Head and Neck Medicine by Alexandros G.Sfakianakis: 09/01/17

Παρασκευή 1 Σεπτεμβρίου 2017

Bugging allergy; role of pre-, pro- and synbiotics in allergy prevention

Publication date: Available online 1 September 2017
Source:Allergology International
Author(s): Christina E. West, Majda Dzidic, Susan L. Prescott, Maria C. Jenmalm
Large-scale biodiversity loss and complex changes in social behaviors are altering human microbial ecology. This is increasingly implicated in the global rise in inflammatory diseases, most notably the "allergy epidemic" in very early life. Colonization of human ecological niches, particularly the gastrointestinal tract, is critical for normal local and systemic immune development and regulation. Disturbances in composition, diversity and timing of microbial colonization have been associated with increased allergy risk, indicating the importance of strategies to restore a dysbiotic gut microbiota in the primary prevention of allergic diseases, including the administration of probiotics, prebiotics and synbiotics. Here, we summarize and discuss findings of randomized clinical trials that have examined the effects of these microbiome-related strategies on short and long-term allergy preventative effects – including new guidelines from the World Allergy Organization which now recommend probiotics and prebiotics for allergy prevention under certain conditions. The relatively low quality evidence, limited comparative studies and large heterogeneity between studies, have collectively hampered recommendations on specific probiotic strains, specific timing and specific conditions for the most effective preventive management. At the same time the risk of using available products is low. While further research is needed before specific practice guidelines on supplement probiotics and prebiotics, it is equally important that the underlying dietary and lifestyle factors of dysbiosis are addressed at both the individual and societal levels.

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Development of a questionnaire to evaluate asthma control in Japanese asthma patients

Publication date: Available online 1 September 2017
Source:Allergology International
Author(s): Yuji Tohda, Soichiro Hozawa, Hiroshi Tanaka
BackgroundThe asthma control questionnaires used in Japan are Japanese translations of those developed outside Japan, and have some limitations; a questionnaire designed to optimally evaluate asthma control levels for Japanese may be necessary. The present study was conducted to validate the Japan Asthma Control Survey (JACS) questionnaire in Japanese asthma patients.MethodsA total of 226 adult patients with mild to severe persistent asthma were enrolled and responded to the JACS questionnaire, asthma control questionnaire (ACQ), and Mini asthma quality of life questionnaire (Mini AQLQ) at Weeks 0 and 4. The reliability, validity, and sensitivity/responsiveness of the JACS questionnaire were evaluated.ResultsThe intra-class correlation coefficients (ICCs) were within the range of 0.55–0.75 for all JACS scores, indicating moderate/substantial reproducibility. For internal consistency, Cronbach's alpha coefficients ranged from 0.76 to 0.92 in total and subscale scores, which were greater than the lower limit of internal consistency. As for factor validity, the cumulative contribution ratio of four main factors was 0.66. For criterion-related validity, the correlation coefficients between the JACS total score and ACQ5, ACQ6, and Mini AQLQ scores were −0.78, −0.78, and 0.77, respectively, showing a significant correlation (p < 0.0001).ConclusionsThe JACS questionnaire was validated in terms of reliability and validity. It will be necessary to evaluate the therapeutic efficacy measured by the JACS questionnaire and calculate cutoff values for the asthma control status in a higher number of patients.Clinical Trial registrationUMIN000016589

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Venous thromboembolism and hyperhomocysteinemia as first manifestation of pernicious anemia: a case series

Hyperhomocysteinemia has been suspected of favoring thrombosis. Several case–control studies and even a meta-analysis have confirmed a link between venous thrombosis and hyperhomocysteinemia. Homocysteine is d...

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Evaluation of carbon dioxide laser therapy for benign tumors of the eyelid margin

Abstract

Eyelid margin tumors require special attention based on both anatomical and histological perspectives. Our aim in this study was to evaluate carbon dioxide (CO₂) laser therapy for the treatment of eyelid margin tumors. Fifty-two patients with 55 eyelid margin tumors were included in this study. All tumors were removed with a CO₂ laser, and histopathological evaluation was obtained in 52 cases. All patients were followed up for a mean period of 8.5 months (range 6 to 14 months). There were no bleedings in the intra- and postoperative period; the wounds were dry and reepithelized after 10–14 days and no recurrence occurred during follow-up period. Compared to the surrounding tissue, the treated area was hypopigmented and maximum five eyelashes (average 2.5) were wasted during the procedure. We achieved complete patient and surgeon satisfaction with cosmetic and therapeutic results. CO₂ laser treatment of eyelid margin is a safe and effective procedure; its cosmetic result is beneficial as it does not cause malposition of the eyelid or damage to the lacrimal drainage system if the tumor is located in its proximity.

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Cetuximab with radiotherapy as an alternative treatment for advanced squamous cell carcinoma of the temporal bone

Publication date: Available online 1 September 2017
Source:Auris Nasus Larynx
Author(s): Koji Ebisumoto, Kenji Okami, Masashi Hamada, Daisuke Maki, Akihiro Sakai, Kosuke Saito, Fukuko Shimizu, Shoji Kaneda, Masahiro Iida
The prognosis of advanced temporal bone cancer is poor, because complete surgical resection is difficult to achieve. Chemoradiotherapy is one of the available curative treatment options; however, its systemic effects on the patient restrict the use of this treatment. A 69-year-old female (who needed peritoneal dialysis) presented at our clinic with T4 left external auditory canal cancer and was treated with cetuximab plus radiotherapy (RT). The primary lesion showed complete response. The patient is currently alive with no evidence of disease two years after completion of the treatment and does not show any late toxicity. This is the first advanced temporal bone cancer patient treated with RT plus cetuximab. Cetuximab plus RT might be a treatment alternative for patients with advanced temporal bone cancer.

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Nasal interleukin 25 as a novel biomarker for patients with chronic rhinosinusitis with nasal polyps and airway hypersensitiveness

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the upper airway and is tightly linked with airway hyperresponsiveness (AHR) and asthma. However, the surrogate biomarkers for indicating AHR and asthma in patients with CRSwNP remain elusive.

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Assessing hypoxia risk during air travel after a severe asthma exacerbation in children

Decreased atmospheric cabin pressure in commercial aircrafts (cruising altitude 9,000–13,000 m), requiring cabin pressurization from 1,530 to 2,440 m, is equivalent to breathing a fraction of inspired oxygen (FiO2) of 15.1% at sea level.

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Growth curves for intracranial volume in normal Asian children fortify management of craniosynostosis

Craniosynostosis alters the morphology of cranial vault, prevents normal cranial growth, and can elevate intracranial pressure over time. Surgical goals in the event of craniosynostosis are to reduce intracranial pressure and to achieve aesthetic cranial contours, but the timing of such surgery is open to debate. Although excess intracranial pressure must be avoided, premature surgical interventions may necessitate secondary revisions. Also, direct attempts to measure intracranial pressure are invasive by design and thus may not be feasible in every case.

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Human Papillomavirus Associated Head and Neck Squamous Cell Carcinoma: Controversies and New Concepts

Publication date: Available online 1 September 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Nuzhat Husain, Azfar Neyaz
High-risk human papillomavirus (HR-HPV) is a causative agent for an increasing subset of oropharyngeal squamous cell carcinoma. HPV 16 accounts for 90% of cases. The chance for malignant transformation due to infection with high-risk HPV is proportional to the expression of the viral oncogene products E6 and E7, which inactivate p53 and retinoblastoma (Rb) tumor suppressor functions. P16 is a surrogate marker of HPV associated HNSCC and 2+/3+ expression in more than 75% cells is diagnostic. Molecular demonstration of integrated virus by in situ hybridization is specific but has low sensitivity. HPV associated oropharyngeal carcinomas classically arise in the tonsillar crypts and commonly have basaloid morphology with a prominent lymphocytic repsonse and minimal despmoplastic reaction. In situ vs invasive carcinomas may be difficult to distinguish in histology. The HPV postitivity overrides traditional prognostic indicators such as tumour grade and histological subtype. Small cell morphology carries a poorer prognosis as does marked tumour anaplasia and multinucleation. Lymph node metastasis is extensive and frequently cystic however extranodal extension, laterality or nodal sizes do not carry prognostic implications as in conventional OSCC and OPSCC. Stage IV is reserved for distant metastasis. HPV-16–positive patients had significantly reduced overall and disease-specific mortality rates and an improved 3-year overall survival (OS) and disease-free survival (DFS) compared to patients with HPV negative tumors. Surgical treatment is the main option for primary and secondary HNSCC. Targeted therapies including drugs targeting EGFR and PIK3CA and have shown some promising results. HPV pathway expressing tumors are less aggressive and may receive adequate curative intent therapy from a reduced radiation or chemotherapy dose revision. OSCC however fails to show a distinct difference between HPV associated and Tobaccco associated cancer and prognostic differences do not clearly exist.

