We would like to comment on the manuscript entitled "Detection of endolymphatic hydrops using traditional MR imaging sequences." by Keller et al. [1]. It is of great clinical value if non-contrast MR imaging can be used to differentiate the endo- and perilymph space as the authors have stated. We read this article with great interest and thank the authors for citing our six papers. However, there are some critical points that need to be clarified in this paper.
http://ift.tt/2swYyaJ
Παρασκευή 30 Ιουνίου 2017
Letter to Editors: Detection of endolymphatic hydrops using traditional MR imaging sequences
Solitary fibrous tumour of the pleura presenting as a giant intrathoracic mass
Solitary fibrous tumours (SFTs) are relatively rare neoplasms thought to originate from the submesothelial connective tissue. SFTs have been described in a variety of sites, including the pleura, orbit, lower respiratory tract, peritoneal cavity and heart. These neoplasms are usually benign, though locally aggressive, and metastatic behaviour has been observed in some cases. We describe a case of a 61-year-old man presenting with weight loss, poor appetite, malaise, worsening dyspnoea on exertion and lower extremity oedema, who was found to have a gigantic—21x21 cm—tumour occupying the entire right hemithorax causing compression and displacement of the mediastinum and liver. Transthoracic CT-guided biopsy revealed SFT of the pleura. The patient underwent preoperative angiography and embolisation of the tumour followed by successful surgical resection via thoracotomy.
http://ift.tt/2sbubr1
Traction suture modification to tongue-in-groove caudal septoplasty
Caudal septal deviation leads to unfavorable esthetic as well as functional effects on the nasal airway. A modification to the tongue-in-groove (TIG) technique to correct these caudal septal deformities is described. With placement of a temporary suspension suture to the caudal septum, manual traction is applied, assuring that the caudal septum remains in the midline position while it is being secured with multiple through-and-through, trans-columellar and trans-septal sutures. From 2003 to 2016, 148 patients underwent endonasal septoplasty using this modified technique, with excellent functional and cosmetic outcomes and a revision rate of 1.4%.
http://ift.tt/2sbwY3p
Three-dimensional printed haptic model from a prenatal surface-rendered oropalatal sonographic view: a new tool in the surgical planning of cleft lip/palate
Three-dimensional (3D) ultrasound has significantly improved prenatal screening and perinatal care in the area of cleft lip/palate and other deformities, providing essential preoperative information to the surgical team. However, current 3D reconstruction modalities are limited primarily to display on a two-dimensional surface. In contrast, a 3D printed haptic model allows both the surgeon and the parents to develop a better understanding of the anatomy and the surgical procedure through the ability to interact directly with the printed model.
http://ift.tt/2tuByh7
Laser irradiation promotes the proliferation of mouse pre-osteoblast cell line MC3T3-E1 through hedgehog signaling pathway
Abstract
Low-level laser could promote osteoblast proliferation, and it has been applied in clinical practice to promote wound healing and tissue regeneration. However, the mechanism related to laser irradiation remains unclear. This study aimed to investigate the effects of low-level laser irradiation on the cell proliferation and the expressions of hedgehog signaling molecules Indian hedgehog (Ihh), Ptch, and Gli in vitro. In our present study, the MTT method was used to evaluate the effect on cell proliferation of laser irradiation on MC3T3-E1 cells. And cell cycle was examined by flow cytometry. Gene and protein expressions of hedgehog signaling molecules, including Ihh, Ptch, Smoothened (Smo), and Gli, were examined by qRT-PCR and western blot analysis. The results showed that laser irradiation at dosage of 3.75 J/cm2 enhances the proliferation of MC3T3-E1 cells compared with control groups (p = 0.00). Moreover, laser irradiation (3.75 J/cm2) increased the cell amount at S phase (p = 0.00). In addition, the expressions of Ihh, Ptch, Smo, and Gli were significantly increased compared to the control during laser irradiation (3.75 J/cm2)-induced MC3T3-E1 osteoblast proliferation. After adding the hedgehog signaling inhibitor CY (cyclopamine), cell proliferation and Ihh, Ptch, Smo, and Gli expressions were inhibited (p = 0.00), and the cell amount at S phase was reduced compared with combination groups (p = 0.00). These results indicated that laser irradiation promotes proliferation of MC3T3-E1 cells through hedgehog signaling pathway. Our findings provide insights into the mechanistic link between laser irradiation-induced osteogenesis and hedgehog signaling pathway.
http://ift.tt/2sbnTHR
Das endoskopische Browlift mittels Endotine Forehead Device bei Fazialisparese
Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113040
Hintergrund: Die Augenpartie ist sowohl in funktioneller Hinsicht als auch für die Expression von Emotionen von zentraler Bedeutung. Eine chronische Fazialisparese mit Lähmung des Stirnastes kann zu einer Brauenptosis mit Einschränkungen des Gesichtsfeldes und einer deutlichen Asymmetrie des Gesichts führen. Das endoskopische Browlift mit resorbierbarem Endotine Forehead Device stellt ein attraktives Konzept zur Korrektur der Brauenptosis und Symmetrisierung der Stirn-/Brauenregion dar. Material und Methoden Das endoskopische Augenbrauen- und Stirnlift unter Anwendung des Endotine Forehead Devices wurde in unserer Klinik bisher an 9 Patienten mit Fazialisparese durchgeführt. Das intraoperative Handling, Komplikationen und das postoperative Ergebnis wurden analysiert. Die Symmetrisierung der Augenbrauen wurde durch die FACEgram-Software erfasst. Zur postoperativen Abfrage der Patientenzufriedenheit wurde nach durchschnittlich 10 Monaten der Glasgow Benefit Inventory Fragebogen eingesetzt. Ergebnisse Mit Hilfe des endoskopischen Stirnlifts mit dem Endotine Forehead Device gelang eine minimal-invasive, komplikationsarme Symmetrisierung der Stirn- und Augenbrauenregion. Operationsbedingte Morbiditäten wurden nicht kaum beobachtet. Folgende Komplikationen wurden beobachtet: Eine Patientin erlitt eine Rezidivptosis bei postoperativem Hämatom. Eine weitere empfand die Palpabilität des Device als störend. Die Patienten berichteten über eine postoperative Steigerung der Lebensqualität, d.er durchschnittliche Punktwert im Glasgow Benefit Inventory nach der Operation lag bei + 29,2 (SD 13,6). Schlussfolgerungen Das endoskopische Brow- und Stirnlift mit dem Endotine Forehead Device stellt eine erfolgreiche, komplikationsarme Therapieoption bei Brauenptosis in Folge einer Fazialisparese dar.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Hereditäre Innenohrdysplasie mit Betroffenheit von aufeinanderfolgenden Generationen einer Familie
Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113039
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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Musikalische Fähigkeiten bei Kindern mit auditiver Verarbeitungs- und Wahrnehmungsstörung
Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113038
Hintergrund In der klinischen Praxis wurden bei Kindern mit auditiven Verarbeitungs- und Wahrnehmungsstörungen (AVWS) Schwierigkeiten bei der Lösung musikalischer Aufgaben beobachtet. Musikalität bei AVWS ist bisher wenig erforscht. Material und Methoden 15 AVWS-Patienten im Alter zwischen 6 und 11 Jahren wurden mit der Messung musikalischer Fähigkeiten (MMF) untersucht und mit 15 Kontrollprobanden verglichen. Ergebnisse AVWS-Patienten zeigen statistisch signifikante Defizite in den Aufgaben zur Tonhöhendifferenzierung, Reproduktion von Rhythmen und Melodien. Zusammenhänge zwischen sprachlichen und musikalischen Leistungen bei AVWS-Patienten wurden nachgewiesen. Schlussfolgerungen Musikalische Fähigkeiten sollten in der AVWS-Diagnostik mehr Beachtung finden. Positive Transfereffekte musikalischen Trainings auf die Sprachentwicklung und allgemeine kognitive Fähigkeiten wurden in zahlreichen Studien nachgewiesen. Bei Vorliegen musikalischer Defizite sollte musikalische Förderung als Therapiemethode bei AVWS diskutiert werden.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Progrediente Verschlechterung des Sprachverstehens nach Cochlea-Implantation
Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113041
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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Variations in Current Procedural Terminology Coding for Craniofacial Surgery: a Need for Review and Change.
Background: A survey was utilized to study the coding practices of surgeons performing craniofacial procedures, in order to determine whether coding for these procedures might be standardized or expanded. Methods: An online survey was designed with 6 sample cases to cover a variety of procedures encountered in the field of craniofacial surgery which was sent to members of 3 professional organizations centered around the practice of craniofacial/maxillofacial surgery. Surgeons were asked to read the vignettes and choose from a series of multiple-choice responses to code the cases, or write in their own response. Codes were based on the American Medical Association current procedural terminology listings. Responses were compiled and tabulated. Results: One hundred twenty-eight people initiated the survey. The largest common coding responses for each vignette were selected by 45.2% of respondents for the case describing placement of an internal mandibular distractor; 45.3% for the case of scaphocephaly remodeling; 67.1% for a case of cranioplasty for trigonocephaly; 47.2% for hypertelorism repair with periorbital osteotomies; 60% for LeFort III advancement with external distractors; and 53.6% for the case describing the removal of an internal mandibular distractor. Between 4 and 12 codes were identified for possible use in each clinical scenario. Conclusion: There appears to be wide variability among those who routinely perform craniofacial surgery as to the appropriate ways to code these procedures. We hope to bring this to the attention of coding committees for further discussion to hopefully bring about more accurate and descriptive codes for craniofacial surgical procedures. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2u8n1oF
http://ift.tt/2u8n1oF
Speech Perceptions and Health-Related Quality of Life Among Children With Cleft Lip and Palate.
