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BACKGROUNDPatients undergoing emergency high-risk abdominal surgery potentially suffer from both systemic dehydration and hypovolaemia. Data on the prevalence and clinical impact of electrolyte disturbances in this patient group, specifically the potential differences in patients with intestinal obstruction (IO) versus perforated viscus (PV) is lacking. METHODSIn this retrospective single center cohort study, adult patients undergoing emergency high-risk abdominal surgery in a standardized perioperative pathway were included. Electrolyte and arterial blood gas analysis were measured prior to and just after surgery. Prevalence and clinical impact of electrolyte disturbances were assessed. RESULTSA total of 354 patients were included in the study. Acid-base and electrolyte disturbances had a high incidence in both groups with preoperative alkalemia dominating preoperatively, significantly more prevalent in IO (45 vs.32%, pp= 0.006 and OR 6.86 (1.71, 32.2) p= 0.009 respectively. Hypochloremic patients presented with reduced long-term survival as compared with the normo- and hyperchloremic patients, with postoperative hypochloremia having the most pronounced association (p

The method of stump closure is controversial in complicated patients, especially with appendix base necrosis or perforation.To evaluate the efficacy and safety of partial cecum resection technique with an endostapler in patients with appendix base necrosis or perforation.Thirty-six patients who underwent laparoscopic partial cecum resection due to appendix base necrosis or perforation between 2015 and 2020 were retrospectively analyzed. In acute complicated appendicitis with appendiceal base necrosis or perforation, it was performed by laparoscopic partial cecum resection using an endostapler within a safe surgical margin. Demographic characteristics, duration of operation, days of hospital stay, and intra- and post-operative complications were evaluated.The mean age of the patients is 42.72 ±16.69, female/male ratio was 19/17 (52.8%/47.2%). No intraoperative complications developed. Mean operative time and hospital stay were 104.75 ±34.96, 4.58 ±2.82 days, respectively. Post-operative complications developed in 5 (13.7%) patients. One of them was wound infection (2.7%), 2 of them were ileus (5.5%) and 2 patients had an intraabdominal abscess (5.5%). Stapler line leak was not observed in any of the patients.The use of an endostapler in laparoscopic appendectomy is a safe and effective technique in cases where appendix base necrosis, appendix perforation or severe inflammation affects the base of the cecum.

Background:. Anogenital distance (AGD) in both humans and animals is a known reflection of fetal endocrine effect on genital virilization and the related abnormalities, including cryptorchidism and hypospadias. However, we introduce here and investigate scrotal base distance (SBD) as a sensitive genital anthropometric biomarker in human infants with cryptorchidism and hypospadias, which are considered early manifestations of testicular dysgenesis syndrome. We aim to assess SBD in patients with cryptorchidism or hypospadias against healthy subjects. Material and methods:. Patients with hypospadias (n = 61, age 17.4 ± 6.3 months) or cryptorchidism (n = 51, age 11.4 ± 4.8 months) were enrolled for assessment of SBD, AGD, and penile length; and compared with a cohort of 102 full-term healthy boys for standard ritual circumcision by measuring age-specific standard deviation scores. Results:. Patients having hypospadias had lower mean SBD, AGD, and penile length standard deviation scores than the control group (p

Purpose To investigate the oncological outcomes of orbital malignant tumors invading the skull base. Methods A retrospective analysis was conducted on 16 patients with orbital malignant tumors invading the skull base. Eleven patients were treated with skull base surgery, four patients were treated with particle therapies, and one patient was treated with chemoradiotherapy (CRT) as initial treatment. Results The most frequent histological type was adenoid cystic carcinoma in seven patients, followed by squamous cell carcinoma in two patients. Local recurrence occurred in two of the six surgically treated patients who did not receive postoperative radiotherapy (RT) or CRT. One of them was successfully salvaged by RT, and the other died of disease. With a median follow‐up of 24 months, the 2‐year overall, local control, and disease‐free survival rates of all patients were 82.5%, 87.5%, and 59%, respectively. Conclusions Patients with positive surgical margins were at risk of local recurrence. Postoperative RT should be considered for all surgically treated patients. Level of Evidence: 4.

