Selecting Trustworthy Papers.

No abstract available

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Hemorrhage and Infarction of the Conjunctiva and Orbit in Essential Thrombocythemia.

An 82-year-old woman who had a history of essential thrombocythemia presented with ocular pain, bleeding, and decreased visual acuity of the left eye. Orbital computed tomography revealed a relatively well-defined homogenous mass-like lesion in the left subconjunctival and intraconal space. Conjunctival biopsy showed acute inflammation with necrosis, vascular ectasia with thrombosis and hemorrhage. After the treatment with hydroxyurea and anagrelide, her symptom and lesion were markedly improved. Hematologic disorders like essential thrombocythemia should be considered in patients with severe spontaneous bleeding around the eye. (C) 2017 by Mutaz B. Habal, MD.

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Antibacterial Effect of Bacteriocin Isolated From Lactobacillus Plantarum ATCC 8014 on Postoperative Infection of Mandibular Fracture In Vivo.

Objective: The primary objective of this study was to verify the effects of bacteriocin in treatment of postoperative infection of mandibular fracture in vivo. Methods: Eighty-two mice were inoculated intravenously with staphylococcal suspensions. Bacterial cultures were obtained from implants. Blood samples were collected at 1, 2, 4, 6, and 8 hours after the injection of bacteriocins. Results: Bacteriocins have significant inhibitory effects on Staphylococcus aureus (P

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Clinical Manifestation of a Patient With Forehead Sparganosis.

Human sparganosis is a parasite infection caused by the larva of a tapeworm of the genus Spirometra. Ocular, central nervous system, auricular, pulmonary, intraosseous, intraperitoneal, and subcutaneous manifestations of this infection in the neck or inguinal region have been described. The authors report the rare occurrence of cutaneous forehead sparganosis of a 19-year-old male who presented with a soft subcutaneous mass in the forehead, along with a related literature review. (C) 2017 by Mutaz B. Habal, MD.

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Simple Percutaneous Transbuccal Approach for Management of Mandibular Angular Fracture.

Objective: To describe a relatively simple, easy, and safe technique for open reduction and internal fixation of the mandibular angle fracture using the combined modified percutaneous and oral approach with no special instrumentation. Patients and Methods: This study was carried out on 10 patients who had traumatic mandibular angle fractures. All patients were managed by open reduction and internal fixation. Intraoral exposure and reduction of the fracture was performed through the gingivolabial incision. Then, a modified percutaneous-transbuccal way was utilized for conduction of the microdrill shaft and screw driver to permit screws fixation with perpendicular relations between plate and inserted screws. Results: There were no registered soft tissue infections, wound dehiscence, occlusal defects, or facial nerve paresis. The mean surgical duration was 39.7 +/- 11.5 minutes. No patients were recorded to have unsatisfactory external scar and further intervention was not required. Conclusion: The described percutaneous approach to mandibular angle fracture can be done effectively and safely using available and operatively fabricated disposable tools. (C) 2017 by Mutaz B. Habal, MD.

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Burkitt Lymphoma in Adult With Atypical Clinical Presentation Primarily Involving the Oral Soft Tissue.

Non-Hodgkin lymphoma is the second most common neoplasm of the head and neck after squamous cell carcinoma. However, it accounts for only 3.5% of all malignancies of the oral cavity. Oral lesions are often a component of disseminated disease process that may involve regional lymph nodes or may at times represent the primary extra nodal form of the disease. Although, isolated oral lymphoma in adults is extremely rare, this paper presents a patient with Burkitt lymphoma in an adult male with atypical clinical presentation primarily involving the oral soft tissue. It is believed that the prognosis of Burkitt lymphoma depends on the extent of the disease, the patient's age, and the timing of diagnosis. Therefore, the role of the dentist in the early diagnosis and prompt referral of patients with Burkitt lymphoma cannot be overemphasized. (C) 2017 by Mutaz B. Habal, MD.

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Management of Pharyngocutaneous Fistula With Negative-Pressure Wound Therapy.

Background: Pharyngocutaneous fistula is a common complication of laryngopharyngeal surgery and is associated with increased morbidity and mortality. Beyond the classical management, negative-pressure wound therapy (NPWT) can be an alternative and effective treatment. Clinical Report: Two patients with pT3N0M0 squamous cell carcinoma of pyriform sinus were subjected to total laryngectomy and pharyngoesophageal reconstruction of a circular (patient 1) and an anterior wall defect (patient 2) with radial forearm free flap and pectoralis major muscle flap, respectively. Both developed a pharyngocutaneous fistula and NPWT was used. A significant decrease of the fistula aperture and exudate was observed after 22 and 21 days of NPWT in patients 1 and 2, respectively. After that standard wound care was instituted and closure of the fistulae was accomplished in 5 and 7 days, respectively. Conclusion: Negative-pressure wound therapy can be an effective treatment for pharyngocutaneous fistula closure, either in the setting of fistulae that persist besides multiple surgical revisions using muscle flaps or as a first-line therapy when fistulae develops. (C) 2017 by Mutaz B. Habal, MD.

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Improving the Results of Cross Lip Vermilion Flap in Cleft Patients.

Cross lip vermilion flap is a myomucosal flap that uses lower red lip to augment deficient upper lip vermilion. Technical note that helps in imitating upper lip tubercle structure is presented. Appropriate patient selection to prevent unfavorable results such as color mismatch, local vermilion excess, and lower lip thinning are presented. Indirect benefits of this flap for decreasing upper incisor tooth show and better balance of upper/lower lip thickness are discussed. (C) 2017 by Mutaz B. Habal, MD.

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Intracranial Anatomic Landmarks for Endoscopic Endonasal Transcribriform Approach to Anterior Skull Base.

Objectives: To help surgeons locating anatomic landmarks when performing endoscopic endonasal transcribriform approach to anterior skull base. Methods: High-resolution axial computed tomography (CT) images at thickness of 0.6 mm, and reconstructed 0.41-mm thick gapless sagittal and coronal CT images were taken from 123 subjects. Using mimics software, first located elementary points and line: nasal spine, midpoint of posterior hard palate and the line between them; then located measured points right/left posterior and anterior points; measured distances between measured points and from measured points to nasal spine and angles between lines connecting measured points to nasal spine and the basic line. Results: The distances from nasal spine to right/left posterior and anterior points of anterior skull base are 68.67 +/- 6.04 and 61.71 +/- 5.09 mm, corresponding angles are 45.89 +/- 4.20[degrees] and 72.07 +/- 4.06[degrees], respectively. The width and length of defect of anterior skull base are 24.45 +/- 2.62 and 31.03 +/- 4.96 mm; its area ranges from 373.75 +/- 94.08 to 800.91 +/- 195.07 mm2. Conclusions: The study provides information about anterior skull base anatomic landmarks, which can help surgeons to locate them and avoid relative complications during endoscopic endonasal transcribriform approach to anterior skull base. The measurements can be used as surgical indicators to investigate the landmarks. (C) 2017 by Mutaz B. Habal, MD.

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Simultaneous Autologus Mandible and Temporomandibular Joint Reconstruction.

Ablative surgery of mandible often necessitates combined reconstruction of the mandible and the temporomandibular joint. Fibula-free flaps with gap arthroplasty or osseochondral grafts are common procedures in the authors' practice. In search for a better reconstructive option free fibula flap is used together with a metatarsal bone flap for the vascular reconstruction of the mandibular body and the condyle at the same time. The 2 osseous-free flaps have been fused and used as a combined flow through double-free flap. The literature has been reviewed for other reconstructive options, but no alternatives providing autologous reconstruction of both the mandible and the condyle with vascular tissue have been found. This is a preliminary report of this new technique which the authors humbly think is very promising. (C) 2017 by Mutaz B. Habal, MD.

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Retropharyngeal Abscess Presenting With Sleep Apnea Syndrome.

Retropharyngeal abscess (RPA) is the second most common deep neck space infection after peritonsiller abscess in pediatric population. Major signs and symptoms on physical examination include fever, hypersalivation, odynophagia, reduced oral intake, sore throat, swelling on the neck, torticollis, limitation in neck mobility, and voice changes. In this paper, the authors present a case of RPA with unusual and interesting presenting symptoms in a 10-month-old infant that exhibit new-onset and worsening snoring and sleep apnea. The purposes of this manuscript are to present the authors' experience with this patient, to emphasize the diagnosis, clinical course, and management of RPA in infants, also to signify the importance of including RPA in the differential diagnosis of patients with sleep apnea syndrome. (C) 2017 by Mutaz B. Habal, MD.

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Unusual Association: Cerebral Arteriovenous Malformation and Chiari Type I Malformation.

Cerebral arteriovenous malformation (AVM) is a common type of cerebral vascular malformation. The imaging findings are enlarged vessels, thrombosed sinuses, and hemorrhage or gliosis on adjacent brain parenchyma. Magnetic resonance (MR) imaging can be used safely for diagnosis. Chiari type I malformation is characterized by a caudal descent of the cerebellar tonsil. Coincidence of cerebral AVM and Chiari type I malformation is very rare. In this paper, the authors report MR imaging findings of a patient with coincidence of cerebral AVM and Chiari type I malformation. (C) 2017 by Mutaz B. Habal, MD.

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Influence Factor in Thickness of Cyst Wall of Epidermal Cysts.

Purpose: An epidermal cyst is one of the most common benign tumors of the skin and its major treatment method is excision. Surgical excision is treatment of choice for epidermal cysts, but the cyst wall may be ruptured during operation, especially when the cyst wall is relatively thin. The incomplete excision of the cyst sometimes occurs because of a rupture of the cyst and incomplete excision may cause recurrence. The purpose of this study is to evaluate the factors that can influence the thickness of the cyst wall of epidermal cysts. Methods: From December 2008 to November 2013, medical records and tissue pathology slides of 290 patients with an epidermal cyst were reviewed retrospectively. The relationships among the regions, history of infection, the age of patients, and the thickness of the cyst and epidermis were analyzed. Results: There was no difference between thickness of cyst wall and site of occurrence and between thickness of epidermis and site of occurrence. The thickness of epidermal cyst wall with previous infection is thicker than those without infection episode (P = 0.01). However, the difference of thickness of epidermis above the cyst between with and without previous infection is not statistically significant (P = 0.641). The thickness of cyst wall and epidermis showed positive correlation (Pearson correlation coefficient 0.391, P = 0.01). Conclusion: From this study, there was a tendency cyst wall with the history of infection or incision and drainage is thicker. When surgical excision, more attention to excise epidermal cyst completely is needed for the prevention of recurrence of the cyst. (C) 2017 by Mutaz B. Habal, MD.

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Review of "Repealing the ACA Without a Replacement-The Risks to American Health Care" by Obama BH in N Engl J Med 376: 297-299, 2017.

