Head and Neck Medicine by Alexandros G.Sfakianakis: 01/04/17

Τετάρτη 4 Ιανουαρίου 2017

Editorial Board/Reviewing Committee

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Calendar of Events

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Preclinical uPAR-targeted multimodal imaging of locoregional oral cancer

Publication date: March 2017
Source:Oral Oncology, Volume 66
Author(s): M.C. Boonstra, P.B.A.A. Van Driel, S. Keereweer, H.A.J.M. Prevoo, M.A. Stammes, V.M. Baart, C.W.G.M. Löwik, A.P. Mazar, C.J.H. van de Velde, A.L. Vahrmeijer, C.F.M. Sier
ObjectivesEstablishing adequate resection margins and lymphatic mapping are crucial for the prognosis of oral cancer patients. Novel targeted imaging modalities are needed, enabling pre- and intraoperative detection of tumour cells, in combination with improved post-surgical examination by the pathologist. The urokinase-receptor (uPAR) is overexpressed in head and neck cancer, where it is associated with tumour progression and metastasis.Material and methodsTo determine suitability of uPAR for molecular imaging of oral cancer surgery, human head and neck tumours were sectioned and stained for uPAR to evaluate the expression pattern compared to normal mucosa. Furthermore, metastatic oral squamous carcinoma cell line OSC-19 was used for targeting uPAR in in vivo mouse models. Using anti-uPAR antibody ATN-658, equipped with a multimodal label, the in vivo specificity was investigated and the optimal dose and time-window were evaluated.ResultsAll human oral cancer tissues expressed uPAR in epithelial and stromal cells. Hybrid ATN-658 clearly visualized tongue tumours in mice using either NIRF or SPECT imaging. Mean fluorescent TBRs over time were 4.3±0.7 with the specific tracer versus 1.7±0.1 with a control antibody. A significant difference in TBRs could be seen between 1nmol (150μg) and 0.34nmol (50μg) dose groups (n=4, p<0.05). Co-expression between BLI, GFP and the NIR fluorescent signals were seen in the tongue tumour, whereas human cytokeratin staining confirmed presence of malignant cells in the positive cervical lymph nodes.ConclusionThis study shows the applicability of an uPAR specific multimodal tracer in an oral cancer model, combining SPECT with intraoperative guidance.

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Systemic Inflammatory Response and Severe Thrombocytopenia after Endovascular Thoracic Aortic Aneurysm Repair

After Endovascular repair of thoracic aortic aneurysm, a systemic inflammatory response, named postimplantation syndrome, can develop. This syndrome is characterized by fever, leukocytosis, and elevated CRP plasma levels and its pathogenetic mechanisms are still unknown. Although this syndrome generally resolves within few days, some patients develop a persisting severe inflammatory reaction leading to mild or severe complications. Here we describe the case of a male patient who developed postimplantation inflammatory syndrome and severe thrombocytopenia after endovascular repair of thoracic aortic aneurysm. Treatment with prednisone (50 mg/bid) for two weeks did not improve the clinical and laboratory findings. We utilized danazol, a weak androgen that has been shown to be effective in the treatment of immune and idiopathic thrombocytopenic purpura, and after 12 days of treatment with danazol (200 mg/bid), the patient improved progressively and platelet number increased up to 53,000/μL. Patients undergoing endovascular repair of thoracic aortic aneurysm should be carefully monitored for the development of postimplantation syndrome. This clinical condition is relatively common after the endovascular repair of aortic aneurysm but is rarely observed after endovascular repair of thoracic aortic aneurysms. The different known therapeutical approaches are still empiric, with reported beneficial effects with the use of NSAID, corticosteroids, and danazol.

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Clinical features of shiitake dermatitis: a systematic review

Summary

Shiitake dermatitis is a rare cutaneous reaction to lentinan, a polysaccharide component in the cell walls of shiitake mushrooms (Lentinula edodes). Herein, we systematically review the case report and case series English-language literature on shiitake dermatitis, which refers to a total of 50 patients (38 males, 12 females; mean age: 44.58 years). The majority of cases occurred after the consumption of raw mushrooms, whereas 22% of cases were caused by the eating of lightly or undercooked mushrooms. The most common clinical presentations, localized symptoms, and systemic findings include linear flagellated dermatitis (98%), pruritus (78%), and fever, diarrhea, and mucosal ulcers, respectively. The diagnosis of this entity continues to be based on clinical findings as laboratory abnormalities, and the findings of skin biopsies and patch/prick tests are nonspecific and inconsistent. The condition is self-limiting, resolving in approximately 12.5 d without treatment. Based on the included case reports, it appears that medical treatment may slightly shorten the course of disease (to 9–11 d, varying by therapy) but should be considered on an individual patient basis. However, the treatment of symptoms, reassurance, and the avoidance of re-exposure are sufficient treatment recommendations for this condition.

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Effects of age of onset on disease characteristics in non-segmental vitiligo

Abstract

In patients with vitiligo, the clinical and laboratory features of the disease may vary according to time of onset. This is addressed in the literature by only a few studies with conflicting results. The aim of this study was to determine the demographic and clinical features of patients with non-segmental vitiligo and to establish the association between vitiligo and autoimmune diseases with a focus on time of disease onset. A total of 224 vitiligo patients for whom complete medical records were available were evaluated retrospectively. Demographic data, scores on the Vitiligo Area Score Index (VASI), clinical features, vitiligo disease activity, repigmentation status, presence of any accompanying autoimmune disease, antinuclear antibody (ANA) titers, serum levels of glucose, thyroid-stimulating hormone (TSH), thyroxine (T4) hormone, anti-thyroid peroxidase (anti-TPO), and anti-thyroglobulin (anti-TG) were recorded. The prevalence of halo nevi was significantly higher (P < 0.001) among children than in other patient groups. The prevalence of leukotrichia was higher in adults with adult-onset disease than in either pediatric patients or adults with childhood-onset disease (P = 0.002). Both anti-TG and anti-TPO levels were significantly higher in adults with adult-onset disease than in pediatric patients and adult patients with childhood-onset disease. The prevalence of autoimmune disease was 22.2%. Anti-TG levels were significantly higher in patients with treatment-related repigmentation than in those without repigmentation. This study shows that clinical features and associations with autoimmune disease may vary according to the age of onset of vitiligo.

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Ferrochelatase gene mutation in Singapore and a novel frame-shift mutation in an Asian boy with erythropoietic protoporphyria

Abstract

Background

Erythropoietic protoporphyria (EPP) is a rare inherited disorder of heme biosynthesis caused by decreased activity of the enzyme ferrochelatase (FECH ). The frequency of the hypomorphic c.333-48C allele in a population directly contributes to the prevalence of EPP in the same population. This study sought to identify the molecular basis of EPP in a Chinese patient from Singapore and the c.333-48C allele frequency among the Chinese population in Singapore.

Materials and methods

FECH gene was screened for mutation in the patient's DNA sample by polymerase chain reaction amplification and DNA sequencing. To validate the identified mutation, the FECH region harboring the mutation was screened in DNA samples from all healthy controls. One patient and 46 ethnically matched healthy controls were included in the study.

Results

A novel c.474dupC which leads to a frameshift and premature stop codon was identified in one allele, while the other allele showed to carry c.333-48C and c.337C>T variants in the patient's FECH. The frequency of the c.333-48C hypomorphic allele is 27% among Chinese population in Singapore.

Conclusions

c.474dupC in one allele trans to hypomorphic c.333-48C and c.337C>T allele in FECH gene may be the underlying cause of the clinical EPP of the studied patient. The FECH hypomorphic c.333-48C allele frequency in Singapore is lower than the Han Chinese (41.3%) and Japanese (43%) populations but nearly the same as the Southeast Asian (31%) population and higher than the European (2.7–11%) population.

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Hidradenitis suppurativa treated with tetracycline in combination with colchicine: a prospective series of 20 patients

Abstract

Background

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder of the follicular epithelium.

Objectives

The objective of the present study was to evaluate the effectiveness of the combination of tetracycline with colchicine in the treatment of HS.

Methods

Twenty patients (10 women and 10 men) with HS were included in an open, prospective, pilot study. All patients were treated with 100 mg minocycline administered orally once per day in combination with 0.5 mg colchicine administered twice per day for 6 months followed by a maintenance regimen of 0.5 mg colchicine administered orally twice per day for 3 months. Patients were examined at baseline and thereafter every 3 months for a total of 9 months. The efficacy of the treatment was evaluated using a physician's global assessment (PGA) scale, the Hurley scoring system, and the Dermatology Life Quality Index (DLQI).

Results

A significant improvement in clinical manifestation was reflected in scores on the Hurley scoring system and DLQI. According to the PGA, patients achieved substantial improvement or complete remission. Clinically, all patients started to show signs of improvement within the first 3 months of therapy and continued to improve over the next 6 months.

Conclusions

This study indicates that the combination of the anti-inflammatory actions of colchicine and minocycline is effective in disease control in HS. Colchicine emerged as a safe option for the maintenance of the obtained result.

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Unilateral blue rubber bleb naevus syndrome with Chiari malformation

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Toll-like receptor (TLR)7 expression in mycosis fungoides and psoriasis: a case–control study

Summary

Background

Toll-like receptors (TLRs) have been implicated in various dermatological diseases. TLR agonists have the capacity to potently activate the innate immune cells of patients with advanced, refractory, cutaneous T-cell lymphoma (CTCL).

Aim

To detect TLR7 gene expression in mycosis fungoides (MF) (a neoplastic skin condition) and to compare it with psoriasis (an inflammatory skin condition) in an attempt to clarify the pathogenic role played by TLR7 in both conditions.

Methods

This case–control study enrolled 28 patients with MF: 30 patients with psoriasis, and 30 age- and sex-matched healthy controls (HCs). A 4-mm punch skin biopsy was obtained from lesional skin of patients and from normal skin of HCs for detection of TLR7 gene expression using real-time PCR.

