Publication date: March 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 94
Author(s): Sunthosh K. Sivam, Charles A. Syms, Susan M. King, Brian P. Perry
IntroductionCochlear implantation is well accepted as the treatment of choice for prelingual deafness in children [1]. However, the safety of routinely performing this procedure on an outpatient basis is debated. We aim to assess immediate postoperative complications that would affect a surgeon's decision to perform pediatric cochlear implantation on an outpatient basis.MethodsA retrospective chart review was conducted which included all children 17 years old or younger who underwent cochlear implantation from 2004 to 2014 in a private neurotology practice. The immediate postoperative complication rates and types of complications were then examined.ResultsA total of 579 cochlear implants were placed in children ages 1–17 years old from 2004 to 2014. The most common complications were nausea/vomiting and dizziness/imbalance. The odds ratio of developing complications in the group ages 1–3 years old versus all other age patients was found to be statistically insignificant (OR 0.90, 95% CI 0.61 to 1.32, p = 0.58). The odds ratio of developing a complication after bilateral implantation compared to unilateral implantation was statistically significant (OR 1.96, 95% CI 1.18 to 3.28, p = 0.01). There was no difference in complication rates when comparing lateral wall and perimodiolar insertions. A total of 6 of 579 (1%) cochlear implants resulted in a complication requiring unplanned medical attention.ConclusionsOverall, this series offers a decade of experience in pediatric cochlear implantation that shows a low incidence of the need for unplanned medical attention in the immediate postoperative period. The most common complication seen is Post-operative nausea and vomiting (PONV) that appears to be amenable to outpatient management even in the youngest populations. This supports providers routinely performing pediatric cochlear implantation on an outpatient basis.
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Τετάρτη 25 Ιανουαρίου 2017
Consideration for routine outpatient pediatric cochlear implantation: A retrospective chart review of immediate post-operative complications
Decompression endoscopic surgery for frontal secondary headache attributed to supraorbital and supratrochlear nerve entrapment: a comprehensive review
Abstract
In the last decade, a new surgical treatment modality was developed for frontal secondary headache, based on the assumption that the trigger of this pain entity is the entrapment of peripheral sensory nerves. The surgery entails a procedure, where an endoscopic approach is used to decompress the supraorbital and supratrochlear nerve branches, which are entrapped by the periosteum in the region of the corrugator supercilii muscle. Candidates for the surgery define their headache as moderate to severe persistent daily pressure or tension, localized in the frontal area, sometimes accompanied by symptoms of nausea and photophobia mimicking a primary headache—migraine. We created a step-by-step screening algorithm which is used to differentiate patients that have the highest chance for a successful surgical decompression. Up to now, published data regarding this type of surgery demonstrate long-lasting successful outcomes while adverse effects are minor. This article reviews and discusses from a surgeon's perspective decompression surgery for secondary headache attributed to supraorbital and supratrochlear nerve entrapment.
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Urinary metabolomics for noninvasive detection of antibody-mediated rejection in children after kidney transplantation.
http://ift.tt/2jhqWsz
Transplantomics: Towards Precision Medicine in Transplantation Research.
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Normothermic perfusion in the assessment and preservation of declined livers prior to transplantation: hyperoxia and vasoplegia - important lessons from the first 12 cases.
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Characterizing the risk of false-positive hepatocellular carcinoma in recipients transplanted with T2 MELD exceptions.
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Organ preservation with chemoradiation in advanced laryngeal cancer: The problem of generalizing results from randomized controlled trials
Source:Auris Nasus Larynx, Volume 44, Issue 1
Author(s): Alvaro Sanabria, Aline L.F. Chaves, Luiz P. Kowalski, Gregory T. Wolf, Nabil F. Saba, Arlene A. Forastiere, Jonathan J. Beitler, Ken-ichi Nibu, Carol R. Bradford, Carlos Suárez, Juan P. Rodrigo, Primož Strojan, Alessandra Rinaldo, Remco de Bree, Missak Haigentz, Robert P. Takes, Alfio Ferlito
BackgroundThe primary goal of treatment in advanced laryngeal cancer is to achieve optimal oncologic outcomes while preserving function and quality of life. Combination of chemotherapy and radiation has been popularized as an alternative to surgery for patients facing total laryngectomy. However, survival analyses from large, population-based databases have not duplicated results reported from randomized trials.MethodsA comprehensive literature review was undertaken to try to better understand the reasons why results differ among randomized trials and population cohort studies.ResultsA variety of reasons are discussed, including differences in patient staging, selection bias, complexity bias, inconsistent terminology, patient compliance and treatment expertise.ConclusionsPersonalized treatment considering all factors is critical for optimal outcomes. In general, evidence supports total laryngectomy for patients with T4 cancers. Definitive chemoradiotherapy strategies are acceptable alternatives for T3 cancers, provided that all resources for the administration of the treatment, follow-up and surgical salvage are available.
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Editorial Board
Source:Auris Nasus Larynx, Volume 44, Issue 1
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Cholesterol influences potassium currents in inner hair cells isolated from guinea pig cochlea
Source:Auris Nasus Larynx, Volume 44, Issue 1
Author(s): Takashi Kimitsuki
ObjectiveThere is a correlation between serum hyperlipidemia and hearing loss. Cholesterol is an integral component of the cell membrane and regulates the activity of ion channels in the lipid bilayer. The aim of this study was to investigate the effects of cholesterol on the potassium currents in IHCs by using the cholesterol-depleting drug, MβCD, and water-soluble cholesterol.MethodsIHCs were acutely isolated from a mature guinea-pig cochlea and potassium currents were recorded. MβCD and water-soluble cholesterol were applied to IHCs under pressure puff pipettes.ResultsIHCs showed outwardly rectifying currents (IK,f and IK,s) in response to depolarizing voltage pulses, with only a slight inward current (IK,n) when hyperpolarized. In 10mM MβCD solutions, the amplitude of outward K currents reversely decreased; however, fast activation kinetics was preserved. In contrast, in solution of 1mM water-soluble cholesterol, the amplitude of outward K currents reversely increased. At the membrane potential of +110mV, relative conductances were 0.87±0.07 and 1.18±0.11 in MβCD solutions and cholesterol solutions, respectively.ConclusionThe amplitude of K currents in isolated IHCs was reversely changed by cholesterol-depleting drug and water-soluble cholesterol. These results demonstrated the possibility of the involvement of IHC function in hyperlipidemia-induced inner ear disorders.
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Tubal function tests with optional myringotomy detect Eustachian tube closing failure in acquired pars flaccida retraction cholesteatoma
Source:Auris Nasus Larynx, Volume 44, Issue 1
Author(s): Phawana Asawapittayanont, Ryoukichi Ikeda, Hidetoshi Oshima, Toshiaki Kikuchi, Hiromitsu Miyazaki, Tetsuaki Kawase, Yukio Katori, Toshimitsu Kobayashi
ObjectiveTo re-evaluate the incidence of Eustachian tube closing failure in acquired middle ear cholesteatoma.MethodThirty-one cases with acquired middle ear cholesteatoma who received surgery were enrolled. Presence of Eustachian tube closing failure was determined through two Eustachian tube function tests. First Step Tests: Test 1: Positive sniff test identified by retraction of the tympanic membrane upon sniffing was observed. Test 2: The pressure in the external auditory meatus was found to change synchronously with that of the nasopharynx during respiration or upon sniffing. Second step test: For cases with negative First Step Tests, myringotomy was performed and Test 2 was repeated.ResultsTest 1 was positive in six (19.4%) and Test 2 was initially positive in nine (29.0%) out of 31 cases. Twelve out of 31 cases (38.7%) were positive for either one of the tests. The remaining 19 cases with initial negative test results subsequently received myringotomy and were subjected to Test 2 again. Positive results were obtained in five (13.9%) additional cases, and a final total of 17 (54.8%) out of 31 cases were positive for Eustachian tube closing failure.ConclusionSniff test with optional myringotomy may be useful for preoperative diagnosis of Eustachian tube closing failure.
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Treatment results of alternating chemoradiotherapy with early assessment for advanced laryngeal cancer: A multi-institutional phase II study
Source:Auris Nasus Larynx, Volume 44, Issue 1
Author(s): Yusuke Nakata, Kei Ijichi, Nobuhiro Hanai, Daisuke Nishikawa, Hidenori Suzuki, Hitoshi Hirakawa, Takeshi Kodaira, Yasushi Fujimoto, Takashi Fujii, Takuya Miyazaki, Takeshi Shimizu, Yasuhisa Hasegawa
ObjectiveTo evaluate the efficacy and safety of alternating chemoradiotherapy (ACRT) with early assessment of advanced laryngeal cancer.MethodsPatients with stage III or IV glottic or supraglottic squamous cell carcinoma were enrolled. ACRT consisted of two cycles of chemotherapy involving 5-fluorouracil and cisplatin (weeks 1 and 6) and radiotherapy (RT; weeks 2 and 7) administered alternately. An early assessment was performed after one cycle of chemotherapy and RT. Patients with a partial response (PR) or a complete response at early assessment continued ACRT. Patients with stable disease (SD) or progressive disease at early assessment discontinued ACRT and underwent salvage surgery. After completion of ACRT, patients who had residual primary tumor and lymph metastasis underwent salvage surgery.ResultsTwenty-eight patients were enrolled in this trial. Median follow-up was 60.0 months. After each cycle of chemotherapy and RT, 24 of the 28 patients (85.7%) were assessed as having a PR at early assessment and continued ACRT, and 4 of 28 patients (14.3%) who were assessed as having SD at early assessment discontinued ACRT and underwent salvage surgery. The estimated 5-year local control and 5-year survival rates were 49.0% and 77.4%, respectively. Larynx preservation was achieved in 17 patients. The estimated 5-year laryngeal preservation rate was 59.4%. Major toxicity included nausea, stomatitis, dermatitis, dysphagia and hemoglobin toxicity. Grade 3 or 4 stomatitis occurred in three patients (10.7%).ConclusionThe clinical results of ACRT with early assessment of advanced laryngeal cancer patients showed sufficient efficacy and safety.
