Head and Neck Medicine by Alexandros G.Sfakianakis: 05/25/17

Πέμπτη 25 Μαΐου 2017

Primary Cutaneous B-Cell Lymphoblastic Lymphoma Arising from a Long-Standing Lesion in a Child and Review of the Literature

Abstract

Precursor B-cell lymphoblastic lymphoma (B-LBL) is a rare entity and primary cutaneous B-LBL is an even more uncommon diagnosis that typically affects children. A 4-year-old boy presented with a persistent rash on his left cheek for almost 2 years and was found to have primary cutaneous B-LBL. We report this case to emphasize that B-LBL should be in the differential diagnosis for an otherwise unimpressive persistent lesion in the head and neck region and review all reported pediatric cases of primary cutaneous B-LBL without extracutaneous involvement.

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Lymphocytic Thrombophilic Arteritis: A Possible Association with Minocycline

Abstract

We describe a case of lymphocytic thrombophilic arteritis in a 15-year-old girl who had previously taken minocycline for a year. Cutaneous polyarteritis nodosa and lymphocytic thrombophilic arteritis share many features and may both be triggered by minocycline. There may be a long latency between drug exposure to minocycline and development of disease.

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Food transit duration is associated with the number of stage II transport cycles when eating solid food

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Takashi Hiraoka, Jeffrey B. Palmer, Martin B. Brodsky, Mitsumasa Yoda, Haruhi Inokuchi, Akio Tsubahara
ObjectiveWhen eating solids, stage II transport (St2Tr) propels triturated food into the pharynx for bolus formation and storage before swallowing. Although the existence of St2Tr is acknowledged, the reason for its existence remains unclear. Understanding it may facilitate development of food appropriate for individuals with dysphagia. The purpose of this study was to explore how measures of duration of eating and swallowing affect the number of St2Tr cycles.DesignVideofluorography was performed on 13 healthy subjects eating 6-g squares of banana, tofu, and cookies. Measurements included the number of St2Tr cycles, duration of processing (from food entering the mouth to onset of swallowing), pre-upper esophageal sphincter (UES) transit duration (from onset of swallowing to onset of UES transit), UES transit duration (leading edge to trailing edge passing the UES), and total sequence duration (from onset of swallowing to terminal swallow). Principal component (PC) analysis was used to identify factors affecting the number of St2Tr cycles. Analysis of covariance was performed using the 1st PC as an independent variable for predicting the number of St2Tr cycles.ResultsAll four duration measures were significantly positively correlated with the number of St2Tr cycles. Analysis revealed two orthogonal PCs with variable loading. The 1st PC was a function of the timing variables. The 2nd PC was a function of the number of swallows.ConclusionsThe number of St2Tr cycles was associated with measures of food transit duration and was greater with harder foods before processing and more viscous foods just before swallowing.

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Food transit duration is associated with the number of stage II transport cycles when eating solid food

Flu-like illness, fever, malaise and chills, followed by severe nonpleuritic chest pain and shortness of breath

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

6948891480

alsfakia@gmail.com

13. Akademia Dermatologii i Alergologii Słupsk − Ustka − Dolina Charlotty 09−12 lutego 2017 roku

Publication date: Available online 24 May 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Maciej Kaczmarski

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A Story in Black and White

Strong engagement from expert radiologists is essential in ensuring the optimal function of a multidisciplinary group focused on the treatment of head and neck cancer. Active participation in multidisciplinary conference can be among the most rewarding roles for radiologists. Despite many benefits to radiologist involvement in multidisciplinary teams, there are obstacles and challenges that can prevent full participation. This article highlights the key issues that should be considered by radiologists and multidisciplinary team leaders when planning participation in a new or existing multidisciplinary group that focuses on the care of patients with head and neck cancer.

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Effectiveness of hemostatic gelatin sponge as a packing material after septoplasty: A prospective, randomized, multicenter study

Publication date: Available online 25 May 2017
Source:Auris Nasus Larynx
Author(s): Sung-Dong Kim, Sung-Lyong Hong, Min-Jung Kim, Joo-Yeon Kim, Yong-Wan Kim, Soo-Kweon Koo, Kyu-Sup Cho
ObjectiveAlthough hemostatic gelatin sponge is a gelatin-based packing material with a powerful hemostatic effect, there were no studies in regard to its efficacy for packing material after septoplasty. The purpose of this study was to investigate the efficacy of hemostatic gelatin sponge nasal packing on patient's subjective symptoms, hemostasis, and wound healing following septoplasty.Subjects and methodsSeventy six adult patients with nasal septum deviation requiring septoplasty were included. Following surgery, one nasal cavity was packed with hemostatic gelatin sponge and the other one with polyvinyl acetate. Patients' subjective symptoms while the packing was in situ, hemostatic properties, patients' pain on removal, degree of bleeding on removal of the packing, time for hemostasis after removal, postoperative wound healing, and the cost of the pack were evaluated.ResultsBoth packs were equally effective in the control of postoperative bleeding following septoplasty. However, hemostatic gelatin sponge packing was significantly more comfortable while in situ and less painful on removal of the pack. The polyvinyl acetate packing was associated with significantly more bleeding on removal, therefore much time was needed to control hemorrhage. There was no significant difference in the cost of the pack used and outcome of wound healing.ConclusionThe use of hemostatic gelatin sponge after septoplasty results in significantly less discomfort and greater patient satisfaction with no adverse reactions when compared with polyvinyl acetate packing. Therefore, hemostatic gelatin sponge may be a useful packing material after septoplasty.

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Evaluation of Penicillin Allergy in the Hospitalized Patient: Opportunities for Antimicrobial Stewardship

Abstract

Purpose of Review

Penicillin allergy is often misdiagnosed and is associated with adverse consequences, but testing is infrequently done in the hospital setting. This article reviews historical and contemporary innovations in inpatient penicillin allergy testing and its impact on antimicrobial stewardship.

Recent Findings

Adoption of the electronic medical record allows rapid identification of admitted patients carrying a penicillin allergy diagnosis. Collaboration with clinical pharmacists and the development of computerized clinical guidelines facilitates increased testing and appropriate use of penicillin and related β-lactams. Education of patients and their outpatient providers is the key to retaining the benefits of penicillin allergy de-labeling.

Summary

Penicillin allergy testing is feasible in the hospital and offers tangible benefits towards antimicrobial stewardship. Allergists should take the lead in this endeavor and work towards overcoming personnel limitations by partnering with other health care providers and incorporating technology that improves the efficiency of allergy evaluation.

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Middle ear adenomatous neuroendocrine tumors: a 25-year experience at MD Anderson Cancer Center

Abstract

Neuroendocrine tumors are extremely rare in the middle ear. We reviewed our institutional experience with middle ear adenomatous neuroendocrine tumors (MEANTs). We searched our institution's pathology files to identify patients treated from 1990 to 2015 who had lesions classified as middle ear adenomas, adenomatous tumors, adenomatous tumors with neuroendocrine differentiation, carcinoid tumors of the middle ear, low-grade neuroendocrine tumors of the middle ear, and neuroendocrine carcinomas of the middle ear and identified 14 such patients for whom follow-up information was available. Herein, we review the pathology and differential diagnosis of these patients' tumors and discuss the management and follow-up of these patients. Our report adds to the series cases of MEANTs with recurrences, lymph node involvement, distant metastases, and tumor-related deaths. Our experience suggests that, although these tumors have long been considered to be low-aggression neoplasms, long-term follow-up studies to ascertain this supposed benignity are warranted.

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Évaluation fonctionnelle du traitement de l’insuffisance glottique par injection d’acide hyaluronique : étude rétrospective à propos de 20 cas

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): C. Dorbeau, F. Marmouset, E. Lescanne, D. Bakhos, S. Morinière
ObjectifsDécrire la technique d'injection de l'acide hyaluronique dans les plis vocaux pour traiter une insuffisance glottique, en évaluer les indications ainsi que les résultats vocaux à 1 mois, et au-delà de 6 mois postopératoires.Patients et méthodesÉtude monocentrique rétrospective de mars 2012 à août 2015. Les critères d'inclusion étaient : paralysie récurrentielle unilatérale ou défaut d'affrontement cordal à mobilité conservée. Les critères d'exclusion étaient : thyroplastie préalable, troubles de déglutition majeurs, troubles cognitifs gênant l'évaluation vocale subjective. L'injection de Restylane^® était réalisée sous anesthésie générale ou locale. On évaluait le Voice Handicap Index (VHI), le temps maximum phonatoire (TMP) et le score GRBAS en préopératoire, puis à 1, et plus de 6 mois postopératoires.RésultatsVingt patients ont été inclus, 14 avaient une paralysie récurrentielle unilatérale et 6 un défaut d'affrontement. L'injection de Restylane^® a été faite sous anesthésie générale pour 16 patients et sous anesthésie locale pour 4 (20 %). À 1 mois postopératoire, on retrouvait une diminution significative du VHI (–36 points, p=0,0001) et du GRBAS (–6,95 points, p=0,0001) et une augmentation significative du TMP (+4,95sec, p=0,0001). À 6 mois, le VHI, le TMP et le GRBAS étaient toujours significativement améliorés (respectivement p=0,0002, p=0,001 et p=0,0001) ; et il n'y avait pas de différence significative entre VHI, TMP et GRBAS à 1 et 6 mois. Trois patients ont présenté une complication mineure, et deux patients ont récupéré une mobilité cordale normale.ConclusionL'injection d'acide hyaluronique est une technique efficace pour la prise en charge des insuffisances glottiques. Elle permet une amélioration des paramètres vocaux objectifs et subjectifs qui reste satisfaisante même à 6 mois du geste.

