Ten-year survival outcomes for patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy: An analysis of 614 patients from a single center

Publication date: June 2017
Source:Oral Oncology, Volume 69
Author(s): Li-Rong Wu, Ya-Tian Liu, Ning Jiang, Yan-Xin Fan, Jing Wen, Sheng-Fu Huang, Wen-Jie Guo, Xiu-Hua Bian, Fei-Jiang Wang, Feng Li, Dan Song, Jian-Feng Wu, Xue-Song Jiang, Ju-Ying Liu, Xia He
ObjectivesIntensity-modulated radiotherapy (IMRT) has been applied in nasopharyngeal carcinoma (NPC) for nearly twenty years, while little is known about the ten-year survival outcomes. This study aimed at evaluating the 10-year survival outcomes for patients with NPC receiving IMRT.Materials and methodsData on 614 patients with newly diagnosed, non-disseminated NPC treated by IMRT between 2004 and 2008 were retrospectively reviewed. Survival outcomes stratified by tumor stage were compared.ResultsThe median follow-up duration was 112.7months (range, 7.6–156.8months) for the entire cohort. The 10-year local relapse-free survival rates for T1, T2 and T3 were 94.2%, 92.5% and 91.4% (P>0.05), respectively, and significantly higher than that of T4 disease (79.3%, P<0.05 for all rates). As N category increased from N0 to N3, the 10-year distant metastasis-free survival rates significantly decreased accordingly (P<0.01 for all rates). Furthermore, the 10-year overall survival rates were 100%, 87.1%, 75.5% and 55.6% for stage I, II, III and IV, respectively (P<0.05 except stage I and II). Multivariate analysis established tumor stage and age as independent prognostic factors. Late toxicities were assessable for 495 (80.6%) patients and most were Grade I/II damages. Xerostomia (387 of 489, 79.1%) and hearing impairment (212 of 495, 42.8%) remained the most troublesome.ConclusionIMRT could achieve satisfactory survival outcomes for NPC patients with acceptable late toxicities. However, distant control still remains poor, especially for patients with N3 disease.



http://ift.tt/2oOEova

Masseteric Nerve for Gracilis Muscle Re-Innervation in Unilateral Facial Palsy: Impact on Quality of Life

Unilateral established or congenital facial palsies are usually treated with neuromuscular transplantation to reanimate the impaired side of the face. One of the most debated points is the motor nerve to choose for the reinnervation of the transplant. Contra-lateral healthy facial nerve is usually preferred, but in selected cases motor nerve to masseter is considered a valuable option. However only a few clinical studies focused on quality of life in this subset of patients are available in literature.

http://ift.tt/2oSAdvq

The effect of early fusion of the spheno-occipital synchondrosis on midface hypoplasia and obstructive sleep apnea in patients with Crouzon syndrome

he investigators hypothesized that patients with Crouzon syndrome and premature fusion of the spheno-occipital synchondrosis (SOS) more often have, or have more severe midface hypoplasia and obstructive sleep apnea (OSA).

http://ift.tt/2nNzji0

Is fine-needle aspiration a reliable tool in the diagnosis of malignant salivary gland tumors?

Salivary gland tumors occur very infrequently. In the Western world they have an annual incidence of 2.5–3 cases per 100,000 people. 1They are divided into major gland (parotid, submandibular and sublingual) and minor gland neoplasms. Histologically, this is a heterogeneous group of tumors, with several different patterns that often overlap, making differentiation between benign and malignant nature difficult.2, 3

http://ift.tt/2oiyFwO

Taking the endochondral route to craniomaxillofacial bone regeneration: A logical approach?

The current golden standard for treatment of craniomaxillofacial critical size bone defects, autologous bone grafting,is associated with several disadvantages which have prompted an increased demand for alternatives. New solutions are emerging in the form of bone tissue engineering. This involves harvesting of multipotent mesenchymal stromal cells (MSCs), after which they can be differentiated towards the osteogenic lineage mimicking intramembranous bone formation. However, translating this approach from laboratory to clinic has met with limited success.

http://ift.tt/2oSnOYh

Proposal for a new bone marker for maxillofacial surgery

The use of ink or dye to outline surgical approaches on the skin is common in plastic and reconstructive operations.1 However, marking bone with ink or dye before an osteotomy is difficult because of the need for irrigation. Some surgeons use burs, which we do not recommend, because it could compromise thin bones, it is time consuming, and irreversible.2

http://ift.tt/2nUTV90

Viral Reactivations and Associated Outcomes in Context of Immune Reconstitution after Pediatric Hematopoietic Cell Transplantation

Publication date: Available online 7 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Rick Admiraal, Coco de Koning, Caroline A. Lindemans, Marc B. Bierings, Annemarie M.J. Wensing, A. Birgitta Versluys, Tom F.W. Wolfs, Stefan Nierkens, Jaap Jan Boelens
BackgroundViral reactivations (VR) following hematopoietic cell transplantation (HCT) contribute to significant morbidity and mortality. Timely immune reconstitution (IR) is suggested to prevent VR.ObjectivesWe studied the relation between IR (as a continuous over-time-predictor) and VR (as time-varying-predictor), and the relation between VR and other clinical outcomes.MethodsIn this retrospective analysis, all patients receiving a first HCT between January-2004 and September-2014 were included. IR (CD3/CD4/CD8 T-cells, NK- and B-cells) was measured bi-weekly until 12 weeks, and monthly thereafter. Main outcomes of interest were VR of adenovirus (AdV), Epstein-Barr-virus (EBV), human-herpesvirus 6 (HHV6), cytomegalovirus (CMV), and BK-virus, screened weekly. Clinical outcomes included overall-survival (OS), event-free-survival, non-relapse-mortality (NRM), and graft-versus-host-disease (GvHD). Cox-proportional-hazard- and Fine-Gray-competing-risk-models were used.Results273 patients (0.1-22.7 years; median follow-up 58 months) were included. Delayed CD4-reconstitution predicted reactivation of AdV (HR 0.995; p=0.022), EBV (HR 0.994, p=0.029), and HHV6 (HR 0.991, p=0.012), but not CMV (p=0.31) and BK (p=0.27). Duration of AdV-reactivation was shorter with timely CD4-reconstitution, defined as ≥50*10⁶ cells/L within 100-days. AdV-reactivation predicted lower OS (HR 2.17, p=0.0039) and higher NRM (HR 2.96, p=0.0008). Concomitant CD4-reconstitution abolished this negative effect of AdV-reactivation: OS (p=0.67) and NRM (p=0.64). EBV- and HHV6-reactivations were predictors for occurrence of GvHD, while CMV- and BK-reactivations did not predict clinical outcomes.ConclusionThese results stress the importance of timely CD4-reconstitution. Strategies to improve CD4-reconstitution may improve HCT-outcomes, including survival, and reduce the need for toxic anti-viral therapies.



http://ift.tt/2oSPqN8

Outcome of Hematopoietic Cell Transplantation for DNA-Double Strand Breakage Repair Disorders

Publication date: Available online 7 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): James Slack, Michael H. Albert, Dmitry Balashov, Bernd H. Belohradsky, Alice Bertaina, Jack Bleesing, Claire Booth, Jochen Büchner, Rebecca H. Buckley, Marie Ouachée-Chardin, Elena Deripapa, Katarzyna Drabko, Mary Eapen, Tobias Feuchtinger, Andrea Finocchi, H Bobby Gaspar, Sujal Ghosh, Alfred Gillio, Luis I. Gonzalez-Granado, Eyal Grunebaum, Tayfun Güngör, Carsten Heilmann, Merja Helminen, Kohei Higuchi, Kohsuke Imai, Krzysztof Kalwak, Nubuo Kanazawa, Gülsün Karasu, Zeynep Y. Kucuk, Alexandra Laberko, Andrzej Lange, Nizar Mahlaoui, Roland Meisel, D. Moshous, Hideki Muramatsu, Suhag Parikh, Srdjan Pasic, Irene Schmid, Catharina Schuetz, Ansgar Schulz, Kirk R. Schultz, Peter J. Shaw, Mary A. Slatter, Karl-Walter Sykora, Shinobu Tamura, Mervi Taskinen, Angela Wawer, Beata Wolska-Kuśnierz, Morton J. Cowan, Alain Fischer, Andrew R. Gennery
BackgroundRare DNA breakage-repair disorders predispose to infection and lympho-reticular malignancies. Hematopoietic cell transplantation (HCT) is curative but co-administered chemo- or radio-therapy is damaging due to systemic radio-sensitivity. We collected HCT outcome data for Nijmegen Breakage syndrome (NBS), DNA ligase IV deficiency (LIG4), Cernunnos-XLF deficiency and ataxia-telangiectasia.MethodsData from 38 centres worldwide, including indication, donor, conditioning regimen, graft-versus-host disease (GvHD) and outcome were analyzed. Conditioning was classified as myeloablative (MAC) if it contained radiotherapy or alkylators and reduced intensity (RIC) if no alkylators and/or fludarabine ≤150 mg/m² and cyclophosphamide ≤ 40 mg/kg were used.Results55 new, 14 updated and 18 previously published patients were analyzed. Median age at HCT was 48 (range 1.5 – 552) months. 29 were transplanted for infection, 21 malignancy, 13 bone marrow failure, 13 pre-emptively, 5 had multiple indications, and 6 had no information. 22 received MAC, 59 RIC, 4 were infused;- information unavailable for 2. 73/77 patients with LIG4, Cernunnos-XLF deficiency or NBS received conditioning. Survival was 53/77 (69%), worse for MAC than RIC (p=0.006). Most deaths occurred early post-transplant suggesting poor tolerance of conditioning. Survival in ataxia-telangiectasia patients was 25%. 41/83 patients experienced aGvHD (49%): less in RIC compared to MAC, 26/56 (46%) vs 12/21 (57%) (p=0.45). Median follow-up was 35 (range 2-168) months. No secondary malignancies were reported during 15 years follow-up. Growth and developmental delay remained post-HCT; immune-mediated complications resolved.ConclusionRIC-HCT resolves DNA repair disorder-associated immunodeficiency. Long-term follow-up is required for secondary malignancy surveillance. Routine HCT for ataxia-telangiectasia is not recommended.

Teaser

Hematopoietic cell transplant cures DNA breakage-repair disorders. Cernunnos-XLF deficiency, LIG4 and Nijmegen breakage syndrome patients receiving alkylator or radiotherapy pre-conditioning have worse survival than those receiving reduced intensity conditioning.


http://ift.tt/2oMwjr1

Interplay Between the Skin Barrier and Immune Cells in Patients with Atopic Dermatitis Unraveled by Means of Mathematical Modeling

Publication date: Available online 7 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): David Bending, Masahiro Ono




http://ift.tt/2oSAm1E

Is IL-1β inhibition the next therapeutic target in asthma?

