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- Efficacy of C1Inhibitor concentrate in hereditary ...
- Successful desensitization in a pediatric patient ...
- Chronic Tearing Induced by Apremilast
- Specific-IgE to galactose-alpha-1,3-galactose (alp...
- Health Literacy and Asthma Among Hispanic and Afri...
- Mechanisms of allergen-specific immunotherapy: div...
- Analysis of blood supply in the hard palate and ma...
- Iodonium salt incorporation in dental adhesives an...
- Oral lichenoid reactions may possibly be associate...
- Can Platelet-Rich Fibrin Improve Healing After Sur...
- Bifid variations of the mandibular canal: cone bea...
- Agenesis of dorsal pancreas associated with pancre...
- Common polymorphism in the glycine N-methyltransfe...
- Complete spontaneous regression of a metastatic me...
- Novel vaccines: Technology and development
- Oral corticosteroids in preschool children with se...
- Surgical Retrieval of Parotid Stones
- Preface
- Survival impact and toxicity of metformin in head ...
- Oral tongue carcinoma among young patients: An ana...
- Exposure to air pollution and risk of prevalence o...
- Comparison of click auditory brainstem response an...
- Transcanal incision and drainage of a parapharynge...
- Evaluation of clinical approaches and physician ad...
- Quality Management in Healthcare: The Pivotal Desi...
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Σάββατο 30 Ιουνίου 2018
Efficacy of C1Inhibitor concentrate in hereditary angioedema with C1Inhibitor deficiency: analysis in the French Cohort
Source:Annals of Allergy, Asthma & Immunology
Author(s): Aude Belbézier, Isabelle Boccon-Gibod, Aurélie Du Thanh, Olivier Fain, Laurence Bouillet
https://ift.tt/2tJeGJD
Successful desensitization in a pediatric patient with acetazolamide allergy
Source:Annals of Allergy, Asthma & Immunology
Author(s): Annette Carlisle, Joshua L. Kennedy, Sheva Chervinskiy, Stacie M. Jones, Robert D Pesek
https://ift.tt/2KC8Sb6
Chronic Tearing Induced by Apremilast
Source:Annals of Allergy, Asthma & Immunology
Author(s): Matthew R. Norris, Leonard Bielory
https://ift.tt/2NcOzCV
Specific-IgE to galactose-alpha-1,3-galactose (alpha-gal) has limited utility in diagnosing meat allergy in a tick-endemic population
Source:Annals of Allergy, Asthma & Immunology
Author(s): Dr Jamma Li, Mr Richard B. Fulton, RachelO'Connell, Dr Helena S. Jang, Prof. Suran L. Fernando
https://ift.tt/2ICNfG1
Health Literacy and Asthma Among Hispanic and African American Urban Adolescents with Undiagnosed Asthma
Source:Annals of Allergy, Asthma & Immunology
Author(s): Melissa A. Valerio, Maureen George, Jianfang Liu, Zainab T. Osakwe, Jean-Marie Bruzzese
https://ift.tt/2NfGs8D
Mechanisms of allergen-specific immunotherapy: diverse mechanisms of immune tolerance to allergens
Source:Annals of Allergy, Asthma & Immunology
Author(s): Anna Głobińska, Tadech Boonpiyathad, Pattraporn Satitsuksanoa, Mirelle Kleuskens, Willem van de Veen, Milena Sokołowska, Mübeccel Akdis
https://ift.tt/2KC8CJa
Analysis of blood supply in the hard palate and maxillary tuberosity—clinical implications for flap design and soft tissue graft harvesting (a human cadaver study)
Abstract
Objectives
The aim of the present study is to provide a detailed macroscopic mapping of the palatal and tuberal blood supply applying anatomical methods and studying specific anastomoses to bridge the gap between basic structural and empirical clinical knowledge.
Materials and methods
Ten cadavers (three dentate, seven edentulous) have been prepared for this study in the Department of Anatomy, Semmelweis University, Budapest, Hungary, and in the Department of Anatomy of the Medical University of Graz. All cadavers were fixed with Thiel's solution. For the macroscopic analysis of the blood vessels supplying the palatal mucosa, corrosion casting in four cadavers and latex milk injection in other six cadavers were performed.
Results
We recorded major- and secondary branches of the greater palatine artery (GPA) and its relation to the palatine spine, different anastomoses with the nasopalatine artery (NPA), and lesser palatal artery (LPA) as well as with contralateral branches of the GPA. Penetrating intraosseous branches at the premolar-canine area were also detected. In edentulous patients, the GPA developed a curvy pathway in the premolar area. The blood supply around the maxillary tuberosity was also presented.
Conclusion
The combination of different staining methods has shed light to findings with relevance to palatal blood supply, offering a powerful tool for the design and execution of surgical interventions involving the hard palate.
Clinical relevance
The present study provides clinicians with a good basis to understand the anatomical background of palatal and tuberal blood supply. This might enable clinicians to design optimized incision- and flap designs. As a result, the risk of intraoperative bleeding and postoperative wound healing complications related to impaired blood supply can be minimized.
https://ift.tt/2KBk7kn
Iodonium salt incorporation in dental adhesives and its relation with degree of conversion, ultimate tensile strength, cell viability, and oxidative stress
Abstract
Objective
The aim of this study was to evaluate the degree of conversion, ultimate tensile strength, cell viability, and oxidative stress of two different ternary initiation systems, using two photoinitiation polymerization times.
Methods
The groups investigated were camphorquinone (CQ); CQ and diphenyleneiodonium hexafluorophosphate (DPI); CQ and ethyl 4-dimethylamine benzoate (EDAB); and CQ, EDAB, and DPI, with EDAB in high and low concentration. To assess the degree of conversion (DC) and the ultimate tensile strength (UTS), a real-time Fourier transform infrared spectroscopy and a universal test machine Emic DL-500 were used, respectively. Cell viability and oxidative stress were evaluated by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide), superoxide dismutase (SOD), total sulfhydryl (SH) content, and thiobarbituric acid reactive species (TBARS) formation assays.
Results
Slight lower cell viability was shown when DPI was associated with high concentrations of EDAB; this reduction seemed to be attenuated when lower concentrations of EDAB were used. When EDAB and DPI were associated, no oxidative damage was shown. The degree of conversion was increased in the ternary systems (CQ + EDAB lower concentration + DPI) group, which did not affect the UTS, cytotoxicity, and oxidative stress parameters. The polymerization time did not affect cell viability, total SH, and TBARS; however, a slight increase was shown in SOD levels.
