Head and Neck Medicine by Alexandros G.Sfakianakis: 01/07/17

Σάββατο 7 Ιανουαρίου 2017

Frontal Sinus Pneumatization Affects Height of the Lateral Lamella and Position of Anterior Ethmoidal Artery

Abstract: Preoperative evaluation of the frontal sinus (FS) and associated anatomical structures may reduce the risk of intraoperative complications and facilitate the management of potential complications. In this study, the authors aimed to evaluate relationship between FS pneumatization and critical anatomical structures. Paranasal sinus computerized tomography scans of 350 sides of 175 patients were evaluated. The pneumatization pattern of the FS, FS dimensions (on the axial, coronal, and sagittal slices), anterior ethmoidal artery, and depth of the of olfactory fossa were evaluated for every patient on both sides. There were 111 (63.4%) male and 64 (36.6%) female patients. The authors found a statistically significant correlation between the depth of olfactory fossa and the anterior ethmoidal artery position (P

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Corrugator: Muscle of Empathy and Determination

No abstract available

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Application of Dexamethasone in the Masseter Muscle During the Surgical Removal of Lower Third Molars

Purpose: The aim of the present study was to analyze the effect of the application of dexamethasone in the masseter muscle during third molar surgery. Methods: This randomized, clinical trial used dependent samples and the split-mouth method. A sample of 30 patients, with impacted or semi-impacted third molars, as well as vertical and mesioangular positions of a similar surgical difficulty (on both sides), was subjected to 2 operations: an experimental operation and a control procedure, with a 30-day wash-out. The choice of which group would be experimental or control was random. The experimental group received 8 mg of dexamethasone, which was applied directly to the masseter muscle immediately after surgery. The control group did not receive corticosteroids. Seven and 15 days after the surgery, the patients were assessed in relation to their levels of pain, trismus, and edema. Results: Concerning edema and trismus, there was a significant difference (P

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Conjoined Twin Separation: Integration of Three-Dimensional Modeling for Optimization of Surgical Planning

Abstract: Conjoined twinning is a rare anomaly, with an incidence of approximately 1 in 100,000 live births. There is a high perinatal mortality rate, but twins who survive pose reconstructive challenges that require meticulous preoperative planning. The authors describe the senior surgeon's career experience with conjoined twin separation, and the evolution of medical modeling and 3-dimensional imaging as a critical component in presurgical planning. The authors performed a retrospective review of all consecutive patients of conjoined twin separation at a single institution from January 2004 to December 2013. Data were collected related to patient demographics, comorbidities, operative technique, perioperative complications, survival, long-term outcomes, and the type of medical modeling system used for preoperative planning. Five sets of conjoined twins underwent separation during the 10-year study period. There were 3 sets of thoraco-omphalopagus twins, 1 set of pyopagus twins, and 1 set of ischiopagus tetrapus twins. The mean age at separation was 70 days, with a mean of 3.5 surgical procedures performed per patient during the first year of life. One set of twins experienced postseparation complications that warranted immediate return to the operating room. The overall survival rate after separation was 70%. The imaging methods used were computed tomography scan with 3-dimensional reconstruction, plaster molds, medical modeling with composite printing, and virtual surgical planning. The use of imaging and medical modeling in presurgical planning has proven to be an important element in optimizing the outcomes for patients with this rare anomaly.

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Modified Heavy Wire Twister as an Efficient Screw Holder and Screw Driver in Maxillofacial Surgery

No abstract available

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A Rare Patient with Facial Duplication

Abstract: Facial duplication, in whole or in part, is a very rare malformation. It may be symmetrical or asymmetric. Those cases that have been reported in the literature constitute a spectrum extending from simple nasal duplication to complete separation of 2 faces. Up to now there are some reports of eye, nose, mandible, or maxilla duplication separately. But there is no report of oral orifice or lips duplication. The present article reports a case of a newborn girl who presented with 2 mouths and also duplication of zygoma and maxilla. Then, we describe her stages of treatment from birth through now that she has 20 years.

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Effect of Submucosal Mesna Application on Mucoperichondrial Elevation in Septoplasty

Objective: It was revealed that the thiol compound named mesna chemically softens the connective tissue with submucosal injection, and facilitates the endoscopic submucosal dissection. The authors aimed to investigate the effect of mesna injection on mucoperichondrial elevation during septoplasty operation. Methods: This study was planned as a patient-control study and performed. Fifty-six patients who had septoplasty operation were divided into 2 groups that are submucosal mesna (group 1) and submucosal saline (group 2) applied ones. In both groups, the measurement was initiated by a timer during the start of septal incision and elevation processes. After bilateral subperichondrial and subperiostal elevation were finished, timer was stopped and time was recorded. After that, mucosal integrity was reviewed and mucosal damage status was recorded. The difficulty of mucoperichondrial elevation for the surgeon was recorded for each patient. Results: Twenty-five (44.7%) of the patients who participated in our study were females while 31 (55.3%) were males. The average elevation periods were 201.4 ± 74.3 seconds in group 1 and 260.2 ± 84.1 seconds in group 2. In mesna applied patients, elevation period was statistically and significantly shorter (P = 0.009). Impairment in mucosal integrity was observed as 33.3% in group 1 and 58.8% in group 2. In mesna applied patients, significantly less impairment in mucosal integrity was observed (P = 0.031). The average mucoperichondrial elevation difficulty for the surgeon is observed as 4.83 ± 2.47 in group 1 and 6.5 ± 1.9 in group 2. Mesna applied patients were defined as significantly easier patients for the surgeon (P = 0.006). Conclusion: Submucosal mesna application is an approach that provides a convenient, fast, and effective mucoperichondrial elevation in septoplasty and protects the mucosal integrity.

