Increasing the Resolution of Transmission Electron Microscopy by Computational Ghost Imaging.

By means of numerical simulations, we demonstrate the innovative use of computational ghost imaging in transmission electron microscopy to retrieve images with a resolution that overcomes the limitations imposed by coherent aberrations. The method requires measuring the intensity on a single pixel detector with a series of structured illuminations. The success of the technique is improved if the probes are made to resemble the sample and the patterns cover the area of interest evenly. By using a simple 8 electrode device as a specific example, a twofold increase in resolution beyond the aberration limit is demonstrated to be possible under realistic experimental conditions.

Ovarian metastases from colorectal cancer: prognostic role of prophylactic oophorectomy. A single center experience.

BACKGROUND: The incidence of ovarian metastases (OM) from colorectal cancer (CRC) is uncommon but women with OM from CRC had poorer quality of life and decreased survival. Mateials and Methods: The authors retrospectively categorized women submitted to surgery for CRC from January 2004 to December 2012 considering previous mono- or bilateral-oophorectomy, oophorectomy performed during colorectal resection, and oophorectomy performed after surgery for CRC and its cause. The analysis focused on two groups: women who underwent surgery for CRC before menopause and after menopause. Survival outcome in terms of overall survival (OS) and disease- free survival (DFS) were assessed and appearance of OM was also evaluated. RESULTS: In postmenopausal women with CRC who underwent left hemicolectomy or anterior resection of the rectum the incidence of OM was 4 % with a statistical significance (p < 0.05). The mean OS of patients with metachronous OM was 26 months and the patients' age ranged from 60 to 70 years. CONCLUSION: The authors suggest prophylactic oophorectomy in postmenopausal women with an age between 60 and 70 years with cancer of left colon or rectum; in these patients there was an increased risk of metachronous OM with related decrease of OS.

Ultrasound and thyroiditis in patient candidates for thyroidectomy.

AIM: Thyroiditis is often associated with nodules based on the Bethesda classification system, and the presence of thyroiditis can make thyroid surgery difficult using both conventional techniques and minimally invasive videoassisted approaches (MIVAT). METHODS: We analyzed 326 patients who underwent total thyroidectomy in 2012. We collected all data in dedicated database. The patients were divided in 4 groups: group 1 no affected by thyroiditis, group 2 affected by thyroiditis, group 3 only histological diagnosis of thyroiditis, group 4all patients affected by thyroiditis. RESULTS: Group 1 included 201 cases, group 2 included 64 patients, group 3 included 61 patients. No statistically significant difference between group 2 and 3 about Ultrasound (US) examination. Statistically significant difference in incidence of "THYR 3-4" between group 1 and group 4. No differences in MIVAT vs. Conventional group. CONCLUSION: US examination of the thyroid is essential for the diagnostic study of the gland also in the selection of a surgical approach. Thyroiditis is a relative contraindication to MIVAT but the experience of the endocrine surgeon is the most important factor to reduce intra and postoperative complications together a correct collaboration in multidisciplinart endocrinological team.

Wide resection of inguinal nerves versus simple section to prevent postoperative pain after prosthetic inguinal hernioplasty: our experience.

