Head and Neck Medicine by Alexandros G.Sfakianakis: 03/10/17

Παρασκευή 10 Μαρτίου 2017

Application of Ultrasound-guided Pigtail Catheter Drainage for Abscesses in the Head and Neck

Abstract

Abscesses in the head and neck are relatively common diseases with varied symptoms and severities. These abscesses are usually caused by upper respiratory infections, trauma, foreign bodies, postoperative infections, malignancies or dental infections.^1,2 The regions where abscesses can develop in the head and neck, include fascial planes and potential spaces such as submandibular, sublingual, submental, parapharyngeal, retropharyngeal, pretracheal, masticator or infratemporal areas.³

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Issue Information - Contents

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Cover Image

The cover image, by Lian Zhou and Wenlong Luo, is based on the Original Article Vascular endothelial growth factor-targeted paclitaxel-loaded liposome microbubbles and inhibition of human epidermoid-2 cell proliferation, DOI: 10.1002/hed.24648.

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Response to Tulchinsky and Avram re: “Long-Term Outcomes of Patients with Papillary Thyroid Cancer Undergoing Remnant Ablation with 30 Millicurie Radioiodine”

Thyroid , Vol. 0, No. 0.

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Vaccine Development

Viral Immunology , Vol. 0, No. 0.

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Influence of third molars in mandibular fractures. Part 1: mandibular angle—a meta-analysis

The aim of this systematic review was to investigate the influence of the presence and position of mandibular third molars on angle fractures. An electronic search was conducted in the PubMed, Scopus, Web of Science, Cochrane Library, and VHL databases, through January 2016. The eligibility criteria included observational studies. The search strategy resulted in 704 articles. Following the selection process, 35 studies were included in the systematic review and 28 in the meta-analysis. Twenty studies presented a score of ≤6 stars in the Newcastle–Ottawa scale assessment, indicating a risk of bias in the analysis.

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Refining the indications for scapula tip in mandibular reconstruction

Mandibular reconstruction in osteoradionecrosis or salvage surgery can often be complicated by the lack of suitable recipient vessels in the ipsilateral neck and the associated requirement for significant extraoral skin reconstruction. The scapula tip with its long vascular pedicle and option of a chimeric soft tissue component offers a versatile reconstructive solution in such cases. This article reports four consecutive cases of mandibular reconstruction with poor ipsilateral vascular options and additional soft tissue requirements in which the scapula tip was justified and preferred.

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Can gene editing and silencing technologies play a role in the treatment of head and neck cancer?

Publication date: May 2017
Source:Oral Oncology, Volume 68
Author(s): Mushfiq H. Shaikh, Daniel T.W. Clarke, Newell W. Johnson, Nigel A.J. McMillan
Conventional treatment strategies have done little to improve the prognosis or disease-free survival in head and neck cancer (HNC) patients. Recent progress in our understanding of molecular aspects of head and neck squamous cell carcinoma (HNSCC) has provided insights into the potential use of molecular targeted therapies in combination with current treatment strategies. Here we review the current understanding of treatment modalities for both HPV-positive and HPV-negative HNSCCs with the potential to use gene editing and silencing technologies therapeutically. The development of sequence-specific RNA interference (RNAi) with its strong gene-specific silencing ability, high target specificity, greater potency and reduced side effects, has shown it to be a promising therapeutic candidate for treating cancers. CRISPR/Cas gene editing is the newest technology with the ability to delete, mutate or replace genes of interest and has great potential for treating HNSCCs. We also discuss the major challenge in using these approaches in HNSCC; that being the choice of target and the ability to deliver the payload. Finally, we highlight the potential combination of RNAi or CRIPSR/Cas with current treatment strategies and outline the possible path to the clinic.

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Correlation of Crtc1/3-Maml2 fusion status, grade and survival in mucoepidermoid carcinoma

Publication date: May 2017
Source:Oral Oncology, Volume 68
Author(s): Andrew C. Birkeland, Susan K. Foltin, Nicole L. Michmerhuizen, Rebecca C. Hoesli, Andrew J. Rosko, Serena Byrd, Megan Yanik, Jacques E. Nor, Carol R. Bradford, Mark E. Prince, Thomas E. Carey, Jonathan B. McHugh, Matthew E. Spector, J. Chad Brenner
ObjectiveMucoepidermoid carcinoma (MEC) is the most common malignant tumor of the salivary glands. Tumor stage and grade have historically been important predictors of survival. An oncogenic CRTC1- or CRTC3-MAML2 gene fusion has been identified in a number of MECs. Historically, these gene fusions have been associated with lower grade tumors and better survival. However, reported gene fusion rates and prognosis varies widely across studies, and have not controlled for tumor grade. We sought to identify gene fusion rates and outcomes in our cohort of MEC patients.Materials and methodsAn IRB-approved retrospective cohort of patients with MEC was identified at the University of Michigan. Clinical, histologic, and outcome data was collected from medical records. RNA was isolated from formalin fixed paraffin-embedded tumor sections, and qRT-PCR was performed to identify CRTC1/3-MAML2 gene fusions. Sanger sequencing of qRT-PCR products was used to confirm gene fusions.ResultsOverall, 90 patient MEC tumors were collected (58 low-grade, 25 intermediate-grade, and 7 high-grade). Gene fusions were identified in 59% (53/90) of tumors. On univariate and bivariate analysis, fusion status did not significantly associate with grade or survival.ConclusionWe have identified a high rate of CRTC1/3-MAML2 gene fusions in a large cohort of MEC. We do not identify any correlation between fusion status with tumor grade or survival. These findings suggest further characterization of MECs is needed before considering the CRTC1/3-MAML2 gene fusion as a prognostic biomarker. Additional genetic drivers may account for survival and grade in MECs.

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Close surgical margin after conservative parotidectomy in early stage low-/intermediate-grade parotid carcinoma: Outcome of watch and wait policy

Publication date: May 2017
Source:Oral Oncology, Volume 68
Author(s): Dominik Stodulski, Bogusław Mikaszewski, Hanna Majewska, Piotr Wiśniewski, Czesław Stankiewicz
AimThe aim of the study was to assess the watch&wait strategy for management of patients with close surgical margin after conservative parotidectomy due to early low/intermediate grade parotid carcinoma.Patients and methodsOut of 78 patients operated on due to primary parotid gland cancer we selected 32 patients with a history of parotidectomy, and preservation of 7th nerve, with negative (≥1mm), but close (≤5mm) surgical margin and who did not receive supplementary radiotherapy due to other indications. Margins ranged from 1 to 3mm (in 27 cases it was 1mm, in 3 cases – 2mm and in 2 cases – 3mm), average 1.2mm. The patients underwent further clinical-histological analysis.Results3 of 32 (9.38%) patients experienced a local recurrence 36, 53 and 56months post-surgery. The 5-year disease-free survival (DFS) was 90.6%. Recurrences were treated surgically, followed by radiotherapy, which resulted in an overall survival of 107, 104 and 104months. One patient died 72months after surgery due to non-oncological causes. The 10-year disease-free survival (DFS) was 96.3%. The 3 patients with recurrence of cancer had histological diagnosis of epithelial-myoepithelial carcinoma LG, with a margin of 2, 1 and 3mm, respectively. There were no other distinctive features.ConclusionThe watch&wait strategy with intensive follow-up seems justified in cases of close margin after excision of I/LG T1/T2 parotid tumors. EMC should be considered as a neoplasm associated with higher risk of recurrence.

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Isotretinoin treatment for acne and risk of depression: A systematic review and meta-analysis

The relationship between isotretinoin treatment for acne and depression is controversial. Quantitative analysis has not yet been conducted.

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Clinical similarity of biosimilar ABP 501 to adalimumab in the treatment of patients with moderate to severe plaque psoriasis: A randomized, double-blind, multicenter, phase III study

ABP 501 is a biosimilar of adalimumab.

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Transoral surgery vs intensity-modulated radiotherapy for early supraglottic cancer: a systematic review

Purpose of review: To provide clinicians with a critical review of outcomes for endolaryngeal surgery and intensity-modulated radiation therapy (IMRT) for early-stage supraglottic cancer. Recent findings: A total of 971 potential articles were reviewed, with inclusion of 14 studies comparing IMRT with transoral surgery. One study analyzed IMRT, one transoral robotic surgery, and the remaining were transoral laser microsurgery studies. A weighted average and 95% confidence interval of all surgery patients showed a local control of 90.36 ± 1.14% (n = 118) for T1 lesions, 83.09 ± 1.36% (n = 232) for T2 lesions, and 86.38 ± 0.82% (n = 429) overall. The one study examining IMRT outcomes reported a local control of 70 ± 10.07% and overall survival of 63% over 5 years for T2 lesions (n = 78), with no reported T1 data or secondary outcomes. Summary: Endolaryngeal surgery as definitive therapy for T1 and T2 supraglottic cancer has excellent local control. Although endolaryngeal surgery performed better than IMRT, the data are limited, and a definitive comparison with surgery cannot be made. Additional studies are required.

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Conservative surgery for laryngeal chondrosarcoma: a review of the most recently proposed approaches

Purpose of review: The aim of this study was to describe the most recent technical nuances for resection and reconstruction of Grade 1 and 2 laryngeal chondrosarcomas, with a special emphasis on those located at the level of the cricoid plate, which is the site of origin of the vast majority of these rare tumours. Recent findings: Even though inherently based on retrospective small clinical series or anecdotal case reports, a number of studies have been recently published focusing on conservative transoral and open-neck surgical procedures aimed at an oncologically sound removal of the tumour together with organ and function preservation. The open-neck conservative approaches herein reported can be roughly distinguished in those achieving a primary airway reconstruction by a tracheo-hyoido-epiglottopexy or an end-to-end crico-tracheal, thyro-crico-tracheal or thyro-tracheal anastomosis, and those requiring a single or double-staged transposition of different microvascular flaps, with or without cartilaginous graft insertion, to reconstruct a subtotal/total cricoidectomy and obtain a rigid and stable subglottic airway. Summary: No meaningful comparison in terms of oncologic and functional outcomes is still possible among the currently available conservative surgical strategies, due to the rarity of laryngeal chondrosarcomas and the heterogeneity of treatments proposed in the literature. However, a reasonable algorithm to approach this difficult clinical entity according to its site of origin and extent of cricoid circumference involved is herein presented.

