Three Decades Single Center Experience of Airway Complications After Lung Transplantation.

Post lung transplantation airway complications like necrosis, stenosis, malacia and dehiscence cause significant morbidity, and are most likely caused by post-operative hypo perfusion of the anastomosis. Treatment can be challenging, and airway stent placement can be necessary in severe cases. Risk factors for development of airway complications vary between studies. In this single center retrospective cohort study, all lung transplant recipients between November 1990 and September 2020 were analyzed and clinically relevant airway complications of the anastomosis or distal airways were identified and scored according to the ISHLT grading system. We studied potential risk factors for development of airway complications and evaluated the impact on survival. The treatment modalities were described. In 651 patients with 1,191 airway anastomoses, 63 patients developed 76 clinically relevant airway complications of the airway anastomoses or distal airways leading to an incidence of 6.4% of all anastomoses, mainly consisting of airway stenosis (67%). Development of airway complications significantly affects median survival in post lung transplant patients compared to patients without airway complication (101 months versus 136 months, p = 0.044). No significant risk factors for development of airway complication could be identified. Previously described risk factors could not be confirmed. Airway stents were required in 55% of the affected patients. Median survival is impaired by airway complications after lung transplantation. In our cohort, no significant risk factors for the development of airway complications could be identified.

Endometrial polypectomy using tissue removal device or electrosurgical snare: a randomised controlled trial.

Background: Hysteroscopic transcervical resection of endometrial polyps is a widely used method and is increasingly performed in office or outpatient care. To ensure patient comfort is key, smaller instruments are preferred while also achieving a complete resection of the pathology. Objectives: To evaluate the effectiveness of the electrosurgical polyp snare (DPS) in comparison with a tissue removal device (TRD). Materials and Methods: This was a randomised controlled non-inferiority trial which included 66 women with symptomatic endometrial polyps who had been referred to the gynaecological outpatient clinic at the Máxima Medical Centre, Veldhoven, the Netherlands. The patients were randomly allocated by using sealed envelopes to treatment with either the DPS (Duckbill®, Cook) or the TRD (Truclear™, Medtronic). Clinicians and patients were not blinded to the treatment performed. An independent observer blindly assessed the results. Main outcome measures: The primary outcome was the complete removal of the endometrial polyp. Secondary outcomes were woman acceptability and pain during the procedure, operating time, peri-operative and immediate postoperative complications. Results: 57% of the polyps in the DPS group and 95% in the TRD group were completely removed (risk difference -0.39; 95% CI: -0.60 to -0.15). Average operating time was longer with DPS compared to the TRD (11.7 min. vs. 6.8 min., p = 0.018). The number of insertions of the hysteroscope was higher with the DPS compared to the TRD (3.9 vs. 1.7, p <0.001). One serious adverse event, a uterine perforation, occurred in the DPS group. Conclusion: The TRD was superior to the DPS in completeness of polyp removal. What is new?: TRD has a higher rate of complete polyp resection, overall safety and higher patient satisfaction, this instrument should be considered as the preferred option in outpatient and office gynaecology.

Value of cone beam computed tomography for detecting bone invasion in squamous cell carcinoma of the maxilla.

OBJECTIVE: To determine the diagnostic value of cone beam computed tomography (CBCT) in detecting bone invasion in maxillary squamous cell carcinoma (MSCC). STUDY DESIGN: In this retrospective cohort study, preoperative CBCT scans were independently assessed by a single surgeon in imaging assessment 1 (IA 1) and by 1 surgeon with 2 dentists in consensus (IA 2) for the presence of bone invasion in MSCC. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, area under the receiver operating characteristic curve (AUC), and Cohen's κ were calculated. Histopathologic results of resection specimens served as the reference standard. RESULTS: Of 27 patients, 19 (70%) had proven bone invasion. IA 1 yielded 68.4% sensitivity, 75.0% specificity, 86.7% PPV, 50.0% NPV, 70.4% accuracy, and 0.717 AUC. All results of IA 2 were true-positive and true-negative, resulting in 100% sensitivity, specificity, PPV, NPV, accuracy, and AUC. The assessments differed in 6 cases. Interobserver κ was fair (0.38, 95% CI 0.04-0.72, P = .038). There was a significant association between CBCT detection of bone invasion and extent of surgical treatment (P = .006) CONCLUSIONS: The diagnostic accuracy of CBCT was high but observer-dependent. CBCT examination may be useful in surgical treatment planning.