BACKGROUND: In the literature, chronic groin pain (i.e. lasting >3 months) occurs in about 10 % of patients who undergo inguinal hernioplasty with prosthesis; it is characterized by a broad range of symptoms, and is relative to individual perceptions of pain. In 2-5 % of cases, the painful symptomatology is so intense that it interferes with daily activities, and can be debilitating in 0.5-6 % of cases. The best known cause of inguinodynia is neuropathy, due to implication of one or more inguinal nerves (iliohypogastric, ilioinguinal, and genitofemoral nerves) into fibroblastic processes; or from nervous stimulation caused by prosthetic material on adjacent nervous trunks. Many therapeutic strategies have been proposed to treat chronic groin pain, including intra-operative prophylactic neurectomy. OBJECTIVE: The purpose of our study was to perform a comparative analysis between outcomes from wide resections of inguinal nerves versus those from simple nervous section (or minimal resection). PATIENTS AND METHODS: We considered 350 patients who had undergone inguinal prosthetic hernioplasty with Trabucco's technique between 2004 and 2010. Wide nervous resection (removal of nerve segments 3-8 cm in length) was performed in 180. The other 170 patients underwent simple section or minimal resection. All patients were checked 1 week, 1 month, and 1 year after surgery. RESULTS: Group 1: At 1-week follow-up, 63 patients (35 %) reported no pain, 113 (63 %) reported moderate pain, and 4 (2 %) intense pain; 1 month after the procedure, 152 patients (84.4 %) reported no pain, 25 (14 %) complained of moderate pain, and 3 (1.6 %) of severe pain; 1 year after surgery, only 1 patient (0.5 %) complained of constant pain. Group 2: At 1 week follow-up, 48 patients (28 %) reported no pain, 101 (59 %) reported moderate pain, and 21 (13 %) intense pain; 1 month after the procedure, 81 patients (47.6 %) had no pain, 72 (42.4 %) complained of moderate pain, and 17 (10 %) of severe pain; 1 year after surgery, 11 patients (6.5 %) had constant pain, and two of them were re-admitted for surgery. The lower incidence of chronic pain after long nervous resection is statistically significant (0.5 vs. 6.5 %; p = 0.006); the incidence of moderate pain 1 month after operation is also lower (14 vs. 42.4 %; p < 0.0001); patients who underwent a long resection experienced faster resolution of pain symptomatology, during a month. Also noteworthy is the lower incidence of intense pain in the short and medium term (after 1 week, 13 vs. 2 %, p = 0.0005; after 1 month, 10 vs. 1.6 %, p = 0.0018). CONCLUSIONS: The prophylactic wide resection of selected segments of inguinal nerves, despite the apparent paradox of greater tissue damage, appears more effective than simple section at preventing postoperative inguinodynia, given both the lower incidence and the faster resolution of painful symptomatology.

Can we pursue minimal invasive surgery in the setting of converted laparoscopic cholecystectomy? Consideration about the "MIVAC" approach.

AIM: Laparoscopic cholecystectomy (LC) is the standard of treatment for symptomatic gallstones disease. Despite surgeon's expertise and laparoscopic technical skills, at times conversion to open laparotomy is still required to carry out safely the surgical procedure. In such cases, we still pursue a minimally invasive approach based on a very short subcostal laparotomy supported by laparoscopic magnification of the reduced surgical field. We named the procedure Minimally Invasive Video-Assisted Cholecystectomy (MIVAC). In the setting of a truly minimal laparotomy, the implementation of a laparoscope makes the difference in terms of improving observation respect to naked eye, providing both details' magnification and deep field illumination. METHODS: Between 2003 and 2010, 1054 LC were performed at a single institution. Seventy-two LC were converted to open laparotomy (6.83%). Reasons for conversion included technical difficulties, aberrant biliary anatomy, dense scarring related to severe cholecystitis, biliary injuries and significant operative bleeding. Our primary endpoint was to evaluate the level of post-operative discomfort along with patient satisfaction from an aesthetic standpoint. RESULTS: Postoperative pain was comparable to LC while subcuticular running sutures ensured acceptable cosmetic results. Medium hospital stay was 24 hours. Both operative and recovery times were comparable to LC and postoperative liver function tests and routine labs did not differ significantly from the preoperative checks. CONCLUSION: The "so called" MIVAC approach appears to be a valid alternative to traditional open cholecystectomy whenever conversion to laparotomy becomes mandatory during the course of LC.

Submersion with grommets: contamination is possible at minimal depth, as demonstrated with a novel middle-ear model.

