Τετάρτη 6 Σεπτεμβρίου 2017
Expression of transcription factors in MEN1-associated pancreatic neuroendocrine tumors
MEN1-associated pancreatic neuroendocrine tumors (pNETs) may potentially express distinct hormones, but the mechanism has not been elucidated. Transcription factors such as MafA and Pdx1 have been identified to lead to beta cell differentiation, while Arx and Brn4 to alpha cell differentiation in developing pancreas. We hypothesized those transcription factors are important to produce specific hormones in pNETs, similarly to developing pancreas, and examined the expression of transcription factors in a case of MEN1 who showed immunohistological coexistence of several hormone-producing pNETs including insulinoma. A 70-year-old woman was found to manifest hypoglycemia with non-suppressed insulinemia and hypercalcemia with elevated PTH level. She was diagnosed as MEN1 based on the manifestation of primary hyperparathyroidism, pituitary adenoma and insulinoma, with genetic variation of MEN1 gene. She had pylorus-preserving pancreaticoduodenectomy because CT scan and SACI test indicated that insulinoma was localized in the head of the pancreas. Histopathological finding was MEN1-associated NET, G1. Interestingly, immunohistological examination of the resected pancreas revealed that two insulinomas, a glucagon-positive NET and a multiple hormone-positive NET coexisted. Hence, we examined the expression of transcription factors immunohistochemically to elucidate the role of the transcription factors in MEN1-associated hormone-producing pNETs. We observed homogeneous expressions of MafA and Pdx1 in insulinomas and Arx in glucagon-positive NET, respectively. Moreover, multiple hormone-positive NETs expressed several transcription factors heterogeneously. Collectively, our results suggested that transcription factors could play important roles in the production of specific hormones in MEN1-associated pNETs, similar to islet differentiation.
Learning points:To date, it has been shown that different hormone-producing tumors coexist in MEN1-associated pNETs; however, the underlying mechanism of the hormone production in MEN1-associated pNETs has not been well elucidated.
Although this case presented symptomatic hypoglycemia, several hormone-producing pNETs other than insulinoma also coexisted in the pancreas.
Immunohistochemical analysis showed MafA and Pdx1 expressions distinctly in insulinoma, and Arx expression particularly in a glucagon-positive NET, while a multiple hormone-positive NET expressed MafA, Pdx1 and Arx.
Collectively, clinicians should consider that several hormone-producing pNETs may coexist in a MEN1 case and examine both endocrinological and histopathological analysis of pNETs, regardless of whether symptoms related to the excess of hormones are observed or not.
http://ift.tt/2wKcHVA
Integra® as a single-stage dermal regeneration template in reconstruction of large defects of the scalp
Publication date: Available online 6 September 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): G. Vithlani, P. Santos Jorge, E. Brizman, K. Mitsimponas
Dermal regeneration templates may be used in the reconstruction of large defects after the excision of cutaneous malignancies. We describe the successful use of Integra® (Integra Lifesciences Corporation, Plainsboro, NJ, USA) as a single-stage regeneration template after the excision of multiple lesions of the scalp with a surface area of 96.7cm2. Second-stage epidermal autografting was precluded because of an unforeseen deterioration in the patient's condition, and the wound re-epithelialised over a period of six months. To the best of our knowledge there are no published reports on the use of this procedure after excision of cutaneous malignancies of the scalp of similar dimensions, without subsequent epidermal autografting (Johnson and Wong, 2016).1
http://ift.tt/2f5RuOc
Acupuncture for temporomandibular joint syndrome
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): W. Rodgers
http://ift.tt/2gJ07ym
Sclerosing thymoma-like thymic amyloidoma with nephrotic syndrome: a case report
Primary localized amyloidosis presenting as an isolated mediastinal mass is extremely rare, especially in the thymus. Sclerosing thymoma is also an extremely rare anterior mediastinal tumor, pathologically cha...
http://ift.tt/2gJ2NvX
Anxiety and pain related to mandibular block injections: comparison of self-reported measures and physiological response.
Publication date: Available online 6 September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Jacco G. Tuk, Jerome A. Lindeboom, Linda Hoogendoorn, Byron W. Taylor, Arjen van Wijk
ObjectiveThe aim of this study was to determine whether patients with a pain score ≥7 (high pain group) after a mandibular block injection had a higher physiological response than patients with scores <7 (low pain group).Study Design: Prior to oral surgery, patients (n = 66) filled out questionnaires to measure anxiety and expected pain. Questionnaires also assessed the patients' experiences with dental injections and dental anxiety, as well as their emotional state and intensity of anxiety. Before, during, and after the injection, physiological responses were measured using the Nexus-10. Patients were then asked about the pain and anxiety they experienced.ResultsThe mean score for pain experienced was 3.45 (SD 2.17) on an 11-point rating scale. Eight patients (12.1%) experienced high injection pain. There was a significant increase in mean sweat secretion and a significant decrease in mean respiration between the relaxing and injection phases. There was a significant positive relationship between experienced anxiety and mean heart rate during the injection phase. No significant difference was found in physiological response between patients who experienced high vs. low pain.ConclusionReported pain was not associated with the physiological response of patients receiving mandibular block injections.
http://ift.tt/2eMQnWV
Radiation-related caries assessment through the international caries detection and assessment system and the post-radiation dental index
Publication date: Available online 6 September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Natalia Rangel Palmier, Ana Carolina Prado Ribeiro, Jéssica Montenegro Fonsêca, João Victor Salvajoli, Pablo Agustin Vargas, Marcio Ajudarte Lopes, Thaís Bianca Brandão, Alan Roger Santos-Silva
Purpose: Although radiation-related caries (RRC) are a well-known toxicity of head and neck radiotherapy, a clinical classification system for RRC has not yet been clinically validated. Therefore, the aim of this study was to assess if the International Caries Detection and Assessment System (ICDAS) and the Post-Radiation Dental Index (PRDI) were viable methods for the assessment of RRC. Methods: Clinicopathological data and intraoral digital photographs of 60 patients (833 teeth) affected by RRC were assessed and classified according to the ICDAS and PRDI criteria. Results: A total of 814 (97.7%) teeth presented RRC lesions ranging from early stage to complete tooth destruction. Mean scores for the whole sample were 5 for ICDAS and 3 for PRDI, indicating that RRC were diagnosed predominately in late stages. ICDAS and PRDI criteria underestimate the clinical expressivity of RRC by not including the whole qualitative clinical spectrum of RRC, such as enamel cracks, delamination, dental crown amputation, surface color alterations, and atypical lesions topography (incisal/cuspal caries). Conclusion: ICDAS and PRDI may not be considered viable for the assessment of RRC. The development of a specific clinical classification system is urgently needed to help clinicians recognize the peculiar patterns of RRC, particularly in incipient cases.
http://ift.tt/2xQuE5c
23 year-old female with a painless left mandibular swelling
Publication date: Available online 6 September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Alia Khan, Scott M. Peters, Chang Han, Angela J. Yoon, Elizabeth M. Philipone
http://ift.tt/2eMPZHX
AAOM clinical practice statement
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
http://ift.tt/2xQuBGy
Mandibular embryonal rhabdomyosarcoma with cartilaginous metaplasia: report of a case and review of literature
Publication date: Available online 6 September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Scott M. Peters, Tim Kunkle, Michael A. Perrino, Elizabeth M. Philipone, Angela J. Yoon
Rhabdomyosarcoma (RMS) is a malignant tumor of the skeletal muscle origin that frequently involves the head and neck region. It represents the second most common pediatric soft tissue sarcoma, and accounts for 3% of all childhood cancers. Herein, we report a case of embryonal rhabdomyosarcoma presenting as a right sided facial swelling in a 7-year-old boy. Histologically, the tumor consisted of classic embryonal rhabdosarcomatous areas with metaplastic cartilage both in the initial biopsy and final resection specimen. Cartilaginous metaplasia arising in the background of RMS is a rare finding, thereby raising a diagnostic challenge. To the best of our knowledge, this represents the first case of a RMS with cartilaginous metaplasia in the oral cavity.
http://ift.tt/2eMEJvi
Sudden sensorineural hearing loss in children and adolescents: Clinical characteristics and age-related prognosis
Source:Auris Nasus Larynx
Author(s): Jin Youp Kim, Jae Joon Han, Woong Sang Sunwoo, Ja-Won Koo, Seung-Ha Oh, Min-Hyun Park, Young Ho Kim
ObjectiveAlthough many studies have investigated sudden sensorineural hearing loss (SSNHL) in adults, there were few studies on SSNHL in the pediatric population; especially research on treatment and prognosis of pediatric SSNHL was limited. The aim of this study was to evaluate clinical characteristics, treatment outcomes and prognostic factors in children and adolescents with SSNHL.MethodsA retrospective review of medical records of 67 pediatric patients (67 ears) who had diagnosed with SSNHL at our hospitals was performed to analyze patients' clinical manifestations and audiograms. All patients were treated with high-dose systemic prednisolone (1mg/kg), and 17 of them underwent intratympanic steroid injection therapy. Audiological evaluation was carried out before and after treatment, and hearing recovery was defined as complete recovery and partial recovery according to Siegel's criteria. Patients were divided into two groups: childhood group (ages between 4 and 12 years old) and adolescence group (age>12years), and clinical characteristics and treatment outcomes were investigated. In addition, patients were divided into two groups according to degree of hearing recovery, and evaluation was made regarding possible prognostic factors.ResultsThe recovery rate in total 67 patients was 55.2%. The recovery rate of the childhood group was significantly lower than that of the adolescence group (p=0.038). While the presence of vertigo did not significantly correlate with prognosis (p=0.219), the presence of tinnitus was significantly associated with hearing recovery (p=0.005). Audiological assessment revealed that a low initial hearing threshold, high speech discrimination score, and descending type of audiogram were positively associated with hearing recovery (p=0.002, p=0.003, and p=0.029, respectively).ConclusionThe childhood group had worse treatment outcomes than the adolescence group. High initial hearing threshold and absence of tinnitus were poor prognostic factors of hearing recovery. Active treatment is required for patients with these poor prognostic factors and childhood patients with SSNHL.
http://ift.tt/2f5y0Jz
Italian survey on benign paroxysmal positional vertigo.
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Italian survey on benign paroxysmal positional vertigo.
Acta Otorhinolaryngol Ital. 2017 Aug;37(4):328-335
Authors: Messina A, Casani AP, Manfrin M, Guidetti G
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common type of peripheral vertigo. BPPV often relapses after the first episode, with a recurrence rate between 15% and 50%. To date both the aetiopathogenetic processes that lead to otoconia detachment and the factors that make BPPV a relapsing disease are still unclear, but recent epidemiological studies have shown a possible association with cardiovascular risk factors. The aim of the present study (Sesto Senso Survey) was to evaluate in the Italian population through an observational survey, the main demographic and clinical characteristics of patients with BPPV (first episode or recurrent) with particular focus on the potential cardiovascular risk factors. The survey was conducted in 158 vestibology centres across Italy on 2,682 patients (mean age 59.3 ± 15.0 years; 39.1% males and 60.9% females) suffering from BPPV, from January 2013 to December 2014. The results showed a high prevalence of cardiovascular risk factors such as high blood pressure (55.8%), hypercholesterolaemia (38.6%) and diabetes (17.7%), as well as a family history of cardiovascular disease (49.4%). A high percentage of patients also had hearing loss (42.9%), tinnitus (41.2%), or both (26.8%). The presence of hypertension, dyslipidaemia and pre-existing cardiovascular comorbidities were significantly related to recurrent BPPV episodes (OR range between 1.84 and 2.31). In addition, the association with diabetes and thyroid/autoimmune disease (OR range between 1.73 and 1.89) was relevant. The survey results confirm the significant association between cardiovascular comorbidities and recurrent BPPV and identify them as a potential important risk factor for recurrence of BPPV in the Italian population, paving the way for the evaluation of new therapeutic strategies in the treatment of this disease.
