Hypophosphatasia (HPP) is a rare, inherited metabolic bone disorder characterized by low serum alkaline phosphatase activity and impaired bone mineralization. Clinical manifestations and severity of symptoms vary widely in HPP, ranging from in utero death to isolated dental manifestations in adults. Treatment with enzyme replacement therapy has been reported to improve outcomes in perinatal, infantile, and childhood forms of HPP. Here, we present a case of a boy with poor linear growth, mild limb bowing, and radiographic rickets who was diagnosed with HPP before 6 months of age. Treatment with enzyme replacement therapy was initiated at 7 months of age, after which significant improvements in radiographic findings and linear growth were demonstrated. This case highlights several important challenges in the diagnosis, classification, and management of HPP.
https://ift.tt/2GDJGCD
Σάββατο 31 Μαρτίου 2018
Brief Clinical Report: Hypophosphatasia—Diagnostic Considerations and Treatment Outcomes in an Infant
A Rare Case of Lemierre-Like Syndrome: A Case Report and Literature Review
Lemierre's syndrome (LS) is a serious rare complication of oropharyngeal infections. It is characterized by thrombosis of internal jugular vein that rapidly progresses into sepsis and is typically caused by anaerobes. Most of the reported cases have been linked to Fusobacterium necrophorum; however, there are a handful of reported cases due to aerobes. It is primarily the disease of healthy young adults and can present in school-aged children. The early recognition and treatment of this complication results in resolution of the illness; nevertheless, there have been some concerns about chronic venous insufficiency as a long-term complication. We report a case of a 6-year-old boy, who presented with fever and headache with a history of sore throat. His blood culture was positive for group A Streptococcus (GAS) and was subsequently found to have internal jugular vein, sigmoid, and transverse sinus vein thrombosis.
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Infectious Aortitis: A Life-Threatening Endovascular Complication of Nontyphoidal Salmonella Bacteremia
A 65-year-old Japanese man living in the United States presented with pyrexia and chills associated with intermittent lower abdominal and back pain for 5 days. He denied recent travel, rash, diarrhea, or rectal bleeding. Physical examination revealed spiking pyrexia, and routine laboratory tests revealed mild leukocytosis and neutrophilia. Abdominal CT with contrast showed findings highly compatible with aortitis. Comprehensive autoimmune evaluation was negative. Salmonella enterica serotype Enteritidis was isolated from blood cultures. IV antibiotics were administered, but the patient continued to experience low-grade pyrexia and mild leukocytosis, and follow-up abdominal CT showed progressive aortic inflammation. The patient therefore underwent resection of the affected aortic segment with in-situ graft replacement and lifelong suppressive antibiotics. The patient is asymptomatic with no complications at 18 weeks of follow-up. This case report illustrates that patients with infectious aortitis from nontyphoidal Salmonella may (1) present with nonspecific and nonlocalizing symptoms and signs except for sepsis; (2) have diagnostic blood cultures and abdominal CT findings; and (3) typically require aggressive, prolonged IV antibiotic therapy and surgery for potential cure of this life-threatening infection.
https://ift.tt/2J939cF
A Large Grade 5 Mobile Aortic Arch Atheromatous Plaque: Cause of Cerebrovascular Accident
Aortic atheromas (aortic atheromatous plaques) are defined by an irregular thickening of the intima ≥2 mm, and a complex plaque is defined as a protruding atheroma ≥4 mm with or without an attached mobile component. Stroke incidence is approximately 25% in patients with mobile plaques of the aortic arch and 2% in patients with quiescent nonmobile plaques. Antiplatelet agents, oral anticoagulants, and statins have been suggested in the management of atheromas. We present an 80-year-old male, with non-ST-segment elevation myocardial infarction (NSTEMI) and chronic dysarthria, found to have an acute cerebrovascular accident (CVA) secondary to embolism from a large 12 mm aortic arch plaque, treated medically with oral antiplatelet therapy, anticoagulation, and statin therapy.
https://ift.tt/2E91lNd
Multiple roles of lymphatic vessels in tumor progression
Qiaoli Ma | Lothar C Dieterich | Michael Detmar
https://ift.tt/2pTZNlS
Next generation natural killer cells for cancer immunotherapy: the promise of genetic engineering
May Daher | Katayoun Rezvani
https://ift.tt/2GspGzm
The safety and risk factors of revision adenoidectomy in children and adolescents: A nationwide retrospective population-based cohort study
To investigate the safety of adenoidectomy and risk factors of re-adenoidectomy, and intend to provide evidence-based information to clinicians for further consideration.
https://ift.tt/2pWg8pW
Multimodality Surgical Approach in Management of Laryngotracheal Stenosis
Introduction. Postintubation laryngotracheal stenosis requires a precise diagnosis and an experienced operator in both endoscopic and surgical treatment. This report presents surgically treated cases of laryngotracheal stenosis secondary to long-term intubation/tracheostomy with review of the literature. Materials and Methods. In this retrospective study, we present 5 cases (a 23-year-old male, 13-year-old male, 22-year-old male, 19-year-old male, and 33-year-old female) of postintubation/tracheostomy laryngotracheal (glottic/subglottic) stenosis in the years 2016 and 2017. Each patient was managed differently. Intubation characteristics, localization of stenosis, surgical technique and material, postoperative complications, and survival of patients were recorded. Results. The site of stenosis was in the subglottis in 4 patients and glottis in 1 patient. The mean length of the stenosis was greater in the postintubation group. Postintubation stenosis had a mean duration of intubation of 6.8 days, compared to 206.25 days of cannulation following tracheostomies. Each patient underwent an average of 2 procedures during their treatment course. One patient underwent open surgical anastomosis because of recurrent subglottic stenosis after multiple treatments. Phonation improved immediately in almost all except in the patient who underwent only endoscopic dilatation. Discussion. The reasons for laryngeal stenosis and its delayed diagnosis have been reviewed from the literature. Suture tension should be appropriate, and placement of the suture knot outside the trachea minimizes formation of granulation tissue. The published reports suggest that resection by endoscopy with laser and open technique resection and primary anastomosis are the best treatment modality so far as the long-term results are concerned. Conclusion. Resection of stenotic segment by open surgical anastomosis and laser-assisted resection is a safe option for the treatment of subglottic stenosis following intubation without the need for repeated dilation. Endoscopic dilation can be reserved for unfit patients.
https://ift.tt/2GMy4xf
Spinal Accessory Nerve Duplication: A Case Report and Literature Review
Aim of the present study is to expand our knowledge of the anatomy of the 11th cranial nerve and discuss the clinical importance and literature pertaining to accessory nerve duplication. We present one case of duplicated spinal accessory nerve in a patient undergoing neck dissection for oral cavity cancer. The literature review confirms the extremely rare diagnosis of a duplicated accessory nerve. Its clinical implication is of great importance. From this finding, a further extension to our knowledge of the existing anatomy is proposed.
https://ift.tt/2uCOanZ
Evaluation of the effects of occlusal splint, trigger point injection and arthrocentesis in the treatment of internal derangement patients with myofascial pain disorders
Publication date: Available online 31 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Itır Şebnem Bilici, Yusuf Emes, Serhat Yalçın, Buket Aybar
https://ift.tt/2Imj8mC
A Multimodal analysis using flowmeter analysis, laser-Doppler spectrophotometry, and indocyanine green videoangiography for the detection of venous compromise in flaps in rats
Publication date: Available online 30 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Lucas M. Ritschl, Leonard H. Schmidt, Andreas M. Fichter, Alexander Hapfelmeier, Klaus-Dietrich Wolff, Thomas Mücke
Venous congestion results in tissue damage and remains the most common failure of free microvascular transfer if it is not recognized early. The purpose of this experimental study was to evaluate venous congestion and describe the findings with two different monitoring tools. A standardized epigastric flap was raised, and total occlusion of the draining vein was temporarily applied for 4, 5, 6, or 7 hours. Blood flow measurements, including laser-Doppler flowmetry, and tissue spectrophotometry (O2C) and indocyanine green (ICG) videoangiography using the FLOW® 800 tool, were performed systematically after each surgical step, an interval of venous occlusion, and 1 week of clinical observation. Both monitoring tools were capable of detecting acute venous occlusion. ICG videoangiography data showed a significant decrease in the first and second maximum, and the area under the curve, during venous occlusion, whereas hemoglobin levels in the O2C analysis remained stable. Changes in fluorescence values in border areas of the flap correlated significantly with the incidence of necrosis. O2C data later showed significant correlation with the area of necrosis, and more individual changes during flap monitoring. ICG videoangiography might therefore be useful in the prediction of flap necrosis in critical areas of perfusion.
https://ift.tt/2Grtchi
Trajectory-guided biopsy of orbital tumor - Technology, principal considerations and clinical implementation -
Publication date: Available online 31 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Majeed Rana, Christoph Sproll, Julian Lommen, Madiha Rana, Alexander Zeller, Norbert Kübler, Karsten Hufendiek, Elvis Hermann, Nils-Claudius Gellrich, Henrik Holtmann
Intraorbital space-occupying lesions always pose a challenge, both in terms of definite surgical removal as well as preoperative sampling for histopathological examination. Despite the use of modern high-resolution imaging techniques, the dignity of orbital lesions can often not be determined with sufficient certainty preoperatively. As the amount and complexity of treatment possibilities continue to increase, detailed diagnostics in advance of treatment choice are essential. Histological classification of orbital lesions can still be considered the gold standard for reliable diagnoses, leading to appropriate treatment.Over recent years minimally invasive surgical approaches have gained more importance in the treatment and diagnosis of cranio-maxillo-facial tumor and trauma.The aim of our study was to adapt and establish a precise procedure for orbital biopsies. 23 patients suffering from space-occupying lesions of unknown dignity were included. Trajectory-guided procedures were pre-planned for all cases. In most cases minimally invasive procedures were suitable for taking biopsies of the orbit. For only two patients a conventional, non-minimally invasive, lateral orbitotomy had to be performed. Further evaluation of the presented procedure demonstrates clearly that trajectory-guided biopsies of the orbit can be performed correctly and effectively, regardless of the suspected lesion's size.
