Ausschreibung Thieme Teaching Award 2018

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 663-663
DOI: 10.1055/s-0043-118833

Georg Thieme Verlag KG Stuttgart · New York

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Sterblichkeit bei Sepsis: Verbesserungen scheinen schwierig

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 656-658
DOI: 10.1055/s-0043-118984

Georg Thieme Verlag KG Stuttgart · New York

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Ambulante Anästhesie: Regionalanästhesie im ambulanten Bereich

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 691-702
DOI: 10.1055/s-0042-120237

Ausgewählte Regionalanästhesieverfahren sind für den ambulant tätigen Anästhesisten eine attraktive Alternative zu Analgosedierung und Narkose – und dies bei hoher Patientenzufriedenheit und seltenen Komplikationen. Dieser Beitrag widmet sich den organisatorischen und hygienischen Anforderungen, die es dabei zu beachten gilt. Des Weiteren gehen die Autoren auf einzelne Verfahren und ihre Anwendung in unterschiedlichen Körperregionen näher ein.
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Georg Thieme Verlag KG Stuttgart · New York

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Perioperatives Vorhofflimmern: Alter und Art der Operation beeinflussen Inzidenz

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 658-658
DOI: 10.1055/s-0043-117035

Georg Thieme Verlag KG Stuttgart · New York

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Ambulante Anästhesie: Grenzen und Möglichkeiten

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 666-678
DOI: 10.1055/s-0042-120247

Ambulante Operationen werden künftig zunehmend nachgefragt werden – Ursachen sind u. a. die alternde Bevölkerung und die finanzielle Lage der Krankenkassen. Der Beitrag geht ausführlich auf Begleiterkrankungen ein, bei denen die Entscheidung ambulant oder stationär sorgfältig abgewogen werden muss. Darüber hinaus nimmt er die betriebs- und volkswirtschaftlichen Grenzen und Möglichkeiten des ambulanten Operierens unter die Lupe.
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Georg Thieme Verlag KG Stuttgart · New York

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Neuronenspezifische Enolase zur Prognose nach Herz-Kreislauf-Stillstand

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 659-660
DOI: 10.1055/s-0043-117055

Georg Thieme Verlag KG Stuttgart · New York

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Der zerebrale Notfall – wichtige anästhesiologische Aspekte

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 716-725
DOI: 10.1055/s-0042-120989

Der zerebrale Notfall ist eine häufige Notfallsituation – und das Gehirn unterscheidet sich durch seine Unersetzbarkeit und minimale Ischämietoleranz von allen anderen Organen. Dieser Beitrag verwendet bewusst den Begriff des zerebralen Notfalls und will sich so von einzelnen Erkrankungsbildern lösen. Der Fokus liegt auf der anästhesiologischen Praxis, aber auch auf dem „Notfall in uns", den jeder Notfall für das Behandlungsteam bedeuten kann.
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Georg Thieme Verlag KG Stuttgart · New York

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Paravertebrale Katheteranalgesie – wirksame Alternative zum Kaudalblock

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 660-660
DOI: 10.1055/s-0043-112726

Georg Thieme Verlag KG Stuttgart · New York

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Ambulante Anästhesie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 664-665
DOI: 10.1055/s-0043-118408

Georg Thieme Verlag KG Stuttgart · New York

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Langzeitversorgung von Patienten verbessern

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 662-663
DOI: 10.1055/s-0043-118974

Georg Thieme Verlag KG Stuttgart · New York

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Ambulante Anästhesie: Organisation in Praxis und Krankenhaus

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 679-690
DOI: 10.1055/s-0042-120238

Ambulante Anästhesie erfolgt immer im Rahmen einer ambulanten Operation – somit hängt der Erfolg davon ab, wie gut die „Einheit ambulantes Operieren" organisiert und aufeinander abgestimmt ist. Dieser Beitrag beleuchtet die vielen rechtlichen Vorgaben, die es beim ambulanten Operieren und Anästhesieren zu erfüllen gilt. Darüber hinaus werden die Organisationsstrukturen im niedergelassenen Bereich und im Krankenhaus erläutert und verglichen.
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Georg Thieme Verlag KG Stuttgart · New York

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Einfühlsame Ärzte sind die besseren Ärzte

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 662-662
DOI: 10.1055/s-0043-118976

Georg Thieme Verlag KG Stuttgart · New York

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Perioperative Anaphylaxie auf Arzneimittel

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 704-715
DOI: 10.1055/s-0043-100231

Im Rahmen eines operativen Eingriffs erhalten Patienten zahlreiche Arzneimittel. Entwickeln sie eine anaphylaktische Reaktion, so ist akut schwer zu beurteilen, welche Substanz für diese verantwortlich ist. Die meisten der intraoperativen Einschätzungen zur Ursache einer Anaphylaxie sind falsch. Umso wichtiger ist es, die verursachende Substanz später zu identifizieren, um eine Reexposition, z. B. bei einer erneuten OP, zu verhindern.
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Georg Thieme Verlag KG Stuttgart · New York

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Geburtshilfliche Anästhesie: Altbewährtes, Kontroversen und neue Perspektiven – Teil 1

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 727-736
DOI: 10.1055/s-0043-104921

In der „Whatʼs New in Obstetric Anesthesia" Lecture, die jedem an der anästhesiologischen Kreißsaalversorgung Interessierten in abgedruckter Form sehr ans Herz gelegt werden kann, werden seit 1975 durch die Society for Obstetric Anesthesia and Perinatology die im Rahmen des Annual Meeting als relevant für die klinische Versorgung erachteten Vorträge zusammengefasst. Nach dem Tode von Gerard W. Ostheimer, Professor of Anesthesiology im Brigham and Womenʼs Hospital in Boston, Massachusetts, wurde sie zur Gerard W. Ostheimer „Whatʼs New in Obstetric Anesthesia" Lecture umbenannt, um dessen Beiträge zur Regionalanästhesie und geburtshilflichen Anästhesie zu würdigen. Jedes Jahr gewährt die von ausgewählten Fachvertretern gehaltene Veranstaltung und ihr Abdruck in namhaften Anästhesie-Journalen Einblick in eine kritische Würdigung rezenter Literatur und die möglichen Konsequenzen für – aber nicht nur – die anästhesiologische Kreißsaalpraxis.Eine ähnliche Veranstaltung hat in Deutschland seit über 16 Jahren Tradition: Das Geburtshilfliche Anästhesiesymposium des Wissenschaftlichen Arbeitskreises Regionalanästhesie und Geburtshilfliche Anästhesie. Anders als in den von Einzelpersonen gehaltenen Vortragsveranstaltungen werden „Evergreens" oder „Hot Topics" der anästhesiologischen Kreißsaalversorgung in regelmäßigem Zyklus oder aus aktuellem Anlass aufgegriffen, präsentiert und vor allem diskutiert. In den Vortragsveranstaltungen offenbart sich oft wesentlich früher als in traditionellen Lehrbuchkapiteln der subtile Wandel in Hinblick auf die diskutierten Themen.Der 2-teilige Beitrag fasst das Symposium 2016 zusammen, stellt jedoch keine offizielle Meinungsbekundung seitens des Arbeitskreises dar. Teil 1 geht auf mütterliche Todesursachen während Schwangerschaft, Geburt und Stillzeit sowie strukturelle Voraussetzungen im Kreißsaal, Adipositas in der Schwangerschaft und Sepsis bei der Schwangeren und im Wochenbett ein. Teil 2 behandelt etablierte Standards und neue Perspektiven im Rahmen der geburtshilflichen Analgesie und Anästhesie bezüglich Epiduralanalgesie, postpunktionellem Kopfschmerz, Anästhesie und Analgesie während und nach Sectio, hämodynamischem Monitoring und postpartaler Blutung.
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Georg Thieme Verlag KG Stuttgart · New York

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Levosimendan bei herzchirurgischen Patienten mit linksventrikulärer Dysfunktion

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 656-656
DOI: 10.1055/s-0043-118982

Georg Thieme Verlag KG Stuttgart · New York

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Remifentanil up2date – Teil 2

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 630-639
DOI: 10.1055/s-0043-114676

Remifentanil wird seit 20 Jahren mit Erfolg in vielen Bereichen der Anästhesiologie eingesetzt. Im 1. Teil wurde die Substanz mit ihren pharmakologischen Charakteristika sowie ihren erwünschten und unerwünschten Wirkungen beschrieben. Der hier vorliegende 2. Teil befasst sich mit der Anwendung des Opioids bei speziellen Patientengruppen und in den verschiedenen anästhesiologisch betreuten Fachdisziplinen.
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Georg Thieme Verlag KG Stuttgart · New York

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Analgosedierung bei OSA-Patienten: Ist der Standard hier sinnvoll?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 645-648
DOI: 10.1055/s-0043-114467

Georg Thieme Verlag KG Stuttgart · New York

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Katastrophenmedizin in und außerhalb der Klinik: auf das Ungeplante vorbereitet sein

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 588-593
DOI: 10.1055/s-0043-116913

Georg Thieme Verlag KG Stuttgart · New York

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Aktuell, übersichtlich und knapp

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 586-586
DOI: 10.1055/s-0042-120977

Georg Thieme Verlag KG Stuttgart · New York

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Nervenschäden nach Regionalanästhesie – welche Risikofaktoren gibt es?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 579-580
DOI: 10.1055/s-0043-116930

Georg Thieme Verlag KG Stuttgart · New York

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Differences in medication adherence are associated with beliefs about medicines in asthma and COPD

Adherence to medication is crucial for achieving treatment control in chronic obstructive lung diseases. This study refers to the "necessity-concerns framework" and examines the associations between beliefs a...

