Dermoscopy of arteriovenous tumour: A morphological study of 39 cases

Abstract

Background/Objectives

Arteriovenous tumour is a distinct, benign, acquired vascular lesion that can be misdiagnosed.

Methods

A dermoscopic examination of 39 cases of arteriovenous tumours collected from four Spanish hospitals was performed to evaluate specific dermoscopic criteria and patterns.

Results

The most common structures found were vascular, 95% of cases (37/39); 90% (35/39) were non-arborising telangiectasia. All the lesions except two (95%) had a homogeneous pigmentation background that was red in 30 cases (77%), bluish-red in three (8%), brown in two (5%) and blue or multicoloured in one case each. Lacunae were seen in only three cases (8%). Non-arborising telangiectasia on a reddish background was identified in 72% of cases.

Conclusions

Dermoscopy is helpful in improving the diagnosis of arteriovenous tumours and allows the observer to differentiate them from other cutaneous lesions such as other vascular tumours, basal cell carcinomas and melanomas.

http://ift.tt/2qsnft2

Programmed cell death 1 blockade-induced cutaneous sarcoid-like epithelioid granulomas in advanced melanoma: A case report

Abstract

Sarcoidosis is a chronic, systemic inflammatory disorder of unknown etiology that is characterized by the formation of noncaseating granuloma in affected organs, most commonly the lung.¹ In pulmonary sarcoidosis patients, the T helper 1 (Th1) cytokine profile of CD4⁺ as well as CD8⁺ T cells was demonstrated in bronchoalveolar lavage fluid.² However, there has been no detailed description of a lymphocyte profile in cutaneous sarcoid-like epithelioid granulomas. Here, we report a case of sarcoid-like epithelioid granulomas induced by nivolumab in a patient with advanced melanoma and we performed functional lymphocyte analysis of the granuloma lesions. All studies were performed in accordance with the ethical principles of the Declaration of Helsinki.

This article is protected by copyright. All rights reserved.

http://ift.tt/2CEcVmO

Mosaic NRASopathy n a child with giant melanocytic congenital naevus, epidermal hamartoma and bilateral nephroblastomatosis: clinical implication for follow-up

Abstract

Various nevoid proliferations result from postzygotic mutation in genes within the RAF/RAS/MAPK pathway, supporting the term "mosaic RASopathy"(1). Giant congenital melanocytic naevus (GCMN) and neurocutaneous melanosis are rare mosaic RASopathies mainly known to be at risk for the development of melanoma and skeletal anomalies are variably recorded (2,3).

This article is protected by copyright. All rights reserved.

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Neutrophilic superficial eccrine ductitis: Proposal of a new disease concept

Abstract

A 3-year-old Japanese boy presented with a 3-month history of itchy erythematous papules on his trunk and forearms, the histologic findings of which were characterized by predominantly neutrophilic inflammation within and around the eccrine sweat ducts and obliteration and disruption of the superficial eccrine sweat ducts. Although the skin disorder had some clinical and histopathologic similarity to miliaria and neutrophilic eccrine hidradenitis, it was ultimately conformed to be neither disorder. Based on this and a case report in the Japanese literature of a 1-year-old boy with erythematous eruptions whose clinical and histopathologic findings were similar to those in our case, we propose the skin disorder in our case, referred to as "neutrophilic superficial eccrine ductitis," as a unique entity.

http://ift.tt/2CHqpOA

A young girl with severe cerebral fungal infection due to card 9 deficiency

Publication date: Available online 4 January 2018
Source:Clinical Immunology
Author(s): Pinar Gur Cetinkaya, Deniz Cagdas Ayvaz, Betül Karaatmaca, Rahsan Gocmen, Figen Söylemezoğlu, Wayne Bainter, Janet Chou, Talal A. Chatila, Ilhan Tezcan
Pattern recognition receptors (PRRs), receptors of the innate immune system, are important in interaction with pathogens. Caspase Recruitment Domain-containing protein 9 (CARD9), a member of PRRs, is an intracellular adaptor protein important in fungal defense. CARD9 deficiency causes a rare primary immunodeficiency (PID) characterized by superficial and deep fungal infections. We report a 17year-old female with a homozygous nonsense mutation in CARD9, who presented with severe cerebral fungal infection of the central nervous system. She was also found to have an heterozygous NLRP12 mutation, which may have had add-on effect on the severity of the infection.



http://ift.tt/2m0tZJS

Augmentation surgery on the cartilaginous portion of the vocal fold in a patient with cricoarytenoid joint ankylosis

Publication date: Available online 5 January 2018
Source:Auris Nasus Larynx
Author(s): Mioko Fukahori, Shun-ichi Chitose, Kiminori Sato, Hiroyuki Kamimura, Kiminobu Sato, Ririko On, Hirohito Umeno
Surgical management of cricoarytenoid joint (CAJ) ankylosis is challenging and has the risk of worsening voice quality. In the present case, augmentation surgery was performed on the cartilaginous portion of the vocal fold in a patient with CAJ ankylosis. A 24-year-old man sustained blunt trauma to the anterior neck three years prior to developing severe breathiness. Posterior glottal insufficiency resulting from lateral fixation of the right vocal fold was observed during phonation under laryngoscopy. In addition, electromyography and CT scan revealed severe ankylosis of the right CAJ. Type I thyroplasty performed on the right vocal fold did not improve postoperative vocal function. Therefore, augmentation surgery on the cartilaginous portion of the right vocal fold was performed via endolaryngeal microsurgery under general anesthesia with jet ventilation. A piece of temporalis fascia was autotransplanted into the submucosal space created at the posterior cartilaginous portion of the right vocal fold. This resulted in the narrowing of the posterior glottal gap during phonation, leading to improvement in hoarseness. Microsurgical management with autologous fascia augmentation of the cartilaginous portion of the vocal fold can be effective in patients with lateral vocal fold fixation due to CAJ ankylosis.



http://ift.tt/2CTvxwL

The global impact of the DRACMA guidelines cow’s milk allergy clinical practice

The 2010 Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines are the only Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines for cow's milk aller...

http://ift.tt/2F18uRk

Vascular Anomalies of the Head and Neck Region

Abstract

Vascular anomalies of the head and neck region are a complex group of lesions that challenge the head and neck physicians. From the very understanding of the difference between its two distinct forms, hemangiomas and vascular malformations to its management remain confusing. The review of this anomaly attempts at comprehensively understanding the disease. Vascular anomalies are easily diagnosed by their clinical presentation, but choice of imaging and management for this spectrum of lesions is varied. The author attempts to categorize the required imaging for the lesion with suggestions on the management of both hemangiomas and vascular malformations. The available treatment options are discussed, and a comprehensive algorithm for management is suggested. Further research in developing drugs that could restrict the growth of these lesions would be the future of the management of vascular lesions.

http://ift.tt/2CuN1OX

Delayed facial nerve decompression for severe refractory cases of Bell’s palsy: a 25-year experience

This study aims to assess the effectiveness of delayed facial nerve decompression for Bell's palsy (BP).

http://ift.tt/2CGuQK7

Pediatric psoriasis: Evolving perspectives

Abstract

Background/Objectives

Childhood-onset psoriasis is a common skin disorder that has recently received increasing attention, particularly because of its significant medical, social, financial, and psychological burdens and its associated comorbidities. With limited data available and lack of standardized management guidelines for pediatric psoriasis, an expert panel desired to provide an updated critical overview and practical guidance for management of the affected population.

Methods

A panel of pediatric dermatologists with extensive experience in pediatric psoriasis defined and prioritized a core set of topics, performed an English-language literature review, prepared critical evaluations and presentations of topic areas, and carried out a consensus meeting and follow-up consensus manuscript.

Results

The summation of evolving perspectives in pediatric psoriasis includes epidemiology and natural history of the disease, precipitating factors and comorbidities, quality of life and burden of disease, clinical features and disease presentation, differential diagnosis, pathogenesis and treatment, including topical, photo, and systemic therapies.

Conclusion

Pediatric psoriasis is an important immune-mediated inflammatory skin disease with potential for significant impact on affected individuals and their caregivers. Current state-of-the-art care is based primarily on experience and expert consensus, but pediatric data are accumulating and therapeutic options are rapidly evolving.

http://ift.tt/2EYKcHJ

The role of frontal sinus drillouts in nasal polyposis

Purpose of review Historically, the common frontal sinusotomy has been reserved only for salvage frontal sinus surgery in patients with severely recalcitrant inflammatory sinus disease. By understanding the pathophysiology of inflammatory sinus disease and the long-term role of topical medication in their treatment, the indications for Draf3 have expanded. Recent findings A major therapeutic impact from endoscopic sinus surgery for inflammatory sinus disease is imparted by allowing sinus access to topical therapies to work. Although traditionally, the Draf3 frontal sinus procedure has been reserved for revision surgery in severe cases, advancements in technology, instrumentation, and techniques has allowed the Draf3 to evolve to efficient and safe procedure, often applied primarily in select patients. There is evidence to support the indication for Draf3 in primary surgery for severe cases. Summary In inflammatory sinus disease, the goal of endoscopic sinus surgery is to convert the complex and limited frontal sinus outflow tracts into a simple common cavity. This allows for local, topical anti-inflammatory treatments to control the disease. When patients have broader inflammatory airway disease and asthma, the Draf3, as part of a neo-sinus cavity, is commonly applied early in surgical care.

http://ift.tt/2qnEEDf

Quality of life outcomes after endoscopic approaches to intracranial tumors

Purpose of review To review the literature on quality of life (QOL) in endoscopic approaches to anterior and central intracranial skull-base disease. As endoscopic surgical techniques have gained widespread acceptance and complications and morbidity remain low and comparable with microscopic and open approaches, a shift to focusing on patients' perception of their own well being as an important outcome parameter has been made. In addition to the traditional measurements of surgical outcomes (extent of resection, recurrence rate, morbidity, survival, and complication rate), the success of a surgery can now be assessed using QOL measures. Recent findings The main tools for assessing QOL in endoscopic skull-base surgery (anterior skull-base questionnaire and 22-item sinonasal outcome test) were not specifically designed for endoscopic skull-base approaches, and recently, a new tool was introduced and validated, the skull-base inventory, adding to our armamentarium, but it has not yet been widely employed. Endoscopic skull-base surgery leads to improved or sustained long-term QOL overall but it is significantly influenced by tumor disease. Specific endoscopic surgical technique (such as nasoseptal flap closure) appears to have less impact on QOL. Summary It is becoming critical to assess therapeutic interventions in terms of impact on a patient's QOL. QOL can be useful in comparing efficacy of surgical interventions, and in the future, it will likely become a reportable indicator of surgical outcome and guide our surgical technique recommendations. Large-scale prospective multicenter trials would be beneficial.

