Publication date: March 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 94
Author(s): Matthew G. Crowson, Marisa A. Ryan, Vaibhav H. Ramprasad, Kevin J. Choi, Eileen Raynor
ObjectivesPediatric patient caregivers may prefer to avoid a surgical intervention and request a medical management option for eustachian tube dysfunction (ETD). However, there are limited published data evaluating the efficacy of intranasal fluticasone in the medical management of ETD as an alternative to tympanostomy tube placement. The objectives of this study were to: 1) determine if intranasal fluticasone (INF) prevented tympanostomy tube placement in children with ETD, and 2) describe differences in patient response to INF related to cleft lip and/or palate (CLP) and Down syndrome.MethodsCase series with planned chart review at a Tertiary academic hospital. We reviewed pediatric patients treated with INF for ETD. Inclusion criteria included ETD, no prior intranasal or oral steroid therapy, and no prior tympanostomy tube placement. Outcomes included time-to- tympanostomy tube placement with or without INF and therapy compliance. Kaplan-Meier survival analyses with log-rank tests and Fisher's exact tests were used to examine outcome variables.Results676 fulfilled inclusion criteria. 393 (58.7%) were male, and 355 (52.5%) Caucasian with mean age of 27.1 months old. 92 (13.6%) had CLP and 46 (6.8%) had Down Syndrome. 266 (39.4%) received INF, and 202 (88.2%) were compliant at their next visit. 474 (70.1%) had tympanostomy tubes placed. Children treated with INF were less likely to have tympanostomy tubes placed than children not treated (52.6% vs. 81.5%; p < 0.0001). Using survival analyses, INF use was associated with significantly longer mean time-to-tympanostomy tube than no INF use (199.4 vs. 133.7 days; p < 0.0001). INF did not reduce time-to-tympanostomy tube in patients with CLP (p = 0.05) or Down Syndrome (p = 0.27).ConclusionINF significantly reduces the number of children requiring tympanostomy tube placement for ETD. The CLP and Down Syndrome anatomical variants may attenuate INF efficacy. Further in vivo characterization of INF action on eustachian tube tissues will help further substantiate these observations.
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Σάββατο 28 Ιανουαρίου 2017
Intranasal fluticasone associated with delayed tympanostomy tube placement in children with eustachian tube dysfunction
Immunotolerant indoleamine-2,3-dioxygenase increases in condyloma acuminata
Abstract
Background
The tryptophan-depleting enzyme indoleamine-2,3-dioxygenase (IDO) is critical for the regulation of immune tolerance and plays an important role in immune-associated skin diseases.
Objectives
To analyze the level of IDO in condyloma acuminata (CA) and its role in this condition.
Methods
IDO expression was assessed in the skin and peripheral blood of healthy subjects and patients with CA. To assess the role of skin IDO in immunity, the ability of isolated epidermal cells to metabolize tryptophan and the influence on polyclonal T cell mitogen (PHA)-stimulated T cell proliferation were explored.
Results
IDO median fluorescence intensities (MFIs) in peripheral blood mononuclear cells (PBMCs) from CA patients were similar to those from healthy controls. Immunohistochemistry showed that IDO(+) cells were rare in normal skin and the control skin of CA patients but were greatly accumulated in wart tissue. Most fluorescence signals of IDO(+) cells were not overlapping with those of CD1a(+) Langerhans cells (LCs). HPV DNA probe in situ hybridization showed a large number of IDO(+) cells in the HPV(-) site. Keratinocytes (KCs) in the skin of healthy subjects and the circumcised skin of CA patients could minimally transform tryptophan into kynurenine, but IDO-competent epidermal cells from warts could transform tryptophan. In addition, these IDO-competent epidermal cells could inhibit PHA-stimulated T cell proliferation. The addition of an IDO inhibitor 1-MT restored the inhibited T cell proliferation.
Conclusion
Abnormally localized high IDO expression might be involved in the formation of a local immune tolerant microenvironment.
This article is protected by copyright. All rights reserved.
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Organisation of the dermal matrix impacts the biomechanical properties of skin
Summary
Background
Human skin has the crucial roles of maintaining homeostasis and protecting against external environment. It offers protection against mechanical trauma due to the reversible deformation of its structure; these biomechanical properties are amenable to dynamic testing using non-invasive devices.
Objectives
To characterise the biomechanical properties of young, white Caucasian and black African/African-Caribbean skin from different anatomical sites; and to relate underlying skin architecture to biomechanical function.
Methods
Using cutometry and ballistometry, the biomechanical properties of buttock and dorsal forearm skin were determined in black African/African-Caribbean (n=18) and white Caucasian (n=20) individuals aged 18-30 years. Skin biopsies were obtained from a subset of the volunteers (black African/African-Caribbean: n=5; white Caucasian: n=6) and processed for histological and immunohistochemical detection of the major elastic fibre components and fibrillar collagens.
Results
We have determined that healthy skin from young African and Caucasian individuals has similar biomechanical properties (F3) in that skin is resilient (capable of returning to its original position following deformation; R1), exhibits minimal fatigue (R4) and is highly elastic (R2, R5 and R7). At the histological level, skin with these biomechanical properties is imbued with strong interdigitation of the rete ridges at the dermal-epidermal junction (DEJ) and candelabra-like arrays of elastic fibres throughout the papillary dermis. Dramatic disruption to this highly organised arrangement of elastic fibres, effacement of the rete ridges and alterations to the alignment of the fibrillar collagens is apparent in white Caucasian forearm and coincides with a marked decline in biomechanical function.
Conclusions
Maintenance of skin architecture – both epidermal morphology and elastic fibre arrangement – is essential for optimal skin biomechanical properties. Disruption to underlying skin architecture, as observed in young white Caucasian forearm, compromises biomechanical function.