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ROLE OF TURMERIC IN MANAGEMENT OF ALVEOLAR OSTEITIS (DRY SOCKET) A RANDOMISED CLINICAL STUDY

Publication date: Available online 1 September 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Parveen Akhter Lone, Syed wakeel Ahmed, Vivek Prasad, Bashir Ahmed
Plants & their extracts have immense potential for the management Treatment of the wounds. The pyhto medicines for the wound healing are not only cheap & affordable but are purportedly safe as hypersensitivity reactions are rarely encountered with the use of these agents, these natural agents induce healing & regeneration of the lost tissue by multiple mechanisms Turmeric commonly is called as Haldi in Hindi. C Longa has been reported to possess anti bacterial, anti fungal & anti inflammatory activities Turmeric is known as traditional herb to Asia & India also called as curcuma longa, with maximum healing properties & other great uses. It is widely used in India & China for traditional Chinese medicine. This act as anti inflammatory agent to treat different kind of diseases & health problems.Aims & objectivesThe aim of this study was to study the therapeutic, healing benefits of turmeric, an herb commonly used in AsiaMaterial & methodsThe study was conducted in department of oral & maxillofacial surgery of Indira Gandhi government dental college jammu.178 patients were selected from the outpatient department of oral & maxillofacial surgery .The diagnosis of dry socket was made clinically. Turmeric dressing with mustard oil was given in group A & in group B ZOE dressing was given.ResultsIn this study there was significant reduction in pain, inflammation & discomfort after turmeric and ZOE dressing. Wound healing was seen faster, than dressing with ZOE. There is no side effect of Turmeric. Statistical analysis was done p<0.05, was found statistically significant

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AMELOBLASTOMA: A RETROSPECTIVE ANALYSIS OF 31 CASES

Publication date: Available online 1 September 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Girish B. Giraddi, Kirti Arora, Aamir Malick Saifi
Aims and objectiveTo evaluate the surgical treatment given and do a regular follow up to study the recurrence rate and complications of ameloblastoma in our institution.Materials and methodsA total of 31 cases of various subtypes of ameloblastoma, treated with different modalities, in the Department of OMFS, were recalled for a follow up & radiographs were taken along with the clinical examination for any recurrence or complications such as fracture/exposure of the reconstruction plate, loosening of the screw, infection of the graft, any draining sinus/signs of infection.ResultsTwo of our patients had fractured reconstruction plate, one patient developed infection, one patient complained of screw exposure and two other patients had infection of the iliac graft.ConclusionWe conclude that an adequate resection with a safe margin could be a treatment option and can be undertaken depending on the extent, location of the lesion and histopathologic variant.

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Evaluation of fracture resistance and mode of failure of premolars restored with nanohybrid composite, ORMOCER and ceramic inlays

Publication date: Available online 1 September 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Mohit. K. Gunwal, Pratima R. Shenoi, Tanvee Paranjape, Sonal Dhote, Ravish Tongya, Magesh Kumar, Sanjay Rastogi
ObjectivesTo evaluate the fracture resistance and mode of failure of maxillary premolars restorations restored with nanohybrid Composite, ORMOCER and Ceramic Inlays.Materials and method100 extracted first maxillary premolar were collected. Samples were divided into five groups. Group I – Intact premolars, Group II –MOD cavities without restorations, Group III – MOD cavities restored with composite restoration, GROUP IV – MOD cavities restored with ORMOCER restoration and GROUP V – MOD cavities restored with ceramic inlays. All the samples were sent for the axial compression test under the universal testing machine. Fracture resistance and fracture modes were recorded.ResultHighest fracture resistance was achieved in Group V (1324.74±336.78) almost comparable to that of natural tooth (1381.07±259.36) (p<0.05), followed by Group IV (MOD cavities with ORMOCER restorations) (1082.27±351.27) (p<0.01) and least fracture resistance in Group III (MOD cavities with composite restorations) (778.35±100.25) (p<0.0001). Mode of fracture in Group IV and Group V are almost similar and In Group III 65% of the cases showed non-restorable fractures.ConclusionORMOCER fracture resistance along with other groups of clinically restorable fracture stand better than Nanohybrid composite.Clinical RelevanceBased on the present study, the dentist can utilize the ORMOCER material as a restoration material for the cavities of posterior teeth which is better in terms of fracture resistance and durability of the restoration when compare to nanohybrid composite.

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The Use of Synthes MatrixWAVE Bone Anchored Arch Bars for Closed Treatment of Multiple Concurrent Mandibular Fractures

Publication date: Available online 1 September 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Elizabeth Kiwanuka, Rajiv Iyengar, Charles Christopher Jehle, Raman Mehrzad, Daniel Kwan
BackgroundMaxillomandibular fixation (MMF) is an important tool in the treatment of facial fractures and bone-anchored arch bar systems have emerged as treatment options. This study illustrates our experience with the Synthes MatrixWAVE MMF system and the novel application in closed treatment of patients with multiple concurrent mandibular fractures.MethodsWe enrolled eight patients with concurrent mandibular fractures and treated them with the Matrix Wave MMF system. The malleable arch bars were fitted and then secured using 6 to 8mm screws. The arch bar was and either stretched or compressed to ensure optimal positioning. 24-gauge interdental fixation wiring was placed using the fish loop technique on either side of the fracture to achieve stabilization of the mandible fractures.ResultsAll eight patients were retained in MMF until stable occlusion was achieved with clinical evidence of healing, approximately 4 to 6 weeks. Post-operative Panorex scans did not reveal any evidence of damage to tooth roots. None of the screws became overly embedded in the mucosa secondary to overgrowth; the arch bars were successfully removed in an outpatient setting without local anesthesia.ConclusionsThe Synthes MatrixWAVE MMF system has unique features such as prominent screw anchor heads and horizontal malleability unique from other bone anchored arch bars. These features allow for completely closed treatment of patients with multiple concurrent mandible fractures.

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Efectividad del colgajo de músculo pectoral mayor miofascial en la reducción de fístulas salivares tras laringectomía total de rescate

Publication date: Available online 1 September 2017
Source:Acta Otorrinolaringológica Española
Author(s): Carlos Miguel Chiesa Estomba, Jose Angel González García, Jon Alexander Sistiaga Suarez, Izaskun Thomas Arrizabalaga, Ekhiñe Larruscain Sarasola, Xabier Altuna Mariezcurrena
IntroducciónLa fístula faringocutánea es la más frecuente de las complicaciones poslaringectomía total. Su incidencia varía entre un 9-25% en pacientes poslaringectomía total primaria, hasta un 14-57% en laringectomía de rescate posradioterapia o posquimioterapia+radioterapia. El colgajo de músculo pectoral mayor miofascial (PMMF) se postula como una herramienta útil para disminuir la incidencia de esta complicación.Material y métodoAnálisis retrospectivo de pacientes tratados mediante laringectomía total de rescate, asociada o no a refuerzo de sutura faríngea con colgajo de PMMF.ResultadosVeinte pacientes fueron incluidos, 18 hombres (90%) y 2 mujeres (10%), en 10 de los cuales se utilizó colgajo de PMMF. La edad promedio fue de 66,65 años. Diecisiete (85%) presentaron un tumor laríngeo y 3 (15%) un tumor de hipofaringe. Ocho (80%) pacientes del grupo sin PMMF presentaron fístula en el postoperatorio, mientras que tan solo 2 (20%) pacientes del grupo de PMMF presentaron fístula durante el postoperatorio (p=0,005). El tiempo promedio para el cierre de la fístula fue significativamente menor en los casos en que se empleó el PMMF (16±11 vs. 76,8±67 días, p=0,001), así como la estancia hospitalaria (19,6±18 vs. 83,9±77 días, p0,001).ConclusiónEl uso del PMMF se asocia a una menor tasa de fístulas poslaringectomía total de rescate en pacientes tratados de forma primaria mediante protocolo de conservación de órgano por cáncer de laringe/hipofaringe, y favorece la cicatrización local disminuyendo el tiempo promedio de cierre de fístulas y la estancia media hospitalaria.IntroductionPharyngocutaneous fistula is the most frequent complication after total laryngectomy. Its incidence varies between 9%-25% in post primary total laryngectomy patients, to 14%-57% in salvage laryngectomy post radiotherapy or post chemotherapy + radiotherapy. The pectoralis major myofascial flap (PMMF)is postulated as a useful tool to decrease the incidence of this complication.Materials and methodRetrospective analysis of a group of patients treated by salvage laryngectomy, associated or not with pharyngeal closure reinforcement with PMMF.ResultsTwenty patients were included, 18 males (90%) and 2 females (10%), in 10 of whom the PMMF was used. The average age was 66.65 years. Seventeen (85%) had a laryngeal tumour and 3 (15%) had a hypopharyngeal tumour. Eight (80%) patients in the non-PMMF group had postoperative fistula, whereas only 2 (20%) patients in the PMMF group had a fistula during the postoperative period (P=.005). The mean time for fistula closure was significantly shorter in the cases where PMMF flap was used (16±11 days vs. 76.8±67 days, P=.001), as was hospital stay (19. 6±18 days vs. 83.9±77 days, P=.001).ConclusionThe use of PMMF in our series is associated with a lower rate of post salvage laryngectomy fistulas in patients treated primarily by organ preservation protocol for laryngeal/hypopharyngeal cancer. In turn, it promotes local healing by decreasing the mean duration of fistula closure and the mean hospital stay.

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oVEMP as an objective indicator of successful repositioning maneuver

Publication date: Available online 31 August 2017
Source:Acta Otorrinolaringológica Española
Author(s): Samir Asal, Osama Sobhy, Amany Balbaa
Background and objectiveBenign paroxysmal positioning vertigo (BPPV) is the most common peripheral vestibular disorder. Canalolithiasis in the posterior semi-circular canal is the most common underlying pathology that can be treated effectively by repositioning maneuvers. Our hypothesis suggested that successful maneuvers can lead to repositioning of dislodged otoconia to the utricle.Materials and methodsAir conducted oVEMP, which is thought to originate from the contra-lateral utricular organ was measured in twenty patients with unilateral BPPV and we compared n1–p1 peak to peak amplitude of the affected ears in 3 separate intervals: on pre-treatment when typical nystagmus was confirmed, immediately after, and 1 week after repositioning maneuvers to assess change, if any, in amplitude.ResultsThis study showed significant increase of oVEMP amplitude in the affected ears after successful repositioning maneuver that was more significant after 1 week.ConclusionsoVEMP can be used as a reliable objective test for ensuring a successful maneuver rather than subjective dependence on the patient's symptoms, which may be misleading due to a remission.

