Association between signs and symptoms of bruxism and presence of tori: a systematic review

Abstract

Objective

This systematic review aims to answer the question: "Is there an association between any specific signs and symptoms of bruxism and the presence of tori?"

Material and methods

Observational studies, which evaluated the association between signs and symptoms of bruxism and tori, were selected. Signs and symptoms of bruxism (such as teeth grinding, jaw clenching, abnormal tooth wear, facial muscle hypertrophy, pain, or fatigue) had to be determined by questionnaire or anamnesis and tori within clinical assessment. Search-strategies were developed for five databases, in addition to three gray literature's databases. The risk of bias was evaluated using the "Meta-Analysis of Statistics Assessment and Review Instrument". A summary of overall strength of evidence was estimated using GRADE's Summary of findings table.

Results

Among 575 studies, five were included. Two studies were categorized as moderate risk of bias and three as high risk of bias. Self-report of teeth grinding and/or clenching presented contradictory results. Presence of abnormal tooth wear increased the odds of having tori, mainly for torus mandibularis. The overall quality of evidence ranged from low to very low.

Conclusion

Based on available evidence, the presence of abnormal tooth wear might be associated with tori, mainly torus mandibularis. There is no sufficient evidence to credit or discredit the association of tori and other signs and/or symptoms of bruxism.

Clinical relevance

Bruxism diagnosis is a challenge. The association between signs and symptoms of bruxism and tori could help clinicians on the recognition of patients susceptible to bruxism. This knowledge might also aid to the understanding of tori's development and stimulate new relevant research.

http://ift.tt/2l4BgZp

Presence of root canal treatment has no influence on periodontal bone loss

Abstract

Aim

The aim of this study was to compare the interproximal bone level at root canal-filled teeth and non-root canal-filled teeth.

Materials and methods

The records of patients from the department were consecutively screened from January 2009 to October 2011. The distance between the coronal reference point to the alveolar bone crest (AC) was assessed at the mesial and distal aspects of root canal-filled teeth (RCF+) and their contralateral non-root canal-filled teeth (RCF−) on periapical radiographs. Generalised linear mixed-effects models were applied.

Results

The sample consisted of 128 pairs of teeth comprising data from 72 patients. The results for AC revealed a median distance of 3.2 mm for RCF+ and 3.4 mm for RCF− (p = 0.61). Using the maximal distance on either the distal or the mesial tooth surface, a median distance of 3.6 mm was detected for RCF+ and 3.8 mm for RCF−, respectively (p = 0.42). Even after taking several tooth- and subject-specific variables into account, the differences between AC on RCF+ and RCF− were statistically not significant (p > 0.05).

Conclusion

The interproximal bone loss did not differ statistically significant between root canal-filled teeth and non-root canal-filled teeth.

Clinical relevance

Existence of appropriately done root canal fillings in periodontitis patients has no effect on the prognosis of periodontal disease.

http://ift.tt/2m6NjTr

Orale Schleimhautalteration – was ist die Ursache?

http://ift.tt/2lXftBh

Simple bone cyst of the mandibular condyle

Benjamin H. J. Rapaport, Andrew A. C. Heggie

Annals of Maxillofacial Surgery 2016 6(2):314-315

Simple bone cysts (SBCs) are benign lesions often found in the long bones of children between their first and second decades. They occasionally occur in the mandible but rarely in the mandibular condyle. A case of a 7-year-old female child with an increasing enlargement of the left mandibular condyle is presented. A 2 cm × 3 cm lytic lesion was explored and curetted through an intraoral vestibular incision and proved to be an SBC. Postoperative recovery was uncomplicated with remodeling of the condylar observed at 3 years follow-up.

http://ift.tt/2kyJlXq

Facial feminization

SM Balaji

Annals of Maxillofacial Surgery 2016 6(2):158-158



http://ift.tt/2lgwx57

Three-dimensional planning in craniomaxillofacial surgery

Josep Rubio-Palau, Alejandra Prieto-Gundin, Asteria Albert Cazalla, Miguel Bejarano Serrano, Gemma Garcia Fructuoso, Francisco Parri Ferrandis, Alejandro Rivera Baró

Annals of Maxillofacial Surgery 2016 6(2):281-286

Introduction: Three-dimensional (3D) planning in oral and maxillofacial surgery has become a standard in the planification of a variety of conditions such as dental implants and orthognathic surgery. By using custom-made cutting and positioning guides, the virtual surgery is exported to the operating room, increasing precision and improving results. Materials and Methods: We present our experience in the treatment of craniofacial deformities with 3D planning. Software to plan the different procedures has been selected for each case, depending on the procedure (Nobel Clinician, Kodak 3DS, Simplant O&O, Dolphin 3D, Timeus, Mimics and 3-Matic). The treatment protocol is exposed step by step from virtual planning, design, and printing of the cutting and positioning guides to patients' outcomes. Conclusions: 3D planning reduces the surgical time and allows predicting possible difficulties and complications. On the other hand, it increases preoperative planning time and needs a learning curve. The only drawback is the cost of the procedure. At present, the additional preoperative work can be justified because of surgical time reduction and more predictable results. In the future, the cost and time investment will be reduced. 3D planning is here to stay. It is already a fact in craniofacial surgery and the investment is completely justified by the risk reduction and precise results.

http://ift.tt/2kyKnTr

Minimally invasive (endoscopic-computer assisted) surgery: Technique and review

Anand Kumar, Nirma Yadav, Shipra Singh, Neha Chauhan

Annals of Maxillofacial Surgery 2016 6(2):159-164

Endoscopic or minimally invasive surgery popular as keyhole surgery is a medical procedure in which endoscope (a camera) is used, and it has gained broad acceptance with popularity in several surgical specialties and has heightened the standard of care. Oral and maxillofacial surgery is a modern discipline in the field of dentistry in which endoscopy has developed as well as widely used in surgeries and is rapidly gaining importance. The use of different visual as well as standard instruments such as laparoscopic and endoscopic instruments, and high-powered magnification devices, has allowed physicians to decrease the morbidity of many surgical procedures by eliminating the need for a large surgical incision. Minimally invasive techniques have evolved through the development of surgical microscopes equipped with a camera to get visual images for maxillofacial surgeries, endodontic procedures, and periodontal surgical procedures. Nevertheless, current experiences and reviewing the literature have intimated that the use of endoscopes, as in different minimally invasive methods, may permit complicated surgeries with less complications, for example, in reconstruction of facial fractures through smaller incisions with less extensive exposure.

http://ift.tt/2lgwxSF

Role of addition of dexamethasone to lignocaine 2% with adrenaline in dental nerve blocks for third molar surgery: A prospective randomized control trial

Saroj Prasad Deo

Annals of Maxillofacial Surgery 2016 6(2):260-266

Context: Dexamethasone has been frequently used in oral surgical procedure and accepted by oral and maxillofacial surgeon community worldwide. However, this is the first clinical trial that used dexamethasone as adjuvant with lignocaine in dental nerve block (DNB). Aims: The purpose of this double-blind, randomized control trial (RCT) was to compare the effect of dexamethasone with normal saline (NS) in a lignocaine DNB. Settings and Design: This prospective, double-blind, RCT was carried out after obtaining approval from the Institutional Ethical Committee. Subjects and Methods: In forty patients, the present placebo-controlled clinical trial was conducted; allocated randomly into two groups: study group (SG) or control group (CG). The single-dose submucosal dexamethasone or NS injection was administered immediately after 2% lignocaine with epinephrine 1:2,00,000 nerves block during mandibular third molar surgery (TMS). Visual analog scale score, number, and exact time nonsteroidal anti-inflammatory drugs were administered were used to measure postoperative analgesia in 2nd and 7th days. Statistical Analysis Used: All the data were entered into the Spreadsheet (Excel, Microsoft) and Chi-square test, Mann–Whitney U-test, Student's paired and unpaired t-test, and Fisher exact test were used. Results: This study found maximum duration of DNB in SG was 248.88 min and in CG was 175.44 min, whereas minimum duration in SG was 197 min and in CG was 140.78 min. Conclusions: Dexamethasone prolongs the action of lignocaine 2% in DNB for TMS.

http://ift.tt/2kyCmhq

Secondary closure of alveolar cleft with resorbable collagen membrane and a combination of intraoral autogenous bone graft and deproteinized anorganic bovine bone

Lobna Abdel Aziz Aly, Nelly Hammouda

Annals of Maxillofacial Surgery 2016 6(2):165-171

Objects: Secondary alveolar bone grafting is a method that enables an excellent oral rehabilitation of the patients having alveolar cleft. The aim of this work is to report the closure of the alveolar cleft with the use of harvested autogenous bone graft combined with deproteinized anorganic bovine bone (Bio-Oss) under local anesthesia. Settings and Sample Population: Nine patients with age range, 8–11 years were consulted for their unilateral alveolar cleft. Materials and Methods: A combination of symphyseal bone and deproteinized bovine bone mineral (DBBM) was placed into the alveolar cleft defect. Clinical and radiographical assessments were performed at 1, 3, and 6 months postoperatively. Results: The healing period was uneventful in all cases, and no complications, such as membrane exposure, infection, or harvest site morbidity, were observed. All treated defect sites exhibited excellent bone formation, with an average of 5.45 mm (range, 2–9 mm; standard deviation 1.93 mm) of augmentation achieved overall. Conclusion: The treatment of vertically deficient alveolar ridges with guided bone regeneration using a mixture of autogenous bone and DBBM and resorbable collagen membrane can be considered successful, using this technique in an out-patient office setting.

http://ift.tt/2lgJmfD

Unusually large-sized peripheral ossifying fibroma

Reena Rachel John, Saravanan Kandasamy, Narendran Achuthan

Annals of Maxillofacial Surgery 2016 6(2):300-303

Fibrous growths in the gingiva with the histopathological presence of calcifications are a common occurrence in the oral cavity. These lesions can be neoplastic in nature with either odontogenic or non odontogenic origin or they can be reactive lesions. This is a case report of an unusual presentation of peripheral ossifying fibroma , unusual because of its abnormally large size with review of literature.

http://ift.tt/2kyQ8jQ

Lugol's iodine identifies dysplastic tissue in precancerous lesions: A clinical trial

Shereen Fatima, Rajarshi Basu, Neelakamal H Hallur

Annals of Maxillofacial Surgery 2016 6(2):172-174

Introduction: Intraepithelial dysplasia, or "invisible" precancerous lesions, provides a challenge for visualization to the surgical team. The prognostic relevance of dysplasia and carcinoma in situ at surgical margins is well documented.Materials and Methods: We evaluated the use of Lugol's iodine in visualizing the surgical margins of dysplastic tissue by an observational study of 100 patients having oral precancerous lesions between June 2013 and March 2016. Conclusion: Lugol's iodine is a simple, inexpensive, and apparently effective means of diagnosing and visualizing the surgical margins of the dysplastic tissue in oral precancerous lesions.

http://ift.tt/2lgvNgr

Three-dimensional evaluation of surgical techniques in neonates with orofacial cleft

Cleide Felício Carvalho Carrara, Eloá Cristina Passucci Ambrosio, Bianca Zeponi Fernandes Mello, Paula Karine Jorge, Simone Soares, Maria Aparecida Andrade Moreira Machado, Thais Marchini Oliveira

