Head and Neck Medicine by Alexandros G.Sfakianakis: 02/07/17

Τρίτη 7 Φεβρουαρίου 2017

Endogenous fluorescence analysis: preliminary study revealing the potential of this non-invasive method to study mummified samples

Abstract

Autofluorescence analysis allows new insights on human tissue without any dye in a non-invasive way and therefore seems well suited to study historical samples. An optical set-up recorded emitted autofluorescence in 1/spectral and 2/lifetime domains from different samples' regions of interest. The studied samples were: a mummified right hand; bog body (Tollund Man) feet, and a Caucasian male hand (control sample). Spectral analysis revealed that mummified hand exhibited broad autofluorescence spectra whereas Tollund Man feet exhibited a weak single peak with 405 nm excitation wavelength. Control sample spectra is weaker than that of the mummified hand but higher than the Tollund Man feet's. Lifetime measurements indicated the presence of classical endogenous fluorophores on the mummified right hand. The Tollund Man feet exhibited two patterns of lifetime measurements: healthy zone exhibited lifetime values at 4 emission wavelengths but skin lesions at only 2 wavelengths. This first report of mummified samples' autofluorescence analysis suggests the potential of optical analysis for archeologic research.

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Supratracheal partial laryngectomy: indications, oncologic and functional results.

Purpose of review: To describe current evidence about supratracheal laryngectomies, focusing on indications, contraindications, oncologic results, functional outcomes and side-effects of this 'extreme' function-sparing surgical approach to laryngeal cancer. Recent findings: In the latest years, some studies have analyzed oncologic and functional results of open partial supratracheal laryngectomy, a surgical approach whose modern technique was recently described. In selected patients, supratracheal partial laryngectomies show promising long-term oncologic and functional outcomes, similar to those of supracricoid partial laryngectomies. Summary: The application of supratracheal laryngectomy in the context of a surgical modular approach can be considered a valid and effective therapeutic choice for selected patients with glottic or transglottic laryngeal cancer with subglottic extension, not only in terms of oncologic results, but also in regard of functional outcomes. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Utilization of ultrasound for diagnostic evaluation and management of peritonsillar abscesses.

Purpose of review: We outlined the management of peritonsillar abscess (PTA) through the use of ultrasound, an imaging modality that continues to emerge as a diverse diagnostic and treatment tool. Our review compares the use of ultrasound to alternative diagnostic modalities, particularly computed tomography (CT). Further, the review evaluates how ultrasound can be used to help facilitate guided drainage of PTA and serve as a suitable alternative to more invasive management options. Recent findings: Studies over the past 5 years have demonstrated that the initial management of PTA with ultrasound is a more cost-efficient and lower-risk option than imaging with CT. Ultrasound possesses great specificity for PTA and may be more diagnostically accurate than previously thought. Ultrasound is particularly well tolerated in children and adults, avoids radiation exposure, as well as minimizes false-positive aspirations. In addition, the ability to utilize ultrasound from different approaches allows for flexibility in the management of PTA. Summary: These findings illustrate that ultrasound is being increasingly considered in the management of stable patients presenting with PTA. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Immediate post-extraction implants with or without pure platelet-rich plasma: a 5-year follow-up study

Abstract

Purpose

The purpose of this study was comparison of clinical and radiographic outcomes of immediate post-extraction implants with or without the use of pure platelet-rich plasma (P-PRP) in the short- and medium-term follow-up.

Methods

A retrospective analysis was performed to assess soft tissue healing, implant and prosthesis survival, marginal bone level changes and biological complications.

Results

A total of 109 partially edentulous patients with 126 implants were included in this analysis. At 4–5 years after loading, cumulative survival rate in test group was 97.4% and in control group was 97.8%, with no significant differences. After 5 years of function, marginal bone loss (MBL) in test group was 0.8 ± 0.35 and 1.02 ± 0.27 mm for immediate and delayed loading, respectively, and in control group was 0.6 ± 0.16 and 0.8 ± 0.89 mm for immediate and delayed loading, respectively. No significant differences in MBL were observed intragroups and intergroups at any time point considered. Soft tissue healing score was significantly higher in test group compared to the control at 3 and 7 days after surgery, with significant differences.

Conclusions

P-PRP implant group showed a better soft tissue management and wound healing in the first 7 days after surgery compared to non-P-PRP implant group. In the medium-term follow-up, comparable clinical and radiographic outcomes were noticed between two groups.

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Phenotypic analysis of circulating T-cell subset and its association with burden of skin disease in patients with chronic actinic dermatitis: a hematologic and clinicopathologic study of 20 subjects

Abstract

Background

Chronic actinic dermatitis (CAD) is a recurrent photosensitive dermatitis that occurs predominantly on sun-exposed areas with unknown etiology. In severe cases, it may present with erythroderma, which is clinicopathologically analogous to cutaneous T-cell lymphoma. Typically, inflammatory infiltrates in the skin lesions are mainly CD8⁺ reactive T cells. However, hematologic characteristics of CAD have not been fully elucidated.

Methods

Twenty patients with CAD ranging in age from 45 to 86 years (median, 64), including 17 males and three females (M/F ratio, 5.7), were examined. All patients were phototested for UV light. In addition, seven of the 20 patients with extensive eruption were also tested for visible light. All biopsy specimens were obtained from the CAD eruptions (n = 25 lesions). Histopathologic and immunohistochemical studies were performed. Furthermore, flow cytometric analysis was performed to determine the CD4/8 ratio using peripheral blood mononuclear cells of 13 of the 20 patients.

Results

In 11 of the 20 patients (55%), the eruption was localized to sun-exposed areas. Skin-infiltrating T cells were CD8-dominant in the CAD eruption. Three patients (15%) showed erythroderma with a reduced CD4/8 ratio (median, 0.7) of peripheral mononuclear cells. As for treatment, eight of the 20 patients (40%) required oral cyclosporine in addition to topical therapies. Subsequently, the reduced CD4/8 ratio was normalized after treatment in two of the three patients with erythroderma.

Conclusions

We considered that there appeared to be a relationship between the reduced CD4/8 ratio of circulating T cells (hematologic burden) and the affected area (skin burden).

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Evaluation of a Two-Year Routine Application of Molecular Testing of Thyroid Fine-Needle Aspirations Using a Seven-Gene Panel in a Primary Referral Setting in Germany

Thyroid , Vol. 0, No. 0.

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Newer proposed classification of periimplant defects: A critical update

Publication date: Available online 7 February 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Deepak Passi, Mahinder Singh, Shubha Ranjan Dutta, Sarang Sharma, Mansi Atri, Jyoti Ahlawat, Abhinav Jain
The term peri-implantitis is used to describe a destructive inflammatory process affecting the soft and hard tissues around osseo integrated implants, leads to the formation of a peri-implant pocket and loss of supporting bone. Predisposing factors are Poor Plaque Control, inflammation, infection, Smoking, Diabetes and Occlusal Overload. It is diagnosed on the basis of clinical and radiographic interpretation and still no definite criteria have been proposed for the diagnosis and treatment of peri-implantitis. However treatment can be both conservative and surgical. The cumulative interceptive supportive therapy protocol serves as good guide for the treatment of the peri-implantitis. There is lack of a standard classification system to differentiate the various degrees of peri-implantitis, which produces dilemma in evaluating the stages clinical and radiological status, treatment and its outcome. Many classification has been proposed in medical literature with their pros and cons but still there is lack of standard classification system of implant defects and definite treatment protocol according to the same. The classification should be easy to use, clearly understandable and help in communication by clinicians of different speciality. This review aimed to introduce a classification system based on added clinical, and detailed radiological parameters with prognosis and staged treatment algorithms.

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Clinical significance of integrin-linked kinase in laryngeal squamous cell carcinoma

Publication date: Available online 7 February 2017
Source:Auris Nasus Larynx
Author(s): Ping-An Wu, Shi-Sheng Li, Qing-Lai Tang, Bing-Bing Liu, Xin-Ming Yang
ObjectiveTo investigate the expression of integrin-linked kinase (ILK) and its relationship with clinicopathological parameters in laryngeal squamous cell carcinoma (LSCC).Methods116 patients who had previously undergone complete resection of tumor for LSCC were studied retrospectively. The level of ILK expression in tumor tissues and adjacent nontumor tissues were determined by immunohistochemistry.ResultsIncreased expression of ILK was found in 65.5% of cases. The expression of ILK protein was significantly associated with tumor grade (p=0.046), lymph node metastasis (p=0.020), and pTNM stage (p=0.019). Kaplan–Meier survival estimates showed a significant correlation between ILK expression and patient survival rate (log-rank p<0.05). The multivariate survival analysis revealed that N status was statistically significant prognostic factor (p<0.001). Other parameters, such as ILK expression, cannot predict disease prognosis separately.ConclusionIncreased expression of integrin-linked kinase is associated with lymph node metastases and patient survival rate in laryngeal squamous cell carcinoma. However, it does not appear to be an independent prognostic predictor in LSCC.

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Diet-induced obesity, gut microbiota and bone, including alveolar bone loss

Publication date: Available online 7 February 2017
Source:Archives of Oral Biology
Author(s): Sathima Eaimworawuthikul, Parameth Thiennimitr, Nipon Chattipakorn, Siriporn C. Chattipakorn
Obesity is a major risk factor for several pathologies, including jaw bone resorption. The underlying mechanisms involved in pathological conditions resulting from obesity include chronic systemic inflammation and the development of insulin resistance. Although numerous studies have indicated the importance of the role of gut microbiota in the pathogenesis of inflammation and insulin resistance in obesity, only a few studies have established a relationship between obesity, gut microbiota and status of the jaw bone. This review aims to summarize current findings relating to these issues, focusing on the role of obesity and gut microbiota on jaw bone health, including possible mechanisms which can explain this link.