http://ift.tt/2ql9igq

Risks and management of long-term corticosteroid use in chronic rhinosinusitis

Purpose of review The purpose of this review is to provide an update on the use and risks of long-term corticosteroids in the management of chronic rhinosinusitis (CRS). Recent findings Long-term use of systemic corticosteroids is not indicated in the management of CRS due to the associated side effects and potential complications. Therefore, recent research has focused on the safety and efficacy of topical corticosteroid, particularly second-generation corticosteroids, and their modes of administration. Second-generation corticosteroids are more potent and have less systemic bioavailability than their first-generation counterparts. However, caution must be taken with concomitant use of more than two types of corticosteroids (topical, systemic, inhaled etc.) and also with their dosage and frequency of administration to avoid adrenal suppression, growth suppression in children, elevated intraocular pressure or epistaxis. Research is ongoing into therapies that may reduce corticosteroid resistance which has been demonstrated in some nasal polyps. Summary Corticosteroids play an essential role in the management of CRS; however, use must be tailored to the patient-specific disease and requires ongoing review and regular reevaluation by their physician.

http://ift.tt/2qmYq1O

Long-term management and outcomes after repair of cerebrospinal fluid rhinorrhea related to idiopathic intracranial hypertension

Purpose of review To identify long-term management strategies and outcomes for the treatment of spontaneous cerebrospinal fluid (CSF) rhinorrhea related to idiopathic intracranial hypertension (IIH). Recent findings Adjuvant treatments following surgical repair of spontaneous CSF leaks are aimed at normalizing intracranial pressure (ICP) to minimize the risk of recurrence. IIH is closely linked to obesity, and growing evidence suggests that weight loss, both through conservative and surgical approaches, is effective at addressing the root cause of this disorder. Recent data also support the use of acetazolamide and dural venous sinus stenting as adjuncts for reducing ICP. Summary Spontaneous CSF rhinorrhea associated with IIH represents a challenging clinical entity, with an increased risk of recurrence compared to CSF leaks because of other causes. Adjunct therapies intended to reduce ICP likely improve outcomes after surgical repair, but further research is necessary to better characterize the effects of these treatment modalities.

http://ift.tt/2qnEzPX

Current opinions in office-based rhinology

Purpose of review The care of rhinologic patients has undergone a remarkable transformation in recent years. With the advent of endoscopic sinus surgery and high-tech image-guided computer systems, the surgical care of patients with benign sinonasal disease has successfully transitioned from the main hospital operating room to the outpatient ambulatory surgical center. Currently, there is yet another movement underway, in an attempt to care for these patients in the office setting. Recent findings As the medical device sector continues to innovate at rapid speed, new technologies such as the radiofrequency ablator, microdebrider, balloon sinus dilator, and steroid-eluting stent have propelled the care of rhinologic patients into the clinic setting. Summary In conjunction with an overall increased attention toward cost and time savings, the push to modernize instrumentation is now enabling the otolaryngologist to keep both the medical and surgical treatment of rhinologic patients, particularly those with chronic disease, within the office setting.

http://ift.tt/2qoU9ee

Editorial introductions

No abstract available

http://ift.tt/2qqsPMr

New instrumentations in the operating room for sinus surgery

Purpose of review The article reviews the advancements in instrumentation in the operating room that augment the speed, safety or outcomes of endoscopic sinus surgery (ESS). The article aims to update the Rhinologist on recent perioperative instruments that may benefit their practice. Recent findings The greatest advancements in the recent years have been in the field of visualization and optics. The introduction of high definition and ultra high definition 4K camera and screens supported by improvements with three-dimensional and variable angled endoscopes have greatly enhanced the quality and range of the visual information available to the sinus surgeon. This is closely supported by flexibility and enhanced functionality of the powered instrumentation with bipolar, monopolar and malleable blades and ever increasing more powerful burs. Summary Recent years have seen notable developments in the areas of optics, cameras and powered instruments to support the sinus surgeon. This article summarizes these developments and highlights the major benefits of these developments.

http://ift.tt/2qqsEkf

Review and update on postoperative opioid use after nasal and sinus surgery

Purpose of review We examine the current literature on pain management after sinus and nasal surgery. The goal after surgery is to provide effective pain management without having too many 'leftovers', as leftover medications are an important source of opioids that are fueling the current prescription narcotic epidemic in the United States. There are more than 250 000 sinus operations and 260 000 septoplasties performed annually, and surgeons commonly prescribe a narcotic pain medication for postoperative pain management. Recent findings The literature suggests that an evidence-based approach may lead surgeons to prescribe significantly less narcotic pain medication for these procedures without affecting pain management. Summary An evidence-based approach to pain management can result in unchanged pain control and a significant positive impact on the narcotic abuse epidemic.

http://ift.tt/2qoTPMy

How does sinus surgery affect topical irrigation distribution?

Purpose of review The current article reviews the literature on the distribution of nasal irrigation in the treatment of chronic sinusitis, especially in how sinus surgery and irrigation techniques affect its delivery to the nasal cavity and paranasal sinuses. Recent findings Nasal irrigation has become a useful tool in the treatment of chronic sinusitis. Used after endoscopic surgery of the paranasal sinuses, irrigation has shown to be effective in improving edema and removing crusts and secretions in that place. However, some relevant points have been considered in the surgical technique and in the postoperative period to improve irrigation access to the paranasal sinuses such as the amplitude of the sinus ostial opening, irrigation volume and device used, as well as head position during irrigation. Summary Postoperative lavage of the paranasal sinus is a recognized adjuvant in the treatment of chronic rhinosinusitis, reducing morbidity and improving local healing, besides allowing the association of topical medications that can be carried to the paranasal sinuses along with the saline increasing the reach of these drugs. Detailed attention to the techniques described in this review improves the distribution of irrigation in the paranasal sinuses after sinus surgery and considerably increases the efficacy of this therapy.

http://ift.tt/2qqsqtp

Updates in the management of sinonasal mucosal melanoma

Purpose of review Sinonasal mucosal melanoma (SNMM) is an aggressive cancer with a poor prognosis. Although there is significant study surrounding the treatment of sinonasal malignancies and cutaneous melanomas, the rarity of this tumor has largely precluded robust outcomes analyses. The authors of this review seek to provide an overview of the recent literature related to the treatment of SNMM with added context from our institutional experience with this disease. Recent findings In the surgical management of sinonasal malignancies and SNMM specifically, resection via endoscopic endonasal technique appears to offer comparable oncologic outcomes versus an open approach. The role of adjuvant therapy continues to be debated, but there is strong evidence for improved rates of local control with radiotherapy after complete resection. In the last few years, significant developments have been made in the study of systemic therapies for cutaneous melanoma. The identification of genetic mutations common to mucosal melanoma has allowed for early trials of targeted therapies, but study is ongoing. Summary Although the study of SNMM is largely limited to small retrospective case series, treatment continues to evolve. Until effective systemic therapies can be identified, endoscopic resection with adjuvant radiotherapy may offer the best disease-free survival with acceptably low morbidity.

http://ift.tt/2qqsgSP

Odontogenic sinusitis: developments in diagnosis, microbiology, and treatment

Purpose of review Odontogenic causes of sinusitis are frequently missed; clinicians often overlook odontogenic disease whenever examining individuals with symptomatic rhinosinusitis. Conventional treatments for chronic rhinosinusitis (CRS) will often fail in odontogenic sinusitis. There have been several recent developments in the understanding of mechanisms, diagnosis, and treatment of odontogenic sinusitis, and clinicians should be aware of these advances to best treat this patient population. Recent findings The majority of odontogenic disease is caused by periodontitis and iatrogenesis. Notably, dental pain or dental hypersensitivity is very commonly absent in odontogenic sinusitis, and symptoms are very similar to those seen in CRS overall. Unilaterality of nasal obstruction and foul nasal drainage are most suggestive of odontogenic sinusitis, but computed tomography is the gold standard for diagnosis. Conventional panoramic radiographs are very poorly suited to rule out odontogenic sinusitis, and cannot be relied on to identify disease. There does not appear to be an optimal sequence of treatment for odontogenic sinusitis; the dental source should be addressed and ESS is frequently also necessary to alleviate symptoms. Summary Odontogenic sinusitis has distinct pathophysiology, diagnostic considerations, microbiology, and treatment strategies whenever compared with chronic rhinosinusitis. Clinicians who can accurately identify odontogenic sources can increase efficacy of medical and surgical treatments and improve patient outcomes.

http://ift.tt/2qoTrh4

Delayed complications from expanded endonasal surgery for intracranial tumors

Purpose of review Delayed complications after endoscopic endonasal approaches to the skull base, defined as complications greater than 1 month postoperatively, are uncommon. These complications are divided into categories including sinonasal, neuroanatomic, endocrine and vascular. This review highlights the most up-to-date advancements and reviews the management of delayed complications for skull base patients. Recent findings Over the last 10 years, the field of endoscopic endonasal skull base surgery has expanded with new data highlighting the long-term patient outcomes. The majority of patients experience increased quality of life (QOL) after these interventions. However, delayed complications including alterations to sinonasal function, delayed encephaloceles from the bony skull base defect and resulting endocrinopathies can significantly impact patient's QOL. Awareness of these complications and their current management is valuable for endoscopic surgeons. Summary Endonasal approaches to the skull base are safe and well tolerated in properly selected patients. This article highlights the delayed complications that require recognition and management by skull base surgeons to ensure the best possible care for patients.

http://ift.tt/2qqs6Ld

Vitiligoid variant of lichen sclerosus in young girls with darker skin types

Abstract

Background/Objectives

Vitiligo and lichen sclerosus are autoimmune disorders characterized by white discoloration, and both frequently affect the anogenital region. Vitiligoid lichen sclerosus refers to a superficial variant of lichen sclerosus in which the lesion appears clinically to be vitiligo based on the predominant presentation of depigmentation and minimal inflammation and sclerosis but histologically is consistent with lichen sclerosus. A limited number of reports have described vitiligoid lichen sclerosus, and from these reports, it appears to primarily affect darker-skinned people.

Methods

We retrospectively reviewed the records of 7 girls with darker skin types seen in our pediatric dermatology clinic who presented with a clinical overlap of vitiligo and lichen sclerosus. All had primarily well-demarcated, depigmented patches characteristic of vitiligo, but the lesions were symptomatic (pruritus, pain, bleeding, constipation), a presentation more consistent with lichen sclerosus.

Results

The girls were all treated with high-potency topical steroids, calcineurin inhibitors, or both. The associated symptoms improved or resolved, but most had minimal improvement of the depigmentation.

