Head and Neck Medicine by Alexandros G.Sfakianakis: 04/27/17

Πέμπτη 27 Απριλίου 2017

Comparison between universal adhesives and two-step self-etch adhesives in terms of dentin bond fatigue durability in self-etch mode

This aim of this study was to compare universal adhesives and two-step self-etch adhesives in terms of dentin bond fatigue durability in self-etch mode. Three universal adhesives – Clearfil Universal, G-Premio Bond, and Scotchbond Universal Adhesive – and three-two-step self-etch adhesives – Clearfil SE Bond, Clearfil SE Bond 2, and OptiBond XTR – were used. The initial shear bond strength and shear fatigue strength of resin composite bonded to adhesive on dentin in self-etch mode were determined. Scanning electron microscopy observations of fracture surfaces after bond strength tests were also made. The initial shear bond strength of universal adhesives was material dependent, unlike that of two-step self-etch adhesives. The shear fatigue strength of Scotchbond Universal Adhesive was not significantly different from that of two-step self-etch adhesives, unlike the other universal adhesives. The shear fatigue strength of universal adhesives differed depending on the type of adhesive, unlike those of two-step self-etch adhesives. The results of this study encourage the continued use of two-step self-etch adhesive over some universal adhesives but suggest that changes to the composition of universal adhesives may lead to a dentin bond fatigue durability similar to that of two-step self-etch adhesives.

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Preliminary investigation of preoperative pregabalin and total intravenous anesthesia doses: a randomized controlled trial

To determine the efficacy of 2 different doses (150-300mg) of preoperative pregabalin on propofol and remifentanil doses for total intravenous anesthesia in laparoscopic cholecystectomy.

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Thymus neuroendocrine tumors with CTNNB1 gene mutations, disarrayed ß-catenin expression, and dual intra-tumor Ki-67 labeling index compartmentalization challenge the concept of secondary high-grade neuroendocrine tumor: a paradigm shift

Abstract

We herein report an uncommon association of intimately admixed atypical carcinoid (AC) and large cell neuroendocrine (NE) carcinoma (LCNEC) of the thymus, occurring in two 20- and 39-year-old Caucasian males. Both tumors were treated by maximal thymectomy. The younger patient presented with a synchronous lesion and died of disease after 9 months, while the other patient was associated with a recurrent ectopic adrenocorticotropic hormone Cushing's syndrome and is alive with disease at the 2-year follow-up. MEN1 syndrome was excluded in either case. Immunohistochemically, disarrayed cytoplasmic and nuclear ß-catenin expression was seen alongside an intra-tumor Ki-67 antigen labeling index (LI) ranging from 2 to 80% in the younger patient's tumor and from 3 to 45% in the other. Both exhibited upregulated cyclin D1 and retinoblastoma, while vimentin was overexpressed in the recurrent LCNEC only. Next-generation sequencing revealed CTNNB1, TP53, and JAK3 mutations in the synchronous tumor and CTNNB1 mutation alone in the metachronous tumor (the latter with the same mutation as the first tumor of 17 years prior). None of the 23 T-NET controls exhibited this hallmarking triple alteration (p = 0.003). These findings suggested that LCNEC components developed from pre-existing CTNNB1-mutated AC upon loss-of-function TP53 and gain-of-function JAK3 mutations in one case and an epithelial-mesenchymal transition upon vimentin overexpression in the other case. Both tumors maintained intact cyclin D1–retinoblastoma machinery. Our report challenges the concept of secondary LCNEC as an entity that develops from pre-existing AC as a result of tumor progression, suggesting a paradigm shift to the current pathogenesis of NET.

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Mandibular wing osteotomy: technical modification

Sometimes conventional orthognathic treatment cannot achieve the desired results. Mandibular wing osteotomy of the lower border, as first described by Triaca et al,1 comprises the entire inferior border under the inferior alveolar nerve (IAN). It can correct the profile of the lower face without changing the interocclusal relations.2 We present a modification of the technique, which improves safety by reducing the possibility of damage to the IAN.

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New method of arch bar fixation

Intermaxillary fixation (IMF) can be done in several ways, and arch bars, brackets, IMF screws and bone-supported arch bars are among them.

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Accuracy of maxillary repositioning by computer-aided orthognathic surgery in patients with normal temporomandibular joints

Our aim was to assess the accuracy of computer-aided orthognathic surgery for maxillary repositioning in 15 patients with mandibular hyperplasia and normal temporomandibular joints (TMJ). We aligned preoperative and postoperative virtual skulls at the cranium using surface superimposition then recorded and calibrated three 3-dimensional coordinates (maxillary dental landmarks U0, 6R, and 6L) on the skulls. Errors between these preoperative and postoperative landmarks were calculated and the largest error of every patient was chosen for assessment.

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Integration of mental health screening in the management of patients with temporomandibular disorders

Mental health disorders such as depression or anxiety, or both, are more common in patients with temporomandibular disorders (TMD) (16%-40%) than in the general population (16%), and failure to recognise them may be detrimental to the management of TMD. Paper-based screening tools previously reported in this group require assessment by clinicians and subsequent collation of data. We describe our experience of a new system − IMPARTS (Integrating mental and physical: research training and services), which uses validated tools to identify and to monitor the progress of patients who may benefit from psychological intervention.

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Aims & Scope/Editorial board

Publication date: July 2017
Source:Archives of Oral Biology, Volume 79

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Promoter methylation of MGMT in oral carcinoma: A population-based study and meta-analysis

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Chinchu Jayaprakash, Raghu Radhakrishnan, Satadru Ray, Kapaettu Satyamoorthy
IntroductionThe relevance of DNA methylation of O⁶-methylguanine-DNA methyltransferase (MGMT) in relation to several cancers and other disorders has been extensively explored in several cancer types.AimsTo ascertain the significance of DNA methylation of MGMT promoter in oral squamous cell carcinoma (OSCC), we undertook a study to a) analyse the methylation patterns of MGMT gene promoter in afflicted and normal population of coastal Karnataka, b) determine the expression status of MGMT in oral cancer cell lines (CAL-27 and SCC-4) and its relationship to DNA methylation and c) performed a meta-analysis of the published data.MethodsBisulfite sequencing of MGMT promoter region was performed on non-malignant/malignant oral samples, and oral cancer cell lines, followed by gene expression studies. Further, using a systematic search, 1024 publications were retrieved from PubMed, Scopus, Google Scholar and Web of Science and 23 relevant articles were reviewed.ResultsSignificant association of MGMT promoter methylation with OSCC (p<0.0001) was observed in the case-control study. The studies chosen for meta-analysis showed predictive significance of MGMT gene promoter. Overall, we obtained a statistically significant (p<0.0001) association for both sensitivity and specificity of MGMT DNA promoter methylation in oral cancer cases without publication bias. Gene expression was significantly elevated in both oral cancer cell lines (p<0.03) after treatment with a demethylating agent (5-Aza-2′-deoxycytidine).ConclusionDNA promoter hypermethylation and gene expression of MGMT may associate with recursive mutagenesis and is a promising biomarker for OSCC prediction. Studies suggest further validation in large distinct cohorts to facilitate translation to clinics.

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Synchrotron X-ray diffraction to understand crystallographic texture of enamel affected by Hunter syndrome

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Malik Arshman Khan, Owen Addison, Alison James, Christian J. Hendriksz, Maisoon Al-Jawad
ObjectiveTo determine whether Hunter syndrome (MPS II) affects the crystallographic texture (preferred orientation) of enamel.DesignSynchrotron X-ray diffraction, being a state of the art technique, has been used to determine the enamel crystallite orientation in enamel affected by Hunter syndrome (MPS II). The incisal, lingual and cervical regions of the MPS II affected tooth were observed and compared to healthy tooth.ResultsIt was observed that there is a loss of organization of crystallites in deciduous incisal enamel affected by Hunter syndrome (MPS II) as compared to healthy deciduous enamel tissue. Generally it was observed that, in contrast to the healthy enamel, the enamel affected by MPS II possessed a lower crystallographic preferred orientation, with a more uniform spatial distribution; however, the enamel at the incisal tip was relatively unaffected.ConclusionHunter syndrome affects the enamel texture in the lingual and cervical regions of the tooth.

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Frequency of MCP-1 (rs1024611) and CCR2 (rs1799864) gene polymorphisms and its effect on gene expression level in patients with AgP

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Sadiye Gunpinar, Nilgun Ozlem Alptekin, V. Betul Ucar, Hasan Acar
ObjectiveTo identify the genetic risk markers of aggressive periodontitis (AgP), researchers focus on genetic components that regulate the immune response. Therefore the purpose of this study was to investigate genetic impact of monocyte chemoattractant protein (MCP)-1–2518A/G and CC chemokine receptor 2 (CCR2) −190G/A gene polymorphisms on AgP susceptibility and the effect of this polymorphism on MCP-1 gene expression in patients with AgP.Material and methodsA total of 215 subjects, 108 AgP and 107 periodontally healthy (H) were recruited in this cross-sectional study (NCT02817568). Gene polymorphisms of MCP-1–2518A/G and CCR2–190G/A were analyzed by a standard polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay. MCP-1 messenger (m) RNA expression was measured using quantitative real-time (RT)-PCR in peripheral blood leukocytes from 26 AgP and 16H controls. Threshold cycles (Ct) values were obtained from the RT-PCR analysis based on SYBR Green detection and data was normalized via ΔCt.ResultsThere were no differences between AgP and H groups with regard to MCP-1 and CCR2 genotype distribution and allele frequencies (p>0.05). In contrast, the MCP-1 mRNA expression levels were higher in homozygous "AA" control subjects than having G⁺ genotype and AA homozygous AgP patients.ConclusionsIt can be concluded that MCP-1 and CCR2 polymorphisms are not associated with AgP in Turkish population. Although in AgP patients, there was AA genotype with MCP-1 mRNA expression it can be speculated that gene expression levels in peripheral blood may not reflect the cytokine/chemokine levels of local tissues.

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Aims & Scope/Editorial board

Publication date: July 2017
Source:Archives of Oral Biology, Volume 79

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Promoter methylation of MGMT in oral carcinoma: A population-based study and meta-analysis

Synchrotron X-ray diffraction to understand crystallographic texture of enamel affected by Hunter syndrome

Frequency of MCP-1 (rs1024611) and CCR2 (rs1799864) gene polymorphisms and its effect on gene expression level in patients with AgP

Immunobiology of Long Noncoding RNAs

Annual Review of Immunology, Volume 35, Issue 1, Page 177-198, April 2017.

