Τρίτη 20 Οκτωβρίου 2015

HeadNeck

Differentiation of benign from malignant cervical lymph nodes in patients with head and neck cancer using PET/CT imaging.

Clin Imaging. 2015

Authors: Payabvash S, Meric K, Cayci Z

Abstract

PURPOSE: To differentiate malignant from benign cervical lymph nodes in patients with head/neck cancer.

METHODS: In this retrospective study, 39 patients with primary head/neck cancer who underwent Positron Emission Tomography (PET)/Computerized Tomography (CT) and image-guided lymph node biopsy were included.

RESULTS: Overall, 23 (59%) patients had biopsy-proven malignant cervical lymphadenopathy. Malignant lymph nodes had higher maximum standardized uptake (SUV-max) value (P<.001) and short-axis diameter (P=.015) compared to benign nodes. An SUV-max of ≥2.5 was 100% sensitive, and an SUV-max ≥5.5 was 100% specific for malignant lymphadenopathy.

CONCLUSION: The PET/CT SUV-max value can help with differentiation of malignant cervical lymph nodes in patients with head/neck cancer.

PMID: 26454617 [PubMed - as supplied by publisher]

A Multidisciplinary Orbit-Sparing Treatment Approach That Includes Proton Therapy for Epithelial Tumors of the Orbit and Ocular Adnexa.

Int J Radiat Oncol Biol Phys. 2015

Authors: Holliday EB, Esmaeli B, Pinckard J, Garden AS, Rosenthal DI, Morrison WH, Kies MS, Gunn GB, Fuller CD, Phan J, Beadle BM, Zhu XR, Zhang X, Frank SJ

Abstract

PURPOSE: Postoperative radiation is often indicated in the treatment of malignant epithelial tumors of the orbit and ocular adnexa. We present details of radiation technique and toxicity data after orbit-sparing surgery followed by adjuvant proton radiation therapy.

METHODS AND MATERIALS: Twenty patients underwent orbit-sparing surgery followed by proton therapy for newly diagnosed malignant epithelial tumors of the lacrimal gland (n=7), lacrimal sac/nasolacrimal duct (n=10), or eyelid (n=3). Tumor characteristics, treatment details, and visual outcomes were obtained from medical records. Acute and chronic toxicity were prospectively scored using Common Terminology Criteria for Adverse Events version 4.0.

RESULTS: The median radiation dose was 60 Gy(RBE) (relative biological effectiveness; [range 50-70 Gy]); 11 patients received concurrent chemotherapy. Dose to ipsilateral anterior optic structures was reduced in 13 patients by having them gaze away from the target during treatment. At a median follow-up time of 27.1 months (range 2.6-77.2 months), no patient had experienced local recurrence; 1 had regional and 1 had distant recurrence. Three patients developed chronic grade 3 epiphora, and 3 developed grade 3 exposure keratopathy. Four patients experienced a decrease in visual acuity from baseline but maintained vision sufficient to perform all activities of daily living without difficulty. Patients with grade ≥3 chronic ocular toxicity had higher maximum dose to the ipsilateral cornea (median 46.3 Gy[RBE], range 36.6-52.7 Gy[RBE] vs median 37.4 Gy[RBE], range 9.0-47.3 Gy(RBE); P=.017).

CONCLUSIONS: Orbit-sparing surgery for epithelial tumors of the orbit and ocular adnexa followed by proton therapy successfully achieved disease control and was well tolerated. No patient required orbital exenteration or enucleation. Chronic grade 3 toxicity was associated with high maximum dose to the cornea. An eye-deviation technique can be used to limit the maximum corneal dose to <35 Gy(RBE).

PMID: 26454680 [PubMed - as supplied by publisher]

Conventionally Fractionated Concurrent Chemoradiotherapy versus Altered Fractionation Radiotherapy Alone in the Definitive Management of Locoregionally Advanced Head and Neck Squamous Cell Carcinoma.

Systematic Review and Meta-analysis of Conventionally Fractionated Concurrent Chemoradiotherapy versus Altered Fractionation Radiotherapy Alone in the Definitive Management of Locoregionally Advanced Head and Neck Squamous Cell Carcinoma.

Clin Oncol (R Coll Radiol). 2015 Oct 7;

Authors: Gupta T, Kannan S, Ghosh-Laskar S, Agarwal JP

Abstract

AIMS: Treatment intensification either by using concurrent chemoradiotherapy (CCRT) or altered fractionation radiotherapy (AFRT) improves outcomes of locoregionally advanced head and neck squamous cell carcinoma (HNSCC). The superiority of one approach over the other, however, remains to be firmly established. The aim of the present study was to compare outcomes of CCRT versus AFRT in the definitive non-surgical management of locoregionally advanced HNSCC for evidence-based decision making.

MATERIALS AND METHODS: An electronic search of Medline via PubMed was conducted with no language, year, or publication status restrictions. The Cochrane Central Register of Controlled Trials (CENTRAL) and Database of Abstracts of Reviews of Effectiveness (DARE) were also searched electronically. Only randomised controlled trials assigning HNSCC patients randomly to conventionally fractionated CCRT or AFRT alone were included. Data were extracted independently by two reviewers and pooled using the Cochrane methodology for meta-analysis and expressed as a hazard ratio with 95% confidence intervals. Overall survival was the primary outcome of interest, whereas disease-free survival, locoregional control and toxicity were secondary end points.

RESULTS: Five randomised controlled trials (involving 1117 patients and 627 deaths) directly comparing conventionally fractionated CCRT with AFRT alone were included. The risk of bias in included studies was low for efficacy outcomes, but high for toxicity outcomes. The overall pooled hazard ratio of death was 0.73 (95% confidence interval = 0.62-0.86), which significantly favoured conventionally fractionated CCRT over AFRT alone (P < 0.0001). Similarly, disease-free survival (hazard ratio = 0.79, 95% confidence interval = 0.68-0.92; P = 0.002) and locoregional control (hazard ratio = 0.71, 95% confidence interval = 0.59-0.84; P < 0.0001) were significantly improved with CCRT. There were no significant differences in the incidence of severe acute toxicity (dermatitis and mucositis) between the two approaches of treatment intensification. Late xerostomia was significantly increased with CCRT. Significant haematological toxicity and nephrotoxicity were seen exclusively with chemotherapy.

CONCLUSION: There is moderate quality evidence that conventionally fractionated CCRT improves survival outcomes compared with AFRT alone in the definitive radiotherapeutic management of locoregionally advanced HNSCC. No form of acceleration can potentially compensate fully for the lack of concurrent chemotherapy.

PMID: 26454839 [PubMed - as supplied by publisher]

Chondroma of Cerebral Falx: A Rare Intracranial Diagnosis.

J Coll Physicians Surg Pak. 2015 Oct;25(10):771-773

Authors: Awan LM, Niaz A, Amin, Vohra AH

Abstract

Chondromas are benign tumors which mostly occur in extremities but also sometimes in the cranium. Intracerebral chondroma is rare condition. Most intracranial chondromas arise from skull base, but chondroma of falx origin is a rare entity and mostly occurs in relation with syndromic disorders such as Mafucci's syndrome or Ollier's syndrome. Here, we report a rare case of falcine intracranial chondroma in a young man who presented with headaches and weakness of lower extremities and no signs of any syndromic disorder. The purpose of this case report was to raise awareness about intracranial chondromas. Chondroma should be considered in the differential diagnosis of calcified masses arising from the falx.

PMID: 26454394 [PubMed - as supplied by publisher]

Stem Cells, Autism and Cerebral Palsy

In the Know and in the News: How Science and the Media Communicate About Stem Cells, Autism and Cerebral Palsy.

Stem Cell Rev. 2015 Oct 10;

Authors: Sharpe K, Di Pietro N, Illes J

Abstract

Stem cell research has generated considerable attention for its potential to remediate many disorders of the central nervous system including neurodevelopmental disorders such as autism spectrum disorder (ASD) and cerebral palsy (CP) that place a high burden on individual children, families and society. Here we characterized messaging about the use of stem cells for ASD and CP in news media articles and concurrent dissemination of discoveries through conventional science discourse. We searched LexisNexis and Canadian Newsstand for news articles from the US, UK, Canada and Australia in the period between 2000 and 2014, and PubMed for peer reviewed articles for the same 10 years. Using in-depth content analysis methods, we found less cautionary messaging about stem cells for ASD and CP in the resulting sample of 73 media articles than in the sample of 87 science papers, and a privileging of benefits over risk. News media also present stem cells as ready for clinical application to treat these neurodevelopmental disorders, even while the science literature calls for further research. Investigative news reports that explicitly quote researchers, however, provide the most accurate information to actual science news. The hope, hype, and promise of stem cell interventions for neurodevelopmental disorders, combined with the extreme vulnerability of these children and their families, creates a perfect storm in which journalists and stem cell scientists must commit to a continued, if not even more robust, partnership to promote balanced and accurate messaging.

PMID: 26454430 [PubMed - as supplied by publisher]

The many faces of small B cell lymphomas with plasmacytic differentiation and the contribution of MYD88 testing.

Virchows Arch. 2015 Oct 10;

Authors: Swerdlow SH, Kuzu I, Dogan A, Dirnhofer S, Chan JK, Sander B, Ott G, Xerri L, Quintanilla-Martinez L, Campo E

Abstract

Plasmacytic differentiation may occur in almost all small B cell lymphomas (SBLs), although it varies from being uniformly present (as in lymphoplasmacytic lymphoma (LPL)) to very uncommon (as in mantle cell lymphomas (MCLs)). The discovery of MYD88 L265P mutations in the vast majority of LPLs has had a major impact on the study of these lymphomas. Review of the cases contributed to the 2014 European Association for Haematopathology/Society for Hematopathology slide workshop illustrated how mutational testing has helped refine the diagnostic criteria for LPL, emphasizing the importance of identifying a clonal monotonous lymphoplasmacytic population and highlighting how LPL can still be diagnosed with extensive nodal architectural effacement, very subtle plasmacytic differentiation, follicular colonization, or uncommon phenotypes such as CD5 or CD10 expression. MYD88 L265P mutations were found in 11/11 LPL cases versus only 2 of 28 other SBLs included in its differential diagnosis. Mutational testing also helped to exclude other cases that would have been considered LPL in the past. The workshop also highlighted how plasmacytic differentiation can occur in chronic lymphocytic leukemia/small lymphocytic lymphoma, follicular lymphoma, SOX11 negative MCL, and particularly in marginal zone lymphomas, all of which can cause diagnostic confusion with LPL. The cases also highlighted the difficulty in distinguishing lymphomas with marked plasmacytic differentiation from plasma cell neoplasms. Some SBLs with plasmacytic differentiation can be associated with amyloid, other immunoglobulin deposition, or crystal-storing histiocytosis, which may obscure the underlying neoplasm. Finally, although generally indolent, LPL may transform, with the workshop cases suggesting a role for TP53 abnormalities.

PMID: 26454445 [PubMed - as supplied by publisher]

Endoscopic submandibular gland resection preserving great auricular nerve and periaural sensation.

Auris Nasus Larynx. 2015 Oct 7;

Authors: Lee DY, Jung KY, Baek SK

Abstract

OBJECTIVE: The preservation of periaural sensation is one of the most important things to improve the postoperative quality of life after performing the surgical procedures via retroauricular approach. The aim of this study is to describe the surgical technique of endoscopic submandibular gland (SMG) resection through the potential plane between great auricular nerve (GAN) and sternocleidomastoid muscle (sub-GAN dissection) and to evaluate its technical feasibility and advantage.

METHODS: The present study enrolled 22 patients who underwent endoscopic SMG resection through linear hairline incision and sub-GAN dissection. The assessment was performed on the following: the cosmetic satisfaction after surgery and surgery-related variables.

RESULTS: There was one case of a postoperative hematoma, which resolved with conservative management via a compression dressing, and one case of transient numbness at the surgical site, which spontaneously resolved within two months. In all other patients, no complications, such as seroma, skin necrosis, or marginal mandibular nerve palsy, occurred. The mean scores of pain and paresthesia evaluated with the graded scale approximated 0 (no pain or paresthesia). The cosmetic result score was as low as 1.5 ("extremely satisfied" or "satisfied").

CONCLUSION: Linear hairline incision and sub-GAN dissection were feasible to acquire the sufficient working space for endoscopic SMG resection without sensory deterioration of GAN. This procedure may be useful to apply the surgery of other upper neck masses or thyroidectomy via retroauricular approach.

PMID: 26454535 [PubMed - as supplied by publisher]

Office-based Autologous Fat Injection Laryngoplasty for Vocal Process Granuloma.

J Voice. 2015 Oct 7;

Authors: Hu HC, Hung YT, Lin SY, Chang SY

Abstract

OBJECTIVE: To present the outcomes of office-based autologous fat injection laryngoplasty for the treatment of vocal process granuloma in conjunction with glottic insufficiency.

STUDY DESIGN: Retrospective chart review.

METHODS: This study included nine patients with vocal process granuloma in conjunction with glottic insufficiency who received autologous fat injection laryngoplasty. Videolaryngostroboscopic data, objective voice assessment, perceptual measurements of vocal quality, and subjective ratings of voice quality were examined before and after treatment.

RESULTS: Of the nine patients, seven (78%) exhibited complete remission. The other two patients (22%) exhibited a partial response following the injection. In a subgroup of five patients who were refractory to antireflux and voice therapies, the resolution rate was 60%. Phonatory function presented significant improvements in jitter, noise-to-harmonic ratio, maximal phonation time, and asthenia. Videolaryngostroboscopic rating revealed significant improvements in closure phase ratio in the vibratory cycle.

CONCLUSIONS: Autologous fat injection laryngoplasty can ameliorate glottic insufficiency and the resulting hyperfunctional behavior of the larynx. This therapy also encourages remission of vocal process granuloma and may represent an alternative treatment strategy.

PMID: 26454769 [PubMed - as supplied by publisher]

An Update on the Role of Immunotherapy and Vaccine Strategies for Primary Brain Tumors.

Curr Treat Options Oncol. 2015 Nov;16(11):54

Authors: Neagu MR, Reardon DA

Abstract

OPINION STATEMENT: Existing therapies for glioblastoma (GBM), the most common malignant primary brain tumor in adults, have fallen short of improving the dismal patient outcomes, with an average 14-16-month median overall survival. The biological complexity and adaptability of GBM, redundancy of dysregulated signaling pathways, and poor penetration of therapies through the blood-brain barrier contribute to poor therapeutic progress. The current standard of care for newly diagnosed GBM consists of maximal safe resection, followed by fractionated radiotherapy combined with concurrent temozolomide (TMZ) and 6-12 cycles of adjuvant TMZ. At progression, bevacizumab with or without additional chemotherapy is an option for salvage therapy. The recent FDA approval of sipuleucel-T for prostate cancer and ipilumimab, nivolumab, and pembrolizumab for select solid tumors and the ongoing trials showing clinical efficacy and response durability herald a new era of cancer treatment with the potential to change standard-of-care treatment across multiple cancers. The evaluation of various immunotherapeutics is advancing for GBM, putting into question the dogma of the CNS as an immuno-privileged site. While the field is yet young, both active immunotherapy involving vaccine strategies and cellular therapy as well as reversal of GBM-induced global immune-suppression through immune checkpoint blockade are showing promising results and revealing essential immunological insights regarding kinetics of the immune response, immune evasion, and correlative biomarkers. The future holds exciting promise in establishing new treatment options for GBM that harness the patients' own immune system by activating it with immune checkpoint inhibitors, providing specificity using vaccine therapy, and allowing for modulation and enhancement by combinatorial approaches.

PMID: 26454859 [PubMed - as supplied by publisher]

Presentations and Outcome of Thyroiditis

Presentations and Outcome of Thyroiditis from a Tertiary Care Hospital of Karachi.

J Coll Physicians Surg Pak. 2015 Oct;25(10):717-720

Authors: Mahar SA, Shahid M, Sarfaraz A, Shaikh Z-, Shaikh S, Shahid N

Abstract

OBJECTIVE: To assess the clinical presentations and short-term outcomes of patients with thyroiditis presenting to a tertiary care hospital in Karachi, Pakistan.

STUDY DESIGN: Case series.

PLACE AND DURATION OF STUDY: Department of Endocrinology, Liaquat National Hospital, Karachi, from June 2014 to February 2015.

METHODOLOGY: Patients between 18 and 70 years of age with acute onset of thyroiditis confirmed on thyroid scan or clinical judgment presenting to the outpatient services were included in the study. Pregnant females, psychiatric patients and patients having other chronic illnesses were excluded from the study.

RESULTS: A total of 26 patients with thyroiditis attended the endocrine clinic. Mean age of patients was 41.2 ± 11.12 years. There were 18 (69.2%) females. Clinical presentations were fever (65.4%), tender neck (23.1%), goiter (19.2%), localized tenderness in neck and palpable lymph nodes (26.9%). Major symptoms reported were: sore throat (69.2%), weight loss (38.5%), upper respiratory tract infection, thyroid pain, tremor, sweating and fever of unknown origin in 26.9% cases. All the patients had raised Erythrocyte Sedimentation Rate (ESR). Low Thyroid Stimulating Hormone (TSH) < 0.4 mlU/L was seen in 88.5% and 57.7% had raised Free T4 > 1.8 ng/dL. Complete recovery was seen in 88.5% patients while 11.5% had early hypothyroidism.

CONCLUSION: Fever and sore throat were the main presenting features of thyroiditis patients. ESR was raised in all patients. A majority of patients had complete recovery with appropriate management; however, few cases developed hypothyroidism.

PMID: 26454385 [PubMed - as supplied by publisher]

Acoustic Analyses of Prolonged Vowels in Young Adults With Friedreich Ataxia.

J Voice. 2015 Oct 7;

Authors: Carson C, Ryalls J, Hardin-Hollingsworth K, Le Normand MT, Ruddy B

Abstract

OBJECTIVES: Finding measures that track disease progression and determine treatment efficacy is vital for appropriate management in Friedreich ataxia (FA). The purpose of this study was to determine which cepstral- and spectral-based measures extracted from prolonged vowels using Analysis of Dysphonia in Speech and Voice (ADSV) program discriminate between those who have FA and normal voice (NV) peers.

STUDY DESIGN: This is a descriptive, prospective study.

METHODS: Initial 2 seconds of prolonged /a/, /i/, and /o/ were analyzed through ADSV from 20 individuals diagnosed with FA and 20 NV individuals. ADSV measures used were cepstral peak prominence (CPP), cepstral peak prominence standard deviation (CPP SD), low/high spectral ratio (L/H ratio), low/high spectral ratio standard deviation (L/H ratio SD), and the Cepstral/Spectral Index of Dysphonia (CSID).

RESULTS: L/H ratio SD was the only measure where significant differences were found across all vowels between groups. Comparing measures per vowel, the vowel /o/ was significantly different between groups on four of five measures. Discrimination analysis revealed 100% of those in the FA group were classified correctly (sensitivity), whereas 95% of NV members were correctly identified (specificity) when all ADSV measures, with the exception of L/H ratio, were entered.

CONCLUSIONS: Unstable periods of phonation, such as initiations of voice production in vowels, may yield robust acoustic cues in the FA population. ADSV provides measures that, when considered together, have excellent sensitivity and very good specificity. Vowels yielded differing results on ADSV measures; analysis of different vowel types is recommended.

PMID: 26454768 [PubMed - as supplied by publisher]

Wernicke's aphasia and semantic aphasia

Varieties of semantic 'access' deficit in Wernicke's aphasia and semantic aphasia.

Brain. 2015 Oct 9;

Authors: Thompson HE, Robson H, Lambon Ralph MA, Jefferies E

Abstract

Comprehension deficits are common in stroke aphasia, including in cases with (i) semantic aphasia, characterized by poor executive control of semantic processing across verbal and non-verbal modalities; and (ii) Wernicke's aphasia, associated with poor auditory-verbal comprehension and repetition, plus fluent speech with jargon. However, the varieties of these comprehension problems, and their underlying causes, are not well understood. Both patient groups exhibit some type of semantic 'access' deficit, as opposed to the 'storage' deficits observed in semantic dementia. Nevertheless, existing descriptions suggest that these patients might have different varieties of 'access' impairment-related to difficulty resolving competition (in semantic aphasia) versus initial activation of concepts from sensory inputs (in Wernicke's aphasia). We used a case series design to compare patients with Wernicke's aphasia and those with semantic aphasia on Warrington's paradigmatic assessment of semantic 'access' deficits. In these verbal and non-verbal matching tasks, a small set of semantically-related items are repeatedly presented over several cycles so that the target on one trial becomes a distractor on another (building up interference and eliciting semantic 'blocking' effects). Patients with Wernicke's aphasia and semantic aphasia were distinguished according to lesion location in the temporal cortex, but in each group, some individuals had additional prefrontal damage. Both of these aspects of lesion variability-one that mapped onto classical 'syndromes' and one that did not-predicted aspects of the semantic 'access' deficit. Both semantic aphasia and Wernicke's aphasia cases showed multimodal semantic impairment, although as expected, the Wernicke's aphasia group showed greater deficits on auditory-verbal than picture judgements. Distribution of damage in the temporal lobe was crucial for predicting the initially 'beneficial' effects of stimulus repetition: cases with Wernicke's aphasia showed initial improvement with repetition of words and pictures, while in semantic aphasia, semantic access was initially good but declined in the face of competition from previous targets. Prefrontal damage predicted the 'harmful' effects of repetition: the ability to reselect both word and picture targets in the face of mounting competition was linked to left prefrontal damage in both groups. Therefore, patients with semantic aphasia and Wernicke's aphasia have partially distinct impairment of semantic 'access' but, across these syndromes, prefrontal lesions produce declining comprehension with repetition in both verbal and non-verbal tasks.

PMID: 26454668 [PubMed - as supplied by publisher]

A rare case report of rib hemangioma mimicking a malignant bone tumor or metastatic tumor.