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Laryngectomie et pharyngo-laryngectomie totale première dans les cancers pharyngolaryngés de stade T4 : résultats carcinologiques et fonctionnels et facteurs pronostiques

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): M. Roux, O. Dassonville, M. Ettaiche, E. Chamorey, G. Poissonnet, A. Bozec
ObjectifsLes objectifs de cette étude étaient d'évaluer les résultats carcinologiques et fonctionnels de la laryngectomie ou pharyngo-laryngectomie totale (PLT) première pour cancer du larynx ou de l'hypopharynx avec extension tumorale extra-laryngée (T4), ainsi que de déterminer les facteurs prédictifs de ces résultats.Matériel et méthodesAnalyse rétrospective des dossiers informatisés de tous les patients ayant bénéficié d'une (P)LT première pour un carcinome épidermoïde du larynx ou de l'hypopharynx de stade T4 dans notre institution entre 2000 et 2014. Les facteurs prédictifs des résultats carcinologiques et fonctionnels ont été recherchés en analyse univariée et multivariée.RésultatsAu total, 63 patients (58 hommes et 5 femmes) d'âge moyen égal à 68,8±9,7 ans ont été inclus dans cette étude. Les survies globale et spécifique étaient de 69 % et 80 % à 3 ans et de 56 % et 69 % à 5 ans respectivement. En analyse multivariée, le sexe féminin (p<0,001), le score ASA (ASA≥3 ; p=0,006) et la présence d'emboles vasculaires (p=0,006) avaient un impact significatif péjoratif sur la survie globale. Six mois après la fin du traitement, 90 % des patients avaient retrouvé une alimentation orale autonome et 83 % de ceux appareillés d'une prothèse phonatoire avaient récupéré une voix intelligible.ConclusionLa (P)LT première reste le traitement de référence des cancers de stade T4 du larynx et de l'hypopharynx. Elle permet d'obtenir des résultats carcinologiques et fonctionnels satisfaisants.

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Tumeurs desmoïdes cervico-faciales de l’enfant : mise au point sur la prise en charge

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): M. Risoud, G. Mortuaire, X. Leroy, P. Leblond, P. Fayoux
ObjectifLes tumeurs desmoïdes cervico-faciales de l'enfant sont des tumeurs rares à agressivité locale potentiellement létales. L'objectif est de discuter la prise en charge de ces tumeurs à partir d'une série de cas et de l'analyse de la littérature.Matériel et méthodesL'étude rétrospective reprenait les données médicales des enfants traités pour tumeur desmoïde cervico-faciale entre 1976 et 2014.RésultatsSur les 6 enfants traités, 5 ont bénéficié d'une chirurgie d'exérèse large dont 2 avaient une invasion microscopie des berges (R1) avec récidive nécessitant une nouvelle exérèse. Un enfant présentant une lésion trop étendue a bénéficié d'une chimiothérapie par méthotrexate et vinorelbine hebdomadaire pendant 18 mois, permettant une régression du volume lésionnel de 93 % sans récidive.ConclusionsLes tumeurs desmoïdes cervico-faciales de l'enfant sont plus agressives que chez l'adulte, avec une morbi-mortalité élevée et un taux élevé de récidive. Un bilan d'imagerie par scanner et IRM est préférable avant biopsie. Bien qu'efficace chez l'adulte, la radiothérapie externe doit être évitée chez l'enfant compte tenu d'une moins bonne efficacité que chez l'adulte, et des séquelles esthétiques, fonctionnelles voire néoplasiques qu'elle comporte à long terme. Le traitement est chirurgical à chaque fois qu'une exérèse radicale large est possible. En cas de risque vital ou fonctionnel trop important, une chimiothérapie sans effet indésirable à long terme (type méthotrexate associé à un vinca-alcaloïde) pourra être proposée. Un suivi prolongé doit être réalisé compte tenu du risque de récidives.

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L’effet de l’insuffisance rénale chronique non diabétique sur la fonction olfactive

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): S. Koseoglu, S. Derin, B. Huddam, M. Sahan
ObjectifsDans l'insuffisance rénale chronique (IRC), la détérioration de la filtration glomérulaire résulte de l'accumulation de métabolites dans le corps, qui affecte tous les organes. Cette étude a été réalisée pour étudier les fonctions olfactives, et déterminer si l'hémodialyse ou la dialyse péritonéale améliore l'odorat chez les patients atteints d'IRC non diabétiques.Matériel et méthodesL'odorat a été analysé chez des patients atteints d'IRC ayant une créatininémie≥2mg/dL et non dialysés, chez des patients atteints d'IRC hémodialysés ou sous dialyse péritonéale, et chez des témoins sains. Les patients diabétiques ont été exclus puisque le diabète à lui seul est une cause de dysfonctionnement olfactif. L'échantillon étudié se composait d'un total de 107 personnes, dont 38 patients atteints d'IRC sous hémodialyse, 15 patients atteints d'IRC sous dialyse péritonéale, 30 patients avec une créatininémie≥2mg/dL sans nécessité de dialyse, et 24 témoins sains avec une fonction rénale normale. L'odorat a été analysé à l'aide du test Sniffin' Stick, et les groupes ont été comparés sur leurs résultats au test.RésultatsTous les paramètres du test Sniffin' Stick ont été altérés chez les patients atteints d'IRC. Les scores médians TDI des patients atteints d'IRC et des sujets sains étaient de 24,75 (13–36) et de 32,5 (27,7–37,75), respectivement, avec une différence statistiquement significative entre les deux (p<0,001). Les fonctions olfactives chez les patients en dialyse étaient meilleures que chez ceux atteints d'IRC non dialysés (p=0,020).ConclusionL'IRC non diabétique affecte négativement les fonctions olfactives. La dialyse améliore l'odorat chez ces patients.

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Efficacité de la radiothérapie « volumetric modulated arc therapy » dans les cancers épidermoïdes ORL : données de la « vraie vie »

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): C. Moncharmont, A. Vallard, J.-B. Guy, J.-M. Prades, C. Rancoule, N. Magné
ObjectifsIl existe peu de données concernant l'efficacité de la radiothérapie en modulation d'intensité volumétrique par arc thérapie (VMAT), délivrée dans le cadre du traitement des cancers épidermoïdes (CE) ORL. L'objectif était d'étudier les résultats et les modes de récidive des patients traités par VMAT à l'encontre d'un CE ORL localement avancé.MéthodesLes données de tous les patients, traités en intention curative par VMAT à l'encontre d'un CE ORL stade III ou IV, ont été rétrospectivement étudiées.RésultatsEntre 2010 et 2013, 130 patients furent traités pour un CE localement avancé de l'oropharynx (n=55 ; 42 %), de l'hypopharynx (n=38 ; 29 %), du larynx (n=22 ; 17 %), ou de la cavité buccale (n=15 ; 12 %). L'âge médian était de 60 ans (39–85). La durée de suivi médiane était de 18,1 mois (0–43,7). À la fin du suivi, 60 patients étaient décédés (46 %). La survie sans progression (SSP) et la survie globale (SG) à 2 ans étaient de 63,6 % et 77,3 % pour les tumeurs laryngées, 60 % et 60 % pour les tumeurs de la cavité buccale, 52,6 % et 57,6 % pour les tumeurs oropharyngées, et 38,8 % et 54,7 % pour les tumeurs hypopharyngées. La plupart des récidives étaient situées dans les champs, ou en bordure de champs de la radiothérapie.ConclusionCette analyse rétrospective est, à notre connaissance, la plus large étude s'intéressant à l'efficacité du VMAT dans les CE ORL. Les résultats et les modes de récidive constatés semblent concorder avec ceux rapportés en radiothérapie conformationnelle par modulation d'intensité (IMRT).

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Editorial Board

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3

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Troubles de l’équilibre post-traumatique

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): M. Elzière, A. Devèze, C. Bartoli, G. Levy
Les causes responsables de troubles de l'équilibre sont multiples et le syndrome subjectif des traumatisés crâniens reste un diagnostic d'élimination. Néanmoins, avec l'avancée des différentes explorations fonctionnelles oto-neurologiques et de l'imagerie cérébrale, il est maintenant possible d'objectiver le plus souvent cette plainte fonctionnelle. Ces dernières années, de nouveaux diagnostics ont été mis en évidence, ce qui a permis une meilleure reconnaissance de ces pathologies dans le domaine de la réparation du dommage corporel. Nous tenterons de préciser l'ensemble de ces étiologies et de déterminer, grâce à une synthèse de la littérature, les éléments pertinents pouvant modifier la prise en charge de ces patients, particulièrement dans le domaine expertal.

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Fonctionnement du système tubotympanique

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): C. Martin, A. Karkas, J.-M. Prades
La trompe d'Eustache (tube auditif) et les cavités tympanomastoïdiennes forment un ensemble anatomique et fonctionnel difficilement dissociable, d'où l'appellation « système tubotympanique ». L'étude de ce système a fait l'objet de nombreux travaux dont les résultats complexes et parfois contradictoires rendent difficile une vue d'ensemble de son fonctionnement. L'objectif cet article est d'en synthétiser les connaissances actuelles, préalable indispensable à la compréhension de son dysfonctionnement et notamment de la genèse de l'otite chronique. L'ensemble du système est tapissé par une muqueuse qui en assure la continuité, bien qu'elle comporte certaines particularités selon la zone concernée, et y joue un rôle primordial. Ainsi, dans des conditions physiologiques, la diffusion gazeuse à travers la muqueuse tympanomastoïdienne assure l'essentiel de l'équilibre pressionnel régnant entre l'oreille moyenne (OM) et le monde extérieur, l'ouverture tubaire n'intervenant que très peu. Lors des changements rapides et importants de la pression atmosphérique, la fonction ventilatoire de la trompe est alors mise en jeu, sous l'effet d'un mécanisme réflexe. Le système possède en outre d'autres fonctions indispensables au bon fonctionnement de l'OM, une fonction de protection vis-à-vis des sécrétions et agents pathogènes en provenance du rhinopharynx, mais aussi de certains bruits physiologiques, une fonction de clairance des cavités de l'OM dépendant du transport mucociliaire des pathogènes, liée en partie à la sécrétion des glandes sous-muqueuses et une fonction de défense immunitaire.

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Recommandation de la SFORL. Prise en charge des épistaxis de l’adulte en première intention

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): E. Bequignon, B. Vérillaud, L. Robard, J. Michel, V.P. Escabasse, L. Crampette, O. Malard
ObjectifLes auteurs exposent les recommandations de la Société française d'oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant la prise en charge des épistaxis en première intention.MéthodesÀ partir d'une revue de la littérature scientifique par un groupe de travail multidisciplinaire, des recommandations ont été rédigées, fondées sur les articles et l'expérience individuelle des membres, puis relues par un groupe de lecture indépendant afin d'aboutir au texte de synthèse. Les recommandations proposées ont été classées en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique décroissant.RésultatsEn première intention, le mouchage, le nettoyage des fosses nasales et une compression bidigitale sont recommandés. En cas de saignement persistant, l'anesthésie locale avec vasoconstriction précède les gestes nasaux à visée diagnostique et thérapeutique. Quand l'origine des saignements n'est pas antérieure, l'endoscopie est essentielle, et localise l'origine des saignements dans la plupart des cas. En cas de saignement actif, une cautérisation est réalisée si le site de saignement est identifié. S'il n'est pas visualisé ou si échec des premières mesures, un tamponnement antérieur pourra être réalisé par un médecin non spécialiste ORL. La survenue d'une épistaxis impose, au décours, la réalisation d'une endoscopie des fosses nasales par un médecin ORL. Les patients doivent être informés des gestes à réaliser en cas d'épistaxis à domicile et des risques des différents traitements.