https://ift.tt/2Imj46m
Safety and Efficacy of a Halobetasol/Tazarotene Fixed Combination in the Treatment of Moderate-to-Severe Plaque Psoriasis: Results of two Phase 3 randomized controlled trials
Topical corticosteroids are the mainstay of psoriasis treatment; long-term safety concerns limit use. Combination with tazarotene may optimize efficacy, minimizing safety/tolerability concerns, In patients with moderate-to-severe plaque psoriasis treated with HP/TAZ lotion, improvement is noted within 2 weeks with few adverse effects observed after 8 weeks., HP/TAZ lotion may provide a realistic topical option for psoriasis management
https://ift.tt/2J9TjHF
Evaluation of the effects of occlusal splint, trigger point injection and arthrocentesis in the treatment of internal derangement patients with myofascial pain disorders
Temporomandibular disorders (TMD) may originate from the joint itself or from pathologies of masticatory muscles. Most pathology seen is myofascial pain disorder (MPD). TMD are characterized by pain, muscle spasms, and constraints in the movements of the temporomandibular joint. In temporomandibular joint disorders, besides the internal derangement, protective muscle spasms are usually observed.
https://ift.tt/2E9Ihym
Implant stability using piezoelectric bone surgery compared with conventional drilling: a systematic review and meta-analysis
The aim of this systematic review was to assess the primary and secondary stability of dental implants placed at sites prepared with piezoelectric bone surgery (PBS) and conventional drilling (CD). The PubMed/MEDLINE and Cochrane Library databases were searched without date or language restriction up to June 2017. Controlled clinical trials in which each patient received implants placed at sites prepared with both PBS and CD were selected. Implant stability had to be measured on day 0 and during the osseointegration period.
https://ift.tt/2pTYHGJ
Implant stability using piezoelectric bone surgery compared with conventional drilling: a systematic review and meta-analysis
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S. García-Moreno, J. González-Serrano, R.M. López-Pintor, B. Pardal-Peláez, G. Hernández, J.M. Martínez-González
The aim of this systematic review was to assess the primary and secondary stability of dental implants placed at sites prepared with piezoelectric bone surgery (PBS) and conventional drilling (CD). The PubMed/MEDLINE and Cochrane Library databases were searched without date or language restriction up to June 2017. Controlled clinical trials in which each patient received implants placed at sites prepared with both PBS and CD were selected. Implant stability had to be measured on day 0 and during the osseointegration period. Methodological quality was assessed using the Cochrane Collaboration tool. A meta-analysis was performed to compare primary stability (on day 0) and secondary stability (after 2 and 3months) between the two groups. The studies included were determined to have a high risk of bias. There was no significant difference between the two groups for primary stability (on day 0) (P=0.51). After 2 and 3months, secondary stability was statistically higher in implants placed with PBS preparation (P=0.04 and P=0.01, respectively). The implant survival rate was 97.5% in the CD group and 100% in the PBS group. PBS preparation improves secondary stability after 2 and 3months in comparison to CD, with similar implant survival rates. Further studies are needed to determine whether implant osseointegration periods could be shortened with PBS preparation.
https://ift.tt/2pVfWq7
An audiological evaluation of syndromic and non-syndromic craniosynostosis in pre-school going children
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Liang Chye Goh, Ali Azman, Hufaidah binti Konting Siti, Wee Vien Khoo, Premala a/p Muthukumarasamy, Meow Keong Thong, Zulkiflee Abu Bakar, Anura Michelle Manuel
ObjectiveTo study the audiological outcome and early screening of pre-school going children with craniosynostosis under follow-up at the University of Malaya Medical Center(UMMC), Kuala Lumpur, Malaysia over a 10 year period.MethodsA retrospective descriptive cohort study on the audiological findings detected during the first hearing assessment done on a child with craniosynostosis using otoacoustic emissions, pure tone audiometry or auditory brainstem response examination. The main aim of this study was to evaluate the type and severity of hearing loss when compared between syndromic and non-sydromic craniosynostosis, and other associated contributory factors.ResultsA total of 31 patients with 62 ears consisting of 14 male patients and 17 female patients were evaluated. Twenty two patients (71%) were syndromic and 9 (29%) were non-syndromic craniosynostosis. Amongst the syndromic craniosynostosis, 9 (41%) had Apert syndrome, 7 (32%) had Crouzon syndrome, 5 (23%) had Pfieffer syndrome and 1 (4%) had Shaethre Chotzen syndrome. Patients with syndromic craniosynostosis were more likely to present with all types and severity of hearing loss, including severe to profound sensorineural hearing loss while children with non-syndromic craniosynostosis were likely to present with normal hearing (p < 0.05). In addition, when the first hearing test was done at a later age, a hearing loss including sensorineural hearing loss is more likely to be present in a child with syndromic craniosynostosis (p < 0.05).ConclusionOur study suggested that children who are born with syndromic craniosynostosis were more likely to suffer from a hearing loss, including that of a severe to profound degree compared to children with non-syndromic craniosynostosis. In addition to that, hearing loss is more likely to be detected when the first hearing test is done at a later age, and this can be an irreversible sensorineural hearing loss. We would like to advocate the need for early audiological screening and follow up in children with syndromic craniosynostosis.
https://ift.tt/2JblGFm
Surgical timing for bilateral simultaneous cochlear implants: When is best?
Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Sebastiano Franchella, Roberto Bovo, Luigia Bandolin, Flavia Gheller, Silvia Montino, Daniele Borsetto, Sara Ghiselli, Alessandro Martini
IntroductionHearing loss is considered the most common congenital disease and the prevalence of neonatal deafness can be estimated between 1 and 2 cases per 1000 live births.Infant deafness must be diagnosed as early as possible and an effective therapeutic intervention needs to be carried out in order to avoid the serious consequences of hearing deprivation during the evolutionary period: alterations in the development of central auditory pathways and lack of language acquisition.The cochlear implant (CI) has proved to be the best instrument to solve the problem of auditory deprivation. In particular, the bilateral CI gives the patient access to binaural hearing which results in benefits in terms of sound localisation and discrimination.The optimal age of application of the CI is a widely discussed topic in the scientific community and the current guidelines indicate a period between 12 and 24 months of age, even though the supporters of the application before 12 months of age are nowadays increasing.Materials and methodsThe study is observational, retrospective, monocentric. 49 paediatric patients (<18 years) with simultaneous bilateral CIs were included. The audiometric threshold and speech tests were carried out during the follow-up 3, 6 and 12 months after the CIs activation and when the patient reached 2 years of age.ResultsThe statistical analysis showed that undergoing bilateral implantation surgery before 2 years of age allows a satisfactory audiometric performance, while there are no particular benefits in performing the surgery before 1 year of age. As far as the speech outcome is concerned, the statistical analysis didn't show significant correlation between the earlier age of implantation and better speech performance if the operation is carried out before 2.5 years of age.ConclusionsThe results of the study indicate that the optimal age to perform the simultaneous bilateral CIs surgery is between 12 and 24 months, without demonstrating any particular benefit in carrying out the procedure before 1 year of age. This may be clinically relevant in terms of avoiding the risks of diagnostic mistakes and reducing the related surgical risk in children under 1 year of age.
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Editorial board
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 3
https://ift.tt/2J9mvhZ
Actinomycose révélée par une ulcération du palais et de la gencive
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 3
Author(s): F. Dessirier, J.-P. Arnault, J. Denamps, H. Sevestre, C. Attencourt, C. Lok
IntroductionL'actinomycose est une infection bactérienne granulomateuse chronique extensive. Elle est rarement révélée par une ulcération buccale.ObservationUne femme diabétique de 76 ans était traitée par dabrafenib pour un mélanome stade IV. Lors d'une consultation de suivi, on constatait deux lésions ulcérées du palais dur et de la gencive, infiltrées et hyperalgiques. Il n'y avait pas de signe associé. Le bilan biologique était sans particularité. La première hypothèse diagnostique évoquée était celle d'un carcinome épidermoïde muqueux survenu sous inhibiteurs de BRAF, bien que cette situation soit très peu décrite dans la littérature. L'examen histologique montrait un grain actinomycosique. La tomodensitométrie du massif facial ne montrait pas d'ostéite. Une antibiothérapie par amoxicilline était instaurée pendant quatre mois, avec une évolution favorable.DiscussionLes actinomycètes sont des bactéries filamenteuses Gram positif, saprophytes de la cavité buccale et du tractus gastro-intestinal, qui deviennent pathogènes sous l'influence de plusieurs facteurs. L'atteinte cervico-faciale, sous la forme d'un nodule inflammatoire péri-mandibulaire avec fistulisation secondaire à la peau ou dans la bouche, est la présentation la plus classique de l'actinomycose. Aucun cas d'infection opportuniste n'a été décrit à notre connaissance sous inhibiteurs de BRAF ; seuls deux cas de tuberculose ont été rapportés avec le sorafenib. Chez notre patiente, les soins dentaires et le diabète sont les deux facteurs favorisants retenus. Nous rappelons par ailleurs l'importance de l'examen des muqueuses chez les patients traités par inhibiteurs de BRAF.BackgroundActinomycosis is a chronic and extensive granulomatous, bacterial infection. Revelation by oral ulceration is rare.Patients and methodsA 76-year-old patient with diabetes was treated with dabrafenib for stage IV melanoma. A follow-up visit revealed two ulcerated, infiltrated and hyperalgesic lesions of the palate and gingiva. There were no associated signs. The laboratory findings were normal. The possibility of squamous cell carcinoma occurring with BRAF inhibitors was discussed, despite the rarity of such cases in the literature. Histological examination showed an actinomycotic grain. A scan of the facial mass showed no osteitis. Antimicrobial therapy was initiated with amoxicillin for four months, with a favorable outcome.DiscussionActinomycetes are Gram-positive filamentous saprophytic bacteria of the oral cavity and the gastrointestinal tract. They can become pathogenic under the influence of several factors. Cervicofacial involvement in the form of a peri-mandibular inflammatory nodule with secondary fistulation on the skin or in the mouth is the classic presentation. To our knowledge, no cases of opportunistic infection under BRAF inhibitors have been described. Only two cases of tuberculosis have been reported with sorafenib. The initial presentation led to suspicion of squamous cell carcinoma. In our patient, poor oral hygiene and diabetes were the two key factors considered. Moreover, this is the first case reported under dabrafenib, which does not appear to be a favoring factor. We would stress the importance of mucosal examination in patients treated with BRAF inhibitors.
