Xeroderma Pigmentosum with Severe Neurological Manifestations/De Sanctis–Cacchione Syndrome and a Novel XPC Mutation

Several genetic disorders caused by defective nucleotide excision repair that affect the skin and the nervous system have been described, including Xeroderma Pigmentosum (XP), De Sanctis–Cacchione syndrome (DSC), Cockayne syndrome, and Trichothiodystrophy. Cutaneous photosensitivity with an increased risk of skin malignancy is a common feature of these disorders, but clinical manifestations commonly overlap these syndromes. Several genes have been found to be altered in these pathologies, but we lack more genotype-phenotype correlations in order to make an accurate diagnosis. Very few cases of DSC syndrome have been reported in the literature. We present a case of a 12-year-old Colombian male, with multiple skin lesions in sun-exposed areas from the age of 3 months and a history of 15 skin cancers. He also displayed severe neurologic abnormalities (intellectual disability, ataxia, altered speech, and hyperreflexia), short stature, and microcephaly, which are features associated with DSC. Genetic testing revealed a novel germline mutation in the XP-C gene (c.547A>T). This is the first case of an XP-C mutation causing De Sanctis–Cacchione syndrome. Multigene panel testing is becoming more widely available and accessible in the clinical setting and will help rapidly unveil the molecular etiology of these rare genetic disorders.

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Long-Term Follow-Up for Differentiated Thyroid Carcinoma Patients: A Reconsideration

Thyroid , Vol. 0, No. 0.


http://ift.tt/2kPY93L

Monitoring of the posterior cricoarytenoid muscle represents another option for neural monitoring during thyroid surgery: Normative vagal and recurrent laryngeal nerve posterior cricoarytenoid muscle electromyographic data

Objective

Intraoperative neural monitoring (IONM) of laryngeal nerves using electromyography (EMG) is routinely performed using endotracheal tube surface electrodes adjacent to the vocalis muscles. Other laryngeal muscles such as the posterior cricoarytenoid muscle (PCA) are indirectly monitored. The PCA may be directly and reliably monitored through an electrode placed in the postcricoid region. Herein, we describe the method and normative data for IONM using PCA EMG.

Study Design

Retrospective review.

Methods

Data were reviewed retrospectively for thyroid and parathyroid surgery patients with IONM of laryngeal nerves from January to August 2016. Recordings of vocalis and PCA EMG amplitudes and latencies with stimulation of laryngeal nerves were obtained using endotracheal (ET) tube-based and postcricoid surface electrodes.

Results

Data comprised EMG responses in vocalis and PCA recording channels with stimulation of the vagus, recurrent laryngeal nerve (RLN), and external branch of the superior laryngeal nerve from 20 subjects (11 left, 9 right), as well as PCA EMG threshold data with RLN stimulation from 17 subjects. Mean EMG amplitude was 725.69 ± 108.58 microvolts (µV) for the ipsilateral vocalis and 329.44 ± 34.12 µV for the PCA with vagal stimulation, and 1,059.75 ± 140.40 µV for the ipsilateral vocalis and 563.88 ± 116.08 µV for the PCA with RLN stimulation. There were no statistically significant differences in mean latency. For threshold cutoffs of the PCA with RLN stimulation, mean minimum and maximum threshold intensities were 0.37 milliamperes (mA) and 0.84 mA, respectively.

Conclusion

This study shows robust and reliable PCA EMG waveforms with direct nerve stimulation. Further studies will evaluate feasibility and application of the PCA electrode as a complementary quantitative tool in IONM.

Level of Evidence

4 Laryngoscope, 2016

http://ift.tt/2jUajHa

Rurality and determinants of hearing healthcare in adult hearing aid recipients

Objective

The objective of this study was to compare the timing of hearing aid (HA) acquisition between adults in rural and urban communities. We hypothesized that time of acquisition of HA after onset of hearing loss is greater in rural adults compared with urban adults. Secondary objectives included assessment of socioeconomic/educational status and impact of hearing loss and hearing rehabilitation of urban and rural HA recipients.

Study Design

Cross-sectional questionnaire survey.

Methods

We assessed demographics, timing of HA fitting from onset of hearing loss, and impact of hearing impairment in 336 adult HA recipients (273 urban, 63 rural) from a tertiary referral center. Amplification benefit was assessed using the International Outcome Inventory for Hearing Aids (IOI).

Results

The time to HA acquisition was greater for rural participants compared to urban participants (19.1 vs. 25.7 years, P = 0.024) for those with untreated hearing loss for at least 8 years. Age at hearing loss onset was correlated with time to HA acquisition (P = −0.54, P < 0.001). Rural HA participants experienced longer commutes to hearing specialists (68 vs. 32 minutes, P < 0.001), were less likely to achieve a degree beyond high school (P < 0.001), and were more likely to possess Medicaid coverage (P = 0.012) compared to urban participants. Hearing impairment caused job performance difficulty in 60% of all participants.

Conclusion

Rural adults are at risk for delayed HA acquisition, which may be related to distance to hearing specialists. Further research is indicated to investigate barriers to care and expand access for vulnerable populations.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2kP4zN5

In Response to “Does the intraoperative nerve monitoring reliably aid in staging of total thyroidectomies?”

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Extracapsular dissection as sole therapy for small low-grade malignant tumors of the parotid gland

Objective

The aim of the study was to investigate whether extracapsular dissection of a primarily unsuspected lesion in the parotid gland could be oncologically sufficient for carefully selected cases of parotid gland malignomas.

Study Design

Retrospective clinical study.

Methods

The records of all patients treated for primary malignant tumors of the parotid gland solely by means of extracapsular dissection between 2006 and 2013 were studied retrospectively. Patients with manifestation of malignant tumors in the parotid gland that were not of primary salivary gland origin (squamous cell carcinomas, lymphomas, melanomas) or who had had revision surgery or other malignant tumors in their history, as well as patients with insufficient data, were excluded from our study sample.

Results

Nine patients, all with low-grade parotid malignancies, were detected. Our study showed acceptable oncologic and functional outcomes throughout.

Conclusion

Our study was able to show very encouraging preliminary results following primary extracapsular dissection as sole surgical therapy for carefully selected low-stage, low-grade, inferiorly located lesions in patients with high compliance.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2kf7yi3

Correlation between auditory brainstem response and hearing prognosis in idiopathic sudden sensorineural hearing loss patients

Publication date: Available online 31 January 2017
Source:Auris Nasus Larynx
Author(s): Hung-Che Lin, Yu-Ching Chou, Chih-Hung Wang, Li-Wen Hung, Cheng-Ping Shih, Bor-Hwang Kang, Wen-Ying Yeh, Hsin-Chien Chen
ObjectiveTo investigate the latency and amplitude of auditory brainstem response (ABR) and hearing prognosis in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).MethodsPatients with ISSNHL were classified into four different recovery groups. All patients' clinical and demographic features were analyzed. Two-channel ABRs were collected in response to click stimuli at 90dB nHL. ABR amplitudes for wave I and ABR latency for waves I, III, and V were analyzed.ResultsOne hundred and two patients (54 men and 48 women) were included in the study. Hearing recovery was observed in 72 cases (70.6%). Waves I, III, and V latencies were significantly prolonged in the affected ears compared with the unaffected ears. A smaller wave I amplitude was found in the affected ear compared with the unaffected ear in the three recovery groups. There was a significant association between wave I latency and hearing outcome (p=0.009) with a prolonged trend from complete to slight hearing recovery group.ConclusionsThere was a significant correlation between wave I latency and hearing outcome in patients with ISSNHL. The finding may provide diagnostic information and serve as a potential prognostic indicator in patients with ISSNHL.



http://ift.tt/2kSZfHX

Genetic signature and profiling of head and neck cancer: where do we stand?.

Purpose of review: To focus on two novel aspects of head and neck squamous cell carcinoma (HNSCC) genetics of special interest: the epithelial-mesenchymal transition (EMT) process, an initial step in tumor progression that finally leads to metastasis formation, by explaining how genes as well as epigenetic factors control this process, and the new diagnostic options based on the analysis of circulating tumor cells (CTCs) and cell-free DNA (cfDNA) that could revolutionize diagnosis in the coming years. Recent findings: We present an intriguing recently described group of factors, namely miRNAs, deregulated during EMT. MiRNAs could serve as novel markers of EMT and metastasis formation and are also a potential therapeutic target. Second, we show recent findings on CTC and cfDNA analysis in HNSCC that demonstrate the usefulness of this new diagnostic approach. Summary: We stress the importance of EMT in the context of metastasis formation and the potential of liquid biopsies in clinical practice. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2jSTg5W

Is p16 an adequate surrogate for human papillomavirus status determination?.

Purpose of review: In head and neck cancer management, immunoexpression of protein p16 is widely used as a surrogate marker for human papillomavirus (HPV) positivity due to challenges of direct HPV testing. Previously p16 has been reported to have good sensitivity but only moderate specificity in HPV-status determination. The aim of this review is to evaluate the existing information on sensitivity and specificity of p16 immunohistochemistry (IHC) in HPV-status determination among the recent studies. Recent findings: We searched the time period from October 2014 to April 2016 and included 28 studies (a total of 31 analyses), which reported both p16 and HPV status in their series. The sensitivity of p16 in HPV determination ranged between 28.2 and 100.0%. The mean and median sensitivities were 90.5 and 95.4%, respectively. The specificity ranged between 31.1 and 100.0%. The mean and median specificities were 83.3 and 87.3%, respectively. Summary: Our review presents current information on the feasibility of p16 IHC in HPV status determination, which is in line with previous studies. Patients with HPV-positive tumors can be identified with p16 IHC, but a risk for misclassification of HPV-negative tumors as HPV positive exists. This fact has to be taken into consideration if HPV status will influence treatment planning. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2kp22eQ

Nasopharyngeal Adenocarcinoma: a Population-Based Analysis

To describe the incidence and determinants of survival of patients with nasopharyngeal adenocarcinoma between the years of 1973 to 2012 using the Surveillance, Epidemiology, and End Result (SEER) database.

http://ift.tt/2ke3miH

Hearing loss in Meniere's disease

Meniere"s disease is an inner ear disorder which episodic sensorineural hearing loss, vertigo, tinnitus and aural fullness sensation are its hallmark symptoms. Acute attacks are superimposed on a gradual deterioration in sensory neural hearing in the involved ear, typically in the low frequencies [1]. If audiometry is done during the attack phase of disease, it shows sensorineural hearing loss which will be reduced after the attack phase.

http://ift.tt/2kP90uR

Antibiotic therapy in critically ill patients: expert opinion of the European Society of Anaesthesia Intensive Care Scientific Subcommittee: A narrative review.