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Corrigendum to “Role of cancer stem cell in radioresistant head and neck cancer” [Auris Nasus Larynx 43 (October (5)) (2016) 556–561]
Source:Auris Nasus Larynx, Volume 44, Issue 1
Author(s): Young Min Park, Sei Young Lee, Suk Won Park, Se-Heon Kim
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Calpain-14 and its association with eosinophilic esophagitis
Source:Journal of Allergy and Clinical Immunology
Author(s): Vladislav A. Litosh, Mark Rochman, Jeffrey K. Rymer, Aleksey Porollo, Leah C. Kottyan, Marc E. Rothenberg
Calpains are a family of intracellular, calcium-dependent cysteine proteases involved in a variety of regulatory processes, including cytoskeletal dynamics, cell-cycle progression, signal transduction, gene expression, and apoptosis. These enzymes have been implicated in a number of disease processes, notably for this review involving eosinophilic tissue inflammation, such as eosinophilic esophagitis (EoE), a chronic inflammatory disorder triggered by allergic hypersensitivity to food and associated with genetic variants in calpain 14 (CAPN14). Herein we review the genetic, structural, and biochemical properties of CAPN14 and its gene product CAPN14, and its emerging role in patients with EoE. The CAPN14 gene is localized at chromosome 2p23.1-p21 and is most homologous to CAPN13 (36% sequence identity), which is located 365 kb downstream of CAPN14. Structurally, CAPN14 has classical calpain motifs, including a cysteine protease core. In comparison with other human calpains, CAPN14 has a unique expression pattern, with the highest levels in the upper gastrointestinal tract, particularly in the squamous epithelium of the esophagus. The CAPN14 gene is positioned in an epigenetic hotspot regulated by IL-13, a TH2 cytokine with increased levels in patients with EoE that has been shown to be a mediator of the disease. CAPN14 induces disruptive effects on the esophageal epithelium by impairing epithelial barrier function in association with loss of desmoglein-1 expression and has a regulatory role in repairing epithelial changes induced by IL-13. Thus CAPN14 is a unique protease with distinct tissue-specific expression and function in patients with EoE and is a potential therapeutic target for EoE and related eosinophilic and allergic diseases.
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Evaluation of the role of splint therapy in the treatment of temporomandibular joint pain on the basis of MRI evidence of altered disc position
To clarify whether altering temporomandibular joint (TMJ) condyle and disc positions by occlusal splint (splint) therapy relieves TMJ pain and to determine whether splint therapy facilitates improvement of the ranges of condyle and articular disc motions.
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Early volumetric changes after vertical augmentation of the atrophic posterior mandible with interpositional block graft versus onlay bone graft: A retrospective radiological study
The aim of this study was to evaluate volumetric and clinical outcomes of atrophic posterior mandibles treated with inlay or onlay bone grafting techniques.
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Clinical course and therapeutic outcomes of operatively and non-operatively managed patients with denosumab-related osteonecrosis of the jaw (DRONJ)
Details regarding risk factors, onset, and outcomes for denosumab-related osteonecrosis (DRONJ) are sparse. This study examines the clinical characteristics and operative and non-operative therapeutic outcomes in patients with DRONJ not previously exposed to other antiresorptives.
http://ift.tt/2jyBF36
Diagnostic and therapeutic modalities for 287 malignant and benign salivary tumors: a cohort study
Salivary gland tumors (SGT's), 3-10% of head/neck tumors, exhibit a striking range of morphological diversity. This minimally symptomatic disease can be challenging to diagnose, and therapeutic policy is still controversial.
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Calculation of resected orbital wall areas in the treatment of endocrine orbitopathy
Orbital wall decompression is routinely used to treat proptosis in endocrine orbitopathy. Until now, however, there has been no investigation to measure the area/extent of the removed walls.
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Cephalometric comparison of early and late secondary bone grafting in the treatment of patients suffering from unilateral cleft lip and palate
The study was based on a retrospective cephalometric assessment of 10-year-olds in order to evaluate the influence of early secondary bone grafting on craniofacial development in patients suffering from non-syndromic complete unilateral cleft lip and palate.The study consisted of 79 patients in the early and 67 patients in the late secondary bone grafting group. The mean age at alveolar bone grafting was 2.5 years (SD 0.03) in the first group and 9.8 years (SD 2.3) in the second group. The primary cleft repair of these 146 patients was always performed in accordance with the one-stage method.
http://ift.tt/2jqV7AS
Lymph node involvement predicts poor prognosis in primary tongue adenoid cystic carcinoma: A preliminary study of 54 cases
Primary tongue adenoid cystic carcinoma (ACC) is extremely rare. The relationship between the patient's prognosis and the tumor's clinicopathological characteristics is uncertain. The aim of this study was to identify the prognostic factors and analyze the overall outcomes for patients with tongue ACC.
http://ift.tt/2jyLFsS
Comparison of intra-articular injection of plasma rich in growth factors versus hyaluronic acid following arthroscopy in the treatment of temporomandibular dysfunction: A randomised prospective study
The main objective of our study was to evaluate the effectiveness of the injection of plasma rich in platelet-derived growth factors (PRGF) versus hyaluronic acid (HA) following arthroscopic surgery in patients diagnosed with internal derangement of the temporomandibular joint (TMJ) with osteoarthritis (OA).
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Genetic Response in Masseter Muscle after Orthognathic Surgery in Comparison with healthy Controls – A Microarray Study
One third of adult patients with orthognathic surgery of a prognathic or retrognathic mandible show relapse. The sagittal split osteotomy of the mandible leads to a displacement of both parts up to 10 mm without any changes of muscle attachment. Changed mandible length needs adaptation of muscle capacity because of changed force to moment ratio. The aim of this Microarray study was to analyze the general genetic response of masseter muscle in patients with retrognathism or prognathism of the mandible six months after surgery in comparison with healthy untreated controls.
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Magnetic resonance imaging of the inferior alveolar nerve with special regard to metal artifact reduction
Magnetic resonance imaging (MRI) is an excellent imaging modality for displaying peripheral nerves. Since the knowledge about MRI of the inferior alveolar nerve (IAN) is limited, this pilot study aims to identify the prospects and limitations of MRI of the IAN, with special consideration of metal artifacts.
http://ift.tt/2jqV7km
Elective neck dissection in unilateral carcinomas of the tongue: Unilateral versus bilateral approach
Elective neck dissection (END) is a common primary treatment strategy for oral tongue squamous cell carcinoma (OTSCC), although uncertainty remains regarding the necessary extent of END for strictly unilateral early stage OTSCC. The authors evaluated two END variations, unilateral and bilateral, to determine the optimal extent.
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Mucous retention cyst of mastoid bone mimicking cholesteatoma
Occlusion of mastoid cells and the aditus ad antrum caused by inflammatory diseases can result in poor ventilation and poor drainage of mastoid cells, which can in turn cause the formation of cysts.
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Simultaneous binaural bithermal caloric testing: Clinical value
Abstract
The aim of this retrospective review was to determine the clinical value of simultaneous binaural bithermal caloric testing (SBT) versus alternate binaural bithermal caloric testing (ABB) in the setting of a tertiary care neurotology clinic. Charts of 131 adults who had presented with otologic complaints and had undergone both SBT and ABB examinations were included in the study. The main outcome measure was the identification of peripheral hypofunction. One hundred two patients had a normal ABB caloric examination; 86 of those 102 patients (84.3%) had normal ABB examinations but abnormal SBT results. We conclude that SBT is a more sensitive measure of peripheral pathology than the traditional ABB examination. If peripheral pathology is suspected but not confirmed by ABB, SBT appears useful for detecting mildly reduced vestibular response.
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Extraosseous Ewing sarcoma: Expanding the differential diagnosis of supraclavicular fossa tumors
Abstract
A broad spectrum of diseases can be included in the differential diagnosis of neck masses. We report a case of extraosseous Ewing sarcoma that presented as a neck mass in a 70-year-old man. To the best of our knowledge, this is the first reported case of extraosseous Ewing sarcoma of the supraclavicular fossa. Published cases of extraosseous Ewing sarcoma in the neck have been described in other age groups, but those tumors were confined to the parapharyngeal space. Also, there have been reported cases in patients older than 70 years in which Ewing sarcoma affected other structures such as the larynx and the pelvis, but none in the soft tissues of the neck. This case adds extraosseous Ewing sarcoma as a possible diagnosis to consider when evaluating a neck mass in the supraclavicular fossa.
