Head and Neck Medicine by Alexandros G.Sfakianakis: 12/01/17

Παρασκευή 1 Δεκεμβρίου 2017

Perceptions of the dental profession: a comparative analysis through scale development

Dentistry is a science-based profession that has a close interaction with people and society. However, despite this close interaction, perceptions of the dental profession by both patients and dental professionals have received little research attention. The purpose of this study was to compare the perceptions of dentists, dental students, and patients toward the dental profession through the development and testing of the Dental Profession Perceptions Scale (DPPS). The DPPS contains a total of 17 items measured on a 5-point Likert response scale. The DPPS showed excellent internal reliability (Cronbach's α = 0.92) and test–retest reliability (r = 0.93). Explanatory and confirmatory factor analyses of the DPPS showed that dentists', dental students', and patients' perceptions of the dental profession could be grouped according to 'status', 'human', and 'scientific' factors. There were no statistically significant differences between participants' DPPS total or sub-scale scores according to dental group, gender, or income. The DPPS developed can be used in future studies as a psychometrically sound measuring tool. Further studies should examine the factors that may affect the perceptions of the dental profession in different societies and cultures.

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Treatment of common recalcitrant warts with topical formic acid

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Annular erythematous plaques on the trunk

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The “Batman flap”: a novel technique to repair a large central glabellar defect

Abstract

Background

Given the critical position of central glabella among the frontal, nasal, and supraorbital aesthetic subunits of the face, the reconstruction of large defects in this area represents a surgical challenge.

Methods

We describe a surgical technique based on a modified, curved, A-T flap to repair a large glabellar defect.

Results

Our modification is useful for large glabellar defects because it enables the distribution of the tension all over the reconstruction sides, avoiding a stressed central area and the subsequent risk of necrosis; functionally, it respects the eyebrows position and since the advancement is parallel to their major axes, it avoids the reduction of the distance between them.

Conclusions

The "Batman flap" enables reconstructing a glabellar defect, with a good aesthetical result and the respect of the relevant aesthetical subunits.

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Cardiopulmonary anomalies in incontinentia pigmenti patients

Abstract

Background

Incontinentia pigmenti (IP) is a rare inherited genodermatosis that usually involves the skin, and also teeth, oral cavity, central nervous system, eyes, blood with eosinophilia, and rarely skeletal system, breast, heart, and lungs. Skin lesions usually appear early, at birth or within the first 2 weeks of life, with four different phases tending to follow Blaschko lines that may overlap.

Case report

We report a rare case of a neonate with transient reversible pulmonary hypertension that presented at day 9 of life. She manifested increasing dyspnea and deterioration of respiratory dynamics with a serious pulmonary hypertension without a primary pulmonary disease. Hence, oxygen therapy at high flows and nitric oxide have been administered with an initial response, but, subsequently, because of the worsening of the respiratory activity, she underwent sildenafil and bosentan treatment with respiratory dynamics improvement and progressive decrease of the pulmonary pressures.

Conclusion

In literature only a few cases of cardiopulmonary anomalies in IP have been described with different outcomes, and these rare complications are probably underestimated by physicians. We could suppose that microangiopathic damages may have a critical role in endothelial alterations, and these processes are probably shared by multiple organs involved in IP and rarely by lungs and heart.

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Bullous pemphigoid complicated by cytomegalovirus disease as a manifestation of immune reconstitution inflammatory syndrome: retrospective analyses of our institutional cases and literature review

Abstract

Background

Cytomegalovirus (CMV) disease induced by reactivation of latent CMV is a fatal viral infection that may develop in a setting of therapy with immunosuppressive agents. There is a clear need to clarify any clinical features and markers of CMV disease.

Objective

We investigated which clinical markers usually available in a clinical setting can predict CMV disease occurring in bullous pemphigoid (BP) patients receiving corticosteroids.

Method

We described a BP patient with CMV disease complicated by gastrointestinal hemorrhage and liver dysfunction. Prompted by this patient, we retrospectively analyzed clinical features and laboratory findings in our institutional four BP patients and previously reported nine BP patients with CMV disease. We also compared these patients with our institutional 42 BP patients not complicated by CMV disease.

Results

High levels of anti-BP180 antibody titers associated with resistance to corticosteroids are a risk factor for the development of CMV disease. A reduction in platelet (PLT) and white blood cell (WBC) counts and an increase in alanine aminotransferase (ALT) levels 3–4 weeks after the initiation of corticosteroids are useful predictive markers for the onset of CMV disease.

Conclusions

Frequent WBC, PLT, and ALT measurements may identify BP patients at a risk of subsequently developing CMV disease. Careful monitoring of CMV disease in BP refractory to systemic corticosteroids may reduce the risk of fatal outcomes.

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What is the role of mitochondrial dysfunction in skin photoageing?

Abstract

Skin ageing is a complex process involving both internal and external factors, which leads to a progressive loss of cutaneous function and structure. Solar radiation is the primary environmental factor implicated in the development of skin ageing and the term photoageing describes the distinct clinical, histological and structural features of chronically sun-exposed skin. The changes that accompany photoageing are undesirable for aesthetic reasons and can compromise the skin and make it more susceptible to a number of dermatological disorders. As a result, skin ageing is a topic that is of growing interest and concern to the general population, illustrated by the increased demand for effective interventions that can prevent or ameliorate the clinical changes associated with aged skin. In this viewpoint essay we explore the role that mitochondria play in the process of skin photoageing. There is continuing evidence supporting the proposal that mitochondria dysfunction and oxidative stress are important contributing factors in the development of skin photoageing. Further skin-directed mitochondrial research is warranted to fully understand the impact of mitochondrial status and function in skin health. A greater understanding of the ageing process and the regulatory mechanisms involved could lead to the development of novel preventative interventions for skin ageing.

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Small animal PET imaging analysis with [18F]FHBG in a mouse model of HSV1-tk gene expression in melanoma

Abstract

The purpose of this study was to establish a small animal model for molecular imaging and to acquire basic data on assessing the efficacy of candidate melanoma drugs using small-animal PET imaging analysis with [¹⁸F]FHBG for herpes simplex virus 1-thymidine kinase (HSV1-tk) gene expression in a melanoma mouse model. The B16 melanoma cell line was transduced with a recombinant lentiviral vector containing the HSV1-tk gene and inoculated into the back skin of C57BL/6J mice. [¹⁸F]FHBG PET imaging showed better contrast for HSV1-tk(+) melanomas compared to brain, heart, gall bladder, intestine, and kidney than did [¹⁸F]FDG PET imaging.

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Mass Murder, Targeted Individuals, and Gang-Stalking: Exploring the Connection

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

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Child Abuse and Neglect, and Psychiatric Disorders in Nonviolent and Violent Female Offenders

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

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Effects of bilateral discectomy and bilateral discopexy on Black Merino Sheep rumination kinematics: TEMPOJIMS - pilot blinded, randomized preclinical study

Publication date: Available online 2 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): D.F. Ângelo, F. Monje, R. González, L. Monico, C. Moura, L. Francisco, D. Sanz, N. Alves, F. Salvado, P. Morouço
BackgroundThe potential for temporomandibular interposal materials is immense, but in order to progress in translational medicine, preclinical trials are essential. This temporomandibular joint interposal material study (TEMPOJIMS) is the first randomized, blinded, and controlled preclinical study (in line with the ARRIVE guidelines) of the TMJ domain.The normal process used by ruminants to break down dry matter involves initial chewing and rumination. This investigation focused on evaluating changes to this process after bilateral discectomy and discopexy.MethodsThis study was conducted using nine black Merino sheep to evaluate changes in chewing after bilateral discectomy and bilateral discopexy, by comparing with a sham surgery control group. The outcomes evaluated were: (1) absolute masticatory time; (2) ruminant time per cycle; (3) ruminant kinematics, and (4) ruminant area. After baseline evaluation and surgical interventions, the outcomes were recorded over 3 successive days, every 30 days, for 6 months.ResultsThe first month after intervention seemed to be the critical period for significant kinematic changes in the discectomy and discopexy groups. However, 6 months after the bilateral interventions, no significant changes were noticed when compared with the control group.ConclusionsThe introduction of kinematic evaluation presents a new challenge that may contribute to the improvement of future studies of the TMJ domain.

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Clinical and histopathological features of nasopalatine duct cyst: A 47-year retrospective study and review of current concepts

Publication date: Available online 2 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Caio César da Silva Barros, Hellen Bandeira de Pontes Santos, Israel Leal Cavalcante, Larissa Santos Amaral Rolim, Leão Pereira Pinto, Lélia Batista de Souza
PurposeTo evaluate the clinical and histopathological features of nasopalatine duct cysts (NDCs) stored in the archives of a referred Oral Pathology Service over a 47-year-period, and to review current concepts about these cysts.Material and MethodsAll NDCs were reviewed, and clinical data were obtained from the patient records. Thirty cases were re-evaluated microscopically by 2 oral pathologists.ResultsAmong 14,564 cases, 30 (0.20%) were NDCs. Fifteen (50.0%) of the patients were female, and the mean age was 42.7 years. The lesions measured on average 2.37±1.69 cm. Histologically, stratified squamous epithelium, alone or in combination with other epithelia, was present in 13 (46.6%) cases. Goblet cells and subepithelial hyalinization were common. Fourteen (46.6%) cases exhibited a slight degree of inflammation. Nerves were observed in 15 (50%) cases and mucous glands in 7 (23.3%). Hyaline ring granulomas (which is described here for the first time in NDC) and cholesterol crystals were not common.ConclusionKnowledge of clinical-histopathological aspects of NDCs provides more accurate data about their nature and behavior. Our results suggest that the predominant epithelial lining of these cystic lesions is exclusively stratified squamous epithelium or combined with another type. Vessels, nerves, mucous glands and inflammatory infiltrate are frequently observed.

