Stent graft repair of anastomotic pseudoaneurysm of femoral-popliteal bypass graft following patch angioplasty

Pseudoaneurysm (PA) following vascular reconstruction is a complication of bypass surgery. Historically, the mainstay of treatment was an open repair; the surgical management consisted of resection of the initial graft with reimplantation of a new bypass either into the original arteriotomy or to a more distal target. Placement of a stent graft to exclude the PA is a viable option. We present a case of an 85-year-old man with prior history of polytetrafluoroethylene femoral–popliteal bypass now with an 8 x 5.6 cm PA of the distal anastomosis site treated with endovascular placement of a Viabahn stent.

http://ift.tt/2hPRbqu

Mesothelial inclusion cyst: a rare occurrence

Mesothelial inclusion cyst is a rare benign tumour that has only 130 cases reported in the literature. Accurate diagnosis and optimal management of this condition remains uncertain. We report a 51-year-old African gentleman, whom presents with abdominal pain and constipation. A computed tomography scan was performed and revealed a large cystic lesion in the right paracolic gutter. The differential diagnosis included appendiceal mucinous neoplasm, cystic tuberculosis and duplication cyst. A laparotomy was performed due to his symptoms and size of the cyst. Macroscopically, the tumour had a size of 25 x 10 x 10 cm and revealed a necrotic lymph node. It was resected en bloc with the appendix and an ileocolic anastomosis performed. Histology revealed a diagnosis of mesothelial inclusion cyst and acute appendicitis. The patient recovered well and had no recurrence at 2-year follow-up.

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Successful surgical excision of a massive symptomatic partially obstructing Brunner's gland hamartoma: a case report

Brunner gland function within the duodenal epithelium is secretion of alkaline mucin to counteract acidic chyme. These glands may grow beyond the duodenal wall to become hamartomas. Rarely, they become large enough to cause obstructive symptoms in the upper gastrointestinal tract. We report a case of one of the largest lesions identified in the literature causing obstruction symptoms. A previously asymptomatic 65-year-old gentleman presented to the emergency department with a single-day history of colicky abdominal pain, cramping and vomiting. After initial imaging with computed tomography was inconclusive, a subsequent esophagogastroduodenoscopy with biopsy and small bowel series was performed indicating a pedunculated polypoid mass. Our patient underwent an uncomplicated exploratory laparotomy with duodenotomy and Heineke-Mikulicz pyloroplasty for resection of a massive Brunner's gland hamartoma. For similar presentations, we recommend this technique.

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Retrospective Study of Rocky Mountain Spotted Fever in Children

Abstract

Background/Objectives

Rocky Mountain spotted fever (RMSF), a lethal tick-borne illness, is prevalent in the south central United States. Children younger than 10 years old have the greatest risk of fatal outcome from RMSF. The objective of the current study was to review pediatric cases of RMSF seen in the dermatology consult service and to evaluate dermatology's role in the diagnosis and management of this disease.

Methods

A retrospective review was performed of inpatient dermatology consultations at a tertiary care center in North Carolina from 2001 to 2011. Data collected included patient demographic characteristics, symptoms, pre- and postconsultation diagnoses, diagnostic procedures, length of hospital stay, and outcome.

Results

A total of 3,912 consultations were conducted in the dermatology service over 10 years. Six patients with RMSF, ranging in age from 22 months to 10 years (mean 5.1 years), were evaluated during April, May, and June. All preconsultation diagnoses included RMSF in the differential diagnosis. All patients underwent skin biopsies, and a culture was obtained in one case. Fifty percent of patients died within 4 days of hospitalization.

Conclusions

Variables associated with mortality from RMSF are delayed diagnosis and initiation of antirickettsial therapy. Physicians should consider RMSF in children presenting with fever and rash during the summer months. Dermatology consultation is useful in evaluating patients with suspicious clinical features of RMSF with skin findings.

http://ift.tt/2hyRDM9

Trichodysplasia Spinulosa in a 7-Year-Old Boy Managed Using Physical Extraction of Keratin Spicules

Abstract

Trichodysplasia spinulosa (TS) is an uncommon skin disease characterized by a folliculocentric papular eruption and keratin spine formation, classically appearing on the central face and ears. It occurs in immunosuppressed patients and is linked to a viral etiology. Diagnostic tests including polymerase chain reaction (PCR) are available for detection of the TS-associated polyomavirus. Effective treatment options include topical cidofovir and oral valganciclovir. We present a case diagnosed using PCR with skin scrapings and treated using physical extraction of the keratin spicules. Significant improvement was noted, suggesting a safe, cost-effective treatment alternative.

