Head and Neck Medicine by Alexandros G.Sfakianakis: 12/29/16

Πέμπτη 29 Δεκεμβρίου 2016

Effect of Perineural Dexamethasone on the Duration of Single Injection Saphenous Nerve Block for Analgesia After Major Ankle Surgery: A Randomized, Controlled Study.

Background and Objectives: Patients undergoing major elective ankle surgery often experience pain from the saphenous nerve territory persisting beyond the duration of a single-injection saphenous nerve block. We hypothesized that perineural dexamethasone as an adjuvant for the saphenous nerve block prolongs the duration of analgesia and postpones as well as reduces opioid-requiring pain. Methods: Forty patients were included in this prospective, randomized, controlled study. All patients received a continuous sciatic catheter and were randomized to receive a single-injection saphenous nerve block with 10 mL of 0.5% bupivacaine with 1:200,000 epinephrine with addition of 1 mL of saline or 1 mL of 0.4% (ie, 4 mg) dexamethasone. The primary outcome was duration of saphenous nerve block estimated as the time until the first opioid request. Secondary outcomes were opioid consumption and pain. Results: The mean (SD) duration of the saphenous nerve block until first opioid request was 29.4 (8.4) hours in the dexamethasone group and 23.2 (10.3) hours in the control group (P = 0.048). The median opioid consumption [interquartile range] during the first 24 hours was 0 mg [0-0] versus 1.5 mg [0-14.2] in the dexamethasone and control groups, respectively. Nonparametric comparison of opioid consumption from 0 to 24 hours was statistically significant. The opioid consumption was similar in the two groups in the time interval 24 to 48 postoperative hours. Conclusion: Perineural dexamethasone as an adjuvant for the single-injection subsartorial saphenous nerve block can prolong analgesia and reduce opioid-requiring pain after major ankle surgery. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.

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Is there a role of food additives in recurrent aphthous stomatitis? a prospective study with patch testing

Abstract

Background

Recurrent aphthous stomatitis (RAS) is a common disease of the oral mucosa with an unknown etiology. This study aimed to determine if food additives play a role in the etiology of RAS as well as to determine if patch testing can be used to detect which allergens cause RAS.

Methods

This prospective study included 24 patients with RAS and 22 healthy controls. All the participants underwent patch testing for 23 food additives.

Results

In total, 21 (87.5%) RAS patients and 3 (13.6%) controls had positive patch test reactions to ≥1 allergens; the difference in the patch test positivity rate between groups was significant (P < 0.05). The most common allergen that elicited positive patch test results in the patient group was cochineal red (n = 15 [62.5%]), followed by azorubine (n = 11 [45.8%]) and amaranth (n = 6 [25%]).

Conclusions

The present findings show that food additives might play a role in the etiology of RAS and that patch testing could be a method for determining the etiology of RAS.

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A Tribute to Tony Bull—Surgeon, Teacher, Leader, Gentleman (1934–2016)

Facial plast Surg 2016; 32: 579-584
DOI: 10.1055/s-0036-1594257

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Worldwide Perspectives in Facial Plastic Surgery

Facial plast Surg 2016; 32: 585-586
DOI: 10.1055/s-0036-1597957

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Optimizing the Soft Tissue Triangle, Alar Margin Furrow, and Alar Ridge Aesthetics: Analysis and Use of the Articulate Alar Rim Graft

Facial plast Surg 2016; 32: 646-655
DOI: 10.1055/s-0036-1596049

The alar lobule, alar margin, and soft triangle facet are receiving more attention in the literature as critical elements to address both preoperatively and during rhinoplasty. We have found that the use of the articulated alar rim graft (AARG) corrects deficiencies in these areas as well as provides mechanical stability to the external valve. In this article, we describe indications for AARG, describe in detail the procedure for AARG placement, and highlight the transformation AARGs can achieve in two illustrated case studies.
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Aesthetic Rhinoplasty as a Surface-Contour Operation: From Analysis to Surgery—Personal Concepts

Facial plast Surg 2016; 32: 587-598
DOI: 10.1055/s-0036-1597146

Numerous beautiful rhinoplasty results have been created by closed rhinoplasty techniques over the past 100 years. This operation was mainly a "reduction" surgery. Overaggressive reduction rhinoplasty is not a hallmark of the closed approach per se, but represents the result of inappropriate aesthetic appraisal, inadequate technical execution, or lack of sound anatomical understanding. Clearly, an operation based primarily on reduction intrinsically exposes the surgeon to the possibility of excessive diminution of support structures and consequently undesirable side effects. The advent of the external approach in the 1970s marked a paradigm shift. In the early 1990s, the external approach witnessed further development with the introduction of "structural rhinoplasty," a deconstruction procedure followed by structural reconstruction. Opponents of the external approach felt that opening every nose can result in an overkill, specifically because the vast majority of patients presenting for cosmetic rhinoplasty neither desire nor require major reconstruction of the nose. In the last decade, the poorly named "closed" approach, once the pariah of rhinoplasty, has been rethought especially in the light of the undesirable long-term side effects, reappraised, and found a new lease of life as "endonasal rhinoplasty." The personal surgical evolution of the senior author (P. P.) has created the concept of "hybrid endonasal rhinoplasty" (HER), where the term "hybrid" implies the incorporation of anatomical concepts and sophisticated suturing–grafting techniques developed by "openers" into the theoretical and technical corpus of HER. The senior author (P. P.) pondered over heterogenous concepts such as filling-reshaping, derived from the so-called medical rhinoplasty, and embodied these concepts into a purely surgical endonasal perspective. Consequently, aesthetic rhinoplasty can be considered a "surface-contour" operation. Nasal analysis, preoperative work-up, surgical logic, and operative techniques have been rethought. The patient is only interested in nasal appearance, not in its anatomy, so deconstructing the nose to change the subtle and demanding interplay of light and shadow is in many cases an overkill. Our emphasis should be on those structures that can be tackled and result in the ultimate aim of altering the aesthetic aspects of surface anatomy. Surface HER can deliver on all these counts.
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Optimizing Outcomes with Clinical Data Registries

Facial plast Surg 2016; 32: 636-637
DOI: 10.1055/s-0036-1596047

Clinical data registries are platforms to extract, store, analyze, and disseminate large amounts of clinical data. The type of data contained in clinical data registries varies by the registry, and may include patient demographics, clinical examination findings, imaging and laboratory results, procedures performed, and patient-reported outcomes. When large numbers of participants submit data to a clinical data registry the data can then be analyzed in aggregate to answer new clinical questions. Analyses on the data may be performed to show outcomes over time, compare procedures, evaluate care patterns, among others. With the launch of an otolaryngology-specific clinical data registry, Regent, facial plastic and reconstructive surgeons have the opportunity to participate in a clinical data registry for the first time. Through broad participation in the registry, the specialty has a chance to optimize patient outcomes in a manner never before possible.
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Suspension Threads

Facial plast Surg 2016; 32: 662-663
DOI: 10.1055/s-0036-1597541

Suture threads are a minimally invasive surgical technique for facial rejuvenation. Its use was initiated by Sulamanidze et al with propylene after Serdev introduced suture with polycaproamide; however, these types of suture increased inflammatory reaction. For correction of the aging face, surgeons are devising more procedures with fewer incisions and shorter postoperative recovery periods. Many of these procedures use absorbable and nonabsorbable sutures in the dermis and subcutis to lift lax skin. The polydioxanone suture is currently a great option for antiaging treatment, because besides the ease of applicability and good results, it also has a low incidence of adverse reactions.
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Rhytidoplasty: SMAS Imbrication Vector Comparison

Facial plast Surg 2016; 32: 599-606
DOI: 10.1055/s-0036-1597145

To determine if there are aesthetic differences in patients who have undergone a SMAS lifting with predominantly oblique-horizontal vectors versus predominantly oblique-vertical vectors. To determine if there are aesthetic differences in the results of the neck using sutures placed in specific areas of the platysmal muscle versus randomly placed sutures for platysmal plication to the mastoid. Comparative, retrospective, blind, and randomized study. Evaluation of preoperative and postoperative photographs of 54 patients who underwent predominantly oblique-horizontal SMAS lifting versus 53 patients who underwent predominantly oblique-vertical traction of the SMAS flap, reviewed by three external, unbiased facial plastic surgeons in a blind study. A 7-point scale was used to grade the improvement of the face and the neck. In the face, SMAS lifting with predominantly oblique-vertical vectors used during the procedure offer statistically better results (p ≤ 0.001) in comparison to predominantly oblique-horizontal vectors in the aesthetical improvement of the malar eminence, melolabial fold and jowls. In the neck, both techniques offer excellent results, but the sutures used for platysmal plication in specific areas offer no statistical differences in aesthetical results from those sutures that are randomly placed in the platysmal muscle. In our study of 107 patients, SMAS lifting using predominantly oblique-vertical vectors seem to have better results than using predominantly oblique-horizontal vectors. For the neck, we do not find statistical differences between randomly placed sutures for platysmal plication versus sutures placed in specific areas of the muscle.
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How to Harmonize the Ethnic Nose