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A case report of disappearing pigmented skin lesions associated with pembrolizumab treatment for metastatic melanoma
Abstract
Pembrolizumab is an immune checkpoint inhibitor that targets the programmed cell death (PD)-1 receptor. Common cutaneous adverse side effects of PD-1 inhibitors include maculopapular rash, pruritus, vitiligo, and lichenoid skin and mucosal reactions. Here, we describe a man in his sixties with metastatic melanoma treated with pembrolizumab who subsequently developed fading or disappearance of pigmented skin lesions, lightening of the skin, and poliosis of the eyebrows, eyelashes, and scalp and body hair. Compared to baseline high-resolution three-dimensional total body photography, we observed fading or disappearing of solar lentigines, seborrheic keratoses, and melanocytic naevi, suggesting that PD-1 inhibitors may affect the evolution of these benign skin lesions. With dermatoscopic follow-up, altered lesions showed either blue-grey peppering/granularity or fading in colour without other identifiable features. No halo lesions or lesions with surrounding inflammation were identified. One changed pigmented lesion that showed blue-grey peppering/granularity on dermoscopy was biopsied and interpreted as a macular seborrheic keratosis with melanophages. Further studies are required to elucidate the effects of PD-1 inhibition on benign skin lesions.
This article is protected by copyright. All rights reserved.
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Recommendations for treatment in Folliculotropic Mycosis Fungoides: Report of the Dutch Cutaneous Lymphoma Group
Summary
Background
Folliculotropic mycosis fungoides (FMF) is an aggressive variant of mycosis fungoides (MF) and generally less responsive to standard skin-directed therapies (SDTs). Recent studies distinguished an indolent (early-stage FMF) and a more aggressive (advanced-stage FMF) subgroup. The optimal treatment for both subgroups needs still to be defined.
Objectives
Evaluation of initial treatment results in patients with early- and advanced-stage FMF.
Methods
203 Patients (84 early-stage, 102 advanced-stage, 17 extracutaneous FMF), included in the Dutch Cutaneous Lymphoma Registry between 1985 and 2014 were studied. Type and results of initial treatment were retrieved from the Dutch Registry. Main outcomes were complete remission (CR), sustained complete remission (SCR), partial remission (>50% improvement; PR) and overall response (OR; CR+PR).
Results
Patients with early-stage FMF were treated with non-aggressive SDTs in 67 of 84 cases, resulting in CR and OR of 28% and 83% for monotherapy topical steroids, 0% and 83% for UVB and 30% and 88% for PUVA, respectively. In patients with advanced-stage FMF these SDTs were less effective (combined CR and OR: 10% and 52%, respectively). In patients with advanced-stage FMF local radiotherapy (CR 63%; OR: 100%), total skin electron beam irradiation (CR: 59%; OR: 100%) and PUVA combined with local radiotherapy (CR: 5%; OR: 75%) were most effective.
Conclusions
The results of the present study demonstrate that not all patients with FMF should be treated aggressively. Patients with early-stage FMF may benefit very well from standard SDTs also used in early-stage classic MF and have an excellent prognosis.
This article is protected by copyright. All rights reserved.
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A novel approach for restoration of hemisected mandibular first molar with immediately loaded single piece BCS implant: A case report
Publication date: Available online 28 January 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Mahender Singh, Ranmeet Batra, Debdutta Das, Shweta Verma, Munish Goel
Mandibular first molars are the major standpoint for occlusion, and also have a wide peri-cemental area. Under specific conditions, hemisection of the tooth is indicated after an endodontic treatment. The following case report presents the hemisection of grossly carious, endodontically treated mandibular first molar, in a 23 year old female, followed by replacement of the mesial root with a single piece immediate loaded BCS (Bi-Cortical Screw) implant and a single unit porcelain fused to metal crown for the prosthetic rehabilitation of the remaining tooth structure, with the BCS implant providing strength and support to the weakened tooth structure. This procedure is an innovation in prosthetic rehabilitation of tooth structure left after hemisection and enhances the predictability of success rate of hemisection.
http://ift.tt/2kGrzgm
Influence of irradiation by a novel CO 2 9.3-μm short-pulsed laser on sealant bond strength
Abstract
The objective of this in vitro study was to evaluate whether irradiation of enamel with a novel CO2 9.3-μm short-pulsed laser using energies that enhance caries resistance influences the shear bond strength of composite resin sealants to the irradiated enamel. Seventy bovine and 240 human enamel samples were irradiated with a 9.3-μm carbon dioxide laser (Solea, Convergent Dental, Inc., Natick, MA) with four different laser energies known to enhance caries resistance or ablate enamel (pulse duration from 3 μs at 1.6 mJ/pulse to 43 μs at 14.9 mJ/pulse with fluences between 3.3 and 30.4 J/cm2, pulse repetition rate between 4.1 and 41.3 Hz, beam diameter of 0.25 mm and 1-mm spiral pattern, and focus distance of 4–15 mm). Irradiation was performed "freehand" or using a computerized, motor-driven stage. Enamel etching was achieved with 37% phosphoric acid (Scotchbond Universal etchant, 3M ESPE, St. Paul, MN). As bonding agent, Adper Single Bond Plus was used followed by placing Z250 Filtek Supreme flowable composite resin (both 3M ESPE). After 24 h water storage, a single-plane shear bond test was performed (UltraTester, Ultradent Products, Inc., South Jordan, UT). All laser-irradiated samples showed equal or higher bond strength than non-laser-treated controls. The highest shear bond strength values were observed with the 3-μs pulse duration/0.25-mm laser pattern (mean ± SD = 31.90 ± 2.50 MPa), representing a significant 27.4% bond strength increase over the controls (25.04 ± 2.80 MPa, P ≤ 0.0001). Two other caries-preventive irradiation (3 μs/1 mm and 7 μs/0.25 mm) and one ablative pattern (23 μs/0.25 mm) achieved significantly increased bond strength compared to the controls. Bovine enamel also showed in all test groups increased shear bond strength over the controls. Computerized motor-driven stage irradiation did not show superior bond strength values over the clinically more relevant freehand irradiation. Enamel that is made caries-resistant with CO2 9.3-μm short-pulsed laser irradiation showed at least equal or significantly higher shear bond strength to pit and fissure sealants than non-laser-irradiated enamel. The risk of a sealant failure due to CO2 9.3-μm short-pulsed laser irradiation appears reduced. If additional laser ablation is required before placing a sealant, the CO2 9.3-μm enamel laser-cut showed equivalent or superior bond strength to a flowable sealant.
