Head and Neck Medicine by Alexandros G.Sfakianakis: Φεβρουαρίου 2017

Τρίτη 28 Φεβρουαρίου 2017

Relapsing bullous amyloidosis of the oral mucosa and acquired cutis laxa in a patient with multiple myeloma: a rare triple association

Summary

It is well known that primary systemic amyloidosis [light chain (AL) amyloidosis] is associated with hidden dyscrasia or multiple myeloma. Acquired cutis laxa (cutis laxa acquisita; CLA) has also been described in patients with plasma cell dyscrasias, including multiple myeloma. We report a case in which haemorrhagic oral bullae were the first sign of an undiagnosed primary systemic amyloidosis related to multiple myeloma IgG-λ and previously diagnosed CLA. There is only one report in literature of this rare triple association; however, in that case the patient did not have oral mucosal involvement or bullous amyloidosis.

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A novel mutation in the RSPO4 gene in a patient with autosomal recessive anonychia

Summary

The Wnt signalling pathway is a major pathway involved in the embryogenic development of the various organs of the body. Appropriate signalling in this pathway relies on the proper functioning of several proteins including the R-spondin family of proteins. Deactivating mutations in R-spondin 4 are associated with anonychia. We present the case of a 26-year-old man presenting with anonychia of the 20 nails, which had been present since birth. Using genetic studies, we identified a novel nonsense mutation, c.164-165TC>AA, characterized by two consecutive mismatch bases. To our knowledge, this mutation is the first to be reported in R-spondin 4 in a Lebanese population. Evaluating new patients with anonychia provides fruitful clinical and molecular findings.

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Otophyma in Morbihan disease

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Lentigo maligna successfully treated with combination therapy of topical tazarotene and imiquimod

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Effectiveness of omalizumab in a case of urticarial vasculitis

Summary

Urticarial vasculitis (UV) is a mainly leucocytoclastic vasculitis with urticarial plaques. Treating these patients is challenging as the available treatments have poor efficacy. Oral corticosteroids are considered the first-line treatment, but H1 antihistamines, dapsone, colchicine, antimalarials, ciclosporin and antileucotrienes have all been tried also. However, because of their adverse effects and/or lack of efficacy, new agents are still needed. Omalizumab, an anti-IgE antibody, shows efficacy in chronic spontaneous urticaria, and might also be a good treatment for angio-oedema and urticarial vasculitis. To our knowledge, there have been only seven relevant case reports published in the English literature. We add a new case of severe chronic recurrent urticarial vasculitis refractory to all of the drugs mentioned above. We started the patient on subcutaneous omalizumab 300 mg every 4 weeks, which produced clinical improvement within the first month and total remission in the fifth month. The patient has remained stable for 23 months, and follow-up is ongoing.

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Management of pinna of haematoma study (MaPHaeS): a multicentre retrospective observational study

Abstract

Objectives

To assess current variation in the management of pinna haematoma (PH) and its effect on outcomes.

Design

Multicentre retrospective observational record-based study.

Setting

Eleven hospitals around the UK.

Participants

Eighty-three patients above the age of 16 with PH.

Outcome Measures

The primary outcome measure was recurrence rate of PH over a six-month period post treatment, assessed by treatment type (scalpel incision vs. needle aspiration). Secondary outcome measures assessed the impact of other factors on recurrence, infection and cosmetic complications of PH over a period of six months.

Results

After adjusting for confounding factors, involvement of the whole ear, and management within an operating theatre were associated with a lower rate of recurrence of pinna haematoma. The drainage technique, suspected aetiology, choice of post-drainage management, grade and specialty of practitioner performing drainage, the use of intra-auricular antibiotic injection and hospital admission did not affect the rate of haematoma recurrence, infection or cosmetic complications.

Conclusions

Where possible PH should be drained in an operating theatre. Multi-centre randomized-controlled trials are required to further investigate the impact of drainage technique and post drainage management on outcome.

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Laryngopharyngeal Reflux in Children with Chronic Otitis Media with Effusion

http://sfaki.blogspot.com/2017/02/laryngopharyngeal-reflux-in-children.html

Children aged 7-10 years of age with OME underwent 24-hour multichannel intraluminal impedance pH-metry. The upper pH sensor was situated 1 cm above the upper esophageal sphincter, and the lower pH sensor was placed 3-5 cm above the lower esophageal sphincter. Parents were asked to complete the gastroesophageal reflux assessment of symptoms in a pediatrics questionnaire.

Twenty-eight children were enrolled; LPR was detected in 19 (67.9%) children. The criteria of the LPR diagnosis was the presence of at least one supraesophageal episode with a pH < 5.0 and a change in the pH value measured from the initial level at the upper sensor of > 0.2. In total, 64 episodes were observed. Assessment of all LPR episodes showed the presence of 246 episodes in the entire study. A considerable predominance of weakly acidic episodes (87.8%) was noted; there were 6.5% acidic episodes, and weakly alkaline episodes reached 5.7%. Pathological GER was noted in 10 (35.7%) subjects. Acid GER was detected in 8 children, 2 of whom demonstrated non-acidic reflux. In the LPR-negative patients, no pathological GER was confirmed with the exception of a single case of non-acidic reflux.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Intermediate-Acting Nondepolarizing Neuromuscular Blocking Agents and Risk of Postoperative 30-Day Morbidity and Mortality, and Long-term Survival.

BACKGROUND: Nondepolarizing neuromuscular blocking drugs (NNMBDs) are commonly used as an adjunct to general anesthesia. Residual blockade is common, but its potential adverse effects are incompletely known. This study was designed to assess the association between NNMBD use with or without neostigmine reversal and postoperative morbidity and mortality. METHODS: This is a retrospective observational study of 11,355 adult patients undergoing general anesthesia for noncardiac surgery at 5 Veterans Health Administration (VA) hospitals. Of those, 8984 received NNMBDs, and 7047 received reversal with neostigmine. The primary outcome was a composite of respiratory complications (failure to wean from the ventilator, reintubation, or pneumonia), which was "yes" if a patient had any of the 3 component events and "no" if they had none. Secondary outcomes were nonrespiratory complications, 30-day and long-term all-cause mortality. We adjusted for differences in patient risk using propensity matched (PM) followed by assessment of the association of interest by logistic regression between the matched pairs as our primary analysis and multivariable logistic regression (MLR) as a sensitivity analysis. RESULTS: Our primary aim was to assess the adverse outcomes in the patients who had received NNMBDs with and without neostigmine. Administration of an NNMBD without neostigmine reversal compared with NNMBD with neostigmine reversal was associated with increased odds of respiratory complications (PM odds ratio [OR], 1.75 [95% confidence interval [CI], 1.23-2.50]; MLR OR, 1.71 [CI, 1.24-2.37]) and a marginal increase in 30-day mortality (PM OR, 1.83 [CI, 0.99-3.37]; MLR OR, 1.78 [CI, 1.02-3.13]). However, there were no statistically significant associations with nonrespiratory complications or long-term mortality. Patients who were administered an NNMBD followed by neostigmine had no differences in outcomes compared with patients who had general anesthesia without an NNMBD. CONCLUSIONS: The use of NNMBDs without neostigmine reversal was associated with increased odds of our composite respiratory outcome compared with patients reversed with neostigmine. Based on these data, we conclude that reversal of NNMBDs should become a standard practice if extubation is planned. (C) 2017 International Anesthesia Research Society

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Safety of Large-Volume, Same-Day Oral Bowel Preparations During Deep Sedation: A Prospective Observational Study.

BACKGROUND: Colonoscopy quality is directly related to the bowel preparation. It is well established that bowel preparations are improved when at least part of the laxative is ingested on the day of the procedure. However, there is concern that this can result in higher gastric residual volumes (GRV) and increase the risk of pulmonary aspiration. The aim of this study is to evaluate GRV and gastric pH in patients who received day-before bowel preparation versus those ingesting their laxative on the day of colonoscopy under anesthesiologist-directed propofol deep sedation. METHODS: This is a prospective observational study for patients undergoing same-day upper endoscopy and colonoscopy. All included patients had large-volume polyethylene glycol lavage preparation and received propofol sedation. Gastric fluid was collected during the upper endoscopy for volume and pH measurement. RESULTS: The study included 428 patients with 56% receiving same-day laxative preparation and the remainder evening-before preparation. Mean +/- SD GRV was 18.1 +/- 10.2 mL, 16.3 +/- 16.5 mL in each of these preparation groups, respectively (P = .69). GRV >= 25 mL or higher than expected GRV adjusted by weight (0.4 mL/kg) were also not different among the study groups (P = .90 and P = .87, respectively). Evaluating GRV based on time since last ingestion of preparation (3-5, 5-7, >7 hours) did not result in any differences (P = .56). Gastric pH was also similar between the bowel preparation groups (P = .23), with mean +/- SD of 2.5 +/- 1.4 for evening-before and 2.5 +/- 1.3 for the same-day preparation. There were more inadequate bowel preparations in day before bowel preparations (P = .001). CONCLUSIONS: A large-volume bowel preparation regimen finished on the day of colonoscopy as close as 3 hours before the procedure results in no increase in GRV or decrease in gastric pH. (C) 2017 International Anesthesia Research Society

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Cross-Disciplinary Perceptions of Structured Interprofessional Rounds in Promoting Teamwork Within an Academic Tertiary Care Obstetric Unit.