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Disorders of the JAK/STAT Pathway in T Cell Lymphoma Pathogenesis: Implications for Immunotherapy

Annual Review of Immunology, Volume 35, Issue 1, Page 533-550, April 2017.

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Mucosal Ecological Network of Epithelium and Immune Cells for Gut Homeostasis and Tissue Healing

Annual Review of Immunology, Volume 35, Issue 1, Page 119-147, April 2017.

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Understanding Human Autoimmunity and Autoinflammation Through Transcriptomics

Annual Review of Immunology, Volume 35, Issue 1, Page 337-370, April 2017.

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Synthetic Immunology: Hacking Immune Cells to Expand Their Therapeutic Capabilities

Annual Review of Immunology, Volume 35, Issue 1, Page 229-253, April 2017.

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Protective and Harmful Immunity to RSV Infection

Annual Review of Immunology, Volume 35, Issue 1, Page 501-532, April 2017.

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Th2 Cells in Health and Disease

Annual Review of Immunology, Volume 35, Issue 1, Page 53-84, April 2017.

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Microbes and Cancer

Annual Review of Immunology, Volume 35, Issue 1, Page 199-228, April 2017.

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Intracellular Nucleic Acid Detection in Autoimmunity

Annual Review of Immunology, Volume 35, Issue 1, Page 313-336, April 2017.

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A Perspective on the Role of Computational Models in Immunology

Annual Review of Immunology, Volume 35, Issue 1, Page 403-439, April 2017.

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Microglia Function in the Central Nervous System During Health and Neurodegeneration

Annual Review of Immunology, Volume 35, Issue 1, Page 441-468, April 2017.

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Antigen-Presenting Cells in the Skin

Annual Review of Immunology, Volume 35, Issue 1, Page 469-499, April 2017.

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Metabolite-Sensing G Protein–Coupled Receptors—Facilitators of Diet-Related Immune Regulation

Annual Review of Immunology, Volume 35, Issue 1, Page 371-402, April 2017.

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Signaling by Antibodies: Recent Progress

Annual Review of Immunology, Volume 35, Issue 1, Page 285-311, April 2017.

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Genetics of Infectious and Inflammatory Diseases: Overlapping Discoveries from Association and Exome-Sequencing Studies

Annual Review of Immunology, Volume 35, Issue 1, Page 1-30, April 2017.

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Thymic Epithelial Cells

Annual Review of Immunology, Volume 35, Issue 1, Page 85-118, April 2017.

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The Lymphatic System: Integral Roles in Immunity

Annual Review of Immunology, Volume 35, Issue 1, Page 31-52, April 2017.

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Memory B Cells of Mice and Humans

Annual Review of Immunology, Volume 35, Issue 1, Page 255-284, April 2017.

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The Biology and Underlying Mechanisms of Cross-Presentation of Exogenous Antigens on MHC-I Molecules

Annual Review of Immunology, Volume 35, Issue 1, Page 149-176, April 2017.

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Unique features in the presentation of insulin epitopes in autoimmune diabetes: an update

Xiaoxiao Wan | Emil R Unanue

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Mortality of Necrotising Fasciitis: relative influence of individual and hospital-level factors, a Nationwide Multi-Level Study, France, 2007-2012

Abstract

Background

Necrotising soft-tissue infections (NSTI) are rare, life-threatening conditions.

Objectives

We aimed to assess whether admitting hospital characteristics were associated with NSTI mortality.

Methods

We studied the French nationwide hospital discharge database (retrospective national cohort). All patients admitted in 2007-2012 with an ICD-10 code of necrotising fasciitis were eligible. We extracted data on the patients (age, sex, ICU admission, co-morbidities) and hospitals (public vs private proprietary; for public hospitals, teaching, yes/no; and number of NSTI admissions, ≥3 NSTI cases/year, yes/no). Multivariable analyses were performed to identify independent predictors of day-28 mortality and in-hospital mortality using mixed logistic regression and Cox proportional hazards models, respectively.

Results

We identified 1537 patients (915 males) with a median age of 60 (IQR, 48-75) years, admitted to 326 hospitals, public (82%) and admitting fewer than three NSTI cases/year (93%). Overall, 364 patients died (23·7%; 95%CI, 21·6-25·9). Patients treated in public teaching centres with ≥3NSTI cases annually had lower day-28 mortality (adjusted odds ratio [aOR], 0·68; 95%CI, 0·46-0·99; p=0·045) and in-hospital mortality rates than patients treated in local hospitals, even after adjusting for potentially relevant individual risk factors. No significant association was found between mortality and inter-hospital transfer.

Conclusions

Our finding highlighted an increased survival in teaching centres with high NSTI volume procedures. If confirmed in other settings, these findings reinforce the importance of expertise in early diagnosis and management of this condition.

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Duration and exclusiveness of breastfeeding and risk of childhood atopic diseases

Abstract

Background

Breastfeeding may have immune modulatory effects that influence the development of childhood allergic sensitization and atopic diseases. We aimed to examine the associations of breastfeeding with childhood allergic sensitization, inhalant or food allergy and eczema, and whether any association was affected by disease-related modification of the exposure or modified by maternal history of maternal history of allergy, eczema or asthma.

Methods

This study among 5,828 children was performed in a population-based prospective cohort from fetal life onwards. We collected information on duration (<2 months, 2-4 months, 4-6 months and ≥6 months) and exclusiveness (non-exclusive vs. exclusive for 4 months) of breastfeeding in infancy by postal questionnaires. At age 10 years, inhalant and food allergic sensitization were measured by skin prick tests, and physician-diagnosed inhalant and food allergy by a postal questionnaire. Data on parental-reported eczema were available from birth until age 10 years.

Results

We observed no association of breastfeeding with any allergic sensitization, physician-diagnosed allergy, or combination of these outcomes. Shorter breastfeeding duration was associated with an overall increased risk of eczema (p-value for trend <0.05). Non-exclusively breastfed children had an overall increased risk of eczema (aOR (95% CI): 1.11 (1.01, 1.23)), compared with children exclusively breastfed for 4 months. Risk period-specific sensitivity analyses, additional adjustment for ointment use for eczema at age 2 months, and cross-lagged modeling showed no consistent results for disease-related modification of the exposure. Results were not modified by maternal history of allergy, eczema or asthma (lowest p-value for interaction =0.13).

Conclusions

Shorter duration or non-exclusiveness of breastfeeding is associated with a weak overall increased risk of eczema but not allergic sensitization or physician-diagnosed allergy at age 10 years

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Anesthetic consideration for neuromuscular diseases.

Purpose of review: The aim of this review is to examine data relating to perioperative management of the patient with neuromuscular disorders Recent findings: Patients with pre-existing neuromuscular disorders are at risk for a number of postoperative complications that are related to anesthetic drugs that are administered intraoperatively. Careful preoperative assessment is necessary to reduce morbidity and mortality. In particular, the risk of postoperative respiratory failure and need for long-term ventilation should be reviewed with patients. The use of succinylcholine should be avoided in muscular dystrophies, motor neuron diseases, and intrinsic muscle disease due to a risk of malignant hyperthermia, hyperkalemia, rhabdomyolysis, and cardiac arrest. The use of quantitative neuromuscular monitoring should be strongly considered whenever nondepolarizing neuromuscular blocking agents are administered. A number of case series and reports have been recently published demonstrating that sugammadex can be safely used in patients with neuromuscular disease; the risk of residual neuromuscular is nearly eliminated when this agent is administered intraoperatively. Summary: Careful assessment and management of patients with underlying neuromuscular diseases is required to reduce postoperative complications. This article reviews the anesthetic implications of patients undergoing surgery with neuromuscular disorder. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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How to treat a patulous Eustachian tube

Publication date: Available online 27 April 2017
Source:American Journal of Otolaryngology
Author(s): Zhengcai Lou

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Severe food allergies: can they be considered rare diseases?

No abstract available

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Apheresis in food allergies

Purpose of review: The prevalence of IgE-mediated food allergy and anaphylaxis has risen rapidly in developed countries, and countries with rapid industrialization may follow. Therapies include elimination diets, Oral ImmunoTherapy, and the administration of biologics, but high serum IgE levels may preclude their use. Consequently, decreasing IgE becomes a rational approach and could be obtained by immunoapheresis. The aim of this review is to evaluate the rationale and advantages of immunoapheresis. Recent findings: The majority of the available adsorbers remove aspecifically all classes of immunoglobulins. Recently, IgE-specific adsorbers have been approved. Data on immunoapheresis for the treatment of allergic diseases with pathologically elevated IgE levels are emerging. In atopic dermatitis, this therapy alone seems to be beneficial. IgE-selective apheresis appears to be sufficient to reduce the risk of anaphylaxis in multiple food allergy (MFA) and, when IgE titers are high, to open the way to treatment with Omalizumab. Summary: Prospective studies, with well designed protocols, are needed to assess the efficacy, tolerability, and cost-effectiveness of immunoapheresis in the field of food allergy.

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Editorial: outcome measures

No abstract available

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Novel immunotherapy and treatment modality for severe food allergies

Purpose of review: In recent years, many studies on oral immunotherapy (OIT) have been conducted; however, few have focused on severe food allergies. The purpose of this review was to assess the efficacy and safety of oral immunotherapies for patients with severe food allergy. Recent findings: We reviewed multiple immunotherapy reports published within a few years or reports focusing on severe food allergies. We also investigated recent studies on OIT and novel food allergy management. Summary: Immunotherapies targeting low-dose antigen exposure and oral food challenges using low-dose target volumes may be safer than conventional OIT. It is necessary to consider which immunotherapy regimen is appropriate based on allergy severity of the patient.

