Clinical and radiographic evaluation of pulpectomy in primary teeth: a 18-months clinical randomized controlled trial

To avoid untoward changes when primary teeth are replaced by permanent teeth, resorption of the material used in primary teeth root canal filling should occur at the same rate as root resorption. The Aim of th...

http://ift.tt/2gIgj3s

Abscess with osteomyelitis of the clivus after adenoidectomy: An uncommon complication of a common procedure

Publication date: Available online 26 October 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): E. Moreddu, C. Le Treut, J.-M. Triglia, R. Nicollas




http://ift.tt/2y8Rj09

P275 Refractory hypereosinophilia manifesting as nodular sclerosis classical hodgkin lymphoma—a case presentation

The differential of hypereosinophilia is broad and includes atopy, infection, malignancy, and in rare cases of exclusion, hypereosinophilic syndrome (HES). Thorough evaluation is necessary to elucidate the cause and prevent sequelae of hypereosinophilia.

http://ift.tt/2iDiB7S

P283 Pneumococcal osteomyelitis: a rare diagnosis suggestive of immune deficiency

Despite routine immunization with pneumococcal conjugate vaccines, Streptococcus pneumoniae is still a significant cause of bacteremia, pneumonia and meningitis. Osteoarticular pneumococcal infections are very rare, accounting for less than 5% of all invasive pneumococcal diseases (IPD).

http://ift.tt/2zaosJ3

P282 Recurrent candidal esophagitis in an otherwise healthy host

Candida Albicans is a yeast that naturally colonizes the skin and mucosa. Chronic Mucocutaneous Candidiasis Syndrome (CMCS) presents with recurrent superficial candida infection, and is associated with other clinical manifestations such as autoimmunity or bacterial infections. Chronic Mucocutaneous Candidaisis Disease (CMCD) is a new entity in which patients present solely with superficial candidiasis. Here we present an interesting case of CMCD.

http://ift.tt/2iDkQIs

P337 Remission of cow’s milk allergy during rituximab therapy: a case report

Food allergy has no known treatment. However, novel therapies are being studied in the hope of promoting tolerance. This case report describes the remission of food allergy during rituximab therapy.

http://ift.tt/2zaon8d

P222 Effects of immunoglobulin e concentration, eosinophil concentration, and atopy status on benralizumab efficacy in asthma

We investigated the efficacy of the anti-eosinophilic monoclonal antibody benralizumab for patients with severe, uncontrolled asthma by high versus low serum IgE concentrations and atopy status.

http://ift.tt/2iBx1p9

OR001 Drug rash eosinophilia and systemic symptoms (DRESS) syndrome identified in electronic health record allergy module

Drug rash eosinophilia and systemic symptoms (DRESS) syndrome is a rare and severe hypersensitivity reaction. Due to challenges in case identification, DRESS epidemiology remains poorly characterized in the US. We used the electronic health record (EHR) allergy module to identify and describe DRESS syndrome cases in an integrated US healthcare system.

http://ift.tt/2zaoeBH

P280 Severe combined immunodeficiency in cartilage hair hypoplasia

Cartilage Hair Hypoplasia (CHH) is associated with immune deficiency, which is a leading cause of mortality in these patients. Newborn screening (NBS) utilizing T-cell receptor excision circles (TRECs) is critical for early diagnosis of severe combined immunodeficiency (SCID), enabling prompt treatment and decreased morbidity/mortality.

http://ift.tt/2iDieKw

OR002 Testing strategies for immediate and delayed reactions to cephalosporins

Similar to penicillin allergy up to 8% of the general population are labeled as cephalosporin allergic; however, specific and validated testing strategies to manage immediate and delayed cephalosporin hypersensitivities are not well defined.

http://ift.tt/2zaPhwL

P206 Effect of inhaled corticosteroid use on weight (BMI) in moderate to severe asthmatic pediatric patients

The effect of inhaled corticosteroids (ICS) on weight (BMI) in moderate to severe asthmatic pediatric patients has not been established. Obesity has been shown to decrease response to ICS as well as increase the risk of worse asthma symptoms.

http://ift.tt/2iGjXiA

OR003 Common misconceptions in the recognition and treatment of anaphylaxis in community hospital based medical professionals

Intramuscular epinephrine is the primary treatment for anaphylaxis. Delays in administration of epinephrine have been associated with increased mortality in anaphylaxis. Despite numerous publications regarding this topic, interdisciplinary recognition, primary treatment and epinephrine administration route choices remain inconsistent. We hypothesize that a multidisciplinary quality improvement project is required to address common misconceptions in order to facilitate the preparedness to recognize and treat anaphylaxis appropriately.

http://ift.tt/2zanYTf

P296 Hypogammaglobulinemia in a patient with Turner’s Syndrome (TS) and celiac disease

Turner's syndrome (TS), a rare chromosomal disorder that affects females, is characterized by loss of one of the X chromosomes. This case report demonstrates a patient with TS who has hypogammaglobulinemia and celiac disease.

http://ift.tt/2iBRhHc

OR004 Safe and effective implementation of chemotherapy outpatient desensitizations

Hypersensitivity reactions (HSRs) to platinum-based chemotherapies are increasing as cancer rates are rising. Desensitization protocols allow patients to receive first-line therapy despite HSRs, but are often performed in the inpatient setting for close monitoring by trained personnel and to mitigate risk. We aimed to evaluate a safe and effective strategy for performing desensitizations in the outpatient setting, with a focus on decreasing delays in medication administration, patient inconvenience, and overall treatment time.

http://ift.tt/2zbfw6e

P230 Long-term assessment of the burden of atopic sensitization in patients with severe/difficult-to-treat asthma

Analyses of data from TENOR II demonstrated that approximately 50% of patients had uncontrolled asthma based on NHLBI impairment category. Here we report the long-term burden of disease in patients relative to aeroallergen sensitization from the TENOR II cohort.

http://ift.tt/2iE14N9

OR005 A penicillin skin testing initiative in an outpatient allergy practice

The penicillin allergy label has significant clinical implications and there is renewed interest in penicillin allergy de-labeling. We identified the clinical characteristics of all penicillin-allergic patients presenting to an outpatient allergy practice, and offered all qualifying patients penicillin skin testing (PST).

http://ift.tt/2zbpVP9

P214 Mepolizumab induction therapy for eosinophilic granulomatosis with polyangiitis (EGPA)

Mepolizumab has been used as an adjuvant therapy for refractory EGPA. We report biopsy confirmed EGPA using conventional doses of Mepolizumab for induction treatment.

http://ift.tt/2iE62tc

OR006 Usability and comprehension of an illustrated Canadian Anaphylaxis Action Plan for Kids (Kids’ CAP study)

We designed a written plan called Canadian Anaphylaxis Action Plan for Kids (Kids' CAP) which incorporate validated pictograms with written instructions. Using a patient-centered approach, we aimed to assess the impact of the Kids' CAP on anaphylaxis recognition and treatment and to determine its perceived usefulness.

http://ift.tt/2zc4vkY

P345 New onset concurrent eosinophilic gastritis in patients with eosinophilic esophagitis: a case series

Eosinophilic Esophagitis (EoE) is thought to be a disease limited to the esophagus.

http://ift.tt/2iCY4ka

OR101 Outcomes of patients with aspirin-exacerbated respiratory disease on omalizumab

The current treatment for patients with aspirin-exacerbated respiratory disease (AERD) who have uncontrolled asthma or chronic rhinosinusitis is aspirin desensitization. However, some patients are unable to undergo or fail desensitization, and treatment with omalizumab is an option although efficacy data is scarce.

http://ift.tt/2zbpMez

P329 Utility and safety of the intermittent oral immunotherapy, step-up method, for severe food allergy patients

Although Oral Immunotherapy (OIT) is a hopeful treatment for severe food allergy patients, its usefulness and safeness is still unclear. We evaluated the utility and safety of our intermittent OIT protocol, Step-up method.

http://ift.tt/2iCY3N8

OR011 Safety of multi-dose immunotherapy vials after routine use

Recent proposed changes to US Pharmaceutical General Chapter <797> (USP <797>) have prompted discussion regarding the safety of multi-dose immunotherapy extract vials after routine use. We present evidence to support the argument that currently accepted aseptic protocols for handling and administration of multi-dose immunotherapy extract maintenance vials during routine patient care does not result in risk of microbial growth and that changes as suggested by the proposed USP <797> guidelines are not needed.

http://ift.tt/2zbpGDJ

A solitary reddish nodule on the lower leg

http://ift.tt/2zSOnC2

The association of HLA B*15:02 allele and Stevens–Johnson syndrome/toxic epidermal necrolysis induced by aromatic anticonvulsant drugs in a South Indian population

Abstract

Background

The presence of HLA-B*15:02 allele is considered a risk factor for development of Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) in patients taking aromatic anticonvulsant drugs like carbamazepine and phenytoin. The genetic association is ethnicity specific. Testing for HLA-B*15:02 allele is suggested as a prerequisite before starting carbamazepine in certain ethnic groups. There are only a few/no studies from south India on HLA association of SJS/TEN.

Aims

To identify any association between HLA-B*15:02 allele and SJS/TEN induced by carbamazepine/phenytoin among native population.

Methods (including settings, design, and statistical analysis used)

A case–control study done in a tertiary care center at Kottayam in Kerala state of south India. Cases were 12 native patients who developed SJS/TEN owing to aromatic anticonvulsant drugs (phenytoin – 8; carbamazepine – 4), and controls were 11 persons tolerant to these drugs from unrelated families of the same ethnic group. HLA-B typing was done by PCR SSP method.

Results

There was only one HLA-B*15:02 carrier among cases and controls. He/she had SJS/TEN induced by carbamazepine.

Conclusions

Association of HLA-B*15:02 with phenytoin-induced SJS/TEN is rare in the population studied. The one limitation of the study was the small sample size.

http://ift.tt/2xtoRSf

Lichen planus pigmentosus and its variants: review and update

Abstract

Lichen planus pigmentosus (LPP) is considered a rare variant of lichen planus (LP). It is characterized by acquired dark brown to gray macular pigmentation located on sun-exposed areas of the face, neck, and flexures, commonly found in dark-skinned patients. In patients with LPP, an inflammatory lichenoid response results in marked pigmentary incontinence. It has been associated with hepatitis C virus, sun exposure, and contactants such as mustard oil and nickel. LPP-inversus affects fair and dark skin, predominantly involving flexural and intertriginous areas, while sun-exposed areas are spared; friction is an associated trigger. LPP along Blaschko's lines has been associated with susceptibility to genetic mosaicisms. LPP can present concomitantly with other variants of LP such as frontal fibrosing alopecia, as well as endocrinopathies, and autoimmune diseases. Treatment is difficult and consists of avoidance of triggers and topical and systemic medications in order to stop the inflammatory reaction and reduce pigmentation, improving aesthetic appearance and quality of life.

http://ift.tt/2zSOltU

Exacerbation of Darier disease by peg-interferon beta-1a in a patient suffering from multiple sclerosis

http://ift.tt/2xqeq1Z

Clinical and radiological improvement in idiopathic calcinosis cutis with topical 25% sodium metabisulfite

http://ift.tt/2zTeXee

Bullous eruption in a patient with B-cell chronic lymphocytic leukemia: a diagnostic challenge

http://ift.tt/2i9m9ej

Dermoscopy in vitiligo: diagnosis and beyond

Abstract

Background

Vitiligo is essentially a clinical diagnosis, and dermoscopy may aid in noninvasive confirmation of diagnosis by excluding other clinically simulating hypopigmentary conditions. More importantly, dermoscopy is rapidly gaining ground as an important adjunct tool to evaluate disease activity.