Background: The association between perception of speech and health-related quality of life (HRQOL) among patients with cleft palate is not well understood. The purpose of this study was to determine: the agreement between patient and parent perception of speech, the correlation between patient/parent speech perception and objective analysis by a speech-language pathologist (SLP), and the relationship between objective speech analysis and HRQOL among children with cleft lip with or without palate (CLCP). Methods: The authors surveyed 108 CLCP patients who received treatment at a large tertiary medical center from 2013 to 2014. Patients and parents were queried regarding their difficulty with speech, and an SLP performed perceptual speech analysis with each patient. Patient-reported survey instruments were used to assess anxiety, depression, anger, peer relationships, stigma, and overall psychosocial health. The authors assessed the agreement between patients and SLP analysis as well as association between speech and HRQOL. Results: Patient and parent-reported speech quality demonstrated moderate agreement regarding the quality of the child's speech (r = 0.46-0.64). Parent and patient speech perception was not well associated with SLP analysis (V = 0.06-0.30). Patient speech perception was correlated with depression (P = 0.03), while SLP analysis was correlated with anger (P = 0.03, P = 0.004), depression (P = 0.007), and difficulty with peer relationships (P = 0.02). Conclusions: Patients and parents have different perceptions of the quality of the child's speech, and their ratings differ from SLP perceptual speech analysis. Both patient speech perception and SLP analysis are correlated with important aspects of quality of life, and should be considered when evaluating children with CLCP. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2tzgztL
http://ift.tt/2tzgztL
The Effect of Anterior Palatoplasty Plus Modified Expansion Sphincter Pharyngoplasty on Voice Performance in Obstructive Sleep Apnea Syndrome.
Objective: We aimed to investigate the effect of anterior palatoplasty (AP) plus modified expansion sphincter pharyngoplasty (MESP) on voice performance in patients with obstructive sleep apnea syndrome (OSAS). Methods: Fourteen OSAS patients who had AP + MESP procedure were included in the study. Voice performances of the patients were analyzed with acoustic voice analysis before surgery, and 6 months after surgery. Results: Preoperative and postoperative F0, jitter percentage, and shimmer percentage were compared. Mean preoperative F0 was 129.85 Hz, and mean postoperative F0 was 138.07 Hz, with a significant difference in between (P = 0.017). Mean preoperative jitter percentage was 0.65, and mean shimmer percentage was 0.88, while those values were 0.67 and 0.84, respectively, in the postoperative period. The differences were not statistically significant (P = 0.801 and 0.652). Conclusion: The AP + MESP procedure performed for OSAS results in improvement of F0 in the long term; however, there were no differences in jitter percentage and shimmer percentage. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2tzu0tW
http://ift.tt/2tzu0tW
Three-Dimensional Anthropometric Evaluation of Facial Morphology.
Objectives: The objectives of this study were to evaluate sexual dimorphism for facial features within Colombian and Mexican-American populations and to compare the facial morphology by sex between these 2 populations. Materials and Methods: Three-dimensional facial images were acquired by using the portable 3dMDface system, which captured 223 subjects from 2 population groups of Colombians (n = 131) and Mexican-Americans (n = 92). Each population was categorized into male and female groups for evaluation. All subjects in the groups were aged between 18 and 30 years and had no apparent facial anomalies. A total of 21 anthropometric landmarks were identified on the 3-dimensional faces of each subject. The independent t test was used to analyze each data set obtained within each subgroup. Results: The Colombian males showed significantly greater width of the outercanthal width, eye fissure length, and orbitale than the Colombian females. The Colombian females had significantly smaller lip and mouth measurements for all distances except upper vermillion height than Colombian males. The Mexican-American females had significantly smaller measurements with regard to the nose than Mexican-American males. Meanwhile, the heights of the face, the upper face, the lower face, and the mandible were all significantly less in the Mexican-American females. The intercanthal and outercanthal widths were significantly greater in the Mexican-American males and females. Meanwhile, the orbitale distance of Mexican-American sexes was significantly smaller than those of the Colombian males and females. The Mexican-American group had significantly larger nose width and length of alare than the Colombian group regarding both sexes. With respect to the nasal tip protrusion and nose height, they were significantly smaller in the Colombian females than in the Mexican-American females. The face width was significantly greater in the Colombian males and females. Conclusions: Sexual dimorphism for facial features was presented in both the Colombian and Mexican-American populations. In addition, there were significant differences in facial morphology between these 2 populations. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2u8fE0q
http://ift.tt/2u8fE0q
Double Vision After Minimally Invasive Orbital Decompression.
Introduction: New onset Diplopia following orbital decompression in thyroid eye disease patients is estimated to occur in up to 30% to 40% of decompression patients, mostly related to deep lateral and medial wall decompressions. Methods: A retrospective chart review of all minimally invasive (fat and minimal bone orbital decompression performed at the UCLA Stein Eye Institute between 2005 and 2015. Inclusion criteria were thyroid eye disease patients older than 18 years undergoing fat only orbital decompression with no previous muscle surgery. Results: The chart review revealed only 5 patients with new onset diplopia after this surgery. The cases are discussed and a possible mechanism for the diplopia is proposed. Discussion: Double vision following minimally invasive orbital decompression is rare and the mechanisms are poorly understood. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2tzqqQu
http://ift.tt/2tzqqQu
Change in Posterior Pharyngeal Space After Counterclockwise Rotational Orthognathic Surgery for Class II Dentofacial Deformity Diagnosed With Obstructive Sleep Apnea Based on Cephalometric Analysis.
Although maxillomandibular advancement (MMA) is an orthognathic surgical procedure used to manage obstructive sleep apnea (OSA) in individuals who are noncompliant with continuous positive airway pressure therapy, simple MMA encounters problems in terms of aesthetic outcomes in Asian populations with preexisting dentoalveolar protrusion. Our current prospective investigation describes changes in posterior pharyngeal space and aesthetic outcomes after counterclockwise rotational orthognathic surgery, which is known to be quite difficult in terms of the maintenance of the skeletal stability in skeletal class II patients with OSA. This prospective study investigated the surgical outcome of patients who suffered from OSA following counterclockwise rotational orthognathic surgery. The patients were skeletal class II patients who underwent orthognathic surgery between March 2013 and December 2014. Cephalometric posterior airway analysis and a questionnaire for facial perception were used to assess pharyngeal airway and patient perception of facial appearance. A total of 14 patients were included. Satisfactory results were achieved without complications in all OSA patients. The airway parameters for anteroposterior length significantly increased. Thirteen patients answered a questionnaire on their facial appearance, and the visual analog scale averaged 7.31 points, indicating a favorable facial appearance. Counterclockwise rotational orthognathic surgery without maxilla advancement for the correction of OSA can effectively increase the posterior pharyngeal space, with favorable aesthetic results. With thoughtful application, this novel approach may be an alternative to standard approaches for the correction of OSA using orthognathic surgery. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2u89ihN
http://ift.tt/2u89ihN
Aesthetic Lateral Canthoplasty: a Gray Line Split Approach.
Background: Many women in Asian countries chase larger and brighter eyes, but to most Asian people only double eye plasty and epicanthoplasty is not enough. As a result, aesthetic lateral canthoplasty, another procedure to lengthen the palpebral fissure, is becoming more and more popular. However, the current procedure of aesthetic lateral canthoplasty has many potential complications, restricting the wide application of this procedure. Methods: Here, the authors developed a minimally invasive method through gray line split and canthopexy to achieve lateral canthoplasty. Eighty-seven patients from February 2013 to January 2016 were included and had the procedure. The lengthen of the palpebral fissure was measured and photographs were also taken before the surgery and in the follow-up periods. Besides, the complications related to this procedure were also investigated. Results: The authors have performed aesthetic lateral canthoplasty in 87 patients, almost all of the follow-up patients have satisfactory results with a lengthen of palpebral fissure ranging from 2.3 to 4.2 mm. Through the long-term follow-up the authors found the lengthen of the palpebral fissure is stable. No serious complications like lacrimal system fistula or hypertrophic scars emerged except 1 patient with conjunctival exposure. Conclusions: Through this gray line split method, the authors can acquire larger and brighter eyes without serious complications. The authors think that this is a good method and worthy of promotion. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2tzhf2s
http://ift.tt/2tzhf2s
Displacement of a Broken Dental Injection Needle Into the Perivertebral Space.
Dental injection needle breakage is an uncommon problem in dental practice. Displacement of the broken fragment into anatomical spaces is, on the other hand, a serious complication that occurs most commonly during inferior alveolar nerve blocks as a result of material wear, incorrect application of the anesthesia technique, or sudden movement of the patient during injection. Further complications such as infection, trismus, and nerve paralysis may exacerbate the condition and, if not treated adequately, life-threatening conditions may develop over time as the fragment dislodges deeper in soft tissues. Clinical symptoms of the patient, as well as the findings gathered from detailed physical examination and radiographic evaluation, are important factors to consider before performing an exploratory surgery. Removal of a broken needle may be troublesome due to its proximity to vital anatomic structures. Multislice computed tomography is a reliable imaging modality that provides accurate information to pinpoint the exact location of the needle fragment. This report describes a case of needle breakage occurred during inferior alveolar nerve block which was performed to extract a third molar tooth and the migration of the broken fragment from the right mandibular ramus area into the perivertebral space, with special emphasis on the surgical retrieval technique with multiplanar computed tomography imaging guidance. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2tzzmVQ
http://ift.tt/2tzzmVQ
Demarcative Necrosis Along Previous Laceration Line After Filler Injection.
In recent years, fillers have been widely used for soft tissue augmentation. Although they are generally considered to be safe, many complications have been reported to date. Nose and nasolabial fold augmentations with fillers can lead to an implementation of nasal skin necrosis, possibly caused by intravascular embolism and/or extravascular compression. Herein, we present a case of a successfully treated patient who experienced skin necrosis after an injection of dermal fillers into the nasolabial fold. Interestingly, we discovered that the patient had experienced a laceration 8 years ago around the area in which the filler was injected. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2u8z7yi
http://ift.tt/2u8z7yi
Mozart Ear Deformity: a Rare Diagnosis in the Ear Reconstruction Clinic.
