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

Παρασκευή 31 Μαρτίου 2017

Novel immunotherapy and treatment modality for severe food allergies.

Purpose of review: In recent years, many studies on oral immunotherapy (OIT) have been conducted; however, few have focused on severe food allergies. The purpose of this review was to assess the efficacy and safety of oral immunotherapies for patients with severe food allergy. Recent findings: We reviewed multiple immunotherapy reports published within a few years or reports focusing on severe food allergies. We also investigated recent studies on OIT and novel food allergy management. Summary: Immunotherapies targeting low-dose antigen exposure and oral food challenges using low-dose target volumes may be safer than conventional OIT. It is necessary to consider which immunotherapy regimen is appropriate based on allergy severity of the patient. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2nK7k5P

Behavioral interventions to improve asthma outcomes: a systematic review of recent publications.

Purpose of review: Asthma outcomes are influenced by factors at multiple ecological levels: the individual and his/her family, home, medical care, and community. This systematic review describes recently published single-level and multilevel behavioral interventions to improve asthma outcomes. Recent findings: Of the 23 total title/abstracts reviewed in the original systematic search of PubMed, Ovid, Scopus, PsychINFO, and CIHAHL reference review databases, six met inclusion criteria. Five of the studies focused on low-income and/or minority populations. Promising interventions include culturally tailored online asthma self-management programs and family-centered asthma education delivered at the bedside during hospitalization for an acute asthma exacerbation. Summary: Culturally, tailored online self-management programs offer difficult-to-reach populations asthma support that can be completed at the time and pace most convenient for the individual user. Family-focused asthma education, delivered at the bedside during an acute asthma hospitalization by highly motivated lay volunteers, is an efficacious and low-cost approach to improving pediatric asthma self-management. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2npq2w9

Novel immunotherapy and treatment modality for severe food allergies.

Behavioral interventions to improve asthma outcomes: a systematic review of recent publications.

Sensitization patterns among patients with atopic dermatitis evaluated in a large tertiary care pediatric center

Publication date: Available online 31 March 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Samantha M. Knox, Elizabeth A. Erwin, Joy L. Mosser-Goldfarb, Rebecca Scherzer

http://ift.tt/2olMBHo

A randomized, single-blinded trial of a tripeptide/hexapeptide healing regimen following laser resurfacing of the face

Summary

Background

A topical healing system containing a combination of active ingredients including a tripeptide and hexapeptide (TriHex Technology™) has been found to stimulate neoelastogenesis and neocollagenesis.

Objective

Evaluate the use of the tripeptide/hexapeptide topical system following fractionated CO₂ laser resurfacing compared to a bland ointment and cream.

Patients/Methods

In this single-blinded, randomized study, 15 female subjects aged 45-70 years underwent laser resurfacing of the face. Subjects were randomized to use of the tripeptide/hexapeptide system (n=10) or a bland dimethicone-based ointment and petrolatum-based cream (n=5) from 3 weeks pre- until 12 weeks postprocedure. A blinded investigator graded erythema, edema, crusting, exudation, and healing on postprocedure days 1, 3, 4, 7, 28, and 84. A photodamage/wrinkle scale was completed on days 28 and 84. Subjects performed symptomatology grading on days 1 through 14 and completed self-assessments at days 28 and 84.

Results

Data from 14 subjects were analyzed. Blinded-investigator-rated healing was better for the tripeptide/hexapeptide system, reaching statistical significance at day 7. The tripeptide/hexapeptide group demonstrated less erythema and exudation during the first postprocedure week, reaching significance at day 3. On days 1 through 14, subjects using the tripeptide/hexapeptide system reported less tenderness and burning/stinging, also reaching significance on day 3. At day 84, subjects using the tripeptide/hexapeptide system reported higher satisfaction and were more likely to recommend the treatment to others.

Conclusion

Postresurfacing use of a tripeptide/hexapeptide system proved effective and well-tolerated. Subject satisfaction was greater among those using this system, which may indicate an improved patient experience following laser resurfacing.

http://ift.tt/2olJvTv

Effectiveness of Nasal Packing in Trans-septal Suturing Technique in Septoplasty: A Randomized Comparative Study

Abstract

Nasal packing is routinely used after septoplasty, but there are patient factors for which its use needs to be reconsidered. Effectiveness of nasal packing in trans-septal suturing technique in septoplasty. Prospective, comparative study, patients submitted to septoplasty were randomized to receive or not nasal packing postoperatively. Comparison in postoperative status for pain, headache, discomfort in swallowing, epiphora, bleeding, infection and pain on pack removal are assessed. In all the patients trans-septal suturing technique was used. Study group has 60 patients. Two groups were made group A in whom nasal packing done post operatively with merocel, group B in whom nasal packing was not done, in both groups quilting sutures were applied on to the septum. There was pain in nose and headache in all the patients in group A. Other symptoms in group A were epiphora, discomfort in swallowing due to ear discomfort. In addition to these there is pain on removal of packs. Routine use of nasal packing can be avoided instead sutures can be placed over the septum, which benefits in improving pain and symptoms due to pack in the postoperative period.

http://ift.tt/2nU1tM0

Correlation between numbers of cells in human dental pulp and age: Implications for age estimation

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Mohammad Zakir Hossain, Sulinda Daud, Phrabhakaran Nambiar, Fathilah Abdul Razak, Norintan Ab-Murat, Roslan Saub, Marina M. Bakri
ObjectiveThe aim of this study was to investigate correlations between dental pulp cell count of odontoblasts, subodontoblasts and fibroblasts and age, within different age groups. Formulation of regression equations using the dental pulp cell count for predicting age was attempted.DesignEighty-one extracted teeth were grouped into two age groups (6–25 years, 26–80 years). The teeth were demineralized and histological sections were prepared for cell count. Regression equations were generated from regression analysis of cell count and tested for age estimation.ResultsThe number of dental pulp cells were found to increase until around the third decade of life and following this, the odontoblasts and subodontoblasts cell numbers began to decline while the fibroblasts seemed to remain almost stationary. The Pearson correlation test revealed a significant positive correlation between the cell number for all type of cells and age in the 6–25 years group (r=+0.791 for odontoblasts, r=+0.600 for subodontoblasts and r=+0.680 for fibroblasts). In the 26–80 years age group, a significant negative correlation of the odontoblasts (r=−0.777) and subodontoblasts (r=−0.715) with age was observed but for fibroblasts, the correlation value was negligible (r=−0.165). Regression equations generated using odontoblasts and subodontoblasts cell number were applicable for age estimation. The standard error of estimates (SEEs) were around±5years for 6–25 years and±8years for 26–80 years age groups. The mean values of the estimated and chronological ages were not significantly different.ConclusionsA significant correlation between the cell count of odontoblasts and subodontoblasts with age was demonstrated. Regression equations using odontoblasts and subodontoblasts cell number can be used to predict age with some limitations.

http://ift.tt/2mXnqKR

Correlation between numbers of cells in human dental pulp and age: Implications for age estimation

Complications in Mandibular Midline Distraction

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1600902

Mandibular midline distraction (MMD) is a relatively new surgical technique for correction of transverse discrepancies of the mandible. This study assesses the amount and burden of complications in MMD. A retrospective cohort study was performed on patients who underwent MMD between 2002 and 2014. Patients with congenital deformities or a history of radiation therapy in the area of interest were excluded. Patient records were obtained and individually assessed for any complications. Complications were graded using the Clavien-Dindo classification system (CDS). Seventy-three patients were included of which 33 were males and 40 were females. The mean follow-up was 2.1 years. Twenty-nine patients had minor complications, grades I and II. Two patients had a grade IIIa and three patients had a grade IIIb complication. Common complications were pressure ulcers, dehiscence, and (transient) sensory disturbances of the mental nerve. This study shows that although MMD is a relatively safe method, complications can occur. Mostly the complications are mild, transient, and manageable without the need for any reoperation.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://ift.tt/2nJnaO6

Abstracts from the Food Allergy and Anaphylaxis Meeting 2016

http://ift.tt/2oISD0x

Infantile hemangiopericytoma of the tongue—Efficacy of ex utero intrapartum treatment procedure and combined-modality therapy

Publication date: Available online 30 March 2017
Source:Auris Nasus Larynx
Author(s): Takenori Ogawa, Ryo Ishii, Daiki Ozawa, Takeshi Rikiishi, Hajime Usubuchi, Mika Watanabe, Yoshimichi Imai, Kenichi Sato, Masatoshi Saito, Yoji Sasahara, Tadashi Matsuda, Shigeo Kure, Yukio Katori
Here we present an extremely rare case of giant infantile hemangiopericytoma (HPC) of the tongue diagnosed prenatally by fetal ultrasonography and MR imaging. Due to airway stenosis, the patient was delivered by the ex utero intrapartum treatment (EXIT) procedure at 36 weeks of pregnancy. Initial diagnosis was infantile hemangioma based on physical examination, diagnostic imaging and the high incidence of hemangioma. The tumor was resistant to conservative treatments. Due to severe tumor hemorrhage, the nutrient vessel was embolized by endovascular treatment on the 73th day after birth. Two days after embolization, a hemiglossectomy was performed. Histological analysis after surgery diagnosed infantile HPC with microscopically positive stumps. After receiving adjuvant chemotherapy, the patient has had no recurrence after 53 months with normal speech and swallowing function resulting in normal growth. Our findings support that infantile HPC is one of the differential diagnosis of infantile hemangioma. The EXIT procedure could be effective for infants with upper respiratory stenosis by head and neck tumor diagnosed prenatally. Though complete resection is required for infantile HPC, our report suggests that a conservative surgical approach followed by adjuvant chemotherapy should be used for giant head and neck infantile HPC.

http://ift.tt/2oIZzLh

Effectiveness of Nasal Packing in Trans-septal Suturing Technique in Septoplasty: A Randomized Comparative Study

Abstract

http://ift.tt/2nU1tM0

The effects of clinical factors on airway outcomes of mandibular distraction osteogenesis in children with Pierre Robin sequence

Mandibular distraction osteogenesis (MDO) is an effective treatment for tongue-based airway obstruction in children with severe Pierre Robin sequence. An investigation was performed to determine whether certain clinical factors influence the airway outcomes of MDO. A literature search of several databases was performed to identify studies providing individual patient data. Data extracted from the studies included patient sex, age at distraction, disease type, experience of any previous surgery on the airway, length of distraction, pre- and postoperative blood oxygen saturation nadir, and osteotomy design.

http://ift.tt/2nJcmzw

Recurrent dislocation: scientific evidence and management following a systematic review

Recurrent mandibular dislocation is a rare condition that can have a negative impact on quality of life. Different surgical techniques are employed in the treatment of this condition, and the demand for maximum healthcare quality has contributed to the implementation of evidence-based clinical practice. The objective of this study was to determine the level of scientific evidence in articles reporting open surgical treatment for recurrent mandibular dislocation. A comprehensive search strategy was conducted to locate relevant articles in the PubMed and Web of Science databases on open surgical treatment for recurrent mandibular dislocation published between January 1974 and August 2014.

