CAR T cells targeting solid tumors: carcinoembryonic antigen (CEA) proves to be a safe target

http://ift.tt/2v36aH4

Association Between Plasma Proprotein Convertase Subtilisin/Kexin Type 9 and the Presence of Metabolic Syndrome in a Predominantly Rural-Based Sub-Saharan African Population

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


http://ift.tt/2tOwvcn

Acquired pachydermatoglyphia: the cutaneous manifestation of pulmonary tumours

Description

A 74-year-old man with active smoking habits presented to the emergency department with a 2-month history of weight loss (20% of previous body mass), dyspnoea and night sweats. Physical examination showed clinical signs of respiratory distress, significant cachexia and thickened velvety palms with pronounced folds (figure 1). The laboratory results revealed leucocytosis of 15 700 cells/µl, thrombocytosis of 547 000/µl and elevated C reactive protein of 6.65 mg/dL. A posteroanterior chest radiograph showed a right pleural effusion and consolidation suggestive of pneumonia.

Figure 1

Thickened velvety palms with pronounced folds consistent with acquired pachydermatoglyphia.

The patient was given antibiotics and submitted to pleural effusion drainage for symptomatic relief. A skin biopsy of the palms was obtained and the histopathological examination identified signs of hyperkeratosis, acanthosis and papillomatosis consistent with acquired pachydermatoglyphia (figure 2).

Figure 2

Skin biopsy consistent with acquired...

http://ift.tt/2h7zxm2

Bacteraemia and liver abscess due to Fusobacterium necrophorum

Fusobacterium necrophorum is the oropharyngeal pathogen usually associated with Lemierre's syndrome, a pharyngeal infection which evolves to sepsis, septic emboli and thrombophlebitis of the adjacent neck vessels. It is an uncommon causative bacteria of a liver abscess, and an extensive workup should, therefore, be performed in order to rule out potential sources of the infection. This case report describes the workup that led to the diagnosis of a colorectal carcinoma, which was deemed to be the source of the Fusobacterium bacteraemia.

http://ift.tt/2eSy2aC

Hypertrophic olivary degeneration

Description

A 30-year-old man underwent MRI of the internal auditory meatus as a routine follow-up after excision of a large left vestibular schwannoma, 2.5 years previously. MRI images showed an incidental finding of left hypertrophic olivary degeneration (figure 1 and figure 2). This phenomenon occurs as a result of Wallerian degeneration of the olivary nucleus secondary to a lesion in the triangle of Guillain and Mollaret, also known as the dento-rubro-olivary pathway (figure 3). The differential diagnoses of hypertrophic olivary degeneration include infarction, infection, neoplasms and demyelination. Differentials can be excluded by the absence contrast enhancement (figure 2).

Figure 1

Axial T2-weighted sequence showing intratumoral haemorrhage within a large left cerebello-pontine angle lesion in keeping with a vestibular schwannoma (panel A). Axial fluid attenuated inversion recovery (FLAIR) image through the posterior fossa after 6 months demonstrating atrophic changes and haemosiderin deposition in the left middle cerebellar peduncle...

http://ift.tt/2h88Zkm

Hiatal hernia mimicking heart problems

Description

A 73-year-old man presented to the emergency department with symptoms of acute coronary syndrome. Findings on examination were dyspnoea, chest tightness and a burning sensation behind the sternum.

On admission, 3 hours after the onset of symptoms, his 12-lead ECG showed a left bundle branch block. Cardiac enzymes revealed only marginally elevated creatine kinase, aspartate transaminase and lactate dehydrogenase levels; however, troponin I (<0.04 ng/mL) was increased to 17 and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) to 1472 pg/mL (73 year normal range: 10–220 pg/mL). Though the consulting cardiologist determined coronary angiography to be unnecessary at the time, the patient was promptly sent to the intensive care unit (ICU) for monitoring and for quick intervention, if needed.

At that time, further information was gathered from the patient and his family. Apparently, the symptoms had started during lunch. The patient had experienced these symptoms several times in the preceding months; this time, however, the...

http://ift.tt/2eSd8IM

Postoperative gluteal compartment syndrome following microsurgical free-flap hand reconstruction: the importance of early recognition and treatment

Compartment syndrome, a surgical emergency, is caused by an increase in pressure within a closed osseofascial space, often due to trauma. This causes a decrease in tissue perfusion and ultimately tissue necrosis and multiorgan failure if not treated in a timely fashion. Gluteal compartment syndrome is a rare variant and often caused by a period of immobilisation secondary to intoxication with alcohol or drugs or during long operations, typically in the supine position. We report on a case of gluteal compartment syndrome developing in a patient postoperatively following a long microsurgical procedure to a hand, which has not been documented before. Although rare, we highlight the clinical course and diagnostic criteria, which are essential for early identification and treatment.

http://ift.tt/2h7NP6i

Adjunctive extracorporeal carbon dioxide removal in refractory status asthmaticus

Status asthmaticus (SA) is a life-threatening disorder. Severe respiratory failure may require extracorporeal membrane oxygenation (ECMO). Previous reports have demonstrated utility of ECMO in SA in various patients with varying success. A 25-year-old man was admitted with status asthmatics and severe hypercapnic respiratory failure. Despite tailored ventilator therapies, such as pressure control ventilation and maximal pharmacological therapy, including general anaesthesia, the patientâ™s condition deteriorated rapidly. Veno-venous ECMO (VV-ECMO) was provided for respiratory support. The patientâ™s clinical condition improved over the following 72âhours and was discharged from the intensive care unit on day 3. This case report demonstrates the successful use of VV-ECMO in a patient with severe respiratory failure due to SA, who failed to respond to maximal therapy. This case adds support to a growing body of literature that shows that ECMO can be used with success for refractory status asthmaticus.

http://ift.tt/2eS6aU7

Intraparotid ductal ectasia: rare cause of parotid swelling

A 41-year-old patient was hospitalised for a chronic right parotid mass. A cervical ultrasound revealed a cystic mass of the parotid. Cervical MRI found a ductal ectasia of the parotid and submandibular glands associated with a retention cyst of the right parotid. He had a right total parotidectomy. Histopathological examination of the lesion revealed a multilocular cystic mass with a diffuse glandular ectasia of salivary ducts. The patient had an uneventful postoperative course without any recurrence of symptoms.

http://ift.tt/2h7zkPM

Gamna-Gandy nodules of the spleen and asplenism in SLE: a novel association?

Description

We present a case of a 53-year-old woman who presented to the emergency room with acute abdominal pain, fever and haemodynamic and respiratory instability and was admitted to the intensive care unit with fulminant septic shock with multiorgan failure. CT imaging of the abdomen showed no gross abnormalities, initial laboratory results are presented in table 1.

Table 1

Laboratory test results

ParameterValueReference valueUnitCRP96<10mg/LESR7<20mm/hourHb8.07.0–9.2mmol/LHt0.400.32–0.44L/LMCV9582–89fLWBC6.5

http://ift.tt/2eRQxw0

Reversible Holmesa{euro}™ tremor due to spontaneous intracranial hypotension

Holmes' tremor is a low-frequency hand tremor and has varying amplitude at different phases of motion. It is usually unilateral and does not respond satisfactorily to drugs and thus considered irreversible. Structural lesions in the thalamus and brainstem or cerebellum are usually responsible for Holmes' tremor. We present a 23-year-old woman who presented with unilateral Holmes' tremor. She also had hypersomnolence and headache in the sitting posture. Her brain imaging showed brain sagging and deep brain swelling due to spontaneous intracranial hypotension (SIH). She was managed conservatively and had a total clinical and radiological recovery. The brain sagging with the consequent distortion of the midbrain and diencephalon was responsible for this clinical presentation. SIH may be considered as one of the reversible causes of Holmes' tremor.

http://ift.tt/2h88XsK

Androgenic alopecia: an entity to consider in adolescence

Description

A 15-year-old healthy adolescent girl went to her physician consultation because she was preoccupied with progressive thinning of her hair since 11 years old. In the last year, she noticed an aggravation, with an excessive hair loss. She does not have hirsutism, acne, asthenia, menstrual irregularities or weight variations. In her family history, she reported that her mother had 'excessive hair loss after pregnancy' and her maternal aunt has alopecia of unknown aetiology. At physical examination it was observed diffuse reduction of capillary thickness and density at the frontal scalp area (figure 1) and vertex (figure 2). Rare black dots were present and the pull test was negative. The analytical study including blood count, iron kinetics, thyroid function and hormonal study had no alterations. The pelvic and adrenal gland's ultrasound were normal. At dermatology consultation, scalp biopsy revealed findings compatible with androgenic alopecia. She started treatment...

http://ift.tt/2eSV3Kk

Extramacular dome-shaped elevation: a novel finding in a case of high myopia

Description

Dome-shaped macula (DSM) is an elevation at the macula seen in about 5%–10% cases of high myopia, usually within a posterior staphyloma, caused by localised inward scleral and choroidal convexity.1 It may lead to visual deterioration when associated with serous foveal detachment (44% cases).2 3 Herein, we describe a similar but 'Extramacular dome-shaped elevation (EDSE)' associated with a large retinal hole.

A 23-year-old myopic female patient was referred to our clinic for pre refractive surgery fundus screening. She had a history of diminution of vision in the left eye more than the right eye since childhood and was using myopic glasses for the same. Best-corrected visual acuity on Snellen chart was 20/20 in the right eye and 20/200 in the left eye. Lower acuity in the left eye was attributed to anisometropic amblyopia as her refractive error was –6.75 D sphere...

http://ift.tt/2h7R0ut

Sclerosing lymphangitis of the penis associated with marked penile oedema and skin erosions

Sclerosing lymphangitis of the penis is a benign, under-reported condition consisting of a asymptomatic firm cord-like swelling around the coronal sulcus of the penis usually affecting men in the second or third decade of life. Penile oedema and erosions are rarely reported. Clinical signs may be remarkable contrasting with the self-limited character of the disease. We report a new case of sclerosing lymphangitis of the penis occurring in a 59-year-old patient marked by penile swelling and several overlying skin erosions, and discuss the clinical features and the pathogenesis aspects of the disease.

http://ift.tt/2eSURL6

Directly observed therapy for clozapine with concomitant methadone prescription: a method for improving adherence and outcome

A young male presented with many years of delusions and hallucinations, with concurrent heroin use and subsequent amphetamine uses. There were no depressive or manic symptoms and psychotic symptoms prior to the amphetamine use. After the trials of two atypical antipsychotics and later clozapine due to treatment resistance, adherence and functionality were poor and there was still persistent drug use. As a result, a long acting injectable adjunct was commenced, but only minimal effects were observed. However after initiation of directly observed treatment of clozapine with methadone, there has been functional and clinical response and drug use has ceased.

http://ift.tt/2h7PUiD

Accidental hypothermic cardiac arrest and rapid mediastinal warming with pleural lavage: a survivor after 3.5 hours of manual CPR

