Cervical plexus block for perioperative analgesia during the cervical spine surgery

Cervical plexus block (CPB) is an effective option for perioperative analgesia for cervical spine surgery [1,2]. Here, we present two cases in which CPB was used during cervical surgery.

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Blocking of multiple posterior branches of cervical nerves using a cervical interfascial plane block

Many posterior branches of cervical nerves dominate the thoracodorsal region. Many posterior branches of cervical nerve run through the space (cervical interfascial plane: CIP) between the multifidus and longissimus muscles at the cervix. We describe a case in which the thoracodorsal region was blocked by injection of a local anesthetic in the CIP by a procedure called the CIP block.

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Transcatheter aortic valve implantation performed with a PECS block and a TTP block

Transcatheter aortic valve implantation (TAVI) for the severe aortic stenosis has unacceptably high estimated surgical risk [1]. In addition, the TAVI may be able to perform earlier rising compared to aortic valve replacement (AVR). However, it is difficult to manage the associated perioperative pain because the Transapical transcatheter aortic valve implantation (TA-TAVI) is through an intercostal thoracotomy and the patients often experience severe pain. In addition, it is difficult to perform the neuraxial anesthesia such as an epidural anesthesia for the patients during the perioperative period.

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Treatment of ventilation failure after tracheal intubation due to asthma attack with high concentration sevoflurane

Asthma involves chronic inflammation of the airways, with reversible airflow obstruction and enhanced bronchial reactivity, and asthma attacks can occasionally occur during the perioperative period. Here, we report a case of severe asthma attack after tracheal intubation, leading to impossible ventilation, which was relieved by high concentration sevoflurane inhalation.

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Comparison between dexmedetomidine and verapamil as an adjuvant to local anesthesia in intravenous regional anesthesia in upper limb orthopedic surgery: a randomized double-blind prospective study

Medhat M Messseha Gerges

Ain-Shams Journal of Anaesthesiology 2016 9(4):576-583

Background The use of intravenous regional anesthesia has increased significantly in recent years. Adjuvants are frequently added to local anesthetics to prolong analgesia following peripheral nerve blockade. Objective This randomized double-blind prospective study was designed to compare the effectiveness of adding dexmedetomidine (α2 adrenoceptor agonist) or verapamil (calcium channel antagonist) as an adjunct to lidocaine in upper limb orthopedic surgery. Patients and methods Sixty adult patients scheduled for elective upper limb orthopedic surgery were divided into three groups: the lidocaine group, in which patients received 3 mg/kg of lidocaine 2% diluted with saline to a total volume of 40 ml; the lidocaine dexmedetomidine group, in which patients received 0.5 µg/kg of dexmedetomidine plus 3 mg/kg of lidocaine 2%; and the lidocaine verapamil group, in which patients received 2.5 mg of verapamil plus 3 mg/kg of lidocaine 2%. The onset and duration of sensory and motor block were recorded. Postoperative Visual Analog Score, onset of tourniquet pain, duration of analgesia, and total analgesic requirements at the 12th postoperative hour were monitored. Results Adding dexmedetomidine or verapamil to lidocaine causes faster onset and prolonged recovery of sensory and motor block and improvement of postoperative analgesia, without causing side effects compared with lidocaine alone. Conclusion The use of either verapamil or dexmedetomidine as an adjuvant to lidocaine solution causes equal improvement of the quality of anesthesia in intravenous regional anesthesia of upper limb orthopedic surgeries.

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Addition of dexamethasone–chlorpheniramine mixture reduces the incidence of vomiting associated with oral ketamine premedication after pediatric dental procedures

Ayman A Abdellatif, Manal M Kamal, Rania A.H. Ishak

Ain-Shams Journal of Anaesthesiology 2016 9(4):478-484

Background Oral ketamine has been shown to induce safe and effective sedation in children, but with a high incidence of postoperative vomiting. Vendexine (dexamethasone–chlorpheniramine mixture) is a commercially available syrup used primarily to treat allergic conditions. Each of its components has antiemetic effects. In the present study, we aimed to determine whether the addition of vendexine to oral ketamine premedication affects the incidence of postoperative vomiting. Patients and methods Sixty-four children scheduled for elective dental procedures under general anesthesia were enrolled in this prospective, randomized, double-blind study. They received an oral premedication mixture (total volume of 0.42 ml/kg) of either ketamine 6 mg/kg (0.12 ml/kg) mixed with dextrose 50% and apple juice (the K group), or ketamine 6 mg/kg (0.12 ml/kg) mixed with dextrose 50% and vendexine syrup (0.25 ml/kg) (the VK group). Sedation onset was noted. Scores for drug acceptance, sedation, emotional status, and behavior during parents' separation, on venipuncture, and face mask application were rated. Incidence of postoperative vomiting, emergence agitation score, fentanyl consumption, and recovery time were also recorded. Results The two groups were comparable as regards sedation onset, scores for drug acceptance, sedation, emotional status, and behavior during parents' separation, on venipuncture, and face mask application. However, a significant reduction of postoperative vomiting in the VK group was noticed compared with the K group (9.3 vs. 37.5%). In addition, emergence agitation and fentanyl consumption were significantly reduced in the VK group. Conclusion Vendexine added to oral ketamine reduces the incidence of postoperative vomiting associated with ketamine premedication in children.

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Severe pre-eclampsia masquerading as peripartum cardiomyopathy in an emergency cesarean section: a challenge to the perioperative physician

Vishal K Pai, Mridul Dhar, Anil P Singh, Atchya A Kumar

Ain-Shams Journal of Anaesthesiology 2016 9(4):623-625

Peripartum cardiomyopathy (PPCM) is a rare and unusual form of cardiac failure of unknown etiology that is observed in late pregnancy or early postpartum. Although the complete pathogenesis of PPCM is not completely understood, the signs and symptoms are similar to those of left-ventricular heart failure. PPCM is diagnosed in a parturient woman only after other causes of cardiac failure have been ruled out. Its management is similar to that of congestive heart failure. This report describes the role of an anesthesiologist in the postoperative management of a parturient woman who was admitted with severe preeclampsia and developed pulmonary edema and heart failure in the postoperative period necessitating management in the ICU. Subsequently, PPCM was diagnosed and managed successfully. The diagnosis of PPCM is challenging and requires a high index of suspicion by the perioperative physician. Routine medical management in the form of digoxin, diuretics, vasodilators, β-blockers, and anticoagulants should be the first step but may also require vasoactive drugs and circulatory support. Future pregnancies are generally avoided in such patients.

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Dexmedetomidine infusion versus fentanyl for analgesia and prevention of emergence agitation and delirium in children undergoing adenotonsillectomy

Sanaa M Elfawal, Abeer M Eldeek, Manal M Kamal

Ain-Shams Journal of Anaesthesiology 2016 9(4):485-492

Background This randomized controlled study aimed to evaluate whether an intraoperative infusion of dexmedetomidine would be a safe and effective substitute to fentanyl intraoperatively, and whether it would be effective in reducing the incidence and severity of emergence agitation and delirium in children undergoing adenotonsillectomy. Patients and methods This study was conducted on 70 pediatric patients, aged 3–7 years, of both sexes, of ASA I and II, who were scheduled for elective adenotonsillectomy. The patients were randomly assigned to two groups: group D (dexmedetomidine infusion group; 35 patients) received intravenous dexmedetomidine (2 μg/kg) over 10 min, followed by 0.7 μg/kg/h until 5 min before the end of the surgery, and group F (intravenous fentanyl group; 35 patients) received intravenous fentanyl 1 μg/kg as a bolus. No premedication was given to any of the patients. The number of patients in each group who needed intraoperative fentanyl, the fentanyl dose, time of administration of fentanyl, duration of surgery and anesthesia, and the time to awakening were recorded. Pain was evaluated using the objective pain scale score in the postanesthesia care unit (PACU), which was managed with rescue intravenous pethidine. Emergence agitation was evaluated in the PACU using two scales: the Pediatric Anesthesia Emergence Delirium scale and the five-point agitation scale described by Cole. Results The time to awakening in group D was significantly shorter compared with that in group F (P<0.05). Group D showed a statistically significantly lower maximum objective pain scale score, lower Pediatric Anesthesia Emergence Delirium score, and lower emergence agitation score compared with group F at arrival at the PACU. There was no statistically significant difference between the two groups as regards preoperative heart rate, but there was significantly lower heart rate in group D than in group F after induction (P<0.05). No side effects were observed during the first 24 h postoperatively in the two groups. Conclusion Dexmedetomidine is a safe and effective analgesic substitute to fentanyl intraoperatively and reduces analgesic requirements postoperatively. It is also effective in reducing the incidence and severity of emergence agitation and delirium in children undergoing adenotonsillectomy.

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Control of autonomic dysreflexia in patients with high level of chronic spinal cord injury during cystoscopy

Ibrahim A Nasr, Khaled M Elnaghy

Ain-Shams Journal of Anaesthesiology 2016 9(4):606-611

Background Autonomic dysreflexia (AD) is a clinical emergency that frequently occurs in patients with spinal cord injury (SCI) during cystoscopy. It should be treated by removing the stimulus and by medications. We aimed in this study to evaluate the effect of adding magnesium sulfate to dexmedetomidine infusion to control AD in high-level chronic SCI patients during cystoscopy. Patients and methods Forty patients with chronic SCI at the level of T6 or above scheduled for cystoscopy were randomly divided into two groups: the dex group, in which the patients received dexmedetomidine infusion 1 µg/kg for 10 min, followed by 0.5 µg/kg/min; and the Mg group, in which patients received a single i.v. dose of magnesium sulfate 50 mg/kg in addition to the same infusion of dexmedetomidine. Blood pressure (BP) and heart rate (HR) were recorded for each patient, and serum magnesium, epinephrine, and norepinephrine levels were estimated preoperatively, intraoperatively, and postoperatively. Results Results showed a significant elevation in intraoperative BP in the Dex group 10 min after cystoscopy and persisted for 20 min compared with the presedation level in the same group and with the same readings in the Mg group. HR dropped down in the Dex group 15 min after cystoscopy and persisted for 15 min compared with the presedation reading in the same group and with the same readings in the Mg group. Serum magnesium was significantly higher intraoperatively and postoperatively in the Mg group, whereas serum epinephrine and serum norepinephrine were significantly higher intraoperatively and postoperatively in the Dex group compared with the presedation level in the same group and with the same readings in the Mg group. Seven patients (35%) in the Dex group experienced a dysreflexic episode [increase in systolic blood pressure (SBP) 30 mmHg or more compared with the presedation reading]; two of them showed elevation of SBP more than 160 mmHg and needed to be treated. On the other hand, only one patient in the Mg group (5%) experienced a dysreflexic episode (SBP 135 mmHg) with no need for medication. Conclusion Addition of a single i.v. dose of magnesium sulfate to dexmedetomidine infusion provides a better control of BP and HR, and reduces the incidence of AD during cystoscopy in patients with high level of chronic SCI.

