Head and Neck Medicine by Alexandros G.Sfakianakis: 05/18/17

Πέμπτη 18 Μαΐου 2017

Validation of a Parent-Reported Diagnostic Instrument in a U.S. Referral Population: The Childhood Eczema Questionnaire

Abstract

Background/Objectives

There is a paucity of validated tools for diagnosing atopic dermatitis (AD) in very young children that do not rely on clinical evaluation. The Childhood Eczema Questionnaire (CEQ)—a diagnostic tool for AD in children younger than 2 years that a caretaker can complete—was recently validated in Sweden. The objective of this study was to validate the tool in a U.S. population. As a substudy, we added an additional question that was independently assessed.

Methods

Children younger than 2 years old were recruited from a dermatology clinic. Their caretakers completed a questionnaire containing the original tool's three questions as well as a fourth question that increased the time frame measured from 1 week to 6 months. Questionnaires with all "yes" answers were considered positive and were compared with a dermatologist diagnosis of AD.

Results

A total of 283 subjects were recruited. The first three questions (the original CEQ) predicted a positive diagnosis of AD with a sensitivity of 0.72 (95% confidence interval [CI] 0.58, 0.82) and a specificity of 0.93 (95% CI 0.87, 0.95). In a separate analysis we included the first two questions and the fourth question and found that the sensitivity increased to 0.82 (95% CI 0.69, 0.90) with a specificity of 0.89 (95% CI 0.83, 0.93).

Conclusion

This study validates a novel parental questionnaire for the diagnosis of AD in children younger than 2 years in a U.S. clinic population.

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Allergic Contact Dermatitis Due to Methylisothiazolinone in a Young Girl's Laundry Detergent

Abstract

Methylisothiazolinone (MI) is an emerging and increasing cause of allergic contact dermatitis (ACD) in children. We present the case of a 7-year-old girl with an unusual dermatitis suspicious for contact allergy. Patch testing confirmed allergy to MI, found only in the patient's laundry detergent. This case highlights the importance of checking household product ingredients and the role of MI as an increasing cause of ACD in children.

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Extracellular ATP is a key modulator of alveolar bone loss in periodontitis

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Itzhak Binderman, Nasir Gadban, Avinoam Yaffe
Periodontal diseases are initiated by pathogenic bacterial biofilm activity that induces a host inflammatory cells immune response, degradation of dento gingival fibrous tissue and its detachment from root cementum. It is well accepted, that osteoclastic alveolar bone loss is governed exclusively through secretion of proinflammatory cytokines. Nevertheless, our findings suggest that once degradation of collagen fibers by MMPs occurs, a drop of cellular strains cause immediate release of ATP from marginal gingival fibroblasts, cell deformation and influx of Ca+2. Increased extracellular ATP (eATP) by interacting with P2×7 purinoreceptors, present on fibroblasts and osteoblasts, induces generation of receptor activator of nuclear factor kB ligand (RANKL) that further activates osteoclastic alveolar bone resorption and bone loss. In addition, increased eATP levels may amplify inflammation by promoting leukocyte recruitment and NALP3-inflammasome activation via P2×7. Then, the inflammatory cells secrete cytokines, interleukin IL-1, TNF and RANKL that further trigger alveolar bone resorption. Moreover, eATP can be secreted from periodontal bacteria that may further contribute to inflammation and bone loss in periodontitis. It seems therefore, that eATP is a key modulator that initiates the pathway of alveolar bone resorption and bone loss in patients with periodontal disease. In conclusion, we propose that strain release in gingival fibroblasts aligned on collagen fibers, due to activity of MMP, activates release of ATP that triggers the pathway of alveolar bone resorption in periodontitis. We predict that by controlling the eATP interaction with its cellular purinoreceptors will reduce significantly bone loss in periodontitis.

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Hyperlipidemia is involved in apoptosis in rat submandibular glands

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Koichiro Irie, Takaaki Tomofuji, Daisuke Ekuni, Tetsuji Azuma, Toshiki Yoneda, Yoshihiro Shimazaki, Manabu Morita
ObjectiveThe aim of the present study was to investigate the effects of hyperlipidemia on histological changes and apoptosis in submandibular glands using apolipoprotein E (apoE)-deficient rats.DesignHistopathological findings related to induced apoptosis in the submandibular glands were compared between apoE-deficient rats (n=6; male; age, 16 weeks) and the corresponding wild-type rats (n=6).ResultsApoE-deficient rats showed significantly higher plasma levels of oxidized low-density lipoprotein (LDL), total cholesterol, very LDL and LDL, and lower plasma levels of high-density lipoprotein when compared to control rats (P<0.05). Lipid deposition in the submandibular gland was observed in apoE-deficient rat group and in none of the control group. Significant increases in vacuolization and apoptosis in acinar cells were observed in apoE-deficient rats, as compared to control rats (P<0.05). The number of active caspase-3-positive cells was also higher in the apoE-deficient rat group when compared with the control group (P<0.01).ConclusionsAccording to our results, hyperlipidemia induced apoptosis in apoE-deficient rat submandibular glands. Oxidized LDL generation in case of hyperlipidemia may trigger off a reaction of apoptotic acinar cells with vacuolization in the submandibular glands.

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Maintenance of claudin-3 expression and the barrier functions of intercellular junctions in parotid acinar cells via the inhibition of Src signaling

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Megumi Yokoyama, Takanori Narita, Hajime Sakurai, Osamu Katsumata-Kato, Hiroshi Sugiya, Junko Fujita-Yoshigaki
ObjectivesSalivary acinar and duct cells show different expression patterns of claudins, which may reflect their different functions. To study the role of claudins in saliva secretion, we examined alterations in the expression patterns of cell adhesion molecules in parotid glands of γ-irradiated rats and analyzed the influence of those changes on intercellular barrier function using primary cultures of parotid acinar cells.DesignRats were γ-irradiated with doses of 5, 15 or 20Gy, and expression levels of cell adhesion molecules were examined by immunoblotting analysis. Acinar cells were isolated from parotid glands and were cultured in the absence or presence of the Src kinase inhibitor PP1. Changes in protein and mRNA expression patterns were determined by immunoblotting and by RT-PCR analyses, respectively. Intercellular barrier function was examined by measuring transepithelial electrical resistance and the paracellular flux of FITC-dextran.ResultsIn irradiated parotid glands, the expression of claudin-4 was enhanced at 15Gy or higher, levels that induce the hyposecretion of saliva, although that increase was transient. At 30days after irradiation, expression levels of cell adhesion molecules were decreased. In primary cultures, the expression of claudin-4 was also increased transiently but the expression of claudin-3 and E-cadherin was decreased. The barrier function of tight junctions was disrupted although the localization of occludin was maintained. The Src kinase inhibitor PP1 suppressed those changes in gene expression and retained the intercellular barrier function.ConclusionsThese results suggest that the inhibition of Src signaling maintains the barrier functions of intercellular junctions in salivary glands, which can be lost due to tissue injury.

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Extracellular ATP is a key modulator of alveolar bone loss in periodontitis

Hyperlipidemia is involved in apoptosis in rat submandibular glands

Maintenance of claudin-3 expression and the barrier functions of intercellular junctions in parotid acinar cells via the inhibition of Src signaling

Scarlet Fever

http://otorhinolaryngology-crete.blogspot.com/2017/05/scarlet-fever.html

A 20-year-old man presented to his primary care physician with a 3-day history of swollen tonsils, sore throat, fevers, chills, and rash. The nonpruritic rash had started on his abdomen, spread to his chest and back, and then appeared on his arms, legs, and face. He had no known allergies or exposures to new medications and had no history of similar rash. Examination revealed exudative tonsillitis (Panel A), strawberry tongue, and cervical adenopathy with tenderness. Skin examination revealed diffuse blanching erythema with punctate papules that caused the skin on his chest, abdomen, back, arms, and legs to have a sandpaper-like quality (Panel B shows the left side of his abdomen). His neck and right flank had linear petechial patches. A rapid test for streptococcal pharyngitis was positive. The finding of acute streptococcal pharyngitis along with the diffuse rash led to a diagnosis of scarlet fever. The rash of scarlet fever is a delayed-type hypersensitivity to an exotoxin and therefore occurs in persons who have had a previous exposure to Streptococcus pyogenes. The rash classically manifests with linear petechial confluences that are known as Pastia's lines, which were seen in this patient. The patient was treated with antibiotic agents and had complete resolution of his symptoms within 3 days.

Alyson Brinker, M.D.

Navy Hospital Guam, Yigo, Guam

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Allergic respiratory disease (ARD), setting forth the basics: proposals of an expert consensus report

The variability of symptoms observed in patients with respiratory allergy often hampers classification based on the criteria proposed in guidelines on rhinitis and asthma.

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Therapie der akuten lymphatischen Leukämie des Erwachsenen

Zusammenfassung

Hintergrund

Die akute lymphatische Leukämie (ALL) ist die häufigste maligne Erkrankung im Kindesalter und hat an den akuten Leukämien des Erwachsenenalters einen Anteil von etwa 20 %.