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Identification of patterns of factors preceding severe or life-threating asthma exacerbations in a nationwide study

Abstract

Background

Reducing near-fatal asthma exacerbations is a critical problem in asthma management.

Objectives

To determine patterns of factors preceding asthma exacerbations in a real-world setting.

Methods

In a nationwide prospective study of 190 patients who had experienced near-fatal asthma exacerbation, cluster analysis was performed using asthma symptoms over the two-week period before admission.

Results

Three distinct clusters of symptoms were defined employing the self-reporting of a visual analogue scale. Cluster A (42.1%): rapid worsening within 7.4 hours from moderate attack to admission, young to middle-aged patients with low BMI and tendency to depression who had stopped anti-asthma medications, smoked, were hypersensitive to environmental triggers and furred pets. Cluster B (40.0%): fairly-rapid worsening within 48 hours, mostly middle-aged and older, relatively good ICS or ICS/LABA compliance, and low perception of dyspnea. Cluster C (17.9%): slow worsening over 10 days before admission, high perception of dyspnea, smokers, and chronic daily mild-moderate symptoms. There were no differences in overuse of short-acting beta-agonists, baseline asthma severity, or outcomes after admission for patients in these three clusters.

Conclusion

To reduce severe or life-threatening asthma exacerbation, personalized asthma management plans should be considered for each cluster. Improvement of ICS and ICS/LABA compliance and cessation of smoking are important in cluster A. To compensate for low perception of dyspnea, asthma monitoring of peak expiratory flow rate and/or exhaled nitric oxide would be useful for patients in cluster B. Avoidance of environmental triggers, increased standard therapy or new anti-type 2 response-targeted therapies should be considered for cluster C.

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Orthodontic management by functional activator treatment: a case report

Managing orthodontic treatment is often very difficult for the orthodontist. Many devices are used during the orthopedic phase of orthodontic treatment, always with different functions. We describe a case of o...

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Lessons from Fukushima: Latest Findings of Thyroid Cancer After the Fukushima Nuclear Power Plant Accident

Thyroid , Vol. 0, No. 0.

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Retrograde parotidectomy and facial nerve outcomes: A case series of 44 patients (Letter to Editor)

Publication date: Available online 1 December 2017
Source:American Journal of Otolaryngology
Author(s): Tam-Lin Chow

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Lymph node ratio as a prognostic factor for survival in patients with head and neck squamous cell carcinoma

Publication date: Available online 2 December 2017
Source:Auris Nasus Larynx
Author(s): Daisuke Sano, Kenichiro Yabuki, Hideaki Takahashi, Yasuhiro Arai, Yoshihiro Chiba, Teruhiko Tanabe, Goshi Nishimura, Nobuhiko Oridate
ObjectiveThe purpose of this study is to validate the concept of lymph node ratio (LNR) in head and neck squamous cell carcinoma (HNSCC).MethodsA total of 63 patients with HNSCC who underwent resection of the primary tumor combined with neck dissection in our institution were analyzed in this study. LNR was defined as the number of positive lymph nodes divided by the total number of lymph nodes excised. LNR was categorized into two groups (<0.068 and ≥0.068) according to the results of receiver-operating characteristic plots for determination of the cut-off value.ResultsLNR≥0.068 was associated with poor overall survival (OS), progression-free survival (PFS) and locoregional recurrence-free survival (LRFS) after resection of the primary tumor combined with neck dissection in patients with HNSCC. Univariate and multivariate data analysis showed that LNR≥0.068 was an independent prognostic factor for OS, PFS and LRFS. Both pathological T stage status (pT3 or 4) and ≥3 positive LNs were also an independent prognostic factors for PFS in patients with HNSCC in our univariate and multivariate analysis.ConclusionThese results suggested that LNR could be useful tools in identifying HNSCC patients with poor outcomes.

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Upper and lower airway remodelling mechanisms in asthma, allergic rhinitis and chronic rhinosinusitis: the one airway concept revisited

Abstract

Allergic rhinitis (AR), chronic rhinosinusitis (CRS) and asthma often co-exist. The one airway model proposes that disease mechanisms occurring in the upper airway may mirror lower airway events. Airway remodelling is the term used to describe tissue structural changes that occur in a disease setting and reflect the dynamic process of tissue restructuring during wound repair. Remodelling has been long identified in the lower airways in asthma and is characterized by epithelial shedding, goblet cell hyperplasia, basement membrane thickening, subepithelial fibrosis, airway smooth muscle hyperplasia and increased angiogenesis. The concept of upper airway remodelling has only recently been introduced, and data so far is limited and often conflicting, an indication that more detailed studies are needed. Whilst remodelling changes in AR are limited, CRS phenotypes demonstrate epithelial hyperplasia, increased matrix deposition and degradation along with accumulation of plasma proteins. Despite extensive research over the past years, the precise cellular and molecular mechanisms involved in airway remodelling remain incompletely defined. This review describes our current rather limited understanding of airway remodelling processes in AR, CRS and asthma, and presents mechanisms both shared and distinct between the upper and lower airways. Delineation of shared and disease-specific pathogenic mechanisms of remodelling between the sinonasal system and the lung may guide the rational design of more effective therapeutic strategies targeting upper and lower airways concomitantly and improving the health of individuals with inflammatory airway diseases.

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Accuracy and eligibility of CBCT to digitize dental plaster casts

Abstract

Objectives

Software-based dental planning requires digital casts and oftentimes cone-beam computed tomography (CBCT) radiography. However, buying a dedicated model digitizing device can be expensive and might not be required. The present study aimed to assess whether digital models derived from CBCT and models digitized using a dedicated optical device are of comparable accuracy.

Material and methods

A total of 20 plaster casts were digitized with eight CBCT and five optical model digitizers. Corresponding models were superimposed using six control points and subsequent iterative closest point matching. Median distances were calculated among all registered models. Data were pooled per scanner and model. Boxplots were generated, and the paired t test, a Friedman test, and a post-hoc Nemenyi test were employed for statistical comparison. Results were found significant at p < 0.05.

Results

All CBCT devices allowed the digitization of plaster casts, but failed to reach the accuracy of the dedicated model digitizers (p < 0.001). Median distances between CBCT and optically digitized casts were 0.064 + − 0.005 mm. Qualitative differences among the CBCT systems were detected (χ ² = 78.07, p < 0.001), and one CBCT providing a special plaster cast digitization mode was found superior to the competitors (p < 0.05).

Conclusion

CBCT systems failed to reach the accuracy from optical digitizers, but within the limits of the study, accuracy appeared to be sufficient for digital planning and forensic purposes.

Clinical relevance

Most CBCT systems enabled digitization of plaster casts, and accuracy was found sufficient for digital planning and storage purposes.

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Fracture behavior of all-ceramic, implant-supported, and tooth–implant-supported fixed dental prostheses

Abstract

Objectives

In vitro investigation of the effects of fixed dental prosthesis (FDP) support and loading conditions on the fracture behavior of all-ceramic, zirconia-based FDP veneered with computer-aided design/computer-aided manufacturing (CAD/CAM)-manufactured lithium disilicate ceramic.

Materials and methods

Based on a model for a 3-unit FDP in the molar region (tooth in region 15, implant in region 17), 16 identical zirconia frameworks were fabricated and veneered with milled lithium disilicate ceramic. Another 16 FDPs were manufactured similarly, using a model in which the tooth was replaced by an implant. The specimens underwent 10,000 thermal cycles between 6.5 and 60 °C and 1,200,000 chewing cycles with a force magnitude of 100 N. All were then subsequently loaded until fracture in a universal testing device. Half of the FDPs were subjected to centric and axial loading on the pontic, the others to eccentric and oblique loading on one cusp of the pontic.

Results

No failures were observed after artificial aging. Fracture loads of tooth–implant-supported restorations were 1636 ± 158 and 1086 ± 156 N for axial and oblique loading, respectively; implant-supported FDPs fractured at 1789 ± 202 and 1200 ± 68 N, respectively. Differences were significant for load application (P < 0.001) and support type (P = 0.020). For the two types of load application, fracture mode differed substantially: complete fracture was observed for centric and axial loading whereas mixed cohesive/adhesive failure was observed for many FDPs loaded eccentrically and obliquely.

Conclusions

The high incidence of chipping of manually veneered implant-supported all-ceramics restorations might be reduced by use of CAD/CAM-manufactured lithium disilicate veneers.

Clinical Relevance

FDPs veneered with lithium disilicate resist occlusal forces of 500 N, irrespective of load application and support type. The fracture resistance of implant-supported FDPs was, however, higher than that of combined tooth–implant-supported FDPs. Their clinical use seems to be justified.

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Wem gehört mein Implantat?

