Intensity-modulated radiation therapy (IMRT), a relatively new method of delivering radiotherapy, can precisely target a point within a specific tumour and reduce the dose to nearby anatomical structures. This is particularly important in the head and neck where radiotherapy can easily and irreparably damage the salivary glands, spinal cord, and eyes, and where, with increasingly better outcomes and survival, late complications of conventional radiotherapy (including osteoradionecrosis of the cervical spine) can be difficult to manage.
http://ift.tt/2xnuAcQ
Σάββατο 26 Αυγούστου 2017
Intensity-modulated radiotherapy in head and neck cancer — an update for oral and maxillofacial surgeons
Diagnostic dilemma between medication-related osteonecrosis and oral squamous cell carcinoma in a mandibular lytic lesion
Osteolytic lesions of the mandible are common, and there are two important differential diagnoses that must be considered: medication-related osteonecrosis of the jaws (MRONJ) and squamous cell carcinoma (SCC). In patients with a history of taking antiresorptive medication as well as risk factors for neoplasia it can be difficult to differentiate between the two. We describe two cases in both of which a mandibular osteolytic lesion was inadequately identified as either MRONJ or SCC because of confusing clinical and histopathological features.
http://ift.tt/2w8rUBr
Diagnostic dilemma between medication-related osteonecrosis and oral squamous cell carcinoma in a mandibular lytic lesion
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S. Tocaciu, O. Breik, B. Lim, C. Angel, N. Rutherford
Osteolytic lesions of the mandible are common, and there are two important differential diagnoses that must be considered: medication-related osteonecrosis of the jaws (MRONJ) and squamous cell carcinoma (SCC). In patients with a history of taking antiresorptive medication as well as risk factors for neoplasia it can be difficult to differentiate between the two. We describe two cases in both of which a mandibular osteolytic lesion was inadequately identified as either MRONJ or SCC because of confusing clinical and histopathological features. We also reviewed relevant publications to identify similar cases. Here we discuss our clinical dilemma when faced with two different conditions that present with similar clinical and histopathological features.
http://ift.tt/2vsiDkK
Intensity-modulated radiotherapy in head and neck cancer — an update for oral and maxillofacial surgeons
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): P.A. Brennan, K.L. Bradley, M. Brands
Intensity-modulated radiation therapy (IMRT), a relatively new method of delivering radiotherapy, can precisely target a point within a specific tumour and reduce the dose to nearby anatomical structures. This is particularly important in the head and neck where radiotherapy can easily and irreparably damage the salivary glands, spinal cord, and eyes, and where, with increasingly better outcomes and survival, late complications of conventional radiotherapy (including osteoradionecrosis of the cervical spine) can be difficult to manage. IMRT has the potential advantage of reducing side effects including xerostomia and myelopathy of the cervical spinal cord. Several clinical trials have recently been published, and in this update we give an overview of IMRT for oral and maxillofacial surgeons, and discuss what the future may hold for radiotherapy.
http://ift.tt/2wRL8vN
Transcriptome comparison identifies potential biomarkers of spine and skull base chordomas
Abstract
Chordomas are rare, slowly growing, locally aggressive bone neoplasms that arise from embryonic remnants of the notochord, showing dual epithelial-mesenchymal differentiation. The high plasticity probably is the main reason for the high variety in phenotypes of chordoma, from its high heterogeneity on a cellular level to its subtype variations depending on tissue location, with its potential to develop from an inactive quiescent form to an aggressive cancer with extreme adaptability and resistance to drugs and other treatments. Gene expression profiles of formalin-fixed, paraffin-embedded skull chordoma, spine chordoma, and normal tissue specimens were generated and compared. Using strict criteria, we identified 222 differentially expressed transcripts unique to skull base chordoma, 261 unique to spine chordoma, and 192 common to both chordoma subtypes. Further analysis of these three groups of transcripts allowed the selection of three subsets of highly differentially expressed genes as potential biomarkers, disease drivers, and therapeutic targets in both chordoma subtypes. Immunohistochemistry revealed LMX1A to be dominant in skull base chordoma, SALL3 to be unique to spine chordoma, and T to be common to both chordoma subtypes. In both chordoma subtypes, the genes with the highest expression were predominantly development-related genes, mostly transcription factors. Our findings indicate that these developmental genes play important oncogenic roles in chordoma, mainly causing high plasticity and resistance to therapy in both these cancer subtypes but also determining their differentiation status and proliferation activity, pointing to features expected of heterogeneous stem cell-like tissues with similarities to their notochord origins.
http://ift.tt/2vh11fq
Publication date: Available online 26 August 2017 Source:Journal of Oral and Maxillofacial Surgery ...
