Head and Neck Medicine by Alexandros G.Sfakianakis: 11/21/16

Δευτέρα 21 Νοεμβρίου 2016

Inhaltsverzeichnis

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Herpes zoster: Low-Level-Laser soll postherpetische Neuralgie lindern

Neuralgische Schmerzen nach durchgemachter Gürtelrose sind oft schwer zu kontrollieren. Besser wäre allemal, sie träten gar nicht erst auf. Nun wurde getestet, ob das mit einer Low-Level-Lasertherapie zu erreichen ist.

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Neue Ansätze bei malignen Melanomen

Für Patienten mit malignem Melanom gibt es neue, wirkungsvolle Therapieansätze. Mit den neuen Optionen kommen auch neue Fragen auf, etwa ob eine Sequenz- oder eine Kombinationstherapie zu bevorzugen ist. Diese Frage war auch Thema in Dresden.

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Sehnsucht nach endloser Unbeschwertheit

Er ist vermutlich so alt wie die Menschheit, und wird wohl auch erst mit ihr sterben: der Wunsch nach ewiger Jugend. Als bewundernswert gilt zwar, wer ein hohes Alter erreicht. Doch waren die äußeren Anzeichen des Alterns — wenigstens im europäischen Raum — nie erstrebenswert oder auch nur geachtet. Der alte Körper schien immer als mit einem Makel behaftet. Kein Wunder also, dass Möglichkeiten der Verjüngung in allen Kulturen die Gemüter — und Körper — beschäftigten.

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Melanom: Kinder folgen nicht der ABCDE-Regel

Melanome im Kindesalter sind selten und präsentieren sich häufig atypisch. Deshalb werden zwei Drittel von ihnen zunächst als benigne Läsionen fehlinterpretiert. Eine Studie aus den USA hat jetzt spezielle Risikofaktoren für das Kindesalter identifiziert.

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Effect of HIV infection in the microuclei frequency on the oral mucosa

Abstract

Background

the genotoxic impact of HIV infection on the oral cavity malignancies is unknown. The aim of this study was to evaluate the effect of HIV infection in micronuclei (MN) frequency on the oral mucosa of HIV+ patients and establish a relationship with early cytogenetic changes in oral carcinogenesis.

Methods

30 HIV + individuals who are under highly active antiretroviral therapy (HAART) and 30 non HIV patients were evaluated. Two smears were taken from the lateral border of the tongue and mouth floor and stained by Feulgen. The frequency of MN was examined in 3000 cells per subject under common microscopy.

Results

MN analysis showed no significant difference between groups by Mann-Whitney test for total MN (p=0.178). Presence of single MN was greater in control group with statistical significance (p=0.009), while in HIV group multiple MN were exhibited in higher mean.

Conclusions

HIV patients under HAART therapy and low viral load values showed higher frequency of multiple MN, which, although not statistically significant, may be caused by the action of the Vpr gene, an accessory gene of HIV. These results corroborate the theory of HIV infection cytogenetic damage.

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Cost-effectiveness of transfacial gland-preserving removal of parotid sialoliths

Objective

Examine outcomes of transfacial gland-preserving removal of difficult parotid stones and compare the cost and operative time to traditional parotidectomy.

Study Design

Cost-effectiveness analysis and retrospective chart review.

Methods

Patients who underwent transfacial removal of symptomatic parotid sialoliths at a tertiary medical center from June 2010 to July 2015 were evaluated. Outcomes included operative technique, stone size, stone location, complications, and symptom relief. In addition, patients who underwent traditional parotidectomy for chronic sialadenitis were identified. The charges and times for both procedures were reviewed and compared.

Results

Forty-four patients underwent transfacial resection for symptomatic parotid sialolithiasis. Stones were most often located in the main duct and hilum (53.3%), with fewer intraglandular stones (46.7%). No facial nerve weakness was observed. Of those with follow-up, 33 (87%) patients reported at least partial resolution of symptoms. Overall transfacial technique charges were significantly less expensive (U.S.$) than parotidectomy (mean difference −8,064.09; 95% confidence interval [CI] −13,472.78 to −2,655.40; P = 0.033). Anesthesia charges (mean difference −2,997.85; 95% CI, −5,748.81 to −246.89; P = 0.035) and operating room charges (mean difference −4,793.91; 95% CI, −8,958.09 to −629.72; P = 0.028) were also less expensive for the transfacial technique. Finally, mean procedure time for transfacial removal of parotid stones was shorter than for parotidectomy (120.2 ± 49.9 vs. 178.4 ± 41.3 minutes, respectively; P = 0.002).

Conclusion

Transfacial gland-preserving removal of difficult parotid stones is a well tolerated and effective alternative to parotidectomy. Moreover, it is faster and less expensive than parotidectomy, maximizing both surgeon time and hospital resources.

Level of Evidence

4. Laryngoscope, 2016

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The prevalence of olfactory dysfunction in chronic rhinosinusitis

Objectives

Many studies have reported that olfactory dysfunction frequently occurs in chronic rhinosinusitis (CRS) populations; however, the prevalence and degree of olfactory loss has not been systematically studied. The aims of this study were to use combined data to report the prevalence of olfactory dysfunction and to calculate weighted averages of olfactory test scores in CRS patients.

Data Sources

A search was conducted in PubMed and Scopus, following the methods of Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.

Review Methods

Studies reporting the prevalence of olfactory dysfunction using objective measures or olfactory test scores using validated scales were included.

Results

A total of 47 articles were included in a systematic review and 35 in the pooled data analysis. The prevalence of olfactory dysfunction in chronic rhinosinusitis was found to be 30.0% using the Brief Smell Identification Test, 67.0% using the 40-item Smell Identification Test, and 78.2% using the total Sniffin' Sticks score. Weighted averages ± standard deviation of olfactory test scores were 25.96 ± 7.11 using the 40-item Smell Identification Test, 8.60 ± 2.81 using the Brief Smell Identification Test, 21.96 ± 8.88 using total Sniffin' Sticks score, 5.65 ± 1.51 using Sniffin' Sticks–Threshold, 9.21 ± 4.63 using Sniffin' Sticks–Discrimination, 9.47 ± 3.92 using Sniffin' Sticks–Identification, and 8.90 ± 5.14 using the Questionnaire for Olfactory Disorders–Negative Statements.

Conclusions

In CRS populations, a significant percentage of patients experience olfactory dysfunction, and mean olfactory scores are within the dysosmic range.

Laryngoscope, 2016

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Dynamic nanomechanical analysis of the vocal fold structure in excised larynges

Objectives/Hypothesis

Quantification of clinical outcomes after vocal fold (VF) interventions is challenging with current technology. High-speed digital imaging and optical coherence tomography (OCT) of excised larynges assess intact laryngeal function, but do not provide critical biomechanical information. We developed a protocol to quantify tissue properties in intact, excised VFs using dynamic nanomechanical analysis (nano-DMA) to obtain precise biomechanical properties in the micrometer scale.

Study Design

Experimental animal study.

Methods

Three pig larynges were bisected in the sagittal plane, maintaining an intact anterior commissure, and subjected to nano-DMA at nine locations with a 250-μm flat-tip punch and frequency sweep load profile (10–105 Hz, 1,000 μN peak force) across the free edge of the VF and inferiorly along the conus elasticus.

Results

Storage, loss, and complex moduli increased inferiorly from the free edge. Storage moduli increased from a mean of 32.3 kPa (range, 6.5–55.38 kPa) at the free edge to 46.3kPa (range, 7.4–71.6) 5 mm below the free edge, and 71.4 kPa (range, 33.7–112 kPa) 1 cm below the free edge. Comparable values were 11.6 kPa (range, 5.0–20.0 kPa), 16.7 kPa (range, 5.7–26.8 kPa), and 22.6 kPa (range, 9.7–38.0 kPa) for loss modulus, and 35.7 kPa (range, 14.4–56.4 kPa), 50.1 kPa (range, 18.7–72.8 kPa), and 75.4 kPa (range, 42.0–116.0 kPa) for complex modulus. Another larynx repeatedly frozen and thawed during technique development had similarly increased storage, loss, and complex modulus trends across locations.

Conclusions

Nano-DMA of the intact hemilarynx provides a platform for quantification of biomechanical responses to a myriad of therapeutic interventions to complement data from high-speed imaging and OCT.

Level of Evidence

NA Laryngoscope, 2016

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Complications of turbinate reduction surgery in combination with tonsillectomy in pediatric patients

Objectives/Hypothesis

To examine whether the addition of turbinoplasty to tonsillectomy and adenoidectomy (T&A) increases the risk of postoperative complications.

Study Design

Retrospective cohort study of children (18 years old and younger) who underwent tonsillectomy and/or turbinoplasty between July 1, 2013 and June 30, 2015 using the 2016 Pediatric Health Information System administrative database

Methods

Patients were divided into three groups: 1) T&A and turbinoplasty, 2) T&A alone, and 3) turbinoplasty alone. Postoperative revisit, hemorrhage requiring cautery, and blood transfusion rates were compared between groups.

