Head and Neck Medicine by Alexandros G.Sfakianakis: 01/05/18

Παρασκευή 5 Ιανουαρίου 2018

The effects of transcutaneous low-level laser therapy on the skin healing process: an experimental model

Abstract

We aim to evaluate the action of transcutaneous laser in the initial wound healing process. The use of low-level laser therapy (LLLT) has proven to be effective on inflammatory modulation and wound healing. The trial was performed on five groups of rats, through a dorsal incision. All groups received treatment on auricular artery. Groups 1 and 3 were treated with transcutaneous LLLT over a period of 15 min. Groups 2 and 4 received one and two inactive laser applications (placebo), respectively. Group 5 was the control one. Blood samples were collected 2 h after the last application of LLLT so that cytokine levels could be measured by ELISA. Tissue fragments were harvested for morphometric, histomorphometric, and RT-qPCR analyses. The morphometric analysis revealed a greater decrease in the wounded area in G1 when compared with G2, whereas in G3, the improvement in the area was greater when compared with G4. Finally, the histomorphometric analysis showed that G1 was the group closer to G5 in terms of collagen fiber count. G2 and G4 had higher amounts of collagen fibers than G5 while G3 had a lower quantity. The use of the transcutaneous LLLT in the current study influenced the wound healing process.

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Comments concerning ‘Meta-analysis of the association between vitiligo and the level of superoxide dismutase or malondialdehyde’

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Identifying criteria for diagnosis of post-traumatic pain and altered sensation of the maxillary and mandibular branches of the trigeminal nerve: a systematic review

Publication date: Available online 5 January 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Maria Devine, Murtaza Hirani, Justin Durham, Donald R. Nixdorf, Tara Renton
Objective: To systematically identify criteria used to diagnose patients with trigeminal nerve injury. Study design: A systematic review of the literature registered in the PROSPERO database. Inclusion criteria: patients diagnosed with nerve injury of the sensory divisions of the maxillary or mandibular branches of the trigeminal nerve, with reported tests and criteria used for diagnosis and persistent pain or unpleasant sensation associated with nerve injury. Results: 28 articles included. Diagnostic tests included clinical neurosensory tests (CNT) (89%), thermal quantitative sensory testing (25%), electromyography (7%) and patient interview (14%). Neuropathic pain was assessed using visual analogue scale (39%), use of neuropathic medication (7%), questionnaires including McGill and PainDETECT (21%). Functional impact was assessed in 14% and psychological impact in 7% of articles. Methodology in performing CNT, application of diagnostic terms and diagnostic grading of nerve injury was not consistent among the included articles making direct comparison of results difficult. Conclusion: Recommendations for assessment and diagnosis of trigeminal nerve injury have been made based on the best available evidence from the review. There is an urgent requirement for a consensus in diagnostic criteria, criteria for assessment and outcome reporting between stakeholder organisations in order to progress knowledge in this field.

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KLICK syndrome: an unusual phenotype

Erythrokeratoderma refers to a group of rare inherited disorders with both clinical and genetic heterogeneities.¹ Lesions usually start in infancy and are characterized by localized and well-demarcated erythematous and hyperkeratotic plaques, sometimes with a migratory nature. Erythrokeratoderma is often inherited as an autosomal dominant trait caused by mutations in the genes GJB3, GJB4, or GJA1, encoding connexins 31, 30.3, and 43, respectively. Erythrokeratoderma may be associated with neurological anomalies and can be caused by ELOVL4.² Recently, mutations in KDSR (3-ketodihydrosphingosine reductase), encoding an enzyme in the ceramide pathway were also demonstrated to lead to erythrokeratoderma.³

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Striate palmoplantar keratoderma resulting from a missense mutation in DSG1

palmoplantar keratodermas (PPKs, OMIM #144200) refer to a large phenotypically and genetically heterogeneous group of keratinisation disorders characterised by marked hyperkeratosis on the surface of the palms and soles.

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Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a critical appraisal

Summary

Aim

Blauvelt et al. (The Lancet 2017; 389: 2287-303) aimed to compare the long-term efficacy and safety of dupilumab with medium-potency topical corticosteroids (TCS) versus placebo with TCS in adults with moderate-to-severe atopic dermatitis (AD).

Setting and design

This multicentre randomised, double-blinded, placebo-controlled trial was conducted in hospitals, clinics and academic institutions across 161 sites in 14 countries.

Study exposure

Adults with moderate-to-severe AD were randomly assigned (3:1:3) to receive subcutaneous dupilumab 300mg once weekly (qw) plus TCS, dupilumab 300mg every 2 weeks (q2w) plus TCS, or placebo plus TCS until week-52.

Primary outcome measures

Co-primary efficacy endpoints were patients (%) achieving Investigator's Global Assessment (IGA) 0/1 and 2-points or higher improvement from baseline, and Eczema Area and Severity Index 75% improvement from baseline (EASI-75) at week-16.

Results

740 patients were included in the trial: 319 were randomly assigned to dupilumab qw, 106 to dupilumab q2w and 315 to the placebo arm. At week-16, more patients in the dupilumab groups achieved the co-primary endpoints: IGA 0/1 (39% [125 patients] qw dosing, 39% [41 patients] q2w dosing vs 12% [39 patients] receiving placebo; p<0.0001) and EASI-75 (64% [204] and 69% [73] vs 23% [73]; p<0.0001). Whilst no new safety signals were identified, adverse effects (AEs) were noted in 261 (83%) in those receiving dupilumab qw plus TCS, 97 (88%) dupilumab q2w plus TCS and 266 (84%) for placebo plus TCS. Rates of conjunctivitis, injection site reactions and local herpes simplex infections were higher in the dupilumab groups compared with placebo.

Conclusions

Blauvelt et al. concluded that dupilumab treatment added to TCS improved AD up to week-52 compared with TCS alone, and also demonstrated acceptable safety.

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Pneumocephalus and seizures following combined spinal-epidural for labor

Most cases of pneumocephalus following neuraxial blocks are associated with accidental dural puncture using loss of resistance to air for identification of the epidural space [1]. To our knowledge, there are no published reports in literature following use of saline for loss of resistance. We report the finding of simultaneous pneumocephalus and a cavernoma in a patient who received a combined spinal-epidural analgesia for labor, using loss of resistance to saline (LORS). The patient provided written consent for the authors to publish this report.

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Editorial Board

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Nasotracheal intubation through pharyngeal flap after pharyngeal flap construction

A 24-year-old woman provided her written consent to publish the details of her case. She had undergone multiple surgeries including pharyngeal flap construction for bilateral cleft lip and palate. All previous operations were performed under general anesthesia by oral intubation. In the present procedure, sagittal split ramus osteotomy under general anesthesia with nasotracheal intubation was planned. We obtained the three-dimensional morphological structure of the pharyngeal flap (Fig. 1). The measurements of the cross-section at the narrowest were 5.1×12.8mm for the left orifice and 3.2×13.2mm for the right.

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Clinical experiences of unilateral anterior sub-costal quadratus lumborum block for a nephrectomy

Among several quadratus lumborum (QL) blocks, an anterior sub-costal QL block is a new technique, and there are only a few reports of this new approach in the literature [1,2]. In this case, we reported two cases in which we used the anterior sub-costal QL block for a nephrectomy.

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Clinical effects of prophylactic use of phentolamine in patients undergoing pheochromocytoma surgery

To the Editor,

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Emergency insertion of the LMA protector airway in patients in the lateral position

The LMAR Protector™ Airway (Teleflex Medical Japan, Tokyo, Protector), a new type of second generation airway, has an integrated cuff pressure indicator that allows continuous cuff pressure monitoring at a glance [1,2]. Continuous cuff pressure monitoring contributes to safe management in the perioperative period in all situations. Here, we report two cases in which the Protector was inserted in an emergency situation with the patient in the lateral position.

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Respiratory effect of interscalene brachial plexus block vs combined infraclavicular plexus block with suprascapular nerve block for arthroscopic shoulder surgery

Shoulder surgery typically results in moderate to severe postoperative pain, especially within the first 24h after surgery. The interscalene nerve block (ISB) is one of the most effective analgesic techniques for shoulder surgery. A common adverse effect after ISB remains the occurrence of ipsilateral phrenic nerve block. In the literature [1] diaphragm-sparing nerve blocks alternative to ISB for shoulder surgery, such as supraclavicular block, distal nerve blocks, intraarticular analgesia, has been reported; recently [2] a new combination of suprascapular nerve block (SSB) and infraclavicular block (ICB) seemed to provide surgical anesthesia and satisfactory postoperative analgesia, but, the respiratory effects of this technique are still not well documented.

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Under pressure: Evaluating the role of intraoperative hemodynamics in postoperative acute kidney injury

In this issue of Journal of Clinical Anesthesia, Wu et al. describe their well-designed randomized trial investigating the impact of targeted mean arterial pressure (MAP) ranges on postoperative acute kidney injury (AKI) [1]. Their study is of pressing concern: postoperative AKI remains a source of shared apprehension among anesthesiologists, surgeons, and nephrologists, for which prevention and treatment strategies are a matter of ongoing debate. The healthcare burden of postoperative AKI is well-described: it is common, costly, and life-threatening.

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Incidence of lower-extremity muscle weakness after quadratus lumborum block

Since the original publication on the quadratus lumborum (QL) block in 2013, various approaches for QL block administration have been reported [1,2]. Lower-extremity muscle weakness after a posterior QL block has been reported as a complication [3]. However, there have been no reports of lower-extremity muscle weakness after a QL block using other approaches. We investigated the incidence of lower-extremity muscle weakness after each type of QL block.

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Lack of generalizability of observational studies' findings for turnover time reduction and growth in surgery based on the State of Iowa, where from one year to the next, most growth was attributable to surgeons performing only a few cases per week

Three observational studies at large teaching hospitals found that reducing turnover times resulted in the surgeons performing more cases. We sought to determine if these findings are generalizable to other hospitals, because, if so, reducing turnover times may be an important mechanism for hospitals to use for growing caseloads.

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Lidocaine post-nasal dripping (LPND): An easy way for awake nasal intubation

Several techniques of topical anesthesia for awake fiberoptic intubation (AFOI) have been described such as "spray as you go" [1,2], nebulization [2], atomization [3,4] transtracheal injection [5]. These require multiple complicated steps [1,2], specialized equipment [2–4], and are invasive [5].