Facial plast Surg 2016; 32: 620-624
DOI: 10.1055/s-0036-1597660

The demand for cosmetic surgery has significantly increased in the past few years mainly due to economic rise witnessed in Brazil. The state of Bahia has predominately Afro-descendant population with the same countrywide scenario, where the surgeon must be able to face challenges such as the specifics demands of rhinoplasty in an ethnic nose. It represents not only a different nasal variety from the Caucasoid, but also a complex anatomical feature, with its own peculiarities, as thicker and oilier skin, with bulky fibrous fatty tissue with numerous sebaceous glands. The nose tip features both inadequate projection and definition, including a short columella and underdeveloped nasal spine. The lower lateral cartilages are lower and thinner if compared with Caucasian noses. The nasal septum is short and fragile, whereas the dorsum is low and wide with deep nasion and wide obtuse angles between nasal bones. Finally, yet importantly, the nose base has increased interalar distance and excess of alar wing, with an ovoid, horizontal, and open nostril. Considering all these uniqueness, the existing challenges to approach an ethnic nose are clear. It requires skill and accurate surgical maneuvers to seek facial harmony while maintaining the characteristics that define the individual ethnicity and identity.
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Transpalpebral Eyebrow Lift

Facial plast Surg 2016; 32: 631-635
DOI: 10.1055/s-0036-1596048

Forehead rejuvenation goals are to raise the eyebrow, attenuate forehead wrinkles, and decrease glabellar frown lines. Endoscopic forehead lift represents a significant progress, even replacing the classic coronal and pretriquial techniques. The transpalpebral eyebrow lift allows safe direct visualization of anatomic structures comparable to the allowed by the endoscopic-assisted technique but dispenses the endoscopic instrumentation, is less expensive, and takes less time to learn. Transpalpebral eyebrow lift is a technique that produces satisfactory results in mild-to-moderate eyebrow ptosis improving eyebrow lateral third ptosis and glabellar wrinkles.
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Endoscopic Brow Elevation and Reshaping

Facial plast Surg 2016; 32: 607-614
DOI: 10.1055/s-0036-1594255

One of the first signs of aging belongs to the upper third of the face. At the same time, the height and shape of the eyebrows are key points of the periorbital aesthetics. A "tired" or "sad" look implies that the complex eyebrow–upper eyelid are showing one or more of these signs. Different surgical techniques as well as nonsurgical have been described to treat this area, every one of them aiming at making the patient look rested and natural. The objective of this study is to describe a technique for endoscopic browlifting, consisting of minimal incisions, a biplanar dissection, and a different fixation technique designed for helping reshape the brow. Twenty-five patients who fulfilled the criteria for the study were analyzed for brow-position changes in height and shape. All the patients were treated by the senior authors using the technique described. This particular surgical technique has shown the advantage of being minimally invasive and effective. Careful analysis of the patient should be made to decide both the technique and the changes desired by the patient and the surgeon. The authors believe the technique described is another option for approaching and fixating the eyebrow.
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Rebuilding the Middle Vault in Rhinoplasty: A New Classification of Spreader Flaps/Grafts

Facial plast Surg 2016; 32: 638-645
DOI: 10.1055/s-0036-1597144

After hump removal in reduction rhinoplasty, one of the main steps is to rebuild the middle vault. Spreader grafts have long been the main tool for the surgeon. Within the last two decades, the spreader flaps have started to be very popular as well. In accordance with the experience and technical preferences of the surgeon, there are many different options. In this article, the spreader grafts are classified as traditional, modified, splinting, and reconstructive. The spreader flaps are designed in accordance with their relationship with the septum and the spreader grafts.
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Treatment Strategy for Revision Rhinoplasty in Asians

Facial plast Surg 2016; 32: 615-619
DOI: 10.1055/s-0036-1594254

Revision rhinoplasty in Asian patients is associated with problems related to the use of grafts or implant materials. Moreover, the septal cartilage of Asian individuals is generally weak and small, which makes it particularly vulnerable to injury or secondary deformity during primary surgery. Hence, there is an increased demand for major reconstruction of the septal cartilage framework during revision surgery in Asian patients. In revision rhinoplasty of the nose in Asian patients, appropriate management of the graft or implant is vital. The common problems resulting in the need for revision surgery include displacement, malposition, extrusion, recurrent inflammation, and infection of dorsally implanted alloplastic material. A short-nose deformity following silicone rhinoplasty is also a common problem that is difficult to manage. Furthermore, residual or recurrent deviation of the deviated nose, undercorrection of the convex nasal dorsum, and tip graft-related complications are frequently encountered problems that require revision. In revision rhinoplasty for Asian patients, autologous tissues, such as conchal cartilage and costal cartilage, play a pivotal role for use as a new dorsal implant or building block for major septal reconstruction. Therefore, it is imperative for surgeons to familiarize themselves with the appropriate use of autologous tissues, particularly costal cartilage.
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Isotretinoin Use in Thick-Skinned Rhinoplasty Patients

Facial plast Surg 2016; 32: 656-661
DOI: 10.1055/s-0036-1596045

One of the characteristics of mestizo patients can be the thick sebaceous skin associated with a poor osteocartilaginous underlying nasal structure. In spite of using a proper structural approach where grafts and sutures are used to define the nasal tip, frequently the results are suboptimal. Surgical techniques have been described to reduce the thickness of the skin-soft tissue envelope, but these frequently give unreliable results. The monitored use of isotretinoin given orally as a complement after performing a rhinoplasty can adequately control the production of the sebaceous glands and thin the skin-subcutaneous tissue envelope in a uniform fashion without compromising the underlying bony and cartilaginous structures of the nose. Patients ideally should be treated jointly with a dermatologist and be followed closely to monitor hepatic function. Follow-up after 2 years with pre- and postoperative pictures shows improved definition of the nasal tip and dramatic improvement on sebaceous gland production.
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Use of “Submental Muscular Medialization and Suspension” to improve the Cervicomental Angle

Facial plast Surg 2016; 32: 625-630
DOI: 10.1055/s-0036-1594259

Many techniques have been presented over recent decades to address the neck contour in facial cosmetic surgery. Despite advances, limitations remain when dealing with the obtuse cervicomental angle. The authors describe a technique for improving the obtuse cervicomental angle. Submental muscular medialization and suspension is a simple yet highly effective surgical technique that can result in dramatic and enduring improvement in the cervicomental angle.
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Dome Division: A Viable Technique Today?

Facial plast Surg 2016; 32: 664-670
DOI: 10.1055/s-0036-1593748

Dome division can still be regarded as a valid surgical procedure today in some particular cases of revision rhinoplasty where the scarring is so extensive as to make precise isolation of the alar cartilages impossible. The presence of asymmetry of the nasal tip, a recurrent feature in the results of rhinoplasty, constitutes the primary indication, as division makes it immediately possible to restore balance between the two domes in such cases. The technique also proves useful in cases of overprojection of the tip as a result of rhinoplasty. Moreover, the procedure has been improved by precise suturing of the cartilaginous stumps so as to avoid its frequently reported complications, arising essentially from the vulnerability of the domal arch to the distorting forces of cicatricial retraction and its resulting lack of stability over time. In this connection, the authors attach crucial importance to direct suturing of the cartilaginous stumps in accordance with a now standardized method that is easy to execute and offers lasting, stable results. This approach makes it possible to re-establish continuity of the cartilaginous domal arch in a form unquestionably closer to the physiological anatomical conformation.
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The Facial Adipose Tissue: A Revision

Facial plast Surg 2016; 32: 671-682
DOI: 10.1055/s-0036-1596046

Recent advantages in the anatomical understanding of the face have turned the focus toward the subcutaneous and deep facial fat compartments. During facial aging, these fat-filled compartments undergo substantial changes along with other structures in the face. Soft tissue filler and fat grafting are valid methods to fight the signs of facial aging, but little is known about their precise effect on the facial fat. This narrative review summarizes the current knowledge about the facial fat compartments in terms of anatomical location, histologic appearance, immune-histochemical characteristics, cellular interactions, and therapeutic options. Three different types of facial adipose tissue can be identified, which are located either superficially (dermal white adipose tissue) or deep (subcutaneous white adipose tissue): fibrous (perioral locations), structural (major parts of the midface), and deposit (buccal fat pad and deep temporal fat pad). These various fat types differ in the size of the adipocytes and the collagenous composition of their extracellular matrix and thus in their mechanical properties. Minimal invasive (e.g., soft tissue fillers or fat grafting) and surgical interventions aiming to restore the youthful face have to account for the different fat properties in various facial areas. However, little is known about the macro- and microscopic characteristics of the facial fat tissue in different compartments and future studies are needed to reveal new insights to better understand the process of aging and how to fight its signs best.
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Drug Survival Analysis Is Not a Good Method for Assessing the Safety or Effectiveness of Systemic Therapies in Psoriasis [Free article]

P. Dávila-Seijo, I. García-Doval
Actas Dermosifiliogr.2017;108:3-5

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Cutaneous Adverse Events of New Anti-melanoma Therapies: Classification and Management [Free article]

S.J.E. Hwang, R. Anforth, G. Carlos, P. Fernandez-Peñas
Actas Dermosifiliogr.2017;108:6-16

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Use of New Techniques in Addition to IHC Applied to the Diagnosis of Melanocytic Lesions, With Emphasis on CGH, FISH, and Mass Spectrometry [Free article]