Ergebnisse

In den vergangenen Jahrzehnten wurden bezüglich der Charakterisierung der ALL und der Optimierung ihrer Therapie wesentliche Fortschritte erzielt. Es wurden biologische Subgruppen und Risikogruppen mit unterschiedlichem klinischem Verlauf identifiziert. Auf der Zuordnung zu diesen Untergruppen basieren aktuelle, individualisierte risikoadaptierte Therapieprotokolle. Etwa 90% der erwachsenen ALL-Patienten erreichen nun eine komplette Remission, und die Heilungschancen erhöhten sich in den vergangenen 30 Jahren von unter 10 % auf über 50 %.

Schlussfolgerungen

Wesentlich für die Verbesserung der Therapieergebnisse waren eine Optimierung der Chemotherapie und Supportivbehandlung, die Integration der Stammzelltransplantation in die Erstlinienbehandlung, individualisierte Therapiemodifikationen unter Berücksichtigung der minimalen Resterkrankung und zielgerichtete Therapien wie der Einsatz von Tyrosinkinaseinhibitoren bei der Ph/BCR-ABL-positiven ALL (Ph: Philadelphia-Chromosom, BCR: „breakpoint cluster region", ABL: „Abelson murine leukemia viral oncogene homolog 1").

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Patterns of Initial Recurrence in Completely Resected Papillary Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.

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Serum Alanine Aminotransferase Trends and Their Relationship with Obesity and Metabolic Syndrome in United States Adolescents, 1999–2014

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

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Ternary graph as a questionnaire: a new approach to assessment of quality of life?

This study was prompted by awareness of the importance of research into quality of life (QoL) for patients with diseases of the head and neck, the important part questionnaires currently play in this field, and awareness of the "questionnaire fatigue" experienced by many patients. Our multidisciplinary research group raised coincidental awareness of the widespread use of ternary graphs in the sciences, social sciences, and humanities as a graphical tool for quantitative, semiquantitative, or purely graphical characteristics of ternary mixtures.

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Targeting T cell metabolism to regulate T cell activation, differentiation and function in disease

Chirag H Patel | Jonathan D Powell

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Periosteal elevation induces supracortical peri-implant bone formation

The aim of the study was to evaluate the possibility of supracortical peri-implant bone formation after periosteal elevation.

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The effect of low-level diode laser on COX-2 gene expression in chronic periodontitis patients

Abstract

Adjunctive treatments to scaling and root planing (SRP) such as lasers, have been utilized in the treatment of chronic periodontitis, mainly aiming to suppress and eliminate the bacteria, as well as enhancing the healing response. Eighty gingival papilla biopsy samples were obtained from 60 patients diagnosed with chronic advanced periodontitis; randomly assigned to three treatment groups (n = 20), as well as 20 subjects with no periodontal disease [group A]. Group B received SRP on a single quadrant/day for four consecutive days. On day 5, all quadrants were rescaled. Groups C and D received the same treatment as group B plus laser application with the low-level diode laser (630-670 nm, 1.875 J/cm2) for five and ten consecutive days, respectively. Papilla biopsies were obtained from subjects and evaluated by RT-PCR for expression of COX-2. The values in the control group were 0.028 0.014 and baseline values for the examined groups were 0.16 0.18. Significantly decreased level of COX-2 expression for groups C and D was found after treatment, while lowest average expression was found in the group that had the 10 laser treatments supplemental to SRP (0,035 0,014). The results of this study show suppression of COX-2 in gingival tissue after low-level laser treatment as adjunct to SRP.

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Surgical Treatment of Posttraumatic Laterognathia: A Case Report and a Literature Review, Focused on the Effects of a Condylar Fracture on the Face

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1601861

Facial asymmetry, following early childhood condylar trauma, is a common complaint among patients who seek surgical treatment. G.D.M., a 27-year-old male patient, sought professional help to correct his cosmetic flaw, caused by a condylar fracture when he was 8-years-old. After the proper orthodontic treatment, he underwent a double jaw orthognathic surgery and, 9 months later, a second one to correct the remaining asymmetry. Two years after this second procedure, the patient is still under surveillance and has no complaints.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

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

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Comparison of the Stability of Mandibular Sagittal Osteotomy Fixation between Two Types of Titanium Miniplates: A Biomechanical Study in Sheep Mandibles

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1603455

This study aimed to compare the biomechanical stability of the fixation of mandibular sagittal split osteotomy of the ramus by two types of titanium miniplates in sheep mandibles. Seven preserved sheep mandibles with similar weight and size were selected, dissected with complete removal of soft-tissue structures, and sectioned in their midline. After performing sagittal split osteotomy, 5 mm of advancement was standardized and samples were divided into two groups according to the type of titanium miniplate (GI = seven hemimandibles were fixed with straight titanium miniplate, GII = seven hemimandibles were fixed with L-shaped titanium miniplates), and then subjected to compressive load. The means (standard deviation) of the compressive load and extension values were 70.68 N (22.26) and 63.36 mm (15.60) to straight miniplates, and 78.80 N (32.54) and 70.55 mm (5.42) to L-shaped miniplates. After comparison and statistical analysis, the results showed no significant difference between the two types of titanium miniplates.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

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Lingual Artery Pseudoaneurysm after Severe Facial Trauma

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1603454

The mortality associated with high-energy trauma has several time peaks and variable prognosis. In the particular case of isolated head and neck trauma, management initially includes stabilizing the patient, especially the airway and circulation, and then proceeding to treat injured structures with debridement and often fracture fixation and coverage. We present a case of a male patient who suffered a severe facial trauma at his workplace. He underwent an initial uneventful emergency surgery for control of bleeding and mandibular osteosynthesis. At 2 weeks postoperatively, a second emergency surgery was required to treat a previously undiagnosed lingual pseudoaneurysm that ruptured spontaneously, with massive oral bleeding. The case highlights the clinical significance and timing of pseudoaneurysm formation, and the surveillance and high index of suspicion required for potentially life-threatening bleeding at later time peaks. Diagnostic and therapeutic angiography effectively treated the late complication. Multidisciplinary management options are reviewed, emphasizing the need for rapid decision making and collaboration to improve outcomes in such significant surgical trauma patients.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

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Erratum to “Transforming growth factor-β1 activates ΔNp63/c-Myc to promote oral squamous cell carcinoma” [Oral Surg Oral Med Oral Pathol Oral Radiol 2016;122:460-482]

Publication date: Available online 18 May 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

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THE USE OF AN ACELLULAR OXYGEN CARRIER IN A HUMAN LIVER MODEL OF NORMOTHERMIC MACHINE PERFUSION.

Background: Normothermic machine perfusion of the liver (NMP-L) is a novel technique that preserves liver grafts under near-physiological conditions whilst maintaining their normal metabolic activity. This process requires an adequate oxygen supply, typically delivered by packed red blood cells (RBC). We present the first experience using an acellular hemoglobin-based oxygen carrier (HBOC) Hemopure in a human model of NMP-L. Methods: Five discarded high-risk human livers were perfused with HBOC-based perfusion fluid and matched to 5 RBC-perfused livers. Perfusion parameters, oxygen extraction, metabolic activity and histological features were compared during 6 hours of NMP-L. The cytotoxicity of Hemopure was also tested on human hepatic primary cell line cultures using an in vitro model of ischemia reperfusion injury. Results: The vascular flow parameters and the perfusate lactate clearance were similar in both groups. The HBOC-perfused livers extracted more oxygen than those perfused with RBCs (O2ER 13.75 vs 9.43 % x105 per gram of tissue, p=0.001). In vitro exposure to Hemopure did not alter intracellular levels of reactive oxygen species and there was no increase in apoptosis or necrosis observed in any of the tested cell lines. Histological findings were comparable between groups. There was no evidence of histological damage caused by Hemopure. Conclusion: Hemopure can be used as an alternative oxygen carrier to packed red cells in NMP-L perfusion fluid. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Endoscopic esophageal and tracheal cauterization for closure of recurrent tracheoesophageal fistula: A case report and review of the literature

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Stacie Gregory, Robert H. Chun, Daiva Parakininkas, Louella Amos, Roger Fons, Diana G. Lerner, Dave R. Lal, Cecille Sulman
ObjectiveRecurrent tracheoesophageal fistula (TEF) can be a diagnostic and therapeutic challenge. Traditional treatment is thoracotomy, which carries significant morbidity and technical difficulty especially in a previously operated field. Recently, endoscopic techniques have been advocated as a primary approach for treatment of recurrent TEF prior to open repair. This case report describes the endoscopic technique used to address a recurrent TEF. The existing literature of all reported endoscopic cauterization methods is reviewed.MethodsAn 8 month old with proximal esophageal atresia and distal TEF underwent endoscopic closure of a recurrent TEF. The fistula was approached endotracheally utilizing Bugbee electrocautery (EC) and endoluminally through the esophagus using argon plasma coagulator and placement of porcine submucosa graft into the tract. Current literature review is presented with a synthesis of data on cases utilizing endoscopically applied EC and the combined results of this closure technique.ResultsOur patient has maintained successful closure after a single treatment confirmed on follow up endoscopy 6 months post repair. Including this patient, there have been 30 patients with recurrent TEF treated utilizing endoscopic EC reported in the literature. The overall success rate is 78.8% with a mean of 1.88 procedures per successful closure. Comparing EC alone to EC combined with tissue glues or laser, success rates are 67% and 86% respectively.ConclusionEndoscopic repair of recurrent TEF has proven to be safe and effective in the literature as an alternative to a second thoracotomy/open surgical repair. EC combined with tissue glues or laser is more effective than EC alone based on available data.