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Satvinder Singh Bakshi
http://ift.tt/2wRiT0b
Retrograde intubation through nasal route in patients with limited mouth opening undergoing oral and maxillofacial surgery
Publication date: Available online 25 August 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Ashwant Kumar Vadepally, Ramen Sinha, A.V.S.S. Subramanya Kumar
BackgroundPatients with limited mouth opening (LMO) often associated with difficult intubation. Retrograde intubation is an alternative technique of establishing definitive airway in these patients when blind nasal intubation fails and fiberoptic bronchoscope is not available. We tested the retrograde intubation through nasal route in patients with LMO less than 2cm.Materials and methodsThe procedure was performed with some modification with regard to retrograde guide on 18 patients requiring maxillofacial surgical procedures to increase mouth opening. Indications for this technique were mandibular fracture (n=6), oral submucous fibrosis (OSMF; n=6), temporomandibular joint (TMJ) ankylosis (n=4) and TMJ dislocation (n=2). All patients were assessed for preoperative interincisal opening; during intubation through specific parameters and; also postoperatively findings were observed.ResultsMean time taken for successful intubation was 5.6min±1.66. One patient had subcutaneous emphysema which was managed conservatively. Postoperatively, four patients had sore throat which resolved in few days. No other complications were encountered.ConclusionIn conclusion, retrograde nasotracheal intubation is an effective and useful technique for airway control in patients with LMO and with only a small risk potential.
http://ift.tt/2vqV9MZ
The clinicopathologic spectrum of mature aggressive B cell lymphomas
Abstract
Our understanding of mature aggressive B cell lymphomas has evolved significantly in the last years as reflected in the 2016 update of the WHO lymphoma classification. A main topic of the 2016 European Association for Haematopathology/Society of Hematopathology lymphoma workshop in Basel therefore was the clinicopathological spectrum of mature aggressive B cell lymphomas with the exception of conventional diffuse large B cell lymphoma. In this review, we summarize two sessions dedicated to "high-grade B cell lymphomas, with MYC and BCL2 and/or BCL6 rearrangements (so-called double/triple-hit lymphomas)" and "high-grade B cell lymphomas, NOS" as defined in the 2016 update of the WHO lymphoma classification, Burkitt lymphoma and related neoplasms, and terminally differentiated aggressive B cell lymphomas. One focus was on cases of Burkitt lymphoma with unusual clinical features such as spontaneous regression or association with immunosuppression, and the new provisional category of Burkitt-like lymphoma with 11q aberration. The large numbers of cases submitted for the new high-grade categories with or without genetic "double/triple hit" demonstrated the broad clinical and pathological spectrum of this group and gave ample opportunity for discussion. In this review, current definitions and our understanding of the main high-grade categories, potential problem areas, and suggestions for the immunophenotypic and genetic work-up of these neoplasms are discussed and illustrated by many interesting and challenging cases submitted to the workshop.
http://ift.tt/2xlNAIO
Clinicopathologic factors associated with recurrence in parotid carcinoma
Publication date: Available online 25 August 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Dong Hoon Lee, Tae Mi Yoon, Joon Kyoo Lee, Sang Chul Lim
IntroductionParotid carcinomas have varying histological types and diverse biologic behaviors. Establishing an adequate treatment plan and predicting recurrence is important.ObjectiveTo analyze the risk factors associated with recurrence in our 5 year experience with 30 cases of primary parotid carcinoma undergoing surgery at a single institute.MethodsFrom January 2009 to December 2013, 30 patients with surgical treatment of parotid carcinoma were identified based on their medical records.ResultsThe 30 patients were comprised of 17 males and 13 females. Among 11 patients with T4 tumors, seven patients had recurrence. Among seven patients with cervical nodal metastasis, all patient except one had recurrence. Clinically late stages (stage III and IV) showed more common recurrence than early stage (stage I and II) lesions. Lymphovascular invasion was seen in 5 patients, and all patients had recurrence. Among 11 patients with extracapsular spread, 7 patients had recurrence. In 17 patients with high grade carcinomas, ten patients had recurrence. In 13 patients with low grade carcinomas, no patients experienced recurrence.ConclusionT- and N-stage, clinical stage, lymphovascular invasion, extracapsular spread, and histopathologic grade correlate significantly with recurrence in parotid carcinoma.
