Cranial tonsillotomy for peritonsillar abscess: what a relief!

Abstract

Peritonsillar abscess (PTA) is a common infection of the oropharynx resulting in painful swallowing, sometimes associated with fever, trismus and a typical voice alteration. Several draining methods have been suggested, including needle aspiration (NA), incision and drainage (ID), or abscesstonsillectomy. However, a gold standard of surgical therapy still does not exist. The aim of this study was to evaluate the outcome in patients who had undergone ID supplemented by cranial tonsillotomy (IDTT) as first-line treatment. A retrospective chart review of all patients who had undergone IDTT at our department in 2015 was performed. Demographic data, clinical findings, pain intensity on a 10-point visual analog scale, operation time and routine bloods before and after IDTT were collected. In addition, a 10-point visual analog scale (VAS) was utilized to measure personal satisfaction 2 weeks and 2 months after surgery. A total of 104 procedures were performed in 65 male and 38 female patients (median age 35 years), including one patient with a contralateral PTA 2 weeks after IDTT. Three patients had experienced abscess formation after admittance for antibiotic treatment of acute tonsillitis. 57.7 % of all patients denied intake of antibiotic therapy in their history at initial presentation. Patients were hospitalized for 3 days (median). The median pain intensity (VAS) within the first three postoperative days was 2, 1 and 1, respectively. Two weeks and 2 months after surgery patients were highly satisfied with the procedure (median value 10). Bleeding complications did not occur. IDTT is a novel surgical concept and associated with great patient comfort. It is safe, easy to learn and associated with an early return to normal diet and physical activity. These findings are supported by a rapid normalization of white blood cell count and C-reactive protein. IDTT eliminates the necessity of painful re-draining of the wound cavity and is free of bleeding complications. In contrast to ID and NA, histological examination of tonsillar tissue is feasible to disclose a previously undetected malign disease. Further analysis is warranted to verify the success rate in the long-term.

http://link.springer.com/10.1007/s00405-016-4158-3

Medial sural artery perforator flap in head and neck reconstruction

Abstract

Medial sural artery perforator (MSAP) flap is a relatively new flap which is a modification of medial gastrocnemius myocutaneous flap. Both radial forearm flap and MSAP has common benefits, such as thinness, long pedicle and pliability; however, MSAP has lower donor site morbidity when compared with radial forearm flap. Because of this reason, the MSAP flap has gained popularity during the last decade. The objective of this study was to determine clinical application results of this flap in reconstruction of post-oncologic defects in the head and neck region. 11 patients operated for head and neck post oncologic defects and reconstructed with MSAP between June 2014 and Dec 2015 were included in the study. Age, gender, histopathology, area of reconstruction, flap size, number of perforators were reviewed. Postoperatively recipient and donor site complications, hospital stay and additional surgical procedures were also analyzed. We had seven uncomplicated cases; one total flap failure due to arterial problem, in three cases due fistula formation and local wound healing problems additional surgeries were performed. All venous anastomosis were performed with 9/0 sutures, nine arterial anastomosis were performed with 9/0 and two arterial anastomosis were performed with 10/0 nylon sutures. Medial sural artery perforator flap is a good alternative in head and neck reconstruction, with the advantages of thin and pliable skin, a reliable vascular pedicle, straightforward intramuscular dissection. But there are certain drawbacks like tedious pedicle and perforator dissection, small arterial pedicle size which complicates anastomosis and obscurities of anatomy. Surgical team must always be ready for a difficult micro anastomosis and an alternative flap choice must be prepared and counseled with the patient in case of inadequate perforators.

http://link.springer.com/10.1007/s00405-016-4078-2

Facial palsy following cochlear implantation

Abstract

Owing to its anatomical location, the facial nerve (FN) is at risk of damage during cochlear implantation, especially during posterior tympanotomy. The aim of this study was, therefore, to evaluate the risk of FN palsy following cochlear implantation surgery via mastoidectomy and posterior tympanotomy approach (facial recess). This is a retrospective study. The data bank of patients who received a cochlear implant between 2000 and 2012 was analyzed. 3403 surgeries were done during this period. Records of the patients who had suffered from FN palsy were evaluated and the type of FN palsy, the severity, time of onset, and need for revision surgery were recorded. 0.76 % (26/3403) of the patients had FN palsy and were, therefore, included in the study. 76.9 % (20/26) subjects were 18 years or older. 0.15 % (5 subjects) suffered from immediate FN palsy and 0.62 % (21 subjects) from delayed FN palsy. Intraoperative FN injury was documented in only three subjects of the immediate FN palsy group. In two subjects with immediate FN palsy, the FN was intraoperatively exposed but not injured, despite these individuals' experiencing FN palsy. In 100 % of the immediate onset FN palsy group a part of the FN was exposed during surgery, whereas it was exposed only in 9.5 % of the delay onset FN palsy group. Although the FN was bone protected in 19 subjects, they had FN palsy. Most of the subjects presented House-Brackmann grade III or IV (69.2 %). All of the subjects were treated initially with a conservative therapy, only 42.3 % (11 subjects) underwent revision surgery. The recovery rate was 80.8 % (in immediate onset palsy 40 %, in delayed onset palsy 90.5 %). Cochlear implantation entails only a minimal risk of FN palsy and that FN palsy is chiefly a transient problem.

http://link.springer.com/10.1007/s00405-016-4124-0

Postoperative pain in patients undergoing a transcutaneous active bone conduction implant (Bonebridge)

Abstract

The objective of the study was to evaluate postoperative pain following a transcutaneous active conductive hearing implant. 27 patients undergoing Bonebridge (BB) bone conduction implantation were evaluated with two pain-related questionnaires. The Headache Impact Test (HIT-6) was used to measure the degree of disability including none or little impact (≤49), mild (50–55), moderate (56–59), and severe (≥60). The Brief Pain Inventory (BPI) was used to assess pain severity score and function interference (0 = no pain to 10 = worst pain); meaningful pain was considered to be ≥3. The impact of surgical factors on postoperative pain was analyzed. Postoperative BB pain results were compared with 11 Vibrant Soundbridge™ (VSB) and 103 cochlear implant (CI) users. The mean pre- and postoperative HIT-6 scores for BB implantation were 42.6 and 41.8, respectively and the mean preoperative BPI pain severity score changed from 0.6 to 0.9 postoperatively, whereas the preoperative interference score changed from 0.1 to 0.3. None of the mean postoperative values revealed significant pain. The retrosigmoid approach, the need for dural or sinus compression, and the use of bone conduction implant lifts had no significant impact on pain scores. The mean postoperative HIT-6 pain scores for patients with BB, VSB, and CI were 41.8, 46.4, and 42.8, respectively, with the differences not being significant. BB implantation causes no significant postoperative pain irrespective of sinus or dura compression. Pain scores were similar to those experienced by patients with other transcutaneous auditory implants such as middle ear or CIs.

http://link.springer.com/10.1007/s00405-016-3972-y

Clinical comparison of two subtypes of cystic vestibular schwannoma: surgical considerations and outcomes

Abstract

Cystic vestibular schwannoma (CVS) is classified as Type A and Type B based on the overall cyst location and cyst wall thickness in magnetic resonance imaging. A retrospective analysis was performed to compare surgical considerations and outcomes between Type A and Type B groups of CVS. We selected 188 patients diagnostic for CVS with surgical resection, and divided them into Type A and Type B groups. General information, preoperative symptoms, the result of neuroimaging, and audiological tests were recorded. Surgical approach, completeness of tumor resection, and intraoperative facial nerve (FN) integrity were taken down. After operation, the short-term and long-term FN functions, complications, and recurrence rate were evaluated. The total tumor removal rate in Type A group was higher than that in Type B group (86.1 vs 72.5 %, p = 0.021). Anatomical FN integrity was preserved in 173 patients (92.0 %), with no significant differences between Type A and Type B. FN function was better in Type A group at hospital discharge. Besides, a good FN function rate was inversely proportional to the tumor size. The long-term FN function and all of the complications had no significant differences between the two groups. Patients in the Type B group are prone to have a lower total tumor removal rate and transient FN dysfunction. The long-term FN function was similar in both groups. Tumor size is another important indication of FN function. All postoperative complications occurred in patients with a tumor larger than grade 3, regardless of the subtypes of CVS.