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Hydrochlorothiazide et cancers cutanés
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 3
Author(s): J.-L. Schmutz
https://ift.tt/2J6RRFI
Thyroid Cartilage Window Approach to Extract a Foreign Body after Migration into the Paraglottic Space
We report a case of fish bone impaction in the paraglottic space, which caused palsy of the left vocal cord. The patient was a 45-year-old man. He presented with throat pain and hoarseness of voice for approximately one week. The diagnosis was made after careful history taking and confirmed by the use of computed tomography scan as the fish bone was not visible endoscopically under local and general anaesthesia. The patient underwent thyroid cartilage window approach, and the fish bone was retrieved. His symptoms have improved significantly, and he did not require tracheostomy. Other cases reported the removal of foreign bodies by other techniques such as laryngofissure and posterolateral approach. Our case is different in that we used a modification of thyroplasty type 1 technique as it has less reported complications than other approaches that were published in literature.
https://ift.tt/2J83vQL
Soft Palate Pleomorphic Adenoma of a Minor Salivary Gland: An Unusual Presentation
Approximately 10% of pleomorphic adenomas occur in the minor salivary glands with the palate being the most common site. Pleomorphic adenomas account for the majority of palatal tumours; however, minor salivary gland tumours have a higher risk of malignancy compared to tumours of the major salivary glands, so appropriate diagnostic evaluation should be prompt. We present a case of a 52-year-old man with a longstanding history of a soft palate pleomorphic adenoma which required excision under general anaesthetic via a mandibular swing approach. As well as the surgical approach to access this tumour; this case is unique as it is the largest soft palate pleomorphic adenoma reported in the literature. We discuss the appropriate preoperative investigations and airway considerations for this patient, as well as the factors to consider when planning operative management of palatal tumours.
https://ift.tt/2pSZTcw
Correction to: Esophagus perforation and myocardial penetration caused by swallowing of a foreign body leading to a misdiagnosis of acute coronary syndrome: a case report
In the publication of this article [1], the Acknowledgements section was missing.
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Coronary artery fistula with associated Takotsubo cardiomyopathy: a case report
Coronary artery fistula, first described by Krause in 1865, is an abnormal communication between the coronary artery and one of the four chambers of the heart or one of the great vessels. The communications ar...
https://ift.tt/2GpAtuh
Induction of a central memory and stem cell memory phenotype in functionally active CD4 + and CD8 + CAR T cells produced in an automated good manufacturing practice system for the treatment of CD19 + acute lymphoblastic leukemia
Abstract
Relapsed/refractory B-precursor acute lymphoblastic leukemia (pre-B ALL) remains a major therapeutic challenge. Chimeric antigen receptor (CAR) T cells are promising treatment options. Central memory T cells (Tcm) and stem cell-like memory T cells (Tscm) are known to promote sustained proliferation and persistence after T-cell therapy, constituting essential preconditions for treatment efficacy. Therefore, we set up a protocol for anti-CD19 CAR T-cell generation aiming at high Tcm/Tscm numbers. 100 ml peripheral blood from pediatric pre-B ALL patients was processed including CD4+/CD8+-separation, T-cell activation with modified anti-CD3/-CD28 reagents and transduction with a 4-1BB-based second generation CAR lentiviral vector. The process was performed on a closed, automated device requiring additional manual/open steps under clean room conditions. The clinical situation of these critically ill and refractory patients with leukemia leads to inconsistent cellular compositions at start of the procedure including high blast counts and low T-cell numbers with exhausted phenotype. Nevertheless, a robust T-cell product was achieved (mean CD4+ = 50%, CD8+ = 39%, transduction = 27%, Tcm = 50%, Tscm = 46%). Strong proliferative potential (up to > 100-fold), specific cytotoxicity and low expression of co-inhibitory molecules were documented. CAR T cells significantly released TH1 cytokines IFN-γ, TNF-α and IL-2 upon target-recognition. In conclusion, partly automated GMP-generation of CAR T cells from critically small blood samples was feasible with a new stimulation protocol that leads to high functionality and expansion potential, balanced CD4/CD8 ratios and a conversion to a Tcm/Tscm phenotype.
https://ift.tt/2pYofmf
Stability of allergens
Source:Molecular Immunology
Author(s): Judith Pekar, Davide Ret, Eva Untersmayr
For proteins to cause IgE-mediated allergic reactions, several common characteristics have to be defined, including small molecular size, solubility and stability to changing pH levels and enzymatic degradation. Nevertheless, these features are not unique for potent allergens, but are also observed in non-allergenic proteins. Due to the increasing awareness by regulatory authorities regarding the allergy pandemic, definition of characteristics unique to potent allergens would facilitate allergenicity assessment in the future. Despite major research efforts even to date the features unique for major allergens have not been elucidated so far. The route of allergen entry into the organism determines to a great extent these required characteristics. Especially orally ingested allergens are exposed to the harsh milieu of the gastrointestinal tract but might additionally be influenced by food processing. Depending on molecular properties such as disulphide bonds contributing to protein fold and formation of conformational IgE epitopes, posttranslational protein modification or protein food matrix interactions, enzymatic and thermal stability might differ between allergens. Moreover, also ligand binding influences structural stability. In the current review article, we aim at highlighting specific characteristics and molecular pattern contributing to a stabilized protein structure and overall allergenicity.
https://ift.tt/2J6KiPu
Nebulized lidocaine ameliorates allergic airway inflammation via downregulation of TLR2
Source:Molecular Immunology, Volume 97
Author(s): Lixia Wang, Muzi Wang, Shuai Li, Huimei Wu, Qiying Shen, Shihai Zhang, Lei Fang, Rongyu Liu
Nebulized lidocaine has been suggested to be beneficial in asthma therapy, but the underlying mechanisms are little known. We aimed to investigate whether Toll-like receptor (TLR) 2 was involved in the protective effect of lidocaine on allergic airway inflammation. Female C57BL/6 mice were sensitized and challenged with ovalbumin (OVA). Meanwhile, some of the mice were treated with TLR2 agonist (Pam3CSK4, 100 μg) intraperitoneally in combination with OVA on day 0. Just after allergen provocation, mice were treated with inhaled lidocaine or vehicle for 30 min. In this model, we found that lidocaine markedly attenuated OVA-evoked airway inflammation, leukocyte recruitment and mucus production. Moreover, lidocaine abrogated the increased concentrations of T cytokines and TNF-α in bronchoalveolar lavage fluid (BALF) of allergic mice, as well as reducing the expression of phosphorylated nuclear factor (P-NF)-κBp65 and the NOD-like receptor pyridine containing 3 (NLRP3), which are important for the production of pro-inflammatory cytokines. In addition, our study showed that lidocaine dramatically decreased OVA-induced increased expression of TLR2 in the lung tissues. Furthermore, activation of TLR2 aggravated OVA-challenged airway inflammation, meanwhile, it also elevated OVA-induced expression of P-NF-κBp65 and NLRP3 in the lungs. However, lidocaine effectively inhibited airway inflammation and counteracted the expression of P-NF-κBp65 and NLRP3 in allergic mice pretreated with Pam3CSK4. Taken together, the present study demonstrated that lidocaine prevented allergic airway inflammation via TLR2 in an OVA-induced murine allergic airway inflammation model. TLR2/NF-κB/NLRP3 pathway may serve as a promising therapeutic strategy for allergic airway inflammation.
https://ift.tt/2pY3PsK
New insights into the structure of the MHC class I peptide-loading complex and mechanisms of TAP inhibition by viral immune evasion proteins
Source:Molecular Immunology
Author(s): Patrique Praest, A. Manuel Liaci, Friedrich Förster, Emmanuel J.H.J. Wiertz
Several hundred million years of co-evolution of vertebrates and invading pathogens have shaped the adaptive immune system to fight back the unwanted invaders through highly sophisticated defense mechanisms. Herpesviruses manage to dodge this immune response by hampering one of the central hinges of human adaptive immunity, the major histocompatibility complex (MHC) class I antigen presentation pathway. One of the bottlenecks of this pathway is the loading of pathogen-derived peptides onto MHC-I molecules in the endoplasmic reticulum (ER). This task is accomplished by the MHC class I peptide-loading complex (PLC), of which the transporter associated with antigen-processing (TAP) is a central component. In this review, we summarize recent structural and functional insights into the molecular architecture of the PLC, how TAP accomplishes the transport of peptides across the ER membrane, and how herpes- and poxviruses inhibit TAP-mediated peptide translocation and subsequent antigen presentation.
