Delayed right chylothorax after left blunt chest trauma: a case report

Chylothorax is a disease that has various causes such as neoplasm, infection, post-surgery trauma, congenital, and venous thrombosis. In approximately 15% of cases of chylothorax, the exact cause is unknown. W...

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Remarkable response to fluorouracil, leucovorin, oxaliplatin, and irinotecan therapy in urothelial cancer of the renal pelvis: a case report

No standard chemotherapy regimen for advanced urothelial cancer has been established, except for cisplatin-based regimens. We report the case of a patient with double primary cancer, urothelial carcinoma of th...

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Outcome of recurrent and metastatic head and neck squamous cell cancer patients after first line platinum and cetuximab therapy

Publication date: June 2017
Source:Oral Oncology, Volume 69
Author(s): Marco Siano, Gabriele Infante, Carlo Resteghini, Maria Chiara Cau, Salvatore Alfieri, Cristiana Bergamini, Roberta Granata, Rosalba Miceli, Laura Locati, Lisa Licitra, Paolo Bossi
ObjectivesSecond-line chemotherapy in recurrent and/or metastatic head and neck cancer (r/mHNSCC) patients showed dismal results with limited tumor response and reduced life expectancy. Outside of clinical trials, data on efficacy of second line treatment after first line anti-EGFR-AB combination therapy are not available.Material and methodsData regarding r/mHNSCC consecutive pts treated with cetuximab and platinum from 2009 to 2014 at our center were retrospectively collected. The analyses of response, Progression-Free Survival (PFS) and Overall Survival (OS), each evaluated starting from first and second-line treatment, were performed. Survival curves were estimated with the Kaplan-Meier method and compared using the log-rank test.ResultsWe identified 117 patients treated with first-line platinum and cetuximab-based therapy. Sixty-four (55%) patients did not receive second-line treatment due to worsening in performance status, 2 were not assessable for response thus 51 patients were included for analysis. Fifty-six percent were smokers/former smokers and 78% were male. Primary tumor sites were oropharynx (39%), oral cavity (31%), larynx/hypopharynx (24%) and others (6%). Regimens used in second-line were mostly monotherapies. Twenty-one % of the patients were treated within a clinical trial.Response rate (PR, CR) was 6% with 45% showing SD as best response. Median PFS was 2.2months (95%CI:1.5–2.8months) and OS 6.1months (95%CI:3.7–7.2months).ConclusionsWithin our single center experience only half of the patients with r/mHNSCC were able to receive second-line treatment. Response rate was unsatisfactory, but median OS seems higher than previously reported in an anti-EGFR-AB naïve population (Leon 2005).



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IL6 is associated with response to dasatinib and cetuximab: Phase II clinical trial with mechanistic correlatives in cetuximab-resistant head and neck cancer

Publication date: June 2017
Source:Oral Oncology, Volume 69
Author(s): L.P. Stabile, A.M. Egloff, M.K. Gibson, W.E. Gooding, J. Ohr, P. Zhou, N.J. Rothenberger, L. Wang, J.L. Geiger, J.T. Flaherty, J.R. Grandis, J.E. Bauman
ObjectiveSrc family kinase (SFK) activation circumvents epidermal growth factor receptor (EGFR) targeting in head and neck squamous cell carcinoma (HNSCC); dual SFK-EGFR targeting could overcome cetuximab resistance.Patients and methodsWe conducted a Simon two-stage, phase II trial of the SFK inhibitor, dasatinib, and cetuximab in biomarker-unselected patients with cetuximab-resistant, recurrent/metastatic HNSCC. Pre- and post-treatment serum levels of interleukin-6 (IL6) were measured by ELISA. HNSCC cell lines were assessed for viability and effects of IL6 modulation following dasatinib-cetuximab treatment.ResultsIn the first stage, 13 patients were evaluable for response: 7 had progressive and 6 had stable disease (SD). Enrollment was halted for futility, and biomarker analysis initiated. Low serum IL6 levels were associated with SD (raw p=0.028, adjusted p=0.14) and improved overall survival (p=0.010). The IL6 classifier was validated in a separate trial of the same combination, but was unable to segregate survival risk in a clinical trial of cetuximab and bevacizumab suggesting serum IL6 may be specific for the dasatinib-cetuximab combination. Enhanced in vitro HNSCC cell death was observed with dasatinib-cetuximab versus single agent treatment; addition of IL6-containing media abrogated this effect.ConclusionClinical benefit and overall survival from the dasatinib-cetuximab combination were improved among patients with low serum IL6. Preclinical studies support IL6 as a modifier of dasatinib-cetuximab response. In the setting of clinical cetuximab resistance, serum IL6 is a candidate predictive marker specific for combined dasatinib-cetuximab. The trial was modified and redesigned as a biomarker-enriched Phase II study enrolling patients with undetectable IL6.



