Background: Deceased organ donors are routinely screened for behaviors that increase the risk of transmissible blood borne viral (BBV) infection, but the impact of this information on organ donation and transplant outcome is not well documented. Our aim was to establish the impact of such behavior on organ donation and utilization, as well transplant recipient outcomes. Methods: We identified all UK deceased organ donors from 2003-2015 with a disclosed history of increased risk behavior (IRB) including intravenous drug use (IVDU), imprisonment and increased risk sexual behavior. Results: Of 17 262 potential donors, 659 (3.8%) had IRB for BBV and 285 (1.7%) were seropositive for BBV, of whom half had a history of IRB (mostly IVDU (78.5%)). Of actual donors with IRB, 393 were seronegative for viral markers at time of donation. A history of recent IVDU was associated with fewer potential donors proceeding to become actual organ donors (64% vs. 75%, p=0.007). Donors with IRB provided 1091 organs for transplantation (624 kidneys and 467 other organs). Transplant outcome was similar in recipients of organs from donors with and without IRB. There were 3 cases of unexpected HCV transmission, all from an active IVDU donor who was HCV seronegative at time of donation, but was found to be viraemic on retrospective testing Conclusion: Donors with a history of IRB provide a valuable source of organs for transplantation with good transplant outcomes and there is scope for increasing the use of organs from such donors. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2mYnWXS
Τρίτη 14 Μαρτίου 2017
Mild Cognitive Impairment and Exposure to General Anesthesia for Surgeries and Procedures: A Population-Based Case-Control Study.
http://ift.tt/2n8G01K
Comparative study of autologous fat vs hyaluronic acid in correction of the nasolabial folds
Summary
Objective
In the article, comparison of the hyaluronic acid (HA) and autologous fat is conducted to evaluate the effectiveness and safety in correction of the nasolabial folds (NLFs).
Methods
From November 2012 to December 2015, a single-blinded, randomized study was conducted. Sixty-two patients were included in the study, and 57 of them completed the whole procedure. The patients were randomly allocated to receive the treatments of HA or fat in both NLFs. The Wrinkle Severity Rating Scale (WSRS) and Global Aesthetic Improvement Scale (GAIS) were used for assessment. Efficacy was assessed using two parameters: evaluation of final improvement by blinded evaluator and patient-self using photographs. The effectiveness endpoint was improvement of scores at 1, 3, 6, 9, and 12 months from baseline. The adverse events (AEs) were recorded.
Results
In the blinded evaluator scores for NLF in accordance with WSRS, there were no significant differences between the two methods within 9 months. A statistically significant difference between the lipoinjection and HA groups was found at 12-month follow-up period. Subjects' self-assessment was similar to the results seen for the evaluator scores. The difference of AEs between the HA and fat group was obvious in the early stage of recovery. In the later stage, the AEs of the HA and fat group were similar.
Conclusions
Both HA gel and autologous fat provide augmentation of NLFs. The magnitude and duration of NLF correction appear to be similarly effective and safe within a period.
http://ift.tt/2mqwaE7
The effect of desflurane versus propofol anesthesia on postoperative delirium in elderly obese patients undergoing total knee replacement: A randomized, controlled, double-blinded clinical trial
The goal of this study was to investigate the incidence of delirium, wake-up times and early post-operative cognitive decline in one hundred obese elderly patients undergoing total knee arthroplasty.
http://ift.tt/2nlYPPG
Successful tracheal intubation with the McGRATH™ MAC during chest compression in a difficult airway patient
We report a case of successful tracheal intubation with the McGRATH™ MAC (McGRATH; Aircraft Medical Ltd., U.K.) videolaryngoscope during chest compression in a difficult airway patient.
http://ift.tt/2nDacyB
Das neue Zweitmeinungsverfahren
Laryngo-Rhino-Otol 2017; 96: 118-119
DOI: 10.1055/s-0042-108311
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2mYeBPM
Partielle Obliteration von Ohr-Radikalhöhlen
Laryngo-Rhino-Otol 2017; 96: 80-82
DOI: 10.1055/s-0042-122481
Die moderne operative Therapie des Mittelohrcholesteatoms hat sich von der früheren, fast dogmatischen Anwendung entweder der 2-Wege Technik oder der Radikalhöhlenoperation zu einer individualisierten Technik gewandelt, in Kenntnis der Pathomechanik (Entwicklung des Cholesteatoms aus einer Retraktionstasche) und den vielfältigen zuverlässigen Einsatzmöglichkeiten einer Knorpelrekonstruktion der Gehörgangswände. In der modernen Ohrchirurgie kommt daher in der Mehrzahl die sogenannte Verfolgungstechnik (die transmeatale Exposition des Cholesteatomsackes ohne zwingende Mastoidektomie mit anschließender Rekonstruktion der Gehörgangswand durch Knorpelplatten) zum Einsatz. Nur in seltenen Fällen ist noch die sogenannte 2-Wege Technik (mit Mastoidektomie) oder die Anlage einer Radikalhöhle erforderlich. Auch hier hat ein Umdenken stattgefunden in Anbetracht der unerträglich hohen Rezidivraten bei der 2-Wege Technik: Sowohl die hohe Zahl der Residualcholesteatome (typischerweise im Schatten der stehengelassenen hinteren Gehörgangswand) als auch die rekurrenten Rezidive (Einsenken einer neuen Retraktion in die vormals ausgebohrte Mastoidhöhle) lassen dieses Verfahren nur noch für sehr gut pneumatisierte und mit reizloser, gasproduzierender Schleimhaut ausgekleidete Mittelohren als erfolgsversprechend erscheinen. Bei der klassischen Radikalhöhlentechnik besteht trotz ihrer geringeren Rezidivrate als großer Nachteil das chronische Ohrenlaufen aufgrund der ständig feuchten Höhle. Ursächlich und schon lange bekannt ist das ungünstige Belüftungsverhältnis der hautausgekleideten großen Höhle (zu kleine Öffnung des Gehörgangs im Verhältnis zum großen Höhenvolumen). Eine stabile Verkleinerung der Höhle mit deutlicher Verringerung der Rezidivrate ist mit körpereigenem Knochenmehl und lückenloser Knorpelplattenabdeckung (aus dem Cavum conchae) möglich. In dem Video wird das Prinzip der Knochenmehl- und Knorpelplattenobliteration mit unserer in Dresden entwickelten Technik dargestellt und es werden einige Tipps zur Erzielung einer stabilen Höhle gegeben.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Dank an die Gutachter
Laryngo-Rhino-Otol 2017; 96: 88-88
DOI: 10.1055/s-0043-101974
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2mY52QT
Hands-on Anleitung für Larynxoperationen in örtlicher Betäubung mittels flexibler Endoskopie und Darstellung am Bildschirm
Laryngo-Rhino-Otol 2017; 96: 83-85
DOI: 10.1055/s-0042-124659
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2mHDKMo
Schädelbasischirurgie
Laryngo-Rhino-Otol 2017; 96: 88-88
DOI: 10.1055/s-0042-121758
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2mY4Ukj
Leserbrief – Rubrik CME-Fortbildung
Laryngo-Rhino-Otol 2017; 96: 86-87
DOI: 10.1055/s-0042-115162
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2nD6Dsl
Die saisonale und perenniale allergische Rhinokonjunktivitis
Laryngo-Rhino-Otol 2017; 96: 89-97
DOI: 10.1055/s-0043-101391