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Retropharyngeal and parapharyngeal abscesses: Factors in medical management failure
Abstract
Retropharyngeal and parapharyngeal abscesses are the most common deep neck infections in the pediatric population. How best to treat these patients, be it intravenous antibiotics or immediate surgical incision and drainage, has long been debated. The purpose of this study was to evaluate patient and abscess characteristics associated with failure of medical treatment. We retrospectively examined 46 patients between 1999 and 2009 at Arnold Palmer Children's Hospital in Orlando. Patient charts were reviewed, and data collected included age, gender of the patient, size of the abscess, days of admission to the hospital, admission to the intensive care unit, and surgical intervention, if applicable. All patients first received 24 to 48 hours of IV antibiotics, at which point a clinical decision was made to proceed with surgery or continue conservative management. When comparing antibiotic treatment failure across age, gender, and abscess size, statistically significant correlation occurred only with the size of the abscess. Medical management was more likely to fail, and surgery needed, when abscesses were larger than 2 cm. Additionally, hospital stay was not statistically different between the medical and surgical groups. Our data demonstrate statistical significance for the ability to treat retro- and parapharyngeal abscesses 2 cm or less in diameter with IV antibiotics alone, without complications, and with a statistically similar average hospital stay compared with surgery. Abscesses larger than 2 cm may be managed medically, as well, but failure of antibiotic therapy alone is more likely, with surgical intervention more often required.
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Endoscopic view of balloon dilation for excision of a sphenoid cyst
The sphenoid sinus can be opened for ventilation, inspection, or biopsy from a transethmoid or transnasal approach after identifying its ostium.
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Intramural esophageal hematoma mimicking a hypopharyngeal tumor
The common presentation of intramural esophageal hematoma is acute onset of retrosternal pain, typically accompanied by dysphagia, odynophagia, or hematemesis.
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Obstructing in utero oropharyngeal mass: Case report of a lymphatic malformation arising within an oropharyngeal teratoma
Abstract
An ex utero intrapartum treatment procedure was performed to deliver a fetus with a multiseptated, entirely cystic, 4.5 x 5.0 x 4.0-cm mass occupying the oropharynx and oral cavity with protrusion from the mouth. Surgical excision was performed, and final pathologic diagnosis revealed a lymphatic malformation arising within a cystic oropharyngeal teratoma. Lymphatic malformations are virtually indistinguishable radiologically from rare, purely cystic teratomata, and efforts have been made to distinguish between the two in utero because of differing available treatment modalities. This represents the first documented case in the literature of a lymphatic malformation arising from within an oropharyngeal teratoma.
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Impact of exercise with TheraBite device on trismus and health-related quality of life: A prospective study
Abstract
Trismus is a common symptom in patients with head and neck cancer that affects many aspects of daily life negatively. The aim of this study was to investigate the impact of structured exercise with the jaw-mobilizing device TheraBite on trismus, trismus-related symptomatology, and health-related quality of life (HRQL) in patients with head and neck cancer. Fifteen patients with trismus (maximum interincisal opening [MIO] ≤35 mm) after oncologic treatment for head and neck cancer, underwent a 10-week exercise program with the TheraBite device and were followed regularly. Time between oncologic treatment and start of TheraBite exercise ranged from 0.7 to 14.8 years (average 6.2 years). MIO, trismus-related symptoms, and HRQL was assessed before and after exercise and after 6 months. A significant improvement in MIO was observed post-exercise (3.5 mm, 15.3%, p = 0.0002) and after 6-month of follow-up (4.7 mm, 22.1%, p = 0.0029). A statistically significant correlation was found between increased MIO and fewer trismus-related symptoms. In conclusion, exercise with TheraBite improved MIO and trismus-related symptoms in patients with trismus secondary to head and neck cancer. Structured exercise with the jaw-mobilizing device seems to be beneficial for patients with trismus independent of time since oncologic treatment.
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Anomalous stapes in Down syndrome
It is important to consider the presence of inner ear anomalies in Down syndrome, which occur in up to approximately 75% of this population
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Evaluation of patient satisfaction with different hearing aids: A study of 107 patients
Abstract
We retrospectively investigated patient satisfaction with different types of hearing aids in 107 patients-60 males and 47 females, aged 8 to 84 years (mean: 53.8)-with unilateral or bilateral hearing loss, each of whom used two different hearing devices for at least 3 years per device. The International Outcome Inventory for Hearing Aids, Turkish edition (IOI-HA-TR) was used to evaluate satisfaction levels; we also calculated our own total individual subjective satisfaction (TISS) scores. We divided 16 different hearing devices into two types: device 1 and device 2; on average, device 2 had more channels, a lower minimum frequency, and a higher maximum frequency. We found that the IOI-HA-TR scores and TISS scores were higher and usage time was greater during device 2 use, and that there was a positive correlation between IOI-HA-TR and TISS scores. A total of 69 patients (64.5%) used device 2 for more than 8 hours per day, while 38 patients (35.5%) used it for 4 to 8 hours per day during the final 2 weeks of the trial. In contrast, 40 patients (37.4%) used device 1 for more than 8 hours, 50 (46.7%) used it for 4 to 8 hours, and the remaining 17 (15.9%) used it for less than 4 hours; the difference in the duration of use of the two devices was statistically significant (p < 0.001). Younger patients and patients with more education were more satisfied with their devices than were older patients and those who were not as well educated. We conclude that devices with good technologic features such as more channels, a lower minimum frequency, and a higher maximum frequency result in better hearing. Also, based on the age difference that we observed, we recommend that psychological support be provided to older patients with aided hearing to enhance their mental health and quality of life.
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ER stress in the pathogenesis of pretibial dystrophic epidermolysis bullosa
Abstract
Dystrophic epidermolysis bullosa (DEB) is a rare hereditary disease characterized by blistering and scarring of the skin 1 and caused by mutations in the COL7A1 gene which codes type VII collagen (C7). Pretibial dominant dystrophic epidermolysis bullosa (DDEB-Pt) is a subtype of DDEB that predominantly affects the pretibial region.
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Gain with no pain? Pain management in dermatological photodynamic therapy
Abstract
Pain during photodynamic therapy (PDT) is the main limiting adverse effect in its use in dermatology. Given its multifactorial nature, we reviewed both intrinsic and extrinsic factors that are involved in PDT pain. We proposed a threshold theory for pain experience in PDT: it positively correlates with fluence rate and dose below certain threshold (rate of ~60 mW/cm2, dose of ~50 J/cm2); when threshold is surpassed, pain intensity no longer increases. Additionally, we carefully compared recent updates on pain management strategies and we suggested that cold air analgesia and low-irradiance light source (such as intense pulsed light and day-light PDTs) represent the current best analgesic options. Finally, we discussed the possible mechanisms of pain experience during PDT. Reactive oxygen species (ROS), TRP channels and inflammatory responses are key mediators in pain. Further investigation in these pathways can help with the development of more effective analgesic strategies. Taken together, for pain management in PDT, individualization plan of analgesia is highly yielded.
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Memory and multitasking performance during acute allergic inflammation in seasonal allergic rhinitis
Abstract
Background
In previous research patients with seasonal allergic rhinitis (SAR) showed poorer school and work performance during periods of acute allergic inflammation, supporting the idea of an impact of SAR on cognitive functions. However, the specific cognitive domains particularly vulnerable to inflammatory processes are unclear.
Objective
In the present study the influence of SAR on memory and multitasking performance, as two potentially vulnerable cognitive domains essential in everyday life functioning, was investigated in SAR patients.
Methods
Non-medicated patients with SAR (n=41) and healthy non-allergic controls (n=42) performed a dual-task paradigm and a verbal learning and memory test during and out of symptomatic allergy periods (pollen vs. non-pollen season). Disease-related factors (e.g., symptom severity, duration of symptoms, duration of disease) and allergy-related quality of life were evaluated as potential influences of cognitive performance.
Results
During the symptomatic allergy period, patients showed (a) poorer performance in word list-based learning (p = .028) and (b) a general slowing in processing speed (p < .001) and a shift in processing strategy (p < .001) in multitasking. Yet, typical parameters indicating specific multitasking costs were not affected. A significant negative association was found between learning performance and duration of disease (r = -.451, p = .004), whereas symptom severity (r = .326; p = .037) and quality of life (r = .379; p = .015) were positively associated with multitasking strategy.
Conclusions
Our findings suggest that SAR has a differentiated and complex impact on cognitive functions, which should be considered in the management of SAR symptoms. They also call attention to the importance of selecting sensitive measures and carefully interpreting cognitive outcomes.
