Πέμπτη 25 Ιανουαρίου 2018
Adding sufentanil to ropivacaine in continuous thoracic paravertebral block fails to improve analgesia after video-assisted thoracic surgery: A randomised controlled trial
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Comparison of double intravenous vasopressor automated system using nexfin versus manual vasopressor bolus administration for maintenance of haemodynamic stability during spinal anaesthesia for caesarean delivery: A randomised double-blind controlled trial
BACKGROUND Hypotension is a common side effect of spinal anaesthesia during caesarean delivery and is associated with maternal and foetal adverse effects. We developed an updated double intravenous vasopressor automated (DIVA) system that administers phenylephrine or ephedrine based on continuous noninvasive haemodynamic monitoring using the Nexfin device. OBJECTIVE The aim of our present study is to compare the performance and reliability of the DIVA system against Manual Vasopressor Bolus administration. DESIGN A randomised, double-blind controlled trial. SETTING Single-centre, KK Women's and Children's Hospital, Singapore. PATIENTS Two hundred and thirty-six healthy women undergoing elective caesarean delivery under spinal anaesthesia. MAIN OUTCOME MEASURES The primary outcome was the incidence of maternal hypotension. The secondary outcome measures were reactive hypertension, total vasopressor requirement and maternal and neonatal outcomes. RESULTS The DIVA group had a significantly lower incidence of maternal hypotension, with 39.3% (46 of 117) patients having any SBP reading less than 80% of baseline compared with 57.5% (65 of 113) in the manual vasopressor bolus group (P = 0.008). The DIVA group also had fewer hypotensive episodes than the manual vasopressor bolus group (4.67 versus 7.77%; P
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Synthetic DMARDs May Blunt Pneumococcal Vaccine Response in Systemic Sclerosis
Pneumococcal vaccination yields a satisfactory antibody response in patients with systemic sclerosis (SSc), but synthetic disease-modifying antirheumatic drugs (DMARDs) might reduce the vaccine response in these individuals, according to a report from Sweden.
Reuters Health Information
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Low-Dose Trifluoperazine May Help Ease Morgellons Symptoms
Reuters Health Information
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Azelaic Acid 15% Gel for the Reduction of Rosacea Lesions
A recent trial assessed the effects of azelaic acid 15% gel on inflammatory lesions of papulopustular rosacea in a real-world setting, with promising results.
Skin Therapy Letter
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Antibiotics, Antidepressants Dominate New FDA Watch List
Presence on list does not mean a drug has been linked to a risk, only that new safety information is available or potential risk has been identified and further review will be or has been completed.
Medscape Medical News
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Editorial Board Page
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 2
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Surgical Landmarks to Locating the Main Trunk of the Facial Nerve in Parotid Surgery: A Systematic Review
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 2
Author(s): Yisi D. Ji, R. Bruce Donoff, Zachary S. Peacock, Eric R. Carlson
PurposeThe purpose of this study was to describe distances from commonly used anatomic landmarks to the main trunk of the facial nerve during parotid surgery.Materials and MethodsA systematic search of the published literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies from January 1, 1990 to January 1, 2017 that measured distances to the main trunk of the facial nerve from common anatomic landmarks were eligible. Inclusion criteria were English-language articles with distances measured from the main trunk of the facial nerve to anatomic landmarks. The primary outcome variable was the distance from the respective anatomic landmarks. Other variables included surgical approach, year, and existential status of subject (cadaveric or living).ResultsThe search yielded 1,412 studies (1,397 by PubMed, 15 by reference searching), with 10 studies meeting the inclusion criteria. Within the 10 studies, there were 30 reported means and 375 dissected cadavers. The most common incision was the standard preauricular incision; the mean distances to the facial trunk from landmarks were 13.6 ± 11.0 mm (n = 6 reported means) for the tragal pointer, 8.79 ± 3.99 mm (n = 7 reported means) for the posterior belly of the digastric muscle, 10.5 ± 1.4 mm (n = 4 reported means) for the tip of the mastoid process, 14.99 ± 1.68 mm (n = 3 means) for the transverse process of C1, 3.79 ± 2.92 mm (n = 6 means) for the tympanomastoid fissure, 9.80 ± 0 mm (n = 1 mean) for the styloid process, and 11.77 ± 1.42 mm (n = 3 means) for the external auditory meatus. Formal assessment of inter-study variability could not be assessed because of the small number of studies and measurements.ConclusionThere are substantial variations in measurements from anatomic landmarks to the main trunk of the facial nerve in the literature. Therefore, multiple landmarks can be used to identify the main trunk of the facial nerve during parotid surgery. The distances reported in this study can guide surgeons during parotid surgery to decrease the risk of facial nerve damage.
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Table of Contents
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 2
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AAOMS Author Disclosure forms
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 2
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Soft Tissue Changes in Patients Undergoing Intraoral Quadrangular Le Fort II Osteotomy Versus Conventional Le Fort I Osteotomy
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 2
Author(s): Florian Wagner, Michael Figl, Julia Cede, Kurt Schicho, Klaus Sinko, Clemens Klug
PurposeThe aim of this study was to evaluate soft tissue changes after intraoral quadrangular Le Fort II osteotomy (IOQLFII) and correlate those changes to underlying osseous changes.Materials and MethodsTwenty-six non-growing patients with midfacial deficiency and Class III malocclusion were analyzed. A study group of 13 patients who underwent IOQLFII was compared with 13 patients who underwent conventional Le Fort I osteotomy (LFI). After fusion of pre- and postoperative computed tomograms, each patient's hard and corresponding soft tissue changes were measured. Measurement points were defined at 3 levels in the IOQLFII group (infraorbital rim [IR], sinus floor [SF], and lateral incisor tip [LI]) and at 2 levels in the LFI group (SF and LI). Linear models were created to test for correlations between hard and soft tissues.ResultsThe slope (a1 coefficient) between anteroposterior hard and soft tissue changes was found to be highly significant at each measurement point for all groups. In the IOQLFII group, soft tissue advancement was 69% (confidence interval [CI], 62 to 77%) of the hard tissue advancement at the IR, 90% (CI, 84 to 96%) at the SF, and 73% (CI, 64 to 82%) at the LI. In the LFI group, the corresponding percentages were 90% (83 to 97%) at SF and 84% (77 to 90%) at LI.ConclusionIOQLFII results in predictable correction of midfacial deficiency. At the IR, bony advancement always resulted in markedly less soft tissue advancement than at the SF level. These results indicate that the planned infraorbital advancement should not be too conservative because soft tissue changes are smaller in this region.