Conclusions

The girls presented in this series appear to have had vitiligoid lichen sclerosus, given the clinical overlap of lichen sclerosus and vitiligo affecting the anogenital region, particularly given that they did not have depigmented patches elsewhere on their body. Previous cases of vitiligoid lichen sclerosus have been reported in darker skin types, and our findings support this possible predisposition. It is important for clinicians to assess patients presenting with genital depigmentation for overlapping features of vitiligo and lichen sclerosus and determine appropriate management.

http://ift.tt/2CtcxE3

Potassium iodide in refractory, recurrent pediatric Sweet syndrome: Guidance in dosing and monitoring

Abstract

We describe a 5-month-old boy with clinical and histopathologic presentation of Sweet syndrome. He responded to systemic corticosteroids, with multiple flares on tapering; potassium iodide was added, which provided complete resolution of Sweet syndrome. Potassium iodide has been used in only a few cases, and no standard dosage has been established in children. We discuss calculation of a pediatric dosage for potassium iodide in Sweet syndrome.

http://ift.tt/2CSuwox

Isotretinoin-induced acne fulminans without systemic symptoms with concurrent exuberant granulation tissue

Abstract

Acne fulminans is a severe form of acne characterized by painful, inflammatory nodules that progress into ulcers and concurrent systemic symptoms. Treatment of acne with isotretinoin can precipitate a syndrome called isotretinoin-induced acne fulminans without systemic symptoms. An exuberant granulation tissue response, another known adverse event associated with isotretinoin, can occur concurrently, inhibiting wound repair and complicating treatment. We report a case of isotretinoin-induced acne fulminans without systemic symptoms with exuberant granulation tissue response that was treated successfully with topical clobetasol ointment.

http://ift.tt/2Cvg30E

Acral pigmented Spitz nevus in a child with transepidermal migration of melanocytes: Dermoscopic and reflectance confocal microscopic features

Abstract

Acral pigmented Spitz nevi are seldom reported in the literature. We report a new case on the palm of a 4-year-old girl that demonstrated correlation between features observed on dermoscopy and reflectance confocal microscopy (RCM). Histopathology revealed a benign intraepidermal Spitz nevus with transepidermal elimination of melanocytes that showed on RCM as focal atypical bright cells concerning for malignancy. This case is one of few reports in the literature combining dermoscopy, reflectance confocal microscopy, and histology for an acral Spitz nevi, which are rarely evaluated by RCM given the thickness of the stratum corneum in acral sites.

http://ift.tt/2CVpJ5T

Clinical features and nail clippings in 52 children with psoriasis

Abstract

Background/Objectives

Nail clipping, the act of cutting the distal portion of a nail for microscopic analysis, can complement the diagnosis of skin diseases with nail involvement, such as psoriasis. This study aimed to describe histopathologic findings on 81 nails from 52 children and adolescents with skin psoriasis and to determine whether these changes correlated with the severity of skin and nail involvement.

Methods

Children with psoriasis were enrolled in this cross-sectional study to obtain Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI) scores. The most altered nails were processed using periodic acid-Schiff with diastase staining.

Results

Fifty-two patients with a median age of 10.5 years were included. The median Nail Psoriasis Severity Index score of the 20 nails from these patients was 17 (range 3-80). The most common findings were pitting (94.2%), leukonychia (73.0%), and longitudinal ridges (63.5%). Eighty-one nail fragments were collected by clipping. Neutrophils were found in 6 samples (7.6%) and serous lakes in 15 (19%). Median nail plate thickness was 0.3 mm (range 0.1-0.63 mm). Patients whose nails had neutrophils had a higher median PASI score (6.1 vs 2.0, P = .03). Patients whose nails had serous lakes had higher median PASI (5.3 vs 1.9, P = .008) and NAPSI (median 45.0 vs 18.0, P = .006) scores.

Conclusion

There seems to be a correlation between some microscopic nail features in children with psoriasis and their PASI and NAPSI scores, so nail clippings from children with suspected psoriasis may help with diagnosis, especially in the presence of neutrophils, and in excluding onychomycosis.

http://ift.tt/2CrlvBZ

Delayed-type hypersensitivity to vaccine aluminum adjuvant causing subcutaneous leg mass and urticaria in a child

Abstract

A 3-year-old girl presented with a 7-month history of a waxing and waning left thigh mass associated with pruritus and erythema at the site of two previous DTaP-HepB-IPV vaccinations. Patch testing was positive to aluminum chloride, supporting a diagnosis of vaccine granuloma secondary to aluminum allergy; her symptoms had been well controlled with antihistamines and topical steroids. Injection site granulomas are a benign but potentially bothersome reaction to aluminum-containing immunizations that can be supportively managed, and we encourage strict adherence to the recommended vaccine schedule in this setting. Patch testing is a sensitive, noninvasive diagnostic tool for patients presenting with this clinical finding, and dermatologist awareness can prevent unnecessary medical examination and provide reassurance.

http://ift.tt/2CUAXYp

Approach to the jewelry aficionado

Abstract

Children's and teens' frequent use of inexpensive "costume" jewelry exposes them to a variety of contact allergens. Greater use heightens the risk of developing allergic contact dermatitis, especially in the setting of body piercings. Several clinical pearls, prevention strategies, and avoidance alternatives are provided in this article to guide clinicians and patients in the management of jewelry-related allergic contact dermatitis.

http://ift.tt/2CsEDzg

Robust Neuronal Discrimination in Primary Auditory Cortex Despite Degradations of Spectro-temporal Acoustic Details: Comparison Between Guinea Pigs with Normal Hearing and Mild Age-Related Hearing Loss

Abstract

This study investigated to which extent the primary auditory cortex of young normal-hearing and mild hearing-impaired aged animals is able to maintain invariant representation of critical temporal-modulation features when sounds are submitted to degradations of fine spectro-temporal acoustic details. This was achieved by recording ensemble of cortical responses to conspecific vocalizations in guinea pigs with either normal hearing or mild age-related sensorineural hearing loss. The vocalizations were degraded using a tone vocoder. The neuronal responses and their discrimination capacities (estimated by mutual information) were analyzed at single recording and population levels. For normal-hearing animals, the neuronal responses decreased as a function of the number of the vocoder frequency bands, so did their discriminative capacities at the single recording level. However, small neuronal populations were found to be robust to the degradations induced by the vocoder. Similar robustness was obtained when broadband noise was added to exacerbate further the spectro-temporal distortions produced by the vocoder. A comparable pattern of robustness to degradations in fine spectro-temporal details was found for hearing-impaired animals. However, the latter showed an overall decrease in neuronal discrimination capacities between vocalizations in noisy conditions. Consistent with previous studies, these results demonstrate that the primary auditory cortex maintains robust neural representation of temporal envelope features for communication sounds under a large range of spectro-temporal degradations.

http://ift.tt/2CBnw1I

59 years old male with local advanced adenoid cystic carcinoma of the hypopharynx – A case report and a review of the literature

Publication date: February 2018
Source:Oral Oncology, Volume 77
Author(s): Amr Muhammed, Ahmed Mohamed, Esraa Elnakib, Amal Omar, Nahawand Elnakib
Minor Salivary Gland tumours are rare, representing 2% of the head and neck tumours and less than 1% of hypopharyngeal cancers. The most common subtype of minor salivary gland tumours is adenoid cystic carcinoma. Although there are several case reports discussed it, there are only two reports discussing hypopharyngeal presentation in the literature, and they were treated by surgical resection. Despite that, our case report still to be unique as it presents a case of irresectable locally advanced tumour subjected to a trial of induction therapy.



http://ift.tt/2CC8cC5

Robust Neuronal Discrimination in Primary Auditory Cortex Despite Degradations of Spectro-temporal Acoustic Details: Comparison Between Guinea Pigs with Normal Hearing and Mild Age-Related Hearing Loss

Abstract

This study investigated to which extent the primary auditory cortex of young normal-hearing and mild hearing-impaired aged animals is able to maintain invariant representation of critical temporal-modulation features when sounds are submitted to degradations of fine spectro-temporal acoustic details. This was achieved by recording ensemble of cortical responses to conspecific vocalizations in guinea pigs with either normal hearing or mild age-related sensorineural hearing loss. The vocalizations were degraded using a tone vocoder. The neuronal responses and their discrimination capacities (estimated by mutual information) were analyzed at single recording and population levels. For normal-hearing animals, the neuronal responses decreased as a function of the number of the vocoder frequency bands, so did their discriminative capacities at the single recording level. However, small neuronal populations were found to be robust to the degradations induced by the vocoder. Similar robustness was obtained when broadband noise was added to exacerbate further the spectro-temporal distortions produced by the vocoder. A comparable pattern of robustness to degradations in fine spectro-temporal details was found for hearing-impaired animals. However, the latter showed an overall decrease in neuronal discrimination capacities between vocalizations in noisy conditions. Consistent with previous studies, these results demonstrate that the primary auditory cortex maintains robust neural representation of temporal envelope features for communication sounds under a large range of spectro-temporal degradations.

http://ift.tt/2CBnw1I

Subglottische Stenose

Laryngo-Rhino-Otol 2018; 97: 12-13
DOI: 10.1055/s-0043-123960

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2CHeGQP

Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2018; 97: 70-71
DOI: 10.1055/s-0043-124782

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2CHe79F

Akute Larynxläsionen nach endotrachealer Intubation bei Kindern

Laryngo-Rhino-Otol 2018; 97: 6-7
DOI: 10.1055/s-0043-121844

Manica D et al. Association of endotracheal tube repositioning and acute laryngeal lesions during mechanical ventilation in children. Eur Arch Otorhinolaryngol 2017; 274: 2871–2876 Akute Larynxverletzungen zählen zu den Hauptrisikofaktoren der erworbenen subglottischen Stenose (SGS) bei Kindern nach intensivmedizinischer Behandlung. Manica und Kolleginnen/ Kollegen haben nun in einer prospektiven klinischen Studie an 231 Kindern untersucht, welche Faktoren das Risiko akuter Läsionen durch endotracheale Intubation über 24 Stunden beeinflussen können.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2ArKm6A

Aus der Gutachtenpraxis: Gehörschäden durch Cabrio fahren?

