Impact of inverted internal limiting membrane-flap technique on functional outcome and structural restoration of small and medium size macular holes

Purpose: To evaluate the impact of the inverted internal limiting membrane (ILM)?flap technique on the visual outcome and anatomical recovery for small (<250 ?), medium (<400 ?), and large (>400 ?) macular holes (MHs). Methods: Retrospective study included consecutive idiopathic MH cases operated on using the inverted ILM?flap technique. Clinical data were retrieved from electronic medical records (EMRs), surgical videos, and optical coherence tomography (OCT) machines. Eyes with axial length >25 mm, coexisting macular diseases, and follow?up <6 weeks were excluded. Data included the presence or absence of ILM flap and restoration of External Limiting Membrane (ELM), Ellipsoid Zone (EZ) lines. Mean visual improvement and structural recovery were compared between eyes showing ILM flap and those showing no flap in three MH size groups. Results: Forty eyes of 38 patients with a mean age of 62.7 ± 10.1 years and a mean MH diameter of 348 ± 152 ?m were included. The mean follow?up was 527 ± 478 days with anatomical closure observed in all eyes. Mean best?corrected visual acuity (BCVA) improved significantly from 0.87 ± 0.38 to 0.35 ± 0.26. ILM flap was visible in 29 (72.5%) all MHs, 7 (53.8%) small MHs (n = 13), 8 (61.5%) medium MHs (n = 13), and 14 (100%) large MHs (n = 14). The mean BCVA change was 0.47 ± 0.34, 0.53 ± 0.48, and 0.56 ± 0.20 in large, medium, and small MHs, respectively, and the difference between eyes showing ILM flap versus no flap in each MH size group was not statistically significant (P > 0.05). However, for medium MHs, it was higher in the ILM flap (0.66 ± 0.52) group compared to the no flap (0.32 ± 0.37) group. One eye with small MH developed significant gliosis resulting in reduced BCVA. ELM was restored in all eyes with small and medium MHs. Conclusion: We observed that the ILM flap did not adversely affect anatomical and visual outcomes for MHs <400 ?m. Restoration of ELM suggests minimal interference in structural recovery by an ILM flap.

Successful Outcome of a Rare Complication of Vaginal Birth: A Case Report

Uterine inversion is a condition in which the interior surface of the relaxed uterus protrudes through the vaginal entrance. Its causes are divided into two categories: puerperal and non-puerperal, with puerperal uterine inversion being more common than non-puerperal uterine inversion. The most common variety is acute inversion, which occurs immediately or within 24 hours after delivery. Chronic Uterine Inversions (CUI) that occur more than four weeks after delivery are uncommon. In this study we discuss a case of a 30-year-old woman who came with the complaints of feeling of a mass in the vagina after her last confinement which was gradually coming down through the vagina and remain outside the introitus for 5 years. Based on clinical and sonographic evaluation, she was diagnosed with CUI and developed post partum haemorrhage. We adopted Haultain’s method for correction of CUI. Since, CUI as a painless vaginal mass in the delayed post-partum period is uncommon and hence documented.

Comparative study of conventional internal limiting membrane peeling versus temporal inverted internal limiting membrane flap for large macular hole treatment

Purpose: To compare the anatomical, morphological, and functional outcomes of the conventional internal limiting membrane (ILM) peeling versus temporal inverted ILM flap technique for large full?thickness macular holes (FTMHs). Methods: Sixty eyes of 60 patients with a minimum base diameter >600 ?m were included in this retrospective interventional study. Patients were divided into conventional ILM peeling (Group 1) and temporal inverted ILM flap (Group 2) groups. The hole closure rate, best?corrected visual acuity (BCVA), ellipsoid zone (EZ), and external limiting membrane (ELM) defects were analyzed at baseline and 6 months after surgery. Results: Hole closure was achieved in 24/32 (75.0%) cases of Group 1 and 27/28 (96.4%) cases of Group 2 (P = 0.029). The mean BCVA (logMAR) changed from 1.23 ± 0.47 to 0.70 ± 0.29 logMAR in Group 1 and from 1.03 ± 0.36 to 0.49 ± 0.24 logMAR in Group 2 at 6 months (P < 0.001 in both cases). U?shaped closure was observed in 5 (15.6%) eyes in Group 1 and 19 (67.9%) eyes in Group 2 (P < 0.001). The total restoration rates of ELM and EZ were significantly higher in the temporal inverted ILM flap group (P = 0.002, P = 0.001, respectively). Conclusion: The study results suggested that the FTMH closure rate, recovery of the outer retinal layers, and, consequently, the post?operative BCVA were better with the temporal inverted ILM flap technique than with the conventional ILM peeling for larger than 600 ?m macular holes.

