Predictors for Postoperative Chyle Leak Following Neck Dissection, a Technique-Based Comparison.

OBJECTIVE: Assess the impact of surgical technique used to address level IV on the rate of postoperative chyle leak. STUDY DESIGN: Retrospective chart review. SETTING: Academic tertiary care center. METHODS: An analysis of 436 consecutive neck dissections (NDs) in 368 patients was performed by 3 head and neck surgeons between 2014 and 2017. Variation in technique reflects individual approaches to the management of level IV and included suture ligation (SL), monopolar electrocautery (MC), and harmonic scalpel transection (HS). Data points included patient demographics, surgical technique, intraoperative findings, postoperative chyle leaks, and leak management. Correlation between variables was analyzed through χ2 test and Student t test with statistical α set at .05. RESULTS: Overall, 12 patients (3.2%) developed chyle leaks postoperatively. Nine of 12 and 3 of 12 presented with left- and right-sided leaks, respectively. Five of 12 leaks occurred following bilateral ND, 5 of 12 following left ND, and 2 of 12 following right ND. Univariate analysis showed a statistically significant difference (P = .001) favoring SL (1.0%) and MC (1.2%) techniques over the HS technique (8.6%). A statistically significant increase existed in the rate of leak with endocrine vs nonendocrine pathology (P = .003). Average duration of leak was 13.3 ± 13.5 days. Management included diet modification (n = 11, 91.6%), pressure-dressing placement (n = 7, 58.3%), and octreotide (n = 5, 41.7%). No cases required reoperation, and no mortality or severe malnutrition was observed in this series. CONCLUSIONS: SL and MC techniques demonstrated superiority over the HS technique in preventative management of chyle leak in level IV, with a significantly higher rate of chyle leak observed in endocrine-related pathology.

Influence of Behavior on Complications of Osseointegrated Bone Conduction Devices in Children.

OBJECTIVE: Compare incidences of complications following implantation of osseointegrated bone conduction devices (OBCD) between children with and without behavioral disorders. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center otology and neurotology practice. PATIENTS: Pediatric patients who underwent implantation of OBCD between May 2009 and July 2014 at Arkansas Children's Hospital. INTERVENTIONS: Implantation with Cochlear BAHA 200 series, Cochlear BAHA BI300, or Oticon OBCD. MAIN OUTCOME MEASURES: Osseointegration failure (OIF) with resulting loss of flange-fixture and/or skin and soft tissue reactions. RESULTS: The total rate of complications was 66.2%, with the majority being minor complications (39.4%). There was no difference in the total rate of complication (p = 0.461), minor complications (p = 0.443), major complications (p = 0.777), and minor and major complications (p = 0.762) between the control group and children with behavioral disorders. CONCLUSION: Behavior was not observed to influence the incidence of OIF or skin/soft tissue reactions after implantation of OBCD in pediatric patients.

Postoperative Calcium Management in Same-Day Discharge Thyroid and Parathyroid Surgery.

OBJECTIVE: To describe a safe and effective postoperative prophylactic calcium regimen for same-day discharge thyroid and parathyroid surgery. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral academic institution. SUBJECTS AND METHODS: In total, 162 adult patients who underwent total thyroidectomy, completion thyroidectomy, unilateral parathyroidectomy, parathyroidectomy with bilateral neck exploration, or revision parathyroidectomy were identified preoperatively to be candidates for same-day discharge. All patients in this study were successfully discharged the same day on our standard prophylactic calcium regimen. RESULTS: Less than 1% (1/162) of patients re-presented to the hospital within 30 days of surgery, and that patient was successfully discharged from the emergency department after negative workup for hypocalcemia. There was no significant difference between preoperative and postoperative calcium levels in the total/completion thyroidectomy groups (9.3 vs 9.2 mg/dL, respectively; P = .14). The average postoperative calcium level in the parathyroid group was well within normal limits (9.5 mg/dL), and the difference in postoperative calcium levels between revision and primary parathyroidectomy cases was not significantly different (P = .34). CONCLUSION: The reported calcium regimen demonstrates a safe, effective, and objective means of postoperative calcium management in outpatient thyroid and parathyroid surgery in appropriately selected patients.