Aim

To study the dermoscopic features of vitiligo and ascertain their correlation with disease activity.

Methods

Retrospective analysis of dermoscopy of 60 cases suffering from vitiligo was undertaken. Dermoscopy was performed using Dermlite II hybrid m dermatoscope at 10× magnification in polarized mode, and photographs were captured by Apple iphone 6. Variables assessed in the dermoscopic evaluation included perifollicular changes, perilesional changes, altered pigmentary network, and presence of specific features such as the starburst appearance, comet tail appearance, leukotrichia, telangiectasia, and any new findings.

Results

Sixty patients with stable, progressive, or repigmenting vitiligo were retrospectively studied. While perifollicular depigmentation (PFD) was predictive of stable vitiligo, perifollicular pigmentation (PFP) was characteristic of active disease. Starburst appearance, altered pigment network, and comet tail appearance, were also noted, and these were typical of progressive vitiligo. A new dermoscopic feature, the 'tapioca sago' appearance (sabudana), was observed in the skin adjacent to the vitiligo lesion only in patients with progressive vitiligo.

Conclusion

Dermoscopy is useful in assessing the stage of evolution and the status of disease activity in vitiligo. The most useful dermoscopic clues are observed in the perifollicular region, since progressive lesions display perifollicular pigmentation and stable/remitting lesions display perifolliclar depigmentation.

http://ift.tt/2gGPEnu

The effect of plasma rich in growth factors combined with follicular unit extraction surgery for the treatment of hair loss: A pilot study

Summary

Background

Hair transplant surgery using follicular unit extraction technique (FUE) is a common surgical procedure for the treatment of severe hair loss. Blood-derived autologous growth factors have also proved to promote hair regeneration in patients with different types of alopecia.

Aims

The aim of this study was to evaluate the safety and clinical efficacy of plasma rich in growth factors (PRGF) technology as an adjuvant therapy for FUE surgery in hair loss affected patients.

Methods

The biologic potential of PRGF was firstly in vitro evaluated over follicular germinal matrix and dermal papilla cells. Afterward, fifteen patients were subjected to routine FUE procedure while 15 patients underwent FUE+PRGF therapy. PRGF group included intradermal injections of growth factors and follicular transfer unit (FTU) preservation in an autologous fibrin clot. Postsurgical patient satisfaction and clinical improvement were evaluated, and PRGF or saline-preserved hair grafts were histomorphometrically analyzed.

Results

Follicular cell proliferation and migration was induced after autologous growth factors treatment. PRGF-preserved FTUs presented higher bioactivity signals and improved integrity of perifollicular structures and extracellular matrix proteins such as collagen and elastic fibers. PRGF not only reduced the postsurgical crust healing and hair fixation period, but also decreased the inflammatory pain and itching sensation.

Conclusions

This preliminary data demonstrate that PRGF is able to minimize the postsurgical follicle loss and potentiate the performance of grafted hairs. The fibrin clot not only acts as a protective barrier against environmental factors, but also provides a biologically active scaffold that induces resident cell proliferation and maintains an optimal integrity of the grafted hair.

http://ift.tt/2iDcXCI

Exogenous pigmentation of skin and nail caused by a millipede in a patient with plantar psoriasis

http://ift.tt/2yVDgKA

Adipose Triglyceride Lipase Gene Polymorphisms is Not Associated with Free Fatty Acid Levels in Chinese Han Population

Metabolic Syndrome and Related Disorders Nov 2017, Vol. 15, No. 9: 474-479.


http://ift.tt/2y77prr

Assessing the role of immune system in cancer progression from minimal residual disease

The immune system plays a major role in resisting the development and progression of cancer. Analysis of the molecular mechanisms of immune resistance to cancer has led to the formulation of several immunotherapeutic strategies. Although the immune system is portrayed in the literature as an effective tool for primary cancer control, its role in the development of recurrent tumors was relatively unexplored. It is well established that most cancers contain a subpopulation of cancer cells, that possess an inherent survival instinct which aids them to adopt a dormant state when subjected to stress [1–4].

http://ift.tt/2gHjA33

Forced expiratory values in 1 second corresponding to Pediatric Respiratory Assessment Measure and Acute Asthma Intensity Research Score values during pediatric acute asthma exacerbations

Acute asthma exacerbations are one of the most frequent reasons for emergency department (ED) visits and hospitalizations. Expert panel guidelines recommend measurement of percent-predicted forced expiratory volume in 1 second (FEV1) or peak expiratory flow for exacerbation severity assessment and treatment decision making.1 These guidelines categorize exacerbation severity according to percent-predicted FEV1 as mild to moderate (FEV1 ≥40%) and severe (FEV1 <40%), but acute care facilities that treat pediatric exacerbations generally do not have the equipment or personnel for such measures of lung function.

http://ift.tt/2gFZK83

Paternal gonadal mosaicism as cause of a puzzling inheritance pattern of activated PI3-kinase delta syndrome

Birth defects caused by de novo chromosomal abnormalities resulting in single-gene defects occur in approximately 5% of all live births.1 Affected offspring have a broad range of illnesses, including primary immunodeficiency diseases, a genetically heterogeneous group of disorders presenting with a clinical spectrum of mild to severe infections, often complicated by autoimmunity and malignancies.2 Most primary immunodeficiency diseases are monogenic diseases with a Mendelian inheritance pattern.

http://ift.tt/2i8A706

Bee moth (Galleria mellonella) allergy

We present a case of bee moth (Galleria mellonella) allergy with new clinical and immunologic features. While taking part in trout fishing games during the past year, a 34-year-old amateur fisherman with no personal history of allergic diseases experienced several attacks of rhinoconjunctivitis and late asthmatic reactions. Symptoms of rhinoconjunctivitis began when starting to fish and persisted during the day. This was followed by mild wheezing and dyspnea during the following night. Symptoms worsened during the most recent fishing excursion, and mild breathing difficulty tends to last until the night of the next day.

http://ift.tt/2gGNSD2

Association of consistently suboptimal quality of life with consistently poor asthma control in children with asthma

Asthma is one of the most prevalent chronic conditions in children, affecting 8.4% of American children and adolescents (approximately 6.2 million) in 2015.1 Although previous studies have found that poor asthma control is associated with impaired physical, psychological, and social aspects of health-related quality of life (HRQoL),2 some studies have suggested that impaired psychological aspects of HRQoL (ie, anxiety and depressive symptoms) cause poor asthma control.3 The effects of impaired HRQoL domains (eg, fatigue, pain, mobility, and peer relationships) in addition to anxiety and depressive symptoms on subsequent asthma outcomes in pediatric populations have been inadequately studied.

http://ift.tt/2i7OpxZ

Treating laryngopharyngeal reflux: Evaluation of an anti-reflux program with comparison to medications

To determine if an anti-reflux induction program relieves laryngopharyngeal reflux (LPR) symptoms more effectively than medication and behavioral changes alone.

http://ift.tt/2zIa4nu

Pediatric airway study: Endoscopic grading system for quantifying tonsillar size in comparison to standard adenotonsillar grading systems

Current grading systems may not allow clinicians to reliably document and communicate adenotonsillar size in the clinical setting. A validated endoscopic grading system may be useful for reporting tonsillar size in future clinical outcome studies. This is especially important as tonsillar enlargement is the cause of a substantial health care burden on children.

http://ift.tt/2hcDV0A

Clinicopathologic features of 28 cases of nail matrix nevi (NMNs) in Asians: Comparison between children and adults

Clinical distinction between nail matrix nevus (NMN) and subungual melanoma (SUM) can be challenging. More precise delineation of the clinicodermoscopic characteristics specific for NMNs is needed.

http://ift.tt/2xpYcpx

Prevalence and clinicopathologic characteristics of multiple myeloma with cutaneous involvement: A case series from Korea

Multiple myeloma (MM) is a plasma cell dyscrasia characterized by the presence of a clonal proliferation of tumor cells. Cutaneous involvement of MM is very rare and remains poorly understood.

http://ift.tt/2zT2V4W

Comorbidities in rosacea: A systematic review and update

Rosacea is linked to abnormalities of cutaneous vasculature and dysregulation of the inflammatory response. Recent reports on rosacea have shown a significant association with cardiovascular, gastrointestinal, and psychiatric diseases, all of which may affect morbidity and mortality among these patients.

http://ift.tt/2zT2YOa

Sweet syndrome in patients with and without malignancy: A retrospective analysis of 83 patients from a tertiary academic referral center

Sweet syndrome is a neutrophilic dermatosis that may be categorized into classic, malignancy-associated, and drug-induced subtypes. Few studies have systematically analyzed this rare disorder.

http://ift.tt/2xpClhT

Langerhans cell histiocytosis: A neoplastic disorder driven by Ras-ERK pathway mutations

Langerhans cell histiocytosis (LCH) is a disorder of myeloid neoplasia of dendritic cells that affects 1 in 200,000 children <15 years of age and even fewer adults. LCH presents with a spectrum of clinical manifestations. High-risk stratification is reserved for infiltration of blood, spleen, liver, and lungs. After decades of debate on the disease pathogenesis, a neoplastic mechanism is now favored on the basis of LCH cell clonality, rare cases of familial clustering, and recent evidence of mutations involving the Ras/Raf/MEK (mitogen-activated protein kinase kinase)/ERK (extracellular signal-regulated kinase) pathway in lesional biopsy specimens.

http://ift.tt/2xs0DrA

Autologous dermis - fat grafts as primary and secondary orbital transplants before rehabilitation with artificial eyes

The aim of this study was to examine the role of autologous dermis-fat grafts in the reconstruction of orbital soft-tissue defects.

http://ift.tt/2i79EA4

Clinical and radiographic evaluation of pulpectomy in primary teeth: a 18-months clinical randomized controlled trial

Abstract

Background

To avoid untoward changes when primary teeth are replaced by permanent teeth, resorption of the material used in primary teeth root canal filling should occur at the same rate as root resorption. The Aim of this study was to compare the success rates of a mixed primary root canal filling (MPRCF, ingredients: zinc oxide–eugenol [ZOE], iodoform, calcium hydroxide) to those of ZOE and Vitapex in pulpectomised primary molars.

Methods

One hundred and sixty primary molars from 155 children (average age 5.88 ± 1.27 years) underwent two-visit pulpectomy using one of the three materials. The clinical and radiographic findings at 6, 12 and 18 months were assessed.

Results

At 6 and 12 months, the MPRCF and ZOE success rates were 100%. The Vitapex group showed clinical success rate and radiographic success rate of 100 and 94.5% at 6 months, and 80.4 and 60.7% at 12 months. The 18-month clinical success rates of the MPRCF, ZOE and Vitapex were 96.2, 92.2 and 71.4% and radiographic success rates were 92.5, 88.2 and 53.6%, respectively. There was a statistically significant difference in the success rates between MPRCF and Vitapex and no significant differences between MPRCF and ZOE. More MPRCF were resorbed at same rate with roots than ZOE and Vitapex. Early resorption of root filling resulted in more failure.

Conclusions

The mixture of ZOE, iodoform and calcium hydroxide can be considered an effective root canal filling material in pulp involved primary teeth and had no adverse effect on tooth replacement.