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Nephrotic syndrome and acute kidney injury induced by malathion toxicity

We treated a case of acute kidney injury and nephrotic syndrome after malathion inhalation. A 69-year-old Japanese man presented with oedema 15 days after inhalation of malathion, a widely used pesticide. Serum albumin was 2.4 g/dL, urinary protein 8.6 g/gCr and serum creatinine 2.5 mg/dL. Kidney biopsy revealed tubular cell damage, epithelial cell damage in glomeruli and diffuse foot process effacement in electron microscopy. Acute kidney injury progressed to treatment with dialysis. Renal function recovered after corticosteroid administration from the 43rd day after admission. Malathion inhalation should be ruled out as a differential diagnosis in individuals who develop acute kidney injury and nephrotic syndrome, especially in rural-dwelling patients.

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Radiation retinopathy treated successfully with aflibercept

Aflibercept (aflibercept) is a novel anti-vascular endothelial growth factor drug indicated for wet age-related macular degeneration and macular oedema secondary to retinal vein occlusion and diabetic macular oedema. While only newly introduced on the market, it is growing in popularity and over 5.5 million doses have been prescribed worldwide. Due to its versatile mechanism, it is indicated for numerous eye pathologies, and in particular, has been adapted to treat various types of retinopathy. To our knowledge, this is the first case report of solely using aflibercept to treat cystoid macular oedema in radiation retinopathy.

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Eosinophilic oesophagitis and coeliac disease: is there an association?

A 25-year-old man was seen in outpatient clinic for progressive solid food dysphagia. He was already medicated with a proton pump inhibitor with no improvement. His blood tests showed a slight microcytic anaemia and peripheral eosinophilia. The oesophago-gastro-duodenoscopy showed longitudinal furrows in the distal two-thirds of the oesophagus and a concentric distal stenosis. The biopsies taken showed eosinophilic infiltrates consistent with eosinophilic oesophagitis. There was no improvement with topical fluticasone, so the patient was started on a systemic corticosteroid with resolution of dysphagia and of the oesophageal stenosis. He was kept on topical steroids for symptomatic control. On repeat endoscopy, the duodenal mucosa showed multiple papules that were biopsied. Histology showed features consistent with coeliacdisease. The patient was asymptomatic but there was evidence of iron deficiency anaemia, and so a gluten-free diet was started. Despite only a partial adherence to the diet, the iron deficiency anaemia resolved.

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Traditional Chinese medicine-facilitated treatments may relieve anxiety symptoms during drug switching from methadone to buprenorphine/naloxone for treating opioid dependence

This study investigated a 51-year-old married man with a history of heroin dependence who underwent methadone maintenance treatment for 7 years. He received traditional Chinese medicine (TCM)-facilitated treatments and switched from methadone to buprenorphine/naloxone. Strong anxiety symptoms were observed during the initial stage; therefore, we prescribed a combination of Chaihu-Shugan-San, Zhi Bai Di Huang and Chin-Gin-Kuan-Ming decoction as the major herbal synergic regimen to relieve the symptoms of opioid withdrawal, anxiety and insomnia. During the treatment course, no precipitating withdrawal syndromes were noted, and the subject was gradually relieved of his anxiety symptoms through continual TCM treatments. In conclusion, TCM is effective in facilitating the switch from methadone to buprenorphine/naloxone and relieving anxiety symptoms. Therefore, focus on TCM-facilitated treatments for heroin dependence should be increased.

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All sorts of tests, only one question: an unexpected cause of hypertension

A 48-year-old woman presented to the Accident and Emergency department with a 4 month history of headaches, nausea and dizziness. She was found to have severe hypertension and hypokalaemia. Extensive investigations did not find any secondary cause for hypertension. The patient was discharged with oral doxazosin therapy which controlled the blood pressure. Before the follow-up appointment at the hypertension clinic, the patient and her husband identified that her headaches coincided with liquorice tea consumption of up to three cups per day. This information was not obtained in the clinical assessment. The patient is now headache and medication free after cessation of liquorice tea. Liquorice ingestion is often a forgotten reversible cause of hypertension. A good history is key to this diagnosis.

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Tuberculosis epididymitis complicated by a cutaneous fistula

A 63-year-old man developed scrotal swelling that became bilateral over 2 months. His symptoms persisted after treatment for epididymitis, and he developed a scrotal fistula with drainage. Mycobacterium tuberculosis grew from the urine and fistula. His symptoms resolved and fistula closed with medical therapy. His case highlights the importance of early recognition, diagnosis and treatment of this form of extrapulmonary tuberculosis.

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Pleomorphic sarcoma of the breast

Description

This is an 81-year-old man with a history of small bowel carcinoid. He was undergoing routine surveillance (every 6 months) CT chest, abdomen and pelvis with contrast, which showed an incidental left breast mass in the lower inner quadrant, 12x9 mm concerning for breast neoplasm, there was left axillary lymphadenopathy (LAD) as well (figure 1). Correlation with clinical examination, mammography and ultrasound were recommended. A left breast ultrasound noted a hypoechoic irregular mass with indistinct margins, 7 mm in size at the 10 o'clock position on the left breast, 3 cm from the nipple (figure 2). Breast imaging-reporting and data system (BI-RADS) category 4. Bilateral mammogram demonstrated a 1.3 cm irregular shaped mass at the 10 o'clock position of the left breast. No lymphadenopathy (LAD) was noted on the mammogram or ultrasound. It was categorised as BI-RADS 5 on the mammogram. Bilateral axillary ultrasonography was obtained to evaluate for...

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Dermoscopy of pseudoxanthoma elasticum

Description

A 22-year-old woman presented with complaints of gradually progressive yellowish asymptomatic papules coalescing to form plaques over the lateral aspects of the neck since last 3 years. There were no associated systemic complaints. No similar complaints were noted in any of the family members. Systemic examination was normal while mucocutaneous examination revealed the presence of symmetrically distributed yellowish monomorphic papules arranged in a linear and reticulate manner on both sides of the neck, axillae and periumbilical area (figure 1). These plaques were confluent at most of the places, occasionally studded with telangiectasias and had a pebble-like feel on palpation with poor elastic recoil. Polarised light dermoscopy at x10 magnification of these plaques showed multiple irregular yellowish areas alternating with multiple linear vessels. These yellowish plaques coalesced to form parallel strands (figure 2A). The fundus examination was within normal limits except diffuse pigmentary degeneration (figure...

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Abrikossoffs tumour on the upper limb: a rare presentation

Abrikossoff's tumour or granular cell tumour is a rare entity. Most common locations are the head and neck, with only a few cases reported on the upper limbs. A 55-year-old man with a nodular lesion on the left arm resorted to surgery consultation. Nodule was firm, mobile, painless and non-ulcerated. Total excision using a Limberg flap procedure was performed. Following 3 months of follow-up, the patient is fine. Abrikossoff's tumour is frequently presented in the second to sixth decade of life as an ulcerated nodule with progressive growth. Malignant form is rare, with metastases occurring in up to 3% of patients. Excision must be accomplished with free margins. Recurrence is rare. Abrikossoff's tumour on the upper limbs is rare. Although benignity is the rule, doctors must be aware of the possibility of harbouring a cancer. Surgery is the treatment of choice.

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Selective aplasia of global fibres of all extraocular muscles in congenital fibrosis of extraocular muscles (CFEOM): a rare presentation

Description

A 15-year-old boy presented in our strabismus clinic with complaints of bilateral ptosis and limitation of ocular movements since birth. He had a positive family history of consanguinity and similar ocular movement abnormalities in his three siblings. There was no history of systemic illness. Physical examination showed normal growth parameters without craniofacial dysmorphism except blepharoptosis and lagophthalmos in both eyes, more marked in the right eye. Right eye best-corrected visual acuity (BCVA) was 6/12 and left eye BCVA was 6/9. Slit-lamp biomicroscopy of right eye showed exposure keratopathy, rest was unremarkable. Fundus examination was within normal limits, with no pigmentary retinopathy or optic atrophy changes. There was almost total external ophthalmoplegia, with normal reacting pupils to both direct and consensual light reflex in each eye. The patient preferred fixation with the left eye as his right eye had severe ptosis covering the pupillary area. The patient had chin up and 15° right...

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Heart failure in dilated cardiomyopathy mimicking asthma triggered by pneumonia

Heart failure is a rare cause of wheezing and may develop into a critical condition in children. Few cases report patients with heart failure, secondary to dilated cardiomyopathy, with high fever. A 23-month-old girl visited the emergency department with high fever, cough, first wheezing episode, chest retraction and tachycardia. The chest X-ray revealed consolidation on the left lower lung field; the cardiothoracic ratio was 60%. She was diagnosed with bronchial asthma triggered by pneumonia, which remained unchanged during four visits. Subsequently, she was diagnosed with heart failure in idiopathic dilated cardiomyopathy and discharged without sequelae. During the first wheezing episode in children with abnormal vital signs, heart failure should be considered in the differential diagnosis, and a chest X-ray should be performed. Additionally, when the cardiothoracic ratio is greater than 50%, 12-lead ECG and echocardiography should be performed. Moreover, cognitive bias should be considered in all emergency care unit situations.

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Vancomycin-resistant Enterococcus faecium bacteraemia as a complication of Kayexalate (sodium polystyrene sulfonate, SPS) in sorbitol-induced ischaemic colitis

We present the case report of an 80-year-old woman with chronic kidney disease stage G5 admitted to the hospital with fluid overload and hyperkalaemia. Sodium polystyrene sulfonate (SPS, Kayexalate) in sorbitol suspension was given orally to treat her hyperkalaemia, which precipitated an episode of SPS in sorbitol-induced ischaemic colitis with the subsequent complication of vancomycin-resistant Enterococcus (VRE) bacteraemia. SPS (Kayexalate) in sorbitol suspension has been implicated in the development of intestinal necrosis. Sorbitol, which is added as a cathartic agent to decrease the chance of faecal impaction, may be primarily responsible through several proposed mechanisms. The gold standard of diagnosis is the presence of SPS crystals in the colon biopsy. On a MEDLINE search, no previous reports of a VRE bacteraemia as a complication of biopsy-confirmed SPS in sorbitol ischaemic colitis were found. To the best of our knowledge, ours would be the first such case ever reported.

