Occupational mycosis fungoides – a case series

Abstract

Background

Mycosis fungoides (MF) is the most frequent type of cutaneous T-cell lymphoma. MF has long been considered to develop as the result of a combination of genetic defects and exogenous triggers. Although no specific MF-associated environmental trigger has been established to date, some studies have suggested that occupational exposures may occasionally trigger the onset of MF.

Objective

In this observational study, we aimed at underscoring the potential association between occupational exposure and MF.

Methods

We ascertained a cohort of 150 MF patients for possible occupational exposure.

Results

Five MF patients with occupational exposure were identified in our cohort. Three patients had intensive contact with aromatic hydrocarbons; two of them were working in the same plant and in the same unit for more than 30 years. The third patient had been in contact with aromatic hydrocarbons for a total of 8 years. Patient 4 had additional contact for 12 years with hydrazine, and patient 5 had been exposed for 3 years to formaldehyde.

Conclusion

The clustering of two cases of MF, an exceptionally rare disease, in the same plant unit, as well as the long-term, intense occupational exposure in other cases, substantiates the notion that occupational exposures may contribute to the pathogenesis of MF.

http://ift.tt/2lG0cnO

Oral lichen planus in childhood: a case series

Abstract

Background

Although the exact incidence of pediatric oral lichen planus (OLP) is unknown, the oral mucosa seems to be less commonly involved, and the clinical presentation is often atypical. The aim of the study is to present a case series of OLP in childhood.

Methods

From our database, we retrospectively selected and analyzed the clinical data of OLP patients under the age of 18 where the diagnosis had been confirmed by histopathological analysis.

Results

The case series from our database shows eight patients, four males and four females. The mean (±SD) age at the time of diagnosis of the disease was 13.5 (±2.73) years, ranging in age from 9 to 17. Clinically, a reticular pattern was present in six patients (75%), and the tongue was the most commonly involved oral site (six cases, 75%). We also report the first case of OLP in a 9-year-old girl affected by autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy.

Conclusions

We report the largest case series of pediatric OLP published in literature thus far. Differences in the disease between adults and pediatric patients have been detected, but further investigation and a larger case series are needed to establish any detailed differences in clinical outcomes.

http://ift.tt/2lkXZSu

An unusual case of multiple cutaneous Rosai-Dorfman disease involving two separate parts of the body

http://ift.tt/2lFZpmK

Blood-Brain Barrier Disruption was less under Isoflurane than Pentobarbital Anesthesia

http://otorhinolarygology.blogspot.com/2017/03/blood-brain-barrier-disruption-was-less.html

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

6948891480

alsfakia@gmail.com

Radiotherapy of nasopharyngeal cancer using Rapidarc: dosimetric study

http://otorhinolarygology.blogspot.com/2017/03/radiotherapy-of-nasopharyngeal-cancer.html

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

6948891480

alsfakia@gmail.com

Oral Cancer Reconstruction using the Supraclavicular Artery Island Flap: Comparison to Free Radial Forearm Flap

Publication date: Available online 2 March 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Christian Welz, Martin Canis, Sabina Schwenk-Zieger, Jennifer L. Spiegel, Bernhard G. Weiß, Yiannis Pilavakis
PurposeTo evaluate if the pedicled supraclavicular artery island flap (SCAIF) is a sufficient alternative to the fasciocutaneous radial forearm flap (RFFF) for oral reconstruction in cancer surgery.Patients and MethodsThe investigators designed and implemented a retrospective cohort study composed of all consecutive patients that underwent head and neck reconstruction after cancer surgery at our tertiary university hospital between 2013 and 2016. Demographics, peri- and postoperative information were recorded and statistical analyzed.ResultsFrom a total of 83 patients who underwent head and neck reconstruction after cancer, 50 were identified with stage III/IV squamous cell carcinoma of the oral cavity and the oropharynx who underwent surgery and reconstruction with SCAIF (n=25) or with RFFF (n=25). The total surgery time (411.0 vs. 576.4 min; p<0.001), flap elevation time (39.00 vs. 93.78 min; p<0.001), need for an intensive care observation (32 vs. 96%; p<0.05) and the rate of tracheostomy (64 vs. 88%; p<0.05) were significantly lower in the SCAIF group. There was no statistical difference in the postoperative complication rate or the postoperative functional swallowing ability between the two groups. The total perioperative costs were significantly lower in patients receiving a reconstruction with SCAIF (2621.15 vs. 4453.77; p<0.01).ConclusionThe results of this study suggest that SCAIF is an easy and reliable flap with shorter operative times and comparable outcomes when compared to the RFFF.



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Integrating genomic data from high-throughput studies with computational modeling reveals differences in the molecular basis of hyposalivation between type 1 and type 2 diabetes

Abstract

Objectives

Both type 1 and type 2 diabetes are accompanied by a high prevalence of hyposalivation (decreased salivary secretion), resulting in oral tissue damage. However, the molecular basis for the hyposalivation is yet unknown. Identifying genes and proteins that account for diabetes-related hyposalivation will help understanding the basis for this condition and identifying disease biomarkers in saliva.

Materials and methods

We integrated genomic data from 110 high-throughput studies with computational modeling, to explore the relationship between diabetes and salivary glands on a genomic scale.

Results

A significant overlap exists between genes that are altered in both types of diabetes and genes that are expressed in salivary glands; 87 type 1 diabetes and 34 type 2 diabetes associated genes are also common to salivary glands. However, the overlap between these genes is not significant.

Conclusions

Type 1 and type 2 diabetes associated genes are involved in the salivary secretion process, but mostly at different parts of it. This suggests that type 1 and type 2 diabetes impair salivary secretion by affecting different processes in the salivary tissue.

Clinical relevance

The genomic characteristics of Type 1 and type 2 diabetes may explain differences in salivary gland tissues morphology and saliva composition in people with diabetes, and suggest candidate proteins for diabetes salivary biomarkers.

http://ift.tt/2mMh9h4

Is there enough evidence to use botulinum toxin injections for bruxism management? A systematic literature review

Abstract

Objective

The objective of the study was to conduct a systematic review of the literature assessing the effects of botulinum toxin (BoNT-A) injections in the management of bruxism.

Materials and methods

Search for articles involved the PubMed, Scopus, Web of Science, Embase, Cochrane, Scielo and Lilacs databases. Specific terms were used and the search carried out from 1980 to March 2016 by three independent researchers. Randomized controlled studies (RCTs), prospective and before–after studies that applied BoNT-A at the masseter and/or temporalis muscles were included.

Results

Three RCTs and two uncontrolled before–after studies out of 904 identified citations were included in this review. All five articles dealt with sleep bruxism and featured a small sample size. None of them was about awake bruxism. Two randomized clinical trials were double-blinded, with a control group using saline solution. Two studies used polysomnography/electromyography for sleep bruxism diagnosis, whilst others were based on history taking and clinical examination. All studies using subjective evaluations for pain and jaw stiffness showed positive results for the BoNT-A treatment. In contrast, the two studies using objective evaluations did not demonstrate any reduction in bruxism episodes, but a decrease in the intensity of muscles contractions.

Conclusion

Despite the paucity of works on the topic, BoNT-A seems to be a possible management option for sleep bruxism, minimizing symptoms and reducing the intensity of muscle contractions, although further studies are necessary especially as far as the treatment indications for bruxism itself is concerned.

Clinical relevance

BoNT-A has been increasingly diffused in dentistry over recent years, being also used for pain management in patients with bruxism. Nonetheless, there is no consensus about its effects in this disorder.

http://ift.tt/2m0VCTN

Prevalence of acne vulgaris and its impact of the quality of life among secondary school-aged adolescents in Sohag Province, Upper Egypt

Summary

Background

Acne vulgaris is the most common dermatological condition encountered in adolescents.

Aim

It was to determine the prevalence of acne vulgaris and its impact of the quality of life among adolescents attending secondary schools in Sohag Province, Upper Egypt.

Patients and methods

This was a cross-sectional study conducted in randomly selected governmental and technical secondary schools in Sohag Province, Upper Egypt. Approval was taken from the scientific research committee of Sohag Faculty of Medicine and also from Ministry of Education. Every student with acne was subjected to full medical history and local examination of head and neck to assess the severity of acne vulgaris. Assessment of the impact of acne vulgaris on their quality of life was carried out using self-reported validated specific questionnaire, the Cardiff Acne Disability Index (CADI).

Results

This study included 994 teenage secondary school students. The overall prevalence of acne vulgaris was 333 (33.5%). The mean age of the students with acne was 16.84±0.87. Acne vulgaris was more common among females than among males (200, 60% vs 133, 40%). The most common form of acne vulgaris was mild 178, 53%, followed by moderate form 135, 41%, and severe form 20, 6%. CADI score was significantly related to the disease grade and it was maximum among those with severe grade, followed by moderate and lastly mild disease grade.

Conclusion

Acne vulgaris is a common skin disease and has a valuable impact on quality of life among adolescents attending secondary schools in Sohag Province, Upper Egypt.

http://ift.tt/2lAeaGM

Abécédaire : qui suis-je ? X’…

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): O. Laccourreye, A. Werner, I. McGill, C. Martin




http://ift.tt/2m1F3p1

Les polymorphismes de l’eNOS (synthase du monoxyde d’azote endothéliale) dans l’otite séromuqueuse

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): M. Ates, C. Cevik, R. Dokuyucu, O. Berber, S. Colak, M. Izmirli
ObjectifsL'otite séromuqueuse (OSM) est la pathologie la plus fréquente après une infection virale des voies respiratoires supérieures chez l'enfant. Les études indiquent le rôle important du monoxyde d'azote (NO) dans l'étiologie de la perte d'audition. Toutefois, il n'existe aucune étude portant sur le rôle des polymorphismes de la synthase du monoxyde d'azote endothéliale (eNOS) dans l'OSM. L'objectif de cette étude est d'évaluer les polymorphismes de l'eNOS chez l'enfant atteint d'OSM.Matériels et méthodesAu total, 89 patients atteints d'OSM et 85 sujets sains appariés en termes d'âge et de sexe ont été inclus dans l'étude. Tous les patients de l'étude ont été soumis à des examens ORL et audiologiques complets. Une analyse ADN a été réalisée avec la technique Polymerase Chain Reaction (PCR) à partir de prélèvements sanguins. Le produit PCR a été coupé par la technique Restriction Fragment Length Polymorphism (RFLP) avec l'enzyme BanII et contrôlé par électrophorèse au gel d'agarose.RésultatsÀ l'issue de l'analyse génétique, il n'y a pas de différence significative entre les patients et les témoins en termes de polymorphisme Glu298Asp de l'eNOS (G/G, G/T, T/T). Lors de la comparaison de ces groupes en termes de répartition des allèles, une relation significative a été constatée entre les patients et les témoins (p=0,037).ConclusionÀ notre connaissance, l'allèle G a été identifié comme prédisposant au développement d'une OSM. Cette étude est la première à indiquer la corrélation entre le polymorphisme G894T de l'eNOS et l'OSM en Turquie.



