Head and Neck Medicine by Alexandros G.Sfakianakis: 09/11/17

Δευτέρα 11 Σεπτεμβρίου 2017

European S3-Guideline on the systemic treatment of psoriasis vulgaris – Update Apremilast and Secukinumab – EDF in cooperation with EADV and IPC

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Supraventricular tachycardia diagnosed by smartphone ECG

Diagnosis of paroxysmal supraventricular tachycardia (PSVT) may be difficult due to its episodic nature, which can be brief and self-limited, limiting the ability for clinicians to diagnose the specific rhythm disorder in a timely manner. We present a case of PSVT, which was unable to be diagnosed through typical evaluation with an event monitor despite several years of symptoms. The patient was ultimately diagnosed using the AliveCor Mobile ECG, a smartphone-based ECG device and application, which he purchased himself and captured a typical atrioventricular node re-entrant tachycardia. The patient was then able to email his cardiologist the tracing, which led to an electrophysiology study and successful slow pathway ablation procedure. Smartphone-based technology has the potential to push diagnostic evaluations outside of the healthcare system and empower patients.

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Dilation of epidural space and posterior soft tissue veins in Hirayama disease

Description

An 18-year-old man presented with distal weakness and amyotrophy of the right hand for a few months. He had no familial or personal medical history. Clinical examination showed atrophy and a marked weakness of right hypothenar and interossei muscles (grade 1/5 on Medical Research Council scale) and a mild weakness of right thumb abduction and wrist extension (4/5). Biceps, brachioradial and triceps tendon reflexes were normal and symmetric. There were no fasciculation, sensory abnormality or pain. Motor nerve conduction studies showed a reduced amplitude of compound muscle action potential of the right ulnar nerve but normal parameters of left ulnar and two median nerves. No focal slowing or conduction block was found. Studies of bilateral median, ulnar and right medial antebrachial cutaneous sensory nerves were normal. Electromyographic examination found active denervation (fibrillation potentials and neurogenic recruitment) in right C8-T1 innervated muscles (abductor pollicis brevis, first dorsal interosseus, extensor...

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Brainstem encephalitis and acute polyneuropathy associated with hepatitis E infection

A 59-year-old man presented with feverish illness. His Glasgow Coma Scale was 15, had reduced visual acuity in the left eye with partial left ptosis and mild left hemiparesis with an extensor left plantar. Over 48 hours, he accrued multiple cranial nerves palsies and progressed to a flaccid paralysis necessitating admission to an intensive care unit.

Cerebrospinal fluid (CSF) study showed 20 lymphocytes and raised protein. Viral and bacterial PCRs were negative. Samples for Lyme, blood-borne viruses, syphilis and autoantibodies were also negative. MRI brain showed T2 abnormalities within the brainstem. Nerve conduction studies revealed an acute motor and sensory axonal neuropathy pattern of Guillian Barre Syndrome (GBS). The patient was treated for both infective and inflammatory causes of brainstem encephalitis and GBS.

Retrospective studies confirmed the presence of hepatitis E virus (HEV) RNA in CSF and serum studies showed positive HEV IgG and IgM prior to intravenous infusion. After 3 months of intensive rehabilitation, the patient was discharged home walking with a frame.

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Issue Information - TOC

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Updated view on epidemiology and clinical aspects of pilomatricoma in adults

Abstract

Background

Clinically, pilomatricoma offers potential for a wide spectrum of differential diagnoses. It typically occurs in pediatric patients with the head being the most common location. A second peak of clinical presentation occurs in adults at age 50–65 years, suggesting a bimodal pattern of occurrence.

Objective

To investigate the clinical and epidemiological features of pilomatricoma in adults over 20 years old, as it is a common and frequently misdiagnosed tumor.

Methods

This was a retrospective study of pilomatricomas surgically removed at a tertiary hospital between January 1994 and December 2014. A search of the all-pathological database of patients aged over 20 years old with a pathological diagnosis of pilomatricoma was carried out.

Results

The clinical preoperative diagnosis of pilomatricoma was made in 34.0% of cases. Tumor location showed a predilection to the head and neck. Of the reported concomitant neoplasm, a majority had accompanying skin tumors.

Conclusion

We conclude that clinical features in adults were similar to those of children. This study outlines clinical presentations that should help to guide differential diagnoses. Additionally, because of similarities between the distribution and depth of vellus hair follicles and pilomatricomas, it is probable that vellus hair bulbs may be the origin of this tumor.

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Radiographic evaluation of condylar positioning in patients undergoing orthognathic surgery

Abstract

Objective

The aim of this study was to evaluate alterations in condylar positioning through submentovertex projection (Hirtz Radiographic Technique) in patients who underwent orthognathic surgery for maxillary advancement and mandibular setback with stable internal fixation.

Methods

A prospective longitudinal clinical study of 40 surgical patients presenting dentofacial deformity admitted in the Oral and Maxillofacial Surgery Department of Federal University of Paraná (UFPR) in the period between March 2013 and December 2015. We performed two submentovertex digital radiographs, one 7 days before surgery and the other one 30 days after the procedure. Cephalometric tracings were made using Radiocef® Studio 2 Software and measured the intercondylar and condylar angles (right and left).

Results

There was a decrease in the intercondylar angle (p < 0.001) and an increase in condylar angles both the right and the left side (p < 0.001) when compared with the pre and postoperative period. There was a larger increase in condylar angle on the right side in males (p = 0.007).

Conclusion

There is a tendency of decreasing of the intercondylar angle after orthognathic surgery, regardless of the alteration in the condylar angles, creating a new position of the condyle in the glenoid fossa. Patients with asymmetry may present greater alterations in the positioning of the opposite condylar to the deviation of the mandibular midline.

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Shrinkage in oral squamous cell carcinoma: An analysis of tumor and margin measurements in vivo, post-resection, and post-formalin fixation

To quantify changes in tumor size and tumor-free margins following surgical resection and formalin fixation of oral cavity squamous cell carcinoma.

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Intussusception caused by heterotopic gastric mucosa in small intestine: a case report

Intestinal intussusception is the most frequent cause of small bowel obstruction in children between the ages of 2 months and 5 years and often remains idiopathic in etiology, even after surgery. On microscopi...

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Radiographic evaluation of condylar positioning in patients undergoing orthognathic surgery

Abstract

Objective

Methods

Results

Conclusion

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Erratum to “Extramammary Paget's disease of the oral mucosa and perioral skin” [Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124 (2):e157-e163.]

Publication date: Available online 11 September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Xiangjian Wang, Lanyan Wu, Xueke Shi, Xin He, Wei Li, Hongmei Zhou

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Sarcoidosis Following Anti-PD-1 and Anti-CTLA-4 Therapy for Metastatic Melanoma

Immune checkpoint inhibitors represent the newest treatment for stage IV melanoma. These agents are generally well tolerated, however severe immune-related adverse effects have been noted in a small, but clinically significant percentage of patients. Specifically, sarcoidosis is a known potential complication following anti-CTLA-4 therapy. We present 2 cases of pulmonary and cutaneous sarcoidosis developing in patients with stage IV melanoma. Both patients were treated with ipilimumab and anti-PD-1 therapy, and both experienced good oncologic responses to treatment; neither had evidence of preexisting sarcoidosis. Of note, both patients developed sarcoidosis only after undergoing immune checkpoint inhibitor therapy. In 1 patient, sarcoidosis developed after initiation of anti-PD-1 therapy, 3 months after the last dose of anti-CTLA-4 monotherapy, suggesting a synergistic immune dysmodulating effect of both checkpoint inhibitors. Ultimately, both patients' symptoms and radiologic findings resolved with corticosteroid treatment, and both patients have tolerated retreatment with PD-1 inhibitors. Sarcoidosis is a rare complication of immune checkpoint inhibitors and can manifest with severe pulmonary manifestations. However, sarcoidosis in this setting is responsive to corticosteroids and does not necessarily recur with retreatment. It is yet unclear whether the development of sarcoidosis in these patients represents unmasking of preexisting autoimmune tendencies or is a marker of oncologic response.

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Immunologic Response Elicited in Breast Cancer Patients Receiving a NeuGcGM3-based Vaccine as Adjuvant Therapy

This study aimed to investigate the immunogenicity of a cancer vaccine consisting of the NeuGcGM3 ganglioside combined with the outer membrane protein complex of Neisseria meningitides to form very small size particles. The vaccine is administered together with Montanide ISA51, as adjuvant treatment for breast cancer patients. After surgical resection and standard first-line chemo/radiotherapy, breast cancer patients in stage II–III were enrolled in a phase III clinical trial and allocated into 2 strata, according to the number of positive lymph nodes [stratum I (0–3); stratum II (≥4)]. Subsequently, patients were randomly assigned to receive the vaccine or placebo. The treatment consisted of 5 vaccine doses (200 μg) every 2 weeks and thereafter monthly reimmunizations to complete 15 doses. The vaccine was well-tolerated and high titers of immunoglobulin M and immunoglobulin G anti-NeuGcGM3 antibodies were similarly detected in each stratum. Hyperimmune sera were able to specifically recognize and kill the NeuGcGM3-expressing L1210 tumor cell line, and these functional capacities were significantly associated with a better clinical outcome in patients of stratum II. Besides, postimmune sera had the capacity to revert in vitro the immunosuppression induced by NeuGcGM3, as measured by the prevention of CD4 downmodulation on human T lymphocytes. Vaccination had no impact on the frequency of regulatory T cells or circulating NK cells. This study demonstrated, for the first time, the immunogenicity of the NeuGcGM3/VSSP/Montanide ISA 51 vaccine in the adjuvant setting and describes the functionality of induced anti-NeuGcGM3 antibodies as potential surrogate biomarkers of clinical benefit.

