Utility of polysomnography in determination of laryngomalacia severity

Publication date: February 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 93
Author(s): Jacqueline E. Weinstein, Claire M. Lawlor, Eric L. Wu, Kimsey H. Rodriguez
ObjectiveTo examine the efficacy of polysomnography in determining the severity of laryngomalacia in pediatric patients.MethodsProspective cohort study. Pediatric patients referred to our pediatric otolaryngology department with a polysomnogram already performed for a presumptive diagnosis of laryngomalacia were enrolled in the study. Patients with concurrent airway lesions or neuromuscular disorders were excluded. Patients underwent history, physical exam, and flexible fiberoptic laryngoscopy. These results were used to calculate a total laryngomalacia severity score.Results25 pediatric patients (n = 25) with an average age of 3.9 months at time of initial evaluation met criteria for enrollment in our study. 100% of patients had obstructive sleep apnea by definition. 80% of these patients underwent supraglottoplasty. The average AHI of those who underwent surgery (57.26) was not significantly different in those who underwent surgery vs. those that did not (55.43) (p = 0.41). In comparison, the average laryngomalacia severity score based from history, physical exam and flexible laryngoscopy was significantly greater in the patients that required supraglottoplasty (11.16) vs. those who did not (5.33) (p = 0.03). In addition a higher laryngomalacia severity score was not correlated with a higher AHI (p = 0.81, r = 0.08, CI: −0.5197 to 0.6235).ConclusionIn our cohort, polysomnography was not useful in determining the severity of laryngomalacia, did not correlate with the clinical evaluation, and alone was not predictive of the patients that would require surgical intervention. History, physical exam, and endoscopic findings remain reliable predictors of disease severity and need for operative intervention.



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Adult Liver Allocation in Eurotransplant.

Liver allocation in Eurotransplant is complex as allocation rules need to follow not only the guidelines of the European Commission but also the specific regulations of each of the 7 Eurotransplant countries with active liver transplant programs. Thirty-eight liver transplant centers served a population of about 135 million in 2015. Around 1600 deceased donor livers are transplanted annually. The number of deceased organ donors remains stable but donor age is increasing. Nevertheless, liver utilization rates are unchanged at around 80%. Donation after circulatory determination of death (DCD) increased 4-fold in the past decade. In Belgium and the Netherlands, DCDs were responsible for 30% of deceased donor liver transplant activity in 2015; Austria only occasionally transplants a DCD liver; other Eurotransplant countries do not have active DCD programs. The most frequent indications for liver transplantation are alcoholic liver disease, hepatocellular carcinoma, and viral hepatitis. Livers are allocated first internationally to high urgency status patients or those with an approved combined organ status (for a liver in combination with heart, lung, intestine, or pancreas) and then on a national basis where allocation is recipient-driven or center-driven, depending on country-specific rules. Median waiting time for an elective liver transplant was 4,4 months in 2015; high urgency status patients waited a median of 2 days for a suitable liver. Mortality on the waiting list was 18% in 2015, 4% of patients were delisted because they became unfit for transplantation. One and 5-year risk unadjusted adult patient survival after transplantation is 80% and 65%. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Conformational variants of HLA-I antigens on Luminex Single Antigen Beads for monitoring antibodies.

No abstract available

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DISEASE REVERSIBILITY IN PATIENTS WITH POSTHEPATITIS C CIRRHOSIS: IS THE POINT OF NO RETURN THE SAME BEFORE AND AFTER LIVER TRANSPLANTATION? A REVIEW.

Liver fibrosis can regress in patients with chronic hepatitis in whom the underlying cause of liver damage is adequately treated. Studies documenting this benefit have been mostly performed in the setting of viral hepatitis, particularly hepatitis C virus (HCV), where sustained viral response (SVR) has been unequivocally shown to result in histological and clinical improvement. With the advent of the new interferon (IFN)-free regimens, highly effective and safe even in those historically considered "difficult to treat and cure patients", additional benefits have been documented in patients treated at advanced stages of disease, including improvement in liver function with hepatic "re-compensation", reduction of portal hypertension, and eventually avoidance of liver transplantation (LT). Disease reversibility has been also demonstrated in the posttransplant setting and appears to be similar to what is observed in the nontransplant patient. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Transoral robotic surgery for management of cervical unknown primary squamous cell carcinoma: Updates on efficacy, surgical technique and margin status

Publication date: March 2017
Source:Oral Oncology, Volume 66
Author(s): Mathew Geltzeiler, Sean Doerfler, Meghan Turner, William Greer Albergotti, Mark Kubik, Seungwon Kim, Robert Ferris, Umamaheswar Duvvuri
ImportanceManagement of cervical unknown primary squamous cell carcinoma (CUP) has evolved with the introduction of transoral robotic surgery (TORS).Objectives1. To describe the efficacy of TORS lingual and palatine tonsillectomy in identifying the primary site of malignancy. 2. To explore how the extent of surgery affects diagnostic yield. 3. To report margin status of TORS resections.Design, setting and participantsA retrospective, single-center cohort study utilizing a prospectively collected database of CUP patients in a high-volume tertiary referral center. Patient underwent operative laryngoscopy plus TORS as clinically indicated.Main outcomes and measuresPrimary end point was successful identification of the primary. The extent of surgery and margin status were also examined.ResultsFrom 2010–2016, 64 patients with CUP were treated. The primary tumor was found in 51 patients (80%). Fourteen patients (22%) were identified with operative laryngoscopy alone. Fifty patients underwent TORS lingual tonsillectomy ± palatine tonsillectomy with 37 primary tumors identified (74%). The primary was located in the lingual tonsil in 32 patients (86%) and palatine tonsil in 5 patients (10%, p<0.001). Negative margins were achieved in 19 patients (51%). The deep margin was the most commonly positive margin (47%, p=0.049).Conclusion and relevanceOperative laryngoscopy with TORS is efficacious, localizing the primary in 80% of patients. If a margin was positive, it was most commonly the deep margin. This study provides valuable information that can help standardize surgical technique, further increasing the diagnostic yield and decreasing the negative margin rate of TORS for CUP.



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Chromosome instability in tumor resection margins of primary OSCC is a predictor of local recurrence

Publication date: March 2017
Source:Oral Oncology, Volume 66
Author(s): Damiana D.C.G. Pierssens, Maarten C. Borgemeester, Stijn J.H. van der Heijden, Carine J. Peutz-Kootstra, Andrea M. Ruland, Annick M. Haesevoets, Peter A.W.H. Kessler, Bernd Kremer, Ernst-Jan M. Speel
BackgroundThe local recurrence rate in oral squamous cell cancer (OSCC) hardly decreases. This is partly due to the presence of (pre)malignant cells in the remaining tissue after resection, that may lead to the development of a new tumor in time. Detection of histologically (pre)malignant cells in the tumor resection margins should predict these patients at risk for recurrence, however this appears to be difficult in routine practice. Purpose of this study was to apply easy-to-use molecular tests for more accurate detection of (pre)malignant cells in histopathologically tumor-free margins, to improve diagnosis of patients at risk.Methods42 patients with firstly diagnosed, radically resected primary OSCC with histopathologically confirmed tumor-free resection margins (treated between 1994 and 2003) were included. Inclusion criteria comprised of follow-up ⩾5years, and radical surgery without postoperative treatment. Formalin-fixed paraffine-embedded tissue sections of 42 tumors, 290 resection margins, and 11 recurrences were subjected to fluorescence in situ hybridization (FISH) to examine chromosome 1 and 7 copy number variations (CNV), and to p53 immunohistochemistry (IHC).Results11 out of the 42 patients developed a local recurrence within 5years. FISH analysis showed that nine of eleven recurrences exhibited CI in at least one of the resection margins (p=0.008). P53 overexpression and routine histopathologic classification were not correlated with recurrent disease. The presence of CI in the resection margins revealed a significantly worse progression-free survival (log-rank p=0.012).ConclusionsCI in the resection margins of OSCC can reliably identify patients at risk for developing a local recurrence.



