Head and Neck Medicine by Alexandros G.Sfakianakis: 04/20/17

Πέμπτη 20 Απριλίου 2017

US antibiotic stewardship and penicillin allergy.

Purpose of review: The purpose of this review is to improve otolaryngologists' antibiotic stewardship by detailing current approaches to penicillin allergy. Recent findings: Although up to 15% of hospitalized patients in the United States have a penicillin allergy recorded on their charts, fewer than 10% of these have a true penicillin allergy. Summary: Using a combination of a detailed allergy history, skin testing and graded-dose administration, many patients whose charts say 'penicillin-allergic' can safely be treated with penicillin and cross-reacting antibiotics. This permits use of narrower-spectrum antibiotics and saves money. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Steroid Resistance of Airway Type 2 Innate Lymphoid Cells (ILC2s) from Severe Asthma: The Role of Thymic Stromal cell Lymphopoietin (TSLP)

Publication date: Available online 20 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Sucai Liu, Mukesh Verma, Lidia Michalec, Weimin Liu, Anand Sripada, Donald Rollins, James Good, Yoko Ito, HongWei Chu, Magdalena M. Gorska, Richard J. Martin, Rafeul Alam
BackgroundILC2s represent an important type 2 immune cell. Glucocorticoid regulation of human ILC2s is largely unknown.ObjectiveTo assess steroid resistance of human blood and airway ILC2s from asthmatic patients and examine its mechanism of induction.MethodsWe studied human blood and lung ILC2s from asthmatic and control subjects by flow cytometry and ELISA.ResultsDexamethasone (Dex) inhibited (P=0.04) CRTH2 and type 2 cytokine expression by blood ILC2s stimulated with IL25 and IL33. However, it failed to do so when ILC2s were stimulated with IL7 and TSLP, two ligands of IL7Rα. Unlike blood ILC2s, BAL ILC2s from asthmatic patients were resistant to Dex. BAL from the asthmatic patients had elevated TSLP but not IL7. The BAL TSLP level correlated (r=0.74) with steroid resistance of ILC2s. TSLP was synergistically induced in epithelial cells by IL13 and human rhinovirus. Mechanistically, Dex upregulated ILC2 expression of IL7Rα , which augmented and sustained STAT5 signaling by TSLP. TSLP induced MEK, c-Fos, ID3, pSTAT3 and pSTAT5—molecules linked to steroid resistance. Dex inhibited c-Fos, ID3 and pSTAT3, but not pSTAT5 and MEK. The MEK inhibitor Trametinib, the JAK-STAT inhibitor Tofacitinib and the STAT5 inhibitor Pimozide reversed steroid resistance of BAL ILC2s.ConclusionsDex inhibited type 2 cytokine production by blood ILC2s. IL7 and TSLP abrogated this inhibition and induced steroid resistance of ILC2s in a MEK and STAT5-dependent manner. BAL ILC2s from asthmatic patients with elevated TSLP were steroid resistant, which was reversed by clinically available inhibitors of MEK and STAT5.

Teaser

Dexamethasone inhibited CRTH2 and IL5 but promoted IL7Rα expression by ILC2s, which led to the development of steroid resistance This steroid resistance was reversed by MEK and STAT5 inhibitors.

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Type 3 innate lymphoid cells induce proliferation of CD94+ NK cells

Publication date: Available online 20 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Shuo Li, Hideaki Morita, Beate Rückert, tadech boonpiyathad, Avidan Neumann, Cezmi Akdis

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Direct monitoring of basophil degranulation by using avidin-based probes

Publication date: Available online 20 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Régis Joulia, Claire Mailhol, Salvatore Valitutti, Alain Didier, Eric Espinosa

Teaser

We show that fluorescent avidin binds to basophil cell surface upon degranulation and can be used to set up a new basophil activation test (BAT). This new assay provides results comparable to those provided by the CD63 exposure-based BAT, but has the advantage to directly monitor granule exteriorization.

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Asthma: the past, the future, the environment, and the costs

Publication date: Available online 20 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Eyal Shemesh, Lawrence C. Kleinman

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Vitamin D downregulates the IL-23 receptor pathway in human mucosal ILC3

Publication date: Available online 20 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Viktoria Konya, Paulo Czarnewski, Marianne Forkel, Anna Rao, Efthymia Kokkinou, Eduardo J. Villablanca, Sven Almer, Ulrik Lindforss, Danielle Friberg, Charlotte Höög, Peter Bergman, Jenny Mjösberg
BackgroundVitamin D deficiency is a risk factor for inflammatory bowel disease (IBD). The IL-23-driven tissue-resident ILC3 play essential roles in intestinal immunity, and targeting IL-23/12 is a promising approach in IBD therapy.ObjectiveWe set out to define the role of 1α,25-dihydroxy vitamin D3 (1,25D) in regulating functional responses of human mucosal ILC3 to IL-23 plus IL-1β stimulation.MethodsTranscriptomes of sorted tonsil ILC3 were assessed by microarray analysis. ILC3 cytokine production, proliferation and differentiation were determined by flow cytometry, ELISA and multiplex immunoassay. Intestinal cell suspensions and ILC3 sorted from gut biopsies of IBD patients were also analyzed along with plasma 25-hydroxy vitamin D3 (25D) detection.ResultsILC3 stimulated with IL-23 plus IL-1β upregulated the vitamin D receptor (VDR) and responded to 1,25D with downregulation of the IL-23 receptor (IL-23R) pathway. Consequently, 1,25D suppressed the IL-22, IL-17F and GM-CSF production from tonsil and gut ILC3. In parallel, 1,25D upregulated genes linked to the IL-1β signaling pathway as well as the IL-1β-inducible cytokines IL-6, IL-8 and MIP-1α/β. The 1,25D-triggered skewing in ILC3 function was not accompanied or caused by changes in viability, proliferation or phenotype. Finally, we confirmed low 25D plasma levels in IBD patients with active inflammation.ConclusionIn the light of the beneficial targeting of IL-23/12 in IBD, 1,25D appears as an interesting therapeutic agent that inhibits the IL-23R pathway, providing a novel mechanism for how ILC3 could be manipulated to regulate intestinal inflammation.

Teaser

We have unraveled the detailed mechanisms behind how vitamin D efficiently suppresses IL-23 receptor signaling in gut innate lymphoid cells, providing incitement for vitamin D supplementation as a therapeutic approach in IBD.

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Allergens involved in the cross-reactivity of Aedes aegypti with other arthropods

Publication date: Available online 20 April 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Jose Fernando Cantillo, Leonardo Puerta, Sylvie Lafosse-Marin, Jose Luis Subiza, Luis Caraballo, Enrique Fernandez-Caldas
BackgroundCross-reactivity between Aedes aegypti and mites, cockroaches, and shrimp has been previously suggested, but the involved molecular components have not been fully described.ObjectiveTo evaluate the cross-reactivity between A aegypti and other arthropods.MethodsThirty-four serum samples from patients with asthma and/or allergic rhinitis were selected, and specific IgE to A aegypti, Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis, Periplaneta americana. and Litopenaeus vannamei was measured by enzyme-linked immunosorbent assay. Cross-reactivity was investigated using pooled serum samples from allergic patients, allergenic extracts, and the recombinant tropomyosins (Aed a 10.0201, Der p 10, Blo t 10, Lit v 1, and Per a 7). Four IgE reactive bands were further characterized by matrix-assisted laser desorption/ionization tandem time of flight.ResultsFrequency of positive IgE reactivity was 82.35% to at least one mite species, 64.7% to A aegypti, 29.4% to P americana, and 23.5% to L vannamei. The highest IgE cross-reactivity was seen between A aegypti and D pteronyssinus (96.6%) followed by L vannamei (95.4%), B tropicalis (84.4%), and P americana (75.4%). Recombinant tropomyosins from mites, cockroach, or shrimp inhibited the IgE reactivity to the mosquito at a lower extent than the extracts from these arthropods. Several bands of A aegypti cross-reacted with arthropod extracts, and 4 of them were identified as odorant binding protein, mitochondrial cytochrome C, peptidyl-prolyl cis-trans isomerase, and protein with hypothetical magnesium ion binding function.ConclusionWe identified 4 novel cross-reactive allergens in A aegypti allergenic extract. These molecules could influence the manifestation of allergy to environmental allergens in the tropics.

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An Innovative Cooling Jacket to Combat Heat Intolerance in Children with Anhidrosis

Abstract

Hyperthermia and heat intolerance are distressing symptoms in patients with anhidrosis. Body cooling devices are an integral part of management of these patients. A cooling jacket made from easily available materials has been invented for a girl with congenital insensitivity to pain and anhidrosis with severe heat intolerance. This innovative cooling jacket may be helpful for anhidrotic children in resource-poor situations.

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Management of a case of myopic foveoschisis with phakic intraocular lens (pIOL) in situ: intraoperative challenges

We describe the case of a 30-year-old man with pathological myopia with a phakic intraocular lens (IOL) (Visian ICL V4c model; STAAR, Monrovia, California, USA) in situ having complaints of metamorphopsia in the left eye with documented myopic foveoschisis on swept-source optical coherence tomography (DRI OCT Triton; Topcon, Tokyo, Japan). The patient underwent pars plana vitrectomy with internal limiting membrane peeling. This report discusses the intraoperative challenges occurring as a result of increased optical aberrations in the presence of a phakic IOL.

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Exogenous Cushing's syndrome due to a Chinese herbalists prescription of ointment containing dexamethasone

Eczema in children is a chronic disabling condition. The impact of this condition on the lives of families is often underestimated by conventional physicians. As a consequence parents may investigate complementary treatment options. Close monitoring by a paediatrician is essential, considering that a variety of adverse effects can occur during the use of complementary treatment. We present a 5-year-old girl with eczema. She visited a Chinese herbalist who prescribed an ointment. The parents noticed that the eczema resolved fast, itching decreased and she was finally sleeping well. However, her behaviour changed and appetite increased. Undetectable levels of serum cortisol were found, which was indicative of exogenous Cushing's syndrome. Analysis of the ointment revealed the presence of dexamethasone. Hydrocortisone substitution and subsequently a reduction schedule were implemented, after which endogenous cortisol production recovered after 4 months. Physicians should be aware that unregistered herbal medicine can contain potent drugs such as glucocorticoids.