BACKGROUND: In 2005, physician and nursing leaders at Brigham and Women's Hospital initiated structured interprofessional rounds (SIPRs) on the labor and delivery (L&D) suite to improve team communication. We performed a cross-sectional analysis of providers' perceptions of SIPRs and their effectiveness in improving teamwork. We hypothesized that on average, providers would perceive SIPRs as being effective in promoting teamwork, but ratings would differ among professional groups. METHODS: After a factor analysis and internal consistency assessment, a 19-item paper-based questionnaire was used to evaluate providers' perceptions using a 5-point Likert scale. Respondents included L&D nurses, midwives, obstetricians, and anesthesiologists who participate in SIPRs. The primary aim was to evaluate the providers' perceptions of SIPRs and their association with professional roles. The outcome was total response score for each provider, ranging from 19 to 95; perception of SIPRs as being effective in promoting teamwork was defined as having a total response score of >66.5 (mean score, >3.5 per question). A univariable linear regression model was performed, followed by a multivariable analysis adjusting for predictors that modified the outcome; predictors included years of professional practice, years of experience on the L&D suite, number of clinical work hours worked weekly, and principal shift assignment among nurses. The associations between these predictors and providers' perceptions were assessed as a secondary aim. RESULTS: A total of 234 practitioners responded (100% response rate). The mean total response score (SD) for all providers was 73.3 (9.5). After multivariable adjustment, the mean total response scores were significantly higher for obstetric providers than for anesthesia ([DELTA] mean, 6.5, 95% CI, 0.3, 12.7 P = .036) and midwifery ([DELTA] mean, 12.5, 95% CI, 2.0, 23.0, P = .009) providers. Providers scored significantly lower if they worked >60 clinical hours per week compared with

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A Randomized Crossover Study Comparing Cervical Spine Motion During Intubation Between Two Lightwand Intubation Techniques in Patients With Simulated Cervical Immobilization: Laryngoscope-Assisted Versus Conventional Lightwand Intubation.

BACKGROUND: In patients with cervical immobilization, jaw thrust can cause cervical spine movement. Concurrent use of a laryngoscope may facilitate lightwand intubation, allowing midline placement and free movement of the lightwand in the oral cavity without jaw thrust. We compared the effects of laryngoscope-assisted lightwand intubation (LALI) versus conventional lightwand intubation (CLI) on cervical spine motion during intubation in patients with simulated cervical immobilization. METHODS: In this randomized crossover study, the cervical spine angle was measured before and during intubation at the occiput-C1, C1-C2, and C2-C5 segments in 20 patients with simulated cervical immobilization who underwent intubation using both the LALI and CLI techniques. Cervical spine motion was defined as the change from baseline in angle measured at each cervical segment during intubation. RESULTS: Cervical spine motion at the occiput-C1 segment was 5.6[degrees] (4.3) and 9.3[degrees] (4.5) when we used the LALI and CLI techniques, respectively (mean difference [98.33% CI]; -3.8[degrees] [-7.2 to -0.3]; P = .007). At other cervical segments, it was not significantly different between the 2 techniques (-0.1[degrees] [-2.6 to 2.5]; P = .911 in the C1-C2 segment and -0.2[degrees] [-2.8 to 2.5]; P = .795 in the C2-C5 segment). CONCLUSIONS: The LALI technique produces less upper cervical spine motion during intubation than the CLI technique in patients with simulated cervical immobilization. (C) 2017 International Anesthesia Research Society

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Anesthetic Management for Percutaneous Minimally Invasive Fetoscopic Surgery of Spina Bifida Aperta: A Retrospective, Descriptive Report of Clinical Experience.

Minimally invasive fetoscopic surgery for spina bifida aperta is a new therapeutic approach to preserve neurologic function by protecting exposed neural tissue. The anesthetic management is of paramount importance for the success of the procedure. Therefore, our protocol was developed with particular attention to safe and adequate maternal and fetal anesthesia, sufficient uterine relaxation as well as prevention of pulmonary edema, placental abruption, and spontaneous labor. As illustrated by this retrospective analysis of 61 cases, these goals can be reliably achieved. The clinical protocol is presented as a supplemental digital content to this manuscript (Supplemental Digital Content 1, http://ift.tt/2lx03TC). (C) 2017 International Anesthesia Research Society

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The Role of NR2B-CREB-miR212/132-CRTC1-CREB Signal Network in Pain Regulation In Vitro and In Vivo.

BACKGROUND: Chronic pain is a debilitating threat to human health, and its molecular mechanism remains undefined. Previous studies have illustrated a key role of cAMP response element-binding protein (CREB) in pain regulation; CREB-regulated transcription coactivator 1 (CRTC1) and microRNA212/132 (miR212/132) are also vital in synaptic plasticity. However, little is known about the interaction among these factors in pain condition. We conducted this experiment mainly to determine the crosstalk between CREB, CRTC1, and miR212/132 in vitro. Moreover, we explored the changes in hyperalgesia on chronic constrictive injury (CCI) mouse in vivo when given CREB-related adenovirus vectors, CRTC1-related adenovirus vectors, and miR212/132-locked nucleic acid (LNA). METHODS: We cultured primary neurons in the spinal cord of mouse embryos. Exogenous glutamate was added to cultured neurons to simulate in vivo pain process. Real-time quantitative polymerase chain reaction was used to determine changes of NR2B, CRTC1, CREB, and miR212/132 at the mRNA level; Western blot was used to detect p-NR2B, p-CREB, and CRTC1 at protein level. Von Frey cilia were used to study mechanical hyperalgesia in a murine model of CCI. CREB-miR (adenovirus vector interfering CREB gene), CREB-AD (adenovirus vector overexpressing CREB gene); CRTC1-miR (adenovirus vector interfering CRTC1 gene), CRTC1-AD (adenovirus vector overexpressing CRTC1 gene), and miR212/132-LNA were injected intrathecally. RESULTS: In vitro, 100 [mu]mol/L glutamate induced p-CREB and miR212/132-LNA. CRTC1 protein was downregulated by CREB-miR and miR212/132-LNA. CRTC1 mRNA was upregulated by CREB-AD and downregulated by CREB-miR and miR212-LNA. P-CREB was upregulated by CRTC1-AD and downregulated by miR212/132. CREB mRNA was upregulated by CRTC1-AD and downregulated by CRTC1-miR. MiR212/132 was upregulated by CRTC1-AD and CREB-AD; downregulated by CREB-miR. In vivo, CRTC1-miR, CREB-miR, and miR212/132-LNA increased paw withdrawal mechanical threshold in various degrees. CONCLUSIONS: The NR2B-CREB-miR212/132-CRTC1-CREB signal network plays an important role in the regulation of pain. Intervening with any molecule in this signal network would reduce pain perception. (C) 2017 International Anesthesia Research Society

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Prophylactic Phenylephrine Infusions to Reduce Severe Spinal Anesthesia Hypotension During Cesarean Delivery in a Resource-Constrained Environment.

Phenylephrine infusions are considered as standard management for obstetric spinal hypotension, but there remains reluctance to implement them in resource-limited contexts. This prospective, alternating intervention study of patients undergoing elective or urgent cesarean delivery under spinal anesthesia compared a vasopressor bolus strategy to fixed-rate, low-dose prophylactic phenylephrine infusion with supplemental boluses. The primary outcome was the incidence of severe hypotension (mean arterial pressure

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Effect of Clopidogrel on Thrombus Formation in an Ex Vivo Parallel Plate Flow Chamber Model Cannot Be Reversed by Addition of Platelet Concentrates or vWF Concentrate.

BACKGROUND: Hemorrhage is the most important complication of antithrombotic therapy with P2Y12 receptor blockers. The administration of platelet concentrates (PCs) and von Willebrand factor (vWF) concentrates are common procedures to normalize impaired primary hemostasis in bleeding patients. We tested whether this strategy reverses the effect of clopidogrel using a parallel plate flow chamber model. METHODS: Whole blood from patients, who received a loading dose of clopidogrel with 600 mg and an ongoing dual antiplatelet therapy with 75 mg/d clopidogrel and 100 mg/d acetyl salicylic acid, compared with blood from healthy volunteers was examined in a collagen-coated parallel plate flow chamber. Blood was perfused by suction at a shear rate of 300/s, which is equivalent to 14 dynes/cm2 to resemble shear stress in conduit arteries. Platelet-covered area, individual thrombus size, and the average thrombus size were assessed morphometrically. The equivalent of 2 or 5 units of PC and/or 2 U/mL of vWF concentrate were used in an attempt to restore coagulation capacity in blood samples of clopidogrel-treated patients. RESULTS: In this model, clopidogrel reduced the increase of thrombus size. The equivalent of 2 U of PC or 2 U/mL of vWF alone did not show any significant changes in thrombus size. 5 U of PC increased thrombus size in clopidogrel-treated patients (P

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In this issue

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News and Announcements

Publication date: Available online 28 February 2017
Source:Journal of Oral and Maxillofacial Surgery

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Elevated expression of TIGIT on CD3+CD4+ T cells correlates with disease activity in systemic lupus erythematosus

It is well-known that lymphocytes play an important role in systemic lupus erythematosus (SLE). T cell immunoreceptor with Ig and immunoreceptor tyrosine-based inhibitory domains (TIGIT) is one of immunosuppre...

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Congenital erosive and vesicular dermatosis with reticulated supple scarring

Abstract

Congenital erosive and vesicular dermatosis with reticulated supple scarring is a rare cutaneous disorder of unknown aetiology first described by Cohen and colleagues in 1985. It classically presents in the neonate as erosions and vesicles that heal within the first months of life, with supple scarring of a reticulated pattern. Along with a review of the literature, this article presents two atypical cases of congenital erosive and vesicular dermatosis with reticulated supple scarring. Patient one presented with neither erosions nor vesicles at birth, yet continued to experience sporadic blistering at the age of 15 months and patient two is the second documented case to develop congenital erosive and vesicular dermatosis after birth.

