Head and Neck Medicine by Alexandros G.Sfakianakis: 01/18/17

Τετάρτη 18 Ιανουαρίου 2017

Editorial Board

Publication date: February 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 93

http://ift.tt/2iM6waT

Letter to the editor

Publication date: February 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 93
Author(s): Ad Snik

http://ift.tt/2jBE2ol

Otitis media in children: A proposal for a new nosological classification

Publication date: February 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 93
Author(s): Sara Torretta, Paola Marchisio

http://ift.tt/2iM0dV7

Prevalence of human papillomavirus in tonsil brushings and gargles in cancer-free patients: The SPLIT study

Publication date: March 2017
Source:Oral Oncology, Volume 66
Author(s): Jean-Damien Combes, Véronique Dalstein, Tarik Gheit, Gary M. Clifford, Massimo Tommasino, Christine Clavel, Jean Lacau St Guily, Silvia Franceschi
ObjectiveTo evaluate human papillomavirus (HPV) prevalence in the tonsil using extensive ex vivo brushing and gargling in a large age-stratified sample of cancer-free patients.Materials and methodsFrom 2012 to 2016, consecutive patients undergoing tonsillectomy for benign indications in 19 French University Hospitals were invited to participate in the SPLIT study. Immediately after resection, half-tonsils were extensively brushed at the pathology laboratories on the surface epithelium and in tonsil crypts to collect exfoliated cells. In 11 centers, patients aged 15 and over (adults) were also asked to provide gargle samples before surgery. HPV-DNA detection used a very sensitive Luminex technology to evaluate 21 HPV types.ResultsTonsil brushings from 692 patients aged 1–70 years and gargles from 268 adults were tested for HPV. Among adults, overall HPV prevalence was 3.6% in tonsil brushings and 13.1% in gargles and HPV16 prevalence was 2.2% and 4.1%, respectively. Among 139 children, tonsil brushings were positive in two girls (1.4%). Percent agreement in HPV detection in paired tonsil brushings and gargles in adults was 85.8% and positive agreement 9.5%. HPV prevalence in gargles significantly varied by sex (prevalence ratio in men vs women=2.1; 95% confidence interval; 1.1–4.1) and tonsillectomy indication (non-infectious vs. infectious=4.9; 1.4–17.0).ConclusionHPV infection is infrequent in tonsil brushings of cancer-free children and adults. In contrast, HPV infection in gargles in adults is rather common. Low agreement in paired tonsil brushings and gargles suggests that gargle is not representative of HPV prevalence in the tonsil.

http://ift.tt/2iM6G2h

Editorial Board/Aims & Scope

Publication date: February 2017
Source:Oral Oncology, Volume 65

http://ift.tt/2jBsqSr

Patient with Rising Thyroglobulin : Hodgkin's Lymphoma,Thyroid Cancer

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

The dangers of parathyroid biopsy

Thoracic outlet mass presenting with severe biochemical hyperparathyroidism and classic hypercalcemic symptoms of renal and bone involvement.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Epidemiologie bösartiger Hodentumoren in Deutschland

Zusammenfassung

Der Artikel gibt einen Überblick über aktuelle epidemiologische Ergebnisse zum Hodenkrebs in Deutschland und beruht im Wesentlichen auf den Daten der epidemiologischen Krebsregister. Hodenkrebs gehört mit jährlich etwa 4100 Neuerkrankungen in Deutschland zu den seltenen Tumoren. Da mehr als 80 % der Erkrankungsfälle vor dem 50. Lebensjahr auftreten, ist er der häufigste bösartige Tumor bei Männern im jungen Erwachsenenalter. Histologisch dominieren mit etwa 60 % Seminome. Nichtseminome treten dagegen vor dem 30. Lebensjahr häufiger auf. In den letzten Jahrzehnten war in Deutschland wie in vielen anderen Industrienationen ein deutlicher Anstieg der altersstandardisierten Erkrankungsrate zu beobachten, der sich in den letzten Jahren nicht mehr fortzusetzen scheint. Fortschritte in der Therapie führen inzwischen dazu, dass die Lebenserwartung der Patienten gegenüber der Allgemeinbevölkerung kaum eingeschränkt ist; ungünstiger ist die Prognose noch bei älteren Patienten mit Nichtseminomen oder selteneren Formen. Aufgrund des jungen Erkrankungsalters und der geringen Mortalität weist die Erkrankung eine hohe Lebenszeitprävalenz auf: Mittlerweile leben in Deutschland geschätzt etwa 120.000 Männer, bei denen jemals ein Hodenkrebs diagnostiziert wurde. Die Erforschung von Langzeit- bzw. Therapiefolgen wie Zweittumoren und kardiovaskulären Erkrankungen stellt somit ein wichtiges Gebiet der epidemiologischen Forschung dar.

http://ift.tt/2k4YpLP

An evaluation of the quality of evidence available to inform current Bone Conduction Hearing Device national policy

Abstract

Objectives

In 2016 NHS England published the commissioning policy on Bone Conducting Hearing Devices (BCHDs). This policy was informed by updated evidence on the clinical and cost effectiveness of BCHDs as well as by the 2013 Bone Anchored Hearing Aid (BAHA) policy. Commissioning policies set the criteria for service delivery and therefore have a major impact on the care received by patients. It is important that stakeholders have a good appreciation of the available evidence informing policy, since this will promote engagement both with the policy as well as with future research leading on from the policy. In this paper, we provide stakeholders with a transparent and pragmatic assessment of the quality of the body of evidence available to inform current BCHD national policy.

Method

1.A systematic review of the literature on BCHDs published since the development of the 2013 policy was performed in September 2016, adhering to PRISMA recommendations. The search terms used were: bone conduction; bone conducting; bone anchor; BAHA; Bone Anchored Hearing Aid; Bone Conducting Hearing Device; BCHD; Bone Conduction Hearing Implant; BCHI; Sophono; Bonebridge; Soundbite; Ponto; Hearing aid; implant; device; hearing device. Publications that could inform current BCHD policy were included. The quality of included articles was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

2.The quality of evidence referenced by the 2013 BAHA policy was assessed using the GRADE system.

Results

1.Out of the 2576 publications on BCHDs identified by the systematic search, 39 met the inclusion criteria for further analysis. Using the GRADE criteria, the quality of evidence was classified as of 'very low quality.'

2.The 2013 BAHA policy was informed by 14 references. The GRADE system classifies the quality of evidence that informed the policy as of 'very low quality'.

Conclusions

The GRADE system defines the body of evidence available to inform current national BCHD policy as of 'very low quality'. There is an urgent need for high quality research to help make informed policy decisions about the care of patients with hearing loss. An (inter)national registry of BCHDs could address this need.

http://ift.tt/2k2c7uX

Letter to editor, plastic temporal bones

Abstract

I was delighted to note that in Table 2 of this review¹ plastic bones got the most pluses of all the platforms. However, I have to disagree with the quote about the malposition of the facial nerve near the second genu and the inadequate representation of the lateral semicircular canal in Pettigrew Temporal Bones. It is impossible for the facial nerve to be malpositioned in my bones. To make the bone I take an impression of a dissected cadaver bone where the Fallopian canal has been deroofed.

http://ift.tt/2iDI0Od

Langzeitergebnisse eines Screeningverfahrens für erwachsene Cochlea-Implantat-Kandidaten

Laryngo-Rhino-Otol
DOI: 10.1055/s-0042-117641

Diese Studie gibt eine Abschätzung der Langzeitergebnisse eines Screeningverfahrens für Cochlea-Implantat-Kandidaten in einer Gruppe von Hörgerätenutzern.In einer retrospektiven Studie wurden Sprachverstehen und Hörschwelle in 185 Patienten (318 Ohren) analysiert. Die in den 2 Jahren nach ipsilateralem Screening erfolgte Behandlung des beobachteten Kollektivs wurde analysiert. Für die mit einem Cochlea-Implantat versorgten Patienten wurden die sprachaudiometrischen Ergebnisse in Beziehung zu ihrem präoperativen Sprachverstehen gesetzt.Von den 96 Fällen, welche als Cochlea-Implantat-Kandidaten identifiziert worden sind, wurden 34 versorgt. Von den 222 als Hörgerätekandidaten klassifizierten Fällen kam es lediglich in 4 Fällen zu einer Cochlea-Implantat-Versorgung. Versorgte Patienten mit einem präoperativen Sprachverstehen mit Hörgerät oberhalb 0% zeigten eine mittlere Verbesserung von 65 Prozentpunkten im Freiburger-Einsilber-Test.Das vorgeschlagene Screeningverfahren ermöglicht ein effektives klinisches Management des Zuweisungsprozesses von Cochlea-Implantat-Kandidaten.
[...]

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://ift.tt/2jNorjw

Einsatz von E-Learning an deutschen Universitäts-HNO-Kliniken

Laryngo-Rhino-Otol
DOI: 10.1055/s-0042-117640

E-Learning ist ein integraler Bestandteil innovativer Lehrkonzepte. Gerade die anatomisch und funktionell anspruchsvolle HNO-Heilkunde eignet sich besonders für selbstgesteuertes und digital visualisiertes Lernen. Der Implementierungsgrad von E-Learning an deutschen HNO-Universitätskliniken sowie systematische Rückmeldungen von Medizinstudierenden in Deutschland sind derzeit nicht bekannt. Wir führten eine Erhebung des Bedarfs und der aktuellen Nutzung von E-Learning im Fach HNO-Heilkunde an den medizinischen Fakultäten der deutschen Universitäten durch. Hierbei wurden im Sommersemester 2015 Lehrstühle und Studierende durch elektronische und papierbasierte Fragebögen befragt. Die Untersuchung ergab eine heterogene Struktur und Qualität an E-Learning-Angebot und -Qualität. Insgesamt findet in der deutschen universitären HNO-Heilkunde bisher relativ wenig E-Learning statt. Jedoch gab über die Hälfte der Kliniken an, dass E-Learning die eigene Lehre verbessert habe. Verbessere Kooperation innerhalb der Fakultäten und zwischen den HNO-Kliniken könnte hier zusätzliche Potentiale erschließen, technische Hürden bewältigen und helfen, ambitioniertere Projekte zu realisieren.
[...]

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://ift.tt/2iTMFdh

Abduzensparese mit Ursache im HNO-Fachgebiet

Laryngo-Rhino-Otol
DOI: 10.1055/s-0042-119031

Patienten mit Abduzensparesen werden oft primär in konservativen Fachrichtungen behandelt. Häufig liegt eine temporäre Störung vor, die mit vaskulären oder neurologischen Erkrankungen assoziiert ist. Selten verursachen Entzündungen, Schädelbasistumore oder Traumata Abduzensparesen, die eine HNO-ärztliche Intervention erforderlich machen. Die vorliegende Arbeit untersucht retrospektiv die Relevanz der Abduzensparese in der HNO und die fachgebietsbezogen erzielten Heilungsraten. In den Jahren 2008–2011 wurden 15 Patienten mit Abduzensparesen behandelt. Davon wurden 14 Patienten operativ und eine Patientin konservativ therapiert. Bei 6 operativ versorgten Patienten handelte es sich um die Komplikation einer Entzündung. Im Rahmen von Nasennebenhöhlenoperationen und Panendoskopien fanden sich bei 7 Patienten Schädelbasismalignome. Bei einem Patienten konnte die Ursache der Parese nicht geklärt werden. In zwei Drittel der Patienten mit entzündlichen Ursachen der Abduzensparese wurde nach kombinierter chirurgischer und i. v.-antibiotischer Therapie die vollständige Remission der Parese erreicht. Alle Tumorpatienten litten auch nach abgeschlossener primärer Radiochemotherapie weiterhin an Abduzensparesen – davon zeigte ein Drittel zumindest eine partielle Remission. Bei der verunfallten Patientin ergab sich im Verlauf von 3 Monaten eine Teilremission der Parese. Das Leitsymptom Abduzensparese erfordert bei komplizierten extrakraniellen Entzündungen, Tumoren oder Traumata den an der Schädelbasis erfahrenen HNO-Chirurgen. Die Remissionsraten der Tumorpatienten sind deutlich schlechter als bei den an Entzündungen erkrankten Patienten. Insgesamt beträgt die Remissionsrate aller Patienten 60% in der untersuchten Gruppe.
[...]