Trial registration

ChiCTR-TRC-14004938. Registered 13 July 2014.

http://ift.tt/2y9bqvd

Editorial Board Page

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11





http://ift.tt/2iFlzsV

Primary Xanthoma of Mandible – A case report

Publication date: Available online 16 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Anik Saha, Shreya Tocaciu, Balanand Subramanian
Xanthomas are common cutaneous and subcutaneous lesions that occur due to altered metabolic or endocrinal function. They are found on skin and around tendon sheaths in individuals with dyslipidaemias. In extremely rare cases, they may present as isolated intrabony lesions in otherwise healthy individuals. The isolated intrabony lesions are referred to as primary xanthomas. We present a case of an incidentally found primary xanthoma, its management, and follow-up in an otherwise healthy patient.



http://ift.tt/2gMuPLg

Table of Contents

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11





http://ift.tt/2iC3v2M

AAOMS Author Disclosure forms

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11





http://ift.tt/2gMckq7

Effects of Low Level Laser Therapy with A Herbal Extract on Alveolar Bone Healing

Publication date: Available online 16 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Anıl Özyurt, Çiğdem Elmas, Cemile Merve Seymen, Veysel Tuncay Peker, Bülent Altunkaynak, Mehmet Nadir Güngör
PurposeThe aim of this study was to investigate the effect of a gallium–aluminum–arsenide (GaAlAs) diode laser used in low-level laser therapy with the application of Mecsina herbal hemostopper on mandibular alveolar bone healing.MethodsStandard semi-spherical bone defects were created on the left mandibular diastema sites of 32 female Long Evans rats. The experimental animals were allocated to four groups as follows: control group (nothing applied), laser group (GaAlAs diode low-level laser therapy), Mecsina group, and laser–Mecsina combination group. To the bone defects, 0.01 mL Mecsina in liquid form was applied. The laser treatment was performed for a duration of 7 days after surgery at an energy dose of 10 J/cm². All animals were sacrificed to observe hard tissue healing histologically, immunohistochemically, and radiologically at 30 days after the surgery.ResultsHistological assessment showed that there were significantly more calcified tissue areas and significantly more osteoblast cells in the laser and laser–Mecsina combination groups than in the other groups (p < 0.01). Qualitative morphological assessment showed that more bone tissue was present in the laser–Mecsina combination group than in other groups.ConclusionThis study demonstrated that low-level laser therapy, Mecsina application, and combined treatments were effective on alveolar bone healing among all the tested treatment modalities.



http://ift.tt/2iDjtcX

Is It Time to Reexamine Reexamination?

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11
Author(s): James R. Hupp




http://ift.tt/2gO7M2D

Masthead

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11





http://ift.tt/2iFlx4h

Outcome Analysis and Unexpected Scenario Prediction in Two-Stage Orthodontic Lower Third Molar Extraction

Publication date: Available online 16 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Tze-Ta Huang., Chen-Jung Chang, Ken-Chung Chen, Jen-Bang Lo, Meng-Yen Chen, Jehn-Shyun Huang
PurposeWe propose a two-stage orthodontic lower third molar extraction procedure to reduce iatrogenic inferior alveolar nerve injury. We tested our hypothesis that there are factors that can predict both dislodgement of the root portion and limited traction distances.Patients and MethodsFifteen patients (mean: 25.7 y/o, 17∼65 y/o) with 20 lower third molars were enrolled. Panoramic films and cone-beam computed tomography were analyzed. Dislodgement of the root portion, traction distance, duration of the orthodontic phase, and post-operative complications were documented. The predictive factors were analyzed and discussed.ResultsThree teeth had dislodgements of the root portion. Mean traction was 59.2 days (range: 33∼77 days), and the mean traction distance was 2.60mm (range: 0.27∼5.20 mm). Root apex cortical bone indentation and root curvature were significantly associated with traction distance. Pulpitis symptoms were documented in one tooth, and no post-operative nerve disturbances occurred.ConclusionOur proposed two-stage orthodontic lower third molar extraction procedure reduced iatrogenic inferior alveolar nerve injury. Cortical bone indentation and root curvature predicted dislodgement of the root portion and limited traction distances.



http://ift.tt/2z8O5d7

Effectiveness, Safety, and Predictors of Response to Botulinum Toxin Type A in Refractory Masticatory Myalgia: A Retrospective Study

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11
Author(s): Shehryar N. Khawaja, Steven J. Scrivani, Nicole Holland, David A. Keith
PurposeMasticatory muscle pain disorders respond well to conservative therapy; however, in some patients the pain becomes refractory. Botulinum toxin type A (BoT-A) therapy has been shown to be an effective modality in the management of refractory headache disorders. Conversely, there are conflicting reports in the literature regarding the efficacy, safety, and predictors of therapeutic response to BoT-A therapy for management of refractory masticatory muscle pain.Materials and MethodsWe performed a retrospective chart review of patients who underwent at least 2 injection cycles of 100 U of BoT-A for refractory masticatory myalgia in the Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, between May 2012 and June 2016. Information regarding demographic, diagnostic, and therapeutic characteristics was extracted and analyzed. The χ² test was used for analysis between independent and dependent variables. Forward step-wise–type logistic regression analysis was conducted to determine the predictors of outcome.ResultsAmong 116 participants, 30.6% reported significant relief in pain for a mean period of 10.1 weeks. A total of 16.4% of participants reported at least 1 adverse effect. The effectiveness of the BoT-A therapy was found to be statistically associated with the presence of muscle hypertrophy (P = .004), range of motion (P = .02), concurrent use of opioid analgesics (P = .003), and local anesthetic trigger-point injections (P = .003). Logistic regression analyses suggested that the presence of muscle hypertrophy and occurrence of adverse effects were predictors of positive outcome. On the contrary, concurrent use of opioid analgesics was found to be a predictor for no or minimal relief.ConclusionsBoT-A therapy provides significant relief for approximately one third of patients with refractory masticatory muscle pain. Therapy is associated with a mild risk of adverse effects. The presence of muscle hypertrophy, occurrence of an adverse effect, and concurrent use of opioid analgesics were found to be predictors of outcome response.



http://ift.tt/2iACMn9

Pathogenesis of cleft palate in Robin sequence: Observations from prenatal MRI

Publication date: Available online 16 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Cory M. Resnick, Judy A. Estroff, Tessa D. Kooiman, Carly E. Calabrese, Maarten J. Koudstaal, Bonnie L. Padwa
PurposeThe etiology of the palatal cleft in Robin sequence (RS) is unknown. The purpose of this study was to assess position of the fetal tongue on prenatal magnetic resonance imaging (MRI) and to suggest a potential relationship between tongue position and development of the cleft palate seen in the majority patients with RS.MethodsThis is a retrospective case-control study including fetuses with prenatal MRIs performed in our center from 2002-2017. Inclusion criteria were: (1) prenatal MRI of adequate quality, (2) live-born infant, and (3) postnatal diagnosis of Robin sequence ("Robin" group) or cleft lip and palate ("CLP" group). Subjects with postnatal RS without a palatal cleft were excluded. A control group with normal facial morphology was gestational-age matched. The outcome variable was tongue position on fetal MRI described as: within the cleft, along the floor-of-mouth, other, or indeterminate.Results122 subjects with mean gestational age at MRI of 25.8±4.9 weeks were included: Robin, n=21 (17%), CLP, n=47 (39%), control, n=54 (44%). The tongue was visualized within the palatal cleft in 76.2% of the Robin group and 4.3% of the CLP group. The tongue was found along the floor-of-mouth (normal position) in the remainder of the Robin and CLP groups, and in 100% of the control group.ConclusionThese findings suggest a relationship between in-utero tongue position and the development of a cleft palate in RS.



http://ift.tt/2iFlvtb

Velopharyngeal Insufficiency and Hypernasal Voice: 15 Years' Experience With Furlow Palatoplasty

Publication date: Available online 16 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): M.I. Rizzo, P. Cecchi, O. Rajabtork Zadeh, M. Zama




http://ift.tt/2z9qQQu

Juvenile Idiopathic Arthritis Practice Patterns Among Oral and Maxillofacial Surgeons

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11
Author(s): Brian E. Kinard, Shelly Abramowicz
PurposeThe purpose of this investigation is to assess the current clinical practices by oral and maxillofacial surgeons (OMSs) in the United States regarding diagnosis and treatment of temporomandibular joint (TMJ) involvement in children with juvenile idiopathic arthritis (JIA).Materials and MethodsWe implemented a cross-sectional survey of academic OMSs in the United States via an electronic survey. The survey included respondent demographic data, patient volumes, diagnostic methods, and management practices for children with JIA and TMJ involvement. The results of the survey were analyzed using descriptive statistics.ResultsThe study respondents were composed of 52 surgeons. Most respondents were men (n = 43, 87.8%), were aged 51 to 60 years (n = 20, 39.2%), were in full-time academics (n = 42, 84%), had more than 20 years of experience (n = 26, 50%), and were seeing 1 to 5 patients with JIA per month (n = 21, 46.7%). Most patients were aged 11 to 15 years (n = 22, 61.1%) and were managed with 1 to 2 systemic medications (n = 30, 81.1%). All OMSs reported evaluating TMJ involvement by reviewing patient history, clinical examination, and imaging. The most commonly used imaging modality was panoramic radiographs (n = 24, 63.2%) and magnetic resonance imaging (n = 22, 57.9%). OMSs decided to inject intra-articular medication based on history and symptoms (n = 36, 94.7%). Once in remission, patients were followed up at yearly (n = 12, 36.4%) or 6-month (n = 10, 30.3%) intervals.ConclusionsOur study shows that, in general, there is consensus among US OMSs regarding diagnosis of TMJ involvement in children with JIA. There is less concordance among the respondents regarding treatment. Currently, management of TMJ involvement in children with JIA is mostly based on expert opinions and retrospective studies. This study further highlights the need for randomized clinical trials and multi-institution collaboration to allow for evidence-based diagnosis and treatment.



http://ift.tt/2izGU6J

Accuracy of 3-Dimensional Virtual Surgical Simulation Combined With Digital Teeth Alignment: A Pilot Study

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11
Author(s): Jung-Hoon Kim, Young-Chel Park, Hyung-Seog Yu, Moon-Key Kim, Sang-Hoon Kang, Yoon Jeong Choi
PurposeTo evaluate the accuracy of virtual surgical simulation combined with digital teeth alignment and the applicability of this technique to the diagnosis and establishment of a 3-dimensional (3D) visualized treatment objective for orthognathic surgery by comparing virtual simulation images with actual post-treatment images.Materials and MethodsThis retrospective study included patients who underwent computed tomography (CT) before and after treatment. The 3D digital images were constructed from the initial CT images and dental cast scan data, and virtual surgical simulation combined with digital teeth alignment was performed. Accuracy of the virtual simulation was analyzed by comparing the distances of skeletal and dental landmarks in the horizontal, sagittal, and coronal reference planes with those on post-treatment images using the Wilcoxon signed rank test. Intraclass correlation coefficients were calculated to evaluate the degree of concordance between the 2 images.ResultsThe study sample included 11 patients (mean age, 18.8 yr). Most landmarks had differences smaller than 2 mm in the 3 reference planes between virtual simulation and post-treatment images; these differences were not statistically significant (P > .05). Most skeletal landmarks, except the A point, B point, and gonion, showed normal to high concordance between the virtual simulation and post-treatment images in the 3 reference planes (P < .05); dental landmarks exhibited a broad range of concordance.ConclusionThe 3D virtual surgical simulation combined with digital teeth alignment using pretreatment CT images yielded results sufficiently accurate to be used for the diagnosis and establishment of visualized treatment objectives for orthognathic surgery.



