Head and Neck Medicine by Alexandros G.Sfakianakis: 11/03/17

Παρασκευή 3 Νοεμβρίου 2017

Nationwide French Study of RET Variants Detected from 2003 to 2013 Suggests a Possible Influence of Polymorphisms as Modifiers

Thyroid , Vol. 0, No. 0.

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Most cited publications in oral and maxillofacial surgery: a bibliometric analysis

Abstract

Background

Citation is one of the most important forms of acknowledgment and recognition received by our peers in academia. This study identifies and characterizes the current topmost highly cited publications in journals specifically dedicated to the specialty. The purpose of this study is to identify, using the citation count, works that have made key contributions in the field and to provide insight into the direction the specialty has taken in the last 30 years.

Methods

Four journals that were dedicated to the field of oral and maxillofacial surgery (OMFS) were selected. The SCOPUS database was utilized to perform a citation analysis on the top 200 publications in the month of May, 2017. Each publication was individually reviewed for the number of citations, the source journal of the manuscript, its year of publications, the article type, the country of origin, the study type, and the level of evidence. We categorized every manuscript within a subspecialty.

Results

The number of citations ranged from 2824 to 118 over the last four decades. The majority of the manuscripts were published in the Journal of Oral and Maxillofacial Surgery (60.5%) followed by the International Journal of Oral and Maxillofacial Surgery (25%). Only 3% of these publications were of level I evidence. The most frequent field of publication was benign pathology (18.5%) followed by dental implantology (19%) and then craniomaxillofacial trauma (12%) and craniomaxillofacial deformities (12%). The majority of the publications were articles, of which 59.5% were case-control, case series, or cohort studies. Nine of the top 20 most cited articles and 12.5% of all the most cited papers were related to osteoradionecrosis, osteochemonecrosis, and bisphosphonates. The majority of these publications originated in the USA (44%), followed by Sweden (9.20%), the Netherlands and UK (7.76%), and Germany (5.82%).

Conclusion

Despite considerable advances in the quality of both clinical and laboratory research, only six level I studies were identified. Osteonecrosis/bisphosphonates and platelet-rich plasma were frequent topics indicating the recent interests in these fields. The USA has continued to play a major role in the research; however, there needs to be more international, multi-institutional cooperative collaborations.

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A case of traumatic infraorbital neuroma

Abstract

A 53-year-old Afghan man presented with a 12-month history of left proptosis, diplopia and facial swelling 20 years after a bomb blast injury. Magnetic resonance and computed tomography imaging revealed a well-circumscribed lesion centred within the left inferior orbit/superior maxillary sinus along with left orbital fracture. Histopathology and immunostaining of the debulked lesion were consistent with traumatic neuroma of the infraorbital nerve. Infraorbital neuromas have developed following orbital decompression surgeries but have not been reported previously following non-surgical trauma.

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Most cited publications in oral and maxillofacial surgery: a bibliometric analysis

Abstract

Background

Methods

Results

Conclusion

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Antiandrogenic drugs, a therapeutic option for frontal fibrosing alopecia patients

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Tofacitinib 2% ointment, a topical janus kinase inhibitor, for the treatment of alopecia areata: a pilot study of 10 patients

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Subclinical Sensitization with Diphenylcyclopropenone is Sufficient for the Treatment of Alopecia Areata: Retrospective Analysis of 159 Cases

Conventional diphenylcyclopropenone contact immunotherapy has been used in the treatment of extensive alopecia areata, but can be associated with severe adverse effects (AEs).Even without an eczematous reaction after sensitization, sufficient therapeutic responses were achieved without severe AEs.Sensitization to induce an eczematous reaction may not be required for successful contact immunotherapy.

http://ift.tt/2A68Jah

A Novel, Non-Invasive Anesthetic Method for Neurotoxin Injection for Palmar Hyperhidrosis

http://ift.tt/2A6Sgm7

Preventing and Responding to Teen Dating Violence: A National Study of School Principals' Perspectives and Practices

Violence and Gender , Vol. 0, No. 0.

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Impact of contracted endodontic cavities on fracture resistance of endodontically treated teeth: a systematic review of in vitro studies

Abstract

Objective

This systematic review was performed to answer the following question: do contracted endodontic cavities (CECs) increase resistance to fracture in extracted human teeth compared to traditional endodontic cavities (TECs)?

Methods

A literature search without restrictions was carried out in PubMed, Science Direct, Scopus, Web of Science, and Open Grey databases. Articles were selected by two independent reviewers. In addition, a reference and hand search was also fulfilled. All included in vitro studies evaluated the influence of CECs on strength to fracture in extracted human teeth and compared to TECs. The quality of the selected studies was evaluated and they were classified as having a low, moderate or high risk of bias.

Results

A total of 810 articles were obtained in the electronic search. After the application of the eligibility criteria, reference and hand search, and duplicate removal, six studies were included in this systematic review. All included studies evaluated the influence of CECs on strength to fracture in extracted human teeth and compared to TECs. Characteristics investigated in the selected articles included the sample size and tooth type, access cavity design, filling and restoration procedures, load at fracture test characteristics, and results. The studies demonstrated large variability among the fracture resistance values and standard deviations and low power. Three of the reviewed studies presented low risk of bias and the other three showed medium risk of bias.

Conclusion

Overall, this systematic review of in vitro studies showed that there is no evidence that supports the use of CECs over TECs for the increase of fracture resistance in human teeth.

Clinical relevance

Recently, CECs have gained attention in endodontics due to maximum tooth structure preservation including the pericervical dentin, which could improve the strength to fracture of endodontically treated teeth. However, the influence of access cavity design on fracture resistance remains limited and controversial.

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Founder Effect of the RETC611Y Mutation in Multiple Endocrine Neoplasia 2A in Denmark: A Nationwide Study

Thyroid , Vol. 0, No. 0.

http://ift.tt/2Ah81b4

An exotic abscess within the United Kingdom from The Gambia: a case report

Furuncular myiasis is a parasitic infection of a live mammal by fly larvae commonly seen in Africa. However, with an increase in international tourism, there is a significant rise in exotic infection in non-en...

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Conjugated Bilirubin Upregulates TIM-3 Expression on CD4+CD25+ T Cells: Anti-Inflammatory Implications for Hepatitis A Virus Infection

Viral Immunology , Vol. 0, No. 0.

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Response to case report: Airway autoimmune responses in severe eosinophilic asthma following low-dose Mepolizumab therapy

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Elastic stains in the evaluation of DCIS with comedo necrosis in breast cancers

Abstract

As concerns the microscopic morphology of ductal carcinoma in situ (DCIS), neoplastic cells are surrounded by both a myoepithelial cell layer and a basement membrane as expected from the outer structure of ducts and lobules. However, in some cases, it is impossible to state whether the structures involved by the disease are ducts or lobules. Altogether 1220 anatomic structures involved by DCIS displaying comedo necrosis from 27 slides of 21 patients (seen on both haematoxylin and eosin-stained and orcein-stained slides) were identified as representing ducts, likely ducts, unclassifiable structures, likely acini or acini on the basis of their distribution and resemblance to normal anatomic structures. All structures were then rated as having a circumferential elastic layer (as normal ducts), a partial elastic layer around more or less than half of the periphery or having no peripheral elastic layer at all (as normal acini). Structures classified as ducts or likely ducts were likely to have an elastic coating, whereas acini and likely acini had no such coating. Unclassifiable structures were generally devoid of an elastic layer. Structures (and cases) that were likely to represent neoductgenesis as proposed by Zhou et al. (Int J Breast Cancer 2014;2014:581706) were generally unclassifiable and devoid of outer elastic layer. Many duct-like structures in DCIS with comedo necrosis are devoid of elastic layer typical of normal ducts, suggesting that these structures are abnormal despite conservation of the myoepithelium and the basement membrane.

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Oral pregabalin for acute pain relief after cervicofacial surgery: a systematic review

Abstract

Objective

The objectives of this systematic review were to unify criteria on the effectiveness of oral pregabalin to treat acute post-operative pain after cervicofacial surgery, to establish the most effective dose regimens, and to determine its effect on rescue medicine consumption and its association with adverse effects.

Materials and methods

PubMed/Medline (National Library of Medicine, Washington, DC), Scopus, Web of Science, and Cochrane databases were searched for studies in any language published between January 2000 and September 2016. The following question was posed, in accordance with PRISMA guidelines: Is oral pregabalin effective and safe for the relief of acute pain after cervicofacial surgery? The critical reading of the literature utilized a list of questions prepared by the CASPe Network, applying the Jadad scale for evaluation of the methodological quality of trials.

Results

Eleven randomized controlled clinical trials were selected. The 11 trials obtained a score ≥ 3, considered as Ib evidence level and high quality. A single oral dose of 75-mg pregabalin before or after cervicofacial surgery alleviates pain and lessens the need for rescue analgesia consumption, while the statistical significance of these effects is higher with a single dose of 150-mg pregabalin, either before or after the surgery.

Conclusion

Oral pregabalin appears to significantly alleviate post-operative pain and reduce rescue analgesia consumption, with no severe adverse effects. However, the ideal dose and most effective administration regimen remain controversial issues that need to be addressed in further high-quality clinical trials.

Clinical relevance

These findings suggest that pregabalin may be useful for acute pain relief after cervicofacial surgery.

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Analgesic Drug Prescription After Carpal Tunnel Surgery: A Pharmacoepidemiological Study Investigating Postoperative Pain.