PMID: 28872163 [PubMed - in process]
http://ift.tt/2eES6K8
Conservative treatment of vestibular schwannoma: growth and Penn Acoustic Neuroma Quality of Life scale in French language.
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Conservative treatment of vestibular schwannoma: growth and Penn Acoustic Neuroma Quality of Life scale in French language.
Acta Otorhinolaryngol Ital. 2017 Aug;37(4):320-327
Authors: Oddon PA, Montava M, Salburgo F, Collin M, Vercasson C, Lavieille JP
Abstract
The aim of this study was to determine the natural history of growth and quality of life (QoL) outcomes for vestibular schwannoma (VS) managed conservatively, and to validate the disease-specific Penn Acoustic Neuroma Quality-of-Life (PANQOL) scale in French language. We retrospectively studied 26 patients with VS managed conservatively. Patient characteristics and radiological findings were collected. Two scales were used to measure QoL: the Short Form-36 Health Survey (SF-36) and the PANQOL scale translated into French. Internal consistency and scores were compared with previous studies. The mean follow-up was 25 months (range 6-72). We observed tumour growth in 14 patients (53.8%), no growth in 12 patients (46.2%) and no case of tumour shrinkage. The mean tumour growth was 2.22 mm/year. No predictive factor of growth was found. Patients with vertigo or dizziness experienced a poorer QoL according to the SF-36 (Social Functioning and Emotional Role Limitation dimensions) and to the PANQOL scale (Balance and Energy dimensions). Our results were comparable with the literature using the SF-36. With the PANQOL scale, our scores were not statistically different with those from Dutch and North American studies except in the field of hearing (p = 0.019). Quality of life becomes essential in the management of VS. According to these results, we support a non-conservative strategy associated with vestibular rehabilitation for patients with dizziness or vertigo. The PANQOL is a validated specific scale for VS, which can be useful in French.
PMID: 28872162 [PubMed - in process]
http://ift.tt/2xNSrCJ
Temporal changes in impedance of implanted adults for various cochlear segments.
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Temporal changes in impedance of implanted adults for various cochlear segments.
Acta Otorhinolaryngol Ital. 2017 Aug;37(4):312-319
Authors: Leone CA, Mosca F, Grassia R
Abstract
Electrode impedance (EI) is the first objective assessment carried out during the surgical procedure and follow-up of cochlear implanted patients. This measure provides information on the integrity of electrodes and on the surrounding environment. It is one of the main factors responsible for energy consumption of the cochlear implant (CI). The aim of our study is to investigate changes over time in EI in adult recipients implanted with the perimodiolar array by comparing differences in various cochlear segments. In addition, we explore the relationship between these objective measures and subjective measures such as T-level and C-level. We studied 28 adult patients. Impedance values (IVs) were calculated in "common-ground" (CG) and in monopolar (M1+2) mode for electrode groups in basal middle and apical segments. We found significant decreases in IVs between activation and 1 month. We obtained higher values for basal impedance, whereas lower IVs were found for apical electrodes at all observation times. Statistical pairing over time between impedance and T/C values showed significant correlation for both global impedance (GI) and T-C levels at CG and M1+2 mode up to 6 months. Segregated statistical analysis also showed a significant and prolonged correlation of basal IVs and fitting parameters. The higher basal impedance over time can be explained by the higher proportion of newly formed tissue in this region. The linear correlation of impedances with the fitting parameters become not significant after 3/6 months for the apical and middle segments and remained significant only for the basal region over time. This behaviour underlines the importance of persistence in intra-cochlear factors in influencing fitting parameters in the basal segment.
PMID: 28872161 [PubMed - in process]
http://ift.tt/2wHGJLo
A mild phenotype of sensorineural hearing loss and palmoplantar keratoderma caused by a novel GJB2 dominant mutation.
| Related Articles |
A mild phenotype of sensorineural hearing loss and palmoplantar keratoderma caused by a novel GJB2 dominant mutation.
Acta Otorhinolaryngol Ital. 2017 Aug;37(4):308-311
Authors: Stanghellini I, Genovese E, Palma S, Falcinelli C, Presutti L, Percesepe A
Abstract
Dominant GJB2 mutations are known to cause a syndromic form of sensorineural hearing loss associated with palmo-plantar skin manifestations. We present the genotype/phenotype correlations of a new GJB2 mutation identified in three generations of an Italian family (proband, mother and grandfather) whose members are affected by sensorineural hearing impairment associated with adult-onset palmoplantar keratoderma. In all affected members we identified a new heterozygous GJB2 mutation (c.66G > T, p.Lys22Asn) whose segregation, population frequency and in silico prediction analysis have suggested a pathogenic role. The p.Lys22Asn GJB2 mutation causes a dominant form of hearing loss associated with variable expression of palmoplantar keratoderma, representing a model of full penetrance, with an age-dependent effect on the phenotype.
PMID: 28872160 [PubMed - in process]
http://ift.tt/2j156yK
Cerebrospinal fluid rhinorrhoea following transsphenoidal surgery for pituitary adenoma: experience in a Chinese centre.
| Related Articles |
Cerebrospinal fluid rhinorrhoea following transsphenoidal surgery for pituitary adenoma: experience in a Chinese centre.
Acta Otorhinolaryngol Ital. 2017 Aug;37(4):303-307
Authors: Zhang C, Ding X, Lu Y, Hu L, Hu G
Abstract
The aim of this study was to elucidate the risk factors for cerebrospinal fluid (CSF) rhinorrhoea following transsphenoidal surgery and discuss its prevention and treatments. We retrospectively reviewed 474 consecutive cases of pituitary adenoma treated with 485 transsphenoidal surgical procedures from January 2008 to December 2011 in our department. We analysed the incidence of intra- and post-operative CSF leakage and outcomes of various repair strategies. Intra-operative CSF leakage was encountered in 85 cases (17.9%), and post-operative CSF rhinorrhoea in 13 cases (2.7%). Seven of the 13 patients with post-operative CSF rhinorrhoea did not experience intra-operative CSF leakage; three of these patients had adrenocorticotropic hormone-secreting adenomas. Of the remaining 6 patients with both intra- and post-operative CSF leakage, 2 were treated for giant invasive prolactinomas, and 2 had previously undergone transsphenoidal surgery. In eight patients, the leak was resolved by lumbar puncture, lumbar external drainage, resting in a semi-reclining position, or other conservative treatment. Two CSF leaks were repaired with gelatine foam and fibrin glue using a transsphenoidal approach, and two with autologous fat graft and sellar floor reconstruction using a transnasal endoscopic approach. After undergoing two transnasal endoscopic repairs, one patient with post-operative CSF rhinorrhoea was successfully treated by further lumbar subarachnoid drainage. In conclusion, procedures using gelatine foam, fibrin glue and autologous fat graft are common and effective techniques for the management of CSF rhinorrhoea after transsphenoidal surgery. When a CSF leak is detected during transsphenoidal surgery, thorough sellar reconstruction and long-term follow-up are necessary.
PMID: 28872159 [PubMed - in process]
http://ift.tt/2eKwBew
Stabilometric findings in patients affected by organic dysphonia before and after phonomicrosurgery.
| Related Articles |
Stabilometric findings in patients affected by organic dysphonia before and after phonomicrosurgery.
Acta Otorhinolaryngol Ital. 2017 Aug;37(4):286-294
Authors: Nacci A, Romeo SO, Berrettini S, Matteucci J, Cavaliere MD, Mancini V, Panicucci E, Ursino F, Fattori B
Abstract
The purpose of this study is to understand if there is any alteration in the posture of patients affected by organic dysphonia and describe possible postural modifications after phonomicrosurgery on the vocal folds. Forty subjects (22 males, 18 females; mean age 32.6 ± 7.5 years) suffering from organic dysphonia (15 cases of polyps, 11 submucosal retention cysts, 10 bilateral fibrous vocal fold nodules and 4 bilateral Reinke's oedema) were examined by open-eye and closed-eye posturography while breathing spontaneously before surgery, 24 hours after surgery and after 6 months. The variables taken into account were: the coordinates of the centre of pressure on both frontal and sagittal planes, length and surface of the track, mean velocity of the oscillations and relative standard deviations, spectral analysis of oscillation frequency, statokinesigram and stabilogram values. No characteristic pathological pattern was seen in basal stabilometry in any of the subgroups (polyps, cysts, Reinke's oedema). Only the subgroup of patients with fibrous vocal fold nodules (8/10; 80%) showed a slight forward shift from the centre of gravity when analysed in both open-eye and closed-eye posturography. A comparison performed within the same subgroup using open-eye and closed-eye posturography before and after surgery revealed no significant difference in any of the parameters being studied. The use of static stabilometry in this study demonstrates the absence of characteristic postural alterations in patients affected by organic dysphonia and also excludes that simple removal of the vocal fold lesion can change posture.
PMID: 28872158 [PubMed - in process]
http://ift.tt/2gMeQw0
Laryngectomy: what is the impact of the type of surgery on life quality and sexual function?
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Laryngectomy: what is the impact of the type of surgery on life quality and sexual function?
Acta Otorhinolaryngol Ital. 2017 Aug;37(4):276-280
Authors: Akil F, Yollu U, Toprak SF, Ayral M
Abstract
The purpose of this study is to compare total and partial larygectomy on private life functions and sexuality in patients with laryngeal cancer. The study included 31 partial laryngectomy patients (Group 1) and 51 total laryngectomy patients (Group 2) who were operated for laryngeal cancer. European Organization for Research and Treatment of Cancer (EORTC) head and neck cancer module (QLQ-H&N35) and Arizona Sexual Experiences Scale (ASEX) forms were filled in by interviewing face to face with patients. HNSW (swallowing), HNSE (senses), HNSP (speech), HNSO (social eating), HNSX (sexuality), HNTE (problems with teeth), HNOM (problems with opening mouth) and HNCO (coughing) scores of EORTC QLQ-H&N35 were significantly higher in group 2 than in group 1. However, according to Arizona test results, there were no significant difference between the two groups.
PMID: 28872157 [PubMed - in process]
http://ift.tt/2wH9RAY
Indications of cone beam CT in head and neck imaging in children.
| Related Articles |
Indications of cone beam CT in head and neck imaging in children.
