Intraoral electrical muscle stimulation in the treatment of snoring

The tone of the intraoral und pharyngeal muscles of the upper airway is of particular importance for the development of snoring. By increasing the tone with electrical stimulation, a reduction in snoring may be achieved. The aim of the study was to record the effects of intraoral muscle stimulation during the day on snoring at night. The prospective bi-centric study included 16 patients with snoring and mild obstructive sleep apnoea (Apnoea Hypopnoea Index [AHI] < 15, BMI < 32). After initial polygraphy, snoring was monitored over 2 weeks (baseline) using a visual analogue scale (VAS; 0-10). This was followed by a 6-week treatment phase (2 × 20 min daily) with an intraoral electrical stimulation device. During and up to 2 weeks after therapy, snoring intensity in addition to use and potential side effects were documented on a daily basis. Three patients discontinued therapy because of technical problems. The 13 remaining patients (11 male/2 female, BMI 26.9 ± 3.2, AHI 9.3 ± 4.6) underwent per-protocol analysis. The mean snoring score was reduced from 5.6 ± 1.1 (baseline) to 3.2 ± 2.7 (after therapy) and remained stable until 2 weeks after treatment (3.3 ± 2.4). In 7 patients (53.9%) the score was reduced by more than 50%. Patients with an AHI < 10 responded better to therapy. No unexpected events occurred. In the present pilot study, the first signs of the effectiveness of intraoral muscle stimulation in snoring patients were shown. In addition to a technical improvement of the stimulator, carrying out controlled trials and assessing potential influencing factors on the success of therapy are necessary.

Long term outcome of patients suffering from cancer and Takotsubo syndrome or myocardial infarction

BACKGROUND

The pathophysiology of takotsubo syndrome (TTS) is unclear so far. There is strong association of the occurrence of TTS and malignant diseases. An association between malignant diseases and myocardial infarction (MI) was found recently and ascribed to common molecular and lifestyle mechanisms.

AIM

To compare the outcome of patients with MI or TTS and malignant diseases in a matched cohort.

METHODS

Patients with TTS or with MI (n = 138 per group) were matched for age and sex and assessed retrospectively and prospectively. Occurrence of malignant diseases and clinical outcome was followed up over 4 years.

RESULTS

At the time of the index event, 8 (5.8%) MI patients and 17 (12.3%) TTS patients were already diagnosed with cancer. During follow up, the rate of patients who developed cancer was significantly higher in the TTS group than in the MI group (log rank P = 0.01). Mortality was higher in the TTS group, but also in the subgroup of TTS patients with cancer (log rank P < 0.05). In the multivariate analysis, male gender, renal impairment and the history of cancer was associated with an increased risk for death.

CONCLUSIONS

Patients with TTS have more often malignant diseases than patients with MI. Cancer patients with TTS have a worse clinical outcome. The underlying mechanism is unclear yet, but the results point at TTS being the syndrome of an extracardiac disease rather than a disease of cardiac origin. Longer and closer follow up of patients with TTS and further studies addressing the mechanism of TTS are needed.

Regional recurrence in a case series of patients with carcinoma of the nasal cavity - therapeutic implications

INTRODUCTION

Surgery is the primary treatment option for squamous cell carcinomas of the nasal cavity (NCSCC). Nodal involvement is rare at the time of initial diagnosis, and the role of diagnostic neck dissection as well as potential adjuvant irradiation of the neck remains controversial. The objective of this study was to assess the oncologic outcomes of patients with NCSCC with special emphasis on cervical lymph node treatment and recurrence.

METHODS

37 previously untreated patients were included in this study. Demographic data, tumor characteristics, therapeutic management, and clinical outcome were analyzed.

RESULTS

Patients with advanced stage tumors were slightly overrepresented in this study and overall 3-year disease-free survival was 63%. A surgical treatment approach was pursued in 89% (n=33) of patients. After total rhinectomy, there were no cases of local recurrence. Overall, 12% (n=4) of all surgically treated patients developed local recurrence. While in 45% of patients (n=15), neck dissection was performed at the time of tumor resection, initial lymph node metastasis was histologically confirmed in only 6% (n=2) of surgically treated patients. Cervical lymph node recurrence occurred in 18% (n=6) of patients, predominantly those with advanced stage tumors, despite prior treatment of the neck.

