Τετάρτη 30 Νοεμβρίου 2016
Use of ultrasound for spinal anesthesia in a super morbidly obese patient
We report the application of ultrasound prescans for spinal anesthesia to morbid obesity patient. A 38-year-old woman with a body mass index (BMI) of 50 (weight: 110 kg; height: 148 cm) was scheduled to undergo pilonidal cyst resection at the bottom of the tailbone. Spinal anesthesia was selected for the procedure, because the patient's position during the surgery was prone and the patient had morbid obesity. To determine the spinal needle insertion point and the distance between the skin and dura, we planned to use ultrasound.
http://ift.tt/2fGSjPO
Magnesium sulfate accelerates the onset of low-dose rocuronium in patients undergoing laryngeal microsurgery
We evaluated the effect of magnesium sulfate—an enhancer of neuromuscular blockade—on onset and duration of low dose of rocuronium, and on operating conditions during laryngeal microsurgery.
http://ift.tt/2gN3m6a
Monitoring of the intraoperative analgesia by pupillometry during laparoscopic splenectomy for splenic hydatid cyst
Echinococcosis causes a hydatid cyst, a worldwide disease. Human beings are intermediate hosts, but dogs complete the life cycle of the cestode. The most common presentation sites are the liver and lungs. We present an unusual case of a primary splenic hydatid cyst. Open splenectomy has traditionally been the treatment of choice for splenic hydatid cysts. In recent years, minimally invasive laparoscopic surgery has been used in appropriate cases. A healthy 48-year-old woman was scheduled for laparoscopic splenectomy.
http://ift.tt/2fGSjiM
Effect of total intravenous vs volatile anesthetics on intraoperatively acquired electrically evoked compound action potential in children undergoing cochlear implant surgery: A randomized prospective study
The purpose of the present study was to compare the effects of inhalational anesthesia to those of total intravenous anesthesia on intraoperative electrically evoked compound action potential (e-ECAP) thresholds in children undergoing cochlear implantation.
http://ift.tt/2gN7Zgv
Medical students’ understanding of oral and maxillofacial surgery: an Irish perspective
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): P.G.C. Kielty, B.R. O'Connor, C.J. Cotter, A.M.C. Goodson, K.F.B. Payne, A. Tahim
Oral and Maxillofacial Surgery (OMFS) remains an enigmatic specialty in Irish medicine and many students are unaware of its scope and the unique career pathway involved. We performed a multicentre cross-sectional study to identify their ability to identify the requirements for entry to specialty training year 3 (ST3) in OMFS, to assess their awareness of OMFS surgeons, and their general awareness of, and exposure to, the specialty. Data were collected through an electronic questionnaire. Participants were asked to select the most suitable surgical specialty to treat a number of common conditions in the head and neck, and to choose the requirements they deemed essential for specialist training. Knowledge was measured by the number of correct responses. A total of 443 medical students participated (University College Cork (UCC) n=328, 74%; Royal College of Surgeons in Ireland (RCSI) n=113, 26%). A total of 318/374 (85%) had had no previous experience of OMFS, 38/374 (10%) had had theoretical teaching only, and 18/374 (5%) had had clinical experience. A total of 212/329 (64%) wished for greater exposure as a student, but only 34/329 (9%) would consider a career in the specialty. The median (IQR) number of correct responses for OMFS procedures was 3.0/10 (2.0), with women, direct entrants, and RCSI students scoring highest. Only 11/367 (3%) could identify the minimum entry requirements for a post of specialist registrar. This study has identified a potential gap in the undergraduate curriculum. Although medical students are rarely taught about OMFS, they show an interest in learning more.
http://ift.tt/2gKJ3Ys
Minimally invasive endoscopic treatment for pediatric combined high grade stenosis as a laryngeal manifestation of epidermolysis bullosa
Source:International Journal of Pediatric Otorhinolaryngology, Volume 92
Author(s): Dora Palinko, Vera Matievics, Ilona Szegesdi, Balazs Sztano, Laszlo Rovo
Epidermolysis bullosa refers to a clinically and genetically heterogeneous group of inherited mucocutaneous diseases. Laryngotracheal lesions are momentous regarding the risk of sudden airway obstruction. The traditional treatment is tracheostomy. This case report highlights the advantages of minimally invasive interventions. A successful combined endoscopic management of a life-threatening respiratory crisis is presented in a 4-year-old child. Combined commissure stenosis with supraglottic spread was treated by CO2 laser dissection and bilateral endoscopic arytenoid abduction lateropexy, supplemented with mitomycin C application. Due to expectable less scarring, the combination of these modern methods may be an efficient solution in these vulnerable respiratory tracts.
http://ift.tt/2fG2dkK
School entry level tele-hearing screening in a town in South India – Lessons learnt
Source:International Journal of Pediatric Otorhinolaryngology, Volume 92
Author(s): Saleth D Monica, Vidya Ramkumar, Mark Krumm, Nitya Raman, Roopa Nagarajan, Lakshmi Venkatesh
IntroductionSchool screening is warranted in developing countries that do not have newborn hearing screening as schools provide access to a large number of young children between 3 and 5 years of age. Due to scarcity of technical manpower and equipment, hearing screening programs are not often conducted in developing countries. In these circumstances, telehealth services appear to be a reasonable solution. Consequently, the purpose of this study was to assess the feasibility of school hearing screening using telehealth technology operated by a practitioner located 400 kms away at a distant hospital.MethodThirty one children received hearing screening procedures in their school. Each child was screened for both in-person and telehealth conditions to assess screening results. Remote computing software was employed for the telehealth condition in order for the practitioner to remotely operate an audiometer, DPOAE system and a video otoscope interfaced to a personal computer at the school site.Teamviewer version 10 was used to provide encrypted videoconferencing and synchronous hearing screening services between the hospital and school sites. All screening was conducted using a mobile phone hotspot or dongle device based internet connection to insure reliable connectivity.ResultsThe outcome revealed no significant difference between PTA and DPOAE performed in-person and tele-hearing screening methods. Concurrence of greater than 87% was achieved between in-person and tele-video-otoscopy. Strengths and challenges were documented for tele-hearing screening in three different dimensions: technical issues, child related and school related. Understanding these challenges may provide more effective tele-audiology services.DiscussionThe results of the study indicate synchronous hearing screening services can be provided in a school setting using mobile hotspot or dongle connectivity in locations where Internet bandwidth is otherwise restricted.