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Comparison of caudal epidural clonidine with fentanyl as an adjuvant to ropivacaine 0.25% for postoperative analgesia in children undergoing various infraumbilical surgeries: A prospective randomized study

Sudheendra Saini, Veena Patodi, Surendra K Sethi, Neena Jain, Pooja Mathur, Beena Thada

Ain-Shams Journal of Anaesthesiology 2016 9(4):493-500

Background Caudal epidural block is commonly used as a safe, reliable, easy-to-administer technique for abdominal and lower limb surgeries in pediatric patients and allows rapid recovery from anesthesia with effective postoperative analgesia. The aim of our study was to compare the efficacy of clonidine versus fentanyl when used as an additive to ropivacaine during single-shot caudal epidural analgesia in pediatric patients for postoperative pain relief. Patients and methods This randomized prospective double-blind study was conducted on 60 children of American Society of Anesthesiologists grades I and II aged 1–7 years scheduled for various infraumbilical surgical procedures who were randomly allocated into two groups to receive either ropivacaine (0.25%, 1 ml/kg) and clonidine (2 μg/kg) (group RC) or ropivacaine (0.25%, 1 ml/kg) and fentanyl (1 μg/kg) (group RF). Caudal epidural block was performed after induction of general anesthesia. Postoperatively, patients were observed for duration of analgesia, sedation score, recovery time, hemodynamics, and side effects or complications. Results Both groups were similar with respect to patient's demographic profile, baseline hemodynamic parameters, and duration of surgery. The analgesic properties and hemodynamics were also comparable in both groups (P>0.05). The mean recovery time and sedation score were significantly lower in group RC as compared with group RF (P<0.05). Side effects such as nausea, vomiting, and respiratory depression were seen only in group RF. Conclusion From our study we concluded that both clonidine (2 μg/kg) and fentanyl (1 μg/kg) can be used as an adjuvant to single-shot caudal epidural anesthesia using 0.25% ropivacaine for effective postoperative analgesia in children. Because of its more favorable side-effect profile, with less respiratory depression, nausea, vomiting, and more patient comfort, clonidine is a better choice for use as an adjuvant to caudal epidural anesthesia in children.

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Monitored anesthesia care with propofol or dexmedetomidine for patients undergoing upper limb surgeries under brachial plexus blockade: a comparative study

Kumkum Gupta, Vasundhra Tyagi, Prashant K Gupta, Bhawana Rastogi, Manish Jain, Manoranjan Bansal

Ain-Shams Journal of Anaesthesiology 2016 9(4):563-568

Background Brachial plexus block is widely used for upper limb surgeries but intraoperatively patients remain aware. The present study aimed to compare the sedative efficacy and safety of propofol infusion versus dexmedetomidine infusion for monitored anesthesia care during upper limb surgeries under ultrasound (US)-guided brachial plexus blockade. Patients and methods Sixty adult consented patients of American Society of Anesthesiologists physical status I–III of both sexes were given 20 ml of 0.75% ropivacaine (150 mg) for brachial plexus blockade under US guidance. The patients were randomized into two groups of 30 patients each, to receive either propofol infusion [group I (P)] or dexmedetomidine infusion [group II (D)] during the intraoperative period. The primary goals were to achieve a sedation score of 2–3 on the Ramsay sedation scale and to compare the duration of postoperative analgesia assessed using the visual analog scale. The hemodynamic stability, respiratory depression, or any complication due to technique or medications was also recorded as secondary outcomes. Results US guidance helped visualization of the nerves, the needle, and the spread of local anesthetic at the brachial plexus block site. Desired sedation score of 2–3 was effectively achieved with intraoperative infusions of dexmedetomidine and propofol. Hypotension occurred in 11 patients of the propofol group, whereas no episode of hypotension was noted in the dexmedetomidine group. Bradycardia was evident in five patients of the dexmedetomidine group. The duration of postoperative analgesia with dexmedetomidine infusion was significantly prolonged when compared with propofol infusion as assessed using visual analog scale. Respiratory depression did not occur in any patient. No adverse events inherent to sedative medication or technique were observed in any patient. Conclusion The clinical efficacy and safety of dexmedetomidine was better than propofol due to prolonged postoperative analgesia and intraoperative hemodynamic stability without respiratory depression.

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Patient-controlled analgesia versus patient-controlled analgesia by proxy for the management of postoperative pain in major pediatric cancer surgery

Essam Mahran, Ahmed H Abou El-Soud, Ahmed S Ragab, Fatma H Elshamy

Ain-Shams Journal of Anaesthesiology 2016 9(4):501-507

Background Children suffer postoperative pain in the same way as adults. Pediatric pain management is a challenge. Patient-controlled analgesia (PCA) is a flexible, reliable, and individualized method in postoperative pain therapy. However, young children are not able to use PCA themselves, and hence they need to receive PCA by proxy (parent or nurse). The guidelines for PCA by proxy in pediatrics are still insufficient. Aim The aim of this study was to determine the safety and efficacy of PCA by proxy after major pediatric cancer surgery. Patients and methods We studied 330 pediatric cancer patients between 1 and 10 years of age scheduled for major surgery. They were divided into three equal groups: group C (child PCA), group P (parent proxy), and group N (nurse proxy). In each group we measured vital signs, pain intensity, total morphine consumption, side effects, and specific PCA monitoring for the first 72 h postoperatively. Results We found that pain scores were higher in the nurse group compared with the other two groups on days 2 and 3 (P < 0.001); morphine consumption was higher in the child group (older age). Vital signs were comparable between groups. There were no significant differences in sedation scale, and there were limited complications with no difference between groups. Conclusion Parent-controlled PCA is a safe and effective method of analgesia for children between 1 and 6 years of age. Nurse-controlled proxy is safe but not effective in controlling child pain. Child-controlled analgesia is safe and effective in children above 6 years of age.

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Preoperative external nasal compression: does it decrease emergence agitation after nasal surgery?

Ayman Kasem, Ashraf Abdelkader

Ain-Shams Journal of Anaesthesiology 2016 9(4):593-597

Background Emergence agitation after nasal surgeries in adults is common. Acute postoperative nasal obstruction with nasal packing is an important factor in developing agitation after nasal surgeries. Aim The aim of this study was to evaluate the effectiveness of preoperative nasal obstruction by means of external nasal compression on the incidence of emergence agitation after nasal surgeries. Methods Sixty patients of American Society of Anesthesiologists I or II between 20 and 45 years of age who were scheduled for nasal surgery were randomly assigned into three equal groups: the control (C) group, the T10 group, in which nasal compression was carried out for 10 min, and the T30 group, in which nasal compression was carried out for 30 min preoperatively. All patients received the same anesthetic technique. The incidence of agitation, and recovery characteristics were evaluated during emergence. Patient satisfaction was evaluated 24 h after surgery. Results There was a significantly lower incidence of emergence agitation and fentanyl consumption during the emergence period in the T30 group. Moreover, patient satisfaction with recovery was significantly higher in the T30 group. Conclusion Elective preoperative external nasal obstruction may decrease the incidence of emergence agitation and improve patient satisfaction with recovery after nasal surgery.

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Lidocaine versus dexmedetomidine infusion in diagnostic laparoscopic gynecologic surgery: a comparative study

Sherif G Anis, Ghada M Samir, Heba B ElSerwi

Ain-Shams Journal of Anaesthesiology 2016 9(4):508-516

Background The aim of this study was to assess the effectiveness of intraoperative lidocaine versus dexmedetomidine infusion on hemodynamic stability during pneumoperitoneum, as well as the recovery profile of diagnostic laparoscopic gynecologic surgeries. Patients and methods A total of 60 female patients of American Society of Anesthesiologist (ASA) physical status I were included in the study and divided into two groups: group L and group D. Group L received lidocaine hydrochloride 2%, and group D received dexmedetomidine hydrochloride. The hemodynamic changes during pneumoperitoneum as well as the recovery profile (postoperative sedation, pain scores, and analgesic requirements) were recorded. Results During pneumoperitoneum, group D patients showed a statistically significant decrease in mean heart rate compared with group L patients. However, the mean systolic blood pressure, diastolic blood pressure, and mean blood pressure in group L patients showed statistically and clinically nonsignificant changes compared with those of group D patients. As regards the recovery profile, group D patients recorded a significantly higher median sedation score compared with group L patients, and the postoperative pain scores were significantly better in group L than in group D patients after 30 min, 1 h from arrival at the postanesthesia care unit, and at 2 h in the ward. However, this resulted in a statistically nonsignificant number of patients requiring pethidine in the postanesthesia care unit, as well as statistically nonsignificant total pethidine requirements of less than 50 mg. Conclusion Lidocaine offers hemodynamic stability during pneumoperitoneum, as well as a decrease in the intensity of postoperative pain with opioid sparing, offering a less sedated patient than dexmedetomidine during day-case diagnostic laparoscopic gynecologic surgery.

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A case report of asystole after a test dose of ceftriaxone in an adult man

Sawsan Aboul-Fotouh, Yosra M Magdy, Rania M Ali

Ain-Shams Journal of Anaesthesiology 2016 9(4):617-619

Ceftriaxone is a commonly used antibiotic for various infections such as respiratory tract infection, urinary tract infection, and enteric fever, as well as in surgical prophylaxis. Hypersensitivity reactions after ceftriaxone therapy are uncommon but are potentially life-threatening, and they may lead to cardiac arrest. Here we report a 44-year-old man who presented with bradycardia, bronchospasm, hypotension, and cardiac arrest (asystole) after a single injected dose of ceftriaxone introduced for surgical prophylaxis. Epinephrine was given intravenously, and cardiopulmonary resuscitation was performed successfully. The patient regained his conscious level 2 h later and became hemodynamically stable within 4 h; next, he was extubated and closely observed for 24 h and then discharged. Physicians should be aware of the risk of anaphylaxis and asystole that may occur after the first dose of ceftriaxone and be ready for managing it properly.

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Dexmedetomidine versus granisetron for the management of postspinal shivering

Usama I Abotaleb, Abdalla M Abdalla, Ahmad S Abdelrahman, Gad S Gad, Abdalla M Elsayed

Ain-Shams Journal of Anaesthesiology 2016 9(4):517-523

Background Shivering is one of the most stressful complications for patients and surgeons during spinal anesthesia. In this prospective, randomized, double-blinded study, we compared the efficacy of dexmedetomidine versus granisetron for control of postspinal shivering. Methods This study was conducted on 120 patients, ASA I–III, of either sex, aged 18–60 years, who were scheduled for elective lower limb and lower abdominal surgeries under spinal anesthesia. The response rate, time taken to control shivering, recurrence rate, and adverse effects were recorded. Results Incidence of shivering in 1127 patients was 52.7% (594 patients): we studied 120 patients; 28 patients (2.5%) developed grade 4 and 92 patients (8.2%) developed grade 3 shivering. There were no statistically significant differences regarding the time for onset of shivering, severity, response rate, need for a second dose, or pethidine between the two groups. However, time to control shivering was shorter in the dexmedetomidine group, with a higher recurrence rate. Incidences of hypotension, bradycardia, and sedation were higher in the dexmedetomidine group. However, there was no incidence of severe bradycardia or respiratory depression in our study. Conclusion Both dexmedetomidine and granisetron effectively reduce postspinal shivering without any major adverse effects. However, dexmedetomidine has rapid onset and short duration, whereas granisetron has less hemodynamic alterations.