Background and Objectives: Carpal tunnel syndrome is a frequent cause of neuropathic pain of the upper limb. Surgery is often proposed in second-line treatment, leading to an expected decrease in analgesic drug consumption. The main objective of this study was to investigate the variations in analgesic drug prescriptions, with a special focus on constant or increasing prescription patterns, before and after surgery for carpal tunnel syndrome. Methods: We designed a retrospective cohort study of French beneficiaries from the health insurance system in Midi-Pyrenees area. All patients undergoing carpel tunnel surgery during a specified period were identified and included. Definition of increased or constant prescription of analgesics was based on the comparison of the accumulated defined daily doses received by months and a difference between early preoperative (2 months before) and late postoperative period (2-12 months after surgery) superior to a -3.5 margin. We performed 4 multivariate logistic regression models to identify factors associated with increased or constant analgesic drug prescription patterns (for all analgesics, opioid, antineuropathic, nonopioid drugs). Results: Among the 3665 patients included, 3255 (89%) received at least 1 analgesic drug during the late postoperative period (39% [n = 1426] for opioids and 15% [n = 563] for antineuropathic drugs). Prescription of analgesic, opioid, or antineuropathic drugs was maintained or increased in the late postoperative period in 11%, 5%, and 3% of the population, respectively. High levels of preoperative pain and female sex were associated with an increase in opioid use, whereas inpatient surgery (vs ambulatory surgery), high levels of preoperative pain, and psychiatric disorders were found to be associated with an increase in antineuropathic drug use. Conclusions: This study revealed that approximately 3% to 5% of patients undergoing carpal tunnel surgery had persistent and even increased use of opioid or antineuropathic drugs more than 2 months after surgery, in relation with possible chronic postoperative pain. Considering the incidence of carpal tunnel syndrome, the risks associated with persistent opioid use in this population should be further monitored. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Transversus Abdominis Plane Catheters for Analgesia Following Abdominal Surgery in Adults.

Transversus abdominis plane (TAP) catheters are increasingly being used as an opioid-sparing analgesic technique following abdominal surgery. The aim of this systematic review is to evaluate the efficacy and safety of TAP catheters for postoperative analgesia following abdominal surgery in adults. The authors searched electronic databases and relevant reference lists for randomized controlled trials published between inception and January 2017. Twelve randomized controlled trials were identified, comprising 661 participants, with several trials showing either an equivalence or superiority in analgesia compared with the alternative modality. Because of the extremely heterogeneous nature of the studies, a specific consensus regarding their results, or the ability to construct a meta-analysis, is unviable. Although there are promising indications for the benefit of TAP catheter techniques, extrapolation/comparison of results and application to patient care will be better elucidated when there is more standardization of TAP catheter techniques and the methodology for measuring efficacy. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Multimarker Assessment of Diastolic Dysfunction in Metabolic Syndrome Patients

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

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Editorial Board/Aims & Scope

Publication date: November 2017
Source:Oral Oncology, Volume 74

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The clinicopathological spectrum of olfactory neuroblastoma and sinonasal neuroendocrine neoplasms: Refinements in diagnostic criteria and impact of multimodal treatments on survival

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Publication date: November 2017
Source:Oral Oncology, Volume 74
Author(s): Mario Turri-Zanoni, Roberta Maragliano, Paolo Battaglia, Marta Giovannardi, Paolo Antognoni, Davide Lombardi, Maria Laura Morassi, Ernesto Pasquini, Paolo Tarchini, Sofia Asioli, Maria Pia Foschini, Fausto Sessa, Piero Nicolai, Paolo Castelnuovo, Stefano La Rosa
ObjectivesTo provide a comprehensive review of the clinical and histopathological features of olfactory neuroblastoma (ONB) and other sinonasal neuroendocrine neoplasms (NENs), in order to refine diagnostic criteria, analyze treatment outcomes, and identify prognostic factors.MethodsData from an Italian multi-institutional database were analyzed. Patients were treated surgically via a minimally-invasive endoscopic approach followed by adjuvant radiotherapy or radiochemotherapy. Neoadjuvant cisplatin/etoposide chemotherapy was administered in cases of poorly-differentiated tumors. A centralized pathology review was performed in all cases. Patients were prospectively observed for survival. Overall (OS) and Disease-free survival (DFS) estimates were determined from Kaplan-Meier analysis and compared using the log-rank test. Statistically significant variables were entered in a multivariate Cox regression model.Results98 patients with a median follow-up of 53months were included. Morphology review and the incorporation of cytokeratin 8/18 in the immunohistochemical panel modified the final diagnosis in 8/98 (8.2%) cases. The neoplasms were ultimately classified into four groups with different immunohistochemical profiles and clinical behaviors: ONB in 67 cases (5-year-OS, 91.6%); NEC (poorly-differentiated neuroendocrine carcinoma) in 22 cases (5-year-OS, 42.6%); MiNEN (mixed neuroendocrine/non-neuroendocrine neoplasm) in five cases (5-year-OS, 0%,0/5 cases); and NET (well-differentiated neuroendocrine tumor) in four cases (5-year-OS, 50%, 2/4 cases). Hyams grade and Ki67 index were independent prognostic factors for ONB. Neoadjuvant chemotherapy appeared to be associated with improved OS and DFS for NEC, independent of other clinicopathological variables.ConclusionsInduction chemotherapy improves survival outcomes in patients affected by poorly-differentiated tumors. Recent advances in histopathological diagnosis, including CK8/18 staining, allow to plan the most appropriate range of multimodal treatments.

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Chemotherapy regimens containing taxanes or fluorouracil in nasopharyngeal carcinoma: Which better?

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Publication date: November 2017
Source:Oral Oncology, Volume 74
Author(s): Jing-Lin Mi, Bin Zhang, Yu-Fei Pan, Yi-Xin Su, Jin-Fang Fan, Shu-Fang Liao, Xiao-Li Qin, Da-Cheng Yao, Hua-Ying Tang, Wei Jiang
ObjectivesThe efficacy of various chemotherapy regimens in nasopharyngeal carcinoma (NPC) remains under debate. We compared the efficacy and toxicity of a taxane-based regimen and regimen including fluorouracil in NPC.Materials and methodsEight-hundred and six patients with stage II-IVB NPC from four institutions in China were pair-matched (1:1 ratio) to the cisplatin plus fluorouracil (PF) group or cisplatin plus taxanes (TP) group using eight clinical factors. Overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS) were assessed using the Kaplan-Meier method and Cox regression model. Toxicities were assessed in all patients.ResultsThree-year DFS was significantly better in the TP group than PF group (82.5% vs. 72.7%, P=0.002), with no significant difference in OS, LRRFS or DMFS. TP led to significantly better DFS compared to PF in the subgroups advanced stage NPC, patients aged ≤45-years-old and female patients. In multivariate analysis, chemotherapy regimen was an independent prognostic factor for DFS [hazard ratio, 0.591, 95% CI 0.444–0.786, P=0.000]. Grade 3–4 leukopenia, neutropenia and anemia were significantly more common in the TP group; grade 3–4 mucositis, vomiting, vasculitis and diarrhea were more common in the PF group.ConclusionTaxane-based regimens have a higher efficacy in NPC than regimens including fluorouracil, especially in patients with advanced stage, patients aged≤45-years-old and female patients.

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Reconstruction Special Edition, Issue 1

Publication date: November 2017
Source:Oral Oncology, Volume 74
Author(s): Matthew Old

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Perforator based rectus free tissue transfer for head and neck reconstruction: New reconstructive advantages from an old friend

Publication date: November 2017
Source:Oral Oncology, Volume 74
Author(s): Stephen Y. Kang, Matthew E. Spector, Douglas B. Chepeha
ObjectivesTo demonstrate three reconstructive advantages of the perforator based rectus free tissue transfer: long pedicle, customizable adipose tissue, and volume reconstruction without muscle atrophy within a contained space.Materials and methodsThirty patients with defects of the head and neck were reconstructed with the perforator based rectus free tissue transfer.ResultsTransplant success was 93%. Mean pedicle length was 13.4cm. Eleven patients (37%) had vessel-poor necks and the long pedicle provided by this transplant avoided the need for vein grafts in these patients. Adipose tissue was molded in 17 patients (57%). Twenty-five patients (83%) had defects within a contained space, such as the orbit, where it was critical to have a transplant that avoided muscle atrophy.ConclusionsThe perforator based rectus free tissue transfer provides a long pedicle, moldable fat for flap customization, and is useful in reconstruction of defects within a contained space where volume loss due to muscle atrophy is prevented.

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Reflections: Paul Bernard Chretien, MD (1931-2017)

Publication date: November 2017
Source:Oral Oncology, Volume 74
Author(s): Gregory T. Wolf

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Vascular consideration in repair of total scalp avulsion

Jun Karibe Oct 24, 2017; 2017:bcr-2017-220605-bcr-2017-220605 Unusual presentation of more common disease/injury

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Use of a dynamic gait trainer for a child with thoracic level spinal cord injury

Wendy Altizer Oct 10, 2017; 2017:bcr-2017-220756-bcr-2017-220756 Novel treatment (new drug/intervention; established drug/procedure in new situation)

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Severe liver injury due to Epsom salt naturopathy

Cyriac Abby Philips Oct 2, 2017; 2017:bcr-2017-221718-bcr-2017-221718 Images in...

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Could kinesiology taping help mitigate pain, breathlessness and abdominal-related symptoms in cancer?

