Head and Neck Medicine by Alexandros G.Sfakianakis: 07/05/17

Τετάρτη 5 Ιουλίου 2017

A hairy port-wine stain with overlying hyperhidrosis on the thigh of a child

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Tumescent local anaesthesia for early dermatosurgery in infants

Abstract

Background

Early paediatric dermatosurgery reveals excellent cosmetic results due to high skin-elasticity and pronounced capacity to recover from trauma. Furthermore, the size of skin lesions increases during life proportionally to skin growth and therefore early removal is of major importance. Selected local anaesthetics like prilocaine can cause methaemoglobinemia. However, in contrast to general anaesthesia many other local anaesthetics do not bare any major risks for infants.

Objective

In this retrospective study, we analysed infants aged less than 7 months receiving tumescent local anaesthesia (TLA) followed by dermatosurgery at our department between 2005 and 2015. The analysis is mainly based on our records. Additional information for a subset of patients was gained by a postoperative survey.

Methods

92 infants (39 male, 53 female) with a median age of 4.2 months (range: 1.5 months; 6.7 months) were included in this study. Additional postoperative information was available for 33 of the 92 studied patients (35%).

Results

Infants were mainly operated for removal of a melanocytic nevus (n=54), followed by haemangioma (n=23), nevus sebaceous (n=6) and other lesions (n=9). The lesions were located on the scalp or neck (n=31), on the extremities (n=31), on the trunk (n=21), in the face (n=6) or on the buttocks (n=3). The median size of excision was 509mm² (range: 16mm²; 3600mm²). Primary defect closure was performed by intracutaneous (n=68) or extracutaneous (n=24) suture techniques. No side effects of local anaesthesia were observed in any patient. Postoperative complications include pain (1/33; 3%), wound healing disorder (1/33; 3%) and visible severe scarring (2/33; 6%).

Conclusions

The combination of TLA and dermatosurgery in infants is a suitable outpatient treatment option for small lesions without any major risks or side effects and the benefit of prolonged postoperative analgesia.

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A potential contribution of psoriasin to vascular and epithelial abnormalities and inflammation in systemic sclerosis

Abstract

Background

Antimicrobial peptides have attracted much attention as a member of disease-associated molecules in systemic sclerosis (SSc), which is pathologically characterized by immune abnormalities, vasculopathy, and tissue fibrosis.

Objective

To investigate the potential contribution of one of the anitimicrobial peptides psoriasin to the development of SSc.

Methods

Psoriasin expression in the skin samples and sera derived from SSc patients and its correlation with clinical parameters were analyzed. Psoriasin expression was evaluated by immunohistochemistry with skin samples from SSc patients and healthy controls. Serum levels of psoriasin were determined by enzyme-linked immunosorbent assay in 51 SSc patients and 19 healthy controls and assessed for the association with clinical symptoms.

Results

The expression of psoriasin was elevated in the epidermis of SSc lesional skin. Serum psoriasin levels were higher in SSc patients, especially in diffuse cutaneous SSc patients with disease duration of <6 years, than in healthy controls. With respect to clinical association, SSc patients with interstitial lung disease, telangiectasia, and pitting scars had significantly augmented levels of serum psoriasin than those without each of these symptoms. In the subgroup of patients with interstitial lung disease, the elevation of serum psoriasin levels was associated with higher ground-glass opacity scores. Furthermore, serum psoriasin levels were decreased after the treatment with intravenous cyclophosphamide pulse as compared to baseline values.

Conclusion

Our findings indicate a possible contribution of psoriasin to the development of clinical symptoms associated with vascular and epithelial abnormalities and inflammation in SSc, further supporting the roles of antimicrobial peptides in the SSc pathogenesis.

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Depression and Suicidality in Psoriasis: Review of the Literature Including the Cytokine Theory of Depression

Abstract

Psoriasis can be a socially isolating disease due to debilitating physical symptoms and the stigma patients feel because of the appearance of their skin. Mental health comorbidities such as anxiety, depression, and suicidal ideation and behavior (SIB) are prevalent in patients with psoriasis. Patients with mild psoriasis can experience psychiatric comorbidities; however, disorders such as depression and SIB are more common in patients with severe psoriasis or psoriatic arthritis. Psychiatric disorders can both result from and contribute to progression of psoriasis, suggesting that psoriasis and psychiatric conditions, such as depression, may have overlapping biological mechanisms. Proinflammatory cytokines such as interleukin (IL) 1 and IL-6 are elevated in both psoriasis and depression, indicating that the inflammatory process may be involved in the progression of both diseases. Elevated cytokine levels in the central nervous system cause physiologic and biochemical changes that may contribute to the development of depression. In this review of the literature, we discuss the evidence that supports the association of psoriasis with mental health disorders and the tools used to detect the presence of these comorbidities. Additionally, we review the most prominent hypotheses on the mechanisms by which the inflammatory response and elevated cytokines can cause depression. These results highlight the role that systemic inflammation plays in the various mental health comorbidities associated with psoriasis, including depression and SIB.

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Expression of monoacylglycerol lipase as a marker of tumour invasion and progression in malignant melanoma

Abstract

Background

Accumulating evidence suggests that the lipid lytic enzyme monoacylglycerol lipase (MAGL) promotes tumour invasion and metastasis through up-regulation of pro-tumourigenic signalling lipids in several tumour cell lines. However, the expression status of MAGL in clinical melanoma tissues and its clinico-pathological significance remain unclear.

Objective

To correlate the tumour expression status of MAGL with the clinico-pathological information of patients with malignant melanoma.

Methods

Polymerase chain reaction (PCR) array screening was performed, and the results were validated using immunocytochemical analysis of tumour and non-tumour melanocytic cell lines. Immunohistochemical staining for MAGL was performed for 74 melanoma samples, including 48 primary and 26 metastatic tumours, in which the expression of MAGL was determined by evaluating the percentage of MAGL-positive tumour cells and the MAGL staining intensity. Finally, we analysed the association of MAGL expression status with tumour progression, tumour thickness and vascular invasion of the primary lesion.

Results

Immunocytochemical analysis revealed that MAGL was expressed in all 12 melanoma cell lines, but not in normal human epidermal melanocytes. In the immunohistochemical analysis, positive staining for MAGL was noted in 32 of 48 (64.5%) primary lesions, 14 of 17 (82.4%) lymph node metastatic lesions and 7 of 9 (77.8%) skin metastatic lesions. Metastatic tumours had a significantly higher staining intensity (p=0.033 for lymph node, p=0.010 for skin). In the analysis of primary lesions, higher MAGL expression correlated with greater tumour thickness (p=0.015) and the presence of vascular invasion (p=0.017). On further evaluation of MAGL-positive primary lesions staining intensity of MAGL tended to be higher in deeper areas of the tumour mass.

Conclusions

The expression of MAGL in tumour cells reflects the aggressiveness of melanoma cells and may serve as a marker of tumour progression.

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Association of atopy and tentative diagnosis of skin cancer - results from occupational skin cancer screenings

Abstract

Background

The relationship between atopic conditions and carcinoma of the skin has been described inconsistently. Population-based data providing information on atopic diseases as well as on skin-cancer are sparse.

Objective

To determine the correlation between atopy and prevalence of precanceroses, nonmelanoma skin-cancer and malignant melanoma (MM), while taking into account known risk factors for skin cancer.

Methods

Data from occupational skin cancer screenings were analysed in a cross-sectional study. Dermatologists performed whole body examinations and collected medical histories. Subjects comprised all employees (16 to 70 years) examined from 2006 to 2014. 'Atopy' was defined by clinical screening diagnosis and/or by participant-reported, pre-existing atopic dermatitis, allergic asthma or other specified allergies confirmed by a physician. Tentative screening diagnoses of skin cancer related to actinic keratosis, basal cell carcinoma and malignant melanoma.

Results

The study cohort comprised 90,265 employees (mean age 43 ± 11 years, 58.5% male), 30.7% of whom were ever diagnosed with an atopic disease. Persons with atopic conditions recorded in their medical history and at the time of screening had a significantly lower prevalence of actinic keratosis (AK), basal cell carcinoma (BCC) and MM. After controlling for age, sex and relevant risk factors (skin type, childhood sun burns), atopy remained significantly protective against BCC (OR 0.77) and MM (OR 0.53).

Conclusion

Design limitations of the study include that all findings of skin cancer were based on clinical examination only and must therefore be considered tentative diagnoses. Furthermore, owing to the cross-sectional study design, causal pathways cannot be proven. However, analyses of data from such a large and general population-based cohort afford valuable insights into the relationship of atopic diseases and skin cancer. They provide the grounds for prospective cohort studies to evaluate and dissect the underlying mechanism.

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Infatile hemangiomas with minimal or arrested growth associated with soft tissue hypertrophy: a case series of 10 patients

Abstract

Background

Infantile hemangiomas with minimal or arrested growth (IH-MAGs) are characterized by a proliferative component of less than 25% of its surface area. The co-occurrence of IH-MAGs and soft tissue anomalies is rare and case series of this association are lacking.

Objective

We present ten cases of IH-MAGs associated with soft tissue hypertrophy and describe their clinical features.

Methods

We reviewed all infantile hemangiomas with minimal or arrested growth seen between 2009 to 2016 in the dermatology clinic department at Hospital Santa Creu i Sant Pau, Barcelona. To collect more patients, we also requested cases from the Hemangioma Investigator Group and members of the Spanish Society of Vascular Anomalies.

Results

Ten patients had IH-MAGs associated with soft tissue hypertrophy; seven involving the arm and three involving the leg. All displayed a segmental pattern, a doughy and puffy texture, and prominent surface veins. No significant asymmetries in limbs and no other visceral anomalies were observed at follow-up (range 15 months to 7 years). One patient reported coldness in the limb with infantile hemangioma, but RMI-angiography did not disclose a vascular malformation underneath the lesion. Ulceration was observed in three patients. The proliferative component in all IH -MAGs had faded at one-year follow-up, while soft tissue hypertrophy and prominent vessels remained unchanged.

Conclusions

In this first case series of IH-MAGS associated with soft tissue hypertrophy Soft tissue hypertrophy was not progressive and remained unchanged over time, unlike the proliferative component of classic infantile hemangioma. The origin of the prominent vessels and the higher ulceration risk are unknown; however, these findings are probably related to a minor disruption of local vessels not detected in imaging tests.