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Perioperative nutrition to enhance recovery after surgery

Dina Salah

Ain-Shams Journal of Anaesthesiology 2016 9(4):469-477

Preoperative malnutrition is a major risk factor for increased postoperative morbidity and mortality. Patients at risk for malnutrition should be identified early. The Nutritional Risk Score is a validated tool to identify patients who should benefit from nutritional support. The adoption of total parenteral nutrition followed by the extraordinary progress in parenteral and enteral feedings, in addition to the increased knowledge of cellular biology and biochemistry, has allowed clinicians to treat malnutrition and improve surgical patient's outcomes. Periods of prolonged fasting should be minimized and nutrition should be commenced as early as possible after surgery, preferably through the enteral route. The surgical patient with established malnutrition should begin aggressive nutrition at least 7–10 days before surgery. Those patients in whom eating is not anticipated beyond the first 5 days following surgery should receive the benefits of early enteral or parenteral feeding depending on whether the gut can be used. Many patients may benefit from newer enteral formulations, such as those designed to enhance immune function (immunonutrition).

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Intravenous low-dose ketamine injection versus dexmedetomidine infusion for prevention of intraoperative shivering during spinal anesthesia

Mostafa Mansour Houssein, Ibrahim Mohamed Ibrahim

Ain-Shams Journal of Anaesthesiology 2016 9(4):524-530

Background Shivering is considered one of the most common adverse effects that occur during spinal anesthesia. Besides causing patient discomfort, shivering also interferes with patient monitoring and increases tissue oxygen demand. The present study was carried out to compare the effectiveness of intravenous low-dose ketamine (0.25 mg/kg) and dexmedetomidine intravenous infusion in prevention of shivering during spinal anesthesia. Materials and methods Sixty patients of both sexes were included in this prospective randomized-controlled study. Patients were divided randomly into two groups of 30 patients each. Group K (30 patients) received low-dose ketamine (0.25 mg/kg) and group D (30 patients) received dexmedetomidine infusion. The primary outcome measure of this study was intraoperative shivering. The secondary outcome measures were hemodynamic changes, sedation scores, and postoperative side effects. Results Patients in group D had a lower incidence of postspinal anesthesia shivering compared with patients in group K. In all, 13.33% of group K patients had grade 3 shivering in comparison with only 3.33% of patients in group D 10 min after the onset of spinal anesthesia (P=0.031). Deeper sedation was observed in group D patients as 36.67% of group D patients had grade 4 sedation compared with 23.33% of patients in group K after 10 min (P=0.048). Conclusion Dexmedetomidine infusion is more effective as an antishivering and sedating agent than low-dose ketamine injection in patients receiving spinal anesthesia.

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Systemic versus perineural dexamethasone as an adjuvant to bupivacaine in combined femoral and sciatic nerve blocks in lower-limb vascular surgeries: a prospective randomized study

Hala E Abdel Naim, Khaled A Elshafaie, Sherif M Soaida, Mohammed M Abdel-Haq, Kareem M Nawar

Ain-Shams Journal of Anaesthesiology 2016 9(4):569-575

Background and aim Various peripheral nerve block techniques have been described to deliver anesthesia and analgesia that allow better functional recovery and shortened hospital stay following major lower-limb surgeries. We aimed to compare the possible effect of perineural dexamethasone versus systemic dexamethasone after nerve stimulator-guided combined femoral and sciatic nerve blocks in lower-limb vascular surgeries. Patients and methods After obtaining approval from the ethical committee of Kasr Al-Ainy University Hospital and obtaining written informed consent, 63 patients aged 18–70 years were randomly allocated into three equal groups. Group P received perineural dexamethasone plus bupivacaine 0.5%, group I received intravenous dexamethasone plus perineural bupivacaine 0.5%, and group B received perineural bupivacaine 0.5% alone. We compared the onset and duration of sensory and motor blockade, duration of analgesia, and hemodynamic changes. Results Sensory and motor block onset showed nonsignificant difference between the three groups. Sensory block duration was significantly longer in group P than in groups I and B. Motor block duration was significantly prolonged in groups P and I when compared with group B. Motor block duration was longer in group P than in group I; however, the difference was statistically nonsignificant (p-value 0.34). The duration of analgesia was significantly longer in group P than in the other groups, and significantly longer in group I compared with group B. Conclusion The use of equal doses of perineural or intravenous dexamethasone as an adjuvant in single injection combined femoral and sciatic nerve blocks is associated with extended duration of sensory and motor blocks, extension of postoperative analgesia duration, and reduced postoperative analgesic requirements.

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Intraperitoneal bupivacaine plus fentanyl after laparoscopic pyeloplasty

Hoda Shokri

Ain-Shams Journal of Anaesthesiology 2016 9(4):531-535

Objective Laparoscopic surgery has decreased the severity of postoperative pain. However, patients often experience abdominal and shoulder pain, requiring significant amounts of opioids and potentially prolonging their hospitalization. This study was conducted to assess the effectiveness of intraperitoneal bupivacaine plus fentanyl in reducing postoperative pain without incidence of postoperative complications in patients undergoing laparoscopic pyeloplasty. Patients and methods After hospital ethics committee approval and obtaining written informed consent, 50 consecutive patients undergoing unilateral laparoscopic pyeloplasty were enrolled in this prospective randomized trial. Patients were randomly divided into two groups using the sealed envelope technique: the BF group (25 patients) received induction with 30 ml of bupivacaine (0.25%) plus fentanyl (20 μg) intraperitoneally just before trocar removal, and the saline group (25 patients) received induction with saline (30 ml). Pain scores, time to first analgesic requirement, postoperative opioid requirements, and occurrence of adverse effects were all recorded. Results There was a significant reduction in 24 h of postoperative opioid utilization and visual analog scale scores in the BF group compared with the saline group at all time points. The time to first opioid consumption was significantly longer in the BF group compared with the saline group. The incidence of complications was not significantly different between the study groups. Systolic and diastolic blood pressures were significantly lower in the BF group compared with the saline group. Conclusion The administration of intraperitoneal bupivacaine plus fentanyl just before trocar removal appears to be a simple, effective, and low-cost method to reduce postoperative pain in adults undergoing laparoscopic pyeloplasty.

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Anatomical distribution and outcome of surgical excision of fibrokeratoma – a clinical analysis of 124 cases

Abstract

Background

Fibrokeratoma is a benign, cutaneous, fibrous tumor usually occurring on the digits. There is little data about their occurrence on nondigital areas and their surgical outcomes.

Objectives

We sought to retrospectively characterize the distribution and surgical outcome of fibrokeratoma.

Methods

We retrospectively reviewed the clinical information of patients with a histopathological diagnosis of fibrokeratoma, including age, gender, lesion site, number of lesions, symptoms and signs, history of trauma, and any recurrence.

Results

We identified 124 patients diagnosed with fibrokeratoma in a 13-year period. The mean age was 42 years. There was a male predilection (2 : 1), and all lesions were solitary. Twenty patients (16%) had symptoms, and 13 patients (10%) had a history of trauma. Thirty patients (24%) had lesions on nondigital areas, including the upper and lower extremities and buttocks. The overall recurrence rate was 4% (five cases). Among them, three recurrent lesions were located on the periungual area of the toe. Nine patients (7%) had giant fibrokeratoma (>1 cm) but none recurred.

Conclusion

Although most fibrokeratomas appeared on the digits, a certain number of cases (24%) were located on nondigital areas. The periungual area of the toe was the most common local recurrent site.

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Proximal onycholysis as a complication of hand, foot, and mouth disease

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Dobutamine aggravates haemodynamic deterioration induced by pleural effusion: A randomised controlled porcine study.

BACKGROUND: Pleural effusion is a common finding in critically ill patients and may contribute to circulatory instability and the need for inotropic support. OBJECTIVE: We hypothesised that dobutamine would affect the physiological determinants preload, afterload, contractility and changes of inferior vena cava characteristics during experimental pleural effusion. DESIGN: A randomised, controlled laboratory study. SETTING: Animal laboratory, conducted from March 2013 to May 2013. ANIMALS: Twenty-four Landrace and Yorkshire female piglets (21.3 +/- 1.7 kg). INTERVENTION: Twenty piglets were included in the analyses. After inducing bilateral pleural effusion (30 ml kg-1), the piglets were block randomised to either incremental dobutamine infusion (n = 10) or control (n = 10). MAIN OUTCOME MEASURES: Ultrasonographic measures of left ventricular end-diastolic area, left ventricular afterload, left ventricular fractional area change and inferior vena cava diameter and distensibility were used to assess the basic physiological effect of incremental dobutamine administration during experimental pleural effusion. RESULTS: In the dobutamine group, preload, measured as left ventricular end-diastolic area, decreased from 11.3 +/- 2.0 cm2 after creation of the pleural effusion to 8.1 +/- 1.5 cm2 at a dobutamine infusion rate of 20 [mu]g kg-1 min-1 (P

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Gerichte zerren an der ärztlichen Schweigepflicht

Eine Krankheit, die über sechs Wochen hinaus verläuft, gehört für die meisten Arbeitnehmer zum Glück nicht zum Alltag. Für die anderen — für ihre Arbeitgeber und auch für ihre Ärzte — wird es dann allerdings kompliziert. Die Frage ist, ob ein weiterer Anspruch auf Lohnfortzahlung besteht.

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Heutzutage in eigener Praxis niederlassen — noch immer lohnenswert

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Melanom: erst Nivolumab, dann Ipilimumab

Die Kombination aus Nivolumab plus Ipilimumab bei fortgeschrittenem Melanom ist erfolgreicher als die jeweilige Monotherapie. Welchen Nutzen eine Sequenztherapie hat, wurde in der Studie CheckMate 064 geprüft.

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Neue und alte Waffen im Armamentarium des Dermatologen

Bei der EADV-Jahrestagung in Wien wurde ein Besucherrekord verzeichnet. Die 11.320 Teilnehmer erfuhren unter anderem, wie der Direktvergleich von Ixekizumab und Ustekinumab ausfiel und welche Kombinationstherapie aus altbekannten Substanzen bei Verrucae vulgares wirkt.

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Moderne Diagnostik von Betalaktamantibiotika

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Synergistic Effects of Serotonin or Dopamine Combined With Lidocaine at Producing Nociceptive Block in Rats.

Background: The purpose of this experiment was to investigate the interactions of the local anesthetic lidocaine combined with an agent (serotonin or dopamine) as infiltrative anesthetics. Methods: Cutaneous analgesia was characterized by the blockade of the cutaneous trunci muscle reflex following 6 skin pinpricks on the rat back. Serotonin or dopamine at producing cutaneous analgesia in a dosage-dependent fashion was compared with lidocaine. Drug-drug interactions were calculated using the isobolographic analysis. Results: We revealed that serotonin, dopamine, and lidocaine provoked dose-related cutaneous analgesic effects. On the 50% effective dose basis, the rank of drugs' potency was found to be serotonin (1.70 [1.56-1.85] [mu]mol) > lidocaine (5.18 [4.67-5.75] [mu]mol) > dopamine (43.0 [40.9-45.2] [mu]mol) (P

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Ultrasound-Guided Needle Technique Accuracy: Prospective Comparison of Passive Magnetic Tracking Versus Unassisted Echogenic Needle Localization.

Background and Objectives: Ultrasound-guided regional anesthesia facilitates an approach to sensitive targets such as nerve clusters without contact or inadvertent puncture. We compared accuracy of needle placement with a novel passive magnetic ultrasound needle guidance technology (NGT) versus conventional ultrasound (CU) with echogenic needles. Methods: Sixteen anesthesiologists and 19 residents performed a series of 16 needle insertion tasks each, 8 using NGT (n = 280) and 8 using CU (n = 280), in high-fidelity porcine phantoms. Tasks were stratified based on aiming to contact (target-contact) or place in close proximity with (target-proximity) targets, needle gauge (no. 18/no. 22), and in-plane (IP) or out-of-plane (OOP) approach. Distance to the target, task completion by aim, number of passes, and number of tasks completed on the first pass were reported. Results: Needle guidance technology significantly improved distance, task completion, number of passes, and completion on the first pass compared with CU for both IP and OOP approaches (P

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Changes in Dorsal Root Ganglion Gene Expression in Response to Spinal Cord Stimulation.