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Open partial laryngectomy after failure of (chemo) radiation: indications, oncologic and functional outcomes

Purpose of review: Early-stage squamous cell carcinoma of the larynx can be successfully treated with radiotherapy or surgery (transoral or open approaches). Oncologic results are comparable while functional results may be different according to the volume of resection. In some countries radiotherapy is often preferred as primary treatment. In case of recurrence, surgical salvage is the only option. Careful examination, endoscopic assessment, computed tomography or magnetic resonance imaging are necessary to assess superficial and deep extensions into the larynx, including cartilage framework and to restage the tumor. Recent findings: The choice between endoscopic and open partial laryngectomy is based on the extension and characteristics of the tumor. Oncologic results of open approaches are encouraging as local control, survival, and laryngeal preservation rates reported in the literature are close to those obtained in nonpreviously treated patients. Functional results are not significantly worse and major complications in the previously irradiated patients undergoing open neck surgery not increased. Supracricoid partial surgery seems to be more and more performed. Summary: With regards to the results, open partial surgery, like in nonpreviously treated patients, is still indicated for the surgical treatment of postradiotherapic recurrent/persistent disease.

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Swallowing after transoral surgery for oropharyngeal cancer: comparison with primary chemoradiotherapy outcomes

Purpose of review: Survival equipoise is recognized between the contemporary surgical and oncological approaches to oropharyngeal squamous cell carcinoma treatment. Primary transoral surgery (TOS) options have emerged that utilize either laser or robotic techniques. Our review presents an overview of the evidence available for swallowing outcomes following TOS approaches and compares these with outcomes following primary oncological management. Recent findings: Meta-analysis of swallow outcomes following TOS or (chemo)radiotherapy is not possible given the heterogeneity of the available data. There are suggestions of less swallowing impairment following primary TOS, but the favourable selection of patients to these case series must be considered. Summary: Minimizing swallowing impairment following oropharyngeal squamous cell carcinoma treatment, while ensuring oncological efficacy, should be a priority for head and neck healthcare providers. Primary TOS may offer an advantage to patients, but only through a team approach that considers how adjuvant oncological therapy could be tailored to individuals. High-quality clinical trials are in progress that will inform future practice.

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Adenoid cystic carcinoma evaluation and management: progress with optimism!

Purpose of review: Adenoid cystic carcinoma (ACC) when diagnosed presents several diagnostic and treatment challenges. The standard treatment of surgery and postoperative radiotherapy has remained the standard of care for the past 3 decades. The purpose of this review is to update what's been reported and what's new since the last review in 2004. Recent findings: As accurate a histological diagnosis and staging of disease should be achieved prior to commencing any treatment. Patients' prognosis, in the long term, is determined by the finding of any solid tumour component in the examined excised specimen. The continued treatment of patients with ACC by surgery and postoperative radiotherapy has not changed in the long-term tumour-free outcome of patients. The majority of patients die because of loco-regional failure and/or distant metastases. Optimism is being generated by the findings at the molecular and genetic level of ACC giving hope that nonsurgical treatment can be complemented by novel treatments that will improve patients' disease cure and improved long-term survival. Summary: The histological grading determined by optical methods has not advanced our selection of treatment and new recent research findings on molecular and genetic factors give new hopes to changing the ACC classification, determining differing treatments and thus influencing an improved and prolonged tumour-free survival for more patients.

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Is p16 an adequate surrogate for human papillomavirus status determination?

Purpose of review: In head and neck cancer management, immunoexpression of protein p16 is widely used as a surrogate marker for human papillomavirus (HPV) positivity due to challenges of direct HPV testing. Previously p16 has been reported to have good sensitivity but only moderate specificity in HPV-status determination. The aim of this review is to evaluate the existing information on sensitivity and specificity of p16 immunohistochemistry (IHC) in HPV-status determination among the recent studies. Recent findings: We searched the time period from October 2014 to April 2016 and included 28 studies (a total of 31 analyses), which reported both p16 and HPV status in their series. The sensitivity of p16 in HPV determination ranged between 28.2 and 100.0%. The mean and median sensitivities were 90.5 and 95.4%, respectively. The specificity ranged between 31.1 and 100.0%. The mean and median specificities were 83.3 and 87.3%, respectively. Summary: Our review presents current information on the feasibility of p16 IHC in HPV status determination, which is in line with previous studies. Patients with HPV-positive tumors can be identified with p16 IHC, but a risk for misclassification of HPV-negative tumors as HPV positive exists. This fact has to be taken into consideration if HPV status will influence treatment planning.

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Editorial introduction

No abstract available

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Different branching patterns of the spinal accessory nerve: impact on neck dissection technique and postoperative shoulder function

Purpose of review: Despite nerve-sparing surgery, postoperative shoulder morbidity remains high and significantly impacts patient's quality of life. This review will focus on recent findings of anatomical nuances of the cranial nerve XI (CN XI) along its course in the neck and possible reasons for postoperative morbidity. Recent findings: The most recent studies identified three different branching patterns of the CN XI in the neck. In type 1 (66%), the branch for trapezius muscle exits at the posterior border of the sternocleidomastoid muscle (mSCM). In type 2 (22%), the branch for trapezius muscle takes off from the common trunk of the CN XI before it enters the mSCM. In type 3 (12%), the motor branch for trapezius muscle exits behind posterior border of mSCM but takes a more medial course to form macroganglia with cervical nerves. Cervical nerves may also contribute to innervation of the trapezius muscle in up to 39% of the cases, but the clinical importance of those connections is not known. Summary: If these anatomical patterns are not recognized and if cervical nerves are resected during neck dissection, shoulder morbidity remains high. The role of cervical nerves in innervation of the trapezius muscle is still controversial and unpredictable.

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Hypoparathyroidism after thyroidectomy: prevention, assessment and management

Purpose of review: Permanent hypoparathyroidism is the most common long-term complication after total thyroidectomy and it can cause significant morbidity and increased costs. Its incidence varies from 30% to 60%. Recent findings: The surgical technique and the extent of thyroidectomy are related to parathyroid injury and hypoparathyroidism. The glands should be identified in situ, carefully manipulated and preserved, as well as their vascularization. In case of incidental removal, routine autotransplantation is advocated. Low calcium levels, identification of fewer than two parathyroid glands at surgery, reoperation for bleeding, Graves disease and heavier thyroid specimens were considered independent predictors of permanent hypocalcemia. Intraoperative parathyroid hormone (PTH) measurements allows the early detection of hypocalcemia. Treatment is recommended for patients with symptoms of hypocalcemia or corrected serum calcium

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Ex utero intrapartum treatment (EXIT) for upper airway obstruction

Purpose of review: Improvements in the antenatal diagnosis of congenital malformations have led to increased detection of fetal airway obstructing lesions, and pediatric ear, nose, and throat surgeons are increasingly involved in these cases. Recent findings: This article outlines the typical range of pathology seen, the logistics in providing support for anticipated deliveries and the multidisciplinary management of complex airway cases. Summary: Traditionally, difficulty in obtaining a patent airway at delivery was a major factor in the dismal prognosis of these pregnancies. The ex utero intrapartum treatment procedure, which involves controlled partial delivery of the fetus whilst maintaining placental circulation, allows various airway maneuvers to be performed to secure the airway in a controlled fashion.

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Genetic signature and profiling of head and neck cancer: where do we stand?

Purpose of review: To focus on two novel aspects of head and neck squamous cell carcinoma (HNSCC) genetics of special interest: the epithelial–mesenchymal transition (EMT) process, an initial step in tumor progression that finally leads to metastasis formation, by explaining how genes as well as epigenetic factors control this process, and the new diagnostic options based on the analysis of circulating tumor cells (CTCs) and cell-free DNA (cfDNA) that could revolutionize diagnosis in the coming years. Recent findings: We present an intriguing recently described group of factors, namely miRNAs, deregulated during EMT. MiRNAs could serve as novel markers of EMT and metastasis formation and are also a potential therapeutic target. Second, we show recent findings on CTC and cfDNA analysis in HNSCC that demonstrate the usefulness of this new diagnostic approach. Summary: We stress the importance of EMT in the context of metastasis formation and the potential of liquid biopsies in clinical practice.

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Supratracheal partial laryngectomy: indications, oncologic and functional results

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

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Utilization of ultrasound for diagnostic evaluation and management of peritonsillar abscesses

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

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Primary Burkitt lymphoma of the supraglottic larynx: a case report and review of the literature

Burkitt lymphoma is a high-grade B cell lymphoma which accounts for less than 1% of all adult cases of non-Hodgkin lymphoma. Rare instances of Burkitt lymphoma developing secondary to prior irradiation have be...

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Molecular mechanisms of therapy resistance in solid tumors: chasing “moving” targets

Abstract

The goal of personalized cancer therapy is to treat tumors based on genomic aberrations that drive their survival and progression. Most patients who receive targeted therapies typically develop resistance and disease progression within a year's time. This review focuses on the heterogeneous mechanisms of therapy resistance to tyrosine kinase inhibitors, endocrine/hormone therapy and checkpoint blockade using non-small cell lung cancer, breast and castration-resistant prostate cancer, and melanoma as classical examples, respectively. In addition, testing for resistance mechanisms and therapeutic approaches to overcoming resistance is addressed.

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A novel skin traction method to facilitate ultrasound-guided femoral nerve block in morbidly obese patients

An ultrasound-guided peripheral nerve block is difficult to perform in morbidly obese patients, particularly those who require catheter placement, due to the amount of subdermal adipose tissue [1]. The skin traction method is reportedly useful for central venous catheter placement in pediatric cases [2]. Here, we propose the use of skin traction to perform a peripheral femoral nerve block.

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The effect of morphine added to bupivacaine in ultrasound guided transversus abdominis plane (TAP) block for postoperative analgesia following lower abdominal cancer surgery, a randomized controlled study

Transversus abdominis plane (TAP) block used for management of surgical abdominal pain by injecting local anesthetics into the plane between the internal oblique and transversus abdominis muscles. We aimed to explore the effect of adding morphine to bupivacaine in ultrasound guided TAP-block in patients undergoing lower abdominal cancer surgery.