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Half knowledge is worse than ignorance....... Imperfect understanding is often more dangerous than ignorance

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

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.

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Intraoperative real-time assessment of blood flow using indocyanine green angiography after anastomoses in free-flap reconstructions

Indocyanine green (ICG) is a cyanine dye generally used in liver function tests. It emits near-infrared fluorescence, and can be detected in the body by specific charged-coupled device cameras.1 This technique, called ICG angiography, allows real-time imaging of the bloodstream. In reconstructive surgery ICG angiography can confirm the presence of penetrating vessel branches, particularly in flaps for breast reconstruction, and evaluation of the bloodstream during kidney transplantation.2,3 However, we know of only one report of its use in free flaps in head and neck surgery.

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Potential of autogenous or fresh-frozen allogeneic bone block grafts for bone remodelling: a histological, histometrical, and immunohistochemical analysis in rabbits

Our aim was to compare the wound healing of autogenous bone grafts with that of fresh-frozen allogeneic block bone in rabbits. We used 25 animals. One was killed before the experiment to provide the allogeneic bone, and the remainder were killed at four time points (n=6 in each group). On histometrical analysis there was a significant difference between the two groups only at 45days and between 15 and 45days in the intergroup analysis. However, there was significantly more revascularisation (p<0.05), resorption (p<0.05), and bony replacement (p<0.05) in the autogenous group in the immunohistochemical analysis.

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Airway management includes reporting unsafe practices

"Pre-hospital airway management is a key component of emergency responders and remains an important task of Emergency Medical Service (EMS) systems worldwide." Jacobs & Grabinsky. "Advances in pre-hospital airway management." International Journal of Critical Illness & Injury Science, 2014 Scenario: An EMS crew, which includes a new paramedic, responds to a call of a patient ...

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Nasal mucociliary transportability of male and female smokers

Publication date: Available online 8 April 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Juliana Souza Uzeloto, Dionei Ramos, Ana Paula C.F. Freire, Diego G.D. Christofaro, Ercy M.C. Ramos
IntroductionFemale smoker's present increased susceptibility to several diseases when compared to the opposite gender. However, there are no studies showing differences in nasal mucociliary transport behavior between male and female smokers.ObjectiveTo compare the nasal mucociliary transportability in male and female smokers and non-smokers, taking into consideration age, anthropometric data, smoking load and pulmonary function.MethodsThe analysis included 139 individuals (33 men and 37 women smokers and 32 men and 37 women non-smokers). All participants answered an initial interview to obtain personal data and smoking load. Anthropometric data and carbon monoxide in the exhaled air were assessed. Individuals also performed pulmonary function test and Saccharin Transit Time test (STT). To compare STT values between men and women, smokers and non-smokers, stratification of all independent variables was performed (sociodemographic, smoking and respiratory variables) into two categories: below and above the median values.ResultsThere was no difference between men and women, smokers and non-smokers, regarding nasal mucociliary transportability. Significant differences were only observed between non-smokers. Among those with less forced vital capacity values (<97.37% of predicted), women presented mucociliary transport faster than men. Moreover, it was observed influence of BMI and COex (women smokers), FCV and FEV1 (men non-smokers) and FEF25–75% (women non-smokers) on STT values.ConclusionBased on the findings of this study, nasal mucociliary transport in male and female adult smokers, apparently healthy, are similar.