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First-in-Human Treatment With a Dendritic Cell-targeting Lentiviral Vector-expressing NY-ESO-1, LV305, Induces Deep, Durable Response in Refractory Metastatic Synovial Sarcoma Patient

Effective induction of antitumor T cells is a pivotal goal of cancer immunotherapy. To this end, lentiviral vectors (LV) are uniquely poised to directly prime CD8 T-cell responses via transduction of dendritic cells in vivo and have shown promise as active cancer therapeutics in preclinical tumor models. However, until now, significant barriers related to production and regulation have prevented their widespread use in the clinic. We developed LV305, a dendritic cell-targeting, integration-deficient, replication incompetent LV from the ZVex platform, encoding the full-length cancer-testis antigen NY-ESO-1. LV305 is currently being evaluated in phase 1 and 2 trials in metastatic recurrent cancer patients with NY-ESO-1 positive solid tumors as a single agent and in combination with anti-PD-L1. Here we report on the first patient treated with LV305, a young woman with metastatic, recurrent, therapy-refractive NY-ESO-1+ synovial sarcoma. The patient developed a robust NY-ESO-1-specific CD4+ and CD8+ T-cell response after 3 intradermal injections with LV305, and subsequently over 85% disease regression that is continuing for >2.5 years posttherapy. No adverse events >grade 2 occurred. This case demonstrates that LV305 can be safely administered and has the potential to induce a significant clinical benefit and immunologic response in a patient with advanced stage cancer.

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Two Cases of Sinusitis Induced by Immune Checkpoint Inhibition

We report the acute onset of aseptic sinusitis in 2 patients receiving the immune checkpoint inhibitors, ipilimumab and nivolumab, for treatment of metastatic melanoma. Ipilimumab, a monoclonal antibody targeting cytotoxic T-lymphocyte antigen-4, and nivolumab, targeting programmed cell death-1, have been associated with numerous immune-related adverse events. To the authors' knowledge, this is the first report of aseptic sinusitis as a consequence of immune checkpoint inhibition therapy.

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Immune monitoring for precision medicine in allergy and asthma

Scott Dexter Boyd | Ramona Amy Hoh | Kari Christine Nadeau | Stephen Joseph Galli

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Immune mechanisms of food allergy and its prevention by early intervention

The meta‐analysis

Fernando de Andrade Quintanilha Ribeiro
Braz J Otorhinolaryngol.2017;83:497

Texto Completo - PDF

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First Clinical Consensus and National Recommendations on Tracheostomized Children of the Brazilian Academy of Pediatric Otorhinolaryngology (ABOPe) and Brazilian Society of Pediatrics (SBP)

Melissa A.G. Avelino, Rebecca Maunsell, Fabiana Cardoso Pereira Valera, José Faibes Lubianca Neto, Cláudia Schweiger, Carolina Sponchiado Miura, Vitor Guo Chen, Dayse Manrique, Raquel Oliveira, Fabiano Gavazzoni, Isabela Furtado de Mendonça Picinin, Paulo Bittencourt, Paulo Camargos, Fernanda Peixoto, Marcelo Barciela Brandão, Tania Maria Sih, Wilma Terezinha Anselmo‐Lima
Braz J Otorhinolaryngol.2017;83:498-506

Resumo - Texto Completo - PDF

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Impact of cartilage graft size on success of tympanoplasty

Waleed Abdelhameed, Ibrahim Rezk, Alhussein Awad
Braz J Otorhinolaryngol.2017;83:507-11

Resumo - Texto Completo - PDF

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Encoding of speech sounds at auditory brainstem level in good and poor hearing aid performers

Hemanth Narayan Shetty, Manjula Puttabasappa
Braz J Otorhinolaryngol.2017;83:512-22

Resumo - Texto Completo - PDF

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Profile and prevalence of hearing complaints in the elderly

Magda Aline Bauer, Ângela Kemel Zanella, Irênio Gomes Filho, Geraldo de Carli, Adriane Ribeiro Teixeira, Ângelo José Gonçalves Bós
Braz J Otorhinolaryngol.2017;83:523-9

Resumo - Texto Completo - PDF

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Preoperative vestibular assessment protocol of cochlear implant surgery: an analytical descriptive study

Roseli Saraiva Moreira Bittar, Eduardo Setsuo Sato, Douglas Jósimo Silva Ribeiro, Robinson Koji Tsuji
Braz J Otorhinolaryngol.2017;83:530-5

Resumo - Texto Completo - PDF

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Treatment of large persistent tracheoesophageal peristomal fistulas using silicon rings

Ibrahim Erdim, Ali Ahmet Sirin, Bahadir Baykal, Fatih Oghan, Ali Guvey, Fatma Tulin Kayhan
Braz J Otorhinolaryngol.2017;83:536-40

Resumo - Texto Completo - PDF

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The effect of melatonin and vitamin C treatment on the experimentally induced tympanosclerosis: study in rats

Sema Koc, Halil Kıyıcı, Aysun Toker, Harun Soyalıç, Huseyin Aslan, Hakan Kesici, Zafer I. Karaca
Braz J Otorhinolaryngol.2017;83:541-5

Resumo - Texto Completo - PDF

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Efficacy of syringe‐irrigation topical therapy and the influence of the middle turbinate in sinus penetration of solutions

Guilherme Henrique Wawginiak, Leonardo Balsalobre, Eduardo Macoto Kosugi, João Paulo Mangussi‐Gomes, Raul Ernesto Samaniego, Aldo Cassol Stamm
Braz J Otorhinolaryngol.2017;83:546-51

Resumo - Texto Completo - PDF

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Evaluation of aesthetic and functional outcomes in rhinoplasty surgery: a prospective study

Sara Sena Esteves, Miguel Gonçalves Ferreira, João Carvalho Almeida, José Abrunhosa, Cecília Almeida e Sousa
Braz J Otorhinolaryngol.2017;83:552-7

Resumo - Texto Completo - PDF

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Medical adherence to intranasal corticosteroids in adult patients

Emre Ocak, Baran Acar, Deniz Kocaöz
Braz J Otorhinolaryngol.2017;83:558-62

Resumo - Texto Completo - PDF

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An often neglected area in crooked nose: middle turbinate pneumatization

Fatih Özdoğan, Halil Erdem Özel, Erkan Esen, Erdem Altıparmak, Selahattin Genç, Adin Selçuk
Braz J Otorhinolaryngol.2017;83:563-7

Resumo - Texto Completo - PDF

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Does stapes surgery improve tinnitus in patients with otosclerosis?

Onur Ismi, Osman Erdogan, Mesut Yesilova, Cengiz Ozcan, Didem Ovla, Kemal Gorur
Braz J Otorhinolaryngol.2017;83:568-73

Resumo - Texto Completo - PDF

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Speech perception performance of subjects with type I diabetes mellitus of noise

Bárbara Cristiane Sordi Silva, Erika Barioni Mantello, Maria Cristina Foss Freitas, Milton César Foss, Myriam de Lima Isaac, Adriana Ribeiro Tavares Anastasio
Braz J Otorhinolaryngol.2017;83:574-9

Resumo - Texto Completo - PDF

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Hearing handicap in patients with chronic kidney disease: a study of the different classifications of the degree of hearing loss

Klinger Vagner Teixeira da Costa, Sonia Maria Soares Ferreira, Pedro de Lemos Menezes
Braz J Otorhinolaryngol.2017;83:580-4

Resumo - Texto Completo - PDF

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Proliferative verrucous leukoplakia: diagnosis, management and current advances

Diogo Lenzi Capella, Jussara Maria Gonçalves, Adelino Antônio Artur Abrantes, Liliane Janete Grando, Filipe Ivan Daniel
Braz J Otorhinolaryngol.2017;83:585-93

Resumo - Texto Completo - PDF

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Canine fossa puncture in endoscopic sinus surgery: report of two cases

Federico Sireci, Matteo Nicolotti, Paolo Battaglia, Raffaele Sorrentino, Paolo Castelnuovo, Frank Rikki Canevari
Braz J Otorhinolaryngol.2017;83:594-9

Resumo - Texto Completo - PDF

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Postauricular neurofibroma – a rare occurrence

Tan Shi Nee, Mazita Ami, Kong Min Han, Primuharsa Putra Sabir Husin Athar
Braz J Otorhinolaryngol.2017;83:600-1

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Thyroid compressive mass, a metastasis of femur chondrosarcoma after 14 years: case report and literature review

François Simon, Marion Classe, Pierre Vironneau, Michel Wassef, Philippe Herman, Nicolas Le Clerc
Braz J Otorhinolaryngol.2017;83:602-4

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Oral manifestations of dengue viral infection

Beuy Joob, Viroj Wiwanitkit
Braz J Otorhinolaryngol.2017;83:605

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“The Use Of Bone Grafts Or Modified BSSO Technique In Large Mandibular Advancements Reduces The Risk Of Persisting Mandibular Inferior Border Defects”

Publication date: Available online 11 September 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Julio Cifuentes, Nicolás Yanine, Daniel Jerez, Ariel Barrera, Jimoh Olubanwo Agbaje, Constantinus Politis
PurposeHealing of the inferior border of the mandible may be compromised in large advancements, leaving an unaesthetic defect at the inferior border. The objective of this article is to compare different bilateral sagittal split osteotomy (BSSO) techniques in order to prevent the incidence of lower border mandibular defects.Patients and MethodsThe authors undertook a retrospective multicenter cohort study comparing three BSSO techniques for advancements greater than 5 millimeters: Traditional Non-Grafted BSSO Technique (group A), Traditional Grafted BSSO Technique (group B) and Modified BSSO Technique (group C). The space created by the mandibular advancement was measured. The presence or absence of a defect was determined one year post-surgery by clinical and radiographic assessment. The bone defect outcome was associated with potential risk predictors (age, sex, side of sagittal split osteotomy, and magnitude of mandibular advancement) by logistic regression analysis.ResultsA total of 1002 operative sites in 501 patients were included in the study. Age 26,8 SD (11), sex (310 female, 191 male) and mandibular advancement (9,3mm right side, 10mm left side) were similar between the groups. (p>.05) The proportion of post-surgical lower border mandibular defects were: group A 54,5%, group B 1,3% and group C 10,6%. The Traditional Grafted BSSO Technique, and Modified BSSO Technique were significantly more effective in preventing the incidence of mandibular lower border defects compared with Traditional Non-Grafted BSSO Technique. (p<.05)ConclusionSurgeons are advised that there is a significant proportion of mandibular lower border defects with the Traditional Non-Grafted BSSO Technique.The use of bone grafts or the modified BSSO technique in mandibular advancements greater than 10 mm significantly reduces the risk of persisting mandibular inferior border defects.