http://ift.tt/2ji3QHn
Lymphoepithelial carcinoma in parotid gland related to EBV infection: A case report
Source:Auris Nasus Larynx
Author(s): Hiroyuki Maeda, Takuya Yamashiro, Yukashi Yamashita, Hitoshi Hirakawa, Shinya Agena, Takayuki Uehara, Sen Matayoshi, Mikio Suzuki
Lymphoepithelial carcinoma commonly occurs at the nasopharynx and rarely occurs at other sites in the head and neck region. It is well known to occur at limited patients of local area as Asia or Arctic Circle. Related to this point, it is pointed out that this tumor has strong relation with Epstein–Barr Virus (EBV) infection.In this time, we experienced to treat lymphoepithelial carcinoma with metastatic cervical lymph nodes occurring at parotid gland. The morbidity ratio of this tumor is less than one percent of all parotid gland tumors. Moreover, we proved the infection of EBV to tumor cell by in situ hybridization (ISH).Incidentally, because it is considered that this tumor has well sensitivity against irradiation or anti-tumor drugs, prognosis of this tumor is better than that of other head and neck tumors with different pathological type. Actually, we tried to perform chemotherapy twice in (Nedaplatin (CDGP) 60mg/m2×day 2 and 5-FU 600mg/m2×day 5) and to irradiate about 70Gy dose against parotid gland and cervical lymph nodes. It could not find local recurrence or metastasis as of now after five years from treatment.
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Multimodal Analgesia, Current Concepts, and Acute Pain Considerations
Abstract
Purpose of Review
Management of acute pain following surgery using a multimodal approach is recommended by the American Society of Anesthesiologists whenever possible. In addition to opioids, drugs with differing mechanisms of actions target pain pathways resulting in additive and/or synergistic effects. Some of these agents include alpha 2 agonists, NMDA receptor antagonists, gabapentinoids, dexamethasone, NSAIDs, acetaminophen, and duloxetine.
Recent Findings
Alpha 2 agonists have been shown to have opioid-sparing effects, but can cause hypotension and bradycardia and must be taken into consideration when administered. Acetaminophen is commonly used in a multimodal approach, with recent evidence lacking for the use of IV over oral formulations in patients able to take medications by mouth. Studies involving gabapentinoids have been mixed with some showing benefit; however, future large randomized controlled trials are needed. Ketamine is known to have powerful analgesic effects and, when combined with magnesium and other agents, may have a synergistic effect. Dexamethasone reduces postoperative nausea and vomiting and has been demonstrated to be an effective adjunct in multimodal analgesia. The serotonin–norepinephrine reuptake inhibitor, duloxetine, is a novel agent, but studies are limited and further evidence is needed.
Summary
Overall, a multimodal analgesic approach should be used when treating postoperative pain, as it can potentially reduce side effects and provide the benefit of treating pain through different cellular pathways.
http://ift.tt/2kzUfc0
JAK inhibitors in dermatology: The promise of a new drug class
New molecularly targeted therapeutics are changing dermatologic therapy. Janus kinase–signal transducer and activator of transcription (JAK-STAT) is an intracellular signaling pathway upon which many different proinflammatory signaling pathways converge. Numerous inflammatory dermatoses are driven by soluble inflammatory mediators, which rely on JAK-STAT signaling, and inhibition of this pathway using JAK inhibitors might be a useful therapeutic strategy for these diseases. Growing evidence suggests that JAK inhibitors are efficacious in atopic dermatitis, alopecia areata, psoriasis, and vitiligo.
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Clinical and pathologic factors associated with subclinical spread of invasive melanoma
Indications to treat invasive melanoma with Mohs micrographic surgery (MMS) or analogous techniques with exhaustive microscopic margin assessment have not been defined.
http://ift.tt/2k4IKcC
Assessment of sleep disturbance in children with allergic rhinitis
Sleep disturbance significantly impairs daily living of children and young adults with allergic rhinitis (AR) in 80% of patients.1–3 Compared with asymptomatic individuals, patients with chronic nocturnal rhinitis symptoms were more likely to report impaired cognitive function and decreased work productivity and performance.4 The Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines suggest that any report of sleep disturbance indicates moderate or severe AR, which has significant implications on treatment recommendations.
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The dangerous liaison between pollens and pollution in respiratory allergy
To recapitulate the more recent epidemiologic studies on the association of air pollution with respiratory allergic diseases prevalence and to discuss the main limitations of current approaches used to establish a link between pollinosis and pollution.
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Three-dimensional morphological changes of the temporomandibular joint and functional effects after mandibulotomy
The midline and paramedian mandibulotomy are surgical procedures that divide the mandibular bone into two halves and disconnects the condylar heads of the TMJ from each other. This study aimed to prospectively...
http://ift.tt/2jBJ6bU
American Thyroid Association (ATA) is looking for patients with hypothyroidism taking hormone treatment to complete survey
The post American Thyroid Association (ATA) is looking for patients with hypothyroidism taking hormone treatment to complete survey appeared first on American Thyroid Association.