Low skeletal muscle mass is a strong predictive factor for surgical complications and a prognostic factor in oral cancer patients undergoing mandibular reconstruction with a free fibula flap.

BACKGROUND: Fibula free flaps (FFF) are effective in accomplishing successful reconstruction for segmental defects of the mandible. Potential risk factors for FFF complications have been described in previous research, e.g. age, comorbidity and smoking. Low skeletal muscle mass (SMM) has shown to be an emerging predictive factor for complications and prognostic factor for survival in head and neck cancer. This study aims to identify the predictive and prognostic value of low SMM for surgical FFF related complications, postoperative complications and survival in patients who underwent mandibular reconstruction with FFF after oral cavity cancer resection. MATERIALS AND METHODS: A retrospective study was performed between 2002 and 2018. Pre-treatment SMM was measured at the level of the third cervical vertebra and converted to SMM at the level of the third lumbar vertebra (L3). SMM at the level of L3 was corrected for squared height. Low SMM was defined as a lumbar skeletal muscle index (LSMI) below 43.2 cm2/m2. RESULTS: 78 patients were included, of which 48 (61.5%) had low SMM. Low SMM was associated with an increased risk of FFF related complications (HR 4.3; p = 0.02) and severe postoperative complications (Clavien-Dindo grade III-IV) (HR 4.0; p = 0.02). In addition low SMM was a prognosticator for overall survival (HR 2.4; p = 0.02) independent of age at time of operation, ACE-27 score and TNM stage. CONCLUSION: Low SMM is a strong predictive factor for FFF reconstruction complications and other postoperative complications in patients undergoing FFF reconstruction of the mandible. Low SMM is also prognostic for decreased overall survival.

High-Permittivity Pad Design for Dielectric Shimming in Magnetic Resonance Imaging Using Projection-Based Model Reduction and a Nonlinear Optimization Scheme.

Inhomogeneities in the transmit radio frequency magnetic field ( ) reduce the quality of magnetic resonance (MR) images. This quality can be improved by using high-permittivity pads that tailor the fields. The design of an optimal pad is application-specific and not straightforward and would therefore benefit from a systematic optimization approach. In this paper, we propose such a method to efficiently design dielectric pads. To this end, a projection-based model order reduction technique is used that significantly decreases the dimension of the design problem. Subsequently, the resulting reduced-order model is incorporated in an optimization method in which a desired field in a region of interest can be set. The method is validated by designing a pad for imaging the cerebellum at 7 T. The optimal pad that is found is used in an MR measurement to demonstrate its effectiveness in improving the image quality.

[Active oxygen in the treatment of (root) caries and its suitability for frail older people]. / Actieve zuurstof bij de behandeling van (wortel)cariës en de toepasbaarheid ervan bij kwetsbare ouderen.

In 2000 it was suggested that there was a new, fast and simple way to treat dental caries based on the outcomes of an in vitro study of the antimicrobial effect of ozone, a form of active oxygen, on caries lesions in dental roots. The aim of the review of literature described in this article was to determine the effectiveness of active oxygen in the treatment of dental (root) caries as demonstrated by in vivo research of frail older people'. From the results it became clear that the quality of the various trials is not very high and that there is, at least at the present time, an insufficient solid scientific evidence base that the use of ozone is an effective treatment for dental (root) caries. It is, however, still too early to conclude that active oxygen, in whatever form, cannot contribute positively to the fight against caries.

[An unusual skin disorder after tooth extraction]. / Een ongewone huidreactie na een extractie.

A 72-year-old woman was referred to a department of oral and maxillofacial surgery because of a unilateral skin eruption of the face after extraction of the right first upper molar, a few days earlier. She had been diagnosed with chronic lymphocytic leukaemia some years before. It appeared to be herpes zoster or'shingles'from the second branch of the trigeminal nerve. Treatment included hospital admission with intravenous antiviral therapy and analgetics. Herpes zoster of the face is a severe infection and requires early treatment. Post herpetic neuralgia is a serious complication of herpes zoster and may adversely affect the quality of life.

The success rate of silicone intubation in congenital lacrimal obstruction.

