Zaahir Turfe

Endovascular coiling versus parent artery occlusion for treatment of cavernous carotid aneurysms: a meta-analysis.

Background and purpose Endosaccular coil embolization and parent artery occlusion (PAO) are established endovascular techniques for treatment of cavernous carotid aneurysms. We performed a systematic review of published series on endovascular treatment of cavernous carotid aneurysms to determine outcomes and complications associated with endovascular coiling and PAO of cavernous carotid artery aneurysms. Methods In September 2013, we conducted a computerized search of MEDLINE and EMBASE for reports on endovascular treatment of intracranial cavernous carotid aneurysms from January 1990 to August 2013. Comparisons were made in periprocedural complications and outcomes between coiling and PAO patients who did not receive bypass. Event rates were pooled across studies using random effects meta-analysis. Results 20 studies with 509 patients and 515 aneurysms were included in this systematic review. Aneurysm occlusion rates at >3 months after operation were significantly higher in the PAO without bypass group (93.0%, 95% CI 86.0 to 97.0) compared with the coiling group (67.0%, 95% CI 55.0 to 77.0) (p<0.01). Retreatment rates were significantly lower in the PAO without bypass group (6.0%, 95% CI 2.0 to 12.0) compared with the coiling group (18.0%, 95% CI 12.0 to 26.0) (p=0.01). Coiling patients had a similar morbidity rate (3.0%, 95% CI 2.0 to 6.0) compared with PAO without bypass patients (7.0%, 95% CI 3.0 to 12.0) (p=0.13). Coiling patients had a similar mortality rate (0.0%, 95% CI 0.0 to 6.0) compared with PAO without bypass patients (4.0%, 95% CI 1.0 to 9.0) (p=0.68). Conclusions Evidence from non-comparative studies suggests that traditional endovascular options are highly effective in treating cavernous sinus aneurysms. PAO is associated with a higher rate of complete occlusion. Periprocedural morbidity and mortality rates are not negligible, especially in patients receiving PAO.

Formant Frequency in Relation to Body Mass Composition

OBJECTIVES This study examines the relationship between total body mass composition and vowel formant frequency and formant dispersion in men. METHODS A total of 60 healthy male volunteers were recruited. Formant frequencies and dispersions of F1, F2, F3, and F4 for the vowels /ɑː/ and /iː/ were determined using spectrographic analysis. RESULTS The mean height and weight were 179.17 cm and 80.53 kg, respectively, with fat-free weight averaging to 67.02 kg (65.5% in the extremities vs 16.7% in the trunk). The body mass index (BMI) was 25.5 ± 3.34 kg/m(2). For the vowel /ɑː/, F1 and F4 correlated poorly with weight and trunk fat-free mass. There was also a poor negative correlation between F4 and muscle mass and body fat-free mass (r < 0.36). For the /iː/ vowel, there was a weak negative correlation between F2, F3, and F4 and height (r = -0.260, -0.299, and -0.320, respectively). Similarly, there was a negative correlation between F2 and muscle mass, trunk fat-free mass, and body fat-free mass (r = -0.291, -0.276, and -0.272, respectively). For the vowel /ɑː/, F1-F2 interspace correlated positively with fat weight, fat mass in the extremities, and trunk (r = 0.313, 0.350, and 0.264, respectively), whereas F2-F3 negatively correlated with weight (r = -0.255). For the /iː/ vowel, only F1-F2 negatively correlated with weight and BMI (r = -0.297 and -0.281). CONCLUSION There is no significant correlation between body mass composition, formant frequencies, and dispersions. All the correlations were poor with r values less than 0.36.

