Fechamento de comunicação bucossinusal com retalho de corpo adiposo de bochecha: relato de caso clínico / Closure of bucosinusal communication with cheek adipose body flap: Clinical case report

A comunicação bucossinusal (CBS) é uma complicação relativamente frequente na prática odontológica que ocorre em procedimentos cirúrgicos, principalmente, exodontias dos molares superiores. O diagnóstico dessa comunicação é feito através de exames clínicos intraorais, empregando a manobra de Valsava, e para a confirmação do diagnóstico, utiliza-se exame radiográfico. A literatura cita inúmeros métodos de tratamento, entretanto não evidenciam a técnica específica para cada caso, entre esses métodos existe o retalho com o corpo adiposo da bochecha, que apresenta alto índice de sucesso no fechamento das CBS. Quando a CBS é fechada incorretamente ou de forma tardia o paciente fica propício a desenvolver quadros de sinusite crônica ou aguda, além de fístulas bucossinusais. Portanto, deve-se identificar e tratar essa comunicação de imediato para evitar o desenvolvimento de outras complicações. O objetivo do presente trabalho é apresentar um caso clínico de um paciente com comunicação bucossinusal atendido na clínica odontológica da Unidade de Ensino Superior de Feira de Santana (UNEF), com a finalidade de demostrar a técnica cirúrgica utilizando a rotação do corpo adiposo da bochecha (Bola de Bichat).

The bucosinusal communication (BCS) is a relatively frequent complication in dental practice that occurs in surgical procedures, especially extractions of the upper molars. The diagnosis of this communication is made through intraoral clinical examinations, using the Valsava maneuver, and for the confirmation of the diagnosis, radiographic examination is used. The literature cites numerous methods of treatment, however they do not evidence the specific technique for each case, among these methods there is the graft with the adipose body of the cheek, which has a high success rate in the closure of the CBS. When the CBS is closed incorrectly or late, the patient is prone to develop chronic or acute sinusitis, in addition to bucosinusal fistulas. Therefore, this communication should be identified and treated immediately to prevent the development of other complications. The objective of the present study is to present a clinical case of a patient with bucosinusal communication attended at the dental clinic of Unidade de Ensino Superior de Feira de Santana (UNEF), with the purpose of demonstrating the surgical technique using the rotation of the adipose body of the cheek (Bichat ball).

Mantle cell lymphoma in the sphenoid sinus showing acute bilateral blindness.

A 57-year-old man was referred to our department with a mass in the sphenoid sinus. Surgical removal of the tumor was performed. However, a testicular mass was found that showed rapid growth. He had undergone inguinal orchiectomy. Five days after the urological surgery, he noticed visual disturbances and bilateral visual loss. Ophthalmological examination revealed total blindness, and magnetic resonance imaging revealed sphenoid mass growth. The patient underwent emergent removal of the tumor, and a diagnosis of malignant lymphoma was made. A final diagnosis of mantle cell lymphoma (MCL) in the testis and sphenoid sinus was made. After receiving treatment with intravenous corticosteroids and chemotherapy for lymphoma, his left vision completely recovered. Although his right vision was lost, he returned to normal social activities. This is the first report in the literature on MCL developing in the sphenoid sinus presenting with bilateral blindness and ipsilateral recovery.

Minimally Invasive Transnasal Approach to the Anteromedial Temporal Fossa and Lateral Sphenoid Using a Novel Landmark between Periorbita and Periosteum of the Pterygopalatine Fossa: A Cadaveric Study.

The anteromedial temporal region and the lateral wall of the sphenoid can be the site of an array of pathology including trigeminal schwannoma, encephalocele, cholesterol granuloma of the petrous apex, malignancy, infection, and sellar pathology extending to the lateral cavernous sinus. Approaches to this region are technically challenging and the existing approach requires sacrifice of all of the turbinates including the nasolacrimal duct, which can cause postoperative complications. We describe a novel anatomical landmark between the periorbita and the periosteum of the pterygopalatine fossa (which is located at the inferolateral periorbital periosteal line [ILPPL]). The posterior one-third of the incision line lies between the foramen rotundum and the superior orbital fissure, which is proximal to the maxillary strut. A 1.5-cm incision can divide the orbital and pterygoid contents and lead us to the posterior inferolateral orbital region, anteromedial temporal region, lateral wall of the sphenoid sinus, and lateral wall of the cavernous sinus. A combined multiangled approach to the ILPPL will enable us to preserve all of the turbinates and the septum, and the nasolacrimal duct, allowing for the preservation of the physiological function and pedicled flaps, such as the middle turbinate, inferior turbinate, and septal membrane flap. The ILPPL is a simple, effective, and novel landmark for the minimally invasive approach to the anteromedial temporal fossa.