http://ift.tt/2z9BmqD

One-Stage Supramaximal Full-Thickness Wedge Resection of Vascular Lip Anomalies

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11
Author(s): Dawn K. De Castro, Zhi Yang Ng, Paul W. Holzer, Milton Waner, Curtis L. Cetrulo, Aaron Fay
PurposeVascular lip anomalies include infantile hemangiomas, venous malformations, and arteriovenous malformations. Surgical management can be complicated by alterations in horizontal length, vertical height, and lip thickness from the underlying pathology. Additional reconstructive challenges include preservation of oral continence, vermillion definition, and the sublabial sulcus. This report describes a technique of supramaximal single-stage full-thickness wedge resection of these lesions.Materials and MethodsA retrospective study approved by the institutional review board of patients who underwent full-thickness resection of vascular lip anomalies from December 2007 through February 2013 was performed. Patient demographics, final diagnosis, preoperative treatment, examination findings (pre- and postoperative), intraoperative management, and follow-up findings were reviewed.ResultsEighteen patients (9 female) with a mean age of 25 ± 19.8 years (range, 3 to 70 yr) were identified. Underlying pathologies were arteriovenous malformation (6), port wine stain with secondary soft tissue hypertrophy (6), capillary malformation (1), venous malformation (3), and infantile hemangioma (2). Prior treatments included embolization, lasers, surgical excision, steroids, and propranolol; 8 patients were treatment naive. All patients underwent a single or double pentagonal-shaped wedge resection of the involved upper or lower lip. An average of 3.75 cm (41.7%; range, 20 to 70%) of horizontal lip length was excised. Four patients required additional concomitant debulking of the vermillion. No intraoperative complications were noted. Postoperatively, 1 patient developed wound dehiscence at 12 days and another had a midline depression with mild oral incontinence. Follow-up averaged 1,074 days (range, 371 to 1,777 days) and patients and their parents reported a high degree of satisfaction with the improvement in lip appearance and symmetry except for 1 patient who required further debulking. The sublabial sulcus and vermillion and cutaneous definition were preserved in all cases.ConclusionDespite the traditional recommendation that no more than 30% of lip length be surgically removed, vascular lip anomalies result in tissue hypertrophy, horizontal elongation, ectropion labii, and tissue expansion that allow up to 70% of the lip to be excised.



http://ift.tt/2iAPYs3

Effect of Religious Belief on Selecting of Graft Materials Used in Oral and Maxillofacial Surgery

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11
Author(s): Zeynep Güngörmüş, Metin Güngörmüş
PurposeVarious graft materials, such as synthetic and biological products, are used routinely in maxillofacial surgery. These materials are usually derived from porcine, bovine, and human tissues; some religious beliefs forbid the dietary use of substances from certain animal sources. The aim of this study was to evaluate the effect of religious belief on selecting different graft types used in maxillofacial surgery.Materials and MethodsIn total, 203 participants were included in this survey. Data were collected using a questionnaire on sociodemographic characteristics and different graft types and the Revised Religious Fundamentalism Scale for religious belief levels of participants. The purpose of the study and the origins of different graft types were explained to participants, and their opinions for the acceptance or rejection of each type were recorded. Data were analyzed using SPSS 20.0 (IBM Corp, Armonk, NY).ResultsThe most preferred grafts were autologous grafts (88.7%), followed by alloplastic grafts (65%), bovine-derived xenografts (60.1%), allografts (53.2%), and porcine-derived xenografts (7.4%). One hundred fifty-nine participants (84.6%) rejected the porcine-derived xenografts for religious reasons, and there was a statistical difference in religious belief levels between participants who accepted and those who rejected porcine-derived xenografts.ConclusionsAutogenous grafts were the most preferred grafts and porcine-derived xenografts were the least preferred grafts. Porcine-derived xenografts were refused specifically for religious reasons, and religious belief and dietary restrictions affected graft selection.



http://ift.tt/2heO39k

News and Announcements

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11





http://ift.tt/2iDnvSF

Unicystic Ameloblastoma Revisited: Comparison of Massachusetts General Hospital Outcomes With Original Robinson and Martinez Report

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11
Author(s): Anne-Frédérique Chouinard, Zachary S. Peacock, William C. Faquin, Leonard B. Kaban
PurposeRobinson and Martinez established unicystic ameloblastoma (UA) as a distinct pathologic entity in 1977. Using their original description, the aims of this study were to compare the clinical presentation and outcomes of UA treated at Massachusetts General Hospital (MGH) with outcomes reported in the original article.Patients and MethodsThis was a retrospective cohort study of MGH patients treated for UA during a 15-year period. Patients were included if they had a confirmed clinical and histologic diagnosis of UA. The primary predictor variable was the source of the study sample (MGH vs Robinson and Martinez). Secondary variables included age, gender, radiographic appearance, treatment, and histologic subtype. The primary outcome variable was the number of recurrences over time comparing the 2 groups.ResultsThere were 19 patients (10 female and 9 male patients) in the MGH group and 20 patients (10 female and 10 male patients) in the Robinson and Martinez study. The lesions were predominantly unilocular (13 in MGH group and 19 in Robinson and Martinez group), located in the mandible (18 in MGH group and 20 in Robinson and Martinez group), and tooth associated (12 in MGH group and 14 in Robinson and Martinez group). No statistically significant demographic differences were noted between the 2 groups. In the MGH group, 13 cases (68%) exhibited mural or intramural ameloblastic epithelium, 4 (21%) were luminal or intraluminal, and 2 were unknown. However, histologic configuration was not reported in the Robinson and Martinez group. MGH patients were treated by enucleation (n = 7, 37%) or resection (n = 12, 63%) compared with enucleation in 100% cases in the Robinson and Martinez group. Overall, the disease-free survival rate was higher in the Robinson and Martinez group, but the difference was not statistically significant (P = .089). Within the MGH group, 100% of recurrences occurred in patients with mural invasion treated by enucleation.ConclusionsThe results of this study support UA as a distinct entity based on demographic, clinical, and radiographic criteria. Outcomes in the MGH group were influenced by the degree of ameloblastic epithelial invasion and suggest that this variable should be considered when planning treatment.



http://ift.tt/2gMBpkD

Characteristics of Supernumerary Teeth in Non-Syndromic Population in an Urban Dental School Setting

Publication date: Available online 16 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Mackensie McBeain, Michael Miloro
PurposeThe purpose of this study is to analyze the clinical records of all patients evaluated for supernumerary teeth at the University of Illinois, Department of Oral and Maxillofacial Surgery postgraduate clinic from January 1, 2010 to October 31, 2015 in order to determine the demographics of impacted supernumerary teeth among different ethnicities within the city of Chicago, Illinois.Patients and MethodsA retrospective case series was completed on subjects eligible for inclusion in the study who had a diagnosis of at least one full bony impacted supernumerary tooth (D7240). Other variables evaluated included date of surgical intervention, age at time of treatment, gender, ethnicity, location and number of supernumerary teeth present, and family history of supernumerary teeth.ResultsThere were 459 male and 308 female patients, with a 1.5:1 male:female ratio. Patient ages ranged from 4 to 51 years (avg. 13.1) at the time of surgery. 74.7% (573) of the patients were of Hispanic descent. Supernumerary teeth were found most frequently in the maxilla (69.9%), specifically in the central incisor region (526 teeth, 51.2%). In the responding patient sample (258 patients), 53 patients (20.5%) reported a family history of supernumerary dentition. Of these 53 patients that reported a family history of supernumerary dentition, 37 (69.8%) were of Hispanic descent. The majority of these Hispanic patients (83.8%) originated from Mexico.ConclusionsThe incidence of supernumerary teeth is higher among male patients (M:F ratio of 1.5:1), and these teeth are most frequently found in the maxilla (69.9%), specifically the central incisor region (51.2%). A large percentage of patients (20.5%) also have first-degree relatives with a supernumerary dentition, and this fact may warrant further investigation into the possible genetics responsible for the formation of supernumerary teeth.



http://ift.tt/2iDnr5n

Four-dimensional computed tomography evaluation of condylar movement in a patient with temporomandibular joint osteoarthritis

Publication date: Available online 16 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Masaya Akashi, Takumi Hasegawa, Satoru Takahashi, Takahide Komori
Temporomandibular joint osteoarthritis (TMJ-OA) is a disease of the bone, cartilage, and supporting tissues of the joint. Patients with advanced TMJ-OA often suffer from symptoms such as pain, swelling, and joint dysfunction, and sometimes required surgical intervention when conservative treatment is not effective. The etiology of TMJ-OA remains elusive. The usefulness of four-dimensional computed tomography (4DCT) in motion analyses of various joints has been recently reported. This article introduces a novel imaging technique of 4DCT which aims to identify kinematic features that may be associated with the etiology of TMJ-OA. In a 69-year-old female patient with severe TMJ-OA, 4DCT evaluation of the condylar movement was performed. During the scan, she was instructed to masticate a cookie normally and her natural condylar movement during mastication was evaluated. The coronal 4DCT motion images revealed that the synovial cavity was narrower on the affected side than on the non-affected side. Repeated friction between the articular surface of the condyle and the caudal surface of the articular eminence was observed during natural mastication. Although friction between the condyle and the articular eminence has been considered as a factor in the initiation and progression of TMJ-OA in previous experimental studies using animals, this is the first study to directly visualize the friction between the atrophic and flattened condylar surface and the articular eminence. 4DCT is a novel imaging technique with the potential to assess kinematic features that cannot be visualized with other imaging modalities in patients with TMJ disease.



http://ift.tt/2hcLeFr

Can Use of Rigid Fixation after Consolidation Benefit Cleft Patients following Distraction Osteogenesis?

Publication date: Available online 16 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Reza Tabrizi, Kemal Tumer, Shervin Shafiei, Ashkan Rashad
PurposeStability of distraction osteogenesis (DO) is an important issue in maxillary advancement of cleft lip and palate (CLP) patients. The aim of this study was to evaluate postoperative stability between patients with and without internal fixation after removing maxillary distraction devices.Materials and MethodsThis randomized clinical trial assessed CLP patients who needed maxillary advancement of more than 6 mm; they were randomly assigned to two groups. In group 1, distraction devices were removed 3 months after distraction and then we placed 4 L miniplates bilaterally in the maxilla. In group 2 (controls), no miniplates were placed after removing distraction devices. By using lateral cephalograms taken on 3 occasions (preoperatively, immediately after removing the distraction device and 18 months after), the vertical and horizontal changes at the A point were determined.ResultsTwenty-two patients were studied in two groups (11 patients in each group). There was no significant difference between the groups for horizontal relapse (P=0.79). The results did not reveal any significant difference for vertical relapse between the two groups (P=0.11). The Pearson's correlation test demonstrated a correlation between the amount of advancement and the horizontal relapse at the A point in group 1 (P=0.01) and in group 2 (P=0.001). In group 1, for every 1 mm maxillary advancement, 0.36 mm relapse was seen (B=0.36, P=0.01). In group 2, for every 1 mm maxillary advancement, 0.43 mm relapse was seen (B=0.43, P=0.001).ConclusionAccording to our results, rigid fixation after consolidation did not increase stability in CLP patients following DO.



http://ift.tt/2iDnazn

Dermatology Guideline Authors Take Big Payments From Industry

Dermatology clinical practice guideline authors often receive large payments from industry and don't always fully disclose them, researchers report.
Reuters Health Information

http://ift.tt/2i8j6Dm

Practices regarding human Papillomavirus counseling and vaccination in head and neck cancer: a Canadian physician questionnaire

Human papillomavirus (HPV) has recently been implicated as a causative agent in a rapidly growing number of oropharyngeal cancers. Emerging literature supports the hypothesis that HPV vaccination may protect a...

http://ift.tt/2gNg7Dw

Human immunodeficiency virus infection acquired through a traditional healer’s ritual: a case report

Globally, over 36 million people were infected with human immunodeficiency virus by the end of 2015. The Sub-Saharan African region home to less than one-fifth of the global population disproportionately harbo...

http://ift.tt/2i76Xyo

RItA: The Italian severe/uncontrolled asthma registry

Abstract

Background

The Italian severe/uncontrolled asthma (SUA) web-based registry encompasses demographic, clinical, functional, inflammatory data; it aims to raise SUA awareness, identifying specific phenotypes and promoting optimal care.