OBJECTIVE: Advice to patients following grommet insertion and waterproofing can vary from clinician to clinician. A laboratory based experiment was performed to determine at what depth water contamination would occur through various grommet tubes. METHODS: A novel experimental ear model was developed using an artificial tympanic membrane and ventilation tubes. Water contamination was identified using an effervescent solid that reacts when in contact with water. Measures of dispersion were used to describe the results. RESULTS: The average depth of water contamination was: 19.64 mm (range = 11-33 mm, standard deviation = 5.55 mm) using a Shepard grommet; 20.84 mm (range = 18-26 mm, standard deviation = 1.97 mm) with a titanium grommet; and 21.36 mm (range = 18-33 mm, standard deviation = 3.03 mm) using a T-tube. Water contamination was possible at depths of 11-33 mm. The average pressure at water effervescent activation was 0.20 kPa. CONCLUSION: Submersion underwater at any depth with grommets is likely to lead to middle-ear contamination. These findings are concordant with clinical studies.

Sensorineural hearing loss in children.

The objective of the study was to examine the aetiology of sensorineural hearing loss (SNHL) in a paediatric population presenting to the National Centre of Medical Genetics. A retrospective chart review from 1998 to 2006. One hundred and twenty nine children were investigated for SNHL. The average age of diagnosis of hearing loss was 36 months. The degree of hearing loss was mild in 8 children, moderate in 33 children, severe in 31 children and profound in 57 children. Eighty-five children (66%) were diagnosed with a hereditary hearing loss, 11 (8%) children had an acquired hearing loss and no cause found in 33 (26%) children. This is the first report of the causes of hearing loss in Irish children. The mean age of diagnosis in our cohort is high and emphasises the need for a neonatal screening programme. There remains a number of children for whom the cause of hearing loss remains unknown.

Revision cochlear implantation: The Irish experience.

Objectives: To report a long-term experience on revision cochlear implantation (RCI) in a single institution, categorize their indications and to identify predictive parameters of implant failure. Methods: A retrospective study was conducted on a prospective database of a national cochlear implant unit. Patients requiring RCI between January 1995 and June 2016 were identified and stratified into adult and paediatric group. Medical records, investigation reports and device analysis reports were reviewed and analysed. Results/Discussion: A total of 37 children and 21 adults were identified requiring RCI on 60 devices. 63.3% of the RCI was indicated due to the device failure, while 36.7% was due to various medical reasons. Higher device failure rate was reported in the paediatric group, due to the high number of direct head trauma, which was not observed in the adult group. The leading medical indication for RCI was due to wound infection (10%). The overall RCI rate was 5.0%, among which 3.1% was due to device failures. A brief discussion on various medical indications, surgical challenges, and the mechanism of thought process to consider RCI, including treatment planning was outlined. Conclusion: RCI in the paediatric population poses a unique challenge. Integrity testing is helpful in identifying a potential device malfunction; however, regular clinical follow-up with multidisciplinary assessments is invaluable in the decision process for RCI.

Day of surgery admission--is this safe practise?

Day of surgery admission (DOSA) describes the process whereby patients are admitted to hospital and have surgery, on the same day. This is the current admission policy in our institution, for most elective Otolaryngology Head and Neck Surgery patients. We audited 75 consecutive patients admitted on the same day as surgery within our department between May 2006 and January 2007. Significant comorbidity was seen in 28 patients (37.3%). Preoperative investigations prior to surgery were conducted in 64 patients (85.3%). About 21 patients (28%) were delayed going to theatre and the average length of delay was 51 mins. Our cancellation rate was 5.3%. Hospital management have embraced the concept of DOSA in our institution without evaluating the risk to patients. If the DOSA policy is to continue it is imperative that an adequate preoperative assessment clinic is established to prevent negative outcomes for our patients.

Wide nervous section to prevent post-operative inguinodynia after prosthetic hernia repair: a single center experience.

