Head and Neck Medicine by Alexandros G.Sfakianakis: 04/14/17

Patients diagnosed with Oral Leukoplakia, Oral submucous fibrosis and Oral Lichen Planus attending the Oral Medicine clinic of Panineeya Institute of Dental Sciences & Research Centre, Hyderabad, India were invited to participate. Eighteen interviews and three focus groups were conducted in a non-clinical setting. Voice recordings were transcribed and translated from Telugu to English. Data coding was performed using the NVivo software.

Results

Sample size for this qualitative study comprised 32 patients. Four main themes emerged: (1) difficulties with diagnosis and knowledge about the condition, (2) physical impairment and functional limitations, (3) psychological and social wellbeing and (4) effects of treatment on daily life. In a majority of the patients, most of the interview time was spent discussing physical impairment and functional limitations. Patients also reported their mouth condition having a debilitating effect on their psychological well-being and social interactions.

Conclusions

'Physical impairment and functional limitations' was the most important theme for many of the patients. However, the impacts of OPMD also extended beyond physical impairment and functional limitations to aspects of daily living, notably psychological and social wellbeing.

http://ift.tt/2piZ6Ar

Branchial cleft cyst: An unusual site for the cervical metastasis of nasopharyngeal carcinoma

Publication date: Available online 14 April 2017
Source:Auris Nasus Larynx
Author(s): Yu-Chang Liao, Mohamad Adel, Li-Yu Lee, Kai-Ping Chang
ObjectiveCancers found in the resected branchial cleft cyst are rare clinically but usually impose substantive diagnostic and treatment challenges for clinicians.MethodsA 31-year-old man presented with a lateral neck mass that was suspected to be an inflammatory branchial cleft cyst. After excision, the pathologic specimen revealed a benign cystic appearance with a focus of undifferentiated carcinoma. Serologic tests for Epstein–Barr virus were negative. A positron emission tomography scan and upper aerodigestive tract endoscopies were negative for any other suspicious lesion.ResultsThe patient underwent random biopsies of the nasopharynx, tongue base, and hypopharynx and bil tonsillectomy. Pathologic examination of the nasopharyngeal biopsies showed the presence of undifferentiated carcinoma. The cancerous part of the branchial cleft cyst and this nasopharyngeal specimen were positive for the latent membrane protein-1 and EBV-encoded RNAs of Epstein–Barr virus (EBV) and confirmed our diagnosis.ConclusionThis is the first report of a NPC metastasizing to a branchial cleft cyst. Molecular diagnostic techniques facilitate the definite diagnosis that enabled us to refine treatment plans and offered the patient a favorable outcome.

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Prophylactic dissection of level V in primary mucosal SCC in the clinically N positive neck: A systematic review

Objective

To review the evidence for level V dissection in the management of previously untreated mucosal squamous cell carcinoma (SCC) of the head and neck presenting with nodal metastasis when level V is clinically uninvolved.

Data Source

The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) were used to conduct a systematic review of the current literature, including all English language articles published after 1990. A literature search was performed on November 29, 2015, of Medline, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library.

Review Methods

The search yielded a total of 270 papers. Strict inclusion and exclusion criteria were applied, leaving 20 eligible papers. Overall prevalence was calculated using random effect meta-analysis.

Results

The overall prevalence of level V occult disease in the node (N)-positive neck, irrespective of subsite, was 2.56% (95% confidence interval 1.29–3.84) (2,368 patients and 2,533 necks). The prevalence of occult level V metastasis was up to 7.7% for oral cavity and 8.3% for oropharyngeal tumors. Five studies reported regional recurrence rates over variable time periods. There is exceedingly limited data on outcomes, such as spinal accessory nerve function, quality of life, and perioperative complications.

Conclusion

Mucosal head and neck SCC presenting with nodal metastasis but with level V clinically uninvolved has a low prevalence of occult level V disease. Routine dissection of level V does not appear to be warranted; however, a definitive conclusion is unable to be drawn due to limited data on morbidity and oncological outcomes. Laryngoscope, 2017

http://ift.tt/2ow995o

Risk factors for free flap failure: a retrospective analysis of 881 free flaps for head and neck defect reconstruction

The aim of this study was to identify the risk factors for free flap failure after head and neck reconstructive surgery. The data of 881 consecutive patients who underwent free flap surgery at the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, between January 2013 and November 2016, were reviewed retrospectively. All surgeries were performed by a single head and neck surgical team. Patient demographic and surgical data that may have an influence on free flap outcomes were recorded.