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Giant atrium, giant clot: need for anticoagulation

Description

We present a patient with medical history of atrial fibrillation, rheumatic mitral valve stenosis and ulcerative colitis who came to the emergency room with onset of bilateral lower extremity pain 2 hours prior to presentation. On examination, feet were pale, cold and pulses were absent. Patient used to be on warfarin for atrial fibrillation which was discontinued 1 month ago by his primary care physician due to recurrent bleeding. Atrial fibrillation with controlled ventricular response was seen on ECG. Emergent arterial Doppler revealed occlusion of the bilateral calf arteries at the level of the tibioperoneal trunk. Patient underwent emergent bilateral right and left groin exploration with bilateral embolectomy and thromboembolectomy. Restoration of flow with no haemodynamically significant atheromatous changes was confirmed by repeat Doppler. Echocardiography revealed severely dilated left atrium measuring 10 cm x 7 cm with large left atrial thrombi (figure 1, online) and severe mitral valve stenosis (mean gradient...

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Atraumatic bilateral humeral head fracture secondary to single seizure

Description

Case 1: A 51-year-old man presented with a single unprovoked generalised tonic clonic seizure (GTCSz), lasting for 4 min, he developed postseizure bilateral shoulder pain and was unable to move his arms as they were painful; there was a history of seizure 7 years ago, he was not on any antiepileptic drugs (AEDs). His sX-ray shoulder showed bilateral comminuted humeral head fracture, which was confirmed by CT of shoulders, see figure 1.He was started on AEDs from a seizure perspective. His neuroimaging, which included an MRI brain (epilepsy protocol) and electroencephalogram (EEG), were normal, see figure 1. From a shoulder management perspective, he was transferred to an orthopaedic surgeon which resulted in corrective surgery.

Figure 1

X-ray and CT of shoulders showing bilateral comminuted humeral head fracture and fracture fragment displacement.

Case 2: A 65-year-old man presented with first seizure of his lifetime, GTCSz, lasting for 3 min, developed...

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Vocal assessment of addicts on methadone therapy via the RBH scale and objective acoustic parameters

Publication date: Available online 10 November 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Veljko Mirkov, Slobodan M. Mitrović
IntroductionA large number of people around the world struggle daily to become free of their addiction to illegal psychoactive substances. In order to create an atmosphere of improved supervision, established communication and improved quality of life for drug addicts, centers have been set up to provide methadone as a substitute.ObjectiveThe aim of the research was to assess the vocal features of drug addicts on methadone therapy via subjective and objective parameters, to ascertain if vocal damage has occurred and to determine whether subjective and objective acoustic vocal parameters are related, and how.MethodsThe research included 34 adults of both genders who were undergoing methadone treatment. A subjective vocal evaluation assessed voice pitch and clarity, while the subjective acoustic analysis utilized the Roughness-Breathiness-Hoarseness scale of roughness-breathiness-hoarseness. Objective acoustic analysis was conducted after recording and analyzing an uninterrupted vocal /a/ of at least three seconds duration, using the "GllotisController" software.ResultsThe subjective acoustic analysis using the Roughness-Breathiness-Hoarseness scale showed pathological values in 52.9% male and 47% female participants. The average values of the roughness-breathiness-hoarseness for the entire sample were 0.91, 0.38 and 0.50, respectively. Lower roughness was associated with a higher fundamental frequency (f0) and lower jitter and shimmer values (p<0.05). There was a statistically significant correlation between breathiness, jitter (p<0.01) and shimmer (p<0.05), and between hoarseness and jitter (p<0.01).ConclusionA statistically significant correlation was found between the two subjective vocal assessments, voice clarity and pitch, and Roughness-Breathiness-Hoarseness scale, and the parameters of the objective acoustic vocal assessment.



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The protective effects of whortleberry extract against cisplatin-induced ototoxicity in rats

Publication date: Available online 10 November 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Doğukan Özdemir, Abdulkadir Özgür, Yıldıray Kalkan, Suat Terzi, Levent Tümkaya, Adnan Yılmaz, Metin Çeliker, Engin Dursun
IntroductionCisplatin is one of the main chemotherapeutic agents used for the treatment of many types of cancer. However, ototoxicity, one of the most serious side effects of cisplatin, restricts its usage.ObjectiveWe aimed to investigate the protective effects of whortleberry extract against cisplatin-induced ototoxicity by evaluating hearing and histopathological cochlear damage and by measuring the biochemical parameters affected byoxidative stress.MethodsForty-eight male rats were included in the study after performing Distortion Product Otoacoustic Emission test to confirm that their hearing levels were normal. The rats were randomly divided into six groups: the control group, the sham group, and, which received only whortleberry extract, only cisplatin, cisplatin+100mg whortleberry extract, cisplatin+200mg whortleberry extract, respectively. Audiologic investigation was performed by performing the Distortion Product Otoacoustic Emission test at the beginning and at the eighth day of the study. Cardiac blood samples were collected for biochemical analysis, and the rats were sacrificed to obtain cochlear histopathological specimens on the eighth day.ResultsThe results revealed that whortleberry protects hearing against cisplatin-induced ototoxicity independent of the dose. However, high doses of whortleberry extract are needed to prevent histopathological degeneration and oxidative stress.ConclusionThe results obtained in this study show that whortleberry extract has a protective effect against cisplatin-induced ototoxicity.



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Up-regulation of serum periostin and squamous cell carcinoma antigen levels in infants with acute bronchitis due to respiratory syncytial virus

Publication date: Available online 6 November 2017
Source:Allergology International
Author(s): Hiroaki Nakamura, Kenichi Akashi, Masako Watanabe, Shoichiro Ohta, Junya Ono, Yoshinori Azuma, Noriko Ogasawara, Keisuke Yamamoto, Norikazu Shimizu, Hiroyuki Tsutsumi, Kenji Izuhara, Toshio Katsunuma
BackgroundPeriostin and squamous cell carcinoma antigen (SCCA) are involved in the pathogenesis of asthma. Acute bronchitis due to respiratory syncytial virus (RSV) infection during infancy exhibits an asthma-like pathogenesis, suggesting that it may be associated with the subsequent development of asthma. However, the mechanism by which RSV infection leads to development of asthma has not yet been fully elucidated.MethodsInfants younger than 36 months were enrolled and classified into three groups. Group I included patients hospitalized with RSV-induced bronchitis. These patients were further stratified into two sub-groups according to whether the criteria for the modified Asthma Predictive Index (mAPI) had been met: Group I consisted of mAPI (+) and mAPI (−) patients; Group II included patients with food allergy as a positive control group; and Group III included children with no allergy as a negative control group. Serum periostin and SCCA levels were measured in the groups. This study was registered as a clinical trial (UMIN000012339).ResultsWe enrolled 14 subjects in Group I mAPI (+), 22 in Group I mAPI (−), 18 in Group II, and 18 in Group III. In Group I, the serum periostin and SCCA levels were significantly higher during the acute phase compared with the recovery phase. However, no significant differences were found between Group I mAPI (+) and mAPI (−).ConclusionsThe serum periostin and SCCA levels increased during acute RSV bronchitis. Both periostin and SCCA may play a role in the pathogenesis of acute bronchitis due to RSV.



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How important is allergic sensitization as a cause of atopic asthma?

Publication date: Available online 2 November 2017
Source:Allergology International
Author(s): Jun Kanazawa, Hironori Masuko, Hideyasu Yamada, Yohei Yatagai, Tohru Sakamoto, Haruna Kitazawa, Hiroaki Iijima, Takashi Naito, Tomomitsu Hirota, Mayumi Tamari, Nobuyuki Hizawa




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Efficacy and safety of omalizumab for the treatment of refractory chronic spontaneous urticaria in Japanese patients: Subgroup analysis of the phase 3 POLARIS study

Publication date: Available online 1 November 2017
Source:Allergology International
Author(s): Michihiro Hide, Atsuyuki Igarashi, Akiko Yagami, Yuko Chinuki, Naoko Inomata, Atsushi Fukunaga, Guenther Kaiser, Junyi Wang, Soichiro Matsushima, Steven Greenberg, Sam Khalil
BackgroundOmalizumab, a humanized anti-IgE monoclonal antibody, proved efficacious and well tolerated in patients with chronic spontaneous urticaria (CSU) refractory to H1 antihistamines (H1AH) in the POLARIS study (NCT02329223), a randomized, double-blind, placebo-controlled trial in East Asian patients. However, data in Japanese patients, who have specific baseline characteristics (e.g., low angioedema incidence, different background medications) that may impact clinical outcomes, are lacking. This pre-specified analysis presents additional patient-level data over time, pharmacokinetic and pharmacodynamics data for omalizumab and IgE, and efficacy and safety data for omalizumab in Japanese patients.MethodsJapanese patients (N = 105) were randomized 1:1:1 to omalizumab 300 mg, 150 mg, or placebo by subcutaneous injection every 4 weeks. Efficacy and safety were assessed primarily based on changes from baseline to Week 12 in weekly itch-severity scores (ISS7) and weekly urticaria activity scores (UAS7), and incidence of adverse events (AEs), respectively. Patient-level UAS7 data over time were also reviewed.ResultsAt Week 12, least squares mean (LSM) changes from baseline in ISS7 were greater with omalizumab vs. placebo (−9.54 and −7.29 for omalizumab 300 mg and 150 mg, respectively, vs. placebo [−5.17]). Corresponding LSM changes from baseline in UAS7 were −21.61 and −15.59 (vs. placebo [−10.88]). Most responders in the omalizumab 300 mg group displayed improvement of disease activity within 2–4 weeks and had well-controlled symptoms during the treatment period. Overall AE incidence was similar across treatment arms.ConclusionsThis subgroup analysis demonstrated that omalizumab is a well-tolerated, beneficial option for treatment of CSU in H1AH-refractory Japanese patients.



