Hypersensitivity incidence after sugammadex administration in healthy subjects: a randomised controlled trial.

BACKGROUND: We evaluated the incidence of hypersensitivity or anaphylaxis after repeated single-dose sugammadex administration in non-anaesthetised adults. METHODS: In this multicentre, double-blind study (NCT02028065), healthy volunteer subjects were randomised (2:2:1 ratio) to one of three groups to receive three repeated intravenous injections of sugammadex 4 or 16 mg kg-1, or placebo, separated by a ∼5 week intervals. Targeted hypersensitivity assessments were performed 0.5, 4, and 24 h post-dosing, and hypersensitivity signs/symptoms were referred to a blinded independent Adjudication Committee. Anaphylaxis was determined per Sampson (Criterion 1). The primary endpoint was the proportion with confirmed hypersensitivity. RESULTS: Of 375 evaluable subjects, 25 had confirmed hypersensitivity [sugammadex 4 mg kg-1: 10/151 (6.6%); sugammadex 16 mg kg-1: 14/148 (9.5%); placebo: 1/76 (1.3%)]. The differences in incidence rates vs placebo were 5.3% (95% confidence interval: -0.9, 10.7) for sugammadex 4 mg kg-1 and 8.1% (1.7, 14.2) for 16 mg kg-1. Incidence was similar across sugammadex doses and dosing occasions, including in subjects with reactions to previous doses. Three subjects (16 mg kg-1 group) required antihistamines/corticosteroids and discontinued the study, per protocol; symptoms resolved and no subject required epinephrine. One subject with anaphylaxis after the first 16 mg kg-1 dose recovered completely post-treatment. There were no clinically relevant anti-sugammadex antibody or tryptase findings. CONCLUSIONS: Hypersensitivity in response to sugammadex administration can occur in healthy subjects without history of previous sugammadex exposure. Hypersensitivity incidence was similar across sugammadex doses and numerically higher than placebo, with no evidence of sensitisation with repeated administration. Hypersensitivity is unlikely to be mediated through sugammadex-specific immunoglobulin G- or E-mediated mast cell stimulation in healthy volunteers. CLINICAL TRIAL REGISTRATION: NCT02028065.

Measurement of water vapor using an imaging field-widened spatial heterodyne spectrometer.

Spatial heterodyne spectroscopy (SHS) has been successfully applied to measure variations in water vapor pressure in the lab. An imaging system is combined with a monolithic field-widened SHS to observe a white-light source through a 1 m length water vapor cell that is designed to produce predictable variations in the water vapor pressure. The performance of the spectrometer design is examined by comparing spectra simulated using a radiative transfer model to observed spectra at several cell pressures. The intended application of the instrument to vertically resolve the water vapor profile in the upper troposphere and lower stratosphere using limb-scattered radiation in a vibrational band of water (1363-1366 nm) is also introduced.

Successful Desensitisation in a Patient with CRIM-Positive Infantile-Onset Pompe Disease.

Pompe disease (PD) is a severe life-threatening disease in which enzyme replacement therapy (ERT) with alglucosidase alfa is the only treatment available. Recently it has been shown that antibody formation may have a significant adverse effect on response to ERT. We report a cross-reactive immunologic material (CRIM)-positive PD infant who developed severe infusion-associated reactions (IARs) after 15 uneventful months of ERT. We successfully got the child to tolerate the ERT by a desensitisation protocol. We diluted the total amount of standard alglucosidase alfa infusion (20 mg/kg/dose) to 1/100 (0.2 mg/kg/dose). The original infusion rates were maintained. We doubled this dose every week. No premedication was given. In 8 weeks, we reached the standard dose without any IAR. No further reactions have been observed during 6 months of follow-up. Importantly, clinical deterioration that was observed during the period of reduced enzyme delivery has almost completely reversed. We conclude that this protocol was effective in our patient, while being safe and easy to follow, and may be suitable in selected cases.

Partially light-controlled imager based on liquid crystal plate and image intensifier for aurora and airglow measurement.