Outcomes of Prosthetic Reconstruction of Irradiated and Nonirradiated Breasts with Fat Grafting

Background: Fat grafting may be beneficial in prosthetic reconstruction of irradiated tissues, but there is a paucity of data on the complication rates associated with this clinical scenario. Methods: All consecutive patients who had undergone fat grafting and prosthetic reconstruction from 2010 to 2013 were enrolled. Variables obtained related to fat grafting and history of irradiation. Implant-related complications in relation to irradiation status were also noted. Results: Eighty-five patients (age 49 ± 10 years) underwent 117 fat grafting procedures. The mean follow-up was 2.6 ± 0.7 years. Fat grafting was predominantly performed to correct soft-tissue deficiency [112 of 117 (95.7 percent)] or to alter skin after irradiation [five of 117 (4.3 percent)]. Thirty-two procedures (27.4 percent) were associated with a complication, with the most common being palpable fat necrosis (23.1 percent). Volume of transferred fat averaged 151.2 ± 76.6 ml per breast. Fat grafting complications did not depend on donor site, technique of fat processing, volume of transferred fat, number of procedures, or irradiation. Implant-related complications were observed after 26 of 117 overall procedures (22.2 percent). No association between implant-related complications and irradiation was observed (OR, 1.3; 95 percent CI, 0.4 to 4.1; p = 0.63). Overall complications following fat grafting in nonirradiated [37 of 82 (45.1 percent)] and irradiated [16 of 35 (45.7 percent)] breasts were not statistically different (OR, 1.02; 95 percent CI, 0.41 to 2.57; p = 0.96). Conclusion: Similar outcomes of irradiated and nonirradiated prosthetic breast reconstruction can be achieved with additional fat grafting. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Aortic Valve Replacement in Octogenarians With Prior Cardiac Surgery

BACKGROUND Transcatheter aortic valve implantation (TAVI) has been advocated for very elderly patients with aortic stenosis, and prior cardiac surgery as a less invasive treatment option. Although surgical aortic valve replacement (AVR) is safe and effective in selected elderly patients, the perioperative and mid-term outcomes of AVR in very elderly with prior cardiac surgery are unknown. METHODS The Society of Thoracic Surgeons (STS) Database at our center enrolled 3,735 patients after AVR since 1997. In this time interval, we identified 61 patients 80 years and older who underwent AVR for severe AS or failed aortic bioprosthesis after having prior cardiac surgery. All clinical parameters were derived from the STS database. Follow-up mortality was assessed using the Social Security Death Index. RESULTS The average age of the patients was 83 ± 2 years, 77% were male, and 75% underwent an isolated coronary artery bypass graft (CABG) as their first cardiac procedure. The mean ejection fraction was 0.53 ± 0.13. The CABG was performed concurrently in 49% of patients at the time of redo sternotomy and AVR. Stented bioprosthesis was implanted in 61% of patients and stentless in 39%. Perioperative mortality was 1.6% (1 of 61). One, 3, 5, and 7 year survival rates were 85%, 69%, 63%, and 43%, respectively. Patients with AVR only had similar survival to patients who underwent concomitant AVR and CABG. Type of aortic prosthesis did not influence postoperative survival. CONCLUSIONS In selected patients over the age of 80 with history of prior cardiac surgery, AVR can be performed safely with very good mid-term outcomes. Age alone should not be exclusion criteria for surgical AVR in octogenarians with prior cardiac surgery.

Laryngopharyngeal symptoms in patients with asthma: a cross‐sectional controlled study

To examine the frequency and severity of laryngopharyngeal symptoms in asthmatic patients. The role of laryngopharyngeal reflux disease as a co‐morbid disease to asthma has not been previously reported.

An unusual craniofacial cleft: Amniotic band syndrome as a possible cause

We report the case of a no. 4 Tessier cleft in association with an unknown cleft of the mandible extending to the external auditory meatus. This has not been previously published in the literature and its underlying pathology remains undetermined. The nature of the cleft, possible classifications, and potential embryologic origins will be discussed. Amniotic band syndrome is the most likely cause of the cleft.