Purpose: Improvement of the differential diagnosis of fibrous dysplasia of the of the base of the skull on the basis of X-ray computed tomography data, taking into account clinical and medical data.Material and methods: The results of examination of 24 patients with lesions of the base of the skull were analyzed. Group 1: 15 patients with fibrous dysplasia, directed to examination with a diagnosis of osteoplastic metastases of the base of the skull. Group 2: 9 patients with metastases to the base of the skull. All patients underwent computer tomography and SPECT/CT.Results: Comparison of clinical and radiological symptoms in patients with metastatic lesions of the base of the skull (group 2) and patients with fibrous dysplasia of the base of the skull (group 1) allows us to state that errors in the differential diagnosis of bone metastases and fibrous dysplasia of the base of the skull in a number of cases are associated with a lack of awareness of radiologists.Conclusion: The presented data will help to improve the diagnosis of fibrous dysplasia of the base of the skull.

Clinical outcomes were reviewed in 30 patients treated by gamma knife radiosurgery for skull base meningiomas with carotid artery encasement (SKBM‐CAE). The overall clinical improvement rate after treatment was 46%. At a median imaging follow‐up of 49 months, tumor volumes were unchanged, were larger, and were smaller or had resolved in 70%, 23%, and 7% of cases, respectively. The crude survival rate at 10 years was 20% and the complication (new cranial nerve deficit not accompanied by imaging‐shown tumor growth) rate was 10%. SKBM‐CAE is amenable to being effectively and safely controlled with the application of gamma knife radiosurgery.

Information about the endonasal endoscopic approach (EEA) for the management of posttraumatic tension pneumocephalus (PTTP) remains scarce. Concomitant rhinoliquorrhea and posttraumatic hydrocephalus (PTH) can complicate the clinical course.The authors systematically reviewed pertinent articles published between 1961 and December 2020 and identified 6 patients with PTTP treated by EEA in 5 reports. Additionally, the authors share their institutional experience including a seventh patient, where an EEA resolved a recurrent PTTP without rhinoliquorrhea.Seven PTTP cases in which EEA was used as part of the treatment regime were included in this review. All cases presented with a defect in the anterior skull base, and 3 of them had concomitant rhinoliquorrhea. A transcranial approach was performed in 6/7 cases before EEA was considered to treat PTTP. In 4/7 cases, the PTTP resolved after the first intent; in 2/ 7 cases a second repair was necessary because of recurrent PTTP, 1 with and 1 without rhinoliquorrhea, and 1/7 case because of recurrent rhinoliquorrhea only. Overall, PTTP treated by EEA resolved with a mean radiological resolution time of 69 days (range 23-150 days), with no late recurrences. Only 1 patient developed a cerebrospinal fluid diversion infection probably related to a first incomplete EEA skull base defects repair. A permanent cerebrospinal fluid diversion was necessary in 3/7 cases.Endonasal endoscopic approach repair of air conduits is a safe and efficacious second-line approach after failed transcranial approaches for symptomatic PTTP. However, the strength of recommendation for EEA remains low until further evidence is presented.

Bone grinding is used to remove the skull bone and access tumors through the nasal passage during cranial base neurosurgery. The generated heat of the spherical diamond tool propagates and could damage the nerves or coagulate the arteries blood. Little is known about the non-Fourier behavior of heat propagation during bone grinding. Therefore, this study develops an analytical model of the hyperbolic Pennes bioheat transfer equation (HPBTE) to calculate the three-dimensional temperature and necrosis in the grinding region. In vitro experimental investigations were carried out, and the contact zone temperature was measured using an infrared thermography system to validate the proposed thermal model. The results demonstrate that the HPBTE provides more reliable temperature evaluation and thermal damage than Fourier or parabolic heat transfer equation (PHTE). Due to the low thermal diffusivity of the bone, the lower grinding feed rate leads to higher temperature amplitude and a smaller radius of the affected zone in the surface and depth of the bone. Also, the intensity of bone necrosis decreases with the increase of the feed rate, and the shape of the damage zone becomes stretched. This analytical model can assess the potential risk of the surgery before clinical trials. Also, it could be used for comparing the different operating conditions to minimize bone necrosis and improve the control process in neurosurgeries.

