Synovial osteochondromatosis in bilateral subacromial bursae

Abstract

We report a rare case of synovial osteochondromatosis in bilateral subacromial bursae. A 73-year-old man presented with sudden shoulder pain. Roentgenograms showed a large number of calcifications between the acromial processes, and a greater tuberosity on both sides. Surgery was performed to remove loose bodies from both sides. There were 11 in the right subacromial bursa, and 9 in the left. According to Milgram’s staging system, this case was diagnosed as stage III. A follow-up examination 10 months after the operation found no recurrence, pain, or limitation of the range of motion on either side.     

Retrospective analysis of clinical outcomes in bilateral cleft lip and palate patients after secondary alveolar bone grafting and premaxilla osteotomy,using a new dento-maxillary scoring system

Evaluation of relevant clinical outcomes in patients with bilateral cleft lip and palate (BCLP) after secondary aveolar bone grafting (SABG) and premaxilla osteotomy (PMO), through the use of a new scoring system.Data were collected retrospectively from all patients with BCLP who were operated on between 2004 and 2014, at the end of follow-up. The treatment protocol consisted of SABG + PMO in patients aged between 9 and 13 years. At the end of follow-up, the following parameters were scored: (un)interrupted dental arch, skeletal sagittal relationship, bone height using the Bergland/Abyholm criteria, and the presence of postoperative fistula. These parameters were combined to produce a dento-maxillary scoring system, giving a final score between 1 and 10. For statistical analysis, the independent t-test was used.Of 55 children, 45 were suitable for analysis. The mean age at time of surgery was 12.0 years (8.9–16.4 yrs), and the mean follow-up time was 11.7 years (5.8–15.8 yrs). The average number of surgeries executed under general anesthesia was 6 (range: 3–11). The average dento-maxillary score in this patient cohort was 7.6 (1–10; median: 8). Among these patients, 31 had an uninterrupted dental arch; the average Bergland/Abyholm score was 2.07; 30 patients exhibited an Angle class I incisor relationship; and, in 38 cases, the oronasal communication was closed after SABG + PMO treatment. A significant effect of fistulas was seen on dento-maxillary score (p = 0.001). Specifically, a significant effect of fistulas was seen on interrupted dental arch (p = 0.002) and on Bergland/Abyholm score (p = 0.037).The proposed dento-maxillary scoring system is a straightforward tool that can be used to describe and analyze the amount of dento-maxillary rehabilitation at the end of the treatment. Persistence of oronasal fistulas in patients with BCLP has a significant impact on interruption of the dental arch, and can influence dental results at the end of the second decade.     

First bilateral non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) co-occurring with bilateral papillary thyroid microcarcinoma. Case report and literature review

IntroductionNon-invasive follicular thyroid neoplasm with papillary-like features (NIFTP) is a recently characterized lesion with very low malignant potential. This has allowed for less aggressive management of this tumor subtype. Papillary thyroid carcinoma (PTC) has malignant potential and requires different considerations in management.Presentation of caseA 33-year-old woman presented to our Thyroid Surgery Clinic with a left neck swelling slowly enlarging over 4 years, and recent right-sided neck pain. Neck ultrasound and fine needle aspiration for cytology found bilateral thyroid nodules, labelled as ‘follicular lesion of undetermined significance’ (FLUS). Final pathology report after total thyroidectomy identified four distinct tumors: bilateral NIFTP lesions and bilateral papillary microcarcinomas.DiscussionManagement of NIFTP comprises partial or total thyroidectomy without further intervention. Management of PTC is the same but with the possible addition of radioactive ablation due to the increased malignant potential. This is the first report of bilateral NIFTP lesions and bilateral papillary microcarcinomas co-occurring together in the same patient, so management was challenging. The decision was made to give the patient low dose radioactive iodine ablation and continue monitoring. Ultrasound of the neck follow up 6 months later showed no residual thyroid tissue or local recurrence.ConclusionAlthough rare, NIFTP can co-occur with PTC. Bilateral NIFTP with bilateral PTC is extremely rare. Surgeons and pathologists need to be aware of this rare entity that can co-occur in both thyroid lobes. Total thyroidectomy is the definitive treatment. Post-surgery surveillance is important and follow up needs to be watchful for any recurrence or metastasis.     

Bone-Conducted Sound Lateralization of Interaural Time Difference and Interaural Intensity Difference in Children and a Young Adult with Bilateral Microtia and Atresia of the Ears

Objective—We used multi-slice helical computerized tomography (MSHCT) to evaluate the 3D characteristics of the laryngeal structures in patients with unilateral vocal fold paralysis (UVFP) during phonation, and compared the results with those obtained using an aerodynamic vocal function test. Material and methods—The subjects were 37 patients with UVFP. The region over the larynx was scanned during quiet phonation and again during inspiration using MSHCT, and 3D endoscopic and coronal reconstruction images were produced. Maximum phonation time (MPT) and mean airflow rate (MFR) during phonation were measured. Results—During phonation, the affected fold was thinner than the healthy fold in 30 subjects and located at a higher position than the healthy fold in 21 subjects. Abduction or thinning of the affected fold during phonation (paradoxical movement) was seen in seven subjects. MFR was significantly greater when the affected fold was thinner than the healthy fold during phonation, and MPT was significantly shorter when the affected fold showed paradoxical movement. Over-adduction of the healthy fold during phonation was present in 15 subjects. There were no significant differences in MPT or MFR between subjects with and without over-adduction. Conclusion—The combination of MSHCT endoscopic and coronal reconstruction images enables the 3D characteristics of the unilaterally paralyzed larynx to be visualized during phonation, and some of these characteristics are significantly correlated with vocal function in patients with UVFP.     