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Determinants for selective transport of exogenously expressed cargo proteins into regulated and constitutive secretory pathways
Publication date: Available online 24 January 2017
Source:Journal of Oral Biosciences
Author(s): Junko Fujita-Yoshigaki, Meguami Yokoyama, Osamu Katsumata-Kato
BackgroundNewly synthesized secretory proteins are transported in vesicles and are sorted towards their appropriate destinations at trans-Golgi networks. It is thought that secretory proteins have sorting signals in their amino acid sequences that determine their destination. Therefore, many researchers have made efforts to identify these signals, using expression of exogenous cargo secretory proteins in various cell types. In this review, we will discuss these results in light of what will be necessary for future analysis of the sorting mechanisms.HighlightEndocrine and exocrine cells have two secretory pathways: regulated and constitutive. Sorting exogenously expressed proteins into these two pathways is dependent not only on the proteins themselves but also on the cell type. The results from in vivo experiments were more complex, where the same protein was delivered to different pathways in different cells.ConclusionIn order to study the sorting mechanism for secretory proteins, some evaluation of the cells' ability to synthesize, transport, and store the proteins is required. The HaloTag method has proved promising for the quantification of transportation in the two pathways.
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Early life travelling does not increase risk of atopic outcomes until 15 years: Results from GINIplus and LISAplus
Abstract
Background
Westernized lifestyle has been blamed for allergy epidemics. One of its characteristics is increased distances and frequency of travelling from early life onwards. Early life travelling to places which substantially differ from home environment in terms of climate, vegetation and food could increase the exposure to further unknown allergens and hence promote the development of allergies, but no epidemiological study has investigated this speculation.
Methods
Detailed data on travelling during the first two years of life as well as a range of atopic outcomes along with potential confounders up to age 15 years were collected prospectively within two large population-based multicentre German birth cohorts - GINIplus and LISAplus. Farthest travelling destination (within Germany; middle/northern/eastern Europe; southern Europe; outside Europe), total number of trips and their combination were considered as exposures. Six atopic outcomes were used: (1) doctor diagnosed asthma, (2) doctor diagnosed allergic rhinitis, (3) nose and eyes symptoms, (4) sensitization to food allergens, (5) sensitization to indoor and (6) outdoor inhalant allergens. Longitudinal associations between each exposure and health outcome pair were analyzed using generalized estimation equations (GEE).
Results
The results of our longitudinal analyses of 5674 subjects do not support the research hypothesis that travelling abroad to different regions in Europe or beyond Europe and frequency of travelling increases prevalence of doctor diagnosed asthma and allergic rhinitis, nose and eyes symptoms and allergic sensitization up to 15 years of age. Furthermore, there was no indication of age-varying effects.
Conclusions
Early life travelling does not seem to increase risk of atopic outcomes. Nevertheless, as we could not account for the type of visited environment or length of stay, these first findings should be interpreted with caution.
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PD-1 expression correlates with disease severity and IL-5 in Chronic Rhinosinusitis with Nasal Polyps
Abstract
Background
Programmed cell Death 1 (PD-1) is a negative regulator of T cell responses. Expression of PD-1 and its ligands PD-L1 and PD-L2 in chronic rhinosinusitis with nasal polyps (CRSwNP) is poorly studied.
Methods
Expression of PD-1, PD-L1, PD-L2, TGF-β, IL-5 and IL-10 mRNA was measured by RT-PCR on tissue homogenates of patients with CRSwNP (n=21) and healthy controls (n=21) and on primary epithelial cells. Disease severity was scored using the Lund-Mackay scores of maxillo-facial CT scans. PD-1 and PD-L1/L2 expression were evaluated at the cellular and tissue level (n=6) by flow cytometry and immunohistochemistry.
Results
PD-1 mRNA expression was increased in tissue homogenates from patients with CRSwNP compared to controls, irrespectively of the atopy status. Importantly, expression of PD-1 correlated with the total CT scan scores (r=0.5, p= 0.02). Additionally, a significant association was found between PD-1 mRNA and expression of IL-5 mRNA in control nasal tissue (r=0.95, p<0.0001) and in CRSwNP (r=0.63, p=0.002). PD-1 was expressed on different subsets of T cells and CD11b- dendritic cells. Both PD-1 and its ligands were expressed on primary epithelial cells from control nasal tissue and nasal polyp tissue.
Conclusions
Higher PD-1 expression was found in CRSwNP than in nasal tissue from controls. This was associated with disease severity and tissue IL-5 expression but unrelated to the patients' atopy status.
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Novel Approaches and Perspectives in Allergen Immunotherapy
Abstract
In this review we report on relevant current topics in allergen immunotherapy (AIT) which were broadly discussed during the 1st Aarhus Immunotherapy Symposium (Aarhus, Denmark) in December, 2015 by leading clinicians, scientists and industry representatives in the field. The aim of this symposium was to highlight AIT-related aspects of public health, clinical efficacy evaluation, mechanisms, development of new biomarkers and an overview of novel therapeutic approaches. Allergy is a public health issue of high socioeconomic relevance, and development of evidence-based action plans to address allergy as a public health issue ought to be on national and regional agendae. The underlying mechanisms are in the focus of current research that lays the ground for innovative therapies. Standardization and harmonization of clinical endpoints in AIT trials as well as current knowledge about potential biomarkers have substantiated proof of effectiveness of this disease-modifying therapeutic option. Novel treatments like peptide immunotherapy, intralymphatic immunotherapy and use of recombinant allergens herald a new age in which AIT may address treatment of allergy as a public health issue by reaching a large fraction of patients.
This article is protected by copyright. All rights reserved.
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Allergen Exposure Chambers (AEC): harmonizing current concepts and projecting the needs for the future - an EAACI Position Paper
Abstract
Backgound
Allergen exposure chambers (AEC) are clinical facilities allowing for controlled exposure of subjects to allergens in an enclosed environment. AEC have contributed towards characterizing the pathophysiology of respiratory allergic diseases and the pharmacological properties of new therapies. In addition, they are complementary to and offer some advantages over traditional multi-centre field trials for evaluation of novel therapeutics. To date, AEC studies conducted have been monocentric and have followed protocols unique to each center. Because there are technical differences among AEC, it may be necessary to define parameters to standardize the AEC so that studies may be extrapolated for driving basic immunological research and for marketing authorization purposes by regulatory authorities.
Methods
For this task force initiative of the European Academy of Allergy and Clinical Immunology (EAACI) experts from academia and regulatory agencies met with chamber operators to list technical, clinical and regulatory unmet needs as well as the prerequisites for clinical validation.
Results
The latter covered the validation process, standardization of challenges and outcomes, intra- and inter-chamber variability and reproducibility, in addition to comparability with field trials and specifics of paediatric trials and regulatory issues.
Conclusion
This EAACI Position Paper aims to harmonize current concepts in AEC and to project unmet needs with the intent to enhance progress towards use of these facilities in determining safety and efficacy of new therapeutics in the future.
This article is protected by copyright. All rights reserved.
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Results of an Allergy educational needs questionnaire for Primary Care
Abstract
Background
It is well recognized that knowledge of allergic conditions is sub-optimal in primary care. The Primary Care Interest Group of the European Academy of Allergy and Clinical Immunology undertook an educational needs survey to better understand what they were and how best to meet them, in the primary care environment.
Method
an electronic questionnaire was devised and distributed as widely as possible.
Results
2226 people from 63 countries opened the e-questionnaire of which 692 provided evaluable responses. 81% were medical doctors with 299 possessing additional qualifications. Self-declared gaps in knowledge were expressed most manifestations of allergy with a correspondingly high self-expressed educational need. The preferred learning modalities were: Online guidelines (69.6%) and courses (68.8%) followed closely by workshops (68%), structured online modules (63.9%) and small local working groups (59.75%). Podcasts and webinars scored poorly with only 25% expressing these as preferred learning modes although there was an age gradient.
The preferred electronic platform was the personal computer (82.6%).
Conclusion
A better understanding of the needs of primary care should help guide the design of educational initiatives to meet those needs.
This article is protected by copyright. All rights reserved.
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MicroRNA-21 contributes to suppress cytokines production by targeting TLR28 in teleost fish
Source:Molecular Immunology, Volume 83
Author(s): Dekun Bi, Junxia Cui, Qing Chu, Tianjun Xu
Toll-like receptors (TLRs) as important pattern recognition receptors, play critical roles in identifying pathogens and activating the immune response. However, when the dysregulation was occurred in this process, it could lead to excessive immune response, so it need many regulatory factors to control this process. Recently, microRNAs (miRNAs) have been shown to act as an important regulator in TLRs signaling pathway. As a member of TLRs family, TLR28 has been newly discovered in teleost fish, and play an important role in the immune response. In this study, we found that the expression of miR-21 was up-regulated after poly(I:C) stimulation, and miR-21 could inhibit the expression of cytokines. Then we predicted the target genes of miR-21, and found that TLR28 is a direct target of miR-21, which could be significantly down-regulated by both miR-21 mimics and pre-miR-21. These results suggested that miR-21 can inhibit the expression of cytokines by negative regulation of TLR28, thereby inhibiting the generation of excessive immunity and maintaining the balance of the body. This study is the first to demonstrate that miRNA can suppresses cytokines by regulating the TLR signaling pathway in teleost fish, and also can provides some new ideas for the research of the regulation of miRNA and immune system in mammals.
