Contained rupture of a mycotic infrarenal aortic aneurysm infected with Campylobacter fetus

Mycotic abdominal aortic aneurysms (MAAAs) are rare entities accounting for 0.65–2% of aortic aneurysms. Campylobacter fetus has a tropism for vascular tissue and is a rare cause of mycotic aneurysm. We present a 73-year-old male patient with contained rupture of a MAAA caused by C. fetus, successfully treated with endovascular aortic repair (EVAR) and antibiotics, which is not previously described for this aetiology. Although open surgery is the gold standard, EVAR is nowadays feasible and potentially represents a durable option, especially in frail patients.

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Massive symptomatic right-sided Bochdalek hernia in an adult man

A 22-year-old man presented to a rural hospital in Australia with right-sided pleuritic chest pain, right shoulder pain and dyspnoea. The patient had been receiving chronic asthma therapy without improvement. CT of the chest was performed after an abnormal X-ray, incidentally revealing one of the largest documented right-sided diaphragmatic hernias, with left lung compression due to mediastinal shift. The patient was definitively managed with thoracotomy alone. The contents of the hernia sac included colon and multiple loops of small bowel with a 10 cm neck. Definitive treatment was achieved with significant reduction in hernia size and formation of a neo-diaphragm with composite mesh. The postoperative period was complicated only by a wound infection. Two weeks after discharge the patient remained clinically well. Repeat chest X-ray showed no recurrence of the hernia. Congenital diaphragmatic hernias should be considered in patients with ongoing respiratory symptoms. Thoracotomy provides a safe approach.

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Kwashiorkor: an unexpected complication to anorexia nervosa

We present the case of a woman aged 48 years, diagnosed with anorexia nervosa (AN) at the age of 12. She was admitted to a highly specialised eating disorder facility with distended abdomen, muscular atrophy, ulcerative dermatitis, electrolyte derangements and low serum albumin. Her weight was 53.1 kg, corresponding to a body mass index (BMI) of 17.9 kg/m². After initial stabilisation, a therapeutic ascites puncture relieved the patient from 6500 mL of ascites. After 6 weeks of nutritional and diuretic treatment, the patient was discharged with a weight of 46.8 kg (BMI 15.7 kg/m²), without ascites and with healed ulcerations. The condition was consistent with kwashiorkor, a complication to malnutrition rarely seen in AN.

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Case of Steven-Johnson Syndrome in a male with breast cancer secondary to docetaxel/cyclophosphamide therapy

The mortality rate for Stevens-Johnson syndrome (SJS) is estimated to be ~12% and for toxic epidermal necrolysis (TEN) it is around 30%. It continues to be a severe life-threatening drug reaction. We present a 60-year-old Caucasian man with a medical history significant for breast cancer status post mastectomy and chemotherapy with docetaxel and cyclophosphamide who presented with severe mucositis and a progressing skin rash consistent with SJS. He was started on high-dose corticosteroids and IVIG but continued to have worsening mucosal ulcerations and severe bleeding from the oral, conjunctival and genital mucosa. He underwent several rounds of plasmapheresis and additional high-dose steroids with mild improvement in the mucocutaneous manifestations. He subsequently developed respiratory failure, which required mechanical ventilation, as well as disseminated intravascular coagulation, diffuse alveolar haemorrhage, with Pneumocystis jirovecii pneumonia which led to his demise on hospital day 15.

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Left ventricular hypertrabeculation: a clinical enigma

Description

A woman aged 25 years was referred to cardiology for atypical chest pain. This was described as sharp non-exertional left-sided chest pain lasting a few seconds. Vitals showed BP 122/85 and pulse 87 bpm. Cardiovascular examination revealed normal S1 and S2, an S4 and no murmurs. ECG showed normal sinus rhythm. Transthoracic echocardiography showed marked trabeculation of the apical lateral segments (figure 1). Cardiac MRI confirmed these trabeculations with no diagnostic criteria for non-compaction.

Figure 1

(A) Cardiac MRI showing the short-axis view of the left ventricle (LV) demonstrating hypertrabeculation appearance (yellow arrow). (B) Two-dimensional echo short-axis view of the LV showing prominent trabeculations (yellow arrow). LV, left ventricle; RV, right ventricle.

Left ventricular (LV) hypertrabeculation is defined by the presence of three or more trabeculations apically and up to the level of papillary muscles, seen in one echocardiographic view.

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A technical consideration when using flow diversion for recurrent aneurysms following stent-assisted coiling

Flow diversion (FD) is a treatment option for recurrent aneurysms including following stent-assisted coiling (SAC), although this approach is both 'off-label' and unproven. A technical challenge of FD placement may involve the microwire catching on the tines of the previously placed stent or potentially going 'in-out-in' from the central axis of the stent. We report a case and technique that assures the wire has safely remained within the central axis of the stent. The procedure was performed in standard fashion except that the intermediate catheter was passed completely through the previously placed stent after the microwire/microcatheter had crossed. The large diameter of the intermediate catheter assured that the microwire did not go 'in-out-in'. The intermediate catheter was completely withdrawn from the stent and the FD was placed in standard fashion. This technique may help to achieve complete FD opening and prevent thromboembolic complications associated with incomplete FD opening.

http://ift.tt/2fWolH1

EACMFS Prizes and Awards

The Council of EACMFS wishes to ensure that all members of the Association are aware of the current awards and prizes that are available. These are designed to provide educational support and also to allow the opportunity for trainees and those who have recently achieved specialist status to visit units outside their own departments.

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Editorial Board

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Obituary for Professor Dr. med. Dr. med. dent. Emil W. Steinhäuser

We will miss but will not forget our honorary memberProfessor Dr. med. Dr. med. dent. Emil W. Steinhäuser, FDSRCS

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Announcements

Dear Colleagues,

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Middle Ear Obliteration with Blind-Sac Closure of the External Auditory Canal for Spontaneous CSF Otorrhea

Outcome Objectives

To (1) identify unique features of patients who underwent middle ear/mastoid obliteration with blind-sac closure of the external auditory canal for spontaneous cerebrospinal fluid (CSF) otorrhea and (2) explore outcomes.

Study Design

Case series with chart review.

Setting

Tertiary care center.

