Management of severe pediatric subglottic stenosis with glottic involvement
METHODS:
Between 1978 and 2008, 33 children with glotto-subglottic stenosis underwent partial cricotracheal resection, and they form the focus of this study. They were compared with 67 children with isolated subglottic stenosis (no glottic involvement). The outcomes measured were need for revision open surgical intervention, delayed decannulation (>6 months), and operation-specific and overall decannulation rates. Fisher's exact test was used for comparison of outcomes.
RESULTS:
Results of preoperative evaluation showed Myer-Cotton grade III or IV stenosis in 32 (97%) patients and grade II stenosis in 1 patient. All patients with glotto-subglottic stenosis were treated with partial cricotracheal resection and simultaneous repair of the glottic pathology. Bilateral fixed vocal cords were seen in 19 (58%) of 33 patients, bilateral restricted abduction was seen in 7 (21%) of 33 patients, and unilateral fixed vocal cord was seen in 7 (21%) of 33 patients. Ten patients underwent single-stage partial cricotracheal resection with excision of interarytenoid scar tissue. The endotracheal tube was kept for a mean period of 7 days as a stent. Twenty-three patients underwent extended partial cricotracheal resection with LT-Mold (Bredam S.A., St. Sulpice, Switzerland) or T-tube stenting. The overall decannulation rate included 26 (79%) patients, and the operation-specific decannulation rate included 20 (61%) patients.
CONCLUSIONS:
Glotto-subglottic stenosis is a complex laryngeal injury associated with delayed decannulation and decreased overall and operation-specific decannulation rates when compared with those after subglottic stenosis without glottic involvement after partial cricotracheal resection.
Management of severe pediatric subglottic stenosis with glottic involvement.
J Thorac Cardiovasc Surg. 2009 Jun 30; George M, Jaquet Y, Ikonomidis C, Monnier P (Hubmed.org)
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Is reduction in the risk of vision loss the only benefit of photodynamic therapy in predominantly classic subfoveal choroidal neovascularization?
Clin Ophthalmol. 2008 Dec; 2(4): 773-80Ghazi NG, Conway BP, Tiedeman JS, Yoon SJPURPOSE: To emphasize the effect of photodynamic therapy (PDT) on the size and progression of the neovascular lesion (NL) and evolution of the disciform scar (DS) in predominantly classic subfoveal choroidal neovascularization (SFCNV). METHODS: A retrospective study of 62 eyes treated with PDT for SFCNV was performed. The greatest linear dimension (GLD) before and at last follow-up after treatment and the size of the DS post-PDT were analyzed. A subgroup of patients with DS in their fellow eye at presentation without prior PDT was also studied. The size of the scar in these eyes was compared to that following PDT. RESULTS: After an average follow-up at 9 months, the size of the NL was stabilized or reduced in 64% of the study eyes with absence of fluorescein leakage in 45%. Only 3 eyes (5%) developed DS. At presentation, 14 patients already had DS in their fellow eye, the size of which was significantly larger than that post-PDT (p = 0.044). It was also significantly larger than that of the potential scar in the study eyes of the same subgroup of patients (p = 0.002) and of the rest of the patients (p = 0.0001). CONCLUSION: This study demonstrates a beneficial effect for PDT on the size of the NL and DS in SFCNV, which might be of great significance, particularly when PDT fails to prevent severe vision loss.
New experimental delayed wound healing
A horizontal incision 4 cm in length was made on the dorsal part of the torso and pure skin flaps were raised in front of and behind this incision. This exposed the panniculus carnosus layer and it was resected. Skin flaps were returned to their places and sutured.
After a 3 week period of healing third degree burn injury was inflicted using hot metal plates both on the healed flaps and at the same location on the opposite side. Scar samples were sent for histopathological examination after healing.
The wounds on the panniculectomy side healed in an average of 43.20 days but on the control side they healed in an average of 32.80 days (p < 0.05). Wound healing was slower and scars were broader and more irregular on the panniculectomy side.
In our new model, addition of panniculectomy to full thickness burn injury significantly delayed wound healing with a decrease in scar quality. This is a simple, economic and effective animal model to study delayed wound healing.
"A new experimental delayed wound healing model in rabbits"
Eur J Dermatol. 2009 Aug 6; Aksoy B, Aksoy HM, Civaş E, Ustün H, Atakan N (Hubmed.org)
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Hydroa vacciniforme-like cutaneous T cell lymphoma
METHODS:
The clinical presentations and the findings of laboratory examinations and skin biopsy of affected tissue in a child with hydroa vacciniforme-like cutaneous T cell lymphoma were retrospectively reviewed.
RESULTS:
The child manifested as rash, fever and lymph node intumesce. Rash was pantomorphia, including edematous erythema, vesicles, crusts, necrosis and depressed scar, and it was mild in winter and severe in summer, mainly involving in the face and extremities. Epstein-Barre vivus (EBV)-IgM was positive. Histopathological findings revealed focal lymphocyte invasion in subcutaneous panniculus adiposus. The clinical symptoms were improved after glucocorticoid treatment in this child.
CONCLUSIONS:
Hydroa vacciniforme-like cutaneous T cell lymphoma has special clinical manifestations. This disorder may be definitely diagnosed by skin biopsy of affected tissue and immunohistochemistry assay. Glucocorticoid treatment is effective. EBV infection may be related to the development of this disorder.
Hydroa vacciniforme-like cutaneous T cell lymphoma: a case report and literature review
Zhongguo Dang Dai Er Ke Za Zhi. 2009 Jul; 11(7): 596-8Li HY, Wang HL, Gao TZ, Zhuo ZH, Li DM, Li H (Hubmed.org)
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Transplanted Blood-Derived Endothelial Progenitor Cells (EPC) Enhance Bridging of Sheep Tibia Critical Size Defects.
Bone. 2009 Aug 5; Rozen N, Bick T, Bajayo A, Shamian B, Schrift-Tzadok M, Gabet Y, Yayon A, Bab I, Soudry M, Lewinson DThe angiogenic events that accompany bone regeneration function as a "limiting factor" and are the primary regulatory mechanisms that direct the healing process. The general aim of this study was to test whether blood-derived progenitor cells that have endothelial characteristics (EPC), when applied to a large segmental defect, would promote bone regeneration. We established a critical-sized gap platform in sheep tibiae. Our model system takes advantage of the physiological wound healing process that occurs during the first two weeks following injury, and results in the gap being filled with scar tissue. EPC were expanded ex-vivo and 2 x 10(7) cells/0.2 ml were implanted into a wedged-shaped canal excavated in the fibrotic scar tissue. Sham treated sheep served as controls. Bone regeneration was followed every two weeks for three months by x-rays radiography. At the end of the experimental period, the regenerating segments were subjected to microcomputed tomographic (muCT) analysis. While minimal bone formation was detected in sham-treated sheep, six out of seven autologous EPC-transplanted sheep showed initial mineralization already by 2 weeks and complete bridging by 8 - 12 weeks post EPC transplantation. Histology of gaps 12 weeks post sham treatment showed mostly fibrotic scar tissue. On the contrary, EPC transplantation led to formation of dense and massive woven bone all throughout the defect. The results of this pre-clinical study open new therapeutic opportunities for the treatment of large scale bone injuries.