In order to obtain information both of aurora and airglow in one image by the same detector, a PLCI based on liquid crystal plate LCP and super second-generation image intensifier SSGII is proposed in this research. The detection thresholds of the CCD for aurora and airglow are calculated. For the detectable illumination range of 10(4)-10(-2) lx, the corresponding electron count is 1.57×10(5) - 0.2 for every pixel of CCD. The structure and work principle of the PLCI are described. An LC is introduced in the front of CCD to decrease the intensities of aurora in overexposure areas by means of controlling transmittances pixel by pixel, while an image intensifier is set between the LC and CCD to increase the intensity of the weak airglow. The modulation transfer function MTF of this system is calculated as 0.391 at a Nyquist frequency of 15 lp/mm. The curve of transmittance with regard to gray level for the LC is obtained by calibration experiment. Based on the design principle, the prototype is made and used to take photos of objects under strong light greater than 2×10(5) lx. The clear details of [symbols: see text] presented in the image indicate that the PLCI can greatly improve the imaging quality. The theoretical calculations and experiment results prove that this device can extend the dynamic range and it provides a more effective method for upper atmospheric wind measurement.

Maintained intentional weight loss reduces cardiovascular outcomes: results from the Sibutramine Cardiovascular OUTcomes (SCOUT) trial.

AIM: The Sibutramine Cardiovascular OUTcomes trial showed that sibutramine produced greater mean weight loss than placebo but increased cardiovascular morbidity but not mortality. The relationship between 12-month weight loss and subsequent cardiovascular outcomes is explored. METHODS: Overweight/obese subjects (N = 10 744), ≥55 years with cardiovascular disease and/or type 2 diabetes mellitus, received sibutramine plus weight management during a 6-week Lead-in Period before randomization to continue sibutramine (N = 4906) or to receive placebo (N = 4898). The primary endpoint was the time from randomization to first occurrence of a primary outcome event (non-fatal myocardial infarction, non-fatal stroke, resuscitated cardiac arrest or cardiovascular death). RESULTS: For the total population, mean weight change during Lead-in Period (sibutramine) was -2.54 kg. Post-randomization, mean total weight change to Month 12 was -4.18 kg (sibutramine) or -1.87 kg (placebo). Degree of weight loss during Lead-in Period or through Month 12 was associated with a progressive reduction in risk for the total population in primary outcome events and cardiovascular mortality over the 5-year assessment. Although more events occurred in the randomized sibutramine group, on an average, a modest weight loss of approximately 3 kg achieved in the Lead-in Period appeared to offset this increased event rate. Moderate weight loss (3-10 kg) reduced cardiovascular deaths in those with severe, moderate or mild cardiovascular disease. CONCLUSIONS: Modest weight loss over short-term (6 weeks) and longer-term (6-12 months) periods is associated with reduction in subsequent cardiovascular mortality for the following 4-5 years even in those with pre-existing cardiovascular disease. While the sibutramine group experienced more primary outcome events than the placebo group, greater weight loss reduced overall risk of these occurring in both groups.

Adapting the buccal micronucleus cytome assay for use in wild birds: age and sex affect background frequency in pigeons.

Micronucleus (MN) formation has been used extensively as a biomarker of damage from genotoxic exposures. The Buccal MN Cytome (BMCyt) assay provides a noninvasive means of quantifying MN frequency in humans, but it has not been developed for use in wildlife. We adapted the BMCyt assay for use in wild birds, with a focus on feral pigeons (Columba livia) as a potential indicator species. Five of six urban bird species sampled using oral cavity swabs produced sufficient buccal cells for the BMCyt assay. The body size of species sampled ranged almost 100-fold (~60 to 5,000 g), but was a not major factor influencing the number of buccal cells collected. Pigeon cells were stained and scored following published BMCyt assay protocols for humans, but with a modified fixation approach using heat and methanol. Pigeons had the same common nuclear abnormalities reported in human studies, and a similar background MN formation frequency of 0.88 MN/1,000 cells. Adult pigeons had on average a threefold higher rate of MN formation than juveniles, and males had a 1.4- to 2.2-fold higher frequency than females. Domestic and feral pigeons did not differ in overall MN frequency. Our results indicate that the BMCyt assay can be used on wild birds, and could provide a means of assessing environmental genotoxicity in pigeons, a useful indicator species. However, bird age and sex are important factors affecting background MN frequency, and thereby the design of environmental studies.