Results

Mean TLR7 level in patients with MF (0.4 ± 0.23) was significantly lower than in patients with psoriasis (1.49 ± 0.46) and in HCs (1.22 ± 0.44) (P < 0.001), and mean TLR7 level in patients with psoriasis was significantly higher than in HCs (P < 0.03). Based on MF staging, 21.4% of patients had stage Ia, 28.6% had stage Ib, 28.6% had stage IIa and 21.4% had stage IIb disease. Comparing the TLR7 levels in relation to MF staging revealed the lowest mean value was in stage IIb and highest mean value in stage Ia, and this was significant (P < 0.001).

Conclusion

Disturbed innate immunity might play a role in the pathogenesis of neoplastic and inflammatory skin conditions. TLR7 could be useful as a prognostic factor in MF.

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Nasopharyngeal Angiofibroma: Paradigm Shift in Management

Abstract

To report on a series of patients of nasopharyngeal angiofibroma of varied ages with different stages and management algorithm which reduced morbidity associated with this tumour. Retrospective. We report a series of ten patients who presented to a tertiary care institution and were diagnosed to have NA from 2012 to 2014. Patients were categorized by Radkowski staging and data was collected to document differences in terms of presentation, operative technique, and postoperative course. All patients underwent preoperative embolization. Stage I and selected stage II lesions were approached endoscopically while the remainder underwent open resection. In comparison with open procedures, endoscopic procedures had less intraoperative blood loss (350 vs. 630 cc), operative time (90 vs. 150 min) and the average hospital stay was one day less (3 vs. 4 days). Proper preoperative work up including nonsurgical intervention in the form of embolisation and selecting proper surgical approach is rewarding in case of angiofibromas of all stages which help to reduce morbidity associated with these benign tumours.

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Neck Trauma: ENT Prospects

Abstract

Neck trauma is a very important surgical emergency faced by ENT surgeons in day to day practice. They are potentially life threatening conditions due to the presence of many vital structures in this area. Timely presentation to the referral centre and proper multidisciplinary approach towards management plays a pivotal role in the healing pattern of the wound and prevention of serious complication like shock, sepsis, laryngeal stenosis or fistula formation. A retrospective study was done in ENT Department, NSCB Medical College, Jabalpur, Madhya Pradesh, India during the period of 2014–2016. 17 patients were included in the study. All the records regarding symptoms at presentation, type and mode of injury, level of injury were analyzed. Management plan undertaken were thoroughly studied and post operative complications like hoarseness, stenosis or fistula formation were noted carefully. 14 out of 17 patients were male, all 17 patients belonged to lower socioeconomic status. Most common age group presenting with neck trauma was between 22 and 40 years. 7 case were homicidal, 5 cases were suicidal and 4 were of accidental injury. Most cases reached hospital within 2–6 h of injury except 3 cases which took more than 8 h. Bleeding from wound site was most common symptom at presentation. Most injuries in 13 out of 17 cases were at thyroid cartilage level. Penetrating neck trauma was most common followed by blunt neck trauma. Most cases required emergency tracheostomy along with primary laryngotracheal repair. Most common post operative complication seen was wound dehiscence, subglottic stenosis and fistula formation. Neck trauma and cut throat injuries are potentially life threatening emergency that require multidisciplinary approach. Timely intervention can be crucial in preventing fatal complications and reducing morbidity period of the patient.

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Juvenile ‘Perinasal’ Angiofibroma

Abstract

The extranasopharyngeal angiofibroma is a separate clinical entity but those involving infratemporal fossa and cheek resemble juvenile nasopharyngeal angiofibroma (JNA) and hence have been labelled as juvenile perinasal angiofibroma (JPA) in this paper. This paper presents a 7th case of JPA and attempts to review the world literature on JPA, along with a proposal of staging the disease. A 16 year male presented with a painless compressible facial swelling since 7 months without any epistaxis or nasal obstruction. Initially a vascular lesion was suspected but JNA without nasal extension was strongly suspected on imaging. A deep trucut biopsy confirmed the histopathology. The vascular enhancement was significant and the tumour was excised through open approach (Weber Fergusson). JPA that can be regarded as a variant of JNA that fails to extend medially. Imaging demonstrates classical JNA findings with a clear nose/nasopharynx. A deep trucut biopsy under control in inpatient settings may sometimes help. JPA presents most commonly in Stage II where an open facial approach preferably following selective preoperative embolization is indicated. Hence with painless compressible (or non-compressible) cheek swelling suspected to be of a vascular etiology, a high degree of clinical suspicion for JPA needs to maintained in order to prevent a misdiagnosis.

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A Model of Electrically Stimulated Auditory Nerve Fiber Responses with Peripheral and Central Sites of Spike Generation

Abstract

A computational model of cat auditory nerve fiber (ANF) responses to electrical stimulation is presented. The model assumes that (1) there exist at least two sites of spike generation along the ANF and (2) both an anodic (positive) and a cathodic (negative) charge in isolation can evoke a spike. A single ANF is modeled as a network of two exponential integrate-and-fire point-neuron models, referred to as peripheral and central axons of the ANF. The peripheral axon is excited by the cathodic charge, inhibited by the anodic charge, and exhibits longer spike latencies than the central axon; the central axon is excited by the anodic charge, inhibited by the cathodic charge, and exhibits shorter spike latencies than the peripheral axon. The model also includes subthreshold and suprathreshold adaptive feedback loops which continuously modify the membrane potential and can account for effects of facilitation, accommodation, refractoriness, and spike-rate adaptation in ANF. Although the model is parameterized using data for either single or paired pulse stimulation with monophasic rectangular pulses, it correctly predicts effects of various stimulus pulse shapes, stimulation pulse rates, and level on the neural response statistics. The model may serve as a framework to explore the effects of different stimulus parameters on psychophysical performance measured in cochlear implant listeners.

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IFN-γ Attenuates Spontaneous Lymphocyte Proliferation by Fuelling Regulatory T Cells in HIV-1-Infected Patients

Viral Immunology , Vol. 0, No. 0.

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The Role of Myeloid-Derived Suppressor Cells in Viral Infection

Viral Immunology , Vol. 0, No. 0.

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Effect of Almond Supplementation on Glycemia and Cardiovascular Risk Factors in Asian Indians in North India with Type 2 Diabetes Mellitus: A 24-Week Study

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

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Population-Based National Prevalence of Thyroid Dysfunction in Spain and Associated Factors: Di@bet.es Study

Thyroid , Vol. 0, No. 0.

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A Novel Gel Pad Laryngeal Ultrasound for Vocal Cord Evaluation

Thyroid , Vol. 0, No. 0.

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Future Meetings

Thyroid Jan 2017, Vol. 27, No. 1: 132-133.

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Lessons Learned After 1000 Cases of Transcutaneous Laryngeal Ultrasound (TLUSG) with Laryngoscopic Validation: Is There a Role of TLUSG in Patients Indicated for Laryngoscopic Examination Before Thyroidectomy?

Thyroid Jan 2017, Vol. 27, No. 1: 88-94.

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Custom-made fibular “cradle” plate to optimise bony height, contour of the lower border, and length of the pedicle in reconstruction of the mandible

The fibular free flap has become the standard method of reconstruction of the body of the mandible since it was first reported in 1989.1

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Microvascular reconstruction of facial defects in settings where resources are limited

The surgical treatment of defects caused by noma is challenging for the surgeon and the patient. Local flaps are preferred, but sometimes, because of the nature of the disease, there is not enough local tissue available. We describe our experience of free tissue transfer in Ethiopia. Between 2008 and 2014, 34 microsurgical procedures were done over 11 missions with the charity Facing Africa, predominantly for the treatment of defects caused by noma (n=32). The mean duration of operation was 442minutes (range 200 – 720).

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Anti-DFS70 antibodies in healthy schoolchildren: A follow-up analysis

Publication date: Available online 4 January 2017
Source:Autoimmunity Reviews
Author(s): Francesca Sperotto, Mara Seguso, Nicoletta Gallo, Mario Plebani, Francesco Zulian

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Immunoplasticity in cutaneous melanoma: beyond pure morphology

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Effect of Er:Yag laser on dentin demineralization around restorations

Abstract

The aim of this study was to evaluate the effect of cavity preparation with Er:YAG laser on dentin adjacent to restorations submitted to cariogenic challenge in situ, by subsuperficial microhardness analysis. Bovine incisors were sectioned, flattened, and polished, resulting in 40 dentin slabs. The slabs were randomly assigned to four groups (n = 10), according to the cavity preparation method: I—high-speed handpiece (control); II—Er:YAG laser (160 mJ; 3 Hz); III—Er:YAG laser (260 mJ; 3 Hz); IV—Er:YAG laser (300 mJ; 3Hz). Cavities were restored with composite resin, and the specimens were fixed in intra-oral appliances, which were worn by 10 volunteers for 14 days for simulating cariogenic challenge in situ. During the experimental period, 20% sucrose solution was dripped over each specimen 6 times a day. Samples were removed, sectioned, and examined for subsuperficial Knoop microhardness at 100, 200, and 300 μm from the restoration and at 30 μm from dentin surface. Split-plot analysis of variance showed no significant difference among the cavity preparation techniques (p = 0.1129), among distances (p = 0.9030), as well as no difference in the interaction between the main factors (p = 0.7338). It was concluded that the cavity preparation with Er:YAG laser did not influence on dentin microhardness submitted to cariogenic challenge in situ.

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Effectiveness of low-level laser therapy on pain intensity, pressure pain threshold, and SF-MPQ indexes of women with myofascial pain

Abstract

Women with temporomandibular disorders (TMD) frequently report pain areas in body regions. This process is associated with central sensitization phenomena, present in chronic pain. The low-level laser therapy (LLLT) has been reported as a therapeutic option for the painful TMD treatment. The aim of this study was to analyze the effect of LLLT on pain intensity (visual analogue scale, VAS), pain sensitivity in orofacial and corporal points (pressure pain threshold, PPT), and on Short Form-McGill Pain Questionnaire (SF-MPQ) indexes of women with myofascial pain (subtype of muscle TMD). Ninety-one women (18–60 years) were included in the study, among which 61 were diagnosed with myofascial pain (Research Diagnostic Criteria for Temporomandibular Disorder—Ia and Ib) and were divided into laser (n = 31) and placebo group (n = 30), and 30 were controls. The LLLT was applied at pre-established points, twice a week, eight sessions (780 nm; masseter and anterior temporal = 5 J/cm², 20 mW, 10 s; TMJ area = 7.5 J/cm², 30 mW, 10 s). Pain intensity, pain sensitivity, and the SF-MPQ indexes were measured at the baseline, during laser sessions, and 30 days after treatment. For intra-group comparisons, the Friedman test was performed, and for inter-group, the Mann-Whitney test. Increased pain sensitivity was found in women with myofascial pain when compared to controls (p < 0.05). There was a reduction in pain intensity for both groups after LLLT. The LLLT did not change the PPT for any group (p > 0.05). Active laser and placebo reduced the indexes of sensory, total pain, and VAS, maintaining the results after 30 days; there was a reduction in the affective pain rating index for both groups, with no maintenance after 30 days for placebo, and the present pain intensity decreased in the laser group and did not change in the placebo after LLLT. In conclusion, the LLLT active or placebo are effective in reducing the overall subjective perception of myofascial pain (VAS and SF-MPQ indexes); however, they have no effectiveness in reducing the pain sensitivity in orofacial and corporal points (PPT increase).