Subjects and Methods

Adults treated for spontaneous cerebrospinal fluid otorrhea from 2007 through 2015 were reviewed and stratified into 2 groups based on the surgery performed: (1) 11 patients underwent middle ear/mastoid obliteration with blind-sac closure of the external auditory canal and (2) 26 patients underwent other procedures. Demographics, body mass index, revised cardiac risk index, Duke Activity Status Index scores, and anticoagulation use were documented. Audiologic data were gathered from pre- and postoperative visits. The primary outcome measure was leak recurrence. Complications were tabulated.

Results

Poor preoperative hearing was a relative indication for obliteration. Obliteration patients had higher body mass index (43.2 vs 34.9 kg/m2; P < .05), incidence of super-morbid obesity (45% vs 7.6%; P = .015), anticoagulation usage (36% vs 0%; P = .004), cardiac risk scores (1.2 vs 0.1 dB; P < .0004), and Duke Activity Status Index scores. There was 1 leak recurrence (9%). Major and minor complication rates were 9% and 36%, respectively. Mean follow-up was 30.8 ± 8.6 months.

Conclusion

Middle ear and mastoid obliteration with blind-sac closure of the external auditory canal is effective for treating spontaneous CSF otorrhea. The small cohort reviewed did not experience any major perioperative morbidity. The technique may be best suited for patients with poor hearing, the infirm, and those in whom craniotomy is contraindicated.

http://ift.tt/2gftaM4

Outcomes of Vestibular Schwannoma Surgery among the Elderly: Analysis of the National Inpatient Sample

Objective

To compare comorbidities and in-hospital complications between elderly and nonelderly patients undergoing vestibular schwannoma (VS) surgery. To examine average length of stay (LOS) and hospital charges among elderly patients.

Study Design

Population-based inpatient registry analysis.

Setting

Academic medical center.

Subjects and Methods

Retrospective analysis of the National Inpatient Sample for patients undergoing VS surgery from 2002 to 2010: 4137 patients met inclusion criteria, with 519 (12.5%) in the elderly cohort (≥65 years). Outcomes of elderly and nonelderly (<65 years) patient cohorts were compared.

Results

Compared with the nonelderly cohort, the elderly cohort had more comorbidities, including diabetes mellitus, hypertension, and pulmonary disease (all P < .001). Elderly patients had longer LOS (6.5 vs 5.4 days; P = .001) but did not incur significantly greater hospital charges. Rates of cerebrospinal fluid leak, meningitis, and facial nerve injury did not vary significantly between groups. The elderly cohort experienced higher rates of in-hospital complications, including acute cardiac events, iatrogenic cerebrovascular infarction/hemorrhage, postoperative bleeding (hemorrhage/hematoma), and in-hospital mortality (all P < .05). In binary logistic regression, correcting for patient demographics and presence of comorbidities, elderly status was associated with 1.848 (95% confidence interval, 1.167-2.927; P = .009) greater odds of medical complications and 13.188 (95% confidence interval, 1.829-95.113; P = .011) greater odds of in-hospital mortality.

Conclusion

Elderly patients undergoing VS surgery have more comorbidities, in-hospital complications, and longer LOS than nonelderly patients. The elderly cohort had a greater rate of in-hospital mortality, though rare. Interestingly, elderly patients did not have a higher rate of many known complications associated with VS surgery and did not incur more hospital charges.

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Three-Dimensional Printing and Its Applications in Otorhinolaryngology-Head and Neck Surgery

Objective

Three-dimensional (3D)-printing technology is being employed in a variety of medical and surgical specialties to improve patient care and advance resident physician training. As the costs of implementing 3D printing have declined, the use of this technology has expanded, especially within surgical specialties. This article explores the types of 3D printing available, highlights the benefits and drawbacks of each methodology, provides examples of how 3D printing has been applied within the field of otolaryngology–head and neck surgery, discusses future innovations, and explores the financial impact of these advances.

Data Sources

Articles were identified from PubMed and Ovid MEDLINE.

Review Methods

PubMed and Ovid Medline were queried for English articles published between 2011 and 2016, including a few articles prior to this time as relevant examples. Search terms included 3-dimensional printing, 3D printing, otolaryngology, additive manufacturing, craniofacial, reconstruction, temporal bone, airway, sinus, cost, and anatomic models.

Conclusions

Three-dimensional printing has been used in recent years in otolaryngology for preoperative planning, education, prostheses, grafting, and reconstruction. Emerging technologies include the printing of tissue scaffolds for the auricle and nose, more realistic training models, and personalized implantable medical devices.

Implications for Practice

After the up-front costs of 3D printing are accounted for, its utilization in surgical models, patient-specific implants, and custom instruments can reduce operating room time and thus decrease costs. Educational and training models provide an opportunity to better visualize anomalies, practice surgical technique, predict problems that might arise, and improve quality by reducing mistakes.

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Mitochondria-Targeted Antioxidant Mitoquinone Reduces Cisplatin-Induced Ototoxicity in Guinea Pigs

Objective

To determine if mitoquinone (MitoQ) attenuates cisplatin-induced hearing loss in guinea pigs.

Study Design

Prospective and controlled animal study.

Setting

Academic, tertiary medical center.

Subjects and Methods

Guinea pigs were injected subcutaneously with either 5 mg/kg MitoQ (n = 9) or normal saline (control, n = 9) for 7 days and 1 hour before receiving a single dose of 10 mg/kg cisplatin. Auditory brainstem response thresholds were measured before MitoQ or saline administration and 3 to 4 days after cisplatin administration.

Results

Auditory brainstem response threshold shifts after cisplatin treatment were smaller by 28 to 47 dB in guinea pigs injected with MitoQ compared with those in the control group at all tested frequencies (4, 8, 16, and 24 kHz, P = .0002 to .04). Scanning electron microscopy of cochlear hair cells showed less outer hair cell loss and damage in the MitoQ group.

Conclusion

MitoQ reduced cisplatin-induced hearing loss in guinea pigs. MitoQ appears worthy of further investigation as a means of preventing cisplatin ototoxicity in humans.

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Multivariate Analysis of Factors Influencing Facial Nerve Outcome following Microsurgical Resection of Vestibular Schwannoma

Objective

To assess through multivariate analysis the clinical pre- and intraoperative factors of facial nerve outcomes at day 8 and 1-year recovery of facial palsy, as compared with day 8 status among patients who underwent total resection of unilateral vestibular schwannoma.