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Spontaneous CSF rhinorrhea from the trigeminal canal in an adolescent

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Jonathan C. Simmonds, Andrew R. Scott
We report a case of a seventeen-year old, healthy, non-obese young woman who presented with retro-orbital headaches and metallictasting, left-sided rhinorrhea. Computed tomography revealed a defect along the medial wall of the canal of V2 within a well-pneumatized lateral recess of the left sphenoid sinus. Prior imaging obtained 4 years earlier in the context of nasal trauma showed no such defect - thus lending support for the arachnoid granulation hypothesis of spontaneous CSF leaks from the sphenoid sinus. We perform a literature review and describe a successful repair through an endoscopic transpterygoid approach, which allowed for resolution of symptoms with minimal postoperative morbidity.

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Silent sinus syndrome and maxillary sinus atelectasis in children

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Farneti Paolo, Sciarretta Vittorio, Macrì Giovanni, Piccin Ottavio, Pasquini Ernesto
ObjectiveSilent sinus syndrome (SSS) and chronic maxillary atelectasis (CMA) are unusual conditions having subtle symptoms with a possible progressive evolution. They are particularly infrequent in the pediatric population. Our objective was to review our experience with pediatric patients having SSS or CMA, and to review all cases involving patients under 14 years of age reported in the literature.MethodsA retrospective review of 6 patients diagnosed with SSS or CMA surgically treated from 2001 to 2014 was carried out. All cases reported in literature were reviewed.ResultsAll patients underwent functional endoscopic sinus surgery with an improvement in symptoms after surgery. Diplopia disappeared in two patients who presented with it and enophthalmos improved in all five patients presenting with it. Only one patient out of four presenting with headache had a persistence of the symptoms which were, however, milder than they had been preoperatively. Endoscopic examination demonstrated a reventilated maxillary sinus in all cases. A radiological examination at follow-up was performed in 5 cases and demonstrated a reexpansion of the maxillary sinus as compared to the contralateral side in all patients except one. None of the patients required an orbital floor reconstruction. Eleven similar cases reported in the literature were analyzed and compared.ConclusionEndoscopic uncinectomy and middle meatal antrostomy should be the treatment of choice for these conditions in patients presenting with enophthalmos and/or hypoglobus and symptoms related to it. Orbital floor reconstruction should be performed as a delayed procedure only in selected cases. Chronic maxillary atelectasis or SSS should be considered as a possible cause of persistent headache of unknown origin in pediatric patients.

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Impacto de la laringectomía total en la situación laboral

Publication date: Available online 17 May 2017
Source:Acta Otorrinolaringológica Española
Author(s): Jose Miguel Costa, Montserrat López, Jacinto García, Xavier León, Miquel Quer
IntroducciónLa laringectomía total es una de las cirugías oncológicas más mutilantes. No existen estudios específicos que evalúen el retorno laboral después de la misma.Pacientes y métodosSe realizó un estudio transversal de una muestra de 116 pacientes laringectomizados que se hallaban libres de enfermedad y con un seguimiento mínimo de 2 años desde la laringectomía total. Se les realizó una encuesta dirigida a conocer la situación laboral, tanto previa como posterior. En el momento de la cirugía 62 (53%) estaban activos laboralmente, 40 (35%) estaban jubilados y 14 (12%) tenían una situación de invalidez.ResultadosEl 60% tenía profesiones con bajo grado de cualificación, siendo el grupo más numeroso los trabajadores de la construcción. De los 62 pacientes laboralmente activos en el momento de la laringectomía total 29 pasaron a inactivos y 33 (53%) mantuvieron la actividad laboral. Los factores más importantes para mantener la actividad laboral fueron el nivel de cualificación profesional y el método de rehabilitación vocal. El 80% de los pacientes con cualificación alta-intermedia mantuvieron su trabajo, frente al 35% en los de cualificación profesional baja (p<0,001). El 70% de los pacientes con prótesis fonatoria mantuvo la actividad laboral, frente a un 31% de los pacientes rehabilitados con erigmofonía (p=0,004). La regresión logística confirmó estas variables como independientes para seguir trabajando.ConclusionesEste es el primer estudio que analiza el impacto de la laringectomía total en la situación laboral. Los factores más importantes para volver a trabajar fueron tener un trabajo cualificado alto-intermedio y la utilización de prótesis fonatoria como método de rehabilitación vocal.IntroductionTotal laryngectomy is one of the most mutilating oncological operations. There are no specific studies evaluating return to work after this surgery.Patients and methodsA cross-sectional study was performed on a sample of 116 laryngectomized patients who were disease- free and had a minimum follow-up of 2 years from total laryngectomy. A survey was conducted to find out their employment situation before and after surgery. At the time of surgery, 62 (53%) were working, 40 (35%) were retired and 14 (12%) were in a disability situation.Results60% had professions with low qualification requirements, the largest group being construction workers. Of the 62 patients active at the time of total laryngectomy, 29 became inactive and 33 (53%) maintained their work activity. The most important factors in maintaining work activity were the level of professional qualification and the method of vocal rehabilitation. Eighty percent of the patients with high-intermediate qualification maintained their jobs, compared to 35% of those with low professional qualifications (P<.001). Seventy percent of the patients with voice prostheses maintained their work activity, compared to 31% of the patients rehabilitated with oesophageal voice (P=.004). Logistic regression confirmed these as independent variables for continuing to work.ConclusionsThis is the first study that analyzes the impact of total laryngectomy on the work situation. The most important factors for a return to work were having a high-intermediate skilled job and the use of voice prosthesis as a method of vocal rehabilitation.

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Enfermedad de Castleman cervical pediátrica

Publication date: Available online 17 May 2017
Source:Acta Otorrinolaringológica Española
Author(s): Cristina Marco Martin, Roberto Méndez Gallart, Carlos Aliste Santos, Máximo Francisco Fraga Rodriguez, Adolfo Bautista Casasnovas

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Immunohistochemical evaluation of podoplanin in odontogenic tumours & cysts using anti-human podoplanin antibody

Publication date: Available online 17 May 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Namrata Singhal, Nitin Khanduri, Deepak Kurup, Brijesh Gupta, Pranjan Mitra, Roshani Chawla
BackgroundOdontogenic Cysts & tumors originate through some aberration from the normal pattern of odontogenesis. Ameloblastoma is one of the most frequent intraosseous odontogenic tumors. However it is no longer appropriate to use the diagnosis of ameloblastoma without specifying the type. Varied-clinical entities of ameloblastoma differ in their biologic behaviour. Odontogenic cysts like dentigerous and radicular cysts are less aggressive in nature than odontogenic tumors. Recently, podoplanin commonly used as a lymphatic endothelial marker in cancers has recently been found to play a possible role in odontogenic tumorigenesis also. Therefore the purpose of this study was to immunohistochemically analyse the expression of podoplanin in ameloblastomas, KCOTs, dentigerous cysts, radicular cysts & dental follicles.MethodsParaffin-embedded tissue specimens of 15 Ameloblastomas (7 follicular, 6 unicystic, 2 desmoplastic),10KCOTs, 5 dentigerous cysts, 5 radicular cysts & 5 dental follicles were immunohistochemically examined using antibody against podoplanin.ResultsAll ameloblastomas displayed podoplanin expression in ameloblast-like cells of the epithelial islands while the stellate-reticulum like cells exhibited no or weak immunostaining. Expression of podoplanin in KCOTs was strongly positive in the cells of the basal and suprabasal layers & odontogenic epithelial nests. Positive immunoreaction for podoplanin was observed in the inflammatory radicular cysts and inflamed dentigerous cyst only and negative or weak expression in the lining epithelium of uninflamed dentigerous cysts and dental follicles.ConclusionOur results suggest that podoplanin can be used as a potential proliferative marker to observe the aggressive behaviour of ameloblastomas and KCOTs.

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The feasibility of endoscopy-CT image registration in the head and neck without prospective endoscope tracking

by W. Scott Ingram, Jinzhong Yang, Beth M. Beadle, Richard Wendt III, Arvind Rao, Xin A. Wang, Laurence E. Court

Purpose

Endoscopic examinations are frequently-used procedures for patients with head and neck cancer undergoing radiotherapy, but radiation treatment plans are created on computed tomography (CT) scans. Image registration between endoscopic video and CT could be used to improve treatment planning and analysis of radiation-related normal tissue toxicity. The purpose of this study was to explore the feasibility of endoscopy-CT image registration without prospective physical tracking of the endoscope during the examination.

Methods

A novel registration technique called Location Search was developed. This technique uses physical constraints on the endoscope's view direction to search for the virtual endoscope coordinates that maximize the similarity between the endoscopic video frame and the virtual endoscopic image. Its performance was tested on phantom and patient images and compared to an established registration technique, Frame-To-Frame Tracking.