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Lymph node characteristics for predicting locoregional recurrence of papillary thyroid cancer in adolescents and young adults

Publication date: March 2017
Source:Oral Oncology, Volume 66
Author(s): Yungang Sun, Xiang Liu, Wei Ouyang, Huijuan Feng, Juqing Wu, Pan Chen, Jing Wang
PurposeTo determine lymph node (LN) characteristics predictive of locoregional recurrence (LRR) in adolescent and young adult (AYA) ages 15–39years presenting with papillary thyroid cancer (PTC) and cervical pathologically proven LN metastases (pN1).Methods and materialsRetrospective chart review was performed for all patients with PTC and nodal metastases who had undergone total thyroidectomy, LN dissection, and postoperative radioactive iodine therapy in a university hospital between 2006 and 2014. Clinical and histopathologic markers that were independently associated with tumor recurrence were evaluated.ResultsIn all, 329 consecutive AYA patients were included. At a median follow-up of 57months, twenty patients (6.08%) experienced LRR. No patients had distant metastases, and no patients died during follow-up. Based on Cox regression analysis, the presence of extranodal extension and more than six metastatic LNs at presentation were independent predictive factors for LRR. However, age, male sex, total number of LNs resected, pN1b, LN ratio, size of the largest metastatic LN, extranodal extension, tumor size, bilateral tumor, multifocality, vascular invasion, and Hashimoto thyroiditis were not correlated with an increased risk for LRR. A cutoff of more than six positive nodes optimally predicted future LRR with sensitivity and specificity values of 85.0% and 60.2%, respectively.ConclusionThe presence of extranodal extension and more than six metastatic LNs were independent predictors of LRR in AYA patients with pN1 disease. Evaluation of these prognostic factors appears to help identify patients who require close monitoring.



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Adjuvant therapies utilization pattern and survival outcomes in high-grade head and neck soft tissue sarcoma; a population based study

Publication date: March 2017
Source:Oral Oncology, Volume 66
Author(s): Omar Mahmoud, Robert Beck, Evelyne Kalyoussef, Richard Chan Park, Soly Baredes, Sung Kim, Michael A. Samuels
PurposeHead and neck soft tissue sarcoma (HNSTS) is a distinct entity within the soft tissue sarcoma group and the evidence supporting treatment options for this disease is poorly defined. Using the National Cancer Database, this study aims to reveal adjuvant therapy utilization patterns and their outcomes.MaterialsHNSTS patients constituted 6.5% of all sarcoma patients and the analysis was limited to non-metastatic patients who underwent resection between 2004 and 2012. Chi-square test assessed the distribution of demographic, tumor and treatment variables in the treatment subgroups. Kaplan-Meier method estimated overall survival and proportional hazards model estimated survival hazard ratios for prognostic factors including age, comorbidity, gender, race, size, grade, margin status, histology, chemotherapy administration and radiotherapy technique/dose.ResultsThe cohort included 2493 patients with a median age of 62years. Adjuvant therapies were more frequently delivered in high-grade, large tumors and with positive surgical margins. Limiting the analysis to 788 high-grade HNSTS patients, adjunctive radiotherapy improved 5-year survival from 44% (95% confidence interval (CI): 38–50) to 49% (CI: 43–55); reducing mortality hazards ratio by 24% (p<0.001). On multivariate analysis, older age, positive surgical margins and large tumor size were significant predictors of poor survival. These findings were consistent after propensity score analysis.ConclusionOur analysis suggests that adjuvant radiotherapy is associated with improved survival in high-grade HNSTS. Higher dose and precise technique did not accentuate this benefit; however, further studies are needed to refine the treatment strategies, including the role of chemotherapy in the management of this rare disease.



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Incidence of pulp sensibility loss of anterior teeth after paramedian insertion of orthodontic mini-implants in the anterior maxilla

The aim of this retrospective investigation was to evaluate the incidence of loss to pulp sensibility testing (PST) of maxillary front teeth after paramedian (3 to 5 mm away from the suture) orthodontic mini-i...

http://ift.tt/2i2Psk3

Is allergic sensitization relevant in severe asthma? Which allergens may be culprit?

Severe asthma is a major health concern. The allergic (IgE-mediated) form of asthma is well known from a pathogenic viewpoint. We searched the available literature to identify which allergens are most frequent...

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Acknowledgment of Reviewers 2016

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


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Hepatitis B Surface Antigen Promotes the Invasion of Hepatitis B Virus-Related Hepatocellular Carcinoma Cells by Upregulation of Toll-Like Receptor 2

Viral Immunology , Vol. 0, No. 0.


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Thyrotropin-producing pituitary adenoma simultaneously existing with Graves’ disease: a case report

Thyrotropin-producing pituitary tumor is relatively rare. In particular, concurrent cases associated with Graves' disease are extremely rare and only nine cases have been reported so far. We describe a case of...

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Meckel's diverticulitis: a rare entity of Meckel's diverticulum

Meckel's diverticulum is the most common congenital abnormality of the small intestine that results from incomplete closure of the vitelline (omphalo-mesenteric) duct. This true diverticulum, ~2 ft from the ileocecal valve commonly found on the anti-mesenteric border of the ileum, is benign and majority asymptomatic. Diagnosis challenges arise when it became inflamed or presented in following ways, for example, haemorrhage (caused by ectopic pepsin—and hydrochloric acid—secreting gastric mucosa), intestinal obstruction (secondary to intussusception or volvulus) or the presence of diverticulum in the hernia sac (Littre's hernia). We report a case of a 59-year-old male who was admitted under the surgical service at Blackpool Victoria Hospital with suspected appendicitis that turned out to be a Meckel's diverticulitis, a rare presentation of an acute abdomen. We discuss the issues involved in his investigation and management as well as perform a literature review comparing different surgical approaches.

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Recurrence of an intra-articular osteoid osteoma of the great toe: a case report and review of the literature

Osteoid osteoma (OO) is a benign tumor that it is not generally seen in the foot and even less frequently in the phalanx (2–4%). The diagnosis when its location is intra-articular is a challenge and often delayed because the symptoms mimic a real arthritis. We report a clinical case involving a 16-year-old male patient who complained of persistent pain of the interphalangeal joint (IPJ) of the left hallux. A juxta-articular OO of the condyle of the proximal phalanx was identified. The patient underwent surgery that included tumor removal preserving the articular cartilage. After a non-complete nidus resection, there was a recurrence. The patient underwent surgery with a removal en-block of the distal part of the proximal phalanx and fusion of the IPJ with interposition of a tricortical autograft. After a follow-up of 30 months, the X-ray showed total arthrodesis of the joint without signs of recurrence or pain.

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Conservative management of migrated percutaneous endoscopic colostomy tube

A 68-year-old male nursing home resident presented following dislodgement of a percutaneous endoscopic colostomy (PEC) tube originally sited to prevent recurrent sigmoid volvulus. Computed tomography demonstrated tube migration into the lumen of the recto-sigmoid junction, where it remained for 12 days before passing spontaneously. During this period, the patient remained asymptomatic; the residual colocutaneous fistula functioned as a decompressive valve. Originally, the patient was due to be discharged with early flexible sigmoidoscopy follow-up. However, complex social issues delayed discharge. During his admission, a second PEC tube was successfully inserted next to the previous colostomy site without complication. This is an unusual case and no similar episodes of asymptomatic PEC migration have been reported. We demonstrate that such cases may be offered an appropriate trial of conservative management. Here, we describe our experience and critically appraise the literature.

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The dangers of parathyroid biopsy

We report an unusual case of a 66-year-old female with a suspicious thoracic outlet mass presenting with severe biochemical hyperparathyroidism and classic hypercalcemic symptoms of renal and bone involvement.

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HPV DNA in saliva from patients with SCC of the head and neck is specific for p16-positive oropharyngeal tumours

Human papillomavirus (HPV) is an important cause of head and neck squamous cell carcinoma (HNSCC), especially in young people. These tumours overexpress p16 and respond well to treatment. The rapid detection o...

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Airway autoimmune responses in severe eosinophilic asthma following low-dose Mepolizumab therapy

Anti-interleukin (IL)-5 monoclonal antibodies as an eosinophil-depleting strategy is well established, with Mepolizumab being the first biologic approved as an adjunct treatment for severe eosinophilic asthma.

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Asthma and the microbiome: defining the critical window in early life

Asthma is a chronic inflammatory immune disorder of the airways affecting one in ten children in westernized countries. The geographical disparity combined with a generational rise in prevalence, emphasizes th...

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Annals of Cardiac Anesthesia: Beacon journey toward excellence: 2015-2017

Poonam Malhotra Kapoor

Annals of Cardiac Anaesthesia 2017 20(1):1-3



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Demonstration of blood flow by color doppler in the femoral artery distal to arterial cannula during peripheral venoarterial-extracorporeal membrane oxygenation

KG Suresh Rao, T Muralikrishna, KR Balakrishnan

Annals of Cardiac Anaesthesia 2017 20(1):108-109



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Anesthesiology and the difficult airway - Where do we currently stand?