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Análisis cepstral de la voz normal y patológica en adultos españoles. Medida de la prominencia del pico cepstral suavizado en vocales sostenidas versus habla conectada

Publication date: Available online 1 September 2017
Source:Acta Otorrinolaringológica Española
Author(s): Jonathan Delgado-Hernández, Nieves M. León-Gómez, Laura M. Izquierdo-Arteaga, Yanira Llanos-Fumero
Introducción y objetivosEn los últimos años se ha incrementado el uso de medidas cepstrales para la evaluación acústica de la voz. Uno de los parámetros más investigados es la prominencia del pico cepstral suavizado (CPPs). Los objetivos de este trabajo son conocer la utilidad de esta medida acústica en la evaluación objetiva de las alteraciones de la voz en español y determinar qué tipo de muestra de voz (vocales sostenidas o habla conectada) es la más sensible para evaluar la severidad de la disfonía.MétodoEn este estudio participaron 40 sujetos, 20 normofónicos y 20 con disfonía. Se grabaron 2 muestras de voz para cada sujeto (una/a/sostenida y 4 frases fonéticamente balanceadas) y se calculó la CPPs con el programa Praat. Tres expertos valoraron perceptivamente la voz de la muestra con el parámetro grado de la escala GRABS.ResultadosSe encontraron valores significativamente menores en las voces disfónicas, tanto para la/a/(t[38]=4,85, p<0,000) como para las frases (t[38]=5,75, p<0,000). En relación con el tipo de muestra de voz más indicado para evaluar la severidad de las alteraciones de la voz se encontró una fuerte correlación con la escala acústico-perceptiva de la CPPs calculada a partir del habla conectada (rs = –0,73) y moderada con la calculada a partir de la vocal sostenida (rs=–0,56).ConclusiónLos resultados de este estudio preliminar apuntan a que la CPPs es una buena medida para detectar la disfonía y para evaluar objetivamente el grado de severidad de las alteraciones en la voz.Introduction and objectivesIn recent years, the use of cepstral measures for acoustic evaluation of voice has increased. One of the most investigated parameters is smoothed cepstral peak prominence (CPPs). The objectives of this paper are to establish the usefulness of this acoustic measure in the objective evaluation of alterations of the voice in Spanish and to determine what type of voice sample (sustained vowels or connected speech) is the most sensitive in evaluating the severity of dysphonia.MethodForty subjects participated in this study 40, 20 controls and 20 with dysphonia. Two voice samples were recorded for each subject (one sustained vowel/a/and four phonetically balanced sentences) and the CPPs was calculated using the Praat programme. Three raters perceptually evaluated the voice sample with the Grade parameter of GRABS scale.ResultsSignificantly lower values were found in the dysphonic voices, both for/a/(t[38]= 4.85, P<.000) and for phrases (t[38] = 5,75, P<.000). In relation to the type of voice sample most suitable for evaluating the severity of voice alterations, a strong correlation was found with the acoustic-perceptual scale of CPPs calculated from connected speech (rs = –0.73) and moderate correlation with that calculated from the sustained vowel (rs = –0,56).ConclusionThe results of this preliminary study suggest that CPPs is a good measure to detect dysphonia and to objectively assess the severity of alterations in the voice.

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Systematic three-dimensional analysis of wafer-based maxillary repositioning procedures in orthognathic surgery

Publication date: Available online 31 August 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Timo Dreiseidler, Max-Philipp Lentzen, Matthias Zirk, Ali-Farid Safi, Joachim E. Zoeller, Matthias Kreppel
PurposeLittle is known about the three-dimensional (3D) transfer accuracy in maxillary repositioning procedures based on conventionally manufactured dental-mounted wafers. The purpose of the present study was a systematic 3D analysis for wafer-based maxillary positioning in orthognathic surgery.Materials and MethodsA total of 92 patients underwent Le Fort I in addition to mandibular bilateral sagittal split osteotomies (BSSO). Alignment of the pre- and postsurgical CBCT data sets allowed measuring maxillary position changes in axial, sagittal and transversal directions.ResultsThe highest achieved absolute transfer inaccuracies were 1.37 mm, ± 0.84 in the sagittal direction, followed by 1.15 mm, ± 0.69 in the axial, as well as 1.05 mm, ± 0.79 in the transversal direction. The largest relative deviations could be found for repositions in the transversal plane (109.4%, ± 4.5), followed by the axial (66.2%, ± 51.5) and sagittal plane (49.3%, ± 2.2). Significant transfer accuracy differences of repositioning procedures in the sagittal direction, mainly advancement procedures, could be detected if performed with (1.75 mm, ± 0.90) or without (1.18 mm, ± 0.78) additional rotational correction component. No significant differences were found between unidirectional and multidirectional maxillary correction procedures.ConclusionThe present study for the first time delivers systematic 3D accuracy data of wafer-based maxillary positioning procedures, attesting to its feasibility but also further encouraging the search for improvement strategies.

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Announcements

Publication date: September 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 9

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Editorial Board

Publication date: September 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 9

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REMOVED: False aneurysm of the facial artery as complication of sagittal split osteotomy, [Journal of Cranio-Maxillofacial Surgery. Volume 36, Issue 3, April 2008, Pages 180–182]

Publication date: September 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 9
Author(s): Helena Pappa, David Richardson, Sasha Niven

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Axial four-dimensional computed tomographic images to analyze crosswise differences in protrusive condylar movement in patients who underwent mandibulectomy and free flap reconstruction

Publication date: Available online 1 September 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Masaya Akashi, Toshinori Sekitani, Yumi Ohtsuki, Yasumasa Kakei, Junya Kusumoto, Takumi Hasegawa, Michinori Maeda, Noriyuki Negi, Kazunobu Hashikawa, Yasuyuki Shibuya, Satoru Takahashi, Takahide Komori
ObjectiveFew studies evaluate condylar movement following mandibular reconstruction. The main objective of this study was to show that axial four-dimensional computed tomography (4DCT) could visualize bilateral protrusive condylar movement directly. We used axial 4DCT images to assess condylar protrusion in patients who underwent mandibular reconstruction.MethodsWe enrolled seven healthy volunteers (median age 30 years, range 27–38 years) and seven patients (median age 65 years, range 52–80 years), who underwent mandibulectomy (segmental in five, hemi in one, marginal in one) and free flap reconstruction (using the fibula in six and the radial forearm in one). Six study subjects were instructed to masticate a cookie during the 4DCT scan (the seventh made chewing motions). The distance between the most anterior and posterior positions of the bilateral condyles on 4DCT (axial view) images were then measured and compared between controls and patients using the Mann-Whitney U-test.ResultsThe crosswise difference in the distances of condylar protrusion was significantly greater in patients than in the controls.ConclusionAxial 4DCT images can visualize a bilateral condylar protrusive path. Axial 4DCT images for patients who have undergone mandibulectomy and reconstruction may be useful for evaluation of functional movement of condyles.

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EACMFS Prizes and Awards

Publication date: September 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 9

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CAD-CAM plates versus conventional fixation plates for primary mandibular reconstruction: a biomechanical in vitro analysis

Publication date: Available online 1 September 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Carsten Rendenbach, Kay Sellenschloh, Lucca Gerbig, Michael M. Morlock, Benedicta Beck-Broichsitter, Ralf Smeets, Max Heiland, Gerd Huber, Henning Hanken
BackgroundCAD/CAM reconstruction plates have become a viable option for mandible reconstruction. The aim of this study was to determine whether CAD/CAM plates provide higher fatigue strength compared with conventional fixation systems.Material and Methods1.0 mm miniplates, 2.0 mm conventional locking plates (DePuy Synthes, Umkirch, Germany), and 2.0 mm CAD/CAM plates (Materialise, Leuven, Belgium/DePuy Synthes) were used to reconstruct a polyurethane mandible model (Synbone, Malans, CH) with cortical and cancellous bone equivalents. Mastication was simulated via cyclic dynamic testing using a universal testing machine (MTS, Bionix, Eden Prairie, MN, USA) until material failure reached a rate of 1 Hz with increasing loads on the left side.ResultsNo significant difference was found between the groups until a load of 300 N. At higher loads, vertical displacement differed increasingly, with a poorer performance of miniplates (p = 0.04). Plate breakage occurred in miniplates and conventional locking plates. Screw breakage was recorded as the primary failure mechanism in CAD/CAM plates. Stiffness was significantly higher with the CAD/CAM plates (p = 0.04).ConclusionCAD/CAM plates and reconstruction plates provide higher fatigue strength than miniplates, and stiffness is highest in CAD/CAM systems. All tested fixation methods seem sufficiently stable for mandible reconstruction.

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The effects of surgically assisted rapid maxillary expansion (SARME) on the dental show and chin projection

Publication date: Available online 31 August 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Tong Xi, Magdalena Laskowska, Neeltje van de Voort, Hossein Ghaeminia, Wojciech Pawlak, Stefaan Bergé, Thomas Maal

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Force and deformation stresses in customized and non-customized plates during simulation of advancement genioplasty

Publication date: Available online 31 August 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): V.F. Ramos, L.A.P.F. Pinto, R.T. Basting
PurposeThe aim of this study was to evaluate the distribution of deformation stresses in customized and non-customized plates during simulated advancement genioplasty, using the finite element method.MethodsA customized plate (Traumec) was developed with 4.75 mm advancement, in ASTM F67 Grade 2 titanium, with four screws. Non-customized (standard) plates with 6 mm advancement (Stryker with six screws and Osteomed with four screws) were used for comparison. All the screws presented the same length (10 mm) and fixation system (2.0). The Traumec and Osteomed plates were fixed with two screws in the mandible, and another two in the segment, whereas the Stryker plate was fixed with three screws in the mandible, and another three in the segment. Six virtual models were generated in a computer-aided design program (Rhinoceros), in which the advancement and insertion of the plates were evaluated. All the plates were submitted to application of perpendicular and oblique forces of 5 N in the chin region.ResultsThe Osteomed plate showed the highest stress value (1506 MPa), and the Traumec, the lowest stress value (560.20 MPa). The Stryker plate showed higher stress values for the segment screws than for the mandibular screws, unlike the other plates.ConclusionsThe customized Traumec plate showed better deformation stress distribution and plate/segment stabilization when submitted to advancement genioplasty.

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A prospective analysis evaluating tissue biopsy location and its clinical relevance in chronic rhinosinusitis with nasal polyps

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) has a high propensity for recurrence. Studies suggest that eosinophilia influences disease severity and surgical outcomes, but the selection of sinonasal site for measuring eosinophilia has not been examined. The aim of this study was to investigate how region-specific tissue eosinophilia affects radiographic severity, comorbidity prevalence, and polyp recurrence risk following sinus surgery.