Results

In phantoms, Location Search had average registration errors of 0.55 ± 0.60 cm for point measurements and 0.29 ± 0.15 cm for object surface measurements. Frame-To-Frame Tracking achieved similar results on some frames, but it failed on others due to the virtual endoscope becoming lost. This weakness was more pronounced in patients, where Frame-To-Frame tracking could not make it through the nasal cavity. On successful patient video frames, Location Search was able to find endoscope positions with an average distance of 0.98 ± 0.53 cm away from the ground truth positions. However, it failed on many frames due to false similarity matches caused by anatomical structural differences between the endoscopic video and the virtual endoscopic images.

Conclusions

Endoscopy-CT image registration without prospective physical tracking of the endoscope is possible, but more development is required to achieve an accuracy suitable for clinical translation.

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Inflammatory infiltrate and mucosal remodeling in chronic rhinosinusitis with and without polyps: structured histopathologic analysis

Background

Chronic rhinosinusitis (CRS) is commonly classified into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Structured histopathologic reporting has the potential to identify salient histologic markers to differentiate subtypes and provide insights into pathophysiologic mechanisms in CRS.

Methods

A structured histopathology report of 13 variables was prospectively employed to analyze ethmoid sinus tissue removed during endoscopic sinus surgery for 99 patients, including 43 CRSsNP and 56 CRSwNP. These variables were compared in association with presence of nasal polyps, radiographic computed tomography scores (Lund-Mackay Score [LMS]), subjective symptoms scores (SNOT-22), duration of CRS, comorbid asthma, and atopy.

Results

Overall inflammation did not differentiate between CRSsNP and CRSwNP (p < 0.26). Compared to CRSsNP, CRSwNP had statistically significant increase in basement membrane thickening (76.8% vs 48.8%, p < 0.004), subepithelial edema (19.6% vs 2.3%, p < 0.01), fibrosis (58.9% vs 27.9%, p < 0.002), hyperplastic/papillary changes (12.5% vs 0.0%, p < 0.016), eosinophilia (41.1% vs 18.6%, p < 0.047), and eosinophilic aggregates (30.4% vs 11.6%, p < 0.022). Higher LMS was associated with increased eosinophilia (p < 0.001), eosinophil aggregates (p < 0.000), inflammation (p < 0.023), basement membrane thickening (p < 0.037), hyperplastic/papillary changes (p < 0.040) and fibrosis (p < 0.000). SNOT-22 scores were not associated with any histologic parameters.

Conclusion

Significant histopathologic differences were evident in patients with CRSwNP and CRSsNP. No single feature reliably differentiated between the 2 subtypes, underscoring the heterogeneity of CRS and limitation of this phenotypic classification system. Eosinophilic aggregates were associated with significantly worse disease, possibly signifying a unique subtype. Further studies are needed to understand the relationship of histopathologic features to disease outcome.

http://ift.tt/2rvM6ZD

Diffuse Parotid Swelling From an Underlying Parotid Mass

A child presented with left jaw pain and symptoms of an upper respiratory infection; the swelling resolved leaving a firm, slightly mobile, subcentimeter mass palpable in the anterior parotid gland that enlarged and became painful. What is your diagnosis?

http://ift.tt/2qxPogB

Evaluation of Monitored Anesthesia Care in Sialendoscopy

This cohort study compares the outcomes of sialendoscopy procedures in patients who underwent general anesthesia with endotracheal intubation or monitored anesthesia care.

http://ift.tt/2rvLZfA

Indocyanine Green Dye Angiography to Predict Postoperative Fistulas After Laryngectomy

This study examines whether noninvasive angiography with indocyanine green dye can be used to evaluate native pharyngeal vascularity to anticipate pharyngocutaneous fistula development after salvage laryngectomy in patients with head and neck cancer.

http://ift.tt/2qxF9Ja

Cost as a Barrier for Hearing Aid Adoption

This Viewpoint explores the broader barriers audiologists face in providing services and technologies to those with reduced hearing ability and why cost is not the main barrier for patients.

http://ift.tt/2rvEVQn

Repeated haemorrhages in peripheral nerve sheath tumours of the salivary glands after minor injury

Publication date: Available online 17 May 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S. Kondo, N. Aoyagi, K. Narihira, M. Furuno, T. Kikuta
Repeated haemorrhages in peripheral nerve sheath tumours of the salivary glands are rare. We report the case of a patient with neurofibromatosis type 1 who had two episodes of massive haemorrhage in his right parotid gland the day after a minor injury. Oral and maxillofacial surgeons should be aware that vasculopathy may occur in patients with these tumours.

http://ift.tt/2qxpslr

Can cyst volume be used to stratify risk of complications following cyst defect reconstruction with iliac crest graft?

Publication date: Available online 17 May 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Ali-Farid Safi, Andrea Grandoch, Timo Dreiseidler, Hans-Joachim Nickenig, Joachim Zöller, Matthias Kreppel

http://ift.tt/2pPwLpg

The epidemiological analysis of maxillofacial fractures in Italy: The experience of a single tertiary center with 1720 patients

Publication date: Available online 17 May 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Paola Bonavolontà, Giovanni Dell'aversana Orabona, Vincenzo Abbate, Luigi Angelo Vaira, Carmelo Lo Faro, Marzia Petrocelli, Federica Attanasi, Giacomo De Riu, Giorgio Iaconetta, Luigi Califano
PurposeMaxillofacial fractures represent a serious public health problem. Their epidemiology is extremely variable, and its analysis is crucial to establish effective treatment and prevention of these injuries. However only two works have been published about maxillofacial fracture epidemiology in Italy.Materials and MethodsThe records of 1720 patients diagnosed with maxillofacial fractures in a 15-years period (2001-2015) in our department were retrospectively reviewed.ResultsA total of 1108 male and 612 female patients were included in the study. The most frequent aetiology of fracture was road traffic injuries (57.1%), followed by assault (21.7%), falls (14.2%), work accidents (3.5%), sport accidents (3.3%) and other causes (0.2%) Significant variations of aetiology were detected between males and females and between Italians and individuals from other countries. The most frequently observed fracture involved the mandible (861 cases, 36%), followed by zygoma (489 cases, 20.4%), orbital walls (386 cases, 16.1%) and maxilla (282 cases, 11.8%).ConclusionRoad traffic legislation enforcement and continuous public education regarding the use of security devices remain an ongoing problem in our region and should be encouraged. In the same way, as migration flows influence and change the epidemiology of facial traumas, it is crucial to establish social support programs that avoid these disadvantaged categories of victims of violence and crime.

http://ift.tt/2qAXPWp

Dental age is more appropriate than chronological age for evaluating the mandibular movement range in children

Publication date: Available online 17 May 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Otto Steinmassl, Patricia-Anca Steinmassl, Anna Schwarz, Adriano Crismani
PurposeThe measurement of excursive jaw movements is an important instrument for evaluating the functional condition of the temporomandibular system. Dento-maxillofacial development differs widely within different age, weight or height clusters. Tooth eruption is part of the development of the temporomandibular system. Therefore, the dental developmental stage might reflect temporomandibular development more appropriately. The aim of this study is to investigate whether the dental age is a more suitable parameter for evaluating the mandibular movement range of children in the mixed dentition stage than chronological age.Materials and MethodsIn a prospective study, the mandibular movement range and relevant temporomandibular findings of 146 children aged 8 to 10 yr were assessed clinically. Alginate impressions were taken and dental casts were generated. Dental age was assessed from the casts.ResultsThe mean mouth opening capacity was 46.2 mm (SD = 5.2); the mean laterotrusion to the left was 10.1 mm (SD = 1.9) and to the right 10.0 mm (SD = 1.8). For protrusion, the mean value was 9.1 mm (SD = 2.0). There was a statistically highly significant correlation between dental age and maximal active mouth opening extent. Statistically significant correlations between chronological age and active jaw movement capacity could not be shown.ConclusionsIn children in the mixed dentition stage, dental age seems to reflect the developmental stage of the temporomandibular system more adequately than chronological age. Therefore, dental age−related normative values could be more appropriate for evaluating the temporomandibular system in children.Clinical trial registration number: 20100302-161.

http://ift.tt/2pPDzDF

A systematic review of soft-to-hard tissue ratios in orthognathic surgery. Part IV: 3D analysis─is there evidence?

Publication date: Available online 17 May 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Sergio Olate, Carlos Zaror, Maurice Y. Mommaerts

http://ift.tt/2qASjDc

Clathrin-mediated endocytosis is required for ANE 30-100K-induced autophagy

Abstract

Background

We identified an autophagy-inducing areca nut (AN) ingredient (AIAI) in the 30-100 kDa fraction of AN extract (ANE 30-100K). This study was to analyze the role of endocytosis in ANE 30-100K-induced autophagy.

Methods

We used benzyl alcohol, dynasore, and shRNA of clathrin and dynamin to assess whether ANE 30-100K-induced cytotoxicity and accumulation of microtubule-associated protein 1 light chain 3 (LC3)-II were affected in oral (OECM-1) and esophageal (CE81T/VGH) carcinoma cells.

Results

Both benzyl alcohol and dynasore effectively reduced ANE 30-100K-induced cytotoxicity and LC3-II accumulation in OECM-1 and CE81T/VGH cells. Downregulated protein expression of both clathrin and dynamin by their shRNA also significantly attenuated ANE 30-100K-induced elevation of LC3-II levels in CE81T/VGH cells.