Laryngo-Rhino-Otol 2018; 97: 50-55
DOI: 10.1055/s-0043-121720

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2CHdLzR

Bogengangsdehiszenz: Verschlussoperationen mit niedriger Komplikationsrate

Laryngo-Rhino-Otol 2018; 97: 7-8
DOI: 10.1055/s-0043-121845

Xie Y et al. Surgical Complications from Superior Canal Dehiscence Syndrome Repair: Two Decades of Experience. Otolaryngol Head Neck Surg 2017; 157: 273–280 Die Bogengangsdehiszenz ist eine seltene Erkrankung des Gleichgewichtsorgans und kann chirurgisch durch eine Verschlussoperation behandelt werden. Wie oft es dabei zu allgemeinen Komplikationen kommt, und welche Risikofaktoren diese beeinflussen, haben Xie und Kolleginnen/Kollegen auf Basis von 242 Fallberichten aus zwei Jahrzehnten ausgewertet.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2lY9UEm

Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2018; 97: 3-4
DOI: 10.1055/s-0043-125289

[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2Arh9ZG

Salvage-Chirurgie bei Tumorrezidiven der Mundhöhle – Einfluss der vorherigen Behandlung und des Patientenalters

Laryngo-Rhino-Otol 2018; 97: 8-10
DOI: 10.1055/s-0043-121838

Tam S et al. Estimating Survival After Salvage Surgery for Recurrent Oral Cavity Cancer. JAMA Otolaryngol Head Neck Surg 2017; 143:685–690 Loko-regionäre Rezidive eines Plattenepithelkarzinoms der Mundhöhle sind lebensbedrohlich und eine klinische Herausforderung. Welche Rolle spielt in diesen Fällen die Salvage-Chirurgie?
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2lZ7lBG

Medikamentöse Therapiemöglichkeiten bei vestibulären Störungen, Nystagmus und zerebellären Ataxien

Laryngo-Rhino-Otol 2018; 97: 14-23
DOI: 10.1055/s-0043-123487

Zur Pharmakotherapie von vestibulären Erkrankungen kommen im Wesentlichen folgende Wirkstoffgruppen zum Einsatz: Antivertiginosa, Antikonvulsiva, Antidepressiva, Antiphlogistika, Anti-Menière-wirksame Substanzen, Migräneprophylaktika, Aminopyridine (Kaliumkanalblocker) und Acetyl-DL-Leucin (eine modifizierte essenzielle Aminosäure). Die Behandlung des Symptoms Schwindel und der begleitenden vegetativen Beschwerden wie Übelkeit, Brechreiz oder Erbrechen sollte zeitlich stets begrenzt werden. Bei einem akuten einseitigen Vestibularisausfall verbessern Kortikosteroide die Erholung der peripher vestibulären Funktion, ohne ausreichende Evidenz für eine allgemeine Empfehlung.Für die Wirksamkeit von Betahistin (16 mg dreimal täglich oder 48 mg dreimal täglich) bei Morbus Menière gibt es bislang keine ausreichende Evidenz, ggf. sollten hierbei höhere Dosierungen angestrebt werden – insbesondere, da in tierexperimentellen Studien eine Verbesserung der Durchblutung des Innenohrs nachgewiesen wurde. Bei der Vestibularisparoxysmie sind Carbamazepin/Oxcarbazepin wahrscheinlich wirksam, es fehlen aber noch randomisierte kontrollierte Studien (RCTs) dazu. Bei der vestibulären Migräne gibt es bislang keine RCTs zur Wirksamkeit von Betablockern oder Topiramat, so dass hier aufgrund von klinischen Erfahrungen die Therapie in Analogie zur Migräne ohne Aura empfohlen wird.Aminopyridine werden für die Behandlung von Patienten mit Downbeat-Nystagmus (2 RCTs) und der episodischen Ataxie Typ 2 (EA2, 1 RCT) empfohlen. Die Wirksamkeit von Aminopyridinen wurde in tierexperimentellen und funktionellen Bildgebungsstudien evaluiert. Acetyl-DL-Leucin, eine modifizierte essenzielle Aminosäure, verbessert die klinischen Symptome der zerebellären Ataxie (bisher 3 Beobachtungsstudien). Nach tierexperimentellen Studien beschleunigt es auch die zentrale Kompensation vestibulärer Störungen; randomisierte klinische Studien dazu waren negativ. Derzeit werden die folgenden klinischen RCTs zu verschiedenen Erkrankungen durchgeführt: Vestibularisparoxysmie (Carbamazepin, VesPa), akute einseitige Vestibulopathie/Neuritis vestibularis (Betahistin, BETAVEST), vestibuläre Migräne (Metoprolol, PROVEMIG), BPPV (Vitamin D, VitD@BPPV), EA2 (Aminopyridin vs. Acetazolamid, EAT-2-TREAT) und zerebelläre Ataxien (Acetyl-DL-Leucin, ALCAT).
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2lY8wBh

Facial Volumization: An Anatomic Approach

Laryngo-Rhino-Otol 2018; 97: 11-11
DOI: 10.1055/s-0043-121767

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2qt2spm

Milbenallergie im HNO-Bereich: Bedeutung, Diagnostik und Therapieoptionen

Laryngo-Rhino-Otol 2018; 97: 56-69
DOI: 10.1055/s-0043-121086

Die allergische Rhinitis betrifft ca. 20 % der Gesamtpopulation in Deutschland, ca. ein Drittel dieser Patienten ist von einer persistierenden Rhinitis aufgrund einer Milbenallergie betroffen 2. Bei Patienten mit perennialer Rhinitis allergica ist die Erkrankung besonders häufig mit anderen allergisch bedingten Komorbiditäten wie Asthma bronchiale, atopischem Ekzem, Schlafstörungen, chronischer Sinusitis oder Tubenfunktionsstörungen assoziiert.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2lX0NDK

Otolaryngology Cases. The University of Cincinnati Clinical Portfolio

Laryngo-Rhino-Otol 2018; 97: 11-11
DOI: 10.1055/s-0043-122248

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2qmFxMs

Rhinoplastik

Laryngo-Rhino-Otol 2018; 97: 72-74
DOI: 10.1055/s-0043-124382

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2lX2j8Z

Reconnoitre ameloblastic carcinoma: A prognostic update

Publication date: February 2018
Source:Oral Oncology, Volume 77
Author(s): Tajindra Singh Saluja, Rashmi Hosalkar
AimMalignant odontogenic tumor, ameloblastic carcinoma (AC) is challenging to study owing to its rarity, complexity and limited availability of literature. This further makes it difficult to establish its clinical characteristics and prognosis. Our study aimed to evaluate AC's clinico-demographic factors and their relation with prognosis and survival.Materials and MethodsLiterature was systematically reviewed for cases pertaining to AC, starting from January 2000 to December 2016. All the required data was obtained, arranged and analysed using Cox regression ratio and Kaplan Meir survival analysis. From the database, 153 cases were retrieved as per the inclusion/exclusion criteria.ResultsThe results demonstrated that age of patient, mode of treatment and metastasis affects overall survival. The categorisation of AC as primary or secondary type does not have any role in determining prognosis.ConclusionOverall survival of AC patient depends upon age, site, treatment and metastasis. For a better prognosis early surgical management of the tumor appears to be the most favourable mode of treatment.



http://ift.tt/2CqjWEq

Late radiation-associated dysphagia in head and neck cancer patients: evidence, research and management

Publication date: February 2018
Source:Oral Oncology, Volume 77
Author(s): F. De Felice, M. de Vincentiis, V. Luzzi, G. Magliulo, M. Tombolini, G. Ruoppolo, A. Polimeni
In head and neck cancer (HNC) scenario, newer radiotherapy (RT) techniques, such as intensity modulated RT (IMRT), aim to reduce acute and late toxicity without impair tumor response and loco-regional control rates. However, late radiation-associated dysphagia (RAD) remains a major clinical problem and has gained a growing importance in the last few years, especially due to human papilloma virus (HPV)-related HNC favorable prognosis.The aim of this review was to provide clinical information about late RAD. The main anatomical structures involved in swallowing were described, in order to define potential organ at risk and available radiation-dose constraints in IMRT plan. Finally, possible rehabilitation strategies were proposed. This is expected to represent an opportunity for improved multidisciplinary management in HNC patients.



http://ift.tt/2CAP0EP

Reader performance in the ultrasonographic evaluation of oropharyngeal carcinoma

Publication date: February 2018
Source:Oral Oncology, Volume 77
Author(s): Farhoud Faraji, Ericka S. Padilla, Dana Blitz, Meghan B. Wenderoth, Ray G. Blanco, Satomi Kawamoto, Sheila Sheth, Ulrike M. Hamper, Carole Fakhry
ObjectiveTo examine reader performance in evaluating oropharyngeal anatomy on ultrasonography.Materials and methodsUltrasound images of the oropharynx comprising normal and malignant anatomic variants were organized into slideshows. Slideshows were administered to 6 readers blinded to participant tumor status and with varying experience reading oropharyngeal sonograms. A training slideshow oriented readers to images of the oropharynx with and without malignant lesions. Readers then evaluated images in a test slideshow for tumor presence and marked orthogonal long and short dimensions of the tumor. Results were analyzed for accuracy, sensitivity, specificity, inter-reader agreement, and measurement error relative to prospectively-identified reference measurements.ResultsEighty-seven percent of base of tongue (BOT) sonograms were identified correctly by a majority of readers. In identifying BOT tumors, median accuracy, sensitivity, specificity, and Fleiss's kappa were 79%, 73%, 85%, and 0.51, respectively. Median measurement error in the long and short axes for BOT tumors was −2.6% (range: −40% to 29%) and −2.6% (range: −56% to 156%), respectively. Eighty-four percent of palatine tonsil sonograms were identified correctly by a majority of readers. In identifying tonsil tumors, median accuracy, sensitivity, specificity, and Fleiss's kappa were 77%, 74%, 78%, and 0.41, respectively. Median measurement error in the long and short axes for tonsil tumors was 3.8% (range: −45% to 32%) and −6.5% (range: −83% to 42%), respectively.ConclusionsOverall, US has clinically useful sensitivity for identification of oropharyngeal carcinoma among readers of diverse clinical backgrounds and experience. US may be useful for the evaluation of features such as tumor dimensions.



http://ift.tt/2CoL5r5

Mandibular reconstruction

Publication date: February 2018
Source:Oral Oncology, Volume 77
Author(s): Kiran Kakarala, Yelizaveta Shnayder, Terance T. Tsue, Douglas A. Girod
Mandibular reconstruction presents unique functional and aesthetic challenges to the reconstructive surgeon. This review will cover current techniques for mandibular reconstruction, including the various plating strategies for rigid fixation, the choice of osseous donor site, and the concurrent reconstruction of associated soft tissue defects. Recent developments and future horizons in mandibular reconstruction including the use of virtual surgical planning and tissue engineering will also be addressed.



http://ift.tt/2CDOBRN

Commentary on letter to the editor on manuscript “Image analysis of interarytenoid area to detect cases of Laryngopharyngeal Reflux: An objective method”

We would like to thank Dr. Lechien and his team for their interest in our article and are grateful to them for their analysis. We would now take this opportunity to comment on their observations.

http://ift.tt/2CGa4dD

A rare presentation of congenital syphilis: Pemphigus syphiliticus in a newborn infant with extensive desquamation of the extremities

Abstract

Congenital syphilis is an infection transmitted from mother to fetus and can present with early but variable cutaneous manifestations. In rare situations, a bullous eruption known as pemphigus syphiliticus may develop. We present an unusual case of broad desquamation of the extremities in a newborn infant who was found to have congenital syphilis. Pemphigus syphiliticus should be considered in the differential diagnosis of neonatal bullous eruptions and erosions.

http://ift.tt/2CTFJFC

Wound infection after inpatient pediatric skin biopsy

Abstract

Punch and shave biopsies are important dermatologic procedures in the inpatient setting but have a risk of wound infection. Data on the incidence of infection in this setting are limited and conflicting. This retrospective study of 127 pediatric inpatients at two tertiary care centers who underwent biopsy demonstrated a low overall risk of infection (n = 1, 0.8%). Twenty-five (19.7%) were neutropenic, and 51 (40.2%) were not taking systemic antibiotics at the time of biopsy; none of these patients developed a wound infection. The overall low rate of infection should reassure physicians who are balancing the risks and benefits of performing a skin biopsy in children in the inpatient setting and suggests that physicians should not defer clinically indicated biopsies because of concern about infection.

