Σάββατο 8 Απριλίου 2017
Hematopoietic stem cell transplantation in advanced cutaneous T-cell lymphoma
Abstract
We retrospectively reviewed data pertaining to five patients with cutaneous T-cell lymphoma (CTCL) who had received hematopoietic stem cell transplantation (HSCT) between 2004 and 2015 at Kurume University Hospital, along with their clinical data until March 2016. For patients with advanced CTCL eligible for HSCT, autologous HSCT was performed when they responded well to chemotherapy, and allogeneic HSCT was selected for patients with advanced mycosis fungoides (MF)/Sézary syndrome (SS) and CTCL other than MF/SS with poor chemosensitivity. Two patients (primary cutaneous anaplastic large cell lymphoma and primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma) who responded well to chemotherapy received autologous HSCT: one patient was alive in partial remission and the other died due to therapy-related acute myeloid leukemia without disease relapse. In the remaining three patients with MF or SS, allogeneic HSCT was performed. Although one patient with MF died due to disease progression, the remaining two patients were alive in complete remission. Although there were two deaths in this study, the outcomes were considered satisfactory.
http://ift.tt/2nQ5xt5
Identification of a heterozygous p.Gly568Val missense mutation in the TRPV3 gene in a Japanese patient with Olmsted syndrome: In silico analysis of TRPV3
Abstract
Olmsted syndrome is a very rare congenital disorder, characterized by palmoplantar keratoderma and periorificial keratotic lesions. Recently, TRPV3 was reported to be a causative gene of Olmsted syndrome. We identified a heterozygous missense mutation of TRPV3, c.1703G>T, p.Gly568Val, in a Japanese patient with Olmsted syndrome. To the best of our knowledge, this is the first report of a Japanese patient with Olmsted syndrome harboring a missense mutation in TRPV3. We conducted in silico analysis of TRPV3 to evaluate whether the p.Gly568Val leads to structural changes in the TRPV3 selectivity filter. The selectivity filter was shown to become dilated and hyperpermeable as a result of genetic mutation (p.Gly573Ser, p.Tr692Gly or p.Gly568Val) as well as after a change in temperature (300 K to 310 K). In silico analysis of TRPV3 could be a useful approach in predicting mutation-induced activated states of ion channels, and thus enrich our understanding of the pathogenesis of Olmsted syndrome.
http://ift.tt/2odWgOG
Apremilast, an oral phosphodiesterase 4 inhibitor, in the treatment of Japanese patients with moderate to severe plaque psoriasis: Efficacy, safety and tolerability results from a phase 2b randomized controlled trial
Abstract
Apremilast, an oral, small-molecule phosphodiesterase 4 inhibitor, works intracellularly within immune cells to regulate inflammatory mediators. This phase 2b randomized, placebo-controlled study evaluated efficacy and safety of apremilast among Japanese patients with moderate to severe plaque psoriasis. In total, 254 patients were randomized to placebo, apremilast 20 mg b.i.d. (apremilast 20) or apremilast 30 mg b.i.d. (apremilast 30) through week 16; thereafter, all placebo patients were re-randomized to apremilast 20 or 30 through week 68. Efficacy assessments included achievement of 75% or more reduction from baseline in Psoriasis Area and Severity Index score (PASI-75; primary) and achievement of static Physician Global Assessment (sPGA; secondary) score of 0 (clear) or 1 (minimal) at week 16. Safety was assessed through week 68. At week 16, PASI-75 response rates were 7.1% (placebo), 23.5% (apremilast 20; P = 0.0032 vs placebo) and 28.2% (apremilast 30; P = 0.0003 vs placebo); sPGA response rates (score of 0 or 1) were 8.8% (placebo), 23.9% (apremilast 20; P = 0.0165 vs placebo) and 29.6% (apremilast 30; P = 0.0020 vs placebo). Responses were maintained with apremilast through week 68. Most common adverse events (AEs) with placebo, apremilast 20 and apremilast 30 (0–16 weeks) were nasopharyngitis (8.3%, 11.8%, 11.8%), diarrhea (1.2%, 8.2%, 9.4%), and abdominal discomfort (1.2%, 1.2%, 7.1%), respectively. Exposure-adjusted incidence of these AEs did not increase with continued apremilast treatment (up to 68 weeks). Apremilast demonstrated efficacy and safety in Japanese patients with moderate to severe plaque psoriasis through 68 weeks that was generally consistent with prior studies.
http://ift.tt/2nPN3ZK
The Demographic Study of Otorhinolaryngological Trauma Among Patients with Head and Neck Trauma and Their Management in a Tertiary Care Centre
Abstract
The trauma has been increasing in frequency, especially in recent decades because of the higher number of automobile accidents and violence. The ear, nose and face region is the area in the body that is commonly involved in head and neck injury. Trauma to this region is often associated with mortality and varying degree of physical, functional and psychological damage. To study the demography, aetiology, clinical presentation, outcome of ENT trauma in our tertiary care centre and to compare our study with previous studies to see the changing trends with passage of time. A prospective study was conducted on 200 head and neck patients with ENT injuries during a period of 1 year from July 2014 to July 2015, who were admitted in ENT Department and Trauma Centre of Gajra Raja Medical College and J.A. Group of Hospital, Gwalior. Most of the patients were young adult males of age group 18–40 years (45, 22.5%) with a male:female ratio 1.78:1. Among them 53% patients were from rural area while 47% were from urban area. RTA is the most prevalent cause of ENT trauma (37%), followed by interpersonal violence (25%). 27% of the patients had facial injury and multiple region injury each. Among 200 patients 33% were managed conservatively on the other hand 66% patients required surgical interventions. Mortality rate was 8%. Among all 184 survivors 25.5% suffered from hearing loss, 14.5% had tympanic membrane perforation with hearing loss, 12% had pinna disfigurement, 10% had change in voice, 6.5% had permanent nasal deformity, 2% had facial nerve palsy. Young male adults were the most prevalent victims of ENT trauma, and Road traffic accidents were responsible for majority of the ENT injuries. Screening of all the patients with head and neck injuries for the presence of trauma in the ENT region should be introduced to enable early detection and therefore prevention of complications.
http://ift.tt/2oOwSRf
Thymus Transplantation for Complete Digeorge Syndrome: European Experience
Source:Journal of Allergy and Clinical Immunology
Author(s): E Graham Davies, Melissa Cheung, Kimberly Gilmour, Jesmeen Maimaris, Joe Curry, Anna Furmanski, Neil Sebire, Neil Halliday, Konstantinos Mengrelis, Stuart Adams, Jolanta Bernatoniene, Ronald Bremner, Michael Browning, Blythe Devlin, Hans Christian Erichsen, H Bobby Gaspar, Lizzie Hutchison, Winnie Ip, Marianne Ifversen, T Ronan Leahy, Elizabeth McCarthy, Despina Moshous, Kim Neuling, Malgorzata Pac, Alina Papadopol, Kathryn L. Parsley, Luigi Poliani, Ida Ricciardelli, David M. Sansom, Tiia Voor, Austen Worth, Tessa Crompton, M Louise Markert, Adrian J. Thrasher
BackgroundThymus transplantation is a promising strategy for the treatment of athymic complete DiGeorge syndrome (cDGS).MethodsTwelve patients with cDGS were transplanted with allogeneic cultured thymus.ObjectiveTo confirm and extend the results previously obtained in a single centre.ResultsTwo patients died of pre-existing viral infections without developing thymopoeisis and one late death occurred from autoimmune thrombocytopaenia. One infant suffered septic shock shortly after transplant resulting in graft loss and the need for a second transplant. Evidence of thymopoeisis developed from 5-6 months after transplantation in ten patients. The median (range) of circulating naïve CD4 counts (x106/L) were 44(11-440) and 200(5-310) at twelve and twenty-four months post-transplant and T-cell receptor excision circles were 2238 (320-8807) and 4184 (1582 -24596) per106 T-cells. Counts did not usually reach normal levels for age but patients were able to clear pre-existing and later-acquired infections. At a median of 49 months (22-80), eight have ceased prophylactic antimicrobials and five immunoglobulin replacement. Histological confirmation of thymopoeisis was seen in seven of eleven patients undergoing biopsy of transplanted tissue including five showing full maturation through to the terminal stage of Hassall body formation. Autoimmune regulator (AIRE) expression was also demonstrated. Autoimmune complications were seen in 7/12 patients. In two, early transient autoimmune haemolysis settled after treatment and did not recur. The other five suffered ongoing autoimmune problems including: thyroiditis (3); haemolysis (1), thrombocytopaenia (4) and neutropenia (1).ConclusionsThis study confirms the previous reports that thymus transplantation can reconstitute T cells in cDGS but with frequent autoimmune complications in survivors.