Mozart ear is a rare auricular deformity; clinically the auricle is characterized by the bulging appearance of the anterosuperior portion of the auricle due to fusion of the crura of the antihelix, an inversion in the normal form of the cavum conchae resulting in its convexity and a slit-like narrowing of the orifice of the external auditory meatus. A retrospective review of clinical and photographic records of patients attended at the ear reconstruction clinic of our hospital between June of 2010 and May 2016 was performed; out of 576 consecutive patients only 3 fulfilled the inclusion criteria, with a prevalence of 0.5%. The authors present these patients. Surgical interventions mainly focus on the correction of the convex concha; however, the procedure should be tailored to the severity of the deformity and the wishes of the patient. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2tz8yoR
http://ift.tt/2tz8yoR
Morphometric Analysis of the Posterior Cranial Fossa in Syndromic and Nonsyndromic Craniosynostosis.
Posterior cranial fossa (PCF) anatomy can be abnormal in craniosynostosis, and hindbrain herniation may occur. This study analyzed PCF anatomy in single suture and complex craniosynostosis. Children with craniosynostosis and age-matched controls were identified. Cephalic index (CI) for cranial vault and PCF as well as tentorial (TA) and occipital angles (OA) were measured on preoperative imaging. Children with syndromic (N = 6), bicoronal (N = 4), sagittal (N = 12), and metopic synostosis (N = 4) as well as controls (N = 10) were enrolled. Mean CI for cranial vault was 0.89, 0.93, 0.65, 0.74, and 0.78, respectively. Corresponding CI for PCF was 0.81, 0.93, 0.62, 0.74, and 0.78. Mean TA and OA were 45.4[degrees] and 96.6[degrees] in syndromic, 39.7[degrees] and 87.0[degrees] in bicoronal, 34.0 and 75.0[degrees] in sagittal, 39.7[degrees] and 87.0[degrees] in metopic synostosis, and 42.9[degrees] and 88.3[degrees] in controls. While CI, TA, and OA in metopic synostosis were similar to controls, abnormalities were found in syndromic, bicoronal, and sagittal synostosis. Syndromic and bicoronal craniosynostosis patients had a higher CI for both cranial vault and PFC as well as larger TA and OA, indicating a brachycephalic skull with steep tentorium and narrow PCF. In sagittal synostosis, CI for cranial vault and PCF were lower and TA and OA smaller, reflecting scaphocephalic deformity also at PCF, with a flat tentorium. This study provides basic PCF morphometry in craniofacial conditions. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2tztRXq
http://ift.tt/2tztRXq
Lower Eyelid Reconstruction After Ablation of Skin Malignancies: How Far Can We Get in a Single-Stage Procedure?.
: Reconstruction of full-thickness lower eyelid defects tends to be a devastating procedure, especially when big amount of tissue has to be removed because of oncological reasons. The applied techniques are mostly difficult to execute and multistaged, often require extensive dissection, and result in scarring and facial disfigurement. The aim of the present study is to demonstrate the authors' experience in single-staged reconstructions of full-thickness defects of the lower eyelid with local tissue only. Material and Methods: A retrospective analysis was conducted identifying patients with postexcisional defects after skin cancer occurring in the lower eyelid, reconstructed in 1 stage. Appropriate demographic, pathological, preoperative, and postoperative clinical data and photo documentation were collected and analyzed. Results: After excluding patients with partial thickness defects (n=5), a total of 13 patients with lower eyelid full-thickness defects were studied, including 9 women and 4 men with mean age 66.5 years (age range 53-79 years). The most common malignancy was basal cell carcinoma (n = 11). In one of the patients 2 synchronous neoplasms were excised simultaneously from the same lower eyelid. The reconstruction was successfully performed in 1 stage in all the patients by recruiting the same eyelid tissue and/or temporal tissue. No additional surgery was needed at a minimal follow-up of 9 months. Conclusion: Local tissue flaps have proven to be a reliable option for a single-stage reconstruction of large full-thickness defects. Tenzel flap technique seems to be a reliable option for repair of defects as large as 60% of the total eyelid length. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2u8mRh3
http://ift.tt/2u8mRh3
Nasal Septal Deformity in Relation to the Mode of Delivery.
Objective: The aim of this study was to find the relation between mode of delivery and the types of septal deviation. Materials and Methods: Records of patients treated for a deviated nasal septum from March 2003 to October 2015 were reviewed. Those with previous facial trauma were excluded. Information retrieved included basic demographic data, mode of delivery, sibling birthing order, type and date of surgery, and postoperational outcomes. Results: A total of 130 records were recovered. According to Guyuron's classification of nasal septal deviation, we found that type 5 was the most common type for patients delivered normally, whereas type 2 was the most common type for those who were delivered by cesarean section. Conclusion: Mode of delivery may be related to a certain type of deviation. However, studies with larger samples are required to support the finding in our study. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2tzgm9Z
http://ift.tt/2tzgm9Z
Open Craniosynostosis Surgery: Effect of Early Intraoperative Blood Transfusion on Postoperative Course.
Correction of craniosynostosis can result in blood loss when the patient already has physiologic anemia. The aim of this study was to determine whether patients benefit from early blood transfusion and whether the timing of blood transfusion affects metabolic disturbances and the postoperative course. In this retrospective review, 71 patients who underwent open calvarial vault remodeling for correction of craniosynostosis were separated into 2 groups according to whether they received blood transfusions early (within the first 30 minutes of surgery) or later (after the first 30 minutes of surgery). Patients were further separated into nonsyndromic and syndromic cohorts. Tracked variables included hemoglobin, hematocrit, arterial blood gas values, lactate level, length of stay, estimated blood loss, and amount of blood transfused in the operating room, amount transfused postoperatively, and total amount transfused. Among all patients, the early transfusion group had a higher hemoglobin nadir overall and received less postoperative blood. Within the nonsyndromic cohort, the early transfusion group had a higher estimated blood loss and received more transfused blood. In the syndromic cohort, the early transfusion group had a hemoglobin nadir that was significantly higher than in the late transfusion group and a lower estimated blood loss, shorter pediatric intensive care unit stay, and less postoperative blood transfused. Syndromic patients also received significantly more blood overall. For syndromic patients undergoing open calvarial vault remodeling, transfusion within the first 30 minutes of surgery should be considered. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2sqSqWj
http://ift.tt/2sqSqWj
Post-Surgical Relapse in Metopic Synostosis and Limitations of the Interfrontal Angle as an Outcome Measure.
Background: The interfrontal angle (IFA) has been utilized as a surrogate for morphologic assessment of the anterior cranial region in metopic synostosis with success in characterizing presenting severity. Its utility as an outcome measure has not been assessed similarly. In this study, we aimed to determine whether meaningful information relative to shape, and relapse in particular, could be assessed using the IFA. Methods: Patients with operatively treated isolated metopic synostosis were identified and included based on the availability of "previously obtained" low-dose computerized tomography (CT) scans at (1) preoperative and 2 postoperative (2) postoperative day-3 and (3) 1 year time points. Relapse was calculated as the percentage of the operatively induced change in IFA that was retained after the first postoperative year. Results: After exclusionary criteria, 19 patients were identified. The mean IFA values at the 3 time points were 119.3[degrees] (+/-9.8), 139.6[degrees] (+/-6.3), and 135.3[degrees] (+/-7.1), chronologically. Of the 19 patients, 14 (73.7%) experienced relapse, with this subgroup averaging 62.4% retention of their surgical change after 1 year. Increased preoperative severity and delayed age at surgical intervention were concurrently associated with an increased occurrence of relapse (P = 0.011). Another model utilizes preoperative IFA to predict the change in IFA that would accompany surgery on a case-by-case basis (P
http://ift.tt/2ta20Ka
http://ift.tt/2ta20Ka
Surgical Outcomes of Endonasal Conjunctivodacryocystorhinostomy According to Jones Tube Location.
Purpose: The aim of this study was to compare surgical outcomes and complications of endonasal conjunctivodacryocystorhinostomy (CDCR) according to Jones tube location. Methods: Patients who underwent endonasal CDCR owing to proximal obstruction of the lacrimal drainage system between 2009 and 2016 were retrospectively reviewed. Patients were divided into 2 groups according to the location of the proximal end of the Jones tube. The canthal-based group included patients in which the proximal end of the Jones tube was located in the medial canthal angle, and the fornix-based group included patients in which the proximal end of the Jones tube was located in the inferomedial conjunctival fornix. Success rates were evaluated at 3 months and 6 months after surgery. Causes of failure, incidence of tube migration, and incidence of canthal deformity were also evaluated. Results: The success rate at 3 months postoperative was 95% in the canthal-based group and 78.6% in the fornix-based group (P = 0.283). Success rates at 6 months postoperative were 85% in the canthal-based group and 71.4% in the fornix-based group, respectively (P = 0.410). The main cause of failure was granuloma in the canthal-based group (2/20) and medial migration in the fornix-based group (3/14). Medial canthal deformity occurred in 12 of 20 cases in the canthal-based group, but none occurred in the fornix-based group. Conclusion: The canthal-based group had a lower migration rate and slightly better surgical success rate than the fornix based group, but canthal deformity was more prevalent. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2sqtMFp
http://ift.tt/2sqtMFp
Reconstruction of a Marjolin Ulcer Defect of the Scalp Invading Brain and Causing Brain Abscess Formation Using Free Latissimus Dorsi Flap.
Marjolin ulcers are known as aggressive malignant tumors that mostly arise over chronic wounds and cutaneous scars. Brain abscess is a serious medical condition that requires surgical drainage along with antibiotic treatment. Here, we report a case with a Marjolin ulcer located over the right parietal bone with intracranial abscess formation along with tumor invasion into brain parenchyma. This patient was a 64-year-old man and had a 4 x 4 cm open wound on his scalp from which a purulent discharge was coming. This wound required surgical excision with security margins, resection of bone, evacuation of the cystic cavity, and excision of the walls of the cystic cavity, which were invaded by the tumor. Duraplasty and reconstruction of the defect with a free lattisimus dorsi flap are performed. To the best of our knowledge, the case reported here is unique because of the formation of brain abscess in the background of a long-lasting Marjolin ulcer invading brain parenchyma. It must be remembered that on the background of cutaneous scars located over the scalp, a Marjolin ulcer may develop, and if left untreated, tumor cells may invade even the brain parenchyma. Long-term asymptomatic brain infections may also accompany the given scenario, and complicate differential diagnosis. (C) 2017 by Mutaz B. Habal, MD.