Acta Otorhinolaryngol Ital. 2017 Aug;37(4):270-275
Authors: Walliczek-Dworschak U, Diogo I, Strack L, Mandapathil M, Teymoortash A, Werner JA, Güldner C
Abstract
For imaging of bony structures, especially for the anterior and lateral skull base in ORL medicine, cone beam computed tomography (CBCT) is an increasingly used alternative to CT, with a lower exposition to plain radiography that makes its use for imaging, particularly in children, very interesting. The aim of this study was to analyse possible indications and settings for CBCT in children and compare them to those of adults. A total of 554 patients (age range 0-18 years, mean age 10.36 years), who underwent CBCT between 01/2004-06/2013 in the ENT department at the university clinic of Marburg were enrolled in this retrospective analysis to evaluate technical parameters and indications. Data on CBCT of all children were compared with previously published data collected from 1730 adults who were diagnosed with the help of CBCT in the ENT department at the university clinic of Marburg, during the years 2012-2013. The most frequent indications of CBCT in children vs. adults were in the anterior skull base region: mid-facial trauma (60.4%) vs. chronic rhinosinusitis (54.8%), disturbed nasal breathing (13.9% vs. 13.0%) and chronic rhinosinusitis (12%) vs. mid-facial trauma (10.8%). For the lateral skull base the main indications were cholesteatoma (20.3%) vs. position control of cochlear implant (CI) electrode (31.2%), chronic otorrhoea (17.5%) vs. cholesteatoma (20.9%), and position control of CI electrode (11.8%) vs. chronic otitis media mesotympanalis (6.8%). CBCT is a suitable imaging modality for bony structures in adults and children. Settings mainly depend on the region of interest. One aim should also be to reduce exposure to radiation in both adults and children.
PMID: 28872156 [PubMed - in process]
http://ift.tt/2xap2FF
The rising incidence of parotid metastases: our experience from four decades of parotid gland surgery.
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The rising incidence of parotid metastases: our experience from four decades of parotid gland surgery.
Acta Otorhinolaryngol Ital. 2017 Aug;37(4):264-269
Authors: Franzen A, Buchali A, Lieder A
Abstract
Secondary neoplasia in the parotid gland is increasingly frequent. We examined outcomes from 40 years of parotid surgery to analyse patterns for metastasis, review the staging procedure and discuss management. We retrospectively examined 772 consecutive cases of parotid surgery in a university hospital between 1975 and 2015 and assessed changes in incidence and management over four decades. In all, 71% percent of patients were male and 29% were female, with a mean age of 68 years, aged between 23 and 93 years. We diagnosed 683 parotid tumours of which 15.8% (n = 108) were malignant; 44% (n = 48) of all malignant lesions were metastases. The incidence of malignant tumours rose from 8% in the first decade, 14% in the second, 17% in the third to 21% in the fourth. The incidence increased even further from 10% in the first to 57% in the final decade. Most frequent tumours were metastases of squamous cell carcinoma (79%), and the majority of these lesions (87%) arose from above the clavicle, with 30 primary tumours in the skin. In most cases, the skin tumour had been excised between 6 and 24 months prior to parotid metastasis. Management consisted of surgery with neck dissection. 48 patients (67%) received adjuvant therapy, but despite aggressive multimodal treatment, disease progressed in the majority of cases, in 57% squamous cell carcinoma of the skin primaries, 67% of mucosal primaries above the clavicle and 83% of infraclavicular primaries. Parotid malignant tumours are increasing in incidence, mostly due to a rise in metastatic malignant tumours within the parotid gland, most of which are metastases of skin tumours, commonly squamous cell carcinoma. Despite multimodal therapy, their recurrence and progression rate remains high. We propose inclusion in head and neck follow-up in all cases of head and neck skin cancers.
PMID: 28872155 [PubMed - in process]
http://ift.tt/2wGJj2v
The Study of Calcium, Phosphonium, Magnesium, and Ferrum Concentration in Serum of Patients With Primary Trigeminal Neuralgia: Erratum
No abstract availablehttp://ift.tt/2j4CYuQ
Research and Clinical Application of Three-Dimensional Location of Amygdaloid Body
Abstract: Accurately representing the spatial location of the amygdaloid body can lay an anatomical basis for the neurosurgery operation for amputation of the amygdaloid body through lateral fissure approach. As we know, there are a number of nerve nucleuses and essential structures locating around amygdaloid body in our brain, especially optic tract. However, only few research had been done to protect these tissues or nerve nucleuses. Thus, we reconstructed the three-dimensional images of the amygdaloid body of the human brain and established a coordinate system. The morphological parameters of the amygdaloid body and the three-dimensional coordinate data were measured. The spherical coordinates (R, θ, ϕ) were constructed by calculating the azimuth angle, elevation angle, and the distance from the coordinates origin to each amygdaloid body centroid. Sixty people brain MRI images without any visible organic disease were used in our research to investigate the average level of related parameters. The authors selected a proper coordinate origin and measured the value of anteroposterior diameter, right-and-left diameter, vertical diameter of the amygdaloid body, and the distance from the optic tract to amygdaloid body. The authors also measured the three-dimensional coordinate data of each centroid of the amygdaloid body in order to provide anatomical suggestion for surgery. The authors confirmed the nearest point from the foremost edge of the brain ventricle temporal horn to the lateral fissure, then viewed it as the coordinate origin. By means of coordinate translation, the authors got various morphological parameters and the coordinate values of each centroid of the amygdaloid body. Spherical coordinates were calculated from the three-dimensional coordinate values. The distances between the different layers of the amygdaloid body and the optic tract were also measured. The reconstruction of the three-dimensional coordinates of amygdaloid body is part of the digital engineering of the human body. The measurement of the parameters provides an important theoretical basis for the clinical amygdaloid body destruction surgery. Finally, the authors get conclusions as follows. There are no significant differences in the measured values of r1, r2, and r3 between the upper and lower diameters, the left and right diameters, the anteroposterior diameter of the amygdaloid body. The measured values of men and women are not statistically significant (P > 0.05). Spherical coordinates (R, θ, ϕ) calculated from the three-dimensional coordinate values and values from different sexes of the amygdaloid body are not statistically significant, either (P > 0.05). The distance between the different levels of the amygdaloid body and the optic tract (h1, h2, h3, h4, h5, h6, and h7) are not statistically significant (P > 0.05).http://ift.tt/2j56ssk
Intracranial Enterogenous Cysts Close to the Brainstem Treated Through the Nerve Endoscope
Abstract: Enterogenous cysts (ECs) are rare, inborn lesions of central nervous system, which mostly occurred in the ventral side of the spinal cord as well as common in children; adult intracranial cysts are rare. Although the morbidity of intracranial ECs is quite low, we also can make a preliminary diagnosis of those patients with the help of imaging examination. In this article, we introduced 1 case of ECs ventral to the brainstem, which present images on magnetic resonance imaging as hypointense lesions on T1-weighted and high-intensity mass on T2-weighted image. In consideration of the difficulty of the surgical approach and the surgical visual field exposure, we use microscope and nerve endoscope to design personalized surgical approach to minimize the surgical injury. Pathologic examination showed that it was typical EC. Not only is the location extremely rare, but also the surgical method is uncommon in this disease. We not only study the intracranial ECs' manifestations, but also discuss the surgical approach and the application of nerve endoscope of our choice,which aims to provides a new surgical therapeutic approach for these lesions.http://ift.tt/2eHZS6f
Three-Dimensional Radiologic Study on Index Measurement of Endonasal Endoscopic Optic Nerve Decompression
Objective: To provide the radiologic basis for the clinical application of endonasal endoscopic optic nerve decompression (EEOND). Methods: CTA images were used to observe the optic canal (OC) and related structures of 60 patients (120 sides) with normal nasal, paranasal sinuses, OC, and other related structures. Results: Optic canal could be classified as: the canal (10 sides, 8.33%), the semicanal (25 sides, 20.83%), the impression (49 sides, 40.83%), and the nonimpression (36 sides, 30%). According to its relationships with the sinuses, OC could be further typed as: ethmoid sinus (22 sides, 18.3%), sphenoid sinus (38 sides, 31.7%), ethmoid and sphenoid sinus (60 sides, 50%). The thickness of OC medial wall is about 1.11 ± 0.24 mm at orbital mouth, 0.87 ± 0.25 mm at middle part and 1.19 ± 0.27 mm at cranial mouth. The arc length of OC bone wall which can be opened from the sinus cavity is about 7.18 ± 0.76 mm at orbital mouth, 8.27 ± 0.93 mm at middle part, and 6.98 ± 0.89 mm at cranial mouth. The length of the OC medial wall is 12.18 ± 1.35 mm. In the three-dimensional Cartesian coordinate system that origined with the last point of middle turbinate root and oriented by temporal side, front side, and superior side, the coordinates of midpoints of OC medial wall are: (3.64 ± 1.11, 8.48 ± 1.65, 23.14 ± 2.67) at orbital mouth, (0.16 ± 1.21, 3.99 ± 1.80, 24.85 ± 2.67) at middle part, and (−3.59 ± 1.22, 0.77 ± 2.13, 26.39 ± 2.68) at cranial mouth. One length unit on the axes is a millimeter. Conclusion: Computed tomography (CT) scanning technique can measure the data of the OC in EEOND. It has great guiding significance for clinical operation.http://ift.tt/2j49tcr
Eyelid and Periorbital Surgery, Second Edition, edited by Mark A. Codner and Clinton D. McCord, Jr Boca Raton, FL: CRC Press, 2016
No abstract availablehttp://ift.tt/2eH4FVt
Comprehensive Treatment of Primary Orbital Arteriovenous Malformation
Abstract: Primary orbital arteriovenous malformations are a rare kind of vascular malformation lesions. The authors present a 17-year-old man presented with swelling and pulsation in the left upper eyelid. The angiogram of the left internal carotid artery showed that arteriovenous malformations at the left upper eyelid area were supplied with one of the branches of ophthalmic artery. In this report, the authors elaborated the comprehensive treatments of primary arteriovenous malformation.http://ift.tt/2xcsIXm
Relative Location of Fundus Meatus Acustici Interni Via Porus Acusticus Internus in Facial Nerve Decompression
Abstract: Facial neural edema is the pathophysiological base of Bell's palsy. The middle cranial fossa approach is used to relieve the oppression of facial nerve at its most narrow course in the facial canal. In this research, the authors mainly discussed the internal auditory canal segment of facial nerve, completely in the shadow of the bony structure, which is inconvenient for transmastoid decompression. Therefore, the objective was to explore the definite position of the fundus meatus acustici interni from internal acoustic pore. Two hundred persons (age 22–60, 100 men and 100 women), presenting with healthy facial nerve, ear, and internal auditory canal, were investigated by computed tomography 3-dimensional reconstruction. Using statistical method to analyze, the authors obtained the definite position of the fundus meatus acustici interni, regarding the internal acoustic pore as the origin of coordinates. Our data provided more significant information for medical workers to improve the efficiency of operation and to prevent complications of surgery.http://ift.tt/2xbZhF9
The Current Challenge For Plastic and Reconstructive Surgery In China, The Biggest Developing Country
No abstract availablehttp://ift.tt/2xbU7Zt
Role of Notch Signaling in the Physiological Patterning of Posterofrontal and Sagittal Cranial Sutures
Background: The mutations in a Notch signaling ligand, jagged 1, are associated with unilateral coronal craniosynostosis in humans. However, the underlying mechanisms of Notch signaling in cranial suture biology still remain unclear. Methods: The temporal and spatial patterns of Notch signaling expression were examined in the posterofrontal and sagittal sutures of Sprague–Dawley rats by real-time quantitative reverse-transcription polymerase chain reaction at postnatal ages of 2, 15, and 25 days. The role of Notch signaling in the proliferation and differentiation of osteoblasts isolated from calvarial was examined in vitro by EdU incorporation assays and real-time quantitative reverse-transcription polymerase chain reaction after activating and inhibiting Notch signaling. Results: The mRNA levels of Notch family members (including Jagged 1, Delta 1, 3, 4, Notch 1–4, Hes 1, and Hes 5) decreased during the posterofrontal cranial suture fusion in rat. However, in the patent sagittal sutures, the mRNA levels of Notch family members (Jagged 2, Delta 1, Notch 1, Notch 3, Hes 5, and Hey 1) increased during suture development. The EdU incorporation assays revealed that the induction of Notch signaling in calvaria osteobalsts using Jagged 1 promoted the proliferation rates in those cells in vitro. Further studies showed that activation of Notch signaling calvaria osteobalsts using Jagged 1 led to the suppression of late osteogenetic markers such as type I collagen and osteocalcin. Conclusions: The regulation of Notch signaling is of crucial importance during the physiological patterning of posterofrontal and sagittal cranial sutures. Thus, targeting this pathway may prove significant for the development of future therapeutic applications in craniosynostosis.http://ift.tt/2xbV8ke
