Head and Neck Medicine by Alexandros G.Sfakianakis: 04/06/17

Πέμπτη 6 Απριλίου 2017

Erratum to: pulp bleeding color is an indicator of clinical and histohematologic status of primary teeth

http://ift.tt/2oH0jVk

OnabotulinumtoxinA injections in detrusor facilitate self-catheterisation in a patient with paraplegia and bladder outlet dyssynergia

This case report describes the case of improvement of clean intermittent catheterisation procedures after each intradetrusor administration of onabotulinumtoxinA in a 45-year-old man with L1 paraplegia with neurogenic detrusor overactivity and bladder outlet dyssynergia.On three occasions, improvement on clean intermittent catheterisation procedures appeared 10 to 14 days after intradetrusor injections of onabotulinumtoxinA and lasted for 9 months. We hypothesise a possible influence of intravesical injections of onabotulinumtoxinA on the storage reflex. We also discuss the possibility of a dispersion of onabotulinumtoxinA towards contiguous structures such as the urethral sphincter.

http://ift.tt/2njuXng

Preferred nasolabial angle in Middle Eastern population

Abstract

To define the preferred nasolabial angle measurement in Middle Eastern population. An observational study was conducted from January 2012 to January 2016 at the Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. A total of 1027 raters, 506 males, and 521 females were asked to choose the most ideal nasolabial angle for 5 males and 5 females lateral photographs whose nasolabial angle were modified with Photoshop into the following angles (85°, 90°, 95°, 100°, 105°, and 110°). Male raters preferred the angle of 89.5° ± 3.5° (mean ± SD) for males and 90.8° ± 5.6° for females. While female raters preferred the angle of 89.3° ± 3.8° for males and 90.5° ± 4.8° for females. ANOVA test compare means among groups: p: 0.342, and there is no statistically significant difference between groups. The results of our study showed an even more acute angles than degrees found in the literature. It shows that what young generation in our region prefers and clearly reflects that what could be explained as under rotation of the nasal tip in other cultures is just the ideal for some Middle Eastern population.

http://ift.tt/2nR0ut7

Reply to the letter to the editor concerning: ‘Relationship between increased carotid artery stiffness and idiopathic subjective tinnitus’

http://ift.tt/2nj7UJm

Effect of hyaluronic acid with or without scaffold material on the regeneration of tympanic membrane perforations

http://ift.tt/2nQY91d

Relationship between increased carotid artery stiffness and idiopathic subjective tinnitus: methodological issues

http://ift.tt/2njgtnt

Idiopathic subglottic stenosis: an epidemiological single-center study

Abstract

A retrospective epidemiological study of patients treated for idiopathic subglottic stenosis (ISS) during 2003–2013 at Oslo University Hospital, Rikshospitalet, was undertaken to assess its incidence, management and treatment outcomes. Out of a total of 123 patients with subglottic stenosis (84 female, 39 men), 38 patients were diagnosed with ISS, all of whom were female. Of these, 23 lived in the South-Eastern Norway Regional Health Authority, representing an incidence of 0.2 per 100,000 (95% CI 0.13–0.3) in this region of 2.9 million inhabitants. Mean age at diagnosis was 54 years (range 20–85 years), and the mean interval between symptom onset and diagnosis was 3.1 years. The 38 patients with ISS underwent a total of 132 operations between 2003 and 2013. All patients were managed endoscopically using laser surgery, with or without corticosteroids and Mitomycin C, with dilatation by balloon or bougie. Eight patients (21.1%) required only one procedure, while 30 patients (78.9%) had multiple operations. The median follow-up for all patients from the first operation was 5.3 years. The mean interval between procedures was 1 year for patients aged 20–48 years, 1.3 years for patients aged 49–61 years and 3.0 years for patients aged 62–85 years. No clinically significant complications were observed. In conclusion, the symptoms of ISS can be treated effectively with laser surgery and dilatation but the recurrence rate remains high and the time interval between operations does not increase with time, making ISS a continuing challenge.

http://ift.tt/2nQZRQc

Repetitive transcranial magnetic stimulation and drugs for tinnitus

http://ift.tt/2njgsjp

Perioperative complications and safety of type II thyroplasty (TPII) for adductor spasmodic dysphonia

Abstract

Type II thyroplasty (TPII) is one of the surgical options offered in the management of adductor spasmodic dysphonia (AdSD); however, there have been no detailed reports of its safety and associated complications during the perioperative period. Our aim was to assess the complications and safety of TPII. TPII was performed for consecutive 15 patients with AdSD from April 2012 through May 2014. We examined retrospectively the perioperative complications, the degree of surgical invasion, and recovery process from surgery. All patients underwent successful surgery under only local anesthesia. Vocal fold erythema was observed in 14 patients and vocal fold edema in 10 patients; however, all of them showed complete resolution within 1 month. No patient experienced severe complications such as acute airway distress or hemorrhage. Fourteen patients were able to have oral from the 1st postoperative morning, with the remaining patient able to have oral intake from the 2nd postoperative day. In addition, no patient experienced aspiration postoperatively. In conclusion, only minor complications were observed in association with TPII in this study. No dysphagia was observed postoperatively, which is an advantage over other treatments. The results of our study suggest that TPII is a safe surgical treatment for AdSD.

http://ift.tt/2nQNJ1I

Benchmarking of venous thromboembolism prophylaxis practice with ENT.UK guidelines

Abstract

The aim of this study was to benchmark our guidelines of prevention of venous thromboembolism (VTE) in ENT surgical population against ENT.UK guidelines, and also to encourage healthcare providers to utilize benchmarking as an effective method of improving performance. The study design is prospective descriptive analysis. The setting of this study is tertiary referral centre (Assir Central Hospital, Abha, Saudi Arabia). In this study, we are benchmarking our practice guidelines of the prevention of VTE in the ENT surgical population against that of ENT.UK guidelines to mitigate any gaps. ENT guidelines 2010 were downloaded from the ENT.UK Website. Our guidelines were compared with the possibilities that either our performance meets or fall short of ENT.UK guidelines. Immediate corrective actions will take place if there is quality chasm between the two guidelines. ENT.UK guidelines are evidence-based and updated which may serve as role-model for adoption and benchmarking. Our guidelines were accordingly amended to contain all factors required in providing a quality service to ENT surgical patients. While not given appropriate attention, benchmarking is a useful tool in improving quality of health care. It allows learning from others' practices and experiences, and works towards closing any quality gaps. In addition, benchmarking clinical outcomes is critical for quality improvement and informing decisions concerning service provision. It is recommended to be included on the list of quality improvement methods of healthcare services.

http://ift.tt/2njgQhO

Primary unclassified sarcoma of the parotid gland: a case of diagnostic and therapeutic challenge

Abstract

Malignant salivary gland sarcomas represent a clinically and histologically diagnostic challenge. Primary unclassified sarcomas of the parotid gland consist a rare salivary gland tumor. We report an unusual case of such a tumor, which occurred in the right parotid gland of a 54-year-old male and presented as an asymptomatic painless mass. The pathologoanatomical examination revealed a rhabdoid large-cell unclassified sarcoma. The patient was treated with superficial parotidectomy and adjuvant radiotherapy. No recurrence was noted in a 10-year follow-up period. Due to the rare occurrence of primary unclassified sarcomas, there is no evidence-based treatment of choice. An optimal approach is best planned in a multidisciplinary setting, taking into consideration the resectability of the tumor, individual patient characteristics, presence of local or distant metastatic activity, local infiltrative behavior and tumor stage. A close follow-up of the patient is strongly recommended.

http://ift.tt/2nR2gu0

The variants of the retro- and hypotympanum: an endoscopic anatomical study

Abstract

The retro- and hypotympanum are hidden areas of the middle ear, only poorly recognized. Nevertheless, this region is of relevant clinical significance, since it is regularly affected by disease such as cholesteatoma. The aim of this study is to explore and describe the anatomical variants of the hypo- and retrotympanum by the means of transcanal endoscopy. We hypothesize a significant variability of this hidden region of the middle ear. Moreover, we believe that the minimal invasive, endoscopic access is suitable since angled scopes may be used to explore the region. To this end a total of 125 middle ears (83 cadaveric dissections, 42 surgical cases) were explored by the means of 3 mm straight and angled scopes. The variants were documented photographically and tabularized. The bony crests ponticulus, subiculum and finiculus were most frequently represented as ridges. The ponticulus showed the highest variability with 38% ridge, 35% bridge and 27% incomplete presentation. The subiculum was bridge-shaped only in 8% of the cases, the finiculus in 17%. The sinus tympani had a normal configuration in 66%. A subcochlear canaliculus was detectable in 50%. The retro- and hypotympanum were classified, respectively, to the present bony crests and sinus in a novel classification type I–IV. In conclusion, we found abundant variability of the bony structures in the retro- and hypotympanum. The endoscopic access is suitable and offers thorough understanding and panoramic views of these hidden areas.

http://ift.tt/2nR2MIy

Post-tonsillectomy pain after using bipolar diathermy scissors or the harmonic scalpel: a randomised blinded study

Abstract

Objective

To compare the postoperative pain following bipolar diathermy scissors tonsillectomy (higher temperature dissection) with harmonic scalpel tonsillectomy (lower temperature dissection).

Methods

Sixty patients aged 7–40 years planned for tonsillectomy with no other concurrent surgery were randomised to either bipolar diathermy scissors or harmonic scalpel as surgical technique. Blinded to the surgical technique, the patients recorded their pain scores (VAS, 0–10) at awakening and the worst pain level of the day in the postoperative period. All intake of pain medication was also recorded.

Results

No statistically significant differences were found between the two groups regarding postoperative pain levels or consumption of pain medication.

