No abstract availablehttp://ift.tt/2nhSEsz
Σάββατο 11 Μαρτίου 2017
Pneumothorax, Pneumomediastinum, and Pneumorrhachis: A Rare Presentation in a Neurological Patient
No abstract availablehttp://ift.tt/2nhSEsz
Acute Pulmonary Edema Following Plasma Exchange in a Patient With Guillian Barre Syndrome
No abstract availablehttp://ift.tt/2nhIx78
Use of Dexmedetomidine for Prophylactic Analgesia and Sedation in Patients With Delayed Extubation After Craniotomy: A Randomized Controlled Trial
Background: We conducted a randomized trial to evaluate the efficacy and safety of dexmedetomidine for prophylactic analgesia and sedation in patients with delayed extubation after craniotomy. Methods: From June 2012 to July 2014, 150 patients with delayed extubation after craniotomy were randomized 1:1 and were assigned to the dexmedetomidine group that received a continuous infusion of 0.6 μg/kg/h (10 μg/mL) or the control group that received a maintenance infusion of 0.9% sodium chloride for injection. The mean percentage of time under optimal sedation (SAS3-4), the percentage of patients who required rescue with propofol/fentanyl, and the total dose of propofol/fentanyl required throughout the course of drug infusion, as well as VAS, HR, MAP, and SpO2 were recorded. Results: The percentage of time under optimal sedation was significantly higher in the dexmedetomidine group than in the control group (98.4%±6.7% vs. 93.0%±16.2%, P=0.008). The VAS was significantly lower in the dexmedetomidine group than in the control group (1.0 vs. 4.0, P=0.000). The HR and mean BP were significantly lower in the dexmedetomidine group than in the control group at all 3 time points (before endotracheal suctioning, immediately after extubation, and 30 min after extubation). No significant difference in SpO2 was observed between the 2 groups. For hemodynamic adverse events, patients in the dexmedetomidine group were more likely to develop bradycardia (5.3% vs. 0%, P=0.043) but had a lower likelihood of tachycardia (2.7% vs. 18.7%, P=0.002). Conclusions: Dexmedetomidine may be an effective prophylactic agent to induce sedation and analgesia in patients with delayed extubation after craniotomy. The use of dexmedetomidine (0.6 μg/kg/h) infusion does not produce respiratory depression, but may increase the incidence of bradycardia.http://ift.tt/2myWeAp
Acute Kidney Injury After Subarachnoid Hemorrhage
Background: Acute kidney injury (AKI) is common in critically ill patients and may contribute to poor outcome. Few data are available on the incidence and impact of AKI in patients suffering from nontraumatic subarachnoid hemorrhage (SAH). Methods: We reviewed all patients admitted to our Department of Intensive Care with SAH over a 3-year period. Exclusion criteria were time from SAH symptoms to intensive care unit (ICU) admission >96 hours and ICU stay 10% of patients after SAH. These patients had more severe neurological impairment and needed more aggressive ICU therapy; AKI did not significantly influence outcome.http://ift.tt/2mevqmp
A Randomized Controlled Trial Studying the Role of Dexamethasone in Scalp Nerve Blocks for Supratentorial Craniotomy
Background: The aim of this double-blinded randomized control study was to examine the role of the steroid dexamethasone as an adjuvant to lignocaine and ropivacaine in scalp nerve blocks in adults undergoing supratentorial craniotomy under general anesthesia. We compared the intraoperative anesthetic and postoperative analgesic requirement with and without the addition of dexamethasone to the local anesthetics. Methods: The consented 90 patients were randomized into 2 groups: one group received 8 mg (2 mL) of dexamethasone, whereas the other received 2 mL of normal saline along with the local anesthetics in the scalp nerve block administered soon after induction of general anesthesia. All patients received oral/intravenous dexamethasone perioperatively to decrease cerebral edema. The general anesthetic technique for induction, maintenance, and recovery was standardized in the 2 groups. The primary outcome assessed was the time to administration of the first dose of analgesic postoperatively. The secondary outcomes included intraoperative opioid requirement, time to emergence, and incidence of postoperative nausea and vomiting. Results: There was no significant difference between the dexamethasone and saline groups with respect to time to first analgesic requirement, intraoperative fentanyl requirements, time to emergence from general anesthesia, and incidence of postoperative nausea and vomiting. Conclusions: Addition of dexamethasone as an adjuvant to local anesthetics in scalp nerve blocks in the setting of perioperative steroid therapy does not appear to provide any additional benefit with respect to prolongation of the duration of the block.http://ift.tt/2myZ8oz
Can Intraoperative Neurological Preconditioning Occur After Intraoperative Hypotensive Episodes?
No abstract availablehttp://ift.tt/2myONsJ
Tramadol-Paracetamol Combination for Postoperative Pain Relief in Elective Single-level Microdisectomy Surgery
Background: The tramadol and paracetamol combination is used frequently for postoperative pain management. The literature on the use of this combination for vertebral surgery is limited. Our objective was to compare a combination of paracetamol 1 g and a lower dose of tramadol (1 mg/kg: group 1T) with a combination of paracetamol 1 g and a higher dose of tramadol (1.5 mg/kg: group 1.5T) for postoperative pain after microdisectomy surgery. Our main outcome measure was Visual Analogue Scale pain scores for 4 hours postoperatively. Methods: This prospective randomized triple-blind clinical trial was conducted at Aga Khan University Hospital, Karachi. Ninety-four patients aged between 18 and 50 years scheduled for elective single-level microdisectomy were allocated randomly into 1 of 2 groups. Twenty minutes before the end of the surgery, patients received the study drugs. Results: There was no significant demographic difference between groups. None of the patients experienced severe pain (VAS>6). There was no significant difference in the mean pain score between groups. The mean score at 4 hours was 2.17 (1.38) in group 1.5T and 1.74 (1.37) in group 1T. The difference was not statistically significant (P=0.14). In group 1.5T, 13 patients reported having nausea and vomiting compared with 2 patients in group 1T. This was a statistically significant difference (P=0.004). The sedation score was similar between groups. Conclusions: The combination of low-dose tramadol (1 mg/kg) and paracetamol has comparable analgesia and a decreased incidence of nausea and vomiting compared with the higher dose of tramadol (1.5 mg/kg) and paracetamol combination.http://ift.tt/2myQgza
Neuroanesthesiology Update
We reviewed manuscripts published in 2016 that are related to the care of neurosurgical patients or the perioperative care of patients with neurological diseases. We address the broad categories of general neurosurgery and neuroanesthesiology, anesthetic neurotoxicity and neuroprotection, stroke, traumatic brain injury, and nervous system monitoring.http://ift.tt/2myRyKs
The Impact of Prehospital Intubation With and Without Sedation on Outcome in Trauma Patients With a GCS of 8 or Less
Background: Although unconsciousness (Glasgow Coma Scale [GCS] 3 to 8) necessitates intubation according national guidelines, there is a notable lack of evidence to support this approach. This study evaluates the impact on outcome of prehospital intubation with and without sedation in trauma patients with a GCS of ≤8. Methods: A retrospective cohort analysis of severely injured trauma patients registered in the TraumaRegister DGU of the German Trauma Society (DGU) from 2002 to 2013 was conducted. Only directly admitted patients alive on admission and with a GCS of ≤8 at the scene were included. The observed outcome was matched with the expected outcome deriving from the Revised Injury Severity Classification, version II (RISC-II). Furthermore, a Standardized Mortality Ratio (SMR) was calculated for various subgroups. Early neurological outcome was classified using the Glasgow Outcome Scale. Results: A total of 21,242 patients fulfilled the study inclusion criteria. A total of 18,975 patients (89.3%) received prehospital intubation. Intubation rates were continuously increasing with decreasing GCS score values. Difference between observed and expected mortality was lower in intubated patients (42.2% [95% confidence interval (CI), 41.5%-42.9%]; RISC-II prognosis 41.4%; SMR 1.020 [95% CI, 1.003-1.037]) compared with nonintubated (30.0% [95% CI, 28.1-31.9%] RISC-II prognosis 26.6% and SMR 1.128 [95% CI, 1.057-1.199]). Patients being sedated before intubation presented significant (Phttp://ift.tt/2myZUBR
The Intraoperative Effect of Methadone on Somatosensory Evoked Potentials
Background: Evoked potentials (EP), both somatosensory evoked potentials (SSEP) and transcranial motor evoked potentials (TcMEP), are often used during complex spine surgery to monitor the integrity of spinal pathways during operations in or around the spine. Changes in these monitored EP signals (increased latency and decreased amplitude) may result from ischemia, direct surgical injury, changes in blood pressure, hypoxia, changes in CO2 tension, and anesthetic agents. Typically, a clinically significant change for SSEPs is defined as an increase in latency >10% or a decrease of amplitude >50%. A clinically significant change for TcMEPs is much more complex but is also described in terms of large signal loss or decrease. Opioids have been shown to both increase latency and decrease the amplitude of SSEPs, although this change is usually not clinically significant. There has been a renewed interest in methadone for use in spine and other complex surgeries. However, the effect of methadone on intraoperative monitoring of SSEPs and TcMEPs is unknown. We present the first study to directly look at the effects of methadone on SSEP and TcMEP monitoring during complex spine surgery. Methods: The goal of this study was to observe the effect of methadone on an unrandomized set of patients. The primary endpoint was methadone's effect on SSEPs, and the secondary endpoint was methadone's effect on TcMEPs. Adult patients undergoing spine surgery requiring intraoperative neuromonitoring were induced with general anesthesia and had a baseline set of SSEPs and TcMEPs recorded. Next, methadone dosed 0.2 mg/kg/lean body weight was given. Repeat SSEPs and TcMEPs were recorded at 5, 10, and 15 minutes, with the timing based on distribution half-life of methadone between 6 and 8 minutes. Postoperatively, adverse events from methadone administration were collected. Results: There was a statistically significant difference found in SSEPs for N20 latency (95% confidence interval [CI], 0.17-0.53; P=0.028), P37 latency (95% CI, 0.65-1.25; P=0.001), and N20 amplitude (95% CI, 0.09-0.32; P=http://ift.tt/2mesWnW
Persistent Premature Atrial Contraction as the Sole Presentation of Trigeminocardiac Reflex during Radiofrequency Thermocoagulation
No abstract availablehttp://ift.tt/2meDYcJ
Intratympanal gentamicin in Meniere’s disease: Effects on individual semicircular canals
Source:Auris Nasus Larynx
Author(s): Béla Büki, Heinz Jünger
ObjectiveIn this retrospective study the aim of the authors was to examine the effect of gentamicin on the individual semicircular canals after low dose, single injection intratympanal gentamicin therapy in Meniere's disease.MethodsData of 32 patients treated between 2011 and 2015 were collected. The high frequency, high acceleration vestibuloocular reflex (VOR) gain was measured in the individual semicircular canals using video head impulse test immediately before the first intratympanal gentamicin instillation and approximately two months later.ResultsIn all cases 'AAO-HNS Class A' vertigo control could be attained at least for several months. In 13 cases only one instillation was necessary. In the other 19 cases the attacks returned after a few months. In 11 cases the injection had to be repeated a second time, in 4 cases 3 injections, in 2 cases 4, in 1 case 5 injections and in another 6 injections were necessary. The initial VOR gain was normal in all cases and two months after one injection it decreased in average by 40% in a highly significant manner. However, there were cases in which, although the patients became free of attacks, the gain values remained normal.ConclusionIt was possible to demonstrate a significant correlation between the gain decrease of the individual canals. There was no prognostic correlation between the initial gain decrease after the first injection and the necessity of further injections. Gain values also decreased slightly but significantly in the lateral and posteriors canals on the contralateral, untreated side, possibly because of the missing disfacilitation from the treated side.