Background and Objectives: Spinal cord stimulation (SCS) has been shown to influence pain-related genes in the spinal cord directly under the stimulating electrodes. There is limited information regarding changes occurring at the dorsal root ganglion (DRG). This study evaluates gene expression in the DRG in response to SCS therapy. Methods: Rats were randomized into experimental or control groups (n = 6 per group). Experimental animals underwent spared-nerve injury, implantation of lead, and continuous SCS (72 hours). Behavioral assessment for mechanical hyperalgesia was conducted to compare responses after injury and treatment. Ipsilateral DRG tissue was collected, and gene expression quantified for interleukin 1b (IL-1b), interleukin 6 (IL-6), tumor necrosis factor [alpha] (TNF-[alpha]), GABA B receptor 1 (GABAbr1), substance P (subP), Integrin alpha M (ITGAM), sodium/potassium ATP-ase (Na/K ATPase), fos proto-oncogene (cFOS), serotonin receptor 3A (5HT3r), galanin (Gal), vasoactive intestinal peptide (VIP), neuropeptide Y (NpY), glial fibrillary acidic protein (GFAP), and brain derived neurotropic factor (BDNF) via quantitative polymerase chain reaction. Statistical significance was established using analysis of variance (ANOVA), independent t tests, and Pearson correlation tests. Results: Expression of IL-1b and IL-6 was reversed following SCS therapy relative to the increase caused by the injury model. Both GABAbr1 and Na/K ATPase were significantly up-regulated upon implantation of the lead, and SCS therapy reversed their expression to within control levels. Pearson correlation analyses reveal that GABAbr1 and Na/K ATPase expression was dependent on the stimulating current intensity. Conclusions: Spinal cord stimulation modulates expression of key pain-related genes in the DRG. Specifically, SCS led to reversal of IL-1b and IL-6 expression induced by injury. Interleukin 6 expression was still significantly larger than in sham animals, which may correlate to residual sensitivity following continuous SCS treatment. In addition, expression of GABAbr1 and Na/K ATPase was down-regulated to within control levels following SCS and correlates with applied current. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Cover Image

The cover image, by Wilfred Levin et al., is based on the Case Report High-dose intravenous steroid regimen for radiationinduced hypoglossal nerve palsy, DOI: 10.1002/hed.24600.

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Issue Information - Contents

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Adhering to the 2014 WHO terminology on borderline ovarian tumors

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Anti-HMGCR and anti-DFS70 antibodies immunofluorescence patterns

Publication date: Available online 12 January 2017
Source:Autoimmunity Reviews
Author(s): Boaz Palterer, Daniele Cammelli, Gianfranco Vitiello, Maria Grazia Giudizi




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Is it safe to use N-acetylcysteine in the treatment of bilateral ectropion on collodion baby?

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Body fat composition in hidradenitis suppurativa: a hospital-based cross-sectional study

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The place and willingness of professional tattooists for melanoma screening

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Digital mucous cyst: surgical closure technique based on self-grafting using skin overlying the lesion

Abstract

Background

Digital mucous cysts or myxoid cysts are relatively common, benign pseudocysts of the digits typically located at the distal interphalangeal joints or in the proximal nail fold. There are several therapeutic modalities for its treatment ranging from conservative to surgical procedures; however, there is no consensus about the best approach.

Material and methods

We describe a surgical technique based on the excision of the digital mucous cyst and reconstruction using a self-grafting from the overlying skin lesion.

Results

The use of the cyst's overlying skin as a partial cutaneous graft followed by a long-term Brown's dressing, in this case, provided a satisfactory functional and esthetic result.

Conclusions

This technique is a new option for the reconstruction of digital mucous cyst defects that decreases the surgical time and avoids a graft removal of healthy skin and consequently a new scar.

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Penile amebiasis mimicking penile squamous cell carcinoma

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Evidence of regulatory myeloid dendritic cells and circulating inflammatory epidermal dendritic cells-like modulated by Toll-like receptors 2 and 7/8 in adults with atopic dermatitis

Abstract

Backgroud

Atopic dermatitis (AD) is a chronic, inflammatory skin disease characterized by intense pruritus and xerosis. Dendritic cells (DC) play an essential role in tissue inflammation in atopic dermatitis (AD) skin, especially the inflammatory epidermal dendritic cells (IDEC), a particular subset of myeloid dendritic cells (mDC). The aim of the present study was to assess the phenotype and function of mDC and circulating IDEC-like in peripheral blood mononuclear cells (PBMC) of adults with AD.

Methods

We selected 21 AD patients and 21 non-AD controls, age and gender matched. Expressions of FcεRI, CD36, TNF, IFN- γ, and IL-10 in mDC were analyzed by flow cytometry under various stimuli, such as staphylococcal enterotoxin B (SEB), TLR2 (Pam3CSK4), TLR4 (LPS), and TLR7/8 (CL097) agonists.

Results

The most prominent findings in AD patients were: (i) enhanced frequency of IL-10 under TLR4 (LPS), and decreased frequency of IFN-γ and TNF under TLR2 (Pam3CSK4) and 7/8 (CL097) stimulation in classic mDC; (ii) elevation of circulating IDEC-like frequency with TLR2 (Pam3CSK4) stimuli, augmented frequency of IFN-γ in nonstimulated condition, and of IL-10 under TLR7/8 (CL097) stimuli in IDEC-like population.

Conclusions

In AD individuals, classic mDC showed an immunomodulatory profile, favoring tolerance in a combined action with IDEC-like, and inducing Th1 polarization. Our findings indicate a potential role of IDEC-like in the maintenance of inflammation in atopic dermatitis patients; moreover, IDEC-like may exert a regulatory impact on T cells of AD individuals through IL-10, often induced by agonist mimicking single stranded RNA virus.

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Comments regarding “Hair regrowth during chemotherapy after scalp cooling technique”

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Parental knowledge, attitude, and behavior toward children with atopic dermatitis

Abstract

Background

Successful control of atopic dermatitis (AD) in children depends on parents' knowledge on the disease and attitude toward ill child, but there is a lack studies exploring parental knowledge, attitude, and behaviors. The aim of this study was to investigate parents' knowledge, attitude, and behavior toward AD.

Methods

A cross-sectional study was conducted at the Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, between February 2015 and March 2016. Parents of children with AD were invited to complete the questionnaire, which was comprised of five parts: parental sociodemographic characteristics, demographic and clinical characteristics of children, knowledge, attitude, and behavior. To assess factors associated with a higher knowledge level on AD, stronger positive attitude, and more supportive behavior, we performed two multiple linear regression models.

Results

The average parental knowledge score was 9.5 ± 1.9 out of 12. The level of knowledge did not correlate with parental conviction that they were well-informed on AD (ρ = −0.121; P = 0.319). Older (β = 0.08, 95% confidence interval [CI] 0.00–0.16, P = 0.040), married/partnered parents (β = −2.14, 95% CI −3.55 to 0.72, P = 0.004), and those who have had AD themselves were more likely to be more knowledgeable on AD. Older (β = 0.18, 95% CI 0.01–0.34, P = 0.036) and employed (β = 3.99, 95% CI 1.59–6.38, P = 0.002) parents had stronger positive attitudes toward their children with AD. More supportive behavior of parents of children with AD was associated with being older (β = 0.24, 95% CI 0.04–0.45, P = 0.020) and less educated (β = −0.76, 95% CI −1.24 to 0.28, P = 0.003).

Conclusion

The importance of understanding AD and accounting for attitudes by family members is obvious for successful control of the disease.

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Adipose Tissue Insulin Resistance in Gestational Diabetes

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


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Gerichte zerren an der Schweigepflicht

Krankheit über sechs Wochen hinaus gehört für die meisten Arbeitnehmer zum Glück nicht zum Alltag. Für die anderen, für ihre Arbeitgeber und auch für ihre Ärzte wird es dann allerdings kompliziert. Besteht ein weiterer Anspruch auf Lohnfortzahlung?

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Heutzutage in eigener Praxis niederlassen — noch immer lohnenswert

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How Much Should Thyroid Cancer Impact Plans for Pregnancy?

Thyroid , Vol. 0, No. 0.


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Iliolumbar artery: a useful pedicle for the iliac crest free flap in maxillofacial reconstruction

The iliac crest free flap is commonly used in maxillofacial reconstruction, and is typically supplied by the deep circumflex iliac artery (DCIA). However, the iliolumbar artery is an alternative blood supply that can potentially be used in such reconstructions. We describe the anatomy of the iliolumbar artery and review publications about its clinical use. We raised four cadaveric iliac crest free flaps using both the DCIA and the iliolumbar artery to illustrate its use in reconstructing maxillofacial defects.

http://ift.tt/2jKoCiG

Kosmetologische Diagnostik der Haare, Nägel und Haut

Haare, Haut und Nägel prägen entscheidend den ästhetischen Gesamteindruck einer Person. Durch die Möglichkeiten der Dermatoskopie als nicht invasive morphologische Untersuchungsmethode wird die Lücke zwischen klinischer Blickdiagnose und histologischer Befunderhebung am Schnittpräparat geschlossen. Dem Untersucher erschließen sich durch diese Technik mikroanatomische Strukturen lebender Haut in dreidimensionaler Perspektive.

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Correlation of antimuscarinic acetylcholine receptor antibody titers and antidesmoglein antibody titers with the severity of disease in patients with pemphigus

Acetylcholine receptor (AchR) antibody levels significantly correlate with disease severity at initial pemphigus diagnosis and during follow-up. However, it is not clear if they are just an epiphenomenon or a potential trigger of the known pathogenic process in pemphigus vulgaris.

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Diagnostic Value of Neutrophil–Lymphocyte Ratios and Mean Platelet Volumes in the Activation of Recurrent Aphthous Stomatitis

Abstract

Recurrent aphthous stomatitis (RAS) is associated with endothelial dysfunction and chronic inflammation. The neutrophil-to-lymphocyte ratio (NLR) and mean platelet voume (MPV) are markers of inflammation and endothelial dysfunction, respectively. In the present report, we discuss the NLR and MPV values of patients with active and inactive RAS. In total, 42 patients (24 females and 18 males) with inactive RAS, 19 patients (12 females and 7 males) with active RAS and 40 healthy controls (24 females and 16 males) were enrolled. MPVs were measured and NLRs calculated. We sought correlations among the MPV and NLR findings in the active and inactive RAS groups and compared them with those of healthy controls. The MPV and NLR values were significantly higher in patients with active than inactive RAS (MPV, 10.6 ± 2.9 vs. 7.1 ± 2.4 fL, p < 0.001; NLR, 3.74 ± 1.9 vs. 2.1 ± 1.43, p = 0.015). In addition, both MPV and NLR values in patients with inactive RAS didn't differ significantly compared to values observed in the controls (MPV, 7.1 ± 2.4 vs. 6.9 ± 2.1 fL, p = 0.126; NLR, 2.1 ± 1.43 vs. 2.07 ± 0.96, p = 0.525). Both the NLR and MPV were significantly higher in patients with active RAS, emphasising the importance of inflammation and endothelial dysfunction in the pathophysiology of RAS activation.

