Primary tinnitus has a severe negative influence on the quality of life of a substantial portion of the general population. When acoustic coordinated reset (CR) neuromodulation stimuli are delivered for several hours per day over several weeks a clinically significant symptom reduction in patients with primary tonal tinnitus has been reported by several clinical sites. Here, we reported the first case where CR neuromodulation was delivered through a hearing aid. A 52-year-old man with chronic primary tonal tinnitus was previously considered untreatable with sound therapy. He initially received the classic CR treatment protocol with signals delivered with the separate proprietary device with his hearing aids removed during treatment. He was subsequently treated with the therapy being deployed through a set of contemporary hearing aids. After 5 months of classic CR treatment with the separate custom device, the THI and VASL/A scores worsened by 57% and 13%/14%, respectively. Using the hearing aid without CR treatment for 5 months no change in tinnitus symptoms was observed. However, after three months of CR treatment delivered through the hearing aids, the THI and VASL/A scores were reduced by 70% and 32%/32%, respectively.
http://ift.tt/2oj78Jg
Τετάρτη 29 Μαρτίου 2017
Technical Feasibility of Acoustic Coordinated Reset Therapy for Tinnitus Delivered via Hearing Aids: A Case Study
Checkpointhemmer beim Melanom: Nebenwirkungen meist geringgradig
Wie stark fallen Nebenwirkungen im Zusammenhang mit der Immuntherapie bei Melanompatienten aus und wie lassen sie sich beherrschen? Antworten auf diese Fragen lassen sich an der gepoolten Auswertung von vier klinischen Studien ablesen.
http://ift.tt/2nxsBy1
Niedrig-Risiko-Basalzellkarzinome: zuerst ein Therapieversuch mit Imiquimod?
In der Behandlung von Basalzellkarzinomen schneidet Imiquimod zwar schlechter ab als die Exzision. Bei frühem Ansprechen scheint der Erfolg aber langfristig Bestand zu haben.
http://ift.tt/2nxCcEY
Ist Ihr Wartebereich noch zeitgemäß?
Als Arzt fachlich immer auf dem neuesten Stand zu sein, ist für Sie wahrscheinlich selbstverständlich. Ob sich Ihre Patienten jedoch bei Ihnen wohlfühlen, gern wiederkommen oder gar Empfehlungen aussprechen, entscheidet sich meist weitaus früher als bei der eigentlichen Behandlung: im Wartebereich.
http://ift.tt/2nC62Kg
GOÄ-Mindestzeiten müssen nicht immer auf die Rechnung
Gehören Zeitvorgaben aus der Gebührenordnung für Ärzte (GOÄ) mit auf die Rechnung? Wann könnte es Ärger mit Patienten oder mit der Krankenversicherung geben, wenn die Angabe der Mindestzeit fehlt? Die Antwort steht, wie so oft, im Kleingedruckten der GOÄ.
http://ift.tt/2nxuZ87
Neuer Ansatz gegen Akne
Ein topischer Hemmstoff der Sebumproduktion hat sich in einer Phase-IIa-Studie bei Acne vulgaris im Gesicht bewährt.
http://ift.tt/2nxG2hw
Kombinationstherapie beim mukosalen Melanom
In einer gepoolten Datenanalyse wurde erstmals Sicherheit und Wirksamkeit von Nivolumab als Monosubstanz und in Kombination mit Ipilimumab beim seltenen, hochaggressiven mukosalen Melanom untersucht.
http://ift.tt/2nxGT1M
Melanom: breites Spektrum an Nebenwirkungen
Anti-PD-1-Antikörper sind eine effektive Therapieoption bei metastasiertem Melanom und anderen Krebsarten. Allerdings können sie immunbedingte unerwünschte Ereignisse induzieren.
http://ift.tt/2nC51lk
Vitiligo: Tacrolimus unterstützt UV-Therapie bei Kindern
Bei Kindern mit Vitiligo wird eine UV-Bestrahlung in der Regel bei großflächigen Pigmentierungsstörungen angewandt, Tacrolimussalbe bei kleineren Flecken. Über die Wirksamkeit einer Kombitherapie bei Kindern war bislang wenig bekannt. Diese Lücke wollten indische Hautärzte mit einer eigenen kleinen Studie füllen.
http://ift.tt/2nxRBp2
So viel verdienen niedergelassene Ärzte
Trotz steigender Betriebskosten: Die wirtschaftliche Lage in den Vertragsarztpraxen hat sich zwischen den Jahren 2011 und 2014 merklich verbessert. Die Einnahmen je Inhaber stiegen um 10,2 %, der Jahresüberschuss — also der Gewinn — um 6,7 %, während die Praxiskosten um 8,9 % zulegten. Das zeigen die aktuellen Daten des Zi-Praxis-Panels (ZiPP), die aus über 5.000 Praxen generiert wurden.
http://ift.tt/2nCch0C
Die Angst vor dem Altern
Narziss wird für Hochmut und Eigenliebe mit dem Tod bestraft, bevor er mit dem Alter konfrontiert werden kann. Sein Seelenverwandter aus dem 19. Jahrhundert hat Jahrzehnte, sein unverändert jugendliches Aussehen auszukosten — was seinen Hochmut erst auf die Spitze treibt. Doch mit dem inbrünstigen Wunsch, nicht zu altern, hat Dorian Gray bereits eine verheerende Wahl getroffen.
http://ift.tt/2nxG210
Zahl der dokumentierten Melanome nimmt zu
Um die Stadienverteilung von Melanomen und die Überlebensraten der Patienten zu analysieren, hatte die Arbeitsgemeinschaft Deutscher Tumorzentren (ADT) die deutschen populationsbasierten und klinischen Tumorregister um Daten zu den zwischen 2002 und 2011 neu diagnostizierten Melanomen gebeten. Nun liegt die Auswertung von 61.895 Fällen vor.
http://ift.tt/2nxH0dC
Vorsicht bei der Selbstbehandlung von Schwielen und Clavi!
Bevor sich Patienten mit Schwielen und Hühneraugen einfach besser passende Schuhe kaufen, behandeln sie sich lieber selbst etwa mit Hühneraugenpflastern, Credohobeln oder sogar Bohrmaschinen. Dies birgt diverse Gefahren. Von welchen Maßnahmen sollten Sie abraten?
http://ift.tt/2nC4ZtI
IL-17A-Antikörper bei palmoplantarer Psoriasis
Psoriasisbedingte Hautveränderungen an Händen und Füßen können jedes Zugreifen und jeden Schritt zur Tortur werden lassen. An diesen Stellen ist der Schuppenflechte allerdings nur schwer beizukommen. Laut einer aktuellen Phase-III-Studie verspricht der humane Antikörper Secukinumab Linderung.
http://ift.tt/2nxC4W2
Das bringen die neuen EBM-Positionen zur Videosprechstunde
Eine Technikpauschale, die außerhalb der Gesamtvergütung läuft, und eine Video-Kontakt-Ziffer: Die neuen Leistungen im EBM für die Videosprechstunde klingen vielversprechend. Am Fernbehandlungsverbot rütteln sie aber nicht.
http://ift.tt/2nC9Jzx
Studiendesigns im Umbruch
Sie heißen CUSTOM, BATTLE oder ALCHEMIST und stehen für eine neue Generation klinischer Studien, die sich von den klassischen Protokollen deutlich unterscheiden — etwa Enrichment-, Umbrella- oder Basket-Designs. Eingeläutet hat diese Entwicklung die genetische Sequenzierung von Tumorgewebe.
