Vascular Lesions.

Classification of vascular lesions based of off the biological behavior has greatly facilitated more accurate diagnoses, optimally defined treatment plans, and better outcomes. Treatment of vascular lesions has taken a more conservative surgical approach with reliance on select medical treatment options, which has greatly reduced morbidity and mortality resulting from extensive surgery. A multidisciplinary approach involving multiple surgical and pediatric subspecialties has led to advancement in both understanding and ideal treatment strategies of these lesions.

Does residual wall size or technique matter in the treatment of Zenker's diverticulum?

OBJECTIVES/HYPOTHESIS: We aimed to compare three surgical techniques (open approach for diverticulectomy with cricopharyngeal myotomy [OA], endoscopic laser-assisted diverticulotomy [ELD], and endoscopic stapler-assisted diverticulotomy [ESD]) for treatment of Zenker's diverticulum with regard to validated swallowing outcomes, radiographic outcomes, complications, and revision rates. We statistically analyzed whether the size of residual postoperative party wall or the specific surgical technique correlates with swallowing outcomes. STUDY DESIGN: Retrospective chart review and radiographic study analysis. METHODS: A retrospective chart review and radiographic analysis of preoperative and postoperative contrast swallow studies were conducted on patients undergoing surgery for Zenker's diverticulum between 2002 and 2014 at our institution. A follow-up validated swallowing outcome questionnaire, the Eating Assessment Tool-10, was administered to measure and compare patients' symptomatic outcomes. RESULTS: Seventy-three patients were reviewed and grouped according to technique. Median follow-up was 1.6 years. ESD resulted in a significantly larger residual party wall than ELD and OA but yielded comparative swallowing outcomes. OA had the highest complication rate and ESD had the highest revision rate. There were no revisions after ELD nor OA. CONCLUSIONS: Despite the predictably larger residual postoperative party wall following ESD, this technique produced statistically comparable swallowing outcomes. Given its low complication rate and comparable results, ESD should be considered first line therapy for medically high-risk patients with Zenker's diverticulum, while acknowledging a higher risk of symptom recurrence. ELD, with its slightly greater risk profile but low recurrence rate, is well suited for most in revision cases. OA may best be reserved for those patients in whom endoscopic approach is not feasible. LEVEL OF EVIDENCE: 4 Laryngoscope, 126:2475-2479, 2016.

Comparative physical mapping links conservation of microsynteny to chromosome structure and recombination in grasses.

Nearly finished sequences for model organisms provide a foundation from which to explore genomic diversity among other taxonomic groups. We explore genome-wide microsynteny patterns between the rice sequence and two sorghum physical maps that integrate genetic markers, bacterial artificial chromosome (BAC) fingerprints, and BAC hybridization data. The sorghum maps largely tile a genomic component containing 41% of BACs but 80% of single-copy genes that shows conserved microsynteny with rice and partially tile a nonsyntenic component containing 46% of BACs but only 13% of single-copy genes. The remaining BACs are centromeric (4%) or unassigned (8%). The two genomic components correspond to cytologically discernible "euchromatin" and "heterochromatin." Gene and repetitive DNA distributions support this classification. Greater microcolinearity in recombinogenic (euchromatic) than nonrecombinogenic (heterochromatic) regions is consistent with the hypothesis that genomic rearrangements are usually deleterious, thus more likely to persist in nonrecombinogenic regions by virtue of Muller's ratchet. Interchromosomal centromeric rearrangements may have fostered diploidization of a polyploid cereal progenitor. Model plant sequences better guide studies of related genomes in recombinogenic than nonrecombinogenic regions. Bridging of 35 physical gaps in the rice sequence by sorghum BAC contigs illustrates reciprocal benefits of comparative approaches that extend at least across the cereals and perhaps beyond.