No abstract available

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Tomographic Evaluation of Prevalence, Position, and Diameter of the Intraosseous Branch of the Posterior Superior Alveolar Artery in Fully Edentulous Individuals.

The objective of this study was to evaluate the presence, position, and diameter of the intraosseous branch (IObr) of the posterior superior alveolar artery in fully edentulous patients. Two-hundred five computed tomography scans of fully edentulous patients were analyzed. The presence of the IObr was investigated in the coronal plane at the lateral wall of the maxillary sinus. In patients in whom the IObr was detected, the artery diameter was measured, and the distance from the artery to the bone crest of the alveolar ridge, the maxillary sinus floor, and the distance of the maxillary sinus floor to the bone crest of the alveolar ridge were measured as well. A descriptive statistical analysis of these parameters was conducted. The IObr was identified in the maxillary sinus in 105 tomography images (51.2%), and its diameter varied between 0.8 and 3.3 mm (1.29 +/- 0.49 mm). The IObr presented with an artery diameter less than 1 mm in 29% of the patients, between 1 and 2 mm diameter in 61% of the patients and with a diameter larger than 2 mm in 10% of patients. Regarding the IObr topography, the distance from the artery to the floor of the maxillary sinus was 9.62 +/- 4.59 mm, and the distance from the artery to the top of crestal bone was 15.15 +/- 4.47 mm. At least 10% of edentulous patients are at risk of bleeding complications during interventions in the maxillary sinus. (C) 2017 by Mutaz B. Habal, MD.

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Evaluation of Dentoalveolar Trauma in Children and Adolescents: a Modified Classification System and Surgical Treatment Strategies for Its Management.

Objective: To retrospectively analyze dentoalveolar trauma in pediatric patients, propose a modified classification, and delineate an approach for its urgent care from the surgeon's perspective. Patients and Methods: Clinical records of patients, attended at the 'A. and P. Kyriakou' Children's Hospital Department of Oral and Maxillofacial Surgery from 2000 to 2015, were retrieved and data were analyzed. Results: A total of 365 cases of dentoalveolar trauma, affecting 363 children and adolescents (221 males and 142 females), with an age range from 1 to 15 years, were treated in the authors' department. The most common injury mechanism was falls. The trauma was graded as class II in most patients (41.65%). The anterior maxilla was injured in the majority of the patients (78.35%). In 230 patients (63%) the trauma involved the primary dentition. Two hundred eighty-nine of the patients were treated with local anesthesia on an emergency basis, while in the rest 76 patients general anesthesia was considered mandatory. Conclusions: Accurate diagnosis, timely treatment, and follow-up are critical for the management of dentoalveolar trauma in pediatric patients. A modified more detailed and severity-specific classification and guidelines for its surgical management may assist practitioners in decision making and effective treatment planning. (C) 2017 by Mutaz B. Habal, MD.

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Removable Partial Denture After Gunshot Injury: Five Year Follow-Up.

The aim of this study was to report a patient of rehabilitation with removable partial denture retained by implants in-patient who suffered injury after firearm shooting. A 19-year-old man presented to the hospital of the Val Paraiso city after being hit by a bullet in the right on the face, affecting the teeth 12 to 16. The surgery to remove the shards of teeth, and bullet was performed. Surgical team opted for installation of implants without bone grafts; however, due to extensive loss of alveolar bone, only 3 tilted implants (2 O3.75 x 8.5 mm and 1 O3.75 x 10 mm) were installed. After recovery, the patient was referred to the Aracatuba Dental School-UNESP for the rehabilitation on the affected region. The difficulty of rehabilitation with conventional fixed prostheses was verified during the prosthetic phase. This way, it was opted for rehabilitation with removable partial dentures associated with dental implant. Two attachment system ERA (ERA, Sterngold) were positioned in the bar to make the removable partial denture. After 5 years of follow-up, the authors can conclude that the use of removable partial denture retained by implants is effective for functional and aesthetic rehabilitation, favoring socialization and self-esteem of the patient. (C) 2017 by Mutaz B. Habal, MD.

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A Rare Complication of Cochlear Implantation After Magnetic Resonance Imaging: Reversion of the Magnet.

Cochlear implants are mechanical devices used for patients with severe sensory-neural hearing loss, which has an inner magnet. It is proven that 1.5 Tesla magnetic resonance imaging (MRI) scanners are safe to use in patients with cochlear implant. In our patient, the authors aim to introduce a rare complication caused after a 1.5 Tesla MRI scanning and the management of this situation; the reversion of the magnet of the implant without displacement and significance of surgery in management. (C) 2017 by Mutaz B. Habal, MD.

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Complications After Treatment of Head and Neck Venous Malformations With Sodium Tetradecyl Sulfate Foam.

Purpose: The aim of this study was to evaluate complications in patients with head and neck venous malformations (VMs) treated with foam sclerotherapy using sodium tetradecyl sulfate (STS). Methods: The authors retrospectively evaluated the complications, pain. and degree of satisfaction in 69 consecutive patients affected by cervicofacial VM managed with STS using the Tessari method in a single institution. Results: The average number of procedures for each patient was 2.1. The most frequent complication was blistering. We observed 1 patient of temporary weakness of a facial nerve branch, 1 paradoxical embolism, and 1 orbital compartment syndrome. The average pain score was 0 (no pain at all) (51.5%). There was no statistically significant correlation between patient satisfaction and the presence of complications or the degree of pain. Conclusions: Sclerotherapy with STS is an effective treatment that yields to very high patient satisfaction. This procedure has an overall low complication rate and is usually effective within a few sessions. However, severe complications may occur; these must be pointed out in the informed consent and the surgeon must be aware of and ready to quickly treat them to prevent long-term sequelae. (C) 2017 by Mutaz B. Habal, MD.

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Endoscopic Endonasal Repair of Isolated Medial Orbital Wall Fracture With Balloon Technique.

Endonasal endoscopic repair of medial orbital wall fractures is minimally invasive and benefits the patients. The authors describe the authors' modified balloon technique, which allows longer support of the orbital wall. From October 2010 through January 2016, the author repaired 9 isolated medial wall fractures by this method. Five patients were diagnosed as having enophthalmos of greater than 2 mm, and 6 patients had persistent diplopia before the operation. The herniated orbital contents that filled the anterior ethmoidal sinus were gently reduced with a 4-mm-diameter 0[degrees] sinus endoscope. Then a posterior nasal cavity balloon (Type B # 32014, KOKEN Co, Japan) was inserted into the ethmoidal sinus and filled with normal saline. The inflation tube of the balloon was sutured to the nasal cavity wall with absorbable sutures. After checking the status of the balloon, the inflation tube was ligated and cut so that it could be hidden inside the nasal cavity. The balloon was removed on an outpatient basis 6 to 7 weeks after the surgery. In this series, the mean inflation volume of the balloon was 1.6 mL, the mean period of leaving the balloon in place was 5.7 weeks, and the mean operative time was 38.6 minutes. Resolution of the preoperative diplopia and enophthalmos was achieved in all 9 patients, and there was no recurrence of prolapse of the orbital contents. This method allows leaving the balloon in place for a long period of time without interfering with daily life, which reduces the risk of rebulging of the orbital contents. (C) 2017 by Mutaz B. Habal, MD.

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Why Is It Surprising That Emotional Intelligence Matters?.

No abstract available

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An Improvement on Central Line Dressings Using an "Omental" Technique.

No abstract available

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Venous Air Embolism: The Severity Depends on Many Factors.

No abstract available

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Research Methodology: The Aims, Practices, and Ethics of Science.

No abstract available

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In Response.

No abstract available

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Atlas of Anatomy (Thieme Anatomy): Pragmatic Simplicity.

No abstract available

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Pectoralis and Serratus Fascial Plane Blocks Each Provide Early Analgesic Benefits Following Ambulatory Breast Cancer Surgery: A Retrospective Propensity-Matched Cohort Study.

BACKGROUND: Pectoralis and serratus blocks have been described recently for use in breast surgery, but evidence supporting their analgesic benefits is limited. This cohort study evaluates the benefits of adding a pectoralis or serratus block to conventional opioid-based analgesia (control) in patients who underwent ambulatory breast cancer surgery at Women's College Hospital between July 2013 and May 2015. We tested the joint hypothesis that adding a pectoralis or serratus block reduced postoperative in-hospital (predischarge) opioid consumption and nausea and vomiting (PONV). We also examined the 2 block types for noninferiority. METHODS: A total of 225 patients were propensity matched on 5 potential confounders among 3 study groups (75 per group): (1) pectoralis; (2) serratus; and (3) control. The propensity-matched cohort was used to evaluate the effect of the study group on postoperative in-hospital oral morphine equivalent consumption and PONV. We considered pectoralis noninferior to serratus block if it was noninferior for both outcomes, within 10 mg morphine and 17.5% in PONV incidence margins. Other outcomes included intraoperative fentanyl requirements, pain scores, time to first analgesic request, and duration of recovery room stay. RESULTS: Both pectoralis and serratus blocks were each associated with reduced postoperative in-hospital opioid consumption and PONV compared with control. Pectoralis was noninferior to serratus block for these 2 outcomes. Pectoralis and serratus blocks were each associated with reduced intraoperative fentanyl requirements, prolonged time to first analgesic request, and expedited recovery room discharge compared with control; there were no differences for the remaining outcomes. CONCLUSIONS: Pectoralis and serratus blocks were each associated with a reduction in postoperative in-hospital opioid consumption and PONV compared with conventional opioid-based analgesia after ambulatory breast cancer surgery. (C) 2017 International Anesthesia Research Society

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In Response.

No abstract available

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Posttransfusion Increase of Hematocrit per se Does Not Improve Circulatory Oxygen Delivery due to Increased Blood Viscosity.

BACKGROUND: Blood transfusion is used to treat acute anemia with the goal of increasing blood oxygen-carrying capacity as determined by hematocrit (Hct) and oxygen delivery (DO2). However, increasing Hct also increases blood viscosity, which may thus lower DO2 if the arterial circulation is a rigid hydraulic system as the resistance to blood flow will increase. The net effect of transfusion on DO2 in this system can be analyzed by using the relationship between Hct and systemic blood viscosity of circulating blood at the posttransfusion Hct to calculate DO2 and comparing this value with pretransfusion DO2. We hypothesized that increasing Hct would increase DO2 and tested our hypothesis by mathematically modeling DO2 in the circulation. METHODS: Calculations were made assuming a normal cardiac output (5 L/min) with degrees of anemia ranging from 5% to 80% Hct deficit. We analyzed the effects of transfusing 0.5 or more units of 300 cc of packed red blood cells (PRBCs) at an Hct of 65% and calculated microcirculatory DO2 after accounting for increased blood viscosity and assuming no change in blood pressure. Our model accounts for O2 diffusion out of the circulation before blood arriving to the nutritional circulation and for changes in blood flow velocity. The immediate posttransfusion DO2 was also compared with DO2 after the transient increase in volume due to transfusion has subsided. RESULTS: Blood transfusion of up to 3 units of PRBCs increased DO2 when Hct (or hemoglobin) was 60% lower than normal, but did not increase DO2 when administered before this threshold. CONCLUSIONS: After accounting for the effect of increasing blood viscosity on blood flow owing to increasing Hct, we found in a mathematical simulation of DO2 that transfusion of up to 3 units of PRBCs does not increase DO2, unless anemia is the result of an Hct deficit greater than 60%. Observations that transfusions occasionally result in clinical improvement suggest that other mechanisms possibly related to increased blood viscosity may compensate for the absence of increase in DO2. (C) 2017 International Anesthesia Research Society

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Topical Ropivacaine in Prevention of Post-Tonsillectomy Pain in Adults.

