Παρασκευή 11 Νοεμβρίου 2016
A Conditioned Behavioral Paradigm for Assessing Onset and Lasting Tinnitus in Rats
by Edward Pace, Hao Luo, Michael Bobian, Ajay Panekkad, Xueguo Zhang, Huiming Zhang, Jinsheng Zhang
Numerous behavioral paradigms have been developed to assess tinnitus-like behavior in animals. Nevertheless, they are often limited by prolonged training requirements, as well as an inability to simultaneously assess onset and lasting tinnitus behavior, tinnitus pitch or duration, or tinnitus presence without grouping data from multiple animals or testing sessions. To enhance behavioral testing of tinnitus, we developed a conditioned licking suppression paradigm to determine the pitch(s) of both onset and lasting tinnitus-like behavior within individual animals. Rats learned to lick water during broadband or narrowband noises, and to suppress licking to avoid footshocks during silence. After noise exposure, rats significantly increased licking during silent trials, suggesting onset tinnitus-like behavior. Lasting tinnitus-behavior, however, was exhibited in about half of noise-exposed rats through 7 weeks post-exposure tested. Licking activity during narrowband sound trials remained unchanged following noise exposure, while ABR hearing thresholds fully recovered and were comparable between tinnitus(+) and tinnitus(-) rats. To assess another tinnitus inducer, rats were injected with sodium salicylate. They demonstrated high pitch tinnitus-like behavior, but later recovered by 5 days post-injection. Further control studies showed that 1): sham noise-exposed rats tested with footshock did not exhibit tinnitus-like behavior, and 2): noise-exposed or sham rats tested without footshocks showed no fundamental changes in behavior compared to those tested with shocks. Together, these results demonstrate that this paradigm can efficiently test the development of noise- and salicylate-induced tinnitus behavior. The ability to assess tinnitus individually, over time, and without averaging data enables us to realistically address tinnitus in a clinically relevant way. Thus, we believe that this optimized behavioral paradigm will facilitate investigations into the mechanisms of tinnitus and development of effective treatments.http://ift.tt/2f05LKk
Rolle der Hochdosischemotherapie bei metastasierten oder rezidivierten Keimzelltumoren männlicher Patienten
Zusammenfassung
Hintergrund
Die Überlebenswahrscheinlichkeit von Patienten mit Keimzelltumoren (KZT) sinkt mit einer steigenden Zahl von Risikofaktoren in der Primärsituation, bei Platinresistenz oder im Rezidiv deutlich. Für diese Patienten stellt die Hochdosischemotherapie (HDCT) eine wichtige Therapieoption als Alternative zur konventionellen Chemotherapie (CDCT) dar.
Ziel der Arbeit
Erläutert wird der Stellenwert der HDCT bei Keimzelltumorpatienten in der Erstlinienbehandlung und im Rezidiv.
Material und Methoden
Die Autoren führten eine PubMed Analyse zu den Stichwörtern
„metastasierter Keimzelltumor" und „Hochdosischemotherapie" durch. Die nach Ansicht der Autoren wichtigsten Artikel wurden für diesen Review zusammengefasst.
Ergebnisse
In der Erstlinientherapie ist die HDCT weiterhin keine Standardtherapie, sollte jedoch bei Patienten mit primär mediastinalen nichtseminomatösen KZT sowie bei ZNS-Metastasen immer in Erwägung gezogen werden. Ebenso kann sie eine wichtige Behandlungsoption für Poor-prognosis-Patienten mit einem inadäquaten Tumormarkerabfall nach Durchführung des ersten Zyklus einer CDCT darstellen. Auch im ersten Rezidiv wird der Einsatz der sequenziellen HDCT weiterhin kontrovers diskutiert. Eine vor kurzem veröffentlichte retrospektive Analyse mit knapp 1600 Patienten zeigte einen Überlebensvorteil von 10–15 % zugunsten der HDCT, weitere Studien bestätigten dies. Dagegen konnte eine prospektive Studie von Pico et al. diesen Vorteil nicht belegen. Allerdings weist diese Studie erhebliche Schwächen auf. Eine internationale, prospektive, randomisierte Phase-III-Studie (TIGER), die im ersten Rezidiv die CDCT mit der HDCT vergleicht, soll den Einsatz der HDCT nun nochmals abschließend klären.
Unumstritten ist der Einsatz einer HDCT im zweiten oder nachfolgenden Rezidiv, wenn zuvor keine HDCT erfolgt ist. Mit jedem späteren Einsatz der HDCT sinkt jedoch die Heilungsrate. Die sequenzielle Gabe der HDCT ist der einmaligen Applikation im Hinblick auf die Toxizität vorzuziehen.
Eine frühzeitige Vorstellung der entsprechenden Patientengruppen an Zentren mit hoher Expertise für die Systemtherapie von Keimzelltumoren wird daher dringend empfohlen.
