Ressecção do tumor e colocação de enxerto de pele parcial no couro cabeludo em um paciente com neurofibromatose tipo 1 / Tumor resection and partial skin graft placement on the scalp in a patient with Neurofibromatosis type 1

A neurofibromatose tipo 1 (NF1) é um distúrbio neurocutâneo hereditário no qual se formam tumores no sistema nervoso (neurofibromas). Os neurofibromas são os tumores benignos mais comuns na NF1. O tipo, o tamanho, o número e a localização dos neurofibromas devem ser considerados para a escolha do tratamento. Apresentamos um caso de NF1, no qual foi realizada uma ampla ressecção do couro cabeludo devido à presença de múltiplos neurofibromas. Associado a isso, a reconstrução foi realizada com retalhos de avanço mais autoenxerto de pele parcial, com resultados favoráveis e boa cobertura das áreas onde os tumores foram removidos.

Neurofibromatosis type 1 (NF1) is an inherited neurocutaneous disorder in which tumors form in the nervous system (neurofibromas). Neurofibromas are the most common benign tumors in NF1. The type, size, number, and location of the neurofibromas should be considered for the choice of treatment. We present a case of NF1, in which a wide scalp resection was performed due to the presence of multiple neurofibromas. Associated with this, reconstruction was performed with advancement flaps plus partial skin autograft with favorable results and good coverage of the areas where the tumors were removed.

Review and Progress in the Treatment of Renal Light Chain Amyloidosis / 罕见病研究

Renal light chain amyloidosis (AL amyloidosis) had poor prognosis before the 21st century. However, the treatment of AL amyloidosis has made great progress in the last decade. We reviewed traditional treatments of AL amyloidosis such as alkylating agents, proteasome inhibitors, and recent advances such as monoclonal antibodies. Bortezomib improved the hematological response and survival effectively of the patients, and the combination of Daratumumab brings faster and deeper hematological response, increasing the response rate of target organs such as the kidneys and heart. The renal response was significant higher in the patients with the therapy of Daratumumab, part of them could achieve very good partial response or better renal response. Autologous hematopoietic stem cell transplantation(auto-HSCT)improves hematological as well as organ response, and could be the first choice among eligible patients. Kidney transplantation is a feasible option for those with good hematological response.

Autologous ilium graft combination with titanium plate for sternal reconstruction: A case report / 中国胸心血管外科临床杂志

@#The sternum is the pivotal component of the thoracic cavity. It is connected with the clavicle and ribs on the upper part and both sides respectively, and plays an important role in protecting the stability of the chest wall. Sternal resection usually results in a large segmental chest wall defect that causes the chest wall to float and requires sternal reconstruction. This paper reports a 62 years male patient with thymic squamous cell carcinoma with sternal metastasis, who underwent thymotomy, sternal tumor resection and autologous lilum graft combined with sternal reconstruction by titanium plate after relevant examination was completed and surgical contraindications were eliminated. The patient was followed up for 6 months, the respiratory and motor functions were normal and the thoracic appearance was good.

Lactate dehydrogenase as a hematopoietic stem cell mobilization biomarker in autologous transplantation

ABSTRACT Introduction: Pre-apheresis peripheral blood CD34+ cell count (PBCD34+) is the most important predictor of good cell mobilization before hematopoietic stem cell transplantation, albeit flow cytometry is not always immediately available. Identification of surrogate markers can be useful. The CD34+ cells proliferate after mobilization, resulting in elevated lactate dehydrogenase (LDH) activity and correlating with the PBCD34+ count. Objective: To determine the LDH cut-off value at which adequate CD34+ cell mobilization is achieved and its diagnostic yield. Materials and methods: A total of 103 patients who received an autologous stem cell transplantation (ASCT) between January 2015 and January 2020 were included. Demographic and laboratory characteristics were obtained, including complete blood count, pre-apheresis PBCD34+ and LDH levels. Receiver operating characteristic (ROC) curves were performed to identify the optimal serum LDH activity cut-off points for ≥ 2 and ≥ 4 × 106 cells/kg post-mobilization CD34+ count and their diagnostic yield. Results: A post-mobilization serum LDH cut-off value of 462 U/L yielded a sensitivity (Se) = 86.8% (positive predictive value [PPV] = 72.7%), a pre- and post-mobilization serum LDH difference cut-off value of 387 U/L, an Se = 45.7% (PPV = 97%) and an LDH ratio of 2.46, with an Se = 47.1% (PPV = 97%) for an optimal mobilization count (CD34+ ≥ 4 × 106). Conclusion: The LDH measurement represents a fast and affordable way to predict PBCD34+ mobilization in cases where flow cytometry is not immediately available. According to the LDH diagnostic yield, it could be used as a surrogate marker in transplant centers, supporting the CD34+ count, which remains the gold standard.