BACKGROUND: Post-tonsillectomy pain is 1 of the most intense postoperative pain conditions. However, optimal and sufficient postoperative analgesic treatment remains unclear. We investigated the effect of topical ropivacaine for post-tonsillectomy pain in 160 adult outpatient surgery patients over 2 postoperative weeks. METHODS: At the end of tonsillectomy, 2 swabs soaked in either 1% ropivacaine or saline were packed into the tonsillar beds for 5 minutes. We used ibuprofen and a combination of acetaminophen (500 mg)-codeine (30 mg) tablets as postoperative analgesics for 2 weeks. The primary outcome was pain intensity on swallowing measured on a numeric rating scale (NRSs) during the first postoperative week expressed as area under curve (AUC). The secondary endpoints included the worst pain experienced during the 2-hour follow-up in the postanesthesia care unit, pain intensity during the second postoperative week, and the number of ibuprofen and acetaminophen-codeine tablets consumed during the 2 postoperative weeks. RESULTS: During the first postoperative week, 120 patients out of 160 (75%) provided complete results, including data on their use of analgesics according to the instructions as well as completed and returned a questionnaire daily. A total of 101 patients (63%) did the same during the second postoperative week. Median (interquartile range [IQR]) of the primary outcome NRSs (AUC) was 38 (19) for the ropivacaine group and 37 (24) for the control group during the first postoperative week (P = .77, -1.0 estimated difference; 95% confidence interval [CI] for the difference, -7.0 to 5.0); no difference was found. Median (IQR) of NRS at rest (NRSr) (AUC) was 24.5 (19) for the ropivacaine group and 24 (22) for the control group during the first postoperative week (P = .96, 0.0 estimated difference; 95% CI for the difference, -5.0 to 5.0); no difference was found. Median (IQR) of the worst pain intensity values (NRSs or NRSr) (AUC) was 5 (3) for the ropivacaine group and 5 (3) for the control group (P = .44, 0.0 estimated difference; 95% CI for the difference, -1.0 to 0.5); no difference was found. During the second postoperative week, median (IQR) of the NRSs (AUC) was 17 (13) for the ropivacaine group and 21 (23) for the control group (P = .05, -4.0 estimated difference; 95% CI for the difference, -9.0 to 0.0) and median (IQR) of the NRSr (AUC) 10.5 (10) for ropivacaine group and 11 (13) for the control group (P = .42, -1.0 estimated difference; 95% CI for the difference, -5.0 to 2.0); no difference was found. The number of rescue analgesics (acetaminophen-codeine tablets) consumed during the second postoperative week was lower in the ropivacaine group than in the control group (median [IQR] of the consumption [AUC] was 10 [12] for the ropivacaine group and 16 [12] for the control group; P = .0008, -7.0 estimated difference; 95% CI of difference, -10 to -3.0). The groups showed no differences in overall risk for post-tonsillectomy bleeding. However, bleeding requiring hemostasis under local anesthesia was more common in the ropivacaine group (18% vs 8%, P = .048, 10% estimated difference; 95% CI for the difference, 0%-21%). CONCLUSIONS: Topical ropivacaine failed to reduce pain intensity during the first postoperative week. We observed no major adverse effects. (C) 2017 International Anesthesia Research Society

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Pediatric Anesthesiology: A Comprehensive Board Review.

No abstract available

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EACMFS Prizes and Awards

The Council of EACMFS wishes to ensure that all members of the Association are aware of the current awards and prizes that are available. These are designed to provide educational support and also to allow the opportunity for trainees and those who have recently achieved specialist status to visit units outside their own departments.

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Editorial Board

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Announcements

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Pseudomonas oryzihabitans sepsis in a 1-year-old child with multiple skin rashes: a case report

Pseudomonas oryzihabitans is a Pseudomonas bacterial organism rarely implicated in human infections. The bacterium has been isolated in a few reported cases of neurosurgical infections...

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Nasal Valve Reconstruction Using a Titanium Implant: An Outcomes Study

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1600900

Septoplasty alone is not always sufficient to correct nasal obstruction. Various techniques have been employed to repair nasal valve collapse and improve airflow.This article aimed to evaluate outcomes and quality of life following nasal valve reconstruction using a titanium implant in patients with nasal valve collapse.This is a single-center retrospective study that consisted of a telephone questionnaire of 37 quality-of-life measures and questions related to the surgical procedure and recovery process to evaluate postsurgical outcomes.Fifteen patients completed the survey. There was a significant improvement in nasal blockage/obstruction, breathing through the nose, sleeping, breathing through nose during exercise, the need to blow nose, sneezing, facial pain/pressure, fatigue, productivity, and restlessness/irritability after surgery. Overall, 100% of patients were satisfied with the results and would recommend this procedure. The most common postoperative complaints were pain (33%) and difficulty breathing (33%). Patients noticed no increase (20%) or a slight increase (73%) in the size of their nose. Sixty percent of patients cannot see the implant and 13% report the implant is barely noticeable.Nasal valve repair with a titanium implant was successful at improving symptoms of nasal obstruction and other quality-of-life issues. Satisfaction was high among all patients. The implants are palpable, thought to be visible by some patients, yet accepted by the majority of patients. This approach may be especially important in patients with prior nasal surgery but continue to experience refractory symptoms.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Article in Thieme eJournals:
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A Comparative Assessment of Postoperative Analgesic Efficacy of Lornoxicam versus Tramadol after Open Reduction and Internal Fixation of Mandibular Fractures

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1600901

Pain after any surgical procedure is inevitable but can be controlled by administration of analgesics in most cases. Postoperative pain after surgical treatment of mandibular fractures can be treated by nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics. The purpose of this study is to critically compare the postoperative analgesic efficacy of small doses of intravenous TRAMADOL (opioid analgesic) versus LORNOXICAM (NSAID) in patients with mandibular trauma undergoing open reduction and internal fixation (ORIF) and to assess the presence of any adverse effects due to NSAID or opioid use. Forty adult ASA grade I–II patients with mandibular trauma, scheduled for ORIF under general anesthesia in the Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere, were selected for the study. The patients were randomly assigned into a tramadol group (Group T) and a lornoxicam group (Group L) and were administered intravenous tramadol 50 mg and intravenous lornoxicam 8 mg, respectively, at specific postoperative intervals. Pain intensity was quantitatively assessed at the 2nd, 4th, 6th, 12th, and 24th postoperative hours using a visual analog scale of 10 cm. Adverse effects of the analgesics were also recorded and compared. Both the drugs resulted in a significant decrease in pain intensity from 2nd to 24th postoperative hours, but better pain control was observed in Group L at 24th postoperative hour. Only two patients experienced nausea and vomiting in Group T and one patient experienced gastric acidity in Group L. The comparative results clearly demonstrate that pain control by intravenous lornoxicam is significantly better than by intravenous tramadol at 24th postoperative hour after ORIF of mandibular trauma. Side effects produced by both the drugs were minor and had no apparent effect on the study results.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Assessment of Fixation of Mandibular Interforaminal Fractures by Using a Single Second-Generation Headless Compression Screw: A Pilot Study

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0036-1594276

The aim of this article is to evaluate the efficacy of a single second-generation headless compression screw along with a lower arch bar in the fixation of interforaminal mandible fractures. A total of seven patients were included in the study. An open approach was used either intraorally or extraorally. A second-generation 3.0 HCS (headless compression screw), 24 to 32 mm in length, diameter at the head of 3.5 mm, smooth shaft with 2.0 mm and at the leading edge 3.0 mm (Synthes, Paoli, PA) was used for the fixation along with a lower arch bar. Postoperative clinical and radiographic follow-up was performed at 3 weeks, 3 months, 6 months, and 1 year. A single, cannulated HCS was found to be effective in fixation of interforaminal mandible fractures except in one case where a miniplate had to be applied subapically. Clinical and radiographic follow-up revealed accurate reduction and fixation in all cases and no postoperative occlusal disturbances. A single, second-generation HCS along with a lower arch bar provides good results when used for the fixation of interforaminal mandible fractures. Headless compression screw fixation of interforaminal mandible fracture is a simple, quick, economic, and efficient method of rigid fixation with minimum complications.
[...]

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Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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The impact of oral Polypodium leucotomos extract on ultraviolet B response: A human clinical study

There is a rationale for adding systemic photoprotective agents to the current photoprotection regimen.

http://ift.tt/2nL0myG

Association Between Non-Infectious Uveitis and Thyroid Dysfunction: A Case Control Study

Thyroid , Vol. 0, No. 0.


http://ift.tt/2nKTO3a

Ultrasound-Pathology Discordant Nodules on Core-Needle Biopsy: Malignancy Risk and Management Strategy

Thyroid , Vol. 0, No. 0.


http://ift.tt/2nTO04j

Single-Session High-Intensity Focused Ultrasound Treatment in Large-Sized Benign Thyroid Nodules

Thyroid , Vol. 0, No. 0.


http://ift.tt/2nTEgXQ

Use of Thudichum nasal speculum for retraction during insertion of dental implants

The success of a minor surgical procedure depends on the proper exposure of the surgical site. A Thudichum nasal speculum is in common use for examination of the nose, but we recommend it for retraction while inserting a dental implant.

http://ift.tt/2n9ugJV

Impact of elimination diets on nutrition and growth in children with multiple food allergies.

Purpose of review: Growth and nutritional intake of children with cows' milk allergy and other food allergens has been thoroughly investigated in recent years across many different countries and age groups. An impaired growth in atopic children should not be attributed only to a high number of allergens and foods to be avoided, but to a general condition of 'sub-inflammation', which unfavorably affects the absorption and utilization of fuel and substrates. Atopic study participants may represent a good target for personalized nutrition and in this review we sought to outline many of the issues that should be taken into account when dietitians advise patients regarding food avoidance and expected effects on growth. Recent findings: The dietary management of food allergy requires appropriate dietary choices to maintain adequate growth, starting with special formulas in infancy. An emerging area of research is the fussy eating related to the exclusion of cow's milk and other foods during infancy and the long-term effects on eating habits and food preferences. Summary: Study participants with either mono or polyallergic diseases should ideally undergo the definition of their allergic and metabolic characteristics, to precisely adjust dietary interventions on an individual basis to support the genetic potential of growth and prevent unfavorable outcomes. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2nE77SC

Impact of elimination diets on nutrition and growth in children with multiple food allergies.