Methods

493 adult patients from 27 Italian centres (recruited in 2011-2014) were analyzed.

Results

Mean age was 53.8yrs. SUA patients were more frequently female (60.6%), with allergic asthma (83.1%). About 30% showed late onset of asthma diagnosis/symptoms (>40yrs); the mean age for asthma symptoms onset was 30.2yrs and for asthma diagnosis 34.4yrs. 97.1% used ICS (dose 2000 BDP), 93.6% LABA in association with ICS, 53.3% LTRAs, 64.1% anti-IgE, 10.7% theophylline, 16.0% oral corticosteroids.

Mean FEV₁% pred of 75.1%, median values of 300/mm³ of blood eosinophil count, 323 kU/l of serum total IgE, 24 ppb of FENO were shown.

Most common comorbidities were allergic rhinitis (62.4%), gastroesophageal reflux (42.1%), sinusitis (37.9%), nasal polyposis (30.2%), allergic conjunctivitis (30.2%).

55.7% of SUA patients had exacerbations in the last 12 months, 9.7% emergency department visits, 7.3% hospitalizations.

Factors associated with exacerbation risk were: obesity (OR, 95%CI 2.46, 1.11-5.41), psychic disorders (2.87, 0.89-9.30 - borderline), nasal polyps (1.86, 0.88-3.89 - borderline), partial/poor asthma treatment adherence (2.54, 0.97-6.67 - borderline), anti-IgE use in a protective way (0.26, 0.12-0.53).

Comparisons to severe asthma multicentre studies and available registries showed data consistency across European and American populations.

Conclusions

An international effort in the implementation of SUA patients registries could help to better understand the clinical features and to manage severe asthma, representing a non negligible socio-economic burden for health services.

This article is protected by copyright. All rights reserved.

http://ift.tt/2i6VKxN

Cockroach is a major cross-reactive allergen source in shrimp-sensitized rural children in southern China

Abstract

Background

Little is known about the prevalence of food allergy (FA) in China.

Objective

To investigate the prevalence of FA and its disparity between urban and rural areas in southern China.

Methods

Europrevall questionnaire responses were obtained from 5,542 school-age-children in urban Guangzhou and 5,319 in rural Shaoguan. A case-control study enrolled 190 children with adverse reactions (ARs) after food intake as cases, and 212 controls in Guangzhou; 116 cases and 233 controls in Shaoguan. These subjects underwent skin-prick test (SPT) and serum IgE measurements to food and inhalant allergens. Allergen extracts from shrimp, house dust mite (HDM), and cockroach were prepared for IgE cross-relativity testing in 23 Guangzhou and 20 Shaoguan shrimp-sensitized subjects.

Results

The prevalence of ARs to shrimp was higher in Guangzhou than Shaoguan children (3.5% vs. 1.4%, p<0.001). However, sensitization rate to shrimp (SPT: 3.7% vs. 11.2%, p=0.015; IgE: 12.6% vs. 36.2%, p<0.001) and cockroach (SPT: 5.3% vs. 33.5%; IgE: 2.6% vs. 27.6%, p<0.001) were lower in Guangzhou. A significant correlation between shrimp and HDM/cockroach IgE was found in Shaoguan children. The proportions of positive IgE to tropomyosin (Pen a 1, Der p 10) were lower than 7.4% in both areas. Cockroach allergen has a significantly higher inhibition rate of binding to IgE to house-dust-mite allergens in Shaoguan sera.

Conclusions

Shrimp is a common allergic food in southern China. Higher proportion of shrimp sensitization in rural subjects could be explained by cross-reactive to cockroach. Tropomyosin was not a major allergen responding for the cross-reactivity.

This article is protected by copyright. All rights reserved.

http://ift.tt/2gG18Yf

Legionnaires' Effect on Smell

Condition:   Legionnaires' Disease
Intervention:   Other: The University of Pennsylvania Smell Identification Test (UPSIT)
Sponsor:   University of Pennsylvania
Recruiting

http://ift.tt/2izL7Yf

Adjuvant Pembrolizumab for Patients With Locally Advanced Esophageal Squamous Cell Carcinoma at High Risk of Recurrence

Condition:   Esophageal Squamous Cell Carcinoma
Intervention:   Drug: Pembrolizumab
Sponsors:   National Taiwan University Hospital;   Merck Sharp & Dohme Corp.
Not yet recruiting

http://ift.tt/2zayUQE

Perioperative Tonsillectomy Protocol Development

Condition:   Tonsillitis
Interventions:   Drug: Acetaminophen and High-Dose Dexamethasone;   Drug: Acetaminophen and Low-dose Dexamethasone;   Drug: Placebo and Low-dose Dexamethasone
Sponsor:   London Health Sciences Centre
Not yet recruiting

http://ift.tt/2iDCtYF

Phase I/II Trial of Epacadostat, Intralesional SD101, Radiotherapy in Patients With Lymphoma

Conditions:   Advanced Solid Tumors;   Lymphoma
Interventions:   Drug: epacadostat;   Drug: SD-101;   Radiation: Radiotherapy
Sponsor:   University of California, Davis
Not yet recruiting

http://ift.tt/2z80qOJ

EPR Tumor Oximetry With CE India Ink

Conditions:   Neoplasms, Malignant;   Breast Neoplasm;   Carcinoma, Basal Cell;   Carcinoma, Squamous Cell;   Melanoma;   Skin Neoplasm;   Head and Neck Neoplasms
Interventions:   Device: Carlo Erba Ink Injection;   Other: EPR Oximetry Measurement
Sponsors:   Harold M. Swartz;   National Cancer Institute (NCI)
Recruiting

http://ift.tt/2iDCkV7

Effect of Post-operative Ibuprofen After Surgery for Chronic Rhinosinusitis

Condition:   Chronic Rhinosinusitis (Diagnosis)
Interventions:   Drug: Ibuprofen 400 mg;   Drug: Acetaminophen 650 mg;   Drug: OxyCODONE 5 Mg Oral Tablet
Sponsor:   University of Washington
Recruiting

http://ift.tt/2iBDwIs

Multidisciplinary Clinic Management of Head and Neck Cancer

This cohort study evaluates a single-day, single-appointment, multidisciplinary head and neck clinic model for reduction in treatment delay and comprehensiveness of cancer care.

http://ift.tt/2iBOiP2

Reconstruction—The Final Dimension in Head and Neck Surgery

This Special Communication of the 2017 Hayes Martin Lecture discusses the state of the art and future directions in reconstructive head and neck surgery.

http://ift.tt/2z9b7R4

Outcomes After Transoral Robotic Surgery for Oropharyngeal Cancer

This study compares functional speech, swallowing, and quality-of-life outcomes between patients with oropharangeal cancer who underwent transoral robotic surgery onlyand those who underwent transoral robotic surgery and received adjuvant radiotherapy or chemoradiotherapy.

http://ift.tt/2iBOca8

Aggressive-Appearing Pediatric Parotid Mass

A young boy had an enlarging right facial mass; a computed tomographic scan showed a discrete necrotic mass in the right parotid gland, and fine-needle aspirate yielded a cellular sample with spindloid features. What is your diagnosis?

http://ift.tt/2za2INp

Perineural and Angiolymphatic Invasion in Oropharyngeal Carcinoma

This study examines the prevalence and prognostic significance of perineural invasion and angiolymphatic invasion in human papillomavirus–positive oropharyngeal squamous cell carcinoma.

http://ift.tt/2iDBcRn

Practices regarding human Papillomavirus counseling and vaccination in head and neck cancer: a Canadian physician questionnaire

Abstract

Background

Human papillomavirus (HPV) has recently been implicated as a causative agent in a rapidly growing number of oropharyngeal cancers. Emerging literature supports the hypothesis that HPV vaccination may protect against HPV-related head and neck cancer (HNC) in addition to HPV-related cervical and anogenital disease. While the association between HPV infection and cervical cancer is widely understood, its relation to HNC is less well known. The purpose of this study was to better understand HPV counseling practices for infection and vaccination in relation to HNC of primary care physicians (PCPs), Obstetricians/Gynecologists (OBGYNs), and Otolaryngology - Head and Neck Surgeons (OHNSs) in Canada.

Methods

A Canada-wide electronic questionnaire regarding counseling practices on HPV infection, transmission, and vaccination was designed and distributed to PCPs, OBGYNs, and OHNSs across Canada through electronic and paper-based methods. Basic Descriptive statistics were used to analyze responses.

Results

In total, 337 physicians responded (239 family physicians, 51 OHNSs, 30 OBGYNs, and 17 pediatricians). Three out of four PCPs reported routine counseling of their patients regarding HPV infection, transmission, and vaccination. Among this group, 68% reported "never" or "rarely" counseling patients that HPV can cause HNC. The most commonly reported reason that PCPs cited for not counseling was a lack of knowledge. The majority of OHNSs (81%) and OBGYNs (97%) counseled patients regarding HPV infection, transmission, and vaccination. However, very few OHNSs (10%) regularly counseled patients with HPV-related HNC about HPV-related anogenital cancer. Similarly, very few OBGYNs (18%) regularly counseled patients with HPV related cervical/anogenital cancer about HPV related HNC.