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Our Volunteers—Celebrating a Century of the AAOMS
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 2
Author(s): James R. Hupp
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Masthead
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 2
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Alveolar Osteitis and Third Molar Pathologies
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 2
Author(s): Glauco Chisci, Aniello Capuano, Stefano Parrini
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Is Virtual Surgical Planning in Orthognathic Surgery Faster Than Conventional Planning? A Time and Workflow Analysis of an Office-Based Workflow for Single- and Double-Jaw Surgery
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 2
Author(s): Thomas Steinhuber, Silvia Brunold, Catherina Gärtner, Vincent Offermanns, Hanno Ulmer, Oliver Ploder
PurposeThe purpose of this study was to measure and compare the working time for virtual surgical planning (VSP) in orthognathic surgery in a largely office-based workflow in comparison with conventional surgical planning (CSP) regarding the type of surgery, staff involved, and working location.Materials and MethodsThis prospective cohort study included patients treated with orthognathic surgery from May to December 2016. For each patient, both CSP with manual splint fabrication and VSP with fabrication of computer-aided design–computer-aided manufacturing splints were performed. The predictor variables were planning method (CSP or VSP) and type of surgery (single or double jaw), and the outcome was time. Descriptive and analytic statistics, including analysis of variance for repeated measures, were computed.ResultsThe sample was composed of 40 patients (25 female and 15 male patients; mean age, 24.6 years) treated with single-jaw surgery (n = 18) or double-jaw surgery (n = 22). The mean times for planning single-jaw surgery were 145.5 ± 11.5 minutes for CSP and 109.3 ± 10.8 minutes for VSP, and those for planning double-jaw surgery were 224.1 ± 11.2 minutes and 149.6 ± 15.3 minutes, respectively. Besides the expected result that the working time was shorter for single-versus double-jaw surgery (P < .001), it was shown that VSP shortened the working time significantly versus CSP (P < .001). The reduction of time through VSP was relatively stronger for double-jaw surgery (P < .001 for interaction). All differences between CSP and VSP regarding profession (except for the surgeon's time investment) and location were statistically significant (P < .01). The surgeon's time to plan single-jaw surgery was 37.0 minutes for CSP and 41.2 minutes for VSP; for double-jaw surgery, it was 53.8 minutes and 53.6 minutes, respectively.ConclusionsOffice-based VSP for orthognathic surgery was significantly faster for single- and double-jaw surgery. The time investment of the surgeon was equal for both methods, and all other steps of the workflow differed significantly compared with CSP.
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Oral/Head and Neck Oncologic and Reconstructive Surgery: The Creation of a Subspecialty in Oral and Maxillofacial Surgery
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 2
Author(s): Eric R. Carlson
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Partial Superficial, Superficial, and Total Parotidectomy in the Management of Benign Parotid Gland Tumors: A 10-Year Prospective Study of 205 Patients
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 2
Author(s): Panagiotis Stathopoulos, Dimosthenis Igoumenakis, William P. Smith
PurposeThe aim of this report is to present an overview of the authors' experience in treating parotid gland tumors for a period of 10 years. This report describes patients' demographics, surgical outcomes, and complications and discusses the management of benign disease with particular emphasis on the importance of facial nerve dissection.Patients and MethodsA total of 205 consecutive patients with different parotid gland tumors underwent surgery at Northampton General Hospital (Northampton, UK) from October 2000 to November 2010. Data were prospectively collected and entered into an electronic database. Patients' demographics, clinical tumor size, type of operation, fine-needle aspiration result, facial nerve status, final histopathologic report, and intraoperative and postoperative complications were recorded and analyzed.ResultsThis study confirmed that good results in low recurrence rate and minimal risk of facial nerve weakness can be achieved with operations less aggressive than traditional superficial parotidectomy, such as partial superficial parotidectomy. Transient facial nerve palsy was significantly more frequent after total (40%; P < .001) and superficial (28%; P < .05) parotidectomy, respectively, than after partial superficial parotidectomy (9.6%).ConclusionBecause the risk or recurrence is higher when surgery is performed by inexperienced surgeons, the authors advocate that parotid gland surgery should be performed by adequately trained operators and the surgical specimen ideally should be examined by a histopathologist experienced in the diagnosis of salivary gland tumors. Recurrence rate for these tumors increases with time; therefore, long-term follow-up is required for these patients.
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Short-Term Evaluation of Gustatory Changes After Surgical Removal of Mandibular Third Molar—A Prospective Randomized Control Trial
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 2
Author(s): Rahul Anand, Dhayasankar Prabhu Shankar, Pedamally Manodh, Pradeep Devadoss, Murugan Aparna, Ravana Sundaram Neelakandan
PurposeThe present study was carried out to prospectively determine the incidence and severity of suprathreshold taste changes after surgical removal of mandibular third molars.Materials and MethodsSixty patients who required removal of impacted third molars were included in the study. Based on the Winter criteria of angulation of impacted mandibular third molars, 15 patients each with mesioangular, distoangular, horizontal, and vertical impacted third molars were selected. The chemo-gustometry chart in pentagon scheme was used to represent the results of gustometry and to establish a correlation between the difficulty index of impacted third molar removal and the incidence of gustatory changes. All patients underwent spatial taste testing preoperatively and 1 week postoperatively.ResultsThe highest incidence of taste changes was noted in category 3 (difficulty score, 7 to 8) and mostly for distoangular and vertically impacted teeth.ConclusionIn their extensive patient analysis of 4 different taste sensations, the authors found that suprathreshold taste changes do occur after surgical removal of an impacted mandibular third molar, with a high difficulty index score indicating the highest prevalence for altered taste sensations for distoangular and vertical impactions.
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Safety concerns of Piezoelectric Units in Implantable Cardioverter Defibrillator
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 2
Author(s): Gonzalo Gómez, Fernando Jara, Baltasar Sánchez, Miguel Roig, Ricard Ferrer, Fernando Duran-Sindreu
PurposeEvidence-based research appears to conflict on the potential risk of electromagnetic interference (EMI) between piezoelectric units (Pzs) and implantable cardioverters and defibrillators (ICDs). The purpose of this study was to observe whether the EMI produced by Pzs is hazardous for ICDs.Materials and MethodsA cross-sectional study of 6 Pzs was conducted in vitro for EMI using an ICD system. To simulate the human body's electrical resistance, electrographic recordings were made of the ICD and lead that were immersed in a bath of saline solution. The variables investigated were the presence of EMI, the distance between the ICD and the Pz, and signal intensity, damage, and type of damage to the ICD and lead. Each series of tests was repeated 3 times, beginning with a 15-second baseline recording (control), until all recording conditions had been covered. Each Pz was recorded under the following conditions: less than 2 cm from the tip of the ICD lead; less than 2 cm from the ICD; less than 2 cm from the lead body and coils; and 15 cm from the lead or the ICD (R4).ResultsIn the positive control (direct contact between the lead or the ICD with the Pz switched on), the ICD detected electrical activity as false heart activity. However, after covering all test conditions, no EMI was produced by the Pzs.ConclusionNo EMI or permanent changes in the functioning of the ICD were detected in vitro.
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Micrognathia and Oropharyngeal Space in Patients With Robin Sequence: Prenatal MRI Measurements
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 2
Author(s): Tessa D. Kooiman, Carly E. Calabrese, Ryne Didier, Judy A. Estroff, Bonnie L. Padwa, Maarten J. Koudstaal, Cory M. Resnick
PurposeMicrognathia is the initiating feature of Robin sequence (RS) and leads to airway obstruction. Prenatal identification of micrognathia is currently qualitative and has not correlated with postnatal findings in previous studies. Oropharyngeal airway space has not been evaluated prenatally. The purposes of this study were to 1) quantitate mandibular characteristics and oropharyngeal size at prenatal magnetic resonance imaging (MRI) and 2) identify differences in fetuses with postnatal RS compared with those with micrognathia (without RS) and normal controls.Materials and MethodsThis is a retrospective case-control study of fetuses with prenatal MRIs performed from 2002 through 2017 who were live born and evaluated postnatally for craniofacial findings. Postnatal findings were used to divide patients into 3 groups: 1) RS (micrognathia, glossoptosis, and airway obstruction), 2) micrognathia without RS ("micrognathia"), and 3) a gestational-age matched control group with normal craniofacial morphology ("control"). Inferior facial angle (IFA), jaw index, and oropharyngeal space (OPS) were calculated and compared among groups.ResultsOf 116 patients in this study, 27 had RS (23%), 35 had micrognathia (30%), and 54 were control subjects (47%). IFA, jaw index, and OPS were statistically significantly smaller in the RS group compared with the comparison groups (P < .0001).ConclusionsPrenatal MRI measurements of micrognathia and OPS are considerably different in patients with RS compared with other groups, including those with micrognathia alone. These measurements might serve as reliable prenatal predictors of RS.
