Publication date: Available online 15 December 2016
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Mohammad Majid Oryadi-Zanjani, Maryam Vahab, Zahra Rahimi, Anis Mayahi
ObjectivesIt is important for clinician such as speech-language pathologists and audiologists to develop more efficient procedures to assess the development of auditory, speech and language skills in children using hearing aid and/or cochlear implant compared to their peers with normal hearing. So, the aim of study was the comparison of the performance of 5-to-7-year-old Persian-language children with and without hearing loss in visual-only, auditory-only, and audiovisual presentation of sentence repetition task.MethodsThe research was administered as a cross-sectional study. The sample size was 92 Persian 5-7 year old children including: 60 with normal hearing and 32 with hearing loss. The children with hearing loss were recruited from Soroush rehabilitation center for Persian-language children with hearing loss in Shiraz, Iran, through consecutive sampling method. All the children had unilateral cochlear implant or bilateral hearing aid. The assessment tool was the Sentence Repetition Test. The study included three computer-based experiments including visual-only, auditory-only, and audiovisual. The scores were compared within and among the three groups through statistical tests in α=0.05.ResultsThe score of sentence repetition task between V-only, A-only, and AV presentation was significantly different in the three groups; in other words, the highest to lowest scores belonged respectively to audiovisual, auditory-only, and visual-only format in the children with normal hearing (P<0.01), cochlear implant (P<0.01), and hearing aid (P<0.01). In addition, there was no significant correlationship between the visual-only and audiovisual sentence repetition scores in all the 5-to-7-year-old children (r = 0.179, n = 92, P = 0.088), but audiovisual sentence repetition scores were found to be strongly correlated with auditory-only scores in all the 5-to-7-year-old children (r = 0.943, n = 92, P = 0.000).ConclusionsAccording to the study's findings, audiovisual integration occurs in the 5-to-7-year-old Persian children using hearing aid or cochlear implant during sentence repetition similar to their peers with normal hearing. Therefore, it is recommended that audiovisual sentence repetition should be used as a clinical criterion for auditory development in Persian-language children with hearing loss.
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Πέμπτη 15 Δεκεμβρίου 2016
Audiovisual Sentence Repetition as a Clinical Criterion for Auditory Development in Persian-Language Children with Hearing Loss
The risk of postoperative bleeding – A (DErmatoSurgical Study Initiative) DESSI-Study
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Supraglottoplasty for Neonatal Laryngomalacia
Kevin and Karla Urrutia were born at term, but as twins they were both underweight – the boy weighing in at 4 pounds 10 ounces and the girl at 4 pounds 15 ounces. "Karla was eating fine after birth, but Kevin had stridor caused by a soft, immature cartilage of the upper larynx that obstructed the airway during inhalation, which made the necessary coordination between breathing and eating very difficult," says their aunt Yamilet Fernandez, MD , who spoke on behalf of the twins' mother Yadira Espindola. "We took him to three different pediatricians, all of whom said he was having trouble eating because he was so tiny."
Zi Yang Jiang, MD
When an upper respiratory infection worsened his condition, the Urrutias took him to Memorial Hermann Memorial City Medical Center, where the pediatric emergency team started an IV and arranged a transfer to Children's Memorial Hermann Hospital in the Texas Medical Center. Fellowship-trained pediatric otolaryngologist Zi Yang Jiang, MD, was called in to evaluate Kevin's airway in February 2016. "We noticed right away that his chin was a little small, and on endoscopic examination we saw that he had laryngomalacia," says Dr. Jiang, an assistant professor in the Department of Otorhinolaryngology-Head and Neck Surgery at UTHealth's McGovern Medical School. "To combat the combination of laryngomalacia, retrognathia and a viral infection, our pediatrics team put him on a CPAP machine to increase pressure in his airway and keep it from collapsing."
A few days later, Dr. Jiang attempted a supraglottoplasty but Kevin's mouth was too small to accommodate the instruments. He recommended waiting a month to give the infant time to grow.
"Kevin was in a cycle of continual worsening," Dr. Jiang says. "He was using so many calories trying to breathe that he was unable to gain weight, which meant that he was not going to outgrow the problem. We wanted him get over the viral infection and grow, and that just takes time."
In total, Kevin, his mother and his aunt spent two months at Children's Memorial Hermann Hospital, where the infant was given supplemental calories through a feeding tube through his nose. "Ultimately we repeated our attempt at a supraglottoplasty, which was successful," Dr. Jiang says. "We released the mucosal band that tethered the vocal cords in order to strengthen the airway. Kevin used a breathing tube immediately after the surgery because of swelling, but after a day and a half the Pediatric Intensive Care team was able to extubate him. We got him off the CPAP and on a nasal cannula, and eventually back to breathing normally without any supplemental oxygen."
Kevin was discharged two weeks after the surgery and returned home with a feeding tube. "After being fed through the tube without a proper meal for so long, he had to relearn how to eat, which took about a month," Dr. Fernandez says. "He's still underweight but breathing and eating well without the feeding tube. He's the loveliest little thing. We're grateful to the staff at the hospital – they were awesome. Dr. Jiang is our savior and we love him for that. We have so much appreciation for what he did for our baby."
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Eight ORL Specialists Named to Top Doctors Lists for 2016
Six members of the Department of Otorhinolaryngology-Head and Neck Surgery have been selected by their peers as Super Doctors® in Texas. Following an extensive independent nomination and research process, the results were published in the June 2016 issue of Texas Monthly magazine.
Martin J. Citardi, MD
Martin J. Citardi, MD , FACS, who specializes in the treatment of complicated sinus and nasal disease and is a core member of the Texas Sinus Institute and Texas Skull Base Physicians, has been named to Super Doctors list for the sixth consecutive year. Dr. Citardi is chief of otorhinolaryngology-head and neck surgery at Memorial Hermann-Texas Medical Center and professor and chair of the Department of Otorhinolaryngology-Head and Neck Surgery at McGovern Medical School. An internationally recognized ear, nose and throat surgeon, he has specialty interests that include difficult-to-treat chronic sinusitis, revision sinus surgery and minimally invasive surgery for tumors of the nose and sinuses.
Ronda Alexander, MD
Ronda E. Alexander, MD , FACS, was named a Super Doctor for the second consecutive year. An assistant professor in the Department of Otorhinolaryngology, Dr. Alexander helped establish the Texas Voice Performance Institute, which she directs. Her clinical interests include evaluation of hoarseness, spasmodic dysphonia, vocal tremor, vocal cord paralysis, extra-esophageal reflux and swallowing disorders. She is specially trained to manage the unique needs of professional voice users. She also has interests in neuromuscular disorders of the head and neck, including tension and migraine headache.