Publication date: Available online 8 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): R. Stokes Peebles




http://ift.tt/2oMuZEA

Efficacy of tofacitinib for the treatment of nail psoriasis: Two 52-week, randomized, controlled phase 3 studies in patients with moderate-to-severe plaque psoriasis

Tofacitinib is an oral Janus kinase inhibitor. Efficacy and safety of tofacitinib in patients with moderate-to-severe plaque psoriasis have been demonstrated.

http://ift.tt/2obL2tX

The effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis

Androgenetic alopecia, or male pattern hair loss, is a hair loss disorder mediated by dihydrotestosterone, the potent form of testosterone. Currently, minoxidil and finasteride are Food and Drug Administration (FDA)–approved, and HairMax LaserComb, which is FDA-cleared, are the only treatments recognized by the FDA as treatments of androgenetic alopecia.

http://ift.tt/2o8otFf

Gingival esthetics and oral health-related quality of life in patients with cleft lip and palate

While the oral health-related quality of life (OHRQoL) is known to be reduced in patients with cleft lip and palate (CLP), its inter-dependency with the soft tissue characteristics of the CLP area remains unclear. This study aimed to evaluate the soft tissue characteristics in the treated cleft area in order to investigate whether gingival esthetics correlate with OHRQoL. Thirty-six patients with unilateral or bilateral CLP (46 cleft areas) were investigated after secondary/tertiary alveolar bone grafting and orthodontic/prosthetic implant treatment using an adapted score to rate gingival esthetics (clinical esthetic score, CES).

http://ift.tt/2nNv1XI

Yellow Fever Virus Modulates the Expression of Key Proteins Related to the microRNA Pathway in the Human Hepatocarcinoma Cell Line HepG2

Viral Immunology , Vol. 0, No. 0.


http://ift.tt/2oMlxkt

Development of mPMab-1, a Mouse–Rat Chimeric Antibody Against Mouse Podoplanin

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


http://ift.tt/2oSonBe

LpMab-23: A Cancer-Specific Monoclonal Antibody Against Human Podoplanin

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


http://ift.tt/2oby8fG

The association of Enamelin, Lactoferrin, and Tumour necrosis factor alpha gene polymorphisms with high caries susceptibility in Chinese children under 4 years old

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Mengchen Wang, Man Qin, Bin Xia
ObjectiveThe aim of this study was to assess the role of ENAM rs3796703, LTF rs1126478, and TNF-α rs1800629 in high caries susceptibility.DesignThe present case–control study included 1005 unrelated children under 4 years old: 505 with severe caries (dmft index ≥4) and 500 who were caries-free (dmft index=0 and without white-spot lesions). Questionnaires were obtained from parents and gardians about the children's diet and oral behavioural habits. All the children received dental examinations and oral swabbing for human genomic DNA collection. ENAM rs3796703, LTF rs1126478, and TNF-α rs1800629 were genotyped by Sanger sequencing.ResultsThe frequency of the ENAM rs3796703T allele (6.7% in the caries group and 4.2% in the caries-free group), CT genotype (12.7% in the caries group and 8.4% in the caries-free group), TNF-α rs1800629 A allele (4.8% in the caries group and 6.8% in the caries-free group), and AG genotype (8.7% in the caries group and 13.2% in the caries-free group) were significantly different between the caries and caries-free groups (p<0.05). No significant difference was found in the LTF rs1126478 allele frequency and genotype distribution between the two groups. The ENAM rs3796703 CT genotype increased caries susceptibility by 60.9% compared to the CC genotype (β=0.746, OR=1.609), and the TNF-α rs1800629 AG genotype reduced caries susceptibility by 47.4% compared to the GG genotype (β=−0.642, OR=0.526). In terms of habits covariates, prolongation of night feeding time by 1 month increased caries susceptibility by 3.3% (β=0.033, OR=1.033); additionally, sweets and acidic drinks consumption 1–2 times per day increased caries susceptibility by 218.2% (β=1.158, OR=3.182), and consumption 3 or more times pe/r day increased susceptibility by 883.5% (β=2.286, OR=9.835) compared to non-consumption. Topical fluoride application decreased caries susceptibility by 43.0% (β=−0.562, OR=0.570).ConclusionsThe ENAM and TNF-α genes are likely associated with caries experience in Chinese children. The ENAM rs3796703 CT genotype might be involved in caries susceptibility, while TNF-α rs1800629 AG genotype might be involved in caries protection.



http://ift.tt/2nUJ6nd

The association of Enamelin, Lactoferrin, and Tumour necrosis factor alpha gene polymorphisms with high caries susceptibility in Chinese children under 4 years old

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Mengchen Wang, Man Qin, Bin Xia
ObjectiveThe aim of this study was to assess the role of ENAM rs3796703, LTF rs1126478, and TNF-α rs1800629 in high caries susceptibility.DesignThe present case–control study included 1005 unrelated children under 4 years old: 505 with severe caries (dmft index ≥4) and 500 who were caries-free (dmft index=0 and without white-spot lesions). Questionnaires were obtained from parents and gardians about the children's diet and oral behavioural habits. All the children received dental examinations and oral swabbing for human genomic DNA collection. ENAM rs3796703, LTF rs1126478, and TNF-α rs1800629 were genotyped by Sanger sequencing.ResultsThe frequency of the ENAM rs3796703T allele (6.7% in the caries group and 4.2% in the caries-free group), CT genotype (12.7% in the caries group and 8.4% in the caries-free group), TNF-α rs1800629 A allele (4.8% in the caries group and 6.8% in the caries-free group), and AG genotype (8.7% in the caries group and 13.2% in the caries-free group) were significantly different between the caries and caries-free groups (p<0.05). No significant difference was found in the LTF rs1126478 allele frequency and genotype distribution between the two groups. The ENAM rs3796703 CT genotype increased caries susceptibility by 60.9% compared to the CC genotype (β=0.746, OR=1.609), and the TNF-α rs1800629 AG genotype reduced caries susceptibility by 47.4% compared to the GG genotype (β=−0.642, OR=0.526). In terms of habits covariates, prolongation of night feeding time by 1 month increased caries susceptibility by 3.3% (β=0.033, OR=1.033); additionally, sweets and acidic drinks consumption 1–2 times per day increased caries susceptibility by 218.2% (β=1.158, OR=3.182), and consumption 3 or more times pe/r day increased susceptibility by 883.5% (β=2.286, OR=9.835) compared to non-consumption. Topical fluoride application decreased caries susceptibility by 43.0% (β=−0.562, OR=0.570).ConclusionsThe ENAM and TNF-α genes are likely associated with caries experience in Chinese children. The ENAM rs3796703 CT genotype might be involved in caries susceptibility, while TNF-α rs1800629 AG genotype might be involved in caries protection.



http://ift.tt/2nUJ6nd

The Rosai–Dorfman Disease: A Differential Diagnosis in Cervical Swelling

Abstract

Rosai–Dorfman disease also known as sinus histiocytosis with massive lymphadenopathy is a rare benign disorder of unknown etiology. It is a benign condition which causes significant cervical lymphadenopathy in children and young adults. These cases are frequently misdiagnosed as lymphoma, and thus it is important to distinguish Rosai–Dorfman disease from other causes of neck swelling because of different treatment modalities. We report here a case of Rosai–Dorfman disease presenting with massive right cervical lymphadenopathy.

http://ift.tt/2oNMJiw

Acquired Angioedema: A Rare Manifestation of Angioimmunoblastic T Cell Lymphoma

Abstract

The clinical presentation except age of onset is similar in different types of angioedema. A lymphoproliferative disorder like angioimmunoblastic T cell lymphoma (AITL) rarely presents with symptoms of angioedema. We present extremely rare case of elderly male with recurrent tongue swelling, pruritus with normal levels of complements and C1 esterase inhibitor protein featuring as acquired angioedema, a rare manifestation of AITL. Initial response to corticosteroids may be misleading and occurs as a result of immunosuppression of AITL. High index of suspicion may prompt need for histopathological diagnosis of lymph node biopsy. Definitive chemotherapeutic treatment may achieve long term remission.

http://ift.tt/2o7kHM9

A Rare Case of Basal Cell Adenocarcinoma of Parotid Gland with Intracranial Extension

Abstract

Basal cell adenocarcinoma (BCAC) is a rare tumour entity. Despite its tendency to be infiltrative and destructive tumour with propensity to recur, it rarely metastasizes and long-term outcome following surgery is favourable. This paper presents a 42-year-old male with residual BCAC of parotid gland that had extended into infratemporal fossa and intracranial. The important aspect of this case is the rarity occurrence of BCAC of parotid with intracranial extension and its surgical approaches to achieve tumour clearance.

http://ift.tt/2nm5NEP

Cartilage Scales Embedded in Fibrin Gel

Facial plast Surg 2017; 33: 225-232
DOI: 10.1055/s-0037-1598184

Multiple techniques have been described for dorsal nasal augmentation in rhinoplasty. In this article, we review common surgical techniques for raising the dorsum or eliminating dorsal irregularities, by highlighting inherent advantages and disadvantages of each method. Within the past few years, the use of diced cartilage grafts has become the workhorse in this field of interest. To overcome drawbacks of methods based on diced cartilage, we present a new concept for autologous augmentation, using regenerative medicine protocols. A mix of cartilage scales with cartilage pâté was embedded in platelet-rich fibrin (PRF). Since December 2015, a total of 48 patients were treated with this technique. Based on our preliminary results, cartilage scales in PRF appear to be a promising and reliable alternative to existing procedures for dorsal nasal augmentation.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2nMORTe

Managing the Dorsum in Rhinoplasty

Facial plast Surg 2017; 33: 119-119
DOI: 10.1055/s-0037-1598032

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2nnZYGR

Dorsal Augmentation Using Autologous Costal Cartilage or Microfat-Infused Soft Tissue Augmentation

