Retrospective cohort study of combined approach for trunk reconstruction using arteriovenous loops and free flaps

Defect reconstruction of the trunk can be performed using microsurgical free flap transplantation. In cases of missing or inappropriate recipient vessels, microsurgical defect reconstruction of the trunk can be achieved by combining free flaps with arteriovenous loops. Here we present our 5-year experience of trunk reconstruction using AV loops and free flaps in a retrospective evaluation. We analyzed 32 cases of trunk reconstruction using a combined approach of free flap transplantation and arteriovenous loops between 2011 and 2016 regarding postoperative complications and perioperative course.

http://ift.tt/2xlEazj

Investigation of blood perfusion by laser speckle contrast imaging in stretched and rotated skin flaps in a porcine model

Dear Sir,

http://ift.tt/2h3JxNB

Lymphatic vessel density and VEGF-C expression as independent predictors of melanoma metastases: methodological issues

Dear Editor-in-Chief,

http://ift.tt/2xlE2jj

Current status and trends of breast reconstruction in argentina

Over the last decade, there has been an exponential increase in implant-based breast reconstructions correlated with a proportional decrease in autologous reconstruction in the US.1,2 We aimed to determine the breast reconstruction trends in Argentina through a survey of plastic surgeons who were invited to answer a multiple-choice anonymous questionnaire sent through email.

http://ift.tt/2h5bXXn

Effect of distal venous drainage on the survival of four-territory flaps with no pedicle vein: results from a rat model

Venous super-drainage can improve flap survival not only because it prevents congestion, but also because it affects the dominant circulation in multi-territory thin skin flaps. We aimed to evaluate the survival of various flap areas and detect vascular changes in artery-based, four-territory skin flaps after different distal venous drainage procedures.

http://ift.tt/2xlVm7Q

Measuring the patient perspective on latissimus dorsi donor site outcomes following breast reconstruction

There is little evidence about the long-term donor site outcome of latissimus dorsi breast reconstruction and no patient-reported outcome measures designed specifically for the procedure.

http://ift.tt/2h3JnWv

The role of ultrasound technology in plastic surgery

The modern medical era is in part characterized by the increased availability of portable imaging devices. Ultrasound devices are used for either high-resolution non-invasive imaging or as a focused acoustic energy source capable of sculpting and shaping tissue. Given the broad scope of the field, plastic and reconstructive surgeons have the unique ability to implement and tailor the use of ultrasound in a variety of clinical situations. This article will review novel uses for ultrasound in the field of plastic surgery.

http://ift.tt/2xlK7wn

Drug interactions in users of tablet vs. oral liquid levothyroxine formulations: a real-world evidence study in primary care

Abstract

Purpose

Several medications may interact with levothyroxine (LT4) intestinal absorption or metabolism, thus reducing its bioavailability. We investigated the variability of thyroid stimulating hormone (TSH) levels and prescribed daily dosages (PDDs) of LT4 before and during potential drug–drug interactions (DDIs) in users of tablets vs. oral liquid LT4 formulations.

Methods

By using the Italian general practice Health Search Database (HSD), we retrospectively selected adult patients with at least one LT4 prescription from 2012 to 2015 and at least 1 year of clinical history recorded. The incident prescription of interacting medications (e.g., proton pump inhibitors, calcium or iron salts) was the index date. Analysis was carried out using a self-controlled study design.

Results

Overall, 3965 users of LT4 formed the study cohort (84.1% women, mean age 56 ± 16.5 years). TSH variability on the entry date was greater among liquid LT4 users than in those prescribed with tablets as shown by the difference between 75th and 25th centile, which were 3.01 and 3.8, respectively. The incidence rate ratio (IRR) for TSH variability did not differ between groups, before and during exposure to DDIs. In contrast, PDDs less likely increased during the exposure to DDI with oral liquid LT4 compared with tablets (IRR = 0.84; 95% CI: 0.77–0.92), especially in patients with post-surgical hypothyroidism (IRR = 0.75; 95% CI: 0.64–0.85).

