High-risk cutaneous squamous cell carcinoma in a Japanese allogeneic bone marrow transplant recipient on long-term voriconazole

Abstract

Cutaneous squamous cell carcinomas arise as secondary cancers in hematopoietic stem cell transplant survivors. They have been documented primarily in Western cohorts and relatively little is known about their occurrence in Asian hematopoietic stem cell transplant recipients, with no reports of squamous cell carcinomas with high-risk features in Asian patients. We describe a case of a cutaneous squamous cell carcinoma with high-risk features on the scalp of a Japanese bone marrow transplant recipient approximately 6.5 years post-transplant, who was on long-term voriconazole. The history of a photodistributed erythema followed by the appearance of multiple actinic keratoses and solar lentigines, together with the rarity of cutaneous squamous cell carcinomas in Asian hematopoietic stem cell transplant cohorts revealed in our literature review, suggest that voriconazole use contributed to the development of high-risk squamous cell carcinoma in our patient.

http://ift.tt/2qBAAer

Phosphorylated signal transducer and activator of transcription 3 in the epidermis in adult-onset Still's disease

Abstract

Adult-onset Still's disease (AOSD) is characterized by multiple systemic inflammation of unknown etiology. Although the typical eruption of AOSD is salmon-pink rheumatoid rash on the trunk and extremities, persistent pruritic papules and plaques have also been reported. Correlations between serum cytokines, including interleukin-6 and -18, and disease activity in AOSD have been reported. Activated signal transducer and activator of transcription 3 (STAT3) is transported into the nucleus, where it functions as a transcription factor that regulates genes involved in cell survival and inflammation. To assess whether STAT3 was phosphorylated in skin samples from AOSD patients, we conducted immunohistochemical analysis of affected and unaffected lesions from four AOSD patients in comparison with 10 normal controls. Quantitative analysis was conducted by measuring the ratio of epidermal keratinocytes with phosphorylated STAT3 (p-STAT3)-positive nuclei to total epidermal keratinocytes. p-STAT3 was found to be more strongly expressed in the nuclei in the epidermis of AOSD than in normal controls. Quantification of the data revealed significant differences in staining for p-STAT3 between AOSD and normal skin. Our findings suggest that phosphorylation of STAT3 may be a potential therapeutic target for AOSD.

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Mycobacterium tuberculosis found at both skin lesions and Mantoux testing site in a patient with erythema induratum of Bazin

Abstract

Mycobacterium tuberculosis is very rarely found in erythema induratum of Bazin; recently, we found an unusual case with positive acid-fast bacilli and polymerase chain reaction for detecting M. tuberculosis in both skin lesions of the extremities and the site of Mantoux test.

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Food-dependent exercise-induced anaphylaxis due to shrimp associated with 43 kDa, a new antigen

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Gnathostomiasis caused by ingestion of raw Oncorhynchus masou ishikawae roe

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Case of reticulated acanthoma with sebaceous differentiation with clinicopathological surveillance

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Typical Chinese pedigree of autosomal dominant genetic disease: Neurofibromatosis type 1 with a novel frame-shift mutation

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Information for Readers

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5





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Table of Contents

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5





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Cost and health care utilization in patients with asthma and high oral corticosteroid use

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Michael S. Broder, Karina Raimundo, Ka Ming Ngai, Eunice Chang, Noelle M. Griffin, Liam G. Heaney




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Instructions for Authors

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5





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Editorial Board

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5





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Can we effectively use radiographic imaging and clinical parameters for making an earlier diagnosis of granulomatous interstitial lung disease in patients with common variable immunodeficiency?

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Terry Harville




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Allergenic extracts to diagnose and treat sensitivity to insect venoms and inhaled allergens

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Taruna Khurana, Jennifer L. Bridgewater, Ronald L. Rabin
ObjectiveTo review allergenic extracts used to diagnose or treat insect allergies, including how the extracts are manufactured and their measurements of potency or concentration.Data SourcesPeer-reviewed articles derived from searching PubMed (National Center for Biotechnology Information) about insect allergies and extract preparation. Encyclopedia of Life (http://www.eol.org/) and http://allergome.org/ were also referenced for background information on insects and associated allergens.Study SelectionsSearch terms used for the PubMed searches included insect allergens and allergies, Apidae, Vespidae, fire ants, cockroach allergies, insect allergen extract preparation, and standardization.ResultsHumans may be sensitized to insect allergens by inhalation or through stings. Cockroaches and moths are predominantly responsible for inhalation insect allergy and are a major indoor allergen in urban settings. Bees, fire ants, and wasps are responsible for sting allergy. In the United States, there are multiple insect allergen products commercially available that are regulated by the US Food and Drug Administration. Of those extracts, honeybee venom and insect venom proteins are standardized with measurements of potency. The remaining insect allergen extracts are nonstandardized products that do not have potency measurements.ConclusionSensitization to inhalational and stinging insect allergens is reported worldwide. Crude insect allergen extracts are used for diagnosis and specific immunotherapy. A variety of source materials are used by different manufacturers to prepare these extracts, which may result in qualitative differences that are not reflected in measurements of potency or protein concentration.



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Penicillin desensitization: Treatment of syphilis in pregnancy in penicillin-allergic patients

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Michele N. Pham, Hsi-en Ho, Mauli Desai




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Clinical characteristics of patients with chronic obstructive pulmonary disease overlapped with bronchial asthma

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Jing-bo Liang, Li-jin Liu, Qiu-hong Fang
BackgroundThe clinical characteristics of patients with chronic obstructive pulmonary disease overlapped with bronchial asthma (COPD-BA) have not been discussed thoroughly.ObjectiveTo reveal the clinical features of patients with COPD-BA, to evaluate the risk factors of COPD-BA, and to provide suggestions for COPD individualized therapy.MethodsA retrospective observational study was performed. A total of 182 patients with COPD (90 with COPD-BA and 92 with pure COPD) were recruited in the study. Information on the following items was collected: demographics, clinical manifestations, complications, laboratory findings, other histories, and inpatient treatments during exacerbation.ResultsA total of 182 patients were diagnosed with COPD, with 90 (49.45%) being classified as having COPD-BA. Patients with COPD-BA were more likely to be female (P = .004) and experienced more severe respiratory exacerbations (P = .04) despite being younger (P = .008). Those patients at onset of recurrent cough and sputum production were younger (P = .001). Significantly, a positive asthmatic family history (P = .03) was observed. Patients with COPD-BA usually had higher level of total serum IgE (although no differences were observed), had higher positive rates of the serum specific IgE (P = .004), and were more like to have an allergic history (P = .003). Allergic factor was the risk factor of COPD-BA (odds ratio, 4.477). During hospitalization, patients with COPD-BA tended to be treated with systemic corticosteroids (P = .008).ConclusionPatients with COPD-BA were characterized by persistent airflow limitation with unique clinical features. Allergic factor was associated with the presence of asthmatic characteristics in patients with COPD. When hospitalized for exacerbation, the individualized therapy for COPD-BA might include the use of corticosteroids systemically.



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How does autism spectrum disorder affect the risk and severity of childhood asthma?

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Urður Jónsdóttir, Jason E. Lang
BackgroundAutism spectrum disorder (ASD) and asthma are among the most common chronic disorders in childhood. Both are associated with altered immune regulation and share several risk factors. The effects of ASD on risk for later asthma and asthma severity remain unclear.ObjectiveTo determine whether ASD in children increases the risk of incident asthma and worsens asthma severity.MethodsWe performed 2 distinct analytic designs (case-control and retrospective longitudinal cohort) using a multistate electronic health records database to assess the odds of new asthma and asthma severity among children with ASD. In both designs, children with ASD were matched with children without ASD according to sex, age, race, ethnicity, location, and insurance status. Pulmonary function, controller medication prescriptions, asthma exacerbations, and asthma-related hospitalizations were collected. The effects of ASD on asthma risk and severity were assessed using multivariable linear and logistic regression.ResultsAmong children with asthma, ASD was associated with reduced exacerbations (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.54–0.92), better forced expiratory volume in 1 second/forced vital capacity ratio (0.876 vs 0.841, P < .001), and lower odds of airflow obstruction (OR, 0.53; 95% CI, 0.31–0.90) but had higher odds of asthma controller prescription (OR, 2.18; 95% CI, 1.62–2.93). In a longitudinal analysis of children without asthma, ASD was found to be protective for new asthma (OR, 0.44; 95% CI, 0.26–0.74).ConclusionAmong children with asthma, concomitant ASD is associated with better asthma-related outcomes but a higher controller treatment burden. In addition, our data did not support ASD as a risk factor for incident asthma.



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Associations between caesarean delivery and allergic outcomes

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Evelyn Xiu Ling Loo, Jordan Zheng Ting Sim, See Ling Loy, Anne Goh, Yiong Huak Chan, Kok Hian Tan, Fabian Yap, Peter D. Gluckman, Keith M. Godfrey, Hugo Van Bever, Bee Wah Lee, Yap Seng Chong, Lynette Pei-chi Shek, Mark Jean Aan Koh, Seng Bin Ang




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A case of atypical, complete DiGeorge syndrome without 22q11 mutation

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Cosby A. Stone, Mary Louise Markert, Roshini S. Abraham, Allison Norton




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Severe delayed-type hypersensitivity to chloramphenicol with systemic reactivation during intradermal testing

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Timothy J. Watts




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Use of a composite symptom score during challenge in patients with suspected aspirin-exacerbated respiratory disease

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Kevin A. Cook, Brian D. Modena, Nathan E. Wineinger, Katharine M. Woessner, Ronald A. Simon, Andrew A. White
BackgroundAspirin-exacerbated respiratory disease is characterized by asthma, chronic rhinosinusitis, nasal polyposis, and sensitivity to aspirin and other nonsteroidal anti-inflammatory drugs. Confirmation of the diagnosis requires provocation challenge with resulting upper and/or lower airways reactivity. Currently, determination of a positive challenge result is based solely on clinical judgment that synthesizes subjective symptoms and objective measures, as a concomitant increase in nasal or bronchial airways resistance is measured in only half of patients.ObjectiveTo describe a quantitative scoring system, based on symptoms typically reported during provocation challenge, used to identify a positive challenge result.MethodsA total of 115 patients were asked to record 10 symptoms, rated on a scale from 1 (mild) to 10 (most severe), at regular intervals during intranasal ketorolac with modified oral aspirin challenge performed in our office. Composite scores, a simple sum of all individual scores, were calculated at each time point and compared with baseline, prechallenge values.ResultsOne hundred of the 115 patients were determined to have a positive challenge result. A statistically significant difference in composite scores was observed in reactors vs nonreactors. All nonreactors recorded an increase in composite score of less than 5, whereas 69% of reactors recorded an increase of 5 or more.ConclusionOur 10-symptom composite score provides a quantitative and comparable measure of symptoms that typically present during a challenge with a positive result. Although an external validation is needed to confirm its diagnostic performance characteristics, a change in composite score of 5 or more appears to be specific to reactors.