http://ift.tt/2gfyMHl
3-dimensional (3D) tissue-engineered skeletal muscle for laryngeal reconstruction
Objective
There is an unmet need for tissue-engineered three-dimensional (3D) muscle constructs for laryngeal reconstruction. Functional engineered muscle could be used to repair postoncologic or traumatic defects or to medialize the vocal fold in cases of paresis/paralysis. Autologous, organized, engineered muscle that has adequate bulk integrates into host tissue and restores function currently does not exist.
Methods
Primary skeletal muscle progenitor cells (MPCs) were isolated from F344 rats. Three-dimensional muscle constructs were created by encapsulating MPCs via flow alignment in a customized collagen formulation and cultured under passive tension. Muscle-specific immunohistochemistry and confocal microscopy were used to evaluate muscle tissue differentiation. After 2 weeks of culture, muscle constructs were implanted into surgically created defects in the rat larynx. Postmortem function testing and histology was performed at 1 and 3 months.
Results
Immunohistochemistry with confocal microscopy demonstrated well-differentiated myotubes, which were well aligned and distributed throughout the engineered construct in vitro. There was evidence of restoration of normal laryngeal function at 1 month postoperative, as indicated by safe swallow (no aspiration events), weight gain, and excellent animal survival. Postmortem specimens demonstrated functional muscle contraction on ex vivo testing, and histology confirmed integration into host tissue.
Conclusion
This is the first study to demonstrate that functional, 3D tissue-engineered skeletal muscle can be developed from primary MPCs and standardized oligomeric collagen. Collectively, these findings may have tremendous clinical implications for autologous laryngeal muscle repair and reconstruction.
Level of Evidence
NA. Laryngoscope, 2017
http://ift.tt/2wxiBMk
Rethinking the laryngopharyngeal reflux treatment algorithm: Evaluating an alternate empiric dosing regimen and considering up-front, pH-impedance, and manometry testing to minimize cost in treating suspect laryngopharyngeal reflux disease
Objectives/Hypothesis
Empiric proton pump inhibitor (PPI) trials for laryngopharyngeal reflux (LPR) are common. A majority of the patients respond to acid suppression. This work intends to evaluate once-daily, 40 mg omeprazole and once-nightly, 300 mg ranitidine (QD/QHS) dosing as an alternative regimen, and use this study's cohort to evaluate empiric regimens prescribed for LPR as compared to up-front testing with pH impedance multichannel intraluminal impedance (MII) with dual pH probes and high-resolution manometry (HRM) for potential cost minimization.
Study Design
Retrospective cohort review and cost minimization study.
Methods
A chart review identified patients diagnosed with LPR. All subjects were treated sequentially and outcomes recorded. Initial QD/QHS dosing increased after 3 months to BID if no improvement and ultimately prescribed MII and HRM if they failed BID dosing. Decision tree diagrams were constructed to determine costs of two empiric regimens and up-front MII and HRM.
Results
Ninety-seven subjects met the criteria. Responders and nonresponders to empiric therapy were identified. Seventy-two subjects (74%) responded. Forty-eight (67% of responders and 49% of all) improved with QD/QHS dosing. Forty-nine (51%) subjects escalated to BID dosing. Twenty-four subjects (33% of responders and 25% of all) improved on BID therapy. Twenty-five subjects (26%) did not respond to acid suppression. Average weighted cost was $1,897.00 per patient for up-front testing, $3,033.00 for initial BID, and $3,366.00 for initial QD/QHS.
Conclusions
An alternate QD/QHS regimen improved the majority who presented with presumed LPR. Cost estimates demonstrate that the QD/QHS regimen was more expensive than the initial BID high-dose PPI for 6 months. Overall per-patient cost appears less with up-front MII and HRM.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2wdlcsf
Postoperative IPTH compared with IPTH gradient as predictors of post-thyroidectomy hypocalcemia
Objectives/Hypothesis
Predicting patients' risk for hypocalcemia after thyroidectomy may allow for same-day discharge. This study was designed to compare postoperative intact parathyroid hormone (IPTH) alone with percentage change in IPTH (IPTH gradient) in predicting post-thyroidectomy hypocalcemia.