Intralesional Lidocaine Anesthesia: A Novel Facilitated Anesthesia Technique for Ethanol Sclerotherapy of Venous Malformation
Objective: The aim of this study was to describe a novel anesthesia, intralesional lidocaine anesthesia (ILA), for ethanol sclerotherapy of venous malformation and evaluate the efficacy and safety. Methods: A prospective study of 100 patients with venous malformations undergoing 100 sclerotherapy procedures with intralesional lidocaine anesthesia (ILA) was conducted. Pain was evaluated by numeric rating scale (NRS) immediately following the procedure. The grade of pain was classified by the NRS as no pain (0), mild (1–3), moderate (4–6), and severe (7–10). Local and systemic complications caused by lidocaine were recorded. Results: The median injected volume of absolute ethanol and 0.25% lidocaine was 5.9 mL and 17.0 mL, respectively. In ILA group, 13 patients had no pain during the procedure, 42 patients had mild pain, 38 patients had moderate pain, and 7 patients had severe pain. The mean NRS scores of the whole ILA group were 3.2 (0–8). No local or systemic complications attributed to lidocaine were reported. Conclusion: In a limited series, intralesional lidocaine anethesia seems to be efficient and safe for use in pain management for ethanol sclerotherapy of venous malformation. This anesthesia technique may be a promising first approach for the ethanol sclerotherapy of venous malformations, as it is easy to handle and has minimal sequelae.http://ift.tt/2xc4DjE
Three Skin Zones in the Asian Upper Eyelid Pertaining to the Asian Blepharoplasty: Erratum
No abstract availablehttp://ift.tt/2xcIkug
Reduction of Surgical Site Infections After Cranioplasty With Perioperative Bundle
Background: Surgical site infections (SSI) are the most common complication after cranioplasty and it is associated with poor prognosis. The aim of this study was to identify the risk factors that triggered the development of SSI after cranioplasty and establish a new perioperative bundle and monitoring system to reduce SSI. Methods: A retrospective review of a database that included all cranioplasty patients from 2001 to 2007 was carried out to determine the prevalence of infection. A surveillance team was set up, which assessed the clinical practice and led to the development of a new perioperative bundle and supervision system. A prospective study between 2008 and 2014 was carried out to observe whether infection rates had changed and whether an active surveillance program can change clinical practice. Results: Retrospective period included 86 adult patients. The overall rate of infection was 10.5% (9 SSI in 86 patients). Age ≥60 years (OR 1.05; 95% CI: 1.00–1.10; P = 0.04), smoking (OR 9.13; 95% CI: 1.65–50.60; P = 0.01), and duration of operation ≥180 minutes (OR1.19; 95% CI: 1.06–1.34; P http://ift.tt/2xc4D38
Single-Stage Reconstruction of Eyebrow Defect Using a V-Y Advancement Pedicle Flap Based on the Orbicularis Oculi Muscle
Abstract: Eyebrows play an important role in face expression and facial mimics by virtue of muscle contraction. Defects or deformity of the eyebrows result in abnormal facial expressions, and may lead to aesthetic issues for patients. The objective of this study is to report the case of a patient, with a congenital skin pigmented nevus at the right side of the eyebrow treated with direct surgical resection and followed by immediate reconstruction of the eyebrow with a V-Y advancement pedicle flap based on the orbicularis oculi muscle.http://ift.tt/2xcIdyQ
Comparison of Two Different Grafts in Nasal Framework Reconstruction of Binder Syndrome: Cartilage and Silicone
Background: Binder syndrome is a rare congenital malformation with a flat facial profile especially a depressed nose. Rhinoplasty plays an important part in the multidisciplinary surgical protocol. Different materials have been proposed to reconstruct nasal framework. But fewer evidence concerns which graft can achieve more stable and appreciated nasal contour. In this article, the authors reported surgical details and experience of nasal framework reconstruction of Binder syndrome, compare the esthetic outcomes of 2 grafts: autologous costal cartilage and L-shaped silicone covered with auricular cartilage. Methods: A retrospective study of 25 Binder syndrome patients (9 with silicone and 16 with costal cartilage) was managed. Anthropometric method was used to evaluate nasal profiles preoperatively and postoperatively. Surgical techniques, complications were reviewed. Statistics analysis was managed. Probability (P) ofhttp://ift.tt/2xcI9z6
Oral Localization of Kaposi Sarcoma: Clinical Presentation and Conservative Management
Abstract: Kaposi sarcoma (KS) caused by human herpes virus type-8 is the most frequent immunosuppression-associated malignancy worldwide and its treatment is still controversial. We report on the clinical management of a patient who developed oral KS after liver transplantation. The disease appeared 1 month after the transplant and recurred after 4 months. The patient represents, to our knowledge, a rare case that was treated successfully only by shifting a conventional immunosuppressive therapy to everolimus alone.http://ift.tt/2xcI6Dq
Commentary on: Treatment of laryngopharyngeal reflux using a sleep positioning device: A prospective cohort study
We reviewed the paper entitled "Treatment of laryngopharyngeal reflux using a sleep positioning device: A prospective cohort study," by Tierney et al. [1] with interest. This is an excellent work. Use of the sleep positioning device constitutes a minimally invasive treatment approach, resulting in more comfortable sleep and an improvement in the symptoms of laryngopharyngeal reflux (LPR). However, the authors did not describe the symptoms of the upper gastrointestinal tract or the performance of gastroscopy or 24-hour oropharyngeal or esophageal pH monitoring.
http://ift.tt/2eGPGeb
Intraoperative imaging during minimally invasive transoral robotic surgery using near-infrared light
The purpose of this study was to determine if the use of the FIREFLY imaging system could be an asset in transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC). The system uses indocyanine green dye (ICG), which fluoresces when illuminated by near-infrared light from the Da Vinci robot. The system may improve visualization of tumor margins, highlight important vascular structures, and help identify the location of tumors and unknown primary head and neck cancers.
http://ift.tt/2j5rdUC
Acupuncture for temporomandibular joint syndrome
Acupuncture for temporomandibular joint (TMJ) syndrome is listed as an "emerging treatment" in the recent edition of BMJ Best Practice,1 which recommends that "Acupuncture treatment can be given weekly for a total of six treatments". In addition, the NICE Clinical Knowledge Summary2 has suggested that referral of the patient to an acupuncture specialist should be considered, to help relax muscular spasm.
http://ift.tt/2gI9Mp1
Integra® as a single-stage dermal regeneration template in reconstruction of large defects of the scalp
Dermal regeneration templates may be used in the reconstruction of large defects after the excision of cutaneous malignancies. We describe the successful use of Integra® (Integra Lifesciences Corporation, Plainsboro, NJ, USA) as a single-stage regeneration template after the excision of multiple lesions of the scalp with a surface area of 96.7cm2. Second-stage epidermal autografting was precluded because of an unforeseen deterioration in the patient's condition, and the wound re-epithelialised over a period of six months.
http://ift.tt/2f5z8gC
Sudden sensorineural hearing loss in children and adolescents: Clinical characteristics and age-related prognosis
Although many studies have investigated sudden sensorineural hearing loss (SSNHL) in adults, there were few studies on SSNHL in the pediatric population; especially research on treatment and prognosis of pediatric SSNHL was limited. The aim of this study was to evaluate clinical characteristics, treatment outcomes and prognostic factors in children and adolescents with SSNHL.
http://ift.tt/2eMhf9q
Comparison of polyvinyl chloride and tin stylets for postoperative sore throat and hoarseness: A randomised trial
No abstract availablehttp://ift.tt/2gLA79k
Anaesthetic management of patients with myopathies
The anaesthetic management of patients with myopathies is challenging. Considering the low incidence and heterogeneity of these disorders, most anaesthetists are unfamiliar with key symptoms, associated co-morbidities and implications for anaesthesia. The pre-anaesthetic assessment aims at the detection of potentially undiagnosed myopathic patients and, in case of known or suspected muscular disease, on the quantification of disease progression. Ancillary testing (e.g. echocardiography, ECG, lung function testing etc.) is frequently indicated, even at a young patient age. One must differentiate between myopathies associated with malignant hyperthermia (MH) and those that are not, as this has significant impact on preoperative preparation of the anaesthesia workstation and pharmacologic management. Only few myopathies are clearly associated with MH. If a regional anaesthetic technique is not possible, total intravenous anaesthesia is considered the safest approach for most patients with myopathies to avoid anaesthesia-associated rhabdomyolysis. However, the use of propofol in patients with mitochondrial myopathies may be problematic, considering the risk for propofol-infusion syndrome. Succinylcholine is contra-indicated in all patients with myopathies. Following an individual risk/benefit evaluation, the use of volatile anaesthetics in several non-MH-linked myopathies (e.g. myotonic syndromes, mitochondrial myopathies) is considered to be well tolerated. Perioperative monitoring should specifically focus on the cardiopulmonary system, the level of muscular paralysis and core temperature. Given the high risk of respiratory compromise and other postoperative complications, patients need to be closely monitored postoperatively.http://ift.tt/2gLzWuG
Microvascular reactivity monitored with near-infrared spectroscopy is impaired after induction of anaesthesia in cardiac surgery patients: An observational study
BACKGROUND: Induction of anaesthesia causes significant macrohaemodynamic changes, but little is known about its effects on the microcirculation. However, alterations in microvascular perfusion are known to be associated with impaired tissue oxygenation and organ dysfunction. Microvascular reactivity can be assessed with vascular occlusion testing, which evaluates the response of tissue oxygen saturation to transient ischaemia and reperfusion. OBJECTIVE: The aim of the current study was to evaluate the effects of an opioid-based anaesthesia induction on microvascular reactivity. We hypothesised that despite minimal blood pressure changes, microvascular function would be impaired. DESIGN: Prospective, observational study. SETTING: Single-centre, tertiary university teaching hospital, Belgium. PATIENTS: Thirty-five adult patients scheduled for elective coronary artery bypass grafting surgery. INTERVENTION: Microvascular reactivity was assessed before and 30 min after anaesthesia induction by means of vascular occlusion testing and near-infrared spectroscopy. MAIN OUTCOME MEASURES: Tissue oxygen saturations, desaturation rate, recovery time (time from release of cuff to the maximum value) and rate of recovery were determined. RESULTS: Data are expressed as median (minimum to maximum). Tissue oxygen saturation was higher after induction of anaesthesia [70 (54 to 78) vs. 73 (55 to 94)%, P = 0.015]. Oxygen consumption decreased after induction, appreciable by the higher minimum tissue oxygen saturation [45 (29 to 69) vs. 53 (28 to 81)%, P http://ift.tt/2gLzQ6i
Early postoperative neuropathic pain assessed by the DN4 score predicts an increased risk of persistent postsurgical neuropathic pain
