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Annals of Plastic Surgery Feb 2024The helix is the most common localization of auricular defects. Various techniques have been successfully used for the reconstruction of helical defects. However,...
BACKGROUND
The helix is the most common localization of auricular defects. Various techniques have been successfully used for the reconstruction of helical defects. However, redistributing the remaining auricular tissue to supply an ideal reconstruction base provides the best possible esthetic outcomes. The aim of this study is to present a new design for a postauricular chondrocutaneous flap to reconstruct the 3-dimensional curve and the folded structures in full-thickness helical defects.
METHODS
Nineteen patients with full-thickness helical defects were treated with the superior pedicle chondrocutaneous flap based on the superior auricular artery. The flap was designed on the postauricular area and comprised 3 sections, namely, deepithelialized, chondrocutaneous, and cutaneous sections (proximal to distal). Levels of patient's satisfaction on the final shape and auricular symmetry, and tissue compatibility between the flap and surrounding tissues were evaluated by the patients and objective observers.
RESULTS
The overall dimensions, projections, and curved structures of the defective helix maintained a smooth and contiguous appearance without asymmetry, notching, or trap-door deformities. The color, texture, and thickness of the flaps matched well with the adjacent auricles, and there was a moderate positive correlation between patient (9.47 ± 0.51) and observer (8.68 ± 0.63) correlation scores (r = 0.7485). The vast majority of the patients were very satisfied with the surgical outcome, and there was a statistically significant improvement in patient satisfaction (mean preoperative score, 1.26 ± 0.45; mean 12-month score, 4.79 ± 0.42; P < 0.00001).
CONCLUSIONS
Reconstruction of full-thickness helical defects requires "like tissue" characteristics and 3-dimensional cartilage support to avoid depression and notch deformities. The postauricular chondrocutaneous flap based on the superior auricular artery was shown to preserve the helical curve and folded sulcus, retain the size and subunits of the auricle, and ensure a color, texture, and thickness match between the flap and the adjacent tissues.
Topics: Humans; Surgical Flaps; Plastic Surgery Procedures; Ear, External; Ear Auricle; Arteries
PubMed: 37830506
DOI: 10.1097/SAP.0000000000003677 -
Facial Plastic Surgery & Aesthetic... Oct 2023
PubMed: 37815884
DOI: 10.1089/fpsam.2023.0102 -
Case Reports in Ophthalmological... 2023Vaccines have been approved worldwide to control the coronavirus disease-19 (COVID-19). However, the postvaccination side effects remain controversial. Here, we describe...
BACKGROUND
Vaccines have been approved worldwide to control the coronavirus disease-19 (COVID-19). However, the postvaccination side effects remain controversial. Here, we describe three Japanese cases of arteritic anterior ischaemic optic neuropathy (AAION) following COVID-19 vaccination. . The first case involved an 87-year-old woman who presented with vision loss in the right eye 2 months after her second COVID-19 vaccine and in the left eye 2 days later. The second case involved an 88-year-old woman who presented with vision loss in both eyes 3 months after receiving a second vaccine. The third case involved an 80-year-old man who presented with vision loss in the right eye 5 months after receiving a second vaccine. The C-reactive protein level and erythrocyte sedimentation rate were elevated in all patients. Biopsy of the temporal artery or auricular cartilage showed arteritic occlusion in case 2 and polychondritis in case 3. These patients were referred to a local Japanese hospital in 2021 over a period of no longer than 3 months.
CONCLUSION
We observed three cases of AAION after the affected individuals received their second COVID-19 vaccine. Further long-term investigations of ophthalmological events after COVID-19 vaccination are warranted.
PubMed: 37727533
DOI: 10.1155/2023/8845850 -
International Journal of Surgery Case... Oct 2023Maggot debridement therapy (MDT) is a treatment for chronic ulcers that involves using live larvae to debride the wound.