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://ift.tt/2jNw89k

Prospektive Untersuchung zur Ergebnisqualität von Schilddrüsenoperationen in einer HNO-Klinik

Laryngo-Rhino-Otol
DOI: 10.1055/s-0042-119071

Die im Hals gelegene Schilddrüse wird in Deutschland nicht als selbstverständliches Betätigungsfeld für den Facharzt für Hals-Nasen-Ohrenheilkunde betrachtet, sondern häufiger – vermutlich aus eher historischen Gründen – vom Allgemeinchirurgen operiert. Da derartige Eingriffe an unserer Abteilung etabliert sind, war dies für uns Anlass, prospektiv unsere Behandlungsresultate zu untersuchen und Erfahrungen darzustellen.Es handelt sich um eine prospektive Untersuchung beginnend im Jahre 2014. Dabei konnten insgesamt 231 Patienten erfasst, die prä-, intra- und postoperativen Befunde erhoben werden. Es handelte sich um 167 Frauen und 64 Männer. Die Altersspanne reichte von 16 bis zu 89 Jahren mit einem Durchschnittsalter von 53,5. Der Median der Verweildauer lag bei 3 Tagen mit einem Minimum von 1 und einem Maximum von 25 Tagen bei einer Patientin mit einem medullären Schilddrüsenkarzinom, die internistisch multimorbide war.Da viele Symptome von Schilddrüsenerkrankungen sich im genuinen Bereich unseres Fachgebietes manifestieren, können wir keinen nachvollziehbaren Grund erkennen, warum Otorhinolaryngologen derartige Eingriffe nicht durchführen sollten, die von der klinischen Untersuchung, der präoperativen Diagnostik, dem subtilen Umgang mit Weichgewebe und nervalen Strukturen sowie der Nachbehandlung unserer Ansicht prädestiniert sind. Neben der eigenen Expertise ist eine enge Kooperation mit den Kollegen der Nuklearmedizin und auch Hausärzten bzw. Internisten unabdingbar.
[...]

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://ift.tt/2iTwFI8

Intranasal azelastine and mometasone exhibit a synergistic effect on a murine model of allergic rhinitis

The purpose of this study was to compare the anti-allergic effects of the combination of azelastine and mometasone with those of either agent alone in a Dermatophagoides farinae (Derf)-induced murine model of allergic rhinitis (AR).

http://ift.tt/2jyFHeQ

Two-stage CO2-laser-assisted bilateral cordectomy for cT1b glottic carcinoma

The aim of the present paper was to investigate the oncological safety of two-stage bilateral cordectomy for the treatment of cT1b glottic SCC, and to compare its oncological outcome and synechia development rate with those of single-stage procedures.

http://ift.tt/2jyIYej

Laryngeal alveolar soft part sarcoma: A case report of a rare malignancy in an atypical location

Laryngeal sarcoma is a rare and potentially aggressive malignancy. In this case report, we present a 23year-old-male with four-years of progressive hoarseness who was found to have a large left paraglottic mass. A partial laryngectomy was successful at completely excising the lesion. Final pathology returned as alveolar soft part sarcoma. Alveolar soft part sarcomas of the larynx are extremely rare with only five cases published in the current literature. This article provides a case presentation with literature review of alveolar soft part sarcoma of the head and neck.

http://ift.tt/2jyArb0

Tongue Retaining Devices for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Obstructive Sleep Apnea (OSA) remains a prevalent and difficult disease to treat [1–4]. Treatment modalities range from the most non-invasive form such as lifestyle modifications to surgical procedures that permanently change the patient's anatomy [5–8]. Selection of a specific type of treatment remains largely based on parameters to address specific physiologic and anatomic variables that contribute to the obstructive etiology [4]. In this fashion, Continuous Positive Airway Pressure (CPAP) serves as the gold standard in effectively addressing the obstruction throughout the upper airway [4,7].

http://ift.tt/2jpfFIw

Inpatient Injection Laryngoplasty for Vocal Fold Immobility: When is it Really Necessary?

To compare pulmonary and swallow outcomes of injection laryngoplasty when performed in the acute versus subacute setting in head & neck and thoracic cancer patients presenting with new onset unilateral vocal fold immobility.

http://ift.tt/2jyOmxZ

Adenoid cystic carcinoma of the base of tongue: A population-based study

The objective was to assess demographic and survival patterns in patients with adenoid cystic carcinoma of the base of tongue.

http://ift.tt/2jpdmFe

Cortactin and phosphorylated cortactin tyr466 expression in temporal bone carcinoma

Cortactin is a multidomain protein engaged in several cellular mechanisms involving actin assembly and cytoskeletal arrangement. Cortactin overexpression in several malignancies has been associated with increased cell migration, invasion, and metastatic potential. Cortactin needs to be activated by tyrosine or serine/threonine phosphorylation. The role of cortactin and phosphorylated cortactin (residue tyr466) was investigated in temporal bone squamous cell carcinoma (TBSCC).

http://ift.tt/2jyDekM

Reconstruction of Midface Defect from Idiopathic Destructive Process Using Medpor Implant

Reconstruction of the midface remains a challenging task for even the most experienced surgeon, with a host of reconstructive options including free tissue transfer, allografts, or prosthetic implants. Presented here is a case of idiopathic bony destruction of the right midface in a 19 year old female, creating a unique defect requiring repair.

http://ift.tt/2jpnptZ

Rethinking surgical technique and priorities for pediatric tonsillectomy

The past 100 years have witnessed dramatic shifts in the concept of ideal surgical goals and operative technique in tonsil surgery. Surgeons are reviving a technique of intracapsular tonsillectomy with increasing precision thanks to modern technology. With intracapsular tonsillectomy, pediatric patients recover faster, use less pain medication, and have a lower risk of dehydration and hemorrhage. Various considerations will dictate the adoption of this technology in the coming years. This current review explores concepts and controversies surrounding tonsillectomy with a focus on quality improvement.

http://ift.tt/2jpiAkr

Facial Nerve Sacrifice During Parotidectomy: A Cautionary Tale in Pathologic Diagnosis

The parotid gland harbors 85% of all salivary gland neoplasms. Though the majority of tumors are benign, complete surgical resection remains the mainstay of treatment. Along with adequate tumor removal, facial nerve preservation is a critical objective. Given the significant negative effects on quality of life following facial nerve sacrifice [1], every effort should be made to spare the nerve until conclusive evidence mandates its removal. Here we share observations from a case where facial nerve sacrifice was considered, but ultimately deferred due to lack of definitive intraoperative pathologic diagnosis.

http://ift.tt/2jpdfK7

Treatment Outcomes in Veterans with HPV-Positive Head and Neck Cancer

Head and neck squamous cell carcinoma (HNSCC) caused by the human papilloma virus (HPV) has an improved prognosis relative to HPV-negative tumors. Patients with HPV-positive disease may benefit from different treatment modalities in order to optimize survival and quality of life. We sought to investigate HPV-positive HNSCC within the military veteran population, and analyze the role of treatment modality in outcomes of patients with HPV-positive and HPV-negative tumors.

http://ift.tt/2jyFCb2

Diagnostic validity of ICDAS and DIAGNOdent combined: an in vitro study in pre-cavitated lesions

Abstract

In a continuous process such as caries, it is important to possess criteria or instruments that allow the lesions to be diagnosed at early stages so that preventive or interceptive treatments can be applied before cavitation takes place. The present study seeks to assess the diagnostic efficacy of the International Caries Detection and Assessment System (ICDAS II) criteria and the DIAGNOdent laser fluorescence (LF) pen in occlusal caries lesions, using histological sections as the gold standard. Sixty-four permanent teeth were examined by two researchers who previously performed and calibrated both the ICDAS II criteria and the use of DIAGNOdent pen. The teeth were then cut into sections and observed under an optical microscope. The sensitivity values were 0.82 (ICDAS II) and 0.85 (LF). The specificity values were 1.00 (ICDAS II) and 0.53 (LF). The intraexaminer reproducibility was 0.892 for ICDAS II and 0.912 for the DIAGNOdent, so it was high for both diagnostic methods. However, the DIAGNOdent pen showed greater sensitivity and the ICDAS criteria more specificity. It was concluded that both methods are efficacious individually but combining the two is recommended to improve the diagnosis.

http://ift.tt/2jaDPFP

Jobsharing: Neue Ausnahme bei der Obergrenze

Zusammenfassung

Ein Vertragsarzt kann sich seinen Sitz mit einem Jobsharer teilen. In gesperrten Planungsbereichen unterliegt der Arzt dann einer Leistungsbegrenzung. Üblicherweise ist die Bemessungsgrundlage das Honorarvolumen der konkreten Praxis aus den letzten 4 Quartalen. Bei unterdurchschnittlichen Praxen richtet sich die Obergrenze seit dem Quartal IV/2016 nun aber nach dem Fachgruppendurchschnitt. Für Fachärzte für plastische Chirurgie oder plastische und ästhetische Chirurgie, die im Vergleich zu den übrigen Fachärzten aus der Fachgruppe der Chirurgen nur über ein geringes vertragsärztliches Honorarvolumen verfügen, eröffnet dies neue attraktive Jobsharing-Möglichkeiten. Jobsharing kann in Form der Anstellung des Jobsharers oder als Jobsharing-Partnerschaft ausgestaltet werden. Soweit keine Übergabe der Praxis an den Jobsharer geplant ist, ist die Anstellung vorzugswürdig. Ist eine Übergabe an den Jobsharer geplant, sollte man eine Vorlaufzeit von gut 5 Jahren einplanen, um die Vorteile des Jobsharing im Nachbesetzungsverfahren voll nutzbar zu machen. Nach 3‑jähriger Jobsharing-Tätigkeit kann der Zulassungsausschuss die Durchführung des Nachbesetzungsverfahrens nicht wegen Überversorgung ablehnen. Nach 5 Jahren gemeinsamer Jobsharing-Tätigkeit ist der Jobsharer darüber hinaus als Nachfolger bevorzugt zu berücksichtigen.

http://ift.tt/2iQC1UG

The Spatial Release of Cognitive Load in Cocktail Party Is Determined by the Relative Levels of the Talkers

