Patient-performed pinnaplasty using industrial nail glue

Publication date: February 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 93
Author(s): Priyanka Chadha, Florian Bast
Malformations of the pinna occur in around 2–5% of all newborns. Prominent ears in childhood can be a source of psychological distress and lead to bullying and social exclusion. We present the case of a 14-year-old girl who inflicted chronic, non-healing wounds in the post auricular area bilaterally after attempting to glue back her ears with industrial strength glue. To our knowledge, this is the first case of its kind to be published.



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Human papillomavirus status and the relative biological effectiveness of proton radiotherapy in head and neck cancer cells

Abstract

Background

Human papillomavirus (HPV)-positive oropharyngeal carcinomas response better to X-ray therapy (XRT) than HPV-negative disease. Whether HPV status influences the sensitivity of head and neck cancer cells to proton therapy or the relative biological effectiveness (RBE) of protons versus XRT is unknown.

Methods

Clonogenic survival was used to calculate the RBE; immunocytochemical analysis and neutral comet assay were used to evaluate unrepaired DNA double-strand breaks.

Results

HPV-positive cells were more sensitive to protons and the unrepaired double-strand breaks were more numerous in HPV-positive cells than in HPV-negative cells (p < .001). Protons killed more cells than did XRT at all fraction sizes (all RBEs > 1.06). Cell line type and radiation fraction size influenced the RBE.

Conclusion

HPV-positive cells were more sensitive to protons than HPV-negative cells maybe through the effects of HPV on DNA damage and repair. The RBE for protons depends more on cell type and fraction size than on HPV status. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

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Complication and surgical site infection for salvage surgery in head and neck cancer after chemoradiotherapy and bioradiotherapy

Publication date: Available online 30 December 2016
Source:Auris Nasus Larynx
Author(s): Hidenori Suzuki, Nobuhiro Hanai, Daisuke Nishikawa, Yujiro Fukuda, Yasuhisa Hasegawa
ObjectiveWe aimed to investigate the complications, surgical site infection (SSI), and survival in salvage surgery without free-flap reconstruction for patients with head and neck squamous cell carcinoma who were treated by platinum-based chemoradiotherapy (Plat-CRT) or cetuximab-based bioradiotherapy (Cet-BRT).MethodsThirty-three patients treated by Plat-CRT and six treated by Cet-BRT had salvage surgery. We categorized postoperative complications according to the Clavien–Dindo classification and SSI according to the wound grading scale. Overall survival calculated by Kaplan–Meier method.ResultsPatients with Cet-BRT were significantly associated with the presence of SSI (P<0.01) and grades IIIb–V of the Clavien–Dindo classification (P<0.01) compared with those with Plat-CRT. Patients with Cet-BRT had a significantly lower overall survival than those with Plat-CRT (P<0.05).ConclusionWe demonstrated that patients with Cet-BRT were significantly more associated with the presence of SSI and grades IIIb–V in the Clavien–Dindo classification than those with CRT.



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Avoiding complications in endoscopic skull base surgery

Purpose of review: Endoscopic skull base surgery has become an established approach for the removal of tumors and cerebrospinal fluid fistulae repair. Compared with external approaches, it provides better aesthetic results and quality of life postoperatively. However, as it becomes popular and expands its indications possible complications should be reassessed in terms of incidence and variability in order to confirm its efficacy and safety. This article reviews the recent literature describing the main categories of possible complications suggesting strategies to minimize their incidence. Recent findings: Detailed preoperative planning based on imaging and histology can prevent major complications. Intraoperative use of image guidance and meticulous hemostasis provide the surgical field needed to avoid complications. Postoperative patient counseling, along with close and detailed nasal postoperative care are significant factors for an optimal outcome. Summary: Monitoring of complications after endoscopic skull base surgery is necessary in order to standardize protocols of management and improve our surgical techniques. The presence of late onset complications underlines the need of a special focus in postoperative care and follow-up.

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25 years of Current Opinion in Otolaryngology & Head and Neck Surgery

No abstract available

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What is the evidence for genetics in chronic rhinosinusitis?

Purpose of review: To perform analysis of evidence in current literature on the topic of genetics and chronic rhinosinusitis (CRS), with a particular focus on recent findings in the cystic fibrosis transmembrane regulator (CFTR), genes associated with primary ciliary dyskinesia, and taste receptor T2R38. Other genes that have been found to have association with CRS are also presented and discussed. Recent findings: Recent studies in CFTR and CRS research have investigated possible CFTR-potentiators for treatment of refractory CRS. The T2R38 gene has been shown to be applicable in the clinical setting with a testable phenotype and may have a role in the prognosis and influencing management strategies of CRS patients. Many genes of the immune system have been studied, with genome-wide association studies and candidate-gene approaches identifying new associations that will need replication and further elucidation. Summary: CRS is a multifactorial disease, with strong evidence of a genetic component in its pathophysiology for some cases. Currently, there are over 70 genes that have been genetically associated with CRS in the past 15 years. Future investigations into genetic causes and predispositions of CRS may allow for improved prognostication and development of disease-prevention strategies as well as novel therapeutic targets.

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The state of sinus care in 2017

No abstract available

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The evidence for olfactory training in treating patients with olfactory loss

Purpose of review: The purpose of this review is to go over the only therapy for olfactory loss supported by level 1a evidence that is currently available, which is olfactory training. This therapy is widely underutilized and has the potential to help many patients with olfactory dysfunction who are otherwise offered no management options. Recent findings: We will review the rationale, clinical studies, and quality of the evidence regarding olfactory training, specifically the olfactory system's inherent ability to regenerate, the plasticity of the system, and the multiple protocols and modifications of protocols present in the literature. Summary: Olfactory training is an effective therapy for some patients suffering from olfactory loss, and, while we do not yet know the optimal duration or number of odorants or exact patient population it may be most beneficial for, as an extremely easy, self-driven therapy with no significant side-effects, it should be consistently offered to this patient population.

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Caudal septum surgery techniques reviewed

Purpose of review: The caudal septum has important functional and aesthetic implications. Deviations in this area can result in important nasal obstruction due not only to blockage of the nasal passage but also to compromise of the internal nasal valve. Cosmetically, alterations in the caudal septum can result in a twisted nasal tip, loss of projection, rotation, and imbalance in the ala-columellar relationship. Contemporary surgical options will be discussed showing how to preserve, reshape, and reinforce the caudal septum to obtain a final looking nose that is not only functional but also aesthetically pleasing. Recent findings: Recent publications have shown that cartilage preservation and remodeling techniques can be efficient in the treatment of the caudal septum. Adequate preoperative diagnosis must be made to be able to create a step-wise approach evolving from simple suturing techniques to more complex ones that require the use of grafts to reposition and keep the caudal septum in the midline with an adequate functional and cosmetic outcome. Summary: Adequate management of the caudal portion of the nasal septum is a challenge because of its importance in nasal function and cosmetic final results. There are many surgical options that can be used to correct and align this structure and there is no one single surgical technique that can be used in all cases. A step-wise approach is presented covering the different techniques used today evolving from simple to more complicated ones. The final surgical objective should be cosmetically pleasing noses that function appropriately.

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Update on nonmalignant lesions of the inferior turbinate

Purpose of review: The inferior turbinates are routinely examined by otolaryngologists on anterior rhinoscopy and nasal endoscopy. Most lesions of the inferior turbinate are benign but can often be confused with malignancy. This review highlights the broad differential of nonmalignant lesions of the inferior turbinates and their management. Recent findings: A variety of infectious, inflammatory, neoplastic, and vascular lesions may affect the inferior turbinates. The most common nonmalignant lesions of the sinonasal region are nasal polyps, inverted papillomas, hemangiomas, and angiofibromas. Early lesions are often asymptomatic and discovered incidentally on routine examination. As these lesions grow they present with nonspecific signs that can be seen in benign, malignant, and infectious etiologies. The most common signs and symptoms are nasal obstruction, rhinorrhea, epistaxis, sinusitis, and hyposmia. Most nonmalignant lesions have characteristic appearances but definitive diagnosis is achieved with biopsy or culture. If the lesions are small the biopsy itself is often curative. Summary: Lesions of the inferior turbinates are rarely isolated to these structures alone. Careful examination can noninvasively assist in early diagnosis of extensive lesions. Once malignancy and processes such as invasive fungal sinusitis or inverted papillomas have been ruled out, treatment of these lesions is ordinarily noncomplicated and definitive.

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Polyps, asthma, and allergy: what's new

Purpose of review: Although chronic rhinosinusitis with nasal polyps, asthma, and allergy share common inflammatory mechanisms, there is no evidence of cause-and-effect relationship. In this review, we present new studies investigating the complex immunology that links these diseases. Advances in new therapies as well as evidence regarding indication and timing of surgery, especially of more complex cases, are highlighted. Recent findings: New studies have endotyped patients in an effort to describe the exact inflammatory profile of each phenotype, whereas described cytokines seem to play a significant role in amplification of T2 inflammation, directly or via innate lymphoid cells. New mAbs that block specific cytokines of these pathways have been developed and seem to show reduced asthma severity as well as improved sinonasal outcomes. Moreover, it has been shown that operating early in the course of disease leads not only to bigger improvements in SNOT-22 outcomes but also to reduced asthma incidence postoperatively in refractory cases. Summary: Applying data from current studies in clinical practice, we could better manage refractory cases with asthma and polyps, both medically and surgically. Treatment has to be patient-centered, and this demands a multidisciplinary-team approach of the airway diseases.

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Editorial introductions

No abstract available

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Sinonasal methicillin-resistant Staphylococcus aureus: updates on treatment

Purpose of review: Over the past two decades, the management of methicillin-resistant Staphylococcus aureus (MRSA) in chronic rhinosinusitis has posed significant challenges. This document reviews current management techniques and novel treatment modalities for sinonasal MRSA infections. Recent findings: Topical antibiotic therapy, that is, drops (ofloxacin) and ointments (mupirocin) as off-label use for the management of MRSA chronic sinusitis, has shown beneficial results. Other more recently trialed nonantibiotic modalities such as antimicrobial photodynamic therapy and colloidal silver irrigation are also showing promise. Summary: Sinonasal MRSA is considered to be associated with recalcitrant chronic sinusitis. Advancements in systemic and local antibiotics in its management have been slow and unsatisfactory. Attention is shifting to the use of nonantibiotic antibacterial treatments. Knowledge of these options is critical to improve the overall management of these chronic patients.