Cor triatriatum dexter: an uncommon cause of neonatal cyanosis.

BACKGROUND: Cor triatriatum dexter (CTD) is an extremely rare pathology, with an incidence of < 0.4%. Its main characteristic is a partitioning of the right atrium by the persistence of the embryonic valve of the right sinus venosus. CLINICAL CASE: In this report, we describe the case of a 7-day-old newborn who presented with persistent cyanosis associated with feeding and crying. The diagnosis of CTD was made after an echocardiogram and confirmed using cardiac magnetic resonance imaging. The patient underwent successful surgery on day 14 with a favorable outcome and without complications. CONCLUSION: The importance of our case lies in the identification of rare heart disease as a cause of cyanosis and desaturation in a neonatal patient in the first days of life who did not present signs of heart failure and whose condition improved with supplemental oxygen. We also demonstrate that early diagnosis with echocardiography and surgical resolution resulted in clear clinical improvement and avoided future complications.

INTRODUCCIÓN: El cor triatriatum dexter es una cardiopatía muy rara, caracterizada por la división parcial del atrio derecho en dos cavidades por la persistencia de una membrana que embriológicamente representa la valva derecha del seno venoso. CASO CLÍNICO: En este reporte de caso, presentamos el caso de un neonato en su día 7 de vida que acude a valoración por presentar desaturación persistente con cianosis al llanto. El diagnóstico se realizó con ecocardiograma posterior al cual se decidió la resección quirúrgica de la membrana, procedimiento que fue llevado a cabo el día 14 de vida con éxito sin complicaciones. CONCLUSIONES: La importancia de este caso clínico radica en la identificación de una cardiopatía rara como causa de cianosis y desaturación en un paciente en etapa neonatal, el cual no presentaba datos de compromiso hemodinámico. También se muestra como un diagnóstico y tratamiento quirúrgico oportuno permitieron una resolución de los síntomas sin complicaciones futuras.

The relationship between cardiac activity, behaviour and endogenous oxytocin and vasopressin in Prader-Willi Syndrome: An exploratory study.

This study aimed to increase our understanding of cardiac activity abnormalities in Prader-Willi Syndrome (PWS) and the relationship between cardiac activity, PWS behaviours thought to be associated with cardiac vagal tone and endogenous oxytocin and vasopressin levels. We compared cardiac activity (respiratory sinus arrhythmia (RSA), low-frequency heart rate variability (LF-HRV), heart period) in 30 adolescents and adults with PWS to 30 typically developing age-matched controls. RSA, LF-HRV, and heart period were lower in individuals with PWS than in the control group. In the control group, RSA was higher for females than males. However, for those with PWS, there was no difference between the sexes. Individuals with the mUPD genetic subtype had lower RSA and LF-HRV than participants with the PWS deletion subtype and compared to typically developing controls, no difference was found between the latter two groups. Heart period was also lower for those with mUPD compared to controls. Higher RSA reduced the odds of having temper outbursts and skin-picking. RSA was lower in those with PWS and psychosis compared to those with PWS without psychosis. Finally, we found RSA correlated with vasopressin for those with mUPD but not deletion. There was no relationship between RSA and oxytocin plasma or saliva levels. Our findings suggest autonomic dysfunction in PWS that is more marked in mUPD than deletion and potentially due to greater loss of parasympathetic activity in mUPD.

Clinical features, operative management and surgical results of first Draf III procedure, revision Draf III approach and the use of mucosal flaps and stents: a systematic review.

