IntroductionBone marrow-derived multipotent adult progenitor cells (MAPCs) are adult allogeneic adherent stem cells currently investigated clinically for use in acute respiratory distress syndrome (ARDS). To date, there is no agreement on which is the best method for stem cells delivery in ARDS. Here, we compared the efficacy of two different methods of administration and biodistribution of MAPC for the treatment of ARDS in a sheep model.MethodsMAPC were labelled with [18F] fluoro-29-deoxy-D-glucose and delivered by endobronchial (EB) or intravenous route 1 hour after lipopolysaccharide infusion in sheep mechanically ventilated. PET/CT images were acquired to determine the biodistribution and retention of the cells at 1 and 5 hours of administration.ResultsThe distribution and retention of the MAPC was dependent on the method of cell administration. By EB route, PET images showed that MAPC remained at the site of administration and no changes were observed after 5 hours, whereas with intravenous route, the cells had broad biodistribution to different organs, being the lung the main organ of retention at 1 and 5 hours. MAPC demonstrated an equal effect on arterial oxygenation recovery by either route of administration.ConclusionThe EB or intravenous routes of administration of MAPC are both effective for the treatment of ARDS in an acute sheep model, and the effect of MAPC therapy is not dependent of parenchymal integration or systemic biodistribution.

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Parathyroid carcinoma is unusual and its intrathyroidal variant is extremely rare. Therefore, few cases have been reported to describe a case of parathyroid carcinoma located inside the thyroid gland. The case corresponds to a 14-year-old girl who came to the office with a severe osteoarticular disease, depression, calcemia of 14.3 mg/dl and parathyroid hormone of 2,792 pg/ml. Right neck exploration was conducted and a parathyroid carcinoma was found located intrathyroidally. A right thyroid lobectomy was performed. A 20-month follow-up period revealed no recurrence of clinical or biochemical signs. In patients with severe hypercalcemia and significant elevation of parathyroid hormone, the diagnosis of parathyroid carcinoma has to be considered. It is worth highlighting the early age of presentation in this case. Treatment has allowed the effective control of the disease and its recommended long-term follow-up.

Background and objectivesPain management for patients undergoing the Nuss procedure for treatment of pectus excavatum can be challenging. In an effort to improve pain management, our institution added bilateral single injection erector spinae plane (ESP) blocks to surgeon placed intercostal nerve cryoablation. We aimed to assess the efficacy of this practice change.MethodsRetrospective clinical data from a single academic medical center were evaluated. Due to an institutional change in clinical management, we were able to perform a before and after study. Twenty patients undergoing Nuss procedure who received bilateral ultrasound-guided single-shot T6 level ESP blocks and intercostal nerve cryoablation were compared with a historical control cohort of 20 patients who underwent Nuss procedure with intercostal nerve cryoablation alone. The primary outcome variables included postoperative pain scores, total hospital opioid use, and hospital length of stay.ResultsMedian total hospital intravenous morphine milligram equivalents was lower for the ESP group than for the control group (0.60 (IQR 0.35–0.88) vs 1.15 mg/kg (IQR 0.74–1.68), p<0.01). There was no difference in postoperative pain scores between the two groups. Mean hospital length of stay was 2.45 (SD 0.69) days for the control group and 1.95 (SD 0.69) days for the ESP group (p=0.03). No adverse events related to block placement were identified.ConclusionsIn a single-center academic practice, the addition of bilateral single injection ESP blocks at T6 to surgeon performed cryoablation reduced opioid consumption without a change in subjectively reported pain scores. The results from this pilot study can provide effect size estimates to guide the design of future randomized trials.

POSTERSConclusion: Thanks to its reliability, the FAMM flap is a good solution in head and neck cancer surgery, even after radiotherapy. However, the size of this flap remains relatively small. For a medium size loss of substance, it is a good alternative between controlled wound healing and bigger flaps. Method: A retrospective analysis of all "2-week-wait" fast track referrals to the department over a 1-year period (starting August 2010). The referring diagnosis, time of consult, and initial management were recorded. A database of all referrals, the picture archiving and communications system (PACS), and computer and paper records were consulted. Head and Neck SurgeryResults: For the period of the study a total of 446 referrals were received, 425 or 95% were seen within 14 days. The average wait was 9 days. The most common reasons for referral included neck lumps, dysphagia, and voice change. Referrals for inappropriate symptoms were not uncommon, however the main issue was duration of symptoms prior to referral, which averaged over 6 months. The diagnostic yield for malignancy was 6%, significantly lower when compared with a number of comparative studies. Although 59.5% of referrals were females, 70.4% of cancer diagnoses were in men. Conclusion:The use of the NICE guidelines by primary care physicians is far from common practice. A greater awareness of the guidelines would have several beneficial outcomes. The number of inappropriate referrals would be reduced and those with cancer should be picked up earlier, thus improving prognosis. Objective: Eagle syndrome is a rare syndrome in which pain occurs cervico-facially, due to the mineralization of the styloid process. We evaluated the features of Eagle syndrome in a Colombian (Latin American) population. Results: The patients collectively consulted for sore throat and referred otodinia. Two patients had pain at the opening of the oral cavity, and no patient had foreign body sensation or syncope. On physical examination the patients had great tenderness from bimanual palpations on the postero-inferior face of the palatine tonsil. All patients underwent computed tomography and elongation of the styloid process was found. The patients underwent resection of the styloid process externally and endorally in 2 cases and in 3 cases respectively; none of them presented with disease recurrence after a mean followup period of 11.4 months. Head and Neck Surgery Conclusion:In conclusion, this rare disease must be considered in the differential diagnosis of cervical-facial pain, through imaging, plain radiography, or computed tomography. Treatment can be surgical or nonsurgical, although surgery is recommended. Head and Neck Surgery Free Flap Reconstruction of Endoscopic Skull Base DefectsSally M. Kamal, MD (presenter); Andrew Cho, MD; Joel P. Jacobson, MD; Kiarash Shahlaie, MD; Quang C. Luu, MD Objective: 1) Propose a novel technique using free tissue transfer to reconstruct large endoscopic skull base surgery defects. 2) Demonstrate the anatomic feasibility of this techn...