Shoulder Function Assessment After Head And Neck Reconstruction With Pedicled Supraclavicular Flap

The supraclavicular artery flap is used for reconstruction of defects of the head and neck. One of the major implications of this procedure is injury to the nerve roots of C3 and C4 of the superficial cervical plexus, which provides sensation over the clavicle, shoulder and proximal chest, thereby causing problems in overall shoulder function. The objective of this study was to assess shoulder function, range of motion, pain, daily activities and overall satisfaction of the patient after using this flap. This study was conducted at the Department of Plastic & Reconstructive Surgery, Dow University of Health Sciences & Dr. Ruth KM Pfau Civil Hospital Karachi, Pakistan, from May 2015 to November 2018. Supraclavicular flap was used in 35 patients who underwent soft tissue reconstruction of defect of the neck after release of post burn contracture. Penn Shoulder Score and Constant Murley Score were used as assessment tools. Assessment by Penn Shoulder Score resulted in 25 (71.4%) patients within the upper quartile and 10 (18.6%) patients within the lower quartile. Constant Murley Score showed 19 (54.2%) of patients had 161°-180° shoulder abduction and lateral elevation. Forward flexion of 161°-180° was seen in 17 (48.5%) patients, 17 (48.5%) had internal rotation till the inter scapular region, 15 (42.8%) had no impairment of external rotation, 19 (54.2%) patients had no impairment of work/recreation, 25 (71.4%) had felt no change in their sleep and 22 (62.8%) were able to position their arm above their head. Overall parameters indicate better function, good range of motion, less pain, resumption of daily activities, and overall satisfaction.

Volumetric laser endomicroscopy and its application to Barrett's esophagus: results from a 1,000 patient registry

Volumetric laser endomicroscopy (VLE) uses optical coherence tomography (OCT) for real-time, microscopic cross-sectional imaging. A US-based multi-center registry was constructed to prospectively collect data on patients undergoing upper endoscopy during which a VLE scan was performed. The objective of this registry was to determine usage patterns of VLE in clinical practice and to estimate quantitative and qualitative performance metrics as they are applied to Barrett's esophagus (BE) management. All procedures utilized the NvisionVLE Imaging System (NinePoint Medical, Bedford, MA) which was used by investigators to identify the tissue types present, along with focal areas of concern. Following the VLE procedure, investigators were asked to answer six key questions regarding how VLE impacted each case. Statistical analyses including neoplasia diagnostic yield improvement using VLE was performed. One thousand patients were enrolled across 18 US trial sites from August 2014 through April 2016. In patients with previously diagnosed or suspected BE (894/1000), investigators used VLE and identified areas of concern not seen on white light endoscopy (WLE) in 59% of the procedures. VLE imaging also guided tissue acquisition and treatment in 71% and 54% of procedures, respectively. VLE as an adjunct modality improved the neoplasia diagnostic yield by 55% beyond the standard of care practice. In patients with no prior history of therapy, and without visual findings from other technologies, VLE-guided tissue acquisition increased neoplasia detection over random biopsies by 700%. Registry investigators reported that VLE improved the BE management process when used as an adjunct tissue acquisition and treatment guidance tool. The ability of VLE to image large segments of the esophagus with microscopic cross-sectional detail may provide additional benefits including higher yield biopsies and more efficient tissue acquisition. Clinicaltrials.gov NCT02215291.

Incidence of venous thromboembolism in different ethnic groups: a regional direct comparison study

BACKGROUND

There are few studies that directly compare the variation in incidence of venous thromboembolism (VTE) according to ethnicity.

OBJECTIVE

The aim of this study was to compare the rates of VTE, deep venous thrombosis (DVT) and pulmonary embolism (PE) among different ethnic groups.

METHOD

The cases diagnosed with VTE, DVT and PE for a period between March 2004 and June 2009 were identified through the hospital-based database system. The 2006 New Zealand Census data were used to calculate the rate of diagnosis.