Facial plast Surg 2017; 33: 162-178
DOI: 10.1055/s-0037-159914

Costal cartilage grafting is increasing in popularity with increased demand for augmentation rhinoplasty and increased need for grafting material for structure rhinoplasty techniques. Use of costal cartilage for dorsal grafting is both art and science. The art is demonstrated in the act of carving a dorsal graft that will reflect the actual contour of the nasal dorsum. The science is linked to the methodology of how the grafts are contoured to match the patient's desires and how the graft is fixed to the bony dorsum to minimize the risk of warping and displacement. Variations in dorsal graft design and methods of fixation are described. Use of the perichondrial interface between dorsal graft and perforated/rasped nasal dorsum acts to ossify the dorsal graft to the underlying bone, creating an immobile and natural appearing nasal dorsum. The fixation of the dorsal graft limits movement and hence decreases the likelihood of warping or deformity. Use of microfat in rhinoplasty has tremendous potential for camouflage and to promote healing of compromised tissues. Using microfat-infused soft tissue augmentation (MISTA), the surgeon is able to deliver microfat to an open surgical field, promote healing, and provide soft tissue augmentation. In this technique, microfat is injected into soft tissue carriers (perichondrium, temporalis fascia, etc.) and then implanted into the surgical field. MISTA has tremendous potential utility in many areas of cosmetic and reconstructive surgery.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2nMZXrn

Aesthetics of the Nasal Dorsum: Proportions, Light, and Shadow

Facial plast Surg 2017; 33: 120-124
DOI: 10.1055/s-0037-1598626

Due to its central location, the nose plays a prominent role in facial aesthetics. As tastes have shifted and techniques have advanced, the accepted "ideal" appearance and proportions of the nose have evolved over time. By assessing the aesthetics of the nasal dorsum through the use of lines and angles, one can more precisely elucidate a goal for the patient's postoperative nasal shape, which should, in turn, guide the surgeon to execute specific operative maneuvers needed to achieve that contour. In assessing the aesthetics of the nasal dorsum, practitioners calculate and observe aspects such as the paired dorsal aesthetic lines, the nasofrontal angle, and the nasofacial angle. There is also additional consideration given to nasal tip position as this must fit harmoniously with the shape of the dorsum. In contrast to the established aesthetic lines and angles, using nasal geometric polygons for the aesthetic evaluation and development of operative goals in rhinoplasty has recently been described in the literature. Constructed ideals, in the form of proportions, lines, and angles, should be used with caution, as there are many factors to consider in the aesthetic analysis of the nasal dorsum, including ethnic differences, and subjective and changing views of beauty.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2nnXo3y

Dorsal Augmentation with Homologous Rib

Facial plast Surg 2017; 33: 195-201
DOI: 10.1055/s-0037-1598031

Dorsal augmentation grafts are used to reconstruct and raise the nasal dorsum in patients with dorsal saddling due to trauma, infection, or previous nasal surgery, as well as in patients with a narrow, congenitally low, and/or wide dorsum. Alloplastic implants and various biomaterials are available for grafting, each with advantages and disadvantages. Although autologous septal cartilage is a preferable and often convenient source of cartilage, it is frequently not sufficient for large volume dorsal augmentation, nor is it available in patients who have had septoplasty, infection, previous rhinoplasty with grafting, or significant trauma. Ear cartilage may be used but it is difficult to make homogenous and smooth, and dorsal irregularities can be seen in the long term especially in thin-skinned patients. For these reasons, we frequently use irradiated costal cartilage from tissue banks as our grafting source, thereby eliminating the morbidity of harvesting the patient's own rib. Proper surgical techniques, the use of antibiotics, and proper sculpting and placement of the cartilage limits complications such as warping, resorption, infection, and extrusion. Irradiated homograft costal cartilage grafts have been used successfully in large numbers of patients with long-term follow-up with low complication rates and serve as a welcome alternative to harvesting a patient's rib cartilage.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2nN95fn

Understanding Approaches to the Dorsal Hump

Facial plast Surg 2017; 33: 125-132
DOI: 10.1055/s-0037-1598033

Dorsal hump reduction is a central component of western aesthetic rhinoplasty. Surgical success begins with knowledge of aesthetic ideals and accurate preoperative analysis. Knowledge of the patient's distortion from aesthetic ideals informs approach, technique, and instrument selection. Both endonasal and external approaches are suitable for dorsal hump reduction, though the latter affords more versatility when other surgical modifications are necessary. The main techniques consist of en bloc, Skoog, and component resection. Each has their distinct advantage, though a surgeon's comfort level with each should impact technique selection. Completion of the dorsal reduction often leaves a defect that must be reconstructed. Failure to anticipate the potential long-term sequelae and appropriately manage the dorsal defect can lead to a poor result and patient dissatisfaction.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2nodwC3

Safety of 2-Octyl Cyanoacrylate in Spreader Grafting

Facial plast Surg 2017; 33: 213-216
DOI: 10.1055/s-0036-1597998

Cyanoacrylate adhesives can make the placement of spreader grafts in open septorhinoplasty technically easier, but its use is off-label beneath the skin. There is a theoretical risk of toxicity from cyanoacrylate breakdown products, but this risk has not been thoroughly studied in rhinoplasty. The objective was to evaluate the effects of subcutaneous cyanoacrylate use during spreader graft placement in rhinoplasty in a retrospective review of open septorhinoplasties in which 2-octyl cyanoacrylate was used to aid placement of spreader grafts. The review was carried out in a tertiary care military academic medical center. A total of 140 adults underwent open septorhinoplasty between September 2013 and May 2016 with spreader graft placement. The authors excluded patients in whom 2-octyl cyanoacrylate was not used to aid graft placement and those who did not follow up postoperatively in our clinic. 108 (85 males and 23 females) patients were included in the final analysis. Nine (8.3%) patients had inflammatory reactions possibly attributable to 2-octyl cyanoacrylate toxicity. The overall rate of postoperative inflammation possibly attributable to 2-octyl cyanoacrylate was 17% among females and 5.9% among males, and this difference was not statistically significant (p = 0.07). However, the rate of postoperative inflammation attributable to 2-octyl cyanoacrylate that required an intervention (incision and drainage or antibiotics) was 2.7% overall, 13% among women and 0% among men, and this difference was significant based on chi-square testing (p < 0.001). Further, revision cases were significantly more likely to develop abnormal postoperative inflammation than initial cases (p = 0.02). Herein, the authors present the largest series of patients in whom 2-octyl cyanoacrylate was used to assist placement of cartilage spreader grafts during open septorhinoplasty. While 2-octyl cyanoacrylate is an effective adjunct to facilitate graft placement, they recommend against its use, as the risk of postoperative inflammation is significant.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2nMQyQv

Midvault Reconstruction in Primary Rhinoplasty

Facial plast Surg 2017; 33: 133-138
DOI: 10.1055/s-0036-1598016

The nasal midvault is an important consideration in rhinoplasty. This region is defined by the attachment of the upper lateral cartilages (ULCs) to the nasal bones superiorly and the cartilaginous septum medially. Inadequate management of the nasal midvault can have negative functional and aesthetic ramifications. Indications for midvault reconstruction in primary rhinoplasty include a narrow midvault, dorsal hump resection, a deviated midvault, and an asymmetric midvault, with an additional relative indication of zone 1 lateral wall insufficiency (LWI), defined as dynamic collapse of a weakened lateral nasal wall at the level of the ULC. Numerous techniques for midvault reconstruction have been described, dating back to Sheen's description of the spreader graft in the 1980s, which remains the gold standard for repair. Herein, the various indications for midvault reconstruction are described, along with a discussion of the most commonly used techniques for successful reconstruction.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2nnZbpj

Facial Augmentation using Expanded Polytetrafluoroethylene Covered Silicone

Facial plast Surg 2017; 33: 241-243
DOI: 10.1055/s-0037-1599093

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2nMORCI

Treating the Deviated or Wide Nasal Dorsum

Facial plast Surg 2017; 33: 139-156
DOI: 10.1055/s-0037-1598034

Both deviation and excessive width of the nasal dorsum result in conspicuous facial disharmony and are often attended by nasal airway dysfunction. Whether the result of developmental growth disturbances, nasal trauma, failed nasal surgery, or combinations therein, deviation and splaying of the nasal dorsum can be exceedingly difficult to treat. Individualized treatment is paramount because contour variations are seemingly endless, and a careful preoperative assessment of the anatomic, physiologic, cosmetic, and psychosocial factors that characterize the deformity is necessary to devise an effective patient-specific treatment plan. Ensuring the linearity, strength, alignment, and aesthetically pleasing profile dimensions of the nasal L-strut is the requisite first step in successful treatment. Releasing all deformed components in a controlled and precise manner using powered instrumentation (whenever possible) to facilitate minimally traumatic and effective repositioning, followed by structural reconstitution of the skeletal framework using autologous graft materials, and then consolidation of the newly created construct with suture fixation completes the transformation to normalcy. Paying equal attention to both cosmetic and functional wellness, while simultaneously seeking to maximize structural stability, serves to optimize the final outcome.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2nnUyf2

Revision of the Nasal Dorsum

Facial plast Surg 2017; 33: 202-206
DOI: 10.1055/s-0036-1598017

Revision of the dorsum in secondary rhinoplasty is challenging, regardless of the cause. Dorsal deformities should be evaluated for both aesthetic and functional. The authors briefly outline the presentation, etiology, pathogenesis, and treatment choices backed by evidence-based data, when applicable, for the following dorsal revision indications in secondary rhinoplasty: inverted-V and midvault narrowing, overresected dorsum, irregular dorsum, saddle nose, and pollybeak.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2nN3mX4

Correcting Deviations of the Lower Third of the Nose

Facial plast Surg 2017; 33: 157-161
DOI: 10.1055/s-0036-1598018

By convention, a "deviated nose" is one in which the lower third is asymmetric with regard to the midline. The lower third of the nose is composed of the lower cartilages, as well as the dorsal and caudal nasal septum. Not only does the deviated nose cause a cosmetic deformity that is often disconcerting for patients, but it may also be associated with functional problems. Airway obstruction may result from a narrowed internal nasal valve in the middle third or from a deviated caudal septum in the lower third. The most common deviation involves both the middle and lower thirds and often requires addressing the underlying dorsal and caudal septum. The most effective technique to correct this type of deviation is the principle of extracorporeal septoplasty, either the traditional or modified, such as the anterior septal reconstruction (ASR) technique combined with the clocking suture. An isolated middle third deviation may be treated with a camouflage graft or a unilateral spreader graft. An isolated lower third deviation involving the septum should be treated with ASR. When an isolated lower third deviation only involves the lower cartilages, it may be corrected using suture techniques, cartilage division techniques, or grafting.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2no7HEG