http://ift.tt/2mVzvPU
Transumbilical Surgery for Duodenal Stenosis in a Child with Situs Inversus: The First Report
Background. Situs inversus is a rare congenital anomaly with a reported incidence of only 1 in 5,000 to 10,000 live births. Congenital duodenal stenosis complicated with situs inversus is an even rarer entity. Case Presentation. A 1-year-old girl with situs inversus who had undergone a hemi-Fontan procedure against a single ventricle in our hospital was referred to our department for vomiting and failure to thrive. An upper gastrointestinal contrast study and endoscopy revealed duodenal stenosis. A transumbilical radical operation as a minimally invasive surgery was successfully performed. After the surgery, she stopped vomiting, and the postoperative course was uneventful with good cosmetic results. Conclusions. To our knowledge, this is the first report of transumbilical surgery for congenital duodenal stenosis with situs inversus as minimally invasive surgery. Transumbilical surgery to situs inversus patient can be performed safely and lead to good cosmetic outcome.
http://ift.tt/2myAzIn
Delivery of glycerol trinitrate after reconstruction with an oral free flap
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): M. Davies, J. Parmar
http://ift.tt/2nrryi0
Intraoperative cell isolation for a cytological assessment of bone resection margins in patients with head and neck cancer
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): M. Nieberler, P. Häußler, M.R. Kesting, A. Kolk, H. Stimmer, K. Nentwig, G. Weirich, K.-D. Wolff
The intraoperative cytological assessment of bony resection margins (ICAB) is a feasible diagnostic approach to support frozen section for assessment of invasion of margins of soft and hard tissue. However, complex resection margins could challenge both diagnostic approaches. Our objective here was to identify the limitations of intraoperative diagnostic methods for assessing margins. We present an advanced cytological approach to assess complex margins that may solve the problem. Data from 119 patients in whom frozen section was supported by ICAB, were reviewed and the reasons for false results analysed. In 35 patients with squamous cell carcinoma infiltrating bone, specimens (n=100) from the resection margin went through an intraoperative cell isolation process for the cytological assessment of bony margins (ICAB). The results were compared with the histological results of the corresponding margins of bone as a reference. Limitations to the assessment of operative bony margins intraoperatively included an infiltrative histological pattern of growth of the carcinoma, with carcinoma cells disseminated within the cancellous bone, complex and uneven resection margins with soft and bony tissue, inflammation, and signs of previous radiotherapy. Intraoperative cell isolation plus (ICICAB) allowed the microscopic assessment of up to 1cm3 of bony tissue to detect disseminated carcinoma cells within the cancellous bone with a sensitivity of 92.3% (95% CI 74.9% to 99.1%), and a specificity of 100% (95% CI 95.1% to 100%), and positive and negative predictive values of 100% (95% CI 85.8% to 100%) and 97.4% (95%CI 90.8% to 99.7%), respectively. Intraoperative cell isolation is a feasible new technique to support ICAB and frozen section in the assessment of bony and soft tissue margins.
http://ift.tt/2myvUpN
Transoral Laser Microsurgery in Early Glottic Lesions
Abstract
Purpose of Review
To give an overview of the evolvement of transoral laser microsurgery (TLM) in the treatment of early glottic carcinoma and highlight the contribution of recent literature.
Recent Findings
The indications and limits of TLM have been well specified. Effects on swallowing have been well documented. Introduction of narrow-band imaging (NBI) and diffusion-weighted magnetic resonance has been shown of additional value for outcome. The first reports on transoral robotic surgery show that it may be of added value in the future.
Summary
TLM for early glottic carcinoma (Tis–T2) has very good oncological outcomes with indications of higher larynx preservation in TLM than that in radiotherapy. The anterior commissure is a risk factor if involved in the cranio-caudal plane, and reduced vocal fold mobility is a risk factor when this is due to arytenoid involvement. The best voice results are achieved when the anterior commissure can be left intact along with part of the vocal fold muscle although even in larger resections, patient self-reported voice handicap is still limited.
http://ift.tt/2mdBNp1
A giant oropharyngeal synovial sarcoma threatening the supraglottic airway – A case report
Publication date: Available online 11 March 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Santosh K. Swain, Alok Das, Mitali Madhumita Rath, Mahesh C. Sahu
Oropharyngeal synovial sarcoma is a rare malignant tumour. It has an aggressive nature and poor prognosis. The treatment of the synovial sarcoma is essentially surgical followed by postoperative chemoradiation. The giant oropharyngeal synovial sarcoma obstructing the airway may create threatening to the patient's airway and challenge to the surgeon. Before treating the patient, safe airway is vital for management of the disease. The appropriate diagnosis and treating the lesion with negative margin can improve the prognosis and survival of the patient. We report a case of oropharyngeal synovial sarcoma obstructing the supraglottic airway in a 29year old man, who undergone tracheostomy for safe airway followed by surgery and chemoradiation.
http://ift.tt/2mxcxvU
A pregnant woman with a surgical site infection after mesh repair of an abdominal wall incisional hernia: a case report
Surgical meshes are widely used in incisional hernia repair. However, there are no reports of pregnancies complicated by infection of surgical meshes used for hernia repair. This is the first case report of a ...
http://ift.tt/2mydaa1
Epithelial cell-enhanced metabolism by low-level laser therapy and epidermal growth factor
Abstract
Reepithelialization and wound closure are the desired outcome for several ulcerative conditions. Such resolution reduces the possibility of wound contamination and maintenance of the injury and improves the reestablishment of tissue morphology and functions. Investigators are seeking adjuvant therapies that can accelerate wound healing and are developing new strategies for clinical applications. This study compared the effects of epidermal growth factor (EGF) application and low-level laser therapy (LLLT) on cultured epithelial cells. Cells were seeded in 24-well plates. After a 24-h incubation, the epithelial cells were either treated with EGF (100 μM in serum-free DMEM for 72 h) or subjected to LLLT (780 nm, 25 mW, 0.5, 1.5, and 3 J/cm2) by three applications every 24 h. Seventy-two hours after cells were treated with EGF or LLLT, cell migration, viability, proliferation, and collagen synthesis were assessed. Cells treated with EGF showed increased cell viability, proliferation, and collagen synthesis compared with those cells that received no treatment. LLLT enhanced cell migration; however, no significant effects of laser irradiation on other cell functions were observed. Comparison of both therapies demonstrated that EGF and LLLT enhanced specific epithelial cell activities related to wound healing.
http://ift.tt/2nh95VW
Vitexin alleviates ox-LDL-mediated endothelial injury by inducing autophagy via AMPK signaling activation
Source:Molecular Immunology, Volume 85
Author(s): Shaoli Zhang, Changlei Guo, Zhigang Chen, Peiyong Zhang, Jianhua Li, Yan Li
Endothelial cell injury plays a crucial role in the development and pathogenesis of cardiovascular disease. Vitexin is a natural flavonoid characterized by anti-oxidative and anti-inflammatory properties. The purpose of this study was to investigate the effects of vitexin on ox-LDL-induced endothelial dysfunction and to explore the underlying molecular mechanisms. In the present study, vitexin was found to play a protective role against ox-LDL-induced endothelial injury. Vitexin significantly promoted cell viability and inhibited apoptosis in ox-LDL-treated HUVECs. The up-regulation of cleaved Caspase-3, cleaved Caspase-9 and Bax induced by ox-LDL were inhibited by treatment with vitexin; meanwhile, the down-regulation of Bcl-2 was suppressed by vitexin. Pretreatment with vitexin was found to inhibit the ox-LDL-induced overexpression of IL-1β, IL-6, TNF-α, E-selectin, ICAM1 and VCAM1. Moreover, vitexin reduced ox-LDL-induced oxidative stress by inhibiting the production of ROS and MDA, and by promoting the expression of SOD. Furthermore, we had shown that vitexin protected against the ox-LDL induced cell injury by activating autophagy. The protective effects of vitexin in ox-LDL-treated HUVECs were all reversed following treatment with the autophagy inhibitor 3-MA. In addition, we found that vitexin increased the expression of p-AMPK and decreased the expression of p-mTOR. The combination of the AMPK inhibitor Compound C plus vitexin significantly reversed the effects of vitexin in ox-LDL-treated HUVECs, such as the inhibition of autophagy, reduction in cell viability, increase in apoptosis and ROS production. In conclusion, these data suggest that vitexin ameliorates ox-LDL-mediated endothelial injury by inducing autophagy via AMPK signaling.