BACKGROUND: Acute neuropathic pain can occur in the postoperative period but any link with persistent post-surgical neuropathic pain remains unclear. OBJECTIVES: The objectives of this study were to prospectively describe the incidence of acute post-surgical neuropathic pain in a large population using the DN4 (clinician administered) questionnaire and to confirm the hypothetical link between acute and persistent neuropathic pain at 2 months after surgery in a large population using the DN2 (self administered) questionnaire. DESIGN: A multi-centre, prospective and observational trial. SETTING: Two consecutive days in 27 hospitals in France. PATIENTS: Six hundred and eight patients undergoing 13 different types of surgery. Fifteen patients were excluded as data were incomplete, and 229 (38.6%) and 260 (43.8%) were not contactable for assessment at 1 and 2 months after surgery, respectively. MAIN OUTCOME MEASURES: Pain was evaluated at least 2 h postoperatively on the same day (D0),on the second day (D2) and at 1 and 2 months after surgery (M1 and M2). Pain was assessed using a 10-point Numeric Rating Scale. If the Numeric Rating Scale score was greater than 0, neuropathic pain was assessed using a DN4 (clinician administered) questionnaire or using a DN2 (self-administered) questionnaire. Acute and persistent postsurgical neuropathic pain (PPSNP) were defined respectively by a DN4 score at least 4/10 on day 0 and/or day 2 and a DN2 score at least 3/7 at 2 months after surgery. RESULTS: Of the 593 patients included, 41.2% were in pain before surgery and 8.2% described neuropathic pain. Early after surgery, the majority of the 593 patients (72.2% on the day of surgery and 71.3% on day 2) experienced acute pain. It was neuropathic in nature in 5.6% of patients (95% CI, 3.6 to 8.3) on the day of surgery and 12.9% (95% CI, 9.7 to 16.7) on day 2. Two months after surgery, PPSNP was present in 33.3% of the 333 patients assessed. Multivariate analysis showed that a DN4 score at least 4/10 on the day of surgery or on day 2 was a significant risk factor for PPSNP [odds ratios 4.22 (95% CI, 2.19 to 8.12)]. CONCLUSION: Our results suggest that early acute postsurgical neuropathic pain significantly increases the risk of persistent post-surgical neuropathic pain. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NTC NCT02826317.http://ift.tt/2vMQnO1
Women awaken faster than men after electroencephalogram-monitored propofol sedation for colonoscopy: A prospective observational study
BACKGROUND: Sedation for colonoscopy using intravenous propofol has become standard in many Western countries. OBJECTIVE: Gender-specific differences have been shown for general anaesthesia in dentistry, but no such data existed for gastrointestinal endoscopy. DESIGN: A prospective observational study. SETTING: An academic teaching hospital of Hannover Medical School. PATIENTS: A total of 219 patients (108 women and 111 men) scheduled for colonoscopy. INTERVENTION: Propofol sedation using electroencephalogram monitoring during a constant level of sedation depth (D0 to D2) performed by trained nurses or physicians after a body-weight-adjusted loading dose. MAIN OUTCOME MEASURES: The primary end-point was the presence of gender-specific differences in awakening time (time from end of sedation to eye-opening and complete orientation); secondary outcome parameters analysed were total dose of propofol, sedation-associated complications (bradycardia, hypotension, hypoxaemia and apnoea), patient cooperation and patient satisfaction. Multivariate analysis was performed to correct confounding factors such as age and BMI. RESULTS: Women awakened significantly faster than men, with a time to eye-opening of 7.3 ± 3.7 versus 8.4 ± 3.4 min (P = 0.005) and time until complete orientation of 9.1 ± 3.9 versus 10.4 ± 13.7 min (P = 0.008). The propofol dosage was not significantly different, with some trend towards more propofol per kg body weight in women (3.98 ± 1.81 mg versus 3.72 ± 1.75 mg, P = 0.232). CONCLUSION: The effect of gender aspects should be considered when propofol is used as sedation for gastrointestinal endoscopy. That includes adequate dosing for women as well as caution regarding potential overdosing of male patients. TRIAL REGISTRATION: ClinicalTrials.gov (Identifier: NCT02687568).http://ift.tt/2vNPgxG
Intraoperative magnesium sulphate decreases agitation and pain in patients undergoing functional endoscopic surgery: A randomised double-blind study
BACKGROUND: Postoperative agitation is harmful for the patient as it may be associated with removal of catheters, nasal packs, oxygen masks and self-injury, and pose a danger to operating theatre staff. OBJECTIVE: The current study investigated the potential role of magnesium sulphate in treatment of postoperative agitation following functional endoscopic sinus surgery. DESIGN: A randomised, double-blinded, placebo-controlled trial. SETTING: ENT operating room, Menofia University Hospitals, Egypt. PATIENTS: A total of 312 adult patients (171 men and 141 women) were enrolled in the study. Eighteen patients (10 men and eight women) were excluded; data from 294 patients were analysed. Inclusion criteria were age between 20 and 60 years, American Society of Anesthesiologists' physical status 1 or 2 scheduled for functional endoscopic sinus surgery. Exclusion criteria were hypertension, cardiac ischaemia, cerebrovascular insufficiency, neuromuscular diseases, pregnancy, prolonged treatment with calcium-channel blockers, diabetic neuropathy or a known allergy to magnesium compounds. INTERVENTIONS: Patients were allocated randomly to either the magnesium group (a magnesium infusion of 30 mg kg−1 in the first hour followed by 9 mg kg−1 h−1 until the end of the surgical procedure) or the control group (0.9% saline at the same volume and rate). Hypotensive anaesthesia was induced by nitroglycerine 5 to 20 μg kg−1 min−1. In the postanaesthetic care unit (PACU), patients were assessed for agitation and pain using the Richmond agitation-sedation scale and numerical rating scale, respectively. PRIMARY OUTCOME: The incidence and severity of agitation measured 5 min after admission to the PACU. RESULTS: Magnesium reduced postoperative agitation at time 0 (P = 0.009) and 5, 10, 15 and 30 min after PACU admission (P http://ift.tt/2vNPbdm
Prophylactic atropine administration attenuates the negative haemodynamic effects of induction of anaesthesia with propofol and high-dose remifentanil: A randomised controlled trial
BACKGROUND: Induction of anaesthesia with propofol and remifentanil often induces unwanted bradycardia and hypotension, raising concerns regarding tissue oxygenation. The electrophysiological cardiac effects of remifentanil can be reversed by atropine. OBJECTIVE: To investigate if prophylactic administration of atropine can attenuate the negative haemodynamic effects of propofol and a high dose of remifentanil during induction of anaesthesia. DESIGN: A double-blind, randomised controlled trial. SETTING: Single-centre, University Medical Center Groningen, The Netherlands. PATIENTS: Sixty euvolaemic patients scheduled for surgery under general anaesthesia. INTERVENTIONS: Anaesthesia was induced and maintained with a target-controlled infusion of propofol with a target effect-site concentration (Ce) of 2.5 μg ml−1, remifentanil (target-controlled infusion), (Ce 8 ng ml−1) and cis-atracurium. Methylatropine (500 μg) or 0.9% saline was administered at immediately before induction of anaesthesia. MAIN OUTCOME MEASURES: The changes (Δ) in mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), rate pressure product, cerebral tissue oxygenation and peripheral tissue oxygenation between induction of anaesthesia (T0) and 10 min later (T10). RESULTS: Atropine significantly attenuated the changes in the outcome measures between T0 and T10. Median (inter-quartile range) changes were MAP, Δ = −24 (−40 to −21) vs. Δ = −37 mmHg (−41 to −31) (P = 0.02); HR, Δ = 0 ± 13 vs. −19 ± 11 bpm (P http://ift.tt/2vNxCtA
Effects of anaesthesia and analgesia on long-term outcome after total knee replacement: A prospective, observational, multicentre study
BACKGROUND: Perioperative regional anaesthesia may protect from persistent postsurgical pain (PPSP) and improve outcome after total knee arthroplasty (TKA). OBJECTIVES: Aim of this study was to evaluate the impact of regional anaesthesia on PPSP and long-term functional outcome after TKA. DESIGN: A web-based prospective observational registry. SETTING: Five Italian Private and University Hospitals from 2012 to 2015. PATIENTS: Undergoing primary unilateral TKA, aged more than 18 years, informed consent, American Society of Anesthesiologists (ASA) physical status classes 1 to 3, no previous knee surgery. INTERVENTION(S): Personal data (age, sex, BMI and ASA class), preoperative pain assessed by numerical rating scale (NRS) score, and risk factors for PPSP were registered preoperatively. Data on anaesthetic and analgesic techniques were collected. Postoperative pain (NRS), analgesic consumption, major complications and patient satisfaction were registered up to the time of discharge. PPSP was assessed by a blinded investigator during a phone call after 1, 3 and 6 months, together with patient satisfaction, quality of life (QOL) and walking ability. MAIN OUTCOME MEASURES: Experience of PPSP according to the type of peri-operative analgesia. RESULTS: Five hundred sixty-three patients completed the follow-up. At 6 months, 21.6% of patients experienced PPSP, whereas autonomy was improved only in 56.3%; QOL was worsened or unchanged in 30.7% of patients and improved in 69.3%. Patients receiving continuous regional anaesthesia (epidural or peripheral nerve block) showed a lower NRS through the whole peri-operative period up to 1 month compared with both single shot peripheral nerve block and those who did not receive any type of regional anaesthesia. No difference was found between these latter two groups. Differences in PPSP at 3 or 6 months were not significantly affected by the type of anaesthesia or postoperative analgesia. A higher NRS score at 1 month, younger age, history of anxiety or depression, pro-inflammatory status, higher BMI and a lower ASA physical status were associated with a higher incidence of PPSP and worsened QOL at 6 months. CONCLUSION: Continuous regional anaesthesia provides analgesic benefit for up to 1 month after surgery, but did not influence PPSP at 6 months. Better pain control at 1 month was associated with reduced PPSP. Patients with higher expectations from surgery, enhanced basal inflammation and a pessimistic outlook are more prone to develop PPSP. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02147730http://ift.tt/2vNP2Xm
Transcutaneous monitoring of partial pressure of carbon dioxide during bronchoscopic procedures performed with jet ventilation: Role of the perfusion index
No abstract availablehttp://ift.tt/2vNgHre
The use of dipyrone in the ICU is associated with acute kidney injury: A retrospective cohort analysis
BACKGROUND: Use of dipyrone (metamizole) in perioperative and ICU pain therapy remains controversial due to a lack of solid evidence weighing dipyrone benefit against its potential life-threatening complications. Although dipyrone has known analgesic and antipyretic properties, its mechanisms of actions are incompletely understood. Although dipyrone effects on renal vasodilator prostaglandin synthesis are documented, little is known about its potential renal side effects, especially in the critical care environment. OBJECTIVE: Investigation of the perioperative nephrotoxic potential of dipyrone in patients prone to acute kidney injury (AKI). DESIGN: Retrospective cohort study. SETTING: Single centre study in a tertiary referral hospital from January 2013 until June 2013. PATIENTS: A total of 500 consecutive patients aged 18 years and older referred to the anaesthesia ICU. Patients were excluded if admitted from or discharged to other ICUs, if referred for post resuscitation care, or if repeatedly admitted to the ICU. MAIN OUTCOME MEASURES: Incidence of AKI, as defined by the Kidney Disease: Improving Global Outcomes Acute Kidney Injury Work Group criteria, and duration of vasopressor therapy. RESULTS: Use of dipyrone was associated with an increased incidence of AKI in a dose-dependent manner with a 1.6-fold increase in the incidence of AKI with each additional gram of intravenous dipyrone per day. Dipyrone dose of more than 2.5 g day−1 was the best risk predictive cut-off for AKI. Patients receiving dipyrone on the ICU presented with a prolonged duration of vasopressor therapy. CONCLUSION: Increasing dipyrone dosage is a potential independent risk factor for AKI in adult ICU patients and may prolong vasopressor therapy. Clinical evidence for a benefit of dipyrone therapy in the ICU is insufficient and needs further critical evaluation.http://ift.tt/2vMzW4p
The risk factors associated with postoperative hemorrhage after tooth extraction: a multi-center retrospective study of patients receiving oral antithrombotic therapy
Abstract
The purpose of this study was to retrospectively investigate the multivariate relationships between specific risk factors and postoperative hemorrhage after tooth extraction in patients who were prescribed oral antithrombotic therapy. Risk factors for postoperative hemorrhage after tooth extraction were evaluated using univariate and multivariate analyses. Patient characteristics such as age and gender; the presence or absence of known comorbidities such as diabetes mellitus, hypertension, cerebral infarction, and alcohol consumption; and perioperative diarrhea were assessed. The drug used for antithrombotic therapy, preoperative blood test results, the presence or absence of preoperative antibiotics or nonsteroidal anti-inflammatory drug (NSAID) administration, the total number of extracted teeth, and the type of surgical procedures were also evaluated. We found that the preoperative administration of antibiotics (odds ratio (OR) = 2.52), an increased prothrombin time international normalized ratio (PT-INR) value (OR = 1.94), and the extraction of multiple teeth (OR = 2.10) were significantly associated with postoperative hemorrhage. There was no significant association between postoperative hemorrhage and any other demographic factors or comorbidities, including concomitant alcohol use. We demonstrated the multivariate relationship between the risk factors and postoperative hemorrhage after tooth extraction in patients receiving oral antithrombotic therapy. Surgeons should be aware of these risks and monitor the PT-INR of anticoagulated patients.
