Influence of Backscatter Radiation on Cranial Bone Fixation Devices

Postoperative radiation can cause ulcer formation, leading to the denudation of skin over alloplastic materials. The influence of backscatter radiation from fixation devices has not been investigated. The aim of this study is to evaluate backscatter dose variations for different cranial bone fixation devices in an experimental model designed to simulate postoperative radiotherapy. The authors assessed the radiation backscatter doses associated with resorbable (PLLA-PGA) and titanium plates. The samples were irradiated with 6 and 10 MV photon beams from a linear accelerator. Measurements were obtained using an ionization chamber and radiochromic films cut from the same batch. As a result, the backscatter radiation of water and PLLA-PGA proportionally decreased as the depth increased. However, the backscatter radiation of the titanium plate increased just above the plate. This depth lies in the region of the scalp. Each material showed a dose of radioactivity that was higher at 10 MV than that at 6 MV. These devices showed a significant difference, which suggested that these materials amplified the dose compared with water at 6 MV. In conclusion, it is supposed that PLLA-PGA should be used to fix the cranium to decrease the potential for radiation ulcers. Address correspondence and reprint requests to Yoshiaki Sakamoto, MD, Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ward, Tokyo 160-8582, Japan; E-mail: ysakamoto@z8.keio.jp Received 26 March, 2017 Accepted 30 December, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Perforating Brain Injury By a Rusty Steel Bar

A perforating head injury is a type of an injury wherein the projectile passes entirely through the cranium leaving both entrance and exit wounds. It is considered less prevalent than other kinds of head trauma such as closed or penetrating head injuries carry a worse prognosis among other varieties of head injuries. Having unique mechanism and pathophysiology it is considered a significant challenge for the practicing neurosurgeon mandating high precaution and novel approach to minimize further damage. Here, we presented a case of a 5-year-old boy who suffered from perforating brain injury by a fallen rusty steel bar. Address correspondence and reprint requests to Ke Wang, MD, PhD, Attending neurosurgeon, Neurosurgery, Shanghai 10th Affiliated Hospital of Tongji University, 301 Yan Chang Road, Shanghai 200072, China; E-mail: 2760223760@qq.com, 2177410002@qq.com Received 29 October, 2017 Accepted 20 December, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Surgical Management and Evaluation of the Craniofacial Growth and Morphology in Cleidocranial Dysplasia

Cleidocranial dysplasia (CCD, MIM 119600) is a rare autosomal dominant disorder affecting bone, cartilage, craniofacial growth, and tooth formation leading to supernumerary teeth. Few reports delineate the genotype–phenotype correlations related to the variations in craniofacial morphology and patterning of the dentition and the complexity of treating patient's malocclusion. Successful management of the craniofacial deformities in patients with CCD requires a multidisciplinary team of healthcare specialists. Approximately 70% of patients are due to point mutations in RUNX2 and

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Comparing the Efficacy of Peritonsillar Injection of Tramadol With Honey in Controlling Post-Tonsillectomy Pain in Adults

Introduction: The authors investigated the effect of honey on post-tonsillectomy pain and compare its efficacy with tramadol. Methods: This clinical trial was performed on 60 patients with American Society of Anesthesia I and II aged between 18 and 55 years and underwent tonsillectomy. Induction of anesthesia was carried out using 2 mg/kg propofol and 0.5 atracurium following 1.5 μg/kg fentanyl administration. Group B was given tramadol at dose of 2 mg/kg and with volume of 4 mL and Group A was given normal saline with the same volume 2 mL of medications were injected using needle (25) into tonsil bed and anterior old of each tonsil by an anesthesiologist. Three minutes after injection, the surgery was performed by the same ENT residents for all patients. In the recovery room Group B received antibiotics and oral acetaminophen. Group A was given antibiotics, oral acetaminophen, and honey dissolved in 40 mL warm water every 6 hours from when the patient was fully awake. Patients in Group A were told to eat honey 3 times a day 7 days postoperatively. Pain was scored using Numeric Rating Scale at the time points of 2, 6, 12, and 24 hours as well as 3 and 7 days postoperatively. Moreover, the healing status and epithelialization degree of tonsillar bed were considered on 1 and 7 days after the surgery by ENT specialist. Results: The mean of pain score was significantly higher in Group A within 24 hours postoperatively as compared with Group B (P 0.05). Considering restoration status and epithelialization degree of tonsillar bed on the 1st and 7th days, there was no statistically significant difference between 2 groups; however, tonsillar bed healing process was better in Group B on the 7th day. Conclusion: The current investigation confirmed the positive impact of tramadol on post-tonsillectomy pain relief in adults. The authors also found that honey can be used as a complementary treatment along with acetaminophen and other analgesics for reducing post-tonsillectomy pain. Considering honey impact on wound healing and its anti-inflammatory effect, it is suggested for relieving complications after surgery. Address correspondence and reprint requests to Vahid Zand, Assistant Professor, Department of Otolaryngology, Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; E-mail: drvzand@gmail.com Received 30 July, 2017 Accepted 30 December, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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The Specific Morphological Features of Alveolar Bone