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Successful treatment of refractory alopecia universalis by persuading a patient not to sleep with her dog

Publication date: Available online 31 October 2017
Source:Allergology International
Author(s): Takahiro Arita, Tomoko Nomiyama, Jun Asai, Norito Katoh




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Phenotype classification using the combination of lung sound analysis and fractional exhaled nitric oxide for evaluating asthma treatment

Publication date: Available online 21 October 2017
Source:Allergology International
Author(s): Terufumi Shimoda, Yasushi Obase, Yukio Nagasaka, Sadahiro Asai
BackgroundWe report the utility of combining lung sound analysis and fractional exhaled nitric oxide (FeNO) for phenotype classification of airway inflammation in patients with bronchial asthma.We investigated the usefulness of the combination of the expiration-to-inspiration sound power ratio in the mid-frequency range (E/I MF) of 200–400 Hz and FeNO for comprehensively classifying disease type and evaluating asthma treatment.MethodsA total of 233 patients with bronchial asthma were included. The cutoff values of FeNO and E/I MF were set to 38 ppb and 0.36, respectively, according to a previous study. The patients were divided into 4 subgroups based on the FeNO and E/I MF cutoff values. Respiratory function, the percentages of sputum eosinophils and neutrophils, and patient background characteristics were compared among groups.ResultsRespiratory function was well controlled in the FeNO low/E/I MF low group (good control). Sputum neutrophil was higher and FEV1,%pred was lower in the FeNO low/E/I MF high group (poor control). History of childhood asthma and atopic asthma were associated with the FeNO high/E/I MF low group (insufficient control). The FeNO high/E/I MF high group corresponded to a longer disease duration, increased blood or sputum eosinophils, and lower FEV1/FVC (poor control).ConclusionsThe combination of FeNO and E/I MF assessed by lung sound analysis allows the condition of airway narrowing and the degree of airway inflammation to be assessed in patients with asthma and is useful for evaluating bronchial asthma treatments.



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Efficacy and safety of benralizumab in Japanese patients with severe, uncontrolled eosinophilic asthma

Publication date: Available online 8 November 2017
Source:Allergology International
Author(s): Ken Ohta, Mitsuru Adachi, Yuji Tohda, Tadashi Kamei, Motokazu Kato, J. Mark Fitzgerald, Masayuki Takanuma, Tadahiro Kakuno, Nobuyuki Imai, Yanping Wu, Magnus Aurivillius, Mitchell Goldman
BackgroundIn the Phase III CALIMA trial, benralizumab significantly reduced asthma exacerbations, increased lung function, and alleviated symptoms for patients with severe, uncontrolled eosinophilic asthma. The aim of this subgroup analysis was to evaluate the efficacy and safety of benralizumab for Japanese patients in the CALIMA trial.MethodsCALIMA was a randomised, controlled trial of 1306 patients (aged 12–75 years; registered at ClinicalTrials.gov: NCT01914757) with severe asthma uncontrolled by medium- to high-dosage inhaled corticosteroids and long-acting β2-agonists (ICS/LABA). Patients received 56 weeks' benralizumab 30 mg either every 4 weeks (Q4W) or every 8 weeks (Q8W; first three doses Q4W), or placebo Q4W. The primary analysis population was patients receiving high-dosage ICS/LABA with blood eosinophils ≥300 cells/μL. This subgroup analysis covered Japanese patients from this group.ResultsOf 83 patients randomised in Japan, 46 were receiving high-dosage ICS/LABA and had blood eosinophils ≥300 cells/μL. Compared with placebo, benralizumab reduced the annual rate of asthma exacerbations by 66% (Q4W; rate ratio 0.34, 95% CI, 0.11–0.99) and 83% (Q8W; rate ratio 0.17, 95% CI, 0.05–0.60); increased prebronchodilator FEV1 by 0.334 L (Q4W; 95% CI, 0.020–0.647) and 0.198 L (Q8W; 95% CI, −0.118 to 0.514); and decreased total asthma symptom score by 0.17 (Q4W; 95% CI, −0.82 to 0.48) and 0.24 (Q8W; 95% CI, −0.87 to 0.40). Percentages of adverse events were consistent with the overall CALIMA group.ConclusionsBenralizumab reduced annual asthma exacerbations and symptoms, increased lung function, and was well-tolerated by Japanese patients with severe, uncontrolled eosinophilic asthma.



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Response to “Providing dermatological care in resource-limited settings: barriers and potential solutions” – reply from authors

We thank Drs. Mahé and Faye for their interest in our article. We applaud them for their tremendous work in improving the delivery of dermatologic care through their programme with healthcare professionals in Mali.

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Psychological stress and psoriasis. A systematic review and meta-analysis

Abstract

Background

Psychological stress has long been linked with psoriasis exacerbation/onset. However, it is unclear if they are associated.

Objective

To determine if antecedent psychological stress and psoriasis exacerbation/onset are associated.

Methods

A comprehensive search of Pubmed, PsycINFO, Cochrane library, and clinicaltrials. gov databases was performed. Studies investigating the association between preceding psychological stress and psoriasis exacerbation/onset were classified as cross-sectional, case-control or cohort. Surveys evaluating beliefs regarding stress-reactivity were analysed separately. Suitable studies were meta-analysed.

Results

Thirty-nine studies were included evaluating 32,537 patients: 19 surveys, 7 cross-sectional, 12 case-controls and 1 cohort. Based on surveys and cross-sectional studies, 46% of patients believed their disease was stress-reactive and 54% recalled preceding stressful events. Case-control studies evaluating stressful events rates prior to psoriasis exacerbation (N=6) or onset (N=6) varied in time lag to recollection (≤9 month to ≥ 5 years). Pooling 5 studies evaluating stressful events preceding psoriasis onset yielded an OR of 3.4 (95%CI, 1.8-6.4, I² =87%), however the only study evaluating documented stress disorder diagnosis reported similar rates (OR 1.2, 95%CI, 0.8-1.8) between patients and controls. Four studies evaluating stressful events prior to psoriasis exacerbation reported comparable rates with controls, while 2 found more frequent/severe preceding events among psoriasis patients. A small prospective cohort study reported a modest association between stress-levels and psoriasis exacerbation (r = 0.28, p < 0.05).

Conclusions

The association between preceding stress and psoriasis exacerbation/onset is based primarily on retrospective studies with many limitations. No convincing evidence exists that preceding stress is strongly associated with psoriasis exacerbation/onset.

This article is protected by copyright. All rights reserved.

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Response to “Providing dermatological care in resource-limited settings: barriers and potential solutions”

We read with interest the paper from Chang et al (1). However, the authors overlooked certain solutions that were developed by our team to improve on a large scale the problem of skin diseases (SD) in resource limited settings (RLS), through an organized, public health approach (2-4).

This article is protected by copyright. All rights reserved.

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Quality requirements for allergen extracts and allergoids for allergen immunotherapy

Publication date: Available online 9 November 2017
Source:Allergologia et Immunopathologia
Author(s): J. Zimmer, A. Bonertz, S. Vieths
All allergen products for allergen immunotherapy currently marketed in the European Union are pharmaceutical preparations derived from allergen-containing source materials like pollens, mites and moulds. Especially this natural origin results in particular demands for the regulatory requirements governing allergen products. Furthermore, the development of regulatory requirements is complicated by the so far missing universal link between certain quality parameters, in particular biological potency, on the one hand and clinical efficacy on the other hand. As a consequence, each allergen product for specific immunotherapy has to be assessed individually for its quality, safety and efficacy. At the same time, biological potency of allergen products is most commonly determined using IgE inhibition assays based on human sera relative to product-specific in house references, ruling out full comparability of products from different manufacturers. This review article aims to summarize the current quality requirements for allergen products including the special requirements implemented for control of chemically modified allergen extracts (allergoids).



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The future of immunotherapy with individual allergens: Immunotherapy with fungi

Publication date: Available online 9 November 2017
Source:Allergologia et Immunopathologia
Author(s): F. Pineda




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Removal of a Frontal Sinus Osteoma and Reconstruction by a Custom-Made Implant with Neuronavigation Assistance

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1607066

The authors report the surgical treatment of an extensive right frontal sinus osteoma assisted by neuronavigation and reconstruction by a hydroxyapatite custom-made implant. The patient presents with ptosis, hypoglobus, and proptosis of the right eye, without any visual impairment. Computed tomographic (CT) scan showed a very large bony mass involving right frontal sinus and displacing the orbital roof. A stereolithographic model–guided planning was carried out to obtain a practical simulation of the surgical operation and it was submitted to a new CT scan to acquire the reference point to realize the neuronavigation assistance, and to achieve the template to realize the hydroxyapatite custom-made implant. Intraoperatively, with the help of neuronavigation assistance, osteotomies were performed by piezoelectric device. The reconstruction was made using a hydroxyapatite custom-made implant. The procedure was damage free, the bony mass was excised, and the orbital roof was repaired without any adverse effects. Postsurgical CT scan and scintigraphy showed a good reconstruction and a good-quality osteoblasts activity on the borders of the implant. Osteoma is a benign slow-growing bone tumor, usually involving the frontal sinus. Navigational assistance offers a very important help to perform safe osteotomies. Hydroxyapatite custom-made implant seems to be an excellent reconstructive method.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Thromboprophylaxis in Head and Neck Microvascular Reconstruction