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The role of sinus surgery in sleep outcomes

Purpose of review: Poor sleep is associated with reduced health, increased morbidity, and increased mortality. Recent findings: Chronic rhinosinusitis (CRS) is one of the most prevalent chronic diseases in the United States, affecting up to 16% of the U.S. population. It has been linked to poor sleep with up to 75% of patients with CRS reporting reduced sleep. Yet there has been little examining the improvement in sleep following surgical treatment of patients with CRS. Summary: In this review, we examine the current knowledge on the association between sleep and CRS as well as review the current data examining the role of sinus surgery. After a structured literature search, we conclude that an evolving body of research demonstrates that sleep is compromised in the majority of patients with CRS. Following surgical treatment of CRS, there is a significant improvement in reported sleep quality that is correlated with subsequent improvement in disease-specific quality of life. Furthermore, we acknowledge that additional research characterizing both objective and subjective measures of sleep following surgical treatment is still needed. Additional investigation is required to better elucidate the underlying pathophysiology of the relationship between sleep dysfunction and CRS.

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Anesthesia for functional endoscopic sinus surgery

Purpose of review: The present article summarizes anesthetic techniques used during functional endoscopic sinus surgery to decrease bleeding and aid in creating a clear surgical field. The applicable physiology behind these anesthetic techniques is reviewed with emphasis on the effect on bleeding and the surgical field. Deliberate hypotension, reverse Trendelenburg positioning, regional anesthesia, and cerebral monitoring are discussed. Recent findings: There are mixed data as to whether traditional inhalation anesthesia or total intravenous anesthesia is superior with respect to better surgical fields and decreased blood loss. A review of the literature tends to favor total intravenous anesthesia. Cerebral oximetry and transcranial Doppler ultrasound are emerging techniques to monitor cerebral perfusion during deliberate hypotension. Summary: Total intravenous anesthesia using propofol and remifentanil is the current favored technique for producing deliberate hypotension during endoscopic sinus surgery due to its hemodynamic stability and smooth rapid emergence.

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Comprehensive management of hereditary hemorrhagic telangiectasia

Purpose of review: Hereditary hemorrhagic telangiectasia (HHT), or Osler Weber-Rendu disease, is a rare inherited disorder of fibrovascular tissue affecting various organs. Epistaxis is the most common symptom of HHT but as the disease affects multiple organs, a multisystem and multidisciplinary approach to management is required. The purpose of this article is to provide an overview of the multidisciplinary approach to HHT for the otolaryngologist and to discuss the current pharmacologic and procedural treatment options available for HHT-related epistaxis. Recent findings: Multidisciplinary expert guidelines have better defined what screening tests are advised for the multisystem evaluation of the HHT patient. New pharmacologic therapies including bevacizumab (Avastin) used submucosally or topically have shown promise as in-office treatment modalities. Sclerotherapy of telangiectasia, including in-office applications, has recently proven safe and effective. Summary: HHT remains a difficult disease to treat. Being aware of the common organ systems involved by the disease will help the practicing otolaryngologist to ensure the patient receives appropriate multidisciplinary care. For HHT-related epistaxis, new medical and surgical options allow for a wider range of treatments than were previously available.

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The role of aspirin desensitization in the management of aspirin-exacerbated respiratory disease

Purpose of review: Aspirin-exacerbated respiratory disease (AERD) is a progressive inflammatory disease of the upper and lower airways characterized by marked eosinophilic nasal polyposis, asthma, and respiratory reactions to medications that inhibit the cyclooxygenase pathway. Aspirin desensitization has proven to be an effective tool in the management of this disease when used in a multidisciplinary setting. The purpose of this article is to review the current literature regarding AERD, aspirin desensitization, and share our opinion regarding the most optimal multidisciplinary approach to these complex patients. Recent findings: Numerous studies, including randomized, double-blind, placebo-controlled trials, have demonstrated the therapeutic effectiveness of aspirin desensitization with significant improvement in number of sinus infections per year, olfactory scores, nasal symptom scores, asthma symptom scores, sinus operations, hospitalizations, emergency room visits, and oral steroid use. Furthermore, the role of surgery is becoming increasingly important for recalcitrant sinus disease with recent studies showing comprehensive surgery as more beneficial to disease management. Summary: Aspirin desensitization is an effective therapeutic tool in the management of AERD. A multidisciplinary approach is critical between the otorhinolaryngologist and allergist to provide the most optimal care for this complex patient population.

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The relationship between lateral displacement of the mandible and scoliosis

Abstract

Objectives

Idiopathic scoliosis is an orthopaedic disease of childhood, with onset and progress occurring until adolescence. Here, the relationship between lateral displacement of the mandible and scoliosis was analysed quantitatively.

Methods

Seventy-nine non-syndromic Japanese patients (18 men, 61 women), who were diagnosed with jaw deformities and underwent surgical orthognathic treatment at Kyushu University Hospital from January 2011 to August 2014, were enrolled. Their mean age at the time of radiography was 25.3 ± 8.7 years. Postero-anterior cephalometric radiographs and chest radiographs were examined. In postero-anterior cephalometric radiographs, a horizontal baseline (X-axis) was drawn as a straight line that intersects both the zygomatic bases, and a vertical line (Y-axis) was marked perpendicular to the X-axis, with an intersection at the anterior nasal spine (ANS). Point A was defined as the intersection of the X- and Y-axes, and line A was defined as the line connecting point A to the menton. The angle made by the X-axis and line A (i.e., lateral displacement of the mandible) was measured. We designated an absolute value even if the mandibular menton was located on the right or left side. In chest radiographs, Cobb's method was used to measure scoliosis curves; the direction of the curve was designated similarly.

Results

Nine (11.4%) individuals had a Cobb angle >10°. There was a positive correlation between the Cobb angle and the degree of mandibular deviation (p < 0.05).

Conclusion

Lateral displacement of the mandible and scoliosis are related.

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An update on endoscopic orbital decompression

Purpose of review: Endoscopic orbital decompression is an ever-evolving surgical procedure with modifications as well as new indications for the procedure. The purpose of this review is to update the reader on optimizing patient selection, surgical timing, highlight the latest modifications to surgical technique and to evaluate surgical outcomes that can be achieved. Recent findings: Patient selection, disease pathology, and optimization of technology can lead to improved outcomes. Changes in technology continue to modify surgical techniques and surgical training, working towards decreased surgical complications with improved outcomes. Historically multiple approaches have been used for orbital decompression and this highlights that a balanced orbital decompression usually leads to the best outcome. Summary: Orbital decompression has evolved significantly since its inception over 100 years ago. Identifying the right patient, the ideal timing, and the indication for the procedure with utilization of technology can lead to improved outcomes and decreased complications.

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Postoperative care in endoscopic sinus surgery: a critical review

Purpose of review: Chronic rhinosinusitis with and without nasal polyps is a common disease affecting people all over the world. Functional endoscopic sinus surgery (FESS) has become the gold standard treatment for medically refractive disease. Postoperative care is recommended by international leaders as an important part of the patient's management. This article is a critical review and discussion focusing on postoperative care, which is based on expert opinion, clinical studies, randomized controlled trials and meta-analysis studies. Recent findings: Postoperative care including nasal rinsing, topical corticosteroids, antibiotics and avoidance of nasal packing are unanimously considered to be the cornerstone of best practice following FESS. However, the effectiveness of in-office nasal debridement is still under debate. Summary: There is a lack of consensus regarding the necessity of performing in-office nasal debridement and the majority of clinicians carry out their postoperative care according to experience and their own preference. This is often determined by the extent of surgery performed, the severity of the postoperative inflammation, as well as being dependent on the patient's discomfort, the time constraints associated with postoperative care and the costs associated with additional appointments. Ideally, nasal debridement should be performed by the operating surgeon under endoscopic control both gently and atraumatically.

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Posttreatment surveillance for sinonasal malignancy

Purpose of review: Sinonasal neoplasms have a high rate of recurrence following treatment, and clinicians utilize a variety of surveillance techniques. Generally, surveillance modality and frequency of follow-up are determined by the guidelines for head and neck cancer as a broad category. However, recent studies have demonstrated that a more tailored approach to follow-up may be necessary. Recent findings: Endoscopy has low sensitivity in recurrence detection, especially in the asymptomatic patient. However, it is able to identify superficial recurrences that may be more amenable to repeat resection. Conversely, imaging [computed tomography (CT), MRI, and 18F-fluorodeoxyglucose-PET/CT] is useful in ruling out disease, but the inflammatory environment of the posttreatment sinonasal cavity leads to a high number of false positives. This is especially notable in PET/CT, which has worse specificity and positive predictive value in sinonasal malignancy than in head and neck malignancy overall, especially in the early posttreatment period. Little data are available on optimal timing and duration of follow-up, but tumor histology and aggressiveness should be considered when choosing a surveillance approach. Summary: Sinonasal malignancy surveillance strategies may warrant modifications of current protocols used for head and neck malignancy. This is due to a number of factors, including a greater diversity of sinonasal disorder and increased duration of posttreatment sinonasal inflammation. Clinicians should be aware of the performance parameters of commonly used surveillance techniques and adjust follow-up regimens based on this information.

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Use of Interactive iBooks for Patient Education in Otology

Physicians in the ambulatory setting face challenges in adequately educating patients in a brief office encounter.

