Heat Sink Effect on Tumor Ablation Characteristics as Observed in Monopolar Radiofrequency,Bipolar Radiofrequency,and Microwave,Using Ex Vivo Calf Liver Model

Thermal ablation of liver tumors near large blood vessels is affected by the cooling effect of blood flow, leading to incomplete ablation. Hence, we conducted a comparative investigation of heat sink effect in monopolar (MP) and bipolar (BP) radiofrequency ablation (RFA), and microwave (MW) ablation devices.With a perfused calf liver, the ablative performances (volume, mass, density, dimensions), with and without heat sink, were measured. Heat sink was present when the ablative tip of the probes were 8.0 mm close to a major hepatic vein and absent when >30 mm away. Temperatures (T1 and T2) on either side of the hepatic vein near the tip of the probes, heating probe temperature (T3), outlet perfusate temperature (T4), and ablation time were monitored.With or without heat sink, BP radiofrequency ablated a larger volume and mass, compared with MP RFA or MW ablation, with latter device producing the highest density of tissue ablated. MW ablation produced an ellipsoidal shape while radiofrequency devices produced spheres.Percentage heat sink effect in Bipolar radiofrequency : Mono-polar radiofrequency : Microwave was (Volume) 33:41:22; (mass) 23:56:34; (density) 9.0:26:18; and (relative elipscity) 5.8:12.9:1.3, indicating that BP and MW devices were less affected.Percentage heat sink effect on time (minutes) to reach maximum temperature (W) = 13.28:9.2:29.8; time at maximum temperature (X) is 87:66:16.66; temperature difference (Y) between the thermal probes (T3) and the temperature (T1 + T2)/2 on either side of the hepatic vessel was 100:87:20; and temperature difference between the (T1 + T2)/2 and temperature of outlet circulating solution (T4), Z was 20.33:30.23:37.5.MW and BP radiofrequencies were less affected by heat sink while MP RFA was the most affected. With a single ablation, BP radiofrequency ablated a larger volume and mass regardless of heat sink.     

Surgical approach after failed enteryx injection for GERD.

OBJECTIVE: We report on 3 patients who underwent laparoscopic antireflux procedures for persistent symptoms of GERD after biopolymer injection. METHODS: Experienced laparoscopic surgeons completed all 3 procedures laparoscopically. In 2 patients, there was an extramural extravasation of the polymer outside and adherent to the esophageal wall. In these patients, a partial posterior fundoplication was used. The third patient, who had the polymer material deposits removed preoperatively by endoscopic mucosal resection, underwent a Nissen fundoplication. RESULTS: Postoperative recovery was uneventful in all cases. At follow-up of 6 to 12 months, all patients were symptom free, off medical therapy, and experiencing no dysphagia. CONCLUSION: Surgical therapy for patients after failed biopolymer injection is safe and effective. The choice of surgery may depend on whether the polymer mass can be removed preoperatively.     

Problems, obstacles and complications of femoral lengthening with the use of the Italian modification of the Ilizarov device]

The results of femoral lengthening using the Italian modification of the Ilizarov are presented. Mean age of the patients was 14 years (ranging from 7 to 29). The most frequent etiology of limb shortening was femoral hypoplasia (7 patients) and sequelae of septic arthritis of the hip and/or the knee (6 patients). Indications for surgical treatment were limb shortening from 3 to 12 cm (mean 6.5 cm), along with axial deviation ranging from 10 degrees to 40 degrees in 6 patients. Mean follow-up time was 15 months (ranging from 6 to 35 months). The Ilizarov apparatus was based on two distal rings, stabilized by "K" wires, and proximally by a ring connected with an Italian femoral arch, stabilized by a Schanz screw. Planned lengthening (ranging from 3.5 cm to 12 cm) was achieved in all treated patients. The healing index ranged from 0.8 to 2.1 month/cm (mean 1.4). Problems, obstacles and complications were analyzed according to the Paley classification. In all 16 patients without primary knee stabilization, limited knee flexion ranging from 5 degrees to 90 degrees (mean 40 degrees) was noted during the distraction phase, which didn't improve significantly during the consolidation phase. Knee flexion improved to a mean 90 degrees after a 6 month follow-up. Bone regenerate defects (cysts, narrowing) were noted in 4 patients. Secondary knee stabilization was performed in 2 cases. In the first case because of knee pain and a severe limitation of knee motion. In the second, during a revision procedure because of distal femur angulation. Premature consolidation was noted in one patient and was treated by osteotomy. In one case axial deviation during the consolidation phase required osteotomy. In another case a fracture of the femur was treated by a plaster cast. In one case 1.5 years after the lengthening procedure subluxation of the hip was noted. Permanent knee flexion limitation to less than 90 degrees was noted in 6 patients. Femoral lengthening with the use of the Italian modification of the Ilizarov device give a high incidence of knee range of motion limitation, which can be decreased by preserving more than 30 degrees knee flexion during the distraction phase.     

