Notalgia paresthetica: factors associated with its perceived severity, duration, side, and localization

Abstract

Background

Notalgia paresthetica (NP) is a disorder characterized by pruritus localized to the patient's back. Little is known about predictors of severity, duration, side, and localization.

Objective

To identify factors associated with perceived severity, duration, side, and localization of NP.

Methods

In a cross-sectional study, disease severity, duration, side, and localization were compared among the considered variables. Multivariate analysis was used to assess each variable contribution in predicting disease severity and its duration.

Results

Sixty-five patients were recruited. Disease involved more female than male patients (Female/Male: 1.6) and after adjusting for all potential confounders, it was perceived as more severe in females (OR = 7.3, 95% CI = 2–26.3, P < 0.01). NP was reported more frequently on the right side among patients sleeping on the left side and conversely (P < 0.05). A higher disease duration was significantly linked to a higher body mass index (OR = 4.8, 95% CI = 1.3–17.1, P < 0.05).

Conclusion

Our study linked female gender to worse disease severity, a higher body mass index to longer disease duration, and prevailing sleep position to NP side expression. The sleeping position should be considered a possible target for treating the disease.

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Acquired bilateral telangiectasia macularis eruptiva perstans: A unique clinical feature of photodamaging rather than a subtype of cutaneous mastocytosis

Abstract

Telangiectasia macularis eruptiva perstans (TMEP) is a rare subtype of cutaneous mastocytosis, characterized by telangiectatic tan to brown macules on the trunk and extremities. Although TMEP has been descried as an uncommon disease in the literature, we often encounter patients with TMEP lesions in the outpatient clinic. We aimed to assess the clinical and histopathological characteristics of acquired bilateral TMEP, and the pathophysiological mechanism of acquired bilateral TMEP among these patients. We retrospectively reviewed 30 patients (28 men and 2 women) with acquired bilateral TMEP; multiple telangiectatic dark red to brown macules that were symmetrically distributed. The clinical characteristics and general histopathological findings of lesional skin were investigated. The number of mast cells was evaluated using immunohistochemical analysis with an antibody directed against c-kit (CD117). Acquired bilateral TMEP was predominantly localized on the sun-exposed area: the upper arm in 30 patients (100%), forearm in 19 patients (63.3%) and anterior chest in 15 patients (50%). A total of 16 patients (53.3%) showed at least one aggravating factor, including UV irradiation, alcohol use and heat exposure. Compared with the mast cell numbers in 19 age- and biopsy site-matched healthy controls (91 ± 29.0/mm²), the number of mast cells in the papillary dermal skin of acquired bilateral TMEP patients was significantly increased (159 ± 37.2/mm², P < 0.01). In addition, a significant difference in vessel numbers in the papillary dermis was observed between acquired bilateral TMEP patients and healthy controls (10.5 ± 1.9 vs 5.4 ± 1.0/mm², P < 0.01). Acquired bilateral TMEP is a relatively common disorder in middle-aged Asian men. An increased number of mast cells and dilated vessels might be a photoaging-related reactive process of chronic sun-exposure, which consequently leads to the formation of characteristic telangiectatic hyperpigmentary macules through certain melanogenic mediators.

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Massive Middle Cerebral Artery Infarction After Surgically Assisted Rapid Palatal Expansion: A Case Report

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7
Author(s): Kenneth Kufta, Luis Perez Melean, M. Sean Grady, Neeraj Panchal
Dentofacial deformities have a marked impact on a patient's quality of life. Fortunately, these deformities often can be corrected through orthodontic and surgical treatment. In adults, transverse maxillary discrepancies are often corrected by performing a surgically assisted rapid palatal expansion (SARPE) procedure. This procedure is accompanied by many of the same complications involved in performing a Le Fort I osteotomy. Although major complications from maxillary surgery are uncommon, severe hemorrhage and cerebrovascular accidents are real risks accompanied by serious sequelae. The purpose of this case report is to describe a case in which a patient developed a massive middle cerebral artery infarct after a SARPE procedure. The authors discuss the possible etiology and pathogenesis of the complication. They also aim to remind surgeons of this rare complication to ensure prompt recognition and management to prevent delays in care.



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Editorial Board Page

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7





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Antibiotic Prophylaxis in Blepharoplasty: Review of the Current Literature

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7
Author(s): Elie M. Ferneini, Steven Halepas, Steven I. Aronin
The purpose of this study was to provide an evidence-based overview of antibiotic prophylaxis in blepharoplasty. We performed a literature search that evaluated the risk of infection associated with blepharoplasty, as well as the risks and benefits of antibiotic prophylaxis. The overall infection rate associated with eyelid surgery is extremely low. However, the use of antibiotic prophylaxis has increased over the past 25 years in esthetic facial procedures. There is no standard of care for or against antibiotic prophylaxis, and routine practices vary widely. This leads to the question of whether reducing the risk of surgical-site infection to near zero outweighs the real danger of antibiotic-related complications, including the escalating emergence of antibiotic-resistant bacteria. No direct consensus can be drawn from the current literature; thus, at this time, there is no current standard of care for oral and maxillofacial surgeons to adhere to in terms of when and if antibiotic prophylaxis is needed when performing blepharoplasty.



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Table of Contents

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7





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Alternative Distraction Osteogenesis Technique After Implant Placement for Alveolar Ridge Augmentation of the Maxilla

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7
Author(s): Renato Luiz Maia Nogueira, Rafael Lima Verde Osterne, Ricardo Teixeira Abreu, Phelype Maia Araújo
An alternative technique to reconstruct atrophic alveolar vertical bone after implant placement is presented. The technique consists of distraction osteogenesis or direct surgical repositioning of an implant-and-bone block segment after segmental osteotomies that can be used in esthetic or unesthetic cases. Initially, casts indicating the implant position are obtained and the future ideal prosthetic position is determined to guide the model surgery. After the model surgery, a new provisional prosthesis is fabricated, and an occlusal splint, which is used as a surgical guide and a device for distraction osteogenesis, is custom fabricated. Then, the surgery is performed. For mobilization of the implant-and-bone block segment, 2 vertical osteotomies are performed and then joined by a horizontal osteotomy. The implant-and-bone block segment is moved to the planned position. If a small movement is planned, then the implant-and-bone segment is stabilized; for larger movements, the implant-and-bone segment can be gradually moved to the final position by distraction osteogenesis. This technique has good predictability of the final position of the implant-and-bone segment and relatively fast esthetic rehabilitation. It can be considered for dental implants in regions of vertical bone atrophy.



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AAOMS Author Disclosure forms

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7





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The Dynamic Landscape of Health Care Insurance—Implications for Our Specialty

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7
Author(s): James R. Hupp




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Masthead

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7





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Endoscope-Assisted Resection of Elongated Styloid Process Through a Retroauricular Incision: A Novel Surgical Approach to Eagle Syndrome

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7
Author(s): Renhui Chen, Faya Liang, Ping Han, Qian Cai, Shitong Yu, Xiaoming Huang
PurposeConventional resection of the elongated styloid process is associated with large-scale tissue dissection and poor surgical exposure. The purpose of this study was to show the feasibility, efficacy, and safety of a novel surgical approach using an endoscopic technique to treat Eagle syndrome.Materials and MethodsThe authors implemented a retrospective cohort study composed of 133 patients undergoing endoscope-assisted styloidectomy (EAS) from June 2010 to August 2015 at a university teaching hospital. Outcome measurements included the length of the styloid process, blood loss, and duration of surgery. The simple verbal response scale for symptom relief, cosmetic appearance of the incision, and postoperative incision pain was used for the assessment of patients' subjective satisfaction.ResultsAll patients underwent EAS without conversion to conventional surgery. One hundred seven patients (80.5%) achieved complete relief of symptoms, with 20 (15%) achieving partial relief. The residual length of the styloid process was 10.1 ± 4.4 mm. One hundred seventy-two incision sides (75.8%) had no pain during the postoperative evaluation. One side (0.4%) showed slight transient facial paresis and 4 sides (1.8%) presented transient ear numbness. The vast majority of patients (122 of 133; 91.7%) considered the cosmetic appearance of the incision to be excellent.ConclusionsThe results of this study suggest that EAS provides a viable surgical approach for Eagle syndrome in efficacy and safety.



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Improving Surgeons' Comfort With Prismatic Glasses During Cleft Palate Surgery: Preliminary Findings

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7
Author(s): Hai Kuang, Guosheng Chen, Qitao Wen, Shuai Li, Lei Chen, Feixin Liang
PurposeWe aimed to observe the effect of prismatic glasses on improving surgeons' comfort during cleft palate surgery.Materials and MethodsA within-subjects design was used. We included 3 oral-maxillofacial surgeons and 6 patients with complete cleft palate in the study. One group of cleft palate patients (3 complete cleft palates) was allocated to each of the 3 surgeons not wearing prismatic glasses, and another similar group of cleft palate patients was allocated to the same 3 surgeons wearing prismatic glasses. The push-back method was performed in all cleft palate patients by all surgeons. The degree of neck flexion exhibited by all surgeons was digitally video recorded. Screen-capture images of the video recordings were collected, and neck flexion in all video recordings was analyzed. All surgeons completed a questionnaire based on a visual analog scale to assess their discomfort symptoms of the neck, shoulders, and back. Operative time and bleeding volume were recorded to assess operational efficiency.ResultsUse of prismatic glasses significantly reduced surgeons' working time spent in pronounced neck flexion during cleft palate surgery (P < .05), and there was a statistically significant reduction in the visual analog scale discomfort scores for the neck, back, and shoulders with the use of prismatic glasses (P < .05). However, no significant difference was found in operational time (P = .337) and bleeding volume (P = .183) attributable to the presence or absence of prismatic glasses.ConclusionsAn ergonomic approach to cleft palate surgery in which surgeons wore prismatic glasses improved neck, back, and shoulder comfort.



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Which Factors Affect Citation Rates in the Oral and Maxillofacial Surgery Literature?

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7
Author(s): Kristie L. Cheng, Thomas B. Dodson, Mark A. Egbert, Srinivas M. Susarla
PurposeCitation rate is one of several tools to measure academic productivity. The purposes of this study were to estimate and identify factors associated with citation rates in the oral and maxillofacial surgery (OMS) literature.Materials and MethodsThis was a retrospective longitudinal study of publications in the Journal of Oral and Maxillofacial Surgery (JOMS), International Journal of Oral and Maxillofacial Surgery (IJOMS), and Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology (OOOO) from January through December 2012. The predictor variables were author- and article-specific factors. The outcome variable was the citation rate, defined as the total number of citations for each article over a 4-year period. Descriptive, bivariate, and multiple regression statistics were computed.ResultsThe authors identified 993 articles published during 2012. The mean number of citations at 4 years after publication was 5.6 ± 5.3 (median, 4). In bivariate analyses, several author- and article-specific factors were associated with citation rates. In a multiple regression model adjusting for potential confounders and effect modifiers, first author H-index, number of authors, journal, OMS focus area, and Oxford level of evidence were significantly associated with citation rate (P ≤ .002).ConclusionThe authors identified 5 factors associated with citation rates in the OMS literature. These factors should be considered in context when evaluating citation-based metrics for OMS. Studies that focus on core OMS procedures (eg, dentoalveolar surgery, dental implant surgery), are published in specialty-specific journals (eg, JOMS or IJOMS), and have higher levels of evidence are more likely to be cited.