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Impact of treatment modality on quality of life of head and neck cancer patients: Findings from an academic medical institution

There are approximately 436,000 head and neck cancer survivors in the United States currently [1], with 5-year survival rates reported at 63.2% for oral cavity and pharynx and 60.6% for larynx [2]. Virtually all head and neck cancer (HNC) patients present with one or more oral or dental complications [3], which can be mild and include discomfort and pain, or more serious, with morbidities such as dysphagia, mucositis, xerostomia or osteoradionecrosis [4–6]. Further, these complications impact quality of life (QOL) long after treatment [5].

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Cetirizine-responsive, persistent idiopathic eosinophilia in a nonatopic child

Atopy is one of the most common causes of eosinophilia in the developed world.1,2 Antihistamines have been successfully used in the treatment of atopy and associated eosinophilia.3,4 However, it is unclear whether antihistaminic therapy is effective in controlling eosinophilia in patients without associated atopy.1–4 We present a case of a nonatopic child who presented with idiopathic eosinophilia responding to antihistaminic therapy.

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Autonomic function in adults with allergic rhinitis and its association with disease severity and duration

The association between allergic rhinitis (AR) and the autonomic nervous system (ANS) has recently received substantial attention. However, no studies have assessed how the heart rate variability (HRV) parameters are associated with duration and disease severity in AR.

http://ift.tt/2hD29na

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

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.

http://ift.tt/2iNqhj4

A veil in the oral cavity: report of two cases of oral synechiae

An oral synechia is an adhesion between the maxilla and the mandible; these adhesions can be found at various locations in the oral cavity. The presence of oral synechiae associated with cleft palate represents a rare congenital deformity. Oral synechiae with cleft palate can have serious implications for airway management and feeding in babies, and hence requires early intervention to reduce morbidity. Two cases of congenital oral synechiae accompanied by cleft palate, in which the synechiae veiled the oral cavity restricting a detailed intraoral examination, are reported here.

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Maxillary advancement versus mandibular setback in class III dentofacial deformity: are there any differences in aesthetic outcomes?

A retrospective evaluation of maxillary advancement and mandibular setback in class III patients was performed and their aesthetic outcomes compared. Patients with a sella–nasion–A-point angle (SNA) of 80–84° were selected. Pre- and postoperative lateral cephalograms were obtained for 34 class III patients; these were divided into two groups according to the surgical procedure performed: mandibular setback group (n=17) and maxillary advancement group (n=17). The pre- and postoperative cervical length, lip–chin–throat angle, lower/upper lip thickness, distance from the lower/upper lip to the aesthetic line, soft tissue angle, facial contour angle, and nasolabial angle of the two groups were compared.

http://ift.tt/2iOiUf6

Increased interleukin (IL)-17 serum levels in patients with hidradenitis suppurativa: Implications for treatment with anti-IL-17 agents

Biologics seem to offer a promising nonsurgical approach in hidradenitis suppurativa (HS), especially in disease with highly pronounced inflammation. Recent studies revealed increased expression of a broad range of cytokines in lesional HS skin, including interleukin (IL)-17.

http://ift.tt/2iqfaje

Management of hidradenitis suppurativa in pregnancy

Hidradenitis suppurativa is a debilitating inflammatory skin disease with a chronic course and often disappointing response to treatment. Though a minority of persons (20%) reports symptom remission during pregnancy, the vast majority experiences no relief (72%), and few experience clinical deterioration (8%). Disease flares are also observed post-partum. The pathophysiological basis for pregnancy-associated fluctuations in clinical status is currently unknown. Because most women with HS require ongoing management throughout pregnancy, it is important to evaluate the suitability and safety of current treatment options for pregnant women.

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Human polyomavirus 6 and 7 are associated with pruritic and dyskeratotic dermatoses

Human polyomavirus (HPyV)6 and HPyV7 are shed chronically from human skin. HPyV7, but not HPyV6, has been linked to a pruritic skin eruption of immunosuppression.

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Trial of Lenvatinib Plus Pembrolizumab in Subjects With Selected Solid Tumors

Condition:   Solid Tumors
Interventions:   Drug: lenvatinib;   Drug: pembrolizumab
Sponsor:   Eisai Co., Ltd.
Not yet recruiting - verified December 2016

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

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.

http://ift.tt/2igvzqh

EUS-FNA for Retropharyngeal Lymph Node (RPLN) in Recurrent Nasopharyngeal Carcinoma (NPC) Patients

Condition:   Nasopharyngeal Carcinoma
Intervention:   Procedure: EUS-FNA for RPLN in NPC patients
Sponsor:   Sun Yat-sen University
Recruiting - verified December 2016

http://ift.tt/2hB2mFt

Relationship of Metabolic Syndrome and Its Components With Thyroid Cancer

Condition:   Thyroid Cancer
Intervention:  
Sponsor:   Lin Liao
Not yet recruiting - verified December 2016

http://ift.tt/2iymBCr

Influence of the SPInal MANipulation on Muscle Spasticity and Manual Dexterity in Cerebral Palsy.

Condition:   Cerebral Palsy, Spastic
Interventions:   Procedure: Spinal manipulation;   Procedure: Imitation of the spinal manipulation
Sponsor:   International Clinic of Rehabilitation, Ukraine
Recruiting - verified December 2016

http://ift.tt/2hAJcQ4

Exercise Program Based on Motor Learning and Forward Head Posture Correction

Conditions:   Musculoskeletal Abnormalities;   Deformity
Intervention:   Other: Exercise program based on motor learning principles
Sponsor:   Eleni Kapreli
Not yet recruiting - verified December 2016

http://ift.tt/2iykWww

Effects of enamel matrix derivative on non-surgical management of peri-implant mucositis: a double-blind randomized clinical trial

Abstract

Background

Peri-implant diseases have been recognized as being among the ever-increasing complications related to dental implants. The aim of this study was to evaluate the adjunctive use of enamel matrix derivative (EMD) to mechanical debridement (MD) in patients with these conditions in terms of clinical parameters and cytokine levels of peri-implant crevicular fluid (PICF).

Methods

In the present double-blind clinical trial, 46 patients with peri-implant mucositis (PM) were randomly divided into control and test groups. Two different therapeutic protocols, consisting of non-surgical MD alone (control group) and MD with the application of EMD (test group), were considered for the two groups. Clinical parameters [bleeding on probing (BOP) and probing depth (PD)] and sampling from PICF were carried out before treatment and 3 months postoperatively. The levels of IL-6 and IL-17 cytokines in PICF were evaluated by enzyme-linked immunosorbent (ELISA).

Results

Three-month post-interventional assay revealed significant improvements in BOP and PD in the test group in comparison to the control group (P < 0.0001). Relative to control, IL-6 and IL-17 levels were reduced significantly (p < 0.05) in the test group compared to the control group.

Conclusion

Application of EMD can be considered an adjunct to MD in the non-surgical treatment of PM. However, complete recovery was not observed using either treatment approach showing that management of implant-associated disease is still a significant clinical problem.

http://ift.tt/2igc9lo

Autonomic function in adults with allergic rhinitis and its association with disease severity and duration

Publication date: Available online 29 December 2016
Source:Annals of Allergy, Asthma & Immunology
Author(s): Min Hee Kim, Eun Ji Choi, Bo-Hyoung Jang, Kyu Seok Kim, Seoung-Gyu Ko, Inhwa Choi
BackgroundThe association between allergic rhinitis (AR) and the autonomic nervous system (ANS) has recently received substantial attention. However, no studies have assessed how the heart rate variability (HRV) parameters are associated with duration and disease severity in AR.ObjectiveTo compare the difference in autonomic conditions among individuals with AR of various durations and severities and healthy controls.MethodsWe divided individuals with AR into subgroups based on duration and severity of disease. Next, we measured HRV, and the results were compared among subgroups and healthy controls.ResultsHigh frequency (HF) and normalized high frequency (NHF) were significantly higher in the intermittent group than in the control group, whereas normalized low frequency (NLF) and the ratio of absolute LF to HF power (LF/HF) were significantly lower in the intermittent group than in the control group. Furthermore, NLF was significantly higher in the persistent group than in the intermittent group. HF and NHF were significantly higher in the mild group than in the control group, whereas NLF and LF/HF were significantly lower in the mild group than in the control group. The total nasal symptom and itchy nose scores were negatively correlated with NHF.ConclusionOur results indicate that patients with intermittent and mild AR have hypervagal activity and hyposympathetic activity, and the predominance lessens in patients with more persistent AR and severe symptoms. Further investigation of the mechanisms underlying the association between autonomic function and persistent and severe AR is needed.



http://ift.tt/2iq4ocL

Cetirizine-responsive, persistent idiopathic eosinophilia in a nonatopic child

Publication date: Available online 29 December 2016
Source:Annals of Allergy, Asthma & Immunology
Author(s): Emily Knight, Philip Fischer, Carola Arndt, Samuel Anim, Avni Joshi




http://ift.tt/2ipYlVD

Impact of treatment modality on quality of life of head and neck cancer patients: Findings from an academic medical institution

Publication date: Available online 29 December 2016
Source:American Journal of Otolaryngology
Author(s): Kara Christopher




http://ift.tt/2iNzCLu

Variability of word discrimination scores in clinical practice and consequences on their sensitivity to hearing loss

Abstract

Speech perception scores are widely used to assess patient's functional hearing, yet most linguistic material used in these audiometric tests dates to before the availability of large computerized linguistic databases. In an ENT clinic population of 120 patients with median hearing loss of 43-dB HL, we quantified the variability and the sensitivity of speech perception scores to hearing loss, measured using disyllabic word lists, as a function of both the number of ten-word lists and type of scoring used (word, syllables or phonemes). The mean word recognition scores varied significantly across lists from 54 to 68%. The median of the variability of the word recognition score ranged from 30% for one ten-word list down to 20% for three ten-word lists. Syllabic and phonemic scores showed much less variability with standard deviations decreasing by 1.15 with the use of syllabic scores and by 1.45 with phonemic scores. The sensitivity of each list to hearing loss and distortions varied significantly. There was an increase in the minimum effect size that could be seen for syllabic scores compared to word scores, with no significant further improvement with phonemic scores. The use of at least two ten-word lists, quoted in syllables rather than in whole words, contributed to a large decrease in variability and an increase in sensitivity to hearing loss. However, those results emphasize the need of using updated linguistic material for clinical speech score assessments.