Methods

Eosinophil cationic protein (ECP) levels in uncinate tissue (UT) and nasal polyp (NP) homogenates from 116 CRSwNP patients were measured using enzyme-linked immunosorbent assay (ELISA). Clinical history, radiographic severity, and time to polyp recurrence were obtained from electronic health records. The correlations between baseline Lund-Mackay scores and comorbidities were compared between UT and NP ECP levels. Cox regression and Kaplan-Meier analysis were then performed to assess whether UT or NP ECP better predicted recurrence. Censoring occurred at 4 years or at last follow-up if there was no endoscopic diagnosis of recurrent polyps.

Results

Lund-Mackay scores were significantly correlated with UT and NP ECP (r = 0.46 and 0.26 respectively, p < 0.05). UT but not NP ECP was significantly higher in patients with asthma (p < 0.01) and aspirin-exacerbated respiratory disease (AERD) (p < 0.05). Polyp recurrence risk was only significantly higher for patients with eosinophilic UT tissue (hazard ratio [HR] = 2.84, p = 0.025). When measured in NP, eosinophilia did not predict recurrence.

Conclusion

Although ECP in NP was higher than in UT tissue, eosinophilia in UT tissue was a more clinically coherent biomarker of baseline radiographic severity, comorbid asthma and AERD, and prospective polyp recurrence risk than NP eosinophilia.

http://ift.tt/2guK76K

Therapeutic potential of α-lipoic acid derivative, sodium zinc histidine dithiooctanamide, in a mouse model of allergic rhinitis

Background

Oxidative stress is involved in various diseases, including allergies. Several studies have pointed to the preventive and therapeutic potential of antioxidants in allergic disorders. However, little is known about the immunomodulatory effects of antioxidants in type I hypersensitivity. In this study we aimed to explore the impact of a water-soluble antioxidant and α-lipoic acid derivative, sodium zinc histidine dithiooctanamide (DHL-HisZn), on mast-cell- and T-cell-mediated allergic and immune responses both in vitro and in vivo.

Methods

The therapeutic impact of DHL-HisZn on mast-cell-mediated type I hypersensitivity was evaluated by a mast-cell degranulation assay using bone marrow-derived mast cells and by a mouse model of ovalbumin (OVA)-induced allergic rhinitis. The effect of DHL-HisZn on the proportion of regulatory T cells (Tregs) was evaluated using flow cytometry.

Results

During the course of OVA-induced allergic rhinitis in mice, serum nitrate was elevated, suggesting the involvement of oxidative stress in allergic responses. DHL-HisZn not only suppressed mast-cell degranulation but also ameliorated OVA-induced nasal hypersensitivity, with significant suppression of serum nitrate. DHL-HisZn treatment significantly suppressed OVA-specific immunoglobulin E (IgE) but enhanced OVA-specific IgG2a in OVA-sensitized and nasal-challenged mice. Furthermore, DHL-HisZn treatment suppressed interleukin-17 production in OVA-stimulated splenocytes. Finally, we demonstrated the induction of Tregs by DHL-HisZn in concanavalin A blasts.

Conclusions

These findings suggest that DHL-HisZn may regulate mast-cell-, T-helper 2 (Th2)-, and Th17-mediated allergic and immune responses by induction of Tregs.

http://ift.tt/2eLUXl2

Glucosamine oral administration as an adjunct to hyaluronic acid injection in treating temporomandibular joint osteoarthritis

Abstract

Objective

To investigate the therapeutic effect of oral glucosamine (GS) as an adjunct to hyaluronic acid (HA) injection on patients with temporomandibular joint osteoarthritis (TMJ OA).

Methods

In this clinical trial, 136 participants, diagnosed as TMJ OA clinically and radiographically, were enrolled and randomized into two groups (Group GS+HA: oral GS+HA injection; Group placebo+HA: oral placebo+HA injection). Pain, maximum inter-incisal mouth opening (MMO), the levels of IL-1β, IL-6, and TGF-β in TMJ synovial were defined as the outcome measurements and conducted before operation, and at 1-month, 1-year follow-up.

Results

In both groups, pain scores were decreased and MMOs were increased at 1-month and 1-year follow-up, the changes at 1-year follow-up showed statistically significant intergroup differences. At 1-month follow-up, only IL-6 concentration was lower in group GS+HA than that in group placebo+HA. One year later, TGF-β concentration was higher, IL-6 and IL-1β concentrations were lower in group GS+HA than those in group placebo+HA.

Conclusions

Both strategies alleviated symptoms in short term, but the patients treated with GS benefited more than those with placebo in long term, which may be due to the suppression of IL-1β and IL-6 and the stimulation of TGF-β.

http://ift.tt/2wpPPw1

Factors related to diagnostic delay of oral squamous cell carcinoma in southern Thailand: revisited

Abstract

Objectives

To evaluate the impact of more open access to health services by Thailand's universal health coverage (UHC) on diagnostic delay of oral squamous cell carcinomas (OSCC) by comparing results with our previous study prior to the UHC. Reasons for delay in attending health care professionals (HCPs) consultation were also investigated.

Methods

A structure questionnaire was employed to interview 154 OSCC consecutive patients. Variables were included for Cox proportional regression models to conclude the hazard ratio of each delay.

Results

Regarding patient delay, those who had more than 12 years education showed less delay (HR 0.46, 95% CI: 0.21−1.01) while longer delay was found in farmers (HR 1.49, 95% CI: 1.05−2.11). Compared with the previous study, there was no association between herbal medication and patient delay, herbal medication and total delay, nor religion and total delay. Professional delay showed no association with any variable. Only half of the patients received initial proper HCP management in both studies. Patient delay was mostly (89.9%) due to unawareness of the lesion severity.

Conclusions

Open access to the healthcare system had an influence on diagnostic delay. Public education and precise clinical acumen by HCPs in OSCC diagnosis are needed for early detection.

http://ift.tt/2vQZ9Wp

Unique heterozygous presentation in an infant with DNA ligase IV syndrome

Publication date: Available online 31 August 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Barbara A. Brunet, Nina Dave

http://ift.tt/2wpKl4A

Parental perception of anxiety in children with eosinophilic esophagitis in a tertiary care center

Publication date: Available online 31 August 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Jaison Jose, Amy Virojanapa, Erik B. Lehman, Alexandra Horwitz, Tracy Fausnight, Punit Jhaveri, Chandran Alexander, Pooja Jhaveri

http://ift.tt/2vQC9a7

Management around invasive procedures in mastocytosis

Publication date: Available online 31 August 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Maud A.W. Hermans, Nicolette J.T. Arends, Roy Gerth van Wijk, P. Martin van Hagen, Hanneke C. Kluin-Nelemans, Hanneke N.G. Oude Elberink, Suzanne G.M.A. Pasmans, Paul L.A. van Daele
ObjectiveMastocytosis is a chronic hematologic disorder that is characterized by the accumulation of aberrant mast cells and typically involves the skin and/or bone marrow. Patients with mastocytosis are at increased risk of anaphylaxis. Based on theoretical assumptions, medical procedures requiring general anesthesia or radiocontrast media are deemed hazardous for patients with mastocytosis. The objective of this article is to provide a comprehensive overview of the actual risk of iatrogenic anaphylaxis and provide recommendations for daily practice.Data SourcesVarious scientific search engines were used (eg, PubMed and Medline).Study SelectionsBecause of the paucity of high-level studies on this topic, all available evidence was considered, including case reports.ResultsReliable data on the incidence of iatrogenic anaphylaxis in mastocytosis are lacking. However, although the incidence as reported in (retrospective) cohort studies is higher than in the general population, it is still lower than commonly anticipated, with an incidence of 5.4% in 1 study. Adequate premedication and avoidance of certain physical stimuli can further decrease this risk by 10-fold. The role of drugs as elicitors of anaphylaxis is perhaps overestimated, and physical stimuli are at least as important in inducing release of mast cell mediators.ConclusionThis article provides practical recommendations for the management of invasive procedures in patients with mastocytosis based on current knowledge of this topic.

http://ift.tt/2wpNdym

Eosinophil-derived neurotoxin as a biomarker for disease severity and relapse in recalcitrant atopic dermatitis

Publication date: Available online 31 August 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Hwan Soo Kim, Ji Hye Kim, Yu Mi Seo, Yoon Hong Chun, Jong-seo Yoon, Hyun Hee Kim, Joon Sung Lee, Jin Tack Kim
BackgroundEosinophils are encountered in many skin diseases, but the role of eosinophils in atopic dermatitis (AD) remains uncertain.ObjectiveTo examine the role of serum eosinophil-derived neurotoxin (EDN), eosinophil cationic protein (ECP), and total IgE as a biomarker of disease severity and relapse in severe recalcitrant AD.MethodsWe enrolled 99 patients with AD: 37 with severe recalcitrant AD, 20 with severe AD, and 42 with mild to moderate AD. We examined the difference in serum level of total IgE, ECP, and EDN between the groups and whether any correlation existed between disease severity and ECP or EDN. Lastly, difference in levels of ECP or EDN between those who experienced relapse was examined in the severe recalcitrant group.ResultsSerum levels of total IgE, ECP, and EDN were significantly higher in the severe recalcitrant AD group and severe AD group compared with the mild to moderate AD group. No significant difference was found in serum levels of total IgE, ECP, and EDN between the severe recalcitrant group and severe group. EDN had a significant positive correlation with the SCORing Atopic Dermatitis. No significant correlation was found between EDN and ECP. In the severe recalcitrant group, 29.7% of patients experienced relapse, and EDN was significantly higher in those who experienced relapse. The cutoff value of EDN for predicting relapse was 64.5.ConclusionEDN correlated with the disease severity of AD. EDN may predict relapse in severe recalcitrant AD. The EDN serum level could be considered a candidate molecule as a clinical biomarker for evaluating AD disease activity and a predictor of relapse.