Results

A total of 75,761 patients met inclusion criteria: 3,079 underwent both T&A and turbinoplasty, 72,043 underwent T&A alone, and 639 underwent turbinoplasty alone. The rate of 14-day relevant revisits after T&A in combination with turbinate reduction surgery was not significantly higher than that of T&A alone (9.4% vs. 8.6%; P = .11). The revisit rate after turbinoplasty alone was 1.4%. Indications for revisits did not differ between the T&A and turbinoplasty group versus T&A alone group (P = .23). Furthermore, the rates of hemorrhage requiring cauterization was similar between the two groups (1.4% vs. 1.5%; P = .64). Twenty-one patients who underwent T&A alone required blood transfusion after they were readmitted; no cases in the other two groups required blood transfusion.

Conclusions

Turbinoplasty and T&A performed together do not increase the risk of postoperative revisit or hemorrhage requiring cauterization, and can therefore be considered as a combined procedure. Pediatric patients will benefit from avoiding the additional risk of multiple anesthetics and repeated intubation.

Level of Evidence

4. Laryngoscope, 2016

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Training Groups

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Editorial Board

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Ultrasonographic findings can identify ‘pseudoprogression’ under nivolumab therapy

Abstract

'Pseudoprogression' is often seen in patients with melanomas who are treated with immune-checkpoint inhibitors such as nivolumab or ipilimumab. We sometimes evaluate metastatic lesions by imaging tests such as CT or PET-CT. 'Pseudoprogression' usually occurs upon the initial administration, which may make it difficult for the physician to determine the disease condition. In our two cases of metastatic melanoma treated with nivolumab (anti-PD-1 antibody), we examined the ultrasonography (US) of target lesions that could be accessed from the body surface, such as those of the regional lymph node or subcutaneous metastasis. In both cases, the US revealed a lesion approximately 10% greater in size after 40-50 days of nivolumab administration, even though the blood flow inside the tumour was reduced by about 20% within 50 days. From about 100 days after blood flow reduction was detected by US, the tumours began to decrease in size. However, contrast CT was unable to detect the association between tumour size and tumour blood flow.

The present cases suggest that US could be a powerful tool for differentiating between 'pseudoprogression' and real progressive disease in patients treated with cancer immunotherapies such as those involving immune-checkpoint inhibitors. The misdiagnosis of progressive disease can lead to unnecessary alternations in the current treatment. Therefore, the US findings in our study could be clinically useful and educational for physicians.

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Regarding “Frontal fibrosing alopecia: possible association with leave-on facial skin care products and sunscreens; a questionnaire study”

Abstract

Using a matched case-control study design, Aldoori et al (2016) report a possible association between frontal fibrosing alopecia (FFA) and the regular use of sunscreens and facial skin care products.¹ We commended the authors for drawing attention to potential environmental causes of this disfiguring condition. However, several methodological limitations drew our attention.

First, we are concerned about selection bias. Control subjects were selected from hospital staff through advertisements and from friends and family of the authors. Ideally, controls should be randomly sampled from the source population that gave rise to cases.

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Aberrant gene expression with deficient apoptotic keratinocyte clearance may predispose to polymorphic light eruption

Abstract

Polymorphic light eruption (PLE) is the commonest photodermatosis, demonstrating intermittently appearing non-scarring pruritic, erythematous papules, vesicles or plaques on patient skin within hours of ultraviolet radiation (UVR) exposure. It depends on genetic susceptibility as well as environmental UVR exposure and is apparently a failure of normal UVR-induced immunosuppression in the presence of simultaneously produced skin photoneoantigens^1,2, with a resulting increased immune response. Reduced TNF-α, IL-4 and IL-10 expression, a lack of neutrophils, reduced T-helper-1/T-helper-2 skewing and reduced Langerhans cell migration have also been demonstrated in UVB-irradiated PLE skin³. Bead-array immunoassay studies have further revealed significantly higher PLE baseline IL-1β and CCL11 (eotaxin) spring plasma levels⁴, while decreased TGFß1, IL-10 and receptor activator of nuclear factor kappa-B ligand (RANKL) epidermal and dermal expression, and reduced T-reg cells occur in UVA-1-irradiated patients⁵, as well as decreased T-reg cell function in all PLE patients, irradiated or not⁶.

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Cutis laxa acquisita – novel insights into impaired elastic fiber regeneration

Abstract

Cutis laxa (CL) is a rare disorder affecting elastic fiber formation¹. The disease is disfiguring and involvement of big vessels in lung and heart often leads to severe complications. CL occurs as an inherited and acquired form, cutis laxa acquisita (CLA). While in the inherited form most mutations have been identified in genes for elastic fiber components like elastin ², fibulin-4 ³, fibulin-5 ⁴, or LTBP-4 ⁵ the pathogenesis of CLA remains poorly understood. Clinically, there often is an association between CLA and paraproteinemia ¹. Deposition of immunoglobulins and complement has been proposed to result in an immune-mediated destruction of elastic fibers ⁶.

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A Japanese Family with Central Hypothyroidism Caused by a Novel IGSF1 Mutation

Thyroid , Vol. 0, No. 0.

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Estimation of Second Primary Cancer Risk After Treatment with Radioactive Iodine for Differentiated Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.

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Periungual and Oral Verruca

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Issue Information - Editorial Board

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Announcement

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Reviewers who have performed more than three reviews in 2016 Thank you so much!

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Announcement

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Forthcoming Events

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Education is the basis for the future of Dermato-Venerology

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Issue Information - TOC

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Immunoreactivity Analysis of the Nonstructural Proteins of Human Enterovirus 71

Viral Immunology , Vol. 0, No. 0.

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T Cell Immunity to Varicella-Zoster Virus in the Setting of Advanced HIV and Multiple Varicella-Zoster Virus Recurrences

Viral Immunology , Vol. 0, No. 0.

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The Association Between Measures of Fitness and Metabolic Health in Treatment-Seeking Youth with Obesity

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

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In utero exposure to LPS alters the postnatal acute-phase response in beef heifers

The potential effect of prenatal LPS exposure on the postnatal acute phase response (APR) to an LPS challenge in heifers was determined. Pregnant crossbred cows were separated into prenatal immune stimulation (PIS) and saline groups (Control). From these treatments, heifer calves were identified at weaning to subsequently receive an exogenous LPS challenge. Sickness behavior scores (SBS) were recorded and blood samples were collected at 30-min intervals from –2 to 8 h and again at 24 h relative to the LPS challenge. There was a treatment x time interaction for the change in vaginal temperature (VT) such that the change in VT was greater in Control than PIS from 150 to 250 min, yet it was greater in PIS than Control from 355 to 440 min and from 570 to 1145 min. There was also a treatment x time interaction for SBS such that scores were greater in Control than PIS at 0.5 h, yet were greater in PIS than Control from 2.5 to 4 h post-LPS. There was a tendency for a treatment x time interaction for serum concentrations of IL-6, which were greater in PIS than Control heifers from 5.5 to 6 h and from 7 to 8 h post-challenge. Thus, a single exposure to LPS during gestation can alter the postnatal APR to LPS in heifer calves.

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Immunogenicity and efficacy of a rationally designed vaccine against vascular endothelial growth factor in mouse solid tumor models

Abstract

Vascular endothelial growth factor (VEGF) plays an important role in the progression of various cancers. The VEGF-specific antibody bevacizumab combined with chemotherapy was shown to significantly improve progression-free survival in certain cancers. However, repeated administration is necessary for effective suppression of VEGF, thereby making the therapy expensive and cumbersome. Thus, it is urgent to develop alternative reagents such as VEGF vaccines. Here we report that DTT-VEGF, a VEGF-based antigen consisting of the receptor-binding domain of VEGF and diphtheria toxin T domain (DTT), not only stimulated neutralizing antibody response, but also induced type 1 immune response as well as anti-tumor cytotoxic T lymphocytes in mice when administered with aluminum hydroxide adjuvant. The antibodies triggered by DTT-VEGF immunization inhibited the binding of VEGF to VEGF receptor and downregulated the serum VEGF levels in tumor-bearing mice. VEGF-specific IgG2a and IgG2b antibodies as well as type 1 cytokines were stimulated by DTT-VEGF vaccination. The splenocytes from DTT-VEGF-immunized mice showed cytotoxic activity against B16-F10 cells expressing VEGF. Extensive necrosis with severe hemorrhage and enhanced CD8⁺ T cell infiltration were observed in tumors from DTT-VEGF-immunized mice. The percentages of CD31⁺ vascular areas in the tumor sections from DTT-VEGF-immunized mice were significantly lower than those of control mice. DTT-VEGF significantly inhibited tumor growth in preventive and therapeutic vaccination settings in mouse models. Our data suggest that DTT is an effective antigen carrier to break immune self-tolerance and our vaccine design has potential to be used for human cancer therapy.

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Lupin and Other Potentially Cross-Reactive Allergens in Peanut Allergy

Abstract

Purpose of Review

The presence of IgE cross-reactivity between peanut allergens and allergens from other legumes and tree nuts has been demonstrated, but the identification of the involved individual allergens is still limited. The aim of this review is to describe new allergenic findings, of potential relevance for cross-reactivity among peanut and lupin.