Laryngo-Rhino-Otol 2017; 96: 855-856
DOI: 10.1055/s-0043-118618

Georg Thieme Verlag KG Stuttgart · New York

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Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2017; 96: 818-819
DOI: 10.1055/s-0043-123359

Georg Thieme Verlag KG Stuttgart · New York

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Helicobacter pylori siedelt gerne auf Mandel-Gewebe

Laryngo-Rhino-Otol 2017; 96: 822-823
DOI: 10.1055/s-0043-119600

Siupsinskiene N et al. Helicobacter pylori in the tonsillar tissue: a possible association with chronic tonsillitis and laryngopharyngeal reflux. J Laryngol Otol 2017; 131: 549–55 Wie häufig finden sich Helicobacter pylori Infektionen in den Gaumenmandeln und welcher Zusammenhang besteht zwischen H. pylori, den soziodemografischen Patientendaten und dem laryngopharyngealen Reflux?
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Georg Thieme Verlag KG Stuttgart · New York

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Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2017; 96: 875-876
DOI: 10.1055/s-0043-122750

Georg Thieme Verlag KG Stuttgart · New York

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Resektion eines Zungenkarzinoms: Neuer Schwellenwert für tumorfreien Rand

Laryngo-Rhino-Otol 2017; 96: 823-824
DOI: 10.1055/s-0043-119602

Zanoni DK et al. A Proposal to Redefine Close Surgical Margins in Sqamous Cell Carcinoma of the Oral Tongue. JAMA Otolaryngol Head neck Surg 2017; 143: 555–560. doi:10.1001/jamato.2016.4238 Bei Zungenkarzinomen gilt die Resektion mit tumorfreien Rändern als Goldstandard. Als negativer Rand wird dabei traditionell ein tumorfreier Rand von mehr als 5 mm definiert. Ob diese willkürlich gesetzte Grenze aber wirklich das Risiko für Lokalrezidive widerspiegelt, ist unklar. Jetzt wurde untersucht, ab welcher Grenze das Risiko wirklich ansteigt und wo ein neuer Schwellenwert liegen könnte.
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Georg Thieme Verlag KG Stuttgart · New York

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Biosimilars und das Wirtschaftlichkeitsgebot

Laryngo-Rhino-Otol 2017; 96: 828-830
DOI: 10.1055/s-0043-122250

Biosimilars unterliegen der Wirtschaftlichkeitsprüfung nach § 106 SGB V. Die konkrete Art der Prüfung hat Einfluss auf das ärztliche Verordnungsverhalten. In der Richtgrößenprüfung führt die Verordnung von Biosimilars in der Regel zwar nicht zu einem Regress, wohl aber erst einmal zur Einleitung eines Prüfverfahrens. Ab 2017 wird die Richtgrößenprüfung entfallen. Die stattdessen zu erwartenden Wirkstoffprüfungen auf regionaler Ebene können Quoten für das Verhältnis von Biosimilars zu Originalpräparaten vorgeben und bei einer Zielverfehlung zu Regressen führen. Erste Vereinbarungen auf regionaler Ebene über konkrete Prüfverfahren sind im Laufe des Jahres zu erwarten.
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Georg Thieme Verlag KG Stuttgart · New York

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Laryngektomie: Prognosefaktoren für Liegedauer, Reoperation und Readmission

Laryngo-Rhino-Otol 2017; 96: 824-825
DOI: 10.1055/s-0043-119603

Helman SN et al. Predictors of Stay, Reoperation, and Readmission Following Total Laryngektomie. Laryngoscope 2017; 127: 1339–1344 Nach totaler Laryngektomie kommt es in bis zu 34 % der Fälle zu Komplikationen. Die Rehospitalisierungsrate ist hoch und beträgt mehr als 26 %. Verlängerte stationäre Aufenthaltsdauer, ungeplante Rückkehr in der Operationssaal und stationäre Wiederaufnahme sind 3 Faktoren, die hohe Kosten verursachen und wichtige Indikatoren der Versorgungsqualität darstellen. US-Forscher suchten diesbezüglich nach unabhängigen perioperativen Risikofaktoren.
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Georg Thieme Verlag KG Stuttgart · New York

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Begutachtung von Hörschäden

Laryngo-Rhino-Otol 2017; 96: 857-874
DOI: 10.1055/s-0043-119043

Die Beurteilung von Hörschäden ist eine häufige Fragestellung in HNO-Gutachten, hierzu zählt die Bewertung von Hörschäden als Unfallfolge, z. B. durch eine Kopfverletzung oder ein akut aufgetretenes Schalltrauma. Schwerhörigkeit als Folge einer beruflich bedingten chronischen Lärmeinwirkung gehört zu den am häufigsten bewerteten Berufskrankheiten überhaupt. Dieser Beitrag beleuchtet die Schadensbewertung und entsprechende Rechtsgrundlagen.
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Georg Thieme Verlag KG Stuttgart · New York

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Beidseitige Stimmlippenlähmung

Laryngo-Rhino-Otol 2017; 96: 826-827
DOI: 10.1055/s-0043-121301

Georg Thieme Verlag KG Stuttgart · New York

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Rhinoplastik

Laryngo-Rhino-Otol 2017; 96: 877-880
DOI: 10.1055/s-0043-119387

Georg Thieme Verlag KG Stuttgart · New York

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Correction to: Abstracts

Abstract

Due to an error with the registration system, the following abstract was regrettably omitted from the Poster Sessions. The abstract should have been included as PS-10-021 and displayed on page S166.

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Development of a brief assessment of activity limitations in children with food allergy

Given the increasing prevalence of food allergies (FA), affecting approximately 8% of children in the United States,1 and the increasing rates of anaphylaxis due to FA,2 parents of children with FA have lowered quality of life (QOL).3,4 Many parents report their family QOL is associated with social limitations due to FA,3 and some parents worry so much about allergen avoidance that they significantly restrict their child's school and social activities.4 Children's day-to-day social functioning is important for maintaining an acceptable QOL and coping with FA.

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Impact of gingivitis treatment for diabetic patients on quality of life related to periodontal objective parameters: A randomized controlled clinical trial

Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): Sheila C. Cortelli, Fernando O. Costa, Antonio Gargioni-Filho, Davi R. Aquino, Luis O.M. Cota, Alexandre P. Scherma, Taís B. Miranda, Jose R. Cortelli
ObjectivesPatients with diabetes have a poor oral health-related quality of life (OHRQoL). It is not clear if this situation could be changed with effective periodontal treatment. This study examined both patients with diabetes and systemically healthy individuals to discover the impact of a gingivitis treatment protocol on OHRQoL and its relation to objective periodontal parameters.DesignAfter ultrasonic debridement, patients were randomly assigned to an essential-oils (EO) or placebo mouthwash group. At baseline and 3 months, OHRQoL was assessed with the Oral Health and Quality of Life-United Kingdom questionnaire (OHQoL–UK) along with clinical, halitometric, microbiological and inflammatory objective parameters. The primary outcome was a change in OHQoL–UK scores. A factor analysis was performed and the impact of the extracted quality of life factor (QLF) and its interactions with diabetes, treatment, and time on the objective parameters, were tested by multiple linear regression models (p < 0.05). Chi-Square test compared questionnaire-answering profiles (p<0.05).ResultsCombined treatment with EO provided OHQoL improvements in both systemic conditions. Positive effect of oral health status on quality of life increased in EO groups but not in placebo groups. Question I (self-confidence) showed the greatest factorial weight, while Question A (food intake) showed the lowest factorial weight. All patients who showed OHRQoL improvements and used the EO rinse showed the lowest plaque and gingival indices and lower levels of bacteria and volatile sulfur compounds.ConclusionsOHRQoL positively changed overtime. Most effective treatment protocols would provide better improvements in OHRQoL which is related to periodontal objective measures.

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Aspects of the final phase of enamel formation as evidenced by observations of superficial enamel of human third molars using scanning electron microscopy

Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): Steinar Risnes, Chunfang Li
ObjectiveEnamel structure reflects ameloblast function. By studying the structure of the superficial enamel, information about ameloblast function toward the end of the secretory stage may be obtained.DesignThe superficial enamel in midcoronal areas of acid-etched facio-lingual sections from human third molars was studied in the scanning electron microscope (SEM).ResultsA great variation was observed in occurrence of prism-free enamel. Prism-free enamel dominated in 40% (mandibular) and 47% (maxillary) of observed areas and had a mean thickness of about 30μm. Striations in the prism-free enamel had an interstriae distance of about 3.3–3.8μm. The angle between prisms and enamel surface was about 60°, between prisms and Retzius lines about 45° and between Retzius lines and enamel surface about 15°. The distances between regularly occurring Retzius lines and between striations in the prism-free enamel both tended to decrease toward the enamel surface. Prisms could change direction as they approached the enamel surface, mostly in cervical direction. Where Retzius lines curved and converged occlusally, prisms tended to deviate in an occlusal direction.ConclusionsJudged from the incremental lines and occurrence of prism-free enamel, ameloblasts slow down and tend to lose their Tomes' process as they approach the end of secretion. The crystals of prism-free enamel belong to the same system as the interprism crystals of prismatic enamel. A method, based on the disposition of fine incremental lines, is suggested for evaluation of ameloblast dynamics in the last stage of enamel secretion.

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Lymph node ratio as a prognostic factor for survival in patients with head and neck squamous cell carcinoma

The purpose of this study is to validate the concept of lymph node ratio (LNR) in head and neck squamous cell carcinoma (HNSCC).

