Head and Neck Medicine by Alexandros G.Sfakianakis: 05/05/17

Παρασκευή 5 Μαΐου 2017

HIF-1α, MDM2, CDK4, and p16 expression in ischemic fasciitis, focusing on its ischemic condition

Abstract

Ischemic fasciitis is a benign myofibroblastic lesion, occurring in the sacral region or proximal thigh of elderly or bedridden individuals. The pathogenesis of ischemic fasciitis is thought to be based on ischemic condition; however, it has never been demonstrated. In this study, we examined the expression of ischemia-associated proteins in ischemic fasciitis by immunohistochemical and genetic methods. Specifically, this study aimed to reveal the expression of HIF-1α, MDM2, CDK4, p16, and gene amplification of MDM2 gene. Seven cases of ischemic fasciitis from among the soft-tissue tumors registered at our institution were retrieved. Histopathological findings were as follows: poorly demarcated nodular masses, a proliferation of spindle-shaped fibroblastic or myofibroblastic cells with oval nuclei and eosinophilic or pale cytoplasm, zonal fibrinous deposition, pseudocystic degeneration, granulation-like proliferation of capillary vessels, ganglion-like cells, myxoid or hyalinized stroma, and chronic inflammatory infiltration. Immunohistochemically, the spindle cells were positive for HIF-1α (7/7 cases), MDM2 (4/7 cases), CDK4 (4/7 cases), p16 (7/7 cases), p53 (2/7 case), cyclin D1 (7/7 cases), and alpha-smooth muscle actin (6/7 cases). Neither MDM2 gene amplification nor USP6 gene split signal was detected in any case. Overexpression of the above proteins may be associated with the pathogenic mechanism of ischemic fasciitis. It is noted that the immunohistochemical positivity of MDM2, CDK4, and p16 do not necessarily indicate malignant neoplasm such as dedifferentiated liposarcoma.

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A rare mutation in the F12 gene in a patient with ACE inhibitor-induced angioedema

Publication date: Available online 5 May 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Camila Lopes Veronez, Faradiba Sarquis Serpa, João Bosco Pesquero

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Inadequacy of current pediatric epinephrine autoinjector needle length for use in infants and toddlers

Publication date: Available online 6 May 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Harold Kim, Chitra Dinakar, Paul McInnis, Dan Rudin, Xavier Benain, William Daley, Elke Platz
BackgroundEpinephrine injection represents the standard of care for anaphylaxis treatment. It is most effective if delivered intramuscularly, whereas inadvertent intraosseous injection may be harmful. The needle length in current pediatric epinephrine autoinjectors (EAIs) is 12.7 mm; however, the ideal needle length for infants and toddlers weighing less than 15 kg is unknown.ObjectiveTo determine the skin-to-bone distance (STBD) and skin-to-muscle distance (STMD) at baseline and after simulated EAI application in infants and toddlers (weighing 7.5–15 kg).MethodsStudy participants recruited from 2 North American allergy clinics underwent baseline and compression (10-lb pressure) ultrasonography of the anterolateral thigh with a modified ultrasound transducer mimicking the footprint and maximum pressure application of an EAI device. Ultrasound images, with clinical data masked, were analyzed offline for STBD and STMD in short-axis approach.ResultsOf 53 infants (mean age, 18.9 months; 54.7% male; 81.1% white; mean weight, 11.0 kg), 51 had adequate images for short-axis STBD measurements. In these infants, the mean (SD) baseline STBD was 22.4 (3.8 mm), and the mean (SD) STMD was 7.9 (1.7) mm. With 10-lb compression, the mean (SD) STBD was 13.3 (2.1) mm, and the mean (SD) STMD was 6.3 (1.2) mm. An EAI with a needle length of 12.7 mm applying 10-lb pressure could strike the bone in 43.1% of infants and toddlers in this cohort.ConclusionOur data suggest that the optimal EAI needle length for infants and toddlers weighing 7.5 to 15 kg should be shorter than the needle length in currently available pediatric EAIs to avoid accidental intraosseous injections.

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Nocturnal sleep architecture is altered by sleep bruxism

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Marcelo Palinkas, Marisa Semprini, João Espir Filho, Graziela de Luca Canto, Isabela Hallak Regalo, César Bataglion, Laíse Angélica Mendes Rodrigues, Selma Siéssere, Simone Cecilio Hallak Regalo
ObjectiveSleep is a complex behaviour phenomenon essential for physical and mental health and for the body to restore itself. It can be affected by structural alterations caused by sleep bruxism. The aim of this study was to verify the effects of sleep bruxism on the sleep architecture parameters proposed by the American Academy of Sleep Medicine.DesignThe sample comprised 90 individuals, between the ages of 18 and 45 years, divided into two groups: with sleep bruxism (n=45) and without sleep bruxism (n=45). The individuals were paired by age, gender and body mass index: a polysomnography was performed at night.ResultsStatistically significant differences were found between (P≤0.05) individuals with sleep bruxism and individuals without sleep bruxism during total sleep time (P=0.00), non-rapid eye movement (NREM) total sleep time (P=0.03), NREM sleep time stage 3 (P=0.03), NREM sleep latency (P=0.05), sleep efficiency (P=0.05), and index of microarousals (P=0.04).ConclusionsSleep bruxism impairs the architecture of nocturnal sleep, interfering with total sleep time, NREM sleep latency, and sleep efficiency.

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Is caffeic acid phenethyl ester more protective than doxycycline in experimental periodontitis?

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Umut Yiğit, Fatma Yeşim Kırzıoğlu, Abdülhadi Cihangir Uğuz, Mustafa Nazıroğlu, Özlem Özmen
Background and objectivesHost modulation therapies (anti-inflammatory drugs, bone-stimulating agents, anti-proteinase etc.) target the inhibition or stabilization of tissue breakdown. The aim of the present study was to evaluate the effects of caffeic acid phenethyl ester (CAPE) and/or low dose doxycycline (LDD) administrations on alveolar bone loss (ABL), serum cytokines and gingival apoptosis, as well as the levels of oxidants and anti-oxidants in rats with ligature-induced periodontitis.Material and methodsThe animals were randomly divided into five groups: Group C (periodontally healthy), Group PC (Periodontitis+CAPE), Group PD (Periodontitis+LDD), Group PCD (Periodontitis+CAPE+LDD), Group P (Periodontitis). Experimental periodontitis was induced for 14days. Levels of ABL, and the serum cytokines, interleukin (IL)-1 β, IL-6, tumor necrosis factor-α (TNF-α) and IL-10 were assessed as were the levels of the oxidants and anti-oxidants, malondialdehyde (MDA), glutathione (GSH) and glutathione peroxidase (GSH-Px), and levels of gingival apoptosis.ResultsThe lowest ABL levels was evident in the PC group, among the experimental groups. There was also less inflammatory infiltration in the PC group than the PD group. IL-1β, IL-6, and IL-10 were lower in the PC group and higher in the P group in comparison to the levels in the other experiment groups. TNF-α levels in the PD group were higher than levels in the PC and PCD groups. The PC and PCD groups did not differ from the C group in regard to MDA levels. The highest GSH-Px level was found in the PC group. Gingival apoptosis in the PC group was not only lower than the PD and PCD groups, but also lower than in the C group.ConclusionThe present study suggests that CAPE has more anti-inflammatory, anti-oxidant and anti-apoptotic effects than LDD, with no additive benefits of a CAPE+LDD combination being evident in rats with periodontitis.

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Influence of masticatory function, dental caries and socioeconomic status on the body mass index of preschool children

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Maria Eliza Soares, Maria Letícia Ramos-Jorge, Bruna Mota de Alencar, Simone Gomes Oliveira, Luciano José Pereira, Joana Ramos-Jorge
ObjectiveThe objective of this study was to determine the influence of masticatory function, dental caries and socioeconomic status on the body mass index (BMI) of preschool children.MethodsA cross-sectional study was conducted with a sample of 285 children aged three to five years allocated to three groups based on the BMI: underweight, ideal weight and overweight/obesity. Socioeconomic status was determined based on the responses of parents/caregivers to a specific form. Cavitated lesions were diagnosed using the criteria of the International Caries Detection and Assessment System. Masticatory function was assessed based on masticatory performance (MP) and the swallowing threshold (ST), which were evaluated based on the results of a test food. Data analysis involved the employment of the Kruskal-Wallis, Mann-Whitney and chi-square tests as well as simple and multiple linear regression analyses.ResultsIn the final multiple regression model, BMI was influenced by monthly household income (β=0.234; 95%CI: 1.014 to 1.647), number of cavitated teeth (β=−0.180; 95%CI: −0.293 to −0.054) and X50 of the ST (β=0.304; 95%CI: 0.213–0.498).ConclusionChildren whose food test resulted in large particles and those from families with a higher monthly income had a higher BMI. Children with a greater number of teeth with cavitated dental caries had a lower BMI.

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Nocturnal sleep architecture is altered by sleep bruxism

Is caffeic acid phenethyl ester more protective than doxycycline in experimental periodontitis?

Influence of masticatory function, dental caries and socioeconomic status on the body mass index of preschool children

A sustained increase of plasma fibrinogen in sudden sensorineural hearing loss predicts worse outcome independently

A number of etiologies of idiopathic sudden sensorineural hearing loss (ISSNHL) have been proposed. Vascular disturbance is one cause of ISSNHL and has been reported to be associated with fibrinogen. We aimed to determine whether hyperfibrinogenemia is associated with poor outcome and whether a serial change in fibrinogen level is associated with outcome.

http://ift.tt/2pPWpsN

Decreased clinic visits for acute respiratory infections following an adult tonsillectomy: A population-based study

This study attempted to investigate the effects of a tonsillectomy on utilization of medical resources for acute respiratory infections by comparing numbers and costs of clinic visits within 1year before and after a tonsillectomy.

http://ift.tt/2pQCTdW

Retrograde Parotidectomy and facial nerve outcomes: A case series of 44 patients

The most common surgical method to remove benign parotid tumors remains the prograde approach. We examined if a retrograde surgical technique offers better outcomes than historical prograde controls.

http://ift.tt/2pQ3olx

A rare mutation in the F12 gene in a patient with ACE inhibitor-induced angioedema

Angioedema without wheals is a rare condition characterized by localized subcutaneous angioedema episodes that affect the extremities (hand, feet, limbs) and face and often are accompanied by painful bowel edemas and potentially life-threatening upper airway obstruction.1 According to Cicardi et al,1 when the family history is negative, angioedema without wheals can be classified into 4 subtypes representing acquired cases: idiopathic histaminergic angioedema, idiopathic non-histaminergic angioedema, angioedema with an acquired C1 inhibitor (C1-INH) deficiency, and acquired angioedema related to angiotensin-converting enzyme (ACE) inhibitors (or ACE-induced angioedema).