CONCLUSION

Excellent local control is achievable for patients with NCSCC, especially with radical tumor resection. While cervical lymph node metastasis is rare at the time of diagnosis, regional lymph node recurrence needs to be taken into consideration when planning therapy and follow-up. Multimodal treatment of the neck may be required for patients with advanced stage tumors.

Percutaneous Closure of Left Atrial Appendage significantly affects Lipidome Metabolism

Patients with non-valvular atrial fibrillation (AF) and a high risk for oral anticoagulation can be treated by percutaneous implantation of left atrial appendage occlusion devices (LAAC) to reduce the risk of cardio-embolic stroke. This study evaluates whether LAAC may influence lipid metabolism, which has never been investigated before. Patients with successful LAAC were included consecutively. Venous peripheral blood samples of patients were collected immediately before (T0, baseline) and 6 months after (T1, mid-term) LAAC. A targeted metabolomics approach based on electrospray ionization liquid chromatography-mass spectrometry (ESI-LC-MS/MS) and MS/MS measurements was performed. A total of 34 lipids revealed a significant change from baseline to mid-term follow-up after successful LAAC. Subgroup analysis revealed confounding influence by gender, age, diabetes mellitus type II, body mass index, left ventricular ejection fraction, creatinine and NT-proBNP. After multivariable adjustment within logistic regression models, these 34 lipids were still significantly altered after LAAC. Successful percutaneous LAAC may affect lipid metabolism and thereby may potentially affect pro-atherogenic and cardio-toxic effects.

Risk stratification in Takotsubo syndrome: a role of mitral annular plane systolic excursion

AIM

Takotsubo syndrome (TTS) patients have a higher mortality rate than the general population. Our study was conducted to determine the short- and long-term outcome of TTS patients associated with a significantly compromised mitral annular plane systolic excursion (MAPSE) on hospital admission.

METHODS AND RESULTS

Our institutional database constituted a collective of 53 patients diagnosed with TTS between 2003 and 2016. The patients were classified into two groups based on the MAPSE, with those presenting with an MAPSE <1 cm on admission categorized into one group (n = 20, 38%) and those presenting with MAPSE ≥1 cm (n = 33, 62%) categorized into another group. Preliminary results indicated that patients with an MAPSE < 1 cm had a greater risk of developing thromboembolic events. The long-term mortality was significantly higher in TTS patients with an MAPSE < 1 cm. In the multivariate Cox regression analysis, cardiogenic shock (hazard ratio 3.5; 95% confidence interval: 1.2-10.7; P = 0.02) and MAPSE < 1 cm (hazard ratio 5.1; 95% confidence interval: 1.3-19.2; P = 0.01) figured as independent predictors of the mortality.

CONCLUSION

Although the short-term mortality rates among TTS patients diagnosed with a reduced MAPSE on admission were as similar as without reduced MAPSE, the long-term mortality rates among TTS patients diagnosed with a reduced MAPSE on admission were significantly higher. There is an urgent need for randomized trials, which could help define uniform clinical management strategies for high-risk TTS patients.

Calcification of the iliac arteries: a marker for leakage risk in rectal anastomosis-a blinded clinical trial

PURPOSE

Anastomotic leakage (AL) is associated with increased morbidity and mortality after colorectal surgery. Calcification of the arteries has been identified as a risk factor for cardiovascular events and can be reliably measured on computed tomography using software assistance. The aim of this prospective study was to prove the value of calcium scoring of the iliac arteries as a predictor of AL after rectal anastomosis.

METHODS

Consecutive patients who underwent colorectal resection with rectal anastomosis were analyzed. Diagnostic computed tomography images were used to detect calcification of the arteries supplying the rectal anastomosis. Logistic regression analysis was used to determine the relationship between vascular calcification and AL.