Named to the Super Doctor Rising Stars list for 2016 are Tang Ho, MD , Ron Karni, MD , Amber Luong, MD , PhD, FACS, and Ibrahim "Trey" Alava, MD.
Tang Ho, MD
Dr. Tang Ho is chief of facial plastic and reconstructive surgery and an assistant professor in the Department of Otorhinolaryngology-Head and Neck Surgery. He is double board-certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology-Head and Neck Surgery. His clinical interests include aesthetic and reconstructive surgeries of the face, including facial rejuvenation procedures (facelift, brow lift, Botox® injection, injectable fillers), rhinoplasty, facial reanimation procedures for patients with facial paralysis, reconstructive surgery of skin cancer defects, and complex microvascular facial reconstruction.
Ron Karni, MD
Dr. Ron Karni, who specializes in transoral robotic surgery (TORS) and thyroid/parathyroid surgery, is chief of the division of Head and Neck Surgical Oncology and an associate professor in the Department. His practice focuses on the management of benign and malignant tumors of the head and neck, including throat cancer, oral cancer, larynx cancer, locally advanced skin cancer, salivary gland tumors and thyroid/parathyroid disease. He also leads a multidisciplinary ultrasound-guided fine needle aspiration clinic for thyroid nodules and neck masses, as well as a survivorship clinic for head and neck cancer patients.
Amber Luong, MD, PhD
Dr. Amber Luong is an associate professor and research director in the Department and also directs a laboratory at the Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases. Her primary research interest focuses on understanding the role of the innate immune response in the pathophysiology of chronic rhinosinusitis, with a particular interest in the role of environmental fungi in initiating these innate immune responses. Dr. Luong's clinical interest parallels her research interest in allergic fungal rhinosinusitis as well as the medical and surgical management of refractory chronic rhinosinusitis, sinonasal tumors, CSF leak repairs, and endoscopic orbital and dacryocystorhinostomy surgery.
Dr. Alava, Dr. Citardi, Dr. Ho, and Dr. Karni were also named to Houstonia magazine's 2016 listing of Top Doctors in Houston. Joining them on the list for the second consecutive year are Soham Roy, MD , FACS, FAAP, and Sancak Yuksel, MD MD . Physicians named to the 2016 list were selected based on nominations solicited from nearly 16,000 medical professionals practicing in eight counties in the Greater Houston area.
Soham Roy, MD
Dr. Soham Roy serves as director of pediatric otolaryngology at Children's Memorial Hermann Hospital and is a professor of otorhinolaryngology at McGovern Medical School. An internationally renowned speaker and author, Dr. Roy is a recognized expert in operating room safety issues and serves as a consultant in the development of innovative and safer surgical devices. He has become a recognized thought leader on the subject of operating room fires and lectures around the world about fire prevention during surgery.
Sancak Yuksel, MD
Dr. Sancak Yuksel is an associate professor in the Department of Otorhinolaryngology-Head and Neck Surgery. His clinical interests include pediatric ear diseases, cochlear implantation, newborn and pediatric swallowing and airway problems, and congenital head and neck lesions. He is also an expert in pediatric and adult complex ear and hearing problems and sialendoscopy, minimally invasive endoscopic management of salivary gland stones.
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2016 International Presentations
Martin J. Citardi, MD , FACS
Professor and Chair of Otorhinolaryngology-Head and Neck Surgery
McGovern Medical School at UTHealth
Martin J. Citardi, MD
Dr. Citardi lectured on "Surgical Navigation: Past, Present and Future" and "Endoscopic Management of CSF Rhinorrhea" at the Endoscopic Endonasal Surgery of the Rhinosinus and Cranial Base Course 2016, sponsored by Sun Yat-sen University Otorhinolaryngology Hospital and Institute in Guangzhou, China, March 21-24. In May, he was a prosector and lecturer on "Maximizing Chronic Rhinosinusitis Care with In-office Procedures" and panelist on "In-office Procedures and Balloon Sinuplasty" at the Seventh Singapore Allergy and Rhinology Course/Third SARC FESS Workshop, sponsored by the Singapore Society of Otolaryngology-Head and Neck Surgery and the Singapore Medical Association. The meeting was held in Singapore on May 5-8. In addition, Dr. Citardi was a prosector and lecturer at the 2nd International Symposium on Navigated Sinus and Skull Base Surgery sponsored by Academus Academy Services in Havana, Cuba, June 11-12. He spoke on "An Integrated Approach to Frontal Sinus Surgery" and "Inverted Papilloma."
Tang Ho, MD , M.Sc., FACS
Chief of Facial Plastic and Reconstructive Surgery
Assistant Professor of Otorhinolaryngology-Head and Neck Surgery
McGovern Medical School at UTHealth
Tang Ho, MD
Dr. Ho was a visiting professor at West China Medical Center and Chengdu Osteology Hospital in Chengdu, China, in March 2016, where he conducted workshops and exchanged experiences on reconstruction following head and neck cancer surgery. On behalf of the Department, he hopes to establish future collaborative relationships with the goal of improving the patient experience and outcomes. Dr. Ho is fluent in Mandarin.
Amber Luong, MD , PhD, FACS
Associate Professor and Research Director of Otorhinolaryngology-Head and Neck Surgery
McGovern Medical School at UTHealth
Amber Luong, MD, PhD
Dr. Luong presented invited lectures on four topics at the 2016 Middle East Otolaryngology Annual Conference held May 24-26 in Dubai, United Arab Emirates: "Novel Means of Diagnosing and Treating Allergic and Non-allergic Irritant Rhinitis," "What is Appropriate Medical Therapy for Non-operated CRS," "In-office Rhinology Procedures" and "From Impactful Research to Innovation in CRS." She was also a panelist discussing "Local Treatment: What Works?" at the European Rhinologic Meeting in Stockholm, Sweden, July 3-7.
Soham Roy, MD , FACS, FAAP
Professor and Vice Chair of Otorhinolaryngology-Head and Neck Surgery
McGovern Medical School at UTHealth
Director of Pediatric Otolaryngology
Children's Memorial Hermann Hospital
Soham Roy, MD
Dr. Roy presented an invited lecture entitled "Supraglottoplasty for All Cases of Laryngomalacia? The Debate" and a peer-reviewed abstract on "Coblation for Glottic Webs" at the European Society of Pediatric Otolaryngology, the largest gathering of pediatric otolaryngologists in the world. T he meeting was held June 18-21 in Lisbon, Portugal.