http://ift.tt/2Cr4sQw

Rapid, successful treatment of atopic dermatitis recalcitrant to topical corticosteroids

Abstract

Atopic dermatitis is responsive to midpotency topical corticosteroids, which are the mainstay of treatment, yet many patients have disease that is "resistant" to triamcinolone prescribed for outpatient use. Such resistance is often due to poor adherence, but patients and caregivers may remain adamant that the steroid was ineffective and assure the physician that it was applied as recommended. We describe the case of a young girl with a 2-year history of atopic dermatitis resistant to triamcinolone whose condition rapidly improved with continued use of triamcinolone. Our case raises the ethical dilemma of whether physicians should base treatment plans on what patients report or what evidence on adherence suggests.

http://ift.tt/2CUuhJB

Lost in Translation: Caring for Limited English Proficiency Patients

http://ift.tt/2m0DdpR

Combination of ligation and timolol before surgical excision of pyogenic granuloma

http://ift.tt/2lYNUZT

Predictive value of basal cell carcinoma biopsies with negative margins: A retrospective cohort study

Pathology reports of basal cell carcinoma (BCC) biopsies often contain comments of positive or negative margins, with only 1-2% of the margin evaluated. The negative predictive value (NPV) of biopsy margin status on residual BCC is unknown.

http://ift.tt/2qo3Mto

“Sweetheart, you should have that looked at”: Ethical Implications of Treating Family Members

http://ift.tt/2lYVljJ

The Vitiligo Extent Score (VES) and the VESplus are responsive instruments to assess global and regional treatment response in patients with vitiligo

http://ift.tt/2lXK1EG

Subsequent non-melanoma skin cancers and impact of immunosuppression in liver transplant recipients

Non-melanoma skin cancers (NMSC) are the most frequent cancers in solid organ transplant recipients, with a high rate of subsequent tumors.

http://ift.tt/2lWF7HX

Management Strategies of Academic Pigmented Lesion Clinic Directors in the United States

http://ift.tt/2qoae3z

Malignancy-associated Dermatomyositis: Retrospective Case-Control Study From a Single Tertiary Care Center

http://ift.tt/2qq6dvt

Progression of undiagnosed cutaneous lymphoma after anti-tumor necrosis factor alpha therapy

Cutaneous lymphoma (CL) diagnosed after anti-tumor necrosis factor (TNF)α therapy has been reported in the literature, yet a clear link between both events remains elusive.

http://ift.tt/2lWsPPM

Is there a doctor onboard? The ethical conundrum of a specialist asked to provide in-flight medical assistance

http://ift.tt/2qplf4S

Dermatology faculty and residents’ perspectives on the dermatology residency application process: A nationwide survey

http://ift.tt/2qlcaK8

The association between dermoscopic features and BRAF mutational status in cutaneous melanoma: significance of the blue-white veil

The genetic basis of melanoma affects its clinicopathological characteristics and increasingly influences its management. BRAF-mutated melanoma may present with specific dermoscopic features.

http://ift.tt/2qpEnzz

Efficacy and safety of switching to ixekizumab in secukinumab non-responders with plaque psoriasis: a multicenter retrospective study of interleukin (IL)-17A antagonist therapies

http://ift.tt/2lWsMU6

TOPICAL CHLORHEXIDINE, POVIDONE-IODINE AND ERYTHROMYCIN IN THE REPAIR OF TRAUMATIC ULCERS ON THE RAT TONGUE: CLINICAL, HISTOLOGICAL AND MICROBIOLOGICAL EVALUATION

Publication date: Available online 4 January 2018
Source:Archives of Oral Biology
Author(s): Dieni da Silveira Teixeira, Maria Antonia Zancanaro de Figueiredo, Karen Cherubini, Maria Claudia Rosa Garcia, Sílvia Dias de Oliveira, Fernanda Gonçalves Salum
ObjectiveThis study investigated the effect of topical application of 0.12% chlorhexidine, 10% povidone-iodine and 50% erythromycin on the optimization of healing process of traumatic ulcers made on ventral tongue of rats.DesignForty-Eight Wistar rats were randomly divided into four groups: control, chlorhexidine (Chx), povidone-iodine (PvI) and erythromycin (Er). An ulcer of 5 mm in diameter was made on the ventral tongue of the animals. After 24 h, a microbiological sample was taken and daily application of the substances started. Six animals each group were euthanized at 4 days and the others at 8 days postoperative, totaling three and seven days of treatment. Prior to euthanasia, a new microbiological collection was performed.ResultsThe experimental groups showed less area of residual ulcer. A significant difference was seen between the PvI and Chx in relation to the control after three days of treatment (p<0.05). Although the experimental groups displayed greater newly formed epithelial area, there was no significant difference compared to the control (p>0.05). Er exhibed the lowest inflammation scores after seven days of treatment (p = 0.05). PvI showed reduction of microorganisms at both times and under aerobic (p < 0.01 at 3 days and p < 0.001 at 7 days) and microaerophilic (p<0.05) conditions. Er significantly reduced the count of microorganisms in aerobic condition when compared to control group (p<0.05 at 3 days and p<0.01 at 7 days).ConclusionsAll drugs promoted reduction of the microorganisms at the site of the injury, which may have a direct effect on the tissue repair process.



http://ift.tt/2EW6z0d

Association between developmental defects of enamel and celiac disease: A meta-analysis

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Débora Souto-Souza, Maria Eliza da Consolação Soares, Vanessa Silva Rezende, Paulo César de Lacerda Dantas, Endi Lanza Galvão, Saulo Gabriel Moreira Falci
ObjectivesStudies have observed the presence of extra-intestinal manifestations of celiac disease (CD), including involvement of the oral cavity, such that developmental defects of enamel (DDE) occur. Thus, the aim of this review was to access the polled prevalence of DDE in individuals with CD, and to establish the strength of the association between these two variables.MethodsTo carry out the systematic review, four electronic databases and the Grey Literature were searched, complemented by a manual search of reference lists within the selected articles. Two pairs of independent reviewers selected the articles, and perform the data extractions and bias risk assessment Studies evaluating the presence of DDE in individuals with CD as well as in healthy individuals and which performed the DDE diagnosis by direct visualization of tooth enamel changes and the CD diagnosis were included. Meta-analyses were performed using the software R.ResultsOf 557 studies, 45 were selected for review, encompassing 2840 patients. The prevalence of DDE in people with CD was 50% (95% CI 0.44–0.57, I² = 88%). In a general analysis, it was observed that patients with CD had a significantly higher prevalence of enamel defects compared to healthy people (RR: 2.31, 95% CI: 1.71–3.12, I² = 98%). Only developmental defects of enamel diagnosed using Aine's method were associated with the disease (RR: 3.30, 95% CI 2.39–4.56, I² = 75%). In a sensitivity analysis involving the deciduous, mixed and permanent dentitions, only individuals with deciduous dentition were observed to have association with the disease (RR: 2.34, 95% CI 1.25–4.39, I² = 39%).ConclusionsPatients with enamel developmental defects should be screened for the possibility of their having celiac disease.



http://ift.tt/2E64NZm

Histological and chemical analyses of mesiodens development and mineralization

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Awady Muhamad, Moskovitz Moti, Cohen Ornit, Zilberman Uri
ObjectiveThis study aimed to compare the developmental timing and mineralization quality of mesiodentes, i.e., supernumerary teeth located mainly in the midline of the maxilla between the central incisors, with the developmental timing and mineralization quality of permanent and primary central incisors.DesignSixteen mesiodentes, nine permanent and seven primary central incisors were collected. The location of the neonatal line was determined using a light microscope at 10× or 20× enlargements. Chemical composition of the enamel at two locations was analyzed using energy dispersive X-ray spectrometer.ResultsNeonatal lines were observed in eight out of 16 mesiodentes, in all primary central incisors and in none of the permanent central incisors. Chemical analyses showed that mesiodentes mineralization was impaired, resulting in higher amount of organic ions and reduced inorganic ions. Discriminant analysis showed minimal overlap of mesiodentes with either primary or permanent centrals.ConclusionsMesiodentes development begins before birth in 50% of the cases but later than the primary centrals. Mineralization of mesiodens is impaired with less mineral content and higher organic content. The results showed that mesiodentes are a special group of teeth with defective morpho-differentiation and mineralization, with little similarity to primary or permanent central incisors.



http://ift.tt/2EWFv0V

TOPICAL CHLORHEXIDINE, POVIDONE-IODINE AND ERYTHROMYCIN IN THE REPAIR OF TRAUMATIC ULCERS ON THE RAT TONGUE: CLINICAL, HISTOLOGICAL AND MICROBIOLOGICAL EVALUATION

Publication date: Available online 4 January 2018
Source:Archives of Oral Biology
Author(s): Dieni da Silveira Teixeira, Maria Antonia Zancanaro de Figueiredo, Karen Cherubini, Maria Claudia Rosa Garcia, Sílvia Dias de Oliveira, Fernanda Gonçalves Salum
ObjectiveThis study investigated the effect of topical application of 0.12% chlorhexidine, 10% povidone-iodine and 50% erythromycin on the optimization of healing process of traumatic ulcers made on ventral tongue of rats.DesignForty-Eight Wistar rats were randomly divided into four groups: control, chlorhexidine (Chx), povidone-iodine (PvI) and erythromycin (Er). An ulcer of 5 mm in diameter was made on the ventral tongue of the animals. After 24 h, a microbiological sample was taken and daily application of the substances started. Six animals each group were euthanized at 4 days and the others at 8 days postoperative, totaling three and seven days of treatment. Prior to euthanasia, a new microbiological collection was performed.ResultsThe experimental groups showed less area of residual ulcer. A significant difference was seen between the PvI and Chx in relation to the control after three days of treatment (p<0.05). Although the experimental groups displayed greater newly formed epithelial area, there was no significant difference compared to the control (p>0.05). Er exhibed the lowest inflammation scores after seven days of treatment (p = 0.05). PvI showed reduction of microorganisms at both times and under aerobic (p < 0.01 at 3 days and p < 0.001 at 7 days) and microaerophilic (p<0.05) conditions. Er significantly reduced the count of microorganisms in aerobic condition when compared to control group (p<0.05 at 3 days and p<0.01 at 7 days).ConclusionsAll drugs promoted reduction of the microorganisms at the site of the injury, which may have a direct effect on the tissue repair process.



http://ift.tt/2EW6z0d

Association between developmental defects of enamel and celiac disease: A meta-analysis