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Odontogenic Tumours of Jaw: A Prospective Study on Clinico-Pathological Profile and Their Management

Abstract

Odontogenic tumours are a group of heterogeneous diseases that range from hamartomatous or non-neoplastic tissue proliferations to benign neoplasms to malignant tumours with metastatic potential. They are rare, comprising about <2–3% of all oral and maxillofacial biopsy specimens. The aim of the present study was to determine the clinico-pathological presentation of this heterogeneous group of lesions and review of literature. The present study was conducted in the ENT department of a Government Medical College and Hospital, West Bengal, India, over the period of 5 years from January 2011 to December 2015. It included a total of 15 patients who were clinico-radiologically diagnosed as odontogenic tumours, and were given appropriate treatment. Their diagnostic and management approaches are discussed. Among 15 odontogenic tumours, 13 were benign and two were malignant. Male to female ratio was 2:3. Mandible to maxilla ratio was 1.8:1. The patients were in between 4 and 56 years of age with highest incidence in 3rd decade of life. All patients are doing well till date with a minimum follow-up of 1 year. Incisional biopsy is considered as gold standard for preoperative diagnosis but FNAC can offer clinicians a less invasive alternative. CT is the choice of investigation for study of lesion, analysis of its extension and surgical planning. The challenge to proper management lies in balancing between conservative and radical approach to reduce morbidity and recurrence both. Final diagnosis is made by post-operative histopathological examination.

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Role of Histopathology in Differentiating Primary Atrophic Rhinitis from Atrophic Stage of Rhinoscleroma

Abstract

Atrophic rhinitis (AR) is a chronic debilitating nasal mucosal disease of unknown aetiology and the definitive treatment is still elusive. This often leads to the patient suffering during the entire life span often depleting the individual psychologically. On the contrary, Rhinoscleroma (RS) for which the aetiology is clearly known and is completely curable has atrophic stage which is clinically indistinguishable from AR. Many cases of atrophic stage of RS are undetected and often they end up being treated as AR. This study was conducted to know the role of histopathology and other factors in differentiating AR and Atrophic stage of RS, which can significantly alter the course of treatment and outcome. Forty-five cases of clinically diagnosed AR were included in the study. Punch biopsy of nasal mucosa was obtained from the anterior end of inferior turbinate. Core culture was performed on one sample and histopathological examination for the other sample. Among the 45 patients, 38 (84.44%) of cases were diagnosed to be AR and 7 (15.56%) cases were diagnosed to be RS by histopathology. Core culture of RS subjects showed positive culture for Klebsiella rhinoscleromatis in five subjects (71%). To conclude, AR cases should be confirmed by histopathological examination to rule out RS, for effective management and to prevent complications.

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Aesthetic and Functional Evaluation of Total Nasal Reconstructions

Abstract

The loss of a portion or the totality of the nose has great relevance on the perception of the beauty of a face and can result in a catastrophic quality of life impairment. Several surgical techniques are currently available for the reconstruction of the nasal pyramid. However, there are very few nasal reconstruction quality evaluation protocols that allow the surgeon to choose objectively the best technique for each kind of defects. Six total nasal reconstruction performed in University of Sassari Maxillofacial Unit were evaluated with a protocol that investigate objectively and subjectively the surgical aesthetic and functional outcome. Sensitivity recovery on the reconstructive flaps was also assessed. Patients reported a satisfactory nasal reconstruction both functionally and aesthetically. Sensitivity recovery on the forehead flap was always present even after pedicle resection or in case of traumatic section of the infraorbital nerve. The use of a three layer reconstruction has proved a viable technique both aesthetically and functionally. In particular the use of the forehead flap to reconstruct the outer layer of the nose allows to carry a tissue with very similar characteristics to the original with a recovery of the sensitivity almost complete.

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Clinico-Pathological Profile of Deep Neck Space Infection: A Prospective Study

Abstract

Deep neck space infections (DNI) has been a common and serious disease, involving several spaces created by planes of greater and lesser resistance between the fascial layers of the neck. Infection of deep neck space has been dangerous due to its potential ease of spread from one space to other space, associated sepsis and upper airway obstruction. This prospective study was done in 45 patients of DNI over a period of 1 year. Patients with age of 1 month to 80 years of both the sexes were included. Patient's particular, clinical presentation and associated co-morbid conditions, physical examination, routine laboratory investigations and radiological investigations were analyzed. Patients were treated, response to the treatment was assessed and follow-up was done. In present study, DNI was more commonly seen in rural population (67%) with a male predominance (69%). Mean age of presentation was 34.4 years. Odontogenic infection (64.11%) was the commonest etiological factor and diabetes mellitus (26.66%) was the commonest co-morbid condition. Most common presenting symptom was neck pain and neck swelling (91.1%) and submandibular space (66.6%) was the most commonly involved space followed by sublingual space (44.6%). Both medical and surgical treatment was needed in most of the cases (77.77%). 77.7% cases showed complete regression, 15.5% showed partial regression and they lost to follow-up, 4.4% expired and 2.2% showed progressive deterioration. DNI is a common and life-threatening disease. Early diagnosis and management is necessary for complete cure and to prevent complications associated with DNIs.

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Safety of Carotid Canal during Transtympanic Dilatation of the Eustachian Tube: A Cadaver Pilot Study

Abstract

To assess the safety of Transtympanic balloon dilatation of the cartilaginous proximal Eustachian tube under endoscopic guidance as it relates to the integrity of the carotid canal in cadaver model. Endoscopic guided Transtympanic dilatations of the cartilaginous proximal end of the Eustachian tube were performed in 15 ears of 8 fresh frozen cadaver heads. CT scans were done before and after dilatation. Images were reviewed by two otologists and one radiologist. Balloon catheter placement and dilatation of the proximal Eustachian tube was feasible in all specimens. Endoscopic examination post dilatation showed a consistent increase in the aperture of the proximal cartilaginous tube in all ears. Review of CT images after dilatation showed no evidence of trauma to the carotid canal in all ears instrumented. Endoscopically guided Transtympanic dilatation of the proximal Eustachian tube is not associated with damage to the carotid canal in cadaver model.

Level of Evidence: 4.

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Galectins: emerging regulatory checkpoints linking tumor immunity and angiogenesis

Santiago P Méndez-Huergo | Ada G Blidner | Gabriel A Rabinovich

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Peripheral Clear Cell Variant of Calcifying Epithelial Odontogenic Tumor: Case Report and Review of the Literature

Abstract

Calcifying epithelial odontogenic tumor (CEOT) is classified as an uncommon, benign, odontogenic neoplasm that is exclusively epithelial in origin. Of all reported cases, peripheral tumors account for 5–6 %, among which clear cell variants are still rare. A rare case of peripheral clear cell variant of CEOT occurring in the mandibular gingiva of a 47-year-old female is presented.

http://ift.tt/2jcSLXn

Endoscopic tympanoplasty

Publication date: Available online 12 January 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Ruwan Kiringoda, Michael S. Cohen
In this chapter, we describe surgical steps to perform endoscopic tympanoplasty via medial or lateral graft approaches. Virtually all pathologies of the tympanic membrane, from small perforations to total drum replacement can be addressed endoscopically. We will detail indications for surgery, selection of approach, discuss operative steps, and address challenges of endoscopic tympanoplasty.



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Combined endoscopic and microscopic approaches to cholesteatoma

Publication date: Available online 12 January 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Joao Flavio Nogueira
Use of rigid endoscopes for visualization in the middle ear have allowed for many procedures which were previously limited to postauricular approaches to be performed in transcanal fashion. Additional benefits of the endoscope include superior visualization, angled perspectives to allow for disease removal without direct line of sight, and wider field of view to allow simultaneous visualization of multiple structures.While maximum benefit from the endoscope may occur with transcanal endoscopic ear surgery, there remains a critical role for the endoscope in combined-approach surgery. Not only can middle ear disease be removed with the endoscope in such cases, but the properties of endoscopic visualization allow for detection of occult mastoid disease. The unique perspective of the middle ear seen through the mastoid along with the ability to insert an instrument through the mastoid while looking through the ear canal (and vice versa) can help achieve surgical goals.



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Transcanal endoscopic stapedotomy

Publication date: Available online 12 January 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Jacob B. Hunter, Brendan P. O′Connell, Alejandro Rivas
Transcanal endoscopic stapes surgery has recently been described as an alternative to the traditional microscopic procedure. The principal advantage cited by proponents of the endoscopic approach is improved visualization, while the primary imitation of the endoscopic approach is the need for one-handed surgery, which limits the ability to suction and provide retraction with the non-dominant hand. The steps of an endoscopic stapedectomy or stapedotomy are generally no different than with a microscope, though it has been suggested that the endoscope reduces the need for bony removal of the postero-superior canal wall and decreases manipulation of the chorda tympani nerve. Herein we describe the perioperative workup and management, surgical technique, and published outcomes of endoscopic stapes surgery.



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Endoscopic management of congenital cholesteatoma

Publication date: Available online 12 January 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Aaron K. Remenschneider, Michael S. Cohen
Congenital cholesteatomas are epithelial cell rests found within the middle ear or mastoid that present behind an intact tympanic membrane. Typically found early in life, these expansile skin cysts can result in conductive hearing loss by impeding or eroding the ossicular chain. If left unaddressed, congenital cholesteatoma can result in erosion of the bony labyrinth, tegmen or facial nerve resulting in significant patient morbidity. Surgical removal of congenital cholesteatoma is recommended, preferably when the lesions are small. When considering a surgical approach for the removal of congenital cholesteatoma, surgeons should consider the size and location of the lesion, as well as the extent of expected reconstruction. Transcanal endoscopic ear surgery can successfully be used to manage congenital cholesteatoma limited to the tympanic cavity. Patient features that favor an endoscopic approach include a circumscribed, unruptured congenital cholesteatoma, intact external auditory canal wall and absence of secondary complications such as labyrinthine fistula, middle fossa extension or facial nerve paresis. We describe our endoscopic operative approach to remove congenital cholesteatoma and also highlight effective methods of tympanic reconstruction.



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Introduction

Publication date: Available online 12 January 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Michael S. Cohen, Daniel J. Lee




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Transcanal endoscopic management of acquired cholesteatoma

Publication date: Available online 12 January 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Muaaz Tarabichi, Mustafa Kapadia
ObjectiveThe aim of this review is to describe and evaluate trans-canal endoscopic technique for treatment of acquired Cholesteatoma.FindingsThis article discuss advantages of endoscopic ear surgery in treating Cholesteatoma and how the hidden sites like the facial recess, sinus tympani and anterior epitympanum are easily accessed using the endoscope thereby reducing residual cholesteatoma. Additionally, endoscopic techniques allow better access to the tympanic cavity and protympanum which translates into better understanding of the etiology of ventilation and reduces recurrent disease.ConclusionThe transcanal endoscopic approach allows minimally invasive removal of cholesteatoma with results that compare well to traditional postauricular tympanomastoidectomy.



