A retrospective review of the dermatologic manifestations of chronic arsenic poisoning in the Philippines

Abstract

Background

The Section of Dermatology of the University of the Philippines, Philippine General Hospital, reported a case of chronic arsenic poisoning from a community in Luzon island to the Department of Health resulting in the conduct of two health and environmental assessment missions in December 2014.

Objective

To describe the demographic profile and cutaneous manifestations of chronic arsenic poisoning among affected residents in Luzon, Philippines.

Methods

A review of the medical records of 116 residents screened during the health assessment missions in December 2014 was conducted.

Results

Among the 116 residents screened, 81 (70%) had clinically confirmed arsenic keratoses and hyperpigmentation. Among them, 52 were males and 29 were females with age range of 4–82 years. Two cases of squamous cell carcinoma in situ were detected through skin biopsy. High levels of arsenic in the tap water and topsoil supported the occurrence of an epidemic of chronic arsenic poisoning.

Conclusion

Specific dermatologic findings of arsenic keratoses and pigmentation were common among the residents screened. Significantly higher occurrence of arsenic keratoses was seen in adults.

http://ift.tt/2otd41G

Characteristics of tree nut challenges in tree nut allergic and tree nut sensitized individuals

Publication date: Available online 27 March 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Christopher Couch, Tim Franxman, Matthew Greenhawt
BackgroundCharacteristics and outcomes of tree nut (TN) oral food challenges (OFCs) in patients with TN allergy or sensitization alone are poorly studied.ObjectiveTo determine the relation between TN sensitization levels and OFC outcomes.MethodsOpen TN OFCs performed from 2007 through 2015 at a referral center were analyzed to compare outcome based on skin prick test (SPT) wheal size, food-specific immunoglobulin E (sIgE), peanut co-allergy, and TN sensitization only vs TN allergy with sensitization to other TNs. Delayed OFC was defined as longer than 12 months from the time of an sIgE level lower than 2 kUA/L.ResultsOverall passage rate was 86% for 156 TN OFCs in 109 patients (54 almond, 28 cashew, 27 walnut, 18 hazelnut, 14 pecan, 13 pistachio, and 2 Brazil nut). Passage rates were 76% (n = 67) in patients with a history of TN allergy who were challenged to another TN to which they were sensitized and 91% (n = 65) in those with TN sensitization only (mean sIgE 1.53 kUA/L; range 0.35–9.14). Passage rates were 89% (n = 110 of 124) for a TN sIgE level lower than 2 kUA/L and 69% (11 of 16) for a TN sIgE level of at least 2 kUA/L. In 44 challenges in patients with peanut allergy and TN co-sensitization, the TN OFC passage rate was 96%. In 41 TN OFCs with a TN SPT wheal size of at least 3 mm, 61% passed, with a mean wheal size of 4.8 mm (range 3–11) in those passing vs 9 mm (range 3–20) in those failing.ConclusionTN challenges are frequently passed in patients with TN sensitization with or without a history of TN reactivity despite a TN SPT wheal of at least 3 mm or a TN sIgE level of at least 2 kUA/L. Nearly all patients with peanut allergy and TN co-sensitization passed the TN challenge, questioning the clinical relevance of "co-allergy."



http://ift.tt/2obG4LX

Two synchronous malignant tumors of the pancreas: a case report

Only a limited number of multiple synchronous primary malignancies of the pancreas have been reported in the medical literature. We report a case of two solid malignant tumors of the pancreas diagnosed preoper...

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Editorial Board/Reviewing Committee

http://ift.tt/2osUDKb

Critical role of environmental factors in the pathogenesis of psoriasis

Abstract

Psoriasis is a common cutaneous disease with multifactorial etiology including genetic and non-genetic factors, such as drugs, smoking, drinking, diet, infection and mental stress. Now, the role of the interaction between environmental factors and genetics are considered to be a main factor in the pathogenesis of psoriasis. However, it is a challenge to explore the mechanisms how the environmental factors break the body balance to affect the onset and development of psoriasis. In this article, we review the pathogenesis of psoriasis and summarize numerous clinical data to reveal the association between environmental factors and psoriasis. In addition, we focus on the mechanisms of environmental risk factors impact on psoriasis and provide a series of potential treatments against environmental risk factors.

http://ift.tt/2nuU6Kl

Dermasence refining gel modulates pathogenetic factors of rosacea in vitro

Summary

Background

Over the counter cosmetics sold for local treatment of slight to moderate rosacea often state the claim of actively modulating rosacea pathogenesis. Factors involved in the pathogenesis of this common yet complex skin disorder include kallikrein-related peptidase 5 (KLK5), LL-37, as well as protease-activated receptor 2 (PAR2) and vascular endothelial growth factor (VEGF).

Objective

The objective was to prove the modulating effect of the cosmetic skin care agent Dermasence Refining Gel (DRG) on factors involved in rosacea pathogenesis.

Methods

We analyzed the effect of DRG on the expression of KLK5, LL-37, PAR2, and VEGF in an in vitro skin model of human reconstituted epidermis.

Results

The expression of CAMP (LL-37 gene, fold change −4.19 [±0.11]), VEGFA (fold change −2.55 [±0.12]) and PAR2 (−1.33 [±0.12]) was reduced, KLK5 expression increased (fold change 2.06 (±0.08)) after 18 h of treatment with DRG in comparison to treatment with the matrix gel only. The reduction in CAMP expression was significant (P<.01). The protein expression of all four inflammatory markers was markedly reduced after 18 hours of DRG treatment in comparison to baseline (0 hour), by measure of fluorescence intensity.

Conclusion

We show evidence explaining the anti-inflammatory effect of Dermasence Refining Gel in rosacea pathogenesis in vitro. The adjunctive use of DRG in mild to moderate rosacea as a topical cosmetic seems medically reasonable.

http://ift.tt/2o4LRpC

Review in peeling complications

Summary

Chemical peeling, a procedure wherein a chemical agent is applied to the skin to cause controlled destruction followed by regeneration and remodeling, is a dynamic tool for the treatment of acne, pigmentation issues, and photoaging [Journal of cutaneous and aesthetic surgery vol. 5 (2012) 254–260]. The results and complications are related to the depth of the procedure, with deeper peels producing more marked results and higher rates of complications. Complications are more likely with darker skin types, certain peeling agents, and sun exposure after treatment [Journal of cutaneous and aesthetic surgery vol. 5 (2012) 254–260]. They can range from minor irritations and uneven pigmentation to permanent scarring. In extremely uncommon cases, the complications can be life-threatening. This knowledge is essential to prevent, reduce, and eliminate the occurrence of complications [Cirurgia dermatológica em consultório. São Paulo: Atheneu; 2009]. Swelling, pain, persistent erythema, pruritus, allergic reactions, folliculitis/acne, infection, herpes recurrence, hypopigmentation and hyperpigmentation, demarcation lines, and scarring are some of the complications that will be discussed in this article. The first step in preventing complications is to identify the patients at risk. By doing so, complications can be anticipated, prevented, and, if they still occur, treated as early as possible.

http://ift.tt/2nbhCbK

Propofol-induced irreversible hair depigmentation: a case report

http://ift.tt/2mKWcaf

Programmed death-ligand 1 and its soluble form are highly expressed in nasal natural killer/T-cell lymphoma: a potential rationale for immunotherapy

Abstract

Nasal natural killer/T-cell lymphoma (NNKTL) is an aggressive neoplasm with poor therapeutic responses and prognosis. The programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) pathway plays an important role in immune evasion of tumor cells through T-cell exhaustion. The aim of the present study was to examine the expression of PD-L1 and PD-1 molecules in NNKTL. We detected the expression of PD-L1 in biopsy samples from all of the NNKTL patients studied. PD-L1 was found on both malignant cells and tumor-infiltrating macrophages, while PD-1-positive mononuclear cells infiltrated the tumor tissues in 36% of patients. Most significantly, soluble PD-L1 (sPD-L1) was present in sera of NNKTL patients at higher levels as compared to healthy individuals and the levels of serum sPD-L1 in patients positively correlated with the expression of PD-L1 in lymphoma cells of tumor tissues. In addition, the high-sPD-L1 group of patients showed significantly worse prognosis than the low-sPD-L1 group. Furthermore, we confirmed that membrane and soluble PD-L1 was expressed on the surface and in the culture supernatant, respectively, of NNKTL cell lines. The expression of PD-L1 was observed in tumor tissues and sera from a murine xenograft model inoculated with an NNKTL cell line. Our results suggest that sPD-L1 could be a prognostic predictor for NNKTL and open up the possibility of immunotherapy of this lymphoma using PD-1/PD-L1 axis inhibitors.

http://ift.tt/2nGuY3Q

TSHR/IGF-1R Cross-Talk, not IGF-1R Stimulating Antibodies, Mediates Graves' Ophthalmopathy Pathogenesis

Thyroid , Vol. 0, No. 0.


http://ift.tt/2nGAWSm

Chemocauterization of second branchial cleft fistula using trichloroacetic acid: A preliminary report

Although second branchial cleft fistula (BCF) can be well treated with surgical excision, neck scarring is unavoidable. We previously reported chemocauterization with trichloroacetic acid (TCA) to close various fistulas. Here, we report chemocauterization of a second BCF without a consequent incision scar.

http://ift.tt/2o0gyfi

Sialendoscopic removal of fish bone-induced sialoliths in the duct of the submandibular gland

Obstructive sialadenitis of the submandibular gland is commonly caused by sialoliths, but more rarely by foreign body-induced sialoliths. Here, we report minimally invasive sialendoscopic removal of fish bone-induced sialoliths in the duct of the submandibular gland. A 43-year-old woman presented with recurrent swelling of the right submandibular gland at other hospital. Computed tomography (CT) showed an 8-mm linear calcification in the posterior part of Wharton's duct. The lesion was deemed difficult to remove and she was followed up.

http://ift.tt/2npnpfG

Corrigendum to

The authors regret < that the dosage of amoxicillin was unclear in the original version of the article. The correct dosage is '2 capsules of amoxicillin 875mg orally' instead of '2g amoxicillin 875mg orally'>.

http://ift.tt/2nbka9U

Comparison of the adult three-dimensional craniofacial features of patients with unilateral craniofacial microsomia with and without early mandible distraction