Objective: The aim of the study was to study the specific morphological features of alveolar bone and compare it to femoral bone in rats. Methods: Twelve 3-month-old nonpregnant female Sprague–Dawley rats were used in the present study. The left maxillae and femurs of 6 rats were used for micro-computed tomography (micro-CT) scanning. The trabecular bone of the distal femur and the interradicular alveolar bone of the maxillary first molar were reconstructed and analyzed. Another 6 rats were used for histological analysis of trabecular bone and alveolar bone. Results: Micro-CT analysis suggested that the femoral trabecular bone was porous with rod-like trabeculae with a scattered distribution in bone marrow, whereas alveolar bone showed a compact structure with plate-like trabeculae and limited bone marrow. Tissue mineral density, bone mineral density, bone volume fraction, and trabecular thickness were dramatically higher in the alveolar bone compared with that in the trabecular bone. Alveolar bone displayed lower trabecular number and trabecular separation. Histomorphometric analysis showed that alveolar bone was formed of compact bone with wide trabeculae, whereas femurs were composed of loose bone with finer trabeculae. Conclusions: In comparison to the spongiosa of the distal femur, alveolar bone displays specific morphological features with compact, wide, and highly mineralized trabeculae. Address correspondence and reprint requests to Lingyong Jiang, Center of Craniofacial Orthodontics, Department of Oral and Cranio-maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No. 639 Zhi Zao Ju Road, Shanghai 200011, China; E-mail: jly117@sina.com Received 20 September, 2017 Accepted 20 December, 2017 SZ and YY equally contributed to this work. This work was supported in part by grants from the National Natural Science Foundation of China (NSFC) [81371121 and 81570950], Shanghai Summit&Plateau Disciplines, the "Chen Xing" project from Shanghai Jiaotong University. The authors report no conflict of interest. © 2018 by Mutaz B. Habal, MD.

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Successful Strategies for Dealing With Infected, Custom-Made Hydroxyapatite Cranioplasty

When a cranioplasty implant becomes infected, standard operating procedure dictates its removal and the initiation of a long course of antibiotic therapy. However, removing such a prosthesis can have a series of adverse consequences, including delayed cognitive and motor recovery, lack of brain tissue protection, unsightly deformity, and the need for two additional surgical procedures, not to mention the additional costs involved. To maintain the advantages of cranioplasty, we opted for a conservative approach (levofloxacin and rifampicin every 24 hours for 8 weeks) in a 68-year-old woman whose custom-made porous hydroxyapatite implant, fitted following aneurysm clipping, had become infected. The tissues overlying the implant were curettaged, and the patient's clinical condition, blood markers, and infection course were continuously monitored (local monitoring was performed by single-photon emission computed tomography [SPECT]/computed tomography [CT after intravenous administration of 99mTc-labeled antigranulocyte antibody). Blood tests and SPECT/CT evidenced a progressive reduction in phlogosis indices and infection locus, even 1 month after antibiotic therapy was commenced, and at 2 years from cranioplasty, the same tests and clinical examination were negative. At 6-year follow-up, clinical assessment revealed nothing out of the ordinary. Hence, specific cases (hydroxyapatite prosthesis, intact dura, cranial CT and magnetic resonance imaging negative for empyema, well-vascularized scalp, antibiotic-responsive bacteria) of infected cranial implant can be treated using a conservative approach consisting of appropriate antibiotic therapy, accompanied by local debridement where necessary, and assiduous monitoring of phlogosis indices and local verification via labeled-leukocyte scintigraphy. Our report, which was compiled after a long-term follow-up period, shows that this conservative procedure appears to be a viable option in cases of infected, custom-made hydroxyapatite cranioplasty, provided that some basic rules concerning clinical and instrumental standards are adhered to, as clearly stated in our report. Address correspondence and reprint requests to Nicola Zingaretti, MD, Department of Plastic Reconstructive Surgery, c/o Ospedale "S. Maria della Misericordia", Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; E-mail: zingarettin@gmail.com. Received 24 July, 2017 Accepted 7 January, 2018 The authors declare no conflicts of interest to disclose. © 2018 by Mutaz B. Habal, MD.