http://ift.tt/2nC4pfu
Reversible Inferolateral ST-Segment Elevation Associated with Small Bowel Obstruction
ST-segment elevation is an important and alarming electrocardiographic sign that necessitates immediate attention but does not always indicate that the primary pathology is cardiac in origin. It needs to be interpreted in the clinical context as several pathological conditions involving especially gastrointestinal tract may lead to delayed diagnosis and treatment as well as complications from invasive unnecessary interventions. We present two patients, a 64-year-old male and a 71-year-old female, who were admitted to the emergency room of a community-based hospital with similar complaints of worsening epigastric abdominal pain and were diagnosed later with small bowel obstruction. Both patients reported a history of abdominal surgeries in the past. Also in both patients the ECG showed signs of ST-segment elevation in inferior and lateral leads. These ECG changes were related to the intra-abdominal pathology as no evidence of contributing coronary artery disease could be found. In addition, prompt resolution of ST-segment elevation was seen after surgical treatment. The pathophysiological etiology of electrocardiographic changes accompanying small bowel obstruction is yet to be explored.
http://ift.tt/2ojbkbP
Artificial sweeteners and mixture of food additives cause to break oral tolerance and induce food allergy in murine oral tolerance model for food allergy
Summary
Background
Processed foods are part of daily life. Almost all processed foods contain food additives such as sweeteners, preservatives and colourants. From childhood, it is difficult to avoid consuming food additives. It is thought that oral tolerance for food antigens is acquired during early life. If tolerance fails, adverse immune responses to food proteins may occur.
Objective
We hypothesised that food additives prevent acquisition of oral tolerance and aimed to verify the safety of food additives.
Methods
We induced experimental oral tolerance in mice for ovalbumin (OVA), a food antigen, by previous oral treatment with OVA before sensitisation with OVA injections. Food additives were administered at the induction of oral tolerance, and food allergy was induced by repeated administration of OVA. Symptoms of food allergy were defined as a change in body temperature and allergic diarrhoea.
Results
Saccharin sodium and a mixture of food additives inhibited acquisition of oral tolerance. Hypothermia and allergic diarrhoea with elevation of OVA-specific IgE were induced in the murine model of oral tolerance. Analyses of antigen presenting cells in mesenteric lymph nodes showed that food additives affected their manner of migration. Additionally, food additives decreased the proportion of CD25hi regulatory T cells among CD4+ T cells in the mesenteric lymph nodes.
Conclusions and Clinical Relevance
A large amount of food additives may prevent acquisition of oral tolerance. Intake of food additives in early life may increase the risk of food allergies.
This article is protected by copyright. All rights reserved.
http://ift.tt/2ocQTR5
Can floseal™ be applied safely during otologic surgery? Assessment of ototoxicity in a chinchilla animal model
In otologic surgery good visualization is paramount, and patients with bleeding diatheses or who need to be anti-coagulated can present a significant challenge. Here, we determine whether Floseal™, a hemostati...
http://ift.tt/2nBXF19
Evaluation of the postoperative cognitive dysfunction in elderly patients with general anesthesia
OBJECTIVE: The present study is aimed to study the neuron-specific enolase (NSE) and S100b proteins in the evaluation of postoperative cognitive dysfunction in elderly patients with general anesthesia.
PATIENTS AND METHODS: A total of 142 aged patients, who were treated with transurethral resection of the prostate (TURP) surgery under general anesthesia with propofol from June 2014 to December 2015, were randomly divided into two groups. The experiment group was given scopolamine butylbromide by intramuscular injection before the operation, while the control group had no preoperative intramuscular injection. The propofol was used for maintenance during the operation. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scales were adopted for testing the patients on preoperative day 1, postoperative day 2 and postoperative day 9. After the surgery, there were 4 cases of postoperative cognitive dysfunction (POCD) patients in experiment group, while 21 cases of POCD patients in control group. While the 142 healthy adult volunteers, who were admitted to physical examination center of our hospital in the corresponding period, were selected as healthy controls. The expression levels of S100b and NSE of patients, as well as healthy controls, were detected by ELISA.
RESULTS: In POCD patients, serum S100b and NSE levels were evidently higher than those of patients without POCD and healthy control group (p < 0.05). S100b and NSE levels of POCD patients in experiment group were significantly lower than those of control group (p < 0.05). Serum S100b and NSE levels are higher, the longer duration of POCD is, as the correlation coefficient rs = -0.1342, -1.6644, p < 0.05.
CONCLUSIONS: The expression levels of S100b protein and plasma NSE in the serum of POCD patients increased, which indicated the severity of the disease. The preoperative intramuscular injection of scopolamine butylbromide has important clinical significance for the prevention of POCD.
L'articolo Evaluation of the postoperative cognitive dysfunction in elderly patients with general anesthesia sembra essere il primo su European Review.
http://ift.tt/2oaugN1
Anesthesia and analgesia in breast surgery: the benefits of peripheral nerve block
Breast surgery is frequently associated with postoperative pain, nausea and vomiting, that result in increased patient's suffering, prolongation of hospital stays and related costs. Thoracic paravertebral nerve block (TPVB) is a viable option to the classic multimodal analgesia in breast surgery as it enhances surgical anesthesia and postoperative analgesia.
In this review, we report the results of a number of studies on the role of TPVB in breast surgery. This technique is associated with a superior control of the pain, a reduction in opioids consumption after surgery, a decrease in postoperative nausea and vomiting, and an overall decrease in length of hospital stay. In particular, TPVB seems to provide the most benefits in patients undergoing an unilateral or bilateral mastectomy followed by immediate reconstruction. Some studies also suggest that the use of regional anesthesia-analgesia could attenuate perioperative immunosuppression and minimize metastases in breast cancer patients.
TPVB can be also coupled with other regional anesthetic techniques such as pectoral nerve block (PNB), thus increasing the reduction in postsurgical pain, opioids consumption and length of hospital stays.
L'articolo Anesthesia and analgesia in breast surgery: the benefits of peripheral nerve block sembra essere il primo su European Review.
http://ift.tt/2ofCQab
Racial disparities in the impact of chronic pruritus: A cross-sectional study on quality of life and resource utilization in United States Veterans
Chronic pruritus has a lifetime prevalence of up to 26% in the worldwide population. Research has shown that the incidence and quality of life (QoL) impact of chronic pruritus varies by race.
http://ift.tt/2ocxCzg
Tumor recurrence of keratinocyte carcinomas judged appropriate for Mohs micrographic surgery using Appropriate Use Criteria
The use of Mohs micrographic surgery (MMS) has increased greatly to treat basal cell and cutaneous squamous cell carcinomas (keratinocyte carcinoma [KC]), and consensus-based Appropriate Use Criteria (AUC) were developed to identify tumors for which MMS is appropriate.
http://ift.tt/2nx9RPh
Association of atopy phenotypes with new development of asthma and bronchial hyperresponsiveness in school-aged children
Although previous studies have investigated the association between atopy phenotypes and allergic diseases, atopy characterizations in association with the development of allergic diseases remain poorly understood.