http://ift.tt/2gMon0W
The utility of early developmental assessments on understanding later nonverbal IQ in children who are deaf or hard of hearing
Source:International Journal of Pediatric Otorhinolaryngology, Volume 92
Author(s): Jareen Meinzen-Derr, Susan Wiley, Jannel Phillips, Mekibib Altaye, Daniel I. Choo
ObjectiveIn children who are deaf or hard of hearing (DHH), it is helpful to have meaningful early measures of development in order to provide effective interventions and offer benchmarks that help recognize varied developmental trajectories. The main objective of this study was to compare results of an early developmental assessment prior to 3 years of age to later nonverbal IQ assessed between 3 and 6 years of age in children who are DHH.MethodsThis study included children 3–6 years of age with bilateral permanent hearing who were enrolled in a prospective cohort study on developmental outcomes. As part of the study, children received the Leiter International Performance Scale-Revised, which provided a nonverbal Brief IQ, as well as standardized language assessment and behavioral checklists. Children were included in this analysis if they had received an early developmental assessment with the Gesell Developmental Schedules-Revised as part of a clinical visit with a developmental pediatrician. Correlation coefficients and multiple regression analysis were used to associate the scores on the Gesell (using a developmental quotient) with scores on the Leiter-R Brief IQ.ResultsForty-five participants who enrolled in the observational study had available evaluation results from the Gesell and complete Brief IQ results from the Leiter-R. The adaptive domain of the Gesell had good correlation (r = 0.61, p < 0.0001) with the Brief IQ on the Leiter-R. Children who had stable developmental or intelligence classifications based on scores (<70, 70 to <85, 85 to <100, ≥100) over time were older (>24 months) at the early Gesell assessment. Degree of hearing loss or maternal education did not appear to confound the relationship between the Gesell and the Leiter-R.ConclusionsThe adaptive domain of the Gesell Developmental Schedules – Revised administered in early childhood (under 3 years of age) has good correlation with the nonverbal Brief IQ on the Leiter International Performance Scale-R. Because children who are DHH have a higher likelihood of having a developmental disability compared to the general population, early developmental assessments are often important. Although early developmental assessments have their limitations, our results indicate that they are fairly robust indicators of later development. Such early indicators can be extremely useful in the clinical and educational management of children who are DHH.
http://ift.tt/2fFXDmP
A mini-survey of moulds and mycotoxins in locally grown and imported wheat grains in Nigeria
Abstract
A preliminary survey involving limited sample size was conducted to determine the spectrum of moulds and mycotoxins in wheat grains from flour mills and local markets in Nigeria. Fourteen wheat samples were analyzed for moulds using standard mycological methods and for toxic fungal metabolites using a liquid chromatography-tandem mass spectrometric method. Fusarium (range of incidence 12.5–61.7%) dominated in the wheat grains though species of Aspergillus (range of incidence 2.24–3.86%) were also recovered from the samples. The identified fungal species were Aspergillus flavus (7.7%), Aspergillus niger clade (2.6%), Fusarium avenaceum (10.9%), Fusarium culmorum (22.4%) and Fusarium graminearum (56.4%). A total of 54 microbial metabolites were detected in the samples at concentration ranging between 0.01 μg/kg for macrosporin and 2560 μg/kg for deoxynivalenol. Among the four mycotoxins addressed by regulations in the European Union (EU) found in the samples, deoxynivalenol (incidence 100%) dominated in the samples and its levels exceeded the maximum acceptable EU limit (750 μg/kg) in 36% of the samples. This report underscores the need for more robust surveys with larger sample sizes and across several agro-ecologies in the country.
http://ift.tt/2gHE90x
Under-Treatment of Patients with Moderate to Severe Psoriasis in the United States: Analysis of Medication Usage with Health Plan Data
Abstract
Introduction
Psoriasis is a chronic inflammatory disorder with significant morbidity and mortality, but a persistent gap appears to exist for the adequate treatment of patients with moderate to severe disease. As the extent of under-treatment is unknown, we attempted to determine overall treatment patterns and estimate under-treatment using a large database.
Methods
Data from the US National Health and Wellness Survey was used to estimate the proportion of patients with mild, moderate or severe psoriasis. The proportion with moderate to severe disease was estimated by excluding those with mild disease, and projecting this to the total insured US population, weighted by age and gender. Using US health plan claims data, patient totals by treatment type were determined between October 1, 2007 and September 30, 2012. Patients had to be continuously enrolled in a health plan and be ≥18 years at the end of the analysis window. Psoriasis was confirmed if patients had at least one claim of any type of psoriasis except psoriatic arthropathy (ICD-9 code 696.1). A monthly treatment history, classified by biologic, traditional oral systemic, phototherapy and topical therapy, was recorded for each patient.
Results
There were an estimated 1.7 million insured US patients with moderate to severe psoriasis. Of these, 1 million (59%) were not treated for their condition in the preceding year. Among 695,488 patients who were treated for psoriasis in the preceding year, 346,201 were currently receiving treatment and 349,287 had lapsed treatment. Of the patients lapsed and currently treated in this period, the numbers who received each treatment type were 156,409 (biologic), 222,657 (traditional oral systemic), 22,911 (phototherapy), and 293,511 (topical). A limitation of the study was that only insurance claims were analyzed.
Conclusion
Moderate to severe psoriasis remains persistently untreated or under-treated. We suggest that potential barriers preventing access to care be explored.
Funding
This study was sponsored by Pfizer Inc.
http://ift.tt/2gJFz8n
Fixed-Combination Gels of Adapalene and Benzoyl Peroxide Provide Optimal Percutaneous Absorption Compared to Monad Formulations of These Compounds: Results from Two In Vitro Studies
Abstract
Introduction
Adapalene 0.1%/benzoyl peroxide 2.5% (0.1% A/BPO) and adapalene 0.3%/BPO 2.5% (0.3% A/BPO) gels are fixed-combination options for the topical treatment of acne. However, the active compounds of these combinations are also available as monads, to be used in association or as monotherapy. These two in vitro studies determined the effect of different treatment regimens on the percutaneous absorption of adapalene (0.1% and 0.3%) gels and BPO 2.5% gel in ex vivo human skin.
Methods
In vitro percutaneous absorption studies were conducted using full-thickness human skin from six donors. Treatment regimens included the application of 0.1% A/BPO, 0.3% A/BPO, or four free-combination regimens of the monads. Skin samples were incubated for 24 h. Concentrations of adapalene and BPO equivalent (BPO-eq) (i.e. benzoic acid after chemical transformation of BPO) were measured using high-performance liquid chromatography. Comparison of regimens was performed using a bioequivalence criterion (estimated ratio bewteen 0.8 and 1.25).
Results
The fixed combination 0.3% A/BPO regimen demonstrated more than three times higher absorption of adapalene versus the fixed-combination 0.1% A/BPO. Based on the bioequivalence acceptance criterion, all four free-combination regimens were different from 0.1% A/BPO and 0.3% A/BPO, with higher adapalene release delivered by the fixed combinations versus the free combinations. For BPO-eq, the results showed that the free-combination regimens where adapalene 0.1% was applied first were different from 0.1% A/BPO, with lower BPO-eq release delivered by these regimens compared to the fixed combination. The regimen adapalene 0.3% for 10 h followed by BPO 2.5% delivered lower BPO-eq release compared to the fixed combination.