RESULTS

Of 139 included and analyzed patients, AL occurred in 15 (11%). The volume and calcium scores were significantly higher in the infrarenal aorta, the left and right common iliac artery, and the left internal iliac artery. In univariate analysis, calcification of the left internal iliac artery and both internal iliac arteries combined correlated with the occurrence of the primary endpoint. A receiver operating curve analysis led to the cut-off values of 30 and 6 for the volume score and calcium score, respectively. They provide a negative predictive value of 0.97 and a positive predictive value of 0.19.

CONCLUSIONS

Calcification in the iliac arteries appears to be a good marker for the risk of leakage after rectal anastomosis. The calcification scoring system is easy to calculate after computed tomography and may aid in patient selection to create a protective ileostomy.

Correction to: Occlusion of left atrial appendage affects metabolomic profile: focus on glycolysis, tricarboxylic acid and urea metabolism

The article Occlusion of left atrial appendage aff ects metabolomic profile:focus on glycolysis, tricarboxylic acid and urea metabolism, written by K. Sattler, M. Behnes, C. Barth, A. Wenke, B. Sartorius, I. El-Battrawy, K. Mashayekhi, J. Kuschyk, U. Hoffmann, T. Papavasiliu, C. Fastner, S. Baumann, S. Lang, X. Zhou, G. Yücel, M. BorggrefeI, Akin, was originally published Online First without open access.

Ultra-short-course booster is effective in recurrent grass pollen-induced allergic rhinoconjunctivitis

Background

A relevant proportion of allergic rhinoconjunctivitis (ARC) patients experience recurrent symptoms after successfully completing allergen immunotherapy (AIT). This prospective, controlled, noninterventional study used internationally standardized instruments to determine the clinical effects of a preseasonal, ultra‐short‐course booster AIT on clinical outcome parameters.

Methods

This two‐arm study included patients aged ≥12 years with recurrent grass pollen‐induced seasonal AR who had completed a successful course of any grass pollen AIT at least 5 years before enrolment. Overall, 56 patients received one preseasonal short‐course booster AIT using tyrosine‐absorbed grass pollen allergoids containing the adjuvant monophosphoryl lipid A (MPL^®); 51 control patients received symptomatic medication. The combined symptom and medication score (CSMS) was recorded in the (peak) grass pollen season. Furthermore, concomitant (antiallergic) medication use, the patients’ state of health, Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ) results and safety/tolerability of the treatment were assessed.

Results

The CSMS in the peak grass pollen season was significantly lower in the booster AIT group (Δ=38.4%, P<.01). Moreover, significantly more patients in this group used no concomitant antiallergic medication throughout the peak grass pollen season. Twice as many patients in the booster AIT group as in the control group reported having a better state of health than in the preceding season. MiniRQLQ results showed significant differences favouring the booster AIT. The booster AIT was generally well tolerated, with only two patients reporting mild, grade 1 systemic adverse events.

Conclusion

Booster AIT using tyrosine‐absorbed allergoids containing the adjuvant MPL^® effectively prevents re‐occurrence of symptoms in patients with grass pollen‐induced ARC.

Genetic immunization with mouse thyrotrophin hormone receptor plasmid breaks self-tolerance for a murine model of autoimmune thyroid disease and Graves' orbitopathy

Experimental models of Graves' hyperthyroid disease accompanied by Graves' orbitopathy (GO) can be induced efficiently in susceptible inbred strains of mice by immunization by electroporation of heterologous human TSH receptor (TSHR) A-subunit plasmid. In this study, we report on the development of a bona fide murine model of autoimmune Graves' disease induced with homologous mouse TSHR A-subunit plasmid. Autoimmune thyroid disease in the self-antigen model was accompanied by GO and characterized by histopathology of hyperplastic glands with large thyroid follicular cells. Examination of orbital tissues showed significant inflammation in extra-ocular muscle with accumulation of T cells and macrophages together with substantial deposition of adipose tissue. Notably, increased levels of brown adipose tissue were present in the orbital tissue of animals undergoing experimental GO. Further analysis of inflammatory loci by ¹⁹ F-magnetic resonance imaging showed inflammation to be confined to orbital muscle and optic nerve, but orbital fat showed no difference in inflammatory signs in comparison to control β-Gal-immunized animals. Pathogenic antibodies induced to mouse TSHR were specific for the self-antigen, with minimal cross-reactivity to human TSHR. Moreover, compared to other self-antigen models of murine Graves' disease induced in TSHR knock-out mice, the repertoire of autoantibodies to mouse TSHR generated following the breakdown of thymic self-tolerance is different to those that arise when tolerance is not breached immunologically, as in the knock-out models. Overall, we show that mouse TSHR A-subunit plasmid immunization by electroporation overcomes tolerance to self-antigen to provide a faithful model of Graves' disease and GO.