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Revisiting Type 2-high and Type 2-low airway inflammation in asthma: current knowledge and therapeutic implications

Abstract

Asthma is a complex respiratory disorder characterized by marked heterogeneity in individual patient disease triggers and response to therapy. Several asthma phenotypes have now been identified, each defined by a unique interaction between genetic and environmental factors, including inflammatory, clinical and trigger-related phenotypes. Endotypes further describe the functional or pathophysiologic mechanisms underlying the patient's disease. Type 2-driven asthma is an emerging nomenclature for a common subtype of asthma and is characterized by the release of signature cytokines IL-4, IL-5 and IL-13 from cells of both the innate and adaptive immune systems. A number of well-recognized biomarkers have been linked to mechanisms involved in Type 2 airway inflammation, including fractional exhaled nitric oxide, serum IgE, periostin, and blood and sputum eosinophils. These Type 2 cytokines are targets for pharmaceutical intervention, and a number of therapeutic options are under clinical investigation for the management of patients with uncontrolled severe asthma. Anticipating and understanding the heterogeneity of asthma and subsequent improved characterization of different phenotypes and endotypes must guide the selection treatment to meet individual patients' needs.

This article is protected by copyright. All rights reserved.

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Semi-quantifiable angiogenesis parameters in association with the malignant transformation of oral leukoplakia

Abstract

Background

Aim of the study was to assess the role of angiogenesis in the process of malignant transformation of clinical diagnosed oral leukoplakia (OL).

Materials and Methods

131 histological preparations (oral leukoplakia/hyperkeratosis without dysplasia (OL; n=49), oral leukoplakia/hyperkeratosis with mild dysplasia (OL-SIN1; n=33), with moderate dysplasia (OL-SIN2; n=13) and leukoplakia-derived oral squamous cell carcinoma (OL-OSCC; n=36)) were evaluated for microvessel density (MVD), vessel diameter as well as for vascular endothelial growth factor (VEGF-A) expression. Data were compared within the groups.

Results

For MVD, there were significant differences between OL and OL-SIN 2/OL-OSCC (P < 0.05) and between OL-SIN 1 and OL-OSCC (P < 0.05). For OL-OSCC, vessel diameters were significantly increased compared to OL (P < 0.05). Expression of VEGF-A increased significantly gradually from OL-SIN 1 to OSCC (each P < 0.05). This was especially evident for lesions of the tongue when compared to the others.

Conclusion

Angiogenesis increases during the transition from OL through dysplasia to OL-OSCC. Especially in OL-OSCCs of the tongue, VEGF-A-expression may be used for estimation of malignant progression of OL.

This article is protected by copyright. All rights reserved.

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Cetuximab sensitivity of head and neck squamous cell carcinoma xenografts is associated with treatment-induced reduction of EGFR, pEGFR, and pSrc

Abstract

Background

The aims of this study were to validate in vitro drug sensitivity testing of head and neck squamous cell carcinoma (HNSCC) cell lines in an in vivo xenograft model and to identify treatment-induced changes in the epidermal growth factor receptor (EGFR) signaling pathway that could be used as markers for cetuximab treatment response.

Materials and methods

The in vitro and in vivo cetuximab sensitivity of two HNSCC cell lines, UT-SCC-14 and UT-SCC-45, was assessed using a crystal violet assay and xenografts in nude mice, respectively. The expression of EGFR, phosphorylated EGFR (pEGFR), phosphorylated Src (pSrc), and Ki-67 were investigated by immunohistochemistry. To verify these results the in vitro expression of EGFR and pEGFR were analyzed with ELISA in a panel of 10 HNSCC cell lines.

Results

A close correlation was found between in vitro and in vivo cetuximab sensitivity data in the two investigated HNSCC cell lines. In treatment sensitive UT-SCC-14 xenografts there was a decrease in EGFR, pEGFR, and pSrc upon cetuximab treatment. Interestingly, in insensitive UT-SCC-45 xenografts an increased expression of these three proteins was found. The change in EGFR and pEGFR expression in vivo was confirmed in cetuximab sensitive and insensitive HNSCC cell lines using ELISA.

Conclusion

High sensitivity to cetuximab was strongly associated with a treatment-induced reduction in pEGFR both in vivo and in vitro in a panel of HNSCC cell lines, suggesting that EGFR and pEGFR dynamics could be used as a predictive biomarker for cetuximab treatment response.

This article is protected by copyright. All rights reserved.

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Tracheostomy in the Morbidly Obese: Difficulties and Challenges

Publication date: Available online 30 December 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Tirbod Fattahi, Christopher Chafin, Anthony Bunnell
PurposeThis manuscript is designed to evaluate the difficulties and challenges associated with open trachesotomy in the morbidly obese patient (BMI≥ 30 kg/m²).Patients & MethodForty patients met all the inclusion criteria. A retrospective chart review was then performed to evaluate indications for tracheostomy, length of intubation prior to tracheostomy, history of previous tracheostomy, length of operative procedure, length of time in the operating room, as well as all perioperative complications.ResultsComplications were classified as intra-operative (5%) and post-operative (17.5%). The average BMI of our patients was 46 kg/m² with a range of 31.1 to 75.3 kg/m². The average length of intubation prior to tracheostomy was 11 days. Ten patients (25%) had undergone a previous tracheostomy. The average operating time was 60 minutes with a range of 20-95 minutes. The average total time in the operating room was 100 minutes with a range of 45-146 minutes.ConclusionOur study shows that while open tracheostomy in the morbidly obese patient is increasing in demand, the procedure can be predictably performed albeit at a much longer duration and a higher peri-operative complication rate compared to the traditional tracheostomy.



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The “drawer-like” resection and reconstruction with Titanium Mesh: a novel surgical technique for treatment of giant ossifying fibroma in the maxilla

Publication date: Available online 29 December 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Mingming Lv, Jun Li, Yi Shen, Liang Wang, Jian Sun
PurposeThe aim of this article is to introduce a new surgical method for treatment of ossifying fibroma (OF) in the maxilla with dislocation of eyeball, and evaluate the postoperative outcomes and prognosis.Patients and MethodsPatients of maxillary OF treated with the "drawer-like" resection were retrieved from 2014 to 2015. The surgical procedure consists of total removal of the orbital floor and majority of the maxilla with the preservation of alveolar ridge, immediately followed by reconstruction with titanium mesh. Postoperative appearance and function were assessed. In addition, the recurrence rate was statistically observed.ResultsThe study included 6 patients of maxillary OF who were treated with "drawer-like" resection. Good esthetics and reduction of the globe have been well achieved in all the patients. Long-term follow-up shows that the recurrence rate is low. It needs to be emphasized that the original occlusal relationship and the masticatory function have been preserved.ConclusionsWith this new method, the original occlusal relationship can be well preserved. Meanwhile, bulging of maxilla and eyeball displacement have been corrected.



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Primary embryonal rhabdomyosarcoma of the liver

Rhabdomyosarcomas are malignant neoplasms with striated muscle differentiation. This is the most common type of soft-tissue sarcoma in children, but occurs rarely in adults. Its occurrence in liver is infrequent. We report a case of primary hepatic embryonal rhabdomyosarcoma in a 67-year-old man. The tumour was occupying the left lobe of the liver with large component of lesion seen bulging in left subhepatic space indenting over the stomach, compressing the pancreas and gall bladder. A percutaneous biopsy was performed which revealed embryonal rhabdomyosarcoma. He underwent a successful left lobectomy with complete resection of the tumour, followed by adjuvant chemotherapy. The patient is free of disease at 24 months of follow-up. Hence, an early diagnosis, prompt surgical resection with negative resection margin along with adjuvant chemotherapy can provide complete remission. This case is extremely rare both due to the age of the patient at presentation and location of the tumour.

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Irreducible posterolateral elbow dislocation: a rare injury

Posterolateral dislocation of the elbow is an injury commonly treated in the emergency department by closed reduction. Very rarely it can be irreducible and require open reduction. Only four cases of irreducible posterolateral elbow dislocation have been described in the literature over the past 50 years. We report the case of a 20-year-old man who sustained such an injury. Open reduction was performed and revealed the radial head protruding or 'buttonholing' through the lateral collateral ligament complex. This case highlights that continued closed reduction of the elbow should not be attempted, as a mechanical block to reduction can occur making reduction impossible.

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Complete androgen insensitivity syndrome with concomitant seminoma and Sertoli cell adenoma: an unusual combination

Androgen insensitivity syndrome is a rare disorder of sex development and its clinical manifestations vary from subtle male infertility to an overt complete androgen insensitivity syndrome (CAIS) with a female phenotype. CAIS is often diagnosed at puberty or in adolescence during investigation for primary amenorrhoea. Undiagnosed patients have an increased risk of development of malignancy in the harboured testes. Inguinal hernia is the commonest mode of presentation of CAIS in childhood and various screening methods are available during the initial herniorrhaphy procedure. Controversy exists in the need to screen and the methods of screening in all cases of premenstrual girls with inguinal hernia. Abnormal observation in a suspicious case requires karyotyping for confirmation. We describe a case of CAIS with simultaneous presence of seminoma and a Sertoli cell adenoma in a 17-year-old patient who had a history of surgery for inguinal hernia at age of 5 years.

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Piggy back intraocular lens for the correction of buckling surgery-induced refractive error in pseudophakia

A 29-year-old man presented to us with bilateral pseudophakia with suboptimal vision in right eye. His uncorrected distance visual acuity (UDVA) on Snellen's chart was 6/36 and 6/9 in right eye (OD) and left eye (OS), respectively. It improved to 6/9 OD with –5.00DS/–0.50DC at 90° and 6/6 OS with –0.5DC at 100°. He had undergone buckling surgery 1 year back for rhegmatogenous retinal detachment in right eye and subsequently developed a myopic refractive error. A spherical piggyback intraocular lens (IOL; Rayner Sulcoflex, East Sussex) was implanted in the sulcus for refractive correction. The postoperative UDVA at 4 weeks was 6/6p. The intraocular pressure was normal and there was no significant endothelial cell loss. Piggyback IOLs can be an effective tool to correct the induced refractive error due to an increase in axial length following buckling surgery.