Skin cancers are the most prevalent malignant disorder affecting humans. Approximately 90% of these are nonmelanoma skin cancer (NMSC), and large tumors, especially at the 'H-zone', can invade deeply and access the skull base. The best treatment for these very advanced skin cancers is craniofacial resection followed by adjuvant treatment, but, currently, systemic therapy and neoadjuvant approaches could be considered for some patients. The current management of NMSC involving the skull base is discussed in this article.Surgical resections with negative margins followed by adjuvant treatment are the best treatment for NMSC with skull base invasion and offer the best outcomes for those patients. This approach usually requires a free flap reconstruction, followed by external beam radiation therapy. The team must keep in mind that some factors, such as gross brain invasion and extensive dura mater extension, are associated with worse outcomes.Although it occurs infrequently, very advanced NMSC can involve the skull base. In these very difficult clinical scenarios, the best therapeutic option is a multidisciplinary approach in a tertiary center.

Background: Acute watery diarrhoea (AWD) is a leading cause of illness and death amongst children in developing countries. Electrolyte and acid-base disturbances play an important role in the associated morbidity and mortality. Objectives: To observe the acid-base and electrolyte changes in moderate and severe dehydration in AWD in children. Methods: This cross sectional study was carried out in the Observation and Referral Unit of Dhaka Shishu (Children) Hospital from July 2018 to December 2018. Children below five years of age who came with acute diarrhoea with moderate to severe dehydration were included in the study. After admission 2ml of whole blood was collected with all aseptic measures at the time of insertion of intravenous cannula before giving intravenous fluids to measure serum levels of Na and K while arterial blood was also taken for analysis. The data was analyzed by using SPSS version 20. Results: Total 125 AWD cases were admitted among them 98(78.4%) had moderate dehydration whereas 27(21.6%) had severe dehydration. Hyponatremic dehydration was present in 41(32.8%) cases. Among them 30(30.6%) had moderate dedydration and 11(40.4%) had severe dehydration, hypernatremic dehydration was present in 11.11% cases, hypokalemia was present in 54(43.2%) cases. Among them 42(42.86%) had moderate dedydration and 12(44.44%) had severe dehydration. Metabolic acidosis was present in 38(30.4%) cases [28(28.57%) in moderate dedydration and 10(37.04%) in severe dehydration]. The comparison of mean serum sodium and potassium value of the children with moderate and severe degrees of dehydration did not attain statistical significance, but there was a significant difference in bicarbonate concentration among moderate and severe dehydration cases (p=0.02). Conclusion: Hyponatremia and hypokalamia was the commonest electrolyte abnormality among moderate to severe dehydration with AWD. Mean serum sodium and potassium of the children with moderate and severe degrees of dehydration did not attain statistical significance, but bicarbonate concentration was significantly low among severe dehydration cases. DS (Child) H J 2020; 36(2): 120-124

Contacting the base is a common injury mechanism for base runners in softball, with ankle sprains being the most common type of injury, but it is not known how the base affects lower extremity mechanics. The purpose of this study was to analyze lower extremity biomechanics while rounding a base. Sixteen recreationally active females with previous softball experience completed two base rounding conditions. A base was securely placed on the force place for the with base (WB) condition, and an outline of the base was taped on the force plate for the no base (NB) condition. Three-dimensional right-leg hip, knee, and ankle kinematics and kinetics were measured during the stance phase of the base rounding and analyzed using statistical parametric mapping (SPM). The WB condition resulted in decreased hip abduction ( p = 0.034), increased dorsiflexion ( p = 0.012), and decreased inversion ( p

We report a case of aseptic abscess in the cavernous body at the base of the penis. In our clinical observation, the patient underwent puncture and drainage of the corpus cavernosum abscess, followed by surgical resection of the abscess wall, with the incisions closed layer by layer with primary suture. In addition, we paid attention to strengthening the postoperative management by using elastic bandages to wrap the penis intermittently to prevent edema; the incision would not be covered with dressings from the third day after the operation, so as to keep the incision site dry in an open way. During the period of indwelling of the catheter after the operation, we noticed the care of the external orifice of the urethra to reduce the occurrence of catheter-related infections. Finally, the patient was diagnosed with a penile aseptic abscess in the cavernous body at the base of the penis. The patient recovered well after surgery and was discharged 1 week later. At 1.5 years after the operation, the shape of the penis returned to normal, and the erectile function was normal. It was seen that good nursing concept is of great help for prognosis, which could avoid infection and edema, and is conducive to wound healing.