Application experience of prelacrimal recess combined with septotomy in resection of recurrent inverted papilloma / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the effectiveness of nasal endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum in resecting recurrent nasal inverted papilloma. Methods:Patients with recurrent nasal inverted papilloma who underwent reoperation in our hospital during the past 2 years were included . The nasal septum may hinder full access to and effective treatment of the lesions at the anterior and medial wall of the maxillary sinus by endoscope, aspirator and surgical instrument in the narrow aperture of the prelacrimal recess, although these lesions could be observed by 70° nasal endoscope. Results:The nasal septum is temporarily opened on the basis of the prelacrimal recess approach, and the nasal endoscope and instrument was introduced through trans-septal window, so as to provide a better view of the operative field and the angular range of the instrument's movement. Conclusion:The recurrent nasal inverted papilloma could be successfully managed by re-endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum, and no recurrence was observed during the 2-year follow-up. This surgical approach is recommended for the inverted papilla which originates from the anterior medial wall of the maxillary sinus, as the tumor can be removed completely using this surgical approach.

Procedure for correction of inverted nipple using tiny incision with primary breast ducts reserved / 中华医学美学美容杂志

Objective:To discuss the procedure for correction of inverted nipple using tiny incision with primary breast ducts reserved.Methods:A total of 35 patients (63 sides) with primary inverted nipples from January 2006 to March 2019 were reviewed retrospectively. Tiny radial incisions were made on the areola around the base of the inverted nipple which had been pulled out. Without skin removed, shorten fiber bundles which caused nipple inverted were totally cut and released. While the primary breast ducts were preserved, purse-string suture was taken around the base of the nipple. The nipple protector was prepared by ourselves, and the nipple was pulled and suspended for 2-6 months.Results:Sixty-three sides of 35 patients with inverted nipples were successfully corrected by this minimally invasive surgery. There was no nipple necrosis. One patient developed mild swelling 3 weeks after operation, and the swelling subsided after symptomatic anti-inflammatory treatment. The average follow-up period was 39 months. After removing the nipple protector, 2 sides (2/63) had a certain degree of recurrence. The rest of the nipples had ideal shape, no obvious scar, good nipple feeling, and retained the possibility of lactation.Conclusions:The procedure for correction of inverted nipple using tiny incision with primary breast ducts reserved has advantages of minimal invasion, safety, less pain, while retaining the possibility of lactation in the future. The clinical effect is satisfactory. It is especially suitable for the correction of type Ⅰ and type Ⅱ inverted nipples.

A case of sinonasal inverted papilloma with malignant transformation and distant metastasis: a 10-year follow-up report / 临床耳鼻咽喉头颈外科杂志

Sinonasal inverted papilloma（SNIP） is a kind of benign tumor originating from the nasal cavity and paranasal sinuses, accounting for 70% of papillomas. The incidence of the disease is more common in males, with an average age of 50-60 years. It is most likely to occur in unilateral maxillary sinus and ethmoid sinus, followed by sphenoid sinus and frontal sinus.It has the characteristics of local invasion, high recurrence rate and malignant tendency, and most malignant transformation into squamous cell carcinoma. Endoscopic nasal resection and appropriate adjuvant therapy can help to reduce the recurrence rate and inhibit further deterioration. We report the results of a 10-year follow-up of a SNIP patient, including the clinical manifestations, recurrence course and treatment plan during the 10 years. The patient underwent multiple nasal endoscopic surgeries, and had a recurrence of multiple focal attachment pattern, and finally had direct invasion and distant metastasis. Tumor recurrence and further deterioration persisted despite the use of a comprehensive treatment.

