Smoking and short-term response to intravitreal anti-Vascular Endothelial Growth Factor injections in neovascular age-related macular degeneration.

PURPOSE: To evaluate the role of smoking status on the response to three monthly intravitreal anti-Vascular Endothelial Growth Factor (anti-VEGF) injections in treatment-naive neovascular AMD (nAMD) patients. METHODS: We conducted a single-center, retrospective, case-control cohort study in Belgium. RESULTS: Intravitreal treatment (IVT) was performed in 147 eyes of 131 patients, including 92 females (70%). Mean age at the time of the first IVT was 79±9 years. Seventeen patients (13%) were actively smoking at the time of the anti-VEGF IVT. On average, active smokers were 11 years younger than non-smokers when starting IVT treatment. They also showed more frequent subretinal fluid than non-smokers (94% vs. 65%). Mann-Whitney analyses comparing change in central macular thickness and change in logarithm of the minimum angle of resolution visual acuity between active smokers and non-smokers showed no significant difference in treatment response between both groups. Likewise, no significant difference was found when comparing treatment response between patients with less than 10 pack-years (PY) (including never-smokers) and patients with over 10 PY. In a binary logistic regression model, male patients responded worse to anti-VEGF IVT than their female counterparts, with an odds ratio (OR) of 0.27 for good response. This was the only statistically significant predictor of treatment response. CONCLUSION: Our study failed to demonstrate an effect of smoking on the short-term treatment response to anti-VEGF in nAMD.

Surgical correction of dentofacial deformities in juvenile idiopathic arthritis: a systematic literature review.

The aim of this study was to assess current evidence for the surgical correction of dentofacial deformities in patients with temporomandibular joint (TMJ) involvement from juvenile idiopathic arthritis (JIA). A systematic literature review, according to the PRISMA guidelines, was conducted. Meta-analyses, randomized controlled trials, cohort studies, observational studies, and case reports were eligible for inclusion. Exclusion criteria were no JIA diagnosis, no clearly defined outcomes, dual publications (except meta-analyses), non peer-reviewed studies, non English language publications, and animal studies. The outcome measures assessed were TMJ function, skeletal alignment, and morbidity. The database search identified 255 citations, of which 28 met the eligibility criteria. Of these, 24 were case reports or case series with a low level of evidence that did not allow for meta-analysis. Extrapolated evidence supports orthognathic surgery in skeletally mature patients with controlled or quiescent JIA and a stable dentofacial deformity. Distraction osteogenesis was recommended for severe deformities. Some authors demonstrated unpredictable postoperative mandibular growth with costochondral grafts. Alloplastic TMJ reconstruction was efficacious, but should be used cautiously in skeletally immature patients. TMJ function and skeletal alignment was improved with reconstruction by any technique and morbidity was low. The surgical correction of arthritis-induced dentofacial deformities is indicated but the level of evidence is low. Prospective multicenter studies are needed.

Glue mesh fixation: Feasibility, tolerance and complication assessment. Results 24months after laparoscopic sacrocolpopexy.

AIM: This study aims to assess short- and mid-term feasibility, strength and tolerance of glue mesh fixation for laparoscopic sacrocolpopexy, as well as postoperative quality of sexual activity. PATIENTS AND METHODS: This original prospective clinical study was carried out in multiple university surgical centres between 2012 and 2013. Data were obtained during immediate postoperative hospitalisation, at 3 and at 24 months postoperatively. For a total of 42 patients subjected to laparoscopic sacrocolpopexy, bladder catheterization and hospitalisation times, pain score, early and late postoperative complications, prolapse staging according to POP-Q classification, and quality of sexual activity were registered. RESULTS: Mean operative time was 120minutes and patients were hospitalised for a mean of 3days. Four complications (9.52%) occurred on the immediate postoperative period, whilst 2 patients (4.76%) complained of pain on day 3 (VAS 1). At the end of the follow-up period (24 months), one patient had a prosthetic exposure, 4 patients (9.52%) complained of stress urinary incontinence (10.81%). Simultaneously, 6 patients (14.29%) experienced dyschezia (2 improved, 1 similar, 1 de novo, 2 worsened), and there was no report of dyspareunia. All anterior and posterior floor prolapses were staged between 0 and 1. All superior floor prolapses were staged between 0 and 2. Concerning sexual impairment, there was no report of dyspareunia, urinary leaks or other problems associated with intercourse, and quality of sexual activity improved. CONCLUSION: Minimally invasive sacrocolpopexy with the use of glue fixation does not lead to increased mid-term morbidity, simultaneously allowing for significant prolapse improvement, and providing global patient satisfaction and overall quality of life.