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Peritonsillar and deep neck infections: a review of 330 cases

Publication date: Available online 9 April 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Paula Martínez Pascual, Paloma Pinacho Martinez, Eviatar Friedlander, Carlos Martin Oviedo, Bartolome Scola Yurrita
IntroductionDeep neck infections (DNI) are defined as suppurative infectious processes of deep visceral spaces of the neck.ObjectiveThe aim of this study is to review different factors that may influence peritonsillar and deep neck Infections (DNI) and may play a role as bad prognosis predictors.MethodsWe present a retrospective study of 330 patients with DNI and peritonsillar infections who were admitted between January 2005 and December 2015 in a tertiary referral hospital. Statistical analysis of comorbidities, diagnostic and therapeutic aspects was performed with Excel and SPSS.ResultsThere has been an increase in incidence of peritonsilar and DNI. Systemic comorbidities such as diabetes or hepatopathy are bad prognosis factors. The most common pathogen was S. viridans (32.1% of positive cultures). 100% of the patients received antibiotics and corticosteroids, 74.24% needed surgical treatment. The most common complications were mediastinitis (1.2%) and airway obstruction (0.9%).ConclusionSystemic comorbidities are bad prognosis predictors. Nowadays mortality has decreased thanks to multidisciplinary attention and improvements in diagnosis and treatment.



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Potential of autogenous or fresh-frozen allogeneic bone block grafts for bone remodelling: a histological, histometrical, and immunohistochemical analysis in rabbits

Publication date: Available online 9 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): E.A. Garbin Junior, V.N. de Lima, G.A.C. Momesso, J.M. Mello-Neto, N.M. Érnica, O. Magro Filho
Our aim was to compare the wound healing of autogenous bone grafts with that of fresh-frozen allogeneic block bone in rabbits. We used 25 animals. One was killed before the experiment to provide the allogeneic bone, and the remainder were killed at four time points (n=6 in each group). On histometrical analysis there was a significant difference between the two groups only at 45days and between 15 and 45days in the intergroup analysis. However, there was significantly more revascularisation (p<0.05), resorption (p<0.05), and bony replacement (p<0.05) in the autogenous group in the immunohistochemical analysis. In later periods, the autogenous bone was replaced by newly-formed bone in all samples, whereas it was always possible to find regions of devitalised bone in the fresh-frozen allogeneic bone grafts. Autogenous grafts were completely replaced whereas, in the fresh- frozen allogeneic grafts, we found acellular tissue that had been incorporated into the receptor bed interface during the later evaluation times.



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Intraoperative real-time assessment of blood flow using indocyanine green angiography after anastomoses in free-flap reconstructions

Publication date: Available online 9 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): T. Eguchi, K. Kawaguchi, A. Basugi, I. Kanai, Y. Hamada




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Designing, implementing and assessing a new formative OSCE for ENT higher surgical trainees: our experience in the North West region

Abstract

Currently Otolaryngology trainees have a six or seven year gap between formal summative assessments, which comprise of the Membership of the Royal College if Surgeons exams (MRCS) during core training and the Fellowship of the Royal Colleges of Surgeons exams (FRCS) at the end of higher surgical training. In between these examinations, trainees undergo formative Work-Place Based Assessments (WPBA) and a summative Annual Review of Competency and Progression (ARCP) however there are no other tests or formal assessments of knowledge and skills to ensure that they are developing and progressing at the required rate.

This article is protected by copyright. All rights reserved.