http://ift.tt/2ocYprH

25-Hydroxyvitamin-D3 serum modulation after use of sunbeds compliant with European Union standards: A randomized open observational controlled trial

Regular use of sunbed exposure has been reported to increase 25-hydroxyvitamin-D3 [25(OH)D] serum levels. However, the influence of sunbeds compliant with the recent European Union standard EN-60335-2-27 on 25(OH)D serum levels is unknown.

http://ift.tt/2oIY7f3

Pigmented epithelioid melanocytoma (animal type melanoma): An institutional experience

Pigmented epithelioid melanocytoma (PEM) is an uncommon, recently described entity with unknown biologic behavior. There is a high rate of regional metastases, but limited evidence of distant metastases or disease-related death.

http://ift.tt/2oIP1il

Long-term safety and tolerability of apremilast in patients with psoriasis: Pooled safety analysis for ≥156 weeks from 2 phase 3, randomized, controlled trials (ESTEEM 1 and 2)

Randomized, controlled trials demonstrated efficacy and safety of apremilast for moderate-to-severe plaque psoriasis and psoriatic arthritis.

http://ift.tt/2pgtoH7

The role of cannabinoids in dermatology

Twenty-eight states currently allow for comprehensive public medical cannabis programs, and this number continues to grow.1 Approximately 1 in 10 adult cannabis users in the United States use it for medical purposes.2 Numerous studies have investigated its uses for chronic pain, spasticity, anorexia, and nausea. In recent years, researchers have also investigated its use for the treatment of dermatologic conditions including pruritus, inflammatory skin disease, and skin cancer.

http://ift.tt/2ogkLrq

Inflammatory myopathy associated with myasthenia gravis with and without thymic pathology: Report of four cases and literature review

Publication date: Available online 13 April 2017
Source:Autoimmunity Reviews
Author(s): Ernestina Santos, Ester Coutinho, Ana Martins da Silva, António Marinho, Carlos Vasconcelos, Ricardo Taipa, Manuel Melo Pires, Guilherme Gonçalves, Carlos Lopes, Maria Isabel Leite
Introductionthe association of myasthenia gravis (MG) and inflammatory myopathy is rare and often only one of the diseases is diagnosed. Thymus pathology may be in the origin of such disease association.Methodswe described four patients with both MG and inflammatory myopathy.Resultsthese cases correspond to 2.3% of our MG cohort. Case 1: MG, polymyositis and thymolipoma; case 2: MG and necrotizing myopathy without thymic pathology on a background of scleroderma, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia (CREST); case 3: MG and dermatomyositis without thymic pathology; case 4: MG and dermatomyositis with type C thymoma.Discussionthe recognition of these neuromuscular co-morbidities contributes to (i) understanding their pathogenic mechanisms, (ii) developing better management approaches and (iii) further improving disease outcomes.

http://ift.tt/2pjXx5k

Rituximab for immunologic renal disease: What the nephrologist needs to know

Publication date: Available online 13 April 2017
Source:Autoimmunity Reviews
Author(s): Andreas Kronbichler, Martin Windpessl, Herwig Pieringer, David R.W. Jayne
Rituximab (RTX), a chimeric, monoclonal anti-CD20 antibody, is increasingly used in immune-mediated renal diseases. While licensed in the induction treatment of ANCA-associated vasculitis, it represents one of the most commonly prescribed off-label drugs. Much of the information regarding its safety has been drawn from experience in hematology and rheumatology. Ample evidence illustrates the safety of RTX, however, rare but serious adverse events have emerged that include progressive multifocal leucoencephalopathy and hepatitis B reactivation. Moderate to severe hypogammaglobulinemia and late-onset neutropenia following RTX therapy confer an increased infectious risk and factors predicting these side effects (i.e. a genetic basis) need to be identified. Nephrologists initiating RTX need to bear in mind that long-term risks and optimal dosing for many renal indications remain unclear. Special considerations must be given when RTX is used in women of childbearing age. We summarize practical aspects concerning the use of RTX. This review will provide nephrologists with information to guide their use of RTX alerting them to safety risks and the need for patient counselling.