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http://ift.tt/2swe9ax
Incidence of Hepatitis B Viral Reactivation After Kidney Transplantation With Low-dose Rituximab Administration.
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Non-HLA Antibodies Impact on C4d staining, Stellate Cell Activation and Fibrosis in Liver Allografts.
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Letter to the editor
Source:American Journal of Otolaryngology
Author(s): Satvinder Singh Bakshi
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Letter to Editors: Detection of endolymphatic hydrops using traditional MR imaging sequences
Source:American Journal of Otolaryngology
Author(s): Shinji Naganawa, Michihiko Sone
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Single-Injection Versus Multiple-Injection Technique of Ultrasound-Guided Paravertebral Blocks: A Randomized Controlled Study Comparing Dermatomal Spread.
Background and Objectives: The objective of this study was to investigate the extent of dermatomal spread following an ultrasound-guided thoracic paravertebral block (PVB) when equal volumes of local anesthetic are injected at 1 versus 5 vertebral levels. Methods: Seventy patients undergoing a unilateral mastectomy were randomized to receive either single or multiple injections of a PVB under real-time ultrasound guidance using a parasagittal approach. The patients in the single-injection group received a PVB at T3-T4 level with 25 mL of 0.5% ropivacaine and 4 subcutaneous sham injections. Patients in the multiple-injection group received 5 injections of a PVB from T1 to T5 level. Five milliliters of 0.5% ropivacaine was injected at each level. Evaluation of the sensory block was carried out 20 minutes following the completion of the PVB. Results: The median (interquartile range) dermatomal spread was not significantly different for the single-injection group (5 [4-6]) compared with the multiple-injection group (5 [5-6]), with a median difference of 0 segments (95% confidence interval, -1 to 0 segments; P = 0.22). The median time to performance of the single-injection PVB was shorter compared with the multiple-injection group (10 minutes), with a mean difference of -4 minutes (95% confidence interval, -6 to -3 minutes; P
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Neuralgic Amyotrophy Attributed Incorrectly to Block-Related Injury: Understanding Errors in Clinical Reasoning.
Objective: We report a case of misdiagnosed neuralgic amyotrophy (brachial plexus neuritis, Parsonage-Turner syndrome). Our primary objective is to review the scientific basis for errors in clinical reasoning. Case Report: We herein report a patient in whom signs and symptoms compatible with neuralgic amyotrophy presented after shoulder surgery. The patient's brachial plexopathy was attributed incorrectly as a complication of interscalene brachial plexus block. The true diagnosis was made only after the patient developed neuralgic amyotrophy in the contralateral upper extremity after a subsequent shoulder surgery on that side, this time without a brachial plexus block. Conclusions: Cognitive bias may lead to errors in clinical reasoning and consequent misdiagnosis. Temporal proximity may falsely implicate regional anesthesia as the causative agent. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.
http://ift.tt/2tyX2d7
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Molecular aspects of allergens in atopic dermatitis
Purpose of review: Molecular allergology uses pure, mainly recombinant and structurally defined allergen molecules and allergen-derived epitopes to study mechanisms of IgE-associated allergy, to diagnose, and even predict the development of allergic manifestations and to treat and prevent IgE-associated allergies. Atopic dermatitis, a chronic inflammatory skin disease is almost always associated with IgE sensitization to allergens. However, also non-IgE-mediated pathomechanisms seem to be operative in atopic dermatitis and it is often difficult to identify the disease-causing allergens. Here we review recent work showing the usefulness of molecular allergology to study mechanisms of atopic dermatitis, for diagnosis and eventually for treatment and prevention of atopic dermatitis. Recent findings: IgE sensitization to airborne, food-derived, microbial allergens, and autoallergens has been found to be associated with atopic dermatitis. Using defined allergen molecules and non-IgE-reactive allergen derivatives, evidence could be provided for the existence of IgE- and non-IgE-mediated mechanisms of inflammation in atopic dermatitis. Furthermore, effects of epicutaneous allergen administration on systemic allergen-specific immune responses have been studied. Multi-allergen tests containing micro-arrayed allergen molecules have been shown to be useful for the identification of culprit allergens in atopic dermatitis and may improve the management of atopic dermatitis by allergen-specific immunotherapy, allergen avoidance, and IgE-targeting therapies in a personalized medicine approach. Summary: Molecular allergology allows for dissection of the pathomechanisms of atopic dermatitis, provides new forms of allergy diagnosis for identification of disease-causing allergens, and opens the door to new forms of management by allergen-specific and T cells-targeting or IgE-targeting interventions in a personalized medicine approach.http://ift.tt/2t9YqzO
Allergen immunotherapy for the treatment of respiratory allergies in the elderly
Purpose of review: Respiratory allergies, including asthma and allergic rhinitis can also occur in the elderly. Allergen immunotherapy for allergic diseases is the only disease-modifying treatment for patients with allergies available thus far. Here, we review current evidence supporting the use of allergen immunotherapy in the elderly and discuss its efficacy and utility for the treatment of respiratory allergic diseases in this setting. Recent findings: Subcutaneous and/or sublingual immunotherapy are effective therapeutic options in not only young but also older patients. Allergen immunotherapy reduces medication and symptom scores in the elderly and can thus be safely prescribed in this population. Summary: Elderly individuals with proven, clinically relevant immunoglobulin E sensitization to inhalant allergens may benefit from allergen immunotherapy for respiratory allergic diseases. Older patients without contraindications should therefore be considered for treatment, with the additional benefit of reduced medication and symptom scores.http://ift.tt/2sqjJQl
Hypersensitivity reactions to gadolinium-based contrast agents
Purpose of review: Gadolinium-based contrast agents (GBCAs) have been utilized since the late 1980s to enhance the diagnostic value of MRI studies. They are known to have excellent safety profile and serious adverse reactions are uncommon despite widespread global use. However, immediate hypersensitivity reactions are well described in the literature, with urticaria the most common manifestation. Anaphylaxis can occur, though fatality is extremely rare. This review explores the incidence of GBCA-related hypersensitivity reactions and highlights potential risk factors. Recent findings: Emerging evidence suggests that immediate hypersensitivity reactions to GBCAs can be IgE-mediated. Skin testing may be informative in confirmation of causality and revealing cross-reactivity patterns. Summary: GBCA hypersensitivity is infrequent but can be serious. Familiarity with management of acute hypersensitivity reactions may be lifesaving. Appropriate use of diagnostic testing can be used to guide future management of patients who have suffered from such reactions.http://ift.tt/2sqlEoj
Seasonal Allergic Rhinitis: A focused systematic review and practice parameter update
Purpose of review: The review compares and contrasts seven major United States and international allergic rhinitis guidelines from 2008 to 2017. Recent findings: Despite many treatment options for allergic rhinitis, patients often report lack of therapeutic control and a reduced quality of life. Guidelines intended to improve allergic rhinitis care have been evolving into evidence based, systematic reviews, with less reliance on consensus of expert opinion characteristic of more traditional guidelines. The first Grading of Recommendations Assessment, Development, and Evaluation-based guideline developed in the United States for seasonal allergic rhinitis was first published in 2017. Summary: When critically analyzing the allergic rhinitis guidelines that use the rigorous Grading of Recommendations Assessment, Development, and Evaluation methodology, different groups of expert authors, using the same reference articles, will, at times, reach different conclusions regarding the quality of the evidence and the strength of the recommendation. Factors potentially contributing to these divergent determinations include: lack of objective primary outcome measures in allergic rhinitis, poorly defined Minimal Clinically Important Difference, failure to include all interested parties in guideline development, for example, patients, and subjectivity inherent in the expert panel.http://ift.tt/2sqBH5C
Aspirin challenge and desensitization: how, when and why
Purpose of review: To investigate the current approach to aspirin challenge (drug provocation) and/or desensitization in patients with histories of hypersensitivity reactions to it, particularly in those with cardiovascular diseases. Recent findings: The literature indicates that patients with coronary artery disease (CAD), including those with an acute coronary syndrome, may safely undergo low-dose aspirin challenge and/or desensitization. Recently, flowcharts regarding challenge/desensitization procedures with aspirin in patients with CAD and histories of aspirin hypersensitivity reactions have become available. Aspirin desensitization and continuous aspirin therapy constitute an effective option in patients with nonsteroidal anti-inflammatory drug-exacerbated respiratory diseases (NERD) who have suboptimally controlled asthma or rhinosinusitis, or require multiple revision polypectomies. Summary: The use of aspirin has proven to reduce morbidity and mortality associated with CAD. There is a general consensus on aspirin's effectiveness in secondary prevention of CAD. Therefore, aspirin desensitization is necessary in patients with CAD and histories of hypersensitivity reactions to it. The effectiveness of aspirin desensitization and continuous therapy in patients with NERD has been shown in numerous studies. However, shared selection criteria of candidates for aspirin challenge/desensitization procedures, and simple and homogeneous protocols are necessary. Moreover, preventive safety measures are still needed in order to reduce the potential risks of these procedures.http://ift.tt/2sq8Deo
Reactions to cytostatic agents in children
Purpose of review: The current review will focus on drug hypersensitivity reactions to chemotherapy specifically to those drugs most used in children. We know that potentially all chemotherapeutic agents can cause infusion reactions, generally defined as adverse drug reactions. Of these, some are Type A, defined as expected and described in the characteristics of the drug and others, and Type B, defined as unexpected reactions which cannot be explained by the known toxicity profile of the drug. When an unexpected reaction occurs, drugs we can refer as hypersensitivity reactions (HSRs). Some of these (HSRs) are allergic reactions as they have an underlying immunologic mechanism. In general, the cytotoxic agents most commonly associated with HSRs are the platinum salts derivatives, taxanes, pegylated liposomal doxorubicin, L-asparaginase, procarbazine, etoposide, bleomycin, and cytarabin. Recent findings: HSRs may also occur in children with cancer, during the treatment with chemotherapeutic drugs. The most used drugs of this group in children to cause HSRs are: carboplatin, L-asparaginase, and methothrexate. The aim of this review is to summarize the incidence and the clinical features of HSRs occurring with these drugs in children. Summary: The aim of this review is to summarize the incidence and the clinical features of HSRs occurring with these drugs in children. The current review will focus on the most involved drugs in children, the type of reactions, the mechanisms involved, and the best way to manage them.http://ift.tt/2sqRq4n
