Primary orbital apocrine adenocarcinoma: case report and literature review.

Primary apocrine adenocarcinoma (PAA) originating from the orbit is a rare malignant neoplasm. We present the case of a 61-year-old-male with PAA of the orbit. The patient underwent a right orbital exenteration, neck dissection, and adjuvant radiotherapy. Orbital exenteration is commonly performed as the primary intervention for PAA of the orbit. The role of adjuvant radiotherapy to prevent local recurrence is unclear and may be determined on a case-by-case basis.

Building the workforce of tomorrow: The weighting of rural exposure in standardised curriculum vitae scoring criteria for entrance into Australian specialty training programs.

OBJECTIVE: To determine the weighting of rural exposure within publicly available standardised curriculum vitae (CV) scoring criteria for trainee medical officer's applying into medical and surgical specialty training programs in Australia and New Zealand. METHODS/DESIGN: An observational analysis of rural exposure point allocations within publicly available standardised CV scoring criteria for entrance into specialty training programs. SETTING: All Australian and New Zealand medical and surgical specialties training programs outlined by the Australian Health Practitioner Regulation Agency (AHPRA) who publish publicly available standardised CV scoring criteria for entrance into specialty training were included. RESULTS: Of the 14 specialty training programs that publish publicly available standardised CV scoring criteria, 8/14 allocate points towards rural exposure. While the allocation of points within this scoring domain varies between the eight training programs, the mean weighting of rural exposure is 13.7%. CONCLUSIONS: The relative weighting of rural exposure varies between the eight specialty training programs who include rural exposure as a CV scoring criteria. The deliberate and strategic construction of CV scoring criteria and inclusion of rural exposure points is important to continue developing the Australian rural specialist workforce. Future development of standardised CV scoring criteria should continue to consider point allocation towards rural exposure and related activities to ensure that the requirements of rural Australian healthcare needs are met across medical and surgical specialties.

Does Twitter improve the dissemination of ophthalmology scientific publications?

PURPOSE: To determine whether Twitter improves dissemination of ophthalmology scientific publications METHODS: Data were collected on articles published on PubMed between the years 2016 and 2021 (inclusive) and identified with the word "ophthalmology". Twitter performance metrics, including the number of tweets, number of likes, and number of retweets were collected from Twitter using the publicly available scientific API. Machine learning and descriptive statistics were used to outline Twitter performance metrics. RESULTS: The number of included articles was 433710. The percentage of articles that were in the top quartile for citation count, which had ≥1 tweet was 34.4% (number 437/1270). Conversely, the percentage of articles that were in the top quartile for citation count, which had 0 tweets was 27.8% (number 12023/43244). When machine learning was used to predict Twitter performance metrics an AUROC of 0.78 was returned. This was associated with an accuracy of 0.97 CONCLUSION: This study has shown preliminary evidence to support that Twitter may improve the dissemination of scientific ophthalmology publications.

Nasolabial Flap Improves Healing in Medication-Related Osteonecrosis of the Jaw.