Study Design

Case series with chart review.

Setting

Tertiary referral center.

Subjects and Methods

This study included 229 patients with preoperative normal facial function and anatomic preservation of the facial nerve. Clinical, radiologic, and intraoperative factors were assessed according to facial nerve function at day 8 and 1 year.

Results

We observed that 74% and 84% of patients had good facial function (House-Brackmann [HB] I-II) at day 8 and 1 year, respectively. Of 60 patients, 26 (43%) who had impaired facial function (HB III-VI) at day 8 recovered good facial function (HB I-II) 1 year after surgery. A structured equation model showed that advanced tumor stage and strong facial nerve adhesion were independently associated with facial nerve conduction block at day 8. No predictive factor of impaired facial function recovery was seen at 1 year. In terms of the extracanalicular diameter of the tumor, the cutoff point to minimize the risk of impaired facial function was 16 mm.

Conclusion

At day 8 after vestibular schwannoma resection, facial function was impaired in the case of large tumors or strong facial nerve adhesion to the tumor. After 1 year, less than half of the patients recovered good facial function, and no predictive factor was found to be associated with this possible recovery.

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Alveolar echinococcosis of the right adrenal gland: a case report and review of the literature

Extrahepatic manifestations of Echinococcus multilocularis are very rare, especially in the adrenal glands. To the best of our knowledge, only seven cases of adrenal alveolar echinococcosis have been reported, al...

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Hysteroscopic management of a heterotopic pregnancy following uterine artery embolization: a case report

Intra-uterine pregnancy coexisting with cervical pregnancy (heterotopic pregnancy) is a rare condition and its management is challenging because of the massive bleeding associated with cervical pregnancy. Uter...

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Purtscher’s retinopathy and renal cortical necrosis: two rare vaso-occlusive complications in a patient with acute pancreatitis: a case report

Purtscher's retinopathy and renal cortical necrosis are two rare vaso-occlusive complications of acute pancreatitis. Purtscher's retinopathy causes sudden impairment of vision, which was first reported in a pa...

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Platelet-rich plasma in androgenic alopecia: Indications, technique, and potential benefits

Publication date: Available online 15 November 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Elie M. Ferneini, Daniel Beauvais, Concetta Castiglione, Moniek V. Ferneini
PurposeThe purpose of this study was to provide an overview of platelet-rich plasma (PRP) injected into the scalp in the management of androgenic alopecia.Materials and MethodsA literature review was performed which evaluated the benefits of PRP in androgenic alopecia.ResultsHair restoration has been on the increase. PRP's main components of platelet-derived growth factor, transforming growth factor and vascular endothelial growth factor have the potential to stimulate hard- and soft-tissue wound healing. In general, PRP had a benefit on patients with androgenic alopecia including increased hair density and quality. Currently, different PRP preparations are being used with no standard technique.ConclusionThis review shows beneficial effects of PRP on androgenic alopecia. However, more rigorous study designs, including larger sample sizes, quantitative measures of effect, and longer follow-up periods, are needed in order to solidify the utility of using PRP for treating our androgenic alopecia patients.



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Acute Invasive Fungal Rhinosinusitis: Presentation of 19 cases, review of the literature and a new classification system

Publication date: Available online 15 November 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Onur Ergun, Emel Tahir, Consultant Oguz Kuscu, Burce Ozgen, Taner Yilmaz
PurposeThe aim of this study is to determine the correlation between AIFRS and underlying diseases, microorganisms, presenting symptoms, extent of disease, radiological findings, and outcomes and propose a new classification system.Material and methodsThe data of 19 AIFRS cases were analyzed retrospectively. MRI and CT were performed in all patients preoperatively. All patients underwent at least one surgical debridement.ResultsHematologic diseases were the most common(52%) underlying disease. Patients with type-2 diabetes and those with multiple etiologies causing immunosuppression had the lowest survival. Both Aspergillus spp. and Mucoraceae spp. were isolated in 9 patients, but were not associated with poor prognosis. Headache and nasal discharge/crusting were the most common presenting symptoms. Premaxillary involvement was significantly correlated with poor prognosis(p=0.001). Unilateral involvement was correlated with poor prognosis although this finding was not significant(p=0.111). The overall mortality rate was 61.2%. Patients with neutropenia that was corrected had 80% survival(p=0.014). Cessation of corticosteroids and regulating the blood glucose level in patients with immunosuppression due to corticosteroid use resulted in 75% survival.ConclusionThere is not a single curative treatment for acute invasive fungal rhinosinusitis (AIFRS). For a favorable prognosis, underlying conditions must be treated in addition to surgical debridement and antifungals.



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Is there evidence for the presence and relevance of the PD-1/PD-L1 pathway in oral squamous cell carcinoma? Hints from an immunohistochemical study

Publication date: Available online 15 November 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Matthias Troeltzsch, Timothy Woodlock, Alix Pianka, Sven Otto, Markus Troeltzsch, Michael Ehrenfeld, Thomas Knösel
PurposeTo examine OSCC specimens for programmed death - ligand - 1 (PD - L1) expression and presence of programmed death - 1 (PD - 1) positive tumor infiltrating lymphocytes (TIL) and to reveal possible clinicopathological implications. It was hypothesized that in case of PD - L1 expression and PD - 1 positive TIL presence of OSCC this would be without clinical relevance.MethodsThe investigators implemented a retrospective cohort study design. The study cohort was chosen in compliance with predefined inclusion criteria. Demographic, clinical and histopathological data were gathered. Tissue microarrays (TMA) were obtained from paraffin embedded OSCC specimens and analyzed immunohistochemically for PD - L1 expression and PD - 1 positive TIL infiltration. PD - L1 positivity of OSCC specimens served as the predictor variable and neck node metastasis as the primary outcome variable. Descriptive and inferential statistics were computed and the significance level was set at p ≤ 0.05.ResultsThe study sample was composed of 88 patients (male: 48, female: 40, mean age: 61.34 years). Significant PD - L1 expression was detected in 29% of the OSCC specimens (26/88) and 83% (73/88) of the specimens exhibited a high rate of PD - 1 positive TIL infiltration. PD - L1 positivity of OSCC samples was significantly associated with the anatomic origin of OSCC (p = 0.039), the presence of cervical metastasis (p = 0.039) and high PD - L1 positive TIL infiltration (p = 0.033).ConclusionA considerable proportion of OSCCs show significant PD - L1 expression. This may be associated with clinical parameters. PD - L1 expression in OSCC might differ depending on its anatomic origin. PD - 1 positive TILs can be detected in most OSCC specimens. These findings might indicate a potential role of the PD - 1/PD - L1 pathway in OSCC.