Sowohl bei der saisonalen allergischen Konjunktivitis (seasonal allergic conjunctivitis, SAC) und ganzjährigen allergischen Konjunktivitis (perennial allergic conjunctivitis, PAC) als auch bei der intermittierenden und persistierenden Rhinitis handelt es sich umweit verbreitete Krankheitsbilder, die in der Mehrzahl der Fälle gemeinsam auftreten und daher zumeist unter dem Oberbegriff der allergischen Rhinokonjunktivitis zusammengefasst werden. SAC und PAC zusammen machen als die 2 akuten Formen mehr als 90% der Gesamtzahl aller Fälle von allergischer Konjunktivitis aus. Verglichen mit den chronischen Formen verlaufen sie harmloser, bekommen jedoch aufgrund der Häufigkeit und sowie des nachgewiesenen Einflusses auf die Lebensqualität der Patienten klinische und sozioökonomische Relevanz. Auslöser der der allergischen Rhinokonjunktivitis zugrunde liegenden IgE-vermittelten Typ-1-Hypersensitivitätsreaktion sind zumeist Aeroallergene. Pathognomonisches Symptom ist Juckreiz. Okulär zeigen sich zudem Chemosis, Bindehautinjektion, wässrige Sekretion sowie Lidschwellungen. HNO-ärztlich finden sich zumeist gesteigerte Nasensekretion, retronasaler Schleimfluss und Niesen. Durch Behinderung der Nasenatmung können Schlaf- und Konzentrationsstörungen auftreten. Therapeutisch können neben der Vermeidung der Allergenexposition durch Modifikation von Umweltfaktoren bei milden Formen von SAC und PAC Tränenersatzmittel eingesetzt werden. Topische Antihistaminika eignen sich insbesondere zur Linderung der akuten Symptomatik. Topische Mastzellstabilisatoren hingegen zeigen einen längerfristigen Effekt. Dual wirksame Kombinationen aus Antihistaminikum und Mastzellstabilisator vereinen gute Wirksamkeit und Anwenderfreundlichkeit. Lokale Steroide sollten bei SAC und PAC zurückhaltend und zeitlich begrenzt angewendet werden. Im Falle einer langfristigen Anwendung antiallergischer Lokalmedikation wird die Verwendung unkonservierter Präparate empfohlen. Die HNO-ärztlich häufig in Kombination mit Antihistaminika angewendeten intranasalen Steroide zeigen bei Verwendung moderner Präparate ein günstiges Nebenwirkungsprofil. Zusammenfassend stellt die allergische Rhinokonjunktivitis ein häufiges und nach korrekter Diagnosestellung gut therapierbares Krankheitsbild dar. Durch gezielte Behandlung kann innerhalb kurzer Zeit eine deutliche Verbesserung der Lebensqualität der betroffenen Patienten erreicht werden.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Implantierbare Knochenleitungs- und aktive Mittelohrhörsysteme
Laryngo-Rhino-Otol 2017; 96: 120-129
DOI: 10.1055/s-0042-122477
Bei audiologischen und/oder anatomischen Limitationen in der Versorgung mit konventionellen Hörgeräten können moderne teil- oder vollimplantierbare Hörsysteme in ausgewählten Fällen die Versorgungsmöglichkeiten komplettieren. Es konnte gezeigt werden, dass sich für eine Vielzahl an Patienten Verbesserungen im Tragekomfort, im Sprachverständnis und somit der Lebensqualität erzielen lassen.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | CME online | Full text
http://ift.tt/2mY50bJ
Fragen für die Facharztprüfung
Laryngo-Rhino-Otol 2017; 96: 130-131
DOI: 10.1055/s-0042-122478
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2nD9Fgk
Schwere Epistaxis stoppen: Klinischer Behandlungspfad zahlt sich aus
Laryngo-Rhino-Otol 2017; 96: 78-79
DOI: 10.1055/s-0043-101083
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2n8uZ0m
GreenLight laser photoselective vaporization of the prostate for treatment of benign prostate hyperplasia/lower urinary tract symptoms in patients with different post-void residual urine
Abstract
The purpose of this study is to assess the safety and efficacy of GreenLight laser photoselective vaporization of the prostate (PVP) for the treatment of benign prostate hyperplasia/lower urinary tract symptoms (BPH/LUTS) in patients with different post-void residual urine (PVR). BPH/LUTS patients treated with PVP from January 2014 to January 2016 were enrolled in the present study. All patients were divided into PVR > 50, 50 ≤ PVR < 400, and PVR ≥ 400 ml groups, and standard general and urological methods for BPH/LUTS were carried out. PVP surgery was performed, and the follow-up outcome was investigated 6 months after surgery. A total of 429 patients were included, and there were no significant differences in comorbid diseases or habits among the three groups. The maximum urinary flow rate (Qmax) differed significantly among the groups (P < 0.001), while patients in the PVR < 50 ml group had higher maximum detrusor pressure (Pdet.max) level than the other two groups (P < 0.001). Patients in 50 ≤ PVR < 400 (P < 0.001) and PVR ≥ 400 (P < 0.001) ml groups were more likely to develop detrusor underactivity than those in the PVR < 50 ml group. All patients were treated with PVP, and there were no severe complications requiring rehospitalization or reoperation except nine designed re-treatments. Follow-up data of 387 patients were available. Significant improvement in outcome parameters (International Prostate Symptom Score [IPSS], Qmax, and PVR) was observed in comparison with baseline measurements for the three groups. PVP significantly improved the IPSS, Qmax, and PVR in patients with different PVR; PVP is a safe and effective procedure for BPH/LUTS patients.
http://ift.tt/2n63k0e
Effect of high laser output on the central bronchi and pulmonary artery
Abstract
A diode-pump Nd:YAG high-power laser (wavelength 1320 nm, power 100 W) is routinely used to surgically remove lung metastases. Even pulmonary lesions in central locations are resectable via this method, yet it also carries a potential risk of damaging the larger bronchi and vessels in the vicinity. Studies investigating the safety of using high-power lasers are lacking. We therefore aimed to examine the direct effects of a 100-watt laser on the bronchi and pulmonary artery at a standard working velocity. From freshly slaughtered pigs, we isolated cylindrical specimens of the trachea, the main and lobar bronchi, and the central pulmonary artery from the both lungs. These specimens were fixed consecutively in rows behind each other on a Styrofoam surface in the laboratory. The laser's handle was clamped into a hydraulic feed unit so that the laser was focused at constant distance perpendicular to the tissue and would move at 10 mm/s over the specimens. The Nd:YAG Laser LIMAX® 120 functioned at a consistent power of 100 W during all the experiments. The lasered specimens were examined macroscopically and histologically for tissue damage. None of the trachea or bronchial walls were perforated. Compared to the pulmonary parenchyma, we observed no vaporization effects—only minor superficial coagulation (with a mean depth of 2.1 ± 0.8 mm). This finding was histologically confirmed in each specimen, which revealed mild superficial coagulation and no damage to the cartilage. In the presence of a residual peribronchial fatty tissue, the laser effect was even attenuated. The pulmonary arteries presented no lumen openings whatsoever, merely a discrete trace of coagulation. The vessel wall revealed increased vacuolization without alteration of the remaining vessel wall. In conclusion, laser resection at 100 W of the central lung areas is safe with respect to airways and blood vessels and the laser output does not need to be reduced when treating these areas.
