Tracheal neoplasms account for less than 1% of all malignancies. In spite of their low incidence, these tumors represent potentially lethal phenomena. In cases of airway compromise and unresectable disease, the airway may be maintained by repeated bronchoscopic debulkings, and the use of CO(2) laser, silicone Montgomery T-tube and tracheal stents. The use of metallic expandable stents to relieve airway obstruction in advanced tracheal tumors was previously reported. Our aim was to evaluate the use of metallic expandable tracheal stents as a palliative relief from severe airway obstruction in cases of locally advanced, inoperable malignant tracheal tumors. Patients suffering from severe airway obstruction secondary to locally advanced tracheal tumors, who presented to the Otolaryngology Head and Neck Surgery and Chest Diseases Departments at the Main Alexandria University Hospital, Egypt, were included in this study. After endoscopic and radiological evaluation, expandable metallic tracheal stents (SENS; Ultraflex tracheal prosthesis; Boston Scientific Corp, Watertown, MA, USA) were inserted under general anesthesia to relieve airway obstruction. Postoperative follow-up with regard to improvement of respiration, tolerability of the stent and reporting of complications was done. Twelve patients were included, eight males and four females with a mean age of 61 years. Four patients (33.3%) had primary tracheal tumors and eight (66.7%) suffered from tumors infiltrating the trachea from nearby structures. The stent was easily inserted in all patients with no significant intraoperative complications. Postoperatively, the stent was well tolerated and all patients experienced good respiration with significant improvement of respiratory function test results. The most common complication reported was granulation tissue formation. Other complications were displacement of the stent, bad breath, re-growth of tumor tissue at the lower end of the stent and retention of secretions. We concluded that Ultraflex self-expandable stent is a good alternative for palliative relief from airway obstruction in cases of inoperable malignant tracheal tumors. Strict follow-up is mandatory for early detection and management of expected complications.

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2016 Background: To differentiate between pseudoprogression and true progression in patients with glioblastoma using MR perfusion radiomic texture analysis (TA). Methods: 98 patients with pathologically-proven diagnosis of GBM were retrospectively included in this IRB approved HIPAA compliant study. All patients underwent DSC and DCE Perfusion MRI as part of their routine clinical care. Images were analyzed using Nordic ICE 2.3 (NordicNeuroLab) ; rCBV and ktrans maps were obtained. Subsequently, 3D slicer 4.3.1(http://www.slicer.org) was used to segment the entire tumor on the different processed maps to create a volume of interest (VOI) for Radiomic TA. Multiple invariant texture features where then extracted from each VOI. 475 invariant texture features were applied to each map. Leave-one-out cross-validation (LOOCV), receiver operating characteristic (ROC), Kaplan Meier, and multivariate Cox proportional hazards regression analyses were used to assess the relationship between texture feature and pseudoprogression and true progression. Results: Variance and sum entropy were the two most significant radiomic features that discriminated between pseudoprogression and true progression. P value, AUC, specificity and sensitivity were 0.03, 89.26%, 81.82%, and 100% respectively. Conclusions: Radiomic TA derived from perfusion images can be helpful in determining true versus pseudoprogression in GBM. Further, this study illustrates successful application of radiomic TA as an advanced processing step for different MRI perfusion maps (DCE, DSC).

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INTRODUCTION:Implant placement in the posterior maxilla is problematic, not only due to inferior properties of bone but also due to loss of vertical bone height which happens after extraction of posterior teeth. When the required additional height is few millimeters, indirect transcrestal sinus lifting procedures is recommended. This study was carried out to compare clinically transcrestal sinus lifting with Densah burs versus osteotome with simultaneous implant placement. MATERIALS AND METHODS:This study was designed to be randomized clinical trial, a total of 11 patients with missing maxillary premolars or molars and with limited vertical bone height below the maxillary sinus floor (5 to 8 mm) received 12 implants either with osteotome or with osseodensification transcrestal sinus lifting. The 11 patients were divided into 2 groups, group A received osseodensification sinus lifting, group B received osteotome sinus lifting. Clinical follow up was done over 6 months. Results: No significant difference was detected regarding postoperative pain and edema. The P value (0.002*) showed a statistically significant difference in the operation time between the 2 groups. The mean of primary stability in densah bur group was 66.17 ±9.57, while the mean in the osteotome group was 54.83 ±7.19. The P value was (0.043*) showed a significant difference in primary stability between both groups. Also there was a significant difference in secondary stability between the 2 groups. CONCLUSION: Both osseodensification and osteotome technique showed a good clinical outcome in 6 months follow up, with better implant stability in the osseodensification cases.