Enteric Duplication Cyst Located at the Posterior Tongue: A Rare Case Report and Review of the Literature

The lingual localization of an enteric duplication is extremely rare but may present with respiratory and feeding problems that require emergency intervention. A 7-month-old boy was brought to our clinic with feeding difficulties and tongue swelling. Physical examination showed a cystic lesion located near the left side of the tongue base that caused tongue protrusion to the contralateral side. During surgery, a 3-cm diameter opaque thick-walled cyst was found to be very closely adherent to the base of tongue, which was excised in its entirety. Following surgery, the patient fed during the early postoperative period and no complications were observed other than hypersalivation. On histological examination, a cystic lesion lined with intestinal mucosa and goblet cells was found. We present the rare case of a duplication cyst of the posterior tongue, with a literature review

Neurochemical markers in CSF of adolescent and adult SMA patients undergoing nusinersen treatment

Background: There is limited information on neurochemical markers being used to support and monitor the affection of motoneurons in patients with spinal muscular atrophy (SMA). The objective of this study was to examine neurochemical markers in cerebrospinal fluid (CSF) under treatment with the antisense-oligonucleotide (ASO), nusinersen. Methods: We measured markers of axonal degeneration [neurofilament light chain (NfL) and phosphorylated neurofilament heavy chain (pNfH)] along with basic CSF parameters in 25 adolescent and adult SMA type 2 and 3 patients at baseline and after four intrathecal injections of nusinersen. Neurochemical markers were compared with controls. In addition, neurochemical markers in SMA patients were related to the Hammersmith Functional Rating Scale Expanded (HFMSE). Results: No significant difference in neurofilament (Nf) values was observed between SMA and control group, neither at baseline nor after four injections of nusinersen. NfL, protein and quotients of albumin (Qalb) increased slightly in SMA patients after the fourth injection. The slight increase of NfL could be related to the development of mild CSF flow change. No relations were observed between changes in Nf and HFMSE. Conclusion: We assume that Nf levels in CSF in these patients may result from slow disease progression in this stage of disease, pre-existing loss of motoneurons due to long disease duration besides affection of the LMN only. Therefore, we conclude that Nf levels in CSF do not seem useful as diagnostic and monitoring markers in adolescent and adult SMA type 2 and 3 patients

A MSFD complementary approach for the assessment of pressures, knowledge and data gaps in Southern European Seas : the PERSEUS experience

PERSEUS project aims to identify the most relevant pressures exerted on the ecosystems of the Southern European Seas (SES), highlighting knowledge and data gaps that endanger the achievement of SES Good Environmental Status (GES) as mandated by the Marine Strategy Framework Directive (MSFD). A complementary approach has been adopted, by a meta-analysis of existing literature on pressure/impact/knowledge gaps summarized in tables related to the MSFD descriptors, discriminating open waters from coastal areas. A comparative assessment of the Initial Assessments (IAs) for five SES countries has been also independently performed. The comparison between meta-analysis results and IAs shows similarities for coastal areas only. Major knowledge gaps have been detected for the biodiversity, marine food web, marine litter and underwater noise descriptors. The meta-analysis also allowed the identification of additional research themes targeting research topics that are requested to the achievement of GES. 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license.peer-reviewe

Dynamische dorsale Stabilisierung der Lendenwirbelsäule mittels computertomographisch gestützter und fluoroskopisch basierter Navigation (Navitrack TM) sowie mit konventioneller Operationstechnik - eine prospektive, randomisierte Vergleichsstudie