Annals of Maxillofacial Surgery 2016 6(2):246-250

Background: Individuals with cleft lip and palate have many anatomic and functional alterations compromising esthetics, hearing, speech, occlusion, and development/craniofacial growth. The rehabilitative treatment of these patients is very challenging and starts at birth aiming at the best treatment for all functional demands. This study aimed to evaluate the dimensional alterations of the dental arches of neonates with cleft lip and palate after two different primary surgical techniques. Materials and Methods: The sample comprised 114 digital models of children aged from 3 to 36 months, with unilateral complete cleft lip and palate divided into two groups. Two different phases were evaluated: precheiloplasty and 1 year after palatoplasty. The evaluation was performed through the digital models of each child obtained by scanning digitalization (3D Scanner). Dental arches measurements were accomplished through Appliance Designer software. The following measurements were assessed: dental arch area, anterior amplitude of the cleft, total length of dental arch, intercanine distance, and intertuberosity distance. t-test was applied to compare differences between groups. Results: No statistically significant differences were observed between groups at precheiloplasty phase. At 1 year after palatoplasty, the groups differed in the total length of dental arch (P = 0.002), with greater values for Group I. Conclusion: This study suggests that the results of the different surgical techniques may alter the growth and development of the dental arches of neonates with cleft lip and palate.

http://ift.tt/2kyDbXb

Volumetric analysis of bone substitute material performance within the human sinus cavity of former head and neck cancer patients: A prospective, randomized clinical trial

Jonas Lorenz, Kathrin Eichler, Mike Barbeck, Henriette Lerner, Stefan Stübinger, Catherine Seipel, Thomas J Vogl, Adorján F Kovács, Shahram Ghanaati, Robert A Sader

Annals of Maxillofacial Surgery 2016 6(2):175-181

Background: In numerous animal and human studies, it could be detected that in bone augmentation procedures, material's physicochemical characteristics can influence the cellular inflammatory pattern and therefore the integration in the host tissue. Histological, histomorphometrical, and clinical analyses of the integration of the biomaterial in the surrounding tissue are well established methodologies; however, they do not make a statement on volume and density changes of the augmented biomaterial. Aims: The aim of the present study was to assess the volume and density of a xenogeneic (Bio-Oss®, BO) and a synthetic (NanoBone®, NB) bone substitute material in split-mouth sinus augmentations in former tumor patients to complete histological and histomorphometrical assessment. Methods: Immediately and 6 months after sinus augmentation computed tomography scans were recorded, bone grafts were marked, and the volume was calculated with radiologic RIS-PACS software (General Electric Healthcare, Chalfont St. Giles, Great Britain) to determine the integration and degradation behavior of both biomaterials. Results: Radiographic analysis revealed a volume reduction of the initial augmented bone substitute material (i.e. 100%) to 77.36 (±11.68) % in the BO-group, respectively, 75.82 (±22.28) % in the NB-group six months after augmentation. In both materials, the volume reduction was not significant. Bone density significantly increased in both groups. Conclusion: The presented radiological investigation presents a favorable method to obtain clinically relevant information concerning the integration and degradation behavior of bone substitute materials.

http://ift.tt/2lgMPv3

6-0 nylon versus 6-0 vicryl rapide in chieloplasty

J K. Dayashankara Rao, Payal Luthra, Varun Arya, Vijay Siwach, Anil K Sheorain, Megha Gupta

Annals of Maxillofacial Surgery 2016 6(2):272-277

Context: Facial cosmetic result is one of the most concerning issues for the parents who get their children operated for cleft lip. Moreover, the discomfort associated with the suture removal encourages one to use any new technology that may replace the need for suture placement. The type of suture material used in surgery has been a long-standing debate among surgeons. In this study, we compared rapidly absorbable suture material (Vicryl Rapide™) with nonabsorbable suture material (nylon). Aims: The aim of this study is to compare the appearance and course of scar, wound infection, and patient's parent perception using Vicryl Rapide and nylon in nonsyndromic congenital cleft lip repair. Settings and Design: This was a randomized prospective controlled clinical trial. Materials and Methods: Twenty patients, in the age group of 3–18 months treated for unilateral congenital cleft lip deformity, were included and randomly allocated to two groups with ten patients each. Skin suturing was done with 6-0 polyamide and 6-0 irradiated polyglactin in Groups A and B, respectively. Patients were evaluated at 1 week, 1, 3, 6 months, and 1 year postoperatively in person by the observer as well as by the patient's parent. Statistical Analysis Used: Descriptive statistical analysis was done using SPSS 20, and Student's t-test was applied. Results: It was found that Vicryl Rapide showed more hypopigmented scars and raised scars than nylon at the end of 1 year though overall appearance was comparable between the groups. Conclusions: Vicryl Rapide showed poorer cosmetic outcomes in terms of height and pigmentation of car as compared to nylon suture of same thickness. However, since scars tend to improve with time, a bigger sample size and a longer follow-up are required to generalize this statement.

http://ift.tt/2kyGFsU

Changes in posterior airway space and mandibular plane hyoid distance following mandibular advancement DO

Pushpa Kumari, SK Roy, Indranil Dev Roy, AK Rajput, MP Prasanna Kumar, Sanjeev Datana, Serat Rahman

Annals of Maxillofacial Surgery 2016 6(2):182-189

Aim: To study the changes in posterior airway space (PAS) and mandibular plane hyoid (MPH) distance following mandibular advancement using distraction osteogenesis (DO). Subjects and Methods: A prospective study was conducted at a tertiary care dental center from May 2009 to May 2014. Twenty-five consecutively operated patients of mandibular hypoplasia who underwent mandibular advancement using distraction with at least 12 months follow-up were included in the study. The study group comprised 15 males and 10 females with an age range of 15–30 years (mean 22 years). Presurgical and postsurgical cephalometric changes were compared to determine the changes in PAS and MPH distance. Results: The mean distraction achieved was 14.50 mm. The mean preoperative MPH was 18.88 mm and mean postoperative MPH was 13.16 mm with a resultant reduction by 32%. Mean preoperative PAS was 6.48 mm and mean postoperative PAS was 11.08 mm. Mean increase in PAS was 75%. Mean preoperative and postoperative SNB values were 75.4° and 79.52°, respectively. The results were statistically analyzed using paired "Student's t-test." Conclusion: From this study, it is concluded that statistically significant changes were achieved in MPH and SNB. Although change in PAS was statistically insignificant, it may have clinical applications, especially in the field of Phase II surgical management of obstructive sleep apnea.

http://ift.tt/2lgKcJz

Bullet removal from the infratemporal fossa

Ahmed Maki Merza

Annals of Maxillofacial Surgery 2016 6(2):292-296

War injuries are the cornerstone of maxillofacial surgery, and it led to the initiation and development of this specialty, and each case represents a challenge to the surgeon who deals with it. In this article, we present a 30-year-old male patient who was referred to our emergency department complaining of gunshot wound, severe pain, and limitation in mouth opening. Preoperative imaging showed a bullet with a very long path lodged in the infratemporal fossa. Three different approaches with the aid of C-arm imaging system were used for the removal of this bullet; the last approach was the successful one.

http://ift.tt/2kyIxlh

Clinical and radiological evaluation of implants placed with osteotome sinus lift technique: 19-month follow-up

Bijan Movahedian Attar, Samaneh Alaei, Hamid Badrian, Amin Davoudi

Annals of Maxillofacial Surgery 2016 6(2):190-194

Aims: Implant placement in the posterior region of the maxilla might be problematic due to poor regional bone quality. The aim of this study was to clinically and radiologically evaluate implants which were placed in the posterior region of the maxilla (with insufficient bone height) with osteotome sinus lift technique after 19-month follow-up. Materials and Methods: Twenty-four patients with posterior maxillary alveolar height ranging from 5 to 8 mm were chosen for this prospective study. After breaking of the cortical bony sinus floor, sufficient bone substitute was placed, and sinus floor was elevated. In this way, a new sinus floor was created, which was designated for further implants placement. Fifty implants were placed immediately after osteotomy sinus lift technique. The mean clinical and radiological follow-up period was 19 months (with a range of 14–24 months). Success factors such as the absence of mobility, pain, infection, and the amount of crestal bone loss were determined in this study. For data analyzing, Kruskal–Wallis and Mann–Whitney tests were used. Results: After 19 months, results showed 96% success rate. Two out of fifty implants failed due to mobility. The mean depth of implants in sinus, mean height of residual crestal bone before surgery, and the mean rate of crestal bone loss were 3.8, 7.9, and 0.71 mm, respectively. Conclusion: Osteotome sinus lift technique is a noninvasive surgical method for enhancing a desired length. Furthermore, implants insertion was successful after osteotome sinus lift technique in cases with insufficient bone height.

http://ift.tt/2lgOY9U

A rare case of parotid gland lipoma arising from the deep lobe of the parotid gland

Francesco Paparo, Mauro Massarelli, Giorgio Giuliani

Annals of Maxillofacial Surgery 2016 6(2):308-310

Lipomas are the most commonly encountered benign mesenchymal tumors, but their occurrence in the head and neck is rare, even more at the level of the parotid region where they can be found nearby the parotid capsule, inside the capsule, or within the gland. In addition, lipomas involving the deep parotid lobe are extremely unusual. That is why lipomas are not often considered for differential diagnosis of parotid lumps. Concerning diagnostic tools, magnetic resonance imaging (MRI) is nowadays considered as the main imaging examination for parotid lipomas due to a characteristic signal intensity on T1- and T2-weighted images. Furthermore, even if the cost of MRI is nearly three times that of computed tomography, MRI is accurate, safe, and has few biological costs for the patient. In this reported case, MRI provided all information for either diagnosis or preoperative planning being the best diagnostic tool regarding tumor margin characteristics and surrounding tissues' involvement. Concerning treatment, surgical excision of parotid masses is always mandatory for definitive diagnosis, but it is challenging because of the facial nerve. For this reason, a well-established surgical technique is mandatory for success. The authors present a rare case of parotid gland lipoma arising from the deep lobe and discuss diagnostic tools and surgical technique.

http://ift.tt/2lUxEuD

Cleft lip and palate: Parental experiences of stigma, discrimination, and social/structural inequalities

Wasiu Lanre Adeyemo, Olutayo James, Azeez Butali

Annals of Maxillofacial Surgery 2016 6(2):195-203

Background: Cleft lip and palate (CLP) are the most common craniofacial birth impairment and one of the most common congenital impairments in humans. Anecdotal evidence suggests that stigmatization, discrimination, and sociocultural inequalities are common "phenomenon" experienced by families of children with CLP in Nigeria. This study aimed to explore the stigmatization, discrimination, and sociocultural inequalities experiences of families with children born with CLP. Materials and Methods: The study was carried out at the surgical outpatient cleft clinic of the Lagos University Teaching Hospital, Lagos, Nigeria. This was a cross-sectional descriptive study among mothers of children born with CLP, using both interviewer-administered questionnaire and a semi-structured interview. Results: A total of 51 mothers of children with cleft lip and/or palate participated in the study. 35.3% of respondents believed cleft was an "act of God," whereas others believed it was either due to "evil spirit" (5.9%), "wicked people" (9.8%). Seventy-three percent of the mothers were ashamed of having a child with orofacial cleft. Two of the respondents wanted to abandon the baby in the hospital. About a quarter of the respondent wished the child was never born and 59% of the fathers were ashamed of the facial cleft. Fifty-one percent admitted that their relatives were ashamed of the orofacial cleft, and 65% admitted that their friends were ashamed of the cleft. In addition, 22% of the respondents admitted that they have been treated like an outcast by neighbors, relatives, and friends because of the cleft of their children. When asked about refusal to carry the affected children by friends, relatives, and neighbors, 20% of respondents said "Yes." Conclusions: Myths surrounding the etiology of orofacial cleft are prevalent in Nigeria. Parents and individuals with CLP experience stigma as well as social and structural inequalities due to societal perceptions and misconception about CLP. Public and health-care professionals must be equipped with necessary knowledge to combat stigma, discrimination, social and structural inequalities, and misconceptions associated with orofacial cleft. CLP should be considered a facial difference rather than a disability.