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Postural Assessment in Class III Patients Before Orthognathic Surgery
Publication date: February 2018
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 2
Author(s): Fernando Zugno Kulczynski, Fernando de Oliveira Andriola, Pedro Henrique Deon, Denizar Alberto da Silva Melo, Rogério Miranda Pagnoncelli
PurposeTo determine the postural characteristics of patients with Class III dentofacial deformities before orthognathic surgery by photogrammetry using SAPO postural assessment software.Materials and MethodsThis was a cross-sectional study. Eligible participants were adult patients who had an indication for orthognathic surgery to correct skeletal Class III dentofacial deformities and were undergoing orthodontic preparation for surgery. Patients were recruited at the outpatient clinic for dentofacial deformities of the authors' institution from March to November 2015. Postural assessment was performed by photogrammetry based on anterior, posterior, and lateral images, which were analyzed using SAPO software.ResultsThe sample consisted of 40 patients with a mean age of 28.7 years; 55% were men. Postural changes were found in most anatomic structures, and the main changes were anterior displacement of the center of gravity (sagittal plane asymmetry, 43.77%) and a tendency to left lateral deviation (frontal plane asymmetry, −3.89%). The anterior view showed a pattern of head tilt to the left (measured value minus reference value [Δ], −0.22), elevation of the left acromion (Δ, 2.31), elevation of the right anterior superior iliac spine (Δ, −0.56), right knee with genu varum (Δ, 1.25), and left knee with genu valgum (Δ, −1.55). The posterior view displayed scapular asymmetry with abduction of the right scapula (Δ, 7.54) and valgus foot deformity (Δright, 8.35; Δleft, 11.60). The lateral view depicted decreased cervical lordosis (Δright, 22.63; Δleft, 19.98), pelvic anteversion (Δright, −0.56; Δleft, −0.26), and genu flexum at the right (Δ, 6.85) and left (Δ, 4.40) knees. Twenty-seven patients (67.5%) reported temporomandibular joint pain.ConclusionsPostural assessment by photogrammetry showed that most anatomic structures were outside the normal range in patients with skeletal Class III dentofacial deformities before orthognathic surgery. These results suggest that dentofacial abnormalities can lead to postural disorders in this population.
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Association Between Polymorphisms in the Genes of Estrogen Receptors and the Presence of Temporomandibular Disorders and Chronic Arthralgia
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 2
Author(s): Valquiria Quinelato, Letícia Ladeira Bonato, Alexandre Rezende Vieira, José Mauro Granjeiro, Ricardo Tesch, Priscila Ladeira Casado
PurposeThe high prevalence of painful temporomandibular disorders (TMDs) in women suggests that estrogen and its receptors play a fundamental etiologic role in the development of this joint pathology through complex action mechanisms. The aim of this study was to evaluate the possible association between polymorphisms in the ESR1 (estrogen receptor-1) and ESRRB (estrogen-related receptor-β) genes and the risk of simultaneous development of TMDs and pain in other joints in the body.Materials and MethodsAll participants were clinically evaluated for the presence of TMD (Research Diagnostic Criteria for TMD) and asked about the presence of chronic joint pain. The control group consisted of 72 patients without TMD and without pain. Participants with arthralgia were divided into 3 groups: with muscular TMD (n = 42), with articular TMD (n = 16), and without TMD and with systemic arthralgia (n = 82). Eight single-nucleotide polymorphisms in the ESR1 (rs12154178, rs1884051, rs2273206, rs7774230) and ESRRB (rs1676303, rs4903399, rs10132091, rs7151924) genes were investigated. The χ2 test and Student t and Mann-Whitney tests were used to assess the relevance of nominal and continuous variables, respectively. A P value less than .05 was considered significant.ResultsThe TT (timin/timin) genotype for the ESR1 (rs2273206) gene was strongly associated with the risk of developing muscle TMDs and temporomandibular joint pain (P = .04). For the ESRRB (rs1676303) gene, an association was observed between the CC (cytosine/cytosine) genotype and the presence of articular TMDs associated with other chronic arthralgia (P = .02). These results were confirmed by the increased risk of developing articular TMDs associated with the C allele (P = .04).ConclusionsThis study supports the hypothesis that changes in the ESR1 and ESRRB genes influence the presence of TMDs associated with chronic joint pain.
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Degree of Keratinization Is an Independent Prognostic Factor in Oral Squamous Cell Carcinoma
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 2
Author(s): Susanne Wolfer, Stefan Elstner, Stefan Schultze-Mosgau
PurposeKeratinization is a routinely reported histologic feature in head and neck cancer. In contrast to numerous clinicopathologic parameters, the prognostic value of keratinization in oral squamous cell carcinoma (OSCC) is rarely reported in the literature. The purpose of this study was to review the outcome of patients with OSCC with a special focus on the degree of keratinization.Patients and MethodsIn this retrospective cohort study, we evaluated the medical records at the Department of Oral and Maxillofacial Surgery, Jena University Hospital, and investigated the outcome of patients with OSCC with disease-free survival and disease-specific survival according to the degree of keratinization. This research also analyzed common clinical and histologic parameters such as age, gender, tumor site, T category, N category, resection margin, lymphovascular invasion, and extracapsular spread. Descriptive statistics were performed, and survival was calculated by the Kaplan-Meier method. Prognostic factors were analyzed by multivariate Cox analysis.ResultsIn the sample of 151 OSCC patients, with a median age of 57.5 years and a male-female ratio of 4.03:1, 119 had tumors with no or low keratinization (K0 to K2) and 32 had tumors with good or high keratinization (K3 or K4). More recurrences were seen in patients with OSCC with low keratinization (P = .0008). The 5-year disease-free survival rate was significantly decreased for OSCC with low keratinization (52.9%) compared with good or high keratinization (93.2%) (P = .0008). The 5-year disease-specific survival rate was reduced to 66.1% (P = .0136) for patients with OSCC with low keratinization. Multivariate analysis showed that extracapsular spread (P = .001) and keratinization (P = .002) are independent, significant prognostic factors for recurrence in OSCC.ConclusionsBesides extracapsular spread, the degree of keratinization seems to be an important prognostic factor for recurrence and survival in OSCC. Our results indicate that the degree of keratinization should be considered in decisions regarding treatment and prognosis for OSCC.
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Correction to: Better recognition, diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy: iMAP—an international interpretation of the MAP (Milk Allergy in Primary Care) guideline
In the original version of this article [1], published on 23 August 2017, an incorrect version of Additional file 4 has been used. The corrected version of Additional file 4 is given in this correction.