This study was conducted to analyze the long-term facial growth of patients with craniofacial microsomia (CFM) after early mandible distraction osteogenesis (DO), and compared adult three-dimensional (3D) craniofacial features of patients with and without early mandibular DO for Pruzansky grade II deformities. The study included 20 patients: 9 with early mandible DO (the DO group) and 11 without previous treatment (the NDO group). Longitudinal radiographs were measured for growth changes after DO.

http://ift.tt/2nuxqd3

Evaluation of hyaluronic matrix efficacy in sinus augmentation: a randomized-controlled histomorphometric and micro–computed tomography analysis

The objective of the present study was to test the hypothesis that the addition of hyaluronic acid–based matrix to collagenated heterologous bone graft for sinus augmentation would enhance bone formation compared to collagenated heterologous bone graft alone in the early healing period, by micro−computed tomography and histomorphometry. Thirteen systemically healthy patients requiring bilateral two-stage maxillary sinus augmentation (residual crest height≤4mm) were enrolled in this split-mouth prospective randomized controlled study.

http://ift.tt/2ncatZO

Circulating Soluble IL-6 Receptor Concentration and Visceral Adipocyte Size Are Related to Insulin Resistance in Taiwanese Adults with Morbid Obesity

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


http://ift.tt/2ncrrad

The Influence of Epicardial Fat and Nonalcoholic Fatty Liver Disease on Heart Rate Recovery in Metabolic Syndrome

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


http://ift.tt/2mKKufG

Circulating Zbed3 Levels in Subjects With and Without Metabolic Syndrome

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


http://ift.tt/2ncurDG

High Prevalence of Vitamin D Deficiency and Correlation of Serum Vitamin D with Cardiovascular Risk in Patients with Metabolic Syndrome

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


http://ift.tt/2nGoVfo

Laryngoscopic and stroboscopic signs in the diagnosis of vocal fold paresis

Objectives/Hypothesis

To identify strobolaryngoscopic findings significant in the diagnosis of paresis.

Study Design

Retrospective cohort study.

Methods

Fellowship-trained laryngologists reviewed 34 videostroboscopic examinations (24 with paresis, eight without paresis, two repeat). They indicated presence or absence of paresis, including side and type, degree of confidence in diagnosis, and ranked clinical findings that influenced diagnosis by order of importance. Fleiss's κ was used to assess inter-rater agreement for paresis presence, side, and type. Clinical findings compelling in diagnosis were tabulated and described. Confidence levels for side and type were compared by analysis of variance/Kruskal-Wallis tests and post hoc pairwise comparisons.

Results

Thirty-one laryngologists completed the review. Inter-rater agreement on presence or absence of paresis was fair at 0.334 (Fleiss's κ). Fourteen examinations were diagnosed with paresis by >70% of raters and considered strong paresis-candidate exams. Diagnosis of paresis side and type were inconsistent, although with statistically significant differences in confidence ratings (unilateral vs. bilateral, recurrent laryngeal nerve [RLN] vs. superior laryngeal nerve [SLN], RLN vs. mixed RLN/SLN). Laryngoscopic and stroboscopic findings with the strongest association with paresis were vocal fold motion anomalies, vocal fold degeneration, glottic insufficiency, and mucosal wave anomalies.

Conclusions

Most laryngologists use strobolaryngoscopy for diagnosis of paresis. Although certain clinical findings were found to be associated with diagnosis, most commonly vocal fold motion anomalies, these varied among raters, especially when determining sidedness and nerve involvement. Future studies should expand the discussion and consideration of strobolaryngoscopic factors and adjunct functional and objective measures to develop a heuristic algorithm for diagnosis of paresis.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2nperio

Real-time continuous image-guided surgery: Preclinical investigation in glossectomy

Objectives/Hypothesis

To develop, validate, and study the efficacy of an intraoperative real-time continuous image-guided surgery (RTC-IGS) system for glossectomy.

Study Design

Prospective study.

Methods

We created a RTC-IGS system and surgical simulator for glossectomy, enabling definition of a surgical target preoperatively, real-time cautery tracking, and display of a surgical plan intraoperatively. System performance was evaluated by a group of otolaryngology residents, fellows, medical students, and staff under a reproducible setting by using realistic tongue phantoms. Evaluators were grouped into a senior and a junior group based on surgical experience, and guided and unguided tumor resections were performed. National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores and a Likert scale were used to measure workloads and impressions of the system, respectively. Efficacy was studied by comparing surgical accuracy, time, collateral damage, and workload between RTC-IGS and non-navigated resections.

Results

The senior group performed more accurately (80.9% ± 3.7% vs. 75.2% ± 5.5%, P = .28), required less time (5.0 ± 1.3 minutes vs. 7.3 ± 1.2 minutes, P = .17), and experienced lower workload (43 ± 2.0 vs. 64.4 ± 1.3 NASA-TLX score, P = .08), suggesting a trend of construct validity. Impressions were favorable, with participants reporting the system is a valuable practice tool (4.0/5 ± 0.3) and increases confidence (3.9/5 ± 0.4). Use of RTC-IGS improved both groups' accuracy, with the junior group improving from 64.4% ± 5.4% to 75.2% ± 5.5% (P = .01) and the senior group improving from 76.1% ± 4.5% to 80.9% ± 3.7% (P = .16).

Conclusions

We created an RTC-IGS system and surgical simulator and demonstrated a trend of construct validity. Our navigated simulator allows junior trainees to practice glossectomies outside the operating room. In all evaluators, navigation assistance resulted in increased surgical accuracy.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2nGoUIr

Onset of bell's palsy in late pregnancy and early puerperium is associated with worse long-term outcomes

Introduction

The incidence of Bell's palsy (BP) is elevated in the late phases of pregnancy. Controversy exists as to whether pregnancy is a risk factor for worse outcomes in BP, and whether such outcomes are the result of factors intrinsic to pregnancy or the tendency to withhold medical therapy in this cohort.

Methods

Long-term facial function outcomes in cases of pregnancy-associated BP (PABP) were compared against outcomes in cases affecting nonpregnant adult women of child-bearing age by a blinded expert using the electronic clinician-graded facial function scale (eFACE) facial grading system.

Results

Fifty-one pregnancy-associated cases and 58 nonpregnancy-associated cases were included. Among patients who received early corticosteroid therapy, significantly worse static, synkinesis, and composite facial function eFACE scores were demonstrated among cases of PABP compared to nonpregnancy-associated cases (static median = 86 vs. 92.5, P = 0.005; synkinesis median = 79 vs. 86, P = 0.007; composite median = 78 vs. 84, P = 0.023). Among those not treated with corticosteroids, significantly worse dynamic and composite facial function eFACE scores were demonstrated in cases of PABP compared to those for nonpregnancy-associated cases (dynamic median = 74 vs. 92.5, P = 0.038; composite median = 73 vs. 86.5, P = 0.038). A trend toward improved outcomes was demonstrated within both groups for those treated with corticosteroids compared to those who were not.

Conclusion

In comparison to cases unrelated to pregnancy, late-term PABP is associated with worse long-term outcomes to a degree that cannot solely be explained by differences in medical therapy.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2np38Xv

Idiopathic intracranial hypertension: Contemporary review and implications for the otolaryngologist

Objectives

1) Review controversies pertaining to the pathophysiology, diagnosis, and treatment of idiopathic intracranial hypertension. 2) Discuss the evolving role of otolaryngologists in managing this disease and related disorders.

Data Sources

Primary literature review, Centers for Disease Control and Prevention website, International Classification of Headache Disorders, Second Edition.

Methods

A comprehensive review of the primary literature was performed from 1990 to 2016 utilizing keywords idiopathic intracranial hypertension, pseudotumor cerebri, benign intracranial hypertension, spontaneous cerebrospinal fluid leak, and encephalocele. Articles were included at the discretion of the authors based on novel and/or historical contributions to the literature.

Results

The incidence of idiopathic intracranial hypertension is increasing along with the obesity epidemic. Undiagnosed patients may present to otolaryngologists with pulsatile tinnitus, dizziness, sleep apnea, and spontaneous cerebrospinal fluid leaks. Although diagnosis is predicated upon imaging findings and lumbar puncture, radiographic signs including empty sella, optic nerve dilation, and globe flattening may suggest the diagnosis. The most effective intervention is weight loss combined with acetazolamide. Surgery is reserved for severe or refractory symptoms and can be highly morbid. Otolaryngologists are increasingly responsible for managing a number of secondary disorders including cerebrospinal fluid rhinorrhea and otorrhea. Failure to manage intracranial hypertension may lead to adverse surgical outcomes.

Conclusions

The knowledge base for idiopathic intracranial hypertension has greatly expanded over the past 25 years. This disease is associated with a number of conditions directly relevant to otolaryngologists. A keen understanding of this disorder and its management may optimize outcomes in a growing number of patients. Laryngoscope, 2017

http://ift.tt/2nGhi8O

The state of academic sleep surgery: A survey of United States residency and fellowship programs

Objectives/Hypothesis

Our objectives were to describe otolaryngology residency programs' experience in and attitudes toward sleep surgery, and describe current otolaryngology sleep fellowships and their impact on future academic practice.

Study Design

E-mail survey.

Methods

A survey was e-mailed to program directors of 106 Accreditation Council for Graduate Medical Education-accredited otolaryngology residencies assessing resident sleep medicine experience, program satisfaction, and impact of sleep faculty. A separate survey was sent to directors of the seven sleep medicine otolaryngology fellowships. Frequency of graduates pursuing academic careers was examined.

Results

Forty-six (43.4%) residency programs responded. Thirty-one (67.4%) have a faculty member with any time spent practicing sleep medicine or surgery. Nineteen (41.3%) have a faculty member with >50% dedicated sleep practice and/or who is board certified in sleep medicine. These programs were significantly more likely to respond "extremely" or "very" satisfied with resident sleep exposure than those without (P < .001). Most programs (69.6%) "strongly agreed" or "agreed" their program would benefit from a dedicated sleep surgeon; there was no significant difference in response rates between programs already with and those without dedicated sleep faculty. All fellowship directors responded. In the past 5 years these programs have trained 11 total fellows. Ten (90.9%) have remained in academic practice.

