Skin eruption and long-lasting fever in a young man

Description

A 20-year-old man presented to emergency room with a 3-week history of general weakness, fever, diffuse arthralgia and skin eruption. His medical history was unremarkable; he did not travel recently, had no contact with an ill person, nor had risky sexual behaviour and took no medication. Physical examination only showed a diffuse, non-painful, infracentimetric and non-confluent macular eruption over the trunks and limbs (figures 1 and 2). Blood test showed elevated C reactive protein and neutrophilic leucocytosis. Serologies for hepatitis C and B viruses, rubella, Epstein-Barr virus, cytomegalovirus, toxoplasmosis and HIV were negative. Urinalysis and chest X-ray were normal. Blood cultures became positive for Neisseria meningitidis, whereas skin biopsy only showed a dermic inflammatory polymorphic (lymphocytic and neutrophilic) infiltrate without specificity with negative aerobic and anaerobic cultures.

Figure 1

Macular lesions on the trunk.

Figure 2

Macular lesions...

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Diencephalic syndrome: a rare cause of failure to thrive

Timely diagnosis of diencephalic syndrome is not often the case for patients presenting with failure to thrive (FTT) because of its rarity and lack of specific symptoms. Herein, we report two cases of diencephalic syndrome (2-year-old girl and 10-month-old boy) presenting with severe emaciation. Both patients had histories of poor weight gain for months despite having good appetites prior to diagnosis. Initial work-up did not reveal the diagnosis. Horizontal nystagmus was noted in both patients: by a neurologist in the first patient and by a family member in the second patient. MRI of the brain showed large suprasellar mass and pilocytic astrocytoma was confirmed by pathology in each case. The patients were started on appropriate chemotherapy with interval improvements in weight gain. These cases illustrate the importance of cranial imaging and consideration of diencephalic syndrome for children presenting with FTT despite normal or increased caloric intake.

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Substantial harm associated with failure of chronic paediatric central venous access devices

Central venous access devices (CVADs) form an important component of modern paediatric healthcare, especially for children with chronic health conditions such as cancer or gastrointestinal disorders. However device failure and complications rates are high.

Over 21/2 years, a child requiring parenteral nutrition and associated vascular access dependency due to 'short gut syndrome' (intestinal failure secondary to gastroschisis and resultant significant bowel resection) had ten CVADs inserted, with ninesubsequently failing. This resulted in multiple anaesthetics, invasive procedures, injuries, vascular depletion, interrupted nutrition, delayed treatment and substantial healthcare costs. A conservative estimate of the institutional costs for each insertion, or rewiring, of her tunnelled CVAD was $A10 253 (2016 Australian dollars).

These complications and device failures had significant negative impact on the child and her family. Considering the commonality of conditions requiring prolonged vascular access, these failures also have a significant impact on international health service costs.

http://ift.tt/2sT95Nt

Renal keratinising desquamative squamous metaplasia: all that hurts is not stone

Description

A 66-year-old Caucasian man with history of hypertension, hyperlipidaemia and 16 pack-year smoking was referred to us for evaluation of recurrent right-sided flank pain and suspected nephrolithiasis. His first episode of pain was 2 years prior to presentation, which was recurrent. There was no associated haematuria, dysuria, fever, chills, urinary hesitancy or incontinence. There was no family history of stones. He underwent multiple ureteroscopies, which have shown glistening, soft, acellular debris in the upper ureter. Last ureteroscopy and pyeloscopy showed normal underlying mucosa, renal pelvis and calyces with no evidence of malignancy. Subsequent MRI also did not show any malignancy. The last available pathology showed minute fragments of acellular keratin debris. Interestingly, he never had imaging evidence of renal stone, although had mild hydronephrosis one time. CT urogram demonstrated an ill-defined filling defect in the anterior right renal pelvis measuring approximately 13x3 mm in axial dimensions (figure 1). During...

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Transient neonatal hypercalcaemia secondary to excess maternal vitamin D intake: too much of a good thing

We report a case of transient neonatal hypercalcaemia secondary to excess maternal vitamin D intake in pregnancy. Vitamin D insufficiency and deficiency in pregnancy are associated with adverse pregnancy outcomes, but there is no definite benefit to supplementation. The Royal College of Obstetrics and Gynaecology recommends routine supplementation with vitamin D₃ 400 IU/day, but higher dose preparations usually recommended for the treatment of vitamin D deficiency are readily available over the counter. This case highlights the risks of excess supplementation, especially at higher doses and in women without evidence of vitamin D deficiency. The amount used in this case was at the upper end of the generally accepted safe dose range, but still less than that commonly recognised to cause problems. Neonatal hypercalcaemia is a potentially serious condition. The current local or national recommendations for vitamin D supplementation and the possible adverse effects of excess vitamin D consumption should be clearly communicated to pregnant women.

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Intraparenchymal pericatheter cyst in ventriculoperitoneal shunt failure

Description

A 60-year-old man status post right parieto-occipital ventriculoperitoneal shunt with programmable valve for indication of delayed hydrocephalus after aneurysmal subarachnoid haemorrhage returns to clinic 7 weeks after placement for insidious onset of headaches, confusion and gait imbalance. CT scan of the head without contrast revealed an intraparenchymal pericatheter cystic collection with severe oedema (figure 1). The patient denied systemic signs of illness, and laboratory markers for infection were low. A tap of the shunt reservoir revealed no spontaneous flow and difficulty in aspirating cerebrospinal fluid (CSF). Laboratory analysis of the fluid showed negative Gram stain, normal chemistry profile and cell counts. MRI of the brain showed a simple cyst with significant oedema, but no restricted diffusion or contrast enhancement of the cyst wall (figures 2 and 3). CT of the abdomen was benign, without evidence of pseudocyst or other cause of distal obstruction.

...

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Sternoclavicular joint osteophytosis: a difficult diagnosis to swallow

Unexplained dysphagia requires prompt investigation to rule out a possible underlying malignancy. We describe the case of a 60-year-old man who presented to his family practitioner with a 1-year history of increasing dysphagia with associated pain over the front of his chest. He was referred on to an ear, nose and throat specialist where no obvious laryngeal pathology was found at direct laryngoscopy, but an 'indentation' of the right anterior larynx, which increased with external pressure on the sternoclavicular joint (SCJ), was noted. A subsequent CT scan of his neck demonstrated osteoarthritis of the right SCJ with an abnormally large posterior osteophyte. The patient was subsequently referred on to an orthopaedic surgeon specialising in SCJ surgery and underwent an arthroscopic excision of his right SCJ. Soon after surgery, the patient's dysphagia had settled and his symptoms remain resolved 1 year post surgery.

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Cupping at the ends of ribs is not always rickets

Description

A 7-week-old baby boy presented with a history of cough, loose stools and respiratory distress since last 7 days. At admission he had a respiratory rate of 64/min, a heart rate of 144/min and an oxygen saturation of 56%. Chest examination revealed crepitations in both lung fields. Rest of the examination was unremarkable. Investigations revealed haemoglobin 82 g/L; white cell count 11.2x10⁹/L (differential counts: polymorphs 68%, lymphocytes 1%, monocytes 26% and eosinophils 5%); absolute lymphocyte count 0.11x10⁹/L; platelet count 102x10⁹/L and C reactive protein 239 g/L. Chest X-ray showed non-homogenous opacities in bilateral lung fields (more on right side) with an absent thymic shadow, cupping at the anterior end of ribs (black arrow, figure 1), flattening of lower end of the right scapula (white arrow, figure 1) and a spur at the inferior-lateral angle of the left scapula (white arrow head, figure 1). These characteristic radiological changes (ie, cupping at...

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Isolated insulin-derived amyloidoma of the breast

Isolated amyloidomas derived from insulin are extremely rare, and there is only one reported case to date of insulin-derived amyloidoma in the breast.

We present the case of a 36-year-old woman reporting a lump in the right breast. It was clinically assessed as a probable fibroadenoma but was removed surgically given the size of the lesion. On histological analysis, the lesion had features consistent with amyloid. Further investigations showed the amyloid to be derived from insulin. The lump was removed in its entirety, and the patient made a full recovery.

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Bilateral interstitial keratitis with anterior stromal infiltrates associated with reactive arthritis

A previously healthy 48-year-old man presented with a 1-week history of migrating polyarthropathy preceded by a viral illness, dysuria and bilateral red eyes. Ocular examination revealed anterior and interstitial stromal keratitis. He was systemically well but had raised erythrocyte sedimentation rate and C reactive protein and was positive for human leucocyte antigen B27 on extensive infective, rheumatological and autoimmune investigations. Although the exact triggering pathogen was not identified, clinical findings were consistent with reactive arthritis. Bilateral interstitial keratitis is a rare manifestation of reactive arthritis which, along with the anterior stromal keratitis, responded well to topical prednisolone sodium phosphate 0.5%. Systemic joint symptoms improved on oral sulfasalazine, non-steroid anti-inflammatory agent and low-dose prednisolone.

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Use of low-dose thrombolytics for treatment of intracardiac thrombus and massive pulmonary embolus after aborted liver transplant leads to recovery of right ventricular function and redo liver transplantation

This is a 61-year-old man with end-stage liver disease who experienced cardiac arrest secondary to a massive pulmonary embolus and intracardiac thrombus during cannulation for veno-venous extracorporeal membrane oxygenation (ECMO) in preparation for orthotopic liver transplantation (OLT). Surgery was aborted and the patient was taken back to the intensive care unit in cardiogenic shock on multiple vasopressors. The patient was unresponsive to heparin bolus and too high risk for systemic thrombolytics or embolectomy. He was ultimately treated with 12 mg total of alteplase through his pulmonary artery catheter over 3 hours. He had subsequent resolution of his cardiogenic shock and proceeded with successful liver transplantation 5 days after his initial event without any bleeding complications. Low-dose thrombolytic therapy in the setting of absolute contraindications to thrombolysis allowed for recovery of cardiac function and, ultimately redo OLT in a patient with otherwise little hope of survival.

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Adrenal crisis in metastatic breast cancer

A female patient with oestrogen receptor-positive and human epidermal growth factor receptor 2 (HER2)-positive invasive lobular breast cancer presented with progressive disease on CT scan. Some days after initiation of antineoplastic chemotherapy and anti-HER2 targeted antibody therapy, the patient presented with profuse diarrhoea, neutropaenia, nausea and weakness. Although Clostridium difficile was rapidly tackled as a causative agent of gastrointestinal complaints, clinical situation did not markedly improve despite proper antimicrobial treatment. The patient reported profound lack of energy, while nausea, vomiting and loose stools still persisted. Additionally slightly exaggerated pigmentation of nonsunexposed skin and mucosal areas led us to the assumption of proopiomelanocortin-derived peptide hypersecretion. The combination of highly elevated adrenocorticotropic hormone and low basal cortisol levels taken from a morning blood sample established the diagnosis of adrenal insufficiency due to metastatic burden, leading to a near Addison crisis by gastrointestinal complications of chemo-immune therapy. Administration of hydrocortisone immediately relieved general symptoms .

http://ift.tt/2tnwvyf

Contribution of arterial spin-labelling MRI in a case with immune reconstitution inflammatory syndrome

Central nervous system immune reconstitution inflammatory syndrome (CNS-IRIS), which occurs most often in HIV-infected patients, is an exacerbation of inflammatory reactions related to opportunistic infections as well as primary CNS malignancies both of which mostly occur in HIV-infected patients. However, differential diagnoses are challenging both clinically and radiologically. We describe a patient with CNS-IRIS due to toxoplasmosis whose ¹¹C-methionine uptake suggested lymphoma but whose arterial spin-labelling MRI led to the correct diagnosis.

