Τρίτη 6 Ιουνίου 2017

Ventilation through an extraglottic tracheal tube: a technique for deep extubation and airway control

Ventilation through an extraglottic tracheal tube: a technique for deep extubation and airway control
Wed, 07 Jun 2017 05:57:03 +0000
Αποτέλεσμα εικόνας για extraglottic tracheal tube
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Emergency front-of-neck access: scalpel or cannula

,The parable of Buridan's ass
Wed, 07 Jun 2017 05:46:05 +0000
Σχετική εικόνα

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Effects of exendin-4 and selenium on the expression of GLP-1R, IRS-1, and preproinsulin in the pancreas of diabetic rats

Abstract

The mechanisms by which exendin-4 and selenium exert their antidiabetic actions are still unclear. Here, we investigated the effects of exendin-4 or selenium administration on the expression of glucagon-like peptide-1 receptor (GLP-1R), insulin receptor substrate-1 (IRS-1), and preproinsulin in the pancreas of diabetic rats. Diabetes was induced by streptozotocin administration. Diabetic rats were injected intraperitoneally with 0.03 μg exendin-4/kg body weight/daily or treated with 5 ppm selenium in drinking water for a period of 4 weeks. GLP-1R and IRS-1 levels were decreased while the level of preproinsulin messenger RNA (mRNA) was increased in the pancreas of diabetic untreated rats, as compared to that in control rats. Treatment of diabetic rats with exendin-4 increased protein and mRNA levels of GLP-1R, and IRS-1, and the mRNA level of preproinsulin in the pancreas, as compared to their levels in diabetic untreated rats. Selenium treatment of diabetic rats increased the pancreatic mRNA levels of GLP-1R, IRS-1, and preproinsulin. Exendin-4 or selenium treatment of diabetic rats also increased the numbers of pancreatic islets and GLP-1R molecules in the pancreas. Therefore, exendin-4 and selenium may exert their antidiabetic effects by increasing GLP-1R, IRS-1, and preproinsulin expression in the pancreas and by increasing the number of pancreatic islets.



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Comparison of Inching Electrodiagnosis Method and Ultrasonographic Findings in the Determination of Median Nerve Entrapment Site in Carpal Tunnel Syndrome.

Objective: The purpose of the study was to evaluate the diagnostic value of both inching method through the electrodiagnostic test and ultrasonographic assay in localizing the site of entrapment in patients with symptoms and signs of carpal tunnel syndrome. Design: Thirty-two hands with confirmed carpal tunnel syndrome through electrodiagnostic test and 30 hands as control group were enrolled. For both groups, sensory and motor latencies by inching technique and cross-sectional area by ultrasonography were measured at the inching points. The statistical analysis was performed by SPSS software, and mean difference with 95% confidence interval was calculated. Results: Mean of sensory peak latency with inching method and cross-sectional area by the ultrasonography was greater in case group compared with the control group (P

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Megalencephalic leukoencephalopathy with cysts: the Glialcam-null mouse model

Abstract

Objective

Megalencephalic leukoencephalopathy with cysts (MLC) is a genetic infantile-onset disease characterized by macrocephaly and white matter edema due to loss of MLC1 function. Recessive mutations in either MLC1 or GLIALCAM cause the disease. MLC1 is involved in astrocytic volume regulation; GlialCAM ensures the correct membrane localization of MLC1. Their exact role in brain ion-water homeostasis is only partly defined. We characterized Glialcam-null mice for further studies.

Methods

We investigated the consequences of loss of GlialCAM in Glialcam-null mice and compared GlialCAM developmental expression in mice and men.

Results

Glialcam-null mice had early-onset megalencephaly and increased brain water content. From 3 weeks, astrocytes were abnormal with swollen processes abutting blood vessels. Concomitantly, progressive white matter vacuolization developed due to intramyelinic edema. Glialcam-null astrocytes showed abolished expression of MLC1, reduced expression of the chloride channel ClC-2 and increased expression and redistribution of the water channel aquaporin4. Expression of other MLC1-interacting proteins and the volume regulated anion channel LRRC8A was unchanged. In mice, GlialCAM expression increased until 3 weeks and then stabilized. In humans, GlialCAM expression was highest in the first 3 years to then decrease and stabilize from approximately 5 years.

Interpretation

Glialcam-null mice replicate the early stages of the human disease with early-onset intramyelinic edema. The earliest change is astrocytic swelling, further substantiating that a defect in astrocytic volume regulation is the primary cellular defect in MLC. GlialCAM expression affects expression of MLC1, ClC-2 and aquaporin4, indicating that abnormal interplay between these proteins is a disease mechanism in megalencephalic leukoencephalopathy with cysts.



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Glioblastoma in natalizumab-treated multiple sclerosis patients

Abstract

We present two natalizumab-treated multiple sclerosis patients who developed glioblastoma multiforme (GBM) with variable outcomes. One patient had an isocitrate dehydrogenase (IDH)-wildtype GBM with aggressive behavior, who declined treatment and died 13 weeks after symptoms onset. The other patient underwent resection of an IDH-mutant secondary GBM that arose from a previously diagnosed grade II astrocytoma. He is still alive 5 years after the diagnosis of GBM. JC virus was not detected in either case. Whether natalizumab played a role in the development of GBM in those patients deserves further investigation.



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The combination of DEX and OND should be recommended in children with a high risk of POV.......Dexamethasone (DEX), ondansetron (OND) and droperidol (DRO) FOR Children undergoing elective surgery under general anaesthesia and considered at high risk for postoperative vomiting (POV)

Clinical assessment of gastric emptying and sensory function utilizing gamma scintigraphy: Establishment of reference intervals for the liquid and solid components of the Nottingham test meal in healthy subjects

Abstract

Background

Current investigations of stomach function are based on small test meals that do not reliably induce symptoms and analysis techniques that rarely detect clinically relevant dysfunction. This study presents the reference intervals of the modular “Nottingham test meal” (NTM) for assessment of gastric function by gamma scintigraphy (GSc) in a representative population of healthy volunteers (HVs) stratified for age and sex.

Methods

The NTM comprises 400 mL liquid nutrient (0.75 kcal/mL) and an optional solid component (12 solid agar-beads (0 kcal). Filling and dyspeptic sensations were documented by 100 mm visual analogue scale (VAS). Gamma scintigraphy parameters that describe early and late phase Gastric emptying (GE) were calculated from validated models.

Key Results

Gastric emptying (GE) of the liquid component was measured in 73 HVs (male 34; aged 45±20). The NTM produced normal postprandial fullness (VAS ≥30 in 41/74 subjects). Dyspeptic symptoms were rare (VAS ≥30 in 2/74 subjects). Gastric emptying half-time with the Liquid- and Solid-component -NTM was median 44 (95% reference interval 28-78) minutes and 162 (144-193) minutes, respectively. Gastric accommodation was assessed by the ratio of the liquid-NTM retained in the proximal:total stomach and by Early phase emptying assessed by gastric volume after completing the meal (GCV0). No consistent effect of anthropometric measures on GE parameters was present.

Conclusions and Inferences

Reference intervals are presented for GSc measurements of gastric motor and sensory function assessed by the NTM. Studies involving patients are required to determine whether the reference interval range offers optimal diagnostic sensitivity and specificity.

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Failure of current investigations to explain the causes of dyspeptic symptoms may be related to small test meals and analysis techniques that rarely detect clinically relevant symptoms. This study provides reference intervals for gastric motor and sensory function by gastric scintigraphy for the large liquid/solid Nottingham test meal (NTM). The NTM is well tolerated and suitable for use in clinical practice.



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Psychological Outcomes of Labiaplasty: A Prospective Study.

No abstract available

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Comment to "Evidence-Based Medicine: A Graded Approach to Lower Lid Blepharoplasty".

No abstract available

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Revision Buttock Implantation: Indications, Procedures, and Recommendations.

No abstract available

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Response to "Psychological Outcomes of Labiaplasty: A Prospective Study".

No abstract available

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Reply to Comment to "A Graded Approach to Lower Lid Blepharoplasty".

No abstract available

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Cervical cancer screening in the era of HPV vaccination: A review of shifting paradigms in cytopathology

Abstract

Significant changes in cervical cancer screening practice, guidelines, and prevention of cervical cancer have taken place in recent years including the raising of initial cervical cancer screening age, changes in frequency of cytology screening, and the adoption of high risk HPV and cytology co-testing for some patients; the introduction of the bivalent, quadrivalent, and 9-valent HPV vaccines; and the recent approval of high risk HPV testing as primary screening with the use of cytology as triage in positive cases. This review discusses the significance of primary HPV screening, the impact of HPV vaccination in the prevalence of cervical cancer and its precursors, the interplay between high risk HPV testing and vaccination, and the implications for clinical and cytological management. Future strategies for cervical screening in the post-vaccination era are also discussed.



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A reformed surgical treatment modality for children with giant cystic craniopharyngioma

Abstract

Objective

Surgical removal plays an important role in treating children’s craniopharyngioma. For a safe and minimally invasive craniotomy, a reformed surgical modality was proposed in this paper by combining the insertion of an Ommaya reservoir system (ORS) by stereotactic puncture, aspiration of cystic fluid in 2-day interval for consecutive 7–10 days, and the delayed tumor resection.

Patients and methods

Eleven patients (aged from 5 to 9 years old) with giant cystic craniopharyngiomas who had undergone the reformed surgical modality during November 2014 and December 2015 were collected as group A. In contrast, seven patients (aged from 5 to 11 years old) who had undergone the traditional directed operation without any prior management from January 2014 to October 2014 were collected into group B. A retrospective analysis was performed for both groups at one institution. The preoperative and postoperative clinical presentations, neuroimaging, early postoperative outcome, and the surgery-related complications of both groups were reviewed.