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Sir Charles Bell: Unheralded laryngologist

Sir Charles Bell is renowned and revered as an outstanding surgeon, anatomist, clinician and teacher and his many contributions to various medical fields have been amply described. What are less well-known are his contributions to the field of laryngology.

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Primary mucosal melanoma of the palatine tonsil: Report of a case and review of the literature

Mucosal melanoma of the palatine tonsil is extremely rare. Due to its poor prognosis, primary tonsillar melanoma requires prompt recognition and treatment.

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A Novel Recombinant Canine Adenovirus Type 1 Detected from Acute Lethal Cases of Infectious Canine Hepatitis

Viral Immunology , Vol. 0, No. 0.

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Brodie abscess of the femoral capital epiphysis in a 2-year-old child caused by Kingella kingae

We report the case of a Brodie abscess of the femoral capital epiphysis from which Kingella kingae was isolated. This is to the best of our knowledge the first report of a Brodie abscess of the femoral capital epiphysis from which K. kingae was isolated.

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Delayed LGI1 seropositivity in voltage-gated potassium channel (VGKC)-complex antibody limbic encephalitis

We utilise a clinical case to highlight why exclusion of voltage-gated potassium channel (VGKC)-complex autoantibody testing in serological evaluation of patients may delay or miss the diagnosis. A 68-year-old man presented with increasing involuntary movements consistent with faciobrachial dystonic seizures (FBDS). Initial evaluation demonstrated VGKC antibody seropositivity with leucine-rich glioma-inactivated 1 (LGI1) and contactin-associated protein-like 2 (CASPR2) seronegativity. Aggressive immunotherapy with methylprednisolone and plasmapheresis was started early in the course of his presentation. Following treatment with immunotherapy, the patient demonstrated clinical improvement. Repeat serum evaluation 4 months posthospitalisation remained seropositive for VGKC-complex antibodies, with development of LGI1 autoantibody seropositivity. VGKC-complex and LGI1 antibodies remained positive 12 months posthospitalisation. Our findings suggest that clinical symptoms can predate the detection of the antibody. We conclude that when suspicion for autoimmune encephalitis is high in the setting of VGKC autoantibody positivity, regardless of LGI1 or CASPR2 seropositivity, early immunotherapy and repeat testing should be considered.

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Syndrome of inappropriate antidiuretic hormone accompanied by bilateral hypothalamic and anterior thalamic lesions with serum antiaquaporin 4 antibody

We described a rare case of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and severe unconsciousness accompanied by bilateral hypothalamic and anterior thalamic lesions with positive serum antiaquaporin 4 (AQP4) antibody. A 29-year-old man was admitted to our hospital due to the subacute progression of an unconscious state. He was observed to be hyponatraemic secondary to SIADH. Brain MRI showed bilateral hypothalamic and anterior thalamic lesions. Anti-AQP4 antibody was detected in his serum. After the administration of intravenous methylprednisolone pulse therapy, his symptoms improved with complete recovery from SIADH and regression of the hypothalamic and anterior thalamic lesions. The patient was transferred to another hospital for rehabilitation with 20 mg/day of oral prednisolone 127 days after admission. This case highlights the importance of testing for anti-AQP4 antibody in patients with unexplainable SIADH, subacute progressive unconsciousness and bilateral hypothalamic and anterior thalamic lesions.

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Transoesophageal three-dimensional echocardiographic diagnosis of Barlows disease

Description

A 67-year-old man with a year history of palpitations and dyspnoea presented to the physician's office. His blood pressure was 140/80 mm Hg and pulse was 80 beats/min. Heart auscultation revealed a loud systolic click followed by a holosystolic murmur. The ECG showed sinus rhythm, P wave +/– in V1 and P wave duration 140 ms in DII. The Holter monitoring showed atrial extrasystoles and an episode of atrial tachycardia (figure 1A).

Figure 1

(A) The Holter monitoring showed atrial extrasystoles and an episode of atrial tachycardia. (B) M-mode echocardiogram showed late systolic sagging of the mitral valve. (C) Transoesophageal echocardiogram showed clearly the prolapsing mitral leaflets and severe mitral regurgitation. (D,E) Three-dimensional echocardiographic imaging demonstrated bileaflet prolapse. Mitral model showed prolapse of the P1, P2, P3 and A1, A2, A3.

The transthoracic echocardiogram M-mode showed late systolic sagging of the mitral...

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Chronic Candidiasis in Children

Abstract

Purpose of Review

Healthy children may develop candidal infections as the result of exposure to antibiotics or corticosteroids, but chronic candidiasis in children after the newborn period is unusual. Chronic mucocutaneous candidiasis (CMC) refers to a group of conditions characterized by recurrent or persistent infections with Candida species, particularly Candida albicans. CMC is a phenotype observed in a spectrum of immunologic disorders, some with endocrinologic and autoimmune features.

Recent Findings

CMC can arise secondary to inherited or acquired T cell deficiencies, but in children is largely due to inborn errors impairing the dectin pathway and IL-17 immunity. We review the current understanding of the pathogenesis of chronic mucocutaneous candidiasis and discuss the immunologic pathways by which the immune system handles Candida. We highlight the historical and recent knowledge of CMC in children, emphasizing recent insights into basic science aspects of the dectin pathway, IL-17 signaling, consequences of AIRE gene defects, and clinical aspects of inheritance, and features that distinguish the different syndromes.

Summary

The clinical phenotype of CMC has many underlying genetic causes. Genetic testing is required for definitive diagnosis.

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Emerging Approaches to Food Desensitization in Children

Abstract

Purpose of Review

The purpose of this review is to highlight the recent advances in food desensitization in children with food allergy.

Recent Findings

Recent advancements in epicutaneous, sublingual, and oral immunotherapy for food allergy in the future may offer children with food allergy and their families a viable option to reduce risk or severity of anaphylaxis with phase III trials ongoing for two of these treatment modalities.

Summary

Food allergy prevalence in children is estimated to be up to 8%. These children are at risk of significant allergic reactions and anaphylaxis. Food avoidance and use of antihistamines or epinephrine has been the standard of care for these patients. This approach also has a significant socioeconomic effects on patients and their families. Recent advancements in understanding food allergy have allowed for exploring new methods of treatment. There is an increasing interest in oral immunotherapy, epicutaneous immunotherapy, or sublingual immunotherapy for food allergy. There have been also innovative approaches to immunotherapy by modification of food allergens (to make them less allergenic while maintain their immunogenicity) or adding adjunctive treatments (probiotics, anti-IgE, etc.) to increase efficacy or safety.

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In response to stomal maturation does not increase the rate of tracheocutaneous fistulas

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Effect of non-coherent infrared light (LED, λ 945 ± 20 nm) on bone repair in diabetic rats—morphometric and spectral analyses

Abstract

Phototherapy using coherent light (lasers) and non-coherent light (light-emitting diodes (LEDs)) has been investigated for the purpose of biomodulation in biological tissues. Several effects can be expected, including pain moderation, biostimulation of cellular tropism, anti-inflammatory effects, regular circulatory stimulation, and tissue repair. The aim of this study was to evaluate the effect of LED (λ945 ± 20 nm, 48 mW) therapy on the regeneration process in femoral lesions of rats (Wistar). Seven irradiation sessions were held, with a 48-h interval between sessions. The animals were euthanised 14, 21, and 28 days after surgery. Bone samples were analysed by histomorphometry, micro X-ray fluorescence spectroscopy, scanning electron microscopy, and optical densitometry. The results demonstrated the effective positive influence of low-intensity LED therapy using the near-infrared region on the tissue repair process in diabetic animals, especially in the early stages of repair (14 and 21 days after surgery). It can be concluded that LED therapy positively influences bone formation in the early stages of the bone repair process in non-diabetic and diabetic animals, without causing changes in the optical density and volume of tissue in the final stages. No influence of LED therapy was observed on the percentage of calcium, percentage of phosphorus, Ca/P ratio, or optical mineral density in non-diabetic animals. However, increased mineral concentration was evident in the diabetic animals treated with the LED during the repair process.

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Photoinactivation effect of eosin methylene blue and chlorophyllin sodium-copper against Staphylococcus aureus and Escherichia coli

Abstract

The use of eosin methylene blue according to Giemsa as photosensitizer is presented for the first time in this paper. The present study evaluated the potential application of chlorophyllin sodium copper salt (CuChlNa) and eosin methylene blue according to Giemsa (EMB) as antimicrobial photosensitizers (aPS) for photodynamic inactivation (PDI) of Staphylococcus aureus (gram-positive) and Escherichia coli (gram-negative) bacteria. The experiments were performed using S. aureus stain ATCC 25923 and E. coli ATCC 25922 in which five aPS concentrations (0.0, 1.0, 2.5, 5.0, 10.0, and 20.0 μM for S. aureus and 0.0, 5.0, 10.0, 20.0, 40.0, and 50.0 μM for E. coli) were prepared and added in 2 mL of a saline solution containing the bacterial inoculum. After aPS incubation, the samples were divided into two groups, one kept in the dark and another submitted to the illumination. Then, the bacterial inactivation was determined 18 h after the incubation at 37 °C by counting the colony-forming units (CFU). The results revealed that both EMB and CuChlNa can be used as aPS for the photoinactivation of S. aureus, while only EMB was able to photoinactivate E. coli. Nevertheless, a more complex experimental setup was needed for photoinactivation of E. coli. The data showed that EMB and CuChlNa presented similar photoinactivation effects on S. aureus, in which bacterial growth was completely inhibited at photosensitizer (PS) concentrations over 5 μM, when samples were previously incubated for 30 min and irradiated by a light dose of 30 J cm⁻² as a result of an illumination of 1 h at 8.3 mW cm⁻² by using a red light at 625 nm with a 1 cm beam diameter and output power of 6.5 mW. In the case of E. coli, bacterial growth was completely inhibited only when combining a PS incubation period of 120 min with concentrations over 20 μM.