A 45-year-old female who presented with a salivary gland tumor on the oral and base of the tongue underwent surgery via intraoral approach. It led to a recurrence of the primary site and metastasis to bilateral cervical lymph nodes within 5 years of surgery. We performed resection of the recurred tumor via transoral approach and endoscope assisted neck dissection via retroauricular approach. The patient has been alive for 5 years without recurrence or any complications. We report on this case where a minimally invasive approach was used to obtain excellent cosmetic results and outstanding surgical outcomes.

Com o aumento da incidência de doenças oncológicas e a demanda da assistência de enfermagem para tais pacientes devido ao desconforto causados pelo seu tratamento radioterápico. Objetivo: Formular um protótipo de uma compressa refrescante à base de camomila, para aplicar em pacientes oncológicos, que se submetem à radioterapia, como forma profilática ou como tratamento para as radiodermatites. Metodologia: Essa compressa foi confeccionada com tecido de algodão crú, tecido impermeável aquablock, TNT, e tecido de fibra siliconada preenchendo o interior da compressa junto com o gel à base de camomila. Resultados: A compressa refrescante à base de camomila, foi feita com materiais de baixo custo, confeccionada de forma manual, constatando que terapias alternativas, podem ser realizadas com mais frequência, pois sua realização é de fácil acesso, podendo trazer muitos benefícios aos pacientes e podendo abranger a todos tipos, com comprovação científica da sua eficácia. Conclusão: Com o aumento da incidência e novos casos de câncer acometendo a população, essas medidas são fundamentais para ser prestado uma assistência de enfermagem centrada na humanização e qualidade de vida do paciente oncológico, com embasamento científico que disponibiliza vários recursos que abrange a área das terapias alternativas, por isso elaboramos uma compressa refrescante à base de camomila, assim podendo trazer um conforto e alívio para os pacientes radioterápicos.

BACKGROUND Acromial and scapular spine fractures after reverse total shoulder arthroplasty (RTSA) are a well-known complication that may negatively impact the effects of long-term outcomes. However, to the best of our knowledge, there has been no report of simultaneous bilateral fractures of the acromion or scapular spine that occurred following staged RTSA. CASE SUMMARY A 79-year-old right-handed male visited our outpatient clinic with a chief complaint of pain and limited motion of both shoulder joints for a one-year duration. Based on plain radiographs and magnetic resonance images, the preoperative diagnosis was bilateral cuff tear arthropathy with failed rotator cuff repair. This patient was treated with staged bilateral RTSA at a two-month interval. At 5 and 3 mo after right and left side surgery, the patient returned to the outpatient clinic with severe pain and limited motion of both shoulder joints for 2 wk without a traumatic event. A computed tomography scan revealed non-displaced acromial base fractures of both shoulders. Considering bilateral involvement, fracture location, and patient’s demand, open reduction and internal fixation (ORIF) using plate for bilateral acromial base fractures were performed. At 2 years after ORIF, the fracture was completely healed, and the patient was satisfied with shoulder status. CONCLUSION This report describes an extremely rare case of simultaneous bilateral acromial base fractures after staged RTSA managed successfully by ORIF with a pre-contoured plate designed for distal clavicle fractures. Although acromial fracture after RTSA can be treated conservatively, simultaneous bilateral fractures may warrant surgical intervention as a means of addressing difficulties in activities of daily living.

