Head and Neck Medicine by Alexandros G.Sfakianakis: 04/26/17

Τετάρτη 26 Απριλίου 2017

Randomized, controlled trial split-faced study of 595-nm pulsed dye laser in the treatment of acne vulgaris and acne erythema in adolescents and early adulthood

Abstract

The high prevalence of acne vulgaris in teenagers has increased comorbidities. Lasers offer alternative options for acne treatment because they have rapid action, low systemic adverse effects, and do not require everyday treatment. To study the efficacy and patients' satisfaction of 595-nm pulse dye laser (PDL) treatment of acne vulgaris and acne erythema in adolescents and early adulthood, we designed a blocked-randomized, split-faced 595-nm PDL (fluence 8 J/cm³ pulse duration 10 ms, spot size 7 mm, 2 session every 2 weeks) study in patients with mild to moderate acne by comparing the laser-treated and non-treated side. The acne lesion counts, acne erythema grading, and acne severity grading were evaluated at baseline and 2, 4, and 8 weeks. Thirty patients were recruited. The results showed no statistically significant difference except the papule count at week 4 which was −1.828 on the treated side and 0.103 on the non-treated side of the face, P-value 0.0018. There was no statistically significant difference of acne severity grading and acne erythema grading between both sides of the face. The mean scores of patients' satisfaction on the laser-treated side were 75, 81, and 81%, respectively. The PDL treatment in this study reveals no significant improvement in acne therapy; however, the patients were satisfied with this laser treatment.

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Hypersensitivity reactions in patients receiving hemodialysis

Publication date: Available online 26 April 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Lavjay Butani, Gianfranco Calogiuri
ObjectiveTo describe hypersensitivity reactions in patients receiving maintenance hemodialysis.Data SourcesPubMed search of articles published during the past 30 years with an emphasis on publications in the past decade.Study SelectionsCase reports and review articles describing hypersensitivity reactions in the context of hemodialysis.ResultsPharmacologic agents are the most common identifiable cause of hypersensitivity reactions in patients receiving hemodialysis. These include iron, erythropoietin, and heparin, which can cause anaphylactic or pseudoallergic reactions, and topical antibiotics and anesthetics, which lead to delayed-type hypersensitivity reactions. Many hypersensitivity reactions are triggered by complement activation and increased bradykinin resulting from contact system activation, especially in the context of angiotensin-converting enzyme inhibitor use. Several alternative pharmacologic preparations and dialyzer membranes are available, such that once an etiology for the reaction is established, recurrences can be prevented without affecting the quality of care provided to patients.ConclusionAlthough hypersensitivity reactions are uncommon in patients receiving hemodialysis, they can be life-threatening. Moreover, considering the large prevalence of the end-stage renal disease population, the implications of such reactions are enormous. Most reactions are pseudoallergic and not mediated by immunoglobulin E. The multiplicity of potential exposures and the complexity of the environment to which patients on dialysis are exposed make it challenging to identify the precise cause of these reactions. Great diligence is needed to investigate hypersensitivity reactions to avoid recurrence in this high-risk population.

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Higher fractional exhaled nitric oxide and Der p 1 exposure in children with asthma living in tropical environments

Publication date: Available online 26 April 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Miguel J. Lanz, Mirna M. Gonzalez, Benjamin J. Efaw, Ronald J. Harbeck

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Lupus miliaris disseminatus faciei: A resistant case with response to cyclosporine

Abstract

Lupus miliaris disseminatus faciei (LMDF) is a chronic, inflammatory dermatosis of unknown etiology, characterized by multiple, monomorphic, symmetrical, reddish-brown papules over forehead, cheeks, and eyelids. Histopathology shows perifollicular epitheloid cell granuloma. Though numerous therapies, ranging from cyclines, macrolides, dapsone tranilast, isotretinoin, steroids, and tacrolimus have been tried, the results are inconsistent, except with systemic steroids. One approach is to administer therapies based on the histological findings and the corresponding mode of action of drugs, thus antibiotics and dapsone are effective in the early inflammatory stage while clofazamine can be used in the granulomatous stage of the disease. A case of LMDF, recalcitrant to multiple systemic therapies, who responded dramatically to cyclosporine (50 mg twice daily), which probably was due to the specific effect on T_H1 cell response which mediates cell mediated immunity responsible for granulomatous changes on histology has been reported. This case highlights that LMDF is an independent granulomatous entity (not a variant of rosacea or tuberculosis).

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Announcement

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Periodontitis and risk of psoriasis: another comorbidity

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Better data on psoriasis and psyche: but do they really reach the clinician?

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Forthcoming Events

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Issue Information

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Increased filaggrin expression in oral lichenoid lesions: is this cause or effect?

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Influence of surface modified dental implant abutments on connective tissue attachment: A systematic review

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Mónica Blázquez-Hinarejos, Raúl Ayuso-Montero, Enric Jané-Salas, José López-López
ObjectiveDetermine whether surface modified prosthetic abutments for dental implants influence connective tissue attachment to the implant-abutment system.DesignA systematic review was conducted using the MEDLINE-PubMed database, with two independent reviewers filtering the titles and abstracts. Two reviewers assessed all potentially relevant articles. An assessment was carried out on the level of evidence of the research according to the guidelines of the Oxford Centre for Evidence-Based Medicine (OCEBM).ResultsAfter an initial search, 109 potentially relevant articles were found. After reading the titles and abstracts, 99 articles were excluded because the surface treatment was limited to the implant and not to the abutment, or because different materials were analysed instead of surface treatments; 28 were also duplicate articles. An additional 6 research studies were included that were of interest and were found by reading the references of the included articles. The studies included are: 7 in vitro studies, 5 experimental studies in animals, 2 clinical trials in humans and 2 clinical cases.ConclusionSurface modification for prosthetic abutments on dental implants can achieve connective tissue attachment to the abutment; however, more studies should be conducted in humans to obtain more and better evidence of these results.

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Stimulation of human gingival fibroblasts viability and growth by roots treated with high intensity lasers, photodynamic therapy and citric acid

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Paula Stephania Brandão Hage Karam, Rafael Ferreira, Rodrigo Cardoso Oliveira, Sebastião Luiz Aguiar Greghi, Maria Lúcia Rubo de Rezende, Adriana Campos Passanezi Sant'Ana, Mariana Schutzer Ragghianti Zangrando, Carla Andreotti Damante
ObjectiveThe aim of this study was to compare the effect of root biomodification by lasers, citric acid and antimicrobial photodynamic therapy (aPDT) on viability and proliferation of human gingival fibroblasts (FGH).DesignGroups were divided in control (CC – only cells), and root fragments treated by: scaling and root planing (positice control – SC), Er:YAG (ER–60mJ,10pps,10Hz,10s,2940nm), Nd:YAG (ND–0.5W,15Hz,10s,1640nm), antimicrobial photodynamic therapy (PDT–InGaAIP,30mW,45J/cm²,30s,660nm,toluidine blue O), citric acid plus tetracycline (CA). Fibroblasts (6th passage, 2×10³) were cultivated in a 24-h conditioned medium by the treated root fragments. Cell viability was measured by MTT test at 24, 48, 72 and 96h. In a second experiment, FGH cells (10⁴) were cultivated on root fragments which received the same treatments. After 24, 48, 72h the number of cells was counted in SEM pictures. In addition, chemical elements were analyzed by energy dispersive spectroscopy (EDS). Data was analyzed by two-way ANOVA (first experiment), repeated measures ANOVA (second experiment) and ANOVA (EDS experiment) tests complemented by Tukey's test (p<0.05).ResultsND, PDT and CA promoted higher cell viability (p<0.05). ND and ER groups presented higher number of cells on root surfaces (p<0.05). ER group presented higher calcium and CA group a higher carbon percentages (p<0.05).ConclusionsAll treatments but scaling and root planing stimulated fibroblast viability while Er:YAG and Nd:YAG treated root surfaces presented higher number of cells.

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Influence of surface modified dental implant abutments on connective tissue attachment: A systematic review

Stimulation of human gingival fibroblasts viability and growth by roots treated with high intensity lasers, photodynamic therapy and citric acid

Dermoscopy pathology correlation in melanoma

Abstract

Dermoscopy is a widely used technique whose role in the clinical (and preoperative) diagnosis of melanocytic and non-melanocytic skin lesions has been well established in recent years. The aim of this paper is to clarify the correlations between the "local" dermoscopic findings in melanoma and the underlying histology, in order to help clinicians in routine practice.

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Issue Information

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Dermoscopic evaluation of melanonychia

Abstract

The prevalence of melanonychia is approximately 1%, and it is a common symptom encountered in daily practise. However, it may also be the first symptom of melanoma of the nail apparatus. Evaluation of adult melanonychia with clinical information and clinical images is sometimes difficult for clinicians. Dermoscopic observation provides important information based on the algorithm method. Melanonychia in children requires a different approach, because dermoscopic features observed in adult nail apparatus melanoma are generally observed in benign pediatric cases.

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Dermoscopy–pathology relationship in seborrheic keratosis

Abstract

Making a definitive diagnosis of seborrheic keratosis (SK) can be challenging for the naked eye due to its wide variation in clinical features. Fortunately, however, most cases of SK exhibit the typical dermoscopic findings of fissures and ridges, hairpin vessels with white halo, comedo-like openings, and milia-like cysts, all of which are helpful to distinguish SK from melanoma, melanocytic nevus, squamous cell carcinoma, basal cell carcinoma (BCC) and other skin tumors. Histopathologically, these dermoscopic characteristics correspond to papillomatous surface of the epidermis, enlarged capillaries of the dermal papillae, pseudohorn cysts in the epidermis opened to the surface of the lesion and intraepidermal cysts, respectively. Clinicians should bear in mind that the clonal type of SK dermoscopically mimics melanoma and BCC by the presence of globule-like structures, while regressing SK exhibits a granular pattern that is similar to the peppering found in melanoma. Furthermore, milia-like cysts alone are insufficient for a conclusive diagnosis of SK because melanoma in rare cases displays cysts along with other SK-like dermoscopic findings.