https://ift.tt/2J3KL4Z
Pre-diagnostic dynamic HPV16 IgG seropositivity and risk of oropharyngeal cancer: Methodologic issues
Source:Oral Oncology
Author(s): Karen S. Anderson, Jon Mork, Hilde Langseth, Garrick Wallstrom
https://ift.tt/2GXSG32
Osteochondroma of the Zygomatic Arch: A Case Report and Review of the Literature
Source:Journal of Oral and Maxillofacial Surgery
Author(s): R. Patel, G. Obeid
https://ift.tt/2E9ryeq
Assessing the Quality of Life in Patients with Dentofacial Deformities Before and After Orthognathic Surgery
Publication date: Available online 31 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Hong Sun, Hong-tao Shang, Li-sheng He, Ming-chao Ding, Zhong-ping Su, Yu-lin Shi
PurposeThis study aimed to assess the effect of health-related quality of life (QoL) among patients with dentofacial deformities who underwent orthognathic surgery, compared to a control group without dentofacial deformities, by using generic oral health and condition-specific approaches.Patients and MethodsIn this prospective study, two questionnaires were administered to 85 patients (31 men and 54 women) who were evaluated before undergoing orthognathic surgery. The Short Form Oral Health Impact Profile Questionnaire (OHIP-14) and the Orthognathic Quality of Life Questionnaire (OQLQ) were administered before and 5–7 months after orthognathic surgery. The control group comprised 96 young university student volunteers without dentofacial deformities.ResultsThe questionnaires were collected 5–7 months post-surgery. The preoperative scores of the patients and the control group were contrasted separately. The respondents' OHIP-14 and OQLQ post-surgery scores were significantly lower (total scores, P < 0.001). The pre-surgery OQLQ all domains scores were significantly higher among the patients than among the controls (total scores, P < 0.001); however, the total scores and three subscale scores of the OHIP-14 in the functional and psychological domains were significantly higher among the patients than among the controls (total scores, P < 0.05). The pre- and post-surgery total OQLQ scores were remarkably different between males and females (P < 0.05). The post-surgery total OQLQ scores were considerably higher in older patients than in younger patients (P < 0.05). All patients in the Class III group who underwent double jaw surgery showed remarkable changes post-surgery (total scores, P < 0.001).ConclusionPatients with dentofacial deformities had a poorer quality of life, compared to the normal population, especially in functional and psychological aspects. Orthognathic surgery had a significant positive impact on QoL. Patients with Class III malocclusion who underwent double jaw surgery seemingly benefitted the most after surgery.
Graphical abstract
https://ift.tt/2H0lNmm
Fracture healing and bone remodeling with human standard-sized magnesium versus polylactide-co-glycolide (PLGA) plate and screw systems using a mini-swine craniomaxillofacial osteotomy fixation model
Publication date: Available online 31 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Benoît Schaller, John Patrik Matthias Burkhard, Madeleine Chagnon, Stefan Beck, Thomas Imwinkelried, Michel Assad
PurposeThis study compared the degradation profile, safety and efficacy of a bioresorbable magnesium (Mg) alloy and polylactide-co-glycolide (PLGA) polymer osteosynthesis systems for the treatment of fractures in a load-sharing maxillofacial environment using a new mini-swine fracture fixation model.MethodsTwo types of clinically relevant situations were evaluated in five Yucatan miniature pigs. Defined porcine midface osteotomies of the supra-orbital rim and zygoma were created and fixed with either coated Mg (test animals) or PLGA plate and screw osteosynthesis systems (control animals). Following surgery, mini-pigs were able to recover for either one or nine months with continuous in vivo post-implantation monitoring. Standardized computed tomography (CT) imaging was taken immediately post-operatively and at termination for all animals. The nine-month cohort additionally underwent CT at 2, 4, and 6 months post-surgery. At necropsy, osteotomy sites and bone-implant units were harvested and the healing was evaluated under micro-CT, histopathology and histomorphometry.ResultsFollowing clinical and radiological follow-up examination, all fracture sites healed well for both magnesium and polymer groups regardless of time. Complete bone union and gradually disappearing osteotomy lines were observed across all implantation sites, with no major consistency change in periprosthetic soft tissue nor soft tissue calcification. Macroscopic and microscopic examination showed no negative influence of gas formation observed with Mg during the healing process. Histopathology demonstrated similar fracture healing outcomes for both plating systems with good biocompatibility as evidenced by a minimal or mild tissue reaction.ConclusionThe present study confirms that WE43-Mg alloy exhibited excellent fracture healing properties before its full degradation and without causing any significant inflammatory reactions in a long-term porcine model. Compared to PLGA implants, magnesium represent a promising new biomaterial with reduced sizes and improved mechanical properties in order to support fracture healing in a load-sharing environment.
https://ift.tt/2pUdy2T
Does sphenopalatine ganglion block improve pain control and intra-operative hemodynamics in children undergoing palatoplasty? A randomized control trial
Publication date: Available online 30 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Anantanarayanan Parameswaran, Muruganand V. Ganeshmurthy, Yashoda Ashok, Manikandhan Ramanathan, Anthony F. Markus, Hermann F. Sailer
BackgroundChildren undergoing cleft palate repair suffer pain, dysphagia and wound irritation in the immediate post-operative phase which may compromise surgical outcome. This trial evaluates the efficacy of spheno-palatine ganglion block (SPGB) in optimizing intra-operative hemodynamics and post-operative analgesia in children undergoing primary palatoplastyMaterials and MethodsThe study was designed as a prospective, double blinded, randomized control trial comparing the use of SPGB with general anesthesia (GA) versus a control group of GA only. Routine pre-operative documentation included type of cleft, patient's weight, hemoglobin(Hb%), packed cell volume(PCV), blood pressure(BP) and echo-cardiogram. Intra-operative monitoring included heart rate, blood pressure and surgical field assessment. Post-operatively, the pain score, pain free duration and need for rescue analgesics were recorded. Post-surgical change in Hb% and PCV values were assessed. Data analysis of collected variables was done using SPSS Version 16 (IBM Corp, Chicago, USA). Quantitative data was assessed for normality using Shapiro Wilk's test and analysed using the Imdependent sample t test, and Fisher Exact test was used for comparison of the binary variable (Gender). The outcome variables were compared between the study and control groups after adjusting for confounding variables. P value of <0.05 was considered statistically significant.Results100 Patients undergoing primary palatoplasty under GA were randomised into control group A (N=49) and study group B (SPGB)(N=51). Three patients were excluded from the Control group due to changes in intraoperative anesthetic protocol. The results demonstrated stastistically significant differences in the post-surgical pain free duration (19.46 Vs 87.59 mins) and mean blood loss (105.5 Vs 62 mL), in favour of the study group. Surgical field and post-op reduction of Hb% and PCV were also significantly favourable for the study group.ConclusionWe conclude that the SPGB is a potent pre-emptive technique offering excellent perioperative analgesia, hemodynamic stability and a clear surgical field.
https://ift.tt/2H420md
Παρασκευή 30 Μαρτίου 2018
Transoral endoscopic thyroid surgery via the tri‐vestibular approach with a hybrid space‐maintaining method: A preliminary report
Head &Neck, EarlyView.
https://ift.tt/2Go3JBt
Systematic review evaluating randomized controlled trials of smoking and alcohol cessation interventions in people with head and neck cancer and oral dysplasia
Head &Neck, EarlyView.
https://ift.tt/2GDXSLT
Immune privilege disruption in folliculotropic mycosis fungoides: investigation of major histocompatibility complex antigen expression
International Journal of Dermatology, EarlyView.
https://ift.tt/2GHwYm9
Paederus dermatitis – touched by champion flies – three clinical manifestations of pederin toxin‐inflicted dermatitis
International Journal of Dermatology, EarlyView.
https://ift.tt/2GnV6a3
Editorial Board
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 135, Issue 2
https://ift.tt/2E7RLKn
Contents
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 135, Issue 2
https://ift.tt/2GZUMiT
Facial Fracture Patterns Associated with Traumatic Optic Neuropathy
Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0038-1641172
Traumatic optic neuropathy (TON) is rare. The heterogeneity of injury patterns and patient condition on presentation makes diagnosis difficult. Fracture patterns associated with TON have never been evaluated. Retrospective review of 42 patients diagnosed with TON at the R. Adams Cowley Shock Trauma Center from May 1998 to August 2010 was performed. Thirty-three patients met criteria for study inclusion of fracture patterns. Additional variables measured included patient demographics and mechanism. Cluster analysis was used to form homogenous groups of patients based on different fracture patterns. Fracture frequency was analyzed by group and study population. Visual depiction of fracture patterns was created for each group. Cluster analysis of fracture patterns yielded five common "groups" or fracture patterns among the study population. Group 1 (n = 3, 9%) revealed contralateral lateral orbital wall (100%), zygoma (67%), and nasal bone (67%) fractures. Group 2 (n = 7, 21%) demonstrated fractures of the frontal bone (86%), nasal bones (71%), and ipsilateral orbital roof (57%). Group 3 (n = 14, 43%) involved fractures of the ipsilateral zygoma (100%), lateral orbital wall (29%), as well as frontal and nasal bones (21% each). Group 4 (n = 5, 15%) consisted of mid- and upper-face fractures; 100% fractured the ipsilateral orbital floor, medial and lateral walls, maxilla, and zygoma; 80% fractured the orbital roof and bilateral zygoma. Group 5 (n = 4, 12%) was characterized by fractures of the ipsilateral orbital floor, medial and lateral orbital walls (75% each), and orbital roof (50%). A notably high 15 of 33 patients (45%) sustained penetrating trauma. Our study demonstrates five fracture pattern groups associated with TON. Zygomatic, frontal, nasal, and orbital fractures were the most common. Fractures with a combination of frontal, nasal, and orbital fractures are particularly concerning and warrant close attention to the eye.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2IiGVUv
Effect of IFN-λ2 on combined allergic rhinitis with nasal polyps
OBJECTIVE: This study sought to investigate the expression of interferon-λ2 (IFN-λ2) in patients with combined allergic rhinitis and nasal polyps (AR+NP), analyze the correlation between IFN-λ2 and tryptase, interleukin 10 (IL-10), and interleukin 12 (IL-12), and identify its peripheral blood cell origins.