Dynamic measurement of near-field radiative heat transfer

Super-Planckian near-field radiative heat transfer allows effective heat transfer between a hot and a cold body to increase beyond the limits long known for black bodies. Until present, experimental techniques to measure the radiative heat flow relied on steady-state systems. Here, we present a dynamic measurement approach based on the transient plane source technique, which extracts thermal properties from a temperature transient caused by a step input power function. Using this versatile method, that requires only single sided contact, we measure enhanced radiative conduction up to 16 times higher than the blackbody limit on centimeter sized glass samples without any specialized sample preparation or nanofabrication.

Occlusion of left atrial appendage affects metabolomic profile: focus on glycolysis, tricarboxylic acid and urea metabolism

BACKGROUND

Left atrial appendage (LAA) closure (LAAC) by implantation of an occlusion device is an established cardiac intervention to reduce risk of stroke while avoiding intake of oral anticoagulation medication during atrial fibrillation. Cardiac interventions can alter local or systemic gene and protein expression. Effects of LAAC on systemic metabolism have not been studied yet.

OBJECTIVES

We aimed to study the effects of interventional LAAC on systemic metabolism.

METHODS

Products of glycolysis, tricarboxylic acid and urea metabolism were analyzed by ESI-LC-MS/MS and MS/MS using the AbsoluteIDQ™ p180 Kit in plasma of 44 patients undergoing successful interventional LAAC at baseline (T0) and after 6 months (T1).

RESULTS

During follow up, plasma concentrations of several parameters of glycolysis and tricarboxylic acid cycle (TCA) and urea metabolism increased (alanine, hexose, proline, sarcosine), while others decreased (aspartate, glycine, SDMA, serine). Multivariate linear regression analysis showed that time after interventional LAAC was an independent predictor for metabolite changes, including the decrease of SDMA (beta -0.19, p < 0.01) and the increase of sarcosine (beta 0.16, p < 0.01).

CONCLUSIONS

Successful interventional LAAC affects different pathways of the metabolome, which are probably related to cardiac remodeling. The underlying mechanisms as well as the long term effects have to be studied in the future.

[Pathophysiology, diagnosis and treatment of Zenker's diverticulum]

Zenker's diverticulum occurs at the dorsal pharyngoesophageal junction through Killian's dehiscence and is caused by increased intrabolus pressure. Symptomatic disease most frequently affects male elderly patients. Primary symptom is oropharyngeal dysphagia, as well as regurgitation of undigested food, halitosis, and chronic aspiration. A barium swallow study is performed to confirm diagnosis. Treatment options for symptomatic patients include open surgery, as well as transoral rigid or flexible endoscopic procedures. Transoral procedures have become the main treatment approach over the past year thanks to reduced intraoperative complication rates compared to open surgery. The septum dividing the diverticulum from the esophagus is most commonly divided by a stapler device, papillotome, or laser. For high-risk patients who are poor candidates for general anesthesia, the procedure can be performed via flexible endoscopy in awake patients, albeit at an increased risk of recurrence.