Antimicrobial treatment is the cornerstone of infection treatment, and the selection of appropriate antibiotic treatment for critically ill patients is challenging. Clinicians working with critically ill patients usually feel a greater obligation towards their patient than towards maintenance of the delicate ecological balance of prevalent microbiological threats and their resistance patterns. Although antibiotic overtreatment is a frequent phenomenon, patient outcomes need not be compromised when antibiotic treatment is driven by informed decision-making. At the 2016 Euro Anaesthesia Conference (London, UK), the European Society of Anaesthesia Intensive Care Scientific Subcommittee convened an expert panel on antibiotic therapy. This article summarises the main conclusions of the panel, namely the principles of antibiotic therapy that all physicians working with critically ill patients must know. (C) 2017 European Society of Anaesthesiology

http://ift.tt/2jTrjgE

Intraoperative monitoring of analgesia using nociceptive reflexes correlates with delayed extubation and immediate postoperative pain: A prospective observational study.

BACKGROUND: Immediate postoperative pain could be prevented by the administration of long-lasting analgesics before the end of the anaesthesia. However, to prevent over or underdosing of analgesics under anaesthesia, tools are required to estimate the analgesia-nociception balance. OBJECTIVE: We investigated whether the pupillary dilation reflex (PDR) and the nociceptive flexion reflex (NFR) at the end of general anaesthesia correlate with immediate postoperative pain, as a sign of analgesic underdosing, and with delayed tracheal extubation as a sign of analgesic overdosing. DESIGN: Prospective observational study. SETTING: Klinikum im Friedrichshain, Berlin, Germany, from May 2013 to April 2015. PATIENTS: A total of 110 patients scheduled for primary hip arthroplasty under general anaesthesia. OBSERVATIONS: Psychometric and clinical data were obtained preoperatively. The PDR and the NFR were assessed preoperatively and at the end of anaesthesia. Shortly after extubation of the trachea, patients rated their pain intensity. ENDPOINTS: The primary endpoint was the immediate postoperative numeric rating scale pain intensity (0 to 10) and the secondary endpoint was the length of the time interval between reflex measurements and tracheal extubation. RESULTS: PDR correlated significantly with the immediate postoperative pain intensity (Spearman's [rho] = -0.28, P

http://ift.tt/2kSEr34

Inferior alveolar neurovascular bundle repositioning: a retrospective analysis

In this study, patients with an insufficient height of bone for implant placement in the posterior mandible were treated by repositioning of the inferior alveolar neurovascular bundle (IANVB). These patients were divided into two groups: those in group A (n=69) did not require a bone graft and implants were placed at the time of nerve repositioning; those in group B (n=9) received bone grafts in conjunction with nerve repositioning and implants were placed upon maturation of the grafts. One hundred and twenty-one nerves were repositioned in 78 patients and 308 implants were placed.

http://ift.tt/2jTsSLF

Correlation between auditory brainstem response and hearing prognosis in idiopathic sudden sensorineural hearing loss patients

To investigate the latency and amplitude of auditory brainstem response (ABR) and hearing prognosis in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).

http://ift.tt/2koFT0C

Social media use for occupational lung disease.

Purpose of review: Social media have great impact on all aspects of life throughout the world. The utilization of social media for occupational lung disease, however, has been much more limited. This article summarizes recent literature concerning social media for occupational lung disease and identifies areas for additional use. Recent findings: Social media are used in six relevant areas: information dissemination, peer-to-peer communication, survey research data collection, participatory research and exposome data acquisition, assessing public concerns, and knowledge generation. There are very clear advantages for information dissemination from experts to workers and on a peer-to-peer basis, although variable credibility and accuracy concerns persist. For research, social media have been used for acquiring data posted for nonresearch purposes and for efficiently collecting information specifically for research. The benefits of efficiency, democracy, and very large data sources may counterbalance concerns about inadequate specification of recruitment strategies and limited control over data quality. Summary: The potential benefits of using social media for lung health-workplace interactions are much greater than the very limited current utilization. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Update on asthma and cleaning agents.

Purpose of review: Asthma due to cleaning products has been known for 20 years, and the interest in this topic is still large because of the number of cleaning workers with respiratory problems. In this review, we sought to highlight the most recent findings on the relationship between exposure to cleaning products and asthma and to summarize the specific literature published between 2013 and 2016. Recent findings: Women are confirmed as most of workers exposed to cleaning products and have a higher frequency than men of work-related respiratory symptoms and diseases. Many cases of asthma due to cleaning products occur in healthcare occupations. The increased risk of asthma has been shown to be related to the number of years in the job and to early life disadvantage. Recent evidence suggests that predisposition to adult-onset asthma may be related to interaction between genes and occupational exposure to low-molecular weight agents/irritants. There is some evidence that an irritant mechanism is more common, although several case reports showed animmunologic mechanism (e.g. disinfectants, amine compounds, aldehydes and fragrances). Summary: The review updated recent findings on epidemiology, cleaning agents and their mechanism, and prevention of asthma due to cleaning agents. This article provides new information on the level of exposure, which is still high in professional cleaners and even more in domestic cleaners, and on the frequency of asthma in professional and domestic cleaners. An irritant mechanism is more common, although an immunological mechanism is possible, especially in healthcare workers exposed to disinfectants. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Editorial: moving ahead faster than ever.

No abstract available

http://ift.tt/2kRLdWQ

Traffic-related air pollution and allergic disease: an update in the context of global urbanization.

Purpose of review: The review aims to give an update on the literature around traffic-related air pollution (TRAP) and allergic disease in the context of global urbanization, as the most populous countries in the world face severe TRAP exposure challenges. Recent findings: As research continues to show that gene-environment interactions and epigenetics contribute to the TRAP-allergy link, evidence around the links to climate change grows. Greenspace may provide a buffer to adverse effects of traffic on health, overall, but pose risks in terms of allergic disease. Summary: The link between traffic-related pollution and allergy continues to strengthen, in terms of supportive observational findings and mechanistic studies. Levels of TRAP across the world, particularly in Asia, continue to dramatically exceed acceptable levels, suggesting that the related adverse health consequences will accelerate. This could be counterbalanced by primary emission control and urban planning. Attention to combined effects of TRAP and allergen exposure is critical to avoiding misleading inferences drawn though examination only of isolated factors. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2kRNP7c

A wide scope of new developments in occupational allergy and clinical immunology.

No abstract available

http://ift.tt/2jsp05t

Experimental comparison between tractional and compressive stress on temporomandibular joint

Abstract

Objective

We experimentally compared the effects of compressive and tractional mechanical stress on the temporomandibular joint (TMJ) of rabbits to assess the etiology of progressive condylar resorption.

Materials and Methods

We performed a cortical osteotomy using custom-made devices that were lengthened by 0.25 mm every 12 h for 1 week after surgery. During this time, the rabbit TMJ was under compressive or tractional mechanical stress. The samples in each group were examined using micro-computed tomography and histological staining.

Results

Scores for the area of bone resorption were higher in the compressive group than in the tractional group. Moreover, scores for the depth of bone resorption were higher in the compressive group than those in the tractional group. We observed a significantly higher prevalence of resorption in the subcondylar bone in the compressive group than in the tractional group. There were substantially more cells that were positive for tartrate-resistant acid phosphatase in the compressive group than in the control and tractional groups.

Conclusions

The outcomes here suggest that excessive mechanical stress, particularly compressive mechanical stress, may significantly affect morphological bone change findings in the TMJ.

This article is protected by copyright. All rights reserved.

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Flagellar filament structural protein induces Sjögren's syndrome-like sialadenitis in mice

Abstract

Objective

Sjögren's syndrome (SS) is a systemic autoimmune disease that primarily affects lacrimal and salivary glands. We previously reported that FliC derived from E. coli could induce autoimmune pancreatitis-like lesions. From these results, we speculated that FliC could also induce SS-like exocrinopathy. In the present study, we investigated the effects of chronic exposure to FliC on lacrimal and salivary glands and the possibility that it might lead to an autoimmune response.

Methods

C57BL/6 mice were repeatedly injected with FliC and histological changes, serum levels of cytokine/chemokines and autoantibodies were evaluated at different time points after the final injection. The presence of sialadenitis was diagnosed by histological methods.

Results

In FliC-treated groups, 57% of subjects developed inflammatory cell infiltrates around ducts in mandibular salivary glands, but not lacrimal glands. In addition, serum levels of total IgG, IgG1 and IgG2a were significantly higher in FliC-treated groups. Intriguingly, serum anti-SSA/Ro levels were also significantly higher in FliC-treated groups. Cytokine analysis revealed that serum levels of IL-1β, IL-12p70, IL-13, IFN-γ, IL-15 and IL-23 seemed to be higher in FliC-treated mice.

Conclusions

Our data suggest that FliC-treated mice develop an SS-like phenotype. Our model may elucidate the relationship between commensal bacteria and SS.

This article is protected by copyright. All rights reserved.

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Differential effects of the combination of tyrosol with chlorhexidine gluconate on oral biofilms

Abstract

Objective

This study assessed the effect of tyrosol and chlorhexidine gluconate in combination against Candida albicans, Candida glabrata and Streptococcus mutans in the planktonic state or forming biofilms in vitro.

Materials and Methods

Checkerboard assays were performed for determination of minimum inhibitory concentration. Biofilms were cultivated during 24 h on specimens of acrylic resin and hydroxyapatite, and treated with the drugs alone or in combination twice a day for 1 min, during 3 days. The antibiofilm effect was determined by quantification of the metabolic activity and cultivable cells. The drug combination was also applied on C. albicans to investigate its action on the number of hyphae. Data were statistically examined by two-way ANOVA and Holm-Sidak test (p < 0.05).

Results

The effect of drug combination on planktonic cells was classified as antagonistic for C. albicans, and indifferent for the other strains. Also, the drugs were ineffective against the tested biofilms. However, the drug combination showed a synergistic effect in reducing the number of hyphae by C. albicans.

Conclusion

The combination of tyrosol with chlorhexidine gluconate was only effective in reducing the number of hyphae by C. albicans, a relevant virulence factor of this species.

This article is protected by copyright. All rights reserved.

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Geriatric Oral and Maxillofacial Dysfunctions in the Context of Geriatric Syndrome

Abstract

Objectives

To propose the application of the concept of geriatric syndrome for common geriatric oral and maxillofacial dysfunctions and to suggest the necessity of developing effective evaluation methods for oral and maxillofacial frailty.

Design

The concepts of frailty and geriatric syndrome based on multi-morbidity and polypharmacy were applied to five common geriatric oral medicinal dysfunctional problems: salivary gland hypofunction (dry mouth), chronic oral mucosal pain disorders (burning mouth symptoms), taste disorders (taste disturbances), swallowing disorders (dysphagia), and oral and maxillofacial movement disorders (oromandibular dyskinesia and dystonia).