Es wurde eine randomisierte, prospektive Studie an 19 Patienten (9 Frauen, 10 Männer) durchgeführt, die sich einer lumbalen Wirbelsäulenoperation mit einem dorsalen dynamischen Stabilisierungssystem unterzogen haben. Kriterien für die dorsal dynamische Stabilisierung waren degenerative radiologische Veränderungen im Bereich der Lendenwirbelsäule mit chronischer Lumbago mit oder ohne pseudoradikuläre Symptomatik, die mit konservativen Therapieanwendungen über einen mindestens sechsmonatigen Zeitraum erfolglos behandelt wurden. Ein weiteres klinisches Einschlusskriterium bestand in einer deutlichen Schmerzreduktion (> 50 %) nach Facettengelenkinfiltration mit einem Lokalanästhetikum auf den zu operierenden Segmenten. Nach Erfüllen der festgelegten radiologischen und klinischen Einschlusskriterien wurde im Rahmen der präoperativen Datenerhebung jedem Patienten erklärt, dass eine Zuordnung in drei Gruppen nach dem Zufallsprinzip erfolgt. Zwei Gruppen wurden mit dem Navitrack/TM-System, die verbliebene Gruppe mittels konventioneller Operationstechnik versorgt. 5 Patienten (22 Pedikelschrauben) wurden mit CT-(Computertomographie-)gestützter Navigation und 7 Patienten (30 Pedikelschrauben) mit fluoroskopisch basierter Navigationstechnik operiert. Die konventionelle Gruppe beinhaltete 7 Patienten (30 Pedikelschrauben). Ein Systemabbruch während den Navigationstechniken ist nicht aufgetreten. Postoperative Infektionen oder neurologische Komplikationen wurden bei keinem Patienten beobachtet. Anhand der für jeden Patienten postoperativ durchgeführten Computertomographie mit pedikelparallelen Rekonstruktionen konnte die genaue Schraubenlage bestimmt werden. Hierzu wurde ein in dieser Form bisher noch nicht veröffentlichter Score entwickelt, der die Parameter Pedikelwandperforation, Schraubeneindringepunkt, Schraubenverlauf im Wirbelkörper und Schraubenkontakt zum Facettengelenk beinhaltete. In keiner der Gruppen lag eine mediale Fehlplatzierung über 1 mm vor, die mit häufig publizierten neurologischen Komplikationen einhergehen kann. Lediglich einmal wurde eine laterale Fehlplatzierung von 4 mm in der konventionellen Gruppe dokumentiert. In der Scorebewertung zeigten sich die besten Ergebnisse für die CT-basierte Navigation, gefolgt von der fluoroskopisch basierten Gruppe. Die Genauigkeit der Pedikelschraubenplatzierung ist hierbei vergleichbar mit den Resultaten anderer Studien. Unsere Studie zeigt, dass durch erfahrene Wirbelsäulenchirurgen sowohl konventionell-manuell als auch navigiert gute Ergebnisse in der Platzierung von Pedikelschrauben erreicht werden. Dennoch sind unserer Meinung nach spezifische Untersuchungsmethoden für ein dynamisches Stabilisationssystem notwendig, um eine korrekte Pedikelschraubenlage zu gewährleisten, da dieser Aspekt für das dynamische System als Langzeitimplantat theoretisch von besonderer Bedeutung ist. Eine hohe Inzidenz an Schraubenlockerungen durch Fehlplatzierungen könnte die Rate an Revisionsoperationen nachhaltig beeinflussen. Letztlich bleibt es abzuwarten, ob durch die verbesserte Schraubenlage im Mittel- und Langzeitverlauf mit der computerunterstützten Navigation eine Reduktion von Revisionsoperationen erzielt werden kann. Hier scheint nach unseren Ergebnissen die Navigation die optimale Schraubenlage zu unterstützen

Association of duodenal and biliary atresias in Martinez–Frias Syndrome: A very rare case

AbstractMartinez–Frias Syndrome (MFS) is a very rarely seen condition with autosomal recessive inheritance and characterized by the presence of duodenal atresia, extrahepatic biliary atresia, hypoplastic pancreas, intrauterine growth retardation (IUGR) with or without tracheoesophageal fistula. To best of our knowledge, only six patients with MFS have been reported in the literature so far

Preliminary investigations on intradiscal pressures during daily activities: an in vivo study using the merino sheep.

PURPOSE: Currently, no studies exist, which attest the suitability of the ovine intervertebral disc as a biomechanical in vivo model for preclinical tests of new therapeutic strategies of the human disc. By measuring the intradiscal pressure in vivo, the current study attempts to characterize an essential biomechanical parameter to provide a more comprehensive physiological understanding of the ovine intervertebral disc. METHODS: Intradiscal pressure (IDP) was measured for 24 hours within the discs L2-L3 and L4-L5 via a piezo-resistive pressure sensor in one merino sheep. The data were divided into an activity and a recovery phase and the corresponding average pressures for both phases were determined. Additionally, IDPs for different static and dynamic activities were analyzed and juxtaposed to human data published previously. After sacrificing the sheep, the forces corresponding to the measured IDPs were examined ex vivo in an axial compression test. RESULTS: The temporal patterns of IDP where pressure decreased during activity and increased during rest were comparable between humans and sheep. However, large differences were observed for different dynamic activities such as standing up or walking. Here, IDPs averaged 3.73 MPa and 1.60 MPa respectively, approximately two to four times higher in the ovine disc compared to human. These IDPs correspond to lower ex vivo derived axial compressive forces for the ovine disc in comparison to the human disc. For activity and rest, average ovine forces were 130 N and 58 N, compared to human forces of 400-600 N and 100 N, respectively. CONCLUSIONS: In vivo IDPs were found to be higher in the ovine than in the human disc. In contrast, axial forces derived ex vivo were markedly lower in comparison to humans. Both should be considered in future preclinical tests of intradiscal therapies using the sheep. The techniques used in the current study may serve as a protocol for measuring IDP in a variety of large animal models