Study Design
Retrospective cohort study.
Methods
Patients undergoing total thyroidectomy by the senior author from May 2015 to May 2016 were included. Serum IPTH was measured preoperatively and 1 hour postoperatively, and IPTH gradient was calculated. Postoperative hypocalcemia was mild (≥8.0, <8.4) or severe (<8.0 and/or hypocalcemic symptoms). Postoperative IPTH and IPTH gradient were compared with hypocalcemia using logistic regression. Receiver operating characteristic analysis of IPTH measures as predictors of hypocalcemia was performed, and the area under the curve (AUC) was calculated.
Results
Overall, 119 patients were included. Forty-seven percent of the patients developed postoperative hypocalcemia, including 26 (22%) with mild and 30 (25%) with severe hypocalcemia. Thirteen patients had hypocalcemic symptoms. Median IPTH gradient and postoperative IPTH each differed significantly by category of hypocalcemia (P < .001). Higher IPTH gradient was significantly associated with odds of severe and symptomatic hypocalcemia (adjusted odds ratio [aOR]: 1.21, 95% confidence interval [CI]: 1.06-1.39 and aOR: 1.34, 95% CI: 1.05-1.71 per 10% increase), whereas lower postoperative IPTH was not (aOR: 1.27, 95% CI: 0.95-1.68 and aOR: 1.44, 95% CI: 0.90-2.31 per 10 pg/mL decrease). The AUC for predicting severe hypocalcemia was nonsignificantly higher for IPTH gradient than postoperative IPTH (AUC = 0.77 vs. 0.69, P = .10). The AUC for predicting symptomatic hypocalcemia was significantly higher for IPTH gradient (AUC = 0.75 vs. 0.72, P = .03).
Conclusions
Our results suggest that the IPTH gradient may be more useful than postoperative IPTH alone in predicting risk of post-thyroidectomy hypocalcemia.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2wxEUkI
Consulting Dr. Google: Quality of Online Resources About Tympanostomy Tube Placement
Objective
Tympanostomy tube (TT) placement is common in children; however, family-centeredness and utility of online information used for decision making and understanding is unknown. We evaluate the quality of leading Internet resources describing TT placement.
Study Design
Cross-sectional descriptive design.
Methods
We performed a Google (Menlo Park, CA) search for terms related to TTs. We defined quality using scaled readability measures (Flesch Reading Ease and Flesch-Kincaid Grade-Level), understandability and actionability (Patient Education Materials Assessment Tool), shared decision-making centrality (Center for Medicare and Medicaid Services informed consent guidelines), and clinical practice guideline (CPG) compatibility. Three reviewers coded each measure. Fleiss κ interrater reliability analysis was performed.
Results
Ten most frequently encountered websites were analyzed. One of 10 met national health literacy standards (mean 10th-grade level reading, median 9th, range 6–15th). All sites were understandable (mean understandability 81.9%, range 73%–92%). Most had low actionability scores (7 of 10, median 47%, mean 44.6%, range 0–80). Shared decision-making centrality was high (mean 5, range 4–6), but most did not list alternative treatment options. Although CPG compatibility was high (mean 3.4, range 1–4), many websites contained inconsistent recommendations about tube duration, follow-up, and water precautions. There was inter-rater agreement for understandability scoring (κ = 0.20; P = 0.02).
Conclusion
Internet resources about TT placement vary in quality pertaining to health literacy, principles of shared decision making, and consistency with practice guidelines. With growing emphasis on patient-/family-centered engagement in healthcare decision making, standardization of content and improved usability of educational materials for common surgical procedures in children such as tympanostomy tube placement should be a public health priority.
Level of Evidence
NA. Laryngoscope, 2017
http://ift.tt/2wdjfvN
Use of pharyngeal packs in functional endoscopic sinus surgery: A randomized controlled trial
Objective
To determine if pharyngeal packs have an effect on postoperative pain and postoperative nausea and vomiting in functional endoscopic sinus surgery (FESS).
Study Design
Forty-six patients scheduled for routine endoscopic sinus surgery were recruited into this study. The patients were randomly allocated to have or to not have pharyngeal packing prior to surgery.
