Graft harvesting for revascularization in the head and neck.

The techniques for revascularization in the neurocranium, skull base, and neck continue to evolve at an exciting pace. In this body of literature, however, techniques for harvesting radial artery and saphenous vein grafts are mainly reported using traditional open techniques. Minimally invasive procedures are fast becoming an alternative to open techniques in many fields and have the potential to become the standard of care. The cardiovascular literature is replete with reports of endoscopically harvested vascular grafts. This article reviews both methods, since the current state of the art involves knowledge of open and endoscopic harvesting techniques

A Biomechanical Evaluation of a Next-Generation Integrated and Modular ACDF Device Possessing Full-Plate, Half-Plate, and No-Profile Fixation Iterations.

Study Design: In vitro biomechanical study. Objectives: The objective of this in vitro biomechanical range-of-motion (ROM) study was to evaluate spinal segmental stability following fixation with a novel anterior cervical discectomy and fusion (ACDF) device ( novel device ) that possesses integrated and modular no-profile, half-plate, and full-plate fixation capabilities. Methods: Human cadaveric (n = 18, C3-T1) specimens were divided into 3 groups (n = 6/group). Each group would receive one novel device iteration. Specimen terminal ends were potted. Each specimen was first tested in an intact state, followed by anterior discectomy (C5/C6) and iterative instrumentation. Testing order: (1) novel device (group 1, no-profile; group 2, half-plate; group 3, full-plate); (2) novel device (all groups) with lateral mass screws (LMS); (3) traditional ACDF plate + cage; (4) traditional ACDF plate + cage + LMS. A 2 N·m moment was applied in flexion/extension (FE), lateral bending (LB), and axial rotation (AR) via a kinematic testing machine. Segmental ROM was tracked and normalized to intact conditions. Comparative statistical analyses were performed. Results: Key findings: (1) the novel half- and full-plate constructs provided comparable reduction in FE and LB ROM to that of traditional plated ACDF ( Conclusions: The novel ACDF device may be a versatile alternative to traditional no-profile and independent plating techniques, as it provides comparable ROM reduction in all principle motion directions, across all device iterations

Comparison of the prognostic value of tumour and patient related factors in patients undergoing potentially curative surgery for colon cancer

<b>Aim</b>: To comprehensively compare the prognostic value of tumour and patient-related factors in patients undergoing curative surgery for colon cancer. <b>Methods</b>: From a database of 287 patients who underwent elective resection between 1997-2005, tumour factors including stage and host factors including systemic inflammatory response (modified Glasgow Prognostic Score (mGPS)) were identified. <b>Results</b>: Median follow-up was 65 months. Over this time period 125 patients died, 80 from cancer. On multivariate analysis of all significant patient and tumour related factors, Dukes stage (P<0.01), vascular invasion (P<0.01), and the mGPS (P<0.01) were independently associated with cancer-survival. Of the patient-related factors, age (P<0.01), haemoglobin (P<0.01), white-cell (P<0.01), neutrophil (P<0.01) and platelet (P<0.01) counts and alkaline phosphatase (P<0.01) were most significantly associated with the mGPS. <b>Conclusion</b>: In addition to tumour-related factors such as Dukes stage and vascular invasion, the pre-operative mGPS should be included to guide prognosis in patients undergoing curative resection for colon cancer

Computed tomographic angiography for the evaluation of aneurysmal subarachnoid hemorrhage.

OBJECTIVES: Computed tomography (CT) followed by lumbar puncture (LP) is currently the criterion standard for diagnosing subarachnoid hemorrhage (SAH) in the emergency department (ED); however, this is based on studies involving a limited number of patients. The authors sought to assess the ability of CT angiography (CTA), a new diagnostic modality, in conjunction with CT/LP to detect SAH. METHODS: Consecutive patients presenting to the ED with symptoms concerning for SAH were approached. All patients had an intravenous catheter placed and underwent a noncontrast head CT followed by CTA. Patients whose CT did not reveal evidence of SAH or other pathology underwent LP in the ED. CTAs were read within 24 hours by a neuroradiologist blinded to the patient\u27s history. RESULTS: A total of 131 patients were approached, 116 were enrolled, and 106 completed the study. In six of 116 patients (5.1%), aneurysm was found on CTA with normal CT and positive findings on LP; three had a positive CTA with normal CT and LP findings (one of which had a negative cerebral angiogram), and there was one false-positive CTA. Follow-up of all 131 patients showed no previously undiagnosed intracranial pathology. In this patient population, 4.3% (5/116) were ultimately found to have an SAH and/or aneurysm. CONCLUSIONS: In this pilot study, CTA was found to be useful in the detection of cerebral aneurysms and may be useful in the diagnosis of aneurysmal SAH. A larger multicenter study would be useful to confirm these results

Esophageal perforation secondary to malignant gastric outlet obstruction: a case report

Background Esophageal perforation is a rare presenting sign of gastric cancer. To date, only nine case reports of this phenomenon have been previously published. Case presentation Esophageal perforation was diagnosed radiographically during workup for acute chest pain in a 67-year-old man. Emergent endoscopy confirmed esophageal perforation and biopsied a pre-pyloric mass confirmed to be adenocarcinoma. The perforation was managed with endoscopically placed transluminal pleural and mediastinal drains and esophageal stenting. The gastric outlet obstruction was temporized with a transpyloric stent. After the patient recovered from sepsis, distal gastrectomy was performed and he made a full recovery. Conclusions Rarely, pre-pyloric gastric cancer can present with Boerhaave syndrome, spontaneous esophageal perforation associated with forceful vomiting. We present the tenth report in the literature of this phenomenon and the first to be initially treated with endoscopic stenting and transluminal thoracoscopic drainage. When endoscopic management is used to treat patients with Boerhaave syndrome, it may be beneficial to examine the entire stomach to evaluate for malignant etiology

The Evaluation of Contralateral Breast Lesions in Breast Cancer Patients Using Reduction Mammoplasty

Purpose: This study evaluated the importance of routine pathological examination of contralateral breast specimens in breast cancer patients using reduction mammoplasty. Methods: The weight of breast tissue resected from the contralateral breast in 71 patients and the number of slices used for pathological evaluation were recorded. Breast lesions found in the contralateral breast and accompanying lesions with tumors were examined. Results: High risk proliferative lesions were reported in the contralateral breast of eight (11.2%) patients, and low-risk lesions were detected in 18 (25%). While the mean age of the patients with high-risk lesions was 45.6, it was 52.8 for the other patients (p = 0.036). Conclusion: Bilateral reduction mammoplasty may be beneficial to delineate some pathologies in contralateral breasts even in those patients with normal clinical and radiological findings. The incidental discovery of these pathologies is much more likely in young breast cancer patients