Results

For group A, the mean value of the maximum tumor diameters shank from 52.36 to 23.82 mm after implementing aspiration of the cystic fluid in 1-day interval for consecutive 8.23 days. Eight patients (72.73%) in group A underwent a gross total resection (GTR), while two (28.57%) patients underwent GTR in group B. The postoperative electrolyte disturbance rate and endocrine disorder rate of group B were significantly higher than those of group A (42.86 vs 36.36%; 71.43 vs 45.45%). Postoperative long-term diabetes insipidus only occurred in one patient of group B, and postoperative visual deterioration occurred in two patients of group B. Besides, one patient of group B died of severe postoperative hypothalamus dysfunction. Patients with residual tumors were applied with additional adjuvant radiotherapy, and no recurrence was observed in follow-up examinations.

Conclusion

A favorable outcome can be achieved by combining the insertion of an ORS by stereotactic puncture, aspiration of cystic fluid in 2-day interval for continuously 7–10 days, and the delayed tumor resection. This combined treatment modality maybe an effective method to treat children with giant cystic craniopharyngiomas.



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Prenatal diagnosis of spina bifida: from intracranial translucency to intrauterine surgery

Abstract

Accurate and timely prenatal diagnosis of spina bifida (SB) is a major goal of modern antenatal care. Prenatal screening for open SB should be first performed at the time of routine first-trimester ultrasound by examining the posterior fossa for obliteration or non-visualization of the fourth ventricle (“intracranial translucency”) and cisterna magna. The second step of screening is the second-trimester anatomy scan, at which time the features of the Chiari type II malformation should be looked for, including ventriculomegaly, scalloping of the frontal bones (“lemon” sign), and backward and caudal displacement of the cerebellar vermis with obliteration of the cisterna magna (“banana” sign). In cases with positive findings, evaluation must include a focused examination of the spine for defects. In cases of closed SB and SB occulta, the cranial and posterior fossa features will not be present as they are not associated with leaking of spinal fluid and resultant hindbrain herniation, highlighting the fact that the spine should be examined thoroughly whenever possible during the second-trimester scan. In tertiary fetal medicine centers, two-dimensional and three-dimensional ultrasound allows an accurate determination of the location, type, extent, and upper level of the spinal defect as well as the presence of associated anomalies. Fetal magnetic resonance imaging should be restricted to candidates for intrauterine surgery as part of the preoperative protocol.



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Hydrocephalus and mucopolysaccharidoses: what do we know and what do we not know?

Abstract

Introduction

The precise incidence of hydrocephalus in patients with mucopolysaccharidoses (MPS) is hard to determine, because the condition lacks a formal, consensus-based definition. The diagnosis of hydrocephalus depends on symptom profile, presence of neuroimaging features, and the outcome of diagnostic tests. Although numerous techniques are used to identify MPS patients who are most likely to have hydrocephalus and respond to treatment, no definitive method exists to prove diagnosis.

Purpose

The authors propose an algorithm to aid in the diagnosis and management of hydrocephalus in MPS patients.

Conclusions

The theory of venous hypertension associated with the morphological changes in the skull base and craniocervical junction indicate the need for future neuroimaging studies including cerebrospinal fluid (CSF) and venous flow measurements to monitor hydrocephalus progression and select therapeutic interventions in MPS patients. Preoperative planning should also be based on the increased risk of intraoperative and postoperative hemorrhagic complications.



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Identification of novel BCL11A variants in patients with epileptic encephalopathy: expanding the phenotypic spectrum

Abstract

BCL11A encodes a zinc finger protein that is highly expressed in hematopoietic tissues and the brain, and that is known to function as a transcriptional repressor of fetal hemoglobin (HbF). Recently, de novo variants in BCL11A have been reported in individuals with intellectual disability syndrome without epilepsy. In this study, we performed whole-exome sequencing of 302 patients with epileptic encephalopathies (EEs), and identified two novel BCL11A variants, c.577delC (p.His193Metfs*3) and c.2351A>C (p.Lys784Thr). Both patients shared major physical features characteristic of BCL11A-related intellectual disability syndrome, suggesting that characteristic physical features and the persistence of HbF should lead clinicians to suspect EEs caused by BCL11A pathogenic variants. Patient 1, with a frameshift variant, presented with Lennox–Gastaut syndrome, which expands the phenotypic spectrum of BCL11A haploinsufficiency. Patient 2, with a p.Lys784Thr variant, presented with West syndrome followed by drug-resistant focal seizures and more severe developmental disability. These two newly described patients contribute to delineating the associated, yet uncertain phenotypic characteristics of BCL11A disease-causing variants.

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Graphical abstract



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Performance of BRCA1/2 mutation prediction models in male breast cancer patients

ABSTRACT

To establish whether existing mutation prediction models can identify which male breast cancer (MBC) patients should be offered BRCA1 and BRCA2 diagnostic DNA screening, we compared the performance of BOADICEA, BRCAPRO and the Myriad prevalence table ('Myriad').

These models were evaluated using the family data of 307 Dutch MBC probands tested for BRCA1/2, 58 (19%) of whom were carriers. We compared the numbers of observed versus predicted carriers and assessed the area under the receiver operating characteristic (ROC) curve (AUC) for each model.

BOADICEA predicted the total number of BRCA1/2 mutation carriers quite accurately (observed/predicted ratio: 0.94). When a cut-off of 10% and 20% prior probability was used, BRCAPRO showed a non-significant better performance (observed/predicted ratio BOADICEA: 0.81, 95% Confidence Interval (CI): (0.60-1.09) and 0.79, 95% CI: (0.57-1.09), vs. BRCAPRO: 1.02, 95% CI: (0.75-1.38) and 0.94, 95% CI: (0.68-1.31), respectively). Myriad underestimated the number of carriers in up to 69% of the cases. BRCAPRO showed a non-significant, higher AUC than BOADICEA (0.798 vs 0.776). Myriad showed a significantly lower AUC (0.671).

BRCAPRO and BOADICEA can efficiently identify MBC patients as BRCA1/2 mutation carriers. Besides their general applicability, these tools will be of particular value in countries with limited healthcare resources.

Thumbnail image of graphical abstract

Graphical abstract



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Distinguishing pathogenic mutations from background genetic noise in cardiology: the use of large genome databases for genetic interpretation

ABSTRACT

Advances in clinical genetic testing has led to increased insight into the human genome, including how challenging it is to interpret rare genetic variation. In some cases, the ability to detect genetic mutations exceeds the ability to understand their clinical impact, limiting the advantage of these technologies. Obstacles in genomic medicine are many and include: understanding the level of certainty/uncertainty behind pathogenicity determination, the numerous different variant interpretation-guidelines used by clinical laboratories, delivering the certain or uncertain result to the patient, helping patients evaluate medical decisions in light of uncertainty regarding the consequence of the findings. Through publication of large publicly available exome/genome databases, researchers and physicians are now able to highlight dubious variants previously associated with different cardiac traits. Also, continuous efforts through data sharing, international collaborative efforts to develop disease-gene specific guidelines, and computational analyses using large data, will indubitably assist in better variant interpretation and classification. This paper discusses the current, and quickly changing, state of variant interpretation resources within cardiovascular genetic research, i.e. publicly available databases and ways of how cardiovascular genetic counsellors and geneticists can aid in improving variant interpretation in cardiology.

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GRAPHICAL ABSTRACT

Distribution of the non-reference allele in SCN5A in Non-Finnish Europeans and African-Americans



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Surgery-first approach in orthognathic surgery: psychological and biological aspects - a prospective cohort study

The aim of this pilot study was to investigate psychological and biological changes after application of a surgery-first orthognathic treatment approach.

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Achieved chin position after genioplasty follows the planned horizontal change better than the planned vertical change

The soft-tissue pogonion closely follows changes of the bony pogonion, but it is unknown how often an augmented bony pogonion reaches the intended position. Here we assessed the agreement between planned surgical changes and achieved results in chin surgery.

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Intraoperative arthroscopy of the TMJ during surgical management of condylar head fractures: „A preliminary report"

The purpose of this preliminary study was to evaluate intraarticular soft tissues of the temporomandibular joint (TMJ) using intraoperative arthroscopy during open reduction and internal fixation (ORIF) of condylar head fractures (CHF).

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Comparison of Inching Electrodiagnosis Method and Ultrasonographic Findings in the Determination of Median Nerve Entrapment Site in Carpal Tunnel Syndrome.

Objective: The purpose of the study was to evaluate the diagnostic value of both inching method through the electrodiagnostic test and ultrasonographic assay in localizing the site of entrapment in patients with symptoms and signs of carpal tunnel syndrome. Design: Thirty-two hands with confirmed carpal tunnel syndrome through electrodiagnostic test and 30 hands as control group were enrolled. For both groups, sensory and motor latencies by inching technique and cross-sectional area by ultrasonography were measured at the inching points. The statistical analysis was performed by SPSS software, and mean difference with 95% confidence interval was calculated. Results: Mean of sensory peak latency with inching method and cross-sectional area by the ultrasonography was greater in case group compared with the control group (P

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Bilateral silent sinus syndrome: A rare case and review of literature

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Type 1 Kounis syndrome in a patient with idiopathic anaphylaxis

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Complete response of skull base inverted papilloma to chemotherapy: Case report

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Differential diagnosis and proper treatment of acute rhinosinusitis: Guidance based on historical data analysis

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Diagnosing environmental allergies: Comparison of skin-prick, intradermal, and serum specific immunoglobulin E testing

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Landmarks for rapid localization of the sphenopalatine foramen: A radiographic morphometric analysis

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Differential expression of microRNAs and their possible roles in patients with chronic idiopathic urticaria and active hives



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Utility of intraoperative flexible endoscopy in frontal sinus surgery

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Effect of topical beclomethasone on inflammatory markers in adults with eosinophilic esophagitis: A pilot study

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Myxofibrosarcoma of the maxillary sinus