William C. Yao, MD
Assistant Professor of Otorhinolaryngology-Head and Neck Surgery
McGovern Medical School at UTHealth
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ORL Department Announces Faculty Promotions
Soham Roy, MD
In recognition of his exemplary track record of clinical care, teaching and research, Soham Roy, MD, FACS, FAAP, has been promoted from associate professor to professor of otorhinolaryngology-head and neck surgery with tenure. Dr. Roy received his undergraduate degree with highest distinction from Stanford University, received a full scholarship for medical education at Washington University School of Medicine in St. Louis and subsequently completed his residency in otolaryngology at the University of Miami. He went on to complete a fellowship in pediatric otolaryngology at the Children's Hospital of Pittsburgh in 2002 prior to joining the faculty at the University of Miami, where he was named Professor of the Year in 2003. Dr. Roy serves as director of pediatric otolaryngology at Children's Memorial Hermann Hospital. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery and is a fellow of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), the American College of Surgeons and the American Academy of Pediatrics. An internationally recognized speaker and author, Dr. Roy has given hundreds of lectures and published numerous scientific articles, book chapters and national research presentations. He serves on specialty committees and is an annual course instructor at the meeting of the AAO-HNS. He has received multiple awards for teaching, clinical care and original scientific research, and received the Honor Award from the AAO-HNS in 2008 for his contributions in research and teaching. He is a recognized expert in operating room safety issues and serves as a consultant in the development of innovative and safer surgical devices. Dr. Roy has become a recognized thought leader on the subject of operating room fires and lectures around the world about fire prevention during surgery.
Ron Karni, MD
Ron J. Karni, MD, who specializes in transoral robotic surgery (TORS) and thyroid/parathyroid surgery and is chief of the division of Head and Neck Surgical Oncology in the Department of Otorhinolaryngology-Head and Neck Surgery, has been promoted to associate professor. He received his medical degree at Baylor College of Medicine and completed residency training at Washington University School of Medicine in St. Louis. Dr. Karni is the author of publications on the novel treatment of occult primary oropharyngeal cancer (the unknown primary) and practical tools to integrate evidence-based methods into the daily practice of medicine. His current research focus includes de-escalation treatment strategies for throat cancer, morphoproteomic analysis of head and neck cancer, and human papillomavirus-related malignancies of the head and neck. Dr. Karni is co-principal investigator of a CPRIT grant studying new treatments for head and neck lymphedema using near-infrared fluorescent technology. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. Dr. Karni's practice focuses on the management of benign and malignant tumors of the head and neck, including throat cancer, oral cancer, larynx cancer, locally advanced skin cancer, salivary gland tumors and thyroid/parathyroid disease. He also leads a multidisciplinary ultrasound-guided fine needle aspiration clinic for thyroid nodules and neck masses, as well as a survivorship clinic for head and neck cancer patients.
Sancak Yuksel, MD
Sancak Yuksel, MD, has been promoted to associate professor of otorhinolaryngology-head and neck surgery. Dr. Yuksel received his medical degree at the Hacettepe University School of Medicine in Ankara, Turkey. He completed his otorhinolaryngology residency at the Istanbul University Cerrahpasa School of Medicine in Istanbul, Turkey. After residency, he pursued advanced training in head and neck and skull base surgery as a fellow in the same Department. Dr. Yuksel served as a research fellow in the Basic Science Laboratory at Children's Hospital of Pittsburgh and worked in numerous National Institutes of Health-funded projects focused on the middle ear and Eustachian tube pathophysiology. He completed a two-year clinical fellowship in the Department of Pediatric Otolaryngology at Children's Hospital of Pittsburgh and also served as an instructor at the University of Pittsburgh School of Medicine. Dr. Yuksel is a member of the American Academy of Otolaryngology-Head and Neck Surgery. His clinical interests include complex pediatric and adult ear diseases, the Cochlear™ Baha® system and cochlear implantation, complex lateral skull base surgery, sialendoscopy, newborn and pediatric swallowing and airway problems and congenital head and neck lesions
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Dr. Yuksel and Dr. Ho Receive Dean’s Teaching Excellence Awards
The Dean's Teaching Excellence Award is an annual recognition presented to faculty and volunteers for outstanding teaching performance. Those chosen to receive the award have exhibited outstanding teaching, incited intellectual curiosity in their students, engaged them in the learning process, helped them develop lifelong skills or otherwise served with distinction.
"Sharing my knowledge hones my medical skills," Dr. Yuksel says. "I feel privileged to be in a position to make a lasting impact on our residents' careers and the lives of their future patients."
"It's a special pleasure to train residents," Dr. Ho says. "As faculty we are privileged to have the opportunity to teach our residents and learn from them at the same time."
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Resident Wins Award for Research at Houston Society of Otolaryngology Meeting
A CORE research grant from the American Academy of Otolaryngology-Head and Neck Surgery Foundation led to groundbreaking work in the lab, resulting in multiple manuscripts about chronic rhinosinusitis and first prize for the best resident research presentation at the May, 2016 meeting of the Houston Society of Otolaryngology. Recipient of the grant and principal investigator of the study is Matthew Tyler, MD , a fourth-year resident in the Department of Otorhinolaryngology-Head and Neck Surgery at UTHealth's McGovern Medical School. Dr. Tyler won the award for his presentation "Large Scale Gene Expression Profiling Reveals Distinct Patterns in Chronic Rhinosinusitis Subtypes."
"Dr. Tyler was able to capitalize on a very large microarray we have, and in his presentation wove cutting-edge research into a clinical story that resonated with the audience," says Dr. Luong, an associate professor and research director in the Department of Otorhinolaryngology who also directs a laboratory at the Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases. "He had some basic science experience before coming into residency and spent time in my lab doing experiments. His hope is to go into an academic rhinologic practice and he's setting the stage for that."
Each year a selection committee from the Houston Society of Otolaryngology chooses the top three or four research manuscripts submitted by residents from the academic medical community in Houston, which includes McGovern Medical School, Baylor College of Medicine, The University of Texas MD Anderson Cancer Center and The University of Texas Medical Branch at Galveston. Judges select a winner based on research data, scientific merit and presentation style.
The national Centralized Otolaryngology Research Efforts (CORE) grants program is a collaboration of several societies, foundations and industry supporters focused on providing support for research in the field of otolaryngology-head and neck surgery. CORE resident research grants are highly competitive.