Conclusion

Usage of the harmonic scalpel does not render less postoperative pain following tonsillectomy when compared with usage of the bipolar diathermy scissors.

http://ift.tt/2njcN5c

Application of a computer-assisted flexible endoscope system for transoral surgery of the hypopharynx and upper esophagus

Abstract

Zenker's diverticulum is a common pathology in the transition zone of the posterior hypopharynx and esophagus. Surgical treatment is routinely performed by ENT and general surgeons. Besides the traditional open transcervical diverticulectomy, the introduction of transoral rigid treatment led to a paradigm change and is now the preferred treatment option for patients who are fit for general anesthesia. The implementation of interventional flexible endoscopy has opened another new micro-invasive approach for patients with high morbidity. Here, we present the potential utilization of a flexible, single port, robot-assisted, and physician-controlled endoscope system to facilitate transoral surgical access to the hypopharynx and upper esophagus. Transoral surgery of the hypopharynx and upper esophagus was performed in human cadavers (n = 5) using the Flex System (Medrobotics, Raynham, USA). Anatomical landmarks were identified, and posterior cricothyroid myotomy was performed with compatible flexible instruments in all cases. The approach to the hypopharynx and upper esophagus using the Flex system is feasible in a cadaveric model. Myotomy with a flexible tool and needle knife (from the perspective of treatment of Zenker´s diverticulum) was successful in all cases. Visualization of the surgical site with the system's HD camera is suitable and the flexible instruments meet the special needs of a micro-invasive transoral approach. Zenker´s diverticulum can be potentially treated with a transoral minimally invasive approach using a computer-assisted flexible endoscope system. This setup could be of advantage in patients with reduced mobility of the cervical spine to prevent open transcervical surgery. In our study, the Flex system enabled advanced visualization of the surgical site and extended intervention options, compared to standard flexible endoscopic treatment. However, general anesthesia is mandatory for the presented approach. Application in live patients with actual pathologies of the hypopharynx and upper esophagus will have to prove suitability for the treatment of Zenker's diverticulum. Further development of the system could include improved instrumentation and an adoption by other disciplines with challenging anatomy such as colorectal surgery.

http://ift.tt/2nQNdAG

High blood tacrolimus and hyperkalemia in a heart transplant patient

AnnCardAnaesth_2017_20_2_270_203933_f1.j

Manoj Kumar Sahu, Sarvesh Pal Singh, Anupam Das, Atul Abraham, Balram Airan, Intekhab Alam, Ramesh Menon, V Devagourou, Anish Gupta

Annals of Cardiac Anaesthesia 2017 20(2):270-271

http://ift.tt/2niSAwo

Anger: An enemy of heart, raj yoga meditation is heart friendly

Usha Kiran, Suruchi Ladha

Annals of Cardiac Anaesthesia 2017 20(2):127-128

http://ift.tt/2niSAfS

Inverted left atrial appendage masquerading as a left atrial mass

Suresh Kumaran, Gladdy George, AV Varsha, Raj Sahajanandan

Annals of Cardiac Anaesthesia 2017 20(2):248-249

An inverted left atrial appendage after cardiac surgery is a rare finding and can be misinterpreted as a thrombus, mass, or vegetation. We report a case where intraoperative transesophageal echocardiography assisted in making an accurate diagnosis.

http://ift.tt/2o3I0X5

Artificial intelligence in mitral valve analysis

Jelliffe Jeganathan, Ziyad Knio, Yannis Amador, Ting Hai, Arash Khamooshian, Robina Matyal, Kamal R Khabbaz, Feroze Mahmood

Annals of Cardiac Anaesthesia 2017 20(2):129-134

Background: Echocardiographic analysis of mitral valve (MV) has become essential for diagnosis and management of patients with MV disease. Currently, the various software used for MV analysis require manual input and are prone to interobserver variability in the measurements. Aim: The aim of this study is to determine the interobserver variability in an automated software that uses artificial intelligence for MV analysis. Settings and Design: Retrospective analysis of intraoperative three-dimensional transesophageal echocardiography data acquired from four patients with normal MV undergoing coronary artery bypass graft surgery in a tertiary hospital. Materials and Methods: Echocardiographic data were analyzed using the eSie Valve Software (Siemens Healthcare, Mountain View, CA, USA). Three examiners analyzed three end-systolic (ES) frames from each of the four patients. A total of 36 ES frames were analyzed and included in the study. Statistical Analysis: A multiple mixed-effects ANOVA model was constructed to determine if the examiner, the patient, and the loop had a significant effect on the average value of each parameter. A Bonferroni correction was used to correct for multiple comparisons, and P = 0.0083 was considered to be significant. Results: Examiners did not have an effect on any of the six parameters tested. Patient and loop had an effect on the average parameter value for each of the six parameters as expected (P < 0.0083 for both). Conclusion: We were able to conclude that using automated analysis, it is possible to obtain results with good reproducibility, which only requires minimal user intervention.

http://ift.tt/2nj0iqg

Erratum: Percutaneous tracheostomy in patients on anticoagulants

Annals of Cardiac Anaesthesia 2017 20(2):282-282

http://ift.tt/2o3wVVS

Forbidden word entropy of cerebral oximetric values predicts postoperative neurocognitive decline in patients undergoing aortic arch surgery under deep hypothermic circulatory arrest

Anna Dubovoy, Peter Chang, Carol Persad, Wei Lau, Elizabeth Jewell, Daniel Cox, Milo Engoren

Annals of Cardiac Anaesthesia 2017 20(2):135-140

Purpose: Up to 53% of cardiac surgery patients experience postoperative neurocognitive decline. Cerebral oximetry is designed to detect changes in cerebral tissue saturation and therefore may be useful to predict which patients are at risk of developing neurocognitive decline. Methods: This is a retrospective analysis of a prospective study originally designed to determine if treatment of cerebral oximetry desaturation is associated with improvement in postoperative cognitive dysfunction in patients undergoing aortic reconstruction under deep hypothermic circulatory arrest. Cognitive function was measured, preoperatively and 3 months postoperatively, with 15 neuropsychologic tests administered by a psychologist; the individual test scores were summed and normalized. Bilateral cerebral oximetry data were stored and analyzed using measures of entropy. Cognitive decline was defined as any decrease in the summed normalized score from baseline to 3 months. Results: Seven of 17 (41%) patients suffered cognitive decline. There was no association between baseline cerebral oximetry and postoperative cognitive dysfunction. Nor were changes in oximetry values associated with cognitive decline. However, cognitive decline was associated with loss of forbidden word entropy (FwEn) (correlation: Rho ρ = 0.51, P = 0.037 for left cerebral oximetry FwEn and ρ = 0.54, P = 0.025 for right cerebral oximetry FwEn). Conclusion: Postoperative cognitive decline was associated with loss of complexity of the time series as shown by a decrease in FwEn from beginning to end of the case. This suggests that regulation of cerebral oximetry is different between those who do and those who do not develop cognitive decline.

http://ift.tt/2o3Cioh

Partial anomalous pulmonary venous return: Scimitar vein

Timothy Heinke, Scott R Stewart, Toby Steinberg, William R Hand, James H Abernathy

Annals of Cardiac Anaesthesia 2017 20(2):259-261

Scimitar syndrome is a rare association of congenital cardiopulmonary anomalies characterized by partial anomalous pulmonary venous return, in which an abnormal right pulmonary vein drains into the inferior vena cava. This case exemplifies the role of transesophageal echocardiography in perioperative management and surgical decision-making.

http://ift.tt/2nj8C9t

An analysis of the factors producing multiple ventricular arrhythmias during pulmonary artery catheterization

Hajime Satoh, Yuka Miyata, Tomohiko Hayasaka, Tsutomu Wada, Yukio Hayashi

Annals of Cardiac Anaesthesia 2017 20(2):141-144

Background: The development of arrhythmias during placement of a pulmonary artery catheter (PAC) is common. Aims: This study was designed to examine factors influencing development of ventricular arrhythmias in adult patients undergoing cardiovascular operations during the catheter placement. Settings and Designs: Prospective, observational, cohort study. Methods: We prospectively studied 174 patients undergoing cardiovascular operations. A PAC was inserted through the right internal jugular vein by staff anesthesiologists. Electrocardiography tracings were recorded as the catheter was advanced from the right atrium to the pulmonary artery. Arrhythmias were classified as absent, single, or multiple (two or more consecutive) ventricular arrhythmias. We examined risk factors to produce ventricular arrhythmias during the placement. Statistical Analysis: The data were analyzed using logistic regression analysis to assess factors for the occurrence of ventricular arrhythmias after univariate analyses. Results: Ventricular arrhythmias (single and multiple) occurred in 149 patients (85.6%) and multiple arrhythmias were observed in 78 patients (44.8%). There were no factors to facilitate the ventricular arrhythmias (single and multiple), whereas it showed that valvular diseases (P = 0.049) and the placement time (P < 0.001) are significant factors to produce multiple arrhythmias. Conclusion: Both valvular diseases and long placement time were significant risk factors to produce multiple ventricular arrhythmias during placement of a PAC.

http://ift.tt/2o3CgwF

Importance of 3D real time perioperative tee in ASD device embolisation

MS Sarvana Babu, Neelam Aggarwal, A Asha, Digraje Sunita Ashok, Thomas Koshy

Annals of Cardiac Anaesthesia 2017 20(2):278-278

http://ift.tt/2nj1Gt3

Carotid artery disease and periprocedural stroke risk after transcatheter aortic valve implantation

Parthasarathy D Thirumala, Sruthi Muluk, Reshmi Udesh, Amol Mehta, John Schindler, Suresh Mulukutla, Vinodh Jeevanantham, Lawrence Wechsler, Thomas Gleason

Annals of Cardiac Anaesthesia 2017 20(2):145-151

Objective/Background: To examine the role of carotid stenosis (CS) and other independent risk factors of perioperative stroke, following transcatheter aortic valve implantation (TAVI). Materials and Methods: Using data from the National Inpatient Sample database for analysis, patients who underwent TAVI were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Various preoperative and perioperative risk factors and their association with perioperative strokes were studied. Results: Data on 7566 patients who underwent a TAVI procedure from 2012 to 2013 were extracted. The average age of the patient population was 81.2 ± 0.32 years. The overall perioperative stroke rate in our patient cohort was 2.79%. Majority (94.6%) of the strokes were ischemic. Multivariate analysis showed the following independent risk factors for perioperative strokes after TAVI: female gender odds ratio (OR) = 2.25 (95% confidence interval [CI], 1.42–3.57), higher van Walraven score OR = 6.6 (95% CI = 3.71–11.73), bilateral CS OR = 4.46 (95% CI = 2.03–9.82), and TAVI with a cardiac procedure done under cardiopulmonary bypass OR = 2.84 (95% CI = 1.57–5.14). Conclusion: Bilateral carotid disease is a significant risk factor for perioperative strokes following TAVI. Preoperative screening with carotid Doppler to identify high-risk patients appears to be warranted. In addition, patients of female gender were found to have an increased risk for carotid disease.

http://ift.tt/2o3EWKN

Transthoracic echocardiography versus transesophageal echocardiography for rupture sinus of Valsalva aneurysm

Ira Dhawan, Vishwas Malik, Kamal Prakash Sharma, Neeti Makhija, Neha Pangasa

Annals of Cardiac Anaesthesia 2017 20(2):245-246

We report a rare case of sinus of Valsalva aneurysm of both right and left coronary sinus (LCS), with perforation of the LCS opening into the left ventricle. The LCS aneurysm with its perforation was undiagnosed on transthoracic echocardiography emphasizing the role of transesophageal echocardiography in delineating the anatomy.

http://ift.tt/2niSZ1D

Impact of dexmedetomidine on hemodynamic changes during and after coronary artery bypass grafting