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Custom-made fibular “cradle” plate to optimise bony height, contour of the lower border, and length of the pedicle in reconstruction of the mandible

Publication date: Available online 4 January 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A.M.C. Goodson, P.L. Evans, H. Goodrum, A.W. Sugar, M.A. Kittur

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Brainstem infarct after Le Fort I osteotomy: A morbid complication

Publication date: Available online 3 January 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): R. Dhurwe, J.P. Sharma, S. Saigal, A. Rai

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The use of ultrasound in planned cesarean delivery under spinal anesthesia for patients having nonprominent anatomic landmarks

The aim of the study was to compare conventional landmark method with ultrasound-guided spinal anesthesia in cesarean delivery cases where spinous processes and interspinous spaces were not prominent on physical examination.

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Round or 'shaped' breast implants? Even plastic surgeons can't tell the difference

Looking at before-and-after photos, plastic surgeons and nurses can't tell whether breast augmentation surgery was done using conventional round implants or newer anatomically shaped implants...

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Is patient satisfaction relevant? Plastic surgeons call for better rating tools

Patient satisfaction has become an important quality measure in the US healthcare system.

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Ki-67 labeling index of neuroendocrine tumors of the lung has a high level of correspondence between biopsy samples and surgical specimens when strict counting guidelines are applied

Abstract

Optimal histopathological analysis of biopsies from metastases of neuroendocrine tumor (NET) of the lung requires more than morphology only. Additional parameters such as Ki-67 labeling index are required for adequate diagnosis, but few studies have compared reproducibility of different counting protocols and modalities of reporting on biopsies of lung NET. We compared the results of four different manual counting techniques to establish Ki-67 LI. On 47 paired biopsies and surgical specimens from 22 typical carcinoids (TCs), 14 atypical carcinoids (ACs), six large cell neuroendocrine carcinomas (LCNECs), and five small cell carcinomas (SCCs) immunohistochemical staining of Ki-67 antigen was performed. We counted, in regions of highest nuclear staining (HSR), a full ×40-high-power field (diameter = 0.55 mm), 500 or 2000 cells, or 2 mm² surface area, including the HSR or the entire biopsy fragment(s). Mitoses and necrosis were evaluated in an area of 2 mm² or the entire biopsy fragment(s). Between the four counting methods, no differences in Ki-67 LI were observed. However, a Ki-67 LI higher than 5% was found in only four cases when in an HSR, 500 cells were counted (18%), five (23%) when in an HSR 2000 cells were counted, four (18%) when 2 mm² were counted, and one (5%) TC case when the entire biopsy was counted. A 20% cutoff distinguished TC and AC from LCNEC and SCC with 100% specificity and sensitivity, while mitoses and necrosis failed to a large extent. Ki-67 LI in biopsy samples was concordant with that in resection specimens when 2000 cells, 2 mm², or the entire biopsy fragment(s) were counted. Our results are important for clinical management of patients with metastases of a lung NET.

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Nasopharyngeal Angiofibroma: Paradigm Shift in Management

Abstract

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Neck Trauma: ENT Prospects

Abstract

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Juvenile ‘Perinasal’ Angiofibroma

Abstract

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IgG4-Related Disease Treated With Rituximab and Palpebral Surgery

This case report describes a patient with IgG4-related disease with orbital pseudotumors treated with rituximab combined with palpebral surgery.

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Incorrect Figure Alignment and Error in Figure Legend

To the Editor We are writing to correct errors in our previously published report, titled "Symptomatic Congenital Hemangioma and Congenital Hemangiomatosis Associated With a Somatic Activating Mutation in GNA11." In Figure 3B, which depicts the region of the p.Q209P somatic mutation in our tumor sample viewed using the Integrated Genome Viewer software, the horizontal gray bars representing individual exome reads were off center. This was the result of our graphics software misaligning the reads with the histogram above it, causing a strange step-off to be seen. Herein, we provide a correctly aligned Figure.

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Diversity of Trial Participants in Dermatology Clinical Trials

This systematic review characterizes and assesses the representation of racial and ethnic minorities and women in randomized clinical trials across a range of dermatologic conditions.

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Progressive Purpura in a Long-Term Care Patient

A man in his 80s presented with a 1-year history of purpura, ecchymoses, anorexia, and weight loss. What is your diagnosis?

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Errors in Figure and Caption

In the article titled "Symptomatic Congenital Hemangioma and Congenital Hemangiomatosis Associated With a Somatic Activating Mutation in GNA11," published online July 20, 2016, and also in the September 2016 issue of JAMA Dermatology, Figure 3B contained an alignment error, and the caption for Figure 3B incorrectly reported the number of nonreference exome sequencing reads. A Letter of explanation has been published, and the original article has been corrected online.

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Spectrum of Diversity in Dermatology

The US Census Bureau projections show that by 2060, the non-Hispanic white population will no longer be the majority population in the United States and will be less than 44% with majority-minority crossover occurring around 2044. There will no longer be one population majority but instead a plurality of racial and ethnic groups. The underrepresentation of minorities in clinical research has been recognized for many years and resulted in national efforts to increase their participation. Lack of diversity in research participants impacts our ability to generalize results because studies may fail to detect relevant findings in specific groups owing to the effects of their unique mix of environmental, physiological, and cultural factors. The National Institutes of Health, the primary source of federal research funding in the United States, enforces a federal law that requires inclusion of women and minorities in all clinical research studies as appropriate for the scientific goals of proposed work. It is important that the scientific community recognize that diversity among research participants is not simply a government requirement but instead a scientific and ethical obligation needed to achieve equality and eliminate health disparities.

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Beyond Race: Female Officers and Violent Police Encounters

Violence and Gender , Vol. 0, No. 0.

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In vitro proliferation of periodontal ligament-like tissue on extracted teeth

Publication date: March 2017
Source:Archives of Oral Biology, Volume 75
Author(s): T. Iwata, C. Mino, T. Kawata
ObjectiveTransplantation of autologous teeth is a routine component of orthodontic treatment. The aim of this study was to develop a method for the regeneration of damaged periodontal ligament (PDL) on extracted teeth using a three-dimensional culture system.DesignWe used the maxillary first premolars or third molars extracted from patients for orthodontic treatment. The extracted teeth were stained with toluidine blue to measure the residual PDL area. After confirming damage of the periodontal tissue on the root surface of the extracted teeth, we tried to regenerate the periodontal tissue. Other extracted teeth were inserted into a cell strainer filled with cellulose-based carrier materials to regenerate the periodontal tissue. The strainer was then placed in a 90-mm culture dish filled with culture medium and incubated at 37°C and 5% CO2 for about 1 month. The cultured teeth were observed under a stereomicroscope and examined by scanning electron microscopy (SEM), and were stained to detect alkaline phosphatase (ALP) activity.ResultToluidine blue staining revealed that the residual periodontal membrane covered an average of 50.4% of the root surface area of each tooth. After culturing extracted teeth with our culture system, globular structures were found on the entire tooth root surface by stereomicroscopy, and PDL-like filamentous tissue was also detected by SEM. The entire tooth root surfaces of the cultured teeth were positive for ALP activity.ConclusionsWe have developed a useful culture method to stimulate the proliferation of cells in PDL-like tissue on the roots of extracted teeth.

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Wettability and surface morphology of eroded dentin treated with chitosan

Publication date: March 2017
Source:Archives of Oral Biology, Volume 75
Author(s): Mirian Saavedra Ururahy, Fabiana Almeida Curylofo-Zotti, Rodrigo Galo, Lucas Fabricio Bahia Nogueira, Ana Paula Ramos, Silmara Aparecida Milori Corona
ObjectiveTo assess the effect of chitosan, at concentrations of 2.5% and 5.0%, on the wettability of the eroded dentin, followed by analysis of surface morphology by SEM.Methods104 bovine dentin slabs were ground, polished and then immersed in 20mL of citric acid (pH=3.2) under continuous stirring for 2h. Specimens were randomly divided according to the dentin substrate: sound and eroded, and then, subdivided into 4 groups (n=10): without rewetting (control), 1% acetic acid, 2.5% chitosan and 5.0% chitosan. Then, a drop of the adhesive system Single Bond 2 (3M) was deposited onto surface of each specimen. The contact angle between dentin surface and the adhesive system was measured by using a goniometer. The other 24 specimens were subjected to analysis under SEM. Statistical analysis was performed using the normality test (Kolmogorov-Smirnov) and Analysis of Variance (ANOVA) (p>0.05).ResultsNo differences were found between the angles produced on the eroded dentin rewetting with chitosan at the concentrations of 2.5% and 5%.ConclusionThe chitosan, regardless of the concentration used, did not influence the eroded dentin wettability. Through SEM analysis, it was found particles of chitosan deposited on the surface and within the dentinal tubules.