OBJECTIVES: Draf III procedure is a challenging endoscopic technique, which has gradually gained an increasing popularity in treating frontal sinus pathologies. The main aim of this systematic review is to offer a comprehensive overview on clinical indications, pre-operative evaluation, surgical techniques, post-operative management and complications of the Draf III procedure. As a step forward, such issues have been comparatively evaluated as referred to patients who underwent primary Draf III procedure and revision DRAF III one). Finally, surgical outcomes related to mucosal flaps and stents to prevent re-stenosis are analyzed. METHODS: A systematic literature review has been performed following PRISMA 2020 checklist statement. An automated search has been carried out by applying an extensive set of queries on the Embase/PubMed, Scopus and Cochrane databases, relating to papers published from 2000 to 2021. RESULTS: Frontal chronic refractory sinusitis is the most frequent indication to Draf III procedure (72%), followed by mucoceles (11%) and skull base or paranasal tumors (10%). The success rate of primary and revision Draf III are 83.5% and 71%, respectively. The re-stenosis phenomenon seems to depend on allergic mechanism and polyposis). The use of mucosal flaps could improve the Draf III efficacy, better than the use of stents (87 vs 72% of neo-ostium patency). CONCLUSION: Draf III is a safe and highly effective surgical technique. However, some limited clinical conditions require some careful technical features, such as the use of mucosal flap, in order to prevent re-stenosis.

Comparison of initial adenosine dose conversion rate for supraventricular tachycardia in the emergency department.

OBJECTIVE: To evaluate the rate of supraventricular tachycardia (SVT) termination between 6 mg and 12 mg initial adenosine doses. METHODS: This multi-center, retrospective cohort study evaluated patients presenting to the emergency department (ED) from January 1, 2020 to June 30, 2022 in SVT and received adenosine. The primary objective of the study is to compare the rate of SVT termination between adenosine 6 mg and 12 mg as documented on a formal electrocardiogram. Secondary endpoints include termination of SVT with subsequent adenosine dose, time to ED disposition, adverse effects, and subgroup analyses of patients with a body mass index greater than or equal to 40 kg/m2 and a history of SVT. RESULTS: Of 213 patients included, a 6 mg initial adenosine dose was administered to 117 patients (54.9 %) and a 12 mg initial adenosine dose was administered to 96 patients (45.1 %). SVT termination following the initial dose of 6 mg or 12 mg was 56.4 % and 79.1 %, respectively (p < 0.001). Among the 46 patients who failed to terminate SVT with an initial 6 mg dose, 33 converted to sinus rhythm with a subsequent adenosine dose in comparison to 1 of the 7 patients receiving an initial dose of 12 mg (71.7 % vs 14.3 %, p = 0.007). Median time to ED disposition, either inpatient admission or discharge, was 209 and 161 min, respectively (p = 0.104). There was no statistical difference in either subgroup analyses. CONCLUSION: A higher rate of SVT termination was observed with an initial adenosine dose of 12 mg in the ED in comparison to the guideline recommended dose of 6 mg. There were no significant differences in adverse effects observed.

Analysis of cerebral venous sinus stenosis by flat panel angiographic CT (FP-CT) to guide treatment for idiopathic intracranial hypertension.

INTRODUCTION: Cerebral venous sinus stenting (CVSS) is an effective treatment for idiopathic intracranial hypertension (IIH) secondary to dural venous sinus stenosis. Traditional selection of patients for CVSS has been made by microcatheter manometry, but pressure measurements are often equivocal. Here we present the results of a series of cases in which venous flat-panel CT (FP-CT) was used as an adjunct to microcatheter manometry to improve decision making and precise stent placement during CVSS. METHODS: Ten consecutive patients with IIH underwent angiography with microcatheter manometry and venous FP-CT, with CVSS if indicated by the results. Cross-sectional measurements of the narrowed sinus were obtained on FP-CT before and after stenting. After the procedure, clinical outcomes were tracked. Follow-up with quantitative MRA with sinus flow measurements was also performed, when available. RESULTS: There was an exponential correlation between measured pressure gradient and degree of stenosis calculated using venous FP-CT. All patients with both a high degree of stenosis measured by FP-CT and a high pressure gradient across the stenosis showed a clinical benefit from stenting. CONCLUSIONS: True measurement of the cross-sectional area of the dural sinus, made by venous phase FP-CT, has a high degree of correlation with elevated venous pressure gradient across the point of stenosis. Even in a limited series of cases, we found an exponential decrease in flow with increasing severity of stenosis. Furthermore, patients with both an elevated venous pressure gradient and critical stenosis of the sinus on FP-CT showed symptomatic improvement after stenting.

The Outcome of Endoscopic Sinus Surgery for Orbital Apex Syndrome Secondary to Sinusitis in a Tertiary Care Center-Our Experience Over 10 Years.