Clinical relevance
Our study emphasizes the relevance of incorporating the third element—iodonium salt—in a binary adhesive systems composed exclusively of CQ and EDAB.
https://ift.tt/2Kotfg3
Oral lichenoid reactions may possibly be associated with abatacept: A case report and literature update
Publication date: Available online 30 June 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Bethany Zembiec-Wheeler, Abberly Lott-Limbach, Hans Malmström, Sharon Elad
Oral Lichenoid Reactions (OLRs) are a group of conditions, with a common clinical appearance and histopathologic pattern that may be induced by several conditions or medications. This report describes an OLR possibly induced by a biologic agent. A 69-year-old woman with rheumatoid arthritis (RA) presented with a chief complaint of oral pain. The patient retroactively reported of skin lesions as well. Clinically, she had mixed red-white mucosal lesions and ulcers suggestive of an OLR. This diagnosis was supported by the histopathologic findings. Withholding the putative etiologic agent, abatacept, resulted in an immediate improvement of both oral and skin lesions.Abatacept and other biologics are thought to help treat inflammation and are becoming more commonly prescribed to treat RA. However, the clinicians should explore these medications as a causative factor for OLR.
https://ift.tt/2NeeJ8q
Can Platelet-Rich Fibrin Improve Healing After Surgical Treatment of Medication-Related Osteonecrosis of the Jaw? A Pilot Study
Publication date: Available online 30 June 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Amerigo Giudice, Selene Barone, Carmen Giudice, Francesco Bennardo, Leonzio Fortunato
ObjectiveThe aim of this study was to evaluate the efficacy of platelet-rich fibrin (PRF) after bone surgery compared to surgery alone in the treatment of medication-related osteonecrosis of the jaw (MRONJ).Study designA total of 47 patients with diagnosis of stage II or III of MRONJ were recruited at the Academic Hospital of Magna Graecia University of Catanzaro and allocated to 2 groups: in the first, patients were treated with PRF in addition to surgery (PRF group), in the other, only bone surgery was performed (non-PRF group). Fisher's exact and Student t tests were used to evaluate differences between the 2 surgical protocols in terms of mucosal integrity, absence of infection, and pain evaluation at scheduled follow-ups of 1 month (T1), 6 months (T2), and 1 year (T3).ResultsAnalysis of mucosal integrity, absence of infection, and pain evaluation showed a significant difference between the 2 groups in favor of PRF only at T1 (p<0.05), while no differences were determined at T2 and T3 (p>0.05).ConclusionOur results suggested that local application of PRF after bone surgery may improve the quality of life limited to the short-term follow-up and reduce pain and post-operative infections.
https://ift.tt/2yVJLPp
Bifid variations of the mandibular canal: cone beam computed tomographic evaluation of 1000 Northern Chinese patients
Publication date: Available online 30 June 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Ya-Qiong Zhang, Ya-Ning Zhao, Deng-Gao Liu, Yuan Meng, Xu-Chen Ma
ObjectivesTo evaluate and quantify variations of bifid mandibular canals (BMCs) in a population of Northern China by using cone beam computed tomography (CBCT).Study designCBCT images of 1000 consecutive patients were analyzed using the NewTom proprietary software. BMCs were identified and classified based on Naitoh's classification. Linear and angular measurements of BMCs were performed. Statistical analyses were conducted using chi-squared and Wilcoxon tests.ResultsBMCs were observed in 13.2% of 1000 patients and 8.4% of 2000 sides. The prevalence of BMCs was significantly lower in patients in the first two decades and in cases with a Class II molar relationship. The retromolar canal (68.4%) was the most common type of BMC observed. No buccolingual canals were identified; however, two special canals were detected. A classification system of three subtypes of retromolar canals was suggested. On average, the beginning site of the branches from the opening of the main canal was at a distance of 8.1 mm. The mean diameter and length of BMCs were 2.1 mm and 12.6 mm, respectively.ConclusionThis study underlined the prevalence and characteristics of BMCs in a population of Northern China. Preoperative identification of BMCs with CBCT may help prevent postoperative complications.
https://ift.tt/2tIbH4f
Agenesis of dorsal pancreas associated with pancreatic neuroendocrine tumor: a case report and review of the literature
Agenesis of the dorsal pancreas is very rare. Less than 70 cases have been reported to date. Some of these cases had an association with a tumor. The literature of agenesis of the dorsal pancreas and agenesis ...
https://ift.tt/2IDGrbe
Common polymorphism in the glycine N-methyltransferase gene as a novel risk factor for cleft lip with or without cleft palate
Publication date: Available online 30 June 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): N. Karas Kuželički, A. Šmid, T. Kek, A. Eberlinc, K. Geršak, I. Mlinarič-Raščan
The objective of this study was to identify new environmental and genetic risk factors for orofacial clefts that arise during early foetal development. In this retrospective, case–control, mother–child pair study, 172 orofacial clefts cases and 199 healthy controls, and their respective mothers, were genotyped for common variants in relevant genes obtained by text and database mining using STRING 10.0. Exposure to environmental risk factors was evaluated using questionnaires. Variant glycine N-methyltransferase (odds ratio (OR) 2.1, 95% confidence interval (95% CI) 1.0–4.4) and dihydrofolate reductase (OR 2.4, 95% CI 1.3–4.5) genotypes were identified as risk factors for cleft lip with or without cleft palate formation. Furthermore, synergy was detected between variant glycine N-methyltransferase and dihydrofolate reductase genotypes in promoting cleft lip with or without cleft palate formation (OR 7, 95% CI 2–23). This study is novel in finding that common glycine N-methyltransferase variant genotypes increase the risk of cleft lip with or without cleft palate.
https://ift.tt/2IEOWm8
Complete spontaneous regression of a metastatic melanoma of the mandible: a case report and follow-up recommendations
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J. Schlabe, K.A. Shah, F. Sheerin, M.J. Payne, A.A. Fasanmade
Regression of metastatic melanoma is very rare and occurs in only 0.23% of cases. Metastasis to the oral cavity is particularly uncommon and accounts for only 1–3% of all oral malignancies. This report presents a case of spontaneous and complete regression of a metastatic melanoma in the mandibular ramus. The patient remains asymptomatic more than 2 years after diagnosis. The patient was followed up regularly. It is recommended that further surveillance imaging be performed in asymptomatic patients following discussion with the surgical and oncological teams. This type of surveillance, together with new systemic treatments, is advocated due to its potential to increase long-term survival even after relapse.
https://ift.tt/2KurddD
Novel vaccines: Technology and development
Publication date: Available online 30 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Sarita U. Patil, Wayne G. Shreffler
The development and widespread use of vaccines, which are defined by the World Health Organization as "biological preparations that improve immunity to a particular disease," represents one of the most significant strides in medicine. Vaccination was first applied to reduce mortality and morbidity from infectious diseases. The World Health Organization estimates that vaccines prevent 2 to 3 million human deaths annually, and these numbers would increase by at least 6 million if all children received the recommended vaccination schedule. However, the origins of allergen immunotherapy share the same intellectual paradigm, and subsequent innovations in vaccine technology have been applied beyond the prevention of infection, including in the treatment of cancer and allergic diseases. This review will focus on how new and more rational approaches to vaccine development use novel biotechnology, target new mechanisms, and shape the immune system response, with an emphasis on discoveries that have direct translational relevance to the treatment of allergic diseases.
https://ift.tt/2lH5Ck6
Oral corticosteroids in preschool children with severe episodes of virus-associated wheeze: to treat or not to treat?