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Améloblastome des maxillaires : prise en charge thérapeutique et taux de récidive

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): A. Laborde, R. Nicot, T. Wojick, J. Ferri, G. Raoul
IntroductionL'améloblastome est une tumeur bénigne odontogène rare à fort potentiel récidivant. Il représente 1 % des tumeurs des maxillaires. Cette étude avait pour but d'observer le taux de récidive des améloblastomes en fonction de leur type de traitement : radical ou conservateur.Patients et méthodesIl s'agissait de recenser de façon rétrospective entre 1991 et 2013 tous les patients ayant eu un diagnostic d'améloblastome, de recueillir leurs caractéristiques topographiques, radiologiques, histologiques, le type de traitement choisi : conservateur (marsupialisation, énucléation, curetage) ou radical (résection osseuse segmentaire interruptrice) et de comparer leurs taux de récidive.RésultatsNous avons inclus 27 patients, il y a eu 22 traitements conservateurs (TC) et 14 traitements radicaux (TR). Le taux de récidive était de 90,9 % dans le groupe TC et de 9,1 % dans le groupe TR avec p=0,025. La durée moyenne de suivi était de 56,2 mois.DiscussionLe taux de récidive du TC a été plus élevé que celui du TR. Ces résultats sont similaires à ceux retrouvés dans la littérature. Le choix du traitement doit s'adapter aux caractéristiques macroscopiques et histologiques de chaque tumeur ainsi qu'au patient.



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Apport diagnostique et pronostique de l’électromyographie dans les immobilités laryngées unilatérales de l’adulte

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): A. Focquet, Y. Péréon, S. Ségura, C. Ferron, O. Malard, F. Espitalier
ButsÉtudier l'apport diagnostique et pronostique de l'électromyographie laryngée (EMGL) face à un trouble de mobilité laryngée unilatérale chez l'adulte.Patients et méthodesÉtude rétrospective de 2007 à 2015 incluant les patients présentant une immobilité laryngée unilatérale et ayant eu une EMGL. Les tracés de type neurogène, normal ou myogène étaient confrontés au contexte clinique. Le potentiel de récupération d'une paralysie unilatérale, évalué par la présence de potentiels de réinnervation sur le tracé de l'EMGL, a été comparé à l'évolution de la mobilité laryngée en laryngoscopie.RésultatsSoixante-trois patients (âge moyen de 59 ans) ont été inclus, mais 2 ont été exclus. Le délai moyen entre l'apparition de l'immobilité et la réalisation de l'EMGL était de 7 mois. Sur un total de 61 patients, 85 % présentaient un tracé neurogène en faveur d'une atteinte nerveuse, 13 % un tracé normal en faveur d'une ankylose crico-aryténoïdienne et un avait une activité de type myogène. Les tracés neurogènes étaient le plus souvent secondaires à une intervention chirurgicale cervicale. Trois quarts des patients présentant des potentiels de réinnervation ont récupéré une mobilité laryngée. La valeur prédictive positive de l'EMGL était de 69,2 %. Trente-huit patients ont été réévalués à distance.ConclusionL'EMGL s'avère être un outil performant pour préciser l'origine d'une immobilité laryngée unilatérale chez l'adulte. Elle a aussi un rôle pronostique dans les paralysies laryngées, l'absence de potentiels de réinnervation pouvant faire proposer précocement une médialisation laryngée si nécessaire.



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Évaluation des symptômes nasosinusiens par l’auto-questionnaire DyNaChron : faut-il le remplir avant ou après la consultation ?

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): D.T. Nguyen, C. Rumeau, M. Felix-Ravelo, P.-L. Nguyen-Thi, R. Jankowski
ObjectifL'évaluation des doléances naso-sinusiennes par auto-questionnaire reste très subjective. Cependant, elle est un outil indispensable pour quantifier les symptômes. L'objectif de cette étude était de comparer les réponses au questionnaire DyNaChron rempli juste avant et juste après une consultation pour un dysfonctionnement nasosinusien chronique.Matériels et méthodesSoixante-dix-huit patients (l'âge moyen : 43,1±16,9 ans) qui ont consulté pour un dysfonctionnement nasosinusien chronique ont participé à cette étude prospective. Les patients ont rempli la version informatisée de l'auto-questionnaire DyNaChron dans une salle dédiée juste avant et juste après l'entretien médical et l'examen physique.RésultatsLes patients ont majoritairement tendance à coter leurs symptômes de façon moins sévère après la consultation. Une différence significative entre les scores moyens avant et après consultation était retrouvée pour l'obstruction nasale (différence de 0,94/10), la rhinorrhée antérieure (0,40) et postérieure (0,26), les troubles de l'odorat (0,65), les douleurs faciales/céphalées (0,65). Il n'y avait pas de différence avant-après pour la toux chronique.ConclusionLes scores de l'auto-évaluation d'un dysfonctionnement nasosinusien chronique sont modestement différents avant et après la consultation. L'interprétation de ces scores doit être prudente et tenir compte des facteurs qui ont pu éventuellement biaiser les réponses.



http://ift.tt/2m1xD5e

Editorial Board

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1





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Place de l’Oramorph en complément de l’ibuprofène et du paracétamol dans la prise en charge de la douleur après adéno-amygdalectomie chez l’enfant

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): R. Wei Chern Gan, T. Kamani, M. Daniel
IntroductionDepuis peu, la codéine n'est plus recommandée dans le traitement de la douleur après (adéno)-amygdalectomie chez l'enfant et l'administration d'Oramorph est proposée en complément du paracétamol et de l'ibuprofène. Ce travail rapporte les besoins réels en Oramorph sur une cohorte de patients.MéthodeEnquête téléphonique rétrospective concernant l'administration d'Oramorph auprès des parents d'enfants opérés d'une (adéno)-amygdalectomie.RésultatsSur les 56 enfants inclus, 41 (73,2 %) se sont vus administrer de l'Oramorph. Quatorze n'en ont pas eu car les parents n'en n'ont pas ressenti le besoin et 1 par peur d'effets secondaires. L'administration d'Oramorph a été source d'inquiétude chez 14 parents au total (25 %), surtout par crainte d'effets secondaires.ConclusionEnviron 3/4 des enfants opérés d'une (adéno)-amygdalectomie ont besoin, pour bénéficier d'une antalgie satisfaisante, d'Oramorph en plus du paracétamol et de l'ibuprofène. L'usage d'Oramorph est adapté à la prise en charge de la douleur après (adéno)-amygdalectomie.



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Paralysie faciale périphérique : parole, communication et fonction motrice orale

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): T. Movérare, A. Lohmander, M. Hultcrantz, L. Sjögreen
ObjectifsCette étude visait à examiner l'effet de la paralysie faciale périphérique unilatérale acquise sur la parole, la communication et les fonctions orales et à étudier la relation entre le degré de paralysie faciale et la capacité à articuler, le contrôle de la salive, la capacité à s'alimenter et la force labiale.Matériels et méthodesDans cette étude descriptive, 27 patients (15 hommes et 12 femmes, âge moyen 48 ans) atteints de paralysie faciale périphérique unilatérale ont été inclus s'ils avaient obtenu un score inférieur à 70 sur l'échelle de Sunnybrook. L'évaluation s'est déroulée lors de consultations ORL de routine sous la forme d'auto-questionnaires portant sur la force labiale, la capacité à articuler et l'intelligibilité, ainsi que sur la capacité ressentie à communiquer, à s'alimenter et à contrôler sa salive.RésultatsLes patients porteurs d'une paralysie faciale unilatérale avaient une force labiale significativement plus faible et une capacité à articuler, à manger et à contrôler leur salivation significativement inférieure en comparaison des données de référence des populations saines. Le degré de paralysie faciale était significativement corrélé à la force labiale mais pas à la capacité à articuler, à l'intelligibilité, à la capacité à communiquer ou à s'alimenter et à contrôler sa salivation.ConclusionLa paralysie faciale périphérique acquise peut affecter la communication et la capacité à s'alimenter et à contrôler sa salivation. Les médecins doivent savoir qu'il n'y a pas de corrélation directe entre le degré de paralysie faciale et son effet sur la communication, la capacité à s'alimenter et à contrôler sa salivation. Il est, par conséquent, recommandé aux médecins de poser des questions spécifiques liées à ces problèmes fonctionnels pendant les consultations de routine et de proposer l'éventuelle intervention d'un orthophoniste ou d'un kinésithérapeute.



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Recommandation de la SFORL. Prise en charge des épistaxis dans le cadre de l’HTA

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): J. Michel, V.P. Escabasse, E. Bequignon, B. Vérillaud, L. Robard, L. Crampette, O. Malard
ObjectifPrésenter les recommandations de la Société française d'oto-rhino-laryngologie (SFORL) concernant la prise en charge des épistaxis dans le cadre de l'hypertension artérielle.MéthodesUn groupe de travail multidisciplinaire a été chargé d'effectuer une revue de la littérature scientifique sur la thématique étudiée. À partir de ces textes et de l'expérience de chacun, des recommandations ont été rédigées, puis relues par un groupe de lecture indépendant du groupe de travail. Une réunion de synthèse a permis d'aboutir au texte final. Les recommandations proposées ont été classées en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique décroissant.RésultatsIl est recommandé de mesurer la pression artérielle des patients à la phase aiguë d'une épistaxis (Grade A), de contrôler médicalement les chiffres tensionnels élevés à la phase aiguë du saignement afin de diminuer sa durée, de surveiller la tension artérielle au décours de l'épistaxis, de contrôler médicalement les chiffres tensionnels élevés au décours du saignement afin de diminuer le risque de récidive. En cas de persistance de chiffres tensionnels élevés au décours d'une épistaxis sévère, il est recommandé de demander un bilan cardiovasculaire pour rechercher une maladie hypertensive sous-jacente (Grade B).



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Recommandation de la SFORL (version courte). Prise en charge spécifique des épistaxis dans le cadre d’une maladie de Rendu-Osler

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): L. Robard, J. Michel, V. Prulière Escabasse, E. Bequignon, B. Vérillaud, O. Malard, L. Crampette
ObjectifLes auteurs exposent les recommandations de la Société française d'oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant la prise en charge spécifique des épistaxis dans le cadre d'une maladie de Rendu-Osler.MéthodesUn groupe de travail multidisciplinaire a été chargé d'effectuer une revue de la littérature scientifique sur la thématique étudiée. À partir de ces textes et de l'expérience de chacun, des recommandations ont été rédigées, puis relues par un groupe de lecture indépendant du groupe de travail. Une réunion de synthèse a permis d'aboutir au texte final. Les recommandations proposées ont été classées en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique décroissant.RésultatsLe diagnostic de maladie de Rendu-Osler s'établit sur la présence de trois signes parmi les quatre critères de Curaçao. Devant une épistaxis aiguë, il est recommandé de réaliser une compression bi-digitale. L'embolisation est réservée aux épistaxis résistantes. Les méchages avec du matériel non résorbable ou des cautérisations sont contre-indiqués. L'éducation thérapeutique est indispensable. Le traitement des télangiectasies de la muqueuse nasale est possible en utilisant différents moyens locaux. En cas de contrôle insuffisant, il est recommandé d'utiliser l'acide tranexamique par voie systémique.