http://ift.tt/2lUwcbq

Auto-tooth bone grafts: An emerging option

Masaharu Mitsugi, In-Woong Um

Annals of Maxillofacial Surgery 2016 6(2):157-157



http://ift.tt/2kSKQfq

Micro-marsupialization versus surgical excision for the treatment of mucoceles

Girish B Giraddi, Aamir Malick Saifi

Annals of Maxillofacial Surgery 2016 6(2):204-209

Background: Mucocele is a common disorder of minor salivary glands which arises due to mucous accumulation resulting from their alteration. Several techniques have been described for the treatment. However, most of them are invasive or require costly armamentarium. Purpose: The present study was conducted to evaluate the efficacy of micro-marsupialization technique as an alternative to surgical excision for the treatment of mucoceles. Materials and Methods: A prospective study was conducted. A total of twenty patients were selected based on clinical diagnosis of mucoceles and were randomly divided into two groups comprising ten patients each. Micro-marsupialization was done in Group 1 patients and surgical excision in Group 2. Patient's gender, age, size, location, duration, complications, and recurrences were evaluated during various visits. Data between the two groups were analyzed by descriptive and analytical (Chi-square tests) statistics. Results: The mean age of the patients in Group 1 was 19.6 ± 9.6 years while in Group 2 was 21.9 ± 11 years. The most common location for mucocele in Group 1 as well as Group 2 patients was lower lip (60% and 80%, respectively). In Group 1, two patients had recurrence while in Group 2, one patient had a recurrence. All recurrent cases were subsequently treated by surgical excision. No statistically significant difference was found between the two methods. Conclusion: Micro-marsupialization technique is as efficacious as surgical excision for the treatment of mucocele. It is advantageous over surgical excision as it is simple to perform, is less invasive therefore not associated with complications associated with invasive procedure, and is well tolerated by patients.

http://ift.tt/2lUsA9r

Postsurgical consequences in lower third molar surgical extraction using micromotor and piezosurgery

Freddy Kersi Mistry, Nidarsh Diwakar Hegde, Mithra Nidarsh Hegde

Annals of Maxillofacial Surgery 2016 6(2):251-259

Background: One of the most critical and crucial steps in surgical extraction is cutting the bone or osteotomy, for which many techniques are used, e.g., chisels and mallet, rotary instruments, and ultrasound bone-cutting instruments. If they are not used judiciously, they can be hazardous. Objectives: To assess the efficiency of piezosurgery unit over micromotor while performing surgical extraction of lower third molars by assessing the time taken for the surgery and measuring postoperative parameters such as pain, trismus, and swelling. Materials and Methods: Thirty patients having bilateral impacted third molars with the same difficulty index were selected for the study. One side surgical removal was done using micromotor and other side by piezosurgery with an interval of 15 days. After each surgery, time taken to finish was measured and patients were followed up on postoperative days 1, 3, 5, 7, and 15 for assessing pain, trismus, and swelling. Data obtained were statistically analyzed. Results: The mean time taken for the micromotor group is 37.90 min whereas by the piezosurgery group is 54.63 min, showing a statistically significant difference (P < 0.001). Furthermore, there is statistically significant difference (P < 0.001) in the level of pain, trismus, and swelling on postoperative days 1, 3, 5, and 7. Even the intragroup comparison of piezosurgical group for trismus and swelling showed no statistically significant difference on postoperative day 7, indicating faster recovery of trismus and swelling. On postoperative day 15, there was no difference in any parameter in both groups indicating complete symptom-free recovery in both groups. Conclusion: It takes more time to perform surgical extraction of third molars when piezosurgical unit is used. Despite that, it causes less pain postoperatively with faster improvement in trismus and quicker reduction in swelling.

http://ift.tt/2kT0jfl

Facial feminization - Surgical modification for Indian, European and African faces

SM Balaji

Annals of Maxillofacial Surgery 2016 6(2):210-213

Introduction: Gender reassignment surgery for facial feminization is being increasingly sought out by males with gender nonconformity issues. Noninvasive camouflage measures such as changing hairstyle, makeup, and filler inserts often do not fetch desired long lasting effects and surgery is sought as a last resort. The facial feminization surgery (FFS) for Indian faces, has no definitive protocol till date and largely remains as an arbitrary undertaking based on individual patient's perception, expectation, and surgeon's ability. This manuscript aims to present a series of the Indian FFS and compare the same with European and African counterparts to highlight the Indian expectation of FFS and thus its modifications. Materials and Methods: Seven patients confirming to gender nonconformity status, seeking FFS, aged between 21 and 36 years (mean 26.3 ± 4.2 years; median 25 years) were surgically treated during 2007–2014. Of them, five were of Indian origin and the rest two from the Europe and Africa. After investigation and para-clinical workup, FFS were carried out in stages with due modifications. Results: Basic surgical guidelines were followed accommodating Indian parameters of facial profile as well as expectations. Various amounts of soft and hard tissue changes were required for individual patients, depending on their individual perception. Conclusion: All seven patients were satisfied with their feminine faces. The challenges and differences in planning and performing Indian FFS are described.

http://ift.tt/2lUyxmF

Adhärenz in der spezifischen Immuntherapie

Zusammenfassung

Allergien nehmen in der westlichen Welt stetig an Bedeutung zu. Seit über 100 Jahren stellt die Immuntherapie die einzig kausale Therapie dar. Die spezifische Immuntherapie (SIT) zielt auf Heilung oder zumindest eine Symptomfreiheit der Allergien. Hierbei stellt die Adhärenz ein komplexes Problem dar. Beide üblicherweise in Deutschland eingesetzten Therapieapplikationen, sublinguale und subkutane Immuntherapien, verzeichnen eine schlechte Persistenz der Patienten. In den meisten Fällen wird die SIT nicht bis zum Ende der empfohlenen Dauer durchgeführt, sondern frühzeitig beendet. Hierbei reichen die Zahlen in der Literatur zu 3‑jährigen Studien von 41–93 % nicht beendeter SLIT und 40–77 % nicht beendeter SCIT. Die Adhärenz der Patienten unterliegt Einflussfaktoren unterschiedlicher Dimensionen, die in komplexen Beziehungen voneinander abhängen. Das Arzt-Patienten-Verhältnis stellt für den Therapieerfolg einen ebenso entscheidenden Faktor dar wie das Verständnis des Patienten von Allergie, Therapie und Bedeutung seiner Adhärenz.

http://ift.tt/2l4Notj

Psychosomatik der Kopfhaut

Zusammenfassung

Das Spektrum zu erwartender psychischer Störungen der Kopfhaut zeigt aufgrund der Sichtbarkeit, einer möglichen Stigmatisierung sowie der Behaarung einige Besonderheiten auf. Von praktischer Relevanz ist die Trichotillomanie, die neu zu den Zwangsstörungen gezählt wird. Eine weitere psychodermatologische Herausforderung stellen Patienten mit Fokussierung eines normwertigen physiologischen Haarausfalls dar. Die Behandlung von psychotrichologischen Erkrankungen erfolgt mit psychosomatischer Grundversorgung, Verhaltenstherapie oder Psychopharmaka.

http://ift.tt/2m6WW4E

Effect of a one-step self-etch adhesive on endogenous dentin matrix metalloproteinases

Degradation of the hybrid layer created in dentin by dentin adhesives is caused by enzyme activities present within the dentin matrix that destroy unprotected collagen fibrils. The aim of the present study was to evaluate the effect of a one-step self-etch adhesive system on dentinal matrix metalloproteinases 2 and 4 (MMP-2 and MMP-9, respectively) using in situ zymography and an enzymatic activity assay. The null hypothesis tested was that there are no differences in the activities of dentinal MMPs before and after treatment with a one-step adhesive system. The MMP-2 and MMP-9 activities in dentin treated with the one-step adhesive, Adper Easy Bond, were quantified using an enzymatic activity assay system. The MMP activities within the hybrid layer created by the one-step adhesive tested were also evaluated using in situ zymography. The enzymatic assay revealed an increase in MMP-2 and MMP-9 activities after treatment with adhesive. In situ zymography indicated that gelatinolytic activity is present within the hybrid layer created with the one-step self-etch adhesive. The host-derived gelatinases were localized within the hybrid layer and remained active after the bonding procedure. It is concluded that the one-step self-etch adhesive investigated activates endogenous MMP-2 and MMP-9 with the dentin matrix, which may cause collagen degradation over time.

http://ift.tt/2lUxNy3

Selected cytokine pathways in rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease leading to joint destruction. Cytokines play a key role in its pathogenesis. They contribute to the induction and maintenance of inflammation and thus provide therapeutic targets. Many cytokines are involved in RA, and this review focuses on a few critical ones: tumor necrosis factor (TNF), interleukin (IL)-6, IL-1, IL-17, and GM-CSF. TNF and IL-6 are both well-established targets in RA treatment, and new biologic agents are reaching the market. IL-1 represents a more complex cytokine as results in humans do not reach those in animal models. IL-17 and GM-CSF are cytokines representing new targets either as early treatment or in non-responders to other biologics. The interaction between cytokines and their signaling pathways are the basis for the development of new strategies with small molecules or bispecific antibodies. Clearly, the targeting of cytokines has been a major progress in RA treatment, but many issues remain open. Although remission can be better achieved, reactivation of the disease too often occurs upon treatment discontinuation. Better understanding and targeting of chronicity remains a goal to achieve in the future.

http://ift.tt/2ltUWH5

Rape, Other, or No Sexual Perpetration Experience Predicting College Men's Empathy with a Rapist

Violence and Gender , Vol. 0, No. 0.


http://ift.tt/2lXaEYH

An Adult Mouse Thyroid Side Population Cell Line that Exhibits Enriched Epithelial–Mesenchymal Transition

Thyroid , Vol. 0, No. 0.


http://ift.tt/2lUkopy

Application of Trotter Approach for Large Intralingual Thyroglossal Duct Cyst in an 88-year-old

Publication date: Available online 17 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Richard L. Arden, Laura K. Miller
Thyroglossal duct cysts (TDC's) are the most common congenital cyst formations in the neck, typically occurring at midline, infrahyoid positions in younger patients. Traditional management has utilized the Sistrunk procedure to minimize recurrence rates. Reports on elderly patients are sparse, and currently only 14 cases have been reported in patients over 70, and 4 patients over 80 years of age. Detailed herein, we report the oldest known patient with TDC, who possessed a purely intralingual location, requiring a Trotter approach and Sistrunk procedure for symptomatic management.