Results

Each of the dysfunctions is caused by various kinds of diseases and/or conditions and medications, thus the concept of geriatric syndrome could be applied. These dysfunctions, suggested as components of oral and maxillofacial geriatric syndrome, are associated and interacted with each other in a complexity of vicious cycle. The resulting functional impairments caused by this syndrome can cause oral and maxillofacial frailty.

Conclusions

Geriatric oral and maxillofacial dysfunctions could be better appreciated in the context of geriatric syndrome. The development of effective methods for evaluating the severity of these dysfunctions and the resulting frailty is essential.

This article is protected by copyright. All rights reserved.

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Ameloblastoma: Current Etiopathological Concepts and Management

Abstract

Ameloblastoma is a benign odontogenic tumor of epithelial origin. It is locally aggressive with unlimited growth capacity and has a high potential for malignant transformation as well as metastasis. Ameloblastoma has no established preventive measures although majority of patients are between ages 30 to 60 years.

Molecular and genetic factors that promote oncogenic transformation of odontogenic epithelium to ameloblastoma are strongly linked to dysregulation of multiple genes associated with mitogen activated protein kinase, sonic hedgehog and WNT/β-catenin signaling pathways. Treatment of ameloblastoma is focused on surgical resection with a wide margin of normal tissue because of its high propensity for loco-regional invasion; but this is often associated with significant patient morbidity.

The relatively high recurrence rate of ameloblastoma is influenced by the type of molecular etiologic factors, the management approach and how early the patient presents for treatment. It is expected that further elucidation of molecular factors that orchestrate pathogenesis and recurrence of ameloblastoma will lead to new diagnostic markers and targeted drug therapies for ameloblastoma.

This article is protected by copyright. All rights reserved.

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Early secondary bone grafting in children with alveolar cleft does not modify the risk of maxillary permanent canine impaction at the age of 10 years

Alveolar cleft management has remarkably improved in the last few years. Today, it is multidisciplinary with functional, esthetic and psychological objectives. Maxillary bone grafting with gingivoperiosteal flaps associated with orthodontic preparation is a integral part of alveolar cleft management (Abyholm et al., 1981, Bergland et al., 1986, Eppley et al., 2000, Theologie-Lygidakis et al., 2014). However, if maxillary bone grafting is performed before the age of 2 years, it might compromise midfacial growth (Robertson et al., 1968, Fudalej et al.

http://ift.tt/2kPnjzv

A novel computer system for the evaluation of nasolabial morphology, symmetry and aesthetics after cleft lip and palate treatment. Part 1: General concept and validation

The need for a widely accepted method suitable for a multicentre quantitative evaluation of facial aesthetics after surgical treatment of cleft lip and palate (CLP) has been emphasized for years. The aim of this study was to validate a novel computer system 'Analyse It Doc' (A.I.D.) as a tool for objective anthropometric analysis of the nasolabial region.

http://ift.tt/2keqsWs

Evaluation of maxillary sinus after Le Fort I osteotomy using various fixation materials

The purpose of this study was to evaluate maxillary sinus and predict the factors affecting the postoperative sinus condition after Le Fort I osteotomy using various fixation materials.

http://ift.tt/2kPpwLq

A novel computer system for the evaluation of nasolabial morphology, symmetry and aesthetics after cleft lip and palate treatment. Part 2: Comparative anthropometric analysis of patients with repaired unilateral complete cleft lip and palate and healthy individuals

The aim of this study was to use a novel system, 'Analyse It Doc' (A.I.D.) for a complex anthropometric analysis of the nasolabial region in patients with repaired unilateral complete cleft lip and palate and in healthy individuals.

http://ift.tt/2keoK7i

The role of parotid gland irradiation in the development of severe hyposalivation (xerostomia) after intensity-modulated radiation therapy for head and neck cancer: Temporal patterns, risk factors, and testing the QUANTEC guidelines

The aims of this study were to investigate temporal patterns and potential risk factors for severe hyposalivation (xerostomia) after intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC), and to test the two QUANTEC (Quantitative Analysis of Normal Tissue Effects in the Clinic) guidelines.

http://ift.tt/2kPryer

Epigenetics of oropharyngeal squamous cell carcinoma: opportunities for novel chemotherapeutic targets

Epigenetic modifications are heritable changes in gene expression that do not directly alter DNA sequence. These modifications include DNA methylation, histone post-translational modifications, small and non-c...

http://ift.tt/2jTsPiH

Genetic signature and profiling of head and neck cancer: where do we stand?.

Purpose of review: To focus on two novel aspects of head and neck squamous cell carcinoma (HNSCC) genetics of special interest: the epithelial-mesenchymal transition (EMT) process, an initial step in tumor progression that finally leads to metastasis formation, by explaining how genes as well as epigenetic factors control this process, and the new diagnostic options based on the analysis of circulating tumor cells (CTCs) and cell-free DNA (cfDNA) that could revolutionize diagnosis in the coming years. Recent findings: We present an intriguing recently described group of factors, namely miRNAs, deregulated during EMT. MiRNAs could serve as novel markers of EMT and metastasis formation and are also a potential therapeutic target. Second, we show recent findings on CTC and cfDNA analysis in HNSCC that demonstrate the usefulness of this new diagnostic approach. Summary: We stress the importance of EMT in the context of metastasis formation and the potential of liquid biopsies in clinical practice. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2jSTg5W

Is p16 an adequate surrogate for human papillomavirus status determination?.

Purpose of review: In head and neck cancer management, immunoexpression of protein p16 is widely used as a surrogate marker for human papillomavirus (HPV) positivity due to challenges of direct HPV testing. Previously p16 has been reported to have good sensitivity but only moderate specificity in HPV-status determination. The aim of this review is to evaluate the existing information on sensitivity and specificity of p16 immunohistochemistry (IHC) in HPV-status determination among the recent studies. Recent findings: We searched the time period from October 2014 to April 2016 and included 28 studies (a total of 31 analyses), which reported both p16 and HPV status in their series. The sensitivity of p16 in HPV determination ranged between 28.2 and 100.0%. The mean and median sensitivities were 90.5 and 95.4%, respectively. The specificity ranged between 31.1 and 100.0%. The mean and median specificities were 83.3 and 87.3%, respectively. Summary: Our review presents current information on the feasibility of p16 IHC in HPV status determination, which is in line with previous studies. Patients with HPV-positive tumors can be identified with p16 IHC, but a risk for misclassification of HPV-negative tumors as HPV positive exists. This fact has to be taken into consideration if HPV status will influence treatment planning. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2kp22eQ

Thanks to you

http://ift.tt/2jSTzQB

Anesthesiologists' perceptions of minimum acceptable work habits of nurse anesthetists

Work habits are non-technical skills that are an important part of job performance. Although non-technical skills are usually evaluated on a relative basis (i.e., "grading on a curve"), validity of evaluation on an absolute basis (i.e., "minimum passing score") needs to be determined.

http://ift.tt/2kebf7A

The important use of ultrasound on a child with chronic pain

We have carefully read, "Interventional and multimodal pain rehabilitation in a child with meralgia paresthetica," by Franklin and colleagues [1]. The authors describe a 9year-old girl with a 6week-history of pain in the distribution of the lateral femoral cutaneous nerve (LFCN). Symptomatic treatment with Gabapentin and Meloxicam, along with physical therapy, was attempted with mild improvement. Subsequently, two ultrasound-guided LFCN nerve blocks were performed with resolution of pain.

http://ift.tt/2jsuZaJ

Effectiveness of active and passive warming for the prevention of inadvertent hypothermia in patients receiving neuraxial anesthesia: A systematic review and meta-analysis of randomized controlled trials

Perioperative hypothermia is a common complication of anesthesia that can result in negative outcomes. The purpose of this review is to answer the question: Does the type of warming intervention influence the frequency or severity of inadvertent perioperative hypothermia (IPH) in surgical patients receiving neuraxial anesthesia?

http://ift.tt/2kdSfpT

Optimal site of administration of the PECS 1 block

The pectoral nerves (PECS) 1 block requires injection of a local anesthetic injected into the space between the pectoral major muscle (PMM) and the pectoral minor muscle (PmM) at third ribs. The procedure is intended to block the intercostobrachial nerve, lateral cutaneous branch, and medial cutaneous nerve of the arm and forearm, and the long thoracic and thoracodorsal nerves. The block can also provide anesthesia to the lateral mammary area as it penetrates nerves in the axillary region [1,2].

http://ift.tt/2jsyePa

Copyright

Publication date: March 2017
Source:Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 25, Issue 1





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Contributors

Publication date: March 2017
Source:Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 25, Issue 1





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Contents

Publication date: March 2017
Source:Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 25, Issue 1





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Forthcoming Issues

Publication date: March 2017
Source:Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 25, Issue 1





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Advances in the Management of Mandibular Condylar Fractures

Publication date: March 2017
Source:Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 25, Issue 1
Author(s): Martin B. Steed




http://ift.tt/2ko5LcY

The Biology of Open Versus Closed Treatment of Condylar Fractures

Publication date: March 2017
Source:Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 25, Issue 1
Author(s): Susan K. Snyder, Larry L. Cunningham




http://ift.tt/2kS8JmU

Plating Options for Fixation of Condylar Neck and Base Fractures

Publication date: March 2017
Source:Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 25, Issue 1
Author(s): Eric L. Bischoff, Ryan Carmichael, Likith V. Reddy




http://ift.tt/2kodckD

Management of Pediatric and Adolescent Condylar Fractures

Publication date: March 2017
Source:Atlas of the Oral and Maxillofacial Surgery Clinics, Volume 25, Issue 1
Author(s): Martin B. Steed, Caleb M. Schadel




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Social media use for occupational lung disease.

Purpose of review: Social media have great impact on all aspects of life throughout the world. The utilization of social media for occupational lung disease, however, has been much more limited. This article summarizes recent literature concerning social media for occupational lung disease and identifies areas for additional use. Recent findings: Social media are used in six relevant areas: information dissemination, peer-to-peer communication, survey research data collection, participatory research and exposome data acquisition, assessing public concerns, and knowledge generation. There are very clear advantages for information dissemination from experts to workers and on a peer-to-peer basis, although variable credibility and accuracy concerns persist. For research, social media have been used for acquiring data posted for nonresearch purposes and for efficiently collecting information specifically for research. The benefits of efficiency, democracy, and very large data sources may counterbalance concerns about inadequate specification of recruitment strategies and limited control over data quality. Summary: The potential benefits of using social media for lung health-workplace interactions are much greater than the very limited current utilization. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Update on asthma and cleaning agents.