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Melanogenesis inhibition in mice using a low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser: a pilot study

Abstract

A low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser, or laser toning, has yielded favorable outcomes in various benign pigmented disorders. However, the exact mechanism of action of laser toning has not been fully elucidated. We sought to determine the inhibitory effect of laser toning on melanogenesis and to assess how laser passes influence the outcomes. To produce perceptible pigmentation, nine HRM-2 melanin-possessing hairless mice were treated with ultraviolet (UV) B radiation on the dorsal skin. This was followed by zero, two, four, or six passes of laser toning twice in 2 weeks on each designated quadrant. The spectrophotometric values and pigmentation-related protein expressions were measured. Pigment changes were found in the mice skin using the Fontana-Masson stain for histopathological analysis. Four- and six-pass laser toning significantly improved the lightness compared to that in the unirradiated control (p < 0.002). The Fontana-Masson stain showed that melanin was considerably decreased in laser-irradiated skin. As the number of laser passes increased, the expression of tyrosinase decreased (p < 0.008). The following parameters also decreased in proportion to the number of laser passes: MITF, TRP-1, TRP-2, p-ERK, and p-Akt. In contrast, TGF-β increased in proportion to the number of laser passes. However, the changes in these six proteins were not statistically significant. Our study demonstrates that laser toning improves skin pigmentation with increased number of passes in a dose-dependent manner. This effect is mediated by tyrosinase inhibition.

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Allergens involved in the cross-reactivity of Aedes aegypti with other arthropods

Cross-reactivity between Aedes aegypti and mites, cockroaches, and shrimp has been previously suggested, but the involved molecular components have not been fully described.

http://ift.tt/2orPjXV

US antibiotic stewardship and penicillin allergy.

MuPeXI: prediction of neo-epitopes from tumor sequencing data

Abstract

Personalization of immunotherapies such as cancer vaccines and adoptive T cell therapy depends on identification of patient-specific neo-epitopes that can be specifically targeted. MuPeXI, the mutant peptide extractor and informer, is a program to identify tumor-specific peptides and assess their potential to be neo-epitopes. The program input is a file with somatic mutation calls, a list of HLA types, and optionally a gene expression profile. The output is a table with all tumor-specific peptides derived from nucleotide substitutions, insertions, and deletions, along with comprehensive annotation, including HLA binding and similarity to normal peptides. The peptides are sorted according to a priority score which is intended to roughly predict immunogenicity. We applied MuPeXI to three tumors for which predicted MHC-binding peptides had been screened for T cell reactivity, and found that MuPeXI was able to prioritize immunogenic peptides with an area under the curve of 0.63. Compared to other available tools, MuPeXI provides more information and is easier to use. MuPeXI is available as stand-alone software and as a web server at http://ift.tt/2pIfAoY.

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Evaluation of tinnitus retraining therapy for patients with normal audiograms versus patients with hearing loss

A few chronic tinnitus patients show normal hearing thresholds in the pure tone audiometry from 125Hz to 8000Hz (≤20dB). We report the characteristics of the course of those patients underwent tinnitus retraining therapy (TRT) compared with other patients suffering from chronic and severe tinnitus.

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Upper airway changes after mandibular setback and/or advancement genioplasty in obese patients

Publication date: Available online 19 April 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Wen Du, Dongming He, Yiyao Wang, Hanghang Liu, Chuhang Liao, Wei Fei, En Luo
PurposeOrthognathic surgery, such as bilateral sagittal split ramus osteotomies (BSSRO), genioplasties, etc., could influence the pharyngeal airway space (PAS) and this proposition has been supported by former studies. The purpose of this study is to assess changes of PAS in body mass index (BMI) excessive patients likely to have narrow airways, before and after BSSRO setback and/or advancement genioplasty surgery by three-dimension CT scanning.Patients and MethodsThirty-five BMI excessive adult patients (BMI≥ 24.0) were treated from 2010 to 2016. Samples were grouped as follows: mandibular setback group (Group A) (n=11), advancement genioplasty group (Group B) (n = 12), and mandibular setback + advancement genioplasty group (Group C) (n = 12). CT-scans were taken 1 week preoperatively (T0), 1 week postoperatively (T1), and at least 1 year postoperatively (T2). The area of PNS-posterior plane (PPA), soft-palate plane (SPA), the most posterior point of tongue base plane (PTA), and the root of epiglottis plane (EA); and the volume of palatopharyngeal part (VP), oropharyngeal part (VO), glossopharyngeal part (VG), and laryngeal part (VL) were measured and compared intra-group with analysis of variance. P value was set at .05.ResultsIn Group A, all results showed statistically significant differences (P<0.05) except VO, VG, VL, SPA, PTA, and EA between T0 and T2. In Group B, VO, VG, VL, SPA, PTA, and EA showed statistically significant increases (P<0.05) between T0 and T2. The hyoid in T2 had a significant advancement compared to T0 (P<0.05). In Group C, there were statistically significant decreases (P<0.05) for VG, VL, PTA, and EA between T0 and T1.ConclusionAmong BMI excessive individuals, the mandibular BSSRO setback may postoperatively decrease the PAS, while an advancement genioplasty may enlarge the PAS after surgery. Therefore, receiving advancement genioplasty concurrently during a BSSRO setback mandibular surgery may help in reducing the negative effects of a PAS decrease.

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Does adjunctive botulinum toxin A reduce pain scores when combined with TMJ arthroscopy for the treatment of concomitant TMJ arthralgia and myofascial pain?

Publication date: Available online 19 April 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Nick Thomas, Sharon Aronovich
IntroductionCurrently, there is no standard of care for the treatment of refractory myofascial pain and concomitant TMJ arthralgia. This comparative study was conducted to determine the effectiveness of botulinum toxin A, as an adjunct to TMJ arthroscopy, in this patient population.Materials & MethodsWe performed a retrospective cohort study of patients who underwent TMJ arthroscopy with (Btx group) or without (control group) intra-muscular botulinum toxin A for TMJ arthritis and refractory myofascial pain at the University of Michigan between 2011 and 2014. For patients in the Btx group, intra-muscular injections of botulinum toxin A were administered at sites of maximal tenderness within the masseter and temporalis muscles. The primary outcome variable was pain score on VAS (0-10). The secondary outcome variables included maximal interincisal opening (MIO), total score for sites of tenderness, total number of tender sites, and diet consistency tolerated. Statistical analysis included means and standard deviations, a student t-test, a simple regression analysis, and multiple regression analysis.ResultsOur study cohort included 52 patients (30 Btx, 22 Control), of which 48 (92.3%) were females. The mean follow-up was 5.56±1.41 months. Patients in the Btx group had a significantly greater reduction in the mean pain score (p=0.04) on VAS compared to the control group (Btx 3.24 vs Control 1.13). On multivariate regression analysis, treatment with Btx trended towards significance (p=0.084) and the pre-operative pain score (p=0.0007) was significantly correlated with the change in pain observed.ConclusionThe use of botulinum toxin A appears to correlate with a clinically superior reduction in pain score compared to the control group. The use of botulinum toxin A may be useful as an adjunctive treatment modality in the management of refractory myofascial pain.

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JAMA Otolaryngology–Head & Neck Surgery Peer Reviewers in 2016

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Unilateral Neck Swelling in a Pediatric Patient

A young child had persistent unilateral neck swelling; examination revealed a firm, immobile, and nontender mass fixed to the underlying right mandible with cortical destruction, extending into the submandibular and sublingual spaces. What is your diagnosis?

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March 2017 Issue Highlights

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Association Between Laryngeal Cancer and Asbestos Exposure

This systematic review assesses the literature to determine whether an association exists between laryngeal cancer and asbestos exposure.

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Lymph Node Biopsy in Patients With Papillary Thyroid Cancer

To the Editor Recently Cabrera et al published a prospective study on 37 patients with papillary thyroid cancer (PTC) who underwent radioguided sentinel lymph node biopsy (SLNB), aimed to correlate the presence of lymph node metastasis with patient and tumor characteristics. The authors stated that this is the first study in which that evaluation has been performed. However, in the largest prospective study of 345 patients with PTC who underwent SLNB with 3-year follow-up, we have already demonstrated that the presence of multifocal or infiltrating PTC was associated with increased nodal metastases.

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The Changing Cochlear Implant Center

This Viewpoint summarizes the origins, challenges, and future of the cochlear implant center.

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JAMA Otolaryngology–Head & Neck Surgery —The Year in Review, 2016

As I complete my first year as Editor of JAMA Otolaryngology–Head & Neck Surgery, I would like to take this opportunity to thank our authors, editors, staff, reviewers, and readers for the many substantial contributions they made to the journal. Without our authors producing the research and sharing their thoughts, experiences, and observations, we would not have the content to create our fine journal. I thank my Deputy Editors, Neal Futran and Sukgi Choi, and Associate Editors, Timothy Smith and Timothy Hullar. I also owe much thanks to Karen Dodson, Editorial Manager, for her wonderful organizational skills and professional support during this past year. And finally, I acknowledge the support of the superb JAMA Network publication staff in Chicago.

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Slowly Growing Neck Mass With Progressive Dysphagia

A man with history of smoking and alcohol use had neck tenderness and dysphagia; computed tomography revealed a heterogeneously enhancing mass in the right side of the neck. What is your diagnosis?

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Ciprofloxacin Plus Fluocinolone in Otitis Media With Tympanostomy Tubes

This randomized clinical trial evaluates the efficacy and safety of topical ciprofloxacin plus fluocinolone acetonide otic solution vs ciprofloxacin otic solution alone and fluocinolone acetonide otic solution alone for acute otitis media in children with tympanostomy tubes.

http://ift.tt/2i5WPoS

Identifying Intraoperative Nerve Monitoring in Thyroid Surgery

To the Editor I read with interest the article titled "Analysis of Variations in the Use of Intraoperative Nerve Monitoring in Thyroid Surgery" by Al-Qurayshi et al. This was a cross-sectional study on the impact of patient demographic factors and surgeon and hospital thyroidectomy volume on the use of intraoperative nerve monitoring (IONM), using the State Inpatient Database for Florida, New York, and Washington. They found that IONM was used in only 8.3% of thyroidectomies. White patients were more likely to undergo IONM than racial minority patients. They also found that use of IONM was higher in thyroidectomies performed by low-volume surgeons, and in low-volume hospitals.

http://ift.tt/2gHuMuQ

Association of Iron Deficiency Anemia With Hearing Loss

This population-based cohort study examines the association between iron deficiency anemia and sensorineural, conductive, or combined hearing loss in young to elderly adults.

http://ift.tt/2hthvFx

Additional Data for Figures

In the Original Investigation titled "Association of Extracapsular Spread With Survival According to Human Papillomavirus Status in Oropharynx Squamous Cell Carcinoma and Carcinoma of Unknown Primary Site," published in the July 2106 issue of JAMA Otolaryngology–Head & Neck Surgery,¹ Figures 1 through 4 were missing the number of patients at risk for the Kaplan-Meier curves. The numbers at risk have now been added. This article was corrected online.