Methods
The placement of pharyngeal packs during FESS is controversial. Theoretically, pharyngeal packs may prevent postoperative nausea and vomiting by preventing ingestion of blood during sinus surgery. However, prior studies have not conclusively demonstrated this to be the case in FESS. Pharyngeal packs have been associated with complications including throat pain, aspiration, and death. The objective of this randomized control trial was to determine if pharyngeal packs have an effect on postoperative throat pain, nausea, and vomiting in order to determine their importance during FESS.
Patients were blinded to intervention. Postoperatively, throat pain and nausea/vomiting scores were recorded.
Results
There was no significant difference in mean throat pain at 4 hours following surgery (P = 0.860). At 24 hours after surgery, patients without pharyngeal packing experienced more pain than those who had a throat pack placed (P = 0.002). There was no significant difference in the level of nausea at 4 hours after surgery (P = 0.315) or at 24 hours after surgery (P = 0.315).
Conclusion
We recommend against the routine use of placing pharyngeal packs during FESS.
Level of Evidence
1b. Laryngoscope, 2017
http://ift.tt/2wdBLnX
Extra-ocular movement restriction and diplopia following orbital fracture repair
Source:American Journal of Otolaryngology
Author(s): H.A. Shah, Taha Shipchandler, Dominic Vernon, Maraya Baumanis, David Chan, William R. Nunery, Hui Bae Harold Lee
PurposeTo report a series of patients with extra-ocular movement restriction and diplopia after orbital fracture repair, and determine the effect of timing of repair and the type of implant used.MethodsA chart review was conducted identifying all patients >18years of age at our institution between June 2005 and June 2008 who underwent orbital fracture repair, and presented with clinically significant diplopia and extra-ocular movement restriction persisting longer than one month after repair. Data collected included timing of repair, implant used within the orbit, and need for revision.ResultsTen patients were identified with a mean time to primary orbital fracture repair at 9days (range 1–48). Seven patients underwent revision of their orbital fracture repair with removal of the previously placed implant and replacement with non-porous 0.4mm Supramid Foil, whereas one patient underwent lateral and inferior rectus recessions without revision of primary fracture repair. Titanium mesh was the intra-orbital implant found in all patients requiring revision of orbital fracture repair. All revisions resulted in resolution of clinically significant diplopia.ConclusionsClinically significant diplopia and extra-ocular movement restriction is not an uncommon complication after orbital fracture repair. In our series, there was a strong association between these complications and the use of porous titanium mesh implants. Revision of fractures significantly improved diplopia in all but one patient. This suggests that meticulous fracture repair and the use of non-porous implants primarily or secondarily may preclude the need for strabismus surgery after orbital trauma.
http://ift.tt/2wHiy0S
Comment on: “The outcomes of overlay myringoplasty: Endoscopic versus microscopic approach”
Source:American Journal of Otolaryngology
Author(s): Zhengcai Lou
http://ift.tt/2xBwohG
A rapid LC-MS/MS method for the determination of moniliformin and occurrence of this mycotoxin in maize products from the Bavarian market
Abstract
A simple LC-MS/MS method was developed for the determination of moniliformin (MON) in maize and applied for the analysis of samples within the official food surveillance. The homogenized samples were extracted with acetonitrile/water 50/50 (v/v) which proved to have the highest extraction efficiency compared to other tested solvents. The centrifuged extracts were diluted with acetonitrile and were measured after chromatographic separation by HILIC (hydrophobic interaction liquid chromatography)-HPLC without any cleanup (dilute and shoot approach). The LOD and LOQ achieved by this procedure were 2.6 and 8.8 μg/kg, respectively. Thirty-nine samples of popcorn, maize meal, and semolina were collected in 2014 and 2015 at mills, cinemas, wholesale, and retail from the Bavarian market (Germany). The rate of contamination with MON was very high (97%) with levels ranging between the LOD and 847 μg/kg. The mean level was 118 μg/kg and the median, 39 μg/kg. The maximum value was detected in maize meal. The results are discussed with respect to possible health implications for the consumer.
http://ift.tt/2wwHfN0
Management of High-Velocity Injuries of the Head and Neck
Trauma centers must prepare to manage high-velocity injuries resulting from a mass casualty incidents as global terrorism becomes a greater concern and an increasing risk. The most recent conflicts in Iraq and Afghanistan have significantly improved understanding of battlefield trauma and how to appropriately address these injures. This article applies combat surgery experience to civilian situations, outlines the physiology and kinetics of high-velocity injuries, and reviews applicable triage and management strategies.