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Identical Twins Discordant for Metopic Craniosynostosis: Evidence of Epigenetic Influences

Abstract: Craniosynostosis, or premature fusion of the cranial sutures, occurs in approximately 1 in 2500 live births. The genetic causes and molecular basis of these disorders have greatly expanded over the last 2 decades, with numerous causative and contributory mutations having been identified. The role of fibroblast growth factor receptor (FGFR) mutations in the etiology of certain eponymous forms of craniosynostosis is now well elucidated; the most common syndromes associated with craniosynostosis are Pfeifer (FGFR1, FGFR2), Apert (FGFR2), Crouzon (FGFR2), Saethre–Chotzen (TWIST1), Jackson–Weiss (FGFR2), Greig (GL13), and Muenke (FGFR3) syndromes. Although pathological expression of these mutations often results in bilateral coronal craniosynostosis, single suture fusions (typically unilateral coronal synostosis) or multiple suture craniosynostosis are possible. The majority of patients diagnosed with craniosynostosis lack an identifiable syndrome or genetic mutation. The etiopathogenesis of these "nonsyndromic" forms of craniosynostosis is believed to involve a complex interplay of genetics, epigenetics, and environmental factors. Evaluation of genes implicated in nonsyndromic craniosynostosis has been conflicting; some evidence demonstrates an interplay between genetic and epigenetic influences while others do not. Certain environmental factors such as teratogenic levels of retinoic acid, maternal metabolic and hematologic disorders, and head growth constraint in utero may increase the likelihood of developing craniosynostosis, but these associations are again tenuous. The authors present 1 of 2 genetically confirmed identical twins discordant for metopic craniosynostosis. The implications of this case are clear: epigenetic influences, environmental influences, or both played a role in the development of this premature suture fusion.

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Encyclopedia of Aesthetic Rejuvenation Through Volume Enhancement by Charles K. Herman and Berish Strauch New York, NY: Thieme Medical Publishers, 2014

No abstract available

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Domino Flaps for Repairing of Secondary Bilateral Cleft Lip With Severe Columella Deformity

Abstract: The patients with secondary bilateral cleft lip and nasal deformity always suffer from a serious part of the horizontal and vertical soft tissue deficiencies in the upper lip and nose, especially the columella. Normally, the Abbe flap is used to increase the soft tissue volume of upper lip. However, how to reconstruct the sever columella deficient, how to make full use of the Abbe flap and the remaining soft tissue of the upper lip, are always the problems that need to be solved by plastic surgeons. Twenty-nine patients with secondary bilateral cleft lip and severe columella deficiency were simultaneously reconstructed with several local flaps like dominos that was called "Domino sliding flaps." Six of the patients had their nasal tip and dorsum or collumella augmented and modified with autologous costal cartilage at the same time. The other 23 patients underwent the autologous auricular cartilage augmentation. The patients were followed from 15 months to 50 months. No secondary deformation occurred in any of the patients. 93.1% patients were satisfied with the aesthetics postoperatively, 89.7% patients were satisfied with the incision and donor site scar. Among them, 3 of the patients got hypertrophic scar on the upper lip and were modified 1 year after their first operations. The operational technique of the domino sliding flaps could better play the role of the Abbe flap. It also gave plastic surgeons an effective method to modify the severe deformities of bilateral cleft lip in 1 stage.

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Large Frontoorbital Osteoma Causing Ptosis

Abstract: Osteomas are the most frequent benign tumor of the paranasal sinuses. The commonest site is the frontal sinus but intraorbital extension of frontal osteoma is rare. Here, the authors report a 15-year-old adolescent boy who presented with left superior orbital rim swelling and ptosis. Waters radiography and computed tomographic scan revealed a bone density mass in the left frontal sinus with upper orbital wall extension. The tumor was removed via open eyebrow incision. The histopathologic evaluation was consistent with osteoma.

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Prevalence of Different Forms and Involved Bones of Craniofacial Fibrous Dysplasia

Background: The purposes of this study were to analyze the prevalence of various craniofacial bones involved in patients with craniofacial fibrous dysplasia (CFD) and to demonstrate the most common form and bone involvement in patients with CFD for surgeons. Methods: To address the research purpose, the authors designed and performed a systematic review with meta-analysis. A comprehensive electronic search without date was performed in August 2013. Data extracted from the previously published literature were analyzed with STATA 11.0 software. Results: Relevant data were extracted from 18 studies (487 total participants) and revealed that in CFD patients, the prevalence of the monostotic type was 56% (95% confidence intervals [CI]: 0.42–0.70; P = 0.000) and polyostotic type was 47% (95% CI: 0.31–0.63; P = 0.000); McCune–Albright syndrome was a relatively rare form (7%; 95% CI: 0.02–0.12; P = 0.006). Subgroup analyses indicated that the maxilla was most commonly involved (28%; 95% CI: 0.42–0.70; P = 0.000) in monostotic CFD, followed by the orbital (27%; 95% CI: −0.23–0.76; P = 0.298), mandibular (25%; 95% CI: 0.16–0.35; P = 0.000), frontal (22%; 95% CI: 0.09–0.34; P = 0.001), and temporal bones (12%; 95% CI: 0.03–0.21; P = 0.012). The prevalence of maxilla involvement in polyostotic CFD patients was as high as 30% (95% CI: 0.18–0.42; P = 0.000). Conclusion: This meta-analysis found that monostotic and polyostotic forms of CFD shared similar prevalence rates. Furthermore, the maxilla was found to be the most commonly involved bone in both monostotic and polyostotic CFD.

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Calculation of an Optic Nerve Injury Risk Profile Before Sphenoid Sinus Surgery

Objectives: Our objective was to analyze variations in the optic nerve (ON) course and surrounding structures in an effort to construct an optic nerve injury risk profile before endoscopic intranasal sphenoidal, or endoscopic endonasal transphenoidal, skull-base surgery, and eventually to construct and formulate a common classification by combining the known classes. The authors used computed tomography (CT) toward this end. Methods: The authors retrospectively reviewed 200 consecutive CT scans (400 sides) of the paranasal sinuses. The pneumatization of the anterior clinoid process, the relationships of the ONs to the sphenoidal sinuses, and ON dehiscence were evaluated. The authors then created a formula by which risk profiles can be constructed for patients for whom sphenoid or parasellar surgery is planned. Results: Pneumatization of the anterior clinoid process was evident in 28.25%. Dehiscence of the bony wall of the ON was evident in 9.5%. The ON course lay adjacent to the sphenoidal sinus, causing sinus wall indentation, in 23%. Cumulative optic nerve injury risk scoring showed that, radiologically, surgery on 8.5% and 1.5% of sphenoid sinuses described here carried severe or critical risk of ON injury, respectively. Conclusions: Head-and-neck surgeons and neurosurgeons should be aware of variations in ON course. The authors composed an optic nerve injury risk classification category based on the sum of individual weights of each of these classes. Reductions in ON injuries require careful evaluation of potential variant anatomies. Preoperative CT scans must be meticulously reviewed to avoid ON injury.

