High-resolution cone-beam computed tomography for assessment of bone invasion in oral cancer: Comparison with conventional computed tomography

Abstract

Background

Radiologic assessment of mandibular bone invasion is critical in evaluating the extent of bone resection required in patients with oral cancer. There are a few reports of improved sensitivity with cone-beam CT (CBCT) over conventional CT.

Methods

A prospective cohort study of patients with oral squamous cell carcinomas adjacent to the mandible requiring marginal or segmental mandibular resection was performed. Patients were treated based on clinical assessment and conventional cross-sectional imaging. Patients and surgeons were blinded to the results of CBCT performed preoperatively. Pathologic examination served as the gold standard.

Results

Forty-five patients were included in the study. Thirty-three percent of the patients underwent segmental mandibulectomy and 37% had bone invasion. The sensitivity and specificity of CBCT were 91% and 60%, respectively, compared to 86% and 68% for CT with bone windows.

Conclusion

A CBCT offers marginally improved sensitivity at the cost of reduced specificity for assessment of bone invasion compared to CT.

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Reflectance confocal microscopy for the diagnosis of Galli-Galli disease

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Silicone tracheobronchial stent: A rare cause for bronchoesophageal fistula and distortion of airway anatomy

Bhupesh Kumar, Ganesh Kumar Munirathinam, Goverdhan Dutt Puri, Anand Kumar Mishra, Virendra Kumar Arya

Annals of Cardiac Anaesthesia 2017 20(3):355-358

Silicone tracheobronchial stents are being increasingly used in a large number of patients for the treatment of tracheal stenosis. One very rare complication due to tracheobronchial stenting is bronchoesophageal fistula (BEF), which has been associated with the use of metallic stents. We report intraoperative management of a patient undergoing repair of a BEF, following previous insertion of a silicone Y-stent that is soft in texture and has not been implicated for this complication till date. In addition, misalignment of this silicone tracheobronchial Y-stent resulted in a tracheal mucosal bulge proximal to the stent that vanished after its removal.

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Risk factors of postcardiotomy ventricular dysfunction in moderate-to-high risk patients undergoing open-heart surgery

Christoph Ellenberger, Tornike Sologashvili, Mustafa Cikirikcioglu, Gabriel Verdon, John Diaper, Tiziano Cassina, Marc Licker

Annals of Cardiac Anaesthesia 2017 20(3):287-296

Introduction: Ventricular dysfunction requiring inotropic support frequently occurs after cardiac surgery, and the associated low cardiac output syndrome largely contributes to postoperative death. We aimed to study the incidence and potential risk factors of postcardiotomy ventricular dysfunction (PCVD) in moderate-to-high risk patients scheduled for open-heart surgery. Methods: Over a 5-year period, we prospectively enrolled 295 consecutive patients undergoing valve replacement for severe aortic stenosis or coronary artery bypass surgery who presented with Bernstein-Parsonnet scores >7. The primary outcome was the occurrence of PCVD as defined by the need for sustained inotropic drug support and by transesophageal echography. The secondary outcomes included in-hospital mortality and the incidence of any major adverse events as well as Intensive Care Unit (ICU) and hospital length of stay. Results: The incidence of PCVD was 28.4%. Patients with PCVD experienced higher in-hospital mortality (12.6% vs. 0.6% in patients without PCVD) with a higher incidence of cardiopulmonary and renal complications as well as a prolonged stay in ICU (median + 2 days). Myocardial infarct occurred more frequently in patients with PCVD than in those without PCVD (19 [30.2%] vs. 12 [7.6%]). By logistic regression analysis, we identified four independent predictors of PCVD: left ventricular ejection fraction <40% (odds ratio [OR] = 6.36; 95% confidence interval [CI], 2.59–15.60), age older than 75 years (OR = 3.35; 95% CI, 1.64–6.81), prolonged aortic clamping time (OR = 3.72; 95% CI, 1.66–8.36), and perioperative bleeding (OR = 2.33; 95% CI, 1.01–5.41). The infusion of glucose-insulin-potassium was associated with lower risk of PCVD (OR = 0.14; 95% CI, 0.06–0.33). Conclusions: This cohort study indicates that age, preoperative ventricular function, myocardial ischemic time, and perioperative bleeding are predictors of PCVD which is associated with poor clinical outcome.

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Methylene blue for post-cardioplumonary bypass vasoplegic syndrome

Neha Pangasa, Rohan Magoon, Vandana Bhardwaj, Amita Sharma, Ameya Karonjkar, Poonam Malhotra Kapoor

Annals of Cardiac Anaesthesia 2017 20(3):381-382



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Neutrophil gelatinase-associated lipocalin as a biomarker for predicting acute kidney injury during off-pump coronary artery bypass grafting

Muralidhar Kanchi, R Manjunath, Jos Massen, Lloyd Vincent, Kumar Belani

Annals of Cardiac Anaesthesia 2017 20(3):297-302

Background: Acute kidney injury (AKI) following cardiac surgery is a major complication resulting in increased morbidity, mortality, and economic burden. In this study, we assessed the usefulness of estimating serum neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker in predicting AKI in patients with stable chronic kidney disease (CKD) and undergoing off-pump coronary artery bypass grafting (OP-CABG). Patients and Methods: We prospectively studied sixty nondialysis-dependent CKD patients with estimated glomerular filtration rate <60 ml/min/1.73 m2 who required elective OP-CABG. Patients were randomized into two groups, Group D received dopamine infusion at 2 μg/kg/min following anesthesia induction till the end of the surgery and Group P did not receive any intervention. Serum creatinine, NGAL, brain natriuretic peptide, and troponin-I were estimated at specified intervals before, during, and after surgery. The results of the study patients were also compared to a simultaneous matched cohort control of thirty patients (Group A) without renal dysfunction who underwent OP-CABG. Results: No patient required renal replacement therapy, and no mortality was observed during perioperative and hospitalization period. Six patients from control group (n = 30), ten patients from placebo group (n = 30), and 12 patients from dopamine group (n = 30) developed stage 1 AKI. However, we did not observe any stage 2 and stage 3 AKI among all the groups. There was a significant increase in serum NGAL levels at the end of surgery and 24 h postoperatively in placebo and dopamine groups as compared to the control. Conclusion: The measurement of NGAL appears to predict the occurrence of AKI after OP-CAB surgery. However, large multicentric studies may be required to confirm the findings of this study.

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Idarucizumab (Praxbind) for reversal of pradaxa prior to emergent repair of contained ruptured transverse arch aneurysm

Erol Vahit Belli, Teng Lee

Annals of Cardiac Anaesthesia 2017 20(3):369-371

Idarucizumab before cardiopulmonary bypass was used for the reversal of dabigatran during an emergent frozen elephant trunk repair of a transverse arch aneurysm. Reversal was successful and minimal not massive transfusion was required with no abnormal sequelae seen with use before cardiopulmonary bypass.

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Coronary artery bypass graft patients' perception about the risk factors of illness: Educational necessities of second prevention

Ali Soroush, Saeid Komasi, Mozhgan Saeidi, Behzad Heydarpour, Danilo Carrozzino, Mario Fulcheri, Paolo Marchettini, Massimo Rabboni, Angelo Compare

Annals of Cardiac Anaesthesia 2017 20(3):303-308

Background: Patients' beliefs about the cause of cardiac disease (perceived risk factors) as part of the global psychological presentation are influenced by patients' health knowledge. Hence, the present study aimed to assess the relationship between actual and perceived risk factors, identification of underestimated risk factors, and indication of underestimation of every risk factor. Materials and Methods: In this cross-sectional study, data of 313 coronary artery bypass graft (CABG) patients admitted to one hospital in the west of Iran were collected through a demographic interview, actual risk factors' checklist, open single item of perceived risk factors, and a life stressful events scale. Data were analyzed by means of Spearman's correlation coefficients and one-sample Z-test for proportions. Results: Although there are significant relations between actual and perceived risk factors related to hypertension, family history, diabetes, smoking, and substance abuse (P < 0.05), there is no relation between the actual and perceived risk factors, and patients underestimate the role of actual risk factors in disease (P < 0.001). The patients underestimated the role of aging (98.8%), substance abuse (95.2%), overweight and obesity (94.9%), hyperlipidemia (93.1%), family history (90.3%), and hypertension (90%) more than diabetes (86.1%), smoking (72.5%), and stress (54.7%). Conclusion: Cardiac patients seem to underestimate the role of aging, substance abuse, obesity and overweight, hyperlipidemia, family history, and hypertension more than other actual risk factors. Therefore, these factors should be highlighted to patients to help them to (i) increase the awareness of actual risk factors and (ii) promote an appropriate lifestyle after CABG surgery.

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Appropriate size of double-lumen tubes in Asians

Chitra Rajeswari Thangaswamy

Annals of Cardiac Anaesthesia 2017 20(3):388-388



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Cardiovascular operation: A significant risk factor of arytenoid cartilage dislocation/subluxation after anesthesia

Seri Tsuru, Mayuko Wakimoto, Takeshi Iritakenishi, Makoto Ogawa, Yukio Hayashi

Annals of Cardiac Anaesthesia 2017 20(3):309-312

Background: Arytenoid cartilage dislocation/subluxation is one of the rare complications following tracheal intubation, and there have been no reports about risk factors leading this complication. From our clinical experience, we have an impression that patients undergoing cardiovascular operations tend to be associated with this complication. Aims: We designed a large retrospective study to reveal the incidence and risk factors predicting the occurrence and to examine whether our impression is true. Settings and Designs: This was a retrospective study. Methods: We retrospectively studied 19,437 adult patients who were intubated by an anesthesiologist in our operation theater from 2002 to 2008. The tracheal intubation was performed by a resident anesthesiologist managing the patients. Only patients whose postoperative voice was disturbed more than 7 days were referred to the Department of Otorhinolaryngology-Head and Neck Surgery and examined using laryngostroboscopy by a laryngologist to diagnose arytenoid cartilage dislocation/subluxation. We evaluated age, sex, weight, height, duration of intubation, difficult intubation, and major cardiovascular operation as risk factors to lead this complication. Statistical Analysis: The data were analyzed by logistic regression analysis to assess factors for arytenoid cartilage dislocation/subluxation after univariate analyses using logistic regression analysis. Results: Our analysis indicated that difficult intubation (odds ratio: 12.1, P = 0.018) and cardiovascular operation (odds ratio: 9.9, P < 0.001) were significant risk factors of arytenoid cartilage dislocation/subluxation. Conclusion: The present study demonstrated that major cardiovascular operation is one of the significant risk factors leading this complication.