The Effect of Erector Spinae Plane Block on Laparoscopic Cholecystectomy Anesthesia: Analysis of Opioid Consumption, Sevoflurane Consumption, and Cost

WOS:000512315600001PubMed: 32023174Background: Erector spinae plane (ESP) block has been increasingly suggested for laparoscopic cholecystectomy (LC) as a part of multimodal analgesia in many studies. However, there is not any study that investigated the perioperative effects of ESP block on anesthetic agent consumption and cost of LC anesthesia. This is the first study that evaluates the effect of ESP block in terms of cost-effectiveness, intraoperative consumption of inhalation agents, and perioperative consumption of opioids. Materials and Methods: In this prospective observational study, 81 patients who underwent LC were included. Patients were divided into two groups: In Group ESP (n = 39) bilateral ultrasound-guided ESP block was performed in preoperative period and in Group non-ESP (n = 42) ESP block was not performed. After standard general anesthesia protocol, anesthesia was maintained with 2% sevoflurane in 50% air and 50% oxygen with controlled ventilation in both groups. All patients were monitored with electrocardiography, noninvasive blood pressure, pulse oximetry, end-tidal carbon dioxide, and bispectral index. The consumption of sevoflurane and opioids in the intraoperative and postoperative 24 hours was recorded. The costs of drugs were determined by multiplying total consumed amounts with unit prices. Results: The costs and the consumed amounts of remifentanyl, sevoflurane, and tramadol were significantly higher in non-ESP group in the perioperative period (respectively, P < .001, P = .01, and P < .001). Conclusions: ESP block for LC decreased the consumed amount and cost of inhaled agents and opioids in the perioperative period

The Effect of Erector Spinae Plane Block on Laparoscopic Cholecystectomy Anesthesia: Analysis of Opioid Consumption, Sevoflurane Consumption, and Cost

WOS: 000512315600001PubMed: 32023174Background: Erector spinae plane (ESP) block has been increasingly suggested for laparoscopic cholecystectomy (LC) as a part of multimodal analgesia in many studies. However, there is not any study that investigated the perioperative effects of ESP block on anesthetic agent consumption and cost of LC anesthesia. This is the first study that evaluates the effect of ESP block in terms of cost-effectiveness, intraoperative consumption of inhalation agents, and perioperative consumption of opioids. Materials and Methods: In this prospective observational study, 81 patients who underwent LC were included. Patients were divided into two groups: In Group ESP (n = 39) bilateral ultrasound-guided ESP block was performed in preoperative period and in Group non-ESP (n = 42) ESP block was not performed. After standard general anesthesia protocol, anesthesia was maintained with 2% sevoflurane in 50% air and 50% oxygen with controlled ventilation in both groups. All patients were monitored with electrocardiography, noninvasive blood pressure, pulse oximetry, end-tidal carbon dioxide, and bispectral index. The consumption of sevoflurane and opioids in the intraoperative and postoperative 24 hours was recorded. The costs of drugs were determined by multiplying total consumed amounts with unit prices. Results: The costs and the consumed amounts of remifentanyl, sevoflurane, and tramadol were significantly higher in non-ESP group in the perioperative period (respectively, P < .001, P = .01, and P < .001). Conclusions: ESP block for LC decreased the consumed amount and cost of inhaled agents and opioids in the perioperative period

24-hours-proportion of ovine IDPs and representative pressure profiles.

<p>a) Frequency distribution of the total data set of IDPs throughout the 24 hour test period subdivided into <i>active phases</i> and <i>rest</i> and 10-seconds real-time profiles of the a) four different <i>static</i> and b) three different <i>dynamic activities</i>.</p

Methology of the in vivo experiment.

<p>Activities of the sheep were monitored by video and the experimental staff. The two identical pressure sensors [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0069610#B1" target="_blank">1</a>] were connected to a telemetry transmitter [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0069610#B2" target="_blank">2</a>] carried by the experimental animal inside a backpack. The signal was transferred wirelessly to the receiver, passed a measuring amplifier and was collected together with the footage in a data monitoring system at a rate of 50 Hz.</p