http://ift.tt/2mxK7mN
Pyoderma gangrenosum avec anticorps anti-cytoplasme des neutrophiles de type anti-protéinase 3 (PR3-ANCA) induits par le propylthiouracile
Publication date: Available online 11 March 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Coster, J.-L. Dargent, N. de Visscher, P. Levecque, P.-P. Roquet-Gravy
IntroductionLes antithyroïdiens de synthèse peuvent être responsables du développement d'anticorps anti-cytoplasme des neutrophiles (ANCA) et de vasculites liées à la présence de ces ANCA, ou de dermatoses neutrophiliques. Le propylthiouracile (PTU) est l'antithyroïdien de synthèse le plus souvent incriminé et ces ANCA sont surtout de type anti-myélopéroxydase (MPO-ANCA). À notre connaissance, aucune publication n'a rapporté d'association entre pyoderma gangrenosum (PG) et ANCA anti-protéinase 3 (PR3-ANCA) induits par le PTU.ObservationUne femme de 68 ans était traitée par du PTU pour un goitre multinodulaire toxique. Elle se présentait en raison d'une ulcération nécrotique étendue de la partie inférieure de l'abdomen. L'anamnèse, la clinique, les prélèvements bactériologiques et histologiques permettaient de poser le diagnostic de pyoderma gangrenosum. Celui-ci était accompagné d'ANCA de spécificité antigénique anti-protéinase 3. L'arrêt du PTU, associé à une courte cure de corticothérapie générale et de ciclosporine, permettait une résolution rapide et complète du pyoderma gangrenosum, parallèlement à une décroissance des ANCA. Aucune rechute n'était objectivée à un an de l'arrêt de tout traitement.DiscussionNous rapportons un cas de PG accompagné de PR3-ANCA induits par le PTU, en l'absence de toute vasculite démontrable.BackgroundSynthetic antithyroid drugs are often used in the treatment of hyperthyroidism, regardless of aetiology. They may cause various side effects, including the development of anti-neutrophil cytoplasmic antibodies (ANCA), ANCA-associated vasculitis, and neutrophilic dermatoses. Propylthiouracil (PTU) is the antithyroid drug most frequently implicated in ANCA-associated diseases specifically involving anti-myeloperoxidase ANCA (MPO-ANCA). To our knowledge, there are no clinical reports describing the association of pyoderma gangrenosum (PG) and anti-proteinase3-ANCA (PR3-ANCA) induced by PTU, with ANCA levels decreasing after antithyroid drug withdrawal.Patients and methodsA 68-year-old woman was treated with propylthiouracil (PTU) for toxic multinodular goitre. She presented necrotic ulceration of the lower abdomen. The patient's history, physical examination, and bacteriological and histological samples led to a diagnosis of pyoderma gangrenosum. This pyoderma involved ANCA with antigenic specificity for proteinase 3. Withdrawal of PTU and a short course of corticosteroids and cyclosporine resulted in rapid and complete resolution of the pyoderma gangrenosum as well as a decrease in ANCA. No relapse was observed one year after cessation of treatment.DiscussionWe report a case of PG associated with PR3-ANCA induced by PTU, without any demonstrable vasculitis.
http://ift.tt/2ngwPtk
Vestibulotoxicity with systemic Gentamicin in different dosing regimens: our experience in 46 patients
Abstract
Although the use of topical gentamicin has declined systemic gentamicin remains an important antimicrobial agent in the management of infections caused by multidrug-resistant gram-negative bacteria. Nephrotoxicity and Ototoxicity from systemic gentamicin is well documented despite normal gentamicin levels (peak and trough) and normal renal function tests
Nephrotoxicity is a predisposing factor for vestibulotoxicity however vestibulotoxicity can still occur, in patients without nephrotoxicity [19 of 46 (43.1%) % in our series] much more significantly in single daily dosing (SDD) compared to multiple daily dosing (MDD)
From our database of 46 patients we analyzed 19 patients with vestibulotoxicity without nephrotoxicity. Eighteen (94.7%) had imbalance, 10 (52.6%) had oscillopsia, while only 1 (5.3%) and 2 (10.5%) complained of tinnitus and hearing loss
Twelve patients received SDD and 5 MDD. The median cumulative dose resulting in vestibulotoxicity in SDD compared to MDD patients was 4.8g (interquartile range (IQR) = 2.2-8.1g) versus 8.2g (IQR = 6.4-9.4g) (p=0.009) and the median duration of therapy-to-time of diagnosis of vestibulotoxicity was 15d (IQR = 5-22d) versus 34.5d (IQR = 24.3-40.3d) (p=0.03)
In patients without renal dysfunction, gentamicin vestibulotoxicity occurred at a lower cumulative dose and with a shorter duration of therapy in patients who had received SDD versus MDD. Prospective safety evaluation regarding vestibulotoxicity for both dosing regimens is warranted.
This article is protected by copyright. All rights reserved.
http://ift.tt/2mN3g50
Chondroradionecrosis of the larynx: 24-year University of Wisconsin experience
ABSTRACT
Background
Chondroradionecrosis (CRN) is an uncommon but significant complication of laryngeal radiotherapy that presents a diagnostic challenge to clinicians through its similarity in presentation to cancer recurrence.
Methods
Two hundred ninety-four patients underwent primary, adjuvant, or salvage radiation for laryngeal cancer from 1991 to 2015 at the University of Wisconsin. Medical records were reviewed to identify and characterize patients with a diagnosis of CRN.
Results
Of the 294 patients, 7 cases (2.4%) of CRN were identified. Development of CRN was associated with the presence of cartilage invasion by tumor (p = .038) and ongoing alcohol use postradiotherapy (p = .036). Additionally, a trend between development of CRN and ongoing smoking postradiotherapy was observed (p = .067).
Conclusion
The diagnosis of CRN is challenging, and the likelihood of successful resolution is modest. A high premium should be placed on efforts directed at prevention, such as tobacco and alcohol cessation. © 2017 Wiley Periodicals, Inc. Head Neck, 2017
http://ift.tt/2nqpu9L
Influence of third molars in mandibular fractures. Part 1: mandibular angle—a meta-analysis
Publication date: Available online 11 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): A.C.V. Armond, C.C. Martins, J.C.R. Glória, E.L. Galvão, C.R.R. dos Santos, S.G.M. Falci
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. The presence of a mandibular third molar increases the chance of an angle fracture (case–control and cross-sectional studies: odds ratio (OR) 3.83, 95% confidence interval (CI) 3.02–4.85, I2=83.1%; case–control studies: OR 3.27, 95% CI 2.57–4.16, I2=81.3%). The third molar positions most favourable to angle fracture according to the Pell and Gregory classification are class B (OR 1.44, 95% CI 1.06–1.96, I2=87.2%) and class II (OR 1.67, 95% CI 1.36–2.04, I2=72.4%). Class A (OR 0.60, 95% CI 0.45–0.81, I2=87.1%) and class I (OR 0.51, 95% CI 0.37–0.71, I2=89.4%) act as protective factors for angle fracture. The results suggest that the presence of the third molar increases the chance of angle fracture by 3.27 times and that the most favourable positions of the third molar for angle fracture are classes B and II, whilst classes A and I act as protective factors.
http://ift.tt/2mwHmSL
Refining the indications for scapula tip in mandibular reconstruction
Publication date: Available online 11 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M.W. Ho, J.S. Brown, R.J. Shaw
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. The blood supply to the lateral scapula through the circumflex scapular system is well established in the literature and this would be the preferred reconstruction in class I mandibular defects associated with a significant soft tissue requirement. The scapula tip would suit cases where the ipsilateral recipient vessels are compromised, and so justify the potential for mandibular reconstruction with inferior bone stock.
http://ift.tt/2muUAy4
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
Bilateral lingual artery stenosis: A rare, late complication of chemoradiotherapy
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): F. Holtz, Y. Monnier, U. Borner, L. Nisa
IntroductionCarotid artery stenosis following radiotherapy (RT) is a known risk factor for the development of cerebrovascular disease with a risk of subsequent stroke or transient ischaemic attack. In contrast, small vessel disease in the neck following RT has been more rarely described.Case reportThe authors report the case of a 61-year-old man who developed partial lingual necrosis 4 years after surgery and postoperative chemoradiotherapy for squamous cell carcinoma of the floor of the mouth. Contrast-enhanced CT scan confirmed subtotal to total occlusion of both lingual arteries. Surgical debridement of the necrosis allowed complete cure of the lesions.DiscussionSmall vessel disease is a possible complication in patients treated by RT for head and neck cancer. Although the risk of these complications is not directly related to the total radiation dose, higher doses appear to accelerate the development of vascular lesions. Practitioners must be aware of the possibility of these complications, especially in patients surviving more than 5 years.
http://ift.tt/2nptR4U
Awareness of obstructive sleep apnea-hypopnea syndrome among the general population of the Lorraine Region of France
Publication date: Available online 11 March 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): F. Arous, J.-M. Boivin, A. Chaouat, C. Rumeau, R. Jankowski, D.T. Nguyen
ObjectiveObstructive sleep apnea-hypopnea syndrome (OSAHS) seems to be underdiagnosed. The aim of this study was to assess awareness of OSAHS among the general population of the Lorraine Region of France.MethodsA descriptive epidemiological study was carried out from July to November 2015 in the Lorraine Region, using an anonymous questionnaire that assessed knowledge of OSAHS-related symptoms and complications. The survey was also circulated on the Internet via social media. Exclusion criteria comprised age under 18 years, refusal to fill out the questionnaire and linguistic barrier.Results1307 subjects filled out the survey: 1020 on paper format and 287 via the Internet. About two-thirds of the population recognized a majority of symptoms. However, there was a significant lack of knowledge of complications, especially cardiological and neurological. Suffering from OSAHS, having had higher education, and being under 40 years of age, were factors linked to better awareness of the syndrome. Internet respondents also showed better awareness.ConclusionDespite encouraging results regarding OSAHS symptoms, the general population showed limited awareness of its complications. Innovative educational campaigns must be organized to inform practitioners and the general public about the disease and raise awareness of its complications.