http://link.springer.com/10.1007/s00405-016-4149-4

Gender-specific risk factors in post-tonsillectomy hemorrhage

Abstract

There are gender-specific differences in the frequency and course of different diseases. Specifically, some studies have shown an increased risk of post-tonsillectomy hemorrhage (PTH). The aim of the study was to investigate gender-specific risk factors for hemorrhage after tonsillectomy (TE)/abscess-TE. We anonymously reviewed and recorded the relevant data of all patients (≥14 years) who underwent a TE/abscess-TE between 2011 and 2013 in the ENT Clinic of the Charité Universitätsmedizin Berlin, Campus Benjamin Franklin. A patient survey was used to complete missing data. We analyzed gender-specific risk factors for PTH. During the study period, 460 operations were performed and the data of 250 patients were analyzed (213 TE and 37 abscess-TE). The median patient age was 27 years (ranging from 14 to 83 years). The rate of primary PTH (<24 h after TE/abscess-TE) was 3 %, and the rate of secondary PTH (>24 h) was 23 %. A significantly higher PTH rate was associated with males (p = 0.037), which was still apparent in ages 21–30 after sub-classification. Multivariate analysis calculated diagnosis, regular alcohol consumption and administration of glucocorticoids to be independent risk factors associated with gender. In conclusion, the PTH rate is gender-specific, and male patients are at higher risk, especially in young adulthood. Therefore, doctors should advise male patients of the increased risk of bleeding and stress the importance of compliance. Also, close postoperative follow-up is desirable.

http://link.springer.com/10.1007/s00405-016-4146-7

Long term results of the titanium clip prosthesis

Abstract

The objective of the study is to evaluate the long term results of ossiculoplasty using the clip titanium partial ossicular replacement prosthesis. This study retrospectively reviews the partial ossiculoplasty conducted using clip titanium partial ossicular replacement prosthesis at a tertiary referral center. Audiometric outcomes and intraoperative findings were postoperatively measured from revision surgery of 47 ears (20 women, 27 men, mean age 43 years) averaging 6.5 years. The overall air-bone gap decreased from 25.7 dB preoperatively to 16.8 dB 6.5 years postoperatively (p ≤ 0.001, η _p² = 0.210). An air-bone gap of <20 dB was present in 28 % of ears preoperatively and increased to 72 % postoperatively. In revision (n = 30) and primary tympanoplasties (n = 17), the preoperative air-bone gaps were reduced from 28.9 and 20.1 to 18.7 dB (p ≤ 0.001, η _p² = 0.240) and 13.2 dB (p = 0.033, η _p² = 0.192), respectively. In canal wall down (n = 15) procedures and tympanoplasties with intact canal wall (n = 32), the mean air-bone gaps diminished from 28.9 to 18.1 dB (p = 0.02, η _p² = 0.245) and 24.2 to 16.1 dB (p ≤ 0.001, η _p² = 0.221), respectively. In our own revision tympanoplasties (n = 8) and second look operations (n = 6), we found that the prostheses were safe to remove without any deleterious effects. Two prostheses were dislocated from the stapes' head due to recurrent cholesteatoma. Therefore, it can be concluded that ossiculoplasty using the clip partial ossicular replacement prosthesis allows for good and reliable long term hearing results. Also, the flexible strips reveal no adverse effects on the encompassed stapes' head and do not complicate revision surgery.

http://link.springer.com/10.1007/s00405-016-4174-3

Efficacy of chlorophyll c2 for seasonal allergic rhinitis: single-center double-blind randomized control trial

Abstract

Chlorophyll c2 extracted from Sargassum horneri improved allergic symptoms in an animal model of allergic rhinitis. In the present study, we explored the efficacy of chlorophyll c2 in patients with seasonal allergic rhinitis. This was a single-center, randomized, double-blind placebo-controlled trial. Sixty-six patients aged 20–43 years, each with a 2-year history of seasonal allergic rhinitis, were randomly assigned to receive either a single daily dose (0.7 mg) of chlorophyll c2 or placebo for 12 weeks. The use of medications including H1-antihistamines and topical nasal steroids was recorded by rescue medication scores (RMSs) noted after 4, 8, and 12 weeks of treatment. Disease-specific quality of life was measured using the Japan Rhinitis Quality of Life Questionnaire (JRQLQ) both before and after 4, 8, and 12 weeks of treatment. The RMS at 8 weeks was significantly better in the chlorophyll c2 than the placebo group (mean RMS difference = −3.09; 95 % confidence interval = −5.96 to −0.22); the mean RMS at 4 weeks was only slightly better in the chlorophyll c2 group. The JRQLQ scores did not differ significantly between the two groups. Chlorophyll c2 would have a potential to be an alternative treatment for allergic rhinitis.

http://link.springer.com/10.1007/s00405-016-4133-z

Evaluation of the application of rhino-septal splints in endoscopic transsphenoidal skull base surgery

Abstract

The endoscopic transnasal route for the surgical removal of tumors in the sellar region is frequently associated with nasal complications such as synechiae or impaired nasal breathing. In this study, we investigated the impact of septal splints on avoiding surgery-related co-morbidities. 49 patients in whom endoscopic transnasal, transsphenoidal surgery for sellar tumors was performed between 2012 and 2014 were studied. In 30 of these, nasal septal splints were applied at the end of surgery to both sides of the septum and left in situ for 10 days (group 1), 19 patients received no splints (group 2). A standardized postsurgical follow-up investigation with endoscopic nasal examination, rhinomanometry and olfactory testing was performed on average 2 months postoperatively. Patients' subjective nose-related discomfort at follow-up was assessed descriptively using a set of standardized self-rating statements on nasal problems. Synechias occurred less likely with nasal septal splints (n = 15; 50 %) than without (n = 16; 84.2 %). Moreover, multiple synechiae were predominantly observed in the group without septal splints (n = 10 vs. n = 2). Rhinomanometry showed improved flow-V150-inspiration scores when splints were used (with significant differences between groups for the left nostril: p = 0.039 and p = 0.022, resp.). In accordance, impaired nasal breathing after surgery was reported more frequently by 76.9 % of patients without splints, but only 56 % of patients with splints. Our results provide support for the application of nasal septal splints when operating endoscopically on tumors in the sellar region to reduce postoperative synechias and to improve nasal breathing.

http://link.springer.com/10.1007/s00405-016-4179-y

Association between vascular supply, stage and tumour size of juvenile nasopharyngeal angiofibroma

Abstract

Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular tumour seen in adolescent males. To study the vascular pattern of these tumours, we retrospectively reviewed the records of patients with JNA who underwent preoperative angiography. Most (82.2 %) of the 45 patients assessed were Radkowski stage III with a mean size of 5.29 cm. There was a significant association between tumour stage and size (p = 0.029). Ten different vessels were seen to supply these tumours. All tumours had primary supply from the distal third of the ipsilateral internal maxillary artery (IMA). Accessory vessel supply was chiefly from the Vidian branch of internal carotid artery (ICA) (55.6 %). Stage III tumours were supplied by a greater number of feeding vessels than earlier stage tumours (p < 0.01). Larger tumours were more likely to have ICA supply (p = 0.04). Bilateral supply was seen in 48.7 %. However, there was no predominance of bilateral over ipsilateral IMA supply even in advanced stage tumours. One patient in our series was found to have a caroticocavernous fistula. Residual or recurrent tumours were characterized by new vasculature (100 %) and greater accessory supply from the ipsilateral ICA (85.7 %). Our study highlights the fact that surgical planning cannot be dependent on staging alone and should include preoperative assessment of tumour vasculature by angiography.