Pars plana vitrectomy combined with inverted internal limiting membrane flap technique for treating macular hole retinal detachment in high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the clinical efficacy of pars plana vitrectomy(PPV)combined with inverted internal limiting membrane flap technique in the treatment of macular hole retinal detachment(MHRD)in high myopia.METHODS: A retrospective clinical study was conducted. A total of 63 patients(64 eyes)with high myopia and MHRD who treated at our hospital from October 2017 to October 2021 were selected as research subjects. They were divided into two groups according to different surgery, with 34 cases(35 eyes)who received PPV combined with inverted internal limiting membrane flap technique in group A, and 29 cases(29 eyes)received PPV combined with internal limiting membrane peeling in group B. The patients were followed up for 6mo. The two groups were compared in terms of the hole closure rate, the reduction rate of retinal detachment and best corrected visual acuity(BCVA)before operation and at 1wk, 1, 3 and 6mo after operation, and the postoperative complications were recorded.RESULTS: The hole closure rate within 6mo after operation was significantly higher in group A than in group B(P&#x0026;#x003C;0.05), but there was no statistically significant difference in the reduction rate of retinal detachment(P&#x0026;#x003E;0.05). The BCVA of the two groups was significantly improved over time after operation(P&#x0026;#x003C;0.05). There was no statistically significant difference in BCVA between the two groups before operation and at 1wk, 1, 3 and 6mo after operation(P&#x0026;#x003E;0.05). Complications were observed in the two groups, but there was no statistically significant difference in the incidence of complications between the two groups(P&#x0026;#x003C;0.05).CONCLUSION: PPV combined with inverted internal limiting membrane flap technique is safe and effective in the treatment of MHRD in high myopia, which can effectively improve the patients' BCVA and the hole closure rate without influence on intraocular pressure.

Prognostic significance of p16, VEGF, and p53 expression patterns, Krouse stage, and smoking status in sinonasal inverted papillomas

Aim: The aim of our study is to analyze the staining models for VEGF, p16, and p53, as well as to understand the biology of inverted papilloma caused by smoking. Materials and Methods: Thirty-one cases, diagnosed with sinonasal inverted papilloma between 2015 and 2019, were included. Demographic data such as age and gender, admission symptoms of the patients, and anatomical location, stage, surgical technique, and recurrence information were obtained from clinical follow-up files. Immunohistochemical staining for p16, VEGF, and p53 were performed on patient materials. Results: In our study, the female to male ratio was 9.33 with an average age of 53.137 ± 13.96 years. Of the patients, 17 were nonsmokers and 14 were smokers. No significant relationship was found between smoking status and relapse and dysplasia. In contrast, a significant relationship between the Krouse stage and dysplasia (P = 0.005) was observed. A similar significant relationship was observed between p16 immunohistochemical expression and dysplasia (P = 0.030). On the other hand, VEGF and p53 immunohistochemical expressions were not significantly related with dysplasia and recurrence. Conclusions: Inverted papillomas are benign tumors that clinically give symptoms similar to nasal polyps. However, recurrence and malignant transformation potential exist and the factors causing this risk are not clearly identified. In our study, no malignant transformation was observed in patients who were admitted to our hospital.

Resultados de la cirugía de sustitución esofágica con tubo gástrico invertido vía ascenso retroesternal en dos hospitales pediátricos / Results of esophageal substitution surgery with inverted gastric tube via retrosternal lift

Resumen Objetivo: Describir resultados de la cirugía de sustitución esofágica con tubo gástrico invertido, vía ascenso retroesternal en dos hospitales pediátricos durante el período marzo 2015 a marzo 2018. Materiales y Método: Un estudio observacional, transversal, con recolección de datos retrospectivo, donde se incluyeron todos los expedientes de pacientes que presentaban patología del esófago por causa adquirida o congénita que fueron operados de sustitución esofágica con tubo gástrico invertido en dos hospitales pediátricos durante 3 años. Resultados: Encontramos 29 niños sometidos a sustitución esofágica, de los cuales 27 cumplieron criterios de inclusión. La edad comprendida entre 2 y 17 años. El 63% corresponde al sexo femenino. La causa más frecuente de sustitución esofágica es por estenosis esofágica por ingesta caustica (92,59%). El 70% presentó algún tipo de complicación luego de la cirugía. La fístula esofagocutánea es la complicación principal con 33,33%. La permanencia en la unidad de cuidados intensivos es menor de 24 horas en un 74% de los niños. Se inicia la vía oral en casi la mitad de casos entre los 10-12 días de posquirúrgico, la estancia hospitalaria es en promedio 18,5 días. La mortalidad es 3,7%. Conclusión: La sustitución esofágica por tubo gástrico invertido vía ascenso retroesternal, es una técnica comparable en resultados a la interposición de colón. Para los autores, el estómago es un órgano ideal para realizar la reconstrucción esofágica, y sus complicaciones son manejables.