A 30-year-old man suffered post-traumatic hypothermic cardiac arrest. On arrival in the emergency department, rectal core temperature was 23°C. Manual cardiopulmonary resuscitation (CPR) was continued as no mechanical chest compression device was available, and active and passive rewarming was undertaken. Bilateral thoracostomies confirmed good lung inflation. Defibrillation and intravenous epinephrine were discontinued until core temperature was elevated above 30°C. Extracorporeal rewarming was unavailable. When no increase in rectal temperature was achieved after 90 min, an alternative oesophageal probe confirmed mediastinal temperature as 23°C. Bilateral chest drain insertion, followed by microwave-heated saline pleural lavage, rapidly raised the oesophageal temperature above 30°C with subsequent successful defibrillation, initially to pulseless electrical activity and finally return of spontaneous circulation 3.5 hours after the commencement of CPR. The patient recovered fully and was discharged without neurological deficit. Rapid mediastinal warming with pleural lavage should be considered in units with no access to extracorporeal rewarming service.

http://ift.tt/2eS5sWX

Disseminated tuberculosis in relatively asymptomatic young woman

Description

A previously healthy 20-year-old woman presented to the emergency department with a history of one episode of generalised tonic–clonic seizure. No history of fever or constitutional symptoms. At admission, she was haemodynamically stable and Glasgow Coma Scale was 8, with no focal neurological deficits. For the workup of seizures, MRI brain (figure 1) was done which revealed multiple ring-enhancing lesions in bilateral temporal, frontal and right parietal lobes. Cerebrospinal fluid examination showed normal cell count with high protein (84 mg/dL) and normal glucose levels (43 mg/dL), and high adenosine deaminase (9.3 U/L) level. Chest X-ray showed (figure 2A) miliary mottling which was confirmed by contrast-enhanced CT (CECT) chest (figure 2B and C). CECT abdomen (figure 3A and B) revealed thick-walled multiloculated collection (7.3x8.4x14.2 cm) with thick internal septations in the left lumbar and iliac fossa region. Pelvic collections were drained with an image-guided pig tail insertion and...

http://ift.tt/2h7QVqF

A perforated caecal volvulus in the foramen of Winslow

The aim of this report is to discuss with high-quality images, a case of a caecal volvulus herniating through the foramen of Winslow with signs of perforation.

http://ift.tt/2v4UMu9

IPL vs PDL in treatment of facial erythema: A split-face study

Summary

Background

Lasers and noncoherent intense pulse light sources effectively treat vascular lesions. Intense pulsed light (IPL), a nonablative treatment for photorejuvenation, uses a flashlamp which emits noncoherent light between 400 and 1400 nm. The light may be filtered to target a specific chromophore. The pulsed dye laser (PDL), at 595 nm, has been the historical standard of care in the treatment of facial erythema. We sought to determine whether IPL may be used in lieu of PDL in reducing facial erythema.

Objectives

To determine whether IPL may be used to treat facial erythema with equal efficacy as PDL used at nonpurpuric settings.

Methods

Prospective investigation of a cohort of 15 subjects with unwanted bilateral facial erythema. Subjects presented for two treatments with an IPL (BBL™ BroadBand Light; Sciton, Palo Alto, CA) to one half of the face and PDL (Cynergy™; Cynosure, Westford, MA) to the other half.

Results

Patients with facial erythema may be successfully treated with IPL or PDL.

Conclusions

Intense pulsed light and pulsed dye laser with nonpurpuric settings were equally effective in reducing facial erythema.

http://ift.tt/2v4drWP

MANDIBULAR PSEUDOCARCINOMATOUS HYPERPLASIA: A RARE POSTOPERATIVE COMPLICATION AND MANAGEMENT

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2
Author(s): LUCIANA YAMAMOTO DE ALMEIDA, CÁSSIO EDVARD SVERZUT, ALEXANDRE ELIAS TRIVELLATO, JESSICA LUANA DOS SANTOS, ALFREDO RIBEIRO DA SILVA, LANA KEI YAMAMOTO ALMEIDA, JORGE ESQUICHE LEÓN




http://ift.tt/2tIpgP9

HISTOPLASMOSIS IN AN HIV-INFECTED PATIENT: REPORT OF AN UNUSUAL CLINICAL MANIFESTATION

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2
Author(s): FELIPE MARTINS SILVEIRA, ANA PAULA NEUTZLING GOMES, SANDRA BEATRIZ CHAVES TARQUÍNIO, THAÍSE GOMES E NÓBREGA, KARINE DUARTE DA SILVA, ANA CAROLINA UCHOA VASCONCELOS




http://ift.tt/2v4nHhY

Table of Contents

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2





http://ift.tt/2tHYUfZ

A MISINTERPRETATION OF THE PROGRESSION TIME OF A TONGUE LESION

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2
Author(s): CARLA RENATA SANOMIYA IKUTA, PAULO SÉRGIO DA SILVA SANTOS, RENATO YASUTAKA DE FARIA YAEDU, CLEVERSON TEIXEIRA SOARES, JOSÉ HUMBERTO DAMANTE




http://ift.tt/2v4yrwE

Society Page

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2





http://ift.tt/2tHOTiP

THE USE OF L-PRF (LEUKOCYTE-PLATELET-RICH FIBRIN) IN THE TREATMENT OF MRONJ

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2
Author(s): GUSTAVO MALUF DIB VALERIO, GABRIELLE SCATTOLIN MOREIRA, ANDRÉ LINS CAVALCANTI CORRÊA DA COSTA, EDUARDO FREGNANI, PAULO SÉRGIO SILVA SANTOS




http://ift.tt/2v4pMdK

Information for Readers

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2





http://ift.tt/2tIr1LS

PRIMARY CUTANEOUS CD8+ T-CELL LYMPHOMA: CASE REPORT SHOWING FACIAL EDEMA WITH MARKED SWELLING OF EYELID AND LIP

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2
Author(s): DAPHINE CAXIAS TRAVASSOS, ELAINE MARIA SGAVIOLI MASSUCATO, CLÁUDIA MARIA NAVARRO, ALFREDO RIBEIRO DA SILVA, ANDREIA BUFALINO, LUCIANA YAMAMOTO DE ALMEIDA, JORGE ESQUICHE LEÓN




http://ift.tt/2v4P0bK

HUMAN PAPILLOMAVIRUS-ASSOCIATED ORAL EPITHELIAL DYSPLASIA

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2
Author(s): SANDRA R. TORRES, WLADIMIR CORTEZZI, ELLEN BRILHANTE CORTEZZI, MICHELLE AGOSTINI, ALICIA RUMAYOR PIÑA, BRUNO AUGUSTO BENEVENUTO DE ANDRADE, MÁRIO JOSÉ ROMAÑACH




http://ift.tt/2tHYQwL

Editorial Board

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2





http://ift.tt/2v4Qd2Z

SURGICAL TREATMENT OF BOTRYOID ODONTOGENIC CYST WITH IMMEDIATE AUTOGENOUS BONE GRAFT

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2
Author(s): HENRIQUE CÔRTES MEIRA, MARIA CASSIA FERREIRA DE AGUIAR, PATRÍCIA CARLOS CALDEIRA, VAGNER RODRIGUES SANTOS, MARIA LETÍCIA FERREIRA ARAÚJO, IGRAINE CRISTINA RODRIGUES VIDAL, RICARDO ALVES MESQUITA




http://ift.tt/2tI2vuG

CHRONIC RECURRENT MULTIFOCAL OSTEOMYELITIS OF THE MANDIBLE

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2
Author(s): AGUIDA MARIA MENEZES AGUIAR MIRANDA, FÁBIO RAMÔA PIRES, JULIANA DE NORONHA SANTOS NETTO, SIMONE MACEDO AMARAL, MARIA DA GLÓRIA MERI LEÃO, MARIANA CAPITÃO




http://ift.tt/2v4E6Tn

GINGIVAL LEUKEMIC INFILTRATION AS THE FIRST MANIFESTATION OF ACUTE MYELOID LEUKEMIA

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2
Author(s): KARIN SÁ FERNANDES, MARINA GALLOTTINI, YARA ANDREA PIRES AFONSO REINA, TALITA CASTRO, MAURICIO FLAMINIO AMATO, PAULO HENRIQUE BRAZ DA SILVA




http://ift.tt/2tHQ4Pk

ORAL LESION COMPATIBLE WITH HPV WITH POSTERIOR SQUAMOUS CELL CARCINOMA

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2
Author(s): JOSE FERREIRA MENEZES FILHO, VIVIANE SILVA SIQUEIRA, ANELISE RIBEIRO PEIXOTO ALENCAR, FABRÍCIO PASSADOR SANTOS, ANDRESA BORGES SOARES, RUFINO KLUG




http://ift.tt/2v4eFS0

AN UNUSUAL PRESENTATION OF FACIAL INFILTRATING LIPOMATOSIS

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2
Author(s): MARIANNA SAMPAIO SERPA, ANA PAULA MOLINA VIVAS, MATHEUS HENRIQUE ALVES DE LIMA, RENATA MENDONÇA MORAES, JOSÉ SATURNINO DA SILVA, FELIPE D'ALMEIDA COSTA, FÁBIO ABREU ALVES




http://ift.tt/2tIpeXx

ESTOMATONET: TELEDIAGNOSIS IN ORAL MEDICINE IMPROVING THE ACCESS OF PRIMARY CARE PATIENTS TO SPECIALIZED TREATMENT

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2
Author(s): VINICIUS COELHO CARRARD, MICHELLE ROXO GONÇALVES, JÉSSICA RODRIGUEZ STREY, CARLOS PILZ, MARCELO RODRIGUES GONÇALVES, MARCO ANTONIO TREVIZANI MARTINS, ERNO HARZHEIM




http://ift.tt/2v4bZnl

ORAL METASTATIC BREAST ADENOCARCINOMA IN A MALE PATIENT

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2
Author(s): NATHALIA DE ALMEIDA FREIRE, NATHALIE HENRIQUES DA SILVA CANEDO, MICHELLE AGOSTINI, BRUNO AUGUSTO BENEVENUTO DE ANDRADE, MÁRIO JOSÉ ROMAÑACH




http://ift.tt/2tIr22o

ORAL MANIFESTATION OF MUCORMYCOSIS IN A BONE MARROW TRANSPLANTED PATIENT

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2
Author(s): BERNAR MONTEIRO BENITES, FELIPE PAIVA FONSECA, CLAUDIA PARAHYBA JOFFILY, YANA AUGUSTA SARKIS NOVIS, SERGIO SAMIR ARAP, RAFAEL SARLO VILELA, EDUARDO RODRIGUES FREGNANI




http://ift.tt/2v4D3D4

ODONTOGENIC CARCINOMA WITH DENTINOID: A CASE REPORT OF AN UNUSUAL MALIGNANT TUMOR

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2
Author(s): ROGERIO GONDAK, KATYA PULIDO DÍAZ, MARISOL MARTÍNEZ MARTÍNEZ, LEANDRO AURELIO LIPORONI MARTINS, PABLO AGUSTIN VARGAS, ADALBERTO MOSQUEDA-TAYLOR




http://ift.tt/2tHYOVF

FIRST AND FATAL MANIFESTATION OF ACQUIRED IMMUNODEFICIENCY SYNDROME

Publication date: August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 2
Author(s): DANIELA ASSIS DO VALE, DANIELLE LIMA CORRÊA DE CARVALHO, MARÍLIA TRIERVEILER, KAREM LÓPEZ ORTEGA




http://ift.tt/2v4zg8z

Photobiomodulation therapy by NIR laser in persistent pain: an analytical study in the rat

