A Case of Organizing Hematoma in a Maxillary Sinus After Reconstruction of a Blow-Out Fracture.

A 36-year-old man presented because of nasal obstruction, rhinorrhea, and postnasal drip. The patient had undergone reconstruction of a blow-out fracture of the orbital floor 12 years before and had sinusitis that likely had resulted from implant migration into the maxillary sinus. The inflammation was successfully resolved, and the implant was removed through a minimally invasive endoscopic sinus surgery technique. On pathologic examination, an organizing hematoma was identified as the cause of the lesion. Pre- and postoperational paranasal sinus computed tomography images were taken to compare the anatomy of the sinus before and following surgery.

Salvage of a Necrotic Flap.

OBJECTIVE: To report the case of a 68-year-old woman with a skin basal cell carcinoma on the nasal dorsum. After excision, the soft tissue defect was reconstructed using a rectangular advancement flap. However, 2 days later skin necrosis was observed. This report was issued to advise how to avoid and manage skin necrosis after regional flap placement. METHODS: This is a retrospective study. RESULTS: Superficial skin necrosis recovered completely after proper medical management. CONCLUSIONS: When planning an advancement flap, care should be taken to design the flap properly and not to injure flap blood supply to avoid skin necrosis. In addition, surgeons should be aware of the difference between superficial and total flap necrosis.

The outcome of endoscopic management of bile leakage after hepatobiliary surgery.

BACKGROUND/AIMS: Despite improvements in surgical techniques and postoperative patient care, bile leakage can occur after hepatobiliary surgery and may lead to serious complications. The aim of this retrospective study was to evaluate the efficacy of endoscopic treatment of bile leakage after hepatobiliary surgery. METHODS: The medical records of 20 patients who underwent endoscopic retrograde cholangiopancreatography because of bile leakage after hepatobiliary surgery from August 2009 to September 2014 were reviewed retrospectively. Endoscopic treatment included insertion of an endoscopic retrograde biliary drainage stent after endoscopic sphincterotomy. RESULTS: Most cases of bile leakage presented as percutaneous bile drainage through a Jackson-Pratt bag (75%), followed by abdominal pain (20%). The sites of bile leaks were the cystic duct stump in 10 patients, intrahepatic ducts in five, liver beds in three, common hepatic duct in one, and common bile duct in one. Of the three cases of bile leakage combined with bile duct stricture, one patient had severe bile duct obstruction, and the others had mild strictures. Five cases of bile leakage also exhibited common bile duct stones. Concerning endoscopic modalities, endoscopic therapy for bile leakage was successful in 19 patients (95%). One patient experienced endoscopic failure because of an operation-induced bile duct deformity. One patient developed guidewire-induced microperforation during cannulation, which recovered with conservative treatment. One patient developed recurrent bile leakage, which required additional biliary stenting with sphincterotomy. CONCLUSIONS: The endoscopic approach should be considered a first-line modality for the diagnosis and treatment of bile leakage after hepatobiliary surgery.

Virologic response and safety of tenofovir versus entecavir in treatment-naïve chronic Hepatitis B patients.

BACKGROUND/AIMS: This study aimed to evaluate the antiviral response and safety of tenofovir (TDF) versus entecavir (ETV) in treatment-naïve CHB patients. PATIENTS AND METHODS: We performed a retrospective cohort study of treatment-naive CHB patients who were treated with TDF or ETV. We analyzed virologic, biochemical, and serologic responses at 3, 6, and 12 months. RESULTS: A total of 107 patients (TDF group = 49, ETV group = 58) were included. Baseline characteristics were similar between the two groups. The estimated proportion of complete virologic response (CVR) in the TDF or ETV group was 44.9% versus 39.7% at 6 months and 89.6% versus 83.2% at 12 months, respectively (P = 0.991). Viral breakthrough was not observed in both groups. One patient in the TDF group and two patients in the ETV group experienced HBeAg loss, respectively (P = 0.657). High HBV DNA level at baseline was a significant negative predictor of virologic response by Cox regression analysis (P = 0.007). The safety profile was similar between the two groups. There was no case with serious adverse event. CONCLUSIONS: Both TDF and ETV were effective in achieving CVR and had a favorable safety profile in treatment-naïve CHB patients. High viral load at baseline was a negative predictive factor of CVR.

O-GlcNAc modification modulates the expression of osteocalcin via OSE2 and Runx2.

O-Linked beta-N-acetylglucosamine (O-GlcNAc) modification, a reversible post-translational modification, has been implicated in the regulation of protein stability, subcellular localization of proteins and protein-protein interaction. Here, we demonstrate that O-GlcNAc modification regulates the expression of osteocalcin, an osteoblast-specific marker, via Runx2 transcriptional activity in osteoblastic differentiation. Protein-associated O-GlcNAc was increased during osteoblastic differentiation in MC3T3-E1 preosteoblasts. In addition, PUGNAc, an inhibitor of O-GlcNAcase, potentiated the expression of osteocalcin caused by ascorbic acid, parathyroid hormone (PTH) and forskolin. By conducting activity assays of the osteocalcin promoter and transcription factor, we found that the OSE2 site in the osteocalcin promoter and Runx2 were important for increased osteocalcin promoter activity by PUGNAc. Furthermore, PUGNAc led to increased O-GlcNAc modification of Runx2, which regulated the transcription of its target gene osteocalcin. Thus, these data provide evidence that O-GlcNAc modification may be a new mode of osteoblastic differentiation regulation.