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Hematolymphoid Tumors of the Head and Neck

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7
Author(s): Eric R. Carlson




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Transalveolar Osteotomy of the Mandibular Canal Wall for the Treatment of Severely Atrophied Posterior Mandible

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7
Author(s): Eduardo Anitua, Sabino Padilla, Mohammad H. Alkhraisat
PurposeTreatment of severe bone atrophy of the posterior mandible requires an advanced surgical bone augmentation technique. This report describes a minimally invasive approach for a residual alveolar height less than 5 mm.Material and MethodsA retrospective case series was conducted in a single private dental clinic. Outcome variables were dental implant survival rate, intraoperative complications, occurrence of neurosensory disturbances, and marginal bone loss. Descriptive analysis was performed for patients' demographic data, postoperative healing, and implant details. Kaplan-Meier method was used to assess the implant survival rate.ResultsThe mean age of the 19 patients was 60 ± 13 years. Twenty-eight implants (5.5 mm long) were placed in a residual alveolar bone height of 4.5 ± 0.6 mm. The implant survival rate was 96% at 5-year follow-up.ConclusionsExtra-short implants and transalveolar preparation of the inferior alveolar cortical bone could be a safe and effective treatment of severe mandibular atrophy.



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Multicenter Retrospective Study of the Risk Factors of Hemorrhage After Tooth Extraction in Patients Receiving Antiplatelet Therapy

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7
Author(s): Souichi Yanamoto, Takumi Hasegawa, Satoshi Rokutanda, Sayaka Komori, Akira Tachibana, Yuka Kojima, Yoshito Koyama, Yasuyuki Shibuya, Hiroshi Kurita, Takahide Komori, Masahiro Umeda
PurposeTo identify the risk factors affecting hemorrhage after tooth extraction in patients receiving antiplatelet therapy, this study investigated the relation between various factors and hemorrhage events after tooth extraction.Patients and MethodsThe records of 264 patients receiving antiplatelet therapy who underwent tooth extraction were retrospectively reviewed from 6 institutions belonging to the Japanese Study Group of Cooperative Dentistry with Medicine. Demographic information, hemorrhage events after tooth extraction, the presence or absence of comorbidities, antiplatelet agent, the use of preoperative antibiotics or nonsteroidal anti-inflammatory drugs, number of teeth extracted, serum creatinine level, estimated glomerular filtration rate, and alanine transaminase level were assessed. Risk factors for hemorrhage after tooth extraction were evaluated by univariate and multivariate analyses.ResultsThe study population of 264 patients consisted of 153 men and 111 women with a mean age of 73.6 years (range, 24 to 96 yr). Six hundred ninety-four teeth were extracted (mean, 2.6 ± 2.3 teeth per patient). In patients receiving antiplatelet therapy, the frequency of hemorrhage after tooth extraction, including mild and self-controlled hemorrhages, was 17.4%. Univariate analysis showed that serum creatinine level and dual antiplatelet therapy were correlated with hemorrhage after tooth extraction (P = .001 and P = .049, respectively). Only serum creatinine was identified as an independent risk factor for hemorrhage after tooth extraction in patients receiving antiplatelet therapy (P = .037).ConclusionsThe risk of hemorrhage after tooth extraction is increased in patients receiving dual antiplatelet therapy with or without chronic kidney disease. Local hemostatic treatments, such as at least suturing, are recommended.



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Primary Lacrimal Sac Melanoma With Metastatic Cervical Disease: A Review of the Literature and Case Report

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7
Author(s): Shiva S. Subramaniam, Rajiv Anand, Timothy K. Mellor, Peter A. Brennan
Primary melanoma arising from the nasolacrimal sac is a rare form of mucosal melanoma, with only 30 cases previously reported in the literature and none reporting cervical metastatic disease. Given the extremely rare nature of this disease, specific guidelines for staging and intervention are impractical and do not exist. As such, case presentations have formed the basis for management. This report describes the only case to the authors' knowledge of primary nasolacrimal sac mucosal melanoma with cervical metastatic disease at the time of diagnosis, which was detected only with positron emission tomographic computer tomography, and briefly reviews the existing published cases to help assist in the development of a general algorithm for patient care.



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Loss of PTEN Expression Is Associated With High MicroRNA 24 Level and Poor Prognosis in Patients With Tongue Squamous Cell Carcinoma

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7
Author(s): Jingzhu Zhao, Jiadong Chi, Ming Gao, Jingtai Zhi, Yigong Li, Xiangqian Zheng
PurposeThe aim of this study was to detect the relationship between phosphatase and tensin homolog deletion on chromosome 10 (PTEN) and microRNA 24 (miR-24) and correlate PTEN expression with important clinical parameters of patients with tongue squamous cell carcinoma (TSCC).Materials and MethodsIn this retrospective case series, all TSCC patients treated at Tianjin Medical University Cancer Institute and Hospital between March 2005 and October 2011 were retrospectively reviewed. Demographic information and clinical data (histologic type, clinical stage, tumor differentiation, and so on) were collected. The miR-24 level was detected by quantitative reverse transcription–polymerase chain reaction. The PTEN level was analyzed by immunohistochemistry and quantitative reverse transcription–polymerase chain reaction. Data analyses were performed by Spearman correlation analysis, Pearson χ² test, and paired t test. Kaplan-Meier curves, log-rank analyses, and a Cox proportional hazards model were used to evaluate the prognostic value of PTEN.ResultsA total of 90 patients (aged 59.4 ± 9.5 years, 53 men and 37 women) were identified. Loss of PTEN expression was detected in 28 of 90 tumors (31.1%). The PTEN messenger RNA level was negatively correlated with the miR-24 level (r = −0.569, P < .01). PTEN expression also was negatively correlated with the miR-24 level (r = −0.621, P < .01). Furthermore, PTEN expression was significantly lower in cancer tissues than in adjacent normal tissues, and its expression was negatively correlated with clinical stage (P < .01) and positively correlated with differentiation (P < .05) in TSCC patients. In addition, the Kaplan-Meier curve indicated that loss of PTEN expression resulted in poor survival of TSCC patients (P < .01). Multivariate analysis indicated that PTEN expression level and clinical stage may be independent prognostic factors for TSCC patients.ConclusionsThis study suggested that PTEN expression was negatively correlated with the miR-24 level in TSCC. The loss of PTEN expression may serve as a predictor of unfavorable prognosis for TSCC patients.



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Biomechanical Evaluation of Different Plating Methods Used in Mandibular Angle Fractures With 3-Dimensional Finite Element Analysis: Favorable Fractures

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7
Author(s): Aysa Ayali, Erkan Erkmen
PurposeThe aim of the present study was to evaluate the performances of 5 different plating techniques for fixation of favorable mandibular angle fractures using the 3-dimensional finite element analysis (FEA) method.Materials and MethodsFive different miniplate placement configurations were considered for the fixation of favorable mandibular angle fractures. The following models were created: a double parallel miniplate (M1) placed at the halfway point of the mandibular angle height; a one-third superior-positioned miniplate (M2); a single miniplate (M3) placed at the halfway point of the mandibular angle height (one-half middle-positioned); a one-third inferior-positioned miniplate (M4); and an X-shape miniplate (M5).ResultsThe M1 and M4 miniplates showed the lowest mechanical stress compared with the other configurations, whereas the M3 and M5 miniplates showed the highest stress levels.ConclusionFor favorable mandibular angle fractures, the authors suggest the M1 miniplate or, if used alone, the M4 miniplate is adequate for rigid fixation.



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How Is Third Molar Status Associated With the Occurrence of Mandibular Angle and Condyle Fractures?

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7
Author(s): Shuai Xu, Jun-jie Huang, Yu Xiong, Ying-hui Tan
PurposeThird molars (M3s) have been hypothesized to be associated with the risk of mandibular angle fracture and mandibular condylar fracture. The authors systematically estimated the relative risk (RR) of M3 status for the development of mandibular angle fracture and mandibular condylar fracture through a meta-analysis of cohort studies.Materials and MethodsIn this systematic review, the PubMed, EMBASE, and Cochrane Library databases were searched from inception to October 2016. The predictor of risk was the presence or absence of M3s. The primary outcome was the RR of mandibular angle or condylar fracture. A fixed- or a random-effects model was applied to evaluate the pooled risk estimates. Sensitivity analysis also was performed to identify the potential sources of heterogeneity. Publication bias was assessed by the Begg and Egger tests.ResultsOverall, 13 retrospective cohort studies were included. Of these, 13 reported the association between M3s and mandibular angle fracture, and 5 reported the association with mandibular condylar fracture. Patients with M3s had an increased risk of mandibular angle fractures (RR = 2.63; 95% confidence interval [CI], 2.15-3.21) but a decreased risk of mandibular condylar fractures (RR = 0.47; 95% CI, 0.25-0.86). Substantial heterogeneity in the risk estimates was found. No evidence of publication bias was found.ConclusionThe present meta-analysis provides further evidence associating the presence of M3s with an increased risk of mandibular angle fractures and a simultaneously decreased risk of mandibular condylar fracture. Because of potentially more serious complications associated with condylar fracture, clinicians should carefully consider the decision to remove M3s to decrease the risk of mandibular angle fracture.