Abstract

In a multi-talker situation, spatial separation between talkers reduces cognitive processing load: this is the "spatial release of cognitive load". The present study investigated the role played by the relative levels of the talkers on this spatial release of cognitive load. During the experiment, participants had to report the speech emitted by a target talker in the presence of a concurrent masker talker. The spatial separation (0° and 120° angular distance in azimuth) and the relative levels of the talkers (adverse, intermediate, and favorable target-to-masker ratio) were manipulated. The cognitive load was assessed with a prefrontal functional near-infrared spectroscopy. Data from 14 young normal-hearing listeners revealed that the target-to-masker ratio had a direct impact on the spatial release of cognitive load. Spatial separation significantly reduced the prefrontal activity only for the intermediate target-to-masker ratio and had no effect on prefrontal activity for the favorable and the adverse target-to-masker ratios. Therefore, the relative levels of the talkers might be a key point to determine the spatial release of cognitive load and more specifically the prefrontal activity induced by spatial cues in multi-talker situations.

http://ift.tt/2jAHXSq

Targeting IκBNS in allergic asthma: Where it resides, matters

Abstract

The activity NF-κB, a pro-inflammatory transcription factor, and its complex modulation play a central role in in inflammatory airways disease such as allergic airway hyperresponsiveness. In a new study, Yokota and colleagues investigated IκBNS – an atypical inhibitor of NF-kB (IκB). Using elegant bone marrow chimera studies in mice, they found that IκBNS differentially modulated NF-κB activity in hematopoietic and non-hematopoietic cells. They also showed that by binding to the promoter region, this nuclear protein directly induced the MUC5AC gene in airway epithelial cells. This study enhances our understanding of how atypical IκB proteins work in regulating NF-κB activity and allergic airway conditions. It also emphasizes that targeting specific molecular pathways of airway inflammation may result in differential effects depending on the targeted tissue compartment. This is important in the search of novel asthma treatments and supports the fact that global anti-inflammatory approaches alone may not provide sufficient therapy.

http://ift.tt/2iKMNsj

15 years of allergen immunotherapy vial sterility testing

The prevalence of allergic rhinitis, atopic dermatitis, and asthma is increasing and is associated with significant morbidity and increasing health care costs. Current treatment options for allergic rhinitis are broad and generally begin with pharmacotherapy and, when practical, allergen avoidance. In the general population, approximately one-third of children and two-thirds of adults report partial or poor relief with pharmacotherapy alone.1 The next step in treatment is often initiation of subcutaneous allergen immunotherapy (AIT).

http://ift.tt/2iDf88A

Evaluation of the Role of Nasal Endoscopy and Computed Tomography Individually in the Diagnosis of Chronic Rhinosinusitis

Abstract

The aims of this study were to assess the individual roles of nasal endoscopy (NE) and computed tomography (CT) in the diagnosis of chronic rhinosinusitis, to evaluate their sensitivity and specificity and determine the superiority of one over the other, if any. The study was conducted over 19 months on patients above 18 years of age attending the ENT OPD at Jaipur Golden Hospital, Rohini, Delhi with persistence of symptoms of chronic rhinosinusitis (CRS) for ≥12 weeks. NE was done in each patient followed by NCCT-PNS (4 mm cuts) evaluated with the Lund Mackay system and score ≥4 was suggestive of disease. On NE, mucopurulent discharge and edema in the middle meatus and ethmoid region were all seen in equal distribution amongst the patients. Polyps in the middle meatus were identified in the least number of patients. On observation for anatomical variants, paradoxical middle turbinate was seen in most patients and prominent agger nasi region in the least patients. On CT the order of involvement of the paranasal sinuses from most to least was—anterior ethmoids, maxillary sinus, posterior ethmoids, sphenoid and frontal sinuses. Ostiomeatal complex was involved in approximately one-third of the patients who had been diagnosed with CRS with CT. Frequency of disease on DNE and CT had a sensitivity of 72.2% and specificity of 63.6% with a p value of 0.024, and positive and negative predictive values of 61.9 and 73.7% respectively. It was concluded at the end of the study that there was a significant correlation between DNE and CT in the diagnosis of CRS.

http://ift.tt/2iKOMwR

Re: Minimal invasive treatment using patient-specific template for mandibular fractures in children: “Wing- splint” by CAD/CAM technology

Publication date: Available online 17 January 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J.-W. Lee, B.-J. Choi, O.-H. Nam, Y.-D. Kwon

http://ift.tt/2jMBtxk

Epstein-Barr-virus-related mucocutaneous ulceration that mimics oral squamous cell carcinoma: the importance of recognising this new condition

Publication date: Available online 17 January 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): T. Aldridge, Paraneetharan, P. Brennan, V. Ilankovan
We report a case and present a literature search of the relatively newly reported condition of Epstein Barr Virus (EBV)-related mucocutaneous ulceration. EBV-related mucocutaneous ulcers clinically present as oral squamous cell carcinoma (OSCC) in immunocompromised elderly patients but usually resolve by stopping or modifying the medication.As the two conditions can present in a similar way, and the management of each is totally different, this case highlights the importance of recognising this condition at an early stage.

http://ift.tt/2jyrU84

Pilomatrixoma of the neck: A forgotten entity

Publication date: Available online 18 January 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Jeyasakthy Saniasiaya, Irfan Mohamad, Zaleha Kamaludin
Pilomatrixoma, also known as pilomatricoma is a rare benign appendageal neoplasm of hair follicle matrix. It usually presents as a superficial, firm mass, commonly found in the head and neck region which may pose a diagnostic challenge as it may resemble other common benign lesions as in this case, sebaceous cyst. Pilomatrixoma remains to be misdiagnosed and are usually not considered in differential diagnosis. We report a case of a young girl with pilomatrixoma of neck, surgical management and histopathological findings.

http://ift.tt/2jysqTO

Metabolic Imaging of Head and Neck Cancer Organoids

by Amy T. Shah, Tiffany M. Heaster, Melissa C. Skala

Head and neck cancer patients suffer from toxicities, morbidities, and mortalities, and these ailments could be minimized through improved therapies. Drug discovery is a long, expensive, and complex process, so optimized assays can improve the success rate of drug candidates. This study applies optical imaging of cell metabolism to three-dimensional in vitro cultures of head and neck cancer grown from primary tumor tissue (organoids). This technique is advantageous because it measures cell metabolism using intrinsic fluorescence from NAD(P)H and FAD on a single cell level for a three-dimensional in vitro model. Head and neck cancer organoids are characterized alone and after treatment with standard therapies, including an antibody therapy, a chemotherapy, and combination therapy. Additionally, organoid cellular heterogeneity is analyzed quantitatively and qualitatively. Gold standard measures of treatment response, including cell proliferation, cell death, and in vivo tumor volume, validate therapeutic efficacy for each treatment group in a parallel study. Results indicate that optical metabolic imaging is sensitive to therapeutic response in organoids after 1 day of treatment (p

http://ift.tt/2jzMh4x

Different Phenotypes of the Two Chinese Probands with the Same c.889G>A (p.C162Y) Mutation in COCH Gene Verify Different Mechanisms Underlying Autosomal Dominant Nonsyndromic Deafness 9

by Qi Wang, Peipei Fei, Hongbo Gu, Yanmei Zhang, Xiaomei Ke, Yuhe Liu

Objectives

By analyzing the different phenotypes of two Chinese DFNA9 families with the same mutation located in the intervening region between the LCCL and vWFA domains of cochlin and testing the functional changes in the mutant cochlin, we investigated the different pathogeneses for mutations in LCCL and vWFA domains.

Methods

Targeted next-generation sequencing for deafness-related genes was used to identify the mutation in the proband in family #208. The probands of family #208 and family #32 with the same p.C162Y mutation were followed for more than 3 years to evaluate the progression of hearing loss and vestibular dysfunction using pure-tone audiometry, caloric testing, electrocochleogram, vestibular-evoked myogenic potential, and video head-impulse test. The disruption of normal cleavage to produce secreted LCCL domain fragments and the tendency to form aggregations of mutant cochlins were tested by in vitro cell experiments.

Results

The two families showed different clinical symptoms. Family #32 was identified as having early-onset, progressive sensorineural hearing loss, similar to the symptoms in DFNA9 patients with cochlin mutations in the vWFA domain. The proband of family #208 endured late-onset recurrent paroxysmal vertigo attacks and progressively deteriorating hearing, similar to symptoms in those with cochlin mutations in the LCCL domain. We therefore suggest that the disrupted cleavage of the LCCL domain fragment is likely to cause vestibular dysfunction, and aggregation of mutant cochlin caused by mutations in the vWFA domain is responsible for early-onset hearing loss. The p.C162Y mutation causes either disruption of LCCL domain fragment cleavage or aggregation of mutant cochlin, resulting in the different phenotypes in the two families.

Conclusion

This study demonstrates that DFNA9 families with the same genotype may have significantly different phenotypes. The mutation site in cochlin is related to the pathological mechanism underlying the different phenotypes.

http://ift.tt/2k1aBt2

In this issue

http://ift.tt/2joGkVV

Role of Serratiopeptidase After Surgical Removal of Impacted Molar: A Systematic Review and Meta-analysis

Abstract

Background

Serratiopeptidase for pain, facial swelling and trismus associated with surgical removal of impacted molar is under investigation. However conclusive evidence on the use of serratiopeptidase is lacking. Hence a systematic review and meta-analysis of randomized controlled studies was carried out.

Methods

Electronic databases were searched for eligible studies and necessary data extracted. The data were analysed using non-Cochrane mode in RevMan 5.0. 95% confidence interval (95% CI) was used to represent the deviation from the point estimate. The heterogeneity between the studies was assessed using Forest plot visually, I² statistics and Chi square test with a statistical P value of <0.10 to indicate statistical significance. Random-effect models were used in case of moderate to severe heterogeneity.

Results

Five studies were included for final review. Serratiopeptidase improved trismus better than corticosteroids with the MD, 95% as 4.42 [3.84, 5]. As regards to swelling, no significant difference was observed for serratiopeptidase when compared to corticosteroids. Paucity of studies precludes any conclusion for other outcome measures as well as for other comparator drugs.