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Temperature evolution of preheated irrigant injected into a root canal ex vivo

Abstract

Objectives

The aim of this study is to test the influence of the temperature of the surrounding medium, flow rate, duration of irrigation, and apical patency on the evolution of the temperature of irrigants injected in a root canal.

Materials and methods

Thermocouples were inserted into an incisor at different positions to monitor irrigant temperature during and after injection at 21, 45, or 60 °C. The tooth was immersed in a water bath at 21 and 37 °C.

Results

Preheated syringes were used for up to 2.5 min before being cooled down from 60 to below 45 °C. The irrigant temperature was higher apically than at coronal levels (P ≤ 0.028). The duration of irrigation had no influence on the average temperatures during delivery (P ≥ 0.337), but the apical patency lowered the intracanal temperature (P = 0.004). The highest temperature measured on the outside of the tooth was 39 °C.

Conclusions

Preheating the irrigant at 60 °C resulted in temperatures higher than 45 °C throughout the root canal, during irrigant delivery. After completion, the temperature dropped rapidly.

Clinical relevance

These results contribute to a better understanding of the optimum irrigant delivery time at given temperature, the cooling rate of irrigant in the syringe, and the influence of heated irrigant temperature in the periodontium, which should guide the preheated syringe turnover.

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Anesthetic and Analgesic Management for Outpatient Knee Arthroplasty

Abstract

Purpose of Review

Total knee arthroplasty traditionally has been associated with significant postoperative pain that can limit recovery and prolong hospital length of stay. Recently, however, due to financial pressures and an emphasis on improving patient satisfaction, many institutions are implementing outpatient and short-stay programs for patients undergoing this procedure. An effective perioperative anesthetic plan is an essential quality of a successful outpatient joint replacement program.

Recent Findings

Improved technology and innovation has led to more effective and efficient strategies that contribute to a smoother and quicker postoperative course. The use of peripheral nerve blocks in conjunction with a variety of systemic analgesics has reduced post-operative pain compared to older modalities. Specifically, the adductor canal and IPACK blocks have become increasingly popular due to their analgesic efficacy and muscle sparing characteristics.

Summary

Outpatient knee arthroplasty is becoming a reality with advancements in surgical pathways that incorporate these newer modalities with an emphasis on multidisciplinary coordination.

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Behavioral Treatments for Post-Traumatic Headache

Abstract

Purpose of Review

Post-traumatic headache (PTH) is a common headache type after traumatic brain injury (TBI). There are no FDA approved medications for PTH, and it is unknown how medications can affect the brain's ability to recover from TBI. Thus, we sought to examine the biopsychosocial factors that influence PTH and the non-pharmacologic treatments studied for headache treatment. We also sought to determine if there is literature examining whether the non-pharmacologic treatments influence the biopsychosocial factors. The non-pharmacologic treatments assessed included cognitive behavioral therapy (CBT), biofeedback, progressive muscle relaxation therapy (PMR), acupuncture, and physical therapy (PT).

Recent Findings

Factors associated with prognosis in PTH may include the following: severity of TBI, stress, post-traumatic stress disorder, other psychiatric comorbidities, sociocultural and psychosocial factors, litigation, base rate misattribution, expectation as etiology, and chronic pain. There are few high quality studies on the non-pharmacologic treatments for PTH. Thermal and EMG biofeedback appear to have been examined the most followed by CBT. Studies did not have secondary outcomes examining the psychosocial factors related to PTH.

Summary

Most of the behavioral studies involved a multi-modality intervention limiting the ability to assess the individual non-pharmacologic interventions we sought to study. There were very few randomized clinical trials evaluating the efficacy of non-pharmacologic interventions. Therefore, future research, which considers the noted biopsychosocial factors, is needed in the field to determine if these interventions reduce PTH.

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Techniques to Optimize Multimodal Analgesia in Ambulatory Surgery

Abstract

Purpose of Review

Ambulatory surgery has grown in popularity in recent decades due to the advancement in both surgical and anesthetic techniques resulting in quicker recovery times, fewer complications, higher patient satisfaction, and reduced costs of care. We review common approaches to multimodal analgesia.

Recent Findings

A multimodal approach can help reduce perioperative opioid requirements and improve patient recovery. Analgesic options may include NSAIDs, acetaminophen, gabapentinoids, corticosteroids, alpha-2 agonists, local anesthetics, and the use of regional anesthesia.

Summary

We highlight important aspects related to pain management in the ambulatory surgery setting. A coordinated approach is required by the entire healthcare team to help expedite patient recovery and facilitate a resumption of normal activity following surgery. Implementation and development of standardized analgesic protocols will further improve patient care and outcomes.

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Myeloid cells in circulation and tumor microenvironment of breast cancer patients

Abstract

Pathological conditions including cancers lead to accumulation of a morphological mixture of highly immunosuppressive cells termed as myeloid-derived suppressor cells (MDSC). The lack of conclusive markers to identify human MDSC, due to their heterogeneous nature and close phenotypical and functional proximity with other cell subsets, made it challenging to identify these cells. Nevertheless, expansion of MDSC has been reported in periphery and tumor microenvironment of various cancers. The majority of studies on breast cancers were performed on murine models and hence limited literature is available on the relation of MDSC accumulation with clinical settings in breast cancer patients. The aim of this study was to investigate levels and phenotypes of myeloid cells in peripheral blood (n = 23) and tumor microenvironment of primary breast cancer patients (n = 7), compared with blood from healthy donors (n = 21) and paired non-tumor normal breast tissues from the same patients (n = 7). Using multicolor flow cytometric assays, we found that breast cancer patients had significantly higher levels of tumor-infiltrating myeloid cells, which comprised of granulocytes (P = 0.022) and immature cells that lack the expression of markers for fully differentiated monocytes or granulocytes (P = 0.016). Importantly, this expansion was not reflected in the peripheral blood. The immunosuppressive potential of these cells was confirmed by expression of Arginase 1 (ARG1), which is pivotal for T-cell suppression. These findings are important for developing therapeutic modalities to target mechanisms employed by immunosuppressive cells that generate an immune-permissive environment for the progression of cancer.

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Phenotype and function of tumor-associated neutrophils and their subsets in early-stage human lung cancer

Abstract

Neutrophils accumulate in many types of human and murine tumors and represent a significant portion of tumor-infiltrating myeloid cells. Our current understanding of the role of neutrophils in tumor development has depended primarily on murine models of cancer. However, there are crucial species differences in the evolution of tumors, genetic diversity, immune and inflammatory responses, and intrinsic biology of neutrophils that might have a profound impact on the tumor development and function of neutrophils in mouse versus human tumors. To date, the majority of experimental approaches to study neutrophils in cancer patients have been limited to the examination of circulating blood neutrophils. The phenotype and function of tumor-associated neutrophils (TANs) in humans, particularly in the early stages of tumor development, have not been extensively investigated. Thus, the long-term goal of our work has been to characterize human TANs and determine their specific role in tumor development. Here, we summarize our findings on human TANs obtained from human early stage lung cancer patients. We will describe the phenotypes of different TAN subsets identified in early stage lung tumors, as well as their functional dialog with T cells.

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Management of the Asthma-COPD Overlap Syndrome (ACOS): a Review of the Evidence

Abstract

Purpose of Review

Examine the definition of the asthma-COPD overlap syndrome (ACOS) and current treatment strategies.

Recent Findings

Patients with the ACOS have a lower quality of life and suffer from more complications than those affected by either disease alone. Diagnosis of ACOS is difficult because of the clinical similarities between the two diseases and the various phenotypes that comprise the syndrome. Defining treatment strategies for ACOS has been challenging because many clinical trials for asthma therapy have purposefully excluded patients with features of COPD, and COPD clinical trials have not included patients who might have an asthmatic component to their disease. Therefore, there are few randomized treatment trials which have included patients who have ACOS.

Summary

Smoking cessation and appropriate vaccinations are cornerstone therapies, and pharmacologic therapy has focused on bronchodilators and inhaled corticosteroids. The role of biologics, such as omalizumab and IL-5 antagonists, in ACOS treatment is still being defined. As of now, with the paucity of randomized control trials guiding treatment strategies, the Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend treating ACOS according to the dominant phenotype.

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The Role of Human Parainfluenza Virus Infections in the Immunopathology of the Respiratory Tract

Abstract

Viral infections are leading causes of both upper and lower airway acute illness in all age groups of healthy persons, and have also been implicated in the acute exacerbations of chronic respiratory disorders like asthma and COPD. Human rhinovirus, respiratory syncytial virus, influenza virus and coronavirus have been considered as the most important respiratory pathogens and relatively little attention has been paid to the role of parainfluenza viruses (hPIVs). Human parainfluenza viruses are single-stranded RNA viruses belonging to the paramyxovirus family that may evoke lower respiratory infections in infants, children and immunocompromised individuals. Among non-immune compromised adults, hPIV infection typically causes mild disease manifested as upper respiratory tract symptoms and is infrequently associated with severe croup or pneumonia. Moreover, hPIV infection may be associated with viral exacerbations of chronic airway diseases, asthma or COPD or chronic rhinosinusitis. In this review, we summarized the basic epidemiology and immunology of hPIVs and addressed the more recent data implicating the role of parainfluenza viruses in the exacerbation of chronic airway disorders.