Cirugía de Ross en Chile: Tasa libre de reoperación y supervivencia global en una cohorte de más de 10 años de seguimiento

Antecedentes: El autoinjerto de válvula pulmonar (VP) u operación de Ross (OpR) tiene excelentes resultados a largo plazo. Es superior a otros tipos de reemplazo valvular en jóvenes adultos, aunque no el estándar de primera línea. Un tiempo quirúrgico prolongado o alta morbimortalidad son importantes preocupaciones. Objetivos: Establecer la morbimortalidad asociada a la OpR por un período >10 años, considerando el tiempo quirúrgico, tasa de reoperación y supervivencia global (SG). Métodos: Cohorte prospectiva (1996-2012), en seguimiento hasta agosto-2023. La SG fue estimada desde la OpR hasta la última consulta o deceso. Mediante regresión de Cox (Hazard Ratio, HR) se estimaron factores asociados a la SG. Resultados: La serie consta de 161 pacientes: 118 de etiología congénita (73.3%), 17 infecciosa (10.6%), 26 reumática (16.1%). La lesión fue estenótica en 79 (49.1%), insuficiencia en 40 (24.8%), mixta en 42 (26.1%). La OpR fue urgente en 11 (6.8%). The median time of ECC and the operation was 149 y 232 minutos, respectivamente. Veintisiete pacientes requirieron reoperación (16.8%). Con una mediana de 19.7 años (17.2-22.2), 23 pacientes fallecieron (14.3%): 1/23 asociado a OpR, 17/23 por causa cardiovascular y 5/23 por causas no cardiovasculares. La lesión mixta se asoció a mayor mortalidad (HR 3.07; IC 95% 1.11-8.47; p=.029). Conclusiones: La OpR es un procedimiento con baja morbimortalidad. La lesión mixta es un factor de riesgo independiente de mayor mortalidad. Sin embargo, la mediana de tiempo de CEC y quirúrgico es prolongado frente a otras técnicas de reemplazo valvular.

Background: Pulmonary valve (PV) autograftor reoperation or Ross surgery (RS), presents excellent long-term results. It is superior to other types of PV replacement in young adults, although it is not the first-line gold standard. A longer operative time or high morbidity and mortality rates are important concerns. Aim: To establish the morbidity and mortality associated with RS for >10 years, considering operative time, reoperation rate and overall survival (OS). Methods: Prospective cohort (1996-2012), with a follow-up until August/2023. The OS was estimated from RS to the last consultation/death. Factors associated to OS were estimated using Cox regression (Hazard Ratio, HR) Results: 161 patients were included: the etiology was congenital (118, 73%), infectious (17, 10.6%), and rheumatic (26,16.1%). The lesion was stenotic in 79 (49.1%), heart failure in 40 (24.8%), mixed in 42 (26.1%). RS was urgent in 11 (6.8%). Extracorporeal circulation (ECC) and operative times were 149 and 232 minutes, respectively. Twenty-seven patients required reoperation (16.8%). With a median follow up of 19.7 years (17.2-22.2), 23 patients died (14.3%): 1/23 associated with RS, 17/23 due to cardiovascular causes, and 5/23 due to non-cardiovascular causes. Mixed injury was associated with higher mortality (HR 3.07; 95% CI 1.11-8.47; p=.029). Conclusions: RS is a procedure with low morbidity and mortality. Mixed injury is an independent risk factor for increased mortality. However, the median ECC and operative times were higher compared to other valvular replacement techniques.

Trasplante cardíaco y autólogo de células progenitoras hematopoyéticas en pacientes con amiloidosis AL / Cardiac and autologous stem cell transplantation hematopoietic in patients with AL amyloidosis

Resumen Objetivo: Describir la evolución de las cadenas livianas libres séricas (CLL) en el período comprendido entre el trasplante cardíaco ortotópico (TCO) y el trasplante de células progenitoras hematopoyéticas (TCPH), la respuesta hematológica al año tras el TCPH y el tratamiento quimioterápico e inmunosupresor en pacientes con amiloidosis AL. Método: Serie de casos de pacientes consecutivos con diagnóstico de amiloidosis AL que recibieron TCO seguido de TCPH del Registro Institucional de Amiloidosis del Hospital Italiano de Buenos Aires, entre enero de 2010 y noviembre de 2021. Se reportaron los valores de CLL entre trasplantes y al año del TCPH. Las variables cuantitativas se describieron como mediana e intervalo intercuartil, y las variables categóricas como frecuencias absolutas y relativas. Resultados: De 106 pacientes con amiloidosis AL, seis tuvieron TCO seguido de TCPH. La mediana de edad fue de 55 años. La mayoría eran hombres (n = 5). En el período entre trasplantes, la CLL involucrada disminuyó en dos pacientes y se mantuvo estable en tres. Todos lograron la remisión hematológica completa al año del TCPH. Un solo paciente presentó recaída en el órgano sólido trasplantado. Tacrolimus, micofenolato de mofetilo y corticoides fue el esquema inmunosupresor utilizado después del TCO. Conclusiones: El TCO representa una opción de tratamiento en pacientes con falla cardíaca grave por amiloidosis, permitiendo luego un tratamiento intensivo con quimioterapia de inducción y TCPH. Si bien faltan estudios, la terapia inmunosupresora después del TCO podría tener algún efecto sobre las células plasmáticas clonales.

Abstract Objective: To describe the evolution of serum free light chains (FLC) in the period between orthotopic heart transplantation (OHT) and autologous stem cell transplantation (ASCT), the hematological response one year after ASCT and chemotherapy and immunosuppressive treatment in patients with AL amyloidosis. Method: Case series of consecutive patients diagnosed with AL amyloidosis who received OHT followed by ASCT from the Institutional Registry of Amyloidosis of the Italian Hospital of Buenos Aires, between January 2010 and November 2021. FLC values between transplants and at year post ASCT. Quantitative variables were described with their median and interquartile range. Categorical variables as absolute and relative frequencies. Results: Of 106 patients with AL amyloidosis, 6 had an OHT followed by ASCT. The median age was 55 years. Most were men (n = 5). In the period between transplants, the involved CLL decreased in two patients and remained stable in three. All achieved complete hematologic remission 1 year after ASCT. A single patient presented relapse in the transplanted solid organ. Tacrolimus, mycophenolate mofetil, and corticosteroids were the immunosuppressive regimen used after OHT. Conclusions: OHT represents a treatment option in patients with severe heart failure due to amyloidosis, allowing later intensive treatment with induction chemotherapy and ASCT. Although studies are lacking, immunosuppressive therapy after OHT might have some effect on clonal plasma cells.