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1607068

Head and neck patients undergoing microvascular reconstruction are at high risk for thromboembolism. While the prevention of thromboembolism has become an essential aspect of care, within the field of microsurgery, concern for anastomotic complications have hindered the creation of an accepted regimen. The aim of this review was to evaluate the risks and benefits of prophylactic agents for thromboprophylaxis. A literature search was conducted in MEDLINE, Cochrane Library, and PubMed/NCBI databases. Articles discussing thromboprophylaxis in otolaryngology, head and neck surgery, or microvascular reconstruction were considered in the review from the past 30 years. The majority of patients undergoing microvascular surgery have multiple risk factors for thrombus formation. Several consensus guidelines exist for the prophylaxis in patients who are critically ill, undergoing surgery, or with malignancy. Significant evidence supports the routine use of mechanical means, such as early mobilization and pneumatic compression along with subcutaneous heparin. Low-molecular-weight heparin is also frequently utilized, although results are largely divided. Data on aspirin remain equivocal. Studies on microvascular failure and flap loss have demonstrated little to no association with chemoprophylaxis. The evidence for postoperative thromboprophylaxis regimens in patients undergoing head and neck free tissue transfer is variable. Multiple studies have supported the use of unfractionated heparin or low-molecular-weight heparin. There appears to be an expert consensus for the combined use of mechanical prophylactic methods and chemical prophylaxis. Prospective randomized trials are required to validate the most effective combination of chemoprophylaxis agents.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Pseudoaneurysm Following Endoscopic-Assisted Repair of Subcondylar Fracture

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1607064

Pseudoaneurysms are a known complication following facial trauma and orthognathic surgery. Few reports exist of this clinical entity following traditional open techniques of repair, and none have been associated with endoscopic-assisted open reduction and internal fixation (ORIF) of a subcondylar fracture. We present a case of a 33-year-old man who developed pseudoaneurysm after endoscopic-assisted ORIF as well as a review of the literature on this topic. While uncommon, this is a potential complication that should be recognized with the use of endoscopic-assisted repair of mandibular fractures.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Traumatic Anterosuperior Dislocation of the Intact Mandibular Condyle into the Temporal Fossa

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1607067

Temporomandibular joint (TMJ) dislocation, or luxation, occurs when the condyle crosses the articular eminence in such a way that it does not return to its correct anatomical position, unless aided by a reduction in external forces for TMJ. The diagnosis of condylar luxation is clinical; however, image exams are important in classifying the types of condylar luxation and associated fractures. Displacement of the TMJ can occur due to either an exaggerated mouth opening or a forced opening and occasionally is associated with a high-impact trauma to the jaw, the latter being an extremely rare condition. Few cases of anterosuperior dislocation of the intact mandibular condyles into the temporal fossa (ADIMC) have been documented in medical literature, many of which are associated with craniofacial trauma. This study describes the case of an ADIMC of the left side combined with facial fractures, as well as the treatment performed. A review of cases found in the literature from 1969 to 2017 was conducted through a detailed bibliographical study.
[...]

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Cartilage Graft Donor Site Morbidity following Rhinoplasty and Nasal Reconstruction

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1607065

Although surgical techniques for rhinoplasty and nasal reconstruction are well established, prospective research on postoperative morbidity remains limited. The aim of this pilot study was to assess costal and auricular cartilage donor site pain and morbidity in patients undergoing rhinoplasty and nasal reconstruction. In this prospective cohort study, we enrolled 55 patients undergoing nasal surgery that required costal or auricular cartilage harvest from February 2015 through May 2016. Each patient was given a symptom-specific patient survey that assessed general pain, nasal pain, graft donor site pain, graft donor site itching, color variation, skin stiffness and thickness, and graft donor site appearance at 1, 4, and 12 weeks after surgery. Our patient group was 55% female (n = 30); the mean age was 47 years. Rib cartilage graft patients had significantly greater nasal pain than cartilage donor site pain. There was no significant difference in rib versus ear cartilage donor site pain. Nearly all patients reported that they were not at all concerned about their scar appearance or ear shape and appearance. No prior studies compare cartilage donor site morbidity in patients undergoing nasal surgery. Our findings challenge the conventional wisdom that utilizing auricular and costal cartilage results in high levels of donor site pain. Surgeons should have a low threshold to harvest rib or ear cartilage when it can improve surgical outcome.
[...]

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A Novel Approach for the Management and Prevention of Self-Induced Masticatory Lingual Trauma in the Neurologically Injured Patient

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1606300

Self-induced masticatory trauma is an unfortunate complication of a variety of neurologic disorders, including epileptic seizures, cerebral palsy, mental retardation, psychiatric disease, and brain trauma, in addition to other described etiologies. While single or occasional occurrences of tongue biting are relatively benign, recurrent self-injury can pose major issues and predispose a patient to chronic, severe complications. To prevent the complications associated with ongoing trauma to the tongue, steps must be taken to protect individuals from chronic self-injurious behavior. Often, these interventions cause significant morbidity to the patient, such as elective removal of the dentition or complications in gaining access to the oral cavity/airway associated with maxillomandibular fixation. In the neurologically impaired patient, immobilization of the jaws is frequently associated with higher rates of agitation, aspiration, or development of complicating infections of the gingival tissues. We report a case of self-induced masticatory trauma managed with the fabrication of a custom-fabricated oral appliance. This treatment modality successfully prevents the recurrence or incidence of self-induced masticatory trauma to the tongue. The benefits of this modality are that it allows access to the oral cavity, prevents immobilization of the jaws, has minimal to no morbidity, and is completely reversible.
[...]

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Auditive Verarbeitungs- und Wahrnehmungsstörung: Ist die Diagnose schon bei Erstklässlern möglich?

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-120580

Hintergrund Signifikante Leistungsunterschiede zwischen Kindern mit und ohne auditive Verarbeitungs- und Wahrnehmungsstörungen (AVWS) im 2., 3. und 4. Grundschuljahr wurden in einer eklektischen AVWS-Testbatterie für die meisten Diagnoseinstrumente festgestellt. Die aktuelle Studie erfolgte mit der Fragestellung, ob dies auch für Kinder der 1. Schulklassenstufe zutrifft. Material und Methoden Leistungen von 41 Kindern mit und von 37 ohne AVWS im 1. Regelgrundschuljahr (Alter: 6–8 Jahre) wurden in 14 spezifisch auditiven Tests miteinander verglichen. Ergebnisse Statistisch signifikante Gruppenunterschiede wurden in 12 Diagnoseinstrumenten aufgedeckt; lediglich in 2 PaTSy-Subtests (Tonfrequenzen; Tonintensitäten) war das nicht der Fall. Bzgl. der monauralen Ordnungsschwelle blieb die Signifikanz nach Bonferroni-Korrektur knapp erhalten. Non-AVWS-Kinder bewältigten die PaTSy-Subtests in 86–89 %, AVWS-Kinder in 73–83 % aller Fälle. Die Testwerte von Jungen bzw. Mädchen mit AVWS waren im Vergleich zu denen von Jungen bzw. Mädchen ohne AVWS durchweg reduziert. Schlussfolgerungen Auch Erstklässler mit „AVWS" ließen sich von solchen ohne „AVWS" statistisch signifikant unterscheiden. In der Tendenz waren bei Erstklässlern mit AVWS dieselben Leistungen gemindert wie bei Grundschülern in höheren Klassenstufen. Der Einsatz sprachfreier audiologischer Verfahren zur klinischen Diagnose von AVWS erscheint für die Altersgruppe 6–8 Jahre jedoch fragwürdig.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Reduktion postoperativer Schmerzen durch Manuelle Medizin bei Erwachsenen nach Tonsillektomie

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-119885

Hintergrund Postoperativer Schmerz nach Tonsillektomie (TE) kann in der Regel durch die Gabe von Analgetika aus der Gruppe der nicht steroidalen Antirheumatika (NSAR) suffizient behandelt werden. Bei einigen Patienten besteht jedoch eine außergewöhnlich therapieresistente Schmerzsymptomatik, welche zudem häufig einseitig stärker ausgeprägt ist. Unsere klinisch praktische Erfahrung hat gezeigt, dass bei diesen Patienten häufig eine Blockierung der oberen Kopfgelenke vorliegt, die durch Manuelle Medizin (MM) erfolgreich therapiert werden kann. In dieser prospektiven, randomisierten, placebo-kontrollierten, einfach verblindeten Studie sollte deshalb untersucht werden, ob sich der schmerzlindernde Effekt dieser Therapie statistisch nachweisen lässt. Material und Methoden 52 erwachsene Patienten mit außergewöhnlich starken (VAS > 4) und / oder einseitigen Schmerzen nach TE (1. bis 4. Tag postoperativ) wurden hinsichtlich des Schmerzverlaufs mittels Visueller Analogskala (VAS) zu 4 Zeitpunkten untersucht: direkt vor (t0) und sofort nach der MM (t1), dann 4 Stunden nach MM (t2) sowie 24 Stunden nach MM (t3). Ergebnisse Die Ergebnisse zeigen eine signifikant höhere Schmerzreduktion (jeweils als Differenz zu t0) in der Verum- als in der Placebogruppe zum Zeitpunkt t1 und t3 (t1: p = 0,012, t3: p = 0,012, beides Bonferroni-adjustiert). Zum Zeitpunkt t2 war die Differenz mit p = 0,54 nicht signifikant. Schlussfolgerungen Anhand der Studie konnte die Wirksamkeit von Manueller Medizin zur Schmerzreduktion bei erwachsenen Patienten mit außergewöhnlich starken bzw. einseitigen Schmerzen nach TE und Hypomobilität der Halswirbelsäule nachgewiesen werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Eine seltene Differentialdiagnose des jugulotympanalen Paraganglioms

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-118006

[...]