Morteza Hashemian, Mehdi Ahmadinejad, Seyed Amir Mohajerani, Alireza Mirkheshti

Annals of Cardiac Anaesthesia 2017 20(2):152-157

Objective: To determine the effect of dexmedetomidine (Dex) on hemodynamic changes during cardiopulmonary pump and postoperative period in coronary artery bypass grafting (CABG). Methods and Design: This study is designed as a double-blinded, randomized clinical trial. Setting: University hospital and single center. Participants: patients candidate for elective CABG. Intervention: Dex 0.5 μg/kg/h or placebo was infused from the initiation of anesthesia up to extubation in Intensive Care Unit (ICU). Measurements: Heart rate (HR) and blood pressure (BP), pain score, and total morphine dose requirement were monitored and compared during cardiac pump up to 12 h postoperative in ICU. Results: Mean arterial pressure was significantly higher in Dex group in postoperation period at 1 (P = 0.010) and 2 h (P = 0.002) compared to control group. HR was significantly lower in Dex group in postcardiopulmonary bypass (CPB) time at 0 h (P = 0.001), 1 h (P = 0.0016), and 2 h (P = 0.001), and then in postoperative period in ICU at 1 h (P = 0.025), 2 h (P = 0.0012), and 4 h (P = 0.0025) compared to control group. Postoperative pain score was significantly lower during 12 h after surgery. Conclusion: Dex could effectively blunt hemodynamic response to surgical stress, particularly during CPB pump and afterward. Infusion of Dex maintains BP at higher range and HR at lower range compared to placebo.

http://ift.tt/2o3CdRv

Mechanical cause for acute left lung atelectasis after neonatal aortic arch repair with arterial switch operation: Conservative management

Madan Mohan Maddali, Pranav Subbaraya Kandachar, Said Al-Hanshi, Mohammed Al Ghafri, John Valliattu

Annals of Cardiac Anaesthesia 2017 20(2):252-255

Respiratory complications due to mechanical obstruction of the airways can occur following pediatric cardiac surgery. Clinically significant intrathoracic vascular compression of the airway can occur when extensive dissection and mobilization of arch and neck vessels is involved as in repair of interrupted aortic arch. This case report describes a neonate who underwent interrupted aortic arch repair along with an arterial switch operation and developed a left lung collapse immediately after tracheal extubation. Fiber-optic bronchoscopy revealed vascular compression as the real culprit. The child was successfully managed conservatively.

http://ift.tt/2nj2m1x

The role of Rajyoga meditation for modulation of anxiety and serum cortisol in patients undergoing coronary artery bypass surgery: A prospective randomized control study

Usha Kiran, Suruchi Ladha, Neeti Makhija, Poonam Malhotra Kapoor, Minati Choudhury, Sambhunath Das, Parag Gharde, Vishwas Malik, Balram Airan

Annals of Cardiac Anaesthesia 2017 20(2):158-162

Introduction: Rajyoga meditation is a form of mind body intervention that is promoted by the Brahma Kumaris World Spiritual University. This form of meditation can be easily performed without rituals or mantras and can be practiced anywhere at any time. The practice of Rajyoga meditation can have beneficial effects on modulating anxiety and cortisol level in patients undergoing major cardiac surgery. Materials and Methods: A prospective randomized control study was carried out in a single tertiary care center. One hundred and fifty patients undergoing elective coronary artery bypass surgery were enrolled in the study. The patients were randomized in two groups namely, Group 1 (Rajyoga group) and Group 2 (Control Group). Anxiety was measured on a visual analog scale 1–10 before the start of Rajyoga training or patient counseling (T1), on the morning of the day of surgery (T2), on the 2nd postoperative day (T3), and on the 5th postoperative day (T4). The serum cortisol level was measured in the morning of the day of surgery (T1), on the 2nd postoperative day (T2) and on the 5th postoperative day (T3), respectively. Results: In the study, it was seen that the anxiety level of the patients before the surgery (T1) and on the day of surgery (T2) were comparable between the two groups. However on the 2nd postoperative day (T3), the patients who underwent Rajyoga training had lower anxiety level in comparison to the control group (3.12 ± 1.45 vs. 6.12 ± 0.14, P < 0.05) and on the 5th postoperative day (T4) it was seen that Rajyoga practice had resulted in significant decline in anxiety level (0.69 ± 1.1 vs. 5.6 ± 1.38, P < 0.05). The serum cortisol level was also favorably modulated by the practice of Rajyoga meditation. Conclusion: Mindbody intervention is found to effective in reducing the anxiety of the patients and modulating the cortisol level in patients undergoing wellknown stressful surgery like coronary artery bypass surgery.

http://ift.tt/2o3wPgY

Modified blalock-taussig shunt and levosimendan for left ventricular preparation in a child with transposition of great arteries and regressed ventricle undergoing rapid 2 stage arterial switch operation

Manoj Kumar Sahu, Anish Gupta, Intekhab Alam, Sarvesh Pal Singh, Ramesh Menon, V Devagouru

Annals of Cardiac Anaesthesia 2017 20(2):265-267

Rapid two-stage arterial switch operation (ASO) is very relevant as many patients of transposition of great arteries (TGA) present late to the hospital when primary switch either is not possible or carries a high risk of morbidity and mortality. Hence, other means apart from the traditional methods of left ventricle preparedness should be tried to help this category of patients, who are to undergo rapid two-stage ASO. We successfully used levosimendan and continuous positive airway pressure after 1st stage operation in a patient with dTGA and regressed ventricle, which helped in left ventricular preparedness, and the child underwent rapid two-stage ASO uneventfully.

http://ift.tt/2nj1wSp

Conscious sedation for balloon mitral valvotomy: A comparison of fentanyl versus sufentanil

Shailendra Deochandra Modak, Deepa G Kane

Annals of Cardiac Anaesthesia 2017 20(2):163-168

Context: Analgesia and sedation are required for the comfort of patient and the cardiologist during balloon mitral valvotomy. Aims: In this study, efficacy of analgesia, sedation, and patient satisfaction with sufentanil was compared with fentanyl. Settings and Design: Single-centered, prospective single-blind study of sixty patients. Materials and Methods: Patients between 15 and 45 years of rheumatic mitral stenosis with valve area of 0.8–1 cm2 undergoing elective balloon mitral valvotomy, randomly divided to receive bolus injection fentanyl 1 mcg/kg (Group 1, n = 30) followed by infusion at 1 mcg/kg/h or bolus of injection sufentanil 0.1 mcg/kg (Group 2, n = 30) followed by continuous infusion at 0.1 mcg/h. Both the groups received injection midazolam bolus 0.02 mg/kg followed by infusion at 15 mcg/kg/h. Pain intensity (by visual analog score [VAS]), level of sedation (by Ramsay sedation scale), overall patient and operator's satisfaction, effect on cardiorespiratory parameters, and discharge score (by modified Aldrete score) were assessed. Statistical Analysis Used: Statistical analysis used Student's unpaired t-test and Chi-square test. P < 0.05 was considered statistically significant. Results: Mean number of bolus doses in fentanyl group was 0.9 versus 0.13 in sufentanil group (P < 0.01). The mean value of mean blood pressure in fentanyl group was 83.52 mmHg versus 88 mmHg in sufentanil group (P < 0.05), but the value was within normal range in both the groups. The mean VAS – patient's opinion in fentanyl group was 8.97 versus 9.53 in sufentanil group (P < 0.05). Mean discharge score in fentanyl group was 17.87 versus 18.23 in sufentanil group (P < 0.05). No statistically significant difference was found with respect to heart rate, respiratory rate, oxygen saturation, PaCO2values, and anxiety scores. Conclusion: Sufentanil was found to be better with respect to analgesia, patient satisfaction, and recovery however not cost-effective for continuous infusion technique.

http://ift.tt/2o3tEGr

Role of MicroRNA in cardiac anesthesia: An innovative consequences and new possibility

Mayadhar Barik, Abhay Kumar, Pravash Ranjan Mishra, Poonam Malhotra Kapoor

Annals of Cardiac Anaesthesia 2017 20(2):274-275

http://ift.tt/2njaCib

Serial semi-invasive hemodynamic assessment following pericardiectomy for chronic constrictive pericarditis

Ujjwal Kumar Chowdhury, Poonam Malhotra Kapoor, Adil Rizvi, Vishwas Malik, Sandeep Seth, Rajiv Narang, Mani Kalaivani, Sarvesh Pal Singh, Sathiya Selvam

Annals of Cardiac Anaesthesia 2017 20(2):169-177

Objectives: This study was designed to prospectively investigate the effects of pericardiectomy via median sternotomy on intra- and postoperative hemodynamics by a new semi-invasive device (Flotrac/VigileoTM monitor) using arterial pressure waveform analysis. Patients and Methods: Thirty consecutive patients aged 15 to 55 years (mean+SD, 31.73 + 13.53 years), who had undergone total pericardiectomy via median sternotomy underwent serial hemodynamic evaluation. FlotracTM Sensor – derived stroke volume, stroke volume variation, systemic vascular resistance index (SVRI), cardiac index and right atrial pressure were measured just before and after pericardiectomy, at 12 hours, 24 hours, 48 hours, 72 hours and at discharge postoperatively. Results: Majority of patients (73.33%) exhibited statistically significant reduction of right atrial pressure and SVRI along with improvement in cardiac index and oxygen delivery in the immediate and late postoperative period. However, the stroke volume and stroke volume variation did not increase proportionately on completion of surgery. Patients with low cardiac output syndrome exhibited persistently high central venous pressure with reduced cardiac index and echocardiographically abnormal diastolic filling characteristics. Conclusions: We conclude that there is early normalization of hemodynamics following pericardiectomy via median sternotomy and the adequacy of pericardiectomy can be accurately assessed by the new semi-invasive arterial pressure waveform analysis device. Stroke volume variation is a non-predictor of fluid requirement during and after pericardiectomy.

http://ift.tt/2o3jOEw

Erratum: Annals of Cardiac Anesthesia: Beacon journey toward excellence: 2015–2017

AnnCardAnaesth_2017_20_2_280_201630_f1.j

Annals of Cardiac Anaesthesia 2017 20(2):280-280

http://ift.tt/2nj50Eu

Methylene blue for postcardiopulmonary bypass vasoplegic syndrome: A cohort study

Michael Mazzeffi, Benjamin Hammer, Edward Chen, Mark Caridi-Scheible, James Ramsay, Christopher Paciullo

Annals of Cardiac Anaesthesia 2017 20(2):178-181

Background: Methylene blue (MB) has been used to treat refractory hypotension in a variety of settings. Aims: We sought to determine whether MB improved blood pressure in postcardiopulmonary bypass (CPB) vasoplegic syndrome (VS) in a complex cardiac surgery population. Furthermore, to determine variables that predicted response to MB. Setting and Design: This was conducted in a tertiary care medical center; this study was a retrospective cohort study. Materials and Methods: Adult cardiac surgery patients who received MB for post-CPB VS over a 2-year period were studied. Mean arterial blood pressure (MAP) and vasopressor doses were compared before and after MB, and logistic regression was used to model which variables predicted response. Results: Eighty-eight patients received MB for post-CPB VS during the study period. MB administration was associated with an 8 mmHg increase in MAP (P = 0.004), and peak response occurred at 2 h. Variables that were associated with a positive drug response were deep hypothermic circulatory arrest during surgery and higher MAP at the time of drug administration (P = 0.006 and 0.02). A positive response had no correlation with in-hospital mortality (P = 0.09). Conclusions: MB modestly increases MAP in cardiac surgery patients with VS. Higher MAP at the time of drug administration and surgery with deep hypothermic circulatory arrest predict a greater drug response.