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One-Step Surgical Correction of Transverse and Anteroposterior Maxillary Deficiencies Using Wire Fixation. A New Approach and Long-Term Stability

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7
Author(s): Max Domingues Pereira, Vivian Farfel, Gabriela Pereira Ribeiro Prado, Lydia Masako Ferreira
PurposeTo describe a retrospective assessment of the long-term stability of a new approach using wire fixation for 1-step surgical correction of transverse and anteroposterior maxillary deficiencies.Patients and MethodsThe authors implemented a case series of 5 adult patients (3 men and 2 women; mean age, 31.4 yr) needing maxillary advancement less than 5 mm and had transverse maxillary deficiency greater than 7 mm who underwent total Le Fort I and median palatal suture osteotomies and had their maxilla advanced and stabilized bilaterally with stainless steel wire. Transverse expansion was performed using a Hyrax expander, which also was used for retention for 4 months after completion of the planned expansion. Follow-up included clinical examination and studies of lateral radiographs and plaster models preoperatively (T0), soon after completion of maxillary expansion (T1), 4 months after T1 (T2), 12 months after T1 (T3), and an average of 4.8 years (minimum, 4 yr 1 month; maximum, 5 yr; standard deviation, 0.3 yr) after T1 (T4).ResultsMaxillary expansions measured at the most cervical points on the palatal face of the upper first premolars and of the upper first molars at T2 were 7.8 and 7.4 mm on average, respectively. In all cases, surgery promoted maxillary anteroposterior advancement. Anteroposterior maxillary skeletal measurements of the angle formed by the sella, nasion, and A point; the distance from the vertical reference line to the A point (A-VRL); the distance of the VRL to the cementoenamel junction (CEJ); and the distance from the perpendicular line of the nasion (Nperp) to the CEJ showed a substantially increase at T1 (P < .05) and stability at T2, T3, and T4; however, A-VRL presented a significant relapse at T4 compared with T1 (P = .037) and T2 (P = .027). The soft tissues expanded at the same rate as the skeletal tissues. The anteroposterior soft tissue measurements Nperp to superior lip and Nperp to the A′ point showed a substantial increase at T2 (P < .05) and stability at T3 and T4. The measurements associated with anteroposterior correction were stable at T4.ConclusionThe proposed technique provides long-term stability of maxillary expansion and anteroposterior repositioning with only 1 surgical intervention. However, considering the small number of patients, a multicenter study is needed before a definitive conclusion can be reached.



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Effectiveness of Corticoid Administration in Orthognathic Surgery for Edema and Neurosensorial Disturbance: A Systematic Literature Review

Publication date: July 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 7
Author(s): Valthierre Nunes de Lima, Cleidiel Aparecido Arauj Lemos, Leonardo Perez Faverani, Joel Ferreira Santiago Júnior, Eduardo Piza Pellizzer
PurposeThe aim of this systematic review was to evaluate the effect of corticosteroid (CS) administration on edema and neural regeneration in orthognathic surgery.Materials and MethodsA systematic literature search was conducted using the PubMed (Medline), Cochrane Library, and Scopus databases. The PICO approach was used, in which patients with skeletal dentofacial deformity composed the population; uni- or bimaxillary orthognathic surgery composed the intervention; administration versus no administration of CSs composed the comparison; and decrease in postoperative edema and neurosensory disorders composed the outcome. Thirty of 240 articles were selected and evaluated for their titles and abstracts in relation to the inclusion and exclusion criteria. After duplicate references were eliminated, 8 articles remained.ResultsPatients who used CSs had lower rates of edema. In fact, after 4 months, there were no remarkable edema rates. These results suggest that neurosensory disorders resolved after 3 months. In addition, in the early and late periods, administration of CSs did not influence the regression of neurosensory disorders.ConclusionsAdministering CSs in orthognathic surgery improved the regression of facial edema independent of the dosage used but did not influence neurosensory disorders.



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Health-related quality of life, fear of recurrence, and emotional distress in patients treated for thyroid cancer

Publication date: Available online 23 June 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S.N. Rogers, V. Mepani, S. Jackson, D. Lowe
Diagnosis of differentiated thyroid carcinoma (papillary or follicular) and its treatment may be associated with a poor health-related quality of life (HRQoL), and with fear of recurrence (FoR), and distress. To our knowledge, this is the first time a single FoR screening question (written to complement a HRQoL questionnaire), has been reported with HRQoL and levels of distress in patients treated for the disease. In April 2014 we did a cross-sectional survey of patients who had presented to the Merseyside and Cheshire thyroid cancer network between April 2009 and November 2013. Questionnaires comprised the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, the THYCA-QoL, the Emotion Thermometers, and the new FoR screening item. A total of 249 surveys were sent and 169 patients responded (68%). The most prevalent issues included tiredness, problems with sleep and needing to rest, pain (particularly in muscles and joints), a dry mouth, hot flushes and tolerating heat, gaining weight, and feeling slowed down or weak; also, having trouble taking long walks or doing strenuous activities, feeling tense, worried, irritable, and anxious, and having difficulty remembering things. One in seven patients (95% CI 9% to 21%) responded to the single FoR question that they "had a lot of fears of recurrence that really preoccupied their thoughts" or were "fearful all the time that their cancer might return and that they struggled with this". Distress overall was relatively low. In conclusion, the HRQoL issues reported by these patients were different from those reported by patients with other cancers of the head and neck. It would be helpful to identify FoR in a subgroup of patients with differentiated thyroid cancer so that they could be given additional support.



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Should we be taking the p (value) out of statistics?

Publication date: Available online 23 June 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A.B. Smith




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CHMP Recommends Imraldi, a Biosimilar to Humira

The CHMP has recommended Imraldi, a biosimilar to Humira.
International Approvals

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Gamma radiation increases the risk of radiation-related root dental caries

The association between radiation exposure and dental caries has been widely discussed. Several factors contribute to dentition breakdown and radiation-related caries (RRC) development but this condition has previously been associated to be an indirect effect due to radiation-induced salivary gland damage [1,2]. It is well known that radiotherapy of head-and-neck induces damage to the salivary glands, which means that patients with chronic hyposalivation are at high-risk for RRC development and progression [3].

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Formation of an international intergroup to coordinate clinical trials in head and neck cancers: HNCIG

Clinical trials in head and neck cancer (HNC) face multiple challenges including low global incidence, excessive patient comorbidity rate, high treatment-related toxicity and more recently a changing tumor biology landscape. As clinical trials evolve to address new knowledge about HNC biology, the overall pool of eligible patients for each trial becomes smaller, leading to more accrual challenges. These challenges have led to the formation of the Head and Neck Cancer Intergroup (HNCIG) comprised of large HNC international and national cooperative groups and sites with the goal of facilitating the conduct of high quality clinical trials in a timely manner to improve outcomes in HNC.

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Hearing loss in enlarged vestibular aqueduct and incomplete partition type II

Publication date: Available online 23 June 2017
Source:American Journal of Otolaryngology
Author(s): Emily Ahadizadeh, Mustafa Ascha, Nauman Manzoor, Amit Gupta, Maroun Semaan, Cliff Megerian, Todd Otteson
PurposeThe purpose of this work is to identify the role of incomplete partition type II on hearing loss among patients with enlarged vestibular aqueduct (EVA).BackgroundEVA is a common congenital inner ear malformation among children with hearing loss, where vestibular aqueduct morphology in this population has been shown to correlate to hearing loss. However, the impact of incomplete partition between cochlear turns on hearing loss has not been, despite meaningful implications for EVA pathophysiology.MethodsA retrospective review of radiology reports for patients who had computed tomography (CT) scans with diagnoses of hearing loss at a tertiary medical center between January 2000 and June 2016 were screened for EVA. CT scans of the internal auditory canal (IAC) for those patients with EVA were examined for evidence of incomplete partition type II (IP-II), measurements of midpoint width and operculum width a second time, and patients meeting Cincinnati criteria for EVA selected for analysis. Statistical analysis including chi-square, Wilcoxon rank-sum, and t-tests were used to identify differences in outcomes and clinical predictors, as appropriate for the distribution of the data. Linear mixed models of hearing test results for all available tests were constructed, both univariable and adjusting for vestibular aqueduct morphometric features, with ear-specific intercepts and slopes over time.ResultsThere were no statistically significant differences in any hearing test results or vestibular aqueduct midpoint and operculum widths. Linear mixed models, both univariable and those adjusting for midpoint and operculum widths, did not indicate a statistically significant effect of incomplete partition type II on hearing test results.ConclusionsHearing loss due to enlarged vestibular aqueduct does not appear to be affected by the presence of incomplete partition type II. Our results suggest that the pathophysiological processes underlying hearing loss in enlarged vestibular aqueduct may not be a result of cochlear malformation, and instead are more likely to involve vestibular aqueduct or cellular and molecular-level mechanisms of hearing loss.



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The landmark for removal of sialoliths using sialendoscopy alone in parotid gland sialolithiasis

Publication date: Available online 23 June 2017
Source:Auris Nasus Larynx
Author(s): Norio Kondo, Toshio Yoshihara, Yukie Yamamura, Kaoru Kusama, Eri Sakitani, Yukako Seo, Mayako Tachikawa, Keiko Kujirai, Erika Ono, Yasuyo Maeda, Tomohito Nojima, Akiko Tamiya, Emiri Sato, Manabu Nonaka
ObjectiveTo assess the general guidelines for removal of sialoliths in parotid gland sialolithiasis using sialendoscopy alone.MethodsWe analyzed 34 sialoliths treated using sialendoscopy in 26 patients with parotid gland sialolithiasis. We divided the Stensen's duct and parotid gland into for parts using computed tomography findings: (A) front of the masseter, (B) anterior and lateral to the center (anterolateral) of the masseter, (C) posterior and lateral to the center (posterolateral) of the masseter, (D) behind of the masseter. The location and size of each sialolith was assessed.ResultsThe removal rates of sialoliths in the different locations by sialendoscopy alone were as follows: front of the masseter, 68.8%; anterolateral of the masseter, 60.0%; posterolateral of the masseter, 0%; and behind of the masseter, 33.3%. The removal rate using sialendoscopy alone was significantly higher in the sections anterior to the center of the masseter than in those posterior to the center of the masseter (66.7% [14/21] vs. 20.0% [2/10]; P=0.019). The size of the sialolith was not correlated to the removal rate by sialendoscopy alone.ConclusionSialoliths of the parotid gland located in positions anterior to the center of the masseter are significantly easier to remove by sialendoscopy alone. The center of the masseter is a general landmark for removal of sialoliths from the parotid gland using sialendoscopy alone. The size of the sialolith is not correlated with removal, except rare huge sialoliths.