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Amenamevir, a novel helicase–primase inhibitor, for treatment of herpes zoster: A randomized, double-blind, valaciclovir-controlled phase 3 study

Abstract

Amenamevir is a potent helicase–primase inhibitor and a novel class of antiviral agent other than nucleoside compounds, such as aciclovir, valaciclovir and famciclovir. This study is the first randomized, double-blind, valaciclovir-controlled phase 3 study to evaluate the efficacy and safety of amenamevir in Japanese patients with herpes zoster when treated within 72 h after onset of rash. A total of 751 patients were randomly assigned to receive either amenamevir 400 mg or 200 mg p.o. once daily or valaciclovir 1000 mg three times daily (daily dose, 3000 mg) for 7 days. The primary efficacy end-point was the proportion of cessation of new lesion formation by day 4 ("day 4 cessation proportion"). The day 4 cessation proportions for amenamevir 400 and 200 mg and valaciclovir were 81.1% (197/243), 69.6% (172/247) and 75.1% (184/245), respectively. Non-inferiority of amenamevir 400 mg to valaciclovir was confirmed by a closed testing procedure. Days to cessation of new lesion formation, complete crusting, healing, pain resolution and virus disappearance were evaluated as secondary end-points. No significant differences were observed in any of the treatment groups. Amenamevir 400 and 200 mg were well tolerated as well as valaciclovir. The proportions of patients who experienced drug-related adverse events were 10.0% (25/249), 10.7% (27/252) and 12.0% (30/249) with amenamevir 400 and 200 mg and valaciclovir, respectively. In conclusion, amenamevir 400 mg appears to be effective and well tolerated for treatment of herpes zoster in immunocompetent Japanese patients.

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Alopecia developed in a transitional case from pemphigus foliaceus to pemphigus vulgaris

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Noonan syndrome with multiple lentigines with PTPN11 (T468M) gene mutation accompanied with solitary granular cell tumor

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Spiny keratoderma: case series and review

Abstract

Background

Spiny keratoderma is a rare, possibly under-reported, condition characterized by discrete keratotic plugs arising from the palms, soles, or both. It has been associated with malignancies though there is debate as to whether spiny keratoderma is a true paraneoplastic phenomenon. It has also been linked to a variety of non-neoplastic conditions, and several cases appear to be familial.

Methods

We describe two additional cases of this rare entity and review the literature.

Results

Thirty-seven cases of spiny keratoderma, including ours, have been reported in the literature. Average age at presentation was 63 years. Earliest age of onset was 11 months. A variety of ethnicities were represented. Ten cases were associated with malignancies. Six cases appeared to be inherited in an autosomal dominant fashion. Several cases were reported in healthy individuals as an incidental finding though it is possible that an associated malignancy or systemic disease will declare itself with time.

Treatment is generally unsatisfying with keratotic spines often recurring on cessation. Interestingly, in some patients, the spines resolve after treatment of an underlying malignancy.

Conclusions

This small case series provides an opportunity to revisit the fascinating phenomena of spiny keratoderma, its possible associations, and implications for follow-up. Due to the association with cancer, all patients presenting with spiny keratoderma should undergo baseline age-appropriate malignancy screening, thence 1-2 times yearly, or as symptoms arise.

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Leprosy: an enigmatic disease

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Antineoplastic therapy-associated flagellate dermatoses

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Adolescent girl with frizzy hair knotted in a bundle

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Role of oxidative stress in melasma: a prospective study on serum and blood markers of oxidative stress in melasma patients

Abstract

Background

Melasma is a common pigmentary disorder presenting in the dermatological clinic. Many factors have been implicated in the pathogenesis, however, the cause still remains elusive. Recently the effect of oxidative damage has been proposed in the etiopathogenesis of melasma. This study was undertaken to evaluate the role of oxidative stress in patients with melasma.

Material and methods

Fifty patients with melasma, age 18 years of age and older, and an equal number of age and sex-matched controls were included in the study. Baseline severity assessment using the modified Melasma Area and Severity Index (modified MASI score) was done in all patients. Serum malondialdehyde, blood superoxide dismutase, and blood glutathione peroxidase levels were measured in cases and controls group and results were compared.

Result

The serum levels of malondialdehyde, superoxide dismutase, and blood glutathione were significantly higher among the cases compared to controls. The difference in the serum concentrations was significant between the two groups (P < 0.01). A positive correlation was found between these enzyme levels and severity of melasma (modified MASI score); however, this correlation was statistically significant with serum malondialdehyde only. The level of oxidative stress among the male and female melasma patients was not statistically different.

Conclusion

Oxidative stress was found to be increased in cases of melasma compared to the control group in this study. This substantiates the role of oxidative stress in etiopathogenesis of melasma; however, further studies are required to reach a definitive conclusion.

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Safety and pharmacodynamics of intranasal GSK2245035, a TLR7 agonist for allergic rhinitis: a randomized trial

Abstract

Background

Toll-like receptor 7 (TLR7) stimulation in the airways may reduce responses to aeroallergens by induction of type 1 interferons (IFNs). GSK2245035 is a novel selective TLR7 agonist in pharmaceutical development.

Objective

Assessment of safety, pharmacodynamics and nasal allergic reactivity following repeated weekly intranasal (i.n.) GSK2245035.

Methods

This randomized, double-blind, placebo-controlled study (TL7116958) was conducted over two pollen seasons (2013–2014) and follow-up study (204509) conducted one year later. Participants with allergic rhinitis (n=42) were randomized to receive eight weekly doses of i.n. GSK2245035 (20 ng [2014 Cohort; n=14] or 80 ng [2013 Cohort; n=14]) or placebo (n=14). Adverse events (AEs), including cytokine release syndrome-AEs (CytoRS-AEs) and nasal symptoms were assessed. Nasal and serum IFN-inducible protein 10 (IP-10) were measured after doses 1 and 8, then 1 (follow-up visit [FUV] 1) and 3 (FUV2) weeks after final dose. Nasal allergen challenges (NAC) and allergic biomarkers assessment (nasal, serum) were conducted at baseline, FUV1, FUV2 and at a follow-up visit 1-year post final dose (FUV3; 2014 Cohort only). A Bayesian framework enabled probability statements for mean effect sizes.

Results

GSK2245035 induced CytoRS-AEs (most commonly headache, median duration <1 day) in 93% of participants at 80 ng, while AE incidence at 20 ng was similar to placebo. There was no evidence of nasal inflammation. Dose-related increases in nasal and serum IP-10 were observed 24h after doses 1 and 8 (>95% certainty). Both doses showed a trend in reducing Total Nasal Symptom Score 15 minutes post NAC at FUV1 and FUV2 but there was no reduction evident at FUV3. Nasal levels of selected allergic biomarkers demonstrated trends for reductions at FUV1, FUV2 and FUV3.

Conclusions and clinical relevance

Weekly i.n. GSK2245035 20 ng was well-tolerated and reduced allergic reactivity to nasal challenge for 3 weeks post treatment.

Clinicaltrials. gov identifiers

NCT01788813/NCT02446613

GSK identifiers

TL7116958/204509

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Evaluation of Caffeine versus codeine for pain and swelling management after implant surgeries: A triple blind clinical trial

There are controversies in recent studies over the application of NSAIDs for controlling pain and swelling after implant surgeries for osseointegration. The aim of this study was to compare caffeine-containing versus codeine-containing analgesics in relation to their anti-inflammatory and analgesic effects after dental implant surgeries.

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Histopathological investigation of intranodular echogenic foci detected by thyroid ultrasonography

To determine the predictability of sonography for detection of calcifications in thyroid nodules by histopathologic examination and to demonstrate the association between calcification pattern and malignancy.

http://ift.tt/2us0UtG

Metastatic squamous cell carcinoma to the superior cervical ganglion mimicking a retropharyngeal lymph node

Metastasis of squamous cell carcinoma (SCC) to the superior cervical ganglion (SCG) has never been reported. Its anatomic location may easily be mistaken for a retropharyngeal lymph node. We present the first case of SCC metastasis to the SCG.

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The contemporary utility of intraoperative frozen sections in thyroid surgery

To determine the accuracy of intraoperative frozen section analysis on thyroidectomy specimens stratified by the Bethesda classification scheme and its utility for intraoperative decision-making.

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Management of the condyle following the resection of tumours of the mandible

The aim of this study was to assess the management of the condyle during the restoration of mandibular defects following tumour resection. A total of 41 patients who underwent simultaneous tumour resection and reconstruction with vascularized iliac myocutaneous flaps for mandibular defects, from September 2010 to October 2014, were included. These patients were divided into three groups: group 1, condyle preserved; group 2, condyle sacrificed; group 3, condyle frozen. Patients were followed up at 1, 3, 6, and 12 months for the evaluation of appearance, occlusion, and speech.

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Effect of low-level laser-treated mesenchymal stem cells on myocardial infarction

Abstract

Cardiovascular disease is the leading cause of death worldwide. Although cardiac transplantation is considered the most effective therapy for end-stage cardiac diseases, it is limited by the availability of matching donors and the complications of the immune suppressive regimen used to prevent graft rejection. Application of stem cell therapy in experimental animal models was shown to reverse cardiac remodeling, attenuate cardiac fibrosis, improve heart functions, and stimulate angiogenesis. The efficacy of stem cell therapy can be amplified by low-level laser radiation. It is well established that the bio-stimulatory effect of low-level laser is influenced by the following parameters: wavelength, power density, duration, energy density, delivery time, and the type of irradiated target. In this review, we evaluate the available experimental data on treatment of myocardial infarction using low-level laser. Eligible papers were characterized as in vivo experimental studies that evaluated the use of low-level laser therapy on stem cells in order to attenuate myocardial infarction. The following descriptors were used separately and in combination: laser therapy, low-level laser, low-power laser, stem cell, and myocardial infarction. The assessed low-level laser parameters were wavelength (635–804 nm), power density (6–50 mW/cm²), duration (20–150 s), energy density (0.96–1 J/cm²), delivery time (20 min–3 weeks after myocardial infarction), and the type of irradiated target (bone marrow or in vitro-cultured bone marrow mesenchymal stem cells). The analysis focused on the cardioprotective effect of this form of therapy, the attenuation of scar tissue, and the enhancement of angiogenesis as primary targets. Other effects such as cell survival, cell differentiation, and homing are also included. Among the evaluated protocols using different parameters, the best outcome for treating myocardial infarction was achieved by treating the bone marrow by one dose of low-level laser with 804 nm wavelength and 1 J/cm² energy density within 4 h of the infarction. This approach increased stem cell survival, proliferation, and homing. It has also decreased the infarct size and cell apoptosis, leading to enhanced heart functions. These effects were stable for 6 weeks. However, more studies are still required to assess the effects of low-level laser on the genetic makeup of the cell, the nuclei, and the mitochondria of mesenchymal stromal cells (MSCs).