In our series of 100 patients who had unsuccessful probing for congenital nasolacrimal duct obstruction, all had silicone intubation associated with infracturing of the inferior turbinate. The age range was from 7 months to 4 years at the time of intubation. Sixty patients had tubes in for 1 year, and all but one, a 3-year-old girl, were treated successfully. Of the 40 who had tubes in place for less than 1 year, 38 were treated successfully. The two unsuccessful cases were those of a 3-year-old boy and a 4-year-old boy, whose tubes were removed at 3 and 4 months, respectively. The overall success rate in our series was 97%; all patients younger than two years old at the time of intubation were treated successfully.

Lower lid reconstruction using tarsoconjunctival grafts and bipedicle skin-muscle flap.

We describe a method of subtotal lower eyelid reconstruction employing either a free tarsoconjunctival graft or a transpositional tarsoconjunctival flap from the upper lid together with a bipedicle skin-muscle advancement flap from the lower lid. A full-thickness skin graft is placed into the defect created by the movement of the bipedicle flap. This technique obviates the need to use a lid-sharing procedure that occludes the fissure and would be indicated for the monocular patient or one who would be at a serious disadvantage with the eye covered for several weeks.

Correction of a deep superior sulcus with dermis-fat implantation.

We describe five patients with deep superior sulcus deformities who had dermis-fat grafts implanted into the preaponeurotic space. Three patients had anophthalmic sockets, and two had normal seeing eyes. The grafts were taken from the left lower abdominal quadrant above the iliac crest and the donor site was closed primarily. At the time of surgery, an effort was made to overcorrect the deformity. All five patients were improved, although one of the anophthalmic patients developed a slight postoperative ptosis. A follow-up of at least one year has shown no sign of fat absorption.

Wavelength and light-dose dependence in tumour phototherapy with haematoporphyrin derivative.

Red light (c. 630 nm) is almost universally used in tumour phototherapy as it is the most penetrating of the porphyrin excitation wavebands. However, measurements of tumour attenuation of light of different wavelengths and of the excitation spectrum of haematoporphyrin derivative in vitro suggested that green light might be more efficient than red in destroying thin tumours. Experimentally, we confirmed this for tumours up to approximately 1.2 mm thick, a depth exceeding that of most carcinomas-in-situ. The superiority of green light over red in terms of the illumination time required to produce equivalent depths of necrosis may extend to greater depths (3-4 mm) if the former is produced by an argon laser and the latter by an argon-pumped dye laser. The relation between depth of necrosis Zn and light dose D is shown to be Zn = sigma gamma-1 1n(D/theta gamma) where sigma gamma is the attenuation coefficient for light at wavelength gamma and theta gamma the threshold light dose for producing necrosis at that wavelength. This logarithmic relationship suggests that it may be difficult to eradicate large tumours merely by increasing the light dose, and indicates the need for other approaches.

Silicone rod frontalis sling for the correction of blepharoptosis.

A frontalis sling procedure for blepharoptosis using a 1 mm solid silicone rod is described. This procedure is ideal for patients requiring frontalis suspension who are at risk for postoperative exposure keratopathy, or for patients likely to need postoperative eyelid position adjustment. These would include individuals with chronic progressive external ophthalmoplegia, third nerve paralysis, and myasthenia gravis. The advantages of this technique are the elasticity and the availability of the silicone rod, together with formation of an eyelid crease and ability postoperatively to adjust the position of the upper eyelid.

Lower eyelid reconstruction with upper eyelid transpositional grafts.

A procedure of lower eyelid reconstruction is described using a transpositional tarsalconjunctival graft from the mid-portion of the ipsilateral upper eyelid, as well as a transpositional skin-muscle flap from the supratarsal area. This technique confines the resconstruction to the local area, provides adequate support, and maintains the upward curve of the lateral aspect of the lower eyelid as well as a sharp canthal angle.

Dacryocystorhinostomy: a modification of the Dupuy-Dutemps operation.

In a series of 112 cases, dacryocystorhinostomy with direct anterior and posterior flap anastomosis has produced a success rate of 94%. Modifications from the original procedure described by Dupuy-Dutemps include preparation of the lacrimal sac flaps and preplacement of the sutures prior to the osteotomy which facilitates accurate identification and approximation with the nasal flaps. Adaptic gauze impregnated with polysporin ointment is packed into the rhinostomy site and out to the anterior nares to maintain patency and minimize clot and membrane formation. Common canalicular stenosis must be recognized and treated with silicone intubation to prevent failure in an otherwise correctable situation.

Automated wet chemical analysers and their applications.

A review is presented of automated analysis, including instrumentation and applications.