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Traitement original des sténoses ischémiques des transplants coliques. À propos de deux cas

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): S. Daldoul, A. Moussi, S. Sayari, M. Ben Moussa
IntroductionLe traitement des sténoses ischémiques du transplant colique est mal codifié.Cas cliniqueNous rapportons deux observations de patientes opérées pour une sténose ischémique de l'extrémité cervicale d'un transplant colique. Ce traitement avait consisté en une résection de la sténose avec confection d'une nouvelle anastomose cervicale après mobilisation du transplant colique par cervico-sterno-laparotomie chez une patiente et un nouveau transplant iléo-colique remplaçant uniquement le segment sténosé de l'ancienne coloplastie chez la deuxième.DiscussionÀ travers ces deux observations, nous discutons la complexité des modalités thérapeutiques de cette complication.ConclusionLe traitement de choix d'une sténose ischémique du transplant colique est la résection avec confection d'une nouvelle anastomose ; parfois la confection d'un nouveau transplant constitue la seule alternative thérapeutique.



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Rhabdomyosarcome primitif de la thyroïde avec thrombose auriculaire chez un adulte

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): B. Febrero, I. Oviedo, A. Ríos, J.M. Rodríguez
IntroductionLe rhabdomyosarcome (RMS) est la tumeur des tissus mous la plus fréquente chez l'enfant. Elle est rare chez l'adulte. L'atteinte de la thyroïde est exceptionnelle et seuls quatre cas ont été rapportés : deux RMS primitives chez des enfants et deux cas chez de jeunes adultes avec dissémination métastatique sur la thyroïde. Nous rapportons le premier cas de la littérature d'un RMS primitif de la thyroïde chez l'adulte avec syndrome cave supérieur.Cas cliniqueUn homme de 67ans a été admis pour un œdème du membre supérieur s'étendant jusqu'à la région latérocervicale. Le scanner a montré une masse de 6cm dans l'hémithyroïde avec thrombose veineuse jusqu'à l'oreillette. Une ponction à l'aiguille fine a indiqué une catégorie Bethesda III. La chirurgie a révélé une thyroïde de consistance pierreuse. Une biopsie peropératoire a montré une néoplasie indifférenciée et aucune intervention chirurgicale complémentaire n'a été réalisée. Le patient est décédé 48heures plus tard. Une histologie définitive a montré un RMS.DiscussionLa thrombose veineuse due à une tumeur thyroïdienne est peu fréquente. Les rares articles de la littérature recommandent l'exérèse des carcinomes thyroïdiens avec thrombose auriculaire le plus rapidement possible après le diagnostic. Toutefois, dans les cas de carcinomes anaplasiques ou peu différenciés, l'exérèse est controversée. Si, dans le cas présent, il y avait eu un diagnostic histologique préopératoire, la chirurgie n'aurait pas été indiquée.



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Nodules de langue : quel est votre diagnostic ?

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): R. Ilham, A. Wafae, L. Essakalli




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Céphalées et diplopie

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): R. Hermann, M. Debeaupte, M. Durbec




http://ift.tt/2myt0CK

Une angine pas comme les autres

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): R. Quatre, E. Lamblin, C.A. Righini




http://ift.tt/2m1wiew

Le lambeau myo-muqueux de buccinateur à charnière postérieure (dit de Bozola)

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): F. Remangeon, M. Hivelin, D. Maurice, L. Lantieri, O. Laccourreye
À partir d'un cas de reconstruction du palais dur après exérèse carcinologique, les auteurs précisent les points clefs de la réalisation du lambeau myo-muqueux de buccinateur à charnière postérieure dit de Bozola et détaillent les limites et les indications de ce lambeau local de translation lors de la chirurgie carcinologique des tumeurs de la cavité buccale et/ou de l'oropharynx.



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Corps étranger de l’orbite : une balle de fusil extraite 20ans après l’accident

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): P. Clarós, J.V.F. Fokouo, A. Clarós
IntroductionLes traumatismes de l'orbite et du globe oculaire sont fréquents. L'incarcération d'une balle de fusil est plutôt rare.Cas cliniqueNous rapportons l'observation et la prise en charge d'un patient victime de chorioretinitis sclopetaria secondaire à un traumatisme par balle remontant à vingt ans.DiscussionNous envisageons les aspects cliniques, diagnostiques et thérapeutiques de ce cas particulier de corps étranger de l'orbite.



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Kyste osseux anévrismal du ramus mandibulaire chez un enfant

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): K. Kilic, M. Sedat Sakat, O. Tan, H. Ucuncu




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Le lymphome de hodgkin du sinus maxillaire, un piège diagnostique ?

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1
Author(s): C. Korenbaum, L. Fornecker, G. Noël, C. Vigneron




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Remerciements aux lecteurs

Publication date: February 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 1





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Topical agents for oral cancer chemoprevention: A systematic review of the literature

Publication date: April 2017
Source:Oral Oncology, Volume 67
Author(s): Lucy Chau, Justin T. Jabara, Wanda Lai, Peter F. Svider, Blake M. Warner, Ho-Sheng Lin, S. Naweed Raza, Andrew M. Fribley
Objectives/hypothesisWe review the use of topical chemoprevention agents in patients with oral potentially malignant disorders (PMD).MethodsA systematic review of studies on topical chemoprevention agents for oral PMD from 1946 to November 2016 was conducted using the MEDLINE database, Embase, and Cochrane Library. Data were extracted and analyzed from selected studies including study type, sample size, demographics, treatment length, response rate, follow-up time, adverse effects, and recurrence.ResultsOf 108 studies, twenty-four, representing 679 cases met the inclusion criteria. The clinical lesions evaluated included oral leukoplakia, erythroplakia (OEL), verrucous hyperplasia (OVH), oral lichen planus, larynx squamous cell carcinoma, and oral squamous cell carcinoma (OSCC). The mean complete response rate for topical retinoid therapy was 32%. The mean complete response rate for 1% bleomycin therapy and 0.5% bleomycin was 40.2% and 25%, respectively. The complete response rate of OVH, OEL, and OSCC to photodynamic therapy ranged from 66.7% to 100%.ConclusionThere are a paucity of data examining topical treatment of oral PMDs. However, the use of topical agents among patients with oral lesions may be a viable complement or even alternative to traditional surgery, radiation, or systemic chemotherapy, with the advantage of reducing systemic side effects and sparing important anatomic structures. This study of 679 cases represents the largest pooled sample size to date, and the preliminary studies in this systematic review provide support for further inquiry.



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Combining cetuximab with chemoradiotherapy in patients with locally advanced nasopharyngeal carcinoma: A propensity score analysis

Publication date: April 2017
Source:Oral Oncology, Volume 67
Author(s): Wei-Xiong Xia, Hu Liang, Xing Lv, Lin Wang, Chao-Nan Qian, Yan-Fang Ye, Liang-Ru Ke, Wen-Ze Qiu, Ya-Hui Yu, Xin-Jun Huang, Guo-Ying Liu, Chong Zhao, Yan-Qun Xiang, Xiang Guo
ObjectiveTo compare the effectiveness of concurrent cisplatin chemoradiotherapy plus cetuximab with that of concurrent chemoradiotherapy (CCRT) alone in locoregionally advanced nasopharyngeal carcinoma (LRANPC) patients.Materials and methodsA total of 3257 LRANPC patients from a prospectively maintained database were included in this observational study to examine the effectiveness of adding cetuximab to CCRT. We compared overall survival (OS), disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) using the propensity score method.ResultsIn this cohort, 131 patients received CCRT plus cetuximab. Cetuximab-treated patients were more likely to receive intensity-modulated radiation therapy and were less likely to receive induction chemotherapy or adjuvant chemotherapy. The addition of cetuximab was associated with increased DMFS compared with CCRT alone based on univariable and multivariable analyses (5-year OS, 94.1% vs. 87.3%; P=0.044), but not with increased OS, DFS, or LRRFS. Propensity score matching identified 96 patients in each cohort and confirmed that a DMFS benefit was associated with the addition of cetuximab (HR, 0.38; 95% CI, 0.15–0.99, P=0.044). Subgroup analyses demonstrated a significant DMFS benefit with CCRT plus cetuximab in patients with N2-N3 stage disease compared with N2-N3 patients receiving CCRT alone (87.9% and 66.2%, respectively; P=0.045).ConclusionsIn conclusion, the addition of cetuximab to first-line chemoradiotherapy is associated with an improvement in DMFS in patients with LRANPC. A prospective randomized clinical trial will be necessary to validate this result.



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Nutzen und Risiken des Mammographiescreenings

Zusammenfassung

Hintergrund

Das Mammographiescreening wird z. T. in der Öffentlichkeit infrage gestellt.

Ziel

Vor- und Nachteile einer Teilnahme am Mammographiescreening werden dargestellt.

Material und Methode

Es erfolgte eine Auswertung internationaler Primärliteratur, Übersichtsarbeiten und Stellungnahmen von Expertengruppen.

Ergebnisse

Die etablierten Mammographiescreening-Programme erreichen oder übertreffen bezüglich Mortalitätssenkung die Ergebnisse der zugrunde gelegten randomisierten Studien. Dem Nutzen der Teilnahme müssen Nachteile wie Überdiagnosen und falsch-positive Verdachtsbefunde gegenübergestellt werden, die jedem Früherkennungsprogramm inhärent sind. Die quantitative Bewertung der Vor- und Nachteile erfordert einen hoch entwickelten epidemiologischen Sachverstand. Die große Mehrzahl der qualifizierten Expertengremien empfiehlt das Mammographiescreening für die Altersgruppe 50–70 Jahre. Die Ablehnung beruht z. T. auf falschen oder unvollständigen Analysen der Studien.