Conclusion

Serratiopeptidase could be used safely and effectively to improve trismus and facial swelling after surgical removal of impacted molar.

http://ift.tt/2jLREuQ

TLR9 mediated regulatory B10 cell amplification following sub-total body irradiation: Implications in attenuating EAE

Publication date: March 2017
Source:Molecular Immunology, Volume 83
Author(s): Jinsheng Hong, Jie Fang, Ruilong Lan, Qi Tan, Yeping Tian, Mei Zhang, Paul Okunieff, Lurong Zhang, Jianhua Lin, Deping Han
Autoimmunity and inflammation are controlled in part by regulatory B (Breg) cells, including the recently identified IL-10-competent B10 cell subset that represents 1%–3% of mouse spleen B cells. In this study, the influence of irradiation on Breg/B10 cell generation and IL-10 production mediated by TLR9 signaling pathways was investigated. Spleen and peritoneal cavity Breg/B10 cell frequencies were significantly expanded three weeks after sub-total body irradiation (sub-TBI, 5Gy or 10Gy) in adult male wild type (WT) C57BL/6(B6) mice but not in TLR9^−/− mice. TLR9 agonist ODN1826 stimulation in vitro for 5h induced more B10 cells to express cytoplasmic IL-10 in sub-TBI WT mice than in TLR9^−/− mice. Prolonged ODN1826 stimulation (48h) induced additional spleen CD19^hiCD5⁺CD1d^hi B cells to express IL-10. TLR9-dependent signaling molecules, MyD88, TRAF6 and IRF8 are involved in sub-TBI induced Breg/B10 cells development and expansion. Furthermore, using a mouse model for multiple sclerosis, we show here that sub-TBI induced Breg/B10 cells dramatically inhibit disease onset and severity when transferred into mice with established experimental autoimmune encephalomyelitis (EAE). Adoptively transferred sub-TBI induced Breg cells significantly suppress inflammatory T cell responses of TH17 and TH1 types in EAE mice. In conclusion, sub-TBI can drive Breg/B10 cell development and expansion, which could be used as a novel tool for suppressing undesirable immunity. The ex vivo expansion and reinfusion of autologous Breg/B10 cells may provide a novel and effective in vivo treatment for severe autoimmune diseases that are resistant to current therapies.

http://ift.tt/2jzPWiK

Reconstruction of Midface Defect from Idiopathic Destructive Process Using Medpor Implant

Publication date: Available online 18 January 2017
Source:American Journal of Otolaryngology
Author(s): Joel Franco, Michael S. Harris, Dominic Vernon, Taha Z Shipchandler
ImportanceReconstruction of the midface remains a challenging task for even the most experienced surgeon, with a host of reconstructive options including free tissue transfer, allografts, or prosthetic implants. Presented here is a case of idiopathic bony destruction of the right midface in a 19 year old female, creating a unique defect requiring repair.ObjectiveDemonstrate a unique case of severe maxillary degeneration and discuss the associated reconstructive challenges and final repair with a prosthetic implant.DesignCase report.ResultsThe patient presented with a 7 month history of an idiopathic progressive deformity of the right cheek. Computed tomography of the paranasal sinuses revealed extensive bone loss of the right midface and orbit. The patient underwent facial reconstruction using a customized Medpor (Stryker Corp, Kalamazoo, MI) implant. At 6 month follow-up the patient and physician were both pleased with the patient's overall appearance. The patient did have some residual lower lid retraction present as well as some lateral pull at the lateral canthus outward from the orbit itself.ConclusionsPreoperative planning for midface reconstruction requires a deep understanding of the aesthetic, functional, and supportive roles this structure holds. Computer assistance allows the creation of custom made implants, providing the reconstructive surgeon with innovative options for reconstruction with minimal morbidity to the patient. As the technology around the design and creation of the custom implants continues to improve, the role of computer assistance in reconstruction will become more prominent.

http://ift.tt/2iJJi5x

Treatment Outcomes in Veterans with HPV-Positive Head and Neck Cancer

Publication date: Available online 18 January 2017
Source:American Journal of Otolaryngology
Author(s): Aaron J. Feinstein, Sophie G. Shay, Elena Chang, Michael S. Lewis, Marilene B. Wang
ObjectivesHead and neck squamous cell carcinoma (HNSCC) caused by the human papilloma virus (HPV) has an improved prognosis relative to HPV-negative tumors. Patients with HPV-positive disease may benefit from different treatment modalities in order to optimize survival and quality of life. We sought to investigate HPV-positive HNSCC within the military veteran population, and analyze the role of treatment modality in outcomes of patients with HPV-positive and HPV-negative tumors.MethodsPatients diagnosed with HNSCC between January 1, 2010 and December 31, 2014 at one regional veterans health center were retrospectively examined. Pathologic specimens underwent testing for HPV subtype and p16 expression. Demographic and clinical factors, including treatment modality, were analyzed for their impact on the primary outcome of overall survival.ResultsThere were 209 patients with primary tumor sites including larynx (25.4%), oral tongue (19.6%), oral cavity (13.4%), oropharynx (17.2%), tonsil (17.2%), unknown primary (2.9%), nasopharynx (1.9%), and multiple sites (2.4%). Patients had HPV-positive (n=82, 39.2%), HPV-negative (n=89, 42.6%) or unknown HPV status (n=38, 18.2%). Primary treatment modalities were chemoradiation (n=124, 59.3%), surgery (n=39, 18.7%), radiation therapy (n=37, 17.7%), or no treatment (n=9, 4.3%). Survival analysis with Cox proportional hazards model demonstrated significant associations with T classification (T4 3.61, P=0.005), N classification (N3 3.52, P=0.0159), M classification (M1 2.8, P=0.0209), and HPV status (HPV-positive 0.43, P=0.0185), but no relation with primary treatment modality (primary surgery vs. primary chemoradiation 1.01, P=0.9718).ConclusionHPV-positive HNSCC in the veteran population has a significantly improved prognosis relative to similarly staged patients with HPV-negative disease. This study demonstrates that the primary treatment modality – chemoradiation, radiation therapy, or surgery – does not impact overall survival among veterans with HPV-positive HNSCC.

http://ift.tt/2jzVIRh

Tumid lupus: An unexpected diagnosis for the otolaryngologist

Publication date: Available online 17 January 2017
Source:American Journal of Otolaryngology
Author(s): Gina D. Jefferson, Vinay K. Aakalu, Marylee Braniecki
Tumid lupus is an uncommon variant of lupus erythematosus. Patients present with subcutaneous lesions. Ophthalmic literature reports disease manifestation as orbital inflammation. Autoimmune serology is often negative. Without a high index of suspicion, the diagnosis is easily overlooked delaying treatment. Tumid lupus is not significantly discussed in the Otolaryngologic literature. Here we present a Case Report of a male who initially presented to Ophthalmology with unilateral orbital complaint of eyelid puffiness. Orbital biopsy and subsequent biopsy of his submental skin lesions ultimately led to this unexpected diagnosis. We discuss the method to diagnose tumid lupus including representative histopathologic findings.

http://ift.tt/2iJE5L2

Intranasal azelastine and mometasone exhibit a synergistic effect on a murine model of allergic rhinitis

Publication date: Available online 18 January 2017
Source:American Journal of Otolaryngology
Author(s): Do Hyun Kim, Boo-Young Kim, Ji-Hyeon Shin, Sung Won Kim, Soo Whan Kim
PurposeThe purpose of this study was to compare the anti-allergic effects of the combination of azelastine and mometasone with those of either agent alone in a Dermatophagoides farinae (Derf)-induced murine model of allergic rhinitis (AR).Materials and MethodsForty BALB/c mice were divided into five groups: azelastine (A), mometasone (M), a combination of azelastine and mometasone (MA), Derf, and control. Derf served as the allergen. Allergic symptom scores, eosinophil counts, and serum Derf-specific IgE levels were measured. The mucosal levels of mRNAs encoding interferon (IFN)-γ, T-bet, interleukin (IL)-4, GATA-3, Foxp3, IL-17, and ROR-γt were determined by real-time polymerase chain reaction. The T-bet, GATA-3, Foxp3, and ROR-γt results were confirmed by Western blotting.ResultsNose-rubbing motions; the levels of mRNAs encoding IL-4, GATA-3, and ROR-γt; and tissue eosinophil count were reduced in the MA compared with those in the Derf group (all P values <0.05). The levels of mRNAs encoding GATA3 and IL-4 mRNA [synthesized by T helper (Th)2 cells] were reduced and that of mRNA encoding Foxp3 was increased in the MA compared with those in the Derf and A groups. Western blotting confirmed these findings.ConclusionWe found that the combination of intranasal azelastine and mometasone synergistically suppressed Th17 responses and (reciprocally) elevated Treg responses. Therefore, this combination not only ameliorated allergic inflammation by suppressing Th2 responses, but also usefully modified the Treg/Th17 balance.

http://ift.tt/2jzLaBD

Complications of Bilateral Neck Dissection in Thyroid Cancer From a Single High-Volume Center.

Complications of Bilateral Neck Dissection in Thyroid Cancer From a Single High-Volume Center.

JAMA Otolaryngol Head Neck Surg. 2017 Jan 12;:

Authors: McMullen C, Rocke D, Freeman J

Abstract
Importance: The morbidity of bilateral lateral neck dissection (BLND) for thyroid cancers has not been described in detail. This study delineates the specific complications arising from BLND for thyroid cancers at a single high-volume center.
Objective: To determine the morbidity associated with BLNDs for differentiated thyroid cancers at our institution.
Design, Setting, and Participants: This was a retrospective review of medical records performed to identify patients having undergone BLNDs for thyroid cancers by a single surgeon at an academic, tertiary medical center in Toronto, Ontario, Canada, from 1988 to 2015. Patients who underwent BLND for papillary, follicular, or medullary thyroid cancers were identified through operative procedure codes and review of operative and pathology reports. The indication for this procedure was suspicious bilateral lateral compartment on imaging and clinical examination. Sixty-two patients who underwent BLND for thyroid cancers, with or without total thyroidectomy and central compartment dissection, were identified.
Main Outcomes and Measures: The main outcome measures for this study were unanticipated medical or surgical complications during the operation or in the postoperative period. Secondary measures were oncologic outcomes, including regional structural or biochemical recurrence.
Results: Of the 62 patients, 24 were male (39%), and 38 (61%) were female. Their mean age was 46 years (range, 17-80 years). The overall risk of permanent hypoparathyroidism was 37%. There was 1 case of unanticipated permanent recurrent nerve paralysis and 1 case of temporary nerve paresis. Postoperative chyle fistula occurred in 6 cases (10%). There were 3 readmissions within 30 days of surgery, 1 pulmonary embolism, and 1 perioperative mortality. Fifty percent of patients had pN0 contralateral necks despite preoperative clinical suspicion. Four patients were found to have anaplastic thyroid cancers intraoperatively. Five patients (8%) developed nodal recurrence in the neck. Four patients died of their disease within available follow-up (mean, 3.2 years).
Conclusions and Relevance: Bilateral lateral neck dissection for thyroid cancers confers a significant amount of morbidity, including a significant rate of hypoparathyroidism. Knowledge of the complications of this procedure, especially in the setting of questionable survival benefit, may assist in preoperative decision-making and patient counseling.

PMID: 28097314 [PubMed - as supplied by publisher]

http://ift.tt/2jzHcJv

Association of Lymphovascular Space Invasion With Locoregional Failure and Survival in Patients With Node-Negative Oral Tongue Cancers.

Association of Lymphovascular Space Invasion With Locoregional Failure and Survival in Patients With Node-Negative Oral Tongue Cancers.

