Forte, Antonio J.

AbstractBackgroundIn recent years, magnetic resonance imaging lymphangiography (MRL) has emerged as a way to predict if patients are candidates for lymphedema surgery, particularly lymphovenous anastomosis (LVA). Our goal was to conduct a systematic review of the literature on the use of MRL for preoperative planning in lymphedema surgery. We hypothesized that MRL could add valuable information to the standard preoperative evaluation of lymphedema patients.MethodsOn February 17, 2020, we conducted a systematic review of the PubMed/MEDLINE, Cochrane Clinical Answers, and Embase databases, without time frame or language limitations, to identify articles on the use of MRL for preoperative planning of lymphedema surgery. We excluded studies that investigated other applications of magnetic resonance imaging, such as lymphedema diagnosis and treatment evaluation. The primary outcome was the examination capacity to identify lymphatic anatomy and the secondary outcome was the presence of adverse effects.ResultsOf 372 potential articles identified with the search, nine studies fulfilled the eligibility criteria. A total of 334 lymphedema patients were enrolled in these studies. Two studies compared MRL findings with those of other standard examinations (indocyanine green lymphography [ICG‐L] or lymphoscintigraphy). No adverse effects due to MRL were reported. A study shown that MRL had higher sensitivity to detect lymphatic vessel abnormalities compared with lymphoscintigraphy and a statistically higher chance of successful LVA was observed when the results of MRL agreed with those of ICG‐L (p < .001).ConclusionsMRL could be useful for preoperative planning in lymphedema surgery. The scientific evidence has been limited, so further studies with greater numbers of patients and cost analysis are necessary to justify the addition of MRL to current preoperative protocols.

Background: Pfeiffer syndrome is a rare syndromic craniosynostosis disorder, with a wide range of clinical manifestations. This study aims to investigate the structural abnormalities of cranial fossa and skull base development in Pfeiffer patients, to provide an anatomic basis for surgical interventions. Method: Thirty preoperative CT scans of Pfeiffer syndrome patients were compared to 35 normal controls. Subgroup comparisons, related to differing suture synostosis, were performed. Results: Overall, the volume of anterior and middle cranial fossae in Pfeiffer patients were increased by 31% (P < 0.001) and 19% (P = 0.004), versus controls. Volume of the posterior fossa in Pfeiffer patients was reduced by 14% (P = 0.026). When only associated with bicoronal synostosis, Pfeiffer syndrome patients developed enlarged anterior (68%, P = 0.001) and middle (40%, P = 0.031) fossae. However, sagittal synostosis cases only developed an enlarged anterior fossa (47%, P < 0.001). The patients with solely bilateral squamosal synostosis, developed simultaneous reduced anterior, middle and posterior cranial fossae volume (all P ≤ 0.002). The overall skull base angulation, measured on both intracranial and subcranial surfaces, grew normally. Conclusion: Enlarged anterior cranial fossae in Pfeiffer syndrome children is evident, except for the squamosal synostosis cases which developed reduced volume in all fossae. Volume of the middle cranial fossa is influenced by associated cranial vault suture synostosis, specifically, sagittal synostosis cases develop normal middle fossa volume, while the bicoronal cases develop increased middle fossa volume. Posterior cranial fossa development is restricted by shortened posterior cranial base length. Surgical intervention in Pfeiffer syndrome patients optimally should be indexed to different suture synostosis.

BACKGROUND: Bioimpedance spectroscopy has been suggested as a useful tool for early diagnosis of breast cancer–related lymphedema (BCRL). We aimed to describe the outcomes of published studies that evaluated bioimpedance analysis as a method for prospective surveillance and early diagnosis of BCRL. METHODS: We queried the PubMed, Ovid Medline, and EMBASE databases to identify studies that evaluated use of bioimpedance spectroscopy as a diagnostic tool. We used the keywords “bioimpedance” AND (“lymphedema” OR “lymphoedema”) in the search. Only English-language studies that reported quantitative outcomes for patients with BCRL were included. RESULTS: Of 152, 235 and 116 identified articles in PubMed, Ovid Medline and EMBASE databases, only 22 were included. Use of bioimpedance analysis for prospective surveillance has been shown to prevent chronic BCRL. All the cross-sectional and retrospective studies that evaluated bioimpedance for diagnosis of BCRL reported significantly different L-Dex scores between lymphedema patients and healthy participants; in addition, bioimpedance scores were positively correlated with volume of lymphedema. CONCLUSION: Bioimpedance analysis is a potential tool with demonstrated benefits for prevention of chronic BCRL and may be an economic and great alternative for early diagnosis of BCRL.

Background: Obstructive sleep apnea is common in patients with Crouzon syndrome, yet it may be caused by multiple factors. This study aims to investigate the natural history of airway development in preoperative Crouzon patients, from infants to adults. Methods: Preoperative computed tomography (CT) scans (Crouzon syndrome, n = 73; control, n = 87) were divided into five age subgroups. CT scans were measured using Materialise software. Results: Before 6 months of age, nasal airway volume in patients with Crouzon syndrome was smaller than normal by 37% ( p = 0.002), and the cross-sectional area at the choana reduced by 45% ( p < 0.001). The reduction of nasal airway volume and cross-sectional area reached their nadir at 2 years of age, with shortening of 44% and 63% (both p < 0.001), respectively. They gradually caught up to normal dimensions after 6 years of age. Between 2 and 6 years, the pharyngeal airway in patients with Crouzon syndrome reduced 44% ( p = 0.011) compared with controls. However, the airway cross-sectional area at condylion and gonion levels was less than normal, before 6 months (35%, p = 0.024) and (44%, p = 0.006) after 2 years of age, respectively. This reduction remains into adulthood. Conclusion: Nasal airway volume is more limited in children with Crouzon syndrome who are younger than 2 years of age. Whereas after 2 years of age, the pharyngeal airway develops significant volume restriction, leading to timing and specific treatment area foci based on the site of temporal maximal constriction.