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In vitro proliferation of periodontal ligament-like tissue on extracted teeth

Wettability and surface morphology of eroded dentin treated with chitosan

TB or not to be? Kikuchi-Fujimoto disease: a rare but important differential for TB

A 29-year-old British Pakistani woman presented with a 2-month history of drenching fevers, night sweats, lethargy and tender cervical and axillary lymphadenopathy. Initial investigations, bloods and imaging were unremarkable. Fever persisted during her admission, and treatment for tuberculosis (TB) lymphadenitis was started postbiopsy until histology confirmed a diagnosis of Kikuchi-Fujimoto's disease (KFD). KFD has a non-specific presentation of fever, night sweats and lymphadenopathy and commonly raises a clinical suspicion of a number of other serious conditions such as TB, lymphoma, HIV, systemic lupus erythematous, toxoplasmosis and infectious mononucleosis. Although rare, KFD should be considered to be a differential diagnosis for fever of unknown origin and tender lymphadenopathy in otherwise well individuals. This case demonstrates the importance of a timely histological biopsy diagnosis to prevent an incorrect diagnosis and administration of unnecessary medications.

http://ift.tt/2j4X1V7

Refractory primary immune thrombocytopenia with subsequent del(5q) MDS: complete remission of both after lenalidomide

A patient with refractory primary immune thrombocytopenia (ITP) characterised by severe skin and mucosal bleedings was treated with several ITP-directed therapies including cyclophosphamide. He later developed therapy-related del(5q) myelodysplastic syndrome with no dysplastic morphological features in bone marrow. He remained severely thrombocytopenic, which suggests ongoing immune mediated platelet destruction. After two 3 week cycles of low-dose lenalidomide, complete cytogenetic remission and complete normalisation of platelet count were observed. This suggests that lenalidomide may be a viable treatment option for ITP in the presence of del(5q) not responding to standard treatments.

http://ift.tt/2iIzNqY

Vitreous base avulsion

Description

A man aged 30 years presented with a history of floaters OD following history of blunt trauma with a cricket ball 1 week ago. Unaided visual acuity was 20/20 OU. OS was normal. OD showed vitreous base avulsion from 5 to 9'o clock position in a typical bucket handle appearance. Ultra-wide-field (Optos) imaging with eye steered inferiorly showed vitreous base avulsion (figure 1). Rest of the ocular examination was within normal limits. The patient was reassured and advised regular follow-up.

Figure 1

Ultra-wide-field pseudocolour photograph of the right eye showing vitreous base avulsion.

Vitreous base avulsion is considered to be pathognomonic of ocular blunt trauma. During trauma, there is anteroposterior compression and rapid and profound equatorial expansion. This avulses the vitreous base from the retina and pars plana due to differences in their elasticity. Only a single case has been reported...

http://ift.tt/2j4Yb2T

Sepsis and siderosis, Yersinia enterocolitica and hereditary haemochromatosis

A 60-year-old woman was admitted with sepsis, relative bradycardia, CT evidence of numerous small liver abscesses and 'skin bronzing' consistent with hereditary haemochromatosis (HH). Yersinia enterocolitica O:9 infection was confirmed by serology specimens taken 10 days apart. Iron overload was detected, and homozygous C282Y gene mutation confirmed HH. Liver biopsy revealed grade IV siderosis with micronodular cirrhosis. Haemochromatosis is a common, inherited disorder leading to iron overload that can produce end-organ damage from excess iron deposition. Haemochromatosis diagnosis allowed aggressive medical management with phlebotomy achieving normalisation of iron stores. Screening for complications of cirrhosis was started that included hepatoma surveillance. Iron overload states are known to increase patient susceptibility to infections caused by lower virulence bacteria lacking sophisticated iron metabolism pathways, for example, Yersinia enterocolitica. Although these serious disseminated infections are rare, they may serve as markers for occult iron overload and should prompt haemochromatosis screening.

http://ift.tt/2j4QwBI

Corticosteroid-induced cryptococcal meningitis in patient without HIV

Cryptococcus neoformans is the most frequent cause of fungal meningitis in humans. Cryptococcus affects people of all ages and has a worldwide distribution. It is the fourth most common infection in AIDS (CD4 counts <100/mm³). Cases also occur in patients with other forms of immunosuppression and in apparently immunocompetent individuals. Chronic high-dose steroid may precipitate such an immunocompromised state and thus create susceptibility to fungal infections. In our case, we describe a 14-year-old boy who was on steroids for tubercular meningitis for a period of 8 weeks after which he developed cryptococcal meningitis. Attention is drawn to the increasing number of reported cases of this disease which have been associated with steroid therapy and this possibility should be remembered when investigating patients with tubercular meningitis especially if they are being treated with steroids.

http://ift.tt/2iIzKeM

Acute traumatic renal arteriocalyceal fistula: selective angioembolisation for haemodynamic instability

Abdominal angiography with selective arteriography and subsequent embolisation is an accepted management modality in the treatment of selected solid organ injuries following blunt abdominal trauma. This management practice is well established in the haemodynamically stable patient; however, this remains more controversial in haemodynamically compromised patients, though warrants consideration in both cases due to the associated benefits of non-operative management. This case report describes the successful non-operative management of a severe renal injury in a young polytraumatised patient following a high-speed motor vehicle crash. In addition, the rare CT diagnosis and management of an acute traumatic arteriocalcyeal fistula is discussed with a focus on the importance of renal parenchymal preservation.

http://ift.tt/2iICBVr

Primitive neuroectodermal tumour of the cervix: a rare diagnosis

A 48-year-old woman presented with symptoms of lower abdominal pain and vaginal discharge for 6 months. Clinical examination and pelvic ultrasound scan suggested a diagnosis of infected Gartner's cyst, for which she underwent vaginal cystectomy. However, histopathology and immunohistochemistry revealed a diagnosis of primitive neuroectodermal tumour of the cervix. Further investigations revealed the stage to be FIGO IIIB, which was inoperable. She received neoadjuvant chemotherapy (vincristine, adriamycin, cyclophosphamide alternating with ifosfamide, cisplatin and etoposide, every 21 days), but the tumour did not respond to treatment and she was started on radiotherapy with definitive intent (55.8 Gray in 31 fractions over 6.2 weeks). A PET-CT performed 2 months after completion of radiotherapy showed complete response, and she is now receiving adjuvant chemotherapy.

http://ift.tt/2j50z9C

ECG changes in hyperemesis gravidarum

This is a case report of a 30-year-old patient presenting at advanced gestation with hyperemesis, who developed a prolonged QT interval secondary to electrolyte imbalance during recovery. This potentially fatal complication should be considered in all patients with hyperemesis gravidarum, especially after a prolonged period of starvation. We hope to highlight the importance of ECG monitoring and careful prescribing in such cases, something that is not considered in current guidelines.

http://ift.tt/2iICE3z

Hirayama disease; an atypical clinical manifestation of a cervical myelopathy with typical MRI features

Description

A young man was evaluated because of progressive weakness in both hands since 2 years. He played sport on a high level and experienced difficulties in catching the ball. Flexion of the neck caused paresthesias and an electric shock like sensation in both arms. He experienced muscle cramps during cold.

Neurological examination revealed almost symmetrical atrophy of the interosseous, thenar and hypothenar muscles without fasciculations and with weakness of these muscles and the distal extensor muscles, sparing the brachioradialis. There was no weakness of the proximal muscles of both arms. The reflexes were normal. There were no signs of a pyramidal syndrome. The examination of the legs, cranial nerves and sensibility was unremarkable.

The paresthesias during flexion of the neck suggested a cervical myelopathy, but the distribution of the muscle weakness suggested a neuromuscular disorder within the differential diagnosis, an anterior horn cell disease, multifocal motor neuropathy (weakness...

http://ift.tt/2j4WoLb

Dabigatran-related leukocytoclastic vasculitis

Dabigatran is a non-vitamin K antagonist oral anticoagulant that has been approved for atrial fibrillation and prevention of venous thromboembolism. Its use has been increasing in the USA since serum drug levels do not need monitoring. To date, no significant skin side effects have been reported other than 4 cases of non-specific skin lesion and 2 cases of leukocytoclastic vasculitis (LCV), which is a small vessel inflammatory disease that presents as palpable purpura in lower extremities. We present a man aged 57 years with chronic deep vein thrombosis who developed palpable purpura, petechiae, swelling in lower extremities, torso and distal upper extremities on the third day after dabigatran initiation. The present case highlights the potential risk for LCV with dabigatran use and provides insight into its management.

http://ift.tt/2iItV12

Is haloperidol the wonder drug for cannabinoid hyperemesis syndrome?

Cannabinoid hyperemesis syndrome (CHS) is a rare clinical syndrome characterised by nausea, cyclic vomiting and severe abdominal pain in association with chronic cannabis use. It is often under-recognised or misdiagnosed, resulting in the unnecessary workup and frequent hospitalisations. Long-term treatment of CHS is abstinence from cannabis, but acute symptomatic management has been a struggle for many clinicians. The present report highlights the use of haloperidol as an agent that successfully and safely treats the unrelenting symptoms of CHS.

http://ift.tt/2j4YbQr

Ecthyma gangrenosum in a case of acute lymphoblastic lymphoma

Description

A 14 year-old-girl, a recently diagnosed case of pre-B acute lymphoblastic leukaemia (on modified BFM-90 protocol, week 2), presented with septic shock (heart rate, 124/min; blood pressure, 70/40 mm Hg) and swelling on the left side of face with necrotic ulcer, local induration and tenderness (figure 1A) of 2 days duration suggestive of ecthyma gangrenosum. Cultures from skin scraping, biopsy and peripheral blood revealed Pseudomonas aeruginosa. Evaluation for mucormycosis (fungal culture and histology of skin/nasal scrapings) was negative. She was promptly treated with empirical antibiotics and antifungals, later tailored per sensitivity (intravenous imipenem, intravenous amikacin). Her situation initially worsened during the first 48 h (figure 1B) but subsequently recovered in 2 weeks (figure 1C, D).