Abstract

Over the past three decades, physicians have used laser sources for the management of different pain conditions obtaining controversial results that call for further investigations. In order to evaluate the pain relieving possibilities of photobiomodulation therapy (PBMT), we tested two near infrared (NIR) laser systems, with different power, against various kinds of persistent hyperalgesia animal models. In rats, articular pain was reproduced by the intra-articular injection of sodium monoiodoacetate (MIA) and complete Freund's adjuvant (CFA), while compressive neuropathy was modelled by the chronic constriction injury of the sciatic nerve (CCI). In MIA and CFA models, (NIR) laser (MLS-Mphi, ASA S.r.l., Vicenza, Italy) application was started 14 days after injury and was performed once a day for a total of 13 applications. In MIA-treated animals, the anti-hyperalgesic effect of laser began 5 min after treatment and vanished after 60 min. The subsequent applications evoked similar effects. In CFA-treated rats, laser efficacy started 5 min after treatment and disappeared after 180 min. In rats that underwent CCI, two treatment protocols with similar fluence but different power output were tested using a new experimental device called Multiwave Locked System laser (MLS-HPP). Treatments began 7 days after injury and were performed during 3 weeks for a total of 10 applications. Both protocols reduced mechanical hyperalgesia and hindlimb weight bearing alterations until 60 min after treatment with a higher efficacy recorded for the animals treated using the higher power output. In conclusion, this study supports laser therapy as a potential treatment for immediate relief of chronic articular or neuropathic pain.

http://ift.tt/2v4eLJn

Cytoskeleton, intercellular junctions, planar cell polarity, and cell movement in amelogenesis

Publication date: Available online 27 July 2017
Source:Journal of Oral Biosciences
Author(s): Sumio Nishikawa
BackgroundTooth enamel is composed of highly mineralized rods surrounded by interrod crystals that are formed by ameloblasts derived from dental epithelium. Secretory ameloblasts migrate during hard tissue formation, both away from the dentin and in groups that slide past each other, resulting in rod decussation. Enamel rod decussation is commonly observed in many animal teeth including humans.HighlightCytoskeleton fibers, such as microtubules, intermediate filaments, and actin filaments, are associated with ameloblast movement. Rat incisor enamel is composed of initial, inner, outer, and final layers. Secretory ameloblasts forming the inner enamel layer move laterally and have proximal and distal junctional complexes attached to actomyosin filaments. Conversely, secretory ameloblasts forming the outer enamel layer cease lateral movement. Secretory ameloblasts forming the inner layer are characterized by anisotropic distribution of adherens junctions, desmosomes, and actomyosin filaments in transverse distal junctional complexes. Isotropic distribution is observed in distal junctional complexes in secretory ameloblasts forming the outer layer. Actin cytoskeleton and junctions may act as a motor apparatus to control the sideways movement of ameloblasts. However, the mechanism that determines whether secretory ameloblasts forming the inner layer move medially or laterally is unclear. One potential group of proteins that may be involved in this process is the core planar cell polarity (PCP) proteins.ConclusionOne core PCP protein, VANGL2, is proposed to be a key molecule determining the direction of ameloblast movement.



http://ift.tt/2v2FKFL

Surgical considerations and safety of cochlear implantation in otitis media with effusion

Publication date: Available online 26 July 2017
Source:Auris Nasus Larynx
Author(s): Rasit Cevizci, Alper Dilci, Fatih Celenk, Recep Karamert, Yildirim Bayazit
ObjectiveTo evaluate the effects of otitis media with effusion on surgical parameters, patient safety, perioperative and postoperative complications.MethodsTotal 890 children who underwent cochlear implantation between 2006 and 2015 were included. The ages ranged from 12 months to 63 months (mean: 32 months). The patients were divided into two groups according to the presence or absence of otitis media with effusion; otitis media with effusion group and non-otitis media group.ResultsOf 890 children, 105 had otitis media with effusion prior to surgery. In non-otitis media with group, there were 785 children. The average duration of surgery was 60min (ranged from 28 to 75min) in non-otitis media group, and 90min (ranged from 50 to 135min) in otitis media with effusion group (p<0.05). Granulation tissue and edematous middle ear and mastoid mucosa were observed in all cases of otitis media with effusion during the surgery. There was no significant difference between the complications of groups with or without otitis media with effusion (p>0.05). In 5 of 105 patients, there was a ventilation tube inserted before cochlear implantation, which did not change the outcome of implantation.ConclusionThere is no need for surgical treatment for otitis media with effusion before implantation since otitis media with effusion does not increase the risks associated with cochlear implantation. Operation duration is longer in the presence of otitis media with effusion. However, otitis media with effusion leads to intraoperative difficulties like longer operation duration, bleeding, visualization of the round window membrane, cleansing the middle ear granulations as well as mastoid and petrous air cells.



http://ift.tt/2v3TU8S

Endoscopic contralateral transmaxillary approach for pterygoid process osteotomy in total maxillectomy: A technical case report

Publication date: Available online 26 July 2017
Source:Auris Nasus Larynx
Author(s): Toyoyuki Hanazawa, Kazuki Yamasaki, Hideaki Chazono, Yoshitaka Okamoto
An approach for total maxillectomy with endoscopic transection of the pterygoid process via the contralateral maxillary sinus is described. In total maxillectomy, the resection of the pterygoid process of the sphenoid is a key step for successful resection. However, a conventional craniofacial approach requires extensive incision in the face, elevation of the lateral cheek flap. Even after elevation of the lateral cheek flap, visualization of this region is not good. An endoscopic approach through the contralateral maxillary sinus improved visualization of the pterygoid process, and osteotomy using a diamond-drilling bar was successfully performed. This technique has the potential to widen the indication for total maxillectomy in malignant neoplasms of the maxillary sinus.



http://ift.tt/2v3TTSm

Management of perioperative laryngospasm by French paediatric anaesthetists

Editor—Perioperative laryngospasm is a life-threating emergency in paediatric patients. A recent multicentre study of children undergoing surgery¹ found a high rate of severe critical events during the perioperative period (5.2%), with an incidence of respiratory critical events of 3.1%. Laryngospasm was one of most frequent respiratory complications (0.2–6.7%). Its effective management requires appropriate diagnosis, followed by prompt and aggressive management. The use of a structured algorithm would lead to earlier recognition and better management.² We undertook a survey in order to explore the practical management of laryngospasm by French paediatric anaesthetists.

http://ift.tt/2eRUPDu

Electroencephalography and delirium in the postoperative period

Abstract

Delirium commonly manifests in the postoperative period as a clinical syndrome resulting from acute brain dysfunction or encephalopathy. Delirium is characterized by acute and often fluctuating changes in attention and cognition. Emergence delirium typically presents and resolves within minutes to hours after termination of general anaesthesia. Postoperative delirium hours to days after an invasive procedure can herald poor outcomes. Easily recognized when patients are hyperactive or agitated, delirium often evades diagnosis as it most frequently presents with hypoactivity and somnolence. EEG offers objective measurements to complement clinical assessment of this complex fluctuating disorder. Although EEG features of delirium in the postoperative period remain incompletely characterized, a shift of EEG power into low frequencies is a typical finding shared among encephalopathies that manifest with delirium. In aggregate, existing data suggest that serial or continuous EEG in the postoperative period facilitates monitoring of delirium development and severity and assists in detecting epileptic aetiologies. Future studies are needed to clarify the precise EEG features that can reliably predict or diagnose delirium in the postoperative period, and to provide mechanistic insights into this pathologically diverse neurological disorder.

http://ift.tt/2h7iPTH

Abstracts for Spring BJA Research Forum meeting, Royal College of Anaesthetists, London, 5th and 6th April 2017

(The authors of all the following abstracts have confirmed that their research received ethics committee approval or was conducted under the Animal (Scientific Procedures) Act (1986) or equivalent.)

http://ift.tt/2eRUO2o

Frequency of surgical treatment and related hospital procedures in the UK: a national ecological study using hospital episode statistics

Abstract

Background: Despite evidence of high activity, the number of surgical procedures performed in UK hospitals, their cost and subsequent mortality remain unclear.Methods: Time-trend ecological study using hospital episode data from England, Scotland, Wales and Northern Ireland. The primary outcome was the number of in-hospital procedures, grouped using three increasingly specific categories of surgery. Secondary outcomes were all-cause mortality, length of hospital stay and healthcare costs according to standard National Health Service tariffs.Results: Between April 1, 2009 and March 31, 2014, 39 631 801 surgical patient episodes were recorded. There was an annual average of 7 926 360 procedures (inclusive category), 5 104 165 procedures (intermediate category) and 1 526 421 procedures (restrictive category). This equates to 12 537, 8073 and 2414 procedures per 100 000 population per year, respectively. On average there were 85 181 deaths (1.1%) within 30 days of a procedure each year, rising to 178 040 deaths (2.3%) after 90 days. Approximately 62.8% of all procedures were day cases. Median length of stay for in-patient procedures was 1.7 (1.3–2.0) days. The total cost of surgery over the 5 yr period was £54.6 billion ($104.4 billion), representing an average annual cost of £10.9 billion (inclusive), £9.5 billion (intermediate) and £5.6 billion (restrictive). For each category, the number of procedures increased each year, while mortality decreased. One-third of all mortalities in national death registers occurred within 90 days of a procedure (inclusive category).Conclusions: The number of surgical procedures in the UK varies widely according to definition. The number of procedures is slowly increasing whilst the number of deaths is decreasing.

http://ift.tt/2h7d5cJ

How powerful is failure to rescue as a global metric? Not as powerful as a commitment to measurement

In a much-discussed study published in 2009, Dr Ghaferi and colleagues¹ revived the concept, originally described in the early 1990s by Jeffrey Silber and colleagues,² of 'failure to rescue'. Ghaferi and colleagues¹ used a prospective, multicentre clinical registry organized by the American College of Surgeons (ACS-NSQIP) to rank hospitals by mortality quintiles. They then evaluated adverse events and noted that across the different mortality quintiles the risk of an adverse event was remarkably consistent. What differed with respect to mortality was not so much the likelihood of a complication, but the ability of a hospital to 'save' a patient who experienced a complication. Hospitals in the lowest mortality quintile had very similar rates of both minor and major complications to those in the highest mortality quintile, yet had half the rates of death. They concluded that 'failure to rescue' patients with complications in the higher mortality quintiles represented an opportunity for improvement; it was not the complications per se that killed patients, but the inability to quickly recognize and respond to their deterioration.

http://ift.tt/2eSfKGl

Simulated emergency cricothyroid incision length

Editor—The revised 2015 Difficult Airway Society (DAS) guidelines for the 'unanticipated difficult airway' include a standardized approach to performance of emergency front-of-neck access in the 'can't intubate, can't oxygenate' (CICO) scenario.¹ We have subsequently changed how we educate colleagues in the management of a CICO scenario using the surgical technique as part of our airway update days and on the Aintree Difficult Airway Management course.

http://ift.tt/2h6Wu92

Delirium, what’s in a name?