RESULTS

The observed annual incidence of VTE during this period was 81.6 per 100000 population. The relative risks of VTE when comparing European subjects with Maori, Pacific Island and Asian subjects after age standardization were 1.98 (95% confidence interval [CI], 1.63-2.41), 3.22 (95% CI, 2.60-3.99) and 4.02 (95% CI, 3.34-4.84), respectively. Relative risks of DVT after age standardization when comparing European subjects with Maori, Pacific Island and Asian subjects, were 2.14 (95% CI, 1.72-2.66), 3.20 (95% CI, 2.46-4.17) and 4.75 (95% CI, 3.80-5.94), respectively. Indirect age standardization was used for comparison of the diagnosis of PE. The ratio between the calculated expected number of cases and the actual number of cases was 1.32 (95% CI, 0.89-1.75) for Maori subjects, 2.96 (95% CI, 1.89-4.03) for Pacific Islanders and 3.89 (95% CI, 3.00-4.78) for Asians.

CONCLUSION

Europeans have a significantly higher incidence of VTE compared with Maori, Pacific Island and Asian populations.

How do we manage venous thromboembolism in pregnancy? A retrospective review of the practice of diagnosing and managing pregnancy-related venous thromboembolism at two major hospitals in Australia and New Zealand

BACKGROUND

North American and European literature suggest that the incidence rate for pregnancy-related thromboembolism (VTE) ranges from 0.5 to 2 per 1000 pregnancies. However, there is a paucity of data regarding pregnancy-related VTE in Australia and New Zealand.

AIMS

To define the epidemiology, management and adverse effects of pregnancy-related VTE in Australia and New Zealand.

METHOD

Retrospective chart review of pregnant patients with objectively diagnosed pregnancy-related VTE at Monash Medical Centre and the North Shore Hospital from January 2007 to March 2011.

RESULTS

Sixty women with VTE were identified, 31 and 29 in the antepartum and post-partum period respectively. VTE occurred as early as 8 weeks of gestation. There was a trend towards higher proportion of PE in the postpartum period. Most antenatal patients were started on enoxaparin and dosed according to weight at diagnosis. A wide variability in maintenance dosing strategies was observed. Three (5%, 95% CI: 1% to 14%) patients suffered major bleeds, all occurring post-partum. Recurrences occurred in two post-partum patients who received a truncated course of enoxaparin for distal deep-vein thrombosis. Although more women had an induction of labour, this did not translate into an increased Caesarean section rate.

CONCLUSION

The epidemiology of pregnancy-related VTE is similar to that of other developed countries. All three bleeding events occurred in the immediate post-partum setting, highlighting the need for caution at this critical time. VTE recurrences occurred in those women with post-partum distal deep-vein thrombosis treated with an abbreviated course of enoxaparin.

Parental [correction of Perinatal] consanguinity: a risk factor for developmental delay in Pakistani children

OBJECTIVE

To investigate the association of parental consanguinity and delayed development in terms of gross motor, fine motor, speech and social aspects in their children.

METHODS

One hundred and seventy seven children (age 15 days--72 months) were evaluated for their developmental status utilizing the Denver Developmental Screening Test (DDST). An unmatched case-control study design was used. Case group consisted of 94 children and control group 83 children. Odds ratios were calculated for parental consanguinity and delay in gross and fine motor, speech and social development in their children, for cases and controls, utilizing Binary Multiple Logistic Regression Analysis. Acquired delay was excluded through detailed birth history in both cases and control group respectively.

RESULTS

Univariate analysis showed high significant Odds ratios for all areas of developmental delay (viz. gross and fine motor, speech and social development), between cases and controls (p < .001). At the multivariate analysis level however, our results showed no increased risk of parental consanguinity on delayed gross and fine motor, speech and social development in their children.

CONCLUSION

Our results show no increased risk of parental consanguinity on delayed gross and fine motor, speech or social development (as measured by the DDST), in their children.