Neuroendocrine tumors (NETs) are neoplasms that originate from cells of the endocrine and nervous systems, and are commonly found in the gastrointestinal and respiratory tracts. Primary intracranial NETs are extremely rare and have been the focus of only a few studies thus far. Herein, we report the case of a primary intracranial NET of the skull base complicated with tension pneumocephalus after radiotherapy. An 84-year-old woman visited a local hospital for a head injury, and CT revealed a skull base tumor. MRI showed that the tumor was located mainly on the clivus and extended into the paranasal sinuses and nasal cavity. We biopsied the tumor via the nasal cavity, and the pathological diagnosis was NET, WHO grade 2. We subsequently administered focal intensity-modulated radiation therapy, but the patient developed tension pneumocephalus 1 year after radiotherapy. We therefore performed endoscopic transnasal cerebrospinal fluid leak closure with a nasoseptal flap. The postoperative course was successful, and the patient returned home but died of an unknown cause 2 years after discharge. The optimal postoperative management of primary intracranial NETs remains controversial. Tension pneumocephalus related to radiotherapy is a rare complication. Assessing skull bone erosion before radiotherapy and performing regular radiological follow-up examinations are essential to prevent this rare complication.

Lactate and base deficit (BD) values are parameters evaluated as indicators of tissue perfusion and have been used as markers of severity of injury and mortality.The aim of the study was to determine the relationship between combined score (CS) and blood transfusion need within 24 h and comparison of the variables between transfusion and non-transfusion group, correlation lactate with BD and with physiological, laboratory parameters, and determining the major risk factors of patients for the need for blood transfusion.The study included a total of 359 patients (245 males, median age: 40, min-max: 18-95) with blunt multi-trauma. De-mographics data, laboratory parameters (hemoglobin [Hb], hematocrit [Htc], lactate, BD, pH), physiologic parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], respiratory rate [RR]), shock index (SI), and revised trauma score (RTS) were recorded. Logistic regression method was used to create the CS formula using lactate and BD values. According to this formula, the probability value of 0.092447509 was calculated for the need for blood transfusion within 24 h. If CS was higher than the probability value, the need for blood transfusion within 24 h was considered. Furthermore, univariate analysis was used to determine major risk for blood transfusion need in 24 h, and the receiver operating characteristic curves were performed to compare CS, lactate, BD, SI and RTS.The comparison between transfusion and non-transfusion group there was significance between SBP, DBP, HR, RR, SpO2, Glasgow coma scale, Hb, Htc, lactate, BD, pH, SI and RTS (for each p0.05). Lactate value has a positive correlation with SI, HR and has a negative correlation with BD, RTS, SBP, and DBP. BD values has a positive correlation with RTS, SBP, DBP, Hb, and Htc and has a negative correlation with SI, HR, and RR. The main risks for blood transfusion need were SI, lactate, BD, SBP, and SpO2%. CS was 0.09 in 100 (27.85%) patients and 41 with high CS had blood transfusion within 24 h (p0.001; OR21.803, sensitivity 83.7%, specificity 81%,positive predictive value 41%, and negative predictive value 96.9%). A ROC curve showed that CS (AUC: 86.) was more significant than SI and RTS for the need for blood transfusion.CS is effective for predicting blood necessity in 24 h for blunt multi-trauma patients.

Currently, cardio rehabilitation is part of the General system of medical care, whose task is to improve the quality of life and maximize the recovery of the patient’s habitual lifestyle. Therefore, it is advisable to include patients with cardiological pathology in rehabilitation programs. Despite the success achieved in recent years in the treatment, prevention and rehabilitation of patients with coronary heart disease (CHD), the search for new and more advanced methods of cardio rehabilitation in this category of patients remains an urgent task.