Rhinoplasty Results Are Influenced by Non-nasal Features

Facial plast Surg 2017; 33: 207-212
DOI: 10.1055/s-0036-1597997

Rhinoplasty results are evaluated both objectively and subjectively following any procedure by plastic surgeons and nonplastic surgeons at meetings, in publications, and online. We aim to evaluate whether subjective aesthetics of non-nasal features, such as the eyes and lips, would influence the overall evaluation of rhinoplasty results. We matched pairs of photographs of patients who had undergone aesthetic rhinoplasty by sex, age, and skin tone. We transferred the eyes/eyebrows and lips from the photographs of the donor patient onto the photographs of the original patient to create composite photographs. Plastic surgeons were asked to rate the rhinoplasty results objectively, and non-plastic surgeons were asked to rate the overall attractiveness of 16 sets of photographs (8 originals and 8 composites). Postoperative photographs that were deemed to be more attractive were associated with higher ratings of rhinoplasty improvement. The objective nasal result may be influenced by non-nasal aesthetic factors as rhinoplasty surgeons gave higher ratings to more attractive faces. Greater emphasis on neutralizing non-nasal factors in pre- and postoperative photographs should be considered.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2nN2Lo6

Dorsal Augmentation-Diced Cartilage Techniques: The Diced Cartilage Glue Graft

Facial plast Surg 2017; 33: 179-188
DOI: 10.1055/s-0037-1598185

The quest for the ideal method for augmenting the nasal dorsum continues to be a matter of debate, with both most surgeons and patients preferring autologous tissue. This article reviews the current use of diced cartilage for nasal augmentation, emphasizing the diced cartilage in fibrin glue (DCG) graft. It offers the first collation of unfavorable outcomes and complications of the DCG graft seen in a series of 108 patients treated at the author's institution. The DCG graft continues to be a versatile graft that is stable over time and combines unique features. It has proved to be particularly well suited for segmental augmentations of the dorsum. Resorption of the graft has been rare and infrequent unfavorable outcomes have all been amenable to successful minor surgical revisions.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2nnYLz2

Interest in Aesthetic Rhinoplasty Scale

Facial plast Surg 2017; 33: 217-224
DOI: 10.1055/s-0036-1597999

Interest in cosmetic surgery is increasing, with rhinoplasty being one of the most popular surgical procedures. It is essential that surgeons identify patients with existing psychological conditions before any procedure. This study aimed to develop and validate the Interest in Aesthetic Rhinoplasty Scale (IARS). Four studies were conducted to develop the IARS and to evaluate different indices of validity (face, content, construct, criterion, and concurrent validities) and reliability (internal consistency, split-half coefficient, and temporal stability) of the scale. The four study samples included a total of 463 participants. Statistical analysis revealed satisfactory psychometric properties in all samples. Scores on the IARS were negatively correlated with self-esteem scores (r = –0.296; p < 0.01) and positively associated with scores for psychopathologic symptoms (r = 0.164; p < 0.05), social dysfunction (r = 0.268; p < 0.01), and depression (r = 0.308; p < 0.01). The internal and test–retest coefficients of consistency were found to be high (α = 0.93; intraclass coefficient = 0.94). Rhinoplasty patients were found to have significantly higher IARS scores than nonpatients (p < 0.001). Findings of the present studies provided evidence for face, content, construct, criterion, and concurrent validities and internal and test–retest reliability of the IARS. This evidence supports the use of the scale in clinical and research settings.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2no8bef

Dorsal Augmentation using Alloplastic Implants

Facial plast Surg 2017; 33: 189-194
DOI: 10.1055/s-0036-1598015

Dorsal augmentation is an essential procedure not only for Asians, who generally have indistinct and poorly developed nasal bridges, but also for Africans and Caucasians, who have similar dorsal deficiencies. There is no single ideal implant or graft for dorsal augmentation. Dorsal augmentation with autologous materials is considered ideal by many surgeons. However, harvesting autologous material is associated with donor-site complications, and these materials are difficult to handle and shape. Despite concerns over complications such as infection, extrusion, and deviation, alloplastic implant materials such as silicone or Gore-Tex have a critically important role in typical cosmetic dorsal augmentation due to their ease of use in producing a cosmetically appealing outcome and evading donor-site complications. A thorough understanding of the shape of an aesthetically pleasing nose, appropriate surgical technique, and proper management methods for complications are the mainstay for the success of dorsal augmentation using alloplastic implants.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2nMXahK

Absorbable Implant to Treat Nasal Valve Collapse

Facial plast Surg 2017; 33: 233-240
DOI: 10.1055/s-0037-1598655

Objective To evaluate the safety and effectiveness of an absorbable implant for lateral cartilage support in subjects with nasal valve collapse (NVC) with 12 months follow-up. Methods Thirty subjects with Nasal Obstruction Symptom Evaluation (NOSE) score ≥ 55 and isolated NVC were treated; 14 cases were performed in an operating suite under general anesthesia and 16 cases were performed in a clinic-based setting under local anesthesia. The implant, a polylactic acid copolymer, was placed with a delivery tool within the nasal wall to provide lateral cartilage support. Subjects were followed up through 12 months postprocedure. Results Fifty-six implants were placed in 30 subjects. The mean preoperative NOSE score was 76.7 ± 14.8, with a range of 55 to 100. At 12 months, the mean score was 35.2 ± 29.2, reflecting an average within-patient reduction of –40.9 ± 31.2 points. The majority (76%) of the subjects were responders defined as having at least one NOSE class improvement or a NOSE score reduction of at least 20%. There were no adverse changes in cosmetic appearance at 12 months postprocedure. Three implants in three subjects required retrieval within 30 days postprocedure and resulted in no clinical sequelae. Conclusion This study demonstrates safety and effectiveness of an absorbable implant for lateral cartilage support in subjects with NVC at 12 months postprocedure.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2no7GAC

Erratum: Hyaluronic Acid Fillers in Soft Tissue Regeneration

Facial plast Surg 2017; 33: 244-244
DOI: 10.1055/s-0037-1601851

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2nMSoAM

The Importance of Facts and the Role of Academic Publishers in Today's World—A Publisher's View

Facial plast Surg 2017; 33: vii-vii
DOI: 10.1055/s-0037-1602425

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2nMYDVf

Evaluation of modified nasal to oral endotracheal tube switch—For modified alar base cinching after maxillary orthognathic surgery

Publication date: Available online 23 March 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Taj Nizam Shakeel Shaik, Sridhar Meka, Pavan Kumar Ch., Naga Neelima Devi Kolli, P. Srinivas Chakravarthi, Vivekanand S. Kattimani, Krishna Prasad L.
BackgroundSoft tissue changes secondary to Maxillary orthognathic surgery are many fold. The alar flare is one among them, which affects the appearance of the patient. Cinch suture has been used to prevent alar flare; but the presence of anaesthetic tube hinders cinching. So, the study was aimed to assess an efficacy of modified nasal to oral tube switch technique for modified alar cinching to prevent alar flare after orthognathic and nasal corrective surgeries.Materials and methodsPatients were randomly allocated in each group, who underwent modified alar base cinching with and without nasal to oral tube switch. Changes in alar base width, upper lip length was measured with Digital Vernier Caliper and nasolabial angle (Cotg-Sn-Ls) on lateral cephalogram at 1st, 3rd, 6th, and 12th months after surgery. The time taken and ease of tube switch were noted. The data obtained were tabulated and interpreted using a test of significance.ResultsStudy results showed no statistical significant difference in perinasal soft changes among both groups. But tube switch appears to be beneficial to prevent alar flare.ConclusionModified alar base cinching was performed effectively in patients with a modified tube switch technique. It increased positive results in comparison with non-shift. The technique of tube switch used is effective in prevention of alar flare. Because of small sample size and limited period of follow up, our study suggests multi centre, randomized studies to know the technical difficulties of tube switch for cinching and aesthetic results with varying anaesthetist and the surgeon's experience.



http://ift.tt/2oLijxJ

Evaluation of graft uptake from the iliac crest in secondary alveolar bone grafting: Bergland’s criteria revisited

Publication date: Available online 23 March 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Kapil Tomar, N.K. Sahoo
Back groundThe secondary alveolar grafting is an integral part in the management of alveolar cleft defect. Particulate cancellous bone and marrow (PCBM) graft obtained from iliac crest are considered as the gold standard.AimAim of the study was to evaluate the graft uptake clinically and radiologically using the Bergland's radiographic scale.Material and methodsA longitudinal descriptive study was conducted on twenty patients of unilateral CLP in the age group of 6–13 years, presenting with residual/secondary alveolar cleft defect with unerupted maxillary lateral incisor/canine adjacent to the defect. Autologous PCBM graft obtained from iliac crest was used in all cases. Post operative clinical and radiological evaluation was carried out using the Bergland's radiographic scale at intervals of 1 week, 1 month and 6 months.Data collection and resultClinical evaluation consisted of assessment for infection, exposure of graft, rejection of graft, wound dehiscence and status of oronasal communication. A four-point Bergland's radiographic scale was used to compare the interdental height of the bone graft with unaffected side and categorized from grade I to IV. After six months, 6 cases were graded as grade I, 11 cases as grade II and 2 cases were grade III. Only one case deteriorated to grade IV which is considered as failure.Summary and conclusionSatisfactory results were obtained in 95% cases. Bergland's radiographic assessment scale is a valuable, easily available and inexpensive diagnostic tool to assess the condition of the grafted bone in SABG.



http://ift.tt/2oRT3To

Neurosensory evaluation of inferior alveolar nerve after bilateral sagittal split ramus osteotomy of mandible

Publication date: Available online 20 March 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): P.G. Antony, Aneesh Sebastian, K. George Varghese, C.R. Sobhana, S. Mohan, C.S. Soumithran, Shiney Domnic, N. Jayakumar
Mandibular skeletal deformities are mostly corrected by Sagittal Split Ramus Osteotomy. One of the main complications of Bilateral Sagittal Split Ramus Osteotomy is impairement of sensory function of Inferior Alveolar Nerve.ObjectivesTo evaluate the occurrence of neurosensory disturbance by comparing the subjective and objective assessment of neurosensory responses after bilateral sagittal split ramus osteotomy.To assess the progress of recovery from the first post operative day till six months. To explain the factors causing neurosensory disturbances.MethodA series of 24 patients with clinically and radiographically diagnosed mandibular skeletal deformity were treated with Bilateral Sagittal Split Ramus Osteotomy. For evaluation of the neurosensory responses, the parameters consist of subjective and objective test in order to compare the subjective and objective assessment.ResultsOn the first post operative day neurosensory disturbances were seen in all the patients. Recovery of sensation was seen in all the patients at the end of this study.ConclusionThe incidence of functional nerve disturbances is acceptable, since the progression towards recovery is inevitable. Prolonged neurosensory disturbance is greatly related to the degree of manipulation of the inferior alveolar nerve.



http://ift.tt/2oLlllz

Effect of oral health education by audio aids, Braille & tactile models on the oral health status of visually impaired children of Bhopal city