Diskussion
Ergebnisse prospektiver Phase-III-Studien werden benötigt, um die Rolle der HDCT in der Behandlung von Patienten mit KZT, insbesondere im ersten Rezidiv, abschließend festzulegen.
http://ift.tt/2fIPLfU
Histopathological Comparison of Condylar Hyperplasia and Condylar Osteochondroma Using Different Staining Methods
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Huanzhong Ji, Jiayang Li, Jun Shao, Dongming He, Yao Liu, Wei Fei, En Luo
PurposeThe objectives of this study were to investigate the application and differential diagnostic value of safranin O staining, safranin-fast green staining and Runt-related transcription factor 2 (Runx2) immunohistochemistry in condylar hyperplasia and condylar osteochondroma.Study DesignHistopathological presence was evaluated using hematoxylin-and-eosin (HE) staining, safranin O staining, safranin-fast green staining and immunohistochemistry of Runx2 in postoperative specimens of normal condyle (control), condylar hyperplasia and condylar osteochondroma.ResultsSafranin O staining clearly highlighted the tissue structure of the condylar cartilage, especially the hypertrophic layer. The safranin-fast green method showed a contrast in staining between the cartilage and the subchondral cancellous bone in the condyle specimens. Both methods were better than HE for morphologically distinguishing condylar hyperplasia and condylar osteochondroma. The expression of Runx2 in condylar hyperplasia was significantly greater than that in condylar osteochondroma.ConclusionsThis study indicated that safranin O staining and safranin-fast green staining are effective staining methods to differentiate between condylar hyperplasia and condylar osteochondroma. Immunohistochemistry findings suggested that Runx2 is valuable in the differential diagnosis of these 2 diseases.
http://ift.tt/2fEcIlE
Osseous osteoarthritic-like changes and joint mobility of the temporomandibular joints and upper cervical spine - is there a relation?
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Liselotte Sonnesen, Arne Petersson, Mie Wiese, Karl Erik Jensen, Palle Svanholt, Merete Bakke
ObjectivesTo compare 1) temporomandibular joint (TMJ) mobility between subjects a) with and without reduced upper cervical spine (UCS) mobility and b) with and without TMJ osseous osteoarthritic-like changes; and 2) UCS osseous changes between subjects a) with and without TMJ osseous osteoarthritic-like changes and b) with and without reduced UCS mobility.Study design39 subjects without pain from TMJ and UCS including 15 women (26-72 years, mean 56.0) and 24 men (27-71 years, mean 49.8) with obstructive sleep apnea (OSA) comprised the patient population. The range of motion (ROM) of the mandible and UCS was assessed clinically. Osseous changes of the TMJ and UCS were assessed by cone beam computed tomography. Differences were tested and adjusted for age and gender by multiple linear and logistic regression analyses.ResultsThe mandibular ROM was within normal range (45-64 mm) but the UCS ROM was reduced in 15 subjects. Osseous TMJ and UCS changes were both found in 38.5% of the subjects. Osseous UCS changes were more frequent in subjects with than without TMJ changes (P=0.0003; Odds Ratio (OR) 21.9). No other significant results were found.ConclusionsThe present findings in OSA patients of co-morbid osseous changes support a possible biomechanical relationship between the TMJs and UCS.
http://ift.tt/2fXjWVt
Development and validation of a quality of life questionnaire for patients with oral potentially malignant disorders
Publication date: Available online 11 November 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Jyothi Tadakamadla, Santhosh Kumar, Ratilal Lalloo, Newell W. Johnson
ObjectiveTo develop and evaluate the validity and reliability of a Quality of Life (QoL) questionnaire for patients with Oral Potentially Malignant Disorders (OPMD).Study designFor item generation, fifteen personal interviews and three focus group discussions were conducted with OPMD patients; Existing QoL questionnaires were reviewed, and inputs from specialist clinicians (n=10) were considered. Data collected from patients were analysed using NVivo. This led to identification of themes, item writing, scaling, item reduction, formatting and pre-testing of the newly developed questionnaire. Validity and reliability of the questionnaire were assessed in a separate sample of 300 subjects (150 each of OPMD patients and healthy subjects).ResultsSixty items were generated from the qualitative data and by reviewing existing questionnaires. The final questionnaire, after item reduction, comprised 20 questions which could be categorised under four domains. Exploratory factor analysis revealed a four-factor structure that conforms to the four domains. The OPMDQoL questionnaire exhibited good discriminant and convergent validity with patients reporting poorer QoL than healthy subjects and correlating significantly with existing questionnaires designed for similar purposes.ConclusionsOur OPMDQoL questionnaire was found to be valid and reliable. We recommend that it be applied in epidemiological and treatment studies of these disorders.
http://ift.tt/2fEa6nN
Oral health status in patients with acquired brain injury: a systematic review
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Mohit Kothari, Rajath Sasidharan Pillai, Simple Futarmal Kothari, Rubens Spin-Neto, Abhishek Kumar, Jørgen Feldbæk Nielsen
ObjectiveTo undertake a systematic review on the current knowledge and future perspectives regarding the status of various oral health factors, including social and behavioral aspects in patients with acquired brain injury (ABI).Study designA structured search strategy was applied to PubMed, Embase, and Scopus electronic databases until January 2016 to identify studies presenting the assessment of the oral health status of patients afflicted with any kind of ABI. The search strategy was restricted to English-language publications, enrolling patients above 18 years. Studies on the association of oral health conditions and brain injury were excluded. No study was excluded based on their qualitative analysis.ResultsA total of 27 studies were reviewed. Stroke was the most commonly studied ABI. Stroke patients had higher number of missing teeth, poorer plaque and gingival index scores and higher colonization of Candida albicans in saliva, all of which significantly reduced after intervention. Oral health related quality (OHrQoL) of life was poorer in patients compared to the population.ConclusionStroke was the most predominant brain injury condition studied in the literature with few publications focusing on other form of brain injury diseases. Overall, oral health has been noted to be poor in patients with ABI, but oral hygiene, and OHrQoL, has been found to be improved when oral hygiene interventions are provided to the patients.