BACKGROUND: Chronic post-operative inguinodynia occurs in about 10 % of patients undergoing inguinal hernioplasty with prosthesis; it is characterized by a broad pleomorphism of symptoms, including relative to individual variability of algic perception. Its intensity can also potentially jeopardize patient's work and social activities. The most notorious cause of inguinodynia is neuropathy, resulting from the involvement of one or more inguinal nerves (iliohypogastric, ilioinguinal and genitofemoral nerves) in fibroblastic processes, or from nervous stimulation, caused by prosthetic material on adjacent nervous trunks. The aim of our study was to provide a comparative analysis between outcomes of wide nerve resection vs. nerve sparing. PATIENTS AND METHODS: In our hospital, between 2000 and 2010, 600 patients underwent monolateral prosthetic inguinal hernia repair, using the original Trabucco technique. In 345 cases, to avoid chronic post-operative pain, we carried out intentional neurectomy, between 3 and 8 cm in length of either the main and/or peripheral branches of the iliohypogastric nerve, ilioinguinal nerve and the genital branch of the genitofemoral nerve, deemed at risk of entrapment because of the prosthetic material. In the control group, which included the other 255 patients, nerves were identified and spared. Follow-up was scheduled at 1 week, 1 month and 1 year after surgery. CASE: 1 week after the operation, 135 patients (39.1 %) did not show pain, 201 (58.3 %) reported moderate pain and 9 (2.6 %) showed intense pain; 1 month after the procedure, 300 patients (87 %) did not have pain, 39 (11.3 %) complained of moderate pain and 6 (1.7 %) demonstrated severe pain; 1 year after surgery, only two patients (0.6 %) complained of persistent pain. CONTROL: At the 1-week follow-up, 114 patients (44.7 %) did not show pain, 111 (43.5 %) reported moderate pain and 30 (11.8 %) intense pain; 1 month after the procedure, 183 patients (71.8 %) did not have pain, 45 (17.6 %) complained of moderate pain and 27 (10.6%) showed severe pain; 1 year after surgery, 11 patients (4.3 %) had persistent pain, and two of them were re-submitted to surgery. The lower incidence of chronic pain after nerve resection is statistically significant (0.6 vs. 4.3 % p = 0.0048); the incidence of moderate pain 1 month after the operation is also lower (11.3 vs. 17.6 % p = 0.0097). In addition, among patients subjected to nerve resection there is a faster resolution of algetic symptomatology, over the course of a month; also noteworthy is the lower incidence of intense pain in the short-and medium-term (after 1 week, 11.8 vs. 2.6 % p = 0.0006 ; after 1 month, 10.6 vs. 1.7 % p < 0.0001). CONCLUSIONS: Despite the apparent paradox of an higher tissue damage, elective neurectomy of selected segments of inguinal nerves, appears an effective technique in preventing chronic postherniorraphy pain, considering both the lower incidence and the faster resolution of painful symptomatology.

Ocular complications of acoustic neuroma surgery.

AIM: To analyse the risk factors involved in the development of ocular complications after acoustic neuroma resection, in particular corneal complications and visual loss, and to identify measures that may reduce these. METHODS: 62 patients who underwent surgery for acoustic neuroma had a standardised ophthalmic examination and retrospective case note review. RESULTS: At final review (mean 37.6 months), although 38 patients reported ocular symptoms, only 22% saw 6/12 or worse. Patients with hypoaesthetic corneas had a higher incidence of corneal pathology (79%) than those with normal sensation (39%). Lagophthalmos increased the incidence of corneal pathology (to 80%); in those with normal closure, the incidence was only 46%. 20 patients required at least one ophthalmic surgical procedure. CONCLUSIONS: After acoustic neuroma resection patients place a considerable burden on the ophthalmologist. Immediate referral postoperatively, and frequent review of those with abnormal sensation may reduce the severity of long term ocular complications.

Nervus intermedius function after vestibular schwannoma removal: clinical features and pathophysiological mechanisms.