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Colorectal cancer metastatic disease progression in Australia: A population-based analysis

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Publication date: August 2017
Source:Cancer Epidemiology, Volume 49
Author(s): Qingwei Luo, Dianne L. O’Connell, Clare Kahn, Xue Qin Yu
BackgroundNo previous Australian population-based studies have described or quantified the progression of colorectal cancer (CRC) to metastatic disease. We describe patterns of progression to metastatic disease for an Australian cohort diagnosed with localised or regional CRC.MethodsAll localised and regional CRC cases in the New South Wales Cancer Registry diagnosed during 2000–2007 were followed to December 2011 for subsequent metastases (identified by subsequent disease episode notifications) or CRC death. Cox regression was used to identify factors associated with metastatic progression.ResultsAfter a median 5.3 years follow-up, 26.4% of the 12757 cases initially diagnosed with localised or regional colon cancer had developed metastatic disease, as had 29.5% of the 7154 rectal cancer cases. For both cancer sites, risk of metastatic progression was significantly higher for those initially diagnosed with regional disease (adjusted hazard ratio [aHR] 3.49 for colon, 2.66 for rectal cancer), and for older cases (e.g. aHR for >79years vs <60years: 1.38 for colon, 1.69 for rectal cancer). Risk of disease progression was significantly lower for females, and varied by histology type. For colon cancer, the risk of disease progression decreased over time. For rectal cancer, risk of metastatic progression was significantly higher for those living in more socioeconomically disadvantaged areas compared with those in the least disadvantaged area.ConclusionsAn understanding of the variation in risk of metastatic progression is useful for planning health service requirements, and can help inform decisions about treatment and follow-up for colorectal cancer patients.



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Correction to: Biomechanical Response of the Infant Head to Shaking: An Experimental Investigation; DOI: 10.1089/neu.2016.4687

Journal of Neurotrauma Jun 2017, Vol. 34, No. 12: 2092-2092.


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Various combinations of velopharyngeal and hypopharyngeal surgical procedures for treatment of obstructive sleep apnea: Single-stage, multilevel surgery

The aim of this study was to investigate the safety and outcomes of velopharyngeal surgeries combined with hypopharyngeal surgeries as single-stage interventions for treatment of obstructive sleep apnea (OSA).

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Lung cancer samples preserved in liquid medium: One step beyond cytology

Abstract

Lung cancer is one of the most common cancer types in men and women worldwide with a high mortality rate. World Health Organization (WHO) classification has accepted biopsy as the primary sample for lung cancer diagnosis, pathological classification and molecular testing for management of patients, yet, the use of alternative sampling procedures is highly encouraged. Bronchial cytological samples require a less invasive collection technique and may be suitable for pathological and molecular analysis and storage in liquid medium. Furthermore, the molecular analysis of bronchial cytological samples allows the detection of molecular biomarkers, which may be useful for the selection of molecular targeted therapies. Thus, the purpose of this review is to describe the usefulness of bronchial cytological samples preserved in liquid medium from lung cancer patients for pathological diagnosis and molecular investigation.



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Cervical thymic cysts

Thymic cysts are rarely occurring benign neck masses, most frequently seen in children. They are remnants of the 3rd and 4th branchial pouches. They may occur at any point along the thymic tract, though they have a predilection for the left side of the neck, often deep in the neck. Patients often present with compressive symptoms. Treatment is surgical excision. Care must be taken, however, to confirm the presence of thoracic thymic tissue prior to excision this neck lesion. On histology, they are defined by the presence of thymic parenchyma and Hassal corpuscles in the cyst wall.

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Laparoscopic total pancreatectomy for multiple endocrine neoplasia type 1 syndrome-associated multifocal, non-functioning pancreatic neuroendocrine tumor: A case report

Abstract

Pancreatic neuroendocrine tumors are rare, accounting for less than 3% of all pancreatic tumors. Although laparoscopic pancreas-preserving surgery for managing sporadic pancreatic neuroendocrine tumors has been described in the literature, laparoscopic total pancreatectomy has rarely been reported. We present a 30-year-old man who was incidentally diagnosed with multiple endocrine neoplasia type 1 syndrome with parathyroid hyperplasia and a non-functioning pancreatic neuroendocrine tumor. He underwent laparoscopic total pancreatectomy with splenectomy. This report highlights the technical details of laparoscopic total pancreatectomy, which appears to be a feasible and safe option in select cases.



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Editorial



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Tiroplastía de medialización con Gore-Tex®: Experiencia de 8 años en Hospital Clínico de la Universidad de Chile

Introducción: La parálisis de cuerda vocal causa disfonía y puede ser complicación posterior a ciertas cirugías. Existen diversos tratamientos, uno de ellos es la tiroplastía de medialización, procedimiento realizado con anestesia local, permitiendo un fino ajuste de la voz. Objetivo: Analizar la experiencia en tiroplastía de medialización con Gore-tex® en el Hospital Clínico de la Universidad de Chile entre los años 2008-2016. Material y método: Estudio descriptivo, retrospectivo, con revisión de fichas clínicas de los pacientes que fueron sometidos a tiroplastía de medialización. Para el análisis de los datos se utilizará la prueba Wilcoxon. Resultados: Se analizaron datos de 21 pacientes, correspondientes a 24 tiroplastías de medialización. La edad promedio fue 54,2 años, 13 parálisis fueron secundarias a cirugía y 8 idiopáticas. En 17 pacientes se obtuvo la encuesta VHI-10 en el pre y posoperatorio, con valores promedio de 33,2y 17,4 (p =0,0003). Cinco pacientes requirieron de algún procedimiento complementario, entre 4 y 22 meses poscirugía: inyección de grasa, de Radiesse y refuerzo con otra prótesis de Gore-teX®. Conclusión: La tiroplastía de medialización es excelente para tratar la parálisis de cuerda vocal unilateral no recuperada en forma espontánea, siendo la encuesta VHI-10 una buena herramienta para evaluar la calidad de la voz.
Introduction: Vocal cord paralysis can cause hoarseness and coud be a complications to following certain surgeries. In its treatment, there are several alternatives, one of them is the medialization thyroplasty. This procedure, is performed under local anesthesia, allowing the fine-tune of the voice. Aim: To analyze the experience in Medialization Thyroplasty with Gore-tex in the Clinical Hospital of the University of Chile between 2008 and 2016. Material and method: Retrospective and descriptive, with the review of patient's clinical records who were treated with medialization thyroplasty. The data analysis is done using Wilcoxon test. Results: Data from 21 patients, corresponding to 24 medialization thyroplasty. The average age was 54.2 years old, 13 paralysis were secondary to surgeries and 8 were Idiopathic. In 17 patients it was posible to get the VHI-10 survey in the pre and postoperative, with an average value of 33.2 and 17.4 (p =0.0003). Five patients required some additional procedure, between 4 and 22 months post surgery: injection of fat, Radiesse and installation of a new Gore-tex prosthesis Conclusions: Medialization thyroplasty is an excellent method to treat paralysis of unilateral vocal cord in cases when is not recovered spontaneously, being the VHI-10 survey a good tool for assessing voice quality.

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Cirugía endoscópica nasosinusal y de base de cráneo asistida por navegación

Introducción: La cirugía guiada por imágenes corresponde a una herramienta quirúrgica que comienza a desarrollarse a mediados del siglo XX. En 1990 comienza a utilizarse en otorrinolaringología, siendo sus principales indicaciones la cirugía endoscópica de cavidades paranasales y la cirugía de base de cráneo anterior. Objetivo: Analizar y presentar el resultado del uso de cirugía guiada por imágenes en pacientes intervenidos en el Hospital Clínico de la Universidad de Chile (HCUCH). Material y método: Se realizó un estudio retrospectivo incluyendo todos los casos de cirugía endoscópica nasosinusal y base de cráneo asistida por imágenes en HCUCH. La selección para usar la navegación se hizo en base a las recomendaciones de la Academia Americana de Otorrinolaringología. Resultados: De un total de 12 pacientes intervenidos con el uso de navegación, se obtuvo 100% de éxito quirúrgico con disminución de los síntomas y sin complicaciones intraoperatorias. Conclusión: La cirugía asistida por navegación en cavidades paranasales y base de cráneo, es una herramienta de suma utilidad en casos seleccionados que potencia las habilidades quirúrgicas del cirujano sin reemplazar sus conocimientos anatómicos. Otorga seguridad y precisión en cirugías que comprometen estructuras nobles como base de cráneo y órbita entre otros.
Introduction: Image Guided Surgery is a surgical tool that develop in the mid-twentieth century. In 1990 it began to be used in otolaryngology, being its main indications endoscopic surgery of paranasal sinuses and anterior skull base. Aim: To analyze and present the result of image-guided surgery in patients undergoing surgery at the Hospital of the University of Chile. Material and method: A retrospective study included all cases of endoscopic sinus surgery and skull base imaging assisted at the Clinical Hospital of the University of Chile from August 2015 to August 2016. The choice to use the navigation was made in based on the recommendations of the American Academy of Otolaryngology, and analyzed case by case. Results: A total of 12 patients were operated using Navigation, achieving 100 % of surgical success with decreased symptoms and without intraoperative complications. Conclusion: Image Guided Surgery in paranasal sinuses and skull base is a tool very useful in selected cases where enhances the surgeon skills without replacing their anatomical knowledge. Provides security and accuracy in surgeries involving noble structures such as the skull base, orbit among others. their anatomical knowledge. Provides security and accuracy in surgeries involving noble structures such as the skull base, orbit among others.