Conclusions

The rate of counseling on HPV infection, transmission, and vaccination in relation to HNC among PCPs is low. The most common reason is a lack of knowledge. Specialists rarely counsel patients with confirmed HPV-related cancer about other HPV-related malignancies. More research is needed on the relationship between different HPV-related cancers in order to better inform counseling practices.

http://ift.tt/2hbccNM

Intranodal Palisaded Myofibroblastoma in a Submandibular Lymph Node

Intranodal palisaded myofibroblastoma (IPM), also known as "intranodal hemorrhagic spindle cell tumor with amianthoid fibers," is a rare benign mesenchymal tumor originating from smooth muscle cells and myofibroblasts, often with the presence of amianthoid fibers. Usually IPM affects inguinal lymph nodes, but three cases have been described in the submandibular and cervical lymph nodes. We report a new case of a 44-year-old women with submandibular mass. Cervical ultrasound showed a suspect right submandibular adenomegaly. The patient underwent an excision of the submandibular mass. Histological features of the tumor include an encapsulated fusocellular proliferation, with nuclear palisading, amianthoid fibers, hemosiderin pigment, and extravasated erythrocytes. In the light of these results, we made the diagnosis of IPM. No recurrence was found 5 years after surgery.

http://ift.tt/2hafXTx

Körperdysmorphe Störung

Zusammenfassung

Menschen mit einer körperdysmorphen Störung (KDS) machen sich übermäßig Sorgen und beschäftigen sich exzessiv mit einer objektiv nichtexistenten – oder zumindest von anderen als unerheblicher Defekt angesehenen – Veränderung in ihrem Erscheinungsbild. Sie können vor ihren eigenen Augen nicht bestehen, fühlen sich hässlich, sind überzeugt, dass ihre Nase, ihr Körperbau, ihre Haut sie entstellen. Je mehr sie sich mit ihrem Aussehen beschäftigen, umso mehr richtet sich der Blick auf die scheinbaren Schönheitsmakel und verfestigt sich der Eindruck der eigenen Unattraktivität. Die Betroffenen empfinden sich nicht als krank; vielmehr sind sie überzeugt, dass es ein körperlicher Makel ist, der sie immer wieder vor den Spiegel zwingt. Solche Patienten suchen einen Hautarzt auf, manche auch einen plastischen Chirurgen, um ihrem Schönheitsideal näherzukommen – dieses bleibt aber für die Patienten aufgrund ihrer verzerrten Körperwahrnehmung unerreichbar.

http://ift.tt/2i6IEk9

Efficacy of microneedling with 70% glycolic acid peel vs microneedling alone in treatment of atrophic acne scars—A randomized controlled trial

Summary

Background

Microneedling with dermaroller and glycolic acid peels is commonly used for treatment of acne scars.

Objective

To compare efficacy of microneedling alone versus combination of microneedling with serial 70% glycolic acid peel in management of atrophic acne scars.

Methods & Materials

Sixty patients with atrophic acne scars were randomized into group 1 receiving microneedling at 0, 6, and 12 weeks and group 2 receiving microneedling at 0, 6, and 12 weeks along with 70% glycolic acid peel at 3, 9, and 15 weeks. Acne scar scoring was performed by a blinded observer using ECCA (Echelle d'evaluation clinique des cicatrices d'acne) scoring at baseline and after 22 weeks. Additionally, patients were asked to grade the improvement in acne scars and skin texture on visual analogue scale (VAS).

Results

Of 60 patients, 52 completed the 22-week study period. The decrement from baseline in mean ECCA score was more in group 2 as compared to group 1 (39.65±2.50 vs 29.58±0.18; P<.001). Group 2 also showed more improvement in skin texture as compared to group 1 on VAS.

Conclusion

Addition of sequential 70% glycolic acid peel to microneedling gives better scar improvement as compared to microneedling alone. In addition to this, it also improves skin texture.

http://ift.tt/2yRCgY0

Recurrent Vitreous Hemorrhage from an Optic Nerve Retinal Arterial Macroaneurysm

Objective: To report a case of recurrent vitreous hemorrhage from an optic nerve retinal arterial macroaneurysm (ONRAM) successfully treated with intraoperative endolaser. Patient and Methods: A 92-year-old woman on oral aspirin and warfarin anticoagulation for atrial fibrillation developed three episodes of dense vitreous hemorrhage from an ONRAM. Due to failure of the vitreous hemorrhage to clear spontaneously, a total of three pars plana vitrectomy (PPV) procedures were performed along with a 1.25-mg intravitreal bevacizumab injection after the third episode of hemorrhage. During the third PPV procedure, a 25-gauge 532-nm green diode laser endoprobe was used to deliver low-power (100 mW) and long-duration (500 ms) laser spots directly on the ONRAM to induce intraoperative shrinkage of the ONRAM. Results: After the endolaser treatment, the macroaneurysm showed involution due to fibrosis without any adverse effects on retinal circulation or visual field defect. No recurrence of vitreous hemorrhage was noted after 2 years of follow-up. Conclusion: Oral anticoagulant use may have been responsible for the atypical clinical course in our patient. Laser photocoagulation, including intraoperative endolaser photocoagulation, may be considered in selected cases of symptomatic ONRAMs.
Case Rep Ophthalmol 2017;8:503–509

http://ift.tt/2lidqv3

Diagnostic and Therapeutic Approach in a Case of Severe Post-Traumatic Hyphema with Subtotal Iridodialysis

Purpose: To report our diagnostic ultrasound-based approach and surgical strategy in a case of severe blunt trauma with complete hyphema, 270° iris disinsertion, and traumatic subluxated cataract. Case Report: A 70-year-old male was referred to our hospital for a blunt trauma in his right eye. A complete examination revealed visual acuity consisting in light perception, a complete hyphema, and an intraocular pressure of 45 mm Hg with moderate pain. Our diagnostic approached was ultrasound based with B-scan examination showing some vitreous hemorrhage and ultrasound biomicroscopy showing a large iris disinsertion of 270° with the iris entirely dislocated in the inferior sector of the anterior chamber. The patient was hospitalized and a systemic and topical treatment was started to lower intraocular pressure. Our surgery consisted in a single-step approach with removal of traumatic cataract with scleral fixation of an intraocular lens and iridoplasty. Conclusion: In our patient, the single-step surgery, supported by anterior and posterior ultrasound imaging, achieved a satisfactory anatomical and functional outcome.
Case Rep Ophthalmol 2017;8:496–502

http://ift.tt/2y6UPrT

Chronic Retinal Necrosis Severely Complicated by Neovascular Glaucoma: A Case Report

Background: Chronic retinal necrosis (CRN) is a rare chronic granular necrotizing retinitis that was first described in 2013. CRN is characterized by intraocular inflammation accompanied by occlusive vasculitis, granular retinitis, and slowly progressing necrosis around the retina in a host with partial immune dysfunction. Cytomegalovirus (CMV) is reported to be a causative agent. There are several ocular complications such as retinal detachment and neovascular glaucoma; however, there has been no description of a clinical manifestation of neovascular glaucoma in CRN. We herein present a case of severe neovascular glaucoma in association with CRN. Case Presentation: An 80-year-old man was referred to our hospital with poor control of inflammation and intraocular pressure (IOP). The IOP in his left eye was 29 mm Hg. Anterior chamber cells (2+) and keratic precipitates were observed. In the peripheral retina, vitreous opacities and granular necrotizing retinitis were noticed. Fluorescein angiography revealed extensive retinal nonperfusion area from the macula lesion to the periphery. PCR analysis of aqueous humor showed the presence of CMV. A diagnosis of CRN was made soon afterwards. Antiviral drug and systemic corticosteroid were administered. The treatment temporally resolved the symptom; however, panretinal photocoagulation and intravitreal injection of bevacizumab were performed to treat iris neovascularization. During the follow-up, trabeculectomy was performed because of poor IOP control. At the final visit, severe uncontrolled neovascular glaucoma caused hyphema, and his left eye lost light perception. Conclusion: The prognosis of CRN is poor because of severe neovascular glaucoma and careful observation and active treatments are necessary.
Case Rep Ophthalmol 2017;8:489–495

http://ift.tt/2ljlRpV

Secukinumab-induzierter subakut-kutaner Lupus erythematodes

Zusammenfassung

Wir berichten über eine 52-jährige Patientin, die unter der Therapie mit Secukinumab einen medikamenteninduzierten subakut kutanen Lupus erythematodes („drug induced lupus erythematodes" [SC-DILE]) entwickelte. Unter einer lokalen Therapie mit einem Steroid der Klasse 3 zeigte sich innerhalb von 4 Wochen eine wesentliche Besserung. Die Systemtherapie wurde auf Ustekinumab umgestellt. DILE („drug induced lupus erythematodes") ist eine seltene, aber zu bedenkende Nebenwirkung unter Biologikatherapie bei 0,5–1 % aller Patienten, die auch bei IL(Interleukin)-17-Blockade auftreten kann. Eine Umstellung der Biologikatherapie ist in den meisten Fällen notwendig.

http://ift.tt/2zERJaW

Juvenile pityriasis rubra pilaris: successful treatment with methotrexate

http://ift.tt/2zHb7Ea

Keeping an Open Mind: Cognitive Bias in the Evaluation of an Infant with Posterior-Lateral Rib Fractures

A four-month-old former premature male is incidentally found to have posterior-lateral rib fractures during evaluation of a febrile illness. This finding led to the initiation of a workup for nonaccidental trauma. A thorough history and physical exam ultimately led to the diagnosis, which was not related to abuse. This case highlights a rare sequela of patent ductus arteriosus repair, cautions medical teams to remain aware of how cognitive bias can affect diagnostic decision-making, and emphasizes the importance of a thorough history, physical exam, and medical record review in cases of suspected nonaccidental trauma.

http://ift.tt/2xpjnbf

HLA-Cw6 and psoriasis

Abstract

Psoriasis is a multifactorial disease with a strong genetic background. HLA-Cw6 is one of the most strongly associated psoriasis susceptibility allele. It is repeatedly observed to affect disease course, phenotypic features, severity, comorbidities, and treatment outcomes. To the best of our knowledge, the roles of HLA-Cw6 in psoriasis have not yet been thoroughly reviewed. The worldwide frequency of HLA-Cw6 allele varies greatly, with HLA-Cw6 allele frequency being generally higher in Caucasians compared to Asians. The allele is associated with Type I early onset psoriasis. Stress, obesity, and streptococcal pharyngitis are commonly observed in HLA-Cw6 positive patients. Phenotypically, HLA-Cw6 is found to be associated with guttate psoriasis in some studies. In addition, patients carrying the allele are more likely to have arm, leg, trunk involvement, and Koebner's phenomenon. Psoriatic arthritis patients with HLA-Cw6 more often have early onset and tend to show cutaneous symptoms before musculoskeletal symptoms. HLA-Cw6 positive patients have been shown to be more responsive to methotrexate and ustekinumab in several studies. However, this difference in ustekinumab efficacy was only moderate in a post hoc analysis of phase III pivotal study. HLA-Cw6 positivity also tends to be less frequent in high-need patients who failed conventional therapy. Small studies have also investigated the role of HLA-Cw6 in remission of psoriasis during pregnancy, photosensitivity and atherosclerosis as comorbidity of psoriasis. Given the diverse nature of psoriasis pathogenesis, as well as the difference of HLA-Cw6 positivity in different ethnic groups, more studies are needed to confirm the role of HLA-Cw6 in psoriasis.

This article is protected by copyright. All rights reserved.

http://ift.tt/2yTyrRZ

The role of the microbiome in psoriasis: moving from disease description to treatment prediction?

Abstract

With several million microbes per cm² of skin, the task of mapping the physiological cutaneous microbiome is enormous. Indeed, the reliance on bacterial culture to identify cutaneous bacterial communities has led to a systematic under-appreciation of cutaneous microbial diversity, potentially limiting our understanding of common inflammatory skin diseases including psoriasis.

However, based heavily on developments in molecular biology and bioinformatics, including next generation sequencing, the last decade has witnessed a marked increase in our understanding of the extent and composition of the cutaneous microbiome. It is already clear that skin-specific (skin site and skin microenvironment), individual-specific (hygiene, sex, age, and hormonal status), disease-specific (atopic eczema, acne) and genetic factors can all influence the cutaneous microbiome, albeit to varying and, as yet ill-defined, extents. This review briefly describes the process of 16S ribosomal RNA sequencing, before charting our current understanding of the cutaneous microbiome in health and the alterations (dysbiosis) associated with chronic inflammatory diseases with particular reference to psoriasis. The possibility and clinical relevance of intra-individual cross-talk between the various microbiomes is discussed and potential mechanisms underpinning the interactions between resident skin flora and the immune system are highlighted. We outline how the power of microbiome studies can be harnessed to provide new insights into disease pathogenesis and treatment selection. Ultimately, in the age of personalized medicine, the integration of cutaneous microbiome signatures and comprehensive disease and drug response endotypes will herald a novel approach in the clinical management of chronic, multi-system inflammatory diseases.