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Systemic sclerosis and exposure to heavy metals: A case control study of 100 patients and 300 controls
Source:Autoimmunity Reviews
Author(s): I. Marie, J-F. Gehanno, M. Bubenheim, A-B. Duval-Modeste, P. Joly, S. Dominique, P. Bravard, D. Noël, A-F. Cailleux, J. Weber, P. Lagoutte, J. Benichou, H. Levesque, J-P. Goullé
Objective.This case control study assessed: the relationship of systemic sclerosis (SSc) related to exposure to heavy metals, the risk of SSc related to occupational exposure in male and female patients.MethodsFrom 2005 to 2008, 100 patients with a definite diagnosis of SSc were included in the study; 3 age, gender, and smoking habits matched controls were selected for each patient. All SSc patients and controls underwent detection and quantification of heavy metal traces in hair samples, using multi-element inductively coupled plasma mass spectrometry (ICP-MS).ResultsSSc patients exhibited higher median levels of the following metals: antimony (p=0.001), cadmium (p=0.0003), lead (p=0.02), mercury (p=0.02), molybdenum (p=0.04), palladium (p<0.001) and zinc (p=0.0003). A marked association between SSc and occupational exposure was further found for: 1) antimony (p=0.008) and platinum (p=0.04) in male patients; and 2) antimony (p=0.02), cadmium (p=0.001), lead (p=0.03), mercury (p=0.03), palladium (p=0.0003) and zinc (p=0.0001) in female patientsConclusionThe results show the impact of occupational risk factors in the development of SSc for: antimony, cadmium, lead, mercury, molybdenum, palladium and zinc. Thus, occupational exposure should be systematically checked in all SSc patients at diagnosis. Finally, the association between SSc and occupational exposure may be variable according to patients" gender.
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Inflammatory eye disease: pre-treatment assessment of patients prior to commencing immunosuppressive and biologic therapy: Recommendations from an expert committee
Source:Autoimmunity Reviews
Author(s): Denis Wakefield, Peter McCluskey, Gerhild Wildner, Stephan Thurau, Gregory Carr, Soon-Phaik Chee, John Forrester, Andrew Dick, Bernard Hudson, Susan Lightman, Justine Smith, Ilknur Tugal-Tutkun
AimTo outline recommendations from an expert committee on the assessment and investigation of patients with severe inflammatory eye disease commencing immunosuppressive and/or biologic therapy.MethodThe approach to assessment is based on the clinical experience of an expert committee and a review of the literature with regard to corticosteroids, immunosuppressive drug and biologic therapy and other adjunct therapy in the management of patients with severe sight-threatening inflammatory eye disease.ConclusionWe recommend a careful assessment and consultative approach by ophthalmologists or physicians experienced in the use of immunosuppressive agents for all patients commencing immunosuppressive and/or biologic therapy for sight threatening inflammatory eye disease with the aim of preventing infection, cardiovascular, metabolic and bone disease and reducing iatrogenic side effects.
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Gender balance in patients with systemic lupus erythrematosus
Source:Autoimmunity Reviews
Author(s): Audrey A Margery-Muir, Christine Bundell, Delia Nelson, David M Groth, John D Wetherall
Factors are reviewed that contribute to the contemporary view of a disproportionate prevalence and incidence SLE in females. Recent studies on the epidemiology of SLE report that global Incidences and prevalences of SLE for Caucasian and Black populations are of the order of 5.5 and 13.1 per year and 81 and 212 per 100,000 persons respectively. Both parameters displayed age dependent variation over a 90-year lifespan. The female to male (F:M) incidence of SLE varied with age, being approximately 1 during the first decade of life, followed by a sharp increase to 9 during the 4th decade, thence declining in subsequent decades before an increase during the 7th or 8th decades. A cognate review of SLE diagnosis in neonates revealed a F:M ratio of ≈1.2, consistent with the epidemiology review and the sporadic nature of SLE. Notional estimates of disease duration showed a steady increase from a base level for both males and females. The linear trend line for males was always lower than the trend line for females, supporting clinical experience that SLE is a more severe disease in males. Over a 14-year interval ending in 2012, the notional duration of SLE increased from 10 to 15years to 20–25years, probably reflecting advances in diagnosis and clinical practice.A metastudy of SLE concordance in twins revealed a 75% discordance in monozygotic twins compared to a 95% discordance in dizygotic twins confirming the importance of environmental factors in susceptibility to SLE. The elevated discordance in dizygotic SLE twins (and between siblings) suggests a role for the intrinsic genomic sexual dimorphism due to divergence of Y chromosome regulatory loci from their X chromosome homologues due to lack of recombination of mammalian sex chromosomes over evolutionary time.Estimates were made of the incidences of SLE in males and females based on population data for nine autosomal deficiency loci of major effect, plus expected male prevalence associated with Kleinfelter's syndrome and female prevalence associated with Triple X syndrome. These genetic abnormalities accounted for ≈4% of female and ≈23% of male Caucasoid prevalence and for SLE resulting in a F:M ratio of ≈0.17. It may be deduced therefore that the impressive preponderance of SLE in females arises from a combination of environmental triggers and susceptibility loci of relatively small effect acting between the interval from the mini-puberty of childhood to the peak of reproductive adulthood. It is in this cohort of females, and especially in the black population, that combinations of loci of minor effect acting together with environmental factors initiate defective apoptosis resulting in consequential autoimmune disease especially SLE. We postulate that because apoptosis is itself a very complex process, and defective apoptosis is an important contributor to SLE, there will be many combinations of susceptibility loci and environmental stimuli that can result in SLE (and other autoimmune disease(s)), of varying severity.