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Long-Term Outcomes of Pediatric Cranial Reconstruction Using Resorbable Plating Systems for the Treatment of Craniosynostosis

Background: Resorbable plating in cranial reconstruction for craniosynostosis has fewer reported complications than rigid hardware. Few long-term outcome studies exist for pediatric patients treated with this technology for cranial vault reconstruction. Methods: A retrospective review was performed on pediatric patients undergoing cranial vault reconstruction for craniosynostosis by 3 surgeons over a 15-year period. MacroPore (Cytori Therapeutics, San Diego, CA) or Lactosorb (Walter Lorenz Surgical Inc, Jacksonville, FL), composed of polyglycolic and polylactic acids, was used for resorbable plate fixation. Results: A total of 203 patients underwent resorbable plate fixation with a mean age of 15.8 months at surgery. Mean length of follow-up was 6.4 years. Lactosorb plating system was used in the majority of patients (74%) compared with MacroPore plating system (26%). Overall, unplanned reoperations were required in 5.4% of patients. Palpable hardware was noticed in 10.3% of patients. Only 3 patients (1.5%) developed exposure of the resorbable hardware requiring removal, all MacroPore plates. Four patients (2%) developed surgical site infection and 3 patients (1.5%) developed a seroma. There were 15.8% requiring later surgical revision with cranial vault expansion or cranioplasty with grafts for residual cranial defects. The majority of revisional reoperations (81%) occurred in the first half of the study before the addition of Allogenix. Conclusions: Resorbable plating systems, specifically Lactosorb, for cranial reconstruction are a safe, reproducible, inexpensive modality with very low complication rates. They have 3-dimensional stability, rigid fixation without causing growth restriction, and lower likelihood of need for removal.

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The Appropriate Retractors for Genioplasty

Abstract: Mental nerve (MN) injury is the most common complications of genioplasty; to protect the MN and oral mucosa, the authors invent and validate the appropriate retractors for genioplasty, and which can avoid the skin and mucous membrane of the lower lip, chin, and the vestibular gingiva of the mandibular incisor from paresthesia or dysesthesia. The patent application for the appropriate retractors for genioplasty is already submitted (Patent No 201610164563.3, China). The retractors provide a better surgical visual field and improve the operation efficiency while reducing the risk of surgery. And the method is simple, safe, efficient, and laborsaving.

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Outcomes of Palatal Lift Prosthesis on Dysarthric Speech

Purpose: This study was designed to investigate the effect of palatal lift prosthesis (PLP) on the speech of individuals with different types of dysarthria. Participants: Thirty (19 males and 11 females) native speakers of Jordanian Arabic with dysarthria participated in the study. The age of the participants ranged from 8 to 67 years with an average of 34.1 years. Traumatic brain injury was the most common etiology of dysarthria among 12 participants, stroke among 11, multiple sclerosis among 3, and pseudobulbar palsy among 2; 1 participant had Parkinson disease, and another participant had amyotrophic lateral sclerosis. Methods: Five acoustic and aerodynamic measures were evaluated to determine the speech outcomes including nasalance scores, sequential motion rate, speech rate, vital capacity, and sound pressure level. The acoustic measures were obtained from the participants in PLP-out and PLP-in conditions. Results: Results showed statistically significant decrease in the nasalance scores of the syllable repetition, vowel prolongation, and sentence repetition tasks in the PLP-in condition below the 28% cutoff score. Furthermore, results revealed statistically significant increase in sequential motion rate, speech rate, vital capacity, and sound pressure level (P = 0.000). Conclusion: The use of PLP is an effective treatment option of dysarthric speech. Besides nasalance scores, the sequential motion rate, speech rate, vital capacity, and sound pressure level are considered reliable speech measures that may be used to evaluate the effect of PLP on dysarthria.

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Effect of Energy Drink on Bone Formation in the Expanded Inter-Premaxillary Suture

Abstract: Maxillary expansion of the median palatal suture is a common procedure in orthodontics. Even after retention, there is a strong tendency to relapse in the expanded suture. The authors' objectives are to accelerate the bone formation process in the expanded suture and to reduce the required retention time by using an energy drink (ED). Twenty rats were divided into 2 groups (n = 20). The expansion-only group was defined as the control group (Group C). The other group was defined as the expansion-plus-energy drink group (Group ED). In Group ED, ED was administered systemically through oro-gastric tubes after the expansion period. After 5 days of expansion, the springs were removed and replaced with short lengths of rectangular retaining wire. Tooth separation was maintained for 12 days. Histomorphometric analysis showed significant differences between the 2 groups in terms of newly formed bone (P = 0.018) and the bone area (P = 0.007). For the parameters that were investigated, Group ED had better results than Group C. These results show that systemic administration of an ED during the early stages of the orthopedic expansion of the inter-maxillary suture areas can stimulate bone formation and decrease the time required for retention.