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Severe type B lactic acidosis and insulin-resistant hyperglycemia related to cadaveric kidney transplantation

Lactic acidosis, increased lactate levels >2mmol/L with a high anion gap metabolic acidosis, commonly occurs due to hypoperfusion/hypoxia (type A) but may also arise due to other causes, often overlooked, such as thiamine deficiency (type B) [1]. We report the perioperative occurrence of severe type B lactic acidosis with insulin-resistant hyperglycemia related to cadaveric kidney transplantation and its rapid resolution after intravenous thiamine administration. Written consent was obtained from the patient.

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Use of dexmedetomidine in a cardiac intensive care unit

Delirium, pain and agitation, known as the "triad of Intensive Care Units (ICU)" [1] are very common in critical patients. At least 20% of patients develop delirium during their stay in the ICU, reaching 80% in those receiving mechanical ventilation [2]. There is a need to identify these patients for appropriate treatment and prevention, as this neuronal dysfunction is associated with increased mortality, length of hospitalization, dependency and disability at discharge [3,4].

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Bilateral adductor canal block catheters in patients undergoing simultaneous bilateral knee arthroplasty: A series of 17 patients

Continuous adductor canal blocks (ACB) have been shown to reduce pain with knee flexion, decrease opioid consumption, and enhance ambulation following total knee arthroplasty [1]. Of the patients who undergo bilateral knee arthroplasties, a small subset have the procedures performed during the same operative encounter rather than a staged procedure [2]. These patients present additional perioperative pain and rehabilitation challenges, in addition to a longer length of hospital stay [2,3]. Adequate analgesia is imperative for immediate postoperative rehabilitation; however, there is a paucity of research regarding regional techniques for simultaneous bilateral knee arthroplasty (SBKA).

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Videolaryngoscope versus Macintosh laryngoscope for tracheal intubation in adults with obesity: A systematic review and meta-analysis

Videolaryngoscopy has become more common since the 2000s. Despite several anecdotal reports in the literature, it remains unclear whether videolaryngoscopy is superior to direct Macintosh laryngoscopy for tracheal intubation in adults with obesity. This systematic review and meta-analysis focused on prospective randomised trials comparing videolaryngoscopes with the Macintosh laryngoscope for tracheal intubation in adults with obesity.

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Retroclavicular approach to infraclavicular brachial plexus block for distal radius fracture in a patient with implanted pacemaker

Patients with implanted pacemaker underwent upper limb surgery under regional anesthesia in the literature are rarely. We report a case of successful retroclavicular approach to infraclavicular brachial plexus block (RA-IBPB) in a patient with implanted pacemaker and with requiring open osteosynthesis due to distal radius fracture.

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Anesthetic management for laparoscopic sleeve gastrectomy to a child

Anesthesia for obese children undergoing weight loss surgery poses a challenge for the anesthetists given that this population has high risk of developing psychosocial and medical comorbidities such as pulmonary and cardiovascular disorders, hypertension, dyslipidemia, obstructive sleep apnea and type 2 diabetes mellitus [1–3].

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Ketorolac dose-response for acute pain is well known and the safety rules for adequate prescribing are clear

The study by Duttchen et al. [1] shows almost no difference in analgesic efficacy when comparing 15 and 30mg of IV ketorolac given intraoperatively to provide postoperative pain relief. In the discussion, the authors indicate that another 2017 study performed in an emergency department similarly showed that in patients with acute pain 10, 15 and 30mg are of similar analgesic efficacy [2], suggesting that these data are new.

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Takotsubo cardiomyopathy complicating thoracoabdominal aortic aneurysm repair

We describe the management of a patient with symptomatic spinal cord hypoperfusion after thoracoabdominal aortic aneurysm repair, where the neurological insult and associated emotional stress precipitated Takotsubo cardiomyopathy. Transthoracic Echocardiography showed akinetic mid and apical left ventricular segments, while basal segments were spared. Emergent coronary angiography ruled out acute coronary syndrome. Excess catecholamines have been postulated as a contributing mechanism to the disease, therefore, catecholamines were avoided to prevent further myocardial injury.

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Detection of human papillomavirus type 52 in a case of gluteal squamous cell carcinoma

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Case of successfully switching from nivolumab to vemurafenib with oral corticosteroids

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Two cases of Japanese spotted fever infected in Rokko mountain near urban area of southern Hyogo Prefecture

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Dabrafenib and trametinib combination therapy safely performed in a patient with metastatic melanoma after severe liver toxicity due to vemurafenib

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Isotopic response

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Assessment of a visual risk communication aid used to support patients with psoriasis in deciding about biological therapy

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Local Anesthetic Systemic Toxicity: A Review of Recent Case Reports and Registries

This review summarizes presenting features, management, and outcomes of local anesthetic systemic toxicity (LAST) from published cases and those submitted to online registries capturing use of intravenous lipid emulsion (ILE) therapy. The results of single-center and multicenter registries and epidemiologic studies complement this information. Between March 2014 and November 2016, 47 separate cases of LAST were described in 35 peer-reviewed articles. Local anesthetic systemic toxicity events occurred as a result of penile blocks (23%), local infiltration (17%), and upper/lower extremity, torso, and neuraxial blockade. Twenty-two patients (47%) were treated with ILE, and 2 patients (4.3%) died. During the same time period, 11 cases submitted to lipidrescue.org were treated with ILE and survived. The incidence of LAST reported in registries is 0.03% or 0.27 (95% confidence interval, 0.21–0.35) per 1000 peripheral nerve blocks (denominator of 251,325). Seizure (53% and 61% from case reports and registries, respectively) was the most common presenting feature. Accepted for publication October 9, 2017. Address correspondence to: Marina Gitman, MD, Department of Anesthesiology, College of Medicine, University of Illinois, 1740 W Taylor St, Suite 3200 W, Chicago, IL 60612 (e-mail: gitman@uic.edu). The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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The Prevalence of Cosmetic Facial Plastic Procedures among Facial Plastic Surgeons

Facial plast Surg
DOI: 10.1055/s-0037-1617423

This is the first study to report on the prevalence of cosmetic facial plastic surgery use among facial plastic surgeons. The aim of this study is to determine the frequency with which facial plastic surgeons have cosmetic procedures themselves. A secondary aim is to determine whether trends in usage of cosmetic facial procedures among facial plastic surgeons are similar to that of nonsurgeons. The study design was an anonymous, five-question, Internet survey distributed via email set in a single academic institution. Board-certified members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) were included in this study. Self-reported history of cosmetic facial plastic surgery or minimally invasive procedures were recorded. The survey also queried participants for demographic data. A total of 216 members of the AAFPRS responded to the questionnaire. Ninety percent of respondents were male (n = 192) and 10.3% were female (n = 22). Thirty-three percent of respondents were aged 31 to 40 years (n = 70), 25% were aged 41 to 50 years (n = 53), 21.4% were aged 51 to 60 years (n = 46), and 20.5% were older than 60 years (n = 44). Thirty-six percent of respondents had a surgical cosmetic facial procedure and 75% has at least one minimally invasive cosmetic facial procedure. Facial plastic surgeons are frequent users of cosmetic facial plastic surgery. This finding may be due to access, knowledge base, values, or attitudes. By better understanding surgeon attitudes toward facial plastic surgery, we can improve communication with patients and delivery of care. This study is a first step in understanding use of facial plastic procedures among facial plastic surgeons.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

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Ablative Fractional CO2 Laser for Facial Atrophic Acne Scars

Facial plast Surg
DOI: 10.1055/s-0037-1606096

Ablative fractional carbon dioxide laser resurfacing is a well-established treatment for acne scars. However, there are limited consensus and guidelines regarding the procedure, such as its treatment plan, efficacy, and safety. In this study, we performed a systematic review to assess the efficacy and safety of the fractional carbon dioxide laser treatment procedure, and to provide evidence-based recommendations concerning its practical use on atrophic acne scars. A comprehensive search was performed in, EMBASE, Ovid, Web of Science, and Cochrane databases, using the keywords "scar(s)," "acne vulgaris," "carbon dioxide," and "fraction* laser(s)" for the period from January 1987 to December 2016. The initial literature search identified 337 articles. The final selection included 30 studies: 12 retrospective studies and 18 prospective randomized clinical trials. Ablative fractional carbon dioxide laser is an effective therapy for the treatment of acne scars. The treatment session, interval, and parameters should be customized for each patient. Combination therapy should be considered for ice-pick type acne scars. The use of dermocosmetics in pre- and postoperative care may be beneficial to patients.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

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Complications in Orthognathic Surgery

The aim of this study was to analyze the presence of complications related to orthognathic surgery performed by surgeons in train. A retrospective study was conducted between 2005 and 2014, analyzing the clinical records of patients treated in the authors' Department. Patients who underwent orthognathic surgery were included, under a bidimensional analysis and with the conventional orthosurgical sequence; intraoperative complications were identified, such as the occurrence of a bad split, bleeding, tissue injury, among others and postoperative variables such as impaired sensation, infection, and alterations in the osteosynthesis systems. A statistical analysis was done using χ2 and Student t tests, considering a statistical significance when P

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Protection of Inferior Alveolar Neurovascular Bundle in Alveolar Bone Operation

Purpose: The aim of this study was to investigate the protection of the inferior alveolar neurovascular bundle in alveolar bone operation in conditions such as chronic osteomyelitis and cementoma. Patients and Methods: The study enrolled 7 cases, 4 with chronic osteomyelitis and 3 with cementoma with pain. Computed tomography scan and 3-dimensional reconstruction were performed for the diseases. Data were processed by ProPlan CMF 1.3 software. The edge of lesion was defined and the inferior alveolar nerve was marked. Template was designed to guide the osteotomy line. Piezosurgery was used for osteotomy, with the avoidance of nerve canal. Current perception threshold (CPT) was performed to evaluate the nerve function after operation. Results: The CPT difference of the affected side before and after operation showed no statistically significant differences compared with that of the unaffected side (P = 0.0556). Conclusions: Digital template protects the inferior alveolar neurovascular bundle with the aid of piezosurgery during alveolar bone resection, which obtained satisfying clinical results. As powerful assistive tools of functional surgery, digital template and piezosurgery achieve both the purposes of treatment and function. Address correspondence and reprint requests to Minjie Chen, MD, Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi-zao-ju Road, Shanghai 200011, China; E-mail: chenminjietougao@126.com; 407102560@qq.com Received 6 April, 2017 Accepted 4 October, 2017 The authors disclose no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Interpositional Arthroplasty by Temporalis Fascia Flap and Galea Aponeurotica Combined With Distraction Osteogenesis: a Modified Method in Treatment of Adult Patients With Temporomandibular Joint Ankylosis and Mandibular Dysplasia