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The outcomes of endoscopic management in young children with subglottic stenosis

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Chao Chen, Wei-hua Ni, Tan-le Tian, Zheng-min Xu
Subglottic stenosis (SGS) is a common cause of obstructed airway in children, and the treatment of pediatric SGS, especially congenital SGS, remains a challenge for the otolaryngologist.ObjectiveTo analyze the outcomes of endoscopic management in young children with SGS.MethodsWe performed a retrospective review of treatment with endoscopic balloon dilation (EBD) or EBD combined with endoscopic anterior cricoid split (EACS) for young SGS children, from December 2008 to December 2015. The ages of patients ranged from 2 days to 12 years, median age was 5 months. The grade of them ranged from II to IV.ResultsFor acute acquired SGS, 19 cases received EBD alone and the other 3 cases received EBD and EACS, the success rate was about 95.5%; For chronic acquired SGS, EBD and EACS was performed in 6 patients with a success rate of 66.7%; For congenital SGS, EBD and EACS was performed in 28 patients with a success rate of 85.7%. Overall, the success rate of endoscopic management in 56 young children was about 87.5%. Besides, No procedure-related complications were observed in any patients.ConclusionsEndoscopic surgical technique offers a safe and effective approach for treatment of young children with SGS, especially in congenital SGS.



http://ift.tt/2sLDMpH

A case of improved hearing with cochlear implantation in Gaucher disease type 1

Gaucher disease is a lysosomal storage disorder that is caused by congenital defective function of the enzyme glucocerebrosidase. Glucocerebroside that is not hydrolyzed by glucocerebrosidase mainly accumulates in the reticular tissue. We describe a Japanese boy with Gaucher disease type 1 who developed bilateral profound sensorineural hearing loss within approximately 4years. We performed cochlear implantation initially on his right ear and again on his left ear 5 months later. The cochlear implants were successfully utilized with a speech discrimination score of 95% on a Japanese sentence recognition test.

http://ift.tt/2t0ON8z

Neck metastasis in patients with T1-2 supraglottic cancer

Unlike glottic cancer, supraglottic cancer often presents with neck metastases. This different might be attributable to the location of the primary lesion. This study aimed to clarify the relationships between the sublocation of T1-2 supraglottic cancer, human papillomavirus (HPV) infection, neck metastasis, and prognosis of supraglottic cancer.

http://ift.tt/2tYiq7L

Health-related quality of life, fear of recurrence, and emotional distress in patients treated for thyroid cancer

Diagnosis of differentiated thyroid carcinoma (papillary or follicular) and its treatment may be associated with a poor health-related quality of life (HRQoL), and with fear of recurrence (FoR), and distress. To our knowledge, this is the first time a single FoR screening question (written to complement a HRQoL questionnaire), has been reported with HRQoL and levels of distress in patients treated for the disease. In April 2014 we did a cross-sectional survey of patients who had presented to the Merseyside and Cheshire thyroid cancer network between April 2009 and November 2013.

http://ift.tt/2t4zlbM

Use of a three-dimensional custom-made porous titanium prosthesis for mandibular body reconstruction

The progress made in recent years in the field of head and neck bone reconstruction is directly related to technological advancements made in computer-aided design and manufacturing (CAD/CAM) and three-dimensional printing in particular. Today these technologies are mainly used in mandibular reconstruction to manufacture aids for harvesting and shaping bone flaps. However problems remain when addressing patients with a contraindication to microsurgery who need extensive bone reconstruction. For these patients who cannot benefit from vascularized bone grafts, surgeons have to find alternative solutions aimed at maintaining best function and aesthetics.

http://ift.tt/2s0ZB7s

Reproduction of the atopic march in an adult after allogeneic bone marrow transplantation from an atopic sibling

Allogeneic bone marrow transplantation (BMT) or hematopoietic stem cell transplantation is an established treatment for several hematologic disorders, such as severe aplastic anemia, leukemia, or severe combined immunodeficiency, among others. Transfer of specific IgE (sIgE)–mediated hypersensitivity after allogeneic BMT to a previously nonallergic recipient has been described.1,2 A prospective study found a long-term allergen sIgE-mediated hypersensitivity transferred during BMT.3 Another study found the appearance of a new allergen sIgE after BMT from atopic donors, suggesting that the atopic condition was transferred from the donor to the recipient.

http://ift.tt/2t0qI1w

Positional and ultrastructural changes in peripheral pulp capillaries correlate with the active phase of dentin deposition and mineralization in rat molars

Publication date: Available online 23 June 2017
Source:Journal of Oral Biosciences
Author(s): Yuta Seino, Yoshiro Takano, Hayato Ohshima
ObjectivesThe mechanisms regulating positional and ultrastructural changes in peripheral pulp capillaries during dentinogenesis have yet to be fully elucidated. This study aimed to clarify the relationship between the spatiotemporal localization and ultrastructure of peripheral capillaries and the dentin deposition and mineralization rate.MethodsMaxillary first molars of 5- to 100-day-old Wistar rats were collected and prepared for transmission electron microscopy. The animals who had received multiple injections of lead disodium ethylenediaminetetraacetic acid were analyzed for dentin deposition rate. Non-demineralized maxillae were examined with an electron probe micro analyzer.ResultsThe dentin deposition rate at the coronal position where dentinogenesis began on day 5 reached a peak during days 10–30, gradually decreased, and ceased on day 60. The mineral content of enamel was low on day 10 (the secretory stage of amelogenesis), drastically increased on day 15 (the maturation stage of amelogenesis), and reached a maximum and persisted until day 30. The dentin underneath the maturing enamel exhibited a synchronous increase in mineral content. The distance between the mineralization front and peripheral capillaries remained almost constant, suggesting that the positional changes of capillaries into the odontoblast layer were not due to migration of capillaries but could be attributed to an increase in the height of the odontoblast layer. Endothelial fenestrations became prominent in the most active phase of dentin deposition and mineralization.ConclusionsThese results indicate that the positional and ultrastructural changes in peripheral capillaries correlate with the active phase of dentin deposition and mineralization.



http://ift.tt/2rLrKeq

PTH monitoring after total parathyroidectomy with forearm auto-transplantation: potential for spuriously high levels from grafted forearm

We have identified a cause of falsely elevated parathyroid hormone (PTH) levels after total parathyroidectomy with forearm auto-transplantation (TPT-ATx). Our cases highlight the need to draw PTH samples remot...

http://ift.tt/2rL55Pz

Facial soft tissue response to maxillo-mandibular advancement in obstructive sleep apnea syndrome patients

Facial profile soft tissue changes after orthognathic surgery are crucial for surgery success. This retrospective study evaluated soft tissue changes after maxillo-mandibular Advancement and counter clockwise ...

http://ift.tt/2rL05uc

Rhesus Cochlear and Vestibular Functions Are Preserved After Inner Ear Injection of Saline Volume Sufficient for Gene Therapy Delivery

Abstract

Sensorineural losses of hearing and vestibular sensation due to hair cell dysfunction are among the most common disabilities. Recent preclinical research demonstrates that treatment of the inner ear with a variety of compounds, including gene therapy agents, may elicit regeneration and/or repair of hair cells in animals exposed to ototoxic medications or other insults to the inner ear. Delivery of gene therapy may also offer a means for treatment of hereditary hearing loss. However, injection of a fluid volume sufficient to deliver an adequate dose of a pharmacologic agent could, in theory, cause inner ear trauma that compromises functional outcome. The primary goal of the present study was to assess that risk in rhesus monkeys, which closely approximates humans with regard to middle and inner ear anatomy. Secondary goals were to identify the best delivery route into the primate ear from among two common surgical approaches (i.e., via an oval window stapedotomy and via the round window) and to determine the relative volumes of rhesus, rodent, and human labyrinths for extrapolation of results to other species. We measured hearing and vestibular functions before and 2, 4, and 8 weeks after unilateral injection of phosphate-buffered saline vehicle (PBSV) into the perilymphatic space of normal rhesus monkeys at volumes sufficient to deliver an atoh1 gene therapy vector. To isolate effects of injection, PBSV without vector was used. Assays included behavioral observation, auditory brainstem responses, distortion product otoacoustic emissions, and scleral coil measurement of vestibulo-ocular reflexes during whole-body rotation in darkness. Three groups (N = 3 each) were studied. Group A received a 10 μL transmastoid/trans-stapes injection via a laser stapedotomy. Group B received a 10 μL transmastoid/trans-round window injection. Group C received a 30 μL transmastoid/trans-round window injection. We also measured inner ear fluid space volume via 3D reconstruction of computed tomography (CT) images of adult C57BL6 mouse, rat, rhesus macaque, and human temporal bones (N = 3 each). Injection was well tolerated by all animals, with eight of nine exhibiting no signs of disequilibrium and one animal exhibiting transient disequilibrium that resolved spontaneously by 24 h after surgery. Physiologic results at the final, 8-week post-injection measurement showed that injection was well tolerated. Compared to its pretreatment values, no treated ear's ABR threshold had worsened by more than 5 dB at any stimulus frequency; distortion product otoacoustic emissions remained detectable above the noise floor for every treated ear (mean, SD and maximum deviation from baseline: −1.3, 9.0, and −18 dB, respectively); and no animal exhibited a reduction of more than 3 % in vestibulo-ocular reflex gain during high-acceleration, whole-body, passive yaw rotations in darkness toward the treated side. All control ears and all operated ears with definite histologic evidence of injection through the intended site showed similar findings, with intact hair cells in all five inner ear sensory epithelia and intact auditory/vestibular neurons. The relative volumes of mouse, rat, rhesus, and human inner ears as measured by CT were (mean ± SD) 2.5 ± 0.1, 5.5 ± 0.4, 59.4 ± 4.7 and 191.1 ± 4.7 μL. These results indicate that injection of PBSV at volumes sufficient for gene therapy delivery can be accomplished without destruction of inner ear structures required for hearing and vestibular sensation.

http://ift.tt/2rZmnN7

Rhesus Cochlear and Vestibular Functions Are Preserved After Inner Ear Injection of Saline Volume Sufficient for Gene Therapy Delivery