Gourav Banerjee Feb 24, 2017; 2017:bcr2016216695-bcr2016216695 case-report

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Unexpected Cardiac Computed Tomography Findings in Patients With Postoperative Myocardial Injury

BACKGROUND: Postoperative myocardial injury (PMI) is a strong predictor of mortality after noncardiac surgery. PMI is believed to be attributable to coronary artery disease (CAD), yet its etiology is largely unclear. We aimed to quantify the prevalence of significant CAD in patients with and without PMI using coronary computed tomography angiography (CCTA). METHODS: This prospective cohort study included patients of 60 years or older without a history of cardiac disease and with and without PMI after intermediate- to high-risk noncardiac surgery. PMI was defined as any serum troponin I level ≥60 ng/L on the first 3 postoperative days. Main exclusion criteria were known cardiac disease and postoperative ischemic symptoms or electrocardiography abnormalities. Noninvasive imaging consisted of a postoperative CCTA. Main outcome was CAD defined as >50% coronary stenosis on CCTA. RESULTS: The analysis included 66 patients. Median peak troponin levels in the PMI (n = 46) and control group (n = 20) were 150 (interquartile range, 120–298) vs 15 (interquartile range, 10–31) ng/L (P

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Teacher and Trustee: Examining the Ethics of Experiential Learning in Transesophageal Echocardiography Education

No abstract available

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Artificial Ventilation: A Basic Clinical Guide

No abstract available

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Neuroprotective Effects of Fasudil, a Rho-Kinase Inhibitor, After Spinal Cord Ischemia and Reperfusion in Rats

BACKGROUND: Excessive Rho/Rho-kinase pathway activation occurs subsequent to stroke. We examined the neuroprotective effects of pre- and posttreatment with fasudil (a Rho-kinase inhibitor) in a rat transient spinal cord ischemia-reperfusion model under normothermic conditions. METHODS: After approval by our animal research committee, male Sprague-Dawley rats were assigned to 1 of 6 groups: pre- and postcontrol (C); pre- and postfasudil (F); and pre- and postsham (S). Fasudil (10 mg/kg) or normal saline was administered intravenously over 30 minutes before ischemia in the pre-F or pre-C groups, and over 30 minutes after reperfusion in the post-F or post-C groups. Sham groups were not subjected to ischemia. Ischemia was induced by aortic occlusion using a balloon catheter combined with hypotension for 10 minutes. Neurologic deficit scores (NDS; 0–8 points) were assessed 1, 7, and 14 days after ischemia, and then histopathologic outcomes were assessed. RESULTS: NDS 7 and 14 days after ischemia in the pre-F group (median [range]; 3.5 [2–6] and 2.5 [0–6]) were lower than those in the pre-C group (5.5 [4–7] and 4.5 [4–6]; P = .046 and P = .049), whereas NDS in the post-F group and in the post-C group were not different. The numbers of intact neurons in the gray matter in the pre- and post-F groups (mean ± standard deviation [95% confidence interval]: 25 ± 7 [20–30] and 16 ± 5 [12–19]) were greater than those in the pre- and post-C groups (11 ± 5 [7–14] and 9 ± 3 [7–11]; P

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The Society for Obstetric Anesthesia and Perinatology Consensus Statement on the Anesthetic Management of Pregnant and Postpartum Women Receiving Thromboprophylaxis or Higher Dose Anticoagulants

Venous thromboembolism is recognized as a leading cause of maternal death in the United States. Thromboprophylaxis has been highlighted as a key preventive measure to reduce venous thromboembolism–related maternal deaths. However, the expanded use of thromboprophylaxis in obstetrics will have a major impact on the use and timing of neuraxial analgesia and anesthesia for women undergoing vaginal or cesarean delivery and other obstetric surgeries. Experts from the Society of Obstetric Anesthesia and Perinatology, the American Society of Regional Anesthesia, and hematology have collaborated to develop this comprehensive, pregnancy-specific consensus statement on neuraxial procedures in obstetric patients receiving thromboprophylaxis or higher dose anticoagulants. To date, none of the existing anesthesia societies' recommendations have weighed the potential risks of neuraxial procedures in the presence of thromboprophylaxis, with the competing risks of general anesthesia with a potentially difficult airway, or maternal or fetal harm from avoidance or delayed neuraxial anesthesia. Furthermore, existing guidelines have not integrated the pharmacokinetics and pharmacodynamics of anticoagulants in the obstetric population. The goal of this consensus statement is to provide a practical guide of how to appropriately identify, prepare, and manage pregnant women receiving thromboprophylaxis or higher dose anticoagulants during the ante-, intra-, and postpartum periods. The tactics to facilitate multidisciplinary communication, evidence-based pharmacokinetic and spinal epidural hematoma data, and Decision Aids should help inform risk–benefit discussions with patients and facilitate shared decision making. Accepted for publication August 24, 2017. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). The Appendix provides the full list of the SOAP VTE Taskforce members, along with their respective affiliations. Reprints will not be available from the authors. Address correspondence to Lisa Leffert, MD, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114. Address e-mail to lleffert@partners.org. © 2017 International Anesthesia Research Society

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Tricuspid Regurgitation Due to Absent Tricuspid Valve Leaflet: Utility of Three-Dimensional Echocardiography

No abstract available

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Can Lung Ultrasound Be the First-Line Tool for Evaluation of Intraoperative Hypoxemia?

No abstract available

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Is It Time to Reconsider the Concepts of “Universal Donor” and “ABO Compatible” Transfusions?

No abstract available

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The Anesthesia Records of Harvey Cushing and Ernest Codman

Hundreds of thousands of anesthesia records are created each day. The earliest records were prepared by 2 medical students in late 19th-century Boston. Ernest Codman and Harvey Cushing went on to become prominent surgeons and contributed much to the safety of the surgical patient. Cushing's career is celebrated due to his associations with William Stewart Halsted, Peter Bent Brigham Hospital, Yale University, in New Haven, Connecticut, and his biography of Sir William Osler. Codman is remembered for introducing the morbidity and mortality conference as well as his drive to improve outcomes and patient safety. We analyze every anesthetic record created by Codman and Cushing and provide both a historical context and perspective on many ways in which their doggedness, brilliance, and insight anticipated many advances that enhanced safety for patients undergoing surgical procedures. Accepted for publication September 4, 2017. Funding: This study received intramural support. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Sukumar P. Desai, MD, Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. Address e-mail to sdesai@partners.org. © 2017 International Anesthesia Research Society

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Type B Aortic Dissection Diagnosed by Left-Sided Transthoracic Ultrasonography in a Woman With Preeclampsia

No abstract available

http://ift.tt/2xVYPYb

Percutaneous Closure of Complex Membranous Ventricular Septal Defect Under Transesophageal Echocardiographic Guidance

No abstract available

http://ift.tt/2zc1AWO

Colloids and the Microcirculation

Colloid solutions have been advocated for use in treating hypovolemia due to their expected effect on improving intravascular retention compared with crystalloid solutions. Because the ultimate desired effect of fluid resuscitation is the improvement of microcirculatory perfusion and tissue oxygenation, it is of interest to study the effects of colloids and crystalloids at the level of microcirculation under conditions of shock and fluid resuscitation, and to explore the potential benefits of using colloids in terms of recruiting the microcirculation under conditions of hypovolemia. This article reviews the physiochemical properties of the various types of colloid solutions (eg, gelatin, dextrans, hydroxyethyl starches, and albumin) and the effects that they have under various conditions of hypovolemia in experimental and clinical scenarios. Accepted for publication September 27, 2017. Funding: H.H. received funding from the China Scholarship Council (No. 201608110082) and the Organization Department of Beijing Municipal Committee (No. 2015000020124G072). C.I. has received honoraria and independent research grants from Fresenius-Kabi, Bad Homburg, Germany, and Baxter HealthCare, Deerfield, IL. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Can Ince, PhD, Department of Intensive Care, Erasmus Medical Center, s-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands. Address e-mail to c.ince@erasmusmc.nl. © 2017 International Anesthesia Research Society

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Profil der Kaposi-Sarkom-Patienten im Kompetenznetz HIV/AIDS

Zusammenfassung

Hintergrund

Das Kaposi-Sarkom (KS) stellt die häufigste der Neoplasien dar, die das „acquired immune deficiency syndrome" (AIDS) definieren. Es wurden nur wenige Studien über den Verlauf und die Behandlung des mit dem „human immunodeficiency virus" (HIV) assoziierten KS in Deutschland durchgeführt.

Ziel der Arbeit

Im Rahmen dieser Studie wurde der Verlauf des HIV-assoziierten KS bei Patienten aus der Kohortendatenbank des Kompetenznetz HIV/AIDS beobachtet.

Material und Methoden

Von HIV-positiven Patienten mit KS aus 9 deutschen Schwerpunktzentren wurden Daten des Zeitraum 1987–2011 retrospektiv erhoben. Kaplan-Meier-Kurven für die Rezidiv- und Überlebenswahrscheinlichkeit wurden berechnet.

Ergebnisse

Bei 222 Patienten wurde ein KS im medianen Lebensalter von 38,5 ± 10,1 Jahren diagnostiziert. Es waren nahezu ausschließlich Männer betroffen (97,7 %). Die HI-Viruslast zum Diagnosezeitpunkt lag bei 7,4 % unter 50 Kopien/ml. Es entwickelten 55,5 % der Patienten ein KS bei CD4-Zellzahlen unter 200 Zellen/µl und 9,5 % bei über 500 Zellen/µl. Bei 68 Patienten bestand die KS-Therapie ausschließlich in der Optimierung bzw. der Einleitung der antiretroviralen Therapie (ART). Zusätzlich wurden 71 Patienten mit pegyliertem liposomalem Doxorubicin behandelt. Während der medianen Follow-up-Dauer von 8,9 ± 4,9 Jahren traten bei 80,2 % der Patienten keine KS-Rezidive auf. Die Überlebenswahrscheinlichkeiten nach 5 und 10 Jahren betrugen 96,8 % und 91,3 %.

Schlussfolgerung

Auch bei gutem Immunstatus traten HIV-assoziierte KS auf. Eine effektive ART stellte die wichtigste Therapiesäule dar. Bei angemessener Therapie zeigten HIV-positive Patienten mit KS eine gute Überlebensrate.