PURPOSE: Medication-related osteonecrosis of the jaw (MRONJ) is an adverse side effect of antiresorptive and antiangiogenic therapeutic agents that is difficult to treat owing to its high relapse rate. The aim of the present study was to determine whether patients with MRONJ treated using decortication and a nasolabial flap compared with those who underwent decortication with mucoperiosteal flaps have better outcomes regarding stable wound closure. MATERIALS AND METHODS: Two groups of patients with MRONJ and intraoral exposed bone were evaluated in a cohort clinical study retrospectively. The primary predictor variable was the treatment group. The experimental group used the nasolabial flap for wound closure, and the control group used the mucoperiosteal flap for closure. The outcome variable was successful wound closure defined as a symptomless and closed wound after at least 12 months. Other study variables included factors such as perioperative drug holiday, duration of postoperative oral antibiotic administration, and postoperative use of nasogastric feeding tubes. Cox proportional hazard regression analysis and Kaplan-Meier curves were used to determine the factors independently associated with the dependent variable. The Mann-Whitney U test and χ2 test were used for analyses regarding group-related data. RESULTS: Both groups showed similar demographics. The 16 study patients receiving nasolabial flaps had a mean age of 69.9 years, and the 16 control patients receiving mucoperiosteal flaps had a mean age of 71.8 years. Both groups included 10 women and 6 men. Of the 16 patients in each group, 15 had received a bisphosphonate and 1, monoclonal antibody therapy. All evaluated patients underwent combined treatment, including decortication and intravenous antibiotics. Of the 16 patients receiving nasolabial flaps, symptomless intact wound closure was achieved in 68.8%. Of the 16 patients with mucoperiosteal closure, 18.7% achieved wound closure, with 81.2% developing a relapse of MRONJ, a statistically significant difference (P < .001). No statistically significant differences were found between the 2 groups in the demographic variables. The mean interval to relapse for the experimental and control groups was 13.6 ± 7.8 and 8.2 ± 7.9 months, respectively (P = .017). CONCLUSIONS: MRONJ is a complication of antiosteoclastic treatment of mostly oncologic, palliative patients, which requires a very methodical approach to surgical treatment. A variety of different methods have been reported. The use of nasolabial flaps can be considered as a highly reliable option for coverage the bone wound with less morbidity than microvascular free flaps and better long-term results compared with mucoperiosteal flaps.

A vital parameter? Systematic review of spirometry in evaluation for intensive care unit admission and intubation and ventilation for Guillain-Barré syndrome.

BACKGROUND: Patients with Guillain-Barré syndrome (GBS) may require intensive care unit (ICU) admission for intubation and ventilation (I + V). The means to predict which patients will require I + V include spirometry measures. The aims of this study were to determine, for adult patients with GBS, how effectively different spirometry parameter thresholds predict the need for ICU admission and the requirement for I + V; and what effects these different parameter thresholds have on GBS patient outcomes. METHOD: A systematic review was conducted of the databases PubMed, EMBASE, and Cochrane library in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The systematic review was registered prospectively on PROSPERO. RESULTS: Initial searches returned 1011 results, of which 8 fulfilled inclusion criteria. All included studies were observational in nature. Multiple studies suggest that a vital capacity below 60% of predicted value on admission is associated with the need for eventual I + V. No included studies evaluated peak expiratory flow rate, or interventions with different thresholds for ICU or I + V. CONCLUSIONS: There is a relationship between vital capacity and the need for I + V. However, there is limited evidence supporting specific thresholds for I + V. In addition to evaluating these factors, future research may evaluate the effect of different patient characteristics, including clinical presentation, weight, age, and respiratory comorbidities, on the effectiveness of spirometry parameters in the prediction of the need for I + V.

Three-Dimensional Heads-up Display in Cataract Surgery: A Review.

Intraocular visualization in cataract surgery is currently achieved using the ophthalmic surgical microscope (OSM). Three-dimensional (3D) heads-up display is a burgeoning intraocular visualization technique for cataract surgery, which projects the surgical view to a 3D monitor. A number of theoretical advantages of this system over the OSM have been proposed. 3D visualization is reported to provide improved depth perception and the heads-up display promotes a more ergonomic surgical position while providing an enhanced view for the entire surgical team. The modern OSMs, however, already allow for safe and efficient cataract surgery, and 3D heads-up display visualization is limited by a steep learning curve. We critically review the literature around 3D heads-up display cataract surgery and compare its safety profile to traditional visualization techniques.

Cryopreserved human amniotic membrane for soft tissue repair in rats.