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Hiding in plain sight: a case of chronic disseminated histoplasmosis with central nervous system involvement

A 64-year-old man presented with gradual onset of confusion, ataxia and 25-pound weight loss over 3 months. MRI of the brain revealed two enhancing cerebellar lesions suspicious for metastases. Positron emission tomography-CT showed enhancement of cervical and axillary lymph nodes. Left axillary lymph node biopsy showed no evidence of malignancy but instead showed fungal organisms morphologically consistent with Histoplasma spp. Disseminated histoplasmosis with central nervous system involvement was suspected. Further history revealed that the patient had been having subjective fever for the past several months. He has had mild pancytopenia for about 2 years, which had not been further evaluated. Additionally, he had an oesophagogastroduodenoscopy 3 months prior to admission, which had shown granulomatous gastritis. Subsequently, the diagnosis of disseminated histoplasmosis was confirmed by serological testing and bone marrow biopsy. The patient was started on liposomal amphotericin B. Unfortunately, the patient had a catastrophic stroke and was transitioned to comfort care measures.

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Persistent sacral chloroma in refractory acute myelogenous leukaemia

Acute myelogenous leukaemia (AML) is a clonal process involving the myeloid subgroup of white blood cells. Chloromas, or myeloid sarcomas, are masses of myeloid leukaemic cells and are a unique aspect of AML. This case involves a 14-year-old boy with AML who presented with multiple chloromas at diagnosis. The patient's extra-calvarial masses and bone marrow involvement responded to chemotherapy; however, his sacral epidural chloromas persisted despite four courses of chemotherapy. The central nervous system, bone marrow and testes have been known to be sanctuary sites for AML. This case illustrates that the sacral spinal canal may potentially be a sanctuary site for the disease process also.

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'Scissor deformity of the toes

Description

A 63-year-old woman presented with an unusual foot deformity involving the left first and second toe causing persistent pain (subjective functional grade 1),1 difficulty in walking and inability to accommodate the foot in regular footwear. She has type 2 diabetes mellitus for the past 8 years and sensorimotor peripheral neuropathy as assessed by vibration perception threshold >25 mV, absence of Semmes-Weinstein monofilament perception and absent ankle reflex. She was a home maker and wore footwear with thumb-hold most of the time. On examination, she had severe hallux valgus (HV) (Manchester Scale: severe score=3)², anatomical grade 11 and over-riding of second toe over the great toe causing 'scissor deformity' (figure 1). In addition, she had hammer and claw toe deformity involving other digits. She was provided with modified footwear to accommodate great toes with a bunion aid.

Figure 1

Both feet showing...

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Cryptococcal meningitis causing obstructive hydrocephalus in a patient on fingolimod

Cryptococcosis is a recognised opportunistic infection in immunocompromised patients. The long-term adverse effect profile of fingolimod, an immunomodulating agent approved for use in multiple sclerosis in 2010, is only just emerging. We report the first case to our knowledge of a patient presenting with obstructive hydrocephalus secondary to cryptococcal meningitis in the setting of fingolimod therapy. Extensive posterior fossa leptomeningeal inflammation with associated cerebellar oedema resulted in effacement of the fourth ventricle and obstructive hydrocephalus requiring urgent ventriculostomy. Induction, consolidative and maintenance antifungal therapy was prescribed and subsequent conversion to a ventriculoperitoneal shunt was successful in relieving the patient's ventriculomegaly. Awareness of these rare, novel and life-threatening complications of fingolimod-associated immunocompromise is critical as the use of such drugs is expected to rise.

http://ift.tt/2sTi8hr

A rare case of malposition of central venous catheter detected by ultrasonography-guided saline flush test

Central venous catheter (CVC) insertion is associated with many potential complications; malposition of the catheter is one of them. A chest X-ray is routinely done to detect the malposition of catheter, but sometimes it has been seen that X-ray is time-consuming and its accuracy is also low for determining the exact position of the catheter tip. In our case, an ultrasonography (USG)-guided CVC was placed into the right internal jugular vein of the patient. As there was no ECG change obtained during insertion of guidewire and catheter, malposition was suspected, which was easily detected by a novel USG-guided saline flush test. We present a case report where USG was used for detection of a misplaced CVC (from right internal jugular vein to right subclavian vein). With ultrasound, the location of the catheter tip can be confirmed in very less time compared with chest X-ray.

http://ift.tt/2tnaO10

Vascularisation of the anterior lens capsule in an eye with excellent visual acuity

A 53-year-old phakic female with a history of nanophthalmos and hyperopia was incidentally found to have unilateral neovascularisation on the left inferoanterior lens surface on routine review for ocular hypertension.

http://ift.tt/2tSMeWK

A rare case of Epstein-Barr virus mucocutaneous ulcer of the colon

Epstein-Barr virus mucocutaneous ulcer (EBVMCU) is a rare form of EBV lymphoproliferative disorder. The disease was recently described in 2010 for the first time in a case series and it was recently identified by the WHO classification of haematological malignancies as a separate category among the EBV lymphoproliferative disorders. We present a case of EBVMCU of the colon presenting as an ulcerating inflammatory mass in a female in her mid-60s who presented initially with abdominal pain and diarrhoea. The patient had extensive workup for her disease and due to progression of her symptoms, she was taken for an exploratory laparotomy. During the procedure, there was an inflammatory mass at the caecum and severe inflammation of the caecum and the terminal ileum and right hemicolectomy was performed. Diagnosis was confirmed by histopathology as EBV-positive lymphoproliferative disorder best classified as EBV-positive mucocutaneous ulcer.

http://ift.tt/2uQTOOI

Eruptive keratoacanthomas in tattoos

http://ift.tt/2tnRyk3

Biphasic synovial sarcoma of the epiglottis: Case report and literature review

Synovial sarcomas are rare malignant tumors supposed to arise from pluripotent mesenchymal stem cells predominantly affecting the deep soft tissue of the lower and upper extremities in young adults. The occurrence of this tumor entity in the head and neck is very uncommon and hence, timely diagnosis and treatment of synovial sarcoma in this region remain a challenge.We describe the clinical and molecular pathological features of a biphasic synovial sarcoma of the epiglottis, a site where the primary manifestation of this tumor entity has not been documented to date.

http://ift.tt/2sSG98v

Hyperthyroidism, Hypothyroidism, and Cause-Specific Mortality in a Large Cohort of Women

Thyroid , Vol. 0, No. 0.


http://ift.tt/2sw3c9L

Variations in Serum Free Thyroxine Concentration Within the Reference Range Predicts the Incidence of Metabolic Syndrome in Non-Obese Adults: A Cohort Study

Thyroid Jul 2017, Vol. 27, No. 7: 886-893.


http://ift.tt/2tOC0XC

Contrasting Phenotypes in Resistance to Thyroid Hormone Alpha Correlate with Divergent Properties of Thyroid Hormone Receptor α1 Mutant Proteins

Thyroid Jul 2017, Vol. 27, No. 7: 973-982.


http://ift.tt/2svmtYN

Future Meetings

Thyroid Jul 2017, Vol. 27, No. 7: 985-985.


http://ift.tt/2tOE3uI

Use of fused deposit modeling for additive manufacturing in hospital facilities: European certification directives

The goal of this study was to identify current European Union regulations governing hospital-based use of fused deposit modeling (FDM), as implemented via desktop three-dimensional (3D) printers.

http://ift.tt/2tXt5DB

Free-flap surgical correction of facial deformity after anteromedial maxillectomy

Anteromedial maxillectomy is typically performed in conjunction with low-dose radiotherapy and intraarterial chemotherapy. In doing so, the extent of surgical defects is reduced. However, nasal deviation and oral incompetence may ensue, due to cicatricial contracture of wounds, and may be distressing to these patients. Herein, we report a series of eight free perforator flap procedures (anterolateral thigh [ALT] flap, 6; thoracodorsal artery perforator [TAP] flap, 2) used to correct such deformities.

http://ift.tt/2uw9mYG

The self-defining axis of symmetry: A new method to determine optimal symmetry and its application and limitation in craniofacial surgery

Analysis of symmetry represents an essential aspect of plastic-reconstructive surgery. For cases in which reference points are either not fixed or are changed due to corrective intervention the determination of a symmetry axis is sometimes almost impossible and a pre-defined symmetry axis would not always be helpful. To assess cranial shape of surgical patients with craniosynostosis, a new algebraic approach was chosen in which deviation from the optimal symmetry axis could be quantified.

http://ift.tt/2tXe98w

Implant rehabilitation in fibular free flap reconstruction: A retrospective study of cases at 1-18 years following surgery

To determine the dental implant and prostheses success rate in a cohort of patients who underwent a vascularized free fibula flap (FFF) for maxillary or mandibular reconstruction.

http://ift.tt/2uvTuFR

Hydroxyapatite collagen scaffold with autologous bone marrow aspirate for mandibular condylar reconstruction

This study was designed with the aim to assess the efficiency of hydroxyapatite/collagen (HA/Col) bio-scaffold with bone marrow aspirate (BMA) to reconstruct mandibular condyle in patients with temporomandibular joint (TMJ) ankylosis.

http://ift.tt/2tXhOmV

The validity and reliability of computed tomography orbital volume measurements

Orbital volume calculations allow surgeons to design patient-specific implants to correct volume deficits. It is estimated that changes as small as 1 ml in orbital volume can lead to enophthalmos. Awareness of the limitations of orbital volume computed tomography (CT) measurements is critical to differentiate between true volume differences and measurement error. The aim of this study is to analyze the validity and reliability of CT orbital volume measurements.

http://ift.tt/2uw3RJD

The pterygoalar bar: A meta-analysis of its prevalence, morphology and morphometry

The pterygoalar (PA) bar is a bony bridge resulting from the partial or complete ossification of a PA ligament. The aim of this meta-analysis was to systematically analyze and provide the most comprehensive data on the prevalence, morphology and topographical anatomy of the PA bar.

http://ift.tt/2tX3A5r

Corrigendum to Aetiology, pathogenesis, and specific management of Stahl's ear: role of the transverse muscle insertion

The authors regret that Figures 1, 3, and 4 are from Dr Viard's collection at Hôpital Saint Luc Saint Joseph Lyon, which had previously not been acknowledged in the text.