Recent Findings

Seventeen allergens of peanut have been included in the official allergen nomenclature database to date. Lupin sensitization has been observed in 15–20% of individuals with known peanut allergy, The majority of lupin seed proteins are comprised of α-conglutins (legumin-like) and β-conglutins (vicilin-like), and to a lesser extent γ-conglutins (vicilin-like) and δ-conglutins (2S albumins).

Summary

Several molecules may fuel peanut-lupin cross-reactivity. Awareness among physicians and general public could avoid unexpected allergic reactions. However, these do not appear frequent and no data suggest a precautionary labelling of lupin in foods.

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Childcare and School Management Issues in Food Allergy

Abstract

Purpose of Review

The goal of this review is to characterize food allergy management and anaphylaxis in schools and assess current policies and level of preparedness of schools to recognize and treat anaphylaxis.

Recent Findings

An increasing number of school-aged children have food allergies, and studies show that a significant number of school children with no known history of allergies will experience their first anaphylactic reaction at school. Stock-unassigned epinephrine auto-injectors are recommended in schools but not mandatory in most states, and therefore, epinephrine is not always available. Non-nursing staff members are sometimes administering epinephrine due to limitations in nurse staffing.

Summary

Wide variations in staff training and lack of stock epinephrine leave many schools inadequately prepared to manage anaphylactic reactions. Emphasis should be placed not only on ensuring all schools have stock epinephrine but also on training a wider range of school staff members to minimize treatment delay with epinephrine and improve clinical outcomes.

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Use of refrigerant spray of a propane/butane/isobutane gas mixture in the management of keratocystic odontogenic tumors: a preliminary study

Abstract

Purpose

Keratocystic odontogenic tumor (KCOT) is an aggressive benign tumor and the management by complete enucleation followed by cryotherapy maintains the inorganic bone matrix, resulting in better repair and reduces the rates of recurrence. A refrigerant spray with a propane/butane/isobutane gas mixture has been pointed to as an alternative to liquid nitrogen, because the device is easy to handle and contain within the cavity, providing better control and lower risk of injury to the adjacent soft tissue. Thus, the aim of this study was to evaluate the outcome of enucleation followed by cryosurgery using a refrigerant spray of this gas mixture in ten patients diagnosed with KCOT.

Method

The biggest lesions received a prior treatment consisting of marsupialization to decrease the tumor size. During the surgeries, the lesions were removed by enucleation and the surgical site was sprayed with the gas mixture.

Results

Wound dehiscence was observed in all cases, which healed by the second intention. The mean follow-up period was 64.3 months (range 24–120 months). Eight of the ten patients showed no evidence of clinical or radiographic recurrence. Pathologic fractures and infections were not observed.

Conclusions

The results obtained suggest that enucleation followed by cryosurgery is an effective therapy for managing KCOT.

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Gel Sonovaginography: A New Way of Evaluating a Variety of Local Vaginal and Cervical Disorders

Gel sonovaginography is a new way of assessing local cervical and vaginal disorders, in which regular transvaginal sonography is known to have limitations. In gel sonovaginography, 20 mL of ultrasound gel is instilled into the vagina, followed by examination with a transvaginal transducer. In a study involving 28 women with known or suspected disorders such as cervical and vaginal cancer, cervical polyps, vaginal septa, and deep infiltrating endometriosis, a substantial improvement in visualization and assessment of local lesions and structures was noted with gel sonovaginography. This simple technique appears to be valuable for accurate diagnosis of local cervical and vaginal disorders.

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Spleen Behind the Heart Complicates Lung-to-Head Ratio Measurement in Left-Sided Congenital Diaphragmatic Hernia

In fetuses with left-sided congenital diaphragmatic hernia, intrathoracic herniation of the spleen is a common occurrence. The herniated spleen can reside posterior to the left atrium of the heart in the right hemithorax and is increasingly differentiated from the lung with the use of newer sonographic equipment. Estimation of the neonatal prognosis relies on accurate measurement of fetal lung size, particularly with commonly used measurements such as the lung-to-head ratio. Here we describe how herniation of the spleen behind the heart can complicate measurement of the lung-to-head ratio on sonography and lead to overestimation, with implications for perinatal prognostication and management.

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Role of Sonography for Evaluation of Gastrointestinal Foreign Bodies

Foreign body ingestion is frequently encountered in children. The locations of the foreign bodies and the period during which they have been present in the thorax and abdomen are important for determining the method and timing of treatment. Although plain radiography and computed tomography are primarily used for assessment of foreign bodies, sonography without radiation is also useful for diagnosis of foreign bodies. This report describes 5 cases of foreign bodies in the digestive tract and the usefulness of sonography for real-time evaluation of foreign bodies with high spatial resolution. Physicians can use sonography along with radiography and computed tomography in cases involving foreign bodies.

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Toll-like receptor ligands induce cytokine and chemokine production in human inner ear endolymphatic sac fibroblasts

Against recent reports concerning cytokine or chemokine in mouse or rat inner ear cells, it is almost unknown whether human inner ear cells would produce cytokine or chemokine. We have for the first time established the human inner-ear-derived fibroblasts from endolymphatic sac.

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Nasopharyngeal carcinoma with mastoid recurrence after concurrent chemoradiotherapy masquerading as acute otomastoiditis

Nasopharyngeal cancer (NPC) with mastoid recurrence is extraordinarily rare, and its development is thought to involve the Eustachian tube. We herein report a case of NPC with mastoid recurrence masquerading as acute otomastoiditis with facial paralysis in a 60-year-old man 44 months after concurrent chemoradiotherapy. The diagnosis was confirmed by exploratory tympanomastoidectomy with biopsy and Epstein–Barr-encoding region (EBER) in situ hybridization. Distant liver metastasis was detected simultaneously, and the patient underwent salvage treatment.

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Supraglottoplastik bei kindlicher Laryngomalazie

Zusammenfassung

Die Laryngomalazie ist die häufigste Ursache des kindlichen Stridors. Typisch ist ein Kollaps der supraglottischen Strukturen während der Inspiration mit daraus resultierendem inspiratorischem Stridor. Die genaue Ätiologie ist bis heute unklar. Die chirurgische Therapie der Wahl ist die Supraglottoplastik. Von 2009–2016 wurden in der Abteilung für pädiatrische HNO-Heilkunde des Klinikums Stuttgart 71 Kinder mittels Supraglottoplastik behandelt. Als Operationsindikation galten in allen Fällen eine Laryngomalazie mit ausgeprägtem Stridor, Sättigungsabfälle und/oder juguläre bzw. thorakale Einziehungen und/oder Fütterungsschwierigkeiten und/oder Gedeihstörungen. Die Gesamterfolgsrate lag bei 86 %. Dabei zeigte sich ein deutlicher Unterschied zwischen der Gruppe mit isolierter Laryngomalazie und der Gruppe mit assoziierten Komorbiditäten. Bei den Kindern mit isolierter Laryngomalazie konnte eine Erfolgsrate von 98 % erreicht werden, bei den Kindern mit assoziierten Komorbiditäten lag sie bei 57 %. Die Supraglottoplastik stellt somit eine sichere und effektive Therapie der symptomatischen Laryngomalazie dar, und ein Absinken der Erfolgsrate korreliert deutlich mit dem Vorliegen kongenitaler Komorbiditäten.

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Anti-inflammatory effect of a fatty acid mixture with high ω-9:ω-6 ratio and low ω-6:ω-3 ratio on rats submitted to dental extraction

Publication date: February 2017
Source:Archives of Oral Biology, Volume 74
Author(s): Radamés Bezerra Melo, Paulo Goberlânio de Barros Silva, Reinaldo Barreto Oriá, José Ulisses de Souza Melo, Conceição da Silva Martins, Aline Matos Cunha, Paulo Roberto Leitão Vasconcelos
ObjectiveTo evaluate the anti-inflammatory effect of pretreatment for three days with a fatty acid mixture with high ω-9:ω-6 ratio and low ω-6:ω-3 ratio on rats submitted to dental extraction.Material and methodsThirty-two male Wistar rats (270–310g) were randomly distributed in four groups (n=8/group): the sham control group and the negative control group received saline; the high omega-6/low omega-9 group received isolipid fatty acid with high ω-6:ω-3 ratio and low ω-9:ω-6 ratio; the high omega-3/low omega-6 group received fatty acid with low ω-6:ω-3 ratio and high ω-9:ω-6 ratio. Saline and oils were administered by gavage for 4days before exodontia and 3days after surgery, followed by euthanasia. Masseter edema was evaluated clinically and tissue samples were submitted to osteoclast count (H&E), myeloperoxidase assay, and western blotting (tumor necrosis factor-alpha and interleukin-1beta).ResultsIn the high omega-3/low omega-6 group, a significant decrease was observed in masseter edema (p<0.0001), myeloperoxidase (p<0.0001), osteoclasts (p=0.0001) and TNF-α expression (p<0.0001), but not in IL-1β expression.ConclusionThe ingestion of fatty acid with high ω-9:ω-6 ratio and low ω-6:ω-3 ratio significantly reduced inflammatory response in rats submitted to dental extraction.