Teaser
In twelve patients with complete DiGeorge syndrome treated with thymus transplantation, there was a 75% survival with T-cell reconstitution. Autoimmunity, mostly manageable, was a frequent occurrence in survivors.http://ift.tt/2ocCamm
Autophagy – Nobel Prize 2016 and Allergy and Asthma Research
Source:Journal of Allergy and Clinical Immunology
Author(s): Harald Renz
http://ift.tt/2oRRJCS
Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure
Plate-related complications following head and neck cancer ablation and reconstruction remains a challenging problem often requiring further management and reconstructive surgeries. We aim to identify an assoc...
http://ift.tt/2oRDpdA
Development of medial pterygoid muscle fibers in rabbits fed with a liquid diet
Source:Archives of Oral Biology, Volume 80
Author(s): Kozue Kuroki, Takumi Morita, Hiroki Takasu, Keisuke Saito, Takuya Fujiwara, Katsunari Hiraba, Shigemi Goto
ObjectiveThis study aimed to investigate the influence of decreased functional load on the medial pterygoid muscle during mastication in rabbits fed with a liquid-diet.Materials and MethodsMedial pterygoid muscles from 54 rabbits (solid- and liquid-diet groups, n=48; unweaned group, n=6) were histochemically examined at 4, 9, 12, 18, and 33 weeks after birth. Six fiber types (I, IC, IIC, IIA, IIAB, and IIB) were distinguished via mATPase staining.ResultsSignificant increases in the diameters of all fiber types were seen up to 33 weeks of age in the solid-diet group; however, no significant increase was noted in fiber types I and IC, from 4 to 33 weeks of age, in the liquid-diet group. The proportion of slow fibers increased up to 12 weeks followed by an increase in the number of fast fibers in the solid-diet group, whereas in the liquid-diet group, the number of slow fiber declined after weaning.ConclusionsLiquid-diet consumption caused muscle fiber atrophy and an increase in the number of fast fibers during early developmental stages after weaning. Furthermore, the growth pattern of the medial pterygoid muscle in the liquid-diet group was different from that in the solid-diet group.
http://ift.tt/2odITxZ
Evaluation of the effect of tacrolimus on periodontitis induced in rats
Source:Archives of Oral Biology, Volume 80
Author(s): Luiz Alexandre Moura Penteado, Gilmara Medeiros Lucena, Marcílio Otávio Brandão Peixoto, Thiago Correia Barbosa, Ana Carolina de Souza Leitão Arruda, Renata Cimões
ObjectiveThis study was to investigate the effect of tacrolimus (FK506) on periodontitis induced in rats.DesignPeriodontal disease was induced in 30 Wistar rats which were then randomly divided into two groups: treatment with a daily injection of 0.9% saline (1mL/day) and treatment with a daily injection of FK506. After periods of 10, 15 and 30days the animals were killed and separate radiographs of the right and left hemimandibles were obtained. One calibrated examiner measured the periodontal bone support (PBS) in the images, after the following treatments: S, saline without ligature; SL, saline with ligature; T, FK506 without ligature; TL, FK506 with ligature. The data were subjected to analysis of variance (ANOVA) and the Tukey test (p<0.01).ResultsThe radiographic results were similar at all evaluation time points. The S treatment had a higher PBS averaging at 10, 15 and 30days, which was statistically significant different compared with the SL treatment and TL treatment, but not significantly different from the T treatment. The SL and TL treatments showed no statistically significant differences between them.ConclusionsTacrolimus used for up to 30days showed no protective or aggravating effects on alveolar bone loss.
http://ift.tt/2ocjh2T
Cigarette smoke extract (CSE) induces RAGE-mediated inflammation in the Ca9-22 gingival carcinoma epithelial cell line
Source:Archives of Oral Biology, Volume 80
Author(s): Nolan T. Sanders, Derek J. Dutson, Justin W. Durrant, Joshua B. Lewis, Shalene H. Wilcox, Duane R. Winden, Juan A. Arroyo, Benjamin T. Bikman, Paul R. Reynolds
ObjectiveThe oral environment is anatomically positioned as a significant gateway for exposure to environmental toxicants. Cigarette smoke exposure compromises oral health by orchestrating inflammation. The receptor for advanced glycation end-products (RAGE) has been implicated in smoke-induced inflammatory effects; however, its role in the oral cavity is unknown. The purpose of this study was to determine RAGE expression by immortalized gingival carcinoma cells and the degree to which RAGE-mediated signaling influences inflammation.DesignGingival epithelia cells (Ca9-22) were exposed to 10% cigarette smoke extract (CSE) for six hours and screened for RAGE expression and inflammatory mediators.ResultsQuantitative PCR and immunoblotting revealed increased RAGE expression following exposure. Furthermore, exposure activated RAGE signaling intermediates including Ras and NF-κB. IL-6 and IL-1β were also elevated in cell culture medium from CSE-exposed cells when compared to controls. A family of anionic, partially lipophilic sulfated polysaccharide derivatives known as semi-synthetic glycosaminoglycan ethers (SAGEs) were used in an effort to block RAGE signaling. Co-treatment of CSE and SAGEs ameliorated inflammatory responses.ConclusionsThese results provide a new perspective on a mechanism of cigarette smoke induced oral inflammation. Further work may show RAGE signaling as a potential target in the treatment of diseases of the oral cavity exacerbated by tobacco smoke exposure.
http://ift.tt/2odE9IO
Development of medial pterygoid muscle fibers in rabbits fed with a liquid diet
Source:Archives of Oral Biology, Volume 80
Author(s): Kozue Kuroki, Takumi Morita, Hiroki Takasu, Keisuke Saito, Takuya Fujiwara, Katsunari Hiraba, Shigemi Goto
ObjectiveThis study aimed to investigate the influence of decreased functional load on the medial pterygoid muscle during mastication in rabbits fed with a liquid-diet.Materials and MethodsMedial pterygoid muscles from 54 rabbits (solid- and liquid-diet groups, n=48; unweaned group, n=6) were histochemically examined at 4, 9, 12, 18, and 33 weeks after birth. Six fiber types (I, IC, IIC, IIA, IIAB, and IIB) were distinguished via mATPase staining.ResultsSignificant increases in the diameters of all fiber types were seen up to 33 weeks of age in the solid-diet group; however, no significant increase was noted in fiber types I and IC, from 4 to 33 weeks of age, in the liquid-diet group. The proportion of slow fibers increased up to 12 weeks followed by an increase in the number of fast fibers in the solid-diet group, whereas in the liquid-diet group, the number of slow fiber declined after weaning.ConclusionsLiquid-diet consumption caused muscle fiber atrophy and an increase in the number of fast fibers during early developmental stages after weaning. Furthermore, the growth pattern of the medial pterygoid muscle in the liquid-diet group was different from that in the solid-diet group.
http://ift.tt/2odITxZ
Evaluation of the effect of tacrolimus on periodontitis induced in rats
Source:Archives of Oral Biology, Volume 80
Author(s): Luiz Alexandre Moura Penteado, Gilmara Medeiros Lucena, Marcílio Otávio Brandão Peixoto, Thiago Correia Barbosa, Ana Carolina de Souza Leitão Arruda, Renata Cimões
ObjectiveThis study was to investigate the effect of tacrolimus (FK506) on periodontitis induced in rats.DesignPeriodontal disease was induced in 30 Wistar rats which were then randomly divided into two groups: treatment with a daily injection of 0.9% saline (1mL/day) and treatment with a daily injection of FK506. After periods of 10, 15 and 30days the animals were killed and separate radiographs of the right and left hemimandibles were obtained. One calibrated examiner measured the periodontal bone support (PBS) in the images, after the following treatments: S, saline without ligature; SL, saline with ligature; T, FK506 without ligature; TL, FK506 with ligature. The data were subjected to analysis of variance (ANOVA) and the Tukey test (p<0.01).ResultsThe radiographic results were similar at all evaluation time points. The S treatment had a higher PBS averaging at 10, 15 and 30days, which was statistically significant different compared with the SL treatment and TL treatment, but not significantly different from the T treatment. The SL and TL treatments showed no statistically significant differences between them.ConclusionsTacrolimus used for up to 30days showed no protective or aggravating effects on alveolar bone loss.