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Impact of gingivitis treatment for diabetic patients on quality of life related to periodontal objective parameters: A randomized controlled clinical trial

Aspects of the final phase of enamel formation as evidenced by observations of superficial enamel of human third molars using scanning electron microscopy

Search Engine Optimization: An Analysis of Rhinoplasty Web sites

Facial plast Surg 2017; 33: 665-669
DOI: 10.1055/s-0037-1607973

The Internet is the primary source of information for facial plastic surgery patients. Most patients only analyze information in the first 10 Web sites retrieved. The aim of this study was to determine factors critical for improving Web site traffic and search engine optimization. A Google search of "rhinoplasty" was performed in Michigan. The first 20 distinct Web sites originating from private sources were included. Private was defined as personal Web sites for private practice physicians. The Web sites were evaluated using SEOquake and WooRANK, publicly available programs that analyze Web sites. Factors examined included the presence of social media, the number of distinct pages on the Web site, the traffic to the Web site, use of keywords, such as rhinoplasty in the heading and meta description, average visit duration, traffic coming from search, bounce rate, and the number of advertisements. Readability and Web site quality were also analyzed using the DISCERN and Health on the Net Foundation code principles. The first 10 Web sites were compared with the latter 10 Web sites using Student's t-tests. The first 10 Web sites received a significantly lower portion of traffic from search engines than the second 10 Web sites. The first 10 Web sites also had significantly fewer tags of the keyword "nose" in the meta description of the Web site. The first 10 Web sites were significantly more reliable according to the DISCERN instrument, scoring an average of 2.42 compared with 2.05 for the second 10 Web sites (p = 0.029). Search engine optimization is critical for facial plastic surgeons as it improves online presence. This may potentially result in increased traffic and an increase in patient visits. However, Web sites that rely too heavily on search engines for traffic are less likely to be in the top 10 search results. Web site curators should maintain a wide focus for obtaining Web site traffic, possibly including advertising and publishing information in third party sources such as "RealSelf."
[...]

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Complications of Midface Fractures

Facial plast Surg 2017; 33: 557-561
DOI: 10.1055/s-0037-1607447

The midface relies on key vertical and horizontal buttresses for proper function and appearance. Trauma to the midface can lead to untoward complications involving critical structures of this area. Many reviews focus on operative management of midface fractures with little focus on complications of the injury and operative repair. We review the current literature on the most common initial and postoperative complications of midface trauma with a specific focus on zygomaticomaxillary complex (ZMC) and Le Fort fracture patterns. A thorough literature review was conducted using PubMed analyzing articles relevant to the subject matter. Various search terms were used to identify articles regarding midface fracture presentation, diagnosis, and management, as well as postoperative complications. Articles were examined by all authors and pertinent information was gleaned for the purpose of generating this review. Disruption of the midfacial buttress system can lead to a significant compromise in form and function. A wide variety of complications are seen in nasal bone fractures, orbital floor fractures, Le Fort, and ZMC fractures. Some fracture patterns can be managed conservatively without operative intervention; however, complications such as loss of facial width/projection, trismus, malocclusion, ocular entrapment, and significant enophthalmos should be managed with open repair. Timing and method of repair depend on patient-specific injury patterns and surgeon preference. Proper management depends on a detailed understanding of the anatomy and pathophysiology of each fracture pattern along with restoration of the patient's premorbid state. Complications of midface fractures result from disruption of the vertical and horizontal buttress support systems. Proper management and repair of midface complications requires a strong understanding of its anatomic basis and pathophysiology. Sequelae from these fractures can be serious and long lasting if not addresses appropriately. Astute diagnosis and timely management can prevent patients from suffering debilitating long-term sequelae.
[...]

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Prophylactic Measures to Prevent Soft Tissue Abnormalities after Trauma

Facial plast Surg 2017; 33: 639-642
DOI: 10.1055/s-0037-1608669

The goal of any reconstructive procedure is a complete return to premorbid form and function. Unfortunately, a return of pretraumatic form is routinely not considered during surgical planning. This leads to uncontrolled contracture of the soft tissue elements and permanent disfigurement. The goal of this article is to review interventions that improve soft tissue healing and long-term outcomes.
[...]

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Management of Malocclusion after Maxillofacial Trauma

Facial plast Surg 2017; 33: 562-570
DOI: 10.1055/s-0037-1608768

Efficacious management of malocclusion following maxillofacial trauma requires understanding of the interaction between teeth and alveolar bone, facial skeleton, temporomandibular joints, and facial neuromusculature. Success is best achieved with a multidisciplinary approach. This article describes the management of malocclusion after primary repair by highlighting important clinical features and offering guidelines for secondary repair through revision surgical reduction, prosthodontic rehabilitation, orthodontic therapy, restorative dentistry, and orthognathic surgery.
[...]

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Erratum: Oblique Turnover Flap for Repositioning and Flattening of the Lateral Crura: A Novel Technique to Manage Cephalic Malposition of Lower Lateral Cartilage

Facial plast Surg 2017; 33: 677-678
DOI: 10.1055/s-0037-1608956

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

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Secondary Repair of the Zygoma

Facial plast Surg 2017; 33: 571-580
DOI: 10.1055/s-0037-1608767

Secondary deformities of the zygoma are a rare entity, thanks to the adoption and refinement of open reduction and internal fixation techniques. These injuries are often difficult to treat due to the unique structural, functional, and aesthetic properties of the zygoma. Purely cosmetic defects can often be managed with implants; however, functional deficits generally require mobilization, correction, and subsequent fixation of the defect(s). Performing the necessary osteotomies to mobilize the zygoma is the most crucial part of the procedure, and had traditionally been executed without the use of computer aids. Planning for and performing this step was very difficult and frequently resulted in unsatisfactory outcomes. Recent advancements in virtual mapping and planning have obviated the need for guesswork and have resulted in improved functional and aesthetic outcomes following repositioning. This article will discuss the use of implants, osteotomies, and computer-assisted design/modeling (CAD/CAM) in addressing secondary deformities of the zygoma.
[...]

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Modern Approaches to Skin Care

Facial plast Surg 2017; 33: 653-660
DOI: 10.1055/s-0037-1607448

Recent years have seen an increased interest in minimally invasive and noninvasive cosmetic surgery and facial aesthetics. There has been a concomitant surge in the focus on skin care, which, by nature, is minimally invasive, and an exponential growth in the popularity and availability of minimally invasive dermatologic procedures and products. This review seeks to provide an overview of the most commonly employed skin care modalities, such as their mechanisms, indications for use, advantages and disadvantages, and side effects. The authors aim to provide the audience with a fundamental understanding of the options currently available to cosmetic surgeons and practitioners. Topics include retinoids, chemical peels, skin-lightening agents, lasers, microneedling, topical antioxidants, and injectables.
[...]

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Complications of Facial Trauma of the Fronto-orbital Region

Facial plast Surg 2017; 33: 581-590
DOI: 10.1055/s-0037-1608712

Traumatic injuries to the orbitofrontal region place some of the most important structures of the face at risk: the eyes, frontal skull, and brain. A thorough knowledge of complications from resultant trauma, and from attempted surgical corrections, is necessary to offer patients the best outcomes, ensuring proper healing with excellent long-term results.
[...]

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Broken-Line Template for Revision of Facial Scars

Facial plast Surg 2017; 33: 675-675
DOI: 10.1055/s-0037-1607449

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Secondary Treatment of Naso-orbital Ethmoid Injuries

Facial plast Surg 2017; 33: 591-597
DOI: 10.1055/s-0037-1608766

Central midface fractures should be treated early due to their propensity for secondary devastating and disfiguring consequences. For example, the expected sequelae to inadequately repaired naso-orbital ethmoid (NOE) injuries include shortened retruded nose, altered palpebral fissures, telecanthus, enophthalmos, and ocular dystopia, to name a few. Secondary repair of NOE fractures is indicated when primary surgical repair is not possible and for any of the aforementioned sequelae. When secondary repair of NOE fractures is necessary, these should be planned carefully while focusing on restoring facial function and aesthetics. Specific attention should focus on midface projection and intercanthal relationship. Virtual surgical planning as intraoperative navigation can be helpful for complex secondary reconstructions.
[...]

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Options in Repositioning the Asymmetric Brow from Paralysis and Trauma

Facial plast Surg 2017; 33: 627-638
DOI: 10.1055/s-0037-1607975

Brow asymmetry is a relatively common occurrence, especially in the facial plastic surgeon's office. In this article, the authors review causes of brow asymmetry, pertinent anatomy, and a litany of treatment options including nonsurgical and surgical approaches. They offer an algorithm that summarizes the various techniques for management with the goal of tailoring treatment tactics to the individual patient's needs.
[...]

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Repair of the Malpositioned Lower Lid

Facial plast Surg 2017; 33: 598-605
DOI: 10.1055/s-0037-1608711

Complications from surgical approaches to the orbit can be associated with debilitating morbidity and negative surgical outcomes. The surgeon must be familiar with the different factors that predispose a patient to these complications and be facile with techniques to avoid them. In this article, the authors discuss the surgical anatomy of the lower eyelid, as well as various complications that result from eyelid surgery, including lower lid retraction, ectropion, entropion, canthal malposition, and midface descent. They also discuss various management techniques that are employed in addressing these complications.
[...]