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Is Cone Beam Computed Tomography Always Necessary for Dental Implant Placement?

Publication date: Available online 15 November 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): George Deeb, Ludmils Antonos, Samuel Tack, Caroline Carrico, Daniel Laskin, Janina Golob Deeb
PurposeThe use of cone beam computed tomography (CBCT) for evaluation of patients for dental implants has gained considerable popularity. This retrospective cohort study was designed to determine if using a clinical examination and a panoramic radiograph (Panorex) for implant selection and determining the need for bone grafting would be comparable to using a CBCT in routine implant cases.Patients and MethodsThe implant size and need for bone grafting was initially determined in 82 patients using a panoramic radiograph and clinical examination. These patients subsequently underwent a CBCT and were again treatment planned by the same surgeon using Simplant treatment planning software in addition to a clinical examination. The length and width of implants selected by each method and the need for bone grafting were recorded and the results were compared statistically with each other and with the actual treatment subsequently rendered.ResultsBoth the Panorex method and the CBCT method accurately predicted implant width to within 1.5mm of the implant actually placed in 100% of cases and length to within 1.5mm in greater than 95% of cases. For bone graft prediction the results indicated that neither the Panorex method nor CBCT method differed significantly from the actual treatment rendered.ConclusionsThe results of this study indicate that the CBCT is more accurate in predicting implant length and width as well as the need for bone grafting procedures. However, for routine unguided implant placement in sites where anatomic structures and bone grafting are not a concern, the use of a panoramic radiograph may be adequate for determining the length and width of the implant.



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The double mandibular osteotomy for vascular and tumor surgery of the parapharyngeal space

Publication date: Available online 15 November 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Thomas Schlieve, Eric R. Carlson, Michael Freeman, Ryan Buckley, Josh Arnold
PurposeThe purpose of this study is to describe our experience utilizing a double mandibular osteotomy for access to the parapharyngeal space in vascular and tumor surgery and to report on the outcomes and complications of this procedure.Patients and MethodsThe authors designed and implemented a case series to review the medical records of all patients treated with a double mandibular osteotomy for parapharyngeal space access from 1994 to 2016. Patient demographics, indication for the procedure, outcomes, and complications were recorded.ResultsA total of 17 patients underwent a double mandibular osteotomy procedure for access to the parapharyngeal space during the study period. There were 7 males (47%) and 10 females (53%) comprising the cohort. The average age was 57 years (range 29-75 years). Follow up ranged from 6-98 months (mean 40 months) and seven (41%) of patients were tobacco users at the time of surgery. The most common indication was high internal carotid artery stenosis (n =6) followed by carotid body paraganglioma (n = 3). Average blood loss was 186 mL and there were no deaths during the study period. Eight post-operative complications were noted in seven patients (41%). No procedures were aborted or compromised due to inadequate parapharyngeal space access. All patients realized clinical and radiographic signs of healing of their osteotomy sites.ConclusionThe double mandibular osteotomy provides adequate access to the parapharyngeal space for effective tumor removal and high carotid surgical intervention with acceptable patient morbidity and complications.



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The American Thyroid Association expresses sadness for the passing of Emeritus Professor Shigenobu Nagataki

Professor Shigenobu Nagakati (1932~2016)

The American Thyroid Association (ATA) is sad to announce that Professor Shigenobu Nagataki passed away on November 12, 2016 in Tokyo, Japan, at 74 years of age.  He had a long distinguished career in thyroidology.  His postgraduate work with Dr. Sidney H. Ingbar at the Thorndike Laboratory and Harvard Unit at Boston City Hospital focused on iodine metabolism in health and disease and the utility of radioisotopes in the study of overall thyroidal economy and pathophysiology.  With his return to Japan began a long, extraordinary and highly productive career that rendered him an internationally acknowledged leader in radiation health issues and the thyroid gland.

Professor Nagataki was a member of the American Thyroid Association since 1969 and one of founders of Asia & Oceania Thyroid Association (AOTA).  He served as President of Asia and Oceania Thyroid Association in 1985, and honorary president since 2000.  He was a leader in the International Thyroid Congress (ITC) from its inception and the Program Organizing Committee Chair of the 2000 meeting in Kyoto.  His life was dedicated to research for thyroid disease, metabolic diseases and radiation health effects.

He also held memberships in The Endocrine Society, American Diabetes Association, Society of Nuclear Medicine, European Thyroid Association, European Association Study Diabetes, European Association Nuclear Medicine, Japanese Society Internal Medicine (honorary), Japanese Society Endocrinology (honorary), Japanese Society Thyroidology (honorary), Japanese Society Diabetes (honorary), Japanese Society Nuclear Medicine (honorary), Japanese Society Rheumatology (honorary), Japanese Society Clinical Immunology (honorary).

The post The American Thyroid Association expresses sadness for the passing of Emeritus Professor Shigenobu Nagataki appeared first on American Thyroid Association.

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Usefulness of component resolved analysis of cat allergy in routine clinical practice

Cat allergy is of great importance, and its prevalence is increasing worldwide. Cat allergens and house dust mite allergens represent the major indoor allergens; however, they are ubiquitous. Cat sensitization...

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Retrospective analysis of the prevalence and incidence of caries in the distal surface of mandibular second molars in British military personnel

Mandibular third molars are commonly removed because of distal caries in the adjacent tooth. To find out the prevalence of distal caries in mandibular second molars we retrospectively studied the primary care dental records of 720 British military personnel (653 men and 67 women) from various centres. These records are standardised and personnel are required to attend for inspection regularly. Those who had been under 20 years of age at enlistment, who had served for at least five years, and had five recorded dental inspections, were included.

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Rare incidence of two histologically different, separate tumours in the right parotid gland

We describe a rare case that involved two distinct tumours in the right parotid gland. These synchronous tumours highlight the benefits of routine radiographic investigations of parotid masses.