Int J Surg Case Rep. 2015 Oct 3;16:141-145

Authors: Haro A, Nagashima A

Abstract

Hemangioma of the rib is a rare benign vascular tumor. This benign disease induces osteolytic changes, and must be distinguished from a malignant bone tumor or metastatic tumor. Definitive diagnosis is achieved by excision biopsy or histological examination after surgical resection in many cases. We here in present a rare case of hemangioma of the rib.

PMID: 26454500 [PubMed - as supplied by publisher]

The effect of adenoidectomy on occlusal development and nasal cavity volume in children with recurrent middle ear infection.

Int J Pediatr Otorhinolaryngol. 2015 Sep 30;

Authors: Niemi P, Numminen J, Rautiainen M, Helminen M, Vinkka-Puhakka H, Peltomäki T

Abstract

OBJECTIVES: The aim of the study was to examine the effect of adenoidectomy on occlusal/dentoalveolar development and nasal cavity volume in children who underwent tympanostomy tube insertion with or without adenoidectomy due to recurrent episodes of middle ear infection.

METHODS: This prospective controlled study consisted of two randomly allocated treatment groups of children, younger than 2 years, who had underwent more than 3-5 events of middle ear infection during the last 6 months or 4-6 events during the last year. At the mean age of 17 months tympanostomy tube placement without adenoidectomy (Group I, n=63) tympanostomy tube placement with adenoidectomy (Group II, n=74) was performed. At the age of 5 years 41 children of the original Group I (14 females, 27 males, mean age 5.2 yrs, SD 0.17) and 59 children of the original Group II (17 females, 42 males, mean age 5.2 yrs, SD 0.18) participated in the re-examination, which included clinical orthodontic examination defining morphological and functional craniofacial status and occlusal bite index to measure upper dental arch dimensions. Acoustic rhinometry and anterior rhinomanometry was made by otorhinolaryngologist at the same day.

RESULTS: No statistically significant differences were found between the groups in the frequencies of morphological or functional characteristics or upper dental arch measurements or in the minimal cross-sectional areas or inspiratory nasal airway resistance measurements.

CONCLUSION: Combining adenoidectomy with tympanostomy tube insertion in the treatment of recurrent middle ear infection at an early age (under the age of 2 years) does not seem to make any difference in occlusal development in primary dentition at the age of 5 years as compared to tympanostomy tube insertion only. Since adenoid size was not evaluated, the findings do not allow interpretation that hypertrophic adenoids should not be removed in children with continuous mouth breathing or sleep disordered breathing.

PMID: 26454528 [PubMed - as supplied by publisher]

Antibiotic resistance of Streptococcus pneumoniae in children with acute otitis media treatment failure.

Int J Pediatr Otorhinolaryngol. 2015 Sep 30;

Authors: Zielnik-Jurkiewicz B, Bielicka A

Abstract

OBJECTIVES: The emergence of antibiotic-resistant bacteria is a major cause of treatment failure in children with acute otitis media (AOM). This study aimed to analyze the types of bacterial strains in fluid isolated from the middle ear of children with AOM who did not respond to oral antibiotic treatment. We also determined the antibiotic resistance of the most frequently isolated bacterial strain (Streptococcus pneumoniae) found in these children.

METHODS: This was a prospective study of 157 children with AOM aged from 6 months to 7 years admitted due to unsuccessful oral antibiotic treatment. All children underwent a myringotomy, and samples of the middle ear fluid were collected for bacteriological examination.

RESULTS: Positive bacterial cultures were obtained in 104 patients (66.2%), with Streptococcus pneumoniae (39.69%), Haemophilus influenzae (16.03%) Staphylococcus aureus (16.03%), Staphylococcus haemolyticus (6.9%) and Streptococcus pyogenes (5.34%) found most frequently. The majority (65.4%) of S. pneumoniae strains were penicillin-intermediate-resistant or penicillin-resistant, and 67.2% strains of S. pneumoniae were multidrug-resistant.

CONCLUSIONS: We identified S. pneumoniae as the most frequently isolated pathogen from the middle ear in children with AOM treatment failure and determined that the majority of strains were antibiotic-resistant. We propose that the microbiological identification of bacterial strains and their degree of antibiotic resistance should be performed prior to therapy in order to choose the most appropriate antibiotic therapy for children with AOM treatment failure.

PMID: 26454530 [PubMed - as supplied by publisher]

Positioning of earphones and variations in auditory thresholds.

Braz J Otorhinolaryngol. 2015

Authors: Almeida BP, Menezes PL, de Andrade KC, Teixeira CF

Abstract

INTRODUCTION: One of the problems observed in pure-tone audiometry tonal has been the variation in test results of a same individual, particularly at frequencies of 4kHz, 6kHz and/or 8kHz. Improper placement of headphones is one of the factors that can cause alterations in results.

OBJECTIVE: To compare differences in auditory thresholds using earphones positioned by the examiner and by the worker.

METHODS: Clinical and experimental study conducted in 2009, with 324 workers aged between 19 and 61 years, with a mean of 33.29 years and mean exposure time of 7.67 years. All subjects were familiar with audiometry procedures. Auditory thresholds were obtained at frequencies of 0.25-8kHz, with earphones positioned by the examiners, and at frequencies of 4, 6 and 8kHz, with earphones placed by workers in a comfortable position, following the examiner's instructions. The thresholds obtained in these two situations were compared.

RESULTS: The three frequencies exhibited better responses with earphones placed by the workers themselves (p<0.001). At a frequency of 8kHz a greater difference was found (p<0.001), with a mean of 13.89dB and standard deviation of 6.07dB.

CONCLUSION: Earphone placement by the workers themselves under supervision of the examiner results in improved mean auditory thresholds at frequencies of 4, 6 and 8kHz, the last one significantly higher than the other two.

PMID: 26454532 [PubMed - as supplied by publisher]

Overview of Immunodeficiency Disorders.

Immunol Allergy Clin North Am. 2015 Nov;35(4):599-623

Authors: Raje N, Dinakar C

Abstract

The spectrum of primary immunodeficiency disorders (PIDs) is expanding. It includes typical disorders that primarily present with defective immunity as well as disorders that predominantly involve other systems and show few features of impaired immunity. The rapidly growing list of new immunodeficiency disorders and treatment modalities makes it imperative for providers to stay abreast of the latest and best management strategies. This article presents a brief overview of recent clinical advances in PIDs.

PMID: 26454309 [PubMed - as supplied by publisher]

Overview of Immunodeficiency Disorders.

Approach to Children with Recurrent Infections.

Immunol Allergy Clin North Am. 2015 Nov;35(4):625-636

Authors: Hernandez-Trujillo VP

Abstract

Recurrent infections in children are a cause for concern. It is essential to distinguish simple recurrent infections caused by exposures in the day care or school settings from those caused by inherent deficiencies in the immune system or other systemic diseases. Multiple diagnostic tools are available for the evaluation of recurrent infections. The sites of infections and organisms responsible are important in guiding clinicians in the appropriate laboratory work-up and diagnosis of these patients. Once a diagnosis is made, proper treatment and management decisions can be made to treat the patients appropriately and ensure their lifelong health.

PMID: 26454310 [PubMed - as supplied by publisher]

Common Variable Immunodeficiency: Diagnosis, Management, and Treatment.

Immunol Allergy Clin North Am. 2015 Nov;35(4):637-658

Authors: Abbott JK, Gelfand EW

Abstract

Common variable immunodeficiency (CVID) refers to a grouping of antibody deficiencies that lack a more specific genetic or phenotypic classification. It is the immunodeficiency classification with the greatest number of constituents, likely because of the numerous ways in which antibody production can be impaired and the frequency in which antibody production becomes impaired in human beings. CVID comprises a heterogeneous group of rare diseases. Consequently, CVID presents a significant challenge for researchers and clinicians. Despite these difficulties, both our understanding of and ability to manage this grouping of complex immune diseases has advanced significantly over the past 60 years.

PMID: 26454311 [PubMed - as supplied by publisher]

Postural influence on intracranial and cerebral perfusion pressure in ambulatory neurosurgical patients

Am J Physiol Regul Integr Comp Physiol. 2015 Oct 14:ajpregu.00302.2015. doi: 10.1152/ajpregu.00302.2015. [Epub ahead of print]
.
Petersen LG1, Petersen JC2, Andresen M3, Secher NH4, Juhler M3.
Author information
1University of Copenhagen, faculty of Health Sciences lonnie@sund.ku.dk.
2University of Copenhagen, faculty of Health Sciences.
3Copenhagen University Hospital.
4University of Copenhagen.
Abstract
We evaluated postural effects on intracranial pressure (ICP) and cerebral perfusion pressure (CPP: mean arterial pressure (MAP) - ICP) in neurosurgical patients undergoing 24-hour ICP monitoring as part of their diagnostic workup. We identified 9 patients (5 women, age 44±20 yrs.; mean±SD) who were "as normal as possible" i.e. without indication for neurosurgical intervention (e.g. focal lesions, global edema, abnormalities in ICP-profile or cerebrospinal fluid dynamics). ICP (tip-transducer probe, Raumedic) in the brain parenchyma (N=7) or in the lateral ventricles (N=2) and cardiovascular variables (Nexfin) were determined from 20° head-down tilt to standing up. Compared to the supine position, ICP increased during 10° and 20° of head-down tilt (from 9.4±3.8 to 14.3±4.7 and 19±4.7 mmHg, P<0.001). Conversely, 10° and 20° head-up tilt reduced ICP to 4.8±3.6 and 1.3±3.6 mmHg and ICP reached -2.4±4.2 mmHg when standing up (P<0.05). Concordant changes in MAP maintained CPP at 77±7 mmHg regardless of body position (P=0.95). During head-down tilt, the increase in ICP corresponded to a hydrostatic pressure gradient with reference just below the heart, likely reflecting the venous hydrostatic indifference point. When upright, the decrease in ICP was attenuated, corresponding to formation of a separate hydrostatic gradient with reference to the base of the skull, likely reflecting the site of venous collapse. ICP therefore seems to be governed by pressure in the draining veins and collapse of neck veins may protect the brain from being exposed to a large negative pressure when upright. Despite positional changes in ICP, MAP keeps CPP tightly regulated.
Copyright © 2015, American Journal of Physiology - Regulatory, Integrative and Comparative Physiology.
KEYWORDS:
Gravity; Hydrostatic pressure; Posture
PMID: 26468260 [PubMed - as supplied by publisher]

Anatomic Assessment of Petrous Internal Carotid Artery, Facial Nerve, and Cochlea Through the Anterior Transpetrosal Approach

J Craniofac Surg. 2015 Oct;26(7):2180-2183.
.
Jiang Y1, Chen Y, Yao J, Tian Y, Su L, Li Y.
Author information
1*Department of Dermatology, the First Affiliated Hospital of Jilin University †Department of the Human anatomy, Jilin Medical College ‡Department of the Human anatomy, Norman Bethune College of Medicine, Jilin University, Changchun, China.
Abstract
The aim of this study was to measure the related parameters of the cochlea, so as to allow preoperative assessment of the anatomic relationship of the petrous internal carotid artery (ICA), the facial nerve (FN), and the cochlea during skull base surgery. Seven parameters of these 3 structures were examined in the computed tomographic scan of 120 patients. The shortest distance from the cupula cochleae to the petrous ICA and the FN is as follows: 19.39 (1.01) mm to the stylomastoid foramen (D2), 10.27 (0.80) mm to the midpoint of the genu of FN canal (D3), 13.66 (0.88) mm to the exocranial opening of the carotid canal (D4), and 5.64 (1.03) mm to the midpoint of carotid knee (D5). The shortest distance between the mastoid segment of FN canal and the vertical segment of the petrous ICA (D6) was 13.33 (1.25) mm. The angle between D2 and D3 was measured at 45.66 (3.31)°, and the angle between D4 and D5 was measured at 41.08 (2.64)°. Clinically, it is relatively safe to work within the distances and angles measured in this research, and these results may give surgeons a practical and specific view of these 3 structures in the skull base approaches such as anterior transpetrosal approach to achieve the best possible surgical outcome and maximize safety.
PMID: 26468807 [PubMed - as supplied by publisher]

The Presence of Clival Foramen Through Multidetector Computed Tomography of the Skull Base

J Craniofac Surg. 2015 Oct;26(7):e580-e582.
Inal M1, Muluk NB, Ozveren MF, Çelebi UO, Şimşek G, Burulday V, Bilgili MY.
Author information
1*Department of Radiodiagnostics †Department of Otolaryngology ‡Department of Neurosurgery §Department of Radiodiagnostics ||Department of Otolaryngology ¶Department of Radiodiagnostics, School of Medicine, Kirikkale University, Kirikkale, Turkey.
Abstract
OBJECTIVES:
Technological advancements in the diagnostic radiology recently permitted reviewing the normal anatomy through multidetector computed tomography (MDCT) imagination. The aim of this paper is retrospectively investigation of the clival foramen and canal through MDCT.
MATERIALS AND METHODS:
One hundred eighty-six MDCT scans were reviewed. First, images were taken at axial plane, and then coronal and sagittal reconstructions of raw data were performed. Later investigations were carried out on these three-dimensional images (3-D imaging). The images were evaluated as clival foramen "present" or "absent."
RESULTS:
In our 186 patients, evaluation of MDCT showed that clival foramen was absent in 66.7% (n = 124) of patients. Only 33.3% (n = 62) of patients had a clival foramen. In 3-D images, clival canal and clival foramen were shown more clearly compared with the MDCT.
CONCLUSIONS:
Knowledge of the clival canal might be useful in patients of questionable clival fracture or during neurosurgical operations in this region. During life the canal contained a vein connecting the basilar plexus with the venous plexus of the vertebral canal, and inferior petrosal sinuses. Before the surgical interventions in the clival region, the presence of the clival canal and foramen should also be known due to its vascular contents. By multidetector computed tomography and 3-D images, clival canal and foramen may be viewed preoperatively.
PMID: 26468827 [PubMed - as supplied by publisher]

Adult hearing-aid users with cochlear dead regions restricted to high frequencies: Implications for amplification.

Int J Audiol. 2015 Oct 13;:1-10

Authors: Pepler A, Lewis K, Munro KJ

Abstract

OBJECTIVES: Cochlear dead regions (DR) are common in adult hearing-aid users, but are usually restricted to high frequencies. The aim was to determine the benefit of high-frequency amplification for ears with and without high-frequency DRs.

DESIGN: Participants were fitted with the study hearing aid and tested under four conditions: unfiltered (NAL-NL2 prescription), and low-pass filtered at 1.5, 2, and 3 kHz. VCV stimuli were presented at 65 dB (A) in quiet and in 20-talker babble at a signal-to-babble ratio of 0 dB.

STUDY SAMPLE: Experienced adult hearing-aid users: one group of 18 with a DR edge frequency above 1.5 kHz, and a group of 18 matched controls.

RESULTS: Overall performance was best in the unfiltered condition. There was no significant difference in mean performance between the two groups when tested in quiet. However, the DR group obtained less benefit from high-frequency amplification when tested in babble: the mean difference between the unfiltered and 3-kHz filtered condition was 6% and 13% for the DR group and controls, respectively.

CONCLUSIONS: In adults with a moderate hearing loss and a restricted DR, speech recognition was always best in the unfiltered condition, although mean performance in babble was lower for the DR group.

PMID: 26460797 [PubMed - as supplied by publisher]

Metastatic carcinoma of breast or a chordoma?

J Cancer Res Ther. 2015 Jul-Sep;11(3):645. doi: 10.4103/0973-1482.139385.
Metastatic carcinoma of breast or a chordoma? A case report and clinical perspectives.
Trivedi S1, Odrazka K.
Author information
1Department of Oncology, Charles University Teaching Hospital, Hradec Kralove, Czech; Royal Marsden Hospital, Sutton, Surrey, UK, .
Abstract
We present a case of chordoma in a patient who had been previously treated for ductal carcinoma of the breast. The initial clinical findings and radiological studies suggested a possibility of metastases. However, the findings also adhered to the classical presentations and findings of the chordoma of the base of skull. It was only after the surgical resection and immunohistochemical confirmation that the diagnosis of chordoma could be established. Here, we discuss chordoma with the analysis of our clinical intrigue.
PMID: 26458596 [PubMed - in process]

Extensive osteolytic skull base amyloidoma simulating malignancy: A rare pseudotumor

J Cancer Res Ther. 2015 doi: 10.4103/0973-1482.137999.
Extensive osteolytic skull base amyloidoma simulating malignancy: A rare pseudotumor producing a diagnostic dilemma.
Agrawal M, Batra VV1, Majumdar K, Upreti L, Singh D.
Author information
1Department of Pathology, Govind Ballabh Pant Hospital, New Delhi, India.
Abstract
Although amyloidomas are quite well-known, intracranial, and especially skull base lesions have been rarely reported. Extensive lesions in the skull base frequently simulate malignancy clinicoradiologically. Diagnosis of these lesions is important as they offer a favorable prognosis. We describe a large infiltrating osteolytic skull base tumor-like lesion in a 45-year-old male without evidence of associated plasma cell dyscrasia. Squash smears and histopathology revealed a plasma cell-rich lesion with abundant amyloid, confirming amyloidoma. To conclude, amyloidoma of the skull base is a rare tumor-like lesion, with timely diagnosis and management offering a good prognosis.
PMID: 26458601 [PubMed - in process]
Similar articles

Skull base neoplasia

J Vet Diagn Invest. 2015 Oct 13. pii: 1040638715611706. [Epub ahead of print]
A retrospective study of skull base neoplasia in 42 dogs.
Rissi DR1.
Author information
1Department of Pathology and Athens Veterinary Diagnostic Laboratory, College of Veterinary Medicine, The University of Georgia, Athens, GA rissi@uga.edu.
Abstract
This study describes the prevalence and distribution of 42 cases of skull base neoplasia in dogs between 2000 and 2014. The average age of affected individuals was 9.5 years, and there was no sex or breed predisposition. The most common skull base neoplasms were meningioma (25 cases) and pituitary adenoma (9 cases). Less common tumors included craniopharyngioma (2 cases), nerve sheath tumor (2 cases), and 1 case each of pituitary carcinoma, meningeal oligodendrogliomatosis, presumed nasal or sinonasal carcinoma, and multilobular tumor of bone. All neoplasms caused some degree of compression of adjacent structures. The distribution of the tumors was greatest in the sellar region (n = 18), followed by the paranasal region (n = 12), caudal cranial fossa (n = 10), central cranial fossa (n = 1), and rostral cranial fossa (n = 1).
© 2015 The Author(s).
KEYWORDS:
Dogs; intracranial neoplasia; skull base
PMID: 26462763 [PubMed - as supplied by publisher]

Clinical features and comprehensive treatment of skull base osteosarcoma

Zhonghua Zhong Liu Za Zhi. 2015
[Clinical features and comprehensive treatment of skull base osteosarcoma].
[Article in Chinese]
Hu K1, Wan J2, Ni S, Li X, Liu S, Meng X, Qian H.
Author information
1Department of Neurosurgery, the Second Hospital of Anhui Medical University, Hefei 230601, China.
2Email: wanjinghai@sina.com.
Abstract
OBJECTIVE:
To analyze the clinical features and treatment of skull base osteosarcoma.
METHODS:
The clinical data of 18 patients with skull base osteosarcoma, who were admitted to the CAMS Cancer Hospital from January 2005 to November 2013, were retrospectively analyzed. The patients were followed up by telephone, outpatient review and other means. Fifteen patients were followed up, 4 cases received surgery only, and 11 cases received surgery with adjuvant chemotherapy and/or radiotherapy. Kaplan-Meier survival curve analysis was used to analyze the clinical data and Log rank method was used for verification.
RESULTS:
Nine patients died among the 15 patients who were followed up for 3-103 months (mean 25.0 months): seven patients died of local recurrence, and two patients died of distant metastasis, and six patients were still alive. Four patients received surgery only, with a median survival time of 25.0 months, and 11 patients received comprehensive treatment, with a median survival time of 47.0 months (P = 0.02). Five patients received sub-total resection, with a mean survival time of 47.0 months, and 10 patients received total resection, with a mean survival time of 45.0 months (P = 0.37). The 1- and 2-year recurrence rates were 46.6% and 68.9%, respectively. The overall 1-, 2-, 3- and 5-year survival rates were 82.4%, 61.8%, 36.0% and 36.0%, respectively, with a median survival time of 30.0 months.
CONCLUSIONS:
To compare the long bone and head and neck osteosarcoma with skull base osteosarcoma, the skull base osteosarcoma has a lower total resection rate, a higher recurrence rate, and a poorer prognosis. Radical surgery and comprehensive treatment are appropriate for skull base osteosarcoma.
PMID: 26463032 [PubMed - in process]

Surgical management of lateral skull base defects

Laryngoscope. 2015 Oct 15. doi: 10.1002/lary.25717. [Epub ahead of print]
.
Patel NS1, Modest MC1, Brobst TD1, Carlson ML1, Price DL1, Moore EJ1, Janus JR1.
Author information
1Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A.
Abstract
OBJECTIVES/HYPOTHESIS:
We sought to analyze key factors that influence the management of lateral skull base defects and implement an algorithm to improve outcomes of reconstruction.
STUDY DESIGN:
Retrospective chart review.
SETTING:
Single tertiary academic referral center.
METHODS:
Adults who underwent temporal bone resection were included. Variables included tumor characteristics, ablative procedure, reconstructive method, and wound complications.
RESULTS:
Seventy-one patients were studied. Lateral temporal bone resection was performed in 55 patients (77%), subtotal temporal bone resection in 14 (20%), and total petrosectomy in two (3%). Primary closure was achieved in 46 patients (35%), with rotational muscle flaps in 21 (46%). The pectoralis major myocutaneous flap (PMMF) was used in nine patients (13%) without major complications. Single-stage free tissue transfer was undertaken in 10 patients (14%) with no flap failures. Primary closure was achieved in 16 of 32 of previously untreated cases (50%) compared to nine of 39 cases of previously treated disease (23%) (P = 0.03). Pedicled or free flaps were used in 18 of 39 cases of previously treated disease (46%) compared to three of 32 previously untreated cases (9%) (P < 0.001). Pedicled or free flaps were used in 13 of 22 cases (59%) in which partial or total auriculectomy was performed, whereas primary closure was achieved in 39 of 49 cases (80%) in which the pinna was preserved (P < 0.001).
CONCLUSION:
Advanced tumors that require adjuvant therapy, revision cases for recurrent disease, and cases involving auriculectomy warrant free flap or PMMF reconstruction, with the latter preferred in poor free flap candidates.
LEVEL OF EVIDENCE:
4. Laryngoscope, 2015.
© 2015 The American Laryngological, Rhinological and Otological Society, Inc.
KEYWORDS:
Skull base reconstruction; auriculectomy; free flap; pedicled flap; temporal bone resection
PMID: 26466854 [PubMed - as supplied by publisher]

Neurosurgical Robots: Review and Trends for Manipulators and Associated Navigational Systems

Ann Biomed Eng. 2015 Oct 14. [Epub ahead of print]
30 Years of Neurosurgical Robots: Review and Trends for Manipulators and Associated Navigational Systems.
Smith JA1, Jivraj J2,3, Wong R2,3, Yang V2,3.
Author information
1Department of Electrical Engineering & Computer Science, York University, Toronto, Canada. drsmith@yorku.ca.
2Department of Electrical & Computer Engineering, Ryerson University, Toronto, Canada.
3Sunnybrook Health Sciences Centre, Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Toronto, Canada.
Abstract
This review provides an examination of contemporary neurosurgical robots and the developments that led to them. Improvements in localization, microsurgery and minimally invasive surgery have made robotic neurosurgery viable, as seen by the success of platforms such as the CyberKnife and neuromate. Neurosurgical robots can now perform specific surgical tasks such as skull-base drilling and craniotomies, as well as pedicle screw and cochlear electrode insertions. Growth trends in neurosurgical robotics are likely to continue but may be tempered by concerns over recent surgical robot recalls, commercially-driven surgeon training, and studies that show operational costs for surgical robotic procedures are often higher than traditional surgical methods. We point out that addressing performance issues related to navigation-related registration is an active area of research and will aid in improving overall robot neurosurgery performance and associated costs.
KEYWORDS:
Neurosurgery; Neurosurgical robot; Surgery; Surgical navigation; Surgical robot
PMID: 26467553 [PubMed - as supplied by publisher]

International Rhinologic Society

Rhinology. 2015 Oct 13. [Epub ahead of print]

[No title available]

Wolf A1, Illini O2, Uy D2, Renner B3, Mueller CA2.