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Management of a case of double aortic arch with tracheal compression complicated with postoperative tracheal restenosis

Hemang Gandhi, T Vikram Kumar Naidu, Amit Mishra, Pankaj Garg, Jigar Surti, Visharad Trivedi, Himanshu Acharya

Annals of Cardiac Anaesthesia 2017 20(3):362-364

Tracheal stenosis in association with the double aortic arch (DAA) is uncommon; however, it carries a high risk of morbidity, mortality, and restenosis. Although surgery is the mainstay of managing a case of the DAA with tracheal stenosis, management of tracheal restenosis requires a multidisciplinary approach. In this case report, we present our successful experience in managing a child of DAA with tracheal stenosis who developed tracheal restenosis after sliding tracheoplasty of trachea.

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Propofol versus Ketofol for Sedation of Pediatric Patients Undergoing Transcatheter Pulmonary Valve Implantation: A Double-blind Randomized Study

Rabie Soliman, Mohammed Mofeed, Tarek Momenah

Annals of Cardiac Anaesthesia 2017 20(3):313-317

Objective: The study was done to compare propofol and ketofol for sedation of pediatric patients scheduled for elective pulmonary valve implantation in a catheterization laboratory. Design: This was a double-blind randomized study. Setting: This study was conducted in Prince Sultan Cardiac Centre, Saudi Arabia. Patients and Methods: The study included 60 pediatric patients with pulmonary regurge undergoing pulmonary valve implantation. Intervention: The study included sixty patients, classified into two groups (n = 30). Group A: Propofol was administered as a bolus dose (1–2 mg/kg) and then a continuous infusion of 50–100 μg/kg/min titrated as needed. Group B: Ketofol was administered 1–2 mg/kg and then infusion of 20–60 μg/kg/min. The medication was prepared by the nursing staff and given to anesthetist blindly. Measurements: The monitors included heart rate, mean arterial blood pressure, respiratory rate, temperature, SPO2and PaCO2, Michigan Sedation Score, fentanyl dose, antiemetic medications, and Aldrete score. Main Results: The comparison of heart rate, mean arterial pressure, respiratory rate, temperature, SPO2and PaCO2, Michigan Sedation Score, and Aldrete score were insignificant (P > 0.05). The total fentanyl increased in Group A more than Group B (P = 0.045). The required antiemetic drugs increased in Group A patients more than Group B (P = 0.020). The durations of full recovery and in the postanesthesia care unit were longer in Group A than Group B (P = 0.013, P < 0.001, respectively). Conclusion: The use of propofol and ketofol is safe and effective for sedation of pediatric patients undergoing pulmonary valve implantation in a catheterization laboratory. However, ketofol has many advantages more than the propofol. Ketofol has a rapid onset of sedation, a rapid recovery time, decreased incidence of nausea and vomiting and leads to rapid discharge of patients from the postanesthesia care unit.

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Sugammadex to reverse neuromuscular blockade in a child with a past history of cardiac transplantation

Karen Miller, Brian Hall, Joseph D Tobias

Annals of Cardiac Anaesthesia 2017 20(3):376-378

Sugammadex is a novel agent for the reversal of neuromuscular blockade. The speed and efficacy of reversal with sugammadex are significantly faster than acetylcholinesterase inhibitors, such as neostigmine. Sugammadex also has a limited adverse profile when compared with acetylcholinesterase inhibitors, specifically in regard to the incidence of bradycardia. This adverse effect may be particularly relevant in the setting of a heart transplant recipient with a denervated heart. The authors present a case of an 8-year-old child, status postcardiac transplantation, who required anesthetic care for laparoscopy and lysis of intra-abdominal adhesions. Sugammadex was used to reverse neuromuscular blockade and avoid the potential adverse effects of neostigmine. The unique mechanism of action of sugammadex is discussed, previous reports of its use in this unique patient population are reviewed, and its potential benefits compared to traditional acetylcholinesterase inhibitors are presented.

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Randomized comparative study of intravenous infusion of three different fixed doses of milrinone in pediatric patients with pulmonary hypertension undergoing open heart surgery

Neeraj Kumar Barnwal, Sanjeeta Rajendra Umbarkar, Manjula Sudeep Sarkar, Raylene J Dias

Annals of Cardiac Anaesthesia 2017 20(3):318-322

Background: Pulmonary hypertension secondary to congenital heart disease is a common problem in pediatric patients presenting for open heart surgery. Milrinone has been shown to reduce pulmonary vascular resistance and pulmonary artery pressure in pediatric patients and neonates postcardiac surgery. We aimed to evaluate the postoperative outcome in such patients with three different fixed maintenance doses of milrinone. Methodology: Patients were randomized into three groups. All patients received fixed bolus dose of milrinone 50 μg/kg on pump during rewarming. Following this, patients in low-dose group received infusion of milrinone at the rate of 0.375 μg/kg/min, medium-dose group received 0.5 μg/kg/min, and high-dose group received 0.75 μg/kg/min over 24 h. Heart rate, mean arterial pressure (MAP), mean airway pressure (MaP), oxygenation index (OI), and central venous pressure (CVP) were compared at baseline and 24 h postoperatively. Dose of inotropic requirement, duration of ventilatory support and Intensive Care Unit (ICU) stay were noted. Results: MAP, MaP, OI, and CVP were comparable in all three groups postoperatively. All patients in the low-dose group required low inotropic support while 70% of patients in the high-dose group needed high inotropic support to manage episodes of hypotension (P = 0.000). Duration of ventilatory support and ICU stay in all three groups was comparable (P = 0.412, P = 0.165). Conclusion: Low-dose infusions while having a clinical impact were more beneficial in avoiding adverse events and decreasing inotropic requirement without affecting duration of ventilatory support and duration of ICU stay.

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Asystole following neuromuscular blockade reversal in cardiac transplant patients

Njinkeng J Nkemngu

Annals of Cardiac Anaesthesia 2017 20(3):385-386



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The blalock and taussig shunt revisited

Usha Kiran, Shivani Aggarwal, Arin Choudhary, B Uma, Poonam Malhotra Kapoor

Annals of Cardiac Anaesthesia 2017 20(3):323-330

The systemic to pulmonary artery shunts are done as palliative procedures for cyanotic congenital heart diseases ranging from simple tetralogy of Fallots (TOFs)/pulmonary atresia (PA) to complex univentricular hearts. They allow growth of pulmonary arteries and maintain regulated blood flow to the lungs till a proper age and body weight suitable for definitive corrective repair is reached. We have reviewed the BT shunt with its anaesthtic considerations and management of associated complications.

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View Point

Prabhat Tewari

Annals of Cardiac Anaesthesia 2017 20(3):285-286



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Interesting images: Multiple coronary artery aneurysms

Jonathon M Howard, Omar Viswanath, Alfredo Armas, Orlando Santana, Gerald P Rosen

Annals of Cardiac Anaesthesia 2017 20(3):331-332

We present the case of a 65-year-old male who presented with stable angina and dyspnea on exertion. His initial workup yielded a positive treadmill stress test for reversible apical ischemia, and transthoracic echocardiogram demonstrated impaired systolic function. Cardiac catheterization was then performed, revealing severe atherosclerotic disease including multiple coronary artery aneurysms. As a result, the patient was advised to and subsequently underwent a coronary artery bypass graft. This case highlights the presence of multiple coronary artery aneurysms and the ability to appreciate these pathologic findings on multiple imaging modalities, including coronary angiogram, transesophageal echocardiography, and direct visualization through the surgical field.

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Anesthetic challenges of extrinsic trachea-bronchial compression due to posterior mediastinal mass: Our experience with a large esophageal mucocele

Saipriya Tewari, Puneet Goyal, Amit Rastogi, Aarti Agarwal, PK Singh

Annals of Cardiac Anaesthesia 2017 20(3):359-361

Large posterior mediastinal masses may lead threatening complications such as critical tracheobronchial compression. Airway management in these individuals is a challenge and being a lower airway obstruction; rescue strategies are limited. We encountered one such case of a large esophageal mucocele causing extrinsic tracheobronchial compression. We have described the anesthetic management of this case using awake fiber-optic assessment followed by intubation. Close communication with the surgical team, meticulous planning of airway management, and early drainage of the mucocele are the cornerstones of management in such patients.

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Inadequate venous drainage-transesophageal echocardiography as rescue

Monish S Raut, Arun Maheshwari, Sumir Dubey, Ganesh Shivnani, Sandeep Joshi, Arvind Verma, Swetanka Das

Annals of Cardiac Anaesthesia 2017 20(3):333-334

Malposition of venous cannula can cause inadequate venous drainage during cardiopulmonary bypass. It would be good clinical practice to use TEE to check the position of inferior venous cannula to avoid this problem at the earliest.

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A rare case of acyanotic congenital heart disease, large patent ductus arteriosus with pre-ductal coarctation of descending thoracic aorta with patent ductus arteriosus closure and extra anatomical bypass grafting

Zara Wani, Deepak Tiwari, Rajeev Gehlot, Deepak Kumar, Sushil Chhabra, Meenaxi Sharma

Annals of Cardiac Anaesthesia 2017 20(3):365-368

We report a case of 18-year-old female patient with large patent ductus arteriosus (PDA)-preductal coarctation of descending thoracic aorta. She underwent large PDA closure with a prosthetic graft from ascending aorta to descending thoracic aorta by mid-sternotomy on cardiopulmonary bypass machine under total hypothermic circulatory arrest.

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An antenatal diagnosis: Congenital high airway obstruction

S Miital, A Mittal, R Singal, S Singal, G Sekhon

Annals of Cardiac Anaesthesia 2017 20(3):335-336

Congenital high airway obstruction (CHAOS) is a rare lethal fetal malformation characterised by obstruction to the fetal upper airway, which can be partial or complete. Antenatal diagnosis of CHAOS is important due to recent management options. Diagnosis is made with secondary changes such as hyperechoic enlarged lungs resulting in mediastinal compression, ascites, hydrops, flattened or everted diaphragms and dilated distal airways. We reported a case of CHAOS, antenatally on ultrasonography (USG) at 20 weeks of gestation.

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Gingival crevicular fluid and plasma oxidative stress markers and TGM-2 levels in chronic periodontitis

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Sema Becerik, Veli Özgen Öztürk, Peter Celec, Natalia Kamodyova, Gül Atilla, Gülnur Emingil
ObjectiveThis study was aimed to evaluate the gingival crevicular fluid (GCF) and plasma transglutaminase-2 (TGM-2), total antioxidant capacity (TAC), total oxidant status (TOS), ferric reducing antioxidant power (FRAP) and thiobarbituric acid reactive substances (TBARS) in patients with chronic periodontal disease.Materials and methodsTwenty patients with chronic periodontitis (CP), 20 patients with gingivitis and 20 healthy subjects were enrolled in the study. Clinical periodontal parameters including probing depth, clinical attachment level, plaque index and papillary bleeding index were recorded. GCF and plasma levels of TGM-2, TAC, TOS, TBARS and FRAP were analyzed.ResultsGCF TGM-2 was significantly lower in CP group than in gingivitis patients (P=0.006). GCF FRAP in CP and gingivitis groups was significantly lower than in healthy subjects (P<0.001). Plasma FRAP level was lower in gingivitis group when compared to healthy subjects (P=0.003). There was no significant difference in GCF and plasma TAC, TOS, TBARS and plasma TGM-2 levels among the study groups (P>0.05). GCF TGM-2 level was positively correlated with GCF TAC and negatively correlated with CAL.ConclusionsDecreased FRAP in GCF and plasma indicating lower antioxidant status of CP patients might suggest the role of oxidative stress in periodontitis. GCF TGM-2 data might suggest that TGM2 is associated with stabilization of the extracellular matrix and wound healing in periodontium rather than gingival inflammation.