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Baicalein enhances the osteogenic differentiation of human periodontal ligament cells by activating the Wnt/β-cateninsignaling pathway

Publication date: Available online 7 February 2017
Source:Archives of Oral Biology
Author(s): Li-Jiao Chen, Bi-Bo Hu, Xin-Lian Shi, Man-Man Ren, Wen-Bin Yu, Sheng-Dan Cen, Rong-Dang Hu, Hui Deng
ObjectivePeriodontium regeneration is one of the most important processes for periodontitis therapy. Human periodontal ligament cells (hPDLCs) play a vital role in the repair and regeneration of periodontal tissues. Our study aimed to investigated the mechanisms underlying the promotion of hPLDCsosteogenic differentiation by baicalein.DesignhPDLCs were obtained from periodontal ligament (PDL) tissues by primary culture. The MTT assay was used to determine the growth curves of hPDLCs treated with different concentrations of baicalein (1.25, 2.5, 5, or 10μM). Alkaline phosphatase (ALP) staining and Alizarin red S staining were performed to assess osteogenic differentiation of hPDLCs administered baicalein. Osteogenic differentiation-related gene and protein expression levels and Wnt/β-catenin pathway signal changes were assessed by qRT-PCR and Western blotting analysis.ResultsThe results showed that baicalein decreased the growth of hPDLCs slightly and increased ALP activity and calcium deposition in a dose-dependent manner. The expression of runt-related transcription factor 2 (RUNX2), bone morphogenetic protein 2 (BMP2), Osterix (OSX) and osteocalcin (OCN) were elevated after baicalein administration. Moreover, baicalein strongly activated the Wnt/β-catenin pathway and up-regulated the expression of β-catenin, lymphoid enhancer factor 1 (LEF1) and Cyclin D1. Dickkopf-related protein 1 (DKK-1) significantly reversed the effects of baicalein on hPDLCs.ConclusionsOur findings indicated that baicalein enhanced the osteogenic differentiation of hPDLCs via the activation of the Wnt/β-catenin signaling pathway, which may represent a potential candidate for periodontitis therapy.

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Diet-induced obesity, gut microbiota and bone, including alveolar bone loss

Baicalein enhances the osteogenic differentiation of human periodontal ligament cells by activating the Wnt/β-cateninsignaling pathway

American Thyroid Association invited to speak at HUD Health & Wellness Event for Thyroid Awareness month

ATA and AAES Member, Dr. Jennifer Rosen, chief of endocrine surgery at Medstar, talks about thyroid disease and thyroid cancer to employee group

The post American Thyroid Association invited to speak at HUD Health & Wellness Event for Thyroid Awareness month appeared first on American Thyroid Association.

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Leitliniengerechte Behandlung bei allergischer Rhinitis noch möglich?

Die Anwendung von Antihistaminika und topischen Glukokortikoiden gilt international als leitliniengerechter therapeutischer Standard bei intermittierender und persistierender allergischer Rhinitis [1]. Dies sagt in Deutschland allerdings nichts aus über die Verordnungs- und Erstattungsfähigkeit dieser Präparategruppen für gesetzlich versicherte Patienten. Trotz der erheblichen Beeinträchtigung der Lebensqualität und des Leistungsvermögens der Patienten sowie der damit verbundenen sozioökonomischen Folgen [2, 3] wird die Erkrankung weiterhin bagatellisiert und unzureichend therapiert.

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Inhaltsverzeichnis

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Haben Sie auch eine fachliche Frage?

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Anaphylaxie: Keine Angst vor Adrenalin

Die Anaphylaxie ist eine akute, systemische allergische Reaktion, die den ganzen Organismus erfassen kann und potenziell lebensbedrohlich ist. Das wichtigste Medikament in der Therapie dieses Notfalls ist Adrenalin. Der folgende Beitrag erläutert, worauf zu achten ist.

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Was kann die Immuntherapie auf Peptidbasis?

Durch die Verwendung von synthetischen Peptiden anstelle von intakten Proteinallergenen sollen Dauer und Nebenwirkungsrisiko der SIT reduziert werden. Erste Phase-IIb-Studien sind Erfolg versprechend.

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Die mühsame Postrhinoskopie vor 150 Jahren

Wie einfach ist das heute alles: Die Nase wird mit einer adstringierenden und anästhesierenden Lösung eingesprüht, eine moderne schmale Endoskopie-Optik eingeführt und der Epipharynx kann gut ausgeleuchtet in jedem Winkel inspiziert werden. Ganz anders vor 150 Jahren. Auch die Postrhinoskopie musste erfunden und mühsam eingeübt werden.

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Schützt das Essen von Allergenen im Kindesalter?

Spielt es eine Rolle für die Entwicklung von Allergien und Autoimmunkrankheiten, wann Kindern Nahrungsmittel angeboten werden, die potenzielle Allergene enthalten? Eine britische Forschergruppe ging dieser Frage nach.

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Vollständige Offenlegung wird gewünscht

Behandlungsfehler – insbesondere, wenn es zu einer Schädigung kam – stellen für Patienten, aber auch für das involvierte Fachpersonal eine schwerwiegende Situation dar. Sie können langanhaltende und belastende Konsequenzen haben. Neben der fachlichen Aufarbeitung eines unerwünschten Ereignisses kommt dem angemessenen und empathischen Umgang mit allen Beteiligten eine zentrale Bedeutung zu, um eine „zweite Traumatisierung" zu vermeiden.

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Verbesserte Schluckdiagnostik mit Narrow Band Imaging

Mit der routinemäßigen Farbschluckuntersuchung bei Dysphagie sind Aspiration und laryngeale Penetration des angefärbten Bolus nicht immer sicher zu erkennen. Durch die hier beschriebene Technik kommt es zu einer erheblichen Verbesserung des Kontrastes des Bolus, sodass sich die Untersuchung sehr viel leichter auswerten lässt.

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Epigenetik beeinflusst Allergie und Toleranz

Neben Erbgut und Umwelteinflüssen spielt eine dritte Kraft eine Rolle bei der Entwicklung von Allergien: die Epigenetik.

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Mängel in der Praxisorganisation nerven Patienten

Wenn Patienten einem Arzt die Treue kündigen, liegt die Ursache oft in vermeintlichen Kleinigkeiten, die aber doch gehörig nerven können, wenn sie sich wiederholen. Schuld sind oft Fehler und Unzulänglichkeiten in der Praxisorganisation.

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Transparenz bei Antibiotika-Resistenzen

Wollen Ärzte wissen, wie es mit Antibiotika-Resistenzen in ihrer Region aussieht, müssen sie selbst aktiv werden. Umfassende Informationen bietet das Robert-Koch-Institut.

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Keine IGeL ohne Vertrag!

Eigentlich ist es eine Binsenweisheit – und doch wird es immer wieder gerne vergessen: Privatleistungen für Kassenpatienten bedürfen einer vorherigen vertraglichen Vereinbarung. Dabei müssen Ärzte auf bestimmte Angaben achten.

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Risikofaktor HPV

Bis vor einigen Jahren galten nur Alkohol und Rauchen als gesicherter Risikofaktor für Kopf-Hals-Tumoren. Mittlerweile hat sich gezeigt: Für die Entwicklung von Plattenepithelkarzinomen des Kopf-Hals-Bereichs spielen auch Infektionen mit humanen Papillomaviren (HPV) eine immer bedeutendere Rolle.

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Fragwürdige Neuerungen

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Otitis externa gezielt behandeln

Zusammenfassung

Jucken im Ohr und der typische Tragusdruckschmerz sind wesentliche Zeichen einer äußeren Gehörgangsentzündung. Zum einen müssen gefährliche Ursachen ausgeschlossen werden, zum anderen gilt es, gezielt und wirtschaftlich zu behandeln.

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Sjögren-Syndrom: Therapieerfolg mittels Elastografie prüfen

Ein Team der TU München untersuchte, ob sich mit Sonoelastografie bei Sjögren-Syndrom der Erfolg einer Lokaltherapie an den Speicheldrüsen überprüfen lässt.

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Tinnitracks: ein Lehrstück aus dem deutschen Gesundheitswesen

Das Angebot an sogenannten Gesundheits-Apps nimmt rasant zu. Einige davon versprechen sogar therapeutischen Nutzen. So auch Tinnitracks, eine App, die angeblich gegen Tinnitus hilft.

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Was hilft bei psychogenen Stimmstörungen?

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Free Bone Grafts for Mandibular Reconstruction in Patients Who Have Not Received Radiotherapy: The 6-cm Rule—Myth or Reality?

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0036-1597583

Bony reconstruction of the mandible after surgical resection results in improved rehabilitation and aesthetics. Composite tissue transfer has transformed reconstruction, particularly in patients who have received radiotherapy. However, there is morbidity related to free tissue transfer. Free nonvascularized bone grafts have much lower morbidity. Surgeons believe that free bone grafts greater than 6.0 cm are prone to failure. The aims of this study was to assess whether bone grafts greater than 6.0 cm in length have a high risk of failure. A retrospective study was performed on all patients who had free bone grafts greater than 6.0 cm in length at Birmingham, UK, and Florida, the United States. None of the patients received radiotherapy. A total of 14 patients had undergone bone grafts for mandibular defects greater than 6.0 cm in length; 13 of the bone grafts were successful. Of these 13, none were infected and there was radiographic evidence of bony union. Some of the patients have been dentally rehabilitated with implants. Contrary to much of the literature and many surgeons belief, our study has shown that long mandibular defects (>6.0 cm) are not a contraindication to the use of free bone grafts. Key principles to achieve success are discussed in this article.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

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Association of Midfacial Fractures with Ophthalmic Injury

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1599228

The aim of this study is to evaluate the incidence of ophthalmic complications following midfacial fractures and investigate its relation to surgical or nonsurgical treatment. This article is a retrospective study, describing the spectrum and incidence of ophthalmic injury in 106 patients presenting with midfacial fractures at the Department of Oral and Maxillofacial Surgery of the University Hospitals Leuven over a period of 16 months (January 2013 to April 2014). The mean age of the patients was 45.6 years with a gender distribution of 68 men and 38 women. The main cause of trauma was road traffic accidents. Forty-one patients suffered an ophthalmic injury following the fracture. Twelve of them had a persistent ophthalmic problem. Ophthalmic examination is necessary during the initial management. The time window for preservation of sight is small and treatment should be started immediately. Development of an emergency trauma scale that includes fractures, symptoms of visual impairment, and patient history is recommended and should stimulate a multidisciplinary approach of complex cases.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

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Immediate post-extraction implants with or without pure platelet-rich plasma: a 5-year follow-up study

Abstract

Purpose

Methods

A retrospective analysis was performed to assess soft tissue healing, implant and prosthesis survival, marginal bone level changes and biological complications.