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Outstanding animal studies in allergy I. From asthma to food allergy and anaphylaxis

Purpose of review: Animal models published within the past 18 months on asthma, food allergy and anaphylaxis, all conditions of rising public health concern, were reviewed. Recent findings: While domestic animals spontaneously develop asthma, food allergy and anaphylaxis, in animal models, divergent sensitization and challenge routes, dosages, intervals and antigens are used to induce asthmatic, food allergic or anaphylactic phenotypes. This must be considered in the interpretation of results. Instead of model antigens, gradually relevant allergens such as house dust mite in asthma, and food allergens like peanut, apple and peach in food allergy research were used. Novel engineered mouse models such as a mouse with a T-cell receptor for house dust mite allergen Der p 1, or with transgenic human hFcγR genes, facilitated the investigation of single molecules of interest. Whole-body plethysmography has become a state-of-the-art in-vivo readout in asthma research. In food allergy and anaphylaxis research, novel techniques were developed allowing real-time monitoring of in-vivo effects following allergen challenge. Networks to share tissues were established as an effort to reduce animal experiments in allergy which cannot be replaced by in-vitro measures. Summary: Natural and artificial animal models were used to explore the pathophysiology of asthma, food allergy and anaphylaxis and to improve prophylactic and therapeutic measures. Especially the novel mouse models mimicking molecular aspects of the complex immune network in asthma, food allergy and anaphylaxis will facilitate proof-of-concept studies under controlled conditions.

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Editorial introductions

No abstract available

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Outstanding animal studies in allergy II. From atopic barrier and microbiome to allergen-specific immunotherapy

Purpose of review: Animal studies published within the past 18 months were assessed, focusing on innate and specific immunomodulation, providing knowledge of high translational relevance for human atopic and allergic diseases. Recent findings: Allergic companion animals represent alternative models, but most studies were done in mice. Atopic dermatitis mouse models were refined by the utilization of cytokines like IL-23 and relevant skin allergens or enzymes. A novel IL-6 reporter mouse allows biomonitoring of inflammation. Both skin pH and the (transferable) microflora have a pivotal role in modulating the skin barrier. The microflora of the gastrointestinal mucosa maintains tolerance to dietary compounds and can be disturbed by antiacid drugs. A key mouse study evidenced that dust from Amish households, but not from Hutterites protected mice against asthma. In studies on subcutaneous and sublingual allergen-specific immunotherapy, much focus was given on delivery and adjuvants, using poly-lacto-co-glycolic particles, CpGs, probiotics or Vitamin D3. The epicutaneous and intralymphatic routes showed promising results in mice and horses in terms of prophylactic and therapeutic allergy treatment. Summary: In atopic dermatitis, food allergies and asthma, environmental factors, together with the resident microflora and barrier status, decide on sensitization versus tolerance. Also allergen-specific immunotherapy operates with immunomodulatory principles.

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Food labeling issues in patients with severe food allergies: solving a hamlet-like doubt

Purpose of review: We review the laws on labeling in the international community, the difficulties they pose to the food manufacturers to prepare the food labels and the methodologies to determine the concentration of potential allergens in foods. Recent findings: European Food Safety Authority and International Life Sciences Institute Europe are evaluating strategies to identify the threshold level of allergen that can trigger a reaction in individuals. The most used techniques to detect the presence of protein in food are Enzyme-linked immunosorbent assay, polymerase chain reaction and real time polymerase chain reaction. Researchers are now trying to apply proteomics to estimate the amount of protein within the food. In order to protect the health of consumers, the Codex Alimentarius Commission updates constantly the list of allergens. In response to these regulations, some industries have also added some precautionary allergen labeling (PAL). It was generally agreed that PAL statements needed to be visible, simple, and safe. It was suggested that PAL be standardized, an action that would occur if the 'Voluntary Incidental Trace Allergen Labelling' process was made mandatory. Summary: So far, no laboratory technique is able to reassure the consumers about the composition of foods found on the packaging. International authorities produced increasingly stringent laws, but more is still to do.

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Asthma prevalence and severity in low-resource communities

Purpose of review: The prevalence of asthma was thought to be low in most low-income countries, but several reports have indicated this is not always true. This is a narrative review of recent publications on the burden of asthma in low and middle-income countries (LMIC) and underprivileged communities from developed countries. Recent findings: Several studies have reported a low prevalence of asthma is LMIC, but indicate it is increasing. In the last few years, however, many surveys demonstrated this may not always be true. An analysis of the International Study for Asthma and Allergy in Childhood phase III database indicated although the prevalence of asthma among children and adolescents is higher in the developed countries, symptoms of asthma are often more severe in less affluent nations. The rate of uncontrolled asthma is also higher among underprivileged communities of developed countries. Secondary analysis of data generated by the WHO's world health survey performed among adults of 70 countries indicate symptoms of asthma are less frequent in middle-income countries and more frequent in the extremes, low income and high income. This sort of U shaped distribution suggests the disease (or syndrome) comprise more than one major phenotype related to diverse underlying mechanisms. In fact, recent reports show symptoms of asthma among the poor are associated with unhygienic living conditions, which may reduce the risk of atopy but increase the risk of nonatopic wheezing. Urbanization and exposure to air pollution also seem to contribute to an increasing prevalence severity of asthma in LMIC. Access to proper diagnosis and treatment with controller medications for asthma, specially with inhaled corticosteroids is feasible and cost-effective, reduce symptoms, health resource utilization, improves quality of life, and reduce mortality in low-resource settings. Summary: Prevalence of asthma was thought to be low in low-income countries, but several reports have indicated this is not always true. Under diagnosis, under treatment, exposure to air pollution, and unhygienic living conditions may contribute to a higher frequency and severity of symptoms of asthma among the poor. Proper diagnosis and treatment with controller medications for asthma is feasible and cost-effective in low-resource settings.

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Impact of elimination diets on nutrition and growth in children with multiple food allergies

Purpose of review: Growth and nutritional intake of children with cows' milk allergy and other food allergens has been thoroughly investigated in recent years across many different countries and age groups. An impaired growth in atopic children should not be attributed only to a high number of allergens and foods to be avoided, but to a general condition of 'sub-inflammation', which unfavorably affects the absorption and utilization of fuel and substrates. Atopic study participants may represent a good target for personalized nutrition and in this review we sought to outline many of the issues that should be taken into account when dietitians advise patients regarding food avoidance and expected effects on growth. Recent findings: The dietary management of food allergy requires appropriate dietary choices to maintain adequate growth, starting with special formulas in infancy. An emerging area of research is the fussy eating related to the exclusion of cow's milk and other foods during infancy and the long-term effects on eating habits and food preferences. Summary: Study participants with either mono or polyallergic diseases should ideally undergo the definition of their allergic and metabolic characteristics, to precisely adjust dietary interventions on an individual basis to support the genetic potential of growth and prevent unfavorable outcomes.

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Behavioral interventions to improve asthma outcomes: a systematic review of recent publications

Purpose of review: Asthma outcomes are influenced by factors at multiple ecological levels: the individual and his/her family, home, medical care, and community. This systematic review describes recently published single-level and multilevel behavioral interventions to improve asthma outcomes. Recent findings: Of the 23 total title/abstracts reviewed in the original systematic search of PubMed, Ovid, Scopus, PsychINFO, and CIHAHL reference review databases, six met inclusion criteria. Five of the studies focused on low-income and/or minority populations. Promising interventions include culturally tailored online asthma self-management programs and family-centered asthma education delivered at the bedside during hospitalization for an acute asthma exacerbation. Summary: Culturally, tailored online self-management programs offer difficult-to-reach populations asthma support that can be completed at the time and pace most convenient for the individual user. Family-focused asthma education, delivered at the bedside during an acute asthma hospitalization by highly motivated lay volunteers, is an efficacious and low-cost approach to improving pediatric asthma self-management.

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Use of biologics in severe food allergies

Purpose of review: Severe cases of food allergy account for the majority of the burden in terms of risks, quality of life, and resource expenditure. The traditional approach to these forms has been strict avoidance. More recently, Oral ImmunoTherapy (OIT) has gained a role in their management. However, in severe food allergies OIT is often infeasible. Recent findings: Case reports, observational, and prospective studies have recently proposed different approaches to severe food allergy. The majority of them include the use of biologics. Omalizumab has been the most studied drug for severe food allergies, and its role as adjuvant treatment to OIT is well established. Interest has been raised on other biologics, as dupilumab, reslizumab, and mepolizumab. Toll-like receptor agonists, and gene therapy using adeno-associated virus coding for Omalizumab are promising alternatives. Summary: The recent studies are deeply influencing the clinical practice. We review the modifications of the clinical approach to severe food allergies so far available. We indicate the possible evolutions of treatment with biologics in severe food allergies.

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Corrigendum

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Issue Information

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Oral mucocoeles in chronic graft-versus-host-disease: report of a case following lung transplantation

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A case of milium-like syringoma limited to the neck

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Brain and lung metastasis secondary to metastatic atypical fibroxanthoma: A rare Australian case

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Can a better patients' phenotyping predict the efficacy of tiotropium in symptomatic asthma?

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Reply

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Vitamin D and food allergies in children: A systematic review and meta-analysis

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25-Hydroxyvitamin D, biomarkers of eosinophilic inflammation, and airway remodeling in children with newly diagnosed untreated asthma

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Association between depression and asthma in Korean adults

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Asthma control in Saudi Arabia: Gender implications

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Atopy, asthma, and the elderly: A paradigm for personalized therapy

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Medical therapy versus dietary avoidance in eosinophilic esophagitis: Which approach is better?