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Corrigendum to “Is there a correlation between nasal septum deviation and maxillary transversal deficiency? A retrospective study on prepubertal subjects” [Int. J. Pediatr. Otorhinolaryngol. 83 (April 2016) 109–112]

Publication date: Available online 21 November 2016
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Fabiana Ballanti, Alberto Baldini, Salvatore Ranieri, Alessandro Nota, Paola Cozza

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Anti-inflammatory effect of a fatty acid mixture with high ω-9:ω-6 ratio and low ω-6:ω-3 ratio on rats submitted to dental extraction

Unerwünschte Arzneimittelreaktionen beim älteren Menschen

Zusammenfassung

Hintergrund

Es existieren nur wenige Daten zu unerwünschten Arzneiwirkungen (UAW) bei älteren Patienten. Es gilt bei diesen, in der Pharmakotherapie besondere Herausforderungen im Hinblick auf Komorbiditäten, Arzneimittelinteraktionen und Compliance zu berücksichtigen.

Ziel

In dieser Arbeit werden Charakteristika von UAW im Alter betrachtet.

Methoden

Neben Daten aus der Literatur wird über erste Ergebnisse aus dem Leipziger Forschungszentrum für Zivilisationserkrankungen (LIFE) berichtet. Hierbei wurde von 2011 bis 2015 eine bevölkerungsbezogene alters- und geschlechtsstandardisierte Stichprobe von Einwohnern der Stadt Leipzig in der Altersgruppe 40 bis 79 Jahre unter anderem zu Allergien inklusive UAW befragt.

Resultate

Es wurden 9537 Probanden eingeschlossen und allergologische Daten von 8979 Probanden ausgewertet. Weibliches Geschlecht, Komorbiditäten und erhöhte Medikamentenzahl waren alle signifikant mit einem erhöhten Risiko für das Auftreten von UAW assoziiert. Frauen berichteten signifikant häufiger von UAW als Männer; 22 % gaben an, jemals auf ein Medikament überempfindlich oder allergisch reagiert zu haben; über eine UAW innerhalb der letzten 12 Monate berichteten 2,3 %. Weniger als 15 % der von UAW betroffenen LIFE-Probanden waren im Besitz eines Dokumentes, das die UAW dokumentierte.

Diskussion

UAW tragen signifikant zur Morbidität bei älteren Menschen bei. Zur Prävention von UAW ist die Kenntnis von patientenbezogenen Faktoren, zugrunde liegenden Erkrankungen, Besonderheiten einzelner Arzneimittel sowie deren Interaktionen nötig.

http://ift.tt/2f0mwsR

Multiple ekkrine Hidrozystome an Stirn und Nase eines 60-jährigen Mannes

Zusammenfassung

Multiple ekkrine Hidrozystome sind gutartige dermale Zysten, die sich von den Schweißdrüsenepithelien ableiten und typischerweise im zentralen Gesichtsbereich bei Frauen auftreten. Durch vermehrtes Schwitzen kommt es häufig zu einer Größenzunahme der klinisch als transluzente Papeln imponierenden Entität. Bisweilen sind Hidrozystome mit anderen Erkrankungen (z. B. Morbus Parkinson) assoziiert. Therapeutisch stehen neben Lasern insbesondere topische und systemische Anticholinergika (Glycopyrrolat, Clonidin, Atropin und Oxybutynin) zur Verfügung, wobei die erzielten Erfolge häufig gering sind.

http://ift.tt/2fjiYxf

Challenges to Treatment of Chronic Pain and Addiction During the “Opioid Crisis”

Abstract

Health care in the USA faces a double challenge, the crisis of chronic pain and the crisis of opioid misuse and overdose. Patients have been prescribed opioids at high doses with unclear indications for long periods of time, putting them at high risk for morbidity and mortality. A significant proportion of these patients have comorbid psychiatric or substance use disorders complicating their pain conditions. The challenges to treating these patients adequately are discussed, along with potential solutions to these issues at the level of the individual provider, healthcare systems, and society.

http://ift.tt/2flekCa

“Katakori”: a Pain Syndrome Specific to the Japanese

http://ift.tt/2gesnZj

Carotid and Vertebral Dissection Imaging

Abstract

Carotid or vertebral artery dissection is the result of a tear in the vessel lining wherein the intima separates the media. This creates a false or pseudo lumen, often accompanied by hemorrhage into the arterial wall. Dissection of these craniocervical vessels often manifests with pain alone but, if untreated, may result in severe neurologic compromise. The causes of dissection are multifactorial, including spontaneous, iatrogenic, and traumatic insults. Regardless of etiology, treatment consists primarily of anticoagulation, whereas endovascular therapy is reserved for cases with persistent thrombus or flow limitation. Given the high risk of neurological compromise or death and the propensity of these injuries to occur in younger individuals, early diagnosis of carotid and vertebral artery dissections is critical. Although angiography remains the criterion standard for diagnosis, advances in noninvasive imaging have placed magnetic resonance and computed tomography at the forefront of diagnosis. This article examines the current imaging modalities used to diagnose this under-recognized entity.

http://ift.tt/2flh6aH

How Well Does the ICHD 3 (Beta) Help in Real-Life Migraine Diagnosis and Management?

Abstract

Classification has played a major role in the diagnosis of primary headache conditions including migraine with and without aura. With many updates and changes, the International Classification of Headache Disorders (ICHD)-3 beta is currently considered as the gold standard for classification of migraine and other headaches. Correct diagnosis of migraine and its subtypes is a first step toward appropriate treatment and crucial to minimizing disability and optimizing health-related quality of life. The ICHD-3 beta version represents the state of the art in migraine diagnosis but is expected to evolve as biological knowledge advances. Future research should focus on identification of biologically homogeneous subgroups of migraine based on genes and biomarkers.

http://ift.tt/2gehWFo

Vestibular Migraine in Children and Adolescents

Abstract

Purpose of review

The goal of this review is to provide an actualized overview on vestibular migraine in childhood and adolescence, with focus on the epidemiology and clinical presentation as well as its treatment.

Recent findings

Vertigo spells in childhood can evolve into other periodic syndromes and/or migraine types and persist even into adulthood.

Summary

Vestibular migraine (VM) and benign paroxysmal vertigo are the most common causes of vertigo in children and adolescents. The diagnostic criteria for VM are dizziness and vertigo, headache, phonophobia and photophobia, and visual aura. The prevention of attacks is the treatment for children and adolescents with VM, as is recommended for migraine with or without aura. Thus, non-pharmacological measures are the first-line option; when these measures fail or daily activities are notably affected, drugs are administrated. Psychological assessment and cognitive behavioral therapy are also important therapeutic measures in this patient group. There is still insufficient research on VM in children and adolescents; future studies on clinical presentation, evolvement, and specific treatment are necessary.

http://ift.tt/2gw57sl

Neumann's tumor in new born: A case requiring surgical intervention

Murali Nirupama, Ganesh Pai, Anand Pai, Reshma Pai

Saudi Journal of Oral Sciences 2014 1(2):117-119

Congenital epulis (CE) also known as granular cell tumor of new born was first described by Neumann in the year 1871. Most frequent location includes maxillary alveolar ridge with a female preponderance up to 8 times more than males. These tumors are usually small and can be solitary or multiple, pedunculated or protuberant mucosa covered nodules presenting at birth. Multiple theories have been proposed for their origin. Though, it may cause panic at birth they are indolent and regress spontaneously. Rare cases require surgical intervention in the neonatal period when symptomatic, causing difficulties in respiration or deglutition. We describe a case of CE in a 2-day-old female neonate, who presented with pink protuberant mass in the anterior alveolar ridge of maxilla. The mass was symptomatic and surgery was indicated. The mass was excised and the benign nature was confirmed by histopathology.

http://ift.tt/25WRdDl

Prevalence of torus palatinus and torus mandibularis in an Indian population

Santosh Patil, Sneha Maheshwari, Suneet Khandelwal Khandelwal

Saudi Journal of Oral Sciences 2014 1(2):94-97

Background and Aim: Oral tori are bony growth present in the oral cavity and are not considered as pathological lesions. Smaller tori do not cause any problems, but larger sized tori can result in significant problems. The aim of this study was to determine the prevalence of torus palatinus (TP) and torus mandibularis (TM) in the Indian population. Study Design: A total of 3087 patients were examined between August, 2010 and October, 2012 for the presence of TP and TM by inspection and palpation. The data were collected and analyzed using SPSS 12.0 (SPSS Inc., Chicago, USA). Results: A total of 36 patients (1.3%) presented with TP, while 214 patients (6.9%) presented with TM. Tori were more frequent in males and this difference was statistically significant (P < 0.05). TP was more common in 31-40 years age group (13 patients, 36.1%), whereas TM was more in the 41-50 years age group (81 patients, 37.9%). The most commonly observed type of TP was flat shaped, whereas bilateral solitary types were the most common TM. Conclusion: The results of this study showed a significantly higher prevalence of tori in males. No difference in the prevalence of TP and TM was noted regarding the age groups. Although, not pathologically significant, these bony overgrowths very often need surgical removal, especially when prosthesis are indicated.