Conclusions

There is significantly increased satisfaction in resident sleep education at otolaryngology programs with dedicated sleep providers. Concurrently, there is strong program interest in sleep surgeons' involvement in resident training. Sleep fellowships are producing surgeons who pursue academic careers. This study provides support to training fellowship-specialized sleep surgeons and encouraging otolaryngology sleep faculty.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2npkymK

Audiovestibular symptoms as predictors of prolonged sports-related concussion among NCAA athletes

Objective

We looked to determine the rates of audiovestibular symptoms following sports-related concussions among collegiate athletes. Further, we assessed the correlation between these symptoms and the time to return to participation in athletic activity.

Study Design

Retrospective analysis of the National Collegiate Athletic Association Injury Surveillance System (NCAA-ISS).

Methods

The NCAA-ISS was queried from 2009 through 2014 for seven men's sports and eight women's sports across divisions 1, 2, and 3. Injuries resulting in concussions were analyzed for audiovestibular symptoms, duration of symptoms, and return to participation times.

Results

From 2009 to 2014, there were 1,647 recorded sports-related concussions, with athletes reporting dizziness (68.2%), imbalance (35.8%), disorientation (31.4%), noise sensitivity (29.9%), and tinnitus (8.5%). Concussion symptoms resolved within 1 day (17.1%), within 2 to 7 days (50.0%), within 8 to 30 days (25.9%), or persisted over 1 month (7.0%). Return to participation occurred within 1 week (38.3%), within 1 month (53.0%), or over 1 month (8.7%). Using Mann-Whitney U testing, overall symptom duration and return to competition time were significantly increased when any of these symptoms were present (P < 0.05). Duration of concussion symptom correlated with dizziness (P = 0.043) and noise sensitivity (P = 0.000), whereas return to participation times correlated with imbalance (P = 0.011) and noise sensitivity (P = 0.000). Dizziness and imbalance (odds ratio: 4.15, confidence interval: 3.20–5.38, P < 0.001) were the two symptoms with the strongest association.

Conclusion

Audiovestibular symptoms are common complaints among collegiate athletes sustaining concussions. Dizziness and noise sensitivity correlated with the duration of concussive symptoms, whereas imbalance and noise sensitivity was correlated with prolonged return to competition time.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2nGmI3L

Nerve transection repair using laser-activated chitosan in a rat model

Objectives/Hypothesis

Cranial nerve transection during head and neck surgery is conventionally repaired with microsuture. Previous studies have demonstrated recovery with laser nerve welding (LNW), a novel alternative to microsuture. LNW has been reported to have poorer tensile strength, however. Laser-activated chitosan, an adhesive biopolymer, may promote nerve recovery while enhancing the tensile strength of the repair. Using a rat posterior tibial nerve injury model, we compared four different methods of nerve repair in this pilot study.

Study Design

Animal study.

Design

Animals underwent unilateral posterior tibial nerve transection. The injury was repaired by potassium titanyl phosphate (KTP) laser alone (n = 20), KTP + chitosan (n = 12), microsuture + chitosan (n = 12), and chitosan alone (n = 14). Weekly walking tracks were conducted to measure functional recovery (FR). Tensile strength (TS) was measured at 6 weeks.

Results

At 6 weeks, KTP laser alone had the best recovery (FR = 93.4% ± 8.3%). Microsuture + chitosan, KTP + chitosan, and chitosan alone all showed good FR (87.4% ± 13.5%, 84.6% ± 13.0%, and 84.1% ± 10.0%, respectively). One-way analysis of variance was performed (F(3,56) = 2.6, P = .061). A TS threshold of 3.8 N was selected as a control mean recovery. Three groups—KTP alone, KTP + chitosan, and microsuture + chitosan—were found to meet threshold 60% (95% confidence interval [CI]: 23.1%-88.3%), 75% (95% CI: 46.8%-91.1%), and 100% (95% CI: 75.8%-100.0%), respectively.

Conclusions

In the posterior tibial nerve model, all repair methods promoted nerve recovery. Laser-activated chitosan as a biopolymer anchor provided good TS and appears to be a novel alternative to microsuture. This repair method may have surgical utility following cranial nerve injury during head and neck surgery.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2npd5UI

What additional treatment is indicated for oral cavity cancer with isolated perineural invasion?

http://ift.tt/2nGlB48

Assessment of frozen section margin analysis during olfactory neuroblastoma surgery

Objectives

1) assess the performance of the intraoperative frozen section procedure to correctly classify biopsies obtained during olfactory neuroblastoma (ONB) surgery; 2) define the relationship between posttest probabilities and pretest probabilities from frozen section analysis; and 3) review incorrectly classified specimens.

Study Design

Study of diagnostic accuracy.

Methods

We searched our institution's pathology database for patients who had ONB surgery between January 1, 2000 and November 16, 2012. We only included patients who had a definitive diagnosis of ONB prior to surgery and frozen sections obtained during surgery. All frozen sections in this study had corresponding permanent sections available to serve as a gold standard. This database was analyzed to obtain classification statistics. The confidence intervals for classification performance were obtained using the bootstrap sampling method. Confidence intervals for posttest probability curves were derived using the Taylor series expansion. Finally, we obtained and reviewed the slides from ambiguous or incorrect reads.

Results

A total of 459 specimens from 33 patients were analyzed. We found the following performance characteristics: sensitivity: 0.89 (0.81, 0.94); specificity: 0.96 (0.94, 0.98); accuracy: 0.95 (0.92, 0.96); likelihood ratio positive: 24.4 (14.5, 44.1); prevalence: 0.20 (0.17, 0.25); positive predictive value: 0.86 (0.78, 0.92); and negative predictive value: 0.97 (0.95, 0.99). Histopathologic review revealed that crush artifacts and inadequate specimen size were major sources of incorrect reads.

Conclusion

We found frozen section assessment of ONB specimens to be an excellent tool for the assessment of intraoperative margins.

Level of Evidence

NA. Laryngoscope, 2017

http://ift.tt/2npky6e

Sternohyoid muscles for reconstruction after thyroid cartilage anterior partial resection

http://ift.tt/2nGv7Ec

Endoscopic management of tissue-engineered tracheal graft stenosis in an ovine model

Objective

To evaluate the safety and efficacy of bronchoscopic interventions in the management of tissue-engineered tracheal graft (TETG) stenosis.

Study Design

Animal research study.

Methods

TETGs were constructed with seeded autologous bone marrow-derived mononuclear cells on a bioartificial graft. Eight sheep underwent tracheal resection and orthotopic implantation of this construct. Animals were monitored by bronchoscopy and fluoroscopy at 3 weeks, 6 weeks, 3 months, and 4 months. Bronchoscopic interventions, including dilation and stenting, were performed to manage graft stenosis. Postdilation measurements were obtained endoscopically and fluoroscopically.

Results

Seven dilations were performed in six animals. At the point of maximal stenosis, the lumen measured 44.6 ± 8.4 mm² predilation and 50.7 ± 14.1 postdilation by bronchoscopy (P = 0.3517). By fluoroscopic imaging, the airway was 55.9 ± 12.9 mm² predilation and 65.9 ± 22.4 mm² postdilation (P = 0.1303). Stents were placed 17 times in six animals. Pre- and poststenting lumen sizes were 62.8 ± 38.8 mm² and 80.1 ± 54.5 mm² by bronchoscopy (P = 0.6169) and 77.1 ± 38.9 mm² and 104 ± 60.7 mm² by fluoroscopy (P = 0.0825). Mortality after intervention was 67% with dilation and 0% with stenting (P = 0.0004). The average days between bronchoscopy were 8 ± 2 for the dilation group and 26 ± 17 in the stenting group (P = 0.05). One hundred percent of dilations and 29% of stent placements required urgent follow-up bronchoscopy (P = 0.05).

Conclusion

Dilation has limited efficacy for managing TETG stenosis, whereas stenting has a more lasting clinical effect.

Level of Evidence

NA. Laryngoscope, 2017

http://ift.tt/2npg0wF

Periodic olfactory assessment in patients undergoing skull base surgery with preservation of the olfactory strip

Objectives/Hypothesis

Others have reported olfactory disturbances following endoscopic approaches to the skull base. However, there is a lack of consensus on the extent and duration of dysfunction. This study aimed to compare our results with previously published work and to validate the olfactory strip–sparing approach.

Study Design

Prospective study to assess olfaction in 50 patients scheduled to undergo resection of skull base tumors via extended endoscopic approaches.

Methods

Patients were divided into two groups. Group I had a nasoseptal flap (NSF), and group II included patients in whom rescue flaps were performed bilaterally. Olfactory outcomes were assessed using repeated University of Pennsylvania Smell Identification Test at baseline, 6 weeks, 3 months, and 6 months following surgery.

Results

Ultimately, 42 patients (seven group I and 35 group II) were available for assessment. Scores for group I were lower than at baseline at 6 weeks postoperatively (30.71 ± 5.5 vs. 24.5 ± 5.4; P = .05). However, by the third postoperative month the scores had improved to a level that was not significantly different from baseline (29.0 ± 3.7; P = .5). At 6 months, the score was 30.0 ± 3.9. Patients in group II showed no difference between their baseline and 6-week scores (31.5 ± 5.3 vs. 29.7 ± 5.9; P = .16). Six months postoperatively, the score was significantly higher (33.78 ± 3.6; P = .04).

Conclusions

Expanded endoscopic approaches to skull base tumors involving reconstruction with an NSF are associated with a short-term negative impact on olfaction. Olfaction does not seem to be affected by the surgical resection of pituitary adenomas associated with rescue flaps. Identification of the olfactory epithelium and meticulous harvesting of the NSF are critical to preserve olfaction.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2nGEgwv

Subtotal petrosectomy: Surgical technique, indications, outcomes, and comprehensive review of literature

Objectives/Hypothesis

To describe the technique of subtotal petrosectomy (STP), to analyze the outcomes, and to review the literature

Study Design

A retrospective review.

Methods

Four hundred sixty cases of STP performed for various indications were included in the study, which was conducted at a quaternary referral center for otology and skull base surgery. Surgical and audiological parameters, and complications were evaluated. Our results were compared with the existing literature on the subject.