Objective: Orbital apex syndrome (OAS) is a rare condition with multiple cranial nerve involvement caused by varied etiologies. It is not only a threat to the patient's vision but also life-threatening due to the intracranial spread of infection, if not diagnosed early and treated accurately. To study the outcome of endoscopic sinus surgery (ESS) for OAS secondary to sinusitis concerning resolution of ptosis, improvement of ophthalmoplegia, visual prognosis, intracranial spread of infection, and mortality. Methods: A retrospective review of patients with OAS secondary to sinusitis who underwent ESS from 2011 to 2021 was tabulated and analyzed. Results: Twenty-seven patients (mean age: 55.11+/-16 years; male 62%) were included in this study. At presentation, blurring of vision (81%), headache (66%), diplopia (63%) ptosis (63%) were the most common symptoms, and ophthalmoplegia (100%) was the most common sign. Five patients had no perception of light and the rest had various degrees of vision impairment. The most common etiopathology of sinusitis was fungal sinusitis (12 mucormycosis and four aspergillus). The final visual prognosis at three months follow-up post-ESS showed vision stabilization (no improvement or worsening) in 13 (48%) patients, improvement in seven (26%) patients, and vision deterioration in two (7%) patients. There was a significant improvement in ptosis (70%) and ophthalmoplegia (85%). There was no intracranial spread of infection or recurrence with a mortality rate of 3.7% (one patient). Conclusion: ESS coupled with appropriate antimicrobials effectively treats OAS secondary to sinusitis with decreased morbidity and mortality.

Optimizing Management of Cavernous Sinus Meningiomas: A Novel Strategy Integrating Endoscopic Endonasal and Transorbital Surgery with Adjuvant Stereotactic Radiotherapy.

BACKGROUND: Cavernous sinus meningiomas (CSMs) are challenging skull base tumors due to their proximity to vital neurovascular structures. Traditional aggressive transcranial resection often leads to significant morbidities with limited improvement of cranial nerve (CN) deficits. Recent advancements in endoscopic skull base surgery and stereotactic radiation therapy (SRT) offer a more conservative approach, facilitating tumor decompression while preserving critical structures. METHODS: This retrospective study reviewed medical records of patients with symptomatic CSMs who underwent endoscopic endonasal and/or transorbital surgery, followed by adjuvant SRT, at our institution between January 2017 and April 2022. Patient demographics, tumor characteristics, surgical approaches, radiation, treatment outcomes, complications, and follow-up time were analyzed. RESULTS: Thirty nine patients with CSMs were included. Endoscopic endonasal approach (EEA) was performed in 24 patients (61.5%), endoscopic transorbital approach (ETOA) in 10 patients (25.6%), and combined approaches in 5 patients (15.2%). Adjuvant SRT was administered to 79.5% of patients. Postoperative outcomes showed recovery of CN 3-6 deficits and vision in 60.8% and 65% of cases, respectively. Complications included postoperative CN 3-6 deficits in 5 cases, and post-radiation visual deterioration in 1 case. During a mean follow-up period of 44 months, tumor progression occurred in 4 patients (12%), with 3 diagnosed as WHO grade II meningiomas and 1 as WHO grade I. CONCLUSIONS: This study supports the use of endoscopic skull base surgery combined with adjuvant SRT for symptomatic CSMs, demonstrating both safety and efficacy. This approach yielded favorable outcomes in symptom improvement, tumor control, and positive safety profile.

Sinonasal teratocarcinosarcoma involving the nasal cavity, unilateral paranasal sinuses, and intracranial invasion: A case report.

BACKGROUND: Sinonasal teratocarcinosarcoma (SNTCS) is a rare and highly invasive neoplasm originating from the nasal cavity and sinuses. Typically, it exhibits an invasive behavior towards adjacent structures; however, in exceptional instances, it may infiltrate the intracranial compartment. Due to the tumor's rarity and lack of distinctive features on computed tomography (CT) and magnetic resonance imaging (MRI) images, SNTCS is often misdiagnosed. CASE SUMMARY: In this study, we present a case of SNTCS in a 56-year-old patient who exhibited unexplained cognitive impairment before admission. CT and MRI scans revealed the presence of a mass in the right nasal cavity, with lesions extending to the right ethmoid sinus and right frontal region. Subsequently, the patient underwent pathological examination for confirmation and received surgical intervention to excise the tumor. The future advancement in our understanding of this disease will significantly contribute to the precise diagnosis and treatment of SNTCS. CONCLUSION: SNTCS is an exceptionally rare malignant tumor that originates from the nasal cavity and paranasal sinuses, presenting a diagnostic challenge due to its non-specific imaging findings. MRI accurately delineates the location, morphological characteristics, size, internal structure, extent of surrounding involvement, and metabolic information of the lesion. These aspects play a pivotal role in the precise localization and qualitative assessment of SNTCS. Nevertheless, a definitive diagnosis still requires a pathological biopsy.