http://ift.tt/2gdMElI
Role of S100A9 in the development of neutrophilic inflammation in asthmatics and in a murine model
Source:Clinical Immunology
Author(s): Tae-Hyeong Lee, Hun Soo Chang, Da-Jeong Bae, Hyun Ji Song, Myung-Sin Kim, Jong Sook Park, Ji Ae Jun, Si Young Lee, Soo Taek Uh, Soo Hyun Kim, Choon-Sik Park
S100A9 is an endogenous danger signal that promotes and exacerbates the neutrophilic inflammatory response. To investigate the role of S100A9 in neutrophilic asthma, S100A9 levels were measured in sputum from 101 steroid-naïve asthmatics using an ELISA kit and the levels were significantly correlated with percentages of neutrophils in sputum. Intranasal administration of recombinant S100A9 markedly increased neutrophil numbers at 8h and 24h later with concomitant elevation of IL-1β, IL-17, and IFN-γ levels. Treatment with an anti-S100A9 antibody restored the increased numbers of neutrophils and the increased airway resistance in OVA/CFA mice toward the levels of sham-treated mice. Concomitantly, the S100A9 and neutrophil elastase double positive cells were markedly reduced with attenuation of IL-1β, IL-17, and IFN-γ levels by the treatment with the anti-S100A9 antibody. Our data support a role of S100A9 to initiate and amplify the neutrophilic inflammation in asthma, possibly via inducing IL-1β, IL-17 and IFN-γ.
http://ift.tt/2xl8PKF
Alcohol Use as a Comorbidity and Precipitant of Primary Headache: Review and Meta-analysis
Abstract
Purpose of Review
In contrast to well-established relationships between headache and affective disorders, the role of alcohol use in primary headache disorders is less clear. This paper provides a narrative overview of research on alcohol use disorders (AUDs) in primary headache and presents a meta-analysis of the role of alcohol as a trigger (precipitant) of headache.
Recent Findings
The majority of studies on AUDs in headache have failed to find evidence that migraine or tension-type headache (TTH) is associated with increased risk for AUDs or problematic alcohol use. The meta-analysis indicated that 22% (95% CI: 17–29%) of individuals with primary headache endorsed alcohol as a trigger. No differences were found between individuals with migraine (with or without aura) or TTH. Odds of endorsing red wine as a trigger were over 3 times greater than odds of endorsing beer.
Summary
An absence of increased risk for AUDs among those with primary headache may be attributable to alcohol's role in precipitating headache attacks for some susceptible individuals. Roughly one fifth of headache sufferers believe alcohol precipitates at least some of their attacks. Considerable study heterogeneity limits fine-grained comparisons across studies and suggests needs for more standardized methods for studying alcohol-headache relationships and rigorous experimental designs.
http://ift.tt/2w6Co3Z
A retrospective analysis of 538 sinonasal fungus ball cases treated at a single tertiary medical center in Korea (1996-2015)
Background
Sinonasal fungus ball (FB) is a type of noninvasive fungal rhinosinusitis affecting immunocompetent hosts. FB, previously considered rare, has been reported with increasing frequency. We reviewed our experience of 538 cases over the past 20 years.
Methods
We retrospectively examined clinical records including clinical presentations, radiological findings, management, and outcomes of FB patients who have undergone surgery for treatment. The number of FB patients who underwent endoscopic sinus surgery (ESS) was calculated annually. Causal relationships between structural variations and FB were also investigated.
Results
The number of FB patients who underwent sinus surgery has increased. The mean age was 58.3 years, and the gender ratio was approximately 2 (female): 1 (male). While the most common presenting symptoms of maxillary sinus FB patients were nasal symptoms, such as postnasal drip and nasal obstruction, sphenoid sinus FB patients presented with headache mostly. On computed tomography (CT) scans, the most common finding was intralesional hyperdensity (77.3%). There was no significant correlation between the presence of FB and structural variations (nasal septal deviation, concha bullosa, Haller cell). Median follow-up period of the patients was 11 months. Recurrence or residual disease occurred in only 6 (1.1%) cases.