http://ift.tt/2pglaP8

Targeting synovial neoangiogenesis in rheumatoid arthritis

Publication date: Available online 14 April 2017
Source:Autoimmunity Reviews
Author(s): Agathe Leblond, Yannick Allanore, Jérôme Avouac
In Rheumatoid arthritis (RA), neoangiogenesis is an early and crucial event to promote the development of the hyperplasic proliferative pathologic synovium. Endothelial cells are critical for the formation of new blood vessels since they highly contribute to angiogenesis and vasculogenesis. Current therapies in RA target the inflammatory consequences of autoimmune activation and despite major improvements these last years still refractory patients or incomplete responders may be seen raising the point of the need to identify complementary additive and innovative therapies. This review resumes the mechanisms of synovial neoangiogenesis in RA, including recent insights on the implication of vasculogenesis, and the regulation of synovial neoangiogenesis by angiogenic and inflammatory mediators. In line with the recent development of vascular-targeted therapies used in cancer and beyond, we also discuss possible therapeutic implications in RA, in particular the combination of targeted immunotherapies with anti-angiogenic molecules.

http://ift.tt/2pkf0e1

Laryngeal function-preserving operation for T4a laryngeal cancer with vocal cord paralysis — A case report

For locally advanced laryngeal cancers, the standard treatment of choice is chemoradiotherapy if organ function needs to be conserved. Surgical treatment with larynx preservation is conducted only for limited cases. For locally advanced laryngeal cancers such as those with vocal cord fixation and/or cricoid cartilage destruction, there is no apparent standardized organ-preserving surgery keeping the essential laryngeal functions, viz. the airway, deglutition and articulation, uncompromized.Recently, our surgical team saw a patient with T4a advanced laryngeal cancer with vocal cord fixation who aspired to maintain his laryngeal function.

http://ift.tt/2pk8fbV

Bilateral spontaneous symptomatic temporomandibular joint herniation into the external auditory canal: A case report and literature review

Spontaneous temporomandibular joint (TMJ) herniation is the entity of protrusion of the retrodiscal contents of the TMJ into the external auditory canal (EAC) through a persistent Huschke's foramen. There have been a number of reports of spontaneous TMJ herniation, but there are no reports of bilateral symptomatic TMJ herniation. We report a case of a 70-year-old man who complained of a crunching sound in both ears during mastication. Examination showed bulging from the anterosuperior wall of the EAC on each side when the patient opened his mouth, which pushed the tympanic membrane medially.

http://ift.tt/2pgwpHm

Clinical experiences of Ultrasound-guided transversus thoracic muscle plane block for children

The transversus thoracic muscle plane (TTP) block has been reported to be able to block multiple anterior branches of intercostal nerves (Th2-6) in the internal mammary region [1]. Therefore, there were some publications for clinical setting [2,3,4]. However, there were no papers of TTP block for children. We reported two cases using the TTP block for children. Case 1 was a 7-year-old girl (120cm, 27kg) with no complications who underwent a funnel chest. To provide good perioperative pain management, we recommended her to receive an epidural anesthesia before a general anesthesia.

http://ift.tt/2pggrNu

Internal image anti-idiotypic antibody: A new strategy for the development a new category of prolactin receptor (PRLR) antagonist

Publication date: July 2017
Source:Molecular Immunology, Volume 87
Author(s): Hainan Lan, Pan Hong, Ruonan Li, Suo L, Shan Anshan, Steven Li, Xin Zheng
Over the past decades, a number of prolactin receptor (PRLR) antagonists have been developed, which can be divided into two categories, PRLR analogue and anti-PRLR antibody. However, until now, there have been no commercially available PRLR antagonists. Here, we described a new approach for the preparation of PRLR antagonist, namely internal image anti-idiotypic antibody strategy. The hybridoma technique was used to generate anti-idiotypic antibodies to PRL. Competitive ELISA, competitive receptor-binding analysis and immunofluorescence assay (IFA) were then used to screen and characterize anti-idiotypic antibodies to PRL. One internal image anti-idiotypic antibody, termed MG7, was obtained. A series of experiments demonstrated that MG7 behaved as a typical internal image anti-idiotypic antibody (Ab2β). MG7 exhibited effective antagonistic activity, which not only inhibited PRL binding to PRLR in a dose-dependent manner but also inhibited PRLR-mediated intracellular signalling. Furthermore, MG7 also blocked Nb2 cell proliferation induced by PRL. The current study suggests that MG7 has the potential application in the PRL/PRLR-related studies in future. In addition, this work also suggests that the internal image anti-idiotypic antibody may represent a novel strategy for the development of PRLR antagonist.

http://ift.tt/2pfT6LI

Thyroid Top-Read Articles

FREE ACCESS through April 28, 2017.
Read now:

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

Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis
Spyridoula Maraka, Naykky M. Singh Ospina, Derek T. O'Keeffe, Ana E. Espinosa De Ycaza, Michael R. Gionfriddo, Patricia J. Erwin, Charles C. Coddington III, Marius N. Stan, M. Hassan Murad, Victor M. Montor