http://ift.tt/2niXfhW

Multiple Nutritional Factors and the Risk of Hashimoto's Thyroiditis

Thyroid , Vol. 0, No. 0.

http://ift.tt/2njck35

Effects of two wattages of low-level laser therapy on orthodontic tooth movement

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): M. Milligan, Y. Arudchelvan, S.-G. Gong
IntroductionMixed outcomes have been found in animal and clinical studies with regard to the use of low-level laser therapy (LLLT) as a modality to accelerate orthodontic tooth movement (OTM). One major reason for the variable findings is the different methodologies and protocols for laser therapy use.ObjectiveThe aim of this study was to determine whether orthodontically moved molars exposed to two different wattages at the same energy density of LLLT exhibited differences in the amount of tooth movement and molecular and histological changes in the adjacent periodontal areas.MethodsAn orthodontic force was applied to rat upper first molars exposed to 500mW (EX-500) and 1000mW (EX-1000) of laser application, with a control group (CT) with no laser application. Gene expression in the periodontal ligament (PDL) and histology of the palatal gingiva of the molars were analyzed.ResultsThere was a statistically significant difference for OTM between EX-500 but not between EX-1000 and CT groups. RANKL and MMP-13 expression levels in the PDL of orthodontically moved molars, however, were increased significantly in laser-exposed groups compared to CT. Early signs of dysplasia were observed in over half of the animals in the EX-1000 group.ConclusionsOur results provide evidence for molecular changes and the potential dysplastic effects of laser on the surrounding soft tissues. Further studies are needed to better identify an optimum laser protocol to maximize the desired effect.

http://ift.tt/2o8E3Cb

Aims & Scope/Editorial board

Publication date: June 2017
Source:Archives of Oral Biology, Volume 78

http://ift.tt/2nJEmA3

Effects of two wattages of low-level laser therapy on orthodontic tooth movement

Aims & Scope/Editorial board

Publication date: June 2017
Source:Archives of Oral Biology, Volume 78

http://ift.tt/2nJEmA3

Allergen-specific immunoglobulin E and allergic rhinitis severity

http://ift.tt/2nJxdiY

Efficacy and safety of an intravenous C1-inhibitor concentrate for long-term prophylaxis in hereditary angioedema

http://ift.tt/2niTaKC

Flexible microsensor technology for real-time navigation tracking in balloon sinus ostial dilation

http://ift.tt/2nJAsqV

Quality-of-life improvement after endoscopic sinus surgery in patients with obstructive sleep apnea

http://ift.tt/2niMigm

Ossifying fibroma of the maxilla and sinonasal tract: Case series

http://ift.tt/2nJfSXE

Intrasinus penetration of a silastic malar implant, which resulted in chronic sinusitis: A case report and literature review

http://ift.tt/2niZHVt

Autoimmune-related nasal septum perforation: A case report and systematic review

http://ift.tt/2nJpq4T

The impact of total immunoglobulin E levels on outcomes of maximal medical therapy for chronic rhinosinusitis

http://ift.tt/2niBsa4

A new method for three-dimensional evaluation of the cranial shape and the automatic identification of craniosynostosis using 3D stereophotogrammetry

Craniosynostosis is a congenital defect which can result in abnormal cranial morphology. Three dimensional (3D) stereophotogrammetry is potentially an ideal technique for the evaluation of cranial morphology and diagnosis of craniosynostosis because it is fast and harmless. This study presents a new method for objective characterization of the morphological abnormalities of scaphocephaly and trigonocephaly patients using 3D photographs of patients and healthy controls. Sixty 3D photographs of healthy controls in the age range of 3–6 months were superimposed and scaled.

http://ift.tt/2p7fenY

Effectiveness of radiotherapy+ozone on tumoral tissue and survival in tongue cancer rat model

Publication date: Available online 6 April 2017
Source:Auris Nasus Larynx
Author(s): Remzi Dogan, Aysenur Meric Hafız, Huriye Senay Kiziltan, Alper Yenigun, Nur Buyukpinarbaslili, Ali Hikmet Eris, Orhan Ozturan
ObjectiveThe objective of this study is to examine therapeutic effect of the combination of radiotherapy and ozone which features increasing of the destruction of cancer cells by increasing oxygen level of the body on advanced tongue cancer induced in rats.MethodsA total of 36 female rats were included in this study as 4 groups.Group 1 (Cancer, n=8): 4NQO.Group 2 (Cancer+Radiotherapy, n=10): 4NQO+Radiotherapy.Group 3 (Cancer+Ozone+Radiotherapy, n=10): 4NQO+Ozone+Radiotherapy.Group 4 (Cancer+Ozone, n=10): 4NQO+Ozone.Group 5 (Control, n=8): Physiological saline solution.At the end of the week 20, rats in Groups 1 and 5 were sacrified. The rats in Groups 2,3 and 4 were waited until oral food intake was disrupted. The necessary applicatione were then carried out and survivals were evaluated. Each rat was sacrified after death. Tongues of the rats were excised, stained with hematoxylin & eosin and histopathologically evaluated.ResultsHistopathologic evaluation: The model that we applied was seen to achieve success in Group 1 in which 7 of the rats developed squamous cell carcinoma and one rat developed dysplasia at the end of the week 20. In Group 2 squamous cell cancer was seen in 6 and dysplasia in 4 rats. Six rats presented normal tongue tissues and 4 rats developed hyperplasia in Group 3.In Group 4; 3 rats had squamous cell cancer, 2 rats dysplasia, 3 rats hyperplasia and 2 rats had normal tissue. In Group 5, normal tongue tissues were observed in all rats. A significant histopathological improvement was observed in Group 3 compared to Group 2 (p<0.05). Histopathologic scorings were similar in Groups 3 and 5 (p>0.05). No statistically significant difference was found in histopathologic scorings between Group 1 and Group 2 (p>0.05). A significant improvement was observed in Group 4 compared to Group 1 (p<0.05). Group 3 showed a significant histologic improvement compared to Group 4 (p<0.05).Evaluation of survival: Survival times were found as 3.4±1.3 days, 76.4±14.9days and 76.4±14.9 days in the Groups 2, 3 and 4; respectively. Survival was significantly longer in Group 3 than in Groups 2 and 4 (p<0.05). Survival was significantly longer in Group 4 compared to Group 2 (p<0.05).ConclusionIn this study, demonstrated that radiotherapy plus ozone application both provided histopathological improvement and prolonged survival in advanced tongue cancer rat model.

http://ift.tt/2o3eT6f

The Emerging Role of 3-Dimensional Printing in Rhinology

Nasal septal perforations, particularly those that are large and irregular in shape, often present as challenging surgical dilemmas. New technology has allowed us to develop techniques using computed tomography imaging and 3-dimensional (3D) printers to design custom polymeric silicone septal buttons. These buttons offer patients an option that avoids a surgical intervention when standard buttons do not fit well or are not tolerated. Preliminary data suggest that buttons designed by 3D printer technology provide more comfort than standard commercially available or hand-carved buttons with equivalent reduction of symptoms.

http://ift.tt/2p7cTcD

Next-Generation Surgical Navigation Systems in Sinus and Skull Base Surgery

Over the past 25 years, rhinologists have adopted surgical navigation technology for endoscopic sinus and skull base procedures. Navigation systems often produce a wide target registration error (TRE). Ideally, next-generation systems will include a leap in target registration error reduce TRE through innovative hardware and software. Incorporation of microsensors will be another important innovation. Future systems are likely to include augmented reality, which can project overlays of critical anatomy on real-world endoscopic images. Recent trends in surgical navigation suggest a phase of rapid evolution.

http://ift.tt/2niw32U

Streamlining the manufacture of custom titanium orbital plates with a stereolithographic three-dimensional printed model

In an earlier paper, we described the use of 3-dimensional reformatted images, stereolithographic models, and rapid prototyping, for reconstruction of the orbital floor or defects of the medial wall with a custom titanium Plate1. When these processes are combined it allows us to construct a titanium implant that precisely fits and reconstructs the contour of the bony defect.2 We also described direct and indirect methods to virtually reconstruct the orbital floor using software that processes data from computed tomography (CT).

http://ift.tt/2oPokWT

Correlates of multiple basal cell carcinoma in a retrospective cohort study: Sex, histologic subtypes, and anatomic distribution

Basal cell carcinoma (BCC) is the most common malignancy in the United States.1 More than 41% of patients with 2 or more BCCs develop a subsequent BCC.2,3 Despite clinical awareness of risk factors for a second BCC, there remains a subset of individuals who develop significantly more BCCs than the average population. In this study, we sought to characterize the factors associated with high-frequency BCC, including sex, anatomic site, and histologic site.

http://ift.tt/2oKJBUy

Fontana-Masson stain in fungal infections

Fontana-Masson (FM) staining is a histopathology technique used to identify dematiaceous fungi. The result often guides initial species identification and antifungal treatment; however, there is evidence that nondematiaceous fungi might react with this stain. Few studies in the current literature address this issue.

http://ift.tt/2o38mbE

Assessment of major comorbidities in adults with atopic dermatitis using the Charlson comorbidity index

There is a growing interest in comorbidities of adults with atopic dermatitis (AD).

http://ift.tt/2oKIzYP

Burden and treatment patterns of advanced basal cell carcinoma among commercially insured patients in a United States database from 2010 to 2014

The burden of advanced basal cell carcinoma (aBCC) is not fully understood.

http://ift.tt/2o2Z5Az

Correction

Humphreys TR, Shah K, Wysong A, Lexa F, MacFarlane D. Answers to CME examination. J Am Acad Dermatol. 2017;76:607.

http://ift.tt/2oKDu2C

Association between atopic dermatitis and contact sensitization: A systematic review and meta-analysis

It is unclear whether patients with atopic dermatitis (AD) have an altered prevalence or risk for contact sensitization. Increased exposure to chemicals in topical products together with impaired skin barrier function suggest a higher risk, whereas the immune profile suggests a lower risk.

http://ift.tt/2o2Sxln

Effectiveness of radiotherapy+ozone on tumoral tissue and survival in tongue cancer rat model

The objective of this study is to examine therapeutic effect of the combination of radiotherapy and ozone which features increasing of the destruction of cancer cells by increasing oxygen level of the body on advanced tongue cancer induced in rats.

http://ift.tt/2oGcUrG

Reduced post-tonsillectomy bleeding rates through a refined technique

The first documented tonsillectomy was performed in the first century A.D. by Cornelius Celsus in Rome. He used his finger to bluntly dissect an inflamed tonsil. Over time, better instruments and technical advances have allowed for the development of new techniques although cold-knife dissection has been the standard procedure for many years and is still used among many practicing otolaryngologists today [1].

http://ift.tt/2nQhPSR

Detection of endolymphatic hydrops using traditional MR imaging sequences

The purpose of this study was to determine whether Meniere's disease (MD) produces endolymphatic cavity size changes that are detectable using unenhanced high-resolution T2-weighted MRI.

http://ift.tt/2nitluh

Perioperative cardiac complications in patients undergoing head and neck free flap reconstruction