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Endoscopic ossiculoplasty

Publication date: Available online 12 January 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Brandon Isaacson, Cameron C. Wick, Jacob B. Hunter
Transcanal endoscopic ear surgery (TEES) is evolving as a treatment modality for temporal bone pathologies. Conductive and mixed hearing loss are most commonly caused by a disruptions of the ossicular chain or tympanic membrane. Pre-operative evaluation with otomicroscopy, audiometry, and in some cases imaging are important in the assessment of conductive or mixed hearing loss. TEES is a novel means of assessing and addressing ossicular chain pathology.



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Potential importance of B cells in aging and aging-associated neurodegenerative diseases

Abstract

Our understanding of B cells as merely antibody producers is slowly changing. Alone or in concert with antibody, they control outcomes of seemingly different diseases such as cancer, rheumatoid arthritis, diabetes, and multiple sclerosis. While their role in activation of effector immune cells is beneficial in cancer but bad in autoimmune diseases, their immunosuppressive and regulatory subsets (Bregs) inhibit autoimmune and anticancer responses. These pathogenic and suppressive functions are not static and appear to be regulated by the nature and strength of inflammation. Although aging increases inflammation and changes the composition and function of B cells, surprisingly, little is known whether the change affects aging-associated neurodegenerative disease, such as Alzheimer's disease (AD). Here, by analyzing B cells in cancer and autoimmune and neuroinflammatory diseases, we elucidate their potential importance in AD and other aging-associated neuroinflammatory diseases.

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Transcanal endoscopic tympanotomy

Publication date: Available online 12 January 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Taha A. Jan, Daniel J. Lee
In this chapter, we describe surgical steps and approaches for transcanal endoscopic tympanotomy. Endoscopic ear surgery (EES) can be safely and effectively utilized for transcanal access to most routine and complex middle ear pathology in children and adults. The superior image detail and wide-angle view of the endoscope greatly enhances its diagnostic and therapeutic value. In the following report, we will review endoscopic middle ear anatomy, basic surgical techniques, and discuss pearls and pitfalls associated with transcanal endoscopic tympanotomy.



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The reconstructive options for oropharyngeal defects in the transoral robotic surgery framework

The primary chemoradiation therapy (CRT) and surgery followed by adjuvant radiotherapy with or without chemotherapy are competing therapeutic approaches with similar oncologic outcomes in the management of oropharyngeal squamous cell carcinoma (OPSCC) [1]. However, CRT may also result in significant functional impairments such as severe dysphagia and feeding tube dependence [2]. Transoral robotic surgery (TORS) is a fascinating new technique that has been proved to be a safe and feasible treatment for selected OPSCC.

http://ift.tt/2jBVAxu

Peripheral Clear Cell Variant of Calcifying Epithelial Odontogenic Tumor: Case Report and Review of the Literature

Abstract

Calcifying epithelial odontogenic tumor (CEOT) is classified as an uncommon, benign, odontogenic neoplasm that is exclusively epithelial in origin. Of all reported cases, peripheral tumors account for 5–6 %, among which clear cell variants are still rare. A rare case of peripheral clear cell variant of CEOT occurring in the mandibular gingiva of a 47-year-old female is presented.

http://ift.tt/2jcSLXn

Iliolumbar artery: a useful pedicle for the iliac crest free flap in maxillofacial reconstruction

Publication date: Available online 11 January 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): T. Singh, K. Andi
The iliac crest free flap is commonly used in maxillofacial reconstruction, and is typically supplied by the deep circumflex iliac artery (DCIA). However, the iliolumbar artery is an alternative blood supply that can potentially be used in such reconstructions. We describe the anatomy of the iliolumbar artery and review publications about its clinical use. We raised four cadaveric iliac crest free flaps using both the DCIA and the iliolumbar artery to illustrate its use in reconstructing maxillofacial defects. It provided a longer pedicle for microvascular anastomosis than the DCIA, was more versatile in orientation of the flap, and allowed the chance of anastomosing both pedicles to "super-charge" the flap's blood supply. We describe a patient in whom this flap was used successfully, which shows that the iliolumbar artery is a suitable pedicle to augment (or replace) the DCIA in an iliac crest free flap.



http://ift.tt/2ilzq1G

Peripheral Clear Cell Variant of Calcifying Epithelial Odontogenic Tumor: Case Report and Review of the Literature

Abstract

Calcifying epithelial odontogenic tumor (CEOT) is classified as an uncommon, benign, odontogenic neoplasm that is exclusively epithelial in origin. Of all reported cases, peripheral tumors account for 5–6 %, among which clear cell variants are still rare. A rare case of peripheral clear cell variant of CEOT occurring in the mandibular gingiva of a 47-year-old female is presented.

http://ift.tt/2jcSLXn

Congenital laryngeal cyst: A report of 2 cases

Publication date: Available online 12 January 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Eng Haw Lim, Hazama Mohamad, Suzina Sheikh Ab Hamid
Congenital laryngeal cysts are uncommon cause of neonatal stridor. They are usually located at the supraglottis. Congenital laryngeal cysts of the vocal cord and subglottis are extremely rare with only few cases being reported in the literature. Herein, we describe 2 cases of congenital laryngeal cysts of the vocal cord and the subglottis respectively.



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Diagnostische Genauigkeit ambulanter Polygraphiegeräte

Zusammenfassung

Hintergund

Die stationäre Polysomnographie (PSG) gilt als Referenzmethode in der Diagnostik des obstruktiven Schlafapnoesyndroms (OSAS). Aufgrund der Wartezeiten und der Kosten fordern Kostenträger eine ambulante Polygraphie (PG) als Alternative. Ziel der Studie war es, die diagnostische Genauigkeit verschiedener ambulanter PG-Geräte im Vergleich zur stationären PSG im realen klinischen Alltag einer HNO-Klinik zu evaluieren.

Material und Methoden

Es wurden extern durchgeführte ambulante PG-Befunde von 406 Patienten einer Klinik retrospektiv mit den entsprechenden PSG-Befunden verglichen.

Ergebnisse

Unter den 406 Patienten befanden sich 343 Männer (85 %) und 63 Frauen (15 %) mit einem mittleren Alter von 50 Jahren. Der Body-Mass-Index (BMI) betrug im Mittel 30 kg/m². Für AHI-Werte aus PG und PSG ergab sich ein Rangkorrelationskoeffizient von r = 0,574. Der AHI wurde in der PG im Mittel um 6,4 (±20,5) Ereignisse/h unterschätzt. Polygraphisch wurde in nur 43 % der Fälle der OSAS-Schweregrad korrekt bestimmt. Sensitivität (90,7 %) sowie Spezifität (45,2 %) der ambulanten PG-Geräte wurde für den Grenzwert AHI ≥ 5/h berechnet. Auf Basis der ambulanten PG-Befunde wäre in 35 Fällen (9 %) eine indizierte Therapie unterlassen worden und in 17 Fällen (4 %) eine nicht erforderliche Therapie veranlasst worden. Die verwendeten PG-Geräte zeigten eine vergleichbare diagnostische Genauigkeit (r = 0,513–0,657) bei einer Sensitivität von 81,3–96,9 % und einer Spezifität von 33,3–50,0 %.

Schlussfolgerung

Die ambulante PG kann im klinischen Alltag den Schweregrad eines OSAS nicht zuverlässig beurteilen. Eine Absicherung durch eine PSG im Schlaflabor bei grenzwertigen Befunden erscheint obligat. Ambulante PG-Systeme sollten als Screeningmethode einer PSG vorgeschaltet sein. Die automatische Auswertung der PG ist nicht ausreichend und muss immer überprüft werden.

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Vorübergehende Hörschwellenabwanderung (Vertäubung) durch Impulslärm

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Radiochirurgie und fraktionierte stereotaktische Radiotherapie des Vestibularisschwannoms

Zusammenfassung

Das Management des Vestibularisschwannoms (VS) sollte immer interdisziplinär sein und das Ergebnis besser als der natürliche Verlauf. Besonders bei kleinen VS können mikrochirurgische Operation (Op.) und Radiochirurgie (RS) alternativ eingesetzt werden. Die RS ist eine spezielle Methode einer (zunächst nur stereotaktisch geführt möglichen) Hochpräzisionsbestrahlung aus vielen Richtungen auf den Zielpunkt (Isozentrum) mit einer einmaligen hohen Dosis. Mit Entwicklung von 3 verschiedenen Systemen – Gamma Knife (Fa. Elekta, Stockholm, Schweden), spezielle Linearbeschleuniger, CyberKnife (Fa. Accuray, Sunnyvale/CA, USA) – wurden auch die Optionen erweitert auf 1–5 Fraktionen für die RS und „multisession radiosurgery" (msRS) bis hin zur konventionellen Fraktionierung über 6 Wochen als stereotaktische Radiotherapie (SRT). Dabei nutzt die RS hohe ablative Einzeldosen, die SRT die bekannten strahlenbiologischen Effekte der multiplen Fraktionen jeweils niedriger Einzeldosen bis hin zu einer dann notwendigen, wesentlich höheren Gesamtdosis. Die Evaluierung ergab, dass RS und SRT vergleichbar hohe Tumorkontrollraten um die 90 % und niedrige Nebenwirkungsraten (1–7 %) erreichen. Eine SRT ist deshalb bei kleinen, aber eindeutig progredienten VS nicht nötig; das hat die RS zu einer sehr komfortablen, effektiven Behandlungsoption gemacht. Größere VS sind neben der SRT auch am CyberKnife mit einer msRS vergleichbar effektiv zu behandeln. Da die moderne MRT-Bildgebung häufiger kleine VS auch als „Zufallsbefunde" entdeckt, kommt der zunächst abwartenden Strategie („wait and scan") eine besondere Bedeutung zu. Erst bei zunehmender Symptomatik und nachweisbarem Tumorwachstum ist die Behandlungsindikation gegeben, dann sollte interdisziplinär über die Optionen Op. und RS/SRT entschieden und dabei auch der Patientenwunsch berücksichtigt werden.

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Chefarzt-Op. nur mit Chefarzt?

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Zertifikat – Zertifizierung – Zertifizitis

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Schwanger im OP

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Rehabilitation bei Kindern und Erwachsenen

Zusammenfassung

Hintergrund

Zu den rehabilitativen Maßnahmen bei hörgeschädigten Patienten gehören medizinische, technische und therapeutisch-pädagogische Interventionen. Die gemeinsame Koordination und Durchführung aller Maßnahmen bestimmen den Erfolg der Cochleaimplantat(CI)-Versorgung. Im Laufe der Geschichte des CI haben sich, bedingt durch erweiterte Indikationskriterien, auch die hör- und sprachtherapeutischen Maßnahmen verändert.

Material und Methode

Es werden aktuelle therapeutische Kenntnisse und Erfahrungen der hör- und sprachtherapeutischen Rehabilitation bei Kindern und Erwachsenen beschrieben. Aktuelle Maßnahmen der Therapie und die Qualitätskontrolle werden dargestellt.

Ergebnisse

Ein effektives Hör- und Sprachtraining bei Kindern und Erwachsenen ist abhängig von der individuellen Zielstellung. Neben der subjektiven Rückmeldung des Patienten wird der Erfolg der CI-Versorgung mittels regelmäßiger Testungen gemessen. Therapeutische Maßnahmen, die in der Therapie bei Kindern und Erwachsenen die Kommunikationsfähigkeit steigern, werden strukturiert beschrieben. Bewährte Testverfahren, die Einsatz in der Therapie, Förderdiagnostik, Nachsorge und Qualitätskontrolle finden, ergänzen die Darstellung.