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Short-term complications after surgically assisted rapid palatal expansion: a retrospective cohort study

Publication date: Available online 18 December 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M. Verquin, L. Daems, C. Politis
Surgically assisted rapid palatal expansion (SARPE) has been considered a safe procedure with minimal patient morbidity. The aim of this study was to identify short-term complications encountered after tooth-borne expansion with a standardized approach to inform surgeons and orthodontists of the patient risk. In this retrospective cohort study, 55 patients (35 female, 20 male) undergoing SARPE between January 2013 and December 2014 were evaluated. Twenty-eight patients developed one or more complications. Postoperative haemorrhage was seen in six patients. Sixteen patients presented with injury to the infraorbital nerve, five had dental complications, and four had severe postoperative pain. A prolonged hospital stay was necessary for six patients and additional surgery was required in two cases. It is concluded that the short-term complications after tooth-borne SARPE are generally mild; however, the number of complications encountered indicates that SARPE is not free of risk and should be preceded by careful patient selection and planning.



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Reconstruction with soft tissue free flaps for large defects after the resection of giant facial neurofibroma

Publication date: Available online 18 December 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): L. Hu, Y. Xi, Y. Wang, L. Jiannan, J. Han, Y. Miao, S. Gokavarapu, C. Zhang, L. Xu
Giant facial neurofibroma leads to disfigurement and functional and neurological deficits. Surgical resection is the mainstay of treatment and poses a great challenge to the surgeon with regard to the restoration of the defects arising from tumour resection. The cases of three male and three female patients diagnosed with giant facial neurofibroma, who underwent radical resection and reconstruction with soft tissue free flaps between 2008 and 2015, were analyzed retrospectively. Clinical data including patient sex, age, preoperative embolization of the nutrient artery, volume of blood loss, type and size of flaps used for reconstruction, and complications were recorded. Three of the six patients underwent preoperative embolization of the nutrient artery. The average volume of blood loss was 2850ml. Reconstruction was performed with anterolateral thigh flaps in four patients and latissimus dorsi myocutaneous flaps in two patients. All free flap reconstructions were successful. Partial necrosis of the scalp and wound dehiscence occurred in one patient each. All complications were managed successfully. In conclusion, the soft tissue free flap is a good choice for the coverage of defects after giant facial neurofibroma resection. Multi-disciplinary treatment should be strengthened to minimize the risks of complications, as well as improving quality of life.



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A study to evaluate the reliability of using two-dimensional photographs, three-dimensional images, and stereoscopic projected three-dimensional images for patient assessment

Publication date: Available online 18 December 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S. Zhu, Y. Yang, B. Khambay
Clinicians are accustomed to viewing conventional two-dimensional (2D) photographs and assume that viewing three-dimensional (3D) images is similar. Facial images captured in 3D are not viewed in true 3D; this may alter clinical judgement. The aim of this study was to evaluate the reliability of using conventional photographs, 3D images, and stereoscopic projected 3D images to rate the severity of the deformity in pre-surgical class III patients. Forty adult patients were recruited. Eight raters assessed facial height, symmetry, and profile using the three different viewing media and a 100-mm visual analogue scale (VAS), and appraised the most informative viewing medium. Inter-rater consistency was above good for all three media. Intra-rater reliability was not significantly different for rating facial height using 2D (P=0.704), symmetry using 3D (P=0.056), and profile using projected 3D (P=0.749). Using projected 3D for rating profile and symmetry resulted in significantly lower median VAS scores than either 3D or 2D images (all P<0.05). For 75% of the raters, stereoscopic 3D projection was the preferred method for rating. The reliability of assessing specific characteristics was dependent on the viewing medium. Clinicians should be aware that the visual information provided when viewing 3D images is not the same as when viewing 2D photographs, especially for facial depth, and this may change the clinical impression.



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Evaluation of temporal bone pneumatization with growth using 3D reconstructed image of computed tomography

Publication date: Available online 16 December 2016
Source:Auris Nasus Larynx
Author(s): Sun Wha Song, Beom Cho Jun, Hojong Kim, Yesun Cho
ObjectiveTo evaluate temporal bone pneumatization with growth using 3D reconstructed computed tomography (CT) images.Patients and MethodsEighty-four temporal bones of 42 patients under the age of 16 years who had undergone head and facial bone CT were included in this retrospective study. The bony growth of the temporal bone and the head size were evaluated with horizontal- and vertical-plane CT images. Pneumatization of the temporal bone was investigated with 3D reconstruction software using axial CT images, dividing them as follows: medially, anterosuperiorly, posterolaterally, and inferiorly. Pneumatization of each individual part was compared with that of other parts and was also evaluated according to the aging process.ResultsThe mean pneumatization was measured as 1696.7mm³ in patients aged under 2 years, 3609.1mm³ in those aged 2–4 years, 5351.1mm³ in those aged 5–7 years, 7295.9mm³ in those aged 8–10 years, 7797.5mm³ in those aged 11–13 years, and 8526.6mm³ in those aged 14–16 years. The degree of temporal bone pneumatization of each part was correlated with that of other parts (p<0.05). The volume of pneumatization increased with growth of the temporal bone and with aging. The degree of pneumatization of specific parts might be related to developmental periods.ConclusionThe pneumatization of one part might affect the pneumatization of other nearby parts, or all parts might be affected by the same driving force of pneumatization.