Schlussfolgerung

Die Teilnahme am Mammographiescreening kann den Frauen der entsprechenden Altersgruppe empfohlen werden. Die einzelne Teilnehmerin sollte möglichst in die Lage versetzt werden, eine Entscheidung zur Teilnahme auf Grundlage der Ergebnisse der Programme und ihrer eigenen Präferenzen zu treffen.

http://ift.tt/2mfMKKC

Sport und Krebsprävention

Zusammenfassung

Hintergrund

In der Presse finden sich Aussagen wie „Sport ist wichtiger als ein Krebsmedikament" und ein wachsendes Angebot an Sportangeboten wird von Tumorpatienten regelmäßig wahrgenommen. Welchen therapeutischen Wert hat Sport für Patienten, was macht ein solches Sportangebot aus, wie häufig und intensiv sollte Sport getrieben werden? Fragen, die sich Ärzte, Therapeuten und Patienten gleichermaßen stellen.

Ziel

Im Sinne der drei klassischen Präventionsebenen (primär, sekundär und tertiär) soll das Potenzial von Sport in der Prävention von Krebs betrachtet werden: Kann Sport das Risiko, an Krebs zu erkranken, verändern? Kann Sport zu der Früherkennung von Krebs beitragen? Hilft Sport Tumorpatienten bei der Bewältigung ihrer Erkrankung?

Material und Methoden

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed zum Thema „Sport, Bewegung und körperlicher Aktivität" sowie „Krebs". Zudem wurden Daten des eigenen Patientenkollektivs ausgewertet.

Ergebnisse und Diskussion

Epidemiologische Studien zeigen eine wirksame Reduzierung von molekularen Faktoren wie hohe Insulin- und IGF-Spiegel sowie eine hohe Insulinresistenz durch Sport, die gleichsam hohe Risikofaktoren für zahlreiche Tumorerkrankungen sind. Andere Faktoren wie Interleukin-6 (IL-6) gelten ebenfalls als Mediatoren der Erkrankung, sind aber auch Teil von physiologischen Anpassungsreaktionen auf Training im Sport, sodass ihre Rolle im Sinne einer präventiven Kausalkette kritisch hinterfragt werden darf. Die Ausübung von Sport oder auch negative Begleiterscheinungen wie die zunehmende Einnahme leistungssteigernder Substanzen kann das Krebsrisiko auch erhöhen. Im Sinne sekundärer Prävention können Sport und sportwissenschaftliche Methoden einen Beitrag leisten, um in der Frühphase der Krebserkrankung drohende Begleiterscheinungen der Erkrankung wie Kachexie aufzudecken. Für die Gestaltung von Trainingsprogrammen für Tumorpatienten werden konkrete Empfehlungen gegeben.

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Kleinzelliges Lungenkarzinom

Zusammenfassung

Hintergrund

Das kleinzellige Lungenkarzinom (SCLC) ist ein aggressiver Tumor mit hoher Metastasierungsneigung und schlechter Prognose. Es ist der Typ des Lungenkarzinoms, der die stärkste Assoziation mit dem Rauchen aufweist. Das SCLC ist zusammen mit dem großzelligen neuroendokrinen Karzinom und den Karzinoiden der Gruppe der neuroendokrinen Tumoren der Lunge zugeordnet.

Ergebgnisse

Definiert wird das SCLC durch seine typische Histologie aus kleinen undifferenzierten Zellen, seine Expression neuroendokriner Marker und eine hohe Proliferationsrate sowie meist ausgedehnte Nekrosen. Morphologisch ist es nicht von kleinzelligen Karzinomen anderer Organe zu unterscheiden. Auf molekularer Ebene stellen die Inaktivierung der TP53- und RB1-Gene die dominierenden und universell vorkommenden Treibermutationen dar, die zu einer genomischen Instabilität des Tumors führen und so mit den durch die mutagene Wirkung des Tabakrauchs zahlreich auftretenden Mutationen zu der sehr hohen Mutationslast dieses Tumors beitragen. Dies erschwert die Identifizierung von Ansatzpunkten für eine zielgerichtete Therapie, bietet jedoch eine mögliche Rationale für den Einsatz von Immuncheckpointinhibitoren.

Schlussfolgerung

Das SCLC ist ein undifferenzierter Tumor, der sich klinisch, prognostisch sowie auch morphologisch und biologisch von anderen Typen des Lungenkarzinoms deutlich unterscheidet und für das noch immer wenige Therapieoptionen bestehen.

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Complications after orthognathic surgery: our experience on 423 cases

Abstract

Introduction

Orthognathic surgery is widely used to correct dentofacial discrepancies. However, this procedure presents numerous possible complications. The aim of our study is to review intraoperative and postoperative complications related to orthognathic surgery based upon a 10-year period in the Maxillofacial Surgery Department of Federico II University of Naples.

Materials and methods

Medical records of 423 patients who undergone orthognathic surgery in a 10-year period were retrospectively analyzed and complications was noted. Statistical analysis was conduced in order to understand if the type of surgical procedure influenced complications rate.

Results

One hundred eighty-five complications in 143 (33.8%) of the 423 treated patients were reported. Complications detected were nerve injury (49 cases, 11.9%), infections (10 cases, 2.4%), complications related to fixation plates or screws (30 cases, 7.1%), bad split osteotomy (8 cases, 1.9%), secondary temporo-mandibular joint disorders (36 cases, 8.5%), dental injuries (21 cases, 5%), condilar resorption (2 cases, 0.5%), and necessity of a second-time surgery (24 cases, 5.7%).

Conclusions

Serious complications seem to be quite rare in orthognathic surgery. Some of the surgical complications found are related to the surgeon experience and not strictly to the risks of the operation itself. Understanding potential complications allows the surgeon to guarantee safe care through early intervention and correctly inform the patient in the preoperative colloquy.

http://ift.tt/2lh0yVR

Spontaneous bone formation after mandible segmental resection in “krokodil” drug-related jaw osteonecrosis patient: case report

Abstract

We report a case of a 48-year-old male patient with "krokodil" drug-related osteonecrosis of both jaws. Patient history included 1.5 years of "krokodil" use, with 8-month drug withdrawal prior to surgery. The patient was HCV positive. On the maxilla, sequestrectomy was performed. On the mandible, sequestrectomy was combined with bone resection. From ramus to ramus, segmental defect was formed, which was not reconstructed with any method. Post-operative follow-up period was 3 years and no disease recurrence was noted. On 3-year post-operative orthopantomogram, newly formed mandibular bone was found. This phenomenon shows that spontaneous bone formation is possible after mandible segmental resection in osteonecrosis patients.

http://ift.tt/2mOLPh4

Black esophagus: acute esophageal necrosis, clinical case and review of literature

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Black esophagus is a rare, multifactorial disease. A case of acute black esophagus following pancreatic resection is presented. The patient referred us with a specific gastrointestinal bleeding. An esophagogastroduodenoscopy confirmed the diagnosis. We performed conservative treatment with complete esophageal re-epithelization and negative follow-up for stenosis or necrosis relapse.</span>

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Delayed leg paraplegia associated with hyperextension injury in patients with diffuse idiopathic skeletal hyperostosis (DISH): case report and review of the literature

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by calcifications and ossification of ligaments and tendon insertions. The patients with DISH are susceptible to spinal column injury with trivial trauma due to immobilization of vertebrae and this easily leads to spinal cord injury. However, only few reports on hyperextension injuries of the thoracolumbar spine with DISH exist. Here we report three cases of those who developed delayed leg paraplegia after hyperextension injuries of the thoracolumbar spine with DISH. All cases complained only lower back pain without neurological deficits and plain radiographs showed no fractures at an initial assessment. The spinal fracture caused by hyperextension injury was diagnosed with computed tomography (CT) and magnetic resonance image (MRI) after delayed leg paraplegia occurred. Many of the fractures caused by hyperextension injuries are not detected only with plain radiographs in patients with DISH. Further investigations using CT and/or MRI should be recommended.</span>

http://ift.tt/2ljCnWB

Surgical anatomy of double pyramidal lobe on total thyroidectomy: a rare case report

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Double pyramidal lobe is a scarce anatomical variation of the thyroid gland. Its presence impinges on the completeness of total and subtotal thyroidectomy and the postoperative treatment. Surgeons should be always aware of this variation in order to perform sufficient resection of the thyroid gland and minimize the possibility of recurrence of benign and malignant thyroidopathies.</span>

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Comparison of inflammatory cytokine release from nasal epithelial cells of non-atopic non-rhinitic, allergic rhinitic and polyp subjects and effects of diesel exhaust particles in vitro

Publication date: Available online 2 March 2017
Source:Allergologia et Immunopathologia
Author(s): A.B. Ozturk, R. Bayraktar, B. Gogebakan, S. Mumbuc, H. Bayram
BackgroundAlthough studies have reported an association between air pollutants and increased allergic airway diseases, such as allergic rhinitis and nasal polyposis, the underlying mechanisms are not fully understood. A limited number of studies have suggested that diesel exhaust particles (DEP) play a role in atopy and the pathogenesis of allergic upper airway diseases. The aim of this study was to investigate the effect of DEP on inflammatory cytokine release, and mRNA expression of transcription factors such as JNK and NF-β in primary nasal epithelial cells (NECs), in vitro.MethodsNECs from non-atopic, non-rhinitic subjects (controls) and patients with allergic rhinitis and nasal polyps were cultured and incubated with 0–100μg/ml DEP for 24h. ELISA and RT-PCR were used to assess the release of IL-8, GM-CSF, and RANTES, and mRNA expression for JNK and NF-κB, respectively.ResultsCompared to control cells, NECs from subjects with atopic polyps released significantly greater amounts of IL-8 (median=887 vs. 176.6pg/μg cellular protein; p<0.0001) and RANTES (median=0.191 vs. 0.02pg/μg cellular protein; p<0.001). While 50μg/ml DEP induced release of RANTES in NECs from patients with allergic rhinitis, 100μg/ml DEP decreased IL-8 levels in NECs from both control and allergic rhinitic subjects. DEP did not affect mRNA expression for JNK and NF-κB from NECs of subjects with polyps.ConclusionsNECs from subjects with various pathologies may respond differently to DEP.



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Polymorphisms of TGFB1, TLE4 and MUC22 are associated with childhood asthma in Chinese population

Publication date: Available online 2 March 2017
Source:Allergologia et Immunopathologia
Author(s): J.B. Chen, J. Zhang, H.Z. Hu, M. Xue, Y.J. Jin
ObjectiveTo investigate whether the genetic variants of TGFB1, TLE4, MUC22 and IKZF3 are associated with the development of asthma in Chinese children.Methods572 adolescent asthma patients and 590 age-matched healthy controls were included in this study. A total of four SNPs were genotyped, including rs2241715 of TGFB1, rs2378383 of TLE4, rs2523924 of MUC22, and rs907092 of IKZF3. Allele frequencies of the patients and the control group were compared by the Chi-square test. The Student t test was used to analyse the relationship between genotypes and clinical feature of the patients.ResultsPatients were found to have significantly different frequencies of allele A of rs2241715, allele G of rs2378383 and allele A of rs2523924 as compared with the controls (40.4% vs. 45.9%, p=0.01 for rs2241715; 17.2% vs. 13.4%, p=0.01 for rs2378383; 15.3% vs. 11.9%, p=0.02 for rs2523924). For patients with severe asthma, those with genotype AA/AG of rs2241715 had remarkably higher FEV1% as compared with those with genotype GG (59.1±4.3% vs. 55.4±3.7%, p<0.001). Moreover, those with genotype GG/GA of rs2378383 had remarkably lower FEV1% as compared with those with genotype AA (54.6±2.9% vs. 58.6±4.1%, p<0.001).ConclusionsGenes TGFB1, TLE4 and MUC22 are associated with the risk of childhood asthma in Chinese population. Our results associating TGFB1 and TLE4 with clinical features of asthma suggest potential application of these parameters in the management of asthma children.