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Human papillomavirus in oral cavity and oropharynx carcinomas in the central region of Brazil
Publication date: January–February 2017
Source:Brazilian Journal of Otorhinolaryngology, Volume 83, Issue 1
Author(s): Guilherme Petito, Megmar Aparecida dos Santos Carneiro, Sílvia Helena de Rabello Santos, Antonio Marcio Teodoro Cordeiro Silva, Rita de Cassia Alencar, Antonio Paulo Gontijo, Vera Aparecida Saddi
IntroductionMolecular studies about carcinomas of the oral cavity and oropharynx demonstrate the presence of human papilomavirus genome in these tumors, reinforcing the participation of human papilomavirus in oral carcinogenesis.ObjectivesThis study aimed to determine the prevalence of human papilomavirus and genotype distribution of HPV16 and HPV18 in oral cavity and oropharynx carcinomas, as well as their association with clinical characteristics of the tumors.MethodsThis is a retrospective study, with clinical data collected from 82 patients. Human papilomavirus detection was conducted on specimens of oral cavity and oropharynx carcinomas included in paraffin blocks. Patients were assisted in a cancer reference center, in the central region of Brazil, between 2005 and 2007. Polymerase chain reaction was used for the detection and genotyping of human papilomavirus.ResultsAmong the patients evaluated, 78% were male. The average age of the group was about 58 years. Risk factors, such as smoking (78%) and alcohol consumption (70.8%) were recorded for the group. HPV DNA was detected in 21 cases (25.6%; 95% confidence interval 16.9–36.6) of which 33.3% were HPV16 and 14.3% were HPV18. The presence of lymph node metastases and registered deaths were less frequent in human papilomavirus positive tumors, suggesting a better prognosis for these cases; however, the differences between the groups were not statistically significant.ConclusionThe results obtained in the present study, with respect to the presence of the high-risk HPV16 and HPV18 genotypes, highlight the importance of human papilomavirus vaccination in the control of oral cavity and oropharynx carcinomas.
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Brachytherapy for Severe, Recalcitrant Acrodermatitis Continua of Hallopeau
http://ift.tt/2ku1OUA
Secukinumab for Acrodermatitis Continua of Hallopeau
http://ift.tt/2jfK2PS
Annular Plaques With Skin Atrophy in a Young Patient
http://ift.tt/2ku2FVr
Anti-Interleukin 23 as a Targeted Treatment Option for Pityriasis Rubra Pilaris
http://ift.tt/2jfZyuY
Precision Medicine in Allergic Disease – Food Allergy, Drug Allergy, and Anaphylaxis-PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology
Abstract
This consensus document summarizes the current knowledge on the potential for precision medicine in food allergy, drug allergy and anaphylaxis under the auspices of the PRACTALL collaboration platform. PRACTALL is a joint effort of the European Academy of Allergy and Clinical Immunology (EAACI) and the American Academy of Allergy, Asthma and Immunology (AAAAI), which aims to synchronize the European and American approaches to allergy care. Precision medicine is an emerging approach for disease treatment based on disease endotypes, which are phenotypic subclasses associated with specific mechanisms underlying the disease. Although significant progress has been made in defining endotypes for asthma, definitions of endotypes for food and drug allergy or for anaphylaxis lag behind. Progress has been made in discovery of biomarkers to guide a precision medicine approach to treatment of food and drug allergy, but further validation and quantification of these biomarkers is needed to allow their translation into practice in the clinical management of allergic disease.
This article is protected by copyright. All rights reserved.
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Increased circulating CXCR5+ CD4+ T follicular helper-like cells in oral lichen planus
Abstract
Background
CD4+ T helper cell is crucial for the inflammatory autoimmune condition of oral lichen planus (OLP). Recently, the pathogenetic functions of T follicular helper (Tfh) cells, a subtype of CD4+ T helper cells, has been revealed in autoimmune diseases for their pivotal regulation on humoral immunity. To explore the potential pathophysiological role of Tfh cells in OLP, the expression of circulating Tfh-like cells and its correlations with IL-21 and B cells were investigated.
Methods
The frequencies of CXCR5+ CD4+ Tfh-like cells and CD19+ B cells were analyzed in peripheral blood of OLP patients and controls by flow cytometry, respectively. Besides, the serum IL-21 concentration was measured using ELISA technology. Furthermore, the correlations of CXCR5+ CD4+ Tfh-like cells with CD19+ B cells and serum IL-21 expression levels were evaluated.
Results
This study showed significant increased circulating Tfh-like cells (P < 0.05) and B cells (P < 0.0001), as well as decreased serum IL-21 expression (P < 0.05) in OLP. Besides, the frequency of Tfh-like cells exhibited negatively correlation with B cells in OLP (r = -0.435, P < 0.05). In particular, the proportion of CXCR5+ CD4+ Tfh-like cells in peripheral blood mononuclear cells of erosive OLP were higher than nonerosive OLP and controls (P = 0.012 and 0.021, respectively).
Conclusions
Increased circulating Tfh-like cells may be involved in the pathogenesis of OLP through abnormal modulation on B cell proliferation and IL-21 production, and associated with different clinical forms of OLP.
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Oral cancer screening for high risk individuals in the primary health care setting using an active approach
Abstract
Background
Oral squamous cell carcinoma (OSCC) is considered a major public health problem. The diagnosis often occurs in advanced stages, causing high morbidity and mortality and therefore prevention strategies should be advocated. This study aims to investigate a model of OSCC screening for high-risk individuals in the Family Health Strategy's (FHS) scenario.
Methods
Participants were men between 50 and 65 years of age registered in a primary health care electronic database and resident in an area with low socioeconomic status in the city of Curitiba (Paraná/Brazil). With the support of an electronic map application, dentistry students visited subjects at their homes.
Results
From the 16 391 registered subjects, 981 were men aged between 50 and 65. From 608 available subjects 233 (38.2%) were identified as smokers and former smokers and 202 (86.6%) were examined. There was a prevalence of 57 (28.2%) potentially malignant lesions and one confirmed case of squamous cell carcinoma. Actual smoking habits, low-income wage and absence from clinical appointments were the key predictors of leukoplakia in this study sample.
Conclusion
This study offers evidence of the possibility of applying a high-risk oriented approach as a secondary prevention measure in the FHS in Brazil or other developing countries.
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Dysregulation of AKT1, a miR-138 target gene, is involved in the migration and invasion of tongue squamous cell carcinoma
Abstract
Background
AKT1, also known as PKBα, is abnormally expressed in various malignancies. In this study, we aimed to evaluate the role of AKT1 in the tongue squamous cell carcinoma (TSCC) and further clarify the mechanisms of AKT1 in the migration and invasion of TSCC.
Methods
At first, immunohistochemistry (IHC) was conducted to detect the expression of AKT1 in TSCC. Then, we determined the role of AKT1 in the migration and invasion of TSCC and further investigated whether AKT1 was the target gene of miR-138 by using dual luciferase reporter assays and western blot.
Results
IHC results suggested that AKT1 dysregulation was a frequent event in TSCC, up-regulation of AKT1 was correlated with lymph node metastasis and associated with reduced overall survival. UM1 cells with higher migratory and invasive abilities had more robust AKT1 protein expression than UM2 cells with lower migratory and invasive abilities. The migration and invasion abilities were inhibited in UM1 cells upon AKT1 knockdown, meanwhile resulted in a decline of metastasis-related proteins (Vimentin, Slug and pERK1/2), and up-regulation of E-cadherin. Luciferase assays revealed that AKT1 was directly targeted by miR-138, and ectopic transfection of miR-138 reduced the expression of AKT1 protein.
Conclusions
Our results confirm that upregulation of AKT1, a miR-138 target gene, is a frequent event in TSCC and contribute to the aggressive behaviors and poor prognosis of TSCC.
This article is protected by copyright. All rights reserved.
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Proliferative verrucous leukoplakia: diagnosis, management and current advances
Publication date: Available online 24 January 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Diogo Lenzi Capella, Jussara Maria Gonçalves, Adelino Antônio Artur Abrantes, Liliane Janete Grando, Filipe Ivan Daniel
IntroductionProliferative verrucous leukoplakia (PVL) is a multifocal and progressive lesion of the oral mucosa, with unknown etiology, and commonly resistant to all therapy attempts with frequent recurrences. It is characterized by a high rate of oral squamous cell carcinoma and verrucous carcinoma transformations.MethodsTo analyze the studies about PVL and develop a concise update. A Pubmed search identifying studies (laboratory research, case series and reviews of literature) that examined patients with PVL was realized.Results and discussionThere are not enough studies about PVL in the literature. The few found studies not present a consensus about its etiology and diagnosis criteria. Although several treatment strategies have been proposed, most of them still show a high recurrence rate.ConclusionMore research about PVL is necessary to understand and treat this disease.