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Phonatory Symptoms and Acoustic Findings in Patients with Asthma: A Cross-Sectional Controlled Study

Abstract

To investigate the prevalence of phonatory symptoms, perceptual, acoustic and aerodynamic findings in patients with asthma compared to a control group. This study is a cross-sectional study. A total of 50 subjects, 31 asthmatic and 19 control subjects matched according to age and gender were enrolled in this study. All subjects were asked about the presence or absence of dysphonia, vocal fatigue, phonatory effort, cough, dyspnea, and respiratory failure. Perceptual evaluation, acoustic analysis and aerodynamic measurements were also performed. Patient's self assessment using the Voice Handicap Index 10 was reported. The mean age of patients was 43.5 years with a female to male ratio of 2:1. There was a statistically significant difference in the prevalence of dysphonia between the two groups (32.3 vs. 5.3%, p value 0.025) with a non-significant higher prevalence of vocal fatigue and phonatory effort. The overall grade of dysphonia was significantly higher in asthmatics compared to controls (p value 0.002). Patients with asthma had also significantly higher degree of asthenia and straining (p value of 0.04 and 0.008, respectively) with borderline significant difference with respect to roughness. There was no significant difference in the means of any of the acoustic parameters between patients and controls except for Shimmer, which was higher in the asthmatic group (p value of 0.037). There was also no significant difference in the Maximum phonation time between the two groups. Dysphonia is significantly more prevalent in patients with asthma compared to controls.

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Phonatory Symptoms and Acoustic Findings in Patients with Asthma: A Cross-Sectional Controlled Study

Abstract

To investigate the prevalence of phonatory symptoms, perceptual, acoustic and aerodynamic findings in patients with asthma compared to a control group. This study is a cross-sectional study. A total of 50 subjects, 31 asthmatic and 19 control subjects matched according to age and gender were enrolled in this study. All subjects were asked about the presence or absence of dysphonia, vocal fatigue, phonatory effort, cough, dyspnea, and respiratory failure. Perceptual evaluation, acoustic analysis and aerodynamic measurements were also performed. Patient's self assessment using the Voice Handicap Index 10 was reported. The mean age of patients was 43.5 years with a female to male ratio of 2:1. There was a statistically significant difference in the prevalence of dysphonia between the two groups (32.3 vs. 5.3%, p value 0.025) with a non-significant higher prevalence of vocal fatigue and phonatory effort. The overall grade of dysphonia was significantly higher in asthmatics compared to controls (p value 0.002). Patients with asthma had also significantly higher degree of asthenia and straining (p value of 0.04 and 0.008, respectively) with borderline significant difference with respect to roughness. There was no significant difference in the means of any of the acoustic parameters between patients and controls except for Shimmer, which was higher in the asthmatic group (p value of 0.037). There was also no significant difference in the Maximum phonation time between the two groups. Dysphonia is significantly more prevalent in patients with asthma compared to controls.

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IDD Newsletter November 2016

IDD NEWSLETTER – November 2015 (PDF File, 9.42 MB)
VOLUME 44 NUMBER 4 NOVEMBER 2016
IODINE GLOBAL NETWORK (formerly ICCIDD Global Network) is a nongovernmental organization dedicated to sustained optimal iodine
nutrition and the elimination of iodine deficiency throughout the world.

The post IDD Newsletter November 2016 appeared first on American Thyroid Association.

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Curious case of the bilaterally absent omohyoid muscle

Publication date: Available online 16 December 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): V. Konduru, C.T. Thomas, P. Gaikwad




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Three-dimensional airways volumetric analysis before and after fast and early mandibular osteodistraction

Newborns with Pierre Robin sequence (PRS) and syndromic micrognathia show microgenia and glossoptosis, which cause reduction of the airway and breathing difficulty from birth. Our goal is to analyze quantitative and qualitative volumetric changes before and after fast and early mandibular osteodistraction (FEMOD) and to compare radiological data.