Results

Two hundred ninety-seven (64.6%) patients had been subjected to multiple surgeries before an STP was performed. The most common indication for STP was recurrent chronic otitis with or without cholesteatoma, with 165 (35.9%) patients. Difficult cases of cochlear implantation, temporal bone fractures, and class B3 tympanomastoid paragangliomas were the next most common indications, with 91 (19.8%), 43 (9.4%), and 38 (8.3%) cases, respectively. The median follow-up of the patient pool was 36 ± 19 months. Recidivism and postauricular wound fistula were the most common complications, seen in five (1.1%) patients each. This series of STP is the largest reported in the literature

Conclusions

STP is a very useful and safe surgical tool in the management of a variety of problematic situations in otology, as it offers the possibility of a definitive cure by offering radical clearance. This procedure can be combined safely with hearing implantation procedures.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2npbIp5

Defining surgical criteria for empty nose syndrome: Validation of the office-based cotton test and clinical interpretability of the validated Empty Nose Syndrome 6-Item Questionnaire

Objectives/Hypothesis

The validated Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) identifies empty nose syndrome (ENS) patients. The unvalidated cotton test assesses improvement in ENS-related symptoms. By first validating the cotton test using the ENS6Q, we define the minimal clinically important difference (MCID) score for the ENS6Q.

Study Design

Individual case–control study.

Methods

Fifteen patients diagnosed with ENS and 18 controls with non-ENS sinonasal conditions underwent office cotton placement. Both groups completed ENS6Q testing in three conditions—precotton, cotton in situ, and postcotton—to measure the reproducibility of ENS6Q scoring. Participants also completed a five-item transition scale ranging from "much better" to "much worse" to rate subjective changes in nasal breathing with and without cotton placement. Mean changes for each transition point, and the ENS6Q MCID, were then calculated.

Results

In the precotton condition, significant differences (P < .001) in all ENS6Q questions between ENS and controls were noted. With cotton in situ, nearly all prior ENS6Q differences normalized between ENS and control patients. For ENS patients, the changes in the mean differences between the precotton and cotton in situ conditions compared to postcotton versus cotton in situ conditions were insignificant among individuals. Including all 33 participants, the mean change in the ENS6Q between the parameters "a little better" and "about the same" was 4.25 (standard deviation [SD] = 5.79) and −2.00 (SD = 3.70), giving an MCID of 6.25.

Conclusions

Cotton testing is a validated office test to assess for ENS patients. Cotton testing also helped to determine the MCID of the ENS6Q, which is a 7-point change from the baseline ENS6Q score.

Level of Evidence

3b. Laryngoscope, 2017

http://ift.tt/2nGph5P

Hearing loss and speech perception in noise difficulties in Fanconi anemia

Objectives/Hypothesis

Fanconi anemia is a hereditary chromosomal instability disorder. Hearing loss and ear abnormalities are among the many manifestations reported in this disorder. In addition, Fanconi anemia patients often complain about hearing difficulties in situations with background noise (speech perception in noise difficulties). Our study aimed to describe the prevalence of hearing loss and speech perception in noise difficulties in Dutch Fanconi anemia patients.

Study Design

Retrospective chart review.

Methods

A retrospective chart review was conducted at a Dutch tertiary care center. All patients with Fanconi anemia at clinical follow-up in our hospital were included. Medical files were reviewed to collect data on hearing loss and speech perception in noise difficulties.

Results

In total, 49 Fanconi anemia patients were included. Audiograms were available in 29 patients and showed hearing loss in 16 patients (55%). Conductive hearing loss was present in 24.1%, sensorineural in 20.7%, and mixed in 10.3%. A speech in noise test was performed in 17 patients; speech perception in noise was subnormal in nine patients (52.9%) and abnormal in two patients (11.7%).

Conclusions

Hearing loss and speech perception in noise abnormalities are common in Fanconi anemia. Therefore, pure tone audiograms and speech in noise tests should be performed, preferably already at a young age, because hearing aids or assistive listening devices could be very valuable in developing language and communication skills.

Level of Evidence

4. Laryngoscope, 2016

http://ift.tt/2npn1h5

Differenzialdiagnostik der Heiserkeit

Laryngo-Rhino-Otol 2017;
DOI: 10.1055/s-0034-1370937

Eine Heiserkeit kann das Leitsymptom einer Dysphonie sein. Zusammen mit einer möglichen Verschlechterung der stimmlichen Leistungsfähigkeit und subjektiven Missempfindungen kann sie ein individuell unterschiedlich starkes Handicap für die Patienten darstellen und eine Einschränkung der Teilhabe am sozialen und beruflichen Leben bedeuten. Da die Ursachen nicht nur funktioneller sondern auch organischer Natur mit schlechter Prognose sein können, müssen Heiserkeiten differenzialdiagnostisch abgeklärt werden. Neben dem Wissen über mögliche Pathogenesen und Therapiemöglichkeiten von Dysphonien, verlangt das differenzialdiagnostische Vorgehen profunde Kenntnisse hinsichtlich der verschiedenen diagnostischen Verfahren und im Besonderen bei der Interpretation der Ergebnisse. Da die Ursachen für Dysphonien sehr vielfältig und nur selten monokausal sind, empfiehlt sich unseres Erachtens ein interdisziplinäres differenzialdiagnostisches Vorgehen im Team.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

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Dysphagie

Laryngo-Rhino-Otol 2017;
DOI: 10.1055/s-0033-1363679

Schluckstörungen können in jedem Lebensalter auftreten und haben eine große Auswirkung auf die Morbidität von Patienten, sowie auch auf die Mortalität, besonders wenn zusätzlich auch eine Aspiration auftritt. Dieser Artikel beschreibt einerseits die Anatomie und Physiologie des Schluckaktes; andererseits auch Ursachen für eine Dysphagie, Untersuchungsmöglichkeiten sowie therapeutische Ansätze.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

http://ift.tt/2mKE9Rl

Notfälle der Sinnesorgane im HNO-Gebiet

Laryngo-Rhino-Otol 2017;
DOI: 10.1055/s-0033-1349848

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  CME online  |  Full text

http://ift.tt/2mKBTd5

Objektive audiologische Diagnostik

Laryngo-Rhino-Otol 2017;
DOI: 10.1055/s-0032-1325232

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  CME online  |  Full text

http://ift.tt/2mKzRcS

Solide Speicheldrüsentumoren

Laryngo-Rhino-Otol 2017;
DOI: 10.1055/s-0032-1321487

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  CME online  |  Full text

http://ift.tt/2mKk9hL

Erkrankungen der Trachea

Laryngo-Rhino-Otol 2017;
DOI: 10.1055/s-0031-1284205

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  CME online  |  Full text

http://ift.tt/2mKnmhm

Schwerhörigkeit – Ätiologie, Diagnostik und auditive Rehabilitation

Laryngo-Rhino-Otol 2017;
DOI: 10.1055/s-0030-1267371

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2mKuBFW

Malignome des Larynx

Laryngo-Rhino-Otol 2017;
DOI: 10.1055/s-0030-1253572

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  CME online  |  Full text

http://ift.tt/2osqDyo

Use of cutting guides during craniosynostosis sequelae surgery: A comparative study between computer-assisted planning and post-operative results

Craniosynostosis sequelae surgery is not well documented. There are some studies evaluating long-term results of craniosynostosis surgery done during childhood for anterior plagiocephaly (Anderson et al., 2005; Selber et al., 2008; Zakhary et al., 2014; Taylor et al., 2015) and trigonocephaly (Cohen et al., 1994; Engel et al., 2012; Wes et al., 2014). Overall, these studies show satisfying results; however, for patients with sequelae such as unaesthetic bone irregularities, frontal orbital defects or re-ossification defects (Zakhary et al.

http://ift.tt/2naUav9

The accuracy of patient specific implant prebented with 3D-printed rapid prototype model for orbital wall reconstruction

This study evaluated the accuracy of blowout fracture reduction using 3D-printed rapid prototyping (RP) skull modeling.

http://ift.tt/2o46ti3

Motivation for orthognathic treatment and anticipated satisfaction levels—a two-centre cross-national audit

This audit investigated factors which motivate patients to seek orthognathic treatment, assessed how confident patients were that they would be satisfied with the outcome of treatment, and explored possible influencing factors.

http://ift.tt/2naT9mO

Gender-specific evaluation of variation of maxillary exposure when smiling

Excessive exposure of maxillary teeth when smiling can have a negative effect on the aesthetics and attractiveness of the face. The presented study was aimed to evaluate the effect of different amounts of gingival exposure on the perception of such human characteristics and qualities as age, attractiveness, gender specificity, and felt sympathy in the context of the whole face.

http://ift.tt/2o4e67R

Strong association of insulin-like growth factor 1 receptor expression with histologic grade, subtype, and HPV status in penile squamous cell carcinomas: a tissue microarray study of 112 cases

Abstract

Insulin-like growth factor-1 receptor (IGF1R) plays a key role in cell growth and transformation. It is overexpressed in several solid tumors. This study evaluates IGF1R immunoexpression in penile squamous cell carcinoma (SCC). Four tissue microarrays were built from formalin-fixed, paraffin-embedded blocks of 112 penile SCC from Paraguay. Membranous IGF1R expression was evaluated by immunohistochemistry using two different approaches. An H-score was calculated in each spot (stain intensity by extent), and a median score per tumor was obtained. The second approach consisted of a score similar to the scoring system that was used for evaluating HER2 immunoexpression. For each case, the highest category obtained at any spot was used for statistical analyses. IGF1R expression was compared by histologic subtype, grade, and human papillomavirus (HPV) status. Median H-score was 22.5. The distribution of IGF1R expression by HER2 approach was as follows: 0 in 33.0% cases, 1+ in 46.4%, 2+ in 14.3%, and 3+ in 6.2%. IGF1R H-scores were associated with basaloid and warty/basaloid subtypes (p = 0.0026) and higher grade (p = 0.00052). Although weaker when using the HER2 approach, the association of IGF1R expression with subtype (p = 0.015) and grade (p = 0.015) remained significant. Furthermore, there was an association between IGF1R expression by HER2 approach and HPV status (p = 0.012). IGF1R was expressed in about two thirds of penile SCC cases, showing a strong positive association with histologic grade, subtype, and HPV status. Considering that grade is a predictor of outcome IGF1R expression may have prognostic relevance and could point to a potential role for IGF1R inhibitors in treating penile SCC.

http://ift.tt/2ntu362

Incidence and burden of comorbid pain and depression in patients with chronic rhinosinusitis awaiting endoscopic sinus surgery in Canada

Abstract

Background

This study sheds important light on the association between sino-nasal symptoms and global quality of life in patients with chronic rhinosinusitis waiting for endoscopic sinus surgery. Using patient-reported information collected pre-operatively, the primary objective was to report on patients' pre-surgical sino-nasal symptoms and their association with self-reported pain and depression. The secondary objective was to report on levels of depression and pain among patients in the sample reporting severe sleep problems.