http://ift.tt/2lX6Y9p

Craniofacial implants at a single centre 2005-2015: retrospective review of 451 implants

Publication date: Available online 16 February 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): R. Elledge, J. Chaggar, N. Knapp, T. Martin, N. White, D. Evriviades, S. Edmondson, S. Parmar
Craniofacial endosseous implants are regularly used to support prostheses in the rehabilitation of complex defects, but reported success rates vary. To review our own clinical practice over 10 years, and particularly to examine the impact of radiotherapy and the timing of placement on the survival of implants, we retrospectively audited the records for all patients who had endosseous implants for prosthetic rehabilitation in our unit between 2005 and 2015. We reviewed 167 records, which gave 451 implants, of which, 222 (49%) were auricular, 98 (22%) nasal, and 131 (29%) orbital. Most were placed after ablative operations for cutaneous malignancy (n=103 patients, 62%). The failure rate of implants placed in bone that was irradiated either before or after placement was significantly higher than that of those placed in non-irradiated bone (univariate analysis: 11% compared with 2%, p<0.001: Kaplan-Meier survival analysis: p<0.001). The timing of placement in relation to radiotherapy (before compared with after) seemed to have no impact on success (p=0.96). Our findings are in keeping with previous reports, and the principal observation is that radiotherapy adversely affects success. We work closely with our maxillofacial prosthetists and place implants at the time of ablation. Our findings seem to support this practice regardless of whether or not the patient will later require adjuvant radiotherapy.



http://ift.tt/2kyhmad

Reconstruction of complex mandibular defects using integrated dental custom-made titanium implants

Publication date: Available online 17 February 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. Rachmiel, D. Shilo, O. Blanc, O. Emodi




http://ift.tt/2kykXFq

Aged rats under zoledronic acid therapy and oral surgery

Aging brings a number of health conditions that can compromise the healing process in elderly individuals, significantly when it comes to bone tissue. The aim of the present study was to analyze the effects of zoledronic acid (ZL) therapy on socket healing of aged male rats.

http://ift.tt/2ltwEwD

Classical versus custom orbital wall reconstruction: Selected factors regarding surgery and hospitalization

Nowadays, in orbital wall reconstruction, maxillofacial surgeons have the possibility to treat patients in modern ways such as with individual implants. Nevertheless, conventional treatment including standard titanium mesh shaped during the surgical procedure is also widely used. The aim of this study was to compare the above methods of orbital wall reconstructions.

http://ift.tt/2m61OHm

Influence of TGF-β1 on tumor transition in oral cancer cell and BMSC co-cultures

TGF-β1 signaling modulates epithelial mesenchymal transitions (EMT) of head and neck squamous cell carcinoma (HNSCC). Bone marrow mesenchymal stromal cells (BMSC) are able to exert a regulating influence on the expression of markers of EMT in HNSCC cells. It was thus the aim of this study to test the hypothesis that TGF-β1 modulates the interactions of tumor transition between BMSCs and HNSCC, affecting the expression of E-cadherin, Vimentin, Snail, Twist, MMP14 and beta-catenin. Furthermore, we analyzed alterations in the AKT-signaling of tumor and stroma cells.

http://ift.tt/2ltp1GR

Computer assisted positioning of the proximal segment after sagittal split osteotomy of the mandible: preclinical investigation of a novel electromagnetic navigation system

Modifications of the temporomandibular joint position after mandible osteotomy are reluctantly accepted in orthognathic surgery. To tackle this problem, we developed a new navigation system using miniaturized electromagnetic sensors. Our imageless navigation approach is therefore optimized to avoid complications of previously proposed optical approaches such as the interference with established surgical procedures and the line of sight problem.

http://ift.tt/2m61NDi

Absence of Chromosomal Translocations and Protein Expression of ALK in Sinonasal Adenocarcinomas

Publication date: January–February 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 1
Author(s): Esteban Pacheco, José Luis Llorente, Alejandro López-Hernández, Cristina García-Inclán, María Costales, Sira Potes Ares, Fernando López, Blanca Vivanco, Mario A. Hermsen
IntroductionChromosomal translocations at 2p23 cause overexpression of anaplastic lymphoma kinase (ALK), a receptor tyrosine kinase involved in signalling pathways that regulate cell proliferation. This translocation occurs in 5% of lung adenocarcinoma and has been demonstrated to be useful as a therapeutic target for crizotinib. Sinonasal adenocarcinomas (SNAC) are histologically similar to lung adenocarcinomas; the aim of this study was to evaluate the presence of ALK alterations in SNAC.MethodBreak-apart fluorescent in situ hybridisation was used to analyse the presence of ALK translocations in 96 tumour samples. In addition, ALK protein expression was studied by immunohistochemistry.ResultsThe samples of SNAC did not show ALK translocation. Moreover, ALK protein expression was absent in all cases.ConclusionsThese results suggest that ALK is not involved in SNAC.



http://ift.tt/2lWBKPB

Swallowing Disorders in Parkinson's Disease

Publication date: January–February 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 1
Author(s): Sandra Mamolar Andrés, María Liliana Santamarina Rabanal, Carla María Granda Membiela, María José Fernández Gutiérrez, Paloma Sirgo Rodríguez, César Álvarez Marcos
IntroductionParkinson's disease is a type of chronic neurodegenerative pathology with a typical movement pattern, as well as different, less studied symptoms such as dysphagia. Disease-related disorders in efficacy or safety in the process of swallowing usually lead to malnutrition, dehydration or pneumonias.The aim of this study was identifying and analyzing swallowing disorders in Parkinson's disease.Subjects and methodsThe initial sample consisted of 52 subjects with Parkinson's disease to whom the specific test for dysphagia SDQ was applied. Nineteen participants (36.5%) with some degree of dysphagia in the SDQ test were selected to be evaluated by volume-viscosity clinical exploration method and fibreoptic endoscopic evaluation of swallowing.ResultsDisorders in swallowing efficiency and safety were detected in 94.7% of the selected sample. With regards to efficiency, disorders were found in food transport (89.5%), insufficient labial closing (68.4%) and oral residues (47.4%), relating to duration of ingestion. Alterations in security were also observed: pharynx residues (52.7%), coughing (47.4%), penetration (31.64%), aspiration and decrease of SaO2 (5.3%), relating to the diagnosis of respiratory pathology in the previous year.ConclusionThe SDQ test detected swallowing disorders in 36.5% of the subjects with Parkinson's disease. Disorders in swallowing efficiency and safety were demonstrated in 94.7% of this subset. Disorders of efficiency were more frequent than those of safety, establishing a relationship with greater time in ingestion and the appearance of respiratory pathology and pneumonias.



http://ift.tt/2lt0mSF

Malignant External Otitis in Spain

Publication date: January–February 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 1
Author(s): Antonio Guerrero-Espejo, Inmaculada Valenciano-Moreno, Rafael Ramírez-Llorens, Palmira Pérez-Monteagudo
IntroductionMalignant external otitis is a necrotising infection, which extends from the squamous epithelium of the ear canal to the adjacent tissue.The objective of the study was to investigate its incidence and other epidemiological data in Spain, reporting the largest case series to date.MethodsA descriptive, retrospective study of the Spanish population was carried out using the minimum basic data set (MBDS) based on data of patients admitted to hospitals in the 2008–2013 period. Patients whose diagnosis (principal or secondary) at discharge was encoded as 380.14 (malignant external otitis), according to ICD-9-CM, were included as cases. The Spanish incidence rate was calculated for all its communities and provinces, as well as by season and mortality.ResultsA total of 355 patients (302 as principal diagnosis and 53 as secondary) were diagnosed. The incidence rate was 1.30 (95% CI, 1.17–1.44) per 106 inhabitants and year, although there were variations among geographical areas. The median age of cases with main diagnosis was 74 years (range 10–95 years). The predominant age group was in patients over 84 years old (19.3 cases per 10⁶ inhabitants and year). The incidence was higher in men and the male–female relative risk was 2.4. Diabetes was present in 74.6% of patients. The diagnosis was predominant in the last quarter of the year. The gross in-hospital mortality rate was 3.7%.ConclusionsMalignant external otitis is seen mostly among male elderly and diabetic patients. The incidence and mortality rate are low in Spain.



http://ift.tt/2kHmeFs

Indications and Radiological Findings of Acute Otitis Media and Its Complications

Publication date: January–February 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 1
Author(s): Elena Pont, Miguel Mazón
Most cases of acute otitis media resolve with antibiotics and imaging is not required. When treatment fails or a complication is suspected, imaging plays a crucial role. Since the introduction of antibiotic treatment, the complication rate has decreased dramatically. Nevertheless, given the critical clinical relevance of complications, the importance of early diagnosis is vital.Our objective was to review the clinical and radiological features of acute otitis media and its complications. They were classified based on their location, as intratemporal or intracranial.Imaging makes it possible to diagnose the complications of acute otitis media and to institute appropriate treatment. Computed tomography is the initial technique of choice and, in most cases, the ultimate. Magnetic resonance is useful for evaluating the inner ear and when accurate evaluation of disease extent or better characterisation of intracranial complications is required.



http://ift.tt/2lsgh3i

Laryngotracheal Stenosis of Autoimmune Aetiology

Publication date: January–February 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 1
Author(s): Maria Dablanca, Ana Maeso, Desiree del C. Méndez, Primitivo Ortega
Autoimmune origin ranks fifth in the etiologic classification of laryngotracheal stenosis. Wegener's disease is the autoimmune illness most associated with stenosis; however, there are other autoimmune diseases that may also be associated with it.A descriptive, retrospective study of 9 cases of laryngotracheal stenosis associated with autoimmune disease was carried out. There were 9 patients (8 females and 1 male) with an average age of 27.9 years. Four of the patients suffered from Wegener's disease, 1 from ulcerative colitis, and 1 from purple vasculitis. The other 3 patients only had positive c-ANA. Endoscopic treatment was performed in 3 cases. The other 6 patients required open surgery. Respiratory results were acceptable. Based on our study, we feel that the immunological profiles should be studied in all patients with stenosis, given that not only Wegener's disease is linked to stenosis.



http://ift.tt/2lWvdEp

Revision Endoscopic Sinonasal Surgery

Publication date: January–February 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 1
Author(s): Pablo Cantillano, Fabián Rubio, Alfredo Naser, Rodolfo Nazar
Introduction and objectivesEndoscopic sinonasal surgery is the procedure of choice in the treatment of chronic rhinosinusitis and sinonasal polyposis refractory to medical treatment, with high rates of success (76%–97.5%). However, 2.5%–24% of those patients will require revision surgery (RESS). In this study, we present the clinical, anatomical, radiological and histological features of patients receiving RESS in our centre during a 3-year period.MethodsA retrospective review of clinical, anatomical, radiological and histopathological data of patients receiving revision endoscopic sinonasal surgery between 2012 and 2014 was carried out.ResultsFrom 299 surgery procedures performed, 27 (9%) were revision surgeries. The mean patient age was 46 years, with a male/female ratio of 1.4/1. The most frequent preoperative and postoperative diagnosis was chronic polypoid rhinosinusitis. The mean time since the previous surgery was 6.1 years, with 11.9 months of mean follow-up since that surgery. Stenotic antrostomy was found during revision in 81.5% of the patients and incomplete anterior ethmoidectomy and persistent uncinate process, in 59.3%. In radiology, 70.4% of patients had persistent anterior ethmoidal cells. Antrostomy or widening of antrostomy was performed in 96.3% of cases and anterior ethmoidectomy or completion of it was performed in 66.7%.ConclusionsPolyps, stenotic antrostomy and incomplete ethmoidectomy were the most frequent causes of revision surgery, in concordance with the procedures performed. The patients had long periods of time without follow-up between surgeries. Further investigation is necessary to generate measures to reduce the number of revision surgeries.