Conclusion
The fixed-combination A/BPO gels provide optimal percutaneous absorption of the active compounds compared to free combinations of adapalene 0.1%, adapalene 0.3%, and BPO 2.5%. The higher concentration of adapalene in the 0.3% A/BPO gel and the resulting higher absorption may explain higher clinical efficacy.
http://ift.tt/2gWeaTJ
Komplementäre Medizin und Prävention
Zusammenfassung
Hintergrund
Die Auswirkungen von Lebensstilfaktoren wie körperliche Aktivität und Ernährung auf Entstehung und Verlauf von Krebs ist seit über 60 Jahren Gegenstand klinischer und epidemiologischer Forschung. Obwohl viele Fragen noch offen bleiben, ermöglichen aktuelle Studien evidenzbasierte Empfehlungen für die primäre und tertiäre Krebsprävention.
Methoden
Im Rahmen einer Literaturrecherche wurden Übersichtsarbeiten zum Einfluss von körperlicher Aktivität und Ernährung auf Krebs sowie Studien zu aktuellen Entwicklungen in diesen Themengebieten identifiziert.
Ergebnisse
Körperliche Aktivität trägt zur primären Prävention von Kolonkarzinomen, postmenopausalem Brustkrebs und Endometriumkarzinomen bei. Der vermehrte Verzehr von rotem Fleisch und verarbeiteten Fleischprodukten ist mit einer Erhöhung des Krebsrisikos assoziiert. Eine obst-, gemüse- und ballaststoffreiche Ernährung hängt demgegenüber mit einer Senkung des Krebsrisikos zusammen. Körperliche Aktivität kann während jeder Therapiephase unter Berücksichtigung der individuellen Probleme durchgeführt werden. Studienergebnisse berichten von verbesserter Leistungsfähigkeit und Lebensqualität, einer Verminderung von therapieassoziierten Nebenwirkungen sowie Senkung des Rezidivrisikos durch eine körperliche Aktivität.
Schlussfolgerungen
Evidenzbasierte Empfehlungen zur Krebsprävention durch körperliche Aktivität und Ernährung sollen in die Behandlung von onkologischen Patienten und in die Versorgung der Allgemeinbevölkerung integriert werden. Innovative Programme wie „Jetzt aktiv!", die kompetente Beratung bezüglich Ernährung und körperlicher Aktivität nach einer Krebserkrankung anbieten, werden an Krebsberatungsstellen entwickelt und erfolgreich eingesetzt.
http://ift.tt/2gLcDf8
Körperliche Beschwerden und psychosoziale Belastungen bei Endometriumkarzinom
Zusammenfassung
Hintergrund
Das Endometriumkarzinom ist in Deutschland die vierhäufigste gynäkologische Tumorerkrankung. Dank der Früherkennung sowie verbesserter medizinischer Therapien liegt das Fünfjahresüberleben für die betroffenen Patientinnen bei 74–91 %. Bei sinkender Mortalität und steigender chronischer Morbidität steigt auch die Zahl der Patientinnen, die an Überlebenszeit gewinnen.
Ziele und Fragestellungen
Ziel dieses Artikels ist es, körperliche und psychische Belastungsfaktoren bei Patientinnen mit Endometriumkarzinom zu benennen und Unterstützungsbedürfnisse aufzuzeigen.
Ergebnisse
Bei der Einschätzung des subjektiven Bedarfs an psychosozialer Beratung, Begleitung oder Behandlung korrelieren der körperliche Zustand und das subjektive Befinden der betroffenen Frauen kaum. Potenziell belastende Kontextfaktoren sollten im Arzt-Patienten-Gespräch aktiv erfragt werden. Zu allen Zeitpunkten im individuellen Krankheits- und Behandlungsverlauf können psychosoziale Belastungen bei Patientinnen, ihren Partnern und Angehörigen auftreten. Ein erleichterter Zugang zu psychoonkologischen/psychosozialen Versorgungsangeboten sollte über alle Behandlungs- und Nachsorgezeiträume bereitgestellt werden. Die Art der Behandlung beeinflusst die Lebensqualität der Betroffenen. Frauen in höherem Lebensalter leiden eher an somatischen Funktionsstörungen, jüngere dagegen häufiger unter psychosozialen Belastungen. Die spezifischen körperlichen Beschwerden umfassen postoperative Schmerzen, Dysurie, Harn- und Stuhlinkontinenz, Scheidentrockenheit und Dyspareunie. Klimakterische Beschwerden treten häufig auf. Im Langzeitverlauf kommen behandlungsbedürftige psychische Belastungen wie Ängste, Anpassungsstörungen und Depressionen hinzu.
Schlussfolgerungen
Je selbstverständlicher und offener mögliche Probleme, z. B. Therapiefolgen, im Arzt-Patienten-Gespräch vom Arzt oder Behandlerteam proaktiv angesprochen werden, desto leichter wird es für die Patientinnen, ihre Schwierigkeiten oder Ängste zu verbalisieren. Dies ist gerade bei gynäkologischen Tumorerkrankungen mit ihren spezifischen Therapiefolgen, die sich unmittelbar auf Körperbild und -erleben sowie Intimität und Sexualität der Betroffenen auswirken, von großer Bedeutung.
http://ift.tt/2fEIxxR
Analysis of feline and canine allergen components in patients sensitized to pets
Component resolved allergen diagnosis allows for a precise evaluation of the sensitization profiles of patients sensitized to felines and canines. An accurate interpretation of these results allows better insi...
http://ift.tt/2fRMDkw
Factors associated to post-operative nausea and vomiting following oral and maxillofacial surgery: a prospective study
Abstract
Aim
This study aims to address and assess possible factors associated with nausea and vomiting (NV) following oral and maxillofacial surgery.
Material and methods
A prospective study was carried out in the period from December 2013 to January 2016 targeting all attended cases in that period. For statistical analysis, Pearson chi-square and Fisher tests were used to verify association and ANOVA and Student's t tests to test for significant difference, p was defined as ≤0.05. The sample group consisted of 207 patients with an average age of 33.56 years (±13.23), and 70.5% of subjects were male.
Results
Calculations based on the predictive model showed that a female patient with prior history of nausea and vomiting who used opioids and had intra-oral surgical access would have a 96% chance of experiencing a nausea and vomiting episode.
Other factors like age, being overweight, anesthesia, surgery duration, and duration of hospital stay also contribute so that these aspects must be paid careful attention prior to surgery to ensure a suitably orientated treatment that will avoid disturbances caused by post-operative nausea and vomiting.