Alternatives to standard acute in-patient care in England: differences in content of care and staff-patient contact.

BACKGROUND: Differences in the content of care provided by acute in-patient mental health wards and residential crisis services such as crisis houses have not been researched. AIMS: To compare planned and actual care provided at alternative and standard acute wards and to investigate the relationship between care received and patient satisfaction. METHOD: Perspectives of stakeholders, including local service managers, clinicians and commissioners, were obtained from 23 qualitative interviews. Quantitative investigation of the care provided at four alternative and four standard services was undertaken using three instruments developed for this study. The relationship of care received to patient satisfaction was explored. RESULTS: No significant difference was found in intensity of staff-patient contact between alternative and standard services. Alternative services provided more psychological and less physical and pharmacological care than standard wards. Care provision may be more collaborative and informal in alternative services. All measured types of care were positively associated with patient satisfaction. Measured differences in the care provided did not explain the greater acceptability of community alternatives. CONCLUSIONS: Similarities in care may be more marked than differences at alternative and standard services. Staff-patient contact is an important determinant of patient satisfaction, so increasing it should be a priority for all acute in-patient services.

Alternatives to standard acute in-patient care in England: roles and populations served.

BACKGROUND: Key questions regarding residential alternatives to standard acute psychiatric care, such as crisis houses and short-stay in-patient units, concern the role that they fulfil within local acute care systems, and whether they manage people with needs and illnesses of comparable severity to those admitted to standard acute wards. AIMS: To study the extent to which people admitted to residential alternatives and to standard acute services are similar, and the role within local acute care systems of admission to an alternative service. METHOD: Our approach combined quantitative and qualitative methods. Consecutive cohorts of patients in six residential alternatives across England and six standard acute wards in the same areas were identified, and clinical and demographic characteristics, severity of symptoms, impairments and risks compared. Semi-structured interviews with key stakeholders in each local service system were used to explore the role and functioning of each alternative. RESULTS: Being already known to services (OR = 2.6, 95% CI 1.3-5.2), posing a lower risk to others (OR = 0.49, 95% CI 0.31-0.78) and having initiated help-seeking in the current crisis (OR = 2.2, 95% CI 1.2-4.3) were associated with being admitted to an alternative rather than a standard service. Stakeholder interviews suggested that alternatives have a role that is similar but not identical to standard hospital services. They can divert some, but not all, patients from acute admission. CONCLUSIONS: Residential alternatives are integrated into catchment area mental health systems. They serve similar, but not identical, clinical populations to standard acute wards and provide some, but not all, of the functions of these wards.

Weight and blood pressure response to weight management and sibutramine in diabetic and non-diabetic high-risk patients: an analysis from the 6-week lead-in period of the sibutramine cardiovascular outcomes (SCOUT) trial.

OBJECTIVE: To assess treatment responses to sibutramine and weight management in diabetic patients during the lead-in period of the Sibutramine Cardiovascular OUTcomes (SCOUT) trial. METHODS: SCOUT is an ongoing, prospective, randomized, double-blind, placebo-controlled outcome trial in cardiovascular high-risk overweight/obese patients. A total of 10 742 patients received single-blind sibutramine and individualized weight management during the 6-week lead-in period; 84% had a history of type 2 diabetes mellitus and additional co-morbidities. Post-hoc analyses assessed anthropomorphic and vital sign responses between patients with and without diabetes. RESULTS: Concomitant antidiabetic medication use was reported by 86% of the diabetic patients (approximately 30% required insulin-alone or in combination). Body weight and waist circumference decreased in diabetic patients: median 2.1 kg; 2.0 cm (both men and women); for those on insulin: 1.9 kg; 1.5/2.0 cm (men/women); without insulin: 2.3 kg; 2.0 cm (both men and women); blood pressure (BP) was also reduced (median systolic/diastolic 3.5/1.0 mmHg) with larger reductions in diabetic patients who were hypertensive and/or lost the most weight (>5%). In diabetic patients who entered with BP at target (<130/<85 mmHg) but did not lose weight (N = 245), increases of 3.5/2.0 mmHg were observed. Non-diabetic patients had greater weight losses (2.5 kg) but smaller reductions in BP (systolic/diastolic -2.5/-0.5 mmHg). Pulse rate increases were less in diabetic vs. non-diabetic patients (1.5 vs. 2.0 bpm). CONCLUSION: In these high-risk diabetic patients, sibutramine and lifestyle modifications for 6 weeks resulted in small, but clinically relevant, median reductions in body weight, waist circumference and BP. A small median increase in pulse rate was recorded.