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Corrigendum to Aetiology, pathogenesis, and specific management of Stahl's ear: role of the transverse muscle insertion

Publication date: Available online 6 July 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. Gleizal, R. Viard, J.T. Bachelet




http://ift.tt/2tOORsV

Spectrophotometric analysis of the effectiveness of a novel in-office laser-assisted tooth bleaching method using Er,Cr:YSGG laser

Abstract

The purpose of this in vitro study was to compare the effectiveness of a novel Er,Cr:YSGG laser-assisted in-office tooth bleaching method with a conventional method by spectrophotometric analysis of the tooth color change. Furthermore, the influence of the application time of the bleaching gel on the effectiveness of the methods and the maintenance of the results 7 days and 1 month after the treatments were also evaluated. Twenty-four bovine incisors were stained and randomly distributed into four groups. Group 1 specimens received an in-office bleaching treatment with 35% H₂O₂ for 2 × 15 min. Group 2 specimens received the same treatment but with extended application time (2 × 20 min). In Group 3, the same in-office bleaching procedure (2 × 15 min) was carried out as that in Group 1, using Er,Cr:YSGG laser irradiation for 2 × 15 s on each specimen to catalyze the reaction of H₂O₂ breakdown. Group 4 specimens received the same bleaching treatment as Group 3 but with extended application time (2 × 20 min). Er,Cr:YSGG laser-assisted tooth bleaching treatment is more effective than the conventional treatment regarding color change of the teeth. Application time of the bleaching agent may influence the effectiveness of the methods. The color change of the tested treatments decreases after 7 days and 1 month. The clinical relevance of this study is that this novel laser-assisted bleaching treatment may be more advantageous in color change and application time compared to the conventional bleaching treatment.

http://ift.tt/2tn6TRS

Aktuelle Entwicklung der molekular zielgerichteten Therapie von Kopf-Hals-Karzinomen

Laryngo-Rhino-Otol
DOI: 10.1055/s-0037-1600927

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2tXB0kw

Hörgeräteversorgung für Erwachsene

Laryngo-Rhino-Otol
DOI: 10.1055/s-0037-1600928

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Extrakranielle Schwannome im Kopf-Hals-Bereich: Klinische Implikationen anhand von 20 Fällen

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-110860

Hintergrund Schwannome sind seltene, benigne Tumore, die von den Gliazellen des peripheren Nervensystems (Schwannsche Zellen) ausgehen. Während es für intrakranielle Schwannome, insbesondere die des N. vestibularis, etablierte Therapiestrategien gibt, liegen zu den extrakraniellen Schwannomen weniger belastbare Daten vor. Methode Es wurde eine retrospektive Analyse von 20 Patienten mit histopathologisch gesicherten extrakraniellen Schwannomen im Kopf-Hals-Bereich mit einem Schwerpunkt auf Tumorlokalisation und postoperativem funktionellem Therapieergebnis durchgeführt. Ergebnisse Die Schwannome im vorliegenden Kollektiv entstammten vornehmlich dem N. facialis (n = 4), dem N. vagus (n = 4) oder dem sympathischen Grenzstrang (n = 3). Die häufigsten Primärsymptome waren Schwellungen (n = 12) und Schmerzen (n = 3). MRT (n = 13), Ultraschall (n = 12) und CT (n = 3) wurden zur Diagnostik eingesetzt. In 18 Fällen wurde ein chirurgischer Behandlungsansatz gewählt (n = 14 komplette Exstirpation, n = 3 Teilexstirpation, n = 1 unbekannter Resektionsumfang). Komplette Schwannomexstirpationen von motorisch-efferentenNerven (n = 10) machten ein Absetzen des Nervens häufiger erforderlich, wenn bereits präoperativ ein motorisches Defizit bestand (3 von 4 = 75 % bei präoperativem Defizit vs. 2 von 6 = 33 % ohne präoperatives Defizit). Schlussfolgerung Extrakranielle Schwannome stellen seltene, meist vom N. facialis, dem sympathischen Grenzstrang oder den kaudalen Hirnnerven ausgehende, benigne Tumore des HNO-Trakts dar, die in der Regel chirurgisch therapiert werden. Mit postoperativen motorischen Defiziten bei kompletten Exstirpationen muss insbesondere bei bereits präoperativ bestehenden Funktionsstörungen gerechnet werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Psychoonkologische Betreuung von Patienten mit Kopf-Hals-Tumoren

Laryngo-Rhino-Otol
DOI: 10.1055/s-0037-1600929

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2uw2c6R

Yellow Nail Syndrome With Dramatic Improvement of Nail Manifestations After Endoscopic Sinus Surgery

Objectives: Yellow nail syndrome (YNS) is a rare disease of unknown cause characterized by the triad of yellow nails, respiratory manifestations, and lymphedema. Although several therapies for YNS have been reported, there is no common consensus in the treatment. In this case report, we present a case of 56-year-old woman with YNS, whose nail manifestation was dramatically improved after endoscopic sinus surgery for the treatment of chronic rhinosinusitis. Methods: Endoscopic sinus surgery involving middle meatal antrostomy was performed for the case of YNS with chronic rhinosinusitis and bronchiectasis resistant to antibacterial drugs. Results: A month after the surgery, the patient's nails eventually showed dramatic improvement. Conclusions: Otorhinolaryngologists should recognize that chronic rhinosinusitis can be a symptom of YNS, and that the aggressive treatment including surgical approach for chronic rhinosinusitis may be a useful in the control of nail manifestation in YNS.

http://ift.tt/2svEXsd

A single amino acid in MRGPRX2 necessary for binding and activation by pruritogens

Publication date: Available online 6 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Vemuri B. Reddy, Thomas A. Graham, Ehsan Azimi, Ethan A. Lerner

Teaser

Substance P, a neuropeptide associated with itch, atopic dermatitis and inflammation, activates MRGPRX2, a member of the mas-related GPCR family. A specific amino acid in the receptor has been found to be critical for activity.


http://ift.tt/2tS26bH

Results from the 5-year SQ grass SLIT-tablet asthma prevention (GAP) trial in children with grass pollen allergy

Publication date: Available online 6 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Erkka Valovirta, Thomas Houmann Petersen, Teresa Piotrowska, Mette Kongensbjerg Laursen, Jens Strodl Andersen, Helle Frobøse Sørensen, Rabih Klink
BackgroundAllergy immunotherapy targets the immunological cause of allergic rhinoconjunctivitis and allergic asthma and has the potential to alter the natural course of allergic disease.ObjectiveThe primary objective was to investigate the effect of the SQ grass SLIT-tablet compared to placebo on the risk of developing asthma.Methods812 children (5-12 years), with a clinically relevant history of grass pollen allergic rhinoconjunctivitis and no medical history or signs of asthma, were included in the randomised, double-blind, placebo-controlled trial, comprising 3 years treatment and 2 years follow-up.ResultsThere was no difference in time to onset of asthma, defined by pre-specified asthma criteria relying on documented reversible impairment of lung function (primary endpoint). Treatment with the SQ grass SLIT-tablet significantly reduced the risk of experiencing asthma symptoms or using asthma medication at the end of trial (odds ratio=0.66, p<0.036), during the 2-year post treatment follow-up, and during the entire 5-year trial period. Also, grass allergic rhinoconjunctivitis symptoms were 22-30% reduced (p<0.005 for all 5 years). At the end of the trial, the use of allergic rhinoconjunctivitis pharmacotherapy was significantly less (27% relative difference to placebo, p<0.001). Total IgE, grass pollen specific IgE, and skin prick test reactivity to grass pollen were all reduced compared to placebo.ConclusionTreatment with the SQ grass SLIT-tablet reduced the risk of experiencing asthma symptoms and using asthma medication, and had a positive, long-term clinical effect on rhinoconjunctivitis symptoms and medication use but did not show an effect on the time to onset of asthma.

Graphical abstract

Teaser

SQ grass SLIT-tablet treatment prevented asthma symptoms and asthma medication use in children with grass pollen ARC and no pre-existing asthma. This disease-modifying effect persisted after end of treatment.


http://ift.tt/2uPOwmB

Functional Role of Kynurenine and Aryl hydrocarbon Receptor Axis in Chronic Rhinosinusitis with Nasal Polyps

Publication date: Available online 6 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Heng Wang, Danh C. Do, Jinxin Liu, Baofeng Wang, Jingjing Qu, Xia Ke, Xiaoyan Luo, Ho Man Tang, Ho Lam Tang, Chengping Hu, Mark E. Anderson, Zheng Liu, Peisong Gao
BackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) is associated with mast cell-mediated inflammation and heightened oxidant stress. Kynurenine (KYN), an endogenous tryptophan metabolite, can promote allergen-induced mast cell activation through the aryl hydrocarbon receptor (AhR).ObjectivesDetermine the role of the KYN/AhR axis and oxidant stress in mast cell activation and the development of CRSwNP.MethodsWe measured expression of indoleamine 2, 3-dioxygenase 1 (IDO1), tryptophan 2, 3-dioxygenase (TDO2), KYN, and oxidized calmodulin-dependent protein kinase II (ox-CaMKII) in nasal polyps and controls. KYN-potentiated ovalbumin (OVA)-induced reactive oxygen species (ROS) generation, cell activation, and ox-CaMKII expression were investigated in wild type (WT) and AhR deficient (AhR^-/-) mast cells. The role of ox-CaMKII in mast cell activation was further investigated.ResultsNasal polyps in CRSwNP showed an increased expression of IDO1, TDO2, and KYN compared with controls. AhR was predominantly expressed in mast cells in nasal polyps. Activated mast cells and local IgE levels were substantially increased in eosinophilic polyps compared with non-eosinophilic polyps and controls. Furthermore, KYN potentiated OVA-induced ROS generation, intracellular Ca²⁺ levels, cell activation, and expression of ox-CaMKII in WT, but not in AhR^-/- mast cells. Compared with non-eosinophilic polyps and controls, eosinophilic polyps showed increased expression of ox-CaMKII in mast cells. Mast cells from ROS-resistant CaMKII MMVVδ mice or pre-treated with CaMKII inhibitor showed protection against KYN-promoted OVA-induced mast cell activation.ConclusionThese studies support a potentially critical but previously unidentified function of the KYN/AhR axis in regulating IgE-mediated mast cell activation through ROS and ox-CaMKII in CRSwNP.

Teaser

The pathogenesis of chronic rhinosinusitis with nasal polyps is associated with increased levels of kynurenine, a tryptophan metabolite, which potentiated allergen-induced mast cell activation through the aryl hydrocarbon receptor and Calmodulin-dependent protein kinase II.


http://ift.tt/2uPWlJ3

Peanut-specific Tr1 cells induced in vitro from allergic individuals are functionally impaired

Publication date: Available online 6 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Laurence Pellerin, Jennifer Anne Jenks, Sharon Chinthrajah, Tina Dominguez, Whitney Block, Xiaoying Zhou, Arram Noshirvan, Silvia Gregori, Maria Grazia Roncarolo, Kari Christine Nadeau, Rosa Bacchetta
BackgroundPeanut allergy is a life threatening condition which lacks regulatory-approved treatment. T regulatory type 1 (Tr1) cells are potent suppressors of immune responses and can be induced in vivo upon repeated antigen exposure or in vitro using tolerogenic dendritic cells (DC-10). Whether or not oral immunotherapy (OIT) leads to antigen-specific Tr1 cell induction has not been established.ObjectivesTo determine whether peanut-specific Tr1 cells can be generated in vitro from peripheral blood of peanut allergic (PA) individuals at baseline or during OIT, and whether they are functional as compared to peanut-specific Tr1 cells induced from healthy controls (HC).MethodsDC-10 were differentiated in the presence of IL-10 from peripheral blood mononuclear cells of PA individuals and HC pulsed with the main peanut allergens Arachis hypogaea (Ara h) 1 and 2, and used as antigen presenting cells for autologous CD4⁺T cells (pea-T10). Pea-T10 cells were characterized by the presence of CD49b⁺LAG3⁺ Tr1 cells, antigen-specific proliferative responses, and cytokine production.ResultsCD49b⁺LAG3⁺ Tr1 cells were induced in pea-T10 cells at comparable percentages from HC and PA individuals. Despite their antigen specificity, pea-T10 cells of PA individuals with or without OIT, as compared to those of HC, were not anergic and had high Th2 cytokine production upon peanut-specific restimulation.ConclusionsPeanut-specific Tr1 cells can be induced from HC and PA individuals, but those from PA individuals are functionally defective independently of the OIT. The unfavorable Tr1/Th2 ratio is discussed as possible cause of PA-Tr1 cell impairment.