Aim: To describe the results of esophageal replacement surgery with an inverted gastric tube via retrosternal ascent in two pediatric hospitals during the period March 2015 to March 2018. Materials and Method: an observational, cross-sectional study with retrospective data collection that included all the records of patients with esophageal discontinuity due to acquired or congenital causes who underwent esophageal replacement surgery with an inverted gastric tube in two pediatric hospitals for 3 years. Results: We found 29 children undergoing esophageal replacement, of which 27 met inclusion criteria. The age between 2 to 17 years. 63% corresponds to the female sex. The most frequent cause of esophageal replacement is esophageal stricture due to caustic ingestion (92.59%). 70% presented some type of complication after surgery. The esophagocutaneous fistula is the main complication with 33.33%. The stay in the intensive care unit is less than 24 hours in 74% of children. The oral route is started in almost half of cases between 10-12 days after surgery; the hospital stay is on average 18.5 days. Mortality is 3.70%. Conclusión: The esophageal substitution by inverted gastric tube via retrosternal ascent is a technique comparable in results to the interposition of the colon. For the authors, the stomach is an ideal organ to perform esophageal reconstruction, and its complications are manageable.

V for vitamin, inverted V for lack of it: A rare case of subacute combined degeneration of cord with bladder symptoms and associated multiple Tarlov cysts

Subacute degeneration of cord (SACD) is a rare presentation of a common disease and it should be kept in mind when the patient develops symptoms of peripheral neuropathy. This is a case of a 65-year-old male who presented with pins and needles sensation of bilateral hands and feet and with difficulty in voiding. Neurological examination showed large fiber neuropathy with an exaggerated knee jerk, absent ankle jerk, extensor plantar, and a positive Romberg’s sign. Routine laboratory investigations showed low hemoglobin and low vitamin B12 levels. Magnetic resonance imaging of the spinal cord showed a hyperintense lesion in the posterior aspect of the cervical cord with a classical “inverted V” sign on the axial section which is suggestive of SACD. Coincidentally, there were multiple Tarlov cysts present. Finally, the patient improved with vitamin B12 injections. This case is unique as an association of SACD with Tarlov cysts with a classical inverted V sign has not been reported according to the literature.

Pre-operative optical coherence tomography predictors: Do they hold any relevance in the era of inverted internal limiting membrane flap in large macular holes?

Purpose: To study the relevance of preoperative OCT predictors in large macular holes (MH) treated using the inverted ILM peel technique. Methods: Prospective study of 95 patients undergoing vitrectomy for large MH between January 2019 and December 2020 was performed by dividing the patients into groups depending on various quantitative parameters and indices of MH such as base diameter (BD), hole form factor (HFF), macular hole index (MHI), diameter hole index (DHI), and tractional hole index (THI) by using parameters such as minimal hole diameter, hole height, nasal and temporal arm lengths. Depending upon the duration of symptoms, patients were divided into three groups: <3 months, 3–6 months, and >6 months. Anatomical success rate, type of closure, and postoperative vision gain were analyzed in relation to the abovementioned diameters, indices, and duration to see if any significance existed. Results: The mean age of patients included in the study was 60.48 ± 13.88 years, with female preponderance (males: females = 37:58). Change in logMAR was statistically significant individually with all studied parameters (P < 0.0001) without influence of size of hole and other indices. BD and DHI levels showed significant association with type of closure as indicated by P values of 0.017 and 0.048, respectively. Duration of symptoms showed no significance in terms of anatomical and functional success. Conclusion: OCT predictors of MH success seem to have lost relevance with inverted flap surgeries as 100% anatomical success is achieved with this technique, with 95.78% (91/95) achieving type 1 closure with statistically significant equivalent functional gain across the indices with no effect of duration of symptoms.