Long-Term Outcomes of Patients with Papillary Thyroid Cancer Undergoing Remnant Ablation with 30 milliCuries Radioiodine
Muhammad Mujammami, Michael P. Hier, Richard J. Payne, Louise Rochon, Michael Tamilia

Follicular Variant of Papillary Thyroid Carcinoma: Hybrid or Mixture?
Gilbert H. Daniels

Thyroid Ultrasound Features and Risk of Carcinoma: A Systematic Review and Meta-Analysis of Observational Studies
Luciana Reck Remonti, Caroline Kaercher Kramer, Cristiane Bauermann Leitão, Lana Catani F. Pinto, Jorge Luiz Gross

Incidences of Unfavorable Events in the Management of Low-Risk Papillary Microcarcinoma of the Thyroid by Active Surveillance Versus Immediate Surgery
Hitomi Oda, Akira Miyauchi, Yasuhiro Ito, Kana Yoshioka, Ayako Nakayama, Hisanori Sasai, Hiroo Masuoka, Tomonori Yabuta, Mitsuhiro Fukushima, Takuya Higashiyama, Minoru Kihara, Kaoru Kobayashi, Akihiro Miya

The post Thyroid Top-Read Articles appeared first on American Thyroid Association.

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Pharmacologic Properties of Novel Local Anesthetic Agents in Anesthesia Practice

Publication date: Available online 14 April 2017
Source:Anesthesiology Clinics
Author(s): Chih H. King, Sascha S. Beutler, Alan D. Kaye, Richard D. Urman

Teaser

Therapeutic duration of traditional local anesthetics when used in peripheral nerve blocks is normally limited. This article describes novel approaches to extend the duration of peripheral nerve blocks currently available or in development. Three newer approaches on extending the duration of peripheral nerve blocks include site-1 sodium channel blockers, novel local anesthetics delivery systems, and novel adjuvants of local anesthetics. Compared with plain amide-based and ester-based local anesthetics, alternative approaches show significant promise in decreasing postoperative pain, rescue opioid requirement, hospital length-of-stay, and overall health care cost, without compromising the established safety profile of traditional local anesthetics.

http://ift.tt/2ozb9v3

Ketorolac, Oxymorphone, Tapentadol, and Tramadol

Publication date: Available online 14 April 2017
Source:Anesthesiology Clinics
Author(s): Nalini Vadivelu, Daniel Chang, Erik M. Helander, Gregory J. Bordelon, Alice Kai, Alan D. Kaye, Dora Hsu, Daniel Bang, Inderjeet Julka

Teaser

Pain remains a tremendous burden on patients and for the health care system, with uncontrolled pain being the leading cause of disability in this country. There are a variety of medications that can be used in the treatment of pain, including ketorolac, oxymorphone, tapentadol, and tramadol. Depending on the clinical situation, these drugs can be used as monotherapy or in conjunction with other types of medications in a multimodal approach. A strong appreciation of pharmacologic properties of these agents and potential side effects is warranted for clinicians.

http://ift.tt/2ouP9jn

Pulmonary Vasodilators and Anesthesia Considerations

Publication date: Available online 14 April 2017
Source:Anesthesiology Clinics
Author(s): Jeremy B. Green, Brendon M. Hart, Elyse M. Cornett, Alan D. Kaye, Ali Salehi, Charles J. Fox

Teaser

Pulmonary hypertension (PH) is a complex disease process of the pulmonary vasculature system characterized by elevated pulmonary arterial pressures. Patients with PH are at increased risk for morbidity and mortality, including intraoperatively and postoperatively. Appreciation by the clinical anesthesiologist of the pathophysiology of PH is warranted. Careful and meticulous strategy using appropriate anesthetic medications, pulmonary vasodilator and inotropic agents, and careful fluid management all increase the likelihood of the best possible outcome in this challenging patient population.

http://ift.tt/2ozkHGr

Cardiovascular Pharmacology

Publication date: Available online 14 April 2017
Source:Anesthesiology Clinics
Author(s): Camellia Asgarian, Henry Liu, Alan D. Kaye

Teaser

Cardiovascular disease remains a leading cause of morbidity and mortality worldwide. The development of therapeutic agents for the treatment of cardiovascular diseases has always been a priority because of the huge potential market for these drugs. These medications should be part of the anesthesiologist's armamentarium because the typical surgical patient is older and has more comorbidities than in the past. This article reviews commonly used cardiovascular medications that are important in managing patients with unstable hemodynamics.