Alternative treatments for chronic spontaneous urticaria beyond the guideline algorithm
Purpose of review: The international EAACI/GA2LEN/EDF/WAO guideline suggests a stepwise approach for the therapeutic management of chronic spontaneous urticaria (CSU), outlined in an algorithm. The aim of this article is to summarize and review the evidence available on alternative treatment options for CSU outside of this algorithm. Recent findings: Although CSU is a common disease, there are a limited number of high-quality studies, and only antihistamines and omalizumab are licensed for its treatment. Most studies regarding alternative therapies for CSU show methodological limitations and a high risk of bias. For many therapies, only case reports and uncontrolled studies exist. Recent publications on alternative treatments for chronic urticaria/CSU include reports on the use of adalimumab, rituximab, vitamin D, probiotics, histaglobulin, injection of autologous whole blood or serum, and phototherapy. Summary: Numerous treatments beyond the guideline algorithm have been evaluated in patients with refractory CSU. The global level of evidence to support their efficacy in CSU is low or very low. Further research is needed to assess the efficacy and safety of alternative therapies of CSU to manage adequately those patients who do not respond to the treatments included in the algorithm.http://ift.tt/2sqRi4T
Pharmacotherapy of mast cell disorders
Purpose of review: Mast cell disorders (MCDs) comprise mastocytosis and disorders referred to as mast cell activation syndrome and are caused by abnormal accumulation and/or activation of mast cells in tissues. Clinical signs and symptoms are protean; therefore, finding suitable treatment options for individual patients entails a challenge for clinicians. The purpose of this manuscript is to review the literature on the available therapeutic interventions in patients with MCD. Recent findings: Pharmacotherapy is mainly directed against the effects of mast cells and their mediators. The current recommendations are exclusively based on expert opinions due to the lack of controlled clinical trials. The targeted therapies aiming at blocking mutant KIT variants and/or downstream signaling pathways are currently being developed and may be considered in severely affected, therapy-refractory patients. Summary: There is currently no method for predicting the best available approach to control symptoms in individual patients with MCD. Therefore, a stepwise, individual-based approach in pharmacotherapy options appears to be most successful strategy and is recommended in all patients. The core component of the treatment in most patients is to control symptoms caused by mast cell mediator release, whereas cytoreductive therapies are mainly reserved for patients with advanced/aggressive systemic mastocytosis.http://ift.tt/2tah9Lq
Allergic contact dermatitis in preservatives: current standing and future options
Purpose of review: Preservatives are well known skin sensitizers and represent one of the main causes of contact allergy. The purpose of this article is to review the current state of contact sensitization induced by preservatives and point future alternatives for products' preservation. Recent findings: Isothiazolinones currently are the most common preservatives responsible of contact allergy in Europe and in the United States, and although some regulatory interventions have been taken place, the current contact allergy outbreak is not yet under control. Despite the ban of methyldibromo glutaronitrile from cosmetics in Europe, sensitized patients are still diagnosed, suggesting other nonregulated sources of exposure. Sensitization rates to formaldehyde and formaldehyde-releasers are lower in Europe in comparison with the United States due to stricter regulations regarding their use. Prevalence of contact allergy to parabens has remained stable over the last decades, whereas iodopropynyl butylcarbamate is an emerging allergen with an increasing prevalence. Future alternatives for products' preservation look for a broad antimicrobial spectrum, but with a better safety profile (in terms of sensitization) than the currently available compounds. Summary: Given the high rates of sensitization reported over the last years, timely regulatory actions are urgently required for some preservatives that currently represent a concern for public health.http://ift.tt/2tadbCS
Atopic dermatitis phenotypes and the need for personalized medicine
Purpose of review: To describe recent developments in therapies which target the molecular mechanisms in atopic dermatitis. Recent findings: Current advances in the understanding of the molecular basis of atopic dermatitis are leading to the stratification of different atopic dermatitis phenotypes. New therapies offer the option to target-specific molecules involved in the pathophysiology of atopic dermatitis. Current new therapies under investigation aim to modulate specific inflammatory pathways associated with distinctive atopic dermatitis phenotypes, which would potentially translate into the development of personalized, targeted-specific treatments of atopic dermatitis. Summary: Despite the unmet need for well tolerated, effective, and personalized treatment of atopic dermatitis, the current standard treatments of atopic dermatitis do not focus on the individual pathogenesis of the disease. The development of targeted, phenotype-specific therapies has the potential to open a new promising era of individualized treatment of atopic dermatitis.http://ift.tt/2t9WAPj
Cholesteatoma as a complication of Langerhans Cell Histiocytosis of the temporal bone: A nationwide cross-sectional analysis
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Jonathan C. Simmonds, Mark Vecchiotti
ObjectiveTo determine if patients with Langerhans Cell Histiocytosis (LCH) of the temporal bone have a higher risk of developing cholesteatoma.MethodsReview of literature and cross-sectional weighted analysis of patients under 19 with a diagnosis of LCH from the National Inpatient Sample (NIS) and Kids' Inpatient Database (KID) from 2000 to 2013. ICD-9 codes and demographics were analyzed; pairwise comparisons and multivariate analyses were performed.ResultsOnly seven cases of cholesteatoma after the treatment for LCH of the temporal bone have been documented in the literature. No significant association between cholesteatoma and LCH was seen (OR 0.747 [0.149–3.751]). Patients with LCH did have a higher incidence of chronic otitis media, chronic otitis externa, chronic sinusitis, hearing loss, and otitis media with effusion.ConclusionOur results show that patients with Langerhans Cell Histiocytosis do not appear to have a higher risk of developing cholesteatoma. However they are more likely to be diagnosed with chronic otitis externa which should be differentiated from cholesteatoma or recurrence of LCH.
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Pediatric head and neck bone sarcomas: An analysis of 204 cases
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Jacob S. Brady, Sei Y. Chung, Emily Marchiano, Jean Anderson Eloy, Soly Baredes, Richard Chan Woo Park
ObjectivesTo analyze the demographics, survival, and treatment efficacy of pediatric sarcomas of the facial skeleton and skull.MethodsRetrospective study of cases from the US National Cancer Institute's Surveillance, Epidemiology, and End Results database. Pediatric patients between the ages of 0 and 18 diagnosed with a malignant sarcoma of either the mandible or the bones of skull, face, and associated joints from 1973 to 2013 were studied.ResultsIn total, 204 patients were included in the analysis. The average age at diagnosis was 11.39 (±5.15) years with a male-to-female ratio of 1.4:1. Whites were the most commonly affected race (76.0%). Malignant mandible sarcomas accounted for 29.9% of the cohort (n = 61). The most common pathology was osteosarcoma, which accounted for 43.6% of the cohort (n = 89). Among patients with known histologic grade (n = 95), 26.0% were AJCC stage III or IV. Overall, 5-year disease-specific survival (DSS) was 80.6%. When stratified by treatment modality, 5-year DSS was 86.0% for surgery alone, 67.9% for radiation alone, and 75.3% for surgery with adjuvant radiotherapy (p = 0.041).ConclusionsOsteosarcoma, Ewing's sarcoma, and chondrosarcoma are the most common subtypes of pediatric head and neck bone sarcoma. Such sarcomas more commonly affect whites and males during pubertal ages. Disease-specific survival is not affected by primary site. Surgery alone is the mainstay of treatment, and demonstrates higher 5-year disease-specific survival compared to radiotherapy alone. Adjuvant radiotherapy does not seem to increase survival, but further investigation is warranted.
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Pathophysiology of esophageal impairment due to button battery ingestion
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Johannes Völker, Christine Völker, Philipp Schendzielorz, Sebastian P. Schraven, Andreas Radeloff, Robert Mlynski, Rudolf Hagen, Kristen Rak
BackgroundThe increased use of button batteries with high energy densities in devices of daily life presents a high risk of injury, especially for toddlers and young children. If an accidental ingestion of a button battery occurs, this foreign body can become caught in the constrictions of the esophagus and cause serious damage to the adjacent tissue layers. The consequences can be ulcerations, perforations with fistula formation and damage to the surrounding anatomical structures. In order to gain a better understanding of the pathophysiology after ingestion, we carried out systematic studies on fresh preparations of porcine esophagi.MethodsThe lithium button battery type CR2032, used most frequently in daily life, was exposed in preparations of porcine esophagi and incubated under the addition of artificial saliva at 37 °C. A total of eight esophagi were analysed by different methods. Measurements of the pH value around the battery electrodes and histological studies of the tissue damage were carried out after 0.5–24 h exposure time. In addition, macroscopic time-lapse images were recorded. Measurements of the battery voltage and the course of the electric current supplemented the experiments.FindingsThe investigations showed that the batteries caused an electrolysis reaction in the moist environment. The positive electrode formed an acidic and the negative electrode a basic medium. Consequently, a coagulation necrosis at the positive pole, and a deep colliquation necrosis at the minus pole occurred. After an exposure time of 12 h, tissue damage caused by the lye corrosion was observed on the side of the negative electrode up to the lamina muscularis. The corrosion progressed up to the final exposure time of 24 h, but the batteries still had sufficient residual voltage, such that further advancing damage would be expected.ConclusionsButton battery ingestion in humans poses an acute life-threatening danger and immediate endoscopic removal of the foreign body is essential. After only 2 h exposure time, significant damage to the tissue could be detected, which progressed continuously to complete esophageal perforation. The primary prevention of battery ingestion is therefore of particular importance.