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Atopic status and latex sensitization in a cohort of 1,628 students of health care faculties

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Anna Elena Wudy, Corrado Negro, Alessandro Adami, Francesca Larese Filon
BackgroundAtopic diseases have increased since the second half of the previous century. Atopic workers are at higher risk to be sensitized to latex, and the first years of exposure are supposed to be especially risky.ObjectiveTo assess atopic status and rate of latex sensitization in health care students starting their exposure to latex gloves.MethodsWe analyzed medical surveillance data from 1,628 health care students from 2010 to 2016. Students completed a questionnaire focused on their previous and current latex exposure and personal and family histories of allergic diseases; underwent skin prick testing with common allergens and latex extract (and/or total and latex-specific immunoglobulin E in serum); and underwent a medical examination.ResultsSkin prick test results for common inhalant allergens showed that 807 of 1,628 students (49.6%) had atopy. Atopy by skin prick testing was associated with male sex (odds ratio 1.49, 95% confidence interval 1.18–1.86), a personal history of oculorhinitis or asthma (odds ratio 10.22, 95% confidence interval 7.4–14.13), and atopic eczema (odds ratio 1.87, 95% confidence interval 1.05–3.36) at multivariate regression analysis. Eleven students (0.7% of total population) were found to be sensitized to latex and all had atopy.ConclusionDespite the high prevalence of atopy in health care students of Trieste, the latex sensitization rate is very low and comparable to general population. This is reasonably due to the low exposure to latex gloves at the time of the evaluation and to low latex release from the gloves currently used in our hospital.



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Comparison between skin prick test and serum immunoglobulin E by CAP system to inhalant allergens

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Young-Hee Nam, Soo-Keol Lee
BackgroundSkin prick tests (SPTs) and measurements of serum specific immunoglobulin E (sIgE) antibodies are the most commonly used diagnostic tools for confirming sensitization. However, disagreement between the tests has been observed.ObjectiveTo compare SPT and the CAP system for diagnosis of sensitization to common inhalant allergens.MethodsSubjects included 2,635 patients 10 to 90 years old who underwent analyses by SPT and CAP at the Dong-A University Hospital (Busan, Korea) from June 2011 through May 2016. The 2 test results were compared for 17 inhalant allergens.ResultsAgreement between the SPT and sIgE level was 75.3%. Overall agreement was moderate (κ = 0.59), with strong agreement for house dust mites and birch (κ > 0.7) and weak agreement for Tyrophagus putrescentiae and dog (κ < 0.3). When CAP was compared with SPT as the reference, the sensitivity was 75.8% and the specificity was 75.2%. Mean wheal size by SPT showed a positive correlation with sIgE levels (r = 0.59), which decreased with age.ConclusionThere was a discrepancy between SPT and CAP for diagnosing allergic sensitization among inhalant allergens. The allergic sensitization and correlation between the tests decreased with age. Cautious interpretation of the clinical relevance of allergen sensitization based on SPT and CAP results is required, especially in older patients.



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Physicians' experience and opinion on contraindications to allergen immunotherapy: The CONSIT survey

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Pablo Rodríguez del Rio, Constantinos Pitsios, Marina Tsoumani, Oliver Pfaar, Giannis Paraskevopoulos, Radoslaw Gawlik, Erkka Valovirta, Desirée Larenas-Linnemann, Pascal Demoly, Moises A. Calderón
BackgroundAllergen immunotherapy (AIT) is the only disease-modifying treatment in allergy but several contraindications limit its use.ObjectiveTo collect the outcome of using AIT in theoretically contraindicated situations in real patients in the Contraindications to Specific ImmunoTherapy (CONSIT) survey.MethodsThe CONSIT is an electronic European Academy of Allergy and Clinical Immunology survey conducted to gather the safety outcomes of patients undergoing subcutaneous, sublingual, or venom AIT and the opinions of physicians on each of 17 selected conditions: children younger than 5 years; starting AIT during pregnancy; controlled severe asthma; arrhythmias; coronary disease; cancer; autoimmune disease; bone marrow and solid organ transplantation; human immunodeficiency virus and acquired immunodeficiency syndrome; previous anaphylaxis during AIT; use of β-blockers, angiotensin-converting inhibitors, cyclosporine, and methotrexate; and inability to communicate. Safety using AIT was reported in a 3-point scale: 1, "no problems"; 2, "minor problems" (requiring only dose modifications); and 3, "major problems" (AIT not tolerated). Each physician was asked about the degree of contraindication that each condition should have: no contraindication (score 1), relative contraindication (score 2), or absolute contraindication (score 3).ResultsFive hundred twenty physicians (75% Europeans, 89% allergists) reported on approximately 45,000 patients undergoing AIT with any of these conditions. Major problems were infrequent, occurring more frequently in patients with asthma (9.9%) and with previous anaphylaxis from AIT (9.5%). Regarding opinions, experienced physicians scored a significantly lower mean for all conditions than non-experienced physicians for all routes.ConclusionMajor problems were infrequent and experienced physicians were less likely to be restrictive in the use of AIT.



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Early childhood allergy symptoms in relation to plasma selenium in pregnant mothers

Publication date: May 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 5
Author(s): Daniela Podlecka, Iwona Stelmach, Joanna Jerzynska, Kinga Polanska, Beata Janasik, Jolanta Gromadzinska, Wojciech Wasowicz, Wojciech Hanke, Pawel Majak, Wlodzimierz Stelmach




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Vestibular syncope: A disorder associated with drop attack in Ménière’s disease

Experiments in humans and animals indicate that vestibular influx through vestibular sympathetic reflex is an important and vital part of the regulatory system of circulation. The otolith organ adjusts the circulatory responses through the vestibular sympathetic reflex during an upright stance and may trigger a vasovagal attack of syncope. The aim of the present study was to evaluate the prevalence and association of syncope attacks among patients with Ménière's disease (MD). Vestibular syncope was defined as a sudden and transient loss of consciousness, which subsides spontaneously in people with vestibular disorders and without localizing neurological deficit.

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Contact allergy in children with atopic dermatitis: a systematic review

Abstract

The importance of contact allergy in children with atopic dermatitis is frequently debated. Previously, patients with atopic dermatitis were believed to have a reduced ability to produce a type IV immunologic response. However, this belief has been challenged and authors have highlighted the risk of underestimating and overlooking allergic contact dermatitis in children with atopic dermatitis. Several studies have been published aiming to shed light on this important question but results are contradictory. To provide an overview of the existing knowledge, we systematically reviewed studies that report frequencies of positive patch test reactions in children with atopic dermatitis. We identified 436 manuscripts of which 31 met the inclusion criteria. Although the literature is conflicting, it is evident that contact allergy is a common problem in children with atopic dermatitis.

This article is protected by copyright. All rights reserved.

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Autotransplantation of teeth using computer-aided rapid prototyping of a three-dimensional replica of the donor tooth: a systematic literature review

This systematic review provides an overview of studies on autotransplantation techniques using rapid prototyping for preoperative fabrication of donor tooth replicas for preparation of the neo-alveolus. Different three-dimensional autotransplantation techniques and their treatment outcomes are discussed. The systematic literature search yielded 19 articles that satisfied the criteria for inclusion. These papers described one case–control study, four clinical observational studies, one study with a clinical and in vitro part, four in vitro studies, and nine case reports.

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Immediate implant placement into fresh extraction sockets versus delayed implants into healed sockets: A systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to compare the survival rate of the implants and the peri-implant tissue changes associated with implants inserted in fresh extraction sockets and those inserted in healed sockets. This review has been registered at PROSPERO under the number CRD42016043309. A systematic search was conducted by two reviewers independently in the databases PubMed/MEDLINE, Embase, and the Cochrane Library using different search terms; articles published until November 2016 were searched for.

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Antibiotic Stewardship im Alltag – „Fragen Sie Ihren Arzt und Apotheker!“

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 274-286
DOI: 10.1055/s-0042-122109

Antibiotic Stewardship (ABS) lässt sich nicht alleine praktizieren. Ein gut etabliertes, interdisziplinäres ABS-Team mit Mandat und Deputat durch die Geschäftsführung kann den Anforderungen im Alltag und bei Ausnahmesituationen wie z. B. einem Ausbruch durch einen multiresistenten Erreger gerecht werden. Klinisch-infektiologische Kompetenz ist dabei für alle Teammitglieder grundlegend. Die Rollen des ABS-Teams bei einem Ausbruchsgeschehen wie dem hier beschriebenen durch einen 4MRGN A. baumannii sind vielfältig. Der rationale Einsatz von Reserveantibiotika und Dosisoptimierung von Antiinfektiva, z. B. durch therapeutisches Drug Monitoring (TDM), stehen dabei im Vordergrund. Durch restriktiven Einsatz von Antibiotika kann der antibiotische Selektionsdruck gesenkt und damit der Bildung weiterer Resistenzen entgegengewirkt werden. Der Einsatz von Reserveantibiotika im Rahmen eines Ausbruchsgeschehens führt zu erheblichen Kostensteigerungen bei gleichzeitig sinkenden Patientenzahlen. Interdisziplinarität zwischen der Hygiene, dem ABS-Team und den verschiedenen Kliniken sowie Unterstützung durch die Geschäftsführung sind wichtig für die Prävention und auch das Management von Ausbrüchen durch multiresistente Erreger.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Schnellübersicht der Anästhesie und Notfallmedizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 245-245
DOI: 10.1055/s-0042-120975

Georg Thieme Verlag KG Stuttgart · New York

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Beatmung mit reinem Sauerstoff verbessert nicht Ergebnisse bei der Reanimation

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 238-239
DOI: 10.1055/s-0043-106424

Georg Thieme Verlag KG Stuttgart · New York

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Stets aktueller Klassiker

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 244-244
DOI: 10.1055/s-0042-106750

Georg Thieme Verlag KG Stuttgart · New York

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Intravenöse Eisengabe: keine signifikante Einsparung von Transfusionen

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 238-238
DOI: 10.1055/s-0043-106426

Georg Thieme Verlag KG Stuttgart · New York

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Antibiotic Stewardship und Hygiene – 2 Seiten einer Medaille

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 248-259
DOI: 10.1055/s-0042-122129

In der öffentlichen Wahrnehmung werden hohe Raten von multiresistenten Erregern in medizinischen Einrichtungen vor allem mit zwei Begriffen assoziiert: erstens „Krankenhaus" und zweitens „Hygieneproblem". Wahrscheinlich mindestens ebenso wichtig oder sogar wichtiger ist jedoch der Antibiotikaeinsatz im ambulanten und stationären Bereich. Antibiotika selektionieren multiresistente Erreger (MRE). Durch die Mikrobiomforschung werden wir diese Zusammenhänge in der Zukunft besser verstehen. Wahrscheinlich bieten sich dadurch auch neue Ansatzpunkte für die Prävention der Ausbreitung von multiresistenten Erregern. Die vorliegenden Daten unterstreichen die Notwendigkeit der engen Interaktion zwischen Krankenhaushygiene und einer rationalen Antiinfektiva-Verordnung (Antibiotic Stewardship).
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Subduralhämatom nach PDA häufiger als angenommen

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 239-240
DOI: 10.1055/s-0043-106425

Georg Thieme Verlag KG Stuttgart · New York

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Quiz intensiv – Stellen Sie die Diagnose!