http://ift.tt/2ouXMdG

Total Parenteral and Enteral Nutrition in the ICU

Publication date: Available online 14 April 2017
Source:Anesthesiology Clinics
Author(s): Amir O. Elhassan, Lien B. Tran, Richard C. Clarke, Sumit Singh, Alan David Kaye

Teaser

Appropriate nutrition in the hospital setting, particularly in critically ill patients, has long been tied to improving clinical outcomes. During critical illness, inflammatory mediators and cytokines lead to the creation of a catabolic state to facilitate the use of endogenous energy sources to meet increased energy demands. This process results in increasing the likelihood of overfeeding. The literature has revealed exponential advances in understanding the molecular basis of nutritional support and evolution of clinical protocols aimed at treating artificial nutritional support as a therapeutic intervention, preventing loss of lean body mass and metabolic deterioration to improve clinical outcomes in the critically ill.

http://ift.tt/2oz8NwA

New Hypnotic Drug Development and Pharmacologic Considerations for Clinical Anesthesia

Publication date: Available online 14 April 2017
Source:Anesthesiology Clinics
Author(s): Mariah Kincaid Tanious, Sascha S. Beutler, Alan D. Kaye, Richard D. Urman

Teaser

Since the public demonstration of ether as a novel, viable anesthetic for surgery in 1846, the field of anesthesia has continually sought the ideal anesthetic—rapid onset, potent sedation-hypnosis with a high therapeutic ratio of toxic dose to minimally effective dose, predictable clearance to inactive metabolites, and minimal side effects. This article aims to review current progress of novel induction agent development and provide an update on the most promising drugs poised to enter clinical practice. In addition, the authors describe trends in novel agent development, implications for health care costs, and implications for perioperative care.

http://ift.tt/2ouYKa2

Pharmacologic Considerations of Anesthetic Agents in Pediatric Patients

Publication date: Available online 14 April 2017
Source:Anesthesiology Clinics
Author(s): Alan D. Kaye, Charles J. Fox, Ira W. Padnos, Kenny P. Ehrhardt, James H. Diaz, Elyse Cornett, Debbie Chandler, Sudipta Sen, Shilpadevi Patil

Teaser

Acute pain in the pediatric population has important differences in terms of biology, intrapopulation variation, and epidemiology. Discussion as to the pharmacologic considerations of anesthetic agents, such as induction agents, neuromuscular blockers, opioids, local anesthetics, and adjuvant agents, is presented in this article. Special considerations and concerns, such as risk for propofol infusion syndrome and adverse potential side effects of anesthesia agents, are discussed. Anesthesiologists managing pediatric patients need to have a firm understanding of physiologic and pharmacologic differences compared with the adult population. Future studies to improve the understanding of pharmacokinetics in the pediatric population are needed.

http://ift.tt/2oz0pNg

Qualitative analysis of the impact of Oral Potentially Malignant Disorders on daily life activities

by Jyothi Tadakamadla, Santhosh Kumar, Ratilal Lalloo, Newell W. Johnson

Objective

To evaluate the impact of Oral Potentially Malignant Disorders (OPMD) on daily life activities.

Materials and methods

Results

Conclusions

http://ift.tt/2piZ6Ar

Dyadic Yoga Intervention for Patient With Head and Neck Cancer Undergoing Radiotherapy and Their Family Caregivers

Conditions: Malignant Neoplasms of Lip Oral Cavity and Pharynx; Head and Neck Cancer
Interventions: Behavioral: Yoga; Behavioral: Yoga Questionnaire; Behavioral: Symptom Questionnaires
Sponsor: M.D. Anderson Cancer Center
Recruiting - verified April 2017

http://ift.tt/2oytgBr

Trial of Stereotactic HYpofractionateD RadioAblative (HYDRA) Treatment of Laryngeal Cancer

Conditions: Malignant Neoplasms of Respiratory and Intrathoracic Organs; Squamous Cell Carcinoma of the Larynx
Interventions: Radiation: Stereotactic Hypofractionated Radioablation; Behavioral: Questionnaires
Sponsors: M.D. Anderson Cancer Center; Cancer Prevention Research Institute of Texas
Not yet recruiting - verified April 2017

http://ift.tt/2peEpIH

Observational Study of Nivolumab in Patients in Germany With Squamous Cell Carcinoma of the Head and Neck Progressing on or After Platinum-Based Therapy

Condition: Head and Neck Cancer
Intervention: Other: Non-Interventional
Sponsor: Bristol-Myers Squibb
Not yet recruiting - verified April 2017

http://ift.tt/2ouhk26

Pembrolizumab and Induction Chemotherapy in Head and Neck Squamous Cell Carcinoma (PICH Study)