http://link.springer.com/10.1007/s00405-016-4136-9

Insertion characteristics and placement of the Mid-Scala electrode array in human temporal bones using detailed cone beam computed tomography

Abstract

The aim of this study was to evaluate the insertion results and placement of the new Advanced Bionics HiFocus Mid-Scala (HFms) electrode array, inserted through the round window membrane, in eight fresh human temporal bones using cone beam computed tomography (CBCT). Pre- and post-insertion CBCT scans were registered to create a 3D reconstruction of the cochlea with the array inserted. With an image fusion technique both the bony edges of the cochlea and the electrode array in situ could accurately be determined, thus enabling to identify the exact position of the electrode array within the scala tympani. Vertical and horizontal scalar location was measured at four points along the cochlea base at an angular insertion depth of 90°, 180° and 270° and at electrode 16, the most basal electrode. Smooth insertion through the round window membrane was possible in all temporal bones. The imaging results showed that there were no dislocations from the scala tympani into the scala vestibule. The HFms electrode was positioned in the middle of the scala along the whole electrode array in three out of the eight bones and in 62 % of the individual locations measured along the base of the cochlea. In only one cochlea a close proximity of the electrode with the basilar membrane was observed, indicating possible contact with the basilar membrane. The results and assessments presented in this study appear to be highly accurate. Although a further validation including histopathology is needed, the image fusion technique described in this study represents currently the most accurate method for intracochlear electrode assessment obtainable with CBCT.

http://link.springer.com/10.1007/s00405-016-4099-x

The eardrum bridge of traumatic tympanic membrane perforation

http://link.springer.com/10.1007/s00405-016-4245-5

Core needle biopsy in the diagnosis of head and neck lesions: a retrospective study of 3 years

Abstract

The management of head and neck tumors is guided by its nature, location and extension. Despite CNB accuracy and efficiency being widely described in the literature, there are few studies that evaluate the diagnostic utility of the technique performed in an outpatient setting, in the diagnosis of head and neck tumors. The aim of this study is to present the experience, sensitivity, specificity and accuracy of the CNB performed in an outpatient setting, free handed, in an important oncology school-hospital. A total of 2007 patients with tumors in the head and neck treated for a period of 3 years were evaluated. A retrospective chart review was performed in 36 of these patients, who underwent core needle biopsy for diagnosis. All samples collected were subjected to histopathological analysis. Values of accuracy, sensitivity and specificity were 94, 92 and 100 %, respectively. In our service, held in an outpatient setting and without the aid of imaging tests, the core needle biopsy proved to be a test with high accuracy values, sensitivity and specificity, easy of application, low morbidity and high predictability, with great use in diagnosing tumors in head and neck.

http://link.springer.com/10.1007/s00405-016-4139-6

The admission patterns of octogenerians nonagenerians and centenarians to the Department of Otoloaryngology

Abstract

Life expectancy in Israel has risen by almost 6 years during the last 25 years, and the proportion of people 65 years of age or older is expected to reach 12 % of the total population by 2020. A substantial increase in the workload for Otolaryngologists and Head and Neck surgeons is anticipated. Our goal was to characterize the admissions of patients 80 years of age and older to the Department of Otolaryngology, Head and Neck Surgery in a tertiary medical center. The study group included all patients 80 years of age and older who were admitted to the Department of OTOHNS in our institute between 2009 and 2013. There were two control groups for comparison divided by age; one group 40–59 years old and the other group 60–79 years old. There were 385 admissions of 317 patients aged 80–103 years (4.2 % of overall admissions). Over the study period, admissions of patients over 80 years increased on average by 3 % per annum (p = 0.4), and those patients over 90 years old by 52 % per annum (p < 0.001). The most common indication was HN malignancy (28.8 %) followed by otologic disorders (22.0 %). Of the overall 158 operations conducted, 131 patients (82.9 %) underwent elective procedures (mainly oncology) and 27 patients (17.1 %) underwent emergent procedures. The distribution of the reasons for admission of the patients older than 80 years is surprisingly different from that of the "younger" patients. With life expectancy rising, our study predicts a workload increase mainly in the HN oncologic and otologic services.

http://link.springer.com/10.1007/s00405-016-4165-4

Cranial tonsillotomy for peritonsillar abscess: what a relief!

Abstract

Peritonsillar abscess (PTA) is a common infection of the oropharynx resulting in painful swallowing, sometimes associated with fever, trismus and a typical voice alteration. Several draining methods have been suggested, including needle aspiration (NA), incision and drainage (ID), or abscesstonsillectomy. However, a gold standard of surgical therapy still does not exist. The aim of this study was to evaluate the outcome in patients who had undergone ID supplemented by cranial tonsillotomy (IDTT) as first-line treatment. A retrospective chart review of all patients who had undergone IDTT at our department in 2015 was performed. Demographic data, clinical findings, pain intensity on a 10-point visual analog scale, operation time and routine bloods before and after IDTT were collected. In addition, a 10-point visual analog scale (VAS) was utilized to measure personal satisfaction 2 weeks and 2 months after surgery. A total of 104 procedures were performed in 65 male and 38 female patients (median age 35 years), including one patient with a contralateral PTA 2 weeks after IDTT. Three patients had experienced abscess formation after admittance for antibiotic treatment of acute tonsillitis. 57.7 % of all patients denied intake of antibiotic therapy in their history at initial presentation. Patients were hospitalized for 3 days (median). The median pain intensity (VAS) within the first three postoperative days was 2, 1 and 1, respectively. Two weeks and 2 months after surgery patients were highly satisfied with the procedure (median value 10). Bleeding complications did not occur. IDTT is a novel surgical concept and associated with great patient comfort. It is safe, easy to learn and associated with an early return to normal diet and physical activity. These findings are supported by a rapid normalization of white blood cell count and C-reactive protein. IDTT eliminates the necessity of painful re-draining of the wound cavity and is free of bleeding complications. In contrast to ID and NA, histological examination of tonsillar tissue is feasible to disclose a previously undetected malign disease. Further analysis is warranted to verify the success rate in the long-term.

http://link.springer.com/10.1007/s00405-016-4158-3

Medial sural artery perforator flap in head and neck reconstruction

Abstract

Medial sural artery perforator (MSAP) flap is a relatively new flap which is a modification of medial gastrocnemius myocutaneous flap. Both radial forearm flap and MSAP has common benefits, such as thinness, long pedicle and pliability; however, MSAP has lower donor site morbidity when compared with radial forearm flap. Because of this reason, the MSAP flap has gained popularity during the last decade. The objective of this study was to determine clinical application results of this flap in reconstruction of post-oncologic defects in the head and neck region. 11 patients operated for head and neck post oncologic defects and reconstructed with MSAP between June 2014 and Dec 2015 were included in the study. Age, gender, histopathology, area of reconstruction, flap size, number of perforators were reviewed. Postoperatively recipient and donor site complications, hospital stay and additional surgical procedures were also analyzed. We had seven uncomplicated cases; one total flap failure due to arterial problem, in three cases due fistula formation and local wound healing problems additional surgeries were performed. All venous anastomosis were performed with 9/0 sutures, nine arterial anastomosis were performed with 9/0 and two arterial anastomosis were performed with 10/0 nylon sutures. Medial sural artery perforator flap is a good alternative in head and neck reconstruction, with the advantages of thin and pliable skin, a reliable vascular pedicle, straightforward intramuscular dissection. But there are certain drawbacks like tedious pedicle and perforator dissection, small arterial pedicle size which complicates anastomosis and obscurities of anatomy. Surgical team must always be ready for a difficult micro anastomosis and an alternative flap choice must be prepared and counseled with the patient in case of inadequate perforators.