Insuficiencia cardiaca secundaria a amiloidosis AL: diagnóstico y tratamiento / Heart failure secondary to amyloidosis AL: diagnosis and treatment

Resumen La amiloidosis por depósito de cadenas livianas de inmunoglobulinas (AL) es una enfermedad poco frecuen te y subdiagnosticada. El mejor tratamiento disponible al momento es el trasplante autólogo de médula ósea (TMO). El compromiso cardíaco es el principal determi nante pronóstico en esta patología y en ocasiones un impedimento para recibir el TMO. Se presenta el caso de un varón de 44 años que consultó por signos y síntomas de insuficiencia cardiaca (IC) con biomarcadores cardia cos elevados. Se realizó un ecocardiograma transtorácico donde se objetivó aumento de espesores parietales con hipoquinesia global y fracción de eyección deteriorada en grado leve (50%). El paciente se internó en unidad coronaria para balance negativo y para estudio etiológico del cuadro. Ante la sospecha de enfermedad infiltrativa, se solicitaron un centellograma óseo con pirofosfato y cadenas livianas libres en suero. El centellograma óseo resultó no sugestivo para amiloidosis por transtiretina y las cadenas livianas libres mostraron una relación me nor a 0.26 con predominio lambda. Se realizó una biopsia de encía que confirmó el diagnóstico de amiloidosis AL. Posterior al diagnóstico comenzó tratamiento qui mioterápico específico con Ciclofosfamida, Bortezomib y Dexametasona (esquema CYBORD) y Daratumumab. Evolucionó con IC refractaria por lo que ingresó a lista de trasplante cardiaco, recibiendo el mismo al poco tiempo con buena evolución. Esto permitió reiniciar el esquema quimioterápico y en segundo término finalmente recibir el TMO, con buena evolución.

Abstract Light chain amyloidosis (AL) is a rare and underdi agnosed disease. The best treatment available is au tologous bone marrow transplantation (BMT). Cardiac involvement is the main prognostic determinant in this pathology and sometimes an impediment to re ceive BMT. We present a clinical case of a 44-year-old who consulted for signs and symptoms of heart failure (HF) with elevated cardiac biomarkers. A transthoracic echocardiogram showed increased wall thickness with global hypokinesia and mildly impaired ejection fraction (50%). The patient was admitted to the coronary unit for treatment with diuretics and for etiological study of the condition. In view of the suspicion of infiltrative disease, a bone scintigraphy with pyrophosphate and free light chains in serum were requested. The bone scintigraphy was not suggestive of transthyretin amyloidosis and the free light chains showed a ratio of less than 0.26 with lambda predominance. A gum biopsy was per formed and confirmed the diagnosis of AL amyloidosis. After diagnosis, specific chemotherapy treatment with Cyclophosphamide, Bortezomib and Dexamethasone (CYBORD scheme) and Daratumumab was started. He evolved with refractory HF so it was decided to admit him to the cardiac transplantation list, receiving the same soon after, with good evolution. This allowed the patient to restart the chemotherapy regimen and finally receive BMT, with good evolution.

Hernioplastia inguinal con tejido autólogo. Técnica de Mohan Desarda

En las consultas de cirugía general se reciben, con frecuencia, pacientes portadores de hernias de la pared abdominal y, dentro de ellas, las hernias de la región inguinal. La hernia, como entidad, se menciona desde el año 1500 a. C. en el papiro Ebers. Su incidencia es alta, con una anatomía compleja, y en ocasiones se plantean porcentajes de recidivas frecuentes, por lo que hace de esta entidad un interesante tema con gran valor para los cirujanos en general. El objetivo de este trabajo es considerar que la técnica de reparación herniaria de Mohan Desarda cumple con los principios fundamentales de reparación de la hernia. En ella las complicaciones son mínimas debido a la utilización de una franja de tejido autólogo como refuerzo para el cierre del defecto, y el índice de recidiva es menor en comparación con el demostrado por otras.

In general surgery consultations, patients carrying hernias of the abdominal walls, and within them, hernias of the abdominal wall, are frequently received. The hernia, as an entity, has been mentioned since the year 1500 BC C. on the Ebers papyrus. Its incidence is high, with a complex anatomy, and sometimes percentages of frequent recurrency are stated, which makes this entity an interesting topic of great value for surgeons in general. The main objective of this work is to consider that Mohan Desarda's hernia repair technique complies with the main principles of hernia repair. In it, complications are minimal due to the use of a strip of autologous tissue as reinforcement for closing the defect, and the recurrence index is lower compared to that demonstrated by others.

