RESUMEN

SUMMARY: Volumetric assessment of brain structures is an important tool in neuroscience research and clinical practice. The volumetric measurement of normally functioning human brain helps detect age-related changes in some regions, which can be observed at varying degrees. This study aims to estimate the insular volume in the normally functioning human brain in both genders, different age groups, and side variations. A cross-sectional retrospective study was conducted on 42 adult Sudanese participants in Al-Amal Hospital, Sudan, between May to August 2022, using magnetic resonance imaging (MRI) and automatic brain segmentation through a software program (BrainSuite). The statistical difference in total insular volume on both sides of the cerebral hemisphere was small. The insular volume on the right side was greater in males, while the left side showed no difference between both genders. A statistically significant difference between males and females was found (p > 0.05), and no statistical difference in different age groups was found according to the one-way ANOVA test (p>0.05). Adult Sudanese males showed a larger insular volume than females. MRI can be used to morphometrically assess the insula to detect any pathological variations based on volume changes.

La evaluación volumétrica de las estructuras cerebrales es una herramienta importante en la investigación y la práctica clínica de la neurociencia. La medición volumétrica del cerebro humano, que funciona normalmente, ayuda a detectar cambios relacionados con la edad en algunas regiones, las cuales se pueden observar en diversos grados. Este estudio tuvo como objetivo estimar el volumen insular en el cerebro humano que funciona normalmente, en ambos sexos, de diferentes grupos de edad y sus variaciones laterales. Se realizó un estudio retrospectivo transversal en 42 participantes sudaneses adultos en el Hospital Al-Amal, Sudán, entre mayo y agosto de 2022, utilizando imágenes de resonancia magnética y segmentación automática del cerebro a través de un software (BrainSuite). Fue pequeña la diferencia estadística en el volumen insular total, en los hemisferios cerebrales. El volumen insular del lado derecho fue mayor en los hombres, mientras que el lado izquierdo no mostró diferencia entre ambos sexos. Se encontró una diferencia estadísticamente significativa entre hombres y mujeres (p > 0,05), y no se encontró diferencia estadística en los diferentes grupos de edad, según la prueba de ANOVA de una vía (p> 0,05). Los hombres sudaneses adultos mostraron un mayor volumen insular que las mujeres. La resonancia magnética se puede utilizar para evaluar morfométricamente la ínsula y para detectar cualquier variación patológica basada en cambios de volumen.

Asunto(s)

RESUMEN

Abstract Introduction Edema and ecchymosis after facial plastic surgery are a troublesome concern for both patients and surgeons. Corticosteroid administration is thought to shorten the recovery period and reduce these sequelae. Data regarding the efficacy of corticosteroid administration remains controversial among surgeons. Objective We conducted this systematic review and meta-analysis to determine the effect of preand postoperative corticosteroids on postoperative complications in patients undergoing facial reconstructive surgery supported with different subgroup analysis. Methods A comprehensive literature search of articles was conducted in PubMed, Cochrane Central, SCOPUS, and EBSCO through October 2019. We included all clinical trials in which patients underwent any type of facial plastic surgery to study the effect of corticosteroids on postoperative complications. We performed subgroup analysis according to the types and doses of corticosteroid preparation, in addition to a subgroup analysis of preor postoperative corticosteroid usage. All statistical analysis was performed using the RevMan software. Results Nineteen studies were included in this systematic review, but only 10 of them were eligible for meta-analysis. The periorbital edema and ecchymosis scores were significantly reduced in the corticosteroids group compared to placebo −0.82, 95% CI (−1.37, −0.26), and -0.95, 95% CI (−1.32, −0.57), respectively. However, these significant differences were not maintained at day 3 and 7. Smaller doses of corticosteroid (8 mg and 10 mg) were associated with smaller differences in the mean score of upper and lower eyelid edema and ecchymosis, while the higher doses were associated with greater differences. Furthermore, preoperative corticosteroid usage significantly reduced the intraoperative bleeding when compared to placebo for higher doses > 50 mg per day (p < 0.0001), but not for 8 mg corticosteroid (p = 0.06). Adding postoperative steroid dose to the preoperative one was associated with less edema and ecchymosis than preoperative administration alone. Conclusion This comprehensive meta-analysis confirms a statistically significant benefit of preoperative corticosteroids. Furthermore, continuing the steroids postoperatively is associated with long-term reduction of complications. Higher doses of corticosteroids are associated with a more significant reduction in edema and ecchymosis, but further studies are recommended to determine the postoperative side effects, including surgical site infection and delayed healing.