The Nuclear Receptor Nr4a1 Acts as a Microglia Rheostat and Serves as a Therapeutic Target in Autoimmune-Driven Central Nervous System Inflammation

Microglia cells fulfill key homeostatic functions and essentially contribute to host defense within the CNS. Altered activation of microglia, in turn, has been implicated in neuroinflammatory and neurodegenerative diseases. In this study, we identify the nuclear receptor (NR) Nr4a1 as key rheostat controlling the activation threshold and polarization of microglia. In steady-state microglia, ubiquitous neuronal-derived stress signals such as ATP induced expression of this NR, which contributed to the maintenance of a resting and noninflammatory microglia phenotype. Global and microglia-specific deletion of Nr4a1 triggered the spontaneous and overwhelming activation of microglia and resulted in increased cytokine and NO production as well as in an accelerated and exacerbated form of experimental autoimmune encephalomyelitis. Ligand-induced activation of Nr4a1 accordingly ameliorated the course of this disease. Our current data thus identify Nr4a1 as regulator of microglia activation and potentially new target for the treatment of inflammatory CNS diseases such as multiple sclerosis.

4D DSA for Dynamic Visualization of Cerebral Vasculature: A Single-Center Experience in 26 Cases

BACKGROUND AND PURPOSE

4D DSA allows acquisition of time-resolved 3D reconstructions of cerebral vessels by using C-arm conebeam CT systems. The aim of our study was to evaluate this new method by qualitative and quantitative means.

MATERIALS AND METHODS

2D and 4D DSA datasets were acquired in patients presenting with AVMs, dural arteriovenous fistulas, and cerebral aneurysms. 4D DSA was compared with 2D DSA in a consensus reading of qualitative and quantitative parameters of AVMs (eg, location, feeder, associated aneurysms, nidus size, drainage, Martin-Spetzler Score), dural arteriovenous fistulas (eg, fistulous point, main feeder, diameter of the main feeder, drainage), and cerebral aneurysms (location, neck configuration, aneurysmal size). Identifiability of perforators and diameters of the injection vessel (ICA, vertebral artery) were analyzed in 2D and 4D DSA. Correlation coefficients and a paired t test were calculated for quantitative parameters. The effective patient dose of the 4D DSA protocol was evaluated with an anthropomorphic phantom.

RESULTS

In 26 patients, datasets were acquired successfully (AVM = 10, cerebral aneurysm = 10, dural arteriovenous fistula = 6). Qualitative and quantitative evaluations of 4D DSA in AVMs (nidus size: r = 0.99, P = .001), dural arteriovenous fistulas (diameter of the main feeder: r = 0.954, P = .03), and cerebral aneurysms (aneurysmal size: r = 1, P = .001) revealed nearly complete accordance with 2D DSA. Perforators were comparably visualized with 4D DSA. Measurement of the diameter of the injection vessel in 4D DSA was equivalent to that in 2D DSA (P = .039). The effective patient dose of 4D DSA was 1.2 mSv.

CONCLUSIONS

4D DSA is feasible for imaging of AVMs, dural arteriovenous fistulas, and cerebral aneurysms. 4D DSA offers reliable visualization of the cerebral vasculature and may improve the understanding and treatment of AVMs and dural arteriovenous fistulas. The number of 2D DSA acquisitions required for an examination may be reduced through 4D DSA.

Electrochemical tuning of the optical properties of nanoporous gold

Using optical in-situ measurements in an electrochemical environment, we study the electrochemical tuning of the transmission spectrum of films from the nanoporous gold (NPG) based optical metamaterial, including the effect of the ligament size. The long wavelength part of the transmission spectrum around 800 nm can be reversibly tuned via the applied electrode potential. The NPG behaves as diluted metal with its transition from dielectric to metallic response shifted to longer wavelengths. We find that the applied potential alters the charge carrier density to a comparable extent as in experiments on gold nanoparticles. However, compared to nanoparticles, a NPG optical metamaterial, due to its connected structure, shows a much stronger and more broadband change in optical transmission for the same change in charge carrier density. We were able to tune the transmission through an only 200 nm thin sample by 30%. In combination with an electrolyte the tunable NPG based optical metamaterial, which employs a very large surface-to-volume ratio is expected to play an important role in sensor applications, for photoelectrochemical water splitting into hydrogen and oxygen and for solar water purification.