Delirium has been known since ancient times. Hippocrates [460–370 Before Common Era (BCE)] may have been the first to describe the syndrome that he called 'phrenitis', marked by confusion and restlessness that fluctuated unpredictably and that was associated with physical illness.¹ Many other names have been used, including acute mental status change, confusional state, confusion, acute brain dysfunction, brain failure, encephalopathy, postoperative psychosis and acute organic syndrome.¹ Of these, the term delirium (derived from the Latin word delirare, deviate from a straight track) has gained acceptance. Besides a more uniform terminology, an important recent achievement includes publication of criteria to define delirium. Although criticized,²³ the criteria of the Diagnostic and Statistical Manual of Mental Disorders (5th edition, DSM-5) have become standard.⁴ According to these criteria, a patient can be considered delirious when all items listed in Table 1 are present at the same time.⁴ In essence, this means that a patient has acutely developed disturbed attention with other cognitive deficits, which is not solely due to underlying dementia and is caused by a physical condition. Table 1Criteria for delirium according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)⁴

• A. A disturbance in attention (i.e. reduced ability to direct, focus, sustain and shift attention) and awareness (reduced orientation to the environment).
• B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.
• C. An additional disturbance in cognition (e.g. memory deficit, disorientation, language, visuospatial ability or perception).
• D. The disturbances in Criteria A and C are not better explained by another pre-existing, established or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma.
• E. There is evidence from the history, physical examination or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e. due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple aetiologies.

http://ift.tt/2h7oysD

Topics for the national audit projects of the Royal College of Anaesthetists

Editor—Moppett and colleagues¹ provide a very fair assessment of the value of the national audit projects (NAPs) performed in the UK during the last decade. However, I would question their statement that the choice of topics for the third and fourth projects performed by the Royal College of Anesthetists (NAP3 and NAP4) was 'in part serendipitous, as a result of the coincidence of the desires of the specialist societies (Pain and Difficult Airway) and the Royal College of Anaesthetists'. The subjects for both audits were discussed at meetings of College Council and, as a member of that group at the time, I remember no input from any society.

http://ift.tt/2h6B0sK

Postoperative delirium portends descent to dementia

Many elderly patients worry that their thinking will be impaired after surgery. Concerns include acute confusion in the days to weeks following surgery, as well as persistent cognitive deficits lasting months to years.¹ Both postoperative delirium (POD) and delayed neurocognitive recovery lasting months after surgery are common in older adults, but reports of non-resolving cognitive decline or neurocognitive disorders (NCDs) are inconsistent.²³ The acute onset inattention and disorganized thinking characteristic of POD often manifest between one and four days after surgery.⁴ Delayed neurocognitive recovery is a subtle NCD that typically lasts weeks to months following surgery. Although transient, both disorders can significantly impact recovery. Patients with POD have increased morbidity and mortality, longer Intensive Care Unit (ICU) stays, decreases in quality of life and are likely to be vulnerable to delayed neurocognitive recovery.⁵⁶ While the pathophysiology of delirium remains unclear, it has been linked with NCDs and dementia in non-surgical patients,⁷ and several studies have suggested that POD may be a risk factor for non-resolving minor and even major NCD (or incident dementia).⁸⁹ In this issue of the British Journal of Anaesthesia, the retrospective cohort studies by Sauër and colleagues¹⁰ and Sprung and colleagues¹¹ investigate the association between POD and persistent NCDs; the conflicting results highlight the difficulties in studying postoperative cognition.

http://ift.tt/2h7oDNg

In This Issue

http://ift.tt/2h7vBl2

Post-anaesthesia care unit delirium: incidence, risk factors and associated adverse outcomes

Delirium is a sudden disturbance in attention and orientation to the environment that develops over a short period of time and tends to fluctuate in severity during the course of the day.¹ The acute confusional state of delirium occurs in 50–80% of critically ill patients and postoperatively (from the day after surgery onwards) in up to 54% of elective major non-cardiac surgical patients.¹ It incurs a huge societal burden, because of, in part, a result of its association with increased morbidity and mortality; each additional day of delirium has been independently associated with a 10% increased risk of death.² Increased morbidity contributes to prolonged hospital length of stay and significant financial implications: delirium is estimated to total $4–16 billion annually.³ Its association with long-term neuropsychological and cognitive deficits^4–7 mandates a better understanding of the pathogenesis of delirium⁸ and the mechanisms underlying the prolonged disruption of cognitive processing.⁹ Despite these apparent strong associations, it remains unclear whether delirium identified in the post-anaesthetic care unit (PACU) or recovery unit is associated with similar outcomes. For anaesthetists, this is a critical question that remains unanswered. Indeed at least some of these events are of limited duration and hence it could be assumed they would be associated with less severe consequences. In this context, PACU delirium is differentiated from postoperative delirium as the latter occurs from the day after surgery onwards whereas the former occurs in the PACU on the day of surgery.

http://ift.tt/2eSfBCN

Approach affects injectate spread in ultrasound-guided thoracic paravertebral block: a cadaveric trial

Editor—Ultrasound-guided thoracic paravertebral block has made much progress, and various approaches have been developed in the past decade.¹ However, the differences in local anaesthetic distribution patterns are unknown. We adopted two patterns of injections, namely the intercostal approach (IC approach)² and the paralaminar in-plane approach (PL approach),³⁴ and compared their injectate spreading patterns in three Thiel-embalmed human cadavers using a dye injection method.⁵⁶ For the IC approach, a 6–13 MHz linear array transducer was placed at the T4, T5 and T9 intercostal levels to visualize the transverse process. An 18-gauge Tuohy needle was inserted from lateral to medial beside the probe to penetrate the internal intercostal membrane next to the tip of the transverse process. For the PL approach, the needle was inserted from medial to lateral using a 5–8 MHz microconvex array transducer to visualize the lateral edge of the vertebral lamina at the T6, T7 and T10 levels. We investigated five injections by the IC approach and four injections by the PL approach using 10 ml of dye of various colours. One injection in each group included real-time, direct observation of the distribution pattern after dissection via a pre-inserted catheter 2.5 cm beyond the needle tip. Paravertebral spread was confirmed in all procedures. In the IC approach group, dye covered the respective intercostal space and the adjacent paravertebral space (PVS) (Fig. 1A), consistent with previous reports.⁷ The injected dye in the PL approach group covered the more longitudinal and medial PVS rather than the lateral intercostal space (Fig. 1B).⁸ Real-time dye injections from the catheter showed that in the IC approach dye first spread to the respective intercostal level following PVS whereas in the PL approach dye first covered the area around the sympathetic trunk followed by the intercostal area.

http://ift.tt/2h7ezUf

Predicting postoperative brain function from the blood: is there a role for biomarkers?

Loss of consciousness upon exposure to general anaesthetics reflects the powerful influence of these drugs on brain physiology. While this phenomenon is usually transient and rapidly resolves upon discontinuation of drug administration, an overwhelming number of both clinical and experimental observations suggest that even relatively short periods of anaesthesia can trigger a myriad of biochemical pathways which, in turn, can give rise to temporary or even lasting changes in neurobehavioural and cognitive function after emergence from anaesthesia.¹ Most of these functional alterations have been described as postoperative delirium or impaired cognitive performance and, therefore, have negative connotations. It is nevertheless important to note that exposure to anaesthetics can also improve both cognition and mood in some specific clinical states, such as in major depressive disorders. This context-dependent impact of anaesthetics on neuronal function probably reflects the major context-dependent modulatory influence of these drugs on neuronal plasticity.¹

http://ift.tt/2h6Wshq

Mind the gap when performing emergency front-of-neck access

Editor—Plan D of the Difficult Airway Society guidelines¹ on managing the can't intubate can't oxygenate (CICO) scenario states that a 6.0 mm cuffed tracheal tube should be railroaded over the bougie when performing scalpel cricothyroidotomy. During our departmental CICO training sessions, conducted on sheep larynxes, we have noticed that candidates have difficulties railroading the tube over the bougie (Frova Intubating Introducer, Cook Medical Ltd. Limerick, Ireland) when using a 6 mm cuffed tracheal tube. This appears to be caused by the tip of the tube catching on the airway as it is being advanced, because of the large gap between the bougie and the tube (Fig. 1A). We noted that when using a smaller 5 mm tube, railroading appeared to be easier, perhaps because the gap between the bougie and the tube is smaller (Fig. 1B). The resistance to advancing the tube over the bougie was almost negligible when using a size 5 mm Melker cuffed emergency cricothyrotomy catheter (Cook Medical Ltd, Limerick, Ireland), as this tube has a tapered tip that fits snugly over the bougie (Fig. 1C).

http://ift.tt/2h7HCXE

Using a worldwide in-app survey to explore sugammadex usage patterns: a prospective observational study

Editor—Via encapsulation, sugammadex can rapidly and completely reverse even profound neuromuscular block induced by rocuronium or vecuronium, which is not possible to achieve with cholinesterase inhibitors.^1–4 Although approved for use in Europe in 2008⁵ and available for several years elsewhere,⁶ the United States Food and Drug Administration (US FDA) delayed approval due to concerns regarding potential hypersensitivity reactions and effects on coagulation tests,⁷ which were ultimately satisfied.^8–10 We are interested in better understanding global experience with sugammadex and the impact, if any, of pharmacoeconomics on post-marketing policies. The present data were analysed from an ongoing, Institutional Review Board (IRB)-approved (Emory University, Atlanta, GA, USA, IRB# 00082571) study of a globally utilized anaesthesia calculator app for the Android platform ('Anesthesiologist')¹¹¹² fitted with a module capable of collecting survey data and app analytics.¹³ We used this tool to deploy a survey assessing global patterns of clinical practice and experience with sugammadex.

http://ift.tt/2eRSfNJ

The Princes of Serendip

Editor—We thank Professor Wildsmith¹ for his interest in our editorial² and for clarifying aspects of the process around NAP3.³

http://ift.tt/2h7oYzr

Availability of critical care services in Taiwan under National Health Insurance

Editor—Since the implementation of Taiwan's National Health Insurance (NHI) programme in 1995, use of health-care services has significantly increased.¹ This is also true for the use of mechanical ventilation and extracorporeal membrane oxygenation.²³ In contrast, information is limited about use of intensive care unit (ICU) beds.⁴ We conducted this study to investigate the availability of the critical care service in Taiwan under the NHI programme.