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Influence of needle bevel design on injection pain and needle deformation in dental local infiltration anaesthesia – randomized clinical trial

The aims of this in vivo study were to evaluate the impact of needle bevel design on patients' pain perception and the mechanical deformation of the needle tip after the injection. In a prospective single-blinded trial, 150 patients received conventional infiltration anaesthesia for dental treatment by one examiner. Patients were randomized for one out of three different needle bevel types (scalpel-designed bevel needle (SB), n=50; triple bevel needle (TB), n=50; regular bevel needle (RB), n=50).

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Acquired heterotopic ossification of the temporomandibular joint

Although the risk factors and diagnosis of heterotopic ossification (HO) are discussed in the orthopedics literature, the etiology of HO, as well as its prevention and management, remain theoretical. Furthermore, there is a lack of information in the literature regarding HO in temporomandibular joint replacement (TMJR). This article provides a qualitative review of information relative to the etiology, diagnosis, and management of HO to inform and encourage further investigation in TMJR. The orthopedic HO literature considered for this qualitative review was drawn from a comprehensive examination of the subject published previously by one of the authors.

http://ift.tt/2t5TRK9

Gingival crevicular fluid and plasma oxidative stress markers and TGM-2 levels in chronic periodontitis

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Sema Becerik, Veli Özgen Öztürk, Peter Celec, Natalia Kamodyova, Gül Atilla, Gülnur Emingil
ObjectiveThis study was aimed to evaluate the gingival crevicular fluid (GCF) and plasma transglutaminase-2 (TGM-2), total antioxidant capacity (TAC), total oxidant status (TOS), ferric reducing antioxidant power (FRAP) and thiobarbituric acid reactive substances (TBARS) in patients with chronic periodontal disease.Materials and methodsTwenty patients with chronic periodontitis (CP), 20 patients with gingivitis and 20 healthy subjects were enrolled in the study. Clinical periodontal parameters including probing depth, clinical attachment level, plaque index and papillary bleeding index were recorded. GCF and plasma levels of TGM-2, TAC, TOS, TBARS and FRAP were analyzed.ResultsGCF TGM-2 was significantly lower in CP group than in gingivitis patients (P=0.006). GCF FRAP in CP and gingivitis groups was significantly lower than in healthy subjects (P<0.001). Plasma FRAP level was lower in gingivitis group when compared to healthy subjects (P=0.003). There was no significant difference in GCF and plasma TAC, TOS, TBARS and plasma TGM-2 levels among the study groups (P>0.05). GCF TGM-2 level was positively correlated with GCF TAC and negatively correlated with CAL.ConclusionsDecreased FRAP in GCF and plasma indicating lower antioxidant status of CP patients might suggest the role of oxidative stress in periodontitis. GCF TGM-2 data might suggest that TGM2 is associated with stabilization of the extracellular matrix and wound healing in periodontium rather than gingival inflammation.



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Role of Demodex mite infestation in rosacea: A systematic review and meta-analysis

The reported prevalence and degrees of Demodex mite infestation in rosacea vary widely.

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Is the Intrinsic Genomic Activity of Thyroxine Relevant In Vivo? Effects on Gene Expression in Primary Cerebrocortical and Neuroblastoma Cells

Thyroid , Vol. 0, No. 0.


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Corrigendum to “MicroRNA-17/20a functions to inhibit cell migration and can be used a prognostic marker in oral squamous cell carcinoma” [Oral Oncol. 49(9) (2013) 923–931]

The authors regret the indicated time points in Fig. 3(a) were incorrect. The correct Fig. 3(a) and (b) appear below. The authors would like to apologise for any inconvenience caused.

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Changes occurring in mucosal contractility of the inferior turbinate and mucociliary clearance following total laryngectomy: A prospective clinical trial

In this study, changes occurring in the contractility capacity of the inferior turbinate and mucociliary clearance time due to the interruption of nasal air flow were examined.

http://ift.tt/2uTzcWG

Randomized double blind trial of amitriptyline versus placebo in treatment of chronic laryngopharyngeal neuropathy

A neuropathic etiology has been suggested for patients with chronic laryngopharyngitis symptoms without visible structural pathology. Prior studies have shown that treatment with neuro-modulating medications is beneficial, but it is unknown if this was due to placebo effect. Our objective was to compare the efficacy of amitriptyline versus placebo in treating chronic laryngopharyngeal neuropathy.

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Eosinophilic hyperplastic lymphogranuloma: Clinical diagnosis and treatment experience of 41 cases

The purpose of this study was to investigate the clinical features of eosinophilic hyperplastic lymphogranuloma (EHLG) in the head and neck.

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Suicide Risk Among Transgender People: A Prevalent Problem in Critical Need of Empirical and Theoretical Research

Violence and Gender , Vol. 0, No. 0.


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Characterization of HER2 gene amplification heterogeneity in invasive and in situ breast cancer using bright-field in situ hybridization

Abstract

The aims of this study were to evaluate and compare the HER2 gene amplification status in invasive and adjacent in situ breast carcinoma, using bright-field in situ hybridization, and to document the possible presence of HER2 genetic heterogeneity (HER2-GH) in both components. A cohort of 100 primary invasive carcinomas (IC) associated with carcinoma in situ (CIS) were evaluated for HER2 gene amplification by SISH according to the 2013 ASCO/CAP HER2 guideline. A second cohort of all the cases with HER2-GH since the introduction of the updated ASCO/CAP HER2 guideline was also characterized, and an evaluation of the HER2 gene amplification in the CIS component, if present, was also done. In the first cohort, the HER2 amplification in the IC was negative in 87% of the cases and positive in 13% of the cases, without the presence of HER2-GH. All the cases had an associated CIS with the same HER2 status as IC, with four cases of CIS presenting HER2-GH. In the CIS, we observed a significant relationship of HER2 gene amplification with high nuclear grade. In the four cases with HER2-GH in CIS, two cases presented HER2 gene amplification in the IC. The second cohort included 12 cases with HER2-GH in a total of 1243 IC cases (0.97%). Additionally, we identified two cases associated with non-amplified CIS. HER2-GH is a rare event in IC and can already be present in CIS, not being an important step in the acquisition of invasive features.

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Clinicopathological characteristics of fallopian tube metastases from primary endometrial, cervical, and nongynecological malignancies: a single institutional experience

Abstract

This study was aimed at investigating the clinicopathological characteristics of tubal metastases originating from primary endometrial, cervical, and nongynecological malignancies. We performed a 4-year retrospective study in which fallopian tube tissues obtained from 60 patients with tubal metastases were examined. In addition, we compared the number of tubal metastasis cases detected during periods of representative or whole tubal sampling. Twenty-three and 37 tubal metastases were found in cases examined after representative and whole tubal sampling techniques, respectively. Four cases of microscopic tubal metastases were detected via whole sampling, whereas no microscopic lesions were identified via representative sampling. The metastatic lesions originated from 14 uterine (10, endometrium; 4, cervix) and 46 nongynecological tumors (21, colon; 15, stomach; 5, biliary; 3, appendix; 2, breast). Tumors were most commonly involved in the muscle and lamina propria (n = 17). We noted distinctive histopathological features according to the extent of mural involvement: fibromyxoid stromal reaction and lymphohistiocytic infiltration in tumors involving the muscle and subepithelial connective tissue, architectural alterations of plicae in those involving the subepithelial connective tissue, and intraluminal mucinous and inflammatory exudate adjacent to intraepithelial tumors. We observed distinctive histopathological features associated with tubal metastases according to the extent of mural involvement. In addition, we demonstrated that the sampling method used in the routine microscopic examination of the fallopian tube affects the detection of tubal metastases. Our data support the notion that it is more logical to thoroughly sample both the fimbrial ends and the nonfimbriated portions of fallopian tubes for all salpingectomy specimens in the setting of cancer surgery.

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Author Guidelines

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Changes occurring in mucosal contractility of the inferior turbinate and mucociliary clearance following total laryngectomy: A prospective clinical trial

Publication date: Available online 12 July 2017
Source:Auris Nasus Larynx
Author(s): Ilker Kocak, Remzi Dogan, Sabri Baki Eren, Selahattin Tugrul, Orhan Ozturan, Aysenur Meric Hafiz
ObjectiveIn this study, changes occurring in the contractility capacity of the inferior turbinate and mucociliary clearance time due to the interruption of nasal air flow were examined.Material & methodsA total of 23 patients undergone total laryngectomy between June 2010 and June 2012 were included in the study. Acoustic rhinometry test was performed in the patients before and after 0.05% oxymetazoline nasal topical decongestant administration. In addition, saccharin test was applied in order to measure mucociliary clearance. The same measurements were repeated at the postoperative months 1, 6 and 12 and the data obtained were statistically compared.ResultsIn evaluation of the patients' contractility capacity at MCA-1 and MCA-2, contractility capacity was found to be significantly decreased from the postoperative first month compared to the preoperative values. The contractility capacity at the postoperative 6th month was significantly lower than that of the postoperative first month. The contractility capacity at the postoperative 12th month was significantly lower than that of the postoperative 6th month.Mucociliary clearance time did not change significantly at the postoperative first month compared to the preoperative value, while this value was significantly decreased at the postoperative 6th month. No statistically significant difference was observed in mucociliary clearance between the postoperative 6th and 12th months.ConclusionContractility capacity of the inferior turbinate decrease over time in patients undergoing total laryngectomy. This indicates that the dysfunction developing in the nasal mucosal structure in the chronical absence of nasal air flow may be resulted from the decreased choncal contractility.



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Torsion of Atypical Meckel’s Diverticulum Treated by Laparoscopic-Assisted Surgery

Introduction. Meckel's diverticulum (MD) is the most common congenital anomaly of the intestine, with an incidence of 2~4%. Of those, only 2% of patients with MD are symptomatic. Torsion of MD is extremely rare, and only a dozen cases have been previously reported. Case Report. The patient was a 49-year-old male who presented to our emergency room with a chief complaint of lower abdominal pain. Computed tomography imaging revealed an irregular polycystic mass connected to the small intestine that measured 7.5 cm in a diameter. A laparoscopic-assisted partial resection of the jejunum was performed. The lesion was found to have caused torsion and was located 130 cm from the ileocecal valve. The specimen was polycystic in appearance and showed communicating links with the submucosal layer of jejunum but not with the lumen. The pathological diagnosis was a torsion of an atypical presentation of MD. Conclusion. This case was different from typical cases of MD in that it was located on significantly oral side and had the appearance of polycystic morphology.