http://link.springer.com/10.1007/s00405-016-4078-2

Facial palsy following cochlear implantation

Abstract

Owing to its anatomical location, the facial nerve (FN) is at risk of damage during cochlear implantation, especially during posterior tympanotomy. The aim of this study was, therefore, to evaluate the risk of FN palsy following cochlear implantation surgery via mastoidectomy and posterior tympanotomy approach (facial recess). This is a retrospective study. The data bank of patients who received a cochlear implant between 2000 and 2012 was analyzed. 3403 surgeries were done during this period. Records of the patients who had suffered from FN palsy were evaluated and the type of FN palsy, the severity, time of onset, and need for revision surgery were recorded. 0.76 % (26/3403) of the patients had FN palsy and were, therefore, included in the study. 76.9 % (20/26) subjects were 18 years or older. 0.15 % (5 subjects) suffered from immediate FN palsy and 0.62 % (21 subjects) from delayed FN palsy. Intraoperative FN injury was documented in only three subjects of the immediate FN palsy group. In two subjects with immediate FN palsy, the FN was intraoperatively exposed but not injured, despite these individuals' experiencing FN palsy. In 100 % of the immediate onset FN palsy group a part of the FN was exposed during surgery, whereas it was exposed only in 9.5 % of the delay onset FN palsy group. Although the FN was bone protected in 19 subjects, they had FN palsy. Most of the subjects presented House-Brackmann grade III or IV (69.2 %). All of the subjects were treated initially with a conservative therapy, only 42.3 % (11 subjects) underwent revision surgery. The recovery rate was 80.8 % (in immediate onset palsy 40 %, in delayed onset palsy 90.5 %). Cochlear implantation entails only a minimal risk of FN palsy and that FN palsy is chiefly a transient problem.

http://link.springer.com/10.1007/s00405-016-4124-0

Postoperative pain in patients undergoing a transcutaneous active bone conduction implant (Bonebridge)

Abstract

The objective of the study was to evaluate postoperative pain following a transcutaneous active conductive hearing implant. 27 patients undergoing Bonebridge (BB) bone conduction implantation were evaluated with two pain-related questionnaires. The Headache Impact Test (HIT-6) was used to measure the degree of disability including none or little impact (≤49), mild (50–55), moderate (56–59), and severe (≥60). The Brief Pain Inventory (BPI) was used to assess pain severity score and function interference (0 = no pain to 10 = worst pain); meaningful pain was considered to be ≥3. The impact of surgical factors on postoperative pain was analyzed. Postoperative BB pain results were compared with 11 Vibrant Soundbridge™ (VSB) and 103 cochlear implant (CI) users. The mean pre- and postoperative HIT-6 scores for BB implantation were 42.6 and 41.8, respectively and the mean preoperative BPI pain severity score changed from 0.6 to 0.9 postoperatively, whereas the preoperative interference score changed from 0.1 to 0.3. None of the mean postoperative values revealed significant pain. The retrosigmoid approach, the need for dural or sinus compression, and the use of bone conduction implant lifts had no significant impact on pain scores. The mean postoperative HIT-6 pain scores for patients with BB, VSB, and CI were 41.8, 46.4, and 42.8, respectively, with the differences not being significant. BB implantation causes no significant postoperative pain irrespective of sinus or dura compression. Pain scores were similar to those experienced by patients with other transcutaneous auditory implants such as middle ear or CIs.

http://link.springer.com/10.1007/s00405-016-3972-y

Clinical comparison of two subtypes of cystic vestibular schwannoma: surgical considerations and outcomes

Abstract

Cystic vestibular schwannoma (CVS) is classified as Type A and Type B based on the overall cyst location and cyst wall thickness in magnetic resonance imaging. A retrospective analysis was performed to compare surgical considerations and outcomes between Type A and Type B groups of CVS. We selected 188 patients diagnostic for CVS with surgical resection, and divided them into Type A and Type B groups. General information, preoperative symptoms, the result of neuroimaging, and audiological tests were recorded. Surgical approach, completeness of tumor resection, and intraoperative facial nerve (FN) integrity were taken down. After operation, the short-term and long-term FN functions, complications, and recurrence rate were evaluated. The total tumor removal rate in Type A group was higher than that in Type B group (86.1 vs 72.5 %, p = 0.021). Anatomical FN integrity was preserved in 173 patients (92.0 %), with no significant differences between Type A and Type B. FN function was better in Type A group at hospital discharge. Besides, a good FN function rate was inversely proportional to the tumor size. The long-term FN function and all of the complications had no significant differences between the two groups. Patients in the Type B group are prone to have a lower total tumor removal rate and transient FN dysfunction. The long-term FN function was similar in both groups. Tumor size is another important indication of FN function. All postoperative complications occurred in patients with a tumor larger than grade 3, regardless of the subtypes of CVS.

http://link.springer.com/10.1007/s00405-016-4149-4

Immunological effects of a novel RNA-based adjuvant in liver cancer patients

Abstract

Evaluation of biological effects of adjuvants on immune cells has been assessed in a limited number of studies. Moreover, no data are available on samples derived from cancer patients who may have a severe immune impairment. The effects of a novel RNA-based adjuvant (RNAdjuvant^® developed by CureVac) were assessed in an ex vivo setting on PBMCs obtained from 8 healthy volunteers and 17 HCC patients, using a multiparametric approach to analyze network dynamics of early immune responses. Evaluation of CD80, CD86 and HLA-DR expression, cytokine production as well as gene expression was performed. Moreover, the downstream effect on CD4⁺ T cell phenotyping was evaluated. Treatment with RNAdjuvant^® showed comparable effects on PBMCs of both HCC and healthy subjects. In particular, CD80, CD86 and HLA-DR expression was found up-regulated in circulating dendritic cells, which promoted a CD4⁺ T cell differentiation toward an effector phenotype. A mixed Th1/Th2 cytokine pattern was induced, although a more predominant production of TNFα and IFNγ was observed in HCC patients versus healthy controls. The cytokine profile was further confirmed by gene transcriptional analysis, which showed up-regulation of several genes involved in innate and adaptive immune-related pathways. The present study is the first demonstration that HCC patients and healthy subjects are equally responsive to an adjuvant. This may suggest that the same vaccine formulation including the RNAdjuvant^® might have similar potency in healthy subjects and cancer patients.

http://link.springer.com/10.1007/s00262-016-1923-5

Immunohistochemical expression of podoplanin (D2-40), lymphangiogenesis and neoangiogenesis in tooth germ, ameloblastomas and ameloblastic carcinomas

Abstract

Background

Ameloblastoma is a benign but locally aggressive odontogenic tumor, while ameloblastic carcinoma is its malignant counterpart. Angiogenesis and lymphangiogenesis in malignancies have been correlated with higher aggressiveness and poor prognosis, as well as greater expression of podoplanin by tumoral cells.

Methods

Immunohistochemical expression of podoplanin, CD34 and CD105 (endoglin) was evaluated in 53 ameloblastomas and 3 ameloblastic carcinomas; additionally, immunohistochemistry for podoplanin was also performed in 10 tooth germs. Microvessel density of blood and lymphatic vessels was calculated and compared between ameloblastomas and ameloblastic carcinomas. Immunoexpression of podoplanin by ameloblastic cells was evaluated in tooth germs, ameloblastomas and ameloblastic carcinomas.

Results

Podoplanin was similarly expressed by odontogenic epithelial cells of tooth germs and ameloblastomas, while its expression was lower in ameloblastic carcinomas. There was not difference in microvessel density assessed by CD34 between ameloblastomas and ameloblastic carcinomas; nevertheless, the latter presented higher amounts of lymphatic and new formed blood vessels.