Author information

1Department of Otorhinolaryngology, Medical University of Graz, Auenbruggerplatz 26, 8036 Graz, Austria.
2Department of Otorhinolaryngology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Wien, Austria.
3Institute of Experimental and Clinical Pharmacology, University of Erlangen-Nurnberg, Krankenhausstr. 9, 91054 Erlangen, Germany.

Abstract

OBJECTIVE:

Assessment of gustatory function in human subjects using the 'taste strips' test is an easy and validated procedure. The aim of this study was to extend this test in order to detect subjects with superior gustatory sensitivity.

METHODS:

The investigation included 134 subjects (29.5±12.6 years, range 18-84 years) with normal gustatory function. Four concentrations of sweet, sour, salty, and bitter were augmented with additional low concentrations (sweet: 25/12.5mg/ml sucrose; sour: 27/15mg/ml citric acid; salty: 6.4/2.6mg/ml sodium chloride, bitter: 0.15/0.06mg/ml quinine hydrochloride), resulting in a maximum extended taste score (ETS) of 24.

RESULTS:

The mean ETS was 14.5 ± 3.2. Specifically, it was 4.5 ± 1.2 for sweet, 2.8 ± 1.0 for sour, 4.0 ± 1.3 for salty, and 3.2 ± 1.2 for bitter. In contrast to the original version of the taste strips test, no ceiling effect was observed. Cluster analysis separated three groups of subjects by ETS, whereas test scores derived from the original four concentrations were insufficient to discriminate the subgroup with higher gustatory sensitivity.

CONCLUSIONS:

The extended taste strips test seems to be a useful tool for the detection of patients with low gustatory thresholds for sweet, sour, salty, or bitter taste.

PMID: 26462295 [PubMed - as supplied by publisher]

Similar articles

Select item 264603962.

Rhinology. 2015 Sep;53(3):287.

In memoriam Prof. Giorgio Sulsenti (1930-2015).

Palma P, Tasca I.

PMID: 26460396 [PubMed - in process]

Similar articles

Select item 264603943.

Rhinology. 2015 Sep;53(3):195-203.

Hereditary haemorrhagic telangiectasia.

Rimmer J, Lund VJ.

Abstract

BACKGROUND:

Hereditary haemorrhagic telangiectasia is an autosomal dominant vascular disease characterized by recurrent epistaxis, mucocutaneous telangiectasia and visceral arteriovenous malformations.

METHODOLOGY:

The genetic basis and pathophysiology of the disease are discussed. Diagnostic criteria and the clinical course of the condition are considered. The current management options, both medical and surgical, are reviewed.

CONCLUSIONS:

Hereditary haemorrhagic telangiectasia requires specialist treatment for the problems it causes, and is best managed in specialist centres. Epistaxis is often the major symptom, significantly affecting patients' quality of life. An understanding of the available treatment options is therefore important for the otorhinolaryngologist.

PMID: 26460394 [PubMed - in process]

Similar articles

Select item 264103574.

Rhinology. 2015 Sep 27. [Epub ahead of print]

Spreader grafts: functional or just aesthetical?

Xavier R1, Azeredo-Lopes S2, Papoila A2.

Author information

1Department of Otolaryngology and Head and Neck Surgery, Hospital da Arrabida, Porto, Portugal.
2Department of Biostatistics and Informatics, Nova Medical School, Universidade Nova de Lisboa, and CEAUL, Lisbon, Portugal.

Abstract

OBJECTIVE:

Spreader grafts are commonly used in rhinoplasty to achieve an aesthetic improvement of the nose or a functional improvement of the nasal airway. Currently, the aesthetic role of spreader grafts is well established. The functional effect of these grafts, however, has been controversial due to the lack of studies clearly demonstrating an increase on nasal airflow assigned to spreader grafts. The purpose of this study is to evaluate the effect of spreader grafts on nasal breathing.

METHODS:

Nasal breathing of 72 consecutive patients undergoing rhinoplasty was evaluated by measuring peak nasal inspiratory flow (PNIF) before surgery and six months after surgery.

RESULTS:

The mean preoperative PNIF of the 72 patients included in this study was 79.44 l/min and the mean postoperative PNIF was 110.42 l/min (p < 0.001). In 37 patients of this study no spreader grafts were used. In this group of patients the mean PNIF values changed from 73.24 l/min before surgery to 99.46 l/min after surgery. In the group of 35 patients in whom spreader grafts were used the mean PNIF values changed from 86.00 l/min before surgery to 122.00 l/min after surgery. The increase in the mean PNIF value after rhinoplasty was slightly higher in the group of patients with spreader grafts than in the group of patients without spreader grafts. The difference in the postoperative increase of PNIF between these two groups of patients, however, is not statistically significant.

CONCLUSIONS:

This study suggests that patients undergoing rhinoplasty have a statistically significant improvement in nasal breathing after surgery. However, patients receiving spreader grafts in a non-randomized way do not have statistically significant greater benefit than those who do not.

PMID: 26410357 [PubMed - as supplied by publisher]

Similar articles

Select item 263971605.

Rhinology. 2015 Sep 23. [Epub ahead of print]

IFRD1 gene polymorphisms are associated with nasal polyposis in cystic fibrosis patients.

Baldan A1, Lo Presti AR1, Belpinati F1, Castellani C2, Bettin MD1, Xumerle L1, Pignatti PR1, Malerba G1, Bombieri C1.

Author information

1Department of Life and Reproduction Sciences, Section of Biology and Genetics, University of Verona, Italy.
2Verona Cystic Fibrosis Centre, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.

Abstract

BACKGROUND:

Nasal polyposis (NP) is an inflammatory disease of the upper nasal airways frequently present in CF patients. Interferon-Related Developmental Regulator 1 (IFRD1) gene was reported as a possible modifier of CF lung disease severity. Three IFRD1 SNPs were analyzed to investigate a possible effect on the development of NP in CF patients.

METHODS AND PATIENTS:

The DNA of 143 patients with CF (40 with and 103 without NP) was purified from peripheral blood samples. IFRD1 SNPs (rs7817, rs3807213, rs6968084) were genotyped by restriction enzyme analysis.

RESULTS:

The T allele of the common polymorphisms rs7817 and the rs7817-rs3807213 haplotype were associated with NP (p = 0.002 and 0.004, respectively).

CONCLUSIONS:

These results showed the association of the IFRD1-rs7817 polymorphism with NP in CF patients.

PMID: 26397160 [PubMed - as supplied by publisher]

Similar articles

Select item 263631696.

Rhinology. 2015 Sep;53(3):277-85. doi: 10.4193/Rhin14.074.

Manifestation of eosinophilic granulomatosis with polyangiitis in head and neck.

Petersen H, Götz P, Both M, Hey M, Ambrosch P, Bremer JP, Holle J, Moosig F, Laudien M.

Abstract

INTRODUCTION:

Besides an obvious clinical involvement of the ear, nose and throat (ENT)-region in Eosinophilic Granulomatosis with Polyangiitis (EGPA), systematic data is sparse. Only a few case series and case reports are available that particularly describe rhinological, otological or other manifestations of EGPA in the ENT-region. Therefore, the objective of this study is to systematically describe data on ENT-region involvement in a large series of EGPA patients.

METHOD:

EGPA patients examined in the Department of Otorhinolaryngology of the Christian-Albrechts-University of Kiel between 1990 and 2010 were included in the study. Criteria for ENT-manifestation were assigned to five subgroups (history, ENT examination, audiological and rhinological diagnostic findings and cranial MRI) and documented cumulatively. EGPA patients were examined in a standardized way based on the validated Ear Nose and Throat Activity Score (ENTAS) or its precursor, including audiological and rhinological diagnostic findings. MRI scans were analysed to further evaluate ENT involvement.

RESULTS:

A total of 95 EGPA patients were included in the study. In approximately 80% of them, ENT-involvement was documented and the assumption of a frequent rhinological manifestation in patients with EGPA was confirmed. Moreover, the data reveals remarkable evidence for an otological manifestation. A missing correlation between the rhinological and the otological manifestation indicates an independent autoimmune-inflammatory process for this manifestation.

CONCLUSION:

The data of the largest monocentric study presented here confirms the hypothesis of a frequent ENT involvement in EGPA patients, in whom rhinological and otological manifestations are most common. Therefore, treatment should include long term follow-up and should be managed interdisciplinary.

PMID: 26363169 [PubMed - in process]

Similar articles

Select item 263631687.

Rhinology. 2015 Sep;53(3):270-6. doi: 10.4193/Rhin14.232.

Autophagy is deficient and inversely correlated with COX-2 expression in nasal polyps: a novel insight into the inflammation mechanism.

Wang LF, Chien CY, Yang YH, Hour TC, Yang SF, Chen HR, Tsai KL, Ko JY, Chen JY.

Abstract

BACKGROUND:

Nasal polyposis is characterised by persistent inflammation of the upper airways. Autophagy has been implicated in many chronic inflammatory diseases. Whether autophagy plays a role in nasal polyp (NP) inflammation is completely unknown and deserves investigation.

METHODS:

LC3 and COX-2 expression, the common autophagy and inflammation indicators, respectively, was analysed by immunoblotting in fresh tissues of NP and control nasal mucosa (NM). Primary cultures of NP-derived fibroblasts (NPDFs) and NMDFs were established for in vitro studies. Autophagy was induced by amino acid starvation and LC3 ectopic overexpression or inhibited by 3-methyladenine in the fibroblasts. Inflammation was induced by IL1-β and TNF-α. LC3 and COX-2 expression was confirmed in NP specimens by immunohistochemistry.

RESULTS:

LC3 expression was decreased while COX-2 expression was significantly increased in fresh NP tissues compared with the NM control. In NMDFs and NPDFs, autophagy induction by starvation and LC3 overexpression downregulated COX-2 expression. Conversely, autophagy inhibition by 3-methyladenine enhanced COX-2 expression. However, IL1-β and TNF-α had no effect on autophagy. Immunohistochemical studies on the NP specimens showed that most displayed low LC3 expression, whereas COX-2 was highly expressed in >50% of the specimens. Examination of two consecutive NP sections from the same tissue blocks revealed a negative correlation between LC3 and COX-2 expression.

CONCLUSION:

Autophagy is deficient in NP tissues and COX-2 is negatively regulated by autophagy in NP-derived fibroblasts. Since COX-2 is essential for the production of pro-inflammatory mediators, this study might help interpret persistent mucosal inflammation in NP. Attenuation of inflammation by restoring autophagy might be a therapeutic strategy for treating NP.

PMID: 26363168 [PubMed - in process]

Similar articles

Publication Types

Select item 263631678.

Rhinology. 2015 Sep;53(3):260-9. doi: 10.4193/Rhin14.316.

The influence of European legislation on the use of diagnostic test allergens for nasal allergen provocation in routine care of patients with allergic rhinitis.

Klimek L, Hammerbacher AS, Hellings PW, Fokkens WJ, Hoffmann HJ, Muraro A, Papadopoulos N.

Abstract

In patients with allergic rhinitis (AR), the nasal provocation test (NPT) is the standard procedure to evaluate the clinical response of the nasal mucosa to allergens with a high specificity and sensitivity. In AR, it is the only test that really measures the response of the diseased mucosa to allergens while skin prick test and serum IgE confirm the clinical suspicion of sensitization. Moreover, it is of special relevance in the detection of patients with Local Allergic Rhinitis (LAR), where general sensitization cannot be measured. For the evaluation of therapeutic interventions, NPT has been used for the clinical monitoring of antiallergic drugs and allergen specific immunotherapy. Legislation within the European Union (EU) defines allergens used for diagnostic tests like NPT to be medicinal products according to Directive 2001/83 EC, but national law is considering these products to be medicinal devices in a number of EU countries. Thus, NPT products are governed by different legislations and therefore standards throughout the EU. In consequence, allergens used for diagnostic purposes need different registrations and Marketing Authorization by national authorities. After a transition period, regulations of EU Directives are to be implemented in national law by all member states. At the moment, most EU countries have not fully implemented these Directives, however, it can be expected that most countries will implement it and enforce their rules within the next years. This development has a tremendous impact on the availability of diagnostic allergens for NPT in Europe and will make make nasal provocation testing very difficult if not impossible. We describe the current situation of diagnostic allergens under the special legislative conditions in the EU with special focus on allergen products used for NPT and the consequences for the diagnosis of AR and LAR.

PMID: 26363167 [PubMed - in process]

Similar articles

Publication Types

Select item 263631669.

Rhinology. 2015 Sep;53(3):249-59. doi: 10.4193/Rhin14.300.

Reduced effect of intravenous antibiotic treatment on sinonasal markers in pulmonary inflammation.

Doht F, Hentschel J, Fischer N, Lehmann T, Markert UR, Böer K, Pfister W, Pletz MW, Guntinas-Lichius O, Mainz JG.

Abstract

BACKGROUND:

Chronic bacterial rhinosinusitis is a common feature in Cystic fibrosis (CF) as mucociliary clearance in the sinonasal compartment is impaired. Aim of the present prospective study was to compare dynamics of inflammatory markers in the upper and lower airways (UAW/LAW) during systemic antibiotic therapy.

METHODS:

Nasal lavage and sputum of 16 CF-patients receiving an IV-antibiotic treatment against Pseudomonas aeruginosa and/ or Staphylococcus aureus were collected before and during treatment (median after 7.5 days). Cytological changes, DNA concentration, and inflammatory markers interleukin (IL)-4, IL-8, IL-13 and Myeloperoxidase (MPO) were assessed in samples from both airway compartments.

RESULTS:

Total cell count declined significantly in LAW-samples but not in UAW. Although MPO and IL-8 decreased significantly in both airway compartments, this was considerably more pronounced for LAW (median decrease MPO: LAW=9.8-fold vs UAW=1.75-fold, respectively; IL-8: LAW=3-fold vs UAW=1.9-fold, respectively).

DISCUSSION:

This is the first publication demonstrating substantially lower effects of IV-antibiotic treatment on sinonasal than on pulmonary inflammatory markers. Consequently, our findings highlight limitations of systemic antibiotic treatment to control infection in the sinonasal compartment. Primarily, we attribute this to the paranasal sinus ́ structure: these hollow organs, which in bacterial sinusitis are frequently filled with pus, mucoeceles and polyps, are not reached effectively by systemic antibiotic treatment.

PMID: 26363166 [PubMed - in process]

Similar articles

Select item 2636316510.

Rhinology. 2015 Sep;53(3):242-8. doi: 10.4193/Rhin14.259.

The effect of "Pyriform Turbinoplasty" on nasal airflow using a virtual model.

Simmen D, Sommer F, Briner HR, Jones N, Kröger R, Hoffmann TK, Lindemann J.

Abstract

BACKGROUND:

A new procedure, pyriform turbinoplasty, is described and nasal airflow is measured before and after this procedure in a virtual model.

METHODOLOGY:

Pyriform turbinoplasty is the submucosal reduction of the bone of the frontal process of the maxilla and the lacrimal bone. It opens part of the lateral margin of the nasal valve area with minimal damage to nasal mucosa. The resection of bone in this area can be extended by "nasal wall lateralization" when the lacrimal bone that joins the uncinate process behind the lacrimal duct as well as the base of the inferior turbinate and the edge of the maxilla at the rim of the pyriform aperture are removed. Nasal airflow was simulated using computational fluid dynamics and ANSYS Fluent solver.

RESULTS:

Analysis using fluid dynamics showed that these procedures help ventilation in the main airflow areas without substantially altering the normal pattern of airflow.

CONCLUSIONS:

The changes after performing a pyriform turbinoplasty seem to be an improvement when compared to the changes after inferior turbinate surgery that can misdirect the airflow largely through the inferior meatus.

PMID: 26363165 [PubMed - in process]

Similar articles

Select item 2636316411.

Rhinology. 2015 Sep;53(3):227-34. doi: 10.4193/Rhin14.196.

Post-operative budesonide irrigations for patients with polyposis: a blinded, randomized controlled trial.

Rawal RB, Deal AM, Ebert CS Jr, Dhandha VH, Mitchell CA, Hang AX, Gore MR, Senior BA, Zanation AM.

Abstract

OBJECTIVE:

To compare normal saline (NS) vs. NS+budesonide irrigations in post- functional endoscopic sinus surgery (FESS) patients with chronic rhinosinusitis with polyposis (CRSwNP). Currently, no evidence exists for NS+budesonide irrigation over NS irrigation alone.

STUDY DESIGN:

Prospective, single-blind, randomized controlled trial.

METHODS:

Subjects were prospectively enrolled to NS or NS+budesonide arms. Patients were evaluated at pre-operative and three post-operative visits (POV): POV1 (1-2 weeks post-op), POV2 (3-8 weeks post-op), and POV3 (3-6 months post-op). Patients were evaluated by three quality of life (QOL) questionnaires (SNOT-22, RSOM-31, and RSDI) and two olfaction scores (UPSIT and the PEA test).

RESULTS:

Fifty patients were randomized, with 25 patients in the NS arm and 25 patients in the NS+budesonide arm. Two patients had unexpected pathology and were excluded from the study. By POV2 and POV3, patients experienced a significant improvement in all three QOL surveys, although the degree of improvement between arms was not significant up through POV3. Neither arm experienced significant olfactory improvement up through POV3.

CONCLUSIONS:

While both NS and NS+budesonide treatments improve QOL for post-FESS patients, neither intervention significantly increases QOL as compared to the other. Olfaction was not significantly improved in either treatment group.

PMID: 26363164 [PubMed - in process]

Similar articles

Publication Types

Select item 2636316312.

Rhinology. 2015 Sep;53(3):221-6. doi: 10.4193/Rhin14.192.

Exposure to odours improves olfactory function in healthy children.

Mori E, Petters W, Schriever VA, Valder C, Hummel T.

Abstract

BACKGROUND:

Short-term exposure to odours, also called "olfactory training" has been shown to improve olfactory function in healthy people but also in people with olfactory loss. Aim of this single center, prospective, controlled study was to investigate the change of olfactory function following twice-daily, short-term exposure to 4 odours over a period of approximately 12 weeks.

MATERIAL AND METHODS:

We compared odour identification abilities and odour thresholds between an olfactory training group (TR group) and a group that did not perform such training (noTR group). Participants exposed themselves twice daily to 4 odours ("rose", "eucalyptus", "lemon", "clove"). Olfactory testing was performed before and after the training period using the "Sniffin' Sticks" test kit (odour identification plus odour thresholds).

RESULTS:

At baseline the two groups were not significantly different in terms of age and measures of olfactory sensitivity. The TR group performed significantly better for odour thresholds for all 4 odours compared to the noTR group after 12 weeks of olfactory training. Also, with regard to odour identification the TR group outperformed the noTR group. No significant differences were found for diary-based intensity ratings.

CONCLUSION:

Repeated exposure to odours seems to improve general olfactory sensitivity in children.

PMID: 26363163 [PubMed - in process]

Similar articles

Select item 2636316213.

Rhinology. 2015 Sep;53(3):212-20. doi: 10.4193/Rhin14.054.

Current management of sinonasal undifferentiated carcinoma.

Lopez F, Suárez V, Vivanco B, Suárez C, Llorente JL.

Abstract

BACKGROUND:

The management of sinonasal undifferentiated carcinoma (SNUC) remains unclear. Low incidence and poor outcomes make treatment standardization difficult. The objective of this study was to review the used treatment and our outcomes.