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Secondary hemophagocytic lymphohistiocytosis in the setting of metastatic renal cell carcinoma: a case report

Hemophagocytic lymphohistiocytosis is a disease process characterized by unregulated hyperactivation of the immune system associated with multiorgan involvement and high mortality rates. Early recognition is c...

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Prenatal Second-Hand Smoke Increases Atopic Dermatitis in Children with TNF-α/TLR4/GSTP1 Polymorphisms

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


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The Cellie Coping Kit for Children with Food Allergy: A Pilot Study

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


http://ift.tt/2mL5DCL

Prenatal Second-Hand Smoke Increases Atopic Dermatitis in Children with TNF-α/TLR4/GSTP1 Polymorphisms

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


http://ift.tt/2mjfDWy

The Cellie Coping Kit for Children with Food Allergy: A Pilot Study

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


http://ift.tt/2mKJV1I

Evaluation of the effect of cigarette smoking on the olfactory neuroepithelium of New Zealand white rabbit, using scanning electron microscope

Abstract

To detect ultra-structural changes of Rabbit's olfactory neuro-epithelium using scanning electron microscope after exposure to cigarette smoking. Sixty six rabbits (Pathogen free New Zealand white rabbits weighing 1–1.5 kg included in the study were randomly assigned into one of three groups: control group did not expose to cigarette smoking, study group 1 was exposed to cigarette smoking for 3 months and study group 2 was exposed to cigarette smoking 3 months and then stopped for 2 months. Olfactory neuro-epithelium from all rabbits were dissected and examined under Philips XL-30 scanning electron microscope. Changes that were found in the rabbits of study group 1 in comparison to control group were loss of microvilli of sustentacular cells (p = 0.016) and decreases in distribution of specialized cilia of olfactory receptor cells (p = 0.046). Also respiratory metaplasia was detected. These changes were reversible in study group 2. Cigarette smoking causes ultra-structural changes in olfactory neuro-epithelium which may explain why smell was affected in cigarette smokers. Most of these changes were reversible after 45 days of cessation of cigarette smoking to the rabbits.

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Vibration-Induced Nystagmus: A Biomarker for Vestibular Deficits - A Synopsis

A review of more than 20 years of experience with vibratory stimulation in vestibular diseases is given. Vibrations in a frequency frame of 30-60 Hz are applied on the mastoid during 20 s. Eye movements are recorded by video-oculography to detect a vibration-induced nystagmus (VIN). A VIN occurs in cases of a side difference between the peripheral vestibular receptors beating to the side of better excitability. In patients with central lesions, a VIN does not appear generally, only exceptionally if the lesion is located laterally in the brain stem. In healthy subjects, a VIN does not occur. The VIN can be considered as an additional tool to detect a peripheral side difference and can reduce the need for caloric stimulation.
ORL 2017;79:112-120

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Predictive Success Factors in Selective Upper Airway Stimulation

Obstructive sleep apnea is one of the most common diseases in Western industrialized countries. A variety of conservative and surgical treatment options are available for its treatment. In recent years, selective upper airway stimulation (sUAS) has been shown to be effective and safe. Different biomarkers have been investigated as predictive clinical success factors in a number of clinical trials. Age does not matter in sUAS, as compared to its predictive role in other therapies. Weight seems to play a limited role, depending on drug-induced sleep endoscopy to rule out a complete concentric collapse with an increased body mass index. For surgical success and the related postoperative tongue motions, a nerve integrity monitoring methodology has been developed for predicting correct cuff placement. Postoperative sonography remains a promising method for the future assessment of predictive markers in sUAS.
ORL 2017;79:121-128

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American Academy of Dermatology (AAD) Annual Meeting

Read clinically focused news coverage of key developments from AAD 2017.
Medscape Dermatology

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Occupational Latex Allergy: the Current State of Affairs

Abstract

Purpose of review

Allergy to natural rubber latex (NRL) reached epidemic proportions during the nineties and led to intense preventive efforts. The aim of this review was to provide a comprehensive compilation of the current status of occupational NRL allergy.

Recent findings

Recent advances led to the characterization of 15 NRL allergens and the development of assays for measuring the allergen content of NRL materials and specific IgE antibodies against NRL allergen components. Preventive measures aimed at reducing workplace exposure to NRL allergens were associated with decreasing incidence rates of NRL allergy. However, a pooled analysis of epidemiological surveys published during the last 10 years provided prevalence estimates of NRL sensitization and allergy similar to those derived from studies conducted before 2003.

Summary

Substantial progress has been made in the understanding and prevention of NRL allergy, although the disease may still remain a worldwide cause of concern.

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Drug-Induced Sleep Endoscopy With Online Cardiorespiratory Monitoring

This cohort study describes a drug-induced sleep endoscopy technique implemented with simultaneous polygraphic monitoring of cardiorespiratory parameters in patients with obstructive sleep apnea syndrome.

http://ift.tt/2lDOha8

Addressing Estimated Hearing Loss in Adults in 2060

This population epidemiology study uses data from the NHANES to estimate the number of adults expected to have hearing loss in the next 43 years.

http://ift.tt/2libQJc

Otogenic Temporomandibular Arthritis in Children

This study describes the symptoms, imaging characteristics, course, and treatment of otogenic septic arthritis of the temporomandibular joint in children.

http://ift.tt/2lDNcPn

Slow-Growing Infiltrative Sinonasal Mass

A man in his 50s was seen for a 6-month history of swelling involving the nasal bridge and right eye and intermittent ipsilateral epistaxis; endoscopy demonstrated a right-sided exophytic mass visible between the middle turbinate and nasal septum. What is your diagnosis?

http://ift.tt/2li9jPy

Panniculite lipomembraneuse au cours d’un rhumatisme psoriasique

Publication date: Available online 1 March 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): H. Cornillier, V. Martaille, F. Maitre, E. Estève




http://ift.tt/2lxjjzx

Malformations lymphatiques kystiques superficielles. Pré-test

Publication date: Available online 1 March 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): R. Gabeff, G. Lorette, D. Herbreteau, A. le Touze, D. Goga, A. Maruani




http://ift.tt/2lYBnpz

Dermatofibrome géant de la jambe

Publication date: Available online 2 March 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): H. Akkari, M. Korbi, M. Njima, M. Belkahla, A. Zakhama, H. Belhadjali, J. Zili




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Yellow fever vaccine-associated neurological disease, a suspicious case

A 70-year-old man with known cardiovascular risk factors, presented with acute onset expression aphasia, agraphia, dyscalculia, right-left disorientation and finger agnosia, without fever or meningeal signs. Stroke was thought to be the cause, but cerebrovascular disease investigation was negative. Interviewing the family revealed he had undergone yellow fever vaccination 18 days before. Lumbar puncture revealed mild protein elevation. Cultural examinations, Coxiella burnetti, and neurotropic virus serologies were negative. Regarding the yellow fever virus, IgG was identified in serum and cerebrospinal fluid (CSF), with negative IgM and virus PCR in CSF. EEG showed an encephalopathic pattern. The patient improved gradually and a week after discharge was his usual self. Only criteria for suspect neurotropic disease were met, but it's possible the time spent between symptom onset and lumbar puncture prevented a definite diagnosis of yellow fever vaccine-associated neurological disease. This gap would have been smaller if the vaccination history had been collected earlier.

http://ift.tt/2lYswnK

False homozygous HLA genotyping results due to copy number neutral loss of heterozygosity in acquired aplastic anaemia

The aim of this case report is to draw attention on possible false human leucocyte antigen (HLA) genotyping in acquired aplastic anaemia prior to allogeneic haematopoietic stem cell transplantation. In acquired aplastic anaemia loss of heterozygosity (LOH) of chromosome 6p is known to occur in around 12%. We report false HLA genotyping results due to LOH and a coinciding steep rise in neutrophils following filgrastim stimulation in a patient with very severe aplastic anaemia. At diagnosis we obtained heterozygous results on peripheral blood. Failing to reach a partial response at 6 months with immune-suppressive therapy we repeated HLA genotyping, obtaining homozygous results. Repeated testing confirmed loss of HLA genotype heterozygosity. HLA genotyping on cells obtained by a buccal swab confirmed the previous HLA heterozygosity. A second course of filgrastim at the time of homozygous HLA genotyping resulted in a steep rise in neutrophils. Stopping filgrastim resulted in an equally steep drop.

http://ift.tt/2lDGlFz

Dramatic resuscitation with Intralipid in an epinephrine unresponsive cardiac arrest following overdose of amitriptyline and propranolol

Amitriptyline and propranolol are life threatening in overdose. The efficacy of intravenous lipid emulsion (ILE) in tricyclic antidepressant and propranolol overdose is unclear. We report a dramatic response to ILE following pulseless electrical activity arrest due to mixed amitriptyline and propranolol overdose.

http://ift.tt/2lYyS6Q

Pelvic renal ectopia, an incidental finding

Description

A woman aged 33 years presented with a 2-week history of non-traumatic back pain, progressive bilateral lower limb weakness with paraesthesia and urinary incontinence. She had a background of recurrent urinary tract infection and hypertension.

Clinical examination revealed reduced power bilaterally (grade 3/5) and reduced reflexes but normal tone. She was unable to walk. Abdominal examination was unremarkable and per rectal examination was normal with good anal tone. She was apyrexial with a blood pressure of 132/86 mm Hg and heart rate of 84 bpm. Admission blood tests (including FBC, CRP, U&E, bone profile, magnesium, B12 and folate) were normal. Urine dipstick was also normal.