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Eosinophilic hyperplastic lymphogranuloma: Clinical diagnosis and treatment experience of 41 cases

Publication date: Available online 12 July 2017
Source:American Journal of Otolaryngology
Author(s): Yang Jiang, Qingquan Hua, Jie Ren, Feng Zeng, Jianfei Sheng, Hua Liao, Zhijian Zhang, Hongxia Guan
PurposeThe purpose of this study was to investigate the clinical features of eosinophilic hyperplastic lymphogranuloma (EHLG) in the head and neck.Materials and methodsCollecting the patients who diagnose with EHLG by pathological examination. The EHLG patients with the masses involved regions, such as involved inguinal region, chest wall, abdominal wall, anterior superior iliac spine or clavicle, instead of head and neck were excluding. All of the participants will sign the informed consent form. The history data includes: clinical history, blood routine test, pathological examination, and recurrence will be collected.ResultsA total of 41 patients of EHLG were included. These patients predominantly presented as an enlarging and painless single or multiple masses with a history of repeated swelling. There were the complaint of itchy skin and pigmentation. The routine blood test showed that the percentage value of eosinophil increased in almost patients including 26 cases had raised absolute eosinophil count. The serum level of lgE was increased in 29 cases remarkably. With the methods of treatments, 36 patients received surgical excision, 3 patients accepted hormonotherapy, and another 2 patients for radiotherapy. The recurrence of EHLG was in 9 patients.ConclusionsEHLG is a rare disease. The clinical manifestation (itchy skin and pigmentation) and increased eosinophil play critical values to the diagnosis of EHLG. Confirmed diagnosis always depends on pathological examination. Surgery is a preferred treatment, while low dose of radiotherapy is necessary for preventing relapse after operation and hormonotherapy.



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Randomized double blind trial of amitriptyline versus placebo in treatment of chronic laryngopharyngeal neuropathy

Publication date: Available online 12 July 2017
Source:American Journal of Otolaryngology
Author(s): Minyoung Jang, Samuel J. Rubin, Daniel J. Stein, Jacob Pieter Noordzij
ObjectiveA neuropathic etiology has been suggested for patients with chronic laryngopharyngitis symptoms without visible structural pathology. Prior studies have shown that treatment with neuro-modulating medications is beneficial, but it is unknown if this was due to placebo effect. Our objective was to compare the efficacy of amitriptyline versus placebo in treating chronic laryngopharyngeal neuropathy.Study designProspective, randomized placebo-controlled trial.MethodsPatients were randomized to receive placebo or amitriptyline for 8weeks. Primary outcome was change in modified Reflux Symptom Index (mRSI) score. Secondary outcomes were change in Voice Handicap Index-10 (VHI) scores, rates of adverse effects, and overall symptom severity.ResultsEighteen patients completed the study. The average difference in mRSI and VHI scores after treatment were not significantly different between study arms. However, more subjects taking amitriptyline felt their symptoms had subjectively improved (6 out of 9, 67%), while the remainder noted no change. In the placebo group, only 4 out of 9 subjects (44%) felt their symptoms were better and 2 felt worse. Subjects took an average of 25mg of amitriptyline or placebo daily by the end of the 8-week treatment period. No serious adverse effects were noted.ConclusionAlthough there was a trend toward greater subjective improvement in overall symptoms with amitriptyline, interpretation is limited due to the small sample size. Larger randomized controlled trials to determine the efficacy of neuro-modulating agents in the treatment of chronic laryngopharyngeal neuropathy, as well as better metrics to characterize this disorder, are warranted.



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A Promising New Treatment for Vitiligo?

Dr Graeme Lipper reviews a proof-of-concept study of a JAK inhibitor that holds potential for the treatment of vitiligo.
Medscape Dermatology

http://ift.tt/2sRKIjY

Advances in Asthma 2016: Designing Individualized Approaches to Management

Publication date: Available online 12 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): William C. Anderson, Andrea Apter, Cullen M. Dutmer, Daniel A. Searing, Stanley J. Szefler
In this years Advances in Asthma review we discuss viral infections in asthma and potential therapeutic agents, the microbiome, novel genetic associations with asthma, air quality and climate effects on asthma, exposures during development and long term sequelae of childhood asthma, patient centered outcome research, and precision medicine. In addition, we discuss application of biomarkers to precision medicine, and new information on asthma medications. New evidence indicates that rhinovirus-triggered asthma exacerbations become more severe as the degree of sensitization to dust mite and mouse increase. The two biggest drivers of asthma severity were an allergy pathway starting with allergic sensitization and an environmental tobacco smoke pathway. In addition, allergic sensitization and blood eosinophils can be used to select medications for management of early asthma in young children. These current findings, among others covered in this review, represent significant steps towards addressing rapidly advancing areas of knowledge that have implications for asthma management.



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Dose of Allergens in a Peanut Snack (Bamba®) Associated with Prevention of Peanut Allergy

Publication date: Available online 12 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): James P. Hindley, Stephanie Filep, Denise Block, Eva M. King, Martin D. Chapman

Teaser

This letter reports the dose of specific allergens (Ara h 1, Ara h 2 and Ara h 6) in the peanut snack (Bamba^®) that was successfully used to prevent peanut allergy in the Learning Early About Peanut (LEAP) study. The results provide weekly doses of specific allergen that are associated with prevention of peanut allergy.


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Specific allergen profiles of peanut foods and of diagnostic or therapeutic allergenic products

Publication date: Available online 12 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Stephanie Filep, Denise Block, Bryan R.E. Smith, Eva M. King, Scott Commins, Michael Kulis, Brian P. Vickery, Martin D. Chapman
Rationale'Generic' immunoassays for peanut cannot discriminate between allergen levels in peanut derived food products or therapeutics. Clinical trials of oral immunotherapy are strengthened by using standardized peanut preparations, with defined doses of major allergens.ObjectiveThis paper describes measurement of Ara h 1, Ara h 2 and Ara h 6 in peanut foods and in peanut flour extracts used for allergy diagnosis and oral immunotherapy.MethodsMonoclonal antibody-based enzyme immunoassays for Ara h 1, Ara h 2 and Ara h 6 were used to compare allergen levels in peanut (n=19) and tree nut (n=16) butter, peanut flour (n=11); oils (n=8); extracts used for diagnosis and oral immunotherapy (n=5); and the National Institute for Standards and Technology Peanut Butter Standard Reference Material® 2387.ResultsRoasted peanut butters contained 991-21,406μg/g Ara h 1 and exceeded Ara h 2 and Ara h 6 levels by 2-4 fold. Similarly, NIST SRM 2387 contained 11,275μg/g Ara h 1; 2,522μg/g Ara h 2 and 2,036μg/g Ara h 6. In contrast, peanut flours contained 787-14,631μg/g Ara h 2 and exceeded Ara h 1 levels by 2-20 fold. Flour extracts used for oral immunotherapy contained 394-505μg/ml Ara h 1, 1,187-5,270μg/ml Ara h 2 and 1,104-8,092μg/ml Ara h 6. In most cases, specific peanut allergens were not detected in tree nut butters or peanut oils.ConclusionsThe results show marked differences in specific peanut allergen profiles in peanut butter, flour and peanut preparations for clinical use. Roasting may increase Ara h 1 levels in peanut butter. Variability in allergen levels could affect the outcome of clinical trials of peanut oral immunotherapy, especially with respect to Ara h 1. Specific allergen measurements will improve standardization and provide accurate dosing of peanut preparations that are being used for oral immunotherapy.

Teaser

The specific (major) allergen content of peanuts foods and of peanut preparations used for allergy diagnosis and oral immunotherapy is highly variable. Allergen measurements provide essential tools for dosing of clinical products used in trials of oral immunotherapy.


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H2Mab-77 is a Sensitive and Specific Anti-HER2 Monoclonal Antibody Against Breast Cancer

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.


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Bilaterale Cochleaimplantatversorgung

Zusammenfassung

Die Cochleaimplantat(CI)-Versorgung gilt als Standard bei der Hörrehabilitation einer hochgradigen Schwerhörigkeit oder Taubheit. Bei beidseitiger Indikation wird heute i. d. R. (leitliniengemäß) eine beidseitige Versorgung empfohlen. Die bilaterale CI-Versorgung ermöglicht besseres Sprachverstehen in Ruhe und im Störlärm sowie Richtungshören und räumliches Hören. Kindern wird mit der bilateralen CI-Versorgung eine auf Hören gestützte Hör-Sprach-Entwicklung ermöglicht. Bilateral versorgte Kinder entwickeln sich schneller im Rahmen ihrer individuellen Möglichkeiten als unilateral versorgte und erreichen z. B. einen größeren Wortschatz. Erst die bilaterale CI-Versorgung ermöglicht „binaurales Hören" mit allen Vorteilen, von denen auch Normalhörende profitieren, nämlich: besseres Sprachverstehen in Ruhe und im Rauschen sowie Richtungs- und räumliches Hören. Naturgemäß benötigt die Entwicklung Zeit. Binaural versorgte CI-Träger profitieren von den gleichen Effekten wie Normalhörende: Kopfschatteneffekt, Squelch-Effekt sowie von Summations- und Redundanzeffekten. Eine sequenzielle Implantation ist nicht zwingend nachteilig; sowohl simultan als auch sequenziell versorgte Patienten profitieren gleichermaßen. Für Kinder scheinen eine möglichst frühe Implantation und ein möglichst kurzes Intervall zwischen beiden Operationen bei beidseits gegebener Indikation vorteilhaft zu sein.

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Update HNO

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Small bowel obstruction due to mesenteric abscess caused by Mycobacterium avium complex in an HIV patient: a case report and literature review

Abstract

Small bowel obstruction in HIV patients is reportedly caused by inflammatory pseudotumor, Kaposi's sarcoma, cryptococcal lymphadenopathy and intestinal tuberculosis. The incidence of Mycobacterium avium complex (MAC) infection in HIV patients is 3% for CD4 cell count of 100–199 /mm³. MAC causing small bowel obstruction is rarely reported in the literature. We report a rare case of MAC causing mesenteric abscess with small bowel obstruction in a HIV patient with a CD4 cell count of 144 /mm³. Patient was a 35-year-old HIV-positive male on highly active antiretroviral therapy who presented with partial small bowel obstruction secondary to mesenteric abscess. He underwent operative intervention for drainage with cultures growing MAC.