METHODS:

From 2001 to 2013, 17 cases of SNUC were treated at our department. Charts were reviewed for standard demographic, tumour size and extension, histological features, treatment strategies, surgical approach, adjuvant therapies, outcomes and complications.

RESULTS:

All patients presented with extensive local disease and 2 patients also had neck metastases. All patients were treated using a multimodality approach: 10 patients underwent surgery and postoperative chemoradiation, 1 patient was treated with surgery and adjuvant radiotherapy, 3 patients were treated with neoadjuvant chemotherapy, surgery and postoperative chemoradiation and the remaining 3 patients were treated with chemoradiotherapy. After median follow-up of 39 months 6 patients developed recurrences. The 3-year local control rate was 76% and the 5-year rate of overall survival was 58%.

CONCLUSIONS:

Management and outcomes of SNUC have improved due to advances in surgery and radiotherapy. Gross tumour resection followed by postoperative radiotherapy should be the standard of care in patients with SNUC. High-precision high-dose radiotherapy should be implemented to try to improve the outcomes.

PMID: 26363162 [PubMed - in process]

Similar articles

Select item 2636316114.

Rhinology. 2015 Sep;53(3):204-11. doi: 10.4193/Rhin14.318.

Endoscopic surgery for malignant sinonasal tumours: an eighteen year experience.

Lund VJ, Wei WI.

Abstract

INTRODUCTION:

Curative resection of malignant tumours of the skull base is increasingly undertaken endoscopically. Hitherto the diverse histology, rarity and long natural history have made it difficult to accrue statistically robust cohorts for comparison with conventional craniofacial resection. It is now possible to make such a comparison in a large personal cohort.

METHOD:

Data on all cases of sinonasal malignancy undergoing endoscopic resection with curative intent over an eighteen year period were collected prospectively and analysed for survival and prognostic factors.

RESULTS:

There were 140 cases, 68 men and 72 women, aged 20-92 years (mean 63 yrs). Follow-up ranged from 6-184 months (mean 60 months). Eighteen different histopathologies were represented with olfactory neuroblastoma (36), malignant melanoma (33) and adenocarcinoma (19) being the commonest. Additional radiotherapy was given in 95 cases and chemotherapy in 49. Overall survival is 84% at 5 years and 69% at 10 years. Overall disease-free survival was 77% at 5 years and 56% at ten. Overall and disease-free survival at 5 (and 10) years is, respectively, 97% and 90% for olfactory neuroblastoma, 79% and 68% for adenocarcinoma and 56% and 39% for malignant melanoma.

CONCLUSION:

These results show that endoscopic resection is an alternative to conventional craniofacial resection in selected cases.

PMID: 26363161 [PubMed - in process]

Similar articles

Select item 2636316015.

Rhinology. 2015 Sep;53(3):193-4. doi: 10.4193/RhinRhin.53E3.

Extending borders.

Fokkens WJ.

PMID: 26363160 [PubMed - in process]

Similar articles

Publication Types

Select item 2636267316.

Rhinology. 2015 Sep 12. [Epub ahead of print]

Smoking effects on quality of life of allergic rhinitis patients after sublingual immunotherapy.

Katotomichelakis M1, Tripsianis G2, Daniilidi A1, Cassimos D1, Kourousis C1, Vogiatzaki T1, Danielides V1.

Author information

1Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece.
2Department of Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece.

Abstract

BACKGROUND:

Although tobacco smoking is of great concern, there is no evidence for the effects of smoking on quality of life (QoL) results after sublingual immunotherapy (SLIT).

OBJECTIVE:

This study aims tο explore any association between smoking habits (duration and quantity) and QoL results after SLIT in allergic rhinitis (AR).

METHODOLOGY:

One hundred and sixty three patients following SLIT for AR were participated. SLIT efficacy related to smoking was prospectively evaluated by means of validated widely used QoL questionnaires, either for assessing psychology (Zung Anxiety Scale, State-Trait Anxiety Inventory, Zung Depression Scale and Beck Depression Inventory) or generic (Short Form-36) ones, pre- and immediately upon cessation of SLIT. Smoking habits were expressed in pack-years.

RESULTS:

Significant improvement of total symptoms score (T5SS) and of all QoL questionnaires' results were observed in our patients' group, both for smokers and non smokers. The comparison of changes between smokers and non smokers, controlling for the effect of all patients' characteristics, showed that there was no significant differences on improvement values. Additionally multivariate linear regression analysis revealed that the effect of pack-years on the QoL scales was not significant.

CONCLUSIONS:

Our results suggest that smoking habits (quantity of daily smoking and duration) do not influence the success of SLIT with regards to QoL outcomes.

PMID: 26362673 [PubMed - as supplied by publisher]

Similar articles

Select item 2634510717.

Rhinology. 2015 Sep 7. [Epub ahead of print]

Endoscopic treatment of inverted papilloma attached in the frontal sinus/recess.

Adriaensen GF1, van der Hout MW1, Reinartz SM1, Georgalas C1, Fokkens WJ1.

Author information

1Department of Otorhinolaryngology, Academic Medical Centre (AMC), Amsterdam, the Netherlands.

Abstract

BACKGROUND:

Inverted papilloma (IP) is a benign sinonasal tumour for which endoscopic surgery, with complete removal of the underlying and surrounding mucoperiosteum at the attachment site followed by drilling and/or coagulation of this area, is the treatment of choice. This can be challenging in the frontal sinus.

OBJECTIVES:

To report on the outcome of treatment for IPs involving the frontal sinus. To propose the possible use of topical 5-fluorouracil 5% (5-FU) in the postoperative management of challenging IPs.

METHODS:

This is a retrospective cohort evaluation of patients with IPs attached in the frontal sinus or in the frontal recess and growing into the frontal sinus. Data on primary or revision surgery, uni- or bilaterality, attachment site, surgical procedure, 5-FU usage, recurrence and follow-up are provided. The end points are disease-free follow-up in months and recurrence.

RESULTS:

Twenty cases, including fifteen revision cases, were retrieved over a period of ten years. All cases were treated endoscopically. Two cases recurred (10%) and the intervention was repeated. In eight cases, 5-FU was applied at the end of surgery. None of these cases recurred. The mean follow-up after the last intervention was 42 months (standard deviation (SD) 22.1).

CONCLUSION:

IP involving the frontal sinus is a surgical challenge that can be successfully addressed endoscopically. The topical application of 5-FU could have a place in postoperative treatment when it is difficult to be absolutely sure that all diseased mucoperichondrium or mucoperiosteum at the attachment site(s) has been completely removed.

PMID: 26345107 [PubMed - as supplied by publisher]

Similar articles

Biomarkers in the management of difficult asthma

Curr Top Med Chem. 2015 Oct 14;

Authors: Florence S, Sophie D, Renaud L

Abstract
Difficult asthma is a heterogeneous disease of the airways including various types of bronchial inflammation and various degrees of airway remodeling. Therapeutic response of severe asthmatics can be predicted by the use of biomarkers of Type2-high or Type2-low inflammation. Based on sputum cell analysis, four inflammatory phenotypes have been described. As induced sputum is time-consuming and expensive technique, surrogate biomarkers are useful in clinical practice. Eosinophilic phenotype is likely to reflect ongoing adaptive immunity in response to allergen. Several biomarkers of eosinophilic asthma are easily available in clinical practice (Blood eosinophils, serum IgE, exhaled nitric oxyde, serum periostin). Neutrophilic asthma is thought to reflect innate immune system activation in response to pollutants or infectious agents while paucigranulocytic asthma is thought to be not inflammatory and characterized by smooth muscle dysfunction. We currently lack of user-friendly biomarkers of neutrophilic asthma and airway remodeling. In this review, we summarize the biomarkers available for the management of difficult asthma.

PMID: 26467509 [PubMed - as supplied by publisher]

Multiple intracranial arteriovenous malformations

Arteriovenous malformations and headache.

J Clin Neurosci. 2015 Oct 9;

Authors: Ellis JA, Mejia Munne JC, Lavine SD, Meyers PM, Connolly ES, Solomon RA

Abstract
Brain arteriovenous malformations (AVM) are complex vascular lesions commonly associated with chronic headache. An occipital location appears to increase the risk of concurrent migraine-like headaches in AVM patients. We have experienced great success in treating these headaches through a multidisciplinary approach to eradicate cerebral AVM. However, the specific clinical characteristics of AVM-associated headaches and the most effective treatment strategies for these patients remain unclear. Here, we provide a comprehensive review of the literature on AVM-associated headaches. We detail the history, classification, epidemiology, presentation, pathophysiology, treatment options, and outcomes for this poorly described condition. Additionally, we illustrate our approach to the management of patients with occipital AVM and associated intractable headaches.

PMID: 26461909 [PubMed - as supplied by publisher]

Hemorrhage risk and clinical features of multiple intracranial arteriovenous malformations.

J Clin Neurosci. 2015 Oct 9;

Authors: Boone CE, Caplan JM, Yang W, Ye X, Colby GP, Coon AL, Tamargo RJ, Huang J

Abstract
The aim of this report is to examine clinical characteristics, treatment strategies, and annual hemorrhage incidence rate for patients with multiple arteriovenous malformations (MAVM). The PubMed and EMBASE databases and the arteriovenous malformations (AVM) database at The Johns Hopkins Hospital were searched to identify patients with MAVM. Data related to demographics, clinical features, management, and treatment outcomes were analyzed with descriptive statistics. Thirty-eight patients met the inclusion criteria. The annual hemorrhage incidence rate was 6.7%. Surgical intervention remained the most common single-modality treatment from 1949-2011. Between 1990 and 2011, multiple-modality treatment strategies (36% of cases) were employed more frequently. The most common presenting features were neurological deficit (74%) and hemorrhage (63%). In patients undergoing staged treatment of MAVM, hemorrhage of an untreated nidus (n=5), visualization of a new nidus (n=9), and disappearance of an untreated nidus (n=2) were observed. Limitations of this study include small sample size and reporting bias. The annual hemorrhage incidence rate for MAVM patients was approximately two- to three-fold greater than the reported annual hemorrhage rates for solitary AVM. Combining different treatment modalities has become the most common management strategy. The potential instability of remaining nidi with staged or incomplete treatment necessitates close follow-up in these cases.

PMID: 26461910 [PubMed - as supplied by publisher]

Cortical spreading depolarization

: Pathophysiology, implications, and future directions.

J Clin Neurosci. 2015 Oct

Authors: Kramer DR, Fujii T, Ohiorhenuan I, Liu CY

Abstract
Cortical spreading depolarization (CSD) is a spreading loss of ion homeostasis, altered vascular response, change in synaptic architecture, and subsequent depression in electrical activity following an inciting neurological injury. First described by Leão in 1944, this disturbance in neuronal electrophysiology has since been demonstrated in a number of animal studies, and recently a few human studies that examine the occurrence of this depolarizing phenomenon in the setting of a variety of pathological states, including migraines, cerebrovascular accidents, epilepsy, intracranial hemorrhages, and traumatic brain injuries. The onset of CSD has been demonstrated experimentally following a disruption in the neuronal environment leading to glutamate-induced toxicity. This initial event leads to pathological changes in the activity of ion channels that maintain membrane potential. Recovery mechanisms such as sodium-potassium pumps that aim to restore homeostasis fail, leading to osmolar shifts of fluid, swelling of the neuron, and ultimately a measurable depression in cortical activity that spreads in the order of millimeters per minute. Equally important is the resulting change in vascular response. In healthy tissue, increased electrical activity is coupled with release of vasodilatory factors such as nitric oxide and arachidonic acid metabolites that increase local blood flow to meet increased energy expenditure. In damaged tissue, not only is the restorative vascular response lacking but a vasoconstrictive response is promoted and the ischemia that follows adds to the severity of the initial injury. Tissue threatened by this ischemic response is then at elevated risk for CSD propagation and falls into a vicious cycle of electrical and hemodynamic disturbance. Efforts have been made to halt this spreading cortical depression using N-methyl-D-aspartate receptor antagonists and other ion channel blockers to minimize the damaging effects of CSD that can persist long after the triggering insult.

PMID: 26461911 [PubMed - as supplied by publisher]

Evita's lobotomy.

J Clin Neurosci. 2015 Oct 10;

Authors: Young GJ, Bi WL, Smith TR, Brewster R, Gormley WB, Dunn IF, Laws ER, Nijensohn DE

Abstract

For 60years, the details about Eva Perón's illness and lobotomy at the end of her life have been obscured from the public. Here, we examine the sociopolitical factors that may have contributed to this secrecy. The first involves Eva Perón's political status and the personality cult surrounding her image, including partisan efforts to present her as a patron saint of Peronism. The second involves the social perceptions, which are often stigmatizing, regarding disease in political or public figures. Notably, neuropsychiatric illness and associated indications for treatment were viewed as oligarchic by the Perón regime, and admission to a lobotomy may have been perceived as anti-Peronist. A third factor involves the growing ignominy of prefrontal lobotomy as a surgical modality, which may have precluded operative exposés. A final factor may be that Eva Perón's lobotomy was in fact performed for behavior and personality modification, and not just for pain control. A brief history of lobotomy is presented, highlighting its adoption as a procedural panacea for psychiatric illnesses, relief of intractable pain from cancer, and management of belligerent behavior, and its subsequent fall from clinical favor. Although a shroud of secrecy still surrounds Eva Perón's prefrontal lobotomy, these factors provide a potential rationale for the circumstances, as well as foster a discussion of cultural elements that may still play a role in the public perception of psychosurgery today.

PMID: 26463273 [PubMed - as supplied by publisher]

Association of TERT Promoter Mutation, but Not BRAF Mutation, with Increased Mortality in PTC.

J Clin Endocrinol Metab. 2015 Oct 13;:jc20152690

Authors: George JR, Henderson YC, Williams MD, Roberts DB, Hei H, Lai SY, Clayman GL

Abstract

CONTEXT: Papillary thyroid carcinoma (PTC) carrying the BRAF mutation has been reported to be associated with high recurrence and potentially increased mortality. PTC carrying the TERT promoter mutation has been associated with older age, recurrence, and aggressive disease.

OBJECTIVE: The objective of this study was to determine the association of BRAF and TERT promoter gene alterations with recurrence and survival in a high-risk population Design: Genomic DNA was analyzed for the BRAF mutation from 256 persistent/recurrent PTC (p/rPTC, 202 new, 54 previously reported), TERT promoter mutation and polymorphism (242 p/rPTC). Two-tailed Fisher exact tests or the Pearson Chi-squared test were performed for the associations between mutations and other variables. Overall and disease-free survivals were compared by log rank tests on Kaplan-Meier plots and by Cox regression analysis. TERT promoter constructs were tested in PTC cell lines to determine their activities in these cells.

RESULTS: BRAF V600E mutation was identified in 235 of 256 (91.8%), TERT promoter mutation at -124 was detected in 77 of 242 (31.8%), and TERT promoter polymorphism at -245 was found in 113 of 242 (46.7%) of p/rPTC patients. A significant difference in survival was found in p/rPTC patients with the TERT promoter mutation, which also displayed increased activity in vitro as compared to the non-mutated promoter sequence. No association was noted between the BRAF mutation or TERT promoter polymorphism and recurrence or survival. A drawback of our study could be the limited numbers of patients with non-mutated BRAF (21 of 256, 8.2%).

CONCLUSIONS: Mutation in the TERT promoter, but not in BRAF, is associated with decreased survival in 19 (24.7%) p/rPTC patients who died of disease and in 38 (49.4%) p/rPTC patients who died at last contact. The presence or absence of the BRAF mutation and TERT promoter polymorphism, however, was not significantly correlated with survival.

PMID: 26461266 [PubMed - as supplied by publisher]

Gestational Diabetes Impairs Human Fetal Postprandial Brain Activity.

J Clin Endocrinol Metab. 2015 Oct 14;:jc20152692

Authors: Linder K, Schleger F, Kiefer-Schmidt I, Fritsche L, Kümmel S, Heni M, Weiss M, Häring HU, Preissl H, Fritsche A

Abstract

CONTEXT: Gestational diabetes (GDM) influences the fetal phenotype.

OBJECTIVE: In the present study, our aim was to determine the effect of GDM specifically on fetal brain activity.

DESIGN: Pregnant participants underwent an oral glucose tolerance test (OGTT, 75 g). At 0, 60, and 120 minutes, maternal metabolism was determined, and fetal auditory evoked fields were recorded with a fetal magnetoencephalographic device.

SETTING: All measurements were performed at the fMEG Center in Tübingen.

PARTICIPANTS: Twelve women with GDM and 28 normal glucose-tolerant (NGT) pregnant women participated on a voluntary basis.

INTERVENTIONS: OGTT (75 g, 120 minutes) was used in this study. Main Outcomes and Measures: Fetal auditory evoked response latencies were determined for this study.

RESULTS: In the fetuses of NGT women, latencies decreased between 0 and 60 minutes from 260 ± 90 to 206 ± 74 ms (P = .008) and remained stable until 120 minutes (206 ± 74 vs 230 ± 79, P =.129). In fetuses of women with GDM, there was no change in response latencies during OGTT (P = .11). Sixty minutes after glucose ingestion, fetal latencies in the GDM group were longer than in the NGT group (296 ± 82 vs 206 ± 74 ms, P = .001). Linear regression revealed a significant effect of maternal glucose, insulin levels, and insulin sensitivity on response latencies after 60 minutes.

CONCLUSIONS: Fetal postprandial brain responses were slower in the offspring of women with GDM. This might indicate that gestational diabetes directly affects fetal brain development and may lead to central nervous insulin resistance in the fetus.

PMID: 26465393 [PubMed - as supplied by publisher]

Threshold effects of vitamin D status on bone health in Chinese adolescents with low calcium intake.

J Clin Endocrinol Metab. 2015 Oct 14;:jc20152849

Authors: Wu F, Laslett LL, Zhang Q

Abstract

CONTEXT: There is no consensus on the definition of vitamin D deficiency for bone health based on serum 25-hydroxyvitamin D (25OHD) levels.

OBJECTIVE: To determine whether thresholds exist for associations between 25OHD levels and bone outcomes, below which low 25OHD levels have adverse effects on bone health.

DESIGN: Cross-sectional study.

SETTING: Secondary school students in Beijing, China, aged 12-15 years.

OUTCOME: Measures and Participants: Serum 25OHD, bone mineral density (BMD) of total body, hip and lumbar spine (LS), serum parathyroid hormone (PTH), bone alkaline phosphatase (BAP) and tartrate-resistant acid phosphatase 5b (TRAP5b) in 222 healthy adolescents, (111 girls, 111 boys).

RESULTS: Prevalence of low 25OHD was 61% (<30nmol/L) and 97% (<50 nmol/L) (mean 25OHD=30 nmol/L). Dietary calcium intake was low (294 and 307 mg/d for boys and girls, respectively). In girls, break-points for 25OHD (nmol/L) were: total body BMD 20 (95%CI:14-27), hip BMD 25 (17-34), LS BMD 22 (14-30), TRAP5b 37 (22-52), and PTH 31 (23-38). In boys: total body BMD 39 (24-55), TRAP5b 33 (20-45), PTH 35 (27-43); no break-points were identified for hip and LS BMD. No break-points were identified for BAP in either gender. Below these break-points, greater 25OHD is associated with increased total body BMD, reduced PTH and TRAP5b, while above them, no such relationship exists.

CONCLUSIONS: Vitamin D deficiency and insufficiency is common in healthy Chinese adolescents. Attaining serum 25OHD levels of >20-37 nmol/L in girls and 33-39 nmol/L in boys had positive influences on BMD and bone remodelling markers. However, estimates may be affected by low calcium intake and low serum 25OHD levels with 97% <50 nmol/L.

PMID: 26465394 [PubMed - as supplied by publisher]

The Influence of Patient Age on Thyroid Nodule Formation, Multinodularity, and Thyroid Cancer Risk.

J Clin Endocrinol Metab. 2015 Oct 14;:jc20153100

Authors: Kwong N, Medici M, Angell TE, Liu X, Marqusee E, Cibas ES, Krane JF, Barletta JA, Kim MI, Reed Larsen P, Alexander EK

Abstract

INTRODUCTION: Though advancing age is known to influence the formation of thyroid nodules, the precise relationship remains unclear. Furthermore, it is uncertain if age influences the risk any thyroid nodule may prove cancerous.

AIM: To determine the impact of patient age on nodule formation, multinodularity, and risk of thyroid malignancy.

METHOD: We conducted a prospective cohort analysis of consecutive adults (ages 20-95 years) who presented for evaluation of nodular disease from 1995-2011. 6,391 patients underwent ultrasound and FNA of 12,115 nodules ≥1 cm. Patients were divided into six age groups and compared using sonographic, cytologic, and histologic endpoints.

RESULT: The prevalence of thyroid nodular disease increases with advancing age. The mean number of nodules at presentation increased from 1.5 in the youngest cohort (ages 20-30) to 2.2 in the oldest cohort (>70 years old; P < 0.001), demonstrating a 1.6% annual increased risk for multinodularity (OR 1.02, P < 0.001). In contrast, the risk of malignancy in a newly identified nodule declined with advancing age. Thyroid cancer incidence per patient was 22.9% in the youngest cohort, but 12.6% in the oldest cohort (OR 0.972, P < 0.001), demonstrating a 2.2% decrease per year in the relative risk of malignancy between ages 20-60, which stabilized thereafter. Despite a lower likelihood of malignancy, identified cancers in older patients demonstrated higher risk histological phenotypes. While nearly all malignancies in younger patients were well-differentiated, older patients were more likely to have higher risk PTC variants, poorly differentiated cancer, or anaplastic carcinoma (P<0.001).

CONCLUSION: With advancing age, the prevalence of clinically relevant thyroid nodules increases while the risk such nodules are malignant decreases. Nonetheless, when thyroid cancer is detected in older individuals, a higher risk histological phenotype is more likely. These data provide insight into the clinical paradox that confronts physicians managing this common illness.