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Clinical case series describes a contraindication for SerenoCem Granules™ in mastoid obliteration: Our experience in sixty-four patients

Abstract

Mastoid obliteration has been performed with various materials including muscle, fat, cartilage, musculoperiosteal flaps, chips and pâté¹. Biocompatible materials used since the 1960s, have a number of potential advantages over autologous tissue. They are sterile, available off the shelf without the need for harvest and have a low risk of implanting cholesteatoma.

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Thyroid High-Impact Articles

FREE ACCESS through April 21, 2017.
Read now:

Latest Impact Factor: 3.784
The Official Journal of: American Thyroid Association

American Thyroid Association Guidelines on the Management of Thyroid Nodules and Differentiated Thyroid Cancer Task Force Review and Recommendation on the Proposed Renaming of Encapsulated Follicular Variant Papillary Thyroid Carcinoma Without Invasion to Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features
Bryan R. Haugen, Anna M. Sawka, Erik K. Alexander, Keith C. Bible, Patrizio Caturegli, Gerard M. Doherty, Susan J. Mandel, John C. Morris, Aziza Nassar, Furio Pacini, Martin Schlumberger, Kathryn Schuff, Steven I. Sherman, Hilary Somerset, Julie Ann Sosa, David L. Steward, Leonard Wartofsky, Michelle D. Williams

Biochemical Markers Reflecting Thyroid Function in Athyreotic Patients on Levothyroxine Monotherapy
Mitsuru Ito, Akira Miyauchi, Mako Hisakado, Waka Yoshioka, Akane Ide, Takumi Kudo, Eijun Nishihara, Minoru Kihara, Yasuhiro Ito, Kaoru Kobayashi, Akihiro Miya, Shuji Fukata, Mitsushige Nishikawa, Hirotoshi Nakamura, Nobuyuki Amino

Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features Accounts for More Than Half of "Carcinomas" Harboring RAS Mutations
Vera A. Paulson, Priyanka Shivdasani, Trevor E. Angell, Edmund S. Cibas, Jeffrey F. Krane, Neal I. Lindeman, Erik K. Alexander, Justine A. Barletta

Outcome of Large Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features
Bin Xu, Giovanni Tallini, Theresa Scognamiglio, Benjamin R. Roman, R. Michael Tuttle, Ronald A. Ghossein

A Novel Gel Pad Laryngeal Ultrasound for Vocal Cord Evaluation
Jung-Woo Woo, Seo Ki Kim, Inhye Park, Jun Ho Choe, Jung-Han Kim, Jee Soo Kim

 

The post Thyroid High-Impact Articles appeared first on American Thyroid Association.

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Perioperative serum levels of procalcitonin, C-reactive protein, and leukocytes in head and neck free flaps

Publication date: Available online 8 April 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S. Koerdt, N. Rommel, N.H. Rohleder, S. Sandig, G. Frohwitter, T. Steiner, K.D. Wolff, M.R. Kesting
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. A total of 100 patients with microvascular head and neck reconstructions were included in the study. Perioperative serum levels of parameters were measured and the clinical data were analyzed and correlated. A total of 13% of all flaps developed reduced postoperative perfusion. Analysis of the parameters revealed statistically significant differences in the overall patient collective over time, irrespective of clinically reduced flap perfusion. Co-factors such as sex and history of tobacco and alcohol abuse showed significant differences. The efficacy of the parameters in free flap monitoring has not been verified, although the role of procalcitonin in postoperative monitoring, with special regard to the early detection of infections, is underlined by the present study results.



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Current protocols in the management of oral submucous fibrosis: An update

Abstract

Oral Submucous Fibrosis (OSMF) is a debilitating condition of oral cavity which has significant potential for malignant transformation. In spite of over 20 years of research, the pathogenesis of the condition is still obscure and no single management modality is effective. Many OSMF treatment protocols have been proposed to alleviate the signs and symptoms of the disorder and there is overwhelming evidence that since areca nut is primary cause, stopping its use may have a considerable effect on symptoms rather than reversing pre-existing fibrosis. We present a review of the current protocols for managing OSMF.