http://ift.tt/2mwrTCr
Two cases of melanomas paradoxically metastasizing to the intestinal tract during nivolumab therapy
Abstract
We report two cases of melanomas in patients who developed intestinal metastasis despite other metastatic sites responding to nivolumab and despite the patients having favorable findings such as vitiligo and normal lactate dehydrogenase. The first case is an 85-year-old man who had been administrated nivolumab for lung/cutaneous metastases. After 22 courses of nivolumab therapy, fever and anorexia had appeared and his bodyweight had decreased. An intussusception on the ileocecal valve was revealed by computed tomography, and emergency surgery revealed metastatic lesions on the colon. The second case is an 87-year-old woman treated with nivolumab for lymph node metastases. After 10 courses, laboratory tests had revealed anemia and positive fecal occult blood. Her bodyweight had decreased. Capsule endoscopy showed scattered tumors and clots, indicating metastases of melanoma. The frequency of symptomatic intestinal metastasis of melanoma is very low. Further, intestinal metastasis of melanoma is difficult to detect through routine examinations. Our cases suggest that fecal occult blood test and decreased bodyweight are indications of intestinal metastases.
http://ift.tt/2mMnjjN
Evaluation of positron emission tomography imaging to detect lymph node metastases in patients with extramammary Paget's disease
Abstract
Patients with extramammary Paget's disease (EMPD) have a relatively good prognosis, when spread of the tumor cells is limited to the epidermis. However, invasive EMPD has a poor prognosis, when the patients have regional lymph node metastasis. Detection of nodal metastasis is thus mandatory to manage EMPD. To evaluate the 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging to assess lymph node metastasis, 15 patients with histologically proven primary EMPD were enrolled in this study. All patients underwent whole-body PET prior to sentinel lymph node biopsy (SLNB). The maximum standardized uptake value (SUVmax) of more than 2.5 was evaluated as positive PET indicative of malignancy. Among 14 cases with the primary genital lesions, 11 cases underwent bilateral SLNB of the inguinal nodal basin and the remaining three cases unilateral SLNB. One case with a primary axillary lesion underwent unilateral SLNB of the axillary nodal basin. Therefore, a total of 26 regional basins were investigated. In general, nodal basins can be categorized into four groups: (i) histologically negative and PET negative (true negative); (ii) histologically positive and PET negative (false negative); (iii) histologically positive and PET positive (true positive); and (iv) histologically negative and PET positive (false positive) groups. In the 26 nodal basins, there were 19 true negative and seven true positive cases, and neither false negative nor false positive cases were observed. The mean SUVmax was significantly higher in the true positive basins (8.03 ± 3.34) than in the true negative basins (0.26 ± 0.56). The SUVmax value may be useful for detection of nodal metastasis.
http://ift.tt/2npzKiv
Twelve-week, multicenter, placebo-controlled, randomized, double-blind, parallel-group, comparative phase II/III study of benzoyl peroxide gel in patients with acne vulgaris: A secondary publication
Abstract
A placebo-controlled, randomized, double-blind, parallel-group, comparative, multicenter study was conducted to investigate the efficacy and safety of benzoyl peroxide (BPO) gel, administrated once daily for 12 weeks to Japanese patients with acne vulgaris. Efficacy was evaluated by counting all inflammatory and non-inflammatory lesions. Safety was evaluated based on adverse events, local skin tolerability scores and laboratory test values. All 609 subjects were randomly assigned to receive the study products (2.5% and 5% BPO and placebo), and 607 subjects were included in the full analysis set, 544 in the per protocol set and 609 in the safety analyses. The median rates of reduction from baseline to the last evaluation of the inflammatory lesion counts, the primary end-point, in the 2.5% and 5% BPO groups were 72.7% and 75.0%, respectively, and were significantly higher than that in the placebo group (41.7%). No deaths or other serious adverse events were observed. The incidences of adverse events in the 2.5% and 5% BPO groups were 56.4% and 58.8%, respectively; a higher incidence than in the placebo group, but there was no obvious difference between the 2.5% and 5% BPO groups. All adverse events were mild or moderate in severity. Most adverse events did not lead to study product discontinuation. The results suggested that both 2.5% and 5% BPO are useful for the treatment of acne vulgaris.
http://ift.tt/2mM9ZvI
Unexpected recalcitrant course of drug-induced erythema multiforme-like eruption and interstitial pneumonia sequentially occurring after nivolumab therapy
Abstract
Vemurafenib improves survival of melanoma patients. However, cutaneous side-effects commonly occur in them. Nivolumab and ipilimumab are monoclonal antibodies against programmed death 1 and cytotoxic T-lymphocyte-associated antigen 4, both of which regulate excessive T-cell activation. Although these agents induce antitumor immunity against melanoma, the modified immune condition may result in an unexpected adverse reaction which has not been observed previously. Herein, we report a case who manifested severe erythema multiforme-like eruption with mucosal involvement associated with vemurafenib following nivolumab. The patient also subsequently suffered from ipilimumab-induced interstitial pneumonia with refractory course. Such a case has never been reported. This case suggested that dermatologists should pay special attention to unexpected adverse events of these drugs, and carefully observe cutaneous and respiratory status of patients during the treatment of melanoma.
http://ift.tt/2mM3QQe
Concomitant confluent and reticulated papillomatosis and acanthosis nigricans in an obese girl with insulin resistance successfully treated with oral minocycline: Case report and published work review
Abstract
Concomitant confluent and reticulated papillomatosis (CRP) and acanthosis nigricans (AN) is rare. We present a case of concomitant CRP and obesity-associated AN in a 12-year-old obese Japanese girl. Curiously, oral minocycline therapy, which has been shown to be effective for CRP, was effective against both CRP and AN. Possible mechanisms by which minocycline could have improved skin lesions of CRP and obesity-associated AN are discussed. In addition, reports of concomitant CRP and obesity-associated AN are reviewed. CRP and obesity-associated AN share common clinicopathological features and some reports have described concomitant CRP and obesity-associated AN. Together with the observation that skin lesions of CRP and obesity-associated AN in the present case responded to oral minocycline therapy, these facts suggest a tight relationship or a common pathogenetic pathway between these pathologies.
http://ift.tt/2npDHnu
Serum soluble interleukin-2 receptor level is more sensitive than angiotensin-converting enzyme or lysozyme for diagnosis of sarcoidosis and may be a marker of multiple organ involvement
Abstract
Skin lesions in sarcoidosis are often the initial symptoms that enable the dermatologist to be the first to diagnose this granulomatosis. However, diagnosis is sometimes very problematic. In 2015, the diagnostic criteria for sarcoidosis were updated in Japan, with elevated serum soluble interleukin-2 receptor (sIL-2R) replacing negative tuberculin reaction. Therefore, we assessed the clinical utility of sIL-2R compared with two other common markers, angiotensin-converting enzyme (ACE) and lysozyme, in patients who visited the dermatology clinic. Data from 72 patients showed that sIL-2R was more sensitive than both ACE and lysozyme in supporting a diagnosis of sarcoidosis (52.8%) compared with ACE (29%) and lysozyme (26.4%). Additionally, the sIL-2R level was significantly higher in patients with multiple organ involvement and parenchymal infiltration. Patients with elevated sIL-2R levels had higher serum ACE and lysozyme levels, a higher incidence of pulmonary involvement, more severe chest radiographic stage and a high incidence of expression-specific signs by imaging analysis. Receiver–operator curve analysis showed that sIL-2R was a better marker at the threshold cut-off point compared with ACE and lysozyme for identifying patients with multiple organ involvement, detecting patients with pulmonary disease and parenchymal infiltration as well as predicting the presence of specific signs in the diagnosis of sarcoidosis. Moreover, the kinetics of sIL-2R levels correlated closely with clinical manifestations, in contrast to the modest changes of ACE and lysozyme levels during the follow-up period. In conclusion, sIL-2R may be considered a good marker for diagnosis and a potential indicator of disease activity.
http://ift.tt/2npJ2eB
Serum carcinoembryonic antigen specifically increases among various serum markers of adenocarcinoma in hypohidrosis or conditions related to hypohidrosis
Abstract
Anhidrosis/hypohidrosis are conditions presenting various level of sweating dysfunction. Among them, acquired idiopathic generalized anhidrosis (AIGA) presents inadequate decrease or loss of sweating without apparent neurological and dermatological symptoms except cholinergic urticaria. Recently, serum level of carcinoembryonic antigen (CEA), one of the most well-known tumor markers, has been proposed as a clinical marker reflecting activity of AIGA. This study was performed to verify the specificity and independence of serum CEA level from the other serum tumor markers especially related to adenocarcinoma. The expression of various tumor markers in the serum collected from three healthy control subjects, four AIGA cases, and a cholinergic urticaria (CU) case with elevation of serum CEA level and history of hyperthermia was analyzed using a membrane-based antibody array. In all AIGA and CU cases, the intensity of CEA was significantly increased (7.60–15.9 times compared with that of control), relatively well-reflecting the serum CEA level, and the mean intensity of CEA was 11.8 times higher than the control subjects (P = 0.0011). On the other hand, the ratio of carbohydrate antigen (CA)125 and CA19-9 was 1.93 and 0.23 times compared with the mean intensity of the control subjects, respectively, and there was no statistical significance. Immunohistochemistry on 10 AIGA cases showed increased expression of CEA but not CA19-9 and CA125 in the eccrine sweat glands. In conclusion, the elevation of serum CEA level was independent from the other tumor markers in hypohidrotic condition represented by AIGA.
http://ift.tt/2npCUDd
Case of harlequin ichthyosis with a favorable outcome: Early treatment and novel, differentially expressed, alternatively spliced transcripts of the ATP-binding cassette subfamily A member 12 gene
Abstract
Harlequin ichthyosis (HI) is the most severe form of autosomal recessive congenital ichthyosis, with a high mortality rate. Recent advances in neonatal care and the early administration of retinoids have improved the survival rate of HI. Here, we present a case of HI who was successfully treated with early administration of etretinate and showed good prognosis. Next-generation sequencing identified novel mutations of the ATP-binding cassette subfamily A member 12 gene (ABCA12), c.5884+4_+5delAA and c.7239G>A, which caused skipping of exons 39 and 48, respectively. Transcripts with exon 48 skipping, which cause a deletion in the second ATP-binding cassette of ABCA12, were dominantly expressed in the skin. Besides the early administration of etretinate, the differential expression of the mutant protein with limited segmental deletion of ABCA12 may be related to the favorable outcome of our patient.
http://ift.tt/2mMd4fF
Long-term future risk of severe exacerbations: distinct 5-year trajectories of problematic asthma
Abstract
Background
Assessing future risk of exacerbations is an important component of asthma management. Existing studies have investigated short-, but not long-term risk. Problematic asthma patients with unfavorable long-term disease trajectory and persistently frequent severe exacerbations need to be identified early to guide treatment.