Results

Conclusions

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Clinical significance of integrin-linked kinase in laryngeal squamous cell carcinoma

To investigate the expression of integrin-linked kinase (ILK) and its relationship with clinicopathological parameters in laryngeal squamous cell carcinoma (LSCC).

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A Dendritic Cell Vaccine Combined With Radiotherapy Activates the Specific Immune Response in Patients With Esophageal Cancer

Dendritic cells (DC) are highly efficient antigen-presenting cells. DC may be used to create DC vaccines against cancer, but the optimal strategies remain to be elucidated. This study aimed to examine the benefits and adverse effects of using esophageal cancer cell antigens to stimulate DC to trigger the specific immune response in patients with esophageal cancer undergoing radiotherapy. This was an observational cohort study performed at Lianshui County People's Hospital between September 2010 and June 2012. Forty patients with esophageal cancer planned to receive radiotherapy were selected, and 28 received the DC vaccine. DC were isolated, loaded with antigens, and intradermally injected after being cultured for 1 week. One week after injection, the patients underwent a delayed-type hypersensitivity test. Serum Th1 cytokines [interleukin (IL)-2, IL-12, and interferon (IFN)-γ] and antigen-specific IFN-γ+CD8+ T cells were tested before and after vaccination. Patients were followed up for 2 years. Adverse events were monitored. Patients in the vaccine group tolerated the DC vaccine. Levels of serum IL-2 (+92.4%), IL-12 (+70.9%), and IFN-γ (+214.3%) as well as the proportion of IFN-γ+CD8+ T cells (3.0–16.4-fold) were significantly increased compared with baseline and the control group (all P

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Therapeutic Vaccine Against Primate Papillomavirus Infections of the Cervix

Currently available prophylactic vaccines have no therapeutic efficacy for preexisting human papillomavirus (HPVs) infections, do not target all oncogenic HPVs and are insufficient to eliminate the burden of HPV induced cancer. We aim to develop an alternative HPV vaccine which is broadly effective and capable of clearing preexisting infection. In an initial attempt to develop a broadly reactive therapeutic vaccine, we designed a putative papillomavirus (PV) ancestor antigen (circulating sequence derived antigenic sequences E1E2—CDSE1E2) based on the conserved E1 and E2 protein sequences from existing oncogenic HPV strains. This antigen was found to be as related to circulating oncogenic Macaca fascicularis papillomaviruses (MfPVs) as to oncogenic HPVs. The CDSE1E2 antigen was fused to a T-cell adjuvant and encoded in chimpanzee 3 and 63 adenoviral vectors. We first showed that the combination of these 2 vaccines induced long-lasting potent CDSE1E2 specific T cell responses in outbred mice. This prime-boost regimen was then tested in female macaques naturally infected with MfPVs. All immunized animals (16/16) responded to the vaccine antigen but with reduced cross-reactivity against existing PVs. Preexisting MfPV infections did not prime vaccine inducible immune responses. Importantly, immunized oncogenic MfPV type 3 (MfPV3) infected animals that responded toward MfPV3 were able to diminish cervical MfPV3 DNA content. Although insufficient breadth was achieved, our results suggest that a relevant level of E1E2 specific T cell immunity is achievable and might be sufficient for the elimination of PV infection. Importantly, naturally infected macaques, offer a relevant model for testing vaccines aimed at eliminating mucosal PV infections.

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Spontaneous Activation of Antigen-presenting Cells by Genes Encoding Truncated Homo-Oligomerizing Derivatives of CD40

The interaction between the CD40 receptor on antigen-presenting cells (APCs) and its trimeric ligand on CD4 T cells is essential for the initiation and progression of the adaptive immune response. Here we undertook to endow CD40 with the capacity to trigger spontaneous APC activation through ligand-independent oligomerization. To this end we exploited the GCN4 yeast transcriptional activator, which contains a leucine zipper DNA-binding motif that induces homophilic interactions. We incorporated GCN4 variants forming homodimers, trimers, or tetramers at the intracellular domain of human and mouse CD40 and replaced the extracellular portion with peptide-β2m or other peptide tags. In parallel we examined similarly truncated CD40 monomers lacking a GCN4 motif. The oligomeric products appeared to arrange in high–molecular-weight aggregates and were considerably superior to the monomer in their ability to trigger nuclear factor kB signaling, substantiating the anticipated constitutively active (ca) phenotype. Cumulative results in human and mouse APC lines transfected with caCD40 mRNA revealed spontaneous upregulation of CD80, IL-1β, TNFα, IL-6, and IL-12, which could be further enhanced by caTLR4 mRNA. In mouse bone-marrow–derived dendritic cells caCD40 upregulated CD80, CD86, MHC-II, and IL-12 and in human monocyte–derived dendritic cells it elevated surface CD80, CD83 CD86, CCR7, and HLA-DR. Oligomeric products carrying the peptide-β2m extracellular portion could support MHC-I presentation of the linked peptide up to 4 days post-mRNA transfection. These findings demonstrate that the expression of a single caCD40 derivative in APCs can exert multiple immunostimulatory effects, offering a new powerful tool in the design of gene-based cancer vaccines.

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DNA Vaccine Encoding HPV16 Oncogenes E6 and E7 Induces Potent Cell-mediated and Humoral Immunity Which Protects in Tumor Challenge and Drives E7-expressing Skin Graft Rejection

We have previously shown that a novel DNA vaccine technology of codon optimization and the addition of ubiquitin sequences enhanced immunogenicity of a herpes simplex virus 2 polynucleotide vaccine in mice, and induced cell-mediated immunity when administered in humans at relatively low doses of naked DNA. We here show that a new polynucleotide vaccine using the same technology and encoding a fusion protein of the E6 and E7 oncogenes of high-risk human papillomavirus type 16 (HPV16) is immunogenic in mice. This vaccine induces long-lasting humoral and cell-mediated immunity and protects mice from establishment of HPV16-E7-expressing tumors. In addition, it suppresses growth of readily established tumors and shows enhanced efficacy when combined with immune checkpoint blockade targeted at PD-L1. This vaccine also facilitates rejection of HPV16-E7-expressing skin grafts that demonstrate epidermal hyperplasia with characteristics of cervical and vulvar intraepithelial neoplasia. Clinical studies evaluating the efficacy of this vaccine in patients with HPV16+ premalignancies are planned.

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Vogt-Koyanagi-Harada–like Syndrome Complicating Pembrolizumab Treatment for Metastatic Melanoma

Vogt-Koyanagi-Harada (VKH) syndrome is a rare condition implicating systemic immune reaction against melanocytes. The pathophysiology is unclear. A genetic predisposition has been suggested as HLA-DR4/DRB1*04 is more common among VKH patients. Drug induced VKH syndrome has been reported in advanced melanoma patients receiving immunotherapy, including ipilimumab and adoptive cell transfer of Tumor-Infiltrating Lymphocyte associated with IL-2. To date, no case of anti PD-1 -induced VKH syndrome has been described. We report here the case of a HLA-DR4/DRB1*04 patient successfully treated with anti PD-1 for advanced melanoma who developed a systemic immune reaction against melanocytes for whom we discuss a VKH-like syndrome diagnosis in a potentially genetically predisposed patient.

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Myoclonic seizure prior to diagnosis of chronic toxic encephalopathy: a case report

"Thinner" is a widely used industrial mixture of organic solvents. Exposure to organic solvents is usually not considered to be a possible cause of epilepsy, despite descriptions of toxic effects on the centra...

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Starplasty tracheostomy: case series and literature review

Abstract

Objectives

The starplasty tracheostomy (SPT) technique has been suggested to reduce the short-term complications of tracheostomy, including accidental decannulation and pneumothorax. The aim of the present study was to conduct a review of key parameters prior to and following treatment of neonates and children with the SPT technique, including indications, complications, perioperative department stay, and overall length of stay in one University-Affiliated Medical Center.

Methods

A retrospective chart review of all children under the age of 18 underwent SPT in a single center between February 2006 and January 2012.

Results

Among the 39 patients reviewed, the median age at the time of surgery was 14.5 months, ranging from 3 days to 8.8 years. The most common indication for SPT was respiratory insufficiency resulting from central nervous system disorders (15, 38.4%) followed by neuromuscular disorders (14, 35.9%). Ten (25.6%) operations were performed on neonatal intensive care unit (NICU) patients and 29 (74.4%) on pediatric intensive care unit (PICU) patients. The median postoperative hospital stay was 19.5 days (range of 3–207 days); however, the median postoperative stay in the PICU was 13.5 days. There were no decannulations or any other short-term complications after SPT, and no SPT-related deaths occurred.

Conclusions

In our series, pediatric SPT was not associated with any major complications. Therefore, we conclude that SPT should be considered as a safe and advantageous alternative for traditional tracheotomy, especially in patients with low probability of future decannulation, and, therefore, at low risk of a persistent tracheocutaneous fistula.

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Spontaneous cerebrospinal fluid leaks in the anterior skull base secondary to idiopathic intracranial hypertension

Abstract

Spontaneous cerebrospinal fluid (CSF) leaks represent a clinical entity in which CSF rhinorrhea occurs in the absence of any inciting event. Spontaneous CSF leaks are associated with elevated intracranial pressure (ICP) or have underlying idiopathic intracranial hypertension (IIH). We report a cohort of patients who have undergone nasal endoscopic repair for spontaneous CSF leaks. We review our perioperative complications and the effectiveness of the nasal endoscopic approach to repair spontaneous CSF leaks. Also, we examine the evidence correlating spontaneous CSF leaks and IIH and the role of decreasing ICP in the treatment of nasal spontaneous CSF leaks. A retrospective analysis of patients with nasal spontaneous cerebrospinal fluid leaks was performed. Data on the nature of presentation, patient body mass index, defect location and size, ICP, clinical follow-up, and complications were collected. Thirty-five patients had nasal spontaneous cerebrospinal fluid leaks with evidence of IIH's symptoms. The most common sites were the cribriform plate, the ethmoid roof, and sphenoid lateral pterygoid recess. All patients underwent endonasal endoscopic surgery to repair the defect. Postoperatively, all patients underwent lumbar drainage and acetazolamide therapy. Nasal spontaneous cerebrospinal fluid leaks represent a surgical challenge because of their high recurrence rates. The most important factor for obtaining a successful repair in these patients is reducing their intracranial pressure through nutritional, medical, or surgical means.