PMID: 26465395 [PubMed - as supplied by publisher]

Pivotal role for the visceral fat compartment in the release of persistent organic pollutants during weight loss.

J Clin Endocrinol Metab. 2015 Oct 15;:jc20152571

Authors: Dirinck E, Dirtu AC, Jorens PG, Malarvannan G, Covaci A, Van Gaal LF

Abstract

CONTEXT: Polychlorinated biphenyls (PCBs), are implicated as potential endocrine disruptors and obesogens. These lipophilic substances are preferentially stored in the fat compartment and released into the circulation during weight loss.

OBJECTIVE: The aim of this study was to examine the contribution of abdominal adiposity, visceral adiposity in particular, to the increase of serum PCB levels during weight loss.

MATERIALS AND METHODS: 45 obese women were prospectively recruited. Twenty individuals received dietary counseling, 25 underwent bariatric surgery. Anthropometric data were collected, intra-abdominal adiposity was assessed by measurement CT scanning of the abdominal fat compartment, delineating the visceral and subcutaneous compartment. Serum levels of 27 PCBs were determined and the sum of all PCBs (∑PCBs) calculated. Follow-up measurements of anthropometric data, CT scanning and PCB levels were performed after 6 months in all patients.

RESULTS: In patients who lost weight, serum ∑PCB levels displayed a rise after 6 months of approximately 50%. Both correlation and regression analysis, focusing on the relative contribution of the visceral versus the subcutaneous fat compartment, indicated that the rise in ∑PCB serum levels after 6 months of weight loss was more pronounced in patients losing relatively more visceral adipose tissue. This trend could be established in the diet-treated, but not the surgery-treated subgroup.

CONCLUSION: Our study suggests that the contribution of PCBs released from the visceral fat compartment might be more pronounced, compared to the subcutaneous fat compartment, during weight loss. These findings are present in the entire study group while subanalysis of the diet versus surgery group indicated the same effect in the diet group, but failed to reach statistical significance in the surgery group. This suggests a possible weight loss method specific effect.

PMID: 26469381 [PubMed - as supplied by publisher]

Circulating stem cells associate with adiposity and future metabolic deterioration in healthy subjects.

J Clin Endocrinol Metab. 2015 Oct 15;:jc20152867

Authors: Paolo Fadini G, Maria Bonora B, Marcuzzo G, Cristina Marescotti M, Cappellari R, Pantano G, Colomba Sanzari M, Duran X, Vendrell J, Plebani M, Avogaro A

Abstract

CONTEXT: Obesity and metabolic syndrome are associated with mild leukocytosis, but whether hematopoietic stem/progenitor cells (HSPCs) play a role in metabolic deterioration is unknown.

OBJECTIVE: To analyze the cross-sectional and longitudinal associations between CD34(+) HSPCs, adiposity, and metabolic syndrome features.

DESIGN: A cross-sectional study on 242 participants, 155 of whom were followed-up and included in a longitudinal assessment.

SETTING: Tertiary referral center for metabolic diseases.

PARTICIPANTS: Healthy working individuals attending a cardiovascular screening program (total n=3,158), and having a baseline measure of circulating CD34(+) cells.

MAIN OUTCOME MEASURES: We collected demographic and anthropometric data, cardiovascular risk factors, and metabolic syndrome parameters.

RESULTS: Participants (34.7% males, mean age 45.9±0.5 years) were free from diabetes and cardiovascular disease. Cross-sectionally, absolute CD34(+) cell counts were directly correlated with BMI and waist circumference, inversely correlated with HDL cholesterol and the quantitative insulin sensitivity check index (QUICKI), and were higher in individuals with the metabolic syndrome. The hematopoietic component contributed most to the association of CD34(+) cells with adiposity. During a 6.3-year follow-up, high absolute levels of CD34(+) cells were associated with increasing waist circumference, declining QUICKI and HDL cholesterol, and with incidence of metabolic syndrome. Relative CD34(+) cell counts showed weaker associations with metabolic parameters than absolute levels, but were longitudinally associated with increasing waist circumference and metabolic syndrome development.

CONCLUSIONS: A mild elevation of circulating CD34(+) progenitor cells, reflecting expansion of HSPCs, is associated with adiposity and future metabolic deterioration in healthy individuals.

PMID: 26469382 [PubMed - as supplied by publisher]

Burden of basal cell carcinoma

Burden of basal cell carcinoma in USA.

Future Oncol. 2015 Oct 15;

Authors: Wu X, Elkin EE, Marghoob AA

Abstract

Basal cell carcinoma (BCC) is the most common malignancy diagnosed in the USA and its incidence continues to increase. While BCC is still most prevalent in the older segments of the population, it is becoming ever more frequent in younger individuals. The costs of treatment and morbidity associated with BCCs place a heavy public health and economic burden on patients, their families and the American healthcare system and underscore the importance of efficient management and prevention efforts directed toward this malignancy. In this article, we address economic aspects of BCC using evidence from large-scale epidemiological studies. This information may help clinicians in developing better and more cost-effective methods for dealing with the most common cancer in America and in the world.

PMID: 26466906 [PubMed - as supplied by publisher]

Specific treatment for cancer-associated thrombosis.

Future Oncol. 2015 Oct 15;

Authors: Laffan M

Abstract

Mike Laffan speaks to Gemma Westcott, Commissioning Editor: Michael Laffan is Professor of Haemostasis and Thrombosis in the Department of Haematology at Imperial College, London, UK, and Director of the Hammersmith Hospital Haemophilia Centre. He trained in medicine at Oxford University and hematology at the Hammersmith and Royal Free hospitals in London. His principal research interests are the structure-function relationship of von Willebrand factor, in particular the role of glycosylation, and the mechanisms and regulation of thrombin generation. He has published extensively on hemostasis and recently edited the 11th edition of Practical Haematology. He also served on NEQAS and the British Committee for Standards in Haematology Task force on Haemostasis and Thrombosis.

PMID: 26467092 [PubMed - as supplied by publisher]

Novel approaches to imaging basal cell carcinoma.

Future Oncol. 2015 Oct 15;

Authors: Rossi AM, Sierra H, Rajadhyaksha M, Nehal K

Abstract

The gold standard of diagnosis for nonmelanoma and melanoma skin cancer has been skin biopsy with routine paraffin embedded hematoxylin and eosin histopathology. This practice is frequently carried out on suspicious lesions to rule out a malignant process. Therefore, as a result, many biopsies are done on benign lesions. Unlike other fields of medicine that rely on noninvasive imaging modalities, the use of imaging devices in dermatology has not been as robust. This has been mainly due to the limited resolution offered by imaging devices that is needed to detect malignant changes in the cutaneous layers. However, the demand for more efficient in vivo and ex vivo imaging tools to reduce the amount of biopsies have led to new areas of investigation using noninvasive modalities to augment the clinical diagnosis of skin cancer. The use of noninvasive imaging both in vivo and ex vivo has the potential to increase efficiency of diagnosis and management, decrease healthcare cost, improve clinical care and enhance patient satisfaction.

PMID: 26467205 [PubMed - as supplied by publisher]

Clival fibrous dysplasia

Ear Nose Throat J.
Clival fibrous dysplasia: Case series and review of the literature.
Heman-Ackah SE1, Boyer H, Odland R.
Author information
1Department of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Abstract
Slightly more than 30 cases of fibrous dysplasia involving the clivus have been reported in the international literature, primarily in the neurosurgery and radiology literature. In this article we present a series of 4 cases involving patients with clival fibrous dysplasia. In a retrospective chart review, 4 patients presenting to tertiary care centers from January 1, 2006, to January 31, 2008, were identified and their presenting symptoms and radiologic findings reviewed. Based on our literature review, we describe the presenting symptoms of patients with clival fibrous dysplasia and characterize the findings of imaging studies associated with this disorder. All patients in this series had a presenting complaint of headache or cranial nerve deficits, which is consistent with previous reports found in our literature review. Additional presenting symptoms that have been reported include dysphagia and a nontender occipital mass; there was also an incidental asymptomatic finding. Magnetic resonance imaging findings are consistent with those associated with fibrous dysplasia at other sites of the body. We conclude that clival involvement in monostotic fibrous dysplasia may not be as rare as previously perceived.
PMID: 25531855 [PubMed - indexed for MEDLINE]

Learning from our failures in blood-brain permeability: what can be done for new drug discovery?

Expert Opin Drug Discov. 2015

Authors: Martel S

Abstract
Many existing pharmaceuticals are rendered ineffective in the treatment of cerebral diseases due to a permeability barrier well known as the blood-brain barrier (BBB). Such barrier between the blood within brain capillaries and the extracellular fluid in brain tissue has motivated several approaches aimed at delivering therapeutics to the brain. These approaches rely on strategies that can be classified as molecular modifications, the use of BBB bypassing pathways, and BBB disruptions. Although several of these approaches that have been investigated so far show promising results, none has addressed the optimization of the ratio of the dose of the drug molecules that contributes to the therapeutic effects. As such, the extensive research efforts, such as prioritizing the enhancement of the BBB permeability alone is likely to fail to provide the best therapeutic effects for a given dose if prior systemic circulation is not avoided while enhancing the spatial targeting only to regions of the brain that need treatment. Hence, new therapeutics for the brain could be synthesized to take advantage of recent technologies for non-systemic delivery and spatially targeted brain uptake.

PMID: 25658294 [PubMed - indexed for MEDLINE]

Dimenhydrinate (DMH)-loaded buccal bioadhesive films for the prevention and treatment of motion sickness

Preparation and in-vivo evaluation of dimenhydrinate buccal mucoadhesive films with enhanced bioavailability.

Drug Dev Ind Pharm. 2015 Oct 12;:1-10

Authors: Yildiz Pekoz A, Sedef Erdal M, Okyar A, Ocak M, Tekeli F, Kaptan E, Sagirli O, Araman A

Abstract
Dimenhydrinate (DMH)-loaded buccal bioadhesive films for the prevention and treatment of motion sickness were prepared and optimized. This study examines the rate of drug release from the films for prolonged periods of time to reduce or limit the frequency of DMH administration. Based on preliminary studies using various polymers and concentrations, hydroxyethylcellulose (2.5, 3.0, and 3.2%), and xanthan gum (2.8%) were chosen as matrix polymers. The films were analyzed with respect to their mechanical, physicochemical, bioadhesive, swelling, and in-vitro release properties. In in-vivo pharmacokinetic studies, xanthan gum-based DMH buccal film was associated with significantly increased DMH plasma levels between 1 h and 5 h after DMH dosing when compared with an oral drug solution. The area under the curve AUC0-7 h value of the mucoadhesive buccal film was two-fold higher than the oral DMH solution. Histological analysis revealed that DMH films cause mild morphological and inflammatory changes in rabbit buccal mucosa. The DMH buccal film is effective for approximately 7 h, thus representing an option for single-dose antiemetic therapy. This dosage regimen could be particularly beneficial for chain travelers who travel for long periods of time.

PMID: 26460061 [PubMed - as supplied by publisher]

Dissolving microneedle-based intradermal delivery of interferon-α-2b.

Drug Dev Ind Pharm. 2015 Oct 15;:1-7

Authors: Chen J, Qiu Y, Zhang S, Gao Y

Abstract
The dermal and transdermal delivery of protein pharmaceuticals faces enormous challenges, and at the same time, has very significant potential for the non-invasive treatment of both localized and systemic diseases. To demonstrate the pharmaceutical usefulness of dissolving microneedles (MNs) containing interferon-α-2b (IFN), IFN MNs were prepared using a new method. IFN were encapsulated in MNs with dose from 4.94 ± 0.64 to 23.79 ± 2.48 μg, and in vitro release test showed the efficiency reached 49.2%. After percutaneous administration of IFN MNs to rats, serum IFN levels were measured for 12 h. The peak serum IFN level, maximum drug concentration (Cmax), and the time to reach maximum concentration (Tmax), were 11.58 ± ng/ml and 40 min, respectively, for high-dose MNs group. The area under the curve (AUC) of MNs group was 28.85 ng·h/ml, while intramuscular injection (IM) group with equal dose was 31.17 ng·h/ml. Immunogenicity analysis showed the anti-IFN antibody got back to normal level at ninth week, and there was no difference between male and female rats. IFN MNs showed good stability for 2 months and no damage to the administered rats' skin. The results demonstrated the IFN MNs have a great potential to provide an alternative to IM.

PMID: 26467418 [PubMed - as supplied by publisher]

Herbal antimicrobials: Allium sativum L. and Eruca sativa miller seed oils

Development and assessment of stable formulations containing two herbal antimicrobials: Allium sativum L. and Eruca sativa miller seed oils.

Drug Dev Ind Pharm. 2015 Oct 15;:1-11

Authors: Sanad RA, Mabrouk MI

Abstract
CONTEXT: Garlic oil and Eruca oil have been reported to have excellent antimicrobial activity. However, the exact knowledge of their required hydrophilic-lipophilic balance (rHLB) values to facilitate their emulsification are still not reported in the literature.
OBJECTIVE: The objective of this study is to determine rHLB values of Garlic and Eruca oils to formulate an elegant stable cream formulation enriched with both oils.
MATERIALS AND METHODS: Emulsions of both oils were prepared by the bottle method using water, Tween 80 and Span 80. Formulated emulsions were evaluated for creaming index (CI), droplet size, and turbidity to determine rHLB. Utilizing determined rHLB, creams were formulated using a combination of two surfactants, Span 60:Brij 58 (1:2.333) at three different concentrations (2, 4, and 6%).
RESULTS: rHLB of Garlic oil and Eruca oil was determined to be 7.92 ± 0.27 and 9.76 ± 0.32, respectively. Stable cream (F1) developed with 2% surfactant blend showed elegant rheological properties, the best antimicrobial activity against Staphyococcus aureus ATCC29737, Escherichia coli ATCC25299 S. aureus (MRSA), Malassezia fufur AUMC No. 5173 with no skin irritation. In addition, its texture parameters and pH were found to be consistent over 12 months at 25 ± 1 °C and 60% relative humidity.
DISCUSSION: The lowest CI, smallest droplet size, and highest turbidity were obtained at the optimum surfactant concentration in the prepared emulsions. Increasing surfactant blend concentration in cream formulations leads to increasing viscosity and consequently decreasing antimicrobial activity.
CONCLUSION: Determination of the rHLB of Garlic and Eruca oils allows the ease of preparation of stable, consistent, and non-irritant cream.

PMID: 26467506 [PubMed - as supplied by publisher]

[The Evaluation of Voice Quality via Signal Typing in Voice using Narrowband Spectrograms].

Laryngorhinootologie. 2015 Oct 15;

Authors: Barsties B, Hoffmann U, Maryn Y

Abstract

Objective: Traditionally, voice quality is evaluated by auditory-perceptual judgment but objective-acoustic analyses are also valid tools. Spectrography is a part of objective-acoustic analyses and is used since around 50 years. Recently, Sprecher et al. (2010) designed a new classification scheme for signal typing in voice using narrowband spectrograms. The present study aimed to explore the external validation between these 2 methods in a larger dataset. Materials and Methods: In total 300 voice samples were used based on the vowel [a:], in which n=270 had various degrees of dysphonia and n=30 were vocally normal. All voice samples were evaluated by 7 speech-language therapists using the RBH-scale and 2 judges analyzed the signal typing in voice using narrowband spectrograms. Results: The intra- and inter-rater reliability of all RBH parameters was fair in average (kappa=0.234-0.383) but the rater reliability was moderate between the 2 judges rating signal typing in voice (kappa=0.457). A strong concurrent validity was identified between the signal typing in voice using narrowband spectrograms and auditory-perceptual judgment of hoarseness and breathiness (H: r=0.746, p=0.000; B: r=0.746, p=0.000) but only fair in roughness (r=0.370, p=0.000). Conclusion: The present results confirmed the results of Sprecher et al. (2010) and it might be meaningful to benefit signal typing in voice using narrowband spectrograms on sustained vowels as a valid complement in the evaluation of hoarseness and breathiness for clinical utility and research.

PMID: 26468672 [PubMed - as supplied by publisher]

[Lateral Sinus Thrombosis - A Rare Complication of an Acute Mastoiditis or Infected Cholesteatoma].

Laryngorhinootologie. 2015 Oct 15;

Authors: Graß SK, Welkoborsky HJ, Bersch C

Abstract

Background: Lateral sinus thrombosis (LST) is a rare but threatening complication of an acute mastoiditis or infected cholesteatoma. Currently only very few papers are available in the literature dealing with the systematic investigation of patients with suspected LST. The purpose of the present study was to evaluate the clinical, intraoperative and therapeutic findings of patients with particular disease. Patients and Methods: For this retrospective study the clinical records of 7 patients which were admitted for a suspected LST were evaluated. All patients underwent mastoidectomy with exposition of the lateral sinus and investigating of its blood flow. Results: A LST was confirmed in 4 patients, 3 patients had a phlebitis. Patients with a LST presented additional symtoms beside otalgia, i. e., dizziness, cephalgia, meningism, deafness of the affected ear, and facial nerve paresis. Postoperative MRI scans revealed a recanalization of the sinus in all cases. Although immediate surgery, 2 patients developed a 2-staged brain abscess in the cerebellum. Conclusion: Clinical symptoms of the SVT are unspecific. In cases of an acute mastoiditis, neurological signs might be pathognomonic and can direct to a LST. Therapeutic concepts comprise intravenous antibiotics and operative elimination of disease. The exposition of the lateral sinus should be performed in any mastoidectomy for a LST in order to scrutinize its blood flow. In case of a thrombosis additional anticoagulative therapy might be indicated. To exclude a 2-staged brain abscess control MRI scans 7 through 14 days postoperatively are recommended.

PMID: 26468673 [PubMed - as supplied by publisher]

[Evaluation of a Classification Model of Horizontal Vascular Lesions of the Vocal Folds].

Laryngorhinootologie. 2015 Oct 15;

Authors: Schossee A, Voigt-Zimmermann S, Kropf S, Arens C

Abstract

Objective: There exists no valid classification of beginning vascular changes of the vocal folds. We tested an own classification model of visible beginning horizontal vascular changes. Material and Methods: 168 indirect endoscopic pictures (84 white light=WL and 84 Narrow Band Imaging=NBI) of vocal folds were presented to 3 different consultants for classification (graduation normal, slight, moderately, high-grade belonged to the vascular features ectasia, meander, convolute, frequency of the vessels, ramification, change in direction). The self-confidence was declared by the consultants with a numeric rating scale. Results: A classification of beginning vascular changes of the vocal folds is possible, especially of ectasia, meander, convolute, frequency of the vessels, ramification, change in direction (p<0.0001). Significantly more vascular lesions can be detected by NBI than with white light endoscopy alone (p<0.0001). There are no significant differences (p=0.3529) in self-confidence of the classification. But it differs between the consultants highly significant (p<0.0001). The inexperienced classifier shows the highest growth in the learning curve. The intrarater- and interratervariability differs only slightly between WL and NBI. Conclusions: Beginning horizontal changes of vocal fold vessels can be classified. Endoscopic NBI-pictures of the vocal folds demonstrate the beginning of vascular changes better compared to endoscopic white light pictures alone. The familiarity and expertise with the classification model and the endoscopic imaging technique affect the self-confidence of the evaluation.

PMID: 26468674 [PubMed - as supplied by publisher]

2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and DTC

2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer.

Thyroid. 2015 Oct 14;

Authors: Haugen BR, Alexander EK, Bible KC, Doherty G, Mandel SJ, Nikiforov YE, Pacini F, Randolph G, Sawka A, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward D, Tuttle RM, Wartofsky L

Abstract
BACKGROUND: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of this these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer.
METHODS: The specific clinical questions addressed in this these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including: electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians (ACP) Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed and communicated to the ATA and task force members.
RESULTS: The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and TSH suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research.
CONCLUSIONS: We have developed evidence-based recommendations to inform clinical decision- making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.

PMID: 26462967 [PubMed - as supplied by publisher]

False positive radioactive iodine-131 uptake mimicking metastasis in pulmonary aspergillosis

Image findings of a false positive radioactive iodine-131 uptake mimicking metastasis in pulmonary aspergillosis identified on single photon emission computed tomography-computed tomography.

J Cancer Res Ther. 2015

Authors: Karuppusamy KK, Antony J, Radhakrishnan ER, Shinto AS

Abstract
High doses of iodine-131 are commonly used in patients with differentiated thyroid cancer after total or subtotal thyroidectomy, in order to ablate the remaining cancer or normal thyroid tissue. Multiple different false-positive scans can occur in the absence of residual thyroid tissue or metastases. The authors present a case of abnormal uptake of radioactive iodine in the aspergilloma, potentially masquerading as pulmonary metastases.

PMID: 26458651 [PubMed - in process]

Low-dose oral lithium therapy and its effect on thyroidal radioiodine uptake, retention, and hormonal parameters

The feasibility of low-dose oral lithium therapy and its effect on thyroidal radioiodine uptake, retention, and hormonal parameters in various subcategories of hyperthyroid patients: a pilot study.