Eosinophilic otitis media diagnosis using flow cytometric immunophenotyping

Objectives: (1) To assess the ability of flow cytometric immunophenotyping to detect and quantitate eosinophils in patients with eosinophilic otitis media (EOM). (2) to evaluate the association of EOM to bronchial asthma.

Methods: Twenty-one patients with chronic otorrhea or middle ear effusion (MEE) were included in this prospective cohort study. Group I composed of 10 patients (14 ears) and associated to bronchial asthma. Group II included 11 patients (11 ears) without bronchial asthma. Samples of MEE were sent for flow cytometric analysis at initial presentation. Patients with positive eosinophils on flow cytometric immunophenotyping were analyzed after one-month course of dexamethasone eardrops.

Results: EOM was diagnosed in all patients of group I and in three patients of group II. The mean eosinophils percentage was 43.5% and 14.2% for group I and group II, respectively (p?=?.006). Those patients showed a significant response to dexamethasone eardrops, both on clinical examination and on flow cytometric analysis with a decrease in eosinophil levels post-treatment. However, this improvement was temporary and symptoms recurred after treatment cessation. Bronchial asthma was not associated to all patients with EOM.

Conclusion: Diagnosis of EOM remained mostly clinical; flow cytometry immunophenotyping of MEE may be helpful as an additional tool in diagnosis and monitoring the response to treatment, particularly in non-asthmatic patients.     

Evaluation of medical and dental visits in New York City: Opportunities to identify persons with and at risk for diabetes mellitus in dental settings

Objective

The identification of persons with or at risk for chronic diseases is a new practice paradigm for oral healthcare. Diabetes mellitus (DM) is a chronic disease of particular importance to oral health providers. This study sought to understand healthcare utilization patterns that would support the introduction of this new practice paradigm.

Methods

The primary and oral healthcare utilization patterns of New York City (NYC) adults were assessed using data collected from the 2013 NYC Community Health Survey. We stratified healthcare utilization patterns by type of provider, insurance, DM diagnosis and DM modifiable risk factors.

Results

Of 6.4 million NYC adults, an estimated 676 000 (10.5%) reported a previous diagnosis of DM, and 3.9 million (69.5%) were identified with one or more modifiable risk factor for DM. Of these at risk individuals, 2.2 million (58.9%) received dental services in the past 12 months, and 545 000 (14.3%) did not see a primary care provider during the same period. Of the approximately 1.16 million adults without health insurance, an estimated 338 000 (26.2%) had a dental visit only.

Conclusion

Healthcare utilization patterns in this urban setting suggest that oral healthcare providers can support the identification of patients with and at risk for DM who may otherwise not have the opportunity for screening.     

Osteomyelitis due to multiple carbapenemase-producing Gram-negative bacteria: The first case report of a GES-13-producing Pseudomonas aeruginosa isolate in Canada

A case of osteomyelitis in an infant following a burn injury sustained in Pakistan caused by a GES-13-producing Pseudomonas aeruginosa (the first reported in Canada) and an OXA-48 producing Klebsiella pneumoniae is described. The present case serves to highlight the importance of international travel as a risk factor for infection with carbapenemase-producing bacteria and the challenges in the laboratory detection of these organisms.