http://ift.tt/2lsK0Jw

Aetiological Diagnosis of Child Deafness: CODEPEH Recommendations

Publication date: January–February 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 1
Author(s): Faustino Núñez-Batalla, Carmen Jáudenes-Casaubón, Jose Miguel Sequí-Canet, Ana Vivanco-Allende, Jose Zubicaray-Ugarteche, Rubén Cabanillas-Farpón
Important progress in the fields of molecular genetics (principally) and diagnostic imaging, together with the lack of a consensus protocol for guiding the diagnostic process after confirming deafness by neonatal screening, have led to this new work document drafted by the Spanish Commission for the Early Detection of Child Deafness (Spanish acronym: CODEPEH). This 2015 Recommendations Document, which is based on the most recent scientific evidence, provides guidance to professionals to support them in making decisions regarding aetiological diagnosis. Such diagnosis should be performed without delay and without impeding early intervention. Early identification of the causes of deafness offers many advantages: it prevents unnecessary trouble for the families, reduces health system expenses caused by performing different tests, and provides prognostic information that may guide therapeutic actions.



http://ift.tt/2lWwueT

IgG4 Orbital Inflammatory Pseudotumor Associated to Unilateral Ethmoid and Maxillary Sinus Aplasia

Publication date: January–February 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 1
Author(s): María Costales, Fernando López, Andrés Coca, José Luis Llorente




http://ift.tt/2lt3AFx

Granular Cell Tumour in the Masseter Muscle

Publication date: January–February 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 1
Author(s): María Martel-Martín, David Virós-Porcuna, Rosa D. Ramirez-Ruiz, Irene Moysset-Agusti




http://ift.tt/2lWwITk

Intraoperative Finding of Non-recurrent Inferior Laryngeal Nerve During Papillary Thyroid Carcinoma Surgery

Publication date: January–February 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 1
Author(s): Antonio Prat-Calero, Pedro Cascales-Sánchez, Agustina Martínez-Moreno




http://ift.tt/2lfQzNh

Aneurysm of the Internal Jugular Vein

Publication date: January–February 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 1
Author(s): Mariel S. Riedemann Wistuba, Amer A. Zanabili Al-Sibbai, Lino Camblor Santervás




http://ift.tt/2lsJZoW

Is the Nasal Airway the Main Mode of Transmission for Pharyngeal Tuberculosis?

Publication date: January–February 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 1
Author(s): Esteban Vergara-de la Rosa, José Galvez-Olortegui, Tomas Galvez-Olortegui, Luis Concepcion-Urteaga




http://ift.tt/2lWw08n

Response to: Is the Nasal Airway the Main Mode of Transmission for Pharyngeal Tuberculosis?

Publication date: January–February 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 1
Author(s): Hind Temsamani




http://ift.tt/2lsNJqO

Reconstruction of complex mandibular defects using integrated dental custom-made titanium implants

Reconstruction of the craniofacial complex is challenging because of the unique anatomy, the presence of vital structures, and the diversity of defects. In craniofacial reconstruction, restoration of appearance and function is the primary goal. Autografts are the gold standard treatment,1 but they have several disadvantages, which has led to research into alloplastic materials. The development of CADCAM systems allows for precise preoperative planning and design of patient-specific implants.2,3 The workflow of custom-made implants is shown in Fig.

http://ift.tt/2kHtLnK

Vehicle type affects filling of fractional laser-ablated channels imaged by optical coherence tomography

Abstract

Ablative fractional laser (AFXL) is an emerging method that enhances topical drug delivery. Penetrating the skin in microscopic, vertical channels, termed microscopic treatment zones (MTZs), the fractional technique circumvents the skin barrier and allows increased uptake of topically applied drugs. This study aims to elucidate the impact of vehicle type on the filling of MTZs from application of liquid, gel, and cream vehicles. Ex vivo pig skin was exposed to 10,600 nm fractional CO₂ laser at 5% density, 120 μm beam diameter, and fluences of 40 and 80 mJ/microbeam (mJ/mb). Six repetitions were performed for each of six interventions (2 fluences and 3 vehicle types, n = 36). MTZ dimensions and filling by vehicle type were evaluated by optical coherence tomography, using blue tissue dye as a contrast-enhancing agent. Outcome measure was degree of MTZ filling assessed as percentages of empty, partially filled, and completely filled MTZs (108–127 MTZs/intervention analyzed) and evaluated statistically using Kruskal-Wallis and Dunn's tests. MTZs reached mid-dermal levels of 225 μm (40 mJ/mb) and 375 μm (80 mJ/mb) penetration depths (p < 0.0001). Filling of MTZs depended on type of applied vehicle. At 80 mJ/mb, liquid (67% completely filled, p < 0.01) and gel (60%, p < 0.05) formulations filled MTZs significantly better than cream formulation (31%). At 40 mJ/mb, liquid and gel formulations filled 90% (p < 0.05) and 77% (p > 0.05) of MTZs completely versus 55% for cream formulation. Thus, filling was overall greater for more superficial MTZs. In conclusion, vehicle type affects filling of MTZs, which may be of importance for AFXL-assisted drug delivery.

http://ift.tt/2l2EdcM

Surveying the Literature: Synopsis of Recent Key Publications.

No abstract available

http://ift.tt/2kxCvkR

In Response: Definitions of Emergency, Urgent, and Elective (Scheduled) Surgery.

No abstract available

http://ift.tt/2kHaO4B

Pitfalls From Physics: Why We Can't "Feel" the Tube Cuff Pressure With Our Fingers.

No abstract available

http://ift.tt/2kxx4CB

Neuromuscular Blocking Agents During Electroconvulsive Therapy: Was the Crossover Design Appropriate and Valid?.

No abstract available

http://ift.tt/2kHaSkx

Neurotoxicity of Anesthetic Drugs on Developing Brain.

No abstract available

http://ift.tt/2kxKX3y

In Response.

No abstract available

http://ift.tt/2kHaHpH

Rationalizing Orthopedic (and Anesthesiology) Weekend Coverage.

No abstract available

http://ift.tt/2kxEdmw

In Response: Effective Doses of Neuromuscular Blockers During Electroconvulsive Therapy and the Effect of ECT Parameters.

No abstract available

http://ift.tt/2kxzh0S

A Guide to Networking for Introverts: From Ice Breaking to Deal Making.

No abstract available

http://ift.tt/2kGYbq7

Building Big Datasets: Do Not Forget the EMR.

No abstract available

http://ift.tt/2kxP1B1

Drug Infusion Systems: Technologies, Performance, and Pitfalls.

This review aims to broadly describe drug infusion technologies and raise subtle but important issues arising from infusion therapy that can potentially lead to patient instability and morbidity. Advantages and disadvantages of gravity-dependent drug infusion are described and compared with electromechanical approaches for precise control of medication infusion, including large-volume peristaltic and syringe pumps. This review discusses how drugs and inert carriers interact within infusion systems and outlines several complexities and potential sources of drug error. Major topics are (1) the importance of the infusion system dead volume; (2) the quantities of coadministered fluid and the concept of microinfusion; and (3) future directions for drug infusion. The infusion system dead volume resides between the point where drug and inert carrier streams meet and the patient's blood. The dead volume is an often forgotten reservoir of drugs, especially when infusion flows slow or stop. Even with medications and carriers flowing, some mass of drug always resides within the dead volume. This reservoir of drug can be accidentally delivered into patients. When dose rate is changed, there can be a significant lag between intended and actual drug delivery. When a drug infusion is discontinued, drug delivery continues until the dead volume is fully cleared of residual drug by the carrier. When multiple drug infusions flow together, a change in any drug flow rate transiently affects the rate of delivery of all the others. For all of these reasons, the use of drug infusion systems with smaller dead volumes may be advantageous. For critically ill patients requiring multiple infusions, the obligate amount of administered fluid can contribute to volume overload. Recognition of the risk of overload has given rise to microinfusion strategies wherein drug solutions are highly concentrated and infused at low rates. However, potential risks associated with the dead volume may be magnified with microinfusion. All of these potential sources for adverse events relating to the infusion system dead volume illustrate the need for continuing education of clinical personnel in the complexities of drug delivery by infusion. This review concludes with an outline of future technologies for managing drug delivery by continuous infusion. Automated systems based on physiologic signals and smart systems based on physical principles and an understanding of dead volume may mitigate against adverse patient events and clinical errors in the complex process of drug delivery by infusion. (C) 2017 International Anesthesia Research Society

http://ift.tt/2kHbyq4

The Anatomical Foundations of Regional Anesthesia and Acute Pain Medicine: Macroanatomy, Microanatomy, Sonoanatomy, Functional Anatomy.

No abstract available

http://ift.tt/2kxH26T

Infective endocarditis causing mitral valve stenosis – a rare but deadly complication: a case report

Infective endocarditis rarely causes mitral valve stenosis. When present, it has the potential to cause severe hemodynamic decompensation and death. There are only 15 reported cases in the literature of mitral...

http://ift.tt/2kGOlVe

Renal replacement therapy in critical care

<span class="paragraphSection">1B2C043C00</span>

http://ift.tt/2kGjEzv

Current recommendations on adult resuscitation

<span class="paragraphSection">1B041I022CO4</span>

http://ift.tt/2lrhMP2

The future of general anaesthesia in obstetrics

<span class="paragraphSection">1A022A092B023B00</span>

http://ift.tt/2kGqa9n

Perioperative management of patients with dementia

<span class="paragraphSection">1A022A033100</span>

http://ift.tt/2lrcTWa

Ketamine: an old drug revitalized in pain medicine

<span class="paragraphSection">1A022E012E023E00</span>

http://ift.tt/2kGjg3Z

Antinociceptive and immunosuppressive effect of opioids in an acute postoperative setting: an evidence-based review

<span class="paragraphSection">1A021D022E013E00</span>

http://ift.tt/2lrv3ab

In liver metastases from small intestinal neuroendocrine tumors, SSTR2A expression is heterogeneous

Abstract

We examined somatostatin receptor type 2A (SSTR2A) expression in primary and metastatic small intestinal neuroendocrine tumors (SI-NETs). We retrieved 156 liver metastases from 26 patients (10 males, 16 females) who had two or more liver lesions resected. A representative formalin-fixed paraffin-embedded section of tumor tissue from each liver metastasis and from the primary tumor, when available, were immunohistochemically stained for SSTR2A. SSTR2A expression was evaluated by the Her2/neu-scoring system and the scoring system proposed by Volante et al. Based on the Her2/neu-scoring system, moderate to strong SSTR2A expression was observed in 121 of 156 (78%) liver metastases. In 15 (58%) subjects, all liver metastases showed moderate to strong SSTR2A expression, whereas in 11 (42%) one or more liver tumors had weak or no expression. Of the 16 stained primaries, 11 (69%) showed heterogeneous SSTR2A expression. The corresponding liver metastases showed only weak to no expression in one, moderate to strong in five, and both weak to no and moderate to strong expression in five of the 11 cases. Using the Volante scoring system, no tumor was scored 0 (0%), two were scored 1 (1%), 38 were scored 2 (24%), and 116 were scored 3 (74%). No statistically significant association was observed between SSTR2A expression and Ki67 index (p = 0.56). Fifteen of 18 (83%) metastatic tumors with a Ki67 index >20% showed moderate to strong SSTR2A. Most liver tumors with weak SSTR2A expression or an IHC score of 2 were detected by OctreoScan. SSTR2A expression in liver metastases of SI-NETs can be variable, even between lesions in the same patient. Expression in metastatic lesions is not always similar to that in the primary tumor. SSTR2A expression is not associated with the Ki67 index.

http://ift.tt/2lrwnu3

Case of gluteal haematoma in the setting of dual antiplatelet overlapping with tumoural calcinosis of the hip

Description

A woman aged 40 years with medical history of end-stage renal disease (ESRD) on haemodialysis. Eight months earlier to this presentation, she underwent coronary angioplasty with two drug-eluting stents due to myocardial infarction. She had been on aspirin and ticagrelor since that time. She presented to the emergency department with severe sudden-onset left hip pain. She did not recall any trauma or any precipitating factors. She had severe tenderness around her left hip joint with marked decreased range of movement. There was no visible ecchymosis or bruises on examination.