Purpose of review: Asthma due to cleaning products has been known for 20 years, and the interest in this topic is still large because of the number of cleaning workers with respiratory problems. In this review, we sought to highlight the most recent findings on the relationship between exposure to cleaning products and asthma and to summarize the specific literature published between 2013 and 2016. Recent findings: Women are confirmed as most of workers exposed to cleaning products and have a higher frequency than men of work-related respiratory symptoms and diseases. Many cases of asthma due to cleaning products occur in healthcare occupations. The increased risk of asthma has been shown to be related to the number of years in the job and to early life disadvantage. Recent evidence suggests that predisposition to adult-onset asthma may be related to interaction between genes and occupational exposure to low-molecular weight agents/irritants. There is some evidence that an irritant mechanism is more common, although several case reports showed animmunologic mechanism (e.g. disinfectants, amine compounds, aldehydes and fragrances). Summary: The review updated recent findings on epidemiology, cleaning agents and their mechanism, and prevention of asthma due to cleaning agents. This article provides new information on the level of exposure, which is still high in professional cleaners and even more in domestic cleaners, and on the frequency of asthma in professional and domestic cleaners. An irritant mechanism is more common, although an immunological mechanism is possible, especially in healthcare workers exposed to disinfectants. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Editorial: moving ahead faster than ever.

No abstract available

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Traffic-related air pollution and allergic disease: an update in the context of global urbanization.

Purpose of review: The review aims to give an update on the literature around traffic-related air pollution (TRAP) and allergic disease in the context of global urbanization, as the most populous countries in the world face severe TRAP exposure challenges. Recent findings: As research continues to show that gene-environment interactions and epigenetics contribute to the TRAP-allergy link, evidence around the links to climate change grows. Greenspace may provide a buffer to adverse effects of traffic on health, overall, but pose risks in terms of allergic disease. Summary: The link between traffic-related pollution and allergy continues to strengthen, in terms of supportive observational findings and mechanistic studies. Levels of TRAP across the world, particularly in Asia, continue to dramatically exceed acceptable levels, suggesting that the related adverse health consequences will accelerate. This could be counterbalanced by primary emission control and urban planning. Attention to combined effects of TRAP and allergen exposure is critical to avoiding misleading inferences drawn though examination only of isolated factors. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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A wide scope of new developments in occupational allergy and clinical immunology.

No abstract available

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A guideline for perioperative smoking cessation

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Inhibition of neutrophil elastase contributes to attenuation of lipopolysaccharide-induced acute lung injury during neutropenia recovery in mice

Abstract

Purpose

Patients in whom neutropenia recovery is complicated by pneumonia have an increased risk of acute lung injury (ALI) and detrimental outcomes. The aim of the present study was to investigate whether inhibition of neutrophil elastase (NE) is effective in lipopolysaccharide (LPS)-induced ALI during neutropenia recovery in a murine model, and whether it upregulates the activation of the MerTK signaling pathway.

Methods

Cyclophosphamide was given to mice to induce neutropenia. Seven days later, they were administered LPS by intratracheal instillation. Sivelestat, a neutrophil elastase inhibitor, was given by intraperitoneal injection once daily starting on day 0 and continuing until mice were sacrificed on day 5 (preventive group). Alternatively, sivelestat was given after, instead of before, LPS administration on day 2 (therapeutic group).

Results

Sivelestat attenuated the lung edema and histopathological changes associated with LPS-induced lung injury. The accumulation of neutrophils and the concentrations of TNF-α, IL-6, and MPO in bronchoalveolar lavage (BAL) fluids were inhibited effectively by sivelestat. The expression of ICAM-1 and NF-κB p65 was also reduced after sivelestat administration. The protein and gene expression of MerTK tended to increase with sivelestat treatment.

Conclusions

Sivelestat significantly attenuated LPS-induced ALI during recovery from neutropenia, and this effect was associated with MerTK induction. These findings suggest that NE inhibition could be a promising means of alleviating lung inflammation without increasing susceptibility to infection in ALI/ARDS during neutropenia recovery.

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Focused cardiac ultrasound in the early resuscitation of severe sepsis and septic shock: a prospective pilot study

Abstract

Purpose

Point-of-care ultrasonography has been increasingly used in the care of critically ill patients; however, reports on its use during active resuscitation are limited. The aim of this study was to investigate the true impact of focused cardiac ultrasound (FCU) during the management of sepsis with early (6-h) resuscitation.

Methods

A prospective pilot observational study was conducted at an academic medical center from March 2011 through July 2012. Patients undergoing resuscitation for severe sepsis or septic shock were prospectively enrolled at medical and combined medical–surgical intensive care units. Patients underwent a 10-min FCU examination when echocardiography was not part of their care plan. FCU was performed by sonographers and interpreted by cardiologists to minimize risks of inadequate image acquisition and misinterpretation. Intensivists completed surveys on their diagnostic and therapeutic plans before and after receiving FCU information.

Results

Of the 30 patients enrolled, 18 (60%) were male and the median age was 61 years [interquartile range (IQR) 50–71 years]. Median central venous oxygen saturation and lactate levels were 59.6% (IQR 53.1–66.2%) and 2.7 mmol/L (IQR 1.2–4.1 mmol/L), respectively. Clinical assessment by intensivists before FCU commonly failed to correctly estimate ventricular function; specifically, left ventricular in 12 patients [40%, 95% confidence interval (CI) 25–58%] and right ventricular function in 15 patients (50%, 95% CI 33–67%). Intensivists' therapeutic plans changed in eight cases (27%, 95% CI 14–44%) after FCU information became available. The most common changes were fluid management and imaging tests. Intensivists' confidence in their therapeutic plans improved for 11 patients (37%, 95% CI 22–55%).

Conclusion

FCU is a valuable examination tool during early resuscitation of severe sepsis and septic shock.

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Effectiveness of Type I Tympanoplasty in Wet and Dry Ear in Safe Chronic Suppurative Otitis Media

Abstract

The aims and objectives of the study were to compare the rate of graft uptake after type 1 tympanoplasty in wet and dry ears and also to compare the postoperative hearing improvement in wet and dry ears. It was a Non Randomized Experimental Study. This study was done in ENT OPD at Tertiary Health Care Institute of Central India. It was conducted from November 2012 to October 2014 on 86 patients having Safe Chronic Suppurative Otitis Media. The patients were divided into two groups as Dry ear group and Wet ear group. Dry ear group included patients whose ear was dry for at least 6 weeks prior to the surgery. Wet ear group included patients who had minimal mucoid discharge in the middle ear which on culture and sensitivity showed no microorganisms. Type 1 Tympanoplasty was done in all patients. Results were analyzed statistically. Complete graft uptake was seen in 86.95% cases of Dry ear group and 80% of Wet ear group and the difference was statistically insignificant. Hearing improvement was achieved in 80% cases in dry group and 67.5% cases in wet group. The difference in hearing improvement in both groups was also statistically insignificant. So conclusion was drawn that, presence of minimal mucoid ear discharge at the time of surgery does not affect the success rate of Type 1 Tympanoplasty.

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Delayed methicillin-resistant Staphylococcus aureus-induced osteomyelitis of the tibia after pin tract infection: two case reports

Pin tract infection is a common complication of external fixation. It usually heals after treatment with debridement, antibiotics, and/or pin removal, only rarely developing into delayed osteomyelitis. We trea...

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Hypertrophic obstructive cardiomyopathy with multiple coronary arteries to right ventricular microfistulas: a case report and review of the literature

Coronary artery microfistulas are a rare anomaly; their association with hypertrophic cardiomyopathy is even rarer and can lead to serious cardiac complications owing to coronary steal phenomena such as angina...

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Merkel cell carcinoma occurring in a black woman: a case report

Merkel cell carcinoma is a rare, very aggressive neuroectodermal tumor of the skin. It is typically located on sun-exposed skin and frequently found in white men aged between 70 and 80 years.

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Sinocutaneous Fistula Formation After Forehead Recontouring Surgery for Transgender Patients.

Forehead recontouring is a common part of facial feminization surgery. The procedure, which alters the shape and structure of the frontal bone, is regarded as safe and well tolerated by patients. The occurrence of delayed complications, however, is much less understood. The authors describe a patient involving the development of a sinocutaneous fistula as a delayed complication of forehead recontouring surgery. The clinical presentation and management of this patient are discussed. As facial feminization surgery expands as a cosmetic option for patients who desire more feminine facial features, practitioners should recognize the potential risk of sinonasal complications associated with forehead recontouring surgery. (C) 2017 by Mutaz B. Habal, MD.

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Craniotomy of the Fused Sagittal Suture Over the Superior Sagittal Sinus Is a Safe Procedure.

Introduction: Spring-assisted cranioplasty to correct sagittal synostosis is based on midline craniotomy through the closed sagittal suture, over the superior sagittal sinus (SSS). The aim of the present study was to evaluate the perioperative safety of this technique. Materials and Methods: This is a retrospective study of all patients operated with median craniotomy and springs from 1998 to the end of 2015. For comparison, all Pi-plasties performed during the same time interval were also evaluated. The safety measures were evaluated based on incidence of damage to SSS, incidence of dural tears, perioperative blood loss, operative time, and hospital stay. Results: In the group that had undergone midline craniotomy combined with springs (n = 225), 4 perioperative damages to SSS and 1 dural tear were seen. The perioperative blood loss was 62.8 +/- 65.3 mL (mean +/- standard deviation). The operative time was 67.9 +/- 21.5 minutes and the hospital stay was 4.8 +/- 1.1 days. In the group that had undergone pi-plasty (n = 105), no damages to SSS but 3 dural tears were seen. The perioperative blood loss was 352.8 +/- 174.4 mL. The operative time was 126.0 +/- 31.7 minutes and the hospital stay was 7.1 +/- 1.4 days. Conclusion: Craniotomy SSS in sagittal synostosis is a safe procedure with low morbidity in terms of damage to the SSS. Midline craniotomy combined with springs has significantly lower preoperative blood loss, operative time, and hospital stay (P

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Successful Treatment of Infantile Hemangiomas With Propranolol in Low-Birth-Weight Infants.

Background: Infantile hemangioma (IH) is a benign neoplasm that causes scarring and cosmetic problems after spontaneous regression. Therefore, aggressive treatments such as laser irradiation and corticosteroid have been used; however, recently, the effect of propranolol has been widely noticed. In this study, the authors applied propranolol to low-birth-weight infants with IHs and evaluated its effect. Methods: Four low-birth-weight infants having IH were selected, with birth weights ranging from 582 to 814 g (average 703 g). The administration of propranolol was started within 4 days of hospitalization. The dosage of propranolol was increased from 0.5 to 2.0 mg/kg/day step by step. Vital signs and blood sugar level were checked prior to every administration of the drug. Continuous monitoring of electrocardiography and arterial oxygen saturation were performed during entire hospitalization. The outcomes were assessed by the patient's family and 2 board-certified plastic surgeons based on 5 parameters pertaining to clinical findings, using a scale of 1 to 10. Reduction rate of the hemangioma was calculated at the end of treatment and compared with the size prior to treatment. Results: The authors could administrate propranolol without any severe side effects in all patients. Infantile hemangiomas gradually shrank soon after the authors started the treatment. Reduction ratios were 22.1% to 100% (average 48.72%), and the comprehensive evaluation of treatment was 7.5 to 10 (average 8.55) on a 10-point scale. Conclusions: With careful monitoring of their vital signs, propranolol could be a good treatment option even for IH in low-birth-weight infants whose birth weights were less than 1000 g. (C) 2017 by Mutaz B. Habal, MD.