INTRODUCTION AND IMPORTANCE
Maggot debridement therapy (MDT) is a treatment for chronic ulcers that involves using live larvae to debride the wound.
CASE PRESENTATION
We report a case of serious arterial bleeding in the cervical region in a 52-year-old woman who was hospitalized in Iran for a malignant ulcer of the retro-auricular area. The patient was brought to the hospital by Emergency medical service due to severe hemorrhagic shock.
CLINICAL DISCUSSION
Debridement is a commonly used method for wound management, aimed at reducing the risk of infection and removing ulcer debridement. Several techniques are available for debridement of chronic wounds, including mechanical, surgical, autolytic, and enzymatic methods, each with its own advantages and disadvantages.
CONCLUSION
Maggot debridement therapy (MDT) is one of these methods that seem to be relatively safer. In this method, some larvae are used for debriding wounds in patients. It is usually used as a last resort treatment but in this case, it was used as a third line after surgery and chemoradiotherapy.
PubMed: 37722309
DOI: 10.1016/j.ijscr.2023.108844 -
Veterinary Clinical Pathology Sep 2023Enterprise Point-of-Care (EPOC) blood analysis is used routinely in wildlife veterinary practice to monitor blood oxygenation, but the reliability of the EPOC calculated...
Reliability of the Enterprise Point-of-Care (EPOC) blood analyzer's calculated arterial oxygen-hemoglobin saturation in immobilized white rhinoceroses (Ceratotherium simum).
BACKGROUND
Enterprise Point-of-Care (EPOC) blood analysis is used routinely in wildlife veterinary practice to monitor blood oxygenation, but the reliability of the EPOC calculated arterial oxygen-hemoglobin saturation (cSaO ) has never been validated in the white rhinoceros (Ceratotherium simum), despite their susceptibility to hypoxemia during chemical immobilization.
OBJECTIVES
We aimed to evaluate the reliability of the EPOC cSaO by comparing it against arterial oxygen-hemoglobin saturation (SaO ) measured by a co-oximeter reference method in immobilized white rhinoceroses.
METHODS
Male white rhinoceroses in two studies (both n = 8) were immobilized by darting with different etorphine-based drug combinations, followed by butorphanol or saline (administered intravenously). Animals in both studies received oxygen via intranasal insufflation after 60 min. Blood samples were drawn, at predetermined time points, from a catheter inserted into the auricular artery and analyzed using the EPOC and a co-oximeter. Bland-Altman (to estimate bias and precision) and area root mean squares (ARMS) plots were used to determine the reliability of the EPOC cSaO compared with simultaneous co-oximeter SaO readings.
RESULTS
The rhinoceros were acidotic (pH of 7.3 ± 0.1 [mean ± standard deviation]), hypercapnic (PaCO of 73.7 ± 10.5 mmHg), and normothermic (body temperature of 37.4 ± 1.8°C). In total, 389 paired cSaO -SaO measurements were recorded (the cSaO ranged between 13.2% and 99.0%, and the SaO ranged between 11.8% and 99.9%). The EPOC cSaO readings were unreliable (inaccurate, imprecise, and poor ARMS) across the entire saturation range (bias -6%, precision 5%, and ARMS 8%).
CONCLUSIONS
The EPOC cSaO is unreliable and should not be used to monitor blood oxygenation in immobilized white rhinoceroses.
Topics: Male; Animals; Oxygen; Point-of-Care Systems; Reproducibility of Results; Arteries; Animals, Wild
PubMed: 37612252
DOI: 10.1111/vcp.13236 -
Journal of Nanobiotechnology Aug 2023The excellent physicochemical and biomedical properties make silk fibroin (SF) suitable for the development of biomedical materials. In this research, the silk fibroin...