Purpose of review: Growth and nutritional intake of children with cows' milk allergy and other food allergens has been thoroughly investigated in recent years across many different countries and age groups. An impaired growth in atopic children should not be attributed only to a high number of allergens and foods to be avoided, but to a general condition of 'sub-inflammation', which unfavorably affects the absorption and utilization of fuel and substrates. Atopic study participants may represent a good target for personalized nutrition and in this review we sought to outline many of the issues that should be taken into account when dietitians advise patients regarding food avoidance and expected effects on growth. Recent findings: The dietary management of food allergy requires appropriate dietary choices to maintain adequate growth, starting with special formulas in infancy. An emerging area of research is the fussy eating related to the exclusion of cow's milk and other foods during infancy and the long-term effects on eating habits and food preferences. Summary: Study participants with either mono or polyallergic diseases should ideally undergo the definition of their allergic and metabolic characteristics, to precisely adjust dietary interventions on an individual basis to support the genetic potential of growth and prevent unfavorable outcomes. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2nE77SC

Volumetric analysis of the maxillary, sphenoid and frontal sinuses: A comparative computerized tomography based study

Publication date: Available online 22 March 2017
Source:Auris Nasus Larynx
Author(s): Oded Cohen, Meir Warman, Moran Fried, Hagit Shoffel-Havakuk, Meital Adi, Doron Halperin, Yonatan Lahav
ObjectiveTo study volume characteristics of the maxillary, sphenoid and frontal sinuses among healthy Caucasians adults, using computed tomography (CT) scans.MethodsA retrospective, case series study in a single academic center, CT scans of 201 consecutive adult subjects, performed between January and September 2014, were reviewed for the volume and dimensions of the paranasal sinuses. Patients with documented sinus pathology or lack of pneumatization were excluded.The study population was subdivided by gender and age (50 men age 25–64; 51 men age ≥65; 50 women age 25–64, and 50 women age ≥65).ResultsThe mean volume of maxillary, sphenoid and frontal sinuses in the four groups were 12.75±4.38 cc; 4.00±1.99 cc and 2.92±2.57 cc, respectively. In both genders, older patients demonstrated a significantly lower volume of the maxillary and sphenoid sinuses (14.81±3.96 cc vs. 11.82±4.28 cc and 4.84±1.97 vs. 3.84±1.89 cc respectively; p<0.001). No age related difference was found in the frontal sinus. Males had significantly larger sinus volumes than females (p<0.001): maxillary 14.38±(4.64) vs. 12.23±(3.82) cc, sphenoid 4.74±(2.06) vs. 3.55±(1.73) cc, frontal 3.74±(2.97) vs. 3.21±(2.79) cc. No synergistic effect of age and gender was found.ConclusionVolumes of the paranasal sinuses correlates with age and gender. Age related volume degeneration is expected in the maxillary and sphenoid sinuses. This volume reduction may influence future surgical and therapeutic approaches in the geriatric population.



http://ift.tt/2mWj7Lw

Intraoperative anxiety and acute glaucoma: A possible link?

On reading Dr Liu's article 'Wound dehiscence after general anesthesia in a child' on your journal [1], they described postoperative high intraocular pressure and wound dehiscence. We'd like to share an acute onset of glaucoma because of tension during the right upper extremity surgery.

http://ift.tt/2nTeaUZ

Differentiation capacity and maintenance of dental pulp stem/progenitor cells in the process of pulpal healing following tooth injuries

Publication date: Available online 22 March 2017
Source:Journal of Oral Biosciences
Author(s): Kotaro Saito, Hayato Ohshima
BackgroundRecently, we demonstrated that a pulse of 5-bromo-2'-deoxyuridine (BrdU) given to prenatal animals discloses the existence of slow-cycling long-term label-retaining cells (LRCs), or putative adult stem/progenitor cells, which reside in the dental pulp. Using several tooth injury models such as cavity preparation, tooth replantation, tooth or tooth crown transplantation, and tooth germ transplantation, we have clarified the dynamics and differentiation capacity of LRCs postoperatively. Our recent studies have demonstrated that allogenic tooth transplantation may influence the maintenance of dental pulp stem/progenitor cells.HighlightDense LRCs are competent to proliferate and differentiate into odontoblast-like cells after tooth injuries. In the case of tooth replantation and autogenic tooth transplantation, dense LRCs remain in the perivascular environment in the center of the dental pulp for a long period. In contrast, allograft LRCs disappear from this niche during postoperative weeks 2–4. The loss of LRCs, even in cases without immunological rejection, is attributed to the extensive apoptosis taking place in these cells, with the exception of newly differentiated odontoblast-like cells.ConclusionHost and recipient interactions that occur with allografts disturb the maintenance of putative stem/progenitor cells, resulting in the disappearance of these cell types.



http://ift.tt/2nDVsDt

A 5-Year-Old Boy With Easy Bruising and a Rash

A 5-year-old boy presents due to easy bruising and a 2-day rash. What's the diagnosis?
Osmosis

http://ift.tt/2mVNZyp

IDD Newsletter February 2017

IDD NEWSLETTER – February 2017
VOLUME 45 NUMBER 1 FEBRUARY 2017
IODINE GLOBAL NETWORK (formerly ICCIDD Global Network) is a nongovernmental organization dedicated to sustained optimal iodine
nutrition and the elimination of iodine deficiency throughout the world.

The post IDD Newsletter February 2017 appeared first on American Thyroid Association.

http://ift.tt/2mRJXna

The outer diameter of the endoscope is important when performing endoscopic transcanal myringoplasty

Publication date: Available online 22 March 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Zhengcai Lou




http://ift.tt/2o5ewan

Canine fossa puncture in endoscopic sinus surgery: report of two cases

Publication date: Available online 22 March 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Federico Sireci, Matteo Nicolotti, Paolo Battaglia, Raffaele Sorrentino, Paolo Castelnuovo, Frank Rikki Canevari
IntroductionChronic rhinosinusitis with nasal polyposis is a common chronic disease that often affects maxillary sinus. Endoscopic sinus surgery is the most common procedure for treating the majority of maxillary sinus lesions.ObjectiveTo demonstrate the role of canine fossa puncture during endoscopic sinus surgery procedure in patients with severe maxillary sinus disease.MethodsWe present 2 cases where canine fossa puncture has been performed as method to obtain a complete access to the maxillary antrum.ResultsAccording our experience, 2 cases on 296 endoscopic sinus surgery (0.6%) where antrostomy and used of angled microdebrider were not sufficient, canine fossa puncture has been performed as an alternative method to obtain a complete access to the maxillary antrum.ConclusionAlthough the advent of endoscopic sinus surgery, our cases support the fact that actually canine fossa puncture is a minimally invasive technique useful in selected cases.



http://ift.tt/2nnM99Y

Preoperative chronic sinusitis as significant cause of postoperative infection and implant loss after sinus augmentation from a lateral approach

Abstract

Objectives

Among intra/postoperative complications of sinus augmentation from a lateral approach, postoperative infection and implant loss are particularly important because they have irreversible consequences. The purpose of this study was to determine the causes of postoperative infection and implant loss after a lateral approach and to determine the appropriate prophylaxis and therapy.

Materials and methods

In total, 109 patients (121 sinuses, 252 implants) were included in this study. The correlation between postoperative infection and implant loss and clinical variables was assessed using logistic regression analyses.

Results

Postoperative infection and implant loss occurred in 8/121 sinuses (6.6%). Infection had the strongest correlation to preoperative chronic sinusitis (p = 0.007), followed by timing of implant insertion. Implant loss had the strongest correlation to preoperative chronic sinusitis (p = 0.007), followed by sex, diabetes, postoperative use of dentures, and intraoperative perforation of the sinus membrane.

Conclusions

Preoperative chronic sinusitis could be a significant cause of postoperative infection and implant loss when using sinus augmentation from a lateral approach. For appropriate prophylaxis and therapy, it is necessary to diagnose the presence of chronic sinusitis that should be treated with proper methods prior to sinus augmentation.

http://ift.tt/2mVgiKE

Effect of the Plasma EBV DNA Change During Chemoradiotherapy in Nasopharyngeal Carcinoma

Condition:   Nasopharyngeal Carcinoma
Intervention:   Diagnostic Test: Plasma EBV DNA
Sponsor:   Taichung Veterans General Hospital
Recruiting - verified March 2017

http://ift.tt/2mt8HXL

Improving Quality of Life Through the Routine Use of the Patient Concerns Inventory for Head and Neck Cancer Patients

Condition:   Cancer of Head and Neck
Interventions:   Other: Patient Concerns Inventory;   Other: No Patient Concerns Inventory
Sponsors:   Aintree University Hospitals NHS Foundation Trust;   The Leeds Teaching Hospitals NHS Trust;   National Institute for Health Research, United Kingdom;   Bangor University
Recruiting - verified March 2017

http://ift.tt/2mUUzTq

Dermoscopic Features of Circumscribed Palmar Hypokeratosis

This case report describes the dermoscopic features found in 3 cases of circumscribed palmar hypokeratosis.

http://ift.tt/2mUF9OY

Chronic Actinic Dermatitis in Lighter vs Darker Skin Types

This evaluation of patients with chronic actinic dermatitis compares demographic and photobiological features between individuals with darker and lighter skin types.

http://ift.tt/2mt8VOs

Social Stigmatization and Lamellar Ichthyosis in Sub-Saharan Africa

This case report details the social stigmatization associated with lamellar ichthyosis that complicates clinicians' ability to treat the disease effectively in sub-Saharan Africa.

http://ift.tt/2mUT3AI

Systemic Immunomodulating Therapies for SJS/TEN

This systematic review and meta-analysis provides an overview on possible immunomodulating treatments for Stevens-Johnson syndrome and toxic epidermal necrolysis and estimates their effects on mortality compared with supportive care.

http://ift.tt/2mtgV2f

A Comparison of Research Grants Targeting Skin Cancer

This analysis reviews National Institute of Health grants targeting skin cancer–related behaviors and relevant outcomes, comparing funding trends along the cancer control continuum.

http://ift.tt/2mV14p6

Indoor Tanning Initiation Among Tanners in the United States

This study characterizes indoor tanning initiation by using self-reported data from Porter Novelli's 2015 Styles database, a web-based online panel weighted to be representative of the US population

http://ift.tt/2mt3gIk

Analysis and Results of Endoscopic Sinus Surgery in Chronic Rhinosinusitis With Polyps