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Smartphone use in dermatology for clinical photography and consultation: Current practice and the law

Abstract

Background

Smartphones are rapidly changing the way doctors capture and communicate clinical information, particularly in highly visual specialties such as dermatology. An understanding of how and why smartphones are currently used in clinical practice is critical in order to evaluate professional and legal risks, and to formulate policies that enable safe use of mobile technologies for the maximal benefit of practitioners and patients.

Methods

Australian dermatologists and dermatology trainees were surveyed on their current practices relating to clinical smartphone use.

Results

Of the 105 respondents, 101 provided useable results. The data show clinical smartphone use is common and frequent, with more than 50% of respondents sending and receiving images on their smartphones at least weekly. Clinical photographs were usually sent via multimedia message or email and were commonly stored on smartphones (46%). Security measures adopted to protect data were limited. There was inadequate documentation of consent for transmission of photographs and advice provided. Only 22% of respondents were aware of clear policies in their workplace regarding smartphone use, and a majority desired further education on digital image management.

Conclusions

Given the frequency of use and the degree of importance placed on the ability to send and receive clinical images, clinical smartphone use will persist and will likely increase over time. Current practices are insufficient to comply with professional and legal obligations, and increase practitioners' vulnerability to civil and disciplinary proceedings. Further education, realistic policies and adequate software resources are critical to ensure protection of patients, practitioners and the reputation of the dermatological profession.

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Unexpected case of sclerosing mucoepidermoid carcinoma of the submandibular salivary gland

Publication date: Available online 28 February 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): I. Gill, L. Brezina, J. Siddiqi

http://ift.tt/2lwifg8

Changes in natural head position in response to mandibular advancement

Publication date: Available online 28 February 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Xiaozhen Lin, Sean P. Edwards
We investigated the change in the natural head position and its relation to the change in the mandibular position in patients with mandibular hypoplasia. Forty-one patients treated by orthognathic surgery were divided into three groups: bilateral sagittal split osteotomy (BSSO) advancement (n=8); BSSO advancement with genioplasty (n=12), and Le Fort I osteotomy with BSSO advancement (n=21). Cone-beam computed tomographic (CT) datasets were collected preoperatively and six weeks postoperatively. The natural head position was measured using the craniocervical angle and the distance from the second vertebra to the frontal plane, and the mandibular position was measured using the craniomandibular angle and the distance from the mandible to the frontal plane. Repeated measures two way ANOVA was used to assess the significance of differences between the angular and linear measurements, and Pearson's correlation coefficient to assess those between the change in the mandibular position and the natural head position. The craniomandibular angle increased and the mandible to frontal plane distance decreased, as planned; the craniocervical angle increased, and the distance from the second vertebra to the frontal plane decreased in all three groups. ANOVA showed a significant difference (p=0.00?) in the time factor (preoperative compared with postoperative) but no significant differences between the groups or interaction (time multiplied by group) factors. There was a significant correlation between the change in mandibular position and the change in the natural head position (p=0.00?). Changes in the natural head position after correction of mandibular hypoplasia are correlated with the change in the mandibular position, regardless of whether a genioplasty or Le Fort I osteotomy was done.

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Additively manufactured sub-periosteal jaw implants

Severe bone atrophy jeopardizes the success of endosseous implants. This technical note aims to present the innovative concept of additively manufactured sub-periosteal jaw implants (AMSJIs). Digital datasets of the patient's jaws and wax trial in occlusion are used to segment the bone and dental arches, for the design of a sub-periosteal frame and abutments in the optimal location related to the dental arch and for the design of the suprastructure. The implants and suprastructure are three-dimensionally (3D) printed in titanium alloy.

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Is there an increased risk of cancer among spouses of patients with an HPV-related cancer: A systematic review

Publication date: April 2017
Source:Oral Oncology, Volume 67
Author(s): Haitham Mirghani, Erich M. Sturgis, Anne Aupérin, Joseph Monsonego, Pierre Blanchard

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Clonal analysis as a prognostic factor in multiple oral squamous cell carcinoma

Publication date: April 2017
Source:Oral Oncology, Volume 67
Author(s): D.B. Gissi, A. Tarsitano, E. Leonardi, A. Gabusi, F. Neri, C. Marchetti, L. Montebugnoli, M.P. Foschini, L. Morandi
ObjectivesA novel classification based on molecular methods to assess clonality defines three types of secondary oral squamous cell carcinoma (OSCC): second primary tumour (SPT) independent from the index tumour, local recurrence (LR), clonally related to the primary tumour, and second field tumour (SFT), derived from the same genetically altered mucosal field as the primary tumour. The present study applied mtDNA analysis in a group of patients experiencing a second loco-regional neoplastic manifestation. The purpose was to differentiate secondary tumours into LRs, SPTs and SFTs and evaluate the prognostic impact in terms of survival rate.Material and methodsThe study population comprised 23 patients who experienced a second neoplastic lesion after a surgical resection of primary OSCC. mtDNA D-loop analysis was applied in paired neoplastic lesions and in clinically and histologically normal mucosa. On the basis of mtDNA results, the second OSCC was classified as LR or SPT or SFT. Disease-free survival was defined as the duration between the appearance of the second neoplastic lesion and death of disease, or last follow-up visit.ResultsSeven secondary tumours were classified as LR, 12 as SFT, 4 as SPT. An altered mucosal field proved a variable significantly related to a better survival rate (p<0.05); 2/12 (16.6%) SFT events failed as compared to 5/7 LRs (71.4%) and 3/4 SPTs (75%).ConclusionmtDNA analysis may be considered a useful tool to differentiate secondary tumours and might influence the choice of the most appropriate treatment in patients with multiple OSCCs.

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Rising incidence of oral tongue cancer among white men and women in the United States, 1973–2012

Publication date: April 2017
Source:Oral Oncology, Volume 67
Author(s): Joseph E. Tota, William F. Anderson, Charles Coffey, Joseph Califano, Wendy Cozen, Robert L. Ferris, Maie St. John, Ezra E.W. Cohen, Anil K. Chaturvedi
BackgroundDespite significant reductions in tobacco use in the US, oral tongue cancer incidence has reportedly increased in recent years, particularly in young white women. We conducted age-period-cohort analyses to identify birth cohorts that have experienced increased oral tongue cancer incidence, and compared these with trends for oropharyngeal cancer, a cancer caused by human papillomavirus (HPV) that has also recently increased.MethodsWe utilized cancer incidence data (1973–2012) from 18 registries maintained by the NCI SEER Program. Incidence trends were evaluated using log-linear joinpoint regression and age-period-cohort modeling was utilized to simultaneously evaluate effects of age, calendar year, and birth year on incidence trends.ResultsIncidence of oral tongue cancer increased significantly among white women during 1973–2012 (0.6% annual increase, p<0.001) and white men during 2008–2012 (5.1% annual increase, p=0.004). The increase was most apparent among younger white individuals (<50years; annual increase of 0.7% for men [p=0.02] and 1.7% for women [p<0.001] during 1973–2012). Furthermore, the magnitude of the increase during 1973–2012 was similar between young white men and women (2.3 vs. 1.8 cases per million, respectively). Incidence trends for oropharyngeal cancer were similar to trends for oral tongue cancer and similar birth cohorts (born after the 1940s) experienced rising incidence of these cancers (p-value: white men=0.12, white women=0.42), although the magnitude of increase was greater for oropharyngeal cancer.ConclusionsThe incidence of oral tongue and oropharyngeal cancer has significantly increased among young white men and women within the same birth cohorts in the US.

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Complications following transoral robotic surgery (TORS): A detailed institutional review of complications

Publication date: April 2017
Source:Oral Oncology, Volume 67
Author(s): Ashley Hay, Jocelyn Migliacci, Daniella Karassawa Zanoni, Jay O. Boyle, Bhuvanesh Singh, Richard J. Wong, Snehal G. Patel, Ian Ganly
ObjectivesTo report the complications occurring following TORS and to identify the factors predictive of complications.MethodsFollowing IRB approval a retrospective analysis of all TORS operations at our institution was performed. Postoperative complications within 45days were collected and graded with the Clavien-Dindo system. Complications were categorized into groups: all complications, not related to TORS and TORS related. Unadjusted odds ratios were calculated to test association between patients with and without a complication.Results122 TORS operations were carried out between June 2010 and August 2015. 77% were male, with a median age of 57. There were 92 primary tumor resections, 10second head and neck primary resections, 13 salvage procedures and 7 other indications. Surgical resection involved 1, 2 or >3 sub-sites in 36%, 28% and 36% patients, respectively.Overall, there were 107 complications (66 TORS related, 41 non-TORS related) that occurred in 57 patients (47%). A major complication occurred in 23 patients (18%). 19 patients had a TORS related major complication and 6 patients experienced a non-TORS related major complication. There was a temporal trend in TORS related major complication rate decreasing from 33% in 2010 to 10% in 2015.Statistical analysis showed that the odds of having any complication were 3 times greater in patients over 60years old (p=0.017), and 2.5 times greater when there were more than 2 subsites resected (p=0.022).ConclusionsAge over 60years and a larger extent of resection were the significant factors predictive of major complications.

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Editorial Board/Aims & Scope

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Publication date: March 2017
Source:Oral Oncology, Volume 66

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Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Paragangliomas

Abstract

Updated editions of The World Health Organization Classification of Tumours Pathology & Genetics for both Head and Neck Tumours and Tumours of Endocrine Organs took place in 2016 based on consensus conferences. These editions present unification of concepts in paragangliomas and highlight expanding knowledge of their etiology. There is a major emphasis in the new bluebooks on familial/syndromic paragangliomas, representing ~40% of all head and neck paragangliomas. Ancillary use of immunohistochemical evaluation, specifically of SDHB, allows the pathologist to screen for a large subset of these potentially hereditary cases. In addition, similarly to other neuroendocrine tumors, paragangliomas are now considered to represent a continuum of risk, and are assessed in terms of risk stratification. Tumors with SDHB mutations pose the highest risk for metastasis. There is currently no validated or endorsed histologic grading system. Paragangliomas remain tumors of undetermined biologic potential and should not be termed benign.