http://ift.tt/2o9kdIM

Individualized Bioselection Treatment Methods in Laryngeal Cancer

This cohort study evaluates the association between individualized bioselection treatment decision criteria and survival of patients with laryngeal cancer.

http://ift.tt/2klYR5G

Individualized Treatment of Laryngeal Cancer

In this issue of JAMA Otolaryngology–Head & Neck Surgery, Wolf et al describe very high survival rates in an unselected cohort of 247 patients with advanced laryngeal cancer. These patients were treated with a program of individualized bioselection. All of us invested in the care of patients with advanced laryngeal cancer must breathe a deep sigh of relief. Only 10 years ago, Hoffman et al, in a landmark review of the national cancer database, evaluated the outcome of 158 426 patients with laryngeal cancer. Between the years of 1985 and 2001, the survival rate had gone down. So what has changed?

http://ift.tt/2klVzzx

Distant Metastases Following Postoperative Intensity-Modulated Radiotherapy

This study examines the characteristics and risk factors of distant metastases following postoperative intensity-modulated radiotherapy in oral squamous cell carcinoma and the clinicopathological characteristics that could be associated with distant-only failure.

http://ift.tt/2ht1oIi

A Congenital Nasal Mass Causing Respiratory Distress

A neonate had noisy breathing and nasal congestion; physical examination revealed significant distress,and retractions, and a mucosalized mass filling the left nasal cavity was visualized on anterior rhinoscopy, requiring nasal stenting to relieve obstruction. What is your diagnosis?

http://ift.tt/2gHl8rZ

Complications of Bilateral Neck Dissection in Thyroid Cancer

This study delineates the specific complications arising from bilateral neck dissection for thyroid cancers at a single high-volume center.

http://ift.tt/2ikRI31

Retropharyngeal Mass

A woman had a sore throat, globus sensation, and dysphagia; she had a hyperintense, enhancing mass in the retropharyngeal and prevertebral spaces with marrow replacement of the C2 vertebral body extending to the odontoid. What is your diagnosis?

http://ift.tt/2hBXdLw

Determinants of Failure and Survival in Patients With Node-Negative Oral Tongue Cancers

This study assesses the association of lymphovascular space invasion with locoregional failure and survival in patients with node-negative oral tongue cancers treated with upfront definitive surgical resection.

http://ift.tt/2iLOMxt

Laryngeal Immunoglobulin G4-Related Disease Resulting in Severe Airway Obstruction

A woman in her 70s with a history of Sjogrens syndrome associated with rheumatoid arthritis complicated by Felty syndrome had progressive shortness of breath for over a decade that rapidly worsened over the course of 1 month.

http://ift.tt/2ipal91

Nodal involvement in Oral Squamous Cell Carcinoma (SCC) patients with and without Oral Sub Mucous Fibrosis (OSMF): A Comparative Study

Publication date: Available online 20 April 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Gaurav Singh, Amar Singh Rana, Anshuman Kumar, Ashish Prajapati, Shubham Kumar, Parul Singh
AimThe aim of the study is to compare and evaluate neck node status of oral cancer patients with and without Oral Sub Mucous Fibrosis (OSMF) treated surgically.MethodologyA total of 50 patients of Indian origin who were diagnosed with Squamous Cell Carcinoma (SCC) of oral cavity and had not taken any prior treatment were included in the study. Clinical examination and metastatic workup was done for all patients. Patients diagnosed with resectable primary and without distant metastasis were taken up for surgery. For all patients, resected specimens were sent for radical histopathological examination.ResultThe differences in nodal involvement in T1, T2 & T3 sized lesions were non-significant, while in T4 sized lesions, a statistically significant lower incidence of nodal involvement in patients with-OSMF as compared to patients without OSMF was observed.ConclusionPresence of N0 neck in T4 lesions in oral SCC patients with OSMF has potential implications on the present pattern of spread and treatment protocols, leading to need for further research with OSMF as independent risk factor for nodal involvement

http://ift.tt/2oVDgn1

Mitochondrial Function in Allergic Disease

Abstract

Purpose of the Review

The connections between allergy, asthma and metabolic syndrome are becoming increasingly clear. Recent research suggests a unifying mitochondrial link between the diverse phenotypes of these interlinked morbidities. The scope of this review is to highlight cellular mechanisms, epidemiology and environmental allergens influencing mitochondrial function and its importance in allergy and asthma. We briefly also consider the potential of mitochondria-targeted therapies in prevention and cure.

Recent Findings

Recent research has shown allergy, asthma and metabolic syndrome to be linked to mitochondrial dysfunction. Environmental pollutants and allergens are observed to cause mitochondrial dysfunction, primarily by inducing oxidative stress and ROS production. Malfunctioning mitochondria change the bioenergetics of the cell and its metabolic profile to favour systemic inflammation, which drives all three types of morbidities.

Summary

Given the existing experimental evidence, approaches targeting mitochondria (e.g. antioxidant therapy and mitochondrial replacement) are being conducted in relevant disease models—with some progressing towards clinical trials, making mitochondrial function the focus of translational therapy research in asthma, allergy and linked metabolic syndrome.

http://ift.tt/2pjj6GE

Chronic Candidiasis in Children

Abstract

Purpose of Review

Recent Findings

Summary

The clinical phenotype of CMC has many underlying genetic causes. Genetic testing is required for definitive diagnosis.

http://ift.tt/2oVrjgV

The Role of Macrolides in Chronic Rhinosinusitis (CRSsNP and CRSwNP)

Abstract

Purpose of Review

We assess the literature on the pharmacokinetics, indications, important considerations, and effectiveness of long-term, low-dose macrolide antibiotics in chronic rhinosinusitis (CRS).

Recent Findings

The key to effective implementation of macrolide therapy in CRS is appropriate patient selection. Macrolides have demonstrated the most benefit in Th1-mediated non-eosinophilic CRS when used for durations of at least 3 months.

Summary

Macrolide antibiotics have demonstrated great benefit when used for their anti-inflammatory or immunomodulatory properties, which include the blockage of pro-inflammatory cytokines, such as interleukin (IL)-8 and tumor necrosis factor-α (TNF-α). They have been used in CRS patients not responding to traditional corticosteroid-based treatment regimens, but appear to be most effective specifically in Th1-mediated non-eosinophilic CRS in long durations and low doses. Further research is needed to better identify characteristics known to correlate with macrolide response so early directed therapy can be implemented.

http://ift.tt/2pjiHnm

Natural Evolution of IgE Responses to Mite Allergens and Relationship to Progression of Allergic Disease: a Review

Abstract

Purpose of Review

Allergenic molecules of the house dust mite (HDM) are crucially important indoor allergens, contributing to allergic rhinitis and asthma around the globe. In the past years, recombinant molecules for diagnostics opened new pathways to investigate individual sensitization profiles and new chances for the prevention and treatment of HDM allergy. This review summarizes the latest findings on the evolution of IgE responses towards mite allergens.

Recent Findings

Several cross-sectional and longitudinal studies confirmed the role of Der p 1 and Der p 2 as major allergenic proteins of the HDM. A newly identified player is the major allergen Der p 23. Apart from identifying the early sensitization towards this molecule as a risk factor for asthma in school age, a recent longitudinal study described sensitization patterns showing that the production of IgE usually starts towards a group of initiator proteins and may stay monomolecular or expand to an oligo- or even polymolecular stage. This phenomenon also correlates to clinical symptoms. A relation between a broad sensitization pattern and symptom severity has also been shown cross-sectionally.

Summary

Individual sensitization profiles towards HDM allergens provide important information to evaluate a patient's current stage and risk for clinical symptoms. This knowledge paves the way for an early and adequate prevention and/or treatment.

http://ift.tt/2pGyt8G

Emerging Approaches to Food Desensitization in Children

Abstract

Purpose of Review

The purpose of this review is to highlight the recent advances in food desensitization in children with food allergy.

Recent Findings

Summary

http://ift.tt/2pIyBrf

New Perspectives on the Diagnosis of Allergy to Anisakis spp.

Abstract

Purpose of Review

To compare the prevalence of sensitization in different countries based on specific IgE values and to evaluate the use of isolated native or recombinant allergens for diagnosis.

Recent Findings

Isolated allergens help in the diagnosis of truly sensitized patients avoiding false positives due to cross-reactions. Their use is therefore highly recommended, especially when used as a combination of several relevant allergens.

Summary

The use of purified allergens allows an accurate diagnosis and this has led to three important findings: (1) in addition to the digestive route of sensitization, occupational and non-digestive exposure seems to be clinically relevant. (2) The parasite appears as an important agent for chronic urticaria. And (3) in endemic countries, the amount of highly sensitized subjects in the general population could be as high as 7%. Adequate information to asymptomatic patients on fish consumption habits would avoid new contacts with parasite allergens and decrease their specific IgE levels and consequently the appearance of acute or chronic episodes induced by the parasite.

http://ift.tt/2pGCfPq

Oral health in patients with renal disease: a longitudinal study from predialysis to kidney transplantation

Abstract

Objectives

The aim of this longitudinal study was to compare the oral health of chronic kidney disease patients at the predialysis (baseline) and post-transplantation (follow-up) stages and to investigate differences in oral health between diabetic nephropathy and other kidney disease patients at follow-up.

Materials and methods

Fifty-three kidney disease patients (34 men) aged 31–86 years were followed up to 157 months. Clinical and radiological oral examinations, salivary and laboratory analyses, and oral health behavior questionnaires were conducted at the predialysis and follow-up stages at Helsinki University Hospital, Finland. Oral inflammatory burden was estimated by calculating deep periodontal pockets, periodontal inflammatory burden (PIBI), decayed, missing, and filled teeth (DMFT), and total dental indices (TDI). Results were analyzed using cross-tabulation Pearson chi-square or Fisher's exact test and the Mann-Whitney U test, and the McNemar and Wilcoxon signed-rank test.

Results

At the predialysis stage, patients more often had calculus and deep periodontal pockets; TDI, PIBI, number of teeth, and salivary flow rates were also statistically significantly higher compared to follow-up. At follow-up, diabetic nephropathy patients more often had Candida growth, more plaque, and used more drugs and had lower stimulated salivary flow than patients with other kidney diseases.