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Recommandation de la SFORL. Prise en charge des épistaxis de l’adulte en deuxième intention

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): B. Verillaud, L. Robard, J. Michel, V. Prulière Escabasse, E. Béquignon, L. Crampette, O. Malard
ObjectifLes auteurs exposent les recommandations de la Société française d'oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant la prise en charge des épistaxis en deuxième intention, c'est-à-dire après échec du tamponnement antérieur et/ou du tamponnement antéro-postérieur.MéthodesUn groupe de travail multidisciplinaire a été chargé d'effectuer une revue de la littérature scientifique sur la thématique étudiée. À partir de ces textes et de l'expérience de chacun, des recommandations ont été rédigées, puis relues par un groupe de lecture indépendant du groupe de travail. Une réunion de synthèse a permis d'aboutir au texte final. Les recommandations proposées ont été classées en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique décroissant.RésultatsIl est recommandé que l'embolisation artérielle soit effectuée par un neuroradiologue expérimenté disposant d'un plateau technique dédié et du matériel adapté afin de limiter le risque de complications. Il est recommandé d'effectuer une angio-TDM du crâne et des TSA avant embolisation dans le cas d'une épistaxis post-traumatique avec suspicion de lésion de l'artère carotide interne. En cas d'épistaxis persistante malgré l'hémostase endoscopique sphéno-palatine, il est recommandé d'effectuer l'hémostase de l'artère ethmoïdale antérieure par voie canthale interne, avec éventuellement une progression assistée par l'endoscope. Il est recommandé en cas d'épistaxis résistante aux procédures chirurgicales et neuroradiologiques habituelles d'effectuer une exploration chirurgicale des fosses nasales et de l'ethmoïde, avec une coagulation élective en cas de saignement en provenance d'une branche artérielle secondaire, voire une ethmoïdectomie en cas de saignement non systématisé. Un arbre décisionnel a été élaboré pour orienter la stratégie thérapeutique de prise en charge d'une épistaxis en deuxième intention.

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Recommandation de la SFORL. Prise en charge des épistaxis dans le cadre des troubles de la coagulation liés aux antithrombotiques

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): V. Escabasse, E. Bequignon, B. Vérillaud, L. Robard, J. Michel, O. Malard, L. Crampette
ObjectifLes auteurs exposent les recommandations de la Société française d'oto-rhino-laryngologie concernant la prise en charge des épistaxis liés aux traitements antithrombotiques.MéthodesUne revue de la littérature scientifique a été effectuée par un groupe de travail multidisciplinaire. À partir de ces textes, des recommandations ont été rédigées, puis relues par un groupe de lecture indépendant du groupe de travail afin d'aboutir au texte final. Les recommandations proposées ont été classées en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique décroissant.RésultatsAvant toute décision de modification du traitement antithrombotique, il est recommandé de rechercher un surdosage et d'évaluer le risque thrombotique. Chez un patient porteur d'un stent, la bi-antiagrégation doit être maintenue durant le mois suivant la pose du stent et si possible pendant 3 mois. En cas d'épistaxis contrôlée par tamponnement avec un surdosage en antivitamine K (AVK), les mesures correctives sont fonction de l'INR. En cas d'épistaxis non contrôlée, il est recommandé d'arrêter les AVK, d'administrer des antidotes et de suivre régulièrement l'évolution de l'INR. En cas d'embolisation par voie endovasculaire, il n'est pas recommandé de modifier le traitement par anticoagulant.

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Comment libérer les évidements : rôle du triangle inter-spino-jugulaire

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): S. Périé, M. Lesnik, S. Samaha, J. Lacau St Guily
La technique des évidements ganglionnaires cervicaux est bien codifiée. Elle permet l'exérèse des groupes ganglionnaires, qui comporte au moins les groupes IIa, IIb, III et IV selon la classification de Robbins pour les cancers des voies aérodigestives supérieures. L'évidement est classiquement réalisé de bas en haut et d'arrière en avant, mais varie en fonction de la localisation des adénopathies. Pour permettre de faciliter l'évidement du groupe IIb, sans traction sur le nerf spinal accessoire, et le contrôle précoce de la veine jugulaire interne en haut, cette libération de la veine facilitant aussi la dissection ultérieure du tronc thyro-linguo-facial et le repérage du XII, le rôle pivot de la libération du triangle inter-spino-jugulaire au début de l'évidement cervical est décrit. La littérature ne distingue pas cette dissection spécifique et son importance. Ce triangle constitue la partie postérieure du groupe IIa, mais est intimement lié anatomiquement à la libération du groupe IIb.

http://ift.tt/2qhuiUY

Kératoaméloblastome mandibulaire

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): S. Anajar, A. Lakhbal, R. Allah Abada, M. Mahtar
IntroductionLe kératoaméloblastome est une tumeur odontogène extrêmement rare, 18 cas seulement ont été rapportés dans la littérature.ObservationNous rapportons un cas de kératoaméloblastome chez une patiente âgée de 32 ans, avec revue de la littérature sur les caractéristiques cliniques, l'aspect radiologique, les résultats histopathologiques et les options de traitement.DiscussionLe kératoaméloblastome est une tumeur rare observée plus fréquemment chez l'homme (sex-ratio de 3:1) et caractérisée par la production de kératine dans les îlots odontogéniques ainsi que dans le stroma fibreux.

http://ift.tt/2r1rfxi

Goitre ectopique parapharyngé gauche coexistant avec une thyroïde eutopique et syndrome de Claude Bernard-Horner postopératoire

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): W. Foma, E. Pegbessou, B. Amana, E. Kpemissi
IntroductionLe but de cette observation est de rapporter un cas de goitre ectopique parapharyngé gauche dont l'exérèse a été marquée par un syndrome de Claude Bernard-Horner postopératoire tout en relevant les difficultés de prise en charge.ObservationIl s'agissait d'une femme de 25 ans, qui a consulté pour dysphagie haute et qui présentait une masse parapharyngée gauche bien limitée refoulant les gros vaisseaux en dehors et en arrière. Une cervicotomie exploratrice a permis l'exérèse de cette masse. L'examen anatomopathologique de la pièce a noté un parenchyme thyroïdien hyperplasique. Le contrôle postopératoire a montré une glande thyroïde eutopique et euthyroïdienne. Les suites opératoires ont été marquées par un syndrome de Claude Bernard-Horner persistant avec un an de recul.DiscussionL'ectopie thyroïdienne parapharyngée coexistant avec une thyroïde fonctionnelle est extrêmement rare. Les masses parapharyngées sont le plus souvent d'origine parotidienne et nerveuse. La chirurgie de l'espace parapharyngé peut entraîner une lésion du sympathique cervical à l'origine du syndrome de Claude Bernard-Horner, comme chez notre patiente.ConclusionL'ectopie thyroïdienne devrait être évoquée dans le diagnostic des masses de l'espace parapharyngé. Bien que rare, le syndrome de Claude Bernard-Horner est à redouter dans la chirurgie de ces masses.

http://ift.tt/2qhBoZt

Plaques érythémateuses sur le pavillon de l’oreille

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): G. Serarslan, C. Arlı, E. Atik

http://ift.tt/2qhpf72

Leishmaniose laryngée, une manifestation rare d’une maladie émergente

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): L. Silva, E. Damrose, A.-M.-F. Fernandes

http://ift.tt/2r1BEZR

Success rate and complications associated with dental implants in the incisive canal region: a systematic review

A systematic review was conducted to evaluate the success rate of dental implants placed in the incisive canal region and the complications related to this procedure. An electronic search was performed in the PubMed, Scopus, and Web of Science databases. Articles reporting the incisive canal deflation technique or neurovascular bundle lateralization technique, with or without concomitant dental implant installation and grafting procedures, were evaluated. Ten articles met the inclusion criteria; only one retrospective study and one longitudinal clinical trial were found.

http://ift.tt/2qhaBwJ

A new approach of splint-less orthognathic surgery using a personalized orthognathic surgical guide system: A preliminary study

The purpose of this study was to evaluate a personalized orthognathic surgical guide (POSG) system for bimaxillary surgery without the use of surgical splint. Ten patients with dentofacial deformities were enrolled. Surgeries were planned with the computer-aided surgical simulation method. The POSG system was designed for both maxillary and mandibular surgery. Each consisted of cutting guides and three-dimensionally (3D) printed custom titanium plates to guide the osteotomy and repositioning the bony segments without the use of the surgical splints.

http://ift.tt/2r1BpOr

Correction

Reich K, Leonardi C, Langley RG, et al. Inflammatory bowel disease among patients with psoriasis treated with ixekizumab: A presentation of adjudicated data from an integrated database of 7 randomized controlled and uncontrolled trials. J Am Acad Dermatol. 2017:76:441-448.e2.

http://ift.tt/2qhHsBp

Infiltrative local anesthesia with articaine is equally as effective as inferior alveolar nerve block with lidocaine for the removal of erupted molars

Abstract

Aim

The aim of this study is to assess the efficacy of 4% articaine with 1:100,000 adrenaline given as buccal and lingual infiltration in adult patients undergoing erupted mandibular first and second molar teeth extraction versus inferior alveolar nerve block technique using 2% lignocaine with 1:80,000 adrenaline.

Materials and methods

A total of 100 patients undergoing extraction of mandibular posterior teeth were divided into two equally matched groups for the study, out of which 50 patients were given 4% articaine with 1:100,000 adrenaline as buccal and lingual infiltration and 50 patients were given 2% lignocaine with 1:80,000 adrenaline using classic direct inferior alveolar nerve block with lingual and buccal nerve block. Efficacy of anesthesia was determined using a numeric analog scale (NAS) ranging from 0 indicating no pain to 10 indicating the worst pain imaginable. The NAS was taken by a different operator to avoid bias.