http://ift.tt/2h7vztq

Abstracts from the BJA Research Forum Glasgow, November 10–11, 2016

(The authors of all the following abstracts have confirmed that their research received ethics committee approval or was conducted under the Animal (Scientific Procedures) Act (1986) or equivalent.)

http://ift.tt/2eRJsv6

Ultrasound-guided central venous catheterization in the prone position

Editor—Central venous catheterization for patients positioned prone poses challenges to the anaesthesiologist, such as anatomical restrictions in head and neck position, lack of anatomical landmark points to approach, and difficult right internal jugular vein (RIJV) needle advancement with the left hand. Here we present an approach for RIJV catheterization in a patient positioned prone using in-plane needle ultrasound guidance.

http://ift.tt/2h7Hck2

Association between delirium and cognitive change after cardiac surgery

Abstract

Background. Previous studies provide inconsistent data on whether postoperative delirium (POD) is a risk factor for postoperative cognitive decline (POCD). We thus investigated the relationship between POD and cognitive change after cardiac surgery and assessed the relationship between preoperative cognitive domain scores and POD.Methods. Postoperative delirium was assessed with the Confusion Assessment Method (CAM) adapted for the intensive care unit and the conventional CAM accompanied by chart review. Cognitive function was assessed with a neuropsychological test battery before elective cardiac surgery and 1 month and 1 yr afterwards. Cognitive change was calculated using the Reliable Change Index (RCI). Multiple linear regression was used to adjust for confounding.Results. Of the 184 patients who completed baseline assessment, 23 (12.5%) developed POD. At 1 month, the decline in cognitive performance was worse in patients with POD [median composite RCI −1.00, interquartile range (IQR) −1.67 to 0.28] than in patients without POD (RCI −0.04, IQR −0.70 to 0.63, P=0.02). At 1 yr, both groups showed cognitive improvement on average compared with baseline (POD patients median composite RCI 0.25, IQR −0.42 to 1.31, vs non-POD patients RCI 0.92, IQR 0.18–1.53; P=0.08). Correction for differences in age and level of education did not change the results. Patients with POD performed less well than patients without POD on the preoperative Trailmaking test part A (P=0.03).Conclusions. Postoperative delirium is independently associated with cognitive decline 1 month after surgery, but cognitive performance generally recovers in 1 yr. Patients with a predisposition to POD can be identified before surgery by worse performance in an attention task.Clinical trial registration. NCT00293592.

http://ift.tt/2eSNdAK

Epstein-Barr virus-positive ileal carcinomas associated with Crohn’s disease

http://ift.tt/2v3VCqX

Two- versus Three-Point Internal Fixation of Displaced Zygomaticomaxillary Complex Fractures

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1604199

Despite the high frequency of the zygomaticomaxillary complex (ZMC) fractures, there is no consensus among facial reconstructive surgeons regarding the best surgical management; thus, surgical choice for ZMC fractures is still challenging. This study included 40 patients with displaced ZMC fracture. Twenty patients were treated with open reduction and internal fixation (OR/IF) using two-point fixation technique (at infraorbital margin and zygomaticofrontal buttress region) and the remaining 20 patients were treated with OR/IF using three-point fixation technique (at frontozygomatic suture, infraorbital margin, and zygomatico maxillary buttress). The results of both types of ZMC fractures repair were then statistically compared. No statistical differences between the two types regarding malar eminence asymmetry; projection (forward displacement) and width (medial displacement) in axial CT; inferior displacement; superior displacement and width (medial displacement) in coronal CT; angle of displacement (outward displacement) in 3D CT; masseter and temporalis muscles power electromyography; actual duration of surgery; and patient satisfaction. On the other hand, the total cost of the used plates and screws was significantly higher with three-point repair than two-point repair (p = 0.003). Moreover, postoperative CT lateral zygoma displacement was statistically significantly better in three-point fixation. Two-point fixation modality for displaced ZMC fractures is as effective as three-point method in fixation and prevents postreduction rotation or clinical displacement with significantly lower cost.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2w4hTCi

Engraftment and Repopulation Potential of Late Gestation Fetal Rat Hepatocytes.

Background: The limited availability of donor organs has led to a search for alternatives to liver transplantation to restore liver function and bridge patients to transplantation. We have shown that the proliferation of late gestation (embryonic day 19; ED19) fetal rat hepatocytes is mitogen-independent, and that mechanisms regulating of mRNA translation, cell cycle progression and gene expression differ from those of adult rat hepatocytes. In the present study, we investigated whether E19 fetal hepatocytes can engraft and repopulate an injured adult liver. Methods: Fetal hepatocytes were isolated using a monoclonal antibody against a hepatic surface protein, leucine amino peptidase (LAP). LAP+ and LAP- fractions were analyzed by immunofluorescence and microarray. Immunopurified E19 liver cells from DPPIV+ rats were transplanted via splenic injection into partial hepatectomized DPPIV- rats that had been pretreated with mitomycin C. Results: More than a third of LAP+ fetal hepatocytes expressed ductal markers. Transcriptomic analysis revealed that these dual expressing cells represent a population of less well differentiated hepatocytes. Upon transplantation, LAP+ late gestation fetal hepatocytes formed hepatic, endothelial and ductal colonies within 1 month. By 10 months, colonies derived from LAP+ cells increased so that up to 35% of the liver was repopulated by donor-derived cells. Conclusions: Late gestation fetal hepatocytes, despite being far along in the differentiation process, possess the capacity for extensive liver repopulation. This is likely related to the unexpected presence of a significant proportion of hepatocyte marker-positive cells maintaining a less well differentiated phenotype. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2eS4F8k

Mounting Clinical Evidence with Tacrolimus Generic Products.

No abstract available

http://ift.tt/2h6FjnZ

Fatal Septic Shock Triggered by Donor Transmitted Varicella Zoster Virus Reinfection 3 Days After Lung Transplantation.

No abstract available

http://ift.tt/2eS5VIt

Occlusion Guided Double-Barreled Fibular Osteoseptocutaneous Free Flap for Refined Mandibular Reconstruction Aided by Virtual Surgical Planning.

Background: There were many articles about double-barreled fibular flap for mandibular reconstruction. The upper layer bone was suit for implant placement as a new alveolar. The lower layer was necessary for contour. But the accurate relationship between the 2 layers bone was rarely reported. Objectives: The purpose of this study was twofold: to evaluate the feasibility of the novel design of the double-barreled fibular flap from virtual surgery to actual result; to evaluate the accuracy and results of occlusion-guided double-barreled fibular free flap in mandible reconstruction. Methods: From 2010 to 2016, 52 patients underwent segmental mandibular reconstruction with double-barreled fibular osteoseptocutaneous flaps with computer aided design/computer aided manufacturing technique. Preoperative computer tomographic (CT) scans were imported into Mimics 10.01 software (Materialise, Leuven, Belgium) for surgical planning. The peroneal vessel pedicel was designed at the lower barrel segmental bone of the double-barreled fibular flap. The double-barreled bone was strung with 16 mm fixation screws instead of mini-plate. Sixty-three dental implants placement was simultaneous in 30 patients and 32 dental implants placement was in second stage in 18 patients. Postoperative CT and digital imaging were evaluated to assess surgical accuracy using software. The pre- and postoperative morphometric measurements were compared using the Fisher exact t test. Results: Two flaps occurred vascular crisis postoperatively. There was no flap necrosis. Four implants failed during 1 to 5 weeks postoperative. Sixty-six CT scans from 33 patients who underwent partial mandibular resection were analyzed. The dimensions of the double-barreled fibula segments after osteotomy showed no difference from the preoperative virtual surgical planning (VSP). But the condylar locations showed a disposition out of the fossa (P

http://ift.tt/2vcetRy

Bevacizumab for the Treatment of Gammaknife Radiosurgery-Induced Brain Radiation Necrosis.

Background: Radiation necrosis is one of the complications of Gammaknife radiosurgery. The traditional treatment of radiation necrosis carries a high risk of failure, Bevacizumab is an antiangiogenic monoclonal antibody against vascular endothelial growth factor, a known mediator of cerebral edema. It can be used to successfully treat brain radiation necrosis. Patient Description: Two patients with a history of small cell lung cancer presented with metastatic disease to the brain. They underwent Gammaknife radiosurgery to brain metastases. Several months later, magnetic resonance imaging showed radiation necrosis with significant surrounding edema. The patients had a poor response to treatment with dexamethasone. They were eventually treated with bevacizumab (5 mg/kg every 2 weeks, 7.5 mg/kg every 3 weeks, respectively), and the treatment resulted in significant clinical and radiographic improvement. Conclusion: Bevacizumab can be successfully used to treat radiation necrosis induced by Gammaknife radiosurgery in patients with cerebral metastases. It is of particular benefit in patients with poor reaction to corticosteroids and other medications. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2v3KLxh

Angle-to-Angle Mandibular Defect Reconstruction With Fibula Flap by Using a Mandibular Fixation Device and Surgical Navigation.

Purpose: Although free fibula flaps are widely used for mandibular reconstruction, 3-dimensional (3D) position is difficult to control in angle-to-angle mandibular defects. The present study describes a revised approach for angle-to-angle mandibular reconstruction with fibula flaps by using mandibular fixation device and surgical navigation. Methods: Preoperative maxillofacial and fibular computed tomography (CT) scans were acquired, and CT data were imported into ProPlan CMF software. Virtual mandibulectomy was performed, and 3D fibula image was superimposed on the mandibular defect. The fibula flap was shaped according to virtual parameters and the stereo model. Surgical navigation was used to check and correct shaped segments. Position of the osteotomy lines and relevant parameters regarding the shape of the fibula flap were provided to the surgeon. A mandibular fixation device (Cibei, China) was fixed to bilateral mandibular ramus before mandibulectomy, which maintained normal mandibular width. Under computer navigation guidance, the fibula flap was accurately positioned in 3D direction, and the defect could be precisely reconstructed despite the lack of stable occlusal relationship after osteotomy. Results: Postoperative CT and 3D error analysis revealed that osteotomy lines and reconstruction contour matched well with preoperative planning. Using our method, we precisely recovered the original configuration of the mandible. Bilateral condyles were located in the temporomandibular joint fossae, and normal mandibular width was maintained. Compared with preoperative positions, the average shift on the remaining mandible was 0.803 +/- 0.502 mm (largest, 1.886 mm). Average shift in the reconstructed mandible was 0.281 +/- 0.300 mm, largest being 2.441 mm. Conclusions: We describe a novel method for angle-to-angle mandibular reconstruction with free fibula flap. A mandibular fixation device combined with computer-assisted techniques involving surgical navigation improved clinical outcomes of this procedure. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2tHu2fF

Computed Tomography Research: Relative Anatomy of Caldwell-Luc Approach in Pterygopalatine Fossa Surgery.