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Role of Camouflage in Management of Facial Trauma Deformities

Facial plast Surg 2017; 33: 643-652
DOI: 10.1055/s-0037-1608710

Facial fractures and soft tissue injuries around the eyes, nose, and mouth can be difficult to manage in the primary setting, but if untreated, the secondary correction of facial trauma is very challenging. Prevention of soft tissue contraction by restoring the skeletal framework is ideal. Staged, individualized camouflage techniques can be effective in improving outcomes.
[...]

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Secondary Repair of Posttraumatic Enophthalmos and Extraocular Movement Disorders

Facial plast Surg 2017; 33: 606-612
DOI: 10.1055/s-0037-1608781

Enophthalmos, or recession of the eye posteriorly and inferiorly, is a potential sequela of orbital trauma and a source of significant cosmetic and functional concern. Late enophthalmos occurs when early reconstruction of the bony orbit fails to completely restore normal orbital shape and volume, resulting in aesthetic deformity and persistent diplopia. In this article, we provide a framework for evaluation of posttraumatic enophthalmos and outline the surgical principles of secondary repair necessary to optimize globe position. With implementation of proper craniofacial exposure, osteotomy, and orbital reconstruction, surgeons may achieve significant improvement in both the aesthetic and functional sequelae of enophthalmos.
[...]

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Comparison of Absorbable and Nonabsorbable Sutures in Columellar Incision Closure in Rhinoplasty and Their Effects to Postoperative Scar

Facial plast Surg 2017; 33: 661-664
DOI: 10.1055/s-0037-1608668

Open technique septorhinoplasty (SRP) provides better surgical control and stronger anatomical assessment; however, one of its biggest disadvantages is postoperative columellar scar. In this study, the authos aimed to compare the absorbable polyglactin 910 (PG) (Vicryl Rapide 6/0; Ethicon Inc.) and nonabsorbable polypropylene (PP) (Prolene 6/0; Ethicon Inc.) suture materials and their effects on the postoperative columellar scar. In this study, 89 patients (61 females and 28 males) who underwent primary open technique SRP were included; 42 patients were included in the PP group and 47 were included in the PG group. Sutures were removed in PP group on 7th postoperative day. Sutures were left to be absorbed in the PG group. Columellar scar was assessed with visual analog scale (VAS) subjectively and with the modified Stony Brook Scar Evaluation Scale (SBSES) objectively in 6th postoperative month. SBSES results in PG and PP groups were 3.88 ± 0.80 and 3.67 ± 0.80, respectively. There was no statistical significance between the two groups (p = 0.352). VAS results in PG and PP groups were 8.04 ± 0.91 and 7.71 ± 0.85, respectively. There was no statistical significance between the two groups (p = 0.200). No postoperative wound infection was seen in either of the groups. PG delivers good postoperative results in columellar scar. We recommend using PG for columellar incision closure since it provides less discomfort and anxiety for the patient, and less office time for the surgeon during the suture removal.
[...]

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The Role of Hair Transplantation for Managing Facial Trauma

Facial plast Surg 2017; 33: 613-620
DOI: 10.1055/s-0037-1608782

Oftentimes, multiple treatment modalities are indicated for the management of trauma to the face. When this trauma involves a hair-bearing area, such as the eyebrow, eyelid, or beard region, hair transplantation can be an effective modality. While most of these facial hair transplants are performed for elective cosmetic indications, advanced techniques of hair transplantation can assure aesthetic outcomes in the optimizing of appearance after trauma. Because hair regrowth requires a good recipient bed, adjuvant therapies to promote vascularization, such as fat transfer and platelet-rich plasma, can be applied in conjunction with hair transplantation. The authors review the indications and the essential techniques of graft harvesting by follicular unit extraction and follicular unit grafting, and recipient site formation and graft planting and management, and present different case examples illustrating these technique.
[...]

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Aesthetic Management of Upper and Midface Trauma

Facial plast Surg 2017; 33: 555-556
DOI: 10.1055/s-0037-1607974

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Scar Revision: Surgical and Nonsurgical Options

Facial plast Surg 2017; 33: 621-626
DOI: 10.1055/s-0037-1607446

Facial scarring represents a challenging issue for the facial plastic surgeon owing to the unpredictable and variable nature of scar formation. The psychologic, cosmetic, and functional implications of facial scars oftentimes necessitate revision. It is important for the facial plastic surgeon to be aware of the invasive and noninvasive options to best educate patients in terms of treatment modalities. As there are multiple options available with no single option touted as superior, management of expectations and patient motivation will allow for realistic treatment planning with the greatest change of success.
[...]

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Aesthetic Nasal Reconstruction Principles and Practice

Facial plast Surg 2017; 33: 676-676
DOI: 10.1055/s-0037-1608769

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

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Optimal Costal Cartilage Graft Selection According to Cartilage Shape: Anatomical Considerations for Rhinoplasty

Facial plast Surg 2017; 33: 670-674
DOI: 10.1055/s-0037-1607972

Costal cartilage grafting is a commonly used reconstruction procedure, particularly in rhinoplasty. Although costal cartilage is broadly used in reconstructive surgery, there are differing opinions regarding which costal cartilage levels provide the most ideal grafts. Grafts are typically designed to match the shape of the recipient site. The shapes of costal cartilage grafts have been described as "boat-shaped," "C-shaped," "canoe-shaped," "U-shaped," "crescent-shaped," "L-shaped," "semilunar," "straight," and "Y-shaped." The shapes of costal cartilages are thought to lend themselves to the shapes of certain grafts; however, there has been little study of the shapes of costal cartilages, and most reports have been anecdotal. Therefore, this study is aimed to detail the average shapes of the most commonly grafted cartilages (i.e., the fifth to seventh cartilages). A total of 96 cadaveric costal cartilages were analyzed through geometric morphometric analysis. The fifth costal cartilage was determined to have the straightest shape and would therefore be particularly suitable for nasal dorsum onlay grafting. The lateral portions of the sixth and, particularly, the seventh costal cartilages have the most acute curvature. Therefore, they would lend themselves to the construction of an en bloc "L"-shaped or hockey stick-shaped nasal dorsum-columellar strut graft.
[...]

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Risk of venous thromboembolism in patients with mycosis fungoides and parapsoriasis: A Danish nationwide population-based cohort study

Active cancers and inflammation increase the risk of venous thromboembolism. It is unknown whether this applies to mycosis fungoides and parapsoriasis.Mycosis fungoides and parapsoriasis patients have increased risk of venous thromboembolism.These findings should increase awareness of comorbidities as part of the disease spectrum in patients with mycosis fungoides and parapsoriasis

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Occurrence of vismodegib-induced cramps in the treatment of basal cell carcinoma: a prospective study in 30 patients

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Book Review: Dermatological Signs of Systemic Disease, Fifth Edition

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Effect of alcohol-based hand rub on hand microbiome and hand skin health in hospitalized adult stem cell transplant patients: a pilot study

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Efficacy and rapid activity of omalizumab retreatments in chronic spontaneous urticaria

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A cross-sectional survey of long-term outcomes for patients with diffuse capillary malformation with overgrowth

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An age-dependent interaction between sex and geographical UV index in melanoma risk

UV exposure may differentially impact risk of melanoma by sex and age group.The female sex plays a significant and independent role in early onset melanoma.More effective preventive strategies can be developed based on the understanding of sex- and age-specific melanoma causes.

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Mycology of chronic suppurative otitis media-cholesteatoma disease: An evaluative study

To detect the prevalence of fungus in chronic suppurative otitis media-cholesteatoma disease and to evaluate its clinical significance.

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Reliability of temporal bone high-resolution CT in patients with facial paralysis in temporal bone fracture

This study aimed to investigate the reliability of temporal bone high-resolution CT (HRCT) in patients with traumatic facial paralysis.

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Helping Cancer Patients Through the Trauma of Hair Loss

Hair loss has a significant and often underappreciated effect on cancer patients' quality of life. Experts provide tips for managing this common treatment toxicity.
Medscape Oncology

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Resolving Perplexity: Comparison of Endoscopic Dacryocystorhinostomy With and Without Stent

Abstract

Endoscopic dacryocystorhinostomy (DCR) is an effective surgical procedure to treat nasolacrimal duct obstruction. This study was conducted with an aim of comparing the success rate between use of stent and without use of stent in endoscopic DCR. A prospective randomized study was conducted. Total 50 cases with signs of nasolacrimal duct blockage were included. The cases were randomly divided in two groups with 25 cases in each group. Group A cases underwent endoscopic DCR with stent and group B without stent. The follow up was till 12th week. Both subjective and objective outcomes were noted. By 12th week, only 8% cases had no relief of symptoms in group A while 92% cases of group A and all cases of group B had complete relief of symptoms. In objective outcome, by the 12th week, in group A 92% cases had full patency while in group B 100% cases had full patency. Overall complications in postoperative period were seen in 28% patients in group A and 12% patients in group B. In this study the surgical results of endoscopic DCR with or without stent came almost equal with no statistical difference in the success rate between stent group and non-stent group. Now that Endoscopic DCR without stent is equally effective and reduces cost, we recommend that the endoscopic DCR without stent should be preferred.

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Oesophageal or transgastric views for estimating mean pulmonary artery pressure with transoesophageal echocardiography?