Limited data exists on cardiac complications following head and neck free flaps.

http://ift.tt/2nQthhi

Evaluation of Various Laryngeal Pathologies: Videolaryngoscopy Versus Videolaryngostroboscopy

Abstract

Voice disorders are common in various laryngeal pathologies. The aim of this study is to evaluate the diagnostic value of videolaryngostroboscopy (VLSS) over videolaryngoscopy (VLS) in laryngeal pathologies. This was a prospective observational study. Detailed examination was carried out for 80 cases which presented with different laryngeal pathologies. Cases were evaluated on the basis of VLS and VLSS in the same sitting and diagnosed separately. Sensitivity, specificity, positive predictive value and negative predictive value were calculated to find out the relationship between diagnoses made by VLS and VLSS. The diagnostic value of VLSS is significant; it has 98.15% Sensitivity and 50% specificity over VLS in finding true vocal cord abnormalities. Around one third of the cases, i.e. 26 cases (32.50%) were misdiagnosed on VLS. Also, VLSS gave additional diagnosis in 6 cases (7.50%) which were missed on VLS. However, the diagnoses revealed by VLS and VLSS were same in 48 cases (60%). The diagnostic value of VLSS correlated with the type of laryngeal pathology. Through the present study, it has been deduced that VLSS is the superior modality for diagnosing laryngeal pathologies. It offers better visualisation of the finer aspects of the vocal cords. It has various advantages over VLS in terms of sensitivity and specificity.

http://ift.tt/2p5EDOV

Binaural Interaction Component of Middle Latency Response in Children Suspected to Central Auditory Processing Disorder

Abstracts

Binaural processing disorder is an important deficit in children with (C)APD so binaural processing evaluations are crucial. There are subjective and objective tests for assessing binaural processing. Subjective tests require patient attention and active so objective evaluation of binaural processing is important. The aim of present study was investigating binaural interaction component (BIC) of middle latency response (MLR) in children suspected to (C)APD. Sixty 8–12 year-old children suspected to (C)APD and sixty normal children were selected based on inclusion criteria. Both groups were matched in terms of sex (40 boys and 20 girls) and age (9.05 ± 1.25 years old). MLR test (monaural right ear, monaural left ear and binaural) was performed in all the cases and BIC was calculated by subtracting binaural response from summed monaural responses. Independent t test showed that latency of Pa and Na (ms), Pa–Na amplitude (µv), BIC latency (ms) and amplitude (µv) were significantly different from normal subjects (p value ≤0.001). Present study showed that MLR and BIC of MLR are clinically available and objective tests that can be used to determining children suspected to (C)APD. These tests might have the potential to separating normal children from children with (C)APD objectively.

http://ift.tt/2o0drBF

Comparative Study of Outcome of Endoscopic Myringoplasty in Active and Inactive Mucosal Chronic Otitis Media Patients

Abstract

The objective of this study was to compare graft uptake and hearing improvement in active and inactive mucosal chronic otitis media patients after endoscopic myringoplasty. This is prospective study conducted at a government medical college and hospital from February 2014 to August 2015. A total of 40 active (wet) ears with mucoid discharge and 40 inactive (dry) ears (at least 6 weeks dry before surgery) with mucosal chronic otitis media were operated on by endoscopic myringoplasty by transcanal approach. Graft uptake and hearing gain rates 3 months after surgery were compared for both groups. Endoscopic myringoplasty using temporal fascia graft via transcanal approach was used. The graft take rate was 77.5% for the active ear group and 85% for the inactive ear group. The hearing gain rate was 82.5% for the inactive ear group and 72.5% for the active ear group. Differences were found to be statistically insignificant for both graft uptake and hearing gain. The success of endoscopic myringoplasty is not adversely affected by the presence of mucoid ear discharge at the time of surgery, and outcomes are comparable to those of the operation done for inactive ear.

http://ift.tt/2nZUdfn

Acute aortic valvular regurgitation with pulmonary haemorrhage in Wegener's granulomatosis presenting as dyspnoea: a rare presentation

Mani Nallasivan<br />Dec 6, 2010; 2010:bcr1120092474-bcr1120092474<br />case-report

http://ift.tt/2oeZYZ5

The Technique for 3D Printing Patient-Specific Models for Auricular Reconstruction

Currently, surgeons approach autogenous microtia repair by creating a two-dimensional (2D) tracing of the unaffected ear to approximate a three-dimensional (3D) construct, a difficult process. To address these shortcomings, this study introduces the fabrication of patient-specific, sterilizable 3D printed auricular model for autogenous auricular reconstruction.

http://ift.tt/2nQqsN8

A new approach to nasomaxillary complex type of nasal bone fracture: Clip operation

Nasal bone fractures comprise almost 40% of all facial injuries. Most are initially reduced using closed reduction. This study introduces a newly developed method, the clip operation via endonasal approach.

http://ift.tt/2oKHRuq

Evaluation of Various Laryngeal Pathologies: Videolaryngoscopy Versus Videolaryngostroboscopy

Abstract

http://ift.tt/2p5EDOV

Reply to: “Differential expression of serpins may selectively license distinct granzyme B functions including antigen cross-presentation”

Publication date: Available online 6 April 2017
Source:Molecular Immunology
Author(s): M.S. Mangan, J. Vega-Ramos, L.T. Joeckel, A.J. Mitchell, A. Rizzitelli, B. Roediger, D. Kaiserman, W.W. Weninger, J.A. Villadangos, P.I. Bird

http://ift.tt/2o2teji

A comparative study of intermaxillary fixation screws and noncompression miniplates in the treatment of mandibular fractures: a prospective clinical study

Abstract

Background

The main goal of treatment of mandibular fractures is to restore normal dental occlusion and promote appropriate bone healing and a normal mouth opening. Recently, there has been a resurgent interest in the use of screws for intermaxillary fixation of mandibular fractures. This study was therefore designed to determine how the clinical outcomes of the use of screws for intermaxillary fixation compare with the use of miniplates in the treatment of mandibular fractures in Nigeria.

Objectives

The objectives of this study are as follows:

To compare the clinical outcomes of the use of 2.0 mm × 9.0 mm screws for intermaxillary fixation with 2.0 mm noncompression miniplates in the treatment of simple unilateral mandibular fractures in Lagos, Nigeria
To determine the clinical outcomes in the use of 2.0 mm × 9.0 mm screws for intermaxillary fixation (IMF) and 2.0 mm noncompression miniplates in the treatment of simple unilateral mandibular fractures
To compare the complications associated with the use of 2.0 mm × 9.0 mm screws for IMF and 2.0 mm noncompression miniplates in the treatment of mandibular fractures

Methodology

This randomized controlled clinical study was carried out at the Department of Oral and Maxillofacial Surgery of the study institution. Subjects with simple unilateral mandibular fractures who met the inclusion criteria were randomly allocated into the study (intermaxillary fixation screw) and control (miniplate) groups through balloting. Factors assessed and compared during and after the procedures included intraoperative pain, postoperative nerve impairment, postoperative occlusion, limitation of mouth opening, incidence of hardware failure, incidence of infection and non-union. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 20.

Results

A total of 56 subjects participated in the study, with 28 subjects in each group. Majority (91%) of the subjects were male. Road traffic crash was the highest aetiological factor while sport was the least (3.6%). A higher proportion (25.0%) of subjects in the miniplate group had major complications compared with 14.3% in the IMF screw group. There was no statistically significant association between site of mandibular fracture, time elapsed before treatment and complications (p < 0.05). All cases of mandibular fractures healed successfully at 6 weeks.

Conclusion

The use of screws for IMF is as effective as 2.0 mm noncompression miniplates in the treatment of simple unilateral mandibular fractures.

http://ift.tt/2oHm7zQ

Postoperative leukocyte changes in facial fracture patients: a randomized prospective study with short-term dexamethasone

Abstract

Purpose

We investigated leukocyte changes in facial fracture patients undergoing surgery. Of specific interest was the effect of perioperative dexamethasone on leukocyte changes.

Methods

Facial fracture patients were randomized to receive perioperatively a total dose of 30 mg of dexamethasone, whereas patients in the control group received no glucocorticoid. All patients received antibiotics until postoperative days 7–10. Leukocyte count was measured on postoperative days 1 and 2. Clinical infections were observed during the follow-up.

Results

A total of 110 adult patients were included in the study. Postoperative leukocytosis was found in 91.2% of patients receiving dexamethasone and in 67.9% of controls. Dexamethasone was associated strongly with leukocyte rise (p < 0.001) on both postoperative days. Transoral surgery and younger age (≤40 years) showed significant associations with leukocytosis on the first postoperative day (p = 0.002). In regression analyses, dexamethasone associated with leukocytosis most significantly (p < 0.001). No association was found with infections.

Conclusions

Dexamethasone use was the most significant predictor of leukocyte rise. As a drug response, perioperative dexamethasone caused sixfold postoperative leukocytosis. High-dose dexamethasone-induced leukocytosis may confuse the clinical decision-making especially in assessment of early infections.

http://ift.tt/2oMvADc

Increased risk of sudden sensorineural hearing loss in patients with hepatitis virus infection

by Hsin-Chien Chen, Chi-Hsiang Chung, Chih-Hung Wang, Jung-Chun Lin, Wei-Kuo Chang, Fu-Huang Lin, Chang-Huei Tsao, Yung-Fu Wu, Wu-Chien Chien

The etiology of sudden sensorineural hearing loss (SSNHL) remains unclear. Possible causes of SSNHL include vascular diseases, viral infection, and autoimmune disorders. Therefore, we investigated whether hepatitis virus infection is correlated with the risk of SSNHL. Using data from the Taiwan Longitudinal Health Insurance Database, we conducted a retrospective matched-cohort study to compare patients diagnosed with hepatitis B or C virus (HBV/HCV) infections from January 1, 2000, to December 31, 2010, (N = 170,942) with frequency-matched controls (N = 512,826) at a ratio of 1:3 by sex, age, and index year. We followed each patient until the end of 2010 and evaluated the incidence of SSNHL. At the end of the follow-up period, 647 (0.38%, 647/170,942) patients developed SSNHL in the HBV/HCV group compared with 978 (0.19%, 978/512,826) in the control groups, with a statistical significance of P

http://ift.tt/2o1TASC

Importance of relying on examples for both anesthesiologists and other physicians to assign unbiased American Society of Anesthesiologists Physical Status Classifications

In this month's issue of the Journal of Clinical Anesthesia, Curatolo and colleagues compare American Society of Anesthesiologists' Physical Status (ASA PS) scoring by anesthesiologists and internal medicine physicians [1]. Using 20 cases (scenarios), they showed that internists assigned significantly lower ASA PS scores than did anesthesiologists [1]. The internists "had a 30–40% chance of under-rating the ASA PS of the patients in the clinical vignettes" compared with the anesthesiologists [1].

http://ift.tt/2oJV3zZ

Less postoperative sore throat after nasotracheal intubation using a fiberoptic bronchoscope than using a Macintosh laryngoscope: A double-blind, randomized, controlled study