http://ift.tt/2ocjh2T
Cigarette smoke extract (CSE) induces RAGE-mediated inflammation in the Ca9-22 gingival carcinoma epithelial cell line
Source:Archives of Oral Biology, Volume 80
Author(s): Nolan T. Sanders, Derek J. Dutson, Justin W. Durrant, Joshua B. Lewis, Shalene H. Wilcox, Duane R. Winden, Juan A. Arroyo, Benjamin T. Bikman, Paul R. Reynolds
ObjectiveThe oral environment is anatomically positioned as a significant gateway for exposure to environmental toxicants. Cigarette smoke exposure compromises oral health by orchestrating inflammation. The receptor for advanced glycation end-products (RAGE) has been implicated in smoke-induced inflammatory effects; however, its role in the oral cavity is unknown. The purpose of this study was to determine RAGE expression by immortalized gingival carcinoma cells and the degree to which RAGE-mediated signaling influences inflammation.DesignGingival epithelia cells (Ca9-22) were exposed to 10% cigarette smoke extract (CSE) for six hours and screened for RAGE expression and inflammatory mediators.ResultsQuantitative PCR and immunoblotting revealed increased RAGE expression following exposure. Furthermore, exposure activated RAGE signaling intermediates including Ras and NF-κB. IL-6 and IL-1β were also elevated in cell culture medium from CSE-exposed cells when compared to controls. A family of anionic, partially lipophilic sulfated polysaccharide derivatives known as semi-synthetic glycosaminoglycan ethers (SAGEs) were used in an effort to block RAGE signaling. Co-treatment of CSE and SAGEs ameliorated inflammatory responses.ConclusionsThese results provide a new perspective on a mechanism of cigarette smoke induced oral inflammation. Further work may show RAGE signaling as a potential target in the treatment of diseases of the oral cavity exacerbated by tobacco smoke exposure.
http://ift.tt/2odE9IO
Inhibition of Voltage-Gated Na+ Channels by Bupivacaine Is Enhanced by the Adjuvants Buprenorphine, Ketamine, and Clonidine.
Background and Objectives: Regional anesthesia includes application of local anesthetics (LAs) into the vicinity of peripheral nerves. Prolongation or improvement of nerve blocks with LAs can be accomplished by coapplication with adjuvants, including buprenorphine, ketamine, and clonidine. While the mechanisms mediating prolonged or improved LA-induced effects by adjuvants are poorly understood, we hypothesized that they are likely to increase LA-induced block of voltage-gated Na+ channels. In this study, we investigated the inhibitory effects of the LA bupivacaine alone and in combination with the adjuvants on neuronal Na+ channels. Methods: Effects of bupivacaine, buprenorphine, ketamine, and clonidine on endogenous Na+ channels in ND7/23 neuroblastoma cells were investigated with whole-cell patch clamp. Results: Bupivacaine, buprenorphine, ketamine, and clonidine are concentration- and state-dependent inhibitors of Na+ currents in ND7/23 cells. Tonic block of resting channels revealed an order of potency of bupivacaine (half-maximal inhibitory concentration [IC50] 178 +/- 8 [mu]M) > buprenorphine (IC50 172 +/- 25) > clonidine (IC50 824 +/- 55 [mu]M) > ketamine (IC50 1377 +/- 92 [mu]M). Bupivacaine and buprenorphine, but not clonidine and ketamine, induced a strong use-dependent block at 10 Hz. Except for clonidine, all substances enhanced fast and slow inactivation. The combination of bupivacaine with one of the adjuvants resulted in a concentration-dependent potentiation bupivacaine-induced block. Conclusions: We demonstrate that buprenorphine, ketamine, and clonidine directly inhibit Na+ channels and that they potentiate the blocking efficacy of bupivacaine on Na+ channels. These data indicate that block of Na+ channels may account for the additive effects of adjuvants used for regional anesthesia. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.
http://ift.tt/2nsXmYm
http://ift.tt/2nsXmYm
A New Step Toward Evidence of In Vivo Perineural Dexamethasone Safety: An Animal Study.
Background and Objectives: The aim of this study was to analyze histological nerve toxicity of perineural dexamethasone administration in combination with ropivacaine on mice. Efficacy of perineural dexamethasone in combination with regional anesthesia is clearly demonstrated. However, the safety of this procedure is still a matter of debate. Methods: A sciatic nerve block was performed on 90 mice. Five groups, each containing 18 mice assigned randomly, were used in these experiments: the sham group (isotonic saline solution), R group (perineural ropivacaine), D group (perineural dexamethasone), RDPN group (perineural ropivacaine and perineural dexamethasone), and the RDS group (perineural ropivacaine and systemic dexamethasone). Sensory and motor blocks were evaluated every 30 minutes for 14 hours. Fourteen and 28 days after this procedure, 9 mice in each group were killed for sciatic nerve histological assessment. Results: No statistical difference was observed between different groups for Wallerian degeneration (P = 0.28 at day 14 and P = 0.22 at day 28) and perineural inflammation (P = 0.9 at day 14). Motor and sensory block durations were tested for each group. A statistical difference was observed for motor block duration between the RDPN group (150 minutes [127-172 minutes]), the RDS group (120 minutes [90-120 minutes]), and the R group (60 minutes [60-90 minutes]). Sensory block duration was also statistically different: 660 minutes (660-720 minutes) in the RDPN group, 480 minutes (427-660 minutes) in RDS group, 330 minutes (240-410) in the R group. Conclusions: A combination of ropivacaine and perineural dexamethasone allows longer sensory block duration compared with ropivacaine alone or ropivacaine and systemic dexamethasone, without increased neural toxicity. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.
http://ift.tt/2ocbJNw
http://ift.tt/2ocbJNw
The predictive value of pre-recruitment achievement on resident performance in anesthesiology
Selecting candidates for residency positions is challenging and there is little research on the correlation between commonly used selection criteria and subsequent performance in anesthesiology. This study examined the association between the selection measures and post-recruitment performance in residency.
http://ift.tt/2pfuK1a
Clinical experiences of ultrasound-guided lateral thoracolumbar Interfascial plane (TLIP) block
An ultrasound-guided thoracolumbar interfascial plane (TLIP) block injects a local anesthetic into the fascial plane between the multifidus and longissimus muscles at approximately the level of the third lumbar vertebra (L3), and can block the ventral rami of the thoracolumbar nerves (L2, 3) [1]. Therefore, the TLIP block provides good perioperative pain relief during lumbar vertebra surgery, as reported by some studies on the TLIP block [2,3]. However, as the injection site is near the incision site of the lumber vertebra surgery, the TLIP block may carry a risk of infection.
http://ift.tt/2ode7Wh
Postoperative analgesic efficacy of single-shot and continuous transversus abdominis plane block after laparoscopic cholecystectomy: A randomized controlled clinical trial
To compare the analgesic efficacy of ultrasound-guided single-shot and continuous transversus abdominis plane (TAP) block to that of IV-PCA in patients undergoing laparoscopic cholecystectomy.
http://ift.tt/2pf7mAH
Influence of the perioperative administration of magnesium sulfate on the total dose of anesthetics during general anesthesia. A systematic review and meta-analysis
Magnesium sulfate displays numerous characteristics that make it a useful drug in anesthesiology (N-methyl-d-aspartate receptor antagonist, vasodilator, antiarrhythmic, inhibitor of catecholamine release and of acetylcholine in the terminal motor plate). The perioperative use of this drug as an adjuvant capable of decreasing the required dose of anesthetics, has been proposed.
http://ift.tt/2od6RJO
Perioperative serum levels of procalcitonin, C-reactive protein, and leukocytes in head and neck free flaps
Microvascular free flaps are considered to be the gold standard in reconstructive head and neck surgery. However, reduced postoperative transplant perfusion is one of the serious postoperative complications and calls for close and reliable monitoring. Procalcitonin, C-reactive protein, and leukocytes are closely associated with local and systemic inflammatory reactions and might have prognostic capacity concerning tissue necrosis. This study aimed to evaluate perioperative serum levels of these three biomarkers to assess their potential in postoperative flap monitoring.
http://ift.tt/2ok9iLd
Review of General Dental Council and General Medical Council “fitness to practise” hearings related to maxillofacial surgery
Dually-registered specialists in oral and maxillofacial surgery (OMFS) may be subject to disciplinary hearings by the General Medical Council (GMC) and the General Dental Council (GDC) for the same allegations, a phenomenon referred to as "double jeopardy" within the specialty. Previous efforts by both councils to simplify regulatory arrangements have made little progress. We have therefore reviewed the range and scope of fitness to practise (FTP) proceedings relevant to OMFS. We searched the online GMC register to find registered OMFS specialists and obtained FTP proceedings from 2004-2016 through a Freedom of Information request from the GDC.