P. Nagarajan, M.T. Tetzlaff, J.L. Curry, V.G. Prieto
Actas Dermosifiliogr.2017;108:17-30

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Precancerous Skin Lesions [Free article]

C. Ferrándiz, J. Malvehy, C. Guillén, C. Ferrándiz-Pulido, M.T. Fernández-Figueras
Actas Dermosifiliogr.2017;108:31-41

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Usefulness of High-Frequency Ultrasound in the Classification of Histologic Subtypes of Primary Basal Cell Carcinoma [Free article]

C. Hernández-Ibáñez, N. Blazquez-Sánchez, M. Aguilar-Bernier, R. Fúnez-Liébana, F. Rivas-Ruiz, M. de Troya-Martín
Actas Dermosifiliogr.2017;108:42-51

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Management of Biologic Therapy in Moderate to Severe Psoriasis in Surgical Patients: Data From the Spanish Biobadaderm Registry [Free article]

S. Galiano Mejías, G. Carretero, C. Ferrandiz, F. Vanaclocha, E. Daudén, F.J. Gómez-García, E. Herrera-Ceballos, I. Belinchón-Romero, J.L. Sánchez-Carazo, J.L. López-Estebaranz, M. Alsina, M. Ferrán, R. Torrado, J.M. Carrascosa, R. Rivera, M. Llamas-Velasco, R. Jiménez-Puya, Mª V. Mendiola, D. Ruiz-Genao, M.A. Descalzo, P. de la Cueva Dobao
Actas Dermosifiliogr.2017;108:52-8

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Usefulness of a Simple Immunohistochemical Staining Technique to Differentiate Anti-p200 Pemphigoid From Other Autoimmune Blistering Diseases: A Report of 2 Cases [Free article]

I. García-Díez, M.E. Martínez-Escala, N. Ishii, T. Hashimoto, J.M. Mascaró Galy, R.M. Pujol, J.E. Herrero-González
Actas Dermosifiliogr.2017;108:e1-5

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Majocchis Granuloma Caused by Trichophyton mentagrophytes in 2 Immunocompetent Patients [Free article]

I. Trocoli Drakensjö, I. Vassilaki, M. Bradley
Actas Dermosifiliogr.2017;108:e6-8

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Asymptomatic Facial Nodule [Free article]

P. Espinosa Lara, Y. Pérez González, J. Jiménez Reyes
Actas Dermosifiliogr.2017;108:59-60

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Indurated Plaque on the Upper Lip of a Patient With Multiple Myeloma [Free article]

C. Ramos-Rodríguez, L. González-López, M. García-Arpa
Actas Dermosifiliogr.2017;108:61-2

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RF–Burning Mouth Syndrome: New Treatments [Free article]

H. Cembrero-Saralegui, A. Imbernón-Moya
Actas Dermosifiliogr.2017;108:63-4

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Screening for Anal Intraepithelial Neoplasia: High-Resolution Anoscopy-Guided Biopsy of the Anal Canal [Free article]

J.B. Repiso-Jiménez, L. Padilla-Espana, T. Fernández-Morano, M. de Troya-Martín
Actas Dermosifiliogr.2017;108:65-6

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Faun Tail Nevus: A Cutaneous Sign of Spinal Dysraphism [Free article]

I. Pérez-López, A. Martinez-López, G. Blasco-Morente, R. Ruiz-Villaverde
Actas Dermosifiliogr.2017;108:67

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Kaposi Varicelliform Eruption: A Dermatologic Complication [Free article]

I. Pérez-López, G. Blasco-Morente, A. Martínez-López, J. Tercedor-Sánchez
Actas Dermosifiliogr.2017;108:68

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Relapse of morphea during Nivolumab therapy for lung adenocarcinoma [Free article]

A. Alegre-Sánchez, P. Fonda-Pascual, D. Saceda-Corralo, E. de las Heras-Alonso
Actas Dermosifiliogr.2017;108:69-70

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Sweet's syndrome-like eruption in association with the exacerbation of Behçet's disease after the Great East Japan Earthquake [Free article]

T. Miura, M. Ohtsuka, T. Yamamoto
Actas Dermosifiliogr.2017;108:70-2

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Congenital Plaque-type Glomuvenous Malformation: 11 Years of Follow-up and Response to Treatment With the Combined Pulsed-Dye and Neodymium:Yttrium-Aluminum-Garnet Laser [Free article]

N. Vargas-Navia, E. Baselga, F.Z. Muñoz-Garza, L. Puig
Actas Dermosifiliogr.2017;108:72-4

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Bullous Morphea: Description of a New Case and Discussion of Etiologic and Pathogenic Factors in Bulla Formation [Free article]

S. Sánchez-Pérez, I. Escandell-González, M.I. Pinazo-Canales, E. Jordá-Cuevas
Actas Dermosifiliogr.2017;108:75-6

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Amlodipine-Associated Photodistributed Telangiectasia [Free article]

E. Rojas Mora, D. Martínez Sánchez, A. Hernández-Núñez, J. Borbujo Martínez
Actas Dermosifiliogr.2017;108:76-7

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Papular Acantholytic Dyskeratosis of the Vulva in a Woman With Benign Familial Pemphigus [Free article]

C. Baliu-Piqué, P. Iranzo
Actas Dermosifiliogr.2017;108:78-9

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Attic cholesteatoma with closure of the entrance to pars flaccida retraction pocket

Publication date: Available online 29 December 2016
Source:Auris Nasus Larynx
Author(s): Shingo Matsuzawa, Yukiko Iino, Daiki Yamamoto, Masayo Hasegawa, Mariko Hara, Akihiro Shinnabe, Hiromi Kanazawa, Naohiro Yoshida
We report three patients with pars flaccida-type cholesteatoma (attic cholesteatoma) with closure of the entrance to the cholesteatoma at the time of surgery. These patients were diagnosed with attic cholesteatoma requiring surgery on the basis of abnormal findings of the pars flaccida, audiometry, and temporal bone computed tomography during the clinical course. Intraoperatively, cholesteatoma matrix and granulation tissue were observed behind the intact pars flaccida epithelium, which suggested that the entrance had apparently closed and the continuity with the cholesteatoma matrix disappeared after resolution of inflammation at the pars flaccida. In such patients, a normal pars flaccida may cause cholesteatoma to be initially overlooked, or misdiagnosed as congenital cholesteatoma. The diagnosis should be carefully made on the basis of the clinical course and the results of various examinations.

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Isolated left brachiocephalic artery with the right aortic arch: A rare differential of large patent ductus arteriosus

Gajendra Dubey, Saurabh Kumar Gupta, Shyam Sundar Kothari

Annals of Pediatric Cardiology 2017 10(1):78-81

We report a case of isolation of the left brachiocephalic artery with the right aortic arch in a 9-year-old male child masquerading as large patent ductus arteriosus with left-to-right shunt. We have emphasized the subtle clinical findings which served as clues to the diagnosis.

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Spectrum of cyanotic congenital heart disease diagnosed by echocardiographic evaluation in patients attending a tertiary cardiac care center of South Rajasthan

Amit Kumar, Kapil Bhargava

Annals of Pediatric Cardiology 2017 10(1):97-98

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Transcatheter pulmonary valve perforation using chronic total occlusion wire in pulmonary atresia with intact ventricular septum

Shweta Bakhru, Shilpa Marathe, Manish Saxena, Sudeep Verma, Rajan Saileela, Tapan K Dash, Nageswara Rao Koneti

Annals of Pediatric Cardiology 2017 10(1):5-10

Background: Perforation of pulmonary valve using radiofrequency ablation in pulmonary atresia with intact ventricular septum (PA IVS) is a treatment of choice. However, significant cost of the equipment limits its utility, especially in the developing economies. Objective: To assess the feasibility, safety, and efficacy of perforation of pulmonary valve using chronic total occlusion (CTO) wires in patients with PA IVS as an alternative to radiofrequency ablation. Methods: This is a single.center, nonrandomized, retrospective study conducted during June 2008 to September 2015. Twenty-four patients with PA IVS were selected for the procedure during the study period. The median age and weight of the study population were 8. days and 2.65 kg, respectively. Four patients were excluded after right ventricular angiogram as they showed right ventricular-dependent coronary circulation. The pulmonary valve perforation was attempted using various types of CTO wires based on the tip load with variable penetrating characteristics. Results: The procedure was successful in 16 of twenty patients using CTO wires: Shinobi in nine, Miracle in four, CROSS-IT in two, and Conquest Pro in one. Two patients had perforation of right ventricular outflow tract (RVOT). Pericardiocentesis was required in one patient to relieve cardiac tamponade. Later, the same patient underwent successful hybrid pulmonary valvotomy. The other patient underwent ductus arteriosus. (DA) stenting. Balloon atrial septostomy was needed in three cases with systemic venous congestion. Desaturation was persistent in five cases necessitating DA or RVOT stenting to augment pulmonary blood flow. There were two early and two late deaths. The mean follow-up was 22.66. ± 16 months. Three patients underwent one and half ventricle repair and one Blalock-Taussig shunt during follow-up. Conclusion: Perforation of the pulmonary valve can be done successfully using CTO wires in selected cases of pulmonary atresia with intact ventricular septum.