Results

The pain scores in both groups were analyzed using the Mann–Whitney U test, and a p value of 0.338 was obtained which is not statistically significant. Hence, no significant difference in the pain score was established between both groups. The adverse effects of both the local anesthetics if any were noted.

Conclusion

From this study, we concluded that the use of 4% articaine with 1:100,000 adrenaline is as effective as inferior alveolar nerve block with lignocaine but without the risk of attendant adverse effects of inferior alveolar nerve block technique.

http://ift.tt/2qhNd1R

Malignant external otitis: The shifting treatment paradigm

Malignant external otitis (MEO) is an aggressive infection occurring in immunocompromised hosts. Increasing antimicrobial resistance is making the disease more difficult to treat.

http://ift.tt/2r1u0i5

Effectiveness of hemostatic gelatin sponge as a packing material after septoplasty: A prospective, randomized, multicenter study

Although hemostatic gelatin sponge is a gelatin-based packing material with a powerful hemostatic effect, there were no studies in regard to its efficacy for packing material after septoplasty. The purpose of this study was to investigate the efficacy of hemostatic gelatin sponge nasal packing on patient's subjective symptoms, hemostasis, and wound healing following septoplasty.

http://ift.tt/2rVY92f

Delayed type of allergic skin reaction to Candida albicans in eosinophilic rhinosinusitis cases

Eosinophilic chronic rhinosinusitis (ECRS) is frequently complicated by asthma, and recognized as refractory and persistent rhinosinusitis. However, the detailed pathophysiology of ECRS has not been elucidated yet. In this study, we investigated the association between recurrent ECRS and intradermal testing to multi-antigens including Candida albicans.

http://ift.tt/2rmS2as

Retention systems for extraoral maxillofacial prosthetic implants: a critical review

We describe the techniques available for retention of implant-supported prostheses: bar-clips, O-rings, and magnets. We present reported preferences and, although this is limited by the heterogeneity of methods used and patients studied, we hope we have identified the best retention systems for maxillofacial prosthetic implants. If practitioners know the advantages and disadvantages of each system, they can choose the most natural and comfortable prosthesis. We searched the PubMed and Scopus databases, and restricted our search to papers published 2001–13.

http://ift.tt/2qlkRj7

Virtual planning of a composite model of bone and teeth to facilitate the adjustment of a hybrid distractor for the transport of alveolar bone

In recent years 3-dimensional computer planning in maxillofacial surgery has been widely used.1 Hammoudeh et al described stereolithographic modelling for the orientation of vectors when using a bone-to-bone distractor,2 but the method is not accurate enough for use with a hybrid distractor.

http://ift.tt/2rEUQ2n

Care of long-term survivors of head and neck cancer after treatment with oral or facial prostheses, or both

The current evidence of good practice in the delivery of long-term supportive care to patients who have been treated for head and neck cancer is sparse. We recruited 10 survivors so that we could follow their experience after their acute treatment was over. There were six men (mean (range) age 72 (54-86) years) and four women (mean (range) age 69 (67-73) years). After ethics committee approval had been given, we used structured interviews and questionnaires to investigate the impact of the resection and reconstruction, the patients' perceived needs, and their use of supportive care services.

http://ift.tt/2qkLZPC

Cell genomics and immunosuppressive biomarker expression influence PD-L1 immunotherapy treatment responses in HNSCC - a computational study

Publication date: Available online 25 May 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Amber M. Bates, Emily Lanzel, Fang Qian, Taher Abbasi, Shireen Vali, Kim A. Brogden
ObjectivesPD-L1 expression is correlated with objective responses rates (ORR) to PD-1 and PD-L1 immunotherapies. However, both immunotherapies have only demonstrated 12.0-24.8% ORR in patients with HNSCC showing a need for a more accurate method to identify those who will respond prior to their therapy. Immunohistochemistry to detect PD-L1 reactivity in tumors can be challenging and additional methods are needed to predict and confirm PD-L1 expression. Here, we hypothesized that HNSCC tumor cell genomics influences cell signaling and downstream effects on immunosuppressive biomarkers and that these profiles can predict patient clinical responses.Study DesignWe identified deleterious gene mutations in SCC4, SCC15, and SCC25 and created cell line-specific predictive computational simulation models. The expression of 24 immunosuppressive biomarkers were then predicted and used to sort cell lines into those that would or would not respond to PD-L1 immunotherapy.ResultsSCC15 and SCC25 were identified as cell lines that would respond to PD-L1 immunotherapy treatment and SCC4 was identified as a cell line that would not likely respond to PD-L1 immunotherapy treatment.ConclusionsThis approach, when applied to patient HNSCC cancer cells, has the ability to predict PD-L1 expression and predict PD-1 or PD-L1 targeted treatment responses in those patients.

http://ift.tt/2qhzKXQ

The effect of bone mass and architecture on mandibular condyle after mandibular distraction

Publication date: Available online 25 May 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Daisuke Suda, Atsushi Ohazama, Takeyasu Maeda, Tadaharu Kobayashi
ObjectiveMandibular distraction surgery is a critical treatment for jaw deformity. However abnormal mandibular condylar bone resorption is often seen as complication after surgery. Our previous study using a rat mandibular distraction model has suggested that over loading leads to mandibular condylar resorption. Host factors are also believed to influence the resorption. To understand the relationship between host factor and the resorption, we investigated the effect of changing bone mass and architecture on mandibular condyle using FK506.Study DesignAn immunosuppressant drug – FK506 – was used to compromise bone mass and architecture in this study. Animals were divided into four groups; distraction surgery (Dist), FK506 administration (FK), distraction surgery with FK506 administration (FK+Dist) and neither surgery nor FK506 administration (Cont).ResultsThe FK group showed reduced bone mass and impaired bone architecture. The Dist group exhibited abnormal bone resorption on the surface of the condyles, which was slightly exacerbated in the FK+Dist group. Bone defect length decreased over time due to bone apposition in the Dist group. However, the FK+Dist group maintained the bone defect length.ConclusionsThese results suggest that bone mass and architecture strongly affect the tolerance to the overloading and adaptation with bone apposition in condylar resorption site.

http://ift.tt/2r1di2d

Identifying high quality medical education websites in Otolaryngology: a guide for medical students and residents

Cole congênito, PF, deiscência tegmem e região petrosa

http://ift.tt/2r1yzsH

Identifying high quality medical education websites in Otolaryngology: a guide for medical students and residents

Abstract

Background

Learners often utilize online resources to supplement formalized curricula, and to appropriately support learning, these resources should be of high quality. Thus, the objectives of this study are to develop and provide validity evidence supporting an assessment tool designed to assess the quality of educational websites in Otolaryngology- Head & Neck Surgery (ORL-HNS), and identify those that could support effective web-based learning.

Methods

After a literature review, the Modified Education in Otolaryngology Website (MEOW) assessment tool was designed by a panel of experts based on a previously validated website assessment tool. A search strategy using a Google-based search engine was used subsequently to identify websites. Those that were free of charge and in English were included. Websites were coded for whether their content targeted medical students or residents. Using the MEOW assessment tool, two independent raters scored the websites. Inter-rater and intra-rater reliability were evaluated, and scores were compared to recommendations from a content expert.

Results

The MEOW assessment tool included a total of 20 items divided in 8 categories related to authorship, frequency of revision, content accuracy, interactivity, visual presentation, navigability, speed and recommended hyperlinks. A total of 43 out of 334 websites identified by the search met inclusion criteria. The scores generated by our tool appeared to differentiate higher quality websites from lower quality ones: websites that the expert "would recommend" scored 38.4 (out of 56; CI [34.4–42.4]) and "would not recommend" 27.0 (CI [23.2–30.9]). Inter-rater and intra-rater intraclass correlation coefficient were greater than 0.7.

Conclusions

Using the MEOW assessment tool, high quality ORL-HNS educational websites were identified.

http://ift.tt/2s0oFHb

A novel frameshift mutation of SMPX causes a rare form of X-linked nonsyndromic hearing loss in a Chinese family

by Zhijie Niu, Yong Feng, Lingyun Mei, Jie Sun, Xueping Wang, Juncheng Wang, Zhengmao Hu, Yunpeng Dong, Hongsheng Chen, Chufeng He, Yalan Liu, Xinzhang Cai, Xuezhong Liu, Lu Jiang

X-linked hearing impairment is the rarest form of genetic hearing loss (HL) and represents only a minor fraction of all cases. The aim of this study was to investigate the cause of X-linked inherited sensorineural HL in a four-generation Chinese family. A novel duplication variant (c.217dupA, p.Ile73Asnfs*5) in SMPX was identified by whole-exome sequencing. The frameshift mutation predicted to result in the premature truncation of the SMPX protein was co-segregated with the HL phenotype and was absent in 295 normal controls. Subpopulation screening of the coding exons and flanking introns of SMPX was further performed for 338 Chinese patients with nonsydromic HL by Sanger sequencing, and another two potential causative substitutions (c.238C>A and c.55A>G) in SMPX were identified in additional sporadic cases of congenital deafness. Collectively, this study is the first to report the role of SMPX in Chinese population and identify a novel frameshift mutation in SMPX that causes not only nonsyndromic late-onset progressive HL, but also congenital hearing impairment. Our findings extend the mutation and phenotypic spectrum of the SMPX gene.

http://ift.tt/2r0on3z

Research advances in Apert syndrome

Publication date: Available online 25 May 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Satrupa Das, Anjana Munshi
Apert syndrome is one of the several genetic syndromes associated with craniosynostosis, a condition that includes premature fusion of one or multiple cranial sutures. There has been significant clinical variation among different sutural synostoses and also within particular suture synostosis. Enormous progress has been made in identifying various mutations associated with Apert Syndrome. Although a causal gene has been defined, the precise role of this mutation in producing craniofacial dysmorphology and other related abnormalities is in the process of discovery. Most of the understanding regarding this rare disorder has been possible due to mouse models that have helped in deciphering the elements of this rare human disease. Thus, molecular and cellular understanding of the disease has taken a leap and further with the advent of technology definitive diagnosis of the syndrome is no more of an issue. In this review, we have discussed and consolidated the possible molecular studies that have contributed in understanding of this rare syndrome. This article may help clinicians and researchers to inform about the latest progress in Apert syndrome.

http://ift.tt/2rEc0NC

The W9 peptide directly stimulates osteoblast differentiation via RANKL signaling