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Strangulated gallbladder caused by a tip of the omentum attached to the abdominal wall: a case report

Abstract

Strangulation of the gallbladder associated with the omentum is extremely rare and, to our knowledge, only two cases have been previously reported. The patient was a 91-year-old female who presented to our emergency room with a chief complaint of upper abdominal pain. Computed tomography imaging revealed a gourd-shaped gallbladder with biphasic appearance divided clearly at the body. In the fundus side, the wall of the gallbladder was oedematous and thickened, while the neck side was intact. On the second day after onset, a laparoscopic cholecystectomy was performed. A tip of the omentum encircling the gallbladder was adhered to the abdominal wall and was strangling the gallbladder. By cutting the omentum at the attachment site, the strangulation was released. Laparoscopic cholecystectomy was performed, and the patient was discharged with an uneventful course. We experienced an extremely rare case of strangulated gallbladder caused by a tip of the omentum attached to the abdominal wall.

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A case of fatal internal jugular vein perforation during nasogastric tube insertion

Abstract

Nasogastric tube (NGT) insertion is a routine procedure in the management of surgical patients. We report the second case of internal jugular vein perforation during NGT insertion. A 79-year-old man presented with diffuse abdominal pain secondary to a perforated viscus. Abdominal CT revealed pneumoperitoneum, necessitating emergent exploratory laparotomy. On post-operative Day 7, the patient developed mild abdominal distension and subjective nausea for which NGT placement was ordered for decompression. Tube placement was confirmed by insufflation of air without aspiration of gastric contents. Output from the NGT upon placement revealed frank blood. The patient then developed respiratory distress requiring intubation, followed by a fatal arrhythmia. Post-mortem exam revealed the trajectory of the NGT through the pharyngeal wall into the right internal jugular vein. This case illustrates the importance of systematic evaluation of all procedures, as the outcome resulted from failure to recognize the initial error in tube placement.

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Snails and Skin Care—An Uncovered Combination

The quest to find the ultimate cure for aging has long captivated the global skin care industry. Novel and imaginative solutions ranging from vampire blood facials to placenta-based skin creams surface annually, each promising results of retained youth. One such recent craze involves the use of snail mucus secretions to reduce pigmentation, scarring, and wrinkles. At first glance, one might question the efficacy of such a product due to little clinical justification; however, the use of snail secretions in medicine can be traced back centuries ago.

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Onycholysis and Eyelash Trichomegaly After Pan-FGFR Inhibitor Use

This case report describes severe onycholysis and eyelash trichomegaly following the use of new selective pan-FGFR inhibitors.

http://ift.tt/2qbYUqY

Spirituality in Dermatology Practice

This Viewport discusses the challenges of helping patients find spiritual solace in the clinical setting amid periods of suffering and addressing their fears, hopes, and suffering

http://ift.tt/2p6jPpL

Enhancing the Relevance of Skin Self-examination for Latinos

This study solicits information from Hispanic focus groups to enhance the relevance of skin self-examination in the Latino community.

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How Microneedles Can Change Cutaneous Drug Delivery

The year was 1971, and Intel had unveiled its first microchip. That same year, the US patent office registered an application from Martin S. Gerstel and Virgil A. Place for the drug delivery device that we know today as a microneedle array. Amazingly, although the sketch submitted by the inventors described a device very much like what we recognize today as a microneedle array, the technology to produce such small needles did not exist at that time. The vision became a reality when microfabrication technology made manufacturing of microscopic needles possible.

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Increasing Diversity in Dermatology Residencies

To the Editor We read the article by Chen and Shinkai with great interest. Diversity in dermatology is a key topic, and this work helps bring it into the spotlight that it truly deserves. However, 2 underrepresented ethnic groups in dermatology were neglected in the article. Native American/Alaska Natives represent 0.9% of the US population, but only 0.2% of dermatologists. Furthermore, Native Hawaiian/Pacific Islanders are also considered underrepresented in dermatology (representing 0.2% of the US population). It may be of value in the future to fully include all underrepresented racial groups in dermatology because these initiatives evolve to enhance the successes of these types of efforts. Not doing so may cause smaller underrepresented groups to feel as if their unique experiences are not being accounted for.

http://ift.tt/2p6mb86

Expedited Microneedle-Assisted Photodynamic Therapy for Actinic Keratoses

This randomized clinical trial evaluates efficacy of and pain associated with microneedle-assisted photodynamic therapy for actinic keratoses.

http://ift.tt/2qsLnu1

Treatment outcome in orthognathic surgery─a prospective randomized blinded case-controlled comparison of planning accuracy in computer-assisted two- and three-dimensional planning techniques (part II)

Publication date: Available online 12 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Martin Bengtsson, Gert Wall, Lennart Greiff, Lars Rasmusson




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The Evolving Nomenclature of Erythema Ab Igne

Erythema ab igne (EIA) presents as a reticulated hyperpigmented erythematous eruption at sites of prolonged heat exposure. While primarily asymptomatic and self-resolving after removal of the heat source, some chronic cases may require topical therapies such as retinoids for improvement of skin discoloration or 5-fluorouracil if dysplastic changes are present. Though rare, few cases may also progress to cutaneous malignant neoplasms, such as squamous cell and Merckel cell carcinoma.

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Internal Store-and-Forward System in an Existing Electronic Health Record

This pilot study describes a store-and-forward teledermatology workflow within an existing electronic health record system, assesses its effectiveness in improving access to care, validates its reliability, and evaluates its ability to capture meaningful outcomes.

http://ift.tt/2oOTeiJ

Sweet’s-like Infiltrate After Talimogene Laherparepvec Melanoma Treatment

This case report describes complete response of advanced melanoma treated with talimogene laherparepvec and subsequent Sweet's-like infiltrate

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Characteristics of the Infiltrating Cells in Histiocytoid Sweet Syndrome

This case series study characterizes the immunohistochemical phenotype of the infiltrate in histiocytoid Sweet syndrome and evaluates whether this variant of Sweet syndrome is more frequently associated with hematologic malignancies than classic Sweet syndrome.

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Suggestions for Increasing Diversity in Clinical Trials

To the Editor The article by Charrow et al discusses the gap in proportional racial representation in clinical trials. We applaud the authors for bringing this topic to the forefront. One shortcoming of the article, however, is that it does not discuss measures for correcting this gap. Therefore, the purpose of this letter is to provide suggestions derived from clinical trial literature to improve minority participation.

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Connective Tissue Nevi in Tuberous Sclerosis Complex

This analysis of patient medical records and skin photography describes the clinical characteristics of connective tissue nevi on the trunk and extremities of patients with tuberous sclerosis complex.

http://ift.tt/2pj1o3b

Incorrect Graph in Figure

In the Original Investigation titled "Correlation of Serum Levels of IgE Autoantibodies Against BP180 With Bullous Pemphigoid Disease Activity," published in the January 2017 issue of JAMA Dermatology,¹ an incorrect graph appeared as Figure 4D and has been replaced with the correct version. This article was corrected online.

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Phototherapy for Vitiligo

This systematic review and meta-analysis evaluates the treatment responses of vitiligo to phototherapy based on all relevant prospective studies.

http://ift.tt/2o8beGL

Henry Radcliffe Crocker—From the Elephant Man to the Textbook

Henry Radcliffe Crocker (1845-1909) was a British dermatologist and a pioneering educator in his field. At the age of 16 years, he left school to apprentice with a general practitioner. From 1870 to 1875, he attended medical school at University College Hospital, London, while also working as a dispenser to supplement his income. In 1876, he became assistant medical officer to the Skin Department at University College Hospital and studied dermatology under his mentor William Tilbury Fox, who he succeeded as department chair in 1879.

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Noninvasive 2-Gene Molecular Assay for Cutaneous Melanoma

This multiple-reader–multiple-case study examines the utility of a noninvasive pigmented lesion assay for LINC/PRAME expression in decisions by dermatologists to biopsy a series of suspicious skin lesions.

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July 2017 Issue Highlights

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Efficacy and Tolerance of Anti-TNF α Agents in Cutaneous Sarcoidosis

This large multicenter observational study explores the efficacy and safety of anti–tumor necrosis factor α agents in treating cutaneous sarcoidosis.

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Frequency of Syphilis Diagnoses by Dermatologists

This study examines frequency of syphilis diagnoses by dermatologists in Rhode Island compared with other clinicians in that state.

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Molecular Differences Between Pediatric and Adult Psoriasis Plaques

The pathology of pediatric psoriasis differs from that of adult psoriasis, a finding that has implications for treatment, researchers suggest.
Reuters Health Information

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FDA Lifts Hold on Concert Pharma's Study Testing Hair Loss Drug

Concert Pharmaceuticals Inc said on Monday the U.S. Food and Drug Administration (FDA) lifted a clinical hold on a trial testing its therapy for alopecia areata, a type of hair loss.
Reuters Health Information

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Allosterische Kinaseinhibitoren

Zusammenfassung

Hintergrund

Die Hemmung der Kinaseaktivität des BCR-ABL1-Onkoproteins durch einen allosterischen Wirkmechanismus eröffnet eine alternative Therapieoption für Patienten mit CML (chronische myeloische Leukämie), die mit konventionellen katalytischen TKI (Tyrosinkinaseinhibitoren) unzureichend behandelbar sind.

Fragestellung

Hinterfragt werden der pathophysiologische Stellenwert des BCR-ABL1-Onkogens, das Wirkprinzip der katalytischen TKI, die klinische Notwendigkeit neuer Therapien für BCR-ABL1-positive Leukämien, der Mechanismus der allosterischen Inhibition, die Entwicklung des ersten klinisch einsetzbaren allosterischen ABL-Inhibitors ABL001 (Asciminib), die präklinischen Ergebnisse und die klinische Entwicklung.

Methoden

Die bisher publizierten mechanistischen und präklinischen Untersuchungen sowie klinischen Ergebnisse der ersten Phase-1-Dosiseskalationsstudie werden zusammengefasst.

Ergebnisse

ABL001 ist ein potenter, selektiver Inhibitor von BCR-ABL1, dessen Resistenzprofil sich von demjenigen der ATP-kompetitiven TKI unterscheidet. Im Mausmodell zeigen Kombinationsstudien eine sehr gute antileukämische Wirkung mit kompletter und dauerhafter Regression der Leukämie und Bestätigung der mit TKI nicht überlappenden Resistenzmechanismen. Ergebnisse der ersten Phase-I-Studie beim Menschen zeigt ABL001 bei Patienten mit CML eine rasch einsetzende antileukämische Wirkung bei bislang guter Verträglichkeit.

Schlussfolgerungen

Das Prinzip der allosterischen Inhibition von BCR-ABL1 mit ABL001 als erstem Vertreter dieser Substanzklasse ist eine vielversprechende Behandlungsoption für Patienten mit unzureichendem Ansprechen oder Unverträglichkeit gegenüber konventionellen TKI und hat das Potenzial, die Therapie der CML weiter zu verbessern.

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The Linear Nail Streak

This case report describes 2 persons with external thumbnail characteristics indicative of linear nail streak.