Graphical abstract

http://ift.tt/2tSbFra

Quantification of dental plaque in oral cavity was enabled by a novel algorithm of image processing

Publication date: Available online 6 July 2017
Source:Journal of Oral Biosciences
Author(s): Naho Sueishi, Tomoko Ohshima, Takashi Oikawa, Hiroshi Takemura, Mai Kasai, Nobuko Maeda, Yoshiki Nakamura
ObjectivesQuantitative analysis of the biofilm has been critical for pathogenicity of oral diseases such as caries and periodontal disease. Currently, the plaque control record (PCR) is used most frequently to evaluate the presence of plaque on teeth, but no quantification methods exist so far. The aim of this study was to establish a method to quantify plaque adhesion on teeth.MethodsA novel algorithm and executing program was developed to calculate the staining volume of biofilm on plastic disks or extracted teeth inoculated by Streptococcus mutans from photographic image data. The biofilm's volume on plastic disks was determined using a confocal microscope, and correlations between image analysis data were analyzed. Subsequently, the amount of plaque in the oral cavity was clinically evaluated using this algorithm.ResultsA strong correlation was observed between the biofilm's volume and the image analysis data. Similar results were also obtained with the biofilm model using extracted teeth. Clinically, it was revealed that an assessment of the amount of plaque adhesion for every tooth was possible, which could not be determined by PCR in the oral cavity.ConclusionsWe successfully developed a novel method, designated "plaque volume ratio," to quantify the plaque accurately from photographic image data. Our findings indicated that this method may be useful for the evaluation of the amount of plaque on the surfaces of not only teeth but also dental materials in the oral cavity.



http://ift.tt/2uvQx8a

Ovine-Based Collagen and Foam Dressings in Extremity Wounds

Regular debridement with the use of these dressings may help in the healing of chronic lower extremity wounds.
Wounds

http://ift.tt/2tDQA42

A multicenter study on objective and subjective benefits with a transcutaneous bone-anchored hearing aid device: first Nordic results

Abstract

Examination of objective as well as subjective outcomes with a new transcutaneous bone-anchored hearing aid device. The study was designed as a prospective multicenter consecutive case-series study involving tertiary referral centers at two Danish University Hospitals. A total of 23 patients were implanted. Three were lost to follow-up. Patients had single-sided deafness, conductive or mixed hearing loss. Intervention: Rehabilitative. Aided and unaided sound field hearing was evaluated objectively using (1) pure warble tone thresholds, (2) pure-tone average (PTA4), (3) speech discrimination score (SDS) in quiet, and (4) speech reception threshold 50% at 70 dB SPL noise level (SRT50%). Subjective benefit was evaluated by three validated questionnaires: (1) the IOI-HA, (2) the SSQ-12, and (3) a questionnaire evaluating both the frequency and the duration of hearing aid usage. The mean aided PTA4 was lowered by 14.7 dB. SDS was increased by 37.5% at 50 dB SPL, SRT50% in noise improved 1.4 dB. Aided thresholds improved insignificantly at frequencies above 2 kHz. 52.9% of the patients used their device every day, and 76.5% used the device at least 5 days a week. Mean IOI-HA score was 3.4, corresponding to a good benefit. In SSQ-12, "quality of hearing" scored especially high. Patients with a conductive and/or mixed hearing loss benefitted the most. This device demonstrates a significant subjective hearing benefit 8 month post surgery. In patients with conductive and/or mixed hearing losses, patient satisfaction and frequency of use were high. Objective gain measures showed less promising results especially in patients with single-sided deafness (SSD) compared to other bone conduction devices.

http://ift.tt/2uuRlds

New CFD tools to evaluate nasal airflow

Abstract

Computational fluid dynamics (CFD) is a mathematical tool to analyse airflow. As currently CFD is not a usual tool for rhinologists, a group of engineers in collaboration with experts in Rhinology have developed a very intuitive CFD software. The program MECOMLAND^® only required snapshots from the patient's cross-sectional (tomographic) images, being the output those results originated by CFD, such as airflow distributions, velocity profiles, pressure, temperature, or wall shear stress. This is useful complementary information to cover diagnosis, prognosis, or follow-up of nasal pathologies based on quantitative magnitudes linked to airflow. In addition, the user-friendly environment NOSELAND^® helps the medical assessment significantly in the post-processing phase with dynamic reports using a 3D endoscopic view. Specialists in Rhinology have been asked for a more intuitive, simple, powerful CFD software to offer more quality and precision in their work to evaluate the nasal airflow. We present MECOMLAND^® and NOSELAND^® which have all the expected characteristics to fulfil this demand and offer a proper assessment with the maximum of quality plus safety for the patient. These programs represent a non-invasive, low-cost (as the CT scan is already performed in every patient) alternative for the functional study of the difficult rhinologic case. To validate the software, we studied two groups of patients from the Ear Nose Throat clinic, a first group with normal noses and a second group presenting septal deviations. Wall shear stresses are lower in the cases of normal noses in comparison with those for septal deviation. Besides, velocity field distributions, pressure drop between nasopharynx and the ambient, and flow rates in each nostril were different among the nasal cavities in the two groups. These software modules open up a promising future to simulate the nasal airflow behaviour in virtual surgery intervention scenarios under different pressure or temperature conditions to understand the effects on nasal airflow.

http://ift.tt/2tWcHDy

Comment on the paper by Dazert et al. entitled ‘Off the ear with no loss in speech understanding: comparing the RONDO and the OPUS 2 cochlear implant audio processors’

http://ift.tt/2uuKpwO

A comparative study of modified transcanalicular diode laser dacryocystorhinostomy versus conventional transcanalicular diode laser dacryocystorhinostomy

Abstract

External dacryocystorhinostomy (DCR) is the gold standard surgical technique for the treatment of primary acquired nasolacrimal duct obstruction (PANDO). However, new techniques such as endoscopic DCR and transcanalicular dacryocystorhinostomy (T-DCR) are being studied in an attempt to reduce surgical time, avoid external scarring and preserve the lacrimal pump while achieving the same efficacy. The purpose of this study was to compare the efficacy between conventional T-DCR and modified transcanalicular dacryocystorhinostomy (MT-DCR) in patients with PANDO. MT-DCR is performed to remove nasal mucosa prior to laser osteotomy. This is a comparative, prospective, interventionist and randomized study. Patients with PANDO were selected to undergo MT-DCR or T-DCR by blocked randomization. PANDO was diagnosed based on clinical presentation, dye disappearance test and dacryocystography. All of the procedures were performed by the same surgery team members. Anatomical success outcome was defined as positive lacrimal syringing and functional success outcome was defined as the absence or improvement of epiphora. A total of 44 surgical procedures were performed (22 MT-DCR and 22 T-DCR). In the case of MT-DCR, the anatomical and functional success rates after 12 months were 90 and 86%, respectively. After T-DCR, these rates were 77 and 72%, respectively (p = 0.162). MT-DCR and T-DCR are both safe and fast procedures with low morbidity and well-tolerated.

http://ift.tt/2tW1UZR

Apurinic/apyrimidinic endonuclease 1 (APE1) is overexpressed in malignant transformation of salivary gland pleomorphic adenoma

Abstract

DNA repair systems play a critical role in protecting the human genome against cumulative damage. The apurinic/apyrimidinic endonuclease 1 is a protein involved in DNA base excision repair and its expression still needs to be investigated in salivary gland tumors. The objective of this study is to analyze the immunoexpression of apurinic/apyrimidinic endonuclease 1 in pleomorphic adenomas and carcinomas ex pleomorphic adenomas of the salivary glands. A total of 33 pleomorphic adenomas and 16 carcinomas ex pleomorphic adenomas of the salivary glands underwent immunohistochemical study by the polymeric biotin-free technique. Immunopositive cells were analyzed quantitatively. For statistical analysis, Mann–Whitney test was performed and a significance level was set at p ≤ 0.05. All analyzed tumors (n = 49) were positive for apurinic/apyrimidinic endonuclease 1. However, there was a higher median expression in carcinomas ex pleomorphic adenomas (p < 0.001). There was no difference between this protein immunoexpression and tumors of major or minor salivary gland. Overexpression was found mainly in cases of carcinomas ex pleomorphic adenomas with lymph node metastasis (p = 0.002) and invasive growth (p = 0.003), when compared to cases without metastasis and without capsular invasion (intracapsular pattern). Our findings revealed that apurinic/apyrimidinic endonuclease 1 is downregulated in pleomorphic adenomas and overexpressed in carcinomas ex pleomorphic adenomas, suggesting that this protein is possibly deregulated in pleomorphic adenoma malignant transformation. Furthermore, the increased expression of this protein is associated with a more aggressive behavior in carcinomas ex pleomorphic adenomas, which suggests that this protein may represent a prognostic biomarker in the studied salivary gland tumors.

http://ift.tt/2uuuQFj

Bacteriology and antibiotic sensitivity of tonsillar diseases in Chinese children

Abstract

Although many bacteriology studies on tonsillar diseases have been completed, only a few studies investigated bacteriology of tonsillar diseases in recent years, especially in Asian children population. The aim of our study is to elucidate the bacterial flora and antibiotic sensitivity of tonsillar diseases in Chinese children. A three-center study was performed on 2994 children with or without tonsillar diseases. We compared and analyzed differences of bacterial pathogens among recurrent tonsillitis, tonsillar hypertrophy and controls. We found that on the surface of tonsil, Staphylococcus aureus, Haemophilus influenzae and Streptococcus pneumoniae were noted in the order given in the recurrent tonsillitis (RT) group. In the tonsillar hypertrophy (TH) and control group, H. influenzae, S. aureus and S. pneumoniae were noted in the order given. For the core of tonsil, H. influenzae, S. aureus and β-hemolytic streptococcus were noted in the order given in both RT and TH group. S. aureus and H. influenzae were the most prevalent types of bacteria present in cultures containing two strains in the RT and TH group, respectively. We also observed some differences in the types of bacteria in the surface and core between the recurrent tonsillitis and tonsillar hypertrophy groups. Our study provides recent bacteria distribution and antibiotic sensitivity for tonsillar diseases in Chinese children and will be helpful in the treatment of these diseases.