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 298-302
DOI: 10.1055/s-0043-103259

Georg Thieme Verlag KG Stuttgart · New York

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Gabapentin – wenig analgetische Effekte in der Akutschmerztherapie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 240-241
DOI: 10.1055/s-0043-102203

Georg Thieme Verlag KG Stuttgart · New York

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Alle Aspekte der modernen Schmerzmedizin auf einen Blick

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 244-244
DOI: 10.1055/s-0042-120976

Georg Thieme Verlag KG Stuttgart · New York

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Patienten erinnern sich an schmerzhafte Maßnahmen auf der ITS

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 241-241
DOI: 10.1055/s-0042-122656

Georg Thieme Verlag KG Stuttgart · New York

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Antibiotic Stewardship: Es ist fünf vor zwölf!

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 246-247
DOI: 10.1055/s-0043-104571

Georg Thieme Verlag KG Stuttgart · New York

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Fit für die Prüfung „Spezielle Schmerztherapie“

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 243-243
DOI: 10.1055/s-0042-104433

Georg Thieme Verlag KG Stuttgart · New York

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Antibiotic Stewardship – From Bench to Bedside

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 260-273
DOI: 10.1055/s-0043-100499

Der Artikel erläutert die praktische Umsetzung eines Antibiotic Stewardship (ABS) in der Klinik. Bei steigender Prävalenz von resistenten Bakterien ist die Ärzteschaft aufgefordert, Antibiotikaverordnungen kritisch zu hinterfragen und zu reduzieren. ABS-Programme sollen dies unterstützen. Hierbei muss insbesondere das Engagement der Klinikleitungen im ABS besser werden. Das Problembewusstsein für den Antibiotikaverbrauch muss besser werden und die Daten darüber intern transparent kommuniziert werden. Jedoch auch in der Ärzteschaft gibt es Schulungsbedarf. Das pathophysiologische Verständnis sowie die akkurate Diagnostik von Infektionserkrankungen müssen verbessert werden. Ärzte brauchen den Mut, auf Antibiotika zu verzichten. Der Konsens innerhalb einer Abteilung und eines Krankenhauses zur Vorenthaltung von Antibiotika muss gestärkt werden. Dabei muss jedoch auch das Bewusstsein steigen, die Sepsis als Notfall zu behandeln und dabei primär die Fokussanierung anzustreben und nicht nur die schnelle Antibiotikatherapie. Die mikrobiologische Präanalytik ist von entscheidender Bedeutung. Hier müssen weniger Abstriche, sondern mehr aussagekräftige Analysemethoden wie Blutkulturen oder invasive Proben angestrebt werden. Schließlich kommt der Interaktionen zwischen Klinikern, Mikrobiologen und Krankenhaushygienikern ein hoher Stellenwert zu.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Ein praxisorientierter Survival-Guide für den Intensivalltag

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 243-244
DOI: 10.1055/s-0042-105826

Georg Thieme Verlag KG Stuttgart · New York

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Management des massiven intraoperativen Blutverlusts anhand eines Fallbeispiels

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 288-296
DOI: 10.1055/s-0042-102821

Der massive intraoperative Blutverlust stellt eine potenziell lebensbedrohliche Komplikation während eines operativen Eingriffs dar. Die letale Trias aus schockbedingter Azidose, Hypothermie und Koagulopathie verstärkt die Blutungsneigung zusätzlich. Um diesen circulus vitiosus zu vermeiden, erfordert das Management einer intraoperativen Massivblutung ein strukturiertes und standardisiertes Vorgehen. Vorrangige Behandlungsziele sind dabei die Aufrechterhaltung einer adäquaten Gewebeoxygenierung, die Wiederherstellung einer suffizienten Gerinnungsfunktion, sowie Normothermie und die Homöostase des Säure-Basen- und Elektrolythaushaltes. Der vorliegende Artikel veranschaulicht diese Therapieziele und ihre pathophysiologischen Hintergründe anhand eines Fallbeispiels.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Vermeidung von Feuer/Brand/Explosion im OP

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 303-309
DOI: 10.1055/s-0042-116688

Die offene Sauerstoffgabe bei Patienten unter Sedierung und die Anwendung von Elektrokoagulation führen die Hitliste im Risikoprofil von Feuer, Brand, oder gar einer Explosion (FBE) in der Nähe von Menschen im OP. Das wesentliche Risiko ist das Dreieck „Oxidation – Zündenergie – entzündbares Material" (OZE). Ein hohes Risiko haben Eingriffe innerhalb oder in der Nähe des Luftwegs bei Anwendung von Laserenergie. Insgesamt treffen diese Ereignisse selten, aber mit steigender Tendenz und meist vollkommen unerwartet ein. Die verheerenden Konsequenzen sowie – bei sachgerechter Durchführung – die mögliche Vermeidung unterstreichen die Frage, mit welchen Maßnahmen das Risiko reduziert oder das Ereignis gar verhindert werden kann.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Intubation fehlgeschlagen – und dann?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 237-238
DOI: 10.1055/s-0043-106427

Georg Thieme Verlag KG Stuttgart · New York

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Quantitative Correlation Between Hyaluronic Acid Filler and Hyaluronidase

Abstract: The hyaluronic acid-based filler (HA filler) is used worldwide in various applications. In particular, the HA filler is used in the plastics and cosmetic medical field for facial rejuvenation and contouring. In this setting, it is injected into the skin or underlying tissue. Complications of HA filler injection have been relieved using hyaluronidase. However, there is no standard dose to adjust for undesirable HA filler lumpness. In this study, the authors tried to analyze any quantitative correlation between HA filler and hyaluronidase. The back of each rat (total 14 rats) was divided into 4 sites. A volume of 0.5 mL HA filler was injected into the subdermal layer at each site and HA filler nodules were created on the dorsum of each rat. Each nodule was allocated to groups 1, 2, 3, and 4 according to the different concentrations of hyaluronidase. As a result, the injected HA filler volume doubled within 4 days of injection, and then decreased slowly thereafter in group 1 (control group with normal saline only). A 30 unit hyaluronidase treatment compensated for the initial volume increase (approximately 30%) with HA filler (0.5 ml) at the fourth day. Sixty units of hyaluronidase reduced the initial volume (0.5 mL) of overinjected or misplaced HA filler on the fourth day. Approximately 90 units of hyaluronidase can reduce to the volume by 0.25 mL (50%) of the injected HA filler on the fourth day. The authors believe that this quantitative analysis of hyaluronidase concentration is helpful to plan the amount of hyaluronidase for correction of HA filler injection errors.

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Giant Orf on the Nose

Abstract: Orf is a zoonotic infectious disease caused by parapoxvirus. Orf lesions are typically seen on the hand, but they have rarely been reported on the nose. Herein, the authors report a rare patient of an orf lesion on the nose of a 52-year-old man after the Muslim celebration of the feast of the sacrifice. The lesion spontaneously recovered 8 weeks after the initial appearance and showed no evidence of recurrence after 1 year of follow-up. Orf virus infections may occur more often after the celebration of the feast of the sacrifice in Muslim countries.

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Update on Treatment of Sagittal Synostosis: What Can We Learn From the 16th Congress of the International Society of Craniofacial Surgery?

No abstract available

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Olfactory Bulb Volume Changes in Patients With Nasal Septal Deviation

Objectives: The olfactory bulb (OB) plays a pivotal role in the processing of olfactory information. The aim of this study was to investigate the OB volume changes and its possible associations with nasal septal deviation. Study Design: Cross-sectional study. Setting: Otolaryngology Department of Bozok University School of Medicine and Neurology Department of Yozgat State Hospital. Subjects and Methods: Ninety patient's cranial magnetic resonance imaging (MRI) studies (46 males and 44 females, mean age 36 ± 13.4 years; range 18–56 years) with isolated nasal septal deviations were recruited for the study. Olfactory bulb volumes in all study subjects were evaluated in T2-weighted coronal MRI images by planimetric manual contouring. Results: Nasal septal deviation angles were found to range between 5° and 23.21° (mean 13.6° ± 3.58°). The right-sided deviations included 17 mild (

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Selecting Trustworthy Papers

No abstract available

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A Rare Case of Malignant Fibrous Histiocytoma (Undifferentiated High-Grade Pleomorphic Sarcoma) of Malar Region

Abstract: Malignant fibrous histiocytoma is a sarcoma with rare occurrence in the oral and maxillofacial region; surgery is the most reliable treatment. Inadequate resection of the sarcoma on the oral and maxillofacial region is associated with a high incidence of local recurrence and a poor prognosis. Only few patients of malignant fibrous histiocytoma of the malar region have been previously reported in the literature. The authors report a new patient of malignant fibrous histiocytoma on the right malar region that treated a complete tumor surgical excision without lymph node dissection. Examination of the resected specimen revealed that the tumor was completely removed.