Juvenile arthritis: current concepts in terminology, etiopathogenesis, diagnosis, and management.

The latest change in terminology from juvenile rheumatoid arthritis (JRA) to juvenile idiopathic arthritis (JIA), established by the International League of Associations for Rheumatology (ILAR), has resulted in some confusion for OMFS and other treating clinicians. JIA comprises a group of systemic inflammatory diseases that result in the destruction of hard and soft tissues in a single or multiple joints. In a significant number of patients, one or both temporomandibular joints (TMJ) are also involved. TMJ disease may be accompanied by pain, swelling, and limitation of motion, as well as mandibular retrognathism, open bite, and asymmetry. The purpose of this article is to provide a review, for the oral and maxillofacial surgeon, of the terminology, etiopathogenesis, diagnosis, and management of children with JIA.

[Anatomic, functional and identity results after clitoris transposition]. / Évaluation des résultats anatomiques, fonctionnels et identitaires après transposition du clitoris chez 30 patientes.

OBJECTIVES: Every year 3 millions of young women had undergone female genital mutilation. The psychological, identical and sexual consequences, as well as the treatment were described only recently. After a sociodemographic and cultural reminder, we analyze the anatomical, psychological, identital, and functional results of the reconstructive surgery. PATIENTS AND METHODS: We conducted a retrospective monocentric study. Thirty women were included in our series. All the patients operated according to the technique of Pierre Foldes were contacted again, to estimate their motivations for this surgery and study the results on femininity, anatomy, psychology and functionality of this intervention. RESULTS: Twenty-six women were able to be estimated in the long term. Their main motivation was in 77% of the cases the research for a feminine identity. We compared the pre- and postoperative results, as well as different predefined under groups. The results shown a significant improvement between the pre- and the postoperative estimation for each of the items. The patients indicate an improvement: anatomical in 96% of the cases, for identity in 88% of the cases, psychological in 96% of the cases, and for sexuality in 88% of the cases. DISCUSSION AND CONCLUSION: This technique allows an improvement for anatomy and functionality but also for physical image, well-being and feminity.

Total alloplastic temporomandibular joint reconstruction using Biomet stock prostheses: the University of Florida experience.

The purpose of this study was to report the subjective and objective outcomes of temporomandibular joint (TMJ) replacement with Biomet stock prostheses at a single institution in Florida. In this retrospective study, patients who underwent TMJ replacement using a Biomet stock prosthesis from 2005 to 2012 were analyzed. Subjective (pain, diet) and objective (maximal incisal opening) information was obtained. In addition, a quality of life measure was obtained pre- and postoperatively. Significance was set at <0.01. Thirty-six patients (26 bilateral, 6 left, and 4 right) who underwent TMJ replacement using a Biomet stock prosthesis were eligible for the study. Maximal incisal opening improved from 26.1mm preoperatively to a mean of 34.4mm postoperatively. The pain score decreased from 7.9 preoperatively to a mean of 3.8 postoperatively. Diet restriction decreased from 6.8 preoperatively to a mean of 3.5 postoperatively. Quality of life improved from a median of 4 preoperatively to a postoperative median of 2. Four implants were removed/replaced because of heterotopic bone formation, infection, and/or loose hardware. Follow-up ranged from 6 to 83 months. Overall, TMJ reconstruction using the Biomet stock joint is effective and safe in this patient population.

[Giant ectopic peritoneal and omental deciduosis mimicking a peritoneal carcinomatosis]. / Décidualisation ectopique géante du péritoine et de l'épiploon mimant une carcinose péritonéale.