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Débora Souto-Souza, Maria Eliza da Consolação Soares, Vanessa Silva Rezende, Paulo César de Lacerda Dantas, Endi Lanza Galvão, Saulo Gabriel Moreira Falci
ObjectivesStudies have observed the presence of extra-intestinal manifestations of celiac disease (CD), including involvement of the oral cavity, such that developmental defects of enamel (DDE) occur. Thus, the aim of this review was to access the polled prevalence of DDE in individuals with CD, and to establish the strength of the association between these two variables.MethodsTo carry out the systematic review, four electronic databases and the Grey Literature were searched, complemented by a manual search of reference lists within the selected articles. Two pairs of independent reviewers selected the articles, and perform the data extractions and bias risk assessment Studies evaluating the presence of DDE in individuals with CD as well as in healthy individuals and which performed the DDE diagnosis by direct visualization of tooth enamel changes and the CD diagnosis were included. Meta-analyses were performed using the software R.ResultsOf 557 studies, 45 were selected for review, encompassing 2840 patients. The prevalence of DDE in people with CD was 50% (95% CI 0.44–0.57, I² = 88%). In a general analysis, it was observed that patients with CD had a significantly higher prevalence of enamel defects compared to healthy people (RR: 2.31, 95% CI: 1.71–3.12, I² = 98%). Only developmental defects of enamel diagnosed using Aine's method were associated with the disease (RR: 3.30, 95% CI 2.39–4.56, I² = 75%). In a sensitivity analysis involving the deciduous, mixed and permanent dentitions, only individuals with deciduous dentition were observed to have association with the disease (RR: 2.34, 95% CI 1.25–4.39, I² = 39%).ConclusionsPatients with enamel developmental defects should be screened for the possibility of their having celiac disease.



http://ift.tt/2E64NZm

Histological and chemical analyses of mesiodens development and mineralization

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Awady Muhamad, Moskovitz Moti, Cohen Ornit, Zilberman Uri
ObjectiveThis study aimed to compare the developmental timing and mineralization quality of mesiodentes, i.e., supernumerary teeth located mainly in the midline of the maxilla between the central incisors, with the developmental timing and mineralization quality of permanent and primary central incisors.DesignSixteen mesiodentes, nine permanent and seven primary central incisors were collected. The location of the neonatal line was determined using a light microscope at 10× or 20× enlargements. Chemical composition of the enamel at two locations was analyzed using energy dispersive X-ray spectrometer.ResultsNeonatal lines were observed in eight out of 16 mesiodentes, in all primary central incisors and in none of the permanent central incisors. Chemical analyses showed that mesiodentes mineralization was impaired, resulting in higher amount of organic ions and reduced inorganic ions. Discriminant analysis showed minimal overlap of mesiodentes with either primary or permanent centrals.ConclusionsMesiodentes development begins before birth in 50% of the cases but later than the primary centrals. Mineralization of mesiodens is impaired with less mineral content and higher organic content. The results showed that mesiodentes are a special group of teeth with defective morpho-differentiation and mineralization, with little similarity to primary or permanent central incisors.



http://ift.tt/2EWFv0V

Correlation between pain and MRI findings in TMD patients

Magnetic resonance imaging has been established as the gold standard for assessment of the temporomandibular joint. Apart from an excellent assessment of the soft tissues it has the advantage not to expose the patient to ionizing radiation. There is a lack of literature concerning the correlation between pain intensity and radiological findings of the temporomandibular joint. Moreover there is the question of whether a progressive degeneration of the cartilaginous components is accompanied by an increasing degeneration of the osseous parts of the mandibular joint and vice versa.

http://ift.tt/2EX71LO

Histo-morphologic characteristics of intra-osseous implants of WE43 Mg alloys with and without heat treatment in an in vivo cranial bone sheep model

WE43 Mg alloy, composed of Mg, Yttrium, Rare Earth elements, and Zirconium, has proved to be a suitable candidate for production of resorbable osteosynthesis implants in both clinical and experimental settings. In a previous study we tested biocompatibility and degradation properties of untreated (as-cast) and artificially aged (T-5) WE43 Mg-alloys as subperiosteal implants on a maxillofacial sheep model. Both the alloy compositions showed excellent biocompatibility, however, with respect to degradation rate, the as-cast form showed increased degradability compared with the T-5.

http://ift.tt/2E7pGDd

“National Trends in Tongue Reduction Surgery for Macroglossia in Children”

1. To examine the frequency of partial glossectomy performed for the indication of macroglossia in children within the United States, assessing for differences in rates of intervention across various demographics. 2. To identify potential morbidities associated with partial glossectomy in this population and determine how such factors may influence length of stay and cost of admission following tongue reduction surgery.

http://ift.tt/2EX70aI

Unilateral Nasal Obstruction

A woman presented with constant right-sided nasal obstruction; computed tomographic scan showed complete opacification of the right paranasal sinuses with mass effect on the medial maxillary wall with mild hyperostosis posterolaterally. What is your diagnosis?

http://ift.tt/2yzumBT

A Possible Association Between Hearing Loss and Zika Virus Infections

This Viewpoint summarizes what is currently known about Zika virus infection associated with hearing loss in both children and adults and points out areas where further research is needed.

http://ift.tt/2xQifwU

Jan 2018 Issue Highlights

http://ift.tt/2lWQU8V

Tonsillectomy for Obstructive Sleep-Disordered Breathing or Recurrent Throat Infection in Children

This Viewpoint summarizes key findings of the 2017 comparative effectiveness review from the Agency for Healthcare Research and Quality on tonsillectomy for obstructive sleep-disordered breathing or recurrent throat infection in children.

http://ift.tt/2yzBMp0

Unusual Cause of Recurrent Meningitis

This case report describes a synchronous cerebrospinal fluid fistulae through the oval and round window membranes in a patient with recurrent meningitis.

http://ift.tt/2hwsHUk

The Epidemic of Guns

The shooting in Las Vegas, Nevada, that left 59 people dead, 10 times that number wounded, and thousands of people with the psychological distress from being present at the scene during and after the massacre has once again raised the issue of what we as a nation can and should do about guns. The solution lies in not just focusing on Las Vegas and the hundreds of other mass shootings that have occurred in the United States in the last 14 months, but rather to underscore that on average almost 100 people die each day in the United States from gun violence. The 36 252 deaths from firearms in the United States in 2015 exceeded the number of deaths from motor vehicle traffic crashes that year (36 161). That same year, the US Centers for Disease Control and Prevention reported that 5 people died from terrorism. Since 1968, more individuals in the United States have died from gun violence than in battle during all the wars the country has fought since its inception.

http://ift.tt/2yzJBLb

Frontal Sinus Drug-Eluting Implants—Effective, but for Which Patients and at What Cost?

Surgical intervention for chronic rhinosinusitis (CRS) is an important treatment option for patients refractory to medical therapy. Despite advances in surgical techniques and operative technology, revision endoscopic sinus surgery (ESS) is necessary in 6% to 19% of patients. Reasons for revision surgery include scarring and adhesion formation, recurrent polyposis, and persistent inflammation. These issues are especially problematic in the frontal recess given the narrow anatomic boundaries that limit the size of the surgical sinusotomy that can be created. Long-term patency rates are reported in the range of 67% to 92%. Attempts to improve the success of frontal sinus surgery by decreasing scarring and inflammation have been long standing and a variety of stenting options exist. Recent advancements in bioabsorbable and drug-eluting stents provide a new possibility for improving postoperative sinus surgery outcomes.

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Outcomes After Transoral Robotic Surgery for Oropharyngeal Cancer

This study compares functional speech, swallowing, and quality-of-life outcomes between patients with oropharangeal cancer who underwent transoral robotic surgery onlyand those who underwent transoral robotic surgery and received adjuvant radiotherapy or chemoradiotherapy.

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Worsening Respiratory Distress in a 7-Month-Old Infant

A 7-month-old male presented with noisy breathing; he fed poorly from the bottle with frequent choking, grunting, and irritability; nasopharyngolaryngoscopy showed no laryngomalacia, laryngeal lesions, or cord paralysis. What is your diagnosis?

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Bioabsorbable Steroid-Releasing Implant in the Frontal Sinus After Endoscopic Sinus Surgery

This randomized clinical trial assess the safety and efficacy of an hourglass-shaped, bioabsorbable, steroid-releasing sinus implant in improving postoperative outcomes when placed in the frontal sinus ostia following endoscopic sinus surgery in patients with chronic rhinosinusitis.

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Treatment of Acute Upper Airway Obstruction—Reply

In Reply We are delighted that Dr Deeb and his colleagues see applicability for use with adults as well as children of our 10 commandments for management of acute upper airway obstruction. Hopefully, our 10 rules have validity based on many years of collective experience, and we know that few otolaryngologists have more experience or wisdom than Dr Ziad Deeb. So, we agree that heart rate should be monitored closely as an indicator of changes in severity of upper airway obstruction and we fully agree that vertical incision for tracheotomy is the quickest and safest kind of incision to make.

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Hypoglossal Nerve Stimulation for Children With Down Syndrome and Sleep Apnea

This case series examines whether hypoglossal nerve stimulation is safe and effective in children with Down syndrome and obstructive sleep apnea.

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Risk of Venous Thromboembolism Among Otolaryngology Patients

This cohort study examines the rate of venous thromboembolism for various otolaryngology procedures compared with an established average-risk field (general surgery) and low-risk field (plastic surgery).

http://ift.tt/2l0oyN9

Association Between Head and Neck Squamous Cell Carcinoma Survival, Smoking at Diagnosis, and Marital Status

This cohort study examines the association between survival and smoking status at the time of diagnosis of head and neck squamous cell carcinoma and the association between marital status and smoking in these same patients.

http://ift.tt/2zuhHRA

Rethinking the Growth Pattern of Thyroid Cancer in Young Patients Based on the Fukushima Database

In response to public concern over radiation exposure after the Fukushima Daiichi nuclear power plant accident of March 11, 2011, the Health Survey of Fukushima Prefecture offered thyroid ultrasonography screening to the 360 000 residents 18 years or younger living in the prefecture at the time of the accident. Approximately 300 000 patients underwent preliminary screening in the 2011 to 2013 period during which radiation effects on thyroid nodules development were expected to be nonexistent. Approximately 2000 individuals in the initial screening met criteria for subsequent screening and approximately 550 of those met criteria for fine-needle biopsy. With biopsy results, approximately 110 patients were identified with cancer or suspected cancer and most of these patients underwent surgery. Consistent with published series of pediatric thyroid cancer, the majority of pathologic diagnoses were papillary carcinoma. The prevalence of carcinoma in this largest-to-date pediatric screening series was 37 cases per 100 000 patients—a number far larger than expected from previous published estimates of pediatric thyroid carcinoma. The overall radiation exposure from the Fukushima accident was much less than that from the Chernobyl accident in 1986 and the high incidence of carcinoma detected was believed to be a result of the unprecedented scope of the ultrasonography screening program rather than from any radiation effects. These findings potentially create cancer risk anxiety in the affected region and possibly imply that a significant proportion of pediatric well-differentiated thyroid carcinomas become dormant or quiescent and never present with clinical disease.

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Weaning Children With Aspiration From Thickened Fluids

This case series describes the experience of a systematic weaning process in children who received thickened liquids due to oropharyngeal dysphagia and identified risk of aspiration.

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Aggressive-Appearing Pediatric Parotid Mass

A young boy had an enlarging right facial mass; a computed tomographic scan showed a discrete necrotic mass in the right parotid gland, and fine-needle aspirate yielded a cellular sample with spindloid features. What is your diagnosis?