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Characterization of isolated retinal vasculitis. Analysis of a cohort from a single center and literature review
Source:Autoimmunity Reviews
Author(s): Laura Pelegrín, José Hernández-Rodríguez, Gerard Espinosa, Víctor Llorenç, Maite Sainz-de-la-Maza, José R. Fontenla, José A. Martínez, Maria C. Cid, Alfredo Adán
IntroductionIsolated retinal vasculitis (IRV) is an inflammatory condition of unknown etiology confined to the retinal vessels. In contrast to secondary retinal vasculitis (RV), IRV has not been well characterized.ObjectiveTo describe and characterize isolated forms of RV.MethodsWe performed a retrospective review (2006–2016) of IRV patients from a multidisciplinary Uveitis Unit. RV diagnosis was based on funduscopic and fluorescein angiography findings. To distinguish between secondary RV and IRV, evaluations included clinical assessment, laboratory inflammatory, autoimmune and microbiological markers and chest radiography. Ophthalmological features at disease onset, therapeutic interventions, ocular relapses, visual outcomes and laboratory findings were recorded. Our cases were subsequently compared with those from a literature review.ResultsAmong 192 patients with RV, 11 (5.7%) were diagnosed with IRV. Seven patients with initially presumed IRV were reclassified as secondary after further evaluation. IRV generally affected adult women. Bilateral ocular involvement and retinal phlebitis were common findings. 72% of patients presented with visual loss, which was severe in 27%. Treatments used included systemic glucocorticoids (82%), additional immunosuppressive agents (27%), intravitreal therapy (37%), panretinal photocoagulation (37%) and pars plana vitrectomy (26%). The annual relapse rate was 0.46. Although final visual acuity was considered good in 86%, 45% experienced worsening and only 27% improved.ConclusionsIRV is a rare sight-threatening condition. Despite intensive local and systemic immunosuppressive treatment, visual improvement is observed in only 27% of cases. When IRV is suspected, a differential diagnosis excluding a systemic disease is always warranted. A multidisciplinary approach and a guided clinical, laboratory and imaging evaluation has proven to be useful to distinguish retinal single-organ vasculitis from secondary forms of RV.
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Can innate and autoimmune reactivity forecast early and advance stages of age-related macular degeneration?
Source:Autoimmunity Reviews
Author(s): Grazyna Adamus
Age-related macular degeneration (AMD) is a major cause of central vision loss in persons over 55years of age in developed countries. AMD is a complex disease in which genetic, environmental and inflammatory factors influence its onset and progression. Elevation in serum anti-retinal autoantibodies, plasma and local activation of complement proteins of the alternative pathway, and increase in secretion of proinflammatory cytokines have been seen over the course of disease. Genetic studies of AMD patients confirmed that genetic variants affecting the alternative complement pathway have a major influence on AMD risk. Because the heterogeneity of this disease there is no sufficient strategy to identify the disease onset and progression sole based eye examination, thus identification of reliable serological biomarkers for diagnosis, prognosis and response to treatment by sampling patient's blood. This review provides an outline of the current knowledge on possible serological (autoantibodies, complement factors, cytokines, chemokines) and related genetic biomarkers relevant to the pathology of AMD, and discusses their application for prediction of disease activity and prognosis in AMD.
http://ift.tt/2kewmJx
Clinical Thyroidology High-Impact Articles
FREE ACCESS through February 10, 2017
Read Now:
Does Meta-Analysis Prove Which Factors Predict Relapse After Antithyroid Drugs Are Discontinued?
Stephen W. Spaulding
Thyroid Cancer Overdiagnosis Is a Result of Screening Programs in South Korea
Elizabeth N. Pearce
The Increased Incidence of Thyroid Cancer Is Worldwide
Jerome M. Hershman
Lymph Node Mapping with Ultrasound Is Highly Useful in the Preoperative Workup of Patients with Thyroid Cancer
Martin Biermann
The post Clinical Thyroidology High-Impact Articles appeared first on American Thyroid Association.
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Laryngeal electromyographic changes in postthyroidectomy patients with normal vocal cord mobility
Abstract
Thyroidectomy has been used for the treatment of thyroid disease for more than 100 years. In spite of the advancement of surgical techniques, there is still a risk of laryngeal nerve injury. The risk of partial or complete injury still depends on some surgical and disease-related factors. The aim of this study is to show the partial injury and to establish these risk factors via laryngeal electromyographic analysis (LEMG) in postthyroidectomy patients with normal vocal cord motion and mucosal anatomy. Patients who had undergone thyroid surgery were enrolled in this prospective study. LEMG analysis was performed to all patients with normal vocal cord mobility preoperatively and was repeated after the first and the third months of surgery. Thyroarytenoid (TA) and cricothyroid (CT) muscles were used to evaluate recurrent and external branch of superior laryngeal nerves, respectively. Four of the 32 patients had mild-to-moderate degrees of partial LEMG changes during preoperative LEMG analysis of TA and CT muscles on each side. After 3 months of surgery, there was a statistically significant worsening of LEMG findings in the right and left external branches of superior and left recurrent laryngeal nerves. Disease and surgery-related risk factors were analyzed. However, there was no significant relationship on the progression of LEMG findings according to these parameters. This is the first prospective study which supports the risk of progression of LEMG changes in patients with normal laryngoscopic examination after thyroid surgery. No reliable significant risk factor was found influencing the LEMG progression.
http://ift.tt/2jgkaZb
Experiences and preferences of patients visiting a head and neck oncology outpatient clinic: a qualitative study
Abstract
The objective of this study is to report on an in-depth evaluation of patient experiences and preferences at a Head and Neck Oncology outpatient clinic. A qualitative research design was used to determine the experiences and preferences of Head and Neck Cancer patients in an Oncology Outpatient Clinic, Maastricht University Medical Center, The Netherlands. Head and Neck Cancer Patients, treated for at least 6 months at the Oncology Clinic, were included. A qualitative research design with patient interviews was used. All interviews were recorded and transcribed verbatim to increase validity. Analysis was done with use of the template approach and qualitative data analysis software. Three of the six dimensions predominated in the interview: (1) respect for patients' values, preferences and expressed need, (2) information, communication and education and (3) involvement of family and friends. The dimensions physical comfort; emotional support; coordination and integration of care were considered to be of less significance. The findings from this study resulted in a deeper understanding of patients' experiences and preferences and can be useful in the transition towards a more patient-centered approach of health care.
http://ift.tt/2k36duS
False-positive cytopathology results for papillary thyroid carcinoma: A trap for thyroid surgeons
Abstract
Objectives
Current preoperative diagnosis of thyroid nodules remains imperfect despite recent advances in cytopathology and molecular diagnostics. False-positivity in preoperative fine needle aspiration cytology (FNAC) may lead to overtreatment of patients, including total thyroidectomy, and sometimes to lawsuits for misdiagnosis and malpractice. In this study, we analyzed clinical characteristics and pathologic findings in patients with false-positivity for papillary thyroid carcinoma (PTC) in FNAC.