The results of facial nerve outcome following vestibular schwannoma removal have generally ignored the sensory component of the nerve. This lack of reporting occurs partly because the distress relating to these functions is less obvious to the surgeon, and partly because the facial nerve grading systems currently used do not include the functions of the nervus intermedius. We have estimated the frequency and nature of abnormalities of nervus intermedius function following vestibular schwannoma removal using a retrospective questionnaire. Questionnaires were mailed to 257 patients and correctly completed and returned by 224 (87%) of the patients. Prior to surgery 5 (2%) of the patients complained of crocodile tears, 9 (4%) noted dryness of the eye, and 15 (6%) complained of an abnormality of taste. Postoperative crocodile tears occurred in 98 (44%), an absence or significant reduction in the production of tears was noted in 162 (72%), and a taste abnormality, either a significant reduction or an alteration in character, was noted in 107 (48%). The onset of crocodile tears approximated to a bimodal distribution, and the recovery of nervus intermedius functions was variable. This study has demonstrated that nervus intermedius abnormalities are common following vestibular schwannoma removal. It also documents their natural history and discusses the underlying pathophysiological mechanisms. We suggest that appropriate preoperative counseling be given to all patients undergoing surgery and that the functions of the nervus intermedius be included in the surgical reporting of facial nerve results in cerebellopontine angle surgery.

Measurement of comfort levels by means of electrical stapedial reflex in children.

BACKGROUND: Patient success and satisfaction with a cochlear implant largely depend on the adequacy of the speech-processing program. The program is generated by means of behaviorally determined threshold and comfort levels for each electrode. As the minimum age for implantation continues to decrease, behavioral methods of measuring comfort levels have become more problematic, and so the need for objective ways to program speech processors has become more important. OBJECTIVES: To evaluate the use of electrically evoked stapedial reflexes (ESRs) to measure comfort levels for children and compare these results with behavioral measurements, and to report the results of a questionnaire assessing the acceptability and general performance of program before and after adjustment of comfort levels measured with ESRs. DESIGN AND SETTING: Before-after trial in the cochlear implant unit of a tertiary hospital. PATIENTS AND METHODS: Programming with the ESR technique was successfully completed in 20 of a consecutive sample of 26 children undergoing programming of their cochlear implants. OUTCOME MEASURES: Programming units as measured by the 2 programming techniques and numerical score of questionnaire. RESULTS: Comfort levels with the ESR method were found to be consistently lower than those obtained with behavioral techniques. Children using programs set with ESRs wore their implants longer and had fewer episodes of discomfort to environmental sounds. CONCLUSION: Comfort level estimation by means of ESRs is reliable and objective and hence a valuable programming tool in the pediatric population.

Tinnitus in children with hearing loss.

There is scant literature relating to tinnitus in children. This may be due in part to the inability of the child to differentiate normal from abnormal, and also adults failing to communicate adequately with children to allow them to describe their observed symptoms. One hundred and two children with severe to profound hearing loss between six to seventeen years of age were questioned as to the presence of tinnitus. The 24 children (23 per cent) who reported tinnitus, also completed a questionnaire, and were interviewed about their symptoms and then were compared to the non-tinnitus children regarding hearing level, age, sex and aetiology of the deafness. No significant difference was found between the two groups. This study documents that tinnitus does exist in a significant number of children with severe to profound deafness and addresses the problem involved in its description and assessment.

Duro-cutaneous fistula caused by a 'congenital' cholesteatoma.

A cervical fistula from a 'congenital' cholesteatoma is described in a 70-year-old man. This was found to communicate with an extradural temporal lobe abscess. The presentation and management is described. No previous report of such a case has been found in a review of the literature.

Nasal airflow in inspiration and expiration.

Inspiratory and expiratory airflow rates were measured in 30 subjects during quiet respiration (at a pressure gradient of 150 Pa) and at peak flow rates. For low flow rates airflow rate was greater for inspiration than for expiration. Conversely at peak flow rates flow was greatest during expiration. Thus there was a reversal in the phase relationship between inspiration and expiration as flow rate increased. It was also found that peak inspiratory flow rate correlated better with values for nasal resistance than did peak expiratory flow rate. Flow rate measured by rhinomanometry during quiet respiration was more sensitive to physiologically induced changes in nasal resistance than was peak flow rate. The findings are discussed with reference to previous work on the physiology of nasal airflow.

B-mode ultrasound demonstration of non-luminal carotid artery invasion by tumour.

Invasion of the adventitia of the carotid artery by tumour is not demonstrated by contrast CT scanning. We report a case in which B-mode ultrasound was successfully used to demonstrate this.