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The Benefits of Using the Ultrasonic BoneScalpel™ in Temporomandibular Joint Reconstruction

Temporomandibular joint (TMJ) reconstruction surgery is challenging and poses multiple risks, potentially leading to well-documented complications (Sidebottom et al., 2013; Hoffman et al., 2015). The main reason for this elevated risk is the complex anatomy in which there are multiple nerves and blood vessels in close approximation to the bone in a confined and difficult-to-access space (Fujimura et al., 2006; Balcioglu et al., 2010). This is significant, because one of the critical steps in any TJR is the removal of diseased hard tissue, typically the condyle, condylar neck, and coronoid.

http://ift.tt/2h0ZD9F

Short-term perioperative teriparatide therapy for the prevention of medication-related osteonecrosis of the jaw: A randomized, controlled preclinical study in rats

Dentoalveolar procedures in patients receiving bisphosphonates and other antiresorptive agents are associated with an increased risk of medication-related osteonecrosis of the jaw (MRONJ). The aim of present study was to evaluate the effects of perioperative teriparatide (TPD) therapy in prevention of MRONJ.

http://ift.tt/2hgoS4b

Prevalence profile of odontogenic cysts and tumors on Brazilian sample after the reclassification of odontogenic keratocyst

The aim of this study was to evaluate the impact of the reclassification of odontogenic keratocyst (OKC) as a tumor on the prevalence profile of odontogenic cysts (OCs) and odontogenic tumors (OTs).

http://ift.tt/2h118VA

Surgical management of ankyloses of the temporomandibular joint by a piezoelectric device

Piezosurgery is commonly used in different field of craniomaxillofacial surgery; since its introduction it has become one of the widely adopted technique for performing osteotomies in orthognathic surgery, distraction osteogenesis and dentoalveolar surgery. Little has been written regarding ultrasonic system for temporomandibular joint surgery (TMJ). In this prospective study we describe the use of piezoelectric device for ankylosis of the TMJ.

http://ift.tt/2h0WR4s

2016 Highlights

Patient Success Stories

A Drug-Eluting Stent Offers A Young Man A Small-But-Mighty Solution To A Chronic Problem

A Novel Lymphatic Imaging System And A Disease-Focused Treatment Team Improve Survivorship In Head And Neck Cancer

The Petty Case: Setting A Good Course Through The Perfect Storm Of Allergens

Supraglottoplasty For Neonatal Laryngomalacia

Granulomatosis With Polyangiitis: A Patient Benefits From Multidisciplinary Care

ECMO Improves Care For A Critical Tracheostomy Patient

Read more Patient Success Stories »

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News

Eight ORL Specialists Named To Top Doctors Lists For 2016

Earbud Volume Could Damage Hearing

Read more News »

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Research

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Management of fish bone impaction in throat – Our experiences in a tertiary care hospital of eastern India

Publication date: Available online 18 December 2016
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Santosh Kumar Swain, Santosh Kumar Pani, Mahesh Chandra Sahu
ObjectiveTo find out prevalence of accidental ingestion of fish bones and its management in a tertiary care hospital of eastern India.Materials & methodsThis is a prospective observational study. Three hundred thirty patients with complains of fish bone in throat who presented to the out patients department of Otorhinolaryngology and the emergency department of a Medical college between January 2008 to December 2015 were shortlisted for study. Followed by conventional examination, most were subjected to endoscopic examination and removal. The parameters analyzed were age and sex distribution, clinical presentation, duration of symptoms, location of impaction, conventional and endoscopic removal techniques.ResultAmong three hundred thirty patients, no foreign body was found in eighty patients. Patients in age group of 21–30years were affected mostly with almost equal sex distribution. Most patients presented with foreign body sensation in throat of short duration with precise finger point localization. Both conventional and endoscopic methods were employed with successful results but with definite advantage of endoscopic method.ConclusionFish bone in throat is a common occurrence in Otorhinolaryngological practice. Fish bone impaction is a common foreign body in the pharynx. Endoscopic removal is distinctly more helpful than the conventional ones.



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Endoscopic tympanoplasty: learning curve for a surgeon already trained in microscopic tympanoplasty

Abstract

The aim of this study was to evaluate the learning curve of endoscopic tympanoplasty for a surgeon already trained in microscopic tympanoplasty. We analyzed the clinical records of 81 patients who underwent transcanal endoscopic type 1 tympanoplasty and 30 control patients who underwent microscopic tympanoplasty between 2013 and 2015 in a tertiary hospital. All operations were performed by a single surgeon already trained in microscopic tympanoplasty. Patients were divided into four groups according to the date of surgery chronologically (group 1 early stage, group 2 intermediate stage, group 3 advanced stage and group 4 control). We evaluated the four groups according to surgery duration, audiometric results, and graft intake success. The operation duration shortened in accordance with the surgeon's experience and there were two subsequent steps during the learning curve: first, after 30 procedures; and second, after 60 procedures. The mean operation duration was 88.60 ± 21.10 min in group 1, and 62.00 ± 12.48 min in group 2. After 60 procedures, the mean operation duration was 43.81 ± 8.34 min in group 3. In the control group, the microscopic tympanoplasty duration was 69.93 ± 12.56 min. When we compared audiologic results (air conduction, bone conduction, and air–bone gap) and graft intake success rates, there were no significant differences between groups. Endoscopic tympanoplasty is a minimally invasive and effective technique. Mastering endoscopic tympanoplasty takes approximately 60 operations for a surgeon already trained in microscopic tympanoplasty. Graft intake success rates and hearing results are stable during the learning curve.