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Advances in Absorbable Biomaterials and Nasal Packing

Nasal biomaterials have been developed to improve postoperative outcomes after functional endoscopic sinus surgery (FESS). These products have been designed to overcome certain common complications in FESS, and to maximize patient comfort. This article evaluates the performance of nonabsorbable and absorbable packing with respect to these outcomes. The collected trials suggest superior performance of bioabsorbable packs compared with absorbable packs with respect to patient comfort. For hemostasis and wound healing, variation in performance metrics makes interstudy comparison difficult. Before further trials are conducted, consensus must be reached among rhinologists as to the proper method of evaluating these products.

http://ift.tt/2m8gGoe

Effects of photodynamic laser and violet-blue led irradiation on Staphylococcus aureus biofilm and Escherichia coli lipopolysaccharide attached to moderately rough titanium surface: in vitro study

Abstract

Effective decontamination of biofilm and bacterial toxins from the surface of dental implants is a yet unresolved issue. This study investigates the in vitro efficacy of photodynamic treatment (PDT) with methylene blue (MB) photoactivated with λ 635 nm diode laser and of λ 405 nm violet-blue LED phototreatment for the reduction of bacterial biofilm and lipopolysaccharide (LPS) adherent to titanium surface mimicking the bone-implant interface. Staphylococcus aureus biofilm grown on titanium discs with a moderately rough surface was subjected to either PDT (0.1% MB and λ 635 nm diode laser) or λ 405 nm LED phototreatment for 1 and 5 min. Bactericidal effect was evaluated by vital staining and residual colony-forming unit count. Biofilm and titanium surface morphology were analyzed by scanning electron microscopy (SEM). In parallel experiments, discs coated with Escherichia coli LPS were treated as above before seeding with RAW 264.7 macrophages to quantify LPS-driven inflammatory cell activation by measuring the enhanced generation of nitric oxide (NO). Both PDT and LED phototreatment induced a statistically significant (p < 0.05 or higher) reduction of viable bacteria, up to −99 and −98% (5 min), respectively. Moreover, besides bactericidal effect, PDT and LED phototreatment also inhibited LPS bioactivity, assayed as nitrite formation, up to −42%, thereby blunting host inflammatory response. Non-invasive phototherapy emerges as an attractive alternative in the treatment of peri-implantitis to reduce bacteria and LPS adherent to titanium implant surface without causing damage of surface microstructure. Its efficacy in the clinical setting remains to be investigated.

http://ift.tt/2m9BA6g

Effect of photobiomodulation therapy (808 nm) in the control of neuropathic pain in mice

Abstract

Neuropathic pain can be defined as the pain initiated or caused by a primary lesion or dysfunction of the central or peripheral nervous system. Photobiomodulation therapy (PBM) stands out among the physical therapy resources used for analgesia. However, application parameters, especially the energy density, remain controversial in the literature. Therefore, this study aimed to investigate the PBM effect, in different energy densities to control neuropathic pain in mice. Fifty (50) mice were induced to neuropathy by chronic constriction surgery of the sciatic nerve (CCI), treated with PBM (808 nm), and divided into five groups: GP (PBM simulation), GS (sham), GL10, GL20, GL40 (energy density of 10, 20, and 40 J/cm², respectively). The evaluations were carried out using the hot plate test and Randall and Selitto test, before and after the CCI surgery, every 15 days during the 90 days experiment. β-Endorphin blood dosage was also tested. For both the hot plate and Randall and Selitto tests, the GL20 and GL40 groups presented reduction of the nociceptive threshold from the 30th day of treatment, the GL10 group only after day 75, and the GP group did not show any improvement throughout the experiment. The β-endorphin dosage was higher for all groups when compared to the GP group. However, only the GL20 group and GL40 presented a significant increase. This study demonstrates that PBM in higher energy density (20, 40 J/cm²) is more effective in the control of neuropathic pain.

http://ift.tt/2n8yjZV

Patterns of non-syndromic permanent tooth agenesis in a large orthodontic population

Publication date: July 2017
Source:Archives of Oral Biology, Volume 79
Author(s): Nikolaos Gkantidis, Hattan Katib, Elias Oeschger, Marina Karamolegkou, Nikolaos Topouzelis, Georgios Kanavakis
ObjectiveThe aim of this study is to explore patterns of non-syndromic permanent tooth agenesis in a large orthodontic patient group.DesignA record review was performed in various orthodontic clinics to identify white patients with non-syndromic permanent tooth agenesis, excluding 3rd molars. Four hundred and fourteen subjects fulfilled the inclusion criteria.ResultsIn the 414 subjects with tooth agenesis, approximately 70% presented 1–2 missing teeth. Symmetric agenesis patterns were often observed in the sample (by jaw, by side, or crossed quadrants), with prevalence approaching 30% for cases with contralateral tooth agenesis within a jaw. In cases with 1 or 2 missing teeth, from the total number of potential tooth agenesis patterns in the sample, a certain part was evident, limiting the variation to 27.8% (44/158). In the entire sample, both in the maxilla and the mandible a certain incisor/premolar agenesis phenotype was observed in 59.0% of cases in isolated form.ConclusionsAlthough there was variation in the tooth agenesis patterns, our findings suggest the involvement of particular genetic, epigenetic, and/or environmental factors in the formation of the entire dentition, which often lead to specific tooth agenesis phenotypes in cases where this process is disrupted.The present study provides a comprehensive categorization of orthodontic cases with tooth agenesis and can assist in planning future epidemiological and genetic studies.

http://ift.tt/2msQ6YJ

Patterns of non-syndromic permanent tooth agenesis in a large orthodontic population

Lokaltherapie der Kopfhaut

Zusammenfassung

Die topische Applikation von Wirksubstanzen auf die Kopfhaut wird bei einer Vielzahl von sog. Haarerkrankungen bzw. Systemdermatosen mit Kopfhautbeteiligung sowie bei Parasitosen praktiziert. Besonderheiten für galenische Konzepte ergeben sich insbesondere aus dem lokoregionär typischen dichten Besatz mit Haarfollikeln und den sich daraus ableitenden besonderen Diffusionsbedingungen, die je nach therapeutischem Ziel stark variieren können. Die Auswahl einer geeigneten Grundlage orientiert sich dabei vordergründig an den physikochemischen Eigenschaften der Wirksubstanz sowie der Beschaffenheit des Applikationsareals. Von Bedeutung für das therapeutische Konzept sind dabei v. a. Behaarung, Vernarbung, Hyperkeratose und Exoserose. Häufig werden niedrigviskose Grundlagen oder Schäume für die Applikation bevorzugt, da diese eine günstige Spreitbarkeit aufweisen. Darüber hinaus können geeignete Applikationshilfen in Form von Rüssel- oder Kammtüllen auf dem Endpackmittel die Akzeptanz und Anwenderfreundlichkeit der Topika unterstützen.

http://ift.tt/2msrGP5

The freeze thaw cycle in cryosurgery – Response to Dr. David Buckley

Abstract

I thank Dr. Buckley, an experienced cryosurgeon, for his kind letter. Indeed, cryosurgery is a powerful therapeutic regimen for virus-induced epithelial diseases, precancerous skin lesions and superficial epithelial tumors in the hands of physicians experienced in cryosurgery (1).

The unti recently published findings on the treatment of actinic keratoses with cryosurgery neither correspond to the clinical experience of Dr. Buckley nor to mine. This is probably the reason that led Dr. Buckley to propose a more detailed procedure of the treatment of actinic keratoses with cryosurgery.

http://ift.tt/2m93sHL

Topical corticosteroids application in the evening is more effective than in the morning in psoriasis: comment

Abstract

We read with great interest the article by Nguyen et al. published ahead-of-print in Journal of the European Academy of Dermatology and Venereology entitled, 'Topical corticosteroids application in the evening is more effective than in the morning in psoriasis'.¹ The authors suggested that the efficacy of topical corticosteroids application in the evening is better than in the morning. However, we wish to make some comments on this article.

Firstly, the application of topical corticosteroids for each patient can be more precisely. In their study, they prescribed a daily total of three to five tubes of betamethasone ointment according to body surface area (BSA) (three tubes for BSA≤1.5 m², four tubes for BSA 1.5-2 m², five tubes for BSA≥2 m²).

http://ift.tt/2mQLKwY

Topical corticosteroids application in the evening is more effective than in the morning in psoriasis: in reply

Abstract

On behalf of all coauthors, we would like to thank Dr Gu and Dr Mi for their interest in our publication [1]. We acknowledge that a given number of finger-tip units according to the body surface area (BSA) is more precise than a number of tubes of corticosteroids according to BSA as we used in our study. However, the mean BSA was 1.91 in group A and 1.96 in group B and the total quantity of corticosteroids tubes used in the two groups was not statistically different (p=0.197).

http://ift.tt/2m95Zl8

Re: The freeze thaw cycle in cryosurgery

Abstract

I agree with Professor Zouboulis, in his article ''Is Cryosurgery Less Effective than Conservative Regimes in the Treatment of Actinic Keratosis?'' (1), when he argures that success rate when treating actinic keratosis with cryosurgery varies widely, largely because of a wide variation in the technique used. I have consistently achieved greater than 90% cure rates when using liquid nitrogen cryosurgery via a cryogun in the treatment of actinic keratosis, hand warts and plantar warts (2 and 3). As far back as 1982, Lubritze and colleagues were achieving a cure rate of greater than 98% after one year when treating actinic keratosis with liquid nitrogen cryosurgery (4).

http://ift.tt/2mQMn9Q

Anti-PD-1 / PD-L1-induced psoriasis from an oncological perspective

Abstract

We read with interest the letter to the editor by Bonigen et al¹ regarding the development of psoriasis during anti-programed cell death protein 1 (PD-1) therapy. The authors describe a series of 17 patients diagnosed with melanoma or lung cancer treated with anti-PD-1 drugs in first line or later. In the final analysis, they also include 4 patients previously described in the literature.

http://ift.tt/2m9jf9B

Noncirrhotic portal hypertension in necrobiotic xanthogranuloma associated with monoclonal gammopathy

Abstract

We report two cases of patients with necrobiotic xanthogranuloma (NXG) associated with monoclonal gammopathy. Besides cutaneous lesions, they both presented idiopathic non-cirrhotic portal hypertension (INCPH).

In 2007, a 65-year-old woman was referred for nodular eruption (Fig. 1 – A) located around the neck. Cervical skin biopsy showed normal epidermis and a layer of inflammatory elements on the reticular dermis.

http://ift.tt/2mQLJZW

Rapid Improvements in Health-related Quality of Life and Itch with Ixekizumab Treatment in Randomized Phase 3 Trials: Results from UNCOVER-2 and UNCOVER-3

Abstract

Background

Patients with moderate-to-severe psoriasis report impaired health-related quality of life (HRQoL).

Objective

To assess speed of onset of ixekizumab-induced clinically relevant improvement in HRQoL.