Unilateral double optic nerve head pits with foveo-schisis detachment treated by modified internal limiting membrane peeling technique

A 44?year?old female with a vision of 10/200 in the right eye had double pits in the temporal segment of the optic disc with serous macular detachment. Spectral?domain optical coherence tomography (SD?OCT) confirmed serous retinal detachment, an outer layer hole, and double optic disc pits. The patient underwent pars plana vitrectomy with modified ILM flap surgery involving fovea?sparing internal limiting membrane peeling (FSIP) technique with inverted ILM flap tucking with gas tamponade. Post surgery, the communications between perineural and intraretinal spaces were obliterated with flaps of ILM covering the pits, with reduced serous macular detachment and BCVA of 20/120. FSIP with inverted internal limiting membrane flap tuck can be an effective technique to manage rare cases of double ODP?M

Flower-petal inverted flap for internal limiting membrane in myopic eyes with macular hole and rhegmatogenous retinal detachment

We demonstrate a modified internal limiting membrane (ILM) inverted flap technique for closure of macular holes (MHs) concurrent with rhegmatogenous retinal detachment in myopic eyes. Multiple ILM flaps were created in a flower?petal configuration around the MH over the detached retina after shallowing the retina as much as possible. Traction was always in a direction that allowed the optic disc to act as an anchor to limit iatrogenic breaks and to bridge the hole with multiple, more secure flaps should one of the flaps revert or break away. The technique proved safe and efficient in MH closure in our series of eight cases. The modification described provides an effective approach for challenging myopic cases in which ILM flap creation is needed over a detached retina.

PPV combined with internal limiting membrane flap or tamping in the treatment of large basal diameter macular hole / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate the efficacy and safety of pars plana vitrectomy(PPV)combined with inverted internal limiting membrane(ILM)flap and PPV combined with ILM tamping in the treatment of large basal diameter idiopathic macular hole(IMH), and to analyze the correlation between postoperative visual acuity and preoperative parameters. <p>METHODS:This study is a retrospective clinical study. Totally 56 patients(57 eyes)with macular hole bottom diameter greater than 1 000μm, who treated in Joint Shantou International Eye Center from January 2018 to December 2020, were enrolled in this study. Thirty eyes were involved in PPV combined with inverted ILM flap(Group 1)and 27 eyes were involved in PPV combined with ILM tamping(Group 2). The best corrected visual acuity(BCVA), the closure of the macular hole, thickness of foveal neurosensory layer and complications were compared between the two groups at 1wk and 1mo after the surgery. Person correlation analysis was used to explore the correlation between preoperative parameters and BCVA at 1mo after operation.<p>RESULTS: There was no significant difference in gender, age, eye type, course of disease, preoperative BCVA, postoperative macular hole healing classification, preoperative hole bottom diameter and eye axis between the two groups(P>0.05). The closure rate of macular hole in Group 1 was 97%, of which type 1 closure was 80%. The closure rate of macular hole in Group 2 was 100%, of which type 1 closure was 78%, and there was no significant difference in the closure rate(P=0.99). The postoperative follow-up BCVA of patients in both groups was better than that before operation(all P<0.01). The BCVA of Group 1 was better than Group 2 at 1mo after operation, and the difference was statistically significant(t= -2.20, P=0.03). There was no significant difference in the thickness of foveal neurosensory layer between two groups at 1mo after operation(t=0.407, P=0.69). The BCVA at 1mo after operation was positively correlated with the hole diameter and preoperative BCVA(r=0.435, P=0.004; r=0.440, P=0.001). There was no complication in both groups during and after operation. <p>CONCLUSION:PPV combined with inverted ILM flap and PPV combined with ILM tamping can improve the closure rate of the hole. The long-term visual acuity of PPV combined with inverted ILM flap is better than that of PPV combined with ILM tamping. There is a significant positive correlation between postoperative BCVA and the bottom diameter of the hole and preoperative BCVA. Preoperative bottom diameter can be used as one of the basis for clinical prognosis.