This article is protected by copyright. All rights reserved.

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Oral submucous fibrosis: an update on current theories of pathogenesis

Abstract

Over the last 40 years, many theories linking oral submucous fibrosis (OSMF) to various risk factors have been proposed. The common Asian habit of repeatedly chronically exposing the oral mucosa with spicy, pungent foods and irritants like supari (areca nut), paan (betel leaves), tobacco (through chewing or smoking) have all been incriminated as causative agents. Systemic factors like nutritional deficiency, genetic predisposition and autoimmunity have also been proposed in the pathogenesis of OSMF. However the precise aetiology of OSMF is still unknown and no conclusive evidence has been found despite many extensive investigations on implicated factors. Most of the ideas proposed have been derived from existing clinical and epidemiological data. We present a comprehensive review of the various theories regarding the pathogenesis of the condition, but have not concentrated on malignant transformation in this article.

This article is protected by copyright. All rights reserved.

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Oral submucous fibrosis: an update on pathophysiology of malignant transformation

Abstract

Oral submucous fibrosis (OSMF) is a potentially malignant condition associated with areca nut chewing. Formerly confined to the Indian subcontinent, it is now often seen in Asian populations of the United Kingdom, USA, and other developed countries, and is therefore a serious problem for global health. What makes it more sinister is the malignant transformation rate, which has been reported to be around 7.6% over a 17-year period. In this concise article, we review the current trends in the pathophysiology of malignant transformation of OSMF.

This article is protected by copyright. All rights reserved.

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Clinical Challenges in the Diagnosis and Treatment of Temporal Bone Osteomyelitis

Temporal bone osteomyelitis is a serious life-threatening condition—a quick and proper diagnosis is needed to start treatment and reduce morbidity and mortality. Changing trends of the disease make a differential diagnosis difficult. To emphasize the importance of a clinical suspicion of this dangerous condition, our experience with three difficult cases is presented. The diagnosis was based on clinical symptoms, otoscopic findings, and findings on computed tomography or magnetic resonance imaging. Neoplasm and granulomatous inflammation were excluded by multiple biopsies. The disease can develop in nondiabetic patients. The disorder might be related to the initial inflammatory process in the middle ear with further direct spreading of infection through defects in the bony walls to deep temporal bone structures. Imaging should be performed early to detect osteolytic lesions of the skull base. Surgery was used for the presence of bone sequestra and infratemporal abscess.

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Factors affecting the quality of life in patients with vitiligo: A nationwide study

Abstract

Background

Little is known about factors affecting the quality of life (QOL) of patients with vitiligo, and previous studies have shown conflicting results.

Objectives

To explore QOL of patients with vitiligo and to identify factors affecting QOL.

Methods

A nationwide questionnaire-based study was conducted with 1123 patients with vitiligo recruited from 21 hospitals in Korea from July, 2015 to June, 2016. Data were collected using a structured questionnaire for demographic information and the Skindex-29 instrument. Mild or severely impaired QOL in patients with vitiligo was assessed according to each arm (symptoms, functioning, and emotions) of the Skindex-29. Multivariate logistic regression analyses were performed to determine the factors associated with QOL.

Results

The enrolled participants consisted of 609 males and 514 females with a mean age of 49.80 years (range, 20–84 years). The median duration of disease was 3.00 years (range, 0–60 years). Using multivariate logistic regression modeling, the involvement of visible body parts and a larger affected body surface area were consistently associated with QOL impairment in all three domains of the Skindex-29. Additionally, the QOL of patients aged 20-59 years, who potentially had a more active social life than older patients, was associated with functional impairment. In addition, a higher educational background was associated with emotional impairment.

Conclusions

The multitude of factors significantly influence the QOL in patients with vitiligo. A better appreciation of these factors would help the management of vitiligo patients.

This article is protected by copyright. All rights reserved.