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Real Opportunity for the Present and a Forward Step for the Future of Bone Tissue Engineering

No abstract available

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Development of One-Step Drill-Tap for a Resorbable Screw

No abstract available

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Sine Qua Non Conditions for Research

No abstract available

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Removal of an Unusual Neglected Foreign Body in Infratemporal Region Using Navigation

Abstract: A 19-year-old male presented with complaint of a bluish mass in the hard palate since 3 months. The patient had a history of trauma 8 years back in the left zygomatic area with a pen. It was lodged in the wound and removed at that time. Computed tomography scan was revealed a linear heterogenous dense structure extending from left infratemporal fossa to oral cavity, traversing through left maxillary sinus, with bone defect seen in lateral and medial wall of maxilla, and in the hard palate, most likely a neglected foreign body. The foreign body was removed by navigation-assisted endoscopic surgery and the palatal perforation repaired using local rotation flap. There were no intraoperative or postoperative complications. Navigation-guided removal of foreign body in proximity to vital structures, in the infratemporal region, is a valuable option with minimal morbidity.

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An Analysis of Independent Variables Affecting Surgical Outcomes in Patients Undergoing Repair of Maxillofacial Trauma: An American College of Surgeons National Surgical Quality Improvement Program Study

Introduction: Facial fractures, from straightforward closed nasal reductions to complex pan facial fractures, are commonly encountered in the Plastic Surgical community. However, very little has been discussed in the literature regarding the outcomes of facial fractures relating to contributing factors. Our aim was to evaluate a battery of independent variables in order to identify, which, if any, factors correlate with suboptimal outcomes in patients who have undergone facial fracture surgery. Methods: Under the data use agreement of the American College of Surgeons public use files of the NSQIP, patients involving repair of facial fractures, Current Procedural Terminology codes 21310 to 21470 inclusive, were queried. The outcomes examined included: wound dehiscence, superficial surgical site infection, deep surgical site infection, readmission, open wound/wound infection and return to the operating room. Results: There were 2069 facial fracture patients in the National Surgical Quality Improvement Program datasets (2005–2013). Thirteen perioperative risk factors and patient comorbidities were evaluated for correlation with the 6 outcomes. Of the 6 outcomes evaluated, open wound/wound infection was the most prevalent outcome (6%). Factors statistically significant for presence of open wound/wound infection were American Society of Anesthesiology classification (P = 0.002), presence of bleeding disorder (P = 0.008), emergency patient (P = 0.001), chronic alcohol use (P = 0.002), and chronic steroid use (P = 0.034). Discussion: Several factors correlated with presence of an open wound/wound infection; however, variables such as diabetes and active tobacco use, which are often thought to contribute to wound infections, were shown to be statistically nonsignificant. Although this study was limited by its observational nature, these data may indicate a change in perception of the factors correlated with wound infections.

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Popliteal Pterygium Syndrome With Syngnathia

Abstract: Popliteal pterygium syndrome is a condition characterized by skin webs on the popliteal fossa, which may impair mobility unless surgically repaired. Affected individuals may also have syndactyly on the fingers and/or toes. Most people with this disorder present cleft lip and cleft palate and they can have syngnathia, that is a congenital adhesion between maxilla and mandible by fibrous bands, which affects the opening of the mouth. The case that we report is about a 2-month-old male, who presented skin webs bilaterally on the popliteal fossa, syndactyly between the IV and the V toe of the right foot and between the III and the IV toe of the left foot, and genital malformations. He was born with complete bilateral cleft lip and complete cleft palate on the left side and incomplete cleft palate on the right side and syngnathia with 4 fibrous bands between the mandibular arch and the maxilla arch on the right side, which affected the opening of the mouth. The case of our patient is very interesting because there have been few reported patients affected by popliteal pterygium syndrome with syngnathia.

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Analysis of Postoperative Bleeding After Posterior Pharyngeal Flap Pharyngoplasty

Abstract: The aim of this study was to analyze the location and cause of postoperative bleeding after posterior pharyngeal flap pharyngoplasty and to investigate the surgical techniques with the goal of treating the bleeding. The patients received posterior pharyngeal flap pharyngoplasty in the Cleft Lip and Palate Treatment and Research Center of Shanghai Jiaotong University School of Medicine from January 2003 to December 2014, and postoperative bleeding in the surgical area was retrospectively analyzed. According to the record of the exploration of hemostasis, the locations and causes of the bleeding were summarized. In the 12-year study, a total of 1037 patients received posterior pharyngeal flap pharyngoplasty, including 621 males and 416 females with ages ranging from 4 to 40 years and a mean age of 13.7 years. Among these patients, 7 individuals (0.68%) experienced significant postoperative bleeding with the exploration of hemostasis. All patients were male, aged 5 to 26 years with a mean age of 15.7 years, and all were sent back to the operating room for exploration of hemostasis under general anesthesia. The sites of bleeding included 2 patients (28.6%) of the soft palate, 2 patients (28.6%) of the pharyngeal flap pedicle, and 3 patients (42.8%) of the nasopharynx. In posterior pharyngeal flap pharyngoplasty, particular attention should be paid to the protection of the blood vessels in the soft palate and the treatment of the vascular pedicle. Postoperative bleeding is very dangerous and generally requires immediate exploration in the operating room under general anesthesia.

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Rapid Spontaneously Resolving Acute Subdural Hematoma

Introduction: This study reports a rare patient of a rapid spontaneously resolving acute subdural hematoma. In addition, an analysis of potential clues for the phenomenon is presented with a review of the literature. Patient Presentation: A 1-year-and-2-month-old boy fell from a height of approximately 2 m. The patient was in a superficial coma with a Glasgow Coma Scale of 8 when he was transferred to the authors' hospital. Computed tomography revealed the presence of an acute subdural hematoma with a midline shift beyond 1 cm. His guardians refused invasive interventions and chose conservative treatment. Repeat imaging after 15 hours showed the evident resolution of the hematoma and midline reversion. Progressive magnetic resonance imaging demonstrated the complete resolution of the hematoma, without redistribution to a remote site. Conclusions: Even though this phenomenon has a low incidence, the probability of a rapid spontaneously resolving acute subdural hematoma should be considered when patients present with the following characteristics: children or elderly individuals suffering from mild to moderate head trauma; stable or rapidly recovered consciousness; and simple acute subdural hematoma with a moderate thickness and a particularly low-density band in computed tomography scans.

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A Review of Techniques Used in the Management of Growing Skull Fractures

Background: Growing skull fractures (GSFs) are rare complications of pediatric head trauma that comprise skull fractures associated with an underlying dural tear and an intact arachnoid membrane. They are often misdiagnosed, and delay in management can lead to progression of the disease along with its neurological sequelae. Multiple clinical reports and qualitative reviews on this entity exist. To our knowledge, this represents the largest clinical review reporting on established techniques in the management of these fractures. Methods: A literature search was performed on the databases Embase, Medline, Cochrane, and PubMed from their inception until February 2015 using the terms "Growing," "Skull," "Fracture," and their equivalent terms. Studies included were case series with 5 or more patients describing GSFs and their management. Results: Twenty-two articles reporting 440 patients were included in the analysis. The mean age at trauma was 8.8 months, with the mean at presentation of 21.9 months and 57.8% of the patients being males. Most commonly, a combined dura-cranioplasty was done in 61.6% of the patients. A range of autoplastic and alloplastic materials were used in both of these techniques. Improvement from preoperative clinical status in seizures and neurological deficits was noted in 18 (12.7%) and 11 (7.05%) of the patients, respectively, following operative repair and medical management. Discussion: Early recognition is crucial in the management and treatment of GSF. Children at risk for developing GSF should be monitored clinically for up to 3 months following the initial insult. The surgical treatment depends on the size of the fracture and the age of the patient. A summary of the presentation, management, associated outcomes, complications, and recommendations discussed in the literature are reported within.

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Review of “Repealing the ACA Without a Replacement—The Risks to American Health Care” by Obama BH in N Engl J Med 376: 297-299, 2017

No abstract available

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Use of Acellular Dermal Matrix in Treatment of Congenital Muscular Torticollis in Patients Over Eight Years of Age

Background: Treatment for neglected or recurred congenital muscular torticollis should be differentiated from primary patients due to the long-standing adjacent tissue contracture. The aim of this study was to evaluate the effect of acellular dermal matrix (ADM) on surgery of recurred and neglected patients of congenital muscular torticollis. Methods: Forty-nine patients were included in the study. All patients underwent resection at the distal end of the sternocleidomastoid muscle. In the study group of 18 patients (ADM group), the defect caused by myectomy and scar tissue removal was covered with ADM. Passive range of neck motion, head tilt, cosmetic and functional satisfaction, and scar was evaluated and compared with the control group of 31 patients (non-ADM group) during follow-up. Logistic and linear regression analyses with adjustment by propensity score were performed to determine the association between ADM implantation and postoperative variables. Results: The mean follow-up period was 18.8 months. No patient required further operation for recurrence during follow-up. The improvement of neck motion in ADM group was significantly superior to non-ADM group at the 1-year follow-up, and the overall assessment score was significantly higher in the ADM group. Acellular dermal matrix implantation was not associated with increased discharge of total drain. Conclusions: In patients over 8 years of age with recurred or neglected congenital muscular torticollis, use of dermal substitute to fill the defect caused by torticollis release is effective in achieving satisfactory neck motion. Surgical sectioning of the sternocleidomastoid muscle and ADM graft should be considered in recurred and neglected torticollis.

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Comment on Perforating Frontal Branch of the Superficial Temporal Artery

No abstract available

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Assessment of Nasal Carriage of Staphylococcus Aureus and Axillar Flora in Patients With Acromegaly

Purpose: Recent study showed that patients with acromegaly have typical skin findings including increased sebum secretion, decreased transepidermal water loss, more alkaline, and colder skin surface correlated with serum growth hormone and insulin-like growth factor 1 levels. Different anatomic localizations and texture of the skin differ in bacterial concentrations. Nasal carriage of Staphylococcus aureus and axillar flora in patients with acromegaly was compared with normal population with regard to duration of acromegaly as well as the growth hormone and insulin-like growth factor 1 levels. Methods: This patient-control prospective study was conducted in university hospitals in Mersin, Turkey. The study consisted of 30 active acromegalic patients and 60 healthy adults who had no previously diagnosed chronic illness as a control group. A total of 90 volunteers were enrolled in this study; nasal and axillar cultures were obtained. Axillar and nasal specimens from anterior nares of the individuals were taken using sterile swabs. Results: Nasal colonization of Staphylococcus aureus was 13.3% in acromegalic patients, but 43.4% in control group. This difference was statistically significant (P = 0.004). Patients and control group compared according to axillar cultures, the authors determined proteus colonization 16.7% in patients with acromegaly but no proteus colonization in control group. This result was statistically significant (P = 0.001). Proteus colonization was negatively correlated only with disease duration in acromegalic patients (P = 0.017). Conclusion: The authors demonstrated that compared with healthy subjects, acromegalic patients had low percentage of nasal carriage of Staphylococcus aureus and more gram-negative basili in the axillar flora. These nasal and axillar flora changes should be considered for prophylactic antibiotics use before surgery and ampiric antibiotics use after surgery.