With the development of endoscopic technique, Caldwell-Luc approach has more wide applications and becomes a common method of pterygopalatine fossa (PPF) surgery. Few data can be used in this approach to avoid injuring the vessels and nerves within this area. In this study, the authors used computed tomography to get the coordinates of inferior orbital fissure, foramen rotundum, sphenopalatine foramen, internal opening of pterygoid canal, the strangulation of PPF, and the greater palatine foramen with canine fossa as the origin. Parameters of 60 patients (120 observations) between 35 and 55 years who have no experience of trauma or surgery before were involved in this study. The data were analyzed by SPSS, statistical software with the comparison between sexes and sides. After calculating the relative distances and angles between these points and canine fossa, the authors get the proportions of the upper part of PPF, and the pterygopalatine canal to PPF, respectively. The authors finally got the safety surgical range. The results are meaningful to safety in surgery and complication avoidance, which can be great references in clinical applications. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2v3CFot

The Effect of Microvascular Decompression on Hemifacial Spasm With Atherosclerosis of Vertebral Artery.

Background: Microvascular decompression (MVD) is the most useful treatment for hemifacial spasm (HFS). In patients of vertebral artery (VA) compression of the facial nerve, MVD is often difficult. Many of the VA are obviously atherosclerotic. In this study, the authors retrospectively compared the effect of MVD for HFS associated with the atherosclerosis of vertebral artery (aVA) with that of MVD for HFS with normal vertebral artery (nVA). Methods: A retrospective study of HFS treated by MVD was conducted between January 2014 and October 2015. There were 186 patients with VA-associated HFS who underwent their first MVD at the authors' institution. Among them, 52 patients of HFS were associated with aVA and 134 patients were associated with nVA. Results: At 1 day, 7 days, 1 month, 3 months, and 1 year after MVD surgery, in aVA group, the effective rate of MVD was 80.77%, 80.77%, 82.00%, 79.59%, and 82.61%, the incidence rate of complication was 15.83%, 13.46%, 14.00%, 12.24%, and 10.87%; in nVA group, the effective rate of operation was 94.03%, 94.78%, 95.42%, 94.53%, and 95.12% (P

http://ift.tt/2tHLMra

Reconstruction of Large Postburn Facial-Scalp Scars by Expanded Pedicled Deltopectoral Flap and Random Scalp Flap: Technique Improvements to Enlarge the Reconstructive Territory.

The scars of face and scalp caused by burning often show as 1 large facial-scalp scar. The deltopectoral flap was recognized as one of the first choices for the facial scar reconstruction. However, this flap cannot cross the level of zygomatic arch traditionally when it was transferred with pedicle. When the flap reconstructed the facial-scalp scars with expanded random scalp flap, another flap was often needed to reconstruct the remaining temple and forehead scars. The authors reviewed 24 patients of large facial-scalp scars reconstructed by expanded pedicled deltopectoral flap and scalp flap with several technique improvements. The seaming scar between the deltopectoral flap and scalp flap in the temple region formed the new hairline. The technique improvements included ligation of the perforating branches of the transverse cervical artery and thoracoacromial artery when dissecting the pocket, the partial bolster compressive dressing to the distal part of the flap and dividing the pedicle partly as a delaying procedure before dividing the pedicle completely. Good skin compliance, normal contours, and emotional expression were noted. There were complications including expander exposure in 3 patients, stretch marks in 5 patients, flap tip necrosis in 2 patients, and mild postoperative hypertrophic scars in 3 patients. In conclusion, the expanded pedicled deltopectoral flap can enlarge the reconstructive territory in face successfully with the technique improvements. The combination of the expanded pedicled deltopectoral flap and scalp flap is a reliable and excellent reconstructive option for large postburn facial-scalp scars. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2v3ZBnc

Three-Dimensional Imaging Anatomic Study and Clinical Application of the Third Ventricle Transcallosal-Transforniceal Approach.

The third ventricle is a narrow, funnel-shaped, unilocular, midline cavity located between the 2 thalami, under the body of the lateral ventricle, in the center of the head. Damaging of brain tissue in the third ventricle when conducting operation under the microscope will lead to serious consequence. The study aimed to precisely detect the relative location of specific structures on the approach to the third ventricle. The authors rebuilt a 3-dimensional reconstruction of the brain and selected specific sections and then measured several crucial distance, angle to precisely assure the approaching pathway and localize the hypothalamic sulcus, interthalamic adhesion, anterior commissure, optic chiasm, and pineal body. In the study, canthomeatal line was used as base line to measure angle. Parameters were obtained from 58 samples (22 males and 36 females) between 21 and 76 years old. Means and standard deviation were calculated as well as the 95% confidence interval for the mean value of the measured data. The data were analyzed by SPSS, statistical software with the comparison between sexes and sides. The results could be reference for clinical and anatomic utilities. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2tHCsn3

Effect of Preserving the Pituitary Stalk During Resection of Craniopharyngioma in Children on the Diabetes Insipidus and Relapse Rates and Long-Term Outcomes.

Objective: The objective of this study was to investigate the effect of preserving an infiltrated pituitary stalk during the resection of craniopharyngioma of pituitary stalk origin on postoperative outcomes and thus provide a theoretical basis for microsurgical treatment and prognosis. Methods: We screened the clinical data of all 103 pediatric patients with craniopharyngioma undergoing surgical treatment at our department between January 2006 and January 2013 and conducted a retrospective analysis of 82 patients with craniopharyngioma originating in the pituitary stalk. The patients were followed up from 12 months to 8 years. We analyzed the effect of preserving the pituitary stalk on the early and persistent diabetes insipidus rates, postoperative relapse rate, and mortality. Results: In the total resection group (n = 67), the early and persistent diabetes insipidus rates were significantly lower in the 46 patients (68.7%) with a pituitary stalk than in those whose pituitary stalk was removed (P 0.05). In the subtotal resection group (n = 15), a significant difference was observed in the early and persistent diabetes insipidus rates (P 0.05). Conclusions: For children with craniopharyngioma of pituitary stalk origin, preserving the pituitary stalk has a significant effect on the early and persistent diabetes insipidus rates. When intraoperative exploration showed excessive adhesion between the tumor and pituitary stalk, we opted to preserve the pituitary stalk, which significantly reduced the early and persistent postoperative diabetes insipidus rates, without significantly increasing the relapse or mortality rate. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2v3KIBG

Postnatal Development of the Spheno-occipital Synchondrosis: A Histological Analysis.

The spheno-occipital synchondrosis (SOS) in cranial base is an important growth center for the craniofacial skeleton, and also is a guide rail for development of the maxilla, midface, and mandible. Previous studies showed that SOS may be a treatment target for youngsters with midfacial hypoplasia and small cranial vault secondary to craniosynostosis. However, most of studies about the SOS are based on imaging data. In this study, we try to explore the characteristics of postnatal development of the mouse SOS based on histological analysis. Our findings showed that the width of the SOS in mice were gradually decreased from newborn mice to adult mice, and the SOS cartilage was gradually became small, then almost completely ossificated in adult mice. The resting and proliferative layers in SOS cartilage were gradually decreased, and almost only hypertrophic chondrocytes while no resting and proliferative layer chondrocytes in adult mice. The proliferative ability of SOS chondrocytes also gradually decreased. These findings will be of benefit for the further clinical treatment for patients with midfacial hypoplasia or small cranial vault secondary to craniosynostosis. Further evidence-based research about the clinical implication is necessary in future. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2tHz4sE

Three-Dimensional Radiologic Study on Index Measurement of Endonasal Endoscopic Optic Nerve Decompression.

Objective: To provide the radiologic basis for the clinical application of endonasal endoscopic optic nerve decompression (EEOND). Methods: CTA images were used to observe the optic canal (OC) and related structures of 60 patients (120 sides) with normal nasal, paranasal sinuses, OC, and other related structures. Results: Optic canal could be classified as: the canal (10 sides, 8.33%), the semicanal (25 sides, 20.83%), the impression (49 sides, 40.83%), and the nonimpression (36 sides, 30%). According to its relationships with the sinuses, OC could be further typed as: ethmoid sinus (22 sides, 18.3%), sphenoid sinus (38 sides, 31.7%), ethmoid and sphenoid sinus (60 sides, 50%). The thickness of OC medial wall is about 1.11 +/- 0.24 mm at orbital mouth, 0.87 +/- 0.25 mm at middle part and 1.19 +/- 0.27 mm at cranial mouth. The arc length of OC bone wall which can be opened from the sinus cavity is about 7.18 +/- 0.76 mm at orbital mouth, 8.27 +/- 0.93 mm at middle part, and 6.98 +/- 0.89 mm at cranial mouth. The length of the OC medial wall is 12.18 +/- 1.35 mm. In the three-dimensional Cartesian coordinate system that origined with the last point of middle turbinate root and oriented by temporal side, front side, and superior side, the coordinates of midpoints of OC medial wall are: (3.64 +/- 1.11, 8.48 +/- 1.65, 23.14 +/- 2.67) at orbital mouth, (0.16 +/- 1.21, 3.99 +/- 1.80, 24.85 +/- 2.67) at middle part, and (-3.59 +/- 1.22, 0.77 +/- 2.13, 26.39 +/- 2.68) at cranial mouth. One length unit on the axes is a millimeter. Conclusion: Computed tomography (CT) scanning technique can measure the data of the OC in EEOND. It has great guiding significance for clinical operation. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2v3A51I

Optic Canal Decompression With Unexpected Changes in Cerebrospinal Fluid of the Optic Canal.

Optic neuritis is a common inflammatory disease of the optic nerve. And the cerebral spinal fluid (CSF) in the subarachnoid space of optic nerve is thought to be homogeneous as in spine. We report a case of optic neuritis, some unexpected opaque fluid observed to flow out from the optic canal during the optic canal decompression surgery when the CSF in spine is normal. One day after the surgery, the visual acuity of the patient improved dramatically to 0.4 from 0.05. This report highlights the possible restrictive pathological changes of the CSF in the optic nerve of acute optic neuritis, which may be the reason of the dysfunction of the optic nerve. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2tHnw8K

A Rare Eyeball Luxation After Cranioplasty and a Four-Year Follow-Up.

A rare patient of reducible eyeball luxation after cranioplasty in a child Crouzon syndrome was reported. To remedy the patient's chronic intracranial hypertension and brachycephaly, orbitofrontal advancement and cranial vault remodeling were carried out. About 25 days of postoperation, an acute eyeball luxation was observed, with the presence of a subcutaneous accumulation of liquid in the bilateral temporal regions. The dislocated eyeballs were brought back by applying gentle manual pressure. The patient received a conservative treatment without a tarsorrhaphy. The dislocation recurrence never occurred again. In a 4-year follow-up, it was shown that the child's vision was normal and proptosis was improved by series craniofacial reconstructions. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2v3Ibak

Treatment of Children With Congenital Severe Blepharoptosis by Frontalis Aponeurosis Flap Advancement Under General Anesthesia in a Single Incision.

Purpose: This study aimed to investigate the effect of frontalis aponeurosis flap advancement in children with congenital severe blepharoptosis. Methods: A total of 23 cases (25 eyes) of children who had congenital severe blepharoptosis and poor levator function (

http://ift.tt/2tHLJeY

Midline Suboccipital Endoscopic Transcerebellomedullary Fissure Keyhole Approach.