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Ciclosporin compared to prednisolone therapy for patients with pyoderma gangrenosum: cost-effectiveness analysis of the STOP GAP trial

Summary

Background

Pyoderma gangrenosum (PG) is a painful, ulcerating skin disease with poor evidence for management. Prednisolone and ciclosporin are the most commonly used treatments, although not previously compared within a randomised controlled trial (RCT)

Objectives

To compare the cost-effectiveness of ciclosporin and prednisolone-initiated treatment for patients with PG.

Methods

Quality-of-life (EuroQoL EQ-5D-3L) and resource data were collected as part of the STOP-GAP trial: a multicentre, parallel-group, observer-blind RCT. Within-trial analysis used bivariate regression of costs and QALYs, with multiple imputation of missing data, informing a probabilistic assessment of incremental treatment cost-effectiveness from a health service perspective.

Results

In the base case analysis, when compared with prednisolone, ciclosporin was cost-effective due to a reduction in costs (net cost: -£1160; 95%CI: (-2991 to 672) and improvement in quality of life (net QALYs: 0.055; 95%CI: 0.018 to 0.093). However, this finding appears driven by a minority of patients with large lesions (≥20cm²) (net cost: -£5310; 95%CI: -9729 to -891; net QALYs: 0.077; 95%CI: 0.004 to 0.151). The incremental cost-effectiveness of ciclosporin for the majority of patients with smaller lesions was £23,374/QALY although the estimate is imprecise: the probability of being cost-effective at a willingness to pay of £20,000/QALY was 43%.

Conclusions

Consistent with the clinical findings of the STOP-GAP trial, patients with small lesions should receive treatment guided by the side effect profiles of the drugs and patient preference - neither strategy is clearly a preferred use of NHS resources. However, ciclosporin-initiated treatment may be more cost-effective for patients with large lesions.

This article is protected by copyright. All rights reserved.

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One-stop-shop with confocal microscopy imaging versus standard care for surgical treatment of basal cell carcinoma: an open label, non-inferiority, randomized controlled multicenter trial

Summary

Background

Routine punch biopsies are considered as the standard care to diagnose and subtype basal cell carcinoma (BCC) when clinically suspected.

Objectives

We assessed the efficacy of a one-stop-shop concept using in vivo reflectance confocal microscopy imaging (RCM) as diagnostic tool versus standard care for surgical treatment in patients with clinically suspected BCC.

Methods

In this open-label, parallel-group, non-inferiority, randomized controlled multicenter trial we enrolled patients with clinically suspected BCC at two tertiary referral centers in Amsterdam, the Netherlands. Patients were randomly assigned to the RCM one-stop-shop (diagnosing and subtyping using RCM followed by direct surgical excision) or standard care (planned excision based upon the histological diagnosis and subtype of a punch biopsy). The primary outcome was the proportion of patients with tumour-free margins after surgical excision of BCC.

Results

Of the 95 included patients, 73 (77%) had a BCC histologically confirmed on surgical excision specimen. All (40/40, 100%) in the one-stop-shop group had tumor free margins. In the standard care group tumor free margins were found in all but two (31/33, 94%). The difference in the proportion of patients with tumor-free margins after BCC excision between the one-stop-shop group and the standard care group was -0·06 (90% confidence interval -0·17 to 0·01), establishing non-inferiority

Conclusions

The proposed new treatment strategy seems suitable in facilitating early diagnosis and direct treatment for patients suffering from BCC, depending on factors such as availability of RCM, size and site of the lesion, patient preference and whether direct surgical excision is feasible.

This article is protected by copyright. All rights reserved.