This article is protected by copyright. All rights reserved.

http://ift.tt/2yOefz2

Continuous Pulse Oximetry and Capnography Monitoring for Postoperative Respiratory Depression and Adverse Events: A Systematic Review and Meta-analysis

BACKGROUND:Death and anoxic brain injury from unrecognized postoperative respiratory depression (PORD) is a serious concern for patient safety. The American Patient Safety Foundation has called for continuous electronic monitoring for all patients receiving opioids in the postoperative period. These recommendations are based largely on consensus opinion with currently limited evidence. The objective of this study is to review the current state of knowledge on the effectiveness of continuous pulse oximetry (CPOX) versus routine nursing care and the effectiveness of continuous capnography monitoring with or without pulse oximetry for detecting PORD and preventing postoperative adverse events in the surgical ward. METHODS:We performed a systematic search of the literature databases published between 1946 and May 2017. We selected the studies that included the following: (1) adult surgical patients (>18 years old); (2) prescribed opioids during the postoperative period; (3) monitored with CPOX and/or capnography; (4) primary outcome measures were oxygen desaturation, bradypnea, hypercarbia, rescue team activation, intensive care unit (ICU) admission, or mortality; and (5) studies published in the English language. Meta-analysis was performed using Cochrane Review Manager 5.3. RESULTS:In total, 9 studies (4 examining CPOX and 5 examining continuous capnography) were included in this systematic review. In the literature on CPOX, 1 randomized controlled trial showed no difference in ICU transfers (6.7% vs 8.5%; P = .33) or mortality (2.3% vs 2.2%). A prospective historical controlled trial demonstrated a significant reduction in ICU transfers (5.6–1.2 per 1000 patient days; P = .01) and rescue team activation (3.4–1.2 per 1000 patient days; P = .02) when CPOX was used. Overall, comparing the CPOX group versus the standard monitoring group, there was 34% risk reduction in ICU transfer (P = .06) and odds of recognizing desaturation (oxygen saturation [SpO2] 1 hour) was 15 times higher (P

http://ift.tt/2xnv963

Perioperative Patient Blood Management to Improve Outcomes

Anemia is common in elective surgery and is an independent risk factor for morbidity and mortality. Historical management of anemia has focused on the use of allogeneic blood transfusion but this in itself is not without risk. It too has been independently associated with morbidity and mortality, let alone the costs and relative shortage of this resource. In recognition of this, patient blood management (PBM) shifts the focus from the product to the patient and views the patient's own blood as a resource that should be conserved and managed appropriately as a standard of care. It consists of 3 pillars: the optimization of red blood cell mass; reduction of blood loss and bleeding; and optimization of the patient's physiological tolerance toward anemia. Integration of these 3 pillars in the form of multimodal care bundles and strategies into perioperative pathways should improve care processes and patient outcome. Preoperative anemia is most commonly caused by functional iron deficiency and should be treated with oral iron, intravenous iron, and/or recombinant erythropoietin. An individualized assessment of the thrombotic risk of discontinuing anticoagulant and antiplatelet medication should be balanced against the risk of perioperative bleeding. Neuraxial anesthetic techniques should be considered and minimally invasive surgery undertaken where appropriate. Cell salvage should be used if significant blood loss is anticipated and pharmacological treatments such as tranexamic acid and fibrin sealants have been shown to reduce blood loss. Point of care tests can guide the perioperative management of dynamic coagulopathy. Blood testing sampling should be performed only when indicated and when taken, sample volume and waste should be minimized. Restrictive blood transfusion thresholds and reassessment after single unit transfusion should be incorporated into clinical practice where appropriate. For PBM to become standard practice in routine surgical care, national health care quality change initiatives must set the agenda for change but the patient-centered approach to PBM should be delivered in a way that is also hospital centered. Characterization of the current practice of PBM at each hospital is crucial to facilitate the benchmarking of performance. Barriers to effective implementation such as lack of knowledge should be identified and acted on. Continuous audit of practice with a focus on transfusion rates and patient outcomes can identify areas in need of improvement and provide iterative feedback to motivate and inspire the main stakeholders. Accepted for publication September 8, 2017. The authors declare no conflicts of interest. Funding: None. Reprints will not be available from the authors. Address correspondence to Neel Desai, FRCA, Department of Anaesthetics, Royal Free Hospital, Pond St, London, NW3 2QG, London, United Kingdom. Address e-mail to neel_d83@hotmail.com. © 2017 International Anesthesia Research Society

http://ift.tt/2zSd15Y

Incidence of Anaphylaxis Associated With Sugammadex

We retrospectively investigated the incidence of potential sugammadex-induced anaphylaxis at a single center in Japan over a period of 3 years. The overall incidence of intraoperative hypersensitivity reaction was 0.22% (95% confidence interval [CI], 0.17%–0.29%), and the incidence of anaphylaxis was 0.059% (95% CI, 0.032%–0.10%). The total number of patients who received sugammadex during the study period was 15,479, and the incidence of anaphylaxis associated with sugammadex was 0.039% (n = 6; 95% CI, 0.014%–0.084%). This result implies that the incidence of sugammadex-associated anaphylaxis could be as high as that for succinylcholine or rocuronium. A prospective study, including testing for identification of cause, is necessary to confirm the exact incidence of sugammadex-induced anaphylaxis; however, the present finding calls attention to this potential. Accepted for publication September 12, 2017. Funding: This work was funded by the Department of Anesthesiology, Jikei University School of Medicine. The authors declare no conflicts of interest. The findings of this study were presented in part at the Annual Meeting of the Japanese Society of Anesthesiologists in Fukuoka, Japan, May 27, 2016, and the Annual Meeting of the American Society of Anesthesiologists in Chicago, IL, October 22, 2016. Reprints will not be available from the authors. Address correspondence to Hiroshi Sunaga, MD, Department of Anesthesiology, Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minatoku, Tokyo 105-8461, Japan. Address e-mail to hs-031@jikei.ac.jp. © 2017 International Anesthesia Research Society

http://ift.tt/2xnZkK9

Evidence Basis for Regional Anesthesia in Ambulatory Arthroscopic Knee Surgery and Anterior Cruciate Ligament Reconstruction: Part II Adductor Canal Nerve Block—A Systematic Review and Meta-analysis

BACKGROUND:Adductor canal block (ACB) has emerged as an effective analgesic regional technique for major knee surgeries in the last decade. Its motor-sparing properties make it particularly attractive for ambulatory knee surgery, but evidence supporting its use in ambulatory arthroscopic knee surgery is conflicting. This systematic review and meta-analysis evaluates the analgesic effects of ACB for ambulatory arthroscopic knee surgeries. METHODS:We conducted a comprehensive search of electronic databases for randomized controlled trials examining the analgesic effects of ACB compared to control or any other analgesic modality. Both minor arthroscopic and anterior cruciate ligament reconstruction (ACLR) surgeries were considered. Rest and dynamic pain scores, opioid consumption, opioid-related adverse effects, time to first analgesic request, patient satisfaction, quadriceps strength, and block-related complications were evaluated. Data were pooled using random-effects modeling. RESULTS:Our search yielded 10 randomized controlled trials comparing ACB with placebo or femoral nerve block (FNB); these were subgrouped according to the type of knee surgery. For minor knee arthroscopic surgery, ACB provided reduced postoperative resting pain scores by a mean difference (95% confidence interval) of −1.46 cm (−2.03 to −0.90) (P

http://ift.tt/2zQuMCN

No Significant Association Between the Transfusion of Small Volumes of Leukocyte-Depleted Red Blood Cells and Mortality Over 7 Years of Follow-up in Patients Undergoing Cardiac Surgery: A Propensity Score Matched Analysis

BACKGROUND:The impact of red blood cell (RBC) transfusion on long-term clinical outcome is controversial. METHODS:We prospectively recorded follow-up data of 6124 cardiac surgical patients who received no transfusion (RBC− group) or 1–2 units of leukocyte-depleted RBC (RBC+ group) at our institution. The primary end point was overall mortality up to 7 years after cardiac surgery; secondary end point was coronary artery revascularization during follow-up. To correct for nonrandomized group assignment, propensity score (PS) matching was performed. A subgroup analysis was also performed in patients with preoperative anemia. RESULTS:PS matching was possible in 4118 patients. During a mean follow-up of 4.05 years (range, 0.0–7.3 years), 140 patients (14.6%) died in the RBC− group and 173 (17.2%) died in the RBC+ group. The hazard ratio for the RBC+ group versus the RBC− group was 1.00 (95% confidence interval, 0.79–1.25; P = .969). The number of revascularizations was 96 (9.9%) and 125 (10.6%), respectively, with a hazard ratio of 1.21 (95% confidence interval, 0.92–1.58; P = .166) for the RBC+ group. Preoperative anemia was not a risk factor for postoperative mortality, even when patients were transfused. CONCLUSIONS:This PS-matched analysis does not provide evidence for an association of the transfusion of small volumes of leukocyte-depleted RBCs with an increased postoperative mortality in cardiac surgical patients. Moreover, preoperative anemia could not be identified as a risk factor for increased postoperative mortality. Accepted for publication September 6, 2017. Funding: This work was supported by the Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Ruhr-University of Bochum, Germany. The authors declare no conflicts of interest. The first two authors contributed equally to this study. Reprints will not be available from the authors. Address correspondence to Armin Zittermann, PhD, Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University of Bochum, Georgstr 11, D-32545 Bad Oeynhausen, Germany. Address e-mail to azittermann@hdz-nrw.de. © 2017 International Anesthesia Research Society

http://ift.tt/2xpDZQC

Single-Stage Repair of Palatal Fistula and Velopharyngeal Incompetence by the New L Flap.

Objective: To describe and assess the results of use of the new L-shaped posterior pharyngeal flap for repair of both palatal fistula and velopharyngeal incompetence. Methods: This study included 10 patients who were diagnosed to have soft palate fistula and persistent velopharyngeal insufficiency (VPI). L-shaped superiorly based pharyngeal flap was harvested from oropharynx and inserted into the soft palate closing the fistula after fistula trimming. The palatal part of the flap (transverse limb) was spread 1 cm horizontally and 1 cm in the anteroposterior direction in soft palate at fistula site closing it without tension. Prior to and after surgery, patients were assessed by examination, video-nasoendoscopy, and speech assessment. Results: Closure of the palatal fistula could be achieved in all patients. Postoperative speech assessment showed significant improvement in the nasal emission, resonance, intraoral pressure, and articulation defects. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in all patients. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea reported. Conclusion: The new used L-shaped pharyngeal flap could properly close palatal fistula and correct velopharyngeal functions (closure and speech) in patients with persistent VPI with no reported significant complication and without the need for palatal dissection or flaps. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2zQ7Kfa

Dermal Regenerative Template as a Cost-Effective Alternative for Complex Scalp Reconstruction.