Publication date: Available online 25 May 2017
Source:Journal of Oral Biosciences
Author(s): Midori Nakamura, Yuko Nakamichi, Toshihide Mizoguchi, Masanori Koide, Teruhito Yamashita, Toshiaki Ara, Hiroshi Nakamura, Josef M. Penninger, Yuriko Furuya, Hisataka Yasuda, Nobuyuki Udagawa
ObjectiveA RANKL-binding peptide, WP9QY (W9), is known to inhibit mouse osteoclastogenesis by stimulating the production of autocrine factors such as bone morphogenetic proteins (BMPs) to induce osteoblast differentiation. In the present study, we investigated whether osteoblastic differentiation is mediated by RANKL signaling.MethodsThe effect of W9 on the differentiation of osteoclasts and osteoblasts was examined in mouse bone-marrow cultures, and in a mouse co-culture system consisting of primary osteoblasts derived from RANKL-deficient or wild-type (WT) newborn mouse calvariae, with WT-derived bone marrow mononuclear cells.ResultsThe addition of the W9 peptide to the WT mouse bone-marrow culture simultaneously inhibited RANKL-induced tartrate-resistant acid phosphatase (TRAP)-positive osteoclast differentiation, and stimulated alkaline phosphatase (ALP)-positive osteoblastic calcified nodule formation. RANKL-deficient osteoblasts exhibited weak ALP activity compared to WT osteoblasts. W9 treatment strongly inhibited TRAP-positive osteoclast formation, and stimulated ALP-positive osteoblast differentiation in co-cultures of WT-derived osteoblasts and bone-marrow cells, in the presence of bone-resorbing factors. In contrast, W9 exerted only a weak effect on ALP-positive osteoblast differentiation in co-cultures with RANKL-deficient osteoblasts, even in the presence of the W9 peptide, parathyroid hormone, and/or BMP-2.ConclusionsThe W9 peptide inhibited RANKL-mediated osteoclast formation in osteoblasts. It also directly stimulated osteoblast differentiation, both via RANKL signaling-mediated autocrine factors, and alternative mechanisms.

http://ift.tt/2rV3ya2

Care of long-term survivors of head and neck cancer after treatment with oral or facial prostheses, or both

Publication date: Available online 25 May 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): E. Worrell, L. Worrell, B. Bisase
The current evidence of good practice in the delivery of long-term supportive care to patients who have been treated for head and neck cancer is sparse. We recruited 10 survivors so that we could follow their experience after their acute treatment was over. There were six men (mean (range) age 72 (54-86) years) and four women (mean (range) age 69 (67-73) years). After ethics committee approval had been given, we used structured interviews and questionnaires to investigate the impact of the resection and reconstruction, the patients' perceived needs, and their use of supportive care services. Their experiences were in line with current treatment of head and neck cancer. Whether they would survive the cancer was an initial fear (up to a year postoperatively), and some subjects reported problems more than five years after treatment, particularly with swallowing, quality of saliva, and intelligible speech. This small group of survivors of head and neck cancer maintained a good quality of life physically, socially, and emotionally. Limitations were put down to their age rather than their diagnosis of cancer or their rehabilitation. Analysis of their perceived needs showed that supportive care services were readily available and were valued by the patients, and that all their needs were met.

http://ift.tt/2rZIK09

Re: Re: Le Fort I advancement osteotomies of 1cm or more. How safe or stable?

Publication date: Available online 24 May 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S. Bhatia, A.W. Sugar

http://ift.tt/2r1p13b

Virtual planning of a composite model of bone and teeth to facilitate the adjustment of a hybrid distractor for the transport of alveolar bone

Publication date: Available online 25 May 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S. Grybauskas, E. Hens-Aumente, P. Serrano-Sanchez

http://ift.tt/2rZLASX

Editorial Board

Publication date: May 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 4

http://ift.tt/2r1hbX6

Current thinking about the management of dysfunction of the temporomandibular joint: a review

Publication date: May 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 4
Author(s): S. Rajapakse, N. Ahmed, A.J. Sidebottom
Increasingly the management of TMJ pathology is becoming a subspecialist interest. The number of patients having TMJ joint replacement had steadily increased over the last decade and there is now NICE guidance on this matter. Whilst the evidence of the management of TMJ disease is limited and there are few randomised controlled trials, the incidence of TMJ pathology has not changed and there is a requirement for guidance on the management. Whilst previously patients with TMJ pain were managed surgically, this is changing, and the vast bulk of initial management is non-surgical/medical. This paper will review the literature on TMD and provide guidance for management.

http://ift.tt/2rZFbHx

Ophthalmic outcomes of fractured zygomas

Publication date: May 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 4
Author(s): R.J. McGalliard, J. Kimpton, N.M.H. McLeod
In patients with fractures of the zygomatic complex, computed tomography (CT) often identifies extensive defects in the orbital floor. Some surgeons recommend routine exploration and repair of these defects during repair of the zygoma, while others advocate a more selective approach, but there is a paucity of evidence either way. We report a retrospective case series of 50 patients who had open reduction and internal fixation of zygomatic fractures by a single surgeon in the maxillofacial department at the John Radcliffe Hospital, Oxford, between 2011and 2014. The orbit was repaired only in those with severe diplopia, or restriction or malpositioning of the globe. Patients were evaluated by age, sex, aetiology, preoperative findings including diplopia and ocular malpositioning, fracture pattern, and morbidity. A total of 14 had preoperative ophthalmic signs. In five these were minimal so treatment was conservative. Nine (eight with diplopia and one with a malpositioned globe) had exploration and seven of them had the orbit repaired at the same time as the zygoma. This was not possible in the remaining two because of the complexity of the defect. There were no postoperative ophthalmic signs in the 41 who did not have orbit explored, or in the seven who had it repaired, and residual signs resolved after planned secondary reconstruction in the remaining two. We recommend that the orbit is explored only in patients with severe diplopia, or restriction or malpositioning of the globe.

http://ift.tt/2r1EdwV

Patients’ experience in the early recovery phase after removal of intraoral squamous cell carcinoma with carbon dioxide laser

Publication date: May 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 4
Author(s): M. Gilmartin, T. Ali, S.N. Rogers
Laser excision of oral cancer is well established. The aim of this cross-sectional survey was to ask patients about their main symptoms and the severity of them during the first postoperative weeks. We devised a short questionnaire in collaboration with patients, and did a cross-sectional survey of 50 consecutive patients who had laser excision of T1 and T2 oral cancers over a two-year period. The response rate was 76% (38/50). Twenty patients reported that eating was "quite a bit" or "very much of a problem" and 13 reported similar for pain. The main problems were eating (n=27), pain (n=16), numbness (n=14), speech (n=13), and swallowing (n=12). It took 11 patients more than 4 weeks to recover, and 11 of the 20 who were employed needed to take time off work (modal duration 3 or 4 weeks). Thirteen patients sought advice postoperatively from the clinic, ward or secretary's office, general practitioner, or accident and emergency department (or other out-of-hours service). The survey shows that morbidity associated with laser excision is relatively high, and more studies are required to provide a better evidence base that will inform improvements in postoperative recovery and care.

http://ift.tt/2rZyjtN

Training Groups

Publication date: May 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 4

http://ift.tt/2r1vJ9g

Evaluation of type-specific antibodies to high risk-human papillomavirus (HPV) proteins in patients with oropharyngeal cancer

Publication date: July 2017
Source:Oral Oncology, Volume 70
Author(s): Martina A. Broglie, Wolfram Jochum, Angelika Michel, Tim Waterboer, Diana Foerbs, René Schoenegg, Sandro J. Stoeckli, Michael Pawlita, Dana Holzinger
ObjectivesHigh risk human papillomavirus (HR-HPV) infection leads to a subgroup of oropharyngeal cancer (OPSCC) characterized by improved treatment response. However an universally accepted definition of an HR-HPV-attributable cancer is lacking.MethodsDetailed, type-specific HPV antibody responses were analyzed by multiplex serology in HR-HPV-attributable OPSCC patients, defined by p16^INK4A overexpression and HR-HPV DNA detection by PCR amplification and sequencing.ResultsFifty patients were prospectively enrolled. 26/50 (52%) tumor samples were positive for both p16^INK4A expression and HR-HPV DNA (22 HPV16, 4 HPV33). Seropositivity was present in 26/26 HPV-attributable OPSCC and one p16^INK4A-positive/HPV DNA-negative case. The sensitivity and specificity to diagnose an HR-HPV-attributable tumor was 100% and 96%, respectively for anti-E6 reactivity, 82% and 100%, respectively for anti-E2 reactivity, and clearly lower for anti-E7, anti-E1, anti-E4 and anti-L1-reactivity. 3yr-overall (OS) and disease specific survival (DSS) was higher in patients with HR-HPV-attributable tumors (OS 88% vs 64%, p=0.02; DSS 90% vs 80%, p=0.07) and seropositive patients (OS 88% vs 62%, p=0.01; DSS 92% vs 78%, p=0.05) than HR-HPV-negative or seronegative patients.ConclusionsDetection of HR-HPV type-specific antibodies highly correlated with HPV-attributable OPSCC and was associated with better survival. HR-HPV antibodies are promising diagnostic, prognostic and potentially screening markers in HR-HPV-attributable OPSCC.

http://ift.tt/2r11f5i

A clinical decision rule to predict zygomatico-maxillary fractures

Publication date: Available online 25 May 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Simon Haworth, Anthony Bates, Andrea Beech, Greg Knepil
Patients presenting with periorbital trauma require clinical assessment to exclude zygomatico-maxillary fractures. A single-centre pilot investigation was undertaken at a general hospital in the United Kingdom. The sample was composed of 229 adult patients attending our emergency department with periorbital injuries. Findings from 17 signs or symptoms of facial injury were recorded on a validated tool. The relationship between clinical presentation and displaced zygomatico-maxillary fracture was assessed using diagnostic test parameters and tests for correlation. A decision-making rule was derived. The presence of a) palpable bony step, b) bony asymmetry, c) lateral sub-conjunctival haemorrhage with no posterior limit, d) anaesthesia or paraesthesia to lip/cheek or side of nose and e) palpable emphysema were all specific features of radiographically displaced zygomatico-maxillary fracture (specificity all >75.0 %, p value for correlation all < 0.001). A decision-making rule based on the presence of any one of features (a),(c),(d) or (e) identified all patients with displaced zygomatico-maxillary fractures in this sample (sensitivity 100% (95% CI 93.4% - 100.0%), specificity 72.6% (95% CI 65.3% - 79.0%). Implementation of this clinical decision-making rule would identify all patients with displaced fractures at the triage stage whilst reducing radiographic exposures by 55% in this sample.