Methods
Severe exacerbation rates over five years for 177 "problematic asthma" patients presenting to a specialist asthma clinic were tracked. Distinct trajectories of severe exacerbation rates were identified using group-based trajectory modeling. Baseline predictors of trajectory were identified and used to develop a clinical risk score for predicting the most unfavorable trajectory.
Results
Three distinct trajectories were found: 58.5% had rare intermittent severe exacerbations ("infrequent"), 32.0% had frequent severe exacerbations at baseline but improved subsequently ("non-persistently frequent"), and 9.5% exhibited persistently frequent severe exacerbations, with the highest incidence of near-fatal asthma ("persistently frequent"). A clinical risk score composed of ≥2 severe exacerbations in the past year (+2 points), history of near-fatal asthma (+1 point), body mass index≥25kg/m2 (+1 point), obstructive sleep apnea (+1 point), gastroesophageal reflux (+1 point) and depression (+1 point) was predictive of the "persistently frequent" trajectory (area under the receiver operating characteristic curve: 0.84; sensitivity 72.2%, specificity 81.1% using cut-off ≥3 points). The trajectories and clinical risk score had excellent performance in an independent validation cohort.
Conclusions
Patients with problematic asthma follow distinct illness trajectories over a period of five years. We have derived and validated a clinical risk score that accurately identifies patients who will have persistently frequent severe exacerbations in the future.
This article is protected by copyright. All rights reserved.
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Epidemiology of drug-induced anaphylaxis in a tertiary hospital in Korea
Publication date: Available online 10 March 2017
Source:Allergology International
Author(s): Han-Ki Park, Min-Gyu Kang, Min-Suk Yang, Jae-Woo Jung, Sang-Heon Cho, Hye-Ryun Kang
BackgroundEpidemiology and risk factors of drug-induced anaphylaxis are difficult to estimate due to lack of confirmative diagnosis and under reporting. Here we report the current state of drug-induced anaphylaxis in Korea based on an in-hospital pharmacovigilance database in a tertiary hospital.MethodsThis study is a retrospective analysis of drug-induced anaphylaxis, reported to an in-hospital pharmacovigilance center in Seoul National University Hospital from June 2009 to May 2013. Anaphylaxis occurred in patients under 18 years of age or developed by medications administered from outside pharmacies or hospitals were excluded. We assessed causative drug, incidence per use of each drug and risk factors of fatal anaphylactic shock.ResultsA total of 152 in-hospital drug-induced anaphylaxis cases were reported during the study period. The single most frequently reported drug was platinum compound and the incidence of anaphylaxis and anaphylactic shock in platinum compounds users was 2.84 and 1.39 per 1000 patients use. Risk factors of anaphylactic shock among total anaphylaxis cases were identified as older age ≥70 years [Odd's ratio (OR), 5.86; 95% confidence interval (CI), 1.70–20.14]. The use of iodinated contrast media (OR, 6.19; 95% CI, 1.87–20.53) and aminosteroid neuromuscular blocking agent (NMBA) (OR, 12.82; 95% CI, 1.50–109.92) were also a risk factor for the development of anaphylactic shock.ConclusionsPlatinum compounds are the most commonly reported causative agents of in-hospital drug-induced anaphylaxis. Older age ≥70 years and drugs such as iodinated contrast media and aminosteroid NMBA are related with high risk of anaphylactic shock.
http://ift.tt/2muNdGC
Protective effects of 1,2,3-triazole derivative KPR-A020 against cisplatin-induced ototoxicity in murine cochlear cultures
Publication date: May 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 96
Author(s): Ye-Ri Kim, Da Jung Jung, Se-Kyung Oh, Taeho Lee, In-Kyu Lee, Kyu-Yup Lee, Un-Kyung Kim
Cisplatin (cis-diaminedichloridoplatinum(II), cis-[PtCl2(NH3)2]) is an effective chemotherapeutic agent in the treatment of several types of malignant solid tumors but its clinical use is associated with ototoxicity. Several studies have investigated the effect of antioxidants on cisplatin-induced ototoxicity in mice. The triazole KPR-A020 has been shown to play a protective role against mitochondrial dysfunction by reducing the production of mitochondrial reactive oxygen species (ROS). The effect of KPR-A020 on cisplatin-induced ototoxicity was examined using cultures of cochlear explants. Healthy mice were randomly divided into 4 groups: control, treated with cisplatin alone (CP), treated with cisplatin and KPR-A020 (CP + KPR-A020), and treated with KPR-A020 alone (KPR-A020). The cochlear explants were harvested for histological and immunohistochemical examinations. Biochemical analyses of the explants revealed that pre-treatment with KPR-A020 prevented an increase in mitochondrial ROS levels. Moreover, the CP + KPR-A020 group showed better hair cell survival than the CP group. Immunohistochemical examinations of cochlear explants stained with anti-caspase-3 revealed greater immunopositivity in the CP group. The CP + KPR-A020 group showed significantly less immunopositivity than the CP group (P < 0.05). Thus, it appears that KPR-A020 protects hair cells in the organ of Corti from cisplatin-induced toxicity by decreasing the production of mitochondrial ROS. The results of this study suggest that KPR-A020 can be used as an antioxidant and antiapoptotic agent to prevent hearing loss caused by cisplatin induced-oxidative stress.
http://ift.tt/2mbeDzA
Story retelling skills in Persian speaking hearing-impaired children
Publication date: May 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 96
Author(s): Farnoush Jarollahi, Reyhane Mohamadi, Yahya Modarresi, Zahra Agharasouli, Shadi Rahimzadeh, Tayebeh Ahmadi, Mohammad-reza Keyhani
ObjectivesSince the pragmatic skills of hearing-impaired Persian-speaking children have not yet been investigated particularly through story retelling, this study aimed to evaluate some pragmatic abilities of normal-hearing and hearing-impaired children using a story retelling test.Methods15 normal-hearing and 15 profound hearing-impaired 7-year-old children were evaluated using the story retelling test with the content validity of 89%, construct validity of 85%, and reliability of 83%. Three macro structure criteria including topic maintenance, event sequencing, explicitness, and four macro structure criteria including referencing, conjunctive cohesion, syntax complexity, and utterance length were assessed. The test was performed with live voice in a quiet room where children were then asked to retell the story. The tasks of the children were recorded on a tape, transcribed, scored and analyzed.ResultsIn the macro structure criteria, utterances of hearing-impaired students were less consistent, enough information was not given to listeners to have a full understanding of the subject, and the story events were less frequently expressed in a rational order than those of normal-hearing group (P < 0.0001). Regarding the macro structure criteria of the test, unlike the normal-hearing students who obtained high scores, hearing-impaired students failed to gain any scores on the items of this section.ConclusionsThese results suggest that Hearing-impaired children were not able to use language as effectively as their hearing peers, and they utilized quite different pragmatic functions.
http://ift.tt/2na0aZV
Lung Ultrasound for the Regional Anesthesiologist and Acute Pain Specialist.
In this article, we discuss the emerging role of lung point-of-care ultrasonography for regional anesthesiologists and pain management specialists. Lung ultrasonography is a well-established clinical tool that is used on a routine basis in emergency rooms and critical care units internationally to evaluate patients with respiratory distress; however, its benefits to the regional anesthesiologist and pain specialist are not as well known and are practiced less frequently. This review article covers the clinical evidence in support of lung point-of-care ultrasonography as a rapid and superior tool to traditional imaging modalities such as chest radiography and fluoroscopy. As anesthesiologists routinely perform nerve blocks that put patients at potential risk of complications such as pneumothorax or diaphragmatic paresis, it is important to understand how to use lung ultrasonography to evaluate for these conditions, as well as to differentiate between other potential causes of respiratory distress, such as interstitial syndrome and pleural effusions. This article describes the normal and pathological findings that can be used to quickly and confidently evaluate a patient for these conditions. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.
http://ift.tt/2mw9uFL
http://ift.tt/2mw9uFL
Multiple erosive lichen planus preceded by solitary lichen planus after combination therapy with nivolumab and radiation
Erosive lichen planus (ELP) is a rare type of LP, which is a T cell-mediated chronic inflammatory disease that develops in the skin and mucosa (1). ELP differs from common solitary LP in that it is accompanied by pain and erosive changes in the lesions (1). Nivolumab is a monoclonal antibody to the immune check point molecule programmed death 1 (PD-1). Nivolumab facilitates T cell activation by cancelling the suppressive effect of PD-1 signaling on T cells, and exerts anti-tumor effects in various cancers (2). The excess T cell activation induced by nivolumab, however, occasionally causes several T cell-mediated diseases, including LP as we have previously reported (3).
This article is protected by copyright. All rights reserved.