http://ift.tt/238VEG9

Hairy intraoral flaps: An uncommon complication of surgical therapy in oral cancer

Gaurav Sharma, Archna Nagpal

Saudi Journal of Oral Sciences 2014 1(2):123-124

http://ift.tt/25WRpT3

Oxidative Priority, Meal Frequency, and the Energy Economy of Food and Activity: Implications for Longevity, Obesity, and Cardiometabolic Disease

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

http://ift.tt/2fiaaYw

Associations Between Lifestyle Characteristics and the Presence of Nonalcoholic Fatty Liver Disease: A Case–Control Study

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

http://ift.tt/2eZ2TRY

Patient-centered quality of life measures after alloplastic temporomandibular joint replacement surgery

Publication date: Available online 20 November 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): X. Alakailly, D. Schwartz, N. Alwanni, C. Demko, M.A. Altay, Y. Kilinc, D.A. Baur, F. Quereshy
The purpose of this study was to evaluate patient-reported outcome measures of quality of life (QoL) for patients with end-stage temporomandibular joint (TMJ) disease who have undergone TMJ prosthetic replacement. The records of 36 patients who had undergone alloplastic total joint replacement procedures were analyzed. Patients were treated using either TMJ Concepts or Biomet/Lorenz prosthetics. Patients were asked to complete a 12-item TMJ-S-QoL survey, which encompassed questions pertaining to pain, speech, chewing function, and various aspects of social life and mental health. The questions were answered on a 5-point scale. Data were analyzed using the Wilcoxon signed-rank test. Among the 36 patients (six male and 30 female), 18 responded to the survey. Markers of QoL after surgery were compared to the preoperative period. Significant improvements were reported for pain (94.4% of patients), chewing (83.3% of patients), speech (55.6% of patients), anxiety (72.2% of patients), activity (66.7% of patients), recreation (61.1% of patients), and mood (66.7% of patients) (all P<0.05). TMJ prosthetic replacement significantly enhanced QoL among patients suffering from chronic pain, limited range of motion, anxiety, impaired speech, and chewing due to end-stage TMJ disease in this sample of surgical patients.

http://ift.tt/2gCi7NX

Prognostic impact of the putative cancer stem cell markers ABCG2, CD133, ALDH1A1 and CD44V7/8 in metastatic melanoma

Despite recent therapeutic advances, a diagnosis of metastatic melanoma still foreshadows a grim prognosis for the majority of patients. One of the factors believed to be associated with the failure of current conventional cancer therapies are the so-called Cancer Stem Cells (CSCs). CSCs share common features with corresponding tissue stem cells, such as self-renewal capacity and the ability to give rise to progeny with the potential to proliferate and differentiate. Therapeutically targeting CSCs may thus eliminate the root cause of the cancer, however this would require the accurate identification of markers distinguishing CSCs from normal cells. The expression of candidate CSC markers is associated with a poor prognosis in a number of cancer types, but their clinical significance remains unclear and to the best of knowledge there have been no clinical studies in melanoma. Here, we aimed to determine the clinical significance of four molecules identifying putative CSCs, namely CD133, ABCG2, ALDH1A1 and CD44v7/8.

http://ift.tt/2gdtBEc

Onset of psoriatic arthritis associated with multiple wasp stings

Publication date: Available online 20 November 2016
Source:Annals of Allergy, Asthma & Immunology
Author(s): Tara Vinyette Saco, Mark C. Glaum, Dennis K. Ledford, Richard F. Lockey

http://ift.tt/2g9wzrI

A Case of Periodontal Necrosis following Embolization of Maxillary Artery for Epistaxis

Embolization of the maxillary artery (MA) is a common treatment modality for refractory epistaxis. Tissue necrosis after embolization of the MA is a rare complication. Here, we reported the first case of the development of necrosis of soft tissue and alveolar bone in the periodontium after embolization. A 48-year-old man with poor oral hygiene and a heavy smoking habit was referred to our clinic due to intractable epistaxis. After treatment with anterior-posterior nasal packing (AP nasal packing), the epistaxis relapsed. Therefore, he underwent embolization of the MA. Although he did not experience epistaxis after embolization, periodontal necrosis developed gradually. The wound healed with necrotomy, administration of antibiotics and prostaglandin, and hyperbaric oxygen therapy. We speculated that the periodontal necrosis was provoked by reduction of blood supply due to embolization and AP nasal packing based on this preexisting morbid state in the periodontium. Poor condition of the oral cavity and smoking may increase the risk of periodontal necrosis after embolization.

http://ift.tt/2fUuMaW

Tolosa-Hunt syndrome and comorbidity of obsessive compulsive disorder and aortic aneurysm

Description

A 59-year-old man with obsessive compulsive disorder (OCD) was on antidepressant treatment for years. Six months ago, he got a severe headache on the left side of his head, reported pain behind his left eye, diplopia and ptosis displayed on his left eyelid. The patient had mild migraine attacks occasionally. However, his previous headache was very intense when compared with earlier ones. By cranial MRI, a lesion (22x7 mm horizontally, 13x8 mm vertically) adjacent to carotid segment 4 (C4) of the left internal carotid artery was found. The lesion showed a hyperintense signal in contrast-enhanced T2-weighted images, which was the result of enhanced abnormal soft tissue extending through the orbital fissure and into the orbital apex. This did not cause compression on the optic nerve and there was slight bulging into the left cavernous sinus (figure 1). The patient's blood and cerebrospinal fluid biochemical parameters were within...

http://ift.tt/2guSaz6

Correction: Aortic valve replacement for Libman-Sacks endocarditis

Keenan JB, Janardhanan R, Larsen BT, et al. Aortic valve replacement for Libman-Sacks endocarditis. BMJ Case Reports 2016; doi:10.1136/bcr-2016-215914

The revised author list of this paper is as follows:

Jack B Keenan, Taufiek Konrad Rajab, Rajesh Janardhanan, Brandon T Larsen, Zain Khalpey

http://ift.tt/2gBAfaP

Cutaneous neck lesion of occult odontogenic origin: search for the tooth

The differential diagnosis for inflammatory neck swellings is vast. A swelling of dental origin should be considered because, while rare, they mimic more common causes of neck lumps. We report the case involving a recurrent submandibular swelling in a young female patient that was presumed to be an epidermoid cyst by her general medical practitioner. After 6 months of unsuccessful treatment in the community, an odontogenic source was identified and treated successfully following referral to a local Oral and Maxillofacial department.

http://ift.tt/2ge8DVq

Thyroid metastasis from lung adenocarcinoma with EML4-ALK rearrangement

Thyroid metastases from lung cancer are very rare. A woman aged 42 years with a tumour in the lower lobe of the right lung was diagnosed as having lung adenocarcinoma positive for echinoderm microtubule-associated proteinlike 4-anaplastic lymphoma kinase. Positron emission tomography demonstrated fluorodeoxyglucose accumulation in the lower lobe of the right lung, the right thyroid lobe and both adrenal glands. We performed fine-needle aspiration biopsy (FNAB) and used reverse transcriptase-PCR (RT-PCR) to diagnose the patient as having metastatic lung adenocarcinoma to the thyroid gland. We believe that FNAB combined with RT-PCR can be an effective method for diagnosing metastatic lung adenocarcinoma to the thyroid gland.

http://ift.tt/2gBDz5Z

Successful improvement of Buschke-Löwenstein tumour in an HIV-infected patient with antiretroviral therapy alone

Buschke-Löwenstein tumour (BLT), also defined as giant condyloma acuminatum, is a rare exophytic tumour affecting the anogenital and perianal regions associated with human papillomavirus (HPV) infections, with a potential of malignant transformation and which is at a greater risk in T-cell mediated immunodeficient patients. Different therapeutic options, alone or in combination, have been reported for the treatment of BLT including local therapy but wide surgical local excision is however recommended as the most important therapeutic intervention. We report a case of a HIV-infected man who developed a voluminous pelvic BLT which disappeared progressively under antiretroviral therapy with no additional treatment, contemporary to an improvement of his immunity, highlighting the possible spontaneous reversibility of HPV-induced tumours in treated HIV infection.

http://ift.tt/2ge42m2

Metastatic trichilemmal carcinoma in a patient with breast cancer

Trichilemmal carcinoma (TC) is described as a very rare cancer of the skin adnexa.^{1 2} Ninety per cent of the lesions present on the scalp. Prognostic factors in TC are limited to lymph node status and surgical margins, with no statistical significance observed for age or gender of the patient, size of tumour or locoregional recurrence. We present a 46-year-old black patient who developed TC during treatment for breast cancer. Postoperative histology of the scalp lesion excision confirmed no involved margins. At the three monthly appointment, the patient was reviewed and multiple, new scalp lesions were noted. A CT scan of the head, neck found multiple lesions on the scalp, limited to the soft tissue, not involving the outer table of the skull. There was bilateral invasion of the parotid glands. To the best of our knowledge, no syndromes or associations between breast cancer and adnexal skin tumours exist.