Methods
We retrospectively reviewed permanent pathology results from 3788 patients who underwent thyroid surgery. Among them, 48 patients had lesions that were deemed suspicious or positive (Bethesda class V or VI) for PTC in preoperative FNAC. We reviewed clinic-pathologic data, radiologic findings and surgical planning in these patients.
Results
The prevalence of pathologic thyroiditis was significantly higher among patients with false-positive FNAC results than in those with confirmed PTC (54.2% versus 9.2%, P < 0.001). The analysis of the permanent pathology reports showed that 26 patients had chronic lymphocytic thyroiditis and 22 patients had no evidence of thyroiditis. Among the patients without pathologic thyroiditis, 19 patients (86.4%) had nodular hyperplasia and 3 (13.6%) had follicular adenoma, while among the patients with pathologic thyroiditis, 7 (26.9%) had no nodule, 14 (53.8%) had nodular hyperplasia, 2 (7.7%) had hyalinized nodules, 2 (7.7%) had follicular adenoma, and 1 (3.8%) had a hyalinizing trabecular tumor. In 42 patients, the extent of surgery (total thyroidectomy or hemithyroidectomy) was to be determined according to intraoperative frozen section biopsy results. Among them, 4 (10.5%) had inconclusive frozen section results, and 38 (90.5%) had benign results on frozen section.
Conclusions
Patient counseling about the possibility of false-positivity is still important. And the presence of thyroiditis might create confusion in the interpretation of cytopathologic results.
This article is protected by copyright. All rights reserved.
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A Retrospective Analysis of Seven Patients with Acquired Immunodeficiency Syndrome and Pharyngeal and/or Laryngeal Talaromyces marneffei Infection
Abstract
1.Talaromyces marneffei, formerly known as Penicillium marneffei, usually affects the monocyte-macrophage system and can cause fatal systemic mycosis in immunocompromised individuals. This retrospective study is the first to describe the clinical and endoscopic (nasal endoscopy, flexible endoscopy) features of penicilliosis with pharynx and/or larynx infection in patients with acquired immunodeficiency syndrome (AIDS).
2.During the study period, 126 patients were diagnosed with penicilliosis. Among them, only seven who presented with culture and/or histopathological evidence of pharyngeal and/or laryngeal T. marneffei infection were included; notably, all of these patients also had AIDS.
3.The most common specific pharyngeal and laryngeal features were sore throat, hoarseness, dysphagia, a pharyngeal and laryngeal mass and/or mucosal ulcerations, and enlargement of multiple cervical and axillary lymph nodes. Evaluation using nasal endoscopy and flexible endoscopy revealed pharyngeal and laryngeal ulcers and/or a mass.
4.Histopathological analysis of all pharyngeal and/or laryngeal tissue samples in our retrospective study revealed positivity for T. marneffei. The most common pathological type was non-reactive necrosis.
5.Histopathology and fungal culture of pharyngeal and laryngeal secretions and tissues are important and safe methods that allow determination of an accurate etiological basis for penicilliosis with pharyngeal and/or laryngeal infection, as well as differentiation from other diseases such as tuberculosis, lymphoma, pharyngeal cancer, and Kaposi's sarcoma.
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Workload and Costs of Audiological Assessment on Tertiary Settings: Data Analysis and Audit
Abstract
It is estimated that hearing impairment affects 850,000 people in Scotland. In a tertiary, referral centre this number reflects over 32,000 of referrals to the department of audiology per annum.
The number of referrals has increased reaching a plateau; in 2015 the number of referrals reached 32,422. The total number of hearing aid fittings carried out each year is on the rise.
Within this tertiary centre covering eight hospitals and a catchment area of 1.16 million people, the annual cost of hearing aids exceeds £1.5 million, not including repairs, batteries and accessories.
Referral to hearing aid ratio varies between different hospitals; this possibly indicates a significant impact of the socioeconomic status to hearing aid acceptance/ provision/ follow up appointments.
The consistently high numbers are likely to place a substantial burden upon the workload within the tertiary centre itself and have corresponding financial implications upon the NHS budget.
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Fibrin sealants in soft-tissue surgery of the head and neck: a systematic review and meta-analysis of randomised controlled trials
Abstract
Background
Fibrin sealants (FS) are commercially available products used in surgical wounds as adjuncts to haemostasis and closure of dead space. The role of FS in soft-tissue head and neck surgery has not been established.
Objectives
To assess if FS improves wound related outcomes in patients undergoing soft-tissue surgery of the head and neck anatomical region that would commonly require a drain.
Type Of Review
Systematic review and meta-analysis of randomised controlled trials (RCTs).
Search Strategy
Medline (1946 – 2016), EMBASE (1974 – 2016), PubMed (2016), CENTRAL (2016), ClinicalTrials. gov (2016), WHO International Clinical Trials Registry and Platform (2016), Research Gate (2016).
Evaluation Method
Two independent reviewers screened and selected studies. Included studies were assessed for risk of bias and data extracted using a predetermined data collection form.