Publication date: Available online 18 March 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Anjali Gautam, Ajay Bhambal, Swapnil Moghe
BackgroundBraille is important language for reading & writing for the visually impaired. It helps them understand & visualize the world via touch. Audio aids are being used to impart health education to the visually impaired. Audio aids are useful in being time saving & can be played repeatedly to achieve desired results. Tactile models help them perceive things which they can't visualize & hence are important learning tool.AimTo evaluate the effect of Oral Health education by Audio aids, Braille & tactile models on the Oral health status of visually impaired children of Bhopal city.Material & MethodsSixty visually impaired children aged 5-18 yrs were selected & randomly divided into three groups (20 children each). Group A: Audio aids + Braille, Group B: Audio aids + tactile models, Group C: Audio aids + Braille + Tactile models. Instructions were given for maintaining good oral hygiene & brushing techniques were explained to all children. After three months time the oral hygiene status was recorded and compared using patient hygiene performance index.ResultsThe present study showed a decrease in the mean plaque scores (that is increase in mean difference of PHP score) at all time intervals in individual group as compared to the baseline that was statistically significant.ConclusionThe study depicts that the combination of audio, Braille & tactile models is an effective way to provide oral health education & improve Oral health status of visually impaired children.



http://ift.tt/2oRXFIX

Effect of scaling & root planing on the activity of ALP in GCF & serum of patients with gingivitis, chronic and aggressive periodontitis: A comparative study

Publication date: Available online 27 March 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Nishi Singh, Siddhartha Chandel, Harmurti Singh, Amiya Agrawal, A.N. Savitha
IntroductionHost response and environmental factors are known to modify periodontal status adversely. Presently serum, saliva, and GCF are being investigated for its biochemical constituents. GCF contains array of biochemical factors, offering potential use as a diagnostic or prognostic biomarker of the biologic state of the periodontium in health and disease. Alkaline phosphatase is produced locally in the periodontium and shows positive correlation with disease activity and PD. Present study was designed to analyze the levels of ALP in GCF and serum of patients with gingivitis, chronic & aggressive periodontitis before and after SRP & to compare the difference within the study groups.MethodsOPD patients grouped into: Gingivitis, Aggressive periodontitis & chronic periodontitis patients. Clinical parameters recorded for each patient prior to therapy. Pooled GCF samples collected using micro capillary tubes from the deepest pocket sites for each patient and stored at −70°C. Serum samples also collected and stored at −20°C. Each patient was subjected to scaling and root planing with two weeks maintenance recall. After 6 to 8 weeks GCF and serum samples collected again and all clinical parameters rerecorded. GCF and serum samples analyzed for levels of ALP by using para nitro phenol assay for the three groups.ResultsALP levels in GCF increased significantly during active phase of disease followed by statistically significant reduction after phase I therapy. Baseline levels of ALP in GCF was CP>AP>G with maximum reduction in GCF ALP after SRP in G>CP>AP group.



http://ift.tt/2oLlnd5

Detection of endolymphatic hydrops using traditional MR imaging sequences

Publication date: Available online 6 April 2017
Source:American Journal of Otolaryngology
Author(s): John H. Keller, Barry E. Hirsch, Ryan S. Marovich, Barton F. Branstetter
PurposeThe 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.Materials & methodsThis retrospective case-control study included patients with documented MD who had a high-resolution T2-weighted or steady-state free procession MRI of the temporal bones within one month of diagnosis, between 2002 and 2015. Patients were compared to age- and sex- matched controls. Cross sectional area, length, and width of the vestibule and utricle were measured in both ears along with the width of the basal turn of the cochlea and its endolymphatic space. Absolute measurements and ratios of endolymph to perilymph were compared between affected, contralateral, and control ears using analysis of variance and post-hoc pairwise comparisons.ResultsEighty-five case-control pairs were enrolled. Mean utricle areas for affected, contralateral, and control ears were 0.038cm², 0.037cm², and 0.033cm². Mean area ratios for affected, contralateral, and control ears were 0.32, 0.32, and 0.29. There was a statistically significant difference between groups for these two variables; post-hoc comparisons revealed no difference between affected and contralateral ears in Meniere's patients, while ears in control patients were different from the ears of patients with MD. All other measurements failed to show significant differences.ConclusionsEnlargement of the endolymphatic cavity can be detected using non-contrast T2-weighted MRI. MRI, using existing protocols, can be a useful diagnostic tool for the evaluation of MD, and intratympanic or delayed intravenous contrast may be unnecessary for this diagnosis.



http://ift.tt/2ohEDOG

Reduced post-tonsillectomy bleeding rates through a refined technique

Publication date: Available online 6 April 2017
Source:American Journal of Otolaryngology
Author(s): Kent Burton, Stephanie Hanke, Anil Gungor




http://ift.tt/2nUcutK

Aging in Mathematics and in Surgery.

No abstract available

http://ift.tt/2oKFPuD

The Outcome of Endoscopic Optic Nerve Decompression for Bilateral Traumatic Optic Neuropathy.

Objective: To investigate the outcomes of endoscopic optic nerve decompression (EOND) for bilateral traumatic optic neuropathy (TON). Methods: A retrospective analysis was conducted in 5 patients with bilateral TON, between January 2003 and December 2013. All the patients underwent preoperative ophthalmological evaluation, flash visual-evoked potentials, computed tomography scan, and systemic corticosteroid therapy. All the patients required an EOND surgery, due to poor response to medical therapy, and the remainder one was only treated with corticosteroid due to operative contraindication. Results: Of the 5 patients (10 eyes) undergoing EOND, visual acuity improved in 30% of eyes (n = 3) with a mean follow-up of 3 months. The remainder 7 eyes still had no light perception. All of the 5 patients undergoing EOND had no operative complications. Conclusion: Treatment for bilateral TON should not be limited on the length of time to injury and visual-evoked potentials results. If surgical conditions permit and with no contraindications, patients should receive active surgical treatment as soon as possible. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2paNcYC

Principles and Practice of Pediatric Plastic Surgery, Second Edition, edited by Michael L. Bentz, Bruce S. Bauer, and Ronald M. Zuker Boca Raton, FL: CRC Press, 2016.

No abstract available

http://ift.tt/2oKO3mT

Cleft and Craniofacial Clinic Formats in the United States: National and Institutional Survey.

Background: Craniofacial teams employ multidisciplinary clinics to optimize patient care. Different clinic formats exist among teams. Formats include providers rotating from room to room as separate specialties, patients rotating from room to room to either separate specialties or as 1 group, as well as providers rotating together as 1 group. Surveys were used to study family preferences between the different formats and to compare them with trends of national practices. Methods: Families of the authors' team clinic patients were surveyed from November 2012 to February 2013, after a clinic format change from patients moving between rooms to see providers, to providers moving between rooms to see patients. This survey focused on patient satisfaction, clinic format preference, and their perception of efficiency. A second, national survey was distributed to 161 American craniofacial teams approved by the American Cleft Palate-Craniofacial Association to survey clinic formats, provider satisfaction, and experience with other formats. Institutional survey data were tabulated as percentages and further analyzed using the Mann-Whitney Test. The national survey data was then tabulated and compared with authors' institutional results. Results: Thirty-nine of 54 (72.2%) families responded to the institutional survey. Providers moving between rooms were associated with greater patient satisfaction (mean 4.8 of 5, 5 being most satisfied) (0

http://ift.tt/2paERnC

Botulinum Toxin Conjugated With Silk Fibroin and 4-Hexylresorcinol.

Purpose: The objective of this study was to evaluate whether silk fibroin (SF) incorporated into 4-hexylresorcinol (4HR) could increase botulinum toxin-A (BTX-A) activity. Material and methods: In total, 30 rats were used for this study. The animals were divided into 6 groups according to the injected materials (SA: saline only; SF; 4HR; B2: 2 units of BTX-A; B2 + SF + 4HR: combination of B2, SF, and 4HR; B5: 5 units of BTX-A). Serial sonography was used for the evaluation of muscle thickness after injection. Immunohistochemical staining was used for the evaluation of myosin type II (myo2) and Bcl-2 protein expression. Results: The relative thickness of the masseter muscle in B2 group was 66.14% +/- 4.55% to the preinjection level; in B2 + SF + 4HR group was 54.59% +/- 4.83%, and in B5 group was 56.19% +/- 8.28%. Any BTX-injected group showed significantly lower value of the relative muscle thickness compared to SA, SF, or 4HR group (P

http://ift.tt/2oKCyLZ

Normal Nasopharyngeal Measurement by Computed Tomography in Adult.

Background: This study aims to investigate the detailed computed tomography (CT) measurement of the nasopharynx (NP) in normal adult detecting mean of its dimension and relation of that measurement to that of the sphenoid sinus. Methodology/Principal: A normal paranasal CT scan and a straight nasal septum of 128 individuals (256 sphenoid sinuses) were included in the study. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes for all subjects. Measurement of the width, length, and anteroposterior dimensions of the NP and sphenoid sinuses were taken separately. Results: In 128 studied CT of adult subjects, the mean height of the NP was 19.4619 +/- 4.52661 and mean depth was 21.80714 +/- 4.62324 while the mean width was 25.31951 +/- 3.80521. No significant relations between diameters of NP and sphenoid sinuses were found. Conclusion: The detailed CT measurement of the NP in normal adult is an easy and reliable measurement. This study put the base of CT measurement of NP for further work to describe changes in such measures in patients with nasal and paranasal sinus anomalies. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2paUCLj

Bilateral Coronoid Hyperplasia in a 43-Year-Old Patient Treated With Intraoral Coronoidectomy.

The mandibular coronoid hyperplasia can be classified as a congenital or development change of the temporomandibular joint. This condition occurs due to a no-neoplasic growth of the coronoid process to the infratemporal fossa. Thus, this part of the bone impacts in the posterior face of the zygomatic bone causing limitation of the mouth opening. The aim of this paper is to report a clinical case of a 43-year-old male with mouth-opening limitation 28 years ago. After clinical and computed tomographic examinations, he was diagnosed with bilateral mandibular coronoid hyperplasia. The treatment proposed was a bilateral coronoidectomy by intraoral approach. In a 1-month postoperative period, the patient reported improvement of the painful complaints and mouth opening. After 1 year, the patient recovered the mouth opening improving his quality of life and there were no more complaints. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2oKHpgp

Displacement of Dental Implant Into the Submental Space After Surgical Integration.

Osseointegrated dental implants are common and widely used to treat edentulism. Implant displacement into the maxillofacial spaces during surgery or after a period of use is a complication recognized in the literature. Foreign objects such as titanium dental implants in the maxillofacial region must be removed because they cause infection due to tissue reaction. In this report, the authors present the case of a patient whose dental implant slipped into the submental space after surgical integration and describe the surgical removal of the implant via an extraoral approach. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2paNbE2

The Strategy of Delayed Reconstruction of the Mandible in War Injuries.