Conclusions

These results indicate that AIAI may be engulfed by cells through clathrin-mediated endocytosis, which promotes the execution of the following autophagy program.

http://ift.tt/2qvTMMP

Genetic etiology of oral cancer

Publication date: July 2017
Source:Oral Oncology, Volume 70
Author(s): Johar Ali, Bibi Sabiha, Hanif Ullah Jan, Syed Adnan Haider, Abid Ali Khan, Saima S. Ali
Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide. It accounts for 2.5% of all new cancer cases and 1.9% of all cancer deaths annually. More than 90% of oral cancers (occurring in the mouth, lip, and tongue) are oral squamous cell carcinoma. The incidence rate of oral cancer varies widely throughout the world, with an evident prevalence in South Asian countries. This high incidence occurs in correlation with oral cancer-associated behaviors such as alcohol, tobacco use. Researchers have reported that these behaviors lead to genetic variations in tumor suppressor genes (APC, p53), proto-oncogenes (Myc), oncogene (Ras) and genes controlling normal cellular processes (EIF3E, GSTM1). Processes such as segregation of chromosomes, genomic copy number, loss of heterozygosity, telomere stabilities, regulations of cell-cycle checkpoints, DNA damage repairs and defects in notch signaling pathways are involved in causing oral cancer. In order to develop preventive and therapeutic options, it is necessary to comprehend the basic molecular mechanisms forcing oral tumorigenesis. This review examines, in detail, the mechanisms of genetic alteration which are considered to be responsible for the initiation of oral cancer.

http://ift.tt/2q0AlYT

Nasal Reconstruction in the Vasculopathic Patient

Saddle nose deformity ranks high among the burden of disease in patients diagnosed with systemic vascular disorders. Nearly one-quarter of patients diagnosed with granulomatosis with polyangiitis (GPA) develop this deformity. The process contributes to the overall cosmetic, mental, and functional toll taken on by a patient. It is only in the last several decades that literature has surfaced highlighting surgical interventions for vasculitis-induced saddle nose deformity.

http://ift.tt/2hBW9qM

Repetitive Transcranial Magnetic Stimulation for Tinnitus

This Viewpoint discusses evidence of the efficacy of repetitive transcranial magnetic stimulation for treatment of tinnitus and the need for a randomized clinical trial.

http://ift.tt/2kowbZg

Cetuximab and Radiotherapy in Laryngeal Preservanion—Reply

In Reply We thank Drs D'Ascanio, Ricci, and Piazza for their interest in the article "Cetuximab and Radiotherapy in Laryngeal Preservation for Cancers of the Larynx and Hypopharynx: A Secondary Analysis of a Randomized Clinical Trial." The contribution of the article was a retrospective subgroup analysis of a randomized trial of primary radiation with and without cetuximab for patients with locoregionally advanced head and neck cancers. Patients with advanced laryngeal and hypopharyngeal tumors often require laryngectomy if they are to undergo surgery. We examined patients with advanced laryngeal and hypopharyngeal tumors from our overall trial of patients with locoregionally advanced head and neck cancer.

http://ift.tt/2i61GWT

Cognitive Training for Adults With Bothersome Tinnitus

This randomized clinical trial evaluates the effect of a cognitive training program on bothersome tinnitus in adults.

http://ift.tt/2iXLn0Z

Left-Sided Facial Pain, Fullness, and Trismus

A young man had left-sided facial pain, fullness, trismus, and decreased acuity in his left lower visual field; physical examination revealed a mass that extended inferiorly to the zygoma into the buccal cavity and posterolaterally to the left superior molars. What is your diagnosis?

http://ift.tt/2kWo49Q

Quality of Life in Children After Submucous Inferior Turbinoplasty

This case series examines changes in sinonasal quality of life for children after outfracture of inferior turbinates and concomitant submucous microdebrider inferior turbinoplasty for chronic nasal congestion.

http://ift.tt/2kWrdGJ

Carbon Dioxide Laser as an Office-Based Surgical Tool

In the mid-19th century, the first transoral laryngeal procedures were performed in awake patients without sedation. As topical and general anesthesia techniques advanced toward the turn of the 20th century, laryngeal surgeons transitioned such care to the operating room, where improved visualization and precision were achieved under anesthesia. During this period of endoscopic laryngeal surgery, the armamentarium of surgeons expanded greatly, and several procedural innovations were made, although for some recurrent conditions, the operating room setting presented drawbacks. For benign diseases, surgeons developed individualized functional thresholds, typically measured by ventilatory or phonatory dysfunction, for taking a patient to the operating room for surgical treatment. This protocol is, of course, more problematic in recurrent diseases, such as papillomatosis, which inherently require repeated and often frequent surgical procedures that impart safety, logistical, and cost burdens.

http://ift.tt/2lXh5tG

Drug-Induced Sleep Endoscopy With Online Cardiorespiratory Monitoring

This cohort study describes a drug-induced sleep endoscopy technique implemented with simultaneous polygraphic monitoring of cardiorespiratory parameters in patients with obstructive sleep apnea syndrome.

http://ift.tt/2lDOha8

Middle Ear Mass Causing Vertigo and Facial Nerve Weakness

A woman had vertigo, profound mixed hearing loss, a mass obstructing the external auditory canal, and facial nerve weakness; computed tomography revealed a soft-tissue mass emanating from the middle ear involving the facial canal with surrounding bony erosion. What is your diagnosis?

http://ift.tt/2iUhBIi

Otogenic Temporomandibular Arthritis in Children

This study describes the symptoms, imaging characteristics, course, and treatment of otogenic septic arthritis of the temporomandibular joint in children.

http://ift.tt/2lDNcPn

Permanent 3D-Printed Tracheal Splint for Severe Tracheomalacia

This case report describes the treatment of severe acquired tracheomalacia with a patient-specific, 3D-printed, permanent tracheal splint.

http://ift.tt/2k5T2eF

Otolaryngology Consultation Trends at an Academic Quaternary Care Center

This study examines trends in otolaryngology–head and neck surgery consultations conducted in emergency departments and inpatient services.

http://ift.tt/2iUnDsH

May 2017 Issue Highlights

http://ift.tt/2rvJQBA

Antireflux Medication and Laryngopharyngeal Reflux in Nasal Resistance

This case-control study describes the association of oral antireflux medication with laryngopharyngeal reflux and nasal resistance.

http://ift.tt/2m6WmV4

Expanding Perspectives in Airway Stenosis

As surgeons, we take pride in our craft and, therefore, are biased toward our preferred techniques. Similarly, our clinical research is often guided by this motivation, steering us to share the outcomes of our favored techniques. This natural bias is evident in the literature. For example, at the time of publication, a PubMed search "Laryngostenosis/surgery[Mesh]" (which includes subglottic stenosis) revealed 1294 articles on surgical approaches to upper airway stenosis. In contrast, the search "Laryngostenosis/drug therapy[Mesh]" (which includes use of mitomycin and other adjuvant therapies) resulted in only 80 articles. The article by Feinstein et al in this issue of JAMA Otolaryngology–Head & Neck Surgery joins several others to reinforce the concept that perhaps it is not the surgical finesse or latest technology used in endoscopic procedures to modify the structural airway anatomy that matters, but rather how we can manipulate the immunologic response and wound healing process afterward. However, this is in contrast to more technically difficult open airway reconstruction, clearly demonstrating improved outcomes and higher "cure rate" in high-volume centers.

http://ift.tt/2l48k0k

Office-Based Laryngeal Surgery Using Carbon Dioxide Lasers

This study evaluates the outcomes and technical problems of using a carbon dioxide laser for office-based laryngeal surgery among adults with vocal lesions treated in a single institution in Taiwan.

http://ift.tt/2lPPZbW

Reconstruction of Saddle Nose Deformity in Granulomatosis With Polyangiitis

This systematic review identifies which techniques were most successful in reconstructive rhinoplasty for patients with a saddle nose deformity secondary to granulomatosis with polyangiitis disease.

http://ift.tt/2hz7CKC

Predictors of Obstructive Sleep Apnea Severity in Adolescents

This case series examines the clinical and demographic factors associated with obstructive sleep apnea severity in adolescents.

http://ift.tt/2l4hwS4

A Cystic Lesion of the Lower Lip

A man presented with an intraoral cystic lesion of the left lower lip; the lesion had developed spontaneously and grew slowly but progressively, and there was an outflow of a clear serous fluid on palpation. What is your diagnosis?

http://ift.tt/2iXCXGO

Endoscopic Management of Subglottic Stenosis

This case series assesses whether surgical technique or adjunctive measures are associated with duration between surgical procedures for subglottic stenosis.

http://ift.tt/2mpkS3c

Understanding the relationship between olfactory-specific quality of life, objective olfactory loss, and patient factors in chronic rhinosinusitis

Background

Chronic rhinosinusitis (CRS) significantly impacts olfaction. However, the relationship between objective olfaction and patient-reported olfactory-specific quality of life (QOL) is not well understood. Furthermore, objective olfactory testing can be time consuming, so we sought to determine if patient-reported olfactory QOL can be used as screening tool for olfactory dysfunction.