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Do post-tonsillectomy patients who report bleeding require observation if no bleeding is present on exam?

Publication date: Available online 7 February 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Sonia Yuen, Kosuke Kawai, David W. Roberson, Ryan Murray
ObjectiveThree to ten percent of tonsillectomy patients experience post-tonsillectomy hemorrhage. Examination of those patients who return to the Emergency Department (ED) with a history of hemorrhage are found to have active bleeding, a coagulum within the fossa, or a normal post-operative exam. It is not known if those with a normal postoperative exam require inpatient observation.MethodsThis is a retrospective series from 1/1/2010 to 12/31/2014 at a tertiary pediatric hospital. We evaluated outcomes in patients who presented to our ED with a history of post tonsillectomy hemorrhage, but thorough inspection failed to demonstrate active bleeding or clot, and were thus deemed to have a normal postoperative exam. This cohort was then evaluated for subsequent active bleeding requiring cauterization. Demographics and clinical data were extracted from the medical record.ResultsIn 337 visits with a history of bleeding, and a normal postoperative exam, 38 (11%) subsequently bled requiring cauterization. 32/38 (84%) bled within 24 h of admission to the ED. No demographic or clinical variables predicted an increased risk of bleeding during observation.ConclusionsEleven percent of patients who presented to the ED with a history of bleeding at home but a normal postoperative exam subsequently bled and required cautery, usually within 24 h. Aside from the history of bleeding at home, we found no additional predictors of subsequent bleeding and recommend this group of patients should be considered for 24 h in-hospital observation prior to discharge.

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Maturation of auditory brainstem responses in young children with congenital monaural atresia

Publication date: April 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 95
Author(s): Konrad Johannes Stuermer, Astrid Foerst, Pascale Sandmann, Dirk Fuerstenberg, Ruth Lang-Roth, Martin Walger
ObjectiveTo date, the impact of conductive hearing loss on the auditory pathway at brainstem level has only been investigated in animal studies, which showed a species-specific delay of maturation. In this study, the functional maturation of auditory brainstem response (ABR) parameters in humans with unilateral atresia of the external auditory canal was investigated.Methods42 newborns and toddlers ranging in age from 13 days to 11 months were included. The click-evoked ABR interpeak latencies (IPL) of the atretic ears and the contralateral ears with normal hearing were evaluated. The children had no comorbidities and had never been fitted with any kind of hearing aid. The absolute latencies (AL) and IPL of a matched control group were compared to the contralateral normally hearing ears of the children with unilateral atresia.ResultsThe mean air-bone gap in the ears with atresia was 44 dB HL. Despite this partial acoustic deprivation, no significant difference between the IPLs of normal ears and ears with atresia could be detected. Both for AL and IPL, the differences between the normal ears and the control group were all within 1 standard deviation to the mean.ConclusionThe data showed that the monaural acoustic deprivation by a block of sound conduction does not produce any delay of functional maturation at brainstem level in this group of patients. With regard to the AL and IPL on brainstem level, no differences between the normal ears of children with unilateral atresia and children with bilateral normal hearing could be detected.

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Using click-evoked auditory brainstem response thresholds in infants to estimate the corresponding pure-tone audiometry thresholds in children referred from UNHS

Publication date: Available online 7 February 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Tsun-Min Lu, Fang-Wei Wu, Hsiuwen Chang, Hung-Ching Lin
ObjectiveTo examine whether behavioral pure-tone audiometry (PTA) thresholds in children can be accurately estimated from the corresponding infants' click-evoked auditory brainstem response (ABR) thresholds through a retrospective review of data from a universal newborn hearing screening (UNHS) program in Taiwan.MethodAccording to medical records from Mackay Memorial Hospital, Taipei Hospital District, 45,450 newborns received hearing screening during January 1999–December 2011. Among these newborns, 104 (82, both ears; 22, one ear; total, 186 ears) received regular follow-up and were recruited as subjects. The relationship between infant click-evoked ABR thresholds and the corresponding child PTA thresholds was determined through Pearson correlation coefficient and linear regression analyses.ResultsThe correlation coefficient between click-evoked ABR thresholds and behavioral PTA thresholds at the average of frequencies of 1–4 and 2–4 kHz was 0.76 and 0.76, respectively. Linear regression analysis showed that behavioral audiometry thresholds at the average of frequencies of 1–4 and 2–4 kHz were accurately estimated from click-evoked ABR thresholds in 57% and 58% children, respectively.ConclusionClick-evoked ABR testing is a reliable tool to cautiously estimate behavioral PTA thresholds at the average of frequencies of 1–4 and 2–4 kHz. For accurately performing hearing aid fitting and auditory rehabilitation in congenitally deaf infants, a combination of frequency-specific tone-burst ABR and click-evoked ABR should be used.

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Can changes in parentally measured acoustic reflectometry levels predict the middle ear status?

Publication date: Available online 7 February 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Nora Erkkola-Anttinen, Miia K. Laine, Paula A. Tähtinen, Aino Ruohola
ObjectiveSpectral gradient acoustic reflectometry (SG-AR) may be used to detect middle ear effusion. Our aim was to investigate whether increasing SG-AR levels between two SG-AR examinations indicate deterioration from a healthy middle ear to acute otitis media (AOM).MethodsWe enrolled 185 children (age 6–35 months) whose parents were willing to use the SG-AR at home daily. Measurement pairs of parental home SG-AR examination results were generated and analyzed. There was one SG-AR examination result obtained within ±1 day of the reference visit and another result within ±1 day of the subsequent visit. We defined the SG-AR level as increasing when the difference between two measurements was ≥2 levels from a lower to a higher level, suggesting development of AOM. When the SG-AR level difference was ≤1, we defined this no change of the SG-AR level. The middle ear diagnosis was determined by pneumatic otoscopy at the study clinic.Results361 paired SG-AR home measurements were obtained. The reference measurement was related to a healthy middle ear as determined by pneumatic otoscopy. Increasing SG-AR levels (59/361), were 63% (95% CI 50%–74%) sensitive and 94% (91%–97%) specific for deterioration of a healthy middle ear to AOM. The positive predictive value was 71% (58%–82%) and the negative predictive value was 92% (88%–95%). When there was no SG-AR level difference between the SG-AR examinations, the corresponding figures were 88% (95% CI 84%–92%), 69% (56%–79%), 93% (89%–95%) and 57% (45%–68%), respectively.ConclusionsThis study shows that increasing SG-AR levels might not be sufficiently sensitive to detect deterioration of the middle ear status from healthy middle ear to AOM in symptomatic children. Importantly, however, the development of AOM seems to be unlikely in an initially healthy middle ear when there is no difference between the SG-AR levels in two separate measurements.

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Influence of nasal septum deformity on nasal obstruction, disease severity, and medical treatment response among children and adolescents with persistent allergic rhinitis

Publication date: Available online 7 February 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Franklin Mariño-Sanchez, Meritxell Valls-Mateus, Paulina Cardenas-Escalante, Oliver Haag, Karen Ruiz-Echevarría, Rosa Jiménez-Feijoo, Jaime Lozano-Blasco, María T. Giner-Muñoz, Ana M. Plaza-Martin, Joaquim Mullol
ObjectiveTo evaluate the impact of different types of nasal septum deformity (NSD) on nasal obstruction, rhinitis severity and response to medical treatment among pediatric persistent allergic rhinitis (PER) patients.MethodsIn a prospective, real-life study, 150 children and adolescents (mean age 13 ± 2.8 years, females 32.6%) diagnosed with PER according to ARIA guidelines were assessed by nasal endoscopy for NSD according to Mladina's classification, their response to medical treatment (intranasal steroids and antihistamines or antileucotriens), the presence of comorbidities, rhinitis severity (modified-ARIA criterion) and nasal obstruction visual analogue scale score (VAS).ResultsMost patients (87%) had 1 of the 7 types of septal deformities. There was a high prevalence of bilateral (types 4 and 6; 46%) and anterior unilateral (types 1 and 2; 25%) NSD in patients not responding to medical treatment. Type 4 (OR = 6.4; p = 0.005) or type 6 (OR = 4.4; p = 0.03) NSD increased the risk of lack of improvement with medical treatment. Coexistence of anterior unilateral or bilateral NSD with severe turbinate enlargement increased >20-fold the risk of lack of improvement. Patients with bilateral NSD presented greater rhinitis severity. Non-responder adolescents displayed higher prevalence of bilateral NSD than children (53% vs. 23%; p = 0.02). Nasal obstruction VAS was higher for patients with anterior than posterior NSD, and greater for patients with bilateral NSD than any other type of septal morphology.ConclusionNasal endoscopy shows that bilateral and unilateral anterior nasal septum deformities are strongly associated with a poor response to medical treatment, greater rhinitis severity and higher nasal obstruction VAS. Consequently, nasal endoscopy is necessary in the PER patients to understand the disease severity as well as to plan a specific surgical treatment in order to improve nasal obstruction, disease severity, and patient's quality of life.