Methods

This post-hoc analysis used pooled data from patients randomized in UNCOVER-2 and UNCOVER-3, and treated with 80 mg ixekizumab every 2 weeks (IXEQ2W), 80 mg ixekizumab every 4 weeks (IXEQ4W), 50 mg etanercept (ETN) twice weekly, or placebo (PBO) for 12 weeks. HRQoL and pruritus were assessed using the Dermatology Life Quality Index (DLQI) and Itch Numeric Rating Scale (NRS), respectively. Minimally clinical important differences (MCID) in DLQI and Itch NRS were defined as ≥ 5-point and ≥ 4-point improvements from baseline, respectively. Time to response from randomization was estimated using Kaplan-Meier methodology and the log-rank test. Hazard ratios between treatments were calculated using a Cox proportional hazards regression model adjusting for studies.

Results

A total of 2570 patients were included: 361 PBO; 740 ETN; 733 IXEQ4W; and 736 IXEQ2W. Significantly greater differences in time to DLQI ≥5 point or Itch NRS ≥4 point improvement for IXEQ2W or IXEQ4W compared to ETN and PBO (P<.001) were observed. The median time when 50% of patients reached a ≥ 5-point reduction in DLQI was shorter for ixekizumab-treated patients (2 weeks, both schedules) compared to ETN- (4 weeks) or PBO-treated (> 12 weeks) patients. Likewise, the median time when 50% of patients reached a ≥ 4-point reduction in Itch NRS was significantly shorter for ixekizumab-treated patients (2 weeks, both schedules) compared to ETN- (8 weeks) or PBO-treated (> 12 weeks) patients. Significantly more ixekizumab-treated patients were likely to achieve MCIDs in DLQI or itch reduction compared to ETN or PBO after 12 weeks of treatment.

Conclusion

Ixekizumab-treated patients achieved more rapid improvements both in HRQoL and itch compared to patients treated with ETN and PBO.

http://ift.tt/2m9dAAg

Chronic Urticaria in the Real-life Clinical Practice Setting in Sweden, Norway and Denmark: Baseline Results from the Non-Interventional Multicentre AWARE Study

Abstract

Background

Chronic urticaria (CU) is characterised by the recurrence of itchy hives and/or angioedema for more than six weeks. AWARE (A World-wide Antihistamine-Refractory Chronic Urticaria Patient Evaluation) is a multinational study designed to document the real-life treatment situation, burden of disease, and clinical resource usage of H1-antihistamine refractory CU patients.

Objective

To examine baseline data from Scandinavian AWARE patients.

Methods

AWARE is a prospective, non-interventional, multinational, umbrella design study, which includes adults (≥18 years) with a confirmed CU diagnosis (>2 months) that is refractory to H1-antihistamines. Baseline patient characteristics, disease activity (urticaria control test [UCT]), pharmacological treatment, comorbidities, and healthcare usage were documented by the treating physician. Quality of life (QoL; dermatology life quality index [DLQI]; chronic urticaria quality of life questionnaire [CU-Q₂oL; Danish patients only]) and work productivity and activity impairment (WPAI) scores were also assessed.

Results

Overall, 158 CU patients from seven centres in Denmark (n=80), Norway (n=50), and Sweden (n=28) were included in this baseline analysis. Mean age and BMI were 40.3 years and 26.5 kg/m², respectively. The majority of patients were female (69.6%), had uncontrolled CU (75.6%; UCT score <12), and had a "spontaneous" component to their CU (61.4% CSU; 20.3% both CSU and chronic inducible urticaria). Common comorbidities included asthma (19.6%), allergic rhinitis (16.5%), and food allergies (8.2%). Overall, 60.1% of patients reported using treatments for CU including non-sedative H1-antihistamines (40.5%), corticosteroids (19%), montelukast (14.6%) and omalizumab (8.2%). Pharmacological treatment rates increased to 96.2% during the baseline visit. On average, patient QoL was moderately affected (mean DLQI score 7.7) and healthcare resource usage was high.

Conclusion

Adult Scandinavian H1-antihistamine refractory CU patients reported high rates of healthcare usage and QoL impairment. Rates of pharmacological treatment use were low before study enrolment but increased to almost 100% during the baseline visit.

http://ift.tt/2mQVkjn

Temporomandibular disorders and whiplash injury: A narrative review

Publication date: Available online 10 March 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): G. Landzberg, M. El-Rabbany, G.D. Klasser, J.B. Epstein
BackgroundThe objective of this paper was to conduct a review investigating the relationship between temporomandibular disorders (TMD) and whiplash injuries (WI).MethodsThe authors conducted a search of PubMed/Medline, Cochrane and Embase for studies discussing prevalence, incidence, severity, treatment or prognosis of TMDs following WI. English language studies published between January 2010 and March 2016 were included. Study quality was assessed using the Ottawa-Newcastle scale.ResultsEight studies investigating TMDs in patients with histories of WI were included. These studies reported associations between WI and TMD and an increase in symptom severity among TMD patients with a history of WI. Additionally, TMD patients with trauma histories display more severe subjective, objective and psychological dysfunction than do typical TMD patients. This results in poorer treatment outcomes.ConclusionsThese findings highlight the need for early evaluation of WI patients for TMDs and for a multidisciplinary approach to their management.

http://ift.tt/2nnkOBu

Adverse pathological features in early oral squamous cell carcinoma and the role of post-operative radiotherapy - a review

Publication date: Available online 10 March 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Narayana Subramaniam, Deepak Balasubramanian, Samskruthi Murthy, Shashikant Limbachiya, Krishnakumar Thankappan, Subramania Iyer

http://ift.tt/2nnGa1W

Importance of tumor extent in adenosquamous carcinoma of the head and neck: a retrospective cohort study

Publication date: Available online 10 March 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Robert J. Lee, Thomas Lin, Serena A. Lee, Kevin K. Lee, Russell E. Christensen
PurposeTo determine the correlates of survival for patients diagnosed with adenosquamous carcinoma of the head and neck.Materials and MethodsPatients diagnosed with adenosquamous carcinoma of the head and neck between 1973 and 2012 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier and Cox proportional hazard regression models were conducted to investigate the prognostic factors and treatment modalities that determine overall survival (OS) and disease-specific survival (DSS).Results235 patients diagnosed with adenosquamous of the head and neck were analyzed. 66.8% were male and 33.2% were female with a median age at diagnosis of 64 years. Kaplan-Meier analysis determined 5-year survival rates of 30% for OS and 50% for DSS. Univariate and multivariate analysis found that age at diagnosis, tumor size, tumor extent of disease, surgical resection, and radiation therapy were independent predictors of OS and DSS.ConclusionThis study, to our knowledge, is the largest study to date determining the correlates of survival for adenosquamous carcinoma of the head and neck. Older age at diagnosis, larger tumor size, and further extent of disease were correlated with decreased survival. Surgical resection improves survival in patients with localized or regional disease while radiation therapy confers survival benefit in patients with distant extent.

http://ift.tt/2n82qR8

Neck failure following elective neck dissection in patients with oral squamous cell carcinoma

Publication date: Available online 10 March 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Hiroaki Shimamoto, Yu Oikawa, Toshimitsu Osako, Hideaki Hirai, Yumi Mochizuki, Kae Tanaka, Hirofumi Tomioka, Hiroyuki Harada
ObjectiveAnalysis of the incidence and clinical relevance of neck failure after elective neck dissection (END) in patients with oral squamous cell carcinoma (OSCC).Study DesignA retrospective study of 188 patients with OSCC without cervical lymph node metastases was conducted; these patients had undergone END from 2005 to 2015. The most common primary tumor location was lower gingiva, followed by tongue .ResultsSupraomohyoid neck dissection (SOHND) was the most common procedure. Neck failure developed in four pathological negative (pN(–)) and three pathological positive (pN(+)) patients. The site of neck recurrence was beyond the dissected field in all cases. The site of recurrence in pN(–) patients was ipsilateral in two patients and contralateral in two, whereas the site in pN(+) patients was ipsilateral in one patient and contralateral in two.ConclusionsAlthough neck failure after END can occur, SOHND is appropriate for END for OSCC. For tongue carcinoma, level IV dissection is recommended and for tumors close to the midline, contralateral neck dissection is also recommended.

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Editorial board

Publication date: March 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 3

http://ift.tt/2mJSa0j

Cancers cutanés : bientôt plus besoin du dermatologue ?

Publication date: March 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 3
Author(s): B. Cribier

http://ift.tt/2nnj0Zk

Conditions d’exercice des dermatologues en Bretagne et projection démographique : enquête transversale

Publication date: Available online 10 March 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): K. Luce, C. Saillard, C. Nizery-Guermeur, E. Brenaut, C. Rousseau, M. Henry, L. Misery, A. Dupuy
IntroductionLe nombre de dermatologues exerçant en Bretagne est en baisse (−4,5 % entre 2010 et 2014), et les délais de rendez-vous s'allongent. L'objectif de notre étude était d'évaluer l'activité des dermatologues et d'établir une projection démographique à 5 ans.MéthodesNous avons mené une enquête auprès des dermatologues inscrits à l'Ordre des médecins, en Bretagne, entre novembre 2014 et janvier 2015. Les internes de dermatologie des promotions 2010 à 2015 en Bretagne ont également été interrogés sur leur formation et leurs projets professionnels à 5 ans.RésultatsSur 147 dermatologues, 144 ont répondu (98 %). Les délais de rendez-vous ont augmenté entre 2010 et 2015 (p<0,001). Il y avait 87 % de femmes parmi les dermatologues de moins de 50 ans, versus 62 % chez les plus de 50 ans (p<0,01). La proportion de dermatologues travaillant moins de 7 demi-journées par semaine était plus élevée chez les femmes (33 % versus 13 %, p=0,02). Trente-trois dermatologues (52 % des plus de 55 ans) avaient envisagé un départ en retraite dans les 5 ans. Sur les 26 internes, 58 % projetaient d'exercer en Bretagne, et 42 % envisageaient de travailler à temps partiel. Nous estimons à 25 le nombre d'internes nouvellement diplômés qui exerceront en Bretagne dans 5 ans.ConclusionNos résultats suggèrent que le nombre de dermatologues en Bretagne devrait encore diminuer de 6 % entre 2015 et 2020.BackgroundThe number of dermatologists in Brittany is currently decreasing (−4.5% from 2010 to 2014) while waiting times for medical appointments are increasing. Our objective was to evaluate the practice activities of dermatologists and to establish a 5-year demographic projection.MethodsWe conducted a cross-sectional survey in Brittany (France) from November 2014 to January 2015. We also interviewed dermatology residents (incoming years: 2010 to 2015), and collected information about their hometown and their career plans in 5years.ResultsResponse rates were 98% for dermatologists and 100% for residents. Waiting times for appointments increased from 2010 to 2015 (P<0.01). Eighty-seven percent of dermatologists under 50 were women vs. 62% of dermatologists aged 50 and over (P<0.01). The proportion of dermatologists working fewer than 7 half-days per week was higher in women (33% vs. 13%, P=0.02). The number of retirements foreseen in 5years was 33 (52%) among the 63 dermatologists aged 55 and over. Among the 26 residents, 58% were planning to practice in Brittany and 42% were considering part-time work. We estimate that the number of newly graduated dermatologists exercising in Brittany in 5years will be 25.ConclusionOur results suggest that the number of dermatologists will continue to decrease by 6% between 2015 and 2020.