http://ift.tt/2gByiLK

Never forget basics

Description

A patient with open fracture of both bones of a leg was posted for wound debridement and external fixation. L3–L4 space was identified by the loss of resistance technique with Tuohy's needle. An epidural catheter was passed through the Tuohy's needle. Aspiration of epidural catheter resulted in cerebro spinal fluid (CSF) tap. We tried to pull the catheter while the needle was in situ. Although there was a little resistance, we could remove the catheter. When we inspected the catheter, it was found that epidural catheter tip with only the 8 cm mark was visible (figure 1). Immediately the Tuohy's needle was removed and it was concluded that the epidural catheter tip was neither palpable nor visible. The patient was given general anaesthesia and allowed surgeons to proceed with the planned surgery. We decided to document and explain to the patient about sheared catheter and not...

http://ift.tt/2gecnGi

Vascular compression of left renal vein: the nutcracker phenomenon

Description

A 75-year-old woman presented to the outpatient clinic with symptoms of upper abdominal pain radiating to the back. On evaluation with contrast-enhanced CT of the abdomen, she was found to have carcinoma of the body of pancreas. Incidentally, vascular compression of the left renal vein was seen between the superior mesenteric artery and the aorta (the nutcracker sign) (figure 1). In view of poor performance status, she underwent palliation with percutaneous splanchnic nerve radiofrequency ablation. Since she was asymptomatic for the vascular compression and serum creatinine was normal (1.2 mg/dL), she was observed for the same.

Figure 1

(A) Axial contrast-enhanced CT image showing mass lesion in the body of pancreas (asterisk) with dilated left renal vein, (B) magnified image showing compression of the left renal vein between the superior mesenteric artery and aorta with dilation of the proximal left renal vein (arrow).

http://ift.tt/2gBCNpj

Complementary and alternative medicine for allergic rhinitis in Japan

Publication date: Available online 21 November 2016
Source:Allergology International
Author(s): Syuji Yonekura, Yoshitaka Okamoto, Daiju Sakurai, Toshioki Sakurai, Tomohisa Iinuma, Heizaburou Yamamoto, Toyoyuki Hanazawa, Shigetoshi Horiguchi, Yuichi Kurono, Kohei Honda, Yuichi Majima, Keisuke Masuyama, Noriaki Takeda, Shigeharu Fujieda, Mitsuhiro Okano, Satoshi Ogino, Kimihiro Okubo
BackgroundComplementary and alternative medicine (CAM) is extensively used in patients with allergic diseases worldwide. The purpose of this study was to investigate the actual situation of CAM practice in the treatment of allergic rhinitis.MethodsWe distributed questionnaires to otolaryngologists at 114 facilities in Japan. The subjects who participated in this study included children <16 years of age and adults ≥16 years of age diagnosed with allergic rhinitis by otolaryngologists. The survey was performed in the period from September 2007 to August 2009. Furthermore, we performed the same investigation out of the hospital setting, such as during general health examinations. All questionnaires were returned to Chiba University and analyzed.ResultsThe proportions of patients who had ever experimented with CAM in the hospital survey were 7.1% (225/3170) and 19.2% (1416/7363) of children and adults, respectively. Approximately 36.2% of the adult patients thought that the treatments were effective. The main reasons for CAM use were safety, convenience and low price. However, the group who spent more than $1000 on CAM felt more dissatisfaction and anxiety related to treatment at the hospital. The situation of CAM practice was not consistent and was instead influenced by the backgrounds of the subjects.ConclusionsMany patients who receive CAM report feeling that the effects of treatment provided by hospitals are insufficient and have concerns about the side effects of such treatments. Information regarding standard treatments, as described in the guidelines, should become widely known and diffused, and strong communication with patients should be considered.

http://ift.tt/2fjvAry

Pitfalls in the use of epinephrine for anaphylaxis: patient and provider opportunities for improvement

Background

Epinephrine remains the mainstay of treatment for life-threatening allergic reactions. A number of challenges are encountered with epinephrine, resulting in underutilization and misutilization of epinephrine. The purpose of this study was to identify the scope of epinephrine pitfalls and opportunities for improvement in the management of allergy emergencies.

Methods

A PubMed search from 1990 to 2015 was performed to identify all cases and reports pertaining to the use and misuse of epinephrine for anaphylaxis. Studies were assessed for obstacles or complications related to proper administration of epinephrine for treatment of allergic reactions, and were divided into problems originating with patients compared to healthcare providers.

Results

There were 1840 publications related to epinephrine use, of which 61 reports met inclusion criteria for pitfalls in the use of epinephrine. The most common problems reported related to lack of autoinjector availability (22), inadequate education of patients or providers (9), uncertainty about when or how to administer epinephrine (9), concern for systemic effects (13), failure to administer (8), and accidental administration (2). Responsibility for errors was divided among patients (18), providers (39), or both (4).

Conclusion

Epinephrine is a potent medication with lifesaving indications and is the standard of care for treatment of anaphylaxis. The delivery of epinephrine in both trained and untrained populations carries certain pitfalls and complications that can have serious consequences. Identification of the scope of the problem is an important step in improving education for both providers and patients who are tasked with use of epinephrine for allergy emergencies.

http://ift.tt/2fTJ1N0

The impact of endoscopic sinus surgery on paranasal physiology in simulated sinus cavities

Background

Surgery improves symptoms for the majority of chronic rhinosinusitis (CRS) patients; however, physiological changes in the sinus cavities remain poorly characterized. Direct measurement of changes in airflow, pressure, temperature, humidity, and intranasal spray distribution following surgery is technically challenging. Accordingly, we have used computational fluid dynamic modeling to quantify how these parameters change postoperatively.

Methods

Computed tomography images from a normal control, a patient with CRS preoperatively and postoperatively, and a patient following an endoscopic Lothrop procedure (ELP) were used to create 4 three-dimensional models of the sinus cavities. Changes in physiologic parameters and topical drug distribution were modeled (inhaled air at 16°C and 10% humidity) at the maxillary ostium, frontal recess, and sphenoid ostium.

Results

Large differences were seen between models. Following surgery, the maxillary ostia were found on average to be cooler (by 2.4°C), with an increased airflow (0.26 m/second; from 0 m/second), and a 9% reduction in absolute humidity. Sphenoid ostial parameters followed a similar trend. Significant changes in frontal recess physiology were seen following ELP in which the recess was 4.2°C cooler, had increased airflow (0.76 m/second) and a 17% reduction in absolute humidity. Topical drug distribution increased with surgery, particularly after ELP.

Conclusion

Surgery changes the geometry and physiology of the paranasal sinuses. These changes are likely to have an impact on wound healing, mucociliary function, and microbial ecology in postoperative cavities. Application of this model to further understand the effects of surgery may help to optimize surgical techniques and improve topical drug delivery.

http://ift.tt/2fK7zdF

Efficacy of olopatadine hydrochloride 0.1%, emedastine difumarate 0.05%, and loteprednol etabonate 0.5% for Chinese children with seasonal allergic conjunctivitis: a randomized vehicle-controlled study

Background

Allergic conjunctivitis (AC) is a disease of various agents that affects the physical and mental health of children. Although the most effective therapy has not been found so far, it is essential to explore the considerable therapeutic method. We compared the clinical efficacy of olopatadine, emedastine, loteprednol etabonate (LE), and vehicle for treating seasonal allergic conjunctivitis (SAC) in Chinese children.

Methods

Eighty cases of 160 eyes aged from 5 to 10 years with SAC were available and those subjects were randomly distributed into 4 groups. Both their eyes received olopatadine hydrochloride 0.1% twice a day, emedastine difumarate 0.05% twice a day, or LE 0.5% 4 times a day, respectively, whereas those of the control group received artificial tears (AT) 0.5% 3 times a day. This study was conducted successfully and the observations were collected before treatment and on day 8 (±1 day) and day 15 (±2 days) afterward. The principal measurement of efficacy was focused on the signs and symptoms of the subjects, evaluated before and after treatment, in addition to visual acuity (VA) and fundus oculi.

Results

On day 8 (±1 day) and day 15 (±2 days), all the antiallergic agents were found to be more effective than vehicle (p < 0.05) in terms of all the symptoms and signs. However, there was no statistical significance (p ≥ 0.05) shown among the treatment groups. There were no evident changes in VA and no clinically significant changes were observed in fundus oculi.