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Paediatric injection medialisation laryngoplasty: Recent Great Ormond Street Hospital experience
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): K.A. Stephenson, L. Cavalli, A. Lambert, J. Fleming, E. Lawes, S. Gupta, C.G. Jephson, L.A. Cochrane
IntroductionUnilateral vocal fold paresis may significantly impair the vocal quality and laryngeal competence of a child. Relatively little literature relates to injection medialisation laryngoplasty (IML) in children and previous reports have involved small numbers of heterogenous cases.MethodsA retrospective review was conducted of paediatric patients managed by our multidisciplinary specialist voice clinic undergoing IML for unilateral vocal fold paresis. Cases of bilateral paresis, those characterised by vocal fold fixation, and patients without formal pre and post-operative voice evaluation were excluded.ResultsEighteen IML procedures were performed in 12 children eligible for inclusion between 2005 and 2015. The average age at time of procedure was 12 years (range 9–15 years). Autologous fat was used in 5 procedures, succeeded by calcium hydroxylapatite (Radiesse® Voice) from 2011 (n = 13). A significant improvement in median GRBAS score components was observed after calcium hydroxylapatite injection in terms of grade (p = 0.008), breathiness (p = 0.002) and aesthenia (p = 0.016). A pre- and post-procedural Voice Handicap Index was self-completed by 6 patients receiving calcium hydroxylapatite injection; the median change in score was an improvement of 19 points (interquartile range 36.5).ConclusionWe describe the outcomes of a comparatively large paediatric series and have found IML using calcium hydroxylapatite to be a reliable technique associated with improved subjective outcome measures. Management of UVCP in the child is a challenge with particular investigative and interventional considerations. Further study supported by high quality subjective and, where possible, objective outcome measures, is required to better inform patient selection, timing of intervention and choice of injection material.
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Disparities in access to pediatric hearing health care.
Purpose of review: There are significant disparities in care facing children with hearing loss. The objective of this review is to assess the current disparities in pediatric hearing healthcare delivery, describe the barriers of efficient and effective pediatric hearing health care, and explore the innovations to improve pediatric hearing healthcare delivery. Recent findings: Children with hearing loss from certain geographic regions or ethnic background are significantly delayed in diagnosis and treatment. Multiple patient characteristics (presentation of hearing loss), parental factors (insurance status, socioeconomic status, educational status, and travel distance to providers), and provider barriers (specialist shortage and primary care provider challenges) prevent the delivery of timely hearing health care. Advances, such as improved screening programs and the expansion of care through remote services, may help to ameliorate these disparities. Summary: Timely identification and treatment of pediatric hearing loss is critical to prevent lifelong language complications. Children from vulnerable populations, such as rural residents, face significant disparities in care. Careful assessment of these barriers and implementation of culturally acceptable interventions are paramount to maximize communication outcomes of children with hearing loss. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Disparities in access to pediatric hearing health care.
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Brief Overview of This Month's JACI
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
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Table of Contents
Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
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Editorial Board
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
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Information for Readers
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
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News & Notes
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
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Cover 1
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
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CME Activities Calendar
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
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Environmental determinants of allergy and asthma in early life
Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
Author(s): Allison J. Burbank, Amika K. Sood, Matthew J. Kesic, David B. Peden, Michelle L. Hernandez
Allergic disease prevalence has increased significantly in recent decades. Primary prevention efforts are being guided by study of the exposome (or collective environmental exposures beginning during the prenatal period) to identify modifiable factors that affect allergic disease risk. In this review we explore the evidence supporting a relationship between key components of the external exposome in the prenatal and early-life periods and their effect on atopy development focused on microbial, allergen, and air pollution exposures. The abundance and diversity of microbial exposures during the first months and years of life have been linked with risk of allergic sensitization and disease. Indoor environmental allergen exposure during early life can also affect disease development, depending on the allergen type, dose, and timing of exposure. Recent evidence supports the role of ambient air pollution in allergic disease inception. The lack of clarity in the literature surrounding the relationship between environment and atopy reflects the complex interplay between cumulative environmental factors and genetic susceptibility, such that no one factor dictates disease development in all subjects. Understanding the effect of the summation of environmental exposures throughout a child's development is needed to identify cost-effective interventions that reduce atopy risk in children.
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Environmental determinants of allergy and asthma in early life
Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
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The environment, epigenome, and asthma
Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
Author(s): Ivana V. Yang, Catherine A. Lozupone, David A. Schwartz
Asthma prevalence has been on the increase, especially in North America compared with other continents. However, the prevalence of asthma differs worldwide, and in many countries the prevalence is stable or decreasing. This highlights the influence of environmental exposures, such as allergens, air pollution, and the environmental microbiome, on disease etiology and pathogenesis. The epigenome might provide the unifying mechanism that translates the influence of environmental exposures to changes in gene expression, respiratory epithelial function, and immune cell skewing that are hallmarks of asthma. In this review we will introduce the concept of the environmental epigenome in asthmatic patients, summarize previous publications of relevance to this field, and discuss future directions.
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An exposome perspective: Early-life events and immune development in a changing world
Publication date: July 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
Author(s): Harald Renz, Patrick G. Holt, Michael Inouye, Alan C. Logan, Susan L. Prescott, Peter D. Sly
Advances in metagenomics, proteomics, metabolomics, and systems biology are providing a new emphasis in research; interdisciplinary work suggests that personalized medicine is on the horizon. These advances are illuminating sophisticated interactions between human-associated microbes and the immune system. The result is a transformed view of future prevention and treatment of chronic noncommunicable diseases, including allergy. Paradigm-shifting gains in scientific knowledge are occurring at a time of rapid global environmental change, urbanization, and biodiversity losses. Multifactorial and multigenerational implications of total environmental exposures, the exposome, require coordinated interdisciplinary efforts. It is clear that the genome alone cannot provide answers to urgent questions. Here we review the historical origins of exposome research and define a new concept, the metaexposome, which considers the bidirectional effect of the environment on human subjects and the human influence on all living systems and their genomes. The latter is essential for human health. We place the metaexposome in the context of early-life immune functioning and describe how various aspects of a changing environment, especially through microbiota exposures, can influence health and disease over the life course.
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The Editors' Choice
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
Author(s): Cezmi A. Akdis, Zuhair K. Ballas
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News Beyond Our Pages
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
Author(s): Marc E. Rothenberg, Jean Bousquet
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The Journal of Allergy and Clinical Immunology: An update on style and substance
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 1
Author(s): Cezmi A. Akdis, Justin Byrne, Zuhair K. Ballas
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Association of Insurance and Community-Level Socioeconomic Status With Treatment and Outcome of Squamous Cell Carcinoma of the Pharynx.
Association of Insurance and Community-Level Socioeconomic Status With Treatment and Outcome of Squamous Cell Carcinoma of the Pharynx.
JAMA Otolaryngol Head Neck Surg. 2017 Jun 29;:
Authors: Shin JY, Yoon JK, Shin AK, Blumenfeld P, Mai M, Diaz AZ
Abstract
Importance: Community-level socioeconomic status, particularly insurance status, is increasingly becoming important as a possible determinant in patient outcomes.
Objective: To determine the association of insurance and community-level socioeconomic status with outcome for patients with pharyngeal squamous cell carcinoma (SCC).
Design, Setting, and Participants: This study extracted data from more than 1500 Commission on Cancer-accredited facilities collected in the National Cancer Database. A total of 35 559 patients diagnosed with SCC of the pharynx from 2004 through 2013 were identified. The χ2 test, Kaplan-Meier method, and Cox regression models were used to analyze data from April 1, 2016, through April 16, 2017.
Main Outcomes and Measures: Overall survival was defined as time to death from the date of diagnosis.
Results: Among the 35 559 patients identified (75.6% men and 24.4% women; median age, 61 years [range, 18-90 years]), 15 146 (42.6%) had Medicare coverage; 13 061 (36.7%), private insurance; 4881 (13.7%), Medicaid coverage; and 2471 (6.9%), no insurance. Uninsured patients and Medicaid recipients were more likely to be younger, black, or Hispanic; to have lower median household income and lower educational attainment; to present with higher TNM stages of disease; and to start primary treatment at a later time from diagnosis. Those with private insurance (reference group) had significantly better overall survival than uninsured patients (hazard ratio [HR], 1.72; 95% CI, 1.59-1.87), Medicaid recipients (HR, 1.99; 95% CI, 1.88-2.12), or Medicare recipients (HR, 2.07; 95% CI, 1.99-2.16), as did those with median household income of at least $63 000 (reference) vs $48 000 to $62 999 (HR, 1.19; 95% CI, 1.13-1.26), $38 000 to $47 999 (HR, 1.31; 95% CI, 1.24-1.38), and less than $38 000 (HR, 1.51; 95% CI, 1.43-1.59). On multivariable analysis, insurance status and median household income remained independent prognostic factors for overall survival even after accounting for educational attainment, race, Charlson/Deyo comorbidity score, disease site, and TNM stage of disease.
Conclusions and Relevance: Insurance status and household income level are associated with outcome in patients with SCC of the pharynx. Those without insurance and with lower household income may significantly benefit from improving access to adequate, timely medical care. Additional investigations are necessary to develop targeted interventions to optimize access to standard medical treatments, adherence to physician management recommendations, and subsequently, prognosis in these patients at risk.
PMID: 28662244 [PubMed - as supplied by publisher]
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Use of Audiometric Measurement for Assessment of Vocal-Fold Function in Postextubation Infants.
Use of Audiometric Measurement for Assessment of Vocal-Fold Function in Postextubation Infants.
JAMA Otolaryngol Head Neck Surg. 2017 Jun 29;:
Authors: Liu YC, Varier I, Ongkasuwan J
Abstract
Importance: Infants with vocal-fold motion impairment (VFMI) have an increased risk of aspiration and pulmonary complications. Flexible nasolaryngoscopy (FNL) is the gold standard for evaluation of vocal-fold mobility. Although safe, FNL causes measurable physiologic changes. Noxious stimuli, especially in neonates in the cardiovascular intensive care unit, may cause imbalance between the pulmonary and systemic circulations and potentially circulatory collapse.