An urgent whole-spine MRI excluded cord compression. It did however reveal a soft tissue mass in the pelvis anterior to the S1 vertebral body, just left to the midline extending into the presacral space. This was initially thought to be a lymph node mass (

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Intraprocedural thrombus formation in a patient with anticoagulated atrial fibrillation

Description

A 57-year-old man with 16-year history of persistent atrial fibrillation (AF) was admitted for electrophysiology study and catheter ablation. He was on amiodarone, carvedilol and warfarin. His international normalised ratio (INR) was 2.2. Intracardiac echocardiogram (ICE) prior to atrial septum puncture did not show any spontaneous echo contrast. After advancing the sheath across the interatrial septum, it was flushed with heparin. A few seconds after sheath placement and prior to placement of lasso catheter a linear thrombus developed which was visible on ICE (figure 1; videos 1 and 2). Activated clotting time (ACT) of >250 ms was maintained prior to trans-septal puncture and after thrombus was seen; heparin was administered to maintain ACT>300 ms. The sheath and catheter were retracted into the inferior vena cava, and with continuous heparin infusion, the thrombus resolved. During hospitalisation and follow-up, patient remained asymptomatic without neurological complications.

...

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Wirksamkeit der Phototherapie bei chronischer Urtikaria

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Lower prevalence of chronic itch in hemodialysis patients on loop diuretics: results from GEHIS (German Epidemiological Hemodialysis Itch Study)

Abstract

Background

Chronic itch (CI) is a very tormenting symptom in hemodialysis (HD) patients. GEHIS (German Epidemiological Hemodialysis Itch Study) is a representative cross-sectional study showing that current chronic itch (CI) affects 25.2% of hemodialysis (HD) patients.

Objective

We investigated drug intake and possible associations between CI and medications of HD patients.

Methods

860 HD patients from a randomly selected cluster-sample of 25 dialysis units (GEHIS) in Germany were investigated. Statistical analyses were performed using R (version 3.3.0) for Windows. Logistic regression was used to identify influential covariates for prevalence of chronic itch and intensity of itch.

Results

Taking loop diuretics (furosemide, torasemide) was significantly negatively associated with the occurrence of CI in HD patients meaning that those who had received any type of loop diuretics were significantly less likely to suffer from less CI compared to those who had not taken them. There were no associations of CI with other medications. No correlation was detected between the intensity of itch and the intake of loop diuretics or any other medication.

Conclusion

Loop diuretics may have an impact on the development of CI in HD patients. As it is most likely that a multifactorial origin may explain CI in HD, future research should also focus on the role of loop diuretics in CI, both on a clinical as well as on a molecular level.

This article is protected by copyright. All rights reserved.

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Quality of life and comorbidities in palmoplantar pustulosis – a cross sectional study on 102 patients

Abstract

Background

Association of palmoplantar pustulosis (PPP) with metabolic and autoimmune diseases has been reported in mostly small case series or anecdotal cases.

Objective

To assess health-related quality of life and prevalence of comorbidities in a large cohort of PPP patients.

Methods

We conducted a cross-sectional study on patients with either active or past PPP. Disease severity was measured by the Palmoplantar Pustulosis Area and Severity Index (ppPASI). Quality of life was assessed by the Dermatology Life Quality Index (DLQI). Comorbidities were evaluated by medical history, blood examination, stool testing for Helicobacter pylori antigen and screening tools for depression and psoriatic arthritis.

Results

A total of 102 patients (87 women, 15 men) with a mean age of 52.6 ± 14.1 years were evaluated. The mean DLQI was 7 ± 6. Comorbidities were frequent and consisted of hypercholesterolemia (38%), hypertension (32%), obesity (27%), metabolic syndrome (26%), depression (24%), diabetes (19%), autoimmune thyroiditis (16%) and psoriatic arthritis (16%).

Conclusion

Patients with PPP have an impaired quality of life and a broad range of comorbidities. Contrary to other reports our investigation failed to show an association between PPP and coeliac disease or H. pylori infection.

This article is protected by copyright. All rights reserved.

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Hepatitis C virus and its cutaneous manifestations: treatment in the direct-acting antiviral era

Abstract

New all-oral direct acting antivirals (DAA) have changed the hepatitis C virus (HCV) treatment landscape. Given that dermatologists frequently encounter HCV-infected patients, knowledge of the current treatment options and their utility in treating HCV-associated dermatologic disorders is important. In addition to highlighting the new treatment options, we review four classically HCV-associated dermatologic disorders – mixed cryoglobulinemia (MC), lichen planus (LP), porphyria cutanea tarda (PCT), and necrolytic acral erythema (NAE) – and examine the role for all-oral direct acting antiviral (DAA) regimens in their treatment. A literature search of English-language publications was conducted of the PubMed and EMBASE databases using search terms including "hepatitis C," "direct acting antivirals," "cutaneous," "mixed cryoglobulinemia," "necrolytic acral erythema," "lichen planus," "porphyria cutanea tarda," "rash," as well as specific drug names, related terms, and abbreviations. Currently, limited data exists on the use of DAAs in HCV patients with cutaneous side effects, although treatment of the underlying HCV is now recommended for nearly all patients, with the new drugs offering much-improved dosage schedules and side effect profiles. The most data exists for MC, in which several studies suggest that DAAs and achievement of sustained virologic response (SVR) improves cutaneous symptoms. Studies of both older and newer regimens are limited by their small size, retrospective nature, lack of appropriate controls, and wide variability in study protocols. Given the strong association, screening for HCV should be considered in patients with MC, LP, PCT, and NAE.

This article is protected by copyright. All rights reserved.

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Analysis of the German DRG-data for livedoid vasculopathy and calciphylaxis

Abstract

Background

Livedoid vasculopathy and calciphylaxis are rare skin disorders. Large cohorts of patients have been missing so far for detailed analysis.

Patients and methods

Data from Diagnosis Related Groups (DRG) of hospitalized cases of livedoid vasculopathy (n_total=1357) and calciphylaxis (n_total= 699) were analysed for the years 2008-2013 concerning sex, age and frequency of diagnosis. To avoid deviations to non-relevant secondary diagnosis and due to changes in ICD-10 indices, we selected the two most recent available years 2013 and 2014 for evaluation of the accompanying diagnoses for both, livedoid vasculopathy (n=519) and calciphylaxis (n=324). Thosewere additionally evaluated as possible comorbidity.

Results

The male-female ratio for livedoid vasculopathy was 2.1:1. Patients older than 45 years comprehended 74.7% of all patients with peaks between the age of 45-50 and 70-75. Livedoid vasculopathy patients suffered from cardiovascular and renal diseases. Coding of coagulation disorders were found rarely in our analysis. For calciphylaxis, we calculated a male-female ratio of 1.7:1. Most of the patients were at an age between 65-80 years. Diagnosis at an age under 35 years was rare. In general, most calciphylaxis patients showed end-stage renal disease with need of dialysis and presented with the resulting complications.

Conclusions

Our data analysis shows relevant comorbidity and cofactors of these rare diseases like livedoid vasculopathy and calciphylaxis in Germany by a large number of cases.

This article is protected by copyright. All rights reserved.

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Comparison of phenotype, comorbidities, therapy and adverse events between psoriatic patients with and without psoriatic arthritis. Biobadaderm registry

Abstract

Background

There are a limited number of studies comparing psoriasis patients without psoriatic arthritis (PsA) to those with arthritis. Previous results are controversial.

Objectives

To perform a comparative analysis of the phenotype, baseline comorbidities, therapeutic profile and incidence of adverse events (particularly overall adverse events, infections and infestations, malignancies, and psychiatric disorders) among psoriatic patients with/without PsA.

Methods

All the patients on the Biobadaderm registry, a prospective inception cohort of psoriasis patients on systemic therapy, were included. Patients were divided into two groups: those with psoriasis without arthritis at the time of entry into the cohort (Pso group), and those with psoriasis and psoriatic arthritis (PsA group) at entry. Patients were followed until the censorship date (last visit in a lost-to-follow-up patient, or 10 November 2015, whichever occurred first). We excluded all the patients who developed any kind of signs and/or symptoms of joint involvement during the follow-up. A descriptive analysis was performed. We estimated incidence ratios (IRR) of adverse events during systemic treatment using a mixed-effects Poisson regression.

Results

We included 2120 patients: 1871 (88%) patients with psoriasis without arthritis, and 249 (12%) with psoriasis and PsA. The follow-up time was 5020 patients-year in the Pso group, and 762 patients-year in the PsA group. Patients with PsA had more comorbidities, particularly hypertension and liver disease; used a higher number of systemic therapies, particularly anti-TNFα drugs and combination therapy; and presented more adverse events (IRR adjusted = 1.29; 95% CI [1.05-1.58]), particularly serious adverse events (IRR adjusted = 1.51; 95% CI [1.01-2.26]) and infections/infestations (IRR adjusted = 1.88; 95% CI [1.27-2.79]), independently of the associated comorbidities and present/past therapies.

Conclusions

Given the differences between patients with psoriasis alone or with psoriasis associated with PsA, patients with psoriasis and PsA should be followed and managed more closely and with specific attention.

This article is protected by copyright. All rights reserved.

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Allergic diseases and asthma in pregnancy, a secondary publication

Every fifth pregnant woman is affected by allergies, especially rhinitis and asthma. Allergic symptoms existing before pregnancy may be either attenuated, or equally often promoted through pregnancy. Optimal a...

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Pru p 3, a marker allergen for lipid transfer protein (LTP)-sensitization also in Central Europe

Abstract

In the Mediterranean area, lipid transfer proteins (LTPs) are important causes of plant food allergies often associated with severe allergic reactions. There, peach LTP (Pru p 3) seems to be the primary sensitizer, whereas in Central Europe little is known about the importance of LTP-sensitization. In this region allergen extract based diagnosis is often complicated by co-sensitization to Bet v 1, the major birch pollen allergen, its cross-reactive food allergens and profilins. We investigated the role of LTP-sensitization in Central European patients displaying strong allergic reactions to plant-derived food. Analysis of IgE-reactivity revealed that ten of thirteen patients were sensitized to Pru p 3, nine to Bet v 1and two to profilin. Our results showed that LTP-sensitization represents a risk factor for severe allergic symptoms in Central Europe. Furthermore, the strong IgE reactivity detected in immunoblots of plant food extracts indicated that Pru p 3 can be used as a marker allergen for LTP-sensitization also in Central European patients.

This article is protected by copyright. All rights reserved.

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Occupational Latex Allergy: the Current State of Affairs

Abstract

Purpose of review

Allergy to natural rubber latex (NRL) reached epidemic proportions during the nineties and led to intense preventive efforts. The aim of this review was to provide a comprehensive compilation of the current status of occupational NRL allergy.

Recent findings

Recent advances led to the characterization of 15 NRL allergens and the development of assays for measuring the allergen content of NRL materials and specific IgE antibodies against NRL allergen components. Preventive measures aimed at reducing workplace exposure to NRL allergens were associated with decreasing incidence rates of NRL allergy. However, a pooled analysis of epidemiological surveys published during the last 10 years provided prevalence estimates of NRL sensitization and allergy similar to those derived from studies conducted before 2003.

Summary

Substantial progress has been made in the understanding and prevention of NRL allergy, although the disease may still remain a worldwide cause of concern.