http://ift.tt/2moawAf
The association between Nd:YAG laser and desensitizing dentifrices for the treatment of dentin hypersensitivity
Abstract
This study aims to evaluate the association between Nd:YAG laser (with and without a photoabsorber) and two desensitizing dentifrices containing 15% NovaMin or 8% arginine, as potential treatments for dentin hypersensitivity (DH). DH was simulated by EDTA application for 2 min. Specimens were then analyzed with an environmental scanning electron microscope (ESEM) to ensure open dentin tubules (ODT), counted by using ImageJ software. Specimens were randomized into eight groups (n = 10): Laser (L), Laser+Photoabsorber (LP), Arginine (A), Arginine+Laser (AL), Arginine+Laser+Photoabsorber (ALP), NovaMin (N), NovaMin+Laser (NL), and NovaMin+Laser+Photoabsorber (NLP). Laser irradiation was performed with 1 W, 100 mJ, 10 Hz, ≅85 J/cm2; 4 irradiations of 10 s each, with 10 s intervals between them. After treatment, specimens were again analyzed by ESEM and submitted to erosive/abrasive cycling for 5 days. A final ESEM analysis was performed. Data were analyzed with two-way repeated measure ANOVA and Tukey tests (α = 0.05). After treatment, groups N, NL, and NLP presented the lower number of ODT, but they did not different from LP, ALP, and AL. Group A presented the highest number of ODT and it did not differ from group L. Groups L, AL, ALP, and LP presented intermediate results, without differing from each other. After cycling, group A presented the highest number of ODT and did not differ significantly from the other groups, except NLP. None of the associations tested presented better tubule occlusion than NovaMin by itself. Arginine was the only treatment that presented improved tubule occlusion when associated with Nd:YAG laser.
http://ift.tt/2n5V93U
Transoral robotic surgery with radial forearm free flap reconstruction: case control analysis
Abstract
Background
The resection of large oropharyngeal tumors traditionally involves a lip-splitting mandibulotomy for adequate margin visualization and free flap reconstruction of the surgical defect. Transoral robotic surgery (TORS) has emerged as a technique that can resect large and complex oropharyngeal tumors, avoiding a lip-splitting approach. The aim of this study is to compare the lip-splitting mandibulotomy approach versus TORS for the management of advanced stage oropharyngeal carcinomas.
Methods
Prospectively collected data from 18 patients with advanced stage oropharyngeal squamous cell carcinoma (OPSCC) who received TORS with radial forearm free flap reconstruction (RFFF) was compared to a matched cohort of 39 patients who received a lip-splitting mandibulotomy and RFFF. Patients were matched for stage, p16 positivity, smoking, age and gender. Length of hospital stay (LOHS), tracheostomy decanulation time, operative time, surgical margin status, and post-operative complications were compared between groups.
Results
Patients who received TORS with RFFF had a significantly lower mean LOHS, compared to patients who were treated by lip-splitting mandibulotomy and RFFF (14.4 vs 19.7 days, p = 0.03). No significant differences were seen between groups in terms of operative time, tracheostomy decannulation time, margin positivity and post-operative complications.
Conclusion
TORS with radial forearm free flap reconstruction is a safe, effective and cost-saving alternative to the lip-splitting mandibulotomy approach for the treatment of advanced stage OPSCC.
http://ift.tt/2mLd277
Tissue-Engineered Larynx: Future Applications in Laryngeal Cancer
Abstract
Purpose of Review
This article reviews the latest developments in tissue engineering for the larynx with a specific focus on the treatment of laryngeal cancer.
Recent Findings
Challenges in tissue engineering a total larynx can be divided into scaffold design, methods of re-mucosalization, and how to restore laryngeal function. The literature described a range of methods to deliver a laryngeal scaffold including examples of synthetic, biomimetic, and biological scaffolds. Methods to regenerate laryngeal mucosa can be divided into examples that use a biological dressing and those that engineer a new mucosal layer de novo. Studies aiming to restore laryngeal function have been reported, but to date, the optimum method for achieving this as part of a total laryngeal transplant is yet to be determined.
Summary
There is great potential for tissue engineering to improve the treatments available for laryngeal cancer within the next 10 years. A number of challenges exist however and advances in restoring function must keep pace with developments in scaffold design.
http://ift.tt/2nqyZ9Z
Thyroglossal Duct Cyst Carcinomas in Pediatric Patients: Report of Two Cases with a Comprehensive Literature Review
Abstract
Thyroglossal duct cyst (TGDC) carcinomas are rarely encountered in the pediatric population. The clinical behavior of these tumors in the pediatric setting is unclear and management is not well defined. Two cases of pediatric thyroglossal duct cyst carcinoma were identified in a review of all thyroglossal duct cysts diagnosed over a ten year period. These two cases were analyzed along with 57 cases of thyroglossal duct cyst carcinoma affecting patients less than 21 years of age compiled from the English literature. Fifty-nine patients (36 females, 23 males) aged 6–20 years (mean 15.0 years) were identified. All presented with an anterior midline neck mass, which was typically mobile and non-tender. The average tumor size was 2.6 cm. Histologically, all tumors were papillary thyroid carcinomas arising in a background of a thyroglossal duct cyst. The tumors exhibited a papillary, follicular, or mixed architecture with classical papillary thyroid carcinoma nuclear features. Soft tissue extension was present in 16 cases. All patients were managed surgically with a Sistrunk procedure, with additional thyroidectomy performed in 29 patients, combined with a lymph node dissection (n = 15), or a Sistrunk and lymph node dissection (n = 5). All patients were stage I at presentation, with 11 showing lymph node metastases. Postoperative radioactive iodine was employed in 20 patients. A papillary carcinoma of the thyroid gland was reported in four of the patients who had concurrent/subsequent thyroidectomies. Recurrences were reported in four patients, with distant metastases in one patient, who died of disease (13 months). Follow up data was available for 45 patients, with an overall mean follow-up of 54.5 months. All patients were alive, with the exception of one who died with disease. TGDC carcinomas in pediatric patients is associated with a good overall prognosis, best managed by Sistrunk procedure alone, with selected lymph node dissection if clinically indicated.
http://ift.tt/2nBImTu
Molekular-allergologische Aspekte der allergenspezifischen Immuntherapie
Zusammenfassung
Die allergenspezifische Immuntherapie (SIT) erreicht keine 100 %ige Wirksamkeit, und auch für das Therapieversagen gibt es keinen verlässlichen Marker. Die Fortschritte in der molekularen Allergologie in den letzten Jahren erlauben inzwischen jedoch eine deutlich verbesserte Charakterisierung der Patienten durch molekular-allergologisch basierte Analyseverfahren (molekulare Phänotypisierung). So können Major- und Minorallergene identifiziert werden, und es bilden sich vereinzelt neben den Markerallergenen für die Schwere einer allergischen Reaktion krankheits- sowie therapieprädiktive Markerallergene bzw. Sensibilisierungsmuster heraus.
http://ift.tt/2mGzQTN
Thyroglossal Duct Cyst Carcinomas in Pediatric Patients: Report of Two Cases with a Comprehensive Literature Review
Abstract
Thyroglossal duct cyst (TGDC) carcinomas are rarely encountered in the pediatric population. The clinical behavior of these tumors in the pediatric setting is unclear and management is not well defined. Two cases of pediatric thyroglossal duct cyst carcinoma were identified in a review of all thyroglossal duct cysts diagnosed over a ten year period. These two cases were analyzed along with 57 cases of thyroglossal duct cyst carcinoma affecting patients less than 21 years of age compiled from the English literature. Fifty-nine patients (36 females, 23 males) aged 6–20 years (mean 15.0 years) were identified. All presented with an anterior midline neck mass, which was typically mobile and non-tender. The average tumor size was 2.6 cm. Histologically, all tumors were papillary thyroid carcinomas arising in a background of a thyroglossal duct cyst. The tumors exhibited a papillary, follicular, or mixed architecture with classical papillary thyroid carcinoma nuclear features. Soft tissue extension was present in 16 cases. All patients were managed surgically with a Sistrunk procedure, with additional thyroidectomy performed in 29 patients, combined with a lymph node dissection (n = 15), or a Sistrunk and lymph node dissection (n = 5). All patients were stage I at presentation, with 11 showing lymph node metastases. Postoperative radioactive iodine was employed in 20 patients. A papillary carcinoma of the thyroid gland was reported in four of the patients who had concurrent/subsequent thyroidectomies. Recurrences were reported in four patients, with distant metastases in one patient, who died of disease (13 months). Follow up data was available for 45 patients, with an overall mean follow-up of 54.5 months. All patients were alive, with the exception of one who died with disease. TGDC carcinomas in pediatric patients is associated with a good overall prognosis, best managed by Sistrunk procedure alone, with selected lymph node dissection if clinically indicated.