BACKGROUND Recent data suggest that in cardiac surgical patients, the pulmonary artery acceleration time (PAT) is useful for estimating mean pulmonary artery pressure (MPAP) noninvasively with transoesophageal echocardiography (TOE). The pulmonary valve can be visualised from multiple echocardiographic windows, but it is unclear which, if any, view correlates best with MPAP. OBJECTIVE(S) To compare the PAT measured with TOE from oesophageal and transgastric views with MPAP obtained invasively with a pulmonary artery catheter. DESIGN A prospective observational study. SETTING St. Vincent's Hospital, Melbourne, a university tertiary referral centre in Australia. PATIENTS Sixty-three patients having cardiac surgery were included in our study. All patients had insertion of both a TOE probe and pulmonary artery catheter; this is the routine standard of care in our centre. INTERVENTION(S) Nil. MAIN OUTCOME MEASURES During a period of haemodynamic stability, the PAT was measured first from an oesophageal view and then immediately after from a transgastric view. The results were then compared with the invasively measured MPAP. RESULTS Simultaneous measurements of MPAP and PAT were taken in 63 patients. In two patients, these measurements were not possible in the transgastric position due to an inability to visualise the right ventricular outflow tract and pulmonary valve. A Bland–Altman analysis of the PAT measured from the upper oesophageal and transgastric views showed a mean difference of 1 ms and limits of agreement of −18 to 16 ms. The area under the receiver operating curves for predicting pulmonary hypertension with PAT were upper oesophageal view 0.99 [95% confidence interval (CI), 0.98 to 1.00] and transgastric view 0.99 (95% CI, 0.97 to 1.00). The agreement between the results from these two views in the diagnosis of pulmonary hypertension (defined as PAT 25 mmHg) with a sensitivity of 94.7% and specificity of 97.6%. The transgastric view predicted pulmonary hypertension with a sensitivity of 89.4% and specificity of 95.2%. CONCLUSION Oesophageal and transgastric measurements of PAT have close agreement and a similar high ability to discriminate between people with and without pulmonary hypertension. The transgastric measurement was unobtainable in a small percentage of patients and required more probe manipulation. We would recommend PAT measurement in the upper oesophageal view. Correspondence to Dr Brian Cowie, Staff Anaesthetist, Department of Anaesthesia, St. Vincent's Hospital, Melbourne, Melbourne, Victoria, Australia E-mail: brian.cowie@svha.org.au © 2017 European Society of Anaesthesiology

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Resolving Perplexity: Comparison of Endoscopic Dacryocystorhinostomy With and Without Stent

Abstract

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Long-term immunological effects of Japanese cedar pollen-based subcutaneous immunotherapy

Publication date: Available online 1 December 2017
Source:Allergology International
Author(s): Chisato Inuo, Hitoshi Ando, Kenichi Tanaka, Yoichi Nakajima, Ikuya Tsuge, Atsuo Urisu, Yasuto Kondo

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Inflammatory disseminated superficial porokeratosis successfully controlled with a combination of topical diclofenac gel and systemic etretinate

Porokeratosis is an uncommon keratinization disorder characterized clinically by annular keratotic plaques and histologically by cornoid lamella, a vertical stack of parakeratotic corneocytes within the horny layer. Disseminated superficial porokeratosis (DSP) manifests with several to hundreds of small annular lesions on sun-exposed and non-sun-exposed body areas [1]. Recently, unusual cases of DSP accompanied by severe pruritus and inflammation have been reported as inflammatory DSP [2, 3]. Here, we report a case of inflammatory DSP successfully controlled with topical diclofenac gel and oral etretinate.

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How Sildenafil (Viagra®) May Cause Melanoma: A Histopathologic Study Providing a Potential Physiological/ Etiopathological Mechanism

The potential role of phosphodiesterase type 5 inhibitors (PDE5-Is) sildenafil (Viagra^®), vardenafil (Levitra^®), and tadalafil (Cialis^®) in development of malignant melanoma is controversial. Four observational studies have examined the association of PDE5-Is) and melanoma (1-4). While a conclusion regarding causality is challenging, the biological basis for an association between PDE5-I exposure and melanoma remains compelling. Melanoma lines expressing the BRAF oncogene downregulate PDE5, leading to vasodilation, invasion and metastasis of melanoma cells (5).

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Endosymbiosis and its significance in dermatology

Abstract

Proposed at the beginning of the 20^th to explain the origin of eukaryotic organelles from prokaryotes, endosymbiosis is now medically defined by various interaction patterns between microorganisms and their residing hosts, best exemplified by the bacterial endosymbiont Wolbachia identified in arthropods and filarial nematodes, which can influence normal development, reproduction, survival, and transmission of the hosts. Based on the transmission modes, vertical or horizontal, and the function of the endosymbionts, the host-symbiont dependence can be divided into primary or secondary.

In dermatology, the role of endosymbionts in skin ectoparasitosis has aroused great interests in the past years. Riesia pediculicola is a primary bacterial endosymbiont in head lice Pediculosis humanus, and supplement their hosts with B vitamins, especially pantothenic acid. In cimicosis, the Gram-negative Wolbachia can synthesize biotin and riboflavin, which are crucial for the growth and reproduction of the bedbug Cimex lectularius. In human demodicosis and rosacea, further study is required to prove the pathogenic role of the Gram-negative bacteria Bacillus oleronius or the Gram-postive bacteria Bacillus cereus demonstrated in the Demodex mites. The high infection rate of adult female ticks Ixodes ricinus with the Gram-negative bacteria Midichloria mitochondrii present in the mitochondria in diverse ovarian cells, with the high seroprevalence rate in tick-exposed subjects, raises the possibility that this nonpathogenic endosymbiont may play a role in immune response and successful transmission of the tick-borne pathogen. The anaerobic protozoan Trichomonas vaginalis and bacteria Mycoplasma hominis are two obligate parasites in the urogenital epithelium, with partially overlapping symptoms. Intracellular localization of Mycoplasma hominis can avoid host immune response and penetration of antibiotics, while Trichomonas vaginalis infected with Mycoplasma hominis seem to have a higher cytopathic activity and ameboid transformation rate. Further study on the biology and pathogenesis of different endosymbionts in dermatological parasitosis will help for development of new treatment modalities.

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Mucocutaneous manifestations of inflammatory bowel disease in central China. a single-center study

Inflammatory bowel disease (IBD) is a group of idiopathic inflammatory conditions affecting the gastrointestinal tract, which consists of Crohn's disease (CD) and ulcerative colitis (UC). IBD has multiple extraintestinal manifestations (EIMs), and the prevalence of mucocutaneous manifestations in IBD has been reported as 21%-41%¹. This study aimed at investigating the prevalence of mucocutaneous manifestations (recurrent aphthous ulcer [RAU], erythema nodosum [EN], psoriasis and pyoderma gangrenosum [PG]) of IBD and analyzing of the associations of diseases in a large treatment center of central China. All cases gave oral informed consent prior to inclusion. This study received the agreement of our committee for the protection of persons involved in clinical research.

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Comment on “Effects of the GaAlAs diode laser (780 nm) on the periodontal tissues during orthodontic tooth movement in diabetes rats: histomorphological and immunohistochemical analysis”

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Chondroitin sulfate and glucosamine sulfate associated to photobiomodulation prevents degenerative morphological changes in an experimental model of osteoarthritis in rats

Abstract

The aim of this study was to compare the effects of combined treatment with chondroitin sulfate and glucosamine sulfate (CS/Gl) and photobiomodulation (PBM) on the degenerative process related to osteoarthritis (OA) in the articular cartilage in rats. Forty male Wistar rats were randomly divided into four groups: OA control group (CG); OA animals submitted to PBM treatment (PBM); OA animals submitted to CS/Gl treatment (CS/Gl); OA submitted to CS/GS associated with PBM treatments (GS/Gl + PBM). The CS/Gl started 48 h after the surgery, and they were performed for 29 consecutive days. Moreover, PBM was performed after the CS/Gl administration on the left joint. Morphological characteristics and immunoexpression of interleukin 10 (IL-10) and 1 beta (IL-1β) and collagen type II (Col II) of the articular cartilage were evaluated. The results showed that all treated groups (CS/Gl and PBM) presented attenuation signs of degenerative process (measured by histopathological analysis) and lower density chondrocytes [PBM (p = 0.0017); CS/Gl (p = 0.0153) and CS/Gl + PBM (p = 0.002)]. Additionally, CS/Gl [associated (p = 0.0089) or not with PBM (p = 0.0059)] showed significative lower values for OARSI grade evaluation. Furthermore, CS/GS + PBM decreased IL-1β protein expression (p = 0.0359) and increased IL-10 (p = 0.028) and Col II imunoexpression (p = 0.0204) compared to CG. This study showed that CS/Gl associated with PBM was effective in modulating inflammatory process and preventing the articular tissue degradation in the knees OA rats.