Investigación interdisciplinaria sobre higiene domiciliaria y peridomiciliaria: aprendizaje significativo a través del aula invertida / Interdisciplinary research on home and peridomiciliary hygiene: meaningful learning through the flipped classroom

La educación interdisciplinaria a través de aula invertida incluyendo la higiene domiciliaria y peridomiciliaria es un punto de partida importante para evitar la propagación de enfermedades de interés en salud pública. Por tal razón, se propuso como objetivo determinar la influencia de la investigación interdisciplinaria sobre higiene domiciliaria y peridomiciliaria imnerso en el aprendizaje significativo a través del aula invertida en estudiantes de posgrado de la UNMSM en Lima-Perú, 2021. El estudio fue experimental con una muestra de 26 estudiantes. Para la recolección de los datos se utilizaron técnicas pedagógicas con instrumentos de prueba de rendimiento. El análisis de los datos fue con estadística descriptiva en base a frecuencias y porcentajes, además de las pruebas de Kolmogorov-Smirnov y Shapiro-Wilk estimando un nivel de significancia α de 0,05. Como resultado el nivel de competencia de aprendizaje significativo fue 73,08% bueno, 26,92% regular y 0,00% nivel bajo, así mismo, las buenas evidencias de aprendizaje a nivel transversal fue de 88,46% (23/26) de solidez en los conocimientos sobre higiene domiciliaria y peridomiciliaria, y a nivel especifica conocer la fauna nociva y saber investigar sobre su control sanitario con 88,46%, existiendo diferencias significativas entre la proporción de buenas evidencias de las pruebas preliminar y formativa, que muestran el desarrollo del aprendizaje de la investigación interdisciplinaria en los estudiantes del Posgrado de UNMSM. Concluyendo, que la inestigación interdiciplinaria y método de aula invertida contribuyen a la resolución de problemas de la comunidad no solo a nivel educativo sino también ambiental(AU)

Interdisciplinary education through the flipped classroom including home and peridomiciliary hygiene is an important starting point to prevent the spread of diseases of public health interest. For this reason, the objective was to determine the influence of interdisciplinary research on home and peridomiciliary hygiene embedded in meaningful learning through the flipped classroom in postgraduate students of the UNMSM in Lima-Peru, 2021. The study was experimental with a sample of 26 students. Pedagogical techniques with performance test instruments were used for data collection. The analysis of the data was with descriptive statistics based on frequencies and percentages, in addition to the Kolmogorov-Smirnov and Shapiro-Wilk tests, estimating a level of significance α of 0.05. As a result, the level of significant learning competence was 73.08% good, 26.92% regular and 0.00% low level, likewise, the good evidence of learning at the transversal level was 88.46% (23/26 ) of solidity in the knowledge about home and peridomiciliary hygiene, and at a specific level knowing the harmful fauna and knowing how to investigate its sanitary control with 88.46%, with significant differences between the proportion of good evidence of the preliminary and formative tests, which show the development of interdisciplinary research learning in UNMSM Postgraduate students. Concluding that interdisciplinary research and the inverted classroom method contribute to solving community problems not only at an educational level but also at an environmental level(AU)

Establishment of in vivo mice inverted two-photon laser scanning microscope microvascular blood flow imaging / 解剖学报

Objective To establish a method of in vivo microvascular imaging and blood flow calculation with better continuous imaging quality. Methods Anesthetized mice with dye injection through tail vein were placed in the center of a 37 ℃ hot plate holder. The stripped tissues were placed in a self￣made low edge confocal dish and immersed in normal saline. The exposed tissues were pressed with self￣made circular metal pads of different weights and sizes. The microvascular blood flow in the liver and hind limb of pregnant mice (n = 3) and normal female mice (n = 3) were measured by the improved device. Results This method can accomplish stable and continuous imaging. The blood flow velocity of liver and hind limb of pregnant mice were faster than that of normal female mice. Conclusion This method can be used for three￣dimensional imaging of microvessels and detection of blood flow velocity in organs.