Results
Of the 421 studies that were screened 11 RCTs met the inclusion criteria. There were 2 RCTs on thyroidectomy, 3 on 'surgery involving neck dissection' (central or lateral), 5 on rhytidectomy and 1 on parotidectomy. There was a tendency for FS to reduce 'mean total drainage volume' (mean difference -26.86ml, 95%CI -43.41 to -10.31, I2=97%, p=0.001). Sub-group analysis of thyroidectomy (mean difference -36.36ml, 95%CI -72.82 to 0.10, I2=79%, p=0.05), 'surgery involving neck dissection' (mean difference -33.21ml, 95%CI -70.01 to 3.59, I2=94%, p=0.08) and rhytidectomy (mean difference -13.79ml, 95%CI -17.57 to -10.01, I2=0%, p<0.00001) concurred with the overall analysis. There was a suggestion that FS may reduce 'mean retention time of drains' by 1.24 days (95%CI -3.32 to 0.85, I2=99%, p=0.25) and 'hospital length of stay' by 2.09 days (95% CI -5.18 to 0.99, I2=97%, p=0.18) but this was not statistically significant. There was also a suggestion that FS may protect against adverse events (RR 0.69, 95%CI 0.35 to 1.38, I2=0%, p=0.29) and haematoma/seroma formation (RR 0.49, 95%CI 0.22 to 1.07, I2=0%, p=0.07).
Conclusions
There was considerable heterogeneity within the RCTs included in this study thus restricting definitive conclusions. FS has however shown a definite benefit in rhytidectomy and potential benefit in other soft-tissue head and neck surgical procedures. Further pragmatic trials are required particularly in the field of lateral neck dissection.
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Editorial Board/Reviewing Committee
Source:International Journal of Oral and Maxillofacial Surgery, Volume 46, Issue 3
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Influence of temporomandibular joint disc displacement on mandibular advancement in patients without pre-treatment condylar resorption
Publication date: March 2017
Source:International Journal of Oral and Maxillofacial Surgery, Volume 46, Issue 3
Author(s): Z. Miao, X.-d. Wang, L.-x. Mao, Y.-h. Xia, L.-j. Yuan, M. Cai, J.-q. Liu, B. Wang, X. Yang, L. Zhu, H.-b. Yu, B. Fang
The purpose of this study was to clarify the correlation between pre-treatment anterior disc displacement and mandibular stability after orthognathic and orthodontic treatment among patients with a skeletal class II malocclusion and without pre-treatment condylar resorption. Thirty-seven patients were included (7 male, 30 female). The mean length of follow-up was 6.76±3.06 years. Patients with condylar resorption before treatment were excluded. Magnetic resonance images and lateral cephalometric radiographs were taken before treatment (T0), after treatment (T1), and at follow-up (T2). Patients were classified according to the degree of disc displacement: −10–10° 'normal', 11–50° 'slight to mild', ≥51° 'moderate to severe'. Results showed the condyle moved posterosuperiorly after treatment, and then moved anteriorly to a more concentric location during the long follow-up period. Condylar movement was found not to correlate with disc displacement. The degree of disc displacement before treatment did not correlate with the post-surgical mandibular positional change in either the sagittal or vertical direction. To conclude, the mandibular bilateral sagittal split ramus osteotomy was stable in the long-term after orthognathic and orthodontic treatment. In the absence of pre-treatment condylar resorption, the degree of initial anterior disc displacement did not have a significant influence on the stability of mandibular advancement.
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Calendar of Events
Source:International Journal of Oral and Maxillofacial Surgery, Volume 46, Issue 3
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Three-dimensional morphological changes of the temporomandibular joint and functional effects after mandibulotomy
Abstract
Background
The midline and paramedian mandibulotomy are surgical procedures that divide the mandibular bone into two halves and disconnects the condylar heads of the TMJ from each other. This study aimed to prospectively evaluate the temporomandibular joint (TMJ) functional and morphological changes after mandibulotomy using a reconstructed 3D models of the TMJ.
Methods
Sixteen adult patients diagnosed with oral and oropharyngeal tumors with planned surgical mandibulotomy (test group, 9 patients) or transoral (control group, seven patients) treatments were included in the study. MRI and CBCT images were obtained immediately preceeding surgery and 6–8 weeks after surgery. Using the MRI-CBCT registered images, TMJ tissues were segmented at the two occasions by the same operator and 3D models were reconstructed for morphological assessment. Changes across time were measured using the volume overlap and Hausdorff distance of the disc and condyle 3D models. Disc-condyle relationship was measured using point-based and color map analysis. To assess the early functional changes, the Jaw function limitation scale (JFLS) and the maximum mouth opening were measured. Two-sample Hotelling T2t-test was performed to determine the significance of the morphological and clinical outcomes' differences between the two groups.
Results
The two-sample Hotelling T2t-test showed significant differences (T2 (df1,df2) = 0.97 (5,26), p <0.01) between the mean values of all outcomes among the 2 groups. The change in disc displacement was significantly different between the two groups (p <0.05). However, the condylar displacement was not significantly different between the two groups (p =0.3). The average of the JFLS score was five times larger after mandibulotomy, and was 2 times larger after transoral surgery (p < 0.01). Patients showed decrease in the average of the maximum interincisal mouth opening by 11 mm after mandibulotomy, and by 5.4 mm after transoral surgery.
Conclusion
The quantitative assessment of the TMJ showed minimal changes of the condylar position and variable degrees of articular disc displacement associated with the paramedian split mandibulotomy. As well, limited jaw functions and vertical mouth opening were noticed more in the mandibultomy group compared to the transoral group in 6- weeks after surgery.
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Next step: functional studies on hypertension, lichen planus and TRPA1 connections
Abstract
We would like to thank for the invaluable insights of Shan and colleagues (Shan et al, 2017). They put forward a most logical hypothesis for a link between Koebner phenomenon and the mechanoreceptor Transient Receptor Potential Ankyrin 1 (TRPA1). As suggested, TRPA1 expression in non-lesion mucosal areas of oral lichen planus (OLP) patients should also be investigated. Furthermore, buccal samples form people displaying mursicatio buccarum may be used to test if prolonged mechanical stimuli alone upregulate TRPA1 in the oral mucosa.
