Enlarged vestibular aqueduct(EVA), the most frequent identifiable cause of congenital hearing loss, is evaluated with high-definition multidetector CT in the axial plane. Our purpose was to determine which reformatted...Enlarged vestibular aqueduct(EVA), the most frequent identifiable cause of congenital hearing loss, is evaluated with high-definition multidetector CT in the axial plane. Our purpose was to determine which reformatted CT measurements are most reproducible. Seven multiplanar reformatted images were created for each of the 64 temporal bones in patients with EVA. Intraclass correlation coefficients(ICC) were used to assess inter-observer variability, and both linear regression and ROC analyses were used to compare the measurements with severity of hearing loss, as assessed by pure tone audiometry. All seven measurements had excellent inter-observer variability, with average-measure ICC ranging from 0.92 to 0.98. There was no statistically significant correlation between the radiologic degree of aqueduct enlargement and severity of hearing loss using any of the seven measurements; ROC analyses revealed areas under the curves ranging from 0.57 to 0.73. Optimal accuracy was obtained with a threshold of 1.75 mm as measured at the aqueductal aperture in the P€oschl plane, with sensitivity of 0.75 and specificity of0.63. Although the radiologic measurement may not serve as a reliable tool for assessing severity of EVA, P€oschl plane reformatting has proven to be better than conventional axial acquisition plane for identifying patients with clinically significant hearing loss.展开更多
Vascularized lymph node transfer is a surgical treatment for lower extremity lymphedema aimed at restoring physiological lymphatic flow.Much variation exists in determining the appropriate donor site from which to har...Vascularized lymph node transfer is a surgical treatment for lower extremity lymphedema aimed at restoring physiological lymphatic flow.Much variation exists in determining the appropriate donor site from which to harvest lymph nodes as well as the optimal recipient site to anastomose the new lymph nodes.This article reviews the underlying principles of free vascularized lymph node transfer and discusses patient-specific,disease-specific and surgery-specific factors in considering recipient sites from the proximal,middle,and distal lower extremity.The clinical outcomes of published studies in lymphatic surgery for lower extremity lymphedema are presented.An omental flap to the middle lower extremity(mid-thigh,popliteal fossa,or medial calf)is then recommended due to the abundance of lymphatic tissue,proximity to pooled lymph fluid,and avoidance of added bulk or poor cosmesis of the distal lower extremity.However,additional clinical outcomes studies are needed and represent an area of further investigation.展开更多
Recent studies suggest that acellular nerve allografts(ANA)have similar efficacy as nerve autografts in certain applications of nerve surgery.However,multiple studies also demonstrate the limitations of nerve allograf...Recent studies suggest that acellular nerve allografts(ANA)have similar efficacy as nerve autografts in certain applications of nerve surgery.However,multiple studies also demonstrate the limitations of nerve allografts,resulting in poor patient outcomes.This submission discusses a recent case series of patients who failed allograft use with subsequent histologic analyses of these allografts.Recommendations on the treatment of nerve gaps are presented,drawing from our current understanding of allograft and autograft utility in reconstruction.Factors taken into account include recipient critical nerve function,existent nerve gap,and nerve diameter.展开更多
Efficacious therapeutics for peripheral nerve injuries remain incompletely described in the literature.However,over the last several decades,delivery of FK506(Tacrolimus)and electrostimulation have demonstrated great ...Efficacious therapeutics for peripheral nerve injuries remain incompletely described in the literature.However,over the last several decades,delivery of FK506(Tacrolimus)and electrostimulation have demonstrated great promise for supplementing surgical advances in treating peripheral nerve injuries.This review describes the discovery,mechanistic investigations,and clinical translation of these strategies to promote functional recovery.FK506 has demonstrated the ability to increase the regeneration rate after nerve injury by a variety of hypothesized mechanisms,yet clinical utility remains limited due to systemic immunosuppression.Local administration of FK506 continues to be an active area of inquiry for minimizing side effects while maintaining its neuroregenerative effects.Electrostimulation of a nerve proximal to the site of surgical nerve repair has demonstrated increased axonal regeneration and accelerated recovery of both motor and sensory nerves.In addition,electrostimulation also appears to improve axon matching during reinnervation from motor to motor and sensory to sensory pathways and is used clinically in our surgeries.However,the specific parameters to best incorporate electrostimulation into the operating theater are still evolving.Utilizing translational rodent and murine models,surgical techniques and these therapeutic strategies have gradually become more viable as safety profiles and mechanisms are gradually understood.This review presents the state of the field for these therapeutic avenues and discusses further areas of research.展开更多