Georg Thieme Verlag KG Stuttgart · New York

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Langzeitergebnisse und Patientenzufriedenheit nach Tympanoplastik mit Titan-Clip-Prothesen

Laryngo-Rhino-Otol 2017; 96: 698-703
DOI: 10.1055/s-0042-12450

Ziel der vorliegenden Arbeit ist die Evaluation der Langzeitergebnisse nach Ossikelkettenrekonstruktion mittels Titan-Clip Prothesen. Hierzu wurde eine retrospektive Analyse mit prospektivem Follow-up bei allen Patienten durchgeführt, bei denen in den Jahren 2002–2013 ein Clip-PORP implantiert wurde. Es erfolgten audiologische Messungen, otoskopische Untersuchungen sowie die Evaluation der Lebensqualität mittels Glasgow Benefit Inventory. 48 Patienten (51 Ohren, 29 Männer, 19 Frauen, Durchschnittsalter 44,1 Jahre) konnten für das Follow-up rekrutiert werden, der Nachbeobachtungszeitraum lag im Mittel bei 6,3 Jahren. Die Schallleitungskomponente wurde insgesamt (0,5–4 kHz) von präoperativ 22,8 dB auf 14,6 dB postoperativ reduziert (p≤0,001). Häufigste Operationsindikation waren Cholesteatome und -Rezidive (52%), gefolgt von chronischen Otitiden (12%), Radikalhöhlenrevisionen (8%) und Schallleitungsstörungen nach Voroperation (14%). In 47 Fällen war das Trommelfell verschlossen (92,2%), 4x (7,8%) bestand ein Defekt. Die Prothese war 39 Mal (75%) in situ, 6x (11,8%) lag eine Protrusion bzw. 2x (4%) eine Verkippung vor, 1x (2%) war die Prothese fehlend und 3x (5,9%) konnte es nicht beurteilt werden. Die postinterventionelle Patientenzufriedenheit wurde insgesamt positiv bewertet (8,4 Punkte), ebenso die allgemeine Unterskala während bei den Unterskalen soziale Unterstützung und körperliche Gesundheit keine Veränderung auftraten. Zusammenfassend ist die Ossikuloplastik mittels Titan-Clip Prothesen ein sicheres und etabliertes Verfahren. Auch langfristig werden gute und stabile audiologische Messresultate durch Reduktion der Schallleitungskomponente aufgezeigt. Die subjektive Lebensqualität ist insgesamt nachhaltig verbessert.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Chirurgie der inneren Nase

Laryngo-Rhino-Otol 2017; 96: 743-745
DOI: 10.1055/s-0043-114740

Georg Thieme Verlag KG Stuttgart · New York

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Leserbrief zu Ernst, A, P. Schlattmann, F. Waldfahrer, M. Westhofen Die Behandlung des M. Menière mit Betahistin: Kritische Anmerkungen zur BEMED-Studie. Laryngo-Rhino-Otol 2017; 96 (08): 519–521

Laryngo-Rhino-Otol 2017; 96: 674-674
DOI: 10.1055/s-0043-119253

Georg Thieme Verlag KG Stuttgart · New York

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Hörverbesserung durch Tympanoplastik

Laryngo-Rhino-Otol 2017; 96: 718-740
DOI: 10.1055/s-0043-114744

Die grundlegenden Techniken der Tympanoplastik wurden Anfang der 1950er Jahre entwickelt und seitdem verfeinert und modifiziert; die Grundprinzipien haben aber auch heute noch ihre Bedeutung. Als Transplantatmaterialien finden überwiegend Knorpel und Perichondrium Verwendung. Zur Ossikelrekonstruktion haben sich insbesondere Titanprothesen als vorteilhaft erwiesen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Antwort auf den Leserbrief von Schaaf/Hesse zum Artikel „Die Behandlung des M. Menière mit Betahistin: Kritische Anmerkungen zur BEMED-Studie“ (Laryngo-Rhino-Otol 2017; 96 (08): 519–521)

Laryngo-Rhino-Otol 2017; 96: 675-675
DOI: 10.1055/s-0043-119254

Georg Thieme Verlag KG Stuttgart · New York

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Leitlinien in der Praxis: Die neue S3-Leitlinie „Nicht erholsamer Schlaf/Schlafstörungen“ – Kapitel „Schlafbezogene Atmungsstörungen“

Laryngo-Rhino-Otol 2017; 96: 685-690
DOI: 10.1055/s-0043-114750

Zu den schlafbezogenen Atmungsstörungen zählen die zentrale Schlafapnoe (ZSA), die obstruktive Schlafapnoe (OSA) und die schlafbezogene Hypoventilation bzw. Hypoxämie. Sie sind häufig und von zunehmender klinischer Relevanz. Das Kapitel zu dieser Krankheitsgruppe aus der S3-Leitlinie „Nicht erholsamer Schlaf/Schlafstörungen" der Deutschen Gesellschaft für Schlafmedizin wurde am 29. November 2016 aktualisiert und bietet Neuerungen zu Epidemiologie, Diagnostik, Therapie und Systematik. Zur Epidemiologie wird die deutlich erhöhte Mortalität schwangerer Frauen mit OSA herausgestellt. In der Diagnostik der OSA wird betont, dass die Polygrafie unter bestimmten Voraussetzungen ausreichen kann. Änderungen der diagnostischen Empfehlungen zur ZSA erlauben nun die Diagnosestellung auch bei geringer Apnoerate unter der Voraussetzung einer typischen klinischen Situation. Entscheidende therapeutische Unterschiede haben sich bei der ZSA mit Herzinsuffizienz ergeben. Ferner wird differenziert zwischen schlafbezogener Hypoventilation und schlafbezogener Hypoxämie. Das Obesitas-Hypoventilations-Syndrom wird insgesamt breiter besprochen. Der vorliegende Artikel fasst die Änderungen zusammen und kommentiert sie.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Stimmlippenzyste

Laryngo-Rhino-Otol 2017; 96: 676-677
DOI: 10.1055/s-0043-114751

Georg Thieme Verlag KG Stuttgart · New York

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Behandlungsfehler, wenn Patient nicht wieder kommt

Laryngo-Rhino-Otol 2017; 96: 716-717
DOI: 10.1055/s-0043-114745

Georg Thieme Verlag KG Stuttgart · New York

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Ein neues Lagerungsmanöver zur Behandlung einer Form von Schwankschwindel auf der Basis eines modifizierten Modells der Macula utriculi

Laryngo-Rhino-Otol 2017; 96: 678-684
DOI: 10.1055/s-0043-118632

Schwindel ist eines der Hauptsymptome unseres Fachgebietes, das in vielen Fällen interdisziplinär abgeklärt werden muss. In den letzten Jahren haben sich die diagnostischen Möglichkeiten, ausgehend von den seit Jahren bewährten Lagerungen und der kalorischen Prüfung, erheblich erweitert, so dass heute wesentlich differenzierter die zugrunde liegenden Störungen erkannt werden können. Gleichwohl sind sowohl in diagnostischer als auch therapeutischer Sicht immer noch viele Fragen offen. In dem nachfolgenden Artikel stellt der Kollege Koch ein neues Lagerungsmanöver als Therapieoption vor, das er bei vorwiegend älteren Patienten angewendet hat, die einen diffusen Schwankschwindel beim Gehen und Stehen, nicht jedoch im Sitzen oder Liegen hatten. Ausgehend von seinen Behandlungserfolgen schlägt er als Erklärung eine Modifikation des gängigen Modells der Macula utriculi vor, die ein weiterer Beitrag in der aktuellen Diskussion zum Thema „Schwindel" sein sollen. Zur weiteren Aufklärung wäre es interessant zu untersuchen, ob die von dem Autor vorgestellte Patientengruppe im Video-Kopfimpulstest verdeckte Sakkaden aufweisen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2017; 96: 741-742
DOI: 10.1055/s-0043-114746

Georg Thieme Verlag KG Stuttgart · New York

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Eine rasch zunehmende Raumforderung der Schilddrüse

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-119758

[...]

Georg Thieme Verlag KG Stuttgart · New York

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Akuter progredienter Exophtalmus

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-119756

Georg Thieme Verlag KG Stuttgart · New York

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Nasenmuschelplastik: Welche Technik hat die Nase vorn?

Laryngo-Rhino-Otol 2017; 96: 672-673
DOI: 10.1055/s-0043-108954

Georg Thieme Verlag KG Stuttgart · New York

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Ballondilatation der Eustachischen Röhre unter lokaler Betäubung

Laryngo-Rhino-Otol 2017; 96: 671-672
DOI: 10.1055/s-0043-117012

Georg Thieme Verlag KG Stuttgart · New York

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Kombinierte Antibiotikatherapie wirksamer bei Paukenröhrchen und Otorrhoe

Laryngo-Rhino-Otol 2017; 96: 670-671
DOI: 10.1055/s-0043-117014

Georg Thieme Verlag KG Stuttgart · New York

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Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2017; 96: 666-667
DOI: 10.1055/s-0043-114755

Liebe Leserinnen und Leser,die aktuelle Ausgabe der Laryngo-Rhino-Otologie bietet einen umfangreichen Strauß zu verschiedenen relevanten Themen unseres schönen Faches.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Hörrehabilitation durch Cochlea-Implantation nach Vestibularisschwannom-Entfernung?

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-119546

Ausgewertet wurden in einer Qualitätssicherungsanalyse 10 Patienten mit einem individuellen Behandlungsversuch nach einer simultanen oder konsekutiven Cochlea-Implantation nach translabyrinthärer Vestibularisschwannomentfernung im Kleinhirnbrückenwinkel. Die Ergebnisse zeigen, dass die Mehrzahl der Patienten mit einseitiger Ertaubung durch die stereophone Hörrehabilitation profitiert. Durch eine schonende chirurgische Präparationstechnik im Bereich des inneren Gehörgangs kann die morphologisch-funktionelle Integrität der neurovaskulären Strukturen gewährleistet werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Multivariate analysis of risk factors for postoperative wound infection following oral and oropharyngeal cancer surgery

The goal of this study was to identify risk factors for wound infections in patients with oral cancer who underwent surgical procedures.