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Diagnostic challenges, the evaluation of antibiotic allergy

Purpose of review: Antibiotic allergy is commonly reported and often challenging to evaluate. This review highlights recent developments in our understanding of antibiotic allergy, primarily surrounding evaluation, and diagnosis of antibiotic allergy. We provide historical context to establish a framework, lending relevance to the latest studies. Recent findings: Clinicians have typically employed skin testing as a first step in the diagnosis of drug allergy, reserving drug provocation challenge, the gold standard for diagnosis, for those with negative skin tests. Although skin tests have a good negative predictive value, the positive predictive value has never been established. An increasing amount of research is demonstrating that drug provocation challenge is well tolerated as the initial evaluation in patients with non-life-threatening reactions to antibiotics. This research also calls into question the value of skin testing in these patients. Summary: Skin testing has long been used as the initial investigation in the diagnosis of drug allergy. New research supports that this may not be necessary in all patients, particularly those with non-life-threatening reactions. Further research into the validity of skin testing is required, along with the development of new diagnostic tests for antibiotic allergy.

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Assessing asthma in the otolaryngologist's office

Purpose of review: To familiarize otolaryngologists and other practitioners with basic diagnosis and treatment of asthma in adults and children based on current literature. Recent findings: Increased fractional excretion of nitrous oxide and sputum eosinophils have been identified in asthmatic patients being evaluated for chronic cough and appear to be more sensitive in diagnosis than traditional spirometry. Both sublingual and subcutaneous immunotherapy modalities are effective in decreasing symptoms and medication use in patients with allergic rhinitis and allergic asthma. Summary: Undiagnosed comorbid asthma is prevalent among patients with chronic rhinosinusitis and allergic rhinitis and control of all diseases processes greatly improves quality of life. Office spirometry is a helpful tool in the evaluation and management of asthma. Otolaryngologists should be able to recognize undiagnosed or poorly controlled asthma, initiate and improve medical therapy, and treat rhinosinusitis to improve asthma control.

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Application of telepractice for head and neck cancer management: a review of speech language pathology service models

Purpose of review: Head and neck cancer (HNC) is a complex and heterogeneous disease, requiring specialist intervention from a multidisciplinary team including speech language pathology (SLP). Unfortunately, multiple patient and service-related challenges exist which currently limit equitable access to SLP support for all individuals. This review highlights the existing evidence for different telepractice models designed to help patients and services optimize management of swallowing and communication disorders arising from HNC. Recent findings: Emerging evidence exists for using computerized screening to enhance the identification of treatment-related toxicities and assist referrals to services, including SLP. Asynchronous telepractice applications are being used to assist delivery of intensive home-based dysphagia therapy, whereas videoconferencing can offer a feasible and effective method to support ongoing management for patients with limited access to local specialist SLP services. Patient and clinician satisfaction with all models has been high. Summary: SLP services can be redesigned to incorporate a range of telepractice models to optimize clinical care at different stages of the HNC survivorship pathway. Early evidence supports telepractice can improve patient access to services, enhance outcomes, and optimize health service efficiency; however, further systematic research is needed into these models, particularly relating to large-scale implementation and costs/economic analyses.

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Voice outcomes for early laryngeal cancer

Purpose of review: Treatment options for early laryngeal cancer are well established with good local control and 5-year survival. The commonest treatments are radiotherapy or transoral laser microsurgery (TLM). There are advantages and disadvantages of the different modalities, but debate continues regarding the voice outcomes posttreatment. This review will focus on early glottic carcinoma and voice outcomes following the different treatments. Recent findings: TLM and radiotherapy are both likely to affect voice quality, but the extent of voice change depends on different factors. These factors can be divided into patient, tumour and treatment factors. Recent meta-analyses data show similar voice outcomes for either modality in the treatment of early glottic carcinoma. However, larger tumours and those involving the anterior commissure are associated with worse voice outcomes. Summary: There are various considerations for the patient and clinician before deciding on the preferred treatment for early glottic carcinoma. Although both TLM and radiotherapy will affect voice outcomes, the recent meta-analyses show similar voice outcomes for either modality in the treatment of early glottic carcinoma. There are numerous variables in the published studies hindering direct comparisons. These include heterogeneous patient groups, different treatment standardization and methods of voice analysis.

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Patient adherence to swallowing exercises in head and neck cancer

Purpose of review: A younger population and improved treatments for head and neck cancer (HNC) mean that more people are now living longer with the consequences of treatment, including long-term swallowing problems (dysphagia). Exercises aim to improve swallowing function, however highly variable adherence rates are currently reported, with no standard measure of adherence. Recent findings: Measuring adherence to swallowing exercises depends on the definition of 'adherence', the tools used to measure adherence, and the acceptable threshold that is used to constitute adherence or nonadherence. Particular barriers to swallowing exercise adherence include the burden of treatment, the commitment required to undertake a home-based exercise programme and the difficulty in motivating patients to exercise before swallowing problems have become apparent. Findings from the wider literature on general exercise interventions highlight the importance of external and patient-related factors on adherence, including patient beliefs, social support, self-regulation and goal setting. Summary: Key barriers and motivators to adherence are presented, which will have implications for the design of future swallowing exercise interventions. The relevance of behaviour change theory in facilitating adherence is highlighted, with ongoing studies used to exemplify how behaviour change components and analysis of patient beliefs can be incorporated into intervention development.

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Immunotherapy for food allergy

Purpose of review: The current review discusses strategies for administering specific immunotherapy (SIT) for the treatment of food allergy. It focuses on three delivery routes for food allergens, immunomodulatory adjuvants and allergen modifications. Recent findings: Interest in SIT for food allergy has been increasing significantly. Sublingual immunotherapy is effective for desensitization with a very favorable adverse event profile. Epicutaneous immunotherapy is also effective, most notably in younger children, with a high rate of local reactions. Oral immunotherapy demonstrates high efficacy, but with a higher risk of gastrointestinal and systemic adverse events. The need for long-term application to sustain desensitization is currently unclear. Immunomodulatory adjuvants may be added to enhance or diminish the immunogenicity of proteins, whereas genetic modifications of food allergens are designed to limit the risk of adverse reactions and address the issues of standardization and supply. Summary: SIT for food allergy is reaching the point where it may soon be used routinely in clinical practice. Current research focuses on new delivery routes and methods to enhance the effectiveness of the therapy while minimizing the risk of adverse reactions. Future efforts are underway to determine the optimal dose for each delivery method and the length of maintenance dosing required to retain the protective effect.

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Behaviour change technique taxonomy: a method of describing head and neck cancer dysphagia intervention delivery

Purpose of review: The purpose of the review is to examine the current state of the art of dysphagia intervention delivery description and to propose use of a new tool to facilitate this: the behaviour change technique taxonomy version 1 (BCTTv1). Recent findings: Describing intervention delivery is difficult, and published research in the field of speech and language therapy (SLT) does not include detail on this key aspect of research protocols. Interventions themselves are often poorly delineated, and a way is needed of classifying how these interventions are delivered in practice. Summary: Use of the BCTTv1 would facilitate clarity and transparency in intervention delivery description and have positive implications for research, clinical practice and undergraduate teaching if employed by the SLT profession.

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Editorial introductions

No abstract available

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Social and quality of life impact using a voice prosthesis after laryngectomy

Purpose of review: This review is intended to give an up-to-date overview of key developments in the evidence base relating specifically to the social and quality of life (QOL) impact of using a voice prosthesis, with reflections on the impact on clinical practice. Recent findings: Recent studies have shed light on the role of social support on psychological adjustment after laryngectomy, developing the existing evidence base on psychological sequelae. Investigations into the relationship between voice intensity/intelligibility and voice handicap/QOL may suggest a relationship for some patients, and current tools for measuring these constructs are evaluated. Recent qualitative research on the lived experience and social impact of using a voice prosthesis is presented. Summary: Little research is currently available exploring the impact of using a voice prosthesis on social participation, which is reflected in the dearth of participation-focused interventions for laryngectomy patients. Further research on the lived experience of tracheoesophageal speech is required to understand this phenomenon and develop appropriate interventions for enhancing communication, participation and QOL with a voice prosthesis after laryngectomy.

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Managing dysphagia in trachesotomized patients: where are we now?

Purpose of review: Tracheostomized patients are medically complex and vulnerable. International attention is now focused on improving the safety and quality of their care. This review summarizes recent evidence in hot-topic areas pertinent to speech and language therapy (SLT) intervention for dysphagia management in tracheostomized patients. Recent findings: The management of tracheostomized patients requires a truly multidisciplinary team (MDT) approach. Without this, patients remain tracheostomized and hospitalized for longer and have slower access to MDT members. Patterns of SLT intervention are variable across the United Kingdom, and further work to achieve consensus on best practice is required. Instrumental evaluation of swallowing provides vital information and can facilitate well tolerated oral feeding even prior to cuff deflation. A systematic review suggests that sensitivity of blue-dye testing is poor, but studies are methodologically flawed. The need for tracheostomy-specific quality of life measures is being addressed by the development of a questionnaire. Summary: In this review, the main research themes relevant to speech and language therapists (SLTs) working with tracheostomized patients are discussed. This patient group poses significant challenges to robust study design. However, recent advances in uniting MDT members globally to improve standards of care are encouraging.

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Voice and swallowing outcomes for adults undergoing reconstructive surgery for laryngotracheal stenosis

Purpose of review: Adult laryngotracheal stenosis is a rare, multifactorial condition which carries a significant physical and psychosocial burden. Surgical approaches have developed in recent years, however, voice and swallowing function can be affected prior to treatment, in the immediate postoperative phase, and as an ongoing consequence of the condition and surgical intervention. In this study we discuss: the nature of the problem; surgical interventions to address airway disorders; optimal patterns of care to maximize voice and swallowing outcomes. Recent findings: Studies in this field are limited and focused on surgical outcomes and airway status with voice and swallowing a secondary consideration. Retrospective studies of swallowing have focused on factors such as the duration of dysphagia symptoms following airway surgery and made comparisons between type of surgery, use of stent, and length of swallowing problems. The literature suggests that patients are likely to return to their preoperative diet. There has been a focus on voice outcomes following cricotracheal resection which results in a postoperative decrease in the fundamental frequency. However, study comparisons are limited by the use of inconsistent outcome measures (for both voice and swallowing) which are often not validated, with heterogeneous groups and varying surgical techniques. Summary: The limited literature suggests that swallowing function is more likely to recover to presurgical status than voice function. Further prospective studies incorporating consistent instrumental, clinician, and patient-reported outcome measurement are required to understand the nature and extent of dysphagia and dysphonia resulting from this condition and its treatment.