http://ift.tt/2wpHQPO

Evaluation of periprocedural hypersensitivity reactions

Publication date: Available online 31 August 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Melissa Iammatteo, Taha Keskin, Elina Jerschow
BackgroundIdentifying the cause of periprocedural hypersensitivity reactions (HSRs) remains challenging because of the multitude of medications involved. Antibiotics are the most common cause in the United States, whereas neuromuscular blocking agents are most common in Europe.ObjectiveTo identify causative agents for periprocedural HSRs.MethodsThis study was a 7-year retrospective medical record review of patients evaluated between December 2009 and January 2017 at a drug allergy center in Bronx, New York for periprocedural HSRs, defined as occurring soon before, during, or soon after a medical procedure or operation with or without general anesthesia. Demographics, description of historical HSRs, results of testing to potential causative medications, and tolerance of subsequent anesthesia were reviewed.ResultsThirty-four patients completed a comprehensive evaluation. Skin testing identified an IgE-mediated cause in 22 patients (64.7%). The most common causative class of medications was induction agents (n = 9 [36%]), with midazolam being the most frequently implicated (n = 6 [3 positive skin test results, 3 equivocal skin test results]). Cefazolin was the most common agent identified (n = 8 [32%]) followed by ondansetron (n = 3 [12%]). Sixteen of 22 contacted patients were exposed to subsequent anesthesia, including 3 patients with negative evaluations. One patient experienced a mild urticarial HSR.ConclusionInduction agents were the most common causative agents in our patients, which differs from other studies. Given the variability in evaluations of periprocedural HSRs across the United States with data published on small sample sizes, there is a need to establish national guidelines to standardize evaluations and to create a national registry to allow for data sharing.

http://ift.tt/2gpJkAo

Identification and validation of asthma phenotypes in Chinese population using cluster analysis

Publication date: Available online 31 August 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Lei Wang, Rui Liang, Ting Zhou, Jing Zheng, Bing Miao Liang, Hong Ping Zhang, Feng Ming Luo, Peter G. Gibson, Gang Wang
BackgroundAsthma is a heterogeneous airway disease, so it is crucial to clearly identify clinical phenotypes to achieve better asthma management.ObjectiveTo identify and prospectively validate asthma clusters in a Chinese population.MethodsTwo hundred eighty-four patients were consecutively recruited and 18 sociodemographic and clinical variables were collected. Hierarchical cluster analysis was performed by the Ward method followed by k-means cluster analysis. Then, a prospective 12-month cohort study was used to validate the identified clusters.ResultsFive clusters were successfully identified. Clusters 1 (n = 71) and 3 (n = 81) were mild asthma phenotypes with slight airway obstruction and low exacerbation risk, but with a sex differential. Cluster 2 (n = 65) described an "allergic" phenotype, cluster 4 (n = 33) featured a "fixed airflow limitation" phenotype with smoking, and cluster 5 (n = 34) was a "low socioeconomic status" phenotype. Patients in clusters 2, 4, and 5 had distinctly lower socioeconomic status and more psychological symptoms. Cluster 2 had a significantly increased risk of exacerbations (risk ratio [RR] 1.13, 95% confidence interval [CI] 1.03–1.25), unplanned visits for asthma (RR 1.98, 95% CI 1.07–3.66), and emergency visits for asthma (RR 7.17, 95% CI 1.26–40.80). Cluster 4 had an increased risk of unplanned visits (RR 2.22, 95% CI 1.02–4.81), and cluster 5 had increased emergency visits (RR 12.72, 95% CI 1.95–69.78). Kaplan-Meier analysis confirmed that cluster grouping was predictive of time to the first asthma exacerbation, unplanned visit, emergency visit, and hospital admission (P < .0001 for all comparisons).ConclusionWe identified 3 clinical clusters as "allergic asthma," "fixed airflow limitation," and "low socioeconomic status" phenotypes that are at high risk of severe asthma exacerbations and that have management implications for clinical practice in developing countries.

http://ift.tt/2wpGNiw

Clinical and biological response to rituximab treatment in 3 patients with acquired C1-inhibitor deficiency

Publication date: Available online 31 August 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Paula J. Busse, Yael Gernez

http://ift.tt/2gpJ0Sc

Filaggrin mutations and Molluscum contagiosum skin infection in patients with atopic dermatitis

Publication date: Available online 31 August 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Sara Manti, Maria Amorini, Caterina Cuppari, Annamaria Salpietro, Francesca Porcino, Salvatore Leonardi, Michele Miraglia Del Giudice, Gianluigi Marseglia, Davide Paolo Caimmi, Carmelo Salpietro
BackgroundAlthough mutations in the filaggrin (FLG) gene have been reported to predispose patients with atopic dermatitis (AD) skin infection susceptibility, to date, the data reported in the literature are still controversial.ObjectiveTo evaluate the role of FLG polymorphisms expression and risk of developing a concomitant Molluscum contagiosum sustained skin infection in the pediatric population with AD.MethodsA total of 100 children with AD and 97 healthy children were enrolled. AD was diagnosed and assessed according to the validated European Task Force on Atopic Dermatitis. DNA samples of patients were analyzed for allelic variants in the promoter and coding exon of FLG. Genotyping was performed with polymerase chain reaction amplification and direct sequencing.ResultsSixteen FLG variants have been detected in 29% of patients with AD: 2 synonymous (rs79808464 and rs116222149), 12 missense (rs11584340, rs113136594, rs145828067, rs374910442, rs747005144, rs145627745, rs144209313, rs74129443, rs192455877, rs150957860, rs138055273, rs147472105), 1 stop gained (rs183942200), and 1 frameshift (rs 558269137). In contrast, only 13% of the control group reported FLG mutations (22 heterozygous variants). In addition, the age at disease onset correlated significantly with FLG variants (P < .001). In addition, the AD with FLG gene variants (rs145627745, rs79808464, rs150957860, rs145828067, rs747005144, rs374910442, rs138055273, rs183942200, rs11584340, and rs113136594) reported moderate to severe Scoring Atopic Dermatitis scores. Finally, the AD group and the AD plus M contagiosum skin infection group had a significant association with FLG mutations when compared with the control group (P < .01).ConclusionFLG mutations are associated with early onset of AD, more severe clinical course of disease, and a significantly increased risk of M contagiosum sustained skin infection.

http://ift.tt/2wYkr9m

Schmerzlose, teigige, livid-rote Schwellung des Nackens und Rückens

http://ift.tt/2wt0qVF

Computerbasierte Diagnostik von Hauttumoren mithilfe künstlicher Intelligenz

http://ift.tt/2vy53QX

Oral melanoma and other pigmentations: when to biopsy?

Abstract

Oral pigmentations (OPs) are often neglected, although a meticulous examination of the oral cavity is important not only in the diagnosis of oral melanoma, but also for the detection of important clinical findings that may indicate the presence of a systemic disease. OPs may be classified into two major groups on the basis of their clinical appearance: focal and diffuse pigmentations, even though this distinction may not appear so limpid in some cases. The former include amalgam tattoo, melanocytic nevi, melanoacanthoma, melanosis, while the latter include physiological/racial pigmentations, smoker's melanosis, drug induced hyperpigmentations, post-inflammatory hyperpigmentations, and OPs associated with systemic diseases.

We will discuss the most frequent OPs and the differential diagnosis with oral mucosal melanoma (OMM), underlining the most frequent lesions that need to undergo a bioptic examination and lesions that could be proposed for a sequential follow-up.

http://ift.tt/2evoIcX

Clinical, pathological and dermoscopic characteristics of cutaneous lesions in LEOPARD syndrome

LEOPARD syndrome (LS) is a rare autosomal disorder associated with multiple congenital anomalies. This term is an acronym for Lentigines (LT), Electrocardiographic conduction defects, Ocular hypertelorism, Pulmonary valve stenosis, Abnormalities of the genitalia, Retardation of growth, and Deafness ^1-3. Mutations in PTPN11 gene cause this syndrome in around 90% of cases, and less frequently other mutations produce this entity^3-4.

http://ift.tt/2wsU8VT

Parallel ridge dermoscopic pattern in plantar atypical Spitz nevus

Clinicopathological classification, diagnosis and management of spitzoid melanocytic lesion presents one of the most intriguing issues in dermatopathology (1,2). No single clinicopathological feature can offer reliable differentiation of Spitz nevus and melanoma. Although not all the experts agree with the concept of Spitzoid neoplasms as a morpho-biological spectrum, there is a four-tiered classification system proposed by Da Forno et al. and encompassing: 1) Spitz nevus; 2) atypical Spitz nevus; 3) (atypical) Spitz tumor; 4) Spitzoid melanoma (1,3). It is commonly said that Spitz nevus can show all the "local" dermoscopic features of melanoma, but in a more or less tidy fashion (4). The occurrence of melanoma-like dermoscopic pattern in Spitz nevus is also possible (4). The relationship between dermoscopic and histopathologic atypia is not absolute, in as much as dermoscopically atypical lesions are not necessarily histopathologically atypical as well.

http://ift.tt/2evt2sA

Cetuximab with radiotherapy as an alternative treatment for advanced squamous cell carcinoma of the temporal bone

The prognosis of advanced temporal bone cancer is poor, because complete surgical resection is difficult to achieve. Chemoradiotherapy is one of the available curative treatment options; however, its systemic effects on the patient restrict the use of this treatment. A 69-year-old female (who needed peritoneal dialysis) presented at our clinic with T4 left external auditory canal cancer and was treated with cetuximab plus radiotherapy (RT). The primary lesion showed complete response. The patient is currently alive with no evidence of disease two years after completion of the treatment and does not show any late toxicity.

http://ift.tt/2gvr0t6

Fluoride in saliva and dental biofilm after 1500 and 5000 ppm fluoride exposure

Abstract

Objectives

The aim of this randomized, double-blind, crossover study was to measure fluoride in saliva and 7-day-old biofilm fluid and biofilm solids after rinsing three times per day for 3 weeks with 0, 1500, or 5000 ppm fluoride (NaF).

Materials and methods

Following the 3-week wash-in/wash-out period, including 1 week of biofilm accumulation, saliva and biofilm samples were collected from 12 participants immediately before (background fluoride), and 10, 30, and 60 min after a single rinse. Biofilm samples were separated into fluid and solids, and samples were analyzed using a fluoride electrode (microanalysis).

Results

The background fluoride concentration was statistically significantly higher in the 5000 compared to the 1500 ppm F rinse group in all three compartments (22.3 and 8.1 μM in saliva, 126.8 and 58.5 μM in biofilm fluid, and 10,940 and 4837 μmol/kg in biofilm solids). The 1-h fluoride accumulation for the 5000 ppm F rinse was higher than for the 1500 ppm F rinse in all three compartments, although not statistically significant for saliva and biofilm solids.