Conclusion

Oral health was better at follow-up than at the predialysis stage; however, attention should be given to the lower salivary flow rate and higher number of drugs used at that stage.

Clinical relevance

This study confirms the importance of treating oral infectious foci at the predialysis stage in order to prevent adverse outcomes after kidney transplantation.

http://ift.tt/2pHT8wg

Ultrastructure of pheochromocytoma: undescribed morphologic features

Abstract

We examined samples of human pheochromocytoma from 11 patients aged 30–70 years including one case of malignant pheochromocytoma with a view to identifying previously unreported ultrastructural details.

We identified two types of nuclear inclusions consisting of irregularly shaped singular or multiple granulofibrillar formations with a typical concentric halo, on the one hand, and accumulations of egg-shaped structures consisting of granules and microfilaments, on the other. In some of the tumor cells, membrane-covered inclusions containing parallel laminar elements arranged in a paracrystalline, periodic fashion, or mega-mitrochondriae characterized by increased electrodensity of their matrix, and fibrillary material in the spaces between the cristae were present. A frequent finding consisted of typical ciliary formations, while rough/smooth tubular aggregates of different size occurred less frequently. Finally, we were able to demonstrate the uptake of norepinephrine by smooth muscle fibers in the periphery of arterial vessels as evidenced by linear accumulations of membrane-covered granules separating bands of contractile smooth muscle components in the peripheral layers of arterial vessels close to norepinephrine producing neoplastic cells.

These findings represent ultrastructural features that contribute to further elucidating the ultrastructural characteristics of the human pheochromocytoma.

http://ift.tt/2p0csUA

Providing anesthesia in resource-limited settings.

Purpose of review: The article reviews the reality of anesthetic resource constraints in low and middle-income countries (LMICs). Understanding these limitations is important to volunteers from high-income countries who desire to teach or safely provide anesthesia services in these countries. Recent findings: Recently published information on the state of anesthetic resources in LMICs is helping to guide humanitarian outreach efforts from high-income countries. The importance of using context-appropriate anesthesia standards and equipment is now emphasized. Global health experts are encouraging equal partnerships between anesthesia health care providers working together from different countries. The key roles that ketamine and regional anesthesia play in providing well tolerated anesthesia for cesarean sections and other common procedures is increasingly recognized. Summary: Anesthesia can be safely given in LMICs with basic supplies and equipment, if the anesthesia provider is trained and vigilant. Neuraxial and regional anesthesia and the use of ketamine as a general anesthetic appear to be the safest alternatives in low-resource countries. Environmentally appropriate equipment should be encouraged and pulse oximeters should be in every anesthetizing location. LMICs will continue to need support from outside sources until capacity building has made more progress. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2oVqLYE

Diminished capacity of opsonization and immune complex solubilization, and detection of anti-C1q antibodies in sera from patients with hereditary angioedema

Publication date: Available online 20 April 2017
Source:Allergology International
Author(s): Daisuke Honda, Isao Ohsawa, Nobuyuki Sato, Hiroyuki Inoshita, Satoshi Mano, Yasuhiko Tomino, Yusuke Suzuki
BackgroundHereditary angioedema (HAE) is an autosomal dominant disease caused by deficiency of C1 esterase inhibitor. Symptoms of HAE include edema, which can potentially cause suffocation. Some patients with HAE exhibit immunological abnormalities, which could prevent an accurate diagnosis. Low levels of complement components are characteristic of HAE and in other settings are thought to reduce elimination of apoptotic cells and immune complex (IC). Thus, we aimed to experimentally clarify the mechanism of immunological abnormalities using sera from HAE patients.MethodsSerum samples from 18 patients with HAE were collected when free from angioedema attack and compared with normal human pooled sera (NHPS) from 20 healthy volunteers. Opsonization was measured as the rate of phagocytosis of apoptotic Jurkat cells by macrophages differentiated from THP-1 cells incubated with serum. IC solubilization in serum was analyzed by quantifying peroxidase released from a synthetic IC composed of peroxidase and anti-peroxidase antibodies. Anti-C1q antibody levels were detected using an enzyme-linked immunosorbent assay.ResultsSerological immunological abnormalities were detected in 12 patients. Opsonization in serum samples from each patient with HAE was lower than that in NHPS (∼20% versus 70%, respectively). The rate of IC solubilization was lower in serum from HAE patients than NHPS. Some patients had high serum anti-C1q antibody levels with increased serum IC levels.ConclusionsSera from patients with HAE exhibit anti-C1q antibodies, with a lower capacity for opsonization and IC solubilization. This may be associated with immunological abnormalities and should be investigated further to facilitate accurate diagnosis of HAE.

http://ift.tt/2ovbqMy

Measuring the impact of dermatological conditions on family and caregivers: a review of dermatology-specific instruments

Abstract

The patient is the centre of a web of relationships and the impact of his/her disease on family members and caregivers must be taken into account. The aim of this study was to identify the specific instruments that measure the impact of a dermatological disease on the quality of life (QoL) of family members, by performing a systematic search of the literature. Fifteen papers were identified, describing the creation and validation of nine instruments. Four of them concerned atopic dermatitis (Dermatitis Family Index, DFI; Parents' Index QoL Atopic Dermatitis, PiQoL-AD; QoL in Primary Caregivers of children with Atopic Dermatitis, QPCAD; Childhood Atopic Dermatits Impact Scale, CADIS), two measured the impact of psoriasis in family members (Psoriasis Family Index, PFI; FamilyPso), one the impact of epidermolysis bullosa (Epidermolysis Bullosa Burden of Disease, EB-BoD), one of ichthyosis (Family Burden Ichthyosis, FBI), and one was generic for dermatological conditions (Family Dermatology Life Quality Index, FDLQI). The EADV quality of life taskforce recommends that the impact of a skin disease on family and caregivers should be measured as part of any thorough evaluation of the burden of a disease. Guidelines are given to choose the most appropriate instruments.

http://ift.tt/2p0hGjg

Frontal fibrosing alopecia: clinical and prognostic classification

Abstract

Background

Frontal fibrosing alopecia (FFA) is a chronic scarring alopecia with an unpredictable evolution. There are no current classifications of this disease that may predict its prognosis.

Objective

To analyze the differences in clinical presentation and evolution of FFA patients and to create a clinical and prognostic classification

Methods

We conducted a retrospective analytical study of FFA patients. Clinical characteristics of frontal hairline recession were used as the sorting variable between patterns of presentation. A cohort of 106 patients homogenously treated with oral dutasteride and topical corticosteroid was followed 12 months.

Results

In all, 242 female patients with a mean age of 61.4 years were included. Patients were classified in three clinical patterns (118 (48.8%) patients as pattern I (linear), 109 patients (45%) as pattern II (diffuse) and 15 patients (6.2%) as pattern III (double-line)). Stabilization was achieved in 37.3% of the 106 patients treated with oral dutasteride and topical corticosteroid. Pattern III patients had less hairline recession and eyebrow involvement at the diagnosis and after treatment.

Limitations

Retrospective design.

Conclusions

FFA patients can be classified in three different clinical patterns with different prognosis. Pattern III patients have the best prognosis, while pattern II patients have the worst prognosis.

http://ift.tt/2oUUIrE

Acantholytic dyskeratotic acanthoma: a possible skin adverse event of vemurafenib treatment

Abstract

Acantholytic dyskeratotic acanthoma (ADA) is a solitary small papule that is pathologically characterized by dyskeratosis with acantholytic acanthosis (1). Vemulafenib is a specific inhibitor of BRAF protein kinase with V600E mutation and is administered to treat metastatic melanoma. Various skin adverse events associated with vemurafenib, including acantholysis and flare up of Darier's disease, have been reported (2, 3). Here we report a case of ADA that developed during vemulafenib treatment for metastatic melanoma. Our case suggests a possibility that vemurafenib may affect epidermal structures which induces acantholysis and dyskeratosis.

http://ift.tt/2oZY8vg

A case of toxic epidermal necrolysis and vanishing bile duct syndrome, requiring liver transplantation

Abstract

A 52-year-old woman presented with a five-day history of headache, fevers and a diffuse, macular erythematous rash. Ten days prior she received cephalexin for a urinary-tract infection. She had a history of gastro-oesophageal reflux disorder and took omeprazole.

http://ift.tt/2oV67rz

Introducing ORL Notes

As we ended last year and began to contemplate our priorities for the current year, we reviewed ORL Progress Notes, which was first released in 2008. Our newsletter has had both print and email distribution; however, over the past several years, the digital reads have become much more popular than the print version. We also observed that the bulk of readers are relying upon "small screens" (i.e., smart phones and tablets) to read our material. Finally, while our email newsletter had been optimized for mobile devices a few years ago, it still did not fulfill current aesthetic and functional expectations. Thus, we concluded that we needed new design.

One obvious change is that the newsletter has a new name—ORL Notes—in place of ORL Progress Notes. We have also chosen to recognize both Memorial Hermann-Texas Medical Center and UTHealth prominently in the header; our Department works at the intersection of these two great institutions, and our success is a result of a collaborative effort. Finally, the new format will allow us to include an image for each post so that readers can get a glimpse into the article.

We have also chosen to end production of the print journal. In its place, we will develop more content for posting on our website—which will also be re-released with a new design later this year.

Regardless of these changes, the newsletter's purpose remained the same. ORL Notes will continue to provide a window into the daily work of the Department—its clinical activities (with an emphasis on the patients under the care of the Department's physicians), educational activities and research endeavors.

We hope that you enjoy ORL Notes. Feel free to share your views by emailing us at UTHealthORL@uth.tmc.edu.