Reconstrucción mandibular con cortical autóloga auto trasplantada del sitio quirúrgico en queratoquiste, revisión de literatura y reporte de caso / Mandibular reconstruction with autologous cortical bone transplanted from the surgical site in keratocyst, literature review, and case report

El queratoquiste es un quiste odontogénico en el cual se describen diferentes opciones terapéuticas tanto conservadores como agresivas, con diferentes tasas de éxito y recidivas. Dependiendo del tratamiento, las técnicas más agresivas presentan mejores resultados, pero involucran un mayor defecto óseo en la zona tratada versus las técnicas conservadoras. El propósito de este reporte de caso es documentar una técnica quirúrgica utilizada en un paciente masculino de 17 años que, tras un tratamiento descompresivo de 8 meses, fue sometido a cirugía con enucleación de la lesión remanente más curetaje mecánico perilesional y uso de solución de Carnoy no modificada, preservando la cortical ósea vestibular mandibular tratada con solución de Carnoy no modificada y reposicionando este segmento óseo mediante osteosíntesis. Se realizó seguimiento clínico e imagenológico postoperatorio de 1 año verificando la remisión del quiste y la neoformación ósea en la zona intervenida. El uso de esta alternativa terapéutica permite evitar el colapso de los tejidos blandos en el defecto óseo subyacente y aportar tejido óseo autógeno tratado que permite una funcionalidad de tramado óseo al cual pueden migrar los elementos celulares para aportar en la regeneración tisular local.

The keratocyst is an odontogenic cyst in which different conservative and aggressive therapeutic options are described, with different success rates and recurrences. Depending on the treatment, the most aggressive techniques present better results but involve a more significant bone defect in the treated area compared to conservative techniques. The purpose of this case report is to document a surgical technique used in a 17-year-old male patient who underwent surgery after eight months of decompressive treatment with enucleation of the remaining lesion plus perilesional mechanical curettage and use of Carnoy's solution unmodified, preserving the mandibular vestibular bone cortex treated with unmodified Carnoy's solution and repositioning this bone segment by osteosynthesis. A one-year postoperative clinical and imaging follow-up was carried out, verifying the remission of the cyst and the new bone formation in the operated area. This therapeutic alternative makes possible to avoid the collapse of the soft tissues in the underlying bone defect and provide treated autogenous bone tissue that allows a bone mesh functionality to which the cellular elements can migrate to contribute to local tissue regeneration.

Supervivencia de injerto graso en la lipotransferencia glútea / Survival of fat graft in gluteal lipotransfer

Introducción: El aumento de glúteos tiene como objetivo lograr una apariencia y contorno más joven; así como crear la proporción ideal entre cintura y cadera. Esto se puede lograr mediante la lipoinyección, aunque en este caso existen controversias en cuanto a la viabilidad del tejido injertado y la supervivencia de la grasa. Objetivo: Determinar el porcentaje de supervivencia del injerto de grasa autóloga y su relación con el volumen inyectado en pacientes sometidas a lipotransferencia glútea. Métodos: Se realizó un estudio observacional, descriptivo, de corte longitudinal y prospectivo con una muestra de 44 pacientes sometidas a lipotransferencia glútea en el Servicio de Cirugía Plástica del Hospital Docente Clínico Quirúrgico Dr. Miguel Enríquez en el período comprendido entre marzo de 2018 y junio de 2021. Resultados: El estudio evidencia que, mediante ultrasonido y fórmulas, el volumen promedio y la altura de la de grasa en los glúteos se duplica en el posoperatorio mediato y disminuye en el posoperatorio tardío sin llegar a los valores del preoperatorio. Además, se estableció que cerca de la media del volumen de grasa autóloga injertada en los glúteos sobrevive de manera definitiva en el posoperatorio tardío. Además, quedó establecido que la relación entre el volumen infiltrado y la supervivencia del injerto de grasa autóloga es inversamente proporcional: mientras mayor es el volumen, menor es su supervivencia. Conclusiones: Solo la mitad del volumen de grasa autóloga injertada en los glúteos sobrevive de manera definitiva, y la supervivencia de la grasa es inversamente proporcional al volumen infiltrado(AU)

Introduction: Buttock augmentation aims to achieve a more youthful appearance and contour; as well as creating the ideal proportion between waist and hips. This can be achieved by lipoinjection, although in this case there are controversies regarding the viability of the injected tissue and the survival of the fat. Objective: To determine the percentage of autologous fat graft survival and its relationship with the injected volume in patients undergoing gluteal fat transfer. Methods: An observational, descriptive, longitudinal and prospective study was carried out, with a sample of 44 patients undergoing gluteal lipotransfer, in the plastic surgery service of the Dr. Miguel Enriquez Clinical Surgical Teaching Hospital, in the intermediate period between March 2018 to June 2021. Results: The study shows that through ultrasound and formulas, the average volume and height of fat in the buttocks doubles in the immediate postoperative period, decreasing in the late postoperative period, without reaching preoperative values. Furthermore, it's established that about the mean volume of autologous fat grafted to the buttocks survives definitively in the late postoperative period. In addition, it was established that the relationship between the infiltrated volume and the survival of the autologous fat graft is inversely proportional, the greater the volume, the less its survival. Conclusions: Only half of the volume of autologous fat injected into the buttocks survives definitively, and the survival of the fat is inversely proportional to the volume injected(AU)