http://ift.tt/2nibwq4
Helmet Wear and Craniofacial Trauma Burden: A Plea for Regulations Mandating Protective Helmet Wear
Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1601430
Helmet wear offers protection in various ways against craniomaxillofacial and brain trauma. The specific pattern and overall burden of craniofacial trauma among helmeted and unhelmeted patients has not been well defined.This is a retrospective review of trauma patients involved in documented helmet-associated injuries that presented to the Mayo Clinic Emergency Department in Rochester, Minnesota, and completed initial trauma evaluation between 1999 and 2015.A total of 417 patients (50% unhelmeted, 82% male) were identified. The median age at injury was 22.9 years (interquartile range [IQR]: 15.2–44.2]) and median follow-up was 26 months ([IQR: 2.2–64.8]). The majority of injuries involved motorcycle accidents (57.6%), bicycles (30.2%), and other modes of injury (12.7%). The mean Glasgow Coma Score (GSC) at the time of presentation was 14.2 (SD ± 2.4) and mean injury severity score (ISS) was 10.2 (SD ± 7.5). Motorcycle accidents had a higher mean ISS compared with other modes of injury (p = 0.048). Unhelmeted patients were more likely to sustain scalp lacerations (p < 0.0001), facial bone fractures (p = 0.01), scalp hematomas (p = 0.041), skull fractures (p = 0.017), and are more likely to require hospital admission (p = 0.0003). Unhelmeted patients' hospital length of stay was on average 2 days longer than helmeted patients' stay (p = 0.0721). Unhelmeted patients were more likely to require out-of-home placement than helmeted patients.Among trauma patients, helmet use was associated with less scalp lacerations and hematomas, facial bones fractures, skull fractures, and need for hospital admission. Adoption of legislation and regulations mandating protective helmet use in all states are strongly encouraged to minimize the burden of craniofacial injuries among unhelmeted patients.
[...]
Thieme Medical Publishers, Inc. 333 Seventh Avenue, New York, NY 10001, USA
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2nBQkPh
Treatment of Mandibular Angle Fractures with Single Three-Dimensional Locking Miniplates without Maxillomandibular Fixation: How Much Fixation Is Required?
Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1600904
The aim of this simple nonrandomized and observational study was to evaluate the efficacy of single three-dimensional (3D) plate for the treatment of mandibular angle fractures without maxillomandibular fixation.A total of 30 patients with noncomminuted fractures of mandibular angle requiring open reduction and internal fixation were included in the study. All the patients were treated by open reduction and internal fixation using single 3D titanium locking miniplate placed with the help of transbuccal trocar or Synthes 90-degree hand piece and screw driver. 3D locking titanium miniplates used in our study was four-holed, box-shaped plate, and screws with 2 mm diameter and 8 mm length. The following clinical parameters were assessed for each patient at each follow-up visit: pain (visual analog scale: 0–5), swelling (visual analog scale: 0–5), mouth opening, infection, paresthesia, hardware failure (plate fracture), occlusal discrepancies, and mobility between fracture fragments.A significant decrease in pain level was seen during the follow-up visits. No statistically significant changes were seen in swelling, but mouth opening increased in the subsequent visits. Also better results were seen in terms of fracture stability and occlusion in the postoperative period. Two cases of infection and two cases of hardware failure were noted in sixth postoperative week.3D plating system is an easy to use alternative to conventional miniplates to treat mandibular angle fractures that uses lesser foreign material, thus reducing the operative time and overall cost of the treatment. Better fracture stability and occlusion was also achieved using the 3D plating system.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2nBSPkv
Fracture of the Clavicle following Radical Neck Dissection and Reconstruction Using Pectoralis Major Myocutaneous Flap Accompanied by Postoperative Radiotherapy
Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1600903
Fracture of the clavicle following radical neck dissection (RND) and/or radiotherapy is a rare complication. Several causes of fracture of the clavicle after treatment of head and neck cancer were postulated in previous reports. We present a case of fracture of the clavicle after treatment of squamous cell carcinoma of the tongue. An 81-year-old Japanese woman underwent RND, subtotal glossectomy, reconstruction using a pectoralis major myocutaneous flap (PMMCF), and postoperative radiotherapy (50.4 Gy). One month after the primary treatment, fracture of the clavicle occurred. It was thought that muscular dynamic factor and reduction of blood supply in the clavicle associated with RND and PMMCF were the causes of the fracture. We have to recognize the occurrence of this complication and try to reduce the factors related to the complication.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2nBRGcU
Sinus Grafts: Science and Techniques—Then and Now
Abstract
Introduction
Sinus lifts have been around for more than four decades now, and the amount of changes that we have seen in techniques and armamentarium coupled with the advent of newer materials is worth taking note of.
Materials and Methods
A complete review of the literature was done since the advent of ways and means to augment the posterior maxilla with a run through of various advantages and disadvantages of the same.
Conclusion
In conclusion, we can say that this procedure is today very predictable and offers clinicians a possibility to rehabilitate the posterior maxilla with implant-based solutions.
http://ift.tt/2oiLJzP
Microcarrier culture enhances osteogenic potential of human periodontal ligament stromal cells
Regeneration of periodontal tissue represents a major challenge to modern tissue engineering, since cell-based therapies require large amounts of periodontal ligament stromal cells (PLSC), which can be obtained only by in vitro expansion. Ideally, the period of the in vitro expansion should be optimized for the generation of large enough numbers of pre-specified progenitor cells ready to contribute to the restoration of periodontal tissues.In the present study, we used a commercially available, three-dimensional culturing platform and alginate microcarrier cell culture system for the propagation of human PLSCs, which were derived using the explant outgrowth method.
http://ift.tt/2oAlWT5
Some Innovative Evolutions in Surgery of the Cranio-Maxillofacial Skeleton
The following remarks were presented on a lecture at the general meeting of the AAOMFS in October 2015 in Washington DC. As the first invitation to the American Association was in 1966 by its President General Bob Shira, this was my last talk in the United States at the age of 95 years.
http://ift.tt/2oAcwH1
Surgical correction of mandibular hypoplasia in hemifacial microsomia, a retrospective study in 39 patients
Repair of the mandibular deformity in hemifacial microsomia (HFM) remains controversial, and there is scant information in the literature regarding the late outcomes. The aim of this study was to evaluate architectural and aesthetic long-term outcomes for primary mandibular surgery in patients with HFM.
http://ift.tt/2nNrmwR
The indication for endoscopic butterfly cartilage myringoplasty in children
Source:Auris Nasus Larynx
Author(s): Zheng-Cai Lou
http://ift.tt/2nkO1NT
Transcanal endoscopic approach to lesions of the suprageniculate ganglion fossa
Source:Auris Nasus Larynx
Author(s): Daniele Marchioni, Alessia Rubini, João Flávio Nogueira, Brandon Isaacson, Livio Presutti
ObjectiveThe aim of this paper would be to describe the first case series of exclusive transcanal endoscopic approach to treat lesions with limited extension at the suprageniculate fossa. This endoscopic approach allowed a complete removal of suprageniculate disesases with low complication rates using a minimally invasive surgical route.MethodsThis is a retrospective chart analysis and a surgery video recording review of these patients were performed in August 2015. From November 2011 to November 2015, 29 patients were submitted to an endoscopic transcanal lateral skull base surgery. From those 29 subjects, in 6 patients an exclusive endoscopic transcanal suprageniculate approach was performed to remove lesions located into the geniculate fossa. Surgical indications, pre-operative assessment, results were collected and the surgical technique were described.ResultsThe final study group was composed of 6 patients. 3 male and 3 female; median age is 25.3 years old. In all 6 subjects it was possible to remove the lesions using an exclusive endoscopic transcanal suprageniculate approach. No intraoperaoperative complications were observed in any patients. The mean follow up period was 15.16 months.ConclusionExclusive endoscopic transcanal suprageniculate approach is definitely a minimally invasive technique and should be consider an optimal solution to treat lesions located in the suprageniculate fossa in some patients. We introduce a minimally invasive approach to the geniculate ganglion region in order to allow complete removal of suprageniculate disesases with low complication rates using a minimally invasive surgical route.