BACKGROUND
The excellent physicochemical and biomedical properties make silk fibroin (SF) suitable for the development of biomedical materials. In this research, the silk fibroin microspheres (SFMS) were customized in two size ranges, and then carried gold nanoparticles or doxorubicin to evaluate the performance of drug loading and releasing. Embolization efficiency was evaluated in rat caudal artery and rabbit auricular artery, and the in vivo distribution of iodinated SFMS (I/I-SFMS) after embolization of rat hepatic artery was dynamically recorded by SPECT. Transhepatic arterial radioembolization (TARE) with I-SFMS was performed on rat models with liver cancer. The whole procedure of selective internal radiation was recorded with SPECT/CT, and the therapeutic effects were evaluated with F-FDG PET/CT. Lastly, the enzymatic degradation was recorded and followed with the evaluation of particle size on clearance of sub-micron silk fibroin.
RESULTS
SFMS were of smooth surface and regular shape with pervasive pores on the surface and inside the microspheres, and of suitable size range for TAE. Drug-loading functionalized SFMS with chemotherapy or radio-sensitization, and the enhanced therapeutic effects were proved in treating HUH-7 cells as lasting doxorubicin release or more lethal radiation. For artery embolization, SFMS effectively blocked the blood supply; when I-SFMS serving as the embolic agent, the good labeling stability and embolization performance guaranteed the favorable therapeutic effects in treating in situ liver tumor. At the 5th day post TARE with 37 MBq/3 mg I-SFMS per mice, tumor activity was quickly inhibited to a comparable glucose metabolism level with surrounding normal liver. More importantly, for the fragments of biodegradable SFMS, smaller sized SF (< 800 nm) metabolized in gastrointestinal tract and excreted by the urinary system, while SF (> 800 nm) entered the liver within 72 h for further metabolism.
CONCLUSION
The feasibility of SFMS as degradable TARE agent for liver cancer was primarily proved as providing multiple therapeutic potentials.
Topics: Animals; Mice; Rabbits; Rats; Fibroins; Gold; Positron Emission Tomography Computed Tomography; Metal Nanoparticles; Arteries; Doxorubicin
PubMed: 37598140
DOI: 10.1186/s12951-023-02032-9 -
Rheumatology (Oxford, England) May 2024To investigate the diagnostic performance of diffusion-weighted imaging (DWI) of the superficial cranial arteries in the diagnosis of GCA. (Comparative Study)
Comparative Study
OBJECTIVES
To investigate the diagnostic performance of diffusion-weighted imaging (DWI) of the superficial cranial arteries in the diagnosis of GCA.
METHODS
Retrospectively, 156 patients with clinically suspected GCA were included. A new 4-point ordinal DWI rating scale was developed. A post-contrast, fat-suppressed, T1-weighted 'black-blood' sequence (T1-BB) was rated for comparison. Ten arterial segments were assessed: common superficial temporal arteries, temporal and parietal branches, occipital and posterior auricular arteries bilaterally. The expert clinical diagnosis after ≥6 months of follow-up was the diagnostic reference standard. Diagnostic accuracy was evaluated for different rating methods.
RESULTS
The study cohort consisted of 87 patients with and 69 without GCA. For DWI, the area under the curve was 0.90. For a cut-off of ≥2 consecutive pathological slices, DWI showed a sensitivity of 75.9%, a specificity of 94.2% and a positive likelihood ratio of 13.09. With a cut-off of ≥3 consecutive pathological slices, sensitivity was 70.1%, specificity was 98.6% and the positive likelihood ratio was 48.38. For the T1-BB, values were 88.5%, 88.4% and 7.63, respectively. The inter-rater analysis for DWI with a cut-off of ≥2 pathological slices showed a kappa of 1.00 on the patient level and 0.85 on the arterial segment level. For the T1-BB the kappa was 0.78 and 0.79, respectively.
CONCLUSION
DWI of the superficial cranial arteries demonstrates a good diagnostic accuracy and reliability for the diagnosis of GCA. DWI is widely available and can be used immediately in clinical practice for patients with suspected GCA.