Methods

This is a cross-sectional study of patient-reported outcomes collected prospectively from a cohort of 261 patients assigned to the wait list for elective endoscopic sinus surgery in a large urban region of Canada.

Results

Younger patients and patients with other medical comorbidities were most likely to report significant symptoms of chronic rhinosinusitis and substantial associated pain and depression. In the primary analyses, patients reporting significant symptoms of chronic rhinosinusitis were more likely to report moderate depression or high pain (p < 0.01). Subsequently, chronic rhinosinusitis patients with severe sleep problems were 82% likely to report moderate or severe depression and pain.

Conclusion

Preoperative management of depression and pain may be considered in order to improve the health-related quality of life of patients waiting for ESS. As depression and pain were highly prevalent, patients with severe sleep problems may be candidates for prioritized access.

http://ift.tt/2orAh41

Incidence and burden of comorbid pain and depression in patients with chronic rhinosinusitis awaiting endoscopic sinus surgery in Canada

This study sheds important light on the association between sino-nasal symptoms and global quality of life in patients with chronic rhinosinusitis waiting for endoscopic sinus surgery. Using patient-reported i...

http://ift.tt/2nZhcts

Prevention of chronic post-surgical pain: the importance of early identification of risk factors

Abstract

Chronic post-surgical pain (CPSP) is currently an inevitable surgical complication. Despite the advances in surgical techniques and the development of new modalities for pain management, CPSP can affect 15–60% of all surgical patients. The development of chronic pain represents a burden to both the patient and to the community. In order to have a meaningful impact on this debilitating condition it is essential to identify those at risk. Early identification of patients at risk will help to reduce the percentage of patients who go on to develop CPSP. Unfortunately, evidence about any effective actions to reduce this condition is limited. This review will focus on providing context to the challenging problem of CPSP. The possible role of both the surgeon and anesthesiologist in reducing the incidence of this problem will be explored.

http://ift.tt/2o2XmhA

Airway spray efficacy of local anesthetic with fiberscope

http://ift.tt/2n9VQFk

Can the descending aortic stroke volume be estimated by transesophageal descending aortic photoplethysmography?

Abstract

Purpose

The aim of this study was to investigate the ability of transesophageal photoplethysmography detected from the descending aorta (dPPG) for predicting low descending aortic stroke volume (dSV) level in cardiac surgical patients.

Methods

Fifteen patients scheduled for elective cardiac surgery were enrolled in our study. A transesophageal echocardiography (TEE) probe with an attached oximetry sensor was placed into the esophagus for paired dPPG signal and descending aortic Doppler blood flow signal acquisition. Metrics, including alternating current (AC), direct current (DC), area under the curve (AUC) and width (W), were extracted from the dPPG signals. The TEE-measured dSV, which was defined as the blood flow through the descending aorta during a cardiac cycle, was chosen as the standard reference. A receiver operating characteristic (ROC) curve was built to evaluate the performance of dPPG metrics in predicting low dSV level, and dSV measuring agreement between TEE and dPPG was analyzed by the Bland–Altman method.

Results

A total of 644 paired dPPG and Doppler signals of the descending aorta were acquired. Significant correlations were found between the dPPG metrics and TEE-measured dSV, and the correlation coefficients between TEE-measured dSV and AUC or AC were 0.64 and 0.66, respectively. AUC and AC values obviously decreased with the reduction of dSV level among the three groups (<20 mL, from 20−40 mL, and >40 mL). The areas under the ROC curve for AUC and AC in predicting low dSV level (<20 mL) were 0.85 and 0.88, respectively. Bland–Altman plot showed a small bias (0.02 mL) but a wide limit of agreement (−18.62 to 18.66 mL) in dSV measurement between dPPG and Doppler technology.

Conclusions

The AC and AUC extracted from the dPPG signal provided a sensitive and qualitative prediction for dSV level. The dSV value could not be accurately measured by dPPG metrics.

Trial Registration

Chinese Clinical Trials Register Identifier: ChiCTR-OCS-12002789.

http://ift.tt/2o2TXz5

Short-term quality of life change perceived by patients after transition to mandibular overdentures

Abstract The aim of this longitudinal observational study was to evaluate the oral health-related quality of life (OHRQoL) following patient rehabilitation with implant-retained mandibular overdentures (IMO) and to identify the contribution of the different domains to OHRQoL. The Oral Health Impact Profile (OHIP-EDENT), Dental Impact on Daily Living (DIDL), and Geriatric Oral Health Assessment Index (GOHAI) questionnaires were completed twice by 25 patients: after 3 months of rehabilitation with complete dentures (CD) and after 3 months of IMO loading using stud abutments. The evaluation after IMO rehabilitation showed significant improvement in three DIDL domains: appearance (p = 0.011), eating and chewing (p = 0.003), and general performance (p = 0.003). The GOHAI results showed significant differences in two domains: psychosocial (p = 0.005) and pain and discomfort (p = 0.0004). The OHIP-EDENT outcomes showed significant improvements in five domains: functional limitation (p = 0.0001), physical pain (p = 0.0002), physical disability (p = 0.0010), and psychological disability and handicap (p = 0.032). The largest observed effect sizes were close to one standard deviation and were observed in the eating and chewing domain (0.93) of the DIDL; the pain and discomfort domain (0.83) of the GOHAI, and the functional limitation (0.89), physical pain (1.02), physical disability (0.84) domains of the OHIP-EDENT. The percentage of satisfied patients increased in all domains. Self-reported OHRQoL of CD wearers was significantly improved after 3 months of treatment with IMO, especially concerning the functional and pain-related aspects.

http://ift.tt/2oalEmC

Performance of a polymer coated silicon microarray for simultaneous detection of food allergen specific IgE and IgG4

Abstract

Background

Microarray-based component-resolved diagnostics (CRD) has become an accepted tool to detect allergen specific IgE-sensitization towards hundreds of allergens in parallel from one drop of serum. Nevertheless specificity and sensitivity as well as a simultaneous detection of allergen specific IgG4, as a potential parameter for tolerance development, remain to be optimized.

Objective

We applied the recently introduced silicon chip coated with a functional polymer named copoly(DMA-NAS-MAPS) to the simultaneous detection of food allergen specific IgE and IgG4, and compared it with ImmunoCAP and ImmunoCAP ISAC. Inter- and intra- slide variation, linearity of signal and working range, sensitivity and application of internal calibrations for IgE and IgG₄ were assessed.

Methods

Native and recombinant allergenic proteins from hen's egg and cow's milk were spotted on silicon chips coated with copoly(DMA-NAS-MAPS) along with known concentrations for human IgE and IgG₄. A serum pool and 105 patient samples were assessed quantitatively and semi-quantitatively with the ImmunoCAP and ImmunoCAP ISAC and correlated with IgE- and IgG₄-specific fluorescence on silicon microarrays.

Results

Allergen specific IgE and IgG₄ were detected in parallel using two fluorescent dyes with no crosstalk. Results from the ImmunoCAP correlated better with microarray fluorescence than with ImmunoCAP ISAC except for the allergen ovomucoid. The working range of the silicon microarray for total hen's egg specific IgE was comparable to the range of 0.1 to >100 kU_A/l of the ImmunoCAP system, whereas for total cow's milk the silicon microarray was less sensitive. Detectable allergen specific IgG₄ could be determined only for low concentrations, but still correlated positively with ImmunoCAP results.

Conclusions

We confirmed the ability of the polymer coated silicon microarray to be comparably sensitive to the ImmunoCAP ISAC for various food allergens. This suggests that the copoly(DMA-NAS-MAPS) microarray is a low cost, self-producible alternative to the commercial ImmunoCAP ISAC in allergy research.

This article is protected by copyright. All rights reserved.

http://ift.tt/2nnFmve

NUT Midline Carcinoma of the Sublingual Gland: Clinical Presentation and Review

Abstract

NUT midline carcinoma (NMC) is a rare and aggressive disease encountered in the midline of the head and neck or mediastinum. Due to its sparse incidence and subtle pathologic features, we aim to increase knowledge and awareness for this pathologic entity. We present an exemplary case of a young, healthy male presenting with oral cavity pain and cervical lymphadenopathy. This patient was initially diagnosed with an unspecified, highly aggressive sublingual gland malignancy and underwent locoregional resection with free flap reconstruction however suffered a rapid local recurrence and widely extensive metastasis within just 1 month. After rigorous analysis, final pathologic diagnosis revealed a poorly differentiated carcinoma with evidence of squamous differentiation that eventually, post-mortem tested positive for NMC. Only one prior case of sublingual gland NMC has been previously reported as we discuss the literature regarding all sublingual gland malignancies as well as the pathologic features and treatment options for NMC. We recommend consideration of testing for the NUT proto-oncogene at the time of biopsy in the clinical setting of a poorly differentiated midline carcinoma, especially with squamous differentiation, of the head or neck in order to identify patients for clinical trial enrollment and appropriately counsel on the poor clinical prognosis. Improving clinician awareness is critical to increase diagnostic accuracy and need to study prospective treatment outcomes as the first step toward improving management of this difficult disease.