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Patients With Sunburn Seen in Emergency Department and Urgent Care

This cohort study examines the demographics and characteristics of patients seen at the emergency department or urgent care clinic for sunburn treatment at 2 major hospitals over a 15-year period.

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Ibrutinib and Bleeding Complications in Cutaneous Surgery

This case report describes bleeding complications in 2 patients being treated with ibrutinib who underwent cutaneous surgery.

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Association of Multiple Primary Skin Cancers With HIV Biomarkers

This cohort study of patients with at least 1 prior nonmelanoma skin cancer (NMSC) evaluates the association of subsequent NMSCs with HIV infection, CD4 count, and viral load.

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Hair Repigmentation During Immunotherapy

This case series study examines hair repigmentation in patients receiving anti–programmed cell death 1 and anti–programmed cell death ligand 1 therapy for treatment of lung cancer.

http://ift.tt/2tIQxDo

Secondary Syphilis Presenting as Glossodynia, Plaques en Prairie Fauchée, and a Split Papule at the Oral Commissure: Case Report and Review

Syphilis has been coined "the great imitator" due to its extreme heterogeneity of presentation and mimicry of other conditions. Therefore, it is essential that physicians be familiar with the full spectrum of its manifestations. Syphilis may also lead to oral lesions that, occasionally, are unaccompanied by concomitant tegumentary findings. Such patients will pose unique diagnostic challenges. We report the case of a 45-year-old HIV-infected male patient in whom secondary syphilis presented with burning mouth and dysgeusia that progressed to glossodynia and odynophagia. Examination revealed painful, shallow erosions on the posterior aspect of the tongue, in a pattern of plaques en prairie fauchée. A painful split papule (fausse perlèche or false angular cheilitis) was also present in the left commissure. There were no cutaneous lesions. The oral lesions were considered highly suggestive of secondary syphilis. A novel VDRL assay (which was previously negative) yielded a titer of 1/128. Complete clinical remission was rapidly achieved after initiation of penicillin therapy. A comprehensive review of the literature on oral manifestations of syphilis is offered.

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A cell line thought to represent mucinous breast cancer probably represents lobular carcinoma with extracellular mucin production

http://ift.tt/2tNhi86

Factors associated with epinephrine administration for anaphylaxis in children before arrival to the emergency department

Publication date: Available online 12 July 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Melissa Robinson, Matthew Greenhawt, David R. Stukus
BackgroundEpinephrine is the first-line treatment for anaphylaxis but may be underused by patients and medical personnel.ObjectiveTo evaluate factors associated with anaphylaxis management before arrival at the emergency department (ED) or urgent care center (UCC).MethodsWe performed a retrospective review of electronic medical records for all patients aged 0 to 25 years presenting with anaphylaxis to the ED or UCC at a pediatric academic referral center during 2009 to 2013.ResultsA total of 408 patients (mean age, 7.25 years; 62% male) were included for analysis. Only 148 patients (36.3%) received epinephrine before arrival at the ED or UCC. Reactions occurring at home (n = 36/114) were less likely to be treated with epinephrine compared with reactions occurring at school (n = 30/49) (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.15–0.59). The odds of receiving epinephrine before arrival at the ED or UCC were significantly lower with a 2-organ system (OR, 0.50; 95% CI, 0.30–0.85) or 3-organ system (OR, 0.41; 95% CI, 0.21–0.81) presentation compared with 1-organ system involvement. Foods (342 [83.8%]) were the most commonly reported provoking trigger. Patients who did not receive epinephrine before arrival at the ED or UCC were significantly less likely to be discharged to home (OR, 0.56; 95% CI, 0.37–0.86; P = .01).ConclusionThis study identifies factors associated with prehospital management of anaphylaxis for children, which highlight that epinephrine administration may be occurring with considerable delay. Increased awareness and education of caregivers, patients, and medical professionals are necessary to provide optimal management.



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Ruxolitinib found to cause eyelash growth: a case report

Hypereosinophilic syndrome is a hematologic disorder in which the eosinophils proliferate.

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Editorial Board

Publication date: April–June 2017
Source:Alergologia Polska - Polish Journal of Allergology, Volume 4, Issue 2





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Contents

Publication date: April–June 2017
Source:Alergologia Polska - Polish Journal of Allergology, Volume 4, Issue 2





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Comparison of ketamine and ketofol for deep sedation and analgesia in children undergoing laser procedure

Abstract

The aim of our study was to research and evaluate cardiovascular and respiratory stability, clinical efficacy, and safety of two different anesthetic agents in pediatric patients who underwent Pulse dye (wavelength 595 nm, pulse duration 0–40 ms, power 0–40 J) and CO₂ (wavelength 10,600 nm, intensity-fraxel mod with SX index 4 to 8, power 0–30 W) laser procedure. This prospective non-blinded study included 203 pediatric patients ASA I-II, aged between 1 month and 12 years who underwent short-term procedural sedation and analgesia for the laser procedure. After oral premedication with midazolam, 103 children were analgo-sedated with ketamine and fentanyl (K group) and 100 with ketofol and fentanyl (KT group). Vital signs, applied drug doses, pulse oximetry, and parental satisfaction questionnaire were used to compare these two groups. Statistical differences were tested using Student's t test, Mann-Whitney U test, chi-square test, and Fisher's exact test. Receiver operating characteristic (ROC) curve analysis was used to assess the cut-off value of the duration of anesthesia predicting apnea. Tachycardia was recorded in a significantly higher number of patients who received ketamine as the anesthetic agent (35.9 vs. 3% respectively). Hypertension was also significantly more frequent in patients who received ketamine in comparison with patients who received ketofol (25.2 vs. 3%). Laryngospasm was not observed in both examined groups. There was no statistically significant difference between groups in satisfaction of parents and doctors. Apnea and respiratory depression occurred significantly more frequent in ketofol than in ketamine group (12 vs. 0.97% and 13 vs. 0%). Based on ROC analysis for apnea, we found a significantly higher number of patients with apnea in the ketofol group when duration of anesthesia was longer than 17 min. Our study has shown that ketofol is more comfortable than ketamine in short-term laser procedures in children, causing less hemodynamic alteration with mild respiratory depression and less post-procedural adverse events.

http://ift.tt/2t3DiOQ

Adaptive Treatment De-escalation in Favorable Risk HPV-Positive Oropharyngeal Carcinoma

Conditions:   Oropharyngeal Carcinoma;   HPV Positive Oropharyngeal Squamous Cell Carcinoma
Interventions:   Radiation: Standard Radiation Treatment;   Radiation: Dose-Deescalated Treatment;   Drug: Cisplatinum
Sponsor:   New York University School of Medicine
Recruiting - verified July 2017

http://ift.tt/2uia4Mo

RAI Plus Immunotherapy for Recurrent/Metastatic Thyroid Cancers

Condition:   Thyroid Cancer
Interventions:   Drug: Durvalumab (Medi4736);   Radiation: Radioiodine (RAI)
Sponsors:   Memorial Sloan Kettering Cancer Center;   AstraZeneca;   MedImmune LLC
Recruiting - verified July 2017

http://ift.tt/2uR0e18

CDx Biopsies for Detection of Laryngopharyngeal Reflux and Laryngeal Lesions

Conditions:   Laryngeal Disease;   Laryngeal Tumor;   Laryngopharyngeal Reflux
Intervention:   Device: Endo CDx Brush biopsy
Sponsors:   CDx Diagnostics;   Rambam Health Care Campus
Not yet recruiting - verified July 2017

http://ift.tt/2uhXaho

Seeing-Moving-Playing: Early Rehabilitation Utilizing Visual and Vestibular Technology Following Traumatic Brain Injury

Condition:   Mild Traumatic Brain Injury; Concussion
Interventions:   Other: Vestibular-Visual Intervention;   Behavioral: standard care
Sponsor:   McGill University Health Center
Not yet recruiting - verified July 2017

http://ift.tt/2uRaExQ

Northern Alberta Psychosocial Telecare (NAPT) Screening for HNC Patients

Condition:   Cancer Distress
Intervention:   Other: NAPT
Sponsor:   University of Alberta
Not yet recruiting - verified July 2017

http://ift.tt/2uihTS6

Phase 1/2 Study of LOXO-195 in Patients With Previously Treated NTRK Fusions or Non-fusion NTRK Cancers

Conditions:   Carcinoma, Non-Small-Cell Lung;   Thyroid Neoplasms;   Sarcoma;   Colorectal Neoplasms;   Salivary Gland Neoplasms;   Biliary Tract Neoplasms;   Brain Neoplasm, Primary;   Breast Ductal Carcinoma NOS;   Melanoma;   Solid Tumors Cancer of Unknown Primary;   Glioblastoma;   Bile Duct Neoplasms;   Astrocytoma;   Head and Neck Squamous Cell Carcinoma;   Pontine Glioma;   Pancreatic Neoplasms;   Ovarian Neoplasms;   Carcinoma, Renal Cell;   Cholangiocarcinoma;   Skin Carcinoma;   Carcinoma, Bronchogenic;   Bronchial Neoplasms;   Lung Neoplasms;   Respiratory Tract Neoplasms;   Thoracic Neoplasms;   Neoplasms, Nerve Tissue;   Nevi and Melanomas;   Intestinal Neoplasms;   Thyroid Cancer;   GIST;   Malignant Peripheral Nerve Sheath Tumors;   Breast Secretory Carcinoma;   Uterine Neoplasms
Intervention:   Drug: LOXO-195
Sponsor:   Loxo Oncology, Inc.
Recruiting - verified July 2017

http://ift.tt/2tHSfol

Estrogen and progesterone receptor–positive bilateral nipple leiomyoma in a man

http://ift.tt/2tMKzQt

Impact of dose volume parameters and clinical factors on acute radiation oral mucositis for locally advanced nasopharyngeal carcinoma patients treated with concurrent intensity-modulated radiation therapy and chemoradiotherapy

Publication date: September 2017
Source:Oral Oncology, Volume 72
Author(s): Kaixin Li, Ling Yang, Peiling Xin, Yuanyuan Chen, Qiang-ying Hu, Xiao-zhong Chen, Ming Chen
PurposeTo prospectively identify the predictive value of different dosimetric parameters and also assess the predictors of acute radiation oral mucositis (ROM).MethodsIn accordance with the RTOG scoring criteria, ninety-two patients with locally advanced nasopharyngeal carcinoma (NPC) treated with concurrent chemoradiotherapy were evaluated for acute ROM which was defined as severe when the score ≥3. Patients' medical records and dosimetric data exported from IMRT plan enable the authors to perform a statistical analysis for the parameters as potential predictors of severe ROM.ResultsBody weight loss and V30Gy (p=0.017 and 0.003, respectively) are related factors to severe ROM. As the receiver operating characteristics (ROC) curve shows, the threshold value of V30 for severe ROM was 73.155% (sensitivity, 0.842; specificity, 0.671), and the area under V30Gy curves was 0.753 (p=0.001).ConclusionNew parameters were found as predictors of severe ROM using dosimetric analysis.