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Osseous Repair in Minimally Invasive Reconstruction of Anterior Skull Base Defects

Abstract: Management of anterior skull base defects is an area of continued innovation for skull base surgeons. Various grafting materials have been advocated for the repair of skull base defects depending on needs, availability, harvest site morbidity, and surgeon preference. Spontaneous bony closure of small skull defects is known to occur in animal models without bone grafts, but this phenomenon has been unexplored in the human skull base. The objective of this study was to evaluate osseous skull base closure in patients undergoing endoscopic repair of skull base defects. A retrospective review was performed on 13 patients who underwent endoscopic repair of skull base defects with free bone grafts who were followed with postoperative computed tomography scans. This cohort was compared to postoperative radiology from patients undergoing transsphenoidal surgery without rigid reconstruction to evaluate for spontaneous osseous closure of sellar defects. Free bone grafts are incorporated into the bony skull base in the majority of patients (84.6% with at least partial incorporation) at mean of 5.3 years postoperatively. By comparison, patients undergoing pituitary surgery did not demonstrate spontaneous osseous closure on postoperative imaging. Human anterior skull base defects do not appear to spontaneously close, even when small, suggesting that there is no "critical size defect" in the human skull base, in contrast to the robust wound healing in animal models of skull convexity and mandibular defects. Free bone grafts incorporate into the skull base over the long-term and may be utilized whenever a rigid skull base reconstruction is desired, regardless of the defect size.

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Ossifying Fibroma Involving Three Quadrants of the Jaws in a Patient With Vitamin D Deficiency

No abstract available

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Aesthetic Lateral Canthoplasty Using Tarso-Conjunctival Advancement Technique

Abstract: Reduced horizontal length of the palpebral fissure is a distinctive characteristic of Asian eyelids, and aesthetic lateral canthal lengthening techniques have been performed for a refinement. The aim of this study is to describe a novel lateral canthoplasty using tarso-conjunctival advancement with a lid margin splitting procedure on the upper eyelids and to report the postoperative results. From December 2011 to June 2014, patients who underwent lateral canthoplasty using the tarso-conjunctival advancement procedure for aesthetic purposes were reviewed retrospectively. The predictor variables were grouped into demographic and operative categories. The primary outcome variables were the distances from the mid-pupillary line to the lateral canthus and the horizontal length of the palpebral aperture (distance from the medial to lateral canthus). Data analyses were performed using descriptive and univariate statistics. Patients who showed increment in objective measurements were considered significant. Aesthetic appearance was also evaluated based on pre- and postoperative clinical photographs. A total of 45 patients were enrolled in this study. Both the distance from the mid-pupil to the lateral canthus (ΔDpupil-lateral; 2.78 ± 0.54 mm, P

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The dangers of parathyroid biopsy

Abstract

Background

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.

Case Presentation

There was clinical suspicion for parathyroid carcinoma, further supported by intra-operative findings. However, the final pathology described a primary hyperceullar parathyroid lesion with pathognomonic changes secondary to fine-needle aspiration (FNA) biopsy, along with a separate parathyroid lesion likely resulting from seeding along the needle tract. Upon further review, record of a remote FNA was discovered. This case highlights the complications associated with parathyroid FNA resulting in a diagnostic challenge and raising the possibility of malignancy.

Conclusions

We therefore recommend to take caution when there is a prior parathyroid FNA, as it can present with the risks of a secondary lesion from seeding and increase resemblance of malignancy both clinically and through pathologic diagnosis.

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

Abstract

Background

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 of HPV in patients with HNSCC may expedite treatment when p16 status is not immediately available.

Methods

Saliva-based DNA collection kits and nested polymerase chain reaction (PCR) were used to determine the HPV status of 62 individuals with biopsy-proven HNSCC. Immunohistochemistry was used to determine tumour p16 status.

Results

A total of 62 patients were included in the study. Twenty-nine samples (47%) were positive for HPV DNA, the majority of which were high risk (HR) subtypes (79%). Patients who tested positive for HR HPV were more likely to have a tumour arising in the oropharynx compared to a non-oropharyngeal site (74 vs 26%; p = 0.003). A positive HR HPV saliva assay was 100% specific (95% CI 59–100%) and had a 100% positive predictive value (95% CI 75–100%) for a p16 positive tumour arising in the oropharynx. In contrast, a negative HR HPV assay had a 96% negative predictive value (95% CI 80–100%) for tumours arising in a non-oropharyngeal site. Independent of site, the saliva assay had a sensitivity of 77% (95% CI 54–91%) and a specificity of 94% (95% CI 77–99%), respectively, for a p16 positive tumour.

Conclusion

We show that a saliva based assay is an effective method for detecting HPV in patients with HNSCC and that a positive HR HPV test is highly specific for p16 positive tumours arising in the oropharynx. This simple and rapid test could be used in cases where a biopsy of the primary tumour is not readily available.

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Clinical factors associated with subclinical spread of in situ melanoma

Subclinical spread of in situ melanoma occurs at a wide frequency, ranging from 12% to 71%.

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Risk of inflammatory bowel disease in patients with rosacea: Results from a nationwide cohort study in Taiwan

A link between rosacea and inflammatory bowel disease (IBD) has been proposed with unknown mechanisms. Epidemiologic evidence of this association needs to be examined.

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Compensated Vestibular Dysfunction Post Cochlear Implantation in Children with Sensorineural Hearing Loss: A Prospective Study

Abstract

Children with sensorineural hearing loss have risk of surgically induced vestibular dysfunction post cochlear implantation due to instrumentation. It is clinically important to estimate the risk of vestibular loss post cochlear implant so the patient can be made fully aware of these risks when considering cochlear implantation. The aim of the study was to identify compensated vestibular dysfunction post cochlear implantation. Vestibular function was evaluated both pre and post CI using monothermal warm air caloric testing. Recordings were made using head band camera on SYNAPSYS Ulmer VNG software. 'Monothermal caloric asymmetry' (MCA) was depicted as 'unilateral weakness' based on the slow phase velocity of nystagmus. MCA of >15% was taken as evidence of canal paresis. The incidence of compensated vestibular dysfunction post CI surgery was found to be 16.66%. The results were statistically significant (p value 0.02) and indicated worsening of canal paresis indicative of vestibular dysfunction. Children for cochlear implantation should undergo evaluation of their vestibular system pre and post surgery. Caution should be exercised before planning bilateral cochlear implantation in the same sitting.

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Underuse of allergy services for patients having systemic reactions to Hymenoptera venom stings

National mortality data in the United States from 1980 to 1999 indicate that serious anaphylactic Hymenoptera sting reactions account for at least 40 deaths each year.1 On the basis of the Internal Classification of Diseases, Ninth Revision coding in emergency departments, this mortality rate may be underestimated.2 Most insect stings result in a transient local reaction that can last several days, and the risk of a systemic reaction in these patients ranges from 5% to 10%.3 Potentially life-threatening systemic reactions to insect stings occur in approximately 0.4% to 0.8% of children and 3% of adults.