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Long-Term Evaluation of Mandibular Growth in Children With FGFR2 Mutations.

Background: Understanding mandibular growth in children with fibroblast growth factor receptor 2 (FGFR2) mutations is important for planning the degree of midface advancement, and for determining the best treatment for obstructive sleep apnea. Yet, relatively little is known about growth of the unoperated mandible in affected children. The purpose of this study was to evaluate mandibular growth through skeletal maturity in Apert, Crouzon, and Pfeiffer syndromes. Methods: A retrospective chart review was performed. Long-term, unoperated mandibular growth was assessed using multiple anthropologic measurements including: mandibular width, height, depth, and the cranial base width (approximating bicondylar width). Measurements were compared over 3 age intervals: 6 to 7 years, 10 years, and at skeletal maturity (15 years+). Results: Out of 327 treated patients with FGFR2 mutations, 21 were found to have complete mandibular measurements through skeletal maturity (11 Apert, 7 Crouzon, and 3 Pfeiffer). Initial measurements revealed that mandibular height and bigonial breadth were slightly larger than normal, but sagittal depth and cranial base width were deficient. Early growth was slightly accelerated along the vertical and sagittal axes, stable across the bigonial distance, and marked deficient at the cranial base. At skeletal maturity, vertical height and bigonial width remained above average, but mandibular depth (forward sagittal growth) and cranial base width, remained deficient. Conclusions: Mandibular growth in children with FGFR2 mutations is not normal with impairments found in forward sagittal growth and skull base widening. Knowledge of these deficiencies has significant implications for both planning the degree of midfacial advancements, as well as treating obstructive sleep apnea. (C) 2017 by Mutaz B. Habal, MD.

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B Cell Lymphoma Underlying Paraffinoma of Glabella.

Soft tissue reactions to paraffin include inflammation, fibrosis, disfigurement, and granulomatous inflammation with foreign body giant cell reaction. The authors report the case of a 77-year-old woman with cutaneous marginal zone B cell lymphoma located on glabella, arising in association with underlying paraffinoma. While it is unclear whether the implant directly contributed to the development of lymphoma, this association has not been previously documented, prompting this report. (C) 2017 by Mutaz B. Habal, MD.

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Primary Carcinosarcoma of the Parotid Gland Mimicking as Parotid Abscess With Deep Neck Infection.

Carcinosarcoma, true malignant mixed tumor, of the parotid is an extremely rare tumor. Pathologically, it is composed of malignant epithelial and malignant mesenchymal elements. The carcinosarcoma of the salivary glands comprised only 0.04% to 0.16% of all malignant salivary tumors with 65% occurring in the parotid gland. This tumor has an aggressive characteristic and is often regarded as a high-grade tumor with distant metastasis occurring in 54% of the patients. Patients usually present between 60 and 65 years of age and most series report no sex predominance. Radiologically, this tumor has a low attenuation center with a thick-enhancing wall and can be misdiagnosed deep neck infection in the parapharyngeal space. In this report, the authors report a patient of true malignant mixed tumor of the parotid gland mimicking as deep neck infection. Radiologic and histologic features including immunohistochemical results are discussed. (C) 2017 by Mutaz B. Habal, MD.

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Midfacial Changes Through Anterior Maxillary Distraction Osteogenesis in Patients With Cleft Lip and Palate.

Maxillary hypoplasia is a major issue in cleft lip and palate patients, and predictable surgical maxillary advancement is required. In the present study, the changes and stability of the maxilla and soft tissue profile achieved after the application of anterior maxillary distraction osteogenesis (AMDO) using intraoral expander in unilateral cleft lip and palate and isolated cleft palate patients were investigated by comparing to the Le Fort I osteotomy (LFI) and maxillary distraction osteogenesis (DO) with rigid external distraction (RED) system. Ten patients who underwent orthognathic treatment with AMDO were examined (AMDO group). Changes in the positions of soft and hard tissue landmarks were calculated from the lateral cephalograms taken before the distraction, at the end of the distraction, and 1 year after the surgery. They were compared with the changes in 7 other unilateral cleft lip and palate patients who underwent LFI (LFI group) and 6 others who underwent DO with RED (RED group). The mean maxillary advancement of the AMDO group was similar to that of the RED group, judged by the change of point A. During DO, the AMDO group showed less clockwise rotation of mandible compared to the RED group. The soft tissue advancement of the upper lip and nose in the AMDO group was similar to that in the RED group, which was significantly larger than that in the LFI group. Our results indicate that AMDO can be surgical option to cleft lip and palate patients with less invasive but excellent improvement in both midfacial skeletal and soft tissue similar to DO-RED. (C) 2017 by Mutaz B. Habal, MD.

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Klestadt Cyst: Magnetic Resonance Imaging.

The Klestadt cyst, also known as nasoalveolar cyst, is an uncommon nonodontogenic tumor located in the maxillofacial soft tissue, on the region corresponding to the nasolabial furrow. Following its first description by Zuckerkandl in 1882,

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New Surgical Technique, Originality, Concept, and Plagiarism.

No abstract available

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Surgical Approach to Foreign Material Within the Mandibular Canal Due to Iatrogenic Factors.

This clinical report describes a relatively infrequent patient with inferior alveolar nerve damage caused by foreign material within the mandibular canal, which is one of the most severe complications of endodontic therapy. Although the circumstance is uncommon, it can have extremely unfavorable consequences for patients, such as anesthesia and paresthesia. In the present case, a patient suffered pain and severe paresthesia in the corresponding area after routine endodontic therapy. Several treatments were conducted to relieve the patient's symptoms, ranging from medication to tooth extraction, but all were of no avail. Ultimately, surgical exploration and debridement were performed with assistance of a customized surgical template. Once the foreign material was excavated, the exacerbation of condition was terminated and gradually reverted. This patient illustrates that special attention is required when undertaking intracanal procedures of lower posterior teeth so as to avoid iatrogenic damage to inferior alveolar nerve. Even more significant, when above-mentioned condition occurs, prompt surgical intervention is essential for recovery of sensation. It also demonstrates the advantages of applying surgical template and piezosurgery in removal of foreign material within the mandibular canal. (C) 2017 by Mutaz B. Habal, MD.

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Conchae Bullosis in a Pediatric Patient.

Pneumatization of the turbinates called concha bullosa is one of the most frequent anatomic variations of the nasal cavity. We report the first case of computed tomography findings of bilateral middle and inferior concha bullosa in a 13-year-old child with nasal obstruction. Here we describe a patient with extreme bilateral bullosa of inferior and middle conchas, as well as crista galli. The patient was treated successfully with endoscopic surgery of conchas. Nasal obstruction secondary to a bilateral turbinate bullosis in a child has not been described before. The clinicians should take this entity into consideration when evaluating the pediatric patients with nasal obstruction. (C) 2017 by Mutaz B. Habal, MD.

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Values Range of Tympanometric Gradient in Otitis Media With Effusion.

Introduction: The aim of this study was to establish how reliable a given tympanogram is in predicting the presence or absence of a middle ear effusion, and to provide new views for the diagnostic information of tympanometry. The use of tympanometric gradient in addition to static admittance is the focus of this study. Materials and Methods: The authors enrolled 146 female and 129 male patients. The participants were allocated into groups as follow: Group A1 consisted of 50 healthy children. Group A2 consisted of 86 children with otitis media with effusion. Group B1 consisted of 85 healthy adults. Group B2 consisted of 54 adults with otitis media with effusion. All diagnostic otoscopic examination and tympanometry were performed in both ears. The authors analyzed the distribution of tympanograms in patients with otitis media with effusion and healthy controls. Results: When the right and left ear canal volume of either children or adults with otitis media with effusion compared with healthy controls, no statistically significant different was observed (P > 0.05). On the other hand, the statistically significant difference was detected for the values of compliance, pressure and gradient of either children or adults with otitis media with effusion compared with healthy controls (P

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Breast Cancer Metastasis on the Neck Mimicking a Glomus Tumor.

Cervical metastases from breast carcinoma are extremely rare after several years of disease-free survival. In this article, a metastatic tumor of the neck originating from a breast carcinoma, which has been treated 14 years ago, is discussed. A case is presented of a 48-year-old female patient with a history of breast carcinoma, which was surgically treated approximately 14 years ago. Patient was evaluated as glomus vagale because of clinical and radiologic characteristics. The resection of the mass was performed under general anesthesia, without any complications. The diagnosis of metastatic breast carcinoma was confirmed by histopathologic evaluation. In the differential diagnosis of cervical masses, the cervical metastasis of the breast carcinoma with mimicking clinical presentations should be kept in the mind; especially patients with breast cancer history. (C) 2017 by Mutaz B. Habal, MD.

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Indications of Potassium Titanyl Phosphate Laser Therapy for Slow-Flow Vascular Malformations in Oral Region.

Background: Indications for laser therapy for slow-flow vascular malformations in the oral and maxillofacial regions have not been clearly documented. The authors aimed to estimate the frequency of resolution of slow-flow vascular malformations and to identify risk and prognostic factors associated with resolution in potassium titanyl phosphate (KTP) laser treatment. Methods: This study was designed as a prospective cohort study. Patients who had diagnosed slow-flow vascular malformations were continuously assigned to receive KTP laser therapy. All patients had intralesional laser photocoagulation performed under local anesthesia. Administered power of the KTP laser was fixed at 2 watts throughout the procedure in all patients. The primary endpoint was to understand the frequency of resolution of slow-flow vascular malformations in KTP laser treatment. Secondary endpoints were: treatment outcomes based on lesion size; treatment outcomes based on location; treatment outcomes based on total energy in joules; types of complications. Treatment outcomes were judged by a clinical assessment as well as reduction in lesion size on magnetic resonance imaging. Results: Data were obtained from 26 patients (9 men, 17 women) with 38 lesions. The average lesion size was 13.5 +/- 7.7 mm. Treatment outcomes based on lesion size showed that cure and regression were obtained in lesions less than 30 mm in size. However, lesions larger than 30 mm showed no response. Lesions in the tongue and lips showed higher cure rates than in other areas. Treatment outcomes based on administered total energy in joules showed that 68% of lesions were treated and responded well at less than 400 joules. Complication rate was relatively high in the buccal mucosal lesions. Immediate postoperative complications such as necrosis were more common in high-energy administration than in low-energy administration. Conclusion: Our results indicated that KTP laser therapy was effective for slow-flow vascular malformations less than 30 mm in size without significant side effects. (C) 2017 by Mutaz B. Habal, MD.