Conclusions

Results suggest that podoplanin does not seem to be involved in invasion mechanisms of ameloblastic carcinomas, as its expression was decreased in the malignant tumoral cells. On the other hand, the increased lymphatic microvessel density and neoangiogenesis found in ameloblastic carcinomas could be related with its aggressiveness and potential for metastasis.

This article is protected by copyright. All rights reserved.

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fjop.12524

Normal orbit skeletal changes in adolescents as determined through cone-beam computed tomography

To determine three-dimensional spatial orbit skeletal changes in adolescents over a 19 to 24 months observation period assessed through cone-beam computed tomography (CBCT).

http://head-face-med.biomedcentral.com/articles/10.1186/s13005-016-0130-0

Normal orbit skeletal changes in adolescents as determined through cone-beam computed tomography

Abstract

Background

To determine three-dimensional spatial orbit skeletal changes in adolescents over a 19 to 24 months observation period assessed through cone-beam computed tomography (CBCT).

Methods

The sample consisted of 50 adolescents aged 11 to 17. All were orthodontic patients who had two CBCTs taken with an interval of 19 to 24 months between images. The CBCTs were analyzed using the third-party software Avizo. Sixteen anatomical landmarks resulting in 24 distances were used to measure spatial structural changes of both orbits. Reliability and measurement error of all landmarks were calculated using ten CBCTs. Descriptive and t-test statistical analyses were used to determine the overall changes in the orbits.

Results

All landmarks showed excellent reliability with the largest measurement error being the Y-coordinate of the left most medial point of the temporalis grooves at 0.95 mm. The mean differences of orbital changes between time 1 and time 2 in the transverse, antero-posterior and vertical directions were 0.97, 0.36 and 0.33 mm respectively. Right to left most antero-inferior superior orbital rim distance had the greatest overall transverse change of 4.37 mm. Right most posterior point of lacrimal crest to right most postero-lateral point of the superior orbital fissure had the greatest overall antero-posterior change of 0.52 mm. Lastly, left most antero-inferior superior orbital rim to left most antero-superior inferior orbital rim had the greatest overall vertical change of 0.63 mm.

Conclusions

The orbit skeletal changes in a period of 19–24 months in a sample of 11–17 year olds were statistically significant, but are not considered to be clinically significant. The overall average changes of orbit measurements were less than 1 mm.

http://link.springer.com/10.1186/s13005-016-0130-0

The Effects of Compensatory Auditory Stimulation and High-Definition Transcranial Direct Current Stimulation (HD-tDCS) on Tinnitus Perception – A Randomized Pilot Study

by Simon Henin, Dovid Fein, Eric Smouha, Lucas C. Parra

Background

Tinnitus correlates with elevated hearing thresholds and reduced cochlear compression. We hypothesized that reduced peripheral input leads to elevated neuronal gain resulting in the perception of a phantom sound.

Objective

The purpose of this pilot study was to test whether compensating for this peripheral deficit could reduce the tinnitus percept acutely using customized auditory stimulation. To further enhance the effects of auditory stimulation, this intervention was paired with high-definition transcranial direct current stimulation (HD-tDCS).

Methods

A randomized sham-controlled, single blind study was conducted in a clinical setting on adult participants with chronic tinnitus (n = 14). Compensatory auditory stimulation (CAS) and HD-tDCS were administered either individually or in combination in order to access the effects of both interventions on tinnitus perception. CAS consisted of sound exposure typical to daily living (20-minute sound-track of a TV show), which was adapted with compressive gain to compensate for deficits in each subject's individual audiograms. Minimum masking levels and the visual analog scale were used to assess the strength of the tinnitus percept immediately before and after the treatment intervention.

Results

CAS reduced minimum masking levels, and visual analog scale trended towards improvement. Effects of HD-tDCS could not be resolved with the current sample size.

Conclusions

The results of this pilot study suggest that providing tailored auditory stimulation with frequency-specific gain and compression may alleviate tinnitus in a clinical population. Further experimentation with longer interventions is warranted in order to optimize effect sizes.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0166208

The Effects of Compensatory Auditory Stimulation and High-Definition Transcranial Direct Current Stimulation (HD-tDCS) on Tinnitus Perception – A Randomized Pilot Study

by Simon Henin, Dovid Fein, Eric Smouha, Lucas C. Parra

Background

Tinnitus correlates with elevated hearing thresholds and reduced cochlear compression. We hypothesized that reduced peripheral input leads to elevated neuronal gain resulting in the perception of a phantom sound.

Objective

The purpose of this pilot study was to test whether compensating for this peripheral deficit could reduce the tinnitus percept acutely using customized auditory stimulation. To further enhance the effects of auditory stimulation, this intervention was paired with high-definition transcranial direct current stimulation (HD-tDCS).

Methods

A randomized sham-controlled, single blind study was conducted in a clinical setting on adult participants with chronic tinnitus (n = 14). Compensatory auditory stimulation (CAS) and HD-tDCS were administered either individually or in combination in order to access the effects of both interventions on tinnitus perception. CAS consisted of sound exposure typical to daily living (20-minute sound-track of a TV show), which was adapted with compressive gain to compensate for deficits in each subject's individual audiograms. Minimum masking levels and the visual analog scale were used to assess the strength of the tinnitus percept immediately before and after the treatment intervention.

Results

CAS reduced minimum masking levels, and visual analog scale trended towards improvement. Effects of HD-tDCS could not be resolved with the current sample size.

Conclusions

The results of this pilot study suggest that providing tailored auditory stimulation with frequency-specific gain and compression may alleviate tinnitus in a clinical population. Further experimentation with longer interventions is warranted in order to optimize effect sizes.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0166208

The effect of intranasal sodium citrate on olfaction in post-infectious loss: results from a prospective, placebo-controlled trial in 49 patients

Abstract

Objectives

Free calcium plays an integral role in peripheral olfactory processing, including feedback inhibition. It has therefore been suggested that reduction of intranasal free calcium with buffer solutions such as sodium citrate may improve olfactory function in patients with smell impairment. Several previous studies have supported this hypothesis, particularly in post-infectious olfactory loss. We therefore aimed to determine whether treatment with intranasal sodium citrate improves olfactory function in patients with post-infectious impairment.

Design

Prospective, single-blind, placebo-controlled trial.

Setting

Interdisciplinary Smell and Taste Clinic, TU Dresden (tertiary referral centre).

Participants

Forty-nine adult participants with post-infectious olfactory impairment (M:F=11:38, mean age 58.71±11.03 years).

Main Outcome Measures

Olfactory function (odour threshold and identification) before and after treatment as determined using 'Sniffin' Sticks'. Patients were treated monorhinally with 1ml sodium citrate solution. The contralateral nasal cavity was treated with 1ml physiological sodium chloride solution, which acted as internal control. Clinical improvement was assumed where threshold or identification score increased by ≥2.5 or 3 points respectively or ≥5.5 points together.

Results

We demonstrated a statistically significant improvement in composite threshold + identification scores following treatment with sodium citrate, compared with placebo. This was true for all patients (mean improvement 0.87±2.68 points, p=0.04), and on subgroup analysis in those with hyposmia (mean improvement 1.15±2.37 points, p=0.02). However the effect size did not reach clinical significance.

Conclusions

Further basic and clinical work is required to fully delineate the effect of intranasal sodium citrate in the treatment of post-infectious olfactory loss.

This article is protected by copyright. All rights reserved.

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fcoa.12789

Transoral laser microsurgery versus radiotherapy for T2 glottic squamous cell carcinoma; A systematic review of local control outcomes

Abstract

Background

Systematic reviews comparing treatment of early glottic cancer with transoral surgery or radiotherapy demonstrate similar oncological outcomes. Most studies of "early stage" laryngeal cancer include Tis, T1a, T1b and T2 cases. The data is dominated by patients with T1 and Tis tumours, although extrapolating these results and applying them for T2 cases may be inappropriate. No previous systematic reviews have focused on T2 cancers as a separate group.