Martina Richtsfeld, Kumar G Belani

Annals of Cardiac Anaesthesia 2017 20(1):4-7



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Outcome of four pretreatment regimes on hemodynamics during electroconvulsive therapy: A double-blind randomized controlled crossover trial

Devangi Ashutosh Parikh, Sanchita Nitin Garg, Naina Parag Dalvi, Priyanka Pradip Surana, Deepa Sannakki, Bharati Anil Tendolkar

Annals of Cardiac Anaesthesia 2017 20(1):93-99



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Comparison of two doses of heparin on outcome in off-pump coronary artery bypass surgery patients: A prospective randomized control study

Murali Chakravarthy, Dattatreya Prabhakumar, Patil Thimmannagowda, Jayaprakash Krishnamoorthy, Antony George, Vivek Jawali

Annals of Cardiac Anaesthesia 2017 20(1):8-13



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Iatrogenic vocal cord paralysis after cardiac surgery: evocative note for surgeon and anesthesiologist

Monish S Raut, Sumir Dubey, Arun Maheshwari

Annals of Cardiac Anaesthesia 2017 20(1):117-118



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Extracorporeal membrane oxygenation in severe influenza infection with respiratory failure: A systematic review and meta-analysis

Shashvat Sukhal, Jaskaran Sethi, Malini Ganesh, Pedro A Villablanca, Anita K Malhotra, Harish Ramakrishna

Annals of Cardiac Anaesthesia 2017 20(1):14-21



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Goal-directed therapy improves the outcome of high-risk cardiac patients undergoing off-pump coronary artery bypass

Poonam Malhotra Kapoor, Rohan Magoon, Rajinder Singh Rawat, Yatin Mehta, Sameer Taneja, R Ravi, Milind P Hote

Annals of Cardiac Anaesthesia 2017 20(1):83-89



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Incidence and progression of cardiac surgery-associated acute kidney injury and its relationship with bypass and cross clamp time

Habib Md Reazaul Karim, Mohd Yunus, Manuj Kumar Saikia, Jyoti Prasad Kalita, Mrinal Mandal

Annals of Cardiac Anaesthesia 2017 20(1):22-27



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An unusual cause of postpartum heart failure

Ibrahim Khaddash, Amer Hawatmeh, Zaid Altheeb, Aiman Hamdan, Fayez Shamoon

Annals of Cardiac Anaesthesia 2017 20(1):102-103



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Selection of an appropriate left-sided double-lumen tube size for one-lung ventilation among Asians

Siti Salwani Ideris, Muhamad Rahimi Che Hassan, Mohd Ramzisham Abdul Rahman, Joanna Su Min Ooi

Annals of Cardiac Anaesthesia 2017 20(1):28-32



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Nucleic acid-based methods for early detection of sepsis

Sarvesh Pal Singh

Annals of Cardiac Anaesthesia 2017 20(1):112-113



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Remifentanil prevents increases of blood glucose and lactate levels during cardiopulmonary bypass in pediatric cardiac surgery

Tomohiro Chaki, Yuko Nawa, Keishi Tamashiro, Eri Mizuno, Naoyuki Hirata, Michiaki Yamakage

Annals of Cardiac Anaesthesia 2017 20(1):33-37



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Percutaneous tracheostomy

Yatin Mehta, Chitra Mehta

Annals of Cardiac Anaesthesia 2017 20(1):121-121



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Assessment of limited chest x-ray technique in postcardiac surgery management

Mehrdad Salehi, Kianoush Saberi, Mehrzad Rahmanian, Ali Reza Bakhshandeh, Shahnaz Sharifi

Annals of Cardiac Anaesthesia 2017 20(1):38-41



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Delirium after cardiac surgery: A pilot study from a single tertiary referral center

Ashok K Kumar, Aveek Jayant, VK Arya, Rohan Magoon, Ridhima Sharma

Annals of Cardiac Anaesthesia 2017 20(1):76-82



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Acute effect of treatment of mitral stenosis on left atrium function

Atooshe Rohani, Shahram Kargar, Afsoon Fazlinejad, Fereshte Ghaderi, Vida Vakili, Homa Falsoleiman, Ramin Khamene Bagheri

Annals of Cardiac Anaesthesia 2017 20(1):42-44



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Prayer sign as a marker of increased ventilatory hours, length of intensive care unit and hospital stay in patients undergoing coronary artery bypass grafting surgery

Tanveer Singh Kundra, Parminder Kaur, N Manjunatha

Annals of Cardiac Anaesthesia 2017 20(1):90-92



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Comparative effect of grape seed extract (Vitis vinifera) and ascorbic acid in oxidative stress induced by on-pump coronary artery bypass surgery

Naser Safaei, Hossein Babaei, Rasoul Azarfarin, Ahmad-Reza Jodati, Alireza Yaghoubi, Mohammad-Ali Sheikhalizadeh

Annals of Cardiac Anaesthesia 2017 20(1):45-51



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Misdirected minitracheostomy tube

Ajmer Singh, Chinmaya Nanda, Yatin Mehta

Annals of Cardiac Anaesthesia 2017 20(1):100-101



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Variation in dermatologist visits by sociodemographic characteristics

Access to dermatologists is an ongoing concern for Medicaid enrollees. Understanding current use is a key step toward designing and implementing policies to improve access.

http://ift.tt/2j0lzzm

Lesions on the back of hands and female gender predispose to stigmatization in patients with psoriasis

Psoriasis vulgaris is characterized by disfiguring and stigmatizing skin lesions. The links among lesions distribution, severity, and stigmatization remain unclear.

http://ift.tt/2ilKyfK

Antrochoanal polyp in pediatric age group

Publication date: Available online 6 January 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Zeyad Mohamed Mandour
Antrochoanal polyp (ACP) is a benign solitary polypoid lesion affecting mainly adults and rarely children. It originates from a hypertrophy of the mucous membrane of the maxillary sinus antrum, and grows through the maxillary sinus ostium towards the nasal cavity and the choana. The clinical data and imaging studies of 39 children with ACP were reviewed. The most commonly affected age group was from 10 to 15years. Clinical presentations included nasal obstruction, rhinorrhea; and rarely, bloody discharge. Ig-E-mediated allergy was established in 61.5% of the patients and only 17.9% of patients had history of asthma. 92.3% of patients had aberrant nasal anatomy, including septal deviation, pneumatized middle turbinate, and inferior turbinate hypertrophy. The development of ACP could be due to an increased pressure level within the maxillary sinus caused by obstruction of the sinus natural ostium and/or anatomical alteration at the ostiomeatal complex at middle meatus level, in a patient with a pre-existing silent antral cyst, subsequently forced to herniate outside, through the sinus fontanelle. For treatment, we suggest performing wide middle meatotomy in addition to correction of all the predisposing anatomical factors.



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Advances in reconstruction of congenital deformities of the ear

Ear reconstruction for microtia, or underdeveloped ears, remains a clinical challenge for plastic and reconstructive surgeons.

http://ift.tt/2hXT4Fu

Incidence of pulp sensibility loss of anterior teeth after paramedian insertion of orthodontic mini-implants in the anterior maxilla

Abstract

Background

The aim of this retrospective investigation was to evaluate the incidence of loss to pulp sensibility testing (PST) of maxillary front teeth after paramedian (3 to 5 mm away from the suture) orthodontic mini-implant (OMI) insertion in the anterior palate.

Methods

A total of 284 patients (102 males, 182 females; mean age was 14.4 years (±8.8) years at time of OMI-Insertion) with a total of 568 OMIs (1.7 mm diameter, length 8 mm) were retrospectively investigated. A binomial regression analysis was performed to explore covariates, such as age, gender, inclination of upper central incisors, dentition status and insertion position of OMIs that could have contributed to loss of sensibility. Statistical significance was set at p < 0.05.

Results

Loss of response to PST was encountered during retention in 3 out of 284 patients and the respective OMIs had been placed at height of the second rugae (R-2). Affected teeth were a right canine, a left lateral and a left central incisor. Subsequent root canal treatment was successful. Results of the binomial regression analysis revealed that the covariate insertion position (R-2) of OMIs (p = 0.008) had statistically significant influence on loss of response to PST.

Conclusions

(1) Although there was no radiographic evidence for direct root injury, the proximity of the implants to the anterior teeth was nevertheless statistically related to loss of PST. (2) In all cases of PST loss OMIs were inserted at the second rugae. Therefore OMIs should be placed either more posteriorly, at the third rugae or in the median plane. (3). Loss of PST was not increased for patients with palatal OMI (0.18%) compared to samples without OMI (0.25%).

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Relationship between increased carotid artery stiffness and idiopathic subjective tinnitus

Abstract

Tinnitus is defined as perception of sound with no external stimulus, and can separate into pulsatile and non-pulsatile types. Arterial stiffness is a parameter that can predict the cardiovascular event and associated with incidence of stroke. It has been shown that increased arterial stiffness may lead to microvascular damage in brain. Our aim was to assess the arterial stiffness of the carotid system in the development and severity of idiopathic subjective tinnitus. Forty subjective tinnitus patients and 40 age- and sex-matched controls were enrolled in the study. The parameters obtained from the participants included pure tone hearing (dB), serum lipid profile (mg/dl), fasting glucose (mg/dl), blood pressure (mmHg), and body mass index (BMI, kg/m²). The common carotid artery (CCA) stiffness index, Young's elastic modulus (YEM), common carotid intima–media thickness (CIMT), peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), pulsatility index (PI), vessel diameter, mean velocity (MV), and volume flow (VF) were measured in both the right and left common carotid arteries in both groups. The CCA stiffness index, YEM measurements, right CIMT, and left PI were found to be significantly higher in the patients than those in the control group (p < 0.05). With regard to the severity of the tinnitus and the patient characteristics, there was a significant positive correlation with the CCA stiffness index, YEM measurements, left CIMT, and neutrophil-to-lymphocyte ratio (NLR). However, only the right and left CCA stiffness parameters were found to be statistically significant in the multivariate analysis as independent predictors of a moderate to high degree of tinnitus. The increased stiffness index of the common carotid arteries was significantly associated with the formation and severity of tinnitus. Therefore, an assessment of the carotideal system may be helpful in these patients.