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Effect of nasal allergen challenge in allergic rhinitis on mitochondrial function of peripheral blood mononuclear cells

Allergic rhinitis is the most common of the atopic diseases, affecting up to 25% of the population worldwide.1 Grass pollen sensitization has been recognized as a major cause of allergic rhinitis. On the pathophysiologic level, allergic rhinitis is an IgE-mediated inflammation of the nasal mucosa. Grass pollen allergy, commonly called hay fever, can also cause more general symptoms, such as as fatigue and unwellness as seen in flulike syndromes. This might be partly related to the activation of a systemic inflammatory pathway after the local nasal inflammatory response, but data from studies concerning the systemic effects of nasal mucosal allergen exposure are limited.

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Ultrasound-guided transversus abdominis plane block for postoperative analgesia in living liver donors: A prospective, randomized, double-blinded clinical trial

Transversus abdominis plane (TAP) block is a peripheral nerve block that reduces postoperative pain, nausea, vomiting and the need for postoperative opioids following various types of abdominal surgery. The primary aim of the present study was to evaluate the effects of TAP block on postoperative analgesia and opioid consumption in living liver donors in whom a right "J" abdominal incision was used.

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Determination of the diagnostic value of the Modified Mallampati Score, Upper Lip Bite Test and Facial Angle in predicting difficult intubation: A prospective descriptive study

Difficult intubation is a significant cause of mortality and morbidity related to anesthesia. We decided to evaluate the value of Modified Mallampati Score, Upper Lip Bite Test and Facial Angle in the prediction of difficult intubation.

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Effect of monetary incentives on first-case of the day starts

We read with interest the article by Kacmar et al., "Effect of monetary incentives on first-case of the day starts" [1]. The authors state that "we are the first to utilize a simple monetary incentive to motivate anesthesiology faculty to significantly increase operating room (OR) efficiency in a large academic center" [1]. We are uncertain how the authors showed "increased OR efficiency." There are two relevant types of OR efficiency. Allocative efficiency effectively refers to the inefficiency of use of OR time [2–4].

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Perioperative opioid administration in children with and without developmental delay undergoing outpatient dental surgery

Prior research has indicated that children with developmental delay (DD) experience qualitative and quantitative differences in health care (Boulet et al., 2009). In the perioperative setting, there is concern that children with DD may be more likely to experience postoperative complications including agitation and nausea/vomiting than typically developing patients (TDP). Differences in the administration and dosage of perioperative opioids may contribute to this, however, empirical investigations are lacking.

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The concentration of desflurane preventing spectral entropy change during surgical stimulation: A prospective randomized trial

To determine the concentration of desflurane necessary to blunt changes in spectral entropy during surgical incision when two different target-controlled effect-site concentrations of remifentanil (1 and 3ng/ml) were infused.

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Combination of femoral and genitofemoral nerve blocks is effective for endovascular aneurysm repair

Abdominal/thoracic endovascular aneurysm repair (EVAR/TEVAR) is a minimally invasive operation for the repair of abdominal/thoracic aortic aneurysms (AAAs/TAAs). Generally, EVAR/TEVAR is performed under general anesthesia or field block anesthesia of inguinal region [1]. Since field block anesthesia sometimes provides insufficient analgesia, conversion to general anesthesia may be required owing to patient discomfort, anxiety and persistent patient movement. In this report, we present a case in which femoral and genitofemoral nerve blocks were performed for analgesia during EVAR.

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Sinonasal respiratory epithelial adenomatoid hamartoma: An overlooked entity

Publication date: Available online 7 January 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Jeyasakthy Saniasiaya, Norasnieda Md Shukri, Ramiza Ramza Ramli, Wan Nor Najmiyah Wan Abdul Wahab, Norzaliana Zawawi
Respiratory epithelial adenomatoid hamartoma is an unusual benign glandular proliferation arising from the respiratory epithelium mostly involving the posterior nasal septum. Herein, we report a classic presentation of chronic rhinosinusitis with bilateral nasal polyposis which turns out to be respiratory epithelial adenomatoid hamartoma. Albeit benign, awareness of this entity is judicious as it may masquerade a more aggressive lesion causing patients to succumb to unnecessary procedure.

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Modified lateral crural spanning suture of the nasal tip: Suspension element

Publication date: Available online 7 January 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Wael K.A. Hussein, Ahmed S. Ismail, Ahmed A. Ibrahim, Ahmed A. Omran
IntroductionSeveral techniques have been described to improve nasal tip definition, such as cartilage resection, tip grafts, and suture placement. Lateral alar convexities are a common deformity that requires attention during rhinoplasty. The lateral crural spanning suture provides a predictable, accurate method of correcting excess lateral crural convexity without the need for procedures that would compromise the integrity of the cartilage.ObjectivesAiming to achieve the maximum support of the nasal tip and to maintain the position of the tip in a fashion that prevents postoperative droopiness, we have modified the classic lateral crural spanning suture.MethodsA prospective study of 113 patients was conducted over patients presented to our hospital aiming at improving nasal tip definition through modified lateral crural spanning suture.ResultsIn this study, added improved of the nasal tip width and rotation was achieved in all the patients admitted for rhinoplasty.

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TRIM52: A nuclear TRIM protein that positively regulates the nuclear factor-kappa B signaling pathway

Publication date: February 2017
Source:Molecular Immunology, Volume 82
Author(s): Wenchun Fan, Tingting Liu, Xiangmin Li, Yun Zhou, Mengge Wu, Xiaofang Cui, Huanchun Chen, Ping Qian
Emerging evidence suggests that TRIM family proteins play a crucial role in regulating the NF-κB signaling pathway. TRIM52 is a novel noncanonical antiviral TRIM gene with a unique expanded RING domain. Information on the biological function of TRIM52 is limited. Herein, we demonstrated TRIM52 involvement in NF-κB activation. We found that TRIM52 overexpression specifically activated the NF-κB signal. TRIM52 overexpression can significantly induce TNFα and IL-6 expression. We also found that the RING domain of TRIM52 was essential for its activation of the NF-κB signal. Further study showed that TRIM52 overexpression did not affect the protein level of IκBα and phosphorylated p65 protein. We found that the pro-inflammatory cytokines TNFα and IL-6 could induce TRIM52 expression. Overall, these data suggested that TRIM52 was a positive regulator of the NF-κB pathway.