http://ift.tt/2u8l1zF

Complex regional pain syndrome: diagnosis and treatment

1D012E023E00

http://ift.tt/2tHSBeW

Differential expression of albumins and globulins of wheat flours of different technological qualities revealed by nanoUPLC-UDMSE

Publication date: Available online 12 July 2017
Source:Food Chemistry
Author(s): Verônica Cristina Mayrinck Victorio, Gustavo H.M.F. Souza, Millena Cristina Barros Santos, Andrés Rodríguez Vega, L.C. Cameron, Mariana Simões Larraz Ferreira
Soluble proteins were extracted from common wheat flour obtained from nine cultivars of different qualities and were analyzed by nanoUPLC and Ultra Definition Mass Spectrometry (UDMS^E) label-free quantitative approach. Collectively, 5,894 proteins were identified and quantified with 8 peptides/protein. A total of 414 proteins were found differentially expressed with 85% proteins not yet described in the literature, according to their biological function. Quality-related proteins, such as puroindolines and chaperones, notably involved in the gluten-protein folding process, were up-regulated in superior (SP) and medium (MD) flours qualities and down-regulated in the low (LW) ones. Domains related to the chaperones activity were also found up-regulated in SP and MD and down-regulated in LW. In this work, nanoUPLC-UDMS^E analysis was effective to identify and quantify metabolic proteins, allowing a clear distinction of the wheat flours and providing new perspectives for evaluating the technological quality based on the low abundant proteins of wheat endosperm.



http://ift.tt/2sPiNBe

Why human anti-Galα1–4Galβ1–4Glc natural antibodies do not recognize the trisaccharide on erythrocyte membrane? Molecular dynamics and immunochemical investigation

Publication date: October 2017
Source:Molecular Immunology, Volume 90
Author(s): Pavel Volynsky, Roman Efremov, Ilya Mikhalev, Kira Dobrochaeva, Alexander Tuzikov, Elena Korchagina, Polina Obukhova, Evgenia Rapoport, Nicolai Bovin
BackgroundHuman blood contains a big variety of natural antibodies, circulating throughout life at constant concentration. Previously, we have found natural antibodies capable of binding to trisaccharide Galα1-4Galβ1-4Glc (P^k) practically in all humans. Intriguingly, the same trisaccharide is a key fragment of glycosphingolipid globotriaosylceramide (Gb3Cer) – normal component of erythrocyte and endothelial cell membrane, i.e. the antibodies and their cognate antigen coexist without any immunological reaction.AimTo explain the inertness of human anti-P^k antibodies towards own cells.Materials and methodsWe used a combination of immunochemical and molecular dynamics (MD) experiments. Antibodies were isolated using affinity media with P^k trisaccharide, their epitope specificity was characterized using ELISA (enzyme-linked immunosorbent assay) with a set of synthetic glycans related to P^k synthetic glycans and FACS (Fluorescence-Activated Cell Sorting) analysis of cells with inserted natural Gb3Cer and its synthetic analogue. Conformations and clustering of glycolipids immersed into a lipid bilayer were studied using MD simulations.ResultsIsolated specific antibodies were completely unable to bind natural Gb3Cer both inserted into cells and in artificial membrane, whereas strong interaction took place with synthetic analogue differing by the presence of a spacer between trisaccharide and lipid part. MD simulations revealed: i) although membrane-bound glycans do not form stable long-living aggregates, their transient packing is more compact in natural Gb3 as compared with the synthetic analog, ii) similar conformation of P^k glycan in composition of the glycolipids, iii) no effect on the mentioned above results when cholesterol was inserted into membrane, and iv) better accessibility of the synthetic version for interaction with proteins.ConclusionsBoth immunochemical and molecular dynamics data argue that the reason of the "tolerance" of natural anti-P^k antibodies towards cell-bound Gb3Cer is the spatial inaccessibility of P^k glycotope for interaction. We can conclude that the antibodies are not related to the blood group P system.



http://ift.tt/2u7Q26E

CD3/CD28 dynabeads induce expression of tn antigen in human t cells accompanied by hypermethylation of the cosmc promoter

Publication date: October 2017
Source:Molecular Immunology, Volume 90
Author(s): Chuanqin Shi, Xue Xu, Xiaofeng Yu, Zhenzhen Du, Xiying Luan, Dachang Liu, Tao Hu
Glycosylation is an important protein post-translational modification. In this process, the intermediate product, Tn antigen, arises from somatic mutations in core1β3-galactosyltransferase-specific molecular chaperone (Cosmc), which is required for the formation of active core1β3-galactosyltransferase (T-synthase). As a type of tumor-associated carbohydrate antigen, Tn antigen is mainly expressed in many human tumor cells and is absent in normal cells. Surprisingly, it is also expressed in normal activated T cells after in vitro stimulation, but the mechanism underlying its expression remains unclear. This study demonstrated that Tn antigen was expressed in activated T cells and that the percentage of positive (Tn⁺) cells increased and subsequently decreased within 72h after stimulation with CD3/CD28 Dynabeads, with peak expression occurring at 48h. During activation, interleukin-4 (IL-4) expression in the T-cell supernatant consistently increased with Tn⁺ cells, and was inversely correlated with serum interferon gamma (IFN-γ) levels. Compared with unactivated (without CD3/CD28 Dynabead stimulation) T cells, the level of T-synthase transcription in activated T cells did not significantly change, whereas T-synthase activity and Cosmc transcription significantly decreased, accompanied by a further increase in methylation of the Cosmc promoter. The results also showed that Cosmc transcription and translation decreased and then increased, and that Cosmc promoter methylation was a dynamic process during T cell activation. These data suggest that hypermethylation of the Cosmc promoter may induce the expression of Tn antigen in activated T cells.



http://ift.tt/2sPi7Mv

Methotrexate, combined with cyclophosphamide attenuates murine collagen induced arthritis by modulating the expression level of Breg and DCs

Publication date: October 2017
Source:Molecular Immunology, Volume 90
Author(s): Jinnan Fan, Jing Luo, Caiping Yan, Runxi Hao, Xiangcong Zhao, Ruihuan Jia, Jiaojiao He, Dan Xu, Miao Miao, Xiaofeng Li
To explore the mechanism of methotrexate (MTX) and its combination with cyclophosphamide (CTX) in collagen-induced arthritis (CIA), we investigated the levels of several immune cells and cytokines in mice with different treatments. CIA was induced in DBA/1 mice at the age of 7 weeks by primary immunization with 100μl emulsion containing 2mg/ml bovine type II collagen which was mixed with complete Freund's adjuvant (CFA). The booster immunization was performed with 50–100μl emulsion containing 2mg/ml bovine type II collagen (CII) mixed with incomplete Freund's adjuvant (IFA). MTX, CTX or both were administrated after the booster immunization. Therapeutic effect was evaluated by arthritic scores, X-rays and assessment of histopathological joint destruction. The expression of TNF-α, IL-6, IL-23, IL-10 were also measured. The frequencies of different immune cell subsets in the lymph node, spleen and bone marrow were determined by flow cytometry analysis. Our results showed that CTX and MTX treatment attenuated the severity of arthritis of CIA mice and reduced the levels of several cytokines. CTX and MTX treated mice showed a lower frequency of B cells in bone marrow. Also, when treated the CIA mice with MTX, alone or together with CTX, the lymph nodes and spleen exhibited a decrease in regulatory B cells (Breg) and dendritic cells (DCs). Notably, the combination of MTX and CTX had a more pronounced effect. By measuring the levels of different immune cells those participated in the development of rheumatoid arthritis (RA), our experiment may help to evaluate the therapeutic effects and prognosis of arthritic diseases.



http://ift.tt/2u82LXk

Phlebologie

http://ift.tt/2ud4IBp

National Partnership for Maternal Safety: Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period.

Complications arising from hypertensive disorders of pregnancy are among the leading causes of preventable severe maternal morbidity and mortality. Timely and appropriate treatment has the potential to significantly reduce hypertension-related complications. To assist health care providers in achieving this goal, this patient safety bundle provides guidance to coordinate and standardize the care provided to women with severe hypertension during pregnancy and the postpartum period. This is one of several patient safety bundles developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. These safety bundles outline critical clinical practices that should be implemented in every maternity care setting. Similar to other bundles that have been developed and promoted by the Partnership, the hypertension safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. This commentary provides information to assist with bundle implementation. (C) 2017 International Anesthesia Research Society

http://ift.tt/2t2W0Gq

Evaluation and management of syndromic congenital hearing loss.

Purpose of review: The purpose of this review is to review the evaluation and management of children with syndromic hearing loss. Specific syndromes and the impact of those syndromes on managing hearing loss will be discussed. Recent findings: Improved molecular testing has increased the ability to identify syndromes-associated hearing loss. Accurate diagnosis of syndromic hearing loss can guide discussions regarding prognosis and appropriate management options for the hearing impairment. Summary: A significant portion of childhood hearing loss is associated with a syndrome. Depending on the syndrome, surgical intervention including a bone-anchored hearing aid or cochlear implant may be helpful. In the future, targeted gene therapies may become a viable option for treating syndromic hearing loss. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2tHetXI

The expanding role of scapular free-flaps.

Purpose of review: The review evaluates the expanding role of scapular free flaps and its application in various complex head and neck defects. Recent findings: The recent literature published focuses on the use of three-dimensional modeling for maxillectomy defects, expanded uses in both the megaflap, the various application of the scapular tip flap, and the feasibility of osseointegrated implants. Summary: The subscapular system of flaps remains a versatile option in head and neck reconstruction. It continues to be one of the best options for large defects requiring generous soft tissue, muscle, and bone. Three-dimensional modeling is currently being applied to complex maxillary defects resulting in increased accuracy and efficiency of reconstruction. Expanded uses have also adopted the latissimus dorsi muscle in conjunction with the scapular bony flap to be used in large defects with resulting decreased fistula rates. Finally, there is sufficient evidence that supports the use of dental implantation into the scapula bone with successful retention rates. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2td3rWU

Evaluation and management of syndromic congenital hearing loss.

Purpose of review: The purpose of this review is to review the evaluation and management of children with syndromic hearing loss. Specific syndromes and the impact of those syndromes on managing hearing loss will be discussed. Recent findings: Improved molecular testing has increased the ability to identify syndromes-associated hearing loss. Accurate diagnosis of syndromic hearing loss can guide discussions regarding prognosis and appropriate management options for the hearing impairment. Summary: A significant portion of childhood hearing loss is associated with a syndrome. Depending on the syndrome, surgical intervention including a bone-anchored hearing aid or cochlear implant may be helpful. In the future, targeted gene therapies may become a viable option for treating syndromic hearing loss. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2tHetXI

The expanding role of scapular free-flaps.