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Chyluria: a scourge of our region

Rajan Kumar Sinha Jul 6, 2015; 2015:bcr2014209188-bcr2014209188 case-report

http://ift.tt/2j0ZuF1

Vanishing lung syndrome mistaken for bilateral spontaneous pneumothorax

Faisal A Khasawneh Oct 17, 2013; 2013:bcr2013201016-bcr2013201016 case-report

http://ift.tt/2Ai3Hs4

Devastating complication of silver nitrate instillation for the treatment of chyluria

Manish Garg Sep 26, 2013; 2013:bcr2013201270-bcr2013201270 case-report

http://ift.tt/2j0ZjJR

Tuberculous gumma: a forgotten entity in the UK

Louise Parker Sep 26, 2013; 2013:bcr2013010462-bcr2013010462 case-report

http://ift.tt/2AfGKG2

Asymptomatic submitral aneurysm: an uncommon complication of a common disease

G Vivek Jun 24, 2013; 2013:bcr2013200032-bcr2013200032 case-report

http://ift.tt/2j0Z8OH

Successful treatment of massive intractable pericardial effusion in a patient with systemic lupus erythematosus with tocilizumab

Yasuyuki Kamata Dec 21, 2012; 2012:bcr2012007834-bcr2012007834 case-report

http://ift.tt/2AfGF5c

Biomarkers related to bullous pemphigoid activity and outcome

Abstract

Bullous pemphigoid (BP) is the most common autoimmune sub-epidermal blistering disease of the skin. Investigation of the BP-associated pathophysiological processes during the last decades showed that the generation of auto-antibodies directed against the hemidesmosome proteins BP180 and BP230, a hallmark of the BP-associated autoimmune response, leads to the recruitment of inflammatory immune cells at the dermal-epidermal junction, and subsequently to the release of a large amount of inflammatory molecules involved in blister formation. Analysis in transversal and longitudinal studies of autoantibodies and inflammatory molecules production both at time of diagnosis and under treatment was mainly performed within the serum but also in the blister fluid. Some autoimmune or inflammatory molecules expression was related to the presence of clinical signs, while others were mere bystanders. In this review, we focused on the autoimmune and inflammatory molecules that have been identified as potential biomarkers of BP development and outcome.

http://ift.tt/2yrIWx5

Tanning Salons Often Ignore Laws Restricting Use by Minors

More than one-third of indoor tanning salons don't follow state laws limiting use by children and teens, a U.S. study suggests.
Reuters Health Information

http://ift.tt/2hzLLkZ

Hyalinizing Clear Cell Carcinoma of the Tonsil: A Case Report

Abstract

Hyalinzing clear cell carcinoma is a rare tumor of the oral cavity and is even more rarely located in the tonsil. Here, we present a case report of a pedunculated tonsillar mass in a nearly asymptomatic patient that was present for 2 years prior to removal. Complete surgical excision was achieved and no adjuvant therapy was recommended. We include a discussion of this rare pathology and its typical clinical presentation and course.

http://ift.tt/2lMZgCw

Sclerosing Mucoepidermoid Carcinoma of the Submandibular Gland Presenting as Chronic Sialadenitis: A Case Report and Review of Literature

Abstract

Sclerosing mucoepidermoid carcinoma of the salivary gland (SMEC) is a rare subtype of mucoepidermoid carcinoma (MEC), first described in 1987 by Chan and Saw. As far as we are aware, only 30 cases have been published since then. Most cases were located in the parotid gland with some cases described in the submandibular and minor salivary glands. SMEC typically presents as a long-standing mass, with a non-specific enhancing appearance on imaging and is often non-diagnostic on fine needle aspiration, making pre-operative diagnosis very difficult. It is characterised by dense sclerosis within an otherwise typical MEC, frequently with lymphoid proliferation and eosinophils at the periphery. The histological diagnosis of SMEC can be challenging, as the sclerosis may obscure the other morphological features, which can lead to misdiagnosis. Grading can also be difficult, and the prognostic value of grading for SMEC remains unclear. Herein is described a new case of SMEC, presenting clinically as chronic sialadenitis in the left submandibular gland of a 41 year old male. A brief literature review and the issues surrounding diagnosis and grading are also discussed.

http://ift.tt/2yrAvSi

Pseudomyogenic Hemangioendothelioma: A Vascular Tumor Previously Undescribed in the Oral Cavity

Abstract

The pseudomyogenic hemangioendothelioma (PMH) is a low-grade malignant vascular neoplasm of different tissue planes including skin and soft tissue. Primary tumors in the skeletal muscle and bone have also been diagnosed. The PMH was introduced into the WHO classification of tumors of soft tissue and bone in 2013. This is the first description of oral involvement. A 21-year-old female presented with a 2-month old swelling of her gingiva. The swelling appeared red in color and was soft in consistency. A clinical diagnosis of a pyogenic granuloma was made and an incisional biopsy was submitted for histopathological evaluation. The lesion consisted of a proliferation of spindle and epithelioid looking cells. Cells were arranged in loose fascicles and sheets. Rhabdomyoblast-like cells were also seen. No mitotic figures were present. Lesional cells were reactive to cytokeratin AE1/AE3 and CD31. Lesional cell reactivity to S100 protein, HMB 45, SMA, Desmin and CD34 was negative. Following the diagnosis, a wide excision for clear margins was performed. No recurrence has been reported 2 years since the removal. The PMH is a cutaneous tumor that behaves in an indolent fashion. This is the first report of oral involvement by this neoplasm. Recognition of its histopathological features and immunohistochemical reactivity will prevent misadventures in the diagnosis of oral lesions.

http://ift.tt/2yqOSXf

Metastasizing Pleomorphic Adenoma Case Report and Review of the Literature

Abstract

Pleomorphic adenoma (PA) is by far the most common salivary gland tumor. It is well known that PA can undergo malignant transformation. However, in rare occasions it can metastasize preserving its benign phenotype. Metastasizing pleomorphic adenoma (MPA) constitutes an extremely rare tumor. Here we are reporting an unusual MPA affecting the mandible that was preceded by a submandibular gland pleomorphic adenoma.

http://ift.tt/2lLv4b1

Hyalinizing Clear Cell Carcinoma of the Bronchus

Abstract

Hyalinizing clear cell carcinoma (HCCC) is an uncommon low-grade minor salivary gland neoplasm that usually arises in the head and neck region. We report a 55-year-old man who presented with a 2.5 cm lung mass that was partially obstructing the right bronchus intermedius. The tumor consisted of cords and nests of clear and eosinophilic cells in a hyalinized stromal background. The neoplastic cells expressed cytokeratin (CK) 7, CK 5/6, high-molecular weight cytokeratin (34BE12), p63 and p40, while TTF-1, napsin A, CK20, S100, smooth muscle actin, synaptophysin and chromogranin were negative. Mucicarmine stain also was negative in the lesional cells. Fluorescence in situ hybridization using break apart probes revealed rearrangement of the Ewing Sarcoma Breakpoint Region 1 gene locus. The morphologic, immunophenotypic and cytogenetic findings confirmed the diagnosis of HCCC, most likely of bronchial submucosal gland origin. To our knowledge, only two other reports of primary pulmonary HCCC are available in English literature.

http://ift.tt/2yrGer9

Hyalinizing Clear Cell Carcinoma of the Tonsil: A Case Report

Abstract

http://ift.tt/2lMZgCw

Sclerosing Mucoepidermoid Carcinoma of the Submandibular Gland Presenting as Chronic Sialadenitis: A Case Report and Review of Literature

Abstract

http://ift.tt/2yrAvSi

Pseudomyogenic Hemangioendothelioma: A Vascular Tumor Previously Undescribed in the Oral Cavity

Abstract

http://ift.tt/2yqOSXf

Olfactory Neuroblastoma with Divergent Differentiation: An Unusual Histologic Finding in a Rare Tumor

Abstract

Olfactory neuroblastoma (ONB) is a rare malignant neoplasm of the sinonasal tract that arises from olfactory epithelium. There have been reports, mainly in tumors treated with chemoradiation or with distant metastases, describing focal histologic changes of divergent cell populations within archetypal ONB. Only three cases have been reported of ONB coexisting with non-neuroendocrine tumors. We describe our experience with a 35-year-old male with a nasal cavity mass extending into the anterior cranial fossa. Pathology revealed this to be a high grade malignant neoplasm with features of olfactory neuroblastoma and a significant divergent population of pancytokeratin and epithelial membrane antigen-reactive cells. The patient underwent combined endoscopic and open craniofacial resection followed by adjuvant chemoradiation. We describe the clinical presentation, treatment, and outcome followed by a review of the literature. Surgical pathology clearly demonstrated two cell populations evenly distributed and displaying classic histologic and immunohistochemical markers of ONB, as well as poorly differentiated cells with an epithelial immunophenotype. The patient is now 16 months status post completion of treatment with no evidence of recurrence. Our patient's presentation is unique and unusual in that the tumor demonstrated a high grade olfactory neuroblastoma and a divergent, epithelial-marker reactive cell population in the same tumor. This combined appearance is unusual and may represent an "olfactory carcinoma". Only one previous case has reported carcinomatous involvement of an ONB. There is insufficient information in the literature to draw conclusions on the impact these divergent cell populations have on prognosis or treatment.

http://ift.tt/2lf2BVI

Metastasizing Pleomorphic Adenoma Case Report and Review of the Literature

Abstract

http://ift.tt/2lLv4b1

Hyalinizing Clear Cell Carcinoma of the Bronchus

Abstract

http://ift.tt/2yrGer9

Hyalinizing Clear Cell Carcinoma of the Tonsil: A Case Report

Abstract

http://ift.tt/2lMZgCw

Sclerosing Mucoepidermoid Carcinoma of the Submandibular Gland Presenting as Chronic Sialadenitis: A Case Report and Review of Literature

Abstract

http://ift.tt/2yrAvSi

Pseudomyogenic Hemangioendothelioma: A Vascular Tumor Previously Undescribed in the Oral Cavity