http://ift.tt/2fXhApL
Primary intraosseous adenoid cystic carcinoma of the mandible: a comprehensive review and analysis of 4 new cases with emphasis on morphologic, immunophenotypic and molecular characteristics
Publication date: Available online 11 November 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Jing Han, Ting Gu, Xi Yang, Longwei Hu, Ronghui Xia, Zhen Tian, Jiang Li, Ling Zhu, Liqun Xu, Chunye Zhang
ObjectiveTo comprehensively review the clinical manifestations, imaging, diagnosis, treatment and pathological features of primary intraosseous adenoid cystic carcinoma (PIACC) of the mandible as well as to analyze PIACC histopathology and molecular features in 4 patient cases.Study DesignWe reviewed the literature and retrospectively studied 4 patient cases of PIACC.ResultsThe clinical and imaging findings of PIACC are similar to other malignant or borderline-malignant mandible tumors. The 4 cases of PIACC included 3 males and 1 female between 41 and 58 years of age. The histopathological features of the tumors resembled those of ACC. We observed abundant osteoclasts resorbing bone at the leading edge of the tumors characterized by solid structure histology but not by the cribriform subtype. Additionally, all 4 cases showed abnormalities in the MYB gene and high expression of MYB protein. All patients survived for the duration of follow-up, and 2 patients showed distant metastases (followed up 3-36 months).ConclusionsPIACC is extremely rare and is often clinically misdiagnosed. Different histological subtypes could show different mechanisms of invasion of the mandible. MYB gene and protein expression abnormalities can be used as indicators for the precise diagnosis of PIACC.
http://ift.tt/2fEcFWF
Examination of the early wound healing process under different wound dressing conditions
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Toshiro Kibe, Takashi Koga, Kazuhide Nishihara, Takao Fuchigami, Takuya Yoshimura, Tetsushi Taguchi, Norifumi Nakamura
ObjectiveVarious types of wound-healing dressings have been used to assist recovery healing of surgical wounds. We analyzed the wound-healing process in an animal model using different existing wound dressings.Study designFull-thickness defects were created using a biopsy punch on the backs of seven-week-old rats. The wounded areas were covered with NEOVEIL (polyglycolic acid (PGA)) or TERUDERMIS (collagen sponge (CS)) affixed using a rat jacket. The wound area, neo-epithelium length, and α-SMA expression were evaluated and compared between the control, PGA and CS groups.ResultsThe wound areas in the control group on day four or seven were significantly smaller than those in PGA and CS groups. The expression of α-SMA in granulation tissue peaked on day four for all groups. The expression of α-SMA in the control group on day four or day seven after injury was greater than in PGA and CS groups. However, there was no significant difference in the expression of α-SMA between the PGA versus CS groups.ConclusionsIn this study, PGA and CS suppressed wound contracture and lowered expression of α-SMA in wound areas. However, PGA and CS did not affect the neo-epithelium length at the wound site.
http://ift.tt/2fXjHd6
Objektive Maße bei der Anpassung der Prozessoren von Cochleaimplantatsystemen
Zusammenfassung
Hintergrund
Die Einstellung der elektrischen Stimulationsniveaus eines Cochleaimplantats (CI) bei der individuellen Anpassung des Sprachprozessors bedient sich insbesondere bei Kindern der Ergebnisse von intracochleär gemessenen elektrisch evozierten Hörnervenantworten („electrically evoked compound action potentials", eCAP) und intraoperativ durchgeführten Beobachtungen des elektrisch ausgelösten Stapediusreflexes (eSR). Der Nutzen dieser objektiven Maße beruht auf dem Zusammenhang zwischen den aus ihnen abgeleiteten Reizantwortschwellen und psychometrischen Daten.
Material und Methoden
Die intraoperative Messung der eCAP-Wachstumsfunktionen für alle Elektroden erfolgte an 30 Ohren erwachsener Patienten. Die reizabhängige Inzidenz der beobachtbaren eSR wurde für alle Elektroden an 16 Ohren erwachsener Patienten aufgezeichnet. Zur Auswertung der Daten wurden Algorithmen eingesetzt, mit deren Hilfe aus der Messreihe ohne Intervention durch den Untersucher Schwellen bestimmt werden können. Wesentliche Merkmale sind hierbei die Umwandlung der Beobachtungen in dichotome Variablen sowie die Betrachtung von Diskriminationsfunktionen und der Überschreitung eines numerischen Schwellenkriteriums.
Ergebnisse
Bei den eCAP-Daten bestehen im Vergleich zum bisherigen Verfahren engere und signifikante Korrelationen zwischen objektiven Schwellen und psychometrischen Größen. Profile erweisen sich im Vergleich zu kumulierten Daten ohne Elektrodenzuordnung als vorteilhaft. Die eSR-Schwellen zeigen ebenfalls signifikante Korrelationen, wenngleich in geringerem Maße und ohne erkennbaren Unterschied zwischen Profilen und kumulierten Daten.