Purpose of review: The review evaluates the expanding role of scapular free flaps and its application in various complex head and neck defects. Recent findings: The recent literature published focuses on the use of three-dimensional modeling for maxillectomy defects, expanded uses in both the megaflap, the various application of the scapular tip flap, and the feasibility of osseointegrated implants. Summary: The subscapular system of flaps remains a versatile option in head and neck reconstruction. It continues to be one of the best options for large defects requiring generous soft tissue, muscle, and bone. Three-dimensional modeling is currently being applied to complex maxillary defects resulting in increased accuracy and efficiency of reconstruction. Expanded uses have also adopted the latissimus dorsi muscle in conjunction with the scapular bony flap to be used in large defects with resulting decreased fistula rates. Finally, there is sufficient evidence that supports the use of dental implantation into the scapula bone with successful retention rates. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2td3rWU

Ultrasound-guided core needle biopsy in salivary glands: A meta-analysis

Objectives/Hypothesis

Core needle biopsy is an effective diagnostic tool widely used in many oncological diagnostic approaches. It provides an adequate tissue sample for histological evaluation of architecture, which allows tumor grading and classification of malignant and benign tumors. This study aimed to provide an updated meta-analysis and systematic review of core needle biopsy in the salivary glands.

Study Design

A literature search using PubMed, Embase, and the Cochrane Library through December 2016.

Methods

Data on true positives, true negatives, false positives, and false negatives were extracted from the relevant articles. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. We calculated accuracy, sensitivity, and specificity with 95% confidence intervals (CIs) using random-effects models that considered both within- and between-study variations.

Results

Our search included 10 observational studies. For core needle biopsy, the sensitivity and specificity for the diagnosis of salivary glands were 0.94 (95% CI: 0.92-0.96, I² = 18.7%, χ²P = .27) and 0.98 (95% CI: 0.97-0.99, I² = 79.6%, χ²P = .00), respectively. The area under the summary receiver operating characteristic curve was 0.98 (95% CI: 0.97-0.99). Seven hematomas, one case of temporary facial paralysis caused by local anesthesia, and no tumor seeding were reported from a total of 1,315 procedures.

Conclusions

Ultrasound core needle biopsy of salivary glands is an excellent diagnostic tool in terms of accuracy, technical performance, and safety profile.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2sOFc1x

Outcomes of medialization laryngoplasty with and without arytenoid adduction

Objectives/Hypothesis

To evaluate the effect of medialization laryngoplasty (ML) performed alone compared to ML with arytenoid adduction (AA) on glottic gap and voice quality in unilateral vocal fold paralysis (UVFP) patients.

Study Design

Retrospective case series.

Methods

UVFP patients treated with ML alone and ML with AA at the University of California San Francisco Voice and Swallowing Center were identified. Demographic information and history of laryngeal procedures were collected. Preoperative and postoperative examinations were digitally analyzed using ImageJ for normalized anterior and posterior glottic gap and voice samples graded with CAPE-V scores.

Results

Forty-seven patients underwent ML and 27 patients underwent ML with AA. Normalized anterior gap (AG) improved in both ML (preop: 4.4 pixel units (u), postop: 0.8 u; P < 0.001) and ML with AA groups (preop: 3.3 u, postop 0.6 u; P < 0.001). There was no statistically significant difference in normalized AG values between treatment groups. Postoperative normalized posterior gap (PG) improved in the ML with AA group only (preop: 1.8 u, postop: 0.5 u; P = 0.01). Overall severity, roughness, and strain voice parameters had acceptable reliability for analysis. Overall severity improved in ML (preop: 54, postop: 27; P < 0.001) and ML with AA (preop: 44, postop: 24; P = 0.005). There was no statistically significant difference in any voice parameter between treatment groups.

Conclusion

UVFP patients undergoing ML may benefit from addition of AA when a large posterior glottic gap is present. In this study, ML with AA but not ML alone resulted in statistically significant improvement in PG.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2u7v6Na

Inverted schneiderian papilloma of the supraglottis: Case report

Inverted schneiderian papillomas are rare benign tumors, most often arising from the sinonasal mucosa. We describe a case of a 59-year-old female with an inverted papilloma of the supraglottis. This is the first reported case of a supraglottic-presenting inverted papilloma. Although rare, this case demonstrates that these tumors should be considered during workup of supraglottic laryngeal masses. Laryngoscope, 2017

http://ift.tt/2sODNs3

Improved autologous cortical bone harvest and viability with 2Flute otologic burs

Objectives

To determine if 2Flute (Stryker Corporation, Kalamazoo, MI) otologic burs improve the size, cellular content, and bone healing of autologous cortical bone grafts harvested during canal wall reconstruction (CWR) tympanomastoidectomy with mastoid obliteration.

Study Design

Institutional review board-approved prospective cohort study.

Methods

Human autologous cortical bone chips were harvested using various burs (4 and 6 mm diameter; multiflute, and 2Flute [Stryker Corporation]) from patients undergoing CWR tympanomastoidectomy for the treatment of chronic otitis media with cholesteatoma. Bone chip size, cell counts, cellular gene expression, and new bone formation were quantified.

Results

Bone chips were significantly larger when harvested with 2Flute (Stryker Corporation) bur compared to multiflute burs at both 6 mm diameter (113 ± 14 μm² vs. 66 ± 8 μm²; P < 0.05) and 4 mm diameter (70 ± 8 μm² vs. 50 ± 3 μm²; P < 0.05). After 2 weeks in culture, cell numbers were significantly higher when harvested with 2Flute (Stryker Corporation) bur compared to multiflute burs at both 6 mm diameter (48.7 ± 3 vs. 31.8 ± 3 cells/μg bone; P < 0.05) and 4 mm diameter (27.6 ± 1.2 vs. 8.8 ± 1.2 cells/μg bone; P < 0.05). Bone-derived cells express osteoblast markers (alkaline phosphatase, osteocalcin). Cultured cells are able to form new bone in culture, and bone formation is facilitated by the presence of bone chips.

Conclusion

Use of 2Flute (Stryker Corporation) otologic burs for human autologous cortical bone harvest results in more viable bone fragments, with larger bone chips and more osteoblasts. Future studies are needed to determine if this leads to improved bone healing.

Level of Evidence

NA. Laryngoscope, 2017

http://ift.tt/2u7Dw7m

Outcomes of laryngohyoid suspension techniques in an ovine model of profound oropharyngeal dysphagia

Objectives/Hypothesis

To evaluate the efficacy of various techniques of laryngohyoid suspension in the elimination of aspiration utilizing a cadaveric ovine model of profound oropharyngeal dysphagia.

Study Design

Animal study.

Methods

The head and neck of a Dorper cross ewe was placed in the lateral fluoroscopic view. Five conditions were tested: baseline, thyroid cartilage to hyoid approximation (THA), thyroid cartilage to hyoid to mandible (laryngohyoid) suspension (LHS), LHS with cricopharyngeus muscle myotomy (LHS-CPM), and cricopharyngeus muscle myotomy (CPM) alone. Five 20-mL trials of barium sulfate were delivered into the oropharynx under fluoroscopy for each condition. Outcome measures included the penetration aspiration scale (PAS) and the National Institutes of Health (NIH) Swallow Safety Scale (NIH-SSS).

Results

Median baseline PAS and NIH-SSS scores were 8 and 6, respectively, indicating severe impairment. THA scores were not improved from baseline. LHS alone reduced the PAS to 1 (P = .025) and NIH-SSS to 2 (P = .025) from baseline. LHS-CPM reduced the PAS to 1 (P = .025) and NIH-SSS to 0 (P = .025) from baseline. CPM alone did not improve scores. LHS-CPM displayed improved NIH-SSS over LHS alone (P = .003).

Conclusions

This cadaveric model represents end-stage profound oropharyngeal dysphagia such as what could result from severe neurological insult. CPM alone failed to improve fluoroscopic outcomes in this model. Thyrohyoid approximation also failed to improve outcomes. LHS significantly improved both PAS and NIH-SSS. The addition of CPM to LHS resulted in improvement over suspension alone.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2sOQ8fA

What is the potential clinical utility of vHIT when assessing adult patients with dizziness?

http://ift.tt/2u6Vd7e

In reference to Pediatric endoscopic ear surgery in clinical practice: Lessons learned and early outcomes

http://ift.tt/2sOltz7

Outcomes of head and neck cancer surgery in the geriatric population based on case volume at academic centers

Objectives/Hypothesis

Evaluate the impact of case volume and other variables on cost and mortality after head and neck oncologic surgery in the geriatric population.

Study Design

Cross-sectional study.

Methods

The Vizient database was accessed for data on geriatric patients (age ≥65 years) who underwent surgery for head and neck cancers (excluding thyroid and skin cancer) at full member academic medical centers between 2009 and 2012. Multivariate, linear regression analyses, χ² tests, and analysis of variance were applied to evaluate significant associations between hospital case volume and independent variables including cost, cost index, mortality, mortality index, length of stay, length of stay index, and readmission rates.

Results

A total of 4,544 patients were included. Total length of stay was 6.72 days in high-volume hospitals, compared to 8.12 days and 7.91 days in moderate- and low-volume hospitals, respectively (P = .0144). Frequency of intensive care unit stays was 36.5% in high-volume hospitals, compared to 42.19% and 40.29% in moderate- and low-volume hospitals, respectively (P = .0048). Mortality (0.78%) and average cost per case ($21,834) was lower, but nonsignificant in high-volume hospitals. Using multiple regression analysis, major severity of disease was positively associated with complication rate (P < .0001) and length of stay (P = .0481).

Conclusions

After controlling for other factors, high-volume academic medical centers have a lower intensive care unit stay, but no difference in mortality or average cost per case when compared to low-volume hospitals.

Level of Evidence

2b Laryngoscope, 2017

http://ift.tt/2u7BNyR

Is middle ear pressure affected by continuous positive airway pressure use?

http://ift.tt/2sOZt7n

Should patients with primary snoring be screened for carotid artery stenosis?

http://ift.tt/2u7RTso

Does a multidisciplinary approach to voice and swallowing disorders improve therapy adherence and outcomes?

http://ift.tt/2sP48pI

In reference to To image or not to Image? A cost-effectiveness analysis of MRI for patients with asymmetric sensorineural hearing loss

http://ift.tt/2u7SxWR

Safety of 100 µg venom immunotherapy rush protocols in children compared to adults

There is a paucity of studies examining the safety of venom immunotherapy (VIT) in children. We aimed to assess the incidence of anaphylactic side effects during rush VIT in a cohort of pediatric patients and ...

http://ift.tt/2uQ0T2Y

Factors associated with epinephrine administration for anaphylaxis in children before arrival to the emergency department

Epinephrine is the first-line treatment for anaphylaxis but may be underused by patients and medical personnel.

http://ift.tt/2u7OHNq