JAMA Otolaryngol Head Neck Surg. 2017 Jan 12;:

Authors: Cassidy RJ, Switchenko JM, Jegadeesh N, Sayan M, Ferris MJ, Eaton BR, Higgins KA, Wadsworth JT, Magliocca KR, Saba NF, Beitler JJ

Abstract
Importance: The indications for adjuvant therapy in resected oral tongue cancers are based on both clinical and pathological factors, with clear evidence for adjuvant radiation in patients with pathologically positive neck lymph nodes, positive margins, and extracapsular extension, but the data for patients with no nodal disease are sparse.
Objective: To investigate determinants of failure and survival in patients with node-negative oral tongue cancer.
Design, Setting, and Participants: Medical records for patients with oral tongue cancer treated with definitive surgery from 2003 to 2013 were reviewed. All patients were cN0 negative and classified as pathologically node-negative (pN0) if a neck dissection was performed. Patients received adjuvant radiotherapy (RT) or chemoradiotherapy (CRT) based on standard clinical and pathological determinants.
Main Outcomes and Measures: Kaplan-Meier and multivariable (MVA) logistic regression and Cox proportional hazard regression analyses were performed to identify patient, tumor, and treatment characteristics predictive of locoregional control (LRC) and overall survival (OS).
Results: A total of 180 patients met entry criteria, with a median follow-up time of 4.9 years (range, 0.9-12.5 years); 102 patients (56.7%) were female and 42 patients (23.3%) were younger than 45 years at diagnosis. One hundred fifty-three patients (85%) had T1/T2 tumors, and 112 patients (62%) had elective neck dissections with confirmed pN0. Lymphovascular space invasion (LVSI) was present in 36 patients (20%). On MVA, LVSI (OR, 0.06; 95% CI, 0.02-0.19; P < .01) was associated with worse LRC. Elective neck dissection (odds ratio [OR], 2.99; 95% CI, 1.16-7.73; P = .02) and receipt of RT (OR, 7.74; 95% CI, 2.27-26.42; P < .01) were associated with improved LRC. Three-year LRC rates were significantly lower for patients with LVSI (38.8%; 95% CI, 22.8%, 54.6%) than those without LVSI (81.9%; 95% CI, 74.4%, 87.4%). On MVA, only LVSI (hazard ratio, 2.20; 95% CI, 1.19-4.06; P = .01) and age greater than 44 years (hazard ratio, 4.38; 95% CI, 1.34-14.27; P = .01) were associated with worse OS. Three-year OS rates were significantly lower in patients with LVSI (71.3%; 95% CI, 53.2%-83.4%) than those without LVSI (90.3%; 95% CI, 83.8%-94.3%).
Conclusions and Relevance: Lymphovascular space invasion in patients with node-negative oral tongue cancer treated with upfront definitive surgery is associated with worse LRC and OS. Node-negative oral cavity cancers with LVSI warrant consideration of further adjuvant therapy, which should be further evaluated in a prospective setting.

PMID: 28097311 [PubMed - as supplied by publisher]

http://ift.tt/2jxzY9m

Laryngeal Immunoglobulin G4-Related Disease Resulting in Severe Airway Obstruction.

Laryngeal Immunoglobulin G4-Related Disease Resulting in Severe Airway Obstruction.

JAMA Otolaryngol Head Neck Surg. 2017 Jan 12;:

Authors: Ferrante SS, Wang L, Kurant D, Daniero JJ

PMID: 28097297 [PubMed - as supplied by publisher]

http://ift.tt/2jxxt6I

A Young Boy With Progressive Dysphonia.

A Young Boy With Progressive Dysphonia.

JAMA Otolaryngol Head Neck Surg. 2017 Jan 12;:

Authors: Puram SV, Doody J, Cunningham MJ

PMID: 28097294 [PubMed - as supplied by publisher]

http://ift.tt/2jxveAw

Decreased expression of 5-HT1A in the circumvallate taste cells in an animal model of depression

Publication date: Available online 18 January 2017
Source:Archives of Oral Biology
Author(s): Doyun Kim, Sena Chung, Sung Ho Lee, Jae Hyung Koo, Jong-Ho Lee, Jeong Won Jahng
ObjectiveIt has been reported that stress can cause anhedonia, a core symptom of depression, and also affect taste responses of the stressed subjects. Anhedonia refers to a reduction of the ability to experience pleasure, which can be detected by decreased response to palatable food in rats. The present study was conducted to examine if stress-induced anhedonia is accompanied by changes in gene expression for taste.DesignFor anhedonia test, rats had free choices of cookies, a palatable food, and chow for 1h following 1h of daily restraint sessions. To examine the development of behavioral depression by restraint stress, ambulatory activity and forced swim tests were performed. Taste cells were harvested from the circumvallate papillae of rats on the 1st, 3rd and 7th day of stress exposure and subjected to the analysis of gene expression for taste.ResultsOne hour of daily stress exposure did not affect chow intake during the entire experimental period. However, from day 2 cookie intake was suppressed, suggesting the development of anhedonia. Ambulatory activity was significantly decreased, and immobility during forced swim test was increased, after the 7th day of stress exposure, but not before. 5-HT1A mRNA expression, but not T1R2, T1R3, T2R6, α-gustducin or PLCβ2 mRNA expression, appeared to be decreased after the 3rd day of stress exposure.ConclusionReduced expression of 5-HT1A in the taste cells, possibly leading to a reduced processing of taste information for palatable food, may additively contribute to the development of anhedonia as a pre-symptomatic feature of depression in stressed subjects.

http://ift.tt/2jxiwBE

Existence of ATP sensitive potassium currents on Human Periodontal ligament cells

Publication date: Available online 17 January 2017
Source:Archives of Oral Biology
Author(s): Phuong Thi Huyen Tran, Young Hee Lee, Janardhan Prasad Bhattarai, Soo Joung Park, Ho-Keun Yi, Seong Kyu Han
ObjectivePotassium channels of the ATP-sensitive family (KATP channel) are inhibited by increase in intracellular ATP. Electrophysiological studies have demonstrated that the kinetics and pharmacological properties of KATP channels vary among different tissues, suggesting structurally and functionally distinct types. There are studies showing human periodontal ligament (PDL) cells respond to mechanical stress by increasing ATP release, which participates in bone resorption or bone homeostasis. So, in this study we investigated the existence of KATP channel subunit and their single channel properties in human periodontal ligaments.Materials & MethodThe human PDL cells were isolated from healthy erupted third molar. For patch-clamp experiments, human PDL fibroblasts were seeded on 3.5cm plastic dishes. The inside-out patch clamp recordings were performed under voltage clamp mode. Reverse transcriptase polymerase chain reaction (RT-PCR) was conducted to identify the channel subunits. All pair-wise comparisons were performed by Paired t-test. A P value <0.05 was considered significant.ResultsWe observed mRNA transcripts for Kir6.1, Kir6.2 and Sur2B subuits in the human PDL cells. In inside-out patch mode, the single channel conductance was 163 pS at symmetrical K⁺ concentration of 140mM and inward rectification was seen in ATP-free bath solution. The reversal potential of the currents was found to be 0mV at symmetrical concentration (140mM) of K⁺ in bath solution. The single channel currents were almost blocked by adding 5mM ATP in the bath solution. However, the currents were not blocked by 100μM glibenclamide, a subunit specific KATP channel blocker.ConclusionsThese results indicate that human PDL cells express KATP channels subunit including SUR2B and Kir6.1 and Kir6.2 which are sensitive to ATP but insensitive to glibenclamide.

http://ift.tt/2jKZGo0

Decreased expression of 5-HT1A in the circumvallate taste cells in an animal model of depression

Existence of ATP sensitive potassium currents on Human Periodontal ligament cells

Dermatologische topische und Systemtherapie in der Schwangerschaft

Zusammenfassung

Während der Schwangerschaft ist ein erfolgreiches und sicheres therapeutisches Management der Patienten zur Verringerung der Krankheitslast möglich. Meist reicht eine topische Therapie, ggf. begleitet von einer Basistherapie. Darüber hinaus können Systemtherapien z. B. bei Autoimmunerkrankungen oder Psoriasis durchaus sicher eingesetzt werden. Hier gilt es, auch bei geplanten Schwangerschaften frühzeitig Medikamente abzusetzen, zu reduzieren, mögliche alternative Therapien zu besprechen bzw. ein frühes Monitoring zu starten. Zu bedenken ist immer, dass Medikamente in möglichst geringer Dosis (ohne Okklusion bei Lokaltherapien) und kurzzeitig (Ausnahme: Autoimmun- oder maligne Erkrankungen) anzuwenden sind. Eine interdisziplinäre Zusammenarbeit zwischen Gynäkologen, Rheumatologen, Internisten und Dermatologen sowie Pharmazeuten ist unabdingbar.

http://ift.tt/2jL7Mgf

Atrophic pityriasis versicolor occurring in a patient with Sjögren's syndrome

Pityriasis versicolor is one of the most frequent epidermal mycotic infections in the world, but its atrophic variant is rarely described. The aetiology of the atrophy is still unknown, and two main hypotheses have been formulated, one suggesting a correlation with long-term use of topical steroids and the other a delayed type hypersensitivity to epicutaneous antigens derived from components of the fungus. Atrophic pityriasis versicolor is a benign disease, but needs to be distinguished from other more severe skin diseases manifesting with cutaneous atrophy. The diagnosis can be easily confirmed by direct microscopic observation of the scales soaked in 15% potassium hydroxide, which reveals the typical 'spaghetti and meatball' appearance, or by a skin biopsy in doubtful cases. Here, we describe a case of extensive atrophic pityriasis versicolor occurring in a woman affected by Sjögren's syndrome which completely resolved after topical antifungal treatment.

http://ift.tt/2jo0ZJx

Multiple pregnancy in a primigravida with uncorrected Pentalogy of Fallot

Pentalogy of Fallot is a cyanotic congenital heart disease that has guarded prognosis without surgical intervention in infancy. Women with uncorrected defects rarely survive into childbearing age and pregnancy in this group is associated with a high rate of perinatal loss. Physiological cardiovascular changes in pregnancy can lead to maternal haemodynamic instability with subsequent adverse cardiac sequelae with or without fetal decompensation. Optimum management and pregnancy outcomes in mother with uncorrected Pentalogy of Fallot and twin pregnancy have not been described in the literature. We describe a successful case of monochorionic diamniotic twin pregnancy in an affected woman who has not undergone surgical repair. Her pregnancy progressed without any adverse cardiopulmonary complications. Her caesarean delivery and postpartum recovery were favourable, with successful birth of two healthy babies at 35.7 weeks. This case emphasises the importance of a multidisciplinary team, especially of obstetricians with expertise in high-risk pregnancies, adult congenital heart disease cardiologists and anaesthesiologist.

http://ift.tt/2jzoilY

Mucormycosis pulmonary abscess, containment in a patient with uncontrolled diabetes mellitus

A 56-year-old Hispanic male with solo risk factor of uncontrolled diabetes mellitus presented with recurrent haemoptysis. Initial concern was for malignancy with postobstructive pneumonia; however, invasive testing and biopsy confirmed infectious mass of fungal aetiology requiring surgical resection followed by a prolonged course of anti-fungal therapy. Discussion centred on approach to, progression of and course of action in the management of pulmonary abscess due to mucormycosis.

http://ift.tt/2jo76Og

A rare cause of constrictive pericarditis

A 67-year-old man presented with 3 months of exertional dyspnoea and 1 week of oedema. Examination revealed elevated neck veins, pulsus paradoxus, muffled heart sounds, decreased breath sounds and pedal oedema. Transthoracic echocardiogram (TTE) demonstrated cardiac tamponade, and chest X-ray showed pleural effusion. Pericardiocentesis, thoracocentesis, laboratory investigations and CT did not elucidate an underlying aetiology. Three weeks later, he presented with recurrent cardiac tamponade and pleural effusion. Pericardial window histology was benign. Pleural and pericardial fluids were again unrevealing. Three months later, he presented with worsening congestive heart failure. TTE, cardiac catheterisation and cardiac MRI were consistent with constrictive pericarditis. Preoperative workup did not identify an underlying cause. The patient underwent subtotal pericardiectomy. Intraoperative frozen section indicated malignancy. Pathology confirmed metastatic poorly differentiated signet ring adenocarcinoma of intestinal origin. He died 4 days postoperatively from multiorgan failure.

http://ift.tt/2jzeM2g

Pain in the neck

Description

A girl aged 4 years presented with a 1-month history of headache, malaise and episodes of unsteady gait. She appeared well with normal observations. She had limited neck extension and lateral rotation with normal neurological examination. A CT head showed no space-occupying lesion and the patient was discharged.