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Management of Head and Neck Burns – a 15 year review

Publication date: Available online 11 September 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Travis J. Hamilton, Jeromy Patterson, Rachael Y. Williams, Walter L. Ingram, Juvonda S. Hodge, Shelly Abramowicz
PurposeThe purpose of this project was to characterize isolated head and neck burns admitted to Grady Memorial Hospital (GMH) Burn Center.Materials and MethodsThis was a retrospective case series of patients admitted to GMH Burn Center with primary diagnosis of head and neck burns from 2000-2015. Demographic data (gender and age) were recorded. Burn details (etiology, mechanism, percent of burned total body surface area [TBSA], depth, and associated injuries) was summarized. Patient management and hospital course were documented. The data were collected using a standardized collection form. Descriptive statistics were computed.ResultsThere were 5,938 patients admitted to burn unit at GMH during the study period. Of them, 2,547 patients had head and neck burns. 205 patients met inclusion criteria. Majority (n=136, 66%) were male with a mean age of 40 years old. The most common burn depth was superficial partial thickness. Flame burns were the most likely mechanism related to full thickness injury. About a quarter of patients had an associated injury such as inhalation or ocular injury. Surgical interventions consisted of tangential excision and split thickness skin grafting, contracture release, excision of hypertrophic scars, and rotational flaps. The mean LOS for isolated head and neck burns was 4.4 days. Overall mortality was 2%.ConclusionThe results of this study show that superficial partial thickness head and neck burns were more likely to occur due to accidental exposure to flames in men older than 55 years. Due to an increase in risk and mortality of inhalation injury associated with head and neck burns, airway protection and respiratory management are critical considerations of head and neck burn management.

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Immediate reconstruction of failed implants in the esthetic zone using a flapless technique and autogenous composite tuberosity graft

Publication date: Available online 11 September 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Gerry M. Raghoebar, Henny J.A. Meijer, Baucke van Minnen, Arjan Vissink
We describe a technique for immediate reconstruction of bone after removal of failed dental implants in the aesthetic region in order to optimize the aesthetic outcome of retreatment. We conducted a study in 16 consecutive patients in which the bony defect resulting from implant removal was immediately reconstructed with a combined autogenous bone and soft tissue graft harvested from the maxillary tuberosity. After a healing period of 3 months, implants were inserted. One year after placement of the definitive restoration, no implants were lost, the peri-implant tissues were healthy, the aesthetics scored with the pink aesthetic score were favorable and the patients were satisfied. With this technique, it appears that immediate reconstruction of the hard and soft tissue components with a combined bone-soft tissue graft after removal of an implant is a feasible treatment option, both from the perspective of the patient and professional. It expedites rehabilitation, reduces morbidity and is accompanied by a favorable aesthetic outcome.

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Periorbital necrotizing fasciitis induced by streptococcus pyogenes: a case report and clarification.

Publication date: Available online 11 September 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): D. Deneubourg, Z. Catherine, P. Lejuste, P. Breton
IntroductionPeriorbital necrotizing fasciitis (PONF) is a rare condition of the face. PONF can lead to blindness, functionnal and aesthetic sequellae, multiple organ failure and death. The aim of this article is, through a case report, to raise the awereness of maxillofacial surgeons on this severe disease.Case reportWe report a case of a 30-year-old woman who presented with a bilateral palpebral oedema and pain three days after a jugal wound was sutured. Necrosis of the skin of the left palpebral unit was extending rapidly. The patient had signs of sepsis. Surgical debridement was performed promptly and associated with intravenous broad-spectrum empiric antibiotics. The patient recovered slowly with no complication other than residual skin defect of both eyelids which was later corrected by fullthickness skin graft.ConclusionSpecial attention should be payed to signs of preseptal cellulitis as they can, in some cases, rapidly turn into a PONF. Early diagnosis and treatment are the keys to favorable outcome.

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“Silent” Sleep Apnea in Dentofacial Deformities and Prevalence of Daytime Sleepiness after Orthognathic/Intranasal Surgery

Publication date: Available online 11 September 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jeffrey C. Posnick, Anayo Adachie, Neeru Singh, Elbert Choi
PurposeThe purposes of this study were to: determine the occurrence of undiagnosed "silent" obstructive sleep apnea (OSA) in dentofacial deformity (DFD) subjects at initial surgical presentation; and to report on the level of daytime sleepiness in DFD subjects with OSA and chronic obstructed nasal breathing (CONB) after undergoing bimaxillary, chin, and intranasal surgery.MethodsA retrospective cohort study of subjects with a bimaxillary DFD and CONB was implemented. Subjects were divided into Group I (no OSA) and Group II (OSA). Group II was further subdivided into Group IIa (referred with polysomnogram [PSG] confirmed OSA) and Group IIb (diagnosis of OSA only after surgical consultation/airway evaluation and positive PSG). Group II subjects were analyzed > 1 year after surgery (range 1-10 years) for daytime sleepiness using the Epworth Sleepiness Survey (ESS). Subjects with postoperative excessive daytime sleepiness (EDS) were assessed for risk factors and continued need for OSA treatment. Subjects in Group II were studied to determine which DFD patterns were most associated with OSA. We compared the prevalence of OSA between our study population and the general population.ResultsTwo-hundred and sixty-two subjects met the inclusion criteria. Twenty-three percent (60/262) had PSG confirmed OSA (Group II). This was much higher than found in the general population. Seven percent (19/262) were known to have OSA at initial surgical consultation (Group IIa). An additional 16% (41/262) were later confirmed by PSG to have OSA (Group IIb). Primary mandibular deficiency and short face DFDs were most likely to have OSA (p=0.000 and 0.001, respectively). In Group II, 91% (55/60) rated their daytime sleepiness as "Not Sleepy" at a minimum of 1 year after surgery. A significant association was found between Group II subjects with post-operative EDS ("sleepy" or "very sleepy") and a preoperative BMI level of overweight (p=0.026).ConclusionOur study found "silent" OSA to be frequent in the DFD population. The prevalence of OSA in DFD subjects exceeded that estimated in the general population, with retrusive jaw patterns most affected. In DFD subjects also presenting with OSA and CONB, we confirmed low levels of daytime sleepiness long-term after simultaneous bimaxillary orthognathic, chin, and intranasal surgery.

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Antiinflammatory strategies in intrahepatic islet transplantation: a comparative study in preclinical models.

Background: The identification of pathway(s) playing a pivotal role in peritransplant detrimental inflammatory events represents the crucial step towards a better management and outcome of pancreatic islet transplanted patients. Recently, we candidate the CXCR1/2 inhibition as a relevant strategy in enhancing pancreatic islet survival after transplantation. Methods: Here, the most clinically used antiinflammatory compounds (IL1-receptor antagonist, steroids and TNF-[alpha] inhibitor) alone or in combination with a CXCR1/2 inhibitor were evaluated in their ability to improve engraftment or delay graft rejection. To rule out bias related to transplantation site, we used well-established preclinical syngeneic (250 C57BL/6 equivalent islets in C57BL/6) and allogeneic (400 Balb/c equivalent islets in C57BL6) intrahepatic islet transplantation platforms. Results: In mice, we confirmed that targeting the CXCR1/2 pathway is crucial in preserving islet function and improving engraftment. In the allogeneic setting, CXCR1/2 inhibitor alone could reduce the overall recruitment of transplant-induced leukocytes and significantly prolong the time to graft rejection both as single agent and in combination with immunosuppression. No other antiinflammatory compounds tested (IL1-receptor antagonist, steroids and TNF-[alpha] inhibitor) alone or in combination with CXCR1/2 inhibitor, improve islet engraftment and significantly delay graft rejection in the presence of MMF+FK-506 immunosuppressive treatment. Conclusions: These findings indicate that only the CXCR1/2-mediated axis plays a crucial role in controlling the islet damage and should be a target for intervention to improve the efficiency of islet transplantation. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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An unusual presentation of chronic cyanide toxicity from self-prescribed apricot kernel extract

Hypoxia under general anaesthesia is a potentially life-threatening condition. A seemingly well 67-year-old man appeared hypoxic with peripheral pulse oximetric measurement during routine anaesthesia. Postoperatively, the patient admitted to daily self-prescription of apricot kernel extract for a period of 5 years. Apricot kernel is a commonly taken extract used for a range of ailments, and is associated with cyanide toxicity, which was confirmed through blood analysis. Our explanation for the hypoxic measurement was the presence of free cyanide interfering with functioning of the peripheral pulse oximeter. On cessation of the apricot kernel extract, peripheral oxygen saturations returned to normal. Cardiac and respiratory causes together with rare haemoglobinopathies were excluded. This case illustrates how chronic dosing of complementary medicines can result in harmful toxicities, which may carry potential for serious consequences and how these chronic toxicities may present to physicians in atypical ways.

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Panorama Dermatologische Praxis

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Mrmc Neo Surgical Ventilating Port and Neo Attic Malleo-Incudal Complex in Endoscopic Management of Limited Attico-Antral Cholesteatoma

Abstract

To study functional outcome of the endoscopic management of limited attico-antral cholesteatoma in terms of visualization of sac, cholesteatoma disease clearance, ABG closure improvement, preservation of residual anatomy and recurrence of disease. It is a prospective study done during Feb 2016 to March 2017 done on 20 pts with limited attico-antral cholesteatoma with CT confirmation. Endoscopic management of limited attico-antral cholesteatoma with complete removal of sac, infected discharge and granulations along with creation of MRMC Neo surgical ventilating port (joining Anterior & posterior isthmuses) done in cases where residual attic anatomy was present to establish physiological attic ventilation and drainage. Whereas in cases of attic and ossicular erosion, ossiculoplasty along with neo attic malleo-incudal complex (with composite tragal cartilage with perichondrium graft) for lateral attic wall reconstruction was done to prevent attic retraction. Patients had mean pre op ABG of 36.29 ± 6.29 and mean post op ABG closure of 16.33 ± 6.50 with no recurrence of cholesteatoma at 6 months of follow up. Patient showed significant (55%) improvement in hearing with all having graft uptake in which four cases having mild pars tensa retraction which recovered later without any intervention. Thus creation of new MRMC Neo surgical ventilating port or neo attic malleo-incudal complex with endoscopic approach allows better visual access to clear the limited attico-antral disease with sparing of normal residual attic anatomy along with physiological ventilation and drainage having better hearing results and outcome.

http://ift.tt/2jjXckl

Structural and functional diversity of collectins and ficolins and their relationship to disease