http://ift.tt/2hyWqyt

Impact of Abernathy malformation on pulmonary circulatory hemodynamics in a univentricular heart

Vinoth Doraiswamy, Kothandam Sivakumar

Annals of Pediatric Cardiology 2017 10(1):90-91

http://ift.tt/2hQtNc3

Mechanism of valve failure and efficacy of reintervention through catheterization in patients with bioprosthetic valves in the pulmonary position

Ryan Callahan, Lisa Bergersen, Christopher W Baird, Diego Porras, Jesse J Esch, James E Lock, Audrey C Marshall

Annals of Pediatric Cardiology 2017 10(1):11-17

Background: Surgical and transcatheter bioprosthetic valves (BPVs) in the pulmonary position in patients with congenital heart disease may ultimately fail and undergo transcatheter reintervention. Angiographic assessment of the mechanism of BPV failure has not been previously described. Aims: The aim of this study was to determine the mode of BPV failure (stenosis/regurgitation) requiring transcatheter reintervention and to describe the angiographic characteristics of the failed BPVs and report the types and efficacy of reinterventions. Materials and Methods: This is a retrospective single-center review of consecutive patients who previously underwent pulmonary BPV placement. (surgical or transcatheter) and subsequently underwent percutaneous reintervention from 2005 to 2014. Results: Fifty-five patients with surgical. (41) and transcutaneous pulmonary valve. (TPV) (14) implantation of BPVs underwent 66 catheter reinterventions. The surgically implanted valves underwent fifty reinterventions for indications including 16 for stenosis, seven for regurgitation, and 27 for both, predominantly associated with leaflet immobility, calcification, and thickening. Among TPVs, pulmonary stenosis. (PS) was the exclusive failure mode, mainly due to loss of stent integrity. (10) and endocarditis. (4). Following reintervention, there was a reduction of right ventricular outflow tract gradient from 43 ± 16 mmHg to 16 ± 10. mmHg (P < 0.001) and RVp/AO ratio from 0.8 ± 0.2 to 0.5 ± 0.2 (P < 0.001). Reintervention with TPV placement was performed in 45. (82%) patients. (34 surgical, 11 transcatheter) with no significant postintervention regurgitation or paravalvular leak. Conclusion: Failing surgically implanted BPVs demonstrate leaflet calcification, thickness, and immobility leading to PS and/or regurgitation while the mechanism of TPV failure in the short- to mid-term is stenosis, mainly from loss of stent integrity. This can be effectively treated with a catheter.based approach, predominantly with the valve-in-valve technique.

http://ift.tt/2hQyUJD

A novel technique for percutaneous closure of an atrial septal defect in a patient with interrupted inferior vena cava using a “modified” short sheath from an internal jugular vein approach

Tharakanatha R Yarrabolu, Andrew Robinson, Athar M Qureshi

Annals of Pediatric Cardiology 2017 10(1):102-103

http://ift.tt/2hQxlLE

Cardiac magnetic resonance feature tracking in Kawasaki disease convalescence

Konstantinos Bratis, Pauline Hachmann, Nicholas Child, Thomas Krasemann, Tarique Hussain, Sophie Mavrogeni, Rene Botnar, Reza Razavi, Gerald Greil

Annals of Pediatric Cardiology 2017 10(1):18-25

Objective: The objective of this study was to determine whether left ventricular (LV) myocardial deformation indices can detect subclinical abnormalities in Kawasaki disease convalescence. We hypothesized that subclinical myocardial abnormalities due to inflammation represent an early manifestation of the disease that persists in convalescence. Background: Myocardial inflammation has been described as a global finding in the acute phase of Kawasaki disease. Despite normal systolic function by routine functional measurements, reduced longitudinal strain and strain rate have been detected by echocardiography in the acute phase. Methods and Results: Peak systolic LV myocardial longitudinal, radial, and circumferential strain and strain rate were examined in 29 Kawasaki disease convalescent patients (15 males; mean [standard deviation] age: 11 [6.6] years; median interval from disease onset: 5.8 [5.4] years) and 10 healthy volunteers (5 males; mean age: 14 [3.8] years) with the use of cardiac magnetic resonance (CMR) feature tracking. Routine indices of LV systolic function were normal in both groups. Comparisons were made between normal controls and (i) the entire Kawasaki disease group, (ii) Kawasaki disease subgroup divided by coronary artery involvement. Average longitudinal and circumferential strain at all levels was lower in patients compared to normal controls. In subgroup analysis, both Kawasaki disease patients with and without a history of coronary involvement had similar longitudinal and circumferential strain at all levels and lower when compared to controls. There were lower circumferential and longitudinal values in Kawasaki disease patients with persisting coronary artery lesions when compared to those with regressed ones. Conclusion: In this CMR study in Kawasaki disease convalescent patients with preserved routine functional indices, we detected lower circumferential and longitudinal strain values compared to normal controls, irrespective of the coronary artery status.

http://ift.tt/2hz5p2A

Pseudoaneurysm of the left atrium following infective endocarditis

Devi A Manuel, Bino John Sahayo, Viji Samuel Thomson, Jacob Jose

Annals of Pediatric Cardiology 2017 10(1):84-86

Transthoracic echocardiogram of a 3-year-old child showed a hypoechoic cavity in the posterior wall of the left atrium communicating with the left ventricle through an orifice in the mitral annulus, suggestive of pseudoaneurysm (Ps), probably the result of infective endocarditis. Three-dimensional echocardiography was helpful to confirm the diagnosis and assess the anatomical relationship of the Ps.

http://ift.tt/2hQxoXP

Elective nasal continuous positive airway pressure to support respiration after prolonged ventilation in infants after congenital cardiac surgery

Hemang Gandhi, Amit Mishra, Rajesh Thosani, Himanshu Acharya, Ritesh Shah, Jigar Surti, Alpesh Sarvaia

Annals of Pediatric Cardiology 2017 10(1):26-30

Background: We sought to compare the effectiveness of oxygen (O2) treatment administered by an O2 mask and nasal continuous positive airway pressure (NCPAP) in infants after congenital cardiac surgery. Methods: In this retrospective observational study, 54 infants undergoing corrective cardiac surgery were enrolled. According to the anesthesiologist's preference, the patients ventilated for more than 48 h were either put on NCPAP or O2 mask immediately after extubation. From pre-extubation to 24 h after treatment, arterial blood gas and hemodynamic data were measured. Results: After 24 h of NCPAP institution, the patients showed a significant improvement in oxygenation compared to O2 mask group. Respiratory rate (per minute) decreased from 31.67 ± 4.55 to 24.31 ± 3.69 (P < 0.0001), PO2 (mmHg) increased from 112.12 ± 22.83 to 185.74 ± 14.81 (P < 0.0001), and PCO2 (mmHg) decreased from 42.88 ± 5.01 to 37.00 ± 7.22 (P < 0.0076) in patients on NCPAP. In this group, mean pediatric cardiac surgical Intensive Care Unit (PCSICU) stay was 4.72 ± 1.60 days, with only 2 (11.11%) patients requiring re-intubation. Conclusion: NCPAP can be used safely and effectively in infants undergoing congenital cardiac surgery to improve oxygenation/ventilation. It also reduces the work of breathing, PCSICU stay, and may reduce the likelihood of re-intubation.

http://ift.tt/2hQBQWz

Transcatheter closure of aortopulmonary window with Amplatzer duct occluder II

Hemant Kumar Nayak, Nurul Islam, Bhanu Kumar Bansal

Annals of Pediatric Cardiology 2017 10(1):93-94

http://ift.tt/2hQxRsN

A pediatric echocardiographic Z-score nomogram for a developing country: Indian pediatric echocardiography study – The Z-score

Rajendra Kumar Gokhroo, Avinash Anantharaj, Devendra Bisht, Kamal Kishor, Nishad Plakkal, Rajeswari Aghoram, Nivedita Mondal, Shashi K Pandey, Ramsagar Roy

Annals of Pediatric Cardiology 2017 10(1):31-38

Background: Almost all presently available pediatric echocardiography Z-score nomograms are based on Western data. They may not be a suitable reference standard for assessing the sizes of cardiac structures of children from developing countries. Objective: This study's objective was to collect normative data of 21 commonly measured cardiovascular structures using M-mode and two-dimensional echocardiography in Indian children aged between 4 and 15 years and to derive Z-score nomograms for each. Subjects and Methods: The study was conducted at two centers in India . Ajmer, Rajasthan, and Mohali, Punjab. We studied a community-based sample involving healthy school going children. After excluding children with cardiovascular abnormalities on the screening echocardiogram, 746 children were included in the final analysis. Echocardiographic assessment was performed using a Philips iE33 system. Results and Analysis: For each parameter measured, seven models were evaluated to assess the relationship of that parameter with the body surface area and the one with the best fit was used to plot the Z-score chart for that parameter. Z score charts were thus derived. Conclusions: The Z-score nomograms derived by this study may be better alternatives to the Western nomograms for use in India and other developing countries for preprocedural decision making in the pediatric population. However, they will require validation in large-scale studies before they can become clinically applicable.

http://ift.tt/2hz2De1

Massive pericardial effusion, yet no signs of tamponade!