http://ift.tt/2noCAE8

Islanded facial artery musculomucosal flap for tongue reconstruction: reply to the comment

This is in response to the letter by Massarelli et al., regarding our technical note on the islanded facial artery musculomucosal flap for tongue reconstruction1. We thank Massarelli et al. for bringing their article on the trilobed buccinator myomucosal flap to our notice and agree with them that our technique of harvesting the flap is identical to the method described by them2.

http://ift.tt/2nJqUiK

Whole Exome Sequencing Identified a Novel Frameshift Mutation in SDR9C7 underlying Autosomal Recessive Congenital Ichthyosis in a Pakistani Family

Abstract

Autosomal Recessive Congenital Ichthyosis (ARCI) is a group of cornification disorders (prevalence 1:200,000) broadly divided into three classes namely Harlequin Ichthyosis (HI; OMIM#242500), Lamellar Ichthyosis (LI; OMIM#242304) and Congenital Ichthyosiform Erythroderma (CIE; OMIM#242100). ARCI clinical features include generalized scaling, hypohidrosis and palmo-plantar hyperlinearity although presentation and severity may vary significantly. A large number of affected individuals present with collodion membrane at birth. HI is the most severe and fatal form of the disease and the neonates are born covered with thick, hard, armor-like plates of cornified skin. The classic form of LI present with dark brown, plate-like scales with no erythroderma and CIE with fine and white scales adjoining generalized erythema. Affected individuals with severe involvement can have ectropion, eclabium, scarring alopecia and palmoplantar keratoderma. Currently, ten genes are reported in association with different ARCI phenotypes: TGM1, ALOX12B, ALOXE3, ABCA12, CYP4F22, NIPAL4, LIPN, CERS3, PNPLA1 and SDR9C7^1,2,3. Here we report a novel frameshift mutation in SDR9C7 (short-chain dehydrogenase/reductase family 9C member 7) underlying ARCI in a consanguineous Pakistani family.

http://ift.tt/2nJwbqt

Application of Ultrasonic Aspirators in Rhinology and Skull Base Surgery

Ultrasonic aspirators (UAs) are increasingly being used in rhinology and skull base surgery. The use of ultrasonic vibration for the removal of bony tissue transfers minimal heat to surrounding tissues and is relatively atraumatic to nearby soft tissue structures. This article details the development and application of this technology in septoturbinoplasty, endoscopic dacryocystorhinostomy (DCR), and skull base surgery. The benefits and limitations of UAs compared with conventionally powered instruments are discussed.

http://ift.tt/2notOWP

Innovations in Balloon Catheter Technology in Rhinology

Since being introduced more than 10 years ago, balloon catheter technology (BCT) has undergone several generations of innovations. From construction to utilization, there has been a myriad of advancements in balloon technology. The ergonomics of the balloon dilation systems have improved with a focus on limiting the extra assembly. "Hybrid" BCT procedures have shown promise in mucosal preservation, including treating isolated complex frontal disease. Multiple randomized clinical trials report improved long-term outcomes in stand-alone BCT, including in-office use. The ever-expanding technological innovations ensure BCT will be a key component in the armamentarium of the modern sinus surgeon.

http://ift.tt/2noF9pX

Advances in Microdebrider Technology

Since its application in nasal surgery, the microdebrider has revolutionized the practice of endoscopic sinus surgery. As the demands and breadth of procedures performed endoscopically have increased, so has the need for improvement in the microdebrider and related technologies. This article addresses how use of the microdebrider has impacted endonasal surgery and discusses current advances, which include creation of specialty hand pieces and blades, increases in instrument rotational speed, incorporation of navigation and energy, adaptation for intracranial use, and disposable instrumentation designed for in office use. Advances in microdebrider technology have improved functionality and expanded the utility of these devices.

http://ift.tt/2nJlfcJ

Endoscopic Skull Base Reconstruction

Endoscopic skull base surgery has developed rapidly over the last decade, in large part because of the expanding armamentarium of endoscopic repair techniques. This article reviews the available technologies and techniques, including vascularized and nonvascularized flaps, synthetic grafts, sealants and glues, and multilayer reconstruction. Understanding which of these repair methods is appropriate and under what circumstances is paramount to achieving success in this challenging but rewarding field. A graduated approach to skull base reconstruction is presented to provide a systematic framework to guide selection of repair technique to ensure a successful outcome while minimizing morbidity for the patient.

http://ift.tt/2nJi98t

Sensitization patterns among patients with atopic dermatitis evaluated in a large tertiary care pediatric center

The prevalence of food and aeroallergen sensitization has increased during the past 20 years and is commonly seen in pediatric patients with atopic dermatitis (AD).1,2 Overall, studies of patients with AD have reported similar patterns of aeroallergen sensitization in different countries, but the prevalence of sensitization to food allergens has varied (egg 35%–54%, peanut 22%–44%, cow's milk 19%–27%).2,3 Given the increase in peanut allergy in the past decade and the knowledge gained from the Learning Early About Peanut (LEAP) Study on the benefits of early introduction of peanut, the relation between peanut sensitization and AD is especially relevant.

http://ift.tt/2or6hq5

Open vs. endoscopic cricopharyngeal myotomy; Is there a difference?

The upper esophageal sphincter (UES) is composed largely of the cricopharyngeus muscle (CP) and acts as the gatekeeper to the esophagus. There are multiple methods of treating UES dysfunction, but myotomy has been shown to be the most definitive means. We aim to evaluate the difference between open and endoscopic CP myotomy (CPM).

http://ift.tt/2nJkzDV

From transmandibular to transoral robotic approach for parapharyngeal space tumors

Parapharyngeal space (PPS) tumors are rare, accounting for 0.5% of all head-and-neck masses. Surgery remains the standard treatment for most cases, including different approaches (cervical approach, parotidectomy, mandibulotomy, transoral/robotic). We report our experience in the management of PPS tumors, aiming to create a surgical algorithm on the base of tumor's radiological and clinical characteristics.

http://ift.tt/2noF31r

Hydroxyapatite bone cement for suboccipital retrosigmoid cranioplasty: A single institution case series

To report rates of cerebrospinal fluid leak, wound infection, and other complications after repair of retrosigmoid craniotomy with hydroxyapatite bone cement.

http://ift.tt/2nJkzUr

Post-operative MRSA infections in head and neck surgery

Surgical site infection (SSI) with methicillin-resistant Staphylococcus aureus (MRSA) is a serious post-operative complication, with head and neck cancer patients at greater risk due to the nature of their disease. Infection with MRSA has been shown to be costly and impart worse outcomes on patients who are affected. This study investigates incidence and risks for MRSA SSIs at a tertiary medical institution.

http://ift.tt/2noDK2o

Parotid adenoid cystic carcinoma: Retrospective single institute analysis

Adenoid cystic carcinoma (ACC) is a uncommon salivary malignant tumor. Our aim was to review our experience with parotid ACC, to identify clinical-pathological parameters predictive for outcome.

http://ift.tt/2nJgIXy

Eustachian tube diameter: Is it associated with chronic otitis media development?

To evaluate the effect of ET diameter on Chronic Otitis Media (COM) pathogenesis.

http://ift.tt/2noxWWJ

Dizziness, malpractice, and the otolaryngologist

To assess malpractice claims related to the management of dizziness in otolaryngology in order to improve care and minimize the risk of litigation.

http://ift.tt/2nJlUuJ

Treatment of locally advanced parotid malignancies with parotidectomy and temporal bone resection

In this study we review our institution's experience and outcomes with temporal bone resection and parotidectomy in the treatment of advanced parotid malignancies.

http://ift.tt/2noIJjM

Role of Radiotherapy in Mucosal Kaposi Sarcoma

http://ift.tt/2nGS4qm

Editorial Board

Publication date: January–March 2017
Source:Alergologia Polska - Polish Journal of Allergology, Volume 4, Issue 1

http://ift.tt/2noA4Oh

The role of microbiota in allergy development

Publication date: Available online 31 March 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Monika Marko, Rafał Pawliczak
The increase of allergic diseases incidence has been noticed in industrialized countries. The reason for that is sought in increasing environment pollution and hygienisation of life. Diseases including asthma, hay fever, eczema and food allergies have dramatically increased over the last century. Microbiota (intestinal microflora) is a community of microorganisms, mainly bacteria that forms in the human digestive system a complex ecosystem. Recently more and more attention is paid to the connection of intestinal microflora with the occurrence of allergic diseases. Microbiota and the beneficial effects of probiotic bacteria on human health is becoming increasingly important in allergy development. However, the importance of probiotics in the prevention of these diseases has not been proven. It is a necessity to design and carry out thorough and detailed research to confirm significance of treatment with using probiotics strains.

http://ift.tt/2nopnLF

Correction

Blauvelt A, Papp KA, Griffiths CEM, Randazzo B, Wasfi Y, Shen Y-K, Li S, Kimball AB. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: Results from the phase III, double-blinded, placebo- and active comparator—controlled VOYAGE 1 trial. J Am Acad Dermatol. 2017;76:405-417.

http://ift.tt/2mWTE96

Correction

Reich K, Armstrong AW, Foley P, Song M, Wasfi Y, Randazzo B, Li S, Shen Y-K, Gordon KB. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the treatment of patients with moderate to severe psoriasis with randomized withdrawal and retreatment: Results from the phase III, double-blind, placebo- and active comparator—controlled VOYAGE 2 trial. J Am Acad Dermatol. 2017;76:418-431.

http://ift.tt/2ns4CzH

Successful treatment of thyroid storm presenting as recurrent cardiac arrest and subsequent multiorgan failure by continuous renal replacement therapy

Summary

Thyroid storm is a rare and potentially life-threatening medical emergency. We experienced a case of thyroid storm associated with sepsis caused by pneumonia, which had a catastrophic course including recurrent cardiac arrest and subsequent multiple organ failure (MOF). A 22-year-old female patient with a 10-year history of Graves' disease was transferred to our emergency department (ED). She had a cardiac arrest at her home and a second cardiac arrest at the ED. Her heart recovered after 20 min of cardiac resuscitation. She was diagnosed with thyroid storm associated with hyperthyroidism complicated by pneumonia and sepsis. Although full conventional medical treatment was given, she had progressive MOF and hemodynamic instability consisting of hyperthermia, tachycardia and hypotension. Because of hepatic and renal failure with refractory hypotension, we reduced the patient's dose of beta-blocker and antithyroid drug, and she was started on continuous veno-venous renal replacement therapy (CRRT) with intravenous albumin and plasma supplementation. Subsequently, her body temperature and pulse rate began to stabilize within 1 h, and her blood pressure reached 120/60 mmHg after 6 h. We discontinued antithyroid drug 3 days after admission because of aggravated hyperbilirubinemia. The patient exhibited progressive improvement in thyroid function even after cessation of antithyroid drug, and she successfully recovered from thyroid storm and MOF. This is the first case of thyroid storm successfully treated by CRRT in a patient considered unfit for antithyroid drug treatment.