A Comparative Review of Osseointegration Failure Between Osseointegrated Bone Conduction Device Models in Pediatric Patients.

OBJECTIVE: Compare rates of osseointegration failure (OIF) between system 2 (200 series) and system 3 (BI300) osseointegrated bone conduction device (OCBD) models. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. PATIENTS: Pediatric patients who were implanted with either system 2 or system 3 OCBD between May 2009 and July 2014 at Arkansas Children's Hospital. INTERVENTIONS: Implantation with either system 2 or system 3 OCBD using 3- and 4-mm implants with 5.5- and 8.5-mm abutments (system 2) or 6- and 9-mm abutments (system 3). MAIN OUTCOME MEASURES: OIF with resulting loss of flange-fixture. RESULTS: OIF occurred in 28.6% (14/49) of implanted fixtures in system 2 compared with 8.0% (2/25) of implanted fixtures in system 3 (p = 0.042). The average time to complication for system 2 was 13 months compared with 3 months for system 3. The causes of OIF in system 2 were trauma (n = 4), chronic soft tissue disease (n = 5), or idiopathic in nature (n = 5). System 3 failures were both because of trauma. Using the combined cohorts, the average age of patients who experienced OIF was 8.7 years, compared with 11.4 years in patients without OIF (p = 0.047). There was no difference in OIF among 3-mm and 4-mm screws (p = 0.876), linear and flap technique (p = 0.375), or surgeons (p = 0.211). CONCLUSION: System 3 OCBD showed a significantly reduced rate of OIF compared with system 2 in our study. Modification to the system 2 implant resulted in improved rate of OIF. Younger age was independently associated with a higher rate of OIF when evaluating both systems.

Low-temperature solution processing of graphene-carbon nanotube hybrid materials for high-performance transparent conductors.

We report the formation of a nanocomposite comprised of chemically converted graphene and carbon nanotubes. Our solution-based method does not require surfactants, thus preserving the intrinsic electronic and mechanical properties of both components, delivering 240 ohms/square at 86% transmittance. This low-temperature process is completely compatible with flexible substrates and does not require a sophisticated transfer process. We believe that this technology is inexpensive, is massively scalable, and does not suffer from several shortcomings of indium tin oxide. A proof-of-concept application in a polymer solar cell with power conversion efficiency of 0.85% is demonstrated. Preliminary experiments in chemical doping are presented and show that optimization of this material is not limited to improvements in layer morphology.

Transmission of Light Through Pigmented Polyethylene Milk Bottles.

Light transmissions through white and yellow pigmented polyethylene milk bottles were measured in the 350- to 800-nm region. The bottles were opaque below 400 nm. Light transmission at 550 nm was 13 and 17% for the white and yellow pigmented bottles, respectively, compared to 72 and 2% for an unpigmented polyethylene bottle and a paperboard milk carton, respectively. The 400- to 550-nm wavelengths, which apparently are harmful to milk quality, were not entirely blocked by the pigmented bottles. A plastic sleeve for fluorescent tubes in dairy cases was opaque below 385 nm and had 92% transmission in the 440- to 800-nm region.

Analytical Technique for Measuring Transmission of Light Through Milk Carton Materials.

Light transmissions through milk carton paperboards, milk cartons, and blow-molded polyethylene containers were measured in the 350 to 800 nm region using a Cary 17D spectrophotometer equipped with a scattered transmission accessory. The paperboards had S-shaped transmission curves and were nearly opaque to wavelengths below 400 nm. Transmission at 800 nm averaged 5-3/4, 5-1/2, 4-1/2, 3, and 3% for the Eco Pak™, half-pint, quart, half-gallon, and gallon carton paperboards, respectively. Depending on wall thickness and wavelength of incident light, polyethylene containers had from 50 to 70% transmission. The effectiveness of different colored inks in reducing light transmission was compared using printed and unprinted areas of the paperboard cartons. Yellow, orange, gold, red, brown, and black inks opacified half-gallon cartons to wavelengths below 500 nm. Light transmission was reduced throughout the visible region by black, brown, and blue inks.