Sunitha Vaidyanathan, Amol Gupta, Kothandam Sivakumar

Annals of Pediatric Cardiology 2017 10(1):100-101

http://ift.tt/2hQxRch

Rheumatic heart disease screening: Current concepts and challenges

Scott Dougherty, Maziar Khorsandi, Philip Herbst

Annals of Pediatric Cardiology 2017 10(1):39-49

Rheumatic heart disease (RHD) is a disease of poverty, is almost entirely preventable, and is the most common cardiovascular disease worldwide in those under 25 years. RHD is caused by acute rheumatic fever (ARF) which typically results in cumulative valvular lesions that may present clinically after a number of years of subclinical disease. Therapeutic interventions, therefore, typically focus on preventing subsequent ARF episodes (with penicillin prophylaxis). However, not all patients with ARF develop symptoms and not all symptomatic cases present to a physician or are correctly diagnosed. Therefore, if we hope to control ARF and RHD at the population level, we need a more reliable discriminator of subclinical disease. Recent studies have examined the utility of echocardiographic screening, which is far superior to auscultation at detecting RHD. However, there are many concerns surrounding this approach. Despite the introduction of the World Heart Federation diagnostic criteria in 2012, we still do not really know what constitutes the most subtle changes of RHD by echocardiography. This poses serious problems regarding whom to treat and what to do with the rest, both important decisions with widespread implications for already stretched health-care systems. In addition, issues ranging from improving the uptake of penicillin prophylaxis in ARF/RHD-positive patients, improving portable echocardiographic equipment, understanding the natural history of subclinical RHD and how it might respond to penicillin, and developing simplified diagnostic criteria that can be applied by nonexperts, all need to be effectively tackled before routine widespread screening for RHD can be endorsed.

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Should we close small ventricular septal defects?

Sangeetha Viswanathan, R Krishna Kumar

Annals of Pediatric Cardiology 2017 10(1):1-4

http://ift.tt/2hQAsDp

Pediatric cardiovascular care in Uganda: Current status, challenges, and opportunities for the future

Twalib Olega Aliku, Sulaiman Lubega, Judith Namuyonga, Tom Mwambu, Michael Oketcho, John O Omagino, Craig Sable, Peter Lwabi

Annals of Pediatric Cardiology 2017 10(1):50-57

In many developing countries, concerted action against common childhood infectious diseases has resulted in remarkable reduction in infant and under-five mortality. As a result, pediatric cardiovascular diseases are emerging as a major contributor to childhood morbidity and mortality. Pediatric cardiac surgery and cardiac catheterization interventions are available in only a few of Sub-Saharan African countries. In Uganda, open heart surgeries (OHSs) and interventional procedures for pediatric cardiovascular disease are only possible at the Uganda Heart Institute (UHI), having been started with the help of expatriate teams from the years 2007 and 2012, respectively. Thereafter, independent OHS and cardiac catheterization have been possible by the local team at the UHI since the year 2009 and 2013, respectively. The number of OHSs independently performed by the UHI team has progressively increased from 10 in 2010 to 35 in 2015, with mortality rates ranging from 0% to 4.1% over the years. The UHI pediatric catheterization team has independently performed an increasing number of procedures each year from 3 in 2013 to 55 in 2015. We herein describe the evolution and current status of pediatric cardiovascular care in Uganda, highlighting the unique aspects of its establishment, existing constraints, and future plans.

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Interventional therapy for partial anomalous pulmonary venous connection with dual drainage

Saurabh Kumar Gupta, Anita Saxena, Rajnish Juneja

Annals of Pediatric Cardiology 2017 10(1):82-83

A 6-year-old boy presented with dual drainage of left upper pulmonary vein, with connection to innominate vein inaddition to its normal connection to the left atrium. Despite relief of aortic stenosis at the age of 3 years, significant left to right shunt persisted. The dual drainage allowed successful percutaneous closure of the levoatriocardinal vein without obstruction to the pulmonary venous flow to the left atrium.

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Modified closed chamber sutureless technique for anomalous pulmonary venous connection

Sabarinath Menon, Thomas Mathew, Jayakumar Karunakaran, Baiju Sashidhar Dharan

Annals of Pediatric Cardiology 2017 10(1):58-60

Visibility continues to be a major problem during repair of obstructed total anomalous pulmonary venous connection (TAPVC) resulting in frequent use of deep hypothermia and low flow bypass. Sutureless technique for primary repair of anomalous pulmonary venous connection is fast becoming popular. In this described modification of sutureless technique through the lateral approach, the left atrium is marsupialized around the common pulmonary venous chamber, except on the right lateral aspect, providing a bloodless field with minimal retraction of heart facilitating the surgery at mild hypothermia. This technique can be particularly useful in small confluence obstructed TAPVC and in mixed TAPVC.

http://ift.tt/2hQBnU8

A rare case of cardiac tumor in a child

Mallar Mukharjee, Jigna N Bathia, Apurba Ghosh, Anil Kumar Singhi

Annals of Pediatric Cardiology 2017 10(1):87-89

Pediatric cardiac tumors are rare and usually benign. An infectious etiology like tuberculosis invading myocardium and presenting as infiltrative mass is extremely rare. We present a case of a 15 month old girl with clinical feature of cardiac failure who had infiltrative multiple myocardial masses in echocardiogram. Advanced cardiac imaging by Cardiac Magnetic resonance imaging (MRI ) helped in tissue delineation. Therapeutic trial of anti-tubercular drugs in view clinical suspicion of Tuberculosis resulted in complete remission of symptom and disappearance of the cardiac mass.

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Surgical repair of tricuspid valve leaflet tear following percutaneous closure of perimembranous ventricular septal defect using Amplatzer duct occluder I: Report of two cases

Saatchi Mahesh Kuwelker, Devi Prasad Shetty, Bharat Dalvi

Annals of Pediatric Cardiology 2017 10(1):61-64

Tricuspid valve (TV) injury following transcatheter closure of perimembranous ventricular septal defect (PMVSD) with Amplatzer ductal occluder I (ADO I), requiring surgical repair, is rare. We report two cases of TV tear involving the anterior and septal leaflets following PMVSD closure using ADO I. In both the patients, the subvalvular apparatus remained unaffected. The patients presented with severe tricuspid regurgitation (TR) 6 weeks and 3 months following the device closure. They underwent surgical repair with patch augmentation of the TV leaflets. Postoperatively, both are asymptomatic with a mild residual TR.

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Isolated facial nerve palsy after arterial switch operation: A rarity

Manoj Kumar Sahu, Intekhab Alam, Sarvesh Pal Singh, Ramesh Menon, Sachin Talwar

Annals of Pediatric Cardiology 2017 10(1):92-93

http://ift.tt/2hz7YSc

Pan masala habits and risk of oral precancer: A cross-sectional survey in 0.45 million people of North India

Publication date: Available online 29 December 2016
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Divya Mehrotra, Sumit Kumar, Shambhavi Mishra, Sandeep Kumar, Prashant Mathur, C.M. Pandey, Arvind Pandey, Kishore Chawdhary
ObjectivesThis cross-sectional community based study was conducted to estimate the prevalence of consumption habits for non tobacco pan masala (ASU) and the risk of developing oral precancer in North India.MethodsThis study was conducted in the old town of Lucknow city in the state of Uttar Pradesh in India. Subjects residing for more than 6 months and aged 15 years or above, were enrolled in the study after their informed consent. A two page survey tool was used to collect the data. A three times more matched sample of non users was randomly obtained from this data to analyze and compare the final results.Results0.45 million subjects were surveyed. Majority of tobacco users were in the age group of 20–35 years among males and 35–39 years among females. Consumption of non tobacco pan masala among males as well as females was most common in 15–19 years of age group. Prevalence of oral precancer (leukoplakia, submucous fibrosis, erythroplakia, lichen planus, smokers palate and verrucous hyperplasia) was 3.17% in non tobacco pan masala users and 12.22% in tobacco users. The odds of developing oral precancer in non tobacco pan masala users was 20.71 (18.79–22.82) and in tobacco users was 88.07 (84.02–92.31) at 95% confidence interval against non users of both.ConclusionThe odds of developing oral precancer even with consumption of pan masala is high, even when it is consumed without tobacco. It is hence recommended to discourage this habit.

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Human ex vivo dentin-pulp complex preservation in a full crown model

Publication date: Available online 29 December 2016
Source:Journal of Oral Biology and Craniofacial Research
Author(s): João Botelho, Maria Alzira Cavacas, Gonçalo Borrecho, Mário Polido, Pedro Oliveira, José Martins Dos Santos
ObjectivesCurrently, there is lack of human in vitro full tooth models that hold the odontoblast layer with pulp tissue in their native environment. The appearance of new in vitro and in vivo models has provided new understanding of the potential of tissue engineering in dental pulp regeneration. However, the development of new in vitro full tooth models will allow us to get closer to in vivo conditions. Thus, the aim of this study is to preserve a living dentin-pulp complex, in a novel in vitro full crown model, after tooth extraction.MethodsTwenty intact third molars, after preparation, were divided into four groups, with five samples each. We placed the negative control samples (C) in saline, and the tested groups were placed (T) in supplemented DMEM, at two different times: 1 and 7 days. The specimens were processed for light microscopy observation.ResultsContrary to C-groups, T-groups showed a functional dentin-pulp complex. The treated dentin-pulp complex presents normal histological appearance.ConclusionsThis study showed that it is possible to preserve a living dentin-pulp complex after tooth extraction during 7 days.