Background: Interpositional arthroplasty (IPA) with temporalis fascia flap has been one of the most frequently performed procedures to treat temporomandibular joint (TMJ) ankylosis. However, recurrence often occurs when the flap lacks bulk or atrophies. Whether to perform IPA or distraction osteogenesis (DO) first has long been a controversial issue when patients presented mandibular dysplasia (MD). This study provided IPA a new graft material sufficient to prevent recurrence, combined the modified protocol of performing DO 6 months after IPA, and evaluated its efficacy in treating TMJ ankylosis patients with MD. Methods: Six patients with unilateral TMJ ankylosis and MD were treated in the authors' study. The temporalis fascia flap and part of adjacent galea aponeurotica were filled the space after surgical release. Mouth-opening exercises started immediately post-IPA. Distraction osteogenesis was performed 6 months after IPA and had a 4-month consolidation. The maximum interincisal distance at preoperative, immediately post-IPA and the latest follow-up were recorded, as was the distraction length. The body mass index was measured at each patient's postoperative visit. Result: All patients had significant improvements in facial aesthetic, mouth-opening, and occlusion. No major complication or recurrence was observed at 3 to 4 years' follow-up. The mean maximum interincisal distance was 4.83 ± 2.79 mm preoperative and 35.67 ± 3.39 mm at the latest follow-up. The mean distraction distance was 16.17 ± 5.98 mm. The body mass index improved from 17.33 ± 0.64 kg/m2 preoperative to 18.75 ± 0.60 kg/m2 before DO. Conclusions: Temporalis fascia flap and adjacent galea aponeurotica as new graft materials are recommended for IPA. The modified staged treatment proved to be reliable and effective to prevent recurrence, improve mandibular length and final occlusion. Address correspondence and reprint requests to Bing Yu, MD, The Craniofacial Center One, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, Beijing 100144, China; E-mail: bybybysun@163.com Received 4 May, 2017 Accepted 4 October, 2017 This study was funded by China Scholarship Council. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Patient Perception and Satisfaction Questionnaire for Microtia Reconstruction: A New Clinical Tool to Improve Patient Outcome

Background: Patients' satisfaction is an increasingly important indicator for successful ear reconstruction surgeries. However, there is no scientifically sound patient-based outcome instrument in this field. This study aims at developing a patient-reported outcome measure for microtia reconstruction for investigating patients' satisfaction and perception of reconstructed ear and clinical researches. Methods: The development of questionnaire included 3 stages. Traditional psychometric tests were used for analysis. At first stage, a preliminary version of the questionnaire was developed using qualitative methods, including interviews with 10 patients. At second stage, the questionnaire was field tested by survey of 76 patients. Redundant items were deleted; acceptability, reliability, and responsiveness were examined. At third stage, survey was conducted to another 94 patients with the shortened questionnaire to further evaluate the acceptability, reliability, and validity. Results: A questionnaire of 12 items for microtia reconstruction was developed. Results demonstrated the instrument satisfied the current criteria. The acceptability (missing data 0.80, item-total correlations >0.7, interitem correlation

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Wedge Osteotomy for Correction of Chin Asymmetry

Chin deviation is generally the visible reflex of a mandibular asymmetry. The difficulty in obtaining a symmetrical result exists, but it can be minimized with the appropriate surgical technique. This article reports the mentoplasty technique with wedge osteotomy performed in an individual with a right-sided chin deviation. Three osteotomies were performed vertically and equidistantly, forming a bone wedge on the contralateral side of the deviation. Horizontal repositioning associated with the rotation caused by the vertical impaction of the chin after bone wedge removal was effective in solving esthetic problems of facial asymmetry, meeting the patient's main complaint. Address correspondence and reprint requests to Pedro Jorge Cavalcante Costa, DDS, MSc, Centro Universitário Tiradentes, Av Comendador Gustavo Paiva, 5017, Cruz das Almas, Maceió AL 57038-000, Brazil; E-mail: pedrojorgeccosta@hotmail.com Received 28 July, 2017 Accepted 5 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Review of “Readiness of US General Surgery Residents for Independent Practice” by George BC, Bohnen JD, Williams RG, Meyerson SL, Schuller MC, Clark MJ, Meier AH, Torbeck L, Mandell SP, Mullen JT, Smink DS, Scully RE, Chipman JG, Auyang ED, Terhune KP, Wise PE, Choi JN, Foley EF, Dimick JB, Choti MA, Soper NJ, Lillemoe KD, Zwischenberger JB, Dunnington GL, DaRosa DA, Fryer JP; Procedural Learning and Safety Collaborative (PLSC) in Ann Surg 266: 582–594, 2017

No abstract available

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Maxillary Sagittal Position in Relation to the Forehead: A Target for Orthognathic Surgery

The relationship of the maxillary incisor to forehead position and angulation may be a predictor for the esthetic antero-posterior maxillary position in orthognathic surgery, but this has not been fully explored in the existing literature. Additionally, this analysis requires a lateral smiling photograph, which is not typically included in orthodontic/orthognathic records. This is a bidirectional study of Caucasian orthodontic patients with malocclusions correctable with nonsurgical and nonextraction treatment. Subjects for Group 1 were enrolled prospectively and records included a lateral smiling photograph. Group 2 patients were collected retrospectively with standard records. The analysis described in Andrews' Element II of The Six Elements of Orofacial Harmony was applied to the smiling photographs for Group 1, resulting in "Incisor- goal anterior limit line (GALL)" measurements. A modified analysis utilizing cephalometric tracings was applied for both the groups, and the results were compared. Forty-nine subjects with mean age 11.8 ± 1.2 years were included (n = 14 for Group 1, n = 35 for Group 2). Mean Incisor-GALL distances were 3.71 ± 5.39 mm for females and 4.47 ± 5.06 mm for males. Correlation between analyses was excellent (intraclass correlation coefficient = 0.872). In conclusion, a modified approach to measuring the Incisor-GALL distance using standard orthodontic records correlated closely with the analysis described by Andrews. Normal values for this measurement are presented for Caucasian patients. Address correspondence and reprint requests to Dr Cory M. Resnick, DMD, MD, Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115; E-mail: cory.resnick@childrens.harvard.edu Received 15 August, 2017 Accepted 12 October, 2017 Dr CMR and Dr ASR are married. This relationship did not introduce any conflict of interest into this study design or implementation, and Dr ASR is an independently credentialed research affiliate of Boston Children's Hospital. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Reconstruction of a Compound Oromandibular Defect by Means of Chimeric Scapular–Parascapular Free Flap Assisted by Virtual Surgical Planning

Background: Reconstruction of an oromandibular defect presents a considerable surgical challenge. But since the advent of microvascularized free flap reconstructive surgery, outcomes have improved significantly so that today almost any defect may be reconstructed. Recently, virtual surgical planning has reduced surgical time, the morbidity associated with surgery, and surgical precision. Objective: This article reports a complex patient with a composite oromandibular defect. Methods: The patient had undergone multiple surgeries with bad results. She presented an orostoma of 5 cm in diameter, osteoradionecrosis and fracture of the left mandibular body, and relapse in the ipsilateral posterior maxilla. Reconstruction was performed by means of a scapular/parascapular chimeric free flap. A customized reconstruction plate was designed virtually based on the mirror image of the contralateral mandibular body. Surgery and the postoperative phase passed without incident. The patient recovered vocal, swallowing, and respiratory function without any problems. At the end of a 1-year follow-up, no complications or tumor relapse had occurred. Conclusions: Composite defects are a surgical challenge in which free flap reconstruction is an evolution that has facilitated treatment and led to improved outcomes. Virtual treatment planning produces more exact results and greater control of surgical techniques. Address correspondence and reprint requests to Josué Hernando, MS, DDS, PhD, University Donostia Hospital, Paseo Dr Beguiristain s/n, San Sebastian (Guipuzkoa), Spain; E-mail: josue.hernando@gmail.com Received 14 September, 2017 Accepted 10 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Surgical Treatment of Synovial Chondromatosis in the Inferior Compartment of the Temporomandibular Joint With Articular Disc Involvement

The authors report an unusual case of painful synovial chondromatosis originated in the inferior compartment of the temporomandibular joint (TMJ) with articular disc involvement in a 56-year-old woman with complaint of severe pain in the right preauricular region. Magnetic resonance images showed advanced destruction of the right articular disc anteriorly displaced, condylar erosion, and distinct nodules within an extremely expanded inferior joint compartment with large amount of fluid, as well as a large TMJ effusion. A scintigraphy showed elevated bone uptake in the right TMJ, demonstrating intense bone remodeling activity in the region. After a right internal maxillary artery embolization, the patient underwent open surgery. The intraoperative procedures, including articular disc removal, condylar remodeling, and replacement of the articular disc, are described in detail. Synovial chondromatosis of the TMJ is a rare disease, especially when it affects the inferior compartment and the articular disc. Initial diagnosis is challenging and imaging techniques (magnetic resonance imaging and scintigraphy) play an important role in identifying signs, making accurate diagnosis, and offering additional information not available with conventional imaging, such as TMJ inflammation or remodeling. In these patients, open surgery may be considered a definitive treatment, since the postoperative recurrence rate is very low. Address correspondence and reprint requests to Amanda Lury Yamashita, DDS, MSc, Dentistry Department, State University of Maringá, Avenida Mandacaru no 1550, CEP: 87080-000, Maringá, Paraná, Brazil; E-mail: amandayamashita@gmail.com Received 14 September, 2017 Accepted 10 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Three-Dimensional Radiological Assessment of Alveolar Bone Volume Preservation Using Bovine Bone Xenograft