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Reply to Wimmer et al.’s comments concerning: ‘off the ear with no loss in speech understanding: comparing the RONDO and the OPUS 2 cochlear implant audio processors’

http://ift.tt/2uuQ8ms

The origin of failure, and an opportunity to learn

http://ift.tt/2tVD7oR

Anatomical variants and bilateral lacrimal pathways surgery: avoiding unnecessary surgery

Abstract

Success rates (SR) of transcanalicular diode laser-assisted dacryocystorhinostomy (TCL DCR) may be affected by the presence of nasal anatomical variations and additionally by whether or not the pathology is bilateral. The aim is to determine whether it is necessary to perform preliminary nasal anatomical variations surgery and to determine whether bilateral cases may be operated simultaneously. We extracted the patients undergoing simultaneous bilateral TCL DCR and we compared SR across the different groups using ANOVA, Chi-square testing and logistical regression. 159 Lacrimal pathways were operated: 89 unilateral and 35 bilateral. Non-nasal anatomical variations (non-NAV) unilateral surgery returned a success of 72.72%. The mean SR for nasal anatomical variations (NAV) unilateral surgery was 70.1%. The SR for non-NAV bilateral surgery was 60.86%. The mean SR for nasal anatomical variations bilateral surgery was 58.33%. As we identified no significant differences in the SR for NAV and non-NAV patients, we can avoid simultaneous corrective surgery.

http://ift.tt/2uuRhue

Head and neck reconstruction in the elderly patient: a safe procedure?

Abstract

Demographic changes strongly affect industrialized countries. While free tissue transfer was initially believed to be beneficial only for younger patients, there is an increasing number of elderly patients requiring microvascular operations in our aging society. Medical and surgical risks for head and neck cancer patients over a certain age who undergo free tissue transfer has hardly been investigated. A retrospective mono-center cohort study was performed. All patients with the age 75 or higher undergoing microvascular operations were reviewed. Patient characteristics including the ASA-status, the ACE-27-score, flap survival and postoperative medical and surgical complications were evaluated. The Clavien–Dindo-classification system for postoperative complications was applied to assess the severity of the complications. A total of 31 patients with an average age of 78.8 years were included. 4 patients suffered from venous congestion and had to undergo revision surgery. All flaps could successfully be salvaged. Higher ASA-status and ACE-score were significantly associated with postoperative medical and surgical complications and a higher severity of the complications. However , neither age nor operating time had influence on the complication rate. Microvascular free tissue transfer can be performed with a high degree of security in selected elderly patients. However, serious medical complications remain a concern, correlating strongly with high ASA and ACE-score. Careful patient selection is mandatory to reduce complications to a minimum.

http://ift.tt/2tWcv70

The interpretation of compact polysomnography/polygraphy in sleep breathing disorders patients: a validation’s study

Abstract

The Otorhinolaryngologist (ENT) frequently has to deal with OSA or suspicious OSA patients and undergone polysomnography (PSG) or portable monitoring (PM) and should be confident about the quality and consistency of the polysomnographic diagnosis. The main polysomnographic traces compressed in a unique epoch, defined as compact PSG/PM (CP), could represent an efficient tool to confirm the quality of PSG/PM Sleep Breathing Disorders diagnosis. This is a validation's study of a CP interpretation's method, analyzing the learning curve, the level of diagnostic accuracy, and the inter-operator agreement in interpreting the CP pattern between a group of ENT specialists not skilled in PSG/PM scoring, but managing SBD patients during daily practice. Seven ENT specialists have been enrolled in the study. 50 CP traces (ranging from normal to all main SBD patterns) have been showed to each participant for the interpretation and scoring process, before and after a 2-h theoretical–practical interactive lesson, focusing on the recognition of the four main oximetric patterns on CP traces (normal, phasic, prolonged, and overlap patterns). Results: before and after the theoretical–practical interactive lesson, the whole diagnostic accuracy in interpreting the 50 CP has been reported improved from 0.12 to 0.80 (median 0.52) to 0.82–0.96 (median 0.92) (p = 0.006) and the inter-scorers' agreement showed a kappa value increased from of 0.18 to 0.75 (p < 0.0001). A complete clinical diagnostic evaluation is essential in OSA patients and the ENT specialist should be concerned to verify if the patient, suitable for surgical therapy, is affected really by an isolated form of OSA. The CP interpretation allows a checking of the proper nosographic SBD framework and could be significantly important for all ENT specialists not skilled in PSG/PM scoring, but managing SBD patients during daily practice. The data reported in our validation's study showed that the CP interpretation's method is easy to apply, with a rapid learning curve. The level of diagnostic accuracy is high with a high inter-scorer agreement in interpreting the CP patterns.

http://ift.tt/2uv7L5y

Classification of parotidectomy: a proposed modification to the European Salivary Gland Society classification system

Abstract

Parotidectomy remains the mainstay of treatment for both benign and malignant lesions of the parotid gland. There exists a wide range of possible surgical options in parotidectomy in terms of extent of parotid tissue removed. There is increasing need for uniformity of terminology resulting from growing interest in modifications of the conventional parotidectomy. It is, therefore, of paramount importance for a standardized classification system in describing extent of parotidectomy. Recently, the European Salivary Gland Society (ESGS) proposed a novel classification system for parotidectomy. The aim of this study is to evaluate this system. A classification system proposed by the ESGS was critically re-evaluated and modified to increase its accuracy and its acceptability. Modifications mainly focused on subdividing Levels I and II into IA, IB, IIA, and IIB. From June 2006 to June 2016, 126 patients underwent 130 parotidectomies at our hospital. The classification system was tested in that cohort of patient. While the ESGS classification system is comprehensive, it does not cover all possibilities. The addition of Sublevels IA, IB, IIA, and IIB may help to address some of the clinical situations seen and is clinically relevant. We aim to test the modified classification system for partial parotidectomy to address some of the challenges mentioned.

http://ift.tt/2tWayb0

Survey about the use of clarithromycin in an ENT outpatient department of a tertiary hospital

Abstract

We undertook this survey about the use of clarithromycin in the Ear, Nose, and Throat (ENT) Outpatient Department of Fudan University Hospital to understand its utilization patterns and rational use. A survey of prescriptions given to outpatients was carried out, and detailed information of the patients, including age, sex, diagnosis, combined medication, and other information, was recorded in Excel spreadsheets. The rationale for each prescription was evaluated retrospectively. Based on our analysis, 82.5% of the clarithromycin prescriptions were for the treatment of rhinosinusitis. It was found that the parameters for the diagnosis of this condition were surprisingly broad and should have been more specific. In addition, the clarithromycin dosage regimen varied in clinical practice. For chronic rhinosinusitis, the duration of treatment was between 8 and 16 days, which was not sufficient. Moreover, clarithromycin was prescribed along with considerable numbers of pharmacotherapeutic anti-allergic drugs. Our survey indicated that improvements in the quality of clarithromycin prescriptions in otolaryngology outpatients should be made. Furthermore, the importance of medical education to patients should be emphasized. In addition, the interaction between clarithromycin and other anti-allergic drugs requires further investigation.

http://ift.tt/2uvdDfg

Contralateral sinus involvement of surgically treated unilateral allergic fungal rhinosinusitis

Abstract

Recurrence of allergic fungal rhinosinusitis (AFRS) is well recognized. However, there is scarcity in the literature describing involvement of the non-diseased sinuses. We aimed to evaluate the recurrence forms of unilateral AFRS as well as to study the possible predictor factors of developing the disease in the contralateral side. Patients with exclusive unilateral AFRS from (2010 to 2015) were enrolled in multi-institutional case–control study. All patients were evaluated after endoscopic sinus surgery for recurrence. Patient's records were reviewed for demographics, medical treatment, and clinical, radiological, and surgical data. A total of 68 patients were identified. Delayed contralateral involvement after the initial surgery was found in 30.8% with mean duration of recurrence 16.9 months. A significant association was found with the presence of pre-operative contralateral symptoms and signs of inflammation (OR 3.49, 95% CI 1.19–10.22, p value 0.02). Post-operative use of budesonide irrigation was associated with less contralateral involvement (OR 0.11, 95% CI 0.01–0.87, p value 0.01). Association of other variables like: comorbidities, perioperative use of systemic steroid, radiological signs, extent of surgery, additional surgery to the contralateral side, and post-operative use of systemic steroids did not show statistical significance. Involvement of the contralateral sinuses in 30% of unilateral AFRS cases is considered significant. The non-diseased sinuses should be involved in the routine endoscopic examination and post-operative treatment. Further studies are necessary to investigate the possibility of prophylactic surgical intervention of the non-diseased sinuses.

http://ift.tt/2tVOAok

What should we expect from robotic surgery for second primary oropharyngeal cancer?

Abstract

The outcomes of second primary oropharyngeal cancer (SPOPC) may not be determined by oropharyngeal cancer but from the other index cancer as well. The management of (SPOPC) remains inconclusive and limited. Transoral robotic surgery (TORS) to maximize the functional outcomes without reducing oncologic effect is suggested as the primary treatment for selected oropharyngeal cancer. This study aimed to evaluate the feasibility and outcomes of TORS for the management of SPOPC. Patients who underwent TORS from January 2011 to June 2015 at a tertian referral center in Taiwan were recruited. Loco-regional status, overall survival (OS), disease-specific survival (DSS), and postoperative functional status were evaluated. Fifteen patients received TORS for SPOPC with curative intent, including eleven with tongue-base carcinomas, and four with tonsil carcinomas. One case was terminated because of inadequate exposure and the other 14 cases were completed with negative pathologic margins. Two-year OS and DSS were 53 and 77%, respectively. Patients with SPOPC occurring within 6 months had poorer outcomes (p = 0.044). The median time to feeding-tube removal was 5 days, and one patient had long-term gastric-tube dependence. Patients of age <65 years with synchronous SPOPC and esophageal cancer as the other index cancer were significant worse in oncologic outcomes. We concluded that TORS is a feasible alternative treatment in selected patients with SPOPC. Patients with metachronous T1–2 SPOPC without an esophageal primary can achieve excellent survival after TORS, while TORS can maximize functional preservation with limited destruction in patients with low life expectancy.

http://ift.tt/2uuJtbG

Outcome of a graduated minimally invasive facial reanimation in patients with facial paralysis

Abstract

Peripheral paralysis of the facial nerve is the most frequent of all cranial nerve disorders. Despite advances in facial surgery, the functional and aesthetic reconstruction of a paralyzed face remains a challenge. Graduated minimally invasive facial reanimation is based on a modular principle. According to the patients' needs, precondition, and expectations, the following modules can be performed: temporalis muscle transposition and facelift, nasal valve suspension, endoscopic brow lift, and eyelid reconstruction. Applying a concept of a graduated minimally invasive facial reanimation may help minimize surgical trauma and reduce morbidity. Twenty patients underwent a graduated minimally invasive facial reanimation. A retrospective chart review was performed with a follow-up examination between 1 and 8 months after surgery. The FACEgram software was used to calculate pre- and postoperative eyelid closure, the level of brows, nasal, and philtral symmetry as well as oral commissure position at rest and oral commissure excursion with smile. As a patient-oriented outcome parameter, the Glasgow Benefit Inventory questionnaire was applied. There was a statistically significant improvement in the postoperative score of eyelid closure, brow asymmetry, nasal asymmetry, philtral asymmetry as well as oral commissure symmetry at rest (p < 0.05). Smile evaluation revealed no significant change of oral commissure excursion. The mean Glasgow Benefit Inventory score indicated substantial improvement in patients' overall quality of life. If a primary facial nerve repair or microneurovascular tissue transfer cannot be applied, graduated minimally invasive facial reanimation is a promising option to restore facial function and symmetry at rest.