Abstract

Pattern recognition molecules are sensors for the innate immune system and trigger a number of pathophysiological functions after interaction with the corresponding ligands on microorganisms or altered mammalian cells. Of those pattern recognition molecules used by the complement system, collagen-like lectins (collectins) are an important subcomponent. Whereas the best known of these collectins, mannose-binding lectin, largely occurs as a circulating protein following production by hepatocytes, the most recently described collectins exhibit strong local biosynthesis. This local production and release of soluble collectin molecules appear to serve local tissue functions at extravascular sites, including a developmental function. In this article, we focus on the characteristics of collectin-11 (CL-11 or CL-K1), whose ubiquitous expression and multiple activities likely reflect a wide biological relevance. Collectin-11 appears to behave as an acute phase protein whose production associated with metabolic and physical stress results in locally targeted inflammation and tissue cell death. Early results indicate the importance of fucosylated ligand marking the injured cells targeted by collectin-11, and we suggest that further characterisation of this and related ligands will lead to better understanding of pathophysiological significance and exploitation for clinical benefit.

http://ift.tt/2gYAqdr

Tissue compartmentalization of T cell responses during early life

Abstract

The immune system in early life is tasked with transitioning from a relatively protected environment to one in which it encounters a wide variety of innocuous antigens and dangerous pathogens. The immaturity of the developing immune system, and particularly the distinct functionality of T lymphocytes in early life, has been implicated in increased susceptibility to infection. Previous work has demonstrated that immune responses in early life are skewed toward limited inflammation and atopy; however, there is mounting evidence that such responses are context- and tissue-dependent. The regulation, differentiation, and maintenance of infant T cell responses, particularly as it relates to tissue compartmentalization, remains poorly understood. How the tissue environment impacts early-life immune responses and whether the development of localized protective immune memory cell subsets are established is an emerging area of research. As infectious diseases affecting the respiratory and digestive tracts are a leading cause of morbidity and mortality worldwide in infants and young children, a deeper understanding of site-specific immunity is essential to addressing these challenges. Here, we review the current paradigms of T cell responses during infancy as they relate to tissue localization and discuss implications for the development of vaccines and therapeutics.

http://ift.tt/2gYKCSV

Aortitis in giant cell arteritis: diagnosis with FDG PET/CT and agreement with CT angiography.

Publication date: Available online 11 September 2017
Source:Autoimmunity Reviews
Author(s): Mona Hommada, Arsène Mekinian, Pierre-Yves Brillet, Sébastien Abad, Claire Larroche, Robin Dhôte, Olivier Fain, Michael Soussan
ObjectivesTo assess the detection rate of aortitis in giant cell arteritis (GCA) with fluorodeoxyglucose positron emission tomography/computed tomography (PET) and to compare the findings with CT angiography (CTA).MethodsFifty-two GCA patients and 27 controls were included. GCA patients had a PET scan at diagnosis (35/52) or during relapse (17/52). Concomitant CTA was performed in 35/52 patients. Aortitis was defined as FDG uptake higher than the liver for PET and wall thickness≥3mm for CTA. Agreement between PET and CTA was evaluated by the kappa coefficient and Spearman correlation coefficient.ResultsAortitis was diagnosed using PET in 40% (14/35) of patients at diagnosis and in 0% of controls (0/27). Agreement was perfect between PET and CT (kappa: 0.72 to 1). PET was positive in 35% (6/17) of patients scanned during GCA relapse, showing aortitis (n=4) and/or articular uptake (n=4). Discrepancies between PET and CT were observed only in relapsing GCA (n=3). Correlation between the maximum standardized uptake value and wall thickness was moderate at diagnosis (r: 0.57 to 0.7) and not significant during relapse.ConclusionsThe detection rate of aortitis in GCA patients using PET is 40%, approximately in the range of CTA rates, suggesting that the two techniques have similar sensitivity. PET seems valuable in relapsing GCA, allowing the detection of vascular and articular activities.

http://ift.tt/2jilRFN

Primary thromboprophylaxis with low-dose aspirin and antiphospholipid antibodies: Pro's and Con's

Publication date: Available online 11 September 2017
Source:Autoimmunity Reviews
Author(s): Laurent Arnaud, Fabrizio Conti, François Chasset, Laura Massaro, Gentian Denas, Francois Chasset, Vittorio Pengo
Whether primary prophylaxis should be prescribed in individuals with antiphospholipid antibodies (aPL) remains controversial due to the lack of relevant evidence-based data. Indeed, it is unclear whether the benefit of LDA outweighs the risk of major bleeding associated LDA in a low-risk population. On the contrary, stratification of aPL-positive subjects according to their aPL profile (combination, isotype and titer), presence of other concomitant risk factors for thrombosis and coexistence of an underling autoimmune disease is essential to decide whether primary prophylactic therapy should be prescribed. Additionally, the management of modifiable thrombotic risk factors is a necessary strategy, and the use of transient prophylaxis is crucial during high-risk periods. Specifically designed prospective trials are urgently needed to determine the real prophylactic impact of aspirin, as well as of alternative or concomitant therapeutic strategies such as hydroxychloroquine, statins or DOACS in aPL positive patients.

http://ift.tt/2eYLsSK

Mrmc Neo Surgical Ventilating Port and Neo Attic Malleo-Incudal Complex in Endoscopic Management of Limited Attico-Antral Cholesteatoma

Abstract

http://ift.tt/2jjXckl

Fractional carbon dioxide laser for the treatment of facial atrophic acne scars: prospective clinical trial with short and long-term evaluation

Abstract

The aim of this study was to evaluate the efficacy and safety of fractional carbon dioxide laser for the treatment of acne scars. Thirty-one participants, 15 female and 16 male, whose mean age was 34.84 ± 10.94 years, were included in this prospective study. The study took place between 2012 and 2016. Participants were evaluated with the "ECCA Grading Scale" before the first session, 3 months (short-term evaluation) and 3 years after the last session (long-term evaluation). Participants received two or three treatment sessions at 4-week intervals, with a 10,600 nm fractional carbon dioxide laser with pulse energies ranging between 100 and 160 mJ, 120 spot type, 75–100 spot/cm² density, and 30 W power. Self-assessments by the participants were done 3 months and 3 years after the last session. The mean ECCA score was 107.90 ± 39.38 before the first session, and 82.17 ± 36.23 at the time of short-term evaluation (p = 0.000). The grade of improvement at the short-term evaluation was as follows: no improvement, mild, moderate, and significant improvement for 7 (22.6%), 11 (35.5%), 9 (29%), and 4 (12.9%) of the participants, respectively. Regarding self-assessments, 80.6 and 61.3% of the participants rated themselves as having at least mild improvement at the short-term and the long-term follow-up periods, respectively. The results of this study suggest that fractional carbon dioxide laser is an efficient treatment option for acne scars. Furthermore, self-assessment results show that more than half of the participants still experience at least mild improvement at the end of 3 years.

http://ift.tt/2xgajIL

Editorial Board (p/u from previous issue)

Publication date: September 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 3

http://ift.tt/2jhufp0

Publication date: September 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 3

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Future and recent issues (p/u from previous issue and update)

Publication date: September 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 3

http://ift.tt/2jhu6Su

Information for authors (p/u from previous issue)

Publication date: September 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 3

http://ift.tt/2f0PSZi

Cover 2 - Masthead (p/u from previous issue)

Publication date: September 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 3

http://ift.tt/2jj3KiV

Pain in cancer survivors; filling in the gaps

Abstract

Cancer survivorship represents a growing clinical challenge for pain clinicians. The population of cancer survivors is rapidly expanding and many of these patients experience pain as a sequelae of their disease and its treatment. The features, pathophysiology and natural history of some painful conditions observed in cancer survivors, such as direct tumour effects, cancer induced bone pain (CIBP) or chronic post-surgical pain have received extensive exposure elsewhere in the literature. In this narrative review, we attempt to 'fill in the gaps' in the knowledge, by providing a succinct outline of a range of less well known pain states encountered in the cancer survivor population. These include neuropathies as a result of graft versus host disease (GVHD), novel chemotherapeutic agents and monoclonal antibodies (mAb), and radiation induced pain states. The increasing prevalence of visceral post-surgical pain and aromatase inhibitor-induced arthralgia (AIA) is also detailed. Additionally an overview of suggested approaches to the assessment of pain in cancer survivors is provided and potential treatment strategies, with a focus on novel approaches are discussed.

http://ift.tt/2gZzPb9

Tumor infiltrating lymphocytes in lymph node metastases of stage III melanoma correspond to response and survival in nine patients treated with ipilimumab at the time of stage IV disease

Abstract

Prognosis of metastatic melanoma improved with the development of checkpoint inhibitors. The role of tumor infiltrating lymphocytes (TILs) in lymph node metastases of stage III melanoma remains unclear. We retrospectively characterized TILs in primary melanomas and matched lymph node metastases (stage III melanoma) of patients treated with the checkpoint inhibitor ipilimumab. Tumor infiltrating lymphocytes were characterized for CD3, CD4, and CD8 expressions by immunohistochemistry. 4/9 patients (44%) responded to treatment with ipilimumab (1 complete and 2 partial remissions, 1 stable disease). All responders exhibited CD4 and CD8 T-cell infiltration in their lymph node metastases, whereas all non-responders did not show an infiltration of the lymph node metastasis with TILs. The correlation between the presence and absence of TILs in responders vs. non-responders was statistically significant (p = 0.008). Median distant metastases free survival, i.e., progression from stage III to stage IV melanoma, was similar in responders and non-responders (22.1 vs. 19.3 months; p = 0.462). Median progression free and overall survival show a trend in favor of the patients having TIL rich lymph node metastases (6.8 vs. 3.3 months, p = 0.09; and all alive at last follow-up vs. 8.2 months, respectively, p = 0.08). Our data suggest a correlation between the T-cell infiltration of the lymph node metastases in stage III melanoma and the response to ipilimumab once these patients progress to stage IV disease.

http://ift.tt/2wl3q4s

Surgeon Performed Thyroid Ultrasound – Proving Utility and Credibility in Selecting Patients for Fine Needle Aspiration According to the American Thyroid Association Guidelines. A Retrospective Study of 500 Patients

Abstract

Design

Case series with chart review.

Setting

Single academic center.