Learning points:

The presenting manifestations of thyroid storm vary and can include cardiac arrest with multiorgan failure in rare cases.

In some patients with thyroid storm, especially those with severe complications, conventional medical treatment may be ineffective or inappropriate.

During thyroid storm, the initiation of CRRT can immediately lower body temperature and subsequently stabilize vital signs.

Early initiation of CRRT can be life-saving in patients with thyroid storm complicated by MOF, even when used in combination with suboptimal medical treatment.

http://ift.tt/2nseY2h

Prophylactic embolisation of the internal maxillary artery in patients with ankylosis of the temporomandibular joint

The aim of the present study was to assess the efficacy of using prophylactic embolisation of the internal maxillary artery to minimise the risk of bleeding during gap arthroplasty.We studied a prospective series of 14 patients with ankylosis of the temporomandibular joint (TMJ) between January 2011 and February 2016, who were under the care of one surgeon.They were all treated by embolisation of the internal maxillary artery 24hours before gap arthroplasty. The main outcome variable was estimated blood loss, and others included the need to extend the gap arthroplasty, and the risk of reankylosis.

http://ift.tt/2nFkhws

How far reaching is our research? An analysis of the journals in which oral and maxillofacial surgery research is cited

In this study we investigate the five most cited articles in the British Journal of Oral and Maxillofacial Surgery (BJOMS). Articles cited were usually published in other OMFS journals (40%) or dentistry journals (32%). The mean (SD) SCImago Journal and Country Rank, (SJR) (an interface to access the bibliometric database of journals) for cited papers was 0.64 (SD=0.56). Nearly one third of citations were of research in OMFS and dentistry, suggesting its relevance to the wider academic community.

http://ift.tt/2okVSiF

Compliance of referral and hospital documentation with National Institute of Health and Care Excellence guidelines for the extraction of third molars: a comparative analysis of two NHS Trusts

To find out whether documentation for the extraction of wisdom teeth complies with National Institute of Health and Care Excellence (NICE) guidelines, we reviewed the referral letters and hospital notes of patients treated at the maxillofacial unit of two NHS Trusts (A: 314 records and B: 280) over 12 months (1 September 2012 to 31 August 2013). Compliance was assessed as unsatisfactory ("indication for extraction not mentioned", "incorrect indication", "indication unclear") or satisfactory ("correct indication implied", "correct indication explicit").

http://ift.tt/2nFz0Y6

Congenital lipoma of the hard palate: case report

Congenital tumours of the oral cavity are uncommon, and most of them are teratoid. Lipoma is a benign tumour of adipose tissue commonly found in adults, and it is rare to find one that is congenital. They are most commonly found in the tongue and maxillary gingiva,1 and to the best of our knowledge, only two cases of lipoma have been reported in the hard palate (Okamoto et al and Gokul et al reported a congenital fibrolipoma and an osteolipoma that were associated with cleft palate, respectively).

http://ift.tt/2okVSPH

Mass Spectrometry to complement standardization of house dust mite and other complex allergenic extracts

Abstract

In the United States, the Center for Biologics Evaluation and Research (CBER) of the US Food and Drug Administration regulates biologics used for diagnosis and treatment of allergic diseases. The Code of Federal Regulations 21CFR680.3(e) states that when measured, the potency of an allergenic extract is assessed according to its allergenic activity. As of 2016, 19 allergenic extracts are standardized for potency in the United States. While these standardized extracts constitute a minority of those available, they treat the most prevalent allergies (e.g. grass and ragweed pollens, dust mites and cat) and those that induce life-threatening anaphylaxis (e.g. Hymenoptera venom). Standardization for potency enhances safety and efficacy of immunotherapy by minimizing the risks of variations in allergen dosing when switching from one lot of manufactured extract to another, and by providing an objective measure of stability of each lot of allergenic extract over time. Allergenic extracts that have multiple immunodominant allergenic proteins are standardized with little or no information about compositional differences among extracts. Here we propose application of mass spectrometry towards measurement of compositional differences among extracts that may affect the efficacy and safety of allergen immunotherapy. In addition, we discuss of house dust mite allergen extracts as a prototypical complex extract that may be standardized by mass spectrometry.

http://ift.tt/2nTRR3T

Dizziness, malpractice, and the otolaryngologist

Publication date: Available online 31 March 2017
Source:American Journal of Otolaryngology
Author(s): Anthony M. Tolisano, Sungjin A. Song, Douglas S. Ruhl, Philip D. Littlefield
PurposeTo assess malpractice claims related to the management of dizziness in otolaryngology in order to improve care and minimize the risk of litigation.Materials and methodsThis is a retrospective review of the LexisNexis "Jury Verdicts and Settlements" database. All lawsuits and out of court adjudications related to the management of dizziness by otolaryngologists were collected. Data including patient demographics, plaintiff allegation, procedure performed, and indemnities were analyzed.ResultsOf 21 cases meeting inclusion criteria, 17 were decided by a trial jury and four were resolved out of court. Jury verdicts favored the plaintiff 53% of the time and a payout was made in 57% of cases overall. Average payments were higher for jury verdicts in favor of the plaintiff ($1.8 million) as compared to out of court settlements ($545,000). Two-thirds of cases involved surgery, most commonly stapes surgery. Legal allegations, including physical injury, negligence, and lack of informed consent failed to predict the legal outcome.ConclusionsAppropriate examination, testing, and referrals within a timely manner are crucial in the management of dizzy patients to avoid misdiagnoses. It is imperative that patients undergoing ear surgery are appropriately counseled that dizziness is a potential complication. The analysis of malpractice literature is complementary to clinical studies, with the potential to educate practitioners, improve patient care, and mitigate risk.

http://ift.tt/2nFAlOJ

Parotid adenoid cystic carcinoma: Retrospective single institute analysis

Publication date: Available online 31 March 2017
Source:American Journal of Otolaryngology
Author(s): Giuditta Mannelli, Lorenzo Cecconi, Martina Fasolati, Roberto Santoro, Alessandro Franchi, Oreste Gallo
PurposeAdenoid cystic carcinoma (ACC) is a uncommon salivary malignant tumor. Our aim was to review our experience with parotid ACC, to identify clinical-pathological parameters predictive for outcome.Materials and methodsWe retrospectively reviewed 228 patients affected by parotid gland carcinomas surgically treated at our Institution. Forty-four ACC were included in this study. Multivariate analysis risk models were built to predict recurrence free probability (RFP), distant recurrence free probability (DRFP), overall survival (OS) and disease free survival (DFS).ResultsTwenty-one patients (47.7%) died from ACC and 2.3% for other causes. The 41% presented local-regional recurrence, with a regional-RFP rate of 93%, and the 34% reported distant metastases (DM). The five and ten-year OS rates were 74% and 50%, respectively.ConclusionsRecurrences were mainly influenced by the presence of perineural invasion and nerve paralysis, whilst female gender and age<50 were predictors for good prognosis.

http://ift.tt/2okKYtt

Post-operative MRSA infections in head and neck surgery

Publication date: Available online 31 March 2017
Source:American Journal of Otolaryngology
Author(s): Sharon Lin, Sami Melki, Michelle V. Lisgaris, Emily N. Ahadizadeh, Chad A. Zender
PurposeSurgical site infection (SSI) with methicillin-resistant Staphylococcus aureus (MRSA) is a serious post-operative complication, with head and neck cancer patients at greater risk due to the nature of their disease. Infection with MRSA has been shown to be costly and impart worse outcomes on patients who are affected. This study investigates incidence and risks for MRSA SSIs at a tertiary medical institution.Materials and methodsThis study reviewed 577 head and neck procedures from 2008 to 2013. Twenty-one variables (i.e. tumor characteristics, patient demographics, operative course, cultures) were analyzed with SPSS to identify trends. A multivariate analysis controlled for confounders (age, BMI, ASA class, length of stay) was completed.ResultsWe identified 113 SSIs of 577 procedures, 24 (21.23%) of which were MRSA. Of all analyzed variables, hospital exposure within the preceding year was a significant risk factor for MRSA SSI development (OR 2.665, 95% CI: 1.06–6.69, z statistic 2.086, p=0.0369). Immunosuppressed patients were more prone to MRSA infections (OR 14.1250, 95%CI: 3.8133–52.3217, p<0.001), and patients with a history of chemotherapy (OR 3.0268, 95% CI: 1.1750–7.7968, p=0.0218). Furthermore, MRSA SSI resulted in extended post-operative hospital stays (20.8±4.72days, p=0.031).ConclusionsPatients who have a history of chemotherapy, immunosuppression, or recent hospital exposure prior to their surgery are at higher risk of developing MRSA-specific SSI and may benefit from prophylactic antibiotic therapy with appropriate coverage. Additionally, patients who develop MRSA SSIs are likely to have an extended postoperative inpatient stay.

http://ift.tt/2nFt1m6

Hydroxyapatite bone cement for suboccipital retrosigmoid cranioplasty: A single institution case series

Publication date: Available online 31 March 2017
Source:American Journal of Otolaryngology
Author(s): Alexander L. Luryi, Ketan R. Bulsara, Elias M. Michaelides
ObjectiveTo report rates of cerebrospinal fluid leak, wound infection, and other complications after repair of retrosigmoid craniotomy with hydroxyapatite bone cement.MethodsRetrospective case review at tertiary referral center of patients who underwent retrosigmoid craniotomy from 2013 to 2016 with hydroxyapatite cement cranioplasty.Outcome measuresPresence of absence of cerebrospinal fluid leak, wound infection, and other complications.ResultsTwenty cases of retrosigmoid craniotomy repaired with hydroxyapatite cement were identified. Median length of follow up was 9.8months. No cases of cerebrospinal fluid leak were identified. One patient developed a wound infection which was thought to be related to a chronic inflammatory response to the implanted dural substitute. No other major complications were noted.ConclusionsA method and case series of suboccipital retrosigmoid cranioplasty using hydroxyapatite cement and a are reported. Hydroxyapatite cement cranioplasty is a safe and effective technique for repair of retrosigmoid craniotomy defects.

http://ift.tt/2okDWop

Eustachian tube diameter: Is it associated with chronic otitis media development?