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Cirugía hipofisiaria endoscópica transesfenoidal, con realización de colgajo nasoseptal: Evaluación del impacto de la técnica en la olfación. Serie de casos

Introducción: La cirugía endoscópica transesfenoidal en la exéresis de patología hipofisaria ha sido ratificada dentro de la mejores opciones para conseguir abordajes exitosos. Para cerrar la brecha ósea, se puede utilizar el colgajo nasoseptal, el cual lograría un cierre adecuado y seguro, evitando complicaciones como persistencia de fístulas de líquido cefalorraquídeo. Dentro de los probables efectos secundarios de este colgajo se señala la presencia de anosmia o hiposmia. Objetivo: Nuestro objetivo es mostrar los resultados obtenidos empleando la técnica del colgajo nasoseptal y la evaluación del olfato posoperatorio. Material y método: Incluimos 14 pacientes con diagnóstico de adenoma hipofisiario intervenidos en nuestro servicio entre diciembre 2014 a diciembre 2015. Se evaluaron diversos parámetros entre otros, olfatometría pre y posoperatorias. A todos se les realizó la técnica endoscópica transesfenoidal. Efectuando la disección del colgajo con la técnica tipo Hadad. La exéresis tumoral fue realizada por neurocirujano, se cubrió la osteotomía con este colgajo. Resultados: De los 14 pacientes, 13 llegaron al estado olfativo preoperatorio. 1 paciente se mantuvo hipósmico mantenidamente. En nuestro estudio, no hemos encontrado deterioro significativo en la calidad del sentido del olfato. Así como tampoco observamos otras complicaciones. Conclusiones: Esta experiencia aún inicial, estimamos que podría ya esbozar una tendencia de mantención de la función olfativa en este tipo de cirugía.
Introduction: Transsphenoidal endoscopic surgery resection of pituitary pathology has been ratified within the best options for successful approaches. To close the gap bone, you can use the nasoseptal flap, which achieved an adequate and secure closure, preventing complications such as persistent cerebrospinal fluid leaks. Among possible side effects of this flap anosmia-hyposmia noted. Aim: Our goal is to show the results obtained using the technique of nasoseptal flap and postoperative evaluation of smell. Material and method: We included 14 patients with a diagnosis of pituitary adenoma surgery in our department between December 2014 to December 2015. Various parameters were evaluated pre and post operative, specially olfactory function. All underwent transsphenoidal endoscopic technique. Performing dissection flap with the technical type Hadad. The tumor resection was performed by neurosurgeon, osteotomy covered with this flap. Results: Of the 14 patients, 13 reached the olfactory preoperative state. 1 patient remained with hyposmia. In our study, we found no significant deterioration in the quality of the sense of smell. Not other complications were found. Conclusions: This is an initial experience, and we estimate that could outline a trend of maintaining olfactory function in this surgery approach.

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Cáncer de laringe: Serie de casos en 6 años en el Complejo Asistencial Doctor Sótero del Río

Introducción: El cáncer de laringe es la segunda causa de muerte en otorrinolaringología. Su tratamiento en estadios avanzados es agresivo y controversial. Objetivo: Reportar los datos de pacientes atendidos en el Complejo Asistencial Doctor Sótero del Río entre los años 2005-2011. Material y método: Análisis retrospectivo descriptivo. Resultados: Total de 38 pacientes, 30 (79%) hombres, mediana de edad 66 años. Los principales motivos de consulta fueron dificultad respiratoria en 18 pacientes (47%) y disfonía en 14 (37%). Se realizó estudio y etapificación con nasofibroscopía y tomografía computarizada. El 71% se presentó en estadio avanzado, de ellos, el 30% recibió quimiorradioterapia exclusiva. La sobrevida global a 2 y 5 años fue de 56% y 42% respectivamente en estadio avanzado y de 100% y 71% respectivamente en estadio precoz. Discusión: El cáncer de laringe es una enfermedad con sobrevida baja a pesar de tratamientos agresivos. Se han planteado alternativas al tratamiento estándar como terapia conservadora con quimiorradioterapia exclusiva o microcirugía láser transoral. Conclusiones: La epidemiología del cáncer laríngeo se ha mantenido relativamente estable y la clasificación TNM sigue siendo fundamental para el tratamiento, especialmente en contexto de nuevas alternativas de manejo de cáncer avanzado. Se espera evaluar estas terapias.
Introduction: Laryngeal cancer is the second cause of death in otolaryngology. Its treatment in advanced stage is aggressive and controversial. Aim: To report data from patients treated in Complejo Asistencial Doctor Sótero del Río in the period between 2005-2011. Material and method: Descriptive retrospective analysis. Results: 38 patients in total, 30 (79%) men, median age 66 years. The main symptoms were breathing difficulty in 18 patients (47%) and dysphonia in 14 (37%). Every patient completed study and disease staging with nasofibroscopy and computed tomography. 71% presented in advanced stage, among them, 30% received exclusive chemoradiotherapy. Overall survival for 2 and 5-year in advanced stage was 56% and 42% respectively; and 100% and 71% in early stage. Discussion: Advanced laryngeal cancer has low survival rate in spite of aggressive treatments. Alternatives to standard care have been proposed, such as conservative therapy with exclusive chemoradiotherapy or transoral laser microsurgery. Conclusions: Laryngeal cancer's epidemiology remains relatively unchanged and TNM classification still remains fundamental for treatment, specially in the context of new therapeutic alternatives for advanced cancer. Evaluation of these therapies is expected.

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Injerto costal para reconstrucción nasal: Experiencia de 6 años en el Hospital San Juan de Dios

Introducción: El injerto de preferencia para cirugía nasal es el cartílago septal. El Injerto de cartílago costal otorga gran material para trabajo ya que posee características similares al cartílago septal. Este injerto se utiliza generalmente para cirugías de dorso nasal, nariz en silla de montar, laterorrinias, disfunciones de la válvula nasal interna y/o externa, poca proyección nasal y rinoplastías de revisión. Objetivo: Conocer las características, resultados y complicaciones de las rinoplastías con injerto de cartílago costal realizadas en el Hospital San Juan de Dios (HSJD) entre los años 2010 y 2016. Material y método: Estudio retrospectivo con revisión de fichas clínicas de pacientes sometidos a cirugías de reconstrucción nasal con injerto de cartílago costal en el HSJD entre enero 2010 y agosto 2016. Resultado: Entre los años 2010 y 2016 se realizaron 20 rinoplastías con uso de cartílago costal: 14 eran hombres (70%) y 6 eran mujeres (30%). En 14 pacientes se usó el cartílago costal en la primera cirugía. No se presentaron complicaciones a corto, mediano y largo plazo. Conclusión: El injerto de cartílago costal es una herramienta útil a la hora de enfrentarse a cirugías complicadas. La técnica quirúrgica no es dificultosa y tiene una baja tasa de complicaciones.
Introduction: The ideal graft for nasal surgery is septal cartilage. The costal cartilage has similar characferistics to the septal cartilage. This particular graft is generally used for nasal dorsum, saddle nose, nasal deviations, dysfunctions of the internal or external nasal valve, poor nasal projection and revision rhinoplasty. Aim: Determine the characteristics, outcomes and complications of rhinoplasty with costal cartilage graft made in the San Juan de Dios Hospital (HSJD) between 2010 and 2016. Material and method: Retrospective study with reviewing medical records of all patients underwent nasal surgery reconstruction with costal cartilage graft in the HSJD between January 2010 and August 2016. Results: Between 2010 and 2016 a total of 20 rhinoplasties were performed with use of costal cartilage. Of these 14 were men (70%) and 6 were women (30%). In 14 patients we used the costal cartilage in the first surgery. No complications in short, medium and long term were presented. Conclusion: The rib cartilage graft is a useful tool when dealing with complicated surgeries. The surgical technique is not difficult and has a low complication rate.

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Tumor condroide del cartílago tiroides: Reporte de un caso clínico y revisión de la literatura

Los tumores condroides de la laringe son poco frecuentes, y generalmente se ubican en el cartílago cricoides. El tratamiento de elección es quirúrgico, con buen pronóstico general. Se presenta el caso de un hombre de 60 años con historia de disfonía. El estudio nasofaringolaringofibroscópico revela una masa laríngea supraglótica. Las imágenes son compatibles con una lesión del cartílago tiroides. La biopsia obtenida por microlaringoscopía directa informa tumor compatible con condroma. Se realiza una resección completa de la masa por abordaje externo, la biopsia corrobora el diagnóstico de tumor condroide de bajo grado. Se describe esta patología mediante revisión bibliográfica.
Chondroid tumors of the larynx are uncommon, and usually located in the cricoid cartilage. Surgery is the treatment of choice, with good prognosis in general. We report the case of a 60-year-old man consulting for dysphonia. The nasopharyngolaryngoscopy showed a supraglottic laryngeal mass. The images were compatible with a thyroid cartilage lesion. The biopsy sample obtained by direct microlaryngoscopy was consistent with a condroma. A complete excision of the lesion was performed by external approach and the biopsy confirmed the diagnosis of a low grade chondroid tumor. We present a review of chondroid tumors of the larynx based on available literature.

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Abordaje endoscópico endonasal puro de estesioneuroblastoma

Presentamos el caso de una mujer de 56 años con diagnóstico de estesioneuroblastoma Kadish C/Hyams II tratado con resección quirúrgica mediante un abordaje endoscópico endonasal puro y radioterapia adyuvante. Describimos el caso y discutimos sus aspectos relevantes.
We report the case of a 56-year-old woman with diagnosis of esthesioneuroblastoma Kadish C/Hyams II treated with a purely endonasal endoscopic resection and adjuvant radiotherapy. We described the case and discuss its relevant aspects.