Conclusion
The occurrence of post-operative nausea and vomiting after oral and maxillofacial surgery was found to be more higher incidence associated to female patients who used opioids, who had a prior history of NV, whose surgery involved intra-oral access, who were in the second or third decades of their lives, who have above average weight, and who have long anesthesia when undergoing surgery, resulting in a long hospital stays.
http://ift.tt/2gL5Fa3
Botulinum Toxin Type A Block of the Sphenopalatine Ganglion in Chronic Rhinosinusitis With Nasal Polyposis
Conditions: Chronic Disease; Nasal Polyposis; Rhinitis
Intervention: Drug: botox injection Multiguide
Sponsors: Norwegian University of Science and Technology; St. Olavs Hospital
Recruiting - verified November 2016
http://ift.tt/2gy9tw6
Intervention: Drug: botox injection Multiguide
Sponsors: Norwegian University of Science and Technology; St. Olavs Hospital
Recruiting - verified November 2016
http://ift.tt/2gy9tw6
Adrenal Cushing syndrome with detectable ACTH from an unexpected source
Mixed corticomedullary adrenal tumours (MCMT) are rare. We describe the second reported case of a male patient presenting with hypertension and Cushing syndrome with MCMT. A man aged 48 years presented with hypertension and signs of Cushing syndrome. 24-hour urine cortisol was elevated, with detectable adrenocorticotropic hormone (ACTH). A high-dose dexamethasone suppression test indicated an adrenal or ectopic Cushing syndrome. Plasma metanephrines were normal. A 3 cm left adrenal mass was identified without potential ectopic sources of ACTH on imaging. After induction of anaesthesia for laparoscopic adrenalectomy, the patient developed resistant hypertension with stress-dose hydrocortisone administration. Surgery was cancelled and repeat testing revealed elevated plasma metanephrines. α-Blockade was administered for a presumed coexisting pheochromocytoma, and the patient underwent adrenalectomy. Pathology revealed an MCMT. This case highlights the importance of a thorough biochemical evaluation in patients with adrenal masses to rule out multiple hormone producing tumours.
http://ift.tt/2gGnVou
Medium-chain acyl-Coenzyme A dehydrogenase deficiency (MCADD): a cause of severe hypoglycaemia in an apparently well child
Medium-chain acyl-Coenzyme A dehydrogenase deficiency (MCADD) is a disorder of fatty acid β oxidation inherited in an autosomal recessive manner. The enzyme is useful in hepatic ketogenesis, a major source of energy once hepatic glycogen stores become depleted during prolonged fasting. It is a cause of hypoketotic hypoglycaemia in a previously well child. MCADD is not part of newborn screening in Ireland; children are likely to be missed if routine hypoglycaemic screen is not instituted when blood glucose level is below 2.6 mmol/L. This is a case of an otherwise healthy 23-month-old baby girl who presented with severe hypoglycaemia with some initial diagnostic dilemma.
http://ift.tt/2fLBNJL
First reported case of peroneal tenosynovitis caused by Coccidioides immitis successfully treated with fluconazole
Coccidioidomycosis is an insidious infection caused by Coccidioides spp (C. immitis and C. posadasii). Disseminated disease occasionally involves tendon sheaths and synovium of the joints leading to tenosynovitis. Here, we describe the case of a 72-year-old woman from southern Arizona, who presented with right ankle pain, redness and swelling for 2 months. Her serum IgG was positive for C. immitis on complement fixation, and her MRI of the right ankle joint showed extensive tenosynovitis of the right peroneal tendons, and subtalar joint effusions with associated synovitis. The purpose of this case is to report an extremely rare manifestation of disseminated C. immitis, that is, peroneal tenosynovitis and challenges involved with diagnosis and treatment. We also document that azole therapy is an effective treatment option for peroneal tenosynovitis caused by C. immitis, and we had to double the dose for slow symptom resolution with 4-week trial with usual 400 mg oral dose of fluconazole.
http://ift.tt/2gGgoGn
Acute promyelocytic leukaemia: looking through 'gums
Description
Examination of the oral cavity provides valuable clues to a large number of systemic disorders. Gum hypertrophy is usually associated with myelomonocytic and monocytic subtypes of acute myeloid leukaemia.1 Its occurrence in a case of acute promyelocytic leukaemia (APL) is unusual.1
We describe a 28-year-old man from India who presented to our hospital with a 2-week history of easy fatiguability and gum bleeding. Examination revealed pallor and marked gum hypertrophy (figure 1). Blood investigations showed haemoglobin 50 g/L, white cell count 5.4x109/L, differential counts 95% promyelocytes, 3% myelocytes, 1% metamyelocytes and 1% neutrophils, platelets 30x109/L, prothrombin time 18 s (control 14 s), activated partial thromboplastin time 42 s (control 34–36 s) and fibrinogen 1.5 g/L (2–4 g/L). Examination of the bone marrow aspirate smears revealed typical Faggot cells (figure 2A, B). Conventional karyotyping revealed t(15;17). PML-RARα was detected in the bone marrow aspirate by reverse...
http://ift.tt/2fLIQ4W
Course of membranous nephropathy during multiple gestations
Description
The physiological adaptations in pregnancy can unmask underlying occult proteinuric renal disease. However, the effect of multiple pregnancies on the course of the disease is variable. We report the clinical course of a case of idiopathic membranous nephropathy through multiple pregnancies.
A 25-year-old Hispanic woman was referred to our institution for worsening generalised swelling of the body, uncontrolled hypertension and 21 g/day of proteinuria at 34 weeks' gestation during her third pregnancy. There were no stigmata suggestive of HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) syndrome. She was previously seen at our institution 5 years ago during her 1st pregnancy when 13 g/day of proteinuria was recorded at 25 weeks of gestation. At that time, she was treated with oral steroids and delivery was induced at 35 weeks due to intrauterine growth restriction. Placental biopsy revealed focal, tightly adherent blood clot, consistent with possible abruption. Renal biopsy performed in the postpartum period...
http://ift.tt/2gGepSe
Early severe coronary artery disease and aortic coarctation in a child with familial hypercholesterolaemia
An 11-year-old boy presented with easy fatigability, multiple xanthomas, and absent pedal pulsations. Laboratory workup showed severe hypercholesterolaemia and non-invasive imaging revealed 'normally functioning' bicuspid aortic valve and tight aortic coarctation. Coronary angiography showed severe right coronary artery (RCA) stenosis. Medical treatment resulted in significant improvement of dyslipidaemia. We successfully performed balloon dilation and stenting of his coarctation, as well as percutaneous coronary intervention for RCA lesion.
http://ift.tt/2gGeDsG
Effect of an early supervised rehabilitation programme compared with home-based exercise after temporomandibular joint condylar discopexy: a randomized controlled trial
Publication date: Available online 29 November 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): N. Capan, S. Esmaeilzadeh, A. Karan, D. Dıracoglu, U. Emekli, A. Yıldız, A. Baskent, C. Aksoy
The goal of rehabilitation after temporomandibular joint (TMJ) surgery is to achieve a normal range of motion. The aim of this study was to compare the impact of a comprehensive and early supervised rehabilitation programme with home-based exercise after TMJ condylar discopexy. Patients diagnosed with disc displacement without reduction were randomized to the study and control groups. After baseline assessments, the same surgical condylar discopexy procedure was applied to both groups. Following surgery, the study group patients underwent a supervised exercise programme conducted by a physiotherapist in the outpatient clinic. This comprised 30-min sessions 3 days per week for 8 weeks in the hospital. The control group patients performed the same exercise programme at home. Maximum mouth opening (MMO), protrusion, and right and left lateral movements were measured. Based on the results, the supervised rehabilitation programme yielded significantly better outcomes for pain at rest and with activity, MMO, and protrusion compared with the home-based exercise programme. Also certain parameters of quality of life improved significantly in the study group. In conclusion, exercise therapy is the cornerstone of rehabilitation of the TMJ, and a supervised rehabilitation programme after TMJ surgery is effective in improving functional parameters.