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Diseño y evaluación de las propiedades antibacterianas de un prototipo de molde de audífono que incorpora cobre en su manufactura
Introducción: La otitis externa infecciosa es una consulta otorrinolaringológica frecuente en usuarios de audífonos. Las propiedades antibacterianas descritas del cobre, han motivado el desarrollo de aplicaciones clínicas de este metal. Objetivo: Evaluar la capacidad antibacteriana de moldes de audífonos manufacturados con polímeros sensible a luz UV, silicona y acrílico que incorporan cobre metálico, en un sistema experimental in vitro. Material y método: Se diseñaron moldes de audífonos con y sin cobre, que fueron inoculados con distintas concentraciones de microorganismos (S aureus y P aeruginosa), para luego determinar el porcentaje de adherencia bacteriana a distintos tiempos de contacto (4, 8 y12 horas). Resultados: Existió reducción significativa en la adhesión bacteriana a los moldes con cobre respecto a aquellos sin cobre, independiente del material, del tipo de microorganismo y del inóculo bacteriano. Discusión: La disminución en la adherencia bacteriana en los prototipos con cobre, puede atribuirse a su actividad inhibitoria sobre los microorganismos en función de su concentración y el tiempo de contacto, ejerciendo su efecto por difusión a través de los distintos materiales. Conclusión: Con estos resultados, se hace necesario el desarrollo de estudios clínicos enfocados en comprobar si el uso de audífonos con cobre disminuyen las otitis externas de origen infeccioso.
Introduction: External otitis of infectious etiology among hearing aid users is a common motive of otolaryngology consultation. Antibacterial properties described copper, they have motivated the development of clinical applications of this metal. Aim: Evaluate the antibacterial capacity of copper-based ear molds manufactured with different materials such UV sensitive polymers, silicone and acrylic incorporating metallic copper, in an experimental system in vitro. Material and method: Ear molds with and without copper, were inoculated with different concentrations of microorganisms (S aureus and P aeruginosa) and determine the percentage of bacterial adherence to different contact times (4-8 and 12 hours). Results: There was significant reduction in bacterial adhesion to copper molds than those without copper, independent of the material, the type of microorganism and the bacterial inoculum. Discussion: The decrease in bacterial adherence on prototypes with copper, can be attributed to inhibitory activity on microorganisms depending on their concentration and contact time, exerting its effect by diffusion through the various materials. Conclusion: With these results, is necessary the development of clinical studies focused on checking whether the use of hearing aids with copper decreases external otitis of infectious origin.
http://ift.tt/2lN0Eol
Estudio epidemiológico descriptivo de pacientes hospitalizados en el Servicio de ORL del Hospital Clínico de la Universidad de Chile entre los años 2007 y 2014
Introducción: Las enfermedades de origen otorrinolaringológico (ORL) tienen una elevada prevalencia en atención primaria de salud, sin embargo, la información epidemiológica en pacientes hospitalizados es bastante escasa. Objetivo: Obtener características demográficas y prevalencia de enfermedades en los pacientes hospitalizados del Servicio de ORL del Hospital Clínico de la Universidad de Chile (HCUCh). Material y método: Estudio de tipo descriptivo y retrospectivo, llevado a cabo en el Servicio de ORL del HCUCh, donde se revisaron los registros electrónicos, existentes de grupos relacionados a diagnóstico (GRD) de egresos, entre los años 2007 y 2014. Resultados: Se incluyeron 7.353 egresos, con un promedio de edad de los pacientes de 28,24 años. La causa de hospitalización más frecuente fue la patología de faringe. Del total de los egresos 87,88% presentaron una intervención quirúrgica donde la amigdalectomía con adenoidectomía alcanzó el 15,7% de las cirugías realizadas. Conclusión: Este estudio nos entrega información epidemiológica sobre los pacientes hospitalizados en un servicio de ORL de un hospital de referencia a nivel nacional.
Introduction: Diseases ofotolaryngology (ENT) origin have a high prevalence in primary health care, however, the epidemiological information on hospitalized patients is almost null. Aim: To obtain demographic and disease prevalence information in hospitalized patients of the ENT Department at the Hospital Clínico de la Universidad de Chile (HCUCh). Material and method: A descriptive and retrospective study, was carried out at the ENT department of the HCUCh, reviewing existing records of diagnostic related groups (GRD) for discharges between 2007 and 2014. Results: We review a total of 7353 discharges, with an average age of patients of 28.24 years. The most frequent cause of hospitalization was pharynx pathology. An 87.88% of discharges had surgery performed, where tonsillectomy with adenoidectomy reached 15,7% of the total. Conclusion: This study provides us with epidemiological information on patients hospitalized in an ENT department in a nationwide referral hospital.
http://ift.tt/2mSvKui
Comparación de las amplitudes y latencias de la onda V del potencial evocado auditivo de tronco cerebral obtenidas a través de estímulos clic y CE-Chirp®
Introducción: El potencial evocado auditivo de tronco cerebral (PEATC) se ha convertido en un procedimiento estándar dentro de la evaluación audiológica. Durante décadas, el estímulo más utilizado ha sido el clic, sin embargo, últimamente se ha propuesto la utilización de estímulos de frecuencia modulada (chirp) para obtener resultados más eficientes. Objetivo: Comparar las amplitudes y las latencias de la onda V del PEATC obtenidas a través de estímulos clic y CE-Chirp® a distintas intensidades. Material y método: Se realizó un estudio de tipo cuantitativo, no experimental, transversal y descriptivo en 17 sujetos a los que se evaluó con un PEATC utilizando estímulos clic y CE-Chirp®. Resultados: Se obtuvieron mayores amplitudes de onda Vpara estímulos CE-Chirp® que para clic, en todas las intensidades evaluadas (80, 60, 40,30 y 20 dBnHL). Se obtuvieron menores latencias en la onda Vpara estímulos CE-Chirp® solo a 80 y 60 dBnHL, mientras que en el resto de las intensidades se obtuvo menores latencias con estímulos clic. Conclusiones: Existen diferencias significativas entre las latencias y amplitudes de la onda V obtenidas con estímulos clic y CE-Chirp®. Mientras los estímulos CE-Chirp® aportan en rapidez en el examen y en la búsqueda del umbral electrofisiológico más preciso, los estímulos clic serían los adecuados al momento de realizar un estudio de topodiagnóstico.
Introduction: The auditory brainstem response (ABR) has become a standard procedure in the audiological evaluation. For decades the most widely used stimulus was the click, but recently the use of chirp stimulus has been proposed for obtain more efficient results. Aim: To compare the amplitudes and latencies of wave V of ABR obtained through click and CE-Chirp® stimuli at different intensities. Material and method: A quantitative, not experimental, transversal and descriptive study was conducted with 17 subjects who were evaluated with ABR using click and CE-Chirp® stimuli. Results: Wave V larger amplitudes were verified for stimulus CE-Chirp®, in all the evaluated intensities (80, 60, 40, 30 and 20 dBnHL). Shorter latencies of wave V were obtained for CE-Chirp® stimuli only at 80 and 60 dBnHL, while it was found that the remaining intensities showed lower latencies with click stimuli. Conclusions: There are significant differences between latencies and amplitudes of the wave V obtained with CE-Chirp® and click stimuli. While the CE-Chirp® stimuli provides faster results for most accurate electrophysiological threshold, click stimuli would be appropriate to conduct site of the lesion testing.
http://ift.tt/2mupFBL
Experiencia clínica en tiroidectomía total del Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello Hospital Guillermo Grant Benavente
Introducción: La tiroidectomía es una de las cirugías más frecuentes realizadas en cabeza y cuello. Existen escasos reportes de experiencia en tiroidectomías en servicios de otorrinolaringología en Chile. Objetivo: Analizar la experiencia clínica con las tiroidectomías totales realizadas en el Servicio de ORL y Cirugía de Cabeza y Cuello de nuestro hospital. Material y método: Estudio descriptivo retrospectivo. Revisión de fichas clínicas de pacientes sometidos a tiroidectomías totales (TT) entre los años 2010 y 2014 en nuestro servicio. Resultados: Se realizaron 271 tiroidectomías totales. La indicación más frecuente fue por tamaño (51%). Los diagnósticos más frecuentes fueron carcinomas papilares (46%) e hiperplasia folicularcoloidea (37%). Se presentaron lesiones transitorias del nervio laríngeo recurrente en 2,9%, y lesiones persistentes en 2,5%. Hipocalcemia transitoria se presentó en el 25% de los pacientes. Discusión: Nuestra serie presenta resultados concordantes con la literatura, presenta una baja tasa de complicaciones, las cuales se observan principalmente en pacientes con vaciamiento cervical y/o en que se observaron 2 o menos paratiroides. Conclusiones: La tiroidectomía total es una técnica quirúrgica segura y nuestra experiencia presenta resultados concordantes a los publicados en la literatura internacional.