Condition: Head and Neck Squamous Cell Carcinoma (HNSCC)
Interventions: Drug: TPF2; Other: Radiotherapy with carboplatin
Sponsor: Centre Antoine Lacassagne
Not yet recruiting - verified April 2017

http://ift.tt/2pexL5k

A Simple Walking Program to Enhance Concurrent Chemoradiotherapy Delivery

Conditions: Brain Cancer; Head and Neck Cancer; Lung Cancer; Gastrointestinal Cancer; Cervical Cancer
Intervention: Behavioral: Pedometer-based Walking Program
Sponsor: Albert Einstein College of Medicine, Inc.
Recruiting - verified April 2017

http://ift.tt/2of9Eiy

Effects of Nutritional Counseling on Nutritional Status and Quality of Life of Head and Neck Cancer Patients

Condition: Head and Neck Neoplasms
Interventions: Other: intensive nutritional counseling; Other: Standard care
Sponsor: University of Sao Paulo General Hospital
Not yet recruiting - verified March 2017

http://ift.tt/2oyuMDR

Evaluate Efficacy and Safety of IBI308 and Paclitaxel/Irinotecan in Patients With Advanced/Metastatic Esophageal Squamous Cell Carcinoma

Condition: Efficacy and Safety
Interventions: Biological: IBI308; Biological: paclitaxel/ irinotecan
Sponsor: Innovent Biologics (Suzhou) Co. Ltd.
Not yet recruiting - verified April 2017

http://ift.tt/2ou7LA6

Incidence of Venous Thromboembolism in Patients Undergoing Major Esophageal Resection

Conditions: Venous Thromboembolism; Thoracic Surgery; Esophageal Cancer
Intervention:
Sponsor: McMaster University
Not yet recruiting - verified April 2017

http://ift.tt/2of3m2j

The Value of EMDR in the Treatment of Tinnitus

Condition: Tinnitus
Interventions: Other: TRT / EMDR; Behavioral: TRT / CBT
Sponsors: University Hospital, Antwerp; Agentschap voor Innovatie door Wetenschap en Technologie
Recruiting - verified April 2017

http://ift.tt/2oytcSd

Long-term effect of presurgical nasoalveolar molding on growth of maxillary arch in unilateral cleft lip and palate: randomized controlled trial

Publication date: Available online 14 April 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): V. Shetty, R.K. Agrawal, H.F. Sailer
The objective of this study was to investigate the long-term effect of presurgical nasoalveolar molding (PNAM) on growth of the maxillary arch through early childhood until 6 years of age in complete unilateral cleft lip and palate (UCLP) patients presenting for PNAM at different ages. Complete UCLP patients who were treated at our centre were divided into two groups. The study group underwent PNAM and was further subdivided into three subgroups (PNAM initiated within 1 month, between 1 and 6 months, and between 6 and 12 months of age in subgroup I, II, and III, respectively). The control group did not undergo PNAM and was further subdivided into three subgroups. Patients were evaluated at T1 (first visit), T2 (before cheiloplasty), and T3 (at 6 years). Between T1and T2, the intersegment distance (ISD) reduced significantly in the study group but increased in the control group, whereas the intercanine width (ICW) in both the study and control groups did not show significant change. Between T2 and T3, ISD and ICW were reduced significantly in the control group due to arch collapse, whereas in the study group, ISD reduced slightly with ICW remaining almost similar to noncleft norms. We conclude that reduced ISD following PNAM improves arch symmetry and stability, and thus may prevent arch collapse in the long term.

http://ift.tt/2oeT4zh

Treatment outcomes of archwise distraction osteogenesis in mandibular dentoalveolar retrognathia cases

Publication date: Available online 14 April 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): C. Yöndem, Y.B. Acar, B.C. Şener, A.N. Erverdi
The aim of this study was to describe the treatment of class II malocclusion by sagittal advancement of the alveolar bone in the symphyseal area using an intraoral archwise distractor device and to determine the effects of this method on the dentoalveolar complex. Fifteen patients (10 female, five male) aged 16–20 years with a class II division 2 malocclusion, characterized by mandibular dentoalveolar retrusion and a prominent chin, underwent archwise alveolar distraction in the anterior mandible. Lateral cephalometric radiographs were obtained before distraction (T0), after 6 weeks of consolidation (T1), and after debonding (T2). Linear and angular skeletal, dental, and soft tissue measurements were performed. Forty-seven parameters were measured for each of the 15 subjects on pre- and postoperative lateral cephalometric radiographs (T0, T1, and T2). The distraction protocol was successful in all patients. Skeletally, the mandible showed a clockwise rotation. B-point moved forward significantly (P<0.05). Overjet decreased significantly (P<0.001). The total profile angle was unaffected, and the improvement in the submental fold was highly significant (P<0.001). The intraoral archwise distraction force that is applied through brackets and archwires is sufficiently effective for alveolar advancement. This procedure is simple and effective in the treatment of specific adult patients with a class II division 2 malocclusion, characterized by a prominent chin and severe mandibular dentoalveolar retrusion.