Publication date: March–April 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 2
Author(s): M. Soledad Cabrera-Ramírez, M. Sandra Domínguez-Sosa, Silvia Andrea Borkoski-Barreiro, Juan Carlos Falcón-González, Ángel Ramos-Macías
Introduction and objectivesEndoscopic sinus surgery is currently the surgical procedure chosen in cases of sinonasal polyposis refractory to medical treatment. The aim of this study was to show our experience in managing such patients operated using endoscopic sinus surgery.MethodA retrospective study of 246 patients with chronic rhinosinusitis and nasal polyps who were operated by endoscopic surgery. We studied the characteristics of the population, symptoms, grade of affectation, complications and recurrences.ResultsThe most frequent comorbidity was asthma (34.6%) and its relationship with Samter's triad (16.3%). Grades 2 and 3 polyposis prevailed according to Lildholdt staging by nasofibroscopy, coinciding with the radiological preoperative staging. The microdebrider did not shorten surgical time but it lowered complications. Reducing the average stay with the use of absorbable haemostatic agents and their effectiveness in controlling haemostasis were statistically significant. We found 23.2% complications, with only one (0.4%) being a major complication; the rest were minor complications, with synechiae as the most frequent (16.3%).ConclusionEndoscopic sinus surgery is a minimally invasive and safe technique. Absorbable haemostatic agents are an effective alternative to get complete and stable haemostasis, reducing mean hospital stay. Synechiae continue being the most frequent complication. The fact that many patients recurred but without complications speaks in favour of a natural evolution of the disease and not of the influence of technique.



http://ift.tt/2nRYqRO

Middle Cranial Fossa Approach for the Repair of Spontaneous Cerebrospinal Fluid Leaks to the Middle Ear

Publication date: March–April 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 2
Author(s): Xabier Altuna, Juan José Navarro, Leire García, Ane Ugarte, Izaskun Thomas
IntroductionSpontaneous cerebrospinal fluid (CSF) leaks to the middle ear due to tegmen tympani defects can result in hearing loss or hypoacusis and predispose to meningitis as well as other neurological complications. Surgical repair of the defect can be performed through a middle cranial fossa (MCF) approach or a transmastoid approach.Material and methodsWe conducted a retrospective study of the patients in our Department due to a spontaneous CSF leak to the middle ear treated using a MCF approach during a 6-year period (2009–2014).ResultsThirteen patients with spontaneous CSF leak to the middle ear were treated with this approach. The primary and first symptom in all of them was conductive hearing loss. In all cases, the defect or defects were closed in a multilayer manner using muscle, temporalis fascia and cortical bone. Minimum follow-up in this series was 14 months, with successful closure in all but one patient (who required reintervention). We found no intra- or postoperative complications due to the craniotomy, and the audiometry improved and normalised in all cases except for the failed case.ConclusionsThe MCF approach with a multilayer closure of the defect is an effective technique for repairing spontaneous CSF leaks to the middle ear and for restoring hearing in these patients.



http://ift.tt/2nJB83Y

Work Activity in Patients Treated With Cochlear Implants

Publication date: March–April 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 2
Author(s): Alicia Huarte, Marta Martínez-López, Raquel Manrique-Huarte, Sandra Erviti, Diego Calavia, Cora Alonso, Manuel Manrique
IntroductionThe aim of this study was to determine the impact that the cochlear implant (CI) had in the working life of individuals implanted, using the first version of a questionnaire developed in the cochlear implant program at the University Clinic of Navarre. Its purpose was to demonstrate that the CI significantly affected the working lives of these patients.Material and methodsThis was a retrospection study on a population of 60 patients (mean age, 48 years old) with bilateral profound sensorineural hearing loss treated with CI and to whom a questionnaire on working life satisfaction was given.ResultsOf the patients completing the questionnaire, 94.23% were currently satisfied at work. Almost all of them (93.05%) were more motivated to go to work after the implantation. The majority (79.31%) considered themselves more competent after surgery and device activation. Social relations at work were considered to have improved after cochlear implantation by 67.23% of patients.ConclusionsThe CI provided positive support in the professional sphere as well as in social abilities by improving communication skills of implanted patients. The development of tools to assess the degree of job satisfaction of patients treated with a CI is of great interest.



http://ift.tt/2nRY6m3

Hiccups. Attitude in Otorhinolaryngology Towards Consulting Patients. A Diagnostic and Therapeutic Approach

Publication date: March–April 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 2
Author(s): Francisco Javier García Callejo, Jaume Redondo Martínez, Tomás Pérez Carbonell, Rafael Monzó Gandía, M. Paz Martínez Beneyto, Inés Rincón Piedrahita
IntroductionHiccup crises are generally benign and self-limiting, but longer episodes affect quality of life and must be treated. There are recognisable causes that otorhinolaryngologists must know and be aware for diagnosis and therapeutic alternatives. The main expression is a spasmodic glottic noise with characteristic neck alterations.Patients and methodsThis was a retrospective study from 1979 with patients suffering persistent or recurrent hiccups. Chronobiology, comorbidity, findings from explorations, therapies and outcomes were noted. Thirty-seven patients were studied (mean age, 45.5±13.5 years; 30 males), with persistent hiccups in 23 (62%).ResultsA potential associated aetiology was observed in 24 cases (65%): oesophageal disorders–mainly gastroesophageal reflux–were detected in 14 cases and concomitant oncological disease was found in 8. Only 3 cases were admitted for surgery due to these findings. Therapeutic strategies with metoclopramide were used in 18 subjects, chlorpromazine in 17 and baclofen in 13, while carbamazepine or haloperidol were used in a minority. Phrenic nerve stimulation was employed in 6 patients. Hiccups disappeared in 32 cases. Out of 22 cases for which follow-up was possible, the hiccups recurred in 5 subjects (the subjects requiring new therapies) and 11 patients died.ConclusionsChronic hiccup represents a multidisciplinary challenge that includes potential head and neck affection, a diagnostic schedule for ruling out causes, frequent base oesophageal alterations and high incidence of malignant neoplasm. Prokinetic and neuroleptic agents with antidopaminergic and anticholinergic effects are the pillars of its treatment.



http://ift.tt/2nJHYGw

Hypoparathyroidism following thyroidectomy: Predictive factors

Publication date: March–April 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 2
Author(s): Cristiana Coimbra, Francisco Monteiro, Pedro Oliveira, Leandro Ribeiro, Mário Giesteira de Almeida, Artur Condé
ObjectiveTo evaluate the incidence and predictive factors for transient and permanent hypocalcemia and hypoparathyroidism following thyroidectomy.MethodWe studied all the 162 patients that underwent thyroid surgery in the ENT department of the Centro Hospitalar Vila Nova Gaia/Espinho from January 2005 to December 2014. We reviewed pre-operative, 6h and 12h after surgery ionized calcium and PTH levels. All patients were reviewed and evaluated according to the following criteria: gender, age, thyroid function, histologic diagnosis of the specimen, surgery extension and presence or absence of hypoparathyroidism.ResultsThere were 31 (19.1%) cases of transient hypoparathyroidism and 8 (5%) of permanent hypoparathyroidism. No significant difference was found for transient hypoparathyroidism when patients were analyzed by gender. However, all cases of permanent hypoparathyroidism were observed in female individuals.Comparing hemithyroidectomy with all other surgical procedures, we found that extension of surgery was a great predictor of transient (p=0.0001) and permanent (p=0.001) hypoparathyroidism.Diagnosis of malignancy was a strong predictor of transient hypoparathyroidism (p=0.002). It was also associated with permanent hypoparathyroidism, although differences did not reach statistical significance (p=0.096).ConclusionExtension of surgery (total thyroidectomy) and diagnosis of malignancy are predictors of transient and permanent hypoparathyroidism.



http://ift.tt/2nRYYHt

A New Malleostapedotomy Prosthesis. Experimental Analysis by Laser Doppler Vibrometer in Fresh Cadaver Temporal Bones

Publication date: March–April 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 2
Author(s): Luis A. Vallejo, María T. Manzano, Antonio Hidalgo, Alberto Hernández, Juan Sabas, Hugo Lara, Elisa Gil-Carcedo, David Herrero
Introduction and objectivesOne of the problems with total ossicular replacement prostheses is their stability. Prosthesis dislocations and extrusions are common in middle ear surgery. This is due to variations in endo-tympanic pressure as well as design defects. The design of this new prosthesis reduces this problem by being joined directly to the malleus handle.The aim of this study is to confirm adequate acoustic-mechanical behaviour in fresh cadaver middle ear of a new total ossicular replacement prosthesis, designed using the finite elements method.MethodsUsing the doppler vibrometer laser, we analysed the acoustic-mechanical behaviour of a new total ossicular replacement prosthesis in the human middle ear using 10 temporal bones from fresh cadavers.ResultsThe transfer function of the ears in which we implanted the new prosthesis was superimposed over the non-manipulated ear. This suggests optimum acoustic-mechanical behaviour.ConclusionsThe titanium prosthesis analysed in this study demonstrated optimum acoustic-mechanical behaviour. Together with its ease of implantation and post-surgical stability, these factors make it a prosthesis to be kept in mind in ossicular reconstruction.



http://ift.tt/2nJQVQ6

Effect of the Stringency of Conditions on Caloric Test Results in Healthy Subjects

Publication date: March–April 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 2
Author(s): Claudio Krstulovic, Bharti Tulsidas Mahtani, Nabil Atrache Al Attrache, Herminio Pérez-Garrigues
The caloric test is widely used to assess vestibular function, but the conditions in which it is performed can vary. Caloric nystagmus obtained in 57 healthy subjects were compared: 24 subjects studied in ideal conditions and 33 subjects in non-ideal conditions. A statistically significant decrease in the slow phase velocity of the 4 irrigations performed on the subjects in non-ideal conditions was observed. This must be considered, especially in subjects with suspected bilateral involvement. Stringent conditions reduce the risk of misdiagnosis with bilateral deficit.