http://ift.tt/2r1910Q

Combined therapy for epistaxis by Hereditary Hemorrhagic Teleangiectasia: A 3-year follow up study on 45 patients

Publication date: Available online 24 May 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Papaspyrou Giorgos, Hecker Dietmar, Linxweiler Maximilian, Schick Bernhard, Al Kadah Basel
Hereditary hemorrhagic telangiectasia (HHT) is a mutilating disease associated with the majority of patients with recurrent epistaxis episodes. The aim of this study was to present a single institution experience with patients treated for nasal epistaxis using a combination of Nd:YAG laser and argon plasma coagulation (APC) vs Nd:YAG laser alone, with a minimum follow-up of 3 years.45 patients (21 men, 24 women) aged from 15 to 84 years with the diagnosis of HHT were treated in the Department of Otolaryngology, Head and Neck Surgery in Homburg/Saar between 10/2002 and 10/2012 because of epistaxis, using a combination of Nd:YAG laser and APC or Nd:YAG laser alone. The observation period ranged from 36 to 120 months.15 patients were treated with Nd:YAG laser alone and 30 patients with combined Nd:YAG laser and APC. A revision was necessary in three patients (20%) in the Nd:YAG laser group and in nine (33.3%) patients in the combined group. The difference between revision rates after the two therapy forms was not statistically significant (p = 0.492). Bipolar coagulation was additionally applied in 33 patients. There was no statistically significant difference (p = 1.00) in revision rates between patients who were additionally treated with bipolar coagulation and those who did not receive bipolar coagulation as part of their treatment. No case of postoperative septal perforation was observed.Nd:YAG laser therapy remains an established option for treating treat epistaxis in HHT patients.

http://ift.tt/2rZf978

Relative susceptibility of airway organisms to antimicrobial effects of nitric oxide

Background

Nitric oxide (NO) is released in the airway as a critical component of innate immune defense against invading pathogenic organisms. It is well documented that bacteriostatic and bactericidal effects of NO are concentration-dependent. However, few data exist comparing relative susceptibility of common pathogens to NO at physiologic concentrations. In this study we evaluated the effects of NO on 4 common airway bacteria and 1 fungus, and examined the potential implications of discrepancies in sensitivity.

Methods

Staphylococcus epidermis, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Candida albicans cultures were adjusted to a uniform optical density (OD) and grown in log phase at 37°C with varying concentrations of NO formed by DETA NONOate. Both OD readings and colony forming units (CFUs) were measured at varying time-points to evaluate for inhibitory effects of NO.

Results

P aeruginosa and C albicans were significantly more sensitive to NO at physiologic concentrations typical of the human airway. S aureus was attenuated by NO to a lesser degree, and K pneumoniae and S epidermis were more resistant to NO at all concentrations tested. Air surface liquid from cultured human sinonasal epithelial cells had an additive effect in bacterial killing of P aeruginosa, but not in S aureus.

Conclusion

Common airway pathogens have varying levels of susceptibility to NO at physiologic concentrations of innate immune defense. Relative sensitivity of P aeruginosa and relative resistance of S epidermis may help explain the composition of the healthy microbiome, as well as opportunistic infection in the absence of induced NO release.

http://ift.tt/2rDvv90

Defining a diagnostic marker: a pragmatic requirement

http://ift.tt/2qkucI8

Household pet exposure, allergic sensitization, and rhinitis in the U.S. population

Background

The effect of animal dander exposure on allergic sensitization may be age-dependent. A comparison between the association of the levels of exposure to pet allergen with rhinitis symptoms and allergic sensitization in children and adults is yet to be performed in the U.S. population.

Methods

Cross-sectional study of 3034 adults (age, 20 to 85 years) and 2104 children (age, 6 to 19 years) in the National Health and Nutrition Examination Survey, 2005–2006. Samples of household dust were collected to measure the amounts of indoor allergens in the participants' homes. Self-reported rhinitis was based on symptoms during the past 12 months, and allergen sensitization was defined as a positive response to any of the 19 specific immunoglobulin E (IgE) antigens tested.

Results

Higher levels of exposure to dog dander were associated with a higher prevalence of any allergic sensitization in adults (prevalence ratio [PR] 1.19; 95% confidence interval [CI], 1.01 to 1.39), but a lower prevalence in children (PR 0.84; 95% CI, 0.73 to 0.096), p-interaction by age group 0.02. Cat exposure was associated with an increased prevalence of rhinitis symptoms in adults (PR for the 3rd vs lowest tertile of cat dander concentrations: 1.14; 95% CI, 1.05 to 1.23) but not in children (PR for the 3rd vs lowest tertile of cat dander IgE concentrations: 0.86; 95% CI, 0.70 to 1.07), p-interaction 0.01.

Conclusion

Allergic sensitization and symptomatic response to pet dander exposure may vary based on age. Further studies are necessary to assess the mechanisms for these apparent differences.

http://ift.tt/2rDNTyC

Perspectives on the Otolaryngology Residency Application Process

This survey study evaluates the perceptions of 2016 otolaryngology–head and neck surgery residency applicants regarding the application process and offers suggestions for reform.

http://ift.tt/2rZdWNd

Rethinking Pain Management in Endoscopic Sinus Surgery

For years, opioid medications have been the centerpiece of perioperative pain management with endoscopic sinus surgery. This approach provides surgeons with the comfort that their patients will experience adequate pain control following their operation. Rarely, however, have we asked if we are overtreating pain. Certainly patients will take only the medication they need, and what's the harm with a few unused pills? Furthermore, are we not better off prescribing beyond the likely needs of our patients to ensure their comfort and minimize postoperative phone calls?

http://ift.tt/2r0Wk6i

Bilateral Hearing and Vestibular Loss in a Patient With Untreated CML

This case study describes a man in his 40s with uncontrolled chronic myeloid leukemia who presented with sudden-onset positional vertigo and profound sensorineural hearing loss.

http://ift.tt/2rZkKuc

Analgesic Effects of Intravenous Acetaminophen vs Placebo for Endoscopic Sinus Surgery

This randomized clinical trial examines the use of intravenous acetaminophen vs placebo in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis.

http://ift.tt/2r11CyK

Partial Resection in Microsurgical Management of Vestibular Schwannomas

This Viewpoint discusses selective use of partial tumor resection, in particular near total resection, over gross total resection when there is concern for imminent facial nerve compromise in the management of vestibular schwannomas.

http://ift.tt/2rYT6xl

Über 5 Jahre hinaus verlängerte endokrine Therapie

http://ift.tt/2qgcYjh

Laser-assisted hatching of human embryos: may two alternative approaches (thinning versus drilling) impact on implant rate?

http://ift.tt/2r176t9

The influence of low-intensity He-Ne laser on the wound healing in diabetic rats

Abstract

The low-level laser irradiation at certain wavelengths is reported to facilitate the healing process of diabetic wounds. Thus, this study carried out to look for the suitable laser parameters that could speed up the healing process. Fourteen healthy male and female rats were used in which a circular wound with a diameter of 2.5 ± 0.2 cm was created on the dorsum in each rat after injected them with alloxan to induced diabetic. They have been divided into two groups: control group (N = 7) and study group (N = 7) to conduct the study. He-Ne laser with a wavelength of 632.8 nm at power density of 4.0 mW/cm² was used to irradiate the study group for five times a week until the wound healed (closed) completely, while the control group was kept untreated. The results showed that the laser-treated group healed (wounds were totally closed) faster compared to the control group. In numbers, the laser-treated group healed on average at the 21st day (0.0 ± 0.0 cm) (P ≤ 0.005), whereas the control group healed after 40 days or even 60 days in some cases (sample no. 2). This confirms that laser promotes the tissue repair process of diabetic wounds and reduces the healing period to the half.

http://ift.tt/2rYUD6v

Comparison of photobiomodulation therapy and suprascapular nerve-pulsed radiofrequency in chronic shoulder pain: a randomized controlled, single-blind, clinical trial

Abstract

Shoulder pain can be difficult to treat due to its complex anatomic structure, and different treatment methods can be used. We aimed to examine the efficacy of photobiomodulation therapy (PBMT) and suprascapular nerve (SSN)-pulsed radiofrequency (RF) therapy. In this prospective, randomized, controlled, single-blind study, 59 patients with chronic shoulder pain due to impingement syndrome received PBMT (group H) or SSN-pulsed RF therapy (group P) in addition to exercise therapy for 14 sessions over 2 weeks. Records were taken using visual analog scale (VAS), Shoulder Pain and Disability Index (SPADI), and Nottingham Health Profile (NHP) scoring systems for pretreatment (PRT), posttreatment (PST), and PST follow-up at months 1, 3, and 6. There was no statistically significant difference in initial VAS score, SPADI, and NHP values between group H and group P (p > 0.05). Compared to the values of PRT, PST, and PST at months 1, 3, and 6, VAS, SPADI, and NHP values were statistically significantly lower in both groups (p < 0.001). There was no statistically significant difference at all measurement times in VAS, SPADI, and NHP between the two groups. We established that PBMT and SSN-pulsed RF therapy are effective methods, in addition to exercise therapy, in patients with chronic shoulder pain. PBMT seems to be advantageous compared to SSN-pulsed RF therapy, as it is a noninvasive method.

http://ift.tt/2r0IRvm

Feeding management strategies among the early Neolithic pigs in the NE of the Iberian Peninsula

Abstract

The socio-economic relevance of domesticated animals during the Early Neolithic in the Iberian Peninsula is indisputable, yet we essentially know little about the way they were managed. Among domesticated animals, pig (Sus domesticus) was a common food source and previous studies have shown the potential of stable isotopes for assessing variability in pig diet in relation to husbandry practices. Nevertheless, this approach has never been applied to the earliest pigs in the Iberian Peninsula. We analyzed the carbon and nitrogen stable isotope composition of pig bone collagen from several Early Neolithic sites in the NE Iberian Peninsula. While pig δ13C values were similar across different populations, there were significant differences in δ15N values between sites. These are attributed to different pig husbandry systems, which may reflect distinct social and spatial organization and interaction with environmental conditions during the Early Neolithic in this region.