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Reflecting on a Foreign Body of the Hard Palate

Abstract: Foreign bodies of the hard palate in infants are rare and are often misdiagnosed as tumors. To our knowledge there are no reports of foreign bodies of the hard palate presenting to plastic surgeons as a cleft palate. This article describes a patient with a foreign body of the hard palate in a 9-month-old boy misdiagnosed as a cleft palate. While similar patients have been reported in the literature of other specialties, no patients have been reported in the plastic surgery literature to our knowledge. It is important for the plastic surgeon to be aware of foreign bodies of the hard palate and to keep these on one's differential in order to deter the use of unnecessary tests and to decrease the risk of any harm.

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Cochlea-Implantation ab dem 70. Lebensjahr – Nutzen der bimodalen Versorgung mit Hörgerät und CI

Laryngo-Rhino-Otol
DOI: 10.1055/s-0042-122343

Die bimodale Versorgung mit Cochlea Implantat (CI) und Hörgerät (HG) auf dem Gegenohr führt zu guten audiologischen Resultaten bei Erwachsenen und Kindern. Bei älteren Patienten ist noch wenig bekannt über den Nutzen der bimodalen Versorgung. Ziel der Studie war, den subjektiven und objektiven Nutzen der bimodalen Versorgung im hohen Alter zu untersuchen, und einen möglichen Zusammenhang mit dem Restgehör herzustellen. 22 postlingual höchstgradig schwerhörige bis ertaubte Patienten mit Alter≥70 Jahre wurden von 2002 bis 2014 mit einseitigem CI versorgt. 17 Patienten waren bimodal (CI und HG) versorgt. Mittels retrospektiver Datenanalyse und strukturierter Befragung wurde der audiologische und subjektive Nutzen beurteilt. Das Zeitintervall von Implantation bis zur letzten audiologischen Messung betrug 6 Monate–12 Jahre. Bimodal betrug die durchschnittliche Einsilberverständlichkeit 61% (in Ruhe bei 65db SPL, binaurale Messung mit CI und HG „best-aided"). Mit CI alleine betrug die durchschnittliche Einsilberverständlichkeit 53%. Der Unterschied von 8% war statistisch nicht signifikant (p=0.35). Das Restgehör auf dem HG-Ohr bei 250 Hz, 500 Hz und 1 kHz zeigte keine statistisch signifikante Korrelation mit dem bimodalen Nutzen. Wir konnten einen deutlichen subjektiven Nutzen der bimodalen Versorgung im hohen Alter bestätigen. In Ruhe und im Vergleich mit CI alleine erreichte die Mehrzahl der Patienten bimodal zwar nur eine gering verbesserte Einsilberverständlichkeit, alle trugen jedoch das HG ganztägig. Das Cochleaimplantat führt auch im hohen Alter bereits nach wenigen Monaten zu einer nutzbaren Sprachverständlichkeit, welche sich im Langzeitverlauf weiter verbessern kann. Bei vorhandenem Restgehör empfehlen wir die regelmässige Überprüfung der bestehenden HG-Versorgung.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Mikrolaryngoskopie: Eine populationsbezogene Analyse zu Outcome, Komplikationen und Operationsraten

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-100765

Obwohl die Mikrolaryngoskopie (MLS) ein integraler Bestandteil der operative HNO-Heilkunde ist, gibt es keine populationsbezogenen Untersuchungen zu den Operationsraten und der Effektivität der MLS in der klinischen Routine. Alle 616 Patienten, die 2011 in einer der 8 Thüringer HNO-Kliniken eine MLS erhielten, wurden hinsichtlich Patientencharakteristika, Therapie, Komplikationen und Nachuntersuchung analysiert. Die stationäre Aufnahme erfolge vorrangig wegen einer gutartigen Erkrankung des Larynx (60%) und bei 33% wegen eines Malignoms oder Verdacht auf ein Malignom. Bei Verdacht auf einen gutartigen Prozess wurde dies in 98% der Fälle bestätigt. Der Verdacht auf einen bösartigen Tumor bestätigte die MLS in 51% der Fälle bzw. wurde in 49% ausgeschlossen. Ein transientes Larynxödem (22%) und revisionspflichtige Blutung (1%) waren die häufigsten Komplikationen. Ein Zahnschaden trat in 2 Fällen auf (0,2%). Ein Rezidiv der ursprünglichen Erkrankung wurde in 14% beobachtet. Eine längere Operationszeit war ein unabhängiger Prädiktor für eine postoperative Blutung (p=0,05) oder ein Larynxödem (p=0,013). Eine Re-MLS (p<0,0001) und die endgültige Diagnose eines bösartigen Tumors (p=0,017) waren unabhängige Prädiktoren für ein Rezidiv. Die Operationsrate lag bei 22,98/100000 Einwohner. Die höchste Inzidenz lag beim Patientenalter von 50–59 Jahren mit 39,76/100000. Gutartige Tumoren waren die häufigste Indikation mit einer Rate von 19,33/100000. Diese populationsbezogene Analyse zeigt dass die MLS eine effektive chirurgische Maßnahme mit geringen Risiken im Alltag des HNO-Arztes ist.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Patienten-Instruktionsvideo mit synchroner Videoaufnahme von Gesichtsbewegungen bei Fazialisparese

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-101699

Um die Schwere einer Fazialisparese zu dokumentieren oder um die Schwere mit einem Grading System zu bewerten, werden Photografien und Videoaufnahmen benötigt. Für die Videoaufnahmen gibt es keinen internationalen Standard, was die Vergleichbarkeit von Patientengruppen behindert. Es wurde ein Instruktionsvideo entwickelt, in dem Patienten Gesichtsbewegungen vorgemacht werden mit der Aufforderung diese nachzumachen. Während die Instruktionen dem Patienten vorgespielt wurden, wurden die Patienten synchron beim Nachmachen der Gesichtsbewegungen mit handelsüblicher Hardware (Webcam, Bildschirm sowie LED-Beleuchtung) gefilmt. Die mimischen Bewegungsübungen wurden so ausgewählt, dass die Patientenaufnahmen anschließend mit verschiedenen Grading Systemen (House-Brackmann, Sunnybrook, Stennert, Yanagihara) oder auch (semi)automatisch ausgewertet werden konnten. Für die Qualitätskontrolle wurde ein Evaluationsbogen erstellt. Das Instruktionsvideo dauert 11 min und 05 s und gliedert sich in 3 Teile: 1) Erklärung des Ablaufs, 2) Vormachen und Nachmachen der mimischen Bewegungen, 3) Nachsprechen von Sätzen für die Analyse der Kommunikationsfähigkeit. Es wurden bisher 13 Probanden und 10 Patienten mit akuter als auch chronischer Fazialisparese gefilmt. Die so gewonnenen Patientenaufnahmen ließen sich nach den oben genannten Grading Systemen auswerten. Die Instruktionen wurden von den Probanden und Patienten als gut erklärt und einfach nachzuahmen bewertet. Es gibt nun ein Instruktionsvideo für die standardisierte Aufzeichnung von Gesichtsbewegungen; dieses sollte zur Bewertung von Fazialisparesen im klinischen Alltag und in Studien verwendet werden, um zukünftig Daten von Patienten innerhalb von internationalen Studien besser vergleichen zu können.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Authors' Reply: "Nonalcoholic fatty liver disease, portal vein thrombosis and coagulation: more questions than answers?.

No abstract available

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Kontroverse Rechtslage zur Kostenübernahme einer Liposuktion bei Lipödem

Zusammenfassung

Die rechtliche Frage, ob bzw. unter welchen Voraussetzungen die Kosten für eine Liposuktionsoperation bei der Fettverteilungsstörungskrankheit Lipödem von den Krankenkassen zu übernehmen ist, wird zwischen den Sozialgerichten und innerhalb der zuständigen Sozialgerichte der ersten und zweiten Instanz kontrovers beurteilt. Neben der richterlichen Entscheidungsfreiheit spielen dabei auch die Durchführungsart der Operation, die bisherigen medizinischen Erkenntnisse und die nach wie vor ausbleibende Entscheidung des Gemeinsamen Bundesausschusses zu dieser Thematik eine entscheidende Rolle. Dieser Beitrag befasst sich mit den unterschiedlichen Entscheidungsströmen durch Wiedergabe und Darstellung ausgewählter und prägnanter Urteile und schließt mit einem Ausblick und einigen Handlungsempfehlungen für die Betroffenen ab.

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Post-Traumatic Dizziness

Abstract

Purpose of Review

Traumatic brain injury (TBI) is a significant cause of morbidity and to a lesser extent mortality yearly. Dizziness remains a common complaint, presenting in up to 80% of patients post-head injury. This has obvious physical and psychological consequences not only to the individual but also a significant economic impact on society as a whole. Despite much being written in the field of TBI including concussion and sports-related head injury, the effects of trauma on the vestibular system have had relatively little study. Large-scale population studies addressing dizziness in the context of head injury do not exist in the literature. This article aims to provide an overview of dizziness post-TBI. The results from a large prospective database from the University Health Network (UHN) Workplace Insurance and Safety Board (WSIB) Neurotology are presented.

Recent Findings

The results of the UHN WSIB Neurotology database (n = 3438 head-injured workers) from the Canadian province of Ontario (1998–2014) either suggested or diagnosed BPPV in 23% post-head injured workers. One hundred and forty-nine workers (4.3%) were diagnosed with other distinct forms of peripheral vestibular dysfunction; the most common episodic type (35% of 149 workers) being a recurrent vestibulopathy (RV). The study did not find a causative link in the TBI patients studied to support a diagnosis for post-traumatic Meniere's as the incidence of the disease in this cohort was equal to that in the general population.

Summary

This article is intended to provide an overview of post-traumatic dizziness following TBI, to discuss generally recognized inner ear disorders post-head injury, the results from the UHN WSIB Neurotology database and to address some of the controversies in the field.

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Intratympanic (IT) Therapies for Menière’s Disease: Some Consensus Among the Confusion

Abstract

Purpose of Review

Aminoglycosides and corticosteroids are commonly used to treat Menière's disease. Intratympanic (IT) administration of these medications allows high inner ear concentrations without significant adverse systemic effects. As a direct result, IT therapy has grown in popularity. Recent studies have compared patient outcomes between IT aminoglycosides and corticosteroids. This review summarizes these findings.