http://ift.tt/2nBImTu
Transoral robotic surgery with radial forearm free flap reconstruction: case control analysis
The resection of large oropharyngeal tumors traditionally involves a lip-splitting mandibulotomy for adequate margin visualization and free flap reconstruction of the surgical defect. Transoral robotic surgery...
http://ift.tt/2mp0ChQ
Thyroglossal Duct Cyst Carcinomas in Pediatric Patients: Report of Two Cases with a Comprehensive Literature Review
Abstract
Thyroglossal duct cyst (TGDC) carcinomas are rarely encountered in the pediatric population. The clinical behavior of these tumors in the pediatric setting is unclear and management is not well defined. Two cases of pediatric thyroglossal duct cyst carcinoma were identified in a review of all thyroglossal duct cysts diagnosed over a ten year period. These two cases were analyzed along with 57 cases of thyroglossal duct cyst carcinoma affecting patients less than 21 years of age compiled from the English literature. Fifty-nine patients (36 females, 23 males) aged 6–20 years (mean 15.0 years) were identified. All presented with an anterior midline neck mass, which was typically mobile and non-tender. The average tumor size was 2.6 cm. Histologically, all tumors were papillary thyroid carcinomas arising in a background of a thyroglossal duct cyst. The tumors exhibited a papillary, follicular, or mixed architecture with classical papillary thyroid carcinoma nuclear features. Soft tissue extension was present in 16 cases. All patients were managed surgically with a Sistrunk procedure, with additional thyroidectomy performed in 29 patients, combined with a lymph node dissection (n = 15), or a Sistrunk and lymph node dissection (n = 5). All patients were stage I at presentation, with 11 showing lymph node metastases. Postoperative radioactive iodine was employed in 20 patients. A papillary carcinoma of the thyroid gland was reported in four of the patients who had concurrent/subsequent thyroidectomies. Recurrences were reported in four patients, with distant metastases in one patient, who died of disease (13 months). Follow up data was available for 45 patients, with an overall mean follow-up of 54.5 months. All patients were alive, with the exception of one who died with disease. TGDC carcinomas in pediatric patients is associated with a good overall prognosis, best managed by Sistrunk procedure alone, with selected lymph node dissection if clinically indicated.
http://ift.tt/2nBImTu
Malignant transformation of oral submucous fibrosis in Taiwan: a nationwide population-based retrospective cohort study
Abstract
Background
Oral submucous fibrosis (OSF) is a one of the well-recognized oral potentially malignant disorders. In this study, we investigated the malignant transformation of OSF in a Taiwanese population.
Methods
A retrospective cohort study was analyzed from Taiwan's National Health Insurance Research Database. A comparison cohort that was randomly frequency-matched with the OSF cohort according to age, sex, and index year. Oral leukoplakia (OL) was further stratified to evaluate for the possible synergistic effects for OSF-associated malignant transformation.
Results
In this cohort, 71 (9.13%) of 778 cases of OSF were observed to transform into oral cancer. The malignant transformation rate was 29.26-fold in the OSF cohort than in the comparison cohort after adjustment (95% confidence intervals 20.55-41.67). To further stratify with oral leukoplakia (OL), OSF with OL (52.46; 95% confidence intervals 20.99-42.42) had higher risk of malignant transformation rate than OSF alone (29.84; 95% confidence intervals 20.99-42.42). The Kaplan-Meier plot revealed the rate free of malignant transformation was significant over the 13 years follow-up period (log-rank test, p<0.001). The mean duration of malignant transformation was 5.1, 2.7, and 2.2 years for non-OSF, OSF alone, and OSF with OL, respectively.
Conclusion
OSF patients exhibited a significantly higher risk of malignant transformation than those without OSF. OL could enhance malignant transformation in patients with OSF.
This article is protected by copyright. All rights reserved.
http://ift.tt/2mW8NWK
Bilateral sagittal split osteotomy-parameters and correlations of postoperative pain management
Abstract
Objectives
Postoperative pain management is of utmost interest for patients undergoing orthognathic surgery. Currently, there is a lack of information regarding process and outcome parameters of postoperative pain management after bilateral sagittal split osteotomy.
Materials and methods
In a prospective clinical study, 31 adults were evaluated on the first postoperative day following bilateral sagittal split osteotomy using the standardized questionnaire of the Germany-wide project Quality Improvement in Postoperative Pain Management (QUIPS). It allows a standardized assessment of patients' characteristics, pain parameters, outcome, and pain therapy process parameters.
Results
Pain management consisted mainly of premedication with midazolam, sufentanil, and metamizol intraoperatively; piritramide in the recovery room; and metamizol and tramadol on ward. Twenty patients (64.5%) showed inadequate pain management with pain levels ≥4. Patients receiving tramadol as opioid on ward presented significantly higher maximum pain levels (p = .037). Significantly lower satisfaction with postoperative pain intensity (p > .001) and significantly higher desire for additional pain medication (p = .023) were detected, when duration of surgery was above the median of 107.5 min.
Conclusions
Inadequate pain management on the first postoperative day following bilateral sagittal split osteotomy was widespread on our ward. QUIPS helped us to identify it and thereby gave us the possibility to improve the situation. Prolonged duration of surgery seems to be a predictor of an elevated postoperative pain medication demand.
Clinical relevance
Only the establishment of an ongoing monitoring of postoperative pain management can help to reduce or even avoid inadequate postoperative pain management. In accordance to the existing literature, we found inadequate postoperative pain management more widespread than thought.
http://ift.tt/2mIhP9j
Persistent Oxygen Requirement beyond Prematurity: A Case of Acquired Pulmonary Vein Stenosis
Acquired pulmonary vein stenosis is a rare cardiac defect and diagnosis can often be challenging, as many cases present with refractory or prolonged oxygen requirement over the expected course. Comorbid conditions can cloud this diagnosis further. Prognosis is poor for most patients. We present a case of idiopathic acquired pulmonary vein stenosis and discuss diagnostics, treatment options, and the need for further collaborative studies.
http://ift.tt/2mIs6Ct
The Practice and Perception of Precautionary Allergen Labelling by the Australasian Food Manufacturing Industry
Abstract
Background
The precautionary allergen labelling (PAL) and Voluntary Incidental Trace Allergen Labelling (VITAL®) tools were designed by industry to assist consumers with selecting safe foods for consumption. However, a sizeable proportion of food products bear no label and it is unclear whether these products are free from allergens and therefore safe to consume or have simply not undergone a risk assessment and therefore remain unlabelled for that reason.
Objective
To assess the prevalence of unlabelled products that have undergone a risk assessment process and to examine the factors influencing industry's uptake of the VITAL® process.
Methods
A web-based questionnaire was distributed to Australasian food and grocery manufacturers.
Results
One hundred and thirty seven Australasian manufacturers were contacted and 59 questionnaires were returned (response rate: 43%). The respondents represented 454 different manufacturing sites. Manufacturers reported that 23% (95% CI 19-28) of products (n = 102/434) that had been through the VITAL® risk assessment process had no PAL statement on the label. 34% (95% CI 30-38), (n = 204/600) of products that had undergone another (non-VITAL®) risk assessment process had no PAL statement. In examining the factors that influenced industry's uptake of the VITAL® process, 25 manufacturers reported on factors that influenced the uptake of the VITAL® process, 76% (CI 95% 55-91) reported that VITAL® was an effective tool because it was based on science; 52% (CI 95% 31-72) reported that it was too time-consuming and 36% (CI 95% 18-57) identified a concern with it not being endorsed by the government.