Introduction: Thyroidectomy is one of the most common surgeries performed in head and neck. There are few reports of experience in thyroidectomy in otolaryngology services in Chile. Aim: To analyze the clinical experience with total thyroidectomy performed in the service of ENT and Head and Neck Surgery of our hospital. Material and method: Retrospective descriptive study. Review of medical records of patients undergoing total thyroidectomy (TT) between 2010 and 2014 in our service records. Results: A total of 271 thyroidectomy were performed. The most frequent indication was size (51%). The most frequent diagnoses were papillary carcinomas (46%) and follicular colloid hyperplasia (37%). We found 2.5% of transient recurrent laryngeal nerve injury and 2.9% had persistent lesions. Transient hypocalcemia occurred in 25% of patients. Discussion: Our series shows good agreement with literature, it has a low rate of complications, which are mainly seen in patients with neck dissection and/or observed 2 or less parathyroid during surgery. Conclusions: Total thyroidectomy is a safe surgical technique, and our experience shows consistent results to those reported in international literature.
http://ift.tt/2mSMDVW
Prácticas audiológicas en Chile: encuesta online para tecnólogos médicos mención otorrinolaringología
Introducción: A nivel internacional existen diversas instituciones que sugieren los estándares mínimos para la realización de los procedimientos audiológicos. Esto tiene como objetivo asegurar la calidad de las evaluaciones auditivas. Esto resulta de importancia en Chile debido a la implementación de programas de salud auditiva en el marco de las garantías explicitas de salud (GES). Objetivo: Documentar las prácticas comunes dentro de Tecnólogo Médico c/m Otorrinolaringología con la finalidad de obtener información para la creación y desarrollo de protocolos estandarizados para la evaluación audiológica. Material y método: Se aplicó un cuestionario de 38 preguntas distribuido a partir de una plataforma online a través de redes sociales y por correo electrónico a los socios de la Sociedad Chilena de Audiología y Otoneurología. Resultados: Se analizaron 121 encuestas finalizadas. Sobre el 70% de los encuestados que ejerce en la zona central. Procedimientos como audiometría de tonos puros, impedanciometría y logoaudiometría son frecuentemente realizados dentro de los encuestados. Estos procedimientos son realizados de acuerdo a lo sugerido dentro de estos profesionales. Conclusión: Existe una alta adherencia de las conductas sugeridas por instituciones internacionales para la realización de los procedimientos más comunes realizados en clínica por parte de los Tecnólogos Médicos c/m Otorrinolaringología.
Introduction: Internationally several institutions suggest minimum standards for the conduct of audiological procedures. This aims to ensure the quality of auditory assessments. This is of importance in Chile due to the implementation of hearing programs under the Explicit Health Guarantees (EHG). Aim: To document common audiological practices of Medical Technologist in order to development standardized protocols for audiological assessment. Material and method: An online-based questionnaire with 38 questions was provided through social networks and by email to members of the Chilean Society of Audiology and Otoneurology. Results: One hundred and twenty one completed surveys were analysed. About 70% of respondents work in the central region of Chile. Procedures such as pure audiometry, tympanometry and speech audiometry were frequently performed by respondents. Respondents followed international guidelines. Conclusion: There is a high adherence to international recommendations when conducting the most common procedures performed in audiology clinics in Chile by the Medical Technologists who responded to the survey.
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Tumor neuroectodérmico primitivo de cavidad nasal
Los tumores neuroectodérmicos primitivos son tumores muy infrecuentes. Derivan de células embrionarias de la cresta neural, y comparten características con los sarcoma de Ewing extraóseos. Se presentan habitualmente en niños y adultos jóvenes, su ubicación más frecuente es en la región toracopulmonar, abdomen y extremidades. Son tumores que presentan una agresividad importante, lo que condiciona un pronóstico sombrío. La ubicación en fosas nasales-cavidades perinasales es anecdótica, existiendo el reporte de tan sólo un caso en la literatura mundial de ubicación en cavidad nasal.
Primitive neuroectodermal tumors are rare malignancies arising from embryonic neural crest cells. They share characteristics with extraosseous Ewing sarcoma. They usually occur in children and young adults and the most common location is the thoracopulmonary region, abdomen and extremities. These tumors have significant aggressiveness, which determines their poor prognosis. The location in nasal fossa-paranasal cavities is anecdotal. Until now only one previous case has been reported in the located in the nasal fossa.
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Glomangiopericitoma: Reporte de un caso
El glomangiopericitoma es un tumor nasosinusal extremadamente raro, más frecuente en pacientes de edad avanzada y en mujeres. Si bien su etiopatogenia es desconocida, se reconocen ciertos factores predisponentes tales como hipertensión arterial, embarazo, trauma y uso de corticoides. Para su diagnóstico, resulta necesario recurrir tanto a estudio por imágenes como a la histología y técnicas de inmunohistoquímica. Microscópicamente se caracteriza por un prominente crecimiento perivascular de células uniformes ovales o fusiformes, dispuestas en fascículos cortos intercalados con capilares de diámetros variables ramificados en "asta de ciervo" y presenta inmuno-rreactividad positiva para actina, factor XIII-A y vimentina principalmente. Clínicamente este tumor presenta un comportamiento generalmente benigno, pero con una elevada tasa de recurrencia. Presentamos el caso de una mujer de 71 años, con antecedentes de hipertensión arterial, que acudió a nuestro centro por rinorrea purulenta y epistaxis unilateral derecha de 5 años de evolución. Al examen se observa masa polipoidea en fosa nasal derecha con abundante vascularización, sin otros hallazgos al examen físico. La lesión es resecada en su totalidad mediante cirugía endoscópica. El estudio histológico e inmunohistoquímico son compatibles con glomangiopericitoma. La paciente evoluciona con remisión de su sintomatología y a los dos meses desde la resección no ha presentado evidencias de recurrencia.
Glomangiopericytoma is an extremely rare sinonasal tumor, more common among elderly and women. Although its etiology and pathogeny are unknown, there are certain predisposing factors, such as arterial hypertension, pregnancy, trauma and corticosteroids. To diagnose this tumor, it is necessary imaging, histopathologic and inmunohistochemical studies. At the microscopic study, it is characterized by a prominent perivascular growth of oval-shaped or fusiform cells, arranged in short fascicles separated by capillary vessels of variable diameters, with staghorn-like ramifications, and lmmunohistochemistry positive mainly for actin, XIII-A factor and vimentin. Clinically, this tumor has a generally benign behavior, but with high recurrence percentage. We present the case of a 71 years old woman, with history of hypertension, who present in our center with a 5 years history of purulent rhinorrhea and right unilateral epistaxis, at the physical exam there is a polypoid mass in the right nasal fossa with rich vascularization, with no other findings. This tumor was resected entirely with endoscopic surgery. Histology and immunohistochemistry were compatible witch gomangiopericytoma. The patient evolve with remission of her symptoms and with no signs of recurrence at two-month follow-up.
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Plasmocitoma extramedular del tabique nasal: Reporte de un caso y revisión bibliográfica
Los plasmocitomas son tumores malignos caracterizados por proliferación anormal de células plasmáticas monoclonales. Éstos pueden originarse tanto en hueso como en tejidos blandos, denominados plasmocitomas óseos solitarios y plasmocitomas extra-medulares (PEM), respectivamente. Estos últimos representan menos del 1% de toda la patología maligna de cabeza y cuello, sin embargo, el reporte de estos casos resulta provechoso frente a la poca casuística al respecto. Presentamos el caso de plasmocitoma extramedular del septo nasal en un varón de 74 años con dificultad respiratoria nasal progresiva y frecuente epistaxis del lado izquierdo. A la especuloscopía nasal se observó en el vestíbulo una elevación tumoral de superficie lisa, grisácea, sésil. La biopsia mostró que era un plasmocitoma. Estudios posteriores descartaron la presencia de mieloma múltiple. Esto confirmó el diagnóstico de PEM. La masa fue completamente disecada, se indicó radioterapia y el paciente no tuvo adherencia al tratamiento. Sobre el mismo lecho al año siguiente reaparece lesión de similares características. Conclusión: Plasmocitoma extramedular del tabique nasal es una entidad rara, de una larga historia natural y que representa un desafío diagnóstico y terapéutico. Dependiendo de la resecabilidad de la lesión, la terapia combinada mediante cirugía y radioterapia es el tratamiento de elección.
Plasmacytomas are malignant tumors characterized by abnormal proliferation of monoclonal plasma cells. They may originate in bone and soft tissue , called solitary bone plasmacytoma and extramedullary plasmacytomas (EMP) respectively. The latter represents less than 1% of all malignant disease of the head and neck, however, the report of these cases it is useful to cope with the shallow casuistics thereon. We report a case of EMP of the nasal septum in a man of 74 years with progressive nasal breathing difficulties and frequent epistaxis on the left side. A nasal speculoscopy was observed in tumor lift lobby smooth, gray, sessile surface. The biopsy showed it was a plasmacytoma. Subsequent studies reject the presence of multiple myeloma. This confirmed the diagnosis of EMP. The mass was completely dissected, radiation therapy is indicated and the patient had no adherence. Upon the same place a similar injury returns. Conclusion: Septum extramedullary plasmacytoma is a rare entity of a long natural history and represents a diagnostic and therapeutic challenge. Depending on the resectability of the lesion, combination therapy with surgery and radiation therapy is the treatment of choice.
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Presencia de la celdilla supra-órbito-etmoidal: Revisión de la literatura a partir de un caso
La celdilla supra-órbito-etmoidal es una variación anatómica que se presenta con diferente frecuencia para las distintas poblaciones. Representa un desafío al realizar cirugía endoscópica funcional del seno frontal debido a que su presencia dificulta el drenaje adecuado del receso del frontal mismo y puede ser confundida con el seno. La celdilla supra-órbito-etmoidal presenta relaciones espaciales constantes con la arteria etmoidal anterior, sirviendo como marcador anatómico confiable para el abordaje quirúrgico. Se destaca la importancia de considerar la presencia de tabiques óseos en el seno frontal en el estudio imagenológico que puedan sugerir la presencia de la celdilla supra-órbito-etmoidal. Se presenta el caso clínico de un paciente que consulta por proptosis del ojo derecho debido a un proceso expansivo por mucocele localizado en dicha variante anatómica.
The supraorbital ethmoid cell its an anatomical variation with different frecuency for diverse populations. It represents a challenge for the endoscopical functional :surgery of the frontal sinus. The supraorbital ethmoid cell presents an estable anatomical relationship with the anterior ethmoidal artery, serving as a dependable anatomical marker for the surgical approach. We stand out the importance to consider the presence of bony septations in the frontal sinus that might suggest the presence of the supraorbital ethmoid cell. We introduce a clinical case from a patient who had an expansive process from a mucocele in the supraorbital ethmoid cell.