PATIENTS AND METHODS: ELISA kits were used to investigate plasma levels of IFN-λ2, tryptase, IL-10, and IL-12 in AR+NP patients and healthy controls (HC). Flow cytometry analysis was carried out to detect IFN-λ2 expression in peripheral blood leukocytes. Immunocytochemical staining was performed to detect nasal polyp IFN-λ2 expression in AR+NP patients.
RESULTS: Elevated plasma IFN-λ2 levels and positive correlations between plasma IFN-λ2 and tryptase levels in AR+NP patients indicated that IFN-λ2 likely contributes to AR+NP pathogenesis. IFN-λ2 expression was upregulated in cytotoxic T cells and eosinophils in AR+NP patients. Nasal polyp mast cells and macrophages in AR+NP patients expressed IFN-λ2.
CONCLUSIONS: The close correlation between IFN-λ2 expression and AR+NP may provide experimental evidence for a possible effect of IFN-λ2 against the allergic inflammatory reaction. Therefore, IFN-λ2 actions may have a potential utility for the treatment and prevention of AR+AP.
L'articolo Effect of IFN-λ2 on combined allergic rhinitis with nasal polyps sembra essere il primo su European Review.
https://ift.tt/2Gp4ydt
Cost‐effectiveness of sialendoscopy versus medical management for radioiodine‐induced sialadenitis
The Laryngoscope, EarlyView.
https://ift.tt/2GrvER7
Post‐acute care use after major head and neck oncologic surgery with microvascular reconstruction
The Laryngoscope, EarlyView.
https://ift.tt/2GK7yV8
Allergic phenotype of chronic rhinosinusitis based on radiologic pattern of disease
The Laryngoscope, EarlyView.
https://ift.tt/2GrXJHN
Transoral resection of extensive pediatric supraglottic neurofibroma
The Laryngoscope, EarlyView.
https://ift.tt/2GK7vsq
A Multimodal analysis using flowmeter analysis, laser-Doppler spectrophotometry, and indocyanine green videoangiography for the detection of venous compromise in flaps in rats
Venous congestion results in tissue damage and remains the most common failure of free microvascular transfer if it is not recognized early. The purpose of this experimental study was to evaluate venous congestion and describe the findings with two different monitoring tools. A standardized epigastric flap was raised, and total occlusion of the draining vein was temporarily applied for 4, 5, 6, or 7 hours. Blood flow measurements, including laser-Doppler flowmetry, and tissue spectrophotometry (O2C) and indocyanine green (ICG) videoangiography using the FLOW® 800 tool, were performed systematically after each surgical step, an interval of venous occlusion, and 1 week of clinical observation.
https://ift.tt/2E8ajtS
Trajectory-guided biopsy of orbital tumor - Technology, principal considerations and clinical implementation -
Intraorbital space-occupying lesions always pose a challenge, both in terms of definite surgical removal as well as preoperative sampling for histopathological examination. Despite the use of modern high-resolution imaging techniques, the dignity of orbital lesions can often not be determined with sufficient certainty preoperatively. As the amount and complexity of treatment possibilities continue to increase, detailed diagnostics in advance of treatment choice are essential. Histological classification of orbital lesions can still be considered the gold standard for reliable diagnoses, leading to appropriate treatment.
https://ift.tt/2GZKeQS
Optimizing outcomes with polymethylmethacrylate fillers
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2GEPJqq
Biologics for pityriasis rubra pilaris treatment: a review of the literature
Pityriasis rubra pilaris (PRP) is a rare inflammatory papulosquamous skin disease, often refractory to conventional therapies. The off-label use of biologics, such as anti-TNF, -IL-12/IL-23, -IL-17 agents, has been proven successful, in the last two decades, in PRP treatment.Our aim was to analyse the literature for the use of biologics in PRP treatment. We conducted a review by "Pubmed" and "clinicaltrial.gov" searches. 68 articles met our selection criteria and were herein discussed. Out of 86 PRP patients, the vast majority of which treated with anti-TNF, -IL-12/IL-23, and -IL-17 biologics, either alone or in combination therapy, a marked-to-complete response (50-78%), a partial response (11-25%) or no/poor response (11-25%) was observed.
https://ift.tt/2Gm2UgD
Dual neutralization of both IL-17A and IL-17F with bimekizumab in patients with psoriasis: results from BE ABLE 1, a 12-week randomized, double-blinded placebo-controlled phase 2b trial
Neutralizing interleukin (IL)-17F in addition to IL-17A may provide a more complete and specific approach to inhibiting inflammation.
https://ift.tt/2Gm2S8v
Evaluation of postoperative changes in vascularized iliac bone grafts used for mandibular reconstruction
Publication date: Available online 30 March 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): T. Noguchi, S. Sarukawa, Y. Tsuchiya, N. Okada, J. Hayasaka, K. Sasaguri, H. Nishino, Y. Jinbu, Y. Mori
Vascularized iliac bone grafts are used for mandibular reconstruction, but the factors affecting graft maintenance are unknown. This study explored the postsurgical changes in vascularized iliac bone grafts in patients who had undergone mandibular reconstruction after segmental resection. The study involved 24 patients (16 men and eight women) with oral tumours or osteoradionecrosis. Thirteen patients required bare bone grafting (BBG) and 11 patients required reconstruction with soft tissue coverage (six with a skin paddle and five with direct closure). The bone graft maintenance rate (with regard to the height of the centre of the graft) was calculated immediately after surgery and at 3, 6, 12, 24, and 36months after surgery. The maintenance rate was significantly lower in the BBG group than in the soft tissue coverage group at 3, 6, 12, 24, and 36months, and in those who were fitted with dentures compared to those who were not at 6, 12, 24, and 36months. Local infection also influenced the maintenance rate, but not significantly so. These findings indicate that the reconstruction technique and denture use can affect the bone graft maintenance rate after mandibular reconstruction with vascularized iliac bone grafts.
https://ift.tt/2GqjaZW
Does two-dimensional vs. three-dimensional surgical simulation produce better surgical outcomes among patients with class III facial asymmetry?
Publication date: Available online 30 March 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): N. Udomlarptham, C.-H. Lin, Y.-C. Wang, E.W.-C. Ko
The aim of this study was to compare the outcomes of traditional two-dimensional planning (2DP) and three-dimensional surgical simulation (3DS) in the surgical correction of skeletal class III with facial asymmetry. This retrospective cohort study included 37 consecutive adult Taiwanese patients. Preoperative and postoperative three-dimensional cephalometric measurements were obtained from cone beam computed tomography scans. The outcome variables were the differences in preoperative and postoperative linear and angular measurements and the differences between the two groups after surgery. When the surgical result was compared between the 2DP and 3DS groups, significant differences were found for four cephalometric variables: the distance from gonion on the non-deviated side to the midsagittal plane (MSP), mid-gonion to the MSP, upper first molar on the non-deviated side to the Frankfort horizontal plane, and the yaw angle. In the 3DS group, mandibular symmetry was achieved because the centre between the bilateral gonions was improved, and because there was no significant difference in the horizontal gonion (Go to the MSP) between the deviated and non-deviated sides after surgery. 3DS provides all the necessary information for planned surgical movements for the correction of facial asymmetry; it should be considered during surgical planning to improve surgical outcomes, particularly the achievement of bilateral mandibular contour symmetry.
https://ift.tt/2GKHLw9
Prognostic value of lymph node count from selective neck dissection in oral squamous cell carcinoma
Publication date: Available online 30 March 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S. Lee, H.J. Kim, I.-H. Cha, W. Nam
Unlike the levels of anatomical exploration, there is no consensus on the extent of lymph node dissection, or lymph node count (LNC), during selective neck dissection (SND). The aim of this study was to validate the prognostic impact of LNC on survival and to determine an optimal LNC cut-off value for SND. A retrospective investigation identified 78 patients with a diagnosis of oral squamous cell carcinoma (OSCC) who underwent SND (levels I–III or levels I–IV). LNC and clinicopathological variables were analyzed for any association with survival in Cox proportional hazards models. Based on the receiver operating characteristic curve, a cut-off value of 19 lymph nodes was found to predict overall survival (OS) (area under the curve 0.732, sensitivity 67.8%, specificity 75.0%; P=0.026) and disease-specific survival (DSS) (area under the curve 0.762, sensitivity 68.1%, specificity 77.8%; P=0.011). On Cox regression, LNC (≥19 vs. <19) was the only independent predictor of OS (hazard ratio 5.29, 95% confidence interval 1.39–20.05; P=0.014) and DSS (hazard ratio 6.76, 95% confidence interval 1.40–32.77; P=0.018). Similar results were obtained in the pathologically lymph node-negative subgroup (n=66). Based on the study findings, SND should include 19 or more lymph nodes for a survival benefit.
https://ift.tt/2GnCB5B
How to treat whiteheads on the nose
Whiteheads are stubborn acne lesions that develop just under the skin. The nose is a common site for whiteheads to form, as this part of the face produces a lot of oil and is touched frequently throughout the day. We look at several ways to treat whiteheads on the nose, as well as how to prevent them in the future.
https://ift.tt/2GlOxF6
Comparison of MRI in pediatric cochlear implant recipients with and without retained magnet
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Walker Brian, Norton Susan, Phillips Grace, Christianson Erin, Horn David, Ou Henry
ObjectiveTo report and compare medical, radiological, and audiological outcomes in pediatric cochlear implant recipients who underwent 1.5 and 3 Tesla strength MRI with and without retained magnet.MethodsRetrospective chart review at a tertiary care pediatric hospital and review of literature. Patients were identified via electronic medical records database search and were included if they had MRI after cochlear implant.ResultsOf twelve instances of MRI in pediatric cochlear implant recipients at our institution, two minor complications and one major complication were recorded. The rate of complication was equal between patients who underwent MRI with and without retained magnet. All minor complications resulted from MRI with retained magnet whereas the only major complication resulted from magnet removal. Two novel complications are reported, including: magnet removal resulting in silastic tear necessitating reimplantation and magnet dislocation with spontaneous reduction. Magnet removal significantly decreased the size of artifact, but did not alter the diagnostic utility of the MRI. While audiological measures varied chronologically from MRI scans, they did not appear to be appreciably altered by MRI.ConclusionMRI with and without magnet retention appear to carry risks of both major and minor complications. For the regions of interest for each scan, MRI quality was not appreciably altered by magnet status. Audiological measures appear unaffected by magnet status during MRI however, this may reflect natural variation.