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Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Hematolymphoid Tumours

Abstract

In 2017, the latest revision to the WHO Classification of Head and Neck Tumours will be released. Similar to the 2005 WHO, the codification of hematopoietic and lymphoid neoplasms of the head and neck is included within chapters pertaining to the nasal cavity and paranasal sinuses, the nasopharynx, the larynx, the oral cavity and oropharynx, the neck and the salivary glands. Herein, we describe both changes to the classification of hematolymphoid neoplasms of the head and neck since the 2005 WHO, as well as recent advances in our understanding of the underlying pathogenesis and molecular pathology of these neoplasms.

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Update From The 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Nasopharynx

Abstract

The current WHO classification system for tumors of the head and neck has made few changes from the previous edition with regards to tumors of the nasopharynx. The classification system is discussed here with particular attention to nasopharyngeal carcinoma, nasopharyngeal papillary adenocarcinoma, salivary gland anlage tumor, hairy polyp, juvenile angiofibroma, and other tumors.

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Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Mucosal Melanomas

Abstract

The updated edition of The World Health Organization Classification of Tumours of the Head and Neck includes discussions on mucosal melanoma of both the sinonasal and oral cavity. Since the prior edition, sinonasal origin is now recognized as the most common site of occurrence of mucosal melanoma in the head and neck (66%) with oral cavity representing 25% of cases. Histologic features of mucosal melanomas vary widely from spindled, epithelioid, and pleomorphic to rhabdoid, plasmacytoid and undifferentiated. Additionally, mucosal melanomas are commonly amelanotic (or minimal pigmentation) (~50%) leading to overlapping features and diagnostic challenges in differentiating mucosal melanomas from other small cell/undifferentiated sinonasal tumors. Since the last edition, formal staging of head and neck mucosal melanomas was added to the American Joint Committee on Cancer entities, though the traditional histologic features that have prognostic significance in cutaneous melanomas fail to stratify mucosal melanomas (i.e. tumor thickness, ulceration). Interestingly, while melanomas of all sites are a malignancy derived from melanocytes, mucosal melanomas are now recognized to have distinct molecular alterations compared to cutaneous or uveal melanomas. BRAF V600E mutations are rare (<6%) in mucosally derived melanomas compared to a rate of 50% in cutaneous melanomas. CD117 (C-Kit) mutations are the most common alteration encountered (~25%) in mucosal sites with potential therapeutic targetability. The recognition of the distinct genetic changes in this subgroup of melanomas means that therapy advances in cutaneous melanomas may not translate to head and neck mucosal melanomas and clinical trials specific to this subgroup of patients are needed.

http://ift.tt/2mHW9HD

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Preface

http://ift.tt/2maehxe

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Tumors of the Nasal Cavity, Paranasal Sinuses and Skull Base

Abstract

The sinonasal tract remains an epicenter of a diverse array of neoplasia. This paper discusses changes to the WHO classification system of tumors involving this area. In particular, seromucinous hamartoma, NUT carcinoma, biphenotypic sinonasal sarcoma, HPV-related carcinoma with adenoid cystic features, SMARCB1-deficient carcinoma, and renal cell-like adenocarcinoma are discussed.

http://ift.tt/2mHG04T

Update from the 4th Edition of the World Health Organization of Head and Neck Tumours: Tumours of the Oral Cavity and Mobile Tongue

Abstract

There have been several additions and deletions in Chapter 4 on Tumours of the oral cavity and mobile tongue in the 2017 fourth edition of the World Health Organization Classification of Tumours of the Head and Neck. This chapter excludes the oropharynx, which now is a stand-alone chapter acknowledging the uniqueness of the oropharynx from the oral cavity. New entries in Chapter 4 include rhabdomyoma, haemangioma, schwannoma, neurofibroma and myofibroblastic sarcoma in the section titled Soft tissue and neural tumours. Discussion of salivary gland entities have been reduced and includes mucoepidermoid carcinoma and pleomorphic adenoma as the other salivary gland types are discussed elsewhere. In the Haematolymphoid tumours section, like the salivary gland section, only tumors that commonly present in the oral cavity are discussed in Chapter 4. Excluded entities in the updated classification include papillary hyperplasia, median rhomboid glossitis, keratoacanthoma, focal oral mucinosis, and secondary tumors. This article will summarize the changes in the new classification since the 2005 edition focusing on selected entities that have had significant changes along with new entries.

http://ift.tt/2ma4ozz

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Oropharynx

Abstract

The changes for oropharyngeal lesions in the 2017 edition of the WHO/IARC Classification of Head and Neck Tumours reference book are dramatic and significant, largely due to the growing impact of high risk human papillomavirus (HPV). The upcoming edition divides tumours of the oral cavity and oropharynx into separate chapters, classifies squamous cell carcinomas (SCC) of the oropharynx on the basis of HPV status, abandons the practice of histologic grading for oropharyngeal SCCs that are HPV positive, recognizes small cell carcinoma of the oropharynx, and combines polymorphous low grade adenocarcinoma and cribriform adenocarcinoma of tongue and minor salivary glands under the single term "polymorphous adenocarcinoma." This review not only calls attention to these changes, but describes the rationale driving these changes and highlights their implications for routine clinical practice.

http://ift.tt/2mHCxnd

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: What is New in the 2017 WHO Blue Book for Tumours of the Hypopharynx, Larynx, Trachea and Parapharyngeal Space

Abstract

Chapter 3 "Tumours of the hypopharynx, larynx, trachea, and parapharyngeal space" of the World Health Organization (WHO) Blue Book 2017 "Classification of Head and Neck Tumours" shows a shortened list of entities, especially due to reducing the number of benign and malignant soft tissue tumours, malignant melanoma and some others, which are transferred to more frequently affected regions of the head and neck. The basic concept of the new edition is to assimilate all advances concerning the discussed tumours in a shorter framework, appropriate for daily work. The main emphasis is on the most frequent lesions and tumors originating from the covering squamous epithelium. Laryngeal and hypopharyngeal conventional squamous cell carcinoma (CSCC), its variants and precursor lesions, occupy a major part of the chapter. New data on etiopathogenesis, with the focus on human papillomavirus (HPV) infection, are discussed in relation to the entities of the squamous epithelium. Although only a small fraction of these lesions are HPV-related, further studies are required for evaluation of the potential prognostic and therapeutic benefit of mRNA HPV determination. In contrast to earlier data, laryngeal and hypopharyngeal verrucous SCC, spindle cell SCC and basaloid SCC are not anymore considered as HPV-related tumours. New data on the pathogenesis of spindle cell SCC exhibiting divergent differentiation by epithelial—mesenchymal transition, are also briefly discussed. The most important innovation is brought by the section on precursor lesions, in which a unified two-tier classification, consisting of low- and high-grade dysplasia, is introduced. The proposed two-tier system can also be transformed into a three-tier classification for treatment purposes, with a distinction between carcinoma in situ and high-grade dysplasia. The reviewed morphological criteria of the proposed system are based on the amended Ljubljana classification. The section on laryngeal neuroendocrine carcinomas (NEC) represents a considerable improvement in terminology and classification. NEC are divided into well-, moderate- and poorly-differentiated neuroendocrine carcinoma. The latter is additionally divided into small cell NEC and large cell NEC (LCNEC). It is of extreme importance that LCNEC, which was associated in the WHO 2005 edition with atypical carcinoid/moderately differentiated neuroendocrine carcinoma, grade II, has now been transferred into the group of poorly differentiated NEC, grade III, displaying a specific morphology and poorer prognosis.

http://ift.tt/2ma6pfc

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: What Is New in the 2017 WHO Blue Book for Tumors and Tumor-Like Lesions of the Neck and Lymph Nodes

Abstract

The World Health Organization (WHO) 2017 Classification of Head and Neck Tumors ("Blue Book") will now include a new chapter on tumors and tumor-like lesions of the neck and lymph nodes, which was not included in the previous edition. Tumors and tumor-like lesions, including a variety of cysts and metastases, can arise in any component in the neck, including soft tissue, lymph nodes, and developmental remnants. The pathology and clinical features of metastatic carcinoma of unknown primary in the head and neck has changed dramatically in the last several years. Many of these tumors which were previously diagnosed as unknown primary are now identified as oropharyngeal and nasopharyngeal carcinomas related to human papillomavirus (HPV), less commonly to Epstein-Barr virus (EBV) and occasionally even to Merkel cell polyomavirus. Many unusual features can arise in these metastases, such as undifferentiated morphology, extensive cystic change with central degeneration, gland formation, and even ciliated cells. Rarely, carcinoma in the neck can arise in association with a heterotopic tissue, primarily thyroid or salivary gland tissue. Tumor-like lesions include branchial cleft cysts, thyroglossal duct cyst, dermoid and teratoid cyst, and ranula. Pathologists should be familiar with the diagnostic features and clinicopathologic corrections of these neck lesions in order to correctly diagnosis them and to provide for proper clinical management. This article will briefly describe the pathologic and clinical features of these entities as they are covered in the new 2017 Blue Book.

http://ift.tt/2mHI2SE

Update From the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Tumours of the Ear