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Japanese standard for clinical stabilometry assessment: Current status and future directions

Stabilometry is a useful tool for examining patients with functional disorders of the vestibular system. However, measurement techniques and devices vary by country. Therefore, international standardization of stabilometry is mandatory to validate the exchange of important findings. This was advocated at the 1983 Posturography Meeting in Kyoto but has not been adopted worldwide, and each country has continued to use unique regional measurement methods. In Japan, stabilometry has widespread application in medical practice in conjunction with research into its applications.

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Japanese standard for clinical stabilometry assessment: Current status and future directions

Publication date: Available online 5 July 2017
Source:Auris Nasus Larynx
Author(s): Masahiko Yamamoto, Kazuo Ishikawa, Mitsuhiro Aoki, Keisuke Mizuta, Yatsuji Ito, Masatsugu Asai, Hideo Shojaku, Toshiaki Yamanaka, Chisato Fujimoto, Toshihisa Murofushi, Tomoe Yoshida
Stabilometry is a useful tool for examining patients with functional disorders of the vestibular system. However, measurement techniques and devices vary by country. Therefore, international standardization of stabilometry is mandatory to validate the exchange of important findings. This was advocated at the 1983 Posturography Meeting in Kyoto but has not been adopted worldwide, and each country has continued to use unique regional measurement methods. In Japan, stabilometry has widespread application in medical practice in conjunction with research into its applications. With a goal of international standardization, we present details of stabilometry measurement methods and their application in Japan, together with a brief history and potential future directions of stabilometry.

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The contemporary utility of intraoperative frozen sections in thyroid surgery

Publication date: Available online 5 July 2017
Source:American Journal of Otolaryngology
Author(s): Samuel J. Trosman, Rohith Bhargavan, Brandon L. Prendes, Brian B. Burkey, Joseph Scharpf
PurposeTo determine the accuracy of intraoperative frozen section analysis on thyroidectomy specimens stratified by the Bethesda classification scheme and its utility for intraoperative decision-making.Study designRetrospective chart review.MethodsA retrospective review was performed on all patients who underwent thyroidectomy or thyroid lobectomy with intraoperative frozen sections at a tertiary care academic center from 2009 to 2015.ResultsThere were 74 total patients who underwent partial or total thyroidectomy with intraoperative frozen section analysis of a thyroid nodule whom had previously undergone a thyroid fine needle aspiration of the nodule. The sensitivity, specificity, positive predictive value, and negative predictive value for a thyroid frozen section with respect to its prediction for malignancy was 81%, 95%, 98%, and 66%, respectively, with a diagnostic accuracy of 85%. For 37 patients with an indeterminate cytologic diagnosis on fine needle aspiration (Bethesda categories III–V), the sensitivity, specificity, positive predictive value, and negative predictive value for a thyroid frozen section was 81%, 91%, 95%, and 67%, respectively, with a diagnostic accuracy of 84%. False positives and false negatives resulted in 1 completion thyroidectomy for benign pathology and 3 reoperations for malignancy not discovered on frozen section.ConclusionWhile intraoperative frozen sections on thyroid specimens may be helpful if positive, the false negative rate remains high. There appears to be limited value in routine frozen sections to guide clinical management and decision-making in the era of the Bethesda system.

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Metastatic squamous cell carcinoma to the superior cervical ganglion mimicking a retropharyngeal lymph node

Publication date: Available online 5 July 2017
Source:American Journal of Otolaryngology
Author(s): Sami P. Moubayed, Rosalie Machado, Marcela Osorio, Azita Khorsandi, Juan Hernandez-Prera, Mark L. Urken
BackgroundMetastasis of squamous cell carcinoma (SCC) to the superior cervical ganglion (SCG) has never been reported. Its anatomic location may easily be mistaken for a retropharyngeal lymph node. We present the first case of SCC metastasis to the SCG.MethodsWe report a case of a 69year-old never smoking male, who presented with right retropharyngeal PETCT-avid disease following chemoradiation for squamous cell carcinoma of the tonsil. He was brought to the operating room for resection, intraoperative radiation and reconstruction.ResultsIntraoperatively, visualization and frozen section confirmed squamous cell carcinoma located in the superior cervical ganglion. The ganglion was resected, intraoperative radiation was given and the patient was reconstructed with a radial forearm free flap. Postoperatively, the patient displayed features of a Horner's syndrome.ConclusionsThe superior cervical ganglion may be mistaken for a retropharyngeal lymph node. Although extremely rare, these entities may be differentiated on the basis of radiological studies.

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Histopathological investigation of intranodular echogenic foci detected by thyroid ultrasonography

Publication date: Available online 5 July 2017
Source:American Journal of Otolaryngology
Author(s): Bilici Suat, Yiğit Özgür, Onur Fırat, Hamit Bahtiyar, Nazlı Mehmet Ali, Günver Feray, Karagöz Yeşim
ObjectiveTo determine the predictability of sonography for detection of calcifications in thyroid nodules by histopathologic examination and to demonstrate the association between calcification pattern and malignancy.MethodsWe prospectively evaluated 81 dominant nodules from 81 patients. Thyroid glands were assessed preoperatively with thyroid ultrasonography, and the presence of sonographic calcification was specified as intranodular coarse and micro calcification. Micro and coarse calcification in surgery specimens were specified postoperatively as present or absent in the histopathological evaluation. The correlation between sonographic and histopathologic calcifications and the relationship between malignancy and calcification patterns were determined.ResultsCalcification was detected histopathologically in 66.7% of the sonographically calcified nodules and in 12.8% of the sonographically noncalcified nodules. The sensitivity and specificity of sonography for detecting histopathologic calcification were 84.8 and 70.8%, respectively, while positive and negative predictive values were 66.7 and 87.2%, respectively. The sonographical and histopathological outcomes for detection of coarse and micro calcification showed 85 and 50% compatibility, respectively. The difference in malignancy rates between sonographic coarse and micro calcified nodules was not significant (p<0.976). Histopathologic detection of calcification showed no significant difference between malignant and benign nodules (p<0.129).ConclusionHistopathology confirmed a high rate of sonographic macrocalcifications. The micro and macro patterns of sonographic calcification showed no particular association with thyroid malignancy. The preoperative risk of malignancy should be determined in conjunction with other known sonographic risk factors and diagnostic tests.

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Will the 8th editions of the UICC & AJCC staging manuals improve the pathological diagnosis of extranodal extension from cervical lymph nodes?

Garcia et al. [1] present noteworthy data having applied the criteria of the 8th edition of the Union for International Cancer Control (UICC) [2] to a series of mucosal squamous cell carcinomas of the head and neck which had originally been reported using the criteria of earlier editions. It is interesting they do not use the term "extranodal extension" (ENE), which has been introduced into the 8th editions of both the UICC and American Joint Committee on Cancer (AJCC) [3] staging manuals, except where the new criteria are quoted in Table 1, instead preferring "extracapsular spread" (ECS).

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Anesthesia for Heart Transplantation

Publication date: Available online 5 July 2017
Source:Anesthesiology Clinics
Author(s): Davinder Ramsingh, Reed Harvey, Alec Runyon, Michael Benggon

Teaser

This review seeks to evaluate current practices in heart transplantation. The goals of this article were to review current practices for heart transplantation and its anesthesia management. The article reviews current demographics and discusses the current criteria for candidacy for heart transplantation. The process for donor and receipt selection is reviewed. This is followed by a review of mechanical circulatory support devices as they pertain to heart transplantation. The pre-anesthesia and intraoperative considerations are also discussed. Finally, management after transplantation also is reviewed.

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Anesthesia for Intestinal Transplantation

Publication date: Available online 5 July 2017
Source:Anesthesiology Clinics
Author(s): Christine Nguyen-Buckley, Melissa Wong

Teaser

The diagnosis of irreversible intestinal failure confers significant morbidity, mortality, and decreased quality of life. Patients with irreversible intestinal failure may be treated with intestinal transplantation. Intestinal transplantation may include intestine only, liver–intestine, or other visceral elements. Intestinal transplantation candidates present with systemic manifestations of intestinal failure requiring multidisciplinary evaluation at an intestinal transplantation center. Central access may be difficult in intestinal transplantation candidates. Intestinal transplantation is a complex operation with potential for hemodynamic and metabolic instability. Patient and graft survival are improving, but graft failure remains the most common postoperative complication.

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Transplantation Anesthesia: The Role of the Anesthesiologist

Publication date: Available online 5 July 2017
Source:Anesthesiology Clinics
Author(s): Lee A. Fleisher

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Anesthetic Considerations in Transplant Recipients for Nontransplant Surgery

Publication date: Available online 5 July 2017
Source:Anesthesiology Clinics
Author(s): Joshua Herborn, Suraj Parulkar

Teaser

As solid organ transplantation increases and patient survival improves, it will become more common for these patients to present for nontransplant surgery. Recipients may present with medical problems unique to the transplant and important considerations are necessary to keep the transplanted organ functioning. A comprehensive preoperative examination with specific focus on graft functioning is required, and the anesthesiologist needs pay close attention to considerations of immunosuppressive regimens, blood product administration, and the risk benefits of invasive monitoring in these immunosuppressed patients. This article reviews the posttransplant physiology and anesthetic considerations for patients after solid organ transplantation.