http://ift.tt/2tWfE6S

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

Publication date: Available online 5 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Sahand Samieirad, Hadi Afrasiabi, Elahe Tohidi, Mohsen Qolizade, Baratollah Shaban, Maryam Asadat Hashemipour, Isa Doaltian Shirvan
IntroductionThere 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.Materials and methods80 patients (40 in each group) were selected as the final sample size. Forty drug packs, which were formulated and made by the consultant pharmacist, each containing 10 capsules of acetaminophen caffeine (consisting of 300 mg of acetaminophen and 20 mg of caffeine), and another 40 packs, each containing 10 capsules of acetaminophen codeine (consisting of 300 mg acetaminophen and 20 mg codeine) were prepared. These drugs were administered randomly to patients 1 hour before surgery and every 6 hours afterwards until 48 hours, according to the protocol. The patients' pain severities were determined at 30-minute, 3-hour, 6-hour, 12-hour, 1-day, 2-day, and 1-week intervals. In addition, the swelling was evaluated after 1 day, 2 days, 3 days, and 1 week. Data were analyzed with Mann-Whitney, student's t, and chi-squared tests, using SPSS 11.ResultsA total of 76 patients, including 38 males and 38 females, with a mean age of 41.06 ± 5 and an age range of 35‒53 years, were studied. The pain severities in patients in the codeine group were significantly less than those in the caffeine group at 3-, 6-, and 12-hour postoperative intervals (p = 0.001). However, the pain severities at the above intervals, even in caffeine group, were within the moderate pain severity range (VAS = 3–7). It is also interesting to note that the pain was at its maximum severity at the 6-hour postoperative interval, and at its minimum at the 1-week interval. The severity of swelling was also evaluated in both groups, indicating that it was significantly less in the caffeine group at 1-, 2-, and 3-day postoperative intervals (p = 0.018).ConclusionAccording to this study, the codeine-containing analgesics are significantly more effective than caffeine-containing ones in reducing postoperative pain. It was also concluded that caffeine-containing analgesics are significantly more effective than codeine-containing ones in reducing postoperative swelling, which was reported to be significantly less within the first 3 days in the caffeine group. As a result, caffeine-containing analgesics are effective and acceptable in reducing both postoperative pain and swelling.



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The self-defining axis of symmetry: A new method to determine optimal symmetry and its application and limitation in craniofacial surgery

Publication date: Available online 6 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Markus Martini, Anne Klausing, Martina Messing-Jünger, Guido Lüchters
PurposeAnalysis of symmetry represents an essential aspect of plastic-reconstructive surgery. For cases in which reference points are either not fixed or are changed due to corrective intervention the determination of a symmetry axis is sometimes almost impossible and a pre-defined symmetry axis would not always be helpful. To assess cranial shape of surgical patients with craniosynostosis, a new algebraic approach was chosen in which deviation from the optimal symmetry axis could be quantified.Materials and MethodsOptimal symmetry was defined based on a single central point in the fronto-orbital advancement (FOA) hyperplane and a corresponding landmark pair. The forehead symmetry evaluation was based on 3D-scans series of 13 children, on whom cranioplasty with FOA was performed and 15 healthy children who served as control group.ResultsChildren with plagiocephaly showed considerable improvement in symmetry postoperatively, with stable values over one year, while those with trigonocephaly and brachycephaly showed constant good symmetry in the forehead both pre- and postoperatively.ConclusionsWith the help of an optimally calculated symmetry axis this new analysis method offers a solution, which is independent of preset dimensions. Patients can be evaluated according to their individual needs regarding symmetry and also be compared with one another.



http://ift.tt/2sQQ6D9

Otolaryngology Research Challenges in Patient Care and Outcomes

Eight years ago, Chalmers and Glasziou estimated that nearly 85% of the public and private monies spent on biomedical research were wasted because of inadequately produced and reported research, thereby slowing improvement in patient care. There have been significant efforts made to remedy these issues, yet they persist because the underlying problems have not been corrected.

http://ift.tt/2uOCU3f

Parental Understanding of Educational Materials on Laryngotracheal Reconstruction

This study assesses the understandability and actionability of parental educational materials for laryngotracheal reconstruction in children.

http://ift.tt/2tQDYq6

Characteristics of Pediatric Patients With Sensorineural Hearing Loss

This cohort study analyzes the etiologic and audiologic characteristics of pediatric-onset unilateral and asymmetric sensorineural hearing loss.

http://ift.tt/2uOVKXU

Addressing the Challenges in Tonsillectomy Research to Inform Health Care Policy

This review provides an overview of the key challenges for research to inform tonsillectomy policy and recommendations to help bridge the evidence-policy gap.

http://ift.tt/2tQLlOd

Cell therapy and scarred vocal folds

Publication date: Available online 6 July 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Mattei, J. Magalon, B. Bertrand, C. Philandrianos, J. Veran, A. Giovanni
Vocal fold microstructure is complex and can be affected by laryngeal microsurgery, inducing scarring that prevents mechanical uncoupling of epithelium and muscle, leading to vibration disorder and disabling dysphonia. Treatment options presently are few, and often without efficacy for vibration, having only an impact on volume to reduce glottal closure defect. The present review of the literature had two aims: (i) to report the current state of the literature on cell therapy in vocal fold scarring; and (ii) to analyze the therapeutic interest of the adipose-derived stromal vascular fraction in the existing therapeutic armamentarium. A PubMed^® search conducted in September 2016 retrieved English or French-language original articles on the use of stem cells to treat vocal fold scarring. Twenty-seven articles published between 2003 and 2016 met the study selection criteria. Mesenchymal stem cells were most widely used, mainly derived from bone marrow or adipose tissue. Four studies were performed in vitro on fibroblasts, and 18 in vivo on animals. End-points comprised: (i) scar analysis (macro- and micro-scopic morphology, viscoelastic properties, extracellular matrix, fibroblasts); and (ii) assessment of stem cell survival and differentiation. The studies testified to the benefit of mesenchymal stem cells, and especially those of adipose derivation. The stromal vascular fraction exhibits properties that might improve results by facilitating production logistics.



http://ift.tt/2tlcx7d

Seronegative Autoimmune Hepatitis A Clinically Challenging Difficult Diagnosis

Autoimmune hepatitis (AIH) is a complex liver disease of unknown cause which results in immune-mediated liver injury with varied clinical presentations. Seronegative AIH follows a similar course to autoantibody-positive disease and diagnosis may be challenging. There are no single serologic tests of sufficient diagnostic specificity, and delay in appropriate treatment may lead to progression of the liver disease and liver failure. The revised conventional diagnostic criteria (RDC) scoring for AIH is complex and not routinely used in the clinical practice. The more recent simplified diagnostic criteria (SDC) scoring proposed by International Autoimmune Hepatitis Group in 2008 has wider application in routine practice facilitating the diagnosis of AIH with a specificity and sensitivity of ~90%. In this report, we describe a case of seronegative autoimmune hepatitis diagnosed using RDC. SDC score calculated in our case was 4 and was not diagnostic for AIH. We subsequently used the complex revised diagnostic criteria for definitive diagnosis. Some of the patients previously diagnosed as cryptogenic active hepatitis of unknown etiology probably had an unrecognized diagnosis of seronegative autoimmune hepatitis. SDC scoring may not be applicable in patients with seronegative autoimmune hepatitis. These patients should be reassessed by using RDC.

http://ift.tt/2tPMRQC

Krebs in der Schweiz

Zusammenfassung

Hintergrund

Immer mehr Personen erkranken an Krebs. Deren Überlebenschancen nehmen aufgrund verbesserter Diagnostik und Therapie zu. Die betroffenen Personen haben besondere Bedürfnisse, die sich weit über den Abschluss der Therapie hinaus erstrecken. In der Folge wird die Nachsorge der sog. „cancer survivors" wichtiger. Die Krebsregistrierung liefert die Datengrundlage für evidenzbasierte Entscheide in der onkologischen Versorgung.

Methoden

Basierend auf den Ergebnissen des Schweizerischen Krebsberichts 2015 wird die Entwicklung von Krebs in der Schweiz (Prävalenz, Inzidenz, Mortalität, Überleben) beschrieben. Daraus abgeleitet werden neue Anforderungen an die Ärzteschaft skizziert und Neuerungen in der schweizerischen Krebsregistrierung erläutert.

Ergebnisse

Die Krebsinzidenz nahm in der Schweiz über die letzten 30 Jahre stetig zu, aktuell erkranken jährlich um die 42.000 Personen. Die Krebssterblichkeit sank im gleichen Zeitraum um 36 % (Männer) bzw. 27 % (Frauen). Momentan leben in der Schweiz rund 320.000 Personen mit einer Krebserkrankung, darunter viele Langzeitüberlebende. Viele davon haben physische, psychische und soziale Bedürfnisse, die bis anhin wenig beachtet wurden. Die Krebsregistrierung in der Schweiz wird durch ein neues Bundesgesetz modernisiert und internationalen Standards angepasst und kann durch die Untersuchung der Behandlungs- und Versorgungsqualität einen wichtigen Beitrag zur besseren Versorgung von Krebspatienten leisten.

Fazit

Eine umfassende, koordinierte und nachhaltige Versorgung von Krebspatienten ist notwendig und bedarf neben entsprechenden Angeboten in der Versorgung auch Weiterentwicklungen in der Krebsregistrierung.

http://ift.tt/2sQh5Pk

Partial response of pulmonary adenocarcinoma with symptomatic brain metastasis to nivolumab plus high-dose oral corticosteroid: a case report

Nivolumab, a monoclonal antibody targeting the programmed death-1 receptor, is indicated in locally advanced or metastatic non-small cell lung cancer, with progression after platinum-based chemotherapy. Up-to-...

http://ift.tt/2tVLjW5

Primary Radiotherapy Versus Primary Surgery for HPV-Associated Oropharyngeal Cancer

Condition:   Oropharyngeal Cancer
Interventions:   Radiation: Radiation;   Procedure: Transoral Surgery (TOS) + Neck Dissection
Sponsor:   David Palma
Not yet recruiting - verified June 2017

http://ift.tt/2tVn2zl

A Clinical Trial of Chemotherapy With Lobaplatin and 5-FU in Recurrent Local or Distant Advanced NPC.