Ruptura prematura de membranas ovulares / Premature rupture of ovular membranes

La ruptura prematura de las membranas ovulares se define como la pérdida de la integridad del amnios y corion antes del inicio del trabajo de parto, afecta el 3 % de los embarazos, causa un tercio de los partos pretérminos, los cuales ocupan el 10,49 % de los nacimientos y es el origen de altos índices de morbimortalidad perinatal. En la actualidad, el manejo de esta patología se orienta principalmente en evitar los factores de riesgo, hacer un diagnóstico adecuado, determinar la edad gestacional en que ocurre, realizar el monitoreo exhaustivo del bienestar materno-fetal y en decidir el momento idóneo de finalización de la gestación para minimizar sus complicaciones. Debido a la compleja y lábil estructura histológica de las membranas ovulares, se ha dejado a un lado el tratamiento directo de la entidad el cual sería sellar o reparar el defecto en sí. En los últimos años, numerosos estudios y protocolos clínicos de prestigiosos centros asistenciales han servido como guía para el manejo de esta entidad, pero en muy pocos se observa una terapia destinada a la reparación de dichas membranas o en sellar tal defecto. Las evidencias científicas demuestran que la regeneración y reparación de las membranas es lenta y compleja y los tratamientos propuestos para reparar o sellar su defecto no han gozado de la aceptación científica para su aprobación, sin embargo, el uso del parche hemático transvaginal endocervical autólogo luce como una alternativa terapéutica prometedora(AU)

The premature rupture of the ovular membranes is defined as the loss of the integrity of the amnion and chorion before the on set of labor, affects 3% of pregnancies, causes athird of preterm births which occupy 10,49% of births and is the origin of high rates of perinatal morbidity and mortality. At present, the management of this pathology is mainly oriented towards avoiding risk factors, making an adequate diagnosis, determining the gestational age in which it occurs, carrying out exhaustive monitoring of maternal-fetal well-being and deciding the ideal moment to end the treatment. Pregnancy to minimizeits complications. Due to the complex and labile histological structure of the ovular membranes, the direct treatment of the entity has been set a side, which would be to seal or repairthe defect it self. In recent years, numerous studies and clinicalprotocols from prestigious health care centers have served as aguide for the management of this entity, but very few have observed a therapy aimed at repairing said membranes or sealing such a defect. Scientific evidence shows that the regeneration and repair of the membranes is slow and complex and the treatment sproposed to repair or seal their defect have not enjoyed scientific acceptance for their approval, how ever, the use of the autologous endocervical transvaginal blood patch looks like a promising therapeutic alternative(AU)

Autotransplante dentário: da previsibilidade à técnica cirúrgica e resultados do tratamento / Dental Autotransplantation: from predictability to surgical technique and treatment results

Objetivo: apresentar o relato de duas pacientes com agenesias dentárias em que cinco dentes autotransplantados foram utilizados como modalidade de tratamento. Além disso, objetiva-se mostrar questões sobre a técnica cirúrgica, suas indicações e previsibilidade. Relato de caso: Neste estudo, foram relatados 5 casos de autotransplante dentário em duas pacientes jovens, em que a equipe realizou os procedimentos e o acompanhamento clínico e radiográfico por 5 e 7 anos. Devido à alta sensibilidade da técnica, foram seguidos princípios previamente estabelecidos na literatura envolvendo o autotransplante dentário. Durante o período de acompanhamento, os dentes se mantiveram em posição e em função e as pacientes não apresentavam queixas associadas. Considerações finais: a técnica do autotransplante dentário, quando bem indicada e executada, é capaz de promover resultados bastante satisfatórios, sendo uma ótima alternativa reabilitadora, com taxas de sucesso elevadas e custos reduzidos. No entanto, critérios em relação aos sítios doadores e receptores e a habilidade do cirurgião devem ser levados em conta para o sucesso do técnica.

Objective: presenting the report of two patients with tooth agenesis in which five autotransplanted teeth were used as a treatment modality. Furthermore, the aim is to show questions about the surgical technique and its indications and predictability. Case report: In this study, 5 cases of dental autotransplantation were reported in two young patients, in which the team performed procedures and had clinical and radiographic follow-up for 5 and 7 years. Due to the high sensitivity of the technique, principles previously established in the literature involving dental autotransplantation were followed. During the follow-up period, the teeth remained in position and function and the patients had no associated complaints. Final considerations: the dental autotransplantation technique, when well indicated and executed, is capable of achieving very satisfactory results, being a great rehabilitative alternative, with high success rates and reduced costs. However, criteria regarding donor and receptor sites and the surgeon's skill must be taken into account for the success of the technique.

A Master Mind Game Code Algorithm Approach to Help Surgical Decision-Making between Retropharyngeal Fat Grafting and Pharyngoplasty for the Treatment of Velopharyngeal Incompetence

Abstract Introduction Velopharyngeal insufficiency (VPI) is a controversial pathology with many surgical options. Objectives To compare pharyngoplasty and retropharyngeal fat grafting and to build a prognostic tool to achieve perfect speech. Methods Retrospective observational cohort study of 114 patients operated for VPI from 1982 to 2019 in a single tertiary center. The instrumental assessment was made using an aerophonoscope and nasofibroscopy. The variables sex, age, genetic syndromes, and type of diagnosis were analyzed with logistic regression model adjusted with propensity score. To generalize results and to build a surgical predictive tool, a marginal analysis concludes the study. Results Among the patients (median [range] age 7 [4-48]), 63 (55.26%) underwent pharyngoplasty and 51 (44.74%) graft. The graft group had no complication, but it had a failure rate of 7.84%. The pharyngoplasty group had no failure, but one patient had postoperative obstructive sleep apnea. The marginal analysis demonstrated that age lower than 7 years, cleft lip and palate, absence of syndrome, and intermittent VPI were important predictive factors of good result regardless of surgical technique. Conclusions Without a statistical demonstration of the superiority of pharyngoplasty over graft, and in the uncertainty of literature background, our perfect-speech patient profile represents an important tool for a postoperative forecast of results in which, like in the Master Mind game, every feature has to be considered not individually but as a pattern of characteristics whose association contributes to the outcome.