Efficacy of Crosseal fibrin sealant (human) in rhytidectomy.

OBJECTIVE: To examine the potential efficacy of Crosseal (the human protein, bovine component-free fibrin sealant) (OMRIX Biopharmaceuticals, Ltd, Brussels, Belgium) to reduce ecchymoses and hematoma formation in patients undergoing rhytidectomy. METHODS: Before initiation of the study, approval was obtained from the US Food and Drug Administration for an Investigational New Drug Application and off-label use of Crosseal and from the Institutional Review Board of the University of California, Davis. Patients undergoing rhytidectomy with or without concomitant procedures were voluntarily enrolled without compensation in the study (N = 9). Patients were randomized according to which side of the rhytidectomy the tissue sealant was placed. In all patients in the study, 1 side of the rhytidectomy was treated with Crosseal; the other, untreated side was used as a control. Before closure of the skin, 2 mL of Crosseal was sprayed through a pressure regulator under the skin flap of the dissected area of the rhytidectomy only on 1 side. The skin was pretrimmed before placement and closed in standard fashion. A pressure dressing was left in place for 3 days before removal. Nine patients were originally enrolled in the study. On postoperative days 3 and 7, photographs were taken of the patients. The photographs were judged by 5 independent reviewers who were blinded as to which side had been treated with Crosseal. The judges rated the degree of ecchymoses on a scale of 1 (minimal) to 10 (severe) and were asked their opinion as to which side of the facelift had been treated with Crosseal. These results were compared using statistical analysis. Also on days 3 and 7, patients were examined for seroma or hematoma formation on each side of the face. RESULTS: Our study demonstrated efficacy of Crosseal in reducing ecchymoses and swelling in all patients. The mean score for ecchymosis on the Crosseal-treated side was 4.5 and on the untreated (control) side was 6.2 (P < .01, Wilcoxon rank sum test). The rate of hematoma or seroma formation was 22% (2 of 9 patients) for the untreated side vs 0% (0 of 9 patients) for the treated side. This did not reach statistical significance (P = .43, Fisher exact test). Small hematomas developed in 2 patients on the control side, which were needle aspirated. There were no known long-term complications from either the use of Crosseal or the rhytidectomy. CONCLUSION: Crosseal is efficacious in reducing ecchymoses after rhytidectomy.

Blood pressure changes associated with sibutramine and weight management - an analysis from the 6-week lead-in period of the sibutramine cardiovascular outcomes trial (SCOUT).