https://ift.tt/2Gn8JWR
Oncologic outcomes of surgical treatment for T3 glottic laryngeal squamous cell carcinoma
Head &Neck, EarlyView.
https://ift.tt/2GjZhYl
New MRI Biomarkers in Head and Neck Cancers
Intervention: Other: MRI examinations
Sponsor: Memorial Sloan Kettering Cancer Center
Recruiting
https://ift.tt/2pNJmrd
Combat zone exposure and respiratory tract disease
International Forum of Allergy &Rhinology, EarlyView.
https://ift.tt/2GoyshY
Lacrimal sac exposure and a superior lateral anterior pedicle flap to improve outcomes of Draf type II and III procedures
International Forum of Allergy &Rhinology, EarlyView.
https://ift.tt/2pQgvSS
Comparing the efficacy of Silastic and gloved‐Merocel middle meatal spacers for functional endoscopic sinus surgery: a randomized controlled trial
International Forum of Allergy &Rhinology, EarlyView.
https://ift.tt/2Ig2fcV
A novel universal device“LINGUAL RING Ri.P.A.Ra” for TMDs and cranio-cervico-mandibular pains: preliminary results of a randomized control clinical trial
OBJECTIVE: The aim of this study was to evaluate functionality and clinical application of a novel immediate device in the treatment of temporomandibular disorders (TMDs). To address the research purpose, authors developed and implemented a randomized control clinical trial.
PATIENTS AND METHODS: Eighty patients were enrolled in this study and were randomly divided into two subgroups based on the treatment applied: patient group (PG) and control group (CG). The CG was not subjected to any kind of treatment, even placebo, in order to be able to assess the spontaneous development of the pathology over time. The PG was treated applying the novel device for a maximum of three months. The following parameters were evaluated at baseline (T0) and at the end of therapy (T1): presence/absence of articular noises, painful symptomatology (articular pains, muscle pains, headache, cervicalgia), parafunctional habits and duration of symptoms. The x2-index of association was performed, with a p-value < 0.05 considered as statistically significant.
RESULTS: No patient in the PG worsened its symptomatology. Thirteen patients (33%) declared themselves cured from their symptoms and were included in a monitoring protocol. Twenty-seven patients (67%) improved their symptoms and were treated with other conservative conventional methods to complete the therapeutic cycle. Therefore, 100% of PG obtained benefits from the application of the new therapeutic approach. In contrast, among patients of CG, eighteen subjects (45%) worsened their symptoms, while eighteen (45%) were defined as stationaries compared to T0 and only four (10%) were defined as improved.
CONCLUSIONS: The device presented the following advantages: immediacy of use, reduction of waiting times for its application, good tolerability and comfort and specificity in the execution of tongue rehabilitation exercises.
L'articolo A novel universal device"LINGUAL RING Ri.P.A.Ra" for TMDs and cranio-cervico-mandibular pains: preliminary results of a randomized control clinical trial sembra essere il primo su European Review.
https://ift.tt/2J6tVCv
High-dose thiamine and essential tremor
Essential tremor is a common neurological disease. The medical treatment of this affection currently involves the use of propranolol, primidone and other drugs. These drugs, however, are often not effective in reducing tremor and cause side effects in a large share of the patients treated. The treatment with intramuscular high-dose thiamine has led to a rapid, remarkable and persistent improvement of the symptoms in two patients with essential tremor. This result suggests the possibility that high doses of intramuscular thiamine may be an affordable alternative, highly effective and long-lasting medical treatment that has shown no relevant side effect.
https://ift.tt/2GoYEZN
Acute brainstem compression
Description
A 34-year-old African woman, whose medical history was unremarkable, presented to the emergency room with severe headache and vomiting. Temperature, blood cells count, plasma electrolytes and chest X-ray were normal. Clinical conditions were rapidly deteriorating and neurological exam disclosed drowsiness, opisthotonus and decerebrate response to pain. Brain CT scan showed a 'full' posterior fossa, mild supratentorial hydrocephalus and herniation of cerebellar tonsils: after contrast, a nodule with ring enhancement and conspicuous perilesional oedema was disclosed in the right cerebellar hemisphere.
The patient was given diuretics and steroids with no success. Since the neurological conditions were worsening, a neurosurgical operation was then performed in emergency: posterior fossa was decompressed, the cerebellar nodular lesion was removed en bloc with microsurgical technique and a transient ventricular drain was placed. Neurological conditions promptly recovered after surgery.
Possible differential diagnosis:
Metastasis
Pyogenic abscess
Primitive brain tumour
Abscess from non-pyogenic agents.
...https://ift.tt/2pQmKGj
Rapid onset of multiple concurrent squamous cell carcinomas associated with the use of an arsenic-containing traditional medicine for chronic plaque psoriasis
We report a case of a 46-year-old Vietnamese man who developed widespread, numerous and concurrent cutaneous squamous cell carcinomas (SCCs) in non-sun exposed skin areas after taking a traditional medicine (TM) formulation for chronic plaque psoriasis. The SCC lesions began to develop within 12–15 months after beginning the arsenic-containing TM. The patient experienced both acute and chronic symptoms consistent with arsenic exposure. Laboratory investigation of a collected hair sample showed a significant arsenic level. The TM formulation used by the patient was tested and demonstrated an extremely high concentration of arsenic.
https://ift.tt/2IgXikm
Beckwith-Weidemann syndrome with IC2 (KvDMR1) hypomethylation defect: a novel mutation
The Beckwith-Wiedemann syndrome (BWS) is a rare genetic syndrome. However, this is one of the most common overgrowth syndromes. This is a genetically and clinically heterogeneous syndrome. Here, we report a case of Beckwith-Weidemann syndrome without macrosomia, visceromegaly and hemihyperplasia but having macroglossia, omphalocele and anterior linear ear lobe creases. The diagnosis was confirmed by gene analysis suggestive of imprinting centre 2 (KvDMR1) hypomethylation defect.
https://ift.tt/2pQmJ5d
Proximal tibiofibular joint dislocation treated using flexible and permanent syndesmosis fixation
We present the case of a 40-year-old man who suffered an isolated proximal tibiofibular dislocation of the left knee after a trauma during a soccer game. Physical examination and radiographic imaging revealed an anterolateral dislocation of the proximal fibula. The diagnosis was confirmed by MRI. The treatment choice was open reduction and internal fixation under direct visualisation using flexible and permanent internal fixation. Postoperative treatment includes knee immobilisation during the first week, and partial weight was allowed for 2 weeks progressing to full weight bearing over 4 weeks. The patient started a gradual and progressive physical therapy programme with range of motion exercises, muscle strengthening and gait training. Full knee range of motion was achieved after 4 weeks. No complaint of pain or hardware discomfort was reported, and the patient is back to daily life and sports activities after 6 months of surgical treatment.
https://ift.tt/2IeLIWM
Childhood obesity in Mexico: social determinants of health and other risk factors
Approximately 50 million children and adolescents in Latin America are affected by the childhood obesity pandemic. We present the case of a 5-year-old Mexican girl with obesity and gastro-oesophageal reflux disease (GORD), in whom prenatal, lifestyle and environmental risk factors were identified. Here, we demonstrate how childhood obesity is rooted since pregnancy and the perinatal stage, and how the social determinants of health like unsafe outdoor conditions, lack of infrastructure to exercise and a suboptimal physical activity curriculum in government schools strongly influence the development and maintenance of childhood obesity and complicate management.
https://ift.tt/2pQA65y
Pseudotumor cerebri as the presentation of Lyme disease in a non-endemic area
Intracranial hypertension is a rare entity in prepubertal children, and its differential diagnosis includes a number of systemic diseases, drugs, vitamin deficiencies and excesses, and hereditary conditions. Infectious aetiology is rare. The case of a 9-year-old boy with intracranial hypertension secondary to acute neuroborreliosis is described. He presented with daily pulsatile frontotemporal headache, pallor, photophobia and phonophobia. His neurological examination revealed papilledema with no nuchal rigidity. The lumbar puncture showed increased pressure (50 cm H2O) and lymphocytic pleocytosis. Serum and cerebrospinal fluid (CSF) Borrelia burgdorferi antibodies were positive. This kind of infection is rare in Portugal but a trip to an endemic area was identified. A careful history, considering the exposure to rural areas together with the intracranial hypertension and inflammatory CSF, are important clues to the diagnosis, allowing the institution to select appropriate treatment.
https://ift.tt/2GoYce3
Essential thrombocytosis 40 years after splenectomy
Description
A 69-year-old man presented at our Department of Neurology in December 2016 with acute aphasia. His medical history was notable of splenectomy after a spleen rupture due to a car accident at the age of 25, a subarachnoidal haemorrhage (SAH) without evidence of cerebral aneurysm at the age of 35 and a non-ST elevation myocardial infarction at the age of 63. For this vascular event, a drug-eluting stent was placed into the ramus interventricularis anterior, followed by combined antiplatelet treatment for 2 years, and up to admission acetylsalicylic acid was given at a dose of 100 mg per day.