Abstract

Sensorineural losses of hearing and vestibular sensation due to hair cell dysfunction are among the most common disabilities. Recent preclinical research demonstrates that treatment of the inner ear with a variety of compounds, including gene therapy agents, may elicit regeneration and/or repair of hair cells in animals exposed to ototoxic medications or other insults to the inner ear. Delivery of gene therapy may also offer a means for treatment of hereditary hearing loss. However, injection of a fluid volume sufficient to deliver an adequate dose of a pharmacologic agent could, in theory, cause inner ear trauma that compromises functional outcome. The primary goal of the present study was to assess that risk in rhesus monkeys, which closely approximates humans with regard to middle and inner ear anatomy. Secondary goals were to identify the best delivery route into the primate ear from among two common surgical approaches (i.e., via an oval window stapedotomy and via the round window) and to determine the relative volumes of rhesus, rodent, and human labyrinths for extrapolation of results to other species. We measured hearing and vestibular functions before and 2, 4, and 8 weeks after unilateral injection of phosphate-buffered saline vehicle (PBSV) into the perilymphatic space of normal rhesus monkeys at volumes sufficient to deliver an atoh1 gene therapy vector. To isolate effects of injection, PBSV without vector was used. Assays included behavioral observation, auditory brainstem responses, distortion product otoacoustic emissions, and scleral coil measurement of vestibulo-ocular reflexes during whole-body rotation in darkness. Three groups (N = 3 each) were studied. Group A received a 10 μL transmastoid/trans-stapes injection via a laser stapedotomy. Group B received a 10 μL transmastoid/trans-round window injection. Group C received a 30 μL transmastoid/trans-round window injection. We also measured inner ear fluid space volume via 3D reconstruction of computed tomography (CT) images of adult C57BL6 mouse, rat, rhesus macaque, and human temporal bones (N = 3 each). Injection was well tolerated by all animals, with eight of nine exhibiting no signs of disequilibrium and one animal exhibiting transient disequilibrium that resolved spontaneously by 24 h after surgery. Physiologic results at the final, 8-week post-injection measurement showed that injection was well tolerated. Compared to its pretreatment values, no treated ear's ABR threshold had worsened by more than 5 dB at any stimulus frequency; distortion product otoacoustic emissions remained detectable above the noise floor for every treated ear (mean, SD and maximum deviation from baseline: −1.3, 9.0, and −18 dB, respectively); and no animal exhibited a reduction of more than 3 % in vestibulo-ocular reflex gain during high-acceleration, whole-body, passive yaw rotations in darkness toward the treated side. All control ears and all operated ears with definite histologic evidence of injection through the intended site showed similar findings, with intact hair cells in all five inner ear sensory epithelia and intact auditory/vestibular neurons. The relative volumes of mouse, rat, rhesus, and human inner ears as measured by CT were (mean ± SD) 2.5 ± 0.1, 5.5 ± 0.4, 59.4 ± 4.7 and 191.1 ± 4.7 μL. These results indicate that injection of PBSV at volumes sufficient for gene therapy delivery can be accomplished without destruction of inner ear structures required for hearing and vestibular sensation.

http://ift.tt/2rZmnN7

Clinical Thyroidology High-Impact Articles

FREE ACCESS through July 5, 2017.
Read Now:

Persistent Hyperthyroidism Is Associated with Increased Mortality
Stephen W. Spaulding

Patients with Toxic Nodular Goiter and Graves' Disease Are at Increased Risk for All-Cause and Cardiovascular Mortality
Elizabeth N. Pearce

Levothyroxine Does Not Lower Hypothyroidism Symptoms in Older Adults with Mild Subclinical Hypothyroidism
Tim I. M. Korevaar

High-Intensity Focused Ultrasound Is Useful in the Treatment of Symptomatic Benign Thyroid Nodules
Stephanie A. Fish

The post Clinical Thyroidology High-Impact Articles appeared first on American Thyroid Association.

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Sustained PASI, DLQI and EQ-5D response of biological treatment in psoriasis: 10 years of real-world data in the Swedish National Psoriasis Register

Summary

Background

Few studies have analysed the long-term effects of biological treatment in psoriasis. PsoReg, the Swedish national register for systemic psoriasis treatment, started in 2006 and includes now ten years of real-world data on effectiveness of biological treatment.

Objective

To analyse long-term real-world outcome data on biological-naïve patients with moderate to severe psoriasis after switching to biological treatment.

Methods

Observational study including biological-naïve patients with at least one registration of outcome before switching to biological treatment while included in PsoReg and at least one follow-up visit. PASI, DLQI and EQ-5D values were analysed at 3-5 months, 6-11 months, and at least once 1 year and above, up to 9 years after switch to biological treatment.

Results

583 patients fulfilled the inclusion criteria. Of these, 399/395/373 patients had observed outcome data beyond one year on PASI/DLQI/EQ-5D, respectively, and 164/168/152 were observed in at least three time periods after switch. Significant (p<0.01) improvement in PASI, DLQI and EQ-5D was observed 3-5 months after switch and sustained under the whole observation period. Mean PASI/DLQI/EQ-5D changed from 13.5 (SD 9.1)/9.0 (SD 8.1)/0.737 (SD 0.222), respectively, before switch, to 4.0 (SD 3.5)/3.7 (SD 4.7)/0.792 (SD 0.208), respectively, 1-5 years after switch.

Conclusion

Biological treatment, as used in clinical practice, show a stable long term effectiveness in all measured dimensions: PASI, DLQI and EQ-5D.

This article is protected by copyright. All rights reserved.

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RNAi knock-down of the Bemisia tabaci Toll gene (BtToll) increases mortality after challenge with destruxin A

Publication date: August 2017
Source:Molecular Immunology, Volume 88
Author(s): Can Zhang, Shao-Qiao Yan, Bin-Bin Shen, Shaukat Ali, Xing-Min Wang, Feng-Liang Jin, Andrew G.S. Cuthbertson, Bao-Li Qiu
Bemisia tabaci (Gennadius) Middle East-Asia Minor 1 (MEAM1) is a well known invasive insect species. Little information is available on immune system of B. tabaci to date. In this study, one of the Toll-like receptors (TLR; namely BtToll) was cloned in MEAM1 B. tabaci which contains an open reading frame of 3153bp, encoding putative 1050 amino acids. Phylogenetic analysis indicated that BtToll is highly identitical with other members of the TLR family. Transcripts of BtToll detected through qRT-PCR were expressed in all developmental stages of B. tabaci and the highest expression level was observed in the 3rd nymphal instar. BtToll was highly expressed in response to immune challenge. RNA interference was used to knockdown the BtToll expression in adults through the oral route which resulted in significant reduction of BtToll transcript. When the adults were challenged with a mycotoxin from entomogenous fungi − destruxin A (DA) and RNAi, the median lethal concentration (LC50) decreased by 70.67% compared to DA treatment only. Our results suggest that BtToll is an important component of the B. tabaci immune system. RNAi technology using dsToll combined with general control methods (using toxin only) can be used as a potential strategy in integrated B. tabaci management programs.



http://ift.tt/2sKi1GM

Comparison of the miRNA expression profiles in fresh frozen and formalin-fixed paraffin-embedded tonsillar tumors

by Zuzana Vojtechova, Jiri Zavadil, Jan Klozar, Marek Grega, Ruth Tachezy

MicroRNAs are considered as promising prognostic and diagnostic biomarkers of human cancer since their profiles differ between tumor types. Most of the tumor profiling studies were performed on rarely available fresh frozen (FF) samples. Alternatively, archived formalin-fixed paraffin-embedded (FFPE) tissue samples are also well applicable to larger-scale retrospective miRNA profiling studies. The aim of this study was to perform systematic comparison of the miRNA expression profiles between FF and macrodissected FFPE tonsillar tumors using the TaqMan Low Density Array system, with the data processed by different software programs and two types of normalization methods. We observed a marked correlation between the miRNA expression profiles of paired FF and FFPE samples; however, only 27-38% of the differentially deregulated miRNAs overlapped between the two source systems. The comparison of the results with regard to the distinct modes of data normalization revealed an overlap in 58–67% of differentially expressed miRNAs, with no influence of the choice of software platform. Our study highlights the fact that for an accurate comparison of the miRNA expression profiles from published studies, it is important to use the same type of clinical material and to test and select the best-performing normalization method for data analysis.

http://ift.tt/2rL4SLW

A child with hypertension and ambiguous genitalia – an uncommon variant of congenital adrenal hyperplasia: a case report

Deficiency in 11β-hydroxylase as a cause of congenital adrenal hyperplasia is uncommon. It should be considered in the differential diagnosis of hypertension with virilization in any prepubescent child.

http://ift.tt/2tX6HGr

Thyrotoxic and pheochromocytoma multisystem crisis: a case report

Thyrotoxic crisis and pheochromocytoma multisystem crisis are rare, life-threatening, emergency endocrine diseases with various clinical manifestations. Here we report a case of a patient who simultaneously de...

http://ift.tt/2sZMySP

Oral vitamin B1-substitution does not decrease genetically determined cleft rate in mice (A/WySn)

Publication date: Available online 23 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Konstanze Scheller, Florian Kalmring, Christian Scheller, Johannes Schubert, Joanna Bialek
PurposeCleft lip and palate (CL/P) are one of the most common human birth defects. Animal experiments and clinical investigations show a clear reduction of teratogenic clefts by a high-dose vitamin B supplementation during early pregnancy, especially in families at risk (reduction of recurrence). The aim of this work was to examine the influence of thiamine (vitamin B1) on CL/P appearance in genetically determined A/WySn mice within different supplementation starting points.Materials and MethodsA total of 24 A/WySn female mice were orally supplemented with high doses (80 mg/kg) of thiamine at different times of pregnancy (5 groups, n=90). The influence of thiamine on the abortion rate and CL/P appearance in the offspring was analyzed with respect to the concentration of thiamine in the serum and amniotic fluid (HPLC-chromatography).Immunochemical analyses of the ThTr-1 und ThTr-2 receptor-status were performed in midface sections of A/WySn-fetuses and the corresponding placenta, with and without CL/P.ResultsHigh doses of orally supplemented thiamine did not reduce the CL/P appearance in A/WySn mice. However, the different starting points of vitamin B1 substitution had some influence. Additionally, an obvious decrease in aborted fetuses was noticed in all supplemented groups. The oral substitution caused a clear increase of the serum concentration in all mothers, but showed no increase of the amniotic fluid concentration. Then immunohistochemistry detected an overexpression of ThTr-1 in the midface and an irregular localization of ThTr-2 in the placenta of fetuses with clefts.ConclusionOur results suggest a time-dependent influence of thiamine on CL/P appearance in female mice. The prophylactic/periconceptional, but not the therapeutic supplementation, starting point can be proposed as a crucial step for regular facial and palatal fusion in embryonic development. The absolute rate of CL/P was not reduced, and the concentration of the water-soluble thiamine could not increase in the amniotic fluid. Thus the proposed local effect of thiamine failed in the development of genetically determined mice.



http://ift.tt/2t3qlUN

Comparative proteomic analysis of two transgenic low-gliadin wheat lines and non-transgenic wheat control

Publication date: Available online 15 June 2017
Source:Journal of Proteomics
Author(s): María Dolores García-Molina, Vera Muccilli, Rosaria Saletti, Salvatore Foti, Stefania Masci, Francisco Barro
Gluten proteins are major determinants of the bread making quality of wheat, but also of important wheat-related disorders, including coeliac disease (CD), and allergies. We carried out a proteomic study using the total grain proteins from two low-gliadin wheat lines, obtained by RNAi, and the untransformed wild type as reference. The impact of silencing on both target and on non-target proteins was evaluated. Because of the great protein complexity, we performed separate analyses of four kernel protein fractions: gliadins and glutenin subunits, and metabolic and CM-like proteins, by using a classical 2D electrophoresis gel based approach followed by RP-HPLC/nESI-MS/MS.As a result of the strong down-regulation of gliadins, the HMW-GS, metabolic and chloroform/methanol soluble proteins were over-accumulated in the transgenic lines, especially in the line D793, which showed the highest silencing of gliadins. Basing on these data, and considering that metabolic proteins and chloroform/methanol soluble proteins (CM-like), such as the α-amylase/trypsin inhibitor family, β-amylase and serpins, were related to wheat allergens, further in vivo analysis will be needed, especially those related to clinical trials in controlled patients, to determine if these lines could be used for food preparation for celiac or other gluten intolerant groups.Biological significanceSeveral enteropathies and allergies are related to wheat proteins. Biotechnological techniques such as genetic transformation and RNA interference have allowed the silencing of gliadin genes, providing lines with very low gliadin content in the grains. We report a proteomic-based approach to characterize two low-gliadin transgenic wheat lines obtained by RNAi technology. These lines harbor the same silencing fragment, but driven by two different endosperm specific promoters (γ-gliadin and D-hordein). The comprehensive proteome analysis of these transgenic lines, by combining two-dimensional electrophoresis and RP-HPLC/nESI-MS/MS, provided a large number of spots differentially expressed between the control and the transgenic lines. Hence, the results of this study will facilitate further safety evaluation of these transgenic lines.