Publication date: Available online 31 March 2017
Source:American Journal of Otolaryngology
Author(s): Ceki Paltura, Tuba Selçuk Can, Behice Kaniye Yilmaz, Mehmet Emre Dinç, Ömer Necati Develioğlu, Mehmet Külekçi
ObjectiveTo evaluate the effect of ET diameter on Chronic Otitis Media (COM) pathogenesis.Study designRetrospective.Subjects and methodsPatients with unilateral COM disease are included in the study. The connection between fibrocartilaginous and osseous segments of the Eustachian Tube (ET) on axial Computed Tomography (CT) images was defined and the diameter of this segment is measured. The measurements were carried out bilaterally and statistically compared.Results154 (76 (49%) male, 78 (51%) female patients were diagnosed with unilateral COM and included in the study. The mean diameter of ET was 1947mm (Std. deviation±0.5247) for healthy ears and 1788mm (Std. deviation±0.5306) for diseased ears. The statistical analysis showed a significantly narrow ET diameter in diseased ear side (p<0.01).ConclusionThe dysfunction or anatomical anomalies of ET are correlated with COM. Measuring of the bony diameter of ET during routine Temporal CT examination is recommended for our colleagues.

http://ift.tt/2nFqeZW

Open vs. endoscopic cricopharyngeal myotomy; Is there a difference?

Publication date: Available online 31 March 2017
Source:American Journal of Otolaryngology
Author(s): Colin Huntley, Maurits Boon, Joseph Spiegel
IntroductionThe upper esophageal sphincter (UES) is composed largely of the cricopharyngeus muscle (CP) and acts as the gatekeeper to the esophagus. There are multiple methods of treating UES dysfunction, but myotomy has been shown to be the most definitive means. We aim to evaluate the difference between open and endoscopic CP myotomy (CPM).MethodsA retrospective review of all patients undergoing endoscopic and open CPM was undertaken. We recorded demographic, clinical, operative, hospital, and postoperative data for both groups from January 2010–March 2015. The endoscopic and open CPM groups were directly compared.ResultsOur cohort consisted of 38 open and 41 endoscopic CPM patients. There were 22 males and 16 females in the open group and 9 males and 32 females in the endoscopic group. The primary diagnosis for both groups was cricopharyngeal hyperfunction. We found a significant improvement in surgical time and symptomatic outcomes in the endoscopic group (p=0.008 and p=0.010).There was no difference in UES preop pressure, hospital stay, complication rate, time to oral intake, or length of follow-up between cohorts.ConclusionEndoscopic CPM is a safe and effective alternative to the open approach. Patients undergoing endoscopic CPM have shorter operative times and improved outcomes when compared to the open approach.

http://ift.tt/2okNz6F

Treatment of locally advanced parotid malignancies with parotidectomy and temporal bone resection

Publication date: Available online 31 March 2017
Source:American Journal of Otolaryngology
Author(s): James R. Martin, Peter Filip, Eric J. Thorpe, John P. Leonetti
PurposeIn this study we review our institution's experience and outcomes with temporal bone resection and parotidectomy in the treatment of advanced parotid malignancies.MethodsPatients undergoing lateral temporal bone resection and parotidectomy from 2007–2013 were identified in the EPIC electronic medical record. Primary tumor location, staging, surgical procedure, and patient demographic and outcome data were collected retrospectively.ResultsFifteen patients underwent combined temporal bone resection and parotidectomy for parotid malignancy. Carcinoma ex-pleomorphic and squamous cell carcinoma were the most common pathologies. Two year disease free survival was 40%. Distant metastases were the most common site of disease recurrence. Only nodal disease was predictive of reduced disease free survival, though pre-operative facial paralysis showed a trend towards significance. Margin status and operating for recurrent tumor did not influence outcome in our series.ConclusionLocal and regional tumor controls are attainable with combined skull base approaches to advanced parotid malignancies. Unfortunately these cases have a high rate of distant recurrence despite negative margins and local control.

http://ift.tt/2nFlvYr

From transmandibular to transoral robotic approach for parapharyngeal space tumors

Publication date: Available online 31 March 2017
Source:American Journal of Otolaryngology
Author(s): Francesco Chu, Marta Tagliabue, Gioacchino Giugliano, Luca Calabrese, Lorenzo Preda, Mohssen Ansarin
PurposeParapharyngeal space (PPS) tumors are rare, accounting for 0.5% of all head-and-neck masses. Surgery remains the standard treatment for most cases, including different approaches (cervical approach, parotidectomy, mandibulotomy, transoral/robotic). We report our experience in the management of PPS tumors, aiming to create a surgical algorithm on the base of tumor's radiological and clinical characteristics.Materials and methodsCritical retrospective analysis of patients with PPS neoplasms who underwent surgery at our Institute. Data were collected on patient age and sex, tumor location and size, preoperative investigations, surgical approaches, histopathology, complications and outcomes.ResultsBetween January 2000 and July 2015, 53 patients were treated at our Institute. Salivary gland tumors were the most common neoplasms followed by neurogenic tumors. CT scan/MRI were the most used preoperative imaging studies. The cervical approach with or without parotidectomy is the most used, providing the best compromise between the need for radicality and low risk of damage to the neurovascular structures. Mandibulotomy is used whenever the mass extends to the cranial base, assuming a higher morbidity, a slower functional recovery and the need for tracheotomy. Recently, TORS has been used for tumors of the PPS with promising outcomes.ConclusionsPPS surgery includes a wide spectrum of approaches but it is still a matter of debate which one guarantees better functional and oncological outcomes. We report a surgical algorithm based on surgical invasiveness and tumor characteristics to standardize PPS tumors management. We also highlight the upcoming role of TORS in this field.

http://ift.tt/2okNyQ9

IL-17A and IL-22 producing neutrophils in psoriatic skin

Abstract

The pro-inflammatory cytokine IL-17 is recognized as playing an important role in the pathogenesis of psoriasis, an inflammatory skin disease, and the relevance of the IL-23/IL-17 axis is underlined by the recent clinical efficacy of treatments targeting this axis ¹.

http://ift.tt/2oqPWRV

Multimodal therapy facilitates a fast-track recovery after surgery - are potential drug-drug interactions of clinical significance in the perioperative period?

Anesthesiologists play an increasingly important role in facilitating a fast-track recovery after surgery [1]. Optimal management of perioperative pain using opioid-sparing multimodal analgesic techniques and preventing postoperative nausea and vomiting (PONV) using prophylactic antiemetics are key elements for achieving an enhanced recovery after surgery [2,3]. Use of multiple non-opioid analgesics acting at differing sites within the central and peripheral nervous systems is a well-documented approach to improving postoperative pain management, with numerous studies demonstrating improvement in pain scores, reduction in opioid usage (opioid-sparing) and adverse side effects, leading to a faster recovery following surgery [4].

http://ift.tt/2mWDHzD

Best practices for our most delicate patients

For over a decade now, many in the pediatric anesthesia community have debated the possible clinical consequences of anesthetic and sedative drugs on the developing brain. Numerous studies in both animals and children have called into question whether the drugs we give our pediatric patients to keep them safe and comfortable may in fact have negative long-term learning and behavior consequences. Although the clinical implications of anesthetic induced neurotoxicity remain uncertain, and may even be potentially clinically irrelevant for the vast majority of our patients, the US Food and Drug Administration's (FDA) recent Safety Announcement encourages all practitioners to address this still as of yet hypothetical risk when using anesthetic and sedative drugs [1].

http://ift.tt/2no7c8U

Do we need another short-acting beta-blocker? A definite maybe…

During the 50years since the development of the first nonselective β blockers by James Black, evolving research has led to the subsequent introduction on the market of a multitude of agents with various β receptor antagonistic properties. We have learned that β1 selective agents offer the advantage of a lesser effect on the bronchial and vascular territories and are currently the preferred agents in patients with coronary artery disease. Their cardiac protective effect has been widely recognized when part of a chronic regimen for patients who sustained a myocardial infarction, where besides a symptomatic effect, they have demonstrated a survival benefit.

http://ift.tt/2mWy8B5

Epidural catheter cutting: mechanisms and management

Epidural catheter insertion can be followed by different complications appearing at its insertion, maintenance and removal. They can be distinguished in haemorrhagic, infectious and mechanical, when directly involving the device with different mechanisms: obstruction, kinking, knotting, displacement, migration, and breakage, or more frequently cutting [1]. Our experience, even limited to a single case, illustrates well this uncommon and unexpected event.

http://ift.tt/2noabye

The effect of melatonin on early postoperative cognitive decline in elderly patients undergoing hip arthroplasty: A randomized controlled trial

The purpose of the present study was to investigate whether exogenous melatonin supplementation could ameliorate early postoperative cognitive decline (POCD) in aged patients undergoing hip arthroplasty with spinal anesthesia.

http://ift.tt/2nodSDQ

Validation of the Nexfin® non-invasive continuous blood pressure monitoring validated against Riva-Rocci/Korotkoff in a bariatric patient population

The present study aimed to validate the Nexfin® monitor and to assess the accuracy compared to classical sphygmomanometry (Riva-Rocci/Korotkoff (RRK)) blood pressure (BP) measurements in patients with obesity scheduled for bariatric surgery.

http://ift.tt/2mWCbxx

Hyperlipidemia and statins use for the risk of new-onset anxiety/depression in patients with head and neck cancer: A population-based study

by Chung-I Huang, Li-Ching Lin, Hung-Cheng Tien, Jenny Que, Wei Chen Ting, Po-Chun Chen, Hsin-Min Wu, Chung-Han Ho, Jhi-Joung Wang, Ren-Hong Wang, Ching-Chieh Yang

Objective

Anxiety/depression is common among patients with head and neck cancer (HNC), and can negatively affect treatment compliance and outcome. The aim of this study was to assess the association between hyperlipidemia and the risk of new-onset anxiety/depression after the diagnosis of HNC and the influence of administering statins.

Methods

A matched longitudinal cohort study of 1632 subjects (408 HNC patients with preexisting hyperlipidemia and 1224 age- and sex-matched HNC patients without hyperlipidemia) was included and analyzed by using data from Taiwan's National Health Insurance Research Database from January 1996 to December 2012. The incidence and hazard ratios (HRs) for the development of new-onset anxiety/depression were examined between the two groups. Cox proportional hazard regression was applied to estimate the relative risks of anxiety/depressive disorders adjusted for potential confounding factors. To estimate the risks of anxiety/depression in different sub-groups, a stratified analysis was also used.

Results

HNC patients with preexisting hyperlipidemia had a higher risk for comorbidities such as hypertension, diabetes mellitus, and cardiovascular disease (P P = 0.03). A Cox regression model revealed that preexisting hyperlipidemia was an independent risk factor for anxiety/depression (aHR, 1.96; 95% CI, 1.30–2.94). Statins use was protective against anxiety/depression among HNC patients with hyperlipidemia (aHR, 0.85; 95% CI, 0.46–1.57), especially for individuals older than 65 years and for females.