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In vivo and in vitro spectrophotometric evaluation of upper central incisors before and after extraction

Abstract

Objectives

This in vivo and in vitro study investigated the influence of pulpal vitality on the optical properties of teeth over a 1-month period.

Materials and methods

We monitored two specific areas (2-mm-thick pure enamel and 3-mm-thick enamel–dentine complex) in 10 teeth against two backgrounds (white and black) using a calibrated reflectance spectrophotometer at the following time points: before extraction (T0); immediately after extraction (T1); at 1-day post-extraction (T2); at 1-week post-extraction (T3); and 1-month post-extraction (T4). We recorded tooth colour based on the Commission Internationale d'Eclairage L*a*b* model and translucency and analysed these characteristics over time using analysis of variance.

Results

The 2-mm-thick pure enamel area showed significant changes (p > 0.05) in L*, a* and b* values between before and 1 month after extraction (T0–T4). Translucency was detectable between (T0–T3) and (T0–T4). The 3-mm-thick enamel–dentine complex also exhibited significant differences (p > 0.05) in L*, a* and b* values within (T0–T4). Translucency value changes significantly (p > 0.05) within the first day (T0–T2) and (T0–T3). CIEDE 2000 DE values revealed no statistically significant differences (p < 0.05) in colour between the T0 L*a*b* measures and all the subsequent measures at times T1, T2, T3 and T4.

Conclusions

Within the limitations of this study, we conclude that the optical characteristics (i.e. colour and translucency) of teeth change after extraction.

Clinical relevance

The results help understanding the precise moment when the colour of extracted tooth changes to identify optimum time to use a tooth for scientific investigation and determine whether it is necessary to extract pulp tissue beforehand.

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Effect of Flat Plane Splint Vertical Thickness on Disc Displacement without Reduction—A Retrospective Matched Cohort Study

Publication date: Available online 5 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Shang-Lun Lin, Shang-Liang Wu, Shun-Yao Ko, Ching-Yu Yen, Jung-Wu Yang
PurposeThe efficacy of occlusal splints for treating temporomandibular disorders (TMDs) remains controversial. This study aimed to evaluate and compare the effectiveness of flat plane splints (FPSs) with a vertical thickness of 3 mm (VT3) and 5 mm (VT5) in treating disc displacement without reduction (DDWOR).MethodsThis retrospective matched cohort study selected the study subjects from 400 TMD patients treated in the Department of Oral and Maxillofacial Surgery of Tainan Sin-Lau Hospital between August 2013 and July 2015. The thickness of occlusal splints was the predictor variable. The outcome variables included joint crepitus sound, deviation of the mandible during opening (DoM), TMD-associated headache, myofascial pain with referral, temporomandibular joint (TMJ) arthralgia, and maximum assisted opening (MAO). The case and control groups were matched with (1:1) by propensity scoring to ensure that there were no statistical differences in the categorical variables and continuous variables. The analysis used χ2 tests, t tests, and multiple regression analyses.ResultsOne-hundred-sixty-two patients were allocated into two groups: the VT3 group and the VT5 group, with 81 patients each. Both VT3 FPSs and VT5 FPSs effectively improved the DDWOR. At 12 months post-treatment (post-Tx), the VT5 group demonstrated remarkable improvement in joint crepitus sound and TMJ arthralgia compared with the VT3 group. No statistical differences in other TMJ-associated symptoms such as DoM, TMD-associated headache, and myofascial pain with referral were observed between the two groups.ConclusionsBoth VT3 and VT5 FPSs can effectively improve various clinical symptoms of DDWOR. The authors suggested that VT5 FPS treatment for at least one year is a suitable option to DDWOR patients with joint crepitus sound and TMJ arthralgia. For DDWOR patients without joint crepitus sound and TMJ arthralgia, there are no differences between the VT3 and VT5 FPSs.



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Buffered 1% Lidocaine with Epinephrine is as Effective as Non-buffered 2% Lidocaine with Epinephrine for Mandibular Nerve Block

Publication date: Available online 5 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Victor T. Warren, Anson G. Fisher, Eric M. Rivera, Pooja T. Saha, Blake Turner, Glenn Reside, Ceib Phillips, Raymond P. White
PurposeAssess outcomes for pulpal anesthesia and pain on injection for buffered 1% lidocaine with 1/100k epinephrine (Epi) vs. non-buffered 2% lidocaine with 1/100k Epi.Subjects and MethodsWith an IRB approved randomized cross-over trial buffered 1% lidocaine with 1/100k Epi was compared to non-buffered 2% lidocaine with 1/100k Epi. After mandibular nerve block with 40mg. of buffered lidocaine or 80mg. of non-buffered lidocaine subjects reported responses at the mandibular 1^st molar and canine after cold and electrical pulp testing (EPT). Subjects also reported pain on injection with a 10pt Likert-type scale. Teeth were tested prior to nerve block and at 30 minute intervals until a positive response returned. Subjects two weeks later were tested with the alternate drug combinations. The same outcomes were assessed.Predictor variables were alternate drug formulations. Outcome variables were subjects' responses to cold and EPT stimulation of the mandibular 1^st molar and canine, and pain on injection. An assessment of treatment difference was performed using Wilcoxon rank sum tests with Proc NPAR1WAY (SAS v 9.3, SAS Institute, Cary, NC). Significance was set at P<0.05.ResultsFifty-seven percent of subjects were female and 43% male. Seventy percent were Caucasian, 17% African American, 13% other ethnicity. Median age was 25 years(IQR 21,26y) with median body weight 140lbs.(IQR 120,155lbs.).Following the cold and EPT tests, the time to sensation return for the molar or canine was not statistically significant comparing the two drug formulations. Subjects reported significantly lower pain scores with the buffered drug vs. the non-buffered, P<0.01.ConclusionsAfter mandibular nerve block buffered 1% Lidocaine with Epi can produce similar clinical outcomes for duration of pulpal anesthesia as can non-buffered 2% lidocaine with Epi, and lower pain on injections, both a potential benefit to patients.



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Ameloblastic fibrodentinoma and ameloblastic fibro-odontoma: an updated systematic review of cases reported in the literature

Publication date: Available online 6 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Bruno Ramos Chrcanovic, Ricardo Santiago Gomez
PurposeTo integrate the available data published on ameloblastic fibrodentinoma (AFD) and ameloblastic fibro-odontoma (AFO) into a comprehensive analysis of its clinical/radiologic features.MethodsAn electronic search was undertaken in August/2016. Eligibility criteria included publications reporting cases of AFD and/or AFO having enough clinical, radiological and histological information to confirm the diagnosis. Demographic data, lesion site and size, treatment approach, and recurrence were analyzed and compared between AFD and AFO.Results55 publications reporting 64 AFDs (60 central, 4 peripheral) and 137 publications reporting 215 AFOs (211 central, 3 peripheral, 1 unknown) were included. The difference in recurrence rate (when the information about recurrence was provided) was not statistically significant. The mean age of the patients affected by AFD was not statistically significantly different from those affected by AFO.ConclusionsAFD and AFO presented several similarities: higher prevalence in males and in mandibles, similar patients' mean age, rate of cortical bone perforation and of the lesions' association with displaced/unerupted teeth and tooth root resorption, mean lesion size, and recurrence rate. The lesions differed with regard to the presence of radiopacities and locularity. Taken together, our data do not support the concept of progressive maturation of these tumoral conditions.



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Mutations de DOCK8 et le dermatologue

Publication date: Available online 5 January 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): O. Dereure




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Epirubicin extravasation: consequences of delayed management

Epirubicin is an anthracycline chemotherapy agent used for treatment of several cancers including oesophageal, breast and gastric. Extravasation is a well-recognised and serious complication of any intravenous therapies but especially chemotherapeutic agents. Signs of the injury can be subtle and without prompt recognition and treatment there can be extensive tissue damage and depending on location of injury this can result in significant functional loss. In this article, a case of delayed management of epirubicin extravasation from a cannula situated at the dorsum of the hand is discussed. Successful surgical reconstruction of the resulting substantial tissue damage using a radial forearm flap 21 days following injury is described.