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Cervical Vagus Nerve Neurilemmoma Mimicking Parathyroid Adenoma

Publication date: March–April 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 2
Author(s): Antonio Prat Calero, Pedro Cascales Sánchez, Agustina Martínez Moreno, Julio Valer Corellano




http://ift.tt/2nJzfnJ

Simulation in Otolaryngology: A Teaching and Training Tool

Publication date: March–April 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 2
Author(s): Natalie Thone, Matías Winter, Raimundo J. García-Matte, Claudia González
Simulation in medical education is an effective method of teaching and learning, allowing standardisation of the learning and teaching processes without compromising the patient. Different types of simulation exist within subspecialty areas of Otolaryngology. Models that have been developed include phantom imaging, dummy patients, virtual models and animal models that are used to teach and practice different skills. Each model has advantages and disadvantages, where virtual reality is an emerging model with a promising future. However, there is still a need for further development of simulation in the area of Otolaryngology.



http://ift.tt/2nSaVx0

Nasopharyngeal Oncocytoma as a Cause of Eustachian Tube Dysfunction

Publication date: March–April 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 2
Author(s): Shirley J. Pérez Pérez, Carlos Almódovar Álvarez, José Diego Contreras Sánchez, Alberto Iñiguez de Onzoño




http://ift.tt/2nRYssZ

Nasal septal schwannoma: An extremely rare tumor

Publication date: March–April 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 2
Author(s): Konstantinos Valsamidis, Iokasti Koutsampasopoulou, Konstantinos Titelis




http://ift.tt/2nJHVdO

Unilateral Deafness Associated With a Glossopharyngeal Neurinoma

Publication date: March–April 2017
Source:Acta Otorrinolaringologica (English Edition), Volume 68, Issue 2
Author(s): Frank Alberto Betances Reinoso, Rios Adela Pérez-Carro, Carlos Miguel Chiesa Estomba




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Pulmonary Kaposi sarcoma presenting as complete lung consolidation

The patient in our case presented with progressive dyspnoea and cough. Chest radiograph reveals complete opacification of the hemithorax. Complete lung consolidation was not seen on chest CT. The patient in this case had extensive pulmonary and endobronchial Kaposi sarcoma (KS) that led to complete consolidation of the right lung that was diagnosed via bronchoscopy. After diagnosis, he was restarted on antiretroviral therapy and single-agent chemotherapy for treatment of pulmonary KS.

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Aspergillus niger infection in an immunosuppressed patient confined solely to the brain

A 68-year-old woman with a background of hypertension, stroke and rheumatoid arthritis presented to her local hospital after a 4-week history of gradual deterioration and increasing confusion with new onset right-sided weakness. Her initial CT scan revealed a rim enhancing mass lesion with surrounding oedema in the left parietal lobe for which she underwent CT stealth-guided biopsy. Microbiology culture of the 2 biopsy samples yielded Aspergillus niger and she was started on the antifungal agent voriconazole. MRI 2 weeks after the procedure also demonstrated radiological findings consistent with intracranial aspergillosis. She later developed leucopenia with neutrophils of 1.5x10⁹/L and her methotrexate and voriconazole were stopped. Voriconazole was changed to oral posaconazole. She did not undergo surgical resection and has continued to improve clinically on posaconazole, with recovery in her white cell count.

http://ift.tt/2nJHT5J

Strongyloides hyperinfection syndrome in an immunocompetent host resulting in bandemia and death

Strongyloides stercoralis infection is usually asymptomatic but can result in a hyperinfection syndrome, most commonly triggered by acquired or iatrogenic immunosuppression. Here, we present a case of a man aged 60 years originally from a strongyloides endemic area with a medical history of alcohol abuse who presents with strongyloides hyperinfection syndrome (SHS) complicated by partial small bowel obstruction, pulmonary haemorrhage, large bandemia without eosinophilia and cardiac arrest resulting in death. This case is notable for the presence of bandemia and absence of eosinophilia, lack of historical risk factors for hyperinfection, specifically corticosteroid immunosuppressants, and dramatic decline in clinical status which ultimately resulted in the patient's death. Clinicians should suspect SHS in immunocompetent patients who are from an endemic area and who have persistent gastrointestinal and/or pulmonary manifestations in the absence of a clear cause.

http://ift.tt/2nRXJYI

Tetraploidy acute myeloid leukaemia after chromosome 16 inversion

Our patient is a 36-year-old man referred by his general physician to the Department of Hematology because of mild neutropenia in a routine analysis at work. There was no history of previous diseases, and examination was normal. Blood investigations confirmed the neutropenia and showed elongation of prothrombin time. A bone marrow examination was performed revealing about 10% of myeloblasts on the aspirate smears. A cytogenetic study showed chromosome 16 inversion in all of these cells and tetraploidy only in some of them, which were extremely large in size. According to the revised WHO classification of tumours (2008), the patient was diagnosed as a case of acute myeloid leukaemia with chromosome 16 inversion.

http://ift.tt/2nJKixg

Extraperitoneal abscess originating from an ischorectal abscess

We describe a case which had ongoing sepsis, despite adequate incision and drainage performed for an ischorectal abscess. The patient was then noted to have an ascending infection reaching the extraperitoneal space of the abdominal cavity. The case reported required multiple episodes of drainage along with lower midline incision for deep-situated abscess. Postoperatively, the abdominal wound was treated with vacuum-assisted closure dressing and antibiotics. The patient was doing well and was discharged with an appointment at the surgical outpatient department. The report signifies the importance of investigating patients who have systemic inflammatory response syndrome despite treating local abscess.

http://ift.tt/2nRXltd

Effect of non-pharmacological intervention for apathy: response to one-on-one reminiscence-based intervention

Apathy has adverse consequences for patients and caregivers. However, the therapeutic approach remains uncertain. Here, we present the case of a man aged 67 years who only developed apathy after surgery for oesophageal cancer. He showed no response to intervention with donepezil, a 'brain training' video game and psychoeducation for apathy. Subsequently, we implemented a programme designed to facilitate recall of 2 themes (editorial content and television shows during the week) once a week. After 3 months, the scores of 2 apathy scales rated by the patient's wife, psychological test scores and brain perfusion single-photon emission CT data improved compared with those obtained before intervention. These results may be attributable to activated 2-way communication as well as benefits of reminiscence therapy, as seen in patients with dementia. Further studies are needed to develop additional non-pharmacological interventions that activate 2-way communication for apathetic patients in ways appropriate to their interests and comorbidities.

http://ift.tt/2nJHmkc

Isolated lower limb hypoplasia secondary to congenital varicella syndrome: a rare occurrence and management of its complications

Isolated lower limb hypoplasia is a rare consequence of maternal congenital varicella syndrome (CVS). The hypoplastic limb is susceptible to multiple injuries, including fractures, especially if there is associated muscle weakness and lack of sensation. We describe a unique index case of a woman aged 26 years with a background of CVS who presented with a distal femur fracture following a fall onto her insensate, hypoplastic right leg. This report highlights the complexities involved in the diagnosis and management of fractures in patients with an anaesthetic limb, and in particular describes limb amputation as a successful treatment modality for distal femur fractures.

http://ift.tt/2nS6diS

Multiple foreign body aspiration

Description

A baby girl aged 3 years 8 months presented 8 months earlier with a history of cough and tight chest for 3 days prior to admission. On chest examination, the child had bilateral wheezing, was mildly distressed and had reduced air entry on the right side over the middle and lower zone. Chest X-ray demonstrated a round object in the oesophagus, but also collapse of the right middle and lower lobes (figure 1A). A metal washer was removed from the oesophagus at the cricopharyngeal level with a rigid scope. The child was then admitted postoperatively to paediatric intensive care unit for aspiration pneumonia. Considerable oesophageal mucosal inflammation was present at the site of the foreign body with no associated perforation. Contrast study performed at that stage demonstrated some narrowing of the oesophagus which did not need dilatation (figure 1B). Eight months later, she presented with...

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Aberrant non-neoplastic liver tissue presenting as an intra-atrial mass

Description

A Caucasian woman aged 66 years underwent transthoracic echocardiography prior to initiation of clozapine treatment for schizophrenia. Echocardiography demonstrated a mobile 25x20x15 mm mass arising from the posterior right atrial wall adjacent to the Eustachian valve. There was no obstruction of the inferior vena cava (IVC), coronary sinus or tricuspid valve. Routine haematology and biochemistry, including liver function and cardiac enzymes, were within normal limits. Physical examination and ECG were unremarkable. Sine sequence cardiac MRI confirmed a low signal mobile right atrial mass (diameter 21x22 mm), appearances and tissue characterisation of which were suggestive of a benign atrial myxoma (figure 1A). The MRI suggested the mobile mass was attached to the Eustachian valve by a thin stalk. Intraoperative transoesophageal echocardiography revealed a non-calcified homogenous broad-based mass adjacent to the IVC–right atrium junction (figure 2A). Right atriotomy confirmed the lesion originated from the middle hepatic vein/IVC junction....

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Malignant hypercalcaemia related to parathyroid hormone-related peptide (PTHrP) secretion from a metastatic pancreatic neuroendocrine tumour (NET)

A 54-year-old woman presented to our centre with acute abdominal pain and vomiting. Routine blood tests showed severe hypercalcaemia (>4 mmol/L). Serum parathyroid hormone (PTH) was suppressed. CT scan detected a pancreatic mass and some liver lesions, initially suspicious for metastatic pancreatic adenocarcinoma. Liver biopsy however revealed the presence of a well-differentiated, grade 1, metastatic neuroendocrine tumour (NET) where prognosis is considerably better. Serum PTHrP was raised, indicating paraneoplastic hypercalcaemia, most likely secondary to the pancreatic NET. Following injection of a short-acting somatostatin analogue octreotide, serum PTHrP levels normalised within 24 hours, causing a rapid drop of serum calcium below the lower limit of normal and an immediate compensatory rise of serum PTH. Ongoing treatment with long-acting somatostatin analogues together with replacement with calcium carbonate, vitamin D3 and once weekly alendronic acid resulted in stable normal adjusted calcium levels over a 3-month follow-up period.

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Bilateral near total blindness due to miliary neurocysticercosis

Description

A man aged 18 years presented to our neuro-ophthalmology clinic with symptoms of headache, and painless and gradual onset bilateral visual loss since 2 months. While systemic examination was normal, visual acuity was noted to be perception of light in both eyes. Both pupils reacted sluggishly to light. Both eyes were found to be normal on examination apart from minimal temporal optic disc pallor. Urgent MRI of the head and orbits was ordered, which revealed numerous foci of neurocysticercosis (NCC) scattered throughout the brain parenchyma, giving it a 'starry sky appearance' (figure 1A). The occipital lobe was also found to be studded with such lesions along with surrounding oedema. A prominent cyst, along with scolex, was found to be lodged near the chiasma, compressing it and the emanating optic nerves (figure 1B, C).

Figure 1

Neuroimaging of miliary neurocysticercosis. (A) T2W axial image showing...

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Primary vertebral leiomyosarcoma masquerading as a nerve sheath tumour

A 47-year-old woman presented with symptoms of low back pain and weakness in bilateral lower limbs. MRI of the spine revealed a mass arising from T11 vertebra involving neural foramina at bilateral T11–12 and right T10–11 levels with extension to the right paravertebral region. Suspecting a nerve sheath tumour, she underwent posterior spinal decompression, stabilisation and debulking, following which her neurological symptoms resolved. Histopathological and immunohistochemical evaluation revealed a leiomyosarcoma. A month later she developed sudden paraparesis and MRI revealed an increase in size of the tumour with cord compression and displacement. She underwent a repeat spinal decompression and debulking procedure after which she received adjuvant radiotherapy via volumetric modulated arc therapy, to a total dose of 45 Gy in 25 fractions over 5 weeks. MRI performed 2 months later revealed complete response and she is disease free for the past 5 months.