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Analysis of the Growth Pattern of Thyroid Cancer in Young Patients

This observational study evaluates the change in diameter and volume of malignant thyroid tumors in children after a nuclear accident in Fukushima, Japan.

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Association of Treatment at High-Volume Facilities With Survival in Nasopharyngeal Cancer

Using the National Cancer Database, this study examines the association of treatment at high-volume facilities with survival in patients receiving chemotherapy for nasopharyngeal cancer.

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Hearing Difficulty in the United States

This survey study analyzes the epidemiologic features and treatment patterns of hearing difficulty in the United States using data from responses from the 2014 National Health Interview Survey.

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Stem Cell Transplant Improves Severe Scleroderma Survival

Among patients with severe scleroderma, stem cell transplant significantly improved survival compared with cyclophosphamide but was associated with higher mortality and short-term side effects, a study found.
Medscape Medical News

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Scalpel Versus Diathermy In Wound Healing Following Mucosal Incisions: A Split Mouth Study

Publication date: Available online 4 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): P U Abdul Wahab, Madhulaxmi Marimuthu, Senthil Nathan Periyasamy, Muthusekhar Marimuthu Ramaswamy, Yogaen Vohra, Abhinav Rajendra Prabhu
AimThe aim of this study was to analyse and compare the healing of scalpel and diathermy incision wounds in oral mucosa.MethodsThis is a prospective split-mouth study conducted from January 2015 to April 2017 among patients undergoing either Lefort 1 or anterior maxillary osteotomy or both. The study groups were classified based on the different techniques used to make the incision [Group A, incision made by scalpel; Group B, incision made by diathermy]. The wound healing was assessed on the 1^st, 3^rd, 7^th and 10^th postoperative days using the Southampton scoring system. Data was statistically analysed using student's t-test for continuous variables, χ² test for categorical variables and a p value < 0.05 was considered significant.ResultsOf the 113 participants who were included in the study, the age range was between 16 and 35 years and 50.4 % were men. Post-operative complications of wound healing were 68.1% (n=77) and 77% (n=87) in group A and group B respectively. Wound healing showed statistical significant difference between both techniques (p<0.001).ConclusionThe findings of the present study suggest that wound caused by scalpel incisions healed better than that compared to diathermy incisions in the oral mucosa.



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Review of HaNDLE-on-QoL: a database of published papers that use questionnaires to report quality of life in patients with cancer of the head and neck

Publication date: Available online 3 January 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): R.J. Wotherspoon, A.N. Kanatas, S.N. Rogers
HaNDLE-on-QoL (Head And Neck Database Listing Evidence on QoL) is a searchable database that comprises abstracts of papers that have used questionnaires to report on quality of life (QoL) in patients with cancer of the head and neck. It can be searched by title, first author, year of publication, words used in the abstract, site of cancer, study design, and questionnaires used. The aim of this paper was to summarise its contents. In May 2017 we searched the website using the criteria above. It contained 1498 papers (including 149 reviews), and the number is increasing each year. Most studies concerned a combination of subsites in the head and neck (n=871); 180 focused specifically on oral sites, and 109 on the larynx. The commonest topics were swallowing (n=353), speech (n=299), pain (n=292), emotions (n=226), and depression (n=193). Nearly all the papers concerned function or predictors of health-related QoL (HRQoL), but 98 were clinical or randomised controlled trials. The site included over 250 questionnaires of which the most common were the European Organisation for Research and Treatment of Cancer C30 (EORTC-C30, n=369), the EORTC-head and neck 35 (EORTC H&N35, n=353), and the University of Washington Quality of Life (UWQoL) (n=276). HaNDLE-on-QoL highlights the complexity of QoL after treatment and the diversity and range of the studies. It is a useful point of reference for those involved in clinical practice or research.



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Concentric, double-puncture arthrocentesis using unwelded Y-shaped needle

Publication date: Available online 3 January 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S.H. Mun, J.K. Kang, Y.J. Shim, B.C. Kim




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Cosmetic facial surgery: are online resources reliable and do patients understand them?

Publication date: Available online 4 January 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): D.H. Awal, C. Mills
Our aim was to assess the quality and readability of online resources regarding common cosmetic maxillofacial procedures. We searched Google for "rhytidectomy", "rhinoplasty", "orthognathic surgery", "genioplasty", "malar implants", "blepharoplasty", "otoplasty", and related terms. In each case we assessed the top 50 results for quality and readability. Quality was measured using the DISCERN questionnaire, benchmark criteria published by the Journal of the American Medical Association (JAMA), and accreditation by the HONcode (Health On the Net code). The Flesch-Kincaid reading grade, Flesch reading ease score, Gunning's fog index, and the Coleman-Liau index, were used to measure readability. A total of 350 sites were assessed and 200 were included in the study. The mean (SD) JAMA and DISCERN scores for all included websites indicated poor quality (0.49/4 (1.07) and 32.77/80 (10.57), respectively). Only eight sites (4%) were certified by the HONcode. There was a significant association between low DISCERN scores and Google Ads (p=0.009) and between low DISCERN scores and the websites of private clinicians or hospitals (p<0.001). The mean (SD) Flesch reading ease score and Gunning's fog score both indicated poor readability that required a moderately high level of literacy (50.59 (11.82) and 13.83 (2.76), respectively). The Flesch-Kincaid and Coleman-Liau scores indicated similar results. Adherence to the JAMA benchmark, certification by the HONcode, and relevant selection on Google Ads would improve quality. The avoidance of medical jargon and use of shorter sentences would improve readability and provide patients with comprehensible explanations that would allow them to have realistic expectations and take responsibility for their own health.



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Histo-morphologic characteristics of intra-osseous implants of WE43 Mg alloys with and without heat treatment in an in vivo cranial bone sheep model

Publication date: Available online 4 January 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Andrea Torroni, Chongchen Xiang, Lukasz Witek, Eduardo D. Rodriguez, Roberto L. Flores, Nikhil Gupta, Paulo G. Coelho
WE43 Mg alloy, composed of Mg, Yttrium, Rare Earth elements, and Zirconium, has proved to be a suitable candidate for production of resorbable osteosynthesis implants in both clinical and experimental settings. In a previous study we tested biocompatibility and degradation properties of untreated (as-cast) and artificially aged (T-5) WE43 Mg-alloys as subperiosteal implants on a maxillofacial sheep model. Both the alloy compositions showed excellent biocompatibility, however, with respect to degradation rate, the as-cast form showed increased degradability compared with the T-5. In the present study, we tested the same alloy composition (i.e. as-cast and T-5) to assess their biological behavior and degradation pattern when implanted as endosteal implants on a calvarial bone sheep model. Six implants in form of cilindrical discs were tested in 6 sheep, one per composition of each disc was placed in two monocortical cranial defect created with high speed trephine bur in the parietal bone. After euthanasia at 6 weeks histomorphological analysis of the bone/implant specimens was performed. WE43-as cast showed higher degradation rate, increased bone remodeling, gas pockets formation and osteolysis compared with the T5 alloy. WE43-T5 showed greater bone/implant interface stability, and seemed to be more suitable for fabrication of endosteal bone screws.



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Correlation between pain and MRI findings in TMD patients

Publication date: Available online 4 January 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Matthias C. Wurm, Tessa K. Behrends, Wüst Wolfgang, Marco Wiesmüller, Andre Wilkerling, Friedrich W. Neukam, Tilo Schlittenbauer
IntroductionMagnetic resonance imaging has been established as the gold standard for assessment of the temporomandibular joint. Apart from an excellent assessment of the soft tissues it has the advantage not to expose the patient to ionizing radiation. There is a lack of literature concerning the correlation between pain intensity and radiological findings of the temporomandibular joint. Moreover there is the question of whether a progressive degeneration of the cartilaginous components is accompanied by an increasing degeneration of the osseous parts of the mandibular joint and vice versa. Therefore, this study aims at analyzing correlations between pain and radiological findings. Furthermore, the link between osseous and cartilaginous degeneration is studied.Materials and methods91 patients who attend our outpatient clinic for temporomandibular disorders are included in this prospective study. Apart from a detailed anamnesis and clinical examination – adapted to the Research Diagnostic Criteria for Temporomandibular Disorders –magnetic resonance imaging of both mandibular joints is performed. Pain intensity is measured using the visual analogue scale. To assess and grade the radiological findings a classification system is established. The evaluation of the osseous components is based on the classification of osteoarthritis by Kellgren and Lawrence whereas the rating of the cartilaginous components is adapted to the Research Diagnostic Criteria for Temporomandibular Disorders. Correlations are verified by Spearman-Rho.Results83,5% of all patients are female. Most of the time, both sides are affected (47.25%). Women state an average pain of 5.7 (±2.4), men 3.5 (±2. 5). 182 discs are examined and assessed with our classification system. Most discs (n = 71) show no pathological changes. The majority of patients show no dislocation (n = 104). The most common forms of dislocation are anterior dislocations (n = 51). The majority of patients show no changes in the osseous component (n = 115). Weak to moderate correlations are found between disc and bone degeneration. Moderate to strong correlations are found between left and right TMJ.ConclusionsThe classification system which is designed and applied during the study proves to be a reliable and practical Instrument. A standardized evaluation of pathologies concerning the temporomandibular joint is possible by using this system. Numerous patients attending our outpatient clinic do not show any signs of degenerative dysfunctions in the mandibular joints. Degenerations of the osseous components tend to be connected with degenerations of the cartilaginous components and vice versa. The question remains if in the future new procedures in imaging will be able to record pathologies not yet detected.



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“National Trends in Tongue Reduction Surgery for Macroglossia in Children”

Publication date: Available online 4 January 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Jonathan C. Simmonds, Anju K. Patel, Nicholas S. Mader, Andrew R. Scott
Objectives1. To examine the frequency of partial glossectomy performed for the indication of macroglossia in children within the United States, assessing for differences in rates of intervention across various demographics. 2. To identify potential morbidities associated with partial glossectomy in this population and determine how such factors may influence length of stay and cost of admission following tongue reduction surgery.Study DesignRetrospective cross-sectional study.SettingThe Kids' Inpatient Database 2003, 2006, 2009, and 2012.SubjectsPatients under age 5 diagnosed with macroglossia who underwent partial glossectomy.MethodsDemographics were analyzed and cross tabulations, linear regression modeling, and multivariate analysis were performed.ResultsDuring the four-years studied, partial glossectomy was performed in 196 children under age 5 with macroglossia. A disproportionately higher rate of intervention was seen in white children (p=0.001), patients undergoing surgery in the mid-west (p<0.001) and patients in the highest socioeconomic quartile (p=0.015). Most patients underwent glossectomy in their second year of life. The average length of stay in patients who underwent partial glossectomy for macroglossia was 9.59 days (Range 1-211 days, median 3.45 days) and the average cost was $56,602 (median $16,330).ConclusionPartial glossectomy for macroglossia is typically performed prior to age 2 in the United States. A higher rate of intervention is seen in white children, those who have surgery in the mid-west and affluent children even when controlling for confounding variables.