Conclusion

Regular exposure to 5000 ppm fluoride elevates background fluoride concentrations in saliva, biofilm fluid, and biofilm solids compared to 1500 ppm fluoride. Increasing the fluoride concentration almost 3.5 times (from 1500 to 5000 ppm) only elevates the background fluoride concentrations in saliva, biofilm fluid, and biofilm solids twofold.

Clinical relevance

Even though fluoride toothpaste may be diluted by saliva, the results of the present study indicate that use of 5000 ppm fluoride toothpaste might lead to improved caries control.

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Composite tumor with pheochromocytoma and immature neuroblastoma: report of two cases with cytogenetic analysis and discussion of current terminology

http://ift.tt/2evrDCx

Effect of the Visual Information Change in Functional Dystonia

Conditions: Dystonia; Dystonic Disorders; Torticollis; Movement Disorders; Central Nervous System Diseases; Nervous System Diseases; Dyskinesias; Neurologic Manifestations
Intervention: Device: prism glasses
Sponsor: Fondation Ophtalmologique Adolphe de Rothschild
Not yet recruiting - verified August 2017

http://ift.tt/2wt0ULb

TTS Esophageal HILZO Stent: A Safety and Feasibility Study

Condition: Esophagus Cancer
Intervention: Device: HILZO esophageal stent
Sponsors: Radboud University; Kebomed B.V.
Recruiting - verified May 2017

http://ift.tt/2vxI9sW

Observations on fluid flow from exposed dentine in primary teeth: An in vitro study

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Monticha Rangcharoen, Varisara Sirimaharaj, Sitthichai Wanachantararak, Noppakun Vongsavan, Bruce Matthews
ObjectiveTo investigate fluid flow through dentine in primary teeth in vitro using the replica technique, and to compare the results with those obtained from permanent dentine.DesignThe experiments were carried out on 22 extracted, mandibular, primary, incisor teeth. The incisal edge was removed to 1mm below the dentino-enamel junction and half the exposed surface etched with phosphoric acid. The exposed dentine was blotted dry and the pressure in the pulp cavity held at 0, 15, 30 or 45cm H2O above atmospheric for 30s. Fluid that accumulated on the dentine surface was recorded with impression material and a replica made with epoxy resin which was examined in a scanning electron microscope.ResultsStructures resembling fluid droplets were present in the replicas of unetched dentine in all 22 teeth, and at all the pulpal pressures tested. The droplets formed at 45cm H2O were significantly larger (median diam., 5.14mm; interquartile range, 3.26mm; Friedman repeated measures analysis of variance on ranks (RMAVR) and Tukey test) than those formed at other pressures. There was no evidence of droplets in the replicas of etched dentine with any of the pulpal pressures.ConclusionsThese results demonstrate that fluid will tend to flow from dentine in deciduous teeth when it is exposed. They are similar to those obtained in a previous study in this laboratory on permanent teeth. The fact that fluid droplets were absent from etched dentine suggests that, after being blotted, the etched dentine matrix absorbed fluid that tended to flow out through the dentinal tubules.

http://ift.tt/2wprJBM

Adiponectin prevents orthodontic tooth movement in rats

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Sigrid Haugen, Kristin Matre Aasarød, Astrid Kamilla Stunes, Mats Peder Mosti, Tanya Franzen, Vaska Vandevska-Radunovic, Unni Syversen, Janne Elin Reseland
ObjectiveThe objective was to examine the effects of repetitive local administration of adiponectin on experimental tooth movement in rats.Materials and methodsThe maxillary right first molar of male Wistar rats (n=24) was moved mesially for 14days, with local adiponectin injections (0.2 or 2μg) every third day. Micro-computed tomography was performed at days 0, 6 and 14 and molar movement, bone density and bone volume fraction were calculated from the scans. Changes in extracellular matrix collagen and cell numbers in the periodontal ligament were analyzed histologically, and levels of circulating cytokines were measured by Luminex and ELISA.ResultsAdiponectin injections induced a reduction in tooth movement after 12 and 14days compared to controls. No tooth movement was observed between days 3 and 14 in the group receiving the highest dosage (2μg) of adiponectin. Differences in bone density and bone volume fractions between treatment and control groups were not identified. Relative size and morphology of collagen fibrils, and cell number in the periodontal region after adiponectin injections were unchanged compared to controls. Levels of circulating adiponectin or other selected factors in plasma were not influenced by the adiponectin injections.ConclusionsSubmucosal injections of adiponectin prevented experimental tooth movement in rats. The effect was dosage-dependent and local. Adiponectin injections caused no detectable changes in bone density, periodontal cell number or collagen content.

http://ift.tt/2woVYZm

Observations on fluid flow from exposed dentine in primary teeth: An in vitro study

Adiponectin prevents orthodontic tooth movement in rats

Disseminate recurrent folliculitis as the presenting picture of hidradenitis suppurativa

Publication date: Available online 31 August 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J. Revuz
BackgroundHidradenitis suppurativa (HS) has a polymorphous clinical presentation. Herein we report two cases of HS revealed by disseminate recurrent folliculitis.Patients and methods case 1A 31-year-old woman consulted for disseminate recurrent folliculitis on the trunk and proximal segments of the limbs that had been ongoing for several years. No other cutaneous lesions were seen, particularly in the classic area for HS lesions. Weight loss and treatment with azithromycin 500mg/day resulted in complete remission, but relapse occurred on dosage reduction.Case 2The elder sister of patient 1, who was also obese and 10 years her senior, presented a similar clinical history, although in addition, she was presenting lesions characteristic of HS on her armpits and inguinal folds; further, she had undergone an operation 3 years earlier for pilonidal sinus. Three months of combined treatment with rifampicin and clindamycin 900 mg/day followed by long-term doxycycline 200mg/day resulted in marked improvement.DiscussionDisseminate folliculitis is not infrequent during the course of HS; it forms part of the clinical picture and is particularly common in the follicular phenotypic variant; however, it is not part of the diagnostic criteria as defined consensually by the Hidradenitis Suppurativa Foundation. The cases we report suggest that a setting of disseminate recurrent folliculitis may constitute the mode of presentation of HS, and may even represent an atypical monosymptomatic form of HS.ConclusionDisseminate recurrent folliculitis constitutes part of the clinical picture of HS; if it is isolated, screening should be performed for personal or familial signs of HS.

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Evolution of the anterolateral thigh free flap

Purpose of review: To review the recent literature on the evolution and advanced uses of the anterolateral thigh (ALT) free flap in reconstruction of oncologic defects of the head and neck. Recent findings: The ALT free flap is a versatile flap that can be harvested in a chimeric fashion with independent, vascularized skin, muscle, fascia, nerve and bone. Various techniques for chimeric flap harvest and flap inset have been described for reconstruction of pharyngocutaneous, oromandibular and radical parotidectomy defects. These reports expand the indications for the ALT free flap while demonstrating good functional and aesthetic outcomes. Summary: The ALT free flap remains popular for reconstruction of head and neck oncologic defects because of its versatility. Continued evolution in chimeric flap harvest techniques for pharyngocutaneous, osseous and radical parotidectomy defects highlights novel advanced reconstructive uses for the ALT free flap.

http://ift.tt/2wthquU

The impact of hearing loss on society in general: an underappreciated problem

No abstract available

http://ift.tt/2vy50ER

The management of pediatric hearing loss caused by auditory neuropathy spectrum disorder

Purpose of review: Auditory neuropathy spectrum disorder (ANSD) is a condition in which auditory testing reveals normal otoacoustic emissions, but auditory brainstem testing is abnormal or absent and speech discrimination is poor. This constellation of findings ostensibly suggests that the cochlea is healthy and an abnormality of conduction or processing of sound occurs along the nerve fibers. As more is learned about this condition, it is becoming clear that ANSD describes heterogeneous, distinct clinical entities that must be taken into account when devising treatment modalities. Recent findings: Modern auditory testing, genetic testing, and neuroimaging can allow for an accurate understanding of the location of the lesion causing ANSD in the auditory pathway. Contributing causes can include genetic mutations, absent or deficient cochlear nerve, hypoxia and jaundice among others. Hearing aids can be successful in the management of ANSD. Several studies suggest that cochlear implantation can lead to successful hearing outcomes in a subset of this patient population. Summary: Auditory neuropathy spectrum disorder represents a relatively rare but important diagnosis for clinicians. Treatment for this condition includes hearing aids and FM systems in more mild cases, and cochlear implants in severe cases. Cochlear implantation for many patients can lead to a good hearing outcomes but the outcome can vary greatly depending on the underlying etiology of ANSD.

http://ift.tt/2vxJ3FN

Increasing access to hearing rehabilitation for older adults

Purpose of review: To provide an update on the recent research and policy developments affecting the current and future care of the 23 million older Americans with untreated hearing loss. Recent findings: Increasing evidence supports the association of age-related hearing loss with significant negative outcomes that affect the ability of older adults to age well. Despite an evolving understanding of the role hearing loss plays in the well being and vitality of older adults, the vast majority of older adults go untreated and hearing health care disparities exist. Recent work to understand the multitude of factors involved in hearing health care decisions, coupled with innovative approaches and technology to deliver hearing care, aim to provide more older adults with equal access to the tools needed to age well. Most importantly, significant national efforts and policy proposals substantiate these efforts and will be reviewed. Summary: Age-related hearing loss is a critical public health issue that affects almost all older adults. Through the application of novel approaches and perspectives, the delivery of hearing health care for older adults is evolving to provide more affordable and accessible care. Accompanying policy efforts provide the necessary support needed to increase access to care significantly.

http://ift.tt/2vxdkES

Editorial introductions

No abstract available

http://ift.tt/2vy4UNv

Brain changes associated with age-related hearing loss

Purpose of review: To discuss brain changes associated with age-related hearing loss (ARHL), including cognitive abilities and neuroimaging findings. This information will be helpful to hypothesize and ultimately understand how ARHL may be mechanistically related to changes in brain structure and function. It will also be helpful to guide the strength of treatment recommendations. Recent findings: ARHL has recently been associated with cognitive impairment and dementia. This observation is present in both cross-sectional and longitudinal analyses, in diverse patient populations, and after controlling for a variety of potential confounders. Preliminary brain imaging studies show smaller brain volumes as well as white matter tract dysfunction in adults with hearing loss. Summary: ARHL is related to cognitive impairment and dementia. More study is needed to determine if the association is causal, and if treatment efforts could reduce the risk of cognitive impairment and dementia. Given the low risk of treating ARHL and the potential health benefit for the aging brain, it is recommended to proactively discuss ARHL and treatment with patients.