She re-presented a week later with neck pain, stiffness and intermittent fever. There were no signs of upper airway obstruction and she continued to eat as normal. Repeat CT of the neck and MRI revealed significant thickening of the retropharyngeal soft tissue with collection in keeping with a retropharyngeal abscess causing significant narrowing of the pharynx along with osteomyelitis of the clivus (see figure 1).

Figure 1

CT neck with contrast showing retropharyngeal abscess and osteomyelitis of the clivus.

She was started on broad-spectrum intravenous antibiotics and surgical drainage was attempted but...

http://ift.tt/2jzp3eR

Primary squamous cell carcinoma of the thyroid with complete response to radical radiotherapy and concurrent cisplatin-based chemotherapy

Chemoradiotherapy and/or surgery are both potentially radical treatments for squamous cell carcinomas. Squamous cell carcinomas are considered chemosensitive tumours compared to adenocarcinomas or anaplastic thyroid malignancies. A 76-year-old man was found to have T4bN0M0 primary squamous cell carcinoma of the thyroid with encasement of the internal carotid artery. The disease was deemed unresectable. Therefore, he was treated with radical radiotherapy with concurrent cisplatin-based chemotherapy. We discuss herein the aetiology, diagnosis and management of primary squamous cell carcinoma of the thyroid. We demonstrate success of chemoradiotherapy in an unresectable case of a rare and aggressive disease.

http://ift.tt/2j9jNvn

Clostridium hastiforme bacteraemia secondary to pyometra in a 64-year-old woman

The Gram-negative, rod-shaped, anaerobe bacteria Tissierella praeacuta was first described in 1908 by Tissier. However, during the past decade, Clostridium hastiforme has been recognised as a later synonym of T. praeacuta. C. hastiforme/T. praeacuta has only rarely been described in previous literature as a cause of human infection. We present here a case report of C. hastiforme/T. praeacuta bacteraemia secondary to pyometra in a 64-year-old woman with a history of multiple sclerosis and an intrauterine device inserted three decades earlier. C. hastiforme/T. praeacuta was isolated from blood as well as pus from the site of infection. The patient was cured with a combination of drainage and antibiotic therapy.

http://ift.tt/2jzeMzi

Perioperative management of a large, late presenting phaeochromocytoma

A 77-year-old man presenting to the emergency department with an acute coronary syndrome was later found to have a phaeochromocytoma. The lateness of this presentation was likely due to the protective α blocking effects of long-term terazosin therapy for his prostatism. α blockers such as terazosin are a well-recognised medical therapy in the perioperative optimisation of phaeochromocytoma because they treat the adrenergic effects of catecholamine release from the tumour such as hypertension. This patient was diagnosed with an ST elevation myocardial infarction (STEMI). A cardiac angiogram showed no evidence of vessel occlusion. A right adrenal mass of 9x8x9 cm was incidentally found and confirmed as a phaeochromocytoma with raised plasma metanephrines and normetanephrines. Following preoperative optimisation and multidisciplinary team involvement, an open right adrenalectomy was performed successfully some months later.

http://ift.tt/2jo2KGM

Stentriever thrombectomy with distal protection device for carotid free floating thrombus: a technical case report

We report the clinical details, imaging findings and management of a 45-year-old man who presented with recurrent transient ischemic attacks due to carotid free floating thrombus. Free floating thrombus of the carotid artery is a very rare condition with a high risk of distal embolic shower. The optimal treatment options are debatable and include medical management, surgical thrombectomy and endovascular thrombectomy. We describe the use of a stentriever with filter protection in the management of carotid free floating thrombus as a novel treatment option.

http://ift.tt/2jxlgim

Late spontaneous decapsulation of the kidney graft in a patient with hepatitis C and treated with sirolimus: possible pathophysiological association in a rare complication

Late decapsulation with fluid collection is a rare complication of renal transplantation with deleterious effects on kidney function. Its physiopathology is unclear but there might be an association with mammalian target of rapamycin (m-TOR) inhibitors, especially in patients with chronic hepatitis C. We report a case of late spontaneous decapsulation 12 years after kidney transplant in a patient infected with hepatitis C under treatment with sirolimus. He underwent marsupialisation of the collection, sirolimus was converted to cyclosporine and hepatitis C treatment was performed with success. This is the first successful case report of late spontaneous decapsulation of the kidney graft in a patient with hepatitis C.

http://ift.tt/2jo720Y

Ocular surface squamous neoplasia treated with topical interferon {alpha} 2b

Description

A 64-year-old male patient presented with fleshy lesion over the right temporal conjunctiva for the past 3 months with a gradual increase in size. History of trauma and pain was absent, and past history did not reveal any significant ocular/systemic morbidities. Right eye examination showed single 6*8 mm lesion fleshy mass on the temporal aspect of right conjunctiva extending from the limbus, and the surface showed 'corkscrew' vessels, with prominent 'feeder' vessel; impression cytology revealed dysplastic cells consistent with ocular surface squamous neoplasia (OSSN) (figure 1A).

Figure 1

(A) Clinical picture of the tumour before starting topical interferon α 2b. (B) At the end of 2 weeks, approximately a quarter reduction in the size of the tumour mass. (C) At the end of 5 weeks, there is a complete regression of the tumour mass along with feeder vessel.

The patient requested for medical line...

http://ift.tt/2jKXehi

Acute mania after levothyroxine replacement for hypothyroid-induced heart block

Psychiatric disturbances can manifest after levothyroxine (LT4) treatment for severe hypothyroidism. We present the case of a young Filipino man with Hashimoto's thyroiditis and high-grade heart block, who was given a full replacement LT4 dose on admission. Twenty-four hours after this dose, he developed manic symptoms, which were addressed with sedatives and neuroleptics with gradual restoration of euthymia the following day. A comprehensive workup did not reveal any findings suggestive of another aetiology for either mania or heart block. We ultimately ascribed the mania as secondary to LT4, and the heart block to hypothyroidism. Although mania is more likely to be precipitated by high starting LT4 doses, reports have shown that symptoms can still arise even at lower doses and with more gradual titration, especially in long-standing hypothyroidism.

http://ift.tt/2jo13t7

Cutaneous Genital Nodules in a Patient With Graft-vs-Host Disease

A woman with chronic graft-vs-host disease presented with several yellow-colored nodules, some of them ulcerated with extrusion of yellow-colored discharge, on the left labia majora and the perianal area. What is your diagnosis?

http://ift.tt/2k4txuT

Interventions for Female Pattern Hair Loss

This Clinical Evidence Synopsis summarizes a Cochrane review on interventions for female pattern hair loss.

http://ift.tt/2j9k01G

Sun Protection by Beach Umbrella vs High SPF Sunscreen

This randomized clinical trial measures sunburn protection offered by a standard beach umbrella compared with that provided by sunscreen with a high sun protection factor.

http://ift.tt/2k4zoQK

Cutaneous Pseudolymphoma Induced by a GM-CSF–Producing Tumor Cell Vaccine

This report describes 2 cases of injection-site cutaneous pseudolymphoma induced by a GM-CSF–producing tumor cell vaccine.

http://ift.tt/2j9gMuM

Influence of Information Framing on Patient Decisions to Treat Actinic Keratosis

This survey-based study assesses the influence of physicians' presentation of information regarding actinic keratosis on patient decisions regarding treatment.

http://ift.tt/2k4uq6C

Novel Alternate Vismodegib Dosing For Advanced Basal Carcinomas

This case series study evaluates a novel alternate dosing regimen of vismodegib that has led to decreased toxicity and eliminates the need for a loading dose.

http://ift.tt/2j9kg0l

Tattoo Artists’ Approach to Melanocytic Nevi

This study examines tattoo artists' awareness of skin cancer and whether this influences the decision to refer clients with a suspicious lesion to a dermatologist.

http://ift.tt/2j9nSzy

In the February BJA ...

http://ift.tt/2jzjlcV

'LIVES: a mnemonic for teaching advanced airway management

http://ift.tt/2iJ8YPz

Preoperative {alpha}-blockade in catecholamine-secreting tumours: fight for it or take flight?

http://ift.tt/2jz8IGU

Efficacy of continuous intravenous glucose monitoring in perioperative glycaemic control: a randomized controlled study

http://ift.tt/2iJiIJv

Quest to determine the ideal position of the central venous catheter tip

http://ift.tt/2jzexEs

Waist circumference is better than body mass index, but sagittal anterior diameter may be even better

http://ift.tt/2iJ5UTL

Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) in children: a step forward in apnoeic oxygenation, paradigm-shift in ventilation, or both?

http://ift.tt/2iJfbuZ

Children and parental anxiolysis in paediatric ambulatory surgery: a randomized controlled study comparing 0.3 mg kg-1 midazolam to tablet computer based interactive distraction

Background. The operating theatre, anaesthesia induction and separation from parents create fear and anxiety in children. Anxiety leads to adverse behavioral changes appearing and sometimes persisting during the postoperative period. Our aim was to compare the effects of midazolam (0.3 mg kg^–¹: MDZ) for premedication with age-appropriate tablet game apps (TAB) on children anxiety during and after ambulatory surgery.

Methods. A randomized controlled trial was conducted from May 16th, 2013 to March 25th, 2014 at the Children Hospital of Lyon. The primary outcome of this study was the change in m-YPAS score at the time of anaesthetic mask induction. Anxiety was also assessed in the waiting surgical area, at the time of separation with parents and when back in the ambulatory surgery ward.

Results. One hundred and eighteen patients aged four-11 yr were recruited, 60 in the TAB Group and 58 in the MDZ Group. Main endpoint was missing for three patients from the MDZ Group. At the time of mask induction, there was no significant difference between MDZ and TAB Group for the m-YPAS score (40.5 (18.6) vs 41.8 (20.7), P = 0.99). There was no significant correlation between m-YPAS score and its evolution over the four period of time between subjects.

Conclusions. We were not able to show whether TAB is superior to MDZ to blunt anxiety in children undergoing ambulatory surgery. TAB is a non-pharmacological tool which has the capacity in reducing perioperative stress without any sedative effect in this population.

Clinical trial registration. NCT 02192710

http://ift.tt/2jziR6z

Indirect admission to intensive care after surgery: what should be considered?

http://ift.tt/2iJ2Ir0

Ketamine inhalation

http://ift.tt/2jz5ZgA

Stopping antithrombotics during regional anaesthesia and eye surgery: crying wolf?

http://ift.tt/2iJ83OY

Preoperative supplementation with fibrinogen concentrate in cardiac surgery

http://ift.tt/2jzhwfN

Paravertebral block in paediatric abdominal surgery--a systematic review and meta-analysis of randomized trials

The increased popularity of paravertebral block (PVB) can be attributed to its relative safety and comparable efficacy when compared with epidural analgesia. It has thus been recommended for open cholecystectomy and other less painful surgeries such as inguinal herniorraphy and appendectomy. We performed a systematic review of PVB in paediatric abdominal conditions to assess its clinical efficacy and side effects compared with other analgesic therapies.