http://ift.tt/2gKfsx9
To the Editor: Combined immunodeficiency and hypoglycemia associated with mutations in hypoxia up-regulated 1
Source:Journal of Allergy and Clinical Immunology
Author(s): Emma M. Haapaniemi, Christopher L. Fogarty, Salla Keskitalo, Shintaro Katayama, Helena Vihinen, Mette Ilander, Satu Mustjoki, Kaarel Krjutškov, Markku Lehto, Timo Hautala, Ove Eriksson, Eija Jokitalo, Vidya Velagapudi, Markku Varjosalo, Mikko Seppänen, Juha Kere
Teaser
We describe recessive mutations in hypoxia up-regulated 1 (HYOU1) in a patient that presented with generalized susceptibility to bacterial and herpetic infections as well as hypoglycemic episodes.http://ift.tt/2fQXWJZ
Effect of bradykinin receptor antagonism on ACE inhibitor-associated angioedema
Source:Journal of Allergy and Clinical Immunology
Author(s): Brittany T. Straka, Claudia E. Ramirez, James B. Byrd, Elizabeth Stone, Alencia Woodard-Grice, Hui Nian, Chang Yu, Aleena Banerji, Nancy J. Brown
BackgroundThe B2 receptor antagonist icatibant is approved for treatment of attacks of hereditary angioedema. Icatibant has been reported to decrease time-to-resolution of angiotensin-converting enzyme (ACE) inhibitor-associated angioedema in one study of European patients.MethodsPatients with ACE inhibitor-associated angioedema (defined as swelling of lips, tongue, pharynx or face during ACE inhibitor use and no swelling in the absence of ACE inhibitor use) were enrolled at Vanderbilt University Medical Center from October 2007 through September 2015 and at Massachusetts General Hospital in 2012. C1 inhibitor deficiency and patients with bowel edema only were excluded. Patients were randomized within six hours of presentation to subcutaneous icatibant 30 mg or placebo at zero and six hours later. Patients assessed severity of swelling using a visual analog scale serially following study drug administration or until discharge.ResultsThirty-three patients were randomized and 31 received treatment, with 13 receiving icatibant and 18 receiving placebo. One patient randomized to icatibant did not complete the visual analog scale and was excluded from analyses. Two-thirds of patients were African American and two-thirds were women. Time-to-resolution of symptoms was similar in placebo and icatibant treatment groups (p=0.19 for the primary symptom and p>0.16 for individual symptoms of face, lip, tongue, or eyelid swelling). Frequency of administration of H1 and H2 blockers, corticosteroids, and epinephrine was similar in the two treatment groups. Time-to-resolution of symptoms was similar in black and white patients.ConclusionsThis study does not support clinical efficacy of a bradykinin B2 receptor antagonist in ACE inhibitor-associated angioedema.
Teaser
This randomized, placebo-controlled double-blind study does not shown any benefit of administration of the bradykinin B2 receptor antagonist icatibant in patients presenting with angiotensin-converting enzyme inhibitor-associated angioedema. This contrasts studies in hereditary angioedema.http://ift.tt/2gxGf0o
An mTORC1/AKT1/Cathepsin H axis controls filaggrin expression and processing in skin, a novel mechanism for skin barrier disruption in Atopic Dermatitis
Publication date: Available online 29 November 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Aishath S. Naeem, Cristina Tommasi, Christian Cole, Stuart J. Brown, Yanan Zhu, Benjamin Way, Saffron AG. Willis Owen, Miriam Moffatt, William O. Cookson, John I. Harper, Di WL, Sara J. Brown, Thomas Reinheckel, Ryan F.L. O'Shaughnessy
BackgroundFilaggrin, encoded by the FLG gene, is an important component of the skin's barrier to the external environment and genetic defects in FLG strongly associate with Atopic Dermatitis (AD). However, not all AD patients have FLG mutations.ObjectiveWe hypothesised that these patients may possess other defects in filaggrin expression and processing, contributing to barrier disruption and AD, and therefore present novel therapeutic targets for this disease.ResultsWe describe the relationship between the mTORC1 protein subunit RAPTOR, the serine/threonine kinase AKT1 and the protease cathepsin H, for which we establish a role in filaggrin expression and processing. Increased RAPTOR levels correlated with decreased filaggrin expression in AD. In keratinocyte cell culture, RAPTOR up-regulation or AKT1 shRNA knockdown reduced the expression of the protease cathepsin H. Skin of cathepsin H-deficient mice and CTSH shRNA knockdown keratinocytes showed reduced filaggrin processing and the mouse showed both impaired skin barrier function and a mild proinflammatory phenotype.ConclusionOur findings highlight a novel, potentially treatable, signalling axis controlling filaggrin expression and processing which is defective in AD.