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Agenda

Publication date: March 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 3

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Galectin-3: an early predictive biomarker of modulation of airway remodeling in patients with severe asthma treated with omalizumab for 36 months

Bronchial asthma is a heterogeneous disease characterized by three cardinal features: chronic inflammation, variable airflow obstruction, and airway hyperresponsiveness. Asthma has traditionally been defined ...

http://ift.tt/2nnaaen

Dermatology Life Quality Index (DLQI) as a psoriasis referral triage tool

Abstract

Most primary care psoriasis referrals in the UK are triaged as 'routine', in part because of the prioritisation of skin cancer. As a result, patients with severe psoriasis may wait several months to be seen, enduring quality of life (QoL) impairment that could have been reduced. Furthermore some patients may spontaneously improve by the time they are seen by a specialist, making the appointment unnecessary at that time. Therefore, following approval from the local ethics committee, we conducted a prospective study to evaluate the usefulness of Dermatology Life Quality Index (DLQI) scores in triaging patients with psoriasis referred to our dermatology secondary health care services.

http://ift.tt/2mrSHls

Isothiocyanates are important as haptens in contact allergy to chloroprene rubber

Summary

Background

Contact allergy to chloroprene rubber products is well known. Thiourea compounds are considered the cause of allergy, despite being non- or weak sensitizers. Diethylthiourea is commonly occurring in this type of products and can decompose to the sensitizer ethyl isothiocyanate.

Objectives

To investigate the clinical importance of degradation products and metabolites from organic thioureas in contact allergy to chloroprene rubber with focus on isothiocyanates and isocyanates.

Methods

Patients with contact allergy to diphenylthiourea were patch tested with phenylisothiocyanate and phenylisocyanate. Patients with known contact allergy to diethylthiourea were retested with diethylthiourea, while chemical analyses of the their chloroprene rubber products were performed. The stability of diethylthiourea, diphenylthiourea and dibutylthiourea in patch test preparations was investigated. Liquid chromatography/mass spectrometry and solid-phase microextraction/gas chromatography were used for determination of organic thioureas and isothiocyanates.

Results

All diphenylthiourea allergic patients reacted to phenylisothiocyanate, 2 of 8 reacted to phenylisocyanate and 6 of 8 reacted to diphenylthiourea. All four diethylthiourea allergic patients reacted at retest, diethylthiourea was detected in all chloroprene rubber samples, with levels of 2-1200 nmol cm⁻². At 35 ᵒC, ethylisothiocyanate was emitted from all samples. Patch test preparations of diethylthiourea, diphenylthiourea and dibutylthiourea all emitted the corresponding isothiocyanate, with diethylthiourea showing the highest rate of isothiocyanate emission.

Conclusions

Thiourea compounds are degraded to isothiocyanates, which are generally strong or extreme sensitizers, thus acting as prehaptens. This process occurs in both chloroprene rubber products and patch test preparations. Positive reactions to phenylisocyanate indicate cutaneous metabolism, as the only known source of exposure to phenylisocyanate is through bioactivation of diphenylthiourea.

http://ift.tt/2mu2bP1

Autosomal dominant familial generalized pustular psoriasis caused by a CARD14 mutation

Abstract

In 2012, gain-of-function mutations in CARD14, which encodes caspase recruitment domain family member 14, were identified as the cause of familial psoriasis vulgaris (PV) and familial pityriasis rubra pilaris (PRP).^1,2 We and another group reported that CARD14 variants are associated with generalized pustular psoriasis (GPP) and palmoplantar pustular psoriasis (PPP).^3-5 The other reports mentioned that CARD14 mutations in individuals with GPP and erythrodermic PRP. ^4,6 Very recently, we described PRP type V as an autoinflammatory disease caused by CARD14 mutations. ⁷

http://ift.tt/2mrWZtg

Arrhythmias in metastatic melanoma patient treated with targeted therapy and ICD implant

Abstract

Metastatic melanoma is an aggressive and rapidly progressive disease. Heart metastases were shown in over 50% of autopsy. However, these metastases are usually clinically silent and reported in less than 2% of living patients^1.2. There are no specific guidelines for the treatment of cardiac metastases as the therapeutic approach varies with the clinical features of the patient.

http://ift.tt/2mu5LbE

EGFR inhibitory monoclonal antibodies and EGFR tyrosine kinase inhibitors have distinct effects on the keratinocyte innate immune response

Abstract

Epidermal growth factor receptor inhibitors (EGFRIs) are a well-established targeted therapy for several cancers. Two categories of EGFRIs are known, EGFR tyrosine kinase inhibitors (EGFR-TKIs) and EGFR monoclonal antibodies (EGFR mAbs). These EGFRIs frequently cause cutaneous adverse effects, such as papulo-pustular eruptions, xerosis and chronic paronychia.

http://ift.tt/2mrNWIz

Poor agreement between a mobile phone application for the analysis of skin lesions and the clinical diagnosis of the dermatologist, a pilot study

Abstract

The use of mobile phone health applications (apps) has become very popular in the population. The SkinVision app (SVA) is the first skin cancer app with an European CE-certification.¹ This means that a product has met EU health, safety and environmental requirements.² SkinVision lets the consumer "take photos of moles and skin conditions to analyse for skin cancer risk".¹ Artificial intelligence is used to automatically interpret the modified image. Based on this analysis, it evaluates lesions as low (green), medium (yellow) or high risk (red).¹

http://ift.tt/2muf9MF

Active sunscreen ingredients in Australia

Abstract

UV radiation exposure is the major contributor to photocarcinogenesis and photoageing. Reducing UV radiation exposure can be achieved by using adequate sunscreen preparations. The use of sunscreen can significantly reduce the incidence of squamous cell carcinoma, actinic keratoses and invasive melanoma. In the Australian market over 900 sunscreen products are available, each with their own brand, formulation and ingredients. It can be difficult for dermatologists and consumers to determine which are the most effective and appropriate products to use. We discuss the specific active ingredients found in sunscreen formulations available in Australia, their mode of protection, photostability, solubility, and side-effects and the methods used by the Therapeutic Goods Administration to determine the ratings and efficacy of each sunscreen.

http://ift.tt/2mboRRi

Intragenic Copy Number Variation in the Filaggrin Gene in Ethiopian Patients with Atopic Dermatitis

Abstract

Genetic variants in filaggrin (FLG) involving truncating mutations or intragenic copy number variation are strongly associated with the risk of developing atopic dermatitis (AD) in European and Asian populations. Few loss-of-function mutations have been identified in Africans, although an association between FLG copy number variation and AD severity in a small African American cohort has been proposed. We studied the association between FLG copy number and AD in 132 Ethiopians and found no association between AD severity and FLG copy number, suggesting that other, still unidentified genetic factors are of more importance in predisposing Ethiopians to AD.

http://ift.tt/2mbiZYv

The Fanny Pack: No Ifs, Ands, or Buts

Abstract

Although the white coat is central to the practice of adult medicine, pediatricians often shed it to avoid creating negative associations and provoking fear in children. In our pediatric dermatology practice, the fanny pack (FP) has replaced many of the functional elements of the white coat. The FP is a kid-friendly way to readily carry key medical supplies from one patient encounter to the next. It is more hygienic, light weight, and affordable than traditional doctor's bags and white coats. In this article we outline the benefits of the FP, which include storage, ergonomics, efficiency, cleanliness, kid-friendliness, and cost-effectiveness.

http://ift.tt/2mJAfXT

Author Guidelines

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“Watchful observation” follow-up scheme after endoscopic CO2 laser treatment for small glottic carcinomas: a retrospective study of 93 cases

Abstract

Objectives

Evaluate the clinical outcome of patients treated with CO2-laser surgery for early-stage glottic carcinomas followed-up with 3 month laryngoscopy regardless of tumor grade and margins.

Design

Case series.

Setting

Retrospective review of the clinical records of patients treated at the ENT department of a tertiary university hospital.

Participants and method

Clinical records from patients with early-stage glottic carcinomas (Tis-T2) treated with curative intent by CO2-laser surgery in a ten year period were evaluated. Regardless of tumor margin status, patients underwent fibre-endoscopy 6 weeks after surgery and a systematic second look by direct laryngoscopy under general anaesthesia at 3 months.

Main outcome measures

Local control, laryngeal preservation rate.

Results

93 patients were included. Disease control was obtained in 90/93 cases. Laryngeal preservation rate was 96.8%. 20 patients had a local residual disease or recurrence after the first laser surgery, but 17 were salvaged (85%). Local residual disease and recurrence were more frequent in patients with advanced disease (T1b/T2), invasion of anterior commissure, and "non-safe" margins.

Conclusion

The proposed follow-up scheme might be a valuable option, but with caution for positive or unevaluable margins as the latter is an independent risk factor for local recurrence. An early laser excision procedure (e.g, within the first two months after surgery) or an alternative strategy may be discussed in this situation. "Watchful observation" should be reserved for compliant patients only so that the risk of missing potential recurrences is minimised.

http://ift.tt/2mbf0er

Inpatient treatment of patients with acute idiopathic peripheral facial palsy: a population-based healthcare research study

Abstract

Objectives

To determine the inpatient management for patients with acute idiopathic facial palsy (IFP) in Thuringia, Germany.

Design

Population-based study.

Setting

All inpatients with IFP in all hospitals with departments of otolaryngology and neurology in 2012 in the German federal state Thuringia.