Ectopic decidual reaction of the peritoneum and the omentum is rare. It is usually an incidental finding during caesarean section and it could mimick macroscopically peritoneal carcinomatosis or tuberculosis. Histology is very important to make diagnosis. Ectopic decidual reaction is physiological, with an excellent prognosis and spontaneous resolution. We report one case of ectopic peritoneal and omental deciduosis of the peritoneum and discovered incidently during caesarian section. Definitive diagnosis was done by immunohistological examination. A laparoscopy four months later showed complete and spontaneous regression of all lesions.

[Laparoscopic creation of a neovagina by Vecchietti's technique: anatomic and functional results]. / Plastie vaginale par technique de Vecchietti cœlioscopique : résultats anatomiques et fonctionnels.

OBJECTIVES: To evaluate vaginoplasty by Vecchietti technique adapted to laparoscopy and the anatomical and functional long term outcomes. PATIENTS AND METHODS: We retrospectively studied the patients with vaginal agenesis (a Mayer-Rokitansky-Küster-Hauser syndrome for seven of young adults) operated from 1997 to 2011. The data of eight patients with a median age of 18years old was collected. Surgical complications were analysed. The functional outcomes were compared to a control group with the Female Sexual Function Index (FSFI). RESULTS: No major complication occurred during surgery. The postoperative mean vaginal measurement was 7.2cm (4.4-10). The total FSFI scores did not differ from that of the control group (19.2 versus 18 p=0.82). Desire, arousal, lubrication, orgasm, satisfaction, and pain of the patients were similar to controls. DISCUSSION AND CONCLUSION: Laparoscopic Vecchietti technique is a fast, simple and safe procedure to create a neovagina, and guarantees good anatomic and functional results.

Adaptability of stock TMJ prosthesis to joints that were previously treated with custom joint prosthesis.

The purpose of this study was to determine if a temporomandibular joint (TMJ) replaced by a custom joint prosthesis could have been replaced by a stock joint prosthesis. Stereolithic models of patients treated with TMJ Concepts® patient fitted joint prosthesis (e.g., custom) were obtained. Biomet Microfixation® TMJ prostheses (e.g. stock) were adapted to these models. Intra-operative insertion of prosthesis, fit and size of stock joints were simulated and evaluated. Adaptability and stability of condyle and fossa as well as their articulation were recorded. 20 models consisting of 34 joints were examined by two oral and maxillofacial surgeons who were blinded to the patient's diagnosis. Overall, 77% of the stock TMJ system fit the stereolithic models. 3mm or less of bone modification was necessary to achieve an acceptable fit. In the majority of the cases examined, a stock TMJ prosthesis had good anatomical adaptation to stereolithic models of patients previously treated with custom TMJ prosthesis, so a stock TMJ prosthesis could have been an acceptable option for these patients. Further prospective clinical studies to compare both systems are necessary.

[Umbilical endometriosis in women free of abdominal surgical antecedents]. / Endométriose ombilicale chez les femmes sans antécédents chirurgicaux.

Primary umbilical endometriosis represents a very rare localization of the disease and is represented by blue, papular, nodular or cystic lesions whose symptoms are related to ovarian cycle. We report the management of three women, free of surgical antecedents presenting with primary umbilical endometriosis. In each woman, abdominal laparoscopy revealed peritoneal pelvic endometriosis. The excision of umbilical lesions was performed with satisfactory esthetical outcomes. In our experience, umbilical endometriosis responsible for highly characteristic features appears playing the role of clinical marker for pelvic endometriosis.

Temporomandibular joint reconstruction after failed teflon-proplast implant: case report and literature review.

Multiple reports document that a foreign-body giant cell reaction forms around Proplast-Teflon temporomandibular joint (TMJ) implants. This results in destruction of surrounding bone and instability of the implants. This case presents a patient whose Proplast-Teflon TMJ implants became displaced into her middle cranial fossa. The staged reconstruction of this patient is described, including removal of the TMJ implants, reconstruction of the defect, concomitant orthodontic treatment and final reconstruction with TMJ Concepts. This process involved a multidisciplinary approach between several medical and dental specialties. At her 3-year follow up, the patient had a stable postoperative result.