Introduction: Alveolar bone is critical in supporting natural teeth, dental implants as well as a removable and fixed prosthesis. Alveolar bone volume diminishes when its associated natural tooth is lost. Objective: The aim of this study is to evaluate the effectiveness of bovine bone granules on alveolar bone socket augmentation for ridge preservation following atraumatic tooth extraction. Materials and Methods: Twenty medically fit patients (12 males and 8 females aged between 18 and 40 years) who needed noncomplicated tooth extraction of 1 mandibular premolar tooth were divided randomly and equally into 2 groups. In control group I, the empty extraction socket was left untreated and allowed to heal in a conventional way. In group II, the empty extraction socket wound was filled with lyophilized bovine bone xenograft granules 0.25 to 1 mm of size, 1 mL/vial. A resorbable pericardium membrane was placed to cover the defect. Clinical and 3-dimensional radiological assessments were performed at day 0, 3 months, and 9 months postoperative. Results: There were no clinical differences in general wound healing between the groups. Comparisons within the groups showed a significant difference of bone resorption of 1.49 mm (95% confidence interval, 0.63–2.35) at 3 months, and further resorption of 1.84 mm (P ≤ 0.05) at 9 months in the control group. No significant changes of bone resorption were observed in group II during the same time interval. Comparison between groups showed a significant difference of bone resorption at 3 and 9 months (2.40 and 2.88 mm, respectively). Conclusion: The use of lyophilized demineralized bovine bone granules in socket preservation to fill in the extraction socket seems essential in preserving the alveolar bone dimension as it showed excellent soft and hard tissue healing. This study concludes that the alveolar bone socket exhibited a dynamic process of resorption from the first day of tooth extraction. Evidence shows the possibility of using bovine bone granules routinely in socket volume preservation techniques following tooth extraction. Address correspondence and reprint requests to Ali Al Qabbani, DDS, MSc, Clinical Instructor/Oral Surgery, Department of Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, UAE, and School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan Malaysia; E-mail: aqabbani@sharjah.ac.ae Received 5 April, 2017 Accepted 10 October, 2017 All procedures performed in our study involving human participants were in accordance with the ethical standards of the institutional and national research committee. Ethical approval was obtained from the Ethical and Research Committee, University of Sharjah and from Human Research Ethics Committee University Sains Malaysia ethical number (No DFCM/18/02/14/027) and (USM/JEPeM/15020045), respectively. The study was supported by a competitive grant from the University of Sharjah and Sharjah Institute for Medical Research. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Mandibular Osteonecrosis Associated With Raloxifene

Osteonecrosis is a disease with diverse pathophysiology, clinical presentation, and management. It may be associated with some medications used to treat systemic issues with bone metabolism. A few cases of jaw bone osteonecrosis have been associated with raloxifene. In this paper, the authors present a clinical report of a 64-year-old woman who presented with a necrosis foci in the right alveolar ridge of the mandible, associated with continued raloxifene use. Address correspondence and reprint requests to Hélder Antônio Rebelo Pontes, DDS, PhD, José Malcher Street, No. 1913, Ap. 801, 66060-230, São Braz, Belém, Pará, Brazil; E-mail: harp@ufpa.br. Received 19 July, 2017 Accepted 20 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Review of “Modern Surgeons: Still Masters of Their Trade or Just Operators of Medical Equipment?” by Krawczyk M in Ann Surg 266;703–705, 2017

No abstract available

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Review of “A Lifetime of Surgical Education: Can We Do Better?” by Lillemoe KD, Klingensmith ME, Darzi A, Taylor SM in Ann Surg 266:555-563, 2017

No abstract available

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Unusual Craniofacial Distraction

A retrospective Institutional Review Board-approved review was performed at the Institute of Reconstructive Plastic Surgery, NYU Langone Medical Center, of patients undergoing craniofacial distraction osteogenesis procedures using the rigid external distractor device between 2000 and 2010. Three particularly challenging cases were identified and are presented here. Address correspondence and reprint requests to Aina V.H. Greig, PhD, FRCS(Plast), Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; E-mail: aina.greig@gstt.nhs.uk Received 25 May, 2017 Accepted 19 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Peripheral Giant Cell Granuloma Associated With Dental Implants

Abstract: Peripheral giant cell granuloma (PGCG) is a nonneoplastic lesion of the oral mucosa arising on the buccal or lingual attached gingiva or alveolar mucosa and the crest of the edentulous alveolar ridge and contains numerous giant cells. This case series describes 3 cases regarding the clinical and surgical management of PGCG associated with dental implants. Materials and Methods: This case series presents 3 patients, mean age 36 years, who showed a pedunculated painless lesion associated with dental implants that radiographically appeared as an osseous rarefaction corresponding the implants. Discussion: Histological examination provided the diagnosis of PGCG. The treatment approach consisted in a surgical complete resection of the lesion and implant removal. After 1-year-follow-up, all the investigated cases did not show signs of recurrence. Conclusion: A correct diagnosis and an appropriate surgical treatment of peri-implant giant cell granuloma are very important aspects for proper management of the lesion. Correspondence to Antonio Scarano, DDS, MD, Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio" of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti-Pescara, Italy; E-mail: antonio.scarano@unich.it Received 5 August, 2017 Accepted 9 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

http://ift.tt/2CMgkkn

Facing a New Face: An Interpretative Phenomenological Analysis of the Experiences of a Blind Face Transplant Patient and His Partner

Increasing evidence points to good functional, aesthetic, and psychosocial outcomes after face transplantation. However, research investigating how patients and their families subjectively experience the transplantation process is lacking thus far. This study aims to investigate the personal experiences of a blind face transplant patient and his partner. In-depth interviews exploring different experiences were conducted with both partners separately 20 months after face transplantation. The interviews were analyzed using interpretative phenomenological analysis. Seven themes were identified in both interviews: coping with the facial trauma, motivation for the face transplantation, outcomes of the face transplantation, acceptance of the new face, gratitude toward the donor family, relation to the medical team, and dealing with the media. Two further themes were only mentioned by the patient (coping with complications and coping with blindness) and one theme only by the partner (loss of choices). The results of this study increase our understanding of the transplantation process as experienced by a face transplant recipient and his partner. They may help to better inform professionals to optimize transplantation procedures or supportive interventions. Address correspondence and reprint requests to Gilbert M. D. Lemmens, PhD, Department of Psychiatry, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium; E-mail: gilbert.lemmens@ugent.be Received 14 August, 2017 Accepted 10 November, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Factors Influencing Perception of Facial Attractiveness: Gender and Dental Education

Purpose: This study was conducted to investigate the gender- and dental education-specific differences in perception of facial attractiveness for varying ratio of lower face contour. Methods: Two hundred eleven students (110 male respondents and 110 female respondents; aged between 20–38 years old) were requested to rate facial figures with alterations to the bigonial width and the vertical length of the lower face. We produced a standard figure which is based on the "golden ratio" and 4 additional series of figures with either horizontal or vertical alterations to the contour of lower face. The preference for each figure was evaluated using a Visual Analog Scale. The Kruskal Wallis test was used for differences in the preferences for each figure and the Mann–Whitney U test was used to evaluate gender-specific differences and differences by dental education. Results: In general, the highest preference score was indicated for the standard figure, whereas facial figure with large bigonial width and chin length had the lowest score. Male respondents showed significantly higher preference score for facial contour that had a 0.1 proportional increase in the facial height-bigonial width ratio over that of the standard figure. For horizontal alterations to the facial profiles, there were no significant differences in the preferences by the level of dental education. For vertically altered images, the average Visual Analog Scale was significantly lower among the dentally-educated for facial image that had a proportional 0.22 and 0.42 increase in the ratio between the vertical length of the chin and the lip. Conclusion: Generally, the standard image based on the golden ratio was the most. Slender face was appealed more to males than to females, and facial image with an increased lower facial height were perceived to be much less attractive to the dentally-educated respondents, which suggests that the dental education might have some influence in sensitivity to vertical changes in lower face. Address correspondence and reprint requests to Min-Suk Kook, DDS, PhD, Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 33, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea; E-mail: omskook@jnu.ac.kr Received 30 April, 2017 Accepted 4 October, 2017 G-HJ and SJ contributed equally to this work. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Is Osteoplasty With Unilateral Osteotomy Effective in the Correction of the Crooked Nose?

Objective: The crooked nose is frequently observed, and a significant number of correction methods have previously been described. Nevertheless, the condition remains a challenging problem for rhinoplastic surgeons. Here, the authors present a technique that the authors have used to correct a crooked nose in selected patients. Methods: A total of 23 patients underwent surgery for a C-shaped crooked nose, and were followed up for an average of 11.4 months. Pre- and postoperative photographs were taken, and these were analyzed to evaluate the results. Results: Osteoplasty and unilateral osteotomy were carried out in all 23 patients and a spreader graft was contralaterally placed. Unilateral osteoplasty was conducted in 17 patients, while bilateral osteoplasty was performed in 6 patients. In 19 patients, a single spreader graft was sufficient, but it was necessary to use a double spreader graft in 4 patients. In summary, 23 C-shaped crooked noses were corrected with osteoplasty plus unilateral osteotomy. Conclusions: Osteoplasty plus unilateral osteotomy, combined with a contralateral spreader graft, is an efficient method that can be safely used in the correction of a C-shaped crooked nose. Address correspondence and reprint requests to Ilker Koçak, MD, Department of Otolaryngology, Koc University Hospital, Davutpasa Cad. No: 4, Topkapi, 34010 Istanbul, Turkey; E-mail: Ikocak@kuh.ku.edu.tr Received 17 June, 2017 Accepted 16 August, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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The efficacy of pre-operative preparation with intravenous iron and/or erythropoietin in anaemic patients undergoing orthopaedic surgery: An observational study

BACKGROUND Pre-operative anaemia and transfusion are common among patients undergoing elective orthopaedic surgery. Application of 'patient blood management' might be the most effective way to reduce both anaemia and transfusion. Pre-operative administration of iron and/or erythropoietin (EPO) is one of the cornerstones of the first pillar of patient blood management, but in a daily clinical setting, efficacy and long-term safety of this measure have not been analysed thoroughly to date. OBJECTIVE To investigate the influence of pre-operative preparation (PREP) of patients with iron and/or EPO on peri-operative transfusion needs and long-term survival. DESIGN AND METHODS This was a single-centre, retrospective study. After approval of our local ethics committee, data of 5518 patients who received total hip or total knee replacement between 2008 and 2014 were included. Patients receiving iron and/or EPO were included in the PREP group, whereas patients without iron and/or EPO were included in the no preparation group. From the full data set, a bias-reduced subset of 662 patients was obtained by means of propensity score-matching to compare peri-operative red blood cell utilisation and long-term survival of patients between groups. RESULTS Patients in the PREP group needed a lower number of units of red blood cells than patients in the no preparation group (0.2 ± 0.8 vs. 0.5 ± 1.3, P