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Simultaneous idiopathic bilateral sudden hearing loss – characteristics and response to treatment
Publication date: Available online 24 January 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Ferit Akil, Umur Yollu, Mehmet Yilmaz, H. Murat Yener, Marlen Mamanov, Ender Inci
IntroductionThe aetiology of sudden hearing loss is poorly defined; however, infectious, vascular and neoplastic aetiologies are presumed to be responsible. In addition, the aetiology of bilateral SHL is also unknown.ObjectiveThe objective of this study is identify the characteristics and treatment response of simultaneous bilateral sudden hearing loss.MethodsThis is a case–control study that practised in tertiary care academic centre. 132 patients with sudden hearing loss (SHL) who were treated with systemic steroid and hyperbaric oxygen together were included. 26 patients had bilateral SHL and 106 patients had unilateral SHL. Patients were evaluated with clinical, audiological and radiological examinations and laboratory tests were done. Findings and response to treatment of the patients were compared.Results and conclusionThe mean ages of patients with unilateral and bilateral SHL were 42.0 years and 24.5 years respectively with a statistically significant difference (p<0.001). Immune response markers were more prevalent in bilateral SHL. Pre-treatment audiologic thresholds were 69.1dB for unilateral SHL and 63.3dB for the left ears and 67.6dB for the right ears for bilateral SHL without significant difference. Post-treatment average hearing threshold in unilateral SHL was 47.0dB and 55.4dB for the left ears and 59.0 for the right ears in bilateral SHL. Average hearing improvement in unilateral SHL group was significant (p<0.001) in spite of it was not significant in bilateral SHL group for both ears. Between the groups; there was a significant difference for hearing improvement favouring unilateral SHL (p<0.001). Tinnitus scores decreased significantly in both groups of patients (p<0.001) in spite of there was no significant difference between the groups of patients. Patients with bilateral SHL showed lower age, worse prognosis and higher rate of positive immune response markers. Cardiovascular risk factors seem to have an important role in the aetiology of unilateral cases whereas this importance was not present in bilateral ones.
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Psoriatic Disease Tied to Elevated Fracture Risk
Patients with psoriatic arthritis and psoriasis may have the same increased risk for fracture as those with rheumatoid arthritis, according to a new study.
Medscape Medical News
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Atopic keratoconjunctivitis complicated by Kocuria koreensis keratitis: the first case
Patients with atopic dermatitis have a predisposition to Staphylococcus aureus and a Herpes simplex virus infection. The treatment of atopic diseases with steroid and immunosuppressive agents induces opportunisti...
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Interesting association of neurofibroma with diffuse cystic lung disease (NF-DLD)
Description
A man aged 46 years presented with gradually progressive weakness of bilateral lower limbs and reduced sensation below the level of nipple for the past 2 months. There was no history of upper limb weakness and his bowel and bladder movements were normal. On enquiry, he also has a 2-year history of dry cough, wheeze and exertional dyspnoea. He is a non-smoker with no other significant medical history. On examination, power of bilateral lower limbs was 0/5, and knee and ankle reflexes were brisk with extensor plantar response. The patient had decreased sensation below the level of D5 vertebra. He had bilateral occasional rhonchi on chest auscultation. MRI of the spinal cord revealed benign intraspinal extradural dumb-bell-shaped lesion, measuring 3.8x2.0x3.0 cm, isointense on T2WI, hyperintense on T1WI, STIR noted at the D6–7 level causing significant spinal cord compression suggestive of neurogenic tumour (Neurofibroma/Schwannoma) (figures 1 and
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Gluteal compartment syndrome with sciatic nerve palsy caused by traumatic rupture of the inferior gluteal artery: a successful surgical treatment
Gluteal compartment syndrome is a rare entity, usually caused by direct trauma. This occurrence with sciatic nerve palsy caused by inferior gluteal artery laceration and compressive haematoma has not been reported in the literature. We describe such a case treated successfully by urgent surgical decompression and resolution of the sciatic nerve palsy. A man aged 41 years sustained blunt trauma to the right gluteal region causing a rupture of the inferior gluteal artery, gluteal compartment syndrome and rapidly progressive sciatic nerve palsy. The condition was treated urgently with interventional radiology, open surgical decompression and debridement. Recovery was complicated by recurrent haematoma formation, treated successfully with subsequent complete resolution of the sciatic nerve palsy. A review of the literature of traumatic gluteal compartment syndrome is presented with discussion of the clinical diagnosis, multidisciplinary treatment and recommendations for treatment of this injury.
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Hereditary leiomyomatosis and renal cell cancer syndrome: a family affair
A 49-year-old woman with cutaneous and uterine leiomyomas, flank pain and a family history of hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome sought genetic testing. She was found to harbour a fumarate hydratase (FH) genetic mutation and a previously undetected renal tumour. The patient underwent radical nephrectomy, and remains well at follow-up. HLRCC syndrome is a rare autosomal dominant disease, with patients at increased risk for cutaneous leiomyomas, early-onset uterine leiomyomas and aggressive renal carcinoma. Although the syndrome may manifest life-threatening complications, outcomes may be improved by preventative family screening and surveillance, compelling early diagnosis.
http://ift.tt/2jZKyFQ
Cystic lymphangioma of spleen in adults
Splenic diseases are rare. Tumours of the spleen are classified as either benign or malignant. Primary benign tumours of the spleen are extremely rare, identified on surgery and autopsy, accounting for <0.007% of all splenic tumours. Splenic lymphangiomas are benign cystic tumours resulting from congenital malformations of the lymphatic system that appear as a single or multiple lesions of the spleen. It mainly affects children and is rarely manifested after the age of 20 years of age. We report a case of cystic lymphangioma of spleen in a 40-year-old woman admitted with a huge mass in the abdomen, which on imaging found to be a cystic mass arising from spleen. On laparotomy the spleen was found occupying a major part of the abdomen. Splenectomy was performed and histopathological examination revealed it to be a cystic lymphangioma of spleen. This case report emphasises on the rarity of the case at this age and the sheer size of the tumour, being largest until as per our knowledge.
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Incidental parathyroidectomy during thyroidectomy increases the risk of postoperative hypocalcemia
Objectives/Hypothesis
The correlation between incidental parathyroidectomy (IP) during thyroidectomy and postoperative hypocalcemia remains controversial. Our aim was to investigate the incidence of IP, risk factors, and impact on patient outcomes.
Study Design
Retrospective cohort study.
Methods
This was a retrospective observational study including 3,186 consecutive patients who underwent thyroidectomy between January 2007 and December 2014. The patients were divided into two groups: the IP group and the non-IP. Numerous clinical parameters were collected and analyzed.
Results
The overall incidence of incidentally excised parathyroid glands during thyroidectomy was 6.4%. Patients with IP had significantly higher incidences of postoperative hypocalcemia and hypoparathyroidism than those without IP (P < 0.001). Intrathyroidal parathyroid glands presented only 2.2% of all removed parathyroid glands. Total thyroidectomy, central compartment lymph node dissection, and reoperation were independent risk factors for IP.
Conclusion
Incidental parathyroidectomy during thyroidectomy is associated with the increased likelihood of postoperative hypocalcemia. All independent risk factors examined in the study for IP are surgery-related. Surgeons should perform meticulous dissection with the intention of avoiding IP and resultant hypocalcemia.
Level of Evidence
4. Laryngoscope, 2017
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Surgical Treatment of Facial Artery Pseudoaneurysm Following Blunt Trauma: Report of a Case
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
Author(s): Ali Payami, Andre H. Montazem
There are few reports of pseudoaneurysm of the facial artery in the literature and very little attention has been paid to their surgical management. Practitioners should be aware of this unusual complication of facial trauma and of the alternatives for treatment of pseudoaneurysms. Surgical resection of selective head and neck pseudoaneurysms provides a safe and effective method for the treatment of these vascular lesions.
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Masthead
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
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Editorial Board Page
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
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Postoperative Delirium Following Orthognathic Surgery in a Young Patient
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
Author(s): Fernanda Herrera da Costa, Paulo Adilson Herrera, Cecília Luiz Pereira-Stabile, Glaykon Alex Vitti Stabile
Delirium is an organic mental syndrome with acute onset characterized by diffuse brain dysfunction and neural activity disorganization. It is usually related to cognition and perception changes, decreased level of consciousness, and disorganization of thoughts that are unrelated to previous dementia. Occurrence is more frequent in patients with previous degenerative disease and elderly patients, especially those older than 85 years. Although the pathophysiology is not totally known, studies have shown that, among the main factors that lead to delirium, the drugs used for general anesthesia induction are the most relevant (hypnotics, anticholinergic drugs, and H2 receptor blockers), especially those used in long surgical procedures. This report describes the case of a 24-year-old woman with a noncontributory medical and psychological history. She underwent bimaxillary orthognathic surgery with a total general anesthesia time of 7 hours. Postoperatively, she developed agitation, confusion, and delirium. After a psychiatry consult and discussion with the anesthesia team, the diagnosis of psychotic break owing to late postoperative delirium was established.
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Table of Contents
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
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Management of Parotid Tumors
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
Author(s): Eric R. Carlson
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AAOMS Author Disclosure forms
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
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Is There an Association Between Temporomandibular Joint Effusion and Arthralgia?