Real-world outcomes and complications of different surgical approaches for significant submacular haemorrhages

Purpose: To evaluate the outcomes and complications after different surgical management of cases with significant sumacular hemorrhage (SMH) of size more than 4 disc diameter (DD). Methods: It was a retrospective interventional study. All consecutive 103 cases of significant SMHs were treated by vitrectomy and divided into three groups. In Group A (<4 weeks, confined to the macula or extending inferiorly, n = 62), vitrectomy, subretinal cocktail of tissue plasminogen activator (tPA), antivascular endothelial growth factor, and air with SF6 gas; in Group B (4–8 weeks, extending beyond macula, n = 31), subretinal tPA followed by SMH drainage either by retinotomy (Group B?1, n = 17) or by temporal 180?degree retinectomy (Group B?2, n = 14) with silicone oil (SO) tamponade; and in Group C (>8 weeks, extending beyond macula, n = 10), SMH removal with autologous retinal pigment epithelium (RPE)?Choroid patch graft transplantations with SO tamponade were performed. Parameters evaluated were best corrected visual acuity (BCVA), Optos, optical computerized tomography, and ultrasonography as required. Results: Significant visual improvement was seen from mean preoperative to mean postoperative BCVA in Group A (P < 0.001), Group B (P < 0.001), and Group C (P < 0.001). Postoperative complications were recurrent SMH (4.84% vs 12.90% vs 10%), vitreous hemorrhage (6.45%, GroupA), hyphema (4.84% vs 12.90% vs 10%), hypotony (nil vs 3.23% vs 20%), macular hole formation (6.45%, Group A), epiretinal membrane (16.13%, Group B), and retinal detachment (3.23%, Group A and 10%, Group C). Conclusion: Surgical approaches for significant submacular hemorrhage are visually awarding, though certain specific complications may arise

Autologous serum eye drops in dry eye disease: Preferred practice pattern guidelines

Autologous serum eye drops provide lubrication and promote epithelial healing. They have been successfully used in the management of ocular surface disorders such as dry eye disease, persistent epithelial defects and neurotrophic keratopathy for many decades. A great deal of variation in the methods of preparation of autologous serum eye drops, the end concentration and the duration of use exists in published literature. In this review, simplified recommendations for preparation, transport, storage and use of autologous serum are described. Evidence for the use of this modality in aqueous deficient dry eye disease is summarized, along with expertise-based rationale.

Comparative evaluation of effectiveness of twenty versus fifty percent autologous serum eye drops in treatment of dry eye

Purpose: The objective of the study was to compare the efficacy and safety of two concentration of autologous serum (AS) 20% vs 50% in recalcitrant moderate?to?severe dry eye patients. Methods: A double?blind prospective, interventional, and randomized study was done on 44 patients (80 eyes) clinically diagnosed with moderate?to?severe dry eye disease (DED) that was refractory to conventional treatment, and all patients were treated with AS20% or AS50% for 12 weeks. We documented Ocular Surface Disease Index (OSDI), tear film breakup time (TBUT), OXFORD corneal staining score (OSS), and Schirmer test (ST) at baseline, 2,4,8, and 12 weeks. These parameters were compared in both groups and between the groups by using Student’s t?test. The study included 11 males and 33 females. Results: Out of 80 eyes, 33 eyes had moderate and 47 had severe DED. The age of patients in AS20% was 44.73 ± 14.37 years, and in AS50% was 46.41 ± 14.47 years. The most common etiology associated with DED was secondary Sjogren syndrome. In moderate DED, both the groups showed significant improvement in both subjective and objective parameters. But in severe DED, the AS20% group failed to show any significant improvement objectively, though subjective improvement was present. Conclusion: In refractory severe DED patients, AS50% is better option for treatment and in moderate DED both concentrations of autologous serum are effective.

Use of enamel matrix- derived proteins combined with bone graft for the treatment of intrabony defects: overview of reviews (FRISBEE review) / Uso de proteínas derivadas de la matriz del esmalte combinado con injerto óseo para el tratamiento de defectos intraóseos: resumen estructurado de revisiones sistemáticas (revisión FRISBEE)

Introduction: The use of enamel matrix-derived proteins (EMD) has increased in recent years due to their tissue-inducing properties that support periodontal regeneration. This study is an overview of systematic reviews with FRISBEE methodology on the use of EMD alone or combined with autologous bone graft materials (BGM) in the treatment of intrabony defects. Materials and Methods: A systematic search in the Epistemonikos database was performed. RevMan 5.3 and GRADEpro were used for data analysis and presentation Results: Four systematic reviews and two clinical trials were identified. All studies analysed change in probing depth, clinical attachment level, gingival margin level and bone defect depth (all changes in favour of EMD+BGM groups: mean difference (MD): 0.37 mm more, MD: 0.7 mm more, MD: 0.3 mm less, MD: 0.75 more, respectively). Conclusions: Adding autologous bone graft to EMD to treat intrabony defects showed better results, but not a relevant clinical difference compared to the use of EMD alone.