Conclusions

Preexisting hyperlipidemia was associated with increased risk of new-onset anxiety/depression in the HNC patients. Statins use for HNC patients with hyperlipidemia could decrease the risk of anxiety/depression, especially for those older than 65 years and for female patients.

http://ift.tt/2oilQTI

Phase 2 Trial of Ipilimumab and Nivolumab in Nasopharyngeal Carcinoma

Condition: Nasopharyngeal Carcinoma
Interventions: Drug: Ipilimumab; Drug: Nivolumab
Sponsors: National Cancer Centre, Singapore; National University, Singapore
Not yet recruiting - verified March 2017

http://ift.tt/2nnAggw

Immunotherapy Study of Evofosfamide in Combination With Ipilimumab

Conditions: Pancreatic Cancer; Melanoma; Squamous Cell Carcinoma of the Head and Neck; Prostate Cancer
Interventions: Drug: Evofosfamide; Drug: Ipilimumab
Sponsors: Threshold Pharmaceuticals; M.D. Anderson Cancer Center
Not yet recruiting - verified March 2017

http://ift.tt/2ojEv1L

Effect of Plum-blossom Needle vs. Tropicamide Eye Drops on Juvenile Myopia

Condition: Myopia
Interventions: Other: Plum-blossom Needle; Drug: Tropicamide Eye Drops
Sponsor: Wenzhou Medical University
Recruiting - verified March 2017

http://ift.tt/2mWbuZK

Obstructive sleep apnea is associated with increased QT corrected interval dispersion: the effects of continuous positive airway pressure

Publication date: Available online 31 March 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Nagihan Bilal, Nursel Dikmen, Fulsen Bozkus, Aylin Sungur, Selman Sarica, İsrafil Orhan, Anil Samur
IntroductionSevere obstructive sleepapnea (OSA) is associated with increased QT corrected interval dispersion (QTcd) and continuous positive airway pressure (CPAP) is thought to improve this arrhythmogenic marker.ObjectiveThe aim of the study was to determine the decrease of ratio of cardiovascular risk in patients with obstructive sleep apnea.MethodsThe study included 65 patients with severe OSA who had an apnea-hypopnea index (AHI) score of >30. Each patient underwent 12-channel electrocardiogram (ECG) monitoring and polysomnography. Patients with an AHI score of <5 were used as the control group. The control group also underwent ECG monitoring and polysomnography testing. The QTcd levels of both groups were calculated. Three months after CPAP treatment, ECG recordings were obtained from the 65 patients with severe OSA again, and their QTcd values were calculated.ResultsThere were 44 male and 21 female patients with severe OSA syndrome. The age, gender, body mass index, initial saturation, minimum saturation, average saturation, and desaturation index were determined in both groups. The QTc intervals of the OSA patients (62.48±16.29ms) were significantly higher (p=0.001) than those of the control group (29.72±6.30ms). There were statistically significant differences between the QTc values before and after the CPAP treatment, with pretreatment QTc intervals of 62.48±16.29ms and 3-month post-treatment values of 41.42±16.96ms (p=0.001). There was a positive and significant correlation between QTcd periods and the AHI and hypopnea index (HI) in OSA patients (p=0.001; r=0.71; p=0.001; r=0.679, respectively).ConclusionCPAP treatment reduced the QTcd in patients with severe OSA. In addition, shortening the QTcd periods in patients with severe OSA may reduce their risk of arrhythmias and cardiovascular disease.

http://ift.tt/2ojMrQM

Uterotonic Medications

Publication date: Available online 30 March 2017
Source:Anesthesiology Clinics
Author(s): Cristianna Vallera, Lynn O. Choi, Catherine M. Cha, Richard W. Hong

Teaser

Uterine atony is a common cause of primary postpartum hemorrhage, which remains a major cause of pregnancy-related mortality for women worldwide. Oxytocin, methylergonovine, carboprost, and misoprostol are commonly used to restore uterine tone. Oxytocin is the first-line agent. Methylergonovine and carboprost are both highly effective second-line agents with severe potential side effects. Recent studies have called into question the effectiveness of misoprostol as an adjunct to other uterotonic agents, but it remains a useful therapeutic in resource-limited practice environments. We review the current role these medications play in the prevention and treatment of uterine atony.

http://ift.tt/2nE3hXi

Anticoagulant Reversal and Anesthetic Considerations

Publication date: Available online 30 March 2017
Source:Anesthesiology Clinics
Author(s): Joseph Meltzer, Joseph R. Guenzer

Teaser

Bleeding complications are a common concern with the use of anticoagulant agents. In many situations, reversing of neutralizing their effects may be warranted. Prothrombin complex concentrate replaces coagulation factors lowered by warfarin, as does fresh frozen plasma, but in a more concentrated form. Protamine negates the effect of heparin and combines chemically with heparin molecules to form an inactive salt. It also partially reverses the effects of low-molecular-weight heparin. Recombinant activated factor VII is a nonspecific procoagulant that activates the extrinsic clotting pathway, resulting in thrombin generation, but does not directly neutralize the activity of any of the new oral anticoagulants.

http://ift.tt/2ojrtRQ

An Update on Nonopioids

Publication date: Available online 30 March 2017
Source:Anesthesiology Clinics
Author(s): Alan David Kaye, Elyse Cornett, Erik Helander, Bethany Menard, Eric Hsu, Brendon Hart, Andrew Brunk

Teaser

Despite an appreciation for many unwanted physiologic effects from inadequate postoperative pain relief, moderate to severe postoperative pain remains commonplace. Although treatment options have evolved in recent years, the use of nonopioid analgesics agents can reduce acute pain-associated morbidity and mortality. This review focuses on the importance of effective postoperative nonopioid analgesic agents, such as acetaminophen, nonsteroidal anti-inflammatory agents, gabapentinoid agents, NMDA antagonists, alpha 2 agonists, and steroids, in opioid sparing and enhancing recovery. A careful literature review focusing on these treatment options, potential benefits, and side effects associated with these strategies is emphasized in this review.

http://ift.tt/2nE1HVh

Alpha-2 Agonists

Publication date: Available online 30 March 2017
Source:Anesthesiology Clinics
Author(s): Viet Nguyen, Dawn Tiemann, Edward Park, Ali Salehi

Teaser

Alpha-2 adrenergic receptors are spread throughout the central and peripheral nervous system, specifically in the pontine locus coeruleus, medullospinal tracts, rostral ventrolateral medulla, and the dorsal horn of the spinal cord. Alpha-2 agonist agents cause neuromodulation in these centers, leading to sedation, analgesia, vasodilatation, and bradycardia with little effect on the respiratory drive, which accounts for their good safety profile. The 2 major drugs in this group are clonidine and dexmedetomidine. Their clinical applications in anesthesia practice include providing sedation in the intensive care unit or for minor procedures, adjuvant to general and regional anesthesia, analgesia, and as premedicating agents.

http://ift.tt/2ojqfWI

Pharmacologic Considerations of Anesthetic Agents in Geriatric Patients

Publication date: Available online 30 March 2017
Source:Anesthesiology Clinics
Author(s): Maunak V. Rana, Lara K. Bonasera, Gregory J. Bordelon

Teaser

Aging is a natural process of declining organ function and reserve. Census data show that the geriatric population is expected to grow to nearly 30%. More than half of geriatric patients have 1 or more surgical procedures in their lifetimes. Moreover, this is the population at greatest risk of morbidity and mortality with any given complication. There is remarkable variability in health across the age spectrum, from fit to frail and compromised. This variability requires a unique approach to anesthetic delivery and drug dosing on an individual basis to avoid complications such as postoperative cognitive dysfunction and delirium.

http://ift.tt/2nDQW5t

The effects of maternal presence during anesthesia induction on salivary cortisol levels in children undergoing tonsillectomy and/or adenoidectomy

Although parental presence during anesthesia induction is suggested to diminish operative stress level in children, there have been conflicting results about this strategy. The aim of this study was to evaluate the effects of maternal presence during induction on operative stress level in children who had tonsillectomy and/or adenoidectomy by determining the salivary cortisol levels.

http://ift.tt/2nHrI7C

ASA physical status classification system: Is it consistent amongst providers and useful in determining need for pre-operative evaluation resources?

In the current issue of Journal of Clinical Anesthesia, Curatolo1 et al. demonstrate a discrepancy between ASA Physical Status classification assignments made by anesthesiologists and those made by their medical and surgical colleagues (and their mid-level providers) in a hospital-based academic practice. Using brief clinical vignettes, the ASA-PS grading done by non-anesthesiologists was significantly lower and more variable than ASA-PS grading done by anesthesiologists. It follows that institutional policies that reflexively trigger pre-operative workup by ASA-PS classifications determined by surgeons and their physician-extenders independent of evaluation by anesthesiologists could create practice variability that leads to under- and over-use of pre-operative evaluation resources.

http://ift.tt/2nmUFT2

Levosimendan does not provide mortality benefit over dobutamine in adult patients with septic shock: A meta-analysis of randomized controlled trials

Despite of advancement in intensive care medicine, sepsis and septic shock carry a high mortality. Levosimendan, an inodilator, may be promising for septic shock patients with myocardial dysfunction; however, firm evidence is lacking. In this meta- analysis of randomized controlled trials, levosimendan has been compared with dobutamine in adult patients with sepsis and septic shock.

http://ift.tt/2nHxNRK

Remifentanil as an alternative to epidural analgesia for vaginal delivery: A meta-analysis of randomized trials

Although epidural analgesia is considered the gold standard for labor pain management, its use may be restricted in some conditions due to clinical contraindications or availability, and suitable alternatives may be required. The objective of this meta-analysis was to determine whether evidence from randomized trials suggests remifentanil PCA (R-PCA) results in significant differences in maternal satisfaction, analgesic efficacy, and safety compared with conventional epidural analgesia (EA).

http://ift.tt/2nn3lZR

Post-mastectomy cancer recurrence with and without a continuous paravertebral block in the immediate postoperative period: a prospective multi-year follow-up pilot study of a randomized, triple-masked, placebo-controlled investigation

Abstract

Purpose

Retrospective studies have associated perioperative regional anesthesia/analgesia during mastectomy for breast cancer with a decreased incidence of cancer recurrence. However, to date, no prospective data from a randomized controlled trial have been reported. In a previous study we found that extending a single-injection paravertebral block with a multiple-day perineural local anesthetic infusion improves analgesia. This follow-up study investigates the rates of cancer recurrence for the single-injection and multiple-day infusion treatments.

Methods

Patients undergoing unilateral (n = 24) or bilateral mastectomy (n = 36) were included in the study. All patients had been diagnosed with breast cancer or tumor in situ, except for six patients who were receiving prophylactic bilateral mastectomy and were excluded from analyses. Patients received unilateral or bilateral single-injection thoracic paravertebral block(s) corresponding to their surgical site(s) with ropivacaine and perineural catheter(s). Subsequently, patients were randomized to receive either ropivacaine 0.4% (n = 30) or normal saline (n = 30) via their catheter(s) until catheter removal on postoperative day 3. Cancer recurrence from the date of surgery until at least 2 years post surgery was investigated via chart review.