Recent Findings

Trials comparing IT corticosteroids to IT placebo or oral therapy have had conflicting results. Most recently, Lambert et al. investigated the effect of IT dexamethasone in a sustained-release formulation compared to placebo. Their findings demonstrated improvement in some secondary measures of vertigo with the sustained-release formulation. IT gentamicin is known to be effective in controlling vertigo in Menière's disease. In a recent study from 2016, Patel et al. compared IT gentamicin and IT methylprednisolone in a double-blind, randomized controlled trial and identified no significant differences between the two in vertigo control.

Summary

IT injections of aminoglycosides and corticosteroids can improve vertigo control. Hearing and vestibular loss however may result with IT aminoglycosides. Corticosteroids demonstrate limited hearing loss but may not have the same efficacy in controlling vertigo. Further investigation in the etiology of Menière's disease is needed to tailor the proposed treatment to suit the disease mechanism.

http://ift.tt/2qtFQDX

Spirituality in Dermatology Practice

This Viewport discusses the challenges of helping patients find spiritual solace in the clinical setting amid periods of suffering and addressing their fears, hopes, and suffering

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Eruptive Keratoacanthomas Associated With Pembrolizumab Therapy

This case report describes 3 patients who developed eruptive keratoacanthomas in association with pembrolizumab treatment and their management.

http://ift.tt/2pIr631

Frequency of Syphilis Diagnoses by Dermatologists

This study examines frequency of syphilis diagnoses by dermatologists in Rhode Island compared with other clinicians in that state.

http://ift.tt/2p6g9EG

Pembrolizumab-Induced Extensive Panniculitis and Nevus Regression

This case report describes a patient with pembrolizumab-induced extensive panniculitis and nevus regression.

http://ift.tt/2pIkFNG

Increasing Diversity in Dermatology Residencies

To the Editor We read the article by Chen and Shinkai with great interest. Diversity in dermatology is a key topic, and this work helps bring it into the spotlight that it truly deserves. However, 2 underrepresented ethnic groups in dermatology were neglected in the article. Native American/Alaska Natives represent 0.9% of the US population, but only 0.2% of dermatologists. Furthermore, Native Hawaiian/Pacific Islanders are also considered underrepresented in dermatology (representing 0.2% of the US population). It may be of value in the future to fully include all underrepresented racial groups in dermatology because these initiatives evolve to enhance the successes of these types of efforts. Not doing so may cause smaller underrepresented groups to feel as if their unique experiences are not being accounted for.

http://ift.tt/2p6mb86

Diagnosis of Melanoma and Melanotic Macules of the Lip

This case series study reports in vivo reflectance confocal microscopy (RCM) features of normal lips of different phototypes and attempts to identify features that assist in distinguishing melanoma from benign melanotic macules using dermoscopy and RCM.

http://ift.tt/2pIoouA

Increasing Diversity in Dermatology Residencies—Reply

In Reply We appreciate the thoughtful response to our article by Kailas and Rigel. We acknowledge that our article omitted key statistics, including those on Native American/Alaska Natives and Native Hawaiian/Pacific Islanders, and thank the authors for pointing these out. It was not our intention to exclude the many underrepresented groups within our specialty through lack of mention; indeed, we fully support ongoing efforts to better characterize our specialty with respect to race and ethnicity as well as other individual characteristics including and not limited to socioeconomic status, religion, gender, sexual orientation, disability, immigration status, and international medical graduate status. We share the conviction of Kailas and Rigel that improved understanding and continued recognition of these disparities in representation between underrepresented minority groups in dermatology and the general population will further strengthen the argument that a call to action is needed.

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Generic Drugs—Changes in Cost and Challenges in Practice

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Medicare Part D Payments for Topical Steroids

This cost analysis assesses Medicare and patient out-of-pocket costs for topical steroids and models potential savings that could result from substitution of the least expensive topical steroid from the corresponding potency class.

http://ift.tt/2p63Qby

Bilastine: a new H1-antihistamine with an optimal profile for updosing in urticaria

Abstract

This review set out to examine published papers detailing the efficacy of bilastine in skin models and urticaria to assess whether it meets the optimal profile for updosing in urticaria, i.e. strong clinical efficacy and freedom from unwanted side effects, particularly sedation. Bilastine is a highly effective H₁-antihistamine even when used at the basic dose of 20 mg daily. Its facilitated uptake after oral dosage gives it a rapid onset and long duration of action. In both wheal and flare studies and in urticaria updosing four fold showed increased effectiveness. With respect to somnolence, bilastine is a substrate for P-glycoprotein, a membrane pump which prevents it crossing the blood–brain barrier. Consequently, bilastine is a practically 'non-sedating' H₁-antihistamine. In conclusion, the excellent profile of bilastine in both efficacy and safety make it the ideal H₁-antihistamine for updosing the daily dose fourfold in difficult-to-treat urticaria as recommended by the EAACI/GALEN/EDF/WAO guideline for the management of urticaria.

This article is protected by copyright. All rights reserved.

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Is endoscopic endonasal transsphenoidal surgery increases the susceptibility to rhinosinusitis

Abstract

The aim of the study was to analyze whether the measurement of changes in the anatomical position and volume of middle concha, the volume changes in the area between the middle concha and lamina papyracea, the evaluation of opacification in major paranasal sinuses, and osteomeatal complex occlusion in cases with middle concha by out-fracture technique during endoscopic endonasal transsphenoidal approach is a minimally invasive surgery, and also to find out whether these changes lead to the development of tendency to rhinosinusitis. It was a retrospective clinical study. Forty-five cases, between 2013 and 2015, planned for endoscopic endonasal transsphenoidal surgery due to hypophyseal pathology at the Neurosurgery Departments of Marmara University Hospital were evaluated retrospectively. The patients were evaluated for the changes in the anatomy of the middle concha and the effects of these changes to paranasal sinuses by paranasal computed tomographies were studied at the preoperative second week and postoperative 12 month. The Lund–Mackay scoring system was used for the evaluation of opacification in the five major paranasal sinuses and occlusion of the osteomeatal complex in the pre- and postoperative period. The Lund–Mackay scoring system was used to analyze the paranasal computed tomography of the patients at the preoperative 2 weeks and postoperative first year. According to the Lund–Mackay scoring system, no significant difference was detected between the preoperative and postoperative opacification of paranasal sinuses (p > 0.05). Besides, there was also no significant difference between the preoperative and postoperative osteomeatal complex occlusion (p > 0.05). Considering the distance between middle concha and lamina papyracea following the out-fracture of the middle concha, a significant lateralization of 0.5 mm between the preoperative and postoperative period was observed (p < 0.05). In addition, a significant change was also detected in the volume of middle concha (p < 0.05). The volume of the area between the middle concha and lamina papyracea was decreased with a statistical significance (p < 0.05). The endoscopic endonasal transsphenoidal surgery causes some variations in the structures of the middle concha, paranasal sinuses, and OMC, but these changes do not lead to significant rhinologic pathologies.

http://ift.tt/2px90AV

Food Allergy in South Africa

Abstract

Purpose of the Review

Whilst food allergy seems to have increased significantly in many developed countries in the past few decades, quality data on the burden of food allergy in many developing countries is scanty. Until recently, South Africa had a dearth of robustly designed food allergy studies. This article summarizes some of the recent research and observations regarding food allergy from the South African setting.

Recent Findings

South Africa has recently seen two important food allergy prevalence studies in selected and unselected populations. Both show allergy rates in keeping with those in several westernized countries. The major difference between sensitization and allergy rates in these studies emphasizes the vital role of the food challenge in differentiating true food allergy from asymptomatic sensitisation in equivocal cases. Eczema, young age and living in an urban population are important risk factors for food allergy in South Africa. Egg and peanut allergy are the most common food allergies in both selected and unselected populations in South Africa. In peanut allergy, Ara h 2 is the most useful component in differentiating true allergy from tolerance in peanut-sensitized patients. Use of internationally derived 95% positive predictive values for peanut and egg allergy produced many false positives in South African studies. Studies in South Africa show a trend towards more conservative introduction of peanut in eczema patients, which needs to be addressed in the light of recent studies showing a protective effect of earlier introduction of peanut. "Novel" allergies such as galactose-alpha-1,3-galactose allergy, food protein-induced enterocolitis syndrome and eosinophilic oesophagitis are being described with increasing frequency in South Africa.

Summary

The surprisingly high prevalence of food allergy in South Africa points towards possible involvement of South Africa in the so-called "food allergy epidemic". This has major implications on the planning of health services in the allergy sector. Food challenges will form a vital role in allergy services. Ninety-five percent positive predictive values for peanut and egg allergy may need revision to be more applicable to the local population.

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A Prospective Multi-center Observational Study in Patients With Mucosal Melanoma of Head and Neck

Condition:   Mucosal Melanoma
Intervention:  
Sponsors:   Sun Yat-sen University;   First Affiliated Hospital, Sun Yat-Sen University;   Zhejiang Cancer Hospital
Recruiting - verified May 2017

http://ift.tt/2qF0gGg

A Study of the Effectiveness in Patients With Gastric or Gastroesophageal Junction Cancer With Nivolumab by Itself or in Combination With Ipilimumab and in Patients With Esophageal Cancer With Combination of Nivolumab and Ipilimumab.

Condition:   Various Advanced Cancer
Interventions:   Drug: Nivolumab monotherapy;   Drug: Nivolumab + Ipilimumab followed by Nivolumab monotherapy;   Drug: Nivolumab + Ipilimumab
Sponsors:   Bristol-Myers Squibb;   Ono Pharmaceutical Co. Ltd
Not yet recruiting - verified May 2017

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Prevalence of Liver Fibrosis and Cirrhosis in Patients With Squamous Cell Carcinoma of the Head and Neck

Conditions:   Liver Fibroses;   Liver Cirrhoses;   Squamous Cell Carcinoma of the Head and Neck
Intervention:   Other: Evaluation of the hepatic fibrosis stage by a hepatological assessment (Clinical, biological and imaging)
Sponsor:   Centre Hospitalier Universitaire, Amiens
Not yet recruiting - verified May 2017

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A Window of Opportunity Study to Assess the Modulation of Biomarkers in Head and Neck Squamous Cell Cancer (HNSCC) By Preoperative Treatment With BYL719

Condition:   Head and Neck Squamous Cell Cancer
Intervention:   Drug: BYL719
Sponsor:   Lawson Health Research Institute
Not yet recruiting - verified April 2017

http://ift.tt/2pYksH4

Role of Imaging to Predict the Deep Surgical Margin in Gingivobuccal Complex Tumors

Conditions:   Buccal Mucosa Cancer;   Gingival Cancer
Interventions:   Procedure: Clinical Evaluation;   Diagnostic Test: Radiological Imaging
Sponsor:   HealthCare Global Enterprise Ltd.
Recruiting - verified April 2017

http://ift.tt/2qF9W3U

Risk of developing psoriasis in patients with schizophrenia: a nationwide retrospective cohort study

Abstract

Background

Schizophrenia is a complex disease proceeds from an interaction between genetic background and environmental factors. Recent studies showed T helper 17 (Th17) signaling, which is the main downstream immune response of psoriasis, is activated in schizophrenia.