Introducción: El uso de proteínas derivadas de la matriz del esmalte (EMD) ha aumentado en los últimos años debido a sus propiedades inductoras de tejidos que apoyan la regeneración periodontal. Este estudio es una revisión sistemática de revisiones sistemáticas utilizando metodología FRISBEE sobre el uso de EMD solo o combinado con materiales injerto óseo autólogo (BGM) en el tratamiento de defectos intraóseos. Materiales y Métodos: Se realizó una búsqueda sistemática en la base de datos Epistemonikos. Se utilizaron RevMan 5.3 y GRADEpro para el análisis y la presentación de los datos. Resultados: Se identificaron cuatro revisiones sistemáticas y dos ensayos clínicos. Todos los estudios analizaron el cambio en la profundidad de sondaje, el nivel de inserción clínica, el nivel del margen gingival y la profundidad del defecto óseo (todos los cambios a favor de los grupos EMD+BGM: MD: 0,37 mm más, media de diferencia (MD): 0,7 mm más, MD: 0,3 mm menos, MD: 0,75 más, respectivamente). Conclusión: La adición de injerto óseo autólogo a la EMD para tratar defectos intraóseos mostró mejores resultados, pero no una diferencia clínica relevante en comparación con el uso de la EMD sola.

O uso da transfusão sanguínea autóloga na cirurgia do aparelho digestivo: uma revisão de literatura / The use of autologous blood transfusion in digestive tract surgery: a literature review

ABSTRACT Background: The use of autologous blood transfusion in digestive tract surgeries, whether after preoperative blood collection or intraoperative blood salvage, is an alternative to allogeneic blood, which brings with it certain risks and shortage, due to the lack of donors. Studies have shown lower mortality and longer survival associated with autologous blood, however the theoretical possibility of spreading metastatic disease is still one of the limiting factors of its use. Objective: To evaluate the application of autologous transfusion in digestive tract surgeries, noting the benefits, damages and effects on the spread of metastatic disease. Methods: This is an integrative review of the literature available in the PubMed, Virtual Health Library and SciELO databases, by searching for "Autologous Blood Transfusion AND Gastrointestinal Surgical Procedures". Observational and experimental studies and guidelines published in the last five years in Portuguese, English or Spanish were included. Results: Not all patients benefit from blood collection before elective procedures, with the time of surgery and hemoglobin levels some of the factors that may indicate the need for preoperative storage. Regarding the intraoperative salvaged blood, it was observed that there is no increased risk of tumor recurrence, but the importance of using leukocyte filters and blood irradiation is highlighted. There was no consensus among the studies whether there is a maintenance or reduction of complication rates compared to allogeneic blood. The cost related to the use of autologous blood may be higher, and the less stringent selection criteria prevent it from being added to the general donation pool. Conclusion: There were no objective and concordant answers among the studies, but the strong evidence of less recurrence of digestive tumors, the possibility of changes in morbidity and mortality, and the reduction of costs with patients suggest that the practice of autologous blood transfusion should be encouraged in digestive tract surgeries. It is necessary to note if the deleterious effects would stand out amidst the possible benefits to the patient and to health care systems.

RESUMO Contexto: O emprego da transfusão sanguínea autóloga nas cirurgias do aparelho digestivo, seja através da coleta de sangue no pré-operatório ou da recuperação de sangue no intraoperatório, é uma alternativa ao sangue alogênico, que traz consigo determinados riscos e a escassez, pela falta de doadores. Estudos têm demonstrado menor mortalidade e maior sobrevida associadas ao sangue autólogo, no entanto a possibilidade teórica de propagação de doença metastática ainda é um dos fatores limitantes do seu uso. Objetivo: Avaliar a aplicação da transfusão autóloga em cirurgias do aparelho digestivo, observando os benefícios, prejuízos e efeitos sobre a propagação de doenças metastáticas. Métodos: Trata-se de uma revisão integrativa da literatura disponível nas bases de dados PubMed, Biblioteca Virtual em Saúde e SciELO, através da busca por "Autologous Blood Transfusion AND Gastrointestinal Surgical Procedures". Foram incluídos estudos observacionais e experimentais e guidelines publicados nos últimos 5 anos, nos idiomas português, inglês ou espanhol. Resultados: Nem todos os pacientes beneficiam-se da coleta de sangue antes de procedimentos eletivos, sendo o tempo de cirurgia e os níveis de hemoglobina alguns dos fatores que podem indicar a necessidade do armazenamento pré-operatório. Em relação ao sangue recuperado no intraoperatório, observou-se que não há maior risco de recorrência de tumores, mas destaca-se a importância do uso de filtros leucocitários e irradiação sanguínea. Não houve consenso entre os estudos se há uma manutenção ou redução das taxas de complicação, em comparação com o sangue alogênico. O custo relacionado ao uso de sangue autólogo pode ser maior, além de os critérios de seleção menos rigorosos impedirem que seja adicionado ao pool geral de doações. Conclusão: Não houve respostas objetivas e concordantes entre os estudos, mas os fortes indícios da menor recorrência de tumores digestivos, a possibilidade de alterações na morbimortalidade e a redução dos custos com os pacientes sugerem que a prática da transfusão sanguínea autóloga seja fomentada nas cirurgias do aparelho digestivo. É necessário observar se os efeitos deletérios se destacariam em meio aos possíveis benefícios ao paciente e aos sistemas de saúde.