Nucl Med Commun. 2015 Oct 13;

Authors: Chouhan A, Abhyankar A, Basu S

Abstract
BACKGROUND: Radioactive iodine (I) (RAI) is used widely for the treatment of hyperthyroidism either as a first-line treatment or following relapse after antithyroid drug treatment. Intrathyroidal retention of RAI is considered an important determinant of its effectiveness, which is believed to be prolonged by lithium.
AIMS AND OBJECTIVES: To study the impact of low-dose oral lithium therapy on RAI uptake and retention parameters in different subgroups of hyperthyroidism patients, and thus explore its potential role in enhancing the therapeutic efficacy of RAI in these groups of patients.
MATERIALS AND METHODS: A total of 28 patients (age range=18-70 years) who were being considered for RAI therapy were included in this prospective pilot study. The patients were divided into two groups: (i) those who had not received any RAI therapy before were included in 'group I' (n=22), whereas (ii) 'group II' (n=6) included patients who were found to be persistently hyperthyroid on biochemical and clinical follow-up despite previous RAI therapy for hyperthyroidism. Patients in group I were further divided into four subgroups on the basis of the underlying etiopathology: (a) subgroup Ia - diffuse toxic goiter (n=15), (b) subgroup Ib - autonomous functioning module (n=2), (c) subgroup Ic - toxic multinodular goiter (n=4), and (d) subgroup Id - nontoxic multinodular goiter (n=1) on the basis of scintigraphic and clinical findings. All patients first underwent 25 μCi I uptake estimation at 2, 24, and 48 h and values thus obtained were considered the baseline for further evaluation. After biochemical assessment of normal renal and liver functions, patients received 900 mg lithium per day in three divided doses orally, and on the fourth day after starting tab lithium, the serum lithium level was estimated with continued lithium administration. On the fifth, sixth, and seventh day, patients underwent lithium-primed 25 μCi I uptake estimation at 2, 24, and 48 h. Retention index (RI) was calculated using the formula [RI=(48 h uptake-24 h uptake)/24 h uptake×100]. A day after completion of uptake study, that is, on the third day from diagnostic (25 μCi I) RAI administration, patients received a fixed 5 mCi therapeutic RAI dose after their suitability for the same was ascertained using clinical, biochemical, and scintigraphic findings as the criteria. Lithium administration was stopped 5 days after therapy.
RESULTS: Lithium priming resulted in a significantly reduced serum FT4 level in subgroup Ia (diffuse goiter) of group I. Similarly, lithium priming resulted in a statistically significant increase in the radioiodine RI in subgroup Ia. Lithium priming resulted in increased retention of radioiodine and reduced serum FT4 level in the rest of the study population also, but the difference was not statistically significant (likely because of fewer patients in these subgroups). The low-dose lithium priming regimen used in the present study was found to be feasible and safe. The mean serum lithium concentration was 0.6 mEq/l with the dose protocol administered and hence was considered safe. Only one patient had achieved a level of 1.5 mEq/l, without any obvious side effects, and it was clinically uneventful. One patient experienced headache necessitating dose reduction.
CONCLUSION: The results of this study, carried out in different groups of patients with hyperthyroidism, suggested that a short course of lithium is safe and could be beneficial for hyperthyroid patients considered for RAI therapy as it increased the RAI retention in thyroid, and thus had the potential to increase the effect of RAI therapy. Alternatively, it is proposed that lithium priming could help reduce the dose of RAI administered without compromising on therapeutic efficacy, with possible potential implications for cost reduction, radiation safety precautions, and lowered radiation dose to nontarget organs.

PMID: 26465804 [PubMed - as supplied by publisher]

Effective Treatment with Intravitreal Injection of Bevacizumab for Exudative Retinal Detachment Secondary to Choroidal Metastasis of Non-Small Cell Lung Carcinoma.

Am J Case Rep. 2015;16:728-32

Authors: Yasui H, Sato K, Takeyama Y, Nishihara H, Maeda M, Gonda H, Suzuki R

Abstract

BACKGROUND Visual disturbance caused by cancer metastasis from other organs is one of the largest challenges to cancer patients' quality of life (QOL). Lung cancer is the most frequent primary site of choroidal metastasis in men, but improvement of visual disturbance has not always been emphasized in lung cancers. Recently intravitreal bevacizumab is a newer modality being tried for local control of choroidal metastases. CASE REPORT A 68-year-old man was admitted the hospital with complaint of visual disturbance in his left eye. He was diagnosed with lung adenocarcinoma cT2N0M1b (OSS, OTH) stage IV. The ophthalmologic evaluation showed exudative fluid, which caused retinal detachment under the retina. Fluorescence angiography showed granular hyperfluorescence with leakage consistent with a tumor. He received radiotherapy for bone metastasis and systematic chemotherapy with carboplatin, pemetrexed, and bevacizumab, as well as intravitreal injection of bevacizumab 1.25 mg to improve the visual disturbance. His visual symptom and retinal detachment improved until he died. An autopsy revealed that the metastatic lesion in his left eye was totally cured macroscopically and microscopically. CONCLUSIONS We report a case of exudative retinal detachment secondary to a metastatic choroidal tumor from lung adenocarcinoma, which was treated with chemotherapy and intravitreal injection of bevacizumab. Although he finally died of lung cancer, he maintained his visual QOL and autopsy revealed complete cure of the choroidal metastasis.

PMID: 26460101 [PubMed - in process]

Vocal Fold Paralysis as a Delayed Consequence of Neck and Chest Radiotherapy.

Otolaryngol Head Neck Surg. 2015

Authors: Crawley BK, Sulica L

Abstract

OBJECTIVE: To describe a series of cases of vocal fold paralysis years after radiation therapy, including presentation, clinical course, and treatment.

STUDY DESIGN: Case series with chart review.

SETTING: Tertiary care center.

SUBJECTS AND METHODS: A review of 8 years of patient records yielded 10 patients (8 male and 2 female; average age 57 years [range, 29-76 years]) with vocal fold paralysis and a history of radiation therapy to the head, neck, or mediastinum. These patients did not have other possible etiologies of vocal fold paralysis. Demographic, diagnostic, clinical course, and treatment data were collected.

RESULTS: On average, 21 years (range, 1-27 years) elapsed between completion of radiation and presentation with vocal fold paralysis. Original pathologies included Hodgkin lymphoma (5), squamous cell carcinoma of the head and neck (4), and peripheral T-cell lymphoma (1). Eight patients had unilateral left vocal fold paralysis, and 2 had bilateral neuropathy; none recovered spontaneously. All patients had dysphonia, and nearly all patients also complained of dysphagia. Six elected not to be treated. Four underwent injection augmentation with resolution of voice complaints.

CONCLUSIONS: Radiation therapy has the potential to cause laryngeal neuropathy years to decades after treatment. The potential for recovery is low, but injection augmentation can relieve symptoms. Development of contralateral neuropathy and altered tissue response are considerations in treatment.

PMID: 25931294 [PubMed - indexed for MEDLINE]

Dysregulated Macrophages Are Present in Bleomycin-Induced Murine Laryngotracheal Stenosis.

Otolaryngol Head Neck Surg. 2015

Authors: Hillel AT, Samad I, Ma G, Ding D, Sadtler K, Powell JD, Lane AP, Horton MR

Abstract

OBJECTIVE: To define the inflammatory cell infiltrate preceding fibrosis in a laryngotracheal stenosis (LTS) murine model.

STUDY DESIGN: Prospective controlled murine study.

SETTING: Laboratory.

SUBJECTS AND METHODS: Chemomechanical injury mice (n = 44) sustained bleomycin-coated wire-brush injury to the laryngotracheal complex while mechanical injury controls (n = 42) underwent phosphate-buffered saline (PBS)-coated wire-brush injury. Mock surgery controls (n = 34) underwent anterior transcervical tracheal exposure only. Inflammatory and fibrosis protein and gene expression were assessed in each condition. Immunohistochemistry served as a secondary outcome.

RESULTS: In chemomechanical injury mice, there was an upregulation of collagen I (P < .0001, P < .0001), Tgf-β (P = .0023, P = .0008), and elastin (P < .0001, P < .0001) on day 7; acute inflammatory gene Il1β (P = .0027, P = .0008) on day 1; and macrophage gene CD11b (P = .0026, P = .0033) on day 1 vs mechanical and mock controls, respectively. M1 marker inducible nitric oxide synthase (iNOS) expression decreased (P = .0014) while M2 marker Arg1 (P = .0002) increased on day 7 compared with mechanical controls. Flow cytometry demonstrated increased macrophages (P = .0058, day 4) and M1 macrophages (P = .0148, day 4; P = .0343, day 7; P = .0229, day 10) compared to mock controls. There were similarities between chemomechanical and mechanical injury mice with an increase in M2 macrophages at day 10 (P = .0196).

CONCLUSIONS: The bleomycin-induced LTS mouse model demonstrated increased macrophages involved with the development of fibrosis. Macrophage immunophenotype suggested that dysregulated M2 macrophages have a role in abnormal laryngotracheal wound healing. These data delineate inflammatory cells and signaling pathways in LTS that may potentially be modulated to lessen fibroblast proliferation and collagen deposition.

PMID: 26084828 [PubMed - indexed for MEDLINE]

Chondrosarcoma of chest wall metastasising to the larynx

J Cancer Res Ther. 2015;

Authors: Singhal A, Mahajan C, Hadi R, Awasthi NP

Abstract

Chondrosarcoma is the most common malignant tumor of the chest wall. Most patients present with painful progressive swelling in the anterior chest wall arising from the costochondrosternal junction. CT scan with intravenous contrast is the investigation of choice. Wide excision with adequate margins is the standard treatment for localized disease after image guided biopsy. The role of chemotherapy and radiotherapy is limited. Lung is the most common site for metastasis. Metastasis to the larynx from chondrosarcoma has not been reported in the literature though primary chondrosarcoma can occur in the larynx. We hereby report a case of laryngeal metastasis from chondrosarcoma of the chest wall as a part of disease failure.

PMID: 26458660 [PubMed - in process]

Opioid-Induced Hyperalgesia.

Pressure Pain Sensitivity in Patients With Suspected Opioid-Induced Hyperalgesia.

Reg Anesth Pain Med. 2015 Oct 14;

Authors: Wasserman RA, Hassett AL, Harte SE, Goesling J, Malinoff HL, Berland DW, Zollars J, Moser SE, Brummett CM

Abstract

BACKGROUND AND OBJECTIVES: This study was designed to test whether a brief quantitative sensory testing assessment could be used to detect hyperalgesia in patients with suspected opioid-induced hyperalgesia (OIH).

METHODS: Twenty patients on long-term opioid therapy with suspected OIH were recruited along with 20 healthy controls. Pressure pain threshold, Pain50, a measure of intermediate suprathreshold pressure pain sensitivity, and tolerance levels were evaluated. As a secondary outcome, changes in pressure pain sensitivity after intravenous administration of placebo (saline) and fentanyl (1.5 μg/kg) were assessed.

RESULTS: There were no significant differences in pain measures between healthy controls and patients. However, there was an association between higher doses of opioids and having a lower pain tolerance (r = -0.46, P = 0.041) and lower Pain50 (r = -0.46, P = 0.044), which was consistent with the hypothesis. Patients on more than 100 mg oral morphine equivalents displayed decreased pressure pain tolerance compared with patients taking less than 100 mg oral morphine equivalents (P = 0.042). In addition, male patients showed a hyperalgesic response to fentanyl administration, which was significant for the Pain50 measure (P = 0.002).

CONCLUSIONS: Whereas there were no differences between patients suspected of having OIH and the healthy controls, the finding that higher doses of opioids were associated with more sensitivity suggests that dose might be an important factor in the development of hyperalgesia. In addition, male patients demonstrated a hyperalgesic response after a bolus of fentanyl. Future studies are needed to develop better diagnostics for detecting hyperalgesia in the clinical setting.

PMID: 26469365 [PubMed - as supplied by publisher]

Preventive Acetaminophen Reduces Postoperative Opioid Consumption, Vomiting, and Pain Scores After Surgery: Systematic Review and Meta-Analysis.

Reg Anesth Pain Med. 2015 Oct 14;

Authors: Doleman B, Read D, Lund JN, Williams JP

Abstract

BACKGROUND AND OBJECTIVES: Preventive analgesia has been proposed as a potential strategy to reduce postoperative pain. However, there is currently no review that focuses on acetaminophen for preventive analgesia.

METHODS: We conducted a search of MEDLINE, EMBASE, Cinahl, AMED, and CENTRAL databases identifying randomized controlled trials that compared preventive acetaminophen with postincision acetaminophen.

RESULTS: Seven studies with 544 participants were included. Overall, the studies showed a reduction in 24-hour opioid consumption (standardized mean difference [SMD] of -0.52; 95% confidence interval [95% CI], -0.98 to -0.06), lower pain scores at 1 hour (MD, -0.50; 95% CI, -0.98 to -0.02) and 2 hours (MD, -0.34; 95% CI, -0.67 to -0.01), and a lower incidence of postoperative vomiting (risk ratio, 0.50; 95% CI, 0.31-0.83) in the preventive acetaminophen group. Current studies are limited by a potential risk of bias.

CONCLUSIONS: To our knowledge, this is the first review to describe a potential preventive effect of acetaminophen. However, well-conducted randomized controlled trials are necessary to substantiate the conclusions of this review.

PMID: 26469366 [PubMed - as supplied by publisher]

Local Anesthetic Systemic Toxicity

A Review of Local Anesthetic Systemic Toxicity Cases Since Publication of the American Society of Regional Anesthesia Recommendations: To Whom It May Concern.

Reg Anesth Pain Med. 2015 Oct 14;

Authors: Vasques F, Behr AU, Weinberg G, Ori C, Di Gregorio G

Abstract

Local anesthetic systemic toxicity (LAST) occurrence may cross several medical specialties. In 2010, the American Society of Regional Anesthesia and Pain Medicine (ASRA) published the first algorithm on LAST management, introducing the use of lipid emulsion (ILE) treatment. In the present study, we retrieved the cases of LAST published between ASRA guidelines dissemination and March 2014. We analyzed the reported clinical manifestations of LAST, characteristics of affected patients, onset time of toxicity, and clinical setting. We also focused on the treatment measures that were applied in the different cases, especially on the use of ILE and adherence to ASRA recommendations. Despite the limits of a review of case reports, the present study calls attention to the insidious nature of LAST, especially its atypical manifestations, and shows that ILE may currently be underadministered in daily clinical practice, especially in nonanesthesiology practice.

PMID: 26469367 [PubMed - as supplied by publisher]

Catheter Entrapment Next to the Inferior Vena Cava.

Management of a Rare Complication of Epidural Analgesia in an Obese Laterally Positioned Parturient: Catheter Entrapment Next to the Inferior Vena Cava.

Reg Anesth Pain Med. 2015 Oct 14;

Authors: Amir A, Lash V, Moore A, Rao P, Torres C, Kaufman I

Abstract

Intravascular, subdural, intrathecal, and subcutaneous placement of epidural catheters are known complications and common causes of anesthesia and analgesia failure. Because the epidural space is located near the retroperitoneum and catheters are placed blindly, it is possible that misplacement could involve other structures, including the inferior vena cava, the aorta, and the lumbar plexus. We report a case of an obese laterally positioned parturient who presented with an epidural catheter lodged in the retroperitoneum. The catheter provided inadequate analgesia for labor, and postpartum computed tomography revealed it to be located in the retroperitoneal space just adjacent to the inferior vena cava. Conventional removal techniques were unsuccessful, and the catheter was finally removed after insertion of a guide wire under fluoroscopy. We conclude that obesity and lateral positioning are factors that increase the risk of epidural catheter misplacement, and a large distance from skin to loss of resistance is a potential sign of misplacement. We recommend ultrasound imaging to aid in the insertion of epidural catheters in high-risk patients.

PMID: 26469368 [PubMed - as supplied by publisher]

Difference Between HPV-Positive and HPV-Negative Non-Oropharyngeal Head and Neck Cancer: Texture Analysis Features on CT.

J Comput Assist Tomogr. 2015 Oct 13;

Authors: Fujita A, Buch K, Li B, Kawashima Y, Qureshi MM, Sakai O

Abstract

OBJECTIVE: To identify the specific texture parameter that shows significant differences between human papillomavirus (HPV)-positive (HPV) and HPV-negative (HPV) non-oropharyngeal carcinoma (non-OPC) using texture analysis.

METHODS: Forty-six patients of non-OPC patients (oral cavity, larynx, and hypopharynx) with known HPV status, who underwent contrast-enhanced computed tomography for initial staging, were retrospectively reviewed. Segmentations of the primary lesion were manually performed, and an in-house developed texture analysis program extracted 42 texture features from each segmented volume. A t test was used to evaluate differences between HPV and HPV non-OPCs (P < 0.05).

RESULTS: Sixteen texture parameters, including 5 histogram features (P ≤ 0.03), 3 gray-level co-occurrence matrix features (P ≤ 0.02), 1 gray-level run-length feature (P = 0.009), 2 gray-level gradient matrix features (P ≤ 0.02), and 5 Law features (P ≤ 0.04), showed significant differences.

CONCLUSIONS: Texture analysis demonstrated significant differences between HPV and HPV non-OPCs on computed tomography images, which may have a potential to prove morphologic feature differences among HPV-related tumors.

PMID: 26466116 [PubMed - as supplied by publisher]

Angiotensin-converting Enzyme Inhibitor-induced Angioedema and Hereditary Angioedema: A Comparison Study of Attack Severity.

Intern Med. 2015;54(20):2583-8

Authors: Javaud N, Charpentier S, Lapostolle F, Lekouara H, Boubaya M, Lenoir G, Mekinian A, Adnet F, Fain O

Abstract

Objective There appears to be differences in the clinical presentation of hereditary angioedema (HAE) and angiotensin-converting enzyme inhibitor-induced (ACE-I) angioedema (AE). The aim of this study was to compare the clinical characteristics of these two AE forms. Methods We conducted a retrospective study of consecutive patients with HAE or ACE-I AE. The attack characteristics experienced by the patients were compared by a logistic regression analysis using generalized estimating equations. Results A total of 56 patients were included in this study (ACE-I AE, n=25; HAE, n=31). A total of 534 attacks were documented. Severe attacks were more common in the patients who had an acute episode of ACE-I AE than HAE. Swelling of the tongue, lips and larynx were significantly associated with ACE-I AE [OR: 8.70 (95% CI, 1.04-73.70), OR: 20.4 (95% CI, 4.9-84.2) and OR: 7.50 (95% CI, 1.20-48.30), respectively]. Conclusion Swelling of the tongue, lips and larynx are significantly more frequent in drug-induced AE than HAE.

PMID: 26466692 [PubMed - in process]

Overexpression of the mitochondrial methyltransferase TFB1M in the mouse does not impact mitoribosomal methylation status or hearing.

Authors: Lee S, Rose S, Metodiev MD, Becker L, Vernaleken A, Klopstock T, Gailus-Durner V, Fuchs H, Hrabě de Angelis M, Douthwaite S, Larsson NG

Abstract

Mitochondrial dysfunction is a well-established cause of sensorineural deafness, but the pathophysiological events are poorly understood. Non-syndromic deafness and predisposition to aminoglycoside-induced deafness can be caused by specific mutations in the 12S rRNA gene of mtDNA and are thus maternally inherited traits. The pathophysiology induced by mtDNA mutations has traditionally been attributed to deficient oxidative phosphorylation, which causes energy crisis with functional impairment of multiple cellular processes. In contrast, it was recently reported that signalling induced by 'hypermethylation' of two conserved adenosines of 12S rRNA in the mitoribosome are of key pathophysiological importance in sensorineural deafness. In support for this concept, it was reported that overexpression of the essential mitochondrial methyltransferase TFB1M in the mouse was sufficient to induce mitoribosomal hypermethylation and deafness. At variance with this model, we show here that 12S rRNA is near fully methylated in vivo in the mouse and thus cannot be further methylated to any significant extent. Furthermore, bacterial artificial chromosome (BAC) transgenic mice overexpressing TFB1M have no increase of 12S rRNA methylation levels and hear normally. We thus conclude that therapies directed against mitoribosomal methylation are unlikely to be beneficial to patients with sensorineural hearing loss or other types of mitochondrial disease.

PMID: 26464487 [PubMed - as supplied by publisher]

Systems biology approaches to adverse drug effects: the example of cardio-oncology.

Nat Rev Clin Oncol. 2015 Oct 13;

Authors: Brown SA, Sandhu N, Herrmann J

Abstract

Increased awareness of the cardiovascular toxic effects of chemotherapy has led to the emergence of cardio-oncology (or onco-cardiology), which focuses on screening, monitoring and treatment of patients with cardiovascular dysfunctions resulting from chemotherapy. Anthracyclines, such as doxorubicin, and HER2 inhibitors, such as trastuzumab, both have cardiotoxic effects. The biological rationale, mechanisms of action and cardiotoxicity profiles of these two classes of drugs, however, are completely different, suggesting that cardiotoxic effects can occur in a range of different ways. Advances in genomics and proteomics have implicated several genomic variants and biological pathways that can influence the susceptibility to cardiotoxicity from these, and other drugs. Established pathways include multidrug resistance proteins, energy utilization pathways, oxidative stress, cytoskeletal regulation and apoptosis. Gene-expression profiles that have revealed perturbed pathways have vastly increased our knowledge of the complex processes involved in crosstalk between tumours and cardiac function. Utilization of mathematical and computational modelling can complement pharmacogenomics and improve individual patient outcomes. Such endeavours should enable identification of variations in cardiotoxicity, particularly in those patients who are at risk of not recovering, even with the institution of cardioprotective therapy. The application of systems biology holds substantial potential to advance our understanding of chemotherapy-induced cardiotoxicity.

PMID: 26462128 [PubMed - as supplied by publisher]

Anti-inflammatory effects of triptolide on IgA nephropathy in rats.

Immunopharmacol Immunotoxicol. 2015 Oct;37(5):421-7

Authors: He L, Peng X, Liu G, Tang C, Liu H, Liu F, Zhou H, Peng Y

Abstract

IgA nephropathy (IgAN) is the finding of immune deposits predominantly containing polymeric IgA in the glomerular mesangium on renal biopsy. Recently studies show that inflammation may involve in the progression of renal glomerulosclerosis and tubulointerstitial scarring in IgAN. This study was designed to evaluate the renoprotective effect of triptolide on IgAN rat model. IgAN was induced in Sprague-Dawley rats by oral and intravenous immunization with BSA for 12 weeks. Rats were treated with triptolide (200 μg/kg/d intragastrically) from 12 to 28 weeks. At Week 28, the rats was sacrificed, kidneys and blood samples were collected for further analysis. Our data shown that IgAN rat model showed marked deterioration of proteinuria together with higher levels of the urine protein:creatinine ratio compared to the normal control. Animals that underwent intermittent exposure to triptolide treatment exhibited significant improvements in the functional parameters without severe side effects. Rats developing IgAN had profound mesangial proliferation and mesangial expansion, intense and diffuse glomerular IgA deposition, while triptolide treatment significantly attenuated it. We also observed that treatment with triptolide significantly decreases serum levels of IL-1β and IL-18, and may exerted anti-inflammatory effects by down-regulating NLRP3 and TLR4 expression. Our study clearly demonstrated that triptolide prevents IgAN progression via an amelioration of inflammasome-mediated proinflammatory cytokine production, thus brought a light of hope for treatment of IgAN.