http://ift.tt/2obgjM1
Cutaneous basal cell carcinoma with distant metastasis to thorax and bone
Abstract
Basal cell carcinoma (BCC) is the most common cutaneous malignancy and is characterized by a high cure rate after local excision. Metastatic BCC (mBCC) is an exceedingly rare event, associated with poor prognosis. We report clinicopathological and immunohistochemical features of 15 mBCC metastatic to the thorax and bone. The patients were 14 males and one female with a mean age at diagnosis of cutaneous BCC of 53 years and at metastasis of 64 years. Primary BCC were primarily located in the head and neck or torso and microscopically included five nodular, three basosquamous, three mixed, and one each of superficial, infiltrative, micronodular, and morpheaform types. Eleven cases metastasized to the lung, three to the bone, and one to the heart. Immunohistochemically, 70% of mBCC were positive for bcl-2, 81% for BerEP4, and 0% for EMA. Treatment consisted of surgery and/or chemotherapy or radiation. Eight patients died at a median interval from metastasis to death of 20 months, and seven were alive at a median interval of 30 months. BCC metastatic to the thoracic organs or bone is rare, mainly affecting older white males. BCC when metastatic commonly affects the lung or bone but rarely the heart. Our results suggest a slightly better prognosis than previously reported, possibly due to improved multimodal treatment strategies. Metastasis from BCC should be considered in a patient with metastatic disease of unknown primary and a history of BCC. Immunohistochemistry may be helpful to reach a final diagnosis.
http://ift.tt/2nrX8QV
Patterns, Presentations and Prognosis of Nasal Polyps
Abstract
Few studies have documented the characteristic features of nasal polyps in the developing countries. In this study, we described the patterns, presentations and prognosis of nasal polyps seen in clinical setting, with a view to improve our understanding of its clinical and epidemiological characteristics. The study was a 10-year retrospective analysis of histologically-confirmed nasal polyps seen between January 2006 and December 2015. Records of patients with intranasal masses were retrieved from our hospital's records department, clinics, wards and theatre suites. Those with nasal polyps were recruited into the study. The results were descriptively analyzed using SPSS statistical soft ware package version 10. There were 84 patients with intranasal masses seen within the reviewed period. Of this, 52 (61.9%) were histologically-confirmed nasal polyps. There were 22 males and 30 females. Their age ranges from 16 to 69 years. The most frequent symptom is nasal obstruction occurring in 76.9% of the cases. None of the patients had epistaxis. Thirty-one (59.6%) were associated with various complications either singly or multiple (Table 1). All (100%) were treated with conventional forceps excision. Eleven (21.2%) of them had recurrence between 3 and 5 years after surgery. None of the polyps or their recurrence exhibited malignant transformation. Nasal polyp is the most common intranasal mass seen in clinical practice. Its rarity in children and propensity for recurrence are reaffirmed. Although, recurrence is a major prognostic challenge, nasal polyp does not exhibit malignant transformation.
Showing frequency distribution of the presenting complaints, radiological findings and complications
Variable
Frequency
%
Presenting complaints
Nasal obstruction
40
76.9
Snoring
32
61.5
Visible nasal mass
25
48.1
Nasal discharge (watery, mucous, purulent)
14
26.9
Paroxysmal sneezing
10
19.2
Loss of sense of smell
9
17.3
Headache
8
15.4
Facial pain
5
9.6
Radiological findings
Opacification of ethmoid and maxillary sinuses
46
88.5
Soft tissue opacity in the nasal cavity
41
78.9
Soft tissue opacity in the nasopharynx
26
50.0
Dome-shaped soft tissue opacity in the maxillary sinus
12
23.1
Fluid level in the maxillary sinus
6
11.5
Clear paranasal sinuses
4
7.7
Complications
Acute rhinosinusitis
5
9.6
Epiphora
6
11.5
Anosmia
9
17.3
Obstructive sleep apnoea
28
53.8
Some patients have multiple complaints/radiological findings/complications
http://ift.tt/2ocj4yy
Tuberculous Bronchoesophageal Fistula in Nephrotic Syndrome: A Silent Assassin
Abstract
Tuberculosis, a global public health concern, is emerging as an important complication in children with nephrotic syndrome. We report a case of an adolescent with nephrotic syndrome who developed fatal miliary tuberculosis after initiation of steroid therapy, presenting as a bronchoesophageal fistula. The case highlights the importance of maintaining a high index of suspicion prior to starting immunosuppressive therapy in pediatric patients of nephrotic syndrome.
http://ift.tt/2nWg3Qd
Drug-Induced Sleep Endoscopy as a Selection Tool for Surgical Management of Obstructive Sleep Apnoea Syndrome: Our Personal Experience
Abstract
The role of Drug-induced sleep endoscopy as a selection tool for surgical management of obstructive sleep apnoea syndrome. Source of data: Polysomnography proved OSA patients, who are planned for surgery in dept. of ENT AND HEAD& NECK, JSS Hospital, Mysore. Study design: A prospective clinical study. Method: 30 Polysomnography proved OSA patients, age between 20 and 60 years have been selected for Drug Induced Sleep Endoscopy (DISE) after taking informed consent for proposed surgery. Inj propofol infusion given throughout the DISE procedure and upper airway nasal endoscopy performed for assessment of site of collapse (Retropalatal, Retrolingual, Hypopharyngral), type of collapse (circumferential, lateral) and severity of obstruction, Lowest SpO2, apnoeic episodes and DISE findings were recorded. Out of these thirty patients 90% were male and 10% were female, observed that 66.7% of males and 40.7% of females belonged to 31–40 age group, and BMI of 63.3% of patient population were overweight, 20% were obese and 5% were normal. Mean fall in SpO2 was 90.20 ± 2.77 in normal subjects, 83.05 ± 5.14 in overweight subjects and 68.83 ± 9.11 in obese subjects. Normal subjects had 0.4 ± 0.9 apnoeic episodes, overweight subjects had 0.9 ± 1.6 episodes and obese subjects had 4.0 ± 2 apnoeic episodes. We observed that 40% had retropalatal airway collapse, 23.3% had airway obstruction at the base of the tongue, 20% had airway obstruction with floppy epiglottis, 12% multiple level collapse, 6.7% of patient population had grade 4 enlarged tonsils, 3.3% had lateral pharyngeal wall collapse, and 0% hypopharyngeal collapse. Out of 30, 29 Patients underwent surgery (Expansion sphincter pharyngo plasty—14, Hyoid advancement—4, Uuvulopalatoplasty—10, Epiglottic surgery—6, Zeta pharyngoplasty—2, midline glossectomy—3, Endoscopic septoplasty—5, Inferio turbinoplasty—2, LASSER Assisted lingual tonsillectomy—1), All these 29 patient were followed for 3 months, at the end of 3rd month again Each subject was evaluated with a baseline Epworth Sleepiness Scale and LEVEL-3 PSG, the results were impressive with statistically significant. DISE is a dynamic, safe, and easy-to-perform technique that visualizes, the anatomical sites of snoring or apneas for assessment site of collapse (Retropalatal, Retrolingual, Hypopharyngral), type of collapse (Circumferential, Lateral) and severity of obstruction and guides the design of a tailor-made treatment plan for a OSA SURGEON in individual cases, which will improves perioperative outcome.
http://ift.tt/2ocJPTf
Genetic evolution of uveal melanoma guides the development of an inflammatory microenvironment
Abstract
Uveal melanoma (UM) is characterized by a number of genetic aberrations that follow a certain chronology and are tightly linked to tumor recurrence and survival. Loss of chromosome 3, bi-allelic loss of BAP1 expression, and gain in chromosome 8q have been associated with metastasis formation and death, while loss of chromosome 3 has been associated with the influx of macrophages and T cells. We used a set of genetically-classified UM to study immune infiltration in the context of their genetic evolution. We show in two independent cohorts that lack of BAP1 expression is associated with an increased density of CD3+ T cells and CD8+ T cells. The presence of extra copies of chromosome 8q in disomy 3 tumors with a normal BAP1 expression is associated with an increased influx of macrophages (but not T cells). Therefore, we propose that the genetic evolution of UM is associated with changes in the inflammatory phenotype. Early changes resulting in gain of chromosome 8q may activate macrophage infiltration, while sequential loss of BAP1 expression seems to drive T cell infiltration in UM.