Graphical abstract

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Identification of evidence for autoimmune pathology of bilateral sudden sensorineural hearing loss using proteomic analysis

Publication date: Available online 23 June 2017
Source:Clinical Immunology
Author(s): Jeon Mi Lee, Jin Young Kim, Jinwoong Bok, Kyu-Sung Kim, Jae Young Choi, Sung Huhn Kim
Sudden sensorineural hearing loss (S-SNHL) is an inner ear disorder with an abrupt hearing loss occurring <3days. The pathologic mechanism of the disease remains unclear, although autoimmunity has been regarded as one of the suggested causes, especially in bilateral form. In this study, we aimed to provide evidence for the involvement of autoimmunity in bilateral S-SNHL using proteomic approaches such as ProtoArray®, western blotting, immunoprecipitation, and liquid column mass spectrometry for mass screening of candidate antigens and autoantibodies based on the hypothesis that multiple autoantibodies and target antigens must exist in order for autoimmune bilateral S-SNHL to develop. As the final outcome, we have proven the involvement of autoimmunity in the disease, and investigated the existence of circulating autoantibodies and candidate antigens. These findings could provide basic evidence necessary for the development of diagnostic biomarkers as well as the understanding of the pathological mechanisms underlying bilateral S-SNHL.S-SNHL: sudden sensorineural hearing loss; LC-MS: liquid chromatography-mass spectrometry; MS: mass spectrometry; autoAb: autoantibody; 1-DE: one-dimensional electrophoresis.



http://ift.tt/2rKHv5f

A case of an anomalous biliary tract diagnosed preoperatively

Abstract

We describe a 48-year-old man with cholecystolithiasis whose preoperative magnetic resonance cholangiopancreatography (MRCP) scan showed that the right accessory hepatic duct branching from the cystic duct dominated an anterior segment of the right hepatic lobe. We observed the right accessory hepatic duct using intraoperative cholangiography, and we were able to perform laparoscopic cholecystectomy without injuring it. He had no complication after discharge, and a drip-infusion cholangiography-computed tomography (DIC-CT) scan demonstrated that the right accessory hepatic duct was intact, and it dominated an anterior segment of the right hepatic lobe. During laparoscopic cholecystectomy, a bile duct injury is the most challenging perioperative complication. We selected MRCP preoperatively; however, if it is necessary for us to observe an anomalous biliary tract more precisely, we recommend selecting DIC-CT endoscopic retrograde cholangiopancreatography. Additionally, we think a bile duct injury can be avoided with intraoperative cholangiography, even if there is an anomalous biliary tract.

http://ift.tt/2sK0AWL

Venous occlusion test applied to the tributaries of the superior mesenteric veins of the pancreas head infiltrated by tumor

Abstract

A 64-year-old white woman presented with cholestatic jaundice, weight loss and a solid lesion in the pancreas head. At multislice computed tomography, a superior mesenteric vein (SMV) and one of it tributaries showed signs of tumor infiltration. At surgery, a venous occlusion test applied to the infiltrated tributary of the SMV showed immediate venous congestion in two-thirds of the distal small intestine. No reconstruction attempt was made due to the small size of the vessel. A biliodigestive anastomosis and lymph node biopsy was performed. The herein assessed case report suggests that the ileal tributary occlusion test applied to patients presenting pancreatic adenocarcinoma, with invasion of the tributaries of the SMV, may be effective in contraindicating resection procedures.

http://ift.tt/2sKbqMf

Wide rectal duplication cyst in an adult resected by anterior approach: efficacy and recurrence

Abstract

Alimentary tract duplications are uncommon congenital abnormalities usually diagnosed and treated in childhood. Rectal involvement is extremely rare. We report the case of a 22-year-old female who presented with chronic abdominal and perianal pain; feeling of rectal fullness. Workup revealed a rectal duplication cyst. The patient underwent a complete transabdominal excision of the cyst: an hybrid laparoscopic and laparotomic technique was adopted. The hybrid isolated anterior abdominal approach is safe and feasible even for the treatment of wide rectal duplication cysts. Real recurrence in rectal duplication cysts is uncommon when the first operation was performed with radical intent.

http://ift.tt/2sJTAJq

Clinical and genetic analysis of patients with cherubism

Abstract

Objective

To describe the clinical and genetic features of patients with cherubism.

Material and Methods

A descriptive analysis of 14 cases from 9 different families was carried out. Clinicopathological, imaging and follow-up data were retrieved from patients' medical files and correlated with the genetic profile of each patient. Genomic DNA isolated from buccal mucosa cells was subjected to direct sequencing analysis of the SH3BP2 gene.

Results

Females were more affected than males (8:6), and the mean age at diagnosis was 8.6 years (range 3 to 30 years). Eleven patients exhibited simultaneous bilateral involvement of the maxilla and mandible. Two patients did not have a familial history of cherubism. Progressive growth pattern was found in 6 patients and stable lesions were observed in other 7 patients, whereas in 1 patient complete spontaneous remission was documented during the follow-up (31 years). Mutations were found in 13 cases and included the typical heterozygous missense mutations R415Q, P418T and P418H at exon 9 of SH3BP2. No correlation between the mutations and the clinical manifestations was observed.

Conclusion

Three different point mutations in the SH3BP2 gene were detected with variable clinical involvement. Genotype-phenotype association studies in larger population with cherubism are necessary to provide important knowledge about molecular mechanisms related to the disease.

This article is protected by copyright. All rights reserved.

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Cytokeratin 19 expression in early oral squamous cell carcinoma and their metastasis: Inadequate biomarker for one-step nucleic acid amplification implementation in sentinel lymph node biopsy procedure

Abstract

Background

Intraoperative analysis of lymph nodes during a sentinel lymph node biopsy (SLNB) procedure could result in one-step surgery for early oral squamous cell carcinoma (OSCC) with an occult nodal metastasis. One-step nucleic acid amplification rapidly detects cytokeratin 19 (CK19) RNA with high accuracy. Sensitivity and specificity of CK19 expression in OSCC was evaluated.

Methods

Immunohistochemical CK19 expression was done in 207 patients with OSCC with 65 cases of paired nodal metastases.

Results

CK19 was expressed in 65% of all OSCC and even less in early OSCC (56%), with poor correlation between primary tumor and (occult) nodal metastasis. Furthermore, ectopic glandular tissue in close proximity of lymph nodes showed strong CK19 expression.

Conclusion

CK19 lacks both sensitivity and specificity as a biomarker for nodal metastasis in OSCC, which questions the suitability for CK19-based one-step nucleic acid amplification in SLNB procedures. Therefore, future studies should focus on other biomarkers, because the concept of fast intraoperative diagnostics during SLNB remains attractive.

http://ift.tt/2sZdrGs

Assessment of videofluoroscopic swallow study findings before and after cricopharyngeal myotomy

Abstract

Background

Cricopharyngeal myotomy is a treatment for obstructive cricopharyngeal bar and Zenker's diverticulitis. Little is reported regarding contrast study findings and their correlation with patient symptoms.

Methods

All patients treated by cricopharyngeal myotomy underwent a preoperative and postoperative videofluoroscopic swallow study (VFSS) and completed the self-reported Eating Assessment Tool (EAT-10). Studies were analyzed quantitatively.

Results

Forty cricopharyngeal myotomies were performed (mean age 76 years; SD 8.72) all for dysphagia. Symptomatic improvement (change in EAT-10 scores) occurred in 95% (38/40). Presurgical versus postsurgical VFSS demonstrated significantly improved pharyngoesophageal segment opening, pharyngeal constriction ratio, and pouch residue (P < .01). Symptomatic improvement was unrelated to the presence of retained barium.

Conclusion

Both symptomatic and objective improvement in swallowing measures occurs after cricopharyngeal myotomy. Pouch remnants and retained barium are seen postoperatively but do not correlate with reported symptoms. Routine follow-up barium studies may be needed to establish a new baseline and allow for comparison if future symptom recurrence occurs.

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Current understanding of cancer stem cells: Review of their radiobiology and role in head and neck cancers

Abstract

Evidence of cancer cells that bear attributes analogous to those of normal stem cells has developed a hierarchical model of cancer's architecture and progression. This subset of cancer stem cells (CSCs) drives the progression and therapy resistance of cancers. Research to identify the phenotypes of these CSCs presents evidence of a subpopulation that is more resistant to therapy and may proliferate in response. Literature shows that CSCs typically represent around 1%-10% of cell populations in head and neck cancer but this proportion may increase in response to a therapeutic radiation dose. This is shown to be not just as a result of preferential killing, but also their capacity to alter divisional dynamics and enlist the support of a complicit microenvironment in therapy resistance and proliferation. The CSCs represent the apex of a hierarchy in the heterogeneity of cancer cells and may be seen as the agents of treatment failure, metastasis, and tumor recurrence, the principal cause of mortality in head and neck cancers. Greater than 90% of head and neck cancers are squamous cell carcinomas (HNSCCs), and among these an increasing incidence of the involvement of the human papillomavirus (HPV) is reported. Chemoradiotherapy along with surgical resection are the interventions of choice for control and cure of HNSCC, but given CSCs therapy resistance and proliferative responses to radiation, the identification and understanding of the radiobiology of this subpopulation is critical to their targeted elimination. This article reviews the current evidence on CSC generally and in HNSCC specifically to identify their phenotype, evaluate their responses to radiotherapy, and evaluate the defensive mechanisms used to resist therapeutic control.