Conclusion

After the treatment, the efficacy presented a similar distribution among the trial groups.

http://ift.tt/2fTKLpu

A high number of stromal tumor-infiltrating lymphocytes is a favorable independent prognostic factor in M0 (stages I–III) esophageal squamous cell carcinoma

Summary

Esophageal cancer is a highly invasive tumor with a poor prognosis. Lymphocytes play an important role in systemic immune responses, but their role in cancers varies depending on the specific tumor microenvironment. The aim of this study was to provide evidence for tumor-infiltrating lymphocytes (TILs) as a prognostic biomarker in esophageal squamous cell carcinoma. TIL analysis was retrospectively performed on full-face hematoxylin and eosin-stained sections from 127 patients. A majority (92.6%) of tumors had at least 10% stromal TILs (sTILs) (range, 10%–90%), and 84.3% of cancers had at least 10% intraepithelial TILs (iTILs) (range, 10%–40%). Multivariate analysis showed progressively better overall survival (P < 0.001, hazard ratio = 0.968, 95% confidence interval 0.955–0.981) and disease-free survival (P = 0.005, hazard ratio = 0.982, 95% confidence interval 0.970–0.995) in patients with higher sTILs. Marginal increases in overall survival and disease-free survival were found in the higher iTILs cohort versus the lower iTILs cohort, but the difference was not significant. In conclusion, in addition to tumor stage increasing stromal lymphocytic infiltration is an independent prognostic factor for esophageal squamous cell carcinoma treated by radical resection.

http://ift.tt/2guhLIy

Outcomes of definitive chemoradiation in patients with esophageal cancer

Summary

The incidence of esophageal cancer has risen dramatically in the Western world. Although surgical resection of esophageal tumors is considered the cornerstone of curative approaches in localized esophageal cancer, approximately 40% of patients who undergo chemoradiation followed by surgery will experience a recurrence. Additionally, surgical resection is not a viable option for many patients with locally advanced unresectable disease, poor general condition or whose condition deteriorated following chemoradiation. Several investigators have, therefore, attempted to evaluate the outcomes of definitive chemoradiation in patients with localized or locally advanced esophageal cancer. The outcomes of concurrent chemoradiation remain a matter of debate given the heterogenous study design and treatment regimens used in recent trials. Understanding the clinical benefit of chemoradiation is essential prior to recommending it as an alternative to surgery. In our review, we present the most recent studies evaluating the role of chemoradiation to better define the clinical outcomes of patients with special attention to overall survival.

http://ift.tt/2g8Px1x

Effects of eosinophilic oesophagitis on quality of life in an adult UK population: a case control study

Summary

Eosinophilic oesophagitis (EoE) is a chronic immune-mediated esophageal disease, characterized by symptoms related to esophageal dysfunction and histologically by eosinophil predominant inflammation. Current evidence for an adverse impact on quality of life (QoL) is conflicting and there are no data from a UK population regarding QoL. We conducted a prospective cross-sectional observational study using the Short Form-36 Health Survey, Hospital Dysphagia/Odynophagia Questionnaire, and the EoE Adult Quality of Life Questionnaire to assess QoL and severity of dysphagia in EoE patients, compared to age and gender matched healthy control subjects. Data were also collected on comorbidity and medication use. Eighty-eight subjects were recruited (44 patients). Patients had higher rates of antihistamine and topical (swallowed) corticosteroid use. Physical QoL did not differ between patients and controls, although patients did report a statistically significant lower mental QoL, with small absolute magnitude of difference. Patients reported higher dysphagia scores and these were negatively correlated with both physical and mental QoL. Higher rates of dysphagia and medication use in patients may among other things account for lower mental QoL. However, a higher rate of dysphagia in patients is not associated with a reduced physical QoL. Our findings are of clinical value, particularly when a new diagnosis of EoE is made, as clinicians can reassure patients that their general physical health should not be greatly affected by the diagnosis. Moreover, it may also be useful for patients to be aware that EoE may have an impact on their mental health, but this effect is likely to be small. We therefore advocate education and reassurance in this respect for all patients at diagnosis.

http://ift.tt/2guk2Dq

P21, COX-2, and E-cadherin are potential prognostic factors for esophageal squamous cell carcinoma

Summary

Much research effort has been devoted to identifying prognostic factors for esophageal squamous cell carcinoma (ESCC) by immunohistochemistry; however, no conclusive findings have been reached thus far. We hypothesized that certain molecules identified in previous studies might serve as useful prognostic markers for ESCC. Therefore, the aim of the current study was to validate the most relevant markers showing potential for ESCC prognosis in our prospective esophageal cancer database. A literature search was performed using the PubMed database for papers published between 1980 and 2015 using the following key words: 'esophageal cancer,' 'prognosis,' and 'immunohistochemistry.' Literature selection criteria were established to identify the most widely studied markers, and we further validated the selected markers in a cohort from our single-surgeon team, including 153 esophageal cancer patients treated from 2000 to 2010. A total of 1799 articles were identified, 82 of which met the selection criteria. Twelve markers were found to be the most widely studied, and the validation results indicated that only P21, COX-2, and E-cadherin were independent prognostic factors for ESCC patients in this series. The systemic review and cohort validation suggest that P21, COX-2, and E-cadherin are potential prognostic factors for ESCC, paving the way for more targeted prospective validation in the future.

http://ift.tt/2g8QjvR

Development of a nomogram for the prediction of pathological complete response after neoadjuvant chemoradiotherapy in patients with esophageal squamous cell carcinoma

Summary

Nomograms incorporating multiple prognostic factors are useful for individualized estimation of survival in cancer patients. However, nomograms for the prediction of pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) in patients with esophageal cancer are scarce. Here, we describe the development of a nomogram for predicting pCR after nCRT in patients with esophageal squamous cell carcinoma (ESCC). We retrospectively reviewed the records of 392 ESCC patients who underwent nCRT followed by esophagectomy. Seventy percent of the participants (n = 274) were randomly assigned to a training cohort, whereas the remaining 30% were included in a validation cohort (n = 118). Data from the training cohort were subjected to multivariate logistic regression analyses for selecting variables to be included in the nomogram. The performance of the resulting nomogram was internally and externally validated by calculating the bias-corrected concordance statistic (c-statistic) and the area under the receiver operating characteristics curve (AUROC) in the training and validation cohorts, respectively. After surgery, 25.77% of the study patients achieved pCR. The following variables were included in the nomogram: (i) age, (ii) pretreatment tumor length, (iii) history of head and neck cancer, (iv) post-nCRT albumin levels, and (v) post-nCRT endoscopic findings coupled with endoscopic biopsy results. The bias-corrected c-statistic and AUROC of the internal and external validation sets were 0.77 and 0.747, respectively. Our nomogram showed a good performance for predicting pCR after nCRT in ESCC patients.

http://ift.tt/2gudzbR

Review of chemotherapeutic approaches for operable and inoperable esophageal squamous cell carcinoma

Summary

The predominant histological types of esophageal cancer are adenocarcinoma and squamous cell carcinoma. Since these two histological types present as different diseases in terms of their epidemiology, pathologenesis, and tumor biology, separate therapeutic approaches should be developed against each type. While surgical resection remains the dominant therapeutic intervention for patients with operable esophageal squamous cell carcinoma (ESCC), their high rates of tumor recurrence have prompted investigation of multimodality therapies that combine surgery with chemotherapy, radiotherapy, and chemoradiotherapy. In Japan, preoperative chemotherapy with cisplatin (CDDP) plus 5-fluorouracil (5-FU) followed by radical esophagectomy has been accepted as the standard therapeutic approach for resactable clinical Stage II/III ESCC. Similarly, the CDDP and 5-FU regimen has been accepted as the first-line treatment for metastatic and unresectable ESCCs in Japan. Thus, in Japan chemotherapy is an indispensable component of therapy for both resectable and unresectable ESCCs. This review discusses the current knowledge, rationale, and available data regarding chemotherapy for resectable and unresectable ESCCs.

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Patterns of reflux in gastroesophageal reflux disease in pediatric population of New South Wales

Summary

This study is to determine the association of ambulatory pH monitoring (24hr pH) with symptoms of gastroesophageal reflux and its other investigations. The clinical and epidemiological profiles of subjects referred for reflux disorders are also studied. Symptoms or group of symptoms, profiles and prior investigations of 1259 consecutive pediatric subjects (with 1332 24hr pH studies performed) referred for evaluation of reflux disorders between 1988 and 2012 were retrospectively studied. Chi-square or fisher exact test was used for hypothesis testing, student t-test for the comparison of means and the Wilcoxon rank-sum test for comparing medians of continuous variables. Gastroesophageal reflux disease (GERD), defined as reflux causing major symptoms and complications, was diagnosed in 57.5% subjects of the total sample. Forty-three percent were girls and 56.7% were boys. The most common age group was between 4 months and 2 years (51.2%). Vomiting (64.4%) and irritability (74%) were the most common symptoms with the neurological conditions (23.2%) being the most frequent underlying condition. The parameters used in 24hr pH were significantly higher in those diagnosed with GERD (P < 0.0001). The prevalence of GERD was found to be significantly higher when both gastrointestinal and respiratory symptoms were present (P = 0.008) at 66.4% than when compared with gastrointestinal (56.5%) and respiratory (52.2%) symptoms in isolation. Symptoms alone were not reliable in diagnosing GERD. Only 57.5% had GERD among patients referred for reflux disorders. 24hr pH is reliable and should be considered routine in reflux disorders, as it identifies patients with pathologic reflux and avoids a needless surgery. © 2016 International Society for Diseases of the Esophagus