http://ift.tt/2qnyMof

Human-aided movement of viral disease and the archaeology of avian osteopetrosis

Abstract

The term avian osteopetrosis is used to describe alterations to the skeletal elements of several species of domestic bird, most typically the chicken, Gallus gallus domesticus (L. 1758). Such lesions are routinely identified in animal bones from archaeological sites due to their distinctive appearance, which is characterised by proliferative diaphyseal thickening. These lesions are relatively uncomplicated for specialists to differentially diagnose, and are caused by a range of avian leucosis viruses in a series of subgroups. Only some avian leucosis viruses cause the development of such characteristic lesions in osteological tissue. Viraemia is necessary for the formation of skeletal pathology, and avian osteopetrosis lesions affect skeletal elements at different rates. Lesion expression differs by the age and sex of the infected individual, and environmental conditions have an impact on the prevalence of avian leucosis viruses in poultry flocks. These factors have implications for the ways in which diagnosed instances of avian osteopetrosis in archaeological assemblages are interpreted. By integrating veterinary research with archaeological evidence for the presence of avian leucosis viruses across Western Europe, this paper discusses the nature of these pathogens, outlines criteria for differential diagnosis, and offers a fresh perspective on the human-aided movement of animal disease in the past through investigation of the incidence and geographic distribution of avian osteopetrosis lesions from the first century BC to the post-medieval period.

http://ift.tt/2qSZPv2

Evaluation of Penicillin Allergy in the Hospitalized Patient: Opportunities for Antimicrobial Stewardship

Abstract

Purpose of Review

Recent Findings

Summary

http://ift.tt/2rCLVi4

The posterior-based buccinator myomucosal flap (Bozola's flap)

Publication date: Available online 24 May 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Rahpeyma, S. Khajehahmadi

http://ift.tt/2r0cSeN

Impact of a multimedia support on the understanding of medical information by hearing-impaired patients before cochlear implantation

Publication date: Available online 24 May 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): C.-E. Rouf, E. Lescanne, A. Villeneuve, K. Reffet, S. Kim, D. Bakhos
IntroductionThe medical information provided in medical consultations is exhaustive but poorly assimilated by patients and relatives. Hearing loss seems to be a further obstacle. The main objective of this study was to compare medical information about cochlear implantation delivered in oral and written form ("standard" group) versus oral, written and digital form ("multimedia" group). The secondary objective was to assess hearing loss as a negative factor for understanding medical information, by comparing understanding in patients with unilateral versus bilateral profound hearing loss.Patients and methodA prospective single-center single-blind study was carried out from September 29, 2015 to June 22, 2016. Twenty-nine CI candidates were included: 11 in the "standard" group, 12 in the "multimedia" group and 6 in the "unilateral hearing loss" group. The primary endpoint was the result on a validated questionnaire (score from 0 to 14) assessing memorization of medical information. Patient satisfaction regarding the information delivered was assessed on a Likert scale.ResultsMemorization scores were 4.6±2.7 and 9.7±2.4 respectively for the "standard" and the "multimedia" group (P=0.0006) and 9.05±1.9 for the "unilateral hearing loss" group. Comparison between the "standard" and "unilateral hearing loss" groups showed a significant difference (P=0.01). Satisfaction scores were highest for digital compared to the other forms of medical information delivery.ConclusionThis study showed that a digital support improved understanding of medical information by candidates for cochlear implantation and that hearing loss was an obstacle to understanding medical information.

http://ift.tt/2rYpkcg

Case 16-2017 — A 69-Year-Old Woman with Urinary Incontinence

Presentation of Case. Dr. John O. Schorge: A 69-year-old woman was evaluated at the gynecologic oncology clinic of this hospital because of persistent urinary incontinence. Seven years before this evaluation, the patient had received a diagnosis of superficial bladder cancer (low grade), for which…

http://ift.tt/2qmOv6U

Congenital Herpes Simplex Virus Type 1 Infection Mimicking Congenital Erosive and Vesicular Dermatosis: Possible Pathogenic Insights

Abstract

Congenital erosive and vesicular dermatosis (CEVD) is a rare entity of unknown etiology. We report a case of congenital herpes simplex virus (HSV) type 1 infection that healed with reticulated and supple scarring, similar to that seen in CEVD. Twenty percent of previously reported cases of CEVD had recurrent HSV infection throughout the first year of life. We postulate that at least some previous cases of CEVD may have been due to undiagnosed congenital HSV infection.

http://ift.tt/2qRQEuO

CD4+ T cells from HIV-1 patients with impaired Th1 effector responses to Mycobacterium tuberculosis exhibit diminished histone and nucleoprotein signatures

Publication date: Available online 25 May 2017
Source:Clinical Immunology
Author(s): Lillian Seu, James A. Mobley, Paul A. Goepfert
HIV+ patients have an increased risk for tuberculosis disease despite clinical management with ARTs. We established a culture model of Mtb-infection in PBMCs from HIV+ PPD+ donors on suppressive ART (median 6.4years) with negligible viral loads (median<50copies/mL) and stable CD4+ T cell counts (517cells/mm^3). We observed that HIV+ patient lymphocytes harbored a recruitment defect to Mtb-infected macrophages. To investigate these immune defects on a per cell basis, purified CD4+ T cells from HIV patients were assessed by label-free quantification protein mass spectrometry. CD4+ T cells from HIV patients displayed diminished nucleoprotein levels – notably of histone variant H2a.Z and ribonucleoprotein A1. Only within healthy donors, transcriptional regulatory histone variant H2a.Z expression was correlated to the extent of IFN-γ induction upon Mtb-infection. Our findings may explain why HIV patients exhibit prolonged immune cell dysfunction despite suppressive ART, and implicate a per cell defect of CD4+ T cells.

Graphical abstract

http://ift.tt/2qf8R79

Indications for Opioid Antagonists

Abstract

Purpose of Review

As opioids have become more common in clinical practice for the treatment of both acute and chronic pain, so too has the need for a deeper understanding of the clinical applications of opioid antagonists. The purpose of this review is to present both the longstanding and potential new indications for the use of drugs that block the effects of opioid receptors.

Recent Findings

There is a growing body of data demonstrating the modulation of pain by opioid antagonists. Additional clinical studies that show their direct antinociceptive effects and/or enhancement of the analgesic potency of opioid agonists are warranted.

Summary

We briefly discuss the well-established role that these agents play in the reversal of life-threatening opioid toxicity and explore both existing and expanding clinical applications, including their apparent paradox that they may themselves be associated with analgesia.

http://ift.tt/2rTqZR1

Ghrelin Protects the Thymic Epithelium From Conditioning-Regimen-Induced Damage and Promotes the Restoration of CD4+ T Cells in Mice After Bone Marrow Transplantation.

Background: The delay in immune reconstitution after hematopoietic stem cell transplantation (HSCT), especially a delay in central immune reconstitution, leads to opportunistic infections and disease relapse after transplantation and affects the long-term outcome of HSCT. This delay is mainly attributable to thymic damage after myeloablative chemotherapy and radiotherapy Methods: We established a model of allogeneic bone marrow transplantation (BMT) in mice and administered ghrelin (GRL) 7 days before the conditioning regimen or the day after BMT. Results: All the GRL-treated mice, especially those administered GRL prior to the conditioning regimen, exhibited more intact thymic architecture and a more rapid restoration of CD4+ T lymphocytes after BMT than those of the corresponding control mice. Moreover, the levels of T cell receptor excision circles (TRECs) were significantly higher in the mice treated with GRL prior to the conditioning regimen than in the control mice at 28 days after BMT. Conclusions: Our findings suggest that GRL may be a novel potential therapeutic approach to protecting the thymic epithelium from conditioning-regimen-induced damage and promoting rapid and durable thymic and peripheral CD4+ T cell recovery after HSCT. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2qZjiZH

Expectations and experiences of follow up and self-care after living kidney donation: a focus group study.

Background: Ensuring donor wellbeing warrants ongoing monitoring following living kidney donation. However, there is considerable variability in donor follow up processes, including information provided to donors regarding self-care. Loss to follow up is common, suggesting that the aims and benefits of monitoring and follow up may not be apparent. We aimed to describe the experiences and expectations of living kidney donors regarding follow up and self-care after donation. Methods: Participants from 3 transplant centers in Australia and Canada participated in 14 focus groups (n=123). Transcripts were analyzed thematically. Results: We identified 4 four themes: lacking identification as a patient (invincibility and confidence in health, immediate return to normality, avoid burdening specialty services, redundancy of specialist attention, unnecessary travel); empowerment for health (self-preservation for devastating consequences, self-advocacy and education, needing lifestyle advice, tracking own results); safety net and reassurance (availability of psychosocial support, confidence in kidney-focused care, continuity and rapport, and access to waitlist priority); and neglect and inattention (unrecognized ongoing debilitations, primary focus on recipient, hospital abandonment, overlooking individual priorities, disconnected from system, coping with dual roles, and lacking support for financial consequences). Conclusions: Living kidney donors who felt well and confident about their health regarded specialist follow up as largely unnecessary. However, some felt they did not receive adequate medical attention, were prematurely detached from the health system, or held unresolved anxieties about the consequences of their decision to donate. Ongoing access to healthcare, psychosocial support, and education may reassure donors that any risks to their health are minimized. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2qeUPCg

Centenarian Livers: Very Long-Term Outcomes of Very Old Grafts.

No abstract available

http://ift.tt/2qZjfgt

Catalase (CAT) promoter and 5′-UTR genetic variants lead to its altered expression and activity in vitiligo

Summary

Background

Oxidative stress is considered to be the initial event during the course of vitiligo. Catalase is mainly involved in the defense against oxidizing agents in the cell through detoxifying H₂O₂.

Objectives

Aims of the present study were 1) to assess the erythrocyte catalase activity and LPO levels, as well as CAT mRNA expression in skin and blood; 2) to investigate CAT promoter rs7943316, rs1001179; 5′-UTR rs1049982 and exon (rs17886350, rs11032709, rs17880442, rs35677492) polymorphisms and; 3) to perform genotype-phenotype/ haplotype correlation analyses, in vitiligo patients and controls from Gujarat.

Methods

Catalase activity and lipid peroxidation levels were measured spectrophotometrically. CAT mRNA levels were estimated using Real-time PCR by SYBR-Green method. SNP genotyping was performed using PCR-RFLP/ ARMS-PCR methods.