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Anesthesia and Perioperative Care in Reconstructive Transplantation

Publication date: Available online 5 July 2017
Source:Anesthesiology Clinics
Author(s): Raymond M. Planinsic, Jay S. Raval, Vijay S. Gorantla

Teaser

Reconstructive transplantation of vascularized composite allografts (VCAs), such as upper extremity, craniofacial, abdominal, lower extremity, or genitourinary transplants, has emerged as a cutting-edge specialty with more than 50 programs in the United States and 30 programs across the world performing these procedures. Most VCAs involve complicated technical planning and preparation, protracted surgery, and complex immunosuppressive or immunomodulatory protocols, each associated with unique anesthesiology challenges. This article outlines key procedural, patient, and protocol-related aspects of VCA relevant to anesthesiology management with the goal of ensuring patient safety and optimizing surgical, immunologic, and functional outcomes.

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Anesthesia for Lung Transplantation

Publication date: Available online 5 July 2017
Source:Anesthesiology Clinics
Author(s): Alina Nicoara, John Anderson- Dam

Teaser

Perioperative management of patients undergoing lung transplantation is challenging and requires constant communication among the surgical, anesthesia, perfusion, and nursing teams. Although all aspects of anesthetic management are important, certain intraoperative strategies (mechanical ventilation, fluid management, extracorporeal mechanical support deployment) have tremendous impact on the subsequent evolution of the lung transplant recipient, especially with respect to allograft function and should be carefully considered. This review highlights some of the intraoperative anesthetic challenges and opportunities during lung transplantation.

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Anesthesia Management of Organ Donors

Publication date: Available online 5 July 2017
Source:Anesthesiology Clinics
Author(s): Victor W. Xia, Michelle Braunfeld

Teaser

The shortage of suitable organs is the biggest obstacle for transplants. At present, most organs for transplant in the United States are from donation after neurologic determination of death (brain death). Potential organs for transplant need to maintain their viability during a series of insults, including the original disease, physiologic derangements during the dying process, ischemia, and reperfusion. Proper donor management before, during, and after procurement has potential to increase the number and quality of organs from donors. Anesthesiologists need to understand the physiologic derangements associated with brain death and the updated donor management during the periprocurement period.

http://ift.tt/2urBQTs

Infectious Complications and Malignancies Arising After Liver Transplantation

Publication date: Available online 5 July 2017
Source:Anesthesiology Clinics
Author(s): Dame W. Idossa, Douglas Alano Simonetto

Teaser

Since the first liver transplant was performed in 1963, great advancements have been made in hepatic transplantation. Surgical techniques have been revised and improved, diagnostic methods for identifying and preventing infections have been developed, and more conservative use of immunosuppressive agents have resulted in better long-term posttransplant outcomes. A total of 7841 liver transplantations were performed in the United States in 2016, resulting in greater than 85% survival at 1 year posttransplant. However, technical surgical complications, infections, rejections, and chronic medical conditions persist. In this review, we discuss the infectious complications and malignancies that may arise after liver transplantation.

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Sinus floor elevation using implants coated with recombinant human bone morphogenetic protein-2: micro-computed tomographic and histomorphometric analyses

Abstract

Objectives

The objective of this study was to determine the validity of a graft-free sinus floor elevation (SFE) procedure with simultaneous placement of recombinant morphogenetic protein-2 (rhBMP-2)-coated implants compared to uncoated control implants.

Methods

In 10 rabbits, SFE was performed on both sides. Dental implants were randomly placed in the sinus filled with a blood clot. Test implants were coated with rhBMP-2, whereas in the control group, implants were uncoated. Micro-computed tomographic and histomophometric analyses were performed at 4 and 8 weeks, including measurement for newly formed bone height (NBHm).

Results

Bone formation was evident along the implant surfaces up to the apex in test, but limited in control implants at 4 weeks. NBHm amounted to 5.1 mm (Q1 = 4.1; Q3 = 5.3) for test implants and to 3.4 mm (2.6; 3.7) for control implants at 4 weeks. NBHm then decreased to 8 weeks (3.4 mm (3.3; 3.7)) for test implants, whereas in control sites, NBHm increased slightly to 4.4 mm (4.1; 4.5) (p = 0.1250; p = 0.6250).

Conclusions

Implants coated with rhBMP-2 presented a strong osteogenic reaction at 4 weeks with more favorable outcomes in terms of bone formation along the implant surface up to the apex compared to uncoated control implants. Remodeling and resorption process between 4 and 8 weeks did not further improve the outcomes in the test, but in the control group.

Clinical relevance

The use of rhBMP-2-coated implants in a graft-free SFE might show an advantage in early implant stability to prevent collapse of membrane. However, a potential clinical benefit still needs to be proven.

http://ift.tt/2uLE7Za

Response to Letter to the Editor: Prevalence of vestibular and balance disorders in children and adolescents according to age category: A multi-center study in Korea

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Jong Dae Lee, Chang-Hee Kim, Seok Min Hong, Sung Huhn Kim, Myung-Whan Suh, Min-Beom Kim, Dae Bo Shim, Hosuk Chu, No Hee Lee, Minbum Kim, Sung Kwang Hong, Jae-Hyun Seo

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Editorial Board

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99

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Letter to the Editor, regarding the article: "Prevalence of vestibular and balance disorders in children and adolescents according to age: A multi-centre study" (2017; 94: 36–39)

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Roeland B. van Leeuwen, Elisabeth A. Cats, Tjasse D. Bruintjes

http://ift.tt/2tr8rbU

Letter to the editor regarding ‘Evaluation of vitamin D levels in children with primary epistaxis’

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): M. Volkan Akdoğan, Evren Hızal

http://ift.tt/2sHXrtH

Reconstruction of parotidectomy and lateral skull base defects.

Purpose of review: The purpose of this review is to summarize the options for reconstruction of parotid and lateral skull base defects based on the size and functional requirements of the defect. Recent findings: Free grafts with dermal fat or acellular human dermis, superficial musculoaponeurotic system flaps, and sternocleidomastoid flaps have been successful in preventing Frey's syndrome and restoring facial contour defects after superficial and total parotidectomy. Lateral skull base resections often require reconstruction with pedicled or free flaps to restore extensive soft tissue and dural defects. Supraclavicular artery island flaps and submental flaps have been recently been gaining popularity for use for these purposes. Free tissue transfer remains the best reconstructive option for repair of large soft tissue and/or dural defects. The most reliable free flap for lateral skull base reconstruction is the anterolateral thigh flap, which is highly versatile because of its large skin paddle and potential for harvest with varying amounts of fascial and muscle tissue. Summary: Here we will summarize the most appropriate and widely used reconstructive options for parotid and lateral skull base defects of various sizes, discussing the most recent evidence pertaining to each technique along with advantages and limitations of each reconstructive strategy. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Hearing health access in developing countries.

Purpose of review: The developing world carries a disproportionate burden of hearing loss. Individuals with hearing loss in austere settings worldwide are also potentially impacted by their impairment to a greater extent owing to underdeveloped or nonexistent hearing health infrastructure. The purpose of this review is to examine the state of the literature on hearing health access in developing countries and identify areas for improvement. Recent findings: Over the last 10 years progress has been made in some areas, whereas other aspects of hearing health in developing countries have changed very little. There has been expansion of efforts to train primary care and local hearing healthcare providers to recognize and appropriately treat preventable causes of hearing loss in the developing world. Applications of telehealth to connect providers and patients in rural locales have grown. Adaptions of newborn hearing screening programs that better fit local resources and customs have been reported. There has been a considerable increase in interest, including cost-benefit analyses, with regard to the use of cochlear implants in the developing world. Summary: In spite of progress, the developing world still shoulders a disproportionate amount of the world's hearing loss, in particular chronic ear disease, and there is a paucity of well trained local hearing healthcare professionals to deal with the challenge. The role of international humanitarian efforts, telemedicine, and education is highlighted. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2uLYp4O

Reconstruction of parotidectomy and lateral skull base defects.

Hearing health access in developing countries.

Breakthrough attacks in patients with hereditary angioedema receiving long-term prophylaxis are responsive to icatibant: findings from the Icatibant Outcome Survey

Patients with hereditary angioedema (HAE) due to C1-inhibitor deficiency (C1-INH-HAE) experience recurrent attacks of cutaneous or submucosal edema that may be frequent and severe; prophylactic treatments can ...

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Review of “Surgical Education and Health Care Reform, Defining the Role and Value of Trainees in an Evolving Medical Landscape” by Fayanju OM, Aggarwal R, Baucom RB, Ferrone CR, Massaro D, Terhune KP in Ann Surg 265: 459–460, 2017

No abstract available

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Surgical Outcomes of Endonasal Conjunctivodacryocystorhinostomy According to Jones Tube Location

Purpose: The aim of this study was to compare surgical outcomes and complications of endonasal conjunctivodacryocystorhinostomy (CDCR) according to Jones tube location. Methods: Patients who underwent endonasal CDCR owing to proximal obstruction of the lacrimal drainage system between 2009 and 2016 were retrospectively reviewed. Patients were divided into 2 groups according to the location of the proximal end of the Jones tube. The canthal-based group included patients in which the proximal end of the Jones tube was located in the medial canthal angle, and the fornix-based group included patients in which the proximal end of the Jones tube was located in the inferomedial conjunctival fornix. Success rates were evaluated at 3 months and 6 months after surgery. Causes of failure, incidence of tube migration, and incidence of canthal deformity were also evaluated. Results: The success rate at 3 months postoperative was 95% in the canthal-based group and 78.6% in the fornix-based group (P = 0.283). Success rates at 6 months postoperative were 85% in the canthal-based group and 71.4% in the fornix-based group, respectively (P = 0.410). The main cause of failure was granuloma in the canthal-based group (2/20) and medial migration in the fornix-based group (3/14). Medial canthal deformity occurred in 12 of 20 cases in the canthal-based group, but none occurred in the fornix-based group. Conclusion: The canthal-based group had a lower migration rate and slightly better surgical success rate than the fornix based group, but canthal deformity was more prevalent.

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Our Surgical Past: An Aid to Understanding the Present and a Guide to the Future

No abstract available

http://ift.tt/2tSm4nu

Hidradenoma of the Chin

Abstract: Clear cell hidradenoma is a rare skin tumor in the head and neck. Clear cell hidradenoma of skin is an uncommon soft tissue tumor originating from the sweat glands. The authors report a case of clear cell hidradenoma developing in the chin in a 61-year-old woman, which occurred during the course of 8 months. The clinical and histologic findings of the tumor are documented. The lesion was totally removed by excision and revealed no evidence of recurrence.