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Effect of pressure-controlled inverse ratio ventilation on dead space during robot-assisted laparoscopic radical prostatectomy: A randomised crossover study of three different ventilator modes

BACKGROUND Pressure-controlled inverse inspiratory to expiratory ratio ventilation (PC-IRV) is thought to be beneficial for reducing the dead space volume. OBJECTIVE To investigate the effects of PC-IRV on the components of dead space during robot-assisted laparoscopic radical prostatectomy (RLRP). DESIGN A randomised crossover study of three different ventilator modes. SETTING A single university hospital from September 2014 to April 2015. PATIENTS Twenty consecutive study participants undergoing RLRP. INTERVENTIONS Patients were ventilated sequentially with three different modes in random order for 30 min: volume control ventilation (VCV; inspiratory to expiratory ratio 0.5), pressure control ventilation (PCV; inspiratory to expiratory ratio 0.5) and PC-IRV. Inverse inspiratory to expiratory ratio was adjusted individually by observing the expiratory flow-time wave to prevent the risk of dynamic pulmonary hyperinflation. MAIN OUTCOME MEASURES The primary outcome included physiological dead space (VDphys), airway dead space (VDaw), alveolar dead space (VDalv) and shunt dead space (VDshunt). VDphys was calculated by Enghoff's method. We also analysed respiratory dead space (VDresp) and VDaw using a novel analytical method. Then, VDalv and VDshunt were calculated by VDalv = VDresp − VDaw and VDshunt = VDphys − VDresp, respectively. RESULTS The VDphys/expired tidal volume (VTE) ratio in PC-IRV (29.2 ± 4.7%) was significantly reduced compared with that in VCV (43 ± 8.5%) and in PCV (35.9 ± 3.9%). The VDshunt/VTE in PC-IRV was significantly smaller than that in VCV and PCV. VDaw/VTE in PC-IRV was also significantly smaller than that in VCV but not that in PCV. There was no significant change in VDalv/VTE. CONCLUSION PC-IRV with the inspiratory to expiratory ratio individually adjusted by the expiratory flow-time wave decreased VDphys/VTE in patients undergoing RLRP. TRIAL REGISTRATION University Hospital Medical Information Network in Japan 000014004. Correspondence to Go Hirabayashi, MD, Department of Anaesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, 3–8–3 Mizonokuchi, Takatsu-ku, Kawasaki, Kanagawa 213–8507, Japan Tel: +81 44 844 3333; fax: +81 44 844 3390; e-mail: hirabayashi1967@gmail.com Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Primary mucinous eccrine carcinoma of the buccal space: A case report and review of the literature

Mucinous eccrine carcinoma is a rare entity that most commonly affects the head and neck. Due to its low frequency of occurrence, review of its etiology, histopathology, and treatment strategies is beneficial to all clinicians who may encounter similar appearing masses.

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Risk factors of sensorineural hearing loss in patients with unilateral safe chronic suppurative otitis media

Chronic suppurative otitis media (CSOM) is the major cause of hearing impairment, especially conductive hearing loss. Few patients also had sensorineural component, the sensorineural hearing loss (SNHL) in CSOM is controversial, especially for safe mucosal type. This study aims to assess the relationship between the frequency of SNHL development in patients with safe mucosal CSOM and its relation to patient's age, sex, duration of disease, size of perforation and different audiological findings.

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Dermatomyositis: A Diagnostic Dilemma

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Fluorescence microscopy for the evaluation of elastic tissue patterns within fibrous proliferations of the skin on hematoxylin-eosin-stained slides

Diagnosis of fibrous tumors can be challenging and expensive due to the use of special stains.

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Reply to “Serious infections among a large cohort of subjects with systemically treated psoriasis”

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Comment on “Association of bullous pemphigoid with malignancy: A systematic review and meta-analysis”

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The alveolar bone protective effects of natural products: A systematic review

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Irlan Almeida Freires, Gustavo Machado Santaella, Janaina de Cássia Orlandi Sardi, Pedro Luiz Rosalen
ObjectivesThis systematic review was carried out to identify which naturally-occurring agents and constituents isolated therefrom have effects in preventing bone loss in a ligature-induced periodontitis model.Materials and methodsEight databases were systematically searched for studies of experimental periodontitis. The data were extracted, analyzed, and the treatment outcomes were given scores based on the level of bone destruction as compared to their untreated induced-periodontitis control.Results294 articles were found, of which 15 met the inclusion criteria. The selected studies tested a multi-herbal formulation; extracts (leaves, barks or fruit) of different plant species; and propolis. The most usual dosing protocol consisted of 3-times-a-day, 11-day treatment. The combined gel of Myracrodruon urundeuva (5%) and Lippia sidoides (0.5%) was the most active treatment, reducing 45–65% bone loss in the region of molars as compared to 73.4% of doxycycline (gold-standard). Ginkgo biloba extract (28–56 mg/kg) and propolis (100–200 mg/kg) prevented bone destruction by 50% and 40–44%, respectively. The other tested samples showed intermediate/weak activity in modulating bone resorption.ConclusionsThe gel of M. urundeuva and L. sidoides, and G. biloba and propolis extracts showed strong alveolar bone protective effectiveness in induced-periodontitis in rats. Further translational research should bridge the gap between the rat study outcomes and the clinical efficacy and long-term toxicity of these formulations in humans. The compilation of the vast literature database presented herein may drive further in vivo and clinical studies with the selected efficacious formulations to subsidize their pharmaceutical application.

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Epigenetic mechanisms in odontogenic tumors: A literature review

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Jorge Sandoval-Basilio, Rogelio González-González, Ronell Bologna-Molina, Mario Isiordia-Espinoza, Gabriela Leija-Montoya, Sofia L. Alcaraz-Estrada, Idanya Serafín-Higuera, Javier González-Ramírez, Nicolás Serafín-Higuera
ObjectiveEpigenetic mechanisms, such as DNA methylation, regulate important biological processes as gene expression and it was suggested that these phenomena play important roles in the carcinogenesis and tumor biology. The aim of this review is to provide the current state of knowledge about epigenetic alterations, focusing mainly on DNA methylation, reported in odontogenic tumors.DesignLiteratures were searched based in the combination of the following keywords: odontogenic tumors, epigenetics, DNA methylation, histone modifications, non-coding RNA, microRNA, DNA methyltransferases. Electronic databases (Medline/PubMed, Scopus and Web of Science) were screened.ResultsThe analysis of epigenetic alterations in different tumors has rapidly increased; however, limited information is available about epigenetic mechanisms involved in the formation of odontogenic tumors. DNA methylation is the most studied epigenetic modification in these tumors and the participation of non-coding RNA's in odontogenic tumors has been recently addressed. Differential expression of DNA methyltransferases, altered DNA methylation patterns and aberrant expression of non-coding RNA's were reported in odontogenic tumors.ConclusionsCurrent studies suggest epigenetics as an emerging mechanism, possibly implicated in etiopathogenesis of odontogenic tumors. Deeper understanding of the epigenetic abnormalities in these tumors could show potential applications as biomarkers or therapeutic possibilities in the future.

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Influence on proliferation and adhesion of human gingival fibroblasts from different titanium surface decontamination treatments: An in vitro study

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Cao Jie, Tong Wang, Pu Yinfei, Tang Zhihui, Meng Huanxin
ObjectivesTo investigate the effects of different decontamination treatments on microstructure of titanium (Ti) surface as well as proliferation and adhesion of human gingival fibroblasts (HGFs).Material and methodsTi discs with machined (M) and sand blasted, acid etched (SAE) surfaces were treated with five different decontamination treatments: (1) stainless steel curette (SSC), ultrasonic system with (2) straight carbon fiber tip (UCF) or (3) metal tip (UM), (4) rotating Ti brush (RTB), and (5) Er:YAG laser (30 mJ/pulse at 30 Hz). Surface roughness was analyzed under optical interferometry. HGFs were cultured on each disc. Proliferation and adhesive strength were analyzed. qRT-PCR and ELISA were performed to detect the RNA and protein expression of FAK, ITGB1, COL1A1, and FN1 respectively from different Ti surfaces.ResultsSurface roughness increased on M surface. Proliferation, adhesive strength and gene expression were higher on M surface than SAE surface. Decontamination treatments affected surface parameters significantly (P < 0.001), making M surface less smooth while SAE surface became less rough. SSC, UCF, UM and RTB decreased proliferation on M surfaces significantly (P < 0.05). UCF, RTB and laser increased proliferation on SAE surface significantly (P < 0.05). UM decreased adhesive strength on M surface significantly and laser increased adhesive strength on SAE surface significantly (P < 0.05). Gene expression increased with time and was altered by decontamination treatments significantly (P < 0.001).ConclusionsDecontamination treatments influence surface roughness and cell behavior of HGFs. Laser might be an optimal decontamination treatment which has the least negative effect on M surface and the most positive effect on SAE surface.

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Epigenetic mechanisms in odontogenic tumors: A literature review

Influence on proliferation and adhesion of human gingival fibroblasts from different titanium surface decontamination treatments: An in vitro study

The alveolar bone protective effects of natural products: A systematic review

Modification of the measurement of the major variables in mandibular condylar fractures: angulation of sidewards displacement and shortening of the height of the ramus

Our aim was to improve the accuracy of measurement of the angulation and the shortening of the height of the ramus in fractures of the mandibular condyle using modified methods. We analysed spiral computed tomography (CT) of 67 unilateral fractures with the OsiriX v 5.0 (©Pixmeo Sarl) and Mimics 19.0 (©2016 Materialise NV, Belgium) and analysed them with SPSS (version 24.0, IBM® SPSS®). Angulation was measured using both the traditional method and our modified method. The results showed significant difference (p = 0.000), and the values measured with the traditional method were lower, which is consistent with geometric analysis.

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Quality improving the provision of the division of ankyloglossia for infants with breast feeding difficulties

Quality improving the provision of the division of ankyloglossia for infants with breast feeding difficulties.