Resumo Introdução O edema e a equimose no pós-operatório da cirurgia plástica facial constituem um problema preocupante para pacientes e cirurgiões. Considera-se que a administração de corticosteroides diminua o período de recuperação e reduza essas complicações. Os dados sobre a eficácia da administração de corticosteroides permanecem controversos entre os cirurgiões. Objetivo Fizemos essa revisão sistemática e metanálise para determinar o efeito da administração de corticosteroides nos períodos pré- e pós-operatório sobre as complicações pós-operatórias em pacientes submetidos à cirurgia reconstrutiva facial apoiada em diferentes análises de subgrupos. Método Foi feita uma busca abrangente de artigos nos bancos de dados PubMed, Cochrane Central, Scopus e Ebsco até outubro de 2019. Incluímos todos os ensaios clínicos cujos pacientes foram submetidos a qualquer tipo de cirurgia plástica facial para estudar o efeito dos corticosteroides nas complicações pós-operatórias. Fizemos a análise de subgrupos de acordo com os tipos e as doses de preparação de corticosteroides, além de uma análise de subgrupos de uso de corticosteroides pré ou pós-operatório. Todas as análises estatísticas foram feitas no software RevMan. Resultados Dezenove estudos foram incluídos nesta revisão sistemática, mas apenas 10 deles foram elegíveis para a metanálise. Os escores de edema periorbital e equimoses reduziram significantemente no grupo de corticosteroides em comparação com o placebo: -0,82, IC95% (-1,37, -0,26) e -0,95, IC95% (-1,32, -0,57), respectivamente. Essas diferenças significantes não se mantiveram nos dias 3 e 7. Doses menores de corticosteroides (8 mg e 10 mg) foram associadas a menores diferenças no escore médio de edema e equimoses palpebrais superiores e inferiores, enquanto as doses mais altas foram associadas a diferenças maiores. Além disso, o corticosteroide pré-operatório reduziu significantemente o sangramento intraoperatório quando comparado ao placebo para doses maiores > 50 mg por dia (p < 0,0001), mas não para 8 mg de corticosteroide (p = 0,06). O uso de corticosteroides no pós- e pré-operatório foi associado a uma diminuição maior de edema e equimoses do que no pré-operatório isoladamente. Conclusão Esta metanálise abrangente confirma um benefício estatisticamente significante do uso de corticosteroides no pré-operatório. Além disso, a manutenção dos esteroides no pós-operatório está associada à redução das complicações em longo prazo. Doses mais altas de corticosteroides estão associadas a uma redução mais significativa no edema e nas equimoses, mas estudos adicionais são recomendados para determinar os efeitos colaterais pós-operatórios como infecção do sítio cirúrgico e atraso na cicatrização.

RESUMEN

INTRODUCTION: Edema and ecchymosis after facial plastic surgery are a troublesome concern for both patients and surgeons. Corticosteroid administration is thought to shorten the recovery period and reduce these sequelae. Data regarding the efficacy of corticosteroid administration remains controversial among surgeons. OBJECTIVE: We conducted this systematic review and meta-analysis to determine the effect of pre- and postoperative corticosteroids on postoperative complications in patients undergoing facial reconstructive surgery supported with different subgroup analysis. METHODS: A comprehensive literature search of articles was conducted in PubMed, Cochrane Central, SCOPUS, and EBSCO through October 2019. We included all clinical trials in which patients underwent any type of facial plastic surgery to study the effect of corticosteroids on postoperative complications. We performed subgroup analysis according to the types and doses of corticosteroid preparation, in addition to a subgroup analysis of pre- or postoperative corticosteroid usage. All statistical analysis was performed using the RevMan software. RESULTS: Nineteen studies were included in this systematic review, but only 10 of them were eligible for meta-analysis. The periorbital edema and ecchymosis scores were significantly reduced in the corticosteroids group compared to placebo -0.82, 95% CI (-1.37, -0.26), and -0.95, 95% CI (-1.32, -0.57), respectively. However, these significant differences were not maintained at day 3 and 7. Smaller doses of corticosteroid (8 mg and 10 mg) were associated with smaller differences in the mean score of upper and lower eyelid edema and ecchymosis, while the higher doses were associated with greater differences. Furthermore, preoperative corticosteroid usage significantly reduced the intraoperative bleeding when compared to placebo for higher doses > 50 mg per day (p < 0.0001), but not for 8 mg corticosteroid (p = 0.06). Adding postoperative steroid dose to the preoperative one was associated with less edema and ecchymosis than preoperative administration alone. CONCLUSION: This comprehensive meta-analysis confirms a statistically significant benefit of preoperative corticosteroids. Furthermore, continuing the steroids postoperatively is associated with long-term reduction of complications. Higher doses of corticosteroids are associated with a more significant reduction in edema and ecchymosis, but further studies are recommended to determine the postoperative side effects, including surgical site infection and delayed healing.