Abstract

The 2017 fourth edition of the World Health Organization Classification of Tumours, specifically as it relates to the ear (Chap. 9), has several changes. Importantly, the number of entities has been significantly reduced by omitting tumors or lesions if they do not occur exclusively or predominantly at this site or if they are discussed in detail elsewhere in the book. These entities include: embryonal rhabdomyosarcoma, osteoma, exostosis, angiolymphoid hyperplasia with eosinophilia, Schneiderian papilloma, inverted papilloma, lipoma of the internal auditory canal, hemangioma, hematolymphoid tumors, and secondary tumors. Paraganglioma was included in the neck chapter. New entries include otosclerosis and cholesteatoma, while refinements to nomenclature, classification and criteria were incorporated into the ceruminous gland tumors and epithelial tumors of the middle and inner ear. Specifically, the middle and inner ear were combined, as practical limitations of origin and imaging make a definitive separation artificial. The classification reflects the state of current understanding for these uncommon entities, with this update only highlighting selected entities that were the most significantly changed.

http://ift.tt/2ma8pEm

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Tumors of the Salivary Gland

Abstract

The salivary gland section in the 4th edition of the World Health Organization classification of head and neck tumors features the description and inclusion of several entities, the most significant of which is represented by (mammary analogue) secretory carcinoma. This entity was extracted mainly from acinic cell carcinoma based on recapitulation of breast secretory carcinoma and a shared ETV6-NTRK3 gene fusion. Also new is the subsection of "Other epithelial lesions," for which key entities include sclerosing polycystic adenosis and intercalated duct hyperplasia. Many entities have been compressed into their broader categories given clinical and morphologic similarities, or transitioned to a different grouping as was the case with low-grade cribriform cystadenocarcinoma reclassified as intraductal carcinoma (with the applied qualifier of low-grade). Specific grade has been removed from the names of the salivary gland entities such as polymorphous adenocarcinoma, providing pathologists flexibility in assigning grade and allowing for recognition of a broader spectrum within an entity. Cribriform adenocarcinoma of (minor) salivary gland origin continues to be divisive in terms of whether it should be recognized as a distinct category. This chapter also features new key concepts such as high-grade transformation. The new paradigm of translocations and gene fusions being common in salivary gland tumors is featured heavily in this chapter.

http://ift.tt/2mHOysx

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Odontogenic and Maxillofacial Bone Tumors

Abstract

The 4th edition of the World Health Organization's Classification of Head and Neck Tumours was published in January of 2017. This article provides a summary of the changes to Chapter 4 Tumours of the oral cavity and mobile tongue and Chapter 8 Odontogenic and maxillofacial bone tumours. Odontogenic cysts which were eliminated from the 3rd 2005 edition were included in the 4th edition as well as other unique allied conditons of the jaws. Many new tumors published since 2005 have been included in the 2017 classification.

http://ift.tt/2mago4e

Relationship between the degree and direction of nasal septum deviation and nasal bone morphology

Abstract

Background

Nasal septal deviation may affect nasal bone growth and facial morphology. Knowledge of nasal morphologic parameters may plays an important role in planning successful rhinoplasty and septoplasty operation. The aim of our study was to evaluate the relationship between the direction and degree of nasal septal deviation with nasal bone morphology, along with factors such as age and gender.

Methods

Maxillofacial computed tomography (CT) of 250 patients with nasal septal deviation was analyzed retrospectively in this study. We excluded patients with factors that could affect their nasal bone morphology, and a total of 203 patients (111 males, 92 females; mean age, 36.23 years; age range, 18–79 years) were evaluated. The nasal deviation angle was measured on coronal CT images as the angle between the most deviated point of the septum, and the midline nasal morphology was determined by measuring nasal length, internasal angle and lateral and intermediate nasal thickness on both sides.

Results

The deviation of nasal septum has been detected as to the right in 107 patients (52.7%) and to the left in 96 patients (47.3%). Lateral and intermediate nasal bone thickness and nasal bone length were significantly greater on the ipsilateral deviation side (Table 3). No significant correlation was found between the variation of the nasal deviation angle and nasal bone morphology (Table 4). There were significant differences between the sexes for all investigated parameters except for the nasal deviation angle (p = 0.660). We found that the only internasal angle increases with aging (p = 0.002).

Conclusion

The study shows that the direction of nasal septal deviation may be a factor that affects nasal bone morphology.

http://ift.tt/2l9iwcC

Psoriasis Treatments Among Hot Topics at AAD Meeting

First-line therapies for moderate to severe psoriasis, the value of vitamin D, and the link between skin disease and problems with other organs will be among the topics covered at the conference.
Medscape Medical News

http://ift.tt/2li3618

Pneumatosis cystoides intestinalis presenting as pneumoperitoneum in a patient with chronic obstructive pulmonary disease: a case report

Pneumatosis cystoides intestinalis, marked by numerous gas-filled cysts in the intestinal wall and submucosa or intestinal submucosa, is a very uncommon condition.

http://ift.tt/2lQy2J3

Beneficial effects of ursodeoxycholic acid via inhibition of airway remodelling, apoptosis of airway epithelial cells, and Th2 immune response in murine model of chronic asthma

Publication date: Available online 28 February 2017
Source:Allergologia et Immunopathologia
Author(s): S. Işık, M. Karaman, S. Çilaker Micili, Ş. Çağlayan-Sözmen, H. Alper Bağrıyanık, Z. Arıkan-Ayyıldız, N. Uzuner, Ö. Karaman
Background and aimsIn previous studies, anti-inflammatory, anti-apoptotic and immunomodulatory effects of ursodeoxycholic acid (UDCA) on liver diseases have been shown. In this study, we aimed to investigate the effects of UDCA on airway remodelling, epithelial apoptosis, and T Helper (Th)-2 derived cytokine levels in a murine model of chronic asthma.MethodsTwenty-seven BALB/c mice were divided into five groups; PBS-Control, OVA-Placebo, OVA-50mg/kg UDCA, OVA-150mg/kg UDCA, OVA-Dexamethasone. Mice in groups OVA-50mg/kg UDCA, OVA-150mg/kg UDCA, OVA-Dexamethasone received the UDCA (50mg/kg), UDCA (150mg/kg), and dexamethasone, respectively. Epithelium thickness, sub-epithelial smooth muscle thickness, number of mast and goblet cells of samples isolated from the lung were measured. Immunohistochemical scorings of the lung tissue for matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor (VEG-F), transforming growth factor-beta (TGF-β), terminal deoxynucleotidyl transferase-mediated dUTP nick endlabeling (TUNEL) and cysteine-dependent aspartate-specific proteases (caspase)-3 were determined. IL-4, IL-5, IL-13, Nitric oxide, ovalbumin-specific immunoglobulin (Ig) E levels were quantified.ResultsThe dose of 150mg/kg UDCA treatment led to lower epithelial thickness, sub-epithelial smooth muscle thickness, goblet and mast cell numbers compared to placebo. Except for MMP-9 and TUNEL all immunohistochemical scores were similar in both UDCA treated groups and the placebo. All cytokine levels were significantly lower in group IV compared to the placebo.ConclusionsThese findings suggested that the dose of 150mg/kg UDCA improved all histopathological changes of airway remodelling and its beneficial effects might be related to modulating Th-2 derived cytokines and the inhibition of apoptosis of airway epithelial cells.

http://ift.tt/2l8Qyhl

Relationship between the degree and direction of nasal septum deviation and nasal bone morphology

A Computer-Aided Diagnosis System Using Artificial Intelligence for the Diagnosis and Characterization of Thyroid Nodules on Ultrasound: Initial Clinical Assessment

Thyroid , Vol. 0, No. 0.

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Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Paragangliomas

Abstract

http://ift.tt/2m9ZZws

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Hematolymphoid Tumours

Abstract

http://ift.tt/2mHMdOd

Update From The 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Nasopharynx

Abstract

http://ift.tt/2maaBvm

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Mucosal Melanomas

Abstract

http://ift.tt/2mHW9HD

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Preface

http://ift.tt/2maehxe

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Tumors of the Nasal Cavity, Paranasal Sinuses and Skull Base

Abstract

http://ift.tt/2mHG04T

Update from the 4th Edition of the World Health Organization of Head and Neck Tumours: Tumours of the Oral Cavity and Mobile Tongue

Abstract

http://ift.tt/2ma4ozz

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Oropharynx

Abstract

http://ift.tt/2mHCxnd

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: What is New in the 2017 WHO Blue Book for Tumours of the Hypopharynx, Larynx, Trachea and Parapharyngeal Space

Abstract

http://ift.tt/2ma6pfc

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: What Is New in the 2017 WHO Blue Book for Tumors and Tumor-Like Lesions of the Neck and Lymph Nodes

Abstract

http://ift.tt/2mHI2SE

Update From the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Tumours of the Ear

Abstract

http://ift.tt/2ma8pEm

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Tumors of the Salivary Gland

Abstract

http://ift.tt/2mHOysx

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Odontogenic and Maxillofacial Bone Tumors

Abstract

http://ift.tt/2mago4e

Impact of self-reported symptoms of allergic rhinitis and asthma on sleep disordered breathing and sleep disturbances in the elderly with polysomnography study

by Sae-Hoon Kim, Ha-Kyeong Won, Sung-Do Moon, Byung-Keun Kim, Yoon-Seok Chang, Ki-Woong Kim, In-Young Yoon

Background

Sleep disordered breathing (SDB) and sleep disturbances have been reported to be associated with allergic rhinitis and asthma. However, population-based studies of this issue in the elderly are rare.

Objective

To investigate the impact of self-reported rhinitis and asthma on sleep apnea and sleep quality using polysomnography in an elderly Korean population.