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A Legacy of Leadership: John M. Converse, Joseph McCarthy, and NYU Plastic Surgery

No abstract available

http://ift.tt/2tSkbr6

Microsurgical Decompression of Inferior Alveolar Nerve After Endodontic Treatment Complications

Abstract: Iatrogenic injury in oral surgery is the most frequent cause of sensory disturbance in the distribution of the inferior alveolar nerve (IAN) and mental nerve. Inferior alveolar nerve damage can occur during third molar extraction, implant location, orthognathic surgery, preprosthetic surgery, salivary gland surgery, local anesthetic injections or during the resection of benign or malignant tumors. Injuries to the IAN can be caused also by endodontic treatment of mandibular molars and premolars when filling material is forced into the tooth and mandibular canal. The sensory disturbances that could follow a damage of the IAN could be hypoesthesia, dysesthesia, hyperesthesia, anesthesia, and sometimes a painful anesthesia that strike ipsilateral lower lip, chin, and teeth. These can undermine life quality by affecting speech, chewing, and social interaction. Treatment of these complications is sometimes difficult and could consist in observation or in surgical decompression of the involved nerve to relieve the patient's symptoms and improve sensory recovery. The most debated points are the timing of intervention and the effective role of decompression in clinical outcome—improvement. The purpose of this article is to show authors' experience with 2 patients treated with microsurgical nerve decompression to remove endodontic material from the mandibular canal and providing also a comprehensive review of the literature.

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The Second-Generation Craniofacial Surgeon: Progress Through Personal Responsibility and Personal Relationships

No abstract available

http://ift.tt/2tS2N5I

Radial Forearm Osteocutaneous Free Flap for Reconstruction of Hard Palate With Alveolar Defect

Abstract: The radial forearm free flap is beneficial for reconstruction of large palatal defect with oronasal fistula. A 51-year-old male patient who had anterior palate defect including alveolus after the radiation therapy of malignant cancer on the nasopharyngeal area undertook the radial forearm osteocutaneous free flap to close the oronasal fisula and restore the alveolar arch. The small radial bone segment was fixed in the alveolar defect and vascular anastomoses were performed with facial vessels in neck. The donor site was closed with split thickness skin graft. All suture wounds in the oral and nasal side had healed primarily with no complication within 1 month. The patient was able to swallow soluble foods in the 3 weeks postoperatively without the leakage phenomena in the nose and decreased hypernasality nature in his speech. Grafted bone union at alveolus was confirmed by follow-up computed tomography scan. There was no complication at left forearm donor site with intact musculoskeletal function. Radial forearm osteocutaneous free flap is a versatile option for its capability of reconstruction in complicated defect of soft and hard plate with alveolar defect.

http://ift.tt/2tShZzJ

Syndrome of the Trephined: Functional Improvement After Reconstruction of Large Cranial Vault Defects

No abstract available

http://ift.tt/2tS709D

Lower Eyelid Reconstruction After Ablation of Skin Malignancies: How Far Can We Get in a Single-Stage Procedure?

Reconstruction of full-thickness lower eyelid defects tends to be a devastating procedure, especially when big amount of tissue has to be removed because of oncological reasons. The applied techniques are mostly difficult to execute and multistaged, often require extensive dissection, and result in scarring and facial disfigurement. The aim of the present study is to demonstrate the authors' experience in single-staged reconstructions of full-thickness defects of the lower eyelid with local tissue only. Material and Methods: A retrospective analysis was conducted identifying patients with postexcisional defects after skin cancer occurring in the lower eyelid, reconstructed in 1 stage. Appropriate demographic, pathological, preoperative, and postoperative clinical data and photo documentation were collected and analyzed. Results: After excluding patients with partial thickness defects (n=5), a total of 13 patients with lower eyelid full-thickness defects were studied, including 9 women and 4 men with mean age 66.5 years (age range 53–79 years). The most common malignancy was basal cell carcinoma (n = 11). In one of the patients 2 synchronous neoplasms were excised simultaneously from the same lower eyelid. The reconstruction was successfully performed in 1 stage in all the patients by recruiting the same eyelid tissue and/or temporal tissue. No additional surgery was needed at a minimal follow-up of 9 months. Conclusion: Local tissue flaps have proven to be a reliable option for a single-stage reconstruction of large full-thickness defects. Tenzel flap technique seems to be a reliable option for repair of defects as large as 60% of the total eyelid length.

http://ift.tt/2tS59Sb

Aging in Mathematics and in Surgery

No abstract available

http://ift.tt/2tRUmr7

Monobloc Frontofacial or Le Fort III Distraction Osteogenesis in Syndromic Craniosynostosis: Three-Dimensional Evaluation of Treatment Outcome and the Need for Central Distraction

Background: The objectives of this study were to investigate the treatment effect, morphology, and volumetric outcomes of monobloc frontofacial or Le Fort III distraction osteogenesis in syndromic craniosynostosis by 3-dimensional evaluation. Materials and Methods: Nine consecutive patients underwent monobloc frontofacial or Le Fort III distraction during 2003 to 2012 were included and evaluated. The patient's evaluation is a minimum of a 4-year follow-up. Pretreatment, post-treatment advancement, and relapse were quantified. The changes in intracranial volume, upper airway volume, globe protrusion, advancement at bilateral malar eminence, and central face were calculated from computerized tomography before and after treatment. Results: After distraction, the intracranial volume was increased by 16.4% in average, and the upper airway volume increased by 64.1%. Orbital protrusion improved by 9.9 mm in the left eye and 10.5 mm in the right eye in comparison to the preoperative status. Bilateral malar eminences advancement was greater than the dorsum advancement by 7.1 mm. Conclusion: The external distraction osteogenesis device caused significant technical difficulties with advancement of the midface in growing bones. The central midface did not advance as hoped for. This finding may suggest a need for modification in the distraction device in order to improve the central facial distraction vector.

http://ift.tt/2tSuiMH

Craniofacial Surgery Fellowship Selection Criteria: A National Program Director Survey

Background: Candidate characteristics for craniofacial fellowship training still remain unknown, as no data are available in the literature. This study aims to provide information on the criteria that are used to select and rank applicants for the craniofacial surgery fellowship match. Method: A 38-question survey was sent in April 2015 to all craniofacial surgery fellowship program directors (n = 29) involved in the US match using QuestionPro Survey Software. The survey investigated factors used for selection of applicants, including medical school, residency training, research experience, fellowship interview, and candidate characteristics. A 5-point Likert scale was used to grade 33 factors from "not at all important" (1) to "essential in making my decision" (5); or for 5 controversial factors from "very negative impact" (1) to "very positive impact in making my decision" (5). Results: A total of 62% (18 out of 29) of responses were received from craniofacial surgery program directors. The most important factors were professionalism and ethics (4.7 ± 0.5), perceived commitment to craniofacial surgery (4.6 ± 0.8), interactions with faculty and staff (4.5 ± 0.5), interpersonal skills (4.5 ± 0.5), and overall interview performance (4.4 ± 0.6). Factors that have a negative impact on the selection process include graduation from a nonplastic surgery residency program (1.9 ± 0.7) or a non-US plastic surgery residency program (2.2 ± 0.6), and visa requirement (2.2 ± 0.5). Conclusion: This study provides data on craniofacial surgery program directors' perception on the criteria important for fellowship applicant selection. It is our hope that program directors, residency programs, and applicants find this data useful as they prepare for the craniofacial fellowship match.

http://ift.tt/2tSlN43

Review of “A Multi-Modal Parcellation of Human Cerebral Cortex” by Glasser M, Coalson TS, Robinson EC, Hacker CD, Harwell J, Yacoub E, Ugurbil K, Andersson J, Beckmann CF, Jenkinson M, Smith SM, Van Essen DC in Nature 536: 171–181, 2016

No abstract available

http://ift.tt/2urbLnL

The Role of Skeletal Stem Cells in the Reconstruction of Bone Defects

Abstract: Craniofacial surgery, since its inauguration, has been the culmination of collaborative efforts to solve complex congenital, dysplastic, oncological, and traumatic cranial bone defects. Now, 50 years on from the first craniofacial meeting, the collaborative efforts between surgeons, scientists, and bioengineers are further advancing craniofacial surgery with new discoveries in tissue regeneration. Recent advances in regenerative medicine and stem cell biology have transformed the authors' understanding of bone healing, the role of stem cells governing bone healing, and the effects of the niche environment and extracellular matrix on stem cell fate. This review aims at summarizing the advances within each of these fields.

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Is Surgical Navigation Useful for Treating Zygomatic Arch Fractures?

Objective: To report the case of a 58-year-old man with a zygomatic arch fracture, which was well localized and reduced using a surgical navigation system. Methods: In this clinical report, the authors suggest intraoperative surgical navigation systems are useful diagnostically and for localizing sites of zygomatic arch fractures. Results: The patient underwent successful closed reduction of zygomatic arch fractures using a surgical navigation system. Conclusions: Surgical navigation is a useful tool for identifying the locations of zygomatic arch fractures and for guiding closed reduction. Surgical navigation is recommended for localizing the sites of zygomatic fractures.

http://ift.tt/2sHP4ym

The Development of Surgery of the Craniofacial Skeleton: A March From South to North (or Caudad to Cephalad)

No abstract available

http://ift.tt/2sHlhpA

Cauliflower-Like Shaped Osteoma

Abstract: Skull osteoma is a benign tumor that slowly and continuously enlarges. It is frequently observed in routine medical practice and many patients show an arc shape. The authors encountered a patient with osteoma with a rare morphology that developed in the occipital region. The patient was a 66-year-old male who had been aware of the presence of a mass in the occipital region for about 50 years, but its uncomfortable feeling had recently increased, and it was resected. The excised tumor showed a pedunculated cauliflower-like shape continuous to the skull. The pathological diagnosis was osteoma. The cause of rare morphologies includes trauma and infection, but this patient had no such past medical history. Since the development site was the occipital region, it was assumed that chronic stimulation caused the rare morphology.

http://ift.tt/2sHrEJb

The Degree of Surgical Frontal Volume Correction in Metopic Synostosis Determines Long-Term Outcomes