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Dermoscopy enhances insight into correct diagnosis

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Review of vasculature visualized on dermoscopy

Abstract

Dermoscopy is a useful tool for finding and screening skin tumors, especially skin cancers. It is well known that it is useful to diagnose pigmented tumors, such as melanocytic lesions. In recent years, after the publication of a revised two-step algorithm in 2010, dermoscopy gradually has been used to diagnose non-pigmented or non-melanocytic lesions based on their vascular structures. Some skin lesions have specific vascular structures that aid in diagnosis. In this review, I discuss the various patterns of the vascular structures and their distribution, focusing on their clinical importance and usefulness in daily medical treatment.

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Issue Information

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Abundance of the benign melanocytic universe: Dermoscopic–histopathological correlation in nevi

Abstract

The broad universe of "melanocytic nevi" includes a variety of different subtypes, which can be classified either due to their morphology, epidemiology, genetic alterations or risk for developing melanoma. Regarding morphology, on the one hand macroscopic/clinical and on the other hand histopathological appearance were used to subdivide in the past, often resulting in confusion and poor interobserver agreement, while nowadays dermoscopy presents the clinician's precious bridge between naked-eye examination and histopathological diagnostics, allowing prediction of the lesions' histopathology, follow up and monitoring over time without need of excision. The non-invasive dermoscopic examination relies on the assessment of colors, patterns and the distribution of both within a cutaneous lesion. Until today, the correspondence of certain dermoscopic colors and patterns to certain histopathological correlates has been reported for a huge amount of different cutaneous lesions. Moreover, the correspondence of certain dermoscopic features to certain body sites, age groups and pigmentary traits, but also to specific genetic alterations in lesions, has been broadly investigated. Dermoscopy has led us to a new understanding of melanocytic nevi's biology and evolution and, last but not least, to a new classification system, which we want to present herein.

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Candida albicans-induced pustular lesions in mice

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Estimating melanin location in the pigmented skin lesions by hue–saturation–lightness color space values of dermoscopic images

Abstract

The depth of melanin in the skin can be estimated roughly by observation of the color exhibited on dermoscopy. Currently, there are no objective methods to estimate it. The aim of the present study was to clarify the relationship between the depth of melanin in the skin and the color variation exhibited, and to objectively estimate the 3-D location of melanin in the pigmented skin lesions from dermoscopic images. Representative colors in dermoscopic images of acral compound nevus, Spitz nevus and blue nevus were evaluated by the subjectively perceived color on dermoscopy and objective values in hue–saturation–lightness color space values. Brown colors due to small quantities of superficial melanin in the skin had high saturation and low lightness values, whereas black colors due to large quantities of superficial melanin had low saturation and low lightness values. On the other hand, colors due to melanin in the dermis were perceived as blue–gray on dermoscopy, but extracted colors showed gray–brown hue and intermediate saturation and high lightness values. In all cases, extracted representative colors of pigmented skin lesions had similar hue values within the red–orange range. Objective estimation of the 3-D location of melanin in the pigmented skin lesions is possible by the saturation and lightness values of the colors extracted from dermoscopic images. Subjectively perceived colors of melanin, especially in the dermis, can be modified by the surrounding environment effect and blue color perception.

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Serum vitamin D level is related to disease severity in pediatric alopecia areata

Summary

Background

Alopecia areata (AA) is the most common cause of inflammatory hair loss. AA is considered an autoimmune disease and occurs with various autoimmune disorders. Recent studies have revealed connection between autoimmune diseases and vitamin D deficiency.

Objectives

In this study, we investigated vitamin D status in AA and its relationship with disease severity, number of patches, and disease duration.

Methods

This study included 20 pediatric patients with AA and 34 pediatric healthy controls. The serum vitamin D levels were evaluated.

Results

The mean serum 25(OH)D concentration of patients was 15.47±7.66 ng/mL and of control group was 11.09±10.53 ng/mL. There was no statistically significant difference between two groups (P: .084). Vitamin D concentration had significantly and negatively correlated with SALT score (P<.001 and r: −.831), number of patch (P<.001 and r: −.989), and disease duration (P<.001 and r: −.997).

Conclusion

Vitamin D deficiency is not the only etiologic factor in AA pathogenesis, but in the presence of other etiological factors, this deficiency can aggravate AA severity, and thus, vitamin D supplementation may be beneficial in treatment of pediatric AA.

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Unilateral Fungal Sphenoiditis Presenting with Diplopia and Ptosis

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Efficacy of TRT Using Noise Presentation from Mobile Phone

Abstract

The purpose of tinnitus retraining therapy (TRT) is to induce habituation, first of the reaction to the tinnitus signal, and subsequently to habituate the perception of tinnitus itself. Habituation of sound is achieved through sound treatment which involves the use of low-level broadband noise mainly through noise maskers. Noise maskers are costly hence there is a need to find an alternate source of noise like MP3 and mobile phones. The goal of present study was to find out whether persons with tinnitus may be successfully treated with TRT using sound treatment from the noise presented through mobile phones. Total 30 male adult patients with tinnitus were enrolled for TRT. TRT comprised of two activities i.e. directive counseling and sound treatment. The most efficient noise stimulus was tape recorded by presenting the noise in the sound field using speakers and was recorded using a digital tape recorder. The recorded noise was saved to the mobile phone of the person with tinnitus and was asked to play it using hands-free at the level which was just audible for the duration of 3–4 hours per day. The Tinnitus interview forms were used to measure: (1) Percentage awareness of tinnitus, (2) Percentage of the time it caused distress and (3) Number of life factors affected. After 6 months these measurements were repeated and an improvement score of 40% was taken as criteria for the significant success of TRT. Out of 30 patients, 25 could continue coming for follow up sessions. Out of these 25 patients, 17 patients (68%) showed significant improvement. The sound treatment may be provided with the help mobile phones, which is a cheaper substitute for costly noise maskers.

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Hypersensitivity reactions in patients receiving hemodialysis

To describe hypersensitivity reactions in patients receiving maintenance hemodialysis.

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Higher fractional exhaled nitric oxide and Der p 1 exposure in children with asthma living in tropical environments

The interaction between environmental exposure and airway inflammation in pediatric asthma is multifactorial, but a specific clinical association exists.1,2 We attempted to study allergens common to our patient population who live in 2 distinctly different indoor environments and their effect on markers of airway inflammation. Our primary objective was to evaluate specific allergen sensitivities and exposures that would affect clinical airway inflammatory markers.3,4 Skin test results and levels of indoor allergens of dust mites, cat, dog, and cockroach were examined and compared with respiratory markers, fractional exhaled nitric oxide (FeNO) and spirometry, and systemic atopic markers, serum eosinophils, and total IgE.

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Modification of orbital retractor to facilitate the insertion of orbital wall implants

The reconstruction of a fractured orbital wall requires both the adaptation and correct positioning of an orbital implant.1 Patient-specific, 3-dimensional, printed models are helpful in the adaptation of the titanium mesh and for navigation inside the orbit. The ideal position of the implant, however, can be challenging.

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Prospective, longitudinal assessment of quality of life in patients with cancer of the head and neck and their primary carers

Cancer of the head and neck has profound psychosocial and physical effects on patients, so quality of life (QoL) is an essential consideration—not only is it of importance to the patient but it also provides a subjective measure of the success of treatment. However, we know of little work about its influence on carers. The aim of this study was to assess the impact of the diagnosis and treatment on the QoL of patients and their carers from baseline (preoperatively) to three months postoperatively.

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Incidence of salivary side effects after radioiodine treatment using a new specifically-designed questionnaire

Sialadenitis is one of the common complications of radioiodine treatment for thyroid malignancy. The aim of this study was to evaluate the prevalence of radioiodine-induced sialadenitis and other side effects by using a self-administered questionnaire. From 1 January 2011 to 31 December 2012 all consecutive patients with a newly-established diagnosis of thyroid cancer who were treated with adjuvant radioiodine at La Timone University Hospital were sent a self-administered questionnaire on salivary complaints that had been specifically designed for this study.

