Neuropsychological changes following electrical injury.

The clinical presentation of electrical injury commonly involves physical, cognitive, and emotional complaints. Neuropsychological studies, including case reports, have indicated that electrical injury (EI) survivors may experience a broad range of impaired neuropsychological functions, although this has not been clarified through controlled investigation. In this study, we describe the neuropsychological test findings in a series of 29 EI patients carefully screened and matched to a group of 29 demographically similar healthy electricians. Participants were matched by their estimated premorbid intellectual ability. Multivariate analysis of variance was used to assess group differences in the following neuropsychological domains: attention and mental speed, working memory, verbal memory, visual memory, and motor skills. EI patients performed significantly worse on composite measures of attention/mental speed and motor skills, which could not be explained by demographic differences, injury parameters, litigation status, or mood disturbance. Results suggest that cognitive changes do occur in patients suffering from electrical injury.     

Use of Vicryl mesh to support the esophageal wall after circular myotomy (Livaditis procedure) in long-gap esophageal atresia — an experimental study

Circular esophageal myotomy (CEM) is currently a well-accepted technique for elongation of the upper esophageal pouch in cases of long-gap esophageal atresia (EA). Esophageal pseudodiverticulum is a frequent and perhaps underreported sequela of this technique, characterized by ballooning or outpouching of the esophageal mucosa in the myotomized area. The present study was designed to seek a supplement for the CEM technique in order to avoid possible pseudodiverticulum formation in the myotomized area. We created an animal model to simulate the anatomic conditions present after primary repair of EA facilitated by CEM. Three groups of dogs underwent either cervical (1 group) or thoracic (2 groups) esophageal myectomy. In the cervical and first thoracic groups, the denuded mucosa was left without any support. In the second thoracic group, the denuded mucosal area was wrapped with polyglactin 910 (Vicryl) mesh. In all three groups the esophagus was narrowed by a Marlex mesh ring 3 cm distal to the myectomized zone, simulating a condition resulting from anastomotic narrowing. The dogs underwent barium swallows under fluoroscopy at different postoperative periods and were killed 4 or 6 months after surgery. The esophagi were removed for gross and radiologic investigation under maximal insufflation as well as for histologic assessment. The proposed canine model proved to be useful for study of the myectomized esophagus, mimicking the anatomy and conditions after CEM in long-gap EA repair. Wrapping the denuded mucosa with Vicryl mesh fortified the weakened esophageal wall, thus diminishing the likelihood of future pseudodiverticulum development. In light of the simplicity of the technique and the absence of any evident risk or complications, we recommend that the use of Vicryl mesh wrap be considered during CEM to reinforce the esophageal wall.Supported by the Slezak Fund for Experimental Surgery (Grant #01370791)     

The goniomaxillar length/goniomandibular length ratio in normal newborn infants: A clinical tool for defining chin position abnormalities

Retrognathia (recessed chin) and prognathism (prominent chin) often present as signs of an underlying condition. Accurate clinical definitions are important. Yet their definitions were according to “clinical impression”, or to seldom used X‐ray criteria. We propose a statistical and anthropometric definition of retrognathia and prognathism based upon the ratio between the goniomaxillar length (distance between the gonion at the mandible angle and the subnasale and the goniomandibular length (distance between the mandible angle and the most anterior point of the bony chin). We assumed that an increase in the ratio indicates retrognathia and a decrease reflects prognathism. We conducted a prospective, observational, anthropometric study in 204 consecutive healthy term infants. Measurements took place on the second day of life, using sliding calipers. Mean ± SD of goniomandibular length (5.1 ± 0.3 cm), goniomaxillar length (5.4 ± 0.3 cm), were calculated. All measurements correlated significantly with gestational age, and with infant birthweight. The mean ± SD goniomaxillar length/goniomandibular length ratio was 1.06 ± 0.05. We defined a normal ratio as being within 2 SD of the mean, that is, between 0.96 and and 1.16. This ratio correlated with neither gestational age nor with birthweight. We conclude that the goniomaxillar length/goniomandibular length ratio can be calculated whenever retro ‐ or prognathism is suspected. A ratio outside of the 95% confidence interval should help in making this diagnosis. An increase in this ratio beyond 2 SD above the mean (1.16) could be interpreted as retrognathia and a decrease beyond 2 SD below the mean (0.96) as prognathism.     

Viral etiopathogenesis of Sjögren's syndrome: role of the hepatitis C virus

Patients with hepatitis C virus (HCV) chronic infection present some extrahepatic manifestations that may mimic the clinical, immunologic and histological manifestations of primary Sj?gren's syndrome (SS). Thus, HCV patients with sicca symptomatology and positive autoantibodies could be misdiagnosed as a 'primary' SS. Nevertheless, there are several clinical and immunologic features that could help us differentiate both processes.     

Comparison of postoperative complications following radical and modified radical mastectomy

A retrospective study was carried out by reviewing the files of 100 patients who had undergone radical mastectomy and 100 patients who had undergone modified radical mastectomy from 1966 to 1975 for the purpose of comparing early and late complications. In each group, 80 patients were involved in long-term follow-up. Immediate postoperative complications—notably seromas, wound infection, and flap necrosis—were found to be considerably fewer following modified radical mastectomy. There was also a significantly lower incidence of late complications, such as limb edema and recurrent infection, after modified radical mastectomy. Since the cure rates achieved by the two radical mastectomy procedures appear to be similar, it is concluded that modified radical mastectomy is the procedure of choice in stages I and II cancer of the breast.