Objective of review

This review compares local control outcomes for T2 glottic squamous cell carcinoma, treated with transoral microsurgery or external beam radiotherapy.

Type of review

This is a systematic review of case series and comparison studies, focusing on oncological outcomes.

Search strategy

Independent searches of Medline, EMBASE and the Cochrane Database were conducted by two authors, using the search terms: laryngeal / glottic / vocal cord combined with carcinoma / cancer / tumour and laser / microsurgery or radiotherapy. Studies of adult patients treated for primary T2N0 glottic SCC with laser surgery or curative radiotherapy were included.

Evaluation method

Full text of studies satisfying the inclusion criteria were reviewed with extraction of local control and survival data and laryngeal preservation rates. The primary end point is local control at 5 years.

Results

Initial searches identified 3252 studies. Following full text review of 183 papers 60 studies met the inclusion criteria, all level IV evidence. 48 studies specified 5-year local control for 1156 patients treated with transoral laser surgery and 3191 patients treated with radiotherapy. Weighted averages of local control at 5 years demonstrated similar results; 75.81% for radiotherapy versus 77.26% for transoral laser surgery.

Conclusions

The results of this review indicate no difference in 5-yeal local control between radiotherapy and transoral surgery for T2 glottic SCC. The data demonstrated higher rates of local failure for T2b compared with T2a cases, although outcomes were similar between laser excision and radiotherapy for each sub-stage. Further research focusing upon functional outcomes for T2 glottic tumours is imperative to guide decision making, ideally with subgroup analysis of T2a and T2b cases.

This article is protected by copyright. All rights reserved.

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fcoa.12790

Methotrexate Treatment and Risk for Cutaneous Malignant Melanoma - a Retrospective Comparative Registry-based Cohort Study

Summary

Background

Methotrexate (MTX) is frequently used as an immunosuppressive drug in inflammatory diseases. It is controversial and not thoroughly investigated whether MTX increases the risk of cutaneous malignant melanoma (CMM).

Objective

The aim of the present study was to investigate whether MTX-exposure increases the risk for CMM.

Methods

A retrospective cohort study was conducted using statistics from The National Board of Health and Welfare. All patients over 18 years in the time period August 2005 to December 2014 that were dispensed with MTX from Swedish pharmacies were registered (n=101,966). For every MTX-exposed patient, five age- and sex-matched patients who had been dispensed a random drug other than MTX, during the same time period were randomly selected (n=509,279). The lists were matched with the Swedish Cancer Registry.

Results

Overall a small but statistically significant (P < 0.001) risk increase for CMM was observed in MTX-exposed patients compared to patients without MTX-exposure. The Kaplan-Meier estimates for the 5-year risk of CMM was 0.48% (95% CI: 0.43% - 0.53%) in the MTX-exposed group and 0.41% (95% CI: 0.39% - 0.43%) in the MTX-unexposed group. However, in a subgroup analysis, the difference between the groups was only preserved in women older than 70 years at treatment start. Moreover, there was no significant difference in incidences between the MTX-exposed and MTX-unexposed patients in the time period.

Conclusion

Our results suggest a small but significant increase in risk for CMM in patients treated with MTX. However, the risk increase observed was considerably lower than earlier observations.

This article is protected by copyright. All rights reserved.

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fbjd.15170

Comparison of anti-interleukin-5 therapies in patients with severe asthma: Global and indirect meta-analyses of randomized placebo-controlled trials

Abstract

Background

Inconsistent results have been reported regarding IL-5 blockade treatment in asthma. There were no direct between-treatment comparisons. Only differences between each drug and placebo were studied.

Methods

We identified all RCTs with anti-IL5 treatments for asthma patients over the 1990-September 2015 period. RCT were searched on Medline, Cochrane and Embase. At least 50 patients were enrolled in each study. Outcomes considered were: exacerbation rate reduction, FEV₁ changes, ACQ-5 improvement, adverse events and serious adverse events.

A global meta-analysis was first conducted followed by an indirect comparison of each IL-5 targeting drug: benralizumab, reslizumab and mepolizumab. Further eosinophilic subgroup analysis and sensitivity analysis was also conducted in case of heterogeneity.

Results

Ten trials involving 3421 patients were eligible for meta-analysis. IL-5 blockade significantly reduced annual exacerbation rates versus placebo by 40% [29-50] (p<0.01, I²=0.61). ACQ-5 was significantly improved versus placebo but below the recognized MCID level (-0.31 [-0.41,-0.21], p<0.01, I²=0.11). FEV₁ changes from baseline were improved versus placebo by 0.09 L [0.05-0.12] (p<0.01, I²=0.28). The subgroup analysis identified a slight additional improvement in mean treatment effects in eosinophilic (>300 mm³/L) severe asthma patients. Similar patterns and rates of adverse events and severe adverse events were reported with the three drugs. The data interpretations were not affected by the sensitivity analysis.

Discussion/ Conclusions

IL-5 blockade appears to be a relevant treatment strategy to improve severe asthma management, particularly for eosinophilic patients. No clear superiority appeared between the drugs when appropriate doses were compared.

This article is protected by copyright. All rights reserved.

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fcea.12853

CD48 on blood leukocytes and in serum of asthma patients varies with severity

Abstract

Background

CD48 is a membrane receptor (mCD48) on eosinophils and mast cells and exists in a soluble form (sCD48). CD48 has a pivotal role in murine asthma and in the proinflammatory interactions of mast cells with eosinophils via its ligand CD244. Thus CD48 might be important in human asthma.

Methods

Therefore, two separate cohorts (IL and UK) comprising mild, moderate, and severe asthma and healthy volunteers were evaluated for blood leukocyte mCD48 expression and sCD48 in serum. Asthmatic bronchial biopsies were immunostained for CD48. sCD48 effect on CD244-dependent eosinophil activation was evaluated.

Results

Eosinophils mCD48 expression was significantly elevated in moderate while downregulated in severe asthma. mCD48 expression on B, T, NK cells and monocytes in severe asthma was significantly increased. sCD48 levels were significantly higher in mild while reduced in severe asthma. sCD48 optimal cut-off values for differentiating asthma from health were identified as >1482 pg/ml (IL) and >1619 pg/ml (UK). In asthmatic bronchial biopsies mCD48 was expressed predominantly by eosinophils. sCD48 inhibited anti-CD244 induced eosinophil activation.

Conclusions

mCD48 and sCD48 are differentially expressed in the peripheral blood of asthma patients of varying severity. sCD48 inhibits CD244-mediated eosinophil activation. These findings suggest that CD48 may play an important role in human asthma.

This article is protected by copyright. All rights reserved.

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fall.13082

23-letnia chora na astmę oskrzelową z utrwalonymi zaburzeniami wentylacji ciężkiego stopnia

Publication date: Available online 9 November 2016
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Małgorzata Farnik
A 23-year-old female reported with atopic asthma and allergic rhinitis diagnosed in childhood, and complaints of frequent exacerbations since adolescence. Spirometry showed gradual progression of obstruction – at the age of 20 – representing very severe obturation. The patient never smoked and had no exposition to any potential irritation factors. Due to frequent exacerbations, the patient often required systemic glucocorticoids; at the age of 21, she was diagnosed with TB. After the antituberculosis treatment was completed, reversibility test was negative, and slow progression of obstruction was still observed (FEV1 20% if predicted value). The patient had presented depression symptoms. She was qualified for anti-IgE treatment; after 8 months, clinically significant improvement was observed – the number of exacerbations was reduced and systemic GCS has been stopped. Spirometry had showed improvement with FEV1 – 38% of predicted. As the exercise tolerance improved, the patient has resumed her academic studies.