Schlussfolgerungen

In der interdisziplinären Arbeit bietet der Einsatz von strukturierten therapeutischen Maßnahmen sowie bewährten Testverfahren die Grundlage, um den individuellen Erfolg zu dokumentieren, vor dem Hintergrund des erwarteten Ergebnisses zu diskutieren und den Patienten über weitere therapeutische Maßnahmen zu beraten.

http://ift.tt/2jIWOet

Vorsicht bei ärztlichen Abrechnungsempfehlungen

http://ift.tt/2iM5Cfz

Toxicological effects of aflatoxin B 1 on the earthworm Eisenia fetida as determined in a contact paper test

Abstract

In this study, aflatoxin B₁ (AFB₁) toxicity toward the earthworm Eisenia fetida (Savigny 1826) was evaluated in contact paper test systems containing distilled water and ethanol or 20 to 400 μg/ml of AFB₁ over 72 h of exposure. The results indicated that AFB₁ could induce significant damage to earthworms (coiling, curling, excessive mucus secretion, clitellum swelling) at greater than 75 μg/ml. Moreover, AFB₁ had harmful effects on E. fetida (degenerative changes such as bulging of the clitella regions) at levels higher than 150 μg/ml. The calculated LD₅₀ was 168.5 μg/ml. These findings confirm that E. fetida and standardized methods based on this organism (OECD 207 1984) are applicable and useful in mycotoxin related toxicity studies.

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Extended lateral thoracic fasciocutaneous biosynthetic flap for reconstruction of full-thickness partial external ear defects: an experimental study

Abstract

External ear reconstruction is a controversial topic in reconstructive plastic surgery. Here, we prepared a pedicled biosynthetic flap for full-thickness, partial ear defects in rabbits. We operated on six adult female New Zealand rabbits weighing 3–4 kg. The dimensions of the lateral thoracic fasciocutaneous flap were 7 × 6 cm. The flap was elevated based on one of the bilaterally located internal thoracic arteries, which were dissected proximally. The pedicled flap was folded in two, and polypropylene mesh was sandwiched in the middle. The flap was adapted to a defect of 3.5 × 3 cm in diameter. In fact, the defect was created before elevation of the flap. Rabbits were followed up for 4 weeks, at the end of which they were killed and their ears were evaluated histopathologically. The survival rate of the rabbits was 100 %. All pedicled biosynthetic flaps were viable, but one showed partial (20 %) necrosis (1/6) and one was partially detached (1/6). Macroscopic (color, thickness, texture) and histological (polymorphonuclear leukocyte invasion in the skin, subcutaneous tissue, and at the junction between the polypropylene mesh and the flap) features of the flap were compared to the ipsilateral ear. A new technique was developed for partial external ear reconstruction with sufficient inner skeletal support and outer skin lining.

Level of evidence Level NA

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Upper airway structural changes induced by CPAP in OSAS patients: a study using drug-induced sleep endoscopy

Abstract

We studied upper airway structural changes induced by continuous positive airway pressure (CPAP) in obstructive sleep apnea syndrome (OSAS) patients using drug-induced sleep endoscopy (DISE). This prospective study was conducted at an academic secondary referral center. In total, 28 male OSAS patients (mean age 41.1 years) with only retropalatal level obstructions were enrolled. Measurements of the obstruction site were obtained in two steps: first a measurement was taken of the obstruction site in accordance with sleep apnea, then, a measurement was taken of the obstruction site in accordance with DISE-assisted CPAP titration, including quantitative changes in the occlusion site before and after CPAP in pixel format using an area calculation program. There was a tendency for persistent closing in cases of antero-posterior (AP) obstruction versus cases of lateral (Lat) obstruction in the CPAP titration. Lat obstructions showed a tendency to be wider than AP obstructions in the quantitative analysis. These results show that the pattern and degree of airway expansion after CPAP differ in accordance with the obstruction site.

http://ift.tt/2jco6t3

Identification of potential crucial gene network related to seasonal allergic rhinitis using microarray data

Abstract

The aim of this study was to reveal a potential key gene network associated with seasonal allergic rhinitis (SAR). The microarray data GSE50101 downloaded from Gene Expression Omnibus were used to screen differentially expressed genes (DEGs) between SAR patients and healthy controls. Then, functional enrichment analysis was conducted using Database for Annotation, Visualization, and Integrated Discovery. Afterwards, the protein–protein interactions (PPIs) of DEGs were obtained from STRING, and the PPI network was constructed. In addition, the PPI network module was analyzed. In total, 98 up-regulated and 63 down-regulated DEGs were identified from the SAR samples, comparing the healthy controls. The up-regulated DEGs were mainly enriched in the Gene Ontology terms about cell death (e.g., DUSP1 and JUN) and pathways related to immune (e.g., FOS and JUN). The down-regulated DEGs were mainly enriched in regulation of transcription (e.g., CEBPD and SCML1). In the PPI network, a set of genes was predicted to interact with each other, such as FOS, JUN, and CEBPD. Furthermore, genes in the network module (e.g., FOS, JUN and CEBPD) was mainly enriched in regulation of transcription, and pathways about immune, such as mitogen-activated protein kinase signaling pathway, B cell receptor signaling pathway, and toll-like receptor signaling pathway. Several genes related to immunity and regulation of transcription, such as FOS, JUN, and CEBPD, may play crucial roles during the process of SAR through the interactions with each other.

http://ift.tt/2jB2yTr

Classification of suprabullar pneumatization according to the skull base attachment of the second lamella

Abstract

The skull base attachment of the second lamella and suprabullar pneumatization are likely to be consistent landmarks if they are systematically classified. This study aimed to classify the pneumatization pattern according to the second lamella skull base attachment. A total of 202 computed tomography sides of 101 patients who underwent endoscopic sinus surgery were studied. Suprabullar pneumatization was defined as air cells present above the ethmoid bulla between the second and third lamellae. Its pattern was classified according to the air cell number and location as in the frontal cell classification. Type 0 suprabullar pneumatization was defined as no air cells between the ethmoid bulla and skull base; type 1, as a single suprabullar cell; and type 2, as multiple suprabullar cells above the ethmoid bulla. In type 3 pneumatization, the second lamella extended into the frontal sinus forming a frontal bullar cell. Type 2 was the most prevalent (40.1 %), followed by types 1, 3, and 0 (24.3, 23.3, and 12.4 %, respectively). The distance between the second lamella and anterior ethmoid artery was 8.93, 8.30, 8.50, and 11.25 mm in types 0, 1, 2, and 3 pneumatization, respectively. No patients had intraoperative injuries in the anterior ethmoid artery or lateral lamella. The second lamella skull base attachment and suprabullar pneumatization pattern could be systematically classified and be a consistent landmark to identify the frontal sinus opening.

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Therapeutic ductal injection in chronic sialadenitis is established

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Gustatory function in chronic otitis media (mucosal type) before and after tympanoplasty

Abstract

Chronic inflammation in the middle ear may result in functional impairment of the chorda tympani nerve, which carries taste from the anterior two-thirds of the tongue. This may lead to impaired taste sensation. Timely intervention and adequate disease clearance may help the chorda tympani nerve to recover. Gustatory function of 107 patients who underwent Tympanoplasty for Chronic otitis media (mucosal type) was evaluated in a cohort of Indian patients. To compare the preoperative and postoperative gustatory function in these patients taste scores were documented preoperatively, and at 6 weeks and 3 months postoperatively, in an effort to document taste function improvement after disease clearance. The taste scores thus obtained were recorded and analyzed. A significant improvement in taste threshold postoperatively in comparison to the preoperative taste scores (p = 0.001) was found. It was observed that age of the patient and duration of illness have a significant impact on the recovery of taste function. Our study suggests that taste perception improves over a period of time after successful tympanoplasty in patients with chronic otitis media (mucosal type).

http://ift.tt/2jAYrGY

Intraductal injection as an effective drug delivery route in the management of salivary gland diseases

Abstract

While conservative approaches for chronic sialoadenitis are in current use, the utility of intraductal injection therapy remains unclear. The purpose of this study is to provide evidence that substances delivered through intraductal injection of the salivary gland are able to be effectively distributed throughout the gland. Methylene blue dye (0.1 %) was injected intraductally into a porcine parotid gland (5 ml) of one group and the porcine submandibular gland (1 or 2 ml, n = 6 for each preparation) of another group. After the injection, the ductal systems were evaluated, sectioned, and observed microscopically. Color area analysis was performed on submandibular gland sections, and the infiltration ratio of the dye was calculated. The papillae of both Stensen's and Wharton's duct openings were easily identified with intraductally delivered methylene blue dye. The dye infiltration began from the central ductal region of the gland and could be easily observed to gradually disperse to the peripheral regions in each acinar. There were no statistically significant differences in infiltration ratios between anterior, midline, and posterior section of the submandibular gland. Also, there were no statistically significant differences in the ratios between 1 and 2 ml injections at all the three section positions. This study demonstrated that desired substances can be evenly delivered throughout the salivary gland through intraductal injections. The use of intraductal injections might serve as a potential therapeutic procedure in the management of salivary gland diseases.

http://ift.tt/2jc9r0U

Does adenoid hypertrophy affect disease severity in children with allergic rhinitis?

Abstract

Our study aims to evaluate the presence of adenoid hypertrophy (AH) in children with allergic rhinitis (AR) and the association of AH disease severity and clinical laboratory finding from retrospective, cross-sectional, and nonrandomized trial. The study included 566 children being treated and followed up for allergic rhinitis. Skin prick test for the same allergens was performed for all patients. Adenoid tissue was analyzed by an ENT specialist and the diagnosis was confirmed based on the patient history, endoscopic physical examination and radiology. Adenoid hypertrophy was detected in 118 (21.2 %) of the children with AR. Children with and without AH did not differ statistically and significantly by gender, age, presence of atopy in the family, exposure to smoke (p > 0.05). Comparison of the groups for AR duration demonstrated significantly higher frequency of persistent rhinitis in patients with AH (p < 0.05). Of the AR patients with AH, 90 (76.3 %) had moderate-severe rhinitis and 274 (62.6 %) AR patients without AH had moderate-severe rhinitis (p = 0.005). Itchy nose was more frequent in AR patients without AH, and nasal congestion was more common in AR patients with AH (p = 0.017 and p = 0.001, respectively). The presence of asthma was more common among AR patients without AH (p = 0.037). Intergroup comparisons for presence of atopic dermatitis, the percentage of eosinophil, serum IgE levels, the number of positive sensitivity, polysensitization, sensitivity to house dust mite, cockroach, pollens and dander yielded no significant difference (p > 0.05). On the other hand, sensitivity to Alternaria alternata was significantly more frequent in AR patients with AH (p = 0.032). The presence of AH increased the severity of the disease and prolongs disease duration. There was a negative relationship between AH and asthma in children with AR. AH is more common among children with mold sensitivity. AH should be considered and investigated particularly in non-asthmatic children with pronounced nasal congestion and A. alternata sensitivity.