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Estesioneuroblastoma o neuroblastoma olfatorio

Estesioneuroblastoma o también llamado neuroblastoma olfatorio es un tumor maligno infrecuente derivado del neuroepitelio olfatorio. La historia clínica de un paciente con un neuroblastoma olfatorio es muy inespecífica. Durante la última década, los métodos endoscópicos se han aplicado gradualmente para el tratamiento de tumores de la base del cráneo. El tratamiento puramente endoscópico endonasal del estesioneuroblastoma ha mostrado excelentes resultados de supervivencia con disminución de las complicaciones. Presentamos un paciente afectado por un neuroblastoma olfatorio tratado solo con cirugía endoscópica endonasal.
Esthesioneuroblastoma or olfactory neuroblastoma is an uncommon malignant tumor arising from the olfactory neuroepithelium. The clinical symptoms of a patient with olfactory neuroblastoma are very inespecific. During the past decade, endoscopic approaches have been gradually applied in treating skull base tumors. The purely endoscopic endonasal surgery for esthesioneuroblastoma showed successful survival results with remarkably decreased complications. We reported a patient who suffered olfactory neuroblastoma treated with only endoscopic endonasal surgery.

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Malformación arteriovenosa en cavidad oral: A propósito de un caso y revisión de la literatura

Las malformaciones arteriovenosas (malformaciones A-V) de alto flujo en la cavidad oral no son una patología frecuente, existen pocos datos publicados sobre su tratamiento y sigue siendo muy controvertido debido a la alta tasa de complicaciones vitales que conlleva y la alta tasa de recurrencia. El único tratamiento curativo es la resección radical, con las consecuencias no sólo vitales, sino también desfigurativas que supone. Presentamos un caso de malformación A-V congénita en región submandibular, suelo de boca derecho y lengua, que tras varios episodios de dolor y aumento de tamaño, sin realizar ninguna medida agresiva, en el último control se observa trombosis espontánea de la misma. En este caso, la evolución con un tratamiento expectante sin cirugía, ha sido la trombosis con mejoría clínica, sin presentar nuevo episodio de aumento de tamaño, ni sangrado doce meses después, a pesar de seguir con una lesión de gran tamaño en el suelo de la boca.
he high-flow arteriovenous malformations (A-V malformations) in oral cavity are not a common disease, there are few published data on treatment and it remains highly controversial because of the high rate of vital complications and the high rate of recurrence. The only curative treatment is radical resection, with not only vital consequences but also the disfigurement involved. We present a case of congenital A-V malformation in right submandibular region, floor of the mouth and tongue. After several episodes of pain and enlargement, in the last control without any aggressive action, the lesion presented spontaneous thrombosis. In this case, despite following with a large lesion on the floor mouth, the evolution with an expectant non-surgical treatment has been the thrombosis with clinical improvement, without presenting new episode of enlargement, nor bleeding twelve months later.

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Hallazgo de arteria lusoria en el estudio de otitis media a repetición: A propósito de una observación pediátrica y revista breve de la literatura

Arteria Lusoria (AL) o arteria subclavia aberrante derecha es una malformación vascular rara. Es la más común de las malformaciones del arco aórtico. Fue descrita por primera vez por Hunalud en 1735. La etiología no está clarificada hasta hoy en día. AL puede formar parte de un cuadro sindrómico (síndrome de Down, síndrome de Edwards) o de una malformación cardiaca compleja. Es casi siempre asintomática, pero algunas veces puede revelarse por signos respiratorios o disfagia. Se elige habitualmente el tratamiento conservador. Les presentamos el caso de un niño de 2 años que presentó una AL revelada atipicamente por otitis media a repetición.
Arteria Lusoria (AL) or aberrant right subclavian artery is a rare congenital aortic arch malformation. Hunauld described it for the first time in 1735.The cause is until now no totally clarified. Usually it is associated with chromosomal disorders such as Down's syndrome, Edwards's syndrome or appears in childhood with complexes cardiovascular abnormalities. Patients are frequently asymptomatic, but it may be revealed by respiratories symptoms or by a dysphagia. The treatment is generally conservative. We expose a case report about a child of 2 years old with AL diagnosed after several episodes of purulent otitis.

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Dolor cervical atípico: Síndrome de Eagle

Presentamos el caso de un varón de 45 años con dolor cervical derecho muy localizado, característico y persistente. El estudio radiológico nos permitió diagnosticar claramente un síndrome de Eagle. Por lo anterior el paciente fue sometido a cirugía de extirpación de apófisis estiloides derecha. El paciente evolucionó sin mayores complicaciones ni incidencias, y obteniendo la resolución del cuadro.
Here we introduce a 45-year-old man suffering from an intense, unique and permanent pain, located in his right neck. Radiology showed us signs leading to the diagnosis of Eagle Syndrome. Surgery of right Styloid apophysis removal, with no complications, letting the patient free of symptoms.

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Manejo del cáncer de cabeza y cuello: ¿Radioterapia a quién, cuándo y por qué?

Revisión del enfrentamiento del paciente con cáncer escamoso de la vía aerodigestiva superior, orientada a la radioterapia. Las principales alternativas de tratamiento para los pacientes con cáncer escamoso de cabeza y cuello son la cirugía y la radioterapia (RT). La planificación del tratamiento debe considerar el tumor primario y la diseminación linfática cervical. La enfermedad subclínica es significativa en este grupo de pacientes. Cuando ésta es mayor a 20%, la disección cervical electiva ha mostrado mejorar la sobrevida libre de enfermedad y la sobrevida global. La RT por Intensidad Modulada (IMRT) permite mayor protección de los tejidos vecinos. El fenómeno de repoblación acelerada implica que dosis insuficientes o períodos largos de interrupción traducen persistencia o recidiva tumoral. Por esta razón, la adyuvancia con RT debe iniciarse precozmente. Para esto, es fundamental una evaluación dental oportuna. Los efectos adversos de la RT se dividen en agudos y tardíos, pudiendo estos últimos presentarse meses o años posterior a la terapia. Los pacientes con indicación de RT deben ser derivados tempranamente y con previa evaluación dental. La IMRT es una excelente herramienta terapéutica cuando es correctamente indicada y aplicada. Los principales beneficios en relación a la cirugía son menor morbilidad y mejor costo-efectividad por lo que suele ser la terapia de elección en enfermedad localizada y una alternativa a la disección cervical electiva.
Radiation therapy for squamous cell carcinoma of the upper aerodigestive tract: review of management. Head and neck cancer treatment includes several treatment options. Surgery and radiotherapy are the most important local treatments. When planning the local treatment, the choices for the primary tumor, and the lymphatic spread to the neck must be considered. Subclinical metastatic disease to the neck is present in about 20% of patients, and can be controlled equally with surgery or radiation therapy. In a randomized trial, elective neck dissection has been shown to improve disease-free, and overall survival when compared with observation and salvage. Intensity-modulated radiotherapy (IMRT) allows a better sparing of normal tissues in the neck, and less morbidity from the treatment. Accelerated repopulation is a main determinant of poor local control in patients treated with radiotherapy who undergo treatment interruptions or a delay in its start. Thus, adjuvant radiotherapy must begin as early as possible, within six weeks of resection. Irradiated patients are at significant risk of dental complications, even when IMRT is used. That makes mandatory a dental evaluation and treatment prior to radiotherapy. Adverse radiation effects can occur during treatment (early reactions), or months to years after completion (late reactions). Patients with indication of radiotherapy must be referred early, preferably after dental evaluation. IMRT is an excellent tool when correctly indicated and uses. Main benefits of elective neck irradiation are less morbidity and higher cosst-effectiveness, making it a very useful treatment alternative to elective neck dissection in patients with localized disease.

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Prevención, diagnóstico y manejo de lesiones laringotraqueales agudas y subagudas posintubación en pacientes pediátricos

Las lesiones laringotraqueales asociadas a intubación se deben principalmente a una técnica defectuosa y a daño por presión del tubo endotraqueal sobre la mucosa; además influyen características propias del paciente y de los cuidados de enfermería. Hasta el 40% de los pacientes pediátricos intubados pueden presentar alteraciones laríngeas inmediatas y hasta 30% tienen estridor o disnea posextubación. Si estos síntomas persisten por más de 3 días tendrían indicación de laringotraqueoscopía. Las lesiones más habituales son edema, úlceras y tejido de granulación. El edema puede producir obstrucción respiratoria aguda que puede manejarse con reintubación con tubos más pequeños y aplicación tópica de crema de corticoides con antibióticos. Las úlceras y granulaciones pueden evolucionar hacia secuelas cicatriciales que comprometen la fisiología laringotraqueal; las granulaciones exofíticas deben retirarse endoscópicamente. Aunque la incidencia de estenosis subglótica posintubación ha disminuido en las últimas décadas, situándose entre 2,7%y 4,2%, algunos estudios sugieren un subdiagnóstico debido a lesiones poco sintomáticas al alta. En el período cicatricial activo, estas estenosis pueden dilatarse para evitar llegar a una cirugía abierta. El manejo otorrinolaringológico de estos pacientes en etapas tempranas es fundamental para evitar secuelas cicatriciales irreversibles que requieren de cirugías complejas, con riesgo vital por obstrucción de la vía aérea.
Intubation-associated laryngotracheal injuries are mainly caused by a defective technique and endotracheal tube pressure-induced mucosal damage; patient factors and nursing care are also important. Up to 40% of intubated pediatric patients may show immediate laryngeal alterations and up to 30% have post-extubation stridor or dyspnea. If these symptoms last for over 3 days, laryngotracheoscopy is indicated. Edema, ulcers and granulation tissue are the most usual lesions. Edema can lead to acute airway obstruction, and is managed by reintubation with a smaller tube and topical application of a corticosteroid and antibiotic cream. Ulcers and granulations can lead to scarring that compromise laryngotracheal physiology; exophytic granulations must be removed endoscopically. Although the incidence of post-intubation subglottic stenosis has diminished over the last decades to about2,7% to 4,2%, some studies suggest that there is a subdiagnosis because of oligosymptomatic lesions at the time of discharge. On the active scarring period, dilatation of the stenosis can be used to avoid open surgery. Early otorhinolaryngologic management of these patients is fundamental for avoiding irreversible cicatricial sequels that require complex surgeries, with life risk due to airway obstruction.