http://ift.tt/2p319Mf

Treatment outcomes of archwise distraction osteogenesis in mandibular dentoalveolar retrognathia cases

The aim of this study was to describe the treatment of class II malocclusion by sagittal advancement of the alveolar bone in the symphyseal area using an intraoral archwise distractor device and to determine the effects of this method on the dentoalveolar complex. Fifteen patients (10 female, five male) aged 16–20 years with a class II division 2 malocclusion, characterized by mandibular dentoalveolar retrusion and a prominent chin, underwent archwise alveolar distraction in the anterior mandible.

http://ift.tt/2pdY77v

Long-term effect of presurgical nasoalveolar molding on growth of maxillary arch in unilateral cleft lip and palate: randomized controlled trial

The objective of this study was to investigate the long-term effect of presurgical nasoalveolar molding (PNAM) on growth of the maxillary arch through early childhood until 6 years of age in complete unilateral cleft lip and palate (UCLP) patients presenting for PNAM at different ages. Complete UCLP patients who were treated at our centre were divided into two groups. The study group underwent PNAM and was further subdivided into three subgroups (PNAM initiated within 1 month, between 1 and 6 months, and between 6 and 12 months of age in subgroup I, II, and III, respectively).

http://ift.tt/2otPVwZ

Treatment of post-anesthesia dementia with perispinal etanercept injection and hyperbaric oxygen therapy: a case report

We report on the first case of successful treatment for post-anesthesia dementia with perispinal etanercept injection combined with hyperbaric oxygen therapy.

http://ift.tt/2pdW1EK

Acute symptomatic peri-lead edema 33 hours after deep brain stimulation surgery: a case report

Symptomatic peri-lead edema is a rare complication of deep brain stimulation that has been reported to develop 4 to 120 days postoperatively.

http://ift.tt/2pgCuRb

Branchial cleft cyst: An unusual site for the cervical metastasis of nasopharyngeal carcinoma

Cancers found in the resected branchial cleft cyst are rare clinically but usually impose substantive diagnostic and treatment challenges for clinicians.

http://ift.tt/2pgtM5r

Novel PIK3CD mutations affecting N-terminal residues of p110δ cause APDS1 in humans

Publication date: Available online 13 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Andrew J. Takeda, Yu Zhang, Gillian L. Dornan, Braden D. Siempelkamp, Meredith L. Jenkins, Helen F. Matthews, Joshua J. McElwee, Weimin Bi, Filiz O. Seeborg, Helen C. Su, John E. Burke, Carrie L. Lucas
APDS is a newly described and prevalent primary immunodeficiency disease, and we now expand the list of mutation sites to include E81K and G124D of p110δ and uncover an intramolecular mechanism of activation that is inhibited by clinically relevant targeting of p110δ.

http://ift.tt/2nLOgG4

Mechanistic Correlates of Clinical Responses to Omalizumab in the Setting of Oral Immunotherapy for Milk Allergy