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Dr. Byrd Recognized by Memorial Hermann Southeast Hospital for Quality and Patient Safety
The hospital's PIQR Committee, a multidisciplinary group of physicians representing all service lines, meets once or twice a month to evaluate the practice of medical staff members and ensure that all Memorial Hermann quality standards are met. The "good catch" recognition was added to the meeting agenda earlier this year.
"Patient safety has always been a priority for physicians, even before today's emphasis on transparency in outcomes," Dr. Byrd says. "The importance of keeping patients safe has been taught in medical schools for centuries. I'm honored to have been recognized by the PIQR Committee but I also have to say that I was just doing my job."
Dr. Byrd provides general ENT services for adults, adolescents and children at Memorial Hermann Southeast Hospital. He has a subspecialty interest in conditions that contribute to sleep disorders, including common snoring and obstructive sleep apnea.
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Dr. Conderman Elected Houston Society of Otolaryngology Officer
Dr. Conderman received his medical degree at the University of Kansas School of Medicine and was elected to the Alpha Omega Alpha Honor Medical Society. Following graduation, he completed his residency in otolaryngology at the University of California-Irvine Medical Center and a facial plastic and reconstructive surgery fellowship with renowned facial plastic surgeon Russell Kridel, MD , at McGovern Medical School.
Dr. Conderman is the coauthor of chapters on upper-lid blepharoplasty in Synopsis of Aesthetic Dermatology and Cosmetic Surgery, as well as rib-grafting for rhinoplasty in Master Techniques in Otolaryngology Head & Neck Surgery. He recently coauthored a chapter on liposuction of the face and neck in Facial Plastic and Reconstructive Surgery. In addition, he is the coauthor of research published in The Laryngoscope and other peer-reviewed journals. His research interests include clinical outcomes in functional and cosmetic rhinoplasty, correction of secondary defects following trauma reconstruction and analysis of face-lifting techniques.
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Texas Hill Country ENT Symposium Recap
More than 60 physicians participated in the biennial Texas Hill Country ENT Symposium, sponsored by the Department of Otorhinolaryngology-Head and Neck Surgery at UTHealth's McGovern Medical School. The two-day continuing medical education meeting was held last April at the Hyatt Regency Lost Pines Resort and Spa in Lost Pines, Texas.
The CME event focused on new information that can be applied at the point of care in outpatient otolaryngology offices, and new technologies that offer better outcomes, cost savings and convenience as solutions for common otolaryngologic clinic problems. Course content was divided into seven modules: sinus, head and neck, patient experience, facial plastics, sleep, pediatric ENT and general safety.
"This is our most popular continuing medical education meeting," says Martin J. Citardi, MD , FACS, chief of otorhinolaryngology at Memorial Hermann-Texas Medical Center and professor and chair of the Department of Otorhinolaryngology-Head and Neck Surgery at McGovern Medical School. "It's a relaxed meeting in an atmosphere that encourages dialogue. The content is practical and aimed at clinicians. The hotel does a fine job, and April is always a nice time of year in the Texas Hill Country."
Presenters, who are faculty at McGovern Medical School, discussed endoscopic management of ophthalmic conditions, in-office procedures for recurrent nasal polyps, in-office balloon and navigation technology for chronic rhinosinusitis, challenging cases in rhinology, integrating ultrasound into a practice, decision-making in early larynx cancer, HPV-associated cancer, the healthcare quality movement, case studies in facial plastic surgery, treatment options in nasal obstruction, local flaps and grafts, home versus in-lab polysomnography, current trends in management of tonsillectomy/adenoidectomy, evaluation and management of pediatric stridor, otitis media, and mitigating fire risk in the OR.
The next Texas Hill Country ENT Symposium is scheduled for April 2018. Watch for more information at http://ift.tt/2hMWLgI.
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Altered expression of apoptosis-regulating miRNAs in salivary gland tumors suggests their involvement in salivary gland tumorigenesis
Abstract
Salivary gland tumors comprise a heterogeneous group of lesions with different histological features and diverse clinical pathophysiology. They account for about 3% of all head and neck tumors. Apoptosis plays an important role during morphogenesis of glandular structures, including that of the salivary gland. Recent studies have demonstrated that several microRNAs (miRNAs) are involved in the control of apoptosis. The aim of the present study was to determine the expression of apoptosis-related miRNAs (miR-15a, miR-16, miR-17-5p, miR-20a, miR-21, miR-29, and miR-34) and their target mRNAs in 25 pleomorphic adenomas, 23 mucoepidermoid carcinomas, and 10 non-neoplastic salivary gland samples by real-time RT-PCR. We observed upregulation of miR-15a, miR-16, miR-17-5p, miR-21, miR-29, and miR-34a in pleomorphic adenomas. The expression of miR-21 and miR-34a was upregulated in 91 and 74% of mucoepidermoid carcinomas, respectively. Downregulation of miR-20a was observed in 75% of pleomorphic adenomas and in 57% of mucoepidermoid carcinomas. APAF1, BAX, BCL2, BID, CASP2, CASP8, DIABLO , and TP53 transcripts were upregulated in both tumor types. BAD transcripts were upregulated in pleomorphic adenomas. CASP3 and CASP6 transcripts were upregulated in mucoepidermoid carcinomas. BCL2, CASP2, CASP6, and CASP8 proteins were mostly absent in mucoepidermoid carcinomas but expressed in few cells in pleomorphic adenomas. Our study provides evidence of alterations in the expression of apoptosis-regulating miRNAs in salivary gland tumors, suggesting possible involvement of these microRNAs in salivary gland tumorigenesis.
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Measurement and Variation in Estimation of Quality of Life Effects of Patients Undergoing Treatment for Papillary Thyroid Carcinoma
Thyroid , Vol. 0, No. 0.
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Multivariate Analysis of Thyrotropin in Preterm Newborns Based on Adequacy of Weight for Gestational Age
Thyroid , Vol. 0, No. 0.
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Anti-Thyrotropin Autoantibodies in Patients with Macro-Thyrotropin and Long-Term Changes in Macro-Thyrotropin and Serum Thyrotropin Levels
http://ift.tt/2hDeMuD
Cell Cycle M-Phase Genes Are Highly Upregulated in Anaplastic Thyroid Carcinoma
Thyroid , Vol. 0, No. 0.