Objective Previous studies have explored the restricted nasopharyngeal airway in Apert syndrome patients. This study aims to investigate the segmented airway volume changes with age and directly analyze their correlations with subcranial dimensions and angulations. Methods Ninety-seven preoperative computed tomography scans (Apert, n = 44; control, n = 53) were included in this study, and divided into 5 age-related subgroups. Computed tomography scans were measured using Mimics and 3-matics software. Results Before 6 months of age, the nasal cavity in Apert syndrome is reduced by 47% (P = 0.002), which gradually approximates normal thereafter; however, there remained a 30% reduction, compared with controls. It is highly correlated with the anteroposterior length of subcranial space, and the position of maxilla and palate. The pharyngeal airway volume in Apert syndrome patients, younger than 6 months, was larger than normal by 129% (P = 0.013). However, between 2 and 6 years of age, the pharyngeal airway becomes smaller than normal, with a 57% (P = 0.010) reduction in childhood and 52% (P = 0.005) in adolescence. It is closely correlated with the intercondylar and intergonial widths. Conclusions Airway compromise in Apert syndrome patients is attributable more to the nasal cavity in infants, but in the older child, it is the pharyngeal region. The restricted nasal airway in Apert syndrome is correlated with the subcranial space length and width, but independent of cranial base flexion. The pharyngeal airway volume in Apert syndrome is not as highly correlated with craniofacial morphology. Rather, it is impacted by the growth of mandible, which often requires surgical intervention later in childhood.

Case: We report a case of a 71-year-old man diagnosed with high-grade undifferentiated pleomorphic sarcoma in the left thigh. He underwent partial resection of the quadriceps and proximal femoral bone, followed by reconstruction with a latissimus dorsi free muscle flap through end-to-end vascular and nerve anastomosis with the femoral vessels and a branch of the femoral nerve, respectively. Recovery of 3/5 knee extension function was achieved 3 months postsurgery without complications. Conclusion: Free neurotized latissimus dorsi muscle transfer is a successful reconstructive option to restore knee extension after quadriceps resection. Level of Evidence: Level IV.

Objetivo: Evaluar una serie de biomarcadores que permiten medir el proceso de cicatrización de las heridas e identificar los materiales que fueron utilizados para realizar dicha medición, teniendo en cuenta su incorporación en apósitos inteligentes. Método: Se realizó una revisión sistemática a partir de PubMed, Medline, CINAHL y Embase, sobre estudios que evaluaran el uso de materiales sensibles a biomarcadores. Se incluyeron estudios en inglés, sin tomar en cuenta el estado o fecha de publicación. No se incluyeron artículos de revisión ni sinopsis de conferencias. Resultados: La búsqueda mostró 296 estudios. Un investigador seleccionó 19 artículos para su inclusión. Todos los estudios fueron experimentales. Se encontraron artículos que evaluaron pH, tensión de oxígeno, temperatura, presión, ácido úrico, y glucosa. Los materiales utilizados fueron hidrogeles, fibras y tintas conductivas. Conclusión: El biomarcador más estudiado fue el pH. Los materiales que evalúan biomarcadores por medio de métodos colorimétricos podrían ser los más adecuados para su incorporación en apósitos inteligentes. Conflicto de interés: Este estudio fue respaldado, en parte, por el centro de Medicina Individualizada de Mayo Clinic, y por la Fundación de Cirugía Plástica (Plastic Surgery Foundation).

Introduction: Based on an established classification system of Apert syndrome subtypes, we aim to directly analyze the correlation between segmented airway volume changes and different skull suture synostosis, so as to provide individualized surgical planning for each subgroup of Apert patients. Methods: CT scans of 44 unoperated Apert syndrome and 53 controls were included and subgrouped as: type I. Bilateral coronal synostosis; type II. Pansynostosis; type III. Perpendicular combinations of cranial vault synostosis. CT scans were measured using Mimics and 3-matics software. Results: Type I developed a 41% ( P = .116) reduction in the nasal cavity, yet a normal sized pharyngeal airway. The reduced nasal airway was linked to the decreased cross sectional area ( r = 0.598, P = .001), vertical dimension ( r = 0.719, P < .001), and narrower width ( r = 0.727, P < .001). Type II developed proportionally reduced nasal airway and pharyngeal airway volumes (both 47%, P = .113 and P = .041), along with the proportionally restricted cross sectional areas at choana and condylion levels by 62 to 65%. This reduction is related to the cranial base length ( r = 0.712, P = .048), and also cranial base angulation ( r = 0.780, P = .023). Nasal and pharyngeal airway developed normal volume in type III. However, the cross sectional areas at the gonion level diminished by 74% ( P < .001). Conclusion: Airway development is influenced by subtype of Apert suture synostosis. Type II pansynostosis Apert patients developed synchronous reduced nasal and pharyngeal airways, which is correlated with the slightly flattened cranial base. Type I bicoronal patients have a smaller nasal cavity, but normally sized hypopharynx. Yet, type III patients developed normal nasopharyngeal airway volume overall.