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Laser for bone healing after oral surgery: systematic review

Abstract

The purpose of this study is to perform a systematic review on the use of lasers in oral surgery for bone healing. Selection of articles was carried out by two evaluators in Pubmed and Web of Science databases for published articles and OpenGray for gray literature. Search strategy was developed based on the PICO Question "Does the use of lasers after oral surgery improve bone healing?". Eligibility criteria were: being on laser; evaluate bone healing; involve oral surgery; do not be about implant, periodontics, orthodontics, osteonecrosis or radiotherapy, nor revisions, clinical cases, etc. Data were collected from each article in a structured spreadsheet and a descriptive analysis was performed. Risk assessment of bias of the articles was carried out through the tool elaborated by the Cochrane collaboration. A total of 827 potentially relevant references were identified. No articles were found in OpenGray. Eleven articles met the eligibility criteria and were included in the systematic review. Most of studies were in vivo and in jaw, being conducted with low-power lasers which were applied immediately after the surgical procedure of extraction. Neoformation and bone density were the outcomes of choice and there was a tendency of increase in bone density, neoformation, regeneration, mineralization, or bone condensation when laser was applied. Regarding the bias risk assessment, studies were not clear in reporting most of the parameters. Low-power laser therapy seems to reduce time of bone healing in oral surgery, although there are no defined protocols and the level of evidence is still considered weak.

http://ift.tt/2AMCMbB

Acne across Europe: an online survey on perceptions and management of acne

Abstract

Background

Acne is common among young people.

Objective

To describe the burden, management and sources of advice, of acne in a representative sample of young people in Europe.

Methods

This cross-sectional survey was conducted in a representative sample of individuals aged 15–24 years from Belgium, Czech and Slovak Republics, France, Italy, Poland and Spain (n=3099).

Results

Most individuals considered their acne (all severity stages) to be no/minor problem, although 29.7% considered it a major problem/burden. Over-the-counter (OTC) topical treatments were used more frequently than prescribed treatments. Acne was diagnosed by physicians in 47.6% of cases; other health professionals (nurses, pharmacists) or patients accounted for the remainder of diagnoses. Physicians were the source of acne information in just over one-quarter of cases (27.0%). The vast majority of advice was from friends/family and the internet.

Conclusion

Almost one-third of young people consider acne to be a major problem/burden. Fewer than half of acne diagnoses are made by a physician and acne is often self-managed using OTC treatments.

http://ift.tt/2kfbmnA

Efficacy of ustekinumab in Palmo plantar pustulosis

Palmo plantar Pustulosis (PPP) is a chronic disorder characterized by sterile pustules and scaly erythematous lesions on the palms and soles. It is more common in women between 40 and 60 years of age with an estimated incidence between 2.8 and 40.9%. PPP is difficult to manage, not only because of its limited response to different treatments, but also because it has a strong impact on patients' quality of life (1) .

http://ift.tt/2BB3fWC

A cross-sectional study of clinical factors associated with acne facial scarring in patients with active acne

Scarring may occur in 45% to 55% of acne patients, it may produce significant psychopathology, and it is challenging to treat.^1,2,3 Identifying factors associated with acne scars may assist in their prevention strategy. We conducted a cross-sectional study to investigate clinical factors associated with acne facial scarring at first visit, including age, sex, smoking, family history of acne, and the history of previous acne treatments. Active acne on the face was graded by the Global Evaluation of Acne (GEA) scale (0-5), as previously described.⁴ The presence of acne scars (atrophic or hypertrophic) on the face, or macular erythema, was recorded. The hospital IRB approved the study. Statistical significance level was set at P < 0.05.

http://ift.tt/2kfbKT4

Eczema-like fish tank granuloma: a new clinical presentation of Mycobacterium marinum infection

Fish tank granuloma is caused by Mycobacterium marinum, a Gram-positive, acid-fast, non-motile, aerobic, non-sporulating, photochromogen bacterium. M. marinum growth is usually slow: 2-6 weeks on Löwenstein-Jensen medium, at the temperature of 25-33°C. In culture, with a light source, the colour changes from white to yellow, because of the accumulation of carotene crystals.

http://ift.tt/2BBStzh

Acral lamellar Ichthyosis – expanding the phenotype of temperature-sensitive keratinization disorders

Lamellar ichthyosis is a MEDOC (Mendelian disorders of cornification) that belongs to the ARCI group (Autosomal recessive congenital ichthyosis) ¹, characterized by large brownish scaly lesions tightly adherent, with typical involvement of the face, which may lead to ectropion. Mutations in at least 12genes have been described in the ARCI group².

http://ift.tt/2kcbzI7

Microneedling for the Treatment of Hair Loss?

Abstract

Microneedling is a minimally invasive dermatological procedure in which fine needles are rolled over the skin to puncture the stratum corneum. This therapy is used to induce collagen formation, neovascularization, and growth factor production of treated areas. It has been used in a wide range of dermatologic conditions, including androgenetic alopecia and alopecia areata, among others. While there are a limited number of studies examining this therapy in the use of hair loss, microneedling has been successfully paired with other hair growth promoting therapies, such as minoxidil, platelet rich plasma, and topical steroids, and shown to stimulate hair follicle growth. It is thought that microneedling facilitates penetration of such first line medications and this is one mechanism by which it promotes hair growth. To date, the area most studied and with the most success has been microneedling treatment of androgenetic alopecia. While the current evidence does not allow one to conclude superiority of microneedling over existing standard therapies for hair loss, microneedling shows some promise in improving hair growth, especially in combination with existing techniques. This review summarizes the current literature regarding microneedling in the treatment of alopecia and calls for further studies to refine a standard treatment protocol.

http://ift.tt/2BA3iBY

The effect of adjuvant radiotherapy on radial forearm free flap volume after soft palate reconstruction in 13 patients

Abstract

Treatment options for squamous cell carcinoma of the soft palate include surgical resection followed by radiotherapy or primary radiotherapy. In most cases sufficient resection margins require reconstruction of the defect with free flaps. The most common flaps used in oropharyngeal carcinoma are the radial forearm free flap and the anterolateral thigh and latissimus dorsi free flap. According to the magnitude of the resection defect, surgeons estimate the size and volume of soft tissue transfer needed for an optimal esthetic and in particular functional outcome.

http://ift.tt/2BBC0eF

Associations between air pollution, climate factors and outpatient visits for eczema in West China Hospital, Chengdu, Southwestern China: a time series analysis

Abstract

Background

Eczema is one of the most common inflammatory dermatoses that can be provoked as a result of external and internal factors. With dense population and rapid economic development of China, air pollution is still a serious problem and the prevalence of eczema has been elevating.

Objective

To determine the association and lagged effects between environmental factors and the outpatient visits for eczema.

Methods

Data of daily outpatient visits for eczema at the clinics of dermatology in West China Hospital within the last 5 years was collected. Data of environmental factors of Chengdu during the same period, including temperature, relative humidity, barometric pressure, wind speed and air pollutants concentrations like sulfur dioxide(SO₂), nitrogen dioxide(NO₂) and particular matter (PM₁₀) was gathered. The Distributed lag non-linear model were used to statistically examine the relationship between eczema and environmental factors and their lagged effects.

Results

Correlation analysis showed that eczema outpatient visits were positively correlated with the air pollutants and were negatively correlated with relative humidity. The barometric pressure and wind speed influenced the outpatient visits in association with air pollutants.

Conclusion

This study provides evidence that environmental factors like relative humidity, multiple air pollutants influence the incidence and prevalence of eczema and have lagged effects.

http://ift.tt/2ke19rD

Dermoscopic features and patterns of poromas: A multicenter observational case-control study conducted by the International Dermoscopy Society (IDS)

Abstract

Background

Poromas are benign cutaneous sweat gland tumours that are challenging to identify. The dermoscopic features of poromas are not well characterised.

Objective

To determine the clinical-dermoscopic features of poromas.

Methods

Cross-sectional, observational study of 113 poromas and 106 matched control lesions from 16 contributors and eight countries. Blinded reviewers evaluated the clinical and dermoscopic features present in each clinical and dermoscopic image.

Results

Poromas were most commonly non-pigmented (85.8%), papules (35.4%), and located on non-acral sites (65.5%). In multivariate analysis, dermoscopic features associated with poroma included white interlacing areas around vessels (OR: 7.9, 95% CI: 1.9-32.5, p=0.004), yellow structureless areas (OR: 2.5, 95% CI: 1.1-6.0, p=0.04), milky-red globules (OR: 3.9, 95% CI: 1.4-11.1, p=0.01), and poorly visualised vessels (OR: 33.3, 95% CI: 1.9-586.5, p=0.02). The presence of branched vessels with rounded endings was positively associated with poromas but did not reach statistical significance (OR: 2.4, 95% CI: 0.8-6.5, p=0.10). The presence of any of these five features was associated with a sensitivity and specificity of 62.8% and 82.0%, respectively.

Conclusion

We identified dermoscopic features that are specific to the diagnosis of poroma. Overall, however, the prevalence of these features was low. Significant clinical and dermoscopic variability is a hallmark of these uncommon tumours, which are most prevalent on non-acral sites.

http://ift.tt/2BD2s7Q

Assessing dutasteride-associated sexual dysfunction using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS)

Abstract

Background

Incidences of sexual dysfunction due to the use of 5 α-reductase inhibitors have been suggested. Despite low sexual dysfunction reported in clinical trials, an analysis of the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database revealed a significant disproportionality in the reporting of sexual dysfunction with the use of finasteride. Therefore, it is likely that a similar relationship with dutasteride may exist.

Objective

To determine whether dutasteride use leads to a higher risk of sexual dysfunction compared to a baseline risk for all other drugs using the FAERS database.

Methods

A case by non-case disproportionality approach was used whereby a Reporting Odds Ratio (ROR) with 95% confidence interval (CI) was calculated. Cases of dutasteride-associated sexual dysfunction were compared to a reference risk of sexual dysfunction for all other drugs in the database.