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Hypersensitivity to biomedical implants: Prevention and diagnosis

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Asthma pathogenesis, diagnosis, and management in the elderly

http://ift.tt/2qd9flI

Ara h2 levels in dust from homes of individuals with peanut allergy and individuals with peanut tolerance

http://ift.tt/2oQMyQk

High mobility group box 1: Biomarker of inhaled corticosteroid treatment response in children with moderate-severe asthma

http://ift.tt/2qcVDXq

In vitro impact of anti-immunoglobulin E monoclonal antibodies, including omalizumab on whole blood basophil histamine release: Assessment of direct induction of basophil histamine release and evaluation of modulation of allergen-induced basophil histamine release

http://ift.tt/2oQZ3v9

Safety of a C1-inhibitor concentrate in pregnant women with hereditary angioedema

http://ift.tt/2qcRqD3

Randomized, placebo-controlled study of cetirizine and loratadine in children with seasonal allergic rhinitis

http://ift.tt/2oRcQBM

A 30-year-old woman with chronic hives, intermittent fevers, and joint pain

http://ift.tt/2qcMXAA

For the Patient

http://ift.tt/2qdethh

Abstracts from the Western Society of Allergy, Asthma and Immunology 2017 Annual Scientific Session, Fairmont Orchid, Big Island, Hawaii, January 29‐February 2, 2017

http://ift.tt/2oR8D10

Letter to the Editor: Can a better patients' phenotyping predict the efficacy of tiotropium in symptomatic asthma?

http://ift.tt/2qdkD0J

Vitamin D and food allergies in children: A systematic review and meta-analysis

http://ift.tt/2oR8CKu

Apremilast for a psoriasis patient with HIV and hepatitis C

Abstract

A 46-year old male with HIV, hepatitis C, and moderate psoriasis was resistant to starting ultra violet B phototherapy due to scheduling issues. The patient had 8% body surface area (BSA) affected on the dorsal hands, elbows, and legs, did not have associated psoriatic arthritis, and had not tried any systemic therapy in the past. He was initiated on an apremilast starter pack (dosages titrated up from 10 mg to 30 mg over the course of one week) and maintained on 30 mg twice a day after one week.

http://ift.tt/2oNT2OU

Adalimumab is a safe option for psoriasis patients with concomitant hepatitis B or C infection: a multicentre cohort study of 37 patients and review of the literature. Reply to Dr. Ricceri letter

Abstract

We thank Ricceri et al. for their comments (1) and interest in our study (2). Despite the recent advances in prevention and treatment of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, these two chronic infections still represent the most common cause of chronic liver disease. Dermatologists are frequently encountering patients with psoriatic disease who have concomitant HBV or HCV infection in daily clinical practice.

Dr Ricceri provided in his letter further long-term follow-up data (60 months) on the use of etanercept or adalimumab in 17 psoriatic patients affected by past HBV infection or chronic HCV infection.

http://ift.tt/2p8TKK7

Pediatric melanoma

Abstract

Pediatric melanoma, although rare, is the most common skin cancer in children. Our current knowledge on pediatric melanoma incidence trends is expanding, as several studies have addressed this issue with conflicting results. Known risk factors for pediatric melanoma include family history of melanoma, a previous history of malignancy, large congenital nevi, numerous melanocytic nevi, sunburns, increased UV exposure and a sun-sensitive phenotype. In younger children melanoma more often presents with atypical features, such as a changing, amelanotic or uniformly colored, often bleeding lesion, not fulfilling in most cases the conventional ABCDE criteria. The major differential diagnoses are melanocytic nevi, proliferative nodules in congenital nevi and atypical Spitz tumors. Moreover, in the younger age group non Caucasian children are over-represented, tumors tend to be thicker and lymph nodes are often involved. Despite the frequent diagnosis at an advanced stage, the overall survival is fair in pediatric melanoma. Specific guidelines for management of melanoma in children do not exist, and most often the disease is treated similarly to melanoma in adults.

http://ift.tt/2oO07PE

Reply: Adalimumab is a safe option for psoriasis patients with concomitant hepatitis B or C infection: a multicentre cohort study of 37 patients and review of the literature

Abstract

We have read with interest the article by Piaserico et al. concerning the use of tumour necrosis factor-alpha (TNF-alpha) blocking agent adalimumab in psoriatic patients with concomitant hepatitis B virus (HBV) or hepatitis C virus (HCV). The authors describe 17 psoriatic patients affected by chronic HBV infection and 20 affected by chronic HCV who were successfully treated with adalimumab with no evidence of HBV or HCV reactivation in a mean follow-up period of 27 and 40 months, respectively.

We have previously described our successful experience of treatment with anti-TNF-alpha therapy in 17 psoriatic patients (11 with past HBV infection, 5 with chronic HCV infection and one affected by both HBV and HCV) without the use of lamivudine or adenofovir, and can now report on long-term follow-up data (mean follow-up period of 60 months).

http://ift.tt/2p8HrxB

Assessment of Sun-Protective Attitudes and Behaviours of Australian Medical Students

Abstract

Skin cancer is a major public health concern in Australia and around the world, and UV radiation exposure is accepted as the most readily modifiable risk factor for the disease¹. The attitudes and behaviours of young adults towards sun protection play an important role in their future risk of skin cancer, and are thus an important target for sun-safety messaging.

A cross-sectional study aiming to investigate the sun-protective behaviours and attitudes of Australian medical students during both everyday outdoor activities and while travelling for leisure was conducted via an online questionnaire.

http://ift.tt/2oNZ8yR

Breast milk IgA to foods has different epitope-specificity than serum IgA – Evidence for entero-mammary link for food-specific IgA?

Abstract

Background

We have previously shown that maternal cow's milk (CM) elimination results in down-regulation of CM-specific IgA antibody levels in BM, but not in serum, suggesting that an entero-mammary link may exist for food-specific antibody-secreting cells.

Objective

We sought to investigate whether food-specific IgA epitope profiles differ intra-individually between mother's serum and BM. We also examined how infants' food epitope-specific IgA develops in early infancy and the relationship of IgA epitope recognition with development of cow's milk allergy (CMA).

Methods

We measured specific IgA to a series of overlapping peptides in major CM allergens (α_s1-, α_s2 -, β- and κ-caseins and β-lactoglobulin) in paired maternal and infant serum as well as BM samples in 31 mother-infant dyads within the first 15 postpartum months utilizing peptide microarray.

Results

There was significant discordance in epitope specificity between BM and maternal sera ranging from only 13% of sample pairs sharing at least one epitope in α_s1-casein to 73% in κ-casein. Epitope-specific IgA was detectable in infants' sera starting at less than 3 months of age. Sera of mothers with a CMA infant had increased binding of epitope-specific IgA to CM proteins compared to those with a non-CMA infant.

Conclusion & Clinical Relevance

These findings support the concept that mother's milk has a distinct anti-food antibody repertoire when compared to the antibody repertoire of the peripheral blood. Increased binding of serum epitope-specific IgA to CM in mothers of infants with CMA may reflect inherited systemic immunogenicity of CM proteins in these families, although specific IgA in breast milk was not proportionally upregulated.

http://ift.tt/2prlWbM

Pocket Anesthesia.

No abstract available

http://ift.tt/2p8Ditb

A Retrospective Study to Evaluate the Effect of Concentration of Hypertonic Saline on Efficacy and Safety of Epidural Adhesiolysis.

BACKGROUND: Percutaneous epidural adhesiolysis (PEA) is a minimally invasive procedure that is performed to relieve low back and/or lower limb pain secondary to adhesions or scarring in the epidural space that is refractory to conservative treatment. The optimal concentration of hypertonic saline might be an important factor in the safety and efficacy of PEA. We evaluated differences in the efficacy and safety of 2 concentrations of hypertonic saline (5% and 10%) used in lumbar PEA at our institutions in a retrospective study. METHODS: Patients who received lumbar PEA between January 2009 and June 2014 at either of 2 large civilian teaching institutions in South Korea were assigned to the 5% or 10% groups according to the osmolality of saline. The primary outcome of this study was the difference in change in the 11-point numerical rating scale (NRS) scores of low back and leg pain from baseline to 6 months after PEA between patients in the 2 groups. The number of additional epidural injections, patients' satisfaction with PEA, and any complications that occurred within 6 months after PEA were reviewed. RESULTS: This study included 543 patients (5% group, 333; 10% group, 210). Post-PEA NRS pain scores were significantly lower compared with those at baseline in both groups; however, there were no significant differences between the 2 groups at 6 months or any time point after PEA with regard to any of the clinical characteristics, except infusion-related pain, which exhibited borderline significance for greater scores in the 10% group compared with those in the 5% group (P = .041). Multivariable linear regression analysis with adjustments for covariates, including the number of additional epidural injections, revealed no significant association between patient group and the decrease in NRS pain scores at 6 months of follow-up. Transient adverse events related to PEA were recorded in 3 patients (10% group, 2; 5% group, 1). CONCLUSIONS: In PEA, 5% hypertonic saline exhibited similar positive outcomes after 6 months of follow-up as 10% hypertonic saline, with less infusion-related pain. This result suggests that infusion of 5% hypertonic saline may be considered as an alternative to 10% hypertonic saline in lumbar PEA. Further prospective randomized studies are required to better appreciate the outcome with regard to the use of different concentrations of hypertonic saline for PEA. (C) 2017 International Anesthesia Research Society

http://ift.tt/2p8URJH

Deep Neuromuscular Block and Surgical Conditions During Bariatric Surgery.

No abstract available

http://ift.tt/2oNUv8a

In Response.

No abstract available

http://ift.tt/2pEe0ok

Waldman's Comprehensive Atlas of Diagnostic Ultrasound of Painful Conditions.

No abstract available

http://ift.tt/2pn5YgO

Post-Anesthesia Care: Symptoms, Diagnosis, and Management.

No abstract available

http://ift.tt/2pEckeL

Prophylactic Pentazocine Reduces the Incidence of Pruritus After Cesarean Delivery Under Spinal Anesthesia With Opioids: A Prospective Randomized Clinical Trial.

BACKGROUND: The incidence of pruritus after cesarean delivery under spinal anesthesia with opioids is high, ranging from 50% to 100%. Pruritus is difficult to prevent; however, pentazocine has been shown to be an effective treatment. Despite this, the prophylactic effect of pentazocine on pruritus has not been defined. This randomized double-blind trial aimed to evaluate the effect of intraoperative IV pentazocine on the incidence of opioid-induced pruritus within the first 24 hours after administration of neuraxial opioids. METHODS: We obtained institutional review board approval and written informed consent from the 122 patients (American Society of Anesthesiologists [ASA] physical status II; aged 20-40 years) scheduled for elective cesarean delivery who were included in this study. Spinal anesthesia was performed with 10 mg of 0.5% hyperbaric bupivacaine, 10 [mu]g of fentanyl, and 100 [mu]g of morphine. After delivery of the baby and placenta, the parturient women were randomized to intravenously receive 15 mg (1 mL) of pentazocine or 1 mL of saline. All women received postoperative analgesia with the epidural infusion of 0.15% levobupivacaine. The presence of pruritus within the first 24 hours after intrathecal administration of opioids was recorded, and severity of itch, numerical rating scale (NRS) for pain, and adverse effects were also recorded at the time of the arrival on the ward, as well as 3, 6, 12, and 24 hours after the intrathecal administration of opioids. RESULTS: A total of 119 women completed the study. IV pentazocine reduced the overall incidence of pruritus within the first 24 hours compared to IV saline, with an estimated relative risk of 69% (95% confidence interval [CI], 52%, 90%; P = .007). IV pentazocine also reduced the severity of pruritus. The incidence of nausea and vomiting was not significantly different. There were no significant differences in postoperative NRS scores. CONCLUSIONS: A single 15-mg dose of IV pentazocine after delivery can reduce both the incidence and severity of pruritus in women who have received subarachnoid opioids during cesarean delivery. (C) 2017 International Anesthesia Research Society

http://ift.tt/2pndYyt

Intrathecal Morphine Versus Extended-Release Epidural Morphine for Postoperative Pain Control in Pediatric Patients Undergoing Posterior Spinal Fusion.