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Sinonasal characteristics and quality of life by SNOT-22 in adult patients with cystic fibrosis

Abstract

The prevalence of chronic sinus disease in cystic fibrosis (CF) has gradually increased. Sinonasal involvement may have influence on pulmonary exacerbations and can have a negative impact on the quality of life. To evaluate nasal characteristics and quality of life in adult patients with CF; to establish an association and determine the predictors in SNOT-22 questionnaire. Cross- sectional study with prospective data collection was performed to evaluate adult CF patients. Patients underwent clinical evaluation, lung function tests, nasal endoscopy, and paranasal sinuses CT scan. All the patients answered the SNOT-22 questionnaire. Results: A total of 91 patients were allocated, of which, 45.1% were male. Patients were divided into three groups by SNOT-22. A high average age, late age of diagnosis, rhinitis symptoms, and clinical criteria for rhinosinusitis were observed more frequently in patients with high SNOT-22 scores (p < 0.05). Overall, 84.6% patients had abnormal CT findings, with aplasia/hypoplasia of the sphenoid sinus being the most common finding. In multiple regression model, age, female gender, and Pseudomonas aeruginosa in the sputum were associated with high SNOT-22 scores in the nasal domain. Hyposmia and lack of medial bulging of lateral nasal wall were variables associated with high SNOT-22 scores in the quality of life domain. In total score, there was a positive association with age and the presence of P. aeruginosa in sputum. Despite high prevalence of abnormal tomographic findings, patients reported mild intensity of sinonasal symptoms. Advanced age and the presence of P. aeruginosa were associated with higher SNOT-22 scores.

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Morbidity and Functional Outcomes with Head and Neck Free Flap Reconstruction in Patients Over 90 Years of Age

Publication date: Available online 18 December 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Adam P. Fagin, Savannah Gelesko, Mark K. Wax, Daniel Petrisor
IntroductionMorbidity of free tissue transfer in the extremes of age is controversial and not well studied in patients over ninety due the rarity of these patients and many clinicians' natural hesitance to perform such a large operation on patients of this group. The purpose of this study was to answer the clinical question, "Do patients over the age of ninety who undergo free flap reconstruction have worse functional outcomes than their younger counterparts?"Study DesignRetrospective chart review of patients over ninety years old who underwent free flap reconstruction at OHSU from 2000 to 2015.MethodsAll patients over the age of ninety undergoing free flap reconstruction were included. Patients under the age of ninety during the same time period were randomly selected to serve as controls.ResultsFree flap reconstructions were performed on fourteen patients over the age of ninety, which were then compared to their randomly selected controls. The only statistically significant difference observed in the outcome variables analyzed was the discharge from hospital location, with the older patients more likely to be discharged to a skilled nursing facility (p=0.002). However, there was no difference in return to baseline level of care at last follow-up between the two groups. There was also no statistically significant difference in major or minor medical or surgical complication rates, duration of hospitalization, duration of tracheostomy, return to baseline respiratory status, or return to baseline feeding status between the two groups.ConclusionPatients over ninety are more likely to be discharged to a skilled nursing facility than their younger counterparts, but otherwise have similar outcomes in terms of complications and return to baseline function. The results of this study suggest that age over ninety should not be a direct contraindication for free flap reconstruction for the head and neck.



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Resorbable Suture as Wound Drain

Publication date: Available online 18 December 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Eric Dierks, Gerald Harper
The placement of a resorbable suture on one edge of the wound can effectively retard the mucosal closure of the defect and thereby duplicate the function of a passive surgical drain. The placement of a double or triple loop of a resorbable suture such as chromic gut on one side of the wound edge can provide an inexpensive and self-eliminating wound drain.



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Prognostic factors in malignant sublingual salivary gland tumors

Publication date: Available online 18 December 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Yanbin Liu, Hong Li, Lizheng Qin, Xin Huang, Ming Su, Zhengxue Han
PurposeThis study identified the prognostic factors and outcomes for malignant sublingual salivary gland tumors, which are rare.Materials and MethodsRetrospective cohort study of patients treated for malignant sublingual salivary gland tumors from 1997 to 2011 was performed. Predictor variables, including age, gender, tumor stage, nodal stage, perineural invasion, margin status, and lymphovascular invasion, were analyzed. Cox regression model was used to determine the prognostic factors for local-regional recurrence, distant metastasis, and survival.ResultsAmong 38 patients, 16 (42.1%) were male. Mean age was 53 years (range: 36–75). A total of 11 (28.9%) patients had T3–4 tumors, and 6 (15.8%) had positive neck lymph nodes. The recurrence rate at 5 years was 18.4%. The distant metastasis rate at 5 years was 23.7%. Multivariable analysis confirmed the independent prognostic importance of the age, N stage, and limited tongue mobility in local-regional recurrence and mortality at 5 years.ConclusionsOur results suggested that age, N stage, and limited tongue mobility are useful as independent predictors of local-regional recurrence and mortality in patients with malignant sublingual salivary gland tumors.