Methods

A total of 348 elderly subjects who underwent one-night polysomnography study among a randomly selected sample were enrolled. Study subjects underwent anthropometric and clinical evaluations. Simultaneously, the prevalence and co-morbid status of asthma and allergic rhinitis, and subjective sleep quality were evaluated using a self-reported questionnaire.

Results

Ever-diagnosis of allergic rhinitis was significantly more prevalent in subjects with SDB compared with those without SDB. Subjects with an ever-diagnosis of allergic rhinitis showed a higher O₂ desaturation index and mean apnea duration. Indices regarding sleep efficiency were affected in subjects with a recent treatment of allergic rhinitis or asthma. Waking after sleep onset was longer and sleep efficiency was lower in subjects who had received allergic rhinitis treatment within the past 12 months. Subjects who had received asthma treatment within the past 12 months showed significantly lower sleep efficiency than others.

Conclusion

Our study indicates that a history of allergic rhinitis is associated with increased risk of SDB in the elderly. Sleep disturbance and impaired sleep efficiency were found in the subjects who had received recent treatment of allergic rhinitis or asthma. Physicians should be aware of the high risk of sleep disorders in older patients with respiratory allergic diseases.

http://ift.tt/2mHClV1

Impact of self-reported symptoms of allergic rhinitis and asthma on sleep disordered breathing and sleep disturbances in the elderly with polysomnography study

by Sae-Hoon Kim, Ha-Kyeong Won, Sung-Do Moon, Byung-Keun Kim, Yoon-Seok Chang, Ki-Woong Kim, In-Young Yoon

Background

Sleep disordered breathing (SDB) and sleep disturbances have been reported to be associated with allergic rhinitis and asthma. However, population-based studies of this issue in the elderly are rare.

Objective

To investigate the impact of self-reported rhinitis and asthma on sleep apnea and sleep quality using polysomnography in an elderly Korean population.

Methods

Results

Conclusion

http://ift.tt/2mHClV1

JSA guideline for the management of malignant hyperthermia crisis 2016

Abstract

Malignant hyperthermia (MH) can be fatal if the crisis is not appropriately treated. It is an inherited disease usually triggered by the administration of volatile inhalational anesthetics and/or succinylcholine, a muscle relaxant. In a patient with suspected MH, the mechanism of calcium release from storage in the sarcoplasmic reticulum in the skeletal muscle is abnormally accelerated. Unexplained hypercarbia representing >55 mmHg of end-tidal carbon dioxide, tachycardia, and muscle rigidity (including masseter muscle rigidity) are early signs of the initiation of MH, because the metabolism is accelerated. The body temperature can rise by >0.5 °C/15 min and may reach ≥40 °C. Respiratory and metabolic acidosis, arrhythmia, cola-colored urine, increased levels of serum potassium, and tented T-waves on electrocardiogram are common and can lead to cardiac arrest. MH should be treated by discontinuation of the triggering agents, administration of intravenous dantrolene (initially 1 mg/kg), and reduction of the body temperature. Early diagnosis and sufficient dantrolene with body temperature reduction are essential to relieve the patient's MH crisis. This guideline in Japanese translation has been posted on the website: http://ift.tt/2l8RHWa.

http://ift.tt/2lTGMwJ

Bryne’s grading system predicts poor disease-specific survival of oral squamous cell carcinoma: a comparative study among different histological grading systems

Publication date: Available online 28 February 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Vivian Petersen Wagner, Liana Preto Webber, Marina Curra, Isadora Peres Klein, Luise Meurer, Vinicius Coelho Carrad, Manoela Domingues Martins
ObjectivesTo access the prognostic value of four histopathological grading systems of oral squamous cell carcinoma (OSCC): the World Health Organization (WHO), Anneroth , Bryne (1989) and Bryne (1992).Study DesignEighty-five cases of OSCC diagnosed between 1996 and 2010 at the Clinics Hospital of Porto Alegre (Porto Alegre, Brasil) were included. Slides stained with hematoxylin-eosin (H&E) were obtained, and a histological grade was assigned based on the consensus of three expert oral pathologists who were blinded to the clinicopathological factors. Each system was correlated with proliferative labeling index (PLI), accessed through Ki67 immunostaining, clinicopathological factors, patient outcome (alive or deceased) and survival time.ResultsThe increase in Bryne (1992) histological grades was accompanied by an increase in PLI. Moreover, this system was the only one associated with patients' outcome (p=0.01) and survival. Grade III tumors of Bryne 1992 grading system were associated with poor disease-specific survival according to univariate and multivariate cox regression and log-rank test (p<0.05). The others systems evaluated presented no association with patients' outcome or survival.ConclusionBryne (1992) grading system is more effective in predicting OSCC survival than the systems proposed by the WHO, Anneroth or Bryne (1989).

http://ift.tt/2llp17i

The efficacy of minocycline mouth rinses on the symptoms associated with recurrent aphthous stomatitis: A Randomized, Double-Blind, Crossover Study assessing different doses of oral rinse

Publication date: Available online 28 February 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Noam Yarom, Keren Zelig, Joel B. Epstein, Meir Gorsky
Objectiveto assess the efficacy of 2 different concentrations of minocycline mouthwashes on recurrent aphthous stomatitis (RAS) symptoms.Study DesignThe two year study was designed as a randomized, double-blind, crossover Study. Healthy subjects, with frequent RAS episodes received two sealed and computer randomized marked kits containing minocycline mouthwashes (0.2% and 0.5% solution). Subjects were asked to use one of the kits on the first episode of RAS started with the first onset of prodromal symptoms until the symptoms resolved or up to a maximum of 10 days (whichever came first). On the following episode the patients were asked to use their second kitResultsA total of 14 subjects (8 males, 6 females) completed the 2 arms of the study. The mean intensity of pain was significantly lower when the 0.5% solution was used compared to the 0.2% solution (p=0.027). The difference reached the level of statistical significance as soon as the end of the second day of use (p=0.032). Only minor and temporary adverse reactions were documentedConclusion0.5% minocycline mouth rinse was found to be more effective than the 0.2% concentration suggested by our group in previous studies for the management of RAS.

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Accuracy of video observation and a three-dimensional head tracking system for detecting and quantifying robot-simulated head movements in cone beam computed tomography

Publication date: Available online 28 February 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Rubens Spin-Neto, Louise H. Matzen, Lars Schropp, Thomas S. Sørensen, Erik Gotfredsen, Ann Wenzel
ObjectivesTo assess the accuracy of detecting robot-simulated head movements using video observation (VO) and three-dimensional head tracking (HT) in a CBCT examination set-up.Study designA mannequin head was mounted on a robot programmed to simulate patient head movements. Six types of movement (tremor, nodding, lateral rotation, lifting, swallowing, and antero-posterior translation), three distances (0.25, 1, and 5mm), and two speeds (1 and 5mm/s) were tested in triplicate (108 examinations). An additional 18 videos and HT of no-motion served as controls for a total of 126 examinations. Three blinded observers viewed video recordings of the examinations, scoring if the head moved and movement type. HT provided quantitative measures of movement distance. Accuracy, sensitivity, and specificity for movement detection by VO and HT were calculated, related to true type, distance, and speed of movement. Differences between the true and the measured movement distances were assessed for HT.ResultsVO movement detection presented accuracy=0.86, sensitivity=0.85, and specificity=0.94. Antero-posterior translation (33.3%) and 0.25mm movements (41.7%) were often not detected by VO. HT correctly detected all cases (accuracy=1). HT presented small differences between the true and the measured movement distances (average 20-54μm).ConclusionsVO missed 41.7% of the 0.25 mm movements. HT correctly detected all movements and quantified movements with an average error <55μm.

http://ift.tt/2llosuB

Autophagy and inflammasomes

Publication date: Available online 27 February 2017
Source:Molecular Immunology
Author(s): James Harris, Tali Lang, Jacinta P.W. Thomas, Maria B. Sukkar, Neel R. Nabar, John H. Kehrl
Autophagy is a ubiquitous cellular mechanism for the targeted lysosomal degradation of various cytosolic constituents, from proteins to organelles. As an essential homeostatic mechanism, autophagy is upregulated in response to numerous environmental and pharmacological stimuli, including starvation, where it facilitates the recycling of essential amino acids. In addition, autophagy plays specific roles within the immune system; it serves as a source of peptides for antigen presentation, a mechanism for the engulfment and degradation of intracellular pathogens and as a key regulator of inflammatory cytokines. In particular, autophagy has been shown to play a number of roles in regulating inflammasome activation, from the removal of inflammasome-activating endogenous signals, to the sequestration and degradation of inflammasome components. Autophagy also plays a role in determining the fate of IL-1β, which is concentrated in autophagosomes. This review discusses a growing body of literature that suggests autophagy is a critical regulator of inflammasome activation and the subsequent release of IL-1 family cytokines.

http://ift.tt/2llndeS

The molecular mechanisms of signaling by cooperative assembly formation in innate immunity pathways

Publication date: Available online 27 February 2017
Source:Molecular Immunology
Author(s): Parimala R. Vajjhala, Thomas Ve, Adam Bentham, Katryn J. Stacey, Bostjan Kobe
The innate immune system is the first line of defense against infection and responses are initiated by pattern recognition receptors (PRRs) that detect pathogen-associated molecular patterns (PAMPs). PRRs also detect endogenous danger-associated molecular patterns (DAMPs) that are released by damaged or dying cells. The major PRRs include the Toll-like receptor (TLR) family members, the nucleotide binding and oligomerization domain, leucine-rich repeat containing (NLR) family, the PYHIN (ALR) family, the RIG-1-like receptors (RLRs), C-type lectin receptors (CLRs) and the oligoadenylate synthase (OAS)-like receptors and the related protein cyclic GMP-AMP synthase (cGAS). The different PRRs activate specific signaling pathways to collectively elicit responses including the induction of cytokine expression, processing of pro-inflammatory cytokines and cell-death responses. These responses control a pathogenic infection, initiate tissue repair and stimulate the adaptive immune system. A central theme of many innate immune signaling pathways is the clustering of activated PRRs followed by sequential recruitment and oligomerization of adaptors and downstream effector enzymes, to form higher-order arrangements that amplify the response and provide a scaffold for proximity-induced activation of the effector enzymes. Underlying the formation of these complexes are co-operative assembly mechanisms, whereby association of preceding components increases the affinity for downstream components. This ensures a rapid immune response to a low-level stimulus. Structural and biochemical studies have given key insights into the assembly of these complexes. Here we review the current understanding of assembly of immune signaling complexes, including inflammasomes initiated by NLR and PYHIN receptors, the myddosomes initiated by TLRs, and the MAVS CARD filament initiated by RIG-1. We highlight the co-operative assembly mechanisms during assembly of each of these complexes.

http://ift.tt/2mpOKk3

Percutaneous probe stimulation for intraoperative neuromonitoring in total endoscopic thyroidectomy: A preliminary experience

ABSTRACT

Background

The purpose of this study was to investigate the feasibility and value of using intraoperative neuromonitoring (IONM) performed via percutaneous probe stimulation during total endoscopic thyroidectomy.