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Stomarezidive, eine klinisch-pathologische Betrachtung

Laryngo-Rhino-Otol
DOI: 10.1055/s-0042-117642

Hintergrund: Untersuchung der präoperativen Tracheotomie als Risikofaktor für das Auftreten von Stomarezidiven und Überprüfung des Resektionsstatus bei Lokalrezidiven. Material und Methoden: Es wurden 124 Patienten mit Laryng(opharyng)ektomie bei Ersttumor hinsichtlich patientenbezogener Daten und tumorfreier Absetzungsränder untersucht. Es erfolgte eine differenzielle Analyse von Patienten mit und ohne vorangegangener Tracheotomie. Ergebnisse: Es traten 18 Rezidive auf, davon 10 Stomarezidive und 8 Fernmetastasen. Fortgeschrittene Primärtumoren, das weibliche Geschlecht wie die sub-/glottische Ausdehnung begünstigten die Notwendigkeit einer präoperativen Tracheotomie. Es zeigte sich kein Zusammenhang zwischen dem Auftreten von Stomarezidiven und einer Nottracheotomie. Bei formalem R0-Status zeigten Patienten mit Lokalrezidiv einen signifikant verringerten Abstand des Tumors zum weichgeweblichen Absetzungsrand (p=0,002). Schlussfolgerungen: Der Zeitpunkt der Tracheotomie beeinflusst nicht das Auftreten von Stomarezidiven. Bei Tumorinfiltration ins ventrale Weichgewebe des Larynx ist eine erweiterte Resektion zu erwägen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Diurnal variations in subcutaneous allergen immunotherapy reactions

Circadian rhythms underlie many immune responses and allergic diseases. Subcutaneous immunotherapy (SCIT) can result in adverse reactions; however, it is unclear whether such reactions have a diurnal pattern.

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Prevalence of food allergies in South Asia

To evaluate the published medical literature on the prevalence and types of food allergies in South Asia.

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Anaphylaxis induced by ingested molds

We present the case of a 22-year-old Spanish woman residing in Madrid with a personal history of milk and egg allergy, which she overcame in her childhood, and seasonal allergic rhinitis and asthma attributable to pollen allergy. No history of β-lactam allergy was recorded. She developed 5 mild to moderate anaphylactic reactions with generalized urticaria and angioedema in the eyelids together with dyspnea and wheezing, nausea, and occasional vomiting, with all symptoms appearing shortly after eating dry cured meat products or blue cheeses, both of which she tolerated in the past.

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Skin testing and drug challenge outcomes in antibiotic-allergic patients with immediate-type hypersensitivity

The evaluation of antibiotic immediate-type hypersensitivity is intricate because of nonstandardized skin testing and challenge method variability.

http://ift.tt/2f2biCE

Successful desensitization to natalizumab using a 1-solution protocol

Natalizumab is a humanized IgG4 monoclonal antibody against the α4-subunit of integrin α4β1 (VLA4 [very late antigen 4]), which is expressed on activated T cells. Antagonism of this target is thought to interfere with leukocyte adhesion to the vascular wall, thereby interfering with leukocyte trafficking across the blood brain barrier and reducing the inflammation within the central nervous system. Natalizumab is indicated for the treatment of relapsing-remitting multiple sclerosis.

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A novel TECTA mutation causes autosomal recessive non-syndromic hearing loss in Iranian kindred

Publication date: Available online 15 November 2016
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Samira Asgharzade, Mohammad Amin Tabatabaiefar, Mohammad Hossein Modarressi, Mohammad Hossein Ghahremani, Somayeh Reiisi, Parisa Tahmasebi, Fatemeh Abdollahnejad, Morteza Hashemzade Chaleshtori
ObjectiveAutosomal recessive nonsyndromic hearing loss (ARNSHL) is a genetically heterogeneous sensorineural disorder. Alpha-tectorin, which is encoded by the TECTA gene, is a non-collagenous component of the tectorial membrane in the inner ear defect of which leads to moderate to severe hearing loss (HL).Methods25 unrelated Iranian multiplex ARNSHL families, negative for GJB2 mutations, were recruited in this study. Clinical inspections including audiometric and otologic examinations ruled out syndromic forms. Genetic linkage analysis was performed using six short tandem repeat markers closely linked to DFNB21. Haplotype and LOD score analysis were used to confirm possible linkage. All coding exons of TECTA were subject to DNA sequencing in the linked family.ResultsA novel homozygous variant (c.734G > A) was found in exon 5 of the TECTA gene in one family leading to a nonsense mutation (p.W245×). It co-segregated with HL in the family. This variant was not detected in 50 controls. All affected individuals in the family had moderate to severe HL. It full filled the criteria of a pathogenic variant.ConclusionOur data confirms the phenotype-directed genotyping for DFNB21 deafness against the typical profound HL phenotype seen in the most families segregating ARNSHL. We recommend mutation screening of TECTA in ARNSHL families segregating moderate to severe HL phenotype.



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Predictors of flourishing among children with hearing loss

Publication date: December 2016
Source:International Journal of Pediatric Otorhinolaryngology, Volume 91
Author(s): Laura Nabors, Cathleen Odar Stough, Ashley Merianos, James Peugh
ObjectivesTo examine parent report of flourishing in children with hearing impairments compared to children without hearing impairments, and to explore whether school engagement and bullying related to child flourishing.MethodsParticipants were 655 children with hearing impairments and 44, 618 children without hearing impairments who were 10–17 years of age. Caregivers completed telephone interviews about their child's functioning for the National Survey of Children's Health.ResultsChildren without hearing loss had higher parent-reported flourishing compared to children with hearing loss when controlling for child demographics (i.e., race, age, sex). School engagement was positively related to flourishing of children with hearing loss. Bullying behaviors were not related to flourishing of children with hearing loss.ConclusionImproving school engagement may increase flourishing of children with hearing loss, which is critical given that children with hearing loss experience lower flourishing than children without hearing loss. Examining the relationships among other risk and resilience factors and flourishing for children with hearing loss will provide information for interventions to enhance the adaptation of these children.