Source:Journal of Allergy and Clinical Immunology
Author(s): Avraham Beigelman, Leonard B. Bacharier
https://ift.tt/2MBimnT
Surgical Retrieval of Parotid Stones
Source:Atlas of the Oral and Maxillofacial Surgery Clinics
Author(s): Fernando Pozzi Semeghini Guastaldi, Jose Sandro Pereira da Silva, Maria J. Troulis, Edward Lahey
https://ift.tt/2yWtKse
Preface
Source:Atlas of the Oral and Maxillofacial Surgery Clinics
Author(s): Michael D. Turner, Maria J. Troulis
https://ift.tt/2yWtGZw
Survival impact and toxicity of metformin in head and neck cancer: An analysis of the SEER-Medicare dataset
Source:Oral Oncology, Volume 84
Author(s): William A. Stokes, Megan Eguchi, Arya Amini, Mohammad K. Hararah, Ding Ding, Jessica D. McDermott, Cathy J. Bradley, Sana D. Karam
ObjectivesRecent preclinical research has renewed interest in the interplay between glucose dysregulation and cancer. Metformin holds promise as an adjunctive antineoplastic agent in head and neck cancer (HNC). We aimed to explore the impact of metformin in HNC patients from a population-based dataset.Patients & MethodsPatients diagnosed with HNC from 2008 to 2011 were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset and categorized into three groups: non-diabetics (nD), diabetics not taking metformin (DnM), and diabetics taking metformin (D + M). Overall survival (OS) and cancer-specific survival (CSS) were compared between groups using Kaplan-Meier and Cox regression controlling for sociodemographic, clinical, and treatment covariates. The incidence of toxicities associated with HNC therapy was compared among groups using χ2 analysis.ResultsAmong 1646 patients, there were 1144 nD, 378 DnM, and 124 D + M. 2-year OS rates was 65.6% for nD, 57.7% for DnM, and 73.4% for D + M by Kaplan-Meier (p < 0.01), and corresponding rates of 2-year CSS were 73.7%, 66.1%, and 88.8% (p < 0.01), respectively. On Cox multivariable analysis, OS among the three groups did not significantly differ; however, CSS was significantly worse among both nD versus DnM as compared to D + M. Toxicity rates were not significantly increased among D + M.ConclusionHNC patients with diabetes taking metformin experience improved CSS. Prospective investigation of the addition of metformin to standard-of-care HNC therapy is warranted.
https://ift.tt/2KtZ2eR
Oral tongue carcinoma among young patients: An analysis of risk factors and survival
Source:Oral Oncology, Volume 84
Author(s): Douglas R. Farquhar, April M. Tanner, Maheer M. Masood, Sagar R. Patel, Trevor G. Hackman, Andrew F. Olshan, Angela L. Mazul, Jose P. Zevallos
IntroductionThe incidence of oral tongue squamous cell carcinoma (OTSCC) in younger adults has rapidly increased over the past two decades. While tobacco and alcohol use may be less likely to cause these tumors, it remains controversial whether differences also exist in their prognosis. Our aim is to examine the risk factors for cancer among young (<45 years old) OTSCC patients at our institution, and to compare their recurrence and survival with older patients in a matched cohort.Materials and methodsAll OTSCC patients seen at our institution between 2000 and 2015 were reviewed. Patients under 45 who with sufficient treatment information were matched 1:1 on race, T-stage, and N-stage with patients 45 and older. Three-year recurrence and survival were determined in stratified and adjusted Cox regression models.ResultsOf 397 OTSCC patients were seen at our institution, 117 (29%) were less than 45 years old. Younger patients were significantly more likely to be female, (50% vs. 39%; p = 0.04) and to abstain from tobacco (51% vs. 39%; p < 0.01). Young patients in the matched cohort were significantly more likely to have a recurrence (HR 3.9 95% CI 1.4–10.5). There was no difference in overall survival.ConclusionYounger OTSCC patients in a matched cohort were more likely to recur within 3 years, although there was no difference in overall mortality. Differences in risk factors and recurrence between older and younger patients suggest that some cancer among younger patients may be distinct from traditional OTSCC.
https://ift.tt/2Mz9I9e
Exposure to air pollution and risk of prevalence of childhood allergic rhinitis: A meta-analysis
Publication date: September 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): Qi-Yuan Zou, Yang Shen, Xia Ke, Su-Ling Hong, Hou-Yong Kang
ObjectivesAllergic rhinitis (AR), a common chronic inflammatory disease in the upper airways. The prevalence of AR in children seems to be increasing recently, and the most significant causes of the increase are thought to be changes in environmental factors, especially air pollution. However, we could not find any meta-analysis on the risk of air pollution exposure on the prevalence of AR in childhood. The aim of this research was to carry out a meta-analysis on the results of recent studies (21 s t century) to present valid information about exposure to air pollution and risk of prevalence of childhood AR.MethodsPubMed, Science, Google Scholar, Elsevier and MDPI web database were searched up to January 1, 2000 to February 28, 2018. Including of air pollution and AR in childhood related to the observation of literature. Meta-analysis, study quality assessment, heterogeneity analysis and publication bias test were using Stata-MP 14.1 and Review Manager version 5.3 software.Results13 studies will be included in the meta-analysis (8 cross-sectional studies, 5 cohort studies). Exposure to NO2 (OREurope = 1.031, 95%CI [1.002,1.060], P = 0.033; ORAsia = 1.236, 95%CI [1.099,1.390], P = 0.000; ORoverall = 1.138, 95%CI [1.052,1.231], P = 0.001); Exposure to SO2 (OREurope = 1.148, 95%CI [1.030,1.279], P = 0.012; ORAsia = 1.044, 95%CI [0.954,1.142], P = 0.352; ORoverall = 1.085, 95%CI [1.013,1.163], P = 0.020); Exposure to PM10 (OREurope = 1.190, 95%CI [1.092,1.297], P = 0.000; ORAsia = 1.075, 95%CI [0.995,1.161], P = 0.066; ORoverall = 1.125, 95%CI [1.062,1.191], P = 0.000); Exposure to PM2.5 (OREurope = 1.195, 95%CI [1.050,1.360], P = 0.007; ORAsia = 1.163, 95%CI [1.074,1.260], P = 0.000; ORoverall = 1.172, 95%CI [1.095,1.254], P = 0.000).ConclusionsExposed to air pollution probable is a risk of prevalence of childhood AR. And the prevalence of AR will be increase when exposed to NO2, SO2, PM10 and PM2.5, but maybe the relationship between SO2/PM10 and prevalence of AR are not closely in Asia.