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Biologics for asthma and allergy

Purpose of review: The development of monoclonal antibody-based biologics targeted at inhibition of the Th2 cytokines interleukin-4, interleukin-5 and interleukin-13 represent potentially effective treatments for asthma and allergic diseases. This short review is based on English-language original articles in PubMed or MedLine that reported significant clinical findings on the evidence demonstrating the effectiveness or otherwise of the targeting of interleukin-4, interleukin-5 or interleukin-13 in asthma or allergic disease. Recent findings: Asthma exhibits marked heterogeneity both clinically and at the molecular phenotypic level requiring specifically targeted treatments to block the key pathways of the disease. It is becoming apparent that significant clinical effects with anticytokine-based biologic therapies are more likely in carefully selected patient populations that take asthma phenotypes into account. Biologics aimed at interleukin-4/13, interleukin-5 or immunoglobulin E are potentially effective treatments for patients with difficult to treat allergic disease. The development of reproducible and straightforward discriminatory biomarkers may aid identification of those patients most likely to benefit from treatment with these expensive interventions. Summary: Overall these biologics-based therapies are effective treatments for difficult to treat asthma and allergic disease with a safety profile comparable with placebo in the majority of published studies.

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Speech and swallowing outcomes following oral cavity reconstruction

Purpose of review: This review explores speech and swallowing outcomes following oral cavity reconstruction for treatment of head and neck cancer, with focus on articles published within 2015–2016. Recent findings: There is limited recent evidence that explores functional outcomes following oral cavity surgery in the literature; therefore, an overview of the literature describing surgical interventions and their associated functional outcomes is timely. Summary: We discuss the challenges associated with achieving adequate surgical margins, alongside optimal functional outcomes. The correlation between the size, site and type of reconstruction with speech and swallowing function are described, along with novel surgical and therapeutic interventions that may reduce treatment morbidity and have the potential to impact positively on quality of life.

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Allergic laryngitis: unraveling the myths

Purpose of review: This article provides a thorough review of the literature highlighting the articles that have advanced our knowledge about the sensitivity of the larynx to allergens in the air or ones consumed. This area of inquiry requires continued interest and investigation. As the field of clinical laryngology changes, and more information is discovered about the possible causal association between allergy and vocal pathologies, practicing otolaryngologists, allergists, and other medical professionals may discover more comprehensive methods to evaluate and treat their allergic patients, particularly those who present with complaints of dysphonia, dysphagia, laryngopharyngeal reflux (LPR), and/or dyspnea. Recent findings: There continues to be epidemiological studies designed to describe the relationship of allergy to vocal symptoms and signs. Both population and smaller studies have recently attempted to link these two conditions. Unfortunately, the patient with chronic laryngeal complaints is often tagged by default with the diagnosis of LPR and treated with proton pump inhibitors, which are not always beneficial. The endoscopic assessment may not be as reliable to make the diagnosis of LPR as the examination is subjective and the inter-rater reliability is low. It has been demonstrated by direct laryngeal provocation studies that sticky-viscous endo-laryngeal mucous is the only reliable finding consistently associated with allergy potential allergic tissue reactivity. Summary: The interrelationship of allergic sensitivity and chronic laryngitis in certain individuals is becoming clearer because our knowledge of inquiry has increased and the available routine technology to diagnose these conditions has remarkably improved. Notwithstanding these advancements, much more research is needed on this subject to reduce the frequency of mis-diagnoses and mis-management of allergic patients.

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Voice outcomes post total laryngectomy

Purpose of review: A consensus and body of robust evidence has developed regarding optimal laryngeal voice outcome measures. This contrasts with a lack of clarity for equivalent assessments in alaryngeal voice. Addressing this situation would enable clinicians to select the best tools currently available to facilitate research, audit and clinical practice. This is important because of the limited knowledge regarding the optimal surgical or reconstruction techniques and rehabilitation regimes for the laryngectomy population. Recent findings: There is currently no evidence to support the use of acoustic instrumental measures in terms of validity. Preliminary data support the validity of a new tracheoesophageal voice auditory–perceptual tool the SToPS, for professional and naive raters. Few specific self-rating tools exist with the Self Evaluation of Communication Experiences after Laryngectomy having the most evidence regarding validity, reliability and clinical utility. Laryngeal self-report questionnaires have been utilized, but concerns have been expressed regarding content validity. Patient self-report outcomes do not concur with professional or naive judgements, which reflect findings in the laryngeal voice literature. Summary: Further research is needed to establish the optimal tools for research and clinical practice. Investigations should also incorporate assessments of real-life communication in daily living rather than solely focussing on recordings in laboratory conditions.

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US antibiotic stewardship and penicillin allergy

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

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Trombose seio lateral

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Retrograde Parotidectomy and facial nerve outcomes: A case series of 44 patients

Publication date: Available online 5 May 2017
Source:American Journal of Otolaryngology
Author(s): Maxwell Kligerman, Yohan Song, David Schoppy, Vasu Divi, Uchechukwu Megwalu, Bruce H. Haughey, Davud Sirjani
PurposeThe most common surgical method to remove benign parotid tumors remains the prograde approach. We examined if a retrograde surgical technique offers better outcomes than historical prograde controls.Materials and methodsA retrospective chart review at Stanford Hospital was conducted to identify retrograde parotidectomies between February 2012 and October 2014 that were staffed by the senior author (DS) with resident involvement. Facial nerve (FN) outcomes and other post-surgical parameters were recorded.ResultsWe identified 44 consecutive cases and found that 18.2% (n=8) of patients experienced temporary paresis and 2.3% (n=1) experienced minor (HB 2) permanent paresis limited to one branch. The average hospital length of stay was 0.64 days and complication rate was 6.8%.ConclusionThe retrograde technique has complication rates comparable to historical rates for the prograde technique and is amenable to minimally invasive outpatient superficial parotidectomy.

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A sustained increase of plasma fibrinogen in sudden sensorineural hearing loss predicts worse outcome independently

Publication date: Available online 5 May 2017
Source:American Journal of Otolaryngology
Author(s): Yoon Ah. Park, Tae Hoon Kong, Young Joon Seo
ObjectivesA number of etiologies of idiopathic sudden sensorineural hearing loss (ISSNHL) have been proposed. Vascular disturbance is one cause of ISSNHL and has been reported to be associated with fibrinogen. We aimed to determine whether hyperfibrinogenemia is associated with poor outcome and whether a serial change in fibrinogen level is associated with outcome.MethodsTwenty-two patients with ISSNHL were enrolled. We compared the levels of fibrinogen in ISSNHL groups classified as improved and non-improved according to improvement of hearing. Blood samples were also collected from patients who visited the emergency room with coronary heart disease (CHD) as the control group.ResultsInitial fibrinogen level was significantly different between the non-improved and improved ISSNHL group (350.63±87.20 vs. 310.71±81.06. The improved ISSNHL group showed a "surge phenomenon", in which fibrinogen started to decrease at day 5 and increased at day 26. In the non-improved group, fibrinogen remained elevated throughout the course of therapy.ConclusionIt is important to measure not only the initial fibrinogen level but also to monitor its change throughout the course of therapy in order to predict the outcome of ISSNHL.

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Decreased clinic visits for acute respiratory infections following an adult tonsillectomy: A population-based study

Publication date: Available online 5 May 2017
Source:American Journal of Otolaryngology
Author(s): Shiu-Dong Chung, Shih-Han Hung, Herng-Ching Lin, Kuan-Chen Chen
PurposeThis study attempted to investigate the effects of a tonsillectomy on utilization of medical resources for acute respiratory infections by comparing numbers and costs of clinic visits within 1year before and after a tonsillectomy.Materials and methodsData for this study were retrieved from the Taiwan Longitudinal Health Insurance Database 2005. The study includes 481 patients aged 18–80years who underwent a tonsillectomy and 481 comparison patients. A multivariate regression model employing difference-in-difference was carried out to assess the independent association between a tonsillectomy and the number and costs of clinic visits.ResultsWe found that for patients who underwent a tonsillectomy, the mean number of clinic visits for acute respiratory care 1year before and after the index date significantly decreased from 7.3 to 4.2 (p<0.001). However, for the comparison group, there was no significant difference in the number (p=0.540) or costs (p=0.221) of clinic visits for acute respiratory care 1year before and after the index date. A multivariate regression model revealed that a tonsillectomy was associated with a reduction of 3.38 in the mean number of clinic visits for acute respiratory care (p<0.001). In other words, a tonsillectomy reduced by 46.3% (3.38/7.3) the number of clinic visits for acute respiratory care after adjusting for sociodemographic characteristics and medical comorbidities compared to comparison patients.ConclusionsThis study demonstrated that a tonsillectomy was of substantial benefit to adult patients in that it provides decreased healthcare utilization for acute respiratory infections.

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Predictors of failure of DISE-directed adenotonsillectomy in children with sleep disordered breathing

Adenotonsillectomy (AT) is the most commonly performed procedure for sleep disordered breathing (SDB) in pediatrics. However, 20-40% of patients will have persistent signs and symptoms of SDB after AT. Drug-in...

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Poppers retinopathy

Joshua Luis Mar 7, 2016; 2016:bcr2016214442-bcr2016214442 case-report

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Use of ticagrelor in human pregnancy, the first experience

Marjan Verbruggen Nov 25, 2015; 2015:bcr2015212217-bcr2015212217 case-report

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Pleural effusion caused by a malpositioned umbilical venous catheter in a neonate

Thangaraj Abiramalatha Oct 30, 2015; 2015:bcr2015212705-bcr2015212705 case-report

http://ift.tt/2p5j6dj

Cutaneous and pleural involvement in a patient with multiple myeloma

Olfa Saidane Oct 5, 2015; 2015:bcr2015211197-bcr2015211197 case-report

http://ift.tt/2qMGZmE

Molecular detection of Schizophyllum commune in a case of allergic fungal rhinosinusitis

Prashant Gupta May 24, 2015; 2015:bcr2015209955-bcr2015209955 case-report

http://ift.tt/2p5JDaz

Steroid unresponsive anti-NMDA receptor encephalitis during pregnancy successfully treated with plasmapheresis

Lokesh Shahani Apr 29, 2015; 2015:bcr2014208823-bcr2014208823 case-report

http://ift.tt/2qMBPHh

Actinomyces meyeri brain abscess following dental extraction

U Clancy Apr 13, 2015; 2015:bcr2014207548-bcr2014207548 case-report

http://ift.tt/2p5JEeD

Rothia aeria: a great mimicker of the Nocardia species

Takeshi Saraya Dec 3, 2014; 2014:bcr2014206349-bcr2014206349 case-report

http://ift.tt/2qMv5sS

Potential involvement of Campylobacter curvus and Haemophilus parainfluenzae in preterm birth