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Clinical and Radiographic Outcomes of Apical Surgery: A Clinical Study

Abstract

Background

Endodontic treatment is usually indicated when teeth with periapical lesions are encountered. However, sometimes root canal treatment results in failure. In that case, one of the treatment choices is retreatment by an orthograde approach. Surgical endodontic therapy is also an alternative to preserve the tooth. Various techniques have been suggested in the literature which has more predictable results. The introduction of modern surgical techniques have enhanced the results of apical surgery procedures. Operating microscopes, magnifying loupes, microinstruments, ultrasonic tips, and biologically acceptable root-end filling materials (such as MTA and SuperEBA) have been introduced to this field with the modern technique, thus the success rates of modern apical surgery has increased significantly.

Objective

The aim of the present study was to evaluate the clinical and radiographic outcomes and periotest values of apical surgery treatment.

Methods

A total of 112 teeth were included. SuperEBA and MTA were used as root-filling materials. The recorded parameters were gender, age, location of the tooth, the presence/absence of a post, coronal restoration of the tooth, previous surgical/nonsurgical treatment of the tooth, the size of periapical lesions, histopathology of periapical lesions, smoking habits. Also the periotest values were recorded.

Results

The overall success rate was 88.4%. With regard to the evaluated variables, only one parameter (tooth type) was found statistically significant. Although the periotest values were decreased after 6 months compared to immediately postoperative measurements, the values were still significantly higher than preoperative measurements.

Conclusion

In this study, apical surgery performed with the modern instruments has significantly successful results with 88.4% success rate.

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Rivaroxaban as an effective alternative to warfarin in a patient with atrial fibrillation, thrombophilia, and left atrial appendage thrombus: a case report

Atrial fibrillation is the most common cardiac arrhythmia. It is responsible for up to 20% of all ischemic strokes. Rate control and anticoagulation are crucial for atrial fibrillation management and stroke pr...

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Nontraumatic Laryngeal Fractures: Report of Two Cases and Review of the Literature

Laryngeal fractures occur mainly in the context of cervical trauma, hanging, or strangulation. Nontraumatic laryngeal fractures are rare and there are few reports in the literature. We present two cases of nontraumatic laryngeal fractures evaluated in our service.

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Background noise lowers the performance of anaesthesiology residents' clinical reasoning when measured by script concordance: A prospective randomised crossover volunteer study.

BACKGROUND: Noise, which is omnipresent in operating rooms and ICUs, may have a negative impact not only patients but also on the concentration of and communication between clinical staff. OBJECTIVE: The present study attempted to evaluate the impact of noise on the performance of anaesthesiology residents' clinical reasoning. Changes in clinical reasoning were measured by script concordance tests (SCTs). DESIGN: This was a prospective, randomised and crossover study. SETTING: Single centre at Rouen University Hospital in April 2014. POPULATION: All year 1 to 4 residents enrolled in the anaesthesiology training programme were included. INTERVENTION: Performance was assessed using a 56-item SCT. Two resident groups were formed, and each was exposed to both quiet and noisy atmospheres during SCT assessment. Group A did the first part of the assessment (28 SCT) in a quiet atmosphere and the second part (28 SCT) in a noisy atmosphere. Group B did the same in reverse order. MAIN OUTCOME MEASURES: The primary outcome of this study was residents' performance as measured by SCT, with and without noise (mean of 100 points 95% confidence interval). RESULTS: Forty-two residents were included. Residents' performance, measured by SCT, was weaker in a noisy environment than in a quiet environment [59.0 (56.0 to 62.0) vs 62.8 (60.8 to 64.9), P = 0.04]. This difference lessened as medical training advanced, as this difference in performance in noisy vs quiet environments was not observed in year 3 and 4 residents [62.9 (59.2 to 66.5) vs 64.0 (61.9 to 66.1), P = 0.60], whereas it was higher for year 1 and 2 residents [54.8 (50.6 to 59.1) vs 61.5 (57.9 to 65.1), P = 0.02]. CONCLUSION: Our study suggests that noise affects clinical reasoning of anaesthesiology residents especially junior residents when measured by SCT. This observation supports the hypothesis that noise should be prevented in operating rooms especially when junior residents are providing care. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/OBJ4xP (C) 2017 European Society of Anaesthesiology

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