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Akzeptanz emotionssensitiver Trainingssysteme von Patienten mit Fazialisparese und deren Angehöriger

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-100764

Neue telemedizinische Technologien können Versorgungsprobleme lösen, die durch den demografischen Wandel erwartet werden. Die vorliegende Studie untersuchte deshalb die Akzeptanz emotionssensitiver Trainingssysteme für Menschen mit Fazialisparese. Es wurden N=76 Patienten mit Fazialisparese und N=44 Angehörige mit Fragebögen befragt (Technikakzeptanz, Technikaffinität, körperliche und psychische Lebensqualität (SF36), Depressivität (PHQ9), soziale Ängste (LSAS) und Funktionsstörungen einzelner Gesichtsregionen (FACE, nur Patienten)). Selbsterstellte Items erfassten die Einstellung hinsichtlich des erwarteten therapeutischen Nutzens, Datenschutz, und Mensch-Trainingssystem-Interface. Patienten- und Angehörigengruppe wurden im Hinblick auf die Mittelwerte der Fragebogenskalen verglichen. Prädiktoren der Akzeptanz der Patienten wurden mit einem Strukturgleichungsmodell untersucht. Patienten und deren Angehörige beurteilten Nutzen, Datenschutz und Gestaltung des Interfaces durchgängig positiv. Es gab keine signifikanten Unterschiede zwischen Patienten und Angehörigen. Der stärkste Prädiktor für die Technikakzeptanz der Patienten war die Technikkompetenz. Des Weiteren war die Akzeptanz umso größer, je depressiver die Patienten und je eingeschränkter ihre Mimik war. Emotionssensitive Trainingssysteme scheinen aus Sicht der Befragten eine sinnvolle therapeutische Option darzustellen. Insbesondere Patienten mit starken Beeinträchtigungen würden solche Technologien akzeptieren. Bei der Entwicklung solcher Systeme sollte auf eine einfache Bedienbarkeit geachtet werden. New technologies in telemedicine may be able to solve impeding supply gaps which are associated with demographic change in Germany. This study evaluated the acceptance of emotion-sensitive training systems for individuals with facial palsy. 76 patients with facial-paralysis and 44 of their relatives where surveyed for technology acceptance and affinity, mental and physical health-related quality of life (HrQoL), depression (PHQ9), social anxiety (LSAS) and dysfunction of facial expression (FACE, patients only). Additional items assessed the patients̓ attitudes regarding therapeutic benefit, data protection and design of human-machine-interfaces. We compared patients and their relatives with univariate tests. Predictors of the patients' technology acceptance were analysed using a Structural Equation Model. Patients and their relatives reported positive attitudes towards therapeutic benefit, data protection and design of the interfaces. No significant differences between both groups were found. The strongest predictor of patients̓ technology acceptance was their technical competence. Furthermore, patients with more severe impairment of facial expression and higher depression scores rated significantly higher acceptance. Emotion-sensitive training systems for patients with facial palsy seem to be a useful therapeutic option if the patients̓ attitudes are considered. Especially patients with severe impairment would accept telemedicine technologies. One focus of the development of such systems should be easy handling of human-machine-interfaces.
[...]

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

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Clinical Pathologic Conference: Acute Onset Malocclusion and Facial Pain

Publication date: Available online 26 April 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Mina D. Fahmy, Anish Gupta, Amrou Abdelkader, Theodore MacKinney, Steven Sewall

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Oral mass revealing Chédiak–Higashi syndrome

This case report describes common oral inflammatory findings leading to the identification of Chédiak–Higashi syndrome (CHS). A 15-year-old girl presented with an enlarging and painful mass on the upper lip. Two weeks after the initial visit, the mass showed further protrusion in the absence of fever. Magnetic resonance imaging revealed a well-circumscribed cystic lesion with a thick capsule, and suggested an abscess derived from the mucous cyst in the upper lip. Inflammation indices were not elevated; however neutrophils were significantly lower than the normal level.

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How to treat a patulous Eustachian tube

We would like to comment on the manuscript entitled "Endoscopic autologous cartilage injection for the patulous Eustachian tube" by Oh et al. [1]. This is an interesting study and excellent work. Although a patulous Eustachian tube (ET) is not usually seen in otorhinolaryngology clinics, it may cause aural fullness and autophony of the voice or breath sounds, negatively affecting the patient's quality of life. The relief of these symptoms is important. Although many scholars have proposed treatment methods, no ideal method has been developed due to the small sample size, short follow-up, and complications seen in the various studies.

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Why are we still unable to accurately determine the malignant potential or the behavior of oral mucosal lesions?

Despite technological advances in medicine, health care providers struggle with the inability to determine the malignant potential of oral mucosal lesions and consequently, the insufficiency in early diagnosis of oral mucosal malignancies. Due to the relatively rare occurrence of oral malignant disease, differentiating ominous lesions of the oral mucosa from much more common benign lesions is challenging since these lesions may have similar appearances and they may not cause clinical complaints of malignant lesions until reaching an advanced stage [1,2].

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Human papillomavirus-associated oropharyngeal cancer: Prioritizing preventive policies in males

The incidence of oropharyngeal cancer (OPC) has increased in the last two decades in spite of the global reduction in tobacco use, the primary risk factor for this neoplasm [1]. This fact has been attributed to OPC's association with human papillomavirus (HPV) [1,2]. It is expected that if the incidence of HPV-associated OPC continues to increase, it will exceed the HPV-associated cervical cancer in prevalence by 2020 [3].

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Teaching and practice patterns of lateral osteotomies for rhinoplasty

Publication date: Available online 26 April 2017
Source:American Journal of Otolaryngology
Author(s): Jenny X. Chen, Elliott D. Kozin, Matthew M. Dedmon, Linda N. Lee
PurposeLateral osteotomies are important during rhinoplasty and represent a challenging technique that otolaryngology and plastic surgery trainees must learn. The approaches for osteotomies are difficult to teach as they are accomplished through tactile feedback. Trends in teaching and practice patterns of lateral osteotomies are poorly described in the literature, and this study aims to fill this knowledge gap.Materials and methodsMembers of the American Academy of Facial Plastic and Reconstructive Surgery were surveyed to characterize surgeon preferences for intranasal versus percutaneous lateral osteotomies and understand how techniques are taught.ResultsAmong surgeons who completed the survey (n=172), 87% reported that they "always" or "mostly" use intranasal lateral osteotomies whereas only 8% "always" or "mostly" use percutaneous approaches. There is no significant trend towards changing osteotomy techniques when teaching trainees. Only 15% of respondents allow trainees to perform lateral osteotomies in more than half of operations.ConclusionsMost facial plastic surgeons prefer to use intranasal lateral osteotomies. However, many do not allow trainees to perform this critical step during rhinoplasty. This study has implications for both patient care and surgical education.

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Skull base osteomyelitis secondary to malignant otitis externa mimicking advanced nasopharyngeal cancer: MR imaging features at initial presentation

Publication date: Available online 26 April 2017
Source:American Journal of Otolaryngology
Author(s): J.P.N. Goh, A. Karandikar, S.C. Loke, T.Y. Tan
PurposeSkull base osteomyelitis (SBOM) is an inflammatory process which often arises from malignant otitis externa (MOE); the diffuse skull base and adjacent soft tissue involvement may be mistaken at initial imaging for advanced nasopharyngeal carcinoma (NPC), especially if there is no prior knowledge of MOE, direct spread from the sphenoid sinus or in atypical presentations of MOE. This study aims to evaluate imaging features on MR that may differentiate SBOM from NPC.Materials and MethodsThe MR examinations of 26 patients diagnosed with SBOM between January 1996 and January 2013 were retrospectively reviewed. Comparison was also made with the MR images of 22 consecutive patients with newly diagnosed advanced T3 and T4 NPC between July 2011 and August 2012. Imaging features in both conditions were compared, including the presence of a nasopharyngeal bulge, nasopharyngeal mucosal irregularity, lateral extension, architectural distortion (or lack thereof), increased T2 signal and enhancement patterns.ResultsThe most prevalent findings in SBOM were lateral extension, increased T2 signal in adjacent soft tissues, lack of architectural distortion and enhancement greater than or equal to mucosa. The combination of these 4 findings was found to best differentiate SBOM from advanced NPC, and found to be statistically significant (p<0.001).ConclusionWe suggest that the combination of lateral extension, increased T2 signal, lack of architectural distortion and enhancement greater than or equal to mucosa is helpful in differentiating SBOM from advanced NPC.

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Retrospective analysis of skin complications related to bone-anchored hearing aid implant: association with surgical technique, quality of life, and audiological benefit

Publication date: Available online 25 April 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Daniel Peñaranda, Juan Manuel Garcia, Maria Leonor Aparicio, Felipe Montes, Clemencia Barón, Roberto C. Jiménez, Augusto Peñaranda
IntroductionThe bone-anchored hearing aid is an effective form of auditory rehabilitation. Due to the nature of the implant, the most common complications are skin related. A number of alternative surgical implantation techniques have been used to reduce the frequency and severity of skin complications, including the U-shaped graft and the linear incision.ObjectiveTo assess skin complications and their association with surgical technique, quality of life, and audiological benefit in patients with bone-anchored hearing aids.MethodsThis was a retrospective study conducted in a tertiary referral center in Bogotá, Colombia. Patients who had been fitted with a bone-anchored hearing aid implant (unilaterally or bilaterally) for at least 6 months were included in the study. The Holgers classification was used to classify skin complications (Grade 0=none; Grade 1=erythema; Grade 2=erythema and discharge; Grade 3=granulation tissue; and Grade 4=inflammation/infection resulting in the removal of the abutment). The Glasgow Benefit Inventory questionnaire was used to determine quality of life, and the Abbreviated Profile of Hearing Aid Benefit questionnaire was used to determine the subjective audiological benefit.ResultsA total of 37 patients were included in the study (30 with unilateral implants and 7 with bilateral implant). Of the 44 implants evaluated, 31 (70.3%) were associated with skin complications (7 [15.9%] Grade 1; 4 [9.1%] Grade 2; 15 [34.1%] Grade 3, 5 [11.4%] Grade 4). The U-shaped graft was statistically associated with major complications (Grades 3 and 4) compared with the linear incision technique (p=0.045). No statistically significant differences were found between Abbreviated Profile of Hearing Aid Benefit scores and severity of complications. Similarly, no differences were found between Glasgow Benefit Inventory physical health questions and skin complications.ConclusionDespite the high frequency, skin complications did not seem to affect quality of life or subjective audiological benefits of patients with bone-anchored hearing aids.

