Speech Outcomes of Buccal Myomucosal Flap Palatal Lengthening for Treatment of Velopharyngeal Insufficiency: Systematic Literature Review and Meta-Analysis.

OBJECTIVE: Buccal myomucosal flaps (BMF) anatomically lengthen the palate in the treatment of velopharyngeal insufficiency (VPI). We systematically reviewed the existing literature on speech outcome of BMF palatal lengthening. DESIGN: Three databases were used to identify studies of interest published in English. Studies that did not use standardized speech assessments were excluded. PRISMA checklist was followed, and the risk of bias in the included studies was assessed. SETTING: Long-term follow up of patients. PATIENTS: With history of cleft palate presenting with VPI. INTERVENTION: BMF palatal lengthening. MAIN OUTCOME MEASURE: Random-effects model meta-analyses were performed for hypernasality, intelligibility, and nasal air emission score improvements, which were derived from reported preoperative and postoperative scores, and controlled for variability of scales and timing of postoperative assessment. RESULTS: From the initial 7115 articles, 13 were included in this review. Two of these had a significant patient overlap and a study with a smaller patient population was excluded. All 12 included articles met the National Institutes of Health Quality Assessment Tool criteria. Six retrospective studies evaluated 230 patients and six prospective studies evaluated 181 patients. The most common indications for BMF were large size of the velopharyngeal gap and prior surgery for VPI. Meta-analyses demonstrated effect sizes below zero, confirming the improvement of standardized assessment scores in patients with VPI after BMF palatal lengthening. Egger regressions revealed low risk of publication bias. CONCLUSIONS: BMF palatal lengthening provides adequate treatment for VPI in patients with large velopharyngeal gap size and a history of prior unsuccessful surgery.

Meckel's Diverticulum, A Rare Presentation in a Neonate.

Meckel's diverticulum is commonly symptomatic the first 2 years of life. Complications associated with Meckel's diverticulum are due to gastrointestinal (GI) bleeding or obstruction. A 5-day-old male presented to the emergency department (ED) with an episode of bright red blood per rectum (BRBPR) associated with emesis. Vital signs were normal and abdomen soft and non-distended. Serial abdominal radiographs progressed to show distention of small bowel and air fluid levels. Operative intervention was undertaken with diagnosis of intestinal obstruction. On exploratory laparotomy, 24 cm of a fibrosed, ischemic closed-loop ileal segment densely adherent to the tip of a Meckel's diverticulum was identified and resected, followed by primary reanastamosis. Histologic findings confirmed ectopic gastric tissue. Symptomatic Meckel's diverticulum is often secondary to intestinal obstruction and hematochezia, findings which are caused by incarcerated inguinal hernia or ileocolic intussusception. Our patient presented with a closed loop, which has not been previously reported.

Hallazgos clínicos e histopatológicos en pacientes con adenomiomatosis vesicular / Clinical and histopathological findings in patients with gallblader adenomyomatosis

Objetivo: El objetivo del estudio es describir la presentación clínica e histopatológica de la adenomiomatosis vesicular en una serie de pacientes colecistectomizados. Material y método: Entre el 1 de enero del 2010 y el 30 abril del 2015 se realizaron 6.957 colecistectomías, diagnosticándose adenomiomatosis en 95 de las vesículas extirpadas (1,4%). Se describen los hallazgos clínicos e histopatológicos en estos pacientes. Resultados: En 53 pacientes (55,8%) se presentó dolor abdominal. Alteraciones histológicas concomitantes se presentaron en la mucosa vesicular de 34 pacientes (35,8%), siendo la metaplasia pilórica la más frecuente (21%); y en 8 pacientes (8,4%) se presentó displasia de alto y bajo grado. Las patologías asociadas más frecuentes fueron colelitiasis 82,1% y colecistitis crónica 85,3%. Conclusiones: En la serie estudiada se observaron diversas alteraciones histológicas, incluyendo la displasia de alto grado. La colelitiasis se presentó con una frecuencia elevada.

Aim: The aim of the study was to describe the clinical and histopathologic presentation of adenomyomatosis (ADM) of the gallbladder in a series of patients. Material and method: Between January 1, 2010 to April 30, 2015, 6957 patients underwent cholecystectomy. Among them, ADM was diagnosed in 95 of cholecystectomy specimens (1.4%). Clinical and pathological findings in these patients are described. Results: In 53 patients (55.8%) presented abdominal pain. Concomitant histological changes occurred in the gallbladder mucosa of 34 patients (35.8%), being the most frequent pyloric metaplasia (21%); and in 8 patients (8.4%) high-grade dysplasia and low-grade dysplasia was presented. The most frequent associated pathologies were cholelithiasis in 82.1%, and chronic cholecystitis in 85.3%. Conclusions: In this serie, various histological changes were observed, including high-grade dysplasia. Cholelithiasis was presented with high frequency.