Martin J. Citardi, MD
Professor & Chair, UTHealth Otorhinolaryngology
Chief of Otorhinolaryngology-Head & Neck Surgery, Memorial Hermann-TMC

http://ift.tt/2o8A5LF

Diffuse normolipemic plane xanthoma on striae

Abstract

Diffuse normolipemic plane xanthoma (DNPX) is a rare skin disorder characterized by the presence of symmetric, asymptomatic, flat, yellow plaques of different size.¹ As it is commonly located on the eyelids, xanthelesma may be a differential diagnostic consideration, but the lesions of DNPX are usually larger and other parts of the face, neck, flexural folds and trunk may also be involved.¹

http://ift.tt/2ovfxbm

High dose pulsed corticosteroid therapy combined with Methotrexate for Severe Alopecia Areata of Childhood

Abstract

Alopecia areata (AA) in childhood can run a chronic course and worsen over time(1). Spontaneous hair regrowth is rarely appreciated in chronic severe AA(2-4). Our centre described the ineffective use of high dose pulsed corticosteroid therapy (HDPCT) in the long term(1). Methotrexate (MTX) as a maintenance therapy following HDPCT showed some success in adults(5). Although the evidence for using either drug individually was weak(6), the combination of using both was not well studied.

http://ift.tt/2pHDcdi

Ultrasonographic features of intravascular fasciitis: case report and review of the literature

Abstract

Intravascular fasciitis (IF), a variant of nodular fasciitis (NF), is a reactive intravascular proliferation of myofibroblasts. IF is an indolent subcutaneous or intramuscular nodule that is most commonly found on the extremities, head and neck.^{1, 2}

http://ift.tt/2oviicx

Videodermoscopy supports the diagnosis of eyelash trichotillomania

Abstract

37-year-old woman presented with extensive erythematous and ulcerative eruptions on the face and chest with concomitant isolated eyelash alopecia. Skin problems started during adolescence; eyelash loss several years before hospital admission.

http://ift.tt/2pHBU29

Immunotherapy and Stereotactic Body Radiotherapy (SBRT) for Metastatic Anaplastic Thyroid Cancer

Condition: Metastatic Anaplastic Thyroid Cancer
Interventions: Drug: durvalumab; Drug: tremelimumab; Radiation: Stereotactic Body Radiotherapy (SBRT)
Sponsors: Memorial Sloan Kettering Cancer Center; AstraZeneca
Not yet recruiting - verified April 2017

http://ift.tt/2oP1As5

Pain Management in Head and Neck Surgery Patients

Condition: Pain Management
Interventions: Drug: Oxycodone; Drug: Acetaminophen; Drug: Gabapentin; Drug: Celecoxib; Drug: Hydrocodone-Acetaminophen
Sponsor: University of Alabama at Birmingham
Not yet recruiting - verified April 2017

http://ift.tt/2pHt44f

Acceptability and Tolerance of Hysteroscopy and Hysterosonography in Consultation

Condition: Metrorrhagia
Interventions: Device: Hysteroscopy; Device: Hysterosonography
Sponsor: Brugmann University Hospital
Not yet recruiting - verified April 2017

http://ift.tt/2oUseyf

A Study to Evaluate the Safety and Efficacy of Using the Combination Treatment of SHR-1210, Gemcitabine and Cis-platinum by Recurrent and Metastatic NPC Subjects

Condition: Nasopharyngeal Carcinoma
Interventions: Biological: SHR-1210; Drug: Gemcitabine; Drug: cis-platinum
Sponsor: Jiangsu HengRui Medicine Co., Ltd.
Not yet recruiting - verified April 2017

http://ift.tt/2oUAdvr

Alcohol intake and risk of rosacea in US women

The epidemiologic association between alcohol and rosacea is unclear and inconsistent based on the previous cross-sectional or case-control studies.

http://ift.tt/2pHhHJA

Unilateral Hearing Loss and Otorrhea

A man in his 70s had painless left-sided otorrhea, aural fullness, and hearing loss; temporal bone computed tomography demonstrated near-complete opacification of the left mastoid air cells and middle ear. What is your diagnosis?

http://ift.tt/2pHfeit

Surgeon Volume in Parathyroid Surgery

This study examines the association between surgeon volume and 30-day rates of complications, mortality, and postdischarge utilization among patients undergoing parathyroidectomy.

http://ift.tt/2oqCwFb

Surgery and Radiotherapy vs Chemoradiotherapy for Oral Cavity Cancer

This study compares the differences in survival between patients with locally advanced oral cavity squamous cell carcinoma treated with surgery followed by postoperative radiotherapy vs chemoradiotherapy.

http://ift.tt/2pWmrY6

Risks and Harms of Management of Incidental Thyroid Nodules

This review assesses the clinical dilemma of the incidental thyroid nodule, the risk for missing a significant cancer, and the potential harms of examination and reviews management recommendations for patients with these findings.

http://ift.tt/2pH9ipJ

Sputum basophils are increased in eosinophilic asthma compared with non-eosinophilic asthma phenotypes

Abstract

Sputum basophil numbers are increased in allergic asthmatics, but it is unclear what role airway basophils play in "TH2-low" asthma phenotypes. Using flow cytometry we found that basophils were significantly increased in all asthmatics (n=26) compared with healthy controls (n=8) (p=0.007) with highest levels observed in eosinophilic asthma (EA; median 0.22%, IQR 0.11-0.47%; n=14) compared with non-EA (0.06%, 0.00-0.20%; n=12; p<0.05). In asthmatics, basophils were positively correlated with sputum eosinophils (r=0.54; p<0.005), and inversely with sputum neutrophils (r=-0.46: p<0.05), but not with FEV₁ (% predicted), FEV₁/FVC, or bronchodilator reversibility. In a subgroup initially identified as inadequately controlled asthma (n=7), there was a trend (p=0.08) towards a reduction in sputum basophils following increased ICS treatment. Our findings suggest that basophils may be particularly important in eosinophilic asthma, and that sputum basophil assessment could be a useful additional indicator of 'TH2-high' asthma.

http://ift.tt/2pVOW8A

Protease-activated receptor-2 suppresses interleukin (IL)-10 expression in B cells via up regulating Bcl2L12 in patients with allergic rhinitis

Abstract

Background and aims

The function of interleukin (IL)-10 producing B cells (B10 cell) is compromised in patients with allergic diseases. Protease-activated receptor (PAR)-2 has immune regulatory functions. This study aims to elucidate the role of PAR2 in the suppression of IL-10 expression in peripheral B cells.

Methods

Peripheral blood B cells were collected from patients with allergic rhinitis (AR). A correlation between the expression of Bcl2 like protein 12 (Bcl2L12) and IL-10 in the B cells was analyzed. An AR mouse model was developed.

Results

We observed that the expression of IL-10 was lower in the peripheral B cells from patients with airway allergy. A negative correlation was identified between the expression of IL-10 and PAR2 in B cells. Activation of PAR2 of B cells increased the expression of Bcl2L12 and suppression of LPS-induced IL-10 expression, which was abolished by knocking down the Bcl2L12 gene. Treating B cells from AR patients with Bcl2L12-shRNA carrying liposomes reversed the capability of IL-10 expression and the immune suppressor function. Administration of Bcl2L12 shRNA-carrying liposomes attenuated experimental AR in mice.

Conclusions

Activation of PAR2 inhibits the expression of IL-10 in B cells, which can be reversed by treating B cells with Bcl2L12 shRNA-carrying liposomes. The data suggest that regulation of Bcl2L12 may be a novel approach in the treatment of AR.

http://ift.tt/2pHbahV

Incremental Burden of Cardiovascular Comorbidity and Psoriatic Arthritis among Adults with Moderate-to-Severe Psoriasis in Five European Countries

Abstract

Background

Moderate-to-severe psoriasis is associated with reduced health-related quality of life (HRQoL). Individuals with psoriasis are at increased risk for other medical conditions, but little information quantifies the incremental burden of psoriasis-associated comorbidity among European adults, and data have generally been limited to clinical samples.

Objective

To quantify the incremental burden of cardiovascular comorbidity and psoriatic arthritis among adults with moderate-to-severe psoriasis in the general population of France, Germany, Italy, Spain, and the United Kingdom (EU5).

Methods

All measures were self-reported and came from the 2010-2013 EU5 National Health and Wellness Surveys (NHWS). Moderate-to-severe psoriasis was identified by >10% body surface area affected by psoriasis and/or use of therapies for moderate-severe disease. Outcomes were SF-12v2/SF-36v2 mental and physical component summary scores (MCS & PCS, respectively), SF-6D health utility, Work Productivity and Activity Impairment (WPAI) questionnaire, and healthcare use in the past 6 months. Generalized linear models compared across CV or PsA groups vs. non-CV or non-PsA groups with appropriate link functions to adjust for covariates.

Results

Among moderate-to-severe psoriasis respondents (n=957), 19.8% (n=190) reported CV comorbidity, and 12.3% (n=118) reported PsA. After adjustment for covariates, CV comorbidity was associated with 3.0 points lower MCS, 3.4 points lower PCS, and 0.05 points lower SF-6D (all p<0.01). Likewise, they had greater mean work impairment (48% vs. 33%), more activity impairment (48% vs. 37%), more healthcare provider visits (8.8 vs. 6.9), emergency room visits (0.65 vs. 0.31) and hospitalizations (0.61 vs. 0.22) (all p<0.05). Compared to non-PsA respondents, PsA respondents also had worse mean MCS (2.6 points), PCS (6.3 points), and SF-6D scores (0.07 points), more work impairment (52% vs. 34%), activity impairment (54% vs. 38%), and healthcare provider visits (10.5 vs. 6.9) (all p<0.05).

Conclusion

CV comorbidity and PsA were associated with significant incremental burden among EU5 adults with moderate-to-severe psoriasis.

http://ift.tt/2pH6qJm

Mitochondrial Function in Allergic Disease

Abstract

Purpose of the Review

Recent Findings

Summary

http://ift.tt/2pjj6GE

New Perspectives on the Diagnosis of Allergy to Anisakis spp.

Abstract

Purpose of Review

To compare the prevalence of sensitization in different countries based on specific IgE values and to evaluate the use of isolated native or recombinant allergens for diagnosis.

Recent Findings

Summary

http://ift.tt/2pGCfPq

The Role of Macrolides in Chronic Rhinosinusitis (CRSsNP and CRSwNP)

Abstract

Purpose of Review

We assess the literature on the pharmacokinetics, indications, important considerations, and effectiveness of long-term, low-dose macrolide antibiotics in chronic rhinosinusitis (CRS).

Recent Findings

Summary

http://ift.tt/2pjiHnm

Natural Evolution of IgE Responses to Mite Allergens and Relationship to Progression of Allergic Disease: a Review

Abstract

Purpose of Review

Recent Findings

Summary

http://ift.tt/2pGyt8G

Sinonasal Undifferentiated Carcinoma in a Patient Previously Treated for an Intestinal-Type Adenocarcinoma: Metachronous Neoplasms or Recurrence of a Different Tumor Type?