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Functional Interplay Between the Putative Measures of Rostral and Caudal Efferent Regulation of Speech Perception in Noise

Abstract

Efferent modulation has been demonstrated to be very important for speech perception, especially in the presence of noise. We examined the functional relationship between two efferent systems: the rostral and caudal efferent pathways and their individual influences on speech perception in noise. Earlier studies have shown that these two efferent mechanisms were correlated with speech perception in noise. However, previously, these mechanisms were studied in isolation, and their functional relationship with each other was not investigated. We used a correlational design to study the relationship if any, between these two mechanisms in young and old normal hearing individuals. We recorded context-dependent brainstem encoding as an index of rostral efferent function and contralateral suppression of otoacoustic emissions as an index of caudal efferent function in groups with good and poor speech perception in noise. These efferent mechanisms were analysed for their relationship with each other and with speech perception in noise. We found that the two efferent mechanisms did not show any functional relationship. Interestingly, both the efferent mechanisms correlated with speech perception in noise and they even emerged as significant predictors. Based on the data, we posit that the two efferent mechanisms function relatively independently but with a common goal of fine-tuning the afferent input and refining auditory perception in degraded listening conditions.

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Functional Interplay Between the Putative Measures of Rostral and Caudal Efferent Regulation of Speech Perception in Noise

Abstract

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Chronic Opioid Use Following Surgery for Oral Cavity Cancer

This cohort study assesses the prevalence of chronic opioid use in patients undergoing surgery for oral cavity cancer and evaluates possible associated clinical factors.

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Margin Distance and Local Recurrence Rate in Oral Cancer Surgery

This cohort study of patients with surgically treated oral cavity squamous cell carcinoma evaluates the association between risk of local recurrence and different sizes, in 1-mm increments, of cancer-free surgical margins.

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Maintenance Treatment of Apatinib in Nasopharyngeal Carcinoma

Condition: Nasopharyngeal Carcinoma
Intervention: Drug: Apatinib mesylate tablet
Sponsors: Guilin Medical University, China; Wuzhou Red Cross Hospital; Guangxi Naxishan Hospital; National Hospital of Guangxi Zhuang Autonomous Region
Recruiting - verified April 2017

http://ift.tt/2qfhx8U

Study to Evaluate Immunological Response to PD-1 Inhibition in Squamous Cell Carcinoma of the Head and Neck (SCCHN)

Condition: Squamous Cell Carcinoma of the Head and Neck
Interventions: Drug: [18F]F-AraG PET Scan, baseline + post anti-PD-1 therapy.; Drug: [18F]F-AraG PET Scan, baseline + post anti-PD-1 therapy.
Sponsors: CellSight Tehnologies, Inc.; Stanford University
Not yet recruiting - verified April 2017

http://ift.tt/2pmfwdV

Oligo-metastases NPC Patients Received Radiation for Primary Tumors and Treatments for Metastatic Lesions

Conditions: Nasopharyngeal Cancer; Neoplasm Metastasis
Intervention: Radiation: radical radiotherapy
Sponsor: Zhejiang Cancer Hospital
Recruiting - verified April 2017

http://ift.tt/2qfgdTp

Occupational Dermatitis Associated With Pyemotes ventricosus

This case series examines 18 employees of a company that produced herbal medicines who experienced unusual pruritic dermatitis.

http://ift.tt/2piUvie

Annular Flaccid Pustules on the Trunk

This case examines a woman in her 50s who presented with itching skin lesions.

http://ift.tt/2q8deQe

Sweet’s-Like Infiltrate After Talimogene Laherparepvec Melanoma Treatment

This case report describes complete response of advanced melanoma treated with talimogene laherparepvec and subsequent Sweet's-like infiltrate

http://ift.tt/2pj82Xf

Errors in Figure Panel Labels

In the case report titled "BRAF V600E mutation in involuting nevus in a patient treated with vemurafenib," published online March 1, 2017, The Figure panel labels for panels C and D were incorrect. Each should read "Nevus specimen after complete excision." This article was corrected online.

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Suggestions for Increasing Diversity in Clinical Trials

To the Editor The article by Charrow et al discusses the gap in proportional racial representation in clinical trials. We applaud the authors for bringing this topic to the forefront. One shortcoming of the article, however, is that it does not discuss measures for correcting this gap. Therefore, the purpose of this letter is to provide suggestions derived from clinical trial literature to improve minority participation.

http://ift.tt/2piPkP7

Enhancing the Relevance of Skin Self-examination for Latinos

This study solicits information from Hispanic focus groups to enhance the relevance of skin self-examination in the Latino community.

http://ift.tt/2q86Mst

Connective Tissue Nevi in Tuberous Sclerosis Complex

This analysis of patient medical records and skin photography describes the clinical characteristics of connective tissue nevi on the trunk and extremities of patients with tuberous sclerosis complex.

http://ift.tt/2pj1o3b

Noninvasive 2-Gene Molecular Assay for Cutaneous Melanoma

This multiple-reader–multiple-case study examines the utility of a noninvasive pigmented lesion assay for LINC/PRAME expression in decisions by dermatologists to biopsy a series of suspicious skin lesions.

http://ift.tt/2q8wz3Q

Birth decade affects the sensitization pattern and asthma-risk in Finnish adult population

Abstract

Background

We have previously shown that sensitizations to several types of allergens distinguishes subjects with and without adult-onset asthma in Finland. The aim was to analyze how age affects sensitization and asthma-risk.

Methods

We used previous population-based case-control data (N=523) from Finnish adult asthma patients with one or two matched controls. Asthma was diagnosed based on a typical history of asthmatic symptoms and lung function tests. Allergic sensitization was determined by skin prick test (SPT) to 17 aeroallergens. Information on demographics was obtained by a questionnaire.

Results

Sensitization to more than one allergen type and the number of positive SPT reactions associated with younger age and asthma. Atopic subjects aged 65 or over were characterized by sensitization to only 1-2 allergens, with very few animal danders and without an association with asthma.

Conclusions

Multiple sensitizations and animal dander sensitization are more common among Finnish asthmatic adults aged under 56 than among older asthmatics. Cohort studies are needed to understand timing of host-environmental interactions behind this.

http://ift.tt/2piS2o5

Changing use and attitudes towards teledermatology in the UK over 10 years: results of the 2016 National Survey

Abstract

Dermatology has been described as a speciality in crisis in the UK, with a shortfall of 250 dermatologists nationally combined with steadily increasing referrals and skin cancer incidence¹. This has fuelled interest in teledermatology (TD). TD utilises telecommunication technology at a distance to exchange medical information. Most commonly this is via store and forward techniques, which involve transmission of patient images and information to a teledermatologist to enable consultation not in real-time.

http://ift.tt/2q837uQ

Paradoxical psoriasiform reactions to anti-TNFα drugs in hidradenitis suppurativa

Abstract

Paradoxical psoriasiform reactions to anti-tumor necrosis factor α (TNFα) agents occur with an incidence of 0.3 to 5.6% in patients with inflammatory bowel diseases and rheumatic diseases¹. Various clinical features have been described while histopathological findings often show lichenoid infiltrate, spongiosis associated with a psoriasiform pattern and a "type I interferon (IFN) signature " in immunohistochemistry²

http://ift.tt/2oMs2jS

Alitretinoin therapy for palmoplantar pustulosis

Abstract

We read with interest the RCT by Reich et al., and we found that the conclusion given: "this study provided no evidence to support further exploration of alitretinoin in the treatment of severe palmoplantar pustulosis (PPP)" should be carefully interpreted.¹ The authors found no significant difference in the percentage change in PPPASI between the alitretinoin (45.2% ±32.8 of improvement) and placebo (44.6%, ±45.9), 95% CI rate difference -31% to 32%.¹

http://ift.tt/2q8fpDI

Oral mass revealing Chédiak–Higashi syndrome

Publication date: Available online 26 April 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): T. Tsuji, Y. Uemura, Y. Nakamura, S. Nonoyama
This case report describes common oral inflammatory findings leading to the identification of Chédiak–Higashi syndrome (CHS). A 15-year-old girl presented with an enlarging and painful mass on the upper lip. Two weeks after the initial visit, the mass showed further protrusion in the absence of fever. Magnetic resonance imaging revealed a well-circumscribed cystic lesion with a thick capsule, and suggested an abscess derived from the mucous cyst in the upper lip. Inflammation indices were not elevated; however neutrophils were significantly lower than the normal level. Giant cytoplasmic granules in neutrophils, eosinophils, and lymphocytes, which are pathognomonic of CHS, were noted. The patient displayed brownish-red hair with some grey hair, and partial oculocutaneous albinism. Hepatosplenomegaly was evident on ultrasonography. The final diagnosis was of an oral infection facilitated by the adolescent form of CHS (gene CHS1/LYST at 1q42.1-2). This report offers a reminder that lip swelling may represent the initial manifestation of the inflammatory response in a patient with loss of immunocompetence due to pathologies such as CHS, and may rarely present as the patient's main complaint.

http://ift.tt/2oJvfQs

In this issue

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The “Crumple Zone” Hypothesis: Association of Frontal Sinus Volume and Cerebral Injury after Craniofacial Trauma

Publication date: Available online 25 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Stephen S. Cai, Corey Mossop, David S. Hersh, Silviu Diaconu, Sara AlFadil, Yvonne Rasko, Michael R. Christy, Arthur J. Nam
Purpose: The paranasal sinuses are complex anatomical structures of unknown significance. One hypothesis theorizes that the sinuses, in the event of a traumatic injury, function as a crumple zone to distribute and absorb energy to protect the brain and other critical structures. The current study investigates the association between frontal sinus (FS) volume and the severity of cerebral insults following craniofacial trauma.Methods: All patients with FS fracture admitted to a level 1 trauma center from 2011 to 2014 were retrospectively reviewed. FS volumes were measured from computed tomography (CT) on admission using a proprietary region growing segmentation tool. Head injuries were classified based on the presence of specific types of intracranial pathology and their corresponding Marshall Score.Results: FS fracture was identified on the admission CT in 165 patients. Male patients had significantly larger FS volume compared to females (8.4 ± 6.3 vs. 4.0 ± 2.9 cm3, p < 0.001). Smaller FS volume was significantly associated with a worse Marshall Score (p = 0.041) and a higher incidence of cerebral contusion (p = 0.016) independent of age, gender, mechanism, ISS, and admission GCS. The inverse correlation between FS volume and the Marshall Score was also statistically significant (Spearman correlation coefficient r = -0.19, p = 0.015). Smaller FS volume was observed in patients who suffered intracranial insults, underwent neurosurgical interventions, and had worse clinical outcomes and trended towards significance with respect to an association with subarachnoid hemorrhage (p = 0.074) and subdural hematoma (p = 0.080), and had a statistically significant association with longer length of stay (p < 0.001).Conclusion: FS volume is inversely correlated with the severity of intracranial pathology following craniofacial trauma. Our findings are consistent with the "crumple zone" hypothesis and suggest that the FS likely plays a role in mitigating intracranial injury. Furthermore, FS volume is significantly different between male and female patients. This is a novel finding that warrants further validation.