Percutaneous Irreversible Electroporation: Long-term survival analysis of 71 patients with inoperable malignant hepatic tumors

Aim of this retrospective analysis was to evaluate the survival times after percutaneous irreversible electroporation (IRE) in inoperable liver tumors not amenable to thermal ablation. 71 patients (14 females, 57 males, median age 63.5 ± 10.8 years) with 103 liver tumors were treated in 83 interventions using IRE (NanoKnife® system). The median tumor short-axis diameter was 1.9 cm (minimum 0.4 cm, maximum 4.5 cm). 35 patients had primary liver tumors and 36 patients had liver metastases. The Kaplan-Meier method was employed to calculate the survival rates, and the different groups were compared using multivariate log-rank and Wilcoxon tests. The overall median survival time was 26.3 months; the median survival of patients with primary land secondary liver cancer did not significantly differ (26.8 vs. 19.9 months; p = 0.41). Patients with a tumor diameter >3 cm (p < 0.001) or more than 2 lesions (p < 0.005) died significantly earlier than patients with smaller or fewer tumors. Patients with hepatocellular carcinoma and Child-Pugh class B or C cirrhosis died significantly earlier than patients with Child-Pugh class A (p < 0.05). Patients with very early stage HCC survived significantly longer than patients with early stage HCC with a median survival of 22.3 vs. 13.7 months (p < 0.05).

Are routine ultrasound examinations helpful in the detection of bleeding complications following laparoscopic inguinal hernia repair?

PURPOSE

Intraabdominal bleeding is a dreaded complication after laparoscopic transabdominal preperitoneal inguinal hernia repairs. Routine postoperative sonographic (US) examination and hemoglobin measurement have been suggested to identify bleeding after surgery. We retrospectively assessed the value of these tests.

METHODS

A total of 995 consecutive patients admitted for laparoscopic inguinal hernia repair to a single teaching hospital were analyzed. US examinations were performed postoperatively on the operative day to identify intraabdominal bleeding. In addition, hemoglobin measurements were obtained on the first postoperative day.

RESULTS

Postoperative US examinations were performed on 971 patients (97.6%). Of these, 945 were examined within 24 hours of surgery. Reoperation was necessary in 1.1% (11/995) of the patients because of a persistent seroma in five cases, intraabdominal or inguinal bleeding or hematomas in five cases, and a trocar hernia in one case. In none of the 11 patients requiring reoperation did US examination or hemoglobin measurement indicate acute bleeding or hematoma.

CONCLUSIONS

Routine postoperative US examination and hemoglobin measurement within the first 24 hours of surgery are not suitable for identifying patients with intraabdominal bleeding who require a reoperation. Instead, US examination and hemoglobin measurement should be part of the patient workup when there is a clinical suspicion of a postoperative complication. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:145-149, 2017.

Intrasurgical dignity assessment of hepatic tumors using semi-quantitative strain elastography and contrast-enhanced ultrasound for optimisation of liver tumor surgery

OBJECTIVE

To evaluate the efficacy of strain elastography (SE) using semi-quantitative measurement methods compared to constrast enhanced ultrasound during liver tumor surgery (Io-CEUS) for dignity assessment of focal liver lesions(FLL).

MATERIAL AND METHODS

Prospective data acquisition and retrospective analysis of US data of 100 patients (116 lesions) who underwent liver tumor surgery between 10/2010 and 03/2016. Retrospective reading of SE color patterns was performed establishing groups depending on dominant color (>50% blue = stiff, inhomogenous, >50% yellow/red/green = soft tissue). Semi-quantitative analysis was performed by Q-analysis based on a scale from 0 (soft) to 6 (stiff). 2 ROIs were placed centrally, 5 ROIs in the lesion's surrounding tissue. Io-CEUS was performed by bolus injection of 5-10 ml sulphurhexaflourid microbubbles evaluating wash-in- and -out- kinetics in arterial, portal venous and late phase. Histopathology after surgical resection served as goldstandard.

RESULTS

100 patients (m: 65, f: 35, mean age 60.5 years) with 116 liver lesions were included. Lesion's size ranged from 0.5 to 8.4 cm (mean 2.42 cm SD±1.44 cm). Postoperative histology showed 105 malignant and 11 benign lesions. Semi-quantitative analysis showed central indurations of >2.5 in 76/105 cases suggesting malignancy. 7 benign lesions displayed no central indurations correctly characterized benign by SE. ROC-analysis and Youden index showed a sensitivity of 72.4% and specificity of 63.6% assuming a cut-off of 2.5. Io-CEUS correctly characterized 103/105 as malignant. Sensitivity was 98%, specificity 72.7%.