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Incorrect Numbers at Risk in Figure
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Declining Prevalence of Hearing Loss in US Adults
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Performance of the Gene Expression Classifier in Thyroid Nodules
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Reconstruction of Saddle Nose Deformity in Granulomatosis With Polyangiitis
http://ift.tt/2hz7CKC
Nasal Reconstruction in the Vasculopathic Patient
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Approach to hypersensitivity reactions from intravenous iron preparations
Abstract
Hypersensitivity reactions (HSRs) to intravenous iron preparations (IVIPs) are well known. With newer preparations, HSRs have become rarer; however, severe reactions may still occur. We retrospectively reviewed records of patients evaluated for HSRs to IVIPs, to determine the safety of controlled re-administration (CRA). Allergological workup included a detailed history, skin prick tests (SPTs) with IVIP, and basophil activation tests (BATs) in some patients. CRA with an IVIP was done if indicated. 31 patients with mild to severe reactions were evaluated. SPTs and BATs were negative in all patients tested. 18 CRAs in 15 patients were performed. 12 patients tolerated the procedure, including three with a previous grade IV HSR. Two developed urticaria, one developed urticaria and dyspnea. The pathophysiology of HSRs to IVIPs remains currently unclear. SPTs and BATs provided no additional information. However, in appropriate situations, CRA under surveillance can be safely performed in most patients.
This article is protected by copyright. All rights reserved.
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Effects of potentially functional polymorphisms in suppressor of cytokine signaling 3(SOCS3) on the risk of head and neck squamous cancer
Abstract
Background
Suppressor of cytokine signaling 3 (SOCS3) has been identified as an inhibitor of JAK/STAT pathway that plays a significant role in carcinogenesis. SOCS3 and JAK2 polymorphisms may influence the gene expression or function, contributing to the disease susceptibility; however, such effect has not been evaluated in head and neck squamous cell carcinoma (HNSCC).
Methods
A case-control study was performed to test the associations of SOCS3 and JAK2 polymorphisms with risk of HNSCC in 576 cases and 1552 cancer-free controls from China. Seven potentially functional polymorphisms predicted by bioinformatics tools were genotyped using Infinium BeadChip platform. The association between genotypes and HNSCC risk was estimated by computing odds ratios (ORs) and 95% confidence intervals (CIs) in univariate and multivariate logistic regression models.
Results
We found that rs2280148 located at 3′-untranslated region of SOCS3 was significantly associated with an increased risk of HNSCC (additive model: adjusted OR=1.21, 95% CI=1.03-1.43, P=0.021). Moreover, rs8064821 located in the promoter region of SOCS3 was linked with a decreased risk of the cancer (additive model: adjusted OR=0.83, 95% CI= 0.71-0.97, P=0.022). Combined analysis of these variants by the number of risk alleles showed a significant locus-dosage effect on the risk of HNSCC (Ptrend = 0.006).
Conclusions
We provided the first evidence that SOCS3 polymorphisms may influence the risk of HNSCC, which could be applied as novel biomarkers to identify individuals at high risk of the disease.
This article is protected by copyright. All rights reserved.
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Healing Acceleration of Oral Mucositis Induced by 5-Fluorouracil with Pistacia atlantica (Bene) Essential Oil in Hamsters
Abstract
Background
Oral mucositis is a common debilitating condition in cancer patients receiving cytotoxic therapies. The present study aimed to evaluate the effects of topical administrations of the essential oil extracted from hull of Pistaciaatlanticafruit (Bene) on healing of oral mucositis in golden hamsters.
Methods
Forty hamsters with oral mucositis induced by 5-Fluorouracil administered on days 0, 5 and 10 and buccal mucosal scratching were randomly divided into four equal groups; group 1 received no additional treatment, group 2 received gel base, groups 3 and 4 received gels containing 5 and 10% oilrespectively. From day 12, after blood sampling of all animals, a half randomly-selected fraction of each group (four half groups) received once daily topical administration of either gel type (gel base, 5% and 10%) or no treatment (control subgroup)over the buccal pouches for 3 days and the remaining halves received the same treatments for 6 days. On each final day 15 and 18, the corresponding subgroups underwent consecutively the repeated blood sampling, mucosal clinical examination and excision for histopathology.
Results
Comparisons on macro- and microscopicaloral mucositis scorings demonstrated dose-dependent healing promotion in the subgroups receiving active gels (P< 0.05). The blood samplings revealed the chemotherapy related pancytopenia with no significant difference among all subgroups on either endpoint (P > 0.05).
Conclusions
The healing effect of the Bene oil could mainly be local and attributed to its antioxidants and fatty acid contents present in nonsaponified and saponified fractions respectively.
This article is protected by copyright. All rights reserved.
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Family of Minn. teen who froze to death sues responders
By EMS1 Staff
MINNEAPOLIS — The parents of a college student who froze to death in 2013 filed a federal lawsuit last week, claiming first responders were negligent in providing their son medical care.
Jake Anderson, 19, was found along the Mississippi River December 2013 after celebrating the end of his first year as a freshman, reported the Star Tribune. Responders who found Anderson said he was frozen to death.
His parents, Bill and Kristi Anderson, are suing first responders for failing to pull Anderson from the cold to try and revive him. The suit references several cases where individuals survived subzero temperatures for 12 hours, even though they did not have a pulse and appeared to be dead.
"We assumed everything was done to save him when they found him," Kristi Anderson said. "When they come and tell you at two in the afternoon that your son is dead, you're presupposing that they have taken every measure to save him."
The Andersons are seeking a minimum of $75,000 per individual named in the suit.
According to their attorney, Anderson was found in a hypothermic state face down, slumped over a metal rail; he was mostly likely exposed to zero degree temperatures from 2 a.m. until he was found six to seven hours later.
The lawsuit alleges that fire officials failed to recognize Anderson as a hypothermia victim and declared him dead after evaluating him for no more than 90 seconds. A fire report stated that Anderson had "no pulse and no breathing and was frozen, indicating obvious death." However, fire procedure indicates that victims must be "cold in a warm environment" or have "obvious mortal trauma" before being classified as dead.
"Everybody who lived through hypothermia was found by somebody who cared about them and did something about it," Bill Anderson said.
A most recent case happened a week before Anderson's death, in which college student Alyssa Lommel was found frozen by a passerby; she had been exposed to minus-17 degrees for over nine hours. She was taken to a hospital and survived.
"You can't make an evaluation when a person is cold in a cold environment," attorney Robert Hopper said.