A search of Medline, Embase, and Web of Science and hand-searching references from inception date to May 2016 was done. Relevant studies were randomized clinical trials in patients 0–18 years old comparing PVB (single shot or continuous catheter) with any comparator and analgesic medication. Pain scores, rescue analgesia and adverse events were compared.

The systematic reviews identified six trials enrolling 358 paediatric patients. PVB medications included bupivacaine, ropivacaine, lidocaine, and fentanyl. Surgical procedures included inguinal herniorraphy, cholecystectomy, and appendectomy. The standardized mean difference in early pain scores favoured PVB: 0.85 [95% confidence interval (CI) 0.12–1.58] at 4–6 h and 0.64 (95% CI 0.28–1.00) at 24 h. One study reported a reduced length of stay. Parental [odds ratio (OR) 5.12 (95% CI 2.59–10.1)] and surgeon [OR 6.05 (95% CI 2.25–16.3)] satisfaction were higher in those receiving a PVB. No major complications occurred with a PVB.

PVB resulted in minimally improved pain scores for up to 24 h after surgery, reduced rescue analgesia requirements, and increased surgeon and parental satisfaction. PVB is a good alternative to caudal and ilioinguinal block in paediatric abdominal surgery.

http://ift.tt/2iJ6h0n

Surgical Pain Management: A Complete Guide to Implantable and Interventional Pain Therapies, S Narang, A Weisheipl and EL Ross (editors)

http://ift.tt/2jz8Vdi

Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: a systematic review and meta-analysis of randomized controlled trials

Background. Dexmedetomidine has been proposed as a perineural local anaesthetic (LA) adjunct to prolong peripheral nerve block duration; however, results from our previous meta-analysis in the setting of brachial plexus block (BPB) did not support its use. Many additional randomized trials have since been published. We thus conducted an updated meta-analysis.

Methods. Randomized trials investigating the addition of dexmedetomidine to LA compared with LA alone (Control) in BPB for upper extremity surgery were sought. Sensory and motor block duration, onset times, duration of analgesia, analgesic consumption, pain severity, patient satisfaction, and dexmedetomidine-related side-effects were analysed using random-effects modeling. We used ratio-of-means (lower confidence interval [point estimate]) for continuous outcomes.

Results. We identified 32 trials (2007 patients), and found that dexmedetomidine prolonged sensory block (at least 57%, P < 0.0001), motor block (at least 58%, P < 0.0001), and analgesia (at least 63%, P < 0.0001) duration. Dexmedetomidine expedited onset for both sensory (at least 40%, P < 0.0001) and motor (at least 39%, P < 0.0001) blocks. Dexmedetomidine also reduced postoperative oral morphine consumption by 10.2mg [-15.3, -5.2] (P < 0.0001), improved pain control, and enhanced satisfaction. In contrast, dexmedetomidine increased odds of bradycardia (3.3 [0.8, 13.5](P = 0.0002)), and hypotension (5.4 [2.7, 11.0] (P < 0.0001)). A 50-60µg dexmedetomidine dose maximized sensory block duration while minimizing haemodynamic side-effects. No patients experienced any neurologic sequelae. Evidence quality for sensory block was high according to the GRADE system.

Conclusions. New evidence now indicates that perineural dexmedetomidine improves BPB onset, quality, and analgesia. However, these benefits should be weighed against increased risks of motor block prolongation and transient bradycardia and hypotension.

http://ift.tt/2iJ8Yiw

Higher risk of opioid-induced respiratory depression in children with neurodevelopmental disability: a retrospective cohort study of 12 904 patients

Background. Children with neurodevelopmental disabilities may be at risk of opioid-induced respiratory depression. We aimed to quantify the risks and effectiveness of morphine nurse-controlled analgesia (morphine-NCA) for postoperative pain in children with neurodevelopmental disabilities.

Methods. We carried out a retrospective cohort study of 12 904 children who received postoperative i.v. morphine-NCA. Subjects were divided into a neurodevelopmental disability group and a control group. Rates of clinical satisfaction, respiratory depression, and serious adverse events were obtained, and statistical analysis, including multilevel logistic regression using Bayesian inference, was performed.

Results. Of 12 904 patients, 2390 (19%) had neurodevelopmental disabilities. There were 88 instances of respiratory depression and 52 serious adverse events; there were no opioid-related deaths. The cumulative incidence of respiratory depression in the neurodevelopmental disability group was 1.09% vs 0.59% in the control group [odds ratio 1.8 (98% chance that the true odds ratio was >1)]. A significant interaction between postoperative morphine dose and neurodevelopmental disabilities was observed, with higher risk of respiratory depression with increasing dose. Satisfaction with morphine-NCA was very high overall, although children with neurodevelopmental disabilities were 1% more likely to have infusions rated as fair or poor (3.3 vs 2.1%, ²P<0.001).

Conclusions. Children with neurodevelopmental disabilities were 1.8 times more likely to suffer respiratory depression, absolute risk difference 0.5%; opioid-induced respiratory depression in this group may relate to increased sensitivity to dose-relate respiratory effects of morphine. Morphine-NCA as described was an acceptable technique for children with and without neurodevelopmental disabilities.

http://ift.tt/2jznflT

Perioperative {alpha}-receptor blockade in phaeochromocytoma surgery: an observational case series

Background. Mortality associated with surgery for phaeochromocytoma has dramatically decreased over the last decades. Many factors contributed to the dramatic decline of the mortality rate, and the influence of an α-receptor blockade is unclear and has never been tested in a randomized trial. We evaluated intraoperative haemodynamic conditions and the incidence of complications in patients with and without α-receptor blockade undergoing surgery for catecholamine producing tumours.

Methods. Haemodynamic conditions and perioperative complications were assessed in 110 patients with (B) and 166 without (N) α-receptor blockade. Data were analysed as a consecutive case series of 303 cases and subsequently via propensity score matching, and presented as mean and confidence interval (CI).

Results. No difference in maximal intraoperative systolic arterial pressures (B = 178 mm Hg (CI 169-187) vs N = 185 mm Hg (CI 177-193; P = 0.2542) and hypertensive episodes above 250 mm Hg were found (P = 0.7474) for the closed case series. No major complications occurred. Propensity score matching (75 pairs) revealed a significant difference of 17 mm Hg in maximal intraoperative systolic bp for these selected pairs (P = 0.024).

Conclusions. Only a slight difference in mean maximal systolic arterial pressure was detected between patients with or without an α-receptor blockade. There was no difference in the incidence of excessive hypertensive episodes between groups and no major complications occurred. The basis for the general recommendation of perioperative α- receptor blockade for phaeochromocytoma surgery demands further study.

http://ift.tt/2iJaBMY

Feasibility of measuring memory response to increasing dexmedetomidine sedation in children

Background. The memory effect of dexmedetomidine has not been prospectively evaluated in children. We evaluated the feasibility of measuring memory and sedation responses in children during dexmedetomidine sedation for non-painful radiological imaging studies. Secondarily, we quantified changes in memory in relation to the onset of sedation.

Methods. A 10 min bolus of dexmedetomidine (2 mcg kg^-1) was given to children as they named simple line drawings every five s. The absence of sedation was identified as any verbal response, regardless of correctness. After recovery, recognition memory was tested with correct Yes/No recognitions (50% novel pictures) and was matched to sedation responses during the bolus period (subsequent memory paradigm).

Results. Of 64 accruals, 30 children (mean [SD]6.1 (1.2) yr, eight male) received dexmedetomidine and completed all study tasks. Individual responses were able to be modelled successfully in the 30 children completing all the study tasks, demonstrating feasibility of this approach. Children had 50% probability of verbal response at five min 40 s after infusion start, whereas 50% probability of subsequent recognition memory occurred sooner at four min five s.

Conclusions. Quantifying memory and sedation effects during dexmedetomidine infusion in verbal children was possible and demonstrated that memory function was present until shortly before verbal unresponsiveness occurred. This is the first study to investigate the effect of dexmedetomidine on memory in children.

Clinical trial registration. NCT 02354378.

http://ift.tt/2jzqeuO

The Effects of T4 Versus T4/T3 on Psychological Distress After Total Thyroidectomy in Thyroid Cancer Patients

Conditions: Thyroid Cancer; Distress; Depression; Anxiety; Fatigue
Interventions: Drug: Comthyroid; Drug: Synthroid
Sponsors: Inje University; Dongnam Institute of Radiological & Medical Sciences
Recruiting - verified January 2017

http://ift.tt/2j9a5Jv

Intraoperative dexamethasone does not increase the risk of postoperative wound infection: a propensity score-matched post hoc analysis of the ENIGMA-II trial (EnDEX)

Background. In a post hoc analysis of the ENIGMA-II trial, we sought to determine whether intraoperative dexamethasone was associated with adverse safety outcomes.

Methods. Inverse probability weighting with estimated propensity scores was used to determine the association of dexamethasone administration with postoperative infection, quality of recovery, and adverse safety outcomes for 5499 of the 7112 non-cardiac surgery subjects enrolled in ENIGMA-II.

Results. Dexamethasone was administered to 2178 (40%) of the 5499 subjects included in this analysis and was not associated with wound infection [189 (8.7%) vs 275 (8.3%); propensity score-adjusted relative risk (RR) 1.10; 95% confidence interval (CI) 0.89–1.34; P=0.38], severe postoperative nausea and vomiting on day 1 [242 (7.3%) vs 189 (8.7%); propensity score-adjusted RR 1.06; 95% CI 0.86–1.30; P=0.59], quality of recovery score [median 14, interquartile range (IQR) 12–15, vs median 14, IQR 12–16, P=0.10), length of stay in the postanaesthesia care unit [propensity score-adjusted median (IQR) 2.0 (1.3, 2.9) vs 1.9 (1.3, 3.1), P=0.60], or the primary outcome of the main trial. Dexamethasone administration was associated with a decrease in fever on days 1–3 [182 (8.4%) vs 488 (14.7%); RR 0.61; 95% CI 0.5–0.74; P<0.001] and shorter lengths of stay in hospital [propensity score-adjusted median (IQR) 5.0 (2.9, 8.2) vs 5.3 (3.1, 9.1), P<0.001]. Neither diabetes mellitus nor surgical wound contamination status altered these outcomes.

Conclusion. Dexamethasone administration to high-risk non-cardiac surgical patients did not increase the risk of postoperative wound infection or other adverse events up to day 30, and appears to be safe in patients either with or without diabetes mellitus.