https://ift.tt/2tEvnWK
Comparison of click auditory brainstem response and chirp auditory steady-state response thresholds in children
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): Konstantinos Mourtzouchos, Maria Riga, Mario Cebulla, Vasilios Danielides, Stefanos Naxakis
ObjectivesDuring the last twenty years, auditory steady-state responses (ASSRs) are being used as an alternative and adjunct to the auditory brainstem response (ABR) for threshold estimation. This study aims at comparing and finding correlations between air-conduction thresholds using the traditional click ABR and the relatively recently used chirp ASSR test methods, for a large pediatric population.MethodsOne hundred and thirty children referred to our Clinic from Hospitals and Clinics of Western Greece ranging in age from 5 to 79 months (mean age = 32.7 ± 14.0 months) participated prospectively.ResultsStrong and statistically significant correlations were found between the average of the 1000, 2000 and 4000 Hz chirp ASSR thresholds and click ABR thresholds (rs = .826, p < .001), and the average of the 2000 and 4000 Hz chirp ASSR and click ABR thresholds (rs = .824, p < .001). Additionally, there have been measurements for some children with hearing loss in the severe-to-profound range during the ASSR test, but no ABR at the upper limits of the equipment. Click ABR and chirp ASSR thresholds averaged at 2000 and 4000 Hz were within 20 dB in 90% of the ears tested.ConclusionsThe results of this study support the inclusion of chirp ASSRs into the pediatric test battery and indicate that they may provide an essential adjunct to the click ABR, especially in the management of very young children with severe-to-profound hearing loss.
https://ift.tt/2ICPt8o
Transcanal incision and drainage of a parapharyngeal abscess in a pediatric patient: A novel technique
Publication date: September 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): Tyler R. Schwartz, Miranda D. Colletta, Michael E. McCormick
The disease of parapharyngeal abscess is well known to the otolaryngologist and is commonly managed via transoral, transcervical, or combined incision and drainage. We report a novel approach to an abscess that was drained through the external auditory canal (EAC). An otherwise healthy 2-year-old female presented with a 4-day history of fevers, decreased oral intake, neck stiffness, and voice changes. CT neck with contrast revealed a deep abscess in the left neck extending from the peritonsillar space into the parapharyngeal space in close proximity to the anterior aspect of the EAC. Because the EAC was the closest surface to the abscess collection, we elected to attempt drainage through this route. Successful incision and drainage was performed via transcanal approach. She received intravenous antibiotics and steroids post-operatively and surgical packing was removed. She was discharged home on post-operative day 5 afebrile and tolerating a regular diet and continued to do well at most recent outpatient follow-up.
https://ift.tt/2NeygFw
Evaluation of clinical approaches and physician adherence to guidelines for otitis media with effusion
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): Nisa Eda Cullas Ilarslan, Fatih Gunay, Seda Topcu, Ergin Ciftci
ObjectivesOtitis media with effusion (OME) is an important clinical entity because of its high prevalence, difficulties in diagnosis, complications and diversities in management. Herein, we aimed to evaluate current physician approaches on OME and determine clinical adherence to current guidelines.Methods and materialsA total of 370 physicians [Group 1: pediatricians (n = 256, 69.2%), Group 2: otorhinolarynologists (n = 114, 30.8%)] completed a survey instrument addressing demographic data and clinical practice parameters on OME in children. We also compared clinical approaches of Group 1 and Group 2. In addition, multiple logistic regression analysis was performed to evaluate factors which may effect correct approaches.ResultsThe mean period of clinical experience was 9.30 ± 8.35 [median 6 (1–40)] years. A total of 311 (84%) respondents reported satisfactory level of self-confidence as regards of clinical approaches to OME. Reduced mobility of the tympanic membrane and preference of pneumatic otoscopy was signified by 107 (28.9%) and 64 (17.3%) respondents, respectively. Fifty-six (15.1%) physicians identified "watchful waiting" for 3 months for children who are not at risk while 314 (84.9%) reported preference of medications, with antibiotics the most preferred prescription (n = 223, 63%). Comparison of Group 1 and Group 2 indicated similar results except better, yet insufficient, characterization of physical examination findings of OME by Group 2 (p < 0.001, for each parameter). Group 2 preferred tympanometry more in uncertain cases (p < 0.001) and handled chronic cases better (p < 0.001). Multiple logistic regression analysis revealed lower signification of reduced mobility of the tympanic membrane for respondents who denoted depending on personal experience ([OR] = 3.077 [95% CI 1.042–9.09]) or following clinical guidelines ([OR] = 3.365 [95% CI 1.38–8.20]) rather than combining them both. Rate of antibiotic avoidance was lowest in physicians with a period of clinical experience<5 years ([OR] = 2.14 [95% CI 1.32–3.48]).ConclusionsDespite notifying high self-confidence and adherence to current guidelines on OME, both pediatricians and otorhinolaryngologists lacked to exhibit proper approaches. Further research is warranted to evaluate the causes of poor adherence to current guidelines and bring suggestions for the maintenance of consistent and correct clinical approaches to OME.