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The first report of a 5-year period cancer registry in Greece (2009–2013): a pathology-based cancer registry

Abstract

Cancer registries are essential in health care, since they allow more accurate planning of necessary health services and evaluation of programs for cancer prevention and control. The Hellenic Society of Pathology (HSP) having recognized the lack of such information in Greece has undertaken the task of a 5-year pathology-based cancer registry in Greece (2009–2013). In this study, > 95% of all pathology laboratories in the national health system hospitals and 100% of pathology laboratories in private hospitals, as well as > 80% of private pathology laboratories have contributed their data. The most common cancer types overall were as follows: breast cancer (18.26%), colorectal cancer (15.49%), prostate cancer (13.49%), and lung cancer (10.24% of all registered cancers). In men, the most common neoplasms were as follows: prostate cancer, colorectal cancer, lung cancer, and gastric cancer. In women, the most common neoplasms were as follows: breast cancer, colorectal cancer, thyroid cancer, and lung cancer. The data on cancer burden in Greece, presented herein, fill the void of cancer information in Greece that affects health care not only nationally but Europe-wise.

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Obstructive sleep apnoea in adults: peri-operative considerationsA narrative review

Obstructive sleep apnoea (OSA) is a common breathing disorder of sleep with a prevalence increasing in parallel with the worldwide rise in obesity. Alterations in sleep duration and architecture, hypersomnolence, abnormal gas exchange and also associated comorbidities may all feature in affected patients. The peri-operative period poses a special challenge for surgical patients with OSA who are often undiagnosed, and are at an increased risk for complications including pulmonary and cardiovascular, during that time. In order to ensure the best peri-operative management, anaesthetists caring for these patients should have a thorough understanding of the disorder, and be aware of the individual's peri-operative risk constellation, which depends on the severity and phenotype of OSA, the invasiveness of the surgical procedure, anaesthesia and also the requirement for postoperative opioids. The objective of this review is to educate clinicians in the epidemiology, pathogenesis and diagnosis of OSA in adults and also to highlight specific tasks in the preoperative assessment, namely to select a suitable intra-operative anaesthesia regimen, and manage the extent and duration of postoperative care to facilitate the best peri-operative outcome. Correspondence to Martin Roesslein, MD, University Medical Center, Department of Anesthesiology and Critical Care Medicine, Hugstetter Str. 55, D - 79106 Freiburg, Germany Tel: +49 761 270 23 470; fax: +49 761 270 23 930; e-mail: martin.roesslein@uniklinik-freiburg.de © 2018 European Society of Anaesthesiology

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An historical examination of nurse anaesthesia practice in the United States and other Group of 7 countries

Many factors determine whether nurses, physicians or both administer anaesthesia in any country. We examined the status of nurse-administered anaesthesia in the Group of 7 nations and explored how historical factors, mixing global and local contexts (such as professional relations, medical and nursing education, social status of nurses, demographics and World Wars in the 20th century), help explain observed differences. Nearly equal numbers of physicians and nurses are currently engaged in the delivery of anaesthesia care in the United States but, remarkably, although the introduction or re-introduction of nurse anaesthesia in the 20th century was attempted in all the other Group of 7 countries (except Japan), it has been successful only in France because of the cooperation with the United States during World War II. Correspondence to Sukumar P. Desai, MD, Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA E-mail: sdesai@bwh.harvard.edu © 2018 European Society of Anaesthesiology

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Self-confidence and level of knowledge after cardiopulmonary resuscitation training in 14 to 18-year-old schoolchildren: A randomised-interventional controlled prospective study in secondary schools in Germany

BACKGROUND Education of schoolchildren in cardiopulmonary resuscitation (CPR) is a strategic goal for improvement of bystander CPR in society. OBJECTIVE(S) The primary objective was to analyse the impact of CPR training on the resuscitation knowledge and self-confidence of secondary schoolchildren. In addition, independent predictors of improved CPR knowledge and self-confidence were investigated. DESIGN Prospective, randomised-interventional controlled study. SETTING Four secondary schools in Germany. PARTICIPANTS Four hundred and twenty-four schoolchildren aged from 14 to 18 years were included into the study. Fifty-one percent were female, and 33% had an immigrant background. INTERVENTION The intervention group received a 90-min CPR training session, whereas controls had no intervention. Levels of knowledge and self-confidence in initiating CPR were analysed by a study questionnaire before (t0), 90 min after (t1) and 6 months after training (t2). MAIN OUTCOME MEASURES Based on the evaluation of study questionnaires, the primary endpoint was to determine the development of resuscitation knowledge and self-confidence in initiating cardiopulmonary resuscitation at survey time-points t0, t1 and t2. RESULTS Schoolchildren in the intervention group (n=207) showed a significantly higher level of knowledge (P 

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Foodborne botulism due to ingestion of home-canned green beans: two case reports

Foodborne botulism is a life-threatening, rapidly progressive disease. It has an incidence of less than 10 cases per year in Germany and mostly affects several previously healthy people at the same time. The o...

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Treatment modalities and risk factors associated with refractory neurosensory disturbances of the inferior alveolar nerve following oral surgery: a multicentre retrospective study

Little research has been conducted into hypoesthesia, and no studies have elucidated the risk factors for refractory hypoesthesia and compared treatment modalities. The purpose of this multicentre retrospective cohort study was to investigate the relationships between various risk factors, treatment modalities, and refractory hypoesthesia. Risk factors for refractory hypoesthesia after oral surgery were evaluated using univariate and multivariate analysis. To minimize the selection bias associated with a retrospective data analysis, a propensity score analysis was performed between the medication and non-medication groups (65 sites in each group).

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Augmentation surgery on the cartilaginous portion of the vocal fold in a patient with cricoarytenoid joint ankylosis

Surgical management of cricoarytenoid joint (CAJ) ankylosis is challenging and has the risk of worsening voice quality. In the present case, augmentation surgery was performed on the cartilaginous portion of the vocal fold in a patient with CAJ ankylosis. A 24-year-old man sustained blunt trauma to the anterior neck three years prior to developing severe breathiness. Posterior glottal insufficiency resulting from lateral fixation of the right vocal fold was observed during phonation under laryngoscopy.

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Treatment for food allergy

Publication date: January 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 1
Author(s): A. Wesley Burks, Hugh A. Sampson, Marshall Plaut, Gideon Lack, Cezmi A. Akdis
Information for Category 1 CME CreditCredit can now be obtained, free for a limited time, by reading the review articles in this issue. Please note the following instructions.Method of Physician Participation in Learning Process: The core material for these activities can be read in this issue of the Journal or online at the JACI Web site: www.jacionline.org. The accompanying tests may only be submitted online at www.jacionline.org. Fax or other copies will not be accepted.Date of Original Release: January 2018. Credit may be obtained for these courses until December 31, 2018.Copyright Statement: Copyright © 2018-2019. All rights reserved.Overall Purpose/Goal: To provide excellent reviews on key aspects of allergic disease to those who research, treat, or manage allergic disease.Target Audience: Physicians and researchers within the field of allergic disease.Accreditation/Provider Statements and Credit Designation: The American Academy of Allergy, Asthma & Immunology (AAAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAAAI designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.List of Design Committee Members: A. Wesley Burks, MD, Hugh A. Sampson, MD, Marshall Plaut, MD, Gideon Lack, MB, BCh, FRCPCH, and Cezmi A. Akdis, MD (authors); Zuhair K. Ballas, MD (editor)Disclosure of Significant Relationships with Relevant CommercialCompanies/Organizations: A. W. Burks reports personal fees from NIH AITC Review Panel, Allertein, American Society for Microbiology, Elsevier, FARE, World Allergy Organization, Adept Field Solutions, Aimmune Therapeutics, Inc, Astellas Pharma Global Development, Inc, Biomerica, Inc, Evelo Biosciences, Inc/Epiva Biosciences, Inc, First Manhattan Co, Genentech, GLG Research, Inc, Insys Therapeutics, Intrommune Therapeutics, PPD Development, LP, Regeneron Pharmceuticals, Inc, Sanofi US Services, SRA International, Stallergenes, UKKO, Inc, and Valeant Pharmaceuticals North America, LLC and reports grants from Food Allergy Research and Education (FARE), National Institutes of Health, and Wallace Research Foundation. H. A. Sampson has received grants from the National Institute of Allergy and Infectious Diseases (AI-44236, CoFar, ITN); has consultant arrangements with Allertein Therapeutics, LLC, Hycor, and UCB; is Chief Scientific Officer of DBV Technologies; has received royalties from UpToDate; and has stock/stock options with DBV Technologies. G. Lack has received grants from the National Institutes of Allergy and Infectious Diseases (NO1-AI-15416 [contract] and UM1AI109565 [grant]), Food Allergy Research and Education (FARE), MRC & Asthma UK Centre, UK Department of Health through the National Institute for Health Research, the National Peanut Board, and Osem; and has consultant arrangements and stock/stock options with DBV Technologies. C. A. Akdis has received grants from Actellion, the European Union projects Medall and Predicta, Allergopharma, the Swiss National Science Foundation, and the Christine Kühne Center for Allergy Research and Education. M. Plaut declares no relevant conflicts of interest. Z. K. Ballas (editor) disclosed no relevant financial relationships.Activity Objectives:1. To understand the relative advantages and drawbacks of each of the 3 main forms of immunotherapy for food allergy (oral immunotherapy [OIT], sublingual immunotherapy [SLIT], and epicutaneous immunotherapy [EPIT]).2. To become familiar with the general protocol design for the different forms of food allergy immunotherapy.3. To know the difference in the commonly used terms in food allergy treatment: desensitization, sustained unresponsiveness, oral tolerance, and remission.Recognition of Commercial Support: This CME activity has not received external commercial support.List of CME Exam Authors: Amy CaJacob, MD, Miranda Curtiss, MD, PhD, Suthida Kankirawatana, MD, Njeri Maina, MD, PhD, Cali Reynolds, MD, and T. Prescott Atkinson, MD, PhDDisclosure of Significant Relationships with Relevant CommercialCompanies/Organizations: The exam authors disclosed no relevant financial relationships.The prevalence of IgE-mediated food allergy is an increasing public health concern effecting millions of persons worldwide. The current standard of treatment is strict avoidance of the offending food or foods, and to date, there are no regulatory approved treatments for food allergy. A significant amount of research has been directed at various forms of food immunotherapy, including oral, sublingual, and epicutaneous delivery routes. Although oral immunotherapy has shown the greatest promise for efficacy in terms of the amount of protein that can be ingested, it has also demonstrated less tolerability and a less favorable safety profile compared with sublingual immunotherapy and epicutaneous immunotherapy, which offers the least protection but has the best safety and tolerability profile. Studies have been conducted with adding adjuvants and anti-IgE to enhance either the efficacy or safety of food immunotherapy. Multiple concepts of food immunotherapy beyond these first-generation treatments are in either animal or early phase 1 studies.



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