Correlation Between the Position of the Hyoid Bone on Lateral Cephalographs and Formant Frequencies

OBJECTIVES The objective of this study is to examine the F1, F2, F3, and F4 during sustained vowels /ɑ/, /i/, /o/, /u/. STUDY DESIGN Prospective cross-sectional study. METHODS Fifty-two consecutive patients aged between 9 years and 38 years were invited to participate in this study. Linear measurements included linear vertical distance from the hyoid bone to the sella turcica (H-S); linear vertical distance from the hyoid bone to the posterior nasal spine (H-PNS); linear measure from the hyoid bone to the most anterior point of the cervical vertebra C3 (H-C3); and linear vertical distance from the hyoid bone to the mandibular plane (H-MP). RESULTS The results showed a moderate and statistically significant correlation between the average fundamental frequency for the vowel /ɑ/ and H-C3, H-S, and H-PNS and another moderate negative correlation between F3 and F4, and the vertical position of the hyoid bone H-C3 and H-S. For the vowel /i/, there was a moderate negative correlation between F1, F3, and F4 and H-S and also a moderate negative correlation between F3 and F4 and H-C3. For the vowel /o/, there was a moderate negative correlation between F4 and H-S and H-PNS. For the vowel /u/, only F4 correlated significantly with H-S. CONCLUSION There is a moderate correlation between the high formants, mostly F4, and the cephalo-caudal position of the hyoid bone.

Differences in parental involvement in the care of children and adolescents with type 1 diabetes mellitus on multiple daily insulin injections versus continuous subcutaneous insulin infusion

Abstract Background: Assessing the degree of involvement of caregivers for children with type 1 diabetes mellitus (T1DM) in their diabetes care, differences in the degree of involvement based on the method of insulin administration (multiple daily injections: MDI/continuous subcutaneous insulin infusion: CSII), and its effect on glycemic control. Methods: This was a cross-sectional study with T1DM patients, ages 6–13 years using a six question survey derived from the Diabetes Family Responsibility Questionnaire (DFRQ). All caregivers (n=140) and participants between ages 11 and 13 (n=60) completed the survey. Results: Significant differences between MDI and CSII caregiver responses were found for responsibility for giving insulin boluses, as well as for rotation of infusion/injection sites (p<0.001 and p=0.03, respectively). A sub-analysis of caregiver responses for caregiver versus child responsibility for giving infusion boluses (excluding shared responsibility) showed that 36% of children in the CSII group had primary responsibility for giving insulin boluses, compared to 17% in the MDI group (p<0.001). The median agreement for all questions combined between participants and caregivers for ages 11–13 (n=60 pairs) was “poor” (κ=0.18). No significant effect of parental involvement on last 2-year average HbA1C was found for CSII or MDI groups (p>0.20). Conclusions: Caregiver reported diabetes care responsibility (mostly parent, mostly child, shared between parent and child) varies for certain aspects of diabetes related care for children ages 6–13, depending upon the mode of insulin administration. Based on the reported degree of parental collaboration, HbA1C did not differ significantly. However, long-term effects are yet to be determined in longitudinal studies.

Nasal endoscopy in total nasal reconstruction

Total nasal reconstruction is a challenging task involving multiple surgical stages. It requires transfer of local and distant tissues to replace three structural layers of the nose: the lining, skeleton, and skin. Besides the paucity of local tissues, creation of the nose is demanding due to functional and aesthetic considerations, limited operative field, and poor visualization inside the created construct. The ability to inspect the newly created nasal cavity is vital in determining the condition of the airways. We present a case of complex total nasal reconstruction, where nasal endoscopy improved control of the reconstructive process and management of exposed hardware.Level of Evidence: Level V, diagnostic study.

Abstract 126: complication rates of fat grafting associated with various modalities of breast reconstruction.

Methods: All breast fat grafting procedures conducted by a single surgeon from 2010 to 2013 were included in the study. The patients’ demographics, comorbidities, indications for fat grafting, technique of fat preparation, volume of transferred fat, and complications resulting from each procedure were noted. Indications for fat grafting were defined as follows: 1. contour deficiency over prosthetic or autologous flap 2. Breast reconstruction after mastectomy and/or implant failure 3. Post lumpectomy 4. Attempt to alter the skin after radiation 5. Congenital or cosmetic. Complications included infection, fat necrosis, cyst formation, wound dehiscence, sterile collection of necrotic fat, and abscess formation.