Methods

This study prospectively enrolled a series of 132 consecutive patients with 156 recurrent laryngeal nerves (RLNs) at risk who received total endoscopic thyroidectomy performed via bilateral breast approach using standardized IONM. The stimulation probe was introduced into the working space by percutaneous puncture. During lateral thyroid dissection, the proximal RLN was periodically stimulated to monitor adverse electromyography (EMG) changes. Preoperative and postoperative vocal cord mobility was routinely examined with laryngofiberoscopy.

Results

All IONMs were successfully performed via percutaneous probe stimulation with no morbidity or scarring in the neck. Twelve nerves (7.7%) showed significant changes in EMG (amplitude reduction, 50% to 90% from baseline EMG) during the lateral thyroid dissection. Compression near the inferior thyroid artery (70%) and traction near the Berry's ligament (30%) were the most common causative mechanisms, and modification of the surgical maneuver resulted in partial recovery of the EMG changes (amplitude reduction, 10% to 80% before wound closure). Of the 12 nerves with adverse EMG changes (final amplitude reduction, 65% to 80%), 8 nerves showed temporary (3 months or less) vocal cord palsy. No cases of permanent vocal cord palsy occurred in this series.

Conclusion

Percutaneous probe stimulation is a simple, effective, and safe method of performing IONM in total endoscopic thyroidectomy when the operating space is limited. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

http://ift.tt/2luUODQ

Paratesticular Angiomyofibroblastoma-Like Tumor: Unusual Case of a Solidocystic Form

The angiomyofibroblastoma-like tumor of the male genital tract is a rare benign tumor. A total of 34 cases have been reported in the literature. We herein report an exceptional case of solidocystic form in its paratesticular location, in a 79-year-old man. Clinical examination objectified a right testicular induration. Macroscopic examination of the orchidectomy objectified a paratesticular solidocystic tumor formation. Microscopically, the solid area was composed of vessels with small caliber and turgidity of endothelial cells. These vessels were surrounded by clusters of epithelioid cells, sometimes having the appearance of giant cells. They were associated with spindle cells. The cystic area was uncoated. Immunohistochemically, the fusiform cells expressed Desmin and Smooth Muscle Actin. Endothelial cells and clusters of cells surrounding large vessels expressed CD34. The expression of receptors for estrogen and progesterone was negative. To our knowledge, this is the second solidocystic case of angiomyofibroblastoma-like tumor of male genital tract.

http://ift.tt/2m9BShm

Syndrome de Muir-Torre et syndrome de Turcot

Publication date: Available online 27 February 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Velter, P. Caussade, J.-P. Fricker, B. Cribier
IntroductionLe syndrome de Lynch (SL) est un syndrome de prédisposition génétique à certains cancers qui associe chez un même individu, ou dans un contexte familial, une tumeur viscérale principalement colo-rectale avec un risque élevé d'autres cancers synchrones ou métachrones. Le SL est lié à des mutations de gènes codant pour des protéines du système de réparation de l'ADN. Il existe des variantes phénotypiques du SL, dont le syndrome de Muir-Torre (SMT) et le syndrome de Turcot (ST), qui prédisposent tous deux au cancer colo-rectal. Ils se distinguent par l'association de tumeurs sébacées bénignes ou malignes pour le SMT et de tumeurs du système nerveux central pour le ST.ObservationUn homme de 59 ans, ayant pour antécédent un cancer colique droit à l'âge de 36 ans, consultait pour une lésion du nez dont l'examen histopathologique révélait un carcinome sébacé. Une étude en immunohistochimie montrait une perte d'expression des protéines MSH2 et MSH6, suggérant fortement le diagnostic de SMT. Son fils avait développé 8 ans auparavant un glioblastome mortel ; le phénotype paternel de SMT rendait probable l'hypothèse d'un ST chez le fils.DiscussionCette observation suggère que plusieurs variantes du syndrome de Lynch peuvent être observées dans une même famille. La question du dépistage des tumeurs cérébrales chez les patients atteints d'un SMT et leurs apparentés est soulevée par ce cas, même s'il n'y a pas de recommandation allant en ce sens. Les recommandations actuelles consistent principalement en une surveillance digestive et gynécologique.IntroductionLynch syndrome (LS) is a syndrome that carries a genetic predisposition to certain cancers associating, either in a single individual or in a family, a visceral tumour, mainly colorectal, with a high risk of other synchronous or metachronous cancers. LS is linked with mutations in the genes coding for proteins in the DNA repair system. Phenotypic variants of SL exist, including Muir-Torre syndrome (MTS) and Turcot syndrome (TS), both of which predispose to colorectal cancer. They may be distinguished by the presence of benign or malignant sebaceous tumours in MTS, and tumours of the central nervous system in TS.Patients and methodsA 59-year-old man, with a history of right colon cancer at the age of 36 years, consulted for a nose lesion shown by histopathological examination to be a sebaceous tumour. Immunohistochemistry revealed loss of expression of proteins MSH2 and MSH6, strongly suggesting a diagnosis of MTS. Eight years earlier, the man's son had developed a fatal glioblastoma; given the paternal phenotype of MTS, the hypothesis of TS in the son is probable.DiscussionThis case suggests that several variants of Lynch syndrome may be seen within the same family. It raises the issue of screening for cerebral tumours in patients with MTS and in their family members, even though such a recommendation does not exist; current recommendations in fact consist primarily of gastrointestinal and gynaecological monitoring.

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Envahissement métastatique des quatre paupières par un cancer du sein

Publication date: Available online 28 February 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): N. Rouanes, F. Grilo-Dias, M.-L. Jullié, J. Marie

http://ift.tt/2m9nvde

Acute otitis media in children: a vaccine-preventable disease?

Publication date: Available online 28 February 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Marco Aurélio Palazzi Sáfadi, Daniel Jarovsky

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Sleep disorders in children with moderate to severe persistent allergic rhinitis

Publication date: Available online 27 February 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Jessica Loekmanwidjaja, Ana Cláudia F. Carneiro, Maria Lúcia T. Nishinaka, Daniela A. Munhoes, Gabriela Benezoli, Gustavo F. Wandalsen, Dirceu Solé
IntroductionAllergic rhinitis is associated with several complications, including sleep disorders. The Children's Sleep Habits Questionnaire has been recently translated and validated in Portuguese for the evaluation of sleep disorders in children.ObjectiveTo assess sleep disorders in children with moderate to severe persistent allergic rhinitis and to correlate the findings with disease severity markers.MethodsWe evaluated 167 children (4–10 years), 112 with allergic rhinitis and 55 controls. Parents/guardians of the children answered the Children's Sleep Habits Questionnaire, consisting of 33 questions divided into eight subscales, which refers to the previous week. Patients with rhinitis were also evaluated regarding the score of nasal and extra-nasal symptoms related to the previous week and the peak nasal inspiratory flow.ResultsThere were no significant differences between groups of different age. All patients with rhinitis were being treated with nasal topical corticosteroids. The total Children's Sleep Habits Questionnaire score was significantly higher among children with rhinitis than in controls (median 48 vs. 43, p<0.001). Significantly higher values were also observed for the parasomnia (9 vs. 8), respiratory disorders (4 vs. 3) and daytime sleepiness (14 vs. 12) subscales. Among the patients with rhinitis, no significant correlation was observed between the total Children's Sleep Habits Questionnaire score and disease activity variables, but moderate correlations were observed for the respiratory distress subscale vs. nasal symptom score (r=0.32) and vs. extra-nasal symptom score (r=0.32).ConclusionChildren with moderate to severe persistent allergic rhinitis, even when submitted to regular treatment, have a higher frequency of sleep disorders than controls, particularly concerning nocturnal breathing disorders, daytime sleepiness, and parasomnias. The intensity of sleep disorders found in some subscales was correlated with objective markers of allergic rhinitis severity.