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Perioperative care of head and neck free flap patients

Purpose of review: This article reviews the recent literature on the perioperative care of head and neck surgical patients undergoing free tissue transfer. Recent findings: As the overall success of head and neck free flaps has plateaued above 95%, recent literature on perioperative flap management has focused on minimizing complications, length of stay, and cost of treatment. Current areas of research include preoperative risk stratification, preoperative and postoperative nutrition, intraoperative fluid management, postoperative level of care, postoperative antibiotic prophylaxis, defining the impact of comorbidities, and developing comprehensive evidence-based perioperative care protocols. Summary: Rates of complications for head and neck free flap surgery remain stubbornly high. Optimization of perioperative nutrition, antibiotics, fluid management, and the establishment of structured pathways has the potential to decrease these complication rates. However, more research is needed into defining and implementing optimal comprehensive care regimens for this complex patient population.

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Hearing health access in developing countries

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

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Reconstruction of parotidectomy and lateral skull base defects

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

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Disparities in access to pediatric hearing health care

Purpose of review: There are significant disparities in care facing children with hearing loss. The objective of this review is to assess the current disparities in pediatric hearing healthcare delivery, describe the barriers of efficient and effective pediatric hearing health care, and explore the innovations to improve pediatric hearing healthcare delivery. Recent findings: Children with hearing loss from certain geographic regions or ethnic background are significantly delayed in diagnosis and treatment. Multiple patient characteristics (presentation of hearing loss), parental factors (insurance status, socioeconomic status, educational status, and travel distance to providers), and provider barriers (specialist shortage and primary care provider challenges) prevent the delivery of timely hearing health care. Advances, such as improved screening programs and the expansion of care through remote services, may help to ameliorate these disparities. Summary: Timely identification and treatment of pediatric hearing loss is critical to prevent lifelong language complications. Children from vulnerable populations, such as rural residents, face significant disparities in care. Careful assessment of these barriers and implementation of culturally acceptable interventions are paramount to maximize communication outcomes of children with hearing loss.

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Closing the gap in cochlear implant access for African-Americans: a story of outreach and collaboration by our cochlear implant program

Purpose of review: Minorities often lag behind in hearing loss evaluation and treatment. Our cochlear implant program aimed to identify the socioeconomic and cultural barriers that prevented our African-American cochlear implant candidates from seeking help for their hearing loss, specifically cochlear implant surgery. Recent findings: Our pilot study surveyed 11 African-Americans with cochlear implants and identified obstacles that included patient–physician mistrust, social stigma, financial cost, and lack of education about the devices and procedures. Our experienced cochlear implant team then addressed these issues in its weekly meetings to review cases and potential cochlear implant candidates, and we partnered with community organizations to improve awareness about cochlear implants among healthcare professionals and the public. Summary: During our cochlear implant team's community outreach to African-Americans with hearing loss, we initiated several actions to address the various disparities in access to care and use of services: development of patient education, patient-run support group, tracking of clinical outcomes, and opportunities for involvement in health policy making for cochlear implants. Cochlear implant teams should deepen their involvement with African-Americans and other minorities with hearing loss to better support and ultimately improve cochlear implant access, performance, and function.

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Evaluation and management of cytomegalovirus-associated congenital hearing loss

Purpose of review: The current article reviews the current literature related to congenital cytomegalovirus (CMV)-related hearing loss. The discussion will focus on the epidemiology, pathogenesis, and clinical presentation of human CMV infection as it pertains to hearing loss. Current methods of CMV diagnosis with a focus on the evolving trend toward broader neonatal screening protocols will also be explored. Discussion of medical, surgical, and audiologic management of the condition will also be addressed. Recent findings: Much of the current research on this topic is focused on improving detection of CMV through screening programs. Some advances in understanding cochlear pathogenesis have also been made. Summary: Congenital CMV infection remains an important cause of hearing loss in infants and children. Early detection of CMV infection can broaden treatment options and allow for improved hearing and language outcome for patients with CMV-associated sensorineural hearing loss.

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Cochlear implantation in children under 12 months of age

Purpose of review: Children with congenital hearing loss are being identified earlier, leading to earlier intervention. Current US Food and Drug Administration (FDA) criteria states a child must be 12 months or older for cochlear implantation. The purpose of this article is to review recent publications regarding the benefits of implanting infants under 12 months of age. Topics include: safety and efficacy of surgery, speech and language acquisition outcomes, audiologic components, and limitations. Recent findings: Since the early 1990s, the candidacy criteria evolved drastically. However, the FDA criteria for cochlear implantation in children has remained at 12 months of age or older since 2000. Recent research indicates implanting below 12 months of age a safe and effective procedure. Speech and language outcomes showed better speech and language advantages. In addition, infants implanted earlier showed normal auditory skills as early as 3 months post cochlear implant activation. This article will also address recent findings on the limitations of earlier implantation. Summary: Recent research demonstrates positive outcomes in children implanted under 12 months of age. Developing research on earlier implantation could lead to a change in the current FDA criteria allowing infants to reach their speech and hearing potential faster.

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Current assessment of newborn hearing screening protocols

Purpose of review: The objective of this article is to assess current newborn hearing screening protocols. We will focus on technologies or modalities used, protocol steps, training of screeners, timing of first screen, and loss to follow-up. A summary of program reports focusing on protocols from Greece, China, South Africa, France, Spain, South Korea, Denmark, Italy, Turkey, Taiwan, South Korea, Poland and Iran as they are recently reported will also be presented. Recent findings: Community-based hearing screening programs in South Africa and efforts in the Asian region are being reported. The use of automated auditory brainstem response and staged procedures are gaining popularity because of low refer rates. However, follow-up issues remain a problem. The importance of having trained nonprofessional screeners and an efficient database is becoming more evident as the number of newborns screened for hearing loss increase each year. Summary: There are many reported protocols using different technologies, involving several stages, implemented in different settings which should not confuse but rather guide stakeholders so that programs may attain certain benchmarks and ultimately help the hard-at-hearing child in achieving his or her full potential.

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The expanding role of scapular free-flaps

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

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Evaluation and management of nonsyndromic congenital hearing loss

Purpose of review: Nonsyndromic congenital hearing loss represents the largest proportion of paediatric sensorineural hearing loss. The optimal evaluation and management of affected patients remains clinically challenging. Current controversies in the diagnostic work-up of nonsyndromic congenital hearing loss are presented in this review. Recent findings: The improved diagnostic yield of comprehensive genetic testing due to new sequencing technologies is changing the diagnostic for congenital hearing loss. Concerns for both ionizing radiation and general anaesthetic exposure are also driving shifts in imaging modality preferences for infants and toddlers. Summary: A thoughtful systematic, targeted approach taking into consideration the audiologic phenotype of the patient is recommended for the work-up of nonsyndromic congenital hearing loss.

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Evaluation and management of syndromic congenital hearing loss

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

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Advances in midface reconstruction: beyond the reconstructive ladder

Purpose of review: This article reviews the anatomy and function of the midface, defect classifications and the breadth of common and novel reconstructive techniques including medical modeling, dental splints, and dental rehabilitation. Recent findings: Historically many classification systems for midface and maxillary defects exist but most defects are unique and an individualized approach is required. There has been an increased interest in using regional pedicled flaps with bone for reconstruction. Free flap reconstruction with the osteocutaneous radial forearm and fibula flap have been recently modified to increase the success of osseointegrated implants. Scapular free flap reconstruction has become increasingly popular because of the versatility, good bony contour match, and long pedicle length with the scapular tip flap. Dental splints are more cost effective than medical modeling and cutting guides but both techniques are complimentary in complex reconstruction. Summary: Midface reconstruction is a unique and challenging surgery demonstrated by the numerous classification systems and techniques available to reconstruct. Recent developments have further augmented these challenging reconstructions.

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Update on the supraclavicular flap

Purpose of review: The purpose of this study is to describe the supraclavicular flap and its utility in head and neck reconstruction in the context of recent studies. Recent findings: Current literature regarding the supraclavicular flap has described its expanded uses in a variety of head and neck reconstructive settings. Its reliability and limited morbidity have been well demonstrated, and it has been cited as a reasonable alternative to other reconstructive options including, in some situations, free tissue transfer. Summary: The supraclavicular flap has shown dependability in reconstruction of defects in the head and neck, and it warrants consideration among reconstructive surgeons, especially for circumstances in which free tissue or other pedicled flaps are less than ideal.

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Early Depiction of a Parotid Tumour in the “School of Athens” (1509–1511) by Raphael (1483–1520)

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Early Depiction of a Parotid Tumour in the “School of Athens” (1509–1511) by Raphael (1483–1520)

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Early Depiction of a Parotid Tumour in the “School of Athens” (1509–1511) by Raphael (1483–1520)

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Delayed diagnosis and management of second trimester abdominal pregnancy

Second trimester abdominal ectopic pregnancies are rare and life threatening. Early diagnosis and treatment are paramount in reducing maternal morbidity and mortality. We describe an unusually late diagnosis of abdominal pregnancy despite multiple ultrasounds beginning in early pregnancy. A 28-year-old G2P1001 sought pregnancy termination at 22 weeks' gestation after fetal anomalies were noted on an 18-week ultrasound during evaluation for elevated maternal serum alfa-fetoprotein. Due to abortion restrictions in her home state, she travelled over 500 miles for abortion care. During dilation and evacuation, suspected uterine perforation led to the finding of a previously undiagnosed abdominal pregnancy. At laparotomy, she underwent left salpingo-oophorectomy and removal of abdominal pregnancy and placenta. A multidisciplinary team approach was paramount in optimising the patient's outcome. Abortion restrictions requiring travel away from the patient's home community interrupted her continuity of care and created additional hardships, complicating management of an unexpected, rare and life-threatening condition.