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103-year-old on dialysis: was it worth it?

It is increasingly common for nephrologists to be faced with the question of whether starting dialysis on an elderly patient is appropriate. We present an extraordinary case of a 103-year-old person who has become the oldest patient in our unit, reportedly the world, to not only remain on haemodialysis, but to thrive on it. This case adds to the compelling literature, which suggests that it is indeed the number and severity of comorbidities that is more likely to impact survival than age alone.

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Optical coherence tomography angiography and fundus autofluorescence in the eyes with choroideremia

A 65-year-old man with presumed choroideremia with preserved central vision was examined by fundus autofluorescence (FAF) and optical coherence tomography angiography (OCTA). FAF showed an isolated area of hyperautofluorescence that involved the fovea. Although the choroid capillary slab of the OCTA showed the medium and large choroidal vessels inferior to the area of retinal pigment epithelium (RPE) atrophy, the choriocapillaris was visible in a relatively wider area than the hyperautofluorescent area in the FAF images. FAF and OCTA images allowed us to detect damage of the RPE before the choriocapillaris atrophy in a case of presumed choroideremia with preserved central vision.

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Contained ruptured abdominal aortic aneurysm presenting as cauda equina syndrome

This is the case report of a contained ruptured aortic aneurysm presenting with acute cauda equina syndrome. The patient was a 79-year-old man. A literature search revealed various unusual presentations of abdominal aortic aneurysm (AAA), including femoral neuropathy, hip pain and others; however, there are no other reports of cauda equina-like syndrome. The present case is therefore another unusual presentation of ruptured abdominal aortic aneurysm and reiterates the utmost importance of careful history taking and clinical examination. Abdominal aortic aneurysm rupture should always be considered in the differential diagnosis of sudden onset isolated lower limb neuropathies and or pain.

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Jejunal perforation: an unusual presentation of metastatic cutaneous squamous cell carcinoma (SCC) in an immunosuppressed patient

We report the rare occurrence of a small bowel perforation secondary to a metastatic cutaneous squamous cell carcinoma (cSCC). A 70-year-old woman, who had previously undergone renal transplantation, presented with severe, sudden-onset abdominal pain. She was peritonitic on initial examination, with evidence of free intra-abdominal air on radiographic imaging. During an exploratory laparotomy, she was found to have a perforated jejunum secondary to disseminated metastases seen throughout her peritoneum. Following histopathological analysis, as well as further imaging studies, the primary malignancy was eventually identified as a cSCC on her upper back. Palliative care was started and the patient died 8 weeks following her initial presentation.

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Tuberculous scleral abscess with choroidal detachment

We present a case of ocular tuberculosis (TB) presenting as scleral abscess with choroidal detachment. A 60-year-old woman presented with intense pain, redness, watering and decreased vision in the right eye (RE) for 1 week duration. Slit lamp examination of RE revealed diffuse scleritis with two pus-pointing areas in the supero-temporal quadrant suggesting scleral abscess. Fundus examination of the RE showed choroidal detachment in the temporal and inferior quadrant. Left eye examination was unremarkable. Ziehl-Neelsen staining of scleral biopsy showed acid-fast bacilli. PCR of the scleral tissue was also positive for Mycobacterium tuberculosis genome. The final diagnosis of tuberculous scleral abscess with choroidal detachment was made and patient showed good response to antitubercular treatment. In countries endemic for TB, it should be considered as a differential diagnosis for scleral abscess, since prompt diagnosis and treatment will ensure good visual outcome as depicted in our case.

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Rare and unusual case of polyarteritis nodosa involving the gastrointestinal tract leading to bowel gangrene

Polyarteritis nodosa (PAN) is a systemic necrotising vasculitis preferentially targeting medium-sized arteries and not related with glomerulonephritis or small vessel involvement. Clinical manifestations of PAN are multisystem. The gastrointestinal, renal, cardiac, musculoskeletal, skin and central nervous systems may be involved. The aetiology remains unknown, and the ensuing vasculitis may lead to aneurysm formation and thrombosis in any organs of the body with resultant ischaemia. PAN of the intestines is a relatively common manifestation of this disease but rarely causes bowel ischaemia resulting in necrosis. Here we report a case of a young Chinese patient who presented with an acute abdomen requiring surgery and made good recovery post operatively. He remains free of symptoms while on steroid therapy.

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Intraoperative OCT assisted descemetopexy with stromal vent incisions and intracameral gas injection for case of non-resolving Descemet's membrane detachment

Descemet's membrane detachment (DMD) though uncommon in the present day scenario of advancing surgical techniques is a significant complication that requires prompt diagnosis and management. A middle-aged man presented to our hospital with poor gain of vision following cataract surgery. There was significant corneal oedema with DMD which was confirmed on anterior segment optical coherence tomography. We describe a modified continuous intraoperative-guided approach for the management of DMD in cases with oedematous hazy corneas. The aim of this technique is to allow early reattachment of Descemet's membrane in chronic cases where fluid pockets prevent reattachment of the posterior layer of cornea. Our technique involves the use of full thickness stromal vent incisions in the paracentral cornea along with intracameral isoexpansile concentration of gas for the successful settlement of the detached Descemet's membrane.

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Thumb and index finger macrodactyly with first carpometacarpal and scaphotrapezotrapezoidal joints fusion: inevitable consequence?

Description

Macrodactyly is a descriptive term used for a rare anomaly of disproportionately large digit noted at birth or that develops within the first years of life. The soft tissue and skeletal elements are diffusely enlarged in the affected digit or digits.12 Most cases appear sporadically without evidence of inheritance. The anomaly is generally unilateral and may affect more than one digit, when the thumb involved, it assumes an abducted and extended attitude. The bony growth continues until physeal closure; however, soft tissue enlargement may continue into adulthood. The enlarged digits stiffen during growth, which further limits function as the enlarged digit or digits often obstruct grasp and pinch. Patients are usually initially evaluated in childhood with indications for surgery based on functional and aesthetic grounds. Macrodactyly's management is very challenging due to its progressive and diffuse nature preventing complete correction to normal....

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Spontaneous rupture of renal angiomyolipoma during pregnancy

A renal angiomyolipoma (AML) is a rare benign tumour of kidney origin. Pregnancy is known to be associated with an increased risk of tumour rupture causing hypovolaemic shock, which is usually managed surgically or through an embolisation procedure. However, having surgery during pregnancy predisposes the mother to a preterm delivery, and the unknown influences of radiation exposure to the fetus make the management of such cases very challenging. A 30-year-old pregnant woman had a sudden onset of gross haematuria at the 20th week of her pregnancy. The MRI showed a 10 cm mass suggestive of AML in the left kidney, with evidence of an intrarenal haematoma. To avoid an iatrogenic preterm delivery and unnecessary fetal exposure to radiation, conservative management was conducted until 34 weeks of gestation, when she came to our hospital reporting of flank pain. An endovascular treatment was performed immediately after an emergency caesarean delivery.

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Novel sleep management method in a toddler displaying fear and trauma: the Boss of My Sleep Book

Sleep problems in toddlers occur in ~40% of children and increase the likelihood of postnatal depression. Most sleep training in toddlers requires contact with a trained professional, and requires a parent to ignore their child's cries, causing distress to many children and parents, increasing attrition and leaving families untreated and at risk. This case study reports success in significantly ameliorating sleep reluctance and bedtime fears in a sleep disturbed toddler with a history of trauma. It uses a novel use of bedtime behaviour management with some positive reinforcement techniques, called the Boss of My Sleep book: a non-cry, online (thus readily and cheaply available without a trained professional) sleep intervention. The system was successful immediately and was sustained after 6 months. The Boss of My Sleep book shows promise as a sleep intervention in toddlers, particularly for those parents who do not want to use cry intensive methods.

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Prominent metalware from pelvic surgery causing dyspareunia

We present a case of female dyspareunia secondary to metalware placement during extensive pelvic surgery following a motor vehicle accident. The patient initially had an uneventful recovery from her operations. However, she noticed pain with vaginal intercourse, due to a screw tip which was palpable on vaginal examination. X-ray imaging confirmed long screws in the medial part of an anterior column plate, which were impacting on the anterior vaginal wall. Subsequent percutaneous removal of two screws resulted in resolution of her symptoms of painful vaginal intercourse. While the pain from mechanical irritation of the vagina was resolved, the patient continues to have difficulty with intercourse, which is related to hip pain as a result of her initial injury and complex pelvic surgery.