BACKGROUND: Posterior spinal fusion for scoliosis is one of the most painful elective pediatric surgeries. Good postoperative pain control allows early ambulation and return of ability to tolerate oral intake. Options for analgesia in this patient population are suboptimal. We hypothesized that extended-release epidural morphine (EREM) would provide better pain control and less adverse effects compared to intrathecal (IT) morphine. METHODS: The primary outcome was total IV morphine consumption during 0-48 hours postoperatively. Secondary outcomes included time until first patient-controlled analgesia (PCA) demand, pain scores, and adverse opioid effects. After institutional review board approval, 71 subjects undergoing posterior spinal fusion for idiopathic scoliosis completed the study. The subjects were randomly allocated to 7.5 [mu]g/kg IT morphine or 150 [mu]g/kg EREM. The final IT morphine and EREM groups contained 37 and 34 subjects, respectively. Postoperative pain was treated with morphine PCA, ketorolac, oral oxycodone, and acetaminophen. Morphine consumption, pain scores, nausea and vomiting, pruritus, and respiratory depression were measured every 4 hours. Parents completed a caregiver questionnaire about their child's pain control regimen after the first postoperative day. RESULTS: There was no difference in total morphine consumption over the first 48 hours between subjects in the EREM and IT morphine groups: median (range) 42.2 (5.5-123.0) and 34.0 (4.5-128.8) mg, respectively (P = .27). EREM and IT morphine groups had no difference in time until first PCA demand. Pain scores were no different between the groups from 8 to 24 hours after surgery. Compared to IT morphine, EREM subjects had lower pain scores from 28 to 36 hours after surgery. The reported incidence of pruritus was lower in the EREM subjects. CONCLUSIONS: There was no difference in total morphine consumption or time until first PCA demand between the EREM and IT morphine groups. EREM provides a longer duration of analgesia after posterior spinal fusion for scoliosis and may be associated with less opioid-induced pruritus. (C) 2017 International Anesthesia Research Society

http://ift.tt/2pE62eZ

Quality Assessment of Meta-analyses Published in Leading Anesthesiology Journals From 2005 to 2014.

Meta-analysis, when preceded by a systematic review, is considered the "gold standard" in data aggregation; however, the quality of meta-analyses is often questionable, leading to uncertainty about the accuracy of results. In this study, we evaluate the quality of meta-analyses published in 5 leading anesthesiology journals from 2005 to 2014. A total of 220 meta-analyses published in Anesthesiology, Pain, British Journal of Anaesthesia, Anaesthesia, or Anesthesia & Analgesia were identified for inclusion. The quality of each meta-analysis was determined using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR). R-AMSTAR rated 11 questions related to systematic reviews and meta-analyses on a scale of 1-4, with 4 representing the highest quality. Overall meta-analyses quality was evaluated using a Spearmen regression analysis and found to positively correlate with time (rs = 0.24, P

http://ift.tt/2p8D997

Comparison of Postoperative Respiratory Monitoring by Acoustic and Transthoracic Impedance Technologies in Pediatric Patients at Risk of Respiratory Depression.

BACKGROUND: In children, postoperative respiratory rate (RR) monitoring by transthoracic impedance (TI), capnography, and manual counting has limitations. The rainbow acoustic monitor (RAM) measures continuous RR noninvasively by a different methodology. Our primary aim was to compare the degree of agreement and accuracy of RR measurements as determined by RAM and TI to that of manual counting. Secondary aims include tolerance and analysis of alarm events. METHODS: Sixty-two children (2-16 years old) were admitted after tonsillectomy or receiving postoperative patient/parental-controlled analgesia. RR was measured at regular intervals by RAM, TI, and manual count. Each TI or RAM alarm resulted in a clinical evaluation to categorize as a true or false alarm. To assess accuracy and degree of agreement of RR measured by RAM or TI compared with manual counting, a Bland-Altman analysis was utilized showing the average difference and the limits of agreement. Sensitivity and specificity of RR alarms by TI and RAM are presented. RESULTS: Fifty-eight posttonsillectomy children and 4 patient/parental-controlled analgesia users aged 6.5 +/- 3.4 years and weighting 35.3 +/- 22.7 kg (body mass index percentile 76.6 +/- 30.8) were included. The average monitoring time per patient was 15.9 +/- 4.8 hours. RAM was tolerated 87% of the total monitoring time. The manual RR count was significantly different from TI (P = .007) with an average difference +/- SD of 1.39 +/- 10.6 but were not significantly different from RAM (P = .81) with an average difference +/- SD of 0.17 +/- 6.8. The proportion of time when RR measurements differed by >=4 breaths was 22% by TI and was 11% by RAM. Overall, 276 alarms were detected (mean alarms/patient = 4.5). The mean number of alarms per patient were 1.58 +/- 2.49 and 2.87 +/- 4.32 for RAM and TI, respectively. The mean number of false alarms was 0.18 +/- 0.71 for RAM and 1.00 +/- 2.78 for TI. The RAM was found to have 46.6% sensitivity (95% confidence interval [CI], 0.29-0.64), 95.9% specificity (95% CI, 0.90-1.00), 88.9% positive predictive value (95% CI, 0.73-1.00), and 72.1% negative predictive value (95% CI, 0.61-0.84), whereas the TI monitor had 68.5% sensitivity (95% CI, 0.53-0.84), 72.0% specificity (95% CI, 0.60-0.84), 59.0% positive (95% CI, 0.44-0.74), and 79.5% negative predictive value (95% CI, 0.69-0.90). CONCLUSIONS: In children at risk of postoperative respiratory depression, RR assessment by RAM was not different to manual counting. RAM was well tolerated, had a lower incidence of false alarms, and had better specificity and positive predictive value than TI. Rigorous evaluation of the negative predictive value is essential to determine the role of postoperative respiratory monitoring with RAM. (C) 2017 International Anesthesia Research Society

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Sporadic versus syndromic keratocysts - Can we predict treatment outcome? A review of 102 cysts

Abstract

Objectives

Keratocystic odontogenic tumor (KCOT) demonstrates variable growth mechanisms and biologic behavior, partly due to origin and histology. We looked for the most contributing factors in predicting outcome of treatment.

Subjects and Methods

We retrospectively reviewed 118 medical files of patients diagnosed with KCOT (by tissue biopsy before surgical treatment) with/without nevoid basal cell carcinoma syndrome (NBCCS) from 1995 to 2015. Data were recorded and analyzed statistically to determine the treatment-outcome correlation. KCOTs in NBCCS patients were termed "syndromic" and random KCOTs termed "sporadic".

Results

Of 102 cysts, 32 were diagnosed with NBCCS. Sporadic KCOTs were significantly larger upon diagnosis (p<0.017). Factors most indicative of post-surgical complications are older age (p<0.011), upper jaw location, and size of lesion ≥9.5 cm². Sporadic KCOTs significantly increased the chances of complications approximately 3 fold (p<0.043). Higher recurrence rate was significant in syndromic cysts (47%) compared to sporadic cysts (20%) (p<0.009). Recurrence time was 3 years on average.

Conclusions

Post-surgical complications may be expected in: older patients, upper jaw location, extensive lesions and sporadic KCOT. Most KCOT recurrence is diagnosed 3 years from treatment.

http://ift.tt/2pEeaME

Maxillofacial prosthodontics practice profile: a survey of non-United States prosthodontists

This study surveyed non-United States maxillofacial prosthodontists (MFP) to determine their practice profile and rationale for pursuing an MFP career.

http://ift.tt/2oQWBoo

Does medical school research productivity predict a resident’s research productivity during residency?

Research productivity is an important component of the CanMEDS Scholar role and is an accreditation requirement of Canadian Otolaryngology training programs. Our objective was to determine if an association ex...

http://ift.tt/2qd0W9k

Nivolumab in Recurrent or Metastatic Salivary Gland Carcinoma of the Head and Neck

Conditions: Salivary Gland Carcinoma; Metastatic Cancer; Recurrent Cancer
Intervention: Drug: Nivolumab
Sponsor: UNICANCER
Recruiting - verified April 2017

http://ift.tt/2oBdDee

A Study of Alectinib in RET-rearranged Non-small Cell Lung Cancer or RET-mutated Thyroid Cancer

Conditions: ALK-positive Non-small Cell Lung Cancer (NSCLC); RET-positive Non-small Cell Lung Cancer (NSCLC); RET-positive Thyroid Cancer
Intervention: Drug: Alectinib
Sponsors: Dana-Farber Cancer Institute; Genentech, Inc.
Not yet recruiting - verified April 2017

http://ift.tt/2oQA0Iv

Topical Antiviral and Antifungal Medications in Pregnancy: A Review of Safety Profiles

Abstract

Medications should be employed with caution in women of childbearing age who are pregnant or considering pregnancy. Compared to oral or parenteral agents, topical medications have limited systemic absorption and are deemed safer. However, their safety profile must be assessed cautiously due to the limited available data. In this article, we aggregate human and animal studies to provide recommendations on utilizing topical antiviral and antifungal medications in pregnancy. For antiviral medications, acyclovir and trichloroacetic acid are safe to use in pregnancy. Docosanol, imiquimod, and penciclovir are likely safe, but should be utilized as second-line agents. Podofilox and podophyllin resin should be avoided. For antifungal medications, clotrimazole, miconazole and nystatin are considered first line agents. Butenafine, ciclopirox, naftifine, oxiconazole, and terbinafine may be utilized after the above agents. Econazole should be avoided during the first trimester and used sparingly during 2^nd and 3^rd trimester. Ketoconazole and selenium sulfide are likely safe, but should be employed in limited areas for brief periods.

http://ift.tt/2qcIePd

Public perception of dermatology and dermatologists in Italy: Results from a population-based national survey

Abstract

Introduction

The public perception of Dermatology and dermatologists may be very relevant in guiding strategies for improving dermatologic care but it has been poorly investigated in Europe.