George Louis Mendz Oct 1, 2014; 2014:bcr2014205282-bcr2014205282 case-report

http://ift.tt/2p58qvA

Maxillary sinusitis with pulmonary tuberculosis

Rashmi Upadhyay Aug 1, 2014; 2014:bcr2014203952-bcr2014203952 case-report

http://ift.tt/2qMoQVN

Calvarial and cutaneous metastasis as the primary presentation of a renal cell carcinoma

Tarun Jindal May 19, 2014; 2014:bcr2013202830-bcr2013202830 case-report

http://ift.tt/2p5E9Nd

Fatal Bipolaris spicifera infection in an immunosuppressed child

Carlos G Teran Feb 3, 2014; 2014:bcr2013009703-bcr2013009703 case-report

http://ift.tt/2qMqkQ5

Subcutaneous endometriosis: a rare cause of deep dyspareunia

Aruna Nigam Jan 6, 2014; 2014:bcr2013202230-bcr2013202230 case-report

http://ift.tt/2p5tT7G

Quetiapine-induced manic episode: a paradox for contemplation

Sundar Gnanavel Dec 4, 2013; 2013:bcr2013201761-bcr2013201761 case-report

http://ift.tt/2qMrsTE

Enterobius vermicularis infection of the ovary

George Powell Oct 31, 2013; 2013:bcr2013201146-bcr2013201146 case-report

http://ift.tt/2p5iHry

Heterotopic ossification of the elbows in a major petrol burn

Shahriar Raj Zaman Aug 27, 2012; 2012:bcr0320126027-bcr0320126027 case-report

http://ift.tt/2qMFxk4

Primary disseminated extrahepatic abdominal hydatid cyst: a rare disease

Jitendra Kumar Kushwaha May 30, 2012; 2012:bcr0220125808-bcr0220125808 case-report

http://ift.tt/2p5teD5

Autoimmune pernicious anaemia as a cause of collapse, heart failure and marked panyctopaenia in a young patient

Justin Carey May 8, 2012; 2012:bcr0120125576-bcr0120125576 case-report

http://ift.tt/2qMpumg

Still dizzy after all these years: a 90-year-old woman with a 54-year history of dizziness

Alina Smirnova Sep 15, 2011; 2011:bcr0520114247-bcr0520114247 case-report

http://ift.tt/2p5rU2V

Cardiac arrhythmias associated with umbilical venous catheterisation in neonates

Gerdina Verheij Jun 21, 2009; 2009:bcr0420091778-bcr0420091778 case-report

http://ift.tt/2pJRycb

An Evaluation of the Surgical Trauma to Intracochlear Structures After Insertion of Cochlear Implant Electrode Arrays: A Comparison by Round Window and Antero-Inferior Cochleostomy Techniques

Abstract

To evaluate the extent of intracochlear damage by histologic assessment of cadaveric temporal bones after insertion of cochlear implants by: round window approach and cochleostomy approach. Cochlear implantation was performed by transmastoid facial recess approach in 10 human cadaveric temporal bones. In 5 temporal bones, electrode insertion was acheieved by round window approach and in the remaining 5 bones, by cochleostomy approach. The bones were fixed, decalcified, sectioned and studied histologically. Grading of insertion trauma was assessed. In the round window insertion group, 2 bones had to be excluded from the study: one was damaged during handling with electrode extrusion and another bone did not show any demonstrable identifiable cochlear structure. Out of the 3 temporal bones, a total of 35 sections were examined: 24 demonstrated normal cochlea, 4 had basilar membrane bulging and 7 had fracture of bony spiral lamina. In the cochleostomy group, histology of 2 bones had to be discarded due to lack of any identifiable inner ear structures. Out of the 3 bones studied, 18 sections were examined: only 3 were normal, 4 sections had some bulge in spiral lamina and 11 had fracture of bony spiral lamina. The fracture of spiral lamina and bulge of basement membrane proportion is relatively higher if we perform cochleostomy as compared to round window approach. Therefore, round window insertion is relatively less traumatic as compared to cochleostomy. However, our sample size was very small and a study with a larger sample is required to further validate these findings.

http://ift.tt/2pJNDfu

Improving gingival zenith in a unilateral cleft patient using Platelet-Rich Fibrin (PRF)

Publication date: Available online 4 May 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Dr. Madhumitha Natarajan, Dr. Bharath Rao K
This case evaluated the short term outcome of alveolar ridge augmentation in a unilateral alveolar cleft patient. A 22year old female patient reported with gaps in her front teeth in 2011. Clinical examination revealed a repaired unilateral cleft of the hard palate (on left side) with a missing 21 and 22. Diagnosis was class II Subdivision with crossbite in 13 region. A non-extraction plan with a quad helix appliance, proximal stripping of lower anteriors. Canine substitution of 23 to replace 22 and prosthetic rehabilitation to replace 21. An alveolar ridge augmentation procedure using PRF (Platelet-rich fibrin) extracted from patient blood using a plasma centrifuge system. The success of grafted bone were evaluated radiologically at 6 months, 12 months postoperatively.

http://ift.tt/2p5jN6o

Are oral and maxillofacial surgery residents being adequately trained to care for pediatric patients?

Publication date: Available online 4 May 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Shelly Abramowicz, Leonard B. Kaban, Andrew S. Wurtzel, Steven M. Roser
PurposeTo evaluate whether current Oral and Maxillofacial Surgery (OMS) residents are receiving adequate training and experience to perform specific surgical procedures and anesthesia for pediatric patients.Materials and MethodsA seventeen-question survey was electronically sent to fellows of the American Academy of Craniomaxillofacial Surgeons. Descriptive data for individual surgeons, their associated residency programs and quantity of specific pediatric procedures performed were collected. Resident case load for inpatient and outpatient procedures and overall experience in medical, surgical and anesthetic management of pediatric OMS patients were explored.ResultsSurveys were sent to the 110 active fellows; 64 completed the questionnaire (58%). There were 59 males and 5 females with a mean age of 50.4. Of them, 68.8% practice in an academic setting. Specifically, 93.8% take after hours emergency call covering adult and pediatric patients and 98.4% have admitting privileges to a children's hospital or a pediatric unit in an adult hospital. Their affiliated residency programs include required rotations in pediatrics or pediatric subspecialties. In their opinion, over 90% of graduating OMS residents have the appropriate skill set to perform dentoalveolar procedures, outpatient anesthesia, orthognathic procedures, and/or alveolar bone grafts. However, residents have limited ability to reconstruct pediatric ramus/condyle unit RCU with a costochondral graft (CCG).ConclusionsResults of this study indicate that, in the opinion of the respondents, graduates of their OMS residency programs have adequate training to perform dentoalveolar procedures, outpatient anesthesia, orthognathic surgery, and alveolar bone grafts in pediatric procedures, but have limited experience with reconstruction of pediatric RCU via CCG.

http://ift.tt/2qJoDDP

Publication date: June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 6

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Editorial Board

Publication date: June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 6

http://ift.tt/2qJm6tl

A microorganism not to be overlooked in studies focusing on osteonecrosis of the jaws: Comment on “Kim SM, et al. Histochemical observation of bony reversal lines in bisphosphonate-related osteonecrosis of the jaw”

Publication date: June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 6
Author(s): Aydin Gülses, Mustafa Ayna, Yahya Açil

http://ift.tt/2q8iKTx

Information for Readers

Publication date: June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 6

http://ift.tt/2qJwAsp

Scalp mass in a 66-year-old female

Publication date: June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 6
Author(s): David Vu, Michael Ellis, Travis Vandergriff, Aparna Naidu

http://ift.tt/2q7Zrts

Society Page

Publication date: June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 6

http://ift.tt/2qJyBor

Incidence and risk factors predisposing plate removal following orthognathic surgery

Publication date: Available online 4 May 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Fredrik Widar, Mariam Afshari, Lars Rasmusson, Christer Dahlin, Hossein Kashani
ObjectiveTo investigate the incidence and reasons for titanium fixation plate removal following orthognathic surgery, identify risk factors predisposing removal and to explore if discomfort was reduced postoperatively.MethodsMedical records of 404 consecutive patients were retrospectively reviewed. All patients received a questionnaire for follow-up. 323 patients answered the questionnaire thus set the sample group.ResultsFifteen percent of all the responding subjects had plates removed and 92% of these patients were relieved from discomfort after removal. Infection was the most common reason for plate removal (10%). Smoking (Hazard Ratio (HR) 2.74) and surgery performed in the mandible (HR 2.40) increased the need for plate removal. For each plate added in the mandible the risk for removal increased with (34%).ConclusionsSmoking, osteotomies and additional numbers of plates in the mandible, resulted in more plate removal. Most of the patients were relieved from discomfort after plate removal.

http://ift.tt/2q89crt

Extranodal lymphoma arising within the maxillary alveolus; a case report

Publication date: Available online 4 May 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): MacDonald D, Li T, Leung SF, Curtin J, Martin M
IntroductionExtra-nodal lymphomas affecting the head and neck arise infrequently within the bones of the jaws. This is a report of a symptom-free patient whose general dentist detected a radiolucency as an incidental finding on conventional radiography.Case Report: The conventional radiography of lesions in the maxilla displayed "floating teeth" indicative of malignancy. This case was then imaged by cone-beam computed tomography (CBCT), multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI). The lymphoma grew rapidly in less than a week between the MDCT and the MRI. All the above cross sectional modalities elicited a provisional diagnosis of a squamous cell carcinoma (SCC).DiscussionEvaluation of the extent of the lesion and its encroachment on adjacent structures is limited by conventional radiography. Nevertheless, conventional radiography can display features that are suggestive of malignant disease. Although cross-sectional imaging of lesions within the anatomically-complex-maxilla has generally taken the form of MDCT and MRI, CBCT has a role. In hindsight the absence of central necrosis should have directed the inclusion of 'extranodal lymphoma arising within the maxillary alveolus' in the provisional diagnosis.

http://ift.tt/2qJrMDm

Methicillin-resistant Staphylococcus aureus and antibiotic use in septorhinoplasty: case report and review of literature

Publication date: June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 6
Author(s): Gregory D. Lohr, Brian Hollabaugh, Patrick Waters, Paul S. Tiwana
Septorhinoplasty is a commonly performed procedure for facial aesthetics and obstructed nasal breathing. There have been only 4 reported cases of methicillin-resistant Staphylococcus aureus (MRSA)–associated postoperative complications following septorhinoplasty reported in the literature across all specialties. In this article, we report a case of MRSA-associated infection after an uncomplicated septorhinoplasty. Risk stratification and outcome of treatment are described, followed by a review of the current literature. We discuss the epidemiology of MRSA colonization, prophylactic use of antibiotics in septorhinoplasty, previously reported MRSA-associated septorhinoplasty infections, and management of complications. There are no current standards for MRSA decolonization before septorhinoplasty. Finally, we offer recommendations for patients at high risk for MRSA infection undergoing septorhinoplasty and considerations for treatment of MRSA infections should they occur after septorhinoplasty.