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Lichenoide Arzneimittelreaktionen
Zusammenfassung
Lichenoide Arzneimittelreaktionen sind im Vergleich zu morbilliformen Arzneimittelexanthemen und durch Medikamente ausgelöste Urtikaria selten und mit einzelnen Arzneimitteln bzw. Arzneimittelgruppen wie Goldpräparaten, Antimalariamedikamenten, β‑Blockern und ACE-Hemmern verbunden. Aktuelle Bedeutung hat ihre Verursachung durch Biologika bzw. Medikamente zur „immune checkpoint inhibition" wie TNF (Tumor-Nekrose-Faktor)-α-Antagonisten und Anti-PD-1(„anti-programme cell death protein 1")-Antikörper erlangt. Meistens manifestieren sie sich in Form eines Lichen planus mit bevorzugter Lokalisation in UV-Licht-abhängigen Hautatrealen, aber auch Schleimhautbeteiligungen bis hin zu bullösen Formen können auftreten.
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Opinion: Making Inactivated and Subunit-Based Vaccines Work
Viral Immunology , Vol. 0, No. 0.
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Development and Validation of the Cholinergic Urticaria Quality of Life Questionnaire: CholU-QoL
Abstract
Background
Cholinergic urticaria (CholU), a common form of chronic inducible urticaria, is characterized by itchy wheals that occur in response to physical exercise or passive warming. CholU patients frequently exhibit a high burden of disease. As of yet, no specific instrument is available to assess their disease-related quality of life (QoL) impairment.
Objective
The aim of this study was to develop and validate the first disease specific QoL instrument for CholU patients, the Cholinergic Urticaria Quality of Life Questionnaire (CholU-QoL).
Methods
Using a combined approach of literature search, semi-structured patient interviews and expert opinion we developed 96 potential CholU-QoL items. Subsequent item selection was performed by means of impact analysis complemented by an expert review for face validity. The resulting final CholU-QoL was then tested for levels of validity, reliability and influence factors in 88 CholU patients. In parallel, an US American-Canadian English version of the CholU-QoL was developed.
Results
The final 28-item CholU-QoL was found to have a 5-domain structure ('symptoms', 'functional life', 'social interaction', 'therapy', 'emotions') with excellent internal consistency. The CholU-QoL also showed a valid total score, and good levels of convergent validity, known-groups validity, as well as test-retest reliability. Multiple regression analysis found no significant drivers of the CholU-QoL total score.
Conclusions & Clinical Relevance
The CholU-QoL is the first disease specific QoL instrument for CholU and also the first specific QoL measure in the field of chronic inducible urticarias. It may serve as a valuable tool for clinical trials and improve routine patient management.
This article is protected by copyright. All rights reserved.
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Prevalence of High-Risk Human Papillomavirus in Tonsil Tissue in Healthy Adults
This retrospective, cross-sectional study examines the prevalence of oropharyngeal human papillomavirus and the spatial relationship between the virus and crypt biofilm in tonsil tissue of otherwise healthy adults.
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Clinical reactivity of celery cultivars in allergic patients – Role of Api g 1
Abstract
Background
Celery (Apium graveolens L.) is a vegetable consumed worldwide. Celery stalks and celeriac roots are often ingredients in convenient food products like spice blends and soups.
Objective
In this study, we examined the allergenicity of distinct celeriac cultivars.
Methods
Sixteen celery allergic patients were identified using a double-blind, placebo-controlled food challenge (DBPCFC). Ten different celeriac cultivars were used for skin prick testing in the patients. Two cultivars were further applied for oral food challenges, their protein composition were analysed by immunoblotting, and contents of major allergen Api g 1 were quantified.
Results
From the 10 investigated celeriac cultivars, two cultivars elicited significantly different skin reactivity ('Anita': 5.0 [2.0 – 12.0] mm vs. 'Prinz': 7.0 [3.0 – 9.5] mm; p = 0.047). Moreover, 'Anita' induced fewer symptoms after a controlled oral celeriac challenge in 14 patient (p < 0.001). The protein profiles on 2DE protein gels showed distinct protein patterns and higher protein amounts of Api g 1 in 'Prinz' than in 'Anita'.
Conclusions & Clinical Relevance
Taken together, the data from this study suggest that cultivar Anita is better tolerated in celery allergic patients than 'Prinz'. Differences in the protein expression profile between the cultivars, particularly the different content of Api g 1, could cause the different allergenicity.
This article is protected by copyright. All rights reserved.
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Otolaryngologic Manifestations of Klippel-Feil Syndrome in Children
This review examines a series of children with Klippel-Feil syndrome to define the otolaryngologic diagnoses made and procedures performed in this challenging patient population.
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Heart Failure and Hearing Loss Among Older Adults in the United States
This secondary analysis of the National Health and Nutrition Examination Survey examines the prevalence and correlates of hearing loss among older adults with and without heart failure in the United States.
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Persistent isoflurane-induced hypotension causes hippocampal neuronal damage in a rat model of chronic cerebral hypoperfusion
Abstract
Background
Postoperative cognitive dysfunction (POCD) is likely to occur in elderly people, who often suffer from cerebral hypoperfusion and white matter lesions even in the absence of cerebral infarctions.
Methods
Thirty-two adult male rats were randomly assigned to one of four groups: the cerebral normoperfusion + normotension group (n = 8), cerebral normoperfusion + hypotension group (n = 8), chronic cerebral hypoperfusion (CCH) + normotension group (n = 8), and CCH + hypotension group (n = 8). A rat model of CCH was developed via the permanent ligation of the bilateral common carotid arteries, but ligation was avoided in the cerebral normoperfusion groups. Two weeks later, the rats were intubated and mechanically ventilated under isoflurane anesthesia, and their mean arterial blood pressure was maintained over 80 mmHg (normotension) or below 60 mmHg (hypotension) for 2 h. After preparing brain slices, histological cresyl violet staining, ionized calcium binding adaptor molecule 1, a marker of microglial activation, or β amyloid precursor protein, a marker of axonal damage, were performed.
Results and conclusion
CCH per se caused microglial activation and axonal damage, which was not accentuated by hypotension. CCH alone did not cause neuronal damage, but CCH combined with hypotension caused significant neuronal damage in the hippocampal CA1 region. These results suggest that persistent hypotension during general anesthesia might cause neuronal damage in patients with CCH, such as elderly people, and contribute to prevention against POCD.
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The effect of in situ simulation training on the performance of tasks related to patient safety during sedation
Abstract
In many countries, procedural sedation outside of the operating room is performed by pediatricians. We examined if in situ sedation simulation training (SST) of pediatricians improves the performance of tasks related to patient safety during sedation in the Emergency Department (ED). We performed a single-center, quasi-experimental, study evaluating the performance of sedation, before-and-after SST. Sixteen pediatricians were evaluated during sedation as part of their usual practice, using the previously validated Sedation-Performance-Score (SPS). This tool evaluates physician behaviors during sedation that are conducive to safe patient outcomes. Following the sedation, providers completed SST, followed by a structured debriefing. They were then re-evaluated with the SPS during a subsequent patient sedation in the ED. Using multivariate regression, odds ratios were calculated for each SPS component, and were compared before and after the SST. Thirty-two sedations were performed, 16 before and 16 after SST. SPS scores improved from a median of 4 (IQR 2–5) to 6 (IQR 4–7) following SST (p < 0.0009, median difference 2, 95% CI 1–3). SST was associated with improved performance in four SPS components. The findings of this pilot study suggest that sedation simulation training of pediatricians improves several tasks related to patient safety during sedation.