The most common causes of mandibular defects are ablative surgery of benign or malignant tumors, severe trauma, inflammatory diseases, and osteoradionecrosis. War injuries are another cause for mandibular defect. Reconstruction of the mandible is considered a challenge to the maxillofacial surgeon due to the accompanying functional and cosmetic importance. The object of this article was to show the role of nonvascularized bone graft in the reconstruction of segmental defect of the mandible resulted from projectiles and its snags. Seventeen patients underwent reconstruction of defect in the body of the mandible using non-vascularized iliac bone graft,in sixteen patients the grafts were fixed by reconstruction plate and in one by stainless-steel wire. In the emergency phase in which life-saving measures were done, in the immediate phase, treatments of associated facial and systemic injuries were carried out. The delayed phase includes the reconstruction of the residual defects and rehabilitation. A total of 17 male patients with a mean age of 34.5 years underwent reconstructive surgery, the time lapse between the injury and the delayed phase of treatment ranged from 20 days to 3 months. The size of the defects ranged from 4 to 7 cm. Treatment was considered successful in 15 patients (88.2%) in whom the grafts were incorporated to mandible with improvement of facial contour and symmetry and satisfactory occlusion of the remaining teeth. Nonvascularized bone graft is considered a feasible option for the reconstruction of a relatively small mandibular defect, especially in ascetic conditions for its role in improving facial appearance and to less extent functional benefit and more advanced method for the reconstruction needed to be introduced especially in war injuries. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2oKHssr

Correction to: Viral Immunol 2013;26:259–267

Viral Immunology Apr 2017, Vol. 30, No. 3: 250-250.


http://ift.tt/2nnf7YQ

MicroRNA-155 Deficiency in Kupffer Cells Ameliorates Liver Ischemia-Reperfusion Injury in Mice.

Background: MicroRNA-155 (miR-155) is known to be involved in autoimmune diseases, inflammation, and transplantation. However, its role in a warm hepatic ischemia-reperfusion (IR) model has not been fully elucidated. Methods: Partial hepatic IR was performed in wild-type and miR-155-deficient mice treated with or without GdCl3, and then the serum transaminase concentration and histology were analyzed. Kupffer cells (KCs) were isolated from the liver after IR, and immunohistochemistry was used to evaluate activation and polarization. In addition, the mRNA concentrations of various inflammatory cytokines were measured. Macrophages were obtained from the abdominal cavity and challenged with or without lipopolysaccharide to determine the influence of miR-155 deficiency on macrophage polarization in vitro. Furthermore, we used in vitro coculture assays to determine the effect of miR-155 deficiency on hepatocyte apoptosis induced directly by KCs. Results: miR-155 deficiency ameliorated liver ischemia-reperfusion injury, and inhibition of KCs by GdCl3 abolished this protective effect. miR-155 deficiency decreased CD80, CD86, and MHC-II expression in KCs following IR and tipped the M1/M2 balance toward an anti-inflammatory profile, where proinflammatory cytokine secretion was suppressed and interleukin-10 (IL-10) was enhanced. In addition, hepatocyte apoptosis was reduced in coculture with miR-155-deficient KCs in vitro. Conclusion: miR-155 deficiency plays an effective role in attenuating liver IRI likely by regulating the activation and inflammatory response, as well as modifying the polarization of KCs. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2nMoLzx

Human Herpesvirus 6 Reactivation in DRESS With Acute Liver Failure: A Missing Key Factor.

No abstract available

http://ift.tt/2nnbJgy

Octogenarian Liver Grafts Reaching Centennial Age after Transplantation.

No abstract available

http://ift.tt/2nMmV1I

Sleep-Disordered Breathing, Postoperative Delirium, and Cognitive Impairment.

Sleep-disordered breathing (SDB) is highly prevalent in the general population and has been associated with cognitive impairment in older individuals. Delirium is an acute decline in cognitive function and attention that often occurs after surgery, especially in older individuals. Several recent studies suggest an association between SDB and postoperative delirium. The aim of this systematic review is to examine the current literature on SDB, postoperative delirium, and cognitive impairment and to discuss the pathophysiology and perioperative considerations. A literature search was performed of Medline (1946-2016), Medline In-Process (June 2016), Embase (1947-2016), Cochrane Central Register of Controlled Trials (May 2016), and Cochrane Database of Systematic Reviews (2005 to June 2016). Inclusion criteria for studies were (1) polysomnography confirmed SDB; (2) postoperative delirium or cognitive impairment confirmed by a validated diagnostic tool; and (3) publications in the English language. All study designs including randomized controlled trials and observational studies were included. The literature search identified 2 studies on SDB and postoperative delirium, 15 studies on SDB and cognitive impairment, and 5 studies on the effect of continuous positive airway pressure on cognitive impairment and delirium in older individuals. SDB was associated with cognitive impairment, and this systematic review revealed that SDB may be a risk factor for postoperative delirium, especially in older individuals. Although the pathophysiology of SDB and postoperative delirium is unclear and effective treatments for SDB to reduce the incidence of delirium have not been studied extensively, preliminary evidence suggests that continuous positive airway pressure therapy may lower the risk of delirium. Health care professionals need to be aware that undiagnosed SDB may contribute to postoperative delirium. Preoperative screening for SDB and strategies to reduce the risk for postoperative delirium may be helpful in older individuals. Further studies are needed to clarify the relationship between SDB and postoperative delirium and elucidate the pathophysiology of postoperative delirium through SDB. (C) 2017 International Anesthesia Research Society

http://ift.tt/2nMmMvk

Computational and In Vitro Experimental Investigation of Intrathecal Drug Distribution: Parametric Study of the Effect of Injection Volume, Cerebrospinal Fluid Pulsatility, and Drug Uptake.

BACKGROUND: Intrathecal drug delivery is an attractive option to circumvent the blood-brain barrier for pain management through its increased efficacy of pain relief, reduction in adverse side effects, and cost-effectiveness. Unfortunately, there are limited guidelines for physicians to choose infusion or drug pump settings to administer therapeutic doses to specific regions of the spine or the brain. Although empiric trialing of intrathecal drugs is critical to determine the sustained side effects, currently there is no inexpensive in vitro method to guide the selection of spinal drug delivery parameters. The goal of this study is to demonstrate current computational capabilities to predict drug biodistribution while varying 3 parameters: (1) infusion settings, (2) drug chemistry, and (3) subject-specific anatomy and cerebrospinal fluid dynamics. We will discuss strategies to systematically optimize these 3 parameters to administer drug molecules to targeted tissue locations in the central nervous system. METHODS: We acquired anatomical data from magnetic resonance imaging (MRI) and velocity measurements in the spinal cerebrospinal fluid with CINE-MRI for 2 subjects. A bench-top surrogate of the subject-specific central nervous system was constructed to match measured anatomical dimensions and volumes. We generated a computational mesh for the bench-top model. Idealized simulations of tracer distribution were compared with bench-top measurements for validation. Using reconstructions from MRI data, we also introduced a subject-specific computer model for predicting drug spread for the human volunteer. RESULTS: MRI velocity measurements at 3 spinal regions of interest reasonably matched the simulated flow fields in a subject-specific computer mesh. Comparison between the idealized spine computations and bench-top tracer distribution experiments demonstrate agreement of our drug transport predictions to this physical model. Simulated multibolus drug infusion theoretically localizes drug to the cervical and thoracic region. Continuous drug pump and single bolus injection were successful to target the lumbar spine in the simulations. The parenchyma might be targeted suitably by multiple boluses followed by a flush infusion. We present potential guidelines that take into account drug specific kinetics for tissue uptake, which influence the speed of drug dispersion in the model and potentially influence tissue targeting. DISCUSSION: We present potential guidelines considering drug-specific kinetics of tissue uptake, which determine the speed of drug dispersion and influence tissue targeting. However, there are limitations to this analysis in that the parameters were obtained from an idealized healthy patient in a supine position. The proposed methodology could assist physicians to select clinical infusion parameters for their patients and provide guidance to optimize treatment algorithms. In silico optimization of intrathecal drug delivery therapies presents the first steps toward a possible care paradigm in the future that is specific to personalized patient anatomy and diseases. (C) 2017 International Anesthesia Research Society

http://ift.tt/2oaUe1G

Total Spinal Anesthesia Failure: Have You Assessed the Sensory Anesthesia in Sacral Dermatomes?.

Intrathecal local anesthetic maldistribution is a well-known cause of spinal anesthesia failure (SAF). This could potentially result in sensory blockade restricted to the sacral dermatomes. We sought to determine the overall incidence of SAF and the role of sacral dermatomes in differentiating between total and partial failures. Of the 3111 spinals prospectively examined, 194 (6.2%) were classified as failures. Of the 72 presumed total failures based on the initial assessment, evaluation of the sacral dermatomes revealed sensory blockade in 32 (44%; 95% confidence interval, 32.7%-56.6%). Sacral dermatome assessment after SAF may be important in safely guiding subsequent anesthetic management. (C) 2017 International Anesthesia Research Society

http://ift.tt/2ohlmwF

How Long Is Too Long? The Prespiked Intravenous Debate.

BACKGROUND: As the number of operative cases increases, there is a greater emphasis on reducing inefficiency while maintaining patient safety. Recently, the issue of prespiking intravenous (IV) bags was raised. No study has assessed whether the risk of infection is related to the length of time a sterile (IV) fluid bag has been spiked. After completion of a pilot study revealed no microbial growth within 24 hours of an IV spike, a larger formal study was undertaken to determine whether there was an increased infection risk within 4 hours of spiking an intravenous fluid bag. METHODS: Five IV administration sets were spiked and hung in busy perioperative areas once a week for a 5-week period. Five samples were drawn from each IV set. Approximately 10 mL was collected per sample. All samples were inoculated in 2 separate growth media. If any growth was noted, the sample was marked as positive. RESULTS: A total of 125 samples were collected over a period of 5 weeks, yielding 250 specimens. No samples were excluded from the study. No growth was identified in any of the specimens. The 95% confidence interval was estimated to be 0, 0.063. DISCUSSION: There was no bacterial growth in prespiked normal saline IV bags in a perioperative environment. Thus, prespiking of normal saline IV bags in advance should pose no risk of infection to a patient if prepared within 4 hours. (C) 2017 International Anesthesia Research Society

http://ift.tt/2nTGJBe

The Association of Frailty With Outcomes and Resource Use After Emergency General Surgery: A Population-Based Cohort Study.