Autoantibodies in sclerosing cholangitis against a shared peptide in biliary and colon epithelium

BACKGROUND/AIMS

A strong association exists between ulcerative colitis and primary sclerosing cholangitis (PSC). Previously, the presence of a unique epitope shared by colon and biliary epithelial cells was shown by using the novel monoclonal antibody (MAb) 7E12H12 developed against a colonic epithelial protein. In the present study, the presence of circulating autoantibody in PSC against this peptide was examined.

METHODS

Sera from 16 patients with PSC, 13 with primary biliary cirrhosis, 6 with secondary biliary stricture, and 6 with chronic liver diseases and 10 normal subjects were used. An inhibition immunoperoxidase assay using the 7E12H12 MAb was developed against sections of bile duct and gallbladder. Sera were also examined in an enzyme-linked immunosorbent assay (ELISA) against the gallbladder extract enriched in 7E12H12-reactive protein.

RESULTS

About two thirds of the sera from patients with PSC blocked the binding of 7E12H12 MAb on the bile duct and gallbladder, whereas non-PSC sera did not. In the ELISA, 93% of PSC sera had circulating immunoglobulin G antibodies against the enriched gallbladder extract. The reactivity of sera from the PSC group was significantly (P < 0.01 to P < 0.0001) higher than in each of the non-PSC groups.

CONCLUSIONS

Sera from patients with PSC contains autoantibodies against a cross-reactive peptide shared by colon and biliary epithelial cells.

The use of two new coagulation probes for control of hemorrhage in laparoscopic liver biopsy

Two new prototype probes, BICAP and Heater, were assessed to determine their effectiveness in controlling post-biopsy bleeding during laparoscopy. A total of 88 patients with a wide spectrum of liver diseases were studied. Both probes were equally effective in stopping bleeding in all patients. We recommend the use of either of these devices in controlling post-biopsy bleeding.

Early diagnosis of spinal-epidural metastasis by magnetic resonance imaging

Sixteen patients with various types of cancer who developed pain along the axial spine were prospectively studied by magnetic resonance imaging (MRI). The studies were performed with a Fonar Beta-3000 (Fonar Co., Melville, NY) permanent magnet operating at 0.3 Tesla (T). Detailed neurologic examinations were followed by bone x-rays, bone scans, and MRI. In 12 patients there were focal neurologic findings. Bone x-rays and bone scans were diagnostic for metastatic disease in 10 cases; MRIs were consistent with metastatic spinal-epidural disease in all 16 patients. Magnetic resonance imaging revealed bone involvement in three patients whose x-rays and bone scans were both negative indicating a higher degree of sensitivity. In six patients thecal compression was obvious on MRI; in three of these previous myelograms had been interpreted as negative. These early results suggest that MRI can serve as a useful tool for diagnosing early spinal-epidural metastases.

New storage procedure for human tumor biopsies prior to estrogen receptor measurement

Breast tumor biopsies required for steroid receptor determination are normally frozen in liquid nitrogen and stored until assay. However, some limitations of this type of storage exist. To try to both eliminate the need for liquid nitrogen and as part of a study of serial assays on a single tumor biopsy, alternative storage media were investigated. This study shows that storage of breast tumor biopsies at -20 degrees in sucrose buffer made 50% in glycerol prevented the tissues from freezing, yet retained the specific estrogen receptor content both quantitatively and in terms of molecular form (8S:4S ratio). Receptor was stable for up to 100 days, and individual samples could be successfully reassayed throughout this period. Forty-four biopsies from 40 patients were halved, and one section from each was stored in liquid nitrogen, while the other was stored in sucrose:glycerol. Overall, the correlation of receptor content between the two storage methods was good. Using a clinical cutoff value of 20 fmol/mg cytosol protein, only one sample of the 44 would have been classified differently after storage in the two media. Progesterone receptor in biopsies stored in sucrose:glycerol also appears to be stable for at least a limited period.