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Efficacy and safety of cisplatin-based versus nedaplatin-based regimens for the treatment of metastatic/recurrent and advanced esophageal squamous cell carcinoma: a systematic review and meta-analysis

Abstract

Cisplatin and nedaplatin show significant antitumor activity and have been widely used for esophageal squamous cell carcinoma (ESCC). However, it is still unclear whether the efficacy and safety of nedaplatin-based regimens are comparable to those of cisplatin-based regimens in patients with metastatic/recurrent or advanced ESCC. Therefore, we conducted a systematic review and meta-analysis to compare the efficacy and safety of these two regimens for the treatment of metastatic/recurrent and advanced ESCC. We systematically searched Pubmed, Web of Science, and the Cochrane Database, as well as abstracts presented at conferences (all up to January 2015), for randomized-controlled and nonrandomized clinical trials that compared cisplatin-based and nedaplatin-based regimens in patients with metastatic/recurrent or advanced ESCC. Data were extracted from the original studies by two independent reviewers. This meta-analysis was performed using Review Manager (RevMan) Version 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) software. Ten eligible trials, including 598 patients diagnosed with metastatic/recurrent or advanced ESCC, were included in our analysis. Our results demonstrated that the nedaplatin-based regimens were comparable to the cisplatin-based regimens in terms of overall survival (OS) (hazard ratio, HR: 1.22, 95% confidence interval, CI: 0.86–1.74, p = 0.26) and overall response rate (ORR) (risk ratio, RR: 0.92, 95% CI: 0.77–1.10, p = 0.37) and generated fewer grade 3 and 4 side effects including nausea (RR: 3.41, 95% CI: 1.67–6.96, p < 0.001) and vomiting (RR: 3.62, 95% CI: 1.77–7.40, p < 0.001) and fewer grade 1 and 2 adverse events including nausea (RR: 1.54, 95% CI: 1.23–1.93, p < 0.001), vomiting (RR: 1.76, 95% CI: 1.76–2.30, p < 0.001), peripheral neuropathy (RR: 1.75, 95% CI: 1.08–2.84, p = 0.02) and renal dysfunction (creatinine) (RR: 3.28, 95% CI: 1.37–7.84, p = 0.008). This systematic review and meta-analysis indicated that the efficacy of nedaplatin-based regimens was comparable to that of cisplatin-based regimens for patients with metastatic/recurrent or advanced ESCC, and that nedaplatin-based regimens were associated with less toxicity and better tolerability. However, this study was a meta-analysis of previously released data; therefore, there is a potential publication bias and heterogeneity among the included trials. Future, well-designed RCTs with large cohorts are warranted.

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Long-term benefit of transoral incisionless fundoplication using the esophyx device for the management of gastroesophageal reflux disease responsive to medical therapy

Summary

Transoral incisionless fundoplication (TIF) using the EsophyX device has been shown to be effective and safe in patients with Gastroesophageal reflux disease (GERD); however, the subset of patients that would mostly benefit from this technique remains unknown. The aim of this study was to evaluate the long-term efficacy and safety of the TIF procedure in patients with a history of esophagitis or proven chronic GERD who have achieved symptom control with the administration of proton pump inhibitors (PPIs) but did not wish to continue receiving medications for life. Forty-five patients with typical GERD symptoms (heartburn, regurgitation, chest pain) and a history of esophagitis grade A and B or proven GERD by esophageal pH monitoring underwent TIF using Esophyx. Patients with eosphagitis C and D or those with large hiatal hernias (>2 cm in length) were excluded. The primary clinical effectiveness measure was GERD symptom elimination at follow up based on normalization of the GERD health related quality of life (GERD-HRQL) questionnaire. After a median follow up period of 59 months (36–75) the median GERD-HRQL scores improved significantly from 27 (2–45) at baseline to 4 (0–26) (P < 0.001) in the 44 patients completing the study. Heartburn was eliminated in 12 out of the 21 patients included (57.1%), regurgitation was eliminated in 15 out of the 17 patients included (88.2%) and finally chest pain was eliminated in 5 patients out of the six patients included (83.3%). Overall, 32 patients out of the 44 patients (72.7%) that completed the study follow up reported elimination of their main symptom, without the need for PPI administration (none PPI usage). Furthermore, six more patients (13.6%), five with heartburn, and one with regurgitation reported half PPI dose taken for <50% of the preceding follow up period (occasional PPI usage), while six more patients (four with heartburn, one with regurgitation, and one with chest pain) reported full or half PPI dose taken for more than 50% of the preceding follow up period (daily PPI usage). Creation of an esophagogastric fundoplication using the EsophyX device abolished reflux symptoms in 72.7% of PPI-responsive GERD patients at a median 59 month follow-up.

http://ift.tt/2gudMvw

Tagging polymorphisms of methyl-CpG binding domain 4 and gastric cardiac adenocarcinoma risk in a Chinese population

Summary

Potential effects of genetic factors on carcinogenesis of gastric cardiac adenocarcinoma (GCA) may exist. The present experiment specifically evaluated the genetic influence of single nucleotide in methyl-CpG binding domain 4 (MBD4) on GCA tumorigenesis. A case–control experiment based on hospital recruited 330 GCA patients and 608 non-cancer patients was carried out. We employed ligation detection reaction method to detect the genotypes. The results revealed that MBD4 rs3138373, rs2005618, and rs3138355 mutations had no significant association with the risk of GCA. However, a lower risk of GCA presented in male patients who carried the MBD4 rs3138355 G>A polymorphic loci by the stratified analyses. In general, The MBD4 gene polymorphism could not influence GCA hereditary predisposition. Nevertheless, whether the finding learned from our experiment could apply to other ethnic groups will remain vague until future multicenter studies further test and verify our conclusions.

http://ift.tt/2g8SFux

Sample Size for Clinical Trials

Abstract

The gold standard of study design in clinical investigation is the randomized controlled trial (RCT). Over the past 50 years, RCTs have come to be considered the primary source of evidence for the efficacy of newer therapeutic interventions (Matthews, 2006). The design of the trial varies with the phase of the clinical trial (I-IV) and is dependent on several statistical exercises. Typically, sample size calculation and statistical power are critical components of study design.

http://ift.tt/2fTtFbb

What's new in atopic eczema? An analysis of systematic reviews published in 2014. Part 2. Treatment and prevention

Summary

This review forms part of a series of annual updates that summarize the evidence base for atopic eczema (AE). It provides a summary of key findings from 12 systematic reviews (SRs) that were published or indexed during 2014, and focuses on the treatment and prevention of AE. For an update of SRs on the epidemiology, mechanisms of disease and methodological issues, see Part 1 of this update. Although phototherapy and various systemic medications (including ciclosporin, azathioprine and methotrexate) are commonly used to treat AE, many of these have not been robustly assessed in head-to-head randomized controlled trials. Educational interventions may improve AE severity and quality of life for children and their families. Intake of probiotics prenatally and postnatally may help prevent AE, but there is little evidence to suggest a role in the treatment of AE. Although no benefit was found for allergen avoidance in preventing AE, the use of immunotherapy to treat AE-associated aeroallergen sensitivity requires further evaluation. There is insufficient evidence for Vitamin D supplementation for the treatment of AE This overview of reviews provides a succinct guide for clinicians and patients wishing to remain up to date with the most recent evidence for the treatment and prevention of AE.

http://ift.tt/2gcuugq

Growth and prevalence of feeding difficulties in children with Robin sequence: a retrospective cohort study

Abstract

Objectives

In addition to breathing problems, patients with Robin sequence (RS) often encounter feeding difficulties (FD). Data regarding the occurrence of FD and possible influencing factors are scarce. The study aim was to elucidate these factors to improve treatment strategies.

Material and methods

A retrospective comparative cohort study was conducted, consisting of 69 infants diagnosed with both RS and a cleft palate and 64 isolated cleft palate only (iCPO) infants. Data regarding FD, growth, and airway intervention were collected during the first 2 years of life. A systematic review of the literature was conducted to identify reported FD in RS patients.

Results

RS patients had more FD (91 %) than iCPO patients (72 %; p = 0.004). Also, nasogastric (NG)-tube feeding was necessary more frequently and for a longer period (both p < 0.001). Growth was lower in RS than iCPO infants (p = 0.008) and was not affected by the kind of airway management (conservative/surgical; p = 0.178), cleft palate grade (p = 0.308), or associated disorders (p = 0.785). By contrast, surgical intervention subtype did significantly affect growth. Mean reported FD for RS in the literature is 80 % (range = 47–100 %), and 55 % (range = 11–100 %) of infants need NG-tube feeding.

Conclusions

FD is present in a large proportion of infants with RS, which indicates the need for early recognition and proper treatment to ensure optimal growth. Growth during the first 2 years of life is significantly lower in RS patients than iCPO patients, which indicates the need for careful attention and long-term follow-up.

Clinical relevance

This study indicates the need for early recognition and proper treatment of FD in RS to ensure optimal growth. In addition, growth needs careful attention and long-term follow-up.

http://ift.tt/2fJM9xi

Αρχειοθήκη ιστολογίου

Δευτέρα 21 Νοεμβρίου 2016

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