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TRAIL facilitates cytokine expression and macrophage migration during hypoxia/reoxygenation via ER stress-dependent NF-κB pathway

Publication date: February 2017
Source:Molecular Immunology, Volume 82
Author(s): Yinan Jiang, Xiaoyan Chen, Mengya Fan, Hui Li, Weina Zhu, Xi Chen, Chenghua Cao, Rui Xu, Yaohui Wang, Yuanfang Ma
Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), which is known as a key molecule to induce cancer cell apoptosis, has also been found to participate in the process of ischemia/reperfusion (I/R) injury. Infiltrated macrophages play dual roles in inflammatory injury and healing following I/R. Whether TRAIL has any effect on macrophages during this process remains elusive. Here we showed that I/R triggered the expressions of TRAIL, DR5 and cytokines (IL-1β, TNFα, CCL-2 and ICAM-1), in addition to macrophage infiltration, which could be abolished by TRAIL neutralizing antibody. In vitro, TRAIL enhanced DR5 expression and facilitated the macrophages migration following hypoxia/reoxygenation (H/R) treatment in a dose-dependent manner via ER stress and NF-κB signaling pathways, which is accompanied by inflammatory factors expression. The increased cytokines production (such as TNFα and IL-1β) stimulated by TRAIL can be blocked by the NF-κB and ER stress inhibitor. The results also suggested that NF-κB activation of macrophages during H/R was regulated by ER stress. Thus, our research present that TRAIL affects functional activities of macrophages during I/R injury, which may be a potential therapeutic target for ischemic heart disease.

http://ift.tt/2j2RPBV

Risque accru de cardiopathie ischémique et de mortalité cardiovasculaire chez les personnes atteintes de maladie de Verneuil (hidradénite suppurée)

Publication date: Available online 6 January 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Maruani, B. Giraudeau, I. Abdo, P. Raphaël

http://ift.tt/2i4pcFN

Enzyme activities in parotid saliva of patients with the restrictive type of anorexia nervosa

Publication date: April 2017
Source:Archives of Oral Biology, Volume 76
Author(s): Elzbieta Paszynska, Agnieszka Slopien, Monika Dmitrzak-Weglarz, Christian Hannig
ObjectiveIn patients with anorexia nervosa (AN) specific signs may occur in the oral cavity, but there are conflicting reports about their significance, especially concerning changes in salivary composition.The aim of this clinical study was to evaluate the resting parotid flow rate (PFR) and the activity of the following enzymes in parotid saliva: amylase, aspartate amino transferase (AST), lysozyme, peroxidase, serine and acidic proteases in the acute phase of the restrictive type of AN and to compare the findings with those in healthy controls.DesignForty-one subjects participated (20 patients with AN, 21 matched healthy controls), parotid saliva was collected using a modified Lashley cap at rest. Enzyme activities were measured with fluorimetric and photometric assays.ResultsThe unstimulated PFR was significantly lower than in the controls, lysozyme and AST activity was significantly lower, and amylase showed a high inter-individual variability. A positive correlation for amylase and lysozyme and negative ones for lysozyme and BMI, lysozyme and IBW%, serine protease and salivary flow were observed.ConclusionsThe reduced PFR and enzyme activities levels suggest that AN does not only affect the quantity of the saliva but also its quality and, its biological functions. The results obtained should help to provide a better understanding of the effect of AN disease on the pathogenesis of at least some oral diseases. Further research is needed on any possible role of reduced lysozyme and transaminase activity in maintaining oral protection against external toxic agents and bacteria.

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Rs12941170 at SOX9 gene associated with orofacial clefts in Chinese

Publication date: April 2017
Source:Archives of Oral Biology, Volume 76
Author(s): Zhong-Lin Jia, Sha He, Shu-Yuan Jiang, Bi-He Zhang, Shi-Jun Duan, Jia-Yu Shi, Ning Huang, Wen-Chao Zhu, Bing Shi
ObjectiveNon-syndromic orofacial cleftings (NSOCs) are considered as complex trait, which results from genetic and/or environmental modifiers. Current findings could only explain small portion of the NSOCs. SOX9 gene plays an important role during craniofacial development in animal models and the Pierre Robin sequence (PRS). However, its role in non-syndromic clefts remains unknown.DesignIn this study, we selected eight SNPs in and around SOX9 gene to make maximum coverage, and genotyped them by using RFLP-PCR and ligase detection reaction (LDR) methods to test its associations among 151 NSOCs (53 NSCLP, 52 NSCLO and 46 NSCPO) from Western Han Chinese population.ResultsAllelic TDT results showed that G allele at rs12941170 of SOX9 was under-transmitted among NSOCs (p=0.00014, OR=0.55 and 95%CI: 0.40–0.75), which could indicate that the G allele is protective against NSOCs; parent-of-origin effect analysis showed that G allele at rs12941170 was maternally under-transmitted (p=0.002), while there was no statistically difference between the maternal and paternal transmission of it. To test if the adjacent SNPs travel together from parents to the affected individual, we carried out the sliding window haplotype analysis, it is interesting to find that the haplotypes carrying the G allele at rs12941170 also was under-transmitted for NSOCs, NSCL/P, NSCLP and NSCPO (lowest p=0.00033).ConclusionsThis study suggested that G allele at rs12941170 was protective, which could decrease the risk for NSOCs from Western Han Chinese population, and it will provide new reference for future research and genetic counseling in NSOCs.