Graphical abstract
Teaser
Capsule:FLG mutations strongly associate with Atopic Dermatitis (AD). However, not all AD patients have FLG mutations. An mTORC/AKT1 signalling axis controls both filaggrin expression and processing by controlling expression of the protease Cathepsin H.http://ift.tt/2gxGwAe
Oral Immunotherapy–Induced Gastrointestinal Symptoms and Peripheral Blood Eosinophil Responses
Source:Journal of Allergy and Clinical Immunology
Author(s): Michael R. Goldberg, Arnon Elizur, Liat Nachshon, Michael Y. Appel, Michael B. Levy, Keren Golobov, Robert Goldberg, Miguel Stein, Marc E. Rothenberg, Yitzhak Katz
Teaser
Capsule Summary: Oral immunotherapy-induced gastrointestinal and eosinophilic responses (OITIGER) is an adverse response to OIT in ∼8% of patients and is typically reversible by decreasing dosage administration. The peripheral blood eosinophil count serves as a biomarker marker for susceptibility and the medical course.http://ift.tt/2gxKOrh
Effects of nongenetic factors on immune cell dynamics in early childhood: The Generation R Study
Publication date: Available online 29 November 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Diana van den Heuvel, Michelle A.E. Jansen, Kazem Nasserinejad, Willem A. Dik, Ellen G. van Lochem, Liesbeth E. Bakker-Jonges, Halima Bouallouch-Charif, Vincent W.V. Jaddoe, Herbert Hooijkaas, Jacques J.M. van Dongen, Henriëtte A. Moll, Menno C. van Zelm
Background. Numbers of blood leukocyte subsets are highly dynamic in childhood and differ greatly between individuals. Inter-individual variation is only partly accounted for by genetic factors.ObjectiveDetermine which nongenetic factors affect the dynamics of innate leukocytes, and naive and memory lymphocyte subsets.Methods. We performed six-color flow cytometry and linear mixed effect modeling to define the dynamics of 62 leukocyte subsets from birth to 6 years of age in 1,182 children with one to five measurements per individual. Subsequently, we defined the impact of prenatal maternal lifestyle-related or immune-mediated determinants, birth characteristics and bacterial/viral exposure-related determinants on leukocyte subset dynamics.Results. Functionally similar leukocyte populations were grouped by unbiased hierarchical clustering of patterns of age-related leukocyte dynamics. Innate leukocyte numbers were high at birth and were predominantly affected by maternal low education level. Naive lymphocytes peaked around 1 year, while most memory lymphocyte subsets more gradually increased during the first 4 years of life. Dynamics of CD4+ T cells were predominantly associated with gender, birth characteristics, and persistent infections with cytomegalovirus (CMV) or Epstein Barr virus (EBV). CD8+ T cells were predominantly associated with CMV and EBV infections, and TCRγδ+ T cells with premature rupture of membranes and CMV infection. B-cell subsets were predominantly associated with gender, breastfeeding and Helicobacter pylori carriership.Conclusions. Our study identifies specific dynamic patterns of leukocyte subset numbers, as well as nongenetic determinants that affect these patterns, thereby providing new insights into the shaping of the childhood immune system.
Graphical abstract
Teaser
Capsule Summary: Human inter-individual immunological diversity can only partly be explained by genetic factors, indicating an important contribution of nongenetic factors. We here analyzed leukocyte dynamics in 1,182 children of the Generation R Study and determined the effect of 26 nongenetic factors on inter-individual immunological diversity.http://ift.tt/2fR7952
Predictive factors and treatment outcome of laryngeal carcinoma recurrence
Abstract
Background
Up to 30% of patients with laryngeal squamous cell carcinoma (SCC) present with recurrence after treatment. We analyzed factors associated with the risk of cancer recurrence and prognosis after recurrence.
Methods
A nationwide laryngeal SCC cohort from Finnish university hospitals during 2001 to 2005 with initial successful therapy (n = 316) was analyzed.
Results
Laryngeal SCC recurred in 22% of patients. The median time to recurrence was 9 months, with 90% occurring within 36 months after treatment. The World Health Organization (WHO) performance status >0, neck metastasis at presentation, and nonsurgical treatment were independent prognostic factors for recurrence. Patients with local recurrence had a 5-year overall survival (OS) of 53% compared with 5% in patients with regional/distant recurrences. OS for glottic and nonglottic laryngeal SCC recurrence was 45% and 0%, respectively.
Conclusion
The type of treatment affected the risk of recurrence in this retrospective series. Local recurrences carried a chance for successful salvage treatment. Routine follow-up beyond 36 months remains controversial. © 2016 Wiley Periodicals, Inc. Head Neck, 2016
http://ift.tt/2gJLucE
Rhinosporidiosis: A Rare Cause of Proptosis and an Imaging Dilemma for Sinonasal Masses
Background. Rhinosporidiosis is a common disease entity in tropical countries; however, it can be encountered in other parts of the world as well due to increasing medical tourism. It may mimic other more malignant and vigorous pathologies of the involved part. Case Report. We present a case of a 36-year-old male presenting with proptosis due to involvement of nasolacrimal duct which is rare. We will discuss typical CT and MRI features of the disease which were present in the case. Conclusion. For a surgeon and a radiologist, this is a necessary differential to be kept in mind for sinonasal masses. CT and MRI are invaluable investigations. However, FNAC is confirmatory. Both clinical and radiological aspects are required to reach correct diagnosis.
http://ift.tt/2g6dh76
“The Crossroad between Dentistry and Medicine” at ADEE & AMEE
By Prof. Rui Amaral Mendes and Dr. Seema Biswas
In August, taking advantage of having our annual meetings in the same city – the beautiful Barcelona – ADEE (the Association for Dental Education in Europe) and its medical counterpart, AMEE (the Association for Medical Education in Europe), convened efforts to hold a joint scientific and business meeting under the topic of: "The crossroad between Dentistry and Medicine".
More than a mere morning workshop's theme, this is a major trend worldwide and should be regarded as one of the major challenges pending upon two of the major stakeholders as far as Heathcare providing is concerned.
According to the World Health Organization, Interprofessional Education (IPE) is a necessary step in planning a "collaborative practice-ready" health workforce that is better prepared to respond to local and global health needs. A similar opinion is shared by ADEE's American colleagues from ADEA.
Still, the important thing is how we, educators, can use a potentially good idea and put in to good use, ensuring that our students get the best possible training, in line with the most recent FDI definition of oral health, as an "integral part of general health and well-being".
Hence, being, as we are, well-aware and committed to this evolving educational paradigm of Interprofessional Education and Learning and Interprofessional Collaborative Practice (IPCP), one must also consider the prospects of a partnership that makes the best out of each other's know-how, while keeping in mind that the European Directive 2005/36/EC, issued by the European Parliament and by the Council, establishing the EU legal foundations for the recognition of professional qualifications, makes it even more pertinent, not to say imperative, that both ADEE and AMEE join efforts in a combine approach advocating for new European Directives calling for a competencies-based approach for the education of dentists and physicians.
We often forget that according to the World Health Organisation, "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".
Hence, when we think about Dental Education and overall services's provision, we can not help to feel that we are currently at a crossroad: one that demands us to move "outside the box" of our Dental Schools and Dental offices, while engaging with the needs of our communities at home and vulnerable communities across the world.
Education, even at the undergraduate level, and service provision are, therefore, intricately linked. We have to accept that we need to train dentists who are far more than just competent technicians, but rather health professionals responsible for oral health and health in general. Dentists need to get to know their patients and their communities better if they are to provide truly effective care.
There is a need for those involved in Dental Education to take the lead on incorporating global health into the undergraduate dental curriculum and to boost global health in postgraduate practice. The key focus should be to provide better dental care to patients at home, work on improving access (for free or at low cost) for patients at home and to fill the gap where dentists are scarce.
Due to socio-economic, cultural and political reasons, large segments of the world's population have limited or no access to regular dental care. Assisting the development of dental services in these areas should be regarded as a win- win strategy for both the developed and developing world as opportunities for training, practice and research lend themselves to twinning established successful programs at home with programmesfor the world's most vulnerable communities.