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Distance between mandibular canal and third molar root among 20-year-old subjects
Abstract
Objectives
The aim of the study was to evaluate the proximity of the mandibular third molar (M3) and the inferior alveolar canal (IAC) in a panoramic radiograph of 20-year-old subjects. The specific aim was to assess differences in this proximity over time.
Materials and methods
Two similar samples of panoramic radiographs taken in a routine oral health examination with 20-year time interval were examined retrospectively and images with both mandibular M3s were included. The material consisted of 300 subjects (25% men, mean age 20.5 ± 0.6 years). The radiographic relationship between the mandibular M3 root and the IAC was assessed as follows: the M3 root was either apart from, tangential to, superimposed with, or inferior to the IAC. Differences between frequencies were tested using the chi-squared test.
Results
In the combined samples, only 16% of the M3s located apart from the IAC, 15% located tangential to, 61% superimposed with, and 8% inferior to the IAC. The proportion of the intimate locations had increased during the 20-year time interval from 79 to 88% (P < 0.01) and especially in females (P < 0.05).
Conclusion
The vast majority of the mandibular M3s situated very close to the mandibular canal.
Clinical relevance
Our results suggest that in the cohort of 20-year-old non-extraction subjects, most of the M3s are possibly at risk for inferior alveolar nerve injury at removal, as judged from the panoramic radiograph, and also the number of such teeth has increased over the 20-year period.
http://ift.tt/2rzVgYW
Lactobacillus rhamnosus intake can prevent the development of Candidiasis
Abstract
Objective
This study aimed to investigate the influence of Lactobacillus rhamnosus intake on the development of candidiasis and cytokines release.
Material and methods
Candida suspensions were inoculated into the oral cavity of experimentally immunosuppressed mice for candidiasis induction. The animals were divided into experimental groups: candidiasis with no probiotic intake (F), candidiasis with probiotic intake during Candida inoculation (FP), and candidiasis with probiotic intake 14 days before inoculation with Candida (FPP); and control groups: (C), (CP), and (CPP) without inducing candidiasis with probiotic intake in the same manner as groups F, FP, and FPP, respectively. After these periods, samples were collected from the oral cavity for yeast counts and, after euthanasia, the tongues of the animals were removed for histological analysis. Sera samples were also collected for analysis of IL-1 beta, TNF-alpha, INF-gamma, IL-12, IL-4, and IL-10.
Results
FP group showed lower Candida counts in the oral cavity, and the presence of Candida was almost not detected in FPP group. In tissues, the counts of fungi were significantly lower in FPP group, followed by FP. Groups that consumed probiotics also had lower histological and inflammatory infiltrates compared to F. Cytokines analysis demonstrated low concentrations of TNF-α, IL-12, IL-4, and IL-10 in all the groups, and no statistical difference between them. The production of IL-6 could be better detected, and the experimental groups that consumed the probiotic showed significant lower levels of this cytokine.
Conclusions
The results suggest that L. rhamnosus intake, especially preventively, may avoid or decrease the development of candidiasis in immunosuppressed mice.
Clinical relevance
This work adds scientific evidences that probiotics intake can avoid the development of candidiasis.
http://ift.tt/2GjHeOE
Sensitivity of caries pathogens to antimicrobial peptides related to caries risk
Abstract
Objectives
Antimicrobial peptides (AMPs) represent important facets of the immune system controlling infectious diseases. However, pathogens show varying susceptibilities to AMPs. This study investigates the susceptibilities of strains of Streptococcus mutans (SM), Actinomyces naeslundii (AN), and Lactobacillus spp. (LB) towards AMPs and if there are correlations between the appearance of such high-risk strains and clinical caries status.
Material and methods
Plaque samples were collected from patients along with clinical examinations. Bacterial strains were identified via selective media, matrix-assisted laser desorption/ionization analysis-time of flight (MALDI-TOF), and arbitrary-primed-PCR (AP-PCR). Each strain was tested for susceptibility to LL-37, HBD-2, HNP-1, and HNP-3 or phosphate-buffered saline as negative control in a biofilm model on hydroxylapatite discs. Survival rates and resulting risk classification for each strain were determined. Correlations were calculated between the number of high-risk strains (all/S. mutans) appearing in patients and their clinical caries status.
Results
Forty-seven patients were included with mean DMFT values of 11.4 ± 8.7. A total of 8 different SM, 30 LB, and 47 AN strains were detected. One-way ANOVA indicated that type/concentration of AMPs had major influence on reductions of Lactobacilli and Actinomyces. Seventeen strains of AN, 2 of SM, and 6 of LB had low susceptibilities to AMPs. The number of such strains in patients showed significant positive correlations to the DMFT values (all p = 0.001; r = 0.452; S. mutans p < 0.0001, r = 0.558).
Conclusion
The occurrence of low susceptible strains to AMPs seems to correlate with the individual caries status.
Clinical relevance
The results may lead to new ways to identify individuals with increased caries risk.
http://ift.tt/2rF4Mdj
Effectiveness of ultrasonically activated irrigation on root canal disinfection: a systematic review of in vitro studies
Abstract
Objectives
Reduction of microbial load from the root canal systems is a pre-requisite for healing of lesions of endodontic origin. Such microbial reduction is influenced by the method of irrigant delivery and activation. The aim of this systematic review was to compare the effect of ultrasonically activated irrigation (UAI) with other irrigation techniques on the reduction of microorganisms during root canal disinfection.
Materials and methods
The research question was created based on the PICO strategy. Two reviewers independently performed a comprehensive literature search in electronic databases. Following application of inclusion and exclusion criteria to the selected articles, a systematic data extraction sheet was constructed. The selected articles were assessed using methodological quality scoring protocol. The risk of bias in selected studies was critically assessed by two reviewers.
Results
A total of 15 articles were included for the systematic review. The included studies were heterogeneous in study design; hence, meta-analysis was not performed. The overall risk of bias for the selected studies was moderate. Overall, UAI showed superior reduction of microbial counts, resulting in better disinfection compared to other irrigation systems chosen for comparison in this review.
Conclusion
The use of UAI can bring about superior microbial reduction within the root canal system compared to other irrigant activation techniques.
Clinical relevance
Activation of irrigants with ultrasonic brings about significant bacterial reduction from the root canal systems compared to other methods of irrigant activation and conventional syringe irrigation. This might help in improving the outcome of root canal treatment.
http://ift.tt/2GfFJki
A web-based endodontic case difficulty assessment tool
Abstract
Objective
To develop a web-based tool to facilitate identification, evaluation and management of teeth requiring endodontic treatment.
Materials and methods
Following a literature search and thorough analysis of existing case difficulty assessment forms, the web-based tool was developed using an online survey builder (Qualtrics, Qualtrics Lab, UT, USA). Following feedback from a pilot study, it was refined and improved. A study was performed, using the updated version (EndoApp) on a cohort (n = 53) of dental professionals and dental students. The participants were e-mailed instructions detailing the assessment of five test cases using EndoApp, followed by completion of a structured feedback form. Analysis of the EndoApp responses was used to evaluate usage times, whereas the results of the feedback forms were used to assess user experience and relevance, other potential applications and comments on further improvement/s.