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Response to “Commentary on ‘Clinicobiochemical evaluation of turmeric with black pepper and nigella sativa in management of oral submucous fibrosis—a double-blind, randomized preliminary study’”

Publication date: June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 6
Author(s): Pratik Rameshchandra Pipalia, Rajeshwari G. Annigeri, Ranjeeta Mehta, Nimesh Jain

http://ift.tt/2qJl8x1

Response to comment on “Reversal lines associated with Actinomyces infection in bisphosphonate-related osteonecrosis of the jaw”

Publication date: June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 6
Author(s): Soung Min Kim, Suk Keun Lee

http://ift.tt/2q8iHXR

Coexpression of growth differentiation factor 11 and reactive oxygen species in metastatic oral cancer and its role in inducing the epithelial to mesenchymal transition

Publication date: June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 6
Author(s): Xiangming Qin, Hai Kuang, Lei Chen, Shanliang Wei, Dahai Yu, Feixin Liang
ObjectivesThe aim of this study was to investigate growth differentiation factor 11 (GDF11) and reactive oxygen species (ROS) expression in metastatic oral cancer and explored their roles in inducing epithelial to mesenchymal transition (EMT).Study DesignThe expression of GDF11, ROS, and EMT-related markers was evaluated in primary tumor tissues from patients with oral squamous cell carcinoma (OSCC). SCC-9 cells, a human tongue carcinoma cell line, were treated with recombinant GDF11. Induction of EMT, expression of EMT-related markers, and the effect of ROS on EMT in SCC-9 cells were analyzed.ResultsOverexpression of GDF11 and ROS was observed in patients with metastatic oral cancer. Downregulated expression of E-cadherin and upregulated expression of vimentin, δ-EF1, SIP-1, MMP-2, and MMP-9 were observed in patients with metastatic oral cancer, relative to the expression of these factors in patients with nonmetastatic oral cancer. With recombinant GDF11 treatment, obvious spindle-shaped cells appeared, and gene expressions of EMT-related markers were altered in SCC-9 cells. Treatment with the powerful antioxidant N-acetylcysteine inhibited GDF11-induced EMT and cell migration.ConclusionsGDF11 induces EMT and cell migration with ROS involvement in SCC-9 cells. Overexpression of GDF11 and ROS is associated with metastatic oral cancer. GDF11 and ROS may participate in metastasis of oral cancer through EMT.

http://ift.tt/2qJrHQ4

Analgesic effects of pre-injection low-level laser/light therapy (LLLT) before third molar surgery: a double-blind randomized controlled trial

Publication date: Available online 4 May 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Jacco G.C. Tuk, Arjen J. van Wijk, Ine Mertens, Zuhal Keles, Jerome A.H. Lindeboom, Dan M.J. Milstein
ObjectiveThe aim of this study was to evaluate the analgesic effects of low-level laser therapy (LLLT) on pre-injection sites in patients scheduled for third molar removal.Study DesignThis double-blind randomized controlled trial included 163 healthy patients undergoing third molar extractions who were randomly divided into a LLLT and placebo group. Objective and subjective datasets were obtained from physiological feedback (heart rate, and sweat response) and a questionnaire, respectively. In the LLLT group each targeted injection site was irradiated twice with 198 mW continuous wave for 30 s with a 0.088 cm² focal spot at an applied energy of 5.94 J and fluence of 67.50 J/cm². Measurements were recorded from four time-points during data acquisition.ResultsThe LLLT and placebo groups did not significantly differ in pain experience scores associated with the injected sites for maxillary or mandibular third molar extractions. Mean heart rates before and during injection were lower in the LLLT group than in the placebo group for both maxillary and mandibular regions. No statistically significant differences were observed for any remaining parameters.ConclusionsThe present data indicated that pre-injection LLLT did not effectively decrease the pain felt during local anesthetic injections prior to third molar surgery.

http://ift.tt/2q8mnsu

Oral squamous cell carcinoma associated with oral submucous fibrosis have better oncologic outcome than those without

Publication date: Available online 4 May 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Pankaj Chaturvedi, Akshat Malik, Deepa Nair, Sudhir Nair, Aseem Mishra, Apurva Garg, Sagar Vaishampayan
ObjectivesOral submucous fibrosis (OSMF) is a potentially malignant disorder associated with the use of areca nut and is mainly seen in the parts of South-East Asia and Indian sub-continent. We hypothesized that Oral cancers occurring in presence of OSMF are clinico-pathologically a distinct entity.Study designWe analyzed 289 treatment naïve patients of oral cancer. They were followed up for a median of 44 months. Association of presence of OSMF with other histopathological factors was done using Chi square test. Kaplan Meier analysis was used for survival analysis.ResultsOral squamous cell carcinoma along with OSMF was seen more often in younger patients (p<0.001), males (p<0.007) and had a lower T (p<0.002), N stage (p<0.000). These were thinner (p<0.002), less infiltrative (p<0.04) tumors and required adjuvant therapy less frequently (p<0.017). The mean disease specific survival, overall for those with and without OSMF was 58.8 and 48.6 months (p<0.002) and specifically for stages III, IV was 49.4 and 38.5 months respectively (p<0.053).ConclusionOral squamous cell carcinomas associated with OSMF are associated with good clinico-pathological profile and have better prognosis and oncological outcomes.

http://ift.tt/2qJrJHG

Relationship between Dental Status and Development of Osteoradionecrosis of the Jaw: A Multicenter Retrospective Study

Publication date: Available online 4 May 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Yuka Kojima, Souichi Yanamoto, Masahiro Umeda, Yumiko Kawashita, Izumi Saito, Takumi Hasegawa, Takahide Komori, Nobuhiro Ueda, Tadaaki Kirita, Shin-ichi Yamada, Hiroshi Kurita, Yasuko Senga, Yasuyuki Shibuya, Hiroshi Iwai
ObjectiveOsteoradionecrosis of the jaws is a serious late adverse event in patients with head and neck cancer undergoing radiotherapy. The aim of this study is to investigate the relationship between dental status and development of osteoradionecrosis.Study DesignMulticenter, retrospective observational study. A total of 392 patients with head and neck cancer who underwent radiotherapy were investigated for correlations between osteoradionecrosis development and various factors. The cumulative occurrence rate of osteoradionecrosis was calculated by the Kaplan-Meier method, and analyzed by Cox regression and log-rank test.ResultsOsteoradionecrosis developed in 30 of 392 patients. In 23 patients, osteoradionecrosis occurred in the mandibular molar region. A univariate analysis showed that oral or oropharyngeal cancer, jaw radiotherapy dose exceeding 50 Gy, periapical periodontitis, and tooth extraction after radiotherapy were significantly correlated with the occurrence of osteoradionecrosis. Among these, oral and oropharyngeal cancer, periapical periodontitis, and tooth extraction after radiotherapy were significant independent risk factors by a multivariate analysis. Further, caries which occurred after RT and progressed rapidly, resulting periapical periodontitis, carious stump, or extraction was a major cause of osteoradionecrosis.ConclusionExtraction of mandibular molars with periapical periodontitis before radiotherapy and strict dental management after radiotherapy may reduce the risk of osteoradionecrosis.

http://ift.tt/2q8eNOP

Cone beam computed tomography incidental findings of the cervical spine and clivus: retrospective analysis and review of the literature

Publication date: June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 6
Author(s): Noura A. Alsufyani
ObjectiveThe aim of this study was to analyze and describe incidental findings in the cervical spine (C-spine) and the clivus encountered in cone beam computed tomography (CBCT) imaging. The wide range of possible anatomic variants and pathoses is discussed in the context of the medical and dental literature to clarify their radiographic appearance and clinical implications as a guide for the oral and maxillofacial radiologist.Study DesignA retrospective analysis of radiographic reports was conducted based on CBCT images from 2 oral and maxillofacial imaging centers. Reports documenting incidental findings in the C-spine or the clivus were selected. Data on patient age and sex were collected, and each incidental finding was categorized as degenerative, congenital, or developmental/pathologic. Each finding is discussed with clinical importance and is pictorially presented.ResultsFrom a total of 7689 CBCT reports, there were 732 incidental findings (9.5%) in the C-spine or the clivus. Most findings were in the C-spine (92.3%), were degenerative in nature (78.7%), and occurred in females in their sixth decade. Logistic regression analysis showed that the odds of presenting with a degenerative incidental finding in the C-spine or the clivus did not differ based on sex but were 5.5 times (95% confidence interval, 3.77-8.04) higher if the patient was aged 50 years or older.ConclusionsThis review is the largest and the first to characterize incidental findings in the C-spine and the clivus. Such findings were reported in 9.5% of radiographic reports. Several presented as uncommon congenital variants that are not usually spotlighted during oral and maxillofacial radiology training.

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“Clinicobiochemical evaluation of turmeric with black pepper and Nigella sativa in management of oral submucous fibrosis—a double-blind, randomized preliminary study”—a commentary

Publication date: June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 6
Author(s): Kalyana Chakravarthy Pentapati, Srikanth Gadicherla, Komal Smriti

http://ift.tt/2q8eLGH

Perforated acute appendicitis with no peritonitis in a premature baby: a case report

Acute appendicitis in a neonate and premature baby is still considered a rare entity as diagnosis is always made after surgical exploration for acute abdominal findings mimicking necrotizing enterocolitis.

http://ift.tt/2pOrugu

Visceral artery pseudoaneurysms: two case reports and a review of the literature

Visceral artery pseudoaneurysms are relatively rare but have a high mortality rate in case of rupture. Their detection in the last decades is rising due to an increased use of computed tomography and angiograp...

http://ift.tt/2phW3Is

Authors’ reply: changes in gustatory function in patients with chronic otitis media before and after tympanoplasty

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Nasal nitric oxide as biomarker in the evaluation and management of chronic rhino-sinusitis with nasal polyposis

http://ift.tt/2q7BcM2

Intracochleäres Schwannom

Zusammenfassung

Wir berichten über eine Patientin, die 37‑jährig, im Jahr 2005, eine akute, gering- bis mittelgradige Hörminderung („Hörsturz") rechts mit Tinnitus und geringem Schwankschwindel erlitt. Eine MRT-Untersuchung des Schläfenbeins zeigte bis auf eine sehr distinkte (< 1 mm), Kontrastmittel aufnehmende Veränderung in der rechten Cochlea unauffällige Befunde. Der initial mittelgradige Hörverlust war danach progredient bis zum vollständigen Hörverlust im Jahr 2015. Eine MRT-Kontrolluntersuchung zeigte eine die gesamte Cochlea ausfüllende Raumforderung.