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Pulsed dye laser on ecchymoses: clinical and histological assessment

http://ift.tt/2jcaZb7

Efficacy of pulsed Nd:YAG laser in the treatment of patients with knee osteoarthritis: a randomized controlled trial

Abstract

The purpose of this study was to investigate the effects of pulsed Nd:YAG laser plus glucosamine/chondroitin sulfate (GCS) in patients with knee osteoarthritis (KOA) by examining changes in pain and knee function, as well as synovial thickness (ST) and femoral cartilage thickness (FCT). Sixty-seven male patients participated, with a mean (SD) age of 53.85 (4.39) years, weight of 84.01 (4.70) kg, height of 171.51 (3.96) cm, and BMI of 28.56 (1.22). Group 1 was treated with high-intensity laser therapy (HILT), GCS, and exercises (HILT + GCS + EX). Group 2 was treated with GCS plus exercises (GCS + EX), and group 3 received placebo laser plus exercises (PL + EX). The outcomes measured were pain level and functional disability using the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. ST and FCT were measured by ultrasound examination. Statistical analyses were performed to compare differences between baseline and after 6 weeks of treatment and then after 3 months of follow-up. Statistical significance was set at p < 0.05. VAS and WOMAC were significantly decreased in all groups after 6 weeks, with nonsignificant differences between 6 weeks and 3 months of follow-up. ST was significantly decreased in the HILT + GCS + EX group posttreatment, with nonsignificant decreases in the GCS + EX and PL + EX groups, as well as nonsignificant differences to FCT in all groups. Overall, pulsed Nd:YAG laser combined with GCS and exercises was more effective than GCS + EX and exercises alone in the treatment of KOA patients.

http://ift.tt/2jAX0s7

Maximal oxygen uptake and exercise tolerance are improved in rats with heart failure subjected to low-level laser therapy associated with resistance training

Abstract

Exercise tolerance and maximal oxygen uptake (VO_2max) are reduced in heart failure (HF). The influence of combined resistance training (RT) and low-level laser therapy (LLLT) on exercise tolerance and VO_2max in HF has not yet been explored. The aim of this study was to evaluate the influence of combined RT and LLLT on VO_2max and exercise tolerance in rats with HF induced by myocardial infarction (MI). Rats were allocated to sedentary sham (Sed-Sham, n = 12), sedentary heart failure (Sed-HF, n = 9), RT heart failure (RT-HF, n = 7) and RT associated with LLLT heart failure (RT + LLLT-HF, n = 7) groups. After MI or sham surgery, rats underwent a RT and LLLT protocol (applied immediately after RT) for 8 weeks. VO_2max and exercise tolerance were evaluated at the end of protocol. HF rats subjected to LLLT combined with RT showed higher VO_2basal (41 %), VO_2max (40 %), VO_2reserve (39 %), run distance (46 %), time to exhaustion (30 %) and maximal velocity (22 %) compared with HF rats that underwent RT alone. LLLT associated with RT improved oxygen uptake and exercise tolerance compared with RT alone in HF rats.

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Otoespongiose

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Malformação com perfuração timpânica

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Lesão por arma de fogo ponta da mastóide

http://ift.tt/2ihGK31

Histiocitose de mastóide

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Hiperplasia de amígdalas palatinas

http://ift.tt/2j5cuW9

Colesteatoma de MAE com erosão para mastóide

http://ift.tt/2ihuoIj

Calculose de Parótida

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Aspiração atical grande

http://ift.tt/2j5aY6u

Hiperplasia de amígdala lingual

http://ift.tt/2ihzy74

Neurofibromatose de Mae

http://ift.tt/2ihyMXx

Complications of Bilateral Neck Dissection in Thyroid Cancer

This study delineates the specific complications arising from bilateral neck dissection for thyroid cancers at a single high-volume center.

http://ift.tt/2ikRI31

Laryngeal Immunoglobulin G4-Related Disease Resulting in Severe Airway Obstruction

A woman in her 70s with a history of Sjogrens syndrome associated with rheumatoid arthritis complicated by Felty syndrome had progressive shortness of breath for over a decade that rapidly worsened over the course of 1 month.

http://ift.tt/2ipal91

Determinants of Failure and Survival in Patients With Node-Negative Oral Tongue Cancers

This study assesses the association of lymphovascular space invasion with locoregional failure and survival in patients with node-negative oral tongue cancers treated with upfront definitive surgical resection.

http://ift.tt/2iLOMxt

A Young Boy With Progressive Dysphonia

A young boy presented with dysphonia and laryngeal abnormalities; flexible laryngoscopy revealed 2 laryngeal lesions, and tracheobronchoscopy revealed a distal tracheal submucosal mass. What is your diagnosis?

http://ift.tt/2ikWvS6

Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: a randomized, placebo-controlled trial on psychological distress

Abstract

Objectives

The aim of this randomized placebo-controlled trail was to compare the effects of an objectively titrated mandibular advancement device (MAD) with those of nasal continuous positive airway pressure (nCPAP) and an intraoral placebo device on symptoms of psychological distress in OSA patients.

Materials and methods

In a parallel design, 64 mild/moderate OSA patients (52.0 ± 9.6 years) were randomly assigned to an objectively titrated MAD, nCPAP, or an intraoral placebo appliance. All patients filled out the Symptom Checklist-90-Revised twice: one before treatment and one after 6 months of treatment. The Symptom Checklist-90-Revised is a multidimensional symptom inventory designed to measure symptomatic psychological distress over the past week. Linear mixed model analyses were performed to study differences between the therapy groups for the different dimensions of the Symptom Checklist-90-Revised over time.

Results

The MAD group showed significant improvements over time in the dimensions "somatization," "insufficiency of thinking and acting," "agoraphobia," "anxiety," "sleeping problems," and "global severity index" (F = 4.14–16.73, P = 0.048–0.000). These improvements in symptoms of psychological distress were, however, not significantly different from those observed in the nCPAP and placebo groups (P = 0.374–0.953).

Conclusion

There is no significant difference between MAD, nCPAP, and an intraoral placebo appliance in their beneficial effects on symptoms of psychological distress.

Clinical relevance

The improvement in psychological distress symptoms in mild/moderate OSA patients under MAD or nCPAP treatment may be explained by a placebo effect.

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Liquid-based versus conventional cytology of oral brush biopsies: a split-sample pilot study

Abstract

Objective

The aim of this prospective split sample study was to evaluate the applicability of liquid-based cytology (LBC) of oral brush biopsies for detection of oral cancer.

Methods

Two different preparation techniques were investigated: the conventional transfer procedure to glass slides and the LBC preparation method. The obtainments of epithelial cells were performed five times with a nylon brush and transferred onto five glass slides. Additionally, the brushes, which were normally discarded, were stored in a fixative solution. Conventional slides and respective thin layers from a total of 113 cases were reviewed with both techniques.

Results

Thin layers showed excellent morphology on a clear background, which allowed an accurate diagnosis. In contrast, the conventional glass slides showed significantly more blood contamination and cell overlapping. The sensitivity of conventional cytological diagnosis was 96.3%, the specificity archived 90.6%, the positive predictive value was 96.3% and the negative predictive value scored 90.6%. The sensitivity of the cytological diagnosis using thin layers archived 97.5%, the specificity was 68.8%, the positive predictive value revealed 88.76% and negative predictive value was 91.7%.

Conclusion

Our findings indicate that in oral cytology, LBC may replace other types of wet-fixed preparations using the full amount of collected cells, resulting in enhanced specimen quality archiving comparable values of diagnostic accuracy.

Clinical relevance

LBC facilitates the cell collection due to simpler handling and less transfer errors by dentists and may improve the overall diagnostic accuracy of oral brush biopsies in future.

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Does ozone clinically enhance the remineralizing potential of nano-hydroxyapatite on initial enamel lesions?

http://ift.tt/2ihvuDS

Psoriasisarthritis

Zusammenfassung

Die Psoriasisarthritis, eine chronisch entzündliche Erkrankung des Bewegungsapparates mit Assoziation zur Psoriasis der Haut, zeichnet sich durch ein variables klinisches Bild mit sehr heterogener Krankheitsbelastung der Patienten aus. Klinische Manifestationen umfassen im Wesentlichen Haut- und Nagelveränderungen, periphere Arthritis, Enthesitis, Daktylitis und/oder Wirbelsäulenbefall. Diese Variabilität bedingt eine individuelle Therapie des Patienten mit unterschiedlichen Therapiezielen. Außer internationalen Leitlinien liegen für die Behandlung der Psoriasisarthritis in Deutschland keine Therapieempfehlungen vor. Aus diesem Grund werden in der vorliegenden Arbeit die gesicherten Punkte, Besonderheiten und zu beachtende Aspekte in der Therapie der Psoriasisarthritis in Deutschland unter Berücksichtigung der verschiedenen Hauptformen der Erkrankung zusammengefasst.

http://ift.tt/2ikRnx5

Diagnostic Value of Neutrophil–Lymphocyte Ratios and Mean Platelet Volumes in the Activation of Recurrent Aphthous Stomatitis

Abstract

Recurrent aphthous stomatitis (RAS) is associated with endothelial dysfunction and chronic inflammation. The neutrophil-to-lymphocyte ratio (NLR) and mean platelet voume (MPV) are markers of inflammation and endothelial dysfunction, respectively. In the present report, we discuss the NLR and MPV values of patients with active and inactive RAS. In total, 42 patients (24 females and 18 males) with inactive RAS, 19 patients (12 females and 7 males) with active RAS and 40 healthy controls (24 females and 16 males) were enrolled. MPVs were measured and NLRs calculated. We sought correlations among the MPV and NLR findings in the active and inactive RAS groups and compared them with those of healthy controls. The MPV and NLR values were significantly higher in patients with active than inactive RAS (MPV, 10.6 ± 2.9 vs. 7.1 ± 2.4 fL, p < 0.001; NLR, 3.74 ± 1.9 vs. 2.1 ± 1.43, p = 0.015). In addition, both MPV and NLR values in patients with inactive RAS didn't differ significantly compared to values observed in the controls (MPV, 7.1 ± 2.4 vs. 6.9 ± 2.1 fL, p = 0.126; NLR, 2.1 ± 1.43 vs. 2.07 ± 0.96, p = 0.525). Both the NLR and MPV were significantly higher in patients with active RAS, emphasising the importance of inflammation and endothelial dysfunction in the pathophysiology of RAS activation.

http://ift.tt/2jnGU5M

Odontogenic Tumours of Jaw: A Prospective Study on Clinico-Pathological Profile and Their Management

Abstract

Odontogenic tumours are a group of heterogeneous diseases that range from hamartomatous or non-neoplastic tissue proliferations to benign neoplasms to malignant tumours with metastatic potential. They are rare, comprising about <2–3% of all oral and maxillofacial biopsy specimens. The aim of the present study was to determine the clinico-pathological presentation of this heterogeneous group of lesions and review of literature. The present study was conducted in the ENT department of a Government Medical College and Hospital, West Bengal, India, over the period of 5 years from January 2011 to December 2015. It included a total of 15 patients who were clinico-radiologically diagnosed as odontogenic tumours, and were given appropriate treatment. Their diagnostic and management approaches are discussed. Among 15 odontogenic tumours, 13 were benign and two were malignant. Male to female ratio was 2:3. Mandible to maxilla ratio was 1.8:1. The patients were in between 4 and 56 years of age with highest incidence in 3rd decade of life. All patients are doing well till date with a minimum follow-up of 1 year. Incisional biopsy is considered as gold standard for preoperative diagnosis but FNAC can offer clinicians a less invasive alternative. CT is the choice of investigation for study of lesion, analysis of its extension and surgical planning. The challenge to proper management lies in balancing between conservative and radical approach to reduce morbidity and recurrence both. Final diagnosis is made by post-operative histopathological examination.

http://ift.tt/2jbG6mN