Results
The average usage time was 2 min 7 s; the average times needed for the last three (Cases 3–5) were significantly less than the preceding two (Cases 1 & 2) test cases. An overwhelming majority of participants expressed favourable views on user experience and relevance of the web-based case difficulty assessment tool. Only two participants (4%) were unlikely or very unlikely to use EndoApp again. The potential application of EndoApp as an 'educational tool' and for 'primary care triage' was deemed the most popular features and of greater importance than the secondary options of 'fee setting' and as a 'dento-legal justification tool'.
Conclusions
Within the study limitations, owing to its ability to quantify the level of difficulty and provide guidance, EndoApp was considered user-friendly and helped facilitate endodontic case difficulty assessment. From the feedback, further improvements and the development of a Smartphone App version are in progress.
Clinical relevance
EndoApp may facilitate treatment planning, improve treatment cost-effectiveness and reduce frequency of procedural errors by providing appropriate guidance on endodontic case management.
http://ift.tt/2rF4Bi9
Case 3-2018: A 5-Month-Old Boy with Hypoglycemia
Presentation of Case. Dr. Micaela R. Atkins (Pediatrics): A 5-month-old boy was admitted to the pediatric intensive care unit (ICU) of this hospital for evaluation of suspected hypoglycemia. The patient was born at another hospital after 40 weeks 4 days of gestation. His mother had had a positive…
http://ift.tt/2DFM9LV
Radio Frequency Ablation and Pulsed Radiofrequency for Treating Peripheral Neuralgias
Abstract
Purpose of Review
Peripheral nerve pain is common among patients with typical management including the use of pain medications, neuropathic agents, steroid injections, and nerve blocks. Additionally, the use of pulsed radiofrequency (PRF) and radiofrequency ablation (RFA) can be used in the management of chronic peripheral nerve pain. Previous studies investigating the effectiveness of RFA and PRF, typically case reports, have demonstrated that peripheral nerve RFA and PRF have the potential to provide relief of chronic pain for long duration. Our study aimed at testing efficacy of RFA/PRF for treating peripheral neuralgia. This was a retrospective review. We identified 16 patients who received 17 RFAs/PRFs. Outcomes of interest collected included pain scores before and after procedures, percent improvement in pain after each procedure, and duration of improvement until the time of data collection. In addition, demographic data including age, sex, and nerves involved were collected.
Recent Findings
Eleven patients (12 RFAs/PRFs) (80%) reported improvement after their procedure. Pain scores improved significantly from 6.3 ± 2.3 before each procedure to 3.6 ± 2.7 after each procedure (p = 0.003). Eleven patients (12 RFAs/PRFs) reported an average improvement of 60.8% ± 35% after their procedure with an average duration of improvement of 128.8 ± 106.8 days.
Summary
RFA and PRF can be used to treat chronic peripheral pain after conservative methods fail to do so. Large clinical trials are needed to confirm our finding.
http://ift.tt/2rEHaFK
Comparative study of Helicobacter pylori eradication rates of concomitant therapy vs modified quadruple therapy comprising proton-pump inhibitor, bismuth, amoxicillin, and metronidazole in Korea
Abstract
Background
The standard triple Helicobacter pylori regimen now shows unacceptably low treatment success in Korea. Administration of the concomitant therapy for 10 days, which has a high cure rate, is recommended as an alternative first-line treatment in areas of high clarithromycin resistance including Korea. Recently, modified bismuth-containing quadruple therapy with amoxicillin (PAM-B therapy) showed excellent results, regardless of dual clarithromycin and metronidazole resistance. This study compared the concomitant therapy with PAM-B therapy as a first-line treatment for H. pylori infection.
Method
Subjects infected with H. pylori and naïve to treatment were performed a head-to-head comparison between 10-day concomitant therapy [rabeprazole 20 mg, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg twice daily] and 14-day PAM-B therapy [rabeprazole 20 mg, amoxicillin 1 g, metronidazole 750 mg, and tripotassium dicitrato bismuthate 600 mg (elemental bismuth 240 mg) twice daily]. Six weeks after treatment, H. pylori eradication was assessed.
Results
Two hundred and seventy subjects were randomized. Both regimens achieved high cure rates: 83.0% (112/135) and 88.1% (119/135) by the intention-to-treat analysis and 95.5% (106/111) and 96.6% (114/118) by the per-protocol analysis, respectively. The intention-to-treat and per-protocol analyses revealed no statistically significant difference in the eradication rate (P = .299 and P = .743, respectively). Rates of adverse events were similar between groups (25.2% vs 23.0%, P -value: .776) Adverse events, which resulted in poor compliance, occurred in six patients of each group, but there were no serious complications.
Conclusions
PAM-B therapy is as effective as concomitant therapy for eradicating H. pylori with comparative safety. PAM-B therapy is regarded as a promising alternative to standard triple therapy for a first-line eradication in Korea.
http://ift.tt/2DI4jfg
Cisplatin Plus Radiotherapy vs Durvalumab Plus Radiotherapy Followed by Durvalumab vs Durvalumab Plus Radiotherapy Followed by Tremelimumab and Durvalumab in Intermediate Risk HPV-Positive Oropharyngeal SCC
Condition: Oropharyngeal Squamous Cell Carcinoma
Interventions: Radiation: Radiation; Drug: Cisplatin; Drug: Durvalumab; Drug: Tremelimumab
Sponsors: Canadian Cancer Trials Group; AstraZeneca
Not yet recruiting
http://ift.tt/2DytMVe
Interventions: Radiation: Radiation; Drug: Cisplatin; Drug: Durvalumab; Drug: Tremelimumab
Sponsors: Canadian Cancer Trials Group; AstraZeneca
Not yet recruiting
http://ift.tt/2DytMVe
Filaggrin gene mutations may influence the persistence of food allergies in Japanese primary school children
Abstract
Mutations in FLG are the underlying cause of ichthyosis vulgaris and are an important predisposing factor for atopic dermatitis (AD).1 In 2011, FLG mutations were reported to increase the risk of peanut allergy2, and they have been proven to increase the risk of other food sensitizations and allergies.3,4 In this study, we comprehensively screened 411 children in Japan for 10 Japanese-population-specific FLG mutations and suggested that FLG mutations influence the persistence of food allergies (FAs).
This article is protected by copyright. All rights reserved.
http://ift.tt/2nbfbZy
Confocal microscopy in adult women with acne
Abstract
Background
Acne is an inflammatory disease of the pilosebaceous follicle, affecting 41–54% of adult women, with a particular form that involves the mandible.
Methods
We characterized infundibulum morphology in two groups of adult women using reflectance confocal microscopy. First, we investigated acne visually "healthy zones" on the forehead in 15 adult women with diffuse acne and compared with acne-free controls. We then compared healthy forehead and affected mandibular zone in 15 acne patients with mandibular involvement. Exposed results had a P < 0.05.