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Tracheal Cartilaginous Sleeve in Syndromic Craniosynostosis: An Underrecognized Source of Significant Morbidity and Mortality.

Tracheal cartilaginous sleeve (TCS) is a rare and previously unrecognized source of morbidity and mortality in patients with certain craniosynostosis syndromes. There is a paucity of reporting on this airway anomaly, and the true incidence of TCS is largely unknown. The purpose of this study was to investigate the incidence of TCS among patients with syndromic craniosynostosis at our institution. Patients with syndromic craniosynostosis who underwent direct bronchoscopy and laryngoscopy were evaluated retrospectively by pediatric otolaryngologists for the presence of TCS and associated anomalies. Among patients with a diagnosis of syndromic craniosynostosis in our craniofacial database, 10 (37%) were found to have previous direct bronchoscopy and laryngoscopy reports. Of these 10 patients, 2 had Crouzon syndrome, 3 had Pfeiffer syndrome, 3 had Apert syndrome, 1 had Muenke syndrome, and 1 had Antley-Bixler syndrome. Eighty percent (8/10) of these patients were found to have some evidence of TCS. The most commonly observed associated findings included the following: tracheostomy dependency (7/10; 70%), hearing loss (6/10; 60%), obstructive sleep apnea (5/10; 50%), cervical spine anomalies (5/10; 50%), developmental delay (5/10; 50%), and enlarged cerebral ventricles (4/10; 40%). Larger multicenter studies are required to further characterize this airway anomaly and its impact on this patient population. Our results confirm the importance of thorough airway evaluation at initial presentation and the need for validated screening protocols. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2jRL200

Wiedemann-Rautenstrauch Syndrome With Bilateral Tarsal Kink: Three Sutures for Correction.

The authors describe a 5-month-old male infant with Wiedemann-Rautenstrauch syndrome, which is an extremely rare condition. He had tarsal kink in upper eyelids in both eyes. The authors treated bilateral tarsal kink with an everting suture via a transconjunctival approach under local anesthesia. (C) 2017 by Mutaz B. Habal, MD.

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Update on Treatment of Sagittal Synostosis: What Can We Learn From the 16th Congress of the International Society of Craniofacial Surgery?.

No abstract available

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An Analysis of Independent Variables Affecting Surgical Outcomes in Patients Undergoing Repair of Maxillofacial Trauma: An American College of Surgeons National Surgical Quality Improvement Program Study.

Introduction: Facial fractures, from straightforward closed nasal reductions to complex pan facial fractures, are commonly encountered in the Plastic Surgical community. However, very little has been discussed in the literature regarding the outcomes of facial fractures relating to contributing factors. Our aim was to evaluate a battery of independent variables in order to identify, which, if any, factors correlate with suboptimal outcomes in patients who have undergone facial fracture surgery. Methods: Under the data use agreement of the American College of Surgeons public use files of the NSQIP, patients involving repair of facial fractures, Current Procedural Terminology codes 21310 to 21470 inclusive, were queried. The outcomes examined included: wound dehiscence, superficial surgical site infection, deep surgical site infection, readmission, open wound/wound infection and return to the operating room. Results: There were 2069 facial fracture patients in the National Surgical Quality Improvement Program datasets (2005-2013). Thirteen perioperative risk factors and patient comorbidities were evaluated for correlation with the 6 outcomes. Of the 6 outcomes evaluated, open wound/wound infection was the most prevalent outcome (6%). Factors statistically significant for presence of open wound/wound infection were American Society of Anesthesiology classification (P = 0.002), presence of bleeding disorder (P = 0.008), emergency patient (P = 0.001), chronic alcohol use (P = 0.002), and chronic steroid use (P = 0.034). Discussion: Several factors correlated with presence of an open wound/wound infection; however, variables such as diabetes and active tobacco use, which are often thought to contribute to wound infections, were shown to be statistically nonsignificant. Although this study was limited by its observational nature, these data may indicate a change in perception of the factors correlated with wound infections. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2jSbVP6

Outcomes in Surgical Treatment of Mucocele in Frontal Sinus.

The aim of the study was to correlate several studies dating from 1997 to 2015 to identify the most effective treatments for mucocele in the frontal sinus (with/without other paranasal sinuses), considering successful outcomes and recurrence. We aimed to conduct a literature review for articles published between 1997 and 2015. For this, we accessed articles in the SciELO database, as well as LILACS, PubMed, and Google Scholar databases. Were identified 32 work-related injuries in the paranasal sinuses; 2 of these were not related to mucoceles or mucopyocele, 4 had no relation to the frontal sinus, 9 were related to the frontal sinus and other paranasal sinuses, 4 were related to mucocele associated with other sinuses, and 13 involved only the frontal sinus. Endoscopic techniques decrease intra- and postoperative morbidity, reducing the operative time, allow a larger view of the lesion and surrounding anatomical structures, and decrease chances of recurrence. Thus, the successful outcomes have been beneficial to both the surgeon and the patient. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2jRNx2L

Plagiocephaly Severity Scale to Aid in Clinical Treatment Recommendations.

Studies have attempted to categorize infant cranial asymmetry in a variety of ways using both observational and quantitative techniques, but none have created a clinical tool that can serve as a treatment guide based on clinical outcomes. In 2006, a research team from Children's Healthcare of Atlanta published the results of a prospective analysis of 224 patients with cranial asymmetries and their treatment outcomes. As a continuation of the previous work, the researchers have identified a plagiocephaly severity scale based on those outcomes to assist medical professionals who treat patients with cranial abnormalities. Our hypothesis is to validate the proposed severity scale that categorizes the clinical presentation and severity of plagiocephaly. Of the 224 patients enrolled, 207 patients were placed in an experimental group and 17 patients who refused treatment were placed in a control group. Digital head shape data were collected. Cross-correlation matrices were computed across variables and regression models resulted in the identification of 5 meaningful variables. A 5-level clinical classification scale was created. Five 1 x 5 analyses of variance were computed to compare each classification level. Four of the 5 analyses of variance identified significant overall effects for classification. A model was developed from the empirical data and the model was tested for accuracy, resulting in 12.1% overall error. The model was validated for both experimental and control groups. The results show that the severity scale is a meaningful outcome-based scale that assists clinicians in developing a treatment plan for treating plagiocephaly. The scale has been validated across a large heterogeneous study sample. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2jSaGiZ

Epigenetics of oropharyngeal squamous cell carcinoma: opportunities for novel chemotherapeutic targets

Abstract

Epigenetic modifications are heritable changes in gene expression that do not directly alter DNA sequence. These modifications include DNA methylation, histone post-translational modifications, small and non-coding RNAs. Alterations in epigenetic profiles cause deregulation of fundamental gene expression pathways associated with carcinogenesis. The role of epigenetics in oropharyngeal squamous cell carcinoma (OPSCC) has recently been recognized, with implications for novel biomarkers, molecular diagnostics and chemotherapeutics. In this review, important epigenetic pathways in human papillomavirus (HPV) positive and negative OPSCC are summarized, as well as the potential clinical utility of this knowledge.

This material has never been published and is not currently under evaluation in any other peer-reviewed publication.

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Molecular cloning, characterization and expression analysis of Tim-3 and Galectin-9 in the woodchuck model

Publication date: March 2017
Source:Molecular Immunology, Volume 83
Author(s): Yanan Liu, Junzhong Wang, Lu Wang, Baoju Wang, Shangqing Yang, Qin Wang, Jinzhuo Luo, Xuemei Feng, Xuecheng Yang, Yinping Lu, Michael Roggendorf, Mengji Lu, Dongliang Yang, Jia Liu
In recent years, a critical role for T cell immunoglobulin mucin domain 3 (Tim-3) and its ligand Galectin-9 (Gal-9) has emerged in infectious disease, autoimmunity and cancer. Manipulating this immune checkpoint may have immunotherapeutic potential and could represent an alternative approach for improving immune responses to viral infections and cancer. The woodchuck (Marmot monax) infected by woodchuck hepatitis virus (WHV) represents an informative animal model to study HBV infection and HCC. In the current study, the cDNA sequences of woodchuck Tim-3 and Gal-9 were cloned, sequenced and characterized. The extracellular domain of Tim-3 cDNA sequence consisted of 576bp coding sequence (CDS) that encoded 192 amino acids. The 1076bp full-length Gal-9 cDNA sequence consisted of 1059bp coding sequence (CDS) that encoded 352 amino acids with a molecular weight of 39.7kDa. The phylogenetic tree analysis revealed that the woodchuck Tim-3 and Gal-9 had the closest genetic relationship with Ictidomys tridecemlineatus. The result of quantification PCR analysis showed that ubiquitous expression of Gal-9 but not Tim-3 in different tissues of naive woodchucks. Elevated liver Gal-9 expression was observed in woodchucks with chronic WHV infection. Moreover, a polyclonal antibody against the extracellular domain of woodchuck Tim-3 were generated and identified by flow cytometry. Our results serve as a foundation for further insight into the role of Tim-3/Galectin-9 signaling pathway in viral hepatitis and HCC in the woodchuck model.



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DnaJ (hsp40) of Streptococcus pneumoniae is involved in bacterial virulence and elicits a strong natural immune reaction via PI3K/JNK

Publication date: March 2017
Source:Molecular Immunology, Volume 83
Author(s): Jin Cui, Chenyu Ma, Guo Ye, Yong Shi, Wenchun Xu, Liang Zhong, Jian Wang, Yibing Yin, Xuemei Zhang, Hong Wang
As a heat shock protein, DnaJ plays an important role in the pathogenesis of pneumococcal infection. However, how the virulence factor-DnaJ elicits host natural immunity still remains unclear. In this study, we investigated the effects of dnaJ deficiency in Streptococcus pneumoniae (S. pneumoniae) on bacterial virulence, and further explored the related molecular mechanisms in vivo and in vitro. By generating dnaJ deficient mutant (ΔdnaJ), the virulence and colonization were detected in murine pneumonia and sepsis models in vivo. Compared with wild-type parent strain, the abilities of rapid colonization and induction of inflammatory responses of ΔdnaJ in mouse lungs were significantly impaired. Simultaneously, recombinant DnaJ purified from E. coli expression system (rDnaJ) induced macrophage strain RAW264.7 to secrete IL-6 by activation of PI3K and JNK signal pathways, which were confirmed by the specific signaling inhibitors. In conclusion, DnaJ, a novel virulence protein, was essential for the virulence and colonization of S. pneumoniae and induced pro-inflammatory cytokine production in macrophages through PI3K/JNK.