OBJECTIVE: To explore vital sign changes among patient subgroups during the 6-week lead-in period of the sibutramine cardiovascular outcomes (SCOUT) trial. METHODS: SCOUT is an ongoing, double-blind, randomized, placebo-controlled outcome trial in overweight/obese patients at high risk of a cardiovascular event. During the 6-week lead-in period, 10,742 patients received sibutramine and weight management. Vital sign changes were assessed post hoc by initial blood pressure (mmHg) categorized as normal (<130/<85), high-normal (130 to <140/85 to <90) or hypertensive (>or=140/>or=90); weight change categories (weight gain/no weight change, >0 to 2.5% weight loss, >2.5 to 5% weight loss and >5% weight loss) and current antihypertensive medication class use (none, one, or two or more). To assess the impact of sibutramine on blood pressure and pulse rate, only patients (N = 10,025) who reported no change in the class of antihypertensive medication used and who did not report an increase in antihypertensive medication use were analysed. RESULTS: At entry, approximately 50% of patients were hypertensive and 26% were high-normal. In hypertensive patients, blood pressure changes (mmHg) decreased by median [5th, 95th percentile] of -6.5 systolic [-27.0, 8.0] and -2.0 diastolic [-15.0, 8.0] (p < 0.001). Hypertensive patients with no weight loss or with weight gain had median decreases of -3.5 systolic [-26.0, 10.0] and -1.5 diastolic [-16.0, 9.0] (p < 0.001). Normotensive patients had median increases of 1.5 systolic [-15.0, 19.5] and 1.0 diastolic [-10.5, 13.0] (p < 0.001) attenuated with increasing weight loss. Approximately 43% of patients initially categorized as hypertensive had a lower blood pressure category at end-point. Concomitant antihypertensive medication classes did not affect blood pressure reductions. Pulse rates were uniformly elevated (median 1-4 bpm, p < 0.001) across blood pressure and weight change categories. CONCLUSIONS: In hypertensive patients (>or=140/>or=90), blood pressure decreases were observed during 6-week treatment with sibutramine even when body weight was unchanged. In patients with normal blood pressure (<130/<85), weight loss of >5% induced decreases in systolic blood pressure; otherwise, small increases were observed. Small pulse rate increases were observed regardless of blood pressure or weight change status.

Efficacy of fibrin sealant (human) (Evicel) in rhinoplasty: a prospective, randomized, single-blind trial of the use of fibrin sealant in lateral osteotomy.

OBJECTIVES: To determine whether patients receiving fibrin sealant placed in a single lateral osteotomy site during rhinoplasty will note substantial improvement in pain, bruising, swelling, and overall healing compared with the untreated side and to determine whether blinded observers detect a substantial difference in bruising and swelling on the basis of review of standard postoperative photographs. METHODS: We conducted a prospective, randomized, single-blind, controlled trial of the use of fibrin sealant (human) (Evicel; Johnson & Johnson-Wound Management, Somerville, New Jersey) in 10 consecutive patients undergoing lateral osteotomy in rhinoplasty. Written consent was obtained from all participants. Each patient was randomized for the use of fibrin sealant on either the right or the left side with the contralateral side acting as the control. Patients were evaluated on postoperative days 1, 7, and 21 with standard photographic views and a patient questionnaire. The blinded observers consisted of 5 raters familiar with the outcomes and results of rhinoplastic surgery. The observers evaluated all photographs and completed a grading scale to define bruising and swelling on each side. RESULTS: The mean patient age was 41 years (age range, 21-66 years). Half of the patients were women. The blinded observer Wilcoxon rank sum test revealed a statistically significant difference on postoperative day 1 for bruising (P< .03; Wilcoxon critical z value, 1.99) and swelling (P< .01; 2.41). Similar findings were discovered on postoperative day 7 for both bruising and swelling (P< .03). On postoperative day 21, bruising retained statistical significance (P< .05); however, swelling did not achieve statistical significance. Patient questionnaires were evaluated and significance was determined for the treated compared with the untreated side of the nose on postoperative days 1, 7, and 21. Categories included pain, bruising and swelling, and overall rate of healing. The Wilcoxon rank sum test revealed no significance for pain or overall rate of recovery (P> .06) on postoperative days 1, 7, or 21. However, bruising and swelling both achieved statistical significance. On postoperative day 1, both pain and swelling scales achieved a significance of P< .01 (Wilcoxon critical z value, 2.34). On postoperative day 7, bruising achieved significance at P< .005 (Wilcoxon critical z value, 2.63) and swelling achieved significance at P< .01 (2.45). Both bruising and swelling achieved equal significance on postoperative day 21 (P< .01; Wilcoxon critical z value, 2.57 and 2.45, respectively). CONCLUSIONS: Fibrin sealant applied to a lateral osteotomy site significantly reduced bruising and swelling per patient report on postoperative days 1, 7, and 21. Physician observation reported significant reduction in bruising on postoperative days 1, 7, and 21 and reduction in swelling on postoperative days 1 and 7. The ease of application and versatility of fibrin sealant enable rapid healing after rhinoplasty and produce increased patient satisfaction.

Olfactory discrimination ability of CD-1 mice for a large array of enantiomers.