Participants

The data of all patients who underwent surgeon performed ultrasound (SUS(between 7/2009 and 9/2012 was retrospectively reviewed.

Main Outcome Measures

A correlation between sonographic features and a non-benign cytology\malignant pathology.

Results

Four hundred ninety eight nodules were included. Solid texture, irregular margins, hypoechogenicity and intranodular vascularity were significantly associated with malignancy when benign to non-benign cytology was compared, and when compared to malignant pathology. Lack of suspicious features was significantly associated with benign lesions, with a negative predictive value of 94%. Except for taller than wider shape, malignancy odds ratio was significantly higher for known suspicious features, reaching 4.81 for irregular borders (CI 2.42-9.55, p<0.001).

Conclusions

SUS has proven to be a reliable and consistent tool to assess the thyroid nodule risk stratification. Surgeons should recognize the potential of this tool and its implementation.

http://ift.tt/2xrZ0xW

Introducing the new Coblation™ Turbinator™ turbinate reduction wand: Our initial experience of twenty-two patients requiring surgery for nasal obstruction

Abstract

Coblation^™ Turbinator^™ is a coblation wand designed specifically for turbinate reduction surgery.

We present an audit of 22 patients evaluating the clinical outcome of septoturbinoplasty for nasal obstruction caused by inferior turbinate hypertrophy using the Coblation^™ Turbinator^™ wand and comparing it to a similar-sized cohort who had microdebrider turbinoplasty.

Primary clinical outcome was evaluated using the Nasal Obstruction Symptom Evaluation (NOSE) scale and the peak nasal inspiratory flow rate measurement and secondary outcome measures were days of admission or readmission rates and episodes of bleeding.

There was improvement in both primary clinical outcome measures for the Coblation^™ Turbinator^™ and this was comparable to the microdebrider with no complications.

This is the first report of clinical outcomes using the Coblation^™ Turbinator^™ for septoturbinoplasty and further long-term studies are required to assess the reproducibility of the data reported here.

http://ift.tt/2gZ9bPM

Correlation of quantitative parameters of magnetic resonance perfusion-weighted imaging with vascular endothelial growth factor, microvessel density and hypoxia-inducible factor-1α in nasopharyngeal carcinoma: evaluation on radiosensitivity study

Abstract

Objectives

To investigate the correlation of parameters of magnetic resonance perfusion-weighted imaging (MR-PWI) with the expression of vascular endothelial growth factor (VEGF), hypoxia-inducible factor-1α (HIF-1α) and microvessel density (MVD) in nasopharyngeal carcinoma (NPC) so as to explore the value of predicting radiosensitivity.

Design

A prospective study.

Setting

Department of Head-and-neck radiotherapy in Hunan Cancer Hospital.

Participants

94 patients of NPC were included between December 2013 and December 2014.

Main Outcome Measures

The expression of VEGF, MVD and HIF-1α were studied by immunohistochemistry, andmagnetic resonance perfusion-weighted imaging (MR-PWI) was performed before and after undergoing radiotherapy (20Gy dose). Parameters of MR-PWI, volume of primary tumour and rate of tumour remission were measured and calculated. Patients with primary local tumour were then divided into completely response group (CR group) and partially response group (non CR group) according to tumour regression condition. Relevant parameters were analysed by Spearman and diagnostic efficiency of radiosensitivity was analysed by receiver operating characteristic curve (ROC).

Results

The expression of VEGF was positively correlated with MVD (r=0.322,p<0.05), but the expression of HIF-1α was no significant correlations with VEGF and MVD; The expression VEGF was in positive correlation with fractional plasma volume (fpv) (r=0.339,p=0.05) before radiotherapy; There was a significant difference in the quantitative parameters of MR-PWI between CR group and non CR group during the course of radiotherapyand at the end of radiotherapy treatment. The change of blood reflux constant (Δkep20) and extravascular extracellular space volume fraction(ΔVe20) before and after treatment was positively correlated with primary local tumour remission condition after three months' treatment, Δkep and ΔVe was negatively correlated with primary local tumour remission condition after three months. Tumour regression rate was only positively correlated with Ve and the average volume of primary tumour after 2 weeks'treatment (V1). ROC curve showed that R20 ≥ 65.69%, and was considered as a threshold to predict primary local tumour remission, with a sensitivity of 0.84 and specificity of 0.69 and area under the curve was 0.819 (p=0.000).

Conclusions

The parameters of MR-PWI with the expression of VEGF, HIF-1α and MVD could be guidance for predicting radiosensitivity in NPC.

http://ift.tt/2xr6hxL

Radiochemotherapie des Harnblasenkarzinoms

Zusammenfassung

Hintergrund

Standardbehandlung des muskelinvasiven Harnblasenkarzinoms ist die Zystektomie mit pelviner Lymphadenektomie. Die primär organerhaltende, trimodale Therapie gilt als Alternative zur radikalen Operation.

Ziel

Konzept und Ergebnisse der trimodalen Therapie, bestehend aus initialer transurethraler Resektion des Blasentumors (TUR-B), gefolgt von der simultanen Radiochemotherapie (RCT), werden vorgestellt.

Material und Methoden

Es erfolgt eine Auswertung retrospektiver Fallserien und prospektiver Therapieoptimierungsstudien zu primär organerhaltenden Behandlungskonzepten. Komparative Metaanalysen zum Vergleich der Zystektomie mit der trimodalen Behandlung werden vorgestellt.

Ergebnisse

Eine komplette TUR-B samt Blasenmapping und Tumorgrundbiopsie sollte vor RCT angestrebt werden. Die Radiosensibilisierung sollte mit einer Cisplatin-basierten Chemotherapie oder mit einer Kombination von 5‑Fluorouracil (5-FU) und Mitomycin C erfolgen. Komplette Remissionsraten nach TUR-B plus RCT werden stadienabhängig zwischen 60 % und 90 % der Patienten sowie Fünfjahresüberlebensraten zwischen 40 % und 75 % mit einem Erhalt der Blase bei ca. 80 % der überlebenden Patienten erreicht.

Schlussfolgerungen

Die trimodale Therapie stellt eine gesicherte Alternative zur radikalen Zystektomie mit kurativer Zielsetzung für Patienten mit muskelinvasivem Harnblasenkarzinom dar. Besonders eignen sich Patienten mit frühen Tumoren (cT2/3N0), bei denen die initiale TUR-B zur möglichst kompletten Tumorentfernung (R0) führt.

http://ift.tt/2xrAKfk

Chapter 22 Mycobiome and Gut Inflammation

Publication date: 2018
Source:Immunity and Inflammation in Health and Disease
Author(s): Elizabeth A. Witherden, David L. Moyes
The current age of high throughput sequencing has revealed to us the amazing complexity and extent of the microbial communities we play host to. Moreover, we are now beginning to understand just how dynamic the interactions between the host and members of these communities are. These interactions are diverse, and the variations in these communities observed between individuals are dependent on a multitude of different microbial and host factors, including inflammatory status. More importantly, it is becoming clear that different disease states are linked to significant changes in the makeup of these communities. While much energy has gone into defining these changes in bacterial communities, there is clear and growing evidence that shifts in host fungal communities (mycobiome) are also intimately linked with disease. In this chapter, we will explore the associations and potential role that the mycobiome plays in gut inflammatory diseases.

http://ift.tt/2wVVQB7

IL-33 and IgE stimulate mast cell production of IL-2 and regulatory T cells expansion in allergic dermatitis

Abstract

Background

We have previously shown that mast cells (MCs) suppress chronic allergic dermatitis in mice. The underlying mechanism involves MC-derived IL-2, which supports regulatory T cell (Treg) response at the site of inflammation. However, it is not clear what are the factors that drive MCs to produce IL-2.

Objective

To understand the mechanisms that lead to IL-2 production from MCs in chronic allergic dermatitis.

Methods

Isolated murine bone marrow derived-MCs (BMMCs) were incubated with various stimulators and IL-2 production was assessed by RT-PCR and ELISA. The response of signaling pathways was evaluated by MAPK inhibitors and Western blot analysis. The effect of MC-IL2 on Tregs was studied by incubation of splenic T cells with conditioned media obtained from activated BMMCs. Dermatitis was elicited by repeated exposures of mouse ears to oxazolone. MCs in mouse and human skin samples were evaluated by immunostaining.

Results

BMMCs released IL-2 in response to IL-33, and IL-2 production was further enhanced by concomitant FcεRI activation. The effect of IL-33 was mediated by activation of the MAPKs family members. IL-2 in conditioned media from IL-33 and IgE-stimulated BMMCs led to considerable expansion of Tregs in vitro. IL-33 levels were elevated in oxazolone-challenged ears along with increased numbers of IL-2 expressing MCs. Human skin with chronic inflammation also contained IL-2 expressing MCs that co-localized with IL-33 staining in the dermis.