Conclusion and clinical relevance
Currently we estimate that at least 30% of products may have been through a risk assessment process and yet bear no PAL statement on the label. Permissive labelling could be incorporated onto these products if they have been assessed to be safe for consumption.
This article is protected by copyright. All rights reserved.
http://ift.tt/2mnQENV
A Case of Cortical Deafness due to Bilateral Heschl Gyrus Infarct
We report the case of a 58-year-old male who presented with an episode of seizure and abrupt onset hearing loss. Neuroimaging revealed acute infarcts in bilateral Heschl gyri. Objective tests of peripheral auditory function were essentially normal and a diagnosis of cortical deafness was made.
http://ift.tt/2mIEiD9
Allergen Immunotherapy Clinical Trial Outcomes and Design: Working Toward Harmonization of Methods and Principles
Abstract
Progress has been made in the harmonization of efficacy and safety outcome measures for allergen immunotherapy (AIT) trials, but unresolved issues still remain. Furthermore, there are discrepancies in recommendations from professional medical societies and regulatory agencies regarding requirements for AIT trials. In this article, we reviewed published recommendations and current data from recent clinical trials, as well as the criteria applied by regulatory authorities for approval of AIT products, to provide updated considerations for conducting phase 3 AIT trials. Topics discussed include analysis of outcomes and trial designs for pediatric and asthma indications, as well as trial designs for perennial allergic rhinoconjunctivitis. In addition, the need for harmonization of safety reporting is emphasized. Considerations presented in this article may further effort to find common ground among professional medical societies and government agencies in developing future recommendations for AIT trial design.
http://ift.tt/2mnbj5w
Allergen Immunotherapy Clinical Trial Outcomes and Design: Working Toward Harmonization of Methods and Principles
Abstract
Progress has been made in the harmonization of efficacy and safety outcome measures for allergen immunotherapy (AIT) trials, but unresolved issues still remain. Furthermore, there are discrepancies in recommendations from professional medical societies and regulatory agencies regarding requirements for AIT trials. In this article, we reviewed published recommendations and current data from recent clinical trials, as well as the criteria applied by regulatory authorities for approval of AIT products, to provide updated considerations for conducting phase 3 AIT trials. Topics discussed include analysis of outcomes and trial designs for pediatric and asthma indications, as well as trial designs for perennial allergic rhinoconjunctivitis. In addition, the need for harmonization of safety reporting is emphasized. Considerations presented in this article may further effort to find common ground among professional medical societies and government agencies in developing future recommendations for AIT trial design.
http://ift.tt/2mnbj5w
Sinnhaftigkeit des PSA-Screenings
Zusammenfassung
Hintergrund
Kaum ein Krebsfrüherkennungsverfahren ist so umstritten wie der PSA-Test. Seit der gleichzeitigen Veröffentlichung der Ergebnisse der europäischen und US-amerikanischen PSA-Screening-Studie im Jahr 2009 wird die Sinnhaftigkeit des PSA-Screenings in der Fachwelt heftig diskutiert. Die z. T. auf diesen Studienergebnissen basierende Empfehlung der US-amerikanischen Preventive Services Task Force (USPSTF) gegen den Einsatz des PSA-Tests im Jahr 2012 hat diese Diskussion weiter verschärft und dazu geführt, dass sich auch öffentliche Medien dieses Themas angenommen haben. Das grundsätzliche und oftmals unkritische in Zweifel ziehen des PSA-Tests, z. T. gepaart mit plakativen Formulierungen, haben zahlreiche Männer, die an einer Früherkennung interessiert sind, verunsichert.
Ziel
Der vorliegende Beitrag soll die Vor- und Nachteile des PSA-Screenings kritisch beleuchten und im letzten Teil einen groben Ausblick auf neue diagnostische Ansätze geben.
Methode
Es wurde eine semistrukturierte Literatursuche in Pubmed bis 2016 durchgeführt.
Schlussfolgerung
Risikoadaptierte Ansätze zum PSA-Screening könnten den Ausweg aus dem Dilemma der PSA-basierten Prostatakrebsfrüherkennung darstellen.
http://ift.tt/2mnkFy7
Three-dimensional analysis of mandibular condyle position in patients with deviated mandibular prognathism
Publication date: Available online 14 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J.-S. Lee, T. Xi, T.-G. Kwon
The purpose of this study was to evaluate the bilateral difference in condyle position in patients with deviated mandibular prognathism. Patients with asymmetrical (n=28) and symmetrical mandibular prognathism (n=23) were compared using the three-dimensional (3D) reformatted image from cone beam computed tomography. Significant positional differences in the condyle and subcondyle region (sigmoid notch) were found between the deviated and contralateral sides in the group with asymmetrical mandibular prognathism, but not in the control group. The lateral condyle was more laterally and inferiorly positioned on the contralateral side than on the deviated side (P<0.05). The sigmoid notch was more laterally, superiorly, and posteriorly positioned on the deviated side (P<0.01). Interestingly, condyle width and height on the deviated side was narrower and shorter than on the contralateral side and in the control group. Menton deviation was closely correlated with the bilateral difference in condyle height and 3D position of the sigmoid notch (P<0.01). The degree of asymmetry was more highly correlated with condyle height than with the spatial orientation of the condyle head. The results demonstrated that mandibular prognathism with asymmetry is associated with bilateral differences in 3D morphology and orientation of the condyle. Therefore, clinicians should consider these variations during surgical planning.
http://ift.tt/2mIbpXL
The effect of low-level laser therapy on tooth movement during canine distalization
Abstract
The aim of the study is to determine the effects of low level laser therapy on tooth movement during canine distalization by evaluating IL-1β, TGF-β1 levels in gingival crevicular fluid. Maxillary first premolars of the 15 Angle Class II division I patients (12–19 years old) were extracted. Right maxillary canines were distalized by standard protocol as control group whereas the left maxillary canines distalized by laser application. A gallium-aluminum-arsenide diode laser with an output power of 20 mW was applied as five doses from the buccal and the palatal side on the day 0, and the 3rd, 7th, 14th, 21th 30th, 33st, 37th, 60th, 63th, and 67th days. Gingival crevicular fluid samples were obtained with filtration paper at the initial, 7th, 14th, and 21th days, and the IL-1ß and TGF-ß1 cytokine levels were analyzed. Orthodontic models and periodontal indices were taken initially and on the days 30th, 60th, and 90th of canine distalization period. Tooth movement was assessed by scanning models (3Shape). The amount of tooth movement in the laser group was 40% more than the control group. First day IL-1ß levels were statistically higher than initial and 21st day levels (P= 0.003, P = 0.012). The rise in IL-1ß levels caused the negative correlations between 7th day IL-1β and 21st day TGF-β1 levels describes the tissue effects of laser application. Periodontal indices showed no sign of gingival inflammation during canine distalization period. As conclusion, laser does accelerate tooth movement and could shorten the whole treatment duration.
http://ift.tt/2mFd7HI
E-cadherin mediated impairment increases anti-apoptotic mechanism through upregulation of Bcl-2: An Immunohistochemical study in various patterns of invasion of oral squamous cell carcinoma
Abstract
Background
Bcl-2 and E-cadherin proteins are known to be involved in the control of apoptotic cell death and invasive potential, respectively, which is an important hallmark of tumor regulation that influences their biologic behavior.
Aim
The current study investigates the relationship of Bcl-2 and E-cadherin immunoexpression to histopathological and clinical prognostic factors in oral squamous cell carcinomas, and correlates E-cadherin/Bcl-2 ratio with Bryne's patterns of invasion.