Condition:   Recurrent Nasopharyngeal Carcinoma
Intervention:   Drug: Lobaplatin
Sponsor:   Sun Yat-sen University
Not yet recruiting - verified July 2017

http://ift.tt/2uuAVls

Determination of Pronostics Factors for Advanced Thyroid Carcinoma (pT3 pT4 or M1 at Diagnosis)

Condition:   Thyroid Cancer
Intervention:   Other: follow up visit
Sponsor:   Hospices Civils de Lyon
Recruiting - verified July 2017

http://ift.tt/2stmXPm

Tolerance and immunity to pathogens in early life: insights from HBV infection

Abstract

Immunity is not static but varies with age. The immune system of a newborn infant is not "defective" or "immature." Rather, there are distinct features of innate and adaptive immunity from fetal life to adulthood, which may alter the susceptibility of newborn infants to infections compared to adults. Increased protection to certain infectious diseases during early life may benefit from a dampened immune response as a result of decreased immune pathology. This concept may offer an alternative interpretation of the different pathological manifestations clinically observed in hepatitis B virus (HBV)-infected patients during the natural history of infection. Herein, we review the immune pathological features of HBV infection from early life to adulthood and challenge the concept of a generic immune tolerant state in young people. We then discuss how the different clinical and virological manifestations during HBV infection may be related to the differential antiviral immunity and pro-inflammatory capacity generated at different ages. Lastly, we address the potential to consider earlier therapeutic intervention in HBV-infected young patients to achieve effective immune control leading to better outcomes.

http://ift.tt/2tuba4n

Idiopathic abdominal cocoon: a rare presentation of small bowel obstruction in a virgin abdomen. How much do we know?

Abdominal cocoon is an extremely rare condition that has been mainly associated with young adolescent women. It was first described in 1978 by Foo et al. We present here a case that describes an otherwise healthy adult man who presented with intestinal obstruction and was found to have an abdominal cocoon, also known as a peritoneal sac. The patient was taken for a laparotomy and the sac was released through blunt dissection along the avascular planes. He was discharged in good condition 3 days postoperatively. We discuss some of the current literature and previously reported cases on this condition.

http://ift.tt/2tQmYA9

Two otherwise healthy young brothers present with intermittent claudication, just a coincidence?

Popliteal artery entrapment syndrome (PAES) is a recognised cause of lower limb peripheral arterial disease in young adults. We describe the cases of two otherwise healthy brothers who presented with the condition 5 years apart. The first brother, who is also the first author of this case report, presented aged 19 with worsening, right-sided, exercise-induced lower leg pain and transient foot pallor. Imaging confirmed PAES and irreversible localised arterial damage. Surgery was performed to release the entrapment and resect the section of diseased artery. The limb was revascularised using an autologous interposition saphenous vein graft. The second brother began experiencing left-sided, exercise-induced lower leg pain aged 24. Again, imaging revealed PAES and irreversible arterial damage. A similar revascularisation procedure was performed. Both siblings fully recovered and are symptom free. Arterial duplex scans have confirmed patent grafts. A correlation in siblings has only been reported in the literature five times previously.

http://ift.tt/2uOd5jT

Affected-ear-up 120° maneuver for treatment of lateral semicircular canal benign paroxysmal positional vertigo

Abstract

Although several researchers have tried various canalith repositioning procedures for lateral canalolithiasis, a standard treatment has not been established. We adopt 120° rotation, which is anatomically appropriate because the principle of cure may be the fixing of pathological debris to the dark cells of the utricle. The aims of this study were to clarify the efficacy rate of the affected-ear-up 120° maneuver and to elucidate the appearance rate of lying-down nystagmus in patients with lateral canalolithiasis. The subjects were 31 patients (26 females, 5 males) who revealed transient direction-changing geotropic positional nystagmus. After determining the involved side, we performed the canalith repositioning procedure immediately. To perform this maneuver: (1) Place the patient in the supine position. (2) Rotate the head toward the healthy side until facing downward 120° from supine. (3) Sit up. (4) Ask the patient to remain upright with the chin down until going to bed. Twenty-nine patients (94%) became symptom free by only one maneuver. However, one patient converted to ipsilateral posterior cupulolithiasis, and another required a second maneuver. Lying-down nystagmus was found in 29 patients (94%), the transient type in 23 (74%), and the persistent type in 6 (19%). The direction of transient (not persistent) lying-down nystagmus was mostly toward the healthy side. These results suggest that the affected-ear-up 120° maneuver is effective and that lying-down nystagmus appears at a high rate.

http://ift.tt/2tu2wmG

Le méthotrexate responsable de nécrose cutanée sévère

Publication date: Available online 5 July 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J.-L. Schmutz




http://ift.tt/2sQ8wEd

Encore un « dernier mot » sur le syndrome de Rowell

Publication date: Available online 5 July 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J.-C. Roujeau, J. Revuz




http://ift.tt/2tkPjhu

Les néoplasies intra-épithéliales différenciées du pénis

Publication date: Available online 6 July 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J.-N. Dauendorffer, B. Cavelier Balloy, M. Bagot, C. Renaud-Vilmer




http://ift.tt/2sQ214o

Longitudinal changes in erectile function after thulium:YAG prostatectomy for the treatment of benign prostatic obstruction: a 1-year follow-up study

Abstract

This study aimed to evaluate the impact of thulium:yttrium-aluminum-garnet (Tm:YAG) (RevoLix®) laser prostatectomy for the treatment of benign prostatic obstructions on erectile function (EF). A total of 208 patients who underwent Tm:YAG laser prostatectomies participated in this study. All cases were evaluated preoperatively and at 3, 6, and 12 months postoperatively using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, and the International Index of Erectile Function (IIEF-5) questionnaires. Patients were divided into groups A (severe erectile dysfunction [ED]), B (moderate ED), and C (mild-to-normal ED), according to their IIEF-5 scores. The median patient ages were 69, 65, and 62 years in groups A, B, and C, respectively. Significant improvements occurred in the IPSS and QoL score within the groups during the 12-month follow-up period. The IIEF-5 scores at 3 months postoperatively were lower than the preoperative scores in groups B and C. The IIEF-5 scores subsequently improved during the 12-month follow-up period. The slope of the relationship between the IIEF-5 score and the time since Tm:YAG laser prostatectomy had a ß value of 0.2210 (95% confidence interval 0.103 to 0.338, p = 0.0003); hence, each postoperative month was associated with an increase of 0.2210 in the IIEF-5 score. The IIEF-5 scores gradually increased and reached the preoperative levels by the 12-month follow-up assessment. Although the IIEF-5 score dropped significantly during the first 3 months postoperatively, it improved over the following 12 months. Tm:YAG laser prostatectomy did not impact on EF ultimately.

http://ift.tt/2tktajm

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

Publication date: Available online 5 July 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): L. Wang, K. Liu, Z. Shao, Z.-J. Shang
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. The TMJ disability index (DI) and craniomandibular index (CMI) differed significantly according to the method of management, as well as the position and morphology of the reconstructed condyle (P<0.01); however, no statistically significant difference in mandible movement was observed between the groups. The DI and CMI values were significantly lower in group 1 patients compared to group 2 and group 3 patients. The results showed that TMJ function in group 1 patients was superior to that in group 2 and group 3 patients, and that function in group 3 patients was better than that in group 2 patients. In conclusion, the condyle should be preserved when benign mandibular lesions are situated near the condyle, as preservation has a positive effect on TMJ function and mandible movement.



http://ift.tt/2sPR6aX

Cervical Chondrocutaneous Branchial Remnants

Abstract

Cervical chondrocutaneous branchial remnants are rare congenital choristomas. These lesions contain a cartilage core surrounded by skin with adnexal structures and subcutaneous fat. Correspondingly, on ultrasound there is a tubular hypoechoic core surrounded by hyperechoic, while on CT there is central intermediate attenuation surrounded by fat attenuation tissues. These features are exemplified in this sine qua non radiology-pathology correlation article. Management includes complete surgical resection and evaluating for potential associated anomalies, such as other branchial apparatus anomalies, as well as cardiac anomalies.

http://ift.tt/2sPqCq4

Performance of the phonological deviation diagram in the evaluation of rough and breathy synthesized voices

Publication date: Available online 5 July 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Leonardo Wanderley Lopes, Jonas Almeida de Freitas, Anna Alice Almeida, Priscila Oliveira Costa Silva, Giorvan Ânderson dos Santos Alves
IntroductionVoice disorders alter the sound signal in several ways, combining several types of vocal emission disturbances and noise. The Phonatory Deviation Diagram (PDD) is a two-dimensional chart that allows the evaluation of the vocal signal based on the combination of periodicity (jitter, shimmer, and correlation coefficient) and noise (Glottal to Noise Excitation – GNE) measurements. The use of synthesized signals, where one has a greater control and knowledge of the production conditions, may allow a better understanding of the physiological and acoustic mechanisms underlying the vocal emission and its main perceptual-auditory correlates regarding the intensity of the deviation and types of vocal quality.ObjectiveTo analyze the performance of the PDD in the discrimination of the presence and degree of roughness and breathiness in synthesized voices.Methods871 synthesized vocal signals were used corresponding to the vowel /ɛ/. The perceptual-auditory analysis of the degree of roughness and breathiness of the synthesized signals was performed using Visual Analogue Scale (VAS). Subsequently, the signals were categorized regarding the presence/absence of these parameters based on the VAS cutoff values. Acoustic analysis was performed by assessing the distribution of vocal signals according to the PDD area, quadrant, shape, and density. The equality of proportions and the chi-square tests were performed to compare the variables.ResultsRough and breathy vocal signals were located predominantly outside the normal range and in the lower right quadrant of the PDD. Voices with higher degrees of roughness and breathiness were located outside the area of normality in the lower right quadrant and had concentrated density.ConclusionThe normality area and the PDD quadrant can discriminate healthy voices from rough and breathy ones. Voices with higher degrees of roughness and breathiness are proportionally located outside the area of normality, in the lower right quadrant and with concentrated density.



http://ift.tt/2ttl7yW

Quality of life and cochlear implant: results in adults with postlingual hearing loss

Publication date: Available online 5 July 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Aline Faria de Sousa, Maria Inês Vieira Couto, Ana Claudia Martinho de Carvalho
IntroductionConsidering the variability of results found in the clinical population using a cochlear implant, researchers in the area have been interested in the inclusion of quality of life measures to subjectively assess the benefits of the implantation.ObjectiveTo assess the quality of life of adult users of CI.MethodsA cross-sectional and clinical study in a group of 26 adults of both genders, with mean duration of CI use of 6.6 years. The Nijmegen Cochlear Implantation Questionnaire and the generic World Health Organization Quality of Life questionnaire were sent electronically.ResultsThe best assessed domain in the quality of life assessment for the cochlear implantation questionnaire was the social domain, whereas for the quality of life questionnaire it was the psychological domain. The variables, gender, time of cochlear implant use and auditory modality did not influence the results of both questionnaires. Only the variable level of education was correlated with the environment domain of the quality of life questionnaire. The variable telephone speech comprehension was associated with a better perception of quality of life for all the domains of the specific questionnaire and for the self-assessment of quality of life in general.ConclusionFrom the users' perspective, both questionnaires showed that the cochlear implant use brought benefits to different aspects related to quality of life.



http://ift.tt/2sJ7dMl

Does pain in the masseter and anterior temporal muscles influence maximal bite force?