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Simultaneous bilateral total hip arthroplasty dislocation with unilateral foot drop following closed reduction

Dislocation following primary and revision arthroplasty is a well-recognised complication with an estimated incidence rate of 0.2–10%. We present a rare case of simultaneous bilateral total hip replacement dislocation, complicated by unilateral foot drop following closed reduction, with no improvement in neurological function at 6-month follow-up.

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Optical coherence tomography of band keratopathy

Description

Band keratopathy is a chronic degenerative disease characterised by the gradual deposition of greyish opacity in superficial cornea over months or years in eyes with chronic uveitis or on intensive topical therapies containing phosphates. The mechanism of calcium deposition in the interpalpebral area of the cornea is multifactorial: salt precipitation as tears evaporate, necrotic debris from superficial keratitis, inflammatory changes in the pH of the ocular surface and the breakdown of phosphates.12 Band keratopathy can result in severe visual loss from corneal opacification. The main goal of surgery is to restore corneal transparency, providing visual rehabilitation, and avoiding amblyopia in children. Treatment includes removal of calcium deposits by chelation using ethylenediaminetetraacetic acid (EDTA), or superficial keratectomy or phototherapeutic keratectomy.3 The choice of the surgical technique and the required depth of surgery can be optimised by prior visualisation of the calcium...

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Idiopathic bilateral haemolacria

DescriptionCase description

A 15-year-old girl presented with a 1-month history of intermittent, bilateral 'bloody tears' (figure 1A, B). History revealed the symptoms began spontaneously 1 month back with an average one episode in 15 days lasting for less than a minute. Examination revealed 20/20 visual acuity in both the eyes with the normal eyelid, conjunctiva, lacrimal sac area, ocular surface, intraocular pressure and fundus. At the time of initial presentation, smear from the bloody tear film did not reveal any abnormal cells except for red blood cells, followed by lacrimal system syringing and probing revealed patent nasolacrimal system without any identifiable cause. Family history was negative for such symptoms/bleeding disorders, no history of any medication usage and of any disease/surgery related to periocular tissue, nose or sinuses. Haematological work-up showed normal complete blood count, bleeding time, clotting time, prothrombin time and liver function test. CT of the...

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Severe amoebic colitis in an HIV-infected male patient

Description

A previously healthy Japanese man aged 67 years was admitted into our hospital after presenting with fever, abdominal pain and watery diarrhoea (occasionally bloody) for 2 weeks. At presentation, he had a fever of 38.9°C and diffuse abdominal tenderness. His white cell count was 7440/μL, C reactive protein 22.18 mg/dL, serum albumin 1.8 g/dL, potassium 2.9 mmol/L and blood urea nitrogen was 26.5 mg/dL. Abdominal CT revealed pancolitis with mild splenomegaly but no hepatic lesions. Stool analysis and culture was negative for pathogenic bacteria, Clostridium difficile and tuberculosis.

After conservative treatment with intravenous drip for 2 days, a sigmoidoscopy was performed. Multiple surface to deep ulcerations with yellowish exudate was observed in the rectosigmoid region (figure 1A). Mucosal biopsy revealed acute colitis with the presence of haemophagocytic amoebic trophozoites (figure 2, arrows). Microscopic examination of the patient's stool also confirmed the presence of Entamoeba histolytica trophozoites and amoebic serology was...

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Mangled extremity: to salvage or not to salvage?

Description

A man aged 34 years post jump from the platform onto an incoming train presented as a level I trauma notification with bilateral mangled lower extremities and tourniquets in place (figure 1). Our patient was evaluated in a multidisciplinary fashion, making sure to follow proper ATLS guidelines. On presentation, he was hypotensive, but responded to crystalloid and blood products. Secondary survey revealed pulseless, paralysed extremities that lacked sensation and were grossly contaminated. The Mangled Extremity Severity Score (MESS) calculated as 9.1 With all factors considered, the patient was emergently taken to the operating theatre for left above knee and right below knee amputations.

Figure 1

Bilateral mangled lower extremities with a calculated Mangled Extremity Severity Score of 9 in a man aged 34 years who attempted suicide by jumping from a train platform.

The mangled extremity represents complex...

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Intercostal artery pseudoaneurysm with spontaneous resolution in the setting of an artery of Adamkiewicz

We report an extremely unique and previously unreported case of a pseudoaneurysm arising from an intercostal artery that also gave origin to the artery of Adamkiewicz. Due to the potential risk of losing the artery of Adamkiewicz, a conservative approach was indicated. On short interval follow-up imaging, the pseudoaneurysm and associated hematoma spontaneously resolved with preservation of the intercostal artery. We performed a literature review of the natural course of pseudoaneurysm as well as their occurrence in the intercostal arteries.

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Bile acids: a potential role in the pathogenesis of pharyngeal malignancy

Abstract

Objective

Gastro-oesophageal reflux disease is thought to be a risk factor for head and neck malignancies. Bile acids are one of the principle components of gastric refluxate and have previously been implicated in the development of oesophageal and bowel malignancies. There is clear evidence that bile acids reflux into the laryngopharynx. Despite this, the carcinogenic properties of bile acids in this area are yet to be fully identified. We therefore investigated the potential role of bile acids in pharyngeal malignancy, through the highly conserved process of epithelial-mesenchymal transition (EMT). EMT occurs in invasion and metastasis and is a central process in the development of epithelial carcinoma.

Design

Translational research study

Methods

Human hypopharyngeal squamous carcinoma FaDu cells were challenged with primary (cholic or chenodeoxycholic) and secondary (deoxycholic or lithocholic) bile acids. EMT relevant proteins TGF-β1 and MMP-9 were measured in the cell culture supernates at 48-hours via ELISA. Cell viability was confirmed >95% via CellTiter-Blue assay.

Results

Significantly greater concentrations of TGF-β1 were measured in the culture supernates of cells treated with cholic acid, deoxycholic acid, chenodeoxycholic acid. MMP-9 levels were increased in deoxycholic acid and lithocolic acid stimulations when compared to control (p<0.05).

Conclusion

This is the first demonstration that bile acids induce TGF-β1 and MMP-9 in pharyngeal cells. TGF-β1 is considered a master switch for EMT while MMP-9 is a part of the EMT proteome which degrades basement membranes. This implies a potential role for bile acids in pharyngeal carcinogenesis through the mechanism of EMT and suggests potential novel therapeutic targets.

This article is protected by copyright. All rights reserved.

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Exhaled breath condensate in asthma: Are we stupid if we do not keep it simple?

Publication date: January–February 2017
Source:Allergologia et Immunopathologia, Volume 45, Issue 1
Author(s): L. Garcia-Marcos




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Comparison of two preoperative protocols for mandibular symphyseal distraction osteogenesis to reduce the risk of tooth damage

Publication date: Available online 30 December 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Heinz Winsauer, Oliver Ploder, Katharina Juengling, Andre Walter, Andreas Kolk




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Association of Iron Deficiency Anemia With Hearing Loss in US Adults.

Association of Iron Deficiency Anemia With Hearing Loss in US Adults.

JAMA Otolaryngol Head Neck Surg. 2016 Dec 29;:

Authors: Schieffer KM, Chuang CH, Connor J, Pawelczyk JA, Sekhar DL

Abstract
Importance: Hearing loss in the US adult population is linked to hospitalization, poorer self-reported health, hypertension, diabetes, and tobacco use. Because iron deficiency anemia (IDA) is a common and easily correctable condition, further understanding of the association between IDA and all types of hearing loss in a population of US adults may help to open new possibilities for early identification and appropriate treatment.
Objective: To evaluate the association between sensorineural hearing loss (SNHL) and conductive hearing loss and IDA in adults aged 21 to 90 years in the United States.
Design, Setting, and Participants: The prevalence of IDA and hearing loss (International Classification of Diseases, Ninth Revision codes 389.1 [SNHL], 389.0 [conductive hearing loss], and 389 [combined hearing loss]) was identified in this retrospective cohort study at the Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. Iron deficiency anemia was determined by low hemoglobin and ferritin levels for age and sex in 305 339 adults aged 21 to 90 years. Associations between hearing loss and IDA were evaluated using χ2 testing, and logistic regression was used to model the risk of hearing loss among those with IDA. The study was conducted from January 1, 2011, to October 1, 2015.
Main Outcomes and Measures: Hearing loss.
Results: Of 305 339 patients in the study population, 132 551 were men (43.4%); mean (SD) age was 50.1 (18.5) years. There was a 1.6% (n = 4807) prevalence of combined hearing loss and 0.7% (n = 2274) prevalence of IDA. Both SNHL (present in 26 of 2274 individuals [1.1%] with IDA; P = .005) and combined hearing loss (present in 77 [3.4%]; P < .001) were significantly associated with IDA. Logistic regression analysis confirmed increased odds of SNHL (adjusted odds ratio [OR], 1.82; 95% CI, 1.18-2.66) and combined hearing loss (adjusted OR, 2.41; 95% CI, 1.90-3.01) among adults with IDA, after adjusting for sex.
Conclusions and Relevance: Iron deficiency anemia was associated with SNHL and combined hearing loss in a population of adult patients. Further research is needed to better understand the potential links between IDA and hearing loss and whether screening and treatment of IDA in adults could have clinical implications in patients with hearing loss.

PMID: 28033450 [PubMed - as supplied by publisher]

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Distant Metastases Following Postoperative Intensity-Modulated Radiotherapy for Oral Cavity Squamous Cell Carcinoma.

Distant Metastases Following Postoperative Intensity-Modulated Radiotherapy for Oral Cavity Squamous Cell Carcinoma.