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Central compartment management in patients with papillary thyroid cancer presenting with metastatic disease to the lateral neck: Anatomic pathways of lymphatic spread

ABSTRACT

Background

Papillary thyroid cancer (PTC) occasionally presents with metastases to the lateral neck, without clinically evident disease in the central neck. These cases may ultimately manifest as either skip metastases to the lateral compartment or as occult metastases in the central compartment.

Methods

This is a retrospective review of 80 patients with PTC with metastases to the lateral cervical lymph nodes treated from 2006 to 2015. Photographs of the cadaveric dissections were used with permission from the author. Schematic illustrations were created to highlight lymphatic drainage pathways.

Results

The rate of skip metastasis in this cohort was 5%. Clinical evidence of central neck disease did not predict the pathologic status of the compartment.

Conclusion

PTC rarely spreads to the lateral neck without depositing metastases within the central neck. This finding is supported by the anatomic pathways for lymphatic spread, not previously highlighted in the English literature. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Node-positive cutaneous squamous cell carcinoma of the head and neck: Survival, high-risk features, and adjuvant chemoradiotherapy outcomes

ABSTRACT

Background

Data lacks to guide treatment of regionally metastatic cutaneous head and neck squamous cell carcinoma (HNSCC).

Methods

We conducted a retrospective review of 80 patients treated for regionally metastatic cutaneous HNSCC. The effect of various clinicopathologic variables on overall survival (OS) was investigated, in addition to outcomes by treatment modality.

Results

On multivariate regression, cutaneous primary >2 cm (p = .03) and extracapsular spread (ECS; p = .01) were significantly associated with decreased OS. Location of regional metastasis (neck vs parotid vs both) had no effect on OS (p = .2), nor did the presence of a cutaneous primary at the time of presentation (p = .9). The 3-year survival was 43%, 52%, and 49% for surgery alone, adjuvant radiation, and adjuvant chemoradiation, respectively. Fifty-one percent of patients had a recurrence of their disease.

Conclusion

Regionally metastatic cutaneous HNSCC is an aggressive disease associated with high recurrence rates. Patients with tumors >2 cm and ECS have poorer OS despite adjuvant therapy. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Transoral laser microsurgery or total laryngectomy for recurrent squamous cell carcinoma of the larynx: Retrospective analysis of 199 cases

ABSTRACT

Background

Surgical treatment options for local recurrences of laryngeal cancer can be either organ-preserving surgery or total laryngectomy. The purpose of this study was to present our evaluation of the treatment with transoral laser microsurgery (TLM) in comparison to laryngectomy.

Methods

We conducted a retrospective review of 199 consecutive patients with recurrent laryngeal cancer at 1 tertiary referral center.

Results

The 5-year overall survival, disease-specific survival, and local control rates were 64.8%, 79.6%, and 57.5%, respectively, for 93 patients with early tumors treated by TLM, 28.9%, 41.7%, and 43.7%, respectively, for 52 patients with advanced tumors treated by TLM as well as 39.4%, 44.6%, and 68.8%, respectively, for 54 patients with advanced tumors treated by total laryngectomy. Five-year larynx-preservation rate was 77.7% for early as well as 68.4% for advanced tumors treated by TLM.

Conclusion

TLM is an option in early and in selected cases of advanced locally recurrent laryngeal cancer. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Defining the surgical margins of adenoid cystic carcinoma and their impact on outcome: An international collaborative study

ABSTRACT

Background

The mainstay of treatment in adenoid cystic carcinoma (ACC) of the head and neck is surgical resection with negative margins. The purpose of this study was to define the margin status that associates with survival outcomes of ACC of the head and neck.

Methods

We conducted univariate and multivariate analyses of international data.

Results

Data of 507 patients with ACC of the head and neck were analyzed; negative margins defined as ≥5 mm were detected in 253 patients (50%). On multivariate analysis, the hazard ratios (HRs) of positive margin status were 2.68 (95% confidence interval [CI], 1.2–6.2; p = .04) and 2.63 (95% CI, 1.1–6.3; p = .03) for overall survival (OS) and disease-specific survival (DSS), respectively. Close margins had no significant impact on outcome, with HRs of 1.1 (95% CI, 0.4–3.0; p = .12) and 1.07 (95% CI, 0.3–3.4; p = .23) for OS and DSS, respectively, relative with negative margins.

Conclusion

In head and neck ACC, positive margins are associated with the worst outcome. Negative or close margins are associated with improved outcome, regardless of the distance from the tumor. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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The Essential Guide to Coding in Otolaryngology By Seth M. Brown, Kimberley J. Pollock, Michael Setzen, Abtin Tabaee, Plural Publishing, San Diego, California, 2016, 391 pp, $159.95

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Microstructure and corrosion behavior of laser surface-treated AZ31B Mg bio-implant material

Abstract

Although magnesium and magnesium alloys are considered biocompatible and biodegradable, they suffer from poor corrosion performance in the human body environment. In light of this, surface modification via rapid surface melting of AZ31B Mg alloy using a continuous-wave Nd:YAG laser was conducted. Laser processing was performed with laser energy ranging from 1.06 to 3.18 J/mm². The corrosion behavior in simulated body fluid of laser surface-treated and untreated AZ31B Mg alloy samples was evaluated using electrochemical technique. The effect of laser surface treatment on phase and microstructure evolution was evaluated using X-ray diffraction and scanning electron microscopy. Microstructure examination revealed grain refinement as well as formation and uniform distribution of Mg₁₇Al₁₂ phase along the grain boundary for laser surface-treated samples. Evolution of such unique microstructure during laser surface treatment indicated enhancement in the corrosion resistance of laser surface-treated samples compared to untreated alloy.

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Histology Rings True

Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 58-year-old man with nonerosive…

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Management of Patients on Abuse-Deterrent Opioids in the Ambulatory Surgery Setting

Abstract

Purpose of Review

The use of prescription opioids for acute and chronic pain has become more prevalent than ever, and concurrent with the increased prescribing of opioids, there has been a steady increase in opioid abuse. Abuse is commonly associated with physical or chemical manipulation of the original opiate to provide more rapid onset of the active ingredient.

Recent Findings

This growing national public health concern has led to the development of various abuse-deterring opioids with the intent of decreasing the diversion of opioids from their prescribed use. Given the ever-increasing percentage of surgeries performed in the ambulatory surgery setting, anesthesia providers will inevitably encounter more and more patients taking these new opioid formulations with abuse-deterring properties. Consequently, a thorough understanding of these medications is vital for optimal anesthetic management.

Summary

This article reviews the scope of the problem of prescription opiate abuse, summarizes the currently available abuse-deterring opioids, and discusses the anesthetic management of patients who are taking these new medications in the outpatient setting.

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Atypical Facial Pain: a Comprehensive, Evidence-Based Review

Abstract

Purpose of Review

The purpose of this article is to focus on an excruciating disorder of the face, named atypical facial pain or persistent idiopathic facial pain (PIFP). It is considered an underdiagnosed condition with limited treatment options. Facial pain can be a debilitating disorder that affects patients' quality of life. Up to 26% of the general population has suffered from facial pain at some point in their lives. It is important to highlight the different types of facial pain to be able to properly manage this condition accordingly.

Recent Findings

Newer interventional modalities such as pulsed radiofrequency ablation (PFR) of the sphenopalatine ganglion, peripheral nerve field stimulators (PNFS), and botulinum toxin injections have promising results. In summary, more prospective studies such as randomized controlled trials are necessary to explore the possibility of their more widespread use as viable procedures for the treatment of PIFP.

Summary

In this review article, we describe the workup and diagnosis of PIFP and highlight recent literature regarding the pathophysiology and treatment of PIFP. PIFP is an excruciating disorder of the face often misdiagnosed as trigeminal neuralgia (TN) However, unlike TN symptoms, the pain is persistent rather than intermittent, usually unilateral, and without autonomic signs or symptoms. When a clinician encounters a patient with neuropathic facial pain whose symptoms are incongruent with the more common etiologies, the diagnosis of atypical facial pain must be entertained. Treatment of PIFP is multidisciplinary. Unfortunately, few randomized controlled trials for the treatment of PIFP exist. However, there are a select number of pharmacological, non-pharmacological, and interventional treatment options that have proven to be moderately effective.

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Pain Management of Patients with Substance Abuse in the Ambulatory Setting

Abstract

Purpose of Review

Abuse of illicit substances and prescription opioids is a growing problem that presents challenges for pain management in the inpatient and outpatient setting. With future patient care models shifting toward shorter hospital stays and more same-day surgeries, it is crucial that clinicians learn to manage this patient population and strike a balance between the overtreatment of pain that can subsequently worsen tolerance and addiction, and the undertreatment of pain that can lead to pseudoaddiction.

Recent Findings

Through recognition of maladaptive behaviors, use of screening programs, and pain contracts, physicians in the outpatient setting can improve their oversight and shepherding of these patients. In the inpatient setting, regularly scheduled rather than PRN opioids are recommended for chronic opioid users, and good communication with the patient's outpatient prescriber of pain medications is essential. For surgical patients on chronic opioid therapy, making a multimodal plan in advance of the day of surgery that may incorporate NSAIDs, tricyclics, gabapentinoids, anticonvulsants, opioid tapering, and regional anesthesia can help alleviate high postoperative pain control requirements.

Summary

In conjunction with such medication management, setting realistic expectations for pain control with preoperative counseling may be highly beneficial. For postoperative pain refractory to other strategies, the use of inpatient low-dose ketamine infusions is a novel approach that is gaining popularity, but this does require monitoring by a dedicated pain service.

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Updates in Pediatric Regional Anesthesia and Its Role in the Treatment of Acute Pain in the Ambulatory Setting

Abstract

Purpose of Review

The purpose of this review is to summarize the latest advances in pediatric regional anesthesia with special emphasis on its role in the ambulatory surgical setting.

Recent Findings

Undertreated pain in children following ambulatory surgery is not a rare occurrence and it is associated with increased morbidity and significant psychosocial harm. Use of regional anesthesia as part of the anesthetic approach in the ambulatory setting is safe when performed on children under general anesthesia and inclusion of certain adjuncts improves block outcomes. Ultrasonographic visualization during blockade improves safety and prolongs duration. Ambulatory continuous nerve blocks in older children are safe, efficacious, and associated with high patient and caregiver satisfaction rates.

Summary

In the ever-growing field of pediatric same-day surgery, safe and efficient flow through the perioperative period necessitates use of a multimodal approach, of which regional anesthesia is but one important component. Perioperative complications are minimized with less opioid use, and yet appropriate pain management must be ensured. Pediatric regional anesthesia has been shown to be exceedingly safe under general anesthesia. Findings demonstrate that advances in ultrasound technology have contributed to safer and longer-lasting analgesia. It facilitates the development of new methods by which regional anesthesia can improve postoperative analgesia in children upon discharge and beyond.