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Rinosporidiosis nasal: Reporte de un nuevo caso y revisión de la literatura
La rinosporidiosis es una enfermedad granulomatosa rara producida por el microorganismo Rhinosporidium seeberi. A pesar de ser considerada una infección endémica en algunas zonas de Asia, en nuestro país es una enfermedad extremadamente rara. Se presenta el caso clínico de un escolar de 10 años que consulta por aumento de volumen en fosa nasal izquierda de 1 mes de evolución, de crecimiento progresivo, con epistaxis autolimitada, presentando al examen físico una lesión polipoídea, en la cual, no existiendo sospecha previa, se determinó mediante histopatología la presencia de rinosporidio-sis. Se discute la epidemiología de la enfermedad, sus mecanismos de diseminación, alternativas de tratamiento y principales complicaciones.
Rhinosporidiosis is a rare granulomatous disease produced by the microorganism Rhinosporidium seeberi. Despite being considered an endemic infection in some areas of Asia, in our country it is an extremely rare disease. We present the case of a 10 year-old boy who consult for increased volumen in the left nostril of 1 month evolution, with progressive growth, self-limited epistaxis, and a physical examination with a polypoid lesion, in which there were no prior suspicion, histopathology determined the presence of rhinosporidiosis. Epidemiology of the disease, its dissemination mechanisms, treatment options and major complications are discussed.
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Tumor fibroso solitario de la glándula tiroides con extensión intratorácica
El tumor fibroso solitario (TFS) es una neoplasia mesenquimal de células fusiformes infrecuente descrita inicialmente en la pleura pero con localización reconocida en otros sitios. El TFS de la glándula tiroides (TFST) es aun más raro. Se describe el caso de una mujer de 65 años de edad, con masa cervical de crecimiento progresivo, a tal punto que ya la masa se hacía notable en parte inferior de su cuello, siendo este el único síntoma narrado. La paciente presentaba una gran masa tiroidea en el lóbulo derecho con extensión intratorácica. Se practicó hemitiroidectomia derecha (paciente tenia historia previa de resección del lóbulo tiroideo izquierdo por lesión benigna) Total, además de toracotomía endoscópica por la extensión de la masa la cual en la tomografía contrastada, se originaba en el lóbulo tiroideo derecho y descendía paralelo a la columna dorsal desplazando a la tráquea y el esófago. La patología reportó un tumor de 15 centímetros, con células fusiformes y patrón de crecimiento hemangiopericítico sin pleomorfismo, atipia, mitosis o necrosis. Luego de practicar diferentes estudios y marcadores tumorales, de todos estudios fueron positivos CD34, Bcl2, CD99 y vimentina. Se diagnosticó tumor fibroso solitario de glándula tiroides. El nervio vago derecho fue lesionado en la cirugía, actualmente está en terapia de voz. Al momento actual casi seis meses luego de su cirugía, no se documenta recidiva tumoral.
Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm initially described as spindle cells in the pleura but recognized location elsewhere. The TFS thyroid gland (TFST) even infrequent. A case of a 65 years old woman with progressive growth of a right cervical mass without associated symptoms described other than cosmesis is described . The patient had a thyroid mass in the right lobe with intrathoracic extension. A right Hemi thyroidectomy and thoracotomy for the extent of the mass was performed. Pathology reported a 15 cm tumor with spindle cell and growth pattern hemangiopericitic without pleomorphism, atypia, mitosis or necrosis. Immunohistochemistry was positive for CD34, Bcl-2, CD99 and vimentin, making the diagnosis of solitary fibrous tumor of thyroid gland. The patient's right Vagus nerve was injured intraoperatively and she is currently under voice therapy. Currently now, almost six months after her surgery she is free of disease.
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Traqueostoma persistente: Cierre con colgajo invertido. Reporte de tres casos clínicos y revisión de la literatura
El traqueostoma persistente es la complicación tardía más frecuente asociada al uso de traqueostomía. Se reportan tres casos de pacientes que se les realizó un cierre exitoso del traqueostoma persistente mediante técnica de cierre primario por planos con colgajo invertido. Las ventajas del método utilizado son que representa una alternativa simple, susceptible de realizar con anestesia local y de manera ambulatoria, con excelentes resultados estéticos, mejorando significativamente la calidad de vida de estos pacientes.
Persistent tracheostoma is the most common late complication associated with the use of tracheostomy. We report three cases in which patients underwent a successful closure of persistent tracheostoma using primary closure in layers with inverted flap technique. The advantages of this method are that it represents a simple alternative and is able to be performed under local anesthesia on an outpatient basis, with excellent aesthetic results, significantly improving the quality of life of these patients.
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Anatomía, fisiología y rol clínico de la corteza vestibular
El sistema vestibular, mediante sus órganos periféricos, nos permite procesar correctamente los cambios de aceleración angular de la cabeza y lineal del cuerpo y así permitirnos una correcta orientación en el espacio. Esta información sensorial es dirigida hacia los núcleos vestibulares y desde aquí se comunica con los núcleos óculo-motores y estructuras del tálamo a través de tractos ascendentes del tronco encefálico. Posteriormente la información se dirige hacia centros subcorticales y corticales de naturaleza eminentemente multisensorial. La naturaleza y función de estas estructuras es controversial. En esta revisión se abordan los principales conceptos y descubrimientos a nivel de investigación básica y clínica del procesamiento cortical generado por estimulación de tipo vestibular.
The vestibular system, thanks to its peripheral organs, allows us to properly process the angular head movements and linear acceleration in order to give us a proper orientation in space. The information from these sensory inputs is routed to the vestibular nuclei and thence ascending tracts of the brainstem, which communicate with the oculomotor nuclei of the thalamus and structures. Then the information goes to subcortical and cortical centers, which are eminently multisensory nature. The nature and function of these structures are controversial. In this review the main concepts and discoveries at the level of basic and clinical research generated cortical processing of vestibular stimulation are addressed.
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Carcinoma basocelular metastásico
El carcinoma basocelular es la neoplasia con mayor incidencia a nivel mundial. Es de crecimiento lento y localmente agresiva pero posee un potencial metastásico extremadamente bajo, que se estima entre 0,0028% y 0,5%. El objetivo de este trabajo es mostrar la experiencia de una institución con el manejo de esta enfermedad metastásica. Estudio descriptivo retrospectivo de los pacientes con carcinoma basocelular metastásico tratados en el Instituto Nacional del Cáncer, entre julio 2004 y julio 2015. Se realizó una revisión de la literatura. Se evidenciaron 3 casos con esta enfermedad poco habitual en un plazo de 11 años. Un paciente falleció a los 42 meses de seguimiento. Hay 2 pacientes aún en control, uno de ellos lleva 29 meses de seguimiento y actualmente tiene enfermedad metastásica pulmonar, y el último paciente lleva 92 meses de seguimiento libre de enfermedad. El carcinoma basocelular metastásico, es una entidad poco frecuente por lo que todos los que nos vemos involucrado en su manejo debemos mantenernos alerta para una pesquisa oportuna. La cirugía asociada a la radioterapia siguen siendo los pilares del tratamiento. Esta patología debiera manejarse en centros de referencia a nivel nacional.
Basal cell carcinoma is the most frequent neoplasm worldwide. It's a slow growing and locally aggressive tumor, but it has a metastatic potential estimated between 0,0028 and 0,5%. The purpose of this study is to show the experience of a center in the management of this metastatic disease. Descriptive retrospective study of patients with metastatic basal cell carcinoma treated at the Instituto nacional del cancer from July2004 to July 2015. A revision of the literature was also made. 3 cases with this unusual disease during an 11 years period. The first one died at 42 months of follow up. There are 2 patients on follow up, 1 of them has lung metastatic disease after 29 months of follow up, and the last one is free of disease with 92 months of follow up. Metastatic basal cell carcinoma is an unusual entity, thus everyone that is involved in it's treatment, must be aware of this in order to do an early diagnosis. Surgery associated to radiotherapy are the mainstays of treatment. This disease should be managed on national referral centers.
http://ift.tt/2mSDigK
Enmascaramiento clínico: Una revisión de la literatura
Son diversos los métodos planteados para aplicar enmascaramiento, de esta forma es necesario revisar la literatura en búsqueda de consenso. Se revisaron críticamente los métodos utilizados y recomendados por la literatura y sociedades internacionales, en torno a la aplicación de enmascaramiento. Se consultó entre agosto y noviembre de 2015 en PUBMED, SciELO y Google Scholar por estudios acerca de métodos de enmascaramiento utilizados en audiometría. También se revisaron las guías de organizaciones internacionales y lo publicado en libros relacionados con el área de audiología. El método de "La Meseta" es el más referenciado, siendo modificado posteriormente. Existen variaciones en criterios de atenuación interaural, necesidad de enmascaramiento, enmascaramiento inicial, incrementos para obtener la meseta y niveles del efecto de oclusión. Se concluye que la literatura muestra diferencias al momento de decidir cuándo enmascarar y cómo hacerlo. No obstante, se puede establecer criterios comunes en relación a los niveles de atenuación interaural, cuándo enmascarar, valores de efecto de oclusión y metodología. El método de "La Meseta" sigue siendo el más recomendado. La modificación realizada por Yacullo es la más referenciada y recomendada en la literatura actual.
Adequate use of masking is key in the correct diagnosis of hearing loss. Various methods are suggested regarding the application of clinical masking, hence the need to review literature in order to reach a consensus. To critically review the specialized literature and international societies' recommendations regarding clinical masking. From August to November 2015, PUBMED, SciELO and Google Scholar articles on clinical masking methods used in tonal audiometries were consulted, as well as international organization guidelines, and literature in the area of Audiology. Hood's plateau method, later revised, received the most references. The modified versions consider the number of increments needed to determine the true threshold, and the occlusion effect. Optimized methods show the variations regarding interaural attenuation, need for masking, initial masking level, increments to reach "The Plateau", and the occlusion effect. Literature shows differences regarding when and how to use masking; however, common criteria can be established with reference to the levels of interaural attenuation, when to use masking, occlusion effect values and methodology. The plateau method proposed by Hood is still the most recommended. Yacullo's optimization is currently the one with the most references and recommendations in specialized literature.
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