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Repercusiones de la roncopatía y respiración bucal en el crecimiento facial

Los trastornos respiratorios obstructivos del sueño corresponden a un amplio espectro de patologías que incluyen a los roncadores primarios, el síndrome de resistencia de vía aérea superior y al síndrome de apnea obstructiva del sueño (SAOS). Dentro de sus manifestaciones clínicas se encuentra la roncopatía y la respiración bucal, las cuales generan alteraciones en el crecimiento craneofacial del niño pudiendo ser la causa de un SAOS residual. El objetivo de esta revisión es analizar las alteraciones del crecimiento craneofacial en niños generadas por la roncopatía y respiración bucal.
Obstructive sleep breathing disorders correspond to a broad spectrum of diseases that include primary snorers, upper airway resistance syndrome and obstructive sleep apnea syndrome (OSAS). Its clinical manifestations include snoring and mouth breathing, which generates alterations in the craniofacial growth of the child that may be the cause of a residual OSAS. The objective of this review is to analyze the alterations of craniofacial growth generated by snoring and mouth breathing in children.

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Importancia de la epidemiología en cáncer laríngeo: Incidencia y mortalidad por carcinoma escamoso de laringe

Actualmente se realiza un diagnóstico anual de 650.000 nuevos casos de carcinoma escamoso de cabeza y cuello en el mundo, siendo el carcinoma escamoso de laringe una patología neoplásica que compete al otorrinolaringólogo. La incidencia mundial del cáncer escamoso de laringe se estima en 3,9 por cada 100.000 habitantes con una mortalidad general de 2,0 por cada 100.000 habitantes. En Chile el registro de cáncer se realiza en base a los cinco registros poblacionales de cáncer que existen. No se tienen datos exactos respecto a incidencia y mortalidad por carcinoma escamoso de laringe, siendo la estimación de la incidencia de 1,2 casos por cada 100.000 habitantes y la estimación de mortalidad ajustada por edad de 0,7 casos por cada 100.000 habitantes. Se han descrito diversos factores de riesgo ambientales y estilos de vida para este cáncer, por lo tanto, las estrategias de prevención primaria en salud son claves a la hora de generar un impacto en la incidencia del carcinoma escamoso de laringe.
The annual diagnosis of head and neck squamous cell carcinoma is 650,000 new cases. The laryngeal carcinoma is a malignant disease that should include an otolaryngologist in its evaluation. The global incidence of laryngeal carcinoma is estimated at 3.9 per 100,000 inhabitants with an overall mortality rate of 2.0 per 100,000 inhabitants. In Chile the cancer registry is based on the five population cancer registries that exist. There is no accurate data on incidence and mortality from laryngeal carcinoma, being an estimated incidence of 1.2 cases per 100,000 inhabitants and an age-adjusted mortality of 0.7 cases per 100.00 inhabitants. There have been described various environmental risk factors and lifestyles for this cancer, therefore, primary prevention strategies are key to generate an impact on the incidence of larynx carcinoma.

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A Modified Bifurcated Periosteal Flap for Simultaneous Reconstruction of Upper and Lower Lateral Canthal Tendons

imageAbstract: A bifurcated periosteal flap is useful for simultaneous reconstruction of the upper and lower lateral canthal tendons. The original technique harvested the flap horizontally from the frontal process of the zygoma, which mostly resulted in an insufficient flap length because of the narrowness of the zygoma. Here, the authors report the use of a modified bifurcated periosteal flap, raised from the superolateral orbital rim. The lower flap was positioned to slant inferiorly to create a downward slope of the lower eyelid for smooth lacrimal drainage by gravity. The authors applied this technique to 2 patients and obtained good cosmetic results without complications such as entropion, ectropion, lower-eyelid sagging, epiphora, or lateral canthal deformity.

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Goddess of Imagination

imageNo abstract available

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Management of Pharyngocutaneous Fistula With Negative-Pressure Wound Therapy

imageBackground: Pharyngocutaneous fistula is a common complication of laryngopharyngeal surgery and is associated with increased morbidity and mortality. Beyond the classical management, negative-pressure wound therapy (NPWT) can be an alternative and effective treatment. Clinical Report: Two patients with pT3N0M0 squamous cell carcinoma of pyriform sinus were subjected to total laryngectomy and pharyngoesophageal reconstruction of a circular (patient 1) and an anterior wall defect (patient 2) with radial forearm free flap and pectoralis major muscle flap, respectively. Both developed a pharyngocutaneous fistula and NPWT was used. A significant decrease of the fistula aperture and exudate was observed after 22 and 21 days of NPWT in patients 1 and 2, respectively. After that standard wound care was instituted and closure of the fistulae was accomplished in 5 and 7 days, respectively. Conclusion: Negative-pressure wound therapy can be an effective treatment for pharyngocutaneous fistula closure, either in the setting of fistulae that persist besides multiple surgical revisions using muscle flaps or as a first-line therapy when fistulae develops.

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A Periodical Article Reviewer as Gottfried: The Uncle of Jean-Christophe

imageNo abstract available

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Periorbital Soft Tissue Anthropometric Analysis of Young Adults

imageAbstract: The authors aim to determine the periorbital soft tissue anthropometric norms for Turkish young adults for right and left eyes using a noninvasive two-dimensional photogrammetric analysis. Anthropometric measurements of the periorbital soft tissue were taken from 172 female and 56 male Turkish adults aged between 18 and 24 years. The periorbital soft tissue profiles (ocular and palpebral) for males and females were digitally analyzed using linear measurements made with standardized photographic records, taken in a natural head position. Statistically significant differences were found for ocular soft tissue measurements according to gender except inner intercanthal distance (P = 0.125) and right horizontal palpebral aperture (P = 0.240). Statistically significant differences were found for palpebral soft tissue measurements according to gender except right pretarsal skin height (P = 0.112) and left pretarsal skin height (P = 0.056). Results were compared with other ethnic groups. Normal periorbital soft tissue measurements are fundamental anatomical parameters utilized in ophthalmology, optometry, ophthalmic industry, oculoplastic surgery, clinical genetics, dermatocosmetology. Further, normal anthropometric measurements generate reference data for studies in craniofacial dysmorphology, oculoplastic surgery, dermatocosmetology, and comparative physical anthropology.

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Effects of Growth Factors From Platelet-Rich Fibrin on the Bone Regeneration

imageAbstract: Platelet-rich fibrin (PRF) has simple manufacturing process without risk of immunologic rejection or infection by additional materials. This study was designed to investigate the effects of platelet-derived growth factors and transforming growth factors-β in PRF on the proliferation and differentiation of osteoblasts. The authors analyzed platelet-derived growth factors and transforming growth factors-β in normal human serum (NHS) and PRF by enzyme-linked immunosorbent assay quantitatively and those in PRF group were significantly increased when compared with NHS. After harvesting osteoblasts from iliac bone, the authors added 10% fetal bovine serum, 10% NHS, and 3% PRF to osteoblasts, respectively and incubated for 24, 48, 72 hours. For analysis of osteoblast proliferation and differentiation, the authors measured DNA synthesis by [3H]-thymidine isotope activity, protein synthesis by sulforhoamine B assay and those were increased according to elapsed time in all groups, but they were significantly increased in 3% PRF. The authors measured alkaline phosphatase activity of osteoblasts, it was increased according to elapsed to time in all groups, but significantly increased in 72 hours. In conclusion, application of PRF to bone defect sites may have an enhanced effect of bone regeneration with low risk of complications, and relatively simple manufacturing process.

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Bilateral Coronoid Hyperplasia in a 43-Year-Old Patient Treated With Intraoral Coronoidectomy

imageAbstract: The mandibular coronoid hyperplasia can be classified as a congenital or development change of the temporomandibular joint. This condition occurs due to a no-neoplasic growth of the coronoid process to the infratemporal fossa. Thus, this part of the bone impacts in the posterior face of the zygomatic bone causing limitation of the mouth opening. The aim of this paper is to report a clinical case of a 43-year-old male with mouth-opening limitation 28 years ago. After clinical and computed tomographic examinations, he was diagnosed with bilateral mandibular coronoid hyperplasia. The treatment proposed was a bilateral coronoidectomy by intraoral approach. In a 1-month postoperative period, the patient reported improvement of the painful complaints and mouth opening. After 1 year, the patient recovered the mouth opening improving his quality of life and there were no more complaints.

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Value of Osteoblast-Derived Exosomes in Bone Diseases

imagePurpose: The authors’ purpose is to reveal the value of osteoblast-derived exosomes in bone diseases. Methods: Microvesicles from supernatants of mouse Mc3t3 were isolated by ultracentrifugation and then the authors presented the protein profile by proteomics analysis. Results: The authors detected a total number of 1536 proteins by mass spectrometry and found 172 proteins overlap with bone database. The Ingenuity Pathway Analysis shows network of “Skeletal and Muscular System Development and Function, Developmental Disorder, Hereditary Disorder” and pathway about osteogenesis. EFNB1 and transforming growth factor beta receptor 3 in the network, LRP6, bone morphogenetic protein receptor type-1, and SMURF1 in the pathway seemed to be valuable in the exosome research of related bone disease. Conclusions: The authors’ study unveiled the content of osteoblast-derived exosome and discussed valuable protein in it which might provide novel prospective in bone diseases research.