Objective

To investigate the public's perception of Dermatology and dermatologists in Italy.

Methods

A representative sampling of Italian adults (n=1500, aged 18-70 years), residing throughout the national territory was interviewed through a population-based telephone survey using a structured questionnaire.

Results

The majority of interviewed aged between 35 and 54 years (45%) and had an intermediate educational level (57%), were employed (56%), and had at least one child in the family (68%). 70% of the interviewed knew at least one skin disease, particularly psoriasis, dermatitis, urticaria, skin tumors and nevi. The general practitioner resulted to be the first health care provider to consult in the case of skin problems for 73% of surveyed, with only 27% referring directly the private dermatologist. The dermatologist was the main referral specialist for psoriasis, pruritus and skin tumors by 66%, 54% and 53% of the sample, respectively. The most common reason for dermatological consultation was the control of nevi. In the case of childhood dermatitis, 52% indicated the paediatrician and 38% the dermatologist as the reference specialist. Almost half of the surveyed turned out to have a trusted dermatologist to consult in the case of skin problems. Finally, among those visited at least one time by a dermatologist, 46% were promoters, i.e. they would recommend their dermatologist to a friend (net promoter score, 27).

Conclusions

The general population has a wide-ranging understanding of skin diseases and the central role of dermatologists in skin care. Patients are looking for technical competence and loyalty, because this lead to more trusted and satisfactory physician-patient relationship. Public campaigns may be relevant in increasing awareness on curability of common skin diseases.

http://ift.tt/2oQOd8t

Consensus statement on prevention and management of adverse effects following rejuvenation procedures with Hyaluronic acid based fillers

Abstract

Facial fillers play an important role in the correction of facial changes associated with ageing. They offer quick treatments in the outpatient setting with minimal subsequent downtime that provide predictable, natural-looking, long-lasting results. Hyaluronic acid soft tissue injectables have established their role as the fillers of choice for patients over the last 2 decades. Hyaluronic acid fillers are rarely associated with adverse reactions, and those that do occur tend to be mild and temporary. However, as with all injected or implanted biomaterials, adverse events can occur and patients must be fully informed of potential risks prior to undergoing treatment. A panel of experts from Germany (D), Austria (A) and Switzerland (CH) developed recommendations and this paper provides the 'DACH Consensus Recommendations' from this group specifically on the use of hyaluronic acid fillers. The aim is to help clinicians recognise potential risks and to provide guidance on how best to treat adverse events if they arise. Contra-indications to hyaluronic acid fillers are also detailed and ways to prevent adverse events occurring are discussed. Hyaluronic acid-based products are claimed by some to be very close to fulfilling many of the requirements of an ideal tissue augmentation agent, nevertheless, the potential benefits of treatment must be carefully weighed against the risk of potential adverse events.

http://ift.tt/2oQFrHx

HPV16 E7 DNA tattooing: safety, immunogenicity, and clinical response in patients with HPV-positive vulvar intraepithelial neoplasia

Abstract

Background

Usual type vulvar intraepithelial neoplasia (uVIN) is caused by HPV, predominantly type 16. Several forms of HPV immunotherapy have been studied, however, clinical results could be improved. A novel intradermal administration route, termed DNA tattooing, is superior in animal models, and was tested for the first time in humans with a HPV16 E7 DNA vaccine (TTFC-E7SH).

Methods

The trial was designed to test safety, immunogenicity, and clinical response of TTFC-E7SH in twelve HPV16⁺ uVIN patients. Patients received six vaccinations via DNA tattooing. The first six patients received 0.2 mg TTFC-E7SH and the next six 2 mg TTFC-E7SH. Vaccine-specific T-cell immunity was evaluated by IFNγ-ELISPOT and multiparametric flow cytometry.

Results

Only grade I-II adverse events were observed upon TTFC-E7SH vaccination. The ELISPOT analysis showed in 4/12 patients a response to the peptide pool containing shuffled E7 peptides. Multiparametric flow cytometry showed low CD4⁺ and/or CD8⁺ T-cell responses as measured by increased expression of PD-1 (4/12 in both), CTLA-4 (2/12 and 3/12), CD107a (5/12 and 4/12), or the production of IFNγ (2/12 and 1/12), IL-2 (3/12 and 4/12), TNFα (2/12 and 1/12), and MIP1β (3/12 and 6/12). At 3 months follow-up, no clinical response was observed in any of the twelve vaccinated patients.

Conclusion

DNA tattoo vaccination was shown to be safe. A low vaccine-induced immune response and no clinical response were observed in uVIN patients after TTFC-E7SH DNA tattoo vaccination. Therefore, a new phase I/II trial with an improved DNA vaccine format is currently in development for patients with uVIN.

http://ift.tt/2qbWnw1

KRAS mutation-induced upregulation of PD-L1 mediates immune escape in human lung adenocarcinoma

Abstract

It was reported that PD-L1 expression was correlated with genetic alterations. Whether PD-L1 was regulated by mutant Kirsten rat sarcoma viral oncogene homolog (KRAS) in non-small-cell lung cancer (NSCLC) and the underlying molecular mechanism were largely unknown. In this study, we investigated the correlation between PD-L1 expression and KRAS mutation and the functional significance of PD-1/PD-L1 blockade in KRAS-mutant lung adenocarcinoma. We found that PD-L1 expression was associated with KRAS mutation both in the human lung adenocarcinoma cell lines and tissues. PD-L1 was up-regulated by KRAS mutation through p-ERK but not p-AKT signaling. We also found that KRAS-mediated up-regulation of PD-L1 induced the apoptosis of CD3-positive T cells which was reversed by anti-PD-1 antibody (Pembrolizumab) or ERK inhibitor. PD-1 blocker or ERK inhibitor could recover the anti-tumor immunity of T cells and decrease the survival rates of KRAS-mutant NSCLC cells in co-culture system in vitro. However, Pembrolizumab combined with ERK inhibitor did not show synergistic effect on killing tumor cells in co-culture system. Our study demonstrated that KRAS mutation could induce PD-L1 expression through p-ERK signaling in lung adenocarcinoma. Blockade of PD-1/PD-L1 pathway may be a promising therapeutic strategy for human KRAS-mutant lung adenocarcinoma.

http://ift.tt/2oNkMmI

Tumor-associated fibrosis as a regulator of tumor immunity and response to immunotherapy

Abstract

Tumor-associated fibrosis is characterized by unchecked pro-fibrotic and pro-inflammatory signaling. The components of fibrosis including significant numbers of cancer-associated fibroblasts, dense collagen deposition, and extracellular matrix stiffness, are well appreciated regulators of tumor progression but may also be critical regulators of immune surveillance. While this suggests that the efficacy of immunotherapy may be limited in highly fibrotic cancers like pancreas, it also suggests a therapeutic opportunity to target fibrosis in these tumor types to reawaken anti-tumor immunity. This review discusses the mechanisms by which fibrosis might subvert tumor immunity and how to overcome these mechanisms.

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Forthcoming Meetings

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Inheritance and the sunshine vitamin

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Issue Information

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Cover Image

The cover image, by C. B. Mathias et al., is based on the Original Article IL-15-deficient mice develop enhanced allergic responses to airway allergen exposure, DOI 10.1111/cea.12886

http://ift.tt/2qk8bIZ

Dermoscopy use by Canadian dermatologists and dermatology residents: a cross sectional nationwide study

Abstract

Dermoscopy has demonstrated clinical benefits in improving early melanoma diagnosis and reducing unnecessary biopsies. Despite this, the prevalence of dermoscopy use by dermatologists varies from 81% to 98% worldwide, with a lack of training being a commonly cited reason for non-use of dermoscopy. To date there are no studies examining the prevalence of dermoscopy use in Canada. Our study aimed to examine the use and learning of dermoscopy by Canadian dermatologists and dermatology residents, as well as the current state of dermoscopy teaching within Canadian dermatology residency programs.

http://ift.tt/2pDKmQe

Survival of sealants in molars affected by molar-incisor hypomineralization: 18-month follow-up

Abstract The objective of this study was to evaluate the clinical survival of sealants applied in first permanent molars (FPMs) affected by molar-incisor hypomineralization (MIH), at 18 months of follow-up. Forty-one first permanent molars were selected from 21 children, 6–8 years of age. MIH was classified by one calibrated examiner (kappa = 0.80) according to EAPD criteria. The inclusion criteria were fully erupted FPMs with MIH or sound FPMs (without MIH) for which sealant treatment was indicated. The FPMs were assigned to two groups: CG (control group) and HG (MIH group). Both groups were treated with sealant (FluroShield). Clinical follow-up was performed from baseline to 18 months to assess anatomical form, marginal adaptation, retention and presence of caries, according to criteria set by the United States Public Health Service-Modified, and was conducted by a blinded examiner (kappa = 0.80). The actuarial method was used to evaluate the survival of the sealants. The survival rates for the groups were compared using Fisher's exact test (α = 5%). The cumulative survival rates were 81% at 1 month, 68.8% at 6 months, 68.8% at 12 months, and 62.6% at 18 months for CG, and 88% at 1 month, 84% at 6 months, 76% at 12 months, and 72% at 18 months for HG. No significant difference was found between the groups. The sealants in molars affected by MIH presented a survival rate similar to the sealants in the control, suggesting that sealants may be an adequate approach for preventing carious lesions in MIH-affected molars.

http://ift.tt/2pmvmTV

Analysis of GLUT-1, GLUT-3, and angiogenic index in syndromic and non-syndromic keratocystic odontogenic tumors

Abstract The aim of this study was to evaluate the immunoexpression of glucose transporters 1 (GLUT-1) and 3 (GLUT-3) in keratocystic odontogenic tumors associated with Gorlin syndrome (SKOTs) and non-syndromic keratocystic odontogenic tumors (NSKOTs), and to establish correlations with the angiogenic index. Seventeen primary NSKOTs, seven recurrent NSKOTs, and 17 SKOTs were selected for the study. The percentage of immunopositive cells for GLUT-1 and GLUT-3 in the epithelial component of the tumors was assessed. The angiogenic index was determined by microvessel count. The results were analyzed statistically using the nonparametric Kruskal-Wallis test and Spearman's correlation test. High epithelial immunoexpression of GLUT-1 was observed in most tumors (p = 0.360). There was a higher frequency of negative cases for GLUT-3 in all groups. The few GLUT-3-positive tumors exhibited low expression of this protein in epithelial cells. No significant difference in the angiogenic index was observed between groups (p = 0.778). GLUT-1 expression did not correlate significantly with the angiogenic index (p > 0.05). The results suggest that the more aggressive biological behavior of SKOTs when compared to NSKOTs may not be related to GLUT-1 or GLUT-3 expression. GLUT-1 may play an important role in glucose uptake by epithelial cells of KOTs and this process is unlikely related to the angiogenic index. GLUT-1 could be a potential target for future development of therapeutic strategies for KOTs.