---

Résumé Nous avons relevé les dossiers de 100 patientes traitées par mammectomie radicale conventionelle et de 100 patientes traitées par mammectomie radicale modifiée et avons comparé les complications post-opératoires observées dans les 2 groupes. Toutes les patientes furent opérées entre 1966 et 1975. Dans chaque groupe, nous avions un recul suffisant chez 80 patientes pour évaluer les résultats à long terme. Les complications post-opératoires, immédiates (sérÔmes, infections de plaie, nécrose de greffe cutanée) ou tardives (lymphoedème du bras, infections à répétition), furent beaucoup plus rares après mammectomie radicale modifiée. Etant donné que les taux de guérison obtenus avec ces 2 opérations semblent Être les mÊmes, nous en concluons que la mammectomie radicale modifiée est l'opération de choix pour traiter les cancers du sein au stade I et II.

     

Biology of desmoplastic melanoma: a case-control comparison with other melanomas.

PURPOSE: Previous studies have established that patients with desmoplastic melanoma (DM) have thicker primary tumors. Consequently, comparisons with other forms of melanoma have been strongly biased by differences in Breslow stage. This is the first case-matched control study comparing DM with other forms of melanoma. PATIENTS AND METHODS: From a database of 3,202 melanoma patients treated at one institution, 89 patients with DM and 178 case-matched control patients (2:1) were identified by matching for tumor thickness, age, sex, and year of diagnosis. Clinical, pathologic, and outcome information was obtained from chart review. RESULTS: Controls were matched successfully to patients for tumor thickness, age, sex, and year of diagnosis. Presentation with American Joint Committee on Cancer stage III or IV disease is less common in patients with DM compared to case-matched control patients (5% v 21%; P < .001). Re-excisions to obtain clear surgical margins are required more often in patients with DM compared to case-matched control patients (21% v 6%; P < .001). Risk of positive sentinel nodes is lower in patients with DM compared to case-matched control patients (8% v 34%; P = .013). Despite these differences, survival rates of patients with DM are the same as case-matched control patients. CONCLUSION: Use of case-matched control patients matched for tumor thickness avoids biases introduced by the advanced Breslow stage of DMs. DMs are more locally aggressive than thickness-matched controls, and positive sentinel nodes are limited to patients with thick primary tumors. Importantly, patients with DM have survival rates similar to patients with other melanomas of similar thickness.     

SENP5 mediates breast cancer invasion via a TGFβRI SUMOylation cascade

Identifying novel mechanisms, which are at the core of breast cancer biology, is of critical importance. Such mechanisms may explain response to treatment, reveal novel targets or drive detection assays.To uncover such novel mechanisms, we used survival analysis on gene expression datasets encompassing 1363 patients. By iterating over the compendia of genes, we screened for their significance as prognosis biomarkers and identified SUMO-specific protease 5 (SENP5) to significantly stratify patients into two survival groups across five unrelated tested datasets. According to these findings, low expression of SENP5 is associated with good prognosis among breast cancer patients.Following these findings, we analyzed SENP5 silencing and show it is followed by inhibition of anchorage-independence growth, proliferation, migration and invasion in breast cancer cell lines. We further show that these changes are conducted via regulation of TGFβRI levels. These data relate to recent reports about the SUMOylation of TGFβRI. Following TGFβRI changes in expression, we show that one of its target genes, MMP9, which plays a key role in degrading the extracellular matrix and contributes to TGFβ-induced invasion, is dramatically down regulated upon SENP5 silencing.This is the first report represents SENP5-TGFβ-MMP9 cascade and its mechanistic involvement in breast cancer.     

Occupation as a potential contributing factor for temporomandibular disorders,bruxism, and cervical muscle pain: a controlled comparative study

The aim of the study was to compare the prevalence of cervical muscle pain (CMP) and myogenic temporomandibular disorders (MFP) among female dentists, high‐tech workers, and a group of subjects employed in other occupations; to investigate the associations among CMP, MFP, and bruxism in those groups; and to evaluate the influence of work‐related stress on MFP and CMP. Evaluation was based on clinical examinations of MFP and CMP and self‐reported questionnaires concerning pain and stress. The diagnosis of sleep bruxism was adapted using the validated diagnostic criteria of the American Academy of Sleep Medicine (International Classification of Sleep Disorders (ICSD‐2), 2005, Westchester, IL), whilst the diagnosis of awake bruxism was made on the basis of a questionnaire. The odds of a subject with MFP experiencing concurrent CMP or bruxism (sleep and/or awake) ranged from 2.603 to 3.077. These results suggest that high‐tech workers and dentists are at greater risk for developing temporomandibular disorders (TMDs) and CMP when compared with general occupation workers, as defined in this study. Furthermore, the associations shown here between TMDs and CMP highlight the importance of palpating neck musculature as part of any routine examination of TMD.