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Review of “Effectiveness of an Integrated Video Recording and Replaying System in Robotic Surgical Training” by Yang K, Perez M, Hubert N, Hossu G, Perrenot C, Hubert J in Ann Surg 265: 521–526, 2017

No abstract available

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A Research of Soft Tissue Lipoma Genesis Factor With Immunohistochemical Analysis

imageIntroduction: Lipoma is the most familiar soft-tissue tumor. But the etiology of lipoma remains imprecise. Sex steroid hormones such as estrogen have effects on muscle and adipose tissue development. There is now significant evidence that sex steroids are involved in the site specificities of adipose tissue metabolism. This association of adipose tissue metabolism between sex steroid hormones suggests a possible role for sex steroids in the pathogenesis of lipoma. Methods: To investigate this concept, the authors evaluated the expression of the estrogen receptor (ER) and the progesterone receptor (PR) in soft tissue lipoma in this study. In addition, angiogenesis and the production of angiogenic factors are fundamental for tumor progression in the form of growth, invasion, and metastasis. Epidermal growth factor receptor (EGFR) is involved in a signaling cascade that influences proliferation and other tumor-promoting activities. In this respect, the authors tried to define the correlation of soft tissue lipoma tumor cell and specific 2 immunohistologic markers, vascular endothelial growth factor (VEGF) and EGFR. The study population included patients who diagnosed with soft tissue lipoma, 20 independent patients were selected. All specimens were stained with hematoxylin and eosin. All slides were examined by a pathologist under a microscope. ER, PR, VEGF, and EGFR expression was analyzed by immunohistochemistry. Result: ER, PR, and EGFR of tumor cell had significantly more negative than positive. And VEGF of tumor cell had significantly more positive than negative. There was no significantly difference between site of tumor and immunohistochemical stain. Discussion and Conclusion: There are only a few studies for ER and PR in soft tissue related tumors. The authors estimated that the abnormal local proliferation and accumulation of adipocyte in soft tissue lipoma is related to sex steroid hormone action, especially estrogen and progesterone. But ER and PR of tumor cell had significantly more negative than positive in this study. The authors concluded that estrogen and progesterone are not impact factor of pathogenesis of soft tissue lipoma. Vascular endothelial growth factor of tumor cell had significantly more positive than negative. Angiogenesis is an essential factor for tumor growth. The VEGF expression of soft tissue lipoma can be understood in the same context. The authors need more study to reveal an association between lipoma and EGFR, because some patients of lipoma were positive to EGFR in this study.

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Comparison of Complications in Parotid Surgery With Harmonic Scalpel Versus Cold Instruments

imageAbstract: Complications following parotid surgery with harmonic scalpel versus cold instruments were seldom discussed. The authors retrospectively analyzed the medical record of 94 patients who received parotid surgery at Tianjin National Clinical Research Center for Cancer between January 2012 and October 2015, and compared the complications in patients operated with either Harmonic FCS9 (HF) or traditional cold instruments (CI). The mean operative time was 65.1 minutes in HF group versus 88.9 minutes for CI group. Intraoperative blood loss was 35 mL in HF group versus 55 mL in CI group. The mean drainage time was 3.7 days in HF group compared with 4.9 days in CI group. The mean total drainage volume was 62 mL in HF group versus 89 mL in CI group. The occurrence of Frey syndrome showed no difference in these 2 groups. Thus, the use of the HF in the surgical treatment of parotid disease is safe and confers advantages over conventional methods of parotid dissection.

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Cranial Reconstruction Using Autologous Bone and Methylmethacrilate

imageBackground: Having in mind the importance of reconstruction of the calvaria, our goal was to compare the complication rates following the use of autologous bone and methylmethacrilate grafts, and explain the factors influencing them. Methods: The authors collected information of all the patients undergoing cranial reconstructive surgery (N = 149) at the Military Medical Academy in Belgrade. Procedures were performed either using a craniotomy bone flap, removed and replaced in the same act, or using methylmethacrilate. These 2 groups were compared using the Chi-squared test, controlling for the confounding influence of the size of the defect. Results: Intracranial neoplasms were the cause for the reconstruction in 71.1% of patients. The total complication rate was 7.4%, while the infection rate was 5.4%. The infection rate was significantly higher in those procedures done using methylmethacrilate (11.3% compared with 2.1%, P = 0.017), but when controlling for the confounding effect of the size of the defect treated, the difference in infection rate was significant only in large defects (13.9% compared with 2%, P = 0.031), while for small defects the difference was not statistically significant. Conclusions: Our study suggests that the material used for reconstruction of calvaria influences the infection rate only in large and complicated defects. Considering the importance of the reconstruction, further studies should explore and confirm the role of material type on the rate of complications.

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Removable Partial Denture After Gunshot Injury: Five Year Follow-Up

imageAbstract: The aim of this study was to report a patient of rehabilitation with removable partial denture retained by implants in-patient who suffered injury after firearm shooting. A 19-year-old man presented to the hospital of the Val Paraíso city after being hit by a bullet in the right on the face, affecting the teeth 12 to 16. The surgery to remove the shards of teeth, and bullet was performed. Surgical team opted for installation of implants without bone grafts; however, due to extensive loss of alveolar bone, only 3 tilted implants (2 Ø3.75 × 8.5 mm and 1 Ø3.75 × 10 mm) were installed. After recovery, the patient was referred to the Araçatuba Dental School—UNESP for the rehabilitation on the affected region. The difficulty of rehabilitation with conventional fixed prostheses was verified during the prosthetic phase. This way, it was opted for rehabilitation with removable partial dentures associated with dental implant. Two attachment system ERA (ERA, Sterngold) were positioned in the bar to make the removable partial denture. After 5 years of follow-up, the authors can conclude that the use of removable partial denture retained by implants is effective for functional and aesthetic rehabilitation, favoring socialization and self-esteem of the patient.

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Multivectored Superficial Muscular Aponeurotic System Suspension for Facial Paralysis

imagePurpose: Facial paralysis is a devastating condition that may cause severe cosmetic and functional deformities. In this study we describe our technique for superficial muscular aponeurotic system (SMAS) suspension using barbed suture and compare the vectors of suspension in relation to the underlying musculature. This study also quantifies the improvements in postoperative symmetry using traditional anthropologic landmarks. Methods: The efficacy of this procedure for improving facial paralysis was determined by comparing anthropometric indices and using Procrustes distance between 4 groupings of homologous landmarks plotted on each patient's preoperative and postoperative photos. Geometric morphometrics was used to evaluate change in facial shape and improvement in symmetry postoperatively. To analyze the vector of suspension in relation to the underlying musculature, specific anthropologic landmarks were used to calculate the vector of the musculature in 3 facial hemispheres from cadaveric controls against the vector of repair in our patients. Results: Ten patients were included in our study. Subjectively, great improvement in functional status was achieved. Geometric morphometric analysis demonstrated a statistically significant improvement in facial symmetry. Cadaveric dissection demonstrated that the suture should be placed in the SMAS in vectors parallel to the underlying musculature to achieve these results. There were no complications in our study to date. Conclusion: In conclusion, multivectored SMAS suture suspension is an effective method for restoring static suspension of the face after facial paralysis. This method has the benefit of producing quick, reliable results with improved function, low cost, and low morbidity.

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Clinical Manifestation of a Patient With Forehead Sparganosis

imageAbstract: Human sparganosis is a parasite infection caused by the larva of a tapeworm of the genus Spirometra. Ocular, central nervous system, auricular, pulmonary, intraosseous, intraperitoneal, and subcutaneous manifestations of this infection in the neck or inguinal region have been described. The authors report the rare occurrence of cutaneous forehead sparganosis of a 19-year-old male who presented with a soft subcutaneous mass in the forehead, along with a related literature review.

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Implantation of Thickened Artificial Bone for Reduction of Dead Space and Prevention of Infection Between Implant and Dura in Secondary Reconstruction of the Skull

imageAbstract: For the treatment of skull defect compensation after neurosurgery, a customized artificial bone is often employed owing to its toughness and the relative ease of producing cosmetically good result. However, implants are vulnerable to infection and removal of implant is sometimes necessary. Several other treatment options such as autologous bone graft or free flap are likely to be considered for the secondary reconstruction to avoid reinfection; however, reimplantation of artificial bone is beneficial for the patients, being not concerned with donor site morbidity. The authors consider one of risk factors of infection of artificial bone as dead space between the implant and dura. To attain reduction of the dead space, we have employed thickened artificial bone. Between 2010 and 2014, 6 patients underwent implantation of thickened artificial bone for the secondary reconstruction. First, the infected artificial material was removed with proper debridement. More than 3 months after the closure of the infected wound, tissue expander was inserted beneath the surrounding scalp to ensure the coverage of subsequently implanted artificial bone without skin tension. The thickened artificial bone was designed from the computed tomography findings so as not to leave any dead space between the implant and dura. After optimal expansion of the scalp, the artificial bone was implanted. Postoperative courses were uneventful and the appearance of the cranial vault was satisfactory in all patients. The authors consider the use of the thickened artificial bone is easier and more suitable for patients having a skull defect, particularly in secondary reconstruction.

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Repeatability Study of Angular and Linear Measurements on Facial Morphology Analysis by Means of Stereophotogrammetry

imageAbstract: The aim of this study was to analyze the repeatability in a stereophotogrammetry digital system used for the evaluation of facial morphology. Thirty healthy Brazilian, 18 to 45 years old (26.71 ± 6.53), had 11 reference landmarks marked on their faces by the same examiner and were photographed with an interval of 1 week by the VECTRA M3. Nine angular measurements (nasolabial, mentolabial, nasofrontal, maxillofacial, nasal, maxillary, mandibular, facial convexity, full facial convexity) and 2 linear measurements (middle facial height and lower facial height) were taken. Repeatability was analyzed by the mean absolute differences, relative error of magnitude, technical error of measurement, intraclass correlation coefficient, and Bland–Altman analysis. Paired t test sought any systematic errors between the acquisitions. Associations among body mass index, age, and the error in the measurements were made using the Pearson correlation coefficient. For the technical error of measurement, the nasolabial and mentolabial angles showed values >2° (clinical limit set for this study). For the relative error of measurement, most of the measures were rated between good and excellent. The maxillofacial angle was only moderate. There was a systematic error for middle facial height. The nasolabial, mentolabial, facial convexity, full facial convexity, maxillofacial, and nasofrontal angles presented intraclass correlation coefficient values rated as excellent. The relationship between age/body mass index and the error found between measurements was not confirmed. The nasolabial and mentolabial angles should be interpreted with caution due to the variability showed. The results found stereophotogrammetry to be repeatable, giving accurate measures within the references established for this study.