Abstract

http://ift.tt/2yqOSXf

Metastasizing Pleomorphic Adenoma Case Report and Review of the Literature

Abstract

http://ift.tt/2lLv4b1

Hyalinizing Clear Cell Carcinoma of the Bronchus

Abstract

http://ift.tt/2yrGer9

Human Fc receptor-like 5 distinguishes IgG2 disulfide isoforms and deamidated charge variants

Publication date: December 2017
Source:Molecular Immunology, Volume 92
Author(s): Oyeleye Alabi, Jessica Dement-Brown, Mate Tolnay
Human Fc receptor-like 5 (FCRL5) is a novel IgG receptor. We reported that IgG2 samples display a thousand-fold range affinity for FCRL5, indicating that attributes beyond the isotype affect binding. We hypothesized that the complex interaction could be exploited to identify distinct changes in the IgG2 molecule. We investigated using surface plasmon resonance two factors that might affect the interaction between IgG2 and FCRL5; heterogeneity related to disulfide isoforms and charge variants. We found that panitumumab and denosumab samples enriched for the more flexible A disulfide isoform bound FCRL5 with two-fold and 82-fold higher apparent affinity, respectively, than the B isoform. We next assessed whether FCRL5 binding can distinguish panitumumab charge variants which increase during storage, using two approaches. First, samples were stored at 40°C to promote acidic variants. Heat stressed panitumumab had up to four-fold higher apparent affinity for FCRL5. Next, we used conditions that promoted deamidation, a common cause of acidic variants. We found that deamidated panitumumab had up to 14-fold higher apparent affinity for FCRL5, indicating that deamidation promotes the interaction. Statistical analyses of kinetic parameters and similarity scores obtained from sensogram comparisons indicated that IgG2 disulfide isoforms, heat stressed and deamidated samples each bind FCRL5 differently. We conclude that based on FCRL5 binding, we can discern distinct changes in the IgG2 molecule, including the disulfide isoform structure and charge variants related to deamidation. Since both IgG2 deamidation and conversion of disulfide isoforms occur in vivo, these findings elucidate the biological FCRL5 ligand.

http://ift.tt/2yrsInF

Molecular characterization of the bovine IER3 gene: Down-regulation of IL-8 by blocking NF-κB activity mediated by IER3 overexpression in MDBK cells infected with bovine viral diarrhea virus-1

Publication date: December 2017
Source:Molecular Immunology, Volume 92
Author(s): Melina Villalba, Fernanda Fredericksen, Carola Otth, Víctor H. Olavarría
The immediate early response 3 (IER3) is a key regulatory factor in the immune response, particularly as related to homeostasis immunomodulation via the nuclear factor kappa B (NF-κB) signaling pathway. The IER3 gene has been identified in mammals and, more recently, in other higher vertebrates. Nevertheless, relatively little is known about this regulator in bovines. Therefore, this study explored, characterized, and compared the genetic context of bovine IER3 to homologous genes in the human, mouse, and canine chromosomes. In silico analysis identified several regions of interest preserved in phylogenetically distant species. Similar analyses were also conducted for interleukin-8, a cytokine in which several putative cis elements were identified for the inducible transcription factor NF-κB. Subsequent challenge assays against the bovine viral diarrhea virus-1 revealed NF-κB signaling pathway activation just 15min post-infection, a process blocked by the BAY-117085 inhibitor. Similarly, infection strongly increased IER3 expression. Interestingly, IER3 down-regulated interleukin-8 expression, as confirmed by IER3 gene inhibition using small interfering RNA, RT-qPCR, and luciferase assays. In conclusion, this is the first report to present data indicating that bovine IER3 is a strong regulator of immune-marker expression, specifically modulating bovine interleukin-8 activation through the NF-κB/IER3 pathway in response to the bovine viral diarrhea virus.

http://ift.tt/2lJWptY

MicroRNA-146a promotes IgE class switch in B cells via upregulating 14-3-3σ expression

Publication date: December 2017
Source:Molecular Immunology, Volume 92
Author(s): Fei Li, Yi Huang, You-Ying Huang, Yan-Song Kuang, Yong-Jian Wei, Li Xiang, Xing-Ju Zhang, Zheng-Cai Jia, Shan Jiang, Jing-Yi Li, Ying Wan
B cells play a critical role in immune responses both in physiological and pathological conditions, and microRNAs have been shown to play important roles in regulating B cell proliferation and function. MiR-146a has been shown to modulate T cell immunity, but its function in regulating B cell response remains partially understood. Our previous studies indicated that germinal center (GC) B cells are significantly expanded in miR-146a-overexpressing (TG) mice. In this study, we further characterized the roles of miR-146a in regulating humoral immune responses to specific antigens. We found that the production of IgE antibody were significantly elevated in TG mice, while the antibody affinity maturation of IgM and IgG were similar between TG mice and the normal controls. We further found higher IgE antibody levels in TG B cell culture supernatant than that in normal controls. A global protein expression comparison of B cells from TG mice and the normal controls through TMT proteomic assay showed that 14-3-3σ, a key factor of immunoglobulin class switch DNA recombination (CSR) in B cells, was highly up-regulated in B cells with overexpression of miR-146a, while Smad4, the target of miR-146a, was decreased. Using an asthma model induced by OVA immunization, we further confirmed the increased level of OVA specific IgE antibodies in TG mice. These results demonstrate that miR-146a enhances class switch and secretion of IgE in B cells by upregulating 14-3-3σ expression, and suggest that miR-146a may be a potential target for asthma therapy.

http://ift.tt/2yrRqV2

Corrigendum to “Respiratory Syncytial virus infection compromises asthma tolerance by recruiting interleukin-17A-producing cells via CCR6-CCL20 signaling” [Mol. Immunol. 88 (2017) 45–57]

Publication date: Available online 2 November 2017
Source:Molecular Immunology
Author(s): Tianyun Shi, Yanchao He, Wei Sun, Yi Wu, Ling Li, Zhijun Jie, Xiao Su

http://ift.tt/2lM7qv5

Laser-induced autofluorescence-based objective evaluation of burn tissue repair in mice

Abstract

Management of burn injuries are a growing concern, especially in determining the progression of healing. Several techniques are being practiced in clinics and have been considered all-time standard approaches to determine pre- and post-treatment outcomes of a healthy healing. However, these kinds of methods involve repeated biopsies and thereby hindering tissue repair. In view of this, our perspective was to develop a non-invasive tool in an attempt to provide a solution to determine the progression of healing, in vivo. Hence, the present study was designed to investigate the ability of laser-induced fluorescence (LIF) to monitor the variations in collagen intensity at various time points (0, 2, 6, 12, 18, 24, and 30 days) during burn tissue repair in mice, post low-power laser therapy (LPLT). The spectral findings demonstrated a significant change in collagen intensity as observed on day 24 (p < 0.05) and 30 (p < 0.01), when treated with LPLT (830 nm 3 J/cm²) as compared to untreated control. From the observation, it was evident that the LIF could objectively monitor the progression of burn tissue repair in vivo.

http://ift.tt/2hA9GRl

The clinical relevance of lipid transfer protein

Abstract

Despite a huge number of studies, many aspects of the lipid transfer protein (LTP)-syndrome, the most frequent primary food allergy in Mediterranean countries, remain unclear. Its peculiar geographical distribution, along with the extreme variability of its clinical expression make this type of food allergy something unique in the panorama of IgE-mediated food-induced allergic reactions. The present review article tried to summarize the current knowledge about the most important aspects of LTP sensitization and allergy, along with the importance of positive and negative co-factors in the clinical expression of the syndrome as well as the issues regarding the cross-reactivity between LTPs present in botanically related and unrelated foods. Further, the possible absence of the protein from some plant foods is discussed.

http://ift.tt/2zg6Drk

Enhanced Antigen-presenting and T-cell Functions During Late-phase Allergic Responses in the Lung

Abstract

Background

Allergic inflammation is a common feature of asthma and may contribute to both development and perpetuation of disease. The interaction of antigen presenting cells (APC) with sensitized helper T lymphocytes (TC) producing Th2 cytokines may determine the inflammatory response. Recruitment of APC and TC to the lung during allergic responses has been demonstrated, but functional studies in humans have been limited.

Objective

This study examined the function of APC and TC accumulating at sites of inflammation after segmental allergen challenge (SAC).

Methods

15 allergic patients underwent SAC, and cells from bronchoalveolar lavage (BAL) were collected after 24 hours. APC and TC from the blood and BAL were purified based on expression of the monocyte marker, CD14; the plasmacytoid dendritic cell (pDC) marker, BDCA4, identifying neuropilin 1 (NRP1); and the helper T cell marker, CD4. Functional activity was assessed using allergen-induced T cell proliferation. Flow-cytometry identified cells expressing CD14 and NRP1.

Results

SAC resulted in a 12-fold increase of mononuclear cells having the morphologic appearance of blood monocytes. Most of these cells co-expressed CD14 and NRP1. After saline challenge, BAL mononuclear cells demonstrated little APC function Following SAC, BAL mononuclear cells showed function equal to pDC from blood and greater than blood monocytes. Purified NRP1⁺ cells from BAL had even greater function than pDC cells from blood (p = .008). Using consistent sources of APC, enhanced proliferation of TC from lung compared to blood was also demonstrated (p = .002).