Material & Methods
Immunohistochemical analyses for Bcl-2 and E-cadherin were performed on paraffin embedded tissue sections on 32 cases of oral squamous cell carcinoma and were scored using qualitative and quantitative (percentage positive) analysis.
Statistical analysis
The resulting data was analyzed using SPSS software version 19. Correlation between patterns of invasion and qualitative scores of Bcl-2 and E-cadherin was calculated using spearman rho correlation. Difference of mean percentage of positive cells of Bcl-2 and E-cadherin in different patterns of invasion was tested by ANOVA followed by tukey HSD test.
Results
Bcl-2 and E-cadherin immunoreactivity was positively correlated with Bryne's pattern of invasion (p value<0.05). An inverse relation was found between Bcl-2 and E-cadherin expression with a significant decrease in ratio of E-cadherin/ Bcl2 from well to poorly differentiated OSCC,stage 1 to stage 4 according to TNM staging and Bryne's patterns 1 to 5 of invasion.
Conclusions
The results pointed to the antagonistic role of E-cadherin and Bcl-2 and thus provide the opportunity for cell survival along with increased invasive potential. The ratio of these molecules can be hypothesized to evaluate risk assessment and prognosis.
This article is protected by copyright. All rights reserved.
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Mutations in PIK3R1 can lead to APDS2, SHORT syndrome or a combination of the two
Source:Clinical Immunology
Author(s): M Bravo García-Morato, S García-Miñaúr, J Molina Garicano, F Santos Simarro, E López-Grandos, A Ferreira Cerdán, R Rodríguez Pena
Mutations in PIK3R1 gene have been associated to two different conditions: a primary immunodeficiency, called APDS2, of recent description and SHORT syndrome. 47 patients with APDS2 have been reported to date, only one of them sharing both PIK3R1-related phenotypes. Here we describe two more patients affected by APDS2 and SHORT syndrome, which highlights that this association may not be so infrequent. We recommend that patients with mutations in PIK3R1 gene should be assessed by both clinical immunologists and clinical geneticists.
http://ift.tt/2mmW6RJ
Prevalence of malignant hyperthermia diagnosis in hospital discharge records in California, Florida, New York, and Wisconsin
Malignant hyperthermia (MH) is a rare yet potentially fatal pharmacogenetic disorder triggered by exposure to inhalational anesthetics and the depolarizing neuromuscular blocking agent succinylcholine. Epidemiologic data on the geographic variation in MH prevalence is scant. The objective of this study is to examine the prevalence of recorded MH diagnosis in patients discharged from hospitals in four states in the United States.
http://ift.tt/2lVTj5U
Craniofacial fibrous dysplasia: A 10-case series
Publication date: Available online 14 March 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Couturier, O. Aumaître, L. Gilain, B. Jean, T. Mom, M. André
ObjectivesFibrous dysplasia of bone is a rare sporadic benign congenital condition in which normal cancellous bone is replaced by fibro-osseous tissue with immature osteogenesis. Sarcomatous transformation is exceptional. Lesions may involve one bone (monostotic) or several (polyostotic). Fibrous dysplasia may be associated with café-au-lait skin macules and endocrinopathy in McCune-Albright syndrome, or with myxoma in Mazabraud's syndrome.MethodsWe report ten cases of patients followed up for craniofacial fibrous dysplasia in our center between 2010 and 2015.ResultsMean age was 43 years (range, 10–72 years). Clinical symptoms comprised headache (n=3) and sensorineural disorder: recurrent anterior uveitis (n=1), visual acuity loss, epiphora and vestibular syndrome (n=1), and hearing loss (n=1). All cases were monostotic. The sphenoid bone was most commonly involved (n=5), followed by the ethmoid (n=1), frontal (n=1), fronto-ethmoid (n=1), temporal (n=1) and fronto-ethmoido-sphenoid (n=1) bones. Five patients were treated with intravenous pamidronate, a bisphosphonate: evolution was favorable for 3 of them at 1–6 months after treatment initiation, with resolution of headache or vestibular syndrome; the other 2 patients were stable. Two patients were operated on.ConclusionDiagnosis of craniofacial fibrous dysplasia should be considered in case of headache, neuralgia, sensory disorder, functional disorder or infectious ENT complications. A medico-surgical approach is useful for these patients.
http://ift.tt/2mV4kUv
Approach to the diagnosis of drug hypersensitivity reactions: similarities and differences between Europe and North America
Drug hypersensitivity reactions (DHRs) affect an unknown proportion of the general population, and are an important public health problem due to their potential to cause life-threatening anaphylaxis and rare ...
http://ift.tt/2mHCPgB
Skeletal lead burden of the British Royal Navy in Colonial Antigua
Abstract
Lead (Pb) has been known to be a cause of human poisoning since ancient times, but despite this it was a widely used metal in the European colonial period. In this study, the relationship between Pb exposure and the demographic variables ancestry and age was explored by comparing the bone Pb levels of individuals that were of either African or European ancestry, excavated from a British Royal Navy hospital cemetery (1793-1822 CE) at English Harbour in Antigua, West Indies. More direct comparisons of Pb levels between the two ancestral groups were possible in this study due to the unsegregated nature of this cemetery. Inductively-coupled plasma mass spectrometry (ICP-MS) was used to determine bulk Pb levels in cortical bone samples from the fibular diaphyses of 23 male individuals. No significant difference was found between the distributions of the Pb levels of the ancestral groups (p = 0.94). Further, no positive correlations or significant differences were found in relation to the individuals' ages and their Pb levels (p = 0.24). Levels of Ba, Ca and rare earth elements, support a largely biogenic origin of lead. This is bolstered by Pb deposition patterns, generated by synchrotron x-ray fluorescence imaging for another study,. The data suggest that naval personnel, regardless of ancestry at English Harbour, had very similar experiences with regards to Pb exposure. Their exposure to the toxic metal was likely not consistent over time as steady exposure would have resulted in accumulation of Pb with age. This study contributes to addressing historical questions regarding the prevalence of Pb poisoning within the British Royal Navy during the colonial period.
http://ift.tt/2mmCQTK
Branchial Arch Anomalies: Recurrence, Malignant Degeneration and Operative Complications
Publication date: Available online 14 March 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Faisal Al-Mufarrej, David Stoddard, Uldis Bite
ObjectiveBranchial arch anomalies (BAA) represent one of the commonest pediatric neck masses, but large case series are lacking with none specifically examining risk of recurrence, surgical complications, and malignancy.Study DesignRetrospective study of patients with BAA at Mayo Clinic from 1/1/1976-7/29/2011.MethodsFeatures studied include age, gender, location, BAA type, symptoms, recurrence, preoperative management, extent of surgery, pathology as well as presence of tracts. Associations with tracts, operative complications, and recurrence were evaluated.Results421 subjects underwent BAA excision during the study period at our institution. Subjects with tracts were symptomatic earlier. Four cases (mean age 60.3 years) of malignancy were identified. Among the 358 (non-remenant) BAA patients with no previous excision, 3.6% recurred at a mean of 47.1 months following surgery. Patients who underwent incision and drainage prior to BAA excision were 3.4 times more likely to recur. 2% experienced complications. Age, BAA type, preoperative imaging and extent of surgery did not affect recurrence or complication rates.ConclusionPatients with history of preoperative incision and drainage should be followed closely for recurrence the first four years. Early BAA excision is not associated with higher complication rate. Extent of resection should be determined by gross margins of BAA. Malignant degeneration was not seen in children. Malignancies have been seen in older patients (over 45 years) diagnosed with BAA, and a thorough work-up is important for correct diagnosis.
http://ift.tt/2mmAC7C
Reliability and validity of the Turkish CHILDREN’S voice handicap INDEX-10 (TR-CVHI-10)
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Elçin TADIHAN ÖZKAN, Arzu TÜZÜNER, Müzeyyen ÇİYİLTEPE, Eren BALO, Müge ÖZÇELİK KORKMAZ, Ali ÇAĞLI
http://ift.tt/2mHgbVE
Allergic disease in 8-year old children is preceded by delayed B-cell maturation
Abstract
Background
We previously reported that exposure to a farming environment is allergy-protective, while high proportions of neonatal immature/naïve CD5+ B cells and putative regulatory T cells (Tregs) are risk factors for development of allergic disease and sensitization up to 3 years of age.