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Frailty index: Intensive care unit complications in head and neck oncologic regional and free flap reconstruction

Abstract

Background

Head and neck extirpations requiring reconstruction are challenging surgeries with high postoperative complication risk.

Methods

Regional and free flap reconstructions of head and neck defects were collected from the 2006-2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The modified frailty index was made of 15 variables, with increasing index scores indicative of frailer patients. Intensive care unit (ICU)-level complications were defined by Clavien-Dindo classification IV and analyzed with multivariable logistic regression.

Results

There were 266 flap reconstructions (126 regional and 140 free) with 86 (7.2%) Clavien-Dindo classification IV complications. As modified frailty index increased, a moderate correlation was demonstrated for Clavien-Dindo classification IV complications (R² = 0.30). Increasing modified frailty index score was correlated on linear regression with free versus regional flaps: Clavien-Dindo classification IV (R² = 0.09; 0.60), morbidity (R² = 0.04; 0.59), and mortality (R² = 0.07; 0.46), respectively. On multivariable analysis, the modified frailty index was associated with Clavien-Dindo classification IV complications for all flaps (odds ratio [OR] 4.38; 95% confidence interval [CI] 1.33-14.48) and free flaps (OR 6.60; 95%CI 1.02-42.52), but not regional flaps (OR 9.05; 95%CI 0.60-137.10).

Conclusion

The modified frailty index score is predictive of critical care support in head and neck resections necessitating reconstruction, specifically for free flaps.

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Impact of metformin on patients with advanced head and neck cancer undergoing concurrent chemoradiotherapy

Abstract

Background

The purpose of this study was to evaluate the impact of metformin on toxicities and survival in patients with head and neck cancer undergoing concurrent chemoradiotherapy (CRT).

Methods

We retrospectively analyzed and compared the clinical characteristics, treatment tolerance, toxicities, and survival of 252 patients with stages III, IVA, and IVB head and neck cancer undergoing concurrent CRT with and without metformin treatment between 2007 and 2010.

Results

Among all patients, 39 patients received metformin whereas 219 patients did not. Both groups had similar clinical characteristics and nearly identical disease-free survival and overall survival. However, the metformin group was less likely to tolerate cisplatin, experienced more weight loss, had a tendency to receive lower doses of radiotherapy, required more feeding tube support, and had grade ≥3 nausea/vomiting and hematological toxicities.

Conclusion

Patients with head and neck cancer undergoing concurrent CRT along with metformin treatment require more careful multidisciplinary assessment and supportive care to ensure successful completion of treatment and avoid treatment-related toxicities.

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Increased risk of paclitaxel-induced peripheral neuropathy in patients using clopidogrel: a retrospective pilot study

Abstract

Paclitaxel-induced peripheral neuropathy (PIPN) is one of the serious adverse events associated with paclitaxel-based cancer treatments. A recent case study showed that the antiplatelet agent clopidogrel inhibits paclitaxel metabolism via cytochrome P450 (CYP) 2C8, resulting in severe PIPN. The aim of this study was to determine the impact of clopidogrel as a risk factor for the development of PIPN, using a retrospective cohort study. Data from paclitaxel-treated patients with or without clopidogrel and low-dose aspirin treatment were retrieved from medical charts. A total of 161 adult patients were included in this study: 135 were controls, 9 were clopidogrel-treated and 17 were aspirin-treated. The clopidogrel group had a greater proportion of males and a higher rate of comorbidities, such as diabetes mellitus and dyslipidemia, than the control group. However, patient characteristics were similar between the clopidogrel and aspirin groups. Severe PIPN was diagnosed in 3 (2.2%) and 2 (22.2%) patients in the control and clopidogrel groups, respectively (odds ratio: 12.0; p = 0.031). No patients in the aspirin group presented with severe neuropathy. These pilot data suggest that concomitant treatment with clopidogrel leads to a greater risk of PIPN. The avoidance of concomitant clopidogrel use may be effective in reducing clopidogrel-associated PIPN.

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Middle meatal packing in endoscopic sinus surgery—to pack or not to pack?—a decision-analysis model

Background

Packing of the middle meatus and ethmoid cavities is a common practice in endoscopic sinus surgery (ESS), but its necessity recently has been challenged. The aim of this study was to formulate a decision-analysis model to determine the need for packing in ESS and identify variables affecting the decision.

Methods

A systematic review of the literature was conducted for all randomized control trials comparing packing to no packing in ESS, and a decision-analysis model was generated. Probabilities and utilities were derived from the literature. Sensitivity analysis was used to determine which variables most affected the model.

Results

No packing was associated with better expected utilities than packing. On sensitivity analysis, packing was preferred when the disutility of no packing outweighed the disutility of packing, and when the probability for synechiae was greater than 35% without packing or lower than 2% with packing. When the component of packing removal was subtracted from the overall disutility simulating absorbable packing, the results favored packing.

Conclusion

Our decision-analysis model indicates that middle meatal packing is not advantageous for patients undergoing ESS. Absorbable packing materials have a less adverse effect on quality of life than nonabsorbable materials.

Level of Evidence

1a. Laryngoscope, 2016

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Sarcopenia and Wound Complication After Total Laryngectomy

This study examines the incidence of sarcopenia in patients with squamous cell carcinoma undergoing total laryngectomy.

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With Experience Comes Wisdom

What a pleasure it is to be able to comment on the Viewpoint by Grundfast et al, "The 10 Commandments of Management for Acute Upper Airway Obstruction in Infants and Children." Having just finished Michael Lewis's book The Undoing Project, which tells the story of Daniel Kahneman, Amos Tversky, and the birth of a new form of behavioral psychology and decision analysis, I am, of course, concerned about the inherent biases in trusting at face value the words of a senior statesman just because he looks and acts the part. Do we hold with heuristic beliefs that with an author's age and experience comes wisdom? I am now "trained" not to ask "who the author is" but "what has he or she actually done" before I trust the narrator that speaks to me.

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Frontal Sinus Lesion

A woman with allergic rhinitis experienced progressive periorbital edema and proptosis of the left eye, with nasal congestion, altered sense of smell, supraorbital pain, proptosis, and periorbital edema; a CT scan revealed extensive thickening of the left frontal bone. What is your diagnosis?

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Exclusion of Eligible Indeterminate Thyroid Nodules in Estimates of Negative Predictive Value for the Gene Expression Classifier

To the Editor Al-Qurayshi et al calculated the negative predictive value (NPV) of the Gene Expression Classifier (GEC) in 154 indeterminate thyroid nodules (ITNs). We reviewed 12 articles that evaluated the diagnostic accuracy of the GEC. In those studies, as with that of Al-Quyrashi et al, estimates for test performance were unreliable, owing to serious methodologic flaws in the authors' approach. The most impactful of these flaws was the exclusion of unexcised GEC-benign ITNs from the analysis, resulting in the calculation of NPV on a nonrepresentative sample GEC-benign ITNs selected for excision. A better method would have been to include GEC-benign ITNs that do not develop ultrasound findings suspicious for malignant neoplasm as true-negative results in the calculation of NPV (Table). We can assume the 22 unexcised GEC-benigns did not have suspicious findings on ultrasound, given that the authors imply that GEC-benign ITNs that "…developed indications for surgery…" underwent excision. Using previously published estimates of the diagnostic accuracy of the TIRADS in ultrasound reporting, we can estimate that about 3 (15%) unexcised 22 GEC-benign ITNs may have also been malignant. Therefore, the observed NPV of the GEC in this study can be estimated to be 44 of 58 (76%).

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Survival After Salvage Surgery for Recurrent Oral Cavity Cancer

This cohort study evaluates overall survival in patients who undergo salvage surgery for recurrent oral cavity squamous cell cancer.

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Exclusion of Eligible Indeterminate Thyroid Nodules in Estimates of Negative Predictive Value for the Gene Expression Classifier

In Reply We appreciate all scientific efforts to improve care for patients with indeterminate nodules. The Afirma assay has been an excellent addition to this endeavor, and our study helpful in understanding test characteristics in a unique patient population.

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The 10 Commandments of Management for Acute Upper Airway Obstruction

This Viewpoint recommends 10 commandments or rules to follow when managing an acute upper airway obstruction in an infant or child.

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Evaluation of Ecological Momentary Assessment for Tinnitus Severity

This observational study uses an ecological momentary assessment to measure tinnitus disability and associated constructs.

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Clinical Outcomes Among Patients Who Contract to Abstain From Alcohol

This case-control study evaluates the association of alcohol abstinence with postoperative outcome in alcohol misusers undergoing major surgical procedures of the head and neck by using an alcohol abstinence contract.

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

Publication date: Available online 26 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): W. Terro, St. J. Crean
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. Thirty-six patients and 21 primary carers were enrolled, and patients completed one head-and-neck-specific measure, the University of Washington Head and Neck, Version Four (UW-V4), and three other questionnaires, both at the time of diagnosis and at one and three months postoperatively. The carers completed similar questionnaires except for the UW-V4. Analysis of the patients' data showed a serious deterioration in psychosocial and physical domains at one month postoperatively. However, the analysis of carers' data showed a highly significant deterioration in anxiety and depression domains (p<0.01), which remained low after three months. These findings highlight the need for psychological support not only for patients but also for their primary carers during the management of carcinoma of the head and neck.

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

Publication date: Available online 26 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): P. Szymor, M. Kozakiewicz

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

Publication date: Available online 26 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): E. Moreddu, K. Baumstarck-Barrau, S. Gabriel, N. Fakhry, F. Sebag, O. Mundler, C. Chossegros, D. Taïeb
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. A total of 413 patients sent the questionnaire back, of whom 100 (24%) had experienced pain, 116 (28%) discomfort or swelling, and 147 (36%) dry mouth or xerostomia. This survey has highlighted the number of side effects of radioiodine treatment in a large group of patients and corroborates previous observations. Our new self-administered questionnaire may be useful to others for follow-up and research.