The left hip joint X-ray (figure 1) showed calcified mass overlying the posterior and lateral aspects of the left greater trochanter consistent with tumoural calcinosis. Besides tumoural calcinosis within the left greater trochanteric bursa, MRI of the left hip joint also showed large left gluteal haematoma 16x9x5.6 cm with diffuse oedematous changes involving gluteal musculature (

http://ift.tt/2l1JWPV

Rare case of pyoderma gangrenosum originating in the spleen

Description

A 51-year-old woman with a moderately controlled type 2 diabetes and previous diagnosis of pyoderma gangrenosum (PG) of the neck presented with acute fever, left upper quadrant pain and isolated splenomegaly. Abdominal contrast-enhanced CT demonstrated loculated splenic collections with thick enhancing walls (figure 1) suspicious for abscess. Although we considered an infectious abscess in the spleen as a differential diagnosis, blood cultures had no growth. After 1 week of antibiotics, imaging demonstrated enlargement of the splenic lesions. Open splenectomy was performed because antibiotics did not show an effect and there was a concern for splenic rupture. The splenic abscesses (figure 2) contained large numbers of inflammatory cells, mainly neutrophils.

Figure 1

Abdominal contrast-enhanced CT demonstrated loculated splenic collections with thick enhancing walls (figure 1) suspicious for abscess.

Figure 2

Pathology findings in the spleen showing splenic...

http://ift.tt/2m3qy2I

Self-Optical Coherence Tomography and Angiography

Purpose: To present a new concept of self-optical coherence tomography (OCT) and self-OCT angiography. Methods: The operator sits in the patient seat and manipulates the instrument body via the joystick with the dominant hand, while the dominant index is ready to press the capture button and while focusing on the fixation target. One senior ophthalmologist judged various OCT machines for ease of self-scan during a major ophthalmic convention. Separately, self-scans were also captured using a single OCT machine by one senior ophthalmologist and 5 junior optometrists and the scans were analyzed for both centration and image quality value (IQV), and compared to regular scans done by an operator. Results: Ten available OCT machines were tested for their ability to allow self-OCT. Machines that had one or more features of auto-alignment, auto-focus, and auto-shoot were ideal for self-OCT or self-OCT angiography. Self-scans done by the ophthalmologist (total 27 scans of right eye, mean IQV = 32.6, and 24 left eyes, mean IQV = 37.3, done over 9 months) and 5 optometrists (total 24 scans, mean 34.8 done in one session) were comparable to scans (total 11, mean IQV = 38.1) done by an operator for image quality. Decentration was very common in self-scans of the macula (37% right eye and 46% left eye) versus 0% for scans of the right eye done by an operator. Conclusions: Self-OCT scans of the macular region can be done with good image quality but are often decentered. Advantages include privacy, potential use by ophthalmic health professionals, airspace station officers, and possible future home self-imaging of macula.
Case Rep Ophthalmol 2017;8:108–115

http://ift.tt/2lqcVOy

Choroidal Nevus-Associated Neovascular Membrane Demonstrated by OCT Angiography

We present a case of choroidal nevus, complicated by a choroidal neovascular membrane (CNV) that was detected by OCT angiography. Choroidal nevi are relatively common intraocular tumors. The presence of subretinal and intraretinal fluids can indicate that a CNV has occurred as a complication, warranting prompt management. However, subretinal and intraretinal fluids are also documented in nevi without CNV. OCT angiography may be of great help in determining whether those fluids are associated or not with a CNV, therefore guiding therapy.
Case Rep Ophthalmol 2017;8:104–107

http://ift.tt/2lV430V

Differential morphological and functional features of fibroblasts explanted from Solar Lentigo

Upon ageing, chronic exposure to ultraviolet radiations and pollution induces benign hyper-pigmented lesions, such as Solar Lentigo maculae (SL) ¹. Well-defined histologically, SL is distinguishable from other hyper-pigmented diseases and can be classified relative to its evolution ^2-4. Differential gene-profiling analyses comparing SL and normal skin biopsies revealed that SL tissues are mainly composed of epidermal activated melanocytes as well as hypo-proliferating and hypo-differentiated keratinocytes with a background of chronic inflammation. In absence of fibroblast markers, immuno-staining analyses for several growth factors and secreted proteins in the upper dermis of SL biopsies strongly suggest that dermal fibroblasts contribute functionally to dysregulation of epidermal cells ⁵. These observations are strengthened by recent studies using a pigmented reconstructed skin model that demonstrates the influence of dermal fibroblasts on skin pigmentation ⁶. However, data on the morphological and functional features of the SL primary fibroblasts that could explain their role in SL disease are not available.

This article is protected by copyright. All rights reserved.

http://ift.tt/2m2p6xO

JAMA Otolaryngology-Head & Neck Surgery.

Related Articles

JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngol Head Neck Surg. 2017 Feb 01;143(2):108

Authors:

PMID: 28208184 [PubMed - in process]

http://ift.tt/2kFqiWA

Omission in Authorship.

Related Articles

Omission in Authorship.

JAMA Otolaryngol Head Neck Surg. 2017 Feb 01;143(2):196

Authors: Sterling M, Mudd P

PMID: 28208183 [PubMed - in process]

http://ift.tt/2kFqhlu

Highlights.

Related Articles

Highlights.

JAMA Otolaryngol Head Neck Surg. 2017 Feb 01;143(2):107

Authors:

PMID: 28208182 [PubMed - in process]

http://ift.tt/2kFzZEq

Author Missing From Byline.

Related Articles

Author Missing From Byline.

JAMA Otolaryngol Head Neck Surg. 2017 Feb 01;143(2):196

Authors:

PMID: 28208181 [PubMed - in process]

http://ift.tt/2kFwHB9

Lingual Tonsillectomy for Treatment of Pediatric Obstructive Sleep Apnea: A Meta-analysis.

Related Articles

Lingual Tonsillectomy for Treatment of Pediatric Obstructive Sleep Apnea: A Meta-analysis.

JAMA Otolaryngol Head Neck Surg. 2017 Feb 16;:

Authors: Kang KT, Koltai PJ, Lee CH, Lin MT, Hsu WC

Abstract
Importance: Evidence indicates correlations between lingual tonsil hypertrophy and pediatric obstructive sleep apnea (OSA). However, to our knowledge, a meta-analysis of surgical outcomes for lingual tonsillectomy in children with OSA has not been conducted.
Objective: To evaluate the therapeutic outcomes of lingual tonsillectomy for treatment of pediatric OSA.
Data Sources: The study protocol was registered on PROSPERO (CRD42015027053). PubMed, MEDLINE, EMBASE, and the Cochrane Reviews databases were searched independently by 2 authors for relevant articles published by September 2016.
Study Selection: The literature search identified English-language studies that used polysomnography to evaluate children with lingual tonsil hypertrophy and OSA after lingual tonsillectomy alone. The search keywords were lingual tonsil, lingual tonsillectomy, sleep endoscopy, sleep apnea, and child.
Data Extraction and Synthesis: Polysomnographic data from each study were extracted. A random-effects model pooled postoperative sleep variable changes and success rates for lingual tonsillectomy in treating pediatric OSA.
Main Outcomes and Measures: Four outcomes for lingual tonsillectomy were analyzed. These included net postoperative changes in the apnea-hypopnea index (AHI), net postoperative changes in the minimum oxygen saturation, the overall success rate for a postoperative AHI less than 1, and the overall success rate for a postoperative AHI less than 5.
Results: This meta-analysis consisted of 4 studies (mean sample size, 18.25 patients), with a total of 73 unique patients (mean [SD] age, 8.3 [1.1] years). Fifty-nine percent (27 of 46) of the patients were male, and 1 of the 4 studies did not specify number of males. Lingual tonsillectomy was indicated for persistent OSA after adenotonsillectomy in all cases. Lingual tonsil hypertrophy was evaluated using computed tomography or magnetic resonance imaging in 1 study, sleep endoscopy in 2 studies, and cine magnetic resonance imaging in 1 study. The mean change in the AHI after lingual tonsillectomy was a reduction of 8.9 (95% CI, -12.6 to -5.2) events per hour. The mean change in the minimum oxygen saturation after lingual tonsillectomy was an increase of 6.0% (95% CI, 2.7%-9.2%). The overall success rate was 17% (95% CI, 7%-35%) for a postoperative AHI less than 1 and 51% (95% CI, 25%-76%) for a postoperative AHI less than 5. Postoperative complications that developed included airway obstruction, bleeding, and pneumonia.
Conclusions and Relevance: Lingual tonsillectomy is an effective surgical management for children with OSA caused by lingual tonsil hypertrophy, and it achieves significant improvement in the AHI and the minimum oxygen saturation. However, children frequently have residual OSA after lingual tonsillectomy, and postoperative complications must be carefully managed.

PMID: 28208178 [PubMed - as supplied by publisher]

http://ift.tt/2l00bNE

Feasibility and Associated Limitations of Office-Based Laryngeal Surgery Using Carbon Dioxide Lasers.

Related Articles

Feasibility and Associated Limitations of Office-Based Laryngeal Surgery Using Carbon Dioxide Lasers.