http://ift.tt/2pen8vJ
Phase I/IIa clinical trial of a novel hTERT peptide vaccine in men with metastatic hormone-naive prostate cancer
Abstract
In newly diagnosed metastatic hormone-naive prostate cancer (mPC), telomerase-based immunotherapy with the novel hTERT peptide vaccine UV1 can induce immune responses with potential clinical benefit. This phase I dose escalation study of UV1 evaluated safety, immune response, effects on prostate-specific antigen (PSA) levels, and preliminary clinical outcome. Twenty-two patients with newly diagnosed metastatic hormone-naïve PC (mPC) were enrolled; all had started androgen deprivation therapy and had no visceral metastases. Bone metastases were present in 17 (77%) patients and 16 (73%) patients had affected lymph nodes. Three dose levels of UV1 were given as intradermal injections combined with GM-CSF (Leukine®). Twenty-one patients in the intention-to-treat population (95%) received conformal radiotherapy. Adverse events reported were predominantly grade 1, most frequently injection site pruritus (86.4%). Serious adverse events considered possibly related to UV1 and/or GM-CSF included anaphylactic reaction in two patients and thrombocytopenia in one patient. Immune responses against UV1 peptides were confirmed in 18/21 evaluable patients (85.7%), PSA declined to <0.5 ng/mL in 14 (64%) patients and in ten patients (45%) no evidence of persisting tumour was seen on MRI in the prostatic gland. At the end of the nine-month reporting period for the study, 17 patients had clinically stable disease. Treatment with UV1 and GM-CSF gave few adverse events and induced specific immune responses in a large proportion of patients unselected for HLA type. The intermediate dose of 0.3 mg UV1 resulted in the highest proportion of, and most rapid UV1-specific immune responses with an acceptable safety profile. These results warrant further clinical studies in mPC.
http://ift.tt/2nridel
The place of hyperbaric oxygen therapy and ozone therapy in sudden hearing loss
Publication date: Available online 8 April 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Serkan Ergözen
http://ift.tt/2nrnMJZ
Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure
Abstract
Background
Plate-related complications following head and neck cancer ablation and reconstruction remains a challenging problem often requiring further management and reconstructive surgeries. We aim to identify an association between surgical site infections (SSI) and plate exposure.
Methods
A retrospective study between 1997 and 2014 was performed to study the association between postoperative SSI and plate exposures. Eligible patients included those with a history of oral squamous cell carcinoma who underwent surgical resection, neck dissection, and free tissue reconstruction. Demographic and treatment related information was collected. SSI were classified based on CDC definition and previously published literature. Univariable analysis on demographic factors, smoking history, diabetes, radiation, surgical and hardware related factors; while multivariable analysis on SSI, plate height, segmental mandibulectomy defects and radiation were conducted such as using cox proportional hazard models.
Results
Three hundred sixty-five patients were identified and included in our study. The mean age of the study group was 59.2 (+/−13.8), with a predominance of male patients (61.9%). 10.7% of our patient cohort had diabetes, and another 63.8% had post-operative radiation therapy. Patients with SSI were more likely to have plate exposure (25 vs. 6.4%, p <0.001). Post-operative SSI, mandibulectomy defects, and plate profile/thickness were associated with plate exposure on univariable analysis (OR = 5.72, p < 0.001; OR = 2.56, p = 0.014; OR = 1.44, p = 0.003 respectively) and multivariable analysis (OR = 5.13, p < 0.001; OR = 1.36, p = 0.017; OR = 2.58, p = 0.02 respectively).
Conclusion
Surgical site infections are associated with higher rates of plate exposure. Plate exposure may require multiple procedures to manage and occasionally free flap reconstruction.
http://ift.tt/2pdSum3
Patterns, Presentations and Prognosis of Nasal Polyps
Abstract
Few studies have documented the characteristic features of nasal polyps in the developing countries. In this study, we described the patterns, presentations and prognosis of nasal polyps seen in clinical setting, with a view to improve our understanding of its clinical and epidemiological characteristics. The study was a 10-year retrospective analysis of histologically-confirmed nasal polyps seen between January 2006 and December 2015. Records of patients with intranasal masses were retrieved from our hospital's records department, clinics, wards and theatre suites. Those with nasal polyps were recruited into the study. The results were descriptively analyzed using SPSS statistical soft ware package version 10. There were 84 patients with intranasal masses seen within the reviewed period. Of this, 52 (61.9%) were histologically-confirmed nasal polyps. There were 22 males and 30 females. Their age ranges from 16 to 69 years. The most frequent symptom is nasal obstruction occurring in 76.9% of the cases. None of the patients had epistaxis. Thirty-one (59.6%) were associated with various complications either singly or multiple (Table 1). All (100%) were treated with conventional forceps excision. Eleven (21.2%) of them had recurrence between 3 and 5 years after surgery. None of the polyps or their recurrence exhibited malignant transformation. Nasal polyp is the most common intranasal mass seen in clinical practice. Its rarity in children and propensity for recurrence are reaffirmed. Although, recurrence is a major prognostic challenge, nasal polyp does not exhibit malignant transformation.
Showing frequency distribution of the presenting complaints, radiological findings and complications
Variable
Frequency
%
Presenting complaints
Nasal obstruction
40
76.9
Snoring
32
61.5
Visible nasal mass
25
48.1
Nasal discharge (watery, mucous, purulent)
14
26.9
Paroxysmal sneezing
10
19.2
Loss of sense of smell
9
17.3
Headache
8
15.4
Facial pain
5
9.6
Radiological findings
Opacification of ethmoid and maxillary sinuses
46
88.5
Soft tissue opacity in the nasal cavity
41
78.9
Soft tissue opacity in the nasopharynx
26
50.0
Dome-shaped soft tissue opacity in the maxillary sinus
12
23.1
Fluid level in the maxillary sinus
6
11.5
Clear paranasal sinuses
4
7.7
Complications
Acute rhinosinusitis
5
9.6
Epiphora
6
11.5
Anosmia
9
17.3
Obstructive sleep apnoea
28
53.8
Some patients have multiple complaints/radiological findings/complications
http://ift.tt/2ocj4yy
Tuberculous Bronchoesophageal Fistula in Nephrotic Syndrome: A Silent Assassin
Abstract
Tuberculosis, a global public health concern, is emerging as an important complication in children with nephrotic syndrome. We report a case of an adolescent with nephrotic syndrome who developed fatal miliary tuberculosis after initiation of steroid therapy, presenting as a bronchoesophageal fistula. The case highlights the importance of maintaining a high index of suspicion prior to starting immunosuppressive therapy in pediatric patients of nephrotic syndrome.
http://ift.tt/2nWg3Qd
Drug-Induced Sleep Endoscopy as a Selection Tool for Surgical Management of Obstructive Sleep Apnoea Syndrome: Our Personal Experience
Abstract
The role of Drug-induced sleep endoscopy as a selection tool for surgical management of obstructive sleep apnoea syndrome. Source of data: Polysomnography proved OSA patients, who are planned for surgery in dept. of ENT AND HEAD& NECK, JSS Hospital, Mysore. Study design: A prospective clinical study. Method: 30 Polysomnography proved OSA patients, age between 20 and 60 years have been selected for Drug Induced Sleep Endoscopy (DISE) after taking informed consent for proposed surgery. Inj propofol infusion given throughout the DISE procedure and upper airway nasal endoscopy performed for assessment of site of collapse (Retropalatal, Retrolingual, Hypopharyngral), type of collapse (circumferential, lateral) and severity of obstruction, Lowest SpO2, apnoeic episodes and DISE findings were recorded. Out of these thirty patients 90% were male and 10% were female, observed that 66.7% of males and 40.7% of females belonged to 31–40 age group, and BMI of 63.3% of patient population were overweight, 20% were obese and 5% were normal. Mean fall in SpO2 was 90.20 ± 2.77 in normal subjects, 83.05 ± 5.14 in overweight subjects and 68.83 ± 9.11 in obese subjects. Normal subjects had 0.4 ± 0.9 apnoeic episodes, overweight subjects had 0.9 ± 1.6 episodes and obese subjects had 4.0 ± 2 apnoeic episodes. We observed that 40% had retropalatal airway collapse, 23.3% had airway obstruction at the base of the tongue, 20% had airway obstruction with floppy epiglottis, 12% multiple level collapse, 6.7% of patient population had grade 4 enlarged tonsils, 3.3% had lateral pharyngeal wall collapse, and 0% hypopharyngeal collapse. Out of 30, 29 Patients underwent surgery (Expansion sphincter pharyngo plasty—14, Hyoid advancement—4, Uuvulopalatoplasty—10, Epiglottic surgery—6, Zeta pharyngoplasty—2, midline glossectomy—3, Endoscopic septoplasty—5, Inferio turbinoplasty—2, LASSER Assisted lingual tonsillectomy—1), All these 29 patient were followed for 3 months, at the end of 3rd month again Each subject was evaluated with a baseline Epworth Sleepiness Scale and LEVEL-3 PSG, the results were impressive with statistically significant. DISE is a dynamic, safe, and easy-to-perform technique that visualizes, the anatomical sites of snoring or apneas for assessment site of collapse (Retropalatal, Retrolingual, Hypopharyngral), type of collapse (Circumferential, Lateral) and severity of obstruction and guides the design of a tailor-made treatment plan for a OSA SURGEON in individual cases, which will improves perioperative outcome.