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Quality Management in Healthcare: The Pivotal Desideratum
Publication date: Available online 30 June 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Anubha Aggarwal, Himanshu Aeran, Manu Rathee
Health care is very complex sector and delivery of service is the fragmented care. Quality can be a common paradigm to address the need of all groups in health care. Quality improvement is the process approach to the organization's operational challenges. The initiative to address the quality in health care has become a global phenomenon. A quality revolution for delivery of service with patient at the center and services around it is the demand of the time. This article comprehensively reviews the quality management in health care service and aims to sensitize the health care professionals towards achieving total quality.
https://ift.tt/2KywxfT
Παρασκευή 29 Ιουνίου 2018
Ayurveda metallic-mineral 'Bhasma-associated severe liver injury
Ayurveda Bhasma is a metallic-mineral preparation homogenised with herbal juices or decoctions and modified with heat treatment to apparently detoxify the heavy metals. It is widely recommended for the treatment of many disease conditions by practitioners of complementary and alternative medicine in the absence of good quality clinical trial evidence on its safety and efficacy. Heavy metal-induced liver injury is widely reported in the literature, and heavy metal adulteration of non-Bhasma-related Ayurveda and herbal products has been well described. We report a patient who developed severe liver injury requiring listing for liver transplantation for improved survival, after consumption of Bhasma for dyspepsia. This case describes the first documented case and toxicology analysis of Ayurveda Bhasma associated with severe drug-induced liver injury. Physicians must be alert regarding patient's use of supposedly safe Ayurveda Bhasma that may promote acute severe liver injury in the absence of other known aetiologies.
https://ift.tt/2lGflHo
Phytobezoar and duodenal ulcer as complication of Duodopa therapy in a patient affected by Parkinsons disease
Continuous duodenal infusion of levodopa/carbidopa intestinal gel (LCIG) is an established treatment to control motor fluctuations in Parkinson's disease. Duodenal infusion allows a steady absorption of the drug in the small bowel, reducing plasmatic fluctuations of levodopa. Some complications may occur during the treatment, often related to intrajejunal percutaneous endoscopic gastrostomy (PEG-J). We report a case of duodenal ulcer associated with a phytobezoar involving the end of jejunal probe, in a patient who underwent PEG-J for LCIG infusion. In the last 2 weeks, the patient suffered from abdominal pain and dyspepsia. Oesophagogastroduodenoscopy showed an ulcerative lesion of the duodenum due to traction of the jejunal tube; the end of the jejunal tube was wrapped in a phytobezoar. This case is interesting because of the extension of the ulcerative lesion due to PEG-J dislocation and because of the subtle symptoms associated with it.
https://ift.tt/2yYgQdo
Just another case of bacterial meningitis... or... is it?
Non-traumatic cerebrospinal fluid (CSF) rhinorrhoea is a rare condition. We describe a case of a 62-year-old woman with pneumococcal bacterial meningitis who later was found to have CSF rhinorrhoea secondary to an eroding skull base tumour, which was proven to be pituitary macroadenoma on biopsy. She recovered well from meningitis without any neurological sequelae and underwent trans-sphenoidal surgery for tumour removal as well as dural repair.
https://ift.tt/2lHuCHK
Ectopic insulinomas in the pelvis secondary to rectum neuroendocrine tumour
We describe a middle-aged woman with recurrent hypoglycaemia, who confirmed with rectum G1 neuroendocrine tumour (NET) 6 years ago. Biochemical assay showed high concentration of serum insulin and C-peptide associated with hypoglycaemia. Because of recurrent hypoglycaemia in June 2015, she underwent a resection of the tail of the pancreas. However, hypoglycaemia attack happened more frequently and severely. 68Ga-DOTA-NOC positron emission tomography/CT revealed five foci in the pelvis with intense uptake. Immediately after excision of the pelvic lesions, insulin and C-peptide decreased to normal levels promptly, and therefore, serum glucose increased significantly. Hypoglycaemia was disappeared, and insulin and C-peptide were normal at 2 years follow-up after surgery. Immunohistochemistry validated the primary rectum NET and pelvic tumours expressed with higher insulin, somatostatin receptor and glucagon-like peptide-1. This is the first reported ectopic pelvic insulinomas secondary to rectum NET, which may originate both from neuroendocrine cells in the rectum and pelvic tissues.
https://ift.tt/2z2JsCu
Pineal gland apoplexy mimicking as migraine-like headache
Description
A 24-year-old female patient presented with acute-onset, vertex headache associated with photophobia, nausea and vomiting. Initially, the headache was mild (pain scale 4/10), but over the next 4–5 hours, the severity of the headache increased to pain scale of 8/10. She had a history of similar headaches of lesser intensity in the past. There was also a strong family history of migraine. Her mother and younger sister used to get similar headaches and got relieved with antimigraine medications. Exact details of her medication history were unavailable since the progression of severity of her headache was gradual. This was unlike thunderclap headache and, in high likelihood, another episode of migraine.
Her vitals were stable. Neurological examination, including funduscopy, was grossly normal
On radiological evaluation, the MRI brain showed T1-weighted hyperintense pineal gland, as seen on the axial view suggestive of intrapineal gland apoplexy (figure 1). The fluid–fluid interface is depicted by the horizontal...
https://ift.tt/2lIXmzR
Unusual cause of elbow pain in a baseball pitcher
An adolescent, right hand-dominant, baseball pitcher presented to sports medicine clinic with posterolateral right elbow pain over 4 months. He rated his pain as 8/10 with pitching, especially at the late cocking phase of throwing. Prior to consult, he had rested 3 months from pitching, progressing to strengthening exercises, with no pain relief. On physical examination, he had 120° of active external rotation, 80° of active internal rotation, mild tenderness to palpation over the capitellum and normal elbow radiography. Magnetic resonance arthrogram of the right elbow revealed subtle, posterolateral joint capsular tear and adjacent synovial hypertrophy. The patient was diagnosed with elbow synovial fold syndrome that was causing impingement at the radiocapitellar joint and was referred to an orthopaedic surgeon. Arthroscopy revealed redundant tissue; scar formation at the radiocapitellar joint was debrided. The patient participated in physical therapy for 2 months and was able to start throwing 3 months later.
https://ift.tt/2tN90xe
Double tongue signs in a case of submandibular space infection
Description
Double tongue signs are a unique physical finding which involve an elevation of floor of the oropharynx caused by a bilateral infection of the submandibular space (a well-known example is Ludwig's angina) (figure 1A).1 2 In this case, an 80-year-old woman with a 10-year history of diabetes mellitus was referred to our emergency department. She presented with swelling from the submandibular region to the neck surface, with a 3-day history of continuous fever, weakness and fatigue. Physical examination revealed neck oedema with erythema and tenderness (figure 1B), without lymphadenopathy. The floor of the oropharynx was clearly swollen and elevated, such that it appeared to be a double tongue; this was erythematous and tender. Enhanced CT of the neck was performed, which revealed bilateral fluid retention with swollen surrounding soft tissues in the submandibular space (figure 2). We...
