Citations

Abstract Background An adipofascial flap in the rat may provide new options for adding vascularization to scarred or nonvascularized beds for a variety of research studies. Current literature lacks sufficient description for a simple reproducible flap model for a vascularized pedicled flap in rats, in particular for neovascularization of allograft nerves for the reconstruction of sciatic nerve defects. The purpose of this study was to describe a surgical technique and determine long-term survivability for the pedicled superficial inferior epigastric artery fascial (SIEF) flap in the rat to meet requirement for a tunneled adipofascial flap to add vascularization to the sciatic nerve area. Methods The technique and use of a 4 × 3-cm SIEF flap are described. Twenty Lewis rats underwent the technique to determine feasibility. The flap was wrapped around processed allograft nerve reconstructions and viability of the flap was evaluated after 12 and 16 weeks. To visualize vessels, nerve grafts were harvested at 12 weeks and stained with hematoxylin-eosin and an antibody against microvessels (CD-34). Results All flaps remained viable after survival of 12 and 16 weeks. Complications included one hematoma formation and two lymphocele formations that did not have any impact on the flap. Immunohistochemistry confirmed an increase in microvessels and Schwann cell nuclei in the SIEF group compared with nerve samples from the unoperated, contralateral side. Conclusion A pedicled adipofascial flap model in the rat to provide a vascular bed for sciatic nerve reconstruction is detailed with long-term survivability evaluation of the flap. This flap is technically simple to be harvested and is suitable for revascularization procedures of various tissues in the lower abdomen, genital area, thigh, or upper limb of the rat.

AbstractHyaline molds, widely distributed in nature, are an important and increasing cause of invasive fungal infections in humans, likely due to an expanding population of immunosuppressed hosts, increases in antifungal resistance, and improvements in laboratory diagnostics. Sinopulmonary disease and disseminated infection are common manifestations in neutropenic patients and transplant recipients, whereas, catheter-related and localized soft tissue infections predominate in immunocompetent hosts. These organisms are not reliably differentiated based on their morphology in tissue; rather, efforts should be made to establish a microbiologic diagnosis via culture or molecular-based methods to guide antifungal management and inform prognosis. Herein, we review the epidemiology, clinical manifestations, diagnosis, and management of these opportunistic pathogens known to cause hyalohyphomycoses: Scedosporium spp., Lomentospora prolificans, Fusarium spp., Scopulariopsis spp., Arthrographis kalrae, Trichoderma spp., Acremonium spp., Paecilomyces variotii, Purpureocillium lilacinum, and Penicillium species.

AbstractCoccidioidomycosis is an infection caused by the geographically restricted dimorphic fungus, Coccidioides. Coccidioidomycosis occurs endemically in the southwestern and western United States, mainly in focused regions of Arizona and California where the incidence is highest, and in Central and South America. Patients with impaired immunity, especially those with impaired cellular immunity, are at higher risk of severe and disseminated disease. In this review, we describe the fungal ecology and mycology, epidemiology, pathophysiology, and normal immune defenses to Coccidioides as well as address current concepts in diagnosis, treatment, and continued care of patients with pulmonary coccidioidomycosis. We also present and answer our most frequently asked questions regarding patients with primary pulmonary coccidioidomycosis.

AbstractIntroduction Vestibular schwannomas (VS) are slow growing tumors. Although there are a wide variety of available treatment options, these tumors are often initially observed. We aimed to establish the presenting symptoms and outcomes of patients treated with initial observation at our institution.Methods The medical records of patients with radiographically diagnosed VS were reviewed from 1989 to 2018. Actuarial estimates of radiographic tumor control and freedom of local therapy were calculated and compared using Cox regression analyses.Results A total of 360 patients were diagnosed with VS at our institution from 1989 through 2018 with a median age of 59.9 years. After radiographic diagnosis, 243 patients (67.5%) opted for initial observation. Local control at 1, 5, and 10 years was 91, 67, and 58%, respectively. On multivariable analysis, factors associated with shorter time to radiographic tumor progression included younger patient age (p = 0.016) and tumors with an extracanalicular component (p = 0.032). Regarding time until definitive treatment only larger baseline American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) tumor size predicted for earlier initiation of therapy (p < 0.001), although this was restricted to tumors with an extracanalicular component (p = 0.004), as opposed to purely internal auditory canal tumors (p = 0.839).Conclusion Many patients who were initially observed continued to have satisfactory local control rates at 10 years. In patients with extracanalicular tumors, larger AAO-HNS tumor measurements were associated with earlier radiographic tumor progression and shorter time to local therapy, with 7 mm serving as a potential threshold value for extracanalicular tumors. Younger patients and tumors with primarily an extracanalicular portion may warrant closer observation.