Asunto(s)

RESUMEN

Background: Ovarian cancer is the most common gynecological malignancy. In patients with advanced ovarian cancer, some biological parameters have prognostic implementations. P27kip1 is an inhibitor of a cycline-dependent kinase, its loss, can contribute to tumor progression. Objective: This study aimed to examine the importance of P27KIP1 protein in predicting the prognosis and response to neoadjuvant chemotherapy in patients with advanced ovarian epithelial cancer and to compare the outcomes of immunohistochemistry with Quantitative Real-time PCR. Patients and methods: We have studied P27KIP1expression by both immunohistochemistry and Quantitative Realtime PCR from 88 patients with advanced ovarian carcinomas undergone radical debulking surgery and received Paclitaxel followed by Cisplatin every 3 weeks for a total of 6 cycles. We also studied their association with both chemotherapy response and patient survival. Results: Nuclear expression of p27KIP1 protein was intense in 86 normal ovarian tissues and 42 of 88 carcinomas. The P27kip1mRNA expression level by qRT-PCR was very low in ovarian cancer tissues relative to its adjacent normal tissues. The results were statistically significant by both methods of determination. p27KIP1 expression was significantly related to good prognostic parameters as low stage tumors, differentiated tumors, absence of ascites, residual disease < 2 cm, and response to chemotherapy but not with histopathological type in case of determination by immunohistochemistry. Comparison of P27kip1 by both immunohistochemistry and qRTPCR with different prognostic parameters revealed no significant difference between both methods in the assessment of these parameters. In 4 years of follow-up, 20.5% of patients were alive without evidence of disease. 6.8% were alive with disease. The disease-related four -year survival rate for the whole group was 28.2%. In multivariate analysis, residual disease, histological type, tumor differentiation, ascites was of independent prognostic significance. Conclusion: In ovarian cancer, patients with loss of p27KIP1 expression are at a greater likelihood of disease progression, p27KIP1 may be used as a molecular marker to predict response to chemotherapy and prognosis. Both immunohistochemistry and qRT-PCR have equal reliability in the determination of p27 KIP1

Asunto(s)

RESUMEN

Reports of systemic associations in patients with Isolated Sagittal Synostosis (ISS) are sparse. Craniofacial surgeons, and other providers, should be aware that a significant proportion of patients with ISS may have syndromic or systemic involvement. This study investigates the incidence of systemic disease and syndromic diagnosis in a cohort of patients presenting with ISS (ie, patients with sagittal synostosis without other sutural involvement). METHODS: This study consists of a retrospective review of patients diagnosed with ISS between 2007 and 2017 at a single institution. Patients were divided according to onset (early <1 year, late >1 year) of ISS. Patient notes were examined for congenital anomalies, systemic conditions, and molecular testing. Only patients with isolated sagittal fusion-meaning, patients with sagittal synostosis and no other sutural involvement-were included. RESULTS: Three hundred seventy-seven patients met the inclusion criteria: systemic conditions were identified in 188/377 (50%) of them. One hundred sixty-one patients with early onset (Group A), and 216 patients with late onset ISS (Group B) were identified. Systemic involvement was identified in 38% of Group A and 60% of Group B, which was statistically significant (P < 0.001). Forty-eight of 377 (13%) of patients had a syndromic diagnosis, and 79% of these were confirmed via genetic testing. Thirty-five percent of patients were diagnosed with central nervous system anomalies and 16% had craniofacial anomalies. CONCLUSIONS: Nearly 50% of the patients initially diagnosed with ISS were found to have some form of systemic involvement. This supports affording full pediatric and genetic evaluation with molecular testing to these children.

Asunto(s)

Asunto(s)