Figure 1

(A) Ecthyma gangrenosum with swelling of the left side of the face with two ulcers of 5x5 mm along the left border of the nose and another measuring 1x2 mm below...

http://ift.tt/2iIyaKd

Congenital anomaly of the posterior arch of the atlas: a rare risk factor for posterior circulation stroke

We report an extremely rare case involving a posterior arch anomaly of the atlas, causing a vertebral artery dissection (VAD) induced posterior circulation stroke. A 16-year-old girl was admitted to hospital because of new onset dizziness. VAD related multiple infarction in the posterior circulation was revealed. The congenital posterior arch anomaly of the atlas, along with instability of the atlantoaxial joint, were discovered accidentally during follow-up. This is the first case of ischemic stroke related to atlantal posterior arch aplasia and atlantoaxial instability. Although rare, it reminds us that investigation of the craniovertebral junction should be considered when stroke occurs in young patients.

http://ift.tt/2j51ffh

Prevention of lingual nerve injury in third molar surgery: literature review

Publication date: Available online 4 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Roberto Pippi, Andrea Spota, Marcello Santoro
PurposeTo identify any factors which may aid the surgeon in preventing or minimizing the risk of lingual nerve injury during third molar surgery.MethodsElectronic research was carried out on the correlation between lingual nerve damage and lower third molar surgery (topographic anatomy, surgical technique, and regional anesthesia) using PubMed, Scopus and Cochrane central databases. The research only included articles published in English up to February 2016.ResultsLingual nerve anatomy varied greatly: direct contact between the lingual nerve and the third molar alveolar wall was reported in a wide range of cases (0-62%) and the nerve was located at the same level or above the top of the ridge in 0-17.6% of cases. No detailed data was found on the actual incidence of lingual nerve injury resulting from local anesthesia by injection. Permanent lingual nerve damage did not show statistically significant differences between the simple buccal approach and the buccal approach + lingual flap retraction, although the latter was significantly associated with an increased risk of temporary damage. As far as permanent damage was concerned, no statistically significant differences were found between the lingual split technique and the buccal approach with or without lingual flap retraction. As opposed to tooth sectioning, ostectomy was strongly statistically associated with permanent lingual nerve damage.ConclusionsResults should be interpreted with extreme caution due to the considerable heterogeneity of the data as well as the considerable influence of several anatomical and surgical variables, all closely related, but which are difficult to analyze independently. It seems preferable to avoid lingual flap elevation, except in selected cases in which the presence of more than one unfavourable surgical variable predict a high risk of nerve injury. Tooth sectioning may reduce the extent of ostectomy or even, in some cases, prevent it, potentially acting as a protective factor in lingual nerve injury.

http://ift.tt/2hQUjkN

Association of Postoperative Nausea-Vomiting (PONV) Incidence with Neutrophil-Lymphocyte Ratio (NLR) in Ambulatory Maxillofacial Surgeries

Publication date: Available online 4 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Ayşe Hande Arpaci, Berrin Işik, Eren Ilhan, Erdal Erdem
PurposePostoperative nausea and vomiting (PONV) constitutes an important factor in ambulatory surgery. Mechanisms of the anti-emetic action of potent anti-inflammatory corticosteroids, which are used extensively for the treatment of PONV, and association between PONV and inflammation, have not been investigated sufficiently. In the present study we aimed at establishing the association between neutrophil-lymphocyte ratio (NLR) and postoperative antiemetic administration, as well as investigating whether NLR would be a biomarker for PONV.Materials and MethodsAnesthesia records of the ASAI-II cases who underwent ambulatory routine oral surgery under general anesthesia were evaluated after obtaining ethical approval from the faculty ethics committee. 5-point scale was used to score postoperative nausea and vomiting. Metoclopramide (Metpamid^®) was used as the first choice in patients who had PONV scale score of 1 or higher. Data belonging to metoclopramide administration during extubation and discharge periods were analyzed.Sixty-four patients were randomized and enrolled in the study as NLR<2 [Group I (n=37)] or NLR>2 [Group II (n=27)] and metoclopramide administration was evaluated in each case. The association between NLR and metoclopramide administration was analyzed statistically using descriptive statistical method in detecting frequencies, chi-square in comparison of the groups and t-test in independent groups.ResultsMetoclopramide administration frequency for PONV was 5.4% in Group I, 96.3% in Group II. Metoclopramide administration frequency in Group II was statistically higher than Group I (p<0,001).ConclusionsWe are of the opinion that NLR can be easily calculated with data obtained from complete blood count, and could be a marker for PONV. Antiemetic prophylaxis could be given after evaluating NLR ratio. However, we suggest that this result should be supported with further prospective studies using a larger series.

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Surgical Splint Design Influences Transverse Expansion in Segmental Maxillary Osteotomies

Publication date: Available online 4 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Kasper Stokbro, Esben Aagaard, Peter Torkov, Lillian Marcussen, R Bryan Bell, Torben Thygesen
PurposeIn segmental maxillary procedures, it is imperative to obtain as much of the planned expansion as possible. Lack of obtained expansion, in addition to late relapse following splint removal, can result in relapse of posterior cross bite. This study investigates the influence of 2 surgical splint designs on achieving the planned transverse expansion in bimaxillary surgery with segmental maxillary procedures.MethodsA total of 42 participants were included in a retrospective observational study. All participants had completed virtually planned, bimaxillary surgery with 3-piece maxillary segmentation. The primary outcome variable was the transverse expansion obtained, measured as the expansion between the maxillary first molars on the preoperative and postoperative cone beam CT scan. The postoperative scan was performed 1 week after surgery with the splint still in place. To test measurement reliability, all measurements were performed twice by the same observer. The primary predictor variable was the planned expansion according to the virtual surgical plan. The primary covariate with influence on the obtained expansion was the surgical splint design. Other covariates of interest included patient age, gender and surgeon. Descriptive and bivariate statistics were performed using Student's t-tests and linear regression analysis.ResultsMeasurements showed a high reliability, with an intraclass correlation coefficient of 0.99 and Bland–Altman plots without systematic errors. The obtained expansion was statistically significantly different from the planned expansion (mean: -0.77 mm, SD: 0.83). Surgical splint design influenced transverse expansion significantly: 77 % of the planned expansion was obtained with high palatal coverage, whereas 50% was obtained with low palatal coverage. No other covariates influenced the expansion obtained.ConclusionNot all of the planned expansion is obtained during segmental bimaxillary surgery. Use of rigid surgical splints with high palatal coverage significantly improves the amount of expansion obtained and is recommended for segmental maxillary procedures.

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In silico analysis of the biomechanical stability of commercially pure Ti and Ti-15Mo plates for the treatment of mandibular angle fracture

Publication date: Available online 4 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Satoshi Yamaguchi, Rodolfo B. Anchieta, Fernando PS. Guastaldi, Nick Tovar, Daisuke Tawara, Satoshi Imazato, Paulo G. Coelho
PurposeTo investigate the influence of different materials and fixation methods on maximum principal stress and displacement in reconstruction plates using in silico three-dimensional finite element analysis (3D-FEA).MethodsCAD models of the mandible and teeth were constructed. CHAMPY and AO/ASIF plates and fixation screws were designed with CAD software. 3D-FEA was performed by image-based CAE software. Maximum and minimum values of biomechanical stability, maximum principal stress and displacement distribution were compared in CHAMPY and AO/ASIF plates made from commercially pure titanium grade 2 (cp-Ti) and titanium-molybdenum (14.47%wt) alloy (Ti-15Mo).ResultsFor plates fixed on a fractured left angle of mandible model, the maximum/minimum values of MPS in the cp-Ti-constructed CHAMPY plate, upper AO/ASIF plate, and lower AO/ASIF plate were 19.5/20.3, 15.2/25.3, and 21.4/4.6% lower, respectively, than for plates made from Ti-15Mo. In the same model, the maximum/minimum values of displacements in cp-Ti-constructed CHAMPY plate, upper AO/ASIF plate, and lower AO/ASIF plate were 1.6/3.8, 3.1/2.7, and 5.4/10.4% higher, respectively, than for plates made from Ti-15Mo.ConclusionThis in silico 3D-FEA demonstrates that Ti-15Mo plates have greater load-bearing capability.

http://ift.tt/2iAqdGl

Three-dimensional analysis of long-term stability after bilateral sagittal split ramus osteotomy fixed with a single miniplate with four monocortical screws and one bicortical screw: a retrospective two-center study

Publication date: Available online 4 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): F. Hernández-Alfaro, M. Raffaini, A. Paredes-de-Sousa-Gil, A.S. Magri, R. Guijarro-Martínez, A. Valls-Ontañón
PurposeThis study aims to evaluate the long-term stability after BSSRO fixed with a single miniplate with four monocortical screws and one bicortical screw (hybrid technique - HT), with the use of a three-dimensional (3D) analysis and an objective measuring tool: cone-beam computed tomography (CBCT).Patients and methodsSixty-four patients who underwent bimaxillary surgery with mandibular advancement fixed with HT were selected from two different departments and enrolled in this retrospective study. All patients received a CBCT scan at 3 time points: preoperatively, 1 month after surgery, and 12 months after surgery. In order to estimate the long-term stability of the HT method, volumetric comparisons were performed using the following measurements: distance between Gonion – B point in the sagittal plane; distance between Gonion (right) - Gonion (left) transversally; and angle between the "mandibular notch-Gonion" plane and the "Gonion – B point" plane vertically.ResultsStatistical analysis evidenced no significant relapse (<1mm or <1º) when using the HT. However, a positive correlation between the amount of advancement and the amount of postoperative relapse was demonstrated.ConclusionIt can be concluded that the HT obtains 3D stable postoperative results after 12 months.