Conclusions

IL-33, in collaboration with IgE, is critical for MC-IL-2 production in allergic skin disease thus leading to Treg stimulation and suppression of allergic dermatitis.

http://ift.tt/2eRqDoH

Aspirin is an Enhancing Factor for Food-dependent Exercise-induced Anaphylaxis in Children

Abstract

Food-dependent exercise-induced anaphylaxis (FDEIA) is typified by the onset of anaphylaxis during or soon after exercise preceded by the ingestion of a causal food. In Japan, a questionnaire-based prevalence study of 76,247 junior high-school students revealed an FDEIA prevalence of 0.017%. ¹ Physical activity is beneficial for children, with positive outcomes pertaining to both mental and physical well-being.

http://ift.tt/2xfYkuL

Hyaluronic acid microneedle patch for the improvement of crow's feet wrinkles

Abstract

Hyaluronic acid (HA) has an immediate volumizing effect, due to its strong water-binding potential, and stimulates fibroblasts, causing collagen synthesis, with short- and long-term effects on wrinkle improvement. We investigated the efficacy and safety of HA microneedle patches for crow's feet wrinkles. Using a randomized spilt-face design, we compared microneedle patches with a topical application containing the same active ingredients. We enrolled 34 Korean female subjects with mild to moderate crow's feet wrinkles. The wrinkle on each side of the subject's face was randomly assigned to a HA microneedle patch or HA essence application twice a week for 8 weeks. Efficacy was evaluated at weeks 2, 4, and 8. Skin wrinkles were measured as average roughness using replica and PRIMOS. Skin elasticity was assessed using a cutometer. Two independent blinded dermatologists evaluated the changes after treatment using the global visual wrinkle assessment score. Subjects assessed wrinkles using the subject global assessment score. Skin wrinkles were significantly reduced and skin elasticity significantly increased in both groups, although improvement was greater in the patch group at week 8 after treatment. In the primary and cumulative skin irritation tests, the HA microneedle patch did not induce any skin irritation. The HA microneedle patch is more effective than the HA essence for wrinkle improvement and is a safe and convenient without skin irritation.

http://ift.tt/2eZcHwu

Development of EMab-51, a Sensitive and Specific Anti-Epidermal Growth Factor Receptor Monoclonal Antibody in Flow Cytometry, Western Blot, and Immunohistochemistry

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

http://ift.tt/2w1p16I

The effect of laser power, blood perfusion, thermal and optical properties of human liver tissue on thermal damage in LITT

Abstract

In this work, the finite-element method (FEM) was used to predict the temperature distribution, and the thermal damage volume in human liver tissue subjected to laser in laser-induced interstitial thermotherapy (LITT). The effect of laser power, blood perfusion, and thermal and optical properties on maximum temperature and thermal damage volume were predicted using the finite-element method. A computer program was written in visual basic language, which was verified by comparing its result with data published elsewhere. The bio-heat equation together with the effect of linear laser source were used to simulate heat transfer through tissue from which the temperature distributions, and the subsequent thermal damage, were obtained based on Arrhenius equation. In this mathematical model for LITT, it was found that increasing laser power, absorption, and scattering coefficient increased the damage zone while increasing tissue water content, perfusion rate, and tissue anisotropy factor decreased the damage zone. These findings are important aspects for doctors in the pre-estimation of the damage zone before starting the therapy so as to kill only the desired zone.

http://ift.tt/2gYr0OW

Indications and Morbidity of Reoperative Thyroid Surgeries in a Military Hospital of Senegal

Objectives. To describe reoperative thyroid surgeries in our department. Study Design. Retrospective cross-sectional and descriptive study at the Ouakam Military Hospital in Dakar (Senegal), over a period of eight and a half years. Methods. The study involved all records of patients who had a reoperative thyroidectomy regardless of the indication and time of the second surgery. Parameters evaluated for first and reoperative surgery were time interval between the two surgeries, operative indications, surgical procedures, intraoperative findings, pathological examination, and morbidity. Results. 30 records of patients were selected out of a total of 698 thyroidectomies (4.3%). Thyroid cancers diagnosed on first surgical specimens were the first indications of reoperations (46.67%) followed by neck hematoma (20%). Completion thyroidectomy with a prophylactic central lymph nodes dissection was the most performed surgical procedure (43.33%) followed by haemostasis (20%). During reoperation, we found active bleeding (20%), textiloma (6.67%), and fourth branchial cleft fistula (3.33%). The morbidity accounted for 10%: lymphorrhea, permanent hypocalcemia, and permanent recurrent nerve palsy, in one case, respectively. There were no statistically significant differences between the morbidity in patients reoperated on and the one for patients operated on once. Conclusion. We did not find an increased risk of postoperative morbidity after reintervention.

http://ift.tt/2eZWMOq

Extraintestinal Salmonellosis in the Immunocompromised: An Unusual Case of Pyomyositis

Salmonella infection can cause a wide range of presentations, predominantly gastrointestinal but occasionally with cardiovascular or other extraintestinal manifestations. The diagnosis of extraintestinal salmonellosis requires a high degree of clinical suspicion and should be considered in patients with deep-seated abscesses especially if they are immunocompromised. We present a case of salmonella causing gastroenteritis complicated by an intramuscular abscess of the left leg. With prompt recognition and multidisciplinary management, the patient recovered with no serious sequela.

http://ift.tt/2wSuGvt

A Comparative Study of Radiograph and Nasal Endoscopy in Diagnosis of Hypertrophied Adenoids

Abstract

Adenoid hypertrophy is a common presentation in the growing age group. It results in varied symptomatology resulting in nasal obstruction, mouth breathing, snoring, nasal discharge and nasal intonation of voice. Diagnostic nasal endoscopy and plain radiograph are the two most widely done investigative procedures. In our study we have compared the results of these two diagnostic modalities in defining the grade of adenoid hypertrophy and establish the differences in results so that a proper diagnosis is made and appropriate management is initiated.

http://ift.tt/2fdsZyQ

Immune Checkpoint Therapy With Nivolumab Esophageal Squamous Cell Carcinoma

Condition: Esophageal Squamous Cell Carcinoma
Intervention: Drug: Nivolimumab+Carboplatin/paclitaxel+Radiation
Sponsor: New York University School of Medicine
Recruiting - verified September 2017

http://ift.tt/2fdxZn6

INCAGN01876 in Combination With Immune Therapies in Subjects With Advanced or Metastatic Malignancies

Conditions: Advanced Malignancies; Metastatic Malignancies
Interventions: Drug: INCAGN01876; Drug: Epacadostat; Drug: Pembrolizumab
Sponsor: Incyte Biosciences International Sàrl
Not yet recruiting - verified August 2017

http://ift.tt/2wRIJ4y

Successful ultrasound-guided drainage of an intra-abdominal collection in late pregnancy

Pregnancy complicated by an intra-abdominal collection is uncommon and poses a challenge in the management. We present a case that illustrates successful treatment via ultrasound-guided drainage of a collection associated with a dermoid cyst in a 30 weeks pregnant patient presenting with fever and right-sided abdominal pain. Following treatment, the patient clinically improved rapidly. The drain was removed 3 days later and a repeat ultrasound scan showed no collection.

http://ift.tt/2wV8Oz3

Pure red cell aplasia and myasthenia gravis: a patient having both autoimmune conditions in the absence of thymoma

This is a patient who was presented initially with symptoms of malaise, tiredness and exertional dyspnoea and found to have a severe normocytic normochromic anaemia with low reticulocyte counts. Bone marrow confirmed the diagnosis of pure red cell aplasia (PRCA) and at the time serology for recent parvovirus infection was positive. He was successfully treated with transfusions and intravenous Ig. Six years later, he had a mild relapse of his PRCA and subsequently developed severe dysphagia and dysarthria which were fatigable. Positive antiacetylcholine receptor antibodies confirmed the diagnosis of myasthenia gravis. The two conditions are both known to be associated with thymoma. Imaging and resection of the thymus gland showed only the presence of a thymic cyst. Treatment with pyrdistogmine and intravenous Ig have kept the patient asymptomatic and in remission. The rare association of the two autoimmune conditions associated in the same patient without thymoma is discussed.

http://ift.tt/2wl36Tu

Neostigmine and glycopyrronium: a potential safe alternative for patients with pseudo-obstruction without access to conventional methods of decompression

Intestinal pseudo-obstruction mimics bowel obstruction. However, on examination, no mechanical cause is identified. This condition will often resolve when managed conservatively, yet in some cases decompression is required to avoid the serious complications of bowel ischaemia and perforation. This is performed endoscopically, and due to the invasive nature and limited access to this service, an alternative treatment option is deemed appealing. Neostigmine has good efficacy in the decompression of pseudo-obstruction but is hindered by its wide side effect profile. In this context, neostigmine requires careful monitoring, which limits its appeal. This side effect profile is minimised when neostigmine is administered in conjunction with glycopyrronium.

This case demonstrates the novel use of neostigmine and glycopyrronium in decompression of the bowel in a patient with pseudo-obstruction. Furthermore, it highlights its value, particularly when conventional techniques for decompression are not accessible.

http://ift.tt/2wUZRFM

Immune thrombocytopenic purpura associated with fingolimod

Fingolimod is an oral sphingosine-1-phosphate receptor modulator which causes lymphocyte sequestration in lymph nodes and is approved for relapsing multiple sclerosis. The Therapeutic Goods Administration of Australia is aware of only one case where fingolimod preceded immune thrombocytopenic purpura (ITP) by 5 weeks. Here we report three such cases.

None were on any medications known to cause ITP and routine investigations were unremarkable. All cases were treated with immunosuppression. Case 1 successfully weaned prednisolone after fingolimod cessation whereas case 2 weaned slowly while continuing fingolimod therapy. Case 3 had more refractory ITP and re-exposure to fingolimod worsened thrombocytopenia.

There was a temporal association between fingolimod exposure and ITP however dose–effect association and pathogenesis remain less clear.

In conclusion, our cases highlight that clinicians should be aware of the possible association between ITP and fingolimod.

http://ift.tt/2wkgnLU

Low-dose intrapleural alteplase (without deoxyribonuclease) in complicated parapneumonic effusion: case series and literature reviews

This case series reviews two cases of elderly patients who presented with fever, cough and shortness of breath. Clinical examinations and initial chest radiographs confirmed unilateral pleural effusion. Thoracenteses were consistent with exudative pleural effusion. We commenced intravenous antibiotics treating for parapneumonic effusions. The first case showed persistent effusion despite drainage, and the second case had a little aspirate from pleural tapping. Subsequent ultrasound of the thorax showed multiloculated effusions. We made the decisions for intrapleural fibrinolytic therapy using low-dose alteplase 2.5 mg each time, in view of the elderly patient as sacrosanct for risk of bleeding. Furthermore, DNase was not used, as it is not yet available in our setting. Both of our patients had good clinical and radiological outcomes, without the need for surgical interventions.

http://ift.tt/2wUOxte

MELAS syndrome associated with a new mitochondrial tRNA-Val gene mutation (m.1616A>G)

We describe the case of a 40-year-old-man with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome, with cardiomyopathy and severe heart failure. He had a mitochondrial transfer RNA (tRNA) mutation (m.1616A>G) of the (tRNA-Val) gene, and it was not found in MELAS syndrome ever before. The presence of this newly observed tRNA-Val mutation (m.1616A>G) may induce multiple respiratory chain enzyme deficiencies and contribute to MELAS syndrome symptoms that are associated with mitochondrial DNA (mtDNA) mutations. We report that the pathognomonic symptom in MELAS syndrome caused by this newly observed mtDNA mutation may be rapid progression of cardiomyopathy and severe heart failure.

http://ift.tt/2wkaNcx

A Comparative Study of Radiograph and Nasal Endoscopy in Diagnosis of Hypertrophied Adenoids