Es erfolgte die transmeatale Tumorentfernung mittels subtotaler Cochleoektomie und partieller Rekonstruktion der Cochlea mit Knorpel und Faszie sowie die Einlage eines Platzhalters („Dummy-CI-Elektrodenträger") zur Vermeidung einer kompletten Fibrosierung der „Neocochlea" während weiterer Verlaufsbeobachtungen mittels MRT.

Die postoperative vestibuläre Funktionsprüfung zeigte einen in allen 3 Ebenen regelrechten vestibulookulären Reflex (vKIT) und eine erhaltende kalorische Erregbarkeit. Die Patientin ist schwindelfrei.

Intralabyrinthäre Schwannome sind eine seltene Differenzialdiagnose des Hörsturzes, die aber bei der Anforderung einer MRT-Untersuchung zur Abklärung eines Hörsturzes speziell angefragt werden sollte. Eine operative Entfernung wachsender Schwannome in der Cochlea durch eine Cochleoektomie ist auch mit Erhalt der Funktion des Gleichgewichtsorgans prinzipiell möglich.

http://ift.tt/2phlj1A

Prevalence of hearing loss in Northern and Southern Germany

Abstract

Background

The HÖRSTAT study conducted in Northwest Germany found hearing impairment in approximately 16% of adults when applying the World Health Organization (WHO) criterion. However, the robustness of extrapolations to a national level might be questioned, as the epidemiological data were collected on a regional level.

Methods

Independently from HÖRSTAT, the "Hearing in Germany" study examined adult hearing in Aalen, a town located in Southwest Germany. Both cross-sectional studies were based on stratified random samples from the general population. The average pure-tone threshold shift at 0.5, 1, 2, and 4 kHz (PTA4), the prevalence of hearing impairment (WHO criterion: PTA4 in the better ear >25), and hearing aid uptake were compared. Data from the Aalen and HÖRSTAT studies were pooled (n = 3105) to extrapolate to the prevalence and the degree of hearing impairment for the years 2015, 2020, and 2025.

Results

Both studies yielded very similar results for PTA4. Weighted for official population statistics, the prevalence of hearing impairment according to the WHO criterion is 16.2% in adults, thus affecting 11.1 million persons in Germany. Owing to demographic changes, the prevalence is expected to increase in the medium term by around 1% per 5‑year period. With a similar degree of hearing loss, hearing aid provision differs from place to place.

Conclusion

When adjusted for gender and age to the European Standard Population, the prevalence of hearing impairment observed both in HÖRSTAT and the Aalen sample is considerably lower than reported for international studies. Since the analysis refers to cross-sectional data only, possible cohort effects are not considered in the prevalence projection.

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Vorbereitung für die Facharztprüfung HNO

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Feasibility of the head-mounted display for ultrasound-guided nerve blocks: a pilot simulator study

Abstract

The head-mounted display (HMD) has the potential to improve the quality of ultrasound-guided procedures. The aim of this non-clinical crossover designed study is to evaluate the feasibility of the HMD for ultrasound-guided nerve block. Eight experienced anesthesiologists performed ultrasound-guided peripheral nerve blocks on a training simulator with a standard approach and with an upside-down approach. Each approach was performed with a control conventional method and with an HMD. The ultrasound image and operating field were recorded by video camera. The procedure time and fractional percentage of time with the needle visible on the ultrasound image were determined. The needle insertion times were 10.4 ± 7.2 s with the control method and 6.8 ± 5.3 s with the HMD method for the standard approach (p = 0.03), and 18.1 ± 10.1 with the control method and 11.8 ± 9.5 s with the HMD method for the upside-down approach (p = 0.002). The fractional percentages of time with the needle visible on the ultrasound image were 34.1 ± 20.9 with the control method and 56.5 ± 13.6% with the HMD method for the standard approach (p < 0.001), and 20.1 ± 13.4 with the control method and 38.2 ± 21.2% with the HMD method for the upside-down approach (p = 0.001). In conclusion, this pilot study using a simulation model indicated that the use of an HMD shortened the procedure time and improved the needle visibility on ultrasound.

http://ift.tt/2pIWbn9

Intrathecal morphine for postoperative pain control following robot-assisted prostatectomy: a prospective randomized trial

Abstract

Purpose

Robot-assisted laparoscopic prostatectomy (RALP) is minimally invasive surgery, but also causes moderate to severe pain during the immediate postoperative period. We evaluated the efficacy and safety of intrathecal morphine (ITM) for postoperative pain control in patients undergoing RALP.

Methods

Thirty patients scheduled for RALP were randomly assigned into one of two groups. In the ITM group (n = 15), postoperative pain was managed using 300 µg intrathecal morphine with intravenous patient-controlled analgesia (IV-PCA). In the IV-PCA group (n = 15), only intravenous patient-controlled analgesia was used. The numerical pain score (NPS; 0 = no pain, 100 = worst pain imaginable), postoperative IV-PCA requirements and opioid-related complications including nausea, vomiting, dizziness, headache and pruritus were compared between the two groups.

Results

The NPSs on coughing were 20 (IQR 10–50) in the ITM group and 60 (IQR 40–80) in the IV-PCA group at postoperative 24 h (p = 0.001). The NPSs were significantly lower in the ITM group up to postoperative 24 h. The ITM group showed less morphine consumption at postoperative 24 h in the ITM group than in the IV-PCA group [5 (IQR 3–15) mg vs 17 (IQR 11–24) mg, p = 0.001]. Complications associated with morphine were comparable between the two groups and respiratory depression was not reported in either group.

Conclusion

Intrathecal morphine provided more satisfactory analgesia without serious complications during the early postoperative period in patients undergoing RALP.

http://ift.tt/2pOoaA0

A matched case–control comparison of hospital costs and outcomes for knee replacement patients admitted postoperatively to acute care versus rehabilitation

Abstract

For select total knee arthroplasty (TKA) patients, we have established an alternative pathway to bypass the acute care surgical ward and directly admit patients from the post-anesthesia care unit to on-campus rehabilitation. We retrospectively examined whether this 'fast track' pathway decreased costs and improved patient outcomes. After reviewing records of consecutive primary unilateral TKA patients over a 15-month period, each patient admitted to rehabilitation was matched with a control admitted to the acute care ward. The primary outcome was estimated total hospitalization cost (length of stay in days multiplied by the average cost per day). Secondary outcomes were length of stay, in-hospital pain scores, opioid use, maximum ambulatory distance and 30-day readmission, morbidity, and mortality. Of the 262 TKA patients during the study period, 14 were admitted to rehabilitation and were matched to 14 patients admitted to acute care. Estimated total hospitalization cost [median (10th–90th percentiles)] was US$30,755 (US$23,066–38,444) for ward patients compared to US$17,620 (US$13,215–33,918) for rehabilitation patients (P = 0.006). This difference [mean (95% CI)] was US$10,143 (US$2174–18,112). There were no other differences. For facilities similar to ours, direct postoperative admission of select TKA patients to subacute rehabilitation may be less costly than acute care and may not negatively affect outcomes.

http://ift.tt/2qAiNqZ

Tongue-out versus tongue-in position during Intensity-Modulated Radiotherapy for base of tongue cancer: Clinical implications for minimizing post-Radiotherapy Swallowing Dysfunction

Abstract

Background

The purpose of this study was to assess whether different tongue positions change the radiation doses to swallowing organs at risks: the pharyngeal constrictor, oral cavity, and larynx during intensity-modulated radiotherapy (IMRT) for base of tongue (BOT) cancer.

Methods

IMRT plans with Tongue-out (IMRT-TO) and tongue-in position (IMRT-TI) was compared in 3 cases.

Results

Distance from BOT to pharyngeal constrictor was increased to 1.8 ± 0.8 cm with IMRT-TO from 0.9 ± 0.6 cm with IMRT-TI (P < .01). Compared to IMRT-TI, IMRT-TO significantly decreased the radiation dose to the anterior oral cavity, oral tongue, superior pharyngeal constrictor, middle pharyngeal constrictor, and supraglottic larynx (all P ≤ .04). IMRT-TO also had a smaller volume irradiated than IMRT-TI to the anterior oral cavity and the oral tongue receiving ≥30 Gy (V30) and V35, and superior pharyngeal constrictor and middle pharyngeal constrictor for V55 and V65 (all P ≤ .04).

Conclusion

Dosimetric advantage with IMRT-TO over IMRT-TI may potentially reduce post-IMRT swallowing dysfunction in selected patients with BOT cancer.

http://ift.tt/2phsmXU

Interstitial PDT using diffuser fiber—investigation in phantom and in vivo models

Abstract

Photodynamic therapy (PDT) has been used for local treatment of several types of tumors. Light penetration of biological tissue is one limiting factor in PDT, decreasing the success rates of the treatment of invasive and solid tumors. In those cases, a possible solution is to use interstitial PDT, in which both diffuser optical fibers are inserted into the tumor. The uniformity of the diffuser emission plays a crucial role in planning the delivery of the appropriate light fluence and in ensuring treatment success. In this study, we characterized a diffuser optical fiber concerning its homogeneity. We showed that the diffuser emission can be inhomogeneous and that the necrosis generated by interstitial PDT using such a diffuser for illumination is asymmetrical in volume as a result. This observation has relevant consequences in achieving success in PDT and phototherapies in general, as the delivered light fluence depends on adequate previous knowledge of the irradiation profile.

http://ift.tt/2qLMBNG

Skin prick test is more useful than specific IgE for diagnosis of buckwheat allergy: A retrospective cross-sectional study

Publication date: Available online 4 May 2017
Source:Allergology International
Author(s): Noriyuki Yanagida, Sakura Sato, Kyohei Takahashi, Ken-ichi Nagakura, Kiyotake Ogura, Tomoyuki Asaumi, Motohiro Ebisawa
BackgroundBuckwheat (BW) is a potentially life-threatening allergen. Usefulness of BW-specific immunoglobulin-E (BW-sIgE) level for diagnosis of BW allergy is controversial, while the skin prick test (SPT) is widely used because of its less invasive procedure and immediate results. However, there are no data comparing usefulness of the SPT and BW-sIgE level. Therefore, our study aimed to clarify efficacy of the SPT for diagnosis of BW allergy.MethodsThis retrospective cross-sectional study evaluated patients who underwent an oral food challenge (OFC) for diagnosis or confirmation of acquired tolerance using 3072 mg of BW protein between July 2006 and April 2014. We then compared the diagnostic performance of BW sIgE and SPT to predict positive OFC results.ResultsWe analyzed 126 patients aged 2–16 years (median, 7.7 years), 18 (14%) of whom showed positive OFC results. Between patients with positive and negative OFC results, there was no significant difference in BW-sIgE level. However, patients with positive OFC results had a larger SPT wheal diameter. Area under the curve for positive OFC results for BW-sIgE level and SPT wheal diameter were 0.583 and 0.791, respectively. The 5%, 10%, 50%, and 90% positive predictive values of SPT wheal diameter were 2.0 mm, 5.2 mm, 14.7 mm, and 24.1 mm, respectively.ConclusionsOur study revealed that the SPT was more useful than BW-sIgE level for diagnosis of BW allergy. Thus, an OFC may be avoided if the patient's SPT wheal diameter is at least 24.1 mm.