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Papilomas rinosinusales en un centro de referencia otorrinolaringológico privado: revisión de 22 años de experiencia

Publication date: Available online 16 December 2016
Source:Acta Otorrinolaringológica Española
Author(s): Aderito de Sousa Fontes, Minaret Sandrea Jiménez, Nelson Urdaneta Lafée, Perfecto A. Abreu Durán, Liwven E. Quintana Páez, Andreina Carmina de Sousa de Abreu
ObjetivosEvaluar la presentación clínica, los resultados al tratamiento y el seguimiento de los pacientes con papilomas rinosinusales (PRS), en un centro de atención terciaria otorrinolaringológica en Caracas (Venezuela).Material y métodosSe realizó una revisión de 94 pacientes con PRS que fueron diagnosticados en nuestro centro otorrinolaringológico desde el 1de julio de 1993 hasta el 31 de junio de 2015. Se evaluaron los datos demográficos, las características clínicas, los hallazgos radiológicos, el origen anatómico, la extensión de la enfermedad hacia estructuras adyacentes, los procedimientos quirúrgicos realizados, la histopatología, el riesgo de recurrencia y la tasa de transformación maligna, y las terapias coadyuvantes.ResultadosSesenta y cinco pacientes (69,1%) eran varones y 29 (30,9%) mujeres, con una edad promedio de 44,5 años (rango 9-80 años). Todos los pacientes fueron sometidos a cirugía endoscópica de senos paranasales. Los subtipos histológicos más comunes de PRS fueron el papiloma invertido (58 pacientes; 61,7%), el papiloma fungiforme o exofítico (35 pacientes; 37,2%) y el papiloma oncocítico (un paciente; 1,1%). El papiloma invertido se asoció en 2 pacientes con carcinoma indiferenciado de células escamosas. Doce pacientes (12,8%) presentaron enfermedad de extensión extrasinusal. Todos estos pacientes recibieron tratamiento adyuvante con técnicas avanzadas de radioterapia. El promedio de duración del seguimiento fue de 9 años y 2 meses. Dieciocho pacientes (19,1%) presentaron enfermedad recurrente durante todo ese periodo de seguimiento.ConclusionesLa resección endoscópica completa de los PRS es el tratamiento de elección. En lesiones menos accesibles endoscópicamente, con extensión periférica o tumores resecados de forma incompleta, las técnicas de radioterapia avanzadas como la radioterapia de intensidad modulada y la radioterapia en arcos de volumen modulado pueden estar indicadas con éxito. El control endoscópico postoperatorio oportuno con biopsias de lesiones sospechosas son importantes para la detección precoz de recidivas y malignización asociada.ObjectivesTo evaluate the clinical presentation, treatment outcome and follow-up of all patients managed with sinonasal papillomas (SP), at a tertiary private otorhinolaryngology centre in Caracas (Venezuela).Material and methodsWe reviewed 94 patients with SP that were treated at our otolaryngology center, from July 1st 1993 to June 31st 2015. The demographic data, clinical features, radiological findings, anatomical origin, disease extension into the adjacent structures, surgical approaches performed, histopathology outcomes, recurrent risk, malignant transformation rate and coadjuvant therapies were assessed.ResultsSixty-five patients (69.1%) were male and 29 (30.9%) female with an average age of 44.5 years (range 9-80 years). All patients underwent endoscopic sinus surgery. The most commont histologic subtypes of SP were inverted papilloma (58 patients; 61.7%), fungiform papilloma (35 patients; 37.2%) and oncocytic papilloma (one patient; 1.1%). SP was associated in 2 patients with undifferentiated squamous cell carcinoma. Twelve patients (12.8%) had disease with extension beyond the sinus without associated malignancy. All these patients received adjuvant treatment with advanced techniques of radiotherapy. The mean duration of the follow-up period was 9 years and 2 months. Eighteen patients (19.1%) had recurrent disease during the entire course of follow-up.ConclusionsComplete endoscopic surgical removal of SP is the treatment of choice. In less endoscopically accessible tumours, with peripheral extension or incompletely resected, Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy may be indicated. Timely post-operative endoscopic follow-up with biopsy of suspected lesions is important for early detection of recurrences and associated malignancy.