Schlussfolgerung
Im Vergleich zum keineswegs einheitlichen internationalen Schrifttum verdeutlichen die erhaltenen Ergebnisse die Notwendigkeit einer konsequenten Schwellendefinition und die Einbeziehung der Elektrodenprofile.
http://ift.tt/2eZOxNb
Musiktherapie bei erwachsenen CI-Trägern
Zusammenfassung
Hintergrund
Hochgradig schwerhörigen und ertaubten Menschen kann durch ein Cochleaimplantat (CI) ein gutes Sprachverstehen ermöglicht werden, während die Wahrnehmung von Musik für CI-Träger oft beeinträchtigt bleibt. Daher wurde ein Musiktherapiekonzept für erwachsene CI-Träger entwickelt und in dieser Studie überprüft.
Methoden
Dreißig postlingual ertaubte, einseitig implantierte erwachsene CI-Träger nahmen an der Studie teil. Erhoben wurden die subjektive Klangqualität des CI („Hearing Implant Sound Quality Index", HISQUI) und musikalische Tests zur Tonhöhe, Melodie und Klangfarbe. Fünfundfünfzig Normalhörende absolvierten die musikalischen Tests.
Ergebnisse
Im Vergleich zu Normalhörenden war bei den CI-Trägern die Wahrnehmung der Tonhöhe, Melodie und Klangfarbe beeinträchtigt. Spezifische Therapieeffekte zeigten sich in der subjektiven Klangqualität des CI, in der Tonhöhe in hoher und tiefer Tonlage sowie in der Klangfarbe, während sich im Melodieerkennen ein allgemeiner Lerneffekt ergab.
Schlussfolgerung
Die Wahrnehmung von Musik ist bei CI-Trägern im Vergleich zu Normalhörenden beeinträchtigt. Durch eine individuelle Musiktherapie in der Rehabilitation konnten in diesem schwierigen Bereich Verbesserungen erzielt werden.
http://ift.tt/2fJp38B
Das Heidelberger CI‑Datenbankmodul
Zusammenfassung
Hintergrund
Die Versorgung mit einem Cochleaimplantat (CI) hat sich als Therapie für funktionell taube Patienten bewährt und etabliert. Die Anzahl der versorgten und rehabilitierten Patienten steigt kontinuierlich. Die daraus entstandenen Daten können wertvolle Informationen für Ärzte, Kostenträger und Wissenschaftler liefern. Bei der Erfassung und Strukturierung der Daten ist der Einsatz moderner Datenbanksysteme sinnvoll.
Material und Methoden
In enger Zusammenarbeit mit der Fa. Innoforce Est., Liechtenstein, entwickelten die Autoren ein bedarfsangepasstes Datenbankmodul für CI-Patienten. Die Daten von 100 aufeinanderfolgenden Patienten wurden erfasst und ausgewertet. Grundzüge des Moduls und eine exemplarische Datenauswertung werden dargestellt.
Ergebnisse
Die Analyse der Daten dieser 100 Patienten ergab 50 Frauen und 50 Männer zwischen 1 und 87 Jahren mit einem Maximalwert im Altersintervall 51–60 Lebensjahre. Über 50 % der Patienten waren auch auf dem Gegenohr stark hörbeeinträchtigt und fielen in den CI-Indikationsbereich. Das Ertaubungsereignis auf dem dann implantatversorgten Ohr lag meistens über 20 Jahre zurück. Die präoperative diagnostische Elektrostimulation des Hörnervs war bei 67 Patienten positiv. Alle 100 Patienten zeigten Hörempfindungen mit dem CI.
Schlussfolgerung
Die präsentierte Patientengruppe ist für die an der HNO-Universitätsklinik Heidelberg mit CI versorgte Population repräsentativ. Die demographische Verteilung entspricht der in der Literatur. Die Hörsituation des Gegenohrs, oft auch im Bereich der CI-Indikation, ist nicht überraschend, weil die CI-Versorgung ein junges Verfahren ist. Die präoperative Elektrostimulation erwies sich alleinstehend als nicht aussagekräftig. Die Hörergebnisse und Übersicht über die Komplikationen waren im Vergleich zu einem reinen Datenspeichersystem, wie etwa ISH-med, leicht zu berechnen.
http://ift.tt/2eZPLbd
Epithetische Versorgung von Nasenseptumperforationen
Zusammenfassung
Hintergrund
Perforationen der Nasenscheidewand können für den Patienten durch vermehrte Borkenbildung, Nasenbluten, behinderte Nasenatmung und pfeifende Atemgeräusche sehr belastend sein. Die Studie soll untersuchen, inwieweit diese Symptomatik durch einen mithilfe einer Abformung individuell hergestellten Obturator aus Silikon beeinflusst werden kann.
Material und Methode
In einer retrospektiven Studie wurden 45 Patienten mit einer symptomatischen Septumperforation untersucht, die über einen Zeitraum von 8 Jahren behandelt wurden. Größe und Lokalisation der Perforation wurden an den Abformungen und bei 28 Patienten auch durch eine In-situ-Messung bestimmt. Die Symptome wurden mit einer visuellen Analogskala (VAS) jeweils vor und nach Versorgung abgefragt (Rücklauf 64 %).