http://ift.tt/2qIk7p3

A solitary fibrous tumour mimicking an aggressive angiomyxoma/liposarcoma

We present a case of a solitary fibrous tumour (SFT) resembling an aggressive angiomyxoma/liposarcoma on radiological imaging, causing significant diagnostic challenges preoperatively. A 76-year-old male was incidentally found to have a large pelvic mass on a CT scan. Further evaluation with an MRI scan confirmed a presacral mass containing fat and soft tissue components. It was inseparable from the sacrococcygeal spine, rectal serosa and the posterior wall of the urinary bladder, but no evidence of invasion was seen. A prominent vascular pedicle arising from the epidural vasculature was also noted. Differentials discussed at the multidisciplinary tumour board were an aggressive angiomyxoma versus a liposarcoma. The patient underwent wide resection of the pelvic tumour, anterior resection and end colostomy. Intraoperatively, a large 20 cm pelvic mass involving the sigmoid mesocolon and presacral fascia was found. Final histology reported an SFT with extensive adipocytic metaplasia.

http://ift.tt/2pIcErp

Optical coherence tomography of the Kayser-Fleischer ring: an ancillary diagnostic tool for Wilsons disease in children

This report presents anterior segment optical coherence tomography (AS-OCT) images of Kayser-Fleischer ring (KFR) in a child. The AS-OCT images highlight differential reflectivity of the KFR depending on amount of copper deposited in cornea, thus supporting the role of AS-OCT as a follow-up tool. Utility of AS-OCT for diagnosing and documenting the KFR in children otherwise uncooperative for detailed slit lamp examination is discussed.

http://ift.tt/2phaDjg

Pathogenesis of Cutaneous Lupus Erythema Associated with and without Systemic Lupus Erythema

Publication date: Available online 5 May 2017
Source:Autoimmunity Reviews
Author(s): Yu-ping Zhang, Jian Wu, Yan-fang Han, Zhen-rui Shi, Liangchun Wang
Cutaneous lupus erythematosus(CLE) can be an individual disease only involving skin, or presents as part of the manifestations of SLE. A small proportion of CLE may progress into SLE, however, the underlying pathogenic mediators remain elusive. By only including researches that clearly described if the subtypes of CLE presented by enrolled subjects was associated with or without SLE, we provided an overview of antibodies, inflammatory cells and inflammatory molecular mediators identified in blood and skin that were possibly involved in lupus skin damages. IgG autoantibodies are crucial for the development of CLE associated with SLE, but the circulating inflammatory cells and molecular mediators require further studies to provide definitive proof for their association with skin damages. Discoid lupus erythematosus(DLE) is the most common subtype of CLE. For DLE without associated with SLE(CDLE), it is lack of evidences if autoantibodies and circulating inflammatory cells are involved in the pathogenesis or not, but is clear that the cutaneous inflammatory infiltrates are dominated by Th1, but not Th17 cells in contrast to the various complex profile in SLE. As the major target cells in skin, keratinocytes may participate the pathophysiological process by increase cell apoptosis and the production of proinflammatory cytokines in SLE and CDLE. Insights into the similarities and differences of the pathogenesis of CLE and CLE associated with SLE will also improve our therapeutic strategies for CLE that is currently adopted from SLE, and prevent the progression of CLE to SLE by providing interventions within an appropriate window of disease development.

http://ift.tt/2pO7evI

Peripheral nervous system involvement in systemic lupus erythematosus: Prevalence, clinical and immunological characteristics, treatment and outcome of a large cohort from a single centre

Publication date: Available online 5 May 2017
Source:Autoimmunity Reviews
Author(s): Pilar Toledano, Ramón Orueta, Ignasi Rodríguez-Pintó, Josep Valls-Solé, Ricard Cervera, Gerard Espinosa
Disorders of peripheral nervous system in patients with systemic lupus erythematosus (PNS-SLE) are a major cause of morbidity. The aims of the present study were to determine the prevalence of PNS-SLE involvement in a large cohort of SLE patients from a single centre, to characterize such involvement, treatment modalities and outcome, and to identify the possible variables that may be associated with its presence.We performed an observational cross-sectional study that included all SLE patients being followed in our department between March and December 2015 who met at least one of the PNS-SLE case definitions proposed in 1999 by the American College of Rheumatology.Overall, 93 out of 524 (17,7%) patients presented with PNS-SLE syndrome; 90 (96.8%) of them were women with a mean age at PNS-SLE syndrome diagnosis was 44.8±14.1years and the average time from diagnosis of SLE to PNS-SLE diagnosis was 88 (range, 541–400) months. The most frequent manifestation was polyneuropathy (36.6%), followed by non-compression mononeuropathy (23.7%), cranial neuropathy and myasthenia gravis (7.5%, each), and Guillain-Barré syndrome (1.1%). The most frequent electrodiagnostic tests (EDX) pattern was axonal degeneration, present in 49 patients that corresponded to 80.3% of the overall EDX patterns. Mixed sensory-motor neuropathy was the most common type of involvement accounted for 56% of cases. Thirty-six out of 90 (40%) received glucocorticoids and/or immunosuppressant agents. Overall, global response (complete and/or partial) to treatments was achieved in 77.4% of patients without differences between the types of PNS-SLE involvement. Older age at SLE diagnosis (37.3±14.8 versus 30.8±12; p=0.001) and absence of hematologic involvement as cumulative SLE manifestation (11.8% versus 21.5%; p=0.034) had independent statistical significant associations with PNS-SLE development.The PNS-SLE involvement is not uncommon. Its most frequent manifestation is sensory-motor axonal polyneuropathy. The involvement occurs more frequently in patients who are diagnosed with SLE at older age. Prospective studies are needed to establish the incidence of PNS-SLE syndromes and the role of hematological manifestations in their development.

http://ift.tt/2pNGF7I

Integrated Diagnosis Project for Inflammatory Myopathies: An association between autoantibodies and muscle pathology

Publication date: Available online 4 May 2017
Source:Autoimmunity Reviews
Author(s): Shigeaki Suzuki, Akinori Uruha, Norihiro Suzuki, Ichizo Nishino
Inflammatory myopathies are a heterogeneous group of immune-mediated diseases that involve skeletal muscle as well as many other organs. The classification of inflammatory myopathies has been based on clinical diagnoses, pathological diagnoses, and autoantibodies, independently. The clinical phenotypes of inflammatory myopathies are characterized by various autoantibodies that are originally detected by RNA or protein immunoprecipitation. However, since the correlation between histological features and autoantibodies had not been fully elucidated, we created the "Integrated Diagnosis Project for Inflammatory Myopathies" in October 2010. Based on our work and previous studies, the three major subsets of inflammatory myopathies defined by autoantibodies are immune-mediated necrotizing myopathy (IMNM), antisynthetase syndrome, and dermatomyositis. IMNM is the pathological entity, characterized by significant necrotic and regeneration muscle fibers with minimal or no inflammatory cell infiltration. The detection of autoantibodies against signal recognition particles or 3-hydroxy-3-methylglutaryl-coenzyme A reductase is important for the diagnosis of IMNM. Antisynthetase syndrome, characterized by myositis, interstitial lung disease, skin rash, arthropathy, and Raynaud phenomenon, is the clinical entity based on the presence of aminoacyl transfer RNA synthetase antibodies. Perifascicular necrosis is a distinctive hallmark of antisynthetase syndrome in muscle pathology. The diagnosis of dermatomyositis is usually based on clinical features of typical skin rash. Several autoantibodies are associated with specific subsets of dermatomyositis. Myxovirus resistance A expression in the myofiber cytoplasm has a better sensitivity for the diagnosis of dermatomyositis compared to perifascicular atrophy. The screening of autoantibodies has clinical relevance for managing patients with inflammatory myopathies.

http://ift.tt/2pO2EgM

Autoimmune diseases and their relation with immunological, neurological and endocrinological axes

Publication date: Available online 4 May 2017
Source:Autoimmunity Reviews
Author(s): Nicolás Coronel-Restrepo, Iván Posso-Osorio, Juan Naranjo-Escobar, Gabriel J. Tobón
The immune response is complex, multifactorial, individualized and often unpredictable. There are multiple interconnected systems that allow a balance between physiological autoreactive processes and pathological autoimmunity with consequent organ-specific or systemic autoimmune disease. Based on the concept of the autoimmunity mosaic, up to 50% of autoimmune disorders do not have a clear etiological factor. In order to achieve a clear understanding of the different systems that influence the development of autoimmune diseases, the clinical auto–immunologist needs a dynamic and comprehensive vision of all interconnected pathways that maintain a precise balance in the organism. This has been and will remain a challenge. Understanding the different pathophysiological processes of these diseases will be the basis for predicting different clinical spectra and has the potential to offer innovative therapeutic approaches. This paper offers a practical overview of the bidirectional communication between the immune and endocrine system and the influence this has on the development of autoimmune diseases.

http://ift.tt/2pO7uZC

Coffee and autoimmunity: More than a mere hot beverage!