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Versatility of buccinator flaps for the treatment of palatal defects: a series of cases

Publication date: Available online 29 December 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): M.A. Gavin Clavero, M.V. Simón Sanz, Ú.M. Jariod Ferrer, A. Mur Til
The buccinator flap is currently one of the best techniques for the reconstruction of defects in the oral cavity and other sites. Reconstruction of the palate is a major challenge because of the functional consequences of the excision of lesions in this area. The main goal is to maintain separation between the mouth and the nose. We have done a cross-sectional retrospective descriptive study of a series of cases reconstruction of palatal defects with buccinator flap at the University Hospital Miguel Servet in Zaragoza during a six-year period and compared our results, morbidity, and mortality with those of published series. The main complication was partial loss of the flap. We have analysed the reasons for this and report the steps needed to avoid it.

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Antitumor Activity of 2,9-Di-Sec-Butyl-1,10-Phenanthroline

by Dongsheng Wang, Shifang Peng, A. R. M. Ruhul Amin, Mohammad Aminur Rahman, Sreenivas Nannapaneni, Yuan Liu, Dong M. Shin, Nabil F. Saba, Jack F. Eichler, Zhuo G. Chen

The anti-tumor effect of a chelating phen-based ligand 2,9-di-sec-butyl-1,10-phenanthroline (dsBPT) and its combination with cisplatin were examined in both lung and head and neck cancer cell lines and xenograft animal models in this study. The effects of this agent on cell cycle and apoptosis were investigated. Protein markers relevant to these mechanisms were also assessed. We found that the inhibitory effect of dsBPT on lung and head and neck cancer cell growth (IC₅₀ ranged between 0.1–0.2 μM) was 10 times greater than that on normal epithelial cells. dsBPT alone induced autophagy, G1 cell cycle arrest, and apoptosis. Our in vivo studies indicated that dsBPT inhibited tumor growth in a dose-dependent manner in a head and neck cancer xenograft mouse model. The combination of dsBPT with cisplatin synergistically inhibited cancer cell growth with a combination index of 0.3. Moreover, the combination significantly reduced tumor volume as compared with the untreated control (p = 0.0017) in a head and neck cancer xenograft model. No organ related toxicities were observed in treated animals. Our data suggest that dsBPT is a novel and potent antitumor drug that warrants further preclinical and clinical development either as a single agent or in combination with known chemotherapy drugs such as cisplatin.

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Determination of serum aflatoxin B 1 -lysine to evaluate the efficacy of an aflatoxin-adsorbing feed additive in pigs fed an aflatoxin B 1 -contaminated diet

Abstract

In this study, serum aflatoxin B₁ (AFB₁)-lysine was determined in order to evaluate the in vivo efficacy of a hydrated sodium calcium aluminosilicate (HSCAS) in pigs fed AFB₁. Twenty-four 49-day-old crossbred barrows were maintained in individual cages and allowed ad libitum access to feed and water. A completely randomized design was used with six animals assigned to each of four dietary treatments for 21 days as follows: (A) basal diet (BD), (B) BD supplemented with 0.5 % HSCAS, (C) BD supplemented with 1.1 mg/kg AFB₁, and (D) BD supplemented with 0.5 % HSCAS and 1.1 mg/kg AFB₁. HSCAS was able to alleviate the toxic effects of AFB₁ on pigs and reduce (P < 0.05) the levels of serum AFB₁-lysine. Cumulative reductions of adduct yield values, calculated through the equation [(pg AFB₁-lysine/mg albumin) / (μg AFB₁/kg body weight)], were 53.0, 62.8, and 72.1 after 7, 14, and 21 days of oral exposure, respectively. AFB₁-lysine has potential as an AFB₁-specific biomarker for diagnostic purposes and for evaluating the efficacy of chemoprotective interventions in pigs.

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Unresolved airway obstruction in a child secondary to multiple pathologies

Publication date: Available online 28 December 2016
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Pek Ser Heng, Suzina Sheikh Hamid, Abdul Razak Ahmad
In neonates, noisy breathing is one of the common presenting illnesses that require immediate attention and it is always referred to otorhinolaryngology (ORL) team for further assessment. Neonatal stridor can arise from congenital or acquired pathologies at different anatomical sites such as supraglottis, glottis, subglottis and laryngotracheal tree. We report a case of a 5-year-old boy with unresolved airway obstruction since the age of 2weeks old. He presented with progressively worsening of stridor and dyspnea. Emergency tracheostomy was done at neonatal period. He was diagnosed with different airway pathologies at different occasions. Tracheomalacia and laryngomalacia were initially found at neonatal and infantile periods. At later age, a subglottic band was revealed and CO2 laser therapy was employed in treatment.

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Increased BAFF expression in nasal polyps is associated with local IgE production, Th2 response and concomitant asthma

Abstract

B-cell activating factor of the TNF family is critical for the survival and maturation of B cells and play a role in the pathophysiology of chronic rhinosinusitis with nasal polyps (CRSwNP). In this study, nasal tissues were enrolled from 25 CRSwNP patients (asthmatic, 16; non-asthmatic, 9), 12 CRSsNP patients and ten control subjects, respectively. The immunoreactivity of BAFF, CD20 and CD138 were examined using immunohistochemistry staining. The mRNA expression of BAFF, CD20, εGLT, AID, GATA3 and CRTH2 were examined using real-time RT-PCR. The protein levels of BAFF, IL-5 and IgE were measured using ELISA assays and the Unicap system, respectively. We found the numbers of BAFF+ cells, CD20+ cells (B cells) and CD138+ cells (plasma cells) were significantly increased in polyp tissues compared with control groups. The concentrations of BAFF, IgE and IL-5 in tissue homogenates were also significantly increased in polyp tissues compared with control groups, and the BAFF protein level in the polyp homogenates was significantly associated with the IgE and IL-5 levels and with concomitant asthma in CRSwNP patients. Our findings indicate that BAFF expression is significantly increased in CRSwNP patients and may orchestrate inflammatory load in polyp tissues by regulating T and B cell-mediated response.

http://ift.tt/2im3XAs

Association of Iron Deficiency Anemia With Hearing Loss

This population-based cohort study examines the association between iron deficiency anemia and sensorineural, conductive, or combined hearing loss in young to elderly adults.

http://ift.tt/2hthvFx

Unilateral Neck Swelling in a Pediatric Patient

A young child had persistent unilateral neck swelling; examination revealed a firm, immobile, and nontender mass fixed to the underlying right mandible with cortical destruction, extending into the submandibular and sublingual spaces. What is your diagnosis?

http://ift.tt/2iJvYTb

Distant Metastases Following Postoperative Intensity-Modulated Radiotherapy

This study examines the characteristics and risk factors of distant metastases following postoperative intensity-modulated radiotherapy in oral squamous cell carcinoma and the clinicopathological characteristics that could be associated with distant-only failure.

http://ift.tt/2ht1oIi

Steinert syndrome and repercussions in dental medicine

Publication date: March 2017
Source:Archives of Oral Biology, Volume 75
Author(s): Helena Baptista, Inês Lopes Cardoso
Steinert syndrome, also called myotonic dystrophy type 1, is a genetic disorder with autosomal dominant transmission characterized by myotonia and a multisystemic clinical picture that affects several tissues of the human body. The most common systemic phenotypes are: muscular, cardiac, respiratory, CNS, ocular, gynecological, digestive, orthopedical, as well as cognitive and psychological symptoms (cognitive decline). Muscles involved in voluntary movement are highly affected by myotonia especially distal muscles of upper limbs. These patients also show changes in face, chewing and pharynx muscles that can lead to swallowing and speech problems, dysphagia and in most cases to food aspiration and suffocation. Poor oral hygiene resulting from reduced motor mobility and reduced saliva flux can lead to gingival inflammation and periodontal disease. Other oral manifestations include disturbances at the temporomandibular articulation, dental occlusion changes and reduction in teeth number as a result of caries. Main causes of death are pneumonia and cardiac arrhythmias.The etiopathogeny of this syndrome is still not clear, conditioning the existence of a specific treatment for this disease. Nowadays, treatments consist on the release of the existing symptoms, in an attempt to give a better life quality to patients. It is very important to implement actions that can prevent complications and consequently decrease death. Treatments should be applied in an early stage of the disease. Bronchoscopy and artificial respiration should be used to prevent pneumonia, and regular electrocardiographic monitoring should be done to evaluate defects in the conductive system. Several approaches have been applied to rehabilitate swallowing dysfunction and avoid aspiration like videofluoroscopy, postural techniques and adjustment of diet type.It is the aim of this paper to clarify the ethiology, diagnosis, systemic and oral characteristics of the syndrome, as well as to discuss treatments to be applied according to patients affected organs.