It's within this context, that, as we look through the feedback of the ADEE and AMEE meetings and workshops in global health, it becomes clear the enthusiasm for global health across all the medical disciplines. This enthusiasm seems centred on clinical practice: global health in the workplace, renewed focus on ensuring that the most vulnerable of our patients receive the best of clinical care, setting an example in the workplace to trainees who are going the extra mile to ensure that they address ALL the health needs of their patients and moving forward together to address the determinants of health in our undergraduate teaching programmes.
Thus, as ADEE and AMEE discuss the modern teaching agenda, we remind ourselves that global health is comprehensive healthcare and research. At BMJ Case Reports, we have the opportunity to put together the input of authors from across the world and emphasise priorities in addressing health disparities and access to healthcare. We have case reports from Trinidad in the West Indies (link) to Queensland in Australia (link). What is key is not so much the reach across the globe as the fact that authors are clinicians writing about patients they see locally daily.
As clinicians write about global health issues, we encourage students to do this, too. Global health problems cannot be tackled without a strong evidence base. Our cases are hugely valuable for teaching and to assist students as they begin to write. These case are also a powerful tool in bringing about improvements in health and should be used again and again as we advocate for our patients. There is extensive guidance on our website, and, as editors we are always to eager to engage with authors on how to make BMJ Case Reports more accessible to our readers and promote excellence in research and education.
http://ift.tt/2fLgzLT
Laryngeal tumours and radiotherapy dose to the cricopharyngeus are predictive of death from aspiration pneumonia
Source:Oral Oncology, Volume 64
Author(s): Jolyne O'Hare, Julia Maclean, Michal Szczesniak, Rashmi Gupta, Peter Wu, Harry Quon, Ian Cook, Peter Graham
ObjectivesAspiration pneumonia is an under-reported treatment sequelae following radiotherapy for head and neck cancer (HNC) patients. This study aims to investigate its incidence and risk factors in this population.Materials and methodsA retrospective review of all HNC patients that had received radiotherapy or chemo radiotherapy with radical intent at a single institution was undertaken (n=206). Dose delivered to the pharyngeal constrictors, base of tongue and cricopharyngeus was calculated and compared between those patients who had died from aspiration pneumonia and those who are alive or had died from other causes.ResultsIn a cohort of 206 patients, the median time of follow up was 3.5years (IQR 1.8–4.9years). The cause of death was known in 80 and one of the leading causes of non-cancer related mortality was aspiration pneumonia (n=12) equating to an annual incidence of 0.016. Patients with a tumour located in the larynx had a higher risk of death compared to other sites (p=0.005). The mean cricopharyngeal dose was significantly higher in those patients who died of aspiration pneumonia (p=0.023) compared to those who were still alive or had died from other causes. In a multivariate regression analysis, maximum cricopharyngeal dose is a significant predictor of death from aspiration pneumonia.ConclusionDose to the cricopharyngeus and tumours located within the larynx is associated with an increased mortality due to aspiration pneumonia. Clinical awareness of high risk groups and more studies into causative nature are needed.
http://ift.tt/2gHsED1
Three cases of interstitial pneumonia with anti-signal recognition particle antibody
Publication date: Available online 29 November 2016
Source:Allergology International
Author(s): Ryuichi Togawa, Yoshinori Tanino, Takefumi Nikaido, Naoko Fukuhara, Manabu Uematsu, Kenichi Misa, Yuki Sato, Nozomu Matsuda, Yoshihiro Sugiura, Sachiko Namatame, Hiroko Kobayashi, Yasuhito Hamaguchi, Manabu Fujimoto, Masataka Kuwana, Mitsuru Munakata
http://ift.tt/2gUIzBN
Parvovirus B19 infection presenting concurrently as papular–purpuric gloves-and-socks syndrome and bathing-trunk eruption
Summary
Parvovirus B19 infection can cause a wide range of cutaneous manifestations, including papular–purpuric gloves-and-socks syndrome (PPGSS) and petechial bathing trunk eruption. We report a case of an immunocompetent woman with a primary parvovirus B19 infection presenting as concurrent PPGSS and petechial bathing trunk eruption. Parvovirus B19 seroconversion was confirmed several days after the onset of the clinical manifestations. The coexistence of these two cutaneous manifestations of primary parvovirus B19 infection has rarely been reported in the literature. It is important to recognize parvovirus B19 infection early, based on the cutaneous manifestations, to avoid potentially serious systemic complications in susceptible individuals.
http://ift.tt/2gITxWO
Mosaic NRAS Q61R mutation in a child with giant congenital melanocytic naevus, epidermal naevus syndrome and hypophosphataemic rickets
Summary
The association of hypophosphataemic rickets with verrucous epidermal naevus (EN) and elevated fibroblast growth factor 23 levels is known as cutaneous–skeletal hypophosphataemia syndrome (CSHS), and can be caused by somatic activating mutations in RAS genes. We report a unique patient with CSHS associated with giant congenital melanocytic naevus (CMN), neurocutaneous melanosis and EN syndrome, manifesting as facial linear sebaceous naevus, developmental delay and ocular dermoids. An activating mutation Q61R in the NRAS gene was found in affected skin and ocular tissue but not blood, implying that the disparate manifestations are due to a multilineage activating mutation (mosaic RASopathy). We speculate on the apparently rare association of CSHS with CMN compared with EN. We also report the favourable outcome of this patient at the age of 8 years after extensive neonatal curettage of the giant CMN and use of vitamin D and phosphate supplementation.
http://ift.tt/2fC8aPM
The Effect of Implementation of Preoperative and Postoperative Care Elements of a Perioperative Surgical Home Model on Outcomes in Patients Undergoing Hip Arthroplasty or Knee Arthroplasty.
http://ift.tt/2gUwgWn
Donor site morbidity and quality of life after microvascular head and neck reconstruction with free fibula and deep-circumflex iliac artery flaps
Publication date: Available online 30 November 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Christopher Schardt, Angela Schmid, Jens Bodem, Johannes Krisam, Jürgen Hoffmann, Christian Mertens
PurposeBone defects after resective tumor surgeries often require the use of microvascular reanastomized bone grafts for reconstruction. The decision as to which specific flap is most suitable for the particular patient is dependent on various factors. The aspects donor site morbidity and quality of life are rarely taken into account in this connection. The aim of this study was to analyze whether these factors, in the future, should influence the choice of donor site.Material and MethodsIn this study, the donor sites of 46 patients with respect to deep-circumflex iliac artery (DCIA) and fibula flaps were analyzed using subjective and objective parameters. The primary outcome was postoperative pain measured by VAS. Postoperative complication evaluations as well as 2 orthopedic scores were implemented (American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and Harris Hip Score) and the patients' quality of life was assessed using the 36-Item Short Form (SF-36) questionnaire to quantify donor site impairment.ResultsPostoperative pain was rated with a mean value of 42.4 mm (SD 34.8) for the DCIA group and 36.9 mm (SD 37.1) for the fibula group (p=0.617). After a mean period of 13.72 months, pain was rated with a mean value of 15.3 mm (SD 21.7) for DCIA and 13.3 mm (SD 22.6mm) for the fibula (p=0.763). Persistent pain, however, was recorded only in 11.11% of DCIA patients and 5.26% of fibula patients. Furthermore pain intensity was higher in the DCIA group. A changed gait pattern was observed in 59.26% of DCIA patients and 21.05% of fibula patients. DCIA patients required walking aids for walking and stair climbing more often. Looking at the results of the 2 orthopedic scores, fibula patients showed slightly better results. Concerning quality of life, patients after reconstructive surgery with DCIA flaps showed slight better results than patients in the fibula group.ConclusionsTaking the results of this study into account, the outcome in terms of pain, morbidity and quality of life did not show a significant superiority of any donor site.