Minneapolis and Hennepin County Medical Center personnel have also been named in the suit. The city attorney's office released a statement stating, "Jake Anderson's death is tragic. However, first responders in the city of Minneapolis, including fire and police personnel, are not responsible for his death. We can only imagine the grief of Mr. Anderson's parents, family and friends are experiencing."
http://ift.tt/2gQ0Kr5
Hepatitis B Virus e Antigen Regulates Monocyte Function and Promotes B Lymphocyte Activation
Viral Immunology , Vol. 0, No. 0.
http://ift.tt/2hyNRTr
Effect of Temporal Fascia and Pedicle Inferior Turbinate Mucosal Flap on Repair of Large Nasal Septal Perforation via Endoscopic Surgery
ORL 2016;78:303-307
http://ift.tt/2gPLric
Oral Biosciences: The annual review 2016
Publication date: Available online 15 December 2016
Source:Journal of Oral Biosciences
Author(s): Hayato Ohshima
BackgroundThe Journal of Oral Biosciences is devoted to the advancement and dissemination of fundamental knowledge concerning every aspect of oral biosciences.HighlightThis review article features the following topics presented in symposia that were held during the annual meeting of the Japanese Association for Oral Biology: "Frontiers of oral physiology," "Genetic and epigenetic changes to determine development, differentiation and carcinogenesis," "Analytical methods and interpretation of variation in tooth morphology," "Regulatory mechanisms of vertebrate developmental body plan revealed by live-imaging and mathematical analyses," "Studies on dentin sialophosphoprotein (DSPP) through morphological and functional perspectives," and "Oral biofilm and microbiome research".ConclusionThese published reviews in the Journal of Oral Biosciences have inspired the readers of the Journal to broaden their knowledge regarding the various aspects of oral biosciences. The current editorial review introduces these exciting review articles.
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Cisplatin + Radiation in SCCHN and Correlation With Oxidative Stress Markers
Intervention: Drug: Cisplatin + XRT
Sponsor: Susanne Arnold
Not yet recruiting - verified November 2016
http://ift.tt/2h4JiNb
Pre-operative Mocetinostat (MGCD0103) and Durvalumab (MEDI4736) (PRIMED) for Squamous Cell Carcinoma of the Oral Cavity
Interventions: Drug: Mocetinostat; Biological: Durvalumab
Sponsors: University Health Network, Toronto; Mirati Therapeutics Inc.; AstraZeneca
Not yet recruiting - verified December 2016
http://ift.tt/2gNEDDu
Comparison of the Retroauricular Approach and the Transcervical Approach for Excision of a Second Brachial Cleft Cyst
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Dongbin Ahn, Gil Joon Lee, Jin Ho Sohn
PurposeAlthough a retroauricular (RA) approach has been proposed for excision of a second brachial cleft cyst (BCC), there has been no direct comparison of the results of the RA approach with those of the conventional transcervical approach. We aimed to evaluate the surgical outcomes of the RA approach under direct vision and to demonstrate its benefits when compared with the conventional transcervical approach for excision of a second BCC.Patients and MethodsFrom January 2012 to May 2016, we enrolled 30 consecutive patients with a second BCC who underwent surgical excision as a primary treatment into this prospective case control study. Thirteen of the 30 patients underwent excision of a second BCC via the RA approach and 17, via the conventional transcervical approach. The surgical results, complications, and subjective scar satisfaction score were estimated and compared between the two groups.ResultsIn all 30 patients, excision of the second BCC was successfully completed under direct vision via RA or the conventional transcervical approach. The mean operating time was significantly less in the conventional group than that in the RA group (68.4 vs. 83.4 min, respectively; P = .019). There were no differences in total drainage amount, drainage duration, duration of hospital stay, or postoperative complications between the two groups. The mean scar satisfaction score was 6.2 in the conventional group and 8.8 in the RA group, and this difference was statistically significant (P < .001).ConclusionThe RA approach under direct vision for excision of a second BCC is feasible and has better cosmetic outcomes than the conventional transcervical approach with no increase in surgical morbidity.
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Clinical differences in auto-fluorescence between viable and non-vital bone: A case-report with histopathological evaluation performed on medication-related osteonecrosis of the jaws
Source:Journal of Oral and Maxillofacial Surgery
Author(s): I. Giovannacci, M. Meleti, D. Corradi, P. Vescovi
Medication-related osteonecrosis of the jaws (MRONJ) is an adverse side effect of several drug therapies including bisphosphonates. Osteonecrosis of the jaw specifically related to BP therapy is usually referred to using the acronym BRONJ. There is still no consensus on the most appropriate management of BRONJ. The highest success rates are recorded following surgical removal of necrotic bone. In particular, Er:YAG laser-assisted surgery shows significantly better results than conventional surgical approaches.According to a position paper published by the American Association of Oral and Maxillofacial Surgeons in 2007, the identification of necrotic bone margins during osteonecrosis removal can be very difficult.In 2015, Ristow performed a review of treatment perspectives for MRONJ and reported that both surgical debridement and resection cannot be standardized due to the lack of guidance that defines the margins of the necrosis.Recently, Ristow and Vescovi proposed the use of auto-fluorescence (AF) of the bone as a possible suitable guide to visualize necrotic bone during surgical debridement/resection. In fact, it seems that vital bone could be highlighted based on its very strong AF, whereas necrotic bone loses AF, thus appearing much darker.The molecular sources of the phenomenon of AF are specific amino acids of the collagen molecules that show AF when irradiated by ultraviolet/blue light. The use of AF as an intraoperative diagnostic tool is entirely new in the management of MRONJ, while it has been used for several years in other fields (e.g.: inter-vertebral disc surgery).The aim of this report is to describe a case of mandibular BRONJ treated with a new surgical approach performed with Er:YAG laser and guided by AF.The histopathological evaluation of the removed hypo-fluorescent bone-block and the hyper-fluorescent surrounding bone was also reported in detail.
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Predictive value of panoramic radiography for injury of inferior alveolar nerve after mandibular third molar surgery
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Naichuan Su, Arjen van Wijk, Erwin Berkhout, Gerard Sanderink, Jan De Lange, Hang Wang, Geert J.M.G. van der Heijden
PurposeThe purpose of this systematic review was to assess the added value of panoramic radiography in predicting (ruling in or out) postsurgical injury of the inferior alveolar nerve (IAN) in the decision-making before mandibular third molar surgery (MM3 surgery).Materials and MethodsMEDLINE and EMBASE were searched electronically to identify the diagnostic accuracy of studies that had assessed the predictive value of 7 panoramic radiographic signs including root-related signs (darkening of the root, deflection of the root, narrowing of the root, and dark and bifid apex of the root) and canal-related signs (interruption of white line of the canal, diversion of the canal and narrowing of the canal) for IAN injury after MM3 surgery.ResultsA total of 8 studies qualified for a meta-analysis. The pooled sensitivity and specificity of the 7 signs ranged from 0.06 to 0.49, and 0.81 to 0.97, respectively. The area under the summary receiver-operator curve (sAUC) ranged from 0.42 to 0.89. The pooled positive predictive value (PPV) and negative predictive value (NPV) ranged from 7.5 to 26.6% and 95.9 to 97.7%, respectively. The added value of a positive sign for ruling in IAN (PPV minus the prior probability) ranged from 3.4 to 22.2%. The added value of a negative sign for ruling out IAN (NPV minus (1 minus the prior probability)) ranged from 0.1 to 2.2%.ConclusionFor all 7 signs the added value of panoramic radiography is too low to consider it appropriate for ruling out postsurgical IAN in the decision-making prior to MM3 surgery. The added value of panoramic radiography for the presence of diversion of the canal, interruption of white line of the canal and darkening of the root may be considered sufficient for ruling in the risk of postsurgical IAN injury in the decision-making prior to MM3 surgery.