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
Author(s): Shehryar N. Khawaja, Heidi Crow, Ruba F.G. Mahmoud, Krishnan Kartha, Yoly Gonzalez
PurposeThe literature on joint effusion (JE) and its association with clinical and radiologic variables in patients with temporomandibular disorders (TMDs) is inconsistent and is characterized by multiple methodologic limitations. The primary aim of this investigation was to evaluate the association between magnetic resonance imaging (MRI) identified JE and temporomandibular joint (TMJ) arthralgia. The secondary aim of this investigation was to determine the association between JE and other clinical and MRI-identified soft tissue characteristics.Materials and MethodsA retrospective cohort study was conducted. Clinical and soft tissue imaging assessments were carried out according to the Diagnostic Criteria for Temporomandibular Disorders guidelines. The dependent variable was JE and the primary independent variable was arthralgia. The secondary independent variables were TMJ pain-associated characteristics and MRI-identified variables. When applicable, Pearson χ2 or t test was used to determine the statistical associations between JE and clinical characteristics and between JE and MRI-identified variables. Furthermore, generalized estimating equation (GEE) modeling was conducted to determine which of the independent clinical and MRI-identified variables were associated with JE.ResultsData for 158 participants, representing 312 joints, were extracted. The mean age of the female sample (59.4%) was 31 ± 11.1 years and that of the male sample (40.6%) was 29.8 ± 9.7 years. No association was found between JE and arthralgia. However, statistically significant associations were found between JE and lateral disc rotation (P = .001) and between JE and disc position in the coronal and sagittal planes (P = .001). The GEE model suggested that disc displacement with reduction (odds ratio = 2.5) was a statistically relevant contributing factor for JE in the absence of degenerative joint disease.ConclusionResults associated JE with the position of the disc in the sagittal plane. No association was found between JE and arthralgia or TMJ pain-associated clinical characteristics in patients with TMDs.
http://ift.tt/2ksUEMq
Whole-Arch Single-Stage Free Flap Reconstruction and Rehabilitation of the Mandible: A Case Report and Technical Considerations on a New Technique
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
Author(s): Jacob G. Yetzer, Kyle S. Ettinger, Kevin Arce, Thomas J. Salinas
The purpose of this report is to describe the techniques used in the reconstruction of a complete angle-to-angle mandibular defect in the absence of any remaining mandibular teeth. Because no remaining dental or occlusal landmarks remain in such a case, additional challenges must be considered.
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Strengthening Feedback in Surgical Education
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
Author(s): James R. Hupp
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Re: “Does the Amount of Screw Fixation Utilized for the Condylar Component of the TMJ Concepts Total Temporomandibular Joint Reconstruction Predispose to Hardware Loss or Postoperative Complications?”
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
Author(s): Louis G. Mercuri
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Improving the Medical Curriculum in Predoctoral Dental Education: Recommendations From the American Association of Oral and Maxillofacial Surgeons Committee on Predoctoral Education and Training
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
Author(s): Matthew J. Dennis, Jeffrey D. Bennett, Dean M. DeLuke, Erik W. Evans, John W. Hudson, Anders Nattestad, Gregory M. Ness, Allison Yeung
Dental procedures are often performed on patients who present with some level of medical fragility. In many dental schools, the exercise of taking a medical history is all too often a transcription of information to the dental chart, with little emphasis on the presurgical risk assessment and the development of a treatment plan appropriate to the medical status of the dental patient. Changes in dentistry, driven by an increasingly medically complex population of dental patients, combined with treatment advances rooted in the biomedical sciences necessitate the adaptation of our dental education to include a stronger background in systemic health. Many predoctoral educators in the American Association of Oral and Maxillofacial Surgeons (AAOMS) have expressed concern about the medical preparedness of our dental students; therefore, the AAOMS and its Committee on Predoctoral Education and Training have provided recommendations for improving the medical curriculum in predoctoral dental education, including a strengthening of training in clinical medicine and biomedical sciences, with specific recommendations for improved training of our dental students and dental faculty.
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In Reply
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
Author(s): Kyle S. Ettinger, Christopher F. Viozzi
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Pre-Emptive Analgesia
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
Author(s): Stuart Lieblich
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Effect of Arthrocentesis on Symptomatic Osteoarthritis of the Temporomandibular Joint and Analysis of the Effect of Preoperative Clinical and Radiologic Features
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
Author(s): Dorrit W. Nitzan, Jesica Svidovsky, Avraham Zini, Yehuda Zadik
PurposeTo evaluate the long-term outcome of arthrocentesis in patients with symptomatic temporomandibular joint (TMJ) osteoarthritis that was unresponsive to nonsurgical interventions.Materials and MethodsSeventy-nine patients (83 joints) with symptomatic TMJ osteoarthritis that had not responded to nonsurgical interventions and who underwent arthrocentesis were included in this study. Demographic, clinical, and radiologic data, including assessment of pain, dysfunction, improvement, and satisfaction, and maximal mouth opening were analyzed.ResultsThe analysis included 67 female patients (84.8%) and 12 male patients (15.2%), 13 to 70 years old, who were followed for 56.9 ± 6.7 months. Sixty-four (81%) reacted favorably to arthrocentesis. For these patients, maximal mouth opening increased from 26.3 ± 0.8 to 39.24 ± 0.9 mm (P < .001). Pain and dysfunction scores decreased from 6.92 ± 0.2 to 2.36 ± 0.3 (P < .001) and from 7.37 ± 0.2 to 2.24 ± 0.4 (P < .001), respectively. Overall score for patient satisfaction with arthrocentesis was 8.78 ± 0.3. The procedure had no lasting complications. Remarkably, the severity of preoperative pain, dysfunction, and range of motion and of radiographic changes did not correlate with the outcome of arthrocentesis. The severity of preoperative or postoperative signs and symptoms was not correlated with the severity of radiographic changes.ConclusionsFor most patients, arthrocentesis offers long-term favorable outcomes for symptomatic TMJ osteoarthritis that has not responded to nonsurgical treatments and otherwise would have required surgical arthroplasty. Severity of preoperative clinical and computerized tomographic findings is not predictive for the success of arthrocentesis. In addition, the lack of correlation between the clinical and radiologic findings negates the commonly used Wilkes classification, which presumes that the clinical signs and symptoms deteriorate together with radiologic changes.
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Dynamic Evaluation of Lavage Efficacy in Upper Compartment of the Temporomandibular Joint
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
Author(s): Ping Zhu, Han Lin, Quan Zhou, Jiahong Lv, Zhiguang Zhang, Yue Xu
PurposeThe aim of this study was to determine the most efficient temporomandibular joint (TMJ) lavage technique for complete irrigation and removal of synovial fluid. The corresponding total lavage fluid volume needed also was investigated.Materials and MethodsThree-dimensional TMJ lavage models of the classic double- and single-needle techniques with modified cannula sizes (diameters, 2.4 and 0.8 mm) were generated based on a constructed upper compartment model. Models were integrated with 2-phase flow models to predict fractional fluid volume (α value) changes of lavage saline and synovial fluid within the upper compartment of the TMJ. Fluid flow diagrams, velocity vectors, and intra-articular pressure data were collected and compared among the models. Models were validated by clinical synovial fluid concentration analyses, with vitamin B12 used as an internal standard.ResultsIn all 8 models, lavage fluid initially gathered around the inflow portal, with a stable mixture of synovial and lavage fluids eventually being established in the compartment. Use of the double-needle technique with a large inflow portal resulted in thorough lavage (α = 100%). When the single-needle or Shepard cannula technique was used, some areas within the upper compartment remained devoid of brisk flow. The 2.4-mm inflow model coupled with a 0.8-mm outflow portal resulted in a stably and persistently high intra-articular pressure (>2.7 × 104 Pa). A minimum volume of 109 mL of lavage fluid was necessary for complete replacement of synovial fluid by saline.ConclusionsWhen a 2.4-mm inflow portal needle was applied, a lavage rate of 100% was obtained with a minimum lavage volume of 109 mL. Using a small inflow portal could lead to inadequate flow, residual synovial fluid, and, ultimately, treatment failure.
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Evaluation of Sialendoscopy-Assisted Treatment of Submandibular Gland Stones
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
Author(s): Jin-Qing Xiao, Hai-Jiang Sun, Qi-Hui Qiao, Xin Bao, Chuan-Bin Wu, Qing Zhou
PurposeThe aim of the present study was to evaluate the therapeutic efficiency of sialendoscopy-assisted operations in the treatment of submandibular gland stones.Materials and MethodsThe data from 8 patients with sialolithiasis who underwent sialendoscopy from August 2015 to January 2016 at the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University (Shenyang, China) were retrospectively reviewed. All the patients had undergone preoperative technetium-99m pertechnetate salivary gland scintigraphy. The results revealed that the salivary glands exhibited normal or slightly reduced uptake and excretion dysfunction. Computed tomography examinations revealed stones located in the intraductal area near the glands or in the branches that could not be removed owing to their deep locations within the mouth. Therefore, an endoscope was inserted, the stones were located intraductally using sialendoscopy, and a transcervical incision was made to remove the stones and preserve the submandibular gland.ResultsThe stones were completely removed, and the submandibular gland was preserved in all cases. The patients recovered well postoperatively, and no complications developed.ConclusionsOur results suggest that sialendoscopy-assisted sialolithectomy is an effective and safe surgical technique for the removal of proximal and intraglandular submandibular gland stones. The patients' quality of life had obviously improved postoperatively.