Topics: Humans; Giant Cell Arteritis; Diffusion Magnetic Resonance Imaging; Female; Male; Retrospective Studies; Aged; Middle Aged; Sensitivity and Specificity; Temporal Arteries; Aged, 80 and over
PubMed: 37555808
DOI: 10.1093/rheumatology/kead401 -
Journal of Veterinary Dentistry Dec 2023The anatomy of the stomatognathic system is important for both clinical evaluations and surgical approaches in all animal species. The aim of this study was to describe...
The anatomy of the stomatognathic system is important for both clinical evaluations and surgical approaches in all animal species. The aim of this study was to describe the innervation and vascularization of the stomatognathic system of the dog. Twelve dogs without a history of disease or cranial malformation were used: 4 brachycephalic, 4 mesocephalic, and 4 dolichocephalic. The dogs were dissected, and arteries, veins, and nerves related to the masticatory and swallowing components were identified. The distribution pattern of these structures in the 3 different skull types were observed. The entire blood supply of the stomatognathic system is derived from the external carotid artery, which originates from the common carotid artery, and terminates as it branches into the superficial temporal and maxillary arteries. The other main branches of the common carotid artery are the occipital, cranial laryngeal, ascending pharyngeal, lingual, facial, caudal auricular, and parotid arteries. Blood drainage was achieved via the external jugular vein, which originates from the union of the linguofacial and maxillary veins. Brachycephalic dogs had blood vessels with greater sinuosity (more deviations) when compared to dolichocephalic and mesocephalic dogs. The stomatognathic system innervation of brachycephalic skull dogs showed differences in the distribution of the facial nerve in the labial commissure and maxillary and mandibular regions. The cranial conformation of dogs demonstrated anatomical variations of the vascular and neural structures of the stomatognathic system. This data may be useful to improve clinical practice, surgical planning, and interpretation of clinical dysfunctions.
Topics: Dogs; Animals; Skull; Stomatognathic System
PubMed: 37499187
DOI: 10.1177/08987564231176021 -
Frontiers in Veterinary Science 2023Measurement of arterial blood pressure is recommended in anaesthetized animals to guide perioperative treatment. Invasive blood pressure measurement is considered the...
BACKGROUND
Measurement of arterial blood pressure is recommended in anaesthetized animals to guide perioperative treatment. Invasive blood pressure measurement is considered the gold standard, however it is also technically challenging, requires specialised equipment and carries certain risks. For these reasons, non-invasive blood pressure measurement devices are commonly used and are expected to provide accurate and reliable results. This requirement is particularly true for rabbits, in whom peri-anaesthetic hypotension is commonly observed and in whom perioperative mortality remains disproportionally high. Several authors have compared different non-invasive devices with invasive measurements in rabbits and have reported contrasting results. However, to date no comparison between invasive measurements and the PetMAP device, that has been designed specifically for veterinary medicine, has been reported.
AIM AND HYPOTHESIS
The aim of the study was the comparison of invasive blood pressure measurement with PetMAP in rabbits. We hypothesised that PetMAP would show acceptable agreement with the invasive measurements according to the American College of Veterinary Internal Medicine guidelines.
MATERIALS AND METHODS
Sixteen client-owned rabbits presenting for various surgical interventions were included in the study. Invasive measurements were performed by cannulation of an auricular artery. The PetMAP cuff was applied distal to the elbow according to the manufacturer's guidelines. For each measurement with PetMAP, three invasive blood pressure values were recorded. The mean of the three invasive values was compared with one value measured with PetMAP.
RESULTS
Data collected from 16 rabbits were used for statistical analysis. In the clinical setting, the PetMAP device showed significant overestimation of systolic, diastolic and mean arterial pressure, which were measured in the auricular artery. In addition, the bias was not constant, implying that the device poorly predicted changes in blood pressure.
CONCLUSION
The PetMAP device did not meet any of the American College of Veterinary Internal Medicine recommendations.
PubMed: 37492435
DOI: 10.3389/fvets.2023.1141480