Ergebnisse
Es fand sich keine Korrelation zwischen der Fläche der Perforation und dem Abstand vom Naseneingang. 31 Patienten (69 %) hatten den Septumobturator bei der letzten Nachuntersuchung noch in situ. Größe und Lokalisation der Perforation waren keine Prädiktoren für den Behandlungserfolg. Folgende Symptome verbesserten sich hoch signifikant: Borkenbildung (VAS Median 75 vs. 31), Nasenbluten (50 vs. 0), Nasenatmungsbehinderung (84 vs. 14) und pfeifendes Atemgeräusch (69 vs. 0). Die subjektiv abgefragte Geruchsbildung und sinusitische Beschwerden änderten sich nicht signifikant. Die Obturatorträger gaben im Median eine subjektive Besserung von 91 % auf der VAS an.
Schlussfolgerung
Der Behandlungserfolg durch den Verschluss der Septumperforation mit einem individuellen Obturator lässt sich bisher nicht sicher vorhersagen. Die überwiegende Mehrzahl der Patienten war mit der Obturatorversorgung außerordentlich zufrieden, da die Symptomatik sich relevant verbessern ließ.
http://ift.tt/2eZMk4r
Präklinische Modelle für Kopf-Hals-Tumoren
Zusammenfassung
Da Plattenepithelkarzinome im Kopf-Hals-Bereich („head and neck squamous cell carcinoma", HNSCC) durch ausgeprägte inter- und intratumorigene Heterogenität charakterisiert sind, variieren sie im Ansprechen auf etablierte Therapieschemata oft erheblich. Darüber hinaus drängt derzeit eine Vielzahl zielgerichteter Therapeutika auf den Markt, die eine effizientere und weniger toxische Behandlung von HNSCC-Patienten ermöglichen sollen. Es besteht daher dringender Bedarf an geeigneten Modellsystemen, um sowohl das individuelle Ansprechen auf die avisierten Therapieregime mit Bestrahlung, Zytostatika und zielgerichteten Therapeutika vorab zu prüfen als auch um die Effektivität neuer Medikamente zu testen. Dabei sollte der pathophysiologische Gewebekontext der Tumorzellen erhalten bleiben, denn direkte und parakrine Interaktionen zwischen Tumorzellen und stromalen Zellen können das Therapieansprechen beeinflussen. In der Vergangenheit wurden komplexere Modellsysteme für die individualisierte Sensitivitätstestung auf Therapeutika etabliert. Sie gelten als viel versprechende Werkzeuge auf dem Weg zur personalisierten Krebstherapie. Der Übersichtsartikel stellt verschiedene Techniken vor, wie 3‑D-organotypische Modelle, patientenabgeleitete Xenograftmodelle (PDX), organotypische multizelluläre Sphäroide und Ex-vivo-Gewebekulturen, die Tumor- wie Stromazellen gleichermaßen repräsentieren, und diskutiert Vor- und Nachteile in Bezug auf die Translation in die klinische Praxis.
http://ift.tt/2eZJpIS
Moderne Schläfenbeinbildgebung
Zusammenfassung
In diesem Beitrag wird der gegenwärtige Stellenwert von Computertomographie (CT), Magnetresonanztomographie (MRT), digitaler Volumentomographie (DVT), digitaler Subtraktionsangiographie (DSA) und Röntgenspezialaufnahmen in der Diagnostik von Schläfenbeinerkrankungen dargelegt, wobei Letztere für diagnostische Zwecke obsolet sind. Möglichkeiten und Grenzen der Schnittbildverfahren beim Erkennen und/oder der Darstellung des Ausmaßes von entzündlichen, traumatischen und tumorösen Erkrankungen bzw. postoperativer Pathologien werden erörtert. Wichtig für die Wahl der im Einzelnen einzusetzenden Methode sind eine konkrete Fragestellung und die Übermittlung klinischer Befunde. Nur durch die CT oder DVT können Mittelohrfehlbildungen nichtinvasiv aufgedeckt werden. Es sind auch die Methoden, mit denen in unklaren Fällen die Diagnose einer Otosklerose untermauert werden kann. Die MRT ist Methode der Wahl bei Erkrankungen des Innenohrs und des inneren Gehörgangs inklusive Innenohrfehlbildungen. Die Endolymphhydrops-Visualisierung bei der Menière-Erkrankung wird derzeit nur in wenigen Einrichtungen erfolgreich realisiert.
http://ift.tt/2eZIkRv
Rare urological manifestation of Henoch-Schönlein purpura: testicular torsion
The Henoch-Schönlein purpura (HSP) is a systemic vasculitis that mostly occurs in children. Besides the most common clinical manifestations such as palpable purpura, arthralgia, abdominal pain and renal disease, it can have urological manifestations. We report a rare case of a 2-year-old boy with the HSP who developed a testicular torsion under corticosteroid treatment.