Now MRI revealed a left hemispheric ischaemic stroke (figure 1A). No major vascular risk factors were found. The only pathological finding was a thrombocytosis of 1700x103 per µL, reference value 150–450x103 per µL. A post-splenectomy syndrome was suspected. However, previous thrombocyte levels as documented during the SAH...
https://ift.tt/2pQGj1j
Adult scurvy associated with psychiatric disorders and breast feeding
Scurvy is a nutritional disease caused by ascorbic acid deficiency and is potentially fatal. It was originally described in the 18th century by James Lind and associated with long sea voyages and insufficient citrus consumption. Its prevalence has declined markedly over the years but has still been described sporadically in certain countries. A 22-year-old woman with an anxiety disorder and anorexia nervosa, recent pregnancy and ongoing breast feeding, presented with a 10-day history of spontaneous haematomas in the lower limbs, gingivorrhagia and fatigue. The examination was remarkable for signs of minor bleeding without haemodynamic compromise, gonalgia and pale skin. Work-up studies revealed the presence of anaemia. Direct anamnesis identified a diet based solely of tea and carbohydrates due to distorted body image. With the working diagnosis of scurvy, nutritional support and oral vitamin C supplementation was initiated. Her symptoms and anaemia resolved in 30 days and the diagnosis was confirmed biochemically.
https://ift.tt/2Goj2u2
Apixaban-induced subdural bleeding: case presentation and literature review
Apixaban is a factor Xa inhibitor which is a non-vitamin K dependent oral anticoagulant known tocause the lowest rate of intracranial bleeding among the same kind of inibitors. In this paper, we report a rare case in a 60-year-old man with a history of hypertension and oligodendroglioma on apixaban for deep venous thrombosis who presented to our hospital with decreased level of consciousness and slurred speech with rapid deterioration. We highlight the risk of subdural bleeding requiring immediate neurosurgical intervention due to apixaban, with literature review.
https://ift.tt/2pPrHPS
Synovial sarcoma of the transverse colon: a rare cause of intussusception
We report a third case of a primary intramural synovial sarcoma of the lower gastrointestinal tract. A 50-year-old woman presented with hematochezia, dizziness and shortness of breath. CT imaging revealed a transverse colo-colonic intussusception with a colonic mass serving as a lead point. A subtotal colectomy was performed with oncologic resection of a sausage-like mass in the mid-transverse colon. Pathological assessment showed a biphasic synovial sarcoma. The postoperative hospital course was without complications and the patient was discharged home with plans for postoperative surveillance.
https://ift.tt/2Ihyvwe
Comparison of Efficacy of Transalveolar Screws and Conventional Dental Wiring Using Erich Arch Bar for Maxillomandibular Fixation in Mandibular Fractures
Abstract
Introduction
Maxillomandibular fixation is required in nearly all cases of facial fractures which can be achieved by conventional dental wiring techniques or newer methods using transalveolar screws.
Material and Methods
A prospective randomized clinical study divided into two groups with thirty adult patients each with mandibular fractures was undertaken comparing the Maxillomandibular fixation technique using transalveolar screws and Erichs arch bar. Total time taken, rate of glove perforation, intraoperative and postoperative complications were noted in both the groups.
Results
The time taken for maxillomandibular fixation in minutes and rate of glove perforation was found to be statistically significantly less for transalveolar group compared to arch bar group (p < 0.05). However, there was no significant difference found in the oral hygiene and gingival status using the Glass index and Gingival index. The rate of screw breakage (04.67%), wire breakage (05.12%), non-vitality due to iatrogenic dental damage (01.66%), soft tissue injury and tooth loss were some of the noted complications during the study.
Conclusion
We found that transalveolar group offered advantages like less time taken with a definite decreased risk of percutaneous injury, while the iatrogenic complications like dental damage can be reduced by taking adequate precautions.
https://ift.tt/2ygMT3d
Cortical Bone Graft and GTR Membrane as “Ceiling Effect” in Alveolar Bone Grafting
Abstract
Background
In orofacial cleft deformity cases, bone grafting is a very essential step in reconstruction of the residual alveolar cleft defect.
Material and Methods
Though various authors have put forth different techniques and graft sources for alveolar bone grafting, at our center, we have used iliac crest as the graft source and cortical bone graft with GTR membrane as "ceiling effect".
Results
We have evaluated a series of cases of secondary alveolar bone grafting done with this technique by same surgeon at our center and have found great success.
Conclusion
In this clinical paper, we describe our surgical technique and also the key points from surgeons experience to ensure a better result.
https://ift.tt/2IiQtif
Facial Anthropometric Norms of the Young Iranian Population
Abstract
Introduction
Facial anthropometric measurement is considered an essential concern of surgeons, orthodontists, artists and forensic scientists. The aim of this study is to investigate facial anthropometric norms of the young Iranian population.
Methods
The study participants consisted of 200 healthy Iranian students (100 males, 100 females) aged 18–25 years old. Twenty-three liner and four angular measurements were investigated twice by a dentist. Independent-samples t test was used to compare indices between males and females and also between countries. A p value less than 0.05 was considered statistically significant.
Results
It was found that the mean measurements of c'–sn' of both sides, nasolabial angle, trichion–gnathion, tragion–tragion and gnathion–gnathion were statistically greater in Iranian males than in females (p < 0.05). Comparing Iranian anthropometric norms with North American Whites, Malays, Turkish and African American women demonstrated that there were statistically significant differences in most anthropometric measurements between Iranians and other populations (p < 0.05).
Conclusion
In Iranians, mean measurements of c'–sn' of the right and left sides, nasolabial angle, trichion–gnathion, tragion–tragion and gnathion–gnathion were greater in men than in women. Comparing Iranian males and females with different ethnicities indicated several interracial differences, which should be taken into consideration when dealing with patients or also practitioners originated in this region.
https://ift.tt/1WDktts
Techniques to Improve Reliability and Predictability of the Dorsal Pedicled Tongue Flap in Closure of Palatal Defects and Oronasal Fistulae
Abstract
Introduction
Despite the improvement in surgical techniques in cleft palate surgery, oronasal fistulas continue to remain a challenge, usually the result of residual palatal and alveolar clefts and post-palatoplasty defects. The tongue flap is an extremely versatile, sturdy, reliable and efficient means of closure of anterior as well as posterior, unilateral and bilateral palatal defects, effectively functionally obliterating the oronasal communication, owing much of its success to its highly vascular structure, good mobility, texture match, central location and low donor site morbidity. However, it has a few drawbacks. Flap dehiscence and detachment during the early postoperative period is a troublesome complication owing to tongue movements during normal activities such as speaking, swallowing, yawning and coughing.
Aim
This article describes some of the methods which can be used to effectively alleviate these shortcomings.
Methods
A protocol of immobilizing the tongue by tethering it to the maxillary teeth for the 3-week postoperative period, and also maintaining the patient on nasogastric feeding, until the patient is taken up for surgical separation the pedicle, was employed in all patients in this case series.
Results
There was a successful and predictable take of the tongue flap at the donor site, namely the palatal/oronasal fistula with its successful closure, in all the patients.
Conclusion
Treatment of the oronasal fistula using a two-layer closure using the nasal mucoperiosteum together with an anteriorly based dorsal tongue flap is an easy and efficient method, whose reliability can be further increased by avoiding a common complication, namely tongue flap detachment in the postoperative period brought on by movements of the tongue, by immobilizing the tongue by tethering it to the maxillary teeth and also maintaining the patient on nasogastric feeding for the 3-week postoperative period.
https://ift.tt/2IgzX1Y
Infection, Alveolar Osteitis, and Adverse Effects Using Metronidazole in Healthy Patients Undergoing Third Molar Surgery: A Meta-analysis
Abstract
Purpose
The aim of this systematic review and meta-analysis was to evaluate the risk of surgical infection, alveolar osteitis, and adverse effects using systemic metronidazole in comparison with placebo in healthy patients undergoing third molar surgery.
Materials and Methods
The eligible reports were identified from diverse science sources. Clinical trials meeting the inclusion and exclusion criteria and an acceptable Oxford Quality Score were included in this study. The evaluation of risk was done using the Risk Reduction Calculator and Review Manager 5.3., from the Cochrane Library. A significant risk reduction was assumed when the upper limit of the 95% confidence intervals was <1 and the lower limit did not cross zero (negative number) alongside a p value of <0.05 for the overall test. Data of 667 patients from five clinical trials were used for the assessment of risk.
Results
Our analysis showed no reduction of the risk of infection or dry socket in patients receiving metronidazole compared to whom took placebo. Meanwhile, the adverse effects did not exhibit a difference between the studied groups.
Conclusion
The routine use of systemic metronidazole to prevent surgical site infection and/or dry socket in healthy patients undergoing third molar surgery is not recommended.
https://ift.tt/2pNdran
Postoperative Facial Baroparesis While Flying: A Rare Complication of Decompressing a Facial Nerve Schwannoma.
Postoperative Facial Baroparesis While Flying: A Rare Complication of Decompressing a Facial Nerve Schwannoma.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Kung RW, Roche JP, Gantz BJ
PMID: 29596587 [PubMed - as supplied by publisher]
https://ift.tt/2IjvzzA
Pulsatile Tinnitus With Imaging.
Pulsatile Tinnitus With Imaging.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Truesdale CM, El-Kashlan HK
PMID: 29596564 [PubMed - as supplied by publisher]
https://ift.tt/2J8xwzR
Tubular Neck Mass.
Tubular Neck Mass.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: McSpadden RP, Orsini M, Higgins K
PMID: 29596558 [PubMed - as supplied by publisher]
https://ift.tt/2pSOkD1
Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure.
Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Duvvuri U, Johnson JT, Chiosea SI
PMID: 29596555 [PubMed - as supplied by publisher]
https://ift.tt/2Idy46s
A Novel Approach to the National Resident Matching Program-The Star System.
A Novel Approach to the National Resident Matching Program-The Star System.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Salehi PP, Benito D, Michaelides E
PMID: 29596554 [PubMed - as supplied by publisher]
https://ift.tt/2IingE5
Thyroidectomy Practice After Implementation of the 2015 American Thyroid Association Guidelines on Surgical Options for Patients With Well-Differentiated Thyroid Carcinoma.