Methods

Olfactory dysfunction was evaluated in 109 patients with CRS using the Questionnaire of Olfactory Disorders–Negative Statements (QOD-NS) and the Sniffin' Sticks Test, assessing for olfactory threshold, discrimination, identification, and overall composite scores (TDI; composite score of threshold, discrimination, and identification). Regression analysis was performed to correlate olfactory metrics and patient and disease-specific factors with QOD-NS scores. Optimal QOD-NS scores to classify patients based upon objective olfactory function were established.

Results

Bivariate and multivariate regression analyses of QOD-NS and CRS-associated comorbidities, objective measures of disease, demographics, and CRS-specific QOL were performed. Non-white race, depression, and worse 22-item Sino-Nasal Outcome Test (SNOT-22) scores correlated with worse QOD-NS scores (p < 0.005). Worse TDI scores correlated with worse QOD-NS scores, and discrimination had the strongest correlation (p < 0.001). Mean ± standard deviation (SD) QOD-NS scores for normosmia, hyposmia, and anosmia were 44 ± 7.2, 35.7 ± 12.8, and 31.6 ± 10.7, respectively. Receiver operating characteristic curve analysis revealed an area under the curve of 0.770 (p < 0.001), and a QOD-NS cutoff of 38.5 to have maximal Youden's index to define normal vs abnormal TDI score.

Conclusion

In CRS, QOD-NS correlates with non-white race, depression, SNOT-22, and TDI score, with discrimination having the strongest correlation. The QOD-NS also appears to be a feasible tool for olfaction screening.

http://ift.tt/2rvhtn5

How does the pattern of aeroallergen sensitization change over time across all ages?

Background

Identification of aeroallergen sensitization is important for diagnosis and management of allergic diseases. Immunoglobulin E (IgE) sensitization status is known to change over time. However, few studies have explored changes in sensitization patterns across all age groups. The aim of the present study was to evaluate the changing patterns of in vitro IgE sensitization tests in allergic rhinitis patients across all age groups.

Methods

We recruited all patients who were diagnosed as having rhinitis and who underwent in vitro IgE sensitization testing from 2007 to 2016. Of these, we included 138 who underwent repeat testing. We analyzed epidemiological data and allergen sensitization patterns.

Results

Of all patients, 56.5% of exhibited changes in allergen sensitization patterns. The allergens to which all age groups were sensitive were most commonly mites, with the exception of patients aged 40 to 59 years. The age group in which "new sensitization," composed of those with "newly developed sensitization" and "sensitization to more allergens," was most frequent was the 2 to 12 years old group, followed by the 20 to 39 years old group. The age group in which "desensitization," composed of those with "negative conversion" and "desensitization to fewer allergens," was most prevalent was the 20 to 39 years old group followed by the 13 to 19 years old group. Grass pollen was the most common newly-sensitized allergen and also the most common desensitized allergen.

Conclusion

IgE sensitization to aeroallergens can change in individuals with allergy. These changes may be different according to the patient's age. If rhinitis symptoms or treatment efficacy changes, repeat IgE sensitization testing is needed to find changes in allergen sensitization patterns.

http://ift.tt/2qWrk8o

Case 15-2017 — A 27-Year-Old Woman with Anemia, Thrombocytosis, and Skin Lesions after Travel Abroad

Presentation of Case. Dr. Alyssa R. Letourneau: A 27-year-old woman was evaluated in the infectious disease clinic of this hospital because of skin lesions, anemia, thrombocytosis, and an elevated blood alkaline phosphatase level. Eleven months before this presentation, the patient traveled abroad;…

http://ift.tt/2pOTiT9

To Evaluate the Efficacy of NY-ESO-1-specific T Cell Receptor (TCR) Affinity Enhancing Specific T Cell in Solid Tumors

Conditions: Bone Sarcoma; Soft Tissue Sarcoma; Melanoma; Liver Cancer; Esophageal Cancer; Breast Cancer; Thyroid Cancer; Ovarian Cancer
Interventions: Drug: Cyclophosphamide; Biological: TAEST16001
Sponsors: Zhujiang Hospital; Xiangxue Life Science Research Center; Guangdong Xiangxue Precision Medical Technology Co., Ltd; Guangzhou Xiangxue Pharmaceutical Co., Ltd
Recruiting - verified May 2017

http://ift.tt/2ruRjA2

The Feasibility and Safety of the TOETVA for Benign Thyroid Nodules

Condition: Thyroid Diseases
Intervention: Procedure: Transoral endoscopic thyroidectomy vestibular approach
Sponsor: The University of Hong Kong
Not yet recruiting - verified May 2017

http://ift.tt/2qVryfK

Iliopsoas and intraperitoneal abscesses associated with pyoderma gangrenosum

http://ift.tt/2pXaTEI

Bilateral breast keloids in an elderly woman associated with bilateral breast cancers and high concentration of serum tumor growth factor-β

Abstract

We report a case of bilateral annular breast keloids in a 72-year-old woman who had been suffering from bilateral breast cancers. Histopathologically, the keloids showed unique distribution of α-SMA+, CD34− myofibroblasts and α-SMA−, CD34+ fibroblasts depending on the region. High serum levels of tumor growth factor-β were detected at 6 months after the development of the breast keloids, but not at 10 months. CD163-positive cells were abundantly detected in the skin of the elevated portion of the keloids. In contrast, these cells were considerably less numerous in the skin of the central healing portion compared with the skin of the elevated expanding portion. One interesting idea based on these results is that high levels of tumor growth factor-β released from CD163-positive cells played a crucial role in the formation of breast keloids through active induction of fibroblast differentiation into myofibroblasts. The present case strongly supports the previously proposed idea that keloids can form as a paraneoplastic phenomenon in breast cancer patients with keloid constitution.

http://ift.tt/2rimjqo

Segmental testicular infarction: a case report

Segmental testicular infarction is a very rare condition, which can mimic a testicular torsion or testicular cancer. Correct diagnosis is difficult but it is important to avoid unnecessary radical treatment.

http://ift.tt/2rv1Agv

Oxford Handbook of Medical Dermatology, second edition, 2016

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Erratum

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Corrigendum

http://ift.tt/2qAm7Qt

Issue Information

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An isolated ulcerated forehead lesion in a 70-year-old man

http://ift.tt/2qAvTCp

Unilateral Enlarged Vestibular Aqueduct Syndrome and Bilateral Endolymphatic Hydrops

Enlarged vestibular aqueduct (EVA) syndrome is a common congenital inner ear malformation characterized by a vestibular aqueduct with a diameter larger than 1.5 mm, mixed or sensorineural hearing loss that ranges from mild to profound, and vestibular disorders that may be present with a range from mild imbalance to episodic objective vertigo. In our study, we present the case of a patient with unilateral enlarged vestibular aqueduct and bilateral endolymphatic hydrops (EH). EH was confirmed through anamnestic history and audiological exams; EVA was diagnosed using high-resolution CT scans and MRI images. Therapy included intratympanic infusion of corticosteroids with a significant hearing improvement, more evident in the ear contralateral to EVA. Although most probably unrelated, EVA and EH may present with similar symptoms and therefore the diagnostic workup should always include the proper steps to perform a correct diagnosis. Association between progression of hearing loss and head trauma in patients with a diagnosis of EVA syndrome is still uncertain; however, these individuals should be advised to avoid activities that increase intracranial pressure to prevent further hearing deterioration. Intratympanic treatment with steroids is a safe and well-tolerated procedure that has demonstrated its efficacy in hearing, tinnitus, and vertigo control in EH.

http://ift.tt/2qAmivf

Clinical severity in Japanese patients with neurofibromatosis 1 based on DNB classification

Abstract

Neurofibromatosis 1 (NF1) is a genetic disease characterized by cutaneous, neurological and osseous complications. Although clinical manifestations of NF1 are variable, there has been no report on evaluation of severity in patients with NF1. To elucidate the grade of severity of NF1, a retrospective study was conducted in 124 NF1 patients at the Department of Dermatology of Tottori University Hospital in 2007–2016. The DNB classification (dermatological, neurological and bone manifestations) in Japan was used for assessment. Based on our current epidemiological data, there were 55 patients (44.3%) in stage 1, 23 (18.6%) in stage 2, three (2.4%) in stage 3, one (0.8%) in stage 4 and 42 (33.9%) in stage 5. The grade of severity in patients with NF1 tended to be higher with aging. Remarkably, 61.8% of the patients in stage 5 had diffuse plexiform neurofibromas with functional disability. We should pay attention to diffuse plexiform neurofibromas that greatly affect quality of life in patients with NF1.

http://ift.tt/2pZCnZj

Lung function parameters in omalizumab responder patients: an interesting tool?

Abstract

Background

Omalizumab, an anti-IgE antibody, is used to treat patients with severe allergic asthma. The evolution of lung function parameters over time and the difference between omalizumab responder and non-responder patients remain inconclusive. The objective of this real-life study was to compare the changes in FEV1 of omalizumab responders and non-responders at 6 months.

Methods

A multicenter analysis was performed in 10 secondary and tertiary institutions. Lung function parameters (forced vital capacity (FVC), pre- and post-bronchodilator FEV1, residual volume (RV) and total lung capacity (TLC) were determined at baseline and at 6 months. Omalizumab response was assessed at the 6-month visit. In the omalizumab responder patients, lung function parameters were also obtained at 12, 18 and 24 months.