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Genetic polymorphism of interleukin-10 (-A592C) among oral cancer with squamous cell carcinoma

Publication date: Available online 7 January 2017
Source:Archives of Oral Biology
Author(s): Prithvi Kumar Singh, Mohammad Kaleem Ahmad, Vijay Kumar, Rajni Gupta, Monica Kohli, Amita Jain, Abbas Ali Mahdi, Jaishri Bogra, Girish Chandra
ObjectiveInterleukin-10 (IL-10) is a pleiotropic cytokine with either immunosuppressive or immunostimulative activities. It has been reported that in cancer, the promoter region polymorphism of IL-10 (-A592C) alters both the expression and serum levels of this cytokine. In the present study, we have addressed the question as to whether the single nucleotide polymorphisms (SNPs) at positions −592A/C in the IL-10 gene promoter, could predispose an individual to oral squamous cell carcinoma (OSCC).DesignWe analyzed the genotype of the IL-10 (-A592C) gene, in 250 histopathologically confirmed OSCC patients and similar number of healthy volunteers taken as controls, in an Indian population by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Allele and genotype frequencies were analyzed by the Student's t-test and the chi-squared test, and strength of associations by the odds ratio (OR) with 95% confidence intervals.ResultsThe genotype and allele distribution of IL-10 (-A592C) gene polymorphism was significantly different between OSCC cases and controls (genotype AA vs AC: OR 2.87; 95 % CI 1.50–5.48; p=0.0016 and AA vs CC: OR 4.08; 95 % CI 1.98–8.41; p=0.0002). The -592 C alleles were found to be significantly different among OSCC cases and controls (OR: 1.44, 95% CI: 1.12–1.85, p<0.0051).ConclusionsThe IL-10 gene promoter region (-592) A/C polymorphism is significantly associated with reduced risk of OSCC. The OSCC group had a significantly greater frequency of genotype AA as compared to control group.

http://ift.tt/2j2k9Ep

Enzyme activities in parotid saliva of patients with the restrictive type of anorexia nervosa

Rs12941170 at SOX9 gene associated with orofacial clefts in Chinese

Genetic polymorphism of interleukin-10 (-A592C) among oral cancer with squamous cell carcinoma

Local extension staging of sinonasal tumors: retrospective comparison between CT/MRI assessment and pathological findings

Abstract

Objectives

To assess the reliability of clinical staging with CT and MRI in sinonasal cancers.

Methods

We conducted a retrospective review of patients who underwent surgery for a sinonasal cancer. The 7^th edition of the TNM classification was used to establish tumor staging. Standardized preoperative CT/MRI staging was compared with the pathological staging based on specimens obtained during surgery from each subsite within and around the tumor.

Results

We analyzed data from 68 patients between January 2010 and December 2014. A comparison of cT and pT stages was established for 49 naso-ethmoidal and 16 maxillary tumors. Clinical staging for naso-ethmoidal cT1 and maxillary cT2 was consistent with pathological results. Clinical staging for naso-ethmoidal cT2, cT3 and cT4b was overstated in comparison with pT findings. The positive predictive value of imaging was less than 65% for the lamina papyracea, the cribriform plate, the dura, and the frontal and sphenoid sinuses. Sensitivity was over 75% for each anatomical site except for the cribriform plate (73.3%) and the sphenoid sinus (57.2%).

Conclusion

Systematic pathologic analysis of the anatomical areas around the sinonasal cancer has to be applied in further studies to improve our therapeutic management. CT/MRI mapping cannot replace accurate assessment of tumor extension during surgery.

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Race is associated with differences in airway inflammation in patients with asthma

Publication date: Available online 6 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Sharmilee M. Nyenhuis, Jerry A. Krishnan, Alalia Berry, William J. Calhoun, Vernon M. Chinchilli, Linda Engle, Nicole Grossman, Fernando Holguin, Elliot Israel, Rick A. Kittles, Monica Kraft, Stephen C. Lazarus, Erik B. Lehman, David T. Mauger, James N. Moy, Stephen P. Peters, Wanda Phipatanakul, Lewis J. Smith, Kaharu Sumino, Stanley J. Szefler, Michael E. Wechsler, Sally Wenzel, Steven R. White, Steven J. Ackerman
BackgroundAfrican American subjects have a greater burden from asthma compared with white subjects. Whether the pattern of airway inflammation differs between African American and white subjects is unclear.ObjectiveWe sought to compare sputum airway inflammatory phenotypes of African American and white subjects treated or not with inhaled corticosteroids (ICSs; ICS+ and ICS−, respectively).MethodsWe performed a secondary analysis of self-identified African American and white subjects with asthma enrolled in clinical trials conducted by the National Heart, Lung, and Blood Institute–sponsored Asthma Clinical Research Network and AsthmaNet. Demographics, clinical characteristics, and sputum cytology after sputum induction were examined. We used a sputum eosinophil 2% cut point to define subjects with either an eosinophilic (≥2%) or noneosinophilic (<2%) inflammatory phenotype.ResultsAmong 1018 participants, African American subjects (n = 264) had a lower FEV1 percent predicted (80% vs 85%, P < .01), greater total IgE levels (197 vs 120 IU/mL, P < .01), and a greater proportion with uncontrolled asthma (43% vs 28%, P < .01) compared with white subjects (n = 754). There were 922 subjects in the ICS+ group (248 African American and 674 white subjects) and 298 subjects in the ICS− group (49 African American and 249 white subjects). Eosinophilic airway inflammation was not significantly different between African American and white subjects in either group (percentage with eosinophilic phenotype: ICS+ group: 19% vs 16%, P = .28; ICS− group: 39% vs 35%, P = .65; respectively). However, when adjusted for confounding factors, African American subjects were more likely to exhibit eosinophilic airway inflammation than white subjects in the ICS+ group (odds ratio, 1.58; 95% CI, 1.01-2.48; P = .046) but not in the ICS− group (P = .984).ConclusionAfrican American subjects exhibit greater eosinophilic airway inflammation, which might explain the greater asthma burden in this population.