PMID: 26466641 [PubMed - in process]

Additive effects of rapamycin and aspirin on dendritic cell allostimulatory capacity.

Immunopharmacol Immunotoxicol. 2015 Oct;37(5):434-41

Authors: Roehrich ME, Wyss JC, Kumar R, Pascual M, Golshayan D, Vassalli G

Abstract

Acting as antigen presenting cells, mature dendritic cells (DCs) initiate both innate and adaptive alloimmune responses. However, immature DCs are weak immunostimulators and mediate tolerogenic effects under certain conditions. Tolerogenic activities of immature DCs can be enhanced by pharmacological agents. Here, we compared pharmacological DC preconditioning with rapamycin and aspirin, applied alone or in combination, on LPS-induced DC maturation and T-cell allostimulatory capacity. Preconditioning with aspirin but not rapamycin tended to reduce the number of mouse bone marrow-derived immature DCs expressing CD40 and major histocompatibility complex class II molecules upon LPS stimulation. Conversely, DC preconditioning with rapamycin, but not aspirin, reduced T-cell alloproliferative responses. A combination of rapamycin and aspirin was more effective than either drug applied alone with respect to inhibition of T-cell alloproliferation. The two agents in combination reduced numbers of CD4(+)IFN-γ(+) Th1 and CD4(+)IL-17(+) Th17 effector cells while maintaining Foxp3(+) regulatory T cells. These results suggest aspirin may moderately enhance rapamycin-mediated inhibition of DC allostimulatory capacity.

PMID: 26466642 [PubMed - in process]

Simultaneous administration of hesperidin or garlic oil modulates diazinon-induced hemato- and immunotoxicity in rats.

Immunopharmacol Immunotoxicol. 2015 Oct;37(5):442-9

Authors: Hassouna I, Ibrahim H, Abdel Gaffar F, El-Elaimy I, Abdel Latif H

Abstract

Diazinon (DZN) has been used for several years in agriculture and urban applications leading to a variety of negative effects on health. Hesperidin (HDN) and garlic oil are naturally occurring compounds present in fruits and vegetables, which have been reported to have antioxidants and anti-inflammatory actions. This study was undertaken to throw light on the modulatory effect of HDN or garlic oil against hemato- and immunotoxicity induced by DZN in Wistar rats. Oral administration of DZN for 30 days resulted in significant decrease in RBCs count, Hb content, Ht value, platelet count, and relative lymphocyte and monocyte counts when compared with control groups. Moreover, DZN reduced significantly the serum total immunoglobulin concentration, hemagglutination titer, quantitative hemolysis of SRBCs, delayed type hypersensitivity, blood mononuclear cell proliferation, phagocytic index and blood T-cell subtypes (CD4(+) and CD8(+)) in comparison with vehicle treatment. Co-administration of HDN or garlic oil, 30 min before DZN was able to normalize most of the hematological and immunological parameters. These results suggested that HDN or garlic oil, the natural antioxidants, can alleviate DZN induced hemato- and immunotoxicity.

PMID: 26466643 [PubMed - in process]

The immunomodulatory effects of barettin and involvement of the kinases CAMK1α and RIPK2.

Immunopharmacol Immunotoxicol. 2015 Oct;37(5):458-64

Authors: Lind KF, Østerud B, Hansen E, Jørgensen TØ, Andersen JH

Abstract

BACKGROUND: Barettin is a marine natural compound with reported anti-inflammatory and antioxidant properties. The combination of these effects led us to explore barettin further as an inhibitor of atherosclerosis development.

METHODS: The effect of barettin on MCP-1 and IL-10 secretion from activated immune cells was detected by ELISA. Determination of cell viability of oxidized low-density lipoprotein (oxLDL) and barettin exposed HUVEC cells were investigated by using CellTiter 96® AQueous One Solution. The kinase inhibition assays were performed using a radioactive ((33)P-ATP) filter binding assay at the University of Dundee, UK.

RESULTS: Barettin reduces the secretion of monocyte chemotactic protein-1 (MCP-1) from LPS-stimulated monocytes, but was not able to prevent oxLDL-induced cell death in HUVEC. Barettin has inhibitory activity against two protein kinases related to inflammation, namely the receptor-interacting serine/threonine kinase 2 (RIPK2) and calcium/calmodulin-dependent protein kinase 1α (CAMK1α). We also demonstrate that barettin reduce the production of the anti-inflammatory cytokine interleukin-10 (IL-10) in a dose and time-dependent manner, possibly by inhibiting CAMK1α.

CONCLUSIONS: The anti-inflammatory activity of barettin is exerted through the regulation of inflammatory mediators such as MCP-1 and IL-10, possibly via inhibition of kinases.

PMID: 26466644 [PubMed - in process]

Cucurbitacin B inhibits immunomodulatory function and the inflammatory response in macrophages.

Immunopharmacol Immunotoxicol. 2015 Oct;37(5):473-80

Authors: Kim M, Park SY, Jin ML, Park G, Son HJ

Abstract

Cucurbitacin B (CuB) is a triterpenoid that is widely distributed in the plant kingdom and has a variety of biological activities. However, the immunomodulatory and anti-inflammatory effects of CuB have not been well characterized. Therefore, in this study, we investigated the effects of CuB on parameters related to antigen presentation and T-cell activation. Specifically, we examined the effects of CuB on basal and lipopolysaccharide (LPS)-induced expression of class I and II MHC molecules, CD40, CD54, CD80, and CD86 in peritoneal macrophages. The LPS-a expression of MHC II, CD40, CD54, and CD80 was significantly attenuated by CuB. However, expression levels of MHC I and CD86 were not changed by CuB. CuB inhibited the production of intracellular reactive oxygen species induced by LPS and blocked the LPS-activated release of pro-inflammatory mediators, such as nitric oxide (NO), prostaglandin E2, tumor necrosis factor-α, interleukin (IL)-6, IL-12, and IL-1β, without any cytotoxicity. Consistent with this, CuB also reduced the expression levels of inducible NO synthase and cyclooxygenase-2 induced by LPS. Furthermore, we demonstrated that the anti-inflammatory effects of CuB were dependent on the induction of heme oxygenase-1 expression via Nrf2 activation. Taken together, these data indicate that CuB possesses immunomodulatory and anti-inflammatory effects, and it may be used as an effective herbal remedy for the treatment and prevention of inflammation.

PMID: 26466646 [PubMed - in process]

Office-Based Subglottic Evaluation in Children With Risk of Subglottic Hemangioma.

Ann Otol Rhinol Laryngol. 2015 Oct 14;

Authors: Chun RH, McCormick ME, Martin T, Drolet BA, Kerschner JE

Abstract

PURPOSE: Children with V3 cutaneous infantile hemangiomas (IH) and PHACE syndrome have a high incidence for airway hemangioma, 29% and 52%, respectively. Therefore, a clinical evaluation for these high-risk children is essential. We report our experience with in-office lower airway evaluation (OLAE) in these high-risk children.

RESULTS: Since 2003, 5 children with IH of the V3 cutaneous distribution and 3 children with PHACE syndrome underwent OLAE. Average age of presentation was 2.75 months. Two children had stridor at initial evaluation, and 1 child had subglottic hemangioma. This child was evaluated serially with OLAE to monitor disease progression and treatment response. A total of 10 upper tracheoscopies were performed on the 8 patients without respiratory complications.

CONCLUSION: An airway evaluation is essential to evaluate and manage this high-risk population. Typically, operative endoscopy requires general anesthesia. However, in these high-risk children, we have performed OLAE without sedation to evaluate the trachea. High-speed recording and playback is essential in this method. Our series demonstrates that awake OLAE is possible and may be a safe technique to evaluate and monitor disease progression in these high-risk patients. These patients avoided general anesthesia and delay in diagnosis and did not incur any complications during or after OLAE.

PMID: 26466859 [PubMed - as supplied by publisher]

Predictors of Posterior Glottic Stenosis: A Multi-Institutional Case-Control Study.

Ann Otol Rhinol Laryngol. 2015 Oct 14;

Authors: Hillel AT, Karatayli-Ozgursoy S, Samad I, Best SR, Pandian V, Giraldez L, Gross J, Wootten C, Gelbard A, Akst LM, Johns MM, North American Airway Collaborative (NoAAC)

Abstract

OBJECTIVE: To assess intrinsic and extrinsic risk factors in the development of posterior glottic stenosis (PGS) in intubated patients.

METHODS: Patients diagnosed with PGS between September 2012 and May 2014 at 3 tertiary care university hospitals were included. Patient demographics, comorbidities, duration of intubation, endotracheal tube (ETT) size, and indication for intubation were recorded. Patients with PGS were compared to control patients represented by patients intubated in intensive care units (ICU).

RESULTS: Thirty-six PGS patients were identified. After exclusion, 28 PGS patients (14 male, 14 female) and 112 (65 male, 47 female) controls were studied. Multivariate analysis demonstrated ischemia (P < .05), diabetes (P < .01), and length of intubation (P < .01) were significant risk factors for the development of PGS. Fourteen of 14 (100%) males were intubated with a size 8 or larger ETT compared to 47 of 65 (72.3%) male controls (P < .05). Posterior glottic stenosis (P < .01), length of intubation (P < .001), and obstructive sleep apnea (P < .05) were significant risk factors for tracheostomy.

CONCLUSION: Duration of intubation, ischemia, diabetes mellitus, and large ETT size (8 or greater) in males were significant risk factors for the development of PGS. Reducing the use of size 8 ETTs and earlier planned tracheostomy in high-risk patients may reduce the incidence of PGS and improve ICU safety.

PMID: 26466860 [PubMed - as supplied by publisher]

[Chemotherapy with paclitaxel leads to microRNA release].

HNO. 2015 Oct 13;

Authors: Maushagen R, Pries R, Wollenberg B

Abstract

BACKGROUND: During recent years, microRNAs (Greek: micros = small; miRNA) have become more important. miRNAs are highly conserved, noncoding, single-stranded RNA molecules 17-28 nucleotide in length. Secreted by tumor cells, miRNAs regulate many biological processes and are also involved in chemoresistance. Classical forms of cancer treatment lead to miRNA release. Which miRNAs are correlated to head and neck squamous cell carcinomas (HNSCC) and their chemoresistance to paclitaxel remains unknown.

OBJECTIVES: Identification of miRNAs expressed in HNSCC and elucidation of those involved in conferring chemoresistance to paclitaxel.

MATERIALS AND METHODS: To identify changes in gene expression, HNSCC cell lines were treated with 10 µM paclitaxel for 48 h and analyzed by microarray analysis. Thereafter, changed in expression of single miRNAs (miR221*, miR222 and miR222*) following paclitaxel treatment were analyzed using a quantitative real-time polymerase chain reaction (qRT-PCR).

RESULTS: Under treatment with paclitaxel, miRNAs were released. The dominant change is upregulation of MIR222 gene expression. Regulation of miR222* expression under paclitaxel treatment seems to be different in human papillomavirus (HPV)-negative and HPV-positive HNSCC cell lines.

CONCLUSION: Expression of mirR221/222 is correlated to cell cycle regulation, carcinogenesis, and chemoresistance. Detailed knowledge of the molecular mechanisms and effects of miRNAs is important for identifying miRNAs as cancer markers, as well as for increasing the efficiency of cancer therapeutics.

PMID: 26464363 [PubMed - as supplied by publisher]

Magnitude of Myocutaneous Flaps and Factors Associated With Loss of Volume in Oral Cancer Reconstructive Surgery.

J Oral Maxillofac Surg. 2015 ;

Authors: Sakamoto Y, Yanamoto S, Ota Y, Furudoi S, Komori T, Umeda M

Abstract

PURPOSE: Myocutaneous flaps are often used to repair oral and maxillofacial defects after surgery for oral cancer; however, their volume decreases during the postoperative period. To facilitate treatment planning, the authors measured the extent of such postoperative flap volume loss and identified associated factors in patients who underwent oral reconstruction with myocutaneous flaps.

MATERIALS AND METHODS: The authors designed and performed a retrospective observational study of patients who underwent reconstructive procedures involving rectus abdominal myocutaneous (RAM) or pectoralis major myocutaneous (PMMC) flaps at Tokai University Hospital, Kobe University Hospital, or Nagasaki University Hospital from April 2009 through March 2013. Flap type and other clinical variables were examined as potential predictors of flap loss. The primary outcome was flap loss at 6 months postoperatively. Correlations between each potential predictor and the primary outcome were examined using multiple regression analysis.

RESULTS: The subjects were 75 patients whose oral defects were reconstructed with RAM flaps (n = 57) or PMMC flaps (n = 18). RAM flaps exhibited a mean volume shrinkage of 22% at 6 months postoperatively, which was less than the 27.5% displayed by the PMMC flaps, but the difference was not important. Renal failure, previous surgery of the oral region, postoperative radiotherapy, and postoperative serum albumin level were found to be meaningful risk factors for postoperative flap volume loss.

CONCLUSION: The results of this study suggest that larger flaps should be used in patients who possess these risk factors or are scheduled to undergo postoperative radiotherapy. Future studies should examine the utility of postoperative nutritional management for preventing flap volume loss.

PMID: 26460885 [PubMed - as supplied by publisher]

Technology for Innovation in Radiation Oncology.

Int J Radiat Oncol Biol Phys. 2015 Nov 1;93(3):485-92

Authors: Chetty IJ, Martel MK, Jaffray DA, Benedict SH, Hahn SM, Berbeco R, Deye J, Jeraj R, Kavanagh B, Krishnan S, Lee N, Low DA, Mankoff D, Marks LB, Ollendorf D, Paganetti H, Ross B, Siochi RA, Timmerman RD, Wong JW

Abstract

Radiation therapy is an effective, personalized cancer treatment that has benefited from technological advances associated with the growing ability to identify and target tumors with accuracy and precision. Given that these advances have played a central role in the success of radiation therapy as a major component of comprehensive cancer care, the American Society for Radiation Oncology (ASTRO), the American Association of Physicists in Medicine (AAPM), and the National Cancer Institute (NCI) sponsored a workshop entitled "Technology for Innovation in Radiation Oncology," which took place at the National Institutes of Health (NIH) in Bethesda, Maryland, on June 13 and 14, 2013. The purpose of this workshop was to discuss emerging technology for the field and to recognize areas for greater research investment. Expert clinicians and scientists discussed innovative technology in radiation oncology, in particular as to how these technologies are being developed and translated to clinical practice in the face of current and future challenges and opportunities. Technologies encompassed topics in functional imaging, treatment devices, nanotechnology, and information technology. The technical, quality, and safety performance of these technologies were also considered. A major theme of the workshop was the growing importance of innovation in the domain of process automation and oncology informatics. The technologically advanced nature of radiation therapy treatments predisposes radiation oncology research teams to take on informatics research initiatives. In addition, the discussion on technology development was balanced with a parallel conversation regarding the need for evidence of efficacy and effectiveness. The linkage between the need for evidence and the efforts in informatics research was clearly identified as synergistic.

PMID: 26460989 [PubMed - in process]

The long-term results and prognostic significance of cutaneous melanoma surgery using sentinel node biopsy with triple technique.

World J Surg Oncol. 2015;13:299

Authors: Rutkowski P, Szydłowski K, Nowecki ZI, Sałamacha M, Goryń T, Mitręga-Korab B, Pieńkowski A, Dziewirski W, Zdzienicki M

Abstract

BACKGROUND: The sentinel lymph node biopsy (SLN) is a basic staging method in all primary cutaneous melanomas ≥pT1b. The standard technique is a triple technique consisting of preoperative lymphoscintigraphy, intraoperative blue-dye lymphography, and gamma-probe assessment. We performed the analysis of long-term results in a very large one-institution series of cutaneous melanoma patients.

METHODS: We have analyzed treatment results of a group of 1764 consecutive patients with cutaneous melanoma, who underwent SLN biopsy between 1997 and 2008 in one tertiary center. Additionally, we have analyzed the outcomes of a group of 473 patients with positive SLN biopsy undergoing completion lymph node dissection (CLND). Median follow-up time was 5.3 years.

RESULTS: Metastases to SLN (SLN+) were found in 19.9 %. Eight-year overall survival (OS) rate in the entire group was 73.5 %, 80 % without SLN metastases (SLN-) and 50 % in group with SLN+ (p < 0.001). Independent prognostic factors for OS were as follows: presence of metastases to SLN, primary tumor ulceration, and higher mitotic index (>5/mm(2)) of primary tumor. The nodal recurrences in the biopsied lymphatic basin were 5.4 %. The metastases to non-sentinel lymph nodes (NSLN found in 27 % of patients with SLN+) correlated (on multivariable logistic regression analysis) with primary tumor thickness >4 mm, SLN metastatic deposit size >1 mm, and extracapsular involvement of SLN. In an additionally analyzed SLN+ group, the NSLN involvement was related to poorer prognosis (8-year OS rate NSLN- vs NSLN+: 59.6 vs. 34.7 %, respectively). The independent prognostic factors for OS in the SLN+ group were a higher Breslow thickness and ulceration of primary tumor, metastases to more than 1 lymph nodes.

CONCLUSIONS: The long-term results confirm crucial prognostic significance of SLN biopsy in cutaneous melanoma. We identified factors related to NSLN involvement, which in the future may limit indications for CLND.

PMID: 26462471 [PubMed - in process]

Current and future treatment of anaplastic lymphoma kinase-rearranged cancer.

World J Clin Oncol. 2015 Oct 10;6(5):104-8

Authors: Mologni L

Abstract

Aberrant forms of the anaplastic lymphoma kinase (ALK) are involved in the pathogenesis of several types of cancer, including anaplastic large cell lymphoma, non-small-cell lung cancer (NSCLC), inflammatory myofibroblastic tumors, colorectal cancer, neuroblastoma and others. In general, the ALK catalytic domain is rearranged and fused to a dimerization domain encoded by an unrelated gene. Less frequently, full-length ALK is activated by point mutations. The common theme is unregulated firing of ALK downstream signalling, leading to uncontrolled cell division and increased cell survival. ALK-driven tumors can be treated with Crizotinib, an orally available dual ALK/MET inhibitor, currently approved for advanced ALK-positive NSCLCs. Crizotinib-treated patients achieve high response rates, with an excellent toxicity profile. However, drug-resistant disease often develops, particularly in NSCLC patients. The processes leading to drug resistance include both ALK-dependent (point mutations or gene amplification), as well as ALK-independent mechanisms, which are here briefly discussed. Recently, Ceritinib has been approved for Crizotinib-refractory NSCLC, further extending patients' survival, but resistance again emerged. Novel ALK kinase inhibitors are currently under clinical development, showing great promise for improved efficacy in drug-resistance disease. It is opinion of the author that drug-resistance is likely to arise under any treatment, due to intrinsic heterogeneity and adaptability of cancer. To prevent or delay this phenomenon, we need to treat less advanced disease, with drugs that are rapidly effective in order not to allow enough time for tumor evolution, and we want to have more and more drugs with non-overlapping resistance profiles, for subsequent lines of targeted therapy. Finally, the use of drug combinations may exponentially decrease the chances of resistance.

PMID: 26468446 [PubMed]

[Current Cancer Immunotherapy Using Activated Lymphocytes - Do Lymphocytes Actually Recognize Cancer Cells ?]

Gan To Kagaku Ryoho. 2015 ;

Authors: Yamaguchi Y, Katata Y, Okawaki M, Yamamura M, Sawaki A

Abstract

Molecular cloning of interleukin-2(IL-2)has enabled adoptive cell therapy(ACT)to be established by using autologous activated lymphocytes. The low of regenerative medicine will promote the active development of ACT for public use, and ACTs that utilize tumor-infiltrating lymphocytes(TIL), in vitro tumor-sensitized lymphocytes, natural killer T cells, and gammadelta T cells are being evaluated as advanced medical treatments in Japan. In addition, chimeric antigen receptor genemodified T(CAR-T)cells and T cell receptor gene-modified T(TCR-T)cells are available for investigational clinical use. CART and TCR-T cells have been associated with serious adverse events as well as drastic clinical efficacies, indicating the importance of choosing the antigens to be targeted. Presently, it is accurate to state that lymphocytes do recognize cancer cells. Clinical ACT research focusing on TILand mutated cancer antigens will be initiated for the development of personalized immunotherapy for cancer in the future.

PMID: 26469157 [PubMed - as supplied by publisher]

Impact of obturation of palatal fistulae on speech quality and aerodynamic parameters in patients with cleft palates.

Authors: Woisard V, Noirrit-Esclassan E, Vandrebeck V, Al Hawat A, Galinier P, Lauwers F

Abstract

OBJECTIVES: The aim of this prospective study was to measure nasal and oral airflow during speech, before and after obturation.

PATIENTS AND METHODS: Included were children aged 3-18 years with nonsyndromic clefts and palatal fistulae. The corpus used was: syllable /pi/; a sentence containing stop consonants and a nasal phoneme; and the description of a picture of a scene. Analysis criteria were: percentage of nasality; value of average flow for the explosion; perceived nasality and intelligibility; and tolerance of the proposed device.

RESULTS: Only 5 children were included due to the observation of an increase in the percentage of nasality after obturation. The value of average flow for the explosion increased in all patients. A decrease in perceived nasality was noted in all but 1 patient. An improvement in intelligibility was observed in 3 out of the 5 children. The tolerance of the device was good.