http://ift.tt/2mQVeJu
Partial cricotracheal resection for severe upper tracheal stenosis: Potential impacts on the outcome
Source:Auris Nasus Larynx
Author(s): Ahmed Musaad Abd El-Fattah, Hisham Atef Ebada, Hazem Emam Amer, Mohammed Mohammed Abosamra, Ali Tawfik
ObjectiveThe aim of this study was to investigate the potential impact of multiple preoperative and intraoperative variables on the outcome of partial cricotracheal resection and tracheal resection anastomosis (PCTR/TRA).MethodsThe study was conducted on 35 consecutive patients of grade III and IV upper tracheal stenosis with or without subglottic involvement. The indication of PCTR/TRA was post intubation stenosis in all patients. Overall complications (major and minor) occurred in 18 patients. Perioperative mortality occurred in 1 patient. Anastomotic complications do not always mean failure of surgery. They may indicate one or more interventions; such as removal of granulation tissue or dilatation of restenosis, with good results in most cases.ResultsAt the end of treatment, 30 (85.7%) patients were decannulated successfully with effortless breathing and with good phonation and swallowing. Several perioperative factors were found to have a significant impact on the outcome of PCTR/TRA. Of these factors, comorbidities had the most significant negative impact, and indeed all the three patients who had comorbidities, were not successfully decannulated. Duration of intubation, length of resected segment and previous open airway interventions was reported to have a significant negative impact on the outcome of surgery.ConclusionPCTR/TRA for treatment of post traumatic subglottic or upper tracheal stenosis has a high success rate, especially in healthy patients without comorbidities, and without previous open airway interventions.
http://ift.tt/2nkPmEw
ATA Signal e-News March 2017 Secretary’s Update
 |
| Victor J. Bernet, MD Secretary/Chief Operating Officer |
Secretary's Update, March 2017
Well, Spring is here and so is the ATA Spring 2017 Satellite Symposium in Orlando, Hypothyroidism: Where Are We Now? This activity is being held 31 March, 2017 between 1:00 and 5:30 pm in the Orange County Convention and Exhibition Center. We hope to see you there! Also, we would very much like to hear your thoughts on potential topics for future symposia.
To indirectly quote Bobbi Smith: we have so many ATA irons in the fire to the point of inducing dizziness. Hyperbole, maybe, but actually not so far from the truth. ATA leadership and committees continue to move forward on initiatives related to our strategic plan. So let's review: Strategic focus on efforts for patients. Well, the Spring Symposia will include a first ever patient panel and a remarkable 11,969 patients have completed a survey, the results of which will be discussed at the symposium. The ATA is also reaching out to patients thru Philip James who hosts the "Doctor Thyroid" podcast series at www.docthyroid.com. He has already interviewed several ATA members and these excellent podcasts are available on the listed website. Furthermore, the ATA headquarters' staff, with support from our consultants at Just Write Solutions, has just submitted an application to participate in the NIH Program "All of Us." If successful, the ATA will receive funding to support patient recruitment and education for this initiative with a special focus on underrepresented groups with thyroid disease within the United States.
Strategic focus on global leadership. We have made several advances. Members Elizabeth Pearce and Angela Leung, composed a letter to request that iodine be included as an essential micronutrient within the strategic plan for the NIH Nutrition Research Task Force (NRTF). The ATA is also involved in an effort to develop modules for primary care thyroid education in India. Furthermore, arrangements have been made with sister societies such as SNMMI to have shared symposia at our respective national meetings. The ATA expressed our concerns about the unintended negative consequences on medical research and international collaboration that the proposed executive order on travel restrictions can be anticipated to engender in several ways: a letter to the White House, a press release on the website and to the public media through NewsWise.
Strategic focus to support research efforts. With support from Rebecca Schweppe, the Research Committee plus assists by Tony Hollenberg and Tony Bianco, the ATA is in negotiations with representatives from the Nuclear Receptor Signaling Atlas (NURSA) soon to be known as Signaling Pathways to develop a data repository for thyroid diseases. This partnership is expected to make a panoply of raw data from various basic science projects available for further analysis with the intent of leading to additional research and meaningful discoveries. The Research Committee is also in the midst of reviewing submissions for awarding of research grants. We appreciate the continuing support from ThyCa, Bite Me Cancer, and the ATA Campaign endowment which make these research funds available.
The ATC Guidelines Policy Task Force continues its efforts. A new initiative with these guidelines is that arrangements have been made to support very methodical literature reviews which will hopefully strengthen the guidelines and facilitate guideline acceptance by the National Guidelines Clearinghouse which represents the newest in guideline standards.
Finally, the webpage for the 87th Annual Meeting of the ATA in Victoria, British Columbia, is open with preliminary information on program http://ift.tt/2oj2wTB. Regular abstract submissions open 29 March, 2017 with a submission deadline of June 7th. The annual program this year is shaping to be a great one and the Program Committee will be adding a Pediatric Symposium to the annual meeting agenda as well.
And with that, are you dizzy yet?
We hope to see you at the symposium in Orlando and please visit the ATA exhibit booth at the ENDO Expo – come see us and say hello. I'll be looking for you!
Sincerely,
Victor J. Bernet, MD
Secretary/Chief Operating Officer
The post ATA Signal e-News March 2017 Secretary's Update appeared first on American Thyroid Association.
http://ift.tt/2ozLNKW
Squamous cell carcinoma of the pinna: which histological features could be used to predict prognosis?
Squamous cell carcinoma (SCC) that originates in the pinna is thought to have a high risk of metastases (up to 16%) compared with under 5% for cutaneous SCC at any other site, and histological features of the primary tumour may provide evidence for further surveillance or treatment. To identify any association between histological features and the risk of metastases we made an electronic search of the histopathological records at the University Hospital Southampton NHS Foundation Trust for all patients who presented with auricular SCC from 2007-2012.
http://ift.tt/2nx40JD
Infantile hemangiopericytoma of the tongue—Efficacy of ex utero intrapartum treatment procedure and combined-modality therapy
Here we present an extremely rare case of giant infantile hemangiopericytoma (HPC) of the tongue diagnosed prenatally by fetal ultrasonography and MR imaging. Due to airway stenosis, the patient was delivered by the ex utero intrapartum treatment (EXIT) procedure at 36 weeks of pregnancy. Initial diagnosis was infantile hemangioma based on physical examination, diagnostic imaging and the high incidence of hemangioma. The tumor was resistant to conservative treatments. Due to severe tumor hemorrhage, the nutrient vessel was embolized by endovascular treatment on the 73th day after birth.
http://ift.tt/2mQKoDm
Transcanal endoscopic approach to lesions of the suprageniculate ganglion fossa
The aim of this paper would be to describe the first case series of exclusive transcanal endoscopic approach to treat lesions with limited extension at the suprageniculate fossa. This endoscopic approach allowed a complete removal of suprageniculate disesases with low complication rates using a minimally invasive surgical route.