http://ift.tt/2o9RFuT

Intraoral Salivary Duct Cyst: Clinical and Histopathologic Features of 177 Cases

Abstract

The salivary duct cyst (SDC) is a reactive ductal ectasia most frequently seen in major salivary glands, and likely caused by obstruction. The aim of this study is to define the clinical and histopathologic spectrum of intraoral SDCs. Cases were retrieved from the archives of Harvard School of Dental Medicine/StrataDx, Inc. from January 2012 to August 2014. There were 177 cases of which 103 (58.2%) occurred in females, with a median age of 56 (range 2–95). Approximately half of cases (45.8%) presented in the area of the buccal mucosa, lower lip mucosa, or mandibular vestibule, and 23.2% presented in the floor of mouth. SDCs were lined at least focally by 1–2 layers of cuboidal/columnar epithelium in 85.3% of cases and showed varying degrees of metaplasia (oncocytic, mucous cell, squamous, ciliated, apocrine-like) in 68.4% of cases. Intraluminal mucous stasis was present in 41.8% of SDCs, incipient calcification was present within 4.5% of SDCs, and chronic obstructive sialadenitis was seen in 90.2% of cases. No cysts showed adenomatous ductal proliferations or true papillary structures with fibrovascular cores, although 41.2% exhibited reactive undulation of cyst lining. Thirty-nine 'papillary oncocytic cystadenoma-like' SDCs (22.0%) demonstrated complete oncocytic metaplasia and marked undulation. An additional seven such cysts (4.0%) had a 'Warthin tumor-like' lymphoplasmacytic infiltrate. Intraoral SDCs occur most commonly in the sixth decade of life in locations distinct from extravasation mucoceles, likely secondary to intraluminal obstruction. SDCs show diverse histopathology and certain phenotypic variants may be mistaken for papillary oncocytic cystadenoma or Warthin tumor.

http://ift.tt/2nF7w77

Solid Cell Nests and Cyst Heterogeneity in Thyroglosal Duct Cysts

http://ift.tt/2o9WVi8

M.ALSHEIKH Technique: Modification to the Soft Tissue Reduction in the Baha ® Attract Surgery

Abstract

To describe a modification to the Baha^® Attract surgical technique that aims to enhance skin closure, create smooth skin across the surface of the wound, reduce surgery time, and improve cosmetics of the surgical site. Retrospective chart review. Patients were implanted between 2014 and 2016 at King Fahad General Hospital (KFGH) (Jeddah, Kingdom of Saudi Arabia). 20 adult patients (11 males, 9 females), all eligible for Baha^® Attract system. One patient only had a previous Baha^® surgery. The normal Baha^® Attract surgical technique with modification to the soft tissue reduction stage is described. The mean surgical time was 35.25 min (range 25–55). Bleeding was present but not significant and easily controlled in four patients. All patients received the 4 mm implant. None of the patients experienced severe pain. The postoperative follow-up period was 6 months for 7 patients and 8 months for 13 patients. Patient feedback and monitoring indicates a good hearing performance and comfort in all patients. The modified Baha^® Attract surgical method causes less postoperative complication, improve cosmetic effect, and provide shorter operative time compared to the conventional Attract procedure.

http://ift.tt/2optB6x

Cheese supplemented with probiotics reduced the Candida levels in denture wearers –RCT

Abstract

Objetives

The access to probiotics should be facilitated in order to encourage their usage. We evaluated the effect of consumption of two experimental probiotic-containing cheese on the oral colonization of Candida in denture wearers.

Methods

Sixty denture wearers harboring oral Candida were randomly allocated in groups who received cheese supplemented with Lactobacillus acidophilus NCFM (T1) or Lactobacillus rhamnosus Lr-32 (T2), daily for 8 weeks, and a control group (C) who received a control cheese. Oral samples were obtained through a mouthwash, and Candida levels determined (CFU/mL) at baseline and after the 8 weeks experimental period.

Results

At baseline, the mean levels of Candida spp. (log CFU/mL) were similar among the groups. However, the mean levels of Candida were significantly reduced in groups T1 and T2 but not in C (Tukey, p < 0.05). The reduction in Candida oral levels occurred independently on the colonizing Candida species, participant age, and use of bi or unimaxillary dentures.

Conclusions

Daily consumption of cheese supplemented with probiotics, either with L. acidophilus NCFM or L. rhamnosus Lr-32, was able to reduce the colonization of oral Candida in complete denture wearers, suggesting its potential in reducing the risk of oral candidiasis in this highly susceptible population.

This article is protected by copyright. All rights reserved.

http://ift.tt/2oqvOi1

Clinico-Dermoscopic Features of Spitz Naevi by Age and Anatomic Site: A Study of 378 Spitz Naevi

Abstract

Spitz naevi (SN) are benign melanocytic naevi characterized by spindled and epithelioid cells in histology seen in both children and adults. In the present study, we aimed to determine whether there is a difference in the dermoscopic features of SN by age and anatomic site. Previous studies have demonstrated this association in congenital and common naevi.

This article is protected by copyright. All rights reserved.

http://ift.tt/2o2rdXc

Intravenous immunoglobulin contributes to control anti-melanoma differentiation-associated protein 5 (MDA5) antibody-associated dermatomyositis with palmar violaceous macules/papules

Abstract

Autoantibodies to melanoma differentiation-associated protein 5 (MDA5) are associated with a subset of dermatomyositis (DM) patients who have rapidly progressive interstitial lung disease (RP-ILD) with poor prognosis. Intensive immunosuppressive therapy is initiated before irreversible lung damage can occur; however, there are few lines of evidence for the treatment of RP-ILD. Here, we report 3 cases of anti-MDA5 antibody-associated DM with RP-ILD in which the patients were treated with combined modality therapy including high-dose prednisolone, tacrolimus, intravenous cyclophosphamide, and immunoglobulins (IVIG). In all 3 cases, the serum ferritin levels, which are known to represent the disease activity of RP-ILD, were decreased after IVIG administration. IVIG might contribute to control of the disease activity of anti-MDA5 antibody-positive DM. Moreover, palmar violaceous macules/papules around the interphalangeal joints, which was observed in all 3 cases in the incipient stage, might be a useful sign to suggest a diagnosis of anti-MDA5 antibody-associated DM.

This article is protected by copyright. All rights reserved.

http://ift.tt/2na8oxi

Is Universal HLA-B*15:02 Screening a Cost-Effective Option in an Ethnically-Diverse Population? A Case Study of Malaysia

Abstract

Background

Strong association was documented between human leukocyte antigen (HLA)-B*15:02 and carbamazepine-induced severe cutaneous adverse reactions (SCARs) in Asians. Beyond Asia, the HLA testing is potentially valuable in many countries with increasingly diverse communities of Asian ancestry, to facilitate an early recognition of patient susceptibility to SCARs.

Objective

To determine the cost-effectiveness of universal HLA-B*15:02 screening in preventing carbamazepine-induced Stevens-Johnson syndrome/ toxic epidermal necrolysis in an ethnically-diverse Malaysian population.

Methods

A hybrid model of a decision tree and Markov model was developed to evaluate three strategies for treating newly-diagnosed epilepsy among adults - (i) carbamazepine initiation without HLA-B*15:02 screening (current practice); (ii) universal HLA-B*15:02 screening prior to carbamazepine initiation; and (iii) alternative treatment [sodium valproate (VPA)] prescribing without HLA-B*15:02 screening. From a societal perspective, base-case analysis and sensitivity analyses were performed over lifetime time horizon. Incremental cost-effectiveness ratios were calculated.

Results

In the base-case analysis, both universal HLA-B*15:02 screening and VPA prescribing were dominated by current practice. Compared to current practice, universal HLA-B*15:02 screening resulted in 0.0255 quality-adjusted life years (QALYs) loss at an additional cost of USD707, while VPA prescribing resulted in 0.2622 QALYs loss at an additional cost of USD4,127, due to estimated differences in antiepileptic treatment efficacy.

Conclusions

This study suggests that universal HLA-B*15:02 screening is unlikely to be a cost-effective intervention in Malaysia compared to current practice. However, with the emergence of an ethnically-diverse population in many other countries, this may render HLA-B*15:02 screening a potentially viable intervention when an increasing proportion of the population is at risk and an equally effective yet safer antiepileptic drug is available.

This article is protected by copyright. All rights reserved.

http://ift.tt/2o2gJHp

High prevalence of alcohol use disorders in patients with inflammatory skin diseases

Abstract

Background

There is a known association between psoriasis and heavy alcohol consumption. Causality remains unclear with evidence supporting both alcohol triggering psoriasis and psoriasis predisposing to heavy alcohol consumption. However, the association between heavy alcohol consumption and other inflammatory skin diseases remains to be defined.

Objective

To examine the prevalence of heavy drinking using the Alcohol Use Disorders Identification Test (AUDIT) in patients with inflammatory skin disease.

Methods

We conducted an observational cross sectional study in a single hospital out-patient department. We recruited 609 patients in 5 groups; psoriasis, eczema, cutaneous lupus (lupus), other inflammatory disorders and a reference population with skin lesions. The primary outcome was the proportion of patients in each group with an alcohol use disorder (AUD).

Results

Observed prevalence of AUD was: psoriasis (30.6%), eczema (33.3%), cutaneous lupus (12.3%), other inflammatory disease (21.8%) and non-inflammatory disease (14.3%). Odds ratios(OR) (95% CI) for AUDs in inflammatory groups compared with non-inflammatory, adjusted for age and gender were: psoriasis 1.65 (0.86-3.17), eczema 2.00 (1.03-3.85), lupus 1.03 (0.39-2.71), other inflammatory 1.32 (0.68-2.56). OR were reduced if also adjusted for DLQI. The prevalence of DLQI of ≥11 was: psoriasis 31.1%, eczema 43.7%, cutaneous lupus 17.5%, other inflammatory 17.2% and non-inflammatory 2.8%.

Conclusions

Patients with eczema attending a single site hospital clinic have been shown to have high levels of alcohol use disorders of a similar level to patients with psoriasis and higher than patients with non-inflammatory skin diseases. The role of alcohol in the exacerbation of eczema needs further investigation. Caution and a full alcohol history is recommended when treating eczema patients with potentially hepatotoxic medication. By identifying heavier drinking patients we may be able to support them with interventions to reduce alcohol intake and potentially improve their skin disease.

This article is protected by copyright. All rights reserved.

http://ift.tt/2na60qd

Synthetic β-nitrostyrene derivative CYT-Rx20 as inhibitor of oral cancer cell proliferation and tumor growth through glutathione suppression and reactive oxygen species induction

ABSTRACT

Background

The β-nitrostyrene family possesses anticancer properties. In this study, β-nitrostyrene derivative CYT-Rx20 (3′-hydroxy-4′-methoxy-β-methyl-β-nitrostyrene) was synthesized and investigated its anticancer activity in oral cancer.