Results
Seven hundred and ninety-one follicles were observed on apparently healthy skin of 15 adult women with acne, with a larger diameter, thicker (68%), and hyper keratinized (65%) follicle border, and more keratin plugs (44%) than in controls. In the second group of 15 adult women with mandibular acne, we compared 569 follicles in the mandibular zone and 475 on forehead. In the mandibular area, follicles were significantly larger, thicker (76%), more hyper keratinized (72%), with more keratin plugs (47%) and increased inflammation (23%) compared with the forehead area. In the mandibular area, 0.2% of follicles showed isolated inflammation without hyper keratinization, and 15.3% had both thickened borders with an onion-like appearance and keratin plugs associated with inflammation.
Conclusions
Hyper keratinization was higher in healthy skin of adult women with acne compared with controls, confirming that microcomedo is crucial in the development of acne lesions. We also demonstrate that the repartition of comedones and microcomedones is inhomogeneous with a great number in the mandibular area where acne lesions are located.
http://ift.tt/2DygAzG
Prevalence and predictors of depressive symptoms among attendees of a tertiary care dermatology clinic in Muscat, Oman
Abstract
Background
Various studies have suggested that depression is more prevalent among patients with skin disorders than in the general population. Most of the studies addressing this subject involve Euro-American populations.
Objectives
The present study aimed to estimate the prevalence of depressive symptoms among patients with dermatological disorders and, then, to decipher the clinical–demographic factors associated with depressive symptoms.
Methods
A cross-sectional analytical study was conducted among a random sample of patients attending a dermatology clinic in Muscat. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depressive symptoms. A logistic regression model was used to find the adjusted and unadjusted odds ratios (ORs).
Results
A total of 260 patients participated in this study, with a response rate of 81%. The prevalence of depression symptoms was 24%. According to regression analysis, family history of depression, comorbid medical disorders, and treatment with topicals or isotretinoin were significant predictors of depression (OR = 9.41, 95% confidence interval [CI]: 2.27–39.05, P = 0.002; OR = 2.0, 95% CI: 1.2–3.21, P = 0.05; OR = 2.28, 95% CI: 1.09–4.76, P = 0.028; and OR = 2.78; 95% CI: 1.08–7.19, P = 0.035, respectively).
Conclusion
This study indicates that depressive symptoms are common among patients with dermatological disorders in Oman, particularly in those with a family history of depression and medical comorbidities, and those who use a specific dermatological medication. Screening for depression in patients attending dermatology clinics is essential in order to detect and promptly treat patients suffering from depression.
http://ift.tt/2Ebl3JT
Long-term pediatric skin eruption-related hospitalizations in offspring conceived via fertility treatment
Abstract
Background
Although concerns have been raised regarding the long-term health risks of offspring conceived following fertility treatments, limited information is available regarding their health status beyond the neonatal period. We aimed to evaluate the risk of long-term eruptive dermatological morbidity among children born following fertility treatments as compared to those conceived spontaneously.
Methods
A population-based cohort study was conducted, including all singleton deliveries occurring between the years 1991 and 2014 at a single tertiary medical center. Fetuses with congenital malformations and multiple gestations were excluded. Children delivered following fertility treatment pregnancies and spontaneous pregnancies were compared. Hospitalizations of the offspring up to the age of 18 years involving cutaneous eruptions were evaluated. A Kaplan–Meier survival curve was used to compare cumulative morbidity incidence and a Cox regression model to control for confounders.
Results
During the study period, 242,187 singleton deliveries met the inclusion criteria, 1.8% of which were following fertility treatments (n = 4324). Eruptive dermatological morbidity of the offspring up to the age of 18 years was significantly more common in the fertility treatment group (1.5%) as compared to spontaneous pregnancies (1.1%; P = 0.023). The Kaplan–Meier survival curve demonstrated a significantly higher cumulative incidence of eruptive dermatological morbidity following fertility treatments (log-rank P = 0.007). Using the Cox regression model, while controlling for multiple confounders, fertility treatment was noted as an independent risk factor for long-term pediatric eruptive dermatological morbidity (adjusted HR = 1.43, CI 1.12–1.83, P = 0.004).
Conclusion
Singletons conceived via fertility treatments appear to be at an increased risk for long-term eruptive dermatological morbidity.
http://ift.tt/2E6ZyK3
A Brodie’s abscess with soft tissue collection—complicating an already difficult diagnosis
Abstract
A healthy 14-year-old boy with a 3-month history of thigh pain and swelling is referred to a specialist centre with an uncertain diagnosis. After extensive tests and imaging a Brodie's abscess is diagnosed. The abscess is complicated by a fistula (cloaca) through the cortical bone of the femur, resulting in a large complex soft tissue collection. This is a presentation, we are unaware has been documented in any literature. After specialist multi-team combined management (Paediatric Trauma and Orthopaedic and Paediatric Infectious Diseases), the patient undergoes two surgical procedures, and extensive antibiotic cover. The patient makes a good recovery with no long lasting sequelae to date.http://ift.tt/2rE0eE4
Pancreaticoduodenectomy with hepatic arterial revascularization for pancreatic head cancer with stenosis of the celiac axis due to compression by the median arcuate ligament: a case report
Abstract
A 71-year-old woman presented to our hospital because pancreatic head cancer was suspected on a medical checkup. Computed tomography showed a 30 mm low-density lesion in the pancreatic head, and the stenosis of the celiac axis (CA) due to the median arcuate ligament (MAL) compression. We made a preoperative diagnosis of pancreatic head cancer and performed laparotomy. Transection of the MAL failed to restore adequate hepatic arterial flow, necessitating arterial revascularization, which was achieved by end-to-end anastomosis between the gastroduodenal artery and the middle colic artery. After reconstruction, Doppler ultrasonography showed improved hepatic arterial signal. The patient was discharged 16 days after surgery with no complications. When planning pancreaticoduodenectomy (PD) for such patients with CA stenosis due to MAL compression, surgeons should simulate a situation of insufficient hepatic arterial flow after division of the MAL, and prepare for reconstruction of the hepatic artery during PD.http://ift.tt/2GeNNSm
Spontaneous closure of multiple enterocutaneous fistula due to abdominal tuberculosis using negative pressure wound therapy: a case report
Abstract
Enterocutaneous fistula (ECF) is one of the most challenging abdominal complications, for surgeons and other healthcare members, which involves significant morbidity and potentially mortality. Despite advancements in both operative and non-operative therapy, fistula-related complications are still unavoidable. Negative pressure wound therapy (NPWT) had been used years to treat chronic wound, to decrease tissue edema, improve circulation, promote healthy granulation tissue and inhibit bacterial growth. We report a 29-year-old male with complicated ECF due to abdominal tuberculosis, that was healed after treated using NPWT. This was the first ECF patient in our hospital treated using NPWT.http://ift.tt/2rDgWDI
Plasma Ropivacaine Concentrations Following Local Infiltration Analgesia in Total Knee Arthroplasty: A Pharmacokinetic Study to Determine Safety Following Fixed-Dose Administration