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Resolución espontánea de atelectasia maxilar crónica en paciente pediátrico: un caso excepcional

Publication date: Available online 18 December 2016
Source:Acta Otorrinolaringológica Española
Author(s): Claudia González, Karen M. García, Soledad Palma, Claudio A. Callejas




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Pigmented epidermotropic metastasis from breast carcinoma

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Biphasic synovial sarcoma with prominent cavernous hemangioma-like stroma

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Erythema multiforme associated with Trueperella pyogenes bacteremia

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Efficacy of topical tacrolimus for treating Kyrle's disease

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Pazopanib induced a partial response in a patient with metastatic fibrosarcomatous dermatofibrosarcoma protuberans without genetic translocations resistant to mesna, doxorubicin, ifosfamide and dacarbazine chemotherapy and gemcitabine–docetaxel chemotherapy

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Lymphomatoid granulomatosis initially presenting as ulcerated subcutaneous and muscle lesions without pulmonary involvement

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Rare case of Netherton syndrome with generalized lentigines

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Long-term efficacy and safety of the dual 5-alpha reductase blocker dutasteride on male androgenetic alopecia patients

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Competing causes of death in the head and neck cancer population

Publication date: February 2017
Source:Oral Oncology, Volume 65
Author(s): Sean T. Massa, Nosayaba Osazuwa-Peters, Kara M. Christopher, Lauren D. Arnold, Mario Schootman, Ronald J. Walker, Mark A. Varvares
Purpose/objectivesThe increasing survivorship of head and neck squamous cell carcinoma (HNSCC) comes with a risk of death from other causes, known as competing causes. The demographics of HNSCC are also evolving with increasing incidence of Human Papillomavirus (HPV) associated tumors. This study describes competing causes of death for the HNSCC population compared to the general population and identifies associated risk factors.MethodsAdult patients with first mucosal HNSCC (2004–2011) were identified from the Surveillance, Epidemiology and End Result database. Competing causes of death were compared to reference populations using proportion of deaths and Standardized Mortality Ratios (SMR). A multivariable competing risk survival analysis yielded subdistribution hazard ratios (HR) for competing mortality.ResultsOf 64,598 HNSCC patients, 24,602 (38.1%) were deceased including 7142 deaths (29.0%) from competing causes. The most common were cardiovascular disease, lung cancer, and other cancers. All relative mortality rates were elevated, especially liver disease (SMR 38.7; 95% CI: 29.4–49.3), suicide (SMR 37.1; 95% CI: 26.1–48.6), and subsequent primary cancers (SMR 7.5; 95% CI: 6.78–8.32). Demographic and tumor factors independently increased risk of competing mortality, including age (HR per 5years 1.24; 95% CI: 1.22–1.25), sex (male HR 1.23; 95% CI: 1.16–1.32), race (Black HR 1.17; 95% CI: 1.09–1.26), insurance (uninsured HR 1.28; 95% CI: 1.09–1.50), and marital status (single HR 1.29; 95% CI: 1.21–1.37).ConclusionNearly one in three HNSCC patients died from competing causes. When developing long term survivorship regimens for HNSCC patients, clinicians should be familiar with this population's specific risks.



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Can ratio of the biggest tumor diameter to total tumor diameter be a new parameter in the differential diagnosis of agressive and favorable multifocal papillary thyroid microcarcinoma?

Publication date: February 2017
Source:Oral Oncology, Volume 65
Author(s): Abbas Ali Tam, Didem Özdemir, Neslihan Çuhacı, Hüsniye Başer, Ahmet Dirikoç, Cevdet Aydın, Aylin Kılıç Yazgan, Reyhan Ersoy, Bekir Çakır
ObjectivesIn this study, we aimed to evaluate the usefulness of a new parameter –ratio of the biggest tumor diameter to total tumor diameter- for the differentiation of agressive and favorable papillary thyroid microcarcinomas (PTMC).Materials and methodsThe diameter of the biggest tumor focus was taken as the primary tumor diameter. Total tumor diameter was calculated as the sum of the maximal diameter of each lesion. Ratio of primary tumor diameter to total tumor diameter was defined as tumor diameter ratio (TDR). Positive and negative predictive value, sensitivity and specificity of TDR to predict capsular invasion, extrathyroidal extension (ETE) and lymph node metastasis (LNM) were determined.ResultsMean TDR was significantly lower in multifocal PTMC patients with capsular invasion, ETE, lymphovascular invasion and LNM compared to patients without these features. The sensitivities of TDR for the detection of LNM, ETE and capsular invasion were 100%, 100% and 94.2%, respectively. Specificity of TDR was 86.2% for LNM, 88% for ETE and 94.7% for capsular invasion. Best cut off values of TDR that can predict capsular invasion, ETE and LNM in multifocal PTMC were 0.62, 0.57 and 0.56, respectively. Multifocal papillary thyroid carcinoma patients with capsular invasion, ETE and LNM had significantly lower mean TDR when compared to ones without these features.ConclusionDecreased TDR was associated with capsular invasion, ETE and LNM in patients with multifocal PTMC and PTC. This new parameter might be particularly helpful for the detection of aggressive behavior in multifocal PTMCs.



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Truth or myth: Definitive chemoradiotherapy doesn’t work for HPV/p16 negative oropharyngeal squamous cell carcinoma?