https://ift.tt/2lKpjYn
Early-stage right temporal lobe variant of frontotemporal dementia: 3 years of follow-up observations
The right temporal lobe variant of frontotemporal dementia (FTD) is an uncommon progressive neurodegenerative disorder. We present the case of a 77-year-old right-handed man who presented with altered behaviour and problems with interpersonal relationships. He had no decline in cognitive function but brain perfusion single-photon emission CT demonstrated distinct hypoperfusion in the right temporal pole. At 2-year follow-up, he could not recognise his wife's relatives; and at 3-year follow-up, he had semantic aphasia. Decreased brain perfusion extended from the right temporal lobe into the contralateral temporal and both frontal lobes. These findings suggest that the right temporal lobe variant of FTD should be considered in elderly patients with altered behaviour and problems with interpersonal relationships, even if dementia is not suspected. The right anterior temporal lobe may play a key role in the onset of the early symptoms of this disease.
https://ift.tt/2yWrl0P
Pseudo-Wellens syndrome secondary to concurrent cannabis and phencyclidine intoxication
Wellens' syndrome is an electrocardiographic pattern of T-wave changes associated with critical stenosis of the proximal left anterior descending artery, signifying imminent risk of an anterior-wall myocardial infarction. The Wellens' electrocardiographic pattern can also be noted in several cardiac and non-cardiac diseases. We chronicle here a unique case of a patient who presented with atypical left chest pain and dizziness for 6 hours. His pain started after he smoked phencyclidine-laced cannabis. Cardiac panel demonstrated normal troponin T levels. Electrocardiogram showed sinus rhythm with new deep biphasic T-wave inversions in anterolateral leads. Coronary angiography showed no pathological processes. Subsequently, ECG changes resolved coincidentally with the resolution of chest pain. He was eventually diagnosed with pseudo-Wellens' syndrome. This paper illustrates that physicians should be vigilant for Wellens' syndrome mimicked by acute phencyclidine and cannabis intoxication. Additionally, we present a review of various aetiologies of pseudo-Wellens' syndrome, especially in patients with substance abuse.
https://ift.tt/2lK3GaB
Suction-induced retinopathy: optical coherence tomography correlations
We report a clinical case of a teenager whose eyes were exposed to highly negative suction pressures for brief seconds. The patient presented with a bilateral cystoid macular oedema associated with a thickening of outer nuclear layer evidenced by optical coherence tomography. The patient's constellation of findings is most easily explained by the abrupt expansion and traction of a cohesive vitreous base onto the retinal layers.
https://ift.tt/2tO4lLG
Inflammatory myofibroblastic tumour: a rare cause of central airway obstruction
Description
A 70-year-old woman with no comorbidities presented with cough, wheezing, exertional dyspnoea and a sensation of throat fullness. She never smoked and was recently diagnosed with asthma based on a normal chest radiograph and pulmonary function testing but failed to improve with bronchodilators and steroids. Her initial chest radiograph was unremarkable, and spirometry suggested a fixed intrathoracic obstruction. CT of the chest obtained after 2 months showed an irregular density in the trachea, 1.4x1.7 cm (figure 1). Flexible bronchoscopy showed a polypoid mass 2–3 cm above the carina adherent to the right wall of the trachea (figure 2). Rigid bronchoscopy with neodymium-doped yttrium aluminium garnet (Nd:YAG) laser photoresection was performed. Given the vascular nature of the tumour, removal was complicated by significant bleeding, which required endobronchial epinephrine and laser coagulation. The patient recovered without further complications. Immunohistochemical staining on the excised tumour was positive for vimentin...
https://ift.tt/2lO7ho9
Second look at Streptococcus sanguinis and the colon
Although the link between Streptococcus bovis bacteraemia and colon cancer is well established, bacteraemia from other viridans group streptococci that commonly colonise colonic mucosa may also herald occult malignancy. We present a case of Streptococcus sanguinis bacteraemia in an elderly man with new anaemia that led to the detection and removal of a high-grade colon neoplasm. This case contributes to a growing body of literature contending that unexplained streptococcal bacteraemia merits a thorough workup that may include relatively invasive procedures such as endoscopy. Diagnostic colonoscopy provides an opportunity to prevent invasive malignancy that may outweigh bleeding and perforation risks in elderly patients.
https://ift.tt/2tSs1P5
Atypical presentation of type B aortic dissection mimicking appendicitis managed medically
This is a case of a 53-year-old male patient with a history of hypertension who developed sudden onset of right lower quadrant pain. On arrival, chest X-ray showed prominent aortic arch without cardiomegaly. CT of the abdomen/pelvis showed aortic dissection in descending aorta without rupture. CT of the chest displayed sparing of ascending and aortic arch. Ultrasound Doppler of the kidney displayed mild renal artery stenosis. Differential diagnosis was acute appendicitis, acute ureteric and severe gastroenteritis. The patient was started on oral blood pressure (BP) medicine to titrate off intravenous nicardipine and esmolol drip. After 10 days, he was switched to oral BP medicine. His leg pain was resolved with normal palpable pulse. One week later, his kidney function worsened. Thus, Lasix and minoxidil were stopped. The patient had no chest/abdominal pain and was tolerating the medicine well during his 2-week follow-up. Acute aortic dissection can be a fatal clinical emergency. Timing is critical during diagnosis and management of patients.
https://ift.tt/2lKw8sG
EBV colitis with ulcerative colitis: a double whammy
We report this case of a 21-year-old immunocompetent man presenting with ulcerative colitis and superimposed Epstein-Barr virus (EBV) colitis. He presented for the first time with symptoms of blood-mixed diarrhoea and raised inflammatory markers. His endoscopic and histological appearances were found to be due to ulcerative colitis for which he was started on standard therapy with intravenous steroids. In spite of this, he continued to be symptomatic and his inflammatory markers continued to rise. A virology screen done showed evidence of previous EBV infection, and in view of poor response to immunosuppression, a superimposed infection was suspected. EBV DNA PCR done on colonic biopsies was found to be positive and the patient was started on intravenous ganciclovir to which he responded well. This case highlights the importance of considering a superimposed infection in patients with poor initial response to steroid therapy in inflammatory bowel disease.
https://ift.tt/2yWqWeP
Adult-onset epileptic aphasia
Aphasia is a language disorder characterised by loss of ability to produce or comprehend written or spoken language. In majority of the cases, it is due to stroke. Aphasia may also present as an ictal or postictal state of temporal or frontal lobe seizures. Nevertheless, its isolated occurrence in individuals without a clear-cut history of seizures raises diagnostic difficulties with important therapeutic implications.