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Immunoproteasome subunit deficiency has no influence on the canonical pathway of NF-κB activation

Publication date: March 2017
Source:Molecular Immunology, Volume 83
Author(s): Annegret Bitzer, Michael Basler, Daniel Krappmann, Marcus Groettrup
Activation of the pro-inflammatory transcription factor NF-κB requires signal-induced proteasomal degradation of the inhibitor of NF-κB (IκB) in order to allow nuclear translocation. Most cell types are capable of expressing two types of 20S proteasome core particles, the constitutive proteasome and immunoproteasome. Inducible under inflammatory conditions, the immunoproteasome is mainly characterized through an altered cleavage specificity compared to the constitutive proteasome. However, the question whether immunoproteasome subunits affect NF-κB signal transduction differently from constitutive subunits is still up for debate. To study the effect of immunoproteasomes on LPS- or TNF-α-induced NF-κB activation, we used IFN-γ stimulated peritoneal macrophages and mouse embryonic fibroblasts derived from mice deficient for the immunoproteasome subunits low molecular mass polypeptide (LMP) 2, or LMP7 and multicatalytic endopeptidase complex-like 1 (MECL-1). Along the canonical signaling pathway of NF-κB activation no differences in the extent and kinetic of IκB degradation were observed. Neither the nuclear translocation and DNA binding of NF-κB nor the production of the NF-κB dependent cytokines TNF-α, IL-6, and IL-10 differed between immunoproteasome deficient and proficient cells. Hence, we conclude that immunoproteasome subunits have no specialized function for canonical NF-κB activation.

Graphical abstract

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Osmophobia and olfactory functions in patients with migraine

Abstract

Olfactory dysfunction and migraine has been associated for a long time. In this study, we planned to compare olfactory functions in patients with migraine and osmophobia with patients having migraine but no osmophobia, in addition with a normal control group using "Sniffin' Sticks" test. The main distinction of this study is that all qualitative and quantitative properties of olfactory functions; threshold, discrimination and identification, are evaluated separately and jointly. Thirty healthy person aged between 16 and 56 (18 women, 12 men) and 60 migraine patients aged between 15 and 54 (39 women, 21 man) were included in the study. All patients have been inquired about osmophobia and have been assessed with Hedonic tone assessment. Osmophobia has been tested for perfume, cigarette smoke, leather, stale food, soy sauce, fish, spices and coffee smells. Olfactory functions has been assessed with "Sniffin' Sticks" smell test. Thresholds, discrimination and identification have been determined for each patient. In migraine patients with osmophobia, threshold was 7.75 ± 2.3, in migraine patients without osmophobia threshold was 8.25 ± 1.5 and threshold was 10.75 ± 1.3 for the control group. Discrimination score was 6 ± 1.2 in migraine patients with osmophobia, 9 ± 0.8 in patients without osmophobia and was 12 ± 1.4 in the control group. In migraine patient with or without osmophobia Threshold/Discrimination/Identification (TDI) scores were lower than the control group. The most important parameter in our study is that discrimination scores were especially lower in patients with osmophobia. We believe that this decrease in discrimination in migraine patients with osmophobia; who claim that they smell everything and they are sensitive to all smells, is significant. Further studies about smell discrimination will help better understand some conditions; especially anosmia and hyposmia after upper respiratory tract infections and parosmia.

http://ift.tt/2k9W5jL

Phonoarticulation in spinocerebellar ataxia type 3

Abstract

Phonoarticulation is characterized by changes in resonance, diadochokinesis, prosody, sound frequency, vocal quality, and intraoral pressure. The main aim of this study was to characterize the phonoarticulation in spinocerebellar ataxia type 3 (SCA3) and correlate it with clinical and genetic factors. Thirty-one patients with SCA3 who were subjected to spontaneous speech recordings and phonoarticulatory diadochokinesis (DDK) participated in the study. Speech analyses were performed starting after 10 s of spontaneous speech, by three experienced speech therapists, using a protocol for dysarthria adapted from the Mayo Clinic. The intra-evaluator reliability was analyzed. The lower the patient's age at disease onset was, the more frequent the occurrences of monofrequency and altered speech rhythm were. Articulation, DDK, resonance, and prosody showed a moderate correlation with the number of "CAG" triplet repeats. We conclude that the phonoarticulation of patients with Machado–Joseph disease (MJD) is characterized by mixed dysarthrophonia with cerebellar and hypokinetic components, and that there is a tendency toward higher frequency of dysarthrophonia symptoms with lower age of disease onset, longer time since onset and higher number of "CAG" triplet repeats.

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Computed tomography findings of the bony portion of the Eustachian tube with or without patulous Eustachian tube patients

Abstract

To investigate the bony segment of the Eustachian tube (ET) using sitting 3D-computed tomography (CT) scans in Patulous Eustachian tube (PET) patients. A retrospective survey of medical records in Sen-En Hospital identified 43 patients and 43 ears with PET and 30 patients and 30 ears with sensorineural hearing loss or vertigo patients as the control. Diagnosis of PET was based on the Proposal on PET Diagnosis Criteria announced by the Otological Society of Japan in 2012. Patients were examined by cone beam CT (Accuitomo; Morita, Kyoto, Japan) in the sitting position. The heights and widths at the tympanic orifice, the middle portion, and isthmus were measured. The lumen of the bony portion was divided into three shapes: peritubal cells (PTC) poor type, PTC good with prominence type, and PTC good without prominence type. In PET patients and the control group, the PTC poor type was identified in nine (21%) and seven ears (23%), PTC good with prominence type was identified in 14 (33%) and seven ears (23%), and PTC good without prominence type was identified in 19 (45%) and 16 ears (53%), respectively. There was no significant difference between the two groups. At the tympanic orifice portion, the average height of the ET lumen was 5.99 ± 1.29 and 6.04 ± 1.41 mm, and the average width of the ET lumen was 2.81 ± 0.82 and 2.78 ± 0.57 mm in the PET and control groups, respectively. The PTC good with prominence type had a significantly smaller width in the tympanic orifice portion than the other types in each group (p < 0.05). The width of the ET lumen in the tympanic orifice averaged 2.87 ± 0.38 and 3.10 ± 0.45 mm in the PTC poor type, 2.23 ± 0.70 and 2.22 ± 0.48 mm in the PTC good with prominence type, and 3.21 ± 0.87 and 2.90 ± 0.50 mm in the PTC good without prominence type in the PET and control groups, respectively. The shape of the bony portion of the ET in PET patients is almost identical to that of controls. Thus, the bony portion has no influence on the pathology of patulous Eustachian tube syndrome. The PTC good with prominence type has a significantly smaller tympanic orifice portion width than the other types. Preoperative evaluation of the bony portion of the ET could provide useful information for ET surgeons.

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Visualization of anatomy in normal and pathologic middle ears by cone beam CT

Abstract

Cone beam computed tomography (CBCT, syn. digital volume tomography = DVT) was introduced into ENT imaging more than 10 years ago. The main focus was on imaging of the paranasal sinuses and traumatology of the mid face. In recent years, it has also been used in imaging of chronic ear diseases (especially in visualizing middle and inner ear implants), but an exact description of the advantages and limitations of visualizing precise anatomy in a relevant number of patients is still missing. The data sets of CBCT imaging of the middle and inner ear of 204 patients were analyzed regarding the visualization of 18 different anatomic structures. A three-step scale (excellent visible, partial visible, not visible) was taken. All analyses were performed by two surgeons experienced in otology and imaging. The indications for imaging were chronic middle ear disease or conductive hearing loss. Previously operated patients were excluded to rule out possible confounders. In dependence of a radiological pathology/opacity of the middle ear, two groups (with and without pathology) were built. Regarding the possibility of excellent visualization, significant differences were only found for small bony structures: incu-stapedial joint (25.8 vs. 63.5 %), long process of incus (42.7 vs. 88.8 %), head of stapes (27.0 vs. 62.6 %), anterior crus of stapes (16.9 vs. 40.9 %) and posterior crus of stapes (19.1 vs. 42.6 %). The other structures (semicircular canals, skull base at mastoid and middle ear, jugular bulb, sinus sigmoideus, facial nerve) could be visualized well in both groups with rates around 85–100 %. Even CBCT shows little limitations in visualization of the small structures of the middle and inner ear. Big bony structures can be visualized in normal as well as in pathologic ears. Overall, due to pathology of middle ear, an additional limitation of evaluation of the ossicular chain exists. In future, studies should focus on comparative evaluation of different diseases and different radiological modalities and be performed by radiologists and otologists together to improve the quality of reports and to answer clinical questions more satisfactorily.

http://ift.tt/2ka0EKR

Cochlear implantation in patients with definite Meniere’s disease

Abstract

The exact pathomechanism of deafening in Meniere's disease (MD) is still unknown; intoxication of hair cells and neural damage from endolymphatic hydrops is discussed. In the literature, there are only a few reports on hearing outcome of MD patients after treatment with cochlear implantation (CI) whereby especially the comparison of MD vs. non-MD patients with CI differs. In this retrospective study, results in speech understanding [Freiburger Einsilber (FES65) and Hochmair–Schulz–Moser test in quiet (HSM) and in noise (HSM + 10 dB)] of 27 implanted MD patients were collected and compared to a matched standard CI cohort. Alternative diagnoses were excluded as far as possible by re-analyzing neuroradiologic imaging. After first fitting, MD patients showed significantly better results in FES and HSM testing compared to controls. At 1-year refitting, this effect could not be seen anymore. To conclude, cochlear implantation is a safe and effective treatment for deafness in MD patients. Results in speech understanding are at least equal compared to general CI recipients. To the best of our knowledge, this retrospective study examined the largest collective of CI users deafened by MD so far.

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Multicenter surgical experience evaluation on the Mid-Scala electrode and insertion tools

Abstract

The HiFocus Mid-Scala electrode is intended to improve hearing for individuals with severe-to-profound hearing loss by providing extended electrical coverage of the cochlea while minimizing trauma related to insertion. The electrode is appropriate for use with a wide range of surgical techniques, including either a cochleostomy or round window insertion, and the use of either a free-hand or tool-assisted approach. The objective of this survey was to evaluate how the HiFocus Mid-Scala electrode and insertion tools was used across a population of cochlear implant recipients of differing ages, audiologic profiles, and anatomical characteristics. The intent was to understand the type and frequency of surgical techniques applicable with the electrode, and to provide guidelines for clinical practice. Two questionnaires were completed by surgeons at implant centres located in the United States, Europe, and Asia. Before any surgeries were conducted, surgeons completed a questionnaire that assessed their overall cochlear implant surgical practice and preferences. Following each HiFocus Mid-Scala electrode insertion, surgeons completed a questionnaire that summarized their experience during that surgical procedure. Questionnaires were completed by 32 surgeons from 16 centres for a total of 143 surgeries (112 adults, 31 children). Most surgeons (62 %) preferred to insert the electrode via the round window or an extended round window compared with a cochleostomy (16 %), whereas the remaining 22 % indicated that they made an insertion choice based on presenting anatomy. Sixty-nine percent preferred a free-hand approach over using insertion tools. In 32 procedures, surgeons elected to deviate from an intended round window insertion to either an extended round window or cochleostomy approach.