Methods

Anticancer activity of CYT-Rx20 and the underlying mechanisms were analyzed using cell viability assay, reactive oxygen species (ROS) generation assay, fluorescence-activated cell sorter analysis, annexin V staining, comet assay, glutathione (GSH)/glutathione disulfide (GSSG) ratio, immunoblotting, soft agar assay, nude mice xenograft study, and immunohistochemistry.

Results

CYT-Rx20-induced cell apoptosis via ROS generation and mitochondrial membrane potential reduction, associated with release of mitochondrial cytochrome C to cytosol and activation of downstream caspases and poly ADP-ribose polymerase (PARP). Furthermore, CYT-Rx20 induced mitochondrial ROS accumulation and mitochondrial dysfunction, followed by GSH downregulation. CYT-Rx20-induced cell apoptosis, ROS generation, and DNA damage were reversed by thiol antioxidants. In nude mice, CYT-Rx20 inhibited oral tumor growth accompanied by increased expression of γH2AX, GSH reductase, and cleaved-caspase-3.

Conclusion

CYT-Rx20 has the potential to be further developed into an antioral cancer drug clinically. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Comparison of the safety of electrotome, Harmonic scalpel, and LigaSure for management of thyroid surgery

ABSTRACT

Background

Energy-based surgical devices, including electrotome, the Harmonic scalpel, and LigaSure, have been widely applied in thyroid surgery, although a comparison of their safety and efficacy has not been reported yet. In this study, we investigated the feasibility of using hemostatic energy-based surgical devices during thyroid surgery in a canine model.

Methods

Twenty-four beagle dogs were randomly divided into the following groups: electrotome (30 kW), electrotome (15 kW), the Harmonic scalpel (output level 3), and LigaSure (middle gear). The hemostatic devices were applied on the thyroid surface for 3 seconds and then near the recurrent laryngeal nerve (RLN; distance of 5 mm, 3 mm, or 1 mm) for 3 seconds. Evoked electromyography (EMG) amplitudes were recorded by intraoperative neuromonitoring (IONM). Acute microstructural morphological damage to thyroid tissues and the RLN were evaluated immediately after the procedure by light and electron microscopy.

Results

Electrotome caused a significant decrease in evoked EMG amplitudes when applied at a vertical distance of 1 mm from the RLN, both at 30 kW (1046 ± 404.3 μV vs 153 ± 245.5 μV; p < .001) and 15 kW (1197 ± 589.2 μV vs 986.3 ± 797.3 μV; p = .037), compared with those evoked under normal conditions. Furthermore, distinct acute microstructural morphological changes of the RLNs were observed by light and electron microscopy. However, no significant functional or histological changes were induced by the electrotome at a vertical distance of 5 mm or 3 mm from the RLN. The Harmonic scalpel and LigaSure induced neither marked changes in evoked EMG amplitudes when applied at vertical distances of 5 mm, 3 mm, or 1 mm (all p > .05) nor microstructural morphological changes in the RLNs. The electrotome (15 kW) caused more serious thermal damage to thyroid tissues than that caused by either the Harmonic scalpel or LigaSure (thermal damaged depth: 0.951 ± 0.061 vs 0.756 ± 0.074, p < .001; 0.951 ± 0.061 vs 0.724 ± 0.116, p < .001). Nevertheless, there were no differences between the Harmonic scalpel and LigaSure groups (p = .435).

Conclusion

LigaSure and the Harmonic scalpel might be safer than electrotome when used in thyroid operations. LigaSure generates less heat than the Harmonic scalpel and electrotome. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Cohort study of oncologic emergencies in patients with head and neck cancer

ABSTRACT

Background

Treatments for head and neck squamous cell carcinoma (HNSCC) are associated with toxicities that lead to emergency department presentation.

Methods

We utilized data from an ongoing prospective cohort of newly diagnosed, previously untreated patients (N = 298) with HNSCC to evaluate the association between clinical and epidemiologic factors and risk for and frequency of emergency department presentation. Time to event was calculated from the date of treatment initiation to emergency department presentation, date of death, or current date. Frequency of emergency department presentation was the sum of emergency department visits during the follow-up time.

Results

History of hypertension, normal/underweight body mass index (BMI), and probable depression predicted increased risk for emergency department presentation. BMI and severe pain were associated with higher frequency of emergency department presentations.

Conclusion

Clinical and epidemiologic factors can help predict patients with HNSCC who will present to the emergency department. Such knowledge may improve treatment-related patient outcomes and quality of life. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Reduced Th22 cell proportion and prevention of atopic dermatitis in infants following maternal probiotic supplementation

Abstract

In the randomized, controlled study Probiotics in the Prevention of Allergy among Children in Trondheim (ProPACT), maternal probiotic supplementation reduced the incidence of atopic dermatitis (AD) in the offspring. In the current study, we hypothesized that the effect was mediated by a shift in the T helper (Th) cells in the children.

Objective

To examine whether Th cell proportions were affected by maternal probiotic supplementation and thus could mediate the preventive effect of probiotics on AD.

Methods

415 pregnant women were randomized to ingest a combination of Lactobacillus rhamnosus GG (LGG), Bifidobacterium animalis subsp. lactis Bb-12 (Bb-12), and Lactobacillus acidophilus La-5 (La-5) or placebo, and their offspring were assessed for AD during the first 2 years of life. Peripheral blood collected at 3 months of age was analyzed for regulatory T cells (n = 140) and Th subsets (n = 77) including Th1, Th2, Th9, Th17 and Th22.

Results

The proportion of Th22 cells was reduced in children in the probiotic group compared to the placebo group (median 0.038% vs 0.064%, p=0.009). The difference between the probiotic and placebo group was also observed in the children who did not develop AD during the 2-year follow-up. The proportion of Th22 cells was increased in children who developed AD compared to the children who did not develop AD (0.090% vs 0.044%, p<0.001). Mediation analysis indicated that the preventive effect of probiotics was partially mediated through the reduction of Th22 cells.

Conclusion

Perinatal maternal probiotic supplementation with a combination of LGG, Bb-12 and La-5 reduced the proportion of Th22 cells in 3-month-old children. This may partially explain the preventive effect of probiotics on AD.

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A Curious Case of Intestinal Diaphragm Disease Unmasked by Perforation of a Duodenal Ulcer

Nonsteroidal anti-inflammatory drugs are a common cause of intestinal injury. A variety of NSAID-induced injuries may occur including ulcers, erosions, colitis, strictures, and diaphragm disease. Diaphragm disease refers to the development of multiple thin, concentric, stenosing strictures in the intestine. Strictures occur most often in the midintestine and are thought to be pathognomonic of NSAID damage. They can lead to intermittent or complete bowel obstruction. Diagnosis may be elusive as there is nothing specific about NSAID-induced injury at endoscopy and histology is also nonspecific. Even at laparotomy, the diagnosis of diaphragm disease may be missed as the serosa may appear normal and strictures can be difficult to palpate. While most NSAID-induced lesions tend to resolve quickly following withdrawal of the offending drug, diaphragm-like strictures usually require intervention such as stricturoplasty or surgical resection of the involved segment of bowel. Here we report the case of a 60-year-old male patient who presented with iron deficiency anaemia and recurrent subacute bowel obstruction. Following endoscopy and repeated CT scanning of his abdomen, he was diagnosed with Crohn's disease. He was treated with 5-ASAs and immune suppression until a perforated duodenal ulcer resulted in emergency laparotomy and the subsequent discovery of multiple intestinal diaphragms attributable to long-standing NSAID use.

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Hormone replacement therapy for chronic tinnitus in menopausal women: our experience with 13 cases

Abstract

Tinnitus is a common complaint among patients visiting an ENT clinic. It can cause severe annoyance and distress to some patients. Many treatment modalities are available for the management of tinnitus, with different degrees of effectiveness.

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LIRA-ADD2SGLT2i - Liraglutide Versus Placebo as add-on to SGLT2 Inhibitors

Conditions:   Diabetes;   Diabetes Mellitus, Type 2
Interventions:   Drug: liraglutide;   Drug: placebo
Sponsor:   Novo Nordisk A/S
Recruiting - verified March 2017

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Study of Oral PQR309 in Patients With Advanced Solid Tumors

Condition:   Cancer
Intervention:   Drug: PQR 309
Sponsors:   PIQUR Therapeutics AG;   Roswell Park Cancer Institute;   M.D. Anderson Cancer Center;   University Hospitals Cleveland Medical Center;   Mayo Clinic;   Hospital Clinic of Barcelona;   University College London Hospitals;   Churchill Hospital
Recruiting - verified March 2017

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Unusual case of chronic maxillary rhinosinusitis

Jérôme R. Lechien, MD, MSc; Julien W. Hsieh, MD; Sven Saussez, MD, PhD

Although maxillary rhinosinusitis due to migration of a distractor is rare, it must be suspected in all patients with a history of dysmorphism surgery and unilateral rhinosinusitis.

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Presbyphonia: What can be done?

Karen Kost, MD, FRCSC; Kourosh Parham, MS, PhD, FACS

In assessing elderly patients with dysphonia, it is important to recognize that prespyphonia is a diagnosis of exclusion, and it may coexist with other vocal disorders.

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Arthritis models: usefulness and interpretation

Abstract

Animal models of arthritis are used to better understand pathophysiology of a disease or to seek potential therapeutic targets or strategies. Focusing on models currently used for studying rheumatoid arthritis, we show here in which extent models were invaluable to enlighten different mechanisms such as the role of innate immunity, T and B cells, vessels, or microbiota. Moreover, models were the starting point of in vivo application of cytokine-blocking strategies such as anti-TNF or anti-IL-6 treatments. The most popular models are the different types of collagen-induced arthritis and arthritis in KBN mice. As spontaneous arthritides, human TNF-α transgenic mice are a reliable model. It is mandatory to use animal models in the respect of ethical procedure, particularly regarding the number of animals and the control of pain. Moreover, design of experiments should be of the highest level, animal models of arthritis being dedicated to exploration of well-based novelties, and never used for confirmation or replication of already proven concepts. The best interpretations of data in animal models of arthritis suppose integrated research, including translational studies from animals to humans.