Aim: To compare the recurrence rate of conjunctival rhinosporidiosis mass excision, with and without cauterization of base. Study Design: Prospective randomized clinical trial. Place and Duration of Study: Department of Ophthalmology, CIMS, Bilaspur (C.G), India. (Feb 2018-Dec 2019) Methodology: Twenty patients (5-25years) who presented with conjunctival mass clinically diagnosed as ocular rhinosporidiosis were included in this study. Patients were recruited from OPD ophthalmology CIMS, Bilaspur (C.G). Patients were divided on alternate basis into two groups. Each group had 10 patients. Group1 included excisions with cauterization of base with wet field cautery and group 2 included excisions without cautery. All the procedures and post-operative evaluation were done by the same surgeon. These two groups were compared for recurrence of mass at the same site and other sites. Post-operative evaluation was done at 1 week, 1 month, 3 months and 6 months. Results: Patients’ age ranged between 5-15 years were more in both groups. There were more males than females and majority of them lived in rural areas where pond water was the only accessible portable water. Lower lid palpebral conjunctiva was more involved. The mean duration of lesion was similar in both groups. All the patients were examined at 1 week, 1 month, 3 months and 6 months post-operatively, to check for recurrence at the same site by the same surgeon. The ear, nose and throat was examined by an otolaryngologist. No recurrence was found after 6 months of the procedure at ocular and extra-ocular sites. Conclusion: Our study concludes that in cases of rhinosporidiosis mass of palpebral conjunctiva, total excision of mass without cauterization of base is as effective as with cauterization of base.

Background and Purpose: With recent advances in secondary prevention management, stroke recurrence rates may have changed substantially. We aim to estimate risks and trends of stroke recurrence over the past 2 decades in a population-based cohort of patients with stroke. Methods: Patients with a first-ever stroke between 1995 and 2018 in South London, United Kingdom (n=6052) were collected and analyzed. Rates of recurrent stroke with 95% CIs were stratified by 5-year period of index stroke and etiologic TOAST (Trial of ORG 10172 in Acute Stroke Treatment) subtype. Cumulative incidences were estimated and multivariate Cox models applied to examine associations of recurrence and recurrence-free survival. Results: The rate of stroke recurrence at 5 years reduced from 18% (95% CI, 15%–21%) in those who had their stroke in 1995 to 1999 to 12% (10%–15%) in 2000 to 2005, and no improvement since. Recurrence-free survival has improved (35%, 1995–1999; 67%, 2010–2015). Risk of recurrence or death is lowest for small-vessel occlusion strokes and other ischemic causes (36% and 27% at 5 years, respectively). For cardioembolic and hemorrhagic index strokes around half of first recurrences are of the same type (54% and 51%, respectively). Over the whole study period a 54% increased risk of recurrence was observed among those who had atrial fibrillation before the index stroke (hazard ratio, 1.54 [1.09–2.17]). Conclusions: The rate of recurrence reduced until mid-2000s but has not changed over the last decade. The majority of cardioembolic or hemorrhagic strokes that have a recurrence are stroke of the same type indicating that the implementation of effective preventive strategies is still suboptimal in these stroke subtypes.

Background: Type1 Diabetes Mellitus (T1DM) is the most common endocrine metabolic disorder of childhood casing significant mortality and morbidity in childhood. Home Monitoring of Blood Glucose (HMBG) and Supplements of insulin as required depending on the blood glucose level at that time is a very important aspect of management in T1DM. The Goal of this study was to determine whether frequent checking of home base blood glucose (HMBG) levels accompanied with insulin self dose adjustment, will lead to improved metabolic control as assessed by reduction in the Glycosylated hemoglobin values (HbA1c).Subject and Method:This study was conducted in G.G.Hospital,,M.P.Shah Medical college,Jamanagar between October 2012 to September 2013 for a period of 1 year including OPD and ward patients. Retrospective analysis of clinical profile of 37patients with T1DM attending our OPD between the age group of 2 to 16 years.A detailed clinical and family history, educational level of parents and insulin regime and insulin dose was recorded. Result:Age distribution in our study showed that 62% cases in the age of more than 10 years, 32% cases in the age group 5-10years and 2 % cases falling in the age group 0-2 years, with male to female ratio of a 1:1.7. The most frequently seen symptoms were polyuria (53%), breathlessness (48%),polydipsia (46%), vomiting (29%) of cases and 82%of the patients were ketotic at the time of presentation. In family members most common associated co-morbidity is type 2 DM(21% ) , hypertension(21%) & thyroid dysfunction (19%). split regimen was observed in (70%)and basal bolus regime in (30%). split mix regime 11(42%) had good(