http://ift.tt/2ocJPTf
Immunohistochemistry evaluation of BMP-2 with β-tricalcium phosphate matrix, polylactic and polyglycolic acid gel, and calcium phosphate cement in rats
Abstract
Purpose
The installation of implants has become a routine procedure in the clinic. However, it takes time and adequate bone thickness, and for that, tissue engineering has made efforts to develop substitutes for autografts, in view of certain disadvantages of this material. The decision to choose the most suitable graft material for each case is an important step in the success of bone reconstruction. This study was to verify, by means of immunohistochemical study, that the addition of bone morphogenetic protein had some influence on biomaterials commercially available, taking into account the formation of mineralized tissue, bone replacement, and the amount of degradation of biomaterials.
Methods
The sample consisted of 72 rats that were divided into eight treatment groups, in which two defects of 5 mm were made in each animal calvaria. Euthanasia was performed at 5, 15, and 30 days postop.
Results
A histologic and histometric analysis was performed to quantitate the area of mineralized tissue formed, the area of newly formed bone, and the area of degradation of the biomaterials. Data were analyzed with multiple comparisons of means by Tukey contrasts, and significant difference was assigned at the level of P < 0.05. The proteins used for immunohistochemical analysis accounted for the process of formation, mineralization, and bone resorption and was performed using ordinal qualitative analysis, where from assigning scores.
Conclusions
Bone morphogenetic protein 2 was shown to be effective as an inducer of bone formation process independent biomaterial used mainly for accelerating the resorption process of the framework.
http://ift.tt/2npQFGt
Proposal for a new bone marker for maxillofacial surgery
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): C.M.S. Fernandes, M.C. Serra, P. Scolozzi
http://ift.tt/2o9Zu49
Review of General Dental Council and General Medical Council “fitness to practise” hearings related to maxillofacial surgery
Publication date: Available online 8 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): R. Taylor, M.H. Ali, T.E. Howe, I. Varley
Dually-registered specialists in oral and maxillofacial surgery (OMFS) may be subject to disciplinary hearings by the General Medical Council (GMC) and the General Dental Council (GDC) for the same allegations, a phenomenon referred to as "double jeopardy" within the specialty. Previous efforts by both councils to simplify regulatory arrangements have made little progress. We have therefore reviewed the range and scope of fitness to practise (FTP) proceedings relevant to OMFS. We searched the online GMC register to find registered OMFS specialists and obtained FTP proceedings from 2004-2016 through a Freedom of Information request from the GDC. We then searched for cases relevant to OMFS, and cross-checked GMC and GDC registers for dual registration before reviewing relevant cases and identifying and discussing themes. Seven OMFS specialists are currently subject to GMC sanctions. A total of 22 GDC hearings related to OMFS, all of which began after 2011. Six involved the practice of OMFS, work within an OMFS department, or work by a dually-registered doctor. While "double jeopardy" is uncommon, it does happen. The cases reviewed raise issues about the remit of the GDC and their understanding of clinical practice in OMFS. We found no evidence of progress in attempts to simplify FTP proceedings. The number of GDC hearings relevant to OMFS is increasing.
http://ift.tt/2nr0DqZ
Evaluation of different treatment protocols for dentin hypersensitivity: an 18-month randomized clinical trial
Abstract
This randomized and longitudinal in vivo study aimed to assess different protocols for the treatment of dentin hypersensitivity with low-power laser (with different doses), high-power laser, and a desensitizing agent, for a period of 12 and 18 months. The lesions from 32 patients (117 lesions), who were submitted to the inclusion and exclusion criteria, were divided into nine groups (n = 13): G1: Gluma Desensitizer (Heraeus Kulzer), G2: low-power laser with low dose (three points of irradiation in vestibular portion and an apical point 30 mW, 10 J/cm2, 9 s per point with the wavelength of 810 nm, with three sessions with an interval of 72 h), G3: low-power laser with high dose (one point in the cervical area, and one apical point 100 mW, 40 J/cm2, 11 s per point with the wavelength of 810 nm in three sessions with an interval of 72 h), G4: low-power laser with low dose + Gluma Desensitizer, G5: low-power laser with high dose + Gluma Desensitizer, G6: Nd:YAG laser (Power Laser™ ST6, Research® in contact 1.0 W, 10 Hz and 100 mJ, ≈85 J/cm2, with the wavelength of 1064 nm), G7: Nd:YAG laser + Gluma Desensitizer, G8: low-power laser with low dose + Nd:YAG laser, and G9: low-power laser with high dose + Nd:YAG laser. The level of sensitivity of each volunteer was assessed by visual analog scale of pain (VAS) with the aid of air from the triple syringe and exploration probe, 12 and 18 months after treatment. All analyses were performed separately for air and probe stimulus. The level of significance was considered for values of p < 0.05. After statistical analysis, all treatments were shown to be effective in reducing dentinal hypersensitivity, and the results were considered not statistically different from those at 12 months. Therefore, until the 18-month evaluation, it could be said that no statistical differences were observed in the sensitivity levels for all treatments.
http://ift.tt/2nOmvrx
Influence of sucrose on growth and sensitivity of Candida albicans alone and in combination with Enterococcus faecalis and Streptococcus mutans to photodynamic therapy
Abstract
This study has evaluated the effects of photodynamic inactivation (PDI) using erythrosine as photosensitizer and green light-emitting diode (LED) on biofilms of Candida albicans alone and in combination with Enterococcus faecalis and Streptococcus mutans. We have also evaluated the effect of sucrose on biofilm formation and bacterial growth and sensitivity to PDI. Biofilms were formed in suspension of 106 cells/ml on plates before being grown in broth culture with and without sucrose and incubated for 48 h. Next, the treatment was applied using erythrosine at a concentration of 400 μM for 5 min and green LED (532 ± 10 nm) for 3 min on biofilms alone and in combination. The plates were washed and sonicated to disperse the biofilms, and serial dilutions were carried and aliquots seeded in Sabouraud agar before incubation for 48 h. Next, the colony-forming units per milliliter (CFU/ml; log10) were counted and analyzed statistically (ANOVA, Tukey test, P ≤ 0.05). Results show that S. mutans favors the growth of C. albicans in biofilms with sucrose, with treatment not being effective. However, when the biofilm was grown without sucrose, we found a reduction in biofilm formation and a significant decrease in the PDI treatment (P < 0.0001). In conclusion, both growth and sensitivity to PDI in biofilms of C. albicans are strongly influenced by bacterial combination, and the presence of sucrose affected directly the growth and sensitivity of the biofilm to PDI as sucrose is the substrate for construction of the exopolysaccharide matrix.
http://ift.tt/2oLmbif
Taking the endochondral route to craniomaxillofacial bone regeneration: A logical approach?