Abstract: Metopic synostosis results in a keel-shaped forehead, reduced frontal intracranial volume (ICV), and lower frontal to total volume ratio. The ratio improves with cranioplasty, but at 3 years of age, the ratio is still not normalized when compared to that in normal children. The aim of the present study was to investigate whether a low frontal to total ICV ratio at 3 years of age was due to relapse or insufficient correction. All children surgically treated for metopic synostosis in combination with a spring at Sahlgrenska University Hospital with subsequent spring extraction between 2002 and 2008 (n = 20) were included. A MATLAB program was used to measure frontal and total ICV. Preoperatively, the frontal to total ICV ratio was 9.8 ± 1.3% (mean ± standard deviation). At spring removal, 6 months after cranioplasty, the ratio had increased to 11.8 ± 2.4%. At 3 years of age, the ratio was 11.6 ± 1.9%. In age-matched normal children, the ratio was 14.4 ± 1.9% preoperatively, 15.3 ± 2.2% at time of spring extraction, and 13.4 ± 1.4% at 3 years of age. Cranioplasty thus improved the frontal to total ICV ratio, but did not normalize it. The ratio did not change from 6 months after the cranioplasty to 3 years of age. These results indicate that a more pronounced frontal volume correction during cranioplasty is necessary to achieve a normalized distribution of ICV in metopic synostosis.

http://ift.tt/2sHlfOu

The Effect of Anterior Palatoplasty Plus Modified Expansion Sphincter Pharyngoplasty on Voice Performance in Obstructive Sleep Apnea Syndrome

Objective: We aimed to investigate the effect of anterior palatoplasty (AP) plus modified expansion sphincter pharyngoplasty (MESP) on voice performance in patients with obstructive sleep apnea syndrome (OSAS). Methods: Fourteen OSAS patients who had AP + MESP procedure were included in the study. Voice performances of the patients were analyzed with acoustic voice analysis before surgery, and 6 months after surgery. Results: Preoperative and postoperative F0, jitter percentage, and shimmer percentage were compared. Mean preoperative F0 was 129.85 Hz, and mean postoperative F0 was 138.07 Hz, with a significant difference in between (P = 0.017). Mean preoperative jitter percentage was 0.65, and mean shimmer percentage was 0.88, while those values were 0.67 and 0.84, respectively, in the postoperative period. The differences were not statistically significant (P = 0.801 and 0.652). Conclusion: The AP + MESP procedure performed for OSAS results in improvement of F0 in the long term; however, there were no differences in jitter percentage and shimmer percentage.

http://ift.tt/2sHfZdw

Echocardiographic Assessment of Mitral Stenosis Orifice Area: A Comparison of a Novel Three-Dimensional Method Versus Conventional Techniques.

BACKGROUND: A comprehensive evaluation of mitral stenosis (MS) severity commonly utilizes two-dimensional (2D) echocardiography techniques. However, the complex three-dimensional (3D) structure of the mitral valve (MV) poses challenges to accurate measurements of its orifice area by 2D imaging modalities. We aimed to assess MS severity by comparing measurements of the MV orifice area using conventional echocardiography methods to 3D orifice area (3DOA), a novel echocardiographic technique which minimizes geometric assumptions. METHODS: Routine 2D and 3D intraoperative transesophageal echocardiographic images from 26 adult cardiac surgery patients with at least moderate rheumatic MS were retrospectively reviewed. Measurements of the MV orifice area obtained by pressure half-time (PHT), proximal isovelocity surface area (PISA), continuity equation, and 3D planimetry were compared to those acquired using 3DOA. RESULTS: MV areas derived by PHT, PISA, continuity equation, 3D planimetry, and 3DOA (mean value +/- standard deviation) were 1.12 +/- 0.27, 1.03 +/- 0.27, 1.16 +/- 0.35, 0.97 +/- 0.25, and 0.76 +/- 0.21 cm2, respectively. Areas obtained from the 3DOA method were significantly smaller than areas derived from PHT (mean difference 0.35 cm2, P

http://ift.tt/2tNf9v6

Tranexamic Acid Does Not Influence Cardioprotection by Ischemic Preconditioning and Remote Ischemic Preconditioning.

Prior studies have suggested that the antifibrinolytic drug aprotinin increases the infarct size after ischemia and reperfusion (I/R) and attenuates the effect of ischemic preconditioning (IPC). Aprotinin was replaced by tranexamic acid (TXA) in clinical practice. Here, we investigated whether TXA influences I/R injury and/or cardioprotection initiated by IPC and/or remote ischemic preconditioning (RIPC). Anesthetized male Wistar rats were randomized to 6 groups. Control animals were not further treated. Administration of TXA was combined with and without IPC and RIPC. Estimated treatment effect was 20%. Compared to control group (56% +/- 11%), IPC reduced infarct size by 46% (30% +/- 6%; mean difference, 26%; 95% confidence interval, 19-33; P

http://ift.tt/2uL9HGf

Reporting of Perioperative Adverse Events by Pediatric Anesthesiologists at a Tertiary Children's Hospital: Targeted Interventions to Increase the Rate of Reporting.

BACKGROUND: Incident reporting systems (IRSs) are important patient safety tools for identifying risks and opportunities for improvement. A major IRS limitation is underreporting of incidents. Perioperative anesthesia IRSs have been established at multiple pediatric institutions and a national pediatric anesthesia IRS for perioperative serious adverse events (SAEs) is maintained by Wake Up Safe (WUS), a patient safety organization dedicated to pediatric anesthesia quality improvement. A confidential, electronic, perioperative IRS was instituted at our tertiary children's hospital, which is a WUS member. The primary study aim was to increase the rate of incident reporting by anesthesiologists at our institution through a series of interventions. The secondary aim was to characterize our reporting behavior relative to national practice by referencing SAE data from WUS. METHODS: Perioperative adverse events reported over a 71-month period (November 2010 to September 2016) were categorized and the monthly reporting rates determined. Effects of 6 interventions targeted to increase the reporting rate were analyzed using control charts. Intervention 5 involved interviewing pediatric anesthesiologists to ascertain incident reporting barriers and motivators. A key driver diagram was developed and used to guide an improvement initiative. Incidents that fulfilled WUS criteria for SAEs were identified and categorized. SAE reporting rates over a 27-month period for 12 WUS member institutions were determined. RESULTS: 2689 perioperative adverse events were noted in 1980 of 72,384 anesthetics. Mean monthly adverse event case rate was 273 (95% confidence interval, 250-297) per 10,000 anesthetics. A subgroup involving 54,469 cases had 529 SAEs in 440 anesthetics; a mean monthly SAE case rate of 80 (95% confidence interval, 69-91) per 10,000 anesthetics. Cardiac, respiratory, and airway events predominated. Relative to WUS peer members, our institution is a high-reporting outlier. The rate of incident reporting per 10,000 anesthetics was sustainably increased from 149 +/- 35 to 387 +/- 73 (mean +/- SD) after implementing mandatory IRS data entry and Intervention 5 quality improvement initiative. Barriers to reporting included concern for punitive repercussions, feelings of incompetence, poor education about what constitutes an event, lack of feedback, and the perception that reporting had no value. These were addressed by IRS education, cultivation of a culture of safety where reporting is encouraged, reporter feedback, and better inclusion of anesthesiologists in patient safety work. CONCLUSIONS: Electronic mandatory IRS data entry and an initiative to understand and address reporting barriers and motivators were associated with sustained increases in the adverse event reporting rate. These strategies to minimize underreporting enhance IRS value for learning and may be generalizable. (C) 2017 International Anesthesia Research Society

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The US Opioid Crisis: A Role for Enhanced Recovery After Surgery.

No abstract available

http://ift.tt/2sqIHv0

Prophylactic Norepinephrine Infusion for Preventing Hypotension During Spinal Anesthesia for Cesarean Delivery.

BACKGROUND: The use of norepinephrine for maintaining blood pressure (BP) during spinal anesthesia for cesarean delivery has been described recently. However, its administration by titrated manually controlled infusion in this context has not been evaluated. METHODS: In a double-blinded, randomized controlled trial, 110 healthy women having spinal anesthesia for elective cesarean delivery were randomly allocated to 1 of 2 groups. In group 1, patients received an infusion of 5 [mu]g/mL norepinephrine that was started at 30 mL/h (2.5 [mu]g/ min) immediately after intrathecal injection and then manually adjusted within the range 0-60 mL/h (0-5 [mu]g/min), according to values of systolic BP measured noninvasively at 1-minute intervals until delivery, with the objective of maintaining values near baseline. In group 2, no prophylactic vasopressor was given, and a bolus of 1 mL norepinephrine 5 [mu]g/mL (5 [mu]g) was given whenever systolic BP decreased to

http://ift.tt/2tNaQjo

Methodological and Reporting Quality of Systematic Reviews Published in the Highest Ranking Journals in the Field of Pain.

BACKGROUND: Systematic reviews (SRs) are important for making clinical recommendations and guidelines. We analyzed methodological and reporting quality of pain-related SRs published in the top-ranking anesthesiology journals. METHODS: This was a cross-sectional meta-epidemiological study. SRs published from 2005 to 2015 in the first quartile journals within the Journal Citation Reports category Anesthesiology were analyzed based on the Journal Citation Reports impact factor for year 2014. Each SR was assessed by 2 independent authors using Assessment of Multiple Systematic Reviews (AMSTAR) and Preferred Reporting Items of Systematic reviews and Meta-Analyses (PRISMA) tools. Total score (median and interquartile range, IQR) on checklists, temporal trends in total score, correlation in total scores between the 2 checklists, and variability of those results between journals were analyzed. RESULTS: A total of 446 SRs were included. Median total score of AMSTAR was 6/11 (IQR: 4-7) and of PRISMA 18.5/27 (IQR: 15-22). High compliance (reported in over 90% SRs) was found in only 1 of 11 AMSTAR and 5 of 27 PRISMA items. Low compliance was found for the majority of AMSTAR and PRISMA individual items. Linear regression indicated that there was no improvement in the methodological and reporting quality of SRs before and after the publication of the 2 checklists (AMSTAR: F(1,8) = 0.22; P = .65, PRISMA: F(1,7) = 0.22; P = .47). Total scores of AMSTAR and PRISMA had positive association (R = 0.71; P

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Patients Undergoing Orthotopic Liver Transplantation Require Lower Concentrations of the Volatile Anesthetic Sevoflurane.