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Osteomyelitis of the Mandibular Condyle: A Report of 2 Cases With Review of the Literature
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
Author(s): Probodh K. Chattopadhyay, Shakil Ahmed Nagori, Rahul P. Menon, Balasundaram Thanneermalai
In the maxillofacial area, osteomyelitis generally involves the mandible more commonly than the maxilla. Osteomyelitis of the mandible more often than not is odontogenic in origin and the dentate part is usually affected. In this context, involvement of the condyle and coronoid processes is very rare. This report describes 2 unique cases of condylar involvement with osteomyelitis. In these cases, the etiologies were unknown and were successfully managed by condylectomy and antibiotics. A comprehensive review of the English-language literature showed only 18 cases of osteomyelitis of the condyle. Odontogenic, otologic, and tubercular causes were the most common causes of osteomyelitis of the condyle. Radiologically, the condyle usually appeared osteolytic and eroded in osteomyelitis and radionucleotide scans were helpful in localizing the inflammation site. In most cases, condylectomy with appropriate antibiotics was required to eliminate the disease.
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Sialosis, Gout Induced or Idiopathic? Case Report
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
Author(s): Keyur Naik, Louis Mandel
Sialosis is observed in relation to diabetes, alcoholism, and malnutrition. An assumed relation between gout and sialosis is probably based on confusion that originated from the therapeutic use of phenylbutazone for gout and the sialadenitis that the medication caused. This report describes a case of sialosis in a patient with a longstanding history of gout that was idiopathic in origin.
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Maxillomandibular Advancement Surgery for Patients Who Are Refractory to Continuous Positive Airway Pressure: Are There Predictors of Success?
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 2
Author(s): Igor Makovey, Anita Valanju Shelgikar, Jeffrey J. Stanley, Adina Robinson, Sharon Aronovich
PurposeThis pilot study was conducted to determine the effectiveness of maxillomandibular advancement (MMA) in the treatment of patients with moderate to severe obstructive sleep apnea (OSA). The predictive value of clinical, radiographic, and treatment-related variables also was investigated in relation to the success or failure of MMA as treatment for OSA.Materials and MethodsA retrospective study design was used to assess the outcomes of MMA in patients with moderate to severe OSA (apnea hypopnea index [AHI] >15 events per hour) at the University of Michigan (Ann Arbor, MI). Data collected included clinical, radiographic, and polysomnographic findings. Primary outcomes of interest included the AHI, minimal oxygen saturation, and percentage of time spent with oxygen saturation lower than 88% as measured by polysomnography.ResultsTwenty patients met the inclusion criteria for the study (mean age, 48.8 ± 12.3 yr). Mean body mass index decreased from 32.03 ± 5.13 kg/m2 at baseline to 29.75 ± 5.23 kg/m2 at follow-up (P = .001). Mean advancements were 13.5 ± 2.7 mm at point B and 16.1 ± 4.5 mm at the pogonion. A 4.5-fold increase in minimal cross-sectional area and a 2.2-fold increase in airway volume were achieved on average. Patients showed a 68.5% decrease in mean AHI from 49.4 to 15.6 events per hour (P < .001). The percentage of time with oxygen saturation lower than 88% was significantly decreased from 15.4% at baseline to 1.4% after surgery (P = .014). The overall surgical success rate was 55% (11 of 20) based on an AHI of fewer than 15 events per hour.ConclusionsThese preliminary results indicate that MMA surgery might be highly effective for select patients with moderate to severe OSA. Despite large increases in airway dimensions, a surgical success rate of 55% was achieved in the overall sample. Assessment of predictive variables for success and failure are discussed.
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Verstorbene Praxischefs hinterlassen oft das reine Chaos
Obwohl sie von Berufs wegen häufig mit ihm konfrontiert werden, schieben Ärzte den Tod gern beiseite. Ganz besonders, wenn es um das eigene Ableben geht. Treffen Praxisinhaber aber keine Vorsorge, um geschäftliche Dinge für den Fall ihres Todes zu regeln, können die Hinterbliebenen arg in die Bredouille kommen.
http://ift.tt/2jYVvYm
Wie Ärzte jetzt einen Telefonausfall verhindern
2018 ist Schluss mit dem ISDN-Netz. Dann wollen große Anbieter ihre Leitungen endgültig umstellen. Aber gerade Arztpraxen kann es auch schon früher treffen. Was können Betroffene jetzt tun?
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USPSTF Recommendation for Obstructive Sleep Apnea Screening in Adults.
USPSTF Recommendation for Obstructive Sleep Apnea Screening in Adults.
JAMA Otolaryngol Head Neck Surg. 2017 Jan 24;:
Authors: Yaremchuk K
PMID: 28118426 [PubMed - as supplied by publisher]
http://ift.tt/2joV2xL
Genetic Response in Masseter Muscle after Orthognathic Surgery in Comparison with healthy Controls – A Microarray Study
Publication date: Available online 25 January 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Maja Marewski, Carola Petto, Matthias Schneider, Winfried Harzer
One third of adult patients with orthognathic surgery of a prognathic or retrognathic mandible show relapse. The sagittal split osteotomy of the mandible leads to a displacement of both parts up to 10 mm without any changes of muscle attachment. Changed mandible length needs adaptation of muscle capacity because of changed force to moment ratio. The aim of this Microarray study was to analyze the general genetic response of masseter muscle in patients with retrognathism or prognathism of the mandible six months after surgery in comparison with healthy untreated controls. We found in tissue samples from masseter muscle a reduction of different entities between patients and controls but less in retrognathic than in prognathic patients (274/429). The different entities to controls in prognathia were reduced from 1862 to 1749 but increased in retrognathia from 1070 to 1563. We have to consider that the total amount of different entities to the controls is higher in patients with prognathic mandible (7364) because of their strong genetic controlled development compared with that in patients with retrognathic mandible (4126), which is more environmentally influenced.It can be concluded that function follows form after surgical change with high inheritance. In retrognathic patients the adaptation could be delayed or the capacity of regeneration potential is not sufficient.
http://ift.tt/2khS8t2
Comparison of intra-articular injection of plasma rich in growth factors versus hyaluronic acid following arthroscopy in the treatment of temporomandibular dysfunction: A randomised prospective study
Publication date: Available online 25 January 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Martín Fernández-Ferro, Jacinto Fernández-Sanromán, Andrés Blanco-Carrión, Alberto Costas-López, Annahys López-Betancourt, Jorge Arenaz-Bua, Bogdan Stavaru Marinescu
PurposeThe main objective of our study was to evaluate the effectiveness of the injection of plasma rich in platelet-derived growth factors (PRGF) versus hyaluronic acid (HA) following arthroscopic surgery in patients diagnosed with internal derangement of the temporomandibular joint (TMJ) with osteoarthritis (OA).Materials and MethodsA total of 100 patients were randomised into two study groups. Group A (n = 50) received an injection of PRGF, and Group B (n = 50) received an injection of HA. The mean age was 35.5 years (range 18-77 years), and 88% of the patients were women. The pain intensity (visual analogue scale) and the extent of maximum mouth opening before and after the procedure were statistically analysed.ResultsBetter results were observed in the group treated with PRGF, with a significant reduction in pain at 18 months, compared with HA treatment. Regarding mouth opening, an increase was observed in both groups, with no significant difference.ConclusionsThe injection of PRGF following arthroscopy is more effective than the injection of HA with respect to pain in patients with advanced internal derangement of the TMJ.
http://ift.tt/2jYwBbb
Efficacy of a Rhealba® Oat Extract-based emollient on chronic pruritus in elderly French outpatients
Abstract
Background
Chronic pruritus, defined as itch persisting more than 6 weeks, is a debilitating problem that affects one in four elderly adults. Emollients are recommended for the management of pruritus, but evidence of efficacy is scarce.
Objective
Assess the efficacy of a Rhealba® Oat Extract-based emollient in the management of chronic pruritus in elderly outpatients.
Methods
This was a randomized, mono-centric, open-label, cross-over study in adults ≥60 years of age with xerosis associated with chronic pruritus. Subjects were randomized 1:1 to start with a 2-week non-treatment phase or a 2-week treatment phase in which they applied the emollient once or twice daily. The primary outcome was subject-assessed pruritus using an established visual analogue scale. Subjects also assessed pruritus using the 5-D itch scale. Investigators assessed xerosis using the Overall Dry Skin Score and measured hydration index by Corneometer®, desquamation by D-Squame and transepidermal water loss by Aquaflux®.
Results
Thirty subjects were included. Pruritus intensity on the visual analogue scale improved significantly more during the treatment phase than during the non-treatment phase (P < 0.0001). This was also observed immediately after the first product application (P < 0.0001). According to the 5-D itch scale, pruritus decreased during the treatment phase but remained stable during the non-treatment phase (P = 0.0042). At the end of the treatment phase, more than half of the subjects reported an improvement in pruritus, and 30% reported complete disappearance, whereas pruritus remained stable during the non-treatment phase (P < 0.0001). Xerosis improved significantly more during the treatment phase than during the non-treatment phase as measured by D-Squame, clinical assessment and hydration index (P < 0.0001). Transepidermal water loss did not significantly change.
Conclusion
Daily use of a Rhealba Oat Extract-based emollient can provide relief to elderly adults who suffer from xerosis associated with chronic pruritus.
http://ift.tt/2k2uu6F