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Re: Styloid Process Fracture Associated With Maxillofacial Trauma: Incidence, Distribution, and Management

Publication date: Available online 5 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Panneerselvam Elavenil, Raja V.B. Krishnakumar

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Varicocele due to renal arteriovenous malformation mimicking a renal tumor: a case report

Renal arteriovenous malformation is an aberrant vascular connection between the renal artery and vein. Acquired renal arteriovenous malformation (arteriovenous fistulae) accounts for approximately 70% of renal...

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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

Publication date: Available online 5 January 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): T. Hasegawa, S.I. Yamada, N. Ueda, S. Soutome, M. Funahara, M. Akashi, S. Furuno, H. Miyamoto, S. Hayashida, R. Amano, K. Mori, Y. Kojima, H. Kurita, T. Kirita, M. Umeda, Y. Shibuya, S. Fujita, T. Komori
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). Moderate or severe hypoesthesia (odds ratio 13.42) and no or late administration of ATP/vitamin B12 (odds ratio 2.28) were significantly associated with refractory hypoesthesia. In the propensity score analysis, the incidence rate of refractory hypoesthesia in the medication group was lower than that in the non-medication group (P<0.001). This study demonstrated the multivariate relationships between various risk factors, treatment modalities, and refractory hypoesthesia. Moderate or severe hypoesthesia and no or late administration of ATP/vitamin B12 were significantly associated with refractory hypoesthesia. Therefore, clinicians should consider these risk factors and initiate early oral administration of ATP/vitamin B12 in cases of hypoesthesia.

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What you should know about alopecia totalis

A look at alopecia totalis, a condition resulting in the loss of all the hair on the scalp. Included is detail on causes and the recovery rate.

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The Use of Omalizumab in Allergen Immunotherapy

Abstract

Although omalizumab (anti-IgE) is currently only approved for the treatment of asthma and chronic idiopathic urticaria, it has also been studied as an off-label treatment for numerous allergic conditions, including use as an adjunct to allergen immunotherapy in the treatment of allergic rhinitis, asthma, venom hypersensitivity, and food allergy. We conducted a review of publications involving the use of omalizumab with allergen immunotherapy, by searching PubMed with key search terms of "omalizumab" and "immunotherapy." Omalizumab has been used in combination with inhalant allergen immunotherapy for the treatment of seasonal allergic rhinitis and co-morbid asthma. While there have been no randomized controlled trials evaluating the addition of omalizumab to venom IT, several case reports and small patient series have been published on the use of omalizumab with venom IT. Omalizumab has been used in conjunction with oral immunotherapy for the treatment of milk, peanut, and egg, as well as other foods in multi-allergen protocols. In conclusion, omalizumab used in conjunction with immunotherapy has shown promising results, especially in the reduction of adverse reactions. At this stage, larger, randomized, placebo-controlled trials are needed to better identify those patients who would benefit the most from the addition of omalizumab to immunotherapy, as well as optimal dosing strategies and duration of treatment.

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A Decade of Research on the 17q12-21 Asthma Locus: Piecing Together the Puzzle

Publication date: Available online 4 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Michelle M. Stein, Emma E. Thompson, Nathan Schoettler, Britney A. Helling, Kevin M. Magnaye, Catherine Stanhope, Catherine Igartua, Andréanne Morin, Charles Washington, Dan Nicolae, Klaus Bønnelykke, Carole Ober
Chromosome 17q12-21 remains the most highly replicated and significant asthma locus. Genotypes in the core region defined by the first GWAS correlate with expression of two genes, ORMDL3 and GSDMB, making these prime candidate asthma genes, although recent studies have implicated GSDMA distal to and PGAP3 proximal to the core region as independent loci. We review here 10 years of studies on the 17q12-21 locus and suggest that genotype-specific risks for asthma at the proximal and distal loci are not specific to early onset asthma and mediated by PGAP3, ORMDL3, and/or GSDMA expression. We propose that the weak and inconsistent associations of 17q SNPs with asthma in African Americans is due to the high frequency of some 17q alleles, the breakdown of linkage disequilibrium on African-derived chromosomes, and possibly different early life asthma endotypes in these children. Finally, the inconsistent association between asthma and gene expression levels in blood or lung cells from older children and adults suggests that genotype effects may mediate asthma risk or protection during critical developmental windows and/or in response to relevant exposures in early life. Thus, studies of young children and ethnically diverse populations are required to fully understand the relationship between genotype and asthma phenotype and the gene regulatory architecture at this locus.

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Role of airway glucose in bacterial infections in patients with chronic obstructive pulmonary disease

Publication date: Available online 5 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Patrick Mallia, Jessica Webber, Simren K. Gill, Maria-Belen Trujillo-Torralbo, Maria Adelaide Calderazzo, Lydia Finney, Eteri Bakhsoliani, Hugo Farne, Aran Singanayagam, Joseph Footitt, Richard Hewitt, Tatiana Kebadze, Julia Aniscenko, Vijay Padmanaban, Philip L. Molyneaux, Ian M. Adcock, Peter J. Barnes, Kazihuro Ito, Sarah L. Elkin, Onn Min Kon, William O. Cookson, Miriam F. Moffat, Sebastian L. Johnston, John S. Tregoning
BackgroundPatients with chronic obstructive pulmonary disease (COPD) have increased susceptibility to respiratory tract infection, which contributes to disease progression and mortality, but mechanisms of increased susceptibility to infection remain unclear.ObjectivesThe aim of this study was to determine whether glucose concentrations were increased in airway samples (nasal lavage fluid, sputum, and bronchoalveolar lavage fluid) from patients with stable COPD and to determine the effects of viral infection on sputum glucose concentrations and how airway glucose concentrations relate to bacterial infection.MethodsWe measured glucose concentrations in airway samples collected from patients with stable COPD and smokers and nonsmokers with normal lung function. Glucose concentrations were measured in patients with experimentally induced COPD exacerbations, and these results were validated in patients with naturally acquired COPD exacerbations. Relationships between sputum glucose concentrations, inflammatory markers, and bacterial load were examined.ResultsSputum glucose concentrations were significantly higher in patients with stable COPD compared with those in control subjects without COPD. In both experimental virus-induced and naturally acquired COPD exacerbations, sputum and nasal lavage fluid glucose concentrations were increased over baseline values. There were significant correlations between sputum glucose concentrations and sputum inflammatory markers, viral load, and bacterial load. Airway samples with higher glucose concentrations supported more Pseudomonas aeruginosa growth in vitro.ConclusionsAirway glucose concentrations are increased in patients with stable COPD and further increased during COPD exacerbations. Increased airway glucose concentrations might contribute to bacterial infections in both patients with stable and those with exacerbated COPD. This has important implications for the development of nonantibiotic therapeutic strategies for the prevention or treatment of bacterial infection in patients with COPD.

http://ift.tt/2quaKgN

Transplantation and Risk for Malignant Melanoma

A study of renal transplant patients shows a 5x increased risk for malignant melanoma.
Medscape Dermatology

http://ift.tt/2CTFES1

Degree of tinnitus improvement with stapes surgery – a systematic review

Publication date: Available online 5 January 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Aliciane Mota G. Cavalcante, Isabella Monteiro de Castro Silva, Bianca Jessica Neves, Carlos Augusto Oliveira, Fayez Bahmad Junior
IntroductionOtospongiosis is temporal bone osteodystrophy, characterized by disordered bone resorption and neoformation in genetically predisposed individuals. Clinically, otospongiosis is characterized by progressive conductive and/or mixed hearing loss and by tinnitus (40–90% – average of 75%).ObjectiveA systematic review of the last two decades of publications that report the degree of tinnitus improvement with stapes surgery.Methods125 articles published in the last 20 years mentioning the relationship between otosclerosis and tinnitus. Literature has always shown that the hearing improvement after stapes surgery was the main result sought and found. However, recent articles has reinforced the need for surgery for the tinnitus improvement. The ideal time to assess tinnitus through different scales is in the sixth month post-operative. The estimated average hearing improvement is 93% and tinnitus is 85.52%.ResultsSummaries of 12 articles were reviewed which fulfilled the search criteria of the survey, and 8 studies were included in the study according the selection criteria. This studies investigating the degree of tinnitus improvement with stapes surgery, using different scales as: Tinnitus Functional Index, Visual Analog Scale, Tinnitus Functional Index and Visual Analog Scale, Visual Analog Scale and "questionnaire asking about tinnitus", Newman's method and Tinnitus Score Advocated by the Japan Audiological Society. The total of the samples of the evaluated articles was of 254 participants.ConclusionWe conclude that stapes surgery is quite effective for the treatment of tinnitus (average improvement is 85.52%), and hearing loss (average improvement is 93%). When deciding about the surgical indication in patients with otosclerosis, the presence and level tinnitus should be considered as well as the level of hearing.

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Comparison of anxiety and child-care education characteristics of mothers who have children with or without speech delays

Publication date: Available online 5 January 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Talih Özdaş, Ayşe Sanem Şahli, Behiye Sarıkaya Özdemir, Erol Belgin
IntroductionSpeech delay in a child could be the cause and/or result of the emotional disorder. The child rearing attitude that the parents have accepted could have both positive and negative effects on the personality of the child.ObjectiveThe current study aimed to investigate the sociodemographic features and the mothers' anxiety of children with speech delay.MethodsOne hundred five mothers with children aged between 3 and 6 years with speech delays were included in the patient group, and 105 mothers who have children aged between 3 and 6 years with normal speech and language development were included in the control group. An information form questionnaire including demographic characteristics, the Family Life and Childrearing Attitude Scale (PARI – Parental Attitude Research Instrument) and beck anxiety scale were requested from all mothers in the patient and the control groups.ResultsIn the current study, there was a significant difference between the groups in terms of gender (p=0.001). According to Parental Attitude Research Instrument, the mean of mothers of the children with speech delays was higher than the mean of mothers of normal children in terms of the answers to overprotective mother aspect (p<0.01). The mothers of children with speech delays had more overprotective motherhood attitudes; however, the difference in terms of the answers to the aspects of democratic attitude and provision of equality, refusal to be a housewife, husband-wife conflict, and suppression and discipline were not statistically significant. The beck anxiety scale, a significant difference was detected between the two groups (p<0.01). It was found that the mothers of children with speech delays had more severe levels of anxiety.ConclusionThe social structure of the family, the attitudes and the behaviors of the mother, and the anxiety levels of the mothers have important effects on child development. Thus, it is necessary to perform further studies related to speech delays, in which many factors play a role in the etiology.