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Enteritis with pneumatosis intestinalis following rotavirus immunisation in an infant with short bowel syndrome

Rotavirus vaccines now form part of the national immunisation schedule in many countries. Contraindications to its use are few but do not currently include infants with short bowel syndrome (SBS). We present a nearly 3-month-old boy with SBS who developed enteritis with pneumatosis intestinalis following administration of the Rotarix vaccine.

http://ift.tt/2plxeOJ

Paracentral acute middle maculopathy: precursor to macular thinning in sickle cell retinopathy

We present a case of paracentral acute middle maculopathy (PAMM) in a patient with sickle cell disease (SCD). Though gradual capillary loss may contribute to pathophysiology of sickle cell retinopathy as well, our case suggests that PAMM may be the precursor lesion to macular thinning commonly observed in patients with SCD. In addition, fluorescein angiography may be unable to detect these acute vascular events occurring at the deep capillary plexus.

http://ift.tt/2oMh3qs

Re “International survey on skin patch test procedures, attitudes and interpretation” L.K. Tanno et al., WAOJ (2016) 9:8

A previous survey on the practice of diagnostic patch testing among representatives of member societies of the World Allergy Organization (WAO) has, in some countries, not addressed those stakeholders actually...

http://ift.tt/2q5wNWE

The efficacy of serratus anterior plane block in analgesia for thoracotomy: a retrospective study

Abstract

Purpose

A multimodal analgesic approach is necessary for post-thoracotomy pain, which can be severe. Intravenous access, central and peripheral nerve blocks are frequently used. The aim of this study was to evaluate the efficacy of serratus anterior plane block (SAPB) in the management of post-thoracotomy pain.

Methods

A total of 40 patients who underwent thoracotomy between January 2014 and January 2016 were retrospectively analyzed. The patients were divided into two groups: Group M (intravenous patient-controlled analgesia morphine; n = 20) and Group S (intravenous patient-controlled analgesia morphine + SAPB; n = 20). The Visual Analogue Scale (VAS) was used for pain evaluation at the 1st, 2nd, 4th, 6th, 8th, 12th and 24th postoperative hours and morphine consumption was evaluated at the 6th, 12th and 24th postoperative hours. Secondary outcomes were additional analgesic requirement, side effects, the Ramsay Sedation Scale (RSS) scores, block onset time and block level.

Results

The VAS scores and the amount of morphine consumed at the 6th, 12th and 24th hours were found to be significantly lower in Group S than in Group M (P < 0.001). No statistically significant difference was found in the rate of side effects, including nausea, vomiting, pruritus, respiratory depression, bradycardia and hypotension, and RSS outcomes between the groups.

Conclusion

Our study suggests that SAPB is an effective adjuvant treatment option for thoracotomy analgesia.

http://ift.tt/2qelMSj

“Spike” in acute asthma exacerbations during enterovirus D68 epidemic in Japan: A nation-wide survey

Publication date: Available online 25 April 2017
Source:Allergology International
Author(s): Seigo Korematsu, Kengo Nagashima, Yasunori Sato, Mizuho Nagao, Shunji Hasegawa, Haruna Nakamura, Shiro Sugiura, Katsushi Miura, Kenji Okada, Takao Fujisawa
BackgroundIn September 2015, Japan experienced an unusual increase in acute asthma hospitalizations of children that coincided with an enterovirus D68 (EV-D68) epidemic. The objective of this study is to investigate whether EV-D68 had a causal relationship with the spike in asthma hospitalizations.MethodsA nation-wide retrospective survey of asthma hospitalizations of children was performed for the period from January 2010 through October 2015. The Japanese Society of Pediatric Allergy and Clinical Immunology asked its affiliated hospitals to report monthly numbers of hospitalizations, ICU admissions and mechanical ventilations due to acute asthma exacerbation. The data were retrieved from medical databases using predefined search criteria: diagnosis of asthma or asthmatic bronchitis, admission, and age <20 years. Monthly numbers of EV-D68 detection were also obtained from the Infectious Disease Surveillance Center of Japan. A Granger causality test was used to analyze the association of EV-D68 detections for asthma exacerbation.ResultsA total of 157 hospitals reported 87,189 asthma hospitalizations, including 477 ICU admissions and 1193 mechanical ventilations, during the survey period of 5 years and 10 months. The numbers of these events increased drastically in September 2015. The Granger causality test verified the association between EV-D68 and asthma hospitalizations/mechanical ventilations. The most-affected age group was 3–6 years old.ConclusionsThe spike in pediatric asthma hospitalizations in Japan in September 2015 was found to be associated with the EV-D68 epidemic. Respiratory pathogens can cause "epidemics" of asthma exacerbation. Coordinated surveillance of infectious diseases and asthma may be beneficial for prevention and better control of both illnesses.

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Primary aortojejunal fistula: a rare cause for massive upper gastrointestinal bleeding

A 68-year-old man presented to the emergency department with haematemesis and shock. Upper endoscopy and selective angiography could not identify the source of bleeding. He underwent selective embolisation of the gastroduodenal artery. The patient then had a period of about 24 hours with relative haemodynamic stability before having another episode of massive upper gastrointestinal bleed. A second attempt to embolise the common hepatic artery and distal coeliac axis was unsuccessful. Hence, he was urgently taken to the operating room for exploratory laparotomy. The source of bleeding could not be identified in the operating room. The patient went into cardiac arrest and expired. Autopsy revealed a fistula between proximal jejunum and a previously unknown abdominal aortic aneurysm (AAA). We present an entity that has only been described a few times in the literature while highlighting the importance of having a broad differential with upper gastrointestinal bleeding, especially when the source is not clearly evident.

http://ift.tt/2pkZn8I

Revisiting propafenone toxicity

Propafenone is a Vaughan Williams class 1c antiarrhythmic medication widely used for treatment of arrhythmias. Although the long-term safety of propafenone use has not been established, it is commonly used for treatment of atrial fibrillation in patients with no structural heart disease. Propafenone is well known as pill-in-the-pocket treatment for its effect in terminating paroxysmal episodes of atrial fibrillation. Herein, we discuss an unusual adverse reaction to propafenone in a patient who presented with symptomatic bradycardia and hypotension. The aim of this article is to increase physician awareness for propafenone toxicity and its management, with a focused literature review on propafenone pharmacotherapy.

http://ift.tt/2q50xTp

Unusual cause for testicular swelling in a child

Myeloid sarcoma is a rare solid tumour composed of primitive precursors of granulocytic series of white blood cells involving extramedullary anatomic site. Here we report the case of a 10-month-old with testicular swelling, who was finally diagnosed with granulocytic sarcoma. This case demonstrates that Granulocytic sarcoma should be considered as a part of the differential diagnosis for testicular swelling in spite of having normal peripheral counts and absence of hepatosplenomegaly.

http://ift.tt/2plciaG

Haemophagocytic lymphohistiocytosis as a consequence of untreated B-cell chronic lymphocytic leukaemia

Haemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening syndrome characterised by defective cytotoxic function and hypercytokinaemia leading to macrophage expansion and haemophagocytosis. Patients often present with unexplained fevers, hepatosplenomegaly and pancytopenia, with elevation in serum ferritin and triglyceride. Acquired forms are triggered by infection, malignancy or rheumatological disorders. HLH in the setting of chronic lymphocytic leukaemia is rarely reported, however, and is usually associated with infection or as a consequence of chemotherapy. We present a case of HLH in a 64-year-old Caucasian woman with the only identified trigger being her hitherto untreated CLL.

http://ift.tt/2q50wij

Alveolar soft part sarcoma presenting with back pain

Description

A 35-year-old man was referred to the Sarcoma service with a 2-year history of worsening back pain, left-sided radicular pain and a mass on CT scan. In the 6 months following the onset of the back pain, he developed progressive numbness and paraesthesia in the L2 dermatome. This was worse on standing. On clinical examination, power was unaffected but somewhat limited by pain. No 'red flag' symptoms were present (table 1). The CT scan demonstrated a large retroperitoneal mass on the left with invasion into the L2 vertebra (figure 1 and 2) and bilateral pulmonary metastases. USS-guided biopsy revealed high grade alveolar soft part sarcoma. He was started on palliative radiotherapy (30 Gy and 10 fractions) and given six cycles of doxorubicin and ifosfamide. Imaging at 8 months postdiagnosis has indicated stable disease.