http://casereports.bmj.com/cgi/content/short/2016/nov11_1/bcr2016217531?rss=1
Acanthosis nigricans in insulinoma: before and after successful surgical enucleation
Description
A 14-year-old girl without diabetes presented with recurrent attacks of generalised tonic–clonic seizures for the past 3 years which had partially been controlled with phenytoin and not with sodium valproate or levetiracetam. A detailed history revealed that each of those episodes was probably related to recurrent spontaneous hypoglycaemia. She was severely obese (body mass index: 36.54 kg/m2) with acanthosis nigricans (AN), facial acne and hirsutism (figure 1). During her hospital stay she developed spontaneous hypoglycaemia (plasma glucose: 25 mg/dL) and biochemical evaluation of the critical sample documented hyperinsulinaemic hypoglycaemia (serum insulin: 16.8 (>3 µIU/mL); C peptide: 3.46 (>0.6 ng/mL); β-hydroxybutyrate: 0.01 (<2.7 mmol/L)). The triphasic CT scan of abdomen revealed a 31x29 mm mass in the neck of the pancreas (figure 2). Screening for other components of multiple endocrine neoplasia type 1 (MEN-1) syndrome was negative. She underwent enucleation of the pancreatic mass and the histopathology was consistent with insulinoma....
http://ift.tt/2fIpUoo
Electromyography needle breaks within the perineum: a rare complication of urodynamics not reported earlier and lesson learnt
The urodynamic study (UDS) is nowadays frequently used by the urologist worldwide to aid in the diagnosis of various urological disorders and electromyography (EMG) is an integral part of it. EMG is performed either by using surface electrodes or concentric needle electrodes. We report an unusual case in which the concentric EMG needle was accidentally broken within the perineum of a man aged 60 years undergoing urodynamics. The needle was removed urgently in a minimally invasive manner under the C-arm guidance without any associated morbidity. This case report highlights the need of urgent intervention in such rare scenarios to help prevent any associated infectious complications. Also, vigilant behaviour during the procedure (and after) to detect such incidents along with detailed patient counselling should be included in the patient management protocol of patients undergoing UDS.
http://ift.tt/2fqHjT4
O012 A single center experience of SCID newborn screening in illinois
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): J. Bergerson, A. Skoskiewicz, R. Fuleihan
http://ift.tt/2fI8UhM
O020 Asthma exacerbations and lung function decline in children during a 52-week controlled trial of omalizumab
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): B. Chipps, S. Szefler, K. Rosen, T. Haselkorn, B. Trzaskoma, B. Ortiz, B. Lanier, W. Busse
http://ift.tt/2fDotsA
O016 IgG4-related ophthalmic disease in children: A case report
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): O. Rojas-Ramirez, M. Nunez-Velazquez, E. Acosta-Jimenez, A. Vargas-Caro
http://ift.tt/2fqwTmr
O010 Post-natal mechanisms of human hematopoietic stem cell self-renewal
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): V. Bundy, S. Sandoval, C. Seet, C. Parekh, C. Chin, C. He, Y. Zhu, L. Kohn, D. Rao, G. Crooks
http://ift.tt/2fIjpn8
O014 Splenomegaly and IgA deficiency predicts granulomatous lymphocytic interstitial lung disease (GLILD) in common variable immunodeficiency (CVID)
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): S. Hartono, M. Motosue, S. Khan, V. Rodriguez, R. Divekar, A. Joshi
http://ift.tt/2fqt0xI
Title Page
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
http://ift.tt/2fDsUU8
O018 Asthma exacerbations and triggers in children with severe/difficult-to-treat asthma: Impact on quality of life
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): A. Luskin, T. Haselkorn, K. Rosen, D. Mink, B. Chipps
http://ift.tt/2fqrw6J
Table of Contents - Concurrent Sessions
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
http://ift.tt/2fIe6Cn
O011 Immunoglobulin management approaches in American patients with common variable immune deficiency and autoimmunity
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): K. Kennedy, C. Cunningham-Rundles, M. Morsheimer
http://ift.tt/2fqwFMe
O013 Novel RAG-1 mutation identified in a patient with hypomorphic severe combined immunodeficiency (SCID)
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): D. Arnold, J. Heimall
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O001 Randomized, double-blind, placebo-controlled trial of recombinant human C1 inhibitor for prophylaxis of hereditary angioedema attacks
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): M. Cicardi, M. Riedl, V. Grivcheva Panovska, D. Moldovan, J. Baker, W. Yang, A. Reshef, S. Andrejevic, R. Lockey, R. Hakl, S. Kivity, L. Bellizzi, J. Harper, A. Relan
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O015 Tolerability of a new human immune globulin subcutaneous, 20% preparation in primary immunodeficiency diseases
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): S. Gupta, M. Stein, I. Melamed, I. Hussain, K. Paris, W. Engl, B. McCoy, C. Rabbat, L. Yel
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O017 Association between maternal infections and antibiotic use during pregnancy with childhood atopic diseases
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): S. Vethachalam, Y. Persaud
http://ift.tt/2fqwCQy
O002 A randomized trial of subcutaneous C1-inhibitor for the prevention of hereditary angioedema attacks
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): B. Zuraw, T. Craig, M. Cicardi, H. Longhurst
http://ift.tt/2fDr8lU
O019 Effects of language barriers on asthma control
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): M. Henao, J. Malerich, J. Kraschnewski
http://ift.tt/2fqtKD3
O021 Efficacy of budesonide/formoterol pressurized metered-dose inhaler versus budesonide alone in children (6-<12 years) with asthma
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): D. Pearlman, G. Eckerwall, J. McLaren, R. Lamarca, M. Puu, C. Jorup, K. Sandin, M. Lanz
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O003 Successful treatment of attacks in hereditary angioedema with normal C1 inhibitor using prophylactic tranexamic acid
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): M. Kearns, K. Reddy, S. Krishnan, C. Radojicic, A. Gonzalez-Estrada
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O004 Childhood presenting hereditary angioedema is diagnosed in adulthood by non-pediatric physicians: Icatibant outcome survey findings
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): H. Longhurst, W. Aberer, L. Bouillet, T. Caballero, A. Bygum, A. Grumach, A. Perrin, I. Andresen, A. Zanichelli, M. Maurer
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O005 Improvement in hereditary angioedema diagnosis: Findings from the icatibant outcome survey
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): A. Zanichelli, M. Magerl, H. Longhurst, W. Aberer, A. Bygum, T. Caballero, L. Bouillet, A. Grumach, A. Perrin, I. Andresen, M. Maurer
http://ift.tt/2fqqF68
O006 Open-label, non-randomized study of single-dose icatibant in pediatric patients with hereditary angioedema: Primary/secondary/pharmacokinetic analyses
Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5, Supplement
Author(s): J. Bernstein, H. Farkas, A. Reshef, W. Aberer, T. Caballero, L. McCarthy, J. Hao, W. Nothaft, J. Schranz, H. Li
http://ift.tt/2fI9gVI
Response to “The Concept of Fragile Skin: a Case of Disease Mongering in Dermatology?”