http://ift.tt/2gFbDbV
Extensive Surgical Procedures Result in Better Treatment Outcomes for Bisphosphonate-Related Osteonecrosis of the Jaw in Patients with Osteoporosis
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Hui Young Kim, Shin-Jae Lee, Soung Min Kim, Hoon Myoung, Soon Jung Hwang, Jin-Young Choi, Jong-Ho Lee, Pill-Hoon Choung, Myung Jin Kim, Byoung Moo Seo
PurposeTo identify risk factors associated with relapse or treatment failure after surgery for bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients with osteoporosis.Patients and MethodsThis is a retrospective cohort study on BRONJ in patients with osteoporosis who underwent surgical procedures between 2004 and 2016 at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. The predictor variables comprised a set of heterogeneous variables, including demographic (age, gender), anatomic (maxilla, mandible, or both; affected location), clinical (disease stage; etiology; comorbidities; history of intravenous bisphosphonate intake), time (conservative treatment before surgery; bisphosphonate treatment before the development of BRONJ; discontinuation of the drug before surgery; time to final follow-up; time to re-operation in case of relapse or treatment failure), and perioperative variables (type of anesthesia; type of surgical procedures). The primary outcome variable was relapse after surgery that required reoperation (yes/no). The descriptive and bivariate statistics were computed to assess the relationships between the study variables and the outcome. To determine risk factors, we conducted a survival analysis with the Cox model.ResultsThe final sample included 325 subjects with a median age of 75 years; 97% were female. After surgery, 30% patients did not completely recuperate and underwent repeat surgery. The time from the first surgery to reoperation ranged from 10 days to 5.6 years. Relapse or failures of treatment most often occurred immediately after surgery. The type of surgical procedure and mode of anesthesia were the most important factors in the treatment outcome. A drug holiday did not appear to influence the likelihood of relapse after surgery.ConclusionsTreatment for BRONJ in patients with osteoporosis might benefit from more careful and extensive surgical procedures rather than curettage performed with local anesthesia.
http://ift.tt/2gF6z7G
Extensive Regional Metastasis of High-Grade Mucoepidermoid Carcinoma of Unknown Primary
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Naseem Ghazali, Alyssa Flashburg, Robert A. Ord
PurposeMucoepidermoid carcinoma (MEC) is the commonest salivary carcinoma. It arises most frequently in major salivary glands but may arise in minor glands or intraosseous sites. MEC of unknown primary very rarely occurs. This report documents only the third case in the medical literature.MethodsA 66-year old man with previous carcinoma-in-situ (CIS) of the left posterior oral tongue that was excised in 2004 and also in 2010, presented with a hard node 3x2 cm at level II of the right neck in July 2015. PET/CT revealed multiple, bilateral cervical lymphadenopathy, with no primary site identified. FNAB/Cytology from the right neck was positive for malignancy, suggestive of metastatic squamous cell carcinoma (SCC). Panendoscopy/biopsy revealed CIS at the tongue bases and tonsils bilaterally (p16-negative). The patient was presented to a tumor board and definitive concurrent cisplatin-based chemoradiation was recommended for TisN2cM0, Stage IVA oropharyngeal CIS and was completed in November 2015. PET-CT in January 2015 showed complex interval changes, with some areas demonstrating improvement (i.e. no uptake in left neck) and worsening in others (i.e. increased metabolic activity in right neck), suggestive of residual disease. Repeat PET/CT in March 2016 showed increased nodal involvement and increasing SUV. Bilateral modified radical neck dissection was undertaken and histology showed High-grade MEC in 51/61 nodes with extracapsular spread and soft tissue involvement.ResultsPatient died May 2016 two months post-surgery. ConclusionsMetastatic MEC of unknown primary is a diagnostic challenge. PET-CT may not be the most reliable diagnostic investigation to identify the primary or metastatic foci as demonstrated in this case.
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Straightforward Method for Coverage of Major Vessels Following Modified Radical Neck Dissection
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Raúl González-García, Carlos Moreno-García, Manuel Moreno-Sánchez, Leticia Román-Romero
A new method for covering the internal jugular vein and carotid artery following exposure of the cervical vascular axis subsequent to neck dissection is presented. To cover the most caudal part of the vascular axis, a platysma coli muscle flap is harvested from its most medial and inferior part of the neck in a caudally-based fashion, while it is slightly rotated posteriorly up to 45º. In addition, a superiorly-based sternocleidomastoid muscle flap involving the posterior half of the muscle after detachment of the clavicle head is harvested and rotated 45º anteriorly to cover the upper two-thirds of the vascular axis. This technique seems to be a good alternative to the pectoralis major myocutaneous flap for covering cervical major vessels if no classical radical neck dissection is performed, especially in those oncologic malnourished patients that will undergo adjuvant radiotherapy following surgical treatment.
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The role of hypoxia inducible factor in nasal inflammations
OBJECTIVE: Hypoxia-inducible factor (HIF) is considered an important transcription factor due to its roles in glycolysis, angiogenesis, cell differentiation, apoptosis, and other cellular pathways. It takes the role in various physiological and pathological states, such as solid tumors, vascular injury, and atherosclerotic lesion progression. In recent studies, HIF is found as a master regulator of body inflammation and immunity, not only in hypoxia but also in normoxia. Nasal inflammation has a close relationship with anoxia. But the role of HIF in nasal inflammation is still unclear.
MATERIALS AND METHODS: We searched the Pubmed using the key words: "Hypoxia-inducible factor" and "nasal" or "Hypoxia-inducible factor", and reviewed the related articles.