Bilateral vagotomy attenuates the severity of secretagogue-induced acute pancreatitis in the rat

PurposeWe assessed the effect of bilateral vagotomy (BV) on the course of acute caerulein-induced pancreatitis (AP) in the rat.Material/methodsThe study was performed on Wistar rats surgically prepared by subdiaphragmatic BV. Control group underwent sham operation. Four days later, AP was induced by subcutaneous injection of caerulein (25 μg/kg/5 h) to the conscious animals with or without BV. After administration of caerulein the blood samples were taken for determination of serum lipase activity and interleukin-10 (IL-10) concentration. Pancreatic tissue samples were subjected to histological examinations and to the measurement of lipid peroxidation products (MDA + 4-HNE) concentration and the activity of an antioxidant enzyme – glutathione peroxidase (GPx). After application of caerulein pancreatic blood flow was measured by laser Doppler flowmetry.ResultsAP was manifested by oedema and neutrophil infiltration of the pancreatic tissue and accompanied by significant increases of serum lipase activity, serum concentration of IL-10 and pancreatic concentration of MDA + 4HNE (ca. 50×, 2× and 4× respectively p ≥ 0.05). Pancreatic activity of GPx and pancreatic blood flow were decreased (both by 60%). In vagotomised rats with AP serum lipase activity and pancreatic concentration of MDA + 4-HNE were lower whereas Il-10 concentration and pancreatic activity of GPx, as well as pancreatic blood flow were significantly higher as compared to AP rats with intact vagal nerves. In AP rats with vagotomy all histological signs of pancreatitis were significantly reduced.ConclusionsBilateral vagotomy resulted in the significant attenuation of caerulein-induced pancreatitis in the rat.     

标准大骨瓣开颅术在治疗重型颅脑损伤中的临床应用探讨

目的探讨标准大骨瓣开颅术在治疗重型颅脑损伤中的临床应用价值。方法回顾性分析我院2009年至2011年间我院收治的55例重型颅脑损伤患者的临床资料,所有患者均行标准大骨瓣开颅术治疗,并观察临床疗效。结果本组55例患者术后行头部CT复查发现,53例（96.4%）血肿消失,另有2例血肿较术前有所缩小,所有患者脑部均未出现新的出血。术后发生迟发性血肿4例,脑脊液切口漏2例,脑积水2例,癫痫1例,并发症发生率为16.4%。术后随访3～6个月,恢复良好39例（70.9%）,中残8例（14.5%）,重残3例（5.5%）,植物生存2例（3.6%）,死亡3例（5.5%）。结论大骨瓣开颅术具有骨窗大、手术暴露范围广、内外减压充分等特点,治疗重型颅脑损伤临床疗效显著,具有很好的临床应用价值,值得进一步推广使用。     

Modified pterional craniotomy without “MacCarty keyhole”

Pterional craniotomy is one of the most widely used approaches in neurosurgery. The MacCarty keyhole has remained the preferred means of beginning the craniotomy to achieve a low access point; however, the bone opening may result in a residual defect and an aesthetically unpleasant depression in the periorbital area. We present our modification of the traditional technique. Instead of drilling the keyhole in the frontoperiorbital area, the classical location, we perform a 5 × 15 mm strip craniectomy at the lowest accessible point in the infratemporal fossa, corresponding to the projection of the most lateral point of the sphenoid ridge. The anterior half of this opening exposes the basal frontal dura, while the posterior half brings the temporal dura into view. This modified technique was applied in 48 pterional craniotomies performed for removal of a variety of neoplasms during 2014–2015. There were no approach-related complications. Aesthetic outcomes and patient acceptance have been good; no patient developed skin depression in the periorbital area. In our experience, craniotomy for a pterional approach with the lowest possible access to the frontotemporal skull base may be performed by drilling a narrow oblong opening, without the use of any keyhole or burr hole, to create a smaller skull defect and achieve optimal aesthetic outcomes.     

双侧平衡去骨瓣治疗重症闭合性颅脑损伤的临床效果分析

目的：探讨双侧平衡去骨瓣减压治疗重症闭合性颅脑损伤的效果。方法择取2006年1月-2014年6月该院收治的重症闭合性颅脑损伤患者92例,按其治疗方法的不同分为为研究组（双侧平衡去骨瓣减压术）和参照组（单侧标准外伤大骨瓣减压术）各46例,分析两组治疗前后颅内压的变化情况,并比较其临床疗效及并发症情况。结果治疗后,两组的颅内压均较治疗前低（P<0.05）,但研究组的颅内压明显低于参照组,差异有统计学意义（P<0.05）;研究组并发症明显少于参照组（P<0.05）,且其总有效率（84.78%）较参照组（54.35%）高（P<0.05）。结论双侧平衡去骨瓣减压治疗重症闭合性颅脑损伤患者的临床效果显著,值得推广。     

小骨窗开颅微创血肿清除术治疗高血压脑出血的临床体会

目的：探讨小骨窗开颅微创血肿清除术和传统骨瓣开颅血肿清除术治疗高血压脑出血的效果。方法：回顾性分析本院2010年1月-2014年10月采用两种手术方法治疗的高血压脑出血患者的临床资料。结果：传统手术患者再出血几率较低,小骨窗微创手术能减少患者术后的并发症,缩短患者的住院时间,并能有效降低患者的致残率,两组比较差异有统计学意义（P<0.05）。结论：在人员技术、设施设备能满足条件的前提下,采用小骨窗开颅微创血肿清除术治疗高血压脑出血效果更好。