Clinical features, diagnosis and treatment of intussusception secondary to inverted Meckel′s diverticulum in children / 中华实用儿科临床杂志

Objective:To explore the clinical characteristics, diagnosis, treatment and prognosis of inverted Meckel′s diverticulum in children, and to summarize the clinical experience.Methods:Ten children who received surgical treatment in Beijing Children′s Hospital, Capital Medical University from October 2018 to October 2021 were retrospectively analyzed.The children were diagnosed with Mecker′s diverticulum.Their data were complete and their fo-llow-up information was available.The clinical features, diagnosis, treatment and prognosis were summarized.There were 6 males and 4 females, whose age of onset ranged from 5 months to 12 years and 5 months.The clinical manifestations were abdominal pain in 8 cases, crying in 2 cases and bloody stool in 3 cases.B-ultrasound showed suspected diseases secondary to inverted Meckel′s diverticulum, including small intestinal intussusception in 6 cases and back junction type intussusception in 4 cases.One case of small intestinal intussusception was misdiagnosed after laparoscopic exploration in other hospitals and suffered from recurrent intussusception.All patients underwent segmental bowel resection.Results:Of the 10 children, 8 cases received laparoscopic exploration and 2 cases underwent open surgery for secondary intestinal necrosis.Postoperative pathology revealed Meckel′s diverticulum.Ectopic tissue was accessible in 8 cases, including ectopic gastric tissue in 7 cases, and ectopic pancreas in 1 case.During the postoperative follow-up period (1 month-3 years), the patients were generally in good condition with no complications such as intestinal obstruction.Conclusions:Intussusception secondary to inverted Meckel′s diverticulum is rare and difficult to diagnose before operation.The diagnosis should be confirmed by surgical exploration and postoperative pathology.However, careful surgical exploration is required since inverted Meckel′s diverticulum is prone to be misdiagnosed during exploration.

Does evaluation of tumor volume or/both origination site better guide to optimal surgery for inverted papilloma? / A avaliação do volume do tumor e/ou dos seus locais de origem fornece a melhor orientação para a técnica cirúrgica ideal do papiloma invertido?

Abstract Introduction Sinonasal inverted papilloma is noted for its high rate of recurrence. Staging systems aid to reduce recurrence and avoid excessive surgeries by guiding the selection of the optimal surgical approach. Objective To evaluate the effectiveness of different endoscopic approaches in inverted papilloma by assessing tumor origin site and tumor volume. Methods Krouse classification system that is based on tumor volume was used for staging; furthermore, tumor origin sites were grouped as lateral nasal wall, medial wall and other walls of maxillary sinus. The main treatment method for all patients was endoscopic sinus surgery. Endoscopic extended middle meatal antrostomy, endoscopic Caldwell-Luc and endoscopic medial maxillectomy were the additional surgery types performed in different combinations. Results Fifty-five patients (42 male) with a mean 54.9 ± 14.4 years of age were included. 37 patients were diagnosed with advanced stage inverted papilloma (67.2 %). Recurrence was observed in 12 patients (21.8 %). In early stage lateral nasal wall origination, no recurrence was observed in the simple tumor resection group (0/10). In early stage medial wall origination, no recurrence was observed in the extended middle meatal antrostomy group (0/8). In advanced stage medial wall origination, the recurrence rates of extended middle meatal antrostomy, extended middle meatal antrostomy + endoscopic Caldwell- Luc and endoscopic medial maxillectomy were 100.0 %, 53.8 % and 13.6 %, respectively (p = 0.002). In advanced stage other walls of maxillary sinus origination, recurrence rates of extended middle meatal antrostomy + endoscopic Caldwell-Luc and endoscopic medial maxillectomy were 20 % and 16.6 %, respectively (p = 0.887). Conclusion Tumor origin site, tumor stage and surgery types show an impact on recurrence. Despite the fact that tumor origin site singly could lead to appropriate selection of the surgery type in most cases, tumor stage carries substantial importance in selection of surgery type for sinonasal-inverted papilloma. An operation plan regarding both tumor volume and tumor origin site may aid surgeons in selecting optimal endoscopic surgical method to avoid recurrence or excessive surgeries.