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Intra-articular lipoma of the hip

Intra-articular lipoma of the hip is a rare entity, with only two reports published in the English-language literature. We present a case of successful arthroscopic resection of an intra-articular peripheral compartment lipoma in a 69-year-old woman with a coincident labral tear. This woman presented with left hip pain that developed gradually over 2 years and increased over 2 months. MRI showed a fat-intense mass in the anterior aspect of the hip joint, convincing for intra-articular lipoma. Physical examination in the operating room reproduced decreased range of motion and evidence of impingement but with a soft endpoint. Arthroscopy revealed an anterior intrasubstance labral tear, which was debrided. The mass was excised and confirmed as true lipoma on histology. The soft endpoint on examination illustrates that a large lipoma of the hip joint can cause clinical symptoms of impingement in the absence of bony abnormality or trauma.

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The cause of the stroke: a diagnostic uncertainty

A 39-year-old man with a history of sickle cell disease (SCD) presented with left leg weakness. He had a normal CT head and CT angiogram, but MRI head showed multiple acute bilateral cortical infarcts including in the right precentral gyrus. The MRI findings were more in keeping with an embolic source rather than stroke related to SCD, although it could not be ruled out. He also had an echocardiogram which revealed a patent foramen ovale. He was treated with antiplatelet therapy and also had red blood cell exchange transfusion. His symptoms improved significantly and he was discharged with follow-up as an outpatient and a cardiology review.

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An unusual case of abdominal pains

Description

A 55-year-old African American man presented to the emergency room with 3 days of new-onset right-sided flank and abdominal pains. His abdominal pains were dull in nature, constant, moderate in severity (approximately 6 out of 10) and radiated to his back and right flank regions. There were no aggravating factors but the patient reported temporary relief with over-the-counter acetaminophen. The pains were associated with mild nausea and vomiting but he denied diarrhoea, constipation, weight loss, fevers or other associated symptoms. His only known medical history was hypertension, controlled with lisinopril. Surgical, social and family history were unremarkable. Other than abdominal pains, a complete review of systems was negative. His blood pressure was 117/78 mm Hg and his pulse was 82 bpm. His physical examination revealed right flank and right lower quadrant abdominal pain without rebound or guarding.

He underwent an abdominal CT scan which showed a 5.2 cmx4.2 cm hypodensed solid right...

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Obesity-related hypogonadism: a reversible condition

Obesity is associated with hypogonadism. While this association is widely accepted, the underlying mechanisms remain unclear. Furthermore, obesity is a risk factor for hypogonadism and conversely hypogonadism may be a risk factor for obesity. We present the case of a morbidly obese man aged 30 years with hypogonadotrophic hypogonadism that underwent a Roux-en-Y gastric bypass operation. Following the surgical treatment of his obesity, the testosterone level returned to normal with improvements in hypogonadal symptoms, which allowed discontinuation of exogenous testosterone therapy. This case report demonstrates reversal of hypogonadism following weight loss with restoration of gonadal function.

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An umbilical bleeding nodule

Description

A 23-year-old woman was referred to the dermatology department through the 2-week wait pathway under clinical suspicion of malignant melanoma in the umbilical region. She presented with a 4-month history of a painful and intermittently bleeding nodule on the umbilical area. The lesion was more prominent during her menstrual cycles and bled. She was otherwise in good general health and denied a history of abdominal or gynaecological surgery. There was no known medical history of endometriosis.

On physical examination, she presented with approximately 1.5 cm soft, brown, well-circumscribed nodule on the inferior aspect of the umbilical area (figure 1). Based on her medical history and examination findings, umbilical endometriosis was suspected. A cutaneous biopsy was performed, which showed endometrial glands and stroma without atypia and scattered siderophages (figure 2). The patient was referred to the gynaecology team for further investigation. Ultrasound studies and abdominal/pelvic...

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Antenatal thoracoamniotic shunting in congenital cystic adenomatoid malformation

Description

This case report describes a baby who was diagnosed antenatally with a significant left-sided congenital cystic adenomatoid malformation.

Following diagnosis of a fluid-filled, macrocystic structure on the left side of the chest, the mother was referred at 27 weeks' gestation to her regional fetal medicine unit for assessment and ongoing management. Fetal MRI demonstrated a cyst measuring 6.7 mm x 4.3 mm, associated with mediastinal shift and affecting cardiac contractility. Scalp oedema and ascites noted at this time indicated evolving fetal hydrops.

At 28 weeks, thoracoamniotic shunt was inserted to drain the lesion. By 29 weeks, the cyst had decreased in size, now 5.1 mm x 3.4 mm. Cardiac function, oedema and ascites had all improved.

Subsequent scans showed that the shunt, initially placed successfully, had completely migrated into the cyst. Further drainage was completed at 37+3 weeks, with 90 mL of fluid needle aspirated.

Labour was induced, and baby was delivered at 37+4...

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The “frontal peak” sign: a potential new indication of open approach in frontal sinus mucoceles with posterior table erosion. A retrospective chart review of thirty-seven patients

To date, most frontal mucoceles are treated endoscopically, provided that there is no major neo-osteogenesis and that the frontal sinus floor is wide enough to provide an adequate working space: the presence of a sinus wall dehiscence is not considered as a contraindication to an endoscopic approach.

We report on a series of 37 patients presenting with frontal sinus mucoceles with posterior table erosion. Thirty-three (89.2%) had minimal erosion and/or a limited protrusion of the mucocele within the anterior cranial fossa on CT-scan, and were successfully operated on through an endoscopic approach.

Four patients (10.8%) displayed a distinct aspect of "frontal peak" on CT-scan, namely an acute angle between the edge of the bony erosion and the dura.

The first 2 patients were operated on through an endoscopic approach and presented with a delayed cerebrospinal fluid leak requiring a duraplasty through an open approach: in both cases, a laceration of the dura against the sharp bony edge of the erosion was found intra-operatively. The 2 other patients were primarily operated on through an open approach to drill out this frontal peak and prevent any dural trauma.

Based on this observation, we suggest that an open approach should be considered in cases of frontal mucoceles with erosion of the posterior table with the "frontal peak" sign.

This article is protected by copyright. All rights reserved.

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Comment on: mucosal and lacrimal flaps for endonasal dacryocystorhinostomy: a systematic review

We have read the article by Green et al.¹ with great interest, given the results from their review, the recommendation of performing a mucosal sparing technique when performing dacryocystorhinostomy seems logical. However, based on our experience we would like to make some comments on this subject.

This article is protected by copyright. All rights reserved.

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Difference Between Respiratory Epithelial Adenomatoid Hamartomas and Small Malignant Tumors of the Olfactory Cleft on CT Scans in Forty-six Patients

Misdiagnosis of respiratory epithelial adenomatoid hamartomas for malignant tumors can lead to an aggressive surgical procedure, which is not necessary in the case of a respiratory epithelial adenomatoid hamartoma.

Detailed analysis of sinonasal CT scans without contrast can help to distinguish respiratory epithelial adenomatoid hamartomas of the olfactory cleft from small malignant tumors (T1 and T2) of the olfactory clefts.

Criteria in favor of diagnosis of small malignant tumors of the olfactory clefts on CT scans without contrast were unilaterality of masses in the olfactory clefts, large olfactory clefts /small olfactory clefts ratio ≥ 2 (sensibility at 91% and specificity at 100%), and presence of bone erosion.

Imaging criteria for the diagnosis of respiratory epithelial adenomatoid hamartomas of the olfactory cleft were the bilaterality of masses in the olfactory cleft, large olfactory cleft /small olfactory cleft ratio < 2, and no bone erosion.

This article is protected by copyright. All rights reserved.

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The Chorda Tympani Retractor in Stapedectomy

The chorda tympani is at risk during stapedectomy and evidence suggests a significant proportion of patients experience postoperative taste disturbance^1,2,3. It is therefore important to minimise this risk by preserving the nerve and limiting unnecessary manipulation. In some patients the anatomy may place the nerve directly in the way of the surgical field, making this difficult to achieve. Here we describe a simple way to retract the chorda tympani anteriorly and keep it held away while performing stapedectomy.

This article is protected by copyright. All rights reserved.

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the Study of Effect of Chronomodulated Chemotherapy on the Dendritic Cells Subsets in the Treatment of Advanced Nasopharyngeal Cancer

Condition:   Locally Advanced Head and Neck Squamous Cell Carcinoma
Interventions:   Device: Chrono-chemotherapy;   Device: Routine intravenous drip;   Drug: induction Chrono-chemotherapy;   Drug: induction Routine-chemotherapy;   Drug: cisplatin chrono-chemotherapy;   Drug: cisplatin routine-chemotherapy;   Radiation: intensity-modulated radiation therapy
Sponsor:   Guiyang Medical University
Recruiting - verified June 2017

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An Exploratory Tumor Biopsy-driven Study to Understand the Relationship Between Biomarkers and Clinical Response in Patients With Head and Neck Cancer Receiving REGN2810 (Anti-PD-1)

Conditions:   Recurrent Squamous Cell Carcinoma of Head;   Recurrent Squamous Cell Carcinoma of Neck;   Metastatic Squamous Cell Carcinoma of Head;   Metastatic Squamous Cell Carcinoma Neck
Intervention:   Drug: REGN2810
Sponsors:   Regeneron Pharmaceuticals;   Sanofi
Not yet recruiting - verified June 2017

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Radiotherapy Combine With Raltitrexed Versus Radiotherapy Alone in Older Patients With HNSCC.

Condition:   Head and Neck Squamous Cell Carcinoma
Interventions:   Drug: Raltitrexed;   Radiation: Intensity Modulated Radiotherapy
Sponsor:   The First Affiliated Hospital of Dalian Medical University
Not yet recruiting - verified June 2017

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SOP – Subkutane Medikamentengabe und Infusionen in der erwachsenen Palliativmedizin

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15. Internationale St.-Gallen-Konsensus-Konferenz: Behandlung des frühen Mammakarzinoms

Zusammenfassung

Hintergrund

Seit über 30 Jahren findet regelmäßig die internationale St.-Gallen-Konferenz zur Behandlung des primären Mammakarzinoms statt. Bei diesem Konsens handelt es sich um ein Meinungsbild von Experten unterschiedlicher Länder und Fachdisziplinen.

Rationale

Vor diesem Hintergrund wurden die Abstimmungsergebnisse des internationalen St.-Gallen-Konsensus-Panels von einer deutschen Arbeitsgruppe führender Brustkrebsexperten für den Klinikalltag in Deutschland diskutiert. Fünf der Brustkrebsexperten aus Deutschland sind zugleich Mitglieder des diesjährigen St.-Gallen-Panels.