A case of epileptic aphasia is reported in which the diagnosis was confirmed by electroencephalogram with a dramatic therapeutic response to an antiepileptic drug.
https://ift.tt/2lKw7VE
Reversible cardiac dysfunction in long-standing hypertension may be global variant of stress cardiomyopathy
An adult man with long-standing poorly controlled cardiac risk factors presented with acute decompensated heart failure (ADHF). Echocardiogram, cardiac MRI and catheterisation suggested idiopathic dilated cardiomyopathy, severe systolic dysfunction, ejection fraction 25% with global left ventricular (LV) dilation and apical thrombus. He responded well to diuretics and gradual uptitration of lisinopril and carvedilol. Follow-up echocardiogram in 2 months demonstrated complete recovery of systolic function, normalisation of LV size and shape with severe LV hypertrophy. This presentation is potentially a global variant of stress cardiomyopathy with recovery of LV function, highlighting the importance of appropriate imaging, catheterisation and clinical monitoring in patients with ADHF.
https://ift.tt/2yWrdhR
Anomalous aortic origin of a coronary artery with an intraseptal course: novel techniques in haemodynamic assessment
Description
A 7-year-old boy presented to the emergency room after an episode of syncope while at home. Although, it was non-exertional, it lasted 2 min and was preceded by angina-like chest pain. Vitals, physical examination, chest radiograph and ECG were normal. Subsequent cardiology evaluation led to an echocardiogram that showed anomalous origin of the left main coronary artery from the opposite sinus of Valsalva with adjacent ostia which was confirmed on CT angiography. In addition, it showed a long 2.5–3 cm deep intraseptal course of the left anterior descending (LAD) and short intraseptal course of the left circumflex (LCX) artery. Stress nuclear perfusion scan and Holter monitoring were negative, but stress cardiac MRI showed an inducible perfusion defect along the anterior interventricular septal wall most prominent at the mid-ventricular and basilar levels. Coronary angiography (figure 1 and video 1) and intravascular ultrasound demonstrated significant systolic compression of the intraseptal segment...
https://ift.tt/2lI0Xyb
Biots breathing associated with acute bacterial meningitis in a child
Description
A 19-month-old boy presented to the emergency room of our hospital with fever and drowsiness following asymmetric focal seizure. On examination the patient was somnolent, had signs of meningeal irritation and intermittent nystagmus. Laboratory examination revealed increased C-reactive protein (200 mg/L), procalcitonin (25.9 ng/mL) and hyponatraemia (132 mEq/L). The initial CT of the brain was normal. Given presumed meningoencephalitis, intravenous dexamethasone, vancomycin, ceftriaxone and acyclovir treatment was started, and the child was admitted to the paediatric intensive care unit. Several hours after the admission, irregular, jerky respirations appeared, consistent with Biot's breathing (figure 1). The patient developed hypertension (129/90 mm Hg) and relative bradycardia (90 bpm). Due to these signs, consistent with increased intracranial pressure, lumbar puncture was deferred and the child received mannitol with notable improvement in his condition. On hospital day 2, lumbar puncture revealed turbid fluid with an opening pressure of 5 cmH2O, white blood cells...
https://ift.tt/2tT6N3D
Subfoveal congenital hypertrophy of retinal pigment epithelium
Description
A 25-year-old man presented with slight blurring of vision in the right eye (RE), noted 3 years ago. There was no positive systemic history. His best corrected visual acuity was 6/9 in RE and 6/6 in the left eye (LE) at presentation. Anterior segment evaluation was unremarkable in both eyes with normal pupil light reflexes. Fundus evaluation revealed a flat circular lesion beneath the fovea, and was measured to be one-third of the size of the optic nerve head. It was a densely pigmented lesion, black in colour, with a surrounding depigmented whitish halo (figure 1). The LE was within normal range on clinical examination. Spectral domain optical coherence tomography (SD-OCT) of RE revealed the lesion to be irregular but flat with hyper-reflectivity at the level of the retinal pigment epithelium (RPE). Discontinuity of the ellipsoid zone was noted to be overlying some parts of the lesion. These findings were also accompanied...
https://ift.tt/2lMbVmq
A case of massive haemoptysis
Description
A 77-year-old female never-smoker presented with massive haemoptysis. Admission plain chest radiograph was normal.
She was haemodynamically stable on presentation but the following morning she had a further large-volume haemoptysis (>500 mL), resulting in respiratory arrest. Following resuscitation, haemoglobin fell from 94 to 66 g/dL. CT angiogram was performed (figure 1).
Figure 1
Sagittal CT angiogram, performed once the patient was stabilised.
She had previously been investigated for small volume haemoptysis and left upper lobe mass-like consolidation, which had fully resolved following a course of antibiotics. Recent bronchoscopy was normal, with no pathological organisms. There was no evidence of malignancy or connective tissue disease, and there was no additional past medical history. CT imaging had been reviewed at a thoracic oncology multi-disciplinary meeting and the previous episode was attributed to non-specific infection.
QuestionWhat is the diagnosis (see figure 1)?
(A) Pulmonary artery...
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Impact of Regional Anesthesia on Gastroesophageal Cancer Surgery Outcomes: A Systematic Review of the Literature
https://ift.tt/2tIaAkO
Epidural Analgesia and Subcutaneous Heparin 3 Times Daily in Cancer Patients With Acute Postoperative Pain
https://ift.tt/2NcpAji
Proceedings From the Society for Advancement of Blood Management Annual Meeting 2017: Management Dilemmas of the Surgical Patient—When Blood Is Not an Option
https://ift.tt/2KysexW
Prospective Observational Investigation of Capnography and Pulse Oximetry Monitoring After Cesarean Delivery With Intrathecal Morphine
https://ift.tt/2tIaCsW
Opioids for Acute Pain Management in Patients With Obstructive Sleep Apnea: A Systematic Review
https://ift.tt/2IEpc9M
Practice of Ultrasound-Guided Palpation of Neck Landmarks Improves Accuracy of External Palpation of the Cricothyroid Membrane
https://ift.tt/2tHh5Es
Dexmedetomidine Versus Remifentanil for Monitored Anesthesia Care During Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Randomized Controlled Trial
https://ift.tt/2IEIDiC
Potent Inactivation-Dependent Inhibition of Adult and Neonatal NaV1.5 Channels by Lidocaine and Levobupivacaine
https://ift.tt/2tG4IZo
Monitoring Depth of Hypnosis: Mid-Latency Auditory Evoked Potentials Derived aepEX in Children Receiving Desflurane-Remifentanil Anesthesia
https://ift.tt/2IDv3Mm
Can STOP-Bang and Pulse Oximetry Detect and Exclude Obstructive Sleep Apnea?