Results

Five of the 54 (9.2%) patients experienced a cancer recurrence following mastectomy—3 of 26 (11.5%) of the patients with perineural ropivacaine and 2 of 28 (7.1%) of the patients with perineural saline.

Conclusions

This pilot study found no evidence that extending a single-injection paravertebral block with a multi-day perineural local anesthetic infusion decreases the risk of post-mastectomy cancer recurrence. However, due to the small sample size of this investigation, further research is needed to draw definitive conclusions.

http://ift.tt/2nmExRE

Superficial cutaneous hemorrhagic lesions in three mycosis fungoides patients using acitretin

http://ift.tt/2nSkC0Q

The dual regulation of substance P-mediated inflammation via human synovial mast cells in rheumatoid arthritis

Publication date: Available online 31 March 2017
Source:Allergology International
Author(s): Yuki Okamura, Shintaro Mishima, Jun-ichi Kashiwakura, Tomomi Sasaki-Sakamoto, Shota Toyoshima, Kazumichi Kuroda, Shu Saito, Yasuaki Tokuhashi, Yoshimichi Okayama
BackgroundNeural pathways are thought to be directly involved in the pathogenesis of rheumatoid arthritis (RA). Although synovial mast cells (MCs) are activated by substance P (SP), the role of MCs in neural pathways in RA remains unknown. The aims of this study were to investigate 1) whether tachykinins are produced by synovial MCs and whether production differs in RA and osteoarthritis (OA) patients, and 2) what is the responsible receptor for SP in synovial MCs.MethodsSynovial tissues were obtained from patients with RA or OA undergoing joint replacement surgery. Cultured synovium-derived MCs were generated by culturing dispersed synovial cells with stem cell factor. SP expression was investigated using immunofluorescence and enzyme immunoassays. Mas-related gene X2 (MrgX2) expression was reduced in human MCs using a lentiviral shRNA silencing technique.ResultsSP expression was localized around the cell membrane in 41% (median) of the MCs in synovium from RA but in only 7% of that from OA, suggesting the activation of MCs. Synovial MCs expressed tachykinin (TAC) 1 mRNA, the expression of which was upregulated by the aggregation of FcɛRI or the addition of aggregated IgG. However, the released SP appeared to be rapidly degraded by MC chymase. Synovial MCs were activated with SP through MrgX2 to release histamine without producing proinflammatory cytokines.ConclusionsActivated synovial MCs may rapidly degrade SP, which may downregulate the SP-mediated activation of synoviocytes in RA. On the other hand, SP activates MCs to induce inflammatory mediators, suggesting the dual regulation of SP-mediated inflammation by MCs in RA.

http://ift.tt/2oGNMgi

Pustular allergic contact dermatitis caused by Disperse Yellow 3 in a dark blue dress

Publication date: Available online 31 March 2017
Source:Allergology International
Author(s): Eri Hotta, Risa Tamagawa-Mineoka, Koji Masuda, Norito Katoh

http://ift.tt/2nSwbF5

Measuring the condylar unit in condylar hyperplasia: from the sigmoid notch or from the mandibular lingula?

Publication date: Available online 30 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): R. Fariña, R. Bravo, R. Villanueva, S. Valladares, A. Hinojosa, B. Martinez
The objective of this study was to determine, in patients with active unilateral condylar hyperplasia, which is the most reliable point to measure the length of the condylar unit: from the sigmoid notch or from the mandibular lingula to the condylar head. On cone beam computed tomography, an observational cross-sectional study was designed for 20 patients with active unilateral condylar hyperplasia. We measured and compared ramus length (affected and healthy sides) and condylar length (measured from the mandibular lingula and from the mandibular sigmoid notch) on both sides. The average of all the differences in ramus height (D.1) was 7.97mm; the average of all the differences in condylar heights measured from mandibular lingula (D.2) was 7.16mm, and measured from the sigmoid notch (D.3) was 4.89mm. No significant difference between D.1 and D.2 (P=0.818). There was a significant difference between D.1 and D.3 (P=0.005) and between D.2 and D.3 (P=0.0005). It can be concluded that the mandibular lingula is the lowest point of the condylar skeletal unit and is therefore a stable parameter to be used in patients with condylar hyperplasia. On the other hand, the sigmoidal notch is not a stable parameter in patients with asymmetry due to condylar hyperplasia.

http://ift.tt/2nqIrcZ

Lateral ridge augmentation with Bio-Oss alone or Bio-Oss mixed with particulate autogenous bone graft: a systematic review

Publication date: Available online 31 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): H.C. Aludden, A. Mordenfeld, M. Hallman, C. Dahlin, T. Jensen
The objective of this systematic review was to test the hypothesis of no difference in implant treatment outcomes when using Bio-Oss alone or Bio-Oss mixed with particulate autogenous bone grafts for lateral ridge augmentation. A search of the MEDLINE, Cochrane Library, and Embase databases in combination with a hand-search of relevant journals was conducted. Human studies published in English from 1 January 1990 to 1 May 2016 were included. The search provided 337 titles and six studies fulfilled the inclusion criteria. Considerable variation prevented a meta-analysis from being performed. The two treatment modalities have never been compared within the same study. Non-comparative studies demonstrated a 3-year implant survival of 96% with 50% Bio-Oss mixed with 50% autogenous bone graft. Moreover, Bio-Oss alone or Bio-Oss mixed with autogenous bone graft seems to increase the amount of newly formed bone as well as the width of the alveolar process. Within the limitations of this systematic review, lateral ridge augmentation with Bio-Oss alone or in combination with autogenous bone graft seems to induce newly formed bone and increase the width of the alveolar process, with high short-term implant survival. However, long-term studies comparing the two treatment modalities are needed before final conclusions can be drawn.

http://ift.tt/2mVvuLY

Role of local alendronate delivery on the osseointegration of implants: a systematic review and meta-analysis

Publication date: Available online 31 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S.V. Kellesarian, T. Abduljabbar, F. Vohra, V.R. Malignaggi, H. Malmstrom, G.E. Romanos, F. Javed
There is controversy regarding whether locally delivered alendronate enhances osseointegration. The aim of this systematic review was to assess the role of local alendronate delivery (topical, or as a coating on implant surfaces) in the osseointegration of implants. The focused question was, "Does the local delivery of alendronate affect osseointegration around implants?". To address this question, indexed databases were searched, without time or language restriction, up to and including January 2017. Various combinations of the following key words were used: "alendronate", "bisphosphonates", "osseointegration", and "topical administration". letters to the editor, historic reviews, commentaries, case series, and case reports were excluded. In total, 18 experimental studies were included: alendronate-coated implants were used in 13 of these studies and local delivery in five studies. The results of 11 of the studies showed that alendronate coating increased new bone formation, the bone volume fraction, or bone-to-implant contact (BIC) and biomechanical properties. Results from two studies in which alendronate was administered topically indicated impaired BIC and/or biomechanical fixation around implants. On experimental grounds, local alendronate delivery seems to promote osseointegration. From a clinical perspective, the results in animal models support phase 1 studies in healthy humans (without co-morbidities other than edentulism).

http://ift.tt/2nqIs0x

How much does experience in guided implant surgery play a role in accuracy? A randomized controlled pilot study

Publication date: Available online 31 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M. Cassetta, M. Bellardini
The current literature is not consistent on whether experience influences accuracy. The aim of this study was to analyze the accuracy of implant insertion performed by inexperienced versus experienced surgeons. Thirty-three implants were inserted by the inexperienced group and 37 implants by the experienced group. Planning and post-surgical computed tomography images were matched and the accuracy data compared. The positioning error was also evaluated. Quantitative data for the two groups were described and illustrated using box plots. The t-test was used to compare accuracy values and positioning error. Significance was set at P≤0.05. In the inexperienced group, the mean coronal, apical, and angular deviation values were 0.75mm (range 1.01–0.51, standard deviation (SD) 0.18), 1.02mm (range 1.99–0.64, SD 0.44), and 3.07° (range 9.22–0.73, SD 2.70). In the experienced group, the mean coronal, apical, and angular deviations were 0.60mm (range 1.00–0.06, SD 0.25), 0.67mm (range 1.67–0.24, SD 0.34), and 3.21° (range 8.01–1.41, SD 1.57). The t-test did not show any statistically significant difference when coronal (P=0.125), apical (P=0.060), and angular (P=0.859) deviations were considered. A statistically significant difference (P=0.000) was determined when the positioning error was considered. Experience had a limited influence on accuracy, but reduced positioning error to a statistically significant degree.

http://ift.tt/2mViIxj

Islanded facial artery musculomucosal flap for tongue reconstruction

Publication date: Available online 31 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): O. Massarelli, L.A. Vaira, G. De Riu

http://ift.tt/2nqibQ8

Histomorphometric analysis of unilateral condylar hyperplasia in the temporomandibular joint: the value of the condylar layer and cartilage island

Publication date: Available online 31 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): B. Vásquez, S. Olate, M. Cantín, C. Sandoval, M. del Sol, M. de Moraes
This study aimed to describe the condylar layer and cartilage island in subjects with unilateral condylar hyperplasia (UCH). Five individuals (15–18 years old) with a diagnosis of UCH, treated in a university hospital in Temuco, Chile, were included. The analysis examined the presence, extension, and thickness of the layers on the condylar surface, the number, depth, and area of the cartilage islands, and the argyrophilic proteins of the nucleolar organizer region (AgNOR) score. Statistical significance was set at P<0.05. The fibrocartilaginous layer was thickest (0.13±0.05mm) and the joint layer was thinnest (0.07±0.01mm) (P<0.05). With respect to the number, depth, and area of the islands, case 1 presented the highest values, followed by case 2; the cartilage island was related to the fibrocartilaginous layer (P<0.05). All cases had AgNOR proteins in the proliferative and fibrocartilaginous layers, as well as the islands with the greatest presence of chondrocytes (P=0.245). A relationship was observed between the histopathological alterations in the different layers on the condylar surface and the thickness of the fibrocartilaginous layer, as well as the thickness of the latter and the number, depth, and area of the cartilage islands in the trabecular bone.

http://ift.tt/2mVhfqx

Successful treatment of multidrug-resistant Pseudomonas aeruginosa pubic symphysis osteomyelitis with ceftolozane/tazobactam

New antibiotic options are needed for the treatment of multidrug-resistant (MDR) Pseudomonas infections. We present a case of a man aged 64 years with a bladder fistula due to radiation, ultimately causing osteomyelitis of the pubic symphysis. Repeated antibiotic courses, without correcting the fistula, resulted in infection with MDR Pseudomonas aeruginosa. He was successfully treated for his osteomyelitis through cystectomy, aggressive debridement and a prolonged course of antimicrobials directed at the MDR Pseudomonas isolate.