Results

A significant disproportionality in reporting of sexual dysfunction with the use of dutasteride was observed. The disproportionality was present for all age ranges except for 31-45 years where there were few overall reports of adverse events.

Limitations

Adverse events can be underreported and selection bias is inherent in the FAERS.

Conclusion

Dutasteride use is associated with an increase in reports of sexual dysfunction.

http://ift.tt/2ke0ZR3

The EXIT (ex-utero intrapartum treatment) procedure - from the paediatric ENT perspective.

The EXIT (ex-utero intrapartum treatment) procedure - from the paediatric ENT perspective.

Acta Otorhinolaryngol Ital. 2017 Nov 30;:

Authors: Pucher B, Szydlowski J, Jonczyk-Potoczna K, Sroczynski J

Abstract
The main principle of the EXIT procedure is to maintain uteroplacental circulation with neonatal anaesthesia by controlled uterine hypotonia. This enables securing the foetal airways and decompress or resect large neck and mediastinal foetal masses. The authors present their experience with use of the EXIT procedure in 7 foetuses in whom evaluation and management of the airways were performed. In 4 patients, the neck mass was surgically removed in the neonatal period, in 1 the propranolol treatment was introduced. Two newborns died shortly after the EXIT procedure. The EXIT procedure allows the paediatric otolaryngologist to provide airway patency of newborns during delivery. Both ultrasound and MR imaging are crucial in the prenatal assessment of foetal head and neck masses. Their application in the evaluation of any foetal anomaly is essential for proper prognosis and treatment. Maternal monitoring for complications such as polyhydramnios and preterm labour are important in planning and desirability of the EXIT procedure.

PMID: 29187760 [PubMed - as supplied by publisher]

http://ift.tt/2Ax9Bc4

Binocular cyclotorsion in superior vestibular neuritis.

Binocular cyclotorsion in superior vestibular neuritis.

Acta Otorhinolaryngol Ital. 2017 Nov 30;:

Authors: Lapenna R, Pellegrino A, Ricci G, Cagini C, Faralli M

Abstract
Conjugated cyclotorsion of the eyes toward the affected side can commonly be observed in vestibular neuritis. The aim of this study was to assess the differences in cyclotorsion between the ipsi- and contralesional eye during selective involvement of the superior branch of the vestibular nerve. We studied binocular cyclotorsion through ocular fundus photographs in 10 patients affected by acute superior vestibular neuritis (SVN). Cyclotorsion was also studied in 20 normal subjects. All SVN patients showed an ipsilesional cycloversion of the eyes. Normal subjects exhibited a constant mild excyclovergence (6.42 ± 2.34°). In SVN patients, contralateral incyclotorsion (8.4 ± 8.14°) was lower and not normally distributed compared to ipsilateral eye excyclotorsion (17.9 ± 4.36°) with no correlation between them. The interocular difference in cyclodeviation could be related to the starting physiological excyclovergence, to different tonic effects on the extraocular muscles of the two eyes and to the different influence of spontaneous nystagmus on cyclodeviation in the two eyes. We recommend referring only to ipsilateral excyclotorsion in the evaluation of utricular function during SVN and its subsequent compensation. Further studies are required to determine the binocular cyclotorsion in the case of other kinds of selective involvement of the vestibular nerve.

PMID: 29187759 [PubMed - as supplied by publisher]

http://ift.tt/2iyjorq

Cochlear obliteration following a translabyrinthine approach and its implications in cochlear implantation.

Cochlear obliteration following a translabyrinthine approach and its implications in cochlear implantation.

Acta Otorhinolaryngol Ital. 2017 Nov 30;:

Authors: Delgado-Vargas B, Medina M, Polo R, Lloris A, Vaca M, Pérez C, Cordero A, Cobeta I

Abstract
The most frequent sequelae following a translabyrinthine approach for vestibular schwannoma resection is complete hearing loss on the affected side. Such patients could benefit from a cochlear implant, provided that two essential requisites are met before surgery: a preserved cochlear nerve and a patent cochlea to accommodate the electrode array. The goal of our study is to determine the prevalence and extent of cochlear ossification following a translabyrinthine approach. Postoperative MRI of 41 patients were retrospectively reviewed. Patients were classified according to the degree of cochlear obliteration into three groups (patent cochlea, partially obliterated cochlea and totally obliterated cochlea). The interval between surgery and the first MRI was studied as well as its relationship with the rate of cochlear ossification. At first postoperative MRI (mean interval of 20 months), 78% of patients showed some degree of cochlear ossification. Differences were found in the time interval between surgery and first MRI for each group, showing a smaller interval of time the patent cochlea group (p > 0.05). When MRI was performed before the first year after surgery, a larger rate of patent cochlea was found (p > 0.05). The present study suggests that cochlear ossification is a time-depending process, whose grounds are still to be defined.

PMID: 29187758 [PubMed - as supplied by publisher]

http://ift.tt/2iwWBMu

The role of laryngectomy in locally advanced thyroid carcinoma. Review of 16 cases.

The role of laryngectomy in locally advanced thyroid carcinoma. Review of 16 cases.

Acta Otorhinolaryngol Ital. 2017 Nov 30;:

Authors: Chala AI, Vélez S, Sanabria A

Abstract
Locally advanced disease with larynx invasion is a challenge to the surgeon, but laryngectomy is almost never necessary in thyroid carcinoma. The aim of this study was to review the clinical outcomes of patients with locally advanced thyroid carcinoma invading the larynx who underwent laryngectomy. A case series of patients treated in a tertiary care hospital was reviewed. Data about the type of operation, method of reconstruction, complications and overall survival of 16 patients operated on between 2002 and 2015 with larynx invasion is presented. There were 10 females. The mean age was 63 ± 8.8 years. Besides total thyroidectomy and neck dissection, four patients underwent total pharyngolaryngectomy, 11 total laryngectomy and one hemi-laryngectomy. Reconstruction was made with regional flaps in 10 patients (7 pectoral/Bakamjian flaps and 3 gastric pull-through procedures) and a jejunum free flap in one patient. Two patients needed carotid artery reconstruction. Five tumours were classic (conventional) papillary carcinoma variants, while the others were aggressive histological varieties (insular, tall cell, sclerosing). The mean tumour size was 4.3 ± 1.6 cm. All tumours had lymphovascular invasion and 12 had positive lymph nodes. Concomitantly, oesophageal/hypopharynx invasion was present in 7 cases and invasion of carotid vessels in 2 cases. There were two postoperative deaths and two anastomotic leaks that were treated conservatively. The mean overall survival was 31 ± 33 months (median 27.6 months, range 0-120). Laryngectomy is an alternative surgical procedure to control selected cases of advanced thyroid carcinoma that offers good local control and long term survival.

PMID: 29187757 [PubMed - as supplied by publisher]

http://ift.tt/2AwaqSf

Pilot study on microvascular anastomosis: performance and future educational prospects.

Pilot study on microvascular anastomosis: performance and future educational prospects.

Acta Otorhinolaryngol Ital. 2017 Nov 30;:

Authors: Berretti G, Colletti G, Parrinello G, Iavarone A, Vannucchi P, Deganello A

Abstract
The introduction of microvascular free flaps has revolutionised modern reconstructive surgery. Unfortunately, access to training opportunities at standardised training courses is limited and expensive. We designed a pilot study on microvascular anastomoses with the aim of verifying if a short course, easily reproducible, could transmit microvascular skills to participants; if the chosen pre-test was predictive of final performance; and if age could influence the outcome. A total of 30 participants (10 students, 10 residents and 10 surgeons) without any previous microvascular experience were instructed and tested during a single 3 to 5 hour course. The two microanastomoses evaluated were the first ever performed by each participant. More than the half of the cohort was able to produce both patent microanastomoses in less than 2 hours; two-thirds of the attempted microanastomoses were patent. The pretest predicted decent scores from poor performances with a sensitivity of 61.5%, specificity of 100%, positive predictive value of 100% and negative predictive value of 40%. Students and residents obtained significantly higher scores than surgeons. Since our course model is short, cost-effective and highly reproducible, it could be introduced and implemented anywhere as an educational prospect for preselecting young residents showing talent and natural predisposition and having ambitions towards microvascular reconstructive surgery.

PMID: 29187756 [PubMed - as supplied by publisher]

http://ift.tt/2AwG7uM

Hemorrhage following transoral robotic surgery (TORS)

Abstract

Background

To report our experience of postoperative hemorrhage in patients following transoral robotic surgery (TORS).

Methods

Data was collected on patients having TORS. Postoperative hemorrhage within 30 days was graded using the Mayo clinic grading system.

Results

TORS operations were performed on 122 patients. There were 23 bleeding events classified as minor to severe following 19 operations (16%). Hemorrhage requiring a return to the operating room occurred after 7 operations (6%). The odds of an emergent hemorrhage was 5.19 times greater in patients that had a staged neck dissection after TORS (p= 0.05). The odds of a postoperative bleeding event were 2.6 times greater in patients receiving a larger resection (p=0.107). There were no hemorrhage events in the 36 patients who received a synchronous neck dissection with transcervical ligation of the external carotid artery.

Conclusions

Surgical intervention for TORS hemorrhage occurred in 6% patients. No haemorrhage occurred in patients who had ligation of the external carotid artery.

http://ift.tt/2BBEo5c

Αρχειοθήκη ιστολογίου

Παρασκευή 1 Δεκεμβρίου 2017

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