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Mandibular sagittal split osteotomy for removal of impacted mandibular teeth: Indications, surgical pitfalls and final outcome

Publication date: Available online 4 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Paolo Scolozzi, Zulma Catherine
PurposeTo determine the indications for and to evaluate the surgical pitfalls and final outcomes of mandibular sagittal split osteotomy (MSSO) for the removal of impacted mandibular teeth.Patients and MethodsIn this retrospective case series study, radiological and clinical data of all patients who underwent MSSO for the removal of impacted mandibular teeth between 2008 and 2015 at the University Hospital of Geneva were reviewed. The primary outcome variables were (1) the indication for the removal of impacted mandibular teeth by MSSO, (2) complications and (3) surgical pitfalls. Other variables included, age and gender, teeth involved, indication for tooth removal, concomitant lesions such as cysts and/or tumors and radiological features.ResultsTwenty-one mandibular-impacted teeth in 18 consecutive patients were extracted (18 third molars, 2 second molars and 1 first molar) by using MSSO. In all patients, the indication for the MSSO approach included deeply impacted teeth associated with an intimate relationship between the IAN and the dental roots as shown on CBCT or CT scan images. Six patients (33.3%) developed a non-disabling hypoesthesia of the IAN. Three patients (16.6%) had major complications including two cases of infections (11.1%) and one case of bad split (5.5%).ConclusionThe present study showed that the MSSO approach is a valuable method for removing deeply impacted teeth in close proximity to to the mandibular canal. Local factors, such as bone remodeling, concomitant large lesions (cysts and/or tumors) and mandibular canal within the buccal cortex, represent pitfalls that might increase the risk of developing complications.

http://ift.tt/2iAw0vy

Temporomandibular lavage versus non-surgical treatments for temporomandibular disorders: A systematic review and meta-analysis

Publication date: Available online 4 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Carl Bouchard, Jean-Paul Goulet, Mehdi El-Ouazzani, Alexis Fournier-Turgeon
PurposeTo investigate the efficacy of temporomandibular joint (TMJ) lavage (arthrocentesis or arthroscopy) for the treatment of temporomandibular disorders (TMDs) in reducing pain and improve jaw motion.Patients and methodsWe performed a systematic review of the literature and meta-analysis of randomized-controlled trials (RCT) comparing TMJ lavage to conservative measures. Data sources were MEDLINE, EMBASE, CENTRAL (Cochrane), Scopus and Web of Science and reference lists of relevant articles. Two independent reviewers identified RCTs by using controlled vocabulary (MeSH, Emtree) and free text terms. Data extracted from the selected studies were: population characteristics, intervention, outcomes and funding sources. Risk of bias was assessed using the Cochrane collaboration risk assessment tool for RCTs.ResultsFive studies met inclusion criteria, for a total of 308 patients. Three studies were categorized as having a high risk of bias and 2 had a low risk. The summary effect of the five studies showed a reduction in pain in the intervention group at 6 months (-0.63, 95% CI [-0.90, -0.37], p < 0.00001, I2 = 88%) and 3 months (-0.47, 95% CI [-0.75, -0.19], p = 0.001, I2 = 85%). This was not the case at 1 month. No difference in mouth opening was observed at 6 months (-0.21, 95% CI [-1.82, 1.40], p < 0.80, I2 = 74%), 3 months (0.20, 95% CI [-1.81, 2.20], p = 0.85, I2 = 68%) and 1 month (-1.18, 95% CI [-2.90, 0.55], p = 0.18, I2 = 0%).ConclusionGiving the relatively small number of patients included in this meta-analysis, the high risk of bias in 3 studies and the statistical and clinical heterogeneity of the included studies, the use of TMJ lavage for the treatment of TMDs should be recommended with cautions giving the lack of strong evidence to support its use.

http://ift.tt/2hQGfrB

Combining Virtual Surgical Planning, Intraoperative Navigation, and 3D Printing in Prosthetic-Based Bilateral Microtia Reconstruction

Publication date: Available online 4 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jason M. Weissler, Michael Sosin, Amir H. Dorafshar, Juan R. Garcia
Reconstructing auricular deformities for bilateral microtia is a demanding challenge especially following failed autologous reconstruction. This case report demonstrates a novel application of virtual surgical planning, computer-assisted design, and intraoperative surgical navigation to preplan and execute placement of custom-tailored silicone auricular prostheses and titanium osseointegrated implants for a bone anchored hearing aid (BAHA) system in a patient with Treacher Collins syndrome that had previously failed autologous reconstruction. Through a collaborative approach between the reconstructive surgeon and anaplastologist, the implementation of advanced digital technologies may offer a superior aesthetic and functional outcome to patients with previously failed reconstruction.

http://ift.tt/2iAxciH

An undergraduate Otolaryngology curriculum comparison in the United Kingdom using a Curriculum Evaluation Framework

Abstract

Objective

1.To compare undergraduate Otolaryngology curricula in the United Kingdom.

2.To develop a tool which would allow undergraduate specialty curricula to be compared.

Design

Development of a Curriculum Evaluation Framework and survey.

Setting

UK medical schools.

Participants

Otolaryngology curricula were requested from all 32 UK medical schools who award a primary medical qualification. 19 curricula were received and examined.

Main outcome measures

A thematic and content analysis of curriculum documents was undertaken. Outcome measures include an examination of curriculum content and methods, type of assessment and alignment of curricula with the General Medical Council's Tomorrow's Doctors document.

Results

Learning objectives were listed by 18 of the 19 medical schools who responded. The most commonly included theme was clinical conditions (100%). Psychosocial aspects of otolaryngology was the least covered theme (37%). Examination skills were covered by the majority (74%).

Outpatient clinics and theatre attendance were the most commonly utilised teaching methods (47%). Student checklists were the most common form of assessment (32%). Only 4 medical schools linked their curricula to the GMC's Tomorrow's Doctors document.

Conclusions

The development of a Curriculum Evaluation Framework allowed for a systematic comparison of curricula. This study, evaluating Otolaryngology curricula, has highlighted the variability of curricula from both a content and methods perspective in the UK.

The study provides those involved with curriculum planning an overview of the main themes currently taught in the UK and offers examples of individual topics. It also offers an insight into the way in which Otolaryngology is taught in the UK.

http://ift.tt/2j4IjgD

Assessment of carotid artery intima-media thickness in patients with obstructive sleep apnea

Abstract

Objective

This study compares the carotid intima-media thickness (CIMT) in different severity of obstructive sleep apnea (OSA) patients, and assesses the role of OSA in carotid artery vasculopathy with control of multiple co-morbidities.

Study Design

Prospective case-control study

Setting

Tertiary referral center

Participants

This study recruited 36 volunteers without the complaints of sleep-disordered breathing, 27 patients with mild-moderate OSA and 39 patients with severe OSA.

Main outcome measures

The CIMT was measured using a Toshiba Aplio 500 ultrasound system (Otawara, Japan) with a 5-14 MHz L probe.

Results

Bilateral and mean CIMT in healthy control, mild-moderate OSA, and severe OSA were 0.69±0.14, 0.72±0.24, and 0.94±0.33, respectively (p<0.01 in ANOVA test). Post-hoc tests show that the severe OSA group had significantly higher mean CIMT than the control and mild-moderate OSA groups (p<0.01). With the cut-off as 1 mm, the increased risks of cardiovascular disease (CVD) for mild-moderate and severe OSA were 11% and 39%, respectively, while no patient in the healthy control group was at risk of CVD. Multivariate linear regression could not prove that OSA itself was an independent factors for increased CIMT (mild-moderate OSA β: 0, [-0.12, 0.13]; severe OSA β: 0.08, [-0.06, 0.22], both p >0.05) after adjusting age, hypertension, and body mass index.

Conclusion

Automated measurement of the CIMT can be a useful tool for CVD risk assessment in patients with OSA. Severity of OSA may be an intermediate factor between multiple co-morbidities and carotid atherosclerotic change.

http://ift.tt/2iIqgAl

Ink spot lentigo

Publication date: Available online 3 January 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M. Berger, L. Thomas, S. Dalle

http://ift.tt/2j9BXRb

Syndrome des cheveux incoiffables : association de malfaiteurs

Publication date: Available online 3 January 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): O. Dereure

http://ift.tt/2iaNOKQ

Traitement du mélanome métastatique. Gestion de risque

Publication date: Available online 4 January 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Lebbe, C. Robert

http://ift.tt/2j9BVcc

Cardiac arrest in accidental hypothermia: Work the patient or don't start resuscitation?

A wrongful death lawsuit for failing to initiate resuscitative efforts was filed against EMS providers by the family of Jake Anderson in late 2016. According to publicly available news sources, Anderson, 19, was found unconscious with no apparent signs of life in freezing temperatures and declared dead with no interventions or transport to a hospital.

The plaintiff is alleging that the responders failed to perform an assessment, failed to follow their own policy and procedures for hypothermia victims in cardiac arrest and essentially abandoned the patient contributing to his death. We will never be able to say with any certainty that resuscitative efforts would have revived Anderson nor do we know all the facts surrounding the case, but for discussion's sake, would you have initiated treatment and transport?

From a medical standpoint, the long-held mantra that one isn't dead until they're warm and dead was recently supported in the journal Resuscitation by Hilmo and colleagues. In this review, "Nobody is dead until warm and dead": Prolonged resuscitation is warranted in arrested hypothermic victims also in remote areas — A retrospective study from northern Norway, Hilmo et al describe their experience successfully resuscitating victims who were down for almost seven hours and one patient who had a core body temperature of 13.7 C (56.6 F). Other interesting results include:

Although overall mortality remains high, survivors had surprisingly good neurologic outcomes with favorable overall quality of life.
There are no great prehospital predictors of survival, so boldly initiating resuscitation in the absence of contraindications is still warranted.
Contraindications to resuscitation include:
- Avalanche burial >35 minutes with airway packed with snow and initial rhythm of asystole
- Asphyxiation
- Hyperkalemia (>12 mmol/L)
- Hypothermia that occurred after cardiac arrest
- Obvious mortality such as body decomposition, decapitation, truncal transection, frozen solid chest wall
Manner of hypothermia (water, wind/air, snow) had no impact on survival rates.
Survival was associated with transport to hospitals with extracorporeal rewarming capabilities

In EMS systems where hospitals with extracorporeal rewarming capabilities are distant, stopping at a smaller hospital en route to check the patient's serum potassium level is also something to consider.

Extracorporeal life support or ECMO has truly changed the survivability curve in victims of accidental hypothermia. Because determining patient viability in the field is next to impossible in the absence of obvious mortality described above, current science supports the initiation of treatment and transport for patients in cardiac arrest due to accidental hypothermia.

http://ift.tt/2j4Rb5P

Topical ivermectin improves allergic skin inflammation

Abstract

Background

Ivermectin (IVM) is widely used in both human and veterinary medicine to treat parasitic infections. Recent reports have suggested that IVM could also have anti-inflammatory properties.

Methods

Here, we investigated the activity of IVM in a murine model of atopic dermatitis (AD) induced by repeated exposure to the allergen Dermatophagoides farinae, and in standard cellular immunology assays.