Main outcome measures

Patients' characteristics and treatment were compared between departments, and the probability of recovery was tested.

Results

291 patients were mainly treated in departments of otolaryngology (55%) and neurology (36%). Corticosteroid treatment was the predominant therapy (84.5%). The probability to receive a facial nerve grading (Odds ratio [OR] =12.939; 95% confidence interval [CI] = 3.599 to 46.516), gustatory testing (OR = 6.878; CI =1.064 to 44.474), and audiometry (OR = 32.505; CI = 1.485 to 711.257) was significantly higher in otolaryngology departments, but lower for cranial CT (OR = 0.192; CI = 0.061 to 0.602), CSF examination (OR = 0.024; CI = 0.006 to 0.102). 131 patients (45%) showed a recovery to House-Brackmann grade ≤II. A pathological stapedial reflex test (Hazard ratio [HR] = 0.416; CI = 0.180 to 0.959) was the only independent diagnostic predictor of worse outcome. Prednisolone dose >500 mg (HR = 0.579; CI 0.400 to 0.838), and no adjuvant physiotherapy (HR = 0.568; CI = 0.407 to 0.794) were treatment-related predictors of worse outcome.

Conclusions

Inpatient treatment of IFP seems to be highly variable in daily practice, partly depending on the treating discipline, and despite the availability of evidence-based guidelines. The population-based recovery rate was worse than reported in clinical trials.

http://ift.tt/2mJquZw

Closure of the trans-columellar incision in open septorhinoplasty in 100 patients: use of an absorbable multi-filament suture

Abstract

Open septorhinoplasty with an inverted-V incision is an established technique for primary and revision cases. Achieving an aesthetic scar is often a paramount concern for the patient and surgeon and can influence patient satisfaction with the overall procedure.

http://ift.tt/2mb0PpA

Progressive Paramedicine: Why and when to manage a patient's airway

Review the three indications that a patient needs their airway managed in this episode of Progressive Paramedicine, an EMS1 original video series.

http://ift.tt/2mPQXoY

Progressive Paramedicine: How to assess, treat the crashing CHF patient

Three keys to the management of the crashing congestive heart failure patient is discussed in this episode of Progressive Paramedicine, an EMS1 original video series.

http://ift.tt/2m8rWAZ

Management of the Asthma-COPD Overlap Syndrome (ACOS): a Review of the Evidence

Abstract

Purpose of Review

Examine the definition of the asthma-COPD overlap syndrome (ACOS) and current treatment strategies.

Recent Findings

Summary

http://ift.tt/2mQ2x3j

The Role of Human Parainfluenza Virus Infections in the Immunopathology of the Respiratory Tract

Abstract

http://ift.tt/2m8nZfB

Effect of diabetes mellitus on postoperative endoscopic sinus surgery outcomes

Background

Endoscopic sinus surgery (ESS) has become the treatment of choice for a variety of nasal conditions. The purpose of this study was to analyze the effect of diabetes mellitus (DM) on postoperative outcomes in ESS.

Methods

Data on endoscopic sinus surgery performed from 2005 to 2013 were collected from the American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database. Two groups were created, based on the presence of a DM diagnosis, and were analyzed for preoperative variables, comorbidities, and postoperative complications using SPSS statistical software.

Results

There were 644 patients included in the analysis, 85 of whom (13.2%) had a diagnosis of DM. Patients with DM were more likely to have higher rates of preoperative dyspnea and hypertension. After accounting for confounding factors, DM patients undergoing ESS were at higher risk of overall medical complications, pneumonia, unplanned reintubation, ventilator use of >48 hours, and mortality. However, after separating patients into outpatient and inpatient groups, DM was found to be an independent predictor of urinary tract infection in outpatients and of ventilator use >48 hours in inpatients.

Conclusion

DM patients undergoing ESS are at increased risk for postoperative medical complications. However, DM does not appear to increase the postoperative surgical complication rate in this population. Furthermore, DM does not appear to have an impact on ESS mortality, readmission, or reoperation rates.

http://ift.tt/2n7zs40

Editorial

http://ift.tt/2ne08wH

Issue Information

http://ift.tt/2n7A4Xq

Unilateral facial nerve palsy as an early presenting symptom of relapse in a paediatric patient with acute lymphoblastic leukaemia

Description

Idiopathic unilateral facial nerve paralysis (Bell palsy) rarely occurs as a presenting symptom of childhood leukaemia, and published reports of Bell palsy as a symptom of leukaemic relapse are even fewer.1–3 These images show the MRI findings in this case of peripheral facial nerve palsy as an early presenting symptom of central nervous system (CNS) relapse.

This patient was diagnosed at 12 years of age with T-cell acute lymphoblastic leukaemia without CNS involvement. Five months into therapy, he developed vision loss in the left eye secondary to optic nerve leukaemic infiltration. Radiation therapy and intensification of his chemotherapy induced a durable radiographic response.

Sixteen months into therapy, the patient presented with a 1-day history of unilateral facial weakness. An MRI of the brain showed mild enhancement of portions of the right facial nerve, consistent with Bell palsy (figure 1). The...

http://ift.tt/2m8imxK

Rheumatic fever with severe carditis: still prevalent in the South West Pacific

Rheumatic heart disease (RHD) has a worldwide prevalence of 33 million cases and 270 000 deaths annually, making it the most common acquired heart disease in the world. There is a disparate global burden in developing countries. This case report aims to address the minimal RHD coverage by the international medical community. A Tahitian boy aged 10 years was diagnosed with advanced heart failure secondary to RHD at a local clinic. Previous, subtle symptoms of changes in handwriting and months of fever had gone unrecognised. Following a rapid referral to the nearest tertiary centre in New Zealand, urgent cardiac surgery took place. He returned home facing lifelong anticoagulation. This case highlights the RHD burden in Oceania, the limited access to paediatric cardiac services in countries where the RHD burden is greatest and the need for improved awareness of RHD by healthcare professionals, and the general public, in endemic areas.

http://ift.tt/2mPPVsW

Vitamin D supplementation in pregnancy, prenatal 25(OH)D levels, race, and subsequent asthma or recurrent wheeze in offspring: Secondary analyses from the Vitamin D Antenatal Asthma Reduction Trial

Publication date: Available online 9 March 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Helene M. Wolsk, Benjamin J. Harshfield, Nancy Laranjo, Vincent J. Carey, George O'Connor, Megan Sandel, Robert C. Strunk, Leonard B. Bacharier, Robert S. Zeiger, Michael Schatz, Bruce W. Hollis, Scott T. Weiss, Augusto A. Litonjua
BackgroundNutrient trials differ from drug trials because participants have varying circulating levels at entry into the trial.ObjectiveWe sought to study the effect of a vitamin D intervention in pregnancy between subjects of different races and the association between 25-hydroxyvitamin D3 (25[OH]D) levels in pregnancy and the risk of asthma/recurrent wheeze in offspring.MethodsThe Vitamin D Antenatal Asthma Reduction Trial is a randomized trial of pregnant women at risk of having children with asthma randomized to 4400 international units/d vitamin D or placebo plus 400 international units/d vitamin D. Asthma and recurrent wheezing until age 3 years were recorded.ResultsAfrican American (AA) women (n = 312) had lower initial levels of 25(OH)D (mean [SD], 17.6 ng/mL [8.3 ng/mL]) compared with non-AA women (n = 400; 27.1 ng/mL [9.7 ng/mL], P < .001). No racial difference was found from vitamin D supplementation in pregnancy on asthma/recurrent wheezing in offspring (P for interaction = .77). Having an initial level of greater than 30 ng/mL and being randomized to the intervention group was associated with the lowest risk for asthma/recurrent wheeze by age 3 years compared with having an initial level of less than 20 ng/mL and receiving placebo (adjusted odds ratio, 0.42; 95% CI, 0.19-0.91).ConclusionsWe did not find differences between AA and non-AA mothers in the effect of maternal vitamin D supplementation and asthma/recurrent wheeze in offspring at 3 years. Maternal supplementation of vitamin D, particularly in mothers with initial 25(OH)D levels of greater than 30 ng/mL, reduced asthma/recurrent wheeze in the offspring through age 3 years, suggesting that higher vitamin D status beginning in early pregnancy is necessary for asthma/recurrent wheeze prevention in early life.

Graphical abstract

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Characteristics of Spitz nevi, Atypical Spitz nevi and Melanomas in patients younger than 20 years

The Spectrum of Spitzoid tumors and early onset melanomas has been extensively studied during the last few years.^{1, 2} Although significant progress has been made in the histopathological and clinical description of these lesions, the biologic potential of the most atypical lesions of the spectrum still remains to be elucidated.

http://ift.tt/2mPOnzj

Management of cancerization field with a medical device containing photolyase: A randomized, double-blind, parallel-group pilot study

At least 6 clinical studies conducted in subjects with actinic keratosis (AK) have demonstrated the therapeutic effect of Eryfotona AK-NMSC^® (ISDIN, Spain), a topically applied film-forming cream containing DNA Repairsomes^™ (broad-spectrum UV filters and the DNA-repair enzyme photolyase, encapsulated in liposomes) (1-6) (registered as medical device in Europe). Recently a German opinion paper reviewed clinical evidence for the efficacy of topical application of this topical cream. They concluded that there was strong evidence that patient at high risk for developing AK would benefit from the year around use of this product marketed in Europe in the medical device category. Eryfotona AK-NMSC has a very high photoprotection factor (SPF >100) combined with and photorepair action (DNA repair enzymes) (7).

http://ift.tt/2m8hIAB

Peri-meatal PeIN and urethral SCC: a case report

A 55-year-old man presented with an asymptomatic lesion adjacent to the urethral meatus of one year's duration (Fig. 1). His medical history was significant for quiescent lung sarcoidosis (treatment never required), asthma and irritable bowel syndrome. His only medication was a budesonide/formoterol inhaler. The plaque had slowly been increasing in size, had not ulcerated or bled and had not impacted sexual or urinary function. Examination did not reveal extension into the urethra. Biopsy revealed undifferentiated penile intraepithelial neoplasia (PeIN) III/carcinoma in situ.

http://ift.tt/2mPDQUu

Propionibacterium acnes phylotypes and acne severity: an observational prospective study

Although a number of facts on the physiopathological mechanisms of acne are now well established, it is still unclear what triggers the severity of this inflammatory disease of the sebaceous follicle. Thus, could the severity of the acne be somehow linked to different strains of its main bacterium, Propionibacterium acnes? We know that there are several types of P. acnes, and a study (1) has recently shown that different strains of P. acnes could up-regulate or down-regulate in vitro inflammatory keratinocyte response.

http://ift.tt/2m8hSrp

Multiple sclerosis association with psoriasis: a large U.S. population, single center, retrospective cross-sectional study

Psoriasis is a chronic inflammatory skin disorder associated with morbidity [1]. Several autoimmune comorbidities including celiac disease, multiple sclerosis and inflammatory bowel disease have been reported in individuals with psoriasis [2].

http://ift.tt/2mPKFpd

Concept of patient-specific shape memory implants for the treatment of orbital floor fractures

Abstract

Purpose

We will aim to develop implants made of a Ni-Ti shape memory alloy which can be applied for the treatment of midface fractures, such as isolated orbital floor fractures. These can then be implanted in a compressed form and unfold automatically in the body. With the help of newly developed application instruments, the implants can be applied along transnasal and transantral approaches into the maxillary sinus. Our objective is to evaluate the operation process and the functionality of these implants, already in a pre-investigation by an experienced surgeon on a phantom.