With use of a conditioning paradigm, the ability of eight CD-1 mice to distinguish between 15 enantiomeric odor pairs was investigated. The results demonstrate a) that CD-1 mice are capable of discriminating between all odor pairs tested, b) that the enantiomeric odor pairs clearly differed in their degree of discriminability and thus in their perceptual similarity, and c) that pre-training with the rewarded stimuli led to improved initial but not terminal or overall performance. A comparison between the proportion of discriminated enantiomeric odor pairs of the CD-1 mice and those of other species tested in earlier studies on the same discrimination tasks (or on subsets thereof) shows a significant positive correlation between discrimination performance and the number of functional olfactory receptor genes. These findings provide the first evidence of a highly developed ability of CD-1 mice to discriminate between an array of non-pheromonal chiral odorants. Further, they suggest that a species' olfactory discrimination capabilities for these odorants may be correlated with its number of functional olfactory receptor genes. The data presented here may provide useful information for the interpretation of findings from electrophysiological or imaging studies in the mouse and the elucidation of odor structure-activity relationships.

Implantable Doppler flow system: experience with 24 microvascular free-flap operations.

OBJECTIVES: Microvascular reconstruction requires postoperative monitoring to prevent vascular occlusion and flap failure. These methods require skilled personnel and can delay diagnosis and treatment of threatened flap failures. The Cook-Swartz implantable Doppler flow system provides continual feedback on vascular pedicle status, which in turn provides rapid assessment of minute-to-minute changes in flap vasculature that may allow intervention before total vascular occlusion and expeditious reexploration for threatened flap failure, possibly improving flap salvage. STUDY DESIGN AND SETTING: Charts of 24 patients with microvascular free-flap reconstruction and implantation of Doppler flow system at Mayo Clinic Rochester were retrospectively reviewed. Surgical technique and flap outcomes were evaluated. RESULTS: Microvascular reconstruction and implantation of Doppler flow system were successful in all patients. Complications were minimal, and postoperative monitoring system facilitated rapid reexploration when necessary. Flap viability was 96%. CONCLUSION: Doppler flow system is reliable for monitoring minute-to-minute changes in microvascular flap vascular status postoperatively, and allows rapid recognition of complications and facilitating reexploration. This is a valuable, easily mastered tool for microvascular reconstructive surgery. SIGNIFICANCE: May alter postoperative monitoring techniques of microvascular surgeons.

Severe postextubation laryngeal obstruction: the role of prior neck dissection and radiation.

Aggressive treatment of advanced head and neck cancer may result in more patients undergoing surgery for unrelated illnesses. We present a case of a patient requiring emergency tracheostomy placement after a routine liver segment resection 10 yr after undergoing a bilateral modified radical neck dissection and radiation therapy. This type of patient may be at increased risk for both postoperative laryngeal edema and neuronal imbalance secondary to their preoperative condition.

Orbital exenteration reconstruction with rectus abdominis microvascular free flap.

OBJECTIVES: To determine the course of reconstructive treatment and outcomes with use of the rectus abdominis free flap after orbital exenteration with or without total maxillectomy. STUDY DESIGN: Retrospective chart review of treatment and outcomes of patients who had rectus abdominis free-tissue transfer for orbital exenteration with or without total maxillectomy at the Mayo Clinic between 1994 and 2004. METHODS: Charts of patients who had rectus abdominis free flap reconstruction after orbital exenteration were retrospectively reviewed and the surgical technique evaluated. An explanation of the surgical technique for rectus abdominis free-tissue transfer to the orbital cavity is provided, along with a discussion of the advantages and disadvantages of this reconstructive method. RESULTS: Twelve of 13 patients who underwent reconstruction with rectus abdominis free-tissue transfer had a successful outcome (flap viability 92%). Cosmetic results were acceptable both to patients and to surgeons. CONCLUSIONS: Rectus abdominis microvascular free-tissue transfer for repair of orbital exenteration defects is a safe and reliable alternative to the use of the temporalis or the pectoralis major muscle as a pedicle flap; it provides a larger volume of well-vascularized tissue and greater placement flexibility without associated orientation problems; and the long vascular pedicle facilitates the use of multiple donor vessels within the head and neck, which is an advantage in previously irradiated patients. Postoperative care and the donor site defect are well tolerated. The flap allows reliable obturation of the oral maxillectomy defect, and it negates the need for cavity care in these patients.