Conclusion
The number of FB patients who underwent surgery has increased steadily over the past 20 years. FB should be considered in patients with unilateral nasal symptoms and unexplained headaches. A preoperative CT scan is an essential tool in making diagnosis easier and faster. Endoscopic surgery is the treatment of choice, with a low morbidity and recurrence rate.
http://ift.tt/2iwB0Tq
Temporal Bone Fracture Requiring Facial Nerve Decompression or Repair
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Keonho Kong, Alexander Sevy
Facial nerve paralysis is one of the complications with temporal bone fractures. While the majority of these are treated medically with observation and steroids, we review the indications and surgical approaches to the facial nerve along its course within the temporal bone. It is important to get an exam as early as possible to determine immediate vs delayed, and complete vs incomplete paralysis. Patients with immediate onset, complete facial nerve paralysis should receive electrodiagnostic testing 3–7 days after onset, to allow for Wallerian degeneration. If there is >90% ENoG degeneration within 6 days or >95% degeneration within 14 days, surgical exploration is recommended. Exact surgical timing for decompression is controversial and definitive data is lacking but some authors have had success even beyond two months post-injury and the risks and benefits should always be discussed with each patient. The approach for surgical decompression of the facial nerve should be based on the site of injury, if discernible, but most commonly involves transmastoid, middle fossa craniotomy or a combination of these approaches. The perigeniculate region is the most commonly injured portion of the facial nerve with temporal bone fractures. If a transection is encountered, the nerve should be repaired by either primary nerve repair if tension free, otherwise a secondary repair with a cable graft should be performed.
http://ift.tt/2ixQtmd
Clinicopathological characteristics and outcomes of squamous cell carcinoma of the tongue in different age groups
Abstract
Background
The clinicopathological features and outcomes of squamous cell carcinoma (SCC) of the tongue in patients of different age groups remain debatable.
Methods
Medical records of 457 patients with tongue SCC were reviewed, grouped by age, followed up, and compared.
Results
Sex and TNM stage showed no intergroup differences. Tongue SCC in patients ≤30 years had the most advanced TNM classification and greatest proportion of poorly differentiation tumors. Both disease-free survival (DFS) and disease-specific survival (DSS) showed no statistically significant difference between the youngest and the oldest groups (P = .605 and P = .520). However, there was a tendency of higher death rate caused by recurrence or metastasis in the youngest group compared with the others (91.7% vs 75.4% and 77.4%).
Conclusion
Young patients had a tendency of higher death rate caused by recurrence or metastasis than middle-age and older patients; therefore, a larger case sample is needed for further confirmation.
http://ift.tt/2w6folQ
Effect of UV irradiation on aflatoxin reduction: a cytotoxicity evaluation study using human hepatoma cell line
Abstract
In this proof-of-concept study, the efficacy of a medium-pressure UV (MPUV) lamp source to reduce the concentrations of aflatoxin B1, aflatoxin B2, and aflatoxin G1 (AFB1, AFB2, and AFG1) in pure water is investigated. Irradiation experiments were conducted using a collimated beam system operating between 200 to 360 nm. The optical absorbance of the solution and the irradiance of the lamp are considered in calculating the average fluence rate. Based on these factors, the UV dose was quantified as a product of average fluence rate and treatment time. Known concentrations of aflatoxins were spiked in water and irradiated at UV doses ranging from 0, 1.22, 2.44, 3.66, and 4.88 J cm−2. The concentration of aflatoxins was determined by HPLC with fluorescence detection. LC-MS/MS product ion scans were used to identify and semi-quantify degraded products of AFB1, AFB2, and AFG1. It was observed that UV irradiation significantly reduced aflatoxins in pure water (p < 0.05). Irradiation doses of 4.88 J cm−2 reduced concentrations 67.22% for AFG1, 29.77% for AFB2, and 98.25% for AFB1 (p < 0.05). Using this technique, an overall reduction of total aflatoxin content of ≈95% (p < 0.05) was achieved. We hypothesize that the formation of ˙OH radicals initiated by UV light may have caused photolysis of AFB1, AFB2, and AFG1 molecules. In cell culture studies, our results demonstrated that the increase of UV dosage decreased the aflatoxin-induced cytotoxicity in HepG2 cells. Therefore, our research finding suggests that UV irradiation can be used as an effective technique for the reduction of aflatoxins.
http://ift.tt/2wP4xNN
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