Results

Our results show that topical IVM improved allergic skin inflammation by reducing the priming and activation of allergen-specific T cells, as well as the production of inflammatory cytokines. While IVM had no major impact on the functions of dendritic cells in vivo and in vitro, IVM directly impaired T cell activation, proliferation and cytokine production following polyclonal and antigen-specific stimulation.

Conclusion

Altogether, our results show that IVM is endowed with topical anti-inflammatory properties that could have important applications for the treatment of T-cell mediated skin inflammatory diseases.

http://ift.tt/2iDBOTd

Overview of Systematic Reviews in Allergy Epidemiology

Abstract

Background

There is a substantial body of evidence on the epidemiology of allergic conditions, which has advanced the understanding of these conditions. We aimed to systematically identify systematic reviews and meta-analyses on the epidemiology of allergic diseases to assess what has been studied comprehensively and what areas might benefit from further research.

Methods

We searched PubMed and EMBASE up to 12/2014 for systematic reviews on epidemiological research on allergic diseases. We indexed diseases and topics covered and extracted data on the search characteristics of each systematic review.

Results

The search resulted in 3,991 entries after removing duplicates, plus 20 other items found via references and conference abstracts; 421 systematic reviews were relevant and included in this overview. The majority contained some evidence on asthma (72.9%). Allergic rhinitis, atopic eczema, and food hypersensitivity were covered in 15.7%, 24.5%, and 9.0%, respectively. Commonly studied risk factors for atopic eczema included dietary and microbial factors, while for asthma, pollution and genetic factors were often investigated in systematic reviews. There was some indication of differing search characteristics across topics.

Conclusion

We present a comprehensive overview with an indexed database of published systematic reviews in allergy epidemiology. We believe that this clarifies where most research interest has focussed and which areas could benefit from further research. We propose that this effort is updated every few years to include the most recently published evidence and to extend the search to an even broader list of hypersensitivity / allergic disorders.

http://ift.tt/2hSy7ds

Sprachaudiometrische Erfassung von „informational masking“

Zusammenfassung

Hintergrund

In Kommunikationssituationen mit mehreren Sprechern erschweren energetische Maskierung (EM) und „informational masking" (IM) die Sprachverständlichkeit. IM beschreibt Maskierungseffekte hervorgerufen durch irrelevante Informationen. Hier wird ein Ansatz zur Erfassung von IM auf der Basis des Oldenburger Satztests (OlSa) unter Berücksichtigung der Wirkung interauraler Zeitdifferenzen („interaural time differences", ITD) und möglicher Alterseffekte beschrieben.

Material und Methoden

Das IM wurde sprachaudiometrisch erfasst, indem jeweils 2 Sätze des OlSa überlagert wurden. Der Zielsatz begann stets mit dem Schlüsselwort „Stefan". Zur Trennung von Ziel und Maskierer wurden ITD von 50 bis 400 µs angeboten. Die Probanden sollten die Aufmerksamkeit selektiv auf den Zielsatz richten. Als potenzielle Einflussgrößen wurden ein auditives Feinstrukturmaß und ein neuropsychologisches Profil erhoben. Untersucht wurden 16 gut hörende Probanden zwischen 18 und 77 Jahren.

Ergebnisse

Trotz des unauffälligen Gehörs der Probanden zeigte sich ein signifikanter Zusammenhang der sprachaudiometrischen Befunde mit den tonaudiometrischen Ergebnissen. Alle Probanden profitierten selbst von kleinen ITD hinsichtlich der Störschallbefreiung von IM. Das Ausmaß der Störschallbefreiung war nicht mit den in dieser Studie untersuchten potenziellen Einflussgrößen zu erklären.

Die Analyse von Fehlerquellen und der Vergleich mit Literaturdaten weist darauf hin, dass der OLSa zur Erfassung von IM geeignet sein kann. In Einklang mit der Literatur steht auch der Zusammenhang sprachaudiometrischer Befunde mit tonaudiometrischen Ergebnissen und der starke Effekt von ITD auf die Störschallbefreiung bei IM.

Schlussfolgerung

Die Erfassung von IM stellt ein alltagsrelevantes sprachaudiometrisches Kriterium dar. Der OlSa scheint aufgrund seiner Struktur gut zur Erfassung von IM geeignet zu sein.

http://ift.tt/2hSARrn

Frontal Fibrosing Alopecia: A research letter

Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia first described by Kossard in 1994. It is considered a clinical variant of lichen planopilaris (LPP). In the last two decades, there have been an explosion of cases worldwide. While predominately seen in Caucasian, post-menopausal women, it has been reported in various ethnicities including African-Americans, Hispanics, Asians, and Indians as well as in pre-menopausal women and men.^1-5 Characterized by progressive, scarring frontotemporal hair loss with perifollicular erythema, follicular keratinization, and reduced follicular orifices, the most common finding is bandlike recession of the scalp hairline.^1-5 Accompanying features include eyebrow thinning, eyelash loss, body hair loss, facial papules, lonely hairs, and occipital alopecia.^1-5 While typically asymptomatic, pruritus and trichodynia can occur. Eyebrow thinning often presents prior to scalp hairline regression and has been seen with milder hairline regression compared to individuals who do not experience eyebrow thinning first.^2-4 Other dermatoses seen in patients with FFA include lichen planus on regions other than the scalp and lichen planus pigmentosus in non-Cacuasians.

http://ift.tt/2ianRLm

Modeling Adherence to Preventive Swallowing Exercises in Head and Neck Cancer

Conditions: Malignant Neoplasms of Lip Oral Cavity and Pharynx; Head and Neck Cancer
Interventions: Behavioral: Questionnaire; Procedure: Blood Draw
Sponsors: M.D. Anderson Cancer Center; National Institute of Dental and Craniofacial Research (NIDCR)
Recruiting - verified January 2017

http://ift.tt/2iHVpUz

High-activity Natural Killer Immunotherapy for Small Metastases of Nasopharyngeal Cancer

Condition: Metastatic Nasopharyngeal Cancer
Intervention: Biological: High-activity natural killer
Sponsors: Fuda Cancer Hospital, Guangzhou; Shenzhen Hank Bioengineering Institute
Recruiting - verified December 2016

http://ift.tt/2iOZgfP

Olaparib and Ramucirumab in Treating Patients With Metastatic or Locally Recurrent Gastric or Gastroesophageal Junction Cancer That Cannot Be Removed by Surgery

Conditions: Adenocarcinoma of the Gastroesophageal Junction; Metastatic Malignant Neoplasm in the Lymph Nodes; Recurrent Gastric Carcinoma; Stage IV Gastric Cancer
Interventions: Other: Laboratory Biomarker Analysis; Drug: Olaparib; Other: Quality-of-Life Assessment; Biological: Ramucirumab
Sponsor: National Cancer Institute (NCI)
Not yet recruiting - verified December 2016

http://ift.tt/2hQJt3l

High-activity Natural Killer Immunotherapy for Small Metastases of Tongue Cancer

Condition: Tongue Cancer
Intervention: Biological: High-activity natural killer
Sponsors: Fuda Cancer Hospital, Guangzhou; Shenzhen Hank Bioengineering Institute
Recruiting - verified December 2016

http://ift.tt/2iP0nw8

Relationship of Metabolic Syndrome and Its Components With Thyroid Nodule(s)

Conditions: Metabolic Syndrome; Thyroid Nodule
Intervention:
Sponsor: Lin Liao
Not yet recruiting - verified December 2016

http://ift.tt/2hQOXLv

Effect of FDG-PET/CT for Simulation and Radiation Treatment Planning in Oral Cancer Patients

Conditions: Oral Cancer; Radiotherapy; Complications
Intervention: Device: PET/CT
Sponsor: Zhongnan Hospital
Not yet recruiting - verified December 2016

http://ift.tt/2iP3rIv

A Prospective Controlled Treatment Trial for Post-Traumatic Headaches

Condition: Post-Traumatic Headaches
Interventions: Drug: Amitriptyline; Procedure: Occipital Nerve Block and Cervical Medial Branch Blocks; Other: Placebo
Sponsors: Boston Children's Hospital; Beth Israel Deaconess Medical Center; Harvard University
Not yet recruiting - verified December 2016

http://ift.tt/2hQLcFK

Diffuse angiomatosis with severe facial disfigurement

http://ift.tt/2hQKWGK

Acantholytic dermatosis of the vagina: the diagnostic challenge of acantholytic disease in the genital region

Summary

We report the case of a 24-year-old woman with an 8-month history of deep pelvic pain and postcoital bleeding. Examination revealed desquamation of the vaginal epithelium with tender fissured plaques in the vagina, initially thought to be vaginal intraepithelial neoplasia. Histology showed squamous mucosa with suprabasal acantholysis and hyperkeratosis, and no evidence of viral infection, dysplasia or malignancy. These findings were consistent with acantholytic dermatosis (AD), a rare lesion that resembles Hailey–Hailey and Darier disease histopathologically, but can be distinguished on a clinical basis. Vulval cases of AD are well recognized, but to our knowledge, this is the first reported case involving the vaginal epithelium alone.

http://ift.tt/2iOJp0C

Autotransplantation of third molars with completely formed roots into surgically created sockets and fresh extraction sockets: a 10-year comparative study

Publication date: Available online 3 January 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): H.J. Yu, P. Jia, Z. Lv, L.X. Qiu
The aim of this study was to analyze and compare the long-term clinical outcomes of mature third molar autotransplantation in surgically created sockets and fresh extraction sockets with regard to survival and functional success rates. A total of 65 third molars with completely formed roots were autotransplanted in 60 patients (average age 33.1 years). Thirty-six of the teeth were autotransplanted into surgically created sockets with or without guided bone regeneration (GBR; delayed autotransplantation), while 29 were autotransplanted into fresh extraction sockets (immediate autotransplantation; control group). All patients underwent annual clinical and radiographic examinations (average follow-up 9.9 years, range 7–13 years). The survival rates for the control, GBR, and no GBR groups were 93.1%, 95.2%, and 80.0%, respectively, with no significant differences among the groups. There were no statistically significant differences among the groups with regard to the frequency of inflammatory root resorption or root ankylosis. Age did not influence the clinical outcomes. These results suggest that the autotransplantation of third molars with completely formed roots is effective in both surgically created and fresh extraction sockets and provides a high long-term success rate if cases are selected and treated appropriately.

http://ift.tt/2iOB5Oq

An old report of idiopathic gingival papillokeratosis with crypt formation

Publication date: Available online 4 January 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Fumio Ide, Kentaro Kikuchi, Kaoru Kusama, Takashi Muramatsu

http://ift.tt/2iCTo9U

Biomaterial shell bending with 3D-printed templates in vertical alveolar ridge augmentation: a technical note

Publication date: Available online 4 January 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): G.F. Draenert, F. Gebhart, G. Mitov, A. Neff

http://ift.tt/2hRLvhW

Announcements

Publication date: January 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 1

http://ift.tt/2hRDklU

Editorial Board

Publication date: January 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 1

http://ift.tt/2i9P9kQ

EACMFS Prizes and Awards

Publication date: January 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 1

http://ift.tt/2hRD0DF

Comparing sensitivity of Hymenoptera allergen components on different diagnostic assay systems: Comparing apples and oranges?