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Panorama Dermatologische Praxis

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Morbus Still im Kindes- und Erwachsenenalter

Zusammenfassung

Die systemische juvenile idiopathische Arthritis (sJIA) ist durch Fieber, Arthritis und weitere Symptome systemischer Inflammation gekennzeichnet. Historisch ist sie nach ihrem Erstbeschreiber George Frederic Still als Morbus Still benannt. Tritt die Erkrankung bei Erwachsenen auf, wird sie als adulte Still-Erkrankung („adult onset Still's disease", AOSD) bezeichnet. Die Pathophysiologie der sJIA und der AOSD wird inkomplett verstanden. Die gesteigerte Aktivierung von Inflammasomen und die Expression proinflammatorischer Zytokine spielen eine zentrale Rolle. S100-Proteine, die durch die Aktivierung von Toll-like-Rezeptoren als positiver Verstärker wirken, sind ebenso erhöht im Serum von sJIA-Patienten messbar. Reduzierte Produktion des immunmodulatorischen Zytokins IL-10 könnte zudem zur Aktivierung von Immunzellen und der Produktion inflammatorischer Botenstoffe beitragen. In diesem Beitrag werden die klinische Präsentation, die Differenzialdiagnostik, der aktuelle Wissensstand zur Pathophysiologie sowie Therapieoptionen der sJIA und der AOSD diskutiert.

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Bildgebung in der Hals‑Nasen‑Ohren-Heilkunde

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Interventionelle Radiologie im Kopf-Hals-Bereich

Zusammenfassung

Gefäßverschließende Maßnahmen neuroradiologischer Interventionen sind ein wichtiges und hilfreiches Werkzeug in der Behandlung verschiedener Erkrankungen im Kopf-Hals-Bereich. Diese interventionellen Maßnahmen erfolgen einerseits in kurativer Intention, zur Reduktion des Operationsrisikos im Rahmen eines multimodalen Therapiekonzepts oder auch zur Verbesserung oder zumindest zum Erhalt einer guten Lebensqualität. Essenziell für die erfolgreiche Behandlung ist neben dem Verständnis der Erkrankung das Wissen um die Gefäßanatomie sog. gefährlicher Anastomosen zwischen extra- und intrakraniellen Gefäßen und der Einsatz geeigneter Techniken und Materialien. Indikationen für einen transarteriellen Gefäßverschluss sind einerseits unkontrollierbare Blutungen unterschiedlicher Genese (traumatisch, vaskuläre Malformation, Tumor), andererseits die Reduktion des intraoperativen Blutverlusts bei hypervaskularisierten Tumoren durch eine präoperative Embolisationsbehandlungen und drittens die Induktion einer Tumornekrose zur regionalen Tumorkontrolle im Rahmen palliativer Embolisationen. Gravierende Komplikationen wie z. B. Schlaganfall, Erblindung und Hirnnervenlähmungen sind nicht selten auf eine unzureichende präinterventionelle Evaluation zurückzuführen. Bei Interventionen im Versorgungsgebiet der A. carotis externa liegt die Komplikationsrate für schwere neurologische Defizite unter 1 %.

http://ift.tt/2qcyRiB

PET-CT bei Karzinomen im Kopf‑Hals‑Bereich

Zusammenfassung

Die ¹⁸F-Fluordeoxyglukose-Positronenemissionstomographie (FDG-PET) gewinnt zunehmenden Stellenwert in der Diagnostik onkologischer Erkrankungen, was zum einen auf der hohen Sensitivität der Methode und zum anderen auf der Möglichkeit einer Ganzkörperuntersuchung beruht. Insbesondere bei der Diagnostik von Kopf-Hals-Karzinomen können sich hierdurch Vorteile ergeben, da ein präzises Primärstaging entscheidender Prognoseparameter ist, woraus letzten Endes das Therapieregime für den Patienten resultiert. Die vorliegende Arbeit stellt die verschiedenen Einsatzmöglichkeiten der Untersuchung mittels Kombination aus PET und Computertomographie (CT) im Rahmen der Diagnostik von Kopf-Hals-Karzinomen dar. Besonderes Augenmerk wird hierbei auf das Primärstaging und die Tumornachsorge gelegt sowie den Stellenwert bei der Diagnostik des CUP-Syndroms („cancer of unknown primary origin"); auch der Einsatz bei der Strahlentherapieplanung sowie neue Aspekte in der PET-Technologie werden beschrieben.

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Indications and extent of central neck dissection for papillary thyroid cancer: An American Head and Neck Society Consensus Statement

ABSTRACT

Background

The primary purposes of this interdisciplinary consensus statement were to review the relevant indications for central neck dissection (CND) in patients with papillary thyroid cancer (PTC) and to outline the appropriate extent and relevant techniques required to accomplish a safe and effective CND.

Methods

A writing group convened by the American Head and Neck Society (AHNS) Endocrine Committee was tasked with identifying the important clinical elements to consider when managing the central neck compartment in patients with PTC based on available evidence in the literature, and the group's collective experience. The position statement paper was then submitted to the full Endocrine Committee, Education Committee, and AHNS Council.

Results

This consensus statement was developed to inform the clinical decision-making process when managing the central neck compartment in patients with PTC from the AHNS. This document is intended to provide clarity through definitions as well as a basic guideline from which to manage the central neck. It is our hope that this improves the quality and reduces variation in management of the central neck, facilitates communication, and furthers research for patients with thyroid cancer.

Conclusion

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Editorial Board

Publication date: May 2017
Source:Journal of Oral Biosciences, Volume 59, Issue 2

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New microbleed after blood-brain barrier leakage in intracerebral haemorrhage

Cerebral microbleeds are increasingly recognised as biomarkers of small vessel disease. Several preclinical and clinical studies have suggested that chronic disruption of the blood–brain barrier is one of the mechanisms for the development of cerebral microbleeds.

A 51-year-old man experienced two left parieto-occipital lobar intracerebral haemorrhages (ICHs) in the timespan of 2 years. Multiple microbleeds surrounding the two haemorrhages were found on MRI, but not at location distant from the haemorrhages. Ten months after the last haemorrhage, an MRI demonstrated a right occipital focus of contrast enhancement. Twenty months after the last ICH, a new cerebral microbleed had developed exactly at the location of the earlier contrast enhancement.

This case demonstrates that blood–brain barrier disruption may be an important factor preceding the development of cerebral microbleeds.

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Leiomyosarcoma: a rare but fatal tumour of the inferior vena cava

Description

Leiomyosarcomas (LMS) of the inferior vena cava (IVC) are a rare entity. Signs and symptoms vary greatly, such as abdominal pain, weight loss/gain, fever, weakness, anorexia or vomiting. CT scan is the imaging modality of choice for evaluation of retroperitoneal LMS, but biopsy is necessary to establish the diagnosis.

A 62-year-old woman presented with intermittent, diffuse, dull and sharp abdominal pain radiating to the lower back, associated with nausea, bloating and constipation. She also had a 15-pound weight gain in 6 months. Prior work-up did not reveal any acute abnormalities and she received treatment for constipation.

Due to persistent symptoms, CT of the abdomen and pelvis was ordered and demonstrated heterogeneously enhancing mass of the IVC extending into the right atrium (figure 1A,B). CT of the chest was done and confirmed the extension of the tumour to the right atrium (figure 1C,D). Figure...

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Case 13-2017: A 41-Year-Old Man with Hearing Loss, Seizures, Weakness, and Cognitive Decline

Presentation of Case. Dr. Haatem M. Reda: A 41-year-old man was seen in the neurology clinic of this hospital because of seizures, weakness, and cognitive decline. The patient had a history of migraine headaches, sensorineural hearing loss, and chronic proteinuria. He had been in his usual health…

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Issue Information

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Corrigendum

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Clinical Snippets

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Corrigendum

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Corrigendum

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Comprehensive management of congenital choanal atresia

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Pierre Brihaye, Isabelle Delpierre, Andrée De Villé, Anne-Britt Johansson, Dominique Biarent, Anne-Laure Mansbach
ObjectivesTo present results of a one-stage minimally invasive surgical procedure for congenital choanal atresia (CCA). Seven outcome measures were applied.Materials and methodsRetrospective study conducted between 1999 and 2015. The same endonasal endoscopic approach with multiflaps and no stenting was used on 36 children. The flaps were attached with fibrine glue. There were 50% unilateral and 50% bilateral cases, 70% primary and 30% secondary surgery. The mean age at primary surgery for bilateral atresia was 10 days and for unilateral atresia 4 years. Associated loco-regional disorders were: hypoplasia of the inferior turbinate, rhinopharyngeal stenosis and rhinopharyngeal web.ResultsThe average follow-up time was 6 years, ranging from 1 to 14 years. There was a functionally patent choanae in 94% of children, and 6% showed severe restenosis with a diameter less than 4 mm, which needed one revision surgery each. Charge patients were not associated with worse outcome. There was no external nasal valve stenosis and no permanent Eustachian tube dysfunction. Synechiae occurred in 3 patients with hyperplastic inferior turbinate. No patients showed any disharmonious nasal growth. In neonates with isolated bilateral CCA, breast-suction could be started within 1 day (range 1–2 days), and pain-killers were needed on average for 1.5 days (range 1–4 days). The hospital stay for unilateral isolated CCA was on average 1.5 days (range 1–2 days) and for bilateral isolated CCA, 8 days (range 3–20 days). Postoperative procedures under a short general anesthesia were necessary in 12 cases, 10 of them were infants under 6 months of age.ConclusionSurgery could be performed safely in the newborn in the early stage of life, even for unilateral atresia. Tendency for restenosis can be minimized by: 1. the construction of an as large as possible uni-neochoanae by removing the posterior part of the vomer and by drilling away the medial pterygoid; 2. in case of rhinopharyngeal stenosis, part of the endochondral clivus bone should be resected; 3. all raw surfaces should be covered by multiple mucosal flaps secured with fibrin glue; 4. no stenting; 5. appropriate postoperative care.

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Αρχειοθήκη ιστολογίου

Πέμπτη 27 Απριλίου 2017

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