Objective: To study the endoscopic anatomy of the 4th ventricle and lateral brainstem regions via the midline suboccipital endoscopic transcerebellomedullary fissure keyhole approach assisted by a neuronavigation system and discuss the feasibility and indications of this approach. Materials and Methods: Craniotomy procedures performed via the midline suboccipital endoscopic transcerebellomedullary fissure keyhole approach were simulated on 8 adult cadaveric heads fixed by formalin, and the related anatomic structures in the 4th ventricles or around the brainstem were observed through the 0[degrees] endoscope or alternatively 30[degrees] one. A neuronavigation system was used to measure the exposed area of the floor of 4th ventricle, the maximum exposure range, the length of the floor of 4th ventricle, the shortest distance from the midpoint of posterior arch of atlas to the opening of the aqueduct in the 4th ventricle and to the jugular foramen on both sides, respectively. Results: All the anatomic structures within the 4th ventricle and partial anatomic landmarks around brainstem were identified by means of the midline suboccipital endoscopic transcerebellomedullary fissure keyhole approach. The exposed area of the floor of 4th ventricle is 459.68 +/- 73.71 mm2. However, the total exposed area is 1601.70 +/- 200.76 mm2. The length of the floor of 4th ventricle is 36.08 +/- 2.63 mm. The shortest distance from the midpoint of posterior arch of atlas to the opening of the aqueduct in the 4th ventricle is 63.87 +/- 2.97 mm, to the jugular foramen on both sides, respectively, is 40.11 +/- 2.47 mm/40.30 +/- 2.31 mm. Conclusions: Midline suboccipital endoscopic transcerebellomedullary fissure keyhole approach can basically meet the medial and lateral route of the transcerebellomedullary fissure approach. A tumor within the 4th ventricle or near the jugular tubercle extending into the 4th ventricle through the cerebellomedullary fissure can be removed by this approach. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2v3Pf6V

Anatomic Study of Ophthalmic Artery Embolism Following Cosmetic Injection.

Introduction: Cosmetic injections of dermal fillers or fat could cause ophthalmic artery embolism and even blindness, the high-risk regions of which are considered glabellar, nasal dorsum, and nasolabial fold. Understanding anatomy of the related arteries is important for a physician to safely perform filler injections. To investigate the mechanisms of ophthalmic artery embolism following the injections, cadaver anatomy was studied. Methods: Ophthalmic artery, facial artery, their branches, and anastomoses among them were anatomized in 12 fresh cadavers. Mimetic injections of hyaluronic acid were performed in glabellar region, nasal dorsum, and nasolabial fold, the relationships between injected filler and related arteries were then investigated. Results: It was clearly found that 4 arteries were located in common injection regions and connected to ophthalmic artery: supratrochlear artery, supraorbital artery, dorsal nasal artery, and angular artery. In the glabellar region, the deep injection on the periosteum will be risky to injure supratrochlear artery and supraorbital artery, whereas in nasal dorsum and nasolabial fold, the sub- superficial musculo aponeurotic system layer injection has the possibility to injure dorsal nasal artery, angular artery, and facial artery. Conclusion: The anatomic mechanism of ophthalmic artery embolism is the anastomoses among the related arteries and ophthalmic artery. Based on the findings of the study, injections in periosteum layer at glabellar region or sub-superficial musculo aponeurotic system layer of nasal dorsum and nasolabial fold are not advised. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2tHyzP3

Methods in Allergy/Immunology: Food Challenges

Publication date: Available online 27 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Barbara K. Ballmer-Weber, Kirsten Beyer
Since there is no in vitro test, which can accurately predict the clinical relevance of a sensitization to food, the oral food challenge still remains the most reliable procedure to confirm or exclude food allergy and to assess the development of tolerance in children with potentially transient food allergies such as to cow's milk, hen's egg, wheat or soy. Although in the last few years component-resolved diagnostic has improved the food allergy diagnostics, especially in peanut and tree nut allergy, the majority of patients still need to undergo oral food challenge. The following paper will describe in whom and how to perform an oral food challenge as well as its interpretation of the results with a focus on suspected IgE-mediated food allergy.



http://ift.tt/2uCb1hy

Erratum to: A Modeling Study of the Responses of the Lateral Superior Olive to Ipsilateral Sinusoidally Amplitude-Modulated Tones

http://ift.tt/2tNLByL

Erratum to: A Modeling Study of the Responses of the Lateral Superior Olive to Ipsilateral Sinusoidally Amplitude-Modulated Tones

http://ift.tt/2tNLByL

Toni-Haid-Reisestipendium für neurootologische Forschung der Arbeitsgemeinschaft Deutschsprachiger Audiologen, Neurootologen und Otologen

http://ift.tt/2uGEa9F

Using the Patients Concerns Inventory for Distress Screening in Post-treatment Head and Neck Cancer Survivors

Publication date: Available online 27 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Naseem Ghazali, Brenda Roe, Derek Lowe, Sank Tandon, Terry Jones, Richard Shaw, Janet Risk, Simon N. Rogers
PurposeCancer patients can experience significant distress during their cancer trajectory, which impacts upon clinical outcomes and quality of life. Screening for distress using holistic assessments can help identify and address unmet concerns/needs. The purpose of this study was to evaluate the relationship between concerns and distress, and the impact of distress on clinic outcomes in post-treatment head and neck cancer patients.Methods170 patients attending routine follow-up clinics were prospectively recruited. All patients completed the Patient Concerns Inventory (PCI) and the Distress thermometer (DT) at preconsultation.ResultsThe rate of significant distress (i.e. DT cut-off score ≥4) was 36% (62/170). Significantly distressed patients selected more items overall than patients without distress (mean, median (QR) of 5.40, 5 (2-8) Vs 2.61, 2 (0-4), p<0.001). Significant distress was most strongly associated with Physical and Functional well-being (p<0.001) and Psychological and Emotional well-being domains (p=0.001). On balance, very little difference was noted between cut-off points of either ≥4 or ≥ 5 PCI items of concern selected. Both cut-off points demonstrated an acceptable level of sensitivity, specificity and predictive values for significant distress. Consultations were longer with increasing numbers of concerns.ConclusionsJust over one-third of patients are significantly distressed. They were more likely to express a higher number of concerns. A cutoff score ≥4 or ≥ 5 PCI items selected can identify those at risk of significant distress. Concerns causing significant distress were related to emotional/psychological issues and physical function.



http://ift.tt/2u2pO1u

The feasibility of cold atmospheric plasma in the treatment of complicated wounds in cranio-maxillo-facial surgery

Publication date: Available online 27 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Stefan Hartwig, Saskia Preissner, Jan Oliver Voss, Moritz Hertel, Christian Doll, Richard Waluga, Jan Dirk Raguse
BackgroundCompromised wound healing in cranio-maxillo-facial surgery is a threat to the patient's rehabilitation. Therapy of chronic and/or infected wounds is time- and cost-consuming, burdensome and occasionally futile. Cold atmospheric plasma is a new approach that promises to overcome these limitations. The aim of this proof-of-concept study was to evaluate the clinical outcome of cold plasma irradiation in patients with impaired wound healing who are refractory to conservative wound therapy and/or revision surgery.Materials and MethodsWe enrolled six patients (mean age: 63.5 years; SD 8.8 years; 1 female and 5 males) who experienced various cranio-maxillo-facial surgical procedures and suffered from wound healing disturbances. In addition to established wound care, all wounds were irradiated with cold atmospheric plasma. The primary outcome variable was the attainment of complete wound closure.ResultsIn all patients, complete remission in terms of wound closure was observed within a mean time of 15.5 weeks (range: 4-38 weeks). No undesirable side effects were observed, and no inflammation or infection occurred after cold plasma initiation.ConclusionThe use of cold atmospheric plasma might offer a reliable, conservative treatment option in complicated wound healing disturbances in cranio-maxillo-facial surgery.



http://ift.tt/2tNrSPG

Biomechanical evaluation of a novel hybrid reconstruction plate for mandible segmental defects: A finite element analysis and fatigue testing

Publication date: Available online 27 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Cheng-Hsien Wu, Yang-Sung Lin, Yu-Shen Liu, Chun-Li Lin
PurposeThis study develops a novel hybrid (NH) reconstruction plate that can provide load-bearing strength, secure the bone transplant at the prosthesis favored position, and also maintain the facial contour in a mandibular segmental defect. A new patient-match bending technique which uses a three-dimensional printing (3DP) stamping process is developed to increase the interfacial fit between the reconstruction plate and mandibular bone.Materials and MethodsThe NH reconstruction plate was designed to produce a continuous profile with non-uniform thickness and triangular cross-screw patterns with a locking-screw feature at the plate base. Two mandible segmental defect finite element models including the NH reconstruction plate to secure a bone flap for occlusal requirement and the commercial straight (CS) reconstruction plate to secure a bone flap along the lower mandible border were generated for biomechanical fatigue testing.ResultsThe simulated results showed that the maximum von Mises stresses of the reconstruction plate for CS secured model are about 4.5 times more than the NH secured model. The bone strains around the fixation screws showed that the CS secured model was meaningfully higher than that of the NH secured model and exceeded the bone limit value. No fracture of any component was found in any sample in the fatigue testing.ConclusionIn conclusion, the newly developed NH reconstruction plate can secure the transplant position in accordance to the individual occlusal requirements without sacrificing the maintenance of facial contour. Finite element−based biomechanical evaluation demonstrates superior mechanical strength compared to commercial standard plates.



http://ift.tt/2u2cudn

Analysis of clinicopathological risk factors for locoregional recurrence of oral squamous cell carcinoma – retrospective analysis of 517 patients

Publication date: Available online 27 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Ali-Farid Safi, Martin Kauke, Andrea Grandoch, Hans-Joachim Nickenig, Joachim E. Zöller, Matthias Kreppel
IntroductionRecurrence is one of the main reasons for poor prognosis of OSCC. The mortality rate is approximately 90% and the 5-year overall survival rate decreases from 90% to 30% when recurrence is diagnosed. Identification of clinicopathological risk factors predicting recurrence may be helpful for patient individualized management and improvement of therapy. Therefore we investigated in our study the incidence of locoregional recurrences and their association with clinicopathological factors to identify possible significant risk factors.Material and methodsOur retrospective study consisted of 517 patients, who were diagnosed and treated between 2003-2013 at the Department for Oral and Maxillofacial Plastic Surgery, University of Cologne. Inclusion criteria were patients with treatment naive oral squamous cell carcinoma and primarily curative intended surgery with negative resection margins. Contingency tables and χ2-test were performed to analyze associations between clinicopathological features and recurrence. Multivariate analysis was performed using binary logistic regression analysis.ResultsWe found out a significant correlation in univariate analysis between locoregional recurrence and number of resected cervical lymph nodes (p=0.013), number of positive cervical lymph nodes (p=0.041), postoperative radiatio (p=0.018), extracapsular spread (p=0.028) as well as grading (p=0.016). In multivariate analysis only grading was shown as independent risk factor for recurrence.ConclusionsHistological grading has been demonstrated as an independent risk factor for locoregional recurrence in the multivariate analysis. Furthermore, univariate analysis indicated the number of resected and positive lymph nodes, postoperative radiatio and extracapsular spread as significant risk factors. Taking these results into account, the mentioned parameters, especially histological grading, need to be considered for an individualized therapy management of patients with OSCC.