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BTK-inhibition is a potent approach to block IgE-mediated histamine release in human basophils

Abstract

Background

Recent data suggest that Bruton′s tyrosine kinase (BTK) is an emerging therapeutic target in IgE receptor (IgER) cross-linked basophils.

Methods

We examined the effects of four BTK inhibitors (ibrutinib, dasatinib, AVL-292, CNX-774) on IgE-dependent activation and histamine release in blood basophils obtained from allergic patients (n=11) and non-allergic donors (n=5). In addition, we examined the effects of these drugs on the growth of the human basophil cell line KU812 and the human mast cell line HMC-1.

Results

All four BTK blockers were found to inhibit anti-IgE-induced histamine release from basophils in non-allergic subjects and allergen-induced histamine liberation from basophils in allergic donors. Drug effects on allergen-induced histamine release were dose-dependent, with IC₅₀ values ranging between 0.001 and 0.5 μM, and the following rank-order of potency: ibrutinib>AVL-292> dasatinib>CNX-774. The basophil-targeting effect of ibrutinib was confirmed by demonstrating that IgE-dependent histamine release in ex vivo blood basophils is largely suppressed in a leukemia patient treated with ibrutinib. Dasatinib and ibrutinib were also found to counteract anti-IgE-induced and allergen-induced upregulation of CD13, CD63, CD164, and CD203c on basophils, whereas AVL-292 and CNX-774 showed no significant effects. Whereas dasatinib and CNX-774 were found to inhibit the growth of HMC-1 cells and KU812 cells, no substantial effects were seen with ibrutinib or AVL-292.

Conclusions

BTK-targeting drugs are potent inhibitors of IgE-dependent histamine release in human basophils. The clinical value of BTK inhibition in the context of allergic diseases remains to be determined.

This article is protected by copyright. All rights reserved.

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Asthma management: A new phenotype-based approach using presence of eosinophilia and allergy

Abstract

Asthma is a heterogeneous disease. The Czech Pneumology and Allergology Societies commissioned 10 experts to review the literature and create joint national guidelines for managing asthma, reflecting this heterogeneity. The aim was to develop an easy-to-use diagnostic strategy as a rational approach to the widening opportunities for the use of phenotype-targeted therapy. The guidelines were presented on websites for public comments by members of both the societies. The reviewers' comments contributed to creating the final version of the guidelines. The key hallmark of the diagnostic approach is the pragmatic concept, which assesses the presence of allergy and eosinophilia in each asthmatic patient. The guidelines define three clinically relevant asthma phenotypes: eosinophilic allergic asthma, eosinophilic non-allergic asthma and non-eosinophilic non-allergic asthma. The resulting multifunctional classification describing the severity, level of control and phenotype is the starting point for a comprehensive treatment strategy. The level of control is constantly confronted with the intensity of the common stepwise pharmacotherapy, and the concurrently included phenotyping is essential for phenotype-specific therapy. The concept of the asthma approach with assessing the presence of eosinophilia and allergy provides a way for more precise diagnosis, which is a prerequisite for using widening options of personalised therapy.

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Characterization of maize chitinase-A, a tough allergenic molecule

Abstract

Background

Food allergies are recognized as an increasing health concern. They are caused by specific proteins called food allergens. Proteins commonly identified as food allergens tend to have one of about 30 different biochemical activities. This leads to the assumption that food allergens must have specific structural features which causes their allergenicity. But these structural features are not completely understood. Uncovering the structural basis of allergenicity would allow improved diagnosis and therapy of allergies and would provide insights for safer food production. The availability of recombinant food allergens can accelerate their structural analysis, and benefit specific studies in allergology. Plant chitinases are an example of food allergenic proteins for which structural analysis of allergenicity has only partially been reported.

Methods

The recombinant maize chitinase, rChiA, was purified from Pichia pastoris extracellular medium by differential precipitation and cation exchange chromatography. Enzyme activity was evaluated by halo-assays and microcalorimetric procedures. rChiA modeling was performed by a two-step procedure, using the Swissmodel server and Modeller software. Allergenicity of rChiA was verified by immunoblot assays with sera from allergic subjects.

Results

rChiA is active in the hydrolysis of glycol chitin and N-acetylchitotetraose, and maintains its activity at high temperatures (70 °C) and low pH (pH 3). The molecule is also reactive with IgE from sera of maize allergic subjects.

Conclusions

rChiA is a valuable molecule for further studies on structure-allergenicity relationships and as a tool for diagnosing allergies.

This article is protected by copyright. All rights reserved.

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Taphonomy and Paleoichnology of Olduvai Hominid 1 (OH1), Tanzania.

Abstract

This paper presents a case study of the Late Pleistocene skeletal remains of Olduvai Hominid 1 (OH1), which were unearthed in Tanzania. Excavated in 1913, this fossil shows severe damage due to subterranean termites (Insecta: Isoptera). By combining methods to quantify and locate traces on the skeleton with the study of the different taphonomic processes that altered the deposit, we demonstrate a non-arbitrary pattern of termite alteration of the skeletal remains. These results shed new light on the possibility to reconstruct the original position of a skeleton in a deposit and the potential to infer the space of decomposition and past funerary practices.

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Bone formation of demineralized human dentin block graft with different demineralization time: in vitro and in vivo study

Publication date: Available online 21 March 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): So-min Park, David-Hyungjin Kim, Eun-Kyoung Pang
ObjectiveTo evaluate structural and physicochemical characteristics of demineralized human dentin block with increasing demineralization time and to assess new bone formation when onlay grafted at different demineralization times in rat calvaria.Study designExtracted human permanent teeth were pretreated and demineralized for 10–90 minutes. Scanning electron microscopy, X-ray diffraction analysis, inductively coupled plasma spectrometry, and energy dispersive X-ray analysis were performed. Demineralized dentin blocks (DDBs) with the representatives of the different demineralization times (10 and 60 minutes) were implanted in vivo onto rat calvaria (male Sprague–Dawley, n = 20 for each carrier). For controls, collagen sponge and human freeze-dried corticocancellous bone blocks (FDBB) were implanted onto calvaria (n = 20). The rats were sacrificed 2 or 8 weeks postoperatively and evaluated radiographically, histologically, and histomorphometrically.ResultsWith increasing demineralization time, the surface structure of dentin blocks showed increased number and size of dentinal tubules. Moreover, the organic components increased, whereas inorganic components decreased. Crystallinity decreased sharply between 10 and 30 minutes' demineralization time. In our in vivo study, at both time points, animals with DDBs showed significantly better bone formation than controls (p < 0.05). The DDB/60 group showed significantly increased new bone area and bone density than the DDB/10 group at 8 weeks (p < 0.05), but showed higher resorption that significantly decreased total augmented area compared with the DDB/10 group (p < 0.05).ConclusionDDB increased new bone formation and bone density. Further studies are needed to determine the optimal demineralization time to maximize space maintenance and bone formation of the graft material.



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Maxillofacial growth and speech outcome after one-stage or two-stage palatoplasty in unilateral cleft lip and palate. A systematic review

Publication date: Available online 22 March 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Rajgopal R. Reddy, Srinivas Gosla Reddy, Anitha Vaidhyanathan, Stefaan J. Bergé, Anne Marie Kuijpers-Jagtman
BackgroundThe number of surgical procedures to repair a cleft palate may play a role in the outcome for maxillofacial growth and speech. The aim of this systematic review was to investigate the relationship between the number of surgical procedures performed to repair the cleft palate and maxillofacial growth, speech and fistula formation in non-syndromic patients with unilateral cleft lip and palate.Material and methodsAn electronic search was performed in PubMed/old MEDLINE, the Cochrane Library, EMBASE, Scopus and CINAHL databases for publications between 1960 and December 2015. Publications before 1950 — journals of plastic and maxillofacial surgery — were hand searched. Additional hand searches were performed on studies mentioned in the reference lists of relevant articles. Search terms included unilateral, cleft lip and/or palate and palatoplasty. Two reviewers assessed eligibility for inclusion, extracted data, applied quality indicators and graded level of evidence.ResultsTwenty-six studies met the inclusion criteria. All were retrospective and non-randomized comparisons of one- and two-stage palatoplasty. The methodological quality of most of the studies was graded moderate to low. The outcomes concerned the comparison of one- and two-stage palatoplasty with respect to growth of the mandible, maxilla and cranial base, and speech and fistula formation.ConclusionsDue to the lack of high-quality studies there is no conclusive evidence of a relationship between one- or two-stage palatoplasty and facial growth, speech and fistula formation in patients with unilateral cleft lip and palate.



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Biometric differentiation of Wild Philippine Pigs from Introduced Sus scrofa in Modern and Archaeological Assemblages

Abstract

In many parts of Eurasia, the Middle East and Southeast Asia where native wild suids occur it is notoriously difficult to differentiate these from introduced domestic pigs in the prehistoric archaeological record. Yet, correct identification of the initial appearance or introduction of domestic pigs (Sus scrofa) is essential for determining the timing for the transition from purely hunting to the adoption of managed animal populations within different regions across the globe. In a recent review of techniques used by zooarchaeologists to distinguish between domestic and wild pig populations the analysts concluded that the most reliable method was metrical analyses, when the data produces a clear two-population pattern, one domestic, the other wild. In this study we demonstrate how linear metrics are an effective tool, albeit at different levels of confidence, for differentiating the native and endemic species of Philippine pig from Sus scrofa, both within modern contemporary assemblages, and the archaeological record.

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Subadult Age-at-Death and Health Status at Niah Cave, Borneo (1500-200 BC)

Abstract

Southeast Asia's transition to rice agriculture is often used as an exception to the general pattern of health decline at the agricultural transition. Niah Cave is the largest known Southeast Asian Neolithic cemetery, providing valuable information about subadult health during the agricultural transition in this region. This study examines the health status and mortuary treatment of subadult skeletal remains (MNI = 49) from the Neolithic cemetery of Niah Cave, Sarawak, Malaysia (1500 – 200 B.C.). This study found few cases of cribra orbitalia (4.6%) and porotic hyperostosis (14%). However, nonspecific infections may have been a risk factor for subadults as over half (65%) died with active cases of periosteal reactions on their long bones. Differential diagnosis determined that possible factors for this include parasite load, rickets, and scurvy. Mortuary practices indicate that subadults may have been treated differently in Phases 1 and 2, but were grated similar mortuary treatment in Phases 3 and 4. This study suggests that changes in mobility patterns may have placed subadults at risk for increased parasite load and vitamin deficiency, while the role of subadults within the community may have changed over time.

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Protuberant fibro-osseous lesion of the skull: two cases with occipital lesions

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Exercise and cancer: from “healthy” to “therapeutic”?