BACKGROUND: Older patients undergoing emergency general surgery (EGS) experience high rates of postoperative morbidity and mortality. Studies focused primarily on elective surgery indicate that frailty is an important predictor of adverse outcomes in older surgical patients. The population-level effect of frailty on EGS is poorly described. Therefore, our objective was to measure the association of preoperative frailty with outcomes in a population of older patients undergoing EGS. METHODS: We created a population-based cohort study using linked administrative data in Ontario, Canada, that included community-dwelling individuals aged >65 years having EGS. Our main exposure was preoperative frailty, as defined by the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator. The Adjusted Clinical Groups frailty-defining diagnoses indicator is a binary variable that uses 12 clusters of frailty-defining diagnoses. Our main outcome measures were 1-year all-cause mortality (primary), intensive care unit admission, length of stay, institutional discharge, and costs of care (secondary). RESULTS: Of 77,184 patients, 19,779 (25.6%) were frail. Death within 1 year occurred in 6626 (33.5%) frail patients compared with 11,366 (19.8%) nonfrail patients. After adjustment for sociodemographic and surgical confounders, this resulted in a hazard ratio of 1.29 (95% confidence interval [CI] 1.25-1.33). The risk of death for frail patients varied significantly across the postoperative period and was particularly high immediately after surgery (hazard ratio on postoperative day 1 = 23.1, 95% CI 22.3-24.1). Frailty was adversely associated with all secondary outcomes, including a 5.82-fold increase in the adjusted odds of institutional discharge (95% CI 5.53-6.12). CONCLUSIONS: After EGS, frailty is associated with increased rates of mortality, institutional discharge, and resource use. Strategies that might improve perioperative outcomes in frail EGS patients need to be developed and tested. (C) 2017 International Anesthesia Research Society

http://ift.tt/2ohmlg7

Creation and Validation of an Automated Algorithm to Determine Postoperative Ventilator Requirements After Cardiac Surgery.

BACKGROUND: In medical practice today, clinical data registries have become a powerful tool for measuring and driving quality improvement, especially among multicenter projects. Registries face the known problem of trying to create dependable and clear metrics from electronic medical records data, which are typically scattered and often based on unreliable data sources. The Society for Thoracic Surgery (STS) is one such example, and it supports manually collected data by trained clinical staff in an effort to obtain the highest-fidelity data possible. As a possible alternative, our team designed an algorithm to test the feasibility of producing computer-derived data for the case of postoperative mechanical ventilation hours. In this article, we study and compare the accuracy of algorithm-derived mechanical ventilation data with manual data extraction. METHODS: We created a novel algorithm that is able to calculate mechanical ventilation duration for any postoperative patient using raw data from our EPIC electronic medical record. Utilizing nursing documentation of airway devices, documentation of lines, drains, and airways, and respiratory therapist ventilator settings, the algorithm produced results that were then validated against the STS registry. This enabled us to compare our algorithm results with data collected by human chart review. Any discrepancies were then resolved with manual calculation by a research team member. RESULTS: The STS registry contained a total of 439 University of California Los Angeles cardiac cases from April 1, 2013, to March 31, 2014. After excluding 201 patients for not remaining intubated, tracheostomy use, or for having 2 surgeries on the same day, 238 cases met inclusion criteria. Comparing the postoperative ventilation durations between the 2 data sources resulted in 158 (66%) ventilation durations agreeing within 1 hour, indicating a probable correct value for both sources. Among the discrepant cases, the algorithm yielded results that were exclusively correct in 75 (93.8%) cases, whereas the STS results were exclusively correct once (1.3%). The remaining 4 cases had inconclusive results after manual review because of a prolonged documentation gap between mechanical and spontaneous ventilation. In these cases, STS and algorithm results were different from one another but were both within the transition timespan. This yields an overall accuracy of 99.6% (95% confidence interval, 98.7%-100%) for the algorithm when compared with 68.5% (95% confidence interval, 62.6%-74.4%) for the STS data (P

http://ift.tt/2nTwSLt

Anesthesiologists and Disaster Medicine: A Needs Assessment for Education and Training and Reported Willingness to Respond.

BACKGROUND: Anesthesiologists provide comprehensive health care across the emergency department, operating room, and intensive care unit. To date, anesthesiologists' perspectives regarding disaster medicine and public health preparedness have not been described. METHODS: Anesthesiologists' thoughts and attitudes were assessed via a Web-based survey at 3 major academic institutions. Frequencies, percentages, and odds ratios (ORs) were used to assess self-reported perceptions of knowledge and skills, as well as attitudes and beliefs regarding education and training, employee development, professional obligation, safety, psychological readiness, efficacy, personal preparedness, and willingness to respond (WTR). Three representative disaster scenarios (natural disaster [ND], radiological event [RE], and pandemic influenza [PI]) were investigated. Results are reported as percent or OR (95% confidence interval). RESULTS: Participants included 175 anesthesiology attendings (attendings) and 95 anesthesiology residents (residents) representing a 47% and 51% response rate, respectively. A minority of attendings indicated that their hospital provides adequate pre-event preparation and training (31% [23-38] ND, 14% [9-21] RE, and 40% [31-49] PI). Few residents felt that their residency program provided them with adequate preparation and training (22% [14-33] ND, 16% [8-27] RE, and 17% [9-29] PI). Greater than 85% of attendings (89% [84-94] ND, 88% [81-92] RE, and 87% [80-92] PI) and 70% of residents (81% [71-89] ND, 71% [58-81] RE, and 82% [70-90] PI) believe that their hospital or residency program, respectively, should provide them with preparation and training. Approximately one-half of attendings and residents are confident that they would be safe at work during response to a ND or PI (55% [47-64] and 58% [49-67] of attendings; 59% [48-70] and 48% [35-61] of residents, respectively), whereas approximately one-third responded the same regarding a RE (31% [24-40] of attendings and 28% [18-41] of residents). Fewer than 40% of attendings (34% [26-43]) and residents (38% [27-51]) designated who would take care of their family obligations in the event they were called into work during a disaster. Regardless of severity, 79% (71-85) of attendings and 73% (62-82) of residents indicated WTR to a ND, whereas 81% (73-87) of attendings and 70% (58-81) of residents indicated WTR to PI. Fewer were willing to respond to a RE (63% [55-71] of attendings and 52% [39-64] of residents). In adjusted logistic regression analyses, those anesthesiologists who reported knowing one's role in response to a ND (OR, 15.8 [4.5-55.3]) or feeling psychologically prepared to respond to a ND (OR, 6.9 [2.5-19.0]) were found to be more willing to respond. Similar results were found for RE and PI constructs. Both attendings and residents were willing to respond in whatever capacity needed, not specifically to provide anesthesia. CONCLUSIONS: Few anesthesiologists reported receiving sufficient education and training in disaster medicine and public health preparedness. Providing education and training and enhancing related employee services may further bolster WTR and help to build a more capable and effective medical workforce for disaster response. (C) 2017 International Anesthesia Research Society

http://ift.tt/2ohp5KE

Surveying the Literature: Synopsis of Recent Key Publications.

No abstract available

http://ift.tt/2nTpU9u

Generative Retrieval Improves Learning and Retention of Cardiac Anatomy Using Transesophageal Echocardiography.

BACKGROUND: Transesophageal echocardiography (TEE) is a valuable monitor for patients undergoing cardiac and noncardiac surgery as it allows for evaluation of cardiovascular compromise in the perioperative period. It is challenging for anesthesiology residents and medical students to learn to use and interpret TEE in the clinical environment. A critical component of learning to use and interpret TEE is a strong grasp of normal cardiovascular ultrasound anatomy. METHODS: Fifteen fourth-year medical students and 15 post-graduate year (PGY) 1 and 2 anesthesiology residents without prior training in cardiac anesthesia or TEE viewed normal cardiovascular anatomy TEE video clips; participants were randomized to learning cardiac anatomy in generative retrieval (GR) and standard practice (SP) groups. GR participants were required to verbally identify each unlabeled cardiac anatomical structure within 10 seconds of the TEE video appearing on the screen. Then a correctly labeled TEE video clip was shown to the GR participant for 5 more seconds. SP participants viewed the same TEE video clips as GR but there was no requirement for SP participants to generate an answer; for the SP group, each TEE video image was labeled with the correctly identified anatomical structure for the 15 second period. All participants were tested for intermediate (1 week) and late (1 month) retention of normal TEE cardiovascular anatomy. Improvement of intermediate and late retention of TEE cardiovascular anatomy was evaluated using a linear mixed effects model with random intercepts and random slopes. RESULTS: There was no statistically significant difference in baseline score between GR (49% +/- 11) and SP (50% +/- 12), with mean difference (95% CI) -1.1% (-9.5, 7.3%). At 1 week following the educational intervention, GR (90% +/- 5) performed significantly better than SP (82% +/- 11), with mean difference (95% CI) 8.1% (1.9, 14.2%); P = .012. This significant increase in scores persisted in the late posttest session at one month (GR: 83% +/- 12; SP: 72% +/- 12), with mean difference (95% CI) 10.2% (1.3 to 19.1%); P = .026. Mixed effects analysis showed significant improvements in TEE cardiovascular anatomy over time, at 5.9% and 3.5% per week for GR and SP groups respectively (P = .0003), and GR improved marginally faster than SP (P = .065). CONCLUSIONS: Medical students and anesthesiology residents inexperienced in the use of TEE showed both improved learning and retention of basic cardiovascular ultrasound anatomy with the incorporation of GR into the educational experience. (C) 2017 International Anesthesia Research Society

http://ift.tt/2ohixvC

It Takes a Village to Deliver Effective and Efficient Care: Team-Based Performance.

No abstract available

http://ift.tt/2nTRPpA

Sevoflurane Posttreatment Attenuates Lung Injury Induced by Oleic Acid in Dogs.