JAMA Otolaryngol Head Neck Surg. 2017 Feb 16;:

Authors: Hu HC, Lin SY, Hung YT, Chang SY

Abstract
Importance: There are few reports evaluating awake, office-based carbon dioxide (CO2) laser surgery for laryngeal lesions. To date, this study was the largest reported case series of office-based laryngeal surgery by fiber delivery CO2 laser. Office-based laryngeal surgical procedures have become increasingly popular. Technical problems and treatment outcomes associated with the use of a CO2 laser for office-based laryngeal surgery have yet to be fully addressed.
Objectives: To discuss a single institution's clinical experience with office-based CO2 laser laryngeal surgery and the feasibility and limitations associated with this procedure.
Design, Setting, and Participants: This retrospective study evaluated 49 laryngeal surgical procedures performed using a CO2 laser in 40 consecutive adult patients at a single institution in Taiwan from July 1, 2014, through September 30, 2015. Laryngeal lesions treated included vocal fold leukoplakia (n = 13), benign vocal fold lesions (n = 10), Reinke edema (n = 4), recurrent respiratory papillomatosis (n = 6), and lesions outside the vocal folds (n = 7).
Interventions: Office-based laryngeal surgery performed using a CO2 laser under topical anesthesia.
Main Outcomes and Measures: Videolaryngoscopy was performed on all patients at each follow-up point. Among patients with benign vocal lesions and Reinke edema, videolaryngostroboscopy, voice laboratory measurements, perceptual measurements of vocal quality, and subjective evaluations were conducted before and after surgery.
Results: Among the 40 patients included in this study (28 men [70%] and 12 women [30%]; median [range] age, 56 [29-83] years), median follow-up time was 6.5 months (range, 1-21 months). Among the 49 procedures, 2 (4%) could not be tolerated by patients owing to severe gag reflex and laryngeal hypersensitivity, 6 (12%) could not completely evaporate lesions owing to an inadequate surgical field or laryngeal instability, and 1 (2%) led to a complication (ie, mild vocal fold wound stiffness). In addition, 2 patients with premalignant vocal fold leukoplakia showed lesion recurrence in the subglottic area. Among patients with benign vocal lesions and Reinke edema, postoperative phonatory function showed large improvements in jitter (effect size, 0.61; median difference, -0.98%; 95% CI, -1.57% to -0.11%), noise to harmonic ratio (effect size, 0.63; median difference, -0.02; 95% CI, -0.07 to -0.01), maximal phonation time (effect size, 0.61; median difference, 3.6 seconds; 95% CI, 1.9 to 8.8 seconds), and Voice Handicap Index-10 score (effect size, 0.60; median difference, -7; 95% CI, -12 to -2).
Conclusions and Relevance: Office-based laryngeal surgery performed using a CO2 laser was shown to be a feasible treatment option for various types of vocal lesions. However, patients should not undergo this procedure if they have multiple bulky lesions or lesions involving the subglottic area, the laryngeal ventricle, or (in cases of inadequate laryngeal stability) the free edge of a vocal fold.

PMID: 28208177 [PubMed - as supplied by publisher]

http://ift.tt/2kFDb2T

Strategies for Targeted Therapy in Head and Neck Squamous Cell Carcinoma Using WEE1 Inhibitor AZD1775.

Related Articles

Strategies for Targeted Therapy in Head and Neck Squamous Cell Carcinoma Using WEE1 Inhibitor AZD1775.

JAMA Otolaryngol Head Neck Surg. 2017 Feb 16;:

Authors: Kao M, Green C, Sidorova J, Méndez E

PMID: 28208168 [PubMed - as supplied by publisher]

http://ift.tt/2kQFDod

Recurrent Unilateral Swelling of the Parotid Gland.

Related Articles

Recurrent Unilateral Swelling of the Parotid Gland.

JAMA Otolaryngol Head Neck Surg. 2017 Feb 16;:

Authors: Haidar YM, Tjoa T, Goddard JA

PMID: 28208165 [PubMed - as supplied by publisher]

http://ift.tt/2l01U5m

Use of the Carbon Dioxide Laser as an Office-Based Surgical Tool: An Old Dog Can Do a New(ish) Trick.

Related Articles

Use of the Carbon Dioxide Laser as an Office-Based Surgical Tool: An Old Dog Can Do a New(ish) Trick.

JAMA Otolaryngol Head Neck Surg. 2017 Feb 16;:

Authors: Parker NP

PMID: 28208164 [PubMed - as supplied by publisher]

http://ift.tt/2kFBaE6

Risk of malignancy in psoriatic patients: Our clinical experience

http://ift.tt/2l0mhzu

Painful nipple hyperkeratosis secondary to vemurafenib

Abstract

Vemurafenib is a selected BRAF kinase inhibitor approved for treating metastatic or unresectable melanoma, which has numerous cutaneous side effects unfortunately, including three previously reported cases of asymptomatic areola and/or nipple hyperkeratosis. We present the first case of painful bilateral nipple hyperkeratosis secondary to vemurafenib in an 84-year-old woman. She was successfully treated with tretinoin 0.05% cream that allowed her to comfortably continue treatment. With increased awareness of this condition, we found a second case of asymptomatic nipple hyperkeratosis secondary to vemurafenib in our clinic. As this medication gains acceptance for treatment of metastatic melanoma, it is imperative that dermatologists are aware of this potentially uncomfortable side effect that can result in decreased compliance and impaired quality of life.

http://ift.tt/2m29SIU

Coronary blood flow and psoriasis

http://ift.tt/2l0tPlX

Treatment of Darier's disease with diclofenac sodium 3% gel

http://ift.tt/2m2f934

Point-of-care testing for coagulation function: CoaguChek ® XS System versus standard laboratory testing in pediatric patients with normal and abnormal coagulation function

Abstract

Purpose

Intraoperative abnormalities of coagulation function may occur for various reasons. In most scenarios, treatment is directed by laboratory parameters. Unfortunately, standard laboratory testing may take 1–2 h. The purpose of the current study was to evaluate a point-of-care testing device (CoaguChek^® XS System) in pediatric patients.

Methods

Patients ranging in age from 2 to 18 years, undergoing posterior spinal fusion (PSF) or cardiac surgery using cardiopulmonary bypass (CPB) were eligible for inclusion. After CPB and/or the surgical procedure, 2.8 ml of blood was obtained and simultaneously tested on both the standard laboratory apparatus and the CoaguChek^® XS System.

Results

The study cohort consisted of 100 patients (50 PSF and 50 cardiac cases) with 13 cases excluded, leaving 87 patients (49 PSF and 38 cardiac cases) for analysis. In PSF cases, reference laboratory international normalized ratio (INR) ranged from 0.98 to 1.77 while CoaguChek^® XS INR ranged from 1.0 to 1.3. The correlation coefficient was 0.69. The results of the Bland–Altman analysis showed a bias of 0.09, precision of 0.1, and 95% limits of agreement ranging from −0.11 to 0.28. In cardiac cases, reference INR ranged from 1.68 to 14.19, while CoaguChek^® XS INR ranged from 1.4 to 7.9. The correlation coefficient was 0.35. The results of the Bland–Altman analysis showed a bias of −1.8, precision of 2.1, and 95% limits of agreement ranging from −6.0 to 2.4.

Conclusions

INR values obtained from CoaguChek^® XS showed a moderate correlation with reference laboratory values within the normal range. However, in the presence of coagulopathy, the discrepancy was significantly greater, thereby making the CoaguChek^® XS clinically unreliable.

http://ift.tt/2lpM7Om

Group 2 innate lymphoid cell activation in the neonatal lung drives type 2 immunity and allergen sensitization

Publication date: Available online 17 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Catherine A. Steer, Itziar Martinez-Gonzalez, Maryam Ghaedi, Patricia Allinger, Laura Mathä, Fumio Takei

Teaser

Neonatal lung immunity is unique due to allergen-independent endogenous IL-33 mediated activation of group 2 innate lymphoid cells (ILC2s) that promote Th2 cell responses, making neonates prone to allergen sensitization and allergic lung diseases.


http://ift.tt/2kQlvm6

Morpholino-based correction of hypomorphic ZAP70 mutation in an adult with combined immunodeficiency

Publication date: Available online 17 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Christina Gavino, Marija Landekic, Jibin Zeng, Ning Wu, Sungmi Jung, Ming-Chao Zhong, Alexis Cohen-Blanchet, Mélanie Langelier, Odile Neyret, Duncan Lejtenyi, Claudia Rochefort, Judith Cotton-Montpetit, Christine McCusker, Bruce Mazer, André Veillette, Donald C. Vinh

Teaser

An adult with hypomorphic ZAP-70 deficiency due to de novo donor splice site mutation manifested autoimmunity, infections especially with DNA-based viruses and lymphoproliferation. Morpholino interference of mutant splice site increased expression of wild-type protein, significantly improving T cell responses.


http://ift.tt/2kwwu8a

Extracellular eosinophilic traps in association with Staphylococcus aureus at the site of epithelial barrier defects in severe airway inflammation

Publication date: Available online 17 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Elien Gevaert, Nan Zhang, Olga Krysko, Feng Lan, Gabriële Holtappels, Natalie De Ruyck, Hans Nauwynck, Shida Yousefi, Hans-Uwe Simon, Claus Bachert
BackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by a Th2-biased eosinophilic inflammation. Eosinophils have been shown to generate so-called extracellular eosinophilic traps (EETs) under similar pathological conditions.ObjectiveOur aim was to investigate a possible link between EET formation and the presence of Staphylococcus aureus, an organism frequently colonizing the upper airways, at the human mucosal site of the disease.MethodsTissue slides were investigated for the presence of EETs and S. aureus, using immunofluorescent staining and PNA-fish assay respectively. An ex vivo human mucosal disease tissue model was used for artificial infection with S. aureus. Cell markers were analyzed using immunohistochemistry, luminex Multiplex assay, ELISA, PCR, immunobloting and linked to the presence of EETs.ResultsAbout 8.8 ± 4.8 % of the infiltrating eosinophils exhibited EETs in patient's nasal polyp tissues. The formation of EETs was associated with increased IL-5 (p < 0.05) and periostin (p < 0.05) tissue levels, and colonization with S. aureus (p < 0.05). Using an ex vivo human mucosal disease tissue model, EET formation was induced (4.2 ± 0.9 fold) upon exposure to S. aureus, but not to S. epidermidis. Eosinophils were shown to migrate (p < 0.01) towards S. aureus and entrap the bacteria both inside and outside the mucosal tissue. Blocking NAPDH oxidase activity, led to a complete inhibition (p < 0.05) of EET formation by S. aureus.ConclusionEosinophils are likely to be specifically recruited to and form EETs at sites of airway epithelial damage to protect the host from infections with S. aureus and possibly other microorganisms in CRSwNP.