Endoscopic versus traditional approaches for excision of juvenile nasopharyngeal angiofibroma.

OBJECTIVES: Juvenile nasopharyngeal angiofibroma (JNA) is an uncommon neoplasm originating in the nasopharynx. The purpose of this study was to determine whether endoscopic approaches had been effective without increasing intraoperative blood loss, length of hospital stay, complications, and rate of recurrence as compared with traditional surgical approaches. STUDY DESIGN: Retrospective chart review to compare outcomes in six consecutive patients who underwent endoscopic resection with outcomes of traditional external excision of JNA at Mayo Clinic between 1975 and 2004. METHODS: The medical records of patients who underwent either endoscopic or external surgical resection of JNA were reviewed retrospectively. The main outcome measures were intraoperative blood loss, length of hospital stay, complications, and recurrence. We review the reasons why we developed our current endoscopic approach to resection and highlight some of the obstacles we have encountered. RESULTS: We identified 65 patients treated for JNA during the studied interval. Their mean age was 15 (range 6-35) years. Six consecutive patients underwent successful resection of JNA by way of an endoscopic approach since 2001. Compared with the conventional surgery group, the endoscopic group had less intraoperative blood loss (225 vs. 1,250 mL), a lower occurrence of complications (1 patient vs. > or = 30 patients), shorter length of hospital stay (2 vs. 5 days), and lower rate of recurrence (0% vs. 24%). CONCLUSION: Endoscopic removal of JNA tumor appears to be safe and effective. Recurrence was not appreciably affected by approach.

Pediatric dermoid cysts of the head and neck.

OBJECTIVE: To review the characteristics and determine treatment outcomes of pediatric dermoid cysts. STUDY DESIGN AND SETTING: Retrospective review of the presentation, diagnosis, treatment, and outcomes of all pediatric dermoid cysts of the head and neck examined between 1980 and 2002 at Mayo Clinic. RESULTS: Forty-nine patients (59% girls) had a dermoid cyst of the head and neck. The median age at diagnosis was 22 months. The most common presenting sign was a palpable mass, noted in 100% of patients. During evaluation, approximately 25 patients (51%) had imaging studies. The most common location of the cysts was periorbital (61%), followed by the neck (18%; including 1 submental cyst). Various surgical approaches were chosen. In 2 patients (4%), the dermoid cyst had an intracranial extension. Only 1 patient experienced recurrence. The median pathologic diameter of the cysts was 1.2 cm. CONCLUSIONS: Dermoid cysts are unusual neoplasms that often present in childhood, with the orbit being the area most commonly affected in the head and neck region. Imaging studies help rule out an intracranial or intraorbital extension. With complete excision, recurrence is unusual. Significance Our review will assist both primary care physicians and subspecialists in diagnosing and treating dermoid cysts.

Coronoid-temporalis pedicled rotation flap for orbital floor reconstruction of the total maxillectomy defect.

OBJECTIVES: Total maxillectomy creates a significant defect in the supporting framework of the orbit. Successful reconstruction of the deficit requires repair of the orbital floor to prevent early and late complications. This paper describes the recreation of the orbital floor using a coronoid-temporalis sling. STUDY DESIGN: Retrospective review of two patients who underwent total maxillectomy and subsequent coronoid-temporalis sling reconstruction of the surgical defect. METHODS: The charts of two patients who underwent coronoid-temporalis reconstruction of the orbital floor were retrospectively reviewed. The outcomes were evaluated. The authors present a method for reconstruction of the orbital floor and discuss the advantages and disadvantages of this method. RESULTS: Two patients underwent successful reconstruction of the orbital floor with a coronoid-temporalis sling procedure. Both patients display acceptable functional and cosmetic results. CONCLUSION: Coronoid-temporalis sling is a readily available and easily modified tissue for reconstruction of the orbital floor. It offers similar results to those previously described techniques in this area without need for further extensive surgery.