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Influence of gender on epithelial host defence peptide gene expression under non-infected and infected conditions: a basic medical research study

Bacterial resistance against conventional antibiotics is increasing. This introduces challenges, for example, in the treatment of infected surgical wounds. Host defence peptides (HDP), which are endogenous peptide antibiotics, show broad-spectrum antimicrobial effectiveness. They protect the organism against pathological microorganisms. Synthetic HDP might supplement or even become alternatives to conventional antibiotics. Knowledge of their quantities under physiological and pathophysiological conditions is therefore required.

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Reconstruction of preauricular soft tissue defects using a superiorly based rotation advancement scalp flap - A novel approach to the surgical treatment of preauricular sinuses

No funding was required for this study and the authors have no conflict of interests to declare.

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Myopericytoma of the neck originating in the middle scalene muscle: A case report

Mark B. Chaskes, MD, MBA; John W. Bishop, MD; Matthew Bobinski, MD, PhD; D. Gregory Farwell, MD

Abstract

We report a case of myopericytoma of the neck. A 23-year-old woman noticed a small, nontender mass in her left supraclavicular fossa. The mass had grown over a period of 5 months, prompting her to seek evaluation. On examination, no motor or sensory deficits were present. Imaging suggested that a mass had originated in the middle scalene muscle. Computed-tomography-guided core needle biopsy demonstrated a spindle-cell neoplasm with smooth-muscle differentiation. Complete surgical excision was performed. Histopathologic and immunohistochemical evaluations of the tissue sample suggested a myopericytoma. Myopericytoma is an extremely rare tumor of the head and neck. To the best of our knowledge, this is the first reported case of a myopericytoma originating in a scalene muscle.

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Management of benign middle ear tumors: A series of 7 cases

Z. Jason Qian, MD; Amy M. Coffey, MD; Kathleen M. O'Toole, MD; Anil K. Lalwani, MD

Abstract

Benign middle ear tumors represent a rare group of neoplasms that vary widely in their pathology, anatomy, and clinical findings. These factors have made it difficult to establish guidelines for the resection of such tumors. Here we present 7 unique cases of these rare and diverse tumors and draw from our experience to recommend optimal surgical management. Based on our experience, a postauricular incision is necessary in nearly all cases. Mastoidectomy is required for tumors that extend into the mastoid cavity. Whenever exposure or hemostasis is believed to be inadequate with simple mastoidectomy, canal-wall-down mastoidectomy should be performed. Finally, disarticulation of the ossicular chain greatly facilitates tumor excision and should be performed early in the procedure.

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A novel etiology for pneumolabyrinth after temporal bone fracture without otic capsule involvement

Thomas J. Muelleman, MD; Vidur Bhalla, MD; Hinrich Staecker, MD, PhD

Abstract

Pneumolabyrinth has been considered an indicator of otic capsule involvement in temporal bone fractures. We present a novel theory for the etiology of pneumolabyrinth in a trauma patient without an otic capsule fracture: passage of intrathecal air into the labyrinth. Our patient experienced transient bilateral pneumolabyrinth after head trauma due to a motor vehicle collision. The patient was noted to have extensive pneumocephalus and a unilateral temporal bone fracture that spared the otic capsule. Initial computed tomography (CT) scans demonstrated air in the cochlea and both internal auditory canals. A high-resolution CT scan 6 hours later showed resolution of this air. Pneumolabyrinth may not be a sensitive indicator of otic capsule involvement in temporal bone fractures. In addition to middle ear sources, air in the labyrinth can also plausibly originate intrathecally, especially in the setting of pneumocephalus.

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Guidelines for radiographic imaging of cranial neuropathies

Aliasgher Khaku, BS; Vijay Patel, BS; Thomas Zacharia, MD; David Goldenberg, MD; Johnathan McGinn, MD

Abstract

Disruption of the complex pathways of the 12 cranial nerves can occur at any site along their course, and many, varied pathologic processes may initially manifest as dysfunction and neuropathy. Radiographic imaging (computed topography or magnetic resonance imaging) is frequently used to evaluate cranial neuropathies; however, indications for imaging and imaging method of choice vary considerably between the cranial nerves. The purpose of this review is to provide an analysis of the diagnostic yield and the most clinically appropriate means to evaluate cranial neuropathies using radiographic imaging. Using the PubMed MEDLINE NCBI database, a total of 49,079 articles' results were retrieved on September 20, 2014. Scholarly articles that discuss the etiology, incidence, and use of imaging in the context of evaluation and diagnostic yield of the 12 cranial nerves were evaluated for the purposes of this review. We combined primary research, guidelines, and best practice recommendations to create a practical framework for the radiographic evaluation of cranial neuropathies.

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A controlled comparison of auditory steady-state responses and pure-tone audiometry in patients with hearing loss

Raman Wadhera, MS; Sharad Hernot, MS; Sat Paul Gulati, MS; Vijay Kalra, MS

Abstract

We performed a prospective interventional study to evaluate correlations between hearing thresholds determined by pure-tone audiometry (PTA) and auditory steady-state response (ASSR) testing in two types of patients with hearing loss and a control group of persons with normal hearing. The study was conducted on 240 ears-80 ears with conductive hearing loss, 80 ears with sensorineural hearing loss, and 80 normal-hearing ears. We found that mean threshold differences between PTA results and ASSR testing at different frequencies did not exceed 15 dB in any group. Using Pearson correlation coefficient calculations, we determined that the two responses correlated better in patients with sensorineural hearing loss than in those with conductive hearing loss. We conclude that measuring ASSRs can be an excellent complement to other diagnostic methods in determining hearing thresholds.

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"Live" tinnitus

Chia-Chun Liu, MD; Ming-Yee Lin, MD

Insects should be killed before removal with instrumentation, irrigation, or suction.

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Laryngeal hemangioma presenting as a laryngocele

Kevin Shaigany, MD; Sidrah M. Ahmad, MD; Nausheen Jamal, MD

Laryngeal hemangiomas and laryngoceles share similar characteristics and should be considered in the differential diagnosis.

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Clinical application of nasometry in patients with nasal obstruction

Georges Ziade, MD; Maher Kasti, MD; Doja Sarieddine, BS; Zein Saadeddine, BS; Abdul-Latif Hamdan, MD

Abstract

The purpose of this case-control study is to report on the clinical application of nasometry as a diagnostic tool in patients with the symptom of nasal obstruction compared with subjects with no history of nasal obstruction. Thirty-eight adult patients (mean age: 28.1 years) complaining of nasal obstruction were enrolled in the study, and another group of 38 adults (mean age: 25.9 years) with no history of nasal obstruction served as controls. Demographic data, including age and sex, were collected. Patients were asked to read three passages; the Zoo passage, the Rainbow passage, and nasal sentences. Nasalance scores were reported on all subjects using a Nasometer II instrument. The control and patient groups each included 22 men and 16 women. No statistically significant difference in nasalance score was found between the study group and the control group in any of the Zoo passage, Rainbow passage and nasal sentences. We conclude that nasometry has limited value in the objective assessment of nasal obstruction as a symptom, which we attribute to nasal obstruction's not always reflecting the volume and pressure in the nasal cavity.

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Endoscopic view of a drainage pathway of a concha bullosa

Eiji Yanagisawa, MD, FACS; Dewey A. Christmas, MD; Joseph P. Mirante, MD, MBA, FACS

A concha bullosa does not require surgical intervention unless it creates obstructive problems with respiration or functional drainage problems.

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Nasal septum granuloma gravidarum

Daniel Thomas Ginat, MD, MS; Charles J. Schatz, MD, FACR

Granuloma gravidarum lesions tend to be highly vascular and demonstrate avid enhancement, but they do not have large draining veins.

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Change in reimbursement and costs in German oncological head and neck surgery over the last decade: ablative tongue cancer surgery and reconstruction with split-thickness skin graft vs. microvascular radial forearm flap

Abstract

Objectives

Defects after ablative tongue cancer surgery can be reconstructed by split-thickness skin grafts or free microvascular flaps. The different surgical options may influence costs, reimbursement, and therefore possible profits. Our goal was to analyze the development of these parameters for different procedures in head and neck reconstruction in Germany over the last decade.

Materials and methods

After tumor resection and neck dissection of tongue cancer, three different scenarios were chosen to calculate costs, reimbursement, length of stay (LoS), and profits. Two options considered were reconstruction by split-thickness skin graft with (option Ia) and without (option Ib) tracheotomy. In addition, we analyzed microvascular reconstruction with radial forearm flap (option II). Furthermore, unsatisfactory results after options Ia and Ib may make secondary tongue plastic with split-thickness skin grafting necessary (option I+). The calculations were performed considering the German Diagnosis Related Group (DRG) system and compared to the specific DRG cost data of 250 German reference hospitals.

Results

The overall average length of stay (aLoS) declined from 16.7 to 12.8 days with a reduction in every option. Until 2011, all options showed similar accumulated DRG reimbursement. From 2012 onwards, earnings almost doubled for option II due to changes in the DRG allocation. As was expected, the highest costs were observed in option II. Profits (reimbursement minus costs) were also highest for option II (mean 2052 €, maximum 3630 Euros in 2015) followed by options Ia (765 €) and Ib/I+ (681 €). Average profits over time would be 17 to 19% higher if adjusted for inflation.

Conclusions

We showed the development of the DRG allocation of two commonly used methods of reconstruction after ablative tongue cancer surgery and the associated LoS, reimbursement, costs, and profits. As expected, the highest values were found for microvascular reconstruction. Microvascular reconstruction may also be the primary choice of treatment from a medical point of view. However, prolonged operation times, intensive care, and hospital stay in connection with complex microvascular operations can easily turn profits into losses as opposed to the results of simple, reliable, and fast split-thickness skin grafting. The inflation rate influences profits in reimbursement systems where costs are based on a previous period of time.