Clinical trial registration. NCT00430989.

http://ift.tt/2iJ7Z1G

Effect of Different Viscous Foods and Liquids on Swallowing Sounds

Condition: Deglutition Disorder
Intervention:
Sponsor: University of Nebraska
Not yet recruiting - verified January 2017

http://ift.tt/2jxaOHO

Does benzodiazepine administration affect patient satisfaction: a secondary analysis of the ConCIOUS study

http://ift.tt/2jz5SSc

Neck-specific Exercise in Chronic Whiplash

Condition: Whiplash Associated Disorders
Intervention: Other: Neck-specific exercise
Sponsor: Linkoeping University
Not yet recruiting - verified January 2017

http://ift.tt/2j9hdFr

Palbociclib With Cetuximab and IMRT for Locally Advanced Squamous Cell Carcinoma

Conditions: Head and Neck Cancer; Locally Advanced; Unresectable
Interventions: Drug: Palbociclib; Drug: Palbociclib; Drug: Palbociclib; Drug: Palbociclib; Drug: Cetuximab; Radiation: Intensity Modulated Radiation Therapy
Sponsor: Mahidol University
Not yet recruiting - verified January 2017

http://ift.tt/2jnVM4z

Neutrophil subset responses in infants with severe viral respiratory infection

Publication date: Available online 17 January 2017
Source:Clinical Immunology
Author(s): Bart Cortjens, Sarah A. Ingelse, Job C. Calis, Alexander P. Vlaar, Leo Koenderman, Reinout A. Bem, Job B. van Woensel
Neutrophils are the predominant inflammatory cells recruited to the respiratory tract as part of the innate immune response to viral infections. Recent reports indicate the existence of distinct functional neutrophil subsets in the circulatory compartment of adults, following severe inflammatory conditions. Here, we evaluated the occurrence of neutrophil subsets in blood and broncho-alveolar lavage fluid during severe viral respiratory infection in infants based on CD16/CD62L expression. We show that during the course of severe respiratory infection infants may develop four heterogeneous neutrophil subsets in blood (mature, immature, progenitor, and suppressive neutrophils), each with distinct activation states. However, while isolated viral respiratory infection was characterized by a relative absence of suppressive neutrophils in both blood and lungs, only patients with bacterial co-infection were shown to produce suppressive neutrophils. These data suggest the occurrence of distinct and unique neutrophil subset responses during severe viral and (secondary) bacterial respiratory infection in infants.

http://ift.tt/2jwI02c

From natalizumab to fingolimod in eight weeks – immunological, clinical, and radiological data in quest of the optimal switch

Publication date: Available online 17 January 2017
Source:Clinical Immunology
Author(s): Andrea Harrer, Georg Pilz, Katrin Oppermann, Marlene Sageder, Shahrzad Afazel, Elisabeth Haschke-Becher, Theo Rispens, Annick de Vries, Mark McCoy, Vlado Stevanovic, Wolfgang Hitzl, Eugen Trinka, Jörg Kraus, Johann Sellner, Peter Wipfler
Natalizumab (NZB) discontinuation during a treatment change is associated with recurrence of disease activity in a significant proportion of multiple sclerosis (MS) patients. The immunological basis why disease reactivation occurs in selected patients is unresolved. In search of a prognostic biomarker for a safe and effective transition from NZB to fingolimod, we monitored five parameters related to pharmacokinetic and pharmacodynamic effects of the two drugs in 12 MS patients until six months on fingolimod. Clearance of free and cell-bound NZB, re-expression of alpha-4, and fingolimod-mediated changes on CD8+ and CD4+ T cell subsets showed pronounced interindividual variability. Higher frequencies of memory CD8+ T cells after six months on fingolimod were the sole association with disease reactivation. None of the investigated parameters thus had potential as prognostic biomarker for the outcome of the switch. Our findings rather support the thesis of broad interindividual differences in the immunopathogenesis of MS.

http://ift.tt/2jnxbg9

Clinical Anatomy of the lingual nerve: a review

Publication date: Available online 18 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Somsak Sittitavornwong, Michael Babston, Douglas Denson, Steven Zehren, Jonathan Friend
PurposeKnowledge of lingual nerve anatomy is of paramount importance to dental practitioners and maxillofacial surgeons. The purpose of this article is to review lingual nerve anatomy from the cranial base to its insertion in the tongue, so as to provide a more detailed explanation of its course in order to prevent procedural nerve injuries.Materials and MethodsFifteen human cadavers from the University of Alabama at Birmingham School of Medicine's Anatomical Donor Program were reviewed. The anatomical structures and landmarks were identified and confirmed by anatomists. Lingual nerve dissection was carried out and reviewed on fifteen halved human cadaver skulls, twenty-eight total specimens.ResultsCadaveric dissection provides a detailed examination of the lingual nerve from the cranial base to tongue insertion. The lingual nerve receives the chorda tympani nerve about 1 cm in distance below the bifurcation of the lingual and inferior alveolar nerves. The pathway of the lingual nerve is in contact with the periosteum of the mandible just behind the internal oblique ridge. The lingual nerve crosses the submandibular duct at the interproximal space between the mandibular first and second molars. The submandibular ganglion is suspended from the lingual nerve at the distal area of the second mandibular molar.ConclusionA zoning classification is another way to more accurately describe the lingual nerve based on close anatomical landmarks as seen in human cadaveric specimens. This system may identify particular areas of interest that may be at greater procedural risk.

http://ift.tt/2iIxjoO

Surgical navigation in oral and maxillofacial surgery – a systematic review of the literature for five useful indications

Publication date: Available online 18 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Iman Azarmehr, Kasper Stokbro, R Bryan Bell, Torben Thygesen
PurposeThis systematic review investigates the most common indications, treatments and outcomes of surgical navigation (SN) published from 2010 to 2015. The evolution of SN and its application in oral and maxillofacial surgery have rapidly developed over recent years and therapeutic indications are discussed.Methods and materialsA systematic search in relevant electronic databases, journals and bibliographies of the included articles was carried out. Clinical studies with more than five patients or more published between 2010 and 2015 were included. Traumatology, orthognathic surgery, cancer and reconstruction surgery, skull base surgery and foreign body removal were the areas of interests.ResultsThe search generated 13 articles; five, six, two and zero studies, respectively, were found that dealt with the previously mentioned five topics. The average technical system accuracy and intra-operative precision reported were <1 mm and 1–2 mm, respectively. In general, SN is reported to be a useful tool for surgical planning, execution, evaluation and research. The largest number of studies and patients was identified in the field of traumatology. Treatment of complex orbital fractures was significantly improved by the use of SN compared to traditionally treated control groups.ConclusionSN seems to be very promising addition to the surgical toolkit. Planning details of the surgery in a 3D virtual environment and execution with real-time guidance can significantly improve precision. Among factors to be considered are the financial investments necessary and the learning curve.

http://ift.tt/2jyxR4u

The use of a chitosan-derived haemostatic agent for post-extraction bleeding control in patients on anti-platelet treatment

Publication date: Available online 18 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Roberto Pippi, Marcello Santoro, Arturo Cafolla
PurposeThe current approach for tooth extraction in patients receiving anti-platelet treatment requires the use of local haemostatic agents without previous thromboembolic treatment interruption. The aim of the present study was to evaluate the effectiveness of an extra-alveolar haemostatic agent, the HemCon® Dental Dressing (HDD), in controlling post-surgical bleeding.MethodsRoutine, atraumatic tooth extractions were performed in a single session under local anesthesia without vasoconstrictor and without APT interruption. All patients underwent the extraction of two teeth in the same session, each one in a different dental hemi-arch and the haemostatic method to be used was randomly chosen: in the test site (SH), the HDD was applied, whereas in the control site (SX), a common haemostatic sponge (CollaPlug, Zimmer Dental) was applied and stabilized in situ with a suture. For each surgery, two different times were measured: the time required for haemostatic agent application (T1) and the time required for haemostasis achievement (T2). Post-operative pain and healing quality was also evaluated.ResultsTwenty out-patients were enrolled. The mean application time was significantly lower in the test group than in the control group; the mean bleeding time in the control group was significantly lower than in the test group; pain values was lower in the test group than in the control group, especially at suture removal; post-extraction socket healing was better in the test group than in the control group.ConclusionHDD seems therefore to be a valid and safe alternative in treating post-extraction sockets in out-patients under single drug anti-platelet treatment, in the absence of surgical wound lacerations.

http://ift.tt/2iIwbRW

Primary intraosseous adenoid cystic carcinoma of the mandible: a comprehensive review with analysis of 2 additional cases

Publication date: Available online 18 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Hong Ying Hu, Yuan Yuan Liu, Hu Wang, Meng Jiang
Primary intra-osseous adenoid cystic carcinoma(IACC) of the mandible is poorly understood due to its rarity. This study performed a comprehensive literature review on the IACC of the mandible. Forty-five cases of IACC reported in literatures and two additional cases present in our hospital were reviewed. The conclusions were that IACC of the mandible generally occurred in the fourth to sixth decades, with no significant gender predilection. Pain and swelling were the most common clinical manifestations. The diagnosis of IACC should based on the clinical, radiological and pathological examinations. With regards to treatment, radical surgery combined with postsurgical radiotherapy was recommended as the best choice. In addition, the histological subtype of the tumor is an important prognostic factor in patients with IACC.

http://ift.tt/2jyV1rE

Clinical Course of Oral Squamous Cell Carcinoma in Patients on Immunosuppressant and Glucocorticoid Therapy

Publication date: Available online 18 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Hideaki Hirai, Hirofumi Tomioka, Yumi Mochizuki, Yu Oikawa, Fumihiko Tsushima, Hiroyuki Harada
PurposeDepressed immune function is a serious adverse effect of long-term immunosuppressant and/or steroid administration at doses that exceed the physiologically required amount. The purpose of this study was to determine the effects of immunosuppression on carcinogenesis, particularly malignant tumor development, in patients with oral squamous cell carcinoma who were immunosuppressed because of immunosuppressant and/or steroid therapy administered for various underlying diseases.MethodsIn this retrospective chart review, 886 patients with oral squamous cell carcinoma were included who received treatment at our department between April 2001 and December 2011. Their clinical characteristics; tumor, node, metastasis (TNM) stage; initial treatment for the primary cancer; mode of cervical lymph node metastasis; incidence rate of distant metastases; white blood cell, neutrophil, and lymphocyte counts on initial examination; and therapeutic outcomes were evaluated and compared between patients on and not on immunosuppressant and/or steroid therapy. Survival rates were calculated using the Kaplan–Meier method.ResultsFourteen patients (5 men, 9 women; mean age, 65.2 years) were identified eligible who were on immunosuppressant and/or steroid therapy. They exhibited a significantly greater number of metastases, extracapsular spread, and distant metastases, of which, number of metastases and extracapsular spread were statistically significant (P = .0213, P = .042 respectively). In 9 patients, total lymphocyte count in the peripheral blood was ≤1,500/μL, indicating the lower limit of the normal range. One patient died as a result of recurrence of the primary tumor. Another patient died as a result of cervical lymph node recurrence. Distant metastases occurred in 2 patients. The cumulative disease-specific 5-year survival rate of patients receiving immunosuppressive therapy was 62.3% and that of patients with cervical lymph node metastasis was 25%.ConclusionThe results of this study suggest that patients with oral squamous cell carcinoma on immunosuppression show progression of cervical lymph node metastasis and extracapusular spread and are at a high risk of developing distant metastases.

http://ift.tt/2jyD8sQ

Αρχειοθήκη ιστολογίου

Τετάρτη 18 Ιανουαρίου 2017

Zusammenfassung

Abstract

Objectives

Method

Results

Conclusions

Abstract

Abstract

Zusammenfassung

Abstract

Abstract

Abstract

Abstract

Background

Methods

Results

Conclusion

Zusammenfassung