Publication date: Available online 13 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Pamela A. Frischmeyer-Guerrerio, Madhan Masilamani, Wenjuan Gu, Erica Brittain, Robert Wood, Jennifer Kim, Kari Nadeau, Kirsi M. Jarvinen, Alexander Grishin, Robert Lindblad, Hugh A. Sampson
Background: In our recent clinical trial, the addition of omalizumab to oral immunotherapy (OIT) for milk allergy improved safety but no significant clinical benefit was detected.Objective: To investigate mechanisms by which omalizumab modulates immunity in the context of OIT, and to identify baseline biomarkers that predict subgroups of patients most likely to benefit from omalizumab.Methods: Blood was obtained at baseline and multiple time-points during a placebo-controlled trial of OIT for milk allergy where subjects were randomized to receive omalizumab or placebo. Immunologic outcomes included measurement of basophil CD63 expression and histamine release (HR), and casein-specific CD4⁺ T regulatory (Treg) cell proliferation. Biomarkers were analyzed in relationship to measurements of safety and efficacy.Results: Milk-induced basophil CD63 expression was transiently reduced in whole blood samples from both omalizumab and placebo subjects. However, IgE-dependent HR increased in washed cell preparations from omalizumab but not placebo subjects. No increase in Treg frequency was evident in either group. Subjects with lower rates of adverse reactions, regardless of arm, experienced better clinical outcomes. Pre-OIT basophil reactivity positively associated with occurrence of symptoms during OIT, while the baseline milk IgE/total IgE ratio correlated with the likelihood of achieving sustained unresponsiveness (SU). A combination of baseline basophil and serologic biomarkers defined a subset of patients where adjunctive therapy with omalizumab was associated with attainment of SU and a reduction in adverse reactions.Conclusions: Combining omalizumab therapy with milk OIT led to distinct alterations in basophil reactivity but not T cell responses. Baseline biomarkers may identify subjects most likely to benefit from adjunctive therapy with omalizumab.

Teaser

Omalizumab distinctly altered IgE-dependent basophil activation but not Treg development during OIT. Baseline biomarkers may identify subjects likely to experience the greatest benefit from this adjunctive therapy in terms of both safety and efficacy.

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Hypersensitivity transfusion reactions due to IgA deficiency are rare according to French hemovigilance data

Publication date: Available online 13 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Charles Tacquard, Karim Boudjedir, Monique Carlier, Jean-Yves Muller, Philippe Gomis, Paul Michel Mertes
In an analysis of a large French hemovigilance database (2004-2014), hypersensitivity transfusion reactions (HTRs) due to IgA deficiency were extremely rare with an frequency far lower than reported so far. In depth investigation of HTRs for IgA deficiency should be limited to moderate to severe recurrent reactions.

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Systems Approach to Uncover Signaling Networks in Primary Immunodeficiency Diseases

Publication date: Available online 13 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jeff Choi, Rosemary Fernandez, Holden T. Maecker, Manish J. Butte

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Capsule Summary: This broad, unbiased approach of studying signaling across all circulating immune cells in healthy subjects allowed identification of disrupted signaling networks in patients with primary immunodeficiencies.

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Moving towards endotypes in atopic dermatitis: identification of patient clusters based on serum biomarker analysis

Publication date: Available online 13 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Judith Lydia Thijs, Ian Strickland, Catharina Ansfrieda Francisca Maria Bruijnzeel-Koomen, Stefan Nierkens, Barbara Giovannone, Eszter Csomor, Bret Richard Sellman, Tomas Mustelin, Matthew Alexander Sleeman, Marjolein Saskia de Bruin-Weller, Athula Herath, Julia Drylewicz, Richard David May, DirkJan Hijnen
BackgroundAtopic dermatitis (AD) is a complex, chronic, inflammatory skin disease with a diverse clinical presentation. It is however unclear whether this diversity exists at a biological level.ObjectiveTo test the hypothesis that AD is heterogeneous at the biological level of individual inflammatory mediators.MethodsSerum from 193 moderate to severe adult AD patients (geomean (95%CI) SASSAD of 22.3 (21.3, 23.3) and 39.1 (37.5, 40.9) respectively) and 30 non-AD healthy controls was analysed for 147 serum mediators, total IgE and 130 allergen specific IgEs. Population heterogeneity was assessed by principal component analysis (PCA) followed by unsupervised k-means cluster analysis of the principal components.ResultsAD patients showed pronounced evidence of inflammation compared to healthy controls. PCA of AD serum data revealed the presence of four potential AD patient clusters. Fifty-seven principal components (PCs) described approximately 90% of the variance. Unsupervised k-means cluster analysis of the 57 largest PCs delivered 4 distinct clusters of AD patients. Cluster 1 had high SASSAD and BSA with the highest levels of PARC, TIMP-1 and sCD14. Cluster 2 had low SASSAD with the lowest levels of IFN-α, TIMP-1 and VEGF. Cluster 3 had high SASSAD with the lowest levels of IFN-β, IL-1 and epithelial cytokines. Cluster 4 had low SASSAD but highest levels of inflammatory markers: IL-1, IL-4, IL-13 and TSLP.ConclusionAD is a heterogeneous disease both clinically and biologically. Four distinct AD patient clusters have been identified that could represent endotypes with unique biological mechanisms. Elucidation of these endotypes warrants further investigation and will require future intervention trials with specific agents such as biologics.

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Αρχειοθήκη ιστολογίου

Παρασκευή 14 Απριλίου 2017

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