Methods

The functionality of the surgical procedure and an implant prototype were both evaluated with the help of a realistic phantom. The minimally invasive application was carried out using the transnasal and transantral approach. Instruments and implant were rated individually on a scale, from −2 (not at all) to +2 (very good) for vaious criteria, such as the implants functionality or the ergonomics of the entire procedure. For a geometric comparison between the manufactured implant and the planned target geometry, the implants were scanned by micro-computed tomography. CAD models were derived from the scans by using reverse engineering.

Results

Both the implants and the application procedure were assessed as good; thus, the implant concept is suitable for further development.

Conclusions

Implants made of shape memory alloys could allow in the future and allow less invasive access to treat orbital floor fractures. The implant design has to be modified that the implant can be stabilized and fixed with screws or a suture to avoid dislocation or implant loosening. The complication rates and risks of conventional orbital reconstructions should be lowered by this new method.

http://ift.tt/2maOQbG

Systematic review and meta-analysis to determine the proportion of maxillofacial trauma resulting from different etiologies among children and adolescents

Abstract

Purpose

This study aimed to determine via systematic review and meta-analysis the proportion of maxillofacial trauma resulting from different etiologies among children and adolescents.

Methods

A systematic review of articles published from 2006 to 2015 (10 years) in English language was performed. The following databases were used: PubMed/MEDLINE, Scopus, and Web of Science. Observational studies reporting the number of children and/or adolescents who suffered maxillofacial trauma resulting from different etiologies were included. Studies were selected by two independent reviewers (Kappa = 0.737). A proportion meta-analysis using random-effect models was performed to estimate the pooled prevalence and the 95% confidence intervals (CI) using Der-Simonian and Laird weights. Heterogeneity among studies was assessed using the I ² statistics.

Results

A total of 27 studies remained after qualitative analysis including 402,339 patients. The male/female ratio ranged from 1.5:1 to 3.5:1. Road traffic accidents corresponded to the main etiology agent of maxillofacial trauma (34%; 95% CI, 25–44), followed by falls (31%; 95% CI, 25–37), violence (11%; 95% CI, 4–19), sports (4%; 95% CI, 3–5), and others (5%; 95% CI, 2–8). Heterogeneity among studies was high, even stratifying by world region. The adapted version of the Newcastle-Ottawa scale for observational studies showed an intermediate score for most of the included studies.

Conclusions

Results suggest that road traffic accidents represent the main cause of maxillofacial trauma among children and adolescents. However, results should be interpreted with caution due to the high heterogeneity.

http://ift.tt/2ndfph4

Metformin Hydrochloride and Doxycycline in Treating Patients With Head and Neck Squamous Cell Carcinoma That Can Be Removed by Surgery

Conditions: Larynx; LIP; Oral Cavity; Pharynx
Interventions: Drug: Metformin Hydrochloride; Drug: Doxycycline; Drug: Metformin +Doxycycline
Sponsor: Sidney Kimmel Cancer Center at Thomas Jefferson University
Not yet recruiting - verified March 2017

http://ift.tt/2n7gzOD

Head and Neck Maskless Immobilization Device in Immobilizing Patients With Intracranial Tumors Undergoing Radiation Therapy

Conditions: Brain and Nervous System; Intracranial Neoplasm
Interventions: Procedure: Computed Tomography; Device: Medical Device; Device: Medical Device; Procedure: Cone-Beam Computed Tomography
Sponsor: Sidney Kimmel Cancer Center at Thomas Jefferson University
Recruiting - verified March 2017

http://ift.tt/2ndIJUT

A Study Evaluating MM-310 in Patients With Solid Tumors

Conditions: Solid Tumors; Urothelial Carcinoma; Gastric Carcinoma; Squamous Cell Carcinoma of the Head and Neck; Ovarian Cancer; Pancreatic Ductal Adenocarcinoma; Prostate Adenocarcinoma; Non-small Cell Lung Cancer; Small Cell Lung Cancer; Triple Negative Breast Cancer; Endometrial Carcinoma; Soft Tissue Sarcoma
Intervention: Drug: MM-310
Sponsor: Merrimack Pharmaceuticals
Not yet recruiting - verified March 2017

http://ift.tt/2n78Vna

P53 Mutational Status and cf HPV DNA for the Management of HPV-associated OPSCC

Conditions: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Oropharyngeal Neoplasms
Interventions: Radiation: Intensity Modulated Radiotherapy (IMRT) - deintensified; Radiation: Intensity Modulated Radiotherapy (IMRT) - standard; Drug: Cisplatin (or alternative) - deintensified; Drug: Cisplatin (or alternative) - standard; Procedure: Assessment for surgical evaluation
Sponsor: UNC Lineberger Comprehensive Cancer Center
Recruiting - verified March 2017

http://ift.tt/2ndOvpJ

Immunohistochemical detection of Mycoplasma salivarium in oral lichen planus tissue

Abstract

Background

Oral lichen planus (OLP) is a T cell-mediated inflammatory disease; however, its exact etiology is unknown. Hyperkeratosis is often observed in OLP lesions. Previous studies have revealed the localization of Mycoplasma salivarium in the epithelial cells of oral leukoplakia with hyperkeratosis. Herein, we investigated the presence of M. salivarium in OLP tissue by immunohistochemistry to determine the causative factor of OLP.

Methods

Forty-one formalin-fixed, paraffin-embedded samples obtained from 31 patients with OLP were examined. Ten samples of normal-appearing oral mucosa were used as controls. Immunohistochemistry (IHC) was performed using anti-M. salivarium monoclonal antibodies.

Results and conclusions

M. salivarium was detected in the epithelium and lymphocyte infiltrate area in 24 of 41 OLP samples (58.5%). The bacteria were intracellularly localized in epithelial cells, while it was unclear whether they were also localized in lymphocyte cells or in the extracellular spaces among the lymphocytes in the subepithelial lymphocyte infiltrate area. Little or no staining was observed in the epithelium in the normal-appearing mucosa samples. Sawtooth rete ridge formation was observed in 21 OLP samples (51.2%), and a significant positive correlation between sawtooth rete ridge formation and IHC positivity was demonstrated. However, the role of M. salivarium in the epithelium and lamina propria of OLP tissue remains unknown.

http://ift.tt/2n76Tna

Systematic review and meta-analysis to determine the proportion of maxillofacial trauma resulting from different etiologies among children and adolescents

Abstract

Purpose

This study aimed to determine via systematic review and meta-analysis the proportion of maxillofacial trauma resulting from different etiologies among children and adolescents.

Methods

Results

Conclusions

http://ift.tt/2ndfph4

Association of Oral Antireflux Medication With Laryngopharyngeal Reflux and Nasal Resistance.

Association of Oral Antireflux Medication With Laryngopharyngeal Reflux and Nasal Resistance.

JAMA Otolaryngol Head Neck Surg. 2017 Mar 09;:

Authors: Dagli E, Yüksel A, Kaya M, Ugur KS, Turkay FC

Abstract
Importance: Laryngopharyngeal reflux (LPR) is thought to be a potential exacerbating factor in upper airway diseases.
Objective: To describe the effect of pharmacologic therapy of laryngopharyngeal reflux on nasal resistance.
Design, Setting, and Participants: Prospective observational study performed between August 30, 2014, and October 1, 2015, at a tertiary care academic center including 50 patients with Reflux Symptom Index higher than 13 and Reflux Finding Score higher than 7 and 50 controls with no history of LPR and nasal disease.
Interventions: Oral antireflux medication was given to the LPR group for 12 weeks.
Main Outcomes and Measures: The measurements of total nasal resistance (TNR) were performed by means of active anterior rhinomanometry technique and Nasal Obstruction Symptom Evaluation (NOSE) was assessed.
Results: The LPR group had 29 (58%) women and a median age of 41.5 years (range, 18-64 years). The control group had 27 (54%) women and a median age of 38.5 years (range, 19-63 years). After treatment, a significant decrease was observed in all parameters. The median (range) TNR scores of the LPR group before and after treatment were 0.29 (0.12-0.36) and 0.19 (0.10-0.31), respectively. The median TNR score of the control group was 0.20 (range, 0.11-0.32). Whereas the TNR scores of the LPR group were higher than those of the control group before treatment (difference, -0.77; 95% CI, -0.10 to 0.05), they were almost the same after treatment (difference, 0.01; 95% CI, -0.01 to 0.03). The median (range) NOSE scores of the LPR group before and after treatment were 0.29 (0.12-0.36) and 0.19 (0.10-0.31), respectively. The median NOSE score of the control group was 0.20 (range, 0.11-0.32).
Conclusions and Relevance: In this study, laryngopharyngeal reflux had a negative effect on nasal resistance and nasal congestion. Treatment was associated with improved subjective and objective nasal findings.

PMID: 28278341 [PubMed - as supplied by publisher]

http://ift.tt/2m79GYC

Αρχειοθήκη ιστολογίου

Παρασκευή 10 Μαρτίου 2017

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