http://ift.tt/2ic5kRR

Steinert syndrome and repercussions in dental medicine

Use of Interactive iBooks for Patient Education in Otology

Publication date: Available online 29 December 2016
Source:American Journal of Otolaryngology
Author(s): Omid Moshtaghi, Yarah M. Haidar, Ronald Sahyouni, Ramin Rajaii, Afsheen Moshtaghi, Amin Mahmoodi, Yaser Ghavami, Harrison W. Lin, Hamid R. Djalilian
IntroductionPhysicians in the ambulatory setting face challenges in adequately educating patients in a brief office encounter.ObjectiveTo evaluate the efficacy of an iPad-based interactive educational module (iBook) in various otologic pathologies.MethodsPatients presenting with symptoms of tinnitus, dizziness, hearing loss, or cochlear implant evaluation were included. In total, 44 patients received the iBook and 22 patients served as controls. Prior to viewing the iBook, patients completed a pre-survey to assess baseline knowledge. After viewing the iBook, patients completed a post-survey to assess changes in perception and knowledge of their disease. Results were compared to that of the control group who did not receive iBook supplementation prior to being seen by the physician.ResultsPaired t-test analysis showed significant improvements (p < 0.01) in both self-reported perception and concrete understanding in various concepts when compared to pre-iBook results. This was further compared to the control group, which showed a significant gain in factual knowledge (p = 0.02).ConclusionPatients who viewed the iBook, personalized to their diagnosis, displayed significantly improved understanding of their condition. Increased use of interactive educational modalities, such as the iBook, can be of benefit to an otologic practice in improving patient education and satisfaction.

http://ift.tt/2hsMRfI

Exérèse d’une tumeur glomique sous-matricielle

Publication date: Available online 28 December 2016
Source:Annales de Dermatologie et de Vénéréologie
Author(s): O. Cogrel

http://ift.tt/2hsSLgP

A Case of a Paracardial Osteophyte Causing Atrial Compression

Design

Single institution consecutive case series.

Setting

Tertiary Head and Neck Cancer Center.

Participants

Eighty-seven patients with head and neck squamous cell carcinoma, who underwent salvage neck dissection after initial radiotherapy (n=30), radiotherapy with carboplatin/5-fluorouracil (n=43), or radiotherapy with cetuximab (n=14).

Main outcome measures

Incidence of complications, disease-specific survival.

Results: Complications occurred in 28% of the patients. Multivariate analysis identified extent of neck dissection as the only independent predictor of surgical complications (p = .010). Surgical complication rate was 16% after radiotherapy with systemic treatment, and 47% after radiotherapy alone (p = .171). The 5-year disease-specific survival was 55%, independent of complications, initial treatment, extent of surgery, and patient related factors.

Conclusion

The only predictor for surgical complications was extent of surgery. Survival was not influenced by complications.

http://ift.tt/2ibBJrq

Controversies in the management of caustic ingestion injury: an evidence based review

Abstract

Background

Caustic ingestion of acid or alkaline substances can cause damage to the upper respiratory and upper digestive tract. Initial presentation following caustic ingestion can include oropharyngeal pain, dysphagia and stridor. Due to this clinical presentation that the resident otolaryngologist is consulted to review and examine these patients to assess for airway compromise and commence initial management and care until airway concern has passed.

Objective of review

This review aims to provide evidence based guidance in the management of those presenting with acute ingestion injury so that informed initial medical therapy can be commenced and appropriate investigations arranged to optimise patient outcome.

Type of review and search strategy

A literature review searched PubMed citing variations on the areas of controversies with "caustic ingestion", "corrosive ingestion", "acid ingestion" and "alkali ingestion" – from 1956 to present with language restrictions.

Evaluation method

The bibliographies of articles were searched for relevant references. The references were then compiled and reviewed independently by two authors (JB & SK), overseen by the senior authors (CP & JR). The review process was conducted independently, with the results then collated, with the aim of identifying the highest levels of evidence in each of the areas of controversy.

Results

Over 100 full text articles were retrieved. Several specific areas of controversy were identified and addressed, with the highest available evidence referenced for each area.

Conclusions

In caustic ingestion injury the urgent assessment of the airway is the first priority with a definitive airway secured in those with airway compromise. In those patients with a stable airway and no clinical or radiological sign of perforation then medical therapy should be commenced and an urgent OGD arranged and this should take place within the first 24 hours to grade the degree of injury and establish long term prognosis. In suspected perforation a surgical opinion should be sought. For those adults who are asymptomatic following ingestion an OGD may not be necessary, however asymptomatic paediatric patients should be treated with more caution and a period of observation is important. Those who are at risk of developing late complications must be followed up.

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An Analysis of the Fate of 917 Manuscripts Rejected from Clinical Otolaryngology

Abstract

Objectives

The fate of all manuscripts rejected from the journal Clinical Otolaryngology over a three-year period was investigated. The aim was to review publication rate, delay, and the impact factors of the journals that the papers went on to be published in.

Design

917 papers were rejected from Clinical Otolaryngology between 2011 and 2013. The fate of these manuscripts was determined by searching for the corresponding author's surname, and if necessary key words from the manuscript title, in both PubMed and Google Scholar.

Main outcome measures

The main outcome measures recorded were: the subsequent publication of the article, delay to publication, and journal of publication

Results

511 papers were subsequently published in journals, representing 55.7% of all rejected manuscripts. The average delay was 15.1 months (Standard Deviation (SD) = 8.8). The impact factor of Clinical Otolaryngology was found to be higher than the average of the journals that accepted the rejected manuscripts in all three years. Only 41 (8%) papers were published in journals with a higher impact factor than Clinical Otolaryngology. Of all subsequently accepted manuscripts 60 (11.7%) were found only on Google Scholar (and not on PubMed).

Conclusions

Rejection from Clinical Otolaryngology certainly does not prevent subsequent publication, although the papers tend to be published after a lengthy delay and in journals with a lower impact factor than Clinical Otolaryngology. When performing literature searches, it is important to search more than one database to ensure as many of the relevant articles are found as possible.

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Efficacy and safety of propranolol for epistaxis in Hereditary Hemorrhagic Telangiectasia (HHT); retrospective, then prospective study, in a total of 21 patients

Hereditary Hemorrhagic Telangiectasia (HHT) is a genetic disorder of angiogenesis associated with disabling epistaxis.

Propranolol, a beta-blocker, exerts anti-angiogenic properties.

In the retrospective study, nine of ten HHT patients receiving propranolol significantly improved their Epistaxis Severity Score.

In the prospective study, after three months of propranolol treatment, the median duration of epistaxis per month significantly decreased as did the number of epistaxis episodes per month in 11 HHT patients.

Tolerance of propranolol was quite satisfactory with only one hypotension among the overall 21 HHT patients.

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Prognostic value of pretreatment peripheral blood markers in paranasal sinus cancer: Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio

ABSTRACT

Background

Pretreatment hematological markers have emerged as prognostic factors for several cancers. The purpose of this study was to present our investigation of the value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting recurrence and mortality for patients with primary sinonasal cancers (SNCs).

Methods

We carried out a retrospective review of patients with SNC who had been treated using endoscopic approaches from 2002 to 2014 at a single institute. The endpoints analyzed were overall survival (OS) and disease-free survival (DFS).

Results

Of 365 patients treated, 215 fulfilled the inclusion criteria. Analysis of epithelial tumors (adenocarcinoma and carcinoma) and advanced-stage cancers (pT3–T4) showed shorter OS and DFS in those patients with higher NLR and PLR. Furthermore, the NLR and PLR were revealed as independent prognostic factors for DFS, with a reduced risk of recurrence in patients with NLR <2.6 (hazard ratio [HR], 0.39; p = .02) and PLR <156.9 (HR, 0.34; p = .001).

Conclusion

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Prospective study of definitive chemoradiation in locally or regionally advanced squamous cell carcinoma of the skin

ABSTRACT

Background

The purpose of this study was to present our evaluation of the outcomes of concurrent chemoradiotherapy (CRT) in patients with locally advanced cutaneous squamous cell carcinoma (SCC).

Methods

This was a prospective phase II study. The primary endpoint was complete response (CR). Patients with locally/regionally advanced cutaneous SCC deemed unsuitable for surgery received definitive radiotherapy (RT; 70 Gy in 35fractions) and concurrent weekly platinum-based chemotherapy (cisplatin 40 mg/m2 or carboplatin area under the curve 2).

Results

Twenty-one patients were enrolled in this study. Eighteen patients had a locally advanced primary or nodal disease in the head and neck region with 66% having stage IV nonmetastatic disease. Of 19 evaluable patients, 10 achieved a CR to definitive CRT with 2 further patients rendered disease-free by salvage surgery for an overall CR of 63%.

Conclusion

This is the only prospective series of CRT for cutaneous SCC. A high CR rate was documented in patients with locoregional advanced disease who were unable to undergo surgery. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

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ACR appropriateness criteria® nasal cavity and paranasal sinus cancers

Abstract

The American College of Radiology (ACR) Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Here, we present the Appropriateness Criteria for cancers arising in the nasal cavity and paranasal sinuses (maxillary, sphenoid, and ethmoid sinuses). This includes clinical presentation, prognostic factors, principles of management, and treatment outcomes. Controversies regarding management of cervical lymph nodes are discussed. Rare and unusual nasal cavity cancers, such as esthesioneuroblastoma and sinonasal undifferentiated carcinomas, are included. © 2016 American College of Radiology. Head Neck, 2016

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Transnasal endoscopic partial maxillectomy: Operative nuances and proposal for a comprehensive classification system based on 1378 cases

ABSTRACT

Background

Despite the development of functional endoscopic endonasal surgery, there are still areas of the maxillary sinus that remain technically difficult to access using a standard middle meatal antrostomy as well as deep-seated skull base lesions requiring expanded transmaxillary approaches.