Table 1

'Red flag' symptoms of back pain4...

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Severe chronic diarrhoea secondary to primary lymph node gastrinoma

The existence of primary lymph node (LN) gastrinoma is questionable and controversial. In fact, the presence of gastrinoma in such uncommon site raises the possibility of metastasis from another occult primary site. An extensive evaluation and careful follow-up is always warranted. A female aged 48 years presented with chronic abdominal pain and watery diarrhoea. Her serum gastrin and chromogranin were elevated, and an underlying gastrinoma was suspected. Further evaluation with an octreotide scan, an endoscopic ultrasound and a secretin stimulation test confirmed the diagnosis. Further evaluation for multiple endocrine neoplasia-1 syndrome was negative. She underwent a surgical enucleation near the head of the pancreas. No other lesions were found after careful exploration of the gastrinoma triangle. Histology showed a LN with a neuroendocrine tumour that tested positively with gastrin and chromogranin stains. Her symptoms resolved postoperatively, her serum gastrin normalised and a repeated octreotide scan was negative.

http://ift.tt/2q4V0w8

Secondary parkinsonism in a patient of psychogenic polydipsia

A 44-year-old man presented with history of slurring of speech, slowness in activities, abnormal posturing of the upper limbs and drooling of saliva from the mouth. He had a 5-yearlong history of compulsive water drinking, consuming 12–15 L of water every day. He was earlier evaluated for the same and found to have low serum sodium (126 mEq/L). Presently, he was admitted at a primary care facility with fever and altered sensorium. He was found to have serum sodium of 94 mEq/L. His sensorium improved with hypertonic saline infusion; however, after a lucid interval of 48 hours, he developed florid extrapyramidal symptoms. Contrast-enhanced MRI brain revealed bilaterally symmetric T2-weighted fluid-attenuated inversion recovery hyperintensity in caudate and lentiform nuclei. A diagnosis of extrapontine myelinolysis with secondary parkinsonism was made. He improved significantly with levodopa therapy.

Psychogenic polydipsia is an important cause of hyponatraemia. Overzealous correction of hyponatraemia can be counterproductive.

http://ift.tt/2pldzOL

Delayed diagnosis of pulmonary tuberculosis in a 13-year-old Malawian boy

Childhood tuberculosis (TB) is a significant global health burden. There are more than 1 million new cases of childhood TB annually. Despite this, many national TB control programs largely focus on identification and treatment of smear positive adults. Early case detection is essential if childhood TB is to be controlled and eradicated.

Delayed diagnosis of TB is associated with more advanced disease and worse treatment outcomes. Younger children who go undiagnosed for long periods are at risk of developing severe pulmonary and extrapulmonary disease, such as meningitis. Additionally, advanced childhood TB is a common respiratory cause of death in TB-endemic areas. Undoubtedly, delayed diagnosis contributes significantly to TB-related morbidity and mortality.

Diagnostic delay may be divided into patient delay, the duration between development of symptoms and presentation to healthcare provider, and healthcare provider delay, the duration between presentation and initiation of appropriate treatment.

http://ift.tt/2q5eP6z

Spontaneous ruptured iliac artery aneurysm causing acute secondary AV fistula

A 73-year-old woman presented with a 6-hour history of sudden onset lower abdominal pain. Her comorbidities included chronic obstructive pulmonary disease and hypertension. She was under surveillance for a known thoracoabdominal aneurysm. On presentation, she was hypotensive with a systolic blood pressure of 50 mm Hg and a pulse of 60 beats per minute. On examination, she had a pulsatile mass with bruit in her right lower abdomen. Pedal pulses were palpable in both feet. Blood gas analysis revealed a metabolic acidosis with a pH of 7.21 and a lactate of 7.1. Haemoglobin remained stable between 90–100 g/dL. Her other routine blood tests were unremarkable, and blood cultures were negative. Imaging showed a ruptured right common iliac artery aneurysm into the right common iliac vein with secondary arteriovenous fistula communication. Surgical intervention was discussed with the patient but due to her frailty, it was deemed not in the patient's best interests.

http://ift.tt/2pl3Jwk

Eculizumab in a child with atypical haemolytic uraemic syndrome and haemophagocytic lymphohistiocytosis triggered by cytomegalovirus infection

We present the case of a 21-month-old girl with two rare and life-threatening conditions, atypical haemolytic uraemic syndrome (aHUS) and haemophagocytic lymphohistiocytosis (HLH), triggered by a cytomegalovirus (CMV) infection. Soon after admission, the girl became anuric and required continuous venovenous haemodiafiltration.

Initial treatments included methylprednisolone, fibrinogen and plasma infusion (for HLH), plasmapheresis (for thrombotic microangiopathy), immunoglobulins (for inflammation), ganciclovir (for CMV infection) and the antibiotic cefotaxime. On day 5, eculizumab (600 mg) was given for aHUS, with rapid improvement in haematological and nephrological parameters. Despite a subsequent isolated episode of right heart thrombosis that resolved with heparin treatment, the patient showed a favourable response to eculizumab (300 mg/15 days), with improved renal function, normal haematological values, and no treatment complications. In conclusion, eculizumab effectively treated aHUS in this case despite a comorbid immunological disease.

http://ift.tt/2q4Wk26

Cystic artery pseudoaneurysm following acute necrotising pancreatitis

Cystic artery pseudoaneurysm is a rare pathology. Of the 20 cases reported so far, chronic cholecystitis and iatrogenic biliary injury form the majority of causes. Currently, there is no published report of such pseudoaneurysms caused secondary to pancreatitis, hence the management in such a scenario is unclear. We hereby present the first such report of cystic artery pseudoaneurysm occurring as a sequel of acute necrotising pancreatitis. A 33-year-old man who recovered from a recent attack of acute pancreatitis was readmitted for melena and fever. Computed tomography of abdomen revealed blood in the gall bladder with pericholecystic blush and resolving pancreatic necrosis. Percutaneous transarterial embolisation of the cystic artery was done. This stabilised the patient but persistent sepsis and clinical deterioration warranted a surgical exploration and cholecystostomy. Hence, transarterial embolisation followed by surgery in selected cases can be an ideal management protocol.

http://ift.tt/2plfpiF

Complicated acute cerebellitis with obstructive hydrocephalus and tonsillar herniation in a child

Acute cerebellitis (AC) is a rare inflammatory syndrome presenting as cerebellar dysfunction, seen more frequently in children. AC can have a variable course with features of cerebellar dysfunction, raised intracranial pressure and neurological deficits, and can sometimes even be potentially fatal due to complications such as obstructive hydrocephalus and brainstem compression, warranting surgical intervention. We report a case of a 12-year-old boy who presented with raised intracranial pressure and ataxia. Imaging with CT and MRI showed AC with obstructive hydrocephalus and tonsillar herniation. He was managed with medications for raised intracranial pressure and with ventriculoperitoneal shunt, and he recovered completely over a period of 2 weeks. Imaging has an important role in the diagnosis of AC and in differentiating it from acute cerebellar ataxia, which has a more benign course. It is crucial to diagnose and promptly manage the rarely occurring but life-threatening complications of AC.

http://ift.tt/2q4Zgfm

Pure form of Ackermanns tumour of the tongue in a young female patient

Description

A 28-year-old female presented to our outpatient department with a painless, well-circumscribed keratotic, exophytic lesion with broad base over the left lateral aspect of the tongue (figure 1). The lesion had a rough, shaggy, papillomatous surface with sharp finger-like surface projections with no surrounding induration (figure 2). She did not have any habits relevant to history. A biopsy performed at a different centre earlier to her visit here suggested of verrucous hyperplasia. Taking into consideration the history of lesion progression and the gross appearance of the lesion, a strong suspicion of verrucous carcinoma (VC) was made. A wide local excision of the lesion with 1-cm margin was done (figure 3). The histopathology showed a verrucoid lesion lined by hyperkeratotic, acanthotic and focally inflamed stratified squamous epithelium with papillomatosis and broad and fused rete with cells showing mild anisonucleosis, overlying fibrocollagenous stroma with dense...

http://ift.tt/2pl5hqp

Writing otorhinolaryngology head & neck surgery operative reports

Publication date: Available online 4 April 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): O. Laccourreye, F. Rubin, A. Villeneuve, P. Bonfils
Only about ten articles devoted to operative reports have been published in the medical literature, but this document is essential, both medically and legally, to ensure optimal management of operated patients. In this technical note, based on published studies on this subject, the authors describe the key features of operating reports after otorhinolaryngology head & neck surgery and emphasize the need to write this document during the minutes after the end of the operation, the importance of standardization and its teaching role during surgical training.

http://ift.tt/2qebq4U

Endoscopic endonasal excision of nasal chondromesenchymal hamartoma with intracranial extension

Publication date: Available online 4 April 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): M. Nakaya, S. Yoshihara, A. Yoshitomi, S. Baba
IntroductionNasal chondromesenchymal hamartoma (NCMH) is an extremely rare benign hamartoma of the sinonasal tract, predominantly involving infants and young children.MethodsWe report the case of a 3-year-old boy of NCMH with extension to anterior skull base.ResultsThe tumor was completely resected piece by piece via an endonasal endoscopic approach. There is no recurrence 3 years after operation.ConclusionsWe reported the case of NCMH extending to skull base was successfully resected by endonasal endoscopic approach.

http://ift.tt/2q6NW5c

Otorhinolaryngologic manifestations of Hartsfield syndrome: Case series and review of literature