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Adherence to acute otitis media diagnosis and treatment guidelines among Israeli otolaryngologists

Publication date: Available online 7 February 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Tal Marom, Mathan Bobrow, Ephraim Eviatar, Yahav Oron, Sharon Ovnat Tamir
IntroductionThe recent Israeli acute otitis media (AOM) guidelines, drafted mainly by pediatricians and family physicians in 2013, addressed diagnostic and therapeutic issues, in order to reduce over-diagnosis and treatment. These guidelines are considered as the 'standard of care' for AOM management. While the adherence rate of pediatricians to previous Israeli AOM guidelines (2004) was reported to be high (>85%), the compliance of otolaryngologists has not been studied.MethodsAn anonymous 19-item questionnaire was circulated among practicing Israeli otolaryngologists (residents [n = 93], specialists [n = 283]). All the items were scored according to the number of correct answers in line with the guidelines, and summed on a 0–100 scale.ResultsResponse rate was 34% (n = 127). Overall, scores of correct answers of residents (n = 48, 52% of all residents) and specialists (n = 79, 28% of all specialists) were similar, and showed comparable moderate adherence to both guidelines: 55.7 vs 58.3 (p = 0.26). Residents were more likely to adhere to the U.S. guidelines, when compared to specialists (score difference 6.1 vs 2.8, p = 0.008). Responders preferred the microscope for diagnosis (48%), over the recommended (pneumatic) otoscope (62%) (p = 0.05), and were more likely to start antibiotic therapy (62%), rather than the 'watchful waiting' (38%) (p = 0.03). Concerning antibiotic treatment, 50% of otolaryngologists prescribed amoxicillin as recommended, at 60–80 mg/kg/d.ConclusionThe moderate adherence rate suggests that the guidelines were partially adopted by otolaryngologists, who use different instrumentation than recommended, and treat more severe/complicated cases. Over-treatment with antibiotics and inaccurate dosing regimens are still common. Better implementation of the AOM guidelines among otolaryngologists should be performed in designated training platforms.

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Bilateral Cochlear Implantation in a Child with Johanson Blizzard Syndrome

Publication date: Available online 6 February 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Meredith A. Holcomb, Habib G. Rizk, Nevitte S. Morris, Ted A. Meyer
Sensorineural hearing loss (SNHL) occurs in more than 80% of cases of Johanson Blizzard Syndrome (JBS). However, limited knowledge exists in medical literature of cochlear implantation (CI) outcomes in children with JBS. We report the case of a 5 year-old male with JBS and bilateral CI. While minimal progress in spoken language scores was noted after 4 years of bilateral CI use, substantial improvements in discrimination of speech sounds and audibility of spoken language and environmental sounds were documented. Cochlear implantation is an available treatment option of profound SNHL in children with JBS even if spoken language outcomes are marginal.

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Useful of temporal bone prototype for drilling training : a prospective study

Abstract

Objectives

Dissection of cadaveric temporal bones (TBs) is considered the gold standard for surgical training in otology. For many reasons, access to the anatomic lab and cadaveric TBs is difficult for some facilities. The aim of this prospective and comparative study was to evaluate the usefulness of a physical TB prototype for drilling training in residency.

Design

Prospective study.

Setting

Tertiary referral centre.

Participants

Thirty-four residents were included. Seventeen residents (mean age 26.7 ± 1.6) drilled on only cadaveric TBs ("traditional" group), in the traditional training method, while seventeen residents (mean age 26.5 ± 1.7) drilled first on a prototype and then on a cadaveric TB ("prototype" group).

Main outcome measures

Drilling performance was assessed using a validated scale. Residents completed a mastoid image before and after each drilling to enable evaluation of mental representations of the mastoidectomy.

Results

No differences were observed between the groups with respect to age, drilling experience, and level of residency. Regarding drilling performance, we found a significant difference across the groups, with a better score in the prototype group (p= 0.0007). For mental representation, the score was statistically improved (p= 0.0003) after drilling in both groups, suggesting that TB drilling improves the mental representation of the mastoidectomy whether prototype or cadaveric TB is used.

Conclusion

The TB prototype improves the drilling performance and mental representation of the mastoidectomy in the young resident population. A drilling simulation with virtual or physical systems seems to be a beneficial tool to improve TB drilling.

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Antimicrobial Sutures Prevent Surgical Site Infections and Lower Costs

Sutures coated with antimicrobial agents like triclosan prevent surgical site infections (SSI) and significantly lower healthcare costs, according to two new meta-analyses.
Reuters Health Information

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“Closed reduction” principles can manage diverse conditions of temporomandibular joint vertical height loss: from displaced condylar fractures to idiopathic condylar resorption

Publication date: Available online 7 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Dorrit W. Nitzan, Sandro Palla
PurposeThe aim of this case series was to describe a modification of the classic "closed reduction" therapy to manage a unilateral or anterior open bite due to loss in vertical height (LVH) caused by several disorders /pathologies other than displaced condylar fractures.MethodsThe protocol included insertion of an occlusal appliance increasing the height of the premature contact and the width of the open bite, stabilization of the dental arches by rigid arches, and the use, during sleep, of rubber bands located in the open bite region to pull the mandible cranially. In addition, when awake the patient performed physiotherapy exercises to guide the mandible into maximum intercuspation. The increased open bite enhanced the effect of the rubber bands in guiding the mandible into the original habitual occlusion while the rigid arches serve to minimize tooth eruption.ResultsThe presented cases demonstrated the favorable outcome of this low-risk treatment in the re-establishment of the original habitual occlusion within one to four weeks and without reconstruction of the deficient vertical height.ConclusionThe efficacy of this complication-free approach to correct the occlusion in various conditions of LVH suggests that this protocol should be applied before venturing into surgical intervention.

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Neck Movement Implicate the Tracheal Tube-tip Displacement in Pediatric Surgery

Conditions: Pediatric Anesthesia; Tracheal Intubation
Intervention:
Sponsor: Beijing Tsinghua Chang Gung Hospital
Not yet recruiting - verified February 2017

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Nivolumab or Nivolumab/Ipilimumab Prior to Chemoradiation Plus Nivolumab With II/III Gastro/Esophageal Cancer

Conditions: Gastric Cancer; Esophageal Cancer; GastroEsophageal Cancer
Interventions: Drug: Nivolumab; Drug: Ipilimumab; Drug: Carboplatin; Drug: Paclitaxel; Radiation: Radiation
Sponsors: Sidney Kimmel Comprehensive Cancer Center; Bristol-Myers Squibb
Not yet recruiting - verified February 2017

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PD-1 Knockout EBV-CTLs for Advanced Stage Epstein-Barr Virus (EBV) Associated Malignancies

Conditions: Stage IV Gastric Carcinoma; Stage IV Nasopharyngeal Carcinoma; T-Cell Lymphoma Stage IV; Stage IV Adult Hodgkin Lymphoma; Stage IV Diffuse Large B-Cell Lymphoma
Interventions: Drug: Fludarabine; Drug: Cyclophosphamide; Drug: Interleukin-2
Sponsor: Yang Yang
Not yet recruiting - verified February 2017

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Comparison of Oxycodone to Control Moderate or Severe Oral Mucositis Pain Induced by Chemoradiotherapy

Condition: Nasopharyngeal Carcinoma
Interventions: Drug: Controlled-release oxycodone; Other: Chemoradiotherapy
Sponsor: Sun Yat-sen University
Recruiting - verified February 2017

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De rhoncho dormientium

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Update HNO

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Panorama

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To Study the Association of the Size and Site of Tympanic Membrane Perforation with the Degree of Hearing Loss

Abstract

Chronic suppurative otitis media is a serious health problem worldwide. It has been a general view that the hearing loss increases with the size of the perforation, more so if it is in the postero- inferior quadrant. The present study is an effort to test the validity of above concepts. With Institutional ethical committee clearance, an observational study was carried at SMS medical college, Jaipur. A total of 90 cases were studied. All cases between the age group 15–50 years with dry tympanic membrane perforations were divided into 3 groups Group I (0–9 mm²), Group II (9–30 mm²), Group III (>30 mm²) with 30 in each group based on size of perforation. Hearing loss was calculated as average of hearing loss at 500, 1000, 2000 Hz. Similarly the site of perforation was grouped as perforation involving anterior quadrant, posterior quadrant and multiple quadrant as Group A, Group B, Group C respectively. At the end of study, data was compiled systematically and analyzed using Post Hoc test. The age group ranges between 15 and 50 years with mean age of 25.6 years. Hearing loss was found to be directly proportional to the size of perforation in our study. (p = 0.000, highly significant). We also observed that hearing loss was more in posterior and multiple perforations than in anterior perforations. (p = 0.000, highly significant). Overall this study has shown significant correlation between the size and the site of the perforation to the degree of hearing loss.

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True Parapharyngeal Space Tumors: Case Series from a Teaching Oncology Center

Abstract

The Parapharyngeal Space (PPS) tumors are rare tumors accounting for 0.5% of the tumors in head and neck region. A retrospective study conducted at Department of Surgical oncology, Vydehi institute of Medical Sciences & Research center, Bengaluru, between 2010 and 2015 identified nine cases treated for PPS tumors. Patients are diagnosed on the basis of clinical examination fine needle aspiration cytology and imaging and considered for excision by one of the varied surgical approaches {transoral(1), transcervical(4), transparotid(0), transcervical-transparotid(1), transmandibular(3) or intratemporal(0) approach}. The choice of approach is defined by the size of the tumor, suspicion of malignancy and the position of the tumor with regard to the superior extent and proximity to the skull base as well as its relation with neurovascular bundle.

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Multifactorial logistic regression analysis of factors associated with the incidence of erosive tooth wear among adults at different ages in Tokyo

Abstract

Objectives

The aim of this study was to evaluate factors associated with the incidence of erosive tooth wear (ETW) among adults at different ages in Tokyo using multifactorial logistic regression analysis.

Materials and methods

The study sample consisted of a total of 1108 subjects aged 15 to 89 years in Tokyo, Japan. Two examiners evaluated ETW in a full-mouth recording. The subjects were asked to complete a self-administered daily diet, habit, and health condition questionnaire. Subjects who had frequent acid consumption or gastric reflux and at least one tooth with initial enamel wear were placed in the ETW-positive group, and the remainder of the subjects was placed in the ETW-negative group. Logistic regression analyses were carried out to identify factors collectively associated with ETW.

Results

Logistic regression analysis showed that greater frequencies of carbonated or sports drink consumption were associated with higher incidence of ETW for all age groups except for 70–89 years. Adults in the 30–39-year group who reported suffering from heartburn were about 22.3 times more likely to develop ETW, while 40–49-year adults who had repeated vomiting were about 33.5 times more likely to exhibit ETW compared with those who did not experience vomiting.