文摘Enlarged vestibular aqueduct(EVA), the most frequent identifiable cause of congenital hearing loss, is evaluated with high-definition multidetector CT in the axial plane. Our purpose was to determine which reformatted CT measurements are most reproducible. Seven multiplanar reformatted images were created for each of the 64 temporal bones in patients with EVA. Intraclass correlation coefficients(ICC) were used to assess inter-observer variability, and both linear regression and ROC analyses were used to compare the measurements with severity of hearing loss, as assessed by pure tone audiometry. All seven measurements had excellent inter-observer variability, with average-measure ICC ranging from 0.92 to 0.98. There was no statistically significant correlation between the radiologic degree of aqueduct enlargement and severity of hearing loss using any of the seven measurements; ROC analyses revealed areas under the curves ranging from 0.57 to 0.73. Optimal accuracy was obtained with a threshold of 1.75 mm as measured at the aqueductal aperture in the P€oschl plane, with sensitivity of 0.75 and specificity of0.63. Although the radiologic measurement may not serve as a reliable tool for assessing severity of EVA, P€oschl plane reformatting has proven to be better than conventional axial acquisition plane for identifying patients with clinically significant hearing loss.
文摘Vascularized lymph node transfer is a surgical treatment for lower extremity lymphedema aimed at restoring physiological lymphatic flow.Much variation exists in determining the appropriate donor site from which to harvest lymph nodes as well as the optimal recipient site to anastomose the new lymph nodes.This article reviews the underlying principles of free vascularized lymph node transfer and discusses patient-specific,disease-specific and surgery-specific factors in considering recipient sites from the proximal,middle,and distal lower extremity.The clinical outcomes of published studies in lymphatic surgery for lower extremity lymphedema are presented.An omental flap to the middle lower extremity(mid-thigh,popliteal fossa,or medial calf)is then recommended due to the abundance of lymphatic tissue,proximity to pooled lymph fluid,and avoidance of added bulk or poor cosmesis of the distal lower extremity.However,additional clinical outcomes studies are needed and represent an area of further investigation.
文摘Recent studies suggest that acellular nerve allografts(ANA)have similar efficacy as nerve autografts in certain applications of nerve surgery.However,multiple studies also demonstrate the limitations of nerve allografts,resulting in poor patient outcomes.This submission discusses a recent case series of patients who failed allograft use with subsequent histologic analyses of these allografts.Recommendations on the treatment of nerve gaps are presented,drawing from our current understanding of allograft and autograft utility in reconstruction.Factors taken into account include recipient critical nerve function,existent nerve gap,and nerve diameter.
文摘Efficacious therapeutics for peripheral nerve injuries remain incompletely described in the literature.However,over the last several decades,delivery of FK506(Tacrolimus)and electrostimulation have demonstrated great promise for supplementing surgical advances in treating peripheral nerve injuries.This review describes the discovery,mechanistic investigations,and clinical translation of these strategies to promote functional recovery.FK506 has demonstrated the ability to increase the regeneration rate after nerve injury by a variety of hypothesized mechanisms,yet clinical utility remains limited due to systemic immunosuppression.Local administration of FK506 continues to be an active area of inquiry for minimizing side effects while maintaining its neuroregenerative effects.Electrostimulation of a nerve proximal to the site of surgical nerve repair has demonstrated increased axonal regeneration and accelerated recovery of both motor and sensory nerves.In addition,electrostimulation also appears to improve axon matching during reinnervation from motor to motor and sensory to sensory pathways and is used clinically in our surgeries.However,the specific parameters to best incorporate electrostimulation into the operating theater are still evolving.Utilizing translational rodent and murine models,surgical techniques and these therapeutic strategies have gradually become more viable as safety profiles and mechanisms are gradually understood.This review presents the state of the field for these therapeutic avenues and discusses further areas of research.