Purpose To demonstrate temporal lobe necrosis (TLN) rate and clinical/dose-volume factors associated with TLN in radiation-naïve patients with head and neck cancer treated with proton therapy where the field of radiation involved the skull base. Materials and Methods Medical records and dosimetric data for radiation-naïve patients with head and neck cancer receiving proton therapy to the skull base were retrospectively reviewed. Patients with Results Between 2013 and 2019, 234 patients were included. The median follow-up time was 22.5 months (range = 3.2–69.3). Overall TLN rates of any grade, ≥ grade 2, and ≥ grade 3 were 5.6% (N = 13), 2.1%, and 0.9%, respectively. The estimated 2-year TLN rate was 4.6%, and the 2-year rate of any brain necrosis was 6.8%. The median time to TLN was 20.9 months from proton completion. Absolute volume receiving 40, 50, 60, and 70 GyRBE (absolute volume [aV]); mean and maximum dose received by the temporal lobe; and dose to the 0.5, 1, and 2 cm3 volume receiving the maximum dose (D0.5cm3, D1cm3, and D2cm3, respectively) of the temporal lobe were associated with greater TLN risk while clinical parameters showed no correlation. Among volume parameters, aV50 gave maximum AUC (0.921), and D2cm3 gave the highest AUC (0.935) among dose parameters. The 11-cm3 cutoff value for aV50 and 62 GyRBE for D2cm3 showed maximum specificity and sensitivity. Conclusion The estimated 2-year TLN rate was 4.6% with a low rate of toxicities ≥grade 3; aV50 ≤11 cm3, D2cm3 ≤62 GyRBE and other cutoff values are suggested as constraints in proton therapy planning to minimize the risk of any grade TLN. Patients whose temporal lobe(s) unavoidably receive higher doses than these thresholds should be carefully followed with MRI after proton therapy.

Osteoradionecrosis of the skull base (SB-ORN) is a serious potentially lethal complication after radiotherapy in the head and neck region and is therefore considered one of the most challenging clinical entities among skull base lesions. Management options includes nasal irrigation, medications such as systemic antibiotics and anti-inflammatory drugs, hyperbaric oxygen therapy, and surgical debridement. Despite these efforts treatment outcomes are associated with a poor prognosis. Recent studies have shown an increased disease control rate with a more aggressive surgical approach including sequestrectomy. One of the main factors associated with poor prognosis is involvement of the internal carotid artery near the skull base. Spontaneous carotid rupture is frequently associated with death and/or severe morbidity and also poses risk of profuse bleeding during surgery. In this article we will deliver a comprehensive review of SB-ORN, including pathophysiology, clinical features, and an update in treatment strategy.

SUMMARY: As a result of their intense physical activity, racehorses suffer high tendon stress which may result in various pathologies. One of these is tendonitis in the tendon of the superficial digital flexor muscle (TSDFM). Conventional treatment with rest, has not shown to be very effective, and regenerative medicine through the application mesenchymal stem cells appears to be a promising therapy. The objective of this work was to assess the effect of the application of autologous MSC on reduction of the scar length in recurrent TSDFM tendinitis in Holsteiner horses, using image analysis. This study included two groups of five animals each: A control group that received conventional treatment (CG) and an experimental group which was also treated with intralesional injections of MSC (EG). Scar evolution was assessed by echographic analysis, with measurements taken of the scar length over a four month period; the length at month zero, was taken as the initial value of 100 %. During the first month, the mean scar length diminished to 81.14 % (EG) and 95.85 % (CG); after the second month, lengths were 64.4 % (EG) and 92.3 % (CG); following the third month lengths were 51.92 % (EG) and 87.42 % (CG); finally at the end of the fourth month the lengths recorded were 26.7 % (EG) and 83.92 % (CG). These results show that treatment with autologous MSC helps TSDFM scar length was significantly reduced, as compared to conventional treatment.