Objective

To investigate if patients with schizophrenia have higher risk of psoriasis.

Methods

In this nationwide retrospective cohort study, we analyzed the 1-million-enroll cohort from Taiwan's National Health Insurance Research Database. Psoriasis and schizophrenia were ascertained by International Classification of Diseases, 9th revision, Clinical Modification coding. The study cohort was comprised of enrollees diagnosed with schizophrenia during the period from January 1, 1996 through December 31, 2010, while the comparison population consisted of enrollees who had not been diagnosed with schizophrenia during the study period. Hazard ratio (HR) and 95% confidence interval (CI) were calculated for the risk of psoriasis associated with schizophrenia using Cox proportional hazards regression.

Results

The adjusted HR of psoriasis associated with schizophrenia was 2.32(95% CI = 1.81-2.98). After 15 years, the cumulative incidence of psoriasis in patients with schizophrenia and comparison population was 2.82% and 1.17%, respectively. The Kaplan-Meier curves for the cumulative incidence of psoriasis in individuals with and without schizophrenia differed significantly(P<0.0001, log-rank test).

Conclusions

Patients with schizophrenia have higher risk of psoriasis, which may be due to common genetic susceptibilities and/or immunologic mechanisms in both diseases. Th17 signaling and pro-inflammatory cytokines may act as a link between these two diseases and are potential therapeutic targets for schizophrenia.

This article is protected by copyright. All rights reserved.

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Expression of G protein-coupled estrogen receptor, GPER in melanoma and in pregnancy-associated melanoma

Abstract

Background

The hormone sensitivity of melanoma and the role of 'classical' estrogen receptor (ER) α and β in tumor progression have been intensively studied with rather contradictory results. The presence of 'non-classical' G protein-coupled estrogen receptor (GPER) has not been investigated on human melanoma tissues.

Objective

To analyze the expression of GPER, ERα and ERβ in pregnancy-associated (PAM) and in non-pregnancy associated (NPAM) melanomas in correlation with traditional prognostic markers and disease-free survival (DFS).

Methods

Receptor protein levels were tested using immunohistochemistry in 81 formalin-fixed paraffin-embedded melanoma tissues. PAMs (n=38) were compared with age- and Breslow thickness-matched cases (n=43) including non-pregnant women (NPAM-W) (n=22) and men (NPAM-M) (n=21). The association between receptor expression and DFS was analyzed by uni- and multivariate Cox proportional hazards regression.

Results

GPER was detected both in PAMs and NPAMs. In 39 of the 41 (95.1%) GPER positive melanomas GPER and ERβ were co-expressed. GPER/ERβ positive melanomas were significantly more common in PAM compared to NPAM (p=0.0001) with no significant difference between genders (p=0.4383). In PAMs the distribution of GPER and ERβ was similar (78.4% versus 81.6%; p=0.8504), while in NPAM ERβ was the representative ER (60.5% versus 27.9%; p=0.0010) without gender difference (59.1% versus 61.9%). GPER/ERβ positive melanomas were associated with lower Breslow thickness, lower mitotic rate and higher presence of peritumoral lymphocyte infiltration (PLI) compared to GPER/ERβ negative cases (p=0.0156, p=0.0036 and p=0.0001) predicting a better DFS (HR=0.785, 95% CI 0.582-1.058). Despite the significantly higher frequency of GPER and ERβ expression in PAM, no significant difference was found in DFS between PAM and NPAM. All but one case failed to show ERα expression.

Conclusions

The presence of GPER and its simultaneous expression with ERβ can serve as a new prognostic indicator in a significant subpopulation of melanoma patients.

This article is protected by copyright. All rights reserved.

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Bioresorbable versus titanium space-maintaining mesh in maxillary sinus floor elevation: a split-mouth study

Publication date: Available online 2 May 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M. Ahmed, A. Abu Shama, R.M. Hamdy, M. Ezz
Maxillary sinus pneumatization limits implant placement in the edentulous posterior maxilla. Grafted sinus floor augmentation through Schneiderian membrane elevation and space obliteration with autogenous bone grafts, bone substitutes, or a combination of the two has often been used to resolve this problem. More recently, non-grafted sinus floor elevation has been established. This is based on the concept of membrane elevation and support either by tenting technique or using space-maintaining mesh. The aim of this study was to evaluate the predictability of new bone formation after sinus floor elevation using space-maintaining mesh without graft material and to illustrate the difference between the use of bioresorbable and titanium meshes. Eight patients with bilateral sinus pneumatization were selected for implant placement in the edentulous posterior maxilla. Pneumatized sinuses were approached through the lateral window technique; these were elevated and maintained with resorbable or titanium meshes. All patients were evaluated clinically and radiographically immediately and at 6 months postoperative. At 6 months, a core bone biopsy was obtained from the planned implant position using a trephine drill, and the bone formed was examined histologically. Healing was uneventful in all patients, and radiographic, clinical, and histological evidence of new bone formation was seen in both groups. Titanium and resorbable meshes were found to be reliable and predictable as space-maintaining devices.



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The Edinburgh modification of the minimal access zygomatic osteotomy, used for the correction of zygomatic orbital hypoplasia

Publication date: Available online 2 May 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J.N. Philip, D.F. Campbell
Zygomatic hypoplasia can be an exceedingly difficult proposition for the surgeon treating facial deformity. The classical approach would be a coronal access, which is time-consuming, leaves a long scar on the scalp that shows in patients with balding patterns, and carries the risk of permanent facial weakness. The Edinburgh technique presents a minimal access approach to the zygomatic osteotomy. This is performed through local incisions and a bone cut made using hand-held diamond-coated wire that mobilizes the entire zygoma.



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A newly identified novel variant in the CSF2RA gene in a child with pulmonary alveolar proteinosis: a case report

The congenital form of pulmonary alveolar proteinosis due to colony stimulating factor 2 receptor alpha gene mutations is a rare disease with only a few cases reported worldwide. In this study we report a new ...

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Innovative 3D Model of the Human Middle Ear in High Resolution with a Histological Microgrinding Method: A Feasibility Study and Comparison with CT

Conclusion. The development of a histological 3D model of the tympanic cavity visualizes the exact microanatomy of the sound conduction organ and is therefore essential for finite elements simulations and surgical training. Objectives. So far, no accurate histological 3D model of the sound conduction system existed in literature. For 3D reconstruction of the very fine structures inside and outside the auditory ossicles, a method based on histological slices allows a more differential analysis of both hard and soft tissues and could thus be superior to μCT. Method. A complete temporal bone was embedded in epoxy resin and microground in distances of about 34 μm. After photodocumentation of every plane, a 3D reconstruction was performed by using the Computer Aided Design (CAD) program Rhinoceros 5®. For comparison, a μCT of the same specimen resulted in a 3D model of the calcified structures in the middle ear. Results. The histological 3D model gives an excellent overview to all anatomical soft and bony tissues of the human auditory ossicles. Specifically the fine blood vessel system and the exact dimension of cartilage areas inside the ossicles can be illustrated much more precisely than with μCT data. The present technique also allows the evaluation of the fine connecting ligaments inside the tympanic cavity.

http://ift.tt/2pHwovH

Impact of venous outflow tract on survival of osteocutaneous free fibula flaps for mandibular reconstruction: A 14-year review

Abstract

Background

The principle reconstructive modality for segmental mandibulectomy defects is the osteocutaneous free fibula flap. Preoperative CT angiography has been recommended to assess the quality of arterial inflow to the flap and donor limb. However, the impact of the venous system on flap viability has not been explored.

Methods

A retrospective review of all patients undergoing free fibula flap mandible reconstruction was performed at a single tertiary cancer center from 2002 to 2015. Overall complications, including operative reexploration and total flap losses, were evaluated.

Results

One hundred seven patients underwent free fibula flap reconstruction of the mandible. Nine patients underwent multiple free flaps and were excluded from this study. Of the remaining 98 patients, 8 patients required operative exploration for microvascular compromise. All patients were found to have venous thrombosis. There were 3 total flaps losses with a salvage rate of 62.5% and overall flap survival of 96.9%. The size of the vena comitantes in the compromised flaps were significantly larger than those of the remaining patients (4.4 mm vs 3.1 mm; P < .0001). Although the total operative times were similar between the 2 groups (585.2 minutes vs 563.3 minutes), the ischemia time was significantly shorter in those cases that required operative takeback (76.5 minutes vs 104.0 minutes; P < .04).

Conclusion

Venous thrombosis of free fibula flaps is more common than arterial thrombosis. Venous stasis in larger vena comitantes may be a contributing factor to microvascular compromise. Anticoagulation and/or handsewn anastomosis may be beneficial if the veins are larger than 4.0 mm in size.

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Structural alterations in tumor-draining lymph nodes before papillary thyroid carcinoma metastasis

Abstract

Background

The purpose of this study was to define and characterize the thyroid tumor-draining lymph nodes in genetically engineered mice harboring thyroid-specific expression of oncogenic Braf^V600E with and without Pten insufficiency.

Methods

After intratumoral injection of methylene blue, the lymphatic drainage of the thyroid gland was visualized in real time. The thyroid gland/tumor was resected en bloc with the respiratory system for histological analysis.

Results

Although mice harboring Braf^V600E mutations were smaller in body size compared with their wild-type (WT) littermates, the size of their thyroid glands and deep cervical lymph nodes were significantly larger. Additionally, the tumor-draining lymph nodes showed increased and enlarged lymphatic sinuses that were distributed throughout the cortex and medulla. Tumor-reactive lymphadenopathy and histiocytosis, but no frank metastases, were observed in all mice harboring Braf^V600E mutations.

Conclusions

The tumor-draining lymph nodes undergo significant structural alterations in immunocompetent mice, and this may represent a primer for papillary thyroid carcinoma (PTC) metastasis.