Open label, interventional, single arm multicentric clinical study to analyze the potency of VELNEZ nasal pack, post-nasal surgery.

Background: Nasal packs are central to nasal surgeries. Primarily, these packs function by controlling bleeding, modulating pain and reducing adhesions postsurgery. However, the major setback of the currently used conventional nasal packs is the unbearable pain the patient undergoes upon removal of these packs. To overcome this shortcoming a variety of biodegradable packs have emerged. This study was aimed at evaluating the safety, efficacy and tolerability of VELNEZ nasal packs. VELNEZ, a patented Datt Mediproducts Pvt. Ltd. nasal pack, is one of its kind biodegradable composite that fragments within a few days of application. Methods: Eighty patients were included in an open label, interventional, single arm clinical study using clinical endpoints to investigate the safety and efficacy of nasal pack VELNEZ. The patients were questioned using a visual analog scale from discharge day to 28th postoperative day (9 follow-up visits) at regular intervals. The standardized questionnaires for hemorrhage control, relief from postoperative pain, moderate obstruction, and pain were used. Results: A total of 76 patients were enrolled in the study and 74 patients completed the study. VELNEZ nasal pack played a significant role in controlling hemorrhage and reducing postoperative pain. The average hemorrhage control time was 7.49 ± 3.90 min with only 34.24% of population complaining of pain on the sixth day of surgery (follow-up 4). Forteen days postsurgery only 10.95% of subject population complained of postoperative pain. This biodegradable composite has an average fragmentation time of 4.7 days in the nasal cavity. In addition, this study did not observe any postoperative adverse events or serious adverse events. Conclusion: VELNEZ, a fragmentable nasal pack, is comfortable, safe, and effective against postsurgery bleeding and pain.

A randomized controlled trial on triamcinolone versus saline impregnated merocel post endoscopic sinus surgery: Our experience in a tertiary care centre.

Purpose: To assess the potential benefit of impregnating Merocel (a non-absorbable nasal dressing) with a topical steroid solution, for use as a direct and slow local delivery system of steroids after sinus surgery to improve postoperative wound healing. Methods: In this randomized controlled trial, 40 patients with bilateral chronic rhinosinusitis with nasal polyposis were subjected to functional endoscopic sinus surgery. Following the completion of the surgery, Merocel packs were inserted in the bilateral nasal cavities and infiltrated with 4 mL triamcinolone (40 mg/mL) in one nasal cavity (treatment group) and 4 mL normal saline in the other (control group). Nasal packs were removed on the third postoperative day and postoperative healing assessment was done on postoperative Weeks 1, 2, 4, and 12. The findings were noted as per Lund Kennedy (LKES) and perioperative sinus endoscopy (POSE) scores and compared on both sides. Results: Significant (P < 0.05) improvement was noted in Lund Kennedy score for crusting and polyp at Week 12, for edema at Week 1, and nasal discharge at Weeks 1 and 12, but there was no significant improvement in scarring at any week. Overall, the difference between the treatment and control arms was statistically significant at all postoperative visits except at Week 4. Also, there was a significant improvement in POSE scores at Weeks 1, 2, and 12 but not at Week 4. Conclusion: This study positively concludes that the nasal cavity packed with drug-soaked packs had less scarring and edema in the postoperative period and the overall wound healing was much better as compared to saline-soaked packs.

Vascular and Neurological Complications in Sphenoid Sinusitis.

Although the cavernous sinus and internal carotid artery are in close proximity to the sphenoid sinus, vascular complications in sphenoid sinusitis are rare due to the intervening mucosa and bone. Variations like dehiscence or aggressive infection can cause vascular complications, leading to cavernous sinus thrombosis, while perivascular inflammation of the internal carotid artery can result in stenosis or occlusion. Untreated or aggressive sphenoid sinusitis can cause neurological complications such as cerebral infarcts, meningitis, subdural empyema, cerebral abscess, and cranial nerve injuries. Magnetic resonance imaging (MRI) of the brain with angiography can depict these complications at an early stage. Additionally, mastoiditis can cause dural venous sinus thrombosis, which, if left untreated, can result in venous infarcts. We report a case of an 11-year-old male with sphenoid sinusitis who developed a left middle cerebral artery (MCA) territory infarct, cavernous sinus thrombophlebitis, subdural empyema, and meningitis. He also developed left transverse and sigmoid sinus thrombosis due to left mastoiditis.