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Jeremie D. Oliver, Deanna C. Menapace, Shelagh A. Cofer
Diagnosis of Hartsfield syndrome includes recognition of three distinct clinical anomalies: holoprosencephaly, ectrodactyly, and bilateral cleft-lip and palate syndrome. A family including three male siblings all affected by Hartsfield syndrome presented to our institution for care. An autosomal dominant variant in Fibroblast Growth Factor Receptor 1 (FGFR1) was identified. This report focuses on otorhinolaryngologic manifestationsof Hartsfield syndrome, previously undescribed, including midline defects of holoprosencephaly, bilateral cleft-lip and palate, retrognathia, gastroesophageal reflux disease, external ear anomalies, eustachian tube dysfunction, and midface abnormalities, in addition to multidisciplinary, long-term management strategies. Multidisciplinary management is imperative in the care of these children with modification of approach based on their medical complexity.

http://ift.tt/2phRuys

Quality and readability of websites for patient information on tonsillectomy and sleep apnea

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Ethan Chi, Noel Jabbour, Nicole Leigh Aaronson
ObjectivesTonsillectomy is a common treatment for obstructive sleep apnea (OSA). The Internet allows patients direct access to medical information. Since information on the Internet is largely unregulated, quality and readability are variable. This study evaluates the quality and readability of the most likely visited websites presenting information on sleep apnea and tonsillectomy.MethodsThe three most popular search engines (Google, Bing, Yahoo) were queried with the phrase "sleep apnea AND tonsillectomy." The DISCERN instrument was used to assess quality of information. Readability was evaluated using the Flesch-Kincaid Reading Grade Level (FKGL) and Flesch Reading Ease Score (FRES).ResultsOut of the maximum of 80, the average DISCERN quality score for the websites was 55.1 (SD- 12.3, Median- 60.5). The mean score for FRES was 42.3 (SD- 15.9, Median- 45.5), which falls in the range defined as difficult. No website was above the optimal score of 65. The mean score for the FKGL was US grade-level of 10.7 (SD- 1.6, Median- 11.6). Only 4(27%) websites were in the optimal range of 6–8. There was very weak correlation between FRES and DISCERN (r = 0.07) and FKGL and DISCERN (r = 0.21).ConclusionsTonsillectomy is one of the most common surgeries in the US. However, the internet information readily available to patients varies in quality. Additionally, much of the information is above the recommended grade level for comprehension by the public. By being aware of what information patients are reading online, physicians can better explain treatments and address misunderstandings. Physicians may consider using similar methods to test the readability for their own resources for patient education.

http://ift.tt/2q6K0kQ

Radiologic Differences between Human Papillomavirus-Related and Human Papillomavirus-Unrelated Oropharyngeal Carcinoma on Diffusion-Weighted Imaging

ORL 2017;79:164-165

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Delayed-onset heat intolerance in a Japanese patient with X-linked hypohidrotic ectodermal dysplasia associated with a large deletion involving four genes

http://ift.tt/2pyn26f

No rubbing, no elastosis perforans serpiginosa

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Promotion of oral surgical wound healing using autologous mucosal cell sheets

Publication date: June 2017
Source:Oral Oncology, Volume 69
Author(s): Jong-Lyel Roh, Hyejin Jang, Jaewang Lee, Eun Hye Kim, Daiha Shin
ObjectivesSevere oral mucosal and tissue defects can lead to pain, infection, and later undesirable healing of scarring and adhesion, resulting in a poor quality of life. In vitro-engineered oral mucosal equivalents for covering such defects are an alternative to avoiding the donor site morbidity of conventional skin or tissue grafts. We examined the efficacy of our newly developed three-dimensional mucosal cell sheets in an in vivo tongue wound model mimicking the surgical extirpation of tongue cancer.Materials and methodsSmall oral mucosal and autologous fibrin samples were obtained from surgical patients and Sprague-Dawley rats. The fibrin was mixed with fibroblasts and seeded with keratinocytes that had been primarily cultured for in vitro cell expansion. The three-dimensional autologous cell sheets, cultured in air-lift interface inserts, were transplanted into deep wounds of the rat ventral tongue. Gross and microscopic findings of the postsurgical wounds were compared between wound control and cell sheet groups.ResultsThe cell sheets were flexible, expandable, and easy to transfer, and had histological characteristics similar to that of the normal oral mucosa, with high p63 positivity. They promoted oral wound healing with earlier re-epithelialization and less fibrosis than that in the wound control. The cell sheet-healed tongue had similar histology to that of a normal tongue.ConclusionsOur engineered cell sheets have potential applicability for the rapid healing of oral mucosal and soft tissue defects, without scarring, adhesion, and functional deficits.Condensed abstractThe efficacy of in vitro-engineered mucosal equivalents, using completely autologous mucosa and plasma, was examined. Transplantation of the autologous cell sheets into deep wounds of the rat ventral tongue promoted oral wound healing with earlier re-epithelialization and less fibrosis than that in controls. Healed and normal tongues showed similar histology.

http://ift.tt/2p3cavP

Small cell carcinoma of the head and neck: An analysis of the National Cancer Database

Publication date: June 2017
Source:Oral Oncology, Volume 69
Author(s): Kelli B. Pointer, Huaising C. Ko, Jeffrey V. Brower, Matthew E. Witek, Randall J. Kimple, Ricardo V. Lloyd, Paul M. Harari, Andrew M. Baschnagel
Purpose/objective(s)To evaluate treatment trends and overall survival of patients with small cell carcinoma of the head and neck region.Materials/methodsPatients from 2004 to 2012 were identified from the National Cancer Database. Patient demographics and overall survival were analyzed. Multivariable analysis was used to identify predictors of survival.ResultsAmong 347,252 head and neck patients a total of 1042 (0.3%) patients with small cell carcinoma were identified. 17% of patients were diagnosed as stage I/II, 61% as stage III/IVA/IVB and 22% as stage IVC disease. The distribution by anatomic site was 9% oral cavity, 12% oropharynx, 35% larynx, 4% hypopharynx, 10% nasopharynx and 30% nasal cavity and paranasal sinuses. The median overall survival by anatomical site was 20.8months for oral cavity, 23.7months for oropharynx, 17.9months for larynx/hypopharynx, 15.1months for nasopharynx and 36.4months for nasal cavity primary tumors. On multivariable analysis across stage, patients with nasal cavity and paranasal sinuses tumors had the best survival and patients with nasopharynx primaries had the worst survival. In stage I/II patients, type of treatment delivered resulted in no overall survival difference (p=0.78). In patients with locally advanced disease, there was no difference in survival between those treated with combined surgery, radiotherapy and chemotherapy compared to those treated only with radiotherapy and chemotherapy (p=0.46). The addition of radiotherapy to chemotherapy in the metastatic setting did not result in improved survival (p=0.14).ConclusionsSmall cell carcinoma of the head and neck is a rare malignancy with a poor prognosis. The addition of surgery to radiotherapy and chemotherapy did not improve survival in patients with locally advanced disease.

http://ift.tt/2qdz5Cd

Peanut-free schools: What does it really mean, and are they necessary?

Publication date: Available online 25 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): David R. Stukus

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Analysis of basophil activation in patients with aspirin-exacerbated respiratory disease

Publication date: Available online 25 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Chihiro Mitsui, Keiichi Kajiwara, Emiko Ono, Kentaro Watai, Hiroaki Hayashi, Yosuke Kamide, Yuma Fukutomi, Kiyoshi Sekiya, Takahiro Tsuburai, Kazuhiko Yamamoto, Masami Taniguchi

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Basophils are a major source of cysteinyl leukotrienes, but little is known about their association with the pathogenesis of aspirin-exacerbated respiratory disease (AERD). We assessed CD203c expression on peripheral basophils of patients with AERD.

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Analysis of organic components in resin-modified pulp capping materials: critical considerations

The purpose of this study was to elucidate the organic composition and eluates of three resin-based pulp-capping materials in relation to their indications and safety data sheets. Uncured samples of Theracal LC, Ultra-Blend Plus, and Calcimol LC were investigated using gas chromatography–mass spectrometry (GC-MS) and ultra-performance liquid chromatography–mass spectrometry (UPLC-MS). Identification/quantification of 7-d leachables of cured samples was performed using GC-MS for 2-hydroxyethyl methacrylate (HEMA), 2-(dimethylamino)ethyl methacrylate (DMAEMA), camphorquinone (CQ), ethylene glycol dimethacrylate (EGDMA), ethyl-4-(dimethylamino)benzoate (DMABEE), and triethylene glycol dimethacrylate (TEGDMA). A similar organic composition was found for Ultra-Blend and Calcimol; however, only Ultra-Blend is indicated for direct pulp-capping. In contrast to the other materials analysed, Theracal contained substances of high molecular weight. The safety data sheets of all materials were incomplete. We detected HEMA, CQ, and TEGDMA in eluates from Ultra-Blend and Calcimol, and it was considered that HEMA might have originated from decomposition of diurethane dimethacrylate (UDMA) in the GC-injector. For Theracal, additives associated with light curing (DMABEE and CQ) were detected in higher amounts (4.11 and 19.95 μg mm⁻²) than in the other materials. Pores were quantified in all samples by micro-computed tomography (micro-CT) analysis, which could influence leaching. The organic substances in the investigated materials might affect their clinical suitability as capping agents, especially for direct capping procedures.

http://ift.tt/2oKP4aL

Strategies for removing a worn-out Bone Anchored Hearing Aid abutment screw

Abstract

First developed by Tjellström over 35 years ago, bone anchored hearing implants have been used effectively as a treatment for conductive or mixed hearing loss.¹ These devices have been implanted safely in adults and children with success rates of 90% or higher.² Nonetheless, bone anchored hearing implants present certain adverse effects most commonly related to soft tissue reaction, implant stability, failure to osseointegrate or due to trauma.

http://ift.tt/2qdqAqZ

Following Surgically Assisted Rapid Palatal Expansion, Do Tooth-Borne or Bone-Borne Appliances Provide More Skeletal Expansion and Dental Expansion?

