Correction of Major Saddle Nose Deformities with Nasomaxillary Depression Using an Intraoral and External Open Rhinoplasty Approach

Nasomaxillary depression, which may be seen with major saddle nose deformities, especially as a sequel to childhood nasal trauma, generally is overlooked during management of the saddle nose. To handle both the saddle nose deformity and nasomaxillary depression, the authors used a one-stage intraoral and external open rhinoplasty approach for 12 patients. Lateral nasal osteotomies and correction of midface retrusion with crescent-shaped autogenous rib cartilage grafts were performed through two bilateral intraoral gingivobuccal incisions. The external open rhinoplasty approach was used for the correction of the saddle nose deformities. The mean follow-up period after the surgery was 2 years (range, 1–3.5 years). The correction of nasal tip depression resulting from midface retrusion was evaluated by lateral cephalometric radiographs. The mean movement of the nasal tip anteriorly in the sagittal plane 1 year after the operation was 5.5 mm (range, 4–7 mm). The functional and aesthetic results were satisfactory for all the patients. As the findings show, the intraoral part of the approach provides a route for the placement of cartilage grafts to correct the depressed nasal tip, augment the paranasal area, and provide support to the lateral alar bases and the controlled low-to-low lateral osteotomies. The external part of the approach provides correction of the saddle nose deformity.     

Early chemosensitivity of normal hematopoietic cells and malignant lymphoblasts predicts relapse in childhood acute lymphoblastic leukemia

For the last 30 years, numerous clinical and biological pretreatment risk factors have been utilized for risk-based treatment assignment in childhood acute lymphoblastic leukemia (ALL). However, with improved chemotherapy regimens, many of these traditional prognostic factors have lost clinical significance. We aimed to improve relapse prediction in children with ALL through evaluation of the early chemosensitivity of normal and malignant cells and to determine the relationship between such chemosensitivity and risk of relapse. We retrospectively analyzed a cohort of 60 children with newly diagnosed ALL of whom 40 patients were in complete remission for at least 4 years and 20 patients relapsed during or following treatment. Time to peripheral blood blast clearance (PBBC) was used as a measure of chemosensitivity of malignant lymphoblasts while end-of-induction complete blood count (CBC) parameters were used as a measure of chemosensitivity of normal hematopoietic cells. Our results showed that longer time to PBBC and lower end-of-induction total leukocyte count (TLC) and absolute neutrophil count (ANC) were significantly associated with increased risk of relapse. In conclusion, time to PBBC and end-of-induction TLC and ANC are important predictors of relapse and should be used to modify the intensity of chemotherapy at earlier time points during the course of treatment. A wider prospective, randomized, controlled trial is required to confirm our results.     

Enhancement in antinociceptive and anti-inflammatory effects of tramadol by transdermal proniosome gel

Oral therapy of tramadol, an opiate analgesic, undergoes extensive hepatic metabolism and requires frequent administration. Transdermal therapy by virtue can overcome these issues and can improve the efficacy and reduce abuse liability of tramadol. The aim of this research was to investigate the possibility of transdermal delivery of tramadol by formulating proniosome gel and evaluate its therapeutic potential in vivo. The effect of formulation composition as well as amount of drug on physicochemical characteristics of prepared proniosomes were examined. Best proniosome gel (F4) was selected and evaluated for drug release, stability and transdermal efficacy by ex vivo and in vivo experiments. The vesicles demonstrated optimal properties including spherical shape, nanosize with good entrapment efficiency, adequate zeta potential, higher stability and greater transdermal flux. The amorphization and dispersion of tramadol in the aqueous core of proniosome vesicles was confirmed by differential scanning calorimeter. Release profile of F4 was distinct (P < 0.001) from control and displayed steady and prolonged tramadol release by Fickian diffusion. Transdermal therapy of F4 showed prominent reduction of induced twitches (P < 0.005) in mice and edema (P < 0.05) in rats, as compared to oral tramadol. The improvement in clinical efficacy of tramadol in transdermal therapy is correlated with the pharmacokinetic data observed. In conclusion, the observed improvement in antinociceptive and anti-inflammatory effects from proniosome carriers signifies its potential to be a suitable alternative to oral therapy of tramadol with greater efficacy.     

Aspergillosis of thyroid gland managed by thyroidectomy

We experienced a very rare case of thyroidal Aspergillus in a 65‐year‐old man who came to our hospital complaining of fever and persistent pain in the articulations. The patient had a history of chronic renal failure. After physical examination and imaging tests, fine‐needle biopsy of the thyroid showed fungus hyphae angling at a45‐degree compatibility with Aspergillus and thyrocites, with Hurthle cell differentiation. We performed left thyroidectomy without any complications. Because most of thyroidal Aspergillus diagnoses are made after autopsy and insufficient data about its management, we present, to the best of our knowledge, the first case of thyroidal Aspergillus in the literature that was treated by left thyroidectomy successfully.