Objective
To examine if B- and T-cell maturation are associated with allergic disease and farming environment over the first 8 years in life.
Methods
In the prospective FARMFLORA study, including both farming and non-farming families, 48 out of 65 children took part in the 8-year follow-up study. Various B- and T-cell maturation variables were examined in blood samples obtained at several occasions from birth to 8 years of age and related to doctors' diagnosed allergic disease and sensitization, and to farming environment.
Results
We found that the incidence of allergic disease was lower among farmers' compared to non-farmers' children during the 8-years follow-up period, and that farmers' children had higher proportions of memory B cells at 8 years of age. Moreover, a high proportion of neonatal CD5+ B cells was a risk factor for and may predict development of allergic disease at 8 years of age. A high proportion of Tregs was not protective against development of these conditions.
Conclusion & Clinical Relevance
High proportions of neonatal naïve B cells remained as a risk factor for allergic disease in school-aged children. Thus, the accelerated B-cell maturation observed among farmers' children may be crucial for the allergy-protective effect of a farming environment.
This article is protected by copyright. All rights reserved.
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Immunologic regulatory effects of human umbilical cord blood-derived mesenchymal stem cells in a murine ovalbumin asthma model
Abstract
Background
Mesenchymal stem cells (MSCs) have multiple immunomodulatory properties and hold therapeutic potential for inflammatory diseases. However, the therapeutic and immunologic effects of human umbilical cord blood-derived MSCs (huMSCs) remain largely unexamined for asthma.
Objective
This study was to investigate the immunomodulatory properties of huMSCs in an ovalbumin (OVA)-induced murine asthma model.
Methods
Mice were injected intraperitoneally with OVA and an aluminum hydroxide adjuvant. huMSCs were administered via the tail-vein (5x105 cells/100uL) to female BALB/c mice prior to the initial OVA challenge. The effects of huMSCs were assessed by investigating airway hyperresponsiveness, histological changes, inflammatory cell numbers, serum allergen-specific antibodies, cytokine production in spleen, lung tissue, and BAL fluid as well as expansion of regulatory T cells.
Results
Administration of huMSCs significantly reduced methacholine bronchial hyperresponsiveness and eosinophil counts in BAL cells. Similarly, there was a significant decrease in serum OVA-specific IgE and IgG1 levels along with Th2 cytokine production (IL-4, IL-5, and IL-13) in the lung and spleen tissues, whereas increased percentage of regulatory T cells was observed after treatment with huMSCs.
Conclusions
Our results suggest that huMSC treatment reduces OVA-induced allergic inflammation, which could be mediated by regulatory T cells.
This article is protected by copyright. All rights reserved.
http://ift.tt/2mUVkP9
Upper lateral cartilage composite flap for closure of complicated septal perforations
Objectives/Hypothesis
To present a novel technique for the repair of large complicated nasal septal perforations using an upper lateral cartilage composite flap.
Study Design
This is a case series of five patients with large septal perforations seen at an academic tertiary care center, who have failed previous treatment measures and were selected to undergo this novel reconstruction for closure of their defects.
Methods
Patients were followed clinically to determine the success of the repair. Pre- and postoperative photographic documentation is presented, as well as a description of the surgical technique.
Results
All patients were found to have large septal perforations exceeding 2 × 3 cm in size. The reconstructed septal perforations remained closed for the duration of follow-up. There were no long-term complications related to this technique.
Conclusions
The composite upper lateral cartilage flap is an effective and reliable means of repairing large and complicated septal defects with respiratory mucosa recruited from the nasal cavity. It may be considered in revision cases prior to entertaining regional extranasal flaps or the use of septal buttons.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2mmyJHo
Malignant glomus tumors of the head and neck in children and adults: Evaluation and management
Objectives/Hypothesis
To describe our current multidisciplinary approach to pediatric malignant glomus tumors of the head and neck and review the current literature.
Study Design
Retrospective chart review at a tertiary referral children's hospital and a comprehensive literature review.
Methods
A comprehensive literature search of PubMed, Embase, Web of Science, Google Scholar, and EBSCO with respect to malignant glomus tumors of the head and neck was conducted. We obtained expert input from other pertinent specialties, including oncology, pathology, and radiology. To highlight the difficulty of evaluation and management of these patients, we also present a pediatric patient with a left neck malignant glomus tumor and lung metastases.
Results
Only two cases of pediatric malignant glomus tumor (including our own) have been reported in the English literature. Overall, 14 malignant glomus tumors have been reported in the head and neck (11 primary and three metastatic). Surgical resection is the mainstay of treatment, but local recurrence is common (five of 11, 45%).
Conclusions
Malignant glomus tumor of the head and neck is an extremely rare tumor in children. Evaluation consists of imaging, and tissue biopsy is necessary for definitive diagnosis. Management options include surgical resection with or without an adjuvant chemotherapy protocol similar to those designed for sarcoma. Additional reports are necessary so that we may determine the utility, if any, of radiotherapy in the management of this tumor. Laryngoscope, 2017
http://ift.tt/2mmzz71
Long-term MRI surveillance after microsurgery for vestibular schwannoma
Objectives
To determine the optimal postoperative magnetic resonance imaging (MRI) schedule and length of follow-up for patients undergoing microsurgical excision of vestibular schwannoma (VS).
Study Design
A retrospective review of patients who underwent microsurgical excision of VS at a single tertiary care center between January 1993 and March 2004.
Methods
Two hundred and twenty subjects were analyzed and characteristics gathered, including tumor size, surgical approach, completeness of resection, and length of follow-up to last MRI. All postoperative MRIs were reviewed. Radiologic progression is defined as a transition to a more advanced MRI grade from a less advanced MRI grade (eg, clean, linear, nodular) and was recorded for each of the subjects' serial MRIs. The MRI categorized findings were also binned into five time periods for summary analyses. Interval-censored survival analysis was performed to model time to recurrence across the population.
Results
Of the non-neurofibromatosis type 2 (NF2) cohort, the average tumor size at the time of resection was 1.98 ± 1.02 cm (range 0.4–5 cm); average length of follow-up was 9.0 ± 4.6 years (range 1–19); 102 subjects (47.2%) underwent a retrosigmoid resection; and 110 (50.9%) underwent a translabyrinthine resection. Eight of these subjects (4.1%) demonstrated radiologic progression; of those, four underwent additional treatment. Survival analysis showed early (1–2 years postoperative), middle (2–10 years postoperative), and late (> 10 years postoperative) radiologic progression events.
Conclusion
The current recommended MRI surveillance schedule after microsurgery for VS includes MRIs at 1, 5, and 10 years postoperatively. Nonparametric survival analysis suggests that a majority of radiologic progression events occur in the first 10 years postoperatively.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2mmjX42
Surface charge modification decreases Pseudomonas aeruginosa adherence in vitro and bacterial persistence in an in vivo implant model
Objective
Chronic, persistent infections complicate otologic procedures utilizing implantable devices such as cochlear implants or tympanostomy tubes. These infections are thought to be due to the establishment of microbial biofilms on implant surfaces. To address this issue, we hypothesized that surface charge modification may inhibit the formation of Pseudomonas aeruginosa biofilms on implant surfaces in vitro and in vivo.