Background: Use of dermal regeneration template (DRT) is well documented in the literature for complex wounds ranging from the scalp, trunk, and lower extremity. Methods: A retrospective cohort study was performed of the use of dermal regeneration template and skin grafting. A literature review was performed of all studies where DRT was used for scalp reconstruction. Results: Patients in the DRT cohort had an average age of 70, with wounds averaging 108 cm2 in size. These patients also had a relatively low rate of complications (0.4), a short hospital stay (average 2 days), and a relatively short operating room time (114 minutes). Conclusion: This study demonstrates dermal regeneration template to be an effective and reliable option for soft tissue reconstruction with minimal morbidity and complications in patients with extensive medical comorbidities. Emerging applications include radiation exposure and hypercoaguable states. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2xphpb5

Surgical Hypercorrection of Trigonocephaly: Evaluation of Surgical Outcomes.

Background: A lasting correction of trigonocephaly is difficult to achieve, as a durable correction requires significant expansion to overcome galeal restriction and soft tissue recoil of the scalp. High rates of relapse have been reported throughout the literature. The specific aim of this study was to determine if the senior author's method of "hypercorrection" decreases relapse and the need for subsequent revisional surgery. Methods: Patients who underwent operative correction of metopic craniosynostosis between 1988 and 2011 were reviewed. All patients underwent the "hypercorrection" technique performed by the senior author. Hypercorrection consisted of a fronto-orbital advancement of 2.5 to 3.5 cm and a concomitant hyperexpansion of bitemporal projection. Split cranial bone grafting ensured adequate coverage of the significantly expanded cranial vault. Only patients who had at least 5 years of follow-up were included for review of outcomes. Relapse was defined as recurrence of bitemporal constriction or lateral orbital retrusion, requiring surgical correction. Results: Fifty-eight patients met criteria. Mean age at the time of surgery was 11 months. Mean follow-up was 9.0 years. During this time, 2 patients exhibited relapse requiring camouflage procedures. Cranial bone defects were found in 4 patients (7%), 3 of whom underwent cranial bone grafting, while 1 underwent methylmethacrylate placement at an outside institution. One patient underwent fat grafting for areas of soft tissue irregularity. No patients exhibited persistent sequelae of hypercorrection significant enough to require repeat fronto-orbital advancement. Conclusion: Surgical hypercorrection of trigonocephaly seems to minimize relapse and the need for revision in long-term follow-up and is therefore an important technique to consider. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2zQkAKx

Isolated Intraorbital Frontosphenoidal Synostosis.

Unilateral anterior plagiocephaly is most commonly the result of deformational plagiocephaly or unilateral coronal synostosis, a premature fusion of the frontoparietal suture. However, other sutures within the coronal ring have been implicated in producing anterior cranial asymmetries. These fusions can occur in isolation or in concert with adjacent sutures. The frontosphenoidal suture is one such suture within the coronal ring that has been involved both concomitantly with and independently of frontoparietal suture fusion. Although isolated frontosphenoidal synostosis has been presented previously in the literature, these reports include patients with fusion of the extraorbital portion of the frontosphenoidal suture. This clinical report presents the first clearly documented patient of isolated frontosphenoidal synostosis that occurs entirely within the intraorbital region. The patient presented to Plastic Surgery Clinic at 3 months of age with left frontal flattening, supraorbital rim retrusion, and temporal bulging that was noted soon after birth. Computed tomography analysis revealed an isolated fusion of the greater and lesser wings of the sphenoid bone to the frontal bone on the left side. The patient had no family history of cranial anomalies and genetic testing was negative for mutations. The infant was treated with a cranial orthotic for 3 months, underwent open fronto-orbital advancement and cranial vault remodeling at 6 months, and continued wearing a cranial orthotic for another 4.5 months. Following surgical and orthotic treatment, the patient achieved a satisfactory result. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2xq7j9P

Positive Effect of Incubated Adipose-Derived Mesenchymal Stem Cells on Microfat Graft Survival.

Autologous fat grafting is commonly used for soft tissue augmentation, but its unpredictably high resorption rate remains a major limitation. Although adipose-derived mesenchymal stem cells (ASCs) are an attractive candidate for enhancing graft retention, their poor posttransplantation viability limits their application. The authors aimed to evaluate the effect of incubated ASCs on microfat graft survival in an immunocompromised mouse model. Lipoaspirates for microfat injection were collected from the wasted lower abdominal adipose tissues of 5 patients who had undergone breast reconstructive surgery with an abdominal flap. Adipose-derived mesenchymal stem cells were also isolated and proliferated from these fat tissues. Sixty athymic mice were randomly allocated to a control group (microfat grafting alone; n = 30) or ASCs group (microfat grafting plus simultaneous human ASCs injection; n = 30). The volume and weight of survived fat were measured at 8 and 16 weeks, and histopathological and immunologic staining was performed at 16 weeks. The survived fat volume of the ASCs group was significantly greater than that of the control group at 8 and 16 weeks, whereas the weight of survived fat tissues did not significantly differ. Histologic evaluation of the harvested fat indicated significantly higher levels of adipocytes, and fewer cysts and fibrosis in the tissues in the ASCs group than in the control group. The ASCs group also exhibited a significantly higher number of capillary vessels than the control group on CD31 and alpha-smooth muscle actin staining. In conclusion, transplanted fat survival is markedly higher when simultaneous microfat graft and ASCs injection were performed, as compared with that in the classical microfat graft alone method in mice; this improvement was primarily attributed to the increased ability to produce blood vessels. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2zPb5Lo

More Than Meets the Eye: The Effect of Intercanthal Distance on Perception of Beauty and Personality.

In judging normalcy, surgeons rely on established facial anthropometric measures and proportions. However, there exists a range of "normal," and a degree of disproportion may be considered more attractive. The authors set out to determine how changes in only intercanthal distance affect the layperson's perception of beauty and personality traits of a face. The authors used Amazon.com's Mechanical Turk (MTurk), a crowdsourcing tool, to determine how changes in intercanthal distance affect overall perception of beauty and personality. MTurk respondents provided demographic information and were asked to survey 16 female subjects, each digitally edited to be hypoteloric or hyperteloric. Data were collected from 490 MTurk crowd raters. Paired t test analysis found that respondents perceived subjects to be more submissive, friendly, and attractive with increased intercanthal distance (P 46 years of age were less likely to perceive a change in any of the 7 traits upon intercanthal widening, compared with respondents between 18 and 25 years of age (P

http://ift.tt/2xpkwQl

An Algorithm for Managing Intraosseous Vascular Anomalies of the Craniofacial Skeleton.

Background: Intraosseous vascular anomalies (IOVA) are rare in the craniofacial skeleton and present a diagnostic and therapeutic challenge. This study aims to describe the clinical management based on a large case series. Methods: A retrospective chart review was performed and 9 IOVA were identified over a 15-year period. Data on demographics, diagnostic features, clinical management, and outcomes were reviewed. Results: Five frontal bone IOVA and 4 orbital IOVA were identified. The postoperative follow-up ranged from 4 months to 4 years. All 9 lesions were diagnosed with computed tomography (CT) imaging. Magnetic resonance imaging (MRI) was used to delineate soft tissue involvement in 2 patients presenting with oculo-orbital dystopia and ophthalmoplegia. En bloc excision was performed in all patients. Preoperative interventional embolization was critical in the successful resection of an orbital IOVA following 2 previously failed attempts that were aborted secondary to hemorrhage. Intraoperative 3-dimensional stereotactic navigation was used for the accurate en bloc excision of a frontal IOVA to prevent injury to the frontal sinus. Reconstruction of esthetic and functional deformities was successfully accomplished. Conclusion: The diagnosis of IOVA relies primarily on clinical assessment and CT imaging. Further interpretation of the involvement of periorbital, facial, and intracranial soft tissue is best defined by MRI. Multidisciplinary care with interventional radiology and neurosurgery must be considered for ensuring the safe and adequate en bloc excision of craniofacial IOVA. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2zQXCTA

Alterations in Nasal Sensibility Following Calcium Hydroxyapatite Dorsal Augmentation.

Background: There are a many types of filler products that surgeons used for soft tissue augmentation. Soft Tissue Fillers, also known as injectable grafts, is a medical device implants. One of the materials used in soft tissue fillers is calcium hydroxylapatite (CaHA) that is commonly used for treating nasal deformities and nasal reshaping too. Calcium hydroxylapatite is a kind of mineral that can be found in human teeth and bones. It is considered long-lasting but nonpermanent filler and is biocompatible with human tissue. Aim: The aim of this study is to measure the alterations in sensibility and patient satisfaction following CaHA filler injection. Patient/Methods: In a prospective study, 30 patients who underwent CaHA filler injections from January to December 2016 at a Private Tertiary Care Hospital in Riyadh, Saudi Arabia were included. Results: Means and standard deviations were measured for pressure threshold values at each test area preprocedure 2 weeks after procedure (Table 1). Alterations between pre and postprocedure values were verified using the match-paired Student t test preprocedures. None of the patients had any subjective sensory symptoms. Majority of patients were extremely satisfied with the results. Conclusion: With correct anatomic knowledge and precise technique in doing the CaHA gel injection procedure, nasal sensibility will not be altered. In addition, injection of CaHA gel can be valuable tool for plastic surgeons to consider for nasal reshaping. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2xpklEF

Surgical Management of Migraine Headache.

Migraine surgery has been recently reported as an alternative to medical management to provide long-term relief in migraine sufferers. A prospective study was designed wherein patients diagnosed with migraine were screened for surgery by injecting botulinum toxin type A at the primary trigger site. Surgery consisted of corrugator supercilii muscle resection to decompress supra-trochlear and supra-orbital nerves with avulsion of zygomaticotemporal branch of trigeminal nerve. Using pre and postsurgery questionnaires, information regarding the degree of reduction of migraines with regard to severity and frequency; and surgical site problems was acquired. Thirty patients volunteered for migraine surgery. Mean migraine headaches reduced from 15.2 +/- 6.3 episodes per month to 1.9 +/- 2.4 episodes per month (P

http://ift.tt/2zQXCD4

Rigid External Distractor-Aided Advancement After Simultaneously Performed LeFort-III Osteotomy and Fronto-Orbital Advancement.

Due to the complex development of the craniofacial skull, corrective surgery is a major challenge for patients with severe craniofaciostenosis. Although fronto-orbital advancement and simultaneous LeFort-III osteotomy in combination with distraction osteogenesis have been reported as a safe and successful method to obtain good esthetic and functional results, there is a lack of studies evaluating this method. Our retrospective study included 12 patients with syndromic craniofaciostenosis, who were primarily treated at our department in accordance with a standardized treatment protocol, consisting of a simultaneous fronto-orbital advancement with LeFort-III osteotomy in combination with a rigid external distractor (RED-II). Distraction distance, duration of operation, postoperative complications, perioperative hemoglobin concentration, esthetic outcome, and the subjective Whitaker Scale were used to evaluate the success of our surgical method. The esthetic outcome of all of our patients was assessed as good. Furthermore, the surgical outcome was assigned I for 11 patients and II for 1 patient, who suffered from wound healing disturbance at the left temporal site, which required revision 2 weeks postoperatively. The mean skeletal advancement of the midface was 16.4 mm, ranging from 12 to 20 mm. Our standardized treatment protocol, consisting of fronto-orbital advancement in combination with LeFort-III osteotomy and application of a rigid external distractor device (RED-III) for patients with severe syndromic craniofaciostenosis, goes along with low infection rates and more predictable and precise esthetic and functional outcomes than the conventional surgical technique without distraction osteogenesis. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2xpkU1e