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ATM et orthodontie, « passé, présent et futur »

Publication date: Available online 9 November 2016
Source:Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Author(s): A. Manière-Ezvan, A. Oueiss, F. Busson
Dans le passé, l'ATM était surtout associée à la croissance du condyle mandibulaire. De nombreux travaux (sur le rat) ont montré le rôle du cartilage condylien dans la réponse de croissance suite à une stimulation par appareil orthopédique. D'où les traitements « orthopédiques » des dysmorphoses de Classe II visant à faire grandir la mandibule ; mais ce concept reste discuté dans la littérature en l'absence de résultats complètement probants et surtout depuis l'apport de la chirurgie orthognathique. Actuellement, le concept opérant est que la sollicitation mécanique et donc la fonction va modeler l'ATM au cours de la croissance et ce, dès le plus jeune âge. La prévention d'une dysmorphose doit donc passer par les conseils comportementaux à adopter par les parents dès la naissance de leur enfant : stimuler la propulsion mandibulaire par l'allaitement au sein, puis par une alimentation dure induisant une mastication unilatérale alternée. La méconnaissance de la spécificité des dysfonctions temporo-mandibulaires (DTM) notamment chez les adolescentes a, dans le passé, laissé un doute sur le rôle positif ou négatif que pouvait avoir un traitement orthodontique sur les ATM. Actuellement, la meilleure connaissance des ATM et des DTM permet d'avoir une meilleure conduite thérapeutique : conseils comportementaux en particulier chez la jeune fille hyperdivergente à petits condyles, contrôle de la position condylienne, réglages occlusaux en fin de traitement orthodontique. Le futur de l'orthodontie vis-à-vis des ATM repose sur la prévention, le dépistage, l'approfondissement de nos connaissances. L'orthodontiste saura ainsi ne pas faire un traitement chez des patients à risque ou saura l'individualiser et le terminer parfaitement bien.In the past, the ATM was mainly associated with the growth of the mandibular condyle. Many studies (on rats) showed the role of condylar cartilage in the growth response following stimulation by orthopedic appliances. From where, Class II dysmorphosis "orthopedic" treatments to grow the mandible; but this concept is discussed in the literature in the absence of fully conclusive results and especially since the contribution of orthognathic surgery. Currently, the operating concept is the mechanical stimulation and therefore the function will shape the ATM during growth and that, from an early age. Prevention of dysmorphoses must go through behavioral counseling to be adopted by parents from the birth of their child: to stimulate mandibular propulsion breastfeeding, then by a hard diet inducing an alternating unilateral chewing. Ignorance of the specificity of temporomandibular dysfunction (TMD) notably among teenagers has, in the past, left a doubt about the positive or negative role that could have orthodontic treatment on the TMJ. Currently, the best knowledge of TMJ and TMD provides a better therapeutic conduct: behavioral counseling especially for the girl hyperdivergente with small condyles, control of the condylar position, occlusal adjustments at the end of orthodontic treatment. The future of TMJ in relation with orthodontics is based on prevention, screening and deepening of our knowledge. The orthodontist will thus not make a treatment in patients at risk or will identify it and finish the treatment perfectly.



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Corrigendum to “Insights into the effector functions of human IgG3 in the context of an antibody targeting transferrin receptor 1” [Mol. Immunol. 67 (2015) 407–415]

Publication date: Available online 9 November 2016
Source:Molecular Immunology
Author(s): Lai Sum Leoh, Tracy R. Daniels-Wells, Otoniel Martínez-Maza, Manuel L. Penichet




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Re: Tattoos: could they be used to advantage as a medical alert in oral and maxillofacial surgery?

Publication date: Available online 9 November 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): N. Kluger




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Protection of free tissue used to reconstruct occipital scalp with a prone-positioning helmet

Publication date: Available online 9 November 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A.K. Al-Rikabi, C.M. McDowall, C.V. Thomas, M.J. Fardy




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Spontaneous Tumour Lysis Syndrome in a Multiple Myeloma

The tumor lysis syndrome (TLS) is a collection of metabolic abnormalities that occur in consequence of the release of intracellular contents following lysis of tumor cells. TLS occurs spontaneously or after chemotherapy. Spontaneous TLS is uncommon occurrence in multiple myeloma (MM). We define a case of a 70-year-old woman patient who was found to have MM with spontaneous TLS, following a compression fracture of the T-12 vertebrae. While serum uric acid and phosphorous levels were high, low calcium levels were identified. There were also acute kidney injury and metabolic acidosis. Upon the diagnosis of TLS, she was treated with hydration, allopurinol, sodium bicarbonate, and calcium gluconate. The improvement of her laboratory data was observed. We submitted this case in order to draw attention to the presentation of MM with spontaneous TLS.

http://www.hindawi.com/journals/crim/2016/9620520/

Mixed Phenotype Acute Leukemia Presenting as Leukemia Cutis

Leukemia cutis (LC) is defined as infiltration of the skin by leukemic cells resulting in clinically recognizable cutaneous lesions. It is common in congenital leukemia and acute myeloid leukemia. However, LC has rarely been reported with mixed phenotypic acute leukemia (MPAL). We report the case of a lady who presented with erythematous papular and nodular lesions all over the body. Skin biopsy showed leukemic infiltration and bone marrow aspiration showed MPAL of the T/myeloid with monocytic differentiation lineage. This is the first report of an adult patient with MPAL of the T/myeloid with monocytic differentiation type presenting with leukemia cutis. She was started on chemotherapy with Hyper-CVAD. There is complete resolution of the skin lesions and she has achieved bone marrow remission after the first cycle of chemotherapy.

http://www.hindawi.com/journals/crim/2016/1298375/

Comment on “Effectiveness of antimicrobial photodynamic therapy (AmPDT) on Staphylococcus aureus using phenothiazinecompound with red laser”

http://link.springer.com/10.1007/s10103-016-2107-4

Cardiovascular Malformations in CHARGE Syndrome with DiGeorge Phenotype: Two Case Reports

Both CHARGE syndrome and DiGeorge anomaly are frequently accompanied by cardiovascular malformations. Some specific cardiovascular malformations such as interrupted aortic arch type B and truncus arteriosus are frequently associated with 22q11.2 deletion syndrome, while conotruncal defects and atrioventricular septal defects are overrepresented in patients with CHARGE syndrome. CHD7 gene mutation is identified in approximately two-thirds of patients with CHARGE syndrome, and chromosomal microdeletion at 22q11.2 is found in more than 95% of patients with 22q11.2 deletion syndrome. CHARGE syndrome is occasionally accompanied by DiGeorge phenotype. We report two patients with dysmorphic features of both CHARGE syndrome and 22q11.2 deletion syndrome. Although both of the two cases did not have 22q11.2 deletion, they had typical dysmorphic features of 22q11.2 deletion syndrome including cardiovascular malformations such as interrupted aortic arch type B. They also had characteristic features of CHARGE syndrome including ear malformation, genital hypoplasia, limb malformation, and endocrinological disorders. CHD7 gene mutation was confirmed in one of the two cases. When a patient with cardiovascular malformations frequently associated with 22q11.2 deletion syndrome does not have 22q11.2 deletion, we suggest that associated malformations characteristic of CHARGE syndrome should be searched for.

http://www.hindawi.com/journals/cripe/2016/8013530/

Different Anesthetic Managements of Esophageal Resection and Reconstruction

Conditions:   Anesthesia;   Esophagus Cancer;   Postoperative Complications
Interventions:   Other: Cardiac Output Maximization;   Other: Cardiac Output Normalization
Sponsors:   National Taiwan University Hospital;   Ministry of Science and Technology, Taiwan
Not yet recruiting - verified November 2016

https://clinicaltrials.gov/ct2/show/NCT02961140?term=HEAD+AND+NECK&recr=Open&lup_s=10%2F27%2F2016&lup_d=14&show_rss=Y&sel_rss=mod14

uPAR PET/CT for Staging Advanced and Localised Oral and Oropharyngeal Cancer

Conditions:   Oral Cancer;   Oropharyngeal Cancer;   Neoplasms;   Head and Neck Neoplasms;   Cancer of Mouth;   Neoplasms by Site
Intervention:   Other: 68Ga-NOTA-AE105 PET/CT
Sponsor:   Rigshospitalet, Denmark
Recruiting - verified November 2016

https://clinicaltrials.gov/ct2/show/NCT02960724?term=HEAD+AND+NECK&recr=Open&lup_s=10%2F27%2F2016&lup_d=14&show_rss=Y&sel_rss=mod14