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Over-the-scope-clip system secured nasojejunal tube feeding in refractory hyperemesis gravidarum

Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy. It complicates up to 2% of all pregnancies and can be associated with adverse outcomes. Its management commonly involves a combination pharmacotherapy, however, the efficacy of such treatment is limited. Supplemental nutrition is often required in refractory cases. Enteral route is preferred over parenteral, given the high rate of intravenous catheter-related complications. Enteral feeding tube placement can be challenging and is commonly thwarted by dislodgement. We present a pharmacotherapy refractory HG case where the over-the-scope-clip (OTSC) system was successfully used for durable mucosal fixation of the nasojejunal feeding tube.

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Cerebellar abscesses, infective endocarditis and bacteraemia due to a rare pathogen: Streptococcus constellatus

Intracranial infections may result from contiguity, such as mastoiditis or acute otitis media, or from haematogenous dissemination from an infectious source. Streptococcus constellatus, a coccus from the normal genital, oral and gastrointestinal flora, has a tendency to form abscesses, but not to cause infective endocarditis (IE). Also, S. constellatus is an extremely rare causative agent of brain abscess. We report the case of a woman with a colorectal tumour who presented with IE and cerebellar abscesses due to a S. constellatus bacteraemia.

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Wet purpura: a sinister sign in thrombocytopenia

Description

A previously healthy, 38-year-old man presented with non-pruritic rash over his legs and trunk noticed 2 hours back. Examination revealed non-palpable purpura over the limbs and trunk. There was multiple 'wet purpura' over the buccal mucosa, palate and tongue (figure 1A). He had mild pallor and direct ophthalmoscopy showed bilateral fundal haemorrhage with sparing of macula. There was no organomegaly or palpable lymphadenopathy. His investigation showed haemoglobin 125 g/L, white blood cell 8.7x10⁹/L, platelet 7x10⁹/L and normal peripheral smear. He was treated with intravenous methylprednisolone (1 g once a day x3 days) and received one single donor platelet (SDP) transfusion. His bone marrow aspirates showed increased megakaryocytes and no atypical cells or excess of blast; overall picture was consistent with immune thrombocytopenia (ITP). His platelet count on day +3 was 55x10⁹/L. He was put on oral prednisolone (1 mg/kg/day). On day +7, he was asymptomatic with no evidence of any mucocutaneous bleed (figure...

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Massive splenomegaly due to concurrent primary Epstein-Barr virus and cytomegalovirus infection in a patient on adalimumab

A 32-year-old man who was receiving adalimumab for seronegative rheumatoid arthritis presented with a 4-week history of fever, night sweats, fatigue, myalgias and diarrhoea. On examination, he had obvious splenomegaly but no lymphadenopathy or pharyngitis. Full blood count revealed mild neutropenia and significant lymphocytosis, with a blood film showing atypical lymphocytes. Liver function tests were mildly deranged with a mixed hepatitic and obstructive pattern. Ultrasound confirmed massive splenomegaly with a span of 21 cm in the long axis. Serological tests confirmed the presence of both primary Epstein-Barr virus and cytomegalovirus infections. The patient had his adalimumab withheld, was treated with supportive measures and improved over a period of 8 weeks. He remained well 5 months after the onset of illness with complete normalisation of blood count and a resolution of the splenomegaly.

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Correction: Atypical presentation of false asystole detection in implantable loop recorder

Simon Andreas Müggler, Jan Steffel, Ardan Muammer Saguner. Atypical presentation of false asystole detection in implantable loop recorder. BMJ Case Rep (Published Online: 03 Aug 2017). doi: 10.1136/bcr-2017-221280.

The corresponding author's full name is Simon Andreas Müggler.

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SALSA—A dance on a slippery floor with changing partners

Publication date: September 2017
Source:Molecular Immunology, Volume 89
Author(s): M.P. Reichhardt, U. Holmskov, S. Meri
It is becoming increasingly clear that the connections between our immune system and the microbiota colonizing us have a tremendous impact on human health. A number of innate molecular defence mechanisms cooperate to selectively target unwanted microorganisms at the mucosal surfaces. Amongst others these include the complement system, IgA and the SALSA molecule. The salivary scavenger and agglutinin (SALSA), also known as deleted in malignant brain tumors 1 (DMBT1), salivary agglutinin (SAG) or gp340 is a multifunctional molecule with important functions in innate immunity, inflammation and epithelial homeostasis. The SALSA protein is expressed at most mucosal surfaces, where it is one of the most abundant proteins. In the fetal meconium and infant intestine it may constitute even up to 10% of the total protein amount. SALSA is found either directly associated with the epithelial surface or secreted into the lining fluids. In the fluid-phase SALSA interacts with a number of bacterial and viral organisms, as well as with endogenous ligands, including IgA, lactoferrin, surfactant proteins and complement components. While complement has been shown to impact the mucosal environment, this remains an area of limited research. The multiple interactions of the SALSA molecule provide a scaffold, where this potent defence system may engage in cooperative microbial clearance together with corresponding mucosal host ligands.With its high abundance, and multiple effects on both host and microbes, the SALSA molecule is a key player in maintaining the immunological balance at the mucosal surfaces. This is further supported by observations linking the expression of different SALSA isoforms to the development of chronic inflammatory conditions, such as Crohn's disease and ulcerative colitis. This review describes the latest advances in understanding functions of SALSA and its different isoforms. Recently recognized functions are related to complement activation and regulation, endothelial development and epithelial homeostasis. In addition, we suggest mechanisms how SALSA regulates inflammation at the mucosal surfaces.

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Selective expression of the transcription elongation factor ELL3 in B cells prior to ELL2 drives proliferation and survival

Publication date: November 2017
Source:Molecular Immunology, Volume 91
Author(s): Lou-Ella M.M. Alexander, January Watters, Jessica A. Reusch, Michelle Maurin, Brook S. Nepon-Sixt, Katerina Vrzalikova, Mark G. Alexandrow, Paul G. Murray, Kenneth L. Wright
B cell activation is dependent on a large increase in transcriptional output followed by focused expression on secreted immunoglobulin as the cell transitions to an antibody producing plasma cell. The rapid transcriptional induction is facilitated by the release of poised RNA pol II into productive elongation through assembly of the super elongation complex (SEC). We report that a SEC component, the Eleven -nineteen Lysine-rich leukemia (ELL) family member 3 (ELL3) is dynamically up-regulated in mature and activated human B cells followed by suppression as B cells transition to plasma cells in part mediated by the transcription repressor PRDM1. Burkitt's lymphoma and a sub-set of Diffuse Large B cell lymphoma cell lines abundantly express ELL3. Depletion of ELL3 in the germinal center derived lymphomas results in severe disruption of DNA replication and cell division along with increased DNA damage and cell death. This restricted utilization and survival dependence reveal a key step in B cell activation and indicate a potential therapeutic target against B cell lymphoma's with a germinal center origin.

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Both Notch1 and its ligands in B cells promote antibody production

Publication date: November 2017
Source:Molecular Immunology, Volume 91
Author(s): Gaizhi Zhu, Xiaoqian Wang, He Xiao, Xiaoling Liu, Ying Fang, Bing Zhai, Ruonan Xu, Gencheng Han, Guojiang Chen, Chunmei Hou, Beifen Shen, Yan Li, Ning Ma, Haitao Wu, Guangchao Liu, Renxi Wang
Notch1 signaling regulates B and T lymphocyte development and also in vitro promotes antibody secretion upon B cell activation. However, it is still unclear about the role of Notch1 in antibody production upon in vitro and in vivo mixture lymphocytes activation. We first showed that Notch1 expressed in LPS-activated CD19^hi B cells and CD19^cre mediated Notch1 knock-down in LPS-activated B cells. Furthermore, we demonstrated that Notch1 knock-down in B cells reduced antibody production in LPS-stimulated B cells but did not affect antibody production in LPS-stimulated splenocytes and in experimental allergic encephalomyelitis (EAE) mice. Importantly, Notch1 ligands Dll1 and Jag1 expressed in B cells and pre-coated Notch1 protein promotes Notch1-knocked down B cells to produce antibody in LPS-stimulated B cells suggesting that Notch1 in other cells may promote antibody production by binding its ligands Dll1 and Jag1 in B cells. Together, our results suggest that both Notch1 and its ligands in B cells play an important role in antibody production.

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NLRC5 promotes cell proliferation via regulating the NF-κB signaling pathway in Rheumatoid arthritis

Publication date: November 2017
Source:Molecular Immunology, Volume 91
Author(s): Ya-ru Liu, Xing Yan, Hai-xia Yu, Yao Yao, Jie-quan Wang, Xiao-feng Li, Ruo-nan Chen, Qing-qing Xu, Tao-tao Ma, Cheng Huang, Jun Li
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease and the pathogenesis remains unclear. Previous studies suggested that fibroblast-like synoviocytes (FLSs) play an important role in RA pathogenesis, including the injury of cartilage, the hyperplasia of the synovium and the release of inflammatory cytokines. We used complete Freund's adjuvant (CFA) induced rats as animal models for studying the RA pathogenesis. NLRC5 as the largest member of the NLR family has been reported to play a critical role in regulating immune responses. Increasing evidence suggests that NLRC5 is an pivotal negative modulator of inflammatory pathways. We investigated the mechanisms and signaling pathways of NLRC5 in RA progression. Significantly increased expression of NLRC5 was found in AA rats synovial tissues and cells. And high expression of inflammatory cytokine and cell proliferation of FLSs accompanied with NLRC5 overexpression, but inhibited in cells with NLRC5 silencing treatment. Interestingly, we found that overexpression of NLRC5 also coordinated the activation of NF-κB signaling pathway. These results suggested that NLRC5 promotes RA progression via the NF-κB signaling pathway potentially.

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Αρχειοθήκη ιστολογίου

Παρασκευή 1 Σεπτεμβρίου 2017

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