Results

Mean pre-bronchodilator FEV1 showed improvement in responders at 6 months, while a decrease was observed in non-responders (+0.2 ± 0.4L and -0.1 ± 0.4L respectively, p<0.01). After an improvement at 6 months, pre- and post-bronchodilator FEV1 remained stable at 12, 18 and 24 months. The FEV1/FVC remained unchanged over time, but the proportion of patients with an FEV1/FVC ratio < 0.7 decreased at 6, 12, 18 and 24 months (55.2%, 54.0%, 54.0% and 44.8%, respectively, p<0.05). Mean RV values decreased at 6 months but increased at 12 months and 24 months (p<0.05). RV/TLC ratio decreased at 6 months and remained unchanged at 24 months.

Conclusion

After omalizumab initiation, FEV1 improved at 6 months in responder patients and then remained stable for 2 years. RV and RV/TLC improved at 6 months.

http://ift.tt/2quyJKu

Value in Oral and Maxillofacial Surgery: A Systematic Review of Economic Analyses

Publication date: Available online 18 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Benjamin Geisler, Yisi D. Ji, Zachary S. Peacock
PurposeThe purpose of this study is to describe the state of economic analyses in the field of oral and maxillofacial surgery (OMS).MethodsA systematic search of published literature up to 2016 was performed. Inclusion criteria were as follows: English language articles on economic analyses pertaining to OMS including anesthesia/pain management, dentoalveolar, orthognathic/cleft/obstructive sleep apnea (OSA), pathology, reconstruction, temporomandibular disorders, trauma, and other. Exclusion criteria were as follows: opinion or perspective articles, studies unrelated to OMS, non-human research, and implant-related studies. Cost-effectiveness analyses (CEAs), cost-utility analyses (CUAs) and cost-minimization analyses (CMAs) were evaluated with the original or a modified Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.ResultsThe search yielded 798 articles, 77 of which met inclusion criteria (1980 to 2016, 48 from the United States). There were an increasing number of studies over time (p for trend<0.01). There were seven economic studies on anesthesia/pain management (9.1%), 16 studies on dentoalveolar surgery (20.7%), 15 studies on orthognathic/cleft/OSA (19.4%), one study in pathology (1.3%), six on reconstruction (7.8%), none on temporomandibular joint disorders/facial pain (0%), 20 studies on trauma (25.9%), and 12 studies categorized as other (15.5%). CEAs made up 11.7% of studies and CMAs 58.4% of studies. Of the 9 CEAs, 55.6% were published after 2010. Of 45 CMAs, 88.6% were published since 2000 and 61.4% since 2010. CEAs met 56.0% (range 29.2 to 87.5%) of the CHEERS criteria while CMA studies met 45.1% (range 23.9 to 76.1%) of the modified CHEERS criteria. Only one study succeeded in estimating costs and health outcomes (value) of an OMS procedure.ConclusionThere is an increasing trend in the number of economic studies in the field of OMS. More high-quality economic evaluations are needed to demonstrate the value of OMS procedures. To determine value, future studies should both compare costs and health-related outcomes.

http://ift.tt/2qufAZe

X-linked Carriers of Chronic Granulomatous Disease: Illness, Lyonization and Stability

Publication date: Available online 18 May 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Beatriz E. Marciano, Christa S. Zerbe, E. Liana Falcone, Li Ding, Suk See DeRavin, Janine Daub, Samantha Kreuzburg, Lynne Yockey, Sally Hunsberger, Ladan Foruraghi, Lisa A. Barnhart, Kabir Matharu, Victoria Anderson, Dirk N. Darnell, Cathleen Frein, Danielle L. Fink, Karen P. Lau, Debra A. Long Priel, John I. Gallin, Harry L. Malech, Gulbu Uzel, Alexandra F. Freeman, Douglas B. Kuhns, Sergio D. Rosenzweig, Steven M. Holland
BackgroundChronic granulomatous disease (CGD) is characterized by recurrent life-threatening bacterial and fungal infections and aberrant inflammation. Mutations in CYBB cause X-linked CGD and account for 65%-70% of cases in western countries.ObjectiveTo understand the clinical manifestations associated with the X-linked CGD carrier state.MethodsWe undertook a comprehensive retrospective study of 162 affected females. We examined dihydrorhodamine oxidation (DHR) data for percent (%) X chromosome inactivation. We correlated lyonization (%DHR+) with clinical features. Where possible, we followed %DHR+ levels over time.ResultsClinical data were available for 93 females: The %DHR+ was 46% (mean) and 47% (median)(SD=24). Using %DHR+ as the criterion for X inactivation, 78% of patients had levels of inactivation 20-80%, suggesting random inactivation that was independent of age. In contrast, carriers with CGD-type infections had median %DHR+ of 8% (n=14, range 0.06-48 %); those with only autoimmune or inflammatory manifestations (AIM) had median %DHR+ of 39% (n=31, range 7.4-74%). Those with both infections and autoimmunity had low %DHR+ (n=6, range=3-14%). A %DHR+ <10 % was strongly associated with infections (OR:99). Strong association persisted when the %DHR+ was <20% (OR=12) Autoimmunity was not associated with %DHR+. In two sets of identical twins the %DHR+ populations tracked closely over time. While the %DHR+ populations were very similar between sisters, those between mothers and daughters were unrelated.ConclusionsA low %DHR+ strongly predicts infection risk in X-linked CGD carriers, while the carrier state itself is associated with autoimmunity.

Teaser

Comprehensive long term follow up of X-CGD carriers identifies low %DHR as a critical predictor of infection susceptibility, whereas the %DHR is unrelated to autoimmune or inflammatory manifestations.

http://ift.tt/2qzaJnY

Sputum transcriptomics reveal up-regulation of IL-1 receptor family members in severe asthma

Publication date: Available online 18 May 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Christos Rossios, Stelios Pavlidis, Uruj Hoda, Chih-Hsi Kuo, Coen Wiegman, Kirsty Russell, Kai Sun, Matthew J. Loza, Frederic Baribaud, Andrew L. Durham, Oluwaseun Ojo, Rene Lutter, Anthony Rowe, Aruna Bansal, Charles Auffray, Ana Sousa, Julie Corfield, Ratko Djukanovic, Yike Guo, Peter J. Sterk, Kian Fan Chung, Ian M. Adcock
BackgroundSputum analysis in asthma is used to define airway inflammatory processes and may guide therapy.ObjectiveTo determine differential gene and protein expression in sputum samples from patients with severe asthma (SA) compared to mild-moderate non-smoking asthmatics (MMA).MethodsInduced sputum was obtained from non-smoking SA (SAn), smokers/ex-smokers with SA (SAsm), MMA and healthy non-smoking controls. Differential cell counts, microarray analysis of cell pellets and SOMAscan analysis of sputum analytes was performed. CRID3 was used to inhibit the inflammasome in a mouse model of severe asthma.ResultsEosinophilic and mixed neutrophilic/eosinophilic inflammation were more prevalent in SA compared to MMA. 42 genes probes were up-regulated (>2-fold) in SAn compared to MMA including IL-1R family and NRLP3 inflammasome members (FDR<0.05). The inflammasome proteins NLRP1, NLRP3 and NLRC4 were associated with neutrophilic asthma and with sputum IL-1β protein whilst eosinophilic asthma was associated with an IL-13-induced Th2 signature and IL1RL1 mRNA expression. These differences were sputum-specific since no activation of NLRP3 or enrichment of IL-1R family genes in bronchial brushings or biopsies in SA was observed. Expression of NLRP3 and of the IL-1R family genes was validated in the Airway Disease Endotyping for Personalized Therapeutics (ADEPT) cohort. Inflammasome inhibition using CRID3 prevented airway hyperresponsiveness and airway inflammation (both neutrophilia and eosinophilia) in a mouse model of severe allergic asthma.ConclusionIL1RL1 gene expression is associated with eosinophilic SA whilst NLRP3 inflammasome expression is highest in neutrophilic SA. Th2-driven eosinophilic inflammation and neutrophil-associated inflammasome activation may represent interacting pathways in SA.