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Anti-inflammatory effects of hyperbaric oxygen on irradiated laryngeal tissues

Publication date: Available online 27 February 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Mitat Arıcıgil, Mehmet Akif Dündar, Abdullah Arslan, Hamdi Arbağ, Abitter Yücel, Meryem Aktan, Sıdıka Fındık, İbrahim Kılınç
IntroductionTo manage the complications of irradiation of head and neck tissue is a challenging issue for the otolaryngologist. Definitive treatment of these complications is still controversial. Recently, hyperbaric oxygen therapy is promising option for these complications.ObjectiveIn this study, we used biochemical and histopathological methods to investigate the efficacy of hyperbaric oxygen against the inflammatory effects of radiotherapy in blood and laryngeal tissues when radiotherapy and hyperbaric oxygen are administered on the same day.MethodsThirty-two Wistar Albino rats were divided into four groups. The control group was given no treatment, the hyperbaric oxygen group was given only hyperbaric oxygen therapy, the radiotherapy group was given only radiotherapy, and the radiotherapy plus hyperbaric oxygen group was given both treatments on the same day.ResultsHistopathological and biochemical evaluations of specimens were performed. Serum tumor necrosis factor-α, interleukin-1β, and tissue inflammation levels were significantly higher in the radiotherapy group than in the radiotherapy plus hyperbaric oxygen group, whereas interleukin-10 was higher in the radiotherapy plus hyperbaric oxygen group.ConclusionWhen radiotherapy and hyperbaric oxygen are administered on the same day, inflammatory cytokines and tissue inflammation can be reduced in an early period of radiation injury.

http://ift.tt/2m3KE06

Impact of body mass index on survival outcome in patients with differentiated thyroid cancer

Publication date: Available online 28 February 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Yousif AL-Ammar, Bader AL-Mansour, Omar AL-Rashood, Mutahir A. Tunio, Tahera Islam, Mushabbab AL-Asiri, Khalid Hussain AL-Qahtani
IntroductionIncreased body mass index (BMI) is known to be associated with the high prevalence of Differentiated Thyroid Cancers (DTC); however data on its impact on survival outcome after thyroidectomy and adjuvant therapy is scanty.ObjectiveWe aimed to evaluate the impact of BMI on overall survival (OS) and disease free survival (DFS) rates in patients with DTC.MethodsBetween 2000 and 2011, 209 patients with DTC (papillary, follicular, hurthle cell) were treated with thyroidectomy followed by adjuvant radioactive iodine-131 (RAI) therapy and thyroid-stimulating hormone (TSH) suppression. Based on BMI, patients were divided into five groups; (a) <18.5kg/m² (underweight); (b) 18.5–25kg/m² (normal weight); (c) 26–30kg/m² (overweight); (d) 31–40kg/m² (obese) and (e) >40kg/m² (morbid obese). Various demographic, clinical and treatment characteristics and related toxicity and outcomes (OS, and DFS) were analyzed and compared.ResultsMedian follow up period was 5.2years (0.6–10). Mean BMI was 31.3kg/m² (17–72); BMI 31–40kg/m² was predominant (89 patients, 42.6%) followed by 26–30kg/m² seen in 58 patients (27.8%). A total of 18 locoregional recurrences (8.6%) and 12 distant metastasis (5.7%) were seen. The 10 year DFS and OS rates were 83.1% and 58.0% respectively. No significant impact of BMI on OS or DFS rates was found (p=0.081). Similarly, multivariate analysis showed that BMI was not an independent prognostic factor for OS and DFS.ConclusionAlthough BMI can increase the risk of thyroid cancer, it has no impact on treatment outcome; however, further trials are warranted.

http://ift.tt/2lkC9tu

Intussusception: a rare complication in a patient with acute leukaemia after consolidation chemotherapy

Intussusception is telescoping of one segment of the gastrointestinal tract into an adjacent one. It is more common in children than adults. When it occurs in adults, it is usually associated with a lead point. Intussusception is very rare in acute leukaemia and has only been reported in few cases. We present a case of an adult woman who presented with intussusception after a cycle of consolidation chemotherapy with high-dose cytarabine for acute myeloid leukaemia. Other causes of acute abdominal pain were excluded, and the diagnosis was established by CT scan of the abdomen and barium enema. No pathological lead points were found intraoperatively. She underwent a right-sided hemicolectomy with complete recovery. To the best of our knowledge, this is only the fourth case of intussusception that has been reported in an adult patient with acute myeloid leukaemia.

http://ift.tt/2m3umo8

Codfish vertebra sign

Description

A woman aged 70 years presented with several years' history of low back pain and bilateral lower limb pains. Her menstrual cycles ceased when she was 44 years of age. Plain X-ray of the lumbosacral spine revealed diffuse osteoporotic changes (figure 1). A battery of investigations was performed; the only abnormal results were slightly raised serum alkaline phosphatase (probably from vertebral fractures) and very low-serum 25-hydroxyvitmain D. Lumbosacral spine MRI was ordered (figure 2) and revealed several codfish vertebrae in addition to lumber spinal stenosis. Dual X-ray absorptiometry revealed a T-score of –2.9 at the spine. The patient's diagnosis was postmenopausal osteoporosis.

Figure 1

Lateral X-ray film of the lumbar spine, which reveals biconcavity of the lumbar vertebrae and osteopenia.

Figure 2

Sagittal T1-weighted (right) and T2-weighted (left) MRI of the lumbosacral spine. The D10–12 vertebrae are also...

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Disseminated cysticercosis incidentally diagnosed in a patient of fracture shaft of femur

Cysticercosis is caused by the larval form of Taenia solium tape worm, cysticercus cellulose. The life cycle of T. solium consists of 2 host, the definite host is a man who harbours the adult forms of the worm in the intestine, while the intermediate host is the pig, where the larval form (cysticercus cellulose) is found in the skeletal muscle. Cysticercosis develops when human beings incidentally become the intermediate host and the eggs mature within their small intestine. The route of entry of the eggs into the human intestine may occur through autoinfection or by ingestion of contaminated food or water. Further, these eggs develop into the larval form which spread throughout the intestinal wall and are disseminated by the blood stream to brain, muscles, subcutaneous tissues or any other organ. Until now, only 50 cases of disseminated forms have been reported in the literature, with the majority of the cases being from Indian subcontinent. Regarding the clinical presentations, symptoms usually depend on the location, size and number of cysts in the involved lesion. However, it may present occasionally with dementia, muscular hypertrophy or subcutaneous nodules with relative absence of focal neurological signs or raised intracranial pressure. We, here, report a case of disseminated cysticercosis, detected incidentally in a man aged 52 years who presented with an open fracture of the right femur.

http://ift.tt/2m3vkQW

Die Wahrnehmung des gesetzlichen Hautkrebsscreenings in der Allgemeinbevölkerung

Zusammenfassung

Hintergrund

Seit 2008 bieten deutsche gesetzliche Krankenversicherungen Hautkrebsscreenings als Standardleistung an. Entsprechend Versicherte ab einem Alter von 35 sind für eine Früherkennungsuntersuchung alle 2 Jahre berechtigt.

Ziel der Arbeit

Ziele der Studie waren die Wahrnehmung und Inanspruchnahme des gesetzlichen Hautkrebsscreenings (gHKS) in der Allgemeinbevölkerung.

Material und Methoden

Eine repräsentative Zufallsstichprobe von n = 1004 erwachsenen gesetzlich Versicherten wurde vom Forsa-Institut mittels computergestützter Telefoninterviews in einer Querschnittstudie im April 2015 befragt.

Ergebnisse

Bei 39 % aller Befragten wurde das Hautkrebsscreening bereits mindestens ein Mal durchgeführt; der Anteil der gHKS-Berechtigten war 45 %; 50 % der Befragten war der Anspruch auf das gHKS bekannt, die Informationsquellen waren vielfältig; 82 % gaben an, dass das Screening von einem Dermatologen durchgeführt wurde. Die Mehrheit (87 %) gab an, dass die Vorteile der Untersuchung gegenüber den Nachteilen überwogen. Während die gHKS-Teilnahmerate konstant zunahm (2011–2013–2015), stagnierte die Kenntnis des gHKS-Anspruchs.

Diskussion

Das Angebot zur Hautkrebsfrüherkennung wurde 7 Jahre nach Einführung des gHKS von knapp der Hälfte der Anspruchsberechtigten genutzt und überwiegend positiv beurteilt. Gleichzeitig ist lediglich 50 % der Befragten der gHKS-Anspruch bekannt. Weitere gezielte Maßnahmen sind nötig, um die Bekanntheit der Maßnahme zu erhöhen.

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MicroRNA miR-371a-3p im Serum

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Radiologic Differences between Human Papillomavirus-Related and Human Papillomavirus-Unrelated Oropharyngeal Carcinoma on Diffusion-Weighted Imaging

Background and Purpose: Human papilloma virus-related oropharyngeal carcinoma (HPV+ OPC) is a unique entity compared to HPV-unrelated (HPV-) OPC. Previous studies were inconclusive regarding the differences between HPV+ and HPV- OPCs on diffusion-weighted imaging (DWI). This study sought to determine if there is an association between HPV status and apparent diffusion coefficient (ADC) values as an imaging biomarker in OPCs. Materials and Methods: OPC patients with pretreatment MRI including DWI were retrospectively reviewed and analyzed as a blinded, controlled cohort. HPV status was biopsy-ascertained with p16 staining. ADC values were determined by placing the largest possible circular region of interest in solid portions of primary tumors and/or metastatic lymph nodes. Necrotic and cystic portions were excluded. Results: Twenty-eight HPV+ and 12 HPV- patients were included. Adjusted for age and sex, ADC values were significantly lower in HPV+ OPC primary tumors (p = 0.013) and lymph node metastases (p = 0.013). The area under the curve (AUC) was 0.85 and 0.90, respectively. A model with a linear combination of the 2 variables yielded an AUC of 0.92. Conclusion: ADC values were significantly lower in both the primary tumors and lymph node metastases in HPV+ OPCs compared to HPV- OPCs. These results confirm the results of prior studies.
ORL 2016;78:344-352

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Αρχειοθήκη ιστολογίου

Τρίτη 28 Φεβρουαρίου 2017

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