Thyroidectomy Practice After Implementation of the 2015 American Thyroid Association Guidelines on Surgical Options for Patients With Well-Differentiated Thyroid Carcinoma.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Hirshoren N, Kaganov K, Weinberger JM, Glaser B, Uziely B, Mizrahi I, Eliashar R, Mazeh H
Abstract
Importance: The recommended extent of surgery for well-differentiated thyroid carcinoma has been modified considerably in the updated 2015 American Thyroid Association guidelines published in January 2016. To date, the changes in clinical practice after publication of these new guidelines have not been demonstrated.
Objective: The aim of this study was to evaluate clinical practice changes associated with implementation of the updated guidelines on the surgical procedure rates of total thyroidectomy, thyroid lobectomy, and completion thyroidectomy at a single tertiary medical center.
Design, Setting, and Participants: This is a retrospective cohort study of 169 patients at the Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Patients with pathologically proved, well-differentiated thyroid carcinoma who underwent surgery between January 1, 2013, and December 31, 2014, were compared with patients who underwent surgery from January 1 to December 31, 2016. A total of 434 thyroidectomy procedures were performed during the study period, and 251 had pathologically proved, well-differentiated thyroid carcinoma. Patients with tumors larger than 4 cm, involved lymph nodes, or bilateral nodules were excluded.
Main Outcomes and Measures: Primary outcomes were the rate of up-front total thyroidectomy vs lobectomy and the rates of completion thyroidectomy before and after the implementation of the new guidelines.
Results: Of the 169 patients in the final analysis, 118 (69.8%) were included from 2013 to 2014 and 51 (30.2%) in 2016. The mean (SD) age for the entire cohort was 44 (13.8) years, and 129 (76.3%) were women. Up-front total thyroidectomy was performed in 72 of 118 patients (61.0%) prior to the 2015 American Thyroid Association guidelines and 16 of 51 (31.4%) following their implementation (odds ratio, 0.29; 95% CI, 0.14-0.59). The rate of completion thyroidectomy also significantly decreased between these periods (73.9% vs 20.0%; odds ratio, 0.09; 95% CI, 0.04-0.19).
Conclusions and Relevance: The updated 2015 American Thyroid Association guidelines implementation was associated with a significant decrease in the rates of both up-front total thyroidectomy and completion thyroidectomy. According to these findings, only 1 of 5 patients who undergoes thyroid lobectomy will require a completion procedure.
PMID: 29596551 [PubMed - as supplied by publisher]
https://ift.tt/2pQvHiX
Preoperative Facial Nerve Mapping to Plan and Guide Pediatric Facial Vascular Anomaly Resection.
Preoperative Facial Nerve Mapping to Plan and Guide Pediatric Facial Vascular Anomaly Resection.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Bly RA, Holdefer RN, Slimp J, Kinney GA, Martinez V, Manning SC, Perkins JA
Abstract
Importance: Facial vascular anomalies are surgical challenges due to their vascularity and facial nerve distortion. To assist facial vascular anomaly surgical treatment, presurgical percutaneous facial nerve stimulation and recording of compound motor action potentials can be used to map the facial nerve branches. During surgery, the nerve map and continuous intraoperative motor end plate potential monitoring can be used to reduce nerve injury.
Objective: To investigate if preoperative facial nerve mapping (FNM) is associated with intraoperative facial nerve injury risk and safe surgical approach options compared with standard nerve integrity monitoring (NIM).
Design, Setting, and Participants: This investigation was a historically controlled study at a tertiary vascular anomaly center in Seattle, Washington. Participants were 92 pediatric patients with facial vascular anomalies undergoing definitive anomaly surgery (from January 1, 1999, through January 1, 2015), with 2 years' follow-up. In retrospective review, a consecutive FNM patient cohort after 2005 (FNM group) was compared with a consecutive historical cohort (1999-2005) (NIM group).
Main Outcomes and Measures: Postoperative facial nerve function and selected surgical approach. For NIM and FNM comparisons, statistical analysis calculated odds ratios of nerve injury and operative approach, and time-to-event methods analyzed operative time.
Results: The NIM group had 31 patients (median age, 3.3 years [interquartile range, 2.2-11.4 years]; 20 [65%] male), and the FNM group had 61 patients (median age, 4.4 years [interquartile range, 1.5-11.0 years]; 26 [43%] male). In both groups, lymphatic malformation resection was most common (19 of 31 [61%] in the NIM group and 32 of 61 [52%] in the FNM group), and the median anomaly volumes were similar (52.4 mL; interquartile range, 12.8-183.3 mL in the NIM group and 65.4 mL; interquartile range, 18.8-180.2 mL in the FNM group). Weakness in the facial nerve branches at 2 years after surgery was more common in the NIM group (6 of 31 [19%]) compared with the FNM group (1 of 61 [2%]) (percentage difference, 17%; 95% CI, 3%-32%). Anterograde facial nerve dissection was used more in the NIM group (27 of 31 [87%]) compared with the FNM group (28 of 61 [46%]) (percentage difference, 41%; 95% CI, 24%-58%). Treatment with retrograde dissection without identification of the main trunk of the facial nerve was performed in 21 of 61 (34%) in the FNM group compared with 0 of 31 (0%) in the NIM group. Operative time was significantly shorter in the FNM group, and patients in the FNM group were more likely to complete surgery sooner (adjusted hazard ratio, 5.36; 95% CI, 2.00-14.36).
Conclusions and Relevance: Facial nerve mapping before facial vascular anomaly surgery was associated with less intraoperative facial nerve injury and shorter operative time. Mapping enabled direct identification of individual intralesional and perilesional nerve branches, reducing the need for traditional anterograde facial nerve dissection, and allowed for safe removal of some lesions after partial nerve dissection through transoral or direct excision.
PMID: 29596549 [PubMed - as supplied by publisher]
https://ift.tt/2Igv0X6
Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure-Reply.
Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure-Reply.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Schoppy DW, Divi V
PMID: 29596548 [PubMed - as supplied by publisher]
https://ift.tt/2pQvCvF
Patients with integrated HPV16 in head and neck cancer show poor survival
Publication date: May 2018
Source:Oral Oncology, Volume 80
Author(s): Tara J. Nulton, Nak-Kyeong Kim, Laurence J. DiNardo, Iain M. Morgan, Brad Windle
ObjectivesWe previously reported identifying three categories of HPV16-positive head and neck tumors based on The Cancer Genome Atlas (TCGA) RNA and DNA sequence data. Category 1 had truly integrated HPV16 genomes, category 2 had simple episomal genomes, and category 3 had novel episomes that were a hybrid between viral and human DNA. Using our categorization, we investigated in this study survival of patients with integrated HPV16 tumors versus patients with episomal HPV16 tumors.Materials and methodsThe TCGA RNA-Seq sequence reads were used to quantify HPV E2 and E7 gene expression, which was used as a marker for HPV integration.ResultsThe results demonstrate that integration is associated with poor survival; those patients with integrated HPV tumors fared no better than non-HPV tumors in their five-year survival. Integrated HPV in tumors was found strikingly to be prevalent in patients born earlier while episomal HPV was prevalent in patients born later. We also observed a fairly constant incidence of all HPV forms among head and neck cancer patients over the last eight years of this study (2006–2013).ConclusionWe propose our characterization of HPV integrated and episomal state is more accurate than previous studies that may have mischaracterized the hybrid HPV-human DNA episomes as integrated. The state of integrated HPV is associated with a poor clinical outcome. Results suggest that the incidence of integrated HPV among all HPV forms peaked and is decreasing. We discuss the importance of our findings for the management of HPV positive head and neck cancer.
https://ift.tt/2J8M0jo
The opioid epidemic and pregnancy: implications for anesthetic care
https://ift.tt/2pQoEH3
Drug error in paediatric anaesthesia: current status and where to go now
https://ift.tt/2GoD1Zw
Developing drugs for treatment of atopic dermatitis in children (≥3 months to <18 years of age): Draft guidance for industry
Pediatric Dermatology, EarlyView.
https://ift.tt/2pQTY8F
Hyper‐immunoglobulin D syndrome with novel mutations in an afebrile infant
Pediatric Dermatology, EarlyView.
https://ift.tt/2IglpPW
Evolution in the Surgical Management of Chronic Rhinosinusitis: Current Indications and Pitfalls
Publication date: Available online 29 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Michael A. Kohanski, Elina Toskala, David W. Kennedy
Chronic rhinosinusitis (CRS) consists of a range of inflammatory conditions in the sinuses that may result in clinical symptoms and the underlying pathophysiology and its relationship to lower airway disease is complex. Current definitions of CRS may serve more as an indication for potential surgical intervention rather than a marker of disease state. CRS can be asymptomatic and may require medical management to avoid disease progression and to minimize the risk of lower airway disease. Endoscopic surgery has undergone a significant evolution and refinement but the most common surgical complication remains persistent inflammation and recurrence of disease. It is important to recognize that surgery alone rarely cures CRS and patients require long-term medical therapy for continued asymptomatic inflammation. Careful post-operative care and endoscopic follow-up to ensure resolution of inflammation is key to ensuring optimal surgical outcomes and reduce the risk of revision surgery. Future work on CRS endotypes will allow for discovery of new therapies to treat CRS as well as refine indications for medical or surgical intervention as well as post-operative care.
https://ift.tt/2E6dL8x
Addressing Gender Discrimination in Oral and Maxillofacial Surgery via the Social Norms Approach
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Rachel Uppgaard
https://ift.tt/2pNXjoa
The association between Helicobacter pylori infection and the risk of advanced colorectal neoplasia may differ according to age and cigarette smoking
Helicobacter, EarlyView.
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Application of precision medicine to the treatment of anaphylaxis
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How to diagnose food allergy
https://ift.tt/2J5vOz7
How to prevent food allergy during infancy: what has changed since 2013?
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How to predict and improve prognosis of food allergy
https://ift.tt/2pShNMF