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Treatment of a complex orthopaedic infection due to extensively drug-resistant Pseudomonas aeruginosa

According to the Centers for Disease Control and Prevention (CDC), approximately 51 000 healthcare-associated infections caused by Pseudomonas aeruginosa occur annually in the USA, more than 6000 of which (13%) are caused by multidrug resistant (MDR) strains. Ceftolozane/tazobactam (TOL/TAZ) (Zerbaxa) was approved by the US Food and Drug Administration (FDA) in December 2014 for the treatment of complicated intra-abdominal and urinary tract infections. At this time, clinical data on the role of TOL/TAZ treatment outside of FDA-approved indications is limited. Herein, we present a case of extensively drug-resistant (XDR) P. aeruginosa osteomyelitis of the upper extremity, which was successfully treated with TOL/TAZ for 8 weeks with optimal clinical and laboratory responses. Monotherapy with TOL/TAZ appears effective for treatment of complicated bone and joint infections with XDR P. aeruginosa in combination with comprehensive surgical management, particularly when few antibiotic options exist.

http://ift.tt/2CJreaf

Axillary artery aneurysm combined with brachial plexus palsy due to Takayasu arteritis

We report the case of a young female patient who presented with a right axillary artery aneurysm with neurological symptoms due to Takayasuarteritis (TA). Decompression of the aneurysm and arterial repair with an interposition vein bypass resulted in a full recovery. The case emphasises that peripheral aneurysms can occur due to TA and that there may be neurological complications.

http://ift.tt/2AwUZoL

Uterocutaneous fistula following B-Lynch suture for primary postpartum haemorrhage

A 30-year-old woman, who had undergone emergency lower segment caesarean section (LSCS) for failed induction 2 months back, presented with a fistulous opening along with discharge from her previous incision scar. She had developed a massive primary postpartum haemorrhage at the time of LSCS 2 months back, which was managed with B-Lynch suture and vessel ligation. Fistulogram revealed a connection between the uterus and the skin. The diagnosis was confirmed by a contrast-enhanced CT scan. Patient was subjected to laparotomy. She was found to have an extensive necrosis of the anterior uterine wall. Total abdominal hysterectomy was done to avoid the risk of sepsis and haemorrhage. Postoperative period was uneventful. Histopathological examination confirmed the necrosis of the uterine wall. This case describes an extremely rare occurrence of uterocutaneous fistula as a result of uterine infarction following the application of B-Lynch suture for primary postpartum haemorrhage.

http://ift.tt/2CJtnmh

Efficacy and safety of maintenance electroconvulsive therapy for sustaining resolution of severe aggression in a major neurocognitive disorder

We report a novel electroconvulsive therapy (ECT) regimen for sustaining the resolution of behavioural and psychological symptoms of dementia (BPSD) using alternating acute and maintenance ECT (M-ECT) trials. A 64-year-old man presenting with major neurocognitive disorder was admitted for acute behavioural disturbances and physical aggression. With few treatment options, the impact on patients' quality of life often supersedes cognitive symptoms and is a predictor of long-term institutionalisation. Recent studies indicate that ECT may be an effective and safe way to address BPSD. Clinicians have little information about when and how to stop a successful course of acute ECT or the long-term advantages of M-ECT with subsequent intermittent acute ECT. This case emphasises the benefit of M-ECT and describes potential challenges associated with abrupt discontinuation. This case is the first to detail tapering ECT for treatment of aggression in dementia by interchanging acute and M-ECT courses in response to symptom burden.

http://ift.tt/2Ax31hE

Varicella zoster meningitis: an atypical case of zoster reactivation in immunocompetent young adult

Varicella virus is a neurotropic virus that can reactivate later in life to cause zoster or shingles. Typically, it affects elderly, immunocompromised population. We report an unusual case of an immunocompetent young adult presenting with occipital headache and zoster rash, without preherpetic and postherpetic neuralgia, who was diagnosed with varicella meningitis on Polymerase chain reaction (PCR). He was treated with intravenous acyclovir and later discharged on famciclovir. Diagnosis of varicella meningitis is difficult in the absence of typical features of zoster rash and requires high index of suspicion. Rapid diagnostic tests including varicella PCR and antithecal antibody testing can help in the confirmation of varicella zoster meningitis.

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Postsurgical pyoderma gangrenosum after an autologous stem cell transplantation for multiple myeloma

We report a man who underwent autologous stem cell transplantation (ASCT) for multiple myeloma. Two months after ASCT, he presented with necrotising cholecystitis due to gallbladder stones and was submitted to laparoscopic cholecystectomy. About a week later, he developed progressive skin ulcers at sites where trochanters had been inserted. Progressive enlargement and necrotic aspect of these ulcers took place despite debridement and large spectrum antibiotics. New ulcers developed at the site of enoxaparin injection at the right arm (pathergy phenomenon). A skin biopsy and clinical evaluation favoured the diagnosis of pyoderma gangrenosum (PG). He was treated with daily methylprednisolone and dapsone with improvement of the lesions. This is the first case in the literature of PG after ASCT. Despite the risk factors, the onset of an autoinflammatory disease right after the transplant is intriguing since PG is extremely rare in immunocompromised patients.

http://ift.tt/2Ayo9Ek

Embolic stroke in a postpartum patient with Fontan physiology

In cardiac physiology, single ventricle typically refers to the presence of a dominant systemic ventricle along with a hypoplastic ventricle. The Fontan operation is used to repair the single ventricle by directing deoxygenated systemic venous flow to the pulmonary arterial circulation. Normal pregnancy physiology, particularly increased intravascular volume, increased heart rate, increased cardiac output, hypercoagulability and decreased systemic vascular resistance, can exacerbate cardiac disease in patients with Fontan circulation, leading to pregnancy complications. Despite the known risks, there are limited data addressing the question of anticoagulation in pregnant patients with Fontan physiology. Herein we present the case of a Fontan patient who had a successful pregnancy and delivery, and developed an embolic stroke in the postpartum period.

http://ift.tt/2CIXTgd

Rash and subcutaneous fat necrosis after DEB-TACE with doxorubicin

A 73-year-old woman with hepatocellular carcinoma localised to the liver was treated with doxorubicin-loaded drug-eluting beads through transcatheter arterial chemoembolisation (DEB-TACE). She developed subcutaneous, erythematous, tender nodules in her abdomen 3 days after the procedure. PET/CT scan that was done to evaluate for evidence of disease progression showed mild avidity of these nodules. Biopsy showed fatty necrosis. Nodules started to improve spontaneously 2 weeks after onset. At 8 weeks after onset, lesions stabilised in size and the associated tenderness and erythema resolved. This represents a rare side effect of TACE procedure in general. It can happen secondary to non-target embolisation of hepatic falciform artery, planned embolisation of extrahepatic collateral supplies and even when there is no clear cause. Spontaneous resolution of acute symptoms usually occurs over the course of few weeks, though subcutaneous lesions consisting of necrotic fat tissue may persist for longer periods.

http://ift.tt/2AynEtW

Radius-Maumenee syndrome: a rare cause of glaucoma

Case presentation of a 41-year-old woman with long-standing bilateral eye injection whose clinical findings included bilateral episcleral vessel engorgement and tortuosity, raised intraocular pressure with open iridocorneal angles and left optic disc cupping. All remaining objective examination was normal. She underwent cranial and orbits CT and CT-angiography scans which were unremarkable. Optical coherence tomography of the peripapillary nerve fibre layer and automated perimetry were compatible with advanced glaucomatous damage on the left eye. The patient was diagnosed with idiopathic elevated episcleral venous pressure or Radius-Maumenee syndrome. If medical therapy is unable to prevent disease progression, left eye filtering surgery will be proposed.

http://ift.tt/2CMNOPl

Vedolizumab-induced acute pancreatitis: the first reported clinical case

Drug-induced acute pancreatitis (DIAP) is a rare, but clinically significant diagnosis. Vedolizumab, an α₄β₇ integrin inhibitor, which was approved in 2015 for treatment of moderate to severe inflammatory bowel disease, is a well-tolerated medication with a favourable safety profile and minimal serious adverse events in premarketing clinical trials. We present the first reported case of acute pancreatitis directly attributable to vedolizumab.

http://ift.tt/2AwUrzd

Isolated lateral leg compartment syndrome following an ankle sprain

Description

A 25-year-old man came to the emergency room after an inversion ankle sprain during a soccer game with friends. He was unable to play after the injury but was able to walk. He complained about a lateral ankle pain that was rapidly increasing in intensity and spreading to the leg. At the first physical examination, we found a lateral malleolus oedema with normal and almost painless dorsi and plantar ankle flexion, but with severe pain with foot inversion and important weakness on foot eversion. He was initially managed with pain medication and leg elevation while waiting for the imagological study. The plain X-ray and ankle CT showed no significant bone or soft tissue lesion.

At second evaluation, approximately 1 hour later (4 hours after initial trauma), the patient pain was worst and he had an important oedema and tenderness of the lateral leg compartment (figure 1). He...

http://ift.tt/2CLZWQU

Bilateral secondary spontaneous pneumothorax

Description

A 40-year-old male patient presented to the emergency department with complaints of shortness of breath associated with bilateral pleuritic chest pain. He denied any history of trauma and had smoked 40 cigarettes daily for the past 22 years.

On examination, the patient appeared breathless with a respiratory rate of 25 breaths/min and peripheral capillary oxygen saturation (SpO₂) of 92% on room air. Neck examination showed no tracheal deviation and chest examination identified decreased bilateral chest expansion with no intercostal retractions. On chest palpation, there was a slightly diminished tactile fremitus on both sides. Chest percussion revealed a hyper-resonant note heard over the right and left upper and mid zones. On auscultation, there were no audible breath sounds and whispered voice sounds were abolished over the right and left upper and mid zones.