Challenging Nasal Pathologies: An Inverted Nasal Papilloma Case Series Illustrating Diagnostic Challenges and Management Strategies.

The sinonasal inverted papilloma is a benign tumor located in the sinuses lining the nasal cavity. It is a very rare tumor, representing approximately 4% of all sinonasal tumors. The incidence of sinonasal inverted papilloma is higher in males than females and is most commonly diagnosed in the 5th decade of life. Four separate cases of sinonasal pathology involving inverted papillomas are presented in this case series. The first clinical case presents a 68-year-old man with persistent nasal symptoms, who was found to have a sinonasal papilloma, which was successfully removed surgically. In the second case, a 61-year-old woman needed multiple procedures for a comprehensive surgical approach due to her inverted papilloma. Despite postoperative complications, the patient showed improvement at later follow-up appointments. In the third case, a 65-year-old man who had an inverted nasal papilloma previously needed surgery to remove and clear the tumor after developing acute sinusitis and rhinosinusitis symptoms. Last but not least, a 57-year-old male presented with nasal blockage and purulent discharge. Polyps were observed during the examination. The initial biopsy indicated the presence of chronic inflammatory polyps. However, during the operation, a first sample biopsy revealed an inflammatory polyp, but due to the appearance of the mass, the surgeon became suspicious and decided to take another biopsy. The second biopsy confirmed the presence of an inverted nasal papilloma. All things considered, these cases demonstrate clinical variability, difficulties in diagnosing, and effective management techniques related to inverted and sinonasal papillomas. The aim of this case series is to emphasize the importance of proper history taking, physical examination, and use of diagnostic tools to distinctly diagnose inverted nasal papilloma as its symptoms are similar to rhinosinusitis, especially chronic rhinosinusitis.

A rare case of inferior sinus venosus atrial septal defect and concomitant hypoplasia of the posterior mitral valve leaflet.

Inferior sinus venosus atrial septal defect (SVASD) is the rarest form of the atrial septal defect (ASD) and can sometimes go unnoticed. Although this defect can be associated with other congenital anomalies, its association with hypoplasia of the posterior mitral leaflet is extremely rare. In this case, we present a woman with a history of surgery for an ostium secundum ASD who exhibited persistent right heart chamber dilation. Echocardiography revealed hypoplasia of the posterior mitral leaflet, and cardiac magnetic resonance (CMR) imaging confirmed the presence of a previously undetected inferior sinus venosus ASD.

Stroke Prevention With Prophylactic Left Atrial Appendage Occlusion in Cardiac Surgery Patients Without Atrial Fibrillation: A Meta-Analysis of Randomized and Propensity-Score Studies.

BACKGROUND: The role of left atrial appendage occlusion (LAAO) in patients without previous atrial fibrillation (AF) is not established. This meta-analysis was conducted on patients with normal sinus rhythm who underwent cardiac surgery, with and without concomitant LAAO, to evaluate its effect on the incidence of cerebrovascular accidents (CVAs). METHODS: A systematic review was conducted from inception until December 2023 for randomized and propensity-score studies comparing CVA in patients without AF undergoing cardiac surgery with or without LAAO. RESULTS: Six studies met our inclusion criteria with a total of 4130 patients: 2146 in the LAAO group and 1984 in the no-LAAO group. The risk ratio of postoperative AF was 1.05 (95% CI, 0.86-1.28); P=0.628. The CVA rates at 5 years were 6.8±1.0% in the no-LAAO group and 4.3±0.8% in the LAAO group (log-rank P=0.021). The Cox regression analysis for CVA in patients undergoing LAAO reported a hazard ratio of 0.65 (95% CI, 0.45-0.94); P=0.022. Landmark analysis at 4 years highlighted a significant difference in overall survival between no-LAAO and LAAO groups, 86±12.2% versus 89.6±11.0%; P=0.041. CONCLUSIONS: In this meta-analysis of patients without previous AF undergoing cardiac surgery, LAAO was associated with a decreased risk of CVA, no difference in the incidence of postoperative atrial fibrillation, and a significant overall survival benefit at a 4-year landmark analysis. Although these findings support LAAO, the randomized LeAAPS trial (Left Atrial Appendage Exclusion for Prophylactic Stroke Reduction Trial), LAA-CLOSURE trial (A Randomized Prospective Multicenter Trial for Stroke Prevention by Prophylactic Surgical Closure of the Left Atrial Appendage in Patients Undergoing Bioprosthetic Aortic Valve Surgery), and LAACS-2 trial (Left Atrial Appendage Closure by Surgery-2) will help define the effectiveness of LAAO in patients undergoing cardiac surgery who have risk factors for AF and CVA. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42024496366.