Resumo Introdução O papiloma invertido nasossinusal é conhecido por sua alta taxa de recorrência. Os sistemas de estadiamento ajudam a reduzir a recorrência e evitar cirurgias excessivas e orientam a seleção da abordagem cirúrgica ideal. Objetivo Avaliar a eficácia de diferentes abordagens endoscópicas no papiloma invertido, de acordo com o local de origem e o volume do tumor. Método Para o estadiamento, usou-se o sistema de classificação de Krouse, baseado no volume do tumor; além disso, os tumores foram agrupados de acordo com seus locais de origem: parede nasal lateral, parede medial e outras paredes do seio maxilar. O principal método de tratamento para todos os pacientes foi a cirurgia endoscópica nasossinusal. Foram feitos, em diferentes combinações, os seguintes tipos de cirurgia: antrostomia estendida do meato médio, Caldwell-Luc endoscópica e maxilectomia medial endoscópica. Resultados Foram incluídos 55 pacientes (42 homens) com média de 54,9 ± 14,4 anos. Trinta e sete pacientes foram diagnosticados com papiloma invertido avançado (67,2%). Foi observada recorrência em 12 pacientes (21,8%). No estágio inicial com origem na parede nasal lateral, não foi observada recorrência no grupo de ressecção simples de tumor (0/10). No estágio inicial com origem na parede medial, não foi observada recorrência no grupo de antrostomia estendida do meato médio (0/8). Com tumor em estágio avançado com origem na parede medial, as taxas de recorrência na antrostomia estendida do meato médio, antrostomia estendida do meato médio + Caldwell-Luc endoscópica e maxilectomia medial endoscópica foram de 100,0%, 53,8% e 13,6%, respectivamente (p = 0,002). No tumor em estágio avançado em outras paredes do seio maxilar, as taxas de recorrência na antrostomia estendida do meato médio + Caldwell-Luc endoscópica e maxilectomia medial endoscópica foram de 20% e 16,6%, respectivamente (p = 0,887). Conclusão O local de origem do tumor, o estágio do tumor e os tipos de cirurgia mostram impacto na recorrência. Apesar da consideração de que na maioria dos casos o local de origem do tumor pode, de forma isolada, orientar a seleção apropriada do tipo de cirurgia, o estágio do tumor tem importância substancial na seleção do tipo de cirurgia para papiloma invertido nasossinusal. Um planejamento cirúrgico considerando tanto o volume quanto o local de origem do tumor pode ajudar os cirurgiões a selecionar o tipo ideal de cirurgia endoscópica para evitar recorrências ou remoções excessivas.

Sleep Deprivation Models in Rodents (Model Kekurangan Tidur dalam Roden) / Jurnal Sains Kesihatan Malaysia

@#Sleep deprivation has been identified as a risk factor for various diseases. The number of patients suffering from sleep deprivation is increasing daily. Therefore, the risk to develop various diseases, including cardiovascular disease is increasing. However, there is a limitation to elucidate the pathophysiological changes following sleep deprivation in humans. Thus, the need arises for sleep deprivation models using animals, which will serve the purpose of understanding the disease in a better way. Several techniques have been developed to model sleep deprivation in animals, including inverted flowerpot and multiple platforms techniques. Genetic and environmental factors, costs, infrastructure and animal life spans are some of the factors that need to be considered when selecting a particular model. Furthermore, when studying sleep deprivation, tissue samples, such as peripheral blood, brain samples and aorta are used to elucidate the underlying mechanisms of a particular disease. Currently, more than ninety percent of all laboratory animal experiments are performed in rats and mice. This review article focuses on models of sleep deprivation in Rodents, which are generally used in research laboratories. The article also tries to evaluate the advantages and disadvantages of each technique discussed, guides the sleep deprivation model and helps researchers to decide on a specific model for their purpose.

Inverted ductal papilloma of the salivary gland

@#This is a case consult of slides stated to be from an excision of a buccal mucosa mass in a 58-year-old-man. The specimen was described as a 3 cm diameter roughly oval tan-gray tissue with a 2 x 1.5 cm mucosal ellipse on the surface that has a central ulcerated punctum. Cut section showed an underlying 1.7 cm diameter roughly oval well-circumscribed mass with a granular tan surface. Histological sections show a papillary lesion with an orifice on the mucosal surface and with epithelial nests invaginating into the underlying lamina propria in a non-infiltrative pattern. (Figure 1) The lesion is composed of papillary epithelial fronds with cleft-like spaces between the fronds. (Figure 2) The papillary fronds are lined by non-keratinizing basaloid stratified squamous cells with a superficial layer of columnar glandular cells along with mucous goblet cells interspersed among the squamous cells. (Figure 3) All the cellular components are devoid of cytologic atypia and mitoses. Based on these microscopic features we signed the case out as inverted ductal papilloma (IDP).