Teaser

The study shows the value of sputum transcriptomics for understanding severe asthma mechanisms and identifies different IL-1R family members with different inflammatory phenotypes. Suppressing the inflammasome attenuates Th2 and non-Th2 features in vivo.

http://ift.tt/2pOfPj2

Early control treatment with montelukast in preschool children with asthma: A randomized controlled trial

Publication date: Available online 16 May 2017
Source:Allergology International
Author(s): Mizuho Nagao, Masanori Ikeda, Norimasa Fukuda, Chizu Habukawa, Tetsuro Kitamura, Toshio Katsunuma, Takao Fujisawa
BackgroundWhile Japanese guideline recommends initial control treatment for preschool children with asthma symptoms more than once a month, Western guidelines do not. To determine whether control treatment with montelukast was more effective than as-needed β2-agonists in this population, we conducted a randomized controlled trial.MethodsEligible patients were children aged 1–5 years who had asthma symptoms more than once a month but less than once a week. Patients were randomly assigned in a 1:1 ratio to receive montelukast 4 mg daily for 48 weeks or as-needed β2-agonists. The primary endpoint was the number of acute asthma exacerbations before starting step-up treatment with inhaled corticosteroids. This study is registered with the University Hospital Medical Information Network clinical trials registry, number UMIN000002219.ResultsFrom September 2009 to November 2012, 93 patients (47 in the montelukast group and 46 in the no-controller group) were enrolled into the study. All patients were included in the analysis. During the study, 13 patients (28%) in the montelukast group and 23 patients (50%) in the no-controller group had acute exacerbations with the mean numbers of 0.9 and 1.9/year, respectively (P = 0.027). In addition, 10 (21%) and 19 (41%) patients received step-up treatment, respectively. Cumulative incidence of step-up treatment was significantly lower in the montelukast group (hazard ratio 0.45, 95% confidence interval 0.21 to 0.92; P = 0.033).ConclusionsMontelukast is an effective control treatment for preschool children who had asthma symptoms more than once a month but less than once a week.

http://ift.tt/2qUn9d4

Correlation Between Socioeconomic Status and Atopic Dermatitis in Korean Adults: The Korea National Health and Nutrition Examination Survey (2007-2014)

Abstract

Introduction

Atopic dermatitis (AD) is one of the most common allergic diseases. Its prevalence has been increasing in recent decades. Social economic status is well-known risk factor of allergic diseases.

Objective

This study was performed to investigate the relationship between social economic status and AD in Korean adults.

Methods

Data were acquired from 47,351 men and women, ≥19 years of age who participated in the Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2007 to 2014. The presence of AD was based on self-reported physician diagnosis of AD in the Health Interview Surveys.

Results

The prevalence of AD was 3.1%, which decreased with increasing age. In univariate analysis, adults with AD were prone to be female, younger, never-married, well educated, lower household members, and urban dwelling (all p<0.01). Monthly family income, smoking status were not associated with the presence of AD. The prevalence of hypertension, diabetes mellitus, and asthma were higher in AD subjects (all p<0.01), while obesity was not associated with adult AD. After adjusting for confounders, logistic regression analysis showed female sex (adjusted odds ratio [aOR]: 1.483, 95% CI: 1.268-1.734), age (p<0.01), marital status (Single: aOR: 1.307, 95% CI: 1.012-1.690; Never-married: aOR: 1.938, 95% CI: 1.513-2.482), urban residence (aOR: 1.281, 95% CI: 1.045-1.569), and asthma (aOR: 1.788, 95% CI: 1.416-2.258) were associated with higher prevalence of AD (all p<0.01).

Conclusion

Female sex, age, marital status, urban residence, and the presence of asthma are important risk factors of the prevalence of AD in Korean adults.

http://ift.tt/2rh85pS

STAT4 expression and activation is increased during mitosis in vitro and in vivo in skin and mucosa derived cell types: implications in neoplastic and inflammatory skin diseases

Abstract

Background

The signal transducer and activator of transcription-4 (STAT4/Stat4) is a transcription factor known to convey signals from interleukin-12, interleukin-23, and interferon-alpha/beta to the nucleus, resulting in activation of dendritic cells, T-helper cell differentiation and production of interferon-gamma.

Objective

To demonstrate a novel role for STAT4 in cell mitosis.

Results

Phosphoserine STAT4 (pSerSTAT4) is increased in cells undergoing mitosis, and is distributed throughout the cytoplasm during this stage of the cell cycle whilst phosphotyrosine STAT4 (pTyrSTAT4) is confined to the chromosomal compartment. This distinct pattern of pSerSTAT4 during mitosis is seen in vitro in human keratinocytes and in other cell types. This is also present in vivo in cells undergoing mitosis in normal skin, psoriasis and squamous cell carcinoma.

Inhibition of STAT4 phosphorylation by lisofylline and depletion of STAT4 by RNA interference results in a delay in progression of mitosis and leads to a reduction in cells completing cytokinesis.

Conclusion

Our data demonstrate that STAT4 plays a role in enabling the normal and timely division of cells undergoing mitosis.

http://ift.tt/2rhraIv

Alopecia Areata – hyperactivity of the hypothalamic-pituitary-adrenal axis is a myth?

Abstract

Introduction

Psychological stress is known to cause exacerbation of different skin pathologies including alopecia areata (AA). A hyperactivity of the HPA axis in patients affected by AA (AA-patients) was proposed to be a neuroendocrine response to stress. Still little is known about MSH and cortisol production in AA settings.

Aim

The aim of the study was to compare trends in a production of melanocyte-stimulating hormone (MSH) and cortisol in patients with AA-patients and healthy controls.

Material and methods

Plasma concentrations of free cortisol and MSH were measured in forty-three AA-patients (35.5±10.6 years) and thirty-seven healthy subjects (35.9±10.5 years) selected from the Dermatology Outpatient Clinic in Katowice at Silesian School of Medicine in Poland. Results were submitted to statistical analysis with W Szapiro-Wilk test and subsequently nonparametric (U Mann-Whitney test) or parametric (t-Student test) statistics were performed.

Results

Mean plasma level of MSH was 5.39 ng/ml in AA-patients and 5.71 ng/ml in healthy controls. The difference between groups was nonsignificant (p=0.435), but the control group manifested higher values of MSH (Q75=13.6 ng/ml vs Q75=5.98 ng/ml) and this tendency was especially stronger in females. AA-patients had greater mean plasma level of cortisol (157,63 ± 91.16 μg/l) than healthy controls (123.32 ± 71.28 μg/l), however the difference between them was also nonsignificant (p=0.063). No sex-dependent tendency to a greater production of cortisol was found.

Conclusions

Expectations of disturbances in production of MSH and cortisol were not fulfilled. Neither MSH nor cortisol plasma levels appear to be clearly changed in AA-patients.

http://ift.tt/2pWcsCS

A novel homozygous DOCK8 mutation associated with unusual coexistence of gross molluscum contagiosum and epidermodysplasia verruciformis in a DOCK8 deficiency patient

Abstract

Dedicator of cytokinesis 8 (DOCK8) deficiency is a primary immunodeficiency, caused by biallelic loss-of-function mutations in the DOCK8 gene, often leading to severe viral infections, but do not usually have epidermodysplasia verruciformis (EV).^1,2 Here we report a Chinese patient with unusual coexistence of gross generalized molluscum contagiosum (MC) and EV.

http://ift.tt/2rhDF6Z

Doxycycline As An Anti-Inflammatory Agent: Updates in Dermatology

Abstract

Doxycycline, a tetracycline antibiotic, is widely used in the field of dermatology for its antibiotic properties, anti-inflammatory properties and good safety profile.

Over the past decades, numerous studies have clarified some of the anti-inflammatory mechanisms of doxycycline. In this review article, we aimed to provide an update on recent data on the anti-inflammatory properties of doxycycline and its potential role in cutaneous inflammatory diseases. Better understanding of these mechanisms might offer the practicing clinicians a better use of this therapeutic tool. In addition, research in this field could help clarify pathogenic aspects of inflammatory dermatologic diseases responsive to this medication.

Further research is needed to fully elucidate the potential of doxycycline as an anti-inflammatory agent and the development of new topical vehicles could open ways to new therapeutic possibilities for dermatologists.

http://ift.tt/2pW6Vfn

Telemedicine in dermatology: findings and experiences worldwide – a systematic literature review

Abstract

Telemedicine has become an important element of health care in many countries and profited from the technological progress of the last two decades. Due to the visual character of the dermatological specialty, teledermatology in particular participated in that development and is becoming a major tool in dermatological consultation.

The objective of this article was to identify the use of teledermatology across the world based on published original articles. A systematic literature search of the Medline and Embase databases for eligible publications (predefined inclusion and exclusion criteria) and a cross-validation search were conducted. Search results were reviewed systematically.

The search resulted in 204 publications meeting the inclusion criteria for analysis. The highest number of published studies on teledermatology was performed in the USA, followed by the United Kingdom, Spain, the Netherlands, Italy and Austria. The majority of dermatological indications for telemedical consultations were not specified or included various kinds of skin diseases, followed by skin cancer and wounds. Research questions predominantly focused on concordance, effectiveness and cost-effectiveness in order to determine the value. Teledermatology proved to be a reliable consultation tool in the majority of studies. If specified, telemedicine was used in daily dermatological routine for patient management purposes, to consult patients in peripheral locations, or for medical support in nursing homes or home care settings.

The application of teledermatology worldwide is highest in North American and European countries while countries with poor geographical distribution of physicians seem to be underrepresented in teledermatological use, as concluded from publication output. Regarding indications, comparison with classic consultation and area of application, most studies were of general nature. For precise determination of the value, systematic studies would be needed. However, teledermatology is already accepted as a valid tool.

http://ift.tt/2rhnXIM

Novel mutation of OCRL1 in Lowe syndrome with multiple epidermal cysts

http://ift.tt/2pWrNmM

Retention of pigment stem cells in Rhododenol-induced leukoderma: Pathological investigation of 11 patients

http://ift.tt/2rhFvES

Αρχειοθήκη ιστολογίου

Πέμπτη 18 Μαΐου 2017

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