BACKGROUND: In animal models, both sevoflurane and propofol protect against acute lung injury (ALI), especially when administered prior to ALI onset. We hypothesized that when compared to propofol, sevoflurane administration after the onset of acute respiratory distress syndrome would mitigate oleic acid (OA)-induced ALI in dogs. METHODS: Dogs were randomly assigned to receive intravenous OA to induce ALI (n = 7 for each OA group) or saline as an OA control (n = 6 for each control). Dogs were then mechanically ventilated for 6 hours during which propofol (5 mg/kg/h) or sevoflurane (1.0 minimum alveolar concentration) was administered for sedation. Study end points included PO2/FIO2 ratio, pulmonary arterial pressure, pulmonary edema, histology, and tumor nuclear factor-[alpha]. RESULTS: In OA-injured animals, oxygenation was worse at 1, 2, 3, and 4 hours after 6-hour mechanical ventilation in sevoflurane-sedated animals compared with propofol-sedated animals, with mean difference (95% confidence interval; propofol minus sevoflurane) of 75 (39-111), 87 (55-119), 66 (44-87), and 67 (27-107) mm Hg for the respective time points. However, sevoflurane reduced the elevated pulmonary arterial pressure and vascular resistance, attenuated pulmonary edema as evidenced by reduced extravascular lung water index, and decreased tumor nuclear factor-[alpha] and diffuse alveolar damage score compared with propofol in the OA-injured lungs. CONCLUSIONS: When compared with propofol, sevoflurane attenuates OA-induced lung damage. However, despite this effect on lung histology and inflammation, sevoflurane worsened oxygenation in OA-induced ALI, possibly via inhibition of hypoxic pulmonary vasoconstriction. (C) 2017 International Anesthesia Research Society

http://ift.tt/2ohmkJ5

Does Bariatric Surgery Decrease Levothyroxine Requirements among Hypothyroid Patients?

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 157-158.


http://ift.tt/2paoqrC

Postoperative Thyroglobulin and Neck Ultrasound Are Useful for Risk Restratification and Decision to Perform 131I Ablation

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 136-139.


http://ift.tt/2oK2LKT

Thyroid Nodules Do Not Increase in Size During Pregnancy

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 150-152.


http://ift.tt/2paddY6

Intensity of 18F-FDG Uptake in Metastatic Differentiated Thyroid Cancer Fails to Predict Growth in Individual Metastatic Lesions

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 140-142.


http://ift.tt/2oJVkmM

Levothyroxine Therapy of Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy Does Not Improve Cognitive Function in the Offspring

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 132-135.


http://ift.tt/2paopE4

Rare Cases of Differentiated Thyroid Cancer with Low-Risk Histology and Distant Metastases Have High Prevalence of RAS and TERT Mutations

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 143-145.


http://ift.tt/2oJQ16M

Hyperthyroidism with Severe Liver Dysfunction Can Be Managed by RAI and Extracorporeal Albumin Dialysis and Hemodialysis

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 153-156.


http://ift.tt/2pai4IP

In Patients with Congenital Hypothyroidism, Prolonged Delay in Performing Neck Ultrasound May Provide Misleading Information

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 146-149.


http://ift.tt/2oJTqSZ

Could Measuring a Spectrum of Metabolites and Proteins Be a Useful Way to Assess Thyroid Function in Some Problematic Patients?

Clinical Thyroidology Apr 2017, Vol. 29, No. 4: 159-161.


http://ift.tt/2pa77XM

Novel Anticoagulant Agents in the Perioperative Setting

Publication date: Available online 7 April 2017
Source:Anesthesiology Clinics
Author(s): Allyson Lemay, Alan D. Kaye, Richard D. Urman

Teaser

An increasing number of oral anticoagulants have become available over the past decade. Each of these agents has differing implications on both regional and neuraxial anesthetic techniques. This article describes the pharmacology, pharmacokinetics, and pharmacodynamics of the most commonly used novel oral anticoagulants (NOACs). It also outlines recent guidelines for the use of NOACs in the perioperative setting, especially with regard to neuraxial anesthesia.


http://ift.tt/2oK0Khq

Erratum

http://ift.tt/2nT2OQh

General anesthetic actions on GABA A receptors in vivo are reduced in phospholipase C-related catalytically inactive protein knockout mice

Abstract

Purpose

The aim of this study was to investigate the action of general anesthetics in phospholipase C-related catalytically inactive protein (PRIP)-knockout (KO) mice that alter GAB_A receptor signaling.

Methods

PRIP regulates the intracellular trafficking of β subunit-containing GABA_A receptors in vitro. In this study, we examined the effects of intravenous anesthetics, propofol and etomidate that act via β subunit-containing GABA_A receptors, in wild-type and Prip-KO mice. Mice were intraperitoneally injected with a drug, and a loss of righting reflex (LORR) assay and an electroencephalogram analysis were performed.

Results

The cell surface expression of GABA_A receptor β3 subunit detected by immunoblotting was decreased in Prip-knockout brain compared with that in wild-type brain without changing the expression of other GABA_A receptor subunits. Propofol-treated Prip-KO mice exhibited significantly shorter duration of LORR and had lower total anesthetic score than wild-type mice in the LORR assay. The average duration of sleep time in an electroencephalogram analysis was shorter in propofol-treated Prip-KO mice than in wild-type mice. The hypnotic action of etomidate was also reduced in Prip-KO mice. However, ketamine, an NMDA receptor antagonist, had similar effects in the two genotypes.

Conclusion

PRIP regulates the cell surface expression of the GABA_A receptor β3 subunit and modulates general anesthetic action in vivo. Elucidation of the involved regulatory mechanisms of GABA_A receptor-dependent signaling would inform the development of safer anesthetic therapies for clinical applications.

http://ift.tt/2oQVrcZ

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

Publication date: Available online 6 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Shakir F. Mustafa, Peter L. Evans, Adrian W. Sugar, Stephen J. Key




http://ift.tt/2nm36D2

Diagnostic Tools in Ocular Allergy

Abstract

Ocular allergy (OA) includes a group of common and less frequent hypersensitivity disorders frequently misdiagnosed and not properly managed. The diagnosis of OA is usually based on clinical history and signs and symptoms, with the support of in vivo and in vitro tests when identification of the specific allergen is required. To date, no specific test is available for the diagnosis of the whole spectrum of the different forms of OA. The lack of recommendations on diagnosis of OA is considered a medical need not only for allergists but also for ophthalmologists.

This position paper aims to provide a comprehensive overview of the currently available tools for diagnosing OA to promote a common nomenclature and procedures to be used by different specialists. Questionnaires, sign and symptom grading scales, tests and potential biomarkers for OA are reviewed. We also identified several unmet needs in the diagnostic tools to generate interest, increase understanding and inspire further investigations. Tools, recommendations and algorithms for the diagnosis of OA are proposed for use by both allergists and ophthalmologists. Several unmet needs in the diagnostic tools should be further improved by specific clinical research in OA.

This article is protected by copyright. All rights reserved.

http://ift.tt/2nLkHQe

Work productivity in rhinitis using cell phones: The MASK pilot study

Abstract

Allergic rhinitis often impairs social life and performance. The aim of this cross-sectional study was to assess the impact of uncontrolled rhinitis assessed by visual analogue score VAS on work productivity using cell phone data collection.

A mobile phone app Allergy Diary, Android and Apple stores collects daily visual analogue scales VAS data for overall allergic symptoms VAS-global measured, nasal VAS-nasal, ocular VAS-ocular, asthma symptoms VAS-asthma and work VAS-work. A combined nasal-ocular score is calculated. Allergy Diary is available in 20 countries. The App includes the Work Productivity and Activity Impairment Allergic Specific Questionnaire WPAI:AS questionnaire in 6 EU countries. All consecutive users who filled the VAS-work from June 1 to October 31, 2016 were included in the study.

A total of 1,136 users filled in 5,818 days of VAS-work. Symptoms of allergic rhinitis were controlled VAS-global<20 in approximately 60% of days. In users with uncontrolled rhinitis, approximately 90% had some work impairment and over 50% had severe work impairment VAS-work>50. There was a significant correlation between VAS-global calculated and VAS-work Rho=0.83, p<0.00001, Spearman rank test. In 144 users, there was a significant correlation between VAS-work and WPAI:AS Rho=0.53, p<0.0001.

This article is protected by copyright. All rights reserved.

http://ift.tt/2nm3x0h

Not little adults: The uniqueness of the pediatric airways

The following is paid content sponsored by Ambu. By Jonathan Lee for EMS1 BrandFocus Kids are not little adults. Everyone has heard this cliché, but why is it so common and what does it mean in terms of pediatric airways" While it is true that pediatric airways are absolutely smaller than their adult counterparts, there also are important differences in structure and function that affect the ...

http://ift.tt/2oJloP5

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

Publication date: Available online 6 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Roberto L. Flores, Hannah Liss, Samuel Raffaelli, Aiza Humayun, Kimberly Khouri, Paulo G. Coelho, Lukasz Witek
PurposeCurrently, 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.MethodsA high-resolution 3D digital photograph was captured of the patient's unaffected ear and surrounding anatomic structures. The photographs were exported and uploaded into Amira, for transformation into a digital (.stl) model, which was imported into Blender, an open source software platform for digital modification of data. The unaffected auricle as digitally isolated and inverted to render a model for the contralateral side. The depths of the scapha, triangular fossa, and cymba were deepened to accentuate their contours. Extra relief was added to the helical root to further distinguish this structure. The ear was then digitally deconstructed and separated into its individual auricular components for reconstruction. The completed ear and its individual components were 3D printed using polylactic acid filament and sterilized following manufacturer specifications.ResultsThe sterilized models were brought to the operating room to be utilized by the surgeon. The models allowed for more accurate anatomic measurements compared to 2D tracings, which reduced the degree of estimation required by surgeons. Approximately 20 grams of the PLA filament were utilized for the construction of these models, yielding a total material cost of approximately $1.ConclusionUsing the methodology detailed in this report, as well as departmentally available resources (3D digital photography and 3D printing), a sterilizable, patient-specific, and inexpensive 3D auricular model was fabricated to be used intraoperatively. This technique of printing customized-to-patient models for surgeons to use as 'guides' shows great promise.



http://ift.tt/2nL7tmv

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

Publication date: Available online 6 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Gyu Sik Jung, Joon Hyun Kwon, Jeong Woo Lee, Jung Dug Yang, Ho Yun Chung, Byung-chae Cho, Kang Young Choi
PurposeNasal 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.Materials and MethodsThe operation was performed in these patients by a single surgeon extensively experienced in facial bone fractures. An absorbable mesh plate made into a clip was used for fixation after open reduction via the endonasal approach. No screws were used for fixation. Nasal packing was removed the first day after surgery; aluminum splinting was removed the third week after surgery. Three-dimensional facial computed tomography and cephalolateral radiography were performed preoperatively and postoperatively. Plastic surgeon satisfaction and postoperative complications were assessed.ResultsFracture relapse was not observed. Reduction status was well maintained. Postoperative complications occurred, with a low final incidence of 1.8% in the third postoperative month. Plastic surgeon satisfaction was very high at 4.58. This operation takes 5−10 minutes, and is simple to perform. It entails a short hospitalization, and the duration during which nasal packing and aluminum splint are maintained is comparable. Undesirable functional, aesthetic complications and secondary surgery resulting from inaccurate relapse were reduced.ConclusionThe clip operation is a useful technique for correcting nasal bone fractures, especially nasomaxillary complex type.



http://ift.tt/2oIX4wo