http://ift.tt/2gHIDlV
The risk factors associated with postoperative hemorrhage after tooth extraction: a multi-center retrospective study of patients receiving oral antithrombotic therapy
Abstract
The purpose of this study was to retrospectively investigate the multivariate relationships between specific risk factors and postoperative hemorrhage after tooth extraction in patients who were prescribed oral antithrombotic therapy. Risk factors for postoperative hemorrhage after tooth extraction were evaluated using univariate and multivariate analyses. Patient characteristics such as age and gender; the presence or absence of known comorbidities such as diabetes mellitus, hypertension, cerebral infarction, and alcohol consumption; and perioperative diarrhea were assessed. The drug used for antithrombotic therapy, preoperative blood test results, the presence or absence of preoperative antibiotics or nonsteroidal anti-inflammatory drug (NSAID) administration, the total number of extracted teeth, and the type of surgical procedures were also evaluated. We found that the preoperative administration of antibiotics (odds ratio (OR) = 2.52), an increased prothrombin time international normalized ratio (PT-INR) value (OR = 1.94), and the extraction of multiple teeth (OR = 2.10) were significantly associated with postoperative hemorrhage. There was no significant association between postoperative hemorrhage and any other demographic factors or comorbidities, including concomitant alcohol use. We demonstrated the multivariate relationship between the risk factors and postoperative hemorrhage after tooth extraction in patients receiving oral antithrombotic therapy. Surgeons should be aware of these risks and monitor the PT-INR of anticoagulated patients.
http://ift.tt/2gHIDlV
Current opinion in otolaryngology: update on vascular injuries in craniomaxillofacial fractures.
Purpose of review: The primary purpose of this chapter is to define current recommendations for vascular work-up of patients with craniomaxillofacial (CMF) trauma with emphasis on imaging to include intraoperative fluorescence, angiography, and surgical exploration. The second goal is to review current management recommendations for observation versus surgical exploration based on the neck zones of injury. Recent findings: Over the past two decades, endovascular techniques are increasingly utilized, particularly in zones I and III of the neck. Additionally, modern advances in radiographic technology have allowed for selective exploration of penetrating zone II injuries. A high suspicion for blunt cerebrovascular injury should be maintained for patients with high-speed deceleration mechanisms of injury, with a majority of patients managed with medical therapy or conservative monitoring over surgical intervention. Summary: CMF fractures are associated with vascular injuries to the intracranial carotid system, extracranial carotid system, or vertebral artery system. A thorough understanding of at risk patients, optimal work-up, and timely treatment algorithms is imperative given the devastating sequellae of stroke and death. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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http://ift.tt/2eHwKfp
European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults.
: Procedural sedation and analgesia (PSA) has become a widespread practice given the increasing demand to relieve anxiety, discomfort and pain during invasive diagnostic and therapeutic procedures. The role of, and credentialing required by, anaesthesiologists and practitioners performing PSA has been debated for years in different guidelines. For this reason, the European Society of Anaesthesiology (ESA) and the European Board of Anaesthesiology have created a taskforce of experts that has been assigned to create an evidence-based guideline and, whenever the evidence was weak, a consensus amongst experts on: the evaluation of adult patients undergoing PSA, the role and competences required for the clinicians to safely perform PSA, the commonly used drugs for PSA, the adverse events that PSA can lead to, the minimum monitoring requirements and post-procedure discharge criteria. A search of the literature from 2003 to 2016 was performed by a professional librarian and the retrieved articles were analysed to allow a critical appraisal according to the Grading of Recommendations Assessment, Development and Evaluation method. The Taskforce selected 2248 articles. Where there was insufficiently clear and concordant evidence on a topic, the Rand Appropriateness Method with three rounds of Delphi voting was used to obtain the highest level of consensus among the taskforce experts. These guidelines contain recommendations on PSA in the adult population. It does not address sedation performed in the ICU or in children and it does not aim to provide a legal statement on how PSA should be performed and by whom. The National Societies of Anaesthesiology and Ministries of Health should use this evidence-based document to help decision-making on how PSA should be performed in their countries. The final draft of the document was available to ESA members via the website for 4 weeks with the facility for them to upload their comments. Comments and suggestions of individual members and national Societies were considered and the guidelines were amended accordingly. The ESA guidelines Committee and ESA board finally approved and ratified it before publication. (C) 2017 European Society of Anaesthesiology
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http://ift.tt/2xQK6hM
Current opinion in otolaryngology: update on vascular injuries in craniomaxillofacial fractures.
Purpose of review: The primary purpose of this chapter is to define current recommendations for vascular work-up of patients with craniomaxillofacial (CMF) trauma with emphasis on imaging to include intraoperative fluorescence, angiography, and surgical exploration. The second goal is to review current management recommendations for observation versus surgical exploration based on the neck zones of injury. Recent findings: Over the past two decades, endovascular techniques are increasingly utilized, particularly in zones I and III of the neck. Additionally, modern advances in radiographic technology have allowed for selective exploration of penetrating zone II injuries. A high suspicion for blunt cerebrovascular injury should be maintained for patients with high-speed deceleration mechanisms of injury, with a majority of patients managed with medical therapy or conservative monitoring over surgical intervention. Summary: CMF fractures are associated with vascular injuries to the intracranial carotid system, extracranial carotid system, or vertebral artery system. A thorough understanding of at risk patients, optimal work-up, and timely treatment algorithms is imperative given the devastating sequellae of stroke and death. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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http://ift.tt/2eHwKfp
Recovery From Ropivacaine-Induced or Levobupivacaine-Induced Cardiac Arrest in Rats: Comparison of Lipid Emulsion Effects.
BACKGROUND: Lipid emulsion treatment appears to have application in the treatment of local anesthetic-induced cardiac arrest. To examine whether the efficacy of lipid resuscitation in the treatment of local anesthetic-induced cardiac arrest is affected by lipophilicity, the effects of lipid infusions were compared between levobupivacaine-induced (high lipophilicity) and ropivacaine-induced (lower lipophilicity) rat cardiac arrest model. METHODS: A total of 28 female Sprague-Dawley rats were anesthetized using sevoflurane, which subsequently underwent tracheostomy, followed by femoral artery and vein cannulation. Two hours after the discontinuation of sevoflurane, either levobupivacaine 0.2% (n = 14) or ropivacaine 0.2% (n = 14) was administered at a rate of 2 mg/kg/min to the awake rats. When the pulse pressure decreased to 0, the infusion of local anesthetic was discontinued, and treatment with chest compressions and ventilation with 100% oxygen were immediately initiated. The total doses of local anesthetics needed to trigger the first seizure and pulse pressure of 0 mm Hg were calculated. The 2 groups were each subdivided into a lipid emulsion group (n = 7) and a control group (n = 7). In the lipid emulsion group, 20% lipid emulsion was administered intravenously (5 mL/kg bolus plus continuous infusion of 0.5 mL/kg/min), while in the control group, the same volume of normal saline was administered. Chest compressions were discontinued when the rate-pressure product had increased by more than 20% of baseline. RESULTS: The cumulative doses of levobupivacaine and ropivacaine that produced seizures and 0 pulse pressure showed no significant difference. Mean arterial blood pressure (MAP) values were higher in the levobupivacaine group than in the ropivacaine group after resuscitation was initiated (P 20% baseline), while only 2 of 7 rats in the control group achieved spontaneous circulation at 10 minutes. In ropivacaine-induced cardiac arrest, there were no significant differences in heart rate and MAP between the lipid and control groups from the start of resuscitation to 10 minutes; spontaneous circulation returned in 6 of 7 lipid group rats, but in only 2 of 7 control group rats at 10 minutes. CONCLUSIONS: Lipid emulsion treatment was more effective for levobupivacaine-induced cardiac arrest than for ropivacaine-induced cardiac arrest. Although lipid therapy is also effective for ropivacaine-induced cardiac arrest, it takes more time than in levobupivacaine-induced cardiac arrest. This suggests that the lipophilicity of local anesthetics influences the efficacy of lipid infusion when treating cardiac arrest caused by these drugs. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. (C) 2017 International Anesthesia Research Society
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http://ift.tt/2xPJvN5
Diagnostic Errors in Patients With Skin Findings
Dr Graeme Lipper presents five cases that typically present to primary care but aren't as straightforward as they initially seem.
Medscape Internal Medicine
http://ift.tt/2j2PX02
Synergistic Effects of Long Wavelength Ultraviolet A1 and Visible Light on Pigmentation and Erythema
Summary
Background
Visible light (VL) induces multiple cutaneous effects. Sunscreen testing protocols recommended by regulatory bodies throughout the world require the use of solar simulators with spectral output in ultraviolet (UV) domain only. However, sunlight contains VL and infrared radiation also.
Objective
This study aimed to evaluate the contributions of VL and UVA on pigmentation and erythema, and optimize parameters for in-vivo testing.
Methods
Ten subjects with Fitzpatrick skin phototype IV-VI were enrolled. Subjects were irradiated on their back with VL using two light sources: one containing pure VL and one containing VL with less than 0.5% UVA1 (VL+UVA1). Four different irradiances were administered to investigate reciprocity behaviour. Assessments, including photography, investigator's global assessment, colorimetry, and spectroscopy, were performed immediately, 24 hours, 7 days and 14 days post-irradiation.
Results
Pigmentation was observed with both light sources; however, pigment intensity was greater with VL+UVA1 than pure VL. Reciprocity was observed in pure VL sites, but not VL+UVA1. Variation in spectral output had greater impact on pigment intensity than irradiance. Clinical erythema was observed on the VL+UVA1 side, but not on the pure VL side. Protocol for testing photoprotection product efficacy against VL induced effects has been proposed.