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Inadvertently boarding a pirate ship: disease progression in a paediatric patient with relapsed metastatic Ewing sarcoma receiving treatment at a centre for alternative therapy in Mexico

Complementary and alternative medicine (CAM) therapies are commonly incorporated into the care of patients with paediatric cancer. Many modalities are safe and effective during cancer treatment and have proved beneficial for symptom relief and quality of life. However, situations where alternative therapy is provided without allopathic medical care supportive care resources can pose a safety risk to patients. This report describes the case of a 16-year-old Chinese girl with metastatic Ewing sarcoma who sought treatment with alternative treatment in Mexico. When her disease progressed with an ensuing significant loss of function, the centre personnel were unable to respond to her acute deterioration or provide necessary medical care. This resulted in her being stranded in a foreign country paralysed, isolated, and with large unanticipated financial expenditures.

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Hyperbaric oxygen therapy in the management of severe leg ulcers from prolidase deficiency

Description

A 31-year-old man presented to our attention showing infected ulcerative lesions with pseudoepitheliomatous hyperplasia of legs and feet, which rendered him unable to walk or to even stand. At the age of 8, he had been diagnosed with prolidase deficiency disorder, based on high levels of imidodipeptiduria and reduced enzymatic activity of erythrocytic prolidase.

At the time of hospitalisation, the patient presented diffuse lower limbs lymphedema, with sock-shaped ulcerative-hyperplastic areas, involving the medial and distal third of legs and feet. Such lesions were exudative and variably deep, showed irregular edges, increased tissue consistency and hyperplastic surrounding skin (figures 1 and 2). To confirm the diagnosis, genetic analysis and prolidase enzymatic activity assay were performed, showing homozygosis for the (c.1342G>A (p. Gly488Arg)) mutation, and a non-determinable prolidase activity in cutaneous fibroblasts. Multiple microbiological examinations from cutaneous swabs turned out to be constantly positive for...

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Disseminated histoplasmosis presenting as diabetic keto-acidosis in an immunocompetent patient

Histoplasma capsulatum causes a spectrum of manifestations from asymptomatic to fatal disseminated disease. Disseminated histoplasmosis is mostly seen in endemic areas among immunocompromised patients such as those with AIDS. Here, we present a patient living in a non-endemic area with previously undiagnosed diabetes mellitus, who presented with septic shock and diabetic ketoacidosis (DKA), and was ultimately diagnosed with disseminated histoplasmosis. The patient rapidly recovered on administration of intravenous liposomal amphotericin followed by oral itraconazole. Uncontrolled diabetes may be a risk factor for disseminated or severe histoplasmosis in otherwise immunocompetent patients.

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First reported case of disseminated Nocardia kroppenstedtii sp nov. infection presenting with brain abscess and endocarditis in an immunocompromised patient with mantle cell lymphoma: challenges in diagnosis and treatment

A 72-year-old man with a history of blastoid variant stage IV relapsed refractory mantle cell lymphoma presented with new central nervous system (CNS) symptoms. Brain imaging was positive for rim-enhancing lesions along with a mitral valve mass on the echocardiogram. It was a challenge to establish the exact aetiology of these lesions in this patient. He was empirically treated with chemotherapy on the presumption that the brain lesions were secondary to progressive malignancy. However, brain biopsy was negative for malignancy and blood cultures were found positive for Nocardia kroppenstedtii sp nov. He subsequently improved with antibiotic therapy. Disseminated Nocardia can present with multiorgan involvement. Clinical and microbiological diagnosis can be challenging. Antimicrobial treatment-related side effects require close monitoring, and dosage changes or therapy adjustments may be necessary.

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Rivaroxaban lessens the number of thrombi in the left atrium and right lower pulmonary vein, as illustrated by transoesophageal echocardiography but not 80-MDCT

Stroke is a clinically important problem. A left atrial thrombus is known as a cause of ischaemic stroke. A pulmonary vein thrombus (PVT) is thought to be rare; however, PVT is common in elderly patients. Additionally, images of PVT with transoesophageal echocardiography (TEE) following treatment have not been well contrasted with that from either 64 or 80-slice multidetector CT (80-MDCT). The images of such changes depicted by TEE remain unknown. An 87-year-old man with hypertension was examined by 80-MDCT and TEE to check the cardiac thrombus. Although 80-MDCT did not depict the thrombus, TEE depicted the thrombus in the left atrium and right lower pulmonary vein (RLPV) clearly. After 6 months of rivaroxaban treatment, the thrombus in the RLPV decreased slightly and the thrombus in the left atrium became small and lucent, as estimated with TEE. Rivaroxaban decreased the size of the thrombus and changed the quality of the thrombus.

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Flaccid paralysis in an infant associated with a dirty wound and application of honey

An infant, who was born preterm at 36 weeks, presented with fever and ulcer at umbilical region which progressed to necrotising fasciitis of anterior abdominal wall. He was treated with intravenous penicillin, intravenous cloxacillin and local application of medicated honey. Subsequently, he required wound debridement. Postoperatively, he required prolonged invasive ventilation due to poor respiratory effort which was associated with hypotonia and areflexia. Nerve conduction study revealed absent responses. The diagnosis of infant botulism was made based on the clinical presentation, nerve conduction study and his clinical progress. Botulinum immunoglobulin was not available. He was treated with intravenous immunoglobulin and oral pyridostigmine. He was successfully extubated after 37 days, and currently the patient is doing well.

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Primary non-Hodgkin's lymphoma of the tongue: a diagnostic dilemma of unusual case presentation

Primary non-Hodgkin's lymphoma of the tongue is extremely uncommon, which makes its diagnosis quite challenging. A panel of 11 markers is used based on morphological differential diagnosis to elucidate the lymphoma subtype. A case of 43-year-old Egyptian man suffering from nodular mass on the right side of the tongue of 4 months duration is presented. No cervical lymphadenopathy was detected. No abdominal organomegaly was noted. The histological evaluation of incisional biopsy revealed a sheet of pleomorphic lymphoid cells with abnormal mitotic figures. A large number of histiocytes were infiltrating the lymphoid cellular sheet. The results of immunophenotyping were extranodal T-cell lymphoma. A proper immunohistochemical workup is crucial for the correct diagnosis and proper management.

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Contralateral inguinal herniation of a transplant ureter causing obstructive uropathy in a renal transplant recipient

Ipsilateral inguinal herniation of the transplanted ureter has been reported as a rare cause of obstructive uropathy in renal transplant recipients. A 73-year-old man presented with acute renal failure 29 years after receiving a deceased donor renal transplant. Radiological investigations demonstrated marked hydronephrosis of the left iliac fossa transplant kidney and herniation of the distal transplant ureter and bladder into the right inguinal canal. The patient underwent placement of a nephrostomy and antegrade stent followed by definitive hernia repair with return of graft function to baseline level.

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Osteoma nasal y calcitonina de salmón inhalada: ¿Coincidencia o consecuencia?

Publication date: Available online 6 January 2017
Source:Acta Otorrinolaringológica Española
Author(s): Zoila A. Peña-Rodríguez, Matilde Haro-García, Juan R. Benito-Navarro




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¿Tienen las mujeres con antecedente de gestación y endodoncia, mayor riesgo de presentar bola fúngica maxilar?

Publication date: Available online 6 January 2017
Source:Acta Otorrinolaringológica Española
Author(s): Esteban Vergara-de la Rosa, José Galvez-Olortegui, Carlos Vargas-Armas, Tomas Galvez-Olortegui




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Masthead - Editorial Board And Table of Contents

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IFAR 2017

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Three consecutive days of application of LED therapy is necessary to inhibit experimentally induced root resorption in rats: a microtomographic study

Abstract

Previous studies have suggested that phototherapy may modulate orthodontic tooth movement and the incidence of root resorption. We aimed to identify a minimal dose-response relationship to LED therapy with regard to orthodontic tooth movement (OTM) and root resorption in rats. Forty-eight male Wistar rats were divided into six groups with equal and random distribution: control (C) no intervention; three daily LED irradiation (CLED); submitted only to OTM (RR); OTM and LED irradiation on the first day (LED1); OTM and two LED irradiation on the first and second days (LED2); and OTM and three LED irradiation on the first, second, and third days (LED3). Orthodontic appliance was installed in groups RR, LED1, LED2, and LED3 to promote OTM. Animals from groups CLED, LED1, LED2, and LED3 received LED therapy (940 nm, 4 J, 4 J/cm2) according to each group of treatment. After 7 days, all the animals were sacrificed. The jaws were fixed and scanned with microtomography (micro-CT). The micro-CT images were reconstructed on 2D and 3D models. These models were used to identify and measure root resorption number and dimensions (diameter, depth, and volume). The distance between the first and second molars was used to verify tooth displacement. The results showed that LED3 group had significantly lower number of root resorption. The root resorption dimensions (diameter and depth) had no significant differences among the experimental groups. LED3 group had significant tooth displacement in relation to C and CLED groups. In conclusion, three daily LED therapy doses are required to inhibit root resorption after appliance of orthodontic forces.