Abstract

A case of a sinonasal undifferentiated carcinoma occurring 2 years after a successfully surgically treated intestinal-type adenocarcinoma has never been reported. Treatment modality of paranasal sinus cancer strictly depends on histology so it is important to recognize a different tumor type in the follow-up of these patients.

http://ift.tt/2pGmxUu

Factors Affecting the Outcome of Stapes Surgery

Abstract

To study the outcome of stapes surgery based on the Clinical, Audiometry, and Surgical pre- and postoperative factors. This study is a prospective study of factors affecting the outcome of stapes surgery in otosclerosis patients. From February 2010 to June 2011, 57 patients of confirmed clinical otosclerosis were analysed. Out of them, 31 patients were included in our study as were available for follow-up. Clinical, audiometry and surgery-related parameters were included to assess the surgery outcome. Results were reported as suggested by AAO-HNS (American Association of Otolaryngology and Head and Neck Surgery) guidelines for stapes surgery, 1995. The paired t-test and analysis of variables test (ANOVA) were used to evaluate the results. A p value of <0.05 was considered significant. There was statistically significant improvement in ABG (air bone gap) closure at 3 months of surgery (p value <0.001). Among all cases, PTA BC (pure tone average bone conduction) at 3 months of surgery was found in the range of 7.5 dB to 43.75 dB. ABG closure was achieved in the range of 0 dB to 27.5 dB among all cases. Variables like gender, degree of hearing loss, type of footplate, sealing material, and piston diameter were definitely predicting the outcome of stapes surgery. Pure tone audiometry plays an important role to diagnose the otosclerosis, to evaluate degree and type of hearing loss and to assess hearing outcome after surgery. Our results may improve knowledge of predictive factors, providing the surgeon with useful information to plan surgery with a better case selection as well as to counsel the patient on the likelihood of success of the procedure.

http://ift.tt/2oZ0j22

Transnasal Stabilization in Naso-orbito-ethmoid Fractures: The Easy Way!

Abstract

Effective management of naso orbito ethmoidal fractures involves both functional and esthetic correction. While functional correction is routinely achieved, in our experience, most secondary deformities resulted from inadequate nasal bridge projection. We hereby suggest a simple technique to stabilize the nasal bridge after mild overcorrection thereby improving the esthetic outcome in naso orbito ethmoidal fractures.

http://ift.tt/2pGuDwz

Increasing the accuracy of mandibular reconstruction with free fibula flaps using functionalized selective laser-melted patient-specific implants A retrospective multicenter analysis

Publication date: Available online 19 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Majeed Rana, Shih-Jan Chin, Thomas Muecke, Marco Kesting, Alexander Groebe, Bjoern Riecke, Max Heiland, Nils-Claudius Gellrich
In this study, selective laser melted patient specific functional implants (PSFI) were utilised in combination with a fibula free flap, for mandible reconstruction. The shape and length of the PSFI, the shaping of fibula graft, its angulation and the length of the screws, were virtually planned before the surgery. Information, such as resection margin and screw lengths, were coded on the implant.22 patients were reconstructed with PSFI and fibula transplantation. Data collected related to the size of the defect, pre- and postoperative intercondylar distance, ischemia time, time consumed to shape the fibula graft and complications. All patients were reconstructed as planned. Depending on the extension of the defect, the fibula grafts were shaped into different shapes, within 41.6 ± 4.9 minutes. The mean difference of pre- and post-operational condyle distances was 1.2 ± 1.4 mm. Postoperative complications such as wound healing disturbance and plate exposure occurred in 8 patients. All PSFIs remained within reconstruction sites during the follow up period. 8 out of the 22 patients had full dental rehabilitation with implants.Based on our results, the use of PSFIs in the reconstruction of mandibular segmental defects may contribute to a better clinical outcome. Further work will be required in order to evaluate their mechanical properties in detail.

http://ift.tt/2oTHPy9

Prospective comparison of perioperative antibiotic management protocols in oncological head and neck surgery

Publication date: Available online 20 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Alexander K. Bartella, Mohammad Kamal, Jan Teichmann, Anita Kloss-Brandstätter, Timm Steiner, Frank Hölzle, Bernd Lethaus
ObjectivesThe adequate perioperative antibiotic prophylaxis in head and neck cancer surgery is an important and easy applicable tool to decrease nosocomial morbidity and mortality by reducing the rate of infections. In the study a strictly perioperative antibiosis is compared with an extended postoperative prophylactic antibiosis. We aim to clarify the value of postoperative prophylactic antibiosis for the recovery and clinical course of patients.Material and MethodsIn this prospective study 75 consecutive patients, who underwent major oncological head and neck surgery were included and divided in three groups, each containing 25 patients. The first group received peri- and postoperative antibiotic prophylaxis (POAP) from the day of operation until the fifth day postoperatively. The second group was treated with perioperative antibiotic prophylaxis (PEAP) only. The third group received perioperative antibiotic prophylaxis and increased local antiseptic care (PAPAC). General anamnestic data was collected, as well as duration of hospitalisation, stay on intensive care unit, rate and type of infections, surgical closure of the tracheostomy, and postoperative blood parameters.ResultsThere were no statistically significant differences in general diseases or extent of surgery between the groups. There were statistically significant fewer patients suffering from surgical site infections in subjects with POAP (n=1) in comparison to PEAP (n=9; p=0.011) and PAPAC n=9; p=0.011). In contrast, other nosocomial infections (pneumonia, urinary tract infection, sepsis) did not decrease under a prolonged antibiotic prophylaxis.ConclusionBased on findings of the study, we recommend an extended postoperative antibiotic prophylaxis for patients undergoing major oncological head and neck surgery.

http://ift.tt/2o7vpWa

Sinonasal Undifferentiated Carcinoma in a Patient Previously Treated for an Intestinal-Type Adenocarcinoma: Metachronous Neoplasms or Recurrence of a Different Tumor Type?

Abstract

http://ift.tt/2pGmxUu

Factors Affecting the Outcome of Stapes Surgery

Abstract

http://ift.tt/2oZ0j22

Transnasal Stabilization in Naso-orbito-ethmoid Fractures: The Easy Way!

Abstract

http://ift.tt/2pGuDwz

Comparison between piezoelectric surgery and conventional saw in sagittal split osteotomies: a systematic review

Publication date: Available online 19 April 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): L.F. Silva, E.N.R. Carvalho-Reis, J.P. Bonardi, V.N. de Lima, G.A.C. Momesso, I.R. Garcia-Junior, L.P. Faverani
A systematic review of the advantages and disadvantages of piezoelectric surgery in comparison with conventional saws for sagittal split osteotomy (SSO) was performed. Relevant studies published in the last 10 years were identified through a search of the PubMed/MEDLINE, Science Direct, and Embase databases and assessed against predetermined eligibility criteria. The initial search resulted in 1736 articles. After applying the inclusion and exclusion criteria, 12 articles remained. A total of 799 patients with an average age of 27.5 years underwent SSO performed using a saw or ultrasonic device. Results showed that it took longer to perform the osteotomies using an ultrasonic device than using a conventional saw. At ≥6 months of follow-up, neurosensory disturbance was seen in 4.7% of patients who underwent piezoelectric surgery versus 61.6% of patients who underwent surgery in which a conventional saw was used. It was found that the use of piezoelectric surgery in SSO leads to the best outcome regarding neurosensory disturbance when compared to conventional saws (P=0.04) at ≥6 months of follow-up. Further studies are required for the evaluation of the other clinical parameters assessed.

http://ift.tt/2oYRuoZ

Three-dimensional surgical modelling with an open-source software protocol: study of precision and reproducibility in mandibular reconstruction with the fibula free flap

Publication date: Available online 19 April 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): L. Ganry, J. Quilichini, C.M. Bandini, P. Leyder, B. Hersant, J.P. Meningaud
Very few surgical teams currently use totally independent and free solutions to perform three-dimensional (3D) surgical modelling for osseous free flaps in reconstructive surgery. This study assessed the precision and technical reproducibility of a 3D surgical modelling protocol using free open-source software in mandibular reconstruction with fibula free flaps and surgical guides. Precision was assessed through comparisons of the 3D surgical guide to the sterilized 3D-printed guide, determining accuracy to the millimetre level. Reproducibility was assessed in three surgical cases by volumetric comparison to the millimetre level. For the 3D surgical modelling, a difference of less than 0.1mm was observed. Almost no deformations (<0.2mm) were observed post-autoclave sterilization of the 3D-printed surgical guides. In the three surgical cases, the average precision of fibula free flap modelling was between 0.1mm and 0.4mm, and the average precision of the complete reconstructed mandible was less than 1mm. The open-source software protocol demonstrated high accuracy without complications. However, the precision of the surgical case depends on the surgeon's 3D surgical modelling. Therefore, surgeons need training on the use of this protocol before applying it to surgical cases; this constitutes a limitation. Further studies should address the transfer of expertise.

http://ift.tt/2pGwd48

UVA 1 laser in the treatment of patients with vitiligo

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Medium-sized nevus spilus of the neck treated with pulsed dye laser

Abstract

Patients with large benign melanocytic lesions located on the neck represent a therapeutic challenge since the neck is a high-risk area for hypertrophic scarring and/or retraction. When treating a benign, extensive and visible melanocytic lesion, the choice of therapy mainly depends on the likelihood of improved cosmesis. We report a case of a 33-year-old woman with a medium-sized Nevus Spilus located on the neck, successfully treated with four sessions of pulsed dye laser. We achieved an excellent clinical and cosmetic result in such a challenging area. No scarring, distortion or significant dyscromia were observed after 24 months.

http://ift.tt/2ouDnnC

Non-cosmetic dermatological use of botulinum neurotoxin

http://ift.tt/2pGyH2K

Herausforderungen in der Behandlung älterer Patienten mit akuter myeloischer Leukämie

Zusammenfassung

Hintergrund

Die akute myeloische Leukämie (AML) ist eine Erkrankung des älteren Patienten mit steigender Inzidenz bis in die 8. Lebensdekade. Die Prognose verschlechtert sich mit zunehmenden Alter drastisch und ist mit einer Fünfjahresüberlebensrate von unter 10 % für Patienten über 60 Jahre unbefriedigend.