Conclusion

Age-specific dietary habits were clearly observed among adults at different ages in Tokyo, and there were significant differences in intrinsic and extrinsic factors between ETW-positive and ETW-negative groups for each age group.

Clinical relevance

Both greater frequency of carbonated and sports drink consumption were associated with higher incidence of ETW among adults at different ages in Tokyo.

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Giant gastric gastrointestinal stromal tumor with severe peritoneal dissemination controlled by imatinib therapy following debulking surgery: a case report

At the time of diagnosis, giant gastric gastrointestinal stromal tumors are sometimes associated with severe peritoneal dissemination. Unresectable gastrointestinal stromal tumors are considered a systemic dis...

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SMARCA4-deficient Sinonasal Carcinoma

Abstract

The term "sinonasal undifferentiated carcinoma (SNUC)" has been coined in 1986 for a highly aggressive sinonasal tract epithelial neoplasm showing distinctive morphology, but lacking any specific line of differentiation. Recent developments resulted in a dynamic splitting of new entities traditionally included in the spectrum of SNUC. Sinonasal NUT-midline carcinoma, adamantinoma-like Ewing family tumors and most recently, SMARCB1(INI1)-deficient sinonasal carcinoma are the main entities defined by specific genetic aberrations. To our knowledge, involvement of subunits of the SWItch/Sucrose Non-fermentable (SWI/SNF) chromatin remodeling complex other than SMARCB1 has not been implicated in the pathogenesis of SNUC-like neoplasms. We herein describe a 40-year-old woman who presented with a large infiltrative mass involving the right nasal cavity and the sinuses with extension into the skull base and periorbital tissue (cT4N2M0). Biopsies were interpreted initially as poorly differentiated neuroendocrine carcinoma followed by surgical resection and radiochemotherapy. No other extra-nasal tumor was detected on imaging. The patient was alive with disease at last follow-up (9 months from initial diagnosis). Histological evaluation showed poorly differentiated small round blue cell neoplasm with diffuse expression of pancytokeratin but not high molecular weight cytokeratin subsets, CK7, p63, S100, desmin or NUT. Neuroendocrine markers showed limited focal weak reactivity. SMARCB1, SMARCA2 and ARID1A were intact in the tumor cells but SMARCA4 was completely lost. This case highlights the rare occurrence of SMARCA4-deficiency in poorly differentiated sinonasal carcinomas and points to the importance of including other SWI/SNF complex subunits in the evaluation of SMARCB1-intact sinonasal malignancies.

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Human Papillomavirus Associated Cancers of the Head and Neck: An Australian Perspective

Abstract

Human papillomavirus (HPV) associated head and neck squamous cell carcinomas (HNSCCs), have become a serious global health problem. Despite decreases in HPV-negative HNSCCs, the prevalence of HPV-positive HNSCCs has significantly increased. HPV-positive cancers are associated with superior survival outcomes when compared to HPV-negative cancers, which appears likely to be associated with differences in the molecular pathogenesis of the two diseases. While therapies are still problematic, the current HPV vaccine programs hold a promise for the primary prevention of HPV-related HNSCCs and since Australia was the first to introduce a nationwide HPV vaccine program, it is in a unique position to observe the effects of the vaccine on HNSCCs. This review discusses the epidemiological trends associated with HPV in HNSCC, with reference to the differences between HPV-positive and HPV-negative HNSCCs and the prevention potential of HPV vaccines.

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SMARCA4-deficient Sinonasal Carcinoma

Abstract

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Human Papillomavirus Associated Cancers of the Head and Neck: An Australian Perspective

Abstract

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Image-guided interstitial high-dose-rate brachytherapy in the treatment of inoperable recurrent head and neck malignancies: An effective option of reirradiation

ABSTRACT

Background

In recurrent head and neck cancer, therapeutic options are limited and high-quality evidence is rare. The purpose of this report was to present our experience of CT-guided interstitial high-dose rate (HDR) brachytherapy in 4 challenging cases of inoperable recurrent head and neck cancer.

Methods

A 53-year-old man with mucosal melanoma of the paranasal sinuses, a 61-year-old man with myofibroblastic sarcoma of the nasal cavity, a 51-year-old woman with nasopharyngeal cancer, and a 44-year-old woman with orbital leiomyosarcoma were treated with reirradiation by HDR brachytherapy after previous comprehensive therapy, including full course external radiotherapy (RT).

Results

All patients showed response to brachytherapy with 1 patient experiencing locoregional failure. The mean lesion-specific disease control was 15 months. Currently, 1 patient is alive and 3 patients died after mean 20 months after treatment.

Conclusion

In patients with inoperable recurrent head and neck cancer, CT-guided interstitial HDR brachytherapy can play a role in providing palliation and tumor control. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Lateral arm free tissue transfer for parotid reconstruction: A pictorial essay

ABSTRACT

Background

The goals of parotid reconstruction are to provide accurate volume reconstruction of the defect while minimizing ptosis, optimize color match to surrounding facial skin, maintain anatomic position of the auricle, and to perform facial nerve rehabilitation in cases in which the facial nerve is removed.

Methods and Results

For many complex parotid defects, the lateral arm free tissue transfer achieves these reconstructive goals and is the ideal donor site for microvascular reconstruction. In this pictorial essay, we describe the anatomy, harvest, inset, and reconstructive advantages of the lateral arm free tissue transfer in complex parotid reconstruction.

Conclusions

The lateral arm donor site provides well-compartmentalized adipose tissue that resists ptosis, favorable color match to facial skin, and the posterior cutaneous nerve to the forearm may be used as a nerve graft for facial nerve rehabilitation. These reconstructive advantages make the lateral arm donor site our primary reconstructive option for complex parotid defects. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Cyclical hypofractionated radiotherapy also known as “QUAD Shot” alone using intensity-modulated radiotherapy for squamous cell carcinoma of the parotid gland in an 85-year-old patient with multiple comorbidities

ABSTRACT

Background

Palliative radiotherapy (RT) is not commonly offered to patients with head and neck cancer because of the belief that toxicity from the RT would not provide great palliative benefits. The purpose of this study was for us to report the advantages of cyclical hypofractionated RT (QUAD Shot) using intensity-modulated RT (IMRT) for an elderly comorbid patient with head and neck cancer.

Methods

An 85-year-old multiple comorbid man with squamous cell carcinoma in the left parotid gland with left facial pain received the IMRT-QUAD Shot (14 Gy/4 fractions, twice-daily treatment with 6 hours interval, on 2 consecutive days) to lesions, which were repeated every 4 weeks 3 times.

Results

With the IMRT-QUAD Shot, he achieved complete left facial pain relief without acute toxicity. At 12 months after the first IMRT-QUAD Shot, he remained without left facial pain, late toxicity, or disease recurrence impacting positively on his quality of life.

Conclusion

The IMRT-QUAD shot is reasonable and safe to apply for symptom palliation in elderly multiple comorbid patients with head and neck cancer. 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Effect of the histone deacetylase inhibitor resminostat on head and neck squamous cell carcinoma cell lines

ABSTRACT

Background

Carcinogenesis is determined by various epigenetic events, such as histone deacetylation. The purpose of this study was to investigate the effect of the new histone deacetylase inhibitor resminostat on head and neck squamous cell carcinoma (HNSCC) cell lines.

Methods

The cytotoxicity of resminostat and cisplatin on HNSCC cell lines SCC25, CAL27, and FaDu was determined using CCK-8 cell proliferation assay and combination index analysis. Cells were irradiated with 2 to 8 Gray. Apoptosis was measured using flow cytometry and expression of Mcl-1, p-AKT, and survivin was investigated.

Results

Treatment with resminostat showed a decrease of cell proliferation of HNSCC cell lines. In addition, a synergistic effect with cisplatin as well as with radiation treatment could be observed. Induction of cell death and dose-dependent downregulation of survivin was evident in all cell lines.

Conclusion

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Survey of return to work of head and neck cancer survivors: A report from a tertiary cancer center in India

ABSTRACT

Background

The rates and factors associated with the return to work of head and neck cancer survivors from low- and middle-income countries, such as India, are largely unknown.

Methods

We conducted a preliminary cross-sectional survey of 250 consecutive eligible head and neck cancer survivors (age <60; ≥6 months posttreatment) to identify return to work rates and sociodemographic, clinical, and quality of life (QOL; European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions [EORTC-QLQ-C30] and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 Head and Neck 35-questions [EORTC-QLQ–H&N35]) correlates.

Results

In our cohort, 92.4% of the patients were employed pretreatment, 65.6% and 81.2% returned to work at 6 months posttreatment and by the time of the survey (median follow-up 19 months), respectively. Family structure (<2 male children, p = .008; eldest child age <20 years, p = .04), a higher level of education (vocational or professional training, p = .013) and female sex (p = .001) were associated with higher return to work. Head and neck cancer survivors who returned to work had better global quality of life (QOL; p = .014) and less coughing (p = .001) but more problems related to sticky saliva (p = .004).

Conclusion

Further studies are needed to address the large unmet needs regarding identification and amelioration of barriers to return to work for head and neck cancer survivors in low- and middle-income countries, such as India. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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ASH 2016 − Schlaglichter von der Jahrestagung der amerikanischen Hämatologen

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Nivolumab ist eine neue Therapieoption beim metastasierten Nierenzellkarzinom

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Duodenocolic fistula diagnosed by endoscopy: a rare complication of colon cancer

Duodenocolic fistula (DCF) is a rare complication of colon cancer with only 70 cases reported since its first description in 1862. Owing to its rarity, current knowledge on DCF still relies on single case reports. We present 2 cases of DCF from a hepatic flexure adenocarcinoma demonstrated initially by endoscopy. 2 adult male patients were admitted due to a 2–3-month history of right-upper quadrant pain, vomiting, diarrhoea and a palpable right upper quadrant mass. In both cases, a circumferential, friable mass was noted on upper endoscopy at the second portion of the duodenum, leading to the ascending colon. A similar-looking lesion was also noted on colonoscopy. Biopsies in both cases confirmed colonic adenocarcinoma. Owing to the advanced nature of the disease, en bloc resection was not achieved. Instead, tube jejunostomy and loop ileostomy were created. Both patients were discharged tolerating feeding with improvement in symptoms.