Abstract

Exercise improves functional capacity and patient-reported outcomes across a range of cancer diagnoses. The mechanisms behind this protection have been largely unknown, but exercise-mediated changes in body composition, sex hormone levels, systemic inflammation, and immune cell function have been suggested to play a role. We recently demonstrated that voluntary exercise leads to an influx of immune cells in tumors, and a more than 60% reduction in tumor incidence and growth across several mouse models. Given the common mechanisms of immune cell mobilization in mouse and man during exercise, we hypothesize that this link between exercise and the immune system can be exploited in cancer therapy in particular in combination with immunotherapy. Thus, we believe that exercise may not just be "healthy" but may in fact be therapeutic.

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Atypical case of Merkel cell carcinoma difficult to diagnose clinically

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Index

Note: Page numbers of article titles are in boldface type.

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Forthcoming Issues

Facial Reconstruction Post-Mohs Surgery

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The Saddle Deformity

This article presents a comprehensive review of past and present modalities in the surgical management of saddle nose deformities. Various surgical techniques, including allograft materials, are systematically reviewed. The senior author's surgical experience and current management approach are highlighted.

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Cleft Septorhinoplasty

Nasal deformity associated with typical cleft lip can cause aesthetic and functional issues that are difficult to address. The degree of secondary nasal deformity is based on the extent of the original cleft deformity, growth over time, and any prior surgical correction to the nose or lip. Repair and reconstruction of these deformities require comprehensive understanding of embryologic growth, the cleft anatomy, as well as meticulous surgical technique and using a spectrum of structural grafting. This article reviews cleft lip nasal deformity, presurgical care, primary cleft rhinoplasty, and definitive cleft septorhinoplasty with a focus on aesthetics and function.

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Essential Anatomy and Evaluation for Functional Rhinoplasty

The nose, a prominent facial feature in defining facial beauty, is responsible for the fundamental physiologic functions of heating, humidifying, and filtering inspired air. When the normal balance of laminar and turbulent airflow become disturbed due to anatomic abnormalities, nasal obstruction may result. To successfully restore these basic physiologic functions, the surgeon must have a detailed understanding of the nasal anatomy and be able to successfully identify the specific cause of the nasal obstruction. This article discusses the fundamental surgical anatomy and the various diagnostic techniques and instruments at the surgeon's disposal.

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Functional Rhinoplasty

FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA

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Copyright

ELSEVIER

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Crafting a Functional Nose

This issue on functional rhinoplasty provides key insights into the complex world of reconstructive rhinoplasty. We have assembled an all-star panel of authors who have shared their key insights for successful surgery. The full spectrum of clinical situations is investigated in detail. Topics from advanced septoplasty to cleft care are well described. We also offer cutting-edge insights into the latest techniques and technologies for evaluating functional nasal surgery. We hope that you enjoy this critical update on functional nasal surgery and incorporate the insights into your own clinical practice.

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Contents

Benjamin C. Marcus

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Contributors

J. REGAN THOMAS, MD, FACS

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Diagnosis of pseudoxanthoma elasticum in a 4-year-old boy

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Evaluation of the correlation between severity of acquired idiopathic generalized anhidrosis and quality of life scores

Abstract

Symptoms of acquired idiopathic generalized anhidrosis (AIGA) include heat retention and/or heat stroke due to the effects of the disorder on the perspiration ability of the whole body under thermal environmental changes or exercise. Additionally, cholinergic urticaria can also occur in these patients. AIGA has a major impact on everyday life. However, the effects of AIGA severity on the quality of life (QOL) of the patients have not been sufficiently defined. The objective of this study was to evaluate the correlation between AIGA severity and QOL. Study subjects comprised 44 patients diagnosed with AIGA at three registered institutions. AIGA severity assessment was conducted and the Dermatology Life Quality Index (DLQI) questionnaire was administered. Correlations between AIGA severity and DLQI, as well as severity by DLQI subscale, were assessed. We found a positive correlation between total score of AIGA severity criteria and DLQI total scores (R = 0.720, P = 0.001). The impairment increased with the increase in AIGA severity (P < 0.01). In relation to the DLQI subscales, leisure (social and sporting activities) impairment was significantly higher for patients with severe AIGA than those with mild AIGA (P < 0.01). Comparing QOL for AIGA patients with that of patients with other dermatological disorders, it is possible that QOL impairment for AIGA patients is as severe as that for patients with atopic dermatitis. AIGA severity and DLQI are correlated and AIGA patients experience disruption of everyday life more broadly than conventionally perceived.

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High prevalence of sensitization to gibberellin-regulated protein (peamaclein) in fruit allergies with negative immunoglobulin E reactivity to Bet v 1 homologs and profilin: Clinical pattern, causative fruits and cofactor effect of gibberellin-regulated protein allergy

Abstract

Gibberellin-regulated protein (GRP) is a new allergen in peach allergy, with an amino acid sequence very well conserved through several botanical species. We investigated the allergenicity of GRP in fruit allergies other than peaches and identified the clinical characteristics of fruit allergy patients with GRP sensitization. One hundred consecutive Japanese patients with fruit allergies were enrolled in the present study. To identify the features of GRP sensitization, we selected patients with negative ImmunoCAP results for Bet v 1 homologs and profilin, which are marker allergens for pollen-food allergy syndrome (PFAS), or lipid transfer protein. These patients underwent specific immunoglobulin E measurements by enzyme-linked immunosorbent assay (ELISA) and skin prick tests (SPT) using purified nPru p 7. Twenty of 100 consecutive patients with fruit allergies had negative ImmunoCAP results for Bet v 1 homologs and profilin. Thirteen (65.0%) of the 20 patients had positive ELISA and/or SPT results using nPru p 7, whereas one of the 20 patients had positive ImmunoCAP results for Pru p 3. In 13 nPru p 7-sensitized patients, the causative foods were peaches (92.3%), apricots (61.5%), oranges (46.2%) and apples (30.8%). Ten patients (76.9%) had multiple causative fruits. Frequent symptoms included facial edema (92.3%) and laryngeal tightness (66.7%). In eight patients (61.5%), exercise or aspirin intake enhanced the allergic reaction onset as cofactors. The prevalence of GRP sensitization was high in Japanese fruit allergy patients except for PFAS patients. In conclusion, GRP-sensitized patients may have allergies to multiple fruits and may show peculiar characteristics such as facial swelling and cofactor dependence.

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A first case of tick bite by Amblyomma coelebs in Japan

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Implantation and Positioning of a Transcutaneous Magnetic Bone Conduction Hearing System for children with microtia in preparation for auricular reconstruction

Abstract

Microtia is a complex congential issue, which can have a functional and psychosocial effect on patients¹. It can occur spontaneously or as part of a syndrome. Microtia is a condition in which otolaryngologists and plastic surgeons work closely together in order to reconstruct the ear aesthetically whilst facilitating effective aiding.

This article is protected by copyright. All rights reserved.

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Limited endoscopic high septoplasty prior to endonasal dacryocystorhinostomy: our experience of nine cases

Abstract

Primary acquired nasolacrimal duct obstruction is a clinical syndrome of unknown cause, manifested by epiphora, infection, blurred vision, and ocular and facial pain. Conservative care is usually ineffective in patients with chronic conditions; thus, dacryocystorhinostomy (DCR) has become the gold standard of treatment for such patients. Since the advent of endoscopic technologies, most patients have undergone endonasal (EN-)DCR; the success rate is comparable to that of external (EX-)DCR.

This article is protected by copyright. All rights reserved.

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Skin cancer diagnosed by using artificial intelligence on clinical images

In a recent Research Letter in Nature an automated classification of a few selected skin lesions has been published, using a deep convolutional neural network (CNN) (Esteva et al, 2017). Convolutional neural network is an important innovation in the field of computer vision. A popular use is for image processing, e.g. applied in face recognition. In the reported study CNN has been applied to a dataset of almost 130,000 clinical images, including some 3,000 dermoscopic images.

This article is protected by copyright. All rights reserved.

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Effect of Tempol on the prevention of irradiation-induced mucositisin miniature pigs

Abstract

Objective

The goals of this study were to (i) establish a useful miniature pig (minipig) model for irradiation-induced oral mucositis and (ii) evaluate the effect of Tempol to prevent its development.

Methods and Materials

Minipigs were irradiated with 6Gy for 5 consecutive days targeting the entire oral cavity. To prevent radiation damage minipigs were treated with 30 mg/kg Tempol 10 minutes before irradiation (n=4), while, the radiation-alone group was similarly injected with saline (n=4). Lesions were graded using an oral mucositis score and visual inspection every three days, and biopsy of multiple sites was performed at day 18. Weight, chest and abdomen circumference were measured every three days.

Results

Lesions began about 12 days post first irradiation fraction and healed about 30 days after irradiation. Epithelial thickness was calculated on the lingual and buccal mucosa on the 18^th day post first irradiation fraction. Tempol provided modest protection from ulceration after irradiation using this treatment strategy.

Conclusions

This study established a useful large animal model for irradiation-induced oral mucositis, and showed modest beneficial effects of Tempol in limiting tissue damage. The latter finding may be potentially valuable in preventing oral mucositis in patients receiving irradiation for head and neck cancers.

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The corpus-predominant gastritis index can be an early and reversible marker to identify the gastric cancer risk of Helicobacter pylori-infected nonulcer dyspepsia

Abstract

Background

Corpus-predominant gastritis index (CGI) is an early histological marker to identify Helicobacter pylori-infected gastric cancer relatives at risk of cancer. This study validated whether CGI is more prevalent in H. pylori-infected nonulcer dyspepsia (NUD) subjects than in duodenal ulcer (DU) controls and whether it is reversible after H. pylori eradication or is correlated with noninvasive biomarkers.

Materials and Methods

In this longitudinal cohort study, 573 H. pylori-infected subjects were enrolled, including 349 NUD and 224 DU. Gastric specimens were provided to assess CGI, spasmolyic polypeptide-expressing metaplasia (SPEM), and Operative Link on Gastric Intestinal Metaplasia assessment (OLGIM). Serum pepsinogen I and II levels were assessed using enzyme-linked immunosorbent assay. CGI subjected were followed up at least 1 year after H. pylori eradication.

Results

NUD subjects had higher prevalence rates of CGI (47.0% vs 29.9%, P<.001) and OLGIM stages III-IV (24.1% vs 15.2%, P=.01) than controls. CGI was highly prevalent in NUD subjects after the age of 40, which was 10 years earlier than atrophic gastritis and intestinal metaplasia. NUD subjects with CGI had higher risk of SPEM (OR 2.86, P<.001) and lower serum pepsinogen I/II ratios (P<.001) than those without CGI. Serum pepsinogen I/II ratios <9 could predict CGI modestly (AUROC 0.69, 95% CI: 0.63-0.74). CGI was regressed after eradication (P<.001).

Conclusions

CGI was more prevalent in H. pylori-infected NUD subjects than in controls, was correlated with SPEM, and may serve as a marker earlier than OLGIM to indicate risk of gastric cancer. Moreover, CGI could be regressed after eradication.

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