Fresh amniotic membrane has been used in medicine since 1910. The reconstruction of immunologic privileged ocular surfaces with cryopreserved amniotic membrane was introduced in the 1990s. The aim of this study was to analyze the use of cryopreserved human amniotic membrane (HAM) as a surgical patch in immunologic unprivileged anatomic sites. In part I of the investigation, the abdominal wall muscle of 36 rats was covered with mono- and multilayered HAM. After 3, 14, and 28 days, respectively, these grafts were evaluated macro- and microscopically. Multilayer samples displayed slower degradation and less inflammation compared with monolayer coverage. In part II of the study, abdominal wall closure with multilayer HAM and with polypropylene mesh was conducted in 20 rats. All rats showed sufficient closure after 21 days, but significantly lower intraabdominal adhesion formation was observed in the HAM rats. The results of this study might pave the way for the use of cryopreserved HAM as graft material in reconstructive surgery.

Ectopic meningioma of the mandible in a 20-year-old woman: a case report and literature review.

Ectopic meningiomas are a very rare tumor entity. We present a case of a meningioma arising in the mandible of a young woman and initially supposed to be a radicular cyst. Histopathological and immunhistochemical evaluation showed typical cell characteristics of a meningioma. Only six cases of ectopic meningiomas in the mandible have been described in the literature until now, mainly in women at an advanced age and with surgical removal of all tumors. For the first time, no surgical excision has been performed in this case and follow-up control after 12 months showed no significant progression or increasing clinical complaints. Hence, surgical removal seems non-urgent. In conclusion, unclear lesions of the jaws, even if they seem to be clear following diagnostics, should be evaluated by incisional biopsy and histopathological evaluation.

Increasing the accuracy of mandibular reconstruction with free fibula flaps using functionalized selective laser-melted patient-specific implants: A retrospective multicenter analysis.

In this study, selective laser melted patient specific functional implants (PSFI) were utilised in combination with a fibula free flap, for mandible reconstruction. The shape and length of the PSFI, the shaping of fibula graft, its angulation and the length of the screws, were virtually planned before the surgery. Information, such as resection margin and screw lengths, were coded on the implant. 22 patients were reconstructed with PSFI and fibula transplantation. Data collected related to the size of the defect, pre- and postoperative intercondylar distance, ischemia time, time consumed to shape the fibula graft and complications. All patients were reconstructed as planned. Depending on the extension of the defect, the fibula grafts were shaped into different shapes, within 41.6 ± 4.9 min. The mean difference of pre- and post-operational condyle distances was 1.2 ± 1.4 mm. Postoperative complications such as wound healing disturbance and plate exposure occurred in 8 patients. All PSFIs remained within reconstruction sites during the follow up period. 8 out of the 22 patients had full dental rehabilitation with implants. Based on our results, the use of PSFIs in the reconstruction of mandibular segmental defects may contribute to a better clinical outcome. Further work will be required in order to evaluate their mechanical properties in detail.

Advanced imaging findings and computer-assisted surgery of suspected synovial chondromatosis in the temporomandibular joint.

Synovial chondromatosis of the joint occurs mainly in teenagers and young adults. Only 3% of these neoplasms are located in the head and neck region. Synovial chondromatosis of the temporomandibular joint is therefore a very rare disorder. Therefore, developing a working, histological confirmation is required for differential diagnosis. In this case series, the outcome of histological investigation and imaging techniques are compared. Based on clinical symptoms, five cases of suspected synovial chondromatosis of the temporomandibular joint are presented. In each of the subjects, the diagnosis was confirmed by histology. Specific imaging features for each case are described. The tomography images were compared with the histological findings. All patients demonstrated preauricular swelling, dental midline deviation, and limited mouth opening. Computer-assisted surgery was performed. Histology disclosed synovial chondromatosis of the temporomandibular joint in four cases. The other case was found to be a developmental disorder of the tympanic bone. The diagnosis of synovial chondromatosis of the temporomandibular joint can only be based on histology. Clinical symptoms are too general and the available imaging techniques only show nonspecific tumorous destruction, infiltration, and/or residual calcified bodies, they are only for advanced cases. A rare developmental disorder of the tympanic bone--persistence of foramen of Huschke--has to be differentiated.