Conclusions

In clinical practice, the use of oral liquid LT4 is not associated with increased PDDs, compared with tablets formulation, during exposure to DDIs. These results support the need for individualizing LT4 formulation to prescribe, especially in patients with various comorbidities and complex therapeutic regimens.

http://ift.tt/2vVbXM1

Impact of etiology, age and gender on onset and severity of hyponatremia in patients with hypopituitarism: retrospective analysis in a specialised endocrine unit

Abstract

Background

Hyponatremia can unmask hypopituitarism and secondary adrenal insufficiency. This is important, since the need to screen for steroid deficiency, in patients with hyponatremia is often neglected.

Patients and methods

In a retrospective study, twenty-five patients (13f/12m, age 58.9 ± 18.6 years) with hyponatremia (119.7 ± 10.5 mmol/L) were identified among 260 in-patients treated for hypopituitarism in our specialized endocrine unit, over the last decade. We analyzed clinical characteristics, etiology, and severity of hypopituitarism in patients who presented with hyponatremia.

Results

Hyponatremia was recorded in 9.6% of our patients with hypopituitarism. In 80.7% it was the key to diagnosis of hypopituitarism. All patients with hyponatremia were steroid deficient with complete hypopituitarism compared to 75% (steroid deficient) and 60% (complete hypopituitarism) of the patients in the cohort. The most common etiology of hypopituitarism was non-functioning pituitary macro adenoma (NFPA) (n = 128, 49.2%). Patients with hyponatremia were divided into two groups, based on the etiology of hypopituitarism: Group 1. with NFPA n = 15 (5F/10M), mean age 71.47 ± 4.8 years, who were significantly older compared to patients with hyponatremia from other rare causes of hypopituitarism in Group 2. n = 10 (8F/2M), mean age 40.2 ± 15.3 years (p < 0.01), such as: congenital hypopituitarism(n = 2), Sheehan's syndrome (n = 2), intracranial aneurysm (n = 2), lymphocytic hypophysitis (n = 1), traumatic brain injury (n = 1), surgery and radiotherapy for astrocytoma (n = 1), pituitary metastasis from bronchial carcinoma (n = 1). Hyponatremia was more severe in Group 2. compared to Group 1. (113.5 ± 10.9 mmol/L vs. 124.3 ± 8.1 mmol/L, p < 0.01). Older age (p = 0.0001) and number of endocrine deficiencies (p < 0.05) were identified as predictive factors for hyponatremia by multivariate analysis in patients with hypopituitarism.

Conclusion

Hyponatremia is an important presenting feature of pituitary disease and a strong indicator of life-threatening steroid deficiency. Old age and severity of hypopituitarism are major risk factors for hyponatremia. In older patients NFPA is the most common etiology, while other rare causes of hypopituitarism are more prevalent in younger patients with hyponatremia.

http://ift.tt/2eWKJOf

Correction

Publication date: Available online 13 September 2017
Source:Archives of Physical Medicine and Rehabilitation





http://ift.tt/2h4bJQv

Drug interactions in users of tablet vs. oral liquid levothyroxine formulations: a real-world evidence study in primary care

Abstract

Purpose

Several medications may interact with levothyroxine (LT4) intestinal absorption or metabolism, thus reducing its bioavailability. We investigated the variability of thyroid stimulating hormone (TSH) levels and prescribed daily dosages (PDDs) of LT4 before and during potential drug–drug interactions (DDIs) in users of tablets vs. oral liquid LT4 formulations.

Methods

By using the Italian general practice Health Search Database (HSD), we retrospectively selected adult patients with at least one LT4 prescription from 2012 to 2015 and at least 1 year of clinical history recorded. The incident prescription of interacting medications (e.g., proton pump inhibitors, calcium or iron salts) was the index date. Analysis was carried out using a self-controlled study design.