Publication date: Available online 4 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Thilo Jakob, Edzard Spillner

http://ift.tt/2hRIu16

Reply

Publication date: Available online 4 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Gunter J. Sturm, Christoph Schrautzer, Lisa Arzt, Werner Aberer

http://ift.tt/2iCNZiN

Absent in Melanoma 2 proteins in SLE

Publication date: Available online 3 January 2017
Source:Clinical Immunology
Author(s): Divaker Choubey, Ravichandran Panchanathan
Type I interferons (IFN-α/β)-inducible PYRIN and HIN domain-containing protein family includes Absent in Melanoma 2 (murine Aim2 and human AIM2), murine p202, and human PYRIN-only protein 3 (POP3). The generation of Aim2-deficient mice indicated that the Aim2 protein is essential for inflammasome activation, resulting in the secretion of interleukin-1β (IL-1β) and IL-18 and cell death by pyroptosis. Further, Aim2-deficiency also increased constitutive expression of the IFN-β and expression of the p202 protein. Notably, an increased expression of p202 protein in female mice associated with the development of systemic lupus erythematosus (SLE). SLE in patients is characterized by a constitutive increase in serum levels of IFN-α and an increase in the expression IFN-stimulated genes. Recent studies indicate that p202 and POP3 proteins inhibit activation of the Aim2/AIM2 inflammasome and promote IFN-β expression. Therefore, we discuss the role of Aim2/AIM2 proteins in the suppression of type I IFNs production and lupus susceptibility.

http://ift.tt/2iOO2bg

Inhaled corticosteroid dose response in asthma

Publication date: Available online 3 January 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): William J. Anderson, Philip M. Short, Sunny Jabbal, Brian J. Lipworth
BackgroundInhaled corticosteroid (ICS) titration in asthma is primarily based on symptoms and pulmonary function. ICSs may not be increased on this basis despite residual airway inflammation.ObjectiveTo compare the dose-response relationships of ICSs on measures of pulmonary function, symptoms, and inflammation in patients with persistent asthma.MethodsWe performed a pooled post hoc analysis of 121 patients with mild to moderate asthma from 4 randomized clinical trials that incorporated an ICS dose ramp. Dose ramps were 0 to 200, 0 to 800, and 200 to 800 μg/d (beclomethasone equivalents). Outcome measures included spirometry, fractional exhaled nitric oxide, airway hyperresponsiveness (AHR), symptoms, serum eosinophilic cationic protein, and blood eosinophils.ResultsWe found a plateau beyond a small improvement at 0 to 200 μg for forced expiratory volume in 1 second: 3.3% (95% confidence interval [CI], 2.0%–4.7%) at 0 to 200 μg vs 0.3% (95% CI, −0.8% to 1.4%) 200 to 800 μg (P = .001). A similar plateau was seen for symptom improvement beyond 0 to 200 μg. Inflammatory and AHR outcomes revealed further room for improvement beyond low-dose ICSs. There was dose-related suppression (P < .001) for fractional exhaled nitric oxide: 40.4 ppb (95% CI, 34.7–46.9 ppb) for ICS free, 26.8 ppb (95% CI, 23.4–30.2 ppb) for 200 μg, and 20.8 ppb (95% CI, 18.8–23.1 ppb) for 800 μg. Eosinophilic cationic protein concentration was significantly reduced with both higher dose ramps. Eosinophil counts also improved across all 3 dose ramps, with dose separation of 370/μL (95% CI, 280–450/μL) for ICS free vs 250/μL (95% CI, 200–300/μL) 800 μg (P = .03). AHR improved with all 3 dose ramps, with greater improvement at lower doses for indirect vs direct challenges.ConclusionICS dose response may extend beyond low dose for inflammation and AHR but not symptoms or spirometry. Further study is required to identify whether this correlates with suboptimal longitudinal asthma control.Trial RegistrationClinicalTrials.gov Identifiers: NCT00667992, NCT00995657, NCT01216579, NCT01544634.

http://ift.tt/2hPB2Aw

Diagnostic and therapeutic strategy in Menière's disease. Guidelines of the French Otorhinolaryngology-Head and Neck Surgery Society (SFORL)

Publication date: Available online 3 January 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): J. Nevoux, V. Franco-Vidal, D. Bouccara, C. Parietti-Winkler, A. Uziel, A. Chays, X. Dubernard, V. Couloigner, V. Darrouzet, T. Mom
ObjectivesThe authors present the guidelines of the French Otorhinolaryngology-Head and Neck Surgery Society (Société française d'oto-rhino-laryngologie et de chirurgie de la face et du cou: SFORL) for diagnostic and therapeutic strategy in Menière's disease.MethodsA work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, then read over by an editorial group independent of the work group. The guidelines were graded according to the literature analysis and recommendations grading guide published by the French National Agency for Accreditation and Evaluation in Health (January 2000).ResultsMenière's disease is diagnosed in the presence of the association of four classical clinical items and after eliminating differential diagnoses on MRI. In case of partial presentation, objective audiovestibular tests are recommended. Therapy comprises medical treatment and surgery, either conservative or sacrificing vestibular function. Medical treatment is based on lifestyle improvement, betahistine, diuretics or transtympanic injection of corticosteroids or gentamicin. The main surgical treatments, in order of increasing aggressiveness, are endolymphatic sac surgery, vestibular neurotomy and labyrinthectomy.

http://ift.tt/2i9j0Kw

Endoscopic-Assisted Sinus Floor Augmentation Combined With Removal of an Antral Pseudocyst of the Ipsilateral Maxillary Sinus.

The aim of this study was to present an endoscopic-assisted intraoral surgical technique for sinus floor augmentation and removal of an antral pseudocyst simultaneously. The patient underwent sinus floor augmentation combined with removal of an antral pseudocyst in the ipsilateral maxillary sinus. Transoral endoscopic technique was applied to check the status of sinus mucosa during the operation. Complications were evaluated. Perforation of the sinus membrane was observed during augmentation procedure, and was covered with an absorbable membrane. No leakage of bone grafts was verified by the endoscope. The patient recovered uneventfully and final dental implants were inserted successfully. Therefore, sinus floor augmentation and removal of the maxillary sinus pseudocyst can be fulfilled at the same time, to reduce the time before dental rehabilitation. Transoral endoscopic technique can be of great helpful to the treatment of maxillary sinus diseases and sinus floor augmentation, owing to minimal invasion and optimal visualization. (C) 2016 by Mutaz B. Habal, MD.

http://ift.tt/2iOtgs4

Miniplate With a Bendable C-Tube Head Allows the Clinician to Alter Biomechanical Advantage in Extremely Complicated Anatomic Structure.

Backgrounds: This article reports C-tube miniplates as a practical temporary anchorage device choice to treat open bite patients with maxillary sinus pneumatization. Methods: The C-tube components are titanium anchor plates and monocortical screws that are basically similar to any other miniplate systems, but it has the unique characteristic of the tube head to be malleable. The manipulation of the head part is easy due to the composition of pure titanium. The I-shaped C-tube with 3 holes and T-shaped C-tube miniplates were placed above the apices of maxillary molars as an absolute anchorage system to intrude the posterior maxilla. The bending of the tube heads assisted in reduction of severe open bite patient with maxillary sinus pneumatization. Results: Sinus perforation during placement of skeletal anchorage system weakens stability of the anchorage and further cause complications. Placement of titanium C-tube miniplates allowed reliable skeletal anchorage and avoided maxillary sinus perforation in patients with extreme pneumatizations. Simple bending of C-tube miniplates ensured increased orthodontic intrusion force without having to replace them, and eliminated consequences such as perforation of maxillary sinus, sinusitis, soft tissue irritation, or infection. Conclusions: Anatomic difficulties in the placement of temporary anchorage device can be easily managed by using the bendable C-tube miniplate. It can serve as a great alternative over miniscrews or regular miniplates with reduced risk of sinus perforation and ability to bend the head portion to control orthodontic vectors and forces. (C) 2016 by Mutaz B. Habal, MD.

http://ift.tt/2hQeTGW

B-Cell Lymphoma in a Patient With a History of Foreign Body Injection.

Dermal filler injection has been one of the most evolving areas of interest in the field of esthetic plastic surgery. This procedure is sometimes preferred to surgery due to shorter procedure and patient recovery times, and because it is suitable for a wide range of applications. Dermal filler injection is considered to be relatively safe, but various late complications such as infection and foreign body granuloma sometimes occur. Postprocedure development of lymphoma also occurs, but is extremely rare. The authors diagnosed extranodal marginal zone B-cell lymphoma of the mucosa associated lymphoid tissue that developed after a filler injection procedure was performed on a patient's face. This 72-year-old female first presented with a palpable mass on her left cheek that developed after a probable silicone injection. An magnetic resonance imaging (MRI) scan and excisional biopsy confirmed the presence of the lymphoma. Complete remission occurred after radiotherapy. This rare case of lymphoma in a patient with a history of foreign body injection indicated that practitioners must be aware that long-standing chronic inflammation resulting from dermal filler injections can trigger lymphoma development. (C) 2016 by Mutaz B. Habal, MD.

http://ift.tt/2iObdSO

Αρχειοθήκη ιστολογίου

Τετάρτη 4 Ιανουαρίου 2017

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