To evaluate whether nasotracheal intubation using a fiberoptic bronchoscope reduces postoperative sore throat.

http://ift.tt/2p6K9Rf

Determining predictive value of preoperative tests for difficult intubation

In the recent article by Mahmoodpoor et al. [1] evaluating the predictive value of several preoperative tests for difficult intubation in a prospective descriptive study, they conclude that facial angle has a high sensitivity, positive and negative predictive value, and Youden index for prediction of difficult intubation, but the best result is achieved when facial angle is used in combination with either the modified Mallampati score or upper lip bit test. As difficult intubation prediction by preoperative tests is a crucial component of safe airway management algorithm [2], their findings have potential implications.

http://ift.tt/2oJT5Q4

Perioperative cardiac complications in patients undergoing head and neck free flap reconstruction

Publication date: Available online 6 April 2017
Source:American Journal of Otolaryngology
Author(s): Peter J. Ciolek, Kate Clancy, Michael A. Fritz, Eric D. Lamarre
BackgroundLimited data exists on cardiac complications following head and neck free flaps.DesignA retrospective review was performed on patients that underwent free flap reconstruction from 2012 to 2015.Results368 flaps were performed. 12.5% of patients experienced a cardiac event. Hypertension, coronary artery disease, heart failure, venous thromboembolism, and anticoagulation were associated with cardiac complications. ASA class was not predictive of cardiac events. 7.6% of patients required anticoagulation, which exhibited a strong association with surgical site hematoma. Cardiac complications led to a significantly increased length of stay.ConclusionsThere is a significant rate of cardiac events in this cohort. When estimating risk, a patient's total burden of comorbidities is more important than any one factor. ASA Class fails to demonstrate utility in this setting. Cardiac events have implications for quality-related metrics including length of stay and hematoma rate.

http://ift.tt/2ni30MH

PcMab-47: Novel Antihuman Podocalyxin Monoclonal Antibody for Immunohistochemistry

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.

http://ift.tt/2nIvJpf

Salivary microbiome of an urban Indian cohort and patterns linked to subclinical inflammation

Abstract

Objective

To profile salivary microbiomes of an urban-living, healthy Indian cohort and explore associations with proinflammatory status.

Methods

51 clinically healthy Indian subjects' salivary microbiomes were analyzed using 16S rRNA Illumina MiSeq sequencing. Community distribution was compared with salivary data from the Human Microbiome Project (HMP). Indian subjects were clustered using microbiome based 'partitioning along medoids' (PAM) and relationships of interleukin 1 beta levels with community composition were analyzed.

Results

Indian subjects presented higher phylogenetic diversity than HMP. Several taxa associated with traditional societies gut microbiomes (Bacteroidales, Paraprevotellaceae and Spirochaetaceae) were raised. Bifidobacteriaceae and Lactobacillaceae were approximately 4-fold greater. A PAM cluster enriched in several Proteobacteria, Actinobacteria and Bacilli taxa and having almost 2- fold higher Prevotella to Bacteroides ratio showed significant overrepresentation of subjects within the highest quartile of salivary interleukin-1 beta levels. Abiotrophia, Anaerobacillus, Micrococcus, Aggregatibacter, Halomonas, Propionivivrio, Paracoccus, Mannhemia, unclassified Bradyrhizobiaceae and Caulobacteraceae were each significant indicators of presence in the highest interleukin-1 beta quartile. 2 OTUs, representing Lactobacillus fermentum and Cardiobacterium hominis significantly correlated with interleukin-1 beta levels.

Conclusion

The salivary microbiome of this urban-dwelling Indian cohort differed significantly from that of a well-studied Western cohort. Specific community patterns were putatively associated with subclinical inflammation levels.

http://ift.tt/2oNOdq8

Reproducibility, repeatability and level of difficulty of two methods for tumor budding evaluation in oral squamous cell carcinoma

Abstract

Background

This study aimed to analyze the reproducibility, repeatability and level of difficulty of two methods for tumor budding evaluation in oral squamous cell carcinoma (OSCC): staining by hematoxylin and eosin (HE), and immunostaining for multi-cytokeratin.

Methods

The evaluation of tumor budding was performed by three examiners in 103 samples of OSCC, using the two methods. A Likert-type scale was used to measure the difficulty in the assessment. The inter-examiner agreement (reproducibility) was estimated using Fleiss's Kappa and the intra-examiner agreement (repeatability) was estimated using Cohen's Kappa. The Friedman test was used to compare the three examiners' perceived levels of difficulty of assessment. The Wilcoxon test was used to compare the level of difficulty of the evaluation between the two methods.

Results

Reproducibility by the immunostaining method for multi-cytokeratin was substantial, being higher than the only fair agreement by the HE. Repeatability by the HE ranged from moderate to substantial among examiners, regardless of the examiner's experience. Repeatability by the immunostaining method for multi-cytokeratin did not vary among examiners, showing almost perfect agreement. The agreement between the two methods ranged from fair to moderate among examiners, being lower in the less experienced examiner. All the examiners presented greater difficulty in the evaluation by the HE.

Conclusion

In view of the unsatisfactory agreement between the two methods of tumor budding evaluation in OSCC, it is recommended that this evaluation should be performed by the immunostaining method for multi-cytokeratin, considering its higher reproducibility, greater replicability and lower difficulty compared to the HE.

http://ift.tt/2nP1fml

Deficient double strand break repair in oral squamous cell carcinoma cell lines

Abstract

Background

Approximately 20% of oral squamous cell carcinoma (OSCC) cases arise without any identifiable environmental cause, suggesting involvement of genetic influences in their aetiology. DNA double strand breaks (DSBs) sever both strands of DNA and pose a potential threat to genomic integrity. A hastened accumulation of somatic mutations consequent to DSB repair is deemed to be a likely event in tumorigenesis of OSCC.

Methods

Two discrete chemical approaches, namely hydrogen peroxide and camptothecin, were used to induce DSB in oral cell lines derived from normal through dysplastic to OSCC tissues. After optimization, gamma histone 2Ax (γH2Ax) foci were counted as an indirect measure of kinetics of DSB and confirmed with Western blot of γH2Ax, Nbs1 and ATM.

Results

Maximal number of γH2Ax foci was detected 1 hour and 2 hours post exposure to camptothecin and hydrogen peroxide respectively; when adjusted for the baseline number of γH2Ax, neoplastic cell lines showed the lowest number of maximal DSB and slowest rate of repair compared to other cell lines. γH₂Ax Western blot closely mirrored the trend observed in immunofluorescent staining for γH₂Ax foci. Changes in the expression level of ATM and Nbs1 was minimal, however ATM expression showed a slight gradual increase in normal cells which reached its peak at 2 hours after exposure to camptothecin.

Conclusions

There is a difference in efficiency of DSB repair pathways in cell lines derived from different stages of oral tumorigenesis with neoplastic cell lines having the most defective DSB repair system.

http://ift.tt/2oJ7WtP

A comparative study of intermaxillary fixation screws and noncompression miniplates in the treatment of mandibular fractures: a prospective clinical study

Abstract

Background

Objectives

The objectives of this study are as follows:

To compare the clinical outcomes of the use of 2.0 mm × 9.0 mm screws for intermaxillary fixation with 2.0 mm noncompression miniplates in the treatment of simple unilateral mandibular fractures in Lagos, Nigeria
To determine the clinical outcomes in the use of 2.0 mm × 9.0 mm screws for intermaxillary fixation (IMF) and 2.0 mm noncompression miniplates in the treatment of simple unilateral mandibular fractures
To compare the complications associated with the use of 2.0 mm × 9.0 mm screws for IMF and 2.0 mm noncompression miniplates in the treatment of mandibular fractures

Methodology

Results

Conclusion

The use of screws for IMF is as effective as 2.0 mm noncompression miniplates in the treatment of simple unilateral mandibular fractures.

http://ift.tt/2oHm7zQ

Postoperative leukocyte changes in facial fracture patients: a randomized prospective study with short-term dexamethasone

Abstract

Purpose

We investigated leukocyte changes in facial fracture patients undergoing surgery. Of specific interest was the effect of perioperative dexamethasone on leukocyte changes.

Methods

Results

Conclusions

http://ift.tt/2oMvADc

Endovascular recanalisation of a chronic occlusion of the retrohepatic IVC associated to a filter in a patient with antiphospholipid syndrome

Inferior vena cava (IVC) filters are useful adjuncts to prevent venous thromboembolism to the pulmonary circulation in the setting of contraindication for anticoagulation. Despite their proven decreased rate of pulmonary embolism, IVC filters are not without complications. We herein present the case of a 22-year-old man with a history of antiphospholipid antibody syndrome who was sent to our institution for evaluation with Budd-Chiari and post-thrombotic syndromes associated to a chronic retrohepatic complete IVC occlusion secondary to an IVC filter placed 5 years earlier. Via common femoral, transjugular and transhepatic accesses, we performed a successful endovascular recanalisation and reconstruction of the IVC with a 16 mmx60 mm covered stent; the hepatic outflow was restored with an 8x20 mm Palmaz stent. At 12-month follow-up, his symptoms have resolved, and his liver tests are within normal limits. He remains on systemic anticoagulation.

http://ift.tt/2ngVXUF

Isolated brachydactyly type E and idiopathic pancreatitis in a patient presenting to a lipid disorders clinic

An 18-year-old female tertiary student was referred to a lipid clinic with hypertriglyceridaemia discovered after presentation with acute pancreatitis. The patient's only medication was l-thyroxine for treatment of hypothyroidism. She was overweight, normotensive, with unremarkable facies. However, she had hypermobile hand joints and brachydactyly resulting in loss of left 3–5 and right 4 and 5 knuckle definitions. Radiography revealed shortening of metacarpals 3–5 on the left and 4 and 5 on the right. Her mother had similar skeletal changes, consistent with a dominant mode of inheritance. Abnormally short digits involving the metacarpals, classified as brachydactyly type E, can be isolated or occur as part of a syndrome. Turner syndrome, Albright hereditary osteodystrophy, hypertension with brachydactyly, chromosome 2q37 microdeletion and PTHLH mutations were excluded following clinical, biochemical and genetic testing. No specific treatment was required. Genetic testing for isolated and syndromic forms of brachydactyly facilitates family screening and prepregnancy counselling.

http://ift.tt/2nHSgm6

Delayed presentation of button battery ingestion: a devastating complication

A 12-month-old child presented with a prolonged history of fever, cough and difficulty breathing, which was initially treated as bronchiolitis. She was discharged but presented again to Accident and Emergency department 4 days later with worsening symptom. Following deterioration in the Emergency department, a chest X-ray revealed a button battery in the upper oesophagus. Emergency oesophagoscopy was performed where a 20 mm button battery was removed and a tracheoesophageal fistula was seen 12 mm above the carina. Near total oesophagectomy, cervical oesophagostomy and gastrostomy were performed with a patch repair of the trachea, followed by a bioabsorbable tracheal stent. The patient spent a prolonged period of time in intensive care and was treated with intravenous antibiotics for mediastinitis. This case highlights the difficulty in diagnosis of button batteries when there is no clear history and the devastating consequences of prolonged exposure.

http://ift.tt/2nh2azG

Analgesia and side effects of the addition of 10 or 20 µg fentanyl to articaine in spinal anesthesia for knee arthroscopy: a randomized and observer-blinded study

Abstract

Objectives

Articaine, a popular and rapidly acting local anesthetic in dentistry, has been also found to be beneficial in ambulatory spinal anesthesia. Analgesia in the intraoperative and immediate postoperative period may be further improved by adding fentanyl to the local anesthetic solution for spinal anesthesia. The aim was to evaluate dose-dependency of analgesia and side effects associated with intrathecal fentanyl additive to articaine for spinal anesthesia in knee arthroscopy patients.