http://ift.tt/2gHPnjt
Patient-specific Biodegradable Implant in Pediatric Craniofacial Surgery
Publication date: Available online 30 November 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): H. Essig, D. Lindhorst, T. Gander, P. Schumann, D. Könü, S. Altermatt, M. Rücker
Surgical correction of premature fusion of calvarial sutures involving the fronto-orbital region can be challenging due to the demanding three-dimensional (3D) anatomy. If fronto-orbital advancement (FOA) is necessary, surgery is typically performed using resorbable plates and screws that are bent manually intraoperatively. A new approach using individually manufactured resorbable implants (KLS Martin Group, Tuttlingen, Germany) is presented in the current paper. Preoperative CT scan data were processed in iPlan (ver. 3.0.5; Brainlab, Feldkirchen, Germany) to generate a 3D reconstruction. Virtual osteotomies and simulation of the ideal outer contour with reassembled bony segments were performed. Digital planning was transferred with a cutting guide, and an individually manufactured resorbable implant was used for rigid fixation. A resorbable patient-specific implant (Resorb X-PSI) allows precise surgery for FOA in craniosynostosis using a complete digital workflow and should be considered superior to manually bent resorbable plates.
http://ift.tt/2gUyZin
Patient-specific polymethylmethacrylate prostheses for secondary reconstruction of large calvarial defects: A retrospective feasibility study of a new intraoperative moulding device for cranioplasty
Publication date: Available online 30 November 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Manuel Moser, Raphael Schmid, Ralf Schindel, Gerhard Hildebrandt
PurposeThe aim of this study was to review a new template-based technique for intraoperative patient-specific cranioplasty manufacturing (PSCM) with polymethylmethacrylate (PMMA) to cover large calvarial defects.Material and MethodsA polypropylene foil thermoformed on a three-dimensional reprint of the calvarial defect was used as an intraoperative moulding device for PMMA between August 2012 and December 2015. Surgical and radiological data were retrospectively reviewed, and a patient questionnaire was used to assess functional and cosmetic outcome (numeric rating scale, Odom´s criteria).ResultsSeventeen patients (mean age 42.2±14.5 years) received PSCM. Operating time averaged 130±34 min, and the approximate blood loss was 293±185ml. Volumetric analysis revealed a lower implant volume compared to index bone (mean 66.5 vs. 72 cm3, p=0.513), the mean difference in thickness being the lowest in the posterior parietal and pterional (0.4-0.7 mm) and the highest in the anterior-superior frontal area (1.8 mm). Cosmetic satisfaction averaged 9±1.5, with 70.6% of patients judging the overall result as excellent or good and 29.4% as satisfactory. Mean follow-up was 19.5±13.3 months, with an overall complication rate of 17.6%, including 11.8% surgical site infections (SSIs) and one implant removal.ConclusionsIntraoperative PSCM using PMMA moulded on a thermoformed polypropylene foil leads to satisfactory outcomes. It is a safe technique with complication rates comparable but not superior to those of other alloplastic techniques, but the device has considerable production costs.
http://ift.tt/2gUzMzL
Influence of Bone Invasion on Outcomes after Marginal Mandibulectomy in Squamous Cell Carcinoma of the Oral Cavity
Publication date: Available online 30 November 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Ivana Petrovic, Pablo H. Montero, Jocelyn C. Migliacci, Frank L. Palmer, Ian Ganly, Snehal G. Patel, Jatin P. Shah
IntroductionMarginal mandibulectomy (MM) is indicated for oral cavity squamous cell carcinomas (OCSCC) that abut or minimally erode the mandible without gross invasion. Successful implementation of MM is predicated on accurate patient selection and appropriate adjuvant treatment based on well-known host and tumor characteristics. The incidence of microscopically diagnosed bone involvement in MM specimens and its implications on outcomes have however not been reported in large contemporary series.PurposeTo report the incidence of bone involvement and analyze its influence on oncologic outcomes in selected patients who underwent MM in treatment of OCSCC.MethodA retrospective cohort study was performed on a consecutive series of previously untreated patients requiring MM, at a tertiary care cancer center between 1985 and 2012 (n=326). The median age was 64 years and 59% were male. The majority of patients (67%) had a primary tumor of the floor of the mouth or lower alveolus, 80% were clinically staged T1-2, and 31% were clinically N+. Postoperative radiation (PORT) was used in 27% and chemoradiation (POCTRT) in 8% of patients who had microscopic bone invasion. The median follow up period was 55 months and endpoints of interest were local and regional recurrence free (LRFS and RRFS) and disease specific (DSS) survival.ResultsMicroscopic bone invasion was present in 15% of patients. (n=49). . Among these cortical invasion was present in 32, medullary in 13 and it was not specified in 4. Eight patients had microscopic positive bone margins. Positive bone margins were associated with medullary bone involvement (p<0.001), floor of mouth and buccal mucosa primary site (p=0.0), and positive soft tissue margins (p=0.05). LRFS and DSS were similar in patients without versus with bone invasion (62.8% vs 79.7% and 76.2% vs 66% respectively, p=NS). LRFS were similar in patients with microscopic positive versus negative bone margins, as long as postoperative adjuvant treatment was administered.ConclusionMicroscopic bone involvement does not adversely influence outcomes but medullary bone involvement does confer a higher risk of positive bone margins. MM and appropriate adjuvant treatment is an effective strategy for treatment of OCSCC in selected patients with primary tumors adherent to or in proximity to the mandible.
http://ift.tt/2gHRBPD
Improving outcome of trauma patients by implementing patient blood management.
http://ift.tt/2gIzV5d
An update on the various practical applications of the STOP-Bang questionnaire in anesthesia, surgery, and perioperative medicine.
http://ift.tt/2fBUUKS
Abnormal cell-clearance and accumulation of autophagic vesicles in lymphocytes from patients affected with Ataxia-Teleangiectasia
Source:Clinical Immunology
Author(s): Roberta D'Assante, Anna Fusco, Loredana Palamaro, Elena Polishchuk, Roman Polishchuk, Gabriella Bianchino, Vitina Grieco, Maria Rosaria Prencipe, Andrea Ballabio, Claudio Pignata
http://ift.tt/2fBVpoh
Εγγραφή σε:
Αναρτήσεις (Atom)