BACKGROUND: Sevoflurane is a volatile anesthetic commonly used to maintain anesthesia in patients with end-stage liver disease (ESLD) undergoing orthotopic liver transplantation (OLT). Growing evidence suggests that patients with ESLD have decreased anesthetic requirements compared to patients with preserved liver function. The potency of volatile anesthetics is expressed as the minimum alveolar concentration (MAC). In this prospective, blinded study, we compared the MAC of sevoflurane among patients with ESLD undergoing OLT and patients with normal liver function undergoing major abdominal surgery. METHODS: After propofol-induced anesthesia, the MAC of sevoflurane was assessed by evaluating motor response to initial skin incision in patients undergoing OLT and in patients with normal liver function undergoing major abdominal surgery. The MAC was determined using Dixon "up-and-down" method and compared between groups. In addition, the bispectral index was documented immediately before and after skin incision. RESULTS: Twenty patients undergoing OLT and 20 control patients were included in the study. The MAC of sevoflurane in patients undergoing OLT was 1.3% (95% confidence interval [CI], 1.1-1.4). In comparison, the MAC of sevoflurane in patients with normal liver function was 1.7% (95% CI, 1.6-1.9), equal to a relative reduction of the MAC in patients with ESLD of 26% (95% CI, 14-39). The bispectral index was higher in patients with ESLD than in control patients at 3 minutes before (47 [95% CI, 40-53] vs 35 [95% CI, 31-40], P = .011), 1 minute before (48 [95% CI, 42-54] vs 37 [95% CI, 33-43], P = .03), and 1 minute after skin incision (57 [95% CI, 50-64] vs 41 [95% CI, 36-47], P

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Anesthesia Adverse Events Voluntarily Reported in the Veterans Health Administration and Lessons Learned.

BACKGROUND: Anesthesia providers have long been pioneers in patient safety. Despite remarkable efforts, anesthesia errors still occur, resulting in complications, injuries, and even death. The Veterans Health Administration (VHA) National Center of Patient Safety uses root cause analysis (RCA) to examine why system-related adverse events occur and how to prevent future similar events. This study describes the types of anesthesia adverse events reported in VHA hospitals and their root causes and preventative actions. METHODS: RCA reports from VHA hospitals from May 30, 2012, to May 1, 2015, were reviewed for root causes, severity of patient outcomes, and actions. These elements were coded by consensus and analyzed using descriptive statistics. RESULTS: During the study period, 3228 RCAs were submitted, of which 292 involved an anesthesia provider. Thirty-six of these were specific to anesthesia care. We reviewed these 36 RCA reports of adverse events specific to anesthesia care. Types of event included medication errors (28%, 10), regional blocks (14%, 5), airway management (14%, 5), skin integrity or position (11%, 4), other (11%, 4), consent issues (8%, 3), equipment (8%, 3), and intravenous access and anesthesia awareness (3%, 1 each). Of the 36 anesthesia events reported, 5 (14%) were identified as being catastrophic, 10 (28%) major, 12 (34%) moderate, and 9 (26%) minor. The majority of root causes identified a need for improved standardization of processes. CONCLUSIONS: This analysis points to the need for systemwide implementation of human factors engineering-based approaches to work toward further eliminating anesthesia-related adverse events. Such actions include standardization of processes, forcing functions, separating storage of look-alike sound-alike medications, limiting stock of high-risk medication strengths, bar coding medications, use of cognitive aids such as checklists, and high-fidelity simulation. (C) 2017 International Anesthesia Research Society

http://ift.tt/2sqIyHY

Identifying novel genes and biological processes relevant to the development of cancer therapy-induced mucositis: An informative gene network analysis

by Cielito C. Reyes-Gibby, Stephanie C. Melkonian, Jian Wang, Robert K. Yu, Samuel A. Shelburne, Charles Lu, Gary Brandon Gunn, Mark S. Chambers, Ehab Y. Hanna, Sai-Ching J. Yeung, Sanjay Shete

Mucositis is a complex, dose-limiting toxicity of chemotherapy or radiotherapy that leads to painful mouth ulcers, difficulty eating or swallowing, gastrointestinal distress, and reduced quality of life for patients with cancer. Mucositis is most common for those undergoing high-dose chemotherapy and hematopoietic stem cell transplantation and for those being treated for malignancies of the head and neck. Treatment and management of mucositis remain challenging. It is expected that multiple genes are involved in the formation, severity, and persistence of mucositis. We used Ingenuity Pathway Analysis (IPA), a novel network-based approach that integrates complex intracellular and intercellular interactions involved in diseases, to systematically explore the molecular complexity of mucositis. As a first step, we searched the literature to identify genes that harbor or are close to the genetic variants significantly associated with mucositis. Our literature review identified 27 candidate genes, of which ERCC1, XRCC1, and MTHFR were the most frequently studied for mucositis. On the basis of this 27-gene list, we used IPA to generate gene networks for mucositis. The most biologically significant novel molecules identified through IPA analyses included TP53, CTNNB1, MYC, RB1, P38 MAPK, and EP300. Additionally, uracil degradation II (reductive) and thymine degradation pathways (p = 1.06⁻⁰⁸) were most significant. Finally, utilizing 66 SNPs within the 8 most connected IPA-derived candidate molecules, we conducted a genetic association study for oral mucositis in the head and neck cancer patients who were treated using chemotherapy and/or radiation therapy (186 head and neck cancer patients with oral mucositis vs. 699 head and neck cancer patients without oral mucositis). The top ranked gene identified through this association analysis was RB1 (rs2227311, p-value = 0.034, odds ratio = 0.67). In conclusion, gene network analysis identified novel molecules and biological processes, including pathways related to inflammation and oxidative stress, that are relevant to mucositis development, thus providing the basis for future studies to improve the management and treatment of mucositis in patients with cancer.

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Issue Information

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Computational fluid dynamics and the study of sinonasal pathophysiology

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Reflectance confocal microscopic evaluation of nonmelanocytic lip lesions

Abstract

Lips display various benign and malignant lesions. Considering their functional and cosmetic importance, noninvasive diagnostic methods are required. In vivo reflectance confocal microscopy (RCM) has already been reported to be useful in the evaluation of various skin lesions. The aim of this study was to define the RCM features of nonmelanocytic lip lesions, compare them with healthy lip, and demonstrate the applicability of RCM as a noninvasive diagnostic method for nonmelanocytic lip lesions. Sixty-seven patients with premalignant/malignant, inflammatory, and infectious lip lesions and twenty-one healthy volunteers were included in the study. Following clinical and RCM examination, histopathological confirmation was obtained in all lesions except herpes labialis, verrucae, and aphthae. RCM features of individual lesions and corresponding groups were evaluated and compared. Pleomorphism was the common feature of premalignant/malignant lesions. Dermal invasion of dyskeratotic keratinocytes was visualized in all squamous cell carcinoma lesions. Spongiosis and inflammatory cells were the common features of inflammatory lesions. Hypergranulosis and necrotic keratinocytes were highly specific for lichen planus. The most specific features for discoid lupus erythematosus were irregular pattern, follicular plugs, and perifollicular inflammatory cells. Virus-infected keratinocytes were visualized in herpes and verrucae. RCM features showed high sensitivity and specificity to detect nonmelanocytic lip lesions. Although the penetration is limited to the papillary dermis in nonmucosal skin, imaging down to the mid-dermis with satisfactory resolution was possible on the lips.

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Clinicopathological features, management and outcome of patients with poorly-differentiated oral and oropharyngeal squamous cell carcinoma

Publication date: Available online 4 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Zhien Feng, Qiao Shi Xu, Chong Wang, Bo Li, Jin Zhong Li, Ming Hui Mao, Hua Li, Li Zheng Qin, Zhengxue Han
BackgroundThe purpose of this study was to explore the clinicopathological features, risk factors, and management of poorly differentiated oral and oropharyngeal squamous cell carcinoma (OOSCC) patients in the northern Chinese population.MethodA total of 118 poorly differentiated OOSCC patients from 2236 consecutive cases were retrospectively enrolled in this study.ResultsCox regression analysis showed that site (hazard ratio (HR): 2.561, 95% confidence interval (CI): 1.064–6.164, p = 0.036) and lymph node ratio (LNR) (HR: 3.915, 95% CI: 1.797–8.530, p = 0.001) were independent predictive factors for 5-year disease-specific survival (DSS). LNR > 0.036, oropharynx site, and advanced clinical stage formulate a model of risk stratification. The patients with a risk score of ≥2 were identified as the high-risk population, and patients with a risk score of 0 or 1 were identified as the low-risk population. Patients in the high-risk population who underwent surgery plus concurrent chemoradiotherapy (CCRT) had markedly better 5-year DSS than those who only underwent surgery (60.0% vs. 20.0%, p = 0.016). However, patients in the low-risk population who underwent surgery alone exhibited a similar 5-year DSS (68.2%) compared with those who received surgery plus radiotherapy (RT) (68.2%) or surgery plus CCRT (50.0%) (p = 0.907).ConclusionsHigh LNR, oropharynx site and advanced clinical stage constitute a model of risk stratification for patients with poorly differentiated OOSCC. If two or more risk factors are present, surgery and adjuvant chemoradiotherapy can give the best prognosis.

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Stability of biodegradable metal (Mg-Ca-Zn alloy) screws compared with absorbable polymer and titanium screws for sagittal split ramus osteotomy of the mandible using the finite element analysis model

Publication date: Available online 4 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Jee-Ho Lee, Hyung-Seop Han, Yu-Chan Kim, Jin-Yong Lee, Bu-Kyu Lee
Mg-Ca-Zn alloy has been suggested for the application of fixation materials during maxillofacial surgery. We investigated the stability of Mg-Ca-Zn alloy for clinical application during orthognathic surgery. The finite element model for the fixation of sagittal split ramus osteotomy was constructed. In the bicortical screw fixation of the mandible setback condition, the stress distributions of Mg-Ca-Za alloy, polylactic acid polymer, and titanium were evaluated using the virtual model with occlusal loading of 132 N. The deformations of the three different materials of fixation screw were observed according to masticatory force ranging from 132 to 1,000 N. When comparing the stress distribution placed on cortical bone between the polymer and magnesium alloy groups, the magnesium alloy screws could bear more stress, thereby decreasing the stress, which might be distributed to other biologic components, such as the condyle and cortical ramus of the mandible. Deformations of the screws according to functional load were minimal, and the deformation remained <0.21 mm at the initial functional load of the mandible after surgery, regardless of materials used. The biodegradable magnesium alloy screw can bear more stress and decrease the detrimental effect on the stability of sagittal split ramus osteotomy setback surgery.