http://ift.tt/2tMYCJ1

Intracanal temperature changes during bone preparations close to and penetrating the inferior alveolar canal: Drills versus piezosurgery

Publication date: Available online 27 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): József Szalma, László Vajta, Edina Lempel, Ákos Tóth, Sára Jeges, Lajos Olasz
PurposeThe aim of this in vitro study was to investigate temperature increases in the inferior alveolar canal (IAC), when different bone preparation methods approximate and penetrate the IAC.Materials and MethodsIn pig mandible, buccal bone removals were performed until the neurovascular bundle became visible. Temperatures were registered with thermocouple probes and with infrared thermometer. Preparations were performed with diamond drills (DD), tungsten carbide drills (TCD), piezoelectric diamond sphere (PT_D) and saw (PT_S) tips, and a combined preparation method was also performed whereby the superficial three-fourths of the bone was removed with TCD and the deepest one-fourth of the bone with PT_D (TCD+PT_D_7°C) or PT_S (TCD+PT_S_7°C), using cooled irrigation (7°C).ResultsPreparations using room temperature irrigation caused significantly less heat on the bone surface than in the IAC. Piezosurgery in the IAC produced significantly higher temperatures (>13°C) than the drills (<4°C). Heat productions of the piezoelectric tips were reduced significantly by applying the combined bone removal methods. The speed of PT_S and TCD+PT_S_7°C were comparable to the speed of TCD, whereas TCD+PT_D_7°C was found to be significantly slower.ConclusionThe speed of piezosurgery is comparable to that of the drills; however, it produces the highest, potentially nerve-harming temperatures. To eliminate the heat consequences during piezosurgery in the IAC, the use of cooled irrigation at 7°C and predrilling is recommended.



http://ift.tt/2u1Zh4w

Discrimination model applied to urinalysis of patients with diabetes and hypertension aiming at diagnosis of chronic kidney disease by Raman spectroscopy

Abstract

Higher blood pressure level and poor glycemic control in diabetic patients are considered progression factors that cause faster decline in kidney functions leading to kidney damage. The present study aimed to develop a quantification model of biomarkers creatinine, urea, and glucose by means of selected peaks of these compounds, measured by Raman spectroscopy, and to estimate the concentration of these analytes in the urine of normal subjects (G_N), diabetic patients with hypertension (G_WOL) patients with chronic renal failure doing dialysis (G_D). Raman peak intensities at 680 cm⁻¹ (creatinine), 1004 cm⁻¹ (urea), and 1128 cm⁻¹ (glucose) from normal, diabetic, and hypertensive and doing dialysis patients, obtained with a dispersive 830 nm Raman spectrometer, were estimated through Origin software. Spectra of creatinine, urea, and glucose diluted in water were also obtained, and the same peaks were evaluated. A discrimination model based on Mahalanobis distance was developed. It was possible to determine the concentration of creatinine, urea, and glucose by means of the Raman peaks of the selected biomarkers in the urine of the groups G_N, G_WOL, and G_D (r = 0.9). It was shown that the groups G_WOL and G_D had lower creatinine and urea concentrations than the group G_N (p < 0.05). The classification model based on Mahalanobis distance applied to the concentrations of creatinine, urea, and glucose presented a correct classification of 89% for G_N, 86% for G_WOL, and 79% for G_D. It was possible to obtain quantitative information regarding important biomarkers in urine for the assessment of renal impairment in patients with diabetes and hypertension, and this information can be correlated with clinical criteria for the diagnosis of chronic kidney disease.

http://ift.tt/2vbuHu0

Will we ever have better glucocorticoids?

Publication date: Available online 27 July 2017
Source:Clinical Immunology
Author(s): Frank Buttgereit, Johannes W.J. Bijlsma, Cindy Strehl
Glucocorticoids are cost-effective drugs with potent anti-inflammatory and immunosuppressive effects. They are used successfully to treat many disorders, including rheumatoid arthritis, polymyalgia rheumatic and other rheumatic diseases. However, these drugs also have the potential to cause adverse effects, particularly if high doses are used for prolonged periods. Therefore, continuous efforts are being made to implement recommendations for optimal dosing of glucocorticoids, monitoring for potential adverse events, adverse event prevention and management. Apart from this, novel and interesting work is underway to develop innovative glucocorticoids or glucocorticoid receptor ligands in order to improve the therapeutic balance. This article briefly mentions a recent publication discussing the question under which conditions long-term treatment with glucocorticoids has an acceptably low level of harm, and focuses then on two current approaches to minimize glucocorticoid adverse effects while keeping or even enhancing their anti-inflammatory efficacy, liposomal glucocorticoids and dissociated agonists of the glucocorticoid receptor.



http://ift.tt/2tNpgRV

Therapy of ulcus cruris of venous and mixed venous arterial origin with autologous, adult, native progenitor cells from subcutaneous adipose tissue: a prospective clinical pilot study

Abstract

Background

The stromal vascular fraction (SVF) of adipose tissue consists of cellular subpopulations with distinct regenerative potential.

Objective

To investigate the regenerative capacities of autologous SVF cells in the treatment of chronic leg ulcers of venous (VLU) and arterial-venous (AVLU) origin.

Methods

Multimorbid ulcer patients received a singular topical treatment with 9-15x10⁶ SVF cells, separated from abdominal lipoaspirates by digestion with collagenase and dispase and applied immediately after isolation. The primary endpoints were the change in wound size 12 weeks after treatment and evaluation of adverse events. Secondary endpoints included the time to complete wound epithelialization and change in pain levels. Postoperative wound treatment modalities and treatment of comorbidities were not intensified compared with preoperative management. Follow-up period was at least 6 months.

Results

Sixteen elderly ulcer patients (7 with VLU, 9 with AVLU) were treated as described. All VLU patients (median ulcer size: 48.25 cm²) and 4 of 9 AVLU patients showed complete epithelialization of the ulcers within 71 to 174 days. In 3 patients with large ulcerations on both legs, ulcerations on the non-treated, contralateral leg also epithelialized. Patients reported a considerable rapid decrease in pain intensity by 2.5 points on average on a visual scale from 1 to 5 within the first two weeks after treatment. The patients were followed-up for 9-44 months (median: 30 months). No severe side effects were observed.

Conclusions

The use of SVF cells presents an effective, minimally invasive option for the treatment of VLU and AVLU even in multimorbid patients. In patients with larger predominantly ischemic AVLU and comorbidities, one-time application of the used amounts of SVF cells was not sufficient in the majority of cases.

This article is protected by copyright. All rights reserved.

http://ift.tt/2tNfQpk

Safety and Efficacy of Dual Wavelength Laser (1064 nm + 595 nm) for Treatment of Non-treated Port-Wine Stains

Abstract

Background

Patients with port-wine stain (PWS) suffer physically and psychologically because of the high incidence (0.3%–0.5%) of the disease. Pulsed dye laser (PDL) at 595 nm is the gold standard of the treatment for PWS. Nevertheless, clinicians intend to determine whether the dual wavelength laser (DWL) (595 nm PDL + 1064 nm Nd:YAG) is an adequate choice in the treatment of non-treated PWS. This study is the first prospective within-patient controlled research seeking to investigate the safety and efficacy of DWL for the treatment of non-treated PWS.

Methods

A total of 61 patients with non-treated flat facial PWS, who were treated using the Cynergy laser system in our clinic, were included in this study. Each PWS lesion was divided into 2 adjacent test treatment sites of similar size and color. The 2 sites were randomly assigned to PDL or DWL treatment in a blinded manner of participants. In each case, 2 sets of treatment parameters were used: 1) 595 nm PDL and 2) 595 nm PDL+1064 nm Nd:YAG. Both had a 10 mm spot size, an epidermal cooling system, and 1 sec interpulse interval between 2 pulses. Clinical efficacy and safety outcomes were evaluated by visual assessment 2 months after treatment.

Results

Comparison by visual evaluation suggests that the responses of non-treated PWS to treatment by PDL and DWL were not significantly different. Moreover, 3 patients developed scarring after DWL treatment.

Conclusion

Compared with PDL, DWL exhibits a higher risk of potential scarring and has no advantage in efficacy of treating non-treated PWS.

This article is protected by copyright. All rights reserved.

http://ift.tt/2u29jlV

Are checkpoint inhibitors a valuable option for metastatic or unresectable vulvar and vaginal melanomas?

Abstract

Immune checkpoint inhibitors might be therapeutic options for unresectable or metastatic melanomas of the vulva and vagina but data available in the literature in these melanomas are very limited ¹²³⁴. The aim of this retrospective study was to investigate the effect of anti-cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) and anti-programmed death 1 (PD-1) antibodies in patients treated in our Skin Cancer Department for unresectable or metastatic vulvar or vaginal melanoma since 2013.

This article is protected by copyright. All rights reserved.

http://ift.tt/2tNkhAy

Severity assessments used for inclusion criteria and baseline severity evaluation in atopic dermatitis clinical trials: a systematic review

Abstract

Background

Numerous inclusion criteria and baseline severity assessments are used in clinical trials of atopic dermatitis (AD), which may limit comparison of results.

Objective

We sought to characterize the inclusion criteria and baseline severity assessments used in randomized controlled trials (RCT) of AD internationally.

Methods

We performed a systematic review of RCT with a pharmacological intervention from 2007-2016. Cochrane Library, EMBASE, GREAT, LILACS, MEDLINE and Scopus were searched. Two authors independently performed study selection and data extraction.

Results

Overall, 212 RCT met inclusion/exclusion criteria. Target population and inclusion criteria based on AD severity were not documented in 78 (36.8%) and 25 (18.7%) studies, respectively. Thirty and 58 severity assessments were used for inclusion criteria and baseline severity, respectively, with only 60.3% concordance between their use. Global assessments were most frequently used for both inclusion criteria and baseline severity assessment in North America (39.5% and 32.1%), while SCORing AD (SCORAD) or objective SCORAD index was most frequently used in Europe (23.5% and 23.0%) and Asia (34.2% and 43.5%). Minimum and maximum thresholds of severity assessments were inconsistently used between studies for inclusion criteria, even within similar target populations. SCORAD, global assessments and body surface area were most frequently used for both inclusion criteria and baseline severity assessment. IGA was particularly used in trials of topical agents.

Conclusions

There was considerable variability and poor documentation of inclusion criteria and baseline severity assessments in RCT for AD. These differences may limit interpretation of a study and comparison of results between studies.

This article is protected by copyright. All rights reserved.

http://ift.tt/2u1YQXP