Ergebnisse

Die Standardtherapien der AML sind zumeist für jüngere Patienten etabliert und nur bedingt auf ältere Patienten übertragbar. Publizierte Daten haben folgende Ergebnisse darstellen können: Es zeigt sich ein Nutzen für eine intensive Induktionstherapie mit Daunorubicin und Ara-C für fitte Patienten bis zum 80. Lebensjahr hinsichtlich des Gesamtüberlebens, aber auch bezogen auf die Lebensqualität in großen Registerstudien. Die Herausforderung im klinischen Alltag bleibt, ältere Patienten, die einer intensiven Chemotherapie unterzogen werden sollten, prätherapeutisch zu identifizieren; dies sollte ggf. in spezialisierten Zentren erfolgen. Die Bedeutung der Postremissionstherapie für ältere Patienten ist in Diskussion und abhängig vom Risikoprofil: 1–2 Zyklen Hochdosis-Ara-C können als Standard angesehen werden. Eine allogene Stammzelltransplantation mit reduzierten Konditionierungsschemata sollte für geeignete Patienten ebenso in Betracht gezogen werden. Zudem stellen hypomethylierende Substanzen wertvolle, zusätzliche Therapieoptionen für ältere AML-Patienten dar, die zunehmend mit neuen Medikamente in klinischen Studien in Kombinationen getestet werden.

Schlussfolgerung

Für jeden älteren Patienten soll eine umfassende AML-Diagnostik durchgeführt und sorgfältig die Eignung für eine intensive Induktionschemotherapie abgewogen werden. Der Einschluss von älteren Patienten in klinische Studien ist für den weiteren Erkenntnisgewinn dieser doch schwierigen Behandlungssituation wesentlich.

http://ift.tt/2pG0yNr

RAF-Inhibitoren

Zusammenfassung

Hintergrund

Die Inhibition des RAF-MAPK-Signalwegs mittels BRAF-Inhibitoren (oder MEK-Inhibitoren) in Tumorerkrankungen wie dem Melanom, die durch BRAF-Mutation forciert werden, ist ein Paradebeispiel für zielgerichtete Therapie. Jedoch stellt die Resistenzentwicklung gegenüber diesen Inhibitoren ein wesentliches Problem dar.

Ziel

Die Autoren geben einen Überblick über den Signalweg, berichten über neueste Studien und Nebenwirkungen dieser Substanzklasse und diskutieren potenzielle Strategien zur Überwindung der Therapieresistenz.

Methoden

Der Beitrag basiert auf einer Recherche und Auswertung aktueller Literatur.

Ergebnisse

BRAF-Inhibitoren beim fortgeschrittenen malignen Melanom mit BRAF-Mutation sind seit 2011 als Monotherapie zugelassen. Diese zielgerichtete Therapie zeigt eine deutliche Verbesserung des progressionsfreien Überlebens und des Gesamtüberlebens. Dem erfolgreichen Einsatz der BRAF-Inhibitoren beim Melanom folgte in kurzer Abfolge auch ein Einsatz bei anderen Tumorerkrankungen mit Nachweis von BRAF-V600E-Mutation. Im Allgemeinen sind BRAF-Inhibitoren gut verträglich. Verschiedene BRAF-Inhibitoren weisen jedoch ein unterschiedliches Nebenwirkungsspektrum auf.

Schlussfolgerung

Kombinationstherapien mit MEK-Inhibitoren führen zu einem verbesserten Ansprechen und längerem Gesamtüberleben.

http://ift.tt/2oYxDGF

Too many instruments for measuring Quality of Life in Atopic Dermatitis

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Announcement

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Issue Information

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Announcement

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Histamine intolerance in chronic urticaria

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Quality of life – an essential parameter for dermatology

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Forthcoming Events

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Unusual course of generalized lymph node primary plasmacytoma in a patient with Sjögren’s syndrome: a case report

Primary lymph node plasmacytoma is a rare disease that typically involves lymph nodes of the neck. In only 15% of cases is the disease generalized. Here, we present a case of generalized lymph node plasmacytom...

http://ift.tt/2o6RpRe

Durable complete remission with aromatase inhibitor therapy in a patient with metastatic uterine carcinosarcoma with poor performance status and coagulation disorders: a case report

Chemotherapy is considered the most appropriate treatment for metastatic uterine sarcoma, despite its limited efficacy. No other treatment has been conclusively proved to be a real alternative, but some report...

http://ift.tt/2o6Lk77

Analysis of mutations in the SOS-1 gene in two Polish families with hereditary gingival fibromatosis

Abstract

Objectives

To establish whether two families from Malopolska and Mazovia Provinces in Poland are affected by hereditary gingival fibromatosis type 1, caused by a single-cytosine insertion in exon 21 of the Son-of-Sevenless-1 gene.

Material And Methods

Six subjects with hereditary gingival fibromatosis and five healthy subjects were enrolled in the study. Gingival biopsies were collected during gingivectomy or tooth extraction and used for histopathological evaluation. Total RNA and genomic DNA were purified from cultured gingival fibroblasts followed by cDNA and genomic DNA sequencing and analysis.

Results

Hereditary gingival fibromatosis was confirmed by periodontal examination, X-ray and laboratory tests. Histopathological evaluation showed hyperplastic epithelium, numerous collagen bundles and abundant to moderate fibroblasts in subepithelial and connective tissue. Sequencing of exons 19-22 of the Son-of-Sevenless-1 gene did not reveal a single-cytosine insertion nor other mutations.

Conclusions

Patients from two Polish families under study had not been affected by hereditary gingival fibromatosis type 1, caused by a single-cytosine insertion in exon 21 of the Son-of-Sevenless-1 gene. Further studies of the remaining regions of this gene as well as of other genes are needed to identify disease-related mutations in these patients. This will help to unravel the pathogenic mechanism of gingival overgrowth.

http://ift.tt/2oST7m2

Some posterior branches of extralaryngeal recurrent laryngeal nerves have motor fibers

Objectives/Hypothesis

Anatomical variations of the recurrent laryngeal nerve (RLN), such as extralaryngeal branching, are a well-known risk factor for RLN injury during thyroid surgery. This study aimed to analyze the surgical anatomy and to investigate the existence of posterior branch motor fibers of extralaryngeal RLNs.

Study Design

Prospective consecutive observational study.

Methods

This was a prospective cohort study of 366 patients between January 2014 and February 2016. Operative data included the type of operation, incidence of nerve bifurcation, the distances among anatomical landmarks. The motor fibers were evaluated using neurostimulation with laryngeal palpation.

Results

A total of 667 RLNs at risk were analyzed in this study, and of these 103 (14.5%) nerves were bifurcated or trifurcated before the laryngeal entry point (LEP). More extralaryngeal branched RLNs were observed on the right side than on the left (17.5% vs. 13.3%, P = .294). The mean distance of the LEP point of division was longer on the left side (16.2 ± 6.7 mm) than on the right (14.7 ± 5.9 mm, P = .132). All branched RLNs had a palpable laryngeal twitch when stimulating anterior branches. When stimulating posterior branches, 28.2%(29/103) of branched RLNs showed palpable laryngeal twitch. Overall incidence of posterior motor branch in total RLNs was 4.3% (29/667).

Conclusions

The motor fibers of the RLN are all located in the anterior branch, whereas some posterior branches have motor function. Identification of all of the branches of the RLN may be mandatory to decrease the risk of postoperative nerve injury.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2oYmaHc

The natural history of subjective tinnitus in adults: A systematic review and meta-analysis of no-intervention periods in controlled trials

Objectives

Tinnitus is a prevalent condition, but little has been published regarding the natural history of the condition. One technique for evaluating the long-term progression of the disease is to examine what happens to participants in the no-intervention control arm of a clinical trial. The aim of this study was to examine no-intervention or waiting-list data reported in trials, in which participants on the active arm received any form of tinnitus intervention.

Data Sources

CINAHL, PsychINFO, EMBASE, ASSIA, PubMed, Web of Science, Science Direct, EBSCO Host, and Cochrane.

Methods

Inclusion criteria followed the PICOS principles: Participants, adults with tinnitus; Intervention, none; Control, any intervention for alleviating tinnitus; Outcomes, a measure assessing tinnitus symptoms using a multi-item patient-reported tinnitus questionnaire. Secondary outcome measures included multi-item patient-reported questionnaires of mood and health-related quality of life and measures that quantified change in tinnitus loudness; Study design, randomized controlled trials or observational studies utilizing a no-intervention or waiting-list control group. Data were extracted and standardized mean difference was calculated for each study to enable meta-analysis.

Results

The evidence strongly favored a statistically significant decrease in the impact of tinnitus over time, though there was significant heterogeneity and clinical significance cannot be interpreted. Outcome data regarding secondary measures did not demonstrate any clinically significant change.

Conclusions

Participants allocated to the no-intervention or waiting-list control arm of clinical trials for a tinnitus intervention show a small but significant improvement in self-reported measures of tinnitus with time; the clinical significance of this finding is unknown. There is, however, considerable variation across individuals. These findings support previous work and can cautiously be used when counseling patients. Laryngoscope, 2017

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Differences in interregional brain connectivity in children with unilateral hearing loss

Objectives

To identify functional network architecture differences in the brains of children with unilateral hearing loss (UHL) using resting-state functional-connectivity magnetic resonance imaging (rs-fcMRI).

Study Design

Prospective observational study.

Methods

Children (7 to 17 years of age) with severe to profound hearing loss in one ear, along with their normal hearing (NH) siblings, were recruited and imaged using rs-fcMRI. Eleven children had right UHL; nine had left UHL; and 13 had normal hearing. Forty-one brain regions of interest culled from established brain networks such as the default mode (DMN); cingulo-opercular (CON); and frontoparietal networks (FPN); as well as regions for language, phonological, and visual processing, were analyzed using regionwise correlations and conjunction analysis to determine differences in functional connectivity between the UHL and normal hearing children.

Results

When compared to the NH group, children with UHL showed increased connectivity patterns between multiple networks, such as between the CON and visual processing centers. However, there were decreased, as well as aberrant connectivity patterns with the coactivation of the DMN and FPN, a relationship that usually is negatively correlated.

Conclusion

Children with UHL demonstrate multiple functional connectivity differences between brain networks involved with executive function, cognition, and language comprehension that may represent adaptive as well as maladaptive changes. These findings suggest that possible interventions or habilitation, beyond amplification, might be able to affect some children's requirement for additional help at school.

Level of Evidence

3b. Laryngoscope, 2017

http://ift.tt/2oYfqcq

Αρχειοθήκη ιστολογίου

Πέμπτη 20 Απριλίου 2017

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