http://ift.tt/2nx6mbs
Spontaneous resolution of hypercalcemia
Source:American Journal of Otolaryngology
Author(s): Emily N. Ahadizadeh, Nauman F. Manzoor, Jay Wasman, Pierre Lavertu
BackgroundPrimary hyperparathyroidism (PHPT) is a frequently encountered endocrine disorder due to benign neoplastic lesions or gland hyperplasia. It is often discovered incidentally when routine lab work reveals hypercalcemia.MethodsThis case presents a 55-year-old male with a neck mass and electrolyte irregularities consistent with PHPT. However, his laboratory values suddenly normalized prior to surgery.ResultsPost-operative pathologic analysis of the specimen demonstrated massive infarction of the affected gland, and explained the spontaneous resolution of the patient's electrolyte derangements.ConclusionsThe objective of this case study is to demonstrate the importance of further investigation in patients with fluctuating lab values and emphasize the potential dangers of gland infarction.
http://ift.tt/2o9r3gt
Ulkus bei Adipositas-assoziierter chronischer Veneninsuffizienz
Zusammenfassung
Hintergrund
Die chronische Veneninsuffizienz ist ein häufig auftretendes Krankheitsbild, bestehend aus einem charakteristischen Symptomkomplex und Hautveränderungen. Häufig sind varikös veränderte Venen mit Refluxen und/oder Obstruktion vorhanden. Auch ohne diese können bei adipösen Patienten durch funktionelle Beeinträchtigungen des venösen (und lymphatischen) Abfluss chronische Veneninsuffizienz-artige Beschwerden und Hautveränderungen bis hin zu Ulzerationen auftreten. Ziel dieser Arbeit war es, Patienten mit Ulzerationen bei Adipositas-assoziierter chronischer Veneninsuffizienz darzustellen und typische Merkmale herauszuarbeiten.
Patientenkollektiv/Material und Methoden
Es wurden 7 Patienten mit Ulzerationen der Unterschenkel bei Adipositas-assoziierter chronischer Veneninsuffizienz untersucht. Neben der klinischen Untersuchung, die auch die Beweglichkeit im Sprunggelenk beurteilte, erfolgten eine digitale Photoplethysmographie, eine Duplexsonographie zum Ausschluss von Refluxen oder Stenosen der Bein- und Beckenvenen sowie eine arterielle Verschlussdruckmessung zum Ausschluss einer peripheren arteriellen Verschlusskrankheit.
Ergebnisse
Bei allen 7 Patienten lag eine Adipositas Grad I–III vor. Es zeigten sich teils multiple Ulzerationen am proximalen oder ventrolateralen Unterschenkel. Die Umgebung zeigte Rötung, Schuppung und Hyperpigmentierung, die als Zeichen einer chronischen Veneninsuffizienz zu werten sind. Häufig traten die Ulzerationen posttraumatisch oder nach Insektenstichen auf.
Diskussion
Die Ursache der Adipositas-assoziierten chronischen Veneninsuffizienz wird in der Erhöhung des intraabdominellen Drucks durch abdominelle Fettmassen gesehen. Diese führt zu einer messbaren venösen Hypertonie. Die Therapie erfolgt durch eine konsequente Kompressionstherapie und eine leitliniengerechte Behandlung der Adipositas.
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Adverse skin reaction to Secukinumab
Abstract
Psoriasis is a chronic, immune-mediated inflammatory skin disorder affecting about 1 to 3% of the population worldwide (1). The treatment of psoriasis has undergone a revolution with the advent of biologic therapies, including TNF-a inhibitors and interleukin (IL) 12/23 and 17 inhibitors. In 2015, secukinumab was the first IL-17A inhibitor approved for the treatment of moderate-to-severe psoriasis, and more recently for the treatment of ankylosing spondylitis and psoriatic arthritis (2). We report a severe cutaneous reaction to secukinumab that required termination of therapy in a patient non-responder to all biologic drugs approved for the treatment of psoriasis.
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Verrucous Eyebrows: A Cutaneous Manifestation of a Systemic Disease
Abstract
Sarcoidosis is an inflammatory disease that can involve numerous organ systems, with the skin being the second most commonly affected.1 The histopathological hallmark of sarcoidosis is the presence of non-caseating epithelioid-cell granulomas, but its numerous clinical manifestations can resemble those of other skin diseases.2,3 We report the unique presentation of a woman who developed verrucous sarcoidal lesions around the eyebrows bilaterally at the site of cosmetic eyebrow tattoos, ultimately leading to a diagnosis of otherwise asymptomatic systemic sarcoidosis.
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Guideline-based clinical decision support in acne patients receiving isotretinoin; improving adherence and cost-effectiveness
Abstract
Clinical practice guidelines have proven to be a tool for condensing the overwhelming quantity of (new) medical knowledge. However, there are barriers to implementation and adherence.1,2 Often guidelines are still bulky texts that do not support in finding patient-specific recommendations.2,3 Aforementioned barriers stimulated the development of clinical decision support (CDS) systems, which could ultimately be incorporated into electronic health records. CDS modifies clinician behavior through recommendations of specific actions. Not the healthcare professional needs to decide whether consultation of a guideline is necessary, but support is delivered directly in daily practice.4,5
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High-dose intravenous immunoglobulin therapy for scleromyxedema: a prospective open label clinical trial using an objective score of clinical evaluation system
Abstract
Background
Scleromyxedema is a primary fibro-mucinosis whose therapy is still challenging.
Objective
To evaluate the safety and efficacy of high-dose intravenous immunoglobulin (IVIg) for the management of scleromyxedema prospectically using an objective score.
Methods
In a prospective open-label study, IVIg was administered to 8 patients with scleromyxedema in a dose of 2 gr/Kg per month. The patients were followed up to a minimum of 6 months and their disease activity and response to treatment were assessed using the Physician's Global Assessment of disease severity (PGA) and a modified objective skin scoring system for patients with scleroderma (modified Rodnan score system for scleromyxedema or mRSSS). We used a stringent statistical nonparametric test, the Mann-Whitney test, to assess the changes in the mRSSS following therapy with IVIg.
Results
Eight patients were included (5 males) with a mean age of 59 years. Mean duration of scleromyxedema was 19 months (6-37 months). The mean duration of treatment was 36.5 months (range 7-74 months).The patients were followed-up for a minimum of 15 months to a maximum of 87 months (mean 44 months). The mean baseline mRSSS of our cohort was 82.38 (37-145, standard deviation 40.763) at the start of treatment, and this significantly decreased to 14.88 (0-37, standard deviation 12.988) (p=0.012) at the last clinical evaluation with a decrease of mRSSS of 81.6%. No considerable side effects were noted. Paraproteinemia remained substantially unchanged. In 6 cases, maintenance infusions were required to preserve disease control while in two patients therapy was stopped after 7 and 11 months. Relapses, however, occurred respectively after 6 and 25 months.
Conclusions
Our study is the first to demonstrate a statistically clinical objective improvement of clinical symptoms of scleromyxedema with IVIg.
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Degos disease, not just a scar: lethal outcome inspite of immunomodulatory therapy
Abstract
Degos disease (DD) or papulosis atrophicans maligna, is an extremely infrequent thrombotic microangiopathy of unknown etiology(1). Clinically, it is characterized by small erythematous papules with an atrophic center that may simulate a simple scar and distinct histopathological feature that is not always present. Due to the rarity of this entity, diagnosis may go unnoticed with the first onset of cutaneous lesions. Therefore, high clinical suspicion and adequate clinicopathological correlation are required to establish an early diagnosis and consequently treatment.
