions: This meta‐analysis showed that narrower implants (<3.3 mm) had significantly lower survival rates compared with wider implants (≥3.3 mm). Other variables, such as type of prosthesis, implant surface, and timing of prosthetic loading, were found to have influenced the implant survival rates.     

Reliability of Partial‐Mouth Recording Systems to Determine Periodontal Status: A Pilot Study in an Adult Portuguese Population

Background: The efficacy of various partial‐mouth recording (PMR) systems is analyzed in the evaluation of periodontal status, using index teeth and different combinations of quadrants. Methods: The study group was formed of 108 adults aged 25 to 65 years old. A full‐mouth examination (FME) was performed in all participants to determine the periodontal probing depth (PD) and clinical attachment level (CAL) at six sites per tooth. The results of PMR using the Ramfjord teeth, the Community Periodontal Index of Treatment Needs teeth, and the four quadrants individually and combined in pairs were compared to the results obtained with FME. Results: Concordance with FME in terms of the prevalence of patients with PD ≥4 mm, CAL ≥2 mm, and CAL ≥4 mm was lowest with examination of single quadrants and highest with combinations that included one superior and one inferior quadrant. Conclusions: PMR systems, particularly with combinations of a superior plus an inferior quadrant, could be useful to evaluate periodontal status based on PD and CAL. This tool could be useful for epidemiologic surveys on periodontal status.     

Infección por Rothia mucilaginosa. ¿Un patógeno respiratorio?

Introduction

To describe the spectrum of infections caused by Rothia mucilaginosa.

Methods

Retrospective study of 20 cases diagnosed with R. mucilaginosa from 2009 to 2012.

Results

Pulmonary infection was the most frequent clinical presentation (n = 14, 70%): bronchiectasis infected (10), followed by pleural empyema (2), pneumonia (1) and acute bronchitis (1). Two episodes were of gastrointestinal origin: cholangitis secondary to biliary drainage and secondary peritonitis. Two episodes included bacteremia in patients with hematological malignancy. One patient had a surgical wound infection with bacteremia, and another had a bacteremic urinary tract infection in a patient with nephrostomy.

Discussion

R. mucilaginosa may be responsible for infections of the lower respiratory tract in predisposed patients.