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Automatic repositioning of jaw segments for three-dimensional virtual treatment planning of orthognathic surgery

Publication date: Available online 4 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Rodrigo Mologni Gonçalves dos Santos, José Mario De Martino, Luis Augusto Passeri, Romis Ribeiro de Faissol Attux, Francisco Haiter Neto
PurposeTo develop a computer-based method for automating the repositioning of jaw segments in the skull during three-dimensional virtual treatment planning of orthognathic surgery. The method speeds up the planning phase of the orthognatic procedure, releasing surgeons from laborious and time-consuming tasks.Materials and MethodsThe method finds the optimal positions for the maxilla, mandibular body, and bony chin in the skull. Minimization of cephalometric differences between measured and standard values is considered. Cone-beam computed tomographic images acquired from four preoperative patients with skeletal malocclusion were used for evaluating the method.ResultsDentofacial problems of the four patients were rectified, including skeletal malocclusion, facial asymmetry, and jaw discrepancies.ConclusionsThe results show that the method is potentially able to be used in routine clinical practice as support for treatment-planning decisions in orthognathic surgery.

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Three-Dimensional analysis of the pharyngeal airway space and hyoid bone position after orthognathic surgery

Publication date: Available online 4 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Amanda Lury Yamashita, Liogi Iwaki Filho, Pablo Cornélius Comelli Leite, Ricardo de Lima Navarro, Adilson Luiz Ramos, Isolde Terezinha Santos Previdelli, Matheus Henrique Dal Molin Ribeiro, Lilian Cristina Vessoni Iwaki
PurposeThe aim of this study was to evaluate changes in the pharyngeal airway space (PAS) and hyoid bone position after orthognathic surgery with cone-beam computed tomography (CBCT).Material and methodsThis study was conducted with the tomographic records of 30 patients with skeletal class II or III deformities submitted to two different types of orthognathic surgery: Group 1 (n = 15), maxillary advancement, and mandibular setback; and Group 2 (n = 15), maxillomandibular advancement. CBCT scans were acquired preoperatively (T0); and at around 1.5 months (T1) and 6.7 months (T2) postoperatively. PAS volume, minimum cross-sectional area (min CSA), and hyoid bone position changes were assessed with Dolphin Imaging 3D software, and results analysed with ANOVA and a Tukey-Kramer test (p < 0.05).ResultsThe hyoid bone was significantly displaced in the horizontal dimension, moving posteriorly in Group 1, and anteriorly in Group 2. Although PAS volume and min CSA increased after both surgeries, these measurements were significantly larger only in Group 2. The significant differences that existed between groups preoperatively no longer existed after the surgeries.ConclusionsBoth orthognathic surgeries assessed resulted in changes in hyoid bone position and increased PAS volume and min CSA, particularly after maxillomandibular advancement surgery.

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Electromyographic analysis of superior orbicularis oris muscle function in children surgically treated for unilateral complete cleft lip and palate

Publication date: Available online 5 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Liliana Szyszka-Sommerfeld, Krzysztof Woźniak, Teresa Matthews-Brzozowska, Beata Kawala, Marcin Mikulewicz
PurposeThe aim of this study was to assess the electrical activity of the superior orbicularis oris muscle in children surgically treated for unilateral complete cleft lip and palate (UCCLP).Material and MethodsThe sample comprised 45 patients 6.38 to 12.68 years of age with UCCLP and 40 subjects 6.61 to 11.71 years of age with no clefts. Electromyographical (EMG) recordings were taken with a DAB-Bluetooth Instrument (Zebris Medical GmbH, Germany) in the rest position and during saliva swallowing, lip protrusion and reciprocal compression of the lips, as well as while producing the phonemes/p/,/b/, and/m/combined with the vowel/a/.ResultsThe electrical activity of the upper lip during saliva swallowing and lip compression was significantly greater in the cleft group. Similar resting level activity was observed in both groups. During the production of the/p/,/b/, and/m/phonemes combined with the vowel/a/the results showed no significant differences in the EMG activity between children with UCCLP and noncleft subjects.ConclusionPatients with UCCLP have abnormal upper lip function characterized by increased activity of the superior orbicularis oris muscle during saliva swallowing and lip compression, and this may affect facial morphology.

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Determinants of Incident Metabolic Syndrome in a Middle Eastern Population: Isfahan Cohort Study

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

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Nonblanching, Palpable Skin Lesions With a Linear Pattern in Henoch-Schönlein Syndrome

This case series examines the prevalence and characteristics of linear nonblanching skin lesions in children with Henoch-Schönlein syndrome.

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Diversity in the Selection of Dermatology Applicants

In Reply We appreciate the thoughtful responses by both Oussedik and Gross to our article, which raise important questions regarding the emphasis on research and standardized testing in the dermatology resident selection process.

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Diversity in the Selection of Dermatology Applicants

To the Editor In the name of diversity, Drs Chen and Shinkai propose eliminating Step 1 scores and research experience, among other things, as selection criteria for dermatology residency. However, Step 1 scores objectively test knowledge-based learning in the basic science years of medical school and are the only standardized assessment for all applicants to residency positions. Among the possible reasons that underrepresented minorities (URMs) have low Step 1 scores presented is that "studying for a good grade…can significantly undermine…learning for the joy of learning."^(p259) Why would joyful learning preclude attaining good grades and demonstrating competency by Step 1 performance? In addition, research experience is important for residency applicants and for dermatology as a specialty. If URMs cannot afford to do research, then perhaps medical student research needs better funding. Rather than discouraging research by medical students and the mentorship provided by the faculty member, it behooves the specialty to find a way to support such research, especially by URMs.

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Nivolumab for Treatment-Related Vitiligo in Relapsed Metastatic Melanoma

This case report describes the use of nivolumab therapy for treatment-related vitiligo in a patient with relapsed metastatic melanoma.

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Diversity in the Selection of Dermatology Applicants

To the Editor We read with great interest the Viewpoint by Chen and Shinkai on rethinking the paradigm by which dermatology applicants are selected. Dermatology is considered one of the least diverse specialties, and to address this lack of diversity in our specialty, Chen and Shinkai offer 6 outstanding recommendations. However, we believe that 1 additional imperative consideration should have been addressed—the role of the research fellowship and its implications for dermatology resident selection.

http://ift.tt/2sqc0Oc

Perineural Invasion of Cutaneous Squamous Cell Carcinoma

This systematic review and pooled analysis compares disease-related outcomes and survival between patients with cutaneous squamous cell carcinoma and clinical perineural invasion vs patients with cutaneous squamous cell carcinoma and incidental perineural invasion.

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Topical Steroids in Chinese Cosmetics

This Viewpoint highlights the importance of eliminating topical steroids from Chinese cosmetic products.

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Expression of Hormone Receptors and HER-2 in Benign and Malignant Salivary Gland Tumors

Abstract

With the advent of targeted therapies, expression of sex hormone receptors and HER-2 in salivary gland tumors (SGTs) is of clinical interest. Previous reports of estrogen (ER) and progesterone (PR) receptor expression have varied. Androgen receptor (AR) and HER-2 overexpression are frequently reported in salivary duct carcinoma (SDC), but have not been studied systematically in other SGTs. This study examines ER, PR, AR, and HER-2 expression in SGTs. Immunohistochemistry for ER, PR, AR, and HER-2 was performed on 254 SGTs (134 malignant). ER, PR, and AR expression was scored using Allred system. HER-2 expression was scored using Dako HercepTest guidelines. FISH for HER-2 amplification was performed on select cases with HER-2 overexpression (2–3+). No SGT demonstrated strong expression of ER or PR. Combined strong AR and HER-2 expression was seen in 22 carcinomas: 14/25 SDC, 3/16 poorly differentiated, two oncocytic, and one each carcinoma ex pleomorphic adenoma, squamous cell, and intraductal carcinoma. Eighteen additional high grade carcinomas had HER-2 overexpression with absent, weak, or moderate AR expression; eight high grade carcinomas had isolated strong AR expression with 0–1+ HER-2 staining. Of 15 tested cases, six demonstrated HER-2 amplification by FISH, all of which had 3+ immunoreactivity. Neither benign nor malignant SGTs had strong expression of ER or PR. None of the benign SGTs overexpressed AR or HER-2. Coexpression of AR and HER-2 should not define SDC, but immunostaining should be considered in high grade salivary carcinomas, as some show overexpression and may benefit from targeted therapy.

http://ift.tt/2sLKPNj

Expression of Hormone Receptors and HER-2 in Benign and Malignant Salivary Gland Tumors

Abstract

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Study of Efficacy and Safety of NIR178 and PDR001 Combination in Patients With Selected Solid Tumors and Non-Hodgkin Lymphoma

Conditions: NSCLC; RCC; Pancreatic Cancer; Urothelial Cancer; Head and Neck Cancer; DLBCL; Microsatellite Stable (MSS) Colon Cancer, TNBC; Melanoma
Interventions: Drug: NIR178 continuosly and PDR001 combination; Drug: NIR178 in combination with 400mg PDR001 continuously or intermittent; Drug: NIR178/PDR001 combo- schedule to be determined
Sponsor: Novartis Pharmaceuticals
Not yet recruiting - verified June 2017

http://ift.tt/2uK7XNC

Improving Evidence-Based Care for Cancer Patients

Conditions: Head and Neck Cancer; Prostate Cancer; Breast Cancer; Lung Cancer; Gynecologic Cancer; Gastrointestinal Cancer
Interventions: Other: Survey; Other: Saliva sample; Other: Smoking Status questions; Other: Health Services
Sponsor: Medical University of South Carolina
Recruiting - verified November 2016

http://ift.tt/2tM3T1V

Expression of Hormone Receptors and HER-2 in Benign and Malignant Salivary Gland Tumors

Abstract

http://ift.tt/2sLKPNj

Αρχειοθήκη ιστολογίου

Τετάρτη 5 Ιουλίου 2017

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