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Morphological features of five-rooted maxillary second molar evaluated by spiral CT

Description

The anatomical characteristics of permanent maxillary molars generally include three roots—one palatal and two buccal, each root with one root canal. The present case report aims at discussing a rare anatomy of the maxillary second molar with five roots.

The complexities and variations of the roots and their canal system present a constant challenge for diagnosis and successful endodontic treatment.1 Newer technologies like spiral CT can also be used to study root canal morphology in complicated cases. Since the subject of study was an extracted tooth, the concern regarding radiation was not there. The use of multislice CT and 3D reconstruction techniques help in understanding the possible anatomical aberrations of maxillary molars and emphasise their role in the confirmatory diagnosis.

A female patient aged 19 years reported to our clinic with pain in the upper right posterior region of the jaw since 3 months. Her medical...

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Sternal stress fracture in a middle-aged woman

A middle-aged premenopausal woman presented with 3 months of right chest wall pain after beginning a new weight training programme. Examination was significant only for mild-to-moderate tenderness to palpation over the right pectoral muscle and sternoclavicular joint. In-office musculoskeletal ultrasound scan, chest X-ray and shoulder X-rays were unremarkable. Subsequent MRI of the chest wall showed oedema in the sternum at the level of the sternoclavicular joint consistent with a sternal stress fracture. She was started on calcium and vitamin D supplementation and told to rest for 6 weeks. After this she began to gradually increase her activity and was pain free after 4 months.

http://ift.tt/2kntr0g

Avoiding misdiagnosis: cystic calcified brain metastases of uterine cervical cancer mimicking neurocysticercosis

The radiological finding of multiple calcified brain lesions is atypical for brain metastases and in absence of a clear evidence of disseminated neoplastic disease the differential diagnosis may be difficult. Calcified brain metastases (CBM) are rarely encountered in clinical practice and they mostly arise from lung, breast and gastrointestinal primitive tumours. Only one case of uterine cervical carcinoma (UCC) with CBM has been reported so far. We describe the case of a 41-year-old Caucasian woman with a history of hysterectomy and bilateral salpingo-oophorectomy for UCC 3 years prior to observation and no evidence of neoplastic recurrence that developed cystic CBM. Owing to their peculiar radiological appearance, lesions were initially misidentified as neurocysticercosis, the most common parasitic infection of the central nervous system. We offer the reader some important teaching points for the differential diagnosis and discuss the rarity of our case.

http://ift.tt/2kDCg4w

Cervical spine arteriovenous fistula associated with hereditary haemorrhagic telangiectasia

Reported is a case of a man aged 55 years who presented with progressive spastic paraparesis. Examination demonstrated multiple cutaneous telangiectases. Subsequent development of upper limb weakness, acute urinary retention and eventual respiratory compromise resulted in the requirement for intensive care unit admission and mechanical ventilation. MRI spine revealed diffuse T2 hyperintensity in the cervical cord with enhancement and cord expansion. Immunomodulatory therapy for a presumed diagnosis of transverse myelitis yielded no response, so a vascular aetiology was suspected. Spinal angiography demonstrated an arteriovenous fistula involving the upper cervical cord. Endovascular embolisation was successfully performed and a marked clinical improvement was achieved. Cervical arteriovenous fistulas can cause progressive myelopathy, subarachnoid haemorrhage and brainstem dysfunction. Management typically comprises endovascular embolisation or surgical interruption. A clinical diagnosis of hereditary haemorrhagic telangiectasia was also made in this case, and spinal arteriovenous fistula formation has been associated with this condition.

http://ift.tt/2knEE17

Unusual sites of metastases of carcinoma cervix

We present a case of metastatic squamous cell carcinoma cervix with solitary bone metastases to the right tibia and multiple cutaneous metastases. A woman aged 52 years with cancer of the cervix and lung metastases, after 21 months of initial diagnosis and palliative chemotherapy presented with pain in the right knee and multiple nodular skin lesions. Bone scintigraphy revealed intense increased tracer activity in the proximal and mid shaft of the right tibia. Biopsy from the tibial lesion confirmed metastatic squamous cell carcinoma. The presentation, diagnosis and management of this rare case are discussed.

http://ift.tt/2kDC9WE

Multiple myeloma presenting with bilateral ankle pain (microangiopathy) and complicated by streptococcal meningitis and Pneumocystis carinii pneumonia

Multiple myeloma is characterised by the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin. This clone of plasma cells proliferates in the bone marrow, resulting in extensive skeletal destruction with osteolytic lesions, osteopenia and pathological fractures. Additional disease-related complications include hypercalcaemia, renal insufficiency, anaemia and infection. We present the case of a 64-year-old woman presenting with rapid onset, painful distal symmetrical lower limb weakness and an acute kidney injury. Owing to her IgG paraprotein (kappa light chain 4620, kappa:lambda ratio 826), she was diagnosed with probable plasma cell myeloma. This diagnosis was confirmed following a trephine biopsy. She required renal replacement therapy, inotropic support and a percutaneous tracheostomy. She became acutely confused with a Glasgow Coma Scale score of 10/15 and a CT head showed no acute pathology. Further investigation with a lumbar puncture confirmed the diagnosis of streptococcal meningitis. She was treated with intravenous acyclovir, ceftriaxone and fluconazole. Her non-bronchoalveolar lavage revealed a diagnosis of Pneumocystis carinii pneumonia and she required treatment with co-trimoxazole. This case report discusses the clinical presentation, diagnostic algorithm and treatment of myeloma. This manuscript offers an important clinical reminder to consider myeloma in the differential diagnosis in patients presenting with bone pain and acute kidney injury.

http://ift.tt/2knwrKc

Body dysmorphic disorder may be under-diagnosed in patients seeking cosmetic procedures

Plastic surgeons and other cosmetic professionals are familiar with the challenges posed by patients with body dysmorphic disorder (BDD) seeking cosmetic procedures, reports a survey study in...

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A Lip Lump: An Unexpected Histological Diagnosis of a Lip Schwannoma

Schwannomas are benign nerve sheath tumours arising from Schwann cells. They comprise 1% of all benign tumours. In the 2016 World Health Organisation Classification of Central Nervous System, they are classified as a tumour of the cranial and paraspinal nerves, Schwannoma 9560/0. A 23-year-old Caucasian lady presented with a seven-month history of a painless right upper lip lump. Examination revealed a small cystic 0.5 cm diameter lesion within the right upper lip. The clinical impression was that of a mucocele. Excision of the lip lesion was performed under local anaesthetic. Histological examination of the excised lesion demonstrated a circumscribed nodule consisting of spindle cells mixed with vascular spaces containing red blood cells and fibrin. Immunohistochemistry for S100 was strongly positive. The findings were consistent with that of a small benign schwannoma. The current consensus is for surgical excision of a conservative nature with no need for margins. If recurrence does occur one needs to consider whether complete enucleation was achieved or whether malignant transformation has occurred.

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Validation of selective use of intraoperative PTH monitoring in parathyroidectomy

Abstract

Background

The objective of this study was to validate our approach of treating primary hyperparathyroidism using sestamibi scan directed parathyroidectomy, without routine use of intraoperative parathyroid hormone measurements (ioPTH).

Methods

We prospectively established a protocol limiting the use of ioPTH to patients with negative or equivocal sestamibi scans, and those who had risk factors for multi-gland disease. We then performed a retrospective review to determine our disease control rate.

Results

128 patients underwent sestamibi-guided parathyroidectomy without (111/128 = 87%) or with (17/128 = 13%) ioPTH. The overall disease control (eucalcemia) rate was 95%. 3/111 (3%) of patients who had surgery without ioPTH measurements required re-exploration.

Conclusions

Selective use of ioPTH is an effective strategy. ioPTH is best reserved for patients who have non-localizing preoperative imaging, are at risk for multi-gland disease, or require revision surgery.

http://ift.tt/2ki6FEA

PCSK9 targets important for lipid metabolism

Abstract

Ischemic heart disease is the main cause of death worldwide and it is accelerated by increased low-density lipoprotein (LDL) cholesterol (LDL-C) and/or lipoprotein (a) (Lp(a)) concentrations. Proprotein convertase subtilisin/kexin type 9 (PCSK9) alters both LDL-C and in part Lp(a) concentrations through its ability to induce degradation of the LDL receptor (LDLR). PCSK9, however, has additional targets which are potentially involved in lipid metabolism regulation such as the very low density lipoprotein receptor (VLDL), CD36 (cluster of differentiation 36) and the epithelial cholesterol transporter (NPC1L1) and it affects expression of apolipoprotein B48. The PCSK9 activity is tightly regulated at several levels by factors influencing its transcription, secretion, or by extracellular inactivation and clearance. Many comorbidities (kidney insufficiency, hypothyreoidism, hyperinsulinemia, inflammation) modify PCSK9 expression and release. Two humanized antibodies directed against extracellular PCSK9 received approval by the European and US authorities and additional PCSK9 directed therapeutics (such as silencing RNA) are already in clinical trials. Their results demonstrate a significant reduction in both LDL-C and Lp(a) concentrations – independent of the concomitant medication – and one of them reduced plaque size in high risk cardiovascular patients; results of two ongoing large clinical endpoints studies are awaited. In this review, we summarize and discuss the recent biological data on PCSK9, the regulation of PCSK9, and finally briefly summarize the data of recent clinical studies in the context of lipid metabolism.