Conclusions
The findings suggest a synergistic relationship between VL and UVA1 and emphasize the need for developing means of photoprotection against VL.
This article is protected by copyright. All rights reserved.
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Violaceous, Photodistributed Cutaneous Eruption and Leg Ulcer
A 69-year-old woman presented for the evaluation of a progressive, asymptomatic cutaneous eruption on her hands and forearms, as well as an enlarging, painful ulcer on her left leg that developed 6 months earlier; her medical history was notable for essential thrombocytosis. What is your diagnosis?
http://ift.tt/2xb87ms
http://ift.tt/2xb87ms
A Transgender Woman With Anogenital Lichen Sclerosus
This case report describes a transgender woman with anogenital lichen sclerosus.
http://ift.tt/2xPp9Uc
http://ift.tt/2xPp9Uc
Incorrect P Value in Table 3
In the article titled "Outlier Practice Patterns in Mohs Micrographic Surgery: Defining the Problem and a Proposed Solution," an incorrect P value in Table 3 has been corrected. Previously, the P value for the "Members in practice" characteristic incorrectly read ".08." The correct P value is ".008." The article was corrected online.
http://ift.tt/2xaYfcr
http://ift.tt/2xaYfcr
Attempting to Define “Hypoallergenic”
The North American Contact Dermatitis Group (NACDG) commends Xu et al for bringing attention to challenges facing dermatologists and consumers. Their original approach of using sales data provides a snapshot of what consumers are actually using (lotions!), and their assessment of commonly used marketing terms and their connection to cost and product composition are innovative.
http://ift.tt/2xP7pIx
http://ift.tt/2xP7pIx
Error in Affiliation
In the article by Albers et al titled "Treatment of Hailey-Hailey Disease With Low-Dose Naltrexone," published online August 2, 2017, there was an error in the affiliations. Dr Arbiser is also at the Atlanta Veterans Administration Medical Center, Decatur, Georgia. The error has been corrected online.
http://ift.tt/2xbb06O
http://ift.tt/2xbb06O
Effect of Topical Fluorouracil Cream on Photodamage
This secondary analysis of a randomized clinical trial investigates the effect of topical fluorouracil, 5%, cream on photoaging using validated photonumeric scales.
http://ift.tt/2xPpGWi
http://ift.tt/2xPpGWi
Performance Characteristics of and Allergens in Best-Selling Moisturizers
This cohort study examines the product performance characteristics and ingredients of best-selling moisturizers.
http://ift.tt/2xbquYo
http://ift.tt/2xbquYo
The Learning Curve in Surgical Practice and Its Applicability to Rhinoplasty
Abstract
The learning curve as a concept has been considered, discussed and debated in medical education and healthcare for over two decades. The precise usage has been recognised in surgical disciplines both broad specialties and sub-specialties. Rollin Daniel in his book stated that, rhinoplasty is the most difficult of all cosmetic operations for three reasons, (a) nasal anatomy is highly variable, (b) the procedure must correct form and function and (c) the final result must meet the patients expectations. With this in mind a study was carried on the perception of learning curve in rhinoplasty based on a surgeon questionnaire at Marien Hospital, Stuttgart, Germany under Prof. Gubisch. Aims of the study were, (1) to extract the perception of learning curve of Rhinoplasty from surgeons across a spectrum of experience, i.e. less experienced to experienced, (2) To calculate the perception of learning curve in rhinoplasty as for other surgical procedures i.e. minimum number, interquartile range, surgical time, accelerators, (3) To chart-out a road-map for a novice rhinoplasty surgeon for continued improvement in surgical skills and ability. The conclusion derived was the concept of learning curve in rhinoplasty cannot be applied to the operation of Septo-Rhinoplasty as a whole because the two factors i.e. interquartile range and minimum number to achieve proficiency have a wide range and cannot be generalized. It is thought that each type of Rhinoplasty should be dealt with separately and learning curve calculated accordingly, i.e. hump reduction, crooked nose and augmentation rhinoplasty.
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Etiology of Noise-Induced Hearing Loss (NIHL) and its Symptomatic Correlation with Audiometry Observations in Type II Diabetes
Abstract
Type II diabetic mellitus (DM) is a chronic metabolic disease that impairs normal insulin production and glucose transport to the liver and muscles. In the India, about 1–5% population suffer from diabetes or related complication. So there is need to cure this disease. DM chronic auditory complications may include spiral ganglia atrophy, degeneration of the vestibulocochlear nerve myelin sheath, reduction of the number of spiral lamina nerve fibres, and thickening of the capillary walls of the stria vascularis and small arteries. This study aims to know the incidence of common parameters, blood sugar levels, levels of lipids and the hearing thresholds of individuals. It is a Noise-Induced Hearing Loss research study featuring hearing impairment in transport workers diagnosed as type II diabetic. All individuals were interviewed by various questioners related to listening ability of subjects and underwent a physical examination, blood investigations and audiometry. Hearing impairment was more prevalent among adults with diabetes. Sensory neuron hearing loss is predominant in both study groups. Mixed Bilateral Hearing Loss showed significant p value in (>.001) by audiometry. The percentage of hearing loss in diabetes (ranges 5.3–28.1%) and in non-diabetics (ranges 3.4–24.1%) and risk factors in diabetes (ranges 22.8–35.1%) over nondiabetics (ranges 17.2–20.1%) which is eye opener. The correlation between type II diabetes and hearing impairment was independent of known risk factors for hearing impairment, such as noise exposure, build-up wax, ototoxic medication, smoking, tobacco chewing etc.
http://ift.tt/2xb2kx2
Anatomical Correlation Between Nasal Vascularisation and the Design of the Endonasal Pedicle Flaps
Abstract
Arteries that supply the nasal septum and the lateral nasal wall include vessels that originate from the external carotid artery and from the internal carotid artery. A variety of local endonasal pedicle flaps can be used in different anatomical areas for endoscopic skull base reconstruction. The main flaps are based on terminal branches of the sphenopalatine artery and on anterior ethmoidal artery. This study will describe the anatomy of these vessels and their relationship with the main flaps.
http://ift.tt/2wHmRq1
Etiology of Noise-Induced Hearing Loss (NIHL) and its Symptomatic Correlation with Audiometry Observations in Type II Diabetes
Abstract
Type II diabetic mellitus (DM) is a chronic metabolic disease that impairs normal insulin production and glucose transport to the liver and muscles. In the India, about 1–5% population suffer from diabetes or related complication. So there is need to cure this disease. DM chronic auditory complications may include spiral ganglia atrophy, degeneration of the vestibulocochlear nerve myelin sheath, reduction of the number of spiral lamina nerve fibres, and thickening of the capillary walls of the stria vascularis and small arteries. This study aims to know the incidence of common parameters, blood sugar levels, levels of lipids and the hearing thresholds of individuals. It is a Noise-Induced Hearing Loss research study featuring hearing impairment in transport workers diagnosed as type II diabetic. All individuals were interviewed by various questioners related to listening ability of subjects and underwent a physical examination, blood investigations and audiometry. Hearing impairment was more prevalent among adults with diabetes. Sensory neuron hearing loss is predominant in both study groups. Mixed Bilateral Hearing Loss showed significant p value in (>.001) by audiometry. The percentage of hearing loss in diabetes (ranges 5.3–28.1%) and in non-diabetics (ranges 3.4–24.1%) and risk factors in diabetes (ranges 22.8–35.1%) over nondiabetics (ranges 17.2–20.1%) which is eye opener. The correlation between type II diabetes and hearing impairment was independent of known risk factors for hearing impairment, such as noise exposure, build-up wax, ototoxic medication, smoking, tobacco chewing etc.
http://ift.tt/2xb2kx2
Anatomical Correlation Between Nasal Vascularisation and the Design of the Endonasal Pedicle Flaps
Abstract
Arteries that supply the nasal septum and the lateral nasal wall include vessels that originate from the external carotid artery and from the internal carotid artery. A variety of local endonasal pedicle flaps can be used in different anatomical areas for endoscopic skull base reconstruction. The main flaps are based on terminal branches of the sphenopalatine artery and on anterior ethmoidal artery. This study will describe the anatomy of these vessels and their relationship with the main flaps.
http://ift.tt/2wHmRq1
Ectopic Hamartomatous Thymoma: A Review Of The Literature With Report Of New Cases And Proposal Of A New Name: Biphenotypic Branchioma
Abstract
Ectopic hamartomatous thymoma (EHT) is a rare benign neoplasm of the lower neck suggesting branchial origin. Despite use of the term thymoma in the nomenclature, there is no evidence of thymic origin or differentiation. It affects middle-aged adults with a remarkable male predominance. To date less than 80 cases have been reported in the English literature. We present here two additional cases of EHT. The first is a benign case in a 31-year-old man, showing typical histological features. The second is a malignant case in a 70-year-old woman, showing intraductal carcinoma arising in intimate association with an EHT. These cases are presented in the context of a review of cases reported in the English literature. The exact origin has not been identified, but is considered to be of branchial apparatus, creating a quandary about the best terminology. Recently, the designation "branchial anlage mixed tumor" or "thymic anlage tumor" were proposed, but do not quite reflect the true nature of the neoplasm. To avoid taxonomic confusion, international consensus on terminology is desired. As this entity is a neoplasm that shows dual mesoderm and endoderm derivation/differentiation, we propose a new name "biphenotypic branchioma."
http://ift.tt/2xa9rG3
Satisfaction with facial profile aesthetics: are norms overrated?
Publication date: Available online 5 September 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): I. Manevska, A. Pavlic, V. Katic, M. Trinajstic Zrinski, M. Drevensek, S. Spalj
This study aimed to explore to what extent adults perceive deviations from the norm of a balanced profile with normal occlusion as reducing satisfaction with facial appearance and having a psychosocial impact. This cross-sectional study included 225 Caucasian subjects (64% women) aged 18–42 years. Their facial profiles were analyzed photogrammetrically and they were classified into three categories: within, below, or above the standard range for the Croatian population with a normal occlusion. Psychosocial issues were assessed by self-reported satisfaction with facial appearance and domains from the Orthognathic Quality of Life Questionnaire: social aspects of dentofacial aesthetics (SA), facial aesthetics concern (FA), and awareness of dentofacial aesthetics (AW). Men with a concave profile were less satisfied with their faces than those with a flat or convex profile (P<0.05). A reduced upper lip height in men resulted in a lower level of satisfaction and increased FA score, when compared to men with a normal or increased upper lip height (P<0.05). In women, a reduced middle third of the face increased AW (P=0.045). Deviations from a well-balanced facial profile, as well as the morphology of the nose and lip, do not increase psychosocial issues to a great extent. The range of acceptable facial characteristics is evidently much broader than the norms.