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Validation of olfactory threshold testing methods

Alan Hirsch, MD; Alexander Roussos, MS; Sally Freels, PhD

Abstract

In patients with chemosensory complaints, a head-to-head comparison of unilateral olfaction threshold testing with the Phenyl Ethyl Alcohol Smell Threshold Test (PEA) and the OLFACT-RL Odor Threshold Test (OLFACT-RL) was undertaken. The charts of 23 consecutive patients presenting with chemosensory complaints seen at the Smell and Taste Treatment and Research Foundation were reviewed and information extracted per Institutional Review Board guidelines. All patients had undergone olfactory testing with the PEA test and the OLFACT-RL test in accordance with their published administration manuals. Using Spearman correlation coefficients to measure the statistical correlation between tests, we found evidence of a correlation between PEA and OLFACT-RL values on the left side only, overall (r = 0.49, p = 0.0184); in those who had hyposmia and did not have anosmia (r = 0.42, p = 0.0668); in those who did not have burning mouth syndrome (r = 0.46, p = 0.0304); and in those who did not have dysosmia (r = 0.47, p = 0.0553). There is no evidence of a correlation on the right side. The correlation for the left nostril suggests that these tests may be interchangeable. However, lack of correlation with the right nostril requires further investigation.

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Glomus faciale tumors: A report of 3 cases and literature review

Sahar Nadimi, MD; John P. Leonetti, MD; Sam J. Marzo, MD; Douglas E. Anderson, MD; Gulrez Mahmood, MD; Derek Bumgarner, MD

Abstract

Our objectives in reporting this case series are to familiarize readers with the rare occurrence of paragangliomas originating along the facial nerve and to provide a literature review. We describe 3 such cases that occurred at our tertiary care academic medical center. Two women and 1 man presented with a tumor adjacent to the vertical segment of the facial nerve. The first patient, a 48-year-old woman, presented with what appeared to be a parotid tumor at the stylomastoid foramen; she underwent a parotidectomy, transmastoid facial nerve decompression, and a shave biopsy of the tumor. The second patient, a 66-year-old man, underwent surgery via a postauricular infratemporal fossa approach, and a complete tumor resection was achieved. The third patient, a 56-year-old woman, presented with a middle ear mass; she underwent complete tumor removal through a transmastoid transcanal approach. All 3 patients exhibited normal facial nerve function both before and after surgery. Paragangliomas of the facial nerve are extremely rare, and their signs and symptoms are unlike those of any other temporal bone glomus tumors. Management options include surgical resection, radiologic surveillance, and radiotherapy. The facial nerve can be spared in selected cases.

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Breast cancer metastases to the head and neck: Case series and literature review

Jeremiah C. Tracy, MD; Nicholas R. Mildenhall, MD; Richard O. Wein, MD; Miriam A. O'Leary, MD

Abstract

Breast cancer is the most common cancer in women and is the second most common cause of cancer-related death. Despite the relatively high prevalence of this disease, breast cancer manifestations in the head and neck are relatively rare. Supraclavicular lymphadenopathy and bony metastases to the mandible and maxilla are the most common manifestation of breast cancer in the head and neck. Head and neck metastases are the first presentation of distant disease in approximately one-third of cases. The prognosis of breast cancer with distant metastases to the head and neck is generally poor, and the management of these lesions is controversial. Overall extent of disease and individual patient prognosis must guide treatment decisions. Atypical cases including maxillary sinus mass, jugular foramen mass, and dermal metastases are presented. Metastatic breast cancer is a rare diagnosis in the head and neck, yet metastatic disease from an infraclavicular primary deserves inclusion on any comprehensive differential diagnosis list. In women, breast carcinoma is the most common infraclavicular primary to metastasize to the head and neck.

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Submandibular salivary gland tumors: Clinical course and outcome of a 20-year multicenter study

Aviram Mizrachi, MD; Gideon Bachar, MD; Yaron Unger, MD; Ohad Hilly, MD; Dan M. Fliss, MD; Thomas Shpitzer, MD

Abstract

The purpose of this retrospective chart review study was to review the nature and clinical course of benign and malignant submandibular gland tumors at 2 major university-affiliated tertiary medical centers. All patients who underwent submandibular salivary gland excision between 1990 and 2010 were included. Clinical and disease-related data were collected from the medical charts. One hundred ninety-three patients were identified, of whom 108 (56%) had non-neoplastic disorders (sialolithiasis and sialadenitis). The remaining 85 patients (44%) had a submandibular salivary gland tumor. The most common benign neoplasm was pleomorphic adenoma (53 patients). Twenty tumors (24%) were malignant: adenoid cystic carcinoma in 11 patients, mucoepidermoid carcinoma in 6 patients, and adenocarcinoma in 3 patients. Recurrence was noted in 7 patients with submandibular gland malignancy and in 2 patients with pleomorphic adenoma. The 5-year disease-free survival rate was 63%. Tumors of the submandibular gland are infrequently malignant. Recurrent submandibular salivary gland pleomorphic adenoma is rare compared with recurrences in the parotid gland.

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Speech perception and auditory performance following cochlear implantation in elderly Koreans

Sungsu Lee, MD, PhD; Hyong-Joo Park, MD; Hyong-Ho Cho, MD, PhD; Yong-Beom Cho, MD, PhD

Abstract

The benefits of cochlear implantation (CI) in the elderly remain debatable in terms of sound and speech perception. Moreover, the results of CI may be affected by the intensity and pitch of spoken language. We conducted a retrospective study to evaluate surgical and hospitalization times, postoperative complications, and hearing outcomes after CI in elderly Koreans. Our study population was made up of 55 postlingually deafened adults who underwent unilateral CI. They were divided into two groups based on age; an older group consisted of 21 patients aged 65 years or older (mean 71.8) at the time of CI, and a comparison group was made up of 34 patients aged 18 to 64 years (mean: 47.5). The mean surgical and hospitalization times and the mean number of postoperative complications in the two groups were comparable. Auditory outcomes were quantified by the speech reception threshold (SRT), the speech discrimination test (SDT), scores on the Korean version of the Glendonald Auditory Screening Procedure (GASP-K), and categories of auditory performance (CAP) scores. The SDT and GASP-K values were significantly lower in the older group at 3 months, 1 year, and 2 years; there were no significant differences in mean SRT and CAP values. We conclude that elderly patients may obtain appreciable benefits from CI without experiencing serious surgical complications. Nevertheless, difficulties in speech perception should be taken into consideration in older patients.

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Airway foreign body occurring during in-office vocal fold injection

Pamela Chia, MD; Aaron Jaworek, MD; Robert T. Sataloff, MD, DMA, FACS

Needle foreign bodies in the upper airway can result in life-threatening infections or hemorrhage from injury to the major vessels in the neck or chest.

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Laryngoceles: Concepts of diagnosis and management

Mohammad Kamal Mobashir, PhD, MD; Waleed M. Basha, PhD, MD; Abd ElRaof Said Mohamed, MD; Mostafa Hassaan, MD; Ahmed M. Anany, MD

Abstract

A laryngocele is an abnormal dilatation of the laryngeal saccule. It is a rare benign lesion of the larynx. Various modalities of treatment have been advocated for its management. We present our treatment results and outcomes of a series of cases of laryngoceles and discuss the concepts of their management. This study included patients with different laryngocele types. Patients with an internal laryngocele underwent endoscopic CO2 laser resection, while those with a combined laryngocele underwent resection via a V-shaped lateral thyrotomy approach. Seven patients had an internal laryngocele, and 4 patients had a combined laryngocele. Hoarseness and neck swelling were the most common symptoms. The mean follow-up period was 8.5 months. None of the patients needed a tracheostomy either preoperatively or postoperatively, or had recurrence of laryngocele. We advocate the lateral thyrotomy approach for combined laryngoceles as it provides safe, precise, and complete resection under direct visualization via a single approach, while we favor the endoscopic laser approach for the internal ones as it allows resection of the entire lesion with minimal laryngeal trauma, less operative time, and a shorter hospital stay.

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25 years of powered endoscopic maxillary antrostomy

Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

Powered endoscopic maxillary antrostomy has continued to be a useful procedure during the past 25 years.

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Unilateral optic disc swelling associated with idiopathic hypertrophic pachymeningitis: a rare cause for a rare clinical finding

Description

A woman aged 28 years presented with a 1-year history of left-sided headache. The headache was continuous and interfering with activities of daily living. She did not have vomiting or visual obscurations. She developed left-sided sixth nerve palsy and facial numbness and was referred to us. On clinical evaluation, she had left-sided sensorineural deafness. Fundus examination showed optic disc swelling on the left side and a normal right eye (figure 1A). MRI brain with contrast showed features of hypertrophic pachymeningitis predominantly affecting the left side involving the tentorium and cerebral cortex (figure 1B, E) and encasing the cavernous sinus (figure 1C, D). Optic nerve sheath dilation was evident on the left side (figure 1F, G). Blood counts, serum biochemical tests and erythrocyte sedimentation rate were normal. The serum was negative for rheumatoid factor, antinuclear antibodies and antidouble-stranded DNA. The...

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Group G Streptococcus dysgalactiae subspecies equisimilis, the clinical significance of a rare infection: endocarditis, polyarteritis, septic bursitis and pneumonia with complicated parapneumonic effusion

Description

A man aged 55 years, a smoker, presented with a 7-day history of fever and additive oligoarthritis affecting both shoulders, left ankle (figure 1) and right fist. Group G Lancefield β-haemolytic Streptococcus dysgalactiae subspecies equisimilis (SDSE) was isolated from blood cultures; immunological study was not suggestive of autoimmunity and antistreptolysin O test was negative. In the first day after hospital admission, ischaemic lesions were seen on the fourth left finger (figure 2) and transoesophageal echocardiography was performed showing mitral valve vegetations and multiple jet mitral regurgitation. Multiple strokes affecting the spleen and right kidney were seen on the CT of the thorax, abdomen and pelvis, as well as multiple areas of lung consolidation with bilateral pleural effusion (a complicated exudate was documented after thoracentesis) and a fluid collection around the iliopsoas tendon (iliopectineal bursitis was confirmed by ultrasound-guided aspiration). We assumed SDSE bacteraemia...

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