Publication date: Available online 4 May 2017
Source:Autoimmunity Reviews
Author(s): Kassem Sharif, Abdulla Watad, Nicola Luigi Bragazzi, Mohammad Adawi, Howard Amital, Yehuda Shoenfeld
Coffee is one of the world's most consumed beverage. In the last decades, coffee consumption has attracted a huge body of research due to its impact on health. Recent scientific evidences showed that coffee intake could be associated with decreased mortality from cardiovascular and neurological diseases, diabetes type II, as well as from endometrial and liver cancer, among others.In this review, on the basis of available data in the literature, we aimed to investigate the association between coffee intake and its influence on the immune system and the insurgence of the most relevant autoimmune diseases. While some studies reported conflicting results, general trends have been identified. Coffee consumption seems to increase the risk of developing rheumatoid arthritis (RA) and type 1 diabetes mellitus (T1DM). By contrast, coffee consumption may exert a protective role against multiple sclerosis, primary sclerosing cholangitis, and ulcerative colitis. Concerning other autoimmune diseases such as systemic lupus erythematosus, psoriasis, primary biliary cholangitis and Crohn's disease, no significant association could be found. In other studies, coffee consumption was shown to influence disease course and management options. Coffee intake led to a decrease in insulin sensitivity in T1DM, in methotrexate efficacy in RA, and in levothyroxine absorption in Hashimoto's disease. Further, coffee consumption was associated with cross reactivity with gliadin antibodies in celiac patients. Data on certain autoimmune diseases like systemic sclerosis, Sjögren's syndrome, and Behçet's disease, among others, are lacking in the existent literature. As such, further research is warranted.

http://ift.tt/2pOaxCT

Clinical spectrum and therapeutic management of systemic lupus erythematosus-associated macrophage activation syndrome: A study of 103 episodes in 89 adult patients

Publication date: Available online 5 May 2017
Source:Autoimmunity Reviews
Author(s): Pierre-Edouard Gavand, Ilaria Serio, Laurent Arnaud, Nathalie Costedoat-Chalumeau, Julien Carvelli, Antoine Dossier, Olivier Hinschberger, Luc Mouthon, Véronique Le Guern, Anne-Sophie Korganow, Vincent Poindron, Clément Gourguechon, Christian Lavigne, François Maurier, Guylaine Labro, Marie Heymonet, Matthieu Artifoni, Amélie Brabant Viau, Cristophe Deligny, Thomas Sene, Louis Terriou, Jean Sibilia, Alexis Mathian, Coralie Bloch-Queyrat, Claire Larroche, Zahir Amoura, Thierry Martin
ObjectivesMacrophage activation syndrome (MAS) is a life-threatening hyperinflammatory syndrome that can occur during systemic lupus erythematosus (SLE). Data on MAS in adult SLE patients are very limited. The aim of this study is to describe the clinical characteristics, laboratory findings, treatments, and outcomes of a large series of SLE-associated MAS. Methods.We conducted a retrospective study that included 103 episodes of MAS in 89 adult patients with SLE.Results103 episodes in 89 adult patients were analyzed. Median age at first MAS episode was 32 (18–80) years. MAS was inaugural in 41 patients (46%).Thirteen patients relapsed. Patients had the following features: fever (100% episodes), increased serum levels of AST (94.7%), LDH (92.3%), CRP (84.5%), ferritin (96%), procalcitonin (41/49 cases). Complications included myocarditis (n=22), acute lung injury (n=15) and seizures (n=11). In 33 episodes, patients required hospitalization in an ICU and 5 died. Thrombocytopenia and high CRP levels were associated independently with an increased risk for ICU admission. High dose steroids alone as first line therapy induced remission in 37/57 cases (64%). Additional medications as first or second line therapies included IV immunoglobulins (n=22), cyclophosphamide (n=23), etoposide (n=11), rituximab (n=3). Etoposide and cyclophosphamide-based regimens had the best efficacy.ConclusionMAS is a severe complication and is often inaugural. High fever and high levels of AST, LDH, CRP, ferritin and PCT should be considered as red flags for early diagnosis. High dose steroids lead to remission in two third of cases. Cyclophosphamide or etoposide should be used for uncontrolled/severe forms.

http://ift.tt/2pNDZXC

The development of offspring from mothers with systemic lupus erythematosus. A systematic review

Publication date: Available online 4 May 2017
Source:Autoimmunity Reviews
Author(s): Fjodor A. Yousef Yengej, Annet van Royen-Kerkhof, Ronald H.W.M. Derksen, Ruth D.E. Fritsch-Stork
ObjectiveTo analyze published data on the influence of maternal systemic lupus erythematosus (SLE) on different aspects of child development.MethodsA systematic review was conducted using PubMed and Embase searches for SLE or SLE-related antibodies and physical, neurocognitive, psychiatric or motor development outcomes in children.ResultsIn total 24 cohort and 4 case-control studies were included after initial screening of 1853 hits. Learning disorders (LD) were reported in 21.4–26% of SLE offspring, exceeding the prevalence in the general population. Four studies reported that dyslexia and reading problems were present in 14.3–21.6% of lupus offspring with a clear male predominance. Furthermore, a twofold increased rate of autism spectrum disorders (ASD) (n=1 study) and a two- to threefold increased risk for speech disorders (n=3 studies) were reported in lupus offspring compared to controls, although the latter was not statistically significant. More divergent results were found for attention deficit (n=5 studies) and behavior disorders (n=3 studies). In two large controlled studies attention disorders were more prevalent and a trend towards more behavior disorders was reported in 2 of 3 studies analyzing this subject. Finally, IQ and motor skills were not affected in respectively 7 and 5 studies. Cardiopulmonary functioning and mood disorders were scarcely investigated (both n=1). Maternal anti-SSA antibodies were associated with LD in offspring in one study. Other SLE-related antibodies were rarely studied.ConclusionThis systematic review suggests that maternal SLE is associated with LD (specifically dyslexia), ASD, attention deficit and probably speech problems in offspring. However, over half of the studies were assigned a low or moderate evidence level. Therefore, further research is necessary to substantiate the found evidence and expand the scope to lesser researched areas such as cardiopulmonary functioning.

http://ift.tt/2pOawPl

Physical inactivity and sedentary behavior: Overlooked risk factors in autoimmune rheumatic diseases?

Publication date: Available online 4 May 2017
Source:Autoimmunity Reviews
Author(s): Ana Jéssica Pinto, Hamilton Roschel, Ana Lúcia de Sá Pinto, Fernanda Rodrigues Lima, Rosa Maria Rodrigues Pereira, Clovis Artur Silva, Eloisa Bonfá, Bruno Gualano
This review aims to (1) summarize the estimates of physical inactivity and sedentary behavior in autoimmune rheumatic diseases; (2) describe the relationship between physical (in)activity levels and disease-related outcomes; (3) contextualize the estimates and impact of physical inactivity and sedentary behavior in autoimmune diseases compared to other rheumatic diseases and chronic conditions; (4) discuss scientific perspectives around this theme and potential clinical interventions to attenuate these preventable risk factors. We compiled evidence to show that estimates of physical inactivity and sedentary behavior in autoimmune rheumatic diseases are generally comparable to other rheumatic diseases as well as to other chronic conditions (e.g., type 2 diabetes, cardiovascular diseases, obesity), in which a lack of physical activity and excess of sedentary behavior are well-known predictors of morbimortality. In addition, we also showed evidence that both physical inactivity and sedentary behavior may be associated with poor health-related outcomes (e.g., worse disease symptoms and low functionality) in autoimmune rheumatic diseases. Thus, putting into practice interventions to make the patients "sit less and move more", particularly light-intensity activities and/or breaking-up sedentary time, are simple and prudent therapeutic approaches to minimize physical inactivity and sedentary behavior, which are overlooked yet modifiable risk factors in the field of autoimmune rheumatic diseases.

http://ift.tt/2pNJdmg

Interstital lung disease in ANCA vasculitis

Publication date: Available online 4 May 2017
Source:Autoimmunity Reviews
Author(s): Marco A. Alba, Luis Felipe Flores-Suárez, Ashley G. Henderson, Xiao Hong, Peiqi Hu, Patrick H. Nachman, Ronald J. Falk, J. Charles Jennette
Anti-neutrophil cytoplasmic antibodies (ANCA) vasculitis are immune-mediated disorders that primarily affect small blood vessels of the airway and kidneys. Lung involvement, one of the hallmarks of microscopic polyangiitis and granulomatosis with polyangiitis, is associated with increased mortality and morbidity. In recent years, several retrospective series and case reports have described the association of interstitial lung disease (ILD) and ANCA vasculitis, particularly those positive for ANCA specific for myeloperoxidase. In the majority of these patients pulmonary fibrosis occurs concurrently or predates the diagnosis of ANCA vasculitis. More importantly, these studies have shown that ILD has an adverse impact on the long-term prognosis of ANCA vasculitis. This review focuses on the main clinical and radiologic features of pulmonary fibrosis associated with anti-neutrophil cytoplasmic antibodies. Major histopathology features, prognosis and therapeutic options are summarized.

http://ift.tt/2pNULbi

Refractory obstetrical antiphospholipid syndrome: Features, treatment and outcome in a European multicentre retrospective study

Publication date: Available online 4 May 2017
Source:Autoimmunity Reviews
Author(s): Arsène Mekinian, Jaume Alijotas-Reig, Fabrice Carrat, Nathalie Costedoat-Chalumeau, Amelia Ruffatti, Maria Grazia Lazzaroni, Sara Tabacco, Aldo Maina, Agathe Masseau, Nathalie Morel, Enrique Esteve Esteve-Valverde, Raquel Ferrer-Oliveras, Laura Andreoli, Sara De Carolis, Laurence Josselin-Mahr, Noémie Abisror, Pascale Nicaise-Roland, Angela Tincani, Olivier Fain
AimTo describe the consecutive pregnancy outcome and treatment in refractory obstetrical antiphospholipid syndrome (APS).MethodsRetrospective multicentre open-labelled study from December 2015 to June 2016. We analyzed the outcome of pregnancies in patients with obstetrical APS (Sydney criteria) and previous adverse obstetrical event despite low-dose aspirin and low-molecular weight heparin LMWH (LMWH) conventional treatment who experienced at least one subsequent pregnancy.ResultsForty nine patients with median age 27years (23–32) were included from 8 European centers. Obstetrical APS was present in 71%, while 26% had obstetrical and thrombotic APS. Lupus anticoagulant was present in 76% and triple antiphospholipid antibody (APL) positivity in 45% of patients. Pregnancy loss was noted in 71% with a median age of gestation of 11 (8–21) weeks. The presence of APS non-criteria features (35% vs 17% in pregnancies without adverse obstetrical event; p=0.09), previous intrauterine death (65% vs 38%; p=0.06), of LA (90% vs 65%; p=0.05) were more frequent in pregnancies with adverse pregnancy outcome, whereas isolated recurrent miscarriage profile was more frequent in pregnancies without any adverse pregnancy outcome (15% vs 41%; p=0.04). In univariate analysis considering all pregnancies (index and subsequent ones), an history of previous intrauterine death was associated with pregnancy loss (odds-ratio 2.51 (95% CI 1.27–4.96); p=0.008), whereas previous history of prematurity related to APS (odds-ratio 0.13 95%CI 0.04 0.41, P=0.006), steroids use during the pregnancy (odds-ratio 0.30 95% CI 0.11–0.82, p=0.019) and anticardiolipids isolated profile (odds-ratio 0.51 95% CI 0.26–1.03, p=0.0588) were associated with favorable outcome. In multivariate analysis, only previous history of prematurity, steroids use and anticardiolipids isolated profiles were associated with live-birth pregnancy.ConclusionThe main features of refractory obstetrical APS were the high rates of LA and triple APL positivity. Steroids could be effective in this APS profile, but prospective studies are necessary.

http://ift.tt/2pNQdPW

Αρχειοθήκη ιστολογίου

Παρασκευή 5 Μαΐου 2017

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