RESULTS: HIF is composed of HIF-α and HIF-β subunits. HIF-a is an adjusting relational subunit, which is divided into three subtypes: HIF-1a, HIF-2a, and HIF-3a. HIF-1a is the key component and best understood. HIF-1a can be activated under hypoxic conditions or by various cytokines and growth factors. HIF-1α accumulation is critical for sustaining human allergic effector cell survival and function. The level of HIF-1a is increased in the patients with allergic rhinitis and become a new therapeutic target. HIF-1a also plays an important role in the pathogenesis of CRS and polyp formation. Some research found that the expression of HIF-1α was increased in CRS with polyps.
CONCLUSIONS: HIF-1a takes an important role in allergic rhinitis and chronic sinusitis. It will be a key therapeutic target of these diseases in the future.
L'articolo The role of hypoxia inducible factor in nasal inflammations sembra essere il primo su European Review.
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Localisation cutanée d’une leucémie à plasmocytes
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Le Guern, M.-M. Farhat, D. Lebas, J.-F. Quinchon, P. Modiano
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Une consultation d’anthropologie médicale ouverte aux migrants : pour quoi faire ?
Source:Annales de Dermatologie et de Vénéréologie
Author(s): P. Charlier
http://ift.tt/2hxDtvu
Obstructive ectopic intratracheal thyroid
Source:Acta Otorrinolaringológica Española
Author(s): Miguel Mayo Yáñez, Gonzalo Nemecio Esquía Medina, Juan Carlos Vázquez Barro
http://ift.tt/2hzKitG
Emphysematous pancreatitis: classic findings
Description
A 55-year-old man with diabetes presented to our hospital with recent onset acute abdominal pain and recurrent vomiting. He was immediately admitted to the intensive care unit for ionotropic and invasive respiratory support. He had an acutely tender abdomen with distension. Haematological examination showed leucopenia (880/mm3), thrombocytopenia (64 000/mm3), elevated C reactive protein (68 mg/mL), metabolic acidosis (pH: 6.88) with a severely elevated blood lactate (14 mmol/L), estimated creatinine clearance <14 mL/min, hyperlipidaemia (1280 U/L) and serum amylase levels of 5134 U/L. Plain CT revealed extensive gas in the pancreatic bed extending into the lesser sac and adjacent retroperitoneal space (figure 1A, B). A diagnosis of acute severe emphysematous pancreatitis was made; although the patient was aggressively treated, unfortunately he died. Retrospective blood cultures were positive for Enterobacter aerogenes.
Figure 1
(A) CT image showing the presence of air lucencies in the epigastric region at the level of L1–L2 vertebral...
http://ift.tt/2hxtciy
Unexplained lymphadenopathies: autoimmune lymphoproliferative syndrome in an adult patient
Autoimmune lymphoproliferative syndrome (ALPS) is characterised by massive enlargement of the lymphoid organs, autoimmune cytopenias and a predisposition to develop lymphoid malignancies. The basic defect is a disturbance of the lymphocyte apoptosis, and a high number of circulating TCRab CD3+CD4–CD8– T-cells (double-negative T cells (DNT cells)). We describe a case of a 41-year-old man with fever, hepatosplenomegaly, multiple lymphadenopathy, autoimmune haemolytic anaemia and severe thrombocytopenia. Peripheral blood immunophenotyping revealed elevation of the characteristic DNT cells in 8% and high levels of interleukin 10. Histopathological analysis of lymph nodes showed lymphadenitis with paracortical hyperplasia. It was assumed as a probable diagnosis of ALPS, and the procedure was to medicate the patient with steroids. As a result, a significant clinical improvement was achieved, and he has been in remission for 2 years. To our knowledge, this is the first case reported in a Portuguese adult patient.
http://ift.tt/2hAoON9
Concomitant multiple myeloma, gastric adenocarcinoma and Evan's syndrome in a patient presenting with anaemia
An association between multiple myeloma (MM) and solid tumours has been previously described.1 Furthermore, autoimmune disorders can precede plasma cell dyscrasias, and the pathogenesis of MM maybe linked to chronic immune stimulation. 2 We describe a case of concomitant MM and gastric adenocarcinoma preceded by Evan's syndrome. A previously healthy woman presented to the emergency room with symptomatic anaemia. Her initial workup was compatible with autoimmune haemolytic anaemia and monoclonal gammopathy of undetermined significance. On progression of the anaemia and development of thrombocytopenia, she was diagnosed with Evan's syndrome. Two months later, she presented with severe back pain and her MRI revealed L4–5 vertebral collapse. The clinical picture was compatible with MM. Occult blood was repeatedly positive in stools, and she underwent oesophagogastroduodenoscopy and was found to have gastric adenocarcinoma. The patient refused surgical resection of the adenocarcinoma and refused active treatment for MM.
http://ift.tt/2hxztuV
Rare cause of neck pain: tumours of the posterior elements of the cervical spine
Here we present two cases of primary bone tumours of the cervical spine in patients who had persistent neck pain—in one case, lasting 8 years. In each case, there was a delay in diagnosis and referral to a spine specialist was prolonged. Primary bone tumours of the spine are rare, which is in contrast to the wide prevalence of cervical neck pain. Many primary care providers may go an entire career without encountering a symptomatic primary cervical spine tumour. In this paper, we discuss the clinical course and treatment of each patient and review the current literature on primary bone tumours of the spine. Owing to the subtle roentgenographic findings of primary cervical tumours, we highlight the importance of advanced imaging in the clinical work-up of simple axial neck pain lasting >6 weeks to avoid misdiagnosis of serious pathology.
http://ift.tt/2hApNgr
Boari flap reconstruction in a male infant with solitary kidney and associated megaureter
A 1-year-old male infant presented with fever and abdominal lump for 3 months with increased leucocyte count (15 300/mm3) and serum creatinine (0.83 mg%). Abdominal ultrasound and renal scan demonstrated solitary left kidney with dilated tortuous left ureter. Voiding cystourethrogram was unequivocal. Left percutaneous nephrostomy was placed after poor response to perurethral catheterisation. His serum creatinine dropped to 0.58 mg/dL. Subsequent percutaneous nephrostogram and CT nephrostogram showed dilated left pelvicalyceal system, dilated, tortuous left ureter. A diagnosis of obstructed megaureter was made and ureteric plication and reimplantation planned. Intraoperatively, there were primitive ureteral valves until proximal one-third of the ureter. The distance between the upper ureter and bladder was ~6 cm. This defect was bridged by Boari flap. The postoperative period was uneventful and now after 6 months of follow-up, he is doing fine.
http://ift.tt/2hxwHFS