Methods

In this randomized, observer- and patient-blinded study, 90 adult patients scheduled for elective ambulatory knee arthroscopy under spinal anesthesia were randomized into three groups: plain articaine 60 mg with saline (group AF0), articaine 60 mg with fentanyl 10 µg (group AF10) or 20 µg (group AF20) in a total volume of 1.9 ml. The blinded observer tested the sensory and the motor block, and performed telephone interviews on the first and seventh postoperative days.

Results

The median (IQR) duration of sensory block at the dermatomal level of T10 was significantly longer in groups AF10, 69 min (56) and AF20, 69 min (45) than in group AF0, 41 min (35) (p = 0.013). Motor block duration was similar in all groups (median 120 min). Group AF20 patients experienced pruritus significantly more often than patients in the other groups (p = 0.039). No acute or late anesthetic side effects occurred, and satisfaction with the anesthetic technique was the same in all groups (97% satisfied).

Conclusions

Fentanyl 10 or 20 µg as additive to articaine for spinal anesthesia prolonged the duration of sensory block significantly and similarly. Fentanyl 20 µg was more often associated with pruritus than fentanyl 10 µg.

http://ift.tt/2o1LFVz

Industry Sponsorship of Research in Otolaryngology

This cross-sectional analysis quantifies research payments made by the health care industry to otolaryngologists and compares the field of otolaryngology with other surgical specialties.

http://ift.tt/2o1vVSn

Neurologic Evaluation in Children With Laryngeal Cleft

This medical record review proposes guidelines for neurologic evaluation and imaging techniques to identify or rule out neuromuscular dysfunction in children with laryngeal cleft.

http://ift.tt/2odNUH9

Superior Canal Dehiscence Syndrome Affecting 3 Families

This case series describes the features of superior canal dehiscence syndrome in the multiple affected members of 3 families and explores the prospect of a genetic origin.

http://ift.tt/2o1zOGQ

Implication for second primary cancer from visible oral and oropharyngeal premalignant lesions in betel-nut chewing related oral cancer

Abstract

Background

Visible oral and oropharyngeal premalignant lesions may be used to monitor for a second primary oral cancer. To control for bias, we focused on the visible oral and oropharyngeal premalignant lesions of patients with oral cancer with a positive betel-nut chewing habit. Visible oral and oropharyngeal premalignant lesions that can predict second primary oral cancers were studied.

Methods

Nine hundred ninety-seven patients with positive betel-nut chewing habits and oral cancer were enrolled in this retrospective cohort study. We analyzed the relevance of their visible oral and oropharyngeal premalignant lesion incidence and relative clinicopathological variables to the development of a second primary oral cancer.

Results

Second primary oral cancer risk was significantly higher in patients with positive visible oral and oropharyngeal premalignant lesions (P < .0001), especially in younger patients (P = .0023; ≤40 years: adjusted odds ratio [OR] 2.66; 40-60 years: adjusted OR 2.61). The heterogeneous leukoplakia was (adjusted OR 2.17) higher than homogeneous leukoplakia.

Conclusion

The predictive value and practicality of visible oral and oropharyngeal premalignant lesions make it a potentially valuable marker in follow-ups of patients with a positive betel-nut chewing habit with oral cancer, especially young patients with heterogeneous leukoplakia.

http://ift.tt/2ngCZgL

Histamine H1 and H4 receptor expression on the ocular surface of patients with chronic allergic conjunctival diseases

Publication date: Available online 5 April 2017
Source:Allergology International
Author(s): Noriko Inada, Jun Shoji, Yukiko Shiraki, Hiroshi Aso, Satoru Yamagami
BackgroundThis study investigated the histamine H1 and H4 receptors mRNA (H1R and H4R, respectively) expression on the ocular surface of patients with chronic forms of allergic conjunctival diseases to determine whether they can serve as biomarkers for allergic inflammation in the conjunctiva.MethodsWe examined 19 patients with vernal or atopic keratoconjunctivitis (AKC/VKC group) and 15 healthy volunteers (control group). The AKC/VKC group was divided into active and stable stage subgroups. Specimens were obtained from the upper tarsal conjunctiva of each participant using a modified impression cytology method. H1R, H4R, and eotaxin-1, -2, and -3 mRNA (eotaxin-1, eotaxin-2, eotaxin-3, respectively) expression was determined by real-time RT-PCR. Immunohistochemical analysis for eosinophil cationic protein (ECP), eosinophil major basic protein (MBP), eotaxin-2, and histamine H4 receptor (H4R) were performed using conjunctival smears.ResultsThe number of H4R-positive patients was higher in the active than the stable stage subgroup and control group, whereas no difference was observed for H1R. H1R levels were higher in the active than in the stable stage subgroup, while those of H4R were higher in the active stage subgroup than in the control group. H1R and H4R levels were correlated with eotaxin-2 level. In immunohistochemical analysis, H4R revealed their expression on eosinophils in conjunctival smears of patients with AKC/VKC.ConclusionsH4R is useful as biomarkers of allergic inflammation on ocular surfaces. Most notably, H4R expressed on eosinophils is useful as a biomarker of eosinophilic inflammation of the ocular surface.

http://ift.tt/2nHwsXU

Maintenance of pathogenic Th2 cells in allergic disorders

Publication date: Available online 5 April 2017
Source:Allergology International
Author(s): Kenta Shinoda, Kiyoshi Hirahara, Toshinori Nakayama
Immunological memory is an important protective mechanism that enables host organisms to respond rapidly and vigorously to pathogens that have been previously encountered. In addition to the protective function, memory CD4⁺ T helper (Th) cells play a central role in the pathogenesis of chronic inflammatory disorders, including asthma. Recently, several investigators have identified phenotypically and functionally distinct memory Th2 cell subsets that produce IL-5. These memory Th2 cell subsets play an important role in the pathology of allergic inflammation and function as memory-type "pathogenic Th2 (Tpath2) cells" both in mice and humans. We review the role of lung Tpath2 cells in the development of allergic inflammation and, in the context of recent findings, propose a mechanism by which Tpath2 cells not only survive but also continue to function at the sites where antigens were encountered. A greater understanding of the functional molecules or signaling pathways that regulate the inflammatory niche for Tpath2 cells may aid in the design of more effective treatments for chronic inflammatory disorders.

http://ift.tt/2o6FLUQ

Foreign Body Aspiration During Inhaled Bronchodilator Administration

Publication date: Available online 5 April 2017
Source:Archivos de Bronconeumología (English Edition)
Author(s): M. Teresa Gómez Hernández, Nuria M. Novoa, Marcelo F. Jiménez

http://ift.tt/2nOl9Of

Endoscopic endonasal nasopharyngectomy: tensor veli palatine muscle as a landmark for the parapharyngeal internal carotid artery

Background

Endoscopic endonasal nasopharyngectomy(EEN) can be a promising option for select patients with recurrent nasopharyngeal carcinoma, but serious complications can occur in terms of parapharyngeal internal carotid artery (PPICA) injury. Several landmarks have been proposed for locating the PPICA. In this study, we investigated the spatial relationship between the tensor veli palatini (TVP) muscle and the PPICA in a cadaveric model.

Methods

Seven fresh cadaver heads were available for anatomic study. Eustachian tube and the levator veli palatine (LVP) muscle were partially sacrificed or truncated to maximize the surgical field, and the TVP muscle was carefully preserved. Complete dissection was defined as when the PPICA could be visualized. We then measured the distance between the posterior margin of the TVP muscle and PPICA (z-axis), and the distance from the midline of the nasopharynx to the PPICA (x-axis).

Results

Thirteen sides of the PPICA were successfully identified. The mean distance between the posterior margin of the TVP to the PPICA (z) was 20.3 mm (range, 12 to 28 mm), and the mean distance between the midline of the nasopharynx to the PPICA (x) was 19.6 mm (range, 15 to 24 mm).

Conclusion

The PPICA was located in the same sagittal plane as the TVP muscle during dissection posteriorly. The PPICA appeared to lie around 2 cm laterally from the midline at around 2 cm in depth from the posterior margin of the TVP muscle. However, the exact position of the PPICA should be assessed using preoperative magnetic resonance imaging and intraoperative image-guided systems.

http://ift.tt/2oHWzm3

Olfactory brain gray matter volume reduction in patients with chronic rhinosinusitis

Background

Chronic rhinosinusitis (CRS) is a common inflammatory condition and a major cause of olfactory loss. Olfactory dysfunction has been associated with reduced olfactory bulb (OB) volume and gray matter (GM) density in the olfactory-related brain areas. The aim of this study was to investigate brain GM structural and OB volume alterations in patients with CRS.

Methods

Structural brain images were collected from 21 CRS patients and 31 healthy controls on a 3-T scanner. Voxel-based morphometry (VBM) was performed to investigate GM. Olfactory bulb volumes were measured using AMIRA software. Psychophysical olfactory testing for odor threshold (T) and identification (I) was performed using the Sniffin' Sticks battery.

Results

CRS patients had significantly lower scores for Sniffin' Sticks olfactory tests than controls (p < 0.001 for T, I, and combined T and I [TI] scores). Region-of-interest analyses revealed no difference in GM volume between CRS patients and healthy controls; however, in CRS patients with severe olfactory dysfunction, GM reduction was observed in the gyrus rectus, orbitofrontal cortex, thalamus, and the insula. In addition, no difference was observed for OB volume in CRS patients compared with healthy controls.

Conclusion

In this study we identified a reduction in gray matter in olfactory brain regions in CRS patients with severe olfactory dysfunction.

http://ift.tt/2nObKq1

Outcomes of endoscopic optic nerve decompression in patients with idiopathic intracranial hypertension

Background

The conventional treatment for idiopathic intracranial hypertension involves weight loss, steroids, diuretics, and/or serial lumbar punctures; however, if the symptoms persist or worsen, surgical intervention is recommended. Surgical options include cerebrospinal fluid diversion procedures, such as ventriculoperitoneal and lumboperitoneal shunts, and optic nerve decompression with nerve sheath fenestration. The latter can be carried out using an endoscopic approach, but the outcomes of this technique have not been firmly established.

Methods

This systematic review examined the outcomes of performing endoscopic optic nerve decompression (EOND) in patients with idiopathic intracranial hypertension (IIH). Six studies were included for a total of 34 patients.