Introduction and overview on autogenous Platelet concentrates.

This special issue on autologous platelet concentrates (APCs) provides clinicians with an overview on the current understanding of the use of these biomaterials for soft and hard-tissue regeneration. The included papers summarize scientific evidence and the clinical findings, presented in simple tables that outline potential benefits including Patient Reported Outcome Measures (PROMs). This approach enables clinicians to assess clinical relevance and researchers to identify significant gaps in the literature. The first part provides a comprehensive summary of the basic science surrounding APC, with particular focus on their preparation methods. Clear recommendations are outlined, which are crucial for obtaining high-quality APCs, alongside an exploration of how APCs may influence both soft and hard tissue healing processes. Part 2 delves into the clinical evidence for the potential benefits of APCs across a range of applications: alveolar ridge preservation, sinus floor elevation, periodontal plastic surgery, guided tissue regeneration, guided bone regeneration, the healing of Medication-Related Osteonecrosis of the Jaw (MRONJ), and endodontic surgery. In the part 3, the discussion turns to the effects of APCs on the healing of extra-oral wounds, including diabetic foot ulcers, venous leg ulcers, pressure injuries, burns, and more. For those clinicians persuaded by the evidence, the fourth section offers a detailed, step-by-step flowchart for each treatment modality, providing a clear guide for clinical application.

Evolution and development of the conduction system in the vertebrate heart: a role for hemodynamics and the epicardium.

Development of the heart is a very intricate and multiplex process as it involves not only the three spatial dimensions but also the fourth or time dimension. Over time, the heart of an embryo needs to adapt its function to serve the increasing complexity of differentiation and growth towards adulthood. It becomes even more perplexing by expanding time into millions of years, allocating related species in the tree of life. As the evolution of soft tissues can hardly be studied, we have to rely on comparative embryology, supported heavily by genetic and molecular approaches. These techniques provide insight into relationships, not only between species, but also between cell populations, signaling mechanisms, molecular interactions and physical factors such as hemodynamics. Heart development depends on differentiation of a mesodermal cell population that - in more derived taxa - continues in segmentation of the first and second heart field. These fields deliver not only the cardiomyocytes, forming the three-dimensionally looping cardiac tube as a basis for the chambered heart, but also the enveloping epicardium. The synchronized beating of the heart is then organized by the conduction system. In this Review, the epicardium is introduced as an important player in cardiac differentiation, including the conduction system.

A novel approach to addressing intercavernous sinus bleeding: Preoperative onyx embolization in the endoscopic endonasal approach for craniopharyngioma resection.

Background: Hemorrhage originating from the intercavernous sinuses during transsphenoidal approaches for skull base injury is a common occurrence, but it can be easily controlled. However, in specific cases, it may necessitate suspending the surgery or result in hemodynamic instability. Case Description: We present the case of a 7-year-old female patient who underwent transsphenoidal endoscopic endonasal for craniopharyngioma resection. The patient's parents gave consent for the procedure. During the procedure, significant intraoperative bleeding occurred, which was necessary to stop the resection. After the surgery, cerebral angiography was performed, which identified a prominent anterior intercavernous venous sinus as the source of the bleeding. A successful embolization using onyx was performed, leading to a satisfactory postoperative recovery without any complications. The patient then underwent a second surgical intervention for the resection of the craniopharyngioma through an endoscopic endonasal transsphenoidal approach. This procedure achieved a complete resection of the lesion without complications, and the patient experienced an adequate postoperative recovery. Conclusion: The objective of this case is to describe a previously unreported technique involving onyx embolization for controlling prominent bleeding from the intercavernous sinus and as a presurgical embolization method to reduce the risk of bleeding during endoscopic endonasal surgery for resection of a craniopharyngioma.