CONCLUSION

Strain elastography is a valuable tool for non-invasive characterization of FLLs. Semi-quantitative intratumoral stiffness values of >2.5 suggested malignancy. However, sensitivity of Io-CEUS in detecting malignant lesions was higher compared to SE. In conclusion SE should be considered for routine use during intraoperative US in addition to Io-CEUS for optimization of curative liver surgery.

Keratoplastiken im Kindes- und Jugendalter

Hintergrund Die Voraussetzungen für das langfristige Überleben einer perforierenden Keratoplastik sind im Säuglings- und Kindesalter aufgrund immunologischer Besonderheiten, der eingeschränkten Untersuchbarkeit sowie reduzierter Compliance und Therapieadhärenz à priori ungünstig. Jedoch stellt eine Hornhautübertragung oftmals die einzige Möglichkeit zur Prävention einer Amblyopie dar und ist somit alternativlos. Wir untersuchten das Indikationsspektrum, das Transplantatüberleben und das Komplikationsspektrum in einem bizentrischen Register aller Keratoplastiken im Kindesalter.

Material und Methoden Aus den elektronischen Transplantatregistern der beiden Zentren wurden alle Patienten recherchiert, die zum Zeitpunkt der jeweils 1. Keratoplastik das 18. Lebensjahr noch nicht vollendet hatten. Aus den Krankenakten wurden die Indikation, etwaiges Transplantatversagen, die Sehschärfe, Verlust des Augapfels und weitere Komplikationen systematisch recherchiert.

Ergebnisse Es wurden insgesamt 104 Augen von 95 Patienten (54 % weiblich) identifiziert. Das Durchschnittsalter bei der Operation betrug im Median 14 Jahre (Quartile 8 und 16 Jahre). Die Nachbeobachtungszeit lag im Median bei 2,7 Jahren. Es zeigten sich folgende Indikationen: Keratokonus (39 %), perforierende Verletzung (18 %), nicht herpetische Hornhautnarben (12 %), herpetische Hornhautnarben (6 %), Sklerokornea (3 %), Verätzung (3 %) und die heterogene Gruppe der sonstigen Indikationen (19 %). Das nach Kaplan-Meier geschätzte klare Transplantatüberleben reichte zum Zeitpunkt der Durchschnittsnachbeobachtungszeit von 100 % (Keratokonus) bis 35 % (Sklerokornea). Ein Verlust des Augapfels war ausschließlich nach perforierender Verletzung (n = 2) zu verzeichnen. Nach 1 Jahr sind in der Kaplan-Meier-Schätzung alle Transplantate in der Gruppe der Säuglinge eingetrübt. In der Gruppe der Kleinkinder bis Jugendlichen sind 90 % der Transplantate zu diesem Zeitpunkt noch klar.

Schlussfolgerungen Die Prognose der Keratoplastik im Kindesalter hängt sowohl von der initialen Indikation und damit indirekt von der Grunderkrankung als auch vom Alter ab. Eine besonders schlechte Prognose zeigte die Gruppe der Säuglinge mit einem nur sehr kurzen Transplantatüberleben. Bei den Indikationen zeigte die Gruppe der Kinder mit Keratokonus die besten Ergebnisse. Als prognostisch ungünstig erwiesen sich Sklerokornea sowie perforierende Augenverletzungen.

FRED Flow Diverter: A Study on Safety and Efficacy in a Consecutive Group of 50 Patients

BACKGROUND AND PURPOSE

Endovascular flow diverters are increasingly used for the treatment of cerebral aneurysms. We assessed the safety and efficacy of the Flow-Redirection Endoluminal Device (FRED) in a consecutive series of 50 patients.