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Mechanisms of ear trauma and reconstructive techniques in 105 consecutive patients

Abstract

Acquired auricular deformities may diminish facial esthetics and cause psychological distress. The aim of this article is to provide an overview of the type of injuries and applied reconstructive techniques in a large academic hospital in The Netherlands. A retrospective chart review was conducted for the last 105 patients who underwent auricular reconstruction for an acquired deformity. Data concerning gender, affected side, cause of injury, anatomical region, the previous and further surgeries, type of cartilage, and skin cover used were collected and analyzed. 105 patients were included. Acquired auricular deformities were mainly caused by bite injuries (22 %), traffic accidents (17 %), burns (9.5 %), and post-otoplasty complications (9.5 %). The upper third of the auricle was most often injured (41 %), followed by the entire auricle (19 %). 70 % of cases required reconstruction with costal cartilage. The most common form of cutaneous cover was a postauricular skin flap (40 % of cases). This study gives a complete overview of causes and treatment of acquired auricular deformities. The results are comparable with the results of similar studies found in literature. Bite wounds are the leading cause of acquired auricular injuries. The upper third is most commonly affected. In the largest percentage of reconstructions, costal cartilage and a postauricular flap were used to correct the deformity.

http://ift.tt/2jM7doC

Double nasoseptal flap technique for endonasal pituitary surgery

Abstract

Endoscopic endonasal approach has been successfully used for the management of pituitary tumors; however, the loss of septal mucosa especially around sphenoethmoidal recess and posterior nasal septum might be a disadvantage of this technique. The aim of this study is to describe a variation of the endonasal approach, "double nasoseptal flap" technique in endoscopic transsphenoidal pituitary surgery, and to evaluate its outcomes. The technique depends on fully harvested bigger nasoseptal flap on one side and smaller on the other. Thirty patients were included. Functional results were assessed by preoperative and postoperative first month visual analogue scale (VAS), and morphology was evaluated by achieving intact septum from the sphenoid ostium to the columella. Sphenoid sinusitis, the presence of synechia and crusting in the sphenoethmoidal recess was also assessed. Mean VAS was 71 and 67 mm preoperatively and postoperatively, respectively (p > 0.01). There were no septal perforations, synechia, and sphenoid sinusitis postoperatively. Three patients had (10 %) crusts on sphenoethmoidal recess on first month postoperatively. Double nasoseptal flap technique has advantages, such as wider exposure during surgery; prepared flaps could be used if needed, better morphological and functional outcomes postoperatively. The technique is safe without any perforations and minimal crusting.

http://ift.tt/2k9RbU3

Epithetic nasal reconstruction for nasal carcinoma: retrospective analysis on 22 patients

Abstract

Advanced nasal cancers usually demand partial or total rhinectomy followed by radiotherapy. Reconstruction of the resulting defects can be achieved by means of reconstructive plastic surgery and/or epithetic surgery. The data of 22 patients who had been treated after nasal ablation by means of custom-made silicone nasal epithesis fixed by bone-anchored magnets between 2003 and 2014 were evaluated retrospectively. There were 15 male (68.2 %) and 7 (31.8 %) female patients. The most common etiology that led to epithetic rehabilitation was a squamous cell carcinoma in 16 patients. An operative revision was necessary in two patients due to screw loss. Twenty patients were still alive with no evidence of disease after minimum follow-up of 2 years (90.9 %). Epithetic rehabilitation after nasal ablation to treat nasal malignancies is an interesting alternative to plastic and reconstructive surgery. Bone-anchored fixation using magnets can achieve a stable epithetic fixation after nasal ablation necessitating, in numerous cases, additional adjuvant therapy like radiation.

http://ift.tt/2jMdArT

Olfactory dysfunction in acute rhinosinusitis: intranasal sodium hyaluronate as adjuvant treatment

Abstract

Acute rhinosinusitis (ARS) is defined as an inflammation of the mucosa of the nose and paranasal sinuses and affects 1–5 % of general population in Europe. Sinonasal diseases represent the main cause of smell alterations in adult patients and lead to mucosal congestion, increased quantity and density of secretions and altered mucociliary transport. For this reason the odorous molecules contained in the inspired air, cannot interact with the olfactory epithelium. Medical therapy of ARS has to reduce the severity and duration of symptoms and prevent complications. Recent studies have shown that Sodium hyaluronate modulate inflammation and has a reparative effect on the nasal mucosa. 48 patients affected by acute rhinosinusitis proven by CT scan, were enrolled. They were submitted to nasal endoscopy, olfactometric and mucociliary transport evaluation (MCTt), Visual Analogue Scale Questionnaire (VAS) at T0, after 14–18 days (T1) and after 30–35 days (T2). The patients were randomized into two treatment groups, A and B, and were treated for 30 days; each group was composed of 24 subjects. All patients received Levofloxacin (500 mg for 10 days) and Prednisone (50 mg for 8 days, 25 mg for 4 days and 12, 5 mg for 4 days). Moreover, Group A received twice a day for 30 days high molecular weight Sodium Hyaluronate (3 %) plus saline solution (3 mL sodium chloride-NaCl—0.9 %) using a nebulizer ampoule for nasal douche. Group B received twice a day for 30 days saline solution (6 mL sodium chloride-NaCl—0.9 %) using a nebulizer ampoule for nasal douche. At T1 Group A shown lower values in MCTt and threshold score was significantly higher than in Group B. VAS showed statistically significant differences between the two groups, in particular for smell, nasal obstruction and for nasal discharge. At T2 Group A MCTt was significantly lower than in Group B; odour threshold improved in both groups but in Group A was still significantly higher than in Group B. No statistical differences between two groups regarding odour discrimination and odour identification were confirmed at T1 and T2. VASy score showed statistically significant differences between the two groups only for nasal discharge.

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Nasopharyngeal Adenocarcinoma: a Population-Based Analysis

Publication date: Available online 31 January 2017
Source:American Journal of Otolaryngology
Author(s): Edward C. Kuan, Jose E. Alonso, Armin Arshi, Maie A. St. John
Objectives/HypothesisTo describe the incidence and determinants of survival of patients with nasopharyngeal adenocarcinoma between the years of 1973 to 2012 using the Surveillance, Epidemiology, and End Result (SEER) database.Study DesignRetrospective cohort study using a national database.MethodsThe SEER registry was utilized to calculate survival trends for patients with nasopharyngeal adenocarcinoma between 1973 and 2012. Patient data was then analyzed with respect to histopathology, age, sex, race, stage, grade, and treatment modalities (surgery and radiation therapy). Overall (OS) and disease-specific survival (DSS) were calculated.ResultsA total of 148 cases of nasopharyngeal adenocarcinoma were identified. The cohort was composed of 54.7% males. The mean age at diagnosis was 59.0years. The median OS was 60.6months. 59.4% of cases were treated with surgery, while 64.1% received radiation therapy. OS at 2, 5, and 10years was 63%, 49%, and 36%, respectively. There was no significant difference in OS and DSS between adenocarcinoma of the nasopharynx versus the sinonasal tract (p>0.05). On univariate analysis, younger age, surgery, surgery and radiation, and lower tumor grade were associated with improved OS and DSS, while papillary subtype, lower stage, and no distant metastasis were associated with improved OS alone (all p<0.05).ConclusionsNasopharyngeal adenocarcinoma is an extremely rare malignancy with poor prognosis, with the exception of the papillary subtype. Age, grade, and surgical therapy are predictors of survival.



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Hearing loss in Meniere's disease

Publication date: Available online 31 January 2017
Source:American Journal of Otolaryngology
Author(s): Hossein Ghazavi, Leila Asadpour




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Effect of Pulse Polarity on Thresholds and on Non-monotonic Loudness Growth in Cochlear Implant Users

Abstract

Most cochlear implants (CIs) activate their electrodes non-simultaneously in order to eliminate electrical field interactions. However, the membrane of auditory nerve fibers needs time to return to its resting state, causing the probability of firing to a pulse to be affected by previous pulses. Here, we provide new evidence on the effect of pulse polarity and current level on these interactions. In experiment 1, detection thresholds and most comfortable levels (MCLs) were measured in CI users for 100-Hz pulse trains consisting of two consecutive biphasic pulses of the same or of opposite polarity. All combinations of polarities were studied: anodic-cathodic-anodic-cathodic (ACAC), CACA, ACCA, and CAAC. Thresholds were lower when the adjacent phases of the two pulses had the same polarity (ACCA and CAAC) than when they were different (ACAC and CACA). Some subjects showed a lower threshold for ACCA than for CAAC while others showed the opposite trend demonstrating that polarity sensitivity at threshold is genuine and subject- or electrode-dependent. In contrast, anodic (CAAC) pulses always showed a lower MCL than cathodic (ACCA) pulses, confirming previous reports. In experiments 2 and 3, the subjects compared the loudness of several pulse trains differing in current level separately for ACCA and CAAC. For 40 % of the electrodes tested, loudness grew non-monotonically as a function of current level for ACCA but never for CAAC. This finding may relate to a conduction block of the action potentials along the fibers induced by a strong hyperpolarization of their central processes. Further analysis showed that the electrodes showing a lower threshold for ACCA than for CAAC were more likely to yield a non-monotonic loudness growth. It is proposed that polarity sensitivity at threshold reflects the local neural health and that anodic asymmetric pulses should preferably be used to convey sound information while avoiding abnormal loudness percepts.

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Phenotypic characterization of oral mucosa: what is normal?

Summary

Background

Knowledge of the phenotypic pattern of oral squamous epithelium is important in the histopathologic evaluation of lesions including cancer. The literature on normal epithelium is controversial as the phenotype has not been evaluated in samples from completely healthy tissue donors without a history of tobacco and alcohol exposure.

Methods

In this study, we evaluated normal upper lip fornix and gingival mucosa from carefully selected young healthy donors without a history of smoking and alcohol exposure, and keratin type 8, 10, 14 and 17, filaggrin and Ki67 were investigated in these donors. The results were compared with profile of epithelium from leukoplakia.

Results

The results demonstrated that the phenotypic patterns of gingiva and upper lip fornix mucosa were different. Surprisingly, a high proportion of gingival samples exhibited keratin 8 and a suprabasal signal for keratin 14. These patterns were compared with that of human oral leukoplakia, and some phenotypic similarities were noted.

Conclusions

These results demonstrated oral epithelium phenotypic plasticity based on functional requirements of the microenvironment, which can be used in diagnosis.

This article is protected by copyright. All rights reserved.

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