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Three Skin Zones in the Asian Upper Eyelid Pertaining to the Asian Blepharoplasty

imageBackground: Natural looking double fold is an essential and aesthetically pleasing masterpiece in Asian blepharoplasty. This study aims to emphasize the 3 skin zone concept in the Asian upper blepharoplasty. Methods: The authors examined the anterior lamella of each skin zone microscopically by performing 31 double-eyelid surgeries and 11 infrabrow lifts. Characteristics of dermal components, subcutaneous tissue, and outer fascia of OOM (OFOOM) at each skin zone were documented. The authors evaluated the vertical scales of each skin zone in young and aged Asian patients who visited the first author's clinic for the primary or secondary upper blepharoplasty with ×3.5 magnifying surgical loupe. Results: The thickness of OOM had no difference among zones 1, 2, and 3. The skin and subdermal tissue had varying characteristics according to its skin zone. At zone 1, it seemed that only thin skin was on the OOM. The anterior lamella of zone 2 seemed to consist of skin, white fascia (OFOOM) including a venous network, and OOM in a gross field. At zone 3, thick skin, thick subcutaneous fatty layer, and OOM were magnified. The OFOOM of zone 3 was not significantly identified due to a sticky adherence with OOM. At the point of vertical scales of skin zone, good eyelids have lower zone 3 ratio and higher zones 1 and 2 ratio with qualified topographic condition. Conclusion: The authors classified the Asian upper eyelid as with 3 skin zones. Based on its anatomical investigation, the authors can afford anthropometric data and supplemental theory for the creation of aesthetic folds.

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Tips and Techniques in Oral Mucosa Harvest for Urological Reconstruction

imageNo abstract available

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Effect of Preoperative Molding Helmet in Patients With Sagittal Synostosis

imageBackground: In our practice, the authors found that molding helmet used for plagiocephaly preoperatively, in patients with sagittal synostosis, decreased bathrocephaly, forehead bossing, and improved posterior vertex, as well as Cephalic Index (CI). This prompted us to investigate the impact of preoperative molding helmet in patients with sagittal synostosis. Methods: A prospective study was performed on patients undergoing surgical correction of sagittal synostosis, over a 5-year period. Patients were categorized into 2 groups. “No Helmet group” only had surgical correction, and “Helmet group” had preoperative molding helmet, prior to surgical correction. Cephalic Index for the 2 groups was compared using t-test. Results: There were 40 patients in the No Helmet group and 18 patients in the Helmet group. For No Helmet group, mean CI at presentation, immediately preoperative, and postoperatively was 0.70 (±0.045), 0.70 (±0.020), and 0.80 (±0.030), respectively, and for Helmet group, it was 0.69 (±0.023), 0.73 (±0.036), and 0.83 (±0.036), respectively. There was no statistically significant difference between CI of the 2 groups at presentation (P = 0.45). Comparison of postoperative CI did show a statistically significant difference between the groups (P = 0.01). For Helmet group, on comparison of CI at presentation and preoperative CI (after helmet therapy), a statistically significant improvement in CI was observed (P = 0.0004). Conclusion: Our results suggest that preoperative molding helmet can decrease bathrocephaly, forehead bossing, and improve posterior vertex as well as CI, prior to surgery and thus can be used as a valuable adjunct in patients with sagittal synostosis.

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Cleft palate with/without cleft lip in French children: radiographic evaluation of prevalence, location and coexistence of dental anomalies inside and outside cleft region

Abstract

Introduction

Prevalence of dental anomalies in cleft patients is higher than that in general population. The objectives of this study were to assess the prevalence of dental anomalies and their coexistence in French children with cleft and, then, to investigate the relation between the dental anomalies and the cleft type.

Material and methods

Seventy-four non-syndromic cleft patients (6–16 years old) from Lille Regional University and Mondor-Chenevier Hospitals (France) were included. Clefts were classified as right/left unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP) and cleft palate (CP). Dental anomalies were investigated on panoramic radiographs and categorized as agenesis, supernumerary teeth, incisor rotations, impacted canines and shape anomalies. Prevalence and gender distribution of dental anomalies, mean number of affected teeth per patient, agenesis occurrence and location, and coexistence of dental anomalies were analysed by cleft type.

Results

96.0% of patients presented at least one dental anomaly (agenesis 83.8%, incisor rotations 25.7%, shape anomalies 21.6%, impacted canines 18.9%, supernumerary teeth 8.1%). BCLP patients had a higher number of affected teeth, and left UCLP patients had a higher one compared to right UCLP patients. Distribution of inside (45.3%) and outside (54.7%) cleft region agenesis was similar. Adjacent (31.8%) and not adjacent (33.3%) combined dental anomalies were often encountered.

Conclusions

Dental anomalies were localized inside as well as outside cleft region and were often associated with each other. BCLP patients were more affected.

Clinical relevance

Early radiographic evaluation allows a comprehensive diagnosis of inside and outside cleft region anomalies, required for the multidisciplinary dental treatment.



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Craniofacial cephalometric morphologies in different cleft types: a retrospective cross-sectional study of 212 patients

Abstract

Objective

The aim of this study was to evaluate and compare the craniofacial cephalometric morphologies among different cleft types in a Spanish population.

Methods

A retrospective cross-sectional study was carried out on 212 patients. The patients were subdivided into four groups according to their cleft types: unilateral cleft lip and palate; bilateral cleft lip and palate; cleft lip; and cleft palate. Angular and linear cephalometric measurements were taken on lateral radiographs.

Results

Unilateral cleft lip and palate was associated with a dolichofacial growth pattern, skeletal Class III with correct maxillary position, and lingual incisor inclination. Bilateral cleft lip and palate was associated with a mesofacial growth pattern, skeletal Class I with protruded maxillary position, and lingual incisor inclination. Cleft palate was associated with a mesofacial growth pattern, skeletal Class III with correct maxillary position, and lingual incisor inclination. Cleft lip was associated with a brachyfacial growth pattern, skeletal Class I with protruded maxillary position, lingual upper incisor inclination, and corrects lower incisor inclination. Significant correlations were observed between cleft types and their craniofacial cephalometric measurements.

Conclusions

The present information can be used for the determination of orthodontic treatment and even future orthognathic surgery planning, a requirement in most cleft patients.



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Associations between mandibular symphysis form and craniofacial structures

Abstract

Objectives

This study aimed to (1) analyze the relationships between mandibular symphysis characteristics (height, prominence, inclination, concavity, and convexity) and facial pattern, skeletal class, lower incisor position, and sex, and (2) determine the associations between the symphysis soft tissue dimensions and the underlying osseous structures.

Methods

Cone-beam computed tomography (CBCT) images were selected for 385 patients (206 women and 179 men). The patients were classified according to their skeletal class and vertical pattern. The lower incisor inclination (IMPA) was recorded. Twelve measurements were taken for each mandibular symphysis using Invivo5 software (Anatomage, San Jose, CA, USA).

Results

Symphyseal measurements were larger in males than in females. Skeletal Class II and III hyperdivergent patients showed the highest symphysis height values. Hypodivergent individuals showed lower symphysis convexity angles. Concavity of the symphysis was greater for Class II hyperdivergent patients. Lower incisor inclination showed a positive correlation with symphysis concavity and inclination. Moderate and weak correlations were found between hard tissue and soft tissue parameters.

Conclusions

Only a few characteristics of symphysis morphology depend on sex, incisor position, skeletal class, and vertical pattern. More significant relationships are found when the vertical pattern and skeletal class are analyzed in combination. The shape of the symphysis soft tissue is not directly correlated with the underlying skeletal structures.



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Natural Radionuclides, Rare Earths and Heavy Metals Transferred to the Wild Vegetation Covering a Phosphogypsum Stockpile at Barreiro, Portugal

Abstract

In Portugal, the industrial production of phosphate fertilizers, has been dealing with a specific raw material—north African phosphate rock—with a high content of trace metals and natural radioactive elements mainly from the 238U decay series. A disabled phosphate plant located in the vicinity of the river Tejo estuary has produced phosphoric acid for several decades (1950–1989) and dumped tons of phosphogypsum (PG) on retention lagoons, formerly decanted and deposited into a stockpile. This paper deals with the assessment of radionuclides, rare earth elements (REEs) and heavy metals transfer to plants (fam. Plantaginaceae, Plantago sp.) and mosses (fam. Bryaceae, Bryum sp.) growing naturally on the PG pile. In Plantago sp., the concentration ratio (CR, plant tissue/PG) was 0.187 for 226Ra and 0.293 for 210Pb. The translocation factor (TF, aerial parts/roots) was 0.781 for 226Ra and 0.361 for 210Pb. In contradiction to the high CR, the leachability of 226Ra from PG was low, lower than 2%. The results confirmed the role of mosses as biomonitors. A high quantity of contaminants collected in its biomass confirmed the hypothesis of their significant transport by air and rain water. High concentrations of heavy metals (As, Cd, Zn, W) in samples collected on the stockpile are an evidence of their transport from former industrial zones in the surroundings and present even more important risk for public health and environment than natural radionuclides and REEs from the PG stockpile.



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Evaluation of a novel antibody to define histone 3.3 G34R mutant brain tumours

Missense somatic mutations affecting histone H3.1 and H3.3 proteins are now accepted as the hallmark of paediatric diffuse intrinsic pontine gliomas (DIPG), non-brain stem paediatric high grade gliomas (pHGG) ...

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