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Nocturnal enuresis in children between laser acupuncture and medical treatment: a comparative study

Abstract

Nocturnal enuresis (NE) is intermittent involuntary voiding during sleep in a child aged 5 years or more. The study was conducted to compare the effect of using laser acupuncture and medication for the treatment of children with nocturnal enuresis (NE) and evaluation of urodynamic parameter after treatment. A randomized study included 45 children ranged from 5 to 15 years presenting with NE. They were randomized into three equal groups—group A, managed with desmopressin acetate; group B, managed with laser acupuncture; and group C, managed with a combination of laser acupuncture and desmopressin—all groups received behavioral therapy. The children were evaluated before and after 3 months of the study to record the efficacy of therapy, side effects and bladder capacity, and 3 months of follow-up after cessation of treatment by bladder diary. A statistically significant higher cure rate was reported in group B patients (73.3 %), while in groups A and C, improvement was reported in 20.0 and 13.3 %, respectively (p value = 0.002). Laser acupuncture is noninvasive, painless tool, with no side effects and lower recurrence rate which can be considered as an alternative therapy for patients with NE.

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One-year follow-up results of intradiscal diode laser, radiofrequency, and pulsed radiofrequency therapies: a retrospective study

Abstract

This study aims to investigate the efficacy of three different percutaneous intradiscal therapies in patients with chronic low back pain (CLBP) due to lumbar disc herniation (LDH). Medical files of a total of 120 patients who received percutaneous intradiscal therapy were retrospectively analyzed. All patients were divided into three groups: group L: diode laser (n = 40), group R: radiofrequency (RF) (n = 40), and group P: pulsed radiofrequency (PRF) (n = 40). The visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were calculated at 1, 3, 6, and 12 months for all patients. One-year follow-up results were as follows: group L: pre-treatment (PreT) VAS 5.6 ± −1, ODI 37.6 ± −4.7, post-treatment 12th month (PT12) VAS 2.8 ± −1.4, ODI 14.1 ± −7.1; group P: PreT VAS 6.0 ± 1, ODI 37.5 ± 5.9, PT12 VAS 3.1 ± 1.3, ODI 20.3 ± 17.0; and group R: PreT VAS 5.6 ± 1.0, ODI 37.9 ± 4.7, PT12 VAS 3.3 ± 1.4, ODI 27.2 ± 14.1. In each of the three groups, there was a statistically significant reduction in the VAS and ODI scores at 1, 3, 6, and 12 months, compared to the baseline values (p < 0.05). The highest reduction in the VAS and ODI scores was observed in group L, whereas the lowest reduction was in group R. We consider that in groups with patient selection criteria at our study; diode laser, RF, and PRF, which are administered using the percutaneous intradiscal route for CLBP patients diagnosed with LDH, may be used as an alternative treatment option.

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Influence of dentin thickness on intrapulpal temperature under simulated pulpal pressure during Nd:YAG laser irradiation

Abstract

The aim of this study was to evaluate the effects of dentin thickness and pulpal pressure simulation (PPS) on the variation of intrapulpal temperature (∆T) when submitted to an adhesive technique using laser irradiation. Sixty sound human molars were sectioned and randomly divided into two groups (n = 30): group 1—1 mm of dentin thickness; group 2—2 mm of dentin thickness. Each group was divided into two subgroups (n = 15): subgroup A—absence of PPS; subgroup P—presence of PPS (15 cm H₂O), sequentially treated with the following: 37 % phosphoric acid, adhesive system (Adper Single Bond), irradiation with Nd:YAG laser (1064 nm, 10 Hz, 60 s) using 60, 80, and 100 mJ/pulse energy parameters and light-curing (10 s). The ∆T was evaluated during the laser irradiation with a digital thermometer. Data were analyzed by three-way ANOVA and Tukey tests (p < 0.05). Three-way ANOVA revealed no significant differences for dentin thickness (p = 0.6512) on ∆T. PPS significantly reduced ∆T (p = 0.0001). The laser energy parameters (p = 0.0027) indicated that 100 mJ presented with significantly greater ∆T when compared to the groups irradiated with 80 and 60 mJ. Dentin thickness did not affect ∆T. The presence of PPS reduced the mean temperature values. The Nd:YAG laser energy parameters had a negative influence on the variation of temperature in the absence of PPS. In the presence of PPS, there was no risk to the pulp, since this study obtained temperature increases below 5.5 °C for all energy parameters, showing the technical viability for in vivo conditions.

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Synergistic effect of high-intensity focused ultrasound and low-fluence Q-switched Nd:YAG laser in the treatment of the aging neck and décolletage

Abstract

High-intensity focused ultrasound (HIFU) is regarded as an effective skin-lifting device; however, literature regarding treatment of the aging neck and décolletage with HIFU is scarce. Our study aimed to evaluate the efficacy of combination with HIFU and low-fluence Q-switched Nd:YAG (LQSNY) laser on the aging neck and décolletage. Nineteen women were assessed. HIFU at two visits and LQSNY laser at six visits were used to irradiate the neck and chest. At week 16, improvements were rated using the Dedo classification, Fabi/Bolton Chest Wrinkle Scale (FBCWS), and Global Aesthetic Improvement Scales (GAIS). Erythema and melanin indices (EMIs) and cervicomental angle were measured. Subject GAIS and satisfaction were evaluated at follow-up visits. At week 16, neck sagging and chest rhytides were improved on Dedo classification and FBCWS, respectively. Pigmentation and rhytides of the neck and chest were rated as improved in 30 % or more of the subjects by physician GAIS and in approximately 80 % of the subjects by subject GAIS. The above differences seemed to be attributable to the initial expectation level and mild severity pertaining to dress custom in Korea. Eighty-four percent of subjects were satisfied with treatment outcomes. EMIs were decreased on the chest. The combination of HIFU and LQSNY is an effective treatment option to mitigate rhytides and pigmentation of the neck and décolletage.

http://ift.tt/2hXyuoF

Facial Nerve Paralysis in Acute Suppurative Otitis Media-Management

Abstract

Facial paralysis is a rare complication of acute suppurative otitis media which requires early detection and appropriate care. We hereby report a case which we managed conservatively with good outcome. Following our experience and review of literature on the subject, antibiotic therapy and corticosteroid therapy, with or without myringotomy were found to be the first-line procedures. Surgery should be employed in case of acute or coalescent mastoiditis, suppurative complications and lack of clinical regression.

http://ift.tt/2iLKJ55

Managing Rhinophyma by Trimodal Therapy-Novel Approach

Abstract

Rhinophyma is characterized by nodular thickening of the Nasal skin, sebaceous gland hyperplasia, dilated pores, and in its late stage, fibrosis. In severe cases, it results in loss of normal facial contours, significant disfigurement, and social isolation. Treatment options for severe rhinophyma include cryosurgery, partial-thickness decortications with subsequent secondary reepithelialisation, laser ablation, full thickness resection with graft or flap reconstruction, excision by electrocautery or radio frequency. We report a case of severe rhinophyma resulting in marked facial disfigurement treated successfully with trimodal therapy with excellent cosmetic outcome on a long term follow up.

http://ift.tt/2iPZCpv

Facial Nerve Paralysis in Acute Suppurative Otitis Media-Management

Abstract

Facial paralysis is a rare complication of acute suppurative otitis media which requires early detection and appropriate care. We hereby report a case which we managed conservatively with good outcome. Following our experience and review of literature on the subject, antibiotic therapy and corticosteroid therapy, with or without myringotomy were found to be the first-line procedures. Surgery should be employed in case of acute or coalescent mastoiditis, suppurative complications and lack of clinical regression.

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Managing Rhinophyma by Trimodal Therapy-Novel Approach

Abstract

Rhinophyma is characterized by nodular thickening of the Nasal skin, sebaceous gland hyperplasia, dilated pores, and in its late stage, fibrosis. In severe cases, it results in loss of normal facial contours, significant disfigurement, and social isolation. Treatment options for severe rhinophyma include cryosurgery, partial-thickness decortications with subsequent secondary reepithelialisation, laser ablation, full thickness resection with graft or flap reconstruction, excision by electrocautery or radio frequency. We report a case of severe rhinophyma resulting in marked facial disfigurement treated successfully with trimodal therapy with excellent cosmetic outcome on a long term follow up.

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Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel

Food allergy is an important public health problem because it affects children and adults, can be severe and even life-threatening, and may be increasing in prevalence. Beginning in 2008, the National Institut...