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Investigating time-efficiency of forward masking paradigms for estimating basilar membrane input-output characteristics
by Michal Fereczkowski, Morten L. Jepsen, Torsten Dau, Ewen N. MacDonald
It is well known that pure-tone audiometry does not sufficiently describe individual hearing loss (HL) and that additional measures beyond pure-tone sensitivity might improve the diagnostics of hearing deficits. Specifically, forward masking experiments to estimate basilar-membrane (BM) input-output (I/O) function have been proposed. However, such measures are very time consuming. The present study investigated possible modifications of the temporal masking curve (TMC) paradigm to improve time and measurement efficiency. In experiment 1, estimates of knee point (KP) and compression ratio (CR) of individual BM I/Os were derived without considering the corresponding individual "off-frequency" TMC. While accurate estimation of KPs was possible, it is difficult to ensure that the tested dynamic range is sufficient. Therefore, in experiment 2, a TMC-based paradigm, referred to as the "gap method", was tested. In contrast to the standard TMC paradigm, the maker level was kept fixed and the "gap threshold" was obtained, such that the masker just masks a low-level (12 dB sensation level) signal. It is argued that this modification allows for better control of the tested stimulus level range, which appears to be the main drawback of the conventional TMC method. The results from the present study were consistent with the literature when estimating KP levels, but showed some limitations regarding the estimation of the CR values. Perspectives and limitations of both approaches are discussed.http://ift.tt/2oz4gqZ
JOSD1 Negatively Regulates Type-I Interferon Antiviral Activity by Deubiquitinating and Stabilizing SOCS1
Viral Immunology , Vol. 0, No. 0.
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Epitope Mapping of the Antibody Response Against the Envelope Proteins of the Feline Foamy Virus
Viral Immunology , Vol. 0, No. 0.
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Angiopoietin-2 is expressed in oral Kaposi's sarcoma
Abstract
Background
Kaposi's sarcoma (KS) persists today as a highly prevalent vascular cancer, often found in HIV patients. Studies have shown that angiopoietin 2 (Ang2), a pro-angiogenic protein, is involved in the pathogenesis of this tumor. However, expression of this protein has not been investigated in oral KS lesions. Thus, we aimed to investigate the expression of Ang2 in samples of oral KS
Methods
Immunohistochemistry was used to evaluate Ang2 expression in 14 oral KS cases, with degrees of expression being analyzed in a semi-quantitative manner. In addition, clinical information such as age, gender, race, tumor location, size, color and appearance, as well as HIV status, was collected and included in the analysis
Results
All patients were white males, mostly HIV-positive, with a mean age of 40 years. Clinically, the lesions were dark red/blue/purple masses, ranging from 1-2.5 cm in diameter, found in various locations such as the tongue, palate, and gingiva. Expression of Ang2 was noted in 72% (10/14) of the samples. Of these, 10% showed weak expression, 60% moderate and 30% strong expression
Conclusions
Our results indicate that Ang2 is expressed in oral KS and, consistent with results from previous studies, show that Ang2 may contribute to the pathogenesis of this lesion.
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Immunophenotype of neutrophils in oral squamous cell carcinoma patients
Abstract
Background
The aim was to explore the immunophenotype of neutrophils and lymphocytes and the inflammatory mediators in patients with oral squamous cell carcinoma, comparing with controls; and to associate with clinicopathological data.
Methods
Blood was collected from patients and controls. The immunophenotype of neutrophils (CD66b, CD16, CD11a, arginase-1), T lymphocytes (CD4, CD8) and the intracellular cytokine production (IL-10, TNF, IFN-γ) was evaluated by flow cytometry. Plasma concentration of sVCAM-1, sTNF-RI, sTNF-RII, IL-1β was measured by ELISA. MPO, Lipocalin-2/NGAL, sICAM-1, and p-Selectin were quantified by Luminex assay. The excised tumors were submitted to immunohistochemistry for neutrophils (CD66b) and lymphocytes (CD3, CD4, CD8). Association with clinical data was explored. p values <0.05 were considered significant.
Results
Patients presented higher percentage of neutrophils and lower lymphocytes, resulting a higher neutrophil/lymphocyte ratio than controls. They also presented higher percentage of neutrophils expressing CD66b+, CD66b+Arginase-1+, CD66b+IL10+, CD66b+TNF+, CD66b+Arginase-1+IL-10+, and lower CD66b+CD16+CD11a+ and CD66b+Arginase-1+TNF+. CD66b+neutrophils were detected in all tumors, with a CD66b+/CD3+ ratio of 0.40. Patients showed higher concentration of plasmatic sVCAM-1 and lower Lipocalin-2/NGAL. Patients with good outcome presented lower percentage of neutrophils, higher percentage of lymphocytes, and lower NLR than patients who died.
Conclusion
The amount and immunophenotype of neutrophils and lymphocytes differ between patients and healthy individuals, with a pro-tumorigenic profile of neutrophils. As these cells also get within tumor microenvironment, they possibly exert systemic and local functions in cancer pathogenesis. The association of neutrophil count with outcome corroborates recent studies and this merits further investigation for applicability as a prognosticator.
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Pulsed Low Dose Rate Radiation With Concurrent Chemotherapy for Non-Small Cell Lung Cancer and Esophageal Cancer
Interventions: Radiation: Pulsed Low Dose Radiation; Drug: Carboplatin; Drug: Paclitaxel
Sponsor: Fox Chase Cancer Center
Recruiting - verified March 2017
http://ift.tt/2oyEbs8
Observation Study of Patients With Non-Small Cell Lung Cancer and Esophageal Cancer Treated With Chemo-Radiation Followed by Surgery
Interventions: Drug: Carboplatin; Drug: Paclitaxel; Radiation: Radiation Therapy
Sponsor: Fox Chase Cancer Center
Recruiting - verified March 2017
http://ift.tt/2obdGNk
Robot-assisted Thoraco-laparoscopic Esophagectomy Versus Minimally Invasive Conventional Thoraco-laparoscopic Esophagectomy
Interventions: Procedure: esophagectomy; Procedure: esophagectomy
Sponsor: Zhiang Li
Not yet recruiting - verified March 2017
http://ift.tt/2oyWMUR
Adrenocortical carcinoma masquerading as Cushing's disease
Cushing's syndrome (CS) can be classified as adrenocorticotropic hormone (ACTH)-dependent or ACTH-independent depending on the ACTH levels. However, 30% of the patients with CS have ACTH levels in the 'grey zone' (5–20 pg/mL), thereby posing a challenge in establishing the aetiological diagnosis. In a patient with full-blown features of Cushing's syndrome with equivocal ACTH levels, and a pituitary microadenoma on contrast-enhanced MRI sella, can falsely lead to a diagnosis of Cushing's disease. Pituitary microadenoma, if <6 mm in size, may be an incidental finding (incidentaloma) in this scenario and can be present in ~3–27% of the healthy population. Therefore, in a patient with CS with equivocal ACTH levels and a pituitary microadenoma, multiple samplings for ACTH and adrenal imaging should be performed to exclude ACTH-independent CS and if required, bilateral inferior petrosal sinus sampling to determine the source of ACTH excess.
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Haemophagocytic lymphohistiocytosis associated with fulminant hepatitis and multiorgan failure following primary Epstein-Barr virus and herpes simplex virus type 1 infection
We present a case of severe fatal hepatitis in a young patient presumably triggered by two ubiquitous viral diseases which occurred in close succession. This case is unusual because of the exceptional chronological sequence of primary Epstein–Barr virus and herpes simplex virus type 1 infection causing systemic immune dysregulation associated with rapidly developing liver failure and consecutive multiorgan failure. Clinical, laboratory and histopathological findings indicated the development of secondary haemophagocytic lymphohistiocytosis triggered by these closely succeeding viral primary infections.