Results

Overall, 3965 users of LT4 formed the study cohort (84.1% women, mean age 56 ± 16.5 years). TSH variability on the entry date was greater among liquid LT4 users than in those prescribed with tablets as shown by the difference between 75th and 25th centile, which were 3.01 and 3.8, respectively. The incidence rate ratio (IRR) for TSH variability did not differ between groups, before and during exposure to DDIs. In contrast, PDDs less likely increased during the exposure to DDI with oral liquid LT4 compared with tablets (IRR = 0.84; 95% CI: 0.77–0.92), especially in patients with post-surgical hypothyroidism (IRR = 0.75; 95% CI: 0.64–0.85).

Conclusions

In clinical practice, the use of oral liquid LT4 is not associated with increased PDDs, compared with tablets formulation, during exposure to DDIs. These results support the need for individualizing LT4 formulation to prescribe, especially in patients with various comorbidities and complex therapeutic regimens.

http://ift.tt/2vVbXM1

Impact of etiology, age and gender on onset and severity of hyponatremia in patients with hypopituitarism: retrospective analysis in a specialised endocrine unit

Abstract

Background

Hyponatremia can unmask hypopituitarism and secondary adrenal insufficiency. This is important, since the need to screen for steroid deficiency, in patients with hyponatremia is often neglected.

Patients and methods

In a retrospective study, twenty-five patients (13f/12m, age 58.9 ± 18.6 years) with hyponatremia (119.7 ± 10.5 mmol/L) were identified among 260 in-patients treated for hypopituitarism in our specialized endocrine unit, over the last decade. We analyzed clinical characteristics, etiology, and severity of hypopituitarism in patients who presented with hyponatremia.

Results

Hyponatremia was recorded in 9.6% of our patients with hypopituitarism. In 80.7% it was the key to diagnosis of hypopituitarism. All patients with hyponatremia were steroid deficient with complete hypopituitarism compared to 75% (steroid deficient) and 60% (complete hypopituitarism) of the patients in the cohort. The most common etiology of hypopituitarism was non-functioning pituitary macro adenoma (NFPA) (n = 128, 49.2%). Patients with hyponatremia were divided into two groups, based on the etiology of hypopituitarism: Group 1. with NFPA n = 15 (5F/10M), mean age 71.47 ± 4.8 years, who were significantly older compared to patients with hyponatremia from other rare causes of hypopituitarism in Group 2. n = 10 (8F/2M), mean age 40.2 ± 15.3 years (p < 0.01), such as: congenital hypopituitarism(n = 2), Sheehan's syndrome (n = 2), intracranial aneurysm (n = 2), lymphocytic hypophysitis (n = 1), traumatic brain injury (n = 1), surgery and radiotherapy for astrocytoma (n = 1), pituitary metastasis from bronchial carcinoma (n = 1). Hyponatremia was more severe in Group 2. compared to Group 1. (113.5 ± 10.9 mmol/L vs. 124.3 ± 8.1 mmol/L, p < 0.01). Older age (p = 0.0001) and number of endocrine deficiencies (p < 0.05) were identified as predictive factors for hyponatremia by multivariate analysis in patients with hypopituitarism.

Conclusion

Hyponatremia is an important presenting feature of pituitary disease and a strong indicator of life-threatening steroid deficiency. Old age and severity of hypopituitarism are major risk factors for hyponatremia. In older patients NFPA is the most common etiology, while other rare causes of hypopituitarism are more prevalent in younger patients with hyponatremia.

http://ift.tt/2eWKJOf

Scholar : Scholar Alert - [ intitle:laryngeal ]

Scholar Alert: [ intitle:laryngeal ]

Inducible laryngeal obstruction: an official joint European Respiratory Society and European Laryngological Society statement

T Halvorsen, ES Walsted, C Bucca, A Bush… - European Respiratory …, 2017

Inducible laryngeal obstruction (ILO) describes an inappropriate, transient, reversible
narrowing of the larynx in response to external triggers. ILO is an important cause of a
variety of respiratory symptoms and can mimic asthma. Current understanding of ILO has