Objective: To examine whether bedside measurement of infant cry volume using a smartphone application can be a screening tool for vocal-fold movement in FNL.
Design, Study, and Participants: This case-control study performed from December 1, 2013, through January 31, 2015, included 42 infants in the intensive care unit at Texas Children's Hospital, Houston.
Main Outcomes and Measures: Patient cry volume in decibels was recorded using a smartphone application placed 12 in from their mouth.
Results: Forty-two infants were identified at the intensive care unit (median age, 33 days; 20 [48%] female and 22 [52%] male), 21 with VFMI and 21 without, based on FNL findings. A statistically significant difference was found in the mean cry volume of infants with (76.60 dB) and without (85.72 dB) VFMI. The absolute difference in the mean cry volume was 9.12 dB (95% CI, 2.74-15.50 dB). A cry volume of 90 dB or greater had a sensitivity of 90.4% (95% CI, 71%-97%) for identification of normal vocal-fold mobility. A cry volume of 75 dB or less had a specificity of 90.5% (95% CI, 71%-97%) for the identification of VFMI. The mean (SE) area under the receiver operating characteristic curve was 0.721 (0.080) (95% CI, 0.565-0.877). The cry volume, however, was not a good screen for aspiration.
Conclusions and Relevance: Bedside measurement of the cry volume with a smartphone application can be used by untrained health care professionals to screen patients for further evaluation of vocal-fold mobility using FNL.
PMID: 28662238 [PubMed - as supplied by publisher]
http://ift.tt/2usqUEa
Control of Pain After Tonsillectomy in Children: A Review.
Control of Pain After Tonsillectomy in Children: A Review.
JAMA Otolaryngol Head Neck Surg. 2017 Jun 29;:
Authors: Tan GX, Tunkel DE
Abstract
Importance: The relief of pain after tonsillectomy in children remains challenging and even controversial. While the need for pain control after this surgery is understood, recent debate has centered around the risks of opioids in children with obstructive sleep apnea syndrome (OSAS) and the possible increases in posttonsillectomy hemorrhage with the use of alternative nonsteroidal anti-inflammatory drugs (NSAIDs).
Observations: We discuss the multiple facets of posttonsillectomy pain control in children. A variety of pharmacologic and nonpharmacologic interventions used before, during, and after surgery are reviewed, presenting the evidence for efficacy and possible adverse effects. We also review the various surgical techniques used in tonsillectomy with a focus on reducing postoperative pain.
Conclusions and Relevance: Clinicians should understand effective methods of analgesia after tonsillectomy in children, and know the potential consequences of each option. Caution should be employed when using opioids, particularly in young children with severe OSAS. Although large studies of NSAID use have shown effective pain management without an increase in posttonsillectomy bleeding frequency, the potential for more severe bleeding events has been debated. Cold dissection techniques lead to less pain, but hot techniques remain popular, with less intraoperative blood loss and shorter operative time. Partial (intracapsular) tonsillectomy seems to reduce pain as well.
PMID: 28662233 [PubMed - as supplied by publisher]
http://ift.tt/2tua2zS
Unilateral Nasal Congestion in an Elderly Man.
Unilateral Nasal Congestion in an Elderly Man.
JAMA Otolaryngol Head Neck Surg. 2017 Jun 29;:
Authors: Cai Y, Parasher AK, Palmer JN
PMID: 28662224 [PubMed - as supplied by publisher]
http://ift.tt/2us6gnG
Antipodocalyxin Antibody chPcMab-47 Exerts Antitumor Activity in Mouse Xenograft Models of Colorectal Adenocarcinomas
Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.
http://ift.tt/2tysmJ8
Different levels of let-7d expression modulate response of FaDu cells to irradiation and chemotherapeutics
by Katarzyna Monika Lamperska, Tomasz Kolenda, Anna Teresiak, Anna Kowalik, Marta Kruszyna-Mochalska, Weronika Jackowiak, Renata Bliźniak, Weronika Przybyła, Marta Kapałczyńska, Piotr Kozlowski
The implication of the let-7 family in cancer development is multifaceted. The family acts as tumor suppressor miRNA although overexpression of let-7 has also been described in many types of cancer, including head and neck squamous cell carcinoma (HNSCC). The aim of this study includes whether different expression levels of let-7d has an influence on chemo- and radiosensitivity. FaDu cell line models with a gradually increased level of let-7d (models from A to E) were generated with the lentiviral system. Expression levels of pluripotency, chemo-radioresistance/apoptosis, and targets of mRNAs were analyzed by real-time reverse transcription-PCR (qRT-PCR). Radiosensitivity was analyzed using a clonogenic assay after irradiation. Response to cisplatin, 5-FU, doxorubicin, and paclitaxel was done with MTT assay. Statistically significant decrease of K-RAS (p = 0.0369) and CASPASE3 (p = 0.0342) were observed with the growing expression level of let-7d. Cisplatin, 5-FU and doxorubicin caused similar decreased of cell survival with the increase of let-7d level (p = 0.004, post-trend p = 0.046; p = 0.004, post trend p = 0.0005 and pp = 0.0001, respectively). All models were resistant to paclitaxel, irrespective of let-7d expression levels. Only two of the generated models (A and C) were radiosensitive (p = 0.0002). Conclusion: the above results indicated that the level of let-7d expression is an important factor for cell response to irradiation and chemotherapeutics.http://ift.tt/2tufxyv
Different levels of let-7d expression modulate response of FaDu cells to irradiation and chemotherapeutics
by Katarzyna Monika Lamperska, Tomasz Kolenda, Anna Teresiak, Anna Kowalik, Marta Kruszyna-Mochalska, Weronika Jackowiak, Renata Bliźniak, Weronika Przybyła, Marta Kapałczyńska, Piotr Kozlowski
The implication of the let-7 family in cancer development is multifaceted. The family acts as tumor suppressor miRNA although overexpression of let-7 has also been described in many types of cancer, including head and neck squamous cell carcinoma (HNSCC). The aim of this study includes whether different expression levels of let-7d has an influence on chemo- and radiosensitivity. FaDu cell line models with a gradually increased level of let-7d (models from A to E) were generated with the lentiviral system. Expression levels of pluripotency, chemo-radioresistance/apoptosis, and targets of mRNAs were analyzed by real-time reverse transcription-PCR (qRT-PCR). Radiosensitivity was analyzed using a clonogenic assay after irradiation. Response to cisplatin, 5-FU, doxorubicin, and paclitaxel was done with MTT assay. Statistically significant decrease of K-RAS (p = 0.0369) and CASPASE3 (p = 0.0342) were observed with the growing expression level of let-7d. Cisplatin, 5-FU and doxorubicin caused similar decreased of cell survival with the increase of let-7d level (p = 0.004, post-trend p = 0.046; p = 0.004, post trend p = 0.0005 and pp = 0.0001, respectively). All models were resistant to paclitaxel, irrespective of let-7d expression levels. Only two of the generated models (A and C) were radiosensitive (p = 0.0002). Conclusion: the above results indicated that the level of let-7d expression is an important factor for cell response to irradiation and chemotherapeutics.http://ift.tt/2tufxyv
Industry relationships are associated with performing a greater number of sinus balloon dilation procedures
Background
Industry outreach promotes awareness of novel technologies. However, concerns have been raised that such relationships may also unduly impact medical decision-making. Our objective in this study was to evaluate industry relationships among practitioners who frequently employ balloon dilation (BD), characterizing whether there is any association between financial relationships and BD utilization.
Methods
Provider utilization data (FY-2014) was accessed for individuals billing BD procedures to Medicare, the largest healthcare payor in the United States. The names of individuals included in these data sets were cross-referenced with the Centers for Medicare and Medicaid Services Open Payment site to determine the extent of industry relationships during this same year. Individuals included in this analysis were organized by those with "significant" ($1,000 to $10,000) and "major" (> $10,000) industry relationships. Practice setting, training, and experience were also evaluated.
Results
Of the 302 otolaryngologists who billed enough BDs for inclusion in this data set, 99.3% were in private practice, 89.7% were board-certified, 8.3% had facial plastic and reconstructive fellowship training, and 1.3% had rhinology fellowship training. There was a significant increase in BDs performed with increasing BD company financial contributions (analysis of variance, p = 0.0003). Individuals without "significant" relationships with BD companies billed fewer BDs than those with at least "significant" (>$1,000) relationships (57.0 ± 4.3 vs 87.7 ± 10.0, p = 0.001).
Conclusion
There is an association between receiving money from industry and the frequency with which otolaryngologists employ BD. Although our analysis demonstrates an association, these results in no way imply causation. Further analysis exploring the reasons for this association may be necessary.
http://ift.tt/2ty0d4E
Prognostic value of nasal cytology and clinical factors in nasal polyps development in patients at risk: can the beginning predict the end?
Background
We evaluated the prognostic value of nasal cytology and clinical factors in predicting nasal polyp (NP) development in patients with history of nonallergic chronic sinonasal inflammation.
Methods
This was a retrospective case-control study of 295 patients followed at our institution for a mean of 85.70 ± 19.41 months. According to the inclusion criteria we enrolled 84 cases with persistent eosinophilic nonallergic sinonasal inflammation (group A) and 106 cases with neutrophilic inflammation (group B), both without evidence of NPs at the baseline. We considered as controls 105 patients affected by nonallergic noninfectious vasomotor rhinitis without evidence of inflammation at nasal cytology (group C). Patients were checked every 6 months for NPs. Temporal analyses was performed by Kaplan-Mayer curves and odds ratios were evaluated by logistic regression analyses.
Results
The percentage of patients that developed NPs was higher in group A (29/84 [34.52%]) than in group B (17/106 [16.03%]) and group C (5/104 [4.7%]) (p < 0.05). Logistic regression analyses showed that eosinophilic patients had a higher risk of NP development over the years than neutrophilic patients compared to controls (odds ratio [OR], 10.55 vs 3.2). We also demonstrated that hypereosinophilia, asthma, and aspirin intolerance may increase the OR differently in eosinophilic patients.