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Salvage surgery in recurrent head and neck squamous cell carcinoma: Oncologic outcome and predictors of disease free survival
Source:Oral Oncology, Volume 67
Author(s): Marc Hamoir, Emma Holvoet, Jerôme Ambroise, Benoît Lengelé, Sandra Schmitz
ObjectiveSalvage surgery in recurrent SCCHN is associated with poor outcomes. This study aimed to better identify suitable surgical candidates and those at high risk of new recurrence.Materials and methodsSingle-center retrospective analysis of 109 patients undergoing salvage surgery for recurrent SCCHN. Univariate and multivariate analyses were used to identify prognostic factors affecting disease-free survival (DFS).ResultsThe following factors showed a significant impact on DFS: Disease-free interval >6months [HR 0.53; p=0.04], age>70years [HR 0.26; p=0.03], primary chemoradiotherapy [HR 2.39; p<0.01] compared to radiotherapy, oropharynx [HR 5.46; p<0.01] and hypopharynx [HR 3.92; p=<0.01] sites, compared to larynx, initial stage III [HR 7.10; p<0.01] and stage IV [HR 4.13; p<0.01], compared to stage I, locoregional recurrence [HR 4.57; p<0.01], compared to local recurrence. Univariate analysis also identified significant postoperative predictors of poor DFS including flap reconstruction [HR 3.44; p<0.01], postoperative complications [HR 2.09; p=0.01], positive margins [HR 3.64; p<0.01] and close margins [HR 3.83; p<0.01]. On multivariate analysis, oropharynx site [HR 3.98; p<0.01], initial stage III [HR 5.93; p<0.01] and locoregional recurrence [HR 2.93; p=0.04] were independent preoperative prognostic factors for DFS. Positive margins [HR 2.32; p=0.04], close margins [HR 2.94; p=0.02], extracapsular spread (ECS) [HR 4.04; p=0.03] and postoperative complications [HR 3.64; p<0.01] were independent postoperative prognostic factors.ConclusionsPatients with advanced primary nonlaryngeal tumor and locoregional recurrence have limited success with salvage surgery. Because patients with positive margins and ECS are at high risk of relapse, adjuvant treatment should be discussed.
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Isolated tracheoesophageal fistula versus esophageal atresia – Early morbidity and short-term outcome. A single institution series
Source:International Journal of Pediatric Otorhinolaryngology, Volume 94
Author(s): R.B. Tröbs, W. Finke, M. Bahr, C. Roll, M. Nissen, M.R. Vahdad, G. Cernaianu
PurposeWe compared the postnatal course, morbidity and early results after repair for cases of isolated or "pure" TEF with those for cases of esophageal atresia (EA) with distal tracheoesophageal fistula (TEF).MethodsTwenty-four consecutive infants were divided into two groups: isolated TEF [TEF group] (n = 5) and EA with distal TEF [EA group] (n = 19). Results. A high rate of prematurity (29%) and major cardiac and other surgically-relevant malformations (0.8 vs. 0.7 per infant) was found in both groups. The median age at surgery was 8 days for the TEF group vs. 1 day for the EA group (p < 0.01). Most infants of both cohorts had stable acid-base and respiratory parameters at admission. Generally, tracheoscopy provided valuable information regarding the position of the TEF. Surgery for isolated TEF was performed via right cervicotomy in 4 cases and via thoracotomy in one. Postoperative thoracostomy tubes were inserted in 3 cases and one emergency gastrostomy was created for acute gastric overextension (exclusively in patients with EA). The duration of postoperative mechanical ventilation (49 vs. 113 h, p = 0.045) and the median length of stay in the pediatric surgery unit (10 vs. 20.5 days, p = 0.003) were shorter for the isolated TEF group. Four EA patients experienced severe events. Total mortality was 8% (0 out of 5 with TEF vs. 2 out of 19 with EA).ConclusionDevelopmental delay and a high rate of morbidity were found in both groups. More complex surgery increased perioperative morbidity in cases of EA. With early recognition of isolated TEF, a less complicated course can be expected in comparison with esophageal atresia.
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Urine cysteinyl leukotriene levels in children with sleep disordered breathing before and after adenotonsillectomy
Source:International Journal of Pediatric Otorhinolaryngology, Volume 94
Author(s): A. Satdhabudha, P. Sritipsukho, S. Manochantr, W. Chanvimalueng, U. Chaumrattanakul, P. Chaumphol
ObjectivesObstructive sleep apnea (OSA) is a common problem in children and is associated with increased cardiovascular, neurobehavioral and somatic growth consequences. Cysteinyl leukotrienes (CysLTs) play a major role with local and systemic relations to the pathophysiology of OSA. The level of CysLTs in urine, blood, exhaled breath and adenotonsillar tissue of OSA children are increased. However it remains unclear whether inflammatory marker levels are alleviated after adenotonsillectomy. Therefore, we compare the urine leukotriene E4 (uLTE4) levels in children before and after adenotonsillectomy and evaluate clinical outcomes on resolution of OSA.MethodsChildren under 15 years who suspected OSA with planned adenotonsillectomy were recruited. Sleep questionnaires, quality of life assessment by OSA-18, physical examination, lateral neck radiographs, overnight SpO2 monitoring and uLTE4 levels were collected. 4 ± 2 weeks post-surgery, OSA-18 was reevaluated and urine was collected again.ResultsThirty-three children with sleep disordered breathing (SDB) were included (mean age 8.1 ± 2.8 years). After adenotonsillectomy, the uLTE4 levels decreased from 961.9 (684.8–1438.2) to 708.6 (538.2–1038.8) pg/mg Cr (P = 0.009). The post-surgery score from sleep questionnaire, OSA-18 questionnaire were significant improved (P < 0.001). Obese children demonstrated an improved quality of life post-surgery, but results were poorer than normal-weight children (P = 0.01). The uLTE4 no obvious improved in obese children.ConclusionsAdenotonsillectomy remains an effective treatment for SDB children that not only alleviated the severity of SDB and improved quality of life; it also decreased levels of the systemic inflammatory marker, uLTE4. However, benefits were more obvious in non-obese children.
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