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Audiological findings in children with ataxia-telangiectasia (A-T) syndrome

Publication date: Available online 15 November 2016
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Pretty O. Afifi, Hanaa Hussein Elsanadiky
AimTo assess peripheral and central hearing in children with A-T.Method3 children diagnosed with A-T according to the diagnostic criteria for A-T of the European Society for Immunodeficiencies. Involuntary movements were seen in the form of chorea-athetosis together with tremors. They were examined to assess both peripheral and central hearing was assessed (hearing thresholds). Sound-field testing, tympanometry, acoustic reflexes, Otoacoustic Emissions (OAEs) and Auditory Brainstem Responses (ABR) were done for all of them.ResultsBasic Audiological evaluation is of a limited value as the children are not co-operative. Sound field testing could not be done. Bilateral normal middle ear functions as reflected by Tympanometry and Acoustic Reflexes. Advanced Audiological evaluation including OAEs and ABR are more valuable in assessing hearing in children with A-T. Bilateral pass response at all test frequencies in DPOAEs. Abnormal ABR findings were obtained in the form of a delay in wave V latency more than 2 SD with subsequent increased in I-V interpeak latency with no significant interaural latency difference.ConclusionConsistent with bilateral normal peripheral hearing sensitivity with central hearing affection.LimitationsThe rarity of the disease, make it difficult to be applied on many cases.



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One-and-a-half nostril endoscopic transsphenoidal approach for pituitary adenomas—a technical report

Abstract

Background

Binostril endoscopic transsphenoidal approach (BETA) provides sufficient manipulation space and wide endoscopic vision, although it increases the trauma of nose. Mononostril endoscopic transsphenoidal approach (META) has minimal trauma of nose, at the expense of space within the operation. We describe a one-and-a-half nostril endoscopic transsphenoidal approach (OETA) that combines the advantages of BETA and META.

Methods

We introduced OETA for pituitary adenomas with a detailed technical description. A retrospective analysis was also performed on 57 consecutive patients who underwent one-and-a-half nostril endoscopic transsphenoidal surgery between March 2014 and June 2015 at Jinling hospital.

Results

The gross total resection rate was 79%. The gross complete resection rate of Knosp grade 3 tumors were 63.6, and 27.3% in grade 4 tumors. Postoperative hormone remission was achieved in 14 out of 18 (77.8%) patients with secreting adenomas. Postoperative abnormal visual function improvement was achieved in 23 out of 32 patients (73%) with preoperative visual dysfunction. The overall intra-operative CSF leak was 17.5%, with the postoperative CSF leak decreased to 3.5% after the sellar reconstruction with the unilateral "rescue" nasoseptal flap procedure. The main sinonasal complaints 2 weeks after surgery were: loss of sense of smell (28%), decrease in sense of taste (4%), trouble breathing during the day (18%), thick nasal discharge (36%), post nasal discharge (8%), dried nasal material (6%), and headache (6%). Three months after surgery, there were no reports of decrease of taste, post nasal discharge, or dried nasal material. Other complaints were decreased significantly. Six months after surgery, the main complaints of sinonasal quality of life were negligible, and overall health status was near complete recovery to preoperative status.

Conclusions

The one-and-a-half nostril endoscopic transsphenoidal approach for pituitary adenomas is a simple and reliable technique. It provides not only a sufficient surgical corridor for a 2-surgeon/4 or 3-hands technique, but also ensures minimal invasion of the nasal canal.

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Predicting Factors for Bilaterality in Papillary Thyroid Carcinoma with Tumor Size

Thyroid , Vol. 0, No. 0.


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Initial Size of Metastatic Lesions Is Best Prognostic Factor in Patients with Metastatic Differentiated Thyroid Carcinoma Confined to the Lung

Thyroid , Vol. 0, No. 0.


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Cow’s milk allergy: towards an update of DRACMA guidelines

In 2010, the diagnosis and treatment of IgE-mediated CMA were systematized in a GRADE guideline.

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Ultra-structural effects of different low-level lasers on normal cultured human melanocytes: an in vitro comparative study

Abstract

The aim of this study was to investigate the effects of the different types of low-level laser therapy (LLLT) on the ultra-structure and number of melanosomes in normal cultured human melanocytes. Specific effects of various types of LLLT on the ultra-structure of melanosomes have not yet been reported. Melanocytes were exposed to LLLT at an energy level of 2.0 J/cm², using a blue (457 nm), red (635 nm), or ultraviolet (UV) (355 nm) laser. After 72 h of irradiation, the melanocytes were fixed in 2.5 % glutaraldehyde (pH 7.2) phosphate buffer for 8 h and analyzed by transmission electron microscopy. Four developmental stages (I to IV) of melanosomes were observed, and their numbers were counted manually. The percentage of stages I, II, III, and IV melanosomes was 12.8, 14.2, 22.6, and 50.3 %, respectively, in the control (sham light). However, the melanosome percentages were 41.2, 5.4, 8.2, and 24.2 % in stages I, II, III, and IV, respectively, in the blue laser-treated group; 58.4, 6.1, 9.3, and 26.2 % for stages I, II, III, and IV, respectively, in the red laser-treated group; and 31.3, 11.1, 16.5, and 41.1 % for stages I, II, III, and IV, respectively, in the UV laser-treated group. The present data show that the amount of stage I is significantly higher (P < 0.0001) in the LLLT-treated cells compared to the control, which indicates significant stimulation of melanogenesis. The red laser was more effective than the other lasers. Moreover, the effects of LLLT on the ultra-structure of melanosomes need to be studied in a larger number of subject groups.

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Erythroplasia of Queyrat treated by laser and light modalities: a systematic review

Abstract

Erythroplasia of Queyrat (EOQ) is a squamous cell carcinoma in situ most commonly located on the glans penis or prepuce. EOQ accounts for roughly 10 % of all penile malignancies and may lead to invasive squamous cell carcinoma. Standard therapy includes local excision, partial or total penectomy, cryotherapy, and topical cytotoxic agents. Treatment of EOQ has proven to be challenging due to low response rates and recurrence. In addition, radical procedures can significantly affect sexual function and quality of life. Alternative laser treatments and photodynamic therapy (PDT) offer promising results for treating EOQ. A systemic review of the literature was performed for articles discussing laser and light therapy for EOQ. Among the patients treated with the CO₂ laser, 81.4 % of cases had complete remission after one session of treatment. Patients treated with PDT presented with more variable results, where 62.5 % of those treated with methyl aminolevulinate photodynamic therapy (MAL-PDT) achieved complete remission. Aminolevulinic acid (ALA-PDT) treatment showed a similar rate of remission at 58.3 %. One study utilized the Nd:YAG laser, which resulted in a recurrence of the lesion in four of the five patients treated. Of the methods reviewed, the CO₂ laser offered the most promising results with a cosmetically excellent prognosis. Further studies with larger power and longer follow-up times are needed to determine the optimal treatment regimen for this penile malignancy.