Grundlage

Grundlage der Diskussion für den deutschen Klinikalltag sind die jährlich aktualisierten Therapieempfehlungen der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO-Mamma 2017) sowie die deutsche S3-Leitlinie, die im Jahre 2017 ebenfalls aktualisiert wird. S3-Leitlinie und AGO-Empfehlungen sind jeweils evidenzbasiert.

Ergebnis

Die diesjährige 15. St.-Gallen-Konsensus-Konferenz stand unter dem Motto „Escalating and De-Escalating", das sich durch alle Therapiebereiche zog, die zur Abstimmung standen. Ziel war und ist es, Patientinnen individuellere Therapieoptionen anzubieten und das Risiko einer Über- bzw. Untertherapie zu vermindern.

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Facial soft tissue response to maxillo-mandibular advancement in obstructive sleep apnea syndrome patients

Abstract

Background

Facial profile soft tissue changes after orthognathic surgery are crucial for surgery success. This retrospective study evaluated soft tissue changes after maxillo-mandibular Advancement and counter clockwise rotation surgery in obstructive sleep apnea syndrome patients.

Methods

Thirty-seven obstructive sleep apnea syndrome patients (30 male, 7 female, mean age 35.8 years) whose underwent maxillo-mandibular-advancement and counter clockwise rotation surgery were studied after two intervals of time, presurgical, postsurgical and follow up (1–6 months and 1–5 years) using Dolphing Imaging Software. The soft tissue changes that were evaluated included Glabela, nasal projection, Subnasale, superior incisor, superior lip, inferior incisor, inferior lip, soft tissue B' point and soft tissue Pogonion. Points were measured from true vertical line on the horizontal plane according to Arnett soft tissue profile analysis. Wilcoxon test was applied for testing differences between T0 (pre surgical), T1 (1–6 months postsurgical) and T2 (1–5 years postsurgical).

Results

Cephalometric points changed to more aesthetic parameters. The largest advancements took place in the mandible, due to patients' anatomic characteristics and treatment planning, whose were measured at cephalometric points B′ (9,05 mm) and Pog' (11,92 mm) at T0–T2. In all patients aesthetics goals were accomplished.

Conclusion

This study showed that maxillo-mandibular advancement and counter clockwise rotation surgery is an effective treatment for OSAS, with good aesthetic results.

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Endométriose ombilicale simulant une chéloïde chez une patiente à peau foncée

Publication date: Available online 23 June 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): H.-S. Kourouma, E.-J. Ecra, A.-S. Allou, M. Kouyaté, Y.-I. Kouassi, M. Kaloga, K.-A. Kouassi, K. Kassi, K. Kouamé, C. Ahogo, I.-P. Gbery, A. Sangaré
IntroductionLe diagnostic des tumeurs ombilicales est dominé par les tumeurs bénignes et par les rares métastases ombilicales de tumeurs abdomino-pelviennes (« nodule de sœur Marie-Joseph »). Nous rapportons un cas d'endométriose ombilicale diagnostiquée à tort comme une chéloïde.ObservationUne femme de 26 ans, de phototype 6, consultait en deuxième avis pour une tuméfaction ombilicale douloureuse. Elle avait depuis 10 mois un nodule de l'ombilic, saignant en période menstruelle, qui avait été traité comme une chéloïde par des infiltrations de corticoïdes. L'examen cutané trouvait un nodule ombilical de 2,5cm de diamètre, de consistance ferme, douloureux à la palpation. Devant le caractère cyclique de la symptomatologie rythmée par les menstruations, une endométriose ombilicale était suspectée. Ce diagnostic était finalement confirmé par l'examen anatomopathologique et un traitement hormonal était institué, sur avis gynécologique, avant une exérèse chirurgicale programmée.ConclusionDevant une tumeur ombilicale simulant une chéloïde, mais associée à une symptomatologie cyclique, le diagnostic différentiel d'endométriose ombilicale ne doit pas être négligé.BackgroundMost umbilical tumors are diagnosed as benign tumors, umbilical metastases of abdominal and pelvic tumors, or Sister Marie Joseph nodule. Herein, we report a case of cutaneous umbilical endometriosis mistaken for a keloid.Patients and methodsA young black woman aged 26 consulted for a painful umbilical tumefaction. She had noted the appearance of a nodule of the umbilicus 10 months ago with bleeding during her menstrual periods. Skin examination revealed a firm and painful umbilical nodule 2.5cm in diameter. She was treated with corticosteroid injections for one month for umbilical keloid. Given that the symptoms recurred regularly at the time of menstruation, we suspected umbilical endometriosis. This diagnosis was finally confirmed by histopathological examination and hormone therapy was instituted on gynecological advice before scheduled surgical excision.ConclusionIn a setting of an umbilical tumor simulating a keloid associated with cyclical symptoms in a black woman, the diagnosis of umbilical endometriosis should not be overlooked by the dermatologist.



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Histoire du mélanome cutané : de la mélanose de Laennec à la fin du XXe siècle

Publication date: Available online 22 June 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J. Chevallier




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Mycosis fongoïde après transplantation cardiaque

Publication date: Available online 23 June 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): Q. Bodard, N. Litrowski, D. Carre, M. Midhat, P. Chenal, P. Bravard
IntroductionLa survenue de cancers cutanés chez les patients greffés d'organe est fréquente du fait de l'immunosuppression induite. Dans la majorité des cas, il s'agit de carcinomes ou de lymphomes B viro-induits par l'EBV (Epstein Barr Virus). Les lymphomes cutanés T sont exceptionnels. Nous rapportons un cas de lymphome cutané T de type mycosis fongoïde chez un patient greffé cardiaque.ObservationUn homme de 68 ans, greffé cardiaque depuis 21 ans, traité par tacrolimus, mycophénolate mofétil et prednisolone, présentait depuis quatre ans une éruption psoriasiforme du tronc, des membres et de la tête résistant à la PUVAthérapie et aux dermocorticoïdes. La biopsie cutanée était en faveur d'un lymphome cutané T épidermotrope. Il n'y avait pas d'altération de l'état général ni d'adénopathie. L'étude en biologie moléculaire trouvait un réarrangement clonal du T-Cells Receptor (TCR) dans le sang et la peau. La recherche de cellules de Sézary circulantes était négative et le TEP-scanner (tomographie à émission de positons) ne mettait pas en évidence de localisation extracutanée. Les applications locales de méchloréthamine étaient peu efficaces. Le bexarotène, compliqué de dysthyroïdie et d'hypertryglycéridémie, n'était pas efficace. Le méthotrexate était contre-indiqué par une insuffisance rénale chronique (liée aux inhibiteurs de la calcineurine) et l'interféron proscrit dans ce contexte de greffe cardiaque. Le patient a finalement reçu de la gemcitabine, efficace initialement mais compliquée d'un choc septique entraînant le décès.ConclusionMême si cette association pourrait être fortuite, la survenue d'un lymphome cutané T de type mycosis fongoïde chez un patient greffé cardiaque doit être signalée. Le contexte de greffe avec immunodépression entraîne des difficultés particulières pour le traitement du mycosis fongoïde.BackgroundSkin cancer occurs frequently in organ transplant patients as a result of induced immunosuppression. Most cases involve carcinomas or B-cell lymphomas induced by the Epstein Barr virus (EBV). Cutaneous T-cell lymphomas remain rare. We report a case of cutaneous T-cell lymphoma of the mycosis fungoides type in a heart transplant recipient.Patients and methodsA 68-year-old man who had received a heart transplant 21years earlier and was being treated with tacrolimus, mycophenolate mofetil and prednisolone had been presenting a psoriasiform rash on his trunk, limbs and head for 4years. The rash was resistant to both PUVA therapy and topical corticosteroids. Histopathological examination suggested epidermotropic cutaneous T-cell lymphoma. There was no impairment of the patient's general state of health nor any adenopathy. Molecular biology revealed TCR rearrangement in both blood and skin. Screening for circulating Sézary cells was negative, and PET scan revealed no signs of extracutaneous localization. Mechlorethamine showed little efficacy, bexarotene was complicated by dysthyroidism, hypertriglyceridemia was ineffective, methotrexate was contraindicated because of calcineurin inhibitor-related chronic kidney failure, and interferon could not be given due to the context of heart transplantation. Finally, we treated our patient with gemcitabine, which initially proved effective but was later complicated by septic shock that resulted in the patient's death.ConclusionThe particularities of our observation are the onset of cutaneous T-cell lymphoma of the mycosis fungoides type in a heart transplant patient, and the therapeutic difficulties encountered in a setting of transplantation with immunodepression.



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Osteogenic potential of three different autogenous bone particles harvested during implant surgery

Abstract

Objectives

The aim was to compare the osteoblast activity and osteogenic potential of autogenous bone particles harvested using three different techniques, determine the most advantageous method of collecting autogenous bone particles.

Subjects and Methods

Bone particles were harvested from 20 patients during dental implant surgery using bone scraping, low-speed drilling, and bone trap filtering. After the osteoblasts were cultured, cell proliferation, migration, mineralization, transcription of osteogenesis-related genes, secretion of osteogenesis-related proteins, and osteoinductive protein content in the bone particle matrix were evaluated.

Results

Osteoblast activity and osteogenic potential were higher in bone samples harvested by scraper or low-speed drilling than in samples harvested by bone trap filter. Although these parameters were slightly lower in the low-speed drilling group than in the scraper group, significant differences were found only in bone Gla-protein levels. However, the levels of osteoinductive proteins in the bone particle matrix were significantly higher in the low-speed drilling group than in the scraper group.

Conclusions

Low-speed drilling is a recommendable and effective technique for collecting autogenous bone particles. In implant operations, low-speed drilling can be considered the first-line option, and if the quantity of harvested bone is insufficient, bone shavings obtained by the scraper may be considered.

This article is protected by copyright. All rights reserved.

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Use of a three-dimensional custom-made porous titanium prosthesis for mandibular body reconstruction

Publication date: Available online 22 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): Q. Qassemyar, N. Assouly, S. Temam, F. Kolb
The progress made in recent years in the field of head and neck bone reconstruction is directly related to technological advancements made in computer-aided design and manufacturing (CAD/CAM) and three-dimensional printing in particular. Today these technologies are mainly used in mandibular reconstruction to manufacture aids for harvesting and shaping bone flaps. However problems remain when addressing patients with a contraindication to microsurgery who need extensive bone reconstruction. For these patients who cannot benefit from vascularized bone grafts, surgeons have to find alternative solutions aimed at maintaining best function and aesthetics. The goal of this article is to present an original method for mandibular body replacement with custom-made porous titanium prostheses in patients ineligible for a bone free flap. This solution has been used for two patients with an intraoral approach, resulting in no visible scars, with simple postoperative care of a short duration. This innovative solution represents an additional option for the treatment of complex mandibular reconstructions.



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