Efficacy analysis of autologous facet joint bone block in lumbar interbody fusion of osteoporosis patients / 北京大学学报(医学版)

OBJECTIVE@#To compare and analyze the feasibility of autologous facet joint bone block as an alternative to polyetheretherketone (PEEK) cage in lumbar intervertebral fusion surgery for patients with osteoporosis.@*METHODS@#From December 2018 to June 2021, the case data of patients with osteoporosis (T value ≤ -2.5 on dual energy X-ray bone density) who underwent posterior lumbar interbody fusion in the Fourth Medical Center, Chinese PLA General Hospital were retrospectively reviewed. All the cases were followed up for no less than 12 months and were divided into two groups according to the differences of interbody fusion materials: the autologous facet joint bone block group (autogenous bone group) and the PEEK cage group (PEEK group). The general data [such as age, gender, body mass index (BMI), primary diagnosis, distribution of fusion segments, bone mineral density of lumbar (BMD), incidence of preoperative complications], the perioperative data (such as duration of operation, intraoperative blood loss, postoperative drainage, perioperative allogeneic blood transfusion rate), and the incidence of postoperative complications were compared between the two groups. Imaging parameters (disc height, lumbar lordosis angle, segment lordosis angle, segmental lordosis angle, disc height improvement rate, and fusion rate) and lumbar functional scores [visual analogue scale (VAS), Oswestry disability index (ODI), Japanese Orthopedics Association (JOA) score for lower back pain] were compared to evaluate the clinical efficacy between the kinds of intervertebral fusion materials 1 week, 3 months and 6 months postoperative and at the last follow-up.@*RESULTS@#A total of 118 patients were enrolled, including 68 cases in the autogenous bone group and 50 cases in the PEEK group, there were no statistical differences in age, gender, BMI, primary diagnosis, distribution of fusion segments, BMD, incidence of preoperative complications, duration of operation, intraoperative blood loss, postoperative drainage, perioperative allogeneic blood transfusion rate, incidence of postoperative complications, all the preoperative imaging parameters and all the lumbar function scores between the two groups (P>0.05). Postoperative superficial surgical site infections occurred in 3 patients in the autogenous bone group and 2 patients in the PEEK group. At the last follow-up, 3 cases of intervertebral graft collapse occurred in the autogenous bone group and 5 cases in the PEEK group, 1 case of graft subsidence in the autogenous bone group and 1 case in the PEEK group. All the imaging parameters showed significant differences between postoperation and preoperation (P < 0.05), and all the imaging parameters showed significant differences between 1 week and 3 months postoperative in both groups (P < 0.05). The height, angle of fusion gap in the autogenous bone group were lower than those in the PEEK group 1 week postoperatively (P < 0.05), and the fusion gap height improvement rate in the autogenous bone group was lower than that in the PEEK group (P < 0.05). The cases in both groups started to show final fusion 3 months after surgery, and the fusion rate in the autogenous bone group was 75% 6 months postoperatively, which was significantly higher than the rate of 56% in the PEEK group (P < 0.05), and there was no statistically significant difference in the final fusion rate between the two groups (P>0.05). The ODI, the postoperative VAS score was significantly lower than that in preoperation, while the postoperative JOA score was significantly higher than that in preoperation (P < 0.05). The ODI was lower while the JOA score was higher of the autogenous bone group than that of the PEEK group 6 months postoperatively (P < 0.05).@*CONCLUSION@#In osteoporosis patients, good interbody fusion rate and improvement of lumbar vertebral function can be obtained by using autologous facet joint bone block or PEEK cage, while the fusion rate and the improvement of lumbar function with autologous facet joint bone block are better than those with PEEK cage 6 months post-operatively. PEEK cage is superior to autologous facet joint bone block in intervertebral distraction and improvement of lumbar lordosis. Significant disc space subsidence occurred in osteoporotic patients within 3 months after lumbar interbody fusion, and the subsidence of PEEK cage was more obvious than that of autologous facet joint bone block.

Effectiveness of autologous hematopoietic stem cell transplantation in the treatment of high-risk neuroblastoma in children: a single-center clinical study / 中国当代儿科杂志

OBJECTIVES@#To investigate the effectiveness of high-dose chemotherapy combined with autologous hematopoietic stem cell transplantation (ASCT) in the treatment of children with high-risk neuroblastoma (NB).@*METHODS@#A retrospective analysis was performed on 29 children with high-risk NB who were admitted to Shanghai Children's Hospital and were treated with high-dose chemotherapy combined with ASCT from January 2013 to December 2021, and their clinical features and prognosis were analyzed.@*RESULTS@#Among the 29 children treated by high-dose chemotherapy combined with ASCT, there were 18 boys (62%) and 11 girls (38%), with a median age of onset of 36 (27, 59) months. According to the International Neuroblastoma Staging System, 6 children (21%) had stage III NB and 23 children (79%) had stage IV NB, and the common metastatic sites at initial diagnosis were bone in 22 children (76%), bone marrow in 21 children (72%), and intracalvarium in 4 children (14%). All 29 children achieved reconstruction of hematopoietic function after ASCT. After being followed up for a median time of 25 (17, 45) months, 21 children (72%) had continuous complete remission and 8 (28%) experienced recurrence. The 3-year overall survival rate and event-free survival rate were 68.9%±16.1% and 61.4%±14.4%, respectively. Presence of bone marrow metastasis, neuron-specific enolase ≥370 ng/mL and positive bone marrow immunophenotyping might reduce the 3-year event-free survival rate (P<0.05).@*CONCLUSIONS@#Children with high-risk NB who have bone marrow metastasis at initial diagnosis tend to have a poor prognosis. ASCT combined with high-dose chemotherapy can effectively improve the prognosis of children with NB with a favorable safety profile.