The gasometric evaluation revealed the presence of hypoxaemia and hypocapnia. A posteroanterior chest radiograph showed...

http://ift.tt/2AuZnVj

Blue toe syndrome as a first sign of systemic sclerosis

We describe an unusual case of blue toe syndrome as the primary and solitary manifestation of systemic sclerosis. The possible cause was long-term occupational exposure in construction work. Blue toe syndrome is a small vessel disease, characterised by the sudden development of painful, blue discolouration in one or more toes. The most common aetiology is atheroembolic disease; however, it can also appear in several conditions ranging from hypercoagulability disorders to underlying systemic diseases such as vasculitis or autoimmune diseases. Here, we describe the case of a 57-year-old man who presented with blue toe syndrome without underlying atheroembolic disease. He was found to have positive anticentromere antibodies, which indicated that systemic sclerosis was the likely primary underlying cause. An extensive systemic evaluation and a thorough physical examination revealed no other symptoms associated with systemic sclerosis. He was prescribed nifedipin and rosuvastatin, and showed complete resolution of symptoms after 3 months.

http://ift.tt/2CHicdU

A Multicenter, Randomized, Case-control Study of Unilateral vs Bilateral Neck Dissection for cN0 Supraglottic Laryngeal Cancer

Conditions: Laryngeal Neoplasms; Malignant Neoplasm of Supraglottis Primary; Neck Dislocation
Interventions: Procedure: Unilateral Neck Dissection; Procedure: Bilateral Neck Dissection
Sponsors: Cancer Institute and Hospital, Chinese Academy of Medical Sciences; Liaoning Tumor Hospital & Institute; Hebei Medical University Fourth Hospital; Jilin Provincial Tumor Hospital; The first affiliated hospital of Jinzhou Medical University
Recruiting

http://ift.tt/2F1dF3t

Vaccination Against Human Papillomavirus (HPV) With the 9-valent Vaccine in HIV-positive Women (the Papillon Study)

Conditions: HPV - Anogenital Human Papilloma Virus Infection; Hiv
Intervention: Biological: Vaccine
Sponsor: Centre Hospitalier Universitaire Saint Pierre
Not yet recruiting

http://ift.tt/2EcwKyF

Early Non Invasive Ventilation and Hematological Malignancies

Conditions: Hematological Malignancies; Chronic Hypoxemic Respiratory Failure; Blood And Marrow Transplantation; Malignant Neoplasm of Breast; Malignant Neoplasms of Bone and Articular Cartilage; Malignant Neoplasms of Digestive Organs; Malignant Neoplasms of Eye Brain and Other Parts of Central Nervous System; Malignant Neoplasms of Female Genital Organs; Malignant Neoplasms of Ill-defined Secondary and Unspecified Sites; Malignant Neoplasms of Independent (Primary) Multiple Sites; Malignant Neoplasms of Lip Oral Cavity and Pharynx; Malignant Neoplasms of Male Genital Organs; Malignant Neoplasms of Mesothelial and Soft Tissue; Malignant Neoplasms of Respiratory and Intrathoracic Organs; Malignant Neoplasms of Thyroid and Other Endocrine Glands; Malignant Neoplasms of Urinary Tract; Malignant Neoplasms Stated as Primary Lymphoid Haematopoietic
Interventions: Other: Non-Invasive Positive Pressure Ventilation (NIPPV); Other: High Flow Nasal Cannula Oxygen Therapy
Sponsor: M.D. Anderson Cancer Center
Recruiting

http://ift.tt/2F0VWcp

Indications for Trans-Nasal Flexible Laryngo-Oesophagoscopy in a head and neck clinic, our experience in 194 patients

Abstract

Lamm introduced fibre-optic imaging in 1930s ¹. In the following decades it has been utilized in otolaryngology as an alternative to indirect mirror laryngoscopy. In its present form it allows for image capture and video recording when connected to a camera, it also allows for manoeuvring around anatomical structures due to its flexibility and articulation. It now forms an essential part of any head and neck examination especially when assessing for suspected cancer.

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Asthma onset pattern and patient outcomes in a chronic rhinosinusitis population

Background

Chronic rhinosinusitis (CRS) is strongly associated with comorbid asthma. This study compares early-onset and late-onset asthma in a CRS population using patient-reported and clinical characteristics.

Methods

At enrollment into a clinical registry, CRS patients completed the 22-item Sino-Nasal Outcome Test (SNOT-22), Asthma Control Test (ACT), mini-Asthma Quality of Life Questionnaire (miniAQLQ), the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29), and medication use questionnaires. Patients also reported comorbid asthma and age at first asthma diagnosis. Early-onset (<18 years) and late-onset (>18 years) asthma groups were defined. Analysis of variance (ANOVA), chi-square, and Kruskal-Wallis tests were used to compare patient responses.

Results

A total of 199 non-asthmatic (56.1%), 71 early-onset asthmatic (20.0%), and 85 late-onset asthmatic (23.9%) CRS patients completed the survey. Body mass index (BMI) was significantly higher in late-onset asthmatic (p = 0.046) while age, gender, race, and smoking history did not differ with time of asthma onset. SNOT-22, ACT, and miniAQLQ were not different between asthma groups, but late-onset asthmatics had significantly lower physical function than non-asthmatics (p = 0.008). Compared to non-asthmatics, late-onset asthmatics showed increased rates of nasal polyps (p < 0.001), higher Lund-Mackay scores (p = 0.005), and had received more oral steroid courses (p < 0.001) and endoscopic surgeries (p = 0.008) for CRS management. Late-onset asthmatics compared to early-onset asthmatics showed increased nasal polyposis (p = 0.011) and oral steroid courses for CRS (p = 0.003).

Conclusion

While CRS-specific and asthma-specific patient-reported outcome measures (PROMs) were not significantly different among groups, CRS patients with late-onset asthma had poorer physical function, more frequent nasal polyposis, and required increased treatment for CRS. Late-onset asthma may predict more severe disease in CRS.

http://ift.tt/2Av06pH

Are multiple sinus cultures necessary during sinus surgery for chronic rhinosinusitis?

Background

Multiple cultures are commonly obtained from different sinuses where purulence is encountered during endoscopic sinus surgery (ESS). This brings into question the utility and necessity of obtaining multiple cultures. The purpose of this study was to evaluate if multiple cultures obtained during a single case is informative in finding additional pathogens or if it is a redundant, cost-increasing practice. We hypothesized that multiple sinus cultures are necessary to identify the pathogens responsible for an individual's sinus disease. We seek to add information on the utility of performing multiple sinus cultures from a patient care and a health economics standpoint.

Methods

This study was a retrospective review of a single rhinologist's surgical database from 2008 to 2016. Patients that underwent ESS for chronic rhinosinusitis (CRS) and had multiple cultures obtained during surgery were included. Culture difference was recorded as a discrepancy of an infectious pathogen between cultures.

Results

We identified 231 patients with multiple sinus cultures. Of those, 39.4% had a difference of pathogens noted on culture between different sinuses. Only 5% of the cohort received clinically relevant benefit from the second culture obtained in regard to a change in antibiotics.

Conclusion

In this retrospective review we showed that, for the practitioner who obtains sinus cultures intraoperatively, limiting this practice to a single culture rather than multiple is cost-effective and sufficient for identifying the pathogen to be treated. This study, and the resultant change in practice, has the potential to reduce healthcare costs associated with the surgical care of the patient with CRS.

http://ift.tt/2CIMCwx

Comparative analysis of the Hom family of outer membrane proteins in isolates from two geographically distinct regions: The United States and South Korea

Abstract

Background

Helicobacter pylori encodes numerous outer membrane proteins (OMPs), but only a few have been characterized in depth. Deletion, duplication, and allelic variation of many of the H. pylori OMPs have been reported, which suggests that these proteins may play key roles in host adaptation. Herein, we characterize the variation observed within the Hom family of OMPs in H. pylori obtained from two geographically distinct populations.

Materials and Methods

PCR genotyping of the hom genes was carried out using clinical isolates from South Korea and the United States. A combination of statistical, phylogenetic, and protein modeling analyses was conducted to further characterize the hom variants.

Results

Variations in the closely related hom genes, homA and homB, occur in regions that are predicted to encode environmentally exposed loops. A similar phenomenon is true for homC^S as compared to homC^L. Conversely, little variation was observed in homD. Certain variants of the Hom family of proteins were more prominent in isolates from the Korean population as compared to isolates from the United States.

Conclusion

En masse, our data show that the homA, homB, and homC profiles vary based upon the geographic origin of the strain; however, the fourth member of the hom family, homD, is more highly conserved. Additionally, protein topology modeling showed that many of the less well-conserved regions between homA and homB and between homC^S and homC^L corresponded to predicted environmentally exposed loops, suggesting that the divergence of the Hom family may be due to host adaptation/pressure.

http://ift.tt/2CLd60g

Levels of malondialdehyde in the gastric juice: Its association with Helicobacter pylori infection and stomach diseases

Abstract

Background

Helicobacter pylori (H. pylori) infection causes elevation of lipid peroxidation product malondialdehyde (MDA) and this association may be due to the bacterium causing reactive oxygen species-mediated damage to DNA in the gastric epithelium. The aim of this study was to investigate the gastric juice MDA levels in relation to H. pylori infection and associated gastric diseases.

Methods

Gastric juice samples were obtained from 117 patients undergoing endoscopy, and gastric juice MDA levels were determined by high-performance liquid chromatography (HPLC) system. We compared the MDA levels between patients with and without H. pylori infection and assessed the differences of MDA levels between chronic gastritis, gastric intestinal metaplasia, and gastric cancer postsurgical resection.

Results

Malondialdehyde levels in gastric juice were significantly higher in chronic gastritis patients with H. pylori infection than in those without H. pylori infection (P < .0001). In patients without H. pylori infection, patients with gastric intestinal metaplasia and gastric cancer postsurgical resection had significantly higher gastric juice MDA level than patients with chronic gastritis. As a whole, patients with gastric intestinal metaplasia and gastric cancer postsurgical resection also had significantly higher MDA levels in gastric juice as compared to patients with chronic gastritis (P < .01). However, the difference of gastric juice MDA levels between gastric intestinal metaplasia and gastric cancer postsurgical resection was not significant.

Conclusion

Malondialdehyde in gastric juice could be used as a potential diagnostic biomarker for H. pylori infection and associated gastric diseases. The gastric juice MDA levels increased proportionally with the severity of gastric diseases.

http://ift.tt/2AwwZlE

Αρχειοθήκη ιστολογίου

Παρασκευή 5 Ιανουαρίου 2018

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