Publication date: Available online 25 April 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Adrien Hamedi-Sangsari, Zahra Chinipardaz, Lee Carrasco
PurposeThe aim of this study is to compare the outcome measures of skeletal and dental expansion with Bone-Borne (BB) versus Tooth-Borne (TB) appliances following SARPE. This study is being done to provide quantitative measurements that will help the oral surgeon and orthodontist in selecting the appliance with, on average, the greatest amount of skeletal expansion and the least amount of dental expansion.MethodsA computerized database search was performed using PubMed, EBSCO, Cochrane, Scopus, Web of Science, and Google Scholar on publications in reputable oral surgery and orthodontic journals. A systematic review and meta-analysis was then completed with the predictor variables of expansion appliance (TB versus BB) and outcome measure of expansion (in millimeters).ResultsA total of 487 articles were retrieved from the six databases. 5 articles were included, 4 with CBCT data and 1 with non-CBCT 3D cast data. There was a significant difference in the skeletal expansion (SMD = 0.92, 95% CI [0.54, 1.30], p = <0.001), in favor of BB appliances, when comparing BB and TB appliances. However, there was not a significant difference in the dental expansion (SMD = 0.05, 95% CI [-0.24, 0.34], p = 0.03).ConclusionThe literature points to the fact that in order to achieve more effective skeletal expansion and minimize dental expansion after SARPE, a Bone-Borne (BB) appliance should be favored.

http://ift.tt/2q5ASNm

Preventive Effect of Phosphodiesterase Inhibitor Pentoxifylline against Medication-Related Osteonecrosis of the Jaw: An Animal Study

Publication date: Available online 26 April 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Gül Merve Yalcin-Ulker, Alev Cumbul, Gonca Duygu-Capar, Ünal Uslu, Kemal Sencift
PurposeThe aim of this experimental study is to investigate the prophylactic effect of pentoxifylline (PTX) on medication- related osteonecrosis of the jaw (MRONJ).MethodsFemale Sprague-Dawley rats (n=33) received zoledronic acid (ZA) for 8 weeks to create osteonecrosis model. The left mandibular second molar teeth were extracted and the recovery period lasted 8 weeks before sacrification. PTX was intraperitoneally administered to prevent MRONJ. The specimens were histopathologically and histomorphometrically evaluated.ResultsHistomorphometrically, between control group and group ZA there was no statistically significant difference in total bone volume (p=0.999); but statistically significant difference in bone ratio in the extraction sockets (p<0.001). A comparison of the bone ratio of ZA group with ZA/PTX group (PTX administered after extraction) showed no statistically significant difference (p=0.69); but statistically significant difference with the ZA/PTX/PTX group (PTX administered before and after extraction) (p=0.008). Histopathologically, between control and ZA groups, there were statistically significant differences for inflammation (p=0.013), vascularization (p=0.022), hemorrhage (p=0.025) and regeneration (p=0.008). Between ZA and ZA/PTX groups, there were no statistically significant differences for inflammation (p=0.536), vascularization (p=0.642), hemorrhage (p=0.765) and regeneration (p=0.127). Between ZA and ZA/PTX/PTX groups, there were statistically significant difference for inflammation (p=0.017), vascularization (p=0.04), hemorrhage (p=0.044) and regeneration (p=0.04).ConclusionIn this experimental model for MRONJ, it might be concluded that although PTX, given after tooth extraction, improves new bone formation that positively affects bone healing, but it is not prophylactic. However, PTX, given before tooth extraction is prophylactic. In conclusion, PTX might affect healing in a positive way via optimizing inflammatory response.

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Comparison of Ozone and Photobiomodulation Therapies on Mental Nerve Injury in Rats

Publication date: Available online 26 April 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Türker Yücesoy, Nükhet Kütük, Dilek Günay Canpolat, Alper ALKAN
AimThis study compares photobiomodulation (PBM) and ozone therapy (OT) techniques on mental nerve injury by counting Schwann cell (SC) numbers, fasciculated nerve branches numbers and measuring the fascicule areas of the nerves.MethodsIn the present study, the effects of ozone and PBM therapies on mental nerve injury were evaluated. Mental nerves of 27 rats were partly suturated and allocated into three groups. Group 1 recevied no treatment, whereas OT and PBM therapies were administered in Group 2 and Group 3, respectively. Number of fascicules after nerve branching and Schwann cell counting before and after nerve injury have been evaluated histologically.ResultsA better healing pattern was observed in the treatment groups. The number of Schwann cells were significantly greater in OT and PBM groups then control groups.ConclusionsOral and maxillofacial surgeons must be familiar with the differential diagnosis, prevention, and management of neurosensory disturbances. This study provides insights into the management of neurosensory disturbances related to mental nerve injury by using OT and PBM. Our study clearly suggest that OT and PBM are promising novel methods in the treatment of mental nerve injury.

http://ift.tt/2q5omxC

Postural Preference and Musculoskeletal Complaints in Oral and Maxillofacial Surgeons

Publication date: Available online 26 April 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Corey A. Taylor, Robert A. Strauss, Alvin M. Best
PurposeOral and maxillofacial surgeons traditionally have suffered from musculoskeletal pain. The aim of this study is to determine the postural preferences of oral and maxillofacial surgeons and its effect on musculoskeletal pain.MethodsThe investigators designed and implemented a cross-sectional study. The association of demographic characteristics with postural preferences and use of loupes was first explored. Then, the relationship between demographic characteristics, postural preferences, and use of loupes with painful musculoskeletal complaints was analyzed. Contingency analysis was used to compare participant's responses and multiple logistic regression was used to identify the significant predictor variables.ResultsThe sample was composed of 153 oral and maxillofacial surgeons of which 32% indicated that they had ever had pain attributable to their practice which lasted more than two weeks. Practitioners reported neck and back pain as being most common. 84% of practitioners stood for both extractions and placement of implants. Those who stood did so for visibility. Practitioners who sat indicated they did so for orthopedic reason (p<0.001). 31% of practitioners indicated loupes use. Those who used loupes were more likely to report pain (P = 0.022).ConclusionThe majority of respondents stood and did not use loupes. Those who did use loupes were more likely to report pain. Those who stood did so for visibility; those who sat did so for orthopedic reasons. Almost a third of respondents reported pain lasting at least two weeks during practice.

http://ift.tt/2oKAfEX

Periostitis ossificans arising in the mandibular bone of young patient: Report of an unusual case and review of the literature

Publication date: Available online 26 April 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Masakatsu Fukuda, Katsuyuki Inoue, Hideaki Sakashita
Periostitis ossificans is a specific type of chronic osteomyelitis, which forms new bone under the periosteum, resulting from a periosteal reaction to chronic inflammation or infections. Periostitis ossificans has conservatively been called Garrè's osteomyelitis before in our region. It commonly impacts the mandible of patients secondary to odontogenic infection. Therapeutic approach involves elimination of the infective origin and antibiotic administration. Here we report an unusual case of periostitis ossificans arising from the mandible of an 11-year-old male patient. The cause of infection was correlated with a lower right unerupted third molar, which had obviously no connection with the oral cavity. The histological diagnosis was chronic osteomyelitis with proliferative periostitis. The patient has been followed for 1 year, without any evidence of recurrences. Periostitis ossificans may be diagnostically problematic, and various conditions must be considered in the differential diagnosis.

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Autotransplantation of Third Molars with Platelet Rich Plasma for Immediate Replacement of Extracted Non-Restorable Teeth: A Case Series

Publication date: Available online 25 April 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jorge Gonzalez-Ocasio, Mark Stevens
PurposeThe aim of this study was to examine the use of platelet rich plasma (PRP) with autotransplantation of third molars as a successful technique to provide immediate tooth structure for space maintenance and masticatory function when premature loss of a permanent tooth occurs and other dental restorative options are not indicated.Materials and MethodsA case series of 10 young healthy individuals of 10 to 17 years of age with one or more immature third molars (one-third to two-thirds of root formation) used to replace extracted non-restorable teeth. Eleven third molars were transplanted, and adapted to sockets of the extracted teeth with the adjunct of PRP. The transplanted teeth were stabilized to the adjacent teeth using orthodontic wires and dental composite for one month. Patients were followed for a period of one year. Function, tooth vitality, root development, and periodontal health were recorded.ResultsAll ten patients had functioning asymptomatic transplanted teeth, with physiologic tooth mobility after splint removal at one month and over one year. All ten patients had positive tooth vitality (cold test) at three, six, and twelve months; all transplants showed positive root development (average growth of 2.01mm) confirmed and measured using periapical radiographs. No patients required root canal therapy (RCT) at any point in the study. Periodontal assessments were performed on the scheduled follow-up appointments with circumferential periodontal probings. Periodontal health was maintained as probings were less than four millimeters during a one-year period.ConclusionAutotransplantation of immature third molars with platelet rich plasma shows excellent results and should be considered a viable option for premature loss of permanent molars. PRP may also have other advantages, such as, promotion of root, and neurosensory development.

http://ift.tt/2q5SbOh

Αρχειοθήκη ιστολογίου

Τετάρτη 26 Απριλίου 2017

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