Teaser

Eosinophils in nasal polyp tissue are likely to be recruited to sites of airway epithelial damage to protect the host against S. aureus infections by forming EETs.


http://ift.tt/2kQrjfz

Influence of TGF-β1 on tumor transition in oral cancer cell and BMSC co-cultures

Publication date: Available online 17 February 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): F. Böhrnsen, F. Godek, J. Kiesel, F.J. Kramer, P. Brockmeyer, H. Schliephake
ObjectivesTGF-β1 signaling modulates epithelial mesenchymal transitions (EMT) of head and neck squamous cell carcinoma (HNSCC). Bone marrow mesenchymal stromal cells (BMSC) are able to exert a regulating influence on the expression of markers of EMT in HNSCC cells. It was thus the aim of this study to test the hypothesis that TGF-β1 modulates the interactions of tumor transition between BMSCs and HNSCC, affecting the expression of E-cadherin, Vimentin, Snail, Twist, MMP14 and beta-catenin. Furthermore, we analyzed alterations in the AKT-signaling of tumor and stroma cells.Materials and MethodsBMSCs were isolated from iliac bone marrow aspirates and co-cultured in trans-well permeable membrane wells with tumor cells of the established HNSCC cell line PCI-13. Following the induction with TGF-β1 under serum free conditions the expression of Vimentin and E-Cadherin was assessed via immunofluorescence. A quantitative RT-PCR analysis of tumor transition markers E-cadherin, Vimentin, Snail, Twist, MMP14 and beta-catenin was performed. Changes in AKT-Signaling were identified via protein analysis.ResultsIn non-induced co-cultures, BMSC were able to suppress Vimentin in PCI-13 as a marker of tumor transition. In TGF-β1 induced co-cultures PCI-13 significantly increased the expression of Vimentin, Twist, Snail, MMP14, GSK3a, PRAS40, 4E-BP1, and AMPKa compared to monolayer controls. TGF-β1 co-cultured BMSC demonstrated a significant increase of Snail, PRAS40, mTOR, GSK3a/b, Bad, PDK1 and 4E-BP1.ConclusionsTGF-β1 was able to attenuate the modulating influence of BMSC in co-culture and drive the co-culture towards a progressive tumor transition, affecting the expression of markers of EMT, AKT-Signaling and proliferative checkpoints.



http://ift.tt/2m1driz

Classical versus custom orbital wall reconstruction: Selected factors regarding surgery and hospitalization

Publication date: Available online 17 February 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Rafał Zieliński, Marta Malińska, Marcin Kozakiewicz
PurposeNowadays, in orbital wall reconstruction, maxillofacial surgeons have the possibility to treat patients in modern ways such as with individual implants. Nevertheless, conventional treatment including standard titanium mesh shaped during the surgical procedure is also widely used. The aim of this study was to compare the above methods of orbital wall reconstructions.Materials and MethodsIn the first group (39 cases), patients were treated by means of computer-aided design/computer-aided manufacturing (CAD/CAM) milled individual implants made of ultra−high-molecular-weight polyethylene, dioxide zirconium and rapid prototyping titanium mesh pre-bent on an ABS model made by a three-dimensional (3D) printer. In the second group (54 cases), intraoperative bending of titanium mesh was implemented.ResultsOphthalmologic outcomes were the same in both groups. In patients who had greater destruction of the orbit, surgical procedures were longer regardless of the material used for individual implants (p<0.05). Time of surgery was shorter in patients in whom individual implants were used. Intraoperative bleeding was higher in patients who were treated using intraoperative bending titanium mesh (p<0.01).ConclusionApplication of CAD/CAM techniques do not give better ophthalmologic results in reference center but improve patient condition post-operatively. For this reason, CAD/CAM is a safer treatment method for patients.



http://ift.tt/2kZQWNf

Low-dose rituximab and concurrent adjuvant therapy for pemphigus: Protocol and single-centre long-term review of nine patients

Abstract

Pemphigus is an autoimmune B-cell mediated blistering disease associated with significant morbidity and mortality. Rituximab has proven effective for the treatment of steroid-refractory pemphigus, although there is controversy over the optimum dosing protocol. Additionally, effective disease control often requires long-term immunosuppression, even in disease-free periods. We present a case series of a single-centre long-term follow up of nine patients with pemphigus, treated with two 500-mg doses of rituximab separated by 14 days along with concurrent adjuvant therapy. In all these patients, low-dose rituximab resulted in B-cell depletion, along with a reduction in blistering disease. Three of these patients required repeat dosing cycles due to either relapsed disease or incomplete disease control following the first dosing cycle, and have remained disease free up to 154 weeks thus far. Six patients developed minor infections during the course of their treatment, but no major complications were observed.

http://ift.tt/2m1qr7P

Diffuse scarring alopecia in a female pattern hair loss distribution

Abstract

We describe three cases of hair loss in a female pattern hair loss (FPHL) distribution with histologic features of lichen planopilaris (LPP). All patients had a history of diffuse, gradual hair loss in a Christmas tree pattern that clinically presented as FPHL on gross and dermoscopic examination. Notably, there were no characteristic clinical signs of LPP and no histologic features of FPHL. These cases are most consistent with cicatricial pattern hair loss (CPHL). This relatively new entity is similar to fibrosing alopecia in a pattern distribution (FAPD) in that they are both scarring alopecias confined to a FPHL distribution, but CPHL lacks the clinical signs of perifollicular erythema and perifollicular keratosis seen in FAPD. These three cases may present an early, subtle form of CPHL and will be of interest to clinicians and histopathologists alike.

http://ift.tt/2kZHN7i

Editorial Board

http://ift.tt/2lqomFF

Cover Image

The cover image, by Stefan Mattheis MD et al., is based on the Original Article Flex Robotic System in transoral robotic surgery: The first 40 patients, DOI: 10.1002/hed.24611.

http://ift.tt/2kERy7L

Issue Information - Contents

http://ift.tt/2kEYuSd

Table of Contents

http://ift.tt/2m12mhC

Editorial Board

http://ift.tt/2kZInC3

Left parapharyngeal ectopic goitre associated with eutopic thyroid and postoperative Horner's syndrome

Publication date: Available online 16 February 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): W. Foma, E. Pegbessou, B. Amana, E. Kpemissi
IntroductionThe authors report a case of left parapharyngeal ectopic goitre, in which resection was followed by postoperative Horner's syndrome, and describe the difficult management of this entity.Case reportA 25-year-old woman presented with upper oesophageal dysphagia and a well-demarcated left parapharyngeal mass displacing the great vessels laterally and posteriorly. The mass was resected via an exploratory neck incision. Histological examination of the operative specimen revealed hyperplastic thyroid parenchyma. The postoperative work-up revealed a eutopic and euthyroid thyroid gland. The postoperative course was marked by Horner's syndrome that persisted at 1-year follow-up.DiscussionParapharyngeal ectopic thyroid coexisting with a functional thyroid is extremely rare. Parapharyngeal masses are usually derived from the parotid gland and nerves. Surgery of the parapharyngeal space can cause injury to the sympathetic trunk, responsible for Horner's syndrome, as in our patient.ConclusionEctopic thyroid should be considered as a possible diagnosis of a parapharyngeal mass. Although rare, Horner's syndrome is a dreaded complication of surgery of the parapharyngeal space.



http://ift.tt/2m1duLl

The new sepsis definition: limitations and contribution to research and diagnosis of sepsis.

Purpose of review: Based on recent clinical, epidemiological, and pathophysiological data, a third international consensus conference was carried out to define new criteria of sepsis in February 2016. This review presents the different items of this new definition, their limitations and their contribution to research and diagnosis of sepsis, in comparison with the previous definitions. Recent findings: Incidence, management, and pathophysiological knowledge of sepsis have improved over the past 20 years. However, sepsis still evolves to a mortal outcome, in one case out of five, with no new recent or specific therapy showing its efficacy on the patient's prognosis. These findings have led to the development of new definition. Summary: The new definition of sepsis incorporates relevant clinical and biological criteria such as SOFA score or serum lactate levels. It no longer takes into account the items of the systemic inflammatory response syndrome, which present a lack of specificity. It also simplifies the different stages of severity by deleting the term of 'severe sepsis' and by defining septic shock as a subset of sepsis. This definition, endorsed by only two international societies of intensive care, has some limitations and so merits prospective validation at different levels. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2lp2Y3V

Intensive care medicine in 2017 urgent need and existing chances to improve outcome.

No abstract available

http://ift.tt/2m1asH6

Cigarette smoking increases bronchial mucosal IL-17A expression in asthmatics, which acts in concert with environmental aeroallergens to engender neutrophilic inflammation

Abstract

Background

Mild asthmatics who smoke cigarettes may develop unstable disease and neutrophilic infiltration of the airways, features more usually associated with severe asthmatic disease. The mechanisms giving rise to this response remain unclear.

Objective

To address the hypothesis that smoking increases bronchial mucosal production of IL-17A which acts on bronchial epithelial cells directly and in concert with other environmental stimuli to induce the production of IL-6 and neutrophil chemotaxins.

Methods

IL-17A, IL-8, IL-6, neutrophils and eosinophils was detected and quantified by immunohistochemistry in endobronchial biopsy sections from smoking and non-smoking asthmatics. Human tracheal epithelial cells (HTEpC) were cultured with IL-17A in the presence/absence of cigarette smoke extract (CSE) and aeroallergens lacking intrinsic protease activity, and IL-6 and IL-8 production measured in vitro.

Results

Expression of IL-17A, IL-6 and IL-8 and neutrophil numbers were significantly elevated in the bronchial mucosa of the asthmatic smokers compared to the non-smokers. Expression of IL-17A correlated with that of IL-8 and neutrophil numbers. In the smoking asthmatics, eosinophil numbers also correlated with expression of IL-8 and IL-17A. Exposure of HTEpC cells to both CSE and IL-17A increased expression of IL-6 and IL-8 in a concentration-dependent and synergistic manner. Co-stimulation with CSE, IL-17A and aeroallergens further increased IL-6 and IL-8 production synergistically.

Conclusions

The data support the hypothesis that asthmatic smokers develop neutrophilic inflammation of the airways propagated at least partly by smoke-induced production of IL-17A which together with smoke and other environmental stimuli acts on airways epithelial cells to induce neutrophil chemotaxins.

This article is protected by copyright. All rights reserved.

http://ift.tt/2kZwNH5

Human eosinophils constitutively express a unique serine protease, PRSS33

Publication date: Available online 16 February 2017
Source:Allergology International
Author(s): Sumika Toyama, Naoko Okada, Akio Matsuda, Hideaki Morita, Hirohisa Saito, Takao Fujisawa, Susumu Nakae, Hajime Karasuyama, Kenji Matsumoto
BackgroundEosinophils play important roles in asthma, especially airway remodeling, by producing various granule proteins, chemical mediators, cytokines, chemokines and proteases. However, protease production by eosinophils is not fully understood. In the present study, we investigated the production of eosinophil-specific proteases/proteinases by transcriptome analysis.MethodsHuman eosinophils and other cells were purified from peripheral blood by density gradient sedimentation and negative/positive selections using immunomagnetic beads. Protease/proteinase expression in eosinophils and release into the supernatant were evaluated by microarray analysis, qPCR, ELISA, flow cytometry and immunofluorescence staining before and after stimulation with eosinophil-activating cytokines and secretagogues. mRNAs for extracellular matrix proteins in human normal fibroblasts were measured by qPCR after exposure to recombinant protease serine 33 (PRSS33) protein (rPRSS33), created with a baculovirus system.ResultsHuman eosinophils expressed relatively high levels of mRNA for metalloproteinase 25 (MMP25), a disintegrin and metalloprotease 8 (ADAM8), ADAM10, ADAM19 and PRSS33. Expression of PRSS33 was the highest and eosinophil-specific. PRSS33 mRNA expression was not affected by eosinophil-activating cytokines. Immunofluorescence staining showed that PRSS33 was co-localized with an eosinophil granule protein. PRSS33 was not detected in the culture supernatant of eosinophils even after stimulation with secretagogues, but its cell surface expression was increased. rPRSS33 stimulation of human fibroblasts increased expression of collagen and fibronectin mRNAs, at least in part via protease-activated receptor-2 activation.ConclusionsActivated eosinophils may induce fibroblast extracellular matrix protein synthesis via cell surface expression of PRSS33, which would at least partly explain eosinophils' role(s) in airway remodeling.



http://ift.tt/2lUFAbW