Conclusion
Our data suggest that early identification of inflammatory patterns and associated clinical factors in patients affected by chronic nonallergic sinonasal inflammation have a prognostic value that can help to identify patients with different risks of NP development. Our data confirm that detection of nasal eosinophilic inflammation represents an early marker for identification of a more aggressive inflammatory phenotype.
http://ift.tt/2u7mIKV
Quality measurement for rhinosinusitis: a review from the Quality Improvement Committee of the American Rhinologic Society
Background
Measuring quality outcomes is an important prerequisite to improve quality of care. Rhinosinusitis represents a high value target to improve quality of care because it has a high prevalence of disease, large economic burden, and large practice variation. In this study we review the current state of quality measurement for management of both acute (ARS) and chronic rhinosinusitis (CRS).
Methods
The major national quality metric repositories and clearinghouses were queried. Additional searches included the American Academy of Otolaryngology–Head and Neck Surgery database, PubMed, and Google to attempt to capture any additional quality metrics.
Results
Seven quality metrics for ARS and 4 quality metrics for CRS were identified. ARS metrics focused on appropriateness of diagnosis (n = 1), antibiotic prescribing (n = 4), and radiologic imaging (n = 2). CRS quality metrics focused on appropriateness of diagnosis (n = 1), radiologic imaging (n = 1), and measurement of patient quality of life (n = 2). The Physician Quality Reporting System (PQRS) currently tracks 3 ARS quality metrics and 1 CRS quality metric. There are no outcome-based rhinosinusitis quality metrics and no metrics that assess domains of safety, patient-centeredness, and timeliness of care.
Conclusions
The current status of quality measurement for rhinosinusitis has focused primarily on the quality domain of efficiency and process measures for ARS. More work is needed to develop, validate, and track outcome-based quality metrics along with CRS-specific metrics. Although there has been excellent work done to improve quality measurement for rhinosinusitis, there remain major gaps and challenges that need to be considered during the development of future metrics.
http://ift.tt/2tyqPCT
Increased expression of TIPE2 in alternatively activated macrophages is associated with eosinophilic inflammation and disease severity in chronic rhinosinusitis with nasal polyps
Background
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial disorder characterized by exaggerated local immune responses. Tumor necrosis factor-α–induced protein 8–like 2 (TIPE2) is a novel protein with potential immune modulating function. The expression and function of TIPE2 in human airway diseases are unclear.
Methods
The expression of TIPE2 in sinonasal mucosal samples was assessed by means of quantitative reverse transcript–polymerse chain reaction, immunohistochemistry, and Western blotting. The human monocytic/macrophage cell line, THP-1 cells, was stimulated with various cytokines. Computed tomography (CT) scan images, endoscopic findings, and symptoms were scored.
Results
Compared with non-eosinophilic polyps and control mucosa, the mRNA and protein expression of TIPE2 was significantly upregulated in eosinophilic polyps, with a further increase in those with asthma. The number of CD68+CD163+ alternatively activated (M2) macrophages was increased in eosinophilic polyps. TIPE2 was mainly expressed by M2 macrophages in sinonasal mucosa and its expression was upregulated in M2 macrophages in eosinophilic polyps. Interleukin (IL)-4 and IL-13, but not interferon (IFN)-γ or IL-17A, induced TIPE2 expression in differentiated THP-1 cells. The mRNA levels of IL-4 and IL-13 correlated with the mRNA levels of TIPE2 and M2 macrophage markers in sinonasal mucosa. Importantly, the number of TIPE2+ cells, particularly TIPE2+CD163+CD68+ M2 macrophages, correlated positively with the number of eosinophils and total inflammatory cells in sinonasal mucosa, as well as disease duration, CT scores, hyposmia scores, and polyp size in CRSwNP.
Conclusion
The T-helper 2 milieu is able to induce TIPE2 expression in macrophages. TIPE2-positive M2 macrophages potentially contribute to eosinophilic inflammation and disease progression in CRSwNP.
http://ift.tt/2u718Gv
VideoEndocrinology™ High-Impact Videos
VideoEndocrinology™
The Official Journal of: American Thyroid Association
FREE ACCESS through July 14, 2017.
Retroperitoneal Paraganglioma Resected Through the Posterior Retroperitoneoscopic Approach
Thanyawat Sasanakietkul, Tobias Carling
Survival in Patients with Medullary Thyroid Cancer After Less Extensive Operations
Reese W. Randle, Maria F. Bates, David F. Schneider, Rebecca S. Sippel, Susan C. Pitt
Personalized Selection Criteria for Radioiodine Administration in Low- and Intermediate-Risk Papillary Thyroid Carcinoma
Clinton D. Bahler, Viraj Maniar, Kristen N. Marley, Steven V. Kheyfets, Cheuk Fan Shum, Chandru P. Sundaram
The post VideoEndocrinology™ High-Impact Videos appeared first on American Thyroid Association.
http://ift.tt/2tsVjWq
Role of sialendoscopy in juvenile recurrent parotitis (JRP)
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): E. Berta, G. Angel, F. Lagarde, B. Fonlupt, L. Noyelles, G. Bettega
Juvenile recurrent parotitis (JRP) is a rare disease of childhood occurring between the ages of 3 and 5 years, characterized by recurrent non-suppurative parotitis, spontaneously evolving towards parotid gland dysfunction. Clinically, JRP presents in the form of unilateral or bilateral, usually asynchronous, swelling of the parotid gland. The diagnosis is based on ultrasound characteristics. Widespread use of sialendoscopy has opened up new prospects for the management of this disease. This review of the literature evaluates the role of sialendoscopy in the management of JRP. A Medline search retrieved 68 articles, 18 of which concerned JRP. Standard treatment consists of antibiotics for at least 10 days at the acute phase of the disease. All studies demonstrated the diagnostic value of sialendoscopy by visualizing strictures, hypovascularization and whitish intraductal debris. Sialendoscopy is also useful for treatment, by allowing intraductal lavage and, when possible, dilatation of strictures. Lavage is performed with saline solution, hydrocortisone, antibiotics or a combination of these solutions, with no significant differences in terms of efficacy. The mode of administration with or without sialendoscopy also appears to provide similar results. Sialendoscopy appears to be a diagnostic and therapeutic option, although it has not been shown to be more effective than simple lavage. All lavage solutions appear to be effective.
http://ift.tt/2s9NoJD
Bronchoprotective tolerance with indacaterol is not modified by concomitant tiotropium in persistent asthma
Abstract
Background
Tiotropium is a long acting antimuscarinic (LAMA), licenced as triple therapy with inhaled corticosteroid and long acting beta-agonist (ICS/LABA). There may be a synergistic benefit between LAMA and LABA as a consequence of receptor cross-talk, which in turn could modify beta-2 receptor down-regulation and associated tolerance induced by LABA.
Objective
We hypothesise this mechanism may result in a reduction of airway hyperresponsiveness (AHR) when using triple therapy.
Methods
We evaluated 14 non-smoking asthmatics using an open-label, randomized crossover design. ICS with Indacaterol and Tiotropium (IND/TIO) vs ICS with Indacaterol (IND) over 4 weeks with challenge performed after 1st and last doses at trough.
Results
We found no significant difference in mannitol sensitivity, expressed as the provocative dose of mannitol required to reach a 15% drop in FEV1, or mannitol reactivity, expressed as the response dose ratio (RDR: max % fall in FEV1 / cumulative dose), when comparing ICS/IND/TIO to ICS/IND. Geometric mean fold differences for RDR comparing single and chronic dosing were 3.26 fold (95%CI 1.46-7.29) and 2.51 fold (95%CI 1.32-4.79) for IND and IND/TIO respectively. Furthermore, salbutamol recovery post challenge was significantly blunted after chronic compared to single dosing with either IND (P<0.005) or IND/TIO (P<0.05).
Conclusion & Clinical Relevance
Our data suggests that concomitant tiotropium does not modify the bronchoprotective tolerance induced by Indacaterol, in turn suggesting that cross-talk may not be clinically relevant when using triple therapy. This study was registered on clinicaltrials. gov as NCT02039011.
This article is protected by copyright. All rights reserved.
http://ift.tt/2s9u675
Comorbidities in adults with asthma: population-based cross-sectional analysis of 1.4 million adults in Scotland
Abstract
Background
Comorbidity in people with asthma can significantly increase asthma morbidity and lower adherence to asthma guidelines.
Objective
The objective of this study was to comprehensively measure the prevalence of physical and mental health comorbidities in adults with asthma using a large nationally representative population.
Methods
Cross-sectional analysis of routine primary care electronic medical records for 1,424,378 adults in the UK, examining the prevalence of 39 comorbidities in people with and without asthma, before and after adjustment for age, sex, social deprivation and smoking status using logistic regression.
Results
Of 39 comorbidities measured, 36 (92%) were significantly more common in adults with asthma. 62.6% of adults with asthma had ≥1 comorbidity vs. 46.2% of those without, and 16.3% had ≥4 comorbidities vs. 8.7% of those without. Comorbidities with the largest absolute increase in prevalence in adults with asthma were: COPD (13.4% vs 3.1%), depression (17.3% vs 9.1%), painful conditions (15.4% vs 8.4%), and dyspepsia (10.9% vs 5.2%). Comorbidities with the largest relative difference in adults with asthma compared to without were: COPD (adjusted odds ratio [aOR] 5.65, 95%CI 5.52-5.79), bronchiectasis (aOR 4.65, 95%CI 4.26-5.08), eczema/psoriasis (aOR 3.30, 95%CI 3.14-3.48), dyspepsia (aOR 2.20, 95%CI 2.15-2.25) and chronic sinusitis (aOR 2.12, 95%CI 1.99-2.26). Depression and anxiety were more common in adults with asthma (aOR 1.60, 95%CI 1.57-1.63, and aOR 1.53, 95%CI 1.48-1.57 respectively).
Conclusions and Clinical Relevance
Physical and mental health comorbidity is the norm in adults with asthma. Appropriate recognition and management should form part of routine asthma care.
This article is protected by copyright. All rights reserved.
http://ift.tt/2tswda5
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