Abstract

http://ift.tt/2fdsZyQ

Erratum of “Hearing thresholds at high frequency in patients with cystic fibrosis: a systematic review”

Publication date: September–October 2017
Source:Brazilian Journal of Otorhinolaryngology, Volume 83, Issue 5
Author(s): Debora T.M. Caumo, Lúcia B. Geyer, Adriane R. Teixeira, Sérgio S.M. Barreto

http://ift.tt/2f0jCpg

Persistent Acute Onset Macroglossia Treated with Compression Therapy

Acute macroglossia, while rare and often limited in duration, can present significant management challenges. The anatomic position of the tongue, which can result in airway compromise in cases of enlargement, contributes significantly to difficulty with management. We review several management options for persistent acute onset lingual macroglossia and present a novel noninvasive management technique in a case which was refractory to several strategies.

http://ift.tt/2wRHsdN

Postoperative Outcomes in Cold Dissection Versus Bipolar Electrocautery Tonsillectomy: A Randomized Double-Blind Controlled Study

Abstract

Tonsillectomy is one of the oldest and most common procedures worldwide. This surgery is performed by different methods include cold dissection technique (CDT) and bipolar electrocautery technique (BET). Assessment and comparison of postoperative outcomes in cold dissection and bipolar electrocautery is the aim of present study. This randomized controlled clinical trial study was conducted as double-blind on 534 patients. The enrolled patients underwent tonsillectomy in Vali-e-Asr Hospital of Birjand city from Oct. 2013–Oct. 2015. Al patients systematically allocated into two groups treated with cold dissection or bipolar electrocautery methods. Intensity of throat pain scores, Otalgia, analgesic consumption, resume normal diet, body temperature and also wound healing on 10th day after operation were measured and compared between the two groups. The gathered data were analyzed by SPSS software (Ver-22) and using necessary tests. The differences between studied groups less than 0.5 (p < 0.05) considered significant statically. 51.7 and 50.6% in the CDT and the BET groups were male respectively. In comparison between the groups the mean of pain scores 4 and 24 h after operation in the BET group were higher significantly (p < 0.001). Otalgia only 4 h after surgery was higher significantly in the BET group (p = 0.008). All the other studied parameters were significantly more desirable in the CDT group (p < 0.001). According to the findings of present study it seems that the CDT is safer and more favorable than the BET in tonsillectomy.

http://ift.tt/2jfelve

The effects of house dust mite sublingual immunotherapy (SLIT)-tablet effects on immunological biomarkers and nasal allergen challenge symptoms

Publication date: Available online 11 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Natasha C. Gunawardana, Qing Zhao, Leonidas N. Carayannopoulos, Kuenhi Tsai, Vladislav A. Malkov, Diana Selverian, Graham Clarke, Tim Mant, Brent Butts, Kaare Lund, Trevor T. Hansel, Hendrik Nolte
SQ HDM SLIT-tablet significantly increased serum HDM-specific IgG4 and IgE blocking factor, and significantly decreased early phase nasal symptoms after nasal allergen challenge. No significant effects on cytokines or gene expression in nasal mucosa were observed.

http://ift.tt/2jhmUpB

Mesenchymal stem cells alleviate oxidative stress-induced mitochondrial dysfunction in the airways

Publication date: Available online 11 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Xiang Li, Charalambos Michaeloudes, Yuelin Zhang, Coen H. Wiegman, Ian M. Adcock, Qizhou Lian, Judith C.W. Mak, Pankaj K. Bhavsar, Kian Fan Chung
BackgroundOxidative stress-induced mitochondrial dysfunction may contribute to inflammation and remodeling in chronic obstructive pulmonary disease (COPD). Mesenchymal stem cells (MSCs) protect against lung damage in animal models of COPD. It is unknown whether these effects occur through attenuating mitochondrial dysfunction in airway cells.ObjectiveTo examine the effect of induced-pluripotent stem cell-derived MSCs (iPSC-MSCs) on oxidative stress-induce mitochondrial dysfunction in human airway smooth muscle cells (ASMCs) in vitro and in mouse lungs in vivo.MethodsASMCs were co-cultured with iPSC-MSCs in the presence of cigarette smoke medium (CSM), and mitochondrial reactive oxygen species (ROS), mitochondrial membrane potential (ΔΨm) and apoptosis were measured. Conditioned media from iPSC-MSCs and trans-well co-cultures were used to detect any paracrine effects. The effect of systemic injection of iPSC-MSCs on airway inflammation and hyper-responsiveness in ozone-exposed mice was also investigated.ResultsCo-culture of iPSC-MSCs with ASMCs attenuated CSM-induced mitochondrial ROS, apoptosis and ΔΨm loss in ASMCs. iPSC-MSC-conditioned media or trans-well co-cultures with iPSC-MSCs reduced CSM-induced mitochondrial ROS but not ΔΨm or apoptosis in ASMCs. Mitochondrial transfer from iPSC-MSCs to ASMCs was observed after direct co-culture and was enhanced by CSM. iPSC-MSCs attenuated ozone-induced mitochondrial dysfunction, airway hyper-responsiveness and inflammation in mouse lungs.ConclusioniPSC-MSCs offered protection against oxidative stress-induced mitochondrial dysfunction in human ASMCs and in mouse lungs, whilst reducing airway inflammation and hyper-responsiveness. These effects are, at least partly, dependent on cell-cell contact that allows for mitochondrial transfer, and paracrine regulation. Therefore, iPSC-MSCs show promise as a therapy for oxidative stress-dependent lung diseases such as COPD.

Teaser

iPSC-MSCs protect against oxidative stress-induced mitochondrial dysfunction, apoptosis, hyper-responsiveness and inflammation in the airways. These findings highlight the potential use of iPSC-MScs as a novel cell-based therapy for COPD.

http://ift.tt/2wUQp5u

Postoperative Outcomes in Cold Dissection Versus Bipolar Electrocautery Tonsillectomy: A Randomized Double-Blind Controlled Study

Abstract

http://ift.tt/2jfelve

Treatment Resistance in Potentially Malignant Disorders – ‘Nature’ or ‘Nurture’…?

Abstract

Background

Contemporary potentially malignant disorder management is based upon provisional histological diagnosis followed by interventional surgery to excise or ablate 'high risk' mucosal lesions. Although the majority of patients achieve disease free status post-treatment, others develop further or persistent disease unresponsive to intervention.

Methods

A detailed, retrospective clinico-pathological review of treatment resistant potentially malignant lesions, from a 590 patient cohort treated by CO₂ laser surgery and followed for a mean of 7.3 years, was undertaken. Clinical outcome was determined at study census date (31 December 2014).

Results

A total of 87 patients (15%) exhibited PMD disease resistant to treatment: 34 (6%) became disease free following further treatment, whilst 53 (9%) had persistent disease despite intervention. Disease free patients were younger, changed lesion appearance from erythroleukoplakia to leukoplakia (p=0.004), developed further lesions at new sites, demonstrated reduction in dysplasia severity with time, and required multiple treatments to achieve disease free status (p=0.0005). In contrast, persistent disease patients were older, male, often presented with proliferative verrucous leukoplakia on gingival and alveolar sites, displayed less severe dysplasia initially and underwent laser ablation rather than excision (p=0.027).

Conclusion

Despite clinico-pathological profiling of treatment resistant patients, the precise inter-relationship between the inherent nature of potentially malignant disease and the external influence of treatment intervention remains obscure.

http://ift.tt/2xVOw5W

Wheezing in Infancy: An Overview of Recent Literature

Abstract

Purpose of Review

Wheezing in infancy is a common presentation with many potential causes. In writing this review, we sought to summarize the newest recommendations and testing available for the more common etiologies of wheezing.

Recent Findings

Regarding the diagnosis of asthma, the modified asthma predictive index has recently been established as a useful predictive tool. Non-breath held multidetector CT with 3D volume rendering airway images is also a newer helpful diagnostic tool for tracheomalacia due to ease of use and its 100% positive predictive value. We found vaccines have greatly reduced the prevalence of epiglottitis, while advances in surgery are improving outcomes in infants with vascular rings.

Summary

Wheezing in infants is a common problem with an extensive differential diagnosis from relatively benign to life threatening. To prevent over-looking a diagnosis that potentially requires surgical correction or emergent care, we recommend a structured approach to the history and physical exam with targeted testing directed towards the most likely diagnoses as outlined in this review.

http://ift.tt/2gWZrFE

Role of Type 2 Innate Lymphoid Cells in Allergic Diseases

Abstract

Purpose of Review

The adaptive immune response orchestrated by type 2 T helper (Th2) lymphocytes, strictly cooperates with the innate response of group 2 innate lymphoid cells (ILC2), in the protection from helminths infection, as well as in the pathogenesis of allergic disease. The aim of this review is to explore the pathogenic role of ILC2 in different type 2-mediated disorders.

Recent Findings

Recent studies have shown that epithelial cell-derived cytokines and their responding cells, ILC2, play a pathogenic role in bronchial asthma, chronic rhinosinusitis, and atopic dermatitis.

Summary

The growing evidences of the contribution of ILC2 in the induction and maintenance of allergic inflammation in such disease suggest the possibility to target them in therapy. Biological therapies blocking ILC2 activation or neutralizing their effector cytokines are currently under evaluation to be used in patients with type 2-dominated diseases.

http://ift.tt/2xpL9rE

Crescentic splinter haemorrhages reflect stroke pathophysiology in hypereosinophilic syndrome

http://ift.tt/2fcsswW

Dermatoscope-guided suturing for an open wound adjacent to the lacrimal sac and the nasolacrimal duct

http://ift.tt/2wS5iWN

Fluconazole-induced Sweet's syndrome: A novel association

http://ift.tt/2fcj4JQ

Prevalence of Human Papillomavirus in Benign and Malignant Laryngeal Lesions in Egyptian Patients: Cross-Sectional Study

Abstract

Objective

To assess the prevalence of HPV in benign and malignant laryngeal lesions among Egyptian patients.

Design

Observational analytical cross-sectional study.

Setting

Ain Shams University hospital, Otorhinolaryngology department.

Participants

Formalin-fixed paraffin-embedded specimens of 126 patients (70 benign laryngeal lesions and 56 squamous cell carcinoma lesions) were assessed for the presence of HPV DNA using MY09/11 PCR-based DNA detection.