Study Design
We evaluated the effect of surface charge modification on bacterial biofilm formation by assessing the effect of the surface charge on bacterial adhesion in vitro and bacterial persistence in vivo.
Methods
To study the effect of surface charge in vitro, the surface wells in culture plates were modified using a layer-by-layer polyelectrolyte assembly method. Bacterial adherence was measured at 30-, 60-, and 120-minute intervals. To study the effect of surface charge modification in vivo, the surface of titanium microscrews was similarly modified and then surgically implanted into the dorsal calvaria of adult rats and inoculated with bacteria. Two weeks after implantation and inoculation, the number of bacteria remaining in vivo was evaluated.
Results
Surface charge modification results in a significant decrease in adherence of bacteria in vitro. Surface charge modification of titanium microscrew implants also resulted in a significant decrease in P. aeruginosa recovered 2 weeks after surgical implantation.
Conclusion
Charge modification decreases the number of bacteria adherent to a surface in vitro and decreases the risk and severity of implant infection in an in vivo rat infection model. These results have promising biomedical applications.
Level of Evidence
NA. Laryngoscope, 2016
http://ift.tt/2mHdQty
Smoking: An independent risk factor for lost productivity in chronic rhinosinusitis
Objectives/Hypothesis
Chronic rhinosinusitis (CRS) is associated with a significant loss of patient productivity that costs billions of dollars every year. Smoking is associated with worsening sinonasal symptoms, but its effect on lost productivity in CRS patients has yet to be described. Therefore, we sought to determine the association between smoking and productivity in patients with CRS.
Study Design
Prospective cross-sectional cohort study of 140 patients with CRS.
Methods
Sinonasal symptom severity was measured using the 22-item Sino-Nasal Outcomes Test. Lost productivity was assessed by asking participants how many days of work and/or school they missed in the last 3 months due to CRS. Associations were sought between lost productivity and smoking.
Results
Participants missed a mean of 3.0 days (standard deviation = 12.8 days) of work or school due to CRS. Having any history of smoking was associated with 6 days of lost productivity due to CRS (adjusted β = 6.20, 95% confidence interval [CI]: 0.64 to 11.77, P = .031). Although the number of active smokers in our study cohort was very small (N = 6), we performed a univariate association between smoking status, considering former smokers and active smokers separately, and found that active smoking (β = 11.75, 95% CI: 2.11 to 21.40, P = .018) had a much larger impact on CRS-related productivity loss than that experienced by former smokers (β = 4.45, 95% CI: −0.32 to 9.23, P = .070).
Conclusions
Smoking (likely driven by active smoking) is independently associated with missed days of work or school in patients with CRS. Further study is needed to determine whether interventions directed at smoking may impact CRS-related productivity loss.
Level of Evidence
2c Laryngoscope, 2017
http://ift.tt/2mHhCDk
Staging cutaneous squamous cell carcinoma metastases to the parotid gland
Objective
The staging of cutaneous squamous cell cancers (cSCC) was revised by the American Joint Committee on Cancer in 2010 to incorporate known prognostic factors and expand the N (node) category. The purpose of this study was to validate this staging system using a North American cohort, and to compare it to the O'Brien P (Parotid) and N staging system.
Methods
An exhaustive collaborative database search was performed for all patients with cSCC metastasis to the parotid gland treated at three major Canadian tertiary referral centers from December 1999 to March 2015. The data collected for each patient included overall survival; disease-free survival; tumor, node, and metastasis) staging; and postoperative radiation status. Post-hoc analysis was completed to discern the strongest prognostic factors of survival as they relate to the abovementioned staging systems.
Results
Of 136 patients identified, 80% had a documented history of previously treated head and neck cSCC an average of 27 months prior to presentation. Average size of the parotid lesion at recurrence was 4.5 cm. Ninety-six percent of patients underwent surgical resection of the parotid metastasis. Five-year overall and disease-free survival is 79% and 55%, respectively. Only cSCC staging and cSCC-N category had statistically significant differences between groups. cSCC staging had the largest percentage of variation in overall survival explained.
Conclusion
Patients with cSCC metastasis to the parotid gland proved to have a moderate survival rate, despite presenting with advanced disease. cSCC staging in the setting of parotid metastasis, despite its limitations, currently offers the most predictive staging system available.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2mmD3Hd
Modified transnasal endoscopic medial maxillectomy through prelacrimal duct approach
Objective
We previously reported a modified endoscopic medial maxillectomy (modified transnasal endoscopic medial maxillectomy through prelacrimal duct approach [MTEMMPDA]) to resect inverted papilloma (IP), for which the inferior turbinate (IT) and nasolacrimal duct (ND) can be preserved. MTEMMPDA is a safe and effective method to obtain wide, straight access to the maxillary sinus (MS). However, there are few reported cases of patients who underwent MTEMMPDA, and even fewer of patients who underwent partial osteotomy of the apertura piriformis and the anterior wall of the MS. In this study, we analyzed the outcomes of 51 patients who underwent MTEMMPDA.
Study Design
Retrospective review.
Methods
All patients who underwent MTEMMPDA at our hospital between January 2004 and December 2015 were included in this study.
Results
Fifty-one patients with sinonasal IP in the MS underwent MTEMMPDA. Recurrence was seen in the MS of one patient (follow-up of 2–138 months). The IT remained unchanged in all 51 patients without atrophy. We have not observed epiphora, eye discharge, dry nose, or persistent crusting after this surgery. Although seven patients had numbness around the upper lip after surgery, this had disappeared by 1 year after surgery. Additional partial osteotomy of the apertura piriformis and the anterior wall of the MS were done in eight patients. Deformation of the external nose was not seen.
Conclusion
This approach appears to be a safe and effective method to resect IP in the MS, even if there is additional partial osteotomy of the apertura piriformis and the anterior wall of the MS.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2mHiGaj
The human endolymphatic sac expresses natriuretic peptides
Objectives/Hypothesis
The function of the human endolymphatic sac (ES) has been enigmatic for decades. Hypotheses include controlling endolymphatic fluid homeostasis and inner ear immunological defense. Additionally, several studies indicate a possible endocrine capacity and a yet undefined role in intracranial pressure homeostasis. However, no direct evidence of such capacity exists. This study aims to explore and identify the hypothesized endocrine capacity of the human ES.
Study Design
DNA microarrays and immunohistochemistry were used for analyses of fresh human ES tissue samples.
Methods
Twelve tissue samples from the human ES were obtained during translabyrinthine surgery for vestibular schwannoma. Microarray technology was used to investigate tissue sample gene expression. Genes specific for an endocrine function were determined, and results were verified by immunohistochemistry.
Results
Several natriuretic peptides were found expressed significantly in the ES, including uroguanylin and brain natriuretic peptide, but also peptides regulating vascular tone, including adrenomedullin 2. In addition, both neurophysin and oxytocin (OXT) were found significantly expressed. All peptides were verified by immunohistochemistry.
Conclusion
The present data support the hypothesis that the human ES may have an endocrine/paracrine capacity through expression of several peptides with potent natriuretic activity. Furthermore, the ES may influence the hypothalamo-pituitary-adrenal axis and may regulate vasopressin receptors and aquaporin-2 channels in the inner ear via OXT expression. We hypothesize that the ES is likely to regulate inner ear endolymphatic homeostasis, possibly through secretion of several peptides, but it may also influence systemic and/or intracranial blood pressure through direct and indirect action on the vascular system and the kidney.
Level of Evidence
N/A. Laryngoscope, 2016
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