[PDF] E-cadherin, β-catenin and Snail immunoexpression in laryngeal squamous cell carcinoma

L CERCELARU, AE STEPAN, C MĂRGĂRITESCU… - Rom J Morphol Embryol, 2017

Abstract E-cadherin, β-catenin and Snail are important molecules involved in cellular
adhesion and epithelial–mesenchymal transition. Loss of E-cadherin expression, nuclear
relocation of β-catenin and high expression of Snail are connected to tumor progression,

[PDF] Primary laryngeal tuberculosis-"The great masquerader"

P Sakthivel, CA Singh, SC Sharma, A Kanodia, B Jat…

Abstract We report a case of primary laryngeal tuberculosis in a 54 year old Indian male,
who had hoarseness as his presenting complaint. This case highlights that laryngeal
tuberculosis may occur even without pulmonary tuberculosis, and the characteristics of the

[HTML] Case Report: Tracheal Aspiration of a Nasal Airway in a Patient With Laryngeal Cancer

C Rowan, PA Pesantes

Airway adjuncts such as oral or nasopharyngeal airways (NPAs) are a staple of basic airway
management. Placed countless times daily in the United States by providers from a wide
range of backgrounds, these devices can be critically important in relieving airway

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Scholar : Ειδοποίηση Μελετητή - [ CPAP ]

Ειδοποίηση Μελετητή:[ CPAP ]

The economic impact of prematurity and bronchopulmonary dysplasia

M Álvarez-Fuente, L Arruza, M Muro, C Zozaya, A Avila… - European Journal of …, 2017

... Severe BPD > 0.3 oxygen and/or respiratory support (IPPV or CPAP) > 0.3 oxygen and/or
respiratory support (IPPV or CPAP) BPD bronchopulmonary dysplasia, PMA postmenstrual age,
IPPV intermittent positive-pressure ventilation, CPAP continuous positive airway pressure ...

减压固定法对经鼻持续气道正压通气新生儿并发症的影响

徐友岚， 梁小敏， 周福心 - 护理实践与研究, 2017

目的：探讨减压固定法对经鼻持续气道正压通气（N-CPAP）新生儿并发症的影响。方法：
选取2015年12月~2016年12月我院确诊治疗的N-CPAP低出生体重早产新生儿100例,
随机分为观察组和对照组,对照组患儿给予常规固定干预,观... . ...

[PDF] Effective Factors of INSURE Method Failure in Treatment of Respiratory Distress Syndrome in Preterm Infants

N Danaei, M Seddigh, R Ghorbani, S Nooripour

... In previous studies, INSURE followed by CPAP applied to the nose was defined as a very effective
and useful method that may reduce the need for MV, and shorten the hospitalization stay (22, 23). ...
Surfactant therapy and CPAP reduce the need of respiratory support. ...

[PDF] TEMA 11 TÉCNICAS MALABSORTIVAS. INDICACIONES Y DETALLES TÉCNICOS CRUCE DUODENAL

C Serra, A Baltasar

... en el resto se redujo drásticamente la necesidad de medicación. 1A ECA El 90% de pacientes
que usaban CPAP dejaron de necesitarla, la medicación para el asma se redujo en el 88% y
la prevalencia del índice de riesgo cardiaco >5 se redujo en el 86%. 1A ECA ...

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Scholar : Ειδοποίηση Μελετητή - [ Obstructiv

Ειδοποίηση Μελετητή:[ Obstructive sleep apnea ]

Obstructive sleep apnea and diet-controlled gestational diabetes

E Wanitcharoenkul, N Chirakalwasan, S Amnakkittikul… - Sleep Medicine, 2017

Abstract Background Obstructive sleep apnea (OSA) was shown to be associated with
gestational diabetes (GDM). However, prevalence of OSA in GDM women, its relationship to
metabolic control and predictive factors have not been studied. Material and Methods Eighty

[PDF] A CORRELATION STUDY ON SLEEP DISTURBANCE AND QUALITYOF LIFE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENT

AS Varghese, A Samad, S Sadan, S Rajendran - 2017

... Bellia V, Catalano F, Scichilone N, Incalzi RA, Spatafora M, Vergani C. Sleep Disorders in the
Elderly With and Without Chronic Airflow Obstruction : the sara study sleep ... Factors responsible
for poor sleep quality in patients with chronic obstructive pulmonary disease. ...