MATERIALS AND METHODS

Inclusion criteria were wide-neck, blister-like, or fusiform/dissecting aneurysms independent of size, treated with the FRED between February 2014 and May 2015. Assessment criteria were aneurysm occlusion, manifest ischemic stroke, bleeding, or death. The occlusion rate was assessed at 3 months with flat panel CT and at 6 months with DSA by using the Raymond classification and the O'Kelly-Marotta grading scale.

RESULTS

Fifty patients with 52 aneurysms were treated with 54 FREDs; 20 patients were treated with the FRED and coils. Aneurysm size ranged from 2.0 to 18.5 mm. Deployment of the FRED was successful in all cases. There were no device-associated complications. One patient developed mild stroke symptoms that fully receded within days. There have been no late-term complications so far and no treatment-related mortality. Initial follow-up at 3 months showed complete occlusion in 72.3% of the overall study group, Six-month follow-up showed total and remnant-neck occlusion in 87.2% of patients, distributed over 81.5% of the FRED-only cases and 95.0% of the cases with combined treatment.

CONCLUSIONS

The FRED flow diverter is a safe device for the treatment of cerebral aneurysms of various types. Our data reveal high occlusion rates at 3 and 6 months, comparable with those in other flow diverters. Long-term occlusion rates are expected.

TORS in HPV-Positive Tumors-The New Standard?

In this chapter, we discuss implications of tumor site and tumor microenvironment properties of human papilloma virus (HPV)-associated cancer formation with special emphasis on the therapeutic modality of transoral robotic surgery (TORS). Over the past years, the development of robotic systems has improved, and therefore, its use in the surgical treatment of HNSCC has become a relevant treatment modality for many patients. Yet, there are limitations. Especially for endolaryngeal TORS procedures, additional technical development is mandatory, particularly with respect to visualization and manipulation. The Flex System has provided new additions that need to be further evaluated. TORS systems are going to improve technical issues and therefore reduce patient morbidity, surgical handling and treatment costs. The developed systems have to be tested and evaluated in prospective trials in order to be able to identify benefits and disadvantages in patient care. With respect to HPV-related OPSCC, TORS has become a valuable surgical alternative for an increasing number of patients.

Long-term outcome following treatment of Adamantinoma and Osteofibrous dysplasia of long bones

INTRODUCTION

Adamantinoma (AD) is an ultimately rare, low-grade malignant bone tumor. In most cases it occurs in the tibia of young adults. Osteofibrous dysplasia (OFD) is a rare, benign, lesion that is typically seen in children. Histopathology, ultrastructure, and cytogenetics indicate that these lesions are closely related. Yet, etiology remains a matter of debate. Local recurrence rates are high for both entities as published in literature and long-term outcomes are scarce, due to the rarity of the disease.

HYPOTHESIS

AD should be treated by En-Bloc resection while ODF can be treated by curettage or by observation. Consequently, the aim of the present study was to answer following questions: Were local recurrence rates of both entities different based on a retrospective review within a tertiary referral center for orthopedic oncology?

MATERIAL AND METHODS

In a retrospective cohort study, 10 patients with AD and 5 patients with OFD (including 1 patient with OFD-like-AD) were reviewed. Primary surgeries for patients with AD were: En-bloc resection in 7, curettage in 2 and amputation in 1. In the OFD group, only 2 patients underwent surgery by curettage. Mean follow-up was 16 years (range: 2-47 years). Nine patients had a minimum follow-up of 10 years (mean: 23 years; range: 10-47 years).

RESULTS

Four patients with AD (40%) and 2 patients with OFD (40%) - all of them following surgical removal - suffered from local recurrence. In the "En bloc" resection group of AD, there were 2 LR (29%). All patients of both groups treated with curettage showed LR. One patient with AD had metastasis at time of diagnosis and died of disease. Another patient with AD was diagnosed with metastasis 67 months after surgery and was still alive with disease at latest follow-up (77 month).

DISCUSSION

The overall prognosis of AD and OFD is good, yet local recurrence rates are high, irrespective of surgical strategy. While an internationally standardized treatment regime is still missing, a more radical surgical approach should be considered, especially when treating AD.

LEVEL OF EVIDENCE

Retrospective study; Level IV.