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Annexin A10 optimally differentiates between intrahepatic cholangiocarcinoma and hepatic metastases of pancreatic ductal adenocarcinoma: a comparative study of immunohistochemical markers and panels
Abstract
Discriminating intrahepatic cholangiocarcinoma (ICC) from hepatic metastases of pancreatic ductal adenocarcinoma (mPDAC) can be challenging. While pathologists might depend on clinical information regarding a primary tumor, their diagnosis will lead the patient either to potentially curative surgery (for ICC) or to palliation (for mPDAC). Beyond the validation of recently published potential biomarkers for PDAC (primary or metastatic) in a large cohort, we assessed diagnostic performance of the most promising candidates in the challenging task of discriminating metastatic PDAC (mPDAC) from ICC. In a training set of 87 ICC and 88 pPDAC, our previously identified biomarkers Annexin A1 (ANXA1), ANXA10, and ANXA13 were tested and compared with 11 published biomarkers or panels (MUCIN 1, Agrin, S100P, MUC5 AC, Laminin, VHL, CK 17, N-Cadherin, ELAC2, PODXL and HSPG2). Biomarkers with best results were further tested in an independent series of biopsies of 27 ICC and 36 mPDAC. Highest AUC values (between 0.72 and 0.84) for the discrimination between ICC and pPDAC were found in the training set for Annexin A1, Annexin A10, MUC5 AC, CK17, and N-Cadherin. These markers were further tested on an independent series of liver biopsies containing ICC or mPDAC. Diagnostic characteristics were evaluated for individual markers as well as for 3× panels. ANXA 10 showed the highest diagnostic potential of all single markers, correctly classifying 75% of mPDAC and 85% of ICC. Our results suggest that ANXA10 may be useful to differentiate between ICC and mPDAC, when only a tissue specimen is available.
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Molecular genetic and immunotherapeutic targets in metastatic melanoma
Abstract
In recent years, melanoma treatment has radically changed with the emergence of targeted therapies and immunotherapies. Both have led to improved survival for patients with advanced or unresectable melanoma. Targeted therapies with BRAF inhibitors in the lead use the presence of activating driver mutations to inhibit tumour growth. Forty to 60% of melanomas harbour BRAF mutations, which makes them susceptible to treatment with BRAF and/or MEK inhibitors. In parallel, the development of immunotherapeutic agents has also expanded. These agents stimulate the endogenous immune system of the patient to eradicate cancer cells. Immune checkpoint inhibitors targeting cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) and programmed death 1 (PD-1) resulted in durable responses in a subset of patients. An important issue with immunotherapy lies in the identification of patients who will benefit from treatment. In this review, we will discuss these recent developments in melanoma therapy and highlight the role of the pathologist in both types of treatment.
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Error in Byline and Results Section and Other Typographical Errors
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Rituximab Treatment of Nivolumab-Induced Bullous Pemphigoid
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Interventions for Hidradenitis Suppurativa
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Focal PLD-Induced Urticarialike Reaction at Cutaneous Transformed Sézary Lesions
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Alopecia Areata Treated With Tofacinitib
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Dermoscopic Clues for Diagnosing Seborrheic Keratosis–like Melanomas
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Phototherapy for Vitiligo
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Possible effect of landscape design on IgE recognition profiles of two generations revealed with micro-arrayed allergens
Abstract
Aim of this study was to investigate possible effects of landscape design on IgE-sensitization profile towards inhalant allergens in patients with respiratory allergy from Uzbekistan where green areas have been changed during the last 2 decades by a State program. Sera from two different generations of Uzbek (n=58) and, for control purposes, from two generations of Austrian (n=58) patients were analyzed for IgE reactivity to 112 different micro-arrayed allergen molecules by ImmunoCAP ISAC technology. Changes of molecular IgE sensitization profiles to pollen allergens in the young versus the middle-aged Uzbek population were associated with replanting whereas those in the Vienna populations reflected natural changes of plant growth. Our data indicate that anthropologic as well as natural changes of the biome may have effects on IgE sensitization profiles already from one to another generation.
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Clinical Outcomes following Inpatient Penicillin Allergy Testing: A Systematic Review and Meta-analysis
Abstract
Background
A documented penicillin allergy is associated with increased morbidity including length of hospital stay and an increased incidence of resistant infections attributed to use of broader-spectrum antibiotics. The aim of the systematic review was to identify whether inpatient penicillin allergy testing affected clinical outcomes during hospitalization.
Methods
We performed an electronic search of Ovid Medline/PubMed, Embase, Web of Science, Scopus and the Cochrane Library over the past 20 years. Inpatients having a documented penicillin allergy that underwent penicillin allergy testing were included.
Results
Twenty-four studies met eligibility criteria. Study sample size was between 24 and 252 patients in exclusively inpatient cohorts. Penicillin skin testing (PST) with or without oral amoxicillin challenge was the main intervention described (18 studies). The population-weighted mean for a negative PST was 95.1% [CI 93.8-96.1]. Inpatient penicillin allergy testing led to a change in antibiotic selection that was greater in the intensive care unit (77.97% [CI 72.0-83.1] vs 54.73% [CI 51.2-58.2], p<0.01). An increased prescription of penicillin (range 9.9-49%) and cephalosporin (range 10.7-48%) antibiotics was reported. Vancomycin and fluoroquinolone use was decreased. Inpatient penicillin allergy testing was associated with decreased healthcare cost in 4 studies.
Conclusions
Inpatient penicillin allergy testing is safe and effective in ruling out penicillin allergy. The rate of negative tests is comparable to outpatient and perioperative data. Patients with a documented penicillin allergy who require penicillin should be tested during hospitalization given its benefit for individual patient outcomes and antibiotic stewardship.
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Effect of Occlusal Plane correction on Lip Cant in two-jaw orthognathic surgery – A Three-dimensional analysis
Publication date: Available online 29 March 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Christian Freudlsperger, Thomas Rückschloß, Oliver Ristow, Jens Bodem, Steffen Kargus, Robin Seeberger, Michael Engel, Jürgen Hoffmann, Christian Mertens
IntroductionThe aim of the present study was to evaluate the impact of canting correction in occlusal plane (OP) on the change of lip cant (LC) using three-dimensional (3D) photogrammetry in combination with cone-beam computed tomographic (CBCT) scans in class III asymmetric patients.Materials and MethodsFourteen asymmetric patients with exclusively skeletal class III malocclusion undergoing two-jaw surgery were included. All patients received 3D-photogrammetry and CBCT scans before (T1) and after orthognathic surgery (T2). After image fusion of the CBCT scans, angular correction of the occlusal plane (COP) between T1 and T2 was measured. Accordingly, angular correction of the lip cant (CLC) was analyzed after matching the preoperative 3D-photogrammetric scan to the postoperative.ResultsAt the T1 stage, the canting of the OP was higher compared to the LC (4.95° vs. 3.77°). During T1 to T2, a significant angular cant correction was observed: COP (2.64°, p=0.004) and CLC (1.76°, p=0.01). In addition, a linear relationship between COP and CLC was revealed with a correlation coefficient for angular change of 0.47. For the linear regression COP turned out to be a predictor for CLC (B=0.372, t(13)= 1.848, p=0.089). Hence a correction of the OP of 1° resulted in a correction of the LC of only 0.372°.DiscussionThe use of CBCT scans in combination with 3D-photogrammetry are valuable tools to accurate analyze canting corrections of the OP and the LC during orthognathic surgery.
