Correcting the crooked nose remains one of the most challenging problems in rhinoplasty. When faced with a twisted nose, rhinoplasty surgeons tend to be divided into those who perform an anatomic reconstruction and those who prefer camouflage techniques. Regardless of the approach used, the revision rate remains fairly high. An anatomic correction of the twisted nose through an open approach was performed. The septum was freed from the extrinsic forces of the deformed nasal bones and upper and lower lateral cartilages. The residual true septal injury was then evaluated. The septal deformity was addressed through quadrangular cartilage resection, repositioning of the caudal septum in the anatomic midline, and correction of the dorsal septal deformity with horizontal control sutures. The skeletal support was then reconstructed with the use of a spreader-extension graft on the concave side and a batten graft on the opposite side. The nasal tip was set relative to the dorsum by fixation to the extension grafts. Residual lateral crus deformities were corrected by a combination of lateral crural spanning sutures or alar spreader grafts. With this approach, straightening the crooked nose without compromising skeletal support or nasal aesthetics was successful.
ObjectiveMesenchymal stem cells (MSCs) have been shown in animal models to attenuate chronic neuropathic pain. This preliminary study investigated if: i) injections of autologous MSCs can reduce human neuropathic pain and ii) evaluate the safety of the procedure.MethodsTen subjects with symptoms of neuropathic trigeminal pain underwent liposuction. The lipoaspirate was digested with collagenase and washed with saline three times. Following centrifugation, the stromal vascular fraction was resuspended in saline, and then transferred to syringes for local injections into the pain fields. Outcome measures at 6 months assessed reduction in: i) pain intensity measured by standard numerical rating scale from 0–10 and ii) daily dosage requirements of antineuropathic pain medication.ResultsSubjects were all female (mean age 55.3 years ± standard deviation [SD] 14.67; range 27–80 years) with pain symptoms lasting from 4 months to 6 years and 5 months. Lipoaspirate collection ranged from 102–214 g with total cell numbers injected from 33 million to 162 million cells. Cell viability was 62%–91%. There were no systemic or local tissue side effects from the stem cell therapy (n=41 oral and facial injection sites). Clinical pain outcomes showed that at 6 months, 5/9 subjects had reduced both pain intensity scores and use of antineuropathic medication. The mean pain score pre-treatment was 7.5 (SD 1.58) and at 6 months had decreased to 4.3 (SD 3.28), P=0.018, Wilcoxon signed-rank test. Antineuropathic pain medication use showed 5/9 subjects reduced their need for medication (gabapentin, P=0.053, Student’s t-test).ConclusionThis preliminary open-labeled study showed autologous administration of stem cells for neuropathic trigeminal pain significantly reduced pain intensity at 6 months and is a safe and well tolerated intervention.
Although there were several outbreaks of the ‘sweating sickness’ (Sudor anglicus) in England between 1485 and 1551, only in 1529 did the disease spread far into the continent. In that year it had a devastating impact, spreading rapidly throughout Germany and thence into Scandinavia and the Baltic area, as well as into the Low Countries, Switzerland, and Austria. This study surveys the effect of the disease in Germany, and in particular draws attention to the astonishing speed with which the medical profession and the book trade there reacted to the crisis, which contrasts markedly with the apparent sluggishness of the response by English physicians and publishers. Nevertheless, it seems that it was the long English experience of the disease that eventually taught the Germans how to deal with it effectively; it is possible that the Reformer Robert Barnes (1495–1540), then in Lübeck, played a role in this. (pp. 147–176)
Aim:Non-melanoma skin cancer (NMSC) of the lower legs is a challenge to treat. Surgery can be difficult given the challenged blood supply.Radiotherapy (RT) is a controversial treatment modality and some radiation oncologists (ROs) will not offer definitive treatment for lesions below the knee for fear of creating a radiation-induced ulcer. This study is a retrospective audit of a single RO’s treatment of lower leg NMSCs. The aim is to evaluate the efficacy of RT in gaining local control of these lesions. The aim is also to document the development of late side effects following RT, including radiation-induced ulcers and their treatment. Referral growth over time was also investigated. Methods:Electronic medical records were searched for patients with lower leg NMSCs treated by the RO between January 2009 and December 2019 at three locations in Sydney, Australia (St Vincent’s Hospital, Mater Hospital, and Macquarie University Hospital). Patient, tumour, treatment, and outcome factors were collected and analysed.Referrals over time were recorded. Results:111 lesions arising in 56 patients were identified. There was even distribution of sex and the mean age was 82 (range 57–95). There were 78 cutaneous squamous cell carcinomas (cSCCs) and 23 basal cell carcinomas (BCC). Median lesion size was 2 centimetres (range 1–10cm). The most common RT modality used was electrons (91 [82%]), followed by superficial RT (SXRT) (20 [18%]). Median duration of follow-up was 4 months (range 0–117 months). Of the 77 lesions treated with curative intent, cure was achieved in 74 (96%) lesions. 2 cSCCs and 1 BCC recurred, with a median time to recurrence of 24 months. 15 (14%) lesions developed a radiation-induced ulcer following RT. Median duration of therapy required for these ulcers was 5 months (range 1–55 months), with conservative treatment being the most common therapy used. Referrals increased from 8 in the 2008-2011 period to 26 in the 2016-2019 period. Conclusion: This study showed RT treatment of lower leg NMSCs achieves local control of lesions with an acceptably low rate of radiation-induced ulcers, thus supporting the use of this modality for this patient population. Referrals grew over time which may reflect growing referrer knowledge and confidence in definitive RT below the knee.
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