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The effectiveness of the Erbium:Yttrium aluminum garnet PIPS technique in comparison to different chemical solutions in removing the endodontic smear layer—an in vitro profilometric study

Abstract

This study evaluated the degree of endodontic smear layer removal using the Er:YAG PIPS technique (2.94 μm) in comparison with different irrigants. Sixty-four single-rooted teeth were endodontically prepared up to size #40 and were divided into 8 groups (a–h) (n = 8). Groups a, b, c, and d were irrigated with (3 % NaOCl + 20 % EDTA), (0.9 % NaCl), (3 % NaOCl), and (20 % EDTA), respectively. Groups e, f, g, and h were treated with (3 % NaOCl + 20 % EDTA + PIPS), (0.9 % NaCl + PIPS), (3 % NaOCl + PIPS), and (20 % EDTA + PIPS), respectively. The settings of the Er:YAG PIPS technique were (0.3 W, 20 mJ, 15 Hz, 50 μs, no water and air). The root canals were examined under a profilometer to evaluate the degree of smear layer removal using Hülsmann scores. The smear layer was present in the coronal, middle, and apical thirds of groups b, c, f, and g. Groups a, d, e, and h exhibited open dentinal tubules in the coronal and middle thirds. However, none of the apical thirds showed open dentinal tubules. No significant difference was observed between the groups treated only with irrigants and those treated with Er:YAG PIPS and the same irrigants (p ≥ 0.0018). The Er:YAG PIPS technique did not show any improved results in removing the smear layer when compared to the irrigants alone. Moreover, the open dentinal tubules in some groups were a result of the chelating action of 20 % EDTA.

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Effect of LED photobiomodulation on fluorescent light induced changes in cellular ATPases and Cytochrome c oxidase activity in Wistar rat

Abstract

Background

Fluorescent light exposure at night alters cellular enzyme activities resulting in health defects. Studies have demonstrated that light emitting diode photobiomodulation enhances cellular enzyme activities.

Objective

The objectives of this study are to evaluate the effects of fluorescent light induced changes in cellular enzymes and to assess the protective role of pre exposure to 670 nm LED in rat model.

Methods

Male Wistar albino rats were divided into 10 groups of 6 animals each based on duration of exposure (1, 15, and 30 days) and exposure regimen (cage control, exposure to fluorescent light [1800 lx], LED preexposure followed by fluorescent light exposure and only LED exposure). Na⁺–K⁺ ATPase, Ca²⁺ ATPase, and cytochrome c oxidase of the brain, heart, kidney, liver, and skeletal muscle were assayed.

Results

Animals of the fluorescent light exposure group showed a significant reduction in Na⁺–K⁺ ATPase and Ca²⁺ ATPase activities in 1 and 15 days and their increase in animals of 30-day group in most of the regions studied. Cytochrome c oxidase showed increase in their level at all the time points assessed in most of the tissues. LED light preexposure showed a significant enhancement in the degree of increase in the enzyme activities in almost all the tissues and at all the time points assessed.

Conclusions

This study demonstrates the protective effect of 670 nm LED pre exposure on cellular enzymes against fluorescent light induced change.

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Experimental tooth movement and photobiomodulation on bone remodeling in rats

Abstract

Photobiomodulation (PBM) is a therapy induced by a specific type of laser that affects biologic systems through non-thermal ways. The study of its basic mechanism has gained interest since little is known about the causes of the different effects of this treatment. In the present study, we investigated the action of the PBM application rate changes in the peri-implant tissues in rats subjected to tooth movement in different periods. Wistar rats (±250 g) received an apparatus in the region of the central incisors superiors tightly (70 g) or not, and they were also subjected to one or three PBM sessions. After 7 or 14 days, the rats were subjected to euthanasia and the jaws were dissected and processed for histology. For analysis, serial sections were made that were stained by Picrosirius Red for analysis of collagen fibers, Masson's trichrome for newly formed bone scan, and Hematoxylin-Eosin for quantification of osteoblasts. PBM applied in one or three sessions increased the population of osteoblasts. Still, the application of three sessions of PBM increased the density of collagen fibers and new bone formation compared to the controls. An increase was observed in the interincisal distance in irradiated groups with three PBM sessions and the application of force for both 7 or 14 days. These findings suggest that PBM can contribute positively to the orthodontic movement. So the laser therapy can be used as an adjunct procedure to be performed concurrently for orthodontic treatment in the dental clinic.

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Vegas (Verruciform Genital-Associated) Xanthoma: A Comprehensive Literature Review

Abstract

Introduction

Verruciform xanthoma is a wart-like benign lesion. The classic histologic appearance consists of foamy histiocytes within elongated dermal papillae and epithelial acanthosis. The lesion most commonly occurs in the oral cavity, but has been reported in extra-oral sites such as the penis, scrotum, and vulva. The clinical and histologic characteristics of verruciform genital-associated (Vegas) xanthomas of the penis, scrotum, and vulva are reviewed.

Methods

PubMed was used to search the following term: verruciform xanthoma. The relevant papers were obtained and reviewed.

Results

There have been 193 cases of genital-associated verruciform xanthomas. There were 164 in men and 29 in women. Similar to verruciform xanthomas of the oral mucosa, they presented as asymptomatic lesions, demonstrated foam cells in the dermal papillae, and were typically managed successfully with surgical excision.

Conclusion

Verruciform xanthoma is a benign lesion characterized by a wart-like growth that is most commonly seen in the oral mucosa. Verruciform xanthomas of the genital region have been coined Vegas xanthomas. Vegas xanthomas have been reported in association with a variety of diseases, as well as in healthy individuals. Biopsy is required for diagnosis, and complete surgical excision is typically curative.