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Marcelo Coelho Goiato, Paulo Renato Junqueira Zuim, Amália Moreno, Daniela Micheline dos Santos, Emily Vivianne Freitas da Silva, Fernanda Pereira de Caxias, Karina Helga Leal Turcio
ObjectiveThe aim of this study was to evaluate changes in pain and muscle force, and the relationship between them, in patients with muscle pain and bruxism, prior to and after treatment.MethodsThirty women with bruxism and myofascial pain (Ia) were included in this study. Sleep bruxism diagnosis was made based on clinical diagnostic criteria, and awake bruxism diagnosis was made by patient questionnaires and the presence of tooth wear. The diagnosis of myofascial pain was established according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD). Dentulous or partially edentulous patients (rehabilitated with conventional fixed prostheses) were included in the study according to the inclusion and exclusion criteria. The pain treatment protocol included occlusal splints, patient education, and physiotherapy for 30days. Bite force was measured using a dynamometer at the central incisor and the first molar regions on both sides. The exams were performed at baseline, after 7days, and 30days after treatment. The Wilcoxon test was used to compare patient pain level response among the periods analyzed in the study. Bite force data were submitted to two-way repeated-measures ANOVA, followed by the Tukey HSD test (p<0.05). A simple regression analysis was performed to verify the relation between pain level and bite force.ResultsResults revealed that there was a statistical difference in pain level over time for both muscles and sides (p<0.01). In the molar region, the bite force exhibited significantly higher values after 30days of treatment, when compared with the baseline (p<0.001). There was a correlation between pain level and bite force only for the temporal muscle in all periods analyzed (p<0.05). There was no strong correlation in the response level points to support the association of pain and bite force.ConclusionsPain level decreased and bite force increased in the molar region after treatment. No strong correlation or dispersion in the relationship between pain levels and bite force was seen in women with myofascial pain and bruxism.



http://ift.tt/2uNqAjF

Regenerative capacity of allogenic gingival margin- derived stem cells with fibrin glue on albino rats’ partially dissected submandibular salivary glands

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Noura Abd El-Latif, Mohamed Abdulrahman, Mohamad Helal, Mohammed E. Grawish
ObjectiveTo evaluate the possible regenerative effect of allogenic gingival margin-derived stem cells (GMSCs) with or without autologous fibrin glue on partially dissected submandibular salivary glands of albino rats.MethodsForty rats were randomly divided into four equal groups. Group I, where no operation was performed, was considered the negative control. Group II rats were considered the positive control and were subjected to a rectangular cut on the outer surface of the center right of the submandibular salivary gland and received no other treatment. Groups III and IV rats were handled as those in group II, but the cut areas of group III were filled with fibrin glue and the cut borders of group IV were injected with 1×10⁵cell/ml GMSCs and then glued with fibrin glue. Five animals from each group were euthanized at the end of the first postoperative week, while the remaining animals were euthanized at the end of the second postoperative week, i.e., end of the experiment.ResultsRegeneration of ductal, acinar, and myoepithelial cells was better in group IV. A two-way ANOVA for proliferating cell nuclear antigen and α-smooth muscle actin revealed an overall significant difference between the different groups (P<0.05). In addition, an LSD post hoc test for multiple comparisons revealed a significant difference between each two groups. An independent sample t-test revealed significant differences between time periods for groups II, III, and IV, but there were no significant differences between the time periods for group I.ConclusionInjecting GMSCs at the cut borders and gluing the cut area with autologous fibrin glue ameliorates the regeneration of partially dissected submandibular salivary gland better than using fibrin glue alone.



http://ift.tt/2ttDFz2

Does pain in the masseter and anterior temporal muscles influence maximal bite force?

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Marcelo Coelho Goiato, Paulo Renato Junqueira Zuim, Amália Moreno, Daniela Micheline dos Santos, Emily Vivianne Freitas da Silva, Fernanda Pereira de Caxias, Karina Helga Leal Turcio
ObjectiveThe aim of this study was to evaluate changes in pain and muscle force, and the relationship between them, in patients with muscle pain and bruxism, prior to and after treatment.MethodsThirty women with bruxism and myofascial pain (Ia) were included in this study. Sleep bruxism diagnosis was made based on clinical diagnostic criteria, and awake bruxism diagnosis was made by patient questionnaires and the presence of tooth wear. The diagnosis of myofascial pain was established according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD). Dentulous or partially edentulous patients (rehabilitated with conventional fixed prostheses) were included in the study according to the inclusion and exclusion criteria. The pain treatment protocol included occlusal splints, patient education, and physiotherapy for 30days. Bite force was measured using a dynamometer at the central incisor and the first molar regions on both sides. The exams were performed at baseline, after 7days, and 30days after treatment. The Wilcoxon test was used to compare patient pain level response among the periods analyzed in the study. Bite force data were submitted to two-way repeated-measures ANOVA, followed by the Tukey HSD test (p<0.05). A simple regression analysis was performed to verify the relation between pain level and bite force.ResultsResults revealed that there was a statistical difference in pain level over time for both muscles and sides (p<0.01). In the molar region, the bite force exhibited significantly higher values after 30days of treatment, when compared with the baseline (p<0.001). There was a correlation between pain level and bite force only for the temporal muscle in all periods analyzed (p<0.05). There was no strong correlation in the response level points to support the association of pain and bite force.ConclusionsPain level decreased and bite force increased in the molar region after treatment. No strong correlation or dispersion in the relationship between pain levels and bite force was seen in women with myofascial pain and bruxism.



http://ift.tt/2uNqAjF

Regenerative capacity of allogenic gingival margin- derived stem cells with fibrin glue on albino rats’ partially dissected submandibular salivary glands

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Noura Abd El-Latif, Mohamed Abdulrahman, Mohamad Helal, Mohammed E. Grawish
ObjectiveTo evaluate the possible regenerative effect of allogenic gingival margin-derived stem cells (GMSCs) with or without autologous fibrin glue on partially dissected submandibular salivary glands of albino rats.MethodsForty rats were randomly divided into four equal groups. Group I, where no operation was performed, was considered the negative control. Group II rats were considered the positive control and were subjected to a rectangular cut on the outer surface of the center right of the submandibular salivary gland and received no other treatment. Groups III and IV rats were handled as those in group II, but the cut areas of group III were filled with fibrin glue and the cut borders of group IV were injected with 1×10⁵cell/ml GMSCs and then glued with fibrin glue. Five animals from each group were euthanized at the end of the first postoperative week, while the remaining animals were euthanized at the end of the second postoperative week, i.e., end of the experiment.ResultsRegeneration of ductal, acinar, and myoepithelial cells was better in group IV. A two-way ANOVA for proliferating cell nuclear antigen and α-smooth muscle actin revealed an overall significant difference between the different groups (P<0.05). In addition, an LSD post hoc test for multiple comparisons revealed a significant difference between each two groups. An independent sample t-test revealed significant differences between time periods for groups II, III, and IV, but there were no significant differences between the time periods for group I.ConclusionInjecting GMSCs at the cut borders and gluing the cut area with autologous fibrin glue ameliorates the regeneration of partially dissected submandibular salivary gland better than using fibrin glue alone.



http://ift.tt/2ttDFz2

Cervical Chondrocutaneous Branchial Remnants

Abstract

Cervical chondrocutaneous branchial remnants are rare congenital choristomas. These lesions contain a cartilage core surrounded by skin with adnexal structures and subcutaneous fat. Correspondingly, on ultrasound there is a tubular hypoechoic core surrounded by hyperechoic, while on CT there is central intermediate attenuation surrounded by fat attenuation tissues. These features are exemplified in this sine qua non radiology-pathology correlation article. Management includes complete surgical resection and evaluating for potential associated anomalies, such as other branchial apparatus anomalies, as well as cardiac anomalies.

http://ift.tt/2sPqCq4

Black swans: challenging the relationship of anaesthetic-induced unconsciousness and electroencephalographic oscillations in the frontal cortex

The study of general anaesthesia and electroencephalographic oscillations in the frontal cortex spans at least four decades, with several notable findings:

• In 1977, Tinker and colleagues¹ proposed, based on studies of the nonhuman primate, that anteriorization—the shift of electroencephalographic power from posterior cortex to frontal cortex—correlated with unresponsiveness during general anaesthesia.
• In the early 1990s, Steriade contributed to our understanding of the neurophysiology of sleep and general anaesthesia in animals, including descriptions of three distinct oscillations involving corticothalamic networks: a slow rhythm at < 1 Hz, a delta rhythm at 1-4 Hz, and a faster theta/alpha rhythm at 7-14 Hz.²³
• In the mid-1990s, the shift of alpha oscillations to more anterior structures was identified during both propofol sedation⁴ and isoflurane/nitrous oxide anaesthesia.⁵
• In 2001, anteriorized alpha and slow-wave activity was posited by John and colleagues⁶ to be an agent-invariant marker of anaesthetic-induced unconsciousness, based on a study of 176 surgical patients.
• In 2004, the disappearance of occipital alpha oscillations and shift to high-power frontal alpha oscillations was found to be associated with propofol-induced unconsciousness in healthy human participants.⁷
• In 2013, Purdon and colleagues⁸ found, using high-density electroencephalography in human volunteers, that anteriorization of alpha and phase-amplitude coupling patterns correlated with propofol-induced unconsciousness.
• In 2014, both propofol and sevoflurane anaesthesia were found to be associated with anterior alpha and slow oscillations in surgical patients.⁹

http://ift.tt/2st87by

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

Publication date: Available online 5 July 2017
Source:Oral Oncology
Author(s): Andrew W. Barrett




http://ift.tt/2uNmDeV

Impact of early prophylactic feeding on long term tube dependency outcomes in patients with head and neck cancer

Publication date: September 2017
Source:Oral Oncology, Volume 72
Author(s): Teresa Brown, Merrilyn Banks, Brett G.M. Hughes, Charles Lin, Lizbeth M. Kenny, Judith D. Bauer
ObjectivesProphylactic gastrostomy tube (PGT) is frequently used in patients with head and neck cancer (HNSCC). There are concerns this leads to tube dependency but this phenomena is not well defined. This study aimed to determine whether early feeding via PGT impacted on longer term tube feeding outcomes.Materials and methodsPatients with HNSCC with PGT were observed monthly post-treatment regarding tube use and time to removal up to twelve months. Patients were from a randomised controlled trial comparing an early feeding intervention via the PGT (n=57) versus usual care which commenced feeding when clinically indicated (n=67).ResultsPatient characteristics; male (88%), mean age 60±10.1years, oropharyngeal tumours (76%), receiving chemoradiotherapy (82%). Tubes were used by 87% (108/124) on completion of treatment and 66% (83/124) one month post. No differences in tube use between groups at any time point or tube removal rates over 12months (p=0.181). In patients free of disease (n=99), the intervention had higher tube use at 4months (p=0.003) and slower removal rates (p=0.047). Overall ten patients had their tube in-situ at 12months (8%) but five were awaiting removal (4% true dependency rate). Of the five patients legitimately using the tube, only one (<1%) was from severe dysphagia post definitive chemoradiotherapy.ConclusionPGT use is high in the acute phase post-treatment. Encouraging early use may prolong time to tube removal but it does not increase long term dependency rates beyond four months post treatment. Monitoring tube use is important to prevent over-estimation of dependency rates.Clinical trial registrationThis trial has been registered in the Australian New Zealand Clinical Trials registry as ACTRN12612000579897. Available at http://ift.tt/17L6Qgm.



http://ift.tt/2tPhO7I