Results

The patients presented with visual field disturbances (32 of 32 [100%]), visual acuity disruptions (33 of 34 [97.1%]), papilledema (26 of 34 [76.5%]), and persistent headache (30 of 33 [90.1%]). The mean duration of symptoms ranged from 7 to 32 months. Overall, the patients showed post-EOND improvement in signs and symptoms associated with IIH, specifically visual field deficits (93.8%), visual acuity (85.3%), papilledema (81.4%), and headaches (81.8%). Interestingly, 11 cases showed postoperative improvement in their symptoms with bony decompression of the optic canal alone, without nerve sheath fenestration. There were no major adverse events or complications reported with this approach.

Conclusion

EOND appears to be a promising and safe surgical alternative for patients with IIH who fail to respond to medical treatment. Further studies are needed before we can attest to the clinical validity of this procedure.

http://ift.tt/2oI2GH3

Oral hairy leukoplakia arising in a patient with hairy cell leukaemia: the first reported case

Oral hairy leukoplakia (OHL) is an oral mucosal lesion that is associated with Epstein-Barr virus infection. It commonly presents as an asymptomatic, non-removable white patch on the lateral borders of the tongue in individuals who are immunocompromised. Historically, OHL was thought to be pathognomonic of HIV infection; however, it is now an established phenomenon in a range of conditions affecting immune competence. Hairy cell leukaemia (HCL) is a rare chronic B cell lymphoproliferative disease named after the distinctive cytology of the atypical cells. We report the first case of OHL arising in an individual with HCL that resolved following remission of the haematological malignancy.

http://ift.tt/2nfOKUw

Giant hiatal hernia: beware of the supine ICU chest X-ray!

Description

An 85-year old woman with a medical history of mild hiatal hernia was admitted to the medical intensive care unit for respiratory distress associated with hypoxaemia and hypercapnia. A diagnosis of cardiogenic oedema was suspected. The situation slightly improved after high-dose diuretics and non-invasive ventilation. The anteroposterior supine chest X-ray revealed a right thoracic opacity. The patient was transferred to the pulmonology unit. A classical erected posteroanterior chest X-ray revealed a large air-fluid level in the right hemithorax (figure 1). An hydropneumothorax or a lung abscess was suspected. A chest CT scan revealed a giant hiatal hernia containing the stomach, the first duodenum, the spleen, the caudal part of the pancreas and the left colic flexure, all elevated in the right hemithorax (figure 2A–C; ). A laparoscopic surgical procedure was performed which involved the excision of the hernia sac, a suture repair of...

http://ift.tt/2nNYZMe

Asthma control in primary care: the results of an observational cross-sectional study in Italy and Spain

Poor asthma control observed in several surveys may be related to a lack of systematic assessment by physicians and/or to patient underestimation of symptoms. Along this line, the purpose of this study was to ...

http://ift.tt/2netpLl

Dermoscopic features of periungual papules in Multicentic Reticulohistiocytosis Dermoscopy in Multicentic Reticulohistiocytosis

Abstract

A 66-year-old woman was diagnosed with MRH based on clinical and histopathological findings. The disease had started 6 months before with arthralgia of the right shoulder joint and symmetric xanthelasma on the palpebrae. One month later symmetric, bilateral arthralgia affecting most of the proximal and distal intraphalangeal joints of both hands have occurred. The multiple, asymptomatic, 2-3 mm in size, reddish -NDASH- brown papules adjacent to the proximal nail fold and two larger asymptomatic flesh-coloured nodules located at the extensor surface of the right antebrachium and the dorsal surface of the third right finger have appeared at the same time. There were no internal organs involvements (except joints), as well as no Raynaud phenomenon.

http://ift.tt/2p4h8FY

Experimental Pseudomonas aeruginosa mediated rhino sinusitis in mink

Publication date: May 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 96
Author(s): S. Kirkeby, A.S. Hammer, N. Høiby, C.M. Salomonsen
ObjectivesThe nasal and sinus cavities in children may serve as reservoirs for microorganisms that cause recurrent and chronic lung infections. This study evaluates whether the mink can be used as an animal model for studying Pseudomonas aeruginosa mediated rhino-sinusitis since there is no suitable traditional animal model for this disease.MethodsNasal tissue samples from infected and control mink were fixed in formalin, demineralized, and embedded in paraffin. A histological examination of sections from the infected animals revealed disintegration of the respiratory epithelium lining the nasal turbinates and swelling and edema of the submucosa. The expression of mucins and sialylated glycans was examined using immunohistochemistry.ResultsMUC1, MUC2 and MUC5AC were upregulated in the inoculated animals as a much stronger staining was present in the respiratory epithelium in the infected animals compared to the controls. The goblet cells in the nasal epithelium from the infected mink showed high affinity to the Maackia amurensis lectin and anti-asialo GM1 indicating a high concentration of α2-3 sialic acid respectively βGalNAc1-4Galβ containing glycans in these mucin producing cells. The nasal cavity in the infected mink shows features of carbohydrate expression comparable to what has been described in the respiratory system after Pseudomonas aeruginosa infection in humans.ConclusionIt is suggested that the mink is suitable for studying Pseudomonas aeruginosa mediated rhino-sinusitis.

http://ift.tt/2oE8QrV

Methylphenidate effects on P300 responses from children and adolescents

Publication date: May 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 96
Author(s): Milaine Dominici Sanfins, Stavros Hatzopoulos, Osmar Henrique Della Torre, Caroline Donadon, Piotr H. Skarzynski, Maria Francisca Colella-Santos

http://ift.tt/2oLZ4RB

Protective role of intratympanic nigella sativa oil against gentamicin induced hearing loss

Publication date: June 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Deniz Tuna Edizer, Ozgur Yigit, Zehra Cinar, Mehmet Gul, Eyyup Kara, Birgul Yigitcan, Duygu Hayır, Ahmet Atas
ObjectiveAminoglycosides, used to combat with life-threatening infections, have a substantial risk of hearing loss. Nigella sativa is an annual herbaceous plant and used for treatment of many diseases for ages. We aimed to investigate the protective role of intratympanic nigella sativa oil against gentamicin induced hearing loss in an animal model.Methods and materialsTwenty eight guinea pigs were randomly divided into four groups: i-control, ii- Intratympanic nigella sativa oil (IT-NSO), iii- Intraperitoneal gentamicin (IP-G) and iv- Intraperitoneal gentamicin and intratympanic nigella sativa oil (IP-G + IT-NSO). Preoperative and postoperative hearing thresholds were determined with auditory brainstem response with click and 8 kHz tone-burst stimuli. Histological analysis of the cochlea specimens were performed under light microscope. Semiquantitative grading of the histological findings was carried out and compared between the groups.ResultsHighest posttreatment hearing thresholds were detected in IP-G group. Posttreatment mean hearing threshold of the IP-G group with click stimulus was significantly higher than the IP-G + IT-NSO group (p = 0.004). whereas the difference was not significant with 8 kHz tone-burst stimulus (p = 0.137). Both IP-G and IP-G + IT-NSO groups had significantly higher hearing thresholds compared to control and IT-NSO groups (p > 0.05). Histological examination of the control and IT-NSO groups demonstrated normal appearance of cochlear nerve, stria vascularis and organ of Corti. IP-G group showed the most severe histological alterations including hydropic and vacuolar degenerations, hair cell damage and deformation of the basilar mambrane. Histological evidence of damage was significantly reduced in IP-G + IT-NSO group compared to IP-G group.ConclusionAddition of intratympanic NSO to systemic gentamicin was demonstrated to have beneficial effects in hearing thresholds which was supported by histological findings.

http://ift.tt/2oE8P7l

Universal newborn hearing screening in southwestern Iran

Publication date: June 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Nader Saki, Arash Bayat, Reza Hoeinabadi, Soheila Nikakhlagh, Majid Karimi, Rezvan Dashti
ObjectivesThe implementation of Neonatal Hearing Screening (NHS) program is still at the preliminary stage particularly in developing countries despite the burden of permanent congenital and early-onset hearing impairment. The purpose of this study was to report results for universal newborn NHS in a cohort of children born in the southwestern region of Iran, as part of a national screening program set up by the Iranian National Health System.MethodsDuring this cross-sectional study, which took place between March 2013 and April 2016, healthy newborns were screened using transient evoked otoacoustic emissions (TEOAEs) and automated auditory brainstem responses (AABRs) methods at several points in time as early as possible after birth. Screening followed a two-stage strategy and newborns referred after the second-stage screening were scheduled for diagnostic evaluation.ResultsA total of 92,521 newborns were screened in the urban (n = 67,780) and rural (n = 24,741) regions. Hearing impairment was confirmed in 223 (2.41 per 1000) newborns. One hundred forty-one (1.52 per 1000) of these newborns were affected bilaterally. More than 87% of these infants (195/223) showed a sensorineural hearing loss, while the defect was found to be conductive in 12 cases (P < 0.001). Of the 223 cases with hearing loss, 28 (12.5%) infants had auditory neuropathy. The majority of the infants, in both urban and rural regions, showed severe hearing impairment. We did not observe any significant difference among the incidences associated with gender (p = 0.29).ConclusionOur results demonstrated that universal newborn hearing screening program is an adequate program for southwestern of Iran with high coverage, low referral rate, and good follow-up rate.

http://ift.tt/2oM5YWT

Editorial Board

Publication date: May 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 96

http://ift.tt/2oEmYS8

Obituary for Professor Renato Fior

Publication date: May 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 96
Author(s): Desiderio Passali

http://ift.tt/2oM3bwX

A rare case of a non-traumatic neck of femur fracture in a 17-year-old boy associated with vitamin D deficiency

Hip fractures in the young, healthy population are rare and often the result of high-energy trauma. A previously healthy 17-year-old patient presented to our institution with a 5-week history of left hip and knee pain in the absence of any trauma. Pelvic radiograph revealed a subacute left femoral neck fracture. He subsequently underwent surgical fixation and made an uneventful recovery. Further endocrine evaluation revealed isolated vitamin D deficiency to be the likely underlying cause for this fracture. Multiple previous opportunities were missed to identify the cause for this patient's symptoms. An intracapsular fracture in a young adult requires early recognition and prompt anatomical reduction. This case emphasises the need to maintain a high index of suspicion for atraumatic fractures in healthy adolescents with unexplained joint pain. Further endocrine and metabolic investigations are warranted, and isolated vitamin D deficiency must be considered as a potential causative factor.

http://ift.tt/2ocX5b4

Αρχειοθήκη ιστολογίου

Πέμπτη 6 Απριλίου 2017

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Objective

Methods

Results

Conclusion

Abstract

Abstract

Abstracts

Abstract

Abstract

Abstract

Background

Objectives

Methodology

Results

Conclusion

Abstract

Purpose

Methods

Results

Conclusions

Abstract

Objective

Methods

Results

Conclusion

Abstract

Background

Methods

Results

Conclusion

Abstract

Background

Methods

Results

Conclusions

Abstract

Background

Objectives

Methodology

Results

Conclusion

Abstract

Purpose

Methods

Results

Conclusions

Abstract

Objectives

Methods

Results

Conclusions