JAMA Otolaryngol Head Neck Surg. 2016 Dec 29;:

Authors: Hosni A, Huang SH, Xu W, Su J, Bayley A, Bratman SV, Cho J, Giuliani M, Kim J, Ringash J, Waldron J, Spreafico A, De Almeidad J, O'Sullivan B, Goldstein D, Hope A

Abstract
Importance: Advances in surgical techniques, the advent of intensity-modulated radiotherapy (IMRT), and the use of concurrent chemotherapy in oral squamous cell carcinoma (OSCC) have led to improvement of locoregional control (LRC), but not distant control (DC). Moreover, the development of distant metastases (DM) in OSCC has a dismal prognosis.
Objective: To determine the characteristics and risk factors of DM following postoperative IMRT in OSCC, and to identify the clinicopathological features that could be associated with distant-only failure (DOF).
Design, Setting, and Participants: Retrospective study of 300 OSCC patients (192 [64%] men and 108 [36%] women) treated with surgery and postoperative IMRT between 2005-2012 in a tertiary cancer center.
Interventions: All patients underwent initial primary curative-intent resection with postoperative IMRT with or without concurrent chemotherapy based on predefined risk features.
Main Outcomes and Measures: Locoregional control, DC, overall survival (OS), and Radiation Therapy Oncology Group grade of 3 or higher late toxic effects. Multivariable analysis identified predictors for DM.
Results: Overall 300 patients were identified (histological grade 2-3 [G2-3], 285 [95%]; pT3-4, 121 [41%]; pN2-3, 141 [47%]). Positive resection margin was present in 64 of 300 (21%) patients and extracapsular extension in 89 of 281 (32%) neck dissections. Median IMRT dose was 66 Gy and concurrent chemotherapy was used in 73 patients (24%). Median follow-up was 41 months. The 5-year local, regional, and distant control and OS were 85%, 82%, 86%, and 69%, respectively. On multivariable analysis, pN2-3 (hazards ratio, 5.7; 95% CI, 2.2-14.7) and G2-3 (HR, 4.9; 95% CI, 2.8-8.9) were predictive of DM. Thirty-nine patients developed DM, of which 20 (51%) were DOF and 12 (31%) were oligometastatic (≤5 lesions). The clinicopathological characteristics in DOF were similar to patients with DM subsequent to locoregional failure. In patients with G2-3, pN2-3, and extracapsullar extension (all together), the 5-year cumulative incidence of DOF was 22%.
Conclusions and Relevance: Surgery and postoperative IMRT with or without concurrent chemotherapy achieved encouraging outcomes. The clinicopathological characteristics of DOF and DM with locoregional failure were similar. Patients with G2-3, pN2-3, and extracapsullar extension (all together) have higher risk of DOF. Both pN2-3 and G2-3 were independent predictors of DM. Patients with these risk factors may be candidates for prospective clinical trials of intensified therapy or surveillance strategies.

PMID: 28033442 [PubMed - as supplied by publisher]

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Unilateral Neck Swelling in a Pediatric Patient.

Unilateral Neck Swelling in a Pediatric Patient.

JAMA Otolaryngol Head Neck Surg. 2016 Dec 29;:

Authors: Clark CM, Bann DV, Zacharia TT

PMID: 28033435 [PubMed - as supplied by publisher]

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A veil in the oral cavity: report of two cases of oral synechiae

Publication date: Available online 29 December 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): A. Dongol, P. Acharya, J.N. Prasad, M.R. Jaisani
An oral synechia is an adhesion between the maxilla and the mandible; these adhesions can be found at various locations in the oral cavity. The presence of oral synechiae associated with cleft palate represents a rare congenital deformity. Oral synechiae with cleft palate can have serious implications for airway management and feeding in babies, and hence requires early intervention to reduce morbidity. Two cases of congenital oral synechiae accompanied by cleft palate, in which the synechiae veiled the oral cavity restricting a detailed intraoral examination, are reported here.



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Maxillary advancement versus mandibular setback in class III dentofacial deformity: are there any differences in aesthetic outcomes?

Publication date: Available online 30 December 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M. Ghassemi, R.-D. Hilgers, U. Fritz, A. Modabber, A. Ghassemi
A retrospective evaluation of maxillary advancement and mandibular setback in class III patients was performed and their aesthetic outcomes compared. Patients with a sella–nasion–A-point angle (SNA) of 80–84° were selected. Pre- and postoperative lateral cephalograms were obtained for 34 class III patients; these were divided into two groups according to the surgical procedure performed: mandibular setback group (n=17) and maxillary advancement group (n=17). The pre- and postoperative cervical length, lip–chin–throat angle, lower/upper lip thickness, distance from the lower/upper lip to the aesthetic line, soft tissue angle, facial contour angle, and nasolabial angle of the two groups were compared. Significant differences were observed for cervical length (P=0.0003) and sex (P=0.003) when comparing maxillary advancement with mandibular setback. Although the preoperative cervical length was similar in the two groups, it increased significantly after maxillary advancement and decreased after mandibular setback. In this study, the differences in aesthetic outcomes depending on the surgical procedure performed were considered. Some aesthetically important parameters proved to be superior after maxillary advancement when compared to mandibular setback, even with the maxilla in the normal position.



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Editorial Board

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Cover Page

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Preparing to Pass the FRCA. C. Whymark

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Associate Editorial Board

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General Information

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Basic Anesthesiology Examination Review. G. W. Williams and E. S. Williams

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Contents Page

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Reply

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In the January BJA ...

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Pre-warming the double-lumen endobronchial tubes to facilitate intubation in incubator

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Assessing influence of thermal softened double-lumen endobronchial tube on postoperative airway injury and morbidity: a call for methodology clarification

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Reply

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Assessment of scoring systems to describe the position of tracheostomy tubes within the airway - the lunar study

Background: Malposition of tracheostomy tubes is difficult to detect at the bedside and may contribute to eventual device misplacement. Endoscopic examination can be undertaken via tracheoscopic (T-view) or trans-laryngeal (L-view) approach, offering more precise detail regarding positioning within the airway. The aims of this study were to evaluate inter-rater agreement between bespoke T and L view scoring systems and subsequently whether T-views could predict L-views.

Methods: Adult intensive care unit patients with percutaneous or surgical tracheostomies were included and paired T and L-views of their tracheostomy tube within the airway were taken on up to four occasions. Images were later scored by five independent raters using bespoke scoring systems. The primary outcome was to determine the T and L view scoring system with the best inter-rater agreement, defined by weighted kappa and intra-class correlation coefficients. The secondary outcome was to assess agreement between T and L-view scoring systems.

Results: Seventy-one T-views and 43 L-views were obtained from a total of 20 patients. Images were scored by five raters, resulting in 355 T-view scores, 215 L-view scores and 215 paired T and L-view scores for comparison. There was good inter-rater agreement (highest T-view k = 0.84, L-view k = 0.72). There was poor agreement between T and L-view scores for each of the paired images (highest k = 0.25) although extreme-to-extreme misclassification rates remained acceptable.

Conclusions: Whilst our data demonstrated good inter-rater agreement between scoring systems, it is not possible to reliably predict the T-view orientation and position of a tracheostomy tube within the airway from the paired L-view.

Clinical trial registration: NCT01356719

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Strong ion and weak acid analysis in severe preeclampsia

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Intensive care utilization and outcomes after high-risk surgery in Scotland: a population-based cohort study

Background. The optimal perioperative use of intensive care unit (ICU) resources is not yet defined. We sought to determine the effect of ICU admission on perioperative (30 day) and long-term mortality.

Methods. This was an observational study of all surgical patients in Scotland during 2005–7 followed up until 2012. Patient, operative, and care process factors were extracted. The primary outcome was perioperative mortality; secondary outcomes were 1 and 4 yr mortality. Multivariable regression was used to construct a risk prediction model to allow standard-risk and high-risk groups to be defined based on deciles of predicted perioperative mortality risk, and to determine the effect of ICU admission (direct from theatre; indirect after initial care on ward; no ICU admission) on outcome adjusted for confounders.

Results. There were 572 598 patients included. The risk model performed well (c-index 0.92). Perioperative mortality occurred in 1125 (0.2%) in the standard-risk group (n=510 979) and in 3636 (6.4%) in the high-risk group (n=56 785). Patients with no ICU admission within 7 days of surgery had the lowest perioperative mortality (whole cohort 0.7%; high-risk cohort 5.3%). Indirect ICU admission was associated with a higher risk of perioperative mortality when compared with direct admission for the whole cohort (20.9 vs 12.1%; adjusted odds ratio 2.39, 95% confidence interval 2.01–2.84; P<0.01) and for high-risk patients (26.2 vs 17.8%; adjusted odds ratio 1.64, 95% confidence interval 1.37–1.96; P<0.01). Compared with direct ICU admission, indirectly admitted patients had higher severity of illness on admission, required more organ support, and had an increased duration of ICU stay.

Conclusions. Indirect ICU admission was associated with increased mortality and increased requirement for organ support.

Trial registration. UKCRN registry no. 15761.

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Association between day and time of admission to critical care and acute hospital outcome for unplanned admissions to adult general critical care units: cohort study exploring the 'weekend effect

Background. We aimed to identify any association between day and time of admission to critical care and acute hospital outcome.

Methods. We conducted a cohort study using prospectively collected data from the national clinical audit of adult critical care. We included 195 428 unplanned admissions from 212 adult general critical care units in England, Wales and Northern Ireland, between April 1, 2013 and March 31, 2015 in the analysis.

Results. Hourly admission rates for unplanned admissions varied more than three-fold during the 24 h cycle. Overall acute hospital mortality was 26.8%. Before adjustment, acute hospital mortality was similar between weekends and weekdays but was significantly lower for admissions at night compared with the daytime (–3.4%, –3.8 to –3.0%; P<0.001). After adjustment for casemix, there remained no difference between weekends and weekdays (–0.0%, –0.4 to +0.3%; P=0.87) or between nighttime and daytime (–0.2%, –0.5 to +0.1%; P=0.21). Delays in admission were reported for 4.3% of admissions and were slightly more common during weekdays than weekends and in the daytime than at night. Delayed admission was associated with a small increase in acute hospital mortality, but adjusting for this did not affect the estimates of the effect of day and time of admission.