Methods

All patients who underwent transnasal endoscopic partial maxillectomy (TEPM) in a single institution from 2000 to 2014 were retrospectively reviewed. The TEPM was classified into 5 types according to the anatomic structures progressively removed and to the access provided.

Results

The TEPM was performed in 1378 patients for the management of: inflammatory diseases in 513 cases (37%), benign sinonasal tumors in 425 cases (31%), skull base malignancies in 285 cases (21%), and as a corridor to address deep-seated skull base lesions in 155 cases (11%).

Conclusion

The TEPM is a stepwise approach offering increasing access that can be tailored to different maxillary, sinonasal, and skull base pathologies with minimal morbidity for patients. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

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Cardiovascular risk and prevention in patients with head and neck cancer treated with radiotherapy

Abstract

Background

The underlying contributors to cardiovascular disease (CVD) in patients with head and neck squamous cell carcinoma (HNSCC) are poorly characterized.

Methods

Patients with HNSCC who underwent definitive or adjuvant (chemo)radiation between 2011 and 2013 were retrospectively reviewed. The 10-year risk estimates for a CVD event were calculated according to the Framingham Risk Score (FRS).

Results

One hundred fifteen patients with predominantly stage III/IV HNSCC had a median follow-up of 2 years. At diagnosis, 23% of patients had CVD. The FRS was higher among patients with laryngeal cancer versus other sites (20.5% vs 14.4%). Twenty-four percent of all patients had uncontrolled blood pressure at diagnosis. Among the patients with CVD, 41% were not taking antiplatelet therapy and 30% were not taking statin therapy. Thirty-four percent of patients without CVD had indications for initiating statin therapy.

Conclusion

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Free profunda femoris artery perforator flap as a first-line choice of reconstruction for partial glossectomy defects

ABSTRACT

Background

Free profunda artery perforator (PAP) flap has recently been brought back for head and neck reconstruction. During the course of 1 year, we performed this procedure for reconstruction of partial glossectomy defects with excellent results.

Methods

From January through December 2015, 21 patients underwent partial glossectomy reconstruction with PAP flaps. Demographics, surgical technique, anatomic variations, success rates, complications, and characteristics are described. Swallowing and speech results after reconstruction are evaluated.

Results

No donor-site complications were observed. Two cases presented complications potentially related to the flap (1 hematoma and 1 prolonged intubation) that were treated successfully. Deglutition and speech assessment resulted in fair to excellent swallowing capacity in all patients. Speech score resulted 4/5 to 5/5 in all patients at 3-month follow-up.

Conclusion

The PAP flap should be considered one of the first-line options for hemiglossectomy reconstruction, receiving special consideration in the high-risk population in which future complex reconstructions could be needed. © 2016 Wiley Periodicals, Head Neck, 2016

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Efficacy and safety of ultrasound-guided radiofrequency ablation of hyperplastic parathyroid gland for secondary hyperparathyroidism associated with chronic kidney disease

Abstract

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Detection of Circulating Tumor Tells as The Guidance of the Neoadjuvant Chemotherapy of Esophageal Cancer

Condition: Esophageal Cancer TNM Staging Primary Tumor (T) T3
Interventions: Procedure: chemotherapy; Procedure: Surgery
Sponsors: The Second Hospital of Shandong University; Shandong Cancer Hospital and Institute; Wuhan YZY Medical Science and Technology Co., Ltd.
Recruiting - verified December 2016

http://ift.tt/2hzdjsW

Endoscopic Ultrasound Plus Submucosal Injection for Early Esophageal Cancer

Condition: Esophageal Cancer
Interventions: Device: submucosal injection needle ; EUS; Device: ordinary endosonography(EUS)
Sponsor: Sun Yat-sen University
Recruiting - verified December 2016

http://ift.tt/2hQDx6m

Surface topological differences of phage infected uropathogenic Escherichia coli (UPEC) strains, revealed by atomic force microscopy

Background: Atomic force microscopy (AFM) is an advance microscopic technique that provides three dimensional structures of cell surfaces with high resolution. In the present study AFM was used for comparative analysis of surface topology of phage infected and uninfected Uropathogenic Escherichia coli (UPEC) cells. Two UPEC strains NE and HN were isolated from urine samples of Urinary tract infection patients and their specific narrow host range lytic phages 3S and HNΦ were isolated from the sewage of different areas. Results: On the basis of one step growth curve both phages characterized as short latent period phages with latency period of about 30 min. On AFM analysis significant difference in topology of healthy and infected cells were observed. It was hypothesized that progeny of both lytic phages released out from their respective host cells in different manner. The image of 3S infected UPEC host cells (NE) revealed multiple internal projections which showed progeny phages released out from host cells through these multiple sites. Whereas images of HNΦ infected HN host cells showed central depression which illustrated that new phages released out through single exit point from the middle of cell. Conclusions: These results are significant to extend future studies on isolated phages as an effective tool for phage therapy.

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Development of T cells carrying two complementary chimeric antigen receptors against glypican-3 and asialoglycoprotein receptor 1 for the treatment of hepatocellular carcinoma

Abstract

Adoptive immunotherapy leveraging chimeric antigen receptor-modified T (CAR-T) cells holds great promise for the treatment of cancer. However, tumor-associated antigens often have low expression levels in normal tissues, which can cause on-target, off-tumor toxicity. Recently, we reported that GPC3-targeted CAR-T cells could eradicate hepatocellular carcinoma (HCC) xenografts in mice. However, it remains unknown whether on-target, off-tumor toxicity can occur. Therefore, we proposed that dual-targeted CAR-T cells co-expressing glypican-3 (GPC3) and asialoglycoprotein receptor 1 (ASGR1) (a liver tissue-specific protein)-targeted CARs featuring CD3ζ and 28BB (containing both CD28 and 4-1BB signaling domains), respectively, may have reduced on-target, off-tumor toxicity. Our results demonstrated that dual-targeted CAR-T cells caused no cytotoxicity to ASGR1⁺GPC3⁻ tumor cells, but they exhibited a similar cytotoxicity against GPC3⁺ASGR1⁻ and GPC3⁺ASGR1⁺ HCC cells in vitro. We found that dual-targeted CAR-T cells showed significantly higher cytokine secretion, proliferation and antiapoptosis ability against tumor cells bearing both antigens than single-targeted CAR-T cells in vitro. Furthermore, the dual-targeted CAR-T cells displayed potent growth suppression activity on GPC3⁺ASGR1⁺ HCC tumor xenografts, while no obvious growth suppression was seen with single or double antigen-negative tumor xenografts. Additionally, the dual-targeted T cells exerted superior anticancer activity and persistence against single-targeted T cells in two GPC3⁺ASGR1⁺ HCC xenograft models. Together, T cells carrying two complementary CARs against GPC3 and ASGR1 may reduce the risk of on-target, off-tumor toxicity while maintaining relatively potent antitumor activities on GPC3⁺ASGR1⁺ HCC.

http://ift.tt/2hz3jzM

Retinoic acid for treatment of systemic sclerosis and morphea: A literature review

Abstract

Systemic sclerosis and morphea are connective tissue diseases characterized by tightening, thickening, and hardening of the skin, leading to significant morbidity. Unfortunately, current treatment options have limited efficacy for many patients. Cutaneous manifestations of these diseases arise from excess collagen deposition and fibrosis in the skin, through pathogenic mechanisms which have yet to be extensively detailed at the causal immune and cellular levels. Research elucidating the mechanism of action of retinoic acid on collagen production in the skin and case series highlighting the success of retinoic acid on the skin manifestations of systemic sclerosis and on morphea demonstrate its promise as a treatment. Herein they will briefly review the treatment options for both systemic sclerosis and morphea, and will discuss the potential of retinoic acid as a therapy and the supporting evidence from the literature, highlighting the previously published basic science and clinical studies investigating the role of retinoic acid in the treatment of sclerotic skin diseases.

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Case 40-2016: A 14-Month-Old Girl with Recurrent Vomiting

Presentation of Case. Dr. Alessio Morley-Fletcher (Pediatrics): A girl 14 months 19 days of age was admitted to a community hospital affiliated with this hospital because of episodes of recurrent vomiting. The patient had been well until she was 11 months 12 days of age, when intermittent vomiting…

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No evidence of intrauterine sensitization against inhalant allergens

Publication date: Available online 28 December 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Helene Mygind Wolsk, Malene Rohr Andersen, Hans Bisgaard, Klaus Bønnelykke
Specific IgE against inhalant allergens in cord blood was a very rare finding when the risk of transfer from the mother was minimized; hence, findings of such IgE should be interpreted with caution.

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Αρχειοθήκη ιστολογίου

Πέμπτη 29 Δεκεμβρίου 2016

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