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An Italian multicentre experience in endoscopic endonasal treatment of congenital choanal atresia: proposal for a novel classification system of surgical outcomes
Publication date: Available online 28 March 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Apostolos Karligkiotis, Paolo Farneti, Stefania Gallo, Alessandro Pusateri, Francesco Zappoli-Thyrion, Vittorio Sciarretta, Fabio Pagella, Paolo Castelnuovo, Ernesto Pasquini
ObjectiveThe purposes of this study were to report our experience with endoscopic treatment of choanal atresia (CA), to illustrate our surgical technique and analyse the different factors that may affect outcomes.Material and methodsA retrospective review was performed of patients affected by congenital CA and treated between June 1996 and November 2013 at three referral centres which follow a uniform policy.ResultsEighty-four patients with CA (55 unilateral and 29 bilateral), aged between one day and 76 years (mean, 13 years) were included. Associated malformations were present in 28 patients. The overall success rate was 93%, with 96.3% and 86.2% success rates for unilateral and bilateral CA respectively. Six patients (7%) required revision surgery for early symptomatic restenosis. Statistical analysis revealed that outcomes were not influenced by sex, previous surgeries, unilateral versus bilateral atresia or associated anomalies. However, age seemed to be a prognostic risk factor for patients under one year-old.ConclusionThe endoscopic endonasal approach is safe and effective, with a very high success rate and low morbidity. The removal of the vomer and the use of mucoperiosteal flaps are the main keys to avoiding postoperative stenosis. The use of stents or Mitomycin C is therefore not mandatory.
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Some Innovative Evolutions in Surgery of the Cranio-Maxillofacial Skeleton
Publication date: Available online 29 March 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Hugo L. Obwegeser
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Three-dimensional surface scanners compared with standard anthropometric measurements for head shape
Publication date: Available online 29 March 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Caroline A.A. Beaumont, Paul G.M. Knoops, Alessandro Borghi, N.U. Owase Jeelani, Maarten J. Koudstaal, Silvia Schievano, David J. Dunaway, Naiara Rodriguez-Florez
Three-dimensional (3D) surface imaging devices designed to capture and quantify craniofacial surface morphology are becoming more common in clinical environments. Such scanners overcome the limitations of two-dimensional photographs while avoiding the ionizing radiation of computed tomography. The purpose of this study was to compare standard anthropometric cranial measurements with measurements taken from images acquired with 3D surface scanners.Two 3D scanners of different cost were used to acquire head shape data from thirteen adult volunteers: M4D scan and Structure Sensor. Head circumference and cephalic index were measured directly on the patients as well as on 3D scans acquired with the two scanners. To compare head volume measurements with a gold standard, magnetic resonance imaging scans were used. Repeatability and accuracy of both devices were evaluated.Intra-rater repeatability for both scanners was excellent (intraclass correlation coefficients > 0.99, p<0.001). Direct and digital measures of head circumference, cephalic index and head volume were strongly correlated (0.85 < r < 0.91, p<0.001). Compared to direct measurements, accuracy was highest for M4D scan.Both 3D scanners provide reproducible data of head circumference, cephalic index and head volume and show a strong correlation with traditional measurements. However, care must be taken when using absolute values.
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Imiquimod treatment for lentigo maligna – LIMIT-1 trial
We read with interest the methods and results of the LIMIT-1 trial regarding primary imiquimod treatment for lentigo maligna (LM) in the journal.1 We applaud the authors for using histopathology from a resective specimen as the reference standard.
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Direct-acting antivirals for hepatitis C virus induce a rapid clinical and biochemical remission of porphyria cutanea tarda
Sporadic porphyria cutanea tarda (PCT) is strongly associated with HCV infection in our population 1,2,3,4. . Therapeutic options for PCT include phlebotomies and low-dose 4-aminoquinolines, which show high rates of disease remission. However, some PCT patients may present frequent relapses attributable to resistance/intolerability/poor adherence to conventional treatments and/or persistence of risk factors. In 2014 we reported the first case of a patient with active PCT and HCV-HIV co-infection cured with direct antiviral agents (DAAs) 5. Herein, we present a larger cohort of patients, demonstrating the rapid and persistent remission of PCT with DAAs regimes administered for HVC infection.
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Elevated levels of Soluble Human Leukocyte Antigen-G (sHLA-G) in the Airways are a Marker for a Low-inflammatory Endotype of Asthma
Source:Journal of Allergy and Clinical Immunology
Author(s): Steven R. White, Jessie Nicodemus-Johnson, Bharathi Laxman, Darcy R. Denner, Edward T. Naureckas, D. Kyle Hogarth, Randi Stern, Alexa Minc, Julian Solway, Anne Sperling, Carole Ober
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Can floseal™ be applied safely during otologic surgery? Assessment of ototoxicity in a chinchilla animal model
Abstract
Background
In otologic surgery good visualization is paramount, and patients with bleeding diatheses or who need to be anti-coagulated can present a significant challenge. Here, we determine whether Floseal™, a hemostatic matrix, is ototoxic in a validated animal model.
Methods
Nine chinchillas housed in the animal care facilities of the Montreal Children's Hospital Research Institute were used for the study. After a myringotomy incision was made in each tympanic membrane, baseline auditory brainstem response measurements were performed at 8, 20, and 25 kHz. In each animal one ear was randomized to receive Floseal™ to the middle ear cavity, whereas the other ear served as the control and received 0.9% sodium chloride. Outcome measures included early (day 7) and late (day 30) auditory brainstem response, clinical evidence of facial nerve or vestibular disturbance and histological evidence of ototoxity.
Results
There was no significant hearing threshold shift on auditory brainstem response across all tested frequencies for both experimental and control ear. No animals receiving Floseal™ developed facial or vestibular nerve dysfunction and there was no histological evidence of ototoxicity.
Conclusion
Based on the preliminary ototoxicity assessment on nine chinchillas, transtympanic Floseal™ does not appear to be ototoxic. More studies are warranted to assess the safety and applicability of the product in humans.
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Novel Heterozygous Mutations in JAG1 and NOTCH2 Genes in a Neonatal Patient with Alagille Syndrome
Alagille Syndrome (ALGS) is a rare autosomal dominant disorder that affects multiple organ systems. Cholestasis as a result of a paucity of intrahepatic bile ducts and congenital heart defects are the two most common features of ALGS. We describe a case of ALGS with novel mutations of JAG1 and NOTCH2 genes in a newborn girl with complex congenital heart disease, bilateral dysplastic kidneys, and malrotation with volvulus.
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Novel case examples of the submental island flap in pediatric head and neck reconstruction
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Joshua P. Wiedermann, Nahir Romero, Rahul K. Shah, Diego Preciado, Jason E. Cohn, Christopher R. Kieliszak, Arjun S. Joshi
The submental island flap was first described as a tool for facial reconstruction after tumor resection. It is now widely used for reconstructing numerous structures in the head and neck region of adults. Pediatric surgical reconstruction is a challenging task that continues to evolve over time. We describe two novel uses of this flap in the pediatric population. The submental island flap is an excellent option for reconstruction in pediatrics given its ease of elevation, excellent cosmetic outcomes, and low donor site morbidity.
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Apheresis in food allergies.
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Apheresis in food allergies.
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