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Incidence of allergic rhinitis in a cohort of young adults from 13–15 years old to 23–25 years old in Castellon (Spain)

Publication date: Available online 15 November 2016
Source:Allergologia et Immunopathologia
Author(s): A. Arnedo-Pena, Mª A. Romeu-Gracia, J.B. Bellido-Blasco, N. Meseguer-Ferrer, E. Silvestre-Silvestre, F. Conde, S. Fernández-González, Mª A. Dubon, M. Ortuño-Forcada, J. Fabregat-Puerto, C. Fenollosa-Amposta, L. Segura-Navas, Mª R. Pac-Sa, L. Museros-Recatala, A. Vizcaino, R. Tosca-Segura
BackgroundThe objective of this study was to estimate the incidence of Allergic Rhinitis (AR) in young adults and its risk or protective factors.MethodsA population-based prospective cohort study was carried out in 2012. The cohort participated in the International Study of Asthma and Allergy in Childhood in Castellon in 1994 and 2002. A telephone survey was conducted using the same questionnaires. A new case of AR was defined as the participants free of the disease in 2002, who self-reported suffering from AR or taking medications for AR in the period 2002–2012.ResultsOf the 1805 schoolchildren in the cohort in 2002, 1435 young adults (23–25 years old) participated (follow-up 79.1%) in 2012; 743 were female and 692 male; their mean age was 24.9±0.6 years. Two hundred new cases of AR occurred in 1259 participants free of the disease with an incidence of 17.3 per 1000 person–years, and the incidence increased from 2002 (RR=1.42; 95% CI 1.15–1.75). The risk factors of AR adjusted by age and gender were sinusitis (RR=1.77; 95% CI 1.16–2.68), atopic dermatitis (RR=1.51; 95% CI 1.11–2.06) and constant exposure to truck traffic (RR=1.88; 95% CI 1.12–3.17). For male participants, the risk factors were asthma, sinusitis and atopic dermatitis, and for females bronchitis was a risk factor and presence of older siblings a protective factor.ConclusionsAn increase in AR incidence was observed. Sinusitis, atopic dermatitis and constant exposure to truck traffic were the risk factors of the AR with some differences by gender.



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Free thyroid transfer: short-term results of a novel procedure to prevent post-radiation hypothyroidism

ABSTRACT

Background

The incidence of radiation-induced hypothyroidism (RIH) in patients with head and neck cancer is >50%. The purpose of this study was to assess the long-term efficacy of free thyroid transfer (FTT) for prevention of RIH in patients with head and neck cancer.

Methods

Hemithyroid dissection was completed in 10 patients with advanced head and neck cancer undergoing ablation, radial forearm free flap (RFFF) reconstruction, and postoperative radiotherapy (RT). The hemithyroid was anastomosed to the donor site vessels in the forearm. Thyroid laboratory testing and technetium (Tc) scans were performed 6 weeks and 12 months postoperatively to establish functional integrity.

Results

FTT was successfully performed in 9 of 10 recruited patients. Postoperative Tc scans demonstrated strong Tc uptake in the forearm donor site at 6 weeks and 12 months in all patients who underwent transplantations.

Conclusion

FTT is feasible with maintenance of function, and may represent a novel strategy for prevention of RIH. © 2016 The Authors Head & Neck Published by Wiley Periodicals, Inc. Head Neck, 2016

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Melanoma: Patient Factors May Personalize Screening

An individual's risk factors for melanoma could be used to develop personalized surveillance programs and education about skin self-examination, a new study suggests.
Medscape Medical News

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Accident ischémique transitoire, une manifestation rare du syndrome d’Eagle

Publication date: Available online 14 November 2016
Source:Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Author(s): J. Usseglio, F. Macian Montoro, S. Martin, J. Lerat, J. Laloze, A. Taibi, J. Brie
IntroductionLe syndrome d'Eagle (SE) a une expression clinique très variée et non spécifique rendant son diagnostic difficile. Il se limite le plus souvent à des douleurs. Les manifestations neurologiques transitoires sont exceptionnelles. Nous exposons le cas d'un patient chez lequel le diagnostic de SE a été porté sur des manifestations neurologiques lors de la flexion antéro-latérale gauche de tête, sans douleur associée.ObservationUn patient de 47 ans avait des manifestations neurologiques transitoires depuis deux ans, à type de paresthésies de l'hémicorps droit et de diminution du champ visuel gauche, déclenchées par la flexion antéro-latérale gauche de la tête et régressant en position neutre. Un doppler transcrânien et un angioscanner des troncs supra-aortiques ont été pratiqués en position neutre puis en rotation droite et gauche de tête. Ils montraient une interruption du flux sylvien gauche et une compression extrinsèque de l'artère carotide interne du même côté en rapport avec l'extrémité inférieure du processus styloïde temporal. Les symptômes ont totalement régressés après résection chirurgicale de ce processus. L'angioscanner de contrôle ne retrouvait plus de compression carotidienne.DiscussionLe SE a des expressions variables, non spécifiques, rendant le diagnostic difficile ou conduisant à des errances diagnostiques. Le SE doit être évoqué devant tout déficit neurologique transitoire, surtout s'il survient lors des mouvements de rotation de la tête. Le traitement consiste en une résection chirurgicale de l'excès de longueur du processus styloïde par voie cervicale ou buccale.IntroductionClinical presentation of Eagle syndrome (ES) is very variable and non-specific, making its diagnosis difficult. It is usually limited to pain. Transient neurological manifestations are exceptional. We report one case in which the diagnosis of ES has been made based on neurological events occurring during left anterolateral head bending, without pain.ObservationA 47-year-old man presented with transient neurological events progressing since two years, half-right body paresthesia and reduced field of vision on the left side type, triggered by left anterolateral head flexion and regressive in neutral position. Transcranial Doppler and CT angiography of the supra-aortic trunks were performed in neutral position and in right and left head rotation that showed a disruption of the left sylvian flow and an extrinsic compression of the left internal carotid artery, due to a musculoskeletal impediment involving the lower end of the temporal styloid process. Complete recovering was achieved after surgical resection of this process. A control CT angiography confirmed the cessation of the compression.DiscussionES has non-specific and highly variable clinical manifestations making diagnosis difficult or leading to misdiagnosis. ES should be considered in any transient neurological deficit, especially when occurring during head rotation. Treatment relies on surgical resection of the excessively long styloid process.



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