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Radiotherapy for juvenile ossifying fibroma of the maxillary sinus: Case report and literature review

Abstract

Background

Juvenile ossifying fibroma (JOF) is a benign fibro-osseous lesion that can be locally aggressive. It is typically treated with surgical excision. A few cases using adjuvant radiotherapy have been reported in the literature.

Methods

We report a case of JOF treated with surgical excision and adjuvant radiotherapy to minimize the risk of local recurrence. We also review the literature.

Results

Our patient tolerated radiotherapy without complication and had not experienced a local recurrence at the time of writing this manuscript.

Conclusions

This is one of the first reports of adjuvant radiotherapy after surgical excision to improve local control in patients with JOF. Radiotherapy should be considered in patients for whom reexcision after a recurrence would result in unacceptable morbidity.

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Intraoperative nerve monitoring during parathyroid surgery: The Fort Worth experience

Abstract

Background

Avoidance of recurrent laryngeal nerve (RLN) injury during parathyroid surgery is of paramount important. The purpose of this study was to determine if intraoperative nerve monitoring allowed for decreased rates of RLN injury during parathyroid surgery.

Method

Between 1997 and 2016, 213 patients undergoing parathyroidectomy were retrospectively analyzed to determine postoperative recurrent nerve injury. Eighty-seven patients did not have intraoperative nerve monitoring, whereas 126 patients did.

Results

Based on the number of patients presenting with nerve injury during the postoperative period operated on with and without nerve monitoring, it was found that the difference in the 2 modalities was not statistically significant (P > .05).

Conclusion

Routine use of intraoperative nerve monitoring during parathyroid surgery may not yield any additional benefit in preventing injury to the RLN.

http://ift.tt/2p8fKm9

Use of Chlorothiazide in the Management of Central Diabetes Insipidus in Early Infancy

Management of central diabetes insipidus in infancy is challenging. The various forms of desmopressin, oral, subcutaneous, and intranasal, have variability in the duration of action. Infants consume most of their calories as liquids which with desmopressin puts them at risk for hyponatremia and seizures. There are few cases reporting chlorothiazide as a temporizing measure for central diabetes insipidus in infancy. A male infant presented on day of life 30 with holoprosencephaly, cleft lip and palate, and poor weight gain to endocrine clinic. Biochemical tests and urine output were consistent with central diabetes insipidus. The patient required approximately 2.5 times the normal fluid intake to keep up with the urine output. Patient was started on low renal solute load formula and oral chlorothiazide. There were normalization of serum sodium, decrease in fluid intake close to 1.3 times the normal, and improved urine output. There were no episodes of hyponatremia/hypernatremia inpatient. The patient had 2 episodes of hypernatremia in the first year of life resolving with few hours of hydration. Oral chlorothiazide is a potential bridging agent for treatment of central DI along with low renal solute load formula in early infancy. It can help achieve adequate control of DI without wide serum sodium fluctuations.

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Trans-Oral Robotic Surgery (TORS) for a Ewing's sarcoma of tongue in pediatric patient: a case report

Publication date: Available online 2 May 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Frank Rikki Canevari, Filippo Montevecchi, Stefania Galla, Raffaele Sorrentino, Claudio Vicini, Federico Sireci




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The multicultural evolution of beauty in facial surgery

Publication date: Available online 2 May 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Eric W. Cerrati, J. Regan Thomas




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Prevalence of pressure equalization tube placement and hearing loss in children with down syndrome

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Gisele F. Bernardi, Carolina T.F. Pires, Nanci P. Oliveira, Renato Nisihara
ObjectiveTo determine the prevalence of pressure equalization tube (PET) placement and hearing loss in children with Down syndrome (DS).Material and methodsWe evaluated 90 DS children births between 1 and 11 years old and compared to 90 children without DS paired in sex and age. Medical records were analyzed consecutively. Were collected data about proceedings PET placement, age of the patient at each PET, adenoidectomy, tonsillectomy and results for audiometry and tympanometry.ResultsAmong the 90 patients with DS, 49 (54.4%) were male, median age of 58 months (15–143 months). In this group, 75 PET were placed in 26/90 children (28.9%) mostly between 3 and 5 years old. In 10/26 (38.5%) was necessary PET replaced. When compared to the control group- 6/90 (6.7%)- children with DS presented OR = 13.7 (95% CI 4.0–47.3) times more likely to use PET. Adenoidectomy and tonsillectomy (44.4% and 42.2% respectively) were significantly more frequent in DS group. The prevalence of hearing loss was 32.1% in the right ear and 26.9% in the left ear. Type B timpanometry was found in more than half of the patients with DS.ConclusionWe found a 13-fold higher risk of PET in DS children, especially between the ages of 3–5 years. The high prevalence of hearing loss and PET placement in patients with DS reinforcing the importance of early and regular follow-up for hearing screening in this population, mostly in preschool-aged children.



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Outcomes and limitations of hospital-based newborn hearing screening

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Shin Hye Kim, Jae Hyun Lim, Jae Joon Han, Young Ju Jin, Sun Kyung Kim, Jin Young Kim, Jae-Jin Song, Byung Yoon Choi, Ja-Won Koo
ObjectivesGlobally, newborn hearing screening (NHS) is variably incorporated into national healthcare systems. The authors reviewed the set-up and evolution process of a hospital-based NHS program in South Korea, where screening costs for low-income families are paid by the National Health Authority.MethodsThe NHS process for 13805 newborns delivered in a tertiary referral center of South Korea from 2005 through 2014 was reviewed. Hearing screening was conducted using automated auditory brainstem response (AABR); hearing loss was confirmed by auditory brainstem response for newborns who did not pass the screening test.ResultsThe mean screening rate for hearing loss was 53.6% (7403 of 13805 newborns), which plateaued at 79.6% over time. Of the 14806 ears (7403 newborns), 1030 (7.0%) were assessed as "refer" on the first AABR, with 204 (1.4%) being assessed as "refer" on the second AABR. In hearing confirmation tests, 74 infants (1.0% of 7403 newborns) were diagnosed with hearing loss, including 13 infants (0.2%) with bilateral moderate to profound sensorineural hearing loss (SNHL). Hearing rehabilitation with long-term follow-up was confirmed in 11 infants.ConclusionsIn this hospital-based NHS program, the screening rate plateaued at ∼50% when the National Health Authority was not involved, but increased to ∼70% when the cost for low-income families was covered by the government. Among infants needing active hearing rehabilitation due to bilateral moderate to profound SNHL, 15% were lost to follow-up. These results demonstrate the need for a universal, mandatory NHS program to systematically register hearing-impaired infants within the government-sponsored public healthcare system.



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Novel EYA1 variants causing Branchio-oto-renal syndrome

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Kyle D. Klingbeil, Christopher M. Greenland, Selcuk Arslan, Arianne Llamos Paneque, Hakan Gurkan, Selma Demir Ulusal, Reza Maroofian, Andrea Carrera-Gonzalez, Stefany Montufar-Armendariz, Rosario Paredes, Nursel Elcioglu, Ibis Menendez, Mahdiyeh Behnam, Joseph Foster, Shengru Guo, Sebastian Escarfuller, Filiz Basak Cengiz, Duygu Duman, Guney Bademci, Mustafa Tekin
IntroductionBranchio-oto-renal (BOR) syndrome is an autosomal dominant genetic disorder characterized by second branchial arch anomalies, hearing impairment, and renal malformations. Pathogenic mutations have been discovered in several genes such as EYA1, SIX5, and SIX1. However, nearly half of those affected reveal no pathogenic variant by traditional genetic testing.Methods and materialsWhole Exome sequencing and/or Sanger sequencing performed in 10 unrelated families from Turkey, Iran, Ecuador, and USA with BOR syndrome in this study.ResultsWe identified causative DNA variants in six families including novel c.525delT, c.979T > C, and c.1768delG and a previously reported c.1779A > T variants in EYA1. Two large heterozygous deletions involving EYA1 were detected in additional two families. Whole exome sequencing did not reveal a causative variant in the remaining four families.ConclusionsA variety of DNA changes including large deletions underlie BOR syndrome in different populations, which can be detected with comprehensive genetic testing.



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Construct, Face, and Content Validation on Voxel-Man® Simulator for Otologic Surgical Training

Objective. To assess the face, content, and construct validity of the Voxel-Man TempoSurg Virtual Reality simulator. Participants and Methods. 74 ear, nose, and throat (ENT) surgeons participated. They were assigned to one of two groups according to their level of expertise: the expert group and the novice group . The participants performed four temporal bone dissection tasks on the simulator. Performances were assessed by a global score and then compared to assess the construct validity of the simulator. Finally, the expert group assessed the face and content validity by means of a five-point Likert-type scale. Results. experienced surgeons performed better and faster than the novices. However, the groups did not differ in terms of bone volume removed or number of injuries . 93.7% of experienced surgeons stated they would recommend this simulator for anatomical learning. Most (87.5%) also thought that it could be integrated into surgical training. Conclusion. The Voxel-Man TempoSurg Virtual Reality simulator constitutes an interesting complementary tool to traditional teaching methods for training in otologic surgery.

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Novel Clinical Observations on Benign Cephalic Histiocytosis in a Large Series

Abstract

Background/Objectives

Benign cephalic histiocytosis (BCH) is a rare form of non-Langerhans cell histiocytosis in infants and young children characterized by self-healing macules and papules occurring primarily in the head and neck region. So far there have been nearly 60 reported cases in the English-language literature.

Methods

In this retrospective study, we evaluated clinical features and follow-up data of 11 patients diagnosed with BCH between 2004 and 2016 in the Department of Dermatovenereology, Istanbul Medical Faculty.

Results

There were 5 girls and 6 boys (median age 24 months, range 9–72 months). The median age at the onset of lesions was 8 months (range 3–36 months). The lesions first appeared on the face in 10 patients and on the trunk in 1. Proximal parts of the extremities and trunk were also involved in nine patients (81.8%). Patients were categorized into two groups based on their clinical features; five had 20 to 30 predominantly red-brown dome-shaped papules and six had 50 to hundreds of yellow-brown or predominantly pinkish brown flat papules. Four patients were lost to follow-up. In seven patients with a mean follow-up of 5 years, four had nearly complete resolution and three showed remarkable regression without treatment.

Conclusion

With 11 additional cases from a single center, BCH seems to be an underrecognized disease. Its clinical presentation is not uniform. Considering that most of the patients in this series and those previously reported had extracephalic involvement, the term "cephalic" needs to be reevaluated.

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