Publication date: Available online 16 December 2016
Source:Oral Oncology
Author(s): Bhisham Chera, Kyle Wang, Alan Monroe, Tom Galloway, Robert Amdur, D. Neil Hayes, Jose Zevallos, William M. Mendenhall




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C omparative Evaluation of the Intranasal Spray Formulation of Midazolam and Dexmedetomidine in Patients Undergoing Surgical Removal of Impacted Mandibular Third Molars: A Split Mouth Prospective Study

Abstract

Purpose

The purpose of this prospective randomized single blinded split mouth study was to conduct a comparative evaluation of the efficacy of intranasal atomised spray formulation of Dexmedetomidine with Midazolam in patients undergoing surgical removal of bilaterally impacted mandibular third molars.

Methods

This prospective study was conducted in twenty volunteers. Each volunteer underwent the surgical removal of an impacted mandibular third molar at two separate appointments at an interval of two weeks. The first third molar surgery was conducted using either intranasal Midazolam (Group M) or intranasal Dexmedetomidine (Group D). At the second appointment the surgical procedure was performed using the sedative agent not used at the first appointment. The primary testing outcome variables were Plasma oxygen saturation (SpO2), pulse and blood pressure and Modified Observer's Assessment of Alertness/Sedation (OAA/S) scale. These were recorded at predetermined intervals starting 10 min before the administration of local anaesthesia and continued up to 10 min after completion of the procedure. In addition surgeon's opinion regarding the patient cooperation, event amnesia, post operative nausea & vomiting were obtained.

Results

The sample composed of twenty patients (M = 9 and F = 11). There was statistically no significant difference between Group M and Group D with respect to mean SpO2. Minor differences were however noted at 20 and 30 min after sedation. There was no significant difference between the groups with respect to mean pulse rate, blood pressure, OAA/S, event amnesia, post operative nausea and vomiting and patient cooperation.

Conclusion

We conclude that Midazolam and Dexmedetomidine are equivalent and can be used in minor oral surgery with minimal complications. These drugs can be used intranasally using nasal atomization device in routine outpatient basis in otherwise normal healthy but anxious patients. All procedures must however be performed in the presence of an anaesthesiologist and with ready availability of emergency drugs and equipment.

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Orthognathic Surgery: A Review of Articles Published in 2014–2015

Abstract

Objectives

We did a retrospective study and reviewed some of the orthognathic surgery related papers that were published between January 2014 and December 2015 in a leading International Maxillofacial Surgery Journal. It was conducted to ascertain the trends of articles being published.

Method

A total of around 57 articles were reviewed, of which most of the full length articles were on post operative outcomes and obstructive sleep apnoea.

Results

Bulk of the studies were retrospective, and less interest was shown onto experimental researches.

Conclusion

A thorough review and analysis thus gives an impression that there is a high requirement of well designed clinical studies.

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Chondrosarcomatous Differentiation in a Large Malignant Melanoma of the Scalp

Background. Divergent differentiation in malignant melanoma is a rare phenomenon, which can lead to delayed diagnosis or misdiagnosis, impacting upon patient treatment and outcome, as well as the understanding of tumour behaviour. Case. We present the case of a large long-standing tumour on the scalp of a 72-year-old female patient, which when excised and examined histologically was revealed to be a nodular malignant melanoma displaying chondrosarcomatous differentiation. Foci suggestive of lentigo maligna were also present. Rapid metastatic spread of the tumour was observed shortly after the primary resection. Discussion. To our knowledge, this is the first reported case in the literature of chondrosarcomatous differentiation in a lentigo maligna melanoma. The clinical and histopathological details and images of this case are presented alongside a discussion regarding such tumours and patterns of similar tumour behaviour.

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Schwannoma Localized Retroperitoneally in a 14-Year-Old Boy

Schwannomas usually occur in adults being between the second and fifth decades, and such neoplasms are extremely rare in a pediatric population. In addition, they are not normally found in the retroperitoneal region. Here, we present a pediatric case of a retroperitoneal schwannoma in an adrenal location where the tumor was not able to be preoperatively differentiated from other benign or malign adrenal gland tumors. In our opinion, this tumor can be included in the differential diagnosis of a nonfunctioning retroperitoneal adrenal mass in children.

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A nasolabial swelling

Publication date: Available online 16 December 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): C.A. Righini, A. Baguant, I. Atallah




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EGFRI-induced papulopustular rosacea-like rash successfully treated with topical ivermectin

Abstract

A 63-year-old Caucasian man presented with a three weeks history of multiple erythematous, rosacea-like, facial and thoracic papules and pustules. No mucosal lesions were present. The patient received a combined therapy for metastatic colon carcinoma with cetuximab 500 mg/m²/week plus capecitabine 500 mg/week; just after the onset he developed the papulopustular rash first on his face with subsequent expansion to the thorax (figure 1, A, B).

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