Conclusions

The marked increase in APC function for allergen-specific TC proliferation during allergic inflammation is largely due to the recruitment of monocytes and dendritic cells. There is also an enhanced response in the lung TC population, consistent with recruitment of allergen-specific T cells. Interactions between recruited APC and TC may occur as an early event promoting allergic airway inflammation.

http://ift.tt/2zuHObR

Feasibility study for clinical application of caspase-3 inhibitors in Pemphigus vulgaris

http://ift.tt/2hApi7D

Allergy and immunology practice parameters and guidelines

Publication date: Available online 2 November 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): David M. Lang, Jay M. Portnoy

http://ift.tt/2iqbyvO

Treatment of seasonal allergic rhinitis

Publication date: Available online 2 November 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Mark S. Dykewicz, Dana V. Wallace, Fuad Baroody, Jonathan Bernstein, Tim Craig, Ira Finegold, Faith Huang, Desiree Larenas-Linnemann, Eli Meltzer, Gary Steven, David I. Bernstein, Joann Blessing-Moore, Chitra Dinakar, Matthew Greenhawt, Caroline C. Horner, David A. Khan, David Lang, John Oppenheimer, Jay M. Portnoy, Christopher R. Randolph, Matthew A. Rank, Mark S. Dykewicz, Dana V. Wallace

http://ift.tt/2h1yCAR

Guiding principles for use of newer biologics and bronchial thermoplasty for patients with severe asthma

Publication date: Available online 2 November 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Michael S. Blaiss, Mario Castro, Bradley E. Chipps, Myron Zitt, Reynold A. Panettieri, Michael B. Foggs
BackgroundSevere asthma poses significant disease-related and economic burdens in the United States. Challenges in practice include how to define "severe asthma" for a given patient, knowing which are the right tests to perform and when, and having a better understanding of a patient's asthma phenotype. Furthermore, current guidelines do not address a clear, practical approach to treatment that is based on a patient's asthma phenotype.ObjectiveTo develop a consensus on the definition of severe asthma, the role of biomarkers and phenotyping severe asthma, and the use of newer biologic therapies and bronchial thermoplasty to help guide practicing clinicians.MethodsA roundtable meeting was convened with a panel of severe asthma experts to discuss areas in practice that are not adequately addressed by current guidelines, specifically phenotype-guided treatment.ResultsWe describe a consensus on the definition of severe asthma, asthma phenotyping with the use of available biomarkers, and guiding principles for newer biologic therapies and bronchial thermoplasty.ConclusionTo optimize therapy and improve outcomes such as daily symptoms, quality of life, exacerbations, and hospitalizations, a clear picture of a patient's asthma phenotype is needed to guide therapy. Determining asthma phenotypes is the foundation of precision medicine for this persistent, often difficult-to-treat disease.

http://ift.tt/2iqnU76

American College of Allergy, Asthma & Immunology Position Paper on the Use of Telemedicine for Allergists

Publication date: Available online 2 November 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Tania Elliott, Jennifer Shih, Chitra Dinakar, Jay Portnoy, Stanley Fineman
The integration of telecommunications and information systems in health care first began 4 decades ago with 500 patient consultations performed via interactive television. The use of telemedicine services and technology to deliver health care at a distance is increasing exponentially. Concomitant with this rapid expansion is the exciting ability to provide enhancements in quality and safety of care. Telemedicine enables increased access to care, improvement in health outcomes, reduction in medical costs, better resource use, expanded educational opportunities, and enhanced collaboration between patients and physicians. These potential benefits should be weighed against the risks and challenges of using telemedicine. The American College of Allergy, Asthma, and Immunology advocates for incorporation of meaningful and sustained use of telemedicine in allergy and immunology practice. This article serves to offer policy and position statements of the use of telemedicine pertinent to the allergy and immunology subspecialty.

http://ift.tt/2h1ypxz

Early experience with a patient-specific virtual surgical simulation for rehearsal of endoscopic skull-base surgery

Background

With the help of contemporary computer technology it is possible to create a virtual surgical environment (VSE) for training. This article describes a patient-specific virtual rhinologic surgical simulation platform that supports rehearsal of endoscopic skull-base surgery. We also share our early experience with select cases.

Methods

A rhinologic VSE was developed, featuring a highly efficient direct 3-dimensional (3D) volume renderer with simultaneous stereoscopic feedback during surgical manipulation of the virtual anatomy, as well as high-fidelity haptic feedback. We conducted a retrospective analysis on 10 patients who underwent various forms of sinus and ventral skull-base surgery to assess the ability of the rhinologic VSE to replicate actual intraoperative findings.

Results

In all 10 cases, the simulation experience was realistic enough to perform dissections in a similar manner as in the actual surgery. Excellent correlation was found in terms of surgical exposure, anatomical features, and the locations of pathology.

Conclusion

The current rhinologic VSE shows sufficient realism to allow patient-specific surgical rehearsal of the sinus and ventral skull base. Further validation studies are needed to assess the benefits of performing patient-specific rehearsal.

http://ift.tt/2xW7REo

Outcomes after complete endoscopic sinus surgery and aspirin desensitization in aspirin-exacerbated respiratory disease

Background

In this study we assessed patient outcomes after complete endoscopic sinus surgery (ESS) and aspirin desensitization for patients with aspirin-exacerbated respiratory disease (AERD).

Methods

A retrospective chart review was conducted for patients with aspirin challenge–proven AERD who underwent complete ESS followed by aspirin desensitization. Outcomes assessed included need for revision surgery and quality-of-life measures using the 22-item Sino-Nasal Outcomes Test (SNOT-22). Data were collected preoperatively, postoperatively prior to desensitization, and then at intervals post-desensitization through 30 months after aspirin desensitization. A longitudinal linear mixed-effects model was used for data analysis.

Results

Thirty-four patients met the inclusion criteria for this study. Thirty-two patients successfully completed aspirin desensitization and were subsequently followed for 30 months after desensitization. Two patients were unable to complete desensitization. Five patients discontinued aspirin maintenance therapy due to gastrointestinal and respiratory side effects. Within the follow-up period, there were only 3 (9.4%) revision sinus surgeries. Notably, 1 of these revision cases occurred in a patient who had discontinued aspirin maintenance therapy. After surgical treatment and prior to desensitization patients had significant reductions in SNOT-22 scores. Our results demonstrate that total SNOT-22 scores remained statistically unchanged from immediate post-desensitization throughout the 30-month follow-up period.

Conclusion

Complete sinus surgery followed by timely aspirin desensitization and maintenance therapy is an effective combination in the long-term management of sinus disease in patients with AERD.

http://ift.tt/2AfdDCW

Versorgungsforschung

http://ift.tt/2iXTlte

CD8+CD28−CD127loCD39+ regulatory T-cell expansion: A new possible pathogenic mechanism for HIV infection?

Publication date: Available online 2 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Daniela Fenoglio, Chiara Dentone, Alessio Signori, Antonio Di Biagio, Alessia Parodi, Francesca Kalli, Giorgia Nasi, Monica Curto, Giovanni Cenderello, Pasqualina De Leo, Valentina Bartolacci, Giancarlo Orofino, Laura Ambra Nicolini, Lucia Taramasso, Edoardo Fiorillo, Valeria Orrù, Paolo Traverso, Bianca Bruzzone, Federico Ivaldi, Eugenio Mantia, Michele Guerra, Simone Negrini, Mauro Giacomini, Sanjay Bhagani, Gilberto Filaci
BackgroundHIV-associated immunodeficiency is related to loss of CD4⁺ T cells. This mechanism does not explain certain manifestations of HIV disease, such as immunodeficiency events in patients with greater than 500 CD4⁺ T cells/μL. CD8⁺CD28⁻CD127^loCD39⁺ T cells are regulatory T (Treg) lymphocytes that are highly concentrated within the tumor microenvironment and never analyzed in the circulation of HIV-infected patients.ObjectivesWe sought to analyze the frequency of CD8⁺CD28⁻CD127^loCD39⁺ Treg cells in the circulation of HIV-infected patients.MethodsThe frequency of circulating CD8⁺CD28⁻CD127^loCD39⁺ Treg cells was analyzed and correlated with viral load and CD4⁺ T-cell counts/percentages in 93 HIV-1–infected patients subdivided as follows: naive (n = 63), elite controllers (n = 19), long-term nonprogressors (n = 7), and HIV-infected patients affected by tumor (n = 4). The same analyses were performed in HIV-negative patients with cancer (n = 53), hepatitis C virus–infected patients (n = 17), and healthy donors (n = 173).ResultsHIV-infected patients had increased circulating levels of functional CD8⁺CD28⁻CD127^loCD39⁺ Treg cells. These cells showed antigen specificity against HIV proteins. Their frequency after antiretroviral therapy (ART) correlated with HIV viremia, CD4⁺ T-cell counts, and immune activation markers, suggesting their pathogenic involvement in AIDS- or non–AIDS-related complications. Their increase after initiation of ART heralded a lack of virologic or clinical response, and hence their monitoring is clinically relevant.ConclusionHIV infection induces remarkable expansion of CD8⁺CD28⁻CD127^loCD39⁺ Treg cells, the frequency of which correlates with both clinical disease and signs of chronic immune cell activation. Monitoring their frequency in the circulation is a new marker of response to ART when effects on viremia and clinical response are not met.

Graphical abstract

http://ift.tt/2A4KYzk

Retention force of removable partial dentures with different double crowns

Abstract

Objectives

The aim of the study was to compare the retentive behaviors of double crowns with different designs and material compositions before and after artificial aging.

Materials and methods

Six pairs of double crowns were fabricated: telescopic crowns 0° made of high-noble metal (group A) or non-precious metal (group B), telescopic zirconia copings with secondary crowns made of electroplated gold 2° (group C), crowns with friction pins 2° made of non-precious metal (group D) or zirconia (group E), and conical crowns 6° made of high-noble metal (group F). Retention forces were assessed before and after artificial aging, and after axial and non-axial loading.

Results

Initially, specimens in group D (13.9 N), B (12.5 N), and E (12.2 N) exhibited the highest retention forces. Retention forces in groups A (9.6 N), C (7.4 N), and F (6.0 N) were statistically significantly lower than those of the other groups (p < 0.05). After artificial aging, double crowns with additional retention elements exhibited the highest retention forces. The largest retention force losses were evident in groups A (70%), B (64%), C (39%), and F (47%).

Conclusions

Double crowns with different designs and made of different materials exhibited different retention forces and different long-term retentive behavior. The highest retention force losses were evident in double crowns with more extended surface contact, such as telescopic crowns.