Results

Vitiligo patients showed significantly decreased CAT mRNA-expression in lesional, non-lesional skin and in blood with reduced catalase activity compared to that of controls. CAT -89A/T and -20T/C polymorphisms were significantly associated with patients, especially with active and generalized vitiligo whereas, no association was observed for -262G/A and exon polymorphisms. 'A_-262T_-89C_-20′ haplotype with variant alleles was found to be associated with 6.4-fold risk of vitiligo. Genotype/ haplotype-phenotype correlation analyses revealed that individuals with susceptible genotypes/ haplotype for CAT -89 A/T and -20 T/C polymorphisms showed significantly decreased catalase mRNA/activity, and only -89 A/T polymorphisms showed significantly increased lipid peroxidation levels, as compared to wild type genotypes/ haplotype.

Conclusions

In conclusion, the present study proposes the crucial role of catalase and its allelic variants in oxidative stress mediated pathogenesis of vitiligo.

http://ift.tt/2qmw7v4

Integrative analyses reveal biological pathways and key genes in psoriasis

Abstract

Background

Psoriasis is a complex disease that is influenced by both genetic and environmental factors with abnormal gene expression in lesional skin. However, no studies are available on genome-scale gene expression of psoriatic lesions in the Chinese population. In addition, systematic studies on the biological pathways, pathogenicity and interaction networks of psoriasis-related genes with abnormal expression profiles require further investigation.

Objectives

To further explore the associated pathways in psoriasis by functional analysis and to identify the key genes by gene pathogenicity analysis.

Methods

We performed RNA sequencing on 60 skin biopsy samples from psoriasis patients and healthy controls to identify the primary differentially expressed genes in psoriatic lesional skin. We retrieved all reported psoriasis-associated genes and performed integrative analyses covering gene expression profiling, pathway analysis, gene pathogenicities and protein-protein interaction networks.

Results

We found that internal and external stimuli may activate immuno-inflammatory responses to promote the development of psoriasis. Pathways associated with infectious diseases and cancers were identified by functional and pathway analyses. The gene pathogenicity analysis revealed five key genes in psoriasis, including PPARD, GATA3, TIMP3, WNT5A and PTTG1.

Conclusions

Our analyses showed that genes contributed to the pathogenesis of psoriasis by activating risk pathways with components abnormality in expression. We identified five potentially pathogenic genes for psoriasis that may serve as important biomarkers for the diagnosis and treatment.

http://ift.tt/2qSdwdJ

Editorial Board Page

Publication date: June 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 6

http://ift.tt/2rCu9ez

Publication date: June 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 6

http://ift.tt/2qj31xn

AAOMS Author Disclosure forms

Publication date: June 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 6

http://ift.tt/2rChtV4

The Year of Living Alternative Factually

Publication date: June 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 6
Author(s): Thomas B. Dodson

http://ift.tt/2qiGtNc

Making Trauma Care Worthwhile

Publication date: June 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 6
Author(s): Roger A. Meyer

http://ift.tt/2rCnPnr

Masthead

Publication date: June 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 6

http://ift.tt/2qiZFKB

The Oral and Maxillofacial Surgery Anesthesia Team Model

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Publication date: June 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 6
Author(s): Douglas W. Fain, Brett L. Ferguson, A. Thomas Indresano, J. David Johnson, Louis K. Rafetto, Scott Farrell, Steven R. Nelson, Victor L. Nannini, Paul J. Schwartz, Robert S. Clark, J. David Morrison, B.D. Tiner, Mark A. Egbert
Oral and maxillofacial surgeons have been providing safe anesthesia to their patients using the anesthesia team model; this has allowed access to care for patients that have significant anxiety. The AAOMS strives to maintain the excellent safety record of the anesthesia team model by creating simulation programs in anesthesia, regularly updating the office anesthesia evaluation program, convening anesthesia safety conferences and strengthening the standards in our training programs. Through these efforts, our delivery of anesthesia to our patients will remain safe and effective.

http://ift.tt/2rCmM74

Surgical Site Infections After Orthognathic Surgery

Publication date: June 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 6
Author(s): Michael Miloro

http://ift.tt/2qiMwRV

Lingual Nerve Measurements in Cadaveric Dissections: Clinical Applications

Publication date: June 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 6
Author(s): Somsak Sittitavornwong, Michael Babston, Douglas Denson, Steven Zehren, Jonathan Friend
PurposeLingual nerve (LN) injury is quite prevalent despite its long-known anatomic course. The purpose of this study was to accurately predict the LN pathway by identifying and measuring close anatomic landmarks; these measurements should help lessen the incidence of LN injury.Materials and MethodsLN dissection was carried out on 15 halved cadaver skulls (total, 28 specimens).ResultsOn average, the LN position was approximately 7 mm below the alveolar crest at the distal end of the mandibular second molar, 5.5 mm anterior to the lingula, and 14.6 mm distal to the alveolar crest at the mandibular second molar. From the base of the skull, the LN traveled 5 mm anteriorly to the inferior alveolar nerve and inferiorly to the posterior attachment of the mylohyoid muscle (approximately 1.5 cm distal to the mandibular second molar), where it turned anteromedially and traveled 7 mm inferiorly to the alveolar crest at the mandibular second molar.ConclusionGiven the multiple procedures by dental practitioners and maxillofacial surgeons, the LN is at high risk for injury. This study validates the proximity of the LN to anatomic structures commonly encountered during head and neck procedures.

http://ift.tt/2rTaowu

Contrasting Patterns for Missing Third Molars in the United States and Sweden

Publication date: June 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 6
Author(s): Caitlin B.L. Magraw, Lars Pallesen, Kevin L. Moss, Elda L. Fisher, Steven Offenbacher, Raymond P. White
PurposeThe purpose of this study was to compare the prevalence of third molars from the US National Health and Nutrition Examination Survey (NHANES) and the Swedish survey.Materials and MethodsThis cross-sectional study involved the comparison of the only published data on third molar prevalence. The number of visible third molars in the NHANES of 2011 through 2012 were assessed in nonclinical settings by trained, calibrated dental hygienists and reported by age decade (approximately 5,000 patients). Similar data were reported for the Swedish population with data collected in clinical settings (approximately 700 patients). The primary outcome variable was the number of third molars (0 to 4); the predictor variables were age cohorts (20 to 29 through 70 to 79 yr). Outcome data were reported with descriptive statistics.ResultsIn the youngest cohort (20 to 29 yr), having no visible third molars was more likely in the US population than in the Swedish population (47 vs 2%, respectively). By 50 to 59 years, outcomes for no third molars were similar in the United States and Sweden (53 and 57%, respectively).ConclusionThe presence or absence of third molars reported from the US and Swedish populations presented contrasting patterns, particularly in the younger cohorts. More comprehensive and detailed data are required in future surveys as population studies on third molars become more important for clinicians and other stakeholders.

http://ift.tt/2rkktpt

Efficacy of Platelet-Rich Fibrin After Mandibular Third Molar Extraction: A Systematic Review and Meta-Analysis

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Publication date: June 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 6
Author(s): Faez Saleh Al-Hamed, Mohamed Abdel-Monem Tawfik, Ehab Abdelfadil, Mohammed A.Q. Al-Saleh
PurposeTo assess the effect of platelet-rich fibrin (PRF) on the healing process of the alveolar socket after surgical extraction of the mandibular third molars.Materials and MethodsPubMed, the Cochrane Central Register of Controlled Trials, Scopus, and relevant journals were searched using a combination of specific keywords ("platelet-rich fibrin," "oral surgery," and "third molar"). The final search was conducted on November 2, 2015. Randomized controlled clinical trials, as well as controlled clinical trials, aimed at comparing the effect of PRF versus natural healing after extraction of mandibular third molars were included.ResultsFive randomized controlled trials and one controlled clinical trial were included. There were 335 extractions (168 with PRF and 167 controls) in 183 participants. Considerable heterogeneity in study characteristics, outcome variables, and estimated scales was observed. Positive results were generally recorded for pain, trismus, swelling, periodontal pocket depth, soft tissue healing, and incidence of localized osteitis, but not in all studies. However, no meta-analysis could be conducted for such variables because of the different measurement scales used. The qualitative and meta-analysis results showed no significant improvement in bone healing with PRF-treated sockets compared with the naturally healing sockets.ConclusionsWithin the limitations of the available evidence, PRF seems to have no beneficial role in bone healing after extraction of the mandibular third molars. Future standardized randomized controlled clinical trials are required to estimate the effect of PRF on socket regeneration.

http://ift.tt/2rkaksC

Comparing Stability of Mandibular Setback Versus 2-Jaw Surgery in Class III Patients With Minimal Presurgical Orthodontics

Publication date: June 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 6
Author(s): Brent E. Larson, Nam-Ki Lee, Moon-Jung Jang, Pil-Young Yun, Jong-Wan Kim, Young-Kyun Kim
PurposeThe aim of this study was to compare treatment time and skeletal stability between mandibular setback surgery (MS) and 2-jaw surgery (2J) with minimal presurgical orthodontics (MPO) in patients with skeletal Class III.Materials and MethodsOne hundred ninety-five patients who underwent orthognathic surgery were enrolled in this retrospective cohort study. Consecutive patients were selected based on standardized inclusion criteria: Class III malocclusion with mandibular prognathism, surgery type, and presurgical orthodontics with non-extraction for less than 6 months (MPO). Lateral cephalograms were taken before surgery (T0), 1 month after surgery (T1), and at debonding (T2). To evaluate surgical changes (T0 to T1) and postsurgical changes (T1 to T2) in skeletodental tissue, linear, angular, and dental measurements were analyzed using paired t test and independent t test.ResultsThirty-one patients were allocated to the MS-MPO group (n = 16) and the 2J-MPO group (n = 15). The 2J-MPO group showed a shorter duration of postsurgical orthodontic and total surgical and orthodontic treatment than the MS-MPO group. Although the 2J-MPO group exhibited advancement and superior impaction of the maxilla from T0 to T1, posterior movement with clockwise rotation of the mandible between the 2 groups did not show a statistical difference. In addition, from T1 to T2, the MS-MPO and 2J-MPO groups presented forward and upward movement and counterclockwise rotation of the mandible, but no intergroup difference was found.ConclusionsThe MS-MPO and 2J-MPO groups showed similar horizontal and vertical mandibular stability. However, the 2J-MPO group presented a shorter surgical and orthodontic treatment time than the MS-MPO group.

http://ift.tt/2qS2OEg

Αρχειοθήκη ιστολογίου

Πέμπτη 25 Μαΐου 2017

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