Background and Objectives The primary aim of this study was to examine the pharmacokinetics of ropivacaine in patients undergoing elective total knee arthroplasty with local infiltration analgesia as the primary analgesic method. We also sought to determine the incidence of biochemical toxicity through measurement of plasma ropivacaine concentrations over the first 24 hours postoperatively. Methods This was a prospective, observational study of 15 patients undergoing elective total knee arthroplasty. Local infiltration analgesia was administered by standard technique with 300 mg ropivacaine and epinephrine 5 μg/mL. Total ropivacaine concentrations were taken at specified time intervals in the 24 hours after tourniquet release and analyzed by liquid chromatography–mass spectrometry. Results Fifteen patients were enrolled into the study. The median peak ropivacaine concentration was 0.57 μg/mL, with a range of 0.32 to 0.88 μg/mL, and occurred between 6 and 24 hours. Age (P = 0.04), weight (P = 0.04), creatinine (P = 0.02), and female sex (P = 0.03) were important predictors of peak concentration. Age (P = 0.02), female sex (P = 0.01), and baseline α1 acid glycoprotein concentrations (P = 0.03) were important predictors for the area under the curve from a ropivacaine concentration versus time plot. Conclusions The peak total ropivacaine concentration was below quoted toxic concentrations (2.2 μg/mL) in all patients. This peak occurred later than has previously been described in those undergoing neuraxial or peripheral nerve block, occurring between 6 and 24 hours. The influence of age, weight, and renal function on systemic ropivacaine concentration should be considered when planning local infiltration analgesia. Female sex is a factor that has not previously been associated with peak ropivacaine concentrations. Accepted for publication August 28, 2017. Address correspondence to: Reuben J. Miller, MBChB, Department of Anaesthesia and Pain Medicine, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand (e-mail: reuben.j.miller@gmail.com). The authors declare no conflict of interest. This research was funded in part by the Counties Manukau Health TUPU fund and the South Auckland Anaesthetic Research Trust. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
http://ift.tt/2FfFq82
http://ift.tt/2FfFq82
Epidural Hematoma Following Cessation of a Direct Oral Anticoagulant: A Case Report
Objective In this case report, we describe a case of epidural hematoma following epidural analgesia in a patient with recent cessation of a direct oral anticoagulant (DOAC). Case Report An 89-year-old woman requiring upper abdominal surgery presented with multiple comorbidities, including a prior cerebrovascular accident resulting in a left-sided hemiparesis and atrial fibrillation requiring anticoagulation with rivaroxaban. In accordance with our departmental guidelines at the time of procedure, rivaroxaban was discontinued 4 days preoperatively. A thoracic epidural was placed at T8/9 immediately prior to induction. Venous thromboembolism prophylaxis was provided with compression devices, and every-12-hour unfractionated heparin initiated 5.5 hours after epidural placement. On postoperative day 2, the patient was noted to have a bilateral motor block, and imaging demonstrated a thoracic epidural hematoma extending from T6 to T11. Preexisting neurological deficits may have delayed detection. With patient agreement, neurosurgery recommended observation rather than surgical decompression because the patient was a poor surgical candidate and limited neurologic recovery was expected. The patient had modest motor recovery over the next few months. Conclusions Guidelines for cessation of DOACs prior to neuraxial techniques are based on pharmacologic half-lives rather than accumulated experience. This case adds to the experience of neuraxial analgesia complications while following these guidelines. Patient risk may be increased by the combination of recent cessation of a DOAC, as well as the cumulative effect of multiple small risk factors. Continued vigilance and reporting of cases of epidural hematomas will enhance our understanding and ultimately improve patient care. Elderly patients and/or patients with prior neurological deficits may present further challenges for early detection and require frequent assessments with comparison to baseline status. Accepted for publication October 4, 2017. Address correspondence to: Melanie Jaeger, MD, FRCPC, Department of Anesthesiology and Perioperative Medicine, Queen's University, Victory 2, Kingston General Hospital, 76 Stuart St, Kingston, Ontario, Canada, K7L 2V7 (e-mail: jaegerm@kgh.kari.net). No funding was acquired for preparation or publication of this article. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
http://ift.tt/2FfFip4
http://ift.tt/2FfFip4
Impact of a new simplified disability scoring system for adult patients with localized scleroderma
Abstract
Localized scleroderma (LoS) involves dermal but not internal inflammation and fibrosis. Cosmetic changes often impact quality of life (QOL), however, impairment of activities of daily living (ADL) in LoS patients has not been investigated. To determine what factor(s) are associated with ADL in adult patients with LoS, we performed a retrospective observational study in 177 Japanese adult LoS patients using a novel LoS disability score based on Barthel's indices of ADL: feeding, bathing, grooming, dressing, bowels, bladder, toilet use, transfers, mobility and stairs. LoS disability scores increased in proportion to the number of affected body parts but were not correlated to age and duration of illness. The presence of leg lesions significantly impaired ADL of LoS patients compared with lesions on other body parts. Patients treated with systemic medications, who tended to have multiple lesions, presented higher LoS disability scores than those without systemic treatments. Our study proposes that physicians evaluate ADL, not only QOL, in LoS patients. Our findings using LoS disability scoring indicate that multiple affected body parts and leg lesions are risk factors for ADL impairment.
http://ift.tt/2BryodN
Current developments in phototherapy for psoriasis
Abstract
Phototherapy utilizes the beneficial effects of ultraviolet (UV) wavelengths to affect immunoregulatory functions. UV light phototherapy using narrowband UV-B (NB-UVB) and bath-psoralen UV-A (bath-PUVA) therapy are well-established treatments for psoriasis. Dual-action mechanisms of UV phototherapy have been identified: apoptosis and immune suppression. NB-UVB depletes pathogenic T cells by inducing apoptosis and regulatory T cells. Other wavelengths are also utilized for phototherapy, namely 308-nm excimer light and 312-nm flat-typed NB-UVB. Excimer light (308-nm) therapy effectively targets the affected skin without unduly exposing other areas and increases the levels of regulatory T cells. Phototherapy improves impaired resting regulatory T cells and increases activated regulatory T cells in patients with psoriasis. Intensive studies of phototherapy effects have led to several improvements in the design, protocols, and light sources, such as UV light-emitting diodes, thereby providing several options for patients with refractory skin disease, such as psoriasis.
http://ift.tt/2n8WwNY
Birth Order and Pediatric Allergic Disease: A Nationwide Longitudinal Survey
Abstract
Background
Environmental factors seem to be related to the incidence of allergic disease. Children with a later birth order are often exposed to environments where pathogens and endotoxins can be found, and thus have a higher risk of developing infectious diseases. Therefore, birth order is regarded as an indicator that reflects postnatal environment. However, longitudinal studies are limited on this subject. This study sought to elucidate the relationships between birth order and allergic disease.
Methods
From a nationwide longitudinal study that followed children born in 2001 (n=47,015), we selected doctors' visits for three types of allergic disease—bronchial asthma, food allergy, and atopic dermatitis—from infancy to 12 years of age and conducted binomial log-linear regression analysis to evaluate the associations between birth order and these diseases. We adjusted for child and parental factors and estimated risk ratio (RR) and 95% confidence interval (CI) for each outcome.
Results
The associations between birth order and bronchial asthma were diverse; later birth order increased the risk in early childhood, but decreased the risks during school age. For example, the adjusted RR comparing third-born or higher and first-born children was 1.19 (95% CI, 1.05 to 1.35) between 30 and 42 months of age, but was 0.76 (95% CI, 0.65 to 0.89) between 10 and 11 years. Later birth order was generally protective for food allergy but increased the risk of atopic dermatitis.
Conclusion
The influence of birth order depended on the type of allergic disease and the childhood period. Childhood is unique in terms of physical and immunological development, and the immune response to the postnatal environment in childhood appears to be heterogeneous.
This article is protected by copyright. All rights reserved.
http://ift.tt/2n8p0HS
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