CONCLUSION: While the small number of patients studied does not permit firm conclusions concerning the efficiency of the obturation, the method described, as well as the introduction of 'speed of explosion' of stop consonants, offer new perspectives to prospectively study obturator effects on speech.

PMID: 24356258 [PubMed - indexed for MEDLINE]

Attention modulates cortical processing of pitch feedback errors in voice control.

Authors: Hu H, Liu Y, Guo Z, Li W, Liu P, Chen S, Liu H

Abstract

Considerable evidence has shown that unexpected alterations in auditory feedback elicit fast compensatory adjustments in vocal production. Although generally thought to be involuntary in nature, whether these adjustments can be influenced by attention remains unknown. The present event-related potential (ERP) study aimed to examine whether neurobehavioral processing of auditory-vocal integration can be affected by attention. While sustaining a vowel phonation and hearing pitch-shifted feedback, participants were required to either ignore the pitch perturbations, or attend to them with low (counting the number of perturbations) or high attentional load (counting the type of perturbations). Behavioral results revealed no systematic change of vocal response to pitch perturbations irrespective of whether they were attended or not. At the level of cortex, there was an enhancement of P2 response to attended pitch perturbations in the low-load condition as compared to when they were ignored. In the high-load condition, however, P2 response did not differ from that in the ignored condition. These findings provide the first neurophysiological evidence that auditory-motor integration in voice control can be modulated as a function of attention at the level of cortex. Furthermore, this modulatory effect does not lead to a general enhancement but is subject to attentional load.

PMID: 25589447 [PubMed - indexed for MEDLINE]

Intraparenchymal meningioma within the basal ganglia of a child: A case report.

Br J Neurosurg. 2015 Oct 14;:1-3

Authors: Reynolds MR, Boland MR, Arias EJ, Farrell M, Javadpour M, Caird J

Abstract

Intraparenchymal meningiomas are rare. To date, no such lesion has been reported within the basal ganglia of a paediatric patient. Here, we describe the case of a 15-year-old-boy who presented with symptoms referable to a cystic, calcified, left basal ganglia intraparenchymal meningioma and discuss the surgical management of this lesion.

PMID: 26466020 [PubMed - as supplied by publisher]

Damage control of civilian penetrating brain injuries in environments of low neuro-monitoring resources.

Br J Neurosurg. 2015 Oct 15;:1-5

Authors: Charry JD, Rubiano AM, Puyana JC, Carney N, David Adelson P

Abstract

INTRODUCTION: Gunshot wounds to the head are more common in military settings. Recently, a damage control (DC) approach for the management of these lesions has been used in combat areas. The aim of this study was to evaluate the results of civilian patients with penetrating gunshot wounds to the head, managed with a strategy of early cranial decompression (ECD) as a DC procedure in a university hospital with few resources for intensive care unit (ICU) neuro-monitoring in Colombia.

MATERIALS AND METHODS: Fifty-four patients were operated according to the DC strategy (<12 h after injury), over a 4-year period. Variables were analysed and results were evaluated according to the Glasgow Outcome Scale (GOS) at 12 months post injury; a dichotomous variable was established as 'favourable' (GOS 4-5) or 'unfavourable' (GOS 1-3). A univariate analysis was performed using a χ(2) test.

RESULTS: Forty (74.1%) of the patients survived and 36 (90%) of them had favourable GOS. Factors associated with adverse outcomes were: Injury Severity Score (ISS) greater than 25, bi-hemispheric involvement, intra-cerebral haematoma on the first CT, closed basal cisterns and non-reactive pupils in the emergency room.

CONCLUSION: DC for neurotrauma with ECD is an option to improve survival and favourable neurological outcomes 12 months after injury in patients with penetrating traumatic brain injury treated in a university hospital with few resources for ICU neuro-monitoring.

PMID: 26469861 [PubMed - as supplied by publisher]

Germinoma of the medulla oblongata - A case report.

Br J Neurosurg. 2015 Oct 15;:1-3

Authors: Budohoski KP, O'Donovan DG, Harris F, Santarius T

Abstract

We describe a case of primary intracranial medulla oblongata germinoma in a 23-year-old female who presented with deteriorating balance and mobility. Imaging demonstrated an exophytic lesion arising from the dorsal medulla oblongata and extending into the fourth ventricle. The tissue sample was obtained via suboccipital craniotomy and a diagnosis of a primary medullary germinoma was made. The patient underwent whole craniospinal axis radiotherapy and remains well and recurrence-free at 1-year follow up.

PMID: 26470001 [PubMed - as supplied by publisher]

Incidental findings of thyroid tissue in cervical lymph nodes: old controversy not yet resolved?

Eur Arch Otorhinolaryngol. 2015 Oct 12;

Authors: Triantafyllou A, Williams MD, Angelos P, Shah JP, Westra WH, Hunt JL, Devaney KO, Rinaldo A, Slootweg PJ, Gnepp DR, Silver C, Ferlito A

Abstract

The clinical significance of papillary or follicular thyroid tissue incidentally discovered in cervical lymph nodes during pathological assessment of neck dissections for non-thyroid cancers of the upper aero-digestive tract is critically reviewed. Special emphasis is given to controversies over normal-looking, nodal, thyroid follicles. Arguments for and against the benign nature of these follicles are considered together with processes that could be involved in their formation. The admittedly limited evidence suggests that benign, thyroid follicular inclusions rarely occur in cervical lymph nodes. Histological criteria that could be helpful in recognizing the inclusions, which include assessing their extent in conjunction with the size of the node, are discussed. Finally, an algorithm based on collaboration between specialists, correlating histological findings with imaging and loco-regional control of the upper aero-digestive tract cancer, is suggested for the management of patients with incidentally discovered, nodal thyroid tissue.

PMID: 26459007 [PubMed - as supplied by publisher]

Management of locally advanced HPV-related oropharyngeal squamous cell carcinoma: where are we?

Eur Arch Otorhinolaryngol. 2015 Oct 13;

Authors: Samuels SE, Eisbruch A, Beitler JJ, Corry J, Bradford CR, Saba NF, van den Brekel MW, Smee R, Strojan P, Suárez C, Mendenhall WM, Takes RP, Rodrigo JP, Haigentz M, Rapidis AD, Rinaldo A, Ferlito A

Abstract

HPV-related (HPV+) oropharyngeal cancer (OPC) has a better prognosis compared to HPV unrelated (HPV-) OPC. This review summarizes and discusses several of the controversies regarding the management of HPV+ OPC, including the mechanism of its treatment sensitivity, modern surgical techniques, chemotherapy regimens, and treatment de-intensification protocols. We also discuss and reconsider potential adverse prognostic factors such as tumor EGFR expression, tumor hypoxia, and patient smoking history, as well as the significance of retropharyngeal adenopathy. Finally, we discuss elective nodal treatment of uninvolved lymph node stations. While this review does not exhaust all controversies related to the management of HPV+ OPC, it aims to highlight some of the most clinically relevant ones.

PMID: 26463714 [PubMed - as supplied by publisher]

Novel modification of voice prosthesis.

Eur Arch Otorhinolaryngol. 2015 Oct 13;

Authors: Al Kadah B, Papaspyrou G, Schneider M, Schick B

Abstract

The undesired dilatation of the tracheooesophageal shunt after surgical implantation of voice prosthesis is a typical complication of this procedure. Temporary removal of the prosthesis and reinsertion after a short period of time is a first-line therapeutical option aiming shrinkage of the shunt. Failure of this measure generally is an indication of revision surgery. We present first experiences treating leakage problems with novel modified voice prosthesis without surgical intervention in specified cases. 11 patients (1 female, 10 male) aging between 51 and 71 years were presented with shunt leakage between 11/2008 and 11/2012 in the ENT-Department of the University Hospital of Homburg/Saar after a custom built voice prosthesis had been used initially successfully. A "Provox 2"(®) voice prosthesis was modified with two discs made of silicone each on the tracheal and oesophageal side and additionally reinforcing the diameter of the prosthesis by a silicone tube. The modified prosthesis was inserted in a retrograde way under general anesthesia, analogical to the approach used with the "Provox 1"(®)-prosthesis. The period of observation ranged between 12 and 48 months. As a measure of control swallowing of methylene blue was used. In all cases leakage suspended. Durability of the modified prosthesis ranged between 2 and 6 months. Neither the patients' complained about, nor did the physicians notice subjectively an impairment of the voice quality. Modifications of "Provox 2"(®)-prosthesis should be regarded in individual cases and constitute a reasonable alternative to revision surgery. A surgical approach is more intricate and costly, more taxing for the patient and susceptible to failure. We regard the necessity of general anesthesia for the insertion of the modified prosthesis as a disadvantage.

PMID: 26463715 [PubMed - as supplied by publisher]

Long-Term Voice Outcomes After Robotic Thyroidectomy.

World J Surg. 2015 Oct 13;

Authors: Song CM, Yun BR, Ji YB, Sung ES, Kim KR, Tae K

Abstract

BACKGROUND: The purpose of this study was to evaluate the long-term voice function after robotic thyroidectomy in comparison with conventional transcervical thyroidectomy.

METHODS: We prospectively evaluated the voice functions of 54 patients with thyroid nodules who underwent robotic thyroidectomy by a gasless unilateral axillary or axillo-breast approach and of 70 patients who underwent conventional thyroidectomy. Subjective voice symptom score (VSS) was evaluated in questionnaires before thyroidectomy and then at 3, 6, 12, and 24 months after surgery. Objective acoustic parameters analyzed during the same period included fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, highest frequency, frequency and intensity range, and maximal phonation time.

RESULTS: At 3 months after surgery, VSS was better in the robotic group than in the conventional group. At 2 years after surgery, VSS had recovered to the pre-operative level in the robotic group, whereas it remained significantly worse at 2 years in the conventional group. The phonatory frequency range and highest frequency were significantly wider and higher, respectively, in the robotic group than the conventional group at 6, 12, and 24 months post-operatively. Within the robotic group, the frequency range and highest frequency recovered to pre-operative levels by 6 months, whereas in the conventional group they remained below the pre-operative levels at 2 years post-operatively. There were no differences in other acoustic parameters between the two groups of patients at any period.

CONCLUSION: Up to 2 years post-operatively, robotic thyroidectomy has advantages in terms of recovery of voice symptoms and acoustic parameters over conventional thyroidectomy.

PMID: 26464152 [PubMed - as supplied by publisher]

Adaptation of Continuous Intraoperative Vagus Nerve Stimulation for Monitoring of Recurrent Laryngeal Nerve During Minimally Invasive Esophagectomy.

World J Surg. 2015 Oct 13;

Authors: Tsang RK, Law S

Abstract

INTRODUCTION: Esophagectomy has risk of recurrent laryngeal nerve (RLN) injury. Conventional nerve monitoring has been used to help identify and protect the RLN. A new concept of continuous intraoperative nerve monitoring (CIONM) by stimulation of the ipsilateral vagus nerve has been used in thyroidectomy. The current report describes adapting the CIONM method for use in video-assisted thoracoscopic (VATS) esophagectomy.

MATERIALS AND METHODS: The nerve monitor employed is NIM 3.0 with automatic periodic stimulation (Medtronics Inc., USA). Patient is intubated with NIM contact-reinforced EMG endotracheal tube (Medtronics Inc., USA). The operation starts with a left lower neck incision, and the stimulating electrode is secured around the left vagus nerve. The patient is then turned to the left lateral position for VATS esophagectomy. CIONM of the left RLN is achieved by regular stimulation of the left vagus nerve, and intact nerve conduction is detected by the electromyography (EMG) of the left vocalis muscle. The alarm is set to activate when EMG amplitude reduces by 50 % or latency prolongs by 10 %.

RESULTS: Initial experience of ten cases showed that a mean time of 35 min was required to complete the electrode insertion in the neck. There was one event in which there was more than 50 % reduction of EMG amplitude that persisted but the patient had no vocal cord paralysis after operation. In another patient, the EMG reduced by 75 % and persisted. The patient had temporary vocal cord paralysis.

CONCLUSION: CIONM is feasible during VATS esophagectomy and can alert the surgeon of imminent injury to the RLNs, thereby preventing permanent injury.

PMID: 26464154 [PubMed - as supplied by publisher]

Risk Factors and Clinical Outcomes of Recurrent Laryngeal Nerve Paralysis After Esophagectomy for Thoracic Esophageal Carcinoma.

World J Surg. 2015 Oct 13;

Authors: Sato Y, Kosugi SI, Aizawa N, Ishikawa T, Kano Y, Ichikawa H, Hanyu T, Hirashima K, Bamba T, Wakai T

Abstract

BACKGROUND: The objectives of this study were to assess the incidence of recurrent laryngeal nerve paralysis (RLNP) using laryngoscopy after esophagectomy for thoracic esophageal carcinoma and to clarify the risk factors influencing postoperative RLNP.

METHODS: A total of 299 patients who underwent laryngoscopic examination after esophagectomy were retrospectively reviewed. Patients who were found to have postoperative RLNP were followed up every 1-3 months, with a median follow-up period of 3 months. Recovery from paralysis was also evaluated on the basis of each affected nerve. Multivariate analyses using logistic regression were used to identify independent risk factors for RLNP. Cumulative recovery rate was calculated using Kaplan-Meier method.

RESULTS: A total of 178 (59.5 %) patients were diagnosed with RLNP by first laryngoscopy [bilateral in 59 (33.1 %) patients, right in 15 (8.4 %), and left in 104 (58.4 %)]. In 206 patients who underwent transthoracic and thoracoscopic esophagectomy, independent risk factors for RLNP were lymph node dissection along the right RLN (odds ratio [OR] 3.01, 95 % confidence interval [CI] 1.06-8.54, P = 0.04) and cervical anastomosis (OR 5.94, 95 % CI 1.78-19.80, P < 0.01). Cumulative recovery rate from RLNP was 61.7 % at 12 months after esophagectomy with 91 nerves eventually recovering from paralysis. Median recovery time was 6 months.

CONCLUSIONS: RLNP developed in 60 % of patients after esophagectomy and may be associated with lymphadenectomy around the right RLN and cervical esophageal mobilization. Although 62 % of affected nerves recovered within 12 months, great attention should be given when performing these procedures.

PMID: 26464155 [PubMed - as supplied by publisher]

Accurate and precise plasma clearance measurement using four 99mTc-DTPA plasma samples over 4 h.

Nucl Med Commun. 2015 Oct 12;

Authors: Wanasundara SN, Wesolowski MJ, Barnfield MC, Waller ML, Murray AW, Burniston MT, Babyn PS, Wesolowski CA

Abstract

OBJECTIVES: Glomerular filtration rate can be measured as the plasma clearance (CL) of a glomerular filtration rate marker despite body fluid disturbances using numerous, prolonged time samples. We desire a simplified technique without compromised accuracy and precision.

MATERIALS AND METHODS: We compared CL values derived from two plasma concentration curve area methods - (a) biexponential fitting [CL (E2)] and (b) Tikhonov adaptively regularized gamma variate fitting [CL (Tk-GV)] - for 4 versus 8 h time samplings from 412 Tc-DTPA studies in 142 patients, mostly paediatric patients, with suspected fluid disturbances.

RESULTS: CL (Tk-GV) from four samples/4 h and from nine samples/8 h, both accurately and precisely agreed with the standard, which was taken to be nine samples/8 h CL from (noncompartmental) numerical integration [CL (NI)]. The E2 method, four samples/4 h, and nine samples/8 h median CL values significantly overestimated the CL (NI) values by 4.9 and 3.8%, respectively.

CONCLUSION: Compared with the standard, CL (E2) from four samples/4 h and from nine samples/8 h proved to be the most inaccurate and imprecise method examined, and can be replaced by better methods for calculating CL. The CL (Tk-GV) can be used to reduce sampling time in half from 8 to 4 h and from nine to four samples for a precise and accurate, yet more easily tolerated and simplified test.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0/.

PMID: 26465802 [PubMed - as supplied by publisher]

Tumor growth-inhibitory effect of an angiotensin-converting enzyme inhibitor (captopril) in a lung cancer xenograft model analyzed using 18F-FDG-PET/CT.

Nucl Med Commun. 2015 Oct 12;

Authors: Nakaya K, Otsuka H, Kondo K, Otani T, Nagata M

Abstract

INTRODUCTION: We administered an angiotensin-converting enzyme inhibitor (captopril) to mice implanted with a human lung adenocarcinoma epithelial cell line (A549 cells) and investigated the tumor growth-inhibitory effect of captopril from the viewpoint of glucose metabolism using F-fluorodeoxyglucose (F-FDG)-PET/CT.

METHODS: Subcutaneous implantation of A549 cells (1.9×10 cells) was carried out in the lower right flank of mice. Fifteen days after the transplantation of A549 cells, mice (six in each group) were treated with captopril (3.0 mg/mouse) or saline (1000 μl/mouse) for 5 days. We performed F-FDG-PET/CT imaging of the mice before and after the treatment and evaluated the degree of F-FDG accumulation in tumors. In both groups (the captopril-administrated and control groups), values for the metabolic tumor volume (MTV), maximum standardized uptake value, total lesion glycolysis, and tumor volume after treatment had a tendency to increase. However, tumor growth was suppressed in the captopril-administrated group compared with the control group.

RESULTS: In terms of the growth rate, the MTV and tumor volume were significantly different (P<0.05). It was found that captopril exerted a potential tumor growth-inhibitory effect; this was because the captopril-administrated group showed low values of MTV, maximum standardized uptake value, total lesion glycolysis, and tumor volume in comparison with the control group.

PMID: 26465803 [PubMed - as supplied by publisher]

Slow Cortical Potential Neurofeedback in Chronic Tinnitus Therapy

Appl Psychophysiol Biofeedback. 2015 Oct 12;

Authors: Milner R, Lewandowska M, Ganc M, Cieśla K, Niedziałek I, Skarżyński H

Abstract

This study is the first to demonstrate outcomes of slow cortical potential (SCP) Neurofeedback training in chronic tinnitus. A 50-year old male patient with tinnitus participated in three SCP training blocks, separated with 1-month breaks. After the training the patient reported decreased tinnitus loudness and pitch, as well as improved quality of daily life. A quantitative electroencephalography analysis revealed close to normal changes of resting state bioelectrical activity in cortical areas considered to be involved in tinnitus generation. The present case study indicates that SCP Neurofeedback training can be considered a promising method for tinnitus treatment.

PMID: 26459345 [PubMed - as supplied by publisher]

Repetitive transcranial magnetic stimulation improves both hearing function and tinnitus perception in sudden sensorineural hearing loss patients.

Sci Rep. 2015;5:14796

Authors: Zhang D, Ma Y

Abstract

The occurrence of sudden sensorineural hearing loss (SSHL) affects not only cochlear activity but also neural activity in the central auditory system. Repetitive transcranial magnetic stimulation (rTMS) above the auditory cortex has been reported to improve auditory processing and to reduce the perception of tinnitus, which results from network dysfunction involving both auditory and non-auditory brain regions. SSHL patients who were refractory to standard corticosteroid therapy (SCT) and hyperbaric oxygen (HBO) therapy received 20 sessions of 1 Hz rTMS to the temporoparietal junction ipsilateral to the symptomatic ear (rTMS group). RTMS therapy administered in addition to SCT and HBO therapy resulted in significantly greater recovery of hearing function and improvement of tinnitus perception compared SCT and HBO therapy without rTMS therapy. Additionally, the single photon emission computed tomography (SPECT) measurements obtained in a subgroup of patients suggested that the rTMS therapy could have alleviated the decrease in regional cerebral brain flow (rCBF) in SSHL patients. RTMS appears to be an effective, practical, and safe treatment strategy for SSHL.

PMID: 26463446 [PubMed - in process]

Αρχειοθήκη ιστολογίου

Τρίτη 20 Οκτωβρίου 2015

HeadNeck

[No title available]

Author information

Abstract

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

In memoriam Prof. Giorgio Sulsenti (1930-2015).

Hereditary haemorrhagic telangiectasia.

Abstract

BACKGROUND:

METHODOLOGY:

CONCLUSIONS:

Spreader grafts: functional or just aesthetical?

Author information

Abstract

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

IFRD1 gene polymorphisms are associated with nasal polyposis in cystic fibrosis patients.

Author information

Abstract

BACKGROUND:

METHODS AND PATIENTS:

RESULTS:

CONCLUSIONS:

Manifestation of eosinophilic granulomatosis with polyangiitis in head and neck.

Abstract

INTRODUCTION:

METHOD:

RESULTS:

CONCLUSION:

Autophagy is deficient and inversely correlated with COX-2 expression in nasal polyps: a novel insight into the inflammation mechanism.

Abstract

BACKGROUND:

METHODS:

RESULTS:

CONCLUSION:

Publication Types

The influence of European legislation on the use of diagnostic test allergens for nasal allergen provocation in routine care of patients with allergic rhinitis.

Abstract

Publication Types

Reduced effect of intravenous antibiotic treatment on sinonasal markers in pulmonary inflammation.

Abstract

BACKGROUND:

METHODS:

RESULTS:

DISCUSSION:

The effect of "Pyriform Turbinoplasty" on nasal airflow using a virtual model.

Abstract

BACKGROUND:

METHODOLOGY:

RESULTS:

CONCLUSIONS:

Post-operative budesonide irrigations for patients with polyposis: a blinded, randomized controlled trial.

Abstract

OBJECTIVE:

STUDY DESIGN:

METHODS:

RESULTS:

CONCLUSIONS:

Publication Types

Exposure to odours improves olfactory function in healthy children.

Abstract

BACKGROUND:

MATERIAL AND METHODS:

RESULTS:

CONCLUSION:

Current management of sinonasal undifferentiated carcinoma.

Abstract

BACKGROUND:

METHODS:

RESULTS:

CONCLUSIONS:

Endoscopic surgery for malignant sinonasal tumours: an eighteen year experience.

Abstract