http://ift.tt/2nH0yxJ

Incidental finding of anomalous circumflex coronary artery from right coronary sinus prior to aortic valve surgery

Anomalous origin of the left circumflex (Cx) artery is a common and mostly benign coronary artery anomaly. We report the case of a man aged 52 years who presented to his local hospital with progressive breathlessness on exertion and syncopal episodes. His admission transthoracic echocardiography (TTE) showed bicuspid aortic valve, severe aortic stenosis with a valve area of 0.5 cm² and his left ventricular ejection fraction (LVEF) was 27%. His coronary angiogram showed normal coronary arteries but anomalous origin of the Cx artery from the right coronary. He underwent elective bioprosthetic aortic valve replacement. His postoperative recovery was uneventful and he was discharged on day 5 postoperatively. His TTE postoperatively showed well-seated aortic valve, improved LVEF to 51%. We here report a case of incidental finding of anomalous Cx artery arising from the right coronary while the patient is being worked up for aortic valve replacement for congenital bicuspid aortic valve.

http://ift.tt/2nmEaX3

Emergence of new-onset psychotic disorder following recovery from LGI1 antibody-associated limbic encephalitis

Neuronal autoantibodies targeting cell surface antigens have been described in association with autoimmune encephalitides which frequently feature psychosis and other psychiatric disturbances alongside neurological signs and symptoms. Little has been written however about the long-term psychiatric status of individuals following recovery from the acute phase of autoimmune encephalitis, despite case series and anecdotal evidence suggesting this may be a cause of considerable disability. Here, we describe a man aged 58 years with no psychiatric history who developed a severe and acute psychotic disorder following resolution of a protracted course of limbic encephalitis associated with antibodies to leucine-rich glioma inactivated 1 protein. No indications of a gross ongoing inflammatory or encephalopathic process were present at presentation of his psychosis. Possible aetiologies of his acute psychosis are discussed. This case highlights the importance of ongoing psychiatric follow-up of patients following an episode of autoimmune encephalitis.

http://ift.tt/2nH5xOZ

False-negative contrast-enhanced spectral mammography: use of more than one imaging modality and application of the triple test avoids misdiagnosis

A 50-year-old woman presented with chest tenderness. On examination, both breasts were lumpy. Bilateral mammography showed heterogeneously dense parenchyma, with possible stromal distortion laterally on the right at the 0900 position. On ultrasound (US), a corresponding 13x9x10 mm irregular hypoechoic mass with internal vascularity was noted and both breasts had a complex heterogeneous fibroglandular background pattern. US-guided core biopsy with marker clip insertion was performed with the diagnosis of a grade 2 invasive ductal carcinoma (IDC). In view of the parenchymal pattern on mammography and US, contrast-enhanced spectral mammography (CESM) was performed for local staging. Mild background enhancement was noted, but there was no enhancement at the lesion site. The patient elected to have bilateral mastectomies and sentinel node biopsies. Final histopathology showed a node negative 11 mm grade 2 oestrogen and progesterone receptor positive, IDC.

http://ift.tt/2nmqRGc

Antimitochondrial antibodies-positive myositis accompanied by cardiac involvement

We report a 55-year-old man who experienced proximal muscle weakness accompanied by the atrial flutter (AFL) with 1:1 conduction. Detailed examination revealed elevated antimitochondrial antibodies (AMA) and creatine kinase (CK). AFL was converted to sinus rhythm by cardioversion. He was diagnosed as AMA-positive myositis-associated AFL and was treated by prednisolone. Although his muscle weakness and CK level improved, AFL with 1:1 conduction reappeared. Therefore, radiofrequency catheter ablation (RFCA) was needed to treat the AFL, resulting in maintenance of sinus rhythm. This case report describes cardiac involvement in a patient with AMA-positive myositis.

http://ift.tt/2nGYwOf

Is nitrogen mustard contamination responsible for the reported MT-45 toxicity?

Abstract

Helander et al. are commended for disseminating their case reports in the recent publication entitled "Acute skin and hair symptoms followed by severe, delayed eye complications in subjects using the synthetic opioid MT-45″.¹ We have followed reports of side effects associated with MT-45 use for several years and the above publication serves as an important reminder of the risks of harm involved in the unregulated use of new psychoactive substances.

http://ift.tt/2oFWnzZ

β2 Integrins Rather than β1 Integrins Mediate Alternaria-induced ILC2 Trafficking to the Lung

Publication date: Available online 30 March 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Maya R. Karta, Peter S. Rosenthal, Andrew Beppu, Christine Y. Vuong, Marina Miller, Sudipta Das, Richard C. Kurten, Taylor A. Doherty, David H. Broide
BackgroundGroup 2 innate lymphoid cells (ILC2s) expand in the lungs of mice during type 2 inflammation induced by the fungal allergen Alternaria alternata. The increase in ILC2 numbers in the lung has been largely attributed to local proliferation and whether ILC2s migrate from the circulation to the lung following Alternaria exposure is unknown.ObjectiveWe examined whether human (lung, lymph node, blood) and mouse lung ILC2s express β1 and β2 integrin adhesion molecules, and whether these integrins are required for trafficking of ILC2 into the lungs of miceMethodsHuman and mouse ILC2s were assessed for surface expression of β1 and β2 integrins adhesion molecules by flow cytometry. The role of β1 and β2 integrins in ILC2 trafficking to the lungs was assessed by in vivo blocking of these integrins prior to airway exposure to Alternaria in mice.ResultsBoth human and mouse lung ILC2s express high levels of β1 and β2 integrin adhesion receptors. Intranasal administration of Alternaria challenge reduced ILC2s in the bone marrow and concurrently increased blood and lung ILC2 levels. In vivo blocking of β2 integrins (CD18) significantly reduced ILC2 levels in the lungs, but did not alter ILC2 proliferation, apoptosis, and function. In contrast, in vivo blocking of β1 integrins or α4 integrins did not affect lung ILC2 levels.ConclusionILC2s increase in number in the mouse lung not only through local proliferation, but also through trafficking from the circulation into the lung using β2 rather than β1 or α4 integrins.

Teaser

ILC2s, which express high levels of Th2 cytokines, are not only resident in the lung, but also traffic from the bone marrow to the lung upon exposure to Alternaria, an allergen associated with severe asthma.

http://ift.tt/2nRRwi7

CTLA-4 Haploinsufficiency in a Patient with an Autoimmune Lymphoproliferative Disorder

Publication date: Available online 30 March 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Zeynep Yesim Kucuk, Louis-Marie Charbonnier, Richard L. McMasters, Talal Chatila, Jack J.H. Bleesing

http://ift.tt/2nCGScJ

Association of Parathyroid Gland Biopsy Excision Technique With Ex Vivo Radiation Counts During Radioguided Parathyroid Surgery.

Association of Parathyroid Gland Biopsy Excision Technique With Ex Vivo Radiation Counts During Radioguided Parathyroid Surgery.

JAMA Otolaryngol Head Neck Surg. 2017 Mar 30;:

Authors: Hinson AM, Lawson BR, Franco AT, Stack BC

Abstract
Importance: Parathyroid biopsy represents a means for normal and hyperfunctional glands to be distinguished intraoperatively. However, no data exist to guide surgeons regarding how much of a parathyroid gland must be biopsied to satisfy the 20% rule.
Objective: To quantify the relative proportion of a hyperfunctional parathyroid gland that must be evaluated with the gamma probe to satisfy the 20% rule.
Design, Setting, and Participants: A retrospective review of surgical data for 24 consecutive patients (16 women, 18 men; mean [SD] age, 66.6 [10] years; range, 51-83 years) who underwent surgery for primary hyperparathyroidism between May and October, 2015, in a tertieary academic medical center.
Main Outcomes and Measures: Extirpated parathyroid glands were sectioned into parallel or pie-shaped biopsies and evaluated ex vivo with a gamma probe to determine what percentage of a hyperfunctional gland must be sampled to meet the Norman 20% rule. The hypothesis was formulated during data collection.
Results: In total, 253 ex vivo biopsy specimens were obtained from 33 surgically removed parathyroid glands. Parathyroid biopsies satisfied the 20% rule with an accuracy that depended on the relative proportion of the parent gland represented: half or more (96.6%; 95% CI, 91.7%-100.0%), a quarter to one-half (87.0%; 95% CI, 79.3%-94.7%), less than a quarter (63.6%; 95% CI, 54.5%-72.8%). When less than a quarter of the gland was removed, pie-shaped biopsies were more likely to satisfy the 20% rule compared with parallel biopsies of the same weight (78.4% vs 56.2%; absolute difference, 22.2%; 95% CI, 4.7%-39.7%).
Conclusions and Relevance: Unless half of a parathyroid gland is biopsied during radioguided parathyroidectomy, the 20% rule cannot reliably rule out the presence of a hyperfunctional parathyroid lesion. Pie-shaped biopsies originating from the center of the gland are associated with a lower rate of false-negative results compared with peripheral biopsies of similar size. Pie-shaped biopsies and biopsy of half or more of each nonexcised parathyroid gland for ex vivo counts may increase the risk of remnant devascularization and resultant hypoparathyroidism.

PMID: 28358958 [PubMed - as supplied by publisher]

http://ift.tt/2oieobz

Slowly Enlarging Neck Mass.

Slowly Enlarging Neck Mass.

JAMA Otolaryngol Head Neck Surg. 2017 Mar 30;:

Authors: Chase T, Dingle I, Ridley MB

PMID: 28358940 [PubMed - as supplied by publisher]

http://ift.tt/2nCGIlB

Association of Transoral Robotic Surgery With Short-term and Long-term Outcomes and Costs of Care in Oropharyngeal Cancer Surgery.

Association of Transoral Robotic Surgery With Short-term and Long-term Outcomes and Costs of Care in Oropharyngeal Cancer Surgery.