Abstract
We thank Dr Elsner for his interest in our supplement "Fragility of epidermis in newborns, children and adolescents" recently published in this journal, but note his concern about the value of the term "fragile skin" as a scientifically useful disease definition, given the wide spectrum of conditions covered by the term [1]. Contrary to what is suggested in the letter by Dr Elsner, fragile skin is not a "disease" and should not be confounded with skin fragility existing in the repertoire of dermatological diseases requiring medical treatment using pharmaceutical interventions (e.g. disorder "skin fragility", leading to mechanical skin tears [2]), but is a perceived skin condition which can be managed by dermo-cosmetic treatments [3]. The skin as our outer defence wall protects the body against a range of microbial, chemical and physical insults and grants a homeostatic balance for the internal environment, including the protection against excessive water loss [2].
This article is protected by copyright. All rights reserved.
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Influence of interpersonal traits on patient outcomes in the treatment of chronic rhinosinusitis
Background
Patient-reported outcome measures (PROMs) measure health states in chronic rhinosinusitis (CRS) and have become the dominant metrics of treatment outcomes. Interpersonal traits (IPTs) are patient-specific factors that include personality type, perceived social support, and trust in physicians. The association of IPTs on treatment outcomes among patients with CRS has not been described previously, and IPTs may represent major clinical factors influencing treatment outcomes.
Methods
Adult patients electing medical or surgical treatment for recalcitrant CRS were prospectively enrolled into a multi-institutional, observational outcomes study. Validated measures of IPTs, including the Big Five Inventory-10 Short Version (BFI-10), Multidimensional Scale of Perceived Social Support (MSPSS), and the Trust in Physician Scale (TPS), were completed and compared with PROMs, which included the 22-item SinoNasal Outcome Test (SNOT-22), the Medical Outcomes Study Short Form-6D (SF-6D), and the Patient Health Questionnaire-2 (PHQ-2).
Results
Three hundred fifty-four participants were included and followed for an average (± standard deviation) of 16.3 (±4.8) months. Significant within-subject improvement in mean PROM scores was reported (all p <0.001). No association was detected between PROM score improvement and baseline BFI-10 or MSPSS scores (p > 0.050). Significant, but weak, absolute correlations were reported between baseline TPS scores and improvement in SNOT-22, SF-6D, and PHQ-2 total scores (p < 0.050; r ≤ 0.138).
Conclusion
Personality type and perceived social support do not associate with improvement after treatment for CRS. However, increased trust in physicians is weakly associated with greater posttreatment improvement. Further study is needed to examine the relationship between physician trust, patient satisfaction, and treatment outcomes among patients with CRS.
http://ift.tt/2eJQjB3
Surgical therapy vs continued medical therapy for medically refractory chronic rhinosinusitis: a systematic review and meta-analysis
Background
The currently accepted treatment paradigm of treating chronic rhinosinusitis (CRS) first with appropriate medical therapy (AMT) and then with surgery if patients are refractory to AMT, has been criticized for lack of evidence. The objective of this study was to reassess the literature and establish the highest level of evidence possible regarding further management of CRS patients refractory to AMT.
Methods
This study was a systematic review (SR) with meta-analysis (MA). Adult CRS patients who received AMT and then underwent either medical or surgical therapy in moderate to high level prospective studies were included. Outcomes assessed were disease-specific quality of life (QOL), nasal endoscopy, health-state utility, missed work days, change in cardinal symptoms of CRS, economic impact, and adverse events.
Results
A total of 970 manuscripts were identified; 6 studies were ultimately included in the SR with 5 included in the MA. Compared to continued medical therapy, endoscopic sinus surgery (ESS) significantly improved patient-based QOL scores (p < 0.00001) and nasal endoscopy scores (p < 0.00001). Difference in missed work days depended heavily on patient choice of intervention. Unpooled analysis showed improvements in olfaction, health utility scores, and cost-effectiveness.