Publication date: Available online 8 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): E.C. Kruijt Spanjer, G.K.P. Bittermann, I.E.M. van Hooijdonk, A.J.W.P. Rosenberg, D. Gawlitta
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. Consequently, attention has shifted towards investigation of the alternative endochondral route of bone regeneration. At a first glance, this approach may not appear logical for maxillofacial bone regeneration as most bones in the faces originate from intramembranous mechanisms. Therefore, the goal of this review is to discuss the sense and non-sense of exploring endochondral bone regeneration as a novel reconstructive option for craniomaxillofacial bone defects. The embryological origin of craniomaxillofacial bone structures and their repair mechanisms are introduced. Also, the potential of MSC-like cells, the neural crest-derived stem cells from craniomaxillofacial sources, are discussed with a focus on regeneration of bone defects. Further, the current status of endochondral bone regeneration from MSCs is highlighted. Together, these aspects contribute in answering whether endochondral bone regeneration can be a logical approach to restore craniomaxillofacial bone defects.
http://ift.tt/2pdusYG
Masseteric Nerve for Gracilis Muscle Re-Innervation in Unilateral Facial Palsy: Impact on Quality of Life
Publication date: Available online 7 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): B. Bianchi, A. Ferri, V. Poddi, M. Bergonzani, G. Pedrazzi, S. Ferrari, E. Sesenna
BackgroundUnilateral 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.MethodsTwenty patients treated for established or congenital unilateral facial palsy reanimated with gracilis muscle transplant reinnervated with masseteric nerve were retrospectively analyzed. The FDI questionnaire on quality of life was administered before and after surgery and statistical analysis of results was conducted to score changes.ResultsOverall results of the questionnaire resulted in a statistically significant improvement after surgery, with a p value of 0.05.ConclusionFacial animation with gracilis muscle transplant re-innervated with masseteric nerve is a safe and reliable procedure in selected unilateral facial palsy patients. Results reported here confirm that surgery mainly improves the functional aspects of a patient's daily life quality, while the impact on social interactions and self-perception is less significant. The comparison of these results with those obtained in patients treated with gracilis muscle transplant re-innervated via contralateral facial nerve suggests that spontaneity is probably highly relevant to improve social aspects of QOL in this subset of patients.
http://ift.tt/2oj5Hgs
Is fine-needle aspiration a reliable tool in the diagnosis of malignant salivary gland tumors?
Publication date: Available online 7 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Francisco Ramírez-Pérez, Raúl González-García, Cristina Hernández-Vila, Florencio Monje-Gil, Luis Ruiz-Laza
http://ift.tt/2pdt20d
The effect of early fusion of the spheno-occipital synchondrosis on midface hypoplasia and obstructive sleep apnea in patients with Crouzon syndrome
Publication date: Available online 8 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Caroline Driessen, Bianca F. Rijken, Priya N. Doerga, Marjolein H. Dremmen, Koen F. Joosten, Irene M. Mathijssen
Introductionhe 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).MethodsA prospective cohort study was performed among patients with Crouzon syndrome to analyze SOS closure, midface hypoplasia represented by the sella-nasion angle (SNA) and OSA.ResultsForty patients were included in whom the OSA-prevalence was 65%. Kaplan Meier analyses suggest a trend towards earlier closure of synchondrosis in patients with OSA (p = 0.066). The mean SNA was 74,7°. There was a positive effect of age on the SNA (p = 0.020). There was no difference in SNA for patients with an open SOS as compared to patients with a closed SOS after correction for age.ConclusionsThe longitudinal data are suggestive of a trend towards earlier fusion of the SOS in patients with Crouzon syndrome and OSA as compared to patients with Crouzon syndrome without OSA. Although the SNA increases with age, our results suggest that this increase in independent closure of the SOS.
http://ift.tt/2oiYKMa
Gingival esthetics and oral health-related quality of life in patients with cleft lip and palate
Publication date: Available online 7 April 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): F. Stelzle, M. Rohde, N. Oetter, K. Krug, M. Riemann, W. Adler, F.W. Neukam, C. Knipfer
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). The patient's OHRQoL was determined using the German short version of the Oral Health Impact Profile questionnaire (OHIP-G14). The results showed a significantly better rating in patients with their own teeth in situ (12.05±1.10) than in patients with implants (6.95±4.78) or prosthetics (4.00±3.58). The best OHRQoL values were achieved by patients with their own teeth integrated into the cleft area (1.32±2.31), followed by patients with implants (2.33±2.33) and prosthetics (3.75±5.87). A significant (P=0.017) correlation was found between OHIP-G14 and CES scores, suggesting an increased OHRQoL in cases with higher oral esthetics in the cleft area. The therapeutic strategy contributes to both gingival esthetics and OHRQoL. The patient's subjective perception of OHRQoL can be attributed to objective gingival esthetic ratings.
http://ift.tt/2nqbK3p
Immunohistochemistry evaluation of BMP-2 with β-tricalcium phosphate matrix, polylactic and polyglycolic acid gel, and calcium phosphate cement in rats
Abstract
Purpose
The installation of implants has become a routine procedure in the clinic. However, it takes time and adequate bone thickness, and for that, tissue engineering has made efforts to develop substitutes for autografts, in view of certain disadvantages of this material. The decision to choose the most suitable graft material for each case is an important step in the success of bone reconstruction. This study was to verify, by means of immunohistochemical study, that the addition of bone morphogenetic protein had some influence on biomaterials commercially available, taking into account the formation of mineralized tissue, bone replacement, and the amount of degradation of biomaterials.
Methods
The sample consisted of 72 rats that were divided into eight treatment groups, in which two defects of 5 mm were made in each animal calvaria. Euthanasia was performed at 5, 15, and 30 days postop.
Results
A histologic and histometric analysis was performed to quantitate the area of mineralized tissue formed, the area of newly formed bone, and the area of degradation of the biomaterials. Data were analyzed with multiple comparisons of means by Tukey contrasts, and significant difference was assigned at the level of P < 0.05. The proteins used for immunohistochemical analysis accounted for the process of formation, mineralization, and bone resorption and was performed using ordinal qualitative analysis, where from assigning scores.
Conclusions
Bone morphogenetic protein 2 was shown to be effective as an inducer of bone formation process independent biomaterial used mainly for accelerating the resorption process of the framework.
http://ift.tt/2npQFGt
Comparison of stroke volume measurement between non-invasive bioreactance and esophageal Doppler in patients undergoing major abdominal–pelvic surgery
Abstract
Purpose
Bioreactance is a non-invasive technology for measuring stroke volume (SV) in the operating room and critical care setting. We evaluated how the NICOM® bioreactance device performed against the CardioQ® esophageal Doppler monitor in patients undergoing major abdominal–pelvic surgery, focusing on the effect of different hemodynamic interventions.
Methods
SVNICOM and SVODM were simultaneously measured intraoperatively, including before and after interventions including fluid challenge, vasopressor boluses, peritoneal gas insufflation/removal, and Trendelenburg/reverse Trendelenburg patient positioning.
Results
A total of 768 values were collected from 21 patients. Pre- and post-intervention measures were recorded on 155 occasions. Bland–Altman analysis revealed a bias of 8.6 ml and poor precision with wide limits of agreement (54 and −37 ml) and a percentage error of 50.6%. No improvement in precision was detected after taking into account repeated measurements for each patient (bias: 8 ml; limits of agreement: 74 and −59 ml). Concordance between changes in SVNICOM and SVODM before and after interventions was also poor: 78.7% (all measures), 82.4% (after vasopressor administration), and 74.3% (after fluid challenge). Using Doppler SV as the reference technique, the area under the receiver operating characteristic curve assessing the ability of the NICOM device to predict fluid responsiveness was 0.81 (0.7–0.9).
Conclusions
In patients undergoing major abdomino-pelvic surgery, SV values obtained by NICOM showed neither clinically or statistically acceptable agreement with those obtained by esophageal Doppler. Although, in the setting of this study, bioreactance technology cannot reliably replace esophageal Doppler monitoring, its accuracy for predicting fluid responsiveness was higher, up to approximately 80%.
Trial registration
Observational study.
http://ift.tt/2npvUue
Occult femoral neck fracture
Description
A 77-year-old woman presented to the emergency department with persistent pain that developed in the right hip after a fall from a standing height. A radiograph and CT of the right hip revealed no evidence of fracture (figure 1A,B), but MRI revealed oedema of the right femoral neck (T1-weighted coronal imaging; figure 1C). She was treated with osteosynthesis (figure 1D) to stabilise the femoral neck fracture, which resulted in a good functional outcome at 6-month follow-up.
Figure 1
(A) A radiograph of the right hip revealed no evidence of fracture. (B) A CT of the right hip revealed no evidence of fracture. (C) MRI (T1-weighted coronal imaging) revealed oedema of the right femoral neck. (D) Patient was treated with osteosynthesis.