Clinical significance

Telescopic crowns with additional retention elements were more resistant to wearing than double crowns without additional retention elements. An additional clinical benefit might be the quick and easy possibility of enhancing retention.

http://ift.tt/2hBe56y

Dose-response effect of photobiomodulation therapy on neuromuscular economy during submaximal running

Abstract

The purpose of this study was to verify the photobiomodulation therapy (PBMT) effects with different doses on neuromuscular economy during submaximal running tests. Eighteen male recreational runners participate in a randomized, double-blind, and placebo-controlled trial, which each participant was submitted to the same testing protocol in five conditions: control, placebo, and PBMT with doses of 15, 30, and 60 J per site (14 sites in each lower limb). The submaximal running was performed at 8 and 9 km h⁻¹ during 5 min for each velocity. Muscle activation of the vastus lateralis (VL), vastus medialis (VM), rectus femoris (RF), biceps femoris (BF), and gastrocnemius lateralis (GL) was collected during the last minute of each running test. The root mean square (RMS) was normalized by maximal isometric voluntary contraction (MIVC) performed a priori in an isokinetic dynamometer. The RMS sum of all muscles (RMS_LEG) was considered as main neuromuscular economy parameter. PBMT with doses of 15, 30, and 60 J per site [33 diodes = 5 lasers (850 nm), 12 LEDs (670 nm), 8 LEDs (880 nm), and 8 LEDs (950 nm)] or placebo applications occurred before running tests. For the statistical analysis, the effect size was calculated. Moreover, a qualitative inference was used to determine the magnitude of differences between groups. Peak torque and RMS during MIVCs showed small effect sizes. According to magnitude-based inference, PBMT with dose of 15 J per site showed possibly and likely beneficial effects on neuromuscular economy during running at 8 and 9 km h⁻¹, respectively. On other hand, PBMT with doses of 30 and 60 J per site showed possible beneficial effects only during running at 9 km h⁻¹. We concluded that PBMT improve neuromuscular economy and the best PBMT dose was 15 J per site (total dose of 420 J).

http://ift.tt/2AdJCmK

Issue Information

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Editorial Board

Publication date: November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 5

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Publication date: November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 5

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Society Page

Publication date: November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 5

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Information for Readers

Publication date: November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 5

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Can we keep the MD program within reach of OMS?

Publication date: November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 5
Author(s): Mark Engelstad

http://ift.tt/2j0TGf2

Hyperbaric oxygen treatment did not significantly affect radiation injury in the mandibular area of rats.

Publication date: Available online 2 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Tonje Sønstevold, Anne Christine Johannessen, Rolf K. Reed, Gerd S. Salvesen, Linda Stuhr
ObjectiveHyperbaric oxygen therapy (HBOT) has been used to enhance the microcirculation and thereby the oxygen tension in tissues. The present study aimed to investigate the effect of HBOT on radiation injury in the mandibular area of rats.Study designThe left mandible of rats were irradiated by external radiotherapy (15 Gy every other week for a total of 75Gy). Four HBOT strategies were used; two prophylactic groups receiving HBOT either between each radiation treatment or immediately following terminated radiation treatment, and two therapeutic groups receiving HBOT after the latent period of 6 weeks post irradiation either every day (standard HBOT protocol) or three days a week for 6 weeks. Tissue samples of the irradiated area were taken from skin, salivary gland and mandible. All tissues were H&E stained for morphological examination. Furthermore, the skin samples were stained with CD31 for blood vessel analysis.Results.There was no change in blood vessel density, or morphology between controls or HBOT tissues post radiation. Two of 5 HBOT rats had either normalization of dentin or the dentin was not affected by irradiation.Conclusions.HBOT did not affect radiation injury of the mandibular area in rats within 12 weeks post irradiation.

http://ift.tt/2zbmFAJ

Osteoradionecrosis: a review of pathophysiology, prevention and pharmacologic management using pentoxifylline, α-tocopherol, and clodronate

Publication date: November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 5
Author(s): Jose Antonio Rivero, Omar Shamji, Antonia Kolokythas
A significant complication of radiotherapy to the head and neck for cancer treatment is osteoradionecrosis (ORN) of the jaws. The management of ORN can be complex and often requires a multimodality approach. Nonsurgical treatments with or without adjunct measures and surgical interventions have all been employed on the basis of staging of the disease process. New theories on the pathophysiology of ORN have led to the identification of novel treatment modalities, including pharmacologic management using pentoxifylline, tocopherol, and clodronate (together referred to as "Pentoclo"). In this review article, we discuss the definition and staging of ORN, its etiology and pathophysiology, and traditional treatment options and present the available information on pentoxifylline, tocopherol, and clodronate and their use in combined therapy for ORN. Limited studies to date have demonstrated the effective pharmacologic use of Pentoclo in treating ORN and radiation-induced injury at other body sites. Further research is necessary to elucidate any potential role for the use of Pentoclo in the management of this debilitating disease process.

http://ift.tt/2iXivbC

Axitinib-related osteonecrosis of the jaw

Publication date: November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 5
Author(s): Vinod Patel, Chris Sproat, Jerry Kwok, Nikki Tanna
Tyrosine kinase inhibitors (TKIs) are oral chemotherapy drugs used primarily to treat leukemias, renal cell carcinomas, gastrointestinal stromal tumors, and neuroendocrine tumors. Within this group, a number of drugs have already been implicated in jaw necrosis. Axitinib (Inlyta) is a novel TKI currently licensed for the treatment of renal cell carcinoma. We report the first case, to our knowledge, of jaw necrosis solely related to this medication and review the literature surrounding TKIs and their implication in osteonecrosis of the jaw.

http://ift.tt/2z9XfDx

Clinicopathologic significance of in vivo antinuclear autoantibodies in oral mucosal biopsies

Publication date: November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 5
Author(s): Rana Alshagroud, Mirdza Neiders, Jill M. Kramer, Lakshmanan Suresh
ObjectiveAlthough antinuclear autoantibody (ANA) staining of oral biopsy specimens is indicative of chronic ulcerative stomatitis, it is not known whether this staining is characteristic of other autoimmune diseases. Our study was undertaken to characterize the various in vivo ANA patterns detected in the oral mucosa by direct immunofluorescence to describe the associated hematoxylin and eosin findings, and determine whether patients with these findings had a coexisting systemic connective tissue disease.Study DesignThis was a retrospective analysis of oral biopsy specimens submitted from 2013 to 2016.ResultsIn vivo ANA staining was present in 72 of the 2019 cases examined. Immunoglobulin G was the most common immunoreactant (71 of 72 cases), and speckled nuclear staining was the most frequent in vivo ANA pattern (52 of 72). In most cases, hematoxylin and eosin staining of biopsy specimens showed mucositis (24 of 34). Detailed clinical information was available for 10 patients, and all of them had an autoimmune disease.ConclusionsWe found similar prevalence of ANA staining with direct immunofluorescence in oral epithelial biopsy specimens as reported for those of skin. In vivo ANA in the oral epithelium may indicate the presence of an immune-mediated disease. Patients who show ANA deposits in oral mucosal biopsy specimens should be investigated for systemic connective tissue disease as well as for chronic ulcerative stomatitis.

http://ift.tt/2iWeVhX

Contrast-enhanced ultrasound for diagnosis of an enlarged cervical lymph node in a patient with oropharyngeal cancer: a case report

Publication date: November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 5
Author(s): Shalva R. Gvetadze, Ping Xiong, Jiang Li, Mingming Lv, Jun Li, Xin Yang, Konstantin D. Ilkaev, Jian Sun
In oral and oropharyngeal cancer, the presence of regional neck metastasis strongly influences treatment planning and survival prognosis. A number of imaging techniques can be utilized in the clinic for diagnosis and staging. A patient with oropharyngeal cancer was staged T2 cN1 after clinical examination, computed tomography, and ¹⁸F-fluorodeoxyglucose positron emission tomography with computed tomography. Contrast-enhanced microbubble imaging was applied for diagnosis of a lymph node suspected of harboring a metastasis. The result of the microbubble procedure showed the suspicious node to be tumor negative, and this was later confirmed by frozen section and serial step section of the harvested node. Contrast-enhanced ultrasonography with introduction of intravenous microbubble contrast may be of benefit in staging oropharyngeal cancer in patients with enlarged neck lymph nodes.

http://ift.tt/2h8RSzK

IV Brazilian Consensus on Rhinitis: 2017 update

Publication date: Available online 2 November 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Eulalia Sakano, Emanuel S.C. Sarinho, Alvaro A. Cruz, Antonio C. Patorino, Edwin Tamashiro, Fábio Kuschnir, Fábio F.M. Castro, Fabrizio R. Romano, Gustavo F. Wandalsen, Herberto J. Chong-Neto, João F. de Mello, Luciana R. Silva, Maria Cândida Rizzo, Mônica A.M. Miyake, Nelson A. Rosário Filho, Norma de Paula M. Rubini, Olavo Mion, Paulo A. Camargos, Renato Roithmann, Ricardo N. Godinho, Shirley Shizue N. Pignatari, Tania Sih, Wilma T. Anselmo-Lima, Dirceu Solé
IntroductionThe guidelines on allergic rhinitis aim to update knowledge about the disease and care for affected patients. The initiative called "Allergic Rhinitis and its Impact on Asthma", initially published in 2001 and updated in 2008 and 2010, has been very successful in disseminating information and evidence, as well as providing a classification of severity and proposing a systemized treatment protocol. In order to include the participation of other medical professionals in the treatment of allergic rhinitis, it is important to develop algorithms that accurately indicate what should and can be done regionally.ObjectiveTo update the III Brazilian Consensus on Rhinitis – 2012, with the creation of an algorithm for allergic rhinitis management.MethodsWe invited 24 experts nominated by the Brazilian Association of Allergy and Immunology, Brazilian Association of Otorhinolaryngology and Head and Neck Surgery and Brazilian Society of Pediatrics to update the 2012 document.ResultsThe update of the last Brazilian Consensus on Rhinitis incorporated and adapted the relevant information published in all "Allergic Rhinitis and its Impact on Asthma" Initiative documents to the Brazilian scenario, bringing new concepts such as local allergic rhinitis, new drugs and treatment evaluation methods.ConclusionA flowchart for allergic rhinitis treatment has been proposed.