Conclusion
On meta-analysis, for CRS patients refractory to AMT, ESS significantly improves objective endoscopic scoring outcomes vs continued medical therapy alone. In patients with refractory CRS who have significant reductions in baseline QOL, ESS results in significant improvements. Continued medical therapy appears to maintain outcomes in patients with less severe baseline QOL. Unpooled analysis demonstrates improvement in health utility, olfaction, and cost-effectiveness following ESS compared to continued medical therapy alone, in medically refractory CRS.
http://ift.tt/2fDp6Cj
Fluorescein-guided intraoperative endoscopy in patients with hereditary hemorrhagic telangiectasia: first impressions
Background
Hereditary hemorrhagic telangiectasia (HHT) is a rare genetic disease that results in mucocutaneous telangiectasias and arteriovenous visceral malformations. Nasal telangiectasias lead to recurrent epistaxis, which affects up to 96% of patients. Different morphologic classifications and methods of visualization of nasal lesions have been described in the literature. We developed a new method of intraoperative endoscopy based on the intravenous administration of fluorescein. Preliminary data of this technique are reported.
Methods
After the intravenous administration of sodium fluorescein, an intraoperative fluorescein-guided endoscopy was carried out using photographic customized yellow filters on top of a 0-degree, 4-mm endoscope.
Results
In 2015, 65 HHT patients underwent surgery for their epistaxis in our institution, and in 7 patients (3 males, 4 females; mean age, 54 years) an intraoperative fluorescein-guided intraoperative nasal endoscopy was performed. No adverse events or complications were observed.
Conclusion
First impressions regarding the usage of this technique in HHT patients seem to be promising and positive in terms of efficacy and safety. However, further studies with larger cohorts of patients should be performed in order to better investigate the use of this method for diagnostic and surgical purposes in HHT.
http://ift.tt/2eJKbsQ
Prevention of sinonasal inflammation by a synthetic glycosaminoglycan
Background
Glycosaminoglycans (GAGs) are polysaccharides that are distributed on respiratory epithelial cells, endothelial cells, and submucosal glands. Uniquely positioned, certain GAGs exhibit anti-inflammatory properties in respiratory diseases and serve important roles in repairing mucosal surfaces and modulating mucociliary clearance. We hypothesized that topical administration of a synthetic GAG (GM-0111) would prevent sinonasal inflammation in a mouse model of rhinosinusitis (RS).
Methods
To test our hypothesis, C57BL/6 mice were intranasally administered fluorescent GM-0111, and sinonasal tissues were examined for coating and penetration ability. To test therapeutic feasibility, mice (n = 6) were given GM-0111 or hyaluronic acid (HA; 800 μg dose) prior to inducing RS with inflammatory molecule LL-37 (115 μg dose). After 24 hours, sinonasal tissues were harvested for histological and biochemical analysis of inflammatory markers (inflammatory cell infiltration, lamina propria [LP] thickening, and neutrophil enzyme myeloperoxidase [MPO]) and cell death.
Results
GM-0111 was observed within sinonasal tissues 1 hour and 24 hours after intranasal administration, indicating rapid and effective coating and penetration. GM-0111 prevented sinonasal tissues from developing inflammatory changes, with significant reductions in mast cell infiltration (p < 0.05), LP thickening (p < 0.001), and MPO levels (p < 0.01) when compared to tissues treated with LL-37 and those pretreated with HA. GM-0111 reduced cell death within sinonasal tissues in contrast to LL-37–treated tissues.
Conclusion
We report a new synthetic GAG (GM-0111) that uniformly coats and penetrates into the sinonasal mucosa to prevent sinonasal inflammation and cell death in a mouse model of RS.
http://ift.tt/2fDnE2Z
Sinonasal adenoid cystic carcinoma: a population-based analysis of 694 cases
Background
Currently, limited literature exists about sinonasal adenoid cystic carcinoma (SNACC). In this study, we analyze the demographics, survival, and treatment efficacy of this rare entity.
Methods
Our study was a retrospective population-based analysis of SNACC in the Surveillance, Epidemiology, and End Results (SEER) database assessing the 40-year time-frame of 1973 to 2013.
Results
Six hundred ninety-four SNACC patients were identified; 53.2% were female and 46.8% were male. Caucasians were most commonly affected (77.1%). SNACC most often arose from the maxillary sinuses, followed by the nasal cavity. The majority of SNACC cases presented as stage IV disease. Nodal and distant metastases were present in 3.6% and 7.1% of all cases, respectively. Overall 5-, 10-, and 20-year disease-specific survival (DSS) rates were 66.5%, 41.1%, and 17.6%, respectively. The presence of distant metastasis dropped the 5-year DSS rate from 64.5% to 20.0%. Cases treated with combined surgery and adjuvant radiotherapy had a slightly improved 5-year DSS rate compared with surgery alone (73.5% vs 72.5%). Surgery alone resulted in higher 10- and 20-year DSS rates (54.2% and 36.8%, respectively) when compared with combined therapy (44.2% and 15.5%), radiotherapy alone (10.8% and 0%), and no surgery or radiotherapy (9.3% and 0%).
Conclusion
This study represents the largest cohort of SNACC patients to date. Factors that confer a survival benefit in SNACC include M0 disease, and presentation primarily in the nasal cavity. Overall low rates of nodal metastasis may not warrant the use of elective neck dissections, unless there is clinical suspicion. Modalities of therapy that include surgery greatly improve survival. Adjuvant radiotherapy appears to slightly improve 5-year disease-free survival but does not impact long-term survival.
http://ift.tt/2eJP8Sp
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