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A Clinical Research of CAR T Cells Targeting EpCAM Positive Cancer

Conditions:   Colon Cancer;   Esophageal Carcinoma;   Pancreatic Cancer;   Prostate Cancer;   Gastric Cancer;   Hepatic Carcinoma
Intervention:   Biological: CAR-T cell immunotherapy
Sponsor:   First Affiliated Hospital of Chengdu Medical College
Recruiting - verified January 2017

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Secured Access to Pembrolizumab for Adult Patients With Selected Rare Cancer Types

Conditions:   Sarcoma;   Ovarian Neoplasm;   Central Nervous System Neoplasm;   Thyroid Neoplasm;   Carcinoma, Neuroendocrine;   Neoplasms, Germ Cell and Embryonal
Intervention:   Drug: Pembrolizumab
Sponsors:   UNICANCER;   National Cancer Institute, France;   Ligue contre le cancer, France;   Merck Sharp & Dohme Corp.
Not yet recruiting - verified January 2017

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Secured Access to Nivolumab for Adult Patients With Selected Rare Cancer Types

Conditions:   Carcinoma, Renal Cell;   Head and Neck Neoplasm;   Skin Neoplasms;   Microsatellite Instability;   Penile Neoplasms
Intervention:   Drug: Nivolumab
Sponsors:   UNICANCER;   National Cancer Institute, France;   Ligue contre le cancer, France;   Bristol-Myers Squibb
Not yet recruiting - verified January 2017

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Pain Perception: Lidocaine Rate/Temp/Buffer

Condition:   Pain
Interventions:   Procedure: Slow, Room Temperature Injection;   Procedure: Rapid, Room Temperature Injection;   Procedure: Slow, Warm Temperature Injection;   Procedure: Rapid, Warm Temperature Injection;   Procedure: Buffered Injection;   Procedure: Non-Buffered Injection;   Drug: Lidocaine;   Drug: Buffer
Sponsor:   Northwestern University
Recruiting - verified January 2017

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Patient Comfort During Dermatologic Procedures

Conditions:   Pain;   Anxiety
Interventions:   Procedure: Hand-holding;   Procedure: Stress Ball
Sponsor:   Northwestern University
Not yet recruiting - verified January 2017

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Follicular helper T cells mediate IgE antibody response to airborne allergens

Publication date: January 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 1
Author(s): Takao Kobayashi, Koji Iijima, Alexander L. Dent, Hirohito Kita
BackgroundTH2 cells have long been believed to play a pivotal role in allergic immune responses, including IgE antibody production and type 2 cytokine–mediated inflammation and pathology. A new T-cell subset, follicular helper T (TFH) cells, is specialized in supporting B-cell maturation and antibody production.ObjectiveWe sought to investigate the roles of TFH cells in allergic immune responses.MethodsNaive mice were exposed to cytokines or natural allergens through the airways. Development of allergic immune responses was analyzed by collecting draining lymph nodes and sera and by challenging the animals. Cytokine reporter mice and gene-deficient mice were used to dissect the immunologic mechanisms.ResultsWe observed the development of IL-4–producing TFH cells and TH2 cells in draining lymph nodes after airway exposure to IL-1 family cytokines or natural allergens. TFH and TH2 cells demonstrated unique phenotypes, tissue localization, and cytokine responses. TFH cells supported the sustained production of IgE antibody in vivo in the absence of other T-cell subsets or even when TH2 cell functions were severely compromised. Conversely, conditional deficiency of the master regulator Bcl6 in CD4⁺ T cells resulted in a marked reduction in TFH cell numbers and IgE antibody levels, but type 2 cytokine responses and eosinophilic inflammation in the airways remained unaffected.ConclusionTFH cells play critical roles in the regulation of IgE antibody production. Allergic immune responses to airborne allergens likely involve 2 distinct subsets of IL-4–producing CD4⁺ T cells, namely TFH and Th2 cells.



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Construction and Validation of a Novel Disease-Specific Quality of Life Instrument for Patients with Primary Antibody Deficiency Disease (PADQOL -16)

Publication date: Available online 5 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Mark Ballow, Mark R. Conaway, Panida Sriaroon, Rima A. Rachid, Filiz O. Seeborg, Carla M. Duff, Francisco A. Bonilla, M. Elizabeth M. Younger, Ralph Shapiro, Ted M. Burns
A disease-specific Health-related Quality of Life survey was developed for adult patients with antibody immune deficiency disorders as a tool (PADQOL-16) for assessing a patient's QOL issues and their relation to clinical status.



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An epigenome-wide association study of total serum immunoglobulin E in Hispanic children

Publication date: Available online 6 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Wei Chen, Ting Wang, Maria Pino-Yanes, Erick Forno, Liming Liang, Qi Yan, Donglei Hu, Daniel E. Weeks, Andrea Baccarelli, Edna Acosta-Perez, Celeste Eng, Yueh-Ying Han, Nadia Boutaoui, Catherine Laprise, Gwyneth A. Davies, Julian M. Hopkin, Miriam F. Moffatt, William O.C.M. Cookson, Glorisa Canino, Esteban G. Burchard, Juan C. Celedón
BackgroundTotal immunoglobulin E (IgE) is a therapeutic target in allergic diseases. DNA methylation in white blood cells (WBCs) was associated with total IgE in an epigenome-wide association study (EWAS) of Caucasians. Whether DNA methylation of eosinophils explains those findings is insufficiently understood.MethodsWe tested for association between genome-wide DNA methylation in WBCs and total IgE in two studies of Hispanic children: the Puerto Rico Genetics of Asthma and Lifestyle Study (PR-GOAL, n = 306) and the Genes-environments and Admixture in Latino Americans (GALA II, n = 573). Whole-genome methylation of DNA from WBCs was measured using the Illumina Infinium HumanMethylation450 BeadChip. Total IgE was measured using the UniCAP 100 system. In PR-GOAL, WBC types (i.e. neutrophils, eosinophils, basophils, lymphocytes, and monocytes) in peripheral blood were measured using Coulter-Counter techniques. In GALA II, WBC types were imputed. Multivariable linear regression was used for the analysis of DNA methylation and total IgE, which was first conducted separately for each cohort, and then combining results from the two cohorts in a meta-analysis.ResultsCpG sites in multiple genes, including novel findings and results previously reported in Caucasians, were significantly associated with total IgE. However, adjustment for WBC types resulted in markedly fewer significant sites. Top findings from this adjusted meta-analysis were in genes ZFPM1 (P=1.5×10^-12), ACOT7 (P=2.5×10^-11), and MND1 (P=1.4×10^-9).ConclusionsIn an EWAS adjusted for WBC types (including eosinophils), methylation changes in genes enriched in pathways relevant to asthma and immune responses were associated with total IgE among Hispanic children.

Teaser

In an EWAS adjusted for WBC types, few DNA methylation changes were significantly associated with total IgE among Hispanic children. Future EWAS of total IgE should account for DNA methylation of WBC types, particularly eosinophils.


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Cover 1

Publication date: January 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 1





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Brief Overview of This Month's JACI

Publication date: January 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 1





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Table of Contents

Publication date: January 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 1





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Editorial Board

Publication date: January 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 1





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Information for Readers

Publication date: January 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 1





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News & Notes

Publication date: January 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 1





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CME Activities Calendar

Publication date: January 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 1





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Using imaging as a biomarker for asthma

Publication date: January 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 1
Author(s): Abhaya Trivedi, Chase Hall, Eric A. Hoffman, Jason C. Woods, David S. Gierada, Mario Castro
There have been significant advancements in the various imaging techniques being used for the evaluation of asthmatic patients, both from a clinical and research perspective. Imaging characteristics can be used to identify specific asthmatic phenotypes and provide a more detailed understanding of endotypes contributing to the pathophysiology of the disease. Computed tomography, magnetic resonance imaging, and positron emission tomography can be used to assess pulmonary structure and function. It has been shown that specific airway and lung density measurements using computed tomography correlate with clinical parameters, including severity of disease and pathology, but also provide unique phenotypes. Hyperpolarized ¹²⁹Xe and ³He are gases used as contrast media for magnetic resonance imaging that provide measurement of distal lung ventilation reflecting small-airway disease. Positron emission tomography can be useful to identify and target lung inflammation in asthmatic patients. Furthermore, imaging techniques can serve as a potential biomarker and be used to assess response to therapies, including newer biological treatments and bronchial thermoplasty.



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Using imaging as a biomarker for asthma

Publication date: January 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 1





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Dynamic intravital imaging of cell-cell interactions in the lymph node

Publication date: January 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 1
Author(s): Jens V. Stein, Santiago F. Gonzalez
In the last decade, the application of 2-photon intravital microscopy as a tool to study cell interactions in different areas of the immune system has offered an unprecedented opportunity to understand the complexity of cell behavior in relation to immune functions. In this review we describe the latest advances in the field of live imaging in the lymph nodes, grouping the different cell populations in 2 compartments according to their motility: the sessile compartment, which is formed by resident cells of stromal origin, macrophages, and resident dendritic cells, and the motile compartment, which is mainly formed by T and B lymphocytes. Here we review how the use of in vivo imaging has contributed to our understanding of the role of these cells in the initiation of the immune response in the draining lymph nodes.



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