Clinical relevance

Surgeons find themselves daily in an area of conflict between economic interests and medical decision-making. Due to its multidimensional aspects, the choice of the reconstructive technique should be primarily based on the best medical care for the patient. But there should also be awareness of the economic risk of all three surgical procedures.

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Successful medical management of acute mesenteric ischemia due to superior mesenteric and portal vein thrombosis in a 27-year-old man with protein S deficiency: a case report

Acute mesenteric ischemia poses a diagnostic challenge due to nonspecific clinical clues and lack of awareness owing to its rarity. Ischemia due to mesenteric venous thrombosis has a good prognosis compared to...

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Skin Regeneration Using an Amniotic-Derived Tissue Graft

How might different processing modalities of amniotic tissues impact wound healing outcomes?
Wounds

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Effectiveness of alpine climate treatment for children with difficult to treat atopic dermatitis: results of a pragmatic randomized controlled trial (DAVOS trial)

Abstract

Background

Alpine climate treatment has historically been used in Europe to treat atopic dermatitis (AD), but no randomized trials have been conducted to provide evidence for its effectiveness.

Objective

To investigate the long-term effectiveness of alpine climate treatment for children with difficult to treat AD.

Materials & Methods

A pragmatic, open, randomized controlled trial was conducted. Children diagnosed with AD that was considered difficult to treat, aged between 8 and 18 years and willing to be treated in Switzerland were randomized to a six week personalized integrative multidisciplinary treatment period in a clinical setting in the alpine climate (Switzerland) or an outpatient setting in moderate maritime climate (Netherlands). Study assessments were conducted at the Wilhelmina Children's Hospital; an electronic portal was used for the collection of questionnaire data.

Primary outcomes were disease activity (SAEASI), quality of life (CDLQI), and catastrophizing thoughts (JUCKKI/JU) six months after intervention. Other assessments were immediately and six weeks after intervention. Subgroup analyses concerned asthma-related outcomes. Children were randomly assigned to either the intervention or control group using a covariate adaptive randomization method, taking age and asthma diagnosis into account. Children, parents, and health care professionals involved in treatment were not blinded to group assignment. Data were analyzed according to intention-to-treat with linear mixed effects models for continuous outcomes. The trial is registered at Current Controlled Trials ISCRTN88136485.

Results

Between September 14^th 2010 and September 30^th 2014, 88 children were enrolled in the trial, 84 children were randomized (41 assigned to intervention, 43 to control) of whom 77 completed the intervention (38/41 (93%) intervention, 39/43 (91%) control) and 74 completed follow-up (38/41 (93%) intervention, 36/43 (84%) control). Six months after intervention there were no significant differences between the groups on disease activity (SAEASI mean difference -3.4 (95%CI -8.5 to 1.7)), quality of life (CDLQI mean difference -0.3 (95%CI -2.0 to 1.4)), and catastrophizing thoughts (JUCCKI/JU subscale mean difference -0.7 (95%CI -1.4 to -0.0)). Immediately and six weeks after intervention, disease activity and quality of life were significantly different in favor of alpine climate treatment. Mean differences on SAEASI were -10.1 (95%CI -14.5 to -5.8) and -8.4 (95%CI -12.2 to -4.6) and on CDLQI -1.9 (95%CI -3.3 to -0.5) and -1.5 (95%CI -2.8 to -0.3) immediately and six weeks after the intervention, respectively. There were no long-term differences on asthma related outcomes. Five serious adverse events occurred during the study period, which were not thought to be related to the treatment.

Conclusions & Clinical relevance

For children with difficult to treat AD, there was no additional long-term benefit of alpine climate treatment, in contrast to the short-term, compared to an outpatient treatment program in moderate maritime climate, using a personalized integrative multidisciplinary treatment approach.

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Assessment of biologically aggressive, recurrent glandular odontogenic cysts for mastermind-like 2 (MAML2) rearrangements: histopathologic and fluorescent in situ hybridization (FISH) Findings in eleven cases

Abstract

Background

Glandular odontogenic cyst (GOC) demonstrates a significant predilection toward localized biologic aggressiveness and recurrence. GOC shares certain histopathologic features with intraosseous mucoepidermoid carcinoma (IMEC). The current investigation evaluates a group of recurrent, biologically aggressive GOCs to determine if any cases demonstrated unique histologic features or Mastermind – like2 (MAML2) rearrangements common to IMEC.

Methods

Microscopic slides from eleven previously diagnosed GOGs were stained with hematoxylin and eosin and assessed by two study participants for ten classic histopathologic features required to establish a diagnosis of GOC. Cases were evaluated utilizing break-apart fluorescent in situ hybridization (FISH) analysis for the presence of MAML2 gene rearrangements. Clinical and demographic data on all patients were recorded.

Results

The mean age for patients included in the study was 55.27 years with a range of 36 to 72 years. The most common presenting symptom was a jaw expansion and all cysts presented initially as a unilocular or multilocular radiolucency. CYSTS displayed a minimum of 6 of 10 histologic parameters necessary for a diagnosis of GOC. One case demonstrated MAML2 rearrangements by FISH. That case also showed marked ciliation of cyst lining epithelial cells and extensive mucous secreting goblet cell proliferation.

Conclusion

Findings in the current study are in concert with previous investigations, and although this study finds ONLY LIMITED molecular evidence to support the premise that recurrent biologically aggressive GOCs are a precursor to IMEC, detection of MAML2 rearrangements in one case suggests that such a theoretic transition, while rare, is possible.

This article is protected by copyright. All rights reserved.

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Association of Dental and Maxillary Sinus Pathologies with Ear, Nose and Throat Symptoms

Abstract

Objectives

To investigate the correlation between cone beam computerized tomography (CBCT) findings in the maxillary sinus, Ear-Nose-Throat (ENT) symptoms and dental pathologies in asymptomatic patients.

Materials and methods

A total 81 patients were referred for CBCT and filled a standard ENT visual analog scale (VAS) questionnaire. CBCT images were analyzed for sinus ostium obstruction, Schneiderian membrane thickening, sinus floor turbidity and the presence of polyps. Dental pathologies were evaluated with the aid of CBCT images, periapical x-rays and clinical examination. A possible correlation between the CBCT findings and the ENT/dental parameters was examined by applying Student's t-test and the chi-square test.

Results

Despite being asymptomatic, most of the 81 patients reported ENT symptoms in the questionnaire, thereby indicating that these symptoms were mainly subclinical. A significant correlation was found between the presence of polyps in the sinus and a decrease in smell/taste. Obstruction of the sinus meatus was associated with coughing; Turbidity was associated with ear congestion. Thickening of the Schneiderian membrane showed an association with both coughing and ear congestion. The mean number of missing posterior teeth correlated with postnasal drip and nasal congestion. Periapical pathology was associated with nasal discharge/runny nose.

Conclusions

The results emphasize the need to evaluate ENT symptoms when radiographic findings are identified in CBCT.

This article is protected by copyright. All rights reserved.

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A novel PITX2 mutation in non-syndromic oro-dental anomalies

Abstract

Objective

To identify oro-dental characteristics and genetic etiology of a family affected with non-syndromic oro-dental anomalies.

Subjects and methods

Physical and oral features were characterised. DNA was collected from an affected Thai family. Whole exome sequencing was employed to identify the pathogenic variants associated with inherited oro-dental anomalies. The presence of the identified mutation was confirmed by Sanger sequencing.

Results

We observed unique oro-dental manifestations including oligodontia, retained primary teeth, taurodont molars, peg-shaped maxillary central incisors, high attached frenum with nodule, and midline diastema in the proband and her mother. Mutation analyses revealed a novel heterozygous frameshift deletion, c.573_574delCA, p.L193QfsX5, in exon 5 of PITX2A in affected family members. The amino acid alterations, localised in the transcriptional activation domain 2 in the C terminus of PITX2, were evolutionarily conserved. Mutations in PITX2 have been associated with autosomal-dominant Axenfeld-Rieger syndrome and non-syndromic eye abnormalities, but never been found to cause isolated oral anomalies.

Conclusions

This study for the first time demonstrates that the PITX2 mutation could lead to non-syndromic oro-dental anomalies in humans. We propose that the specific location in the C-terminal domain of PITX2 is exclusively necessary for tooth development.

This article is protected by copyright. All rights reserved.

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Outcomes of oral lichen planus and oral lichenoid lesions treated with topical corticosteroid

Abstract

Objective. To determine corticosteroid treatment effectiveness in patients with Oral Lichen Planus/Oral Lichenoid Lesions (OLP/OLL). Material and methods. Twenty-one OLP and eighty-one OLL patients received 0.05% clobetasol propionate (CP) or 0.05% triamcinolone acetonide (TA) in aqueous solution (AS) or orabase (OB), evaluating responses to treatment and follow-up compliance. Results. Lesions were atrophic (72/102; 70.6%), extensive (58/100; 58%), producing eating difficulties (62/102; 60.8%) and spontaneous pain (30/102; 29.4%); 50 patients (49%) received CP-AS. The mean±sd percentage of follow-ups attended was 43±32%. Symptom remission was achieved in 46% of patients receiving CP-AS, 36.36% of those receiving TA-AS, 20% of those receiving CP-OB, and 25% of those receiving TA-OB. Follow-up compliance was poor in 66.7% of patients. Among 51 patients with continuous symptoms, 64.7% evidenced total remission at treatment completion; among 33 with intermittent symptoms, 73.1% had outbreaks 2-3 times/year and 51.5% controlled outbreaks with <6 corticosteroid applications. Adverse effects were observed in 7 patients (6.8%) (moon face, hirsutism, capillary fragility) in induction stage, subsiding with dose; among 15 patients under maintenance treatment for >6 months, 1 showed hypothalamic–pituitary–adrenal (HPA) axis inhibition but not adrenal insufficiency. Conclusions. Our treatment proved highly effective and safe. Recall programs are desirable to enhance follow-up compliance.

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