Occult femoral neck fractures are frequently misdiagnosed.1 Once misdiagnosed, the non-displaced fracture may become...
http://ift.tt/2oPpl42
Innate immunity in Sjögren's syndrome
Source:Clinical Immunology
Author(s): Jeremy Kiripolsky, Liam G. McCabe, Jill M. Kramer
Sjögren's syndrome (SS) is an autoimmune disease of exocrine tissue that primarily affects women. Although patients typically experience xerostomia and xerophthalmia, numerous systemic disease manifestations are seen. Innate immune hyperactivity is integral to many autoimmune diseases, including SS. Results from SS mouse models suggest that innate immune dysregulation drives disease and this is a seminal event in SS pathogenesis. Findings in SS patients corroborate those in mouse models, as innate immune cells and pathways are dysregulated both in exocrine tissue and in peripheral blood. We will review the role of the innate immune system in SS pathogenesis. We will discuss the etiology of SS with an emphasis on innate immune dysfunction. Moreover, we will review the innate cells that mediate inflammation in SS, the pathways implicated in disease, and the potential mechanisms governing their dysregulation. Finally, we will discuss emerging therapeutic approaches to target dysregulated innate immune signaling in SS.
http://ift.tt/2o8LWWQ
Skin inflammation induced by lupus serum was inhibited in IL-1R deficient mice
Source:Clinical Immunology
Author(s): Xiaoyan Li, Xuanxuan Guo, Huicheng Liu, Gongming Gao, Guangqiong Xu, Xibin Fei, Xiang Fang, Wei Qiao, Guo-Min Deng
Skin inflammation induced by lupus serum is a useful tool to investigate the pathogenesis of lupus skin injury. IL-1 is a proinflammatory cytokine, and its role in lupus skin lesion is still unclear. We determined the role of IL-1 in lupus skin injury by using gene deficient mice. We found that skin inflammation induced by lupus serum was significantly reduced in IL-1R deficient mice and caspase-1 deficient mice. IL-1R deficiency did not affect the expression of FcγRI (CD64), FcγRII (CD32) and MHC class II (CD74) induced by lupus serum. IL-1R deficiency reduced the lipid raft clustering, and decreased expression of MCP-1 and TNFα in monocytes. Keratinocyte proliferation induced by lupus serum was significantly decreased in TNFα deficient mice. Our findings indicate that IL-1 plays an important role in skin lesions of SLE. This study suggests that IL-1 is a therapeutic target in skin lesions of SLE.
http://ift.tt/2oMLbWy
The role of IL-6 and STAT in sleep and neuroinflammation
Source:Clinical Immunology
Author(s): Guilherme L. Fernandes, Paula Araujo, Sergio Tufik, Monica L. Andersen
http://ift.tt/2o8Y2Pp
Hearing thresholds and ventilation tube treatment in children with unilateral cleft lip and palate
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Birgitta Tengroth, Christina Hederstierna, Erik Neovius, Traci Flynn
ObjectiveChildren with cleft lip and palate have a high prevalence of otitis media with effusion (OME) which is often associated with a fluctuating, conductive hearing loss in the low and mid-frequencies and a risk for permanent hearing loss in the higher frequencies. Although common, there is no consensus on the treatment of OME with ventilation tubes. The aim of this study is to document if the risk for permanent hearing loss and acquired cholesteatoma increases due to treatment with ventilation tubes (VT treatments) during childhood in a group of children with cleft lip and palate.MethodsA retrospective medical chart review of 33 children (25 boys and 8 girls) born with unilateral cleft lip and palate (UCLP) was completed. Audiological data (results of hearing sensitivity tests, the total number of hearing tests, and number of VT treatments) were extracted from medical records from when the children were 4–7 and >7–10 years of age.ResultsThe hearing thresholds in the speech frequencies improved with age (p < 0,05) but a minority of the children continued to present with elevated hearing thresholds in the higher frequencies at >7–10 years of age. There were no significant correlations between number of VT treatments and hearing thresholds at >7–10 years. Four of the 33 children presented with complications: two children exhibited perforations of the ear drum (6.1%) and two children developed unilateral cholesteatoma (6.1%).ConclusionIn the current study, the hearing sensitivity of children with cleft lip and palate improved with age. However, this improvement was not seen in the higher frequencies. Twelve percent of the children experienced complications following VT treatments. Due to these complications, it is recommended that all children with cleft palate should have routine follow-ups by an ENT doctor and audiologist. As part of the routine follow-up care, hearing assessments should be performed before and after VT treatments.
http://ift.tt/2pcL5DM
Breast and pleuropulmonary metastasis of multirecurrent scalp dermatofibrosarcoma protuberans: a case report
Dermatofibrosarcoma protuberans is a rare tumor, representing about 0.1% of skin malignant tumors. It is characterized by local aggressiveness with significant potential for recurrence. Although metastasis is ...
http://ift.tt/2o8vMwE
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
Psychological profiles in patients with Symptomatic Reticular forms of Oral Lichen Planus: a prospective cohort study
Abstract
Objectives
To analyze intra, extra-oral symptoms and psychological profiles in symptomatic patients with reticular (R) forms of oral lichen planus (OLP).
Materials and Methods
Thirty symptomatic R-OLP (sR-OLP) patients were compared with an equal number of non-symptomatic R-OLP (nsR-OLP) patients, burning mouth syndrome (BMS) patients and healthy subjects (HS). The Numeric Rating Scale (NRS), the Total Pain Rating Index (T-PRI) and the Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A) were administered. Descriptive statistics, the non-parametric ANOVA procedure by Kruskal-Wallis, the exact Fisher test and the multiple comparison test by the Mann-Whitney U test were performed.
Results
The median and IQR of the HAM-D and HAM-A were 16.0 (11.7-24.0) and 17.5 (13.7-27.2) for the BMS and 13.5 (12.0-15.0) and 15.5 (10.7-18.0) for the sR-OLP patients, 2.0 (2.0-3.2) and 2.0 (2.0-4.0) for the nsR-OLP patients and 3.0 (2.0-4.0) and 3.0 (2.0-4.0) for the HS, respectively. The median and IQR of the NRS and T-PRI were 9.0 (7.7-10.0) and 11.0 (9.0-12.2)for the BMS and 9.0 (7.7-10.0) and 11.5 (7.0-13.0) for the sR-OLP patients, respectively. Comparison analysis between the BMS and sR-OLP patients revealed a not significant difference between the medians of the psychological profile and pain in the two groups (p-value >0.05).
Conclusions
The oral complaints are correlate with anxious and depressive symptoms in sR-OLP patients. Mood disorders could modulate the pain perception or that patients could develop two different associated oral diseases, OLP and BMS.
This article is protected by copyright. All rights reserved.
http://ift.tt/2noUueL
High fractional exhaled nitric oxide and sputum eosinophils are associated with an increased risk of future virus-induced exacerbations -NDASH- a prospective cohort study
Abstract
Background
The major trigger of asthma exacerbations is infection with a respiratory virus, most commonly rhinovirus. Type 2 inflammation is known to be associated with an increased risk of exacerbations in general. Whether type 2 inflammation at baseline increases the risk of future virus-induced exacerbations is unknown.
Objective
To assess whether type 2 inflammation is associated with an increased risk of virus-induced exacerbations of asthma.
Methods
Stable asthmatics had spirometry, skin prick test, measurement of FeNO and sputum induced for differential cell counts. Patients were followed-up for 18-months, during which they were assessed at the research unit when they had symptoms of an exacerbation. Nasal swabs collected at these assessments underwent viral detection by PCR.
Results
A total of 81 asthma patients were recruited, of which 22 (27%) experienced an exacerbation during the follow-up period. Of these, 15 (68%) had a respiratory virus detected at exacerbation. Sputum eosinophils > 1% at baseline increased the risk of having a subsequent virus-induced exacerbation (HR 7.6 95% CI 1.6-35.2, p=0.010), as did having FeNO > 25 ppb (HR 3.4 95% CI 1.1-10.4, p=0.033).
This article is protected by copyright. All rights reserved.
http://ift.tt/2o8DK8P
Cerebral infarction in cervical plexus block
Carotid endarterectomy (CEA) is indicated for the treatment of caroid artery disease [1,2], in which the artery becomes narrow. We have sometimes performed a cervical plexus block (CPB) to achieve the better postoperative analgesia [3]. Cerebral infraction occurred during the procedure of the CPB in this time. Such the case has not been reported until now. In case, a 73-year-old female, with a history of diabetes, underwent a right CEA due to atherosclerosis at the right carotid bifurcation. After a general anesthesia (propofol, fentanyl and rocuronium), we performed a prescan of the CPB.
http://ift.tt/2oMFPdV
Preoperative risk stratification of critically ill patients
Risk assessment historically emphasized cardiac morbidity and mortality in elective, outpatient, non-cardiac surgery. However, critically ill patients increasingly present for therapeutic interventions. Our study investigated the relationship of American Society of Anesthesiologists (ASA) class, revised cardiac risk index (RCRI), and sequential organ failure assessment (SOFA) score with survival to discharge in critically ill patients with respiratory failure.
http://ift.tt/2pcAkkR
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