Conclusions. The day of week and time of admission have no influence on patient mortality for unplanned admissions to adult general critical care units within the UK. Ways to improve critical care and hospital systems to minimize delays in admission and potentially improve outcomes need to be ascertained in future research.

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Effect of anaesthesia type on postoperative mortality and morbidities: a matched analysis of the NSQIP database

Background. The anaesthetic technique may influence clinical outcomes, but inherent confounding and small effect sizes makes this challenging to study. We hypothesized that regional anaesthesia (RA) is associated with higher survival and fewer postoperative organ dysfunctions when compared with general anaesthesia (GA).

Methods. We matched surgical procedures and type of anaesthesia using the US National Surgical Quality Improvement database, in which 264,421 received GA and 64,119 received RA. Procedures were matched according to Current Procedural Terminology (CPT) and ASA physical status classification. Our primary outcome was 30-day postoperative mortality and secondary outcomes were hospital length of stay, and postoperative organ system dysfunction. After matching, multiple regression analysis was used to examine associations between anaesthetic type and outcomes, adjusting for covariates.

Results. After matching and adjusting for covariates, type of anaesthesia did not significantly impact 30-day mortality. RA was significantly associated with increased likelihood of early discharge (HR 1.09; P< 0.001), 47% lower odds of intraoperative complications, and 24% lower odds of respiratory complications. RA was also associated with 16% lower odds of developing deep vein thrombosis and 15% lower odds of developing any one postoperative complication (OR 0.85; P < 0.001). There was no evidence of an effect of anaesthesia technique on postoperative MI, stroke, renal complications, pulmonary embolism or peripheral nerve injury.

Conclusions. After adjusting for clinical and patient characteristic confounders, RA was associated with significantly lower odds of several postoperative complications, decreased hospital length of stay, but not mortality when compared with GA.

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Safety of sedation for gastrointestinal endoscopy in a group of university-affiliated hospitals: a prospective cohort study

Background. Service models for gastrointestinal endoscopy sedation must be safe, as endoscopy is the most common procedure performed under sedation in many countries. The aim of this prospective cohort study was to determine the patient risk profile, and incidence of and risk factors for significant unplanned events, in adult patients presenting for gastrointestinal endoscopy in a group of university-affiliated hospitals where most sedation is managed by anaesthetists.

Methods. Patients aged ≥18 yr presenting for elective and emergency gastrointestinal endoscopy under anaesthetist-managed sedation at nine hospitals affiliated with the University of Melbourne, Australia, were included. Outcomes included significant airway obstruction, hypoxia, hypotension and bradycardia; unplanned tracheal intubation; abandoned procedure; advanced life support; prolonged post-procedure stay; unplanned over-night admission and 30-day mortality.

Results. 2,132 patients were included. Fifty percent of patients were aged >60 yr, 50% had a BMI >27 kg m ^–2, 42% were ASA physical status III-V and 17% were emergency patients. The incidence of significant unplanned events was 23.0% (including significant hypotension 11.8%). Significant unplanned intraoperative events were associated with increasing age, BMI <18.5 kg m ^–2, ASA physical status III-V, colonoscopy and planned tracheal intubation. Thirty-day mortality was 1.2% (0.2% in electives and 6.0% in emergencies) and was associated with ASA physical status IV-V and emergency status.

Conclusions. Patients presenting for gastrointestinal endoscopy at a group of public university-affiliated hospitals where most sedation is managed by anaesthetists, had a high risk profile and a substantial incidence of significant unplanned intraoperative events and 30-day mortality.

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Coordinated perioperative care--a high value proposition?

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Medication safety in the operating room: literature and expert-based recommendations

Human error poses significant risk for hospitalized patients causing an estimated 100,000 to 400,000 deaths in the USA annually. Medication errors contribute, with error occurring in 5.3% of medication administrations during surgery. In this study 70.3% of medication errors were deemed preventable. Given the paucity of randomized controlled studies, we undertook a rigorous review of the literature to identify recommendations supported by expert opinions. An extensive literature search pertaining to medication error, medication safety, operating room, and anaesthesia was performed. The National Guidelines Clearinghouse was searched for any anaesthesia or operating room medication safety guidelines.

A total of 74 articles were included. Recommendations were tabulated and assigned points based on a scale revised from a prior study. A total of 138 unique recommendations were identified, with point tallies ranging from 4 to 190. An in-person focus meeting occurred, where the 138 recommendations were reviewed, combined and condensed. A modified Delphi process was used to eliminate items found to be unimportant or those unable to be quantified (e.g. "minimize fatigue"). A total of 35 specific recommendations remained. Adverse events as a result of medication errors occur frequently in the operative setting. There are few rigorous studies to direct medication safety strategies, but this should not lead us to do nothing. The overwhelming consensus regarding best practices should be accepted, and the recommendations implemented. Our list of recommended strategies can hopefully be used to assess local vulnerabilities and institute system solutions.

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Plasmacytoid dendritic cell distribution and maturation are altered in lupus prone mice prior to the onset of clinical disease

Publication date: Available online 30 December 2016
Source:Clinical Immunology
Author(s): Jennifer L. Scott, Jena R. Wirth, Jackie G. EuDaly, Gary S. Gilkeson, Melissa A. Cunningham
Plasmacytoid dendritic cells (pDCs) and their production of type I interferons (IFN) are key pathogenic mediators of systemic lupus erythematosus (SLE). Despite the key role of pDCs in SLE, the mechanism by which pDCs promote disease is not well understood. The first objective for this study was to assess the number and maturation state of pDCs in pre-disease NZM2410 lupus prone mice compared to control mice. Second, we sought to identify mechanisms responsible for the alteration in pDCs in NZM mice prior to onset of clinical disease. We compared the number and percent of pDCs in the spleens and bone marrow (BM) of pre-disease NZM24010 (NZM) mice to C57BL/6 (B6) control mice. In the spleens of pre-disease NZM mice, pDC percent and number were increased. This increase occurs in parallel with a decrease in BM pDC number and percent in the NZM mice. The decrease in BM pDC number suggests the increase in spleen pDCs is a result of altered pDC distribution and not increased production of pDCs in the BM. To determine if pDC developmental potential is altered in lupus prone mice, we cultured BM from NZM and B6 mice in vitro. We found a reduced percentage/number of pDCs developing from the BM of NZM mice compared to B6 mice, which further supports that the increase in pDC number is a result of altered pDC distribution rather than increased pDC production. To better characterize the pDC population, we compared the percentage of mature pDCs in the spleens and BM of NZM mice to controls. In the NZM mice, there is a dramatic reduction in the number of mature pDCs in the BM of NZM mice, suggesting that mature pDCs exit the BM at a higher rate/earlier maturation time compared to healthy mice. We conclude that pDCs contribution to disease pathogenesis in NZM mice may include the alteration of pDC distribution to increase the number of pDCs in the spleen prior to disease onset.



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Oral health of children with attention deficit hyperactivity disorder

This study assessed and compared oral health and oral-health behaviours among children with and without attention deficit hyperactivity disorder (ADHD). The study included 31 children, 12–18 yr of age, with ADHD and 31 age- and gender-matched children without ADHD. Clinical data were recorded by a trained and calibrated examiner for caries, traumatic dental injuries, periodontal health, tooth wear, and salivary function. A questionnaire was also given to parents or caregivers about the oral health habits and behaviours of these children. Data were compared using Mann–Whitney U-tests and chi-square tests. No significant differences were found between children, with or without ADHD, in caries extent or prevalence, dental trauma prevalence, prevalence of periodontal disease or plaque, tooth wear, or unstimulated salivary flow. Children with ADHD had a significantly higher percentage of sites with gingival bleeding, as well as a higher frequency of parent-reported dislike of dentists, bruxism, history of assisted toothbrushing, and toothbrushing duration <1 min. They also had higher attendance at government dental clinics. The findings indicate that children with ADHD have poorer oral hygiene and more adverse oral-health attitudes and behaviours than do children without ADHD.

http://ift.tt/2hwdH6t

Update on the use of immunoglobulin in human disease: A review of evidence

Publication date: Available online 29 December 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Elena E. Perez, Jordan S. Orange, Francisco Bonilla, Javier Chinen, Ivan K. Chinn, Morna Dorsey, Yehia El-Gamal, Terry O. Harville, Elham Hossny, Bruce Mazer, Robert Nelson, Elizabeth Secord, Stanley C. Jordan, E. Richard Stiehm, Ashley A. Vo, Mark Ballow
Human immunoglobulin preparations for intravenous or subcutaneous administration are the cornerstone of treatment in patients with primary immunodeficiency diseases affecting the humoral immune system. Intravenous preparations have a number of important uses in the treatment of other diseases in humans as well, some for which acceptable treatment alternatives do not exist. We provide an update of the evidence-based guideline on immunoglobulin therapy, last published in 2006. Given the potential risks and inherent scarcity of human immunoglobulin, careful consideration of its indications and administration is warranted.