https://ift.tt/2ICWOEZ
Cervical Spine Motion During Tracheal Intubation Using an Optiscope Versus the McGrath Videolaryngoscope in Patients With Simulated Cervical Immobilization: A Prospective Randomized Crossover Study
https://ift.tt/2tHTCmH
Preoperative High-Dose Methylprednisolone and Glycemic Control Early After Total Hip and Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial
https://ift.tt/2IFwE4f
Apparent Hyperthyroidism Caused by Biotin-Like Interference from IgM Anti-Streptavidin Antibodies
Thyroid, Ahead of Print.
https://ift.tt/2lKRypO
Sobetirome and its Amide Prodrug Sob-AM2 Exert Thyromimetic Actions in Mct8-Deficient Brain
Thyroid, Ahead of Print.
https://ift.tt/2tSicQW
Protective Effect of Metformin Against Thyroid Cancer Development: A Population-Based Study in Korea
Thyroid, Ahead of Print.
https://ift.tt/2lKRzdm
American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults
Thyroid, Ahead of Print.
https://ift.tt/2lGWwDI
Retraction of: Hair Iodine for Human Iodine Status Assessment, Thyroid 24(6);2014:1018–1026; DOI: 10.1089/thy.2012.0499
Thyroid, Ahead of Print.
https://ift.tt/2tSU3tC
Structure of a Thyrotropin Receptor Monoclonal Antibody Variable Region Provides Insight into Potential Mechanisms for its Inverse Agonist Activity
Thyroid, Ahead of Print.
https://ift.tt/2lIo77G
Mast cells and basophils in allergic inflammation
Masato Kubo
https://ift.tt/2IFjvYX
Mechanisms leading to T-cell activation in drug hypersensitivity
https://ift.tt/2N8qjBP
Does evidence support the use of cat allergen immunotherapy?
https://ift.tt/2IHOrYQ
Management of adverse reactions to first-line tuberculosis antibiotics
https://ift.tt/2IA444p
Hypersensitivity reactions to beta-lactams in children
https://ift.tt/2tGNhYQ
NSAIDs hypersensitivity: questions not resolved
https://ift.tt/2N8q7m5
Genetic and nongenetic factors that may predispose individuals to allergic drug reactions
https://ift.tt/2KycHy7
The potential role of pharmacogenomics and biotransformation in hypersensitivity reactions to paracetamol
https://ift.tt/2N8q1ed
Is the evidence of local allergic rhinitis growing?
https://ift.tt/2IBA6gv
Interaction between foods and nonsteroidal anti-inflammatory drugs and exercise in the induction of anaphylaxis
https://ift.tt/2tGpp7L
Monoclonal antibodies for the treatment of atopic dermatitis
https://ift.tt/2IEqgKG
Tension band plating of an anterior tibial stress fracture nonunion in an elite athlete, initially treated with intramedullary nailing: a case report
Leg pain in athletes is a common condition and is often related to tibial stress fracture. When non-operative treatment fails, the optimal surgical treatment is controversial. The aim of this study was to repo...
https://ift.tt/2lHfFWd
EMA Panel Backs Combo Drug for Hyperuricemia in Gout Patients
Duzallo contains two medicines in one pill to address both the underelimination and overproduction of uric acid. The FDA approved the drug in August 2017.
International Approvals
https://ift.tt/2tDxHNG
Evaluation of lung function in patients submitted to total laryngectomy
Publication date: Available online 29 June 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Mario A. Castro, Rogério A. Dedivitis, João M. Salge, Leandro L. Matos, Claudio R. Cernea
IntroductionThe post-laryngectomy state presents with several alterations in lung function. A reliable estimation of lung function can be very useful in laryngectomees to prevent postoperative complications and to evaluate the results of the treatment.ObjectiveCharacterize the presence of respiratory functional disorders and the functional pattern of laryngectomees through the use of an extratracheal device.MethodsThis transversal study included 50 patients who had undergone total laryngectomy at least 6 months prior to this investigation, as the treatment of choice for laryngeal cancer.Results56% percent of the participants had altered breathing pattern, distributed as follows: 14 with obstructive pattern with no air trapping, 11 with obstructive pattern with air trapping and only 3 with restrictive pattern. On average, the diffusion decreased (74.3%) and airway resistance increased (121.7%) when compared to the expected average values for the Brazilian individuals.ConclusionMost patients submitted to total laryngectomy present altered lung function, usually the obstructive type, frequently associated to a history of smoking.
https://ift.tt/2KCnHxX
FDA OKs New Topical Treatment for Excessive Underarm Sweating
Qbrexza (Dermira) is a topical anticholinergic cloth applied to the underarms and is designed to block sweat production by inhibiting sweat gland activation in patients with axially primary hyperhidrosis.
FDA Approvals
https://ift.tt/2lK7VTv
Determinants of level Ib involvement in oral squamous cell carcinoma and implications for submandibular gland-sparing neck dissection
Publication date: Available online 29 June 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): N. Subramaniam, D. Balasubramanian, R. Reddy, P. Rathod, S. Murthy, S. Vidhyadharan, K. Thankappan, S. Iyer
Traditional neck dissection for oral squamous cell carcinoma (OSCC) involves removal of the submandibular salivary gland. Several studies have cited the low incidence of direct gland invasion by tumours and have recommended gland-sparing neck dissection. In this study, a detailed audit of level Ib involvement in OSCC was performed in order to assess the feasibility of submandibular gland-sparing in neck dissection; the rate of direct involvement by the primary tumours, the involvement of periglandular level Ib nodes, and their determinants were investigated. A total of 586 neck dissection specimens obtained between 2005 and 2014 from patients operated on at the study institution for floor of mouth, tongue, and buccal primaries, were evaluated for direct invasion of the gland and periglandular lymphadenopathy. Of 226 node-positive patients, 21 (9.3%) had direct gland invasion by tumour. Risk factors were tumour diameter >4cm (P=0.002) and depth of invasion >10mm (P=0.003). Determinants of periglandular lymphadenopathy were depth of invasion >10mm (P<0.001), perineural invasion (P=0.02), lymphovascular invasion (P=0.014), and moderate/poor differentiation (P<0.0001). Gland-sparing neck dissection is safe in early tumours (pT1pN0–1), with a good chance of minimizing xerostomia without radiotherapy. Larger tumours without clear evidence of submandibular gland invasion or suspicious level Ib lymphadenopathy may be considered for gland preservation, however the oncological safety is unclear.
https://ift.tt/2yW8gf3