Main outcome measures

Percentage of positive samples was calculated.

Results

All 70 benign laryngeal lesion specimens were negative for the HPV DNA while 2 of the 56 squamous cell carcinoma lesions (3.6%) were positive.

Conclusions

The presence of HPV DNA in only two specimens in our study suggests that the proportion of laryngeal squamous cell carcinomas attributable to infection by HPV seems to be very low in Egypt.

http://ift.tt/2eYViUI

Prevalence of synchronous bilateral tonsil squamous cell carcinoma:A retrospective study

Abstract

Objectives

The prevalence of synchronous bilateral tonsil cancer remains unexplored. To date, only 38 cases have been described in the literature. With an aim to substantiate the Danish recommendation of performing bilateral tonsillectomy in patients with suspected or proven tonsil cancer and in patients with cervical carcinoma metastasis from an unknown primary tumour, the current study was undertaken to determine the prevalence of synchronous bilateral tonsil cancer.

Design

A retrospective review of all patients diagnosed with tonsil cancer in the period 2000-2015, Aarhus University Hospital, Denmark, was performed.

Results

Seven of 211 (3.3%) consecutive patients with tonsil cancer, who had undergone bilateral tonsillectomy (n=180) or unilateral tonsillectomy (clinically normal side) combined with contralateral tonsil biopsy (side with suspected cancer) (n=31), had synchronous bilateral tonsil cancer. Furthermore, dysplasia was found in the contralateral tonsil in two patients with unilateral tonsil cancer. Four of 171 (2.3%) patients with suspected unilateral tonsillar cancer had additional contralateral tonsil cancer. Three of 34 (8.8%) patients without clinical signs of tonsillar malignancy on any side (32 patients with carcinoma of unknown primary) had synchronous bilateral tonsil cancer. In none of the patients were bilateral tonsil cancer suspected. Patients with unilateral vs synchronous bilateral tonsil cancer had similar clinical and tumour characteristics

Conclusion

Knowledge on additional contralateral synchronous tonsil cancer is crucial for avoidance of early recurrence of oropharyngeal cancer in patients with tonsil cancer. Based on our findings, we recommend bilateral tonsillectomy in all patients with suspected or proven tonsil cancer and carcinoma of unknown primary.

http://ift.tt/2jhKbHW

Do patients benefit from orthognathic surgery? A systematic review on the effects of elective orthognathic surgery on psychosocial functioning and patient satisfaction

The main purpose of this systematic review was to determine the current state of evidence regarding patient satisfaction with, and the impact of, orthognathic surgery on psychosocial functioning of patients 17 yr of age and older. A secondary aim was to determine whether individuals with psychiatric disorders and mental health conditions are more likely to be dissatisfied with the treatment outcome than those without. We systematically searched PubMed, PsycInfo, and Embase for relevant studies (up to 6 June 2016). After selection of articles we determined the Directness of Evidence (DoE) and Risk of Bias (RoB). We identified 3,948 studies (1,053 studies in Pubmed, 2,023 in Embase, and 872 in PsycInfo). Of these, 87 remained after screening of title and abstract, while after full-text screening only nine remained for DoE and RoB assessment. All nine studies had a high RoB and a low or moderate DoE. The quality of the methods of studies, published to date, on the effects of orthognathic surgery on patient satisfaction or the psychosocial impact carry a high RoB. Therefore, these do not allow inferences on the effects of orthognathic surgery on patient satisfaction or their psychosocial functioning.

http://ift.tt/2gWEj2x

Systemic Cystic Angiomatosis Mimicking Metastatic Cancer: A Case Report and Review of the Literature

Systemic cystic angiomatosis is a rare benign disorder due to the maldeveloped vascular and lymphatic system with less than 50 cases reported in literature so far. We report here a case of systemic cystic angiomatosis (SCA) with multisystem involvement affecting the neck, thyroid, thoracic cavity, and skeletal system. The patient initially presented in her 4th decade of life with isolated lymphangioma in the neck requiring surgery. However, she experienced full-blown manifestations of SCA in her 6th decade which closely mimicked metastatic cancer. The diagnosis of SCA could only be established after multiple biopsies. The radiological and histological features of SCA with its course over 31 years in this patient have been described.

http://ift.tt/2wShBT8

Morphometric Analysis of the External Auditory Canal by Computed Tomography in Indian Population

Abstract

Various studies have shown variations in size and shape of different anthropometric measurements of external auditory canal. We conducted an anthropometric study of the three-dimensional anatomy of the osseous external auditory canal (OEAC) using high-resolution computed tomography the temporal bone to identify the variations in subset of Indian population from North India. A retrospective review of high-resolution computed tomography images of the temporal bones of 125 patients (250 external auditory canals) of different ages (mean 28.43 years) acquired from September 2014 to February of 2015 was performed. Using a method, as proposed by Mahboubio et al. (Otol Neurotol 33:715–720, 2012), six defined dimensions of the OEAC in the parasagittal planes were recorded at the level of annulus, midcanal and the outermost point of osseous external auditory canal at bony-cartilaginous junction. The length and shape of the OEAC were also studied and the frequency rate of each was recorded. The most prevalent shape of the OEAC was found to be conical (64%) and the mean osseous external auditory canal length was 9.61 mm. The length of the OEAC was significantly different between ages above and below 12 years while the 6 defined cross sectional dimensions were statistically significant between ages above and below 8 years. The history of chronic suppurative otitis media had a significant bearing on the inferior mid-anteroposterior dimension at the level of bony-cartilaginous junction. There was statistically significant difference in supero-inferior diameter in the posterior half at the level of mid-canal and outer bony-cartilaginous junction between males and females. The comprehensive set of standardized measurements collected in this study provides three-dimensional information on osseous external auditory canal geometry. These measurements and the methodology will contribute to the development of element models of the osseous canal for computational modeling purposes and also provide important measurements for design of in-the-canal hearing aids, specialized earplugs and for defining average sizes for canalplasty procedures, in pre- and postoperative surgical planning and assessment of canal atresia and stenosis in Indian population. No such previous study has been done in North Indian population.

http://ift.tt/2eYOnuN

Wheezing in Infancy: An Overview of Recent Literature

Abstract

Purpose of Review

Recent Findings

Summary

http://ift.tt/2gWZrFE

Role of Type 2 Innate Lymphoid Cells in Allergic Diseases

Abstract

Purpose of Review

Recent Findings

Recent studies have shown that epithelial cell-derived cytokines and their responding cells, ILC2, play a pathogenic role in bronchial asthma, chronic rhinosinusitis, and atopic dermatitis.

Summary

http://ift.tt/2xpL9rE

Elucidation of salvage laryngectomy pathologic and clinical variables to guide further treatment intensification investigation

Objective/Hypothesis

There are limited treatment options beyond surgical salvage for patients who fail nonoperative treatment for laryngeal squamous cell carcinoma. In this study, we examine the failure patterns after surgical salvage and the potential pathologic and clinical prognostic variables that might guide further postoperative intensification investigation.

Study Design

Retrospective analysis at a tertiary academic referral center.

Methods

From an institutional review board-approved institutional head and neck cancer registry, a consecutive series of 147 patients who underwent salvage laryngectomy for squamous cell cancer recurrence or persistence after radiotherapy with or without chemotherapy between May 1995 and May 2016 were identified. Variables potentially associated with oncologic outcome after surgical salvage were then collected and retrospectively evaluated.

Results

The projected 2-year locoregional failure rate was 21.8% (95% confidence interval [CI], 14.6%–29.0%]), and the overall survival 65% (95% CI, 57.5%–74.3%) for the entire cohort after salvage laryngectomy. On multivariable analysis, sarcomatoid/spindle cell pathology (hazard ratio [HR], 3.147; 95% CI, 1.181–8.386; P = 0.022), lymphovascular space invasion (LVSI) (positive vs. negative; HR, 2.31; 95% CI, 1.21–4.42; P = 0.011), and advanced initial American Joint Committee on Cancer 7th Edition grouped stage (stages III–IVB vs. stages I–II; HR, 1.64; 95% CI, 1.04–2.6; P = 0.035) were found to be independently associated with inferior disease-free survival. No other clinical or pathologic variables predicted failure.

Conclusion

Salvage laryngectomy after nonoperative treatment failure results in successful locoregional control rates and survival in the majority of patients failing initial therapy. This should temper enthusiasm for routine treatment intensification with postoperative re-irradiation and/or other systemic treatments for the vast majority of patients. Sarcomatoid pathology, LVSI, and an advanced initial stage are associated with inferior disease-free survival. The presence of these factors may warrant further investigational study of treatment intensification after salvage laryngectomy.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2wRTVOw

Excised larynx evaluation of subthyroid cartilage approach to medialization thyroplasty

Objectives/Hypothesis

To describe an alternative approach to medialization thyroplasty involving dissection underneath the thyroid cartilage with placement of a Gore-Tex implant, and to evaluate its effect on a range of phonatory measures using an excised canine larynx model.

Study Design

Animal model.

Methods

On each of eight excised canine larynges, the conditions of normal, paralysis, medialization thyroplasty by standard transthyroid cartilage approach, and medialization thyroplasty by experimental subthyroid cartilage approach were performed. Aerodynamic, acoustic, and mucosal wave parameters were measured for each condition.

Results

Compared to the vocal fold paralysis state, both the transthyroid and subthyroid approaches for Gore-Tex insertion resulted in significant decreases in phonation threshold pressure and phonation threshold flow. Both approaches also significantly decreased percent jitter, decreased percent shimmer, and improved signal-to-noise ratio. The mucosal wave was preserved after insertion of the Gore-Tex implant for both approaches. For all the phonatory measures except phonation threshold flow, there were no significant differences between the transthyroid and subthyroid approaches.

Conclusions

Gore-Tex implantation via a subthyroid approach in an excised canine larynx model can produce effective medialization, preserve the mucosal wave, and significantly improve aerodynamic and acoustic parameters without meaningful difference compared to a traditional transthyroid approach. The subthyroid approach does not require creation of a thyroid cartilage window and could be a potentially valuable alternative method of performing medialization thyroplasty.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2gX4DJC

Αρχειοθήκη ιστολογίου

Δευτέρα 11 Σεπτεμβρίου 2017

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