JAMA Otolaryngol Head Neck Surg. 2017 Mar 30;:

Authors: Motz K, Chang HY, Quon H, Richmon J, Eisele DW, Gourin CG

Abstract
Importance: The treatment of oropharyngeal cancer has undergone a paradigm shift in the past 2 decades, with an increase in the use of nonoperative treatment owing to poor functional outcomes associated with traditional surgical approaches. Transoral robotic surgery (TORS) allows surgical resection of oropharyngeal cancer (OPC) with less morbidity through a minimally invasive approach.
Objective: To investigate the relationship among TORS and short- and long-term outcomes and costs in surgically treated patients with OPC.
Design, Setting, and Participants: Retrospective cross-sectional analysis of 3573 patients who underwent an ablative procedure for OPC in 2010 to 2012 using the MarketScan Commercial Claim and Encounters database.
Main Outcomes and Measures: The association between TORS and short- and long-term outcomes, length of hospitalization, and treatment-related costs was analyzed using descriptive statistics and multivariate regression modeling.
Results: Transoral robotic surgery was performed in 304 surgical cases (8.5%); 94.7% of patients were 40 to 64 years old, and 70.7% were male. The use of TORS increased from 4.1% of surgical cases in 2010 to 13.2% of surgical cases in 2012. Patients who underwent TORS had a lower rate of tracheotomy during treatment (3.9% vs 11.4%), and posttreatment gastrostomy tube use (21.9% vs 34.2%), compared with patients undergoing non-TORS procedures. On multivariate analysis, TORS was not associated with significant differences in postoperative complications or length of hospitalization. There was no significant difference in the odds of receiving postoperative radiation therapy between patients who underwent TORS and those who did not; however, among patients receiving radiation therapy, chemoradiation was significantly less likely following TORS (odds ratio [OR], 0.52; 95% CI, 0.29-0.90). TORS was associated with significantly decreased odds of posttreatment gastrostomy (OR, 0.54; 95% CI. 0.30-0.95) and tracheostomy during treatment (OR, 0.17; 95% CI, 0.06-0.55) at 1 year, and was associated with significantly decreased overall treatment-related costs of care (mean incremental cost, -$22 724).
Conclusions and Relevance: The use of TORS for surgical resection of OPC is increasing in the United States and is associated with significantly lower use of adjuvant chemoradiation, late gastrostomy and tracheostomy dependence, and lower overall treatment-related costs of care. These data have implications for discussions of value in OPC care at a time of health care reform.

PMID: 28358930 [PubMed - as supplied by publisher]

http://ift.tt/2oipVrx

Prevalence of skin diseases treated at public referral hospitals in KwaZulu-Natal, South Africa

Abstract

In South Africa(S.A), a country of about 50.6 million inhabitants, approximately 85% of the population is dependent on the public health sector. A total of 220 dermatologists practise in South Africa, with a ratio of 1 dermatologist: 216 000 people and most practising in the private urban areas. The importance and the need to quantify the burden of disease led us to describe prospectively the epidemiology of skin conditions in five public referral hospitals in the second most populous province of South Africa (S.A), KwaZulu Natal (KZN).

http://ift.tt/2mUWxXJ

Controlling the anaphylatoxin C5a in diseases requires a specifically targeted inhibition

Publication date: Available online 30 March 2017
Source:Clinical Immunology
Author(s): Niels C. Riedemann, Maria Habel, Jana Ziereisen, Marlen Hermann, Conny Schneider, Cyrill Wehling, Michael Kirschfink, Karim Kentouche, Renfeng Guo
The terminal complement split product C5a has been described as an important mediator in inflammatory diseases. C5a is generated upon cleavage of C5 and earlier research suggests that, besides the known C5 convertases formed upon activation of the complement pathways, various enzymes could activate C5 directly. We demonstrate that eculizumab effectively blocks C5 activation when mediated by C5-convertase formation, but fails to block C5a generation resulting from direct enzymatic cleavage by trypsin and thrombin. C5a generated by these enzymes is shown to be fully biologically functional and can be blocked by IFX-1, a specific monoclonal anti-human C5a antibody. We further report clinical cases of atypical hemolytic uremic syndrome (aHUS) and C3 Glomerulonephritis (C3GN) patients under treatment with eculizumab presenting substantially elevated C5a levels. Thus, blocking the C5 convertase mediated activation of C5 may not be efficient to control C5a-mediated effects in human disease and that a targeted approach is warranted.

http://ift.tt/2nmaLwr

The Distribution of Transplanted Umbilical Cord Mesenchymal Stem Cells in Large Blood Vessel of Rats With Traumatic Brain Injury.

The author aim to track the distribution of human umbilical cord mesenchymal stem cells (MSCs) in large blood vessel of traumatic brain injury -rats through immunohistochemical method and small animal imaging system. After green fluorescent protein (GFP) gene was transfected into 293T cell, virus was packaged and MSCs were transfected. Mesenchymal stem cells containing GFP were transplanted into brain ventricle of rats when the infection rate reaches 95%. The immunohistochemical and small animal imaging system was used to detect the distribution of MSCs in large blood vessels of rats. Mesenchymal stem cells could be observed in large vessels with positive GFP expression 10 days after transplantation, while control groups (normal group and traumatic brain injury group) have negative GFP expression. The vascular endothelial growth factor in transplantation group was higher than that in control groups. The in vivo imaging showed obvious distribution of MSCs in the blood vessels of rats, while no MSCs could be seen in control groups. The intravascular migration and homing of MSCs could be seen in rats received MSCs transplantation, and new angiogenesis could be seen in MSCs-transplanted blood vessels. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2nRbz05

Idiopathic Sialolithiasis: Scalpel Versus Current Trends in Management.

Idiopathic sialolithiasis is one of the most common affliction of the salivary glands with the submandibular gland most frequently involved. The article discusses the occurrence and incidence of this condition with a review of different diagnostic and treatment modalities. In light of several advances to diagnose and treat sialolithiasis, a simple sialolithotomy for idiopathic submandibular gland sialolithiasis may prove to be a preferred treatment for selected patients as it remains a cost-effective and simple out-patient department procedure with minimal/no complications and a highly satisfactory outcome. For stones slightly proximal in the Wharton duct, a "dual" approach of milking the gland to bring the stone more distally followed by a sialolithotomy with a scalpel proves to be a quick and effective procedure. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2oFpOlB

Salvage of a Necrotic Flap.

Objective: To report the case of a 68-year-old woman with a skin basal cell carcinoma on the nasal dorsum. After excision, the soft tissue defect was reconstructed using a rectangular advancement flap. However, 2 days later skin necrosis was observed. This report was issued to advise how to avoid and manage skin necrosis after regional flap placement. Methods: This is a retrospective study. Results: Superficial skin necrosis recovered completely after proper medical management. Conclusions: When planning an advancement flap, care should be taken to design the flap properly and not to injure flap blood supply to avoid skin necrosis. In addition, surgeons should be aware of the difference between superficial and total flap necrosis. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2nRdHVx

The Degree of Surgical Frontal Volume Correction in Metopic Synostosis Determines Long-Term Outcomes.

Metopic synostosis results in a keel-shaped forehead, reduced frontal intracranial volume (ICV), and lower frontal to total volume ratio. The ratio improves with cranioplasty, but at 3 years of age, the ratio is still not normalized when compared to that in normal children. The aim of the present study was to investigate whether a low frontal to total ICV ratio at 3 years of age was due to relapse or insufficient correction. All children surgically treated for metopic synostosis in combination with a spring at Sahlgrenska University Hospital with subsequent spring extraction between 2002 and 2008 (n = 20) were included. A MATLAB program was used to measure frontal and total ICV. Preoperatively, the frontal to total ICV ratio was 9.8 +/- 1.3% (mean +/- standard deviation). At spring removal, 6 months after cranioplasty, the ratio had increased to 11.8 +/- 2.4%. At 3 years of age, the ratio was 11.6 +/- 1.9%. In age-matched normal children, the ratio was 14.4 +/- 1.9% preoperatively, 15.3 +/- 2.2% at time of spring extraction, and 13.4 +/- 1.4% at 3 years of age. Cranioplasty thus improved the frontal to total ICV ratio, but did not normalize it. The ratio did not change from 6 months after the cranioplasty to 3 years of age. These results indicate that a more pronounced frontal volume correction during cranioplasty is necessary to achieve a normalized distribution of ICV in metopic synostosis. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2oFiVRw

Histomorphometric Comparison of Bone Regeneration in Critical-Sized Bone Defects Using Demineralized Bone Matrix, Platelet-Rich Fibrin, and Hyaluronic Acid as Bone Substitutes.

Aim: To compare bone regeneration in the critical-sized bone defects grafted with demineralized bone matrix, platelet-rich fibrin, and hyaluronic acid in rats. Materials and Methods: Forty Wistar Albino rats allocated into 4 experimental groups: platelet-rich fibrin (PRF) group, noncross-linked hyaluronic acid gel (HA) group, demineralized bone matrix in putty form (DBM) group, and control group. A critical-sized defect of 8 mm was formed involving the sagittal suture for each rat under anesthetic induction. All animals were sacrificed at 21st day after surgery and histomorphometric parameters of total horizontal length (THL) and total vertical length (TVL) of newly produced bone and longest bone trabecula (LBT) were measured in the histologic slides. The difference between experimental groups for these parameters was analyzed. Results: There was statistically significant difference in THL and LBT but not in TVL. Total horizontal length was significantly increased in DBM group compared with control and HA groups (P

http://ift.tt/2nReENP

Craniosynostosis and Guanine Nucleotide-binding Protein Alpha Stimulating Mutation: Risk of Bleeding Diathesis and Circulatory Collapse in Patients Undergoing Cranial Vault Reconstruction.

Reconstruction of the craniosynostosis deformity is a relatively safe operation with low overall complication risks. Despite expected risk of significant blood loss, life-threatening bleeding is relatively rare, and there is a low incidence of reported deaths in the literature. Several modalities have been described for perioperative mitigation of blood loss and transfusion requirements. Due to the low overall risk of life-threatening bleeding and circulatory collapse, it is judicious that any potential causes of such unusual but potentially significant fatal bleeding complication be evaluated and reported to increase awareness for craniofacial surgeons treating these conditions. In this report and literature review, the authors present a highly unusual patient with significant bone bleeding and circulatory collapse in a metopic craniosynostosis patient with guanine nucleotide-binding protein alpha stimulating (GNAS) mutation; perform a literature review regarding bleeding diathesis in craniosynostosis patients with GNAS mutations; and suggest guidelines to potentially prevent mortality in such patients. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2oFt7JL

Whole Blood in Pediatric Craniofacial Reconstruction Surgery.

Background: Pediatric complex cranial vault reconstruction (CCVR) surgery is often associated with significant blood loss and transfusion. The authors recently changed our transfusion practice during CCVR to using whole blood (WB) instead of reconstituted blood (RB). The aim of this study was to assess the impact of this practice change. Our hypothesis was that replacement with WB would be as effective as RB for the outcomes of total perioperative blood donor exposures (BDEs) and the incidence of laboratory evidence of postoperative coagulopathy. Methods: The authors queried the Pediatric Craniofacial Surgery Perioperative Registry for children ages

http://ift.tt/2nRjYR2

Αρχειοθήκη ιστολογίου

Παρασκευή 31 Μαρτίου 2017

Summary

Background

Objective

Patients/Methods

Results

Conclusion

Abstract

Abstract

Abstract

Abstract

Abstract

Teaser

Teaser

Teaser

Teaser

Teaser

Abstract

Purpose

Methods

Results

Conclusions

Abstract

Teaser

Abstract