http://ift.tt/2A2kfUl

Button battery ingestion in children

Purpose of review: As the demand for small electronics continues to grow so does the risk of oesophageal ingestion of button batteries. These small but powerful sources of energy are ubiquitous in every household and when swallowed, especially in small children, have been shown to create significant injury in a short amount of time leading to long-term morbidity and possible death. This review highlights the latest findings regarding epidemiology, pathophysiology, diagnosis and management of ingested button batteries. Recent findings: Updated epidemiology from the National Capital Poison Center, new bench research looking at injury patterns and possible mitigation strategies, updated ideas on management algorithms including the use of a trauma protocol, close-look second endoscopy and management of button batteries in the lower gastrointestinal tract are reviewed in this paper. Summary: Despite advances in the understanding of injury mechanics and innovations leading to early diagnosis and improved management of button battery ingestion, parental and provider education remain the most important tools to keep children well tolerated from the sequelae of these potentially fatal events. Collaboration between healthcare experts, public health and industry is essential to find a safe answer to this ongoing threat.

http://ift.tt/2h7hj4V

Otolaryngologic management of Down syndrome patients: what is new?

Purpose of review: The management of children with Down syndrome as it pertains to the otolaryngologist continues to evolve. Obstructive sleep apnea (OSA) has dominated the recent literature, but other topics including hearing loss, swallowing, and perioperative considerations are also reported. Recent findings: The prevalence of OSA in children with Down syndrome ranges from 57 to 73% in certain cohorts, and, whereas adentonsillectomy can decrease Apnea–Hypopnea Index, up to 80% may have persistent OSA. Surgical techniques involving reduction of the base of tongue are effective for those who fail adenotonsillectomy, and it is expected that drug-induced sleep endoscopy may improve outcomes. New technology is also on the horizon that can assist with diagnosis and treatment including computational modelling and upper airway stimulation. Children with Down syndrome may not respond to medical management of eustachian tube dysfunction as well as normally developing children. In addition, there is a high prevalence of inner ear anomalies, increasing the risk for sensorineural hearing loss. Summary: Questions remain pertinent to the otolaryngologist regarding the ideal management of children with Down syndrome. Additional studies are necessary, to optimize understanding and treatment of this complex population, in particular as opportunities develop with technological advances.

http://ift.tt/2h8EmMI

Editorial

No abstract available

http://ift.tt/2zbp6Ws

Role of reinnervation in the management of recurrent laryngeal nerve injury: current state and advances

Purpose of review: To present the current state of knowledge concerning different laryngeal reinnervation procedures for unilateral and bilateral vocal palsy. Recent findings: Recent reports show positive outcomes on both unilateral and bilateral reinnervations. The phrenic nerve is the most commonly used donor for bilateral vocal palsy, but use of the superior laryngeal nerve has also been suggested. Summary: Reinnervation of the larynx is a complex undertaking that can be performed by ENT surgeons with skills in microsurgery. Advances in this this field represent a paradigm shift in laryngeal rehabilitation and a prerequisite for laryngeal transplantation. Advances in basic understanding of nerve regeneration and in particular the need to surgically manage competitive reinnervation make the results of laryngeal reinnervation more predictable.

http://ift.tt/2zbp3Kg

Emerging techniques in assessment and treatment of muscle tension dysphonia

Purpose of review: The purpose of this review is to summarize current evidence regarding treatment for muscle tension dysphonia (MTD) and to present recent advances in evaluation and management. Recent findings: It is generally accepted that voice therapy for MTD is effective, but current systematic reviews report limited evaluation specific to MTD patients with moderate evidence, at best, available to support voice therapy techniques. Individual studies are difficult to compare because of heterogeneity. Considerable work is underway to identify most important metrics to include in assessment, and to advance and define direct voice therapy approaches. Summary: Further standardization of assessment and treatment protocols for MTD will improve future research. Novel therapeutic techniques are under investigation. In small studies, these have found value in improving voice outcomes and measures compared with pretreatment values but have not met success greater than existing therapeutic methods.

http://ift.tt/2zaDA8Q

Management of Type I and Type II laryngeal clefts: controversies and evidence

Purpose of review: To summarize the pediatric Type I and Type II laryngeal cleft literature, paying special attention to recent trends, including evolution of surgical techniques, standardization of outcome assessments, and utilization of management algorithms. Recent findings: There are a variety of options to choose from whenever considering Type I and Type II cleft repair, including endoscopic repair, transoral robotic surgery, and injection laryngoplasty. Conservative management including feeding therapy and treatment of comorbid medical conditions is recommended prior to repair. Validated outcome measures have arisen for swallow study interpretation and timing, as well as caregiver quality-of-life assessment. In addition, a series of medical algorithms have been proposed, which provide specific recommendations for diagnosis, treatment, and follow-up. Summary: For clefts that fail conservative management, endoscopic repair has become the gold standard. In addition, injection laryngoplasty appears to provide both a diagnostic and therapeutic option in the management of these patients. Transoral robotic-assisted endoscopic repair appears well tolerated and feasible, although broader implementation of this technology remains limited. The development and refinement of best practice algorithms can help standardize management and improve decision-making. Furthermore, incorporating validated outcome measures, recorded and followed over time, will improve both patient care and research efforts moving forward.

http://ift.tt/2zbp156

Benign vocal fold lesions: update on nomenclature, cause, diagnosis, and treatment

Purpose of review: The management of benign vocal fold lesions (BVFLs) continues to evolve. This article will review the recent literature surrounding the nomenclature, cause, diagnosis, and treatment of BVFLs, including polyps, nodules, cysts, and reactive lesions. Recent findings: The taxonomy of vocal fold lesions has been refined, and it serves as a common descriptive language for diagnosis, treatment algorithms, and reporting of outcomes. Though these lesions are known to be the result of phonotrauma, investigation into inflammatory mediators, apoptosis, and laryngopharyngeal reflux provide further elucidation of their underlying pathophysiology. The future of diagnosis, for which direct fiberoptic visualization and stroboscopy are the current gold standard, may utilize narrow-band imaging and videokymography; the clinical utility of ultrasound and optical coherence tomography is more remote. Angiolytic laser therapy and intralesional steroid injection are acceptable options for treatment of BVFLs. Voice therapy and microsurgical excision are mainstays of treatment. Summary: Recent clinical and basic science research has expanded upon an extensive literature surrounding the nomenclature, cause, diagnosis, and treatment of benign subepithelial vocal fold lesions. There remains a strong need for the advancement of rigorous diagnostic principles, evaluation of therapeutic interventions, and development of best practices guidelines.

http://ift.tt/2zbp012

Editorial introductions

No abstract available

http://ift.tt/2zbOkDO

Voice rest after laryngeal surgery: what's the evidence?

Purpose of review: This article aims to review previous research reports and to summarize current strategies for the optimal duration of voice rest and the effect of phonatory stimulation after phonomicrosurgery. Recent findings: Voice rest is commonly recommended after laryngeal surgery to prevent worsening of vocal fold injuries. However, there are no established standard protocol for voice rest, and the type and duration of voice rest vary among clinicians. The most effective duration of voice rest is unknown. Recently, early vocal stimulation was recommended as a means to improve wound healing, on the basis of the basic and clinical researches. Summary: It seems that early vocal stimulation may enhance the wound healing process in the vocal fold. More basic and clinical researches are warranted to investigate appropriate timing of initiation of stimulation, as well as the type and amount of stimulation that are available for human.

http://ift.tt/2zboX5m

Update on pediatric sinus surgery: indications and outcomes

Purpose of review: To review the recent literature of pediatric endoscopic sinus surgery (ESS). Recent findings: Sinus balloon catheter dilation is an important addition to the surgical treatment tools for pediatric chronic rhinosinusitis (PCRS). ESS is a safe and effective therapeutic modality for uncomplicated PCRS. For PCRS complicated by comorbidities including cystic fibrosis and primary ciliary dyskinesia, ESS and adjuvant medical therapy confers significant sinus, pulmonary, and quality of life benefits to pediatric patients. Summary: ESS is a safe and effective treatment modality in the management of pediatric acute and chronic sinus disorders.

http://ift.tt/2zboVKM

Vocal fold leukoplakia: incidence, management, and prevention

Purpose of review: The purpose of this article is to provide an update on English-language literature evaluating the current understanding of incidence, management, and prevention of vocal fold leukoplakia focusing on premalignancy. Recent findings: Recent studies have continued to try to elucidate factors influencing recurrence and progression of dysplastic disease, though results vary. Although advanced diagnostic techniques have attempted to predict disease behavior, tissue diagnosis continues to be essential. Studies reinforce the necessity of removal of disease as the primary treatment, whereas use of photoangiolytic lasers via the ablative technique has increased, as has transition of some patients into the office-based settings for treatment. Although genetic and molecular testing may hold promise for predictive purposes, further study is necessary, and chemotherapy for recalcitrant disease continues to be an area of study with few case studies being reported. Summary: Management of vocal fold leukoplakia continues to progress in terms of identification and treatment. Although many work to advance our knowledge in the field and push treatment strategies toward newer avenues, pathologic diagnosis, eradiation of disease on the basis of experience and skill, and close surveillance continue to be paramount.

http://ift.tt/2zboT5C

Αρχειοθήκη ιστολογίου

Παρασκευή 3 Νοεμβρίου 2017

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