Surgical Weight Loss to Treat Atrial Fibrillation Risk and Progression

CJ Nalliah, P Sanders, JM Kalman - Current Cardiovascular Risk Reports, 2017

... Firstly, weight impacts other established AF risk factors such as hypertension, hyperlipidemia,
glycemic control, and obstructive sleep apnea. Additionally, impaired diastolic function,
inflammation, and pericardial fat have emerged as important mechanistic players in AF. ...

[PDF] REVEAL THE TRUTH OF PENTRAXIN 3 AS BIOMARKER FOR INFLAMMATORY CARDIOVASCULAR DISEASE

N Tyagi, C Kaur, J Prasad, N Bhutani, S Sucharita - 2017

... 22. T. Kasai, K. Inoue, T. Kumagai et al. Plasma pentraxin3 and arterial stiffness in men with
obstructive sleep apnea. The American Journal of Hypertension, 2010. 23. Y. Naito, T. Tsujino,
H. Akahori et al. Increase in tissue and circulating pentraxin3 levels ...

Prevalence and correlates of sleep-related problems in adults receiving medical cannabis for chronic pain James A. Cranford1, J. Todd Arnedt1, Deirdre A. Conroy1, …

C Bourque, FC Blow, M Ilgen, JA Cranford - 2017

... term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep ...
sleeping today because of pain, and roughly 30% of participants indicated that their pain-related
sleep problems occurred every night and/or multiple times per night. 3.3. ...

Blood Gas II

DA Biggs - Data Interpretation in Anesthesia, 2017

... It could also be seen in patients with neuromuscular disease. (c) Airway
obstruction—could be secondary to residual muscle weakness, air- way surgery, or
laryngospasm. The patient could have a history of obstruc- tive sleep apnea. ...

OSAS 与代谢综合征的关系探讨

马永菊， 徐少泽， 许庆梅， 赵孝强 - 收藏, 2017

... 摘要】：阻塞性睡眠呼吸暂停综合征(Obstructive Sleep Apnea Syndrome)是由于睡眠中上气道阻塞 ...
OSAS即阻塞性睡眠呼吸暂停综合征(Obstructive SleepApnea Syndrome),是由于人体在睡眠的
过程中上气道的阻塞,造成气道阻力的增加,使得呼吸开始变得缓慢或者暂停 ...

阻塞性睡眠呼吸暂停低通气综合征发病危险因素的研究进展

梁敏， 刘冀 - 收藏, 2017

... 摘要】：阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)
是一种临床常见的慢性呼吸系统疾病,是指睡眠时上气道塌陷阻塞而引起的呼吸暂停和通气不足、
伴有打鼾、睡眠结构紊乱、频繁发生的血氧饱和度下降、白天嗜睡等一系列临床综合征。由于 ...

2017 Canadian Stroke Congress Abstracts

HCBT Either - International Journal of Stroke, 2017

... MET < 1.5 was considered sedentary. Results: Participants (n ¼ 19; 12 males) spent
10 hours sleeping and 4 hours resting each day, with 86.9% of their waking hours
considered to be sedentary. They received on average ...

[PDF] CARDIAC AND PRESSOR FUNCTIONS IN EXERCISING YOUNG MEN FOLLOWING VITAMIN C SUPPLEMENTATION

OO Omodara, SI Jaja

... Frequent and regular physical exercise boosts the immune system and helps prevent "diseases
of affluence" such as cardiovascular disease, type 2 diabetes, and obesity.[2,3] It may also help
prevent stress and depression, increase quality of sleep and act as a non ...

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