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Extensively hydrolysed casein formula containing L. rhamnosus GG reduces the occurrence of other allergic manifestations in children with cow’s milk allergy: 3-year randomized controlled trial

Publication date: Available online 30 December 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Roberto Berni Canani, Margherita Di Costanzo, Giorgio Bedogni, Antonio Amoroso, Linda Cosenza, Carmen Di Scala, Viviana Granata, Rita Nocerino
BackgroundChildren with cow's milk allergy (CMA) have an increased risk of developing other allergic manifestations (AMs).ObjectiveWe performed a parallel-arm randomized controlled trial (RCT) to test whether the administration of an extensively hydrolysed casein formula (EHCF) containing the probiotic L. rhamnosus GG (LGG) can reduce the occurrence of other AMs in CMA children.MethodsChildren with IgE-mediated CMA were randomly allocated to EHCF or EHCF+LGG groups and followed for 36 months. The main outcome was the occurrence of at least one AM (eczema, urticaria, asthma and rhinoconjunctivitis). The secondary outcome was tolerance acquisition, defined as the negativization of a double-blind food challenge at 12 months, 24 months and 36 months. AMs were diagnosed according to standardized criteria. Tolerance acquisition was evaluated every 12 months.ResultsA total of 220 children (147 males, 67%) with a median (IQR) age of 5.0 (3.0–8.0) months were randomized and 110 children were placed in the EHCF group and 110 children were placed in the EHCF+LGG group. In the complete case analysis, the absolute risk difference (ARD) for the occurrence of at least one AM over 36 months was -0.23 [95%CI -0.36 to -0.10, p<0.001] and the ARD for the acquisition of cow's milk tolerance was 0.20 (95%CI 0.05 to 0.35, p<0.01) at 12 months, 0.24 (95%CI 0.08 to 0.41, p<0.01) at 24 months and 0.27 (95%CI 0.11 to 0.43, p<0.001) at 36 months. In the sensitivity analysis, the effect size of the main outcome was virtually unchanged when the occurrence of AM was assigned to all 27 missing children.ConclusionsEHCF+LGG reduces the incidence of other AMs and hastens the development of oral tolerance in children with IgE-mediated CMA.

Teaser

EHCF+LGG reduces the incidence of other AMs in children with IgE-mediated CMA and increases the acquisition of tolerance at 12 months, 24 months and 36 months.


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Tofacitinib relieves symptoms of stimulator of interferon genes (STING)–associated vasculopathy with onset in infancy caused by 2 de novo variants in TMEM173

Publication date: Available online 29 December 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Jieun Seo, Jung-Ah Kang, Dong In Suh, Eun-Byeol Park, Cho-Rong Lee, Sun Ah Choi, Soo Yeon Kim, Yeji Kim, Sang-Heon Park, Michael Ye, Soon-Hak Kwon, June Dong Park, Byung Chan Lim, Dong Hun Lee, Suk-Jo Kang, Murim Choi, Sung-Gyoo Park, Jong-Hee Chae




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Review of "Professionalism Training for Surgical Residents: Documenting the Advantages of a Professionalism Curriculum" by Hochberg MS, Berman RS, Kalet AL, Zabar S, Gillespie C, Pachter HL in Ann Surg 264:501-507, 2016.

No abstract available

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Review of "Making Milestones: Development and Implementation of a Formal Socioeconomic Curriculum in a Neurosurgical Residency Training Program" by Youngerman BE, Zacharia BE, Hickman ZL, Bruce JN, Solomon RA, Benzil DL in Neurosurgery 79:492-498, 2016.

No abstract available

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Posttraumatic Intradiploic Pseudomeningocele of the Occipito-Cervical Region.

Pseudomeningocele is a collection of the cerebrospinal fluid in the extradural space due to a defect in the dura-arachnoid layer of the meninge, and manifests as a fibrous capsule in the space of subcutaneous tissues. Classically, growing skull fracture caused by the pseudomeningocele is not uncommon in the pediatric age group. However, a posttraumatic intradiploic pseudomeningoceles is extremely rare, and only a few patients have been described. Herein, the authors present a 6-year-old girl who developed an intradiploic pseudomeningocele of the occipito-cervical region after a severe head trauma. (C) 2016 by Mutaz B. Habal, MD.

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Modified Superior-Based Pharyngeal Flap Is Effective in Treatment of Velopharyngeal Insufficiency Regardless of the Preoperative Closure Pattern.

Velopharyngeal insufficiency (VPI) is certainly one of the most important problems confronted after cleft palate repairs. In this study, it was aimed to evaluate the preoperative and postoperative speaking results of patients who underwent modified superior-based pharyngeal flap. Sixty-six children who underwent modified superiorly based pharyngeal flap for treatment of VPI between 2005 and 2013 were retrospectively reviewed. The study population was evaluated in 2 distinctive groups depending on their preoperative velopharyngeal closure pattern as: coronal closure pattern or noncoronal closure patterns (ie, circular, sagittal with or without the presence of a Passavant ridge). The speech outcome of the patients was evaluated using the objective assessment tools of nasopharyngoscopy and nasometer. Coronal closure pattern was determined in 24 patients (36.4%) and noncoronal closure pattern in 42 patients (63.6%). The mean follow-up period was 14.67 +/- 3.90 and 13.74 +/- 3.53 months in the coronal and noncoronal groups, respectively. The results demonstrated that the postoperative nasalance scores of all syllables except (m) and (n) were found to be significantly lower compared to those of the preoperative period (P

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A Giant Aneurysmal Bone Cyst in the Mandibular Condyle.

Aneurysmal bone cyst (ABC) is a rare, rapidly expanding, locally destructive, and easily misdiagnosed lesion. An ABC of the condyle is rare. This report presents a 25-year-old female with a giant ABC in the left mandibular condyle. This patient was treated with surgical resection of the affected bone and immediate mandibular reconstruction using autologous bone. Follow-up to date showed no signs of recurrence. The clinical feature, imaging finding, pathogenesis, and treatment methods of ABCs are discussed. (C) 2016 by Mutaz B. Habal, MD.

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Variations of Cords of Brachial Plexus and Branching Pattern of Nerves Emanating From Them.

Brachial plexus is complex network of nerves, formed by joining and splitting of ventral rami of spinal nerves C5, C6, C7, C8, and T1 forming trunks, divisions, and cords. The nerves emerging from trunks and cords innervate the upper limb and to some extent pectoral region. Scanty literature describes the variations in the formation of cords and nerves emanating from them. Moreover, the variations of cords of brachial plexus and nerves emanating from them have iatrogenic implications in the upper limb and pectoral region. Hence study has been carried out. Twenty-eight upper limbs and posterior triangles from 14 cadavers fixed in formalin were dissected and rare and new variations of cords were observed. Most common variation consisted of formation of posterior cord by fusion of posterior division of upper and middle trunk and lower trunk continued as medial cord followed by originating of 2 pectoral nerves from anterior divisions of upper and middle trunk. Other variations include anterior division of upper trunk continued as lateral cord and pierced the coracobrachialis, upper and middle trunk fused to form common cord which divided into lateral and posterior cords, upper trunk gave suprascapular nerve and abnormal lateral pectoral nerve and formation of median nerve by 3 roots. These variations were analyzed for diagnostic and clinical significance making the study relevant for surgeons, radiologists in arresting failure patients and anatomists academically in medical education. (C) 2016 by Mutaz B. Habal, MD.

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Effect of Platelet-Rich Plasma on Bone Grafting of Alveolar Clefts.

The purpose of this study was to evaluate the effectiveness of platelet-rich plasma (PRP) on the absorption of the bone graft in the alveolar cleft. Twenty-nine patients with alveolar clefts in unilateral cleft lip were examined; 6 were the control group and received iliac cancellous bone and marrow grafts without PRP, while the remaining 23 comprised the PRP group and received grafts with PRP. Quantitative evaluation of remaining bone was made by the computer-aided engineering with multidetector row computed tomography at 1 month and 1 year after surgery. Satisfactory bone bridging formation was observed in all patients. Two patients in control group and 1 patient in PRP group developed wound dehiscence with minor bone exposure. One year postoperatively, the canine was exposed and orthodontically guided into an ideal arch relation in all patients. The mean resorption ratio was 49.9 +/- 17.2% and 44.9 +/- 14.4% with no significant difference (P = 0.60). In conclusion, there is currently no evidence to suggest that autologous PRP is of value for effect on the bone resorption for alveolar bone graft. (C) 2016 by Mutaz B. Habal, MD.

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Neonatal Soft Tissue Reconstruction Using a Bioengineered Skin Substitute.

Total parenteral nutrition (TPN) can be a lifesaving intervention for premature neonates and it is often delivered through peripheral access in this unique population. However, extravasation and tissue damage can result. Current literature lacks strong evidence regarding the treatment and reconstruction of such injuries in this age group. The authors present a patient with a 30-week gestational age premature newborn whom suffered an extravasation injury with peripherally administered TPN leading to full thickness skin and soft tissue necrosis of the dorsum of the right hand. This was serially debrided and ultimately repaired using Apligraf (Graftskin, Living Skin Equivalent, LSE; Organogenesis Inc, Canton, MA), which rapidly facilitated secondary healing. (C) 2016 by Mutaz B. Habal, MD.

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The Efficacy of Cyclic Injection of Bone Morphogenetic Protein-2 in Large-Scale Calvarial Bone Defects.

Bone morphogenetic protein-2 (BMP-2) appears to be one of the most potent growth factors thus far studied. However, recent publications on the clinical application of BMP-2 revealed that its correct control is the paramount issue in clinical practice. For improving BMP-2 delivery, the cyclic administration might be an alternative. Accordingly, the authors cyclically injected BMP-2 in a cyclic injection model of large cranial defects to maintain the proper dosage during the bone healing process. A 10-mm diameter calvarial bone defect was produced using a round drill in 8-week-old Sprague-Dawley rats. Silk-hydroxyapatite scaffolds soaked in the appropriate concentration of BMP-2 were implanted into the defect. The animals were split into 4 single-injection groups and 3 multiple-injection groups; the latter groups received weekly subcutaneous injections of BMP-2 solution (1, 5, and 10 [mu]g/mL) for 4 weeks, whereas the former groups received a single injection of BMP-2 at these concentrations. Each rat underwent computed tomography at 8 weeks. In terms of total volumes of the new bone, the 5 [mu]g/mL multiple-injection BMP-2 group had significantly greater increases in bone volume than the single-injection groups. In terms of bone thickness, the multiple-injection groups had better outcomes than the single-injection groups. Thus, the cyclic injection protocol restored the original thickness without overgrowth. Cyclic injection of BMP-2 permits more accurate dosage control than single injection and improves thickness and dense bone regeneration. Therefore, it may represent a promising approach for future clinical trials. Further investigation using a greater number of animals is required. (C) 2016 by Mutaz B. Habal, MD.

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