http://ift.tt/2wH5fKZ
The action of anti-inflammatory agents in healthy temporomandibular joint synovial tissues is sex-dependent
Publication date: Available online 5 September 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S.R. Figueroba, M.F. Groppo, D. Faibish, F.C. Groppo
This study evaluated the effects of dexamethasone, parecoxib, and glucosamine on cartilage thickness and cytokine levels in the temporomandibular joint (TMJ). Forty-eight rats (24 female, 24 male) were assigned to four treatments administered once daily for 7 days: control (saline intramuscularly), parecoxib (0.3mg/kg intramuscularly), dexamethasone (0.1mg/kg intramuscularly), and glucosamine (80mg/kg orally). The thickness of TMJ cartilage and levels of four cytokines were measured. Median cartilage thickness was higher in males than in females in the control (253.2 vs. 240.4μm, P=0.0036), parecoxib (227.3 vs. 192.1μm, P<0.0001), and dexamethasone (227.1 vs. 170.5μm, P=0.017) groups, but was lower in males in the glucosamine group (214.5 vs. 239.6μm, P=0.0001). IL-1β was not detected. Median IL-1α levels differed between males and females in the parecoxib group (0.08 vs. 0.04ng/ml, P=0.0055), but not in the control (0.07 vs. 0.06ng/ml), dexamethasone (0.06 vs. 0.04ng/ml), or glucosamine (0.08ng/ml vs. 0.06ng/ml) groups (all P>0.05). Only dexamethasone induced lower IL-6 levels in males than in females (median 4.6 vs. 2.1ng/ml, P=0.0044). Median TNF-α levels did not differ between males and females in the control (0.07 vs. 0.05ng/ml) or parecoxib (0.07 vs. 0.05ng/ml) groups (both P>0.05), but dexamethasone (0.09 vs. 0.05ng/ml, P=0.0002) and glucosamine (0.09 vs. 0.07ng/ml, P=0.0259) induced higher TNF-α levels in females. Thus, the effects of the three treatments on the levels of cytokines and thickness of condylar cartilage were sex-dependent.
http://ift.tt/2vLRFc6
Nivolumab Plus Ipilimumab in Patients With Renal Medullary Carcinoma
Conditions: Renal Medullary Carcinoma; Other Disorders of Kidney and Ureter
Interventions: Drug: Nivolumab; Drug: Ipilimumab
Sponsors: M.D. Anderson Cancer Center; Bristol-Myers Squibb
Not yet recruiting - verified September 2017
http://ift.tt/2xOmpXj
Interventions: Drug: Nivolumab; Drug: Ipilimumab
Sponsors: M.D. Anderson Cancer Center; Bristol-Myers Squibb
Not yet recruiting - verified September 2017
http://ift.tt/2xOmpXj
Efficacy of Nasogastric Tube Application in Postoperative Care of Esophagectomy
Condition: Esophageal Cancer
Intervention: Procedure: Discharge the NG tube during the surgery
Sponsor: Fudan University
Not yet recruiting - verified August 2017
http://ift.tt/2xaNVRu
Intervention: Procedure: Discharge the NG tube during the surgery
Sponsor: Fudan University
Not yet recruiting - verified August 2017
http://ift.tt/2xaNVRu
Adjuvant Radiotherapy for T3N0M0 Esophageal Squamous Cell Carcinoma With Positive Circumstantial Resection Margin
Conditions: Esophageal Squamous Cell Carcinoma; Positive Circumferential Resection Margin
Intervention: Radiation: radiation
Sponsor: Fudan University
Not yet recruiting - verified August 2017
http://ift.tt/2xO2RCe
Intervention: Radiation: radiation
Sponsor: Fudan University
Not yet recruiting - verified August 2017
http://ift.tt/2xO2RCe
Efficacy and Safety of Apatinib for Recurrent or Metastatic Esophageal Squamous Cell Carcinoma
Condition: Esophageal Neoplasms
Intervention: Drug: Apatinib
Sponsor: Fudan University
Recruiting - verified September 2017
http://ift.tt/2xadMJg
Intervention: Drug: Apatinib
Sponsor: Fudan University
Recruiting - verified September 2017
http://ift.tt/2xadMJg
Whole Body Electromyostimulation and Nutritional Therapy for Patients With Esophageal and Bronchial Carcinoma
Conditions: Cancer of Esophagus; Cancer, Lung
Interventions: Procedure: whole body electromyostimulation exercise; Procedure: protein-rich nutrition therapy
Sponsor: University of Erlangen-Nürnberg Medical School
Recruiting - verified September 2017
http://ift.tt/2xOzIHg
Interventions: Procedure: whole body electromyostimulation exercise; Procedure: protein-rich nutrition therapy
Sponsor: University of Erlangen-Nürnberg Medical School
Recruiting - verified September 2017
http://ift.tt/2xOzIHg
A murine Ig light chain transgene reveals IGKV3 gene contributions to anti-collagen types IV and II specificities
Source:Molecular Immunology, Volume 91
Author(s): Amy G. Clark, Inge M. Worni-Schudel, Francesca M. Korte, Mary H. Foster
A subset of autoimmune diseases result from autoantibodies targeting epitopes on matrix collagen. The most extensively studied are anti-glomerular basement membrane glomerulonephritis (or its systemic counterpart Goodpasture's disease) that destroys kidneys and lungs, and rheumatoid arthritis that leads to disabling arthritis. Autoantibodies in these disorders bind evolutionarily conserved conformational epitopes on the noncollagenous domain 1 (NC1) of the alpha3 chain of type IV [alpha3(IV)NC1] collagen in glomerular and alveolar basement membranes, and on native or citrullinated type II collagen (CII) in joint cartilage, respectively. The genetic origins of pathogenic anti-collagen B cells in these diseases is unknown, but observations from murine models raise the possibility that they overlap despite distinct in vivo immunopathologies. Monoclonal autoantibodies isolated from mice immunized with alpha3(IV)NC1 collagen or CII show a biased use of Ig light chains (LC) encoded by genes of the IGKV3 subgroup (previously Vk21 family), paired with diverse Ig heavy chains. To further explore this relationship and determine if a single murine IGKV3 LC independently predisposes to both anti-collagen responses, we generated a novel transgenic (Tg) C57BL/6 mouse that expresses a productively rearranged IGKV3-encoded LC, termed mLCV3-Tg, in conjunction with endogenously rearranged Ig heavy chains. Tg mice are also genetically deficient in endogenous kappa chains to permit tracking of the mLCV3 transgene. We show that mLCV3-Tg mice are susceptible to humoral autoimmunity against both collagen chains. Anti-alpha3(IV)NC1 collagen, but not anti-CII, mLCV3-encoded Ig are detected in serum of unmanipulated Tg mice, while Toll-like receptor ligands induce secretion of mLCV3-Tg autoantibodies of both collagen specificities from splenocytes ex vivo. This indicates developmental survival of mLCV3-Tg B cells reactive with each antigen, and is consistent with production of the two anti-collagen autoIg from distinct B cell populations. Reduced B cell numbers, low serum Ig kappa levels, low cell surface Ig kappa density, and abundant endogenous lambda chain expression suggest that subsets of IGKV3-encoded B cells are regulated in vivo by mechanisms that include deletion, anergy, and LC editing. These results support the notion that murine IGKV3 LCs contribute structural fitness to antigen binding sites that support diverse anti-collagen autoimmune responses, that these responses are regulated in vivo, and that these cells can nonetheless readily escape immune regulation.
http://ift.tt/2xacQEL
Human β-defensin 3 inhibits periodontitis development by suppressing inflammatory responses in macrophages
Publication date: November 2017
Source:Molecular Immunology, Volume 91
Author(s): Di Cui, Jinglu Lyu, Houxuan Li, Lang Lei, Tianying Bian, Lili Li, Fuhua Yan
Human β-defensin 3 (hBD3) is a cationic peptide with immunomodulatory effects on both innate and acquired immune responses. Periodontitis, an inflammatory disease that extends deep into periodontal tissues, causes the loss of supporting structures around the tooth. The present study assessed the effects of hBD3 as a monotherapy for periodontitis in mice and explored its potential mechanism. In vivo, hBD3 inhibited the levels of tumour necrosis factor (TNF)-α, interleukin-6, and matrix metalloprotease-9 in periodontium exposed to Porphyromonas gingivalis (P.g) in a mouse periodontitis model; reduced osteoclast formation and lower alveolar bone loss were also observed. In addition, hBD3 was related to the expression of polarization signature molecules in circulating monocytes. In vitro, hBD3 notably suppressed the production of TNF-α and interleukin-6 in RAW 264.7 cells stimulated by the lipopolysaccharide of P.g. Moreover, hBD3 attenuated polarization of RAW 264.7 cells into the M1 phenotype, with reduced activation of nuclear factor-κB signal transduction. In conclusion, hBD3 exhibits potent anti-periodontitis properties both in vitro and in vivo, and this effect may be correlated to inhibition of the nuclear factor-κB pathway and macrophage polarization.
http://ift.tt/2xaTRKg
DAF in diabetic patients is subject to glycation/inactivation at its active site residues
Source:Molecular Immunology
Author(s): Rudolf Flückiger, Enzo Cocuzzi, Ram H. Nagaraj, Menachem Shoham, Timothy S. Kern, M. Edward Medof
Decay accelerating factor (DAF or CD55) is a cell associated C3 and C5 convertase regulator originally described in terms of protection of self-cells from systemic complement but now known to modulate adaptive T cell responses. It is expressed on all cell types. We investigated whether nonenzymatic glycation could impair its function and potentially be relevant to complications of diabetes mellitus and other conditions that result in nonenzymatic glycation including cancer, Alzheimer's disease, and aging. Immunoblots of affinity-purified DAF from erythrocytes of patients with diabetes showed pentosidine, glyoxal-AGEs, carboxymethyllysine, and argpyrimidine. HPLC/MS analyses of glucose modified DAF localized the sites of AGE modifications to K125 adjacent to K126, K127 at the junction of CCPs2-3 and spatially near R96, and R100, all identified as being critical for DAF's function. Functional analyses of glucose or ribose treated DAF protein showed profound loss of its regulatory activity. The data argue that de-regulated activation of systemic complement and de-regulated activation of T cells and leukocytes could result from non-enzymatic glycation of DAF.
http://ift.tt/2wGq5tL
Oropharyngeal lymphoma: A US population based analysis
Source:Oral Oncology, Volume 73
Author(s): Hani M. Rayess, Michael Nissan, Amar Gupta, Michael A. Carron, S. Naweed Raza, Andrew M. Fribley
ObjectivesTo describe the epidemiology and analyze factors determinant of survival in patients with oropharyngeal lymphoma, using the Surveillance Epidemiology and End Results (SEER) database.Methods2504 patients with oropharyngeal lymphoma were identified using the most recent SEER database entry from 1976 to 2016. Demographic information, Ann Arbor stage, tumor histopathology and location were collected. Multivariate analysis was used to analyze patient and tumor characteristics associated with survival.ResultsThe mean age of the patients studied was 60.5years, 58.4% of the subjects were male and 81% were white. Diffuse large B cell lymphoma (DLBCL) was the most common histologic subtype involving 56.9% of cases. The most common subsite of origin was the tonsil, with 71% of lymphomas originating from there. The association of survival with stage, age, tumor location, presence of B symptoms, tumor pathology, gender and race was analyzed using multivariate regression. Decreased survival was significantly associated with patient age p<0.0001, Ann Arbor staging p=0.005, the presence of B symptoms p=0.003 and tumor histopathology (T cell tumors) p=0.01. Patients with tumors originating from the soft palate were significantly more likely to die asa result of their disease p=0.03.ConclusionOropharyngeal lymphoma most commonly originates from the tonsil. DLBCL is the most common subtype and has a good prognosis. The presence of B symptoms, tumors originating from the soft palate and patients with T cell tumors have the worst prognosis. This information can potentially be of great utility to the head and neck surgeon discussing prognosis with patients suffering from oropharyngeal lymphoma.
http://ift.tt/2xO3Cv2
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