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To Study the Association of the Size and Site of Tympanic Membrane Perforation with the Degree of Hearing Loss

Abstract

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True Parapharyngeal Space Tumors: Case Series from a Teaching Oncology Center

Abstract

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Use of autogenous bone and beta-tricalcium phosphate in maxillary sinus lifting: histomorphometric study and immunohistochemical assessment of RUNX2 and VEGF

Publication date: Available online 6 February 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): R.S. Pereira, L.F. Gorla, F.B.J.D. Boos, R. Okamoto, I.R. Garcia Júnior, E. Hochuli-Vieira
The aim of this study was to compare the use of beta-tricalcium phosphate (β-TCP) (chronOS) with autogenous bone grafts alone in maxillary sinus elevation surgery. The test samples were β-TCP alone, β-TCP mixed with autogenous bone grafts (1:1), and autogenous bone grafts alone. Twelve maxillary sinuses were grafted with β-TCP (group 1), nine with β-TCP+autogenous bone graft (group 2), and 12 with autogenous bone graft (group 3). After 6 months, biopsies were obtained concurrent to the placement of dental implants; these were subjected to histomorphometric analysis and immunohistochemical analysis for runt-related transcription factor 2 (RUNX2) and vascular endothelial growth factor (VEGF). The average bone formation in group 1 was 46.3±11.6% in the pristine bone region, 47.6±9.9% in the intermediate region, and 44.8±22.1% in the apical region; in group 2, values were 35.0±15.8%, 32.5±13.7%, and 32.8±16.0%, respectively; in group 3, values were 43.1±16.0%, 31.0±13.0%, and 46.1±16.3%, respectively. Immunostaining of samples in group 2 showed high cellular activity and immature bone; this differed from groups 1 and 3, in which mature bone was demonstrated. Thus, this study showed that β-TCP presents the same behaviour as autogenous bone graft, which makes it a good bone substitute.

http://ift.tt/2kD8vko

Changes in condylar position after BSSRO with and without Le Fort I osteotomy via surgery-first approach in mandibular prognathism with facial asymmetry

Publication date: Available online 6 February 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Jiyin Li, Sun-Youl Ryu, Hong-Ju Park, Min-Suk Kook, Seunggon Jung, Jeong Joon Han, Hee-Kyun Oh
ObjectivesThis study aimed to evaluate changes in condylar position after bilateral sagittal split ramus osteotomy (BSSRO) with and without Le Fort I osteotomy via surgery-first approach in patients with facial asymmetry.Study DesignEighteen patients (36 condyles) who received surgical-orthodontic treatment using a SFA were included and divided into two groups depending on the extent of surgery: BSSRO-only group (n=12) and BSSRO with Le Fort I osteotomy group (n=6). Using computed tomography images taken preoperatively, immediately postoperatively, and 6 months postoperatively, surgical and postoperative changes of the condylar position were analyzed three-dimensionally.ResultsBoth groups showed mainly lateral and inferior displacement with inward rotation immediately after surgery, and medial and superior returning movement with outward rotation 6 months after surgery. There was no statistical difference in time-course changes of the condylar position between two groups. In comparing the deviated and nondeviated sides, deviated side showed significantly greater amount of bodily shift and rotational movement after surgery than nondeviated side in both groups.ConclusionThese results suggest that BSSRO in SFA, either with or without Le Fort I osteotomy, may cause condylar displacement after surgery and displaced condyles return to their original position in both deviated- and nondeviated sides.

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Salvage Transoral Laser Microsurgery for Radiorecurrent Laryngeal Cancer: Indications, Limits, and Outcomes

Abstract

Purpose of Review

The aim of this report is to identify relevant literature reports on salvage transoral laser microsurgery (TLM); to consider its oncologic and functional outcomes, as well as reported complications; and to address indications and limitations of salvage TLM.

Findings

The weighted average of local control after first salvage TLM was 57%. Repeated TLM procedures for second or third recurrences were required in up to 41% of cases, resulting in a weighted average of local control with TLM alone of 67%. The rate of definite laryngeal preservation was 73%. The ultimate local control rate, including cases that required total laryngectomy, was 90%. The overall complication rate after salvage TLM was 14%.

Summary

Salvage TLM of radiorecurrent laryngeal cancer yields excellent oncologic outcomes. Serious complications are scarce, hospitalization times are short, and functional outcomes in terms of voice and swallowing are favorable when compared to open conservation laryngeal surgery. The key to success is an optimal patient selection.

http://ift.tt/2jXJ4bh

Clinical Value of the Epstein-Barr Virus and p16 Status in Patients with Nasopharyngeal Carcinoma: A Single-Centre Study in Japan

Background: The clinical significance of the Epstein-Barr virus (EBV) status and p16 expression was unknown in nasopharyngeal carcinoma (NPC). Methods: We retrospectively studied our pathology database for 13 years to determine the prevalence of EBV and p16 expression and their association with prognosis in cases of NPC. We performed immunohistochemistry for the p16 protein and in situ hybridization (ISH) for EBV-encoded small RNAs and human papillomavirus (HPV) DNA. Results: Of the 43 patients with NPC, 27 (63%), 6 (14%), and 10 (23%) cases were EBV positive, EBV negative with keratinization, and EBV negative without keratinization, respectively. No cases were HPV positive by ISH. Among the 21 EBV-positive tumours that were tested for p16, only 2 tumours were p16 positive. The keratinization-positive group included only males, typically >60 years of age (5 of 6) and with T4 tumours (3 of 6). In contrast, the EBV-positive cohort tended to be younger (Conclusion: In areas, such as Japan, that are nonendemic for both EBV and HPV, the causality of NPC appears to be more heterogeneous.
ORL 2016;78:334-343

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Osteosynthesis using cannulated headless Herbert screws in mandibular angle fracture treatment: A new approach?

Publication date: Available online 6 February 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Jürgen Wallner, Knut Reinbacher, Mathias Feichtinger, Mauro Pau, Georg Feigl, Franz Quehenberger, Katja Schwenzer-Zimmerer, Wolfgang Zemann
IntroductionFractures of the mandibular angle are a common type of facial skull fracture. Although operative treatment includes a wide range of fixation techniques, a definite gold standard method has yet to be established. Headless, cannulated Herbert screws, often used in many forms of minimally invasive trauma surgery, provide functional and stable fracture fixation.Materials and MethodsIn a prospective, double-randomised, controlled, parallel-group− designed, in vitro trial, the biomechanical behaviour of the Herbert bone screw system was compared to that of a conventional locking plate system in 40 mandibular angle fractures of human mandible cadaver phantoms.ResultsThe mean stress values were 250 (±68.0) N in the plate subgroup and 200 (±61.0) N in the screw subgroup. The respective mean strain values were 7.90 (±2.7) mm and 6.90 (±2.2) mm, and the respective mean stiffness were values 1.10 (±0.61) N/m and 0.78 (±0.40) N/m. The differences in the results obtained using the two treatments were not significant (p=0.55).ConclusionsThe biomechanical behaviour of the two fixation systems within the tested loads did not significantly differ with respect to postoperative parameters clinically relevant in osteosynthesis. Both systems met the mandibular angle assessment criterion, which is considered to be sufficient for clinical use. The results indicate the potential clinical utility of these two systems, and recommend further testing.

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Faulty Study Design Produces an Outcome That May Confuse Medical Fraternity: A Serious Publication Bias.

No abstract available

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Pediatric Cardiopulmonary Arrest in the Postanesthesia Care Unit, Rare but Preventable: Analysis of Data From Wake Up Safe, The Pediatric Anesthesia Quality Improvement Initiative.

BACKGROUND: Nearly 20% of anesthesia-related pediatric cardiac arrests (CAs) occur during emergence or recovery. The aims of this case series were to use the Wake Up Safe database to describe the following: (1) the nature of pediatric postanesthesia care unit (PACU) CA and subsequent outcomes and (2) factors associated with harm after pediatric PACU CA. METHODS: Pediatric CAs in the PACU were identified from the Wake Up Safe Pediatric Anesthesia Quality Improvement Initiative, a multicenter registry of adverse events in pediatric anesthesia. Demographics, underlying conditions, cause of CA, and outcomes were extracted. Descriptive statistics were used to characterize data and to assess risk of harm in those suffering CA. RESULTS: A total of 26 CA events were included: 67% in children

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In Response.

No abstract available

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Cover 1

Publication date: February 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 2

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Brief Overview of This Month's JACI

Publication date: February 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 2

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CTLA4-Ig effectively controls immune activation and inflammatory disease in a novel murine model of leaky SCID

Publication date: Available online 7 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Stéphanie Humblet-Baron, Susann Schönefeldt, Josselyn Garcia-Perez, Frédéric Baron, Emanuela Pasciuto, Adrian Liston
BackgroundSevere combined immunodeficiency (SCID) can be caused by loss-of-function mutations in genes involved in the DNA recombination machinery, such as RAG1, RAG2 or DCLRE1C. Defective DNA recombination causes a developmental block in T cells and B cells, resulting in high susceptibility to infections. Hypomorphic mutations in the same genes can also give a partial loss of T cells, in a spectrum including leaky SCID (LS) and Omenn syndrome (OS). These patients not only develop life-threatening infections due to immunodeficiency, but also develop inflammatory/autoimmune conditions due to the presence of autoreactive T cells.ObjectiveWe sought to develop a preclinical model that fully recapitulates the symptoms of LS/OS patients including a model for testing therapeutic intervention.MethodsWe generated a novel mutant mouse (Dclre1c^leaky) that develops a LS phenotype. Mice were monitored for diseases and immune phenotype and immune function were evaluated using flow cytometry, ELISA and histology.ResultsDclre1c^leaky mice present with a complete blockade of B cell differentiation, with a leaky block in T cell differentiation resulting in an oligoclonal TCR repertoire and enhanced cytokine secretion. Dclre1c^leaky mice also developed inflammatory symptoms including wasting, dermatitis, colitis, hypereosinophilia and high IgE levels. Development of a preclinical murine model for LS allowed the testing of potential treatment, with administration of CTLA4-Ig reducing disease symptoms and immunological disturbance, resulting in increased survival.ConclusionThese data suggest that CTLA4-Ig should be evaluated as a potential treatment of inflammatory symptoms in LS and OS patients.

Teaser

CTLA4-Ig controls immune dysregulation in an Artemis deficient mouse model that recapitulates leaky SCID/ Omenn Syndrome clinical manifestations.

http://ift.tt/2ljXSTK

Αρχειοθήκη ιστολογίου

Τρίτη 7 Φεβρουαρίου 2017

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