http://ift.tt/2jeNP0p

Impaired NK cell functions in patients with STAT1 gain-of-function mutations

Publication date: Available online 6 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Giovanna Tabellini, Donatella Vairo, Omar Scomodon, Nicola Tamassia, Rosalba Monica Ferraro, Ornella Patrizi, Sara Gasperini, Annarosa Soresina, Giuliana Giardino, Claudio Pignata, Vassilios Lougaris, Alessandro Plebani, Laura Dotta, Marco A. Cassatella, Silvia Parolini, Raffaele Badolato
BackgroundGain-of-function (GOF) mutations affecting the coiled-coil domain or the DNA-binding domain of the Signal Transducer and Activator of Transcription 1 (STAT1) cause chronic mucocutaneous candidiasis disease (CMCD). This condition is characterized by fungal and bacterial infections due to impaired generation of Th17 cells; meanwhile some CMCD patients may also develop viral or intracellular pathogens infections.ObjectiveTo Investigate the effect of GOF-STAT1 mutations on functioning of Natural Killer (NK) cells.MethodsSince STAT1 is involved in the signaling response to several cytokines, we studied NK cell functional activities and STAT1 signaling in eight patients with STAT1-GOF mutations.ResultsFunctional analysis of NK cells shows a significant impairment of cytolytic and degranulation activities in patients with STAT1-GOF mutations. Moreover, NK cells from these patients display lower production of IFN-γ in response to IL-15 and reduced proliferation after stimulation with IL-2 or IL-15, suggesting that STAT5 signaling is affected. In addition, signaling studies demonstrate that the increased phosphorylation of STAT1 in response to IFN-α is associated with detectable activation of STAT1 and increased STAT1 binding to IFIT1 promoter in response to IL-15, while STAT5 phosphorylation and DNA binding to IL2RA are reduced or not affected in response to the same cytokine.ConclusionThese observations suggest that persistent activation of STAT1 might affect NK cell proliferation and functional activities.

Teaser

Gain-of-function (GOF) mutations of the Signal Transducer and Activator of Transcription 1 (STAT1) resulting in increased phosphorylation of the protein lead to chronic mucocutaneous candidiasis disease (CMCD). Abnormal signaling of STAT1 results in impaired response of NK cells to IL-15, leading to defects of proliferation, IFN-γ production and cytolytic activity that may contribute to the increased susceptibility of patients with STAT1-GOF mutations to viruses and intracellular pathogens.

http://ift.tt/2i0xm3I

Alolateropexy for management of droopy nose

Abstract

The surgical management of droopy nose remains problematic. Corrective techniques described in the literature¹ may be difficult to perform or sometimes lead to unsatisfactory results. Dome sutures or grafts such as columellar strut often give good initial results but may deteriorate over time ^{2, 3}.

http://ift.tt/2i3PN64

Single sided deafness affects language and auditory development – a case control study

Abstract

Objectives

To examine auditory, linguistic and cognitive outcomes of children with single sided deafness (SSD). An increasing body of research suggests that children with SSD lag behind with respect to their normal hearing (NH) peers. In the present study we tap into certain developmental skills.

Design

Case–control study.

Participants

21 children with SSD between 5 and 15 years of age participated. Per child with SSD two NH control children were matched on age and gender.

Outcome measures

Morphology, syntax and vocabulary were examined and performance was assessed in depth by focusing on sub skills and type of errors made. Furthermore, tests of short term and working memory were conducted and aspects of hearing disability were assessed by means of the speech spatial and qualities of hearing questionnaire (SSQ).

Main results

The children with SSD lagged behind in their scores on the three language tests and showed some differences to the NH group concerning type of errors and difficulty of the several subskills. Furthermore, scores on the SSQ indicated that in daily life, the children with SSD experience problems in spatial hearing and in understanding speech in noisy situations, and that the effort they have to put into listening and in understanding speech is considerably greater than in NH children.

Conclusions

The present study showed differences between children with SSD and NH children on several language skills and on auditory behavior. Possibly, early intervention could prevent such language difficulties and minimize problems with spatial hearing and speech understanding.

http://ift.tt/2jeMx5C

Glycine decarboxylase and HIF-1α expression are negative prognostic factors in primary resected early-stage non-small cell lung cancer

Abstract

Glycine decarboxylase (GLDC) was recently described as a critical enzyme of tumor-initiating cells and, thus, a driver of tumorigenesis in lung non-small cell cancer (NSCC). It is important in metabolism under hypoxic conditions. Hypoxia-inducible factor 1-alpha (HIF-1α) is the unique subunit that determines HIF system activity, thereby regulating the adverse effects of hypoxia on cancer outcome. We examined the expression and prognostic significance of GLDC and HIF-1α in primary resected stage I/II NSCC. Immunohistochemistry for GLDC and HIF-1α was validated on two lung NSCC cell lines (A549, NCI-H460) and evaluated on a tissue microarray with 428 lung NSCC: 184 adenocarcinomas, 211 squamous cell carcinomas, and 33 large cell carcinomas (LCC). The results were correlated with clinico-pathological parameters. High levels of GLDC expression were detected in 33/428 cases (7.7%). HIF-1α was expressed in 71 (16.6%) cases and more frequently in squamous cell carcinoma (p < 0.001). Significantly longer survival was seen in younger patients (p = 0.007), patients with non-LCC histology (p = 0.006), lower primary tumor category (p = 0.002), and Union for International Cancer Control (UICC) stage (p = 0.001). Both GLDC and HIF-1α were significantly associated with worse tumor-related survival (p = 0.013, p = 0.021, respectively), although not independent from each other in multivariate models. The combination of low-GLDC/negative HIF-1α expression was significantly prognostic for longer survival (p = 0.002) and emerged as an independent prognostic factor in multivariate analysis (p = 0.007, HR 2.052), next to UICC stage and age. We show that the combination of GLDC and HIF-1α expression is an independent prognostic factor in early-stage NSCC. Our results will assist future development of therapeutic approaches targeting GLDC or exploiting tumor hypoxia.

http://ift.tt/2jeCRb3

Reply to letter to the editor regarding: Idiopathic gingival papillokeratosis with crypt formation; a report of 7 cases of a previously undescribed entity

Publication date: Available online 6 January 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Vikki Noonan

http://ift.tt/2i3AQkq