Case 34-2016: A 17-Year-Old Boy with Myopia and Craniofacial and Skeletal Abnormalities

Presentation of Case. Dr. Angela E. Lin: A 17-year-old boy was referred to the medical genetics clinic of this hospital because of high myopia (i.e. severe nearsightedness) and craniofacial and other skeletal abnormalities. As a child, the patient had had difficulty with articulation and had…

http://www.nejm.org/doi/full/10.1056/NEJMcpc1610096?rss=searchAndBrowse

Nasal and Tracheal Cytological Changes After Total Laryngectomy in Long-Term Survivors

Objective:

Complete separation of upper and lower respiratory tract after total laryngectomy results in permanent effects on nasal cavities and tracheo-bronchial airways. Aim of this study is evaluating nasal and tracheal cytological alterations of mucosa in laryngectomy long-term survivors, analyzing the feasibility of scraping for cytological examination of tracheal mucosa.

Methods:

Twenty-five laryngectomy patients underwent symptoms' evaluation, endoscopic fiber optic examination, prick tests, and nasal and tracheal scraping for cytological exam. Twenty-five healthy subjects underwent the same assessment, except for tracheal scraping. Eleven laryngectomy patients accepted inferior turbinate biopsy for histological examination.

Results:

Nasal cytological analysis demonstrated mucous cell metaplasia in 20% of laryngectomized patients, but it was absent in all healthy subjects; no squamous cell metaplasia was found in both groups. In 15 patients (60%), bacteria were present, without inflammatory infiltrate. Tracheal cytological analysis demonstrated a quite high rate of squamous cell metaplasia (24%), neutrophilic infiltrate (32%), and presence of bacteria (40%). Histological examination of inferior turbinate showed submucosal stromal fibrosis in all patients and submucosal inflammatory infiltrate in 1 case (9%).

Conclusion:

Nasal cavities and trachea of laryngectomy patients undergo long-term cytological and histological changes of mucosa and submucosa, probably due to airflow modifications.

http://aor.sagepub.com/cgi/content/abstract/0003489416676500v1?rss=1

Soft Palate Injuries During Orotracheal Intubation With the Videolaryngoscope

Objective:

The videolaryngoscope has gained popularity for providing superior visualization in intubations. A rare complication of this technology is soft palate injury. Through a literature review and case series, we highlight the risks associated with the Glidescope and McGrath videolaryngoscopes and the management of soft palate injuries.

Method:

A case series of multi-institutional review of medical records was performed to identify patients with soft palate injuries from the videolaryngoscope. A literature review was also performed to analyze risk factors, mechanism of injury, complications, and management of palate injuries.

Results:

Of 9 cases, 3 resulted in soft palate perforations, which required primary closure. The remaining 6 patients sustained a soft palate laceration, which was treated conservatively. This injury commonly occurs when the intubator is focused on the video monitor and blindly inserts the Glidescope into the oropharynx. The rigid stylet used with the Glidescope increases the propensity for oropharyngeal injuries during blind insertions.

Conclusion:

Proper training, an awareness of this potential complication, and direct oral cavity visualization are recommended while inserting the videolaryngoscope. Repair is recommended for through-and-through perforations or if a large hanging flap is present. Antibiotics should be considered for lacerations greater than 1 to 2 cm.

http://aor.sagepub.com/cgi/content/abstract/0003489416678008v1?rss=1

Multivariate Analysis of Risk Factors in the Development of a Lower-Pitched Voice After Thyroidectomy

Objectives:

Thyroid surgeons frequently encounter outpatients with mobile vocal cords complaining of lower-pitched voices following thyroidectomy. This study investigated the clinical and pathological parameters affecting voice pitch following thyroid surgery.

Methods:

We analyzed the data of 393 patients with mobile vocal cords and who also underwent thyroid surgery. Speaking fundamental frequency (SFF) and fundamental frequency (F0) were compared before and after surgery.

Results:

Approximately 26.7% of patients had significantly lowered SFFs (SFF ≥ 12 Hz), and 30.2% exhibited significantly lower sustained vowel F0s (F0 ≥ 12 Hz) following thyroid surgery. On multivariate analysis, only gender: female remained a significant predictor of a clinically significant change in SFF following thyroid surgery (P < .001). Gender: female and extent of surgery: total remained significant predictors of a clinically significant change in F0 after surgery (P = .006 and P = .007, respectively).

Conclusions:

Appreciable proportions of patients experience lower-pitched voice and related vocal symptoms early after thyroid surgery. Such problems develop more frequently in females who underwent total thyroidectomy.

http://aor.sagepub.com/cgi/content/abstract/0003489416675875v1?rss=1

Diagnostic Challenges in a Case of IgG4-RD Affecting the Temporal Bone

Introduction:

Immunoglobulin G4–related disease (IgG4-RD) is a recently described fibroinflammatory condition with a characteristic histology. While IgG4-RD can affect a great variety of anatomical sites, it has been seldom described in the temporal bone.

Methods:

Herein, a case IgG4-RD occurring in the temporal bone of a 35-year-old woman is reported.

Discussion:

This case of IgG4-RD of the temporal bone proved a uniquely challenging diagnosis due to slightly atypical histology falling outside of "highly suggestive" criteria.

Conclusions:

We suggest that IgG4-RD remains a challenging diagnosis to reach despite increased awareness of the condition. We further suggest that clinicopathologic correlation remain the cornerstone of diagnosis as the spectrum of presentations of this newly described disease may be wider than previously anticipated.

http://aor.sagepub.com/cgi/content/abstract/0003489416678009v1?rss=1

Editorial on "Minimal Margin Extracapsular Dissection: A Viable Alternative Technique for Benign Parotid Lesions?"

http://aor.sagepub.com/cgi/reprint/0003489416676039v1?rss=1

Swallowing Quality of Life After Zona Incerta Deep Brain Stimulation

Objectives:

The management of Parkinson's disease (PD) has been improved, but management of signs like swallowing problems is still challenging. Deep brain stimulation (DBS) alleviates the cardinal motor symptoms and improves quality of life, but its effect on swallowing is not fully explored. The purpose of this study was to examine self-reported swallowing-specific quality of life before and after caudal zona incerta DBS (cZI DBS) in comparison with a control group.

Methods:

Nine PD patients (2 women and 7 men) completed the self-report Swallowing Quality of Life questionnaire (SWAL-QOL) before and 12 months after cZI DBS surgery. The postoperative data were compared to 9 controls. Median ages were 53 years (range, 40-70 years) for patients and 54 years (range, 42-72 years) for controls.

Results:

No significant differences were found between the pre- or postoperative scores. The SWAL-QOL total scores did not differ significantly between PD patients and controls. The PD patients reported significantly lower scores in the burden subscale and the symptom scale.

Conclusions:

Patients with PD selected for cZI DBS showed good self-reported swallowing-specific quality of life, in many aspects equal to controls. The cZI DBS did not negatively affect swallowing-specific quality of life in this study.

http://aor.sagepub.com/cgi/content/abstract/0003489416675874v1?rss=1

Book Review: Cases in Head and Neck Cancer: A Multidisciplinary Approach

http://aor.sagepub.com/cgi/reprint/0003489416678565v1?rss=1

Book Review: Laryngeal Physiology for the Surgeon and Clinician

http://aor.sagepub.com/cgi/reprint/0003489416675271v1?rss=1