Objectives: To describe a rare case of infratemporal phosphaturic mesenchymal tumor (PMT), a “nonphosphaturic” variant in the infratemporal skull base, in a 5-year-old boy. Methods: This was a retrospective study of the patient's clinical and biochemical features, computed tomography (CT), maxillofacial magnetic resonance imaging (MRI), histopathology as well as surgical treatment and follow-up. Results: The boy suffered from a right preauricular mass and ipsilateral hearing loss. Temporal bone CT and maxillofacial MRI demonstrated a circumscribed infratemporal skull base lesion. Histomorphologically, the lesion demonstrated typical microscopic features of PMTs and was positive for vimentin, smooth muscle actin, and FGF-23. However, there was no clinical or biochemical evidence of tumor-induced osteomalacia (TIO), and ultimately a diagnosis of a “nonphosphaturic” variant of PMTs was made. No postoperative recurrence was observed during follow-up. Conclusions: PMTs are rare and have a low incidence among children. They are histologically distinctive tumors associated with phosphaturia and TIO. So-called “nonphosphaturic” variants, occurring without known phosphaturia, are even rarer. Pathologists and clinicians need to be aware of the presence of a PMT with an absence of osteomalacia symptoms. Wide surgical resection and long-term follow-up are necessary. Intraoperative functional and aesthetic concerns should be emphasized as well, particularly in pediatric patients.

PurposeStereotactic radiosurgery (SRS) is an effective and less invasive therapeutic option for cavernous sinus (CS) tumors. However, its long-term effectiveness and neurological outcomes have yet to be fully elucidated. We aimed to examine the long-term outcomes of SRS for CS tumors.MethodsOverall, 127 patients with benign CS tumors, including 91 with meningioma, 14 with trigeminal schwannoma (TS), 14 with non-functioning pituitary adenoma (PA), and eight with cavernous hemangioma (CH), treated with SRS at our institution from 1990 to 2018, were included. Tumor control and functional preservation/recovery were evaluated in detail.ResultsThe mean post-SRS follow-up period was 102 months. The progression-free survivals (PFSs) were 97% at 5 years, 90% at 10 years, and 88% at 15 years for the entire cohort; 96% at 5 years and 87% at 10 years for meningiomas; and 100% at 10 years for the other tumors. No significant difference was observed among the tumor types (log-rank test; meningioma vs. TS, p = 0.232, meningioma vs. PA, p = 0.297, meningioma vs. CH, p = 0.277). Improvement in cranial nerve (CN) function was observed in 35 (27%) patients. TSs tended to show CN improvements more often than meningiomas did (total improvements, 62% vs. 23%; p = 0.004, eye movement function, 100% vs. 20%; p = 0.002). Deterioration, or development of new CN deficits, was observed in 11 (9%) patients.ConclusionSRS provides durable tumor control and contributes to sufficient preservation of CN function.

The purpose of this study was to investigate survival differences between low-grade and high-grade base of tongue (BOT) adenocarcinoma by examining demographics, tumor characteristics, and treatment modalities.The National Cancer Database was queried for patients with BOT adenocarcinoma between 2004 and 2017. Univariate and multivariate analyses were performed for all cases of BOT adenocarcinoma. Subsequent analysis focused on low-grade (grade 1 and grade 2) and high-grade (grade 3 and grade 4) BOT adenocarcinoma.A total of 286 patients with BOT adenocarcinoma were included in the main cohort and divided into low grade (n = 137) and high grade (n = 66). The 5-year overall survival for all patients, low-grade, and high-grade was 67%, 85%, and 58%, respectively. Prognostic factors associated with decreased survival for the main cohort include advanced age (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.02-1.06), non-white race (HR: 1.79; 95% CI: 1.04-3.25), public insurance (HR: 1.79; 95% CI: 1.02-3.14) and high-grade 3,4 (HR: 2.63; 95% CI: 1.51-4.56). The prognostic factor associated with increased survival for the main cohort was surgery (HR: 0.59; 95% CI: 0.36-0.96). Radiotherapy was associated with improved overall survival for high-grade BOT adenocarcinoma (HR: 0.09; 95% CI: 0.02-0.49) but not for low-grade BOT adenocarcinoma (HR: 0.93; 95% CI: 0.38-2.32).This investigation is the largest to date analyzing the association of treatment modalities with overall survival in BOT adenocarcinoma. Surgery remains standard of treatment, particularly in low-grade cases, with radiotherapy offering additional survival benefit for high-grade BOT adenocarcinoma.