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Unilateral Maxillary Sinus Actinomycosis with a Closed Oroantral Fistula

Actinomycosis is a bacterial infection due to Actinomyces israelii, a gram-positive, anaerobic organism that normally affects the cervicofacial region. However, facial injury or trauma (i.e., dental procedures) can allow this bacteria to inhabit other regions. There have been rare reports of actinomycosis of the paranasal sinuses. We present a case of a 50-year-old female who originally presented with a suspected oroantral fistula who subsequently was found to have actinomycosis involving her right maxillary sinus. Additionally, the dental extraction site revealed no connection with the maxillary sinus. We discuss the diagnostic approach and management of this patient as it relates to the limited existing literature.

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Increasing Clinical Faculty Engagement in Problem-Driven Research

This Viewpoint describes the "Magic Wand" Initiative, a program instituted at Massachusetts General Hospital to increase the involvment of clinical faculty in problem-driven research.

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Complications after orthognathic surgery: our experience on 423 cases

Abstract

Introduction

Orthognathic surgery is widely used to correct dentofacial discrepancies. However, this procedure presents numerous possible complications. The aim of our study is to review intraoperative and postoperative complications related to orthognathic surgery based upon a 10-year period in the Maxillofacial Surgery Department of Federico II University of Naples.

Materials and methods

Medical records of 423 patients who undergone orthognathic surgery in a 10-year period were retrospectively analyzed and complications was noted. Statistical analysis was conduced in order to understand if the type of surgical procedure influenced complications rate.

Results

One hundred eighty-five complications in 143 (33.8%) of the 423 treated patients were reported. Complications detected were nerve injury (49 cases, 11.9%), infections (10 cases, 2.4%), complications related to fixation plates or screws (30 cases, 7.1%), bad split osteotomy (8 cases, 1.9%), secondary temporo-mandibular joint disorders (36 cases, 8.5%), dental injuries (21 cases, 5%), condilar resorption (2 cases, 0.5%), and necessity of a second-time surgery (24 cases, 5.7%).

Conclusions

Serious complications seem to be quite rare in orthognathic surgery. Some of the surgical complications found are related to the surgeon experience and not strictly to the risks of the operation itself. Understanding potential complications allows the surgeon to guarantee safe care through early intervention and correctly inform the patient in the preoperative colloquy.

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Spontaneous bone formation after mandible segmental resection in “krokodil” drug-related jaw osteonecrosis patient: case report

Abstract

We report a case of a 48-year-old male patient with "krokodil" drug-related osteonecrosis of both jaws. Patient history included 1.5 years of "krokodil" use, with 8-month drug withdrawal prior to surgery. The patient was HCV positive. On the maxilla, sequestrectomy was performed. On the mandible, sequestrectomy was combined with bone resection. From ramus to ramus, segmental defect was formed, which was not reconstructed with any method. Post-operative follow-up period was 3 years and no disease recurrence was noted. On 3-year post-operative orthopantomogram, newly formed mandibular bone was found. This phenomenon shows that spontaneous bone formation is possible after mandible segmental resection in osteonecrosis patients.

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Reply to: adverse effects of hyperchloraemic solutions

No abstract available

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Postoperative delirium guidelines: The greater the obstacle, the more glory in overcoming it

No abstract available

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Chronic pain management for the hospitalized patient

No abstract available

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European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium

The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care, postoperative detection of delirium and management of delirious patients. The scope of this guideline is not to cover ICU delirium. Considering that many medical disciplines are involved in the treatment of surgical patients, a team-based approach should be implemented into daily practice. This guideline is aimed to promote knowledge and education in the preoperative, intraoperative and postoperative setting not only among anaesthesiologists but also among all other healthcare professionals involved in the care of surgical patients.

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Intraoperative hypotension and change in estimated glomerular filtration rate after major abdominal surgery: A prospective observational study

No abstract available

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Antibiotic therapy in the critically ill - expert opinion of the Intensive Care Medicine Scientific Subcommittee of the European Society of Anaesthesiology

Antimicrobial treatment is the cornerstone of infection treatment, and the selection of appropriate antibiotic treatment for critically ill patients is challenging. Clinicians working with critically ill patients usually feel a greater obligation towards their patient than towards maintenance of the delicate ecological balance of prevalent microbiological threats and their resistance patterns. Although antibiotic overtreatment is a frequent phenomenon, patient outcomes need not be compromised when antibiotic treatment is driven by informed decision-making. At the 2016 Euro Anaesthesia Conference (London, UK), the European Society of Anaesthesia Intensive Care Scientific Subcommittee convened an expert panel on antibiotic therapy. This article summarises the main conclusions of the panel, namely the principles of antibiotic therapy that all physicians working with critically ill patients must know.

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Improving perioperative outcome: time to update protocols

No abstract available

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Patient-completed, preoperative web-based anaesthetic assessment questionnaire (electronic Personal Assessment Questionnaire PreOperative): Development and validation

BACKGROUND: Worldwide, guidelines support the routine use of anaesthetic preoperative assessment (POA), a process that is frequently supported by pro formas and unvalidated questionnaires. Electronic questionnaires can provide reliable data. A local initiative has seen the development of a computerised electronic Personal Assessment Questionnaire (ePAQ). OBJECTIVE: To develop and validate a novel electronic instrument for POA. DESIGN: The content and face validity were evaluated in 30 patients. The questionnaire was then modified and completed by a further 300 patients, evaluating the reliability of its items and scoring algorithms for BMI and American Society of Anesthesiologists (ASA) physical status. The study was approved by the South Yorkshire Regional Ethics Committee (REC 09/H1308/127). SETTING: The study was conducted in a tertiary teaching hospital in the United Kingdom between January 2011 and February 2012 and was funded by a research grant from the Charitable Trustees of Sheffield Teaching Hospitals National Health Service Foundation Trust. PATIENTS: A total of 330 patients aged 18 years or older, listed for surgery and able to read and understand English, were recruited. Neurosurgery; ear, nose and throat; orthopaedics; gynaecology; general and plastic surgery; ophthalmology and urology patients were included. All participants provided written consent. MAIN OUTCOME MEASURES: Validation including test–retest analysis, assessment of patient value and burden, assessment of accuracy, mean score difference of BMI estimation and comparison of inter-rater ASA grading. RESULTS: In all, 77% of patients reported that the ePAQ helped with communication, 99% that it was easy to complete and 98% that they would be happy to use it again. ePAQ preoperative assigned ASA grades matched consultant-assigned grades more frequently than nurse-assigned grades. Self-reported BMI classification was correct in 78% of patients and within one WHO category in a further 21%. Test–retest scores were good. CONCLUSION: Initial evaluation suggests that ePAQ is acceptable to patients. Data collected using the system were found to be reliable, and its intrinsic scoring systems for ASA and BMI are comparable with values assigned by clinicians.

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Early perioperative immunological effects of anaesthesia and analgesia in patients undergoing prostate cancer surgery: A randomised pilot study

No abstract available

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Kinetics of plasma biomarkers of inflammation and lung injury in surgical patients with or without postoperative pulmonary complications

BACKGROUND: Postoperative pulmonary complications (PPCs) are common after major abdominal surgery. The kinetics of plasma biomarkers could improve identification of patients developing PPCs, but the kinetics may depend on intraoperative ventilator settings. OBJECTIVE: To test whether the kinetics of plasma biomarkers are capable of identifying patients who will develop PPCs, and whether the kinetics depend on the intraoperative level of positive end-expiratory pressure (PEEP). DESIGN: A preplanned substudy of a randomised controlled trial. SETTING: Operation room of five centres. PATIENTS: Two hundred and forty-two adult patients scheduled for abdominal surgery at risk of developing PPCs. INTERVENTIONS: High (12 cmH2O) versus low (≤2 cmH2O) levels of PEEP. MAIN OUTCOME MEASURES: Individual PPCs were combined as a composite endpoint. Plasma samples were collected before surgery, directly after surgery and on the fifth postoperative day. The levels of the following were measured: tumour necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8, the soluble form of the Receptor for Advanced Glycation End–products (sRAGE), Surfactant Protein (SP)-D, Clara Cell protein (CC)-16 and Krebs von den Lungen 6 (KL6). RESULTS: Blood sampling was complete in 242 patients: 120 patients in the high PEEP group and 122 patients in the low PEEP group. Increases in plasma levels of TNF- IL-6, IL-8 and CC-16, and a decrease in plasma levels of SP-D were greater in patients who developed PPCs; however, the area under the receiver operating characteristic curve was low for all biomarkers. CC-16 was the only biomarker whose level increased more in patients who had received high levels of PEEP. CONCLUSION: In patients undergoing abdominal surgery and at risk of developing PPCs, plasma levels of biomarkers for inflammation or lung injury showed distinct kinetics with development of PPCs, but none of the biomarkers showed sufficient prognostic value. The use of high levels of PEEP was associated with increased levels of CC-16, suggesting lung overdistension. TRIAL REGISTRATION: The PROVHILO trial, including this substudy, was registered at clinicaltrials.gov (NCT01441791).

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Personal electronic device use in the operating room: A survey of usage patterns, risks and benefits

No abstract available

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Adverse effects of hyperchloraemic solutions

No abstract available

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Retraction: Comparison of four facial muscles, orbicularis oculi, corrugator supercilii, masseter or mylohyoid, as best predictor of good conditions for intubation: A randomised blinded trial. Lee HJ, Kim KS, Jeong JS, et al.

No abstract available

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Papilla and alveolar crest levels in immediate versus delayed single-tooth zirconia implants

Publication date: Available online 1 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): K. Kniha, H. Kniha, S.C. Möhlhenrich, S. Milz, F. Hölzle, A. Modabber
The aim of this study was to determine the correlation between the papilla deficit and the distance between the bone crest at the neighbouring tooth and the contact point of the clinical crown (distance 4) for immediate and delayed zirconia implants. This prospective observational study included 78 patients with 82 implants investigated at the 1-year follow-up. Patients received single-unit zirconia implants (Straumann PURE Ceramic Implant with ZLA surface) that were placed using either the delayed (group A) or immediate (group B) protocol after tooth extraction. The distance of the alveolar crest of the neighbouring tooth to the height of the interdental papilla and the absence of the papilla were also assessed. There was a strong correlation between the papilla deficit and distance 4 in group A (Spearman's rho=0.64). However, in group B, only a weak correlation between the two distances was found (Spearman's rho=0.28). A full soft tissue margin was generated when distance 4 was 7–8mm or less. Delayed implant placement showed a critical distance between the alveolar crest at the neighbouring tooth and the contact point of the crown risking a visible papilla deficit of between 7mm and 8mm.



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