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The State of Technology in Craniosynostosis

Introduction: Craniosynostosis, the premature fusion of ≥1 cranial sutures, is the leading cause of pediatric skull deformities, affecting 1 of every 2000 to 2500 live births worldwide. Technologies used for the management of craniofacial conditions, specifically in craniosynostosis, have been advancing dramatically. This article highlights the most recent technological advances in craniosynostosis surgery through a systematic review of the literature. Methods: : A systematic electronic search was performed using the PubMed database. Search terms used were "craniosynostosis" AND "technology" OR "innovation" OR "novel." Two independent reviewers subsequently reviewed the resultant articles based on strict inclusion and exclusion criteria. Selected manuscripts deemed novel by the senior authors were grouped by procedure categories. Results: Following review of the PubMed database, 28 of 536 articles were retained. Of the 28 articles, 20 articles consisting of 21 technologies were deemed as being novel by the senior authors. The technologies were categorized as diagnostic imaging (n = 6), surgical planning (n = 4), cranial vault evaluation (n = 4), machine learning (n = 3), ultrasound pinning (n = 3), and near-infrared spectroscopy (n = 1). Conclusion: Multiple technological advances have impacted the treatment of craniosynostosis. These innovations include improvement in diagnosis and objective measurement of craniosynostosis, preoperative planning, intraoperative procedures, communication between both surgeons and patients, and surgical education. Address correspondence and reprint requests to Mirko Gilardino, MD, MSc, FRCSC, FACS, Director, Plastic Surgery Residency Program, Associate Professor of Surgery, Division of Plastic & Reconstructive Surgery, McGill University Health Centre, Director, H.B. Williams Craniofacial & Cleft Surgery Unit, Montreal Children's Hospital, 1001 Decarie Boulevard, B05.3310, Montreal H4A 3J1, Canada; E-mail: mirkogilardino@hotmail.com Received 28 July, 2017 Accepted 5 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Ruptured Pseudoaneurysm of the Maxillary Artery and Its Branches Following Le Fort I Osteotomy: Evidence-Based Guidelines

Background: Although rare, pseudoaneurysms (PA) can develop following Le Fort I osteotomy and lead to life-threatening hemorrhage. However, the typical presentation of a PA following a Le Fort I osteotomy is not well characterized. Evidence-based guidelines are not currently available for evaluation of PA following Le Fort I osteotomy. Methods: A case report is presented of a 27-year-old man who underwent Le Fort I advancement and subsequently developed a bleeding PA. A comprehensive search of journal articles was performed using the MEDLINE/PubMed database between 1964 and April 2016. Keywords and phrases used were "(osteotomy OR craniofacial OR orthognathic) AND (pseudoaneurysm OR aneurysm OR epistaxis)." Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines were followed. Results: : The literature search yielded 13 reports of 18 patients. All 18 patients underwent Le Fort I osteotomy and subsequently developed a delayed postoperative bleeding PA. All studies were level IV or V evidence. Twenty-eight percent (N = 5) of the cases documented "excessive" intraoperative bleeding or more than 500 mL of estimated blood loss. The average time for the first bleeding episode and time until final bleed was 17.3 ± 14.3 days (range: 3–62 days) and 27.8 ± 21.2 days following surgery (range: 6–77 days), respectively. Sixty-seven percent (N = 12) had multiple episodes of bleeding. The duration between the bleeding events averaged 10.6 (± 7.9 days) with a range of 1 to 35 days. Bleeding PA's were treated with image-guided embolization (15/18 patients; 83.3%) or ligation or clamping (3/18 patients; 16.7%). Conclusion: In the setting of recurrent and/or delayed postoperative epistaxis following Le Fort I osteotomy, surgeons should maintain a high clinical suspicion for PA. Ruptured PA's are often preceded by multiple episodes of progressively worsening epistaxis. Based on the presented case report and pooled data from the literature, angiography is recommended to evaluate for PA in the setting of recurrent epistaxis following Le Fort I osteotomy, especially within the first 4 weeks following surgery. Address correspondence and reprint requests to Jesse A. Goldstein, MD, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Faculty Pavilion, Suite 7104, Pittsburgh, PA 15224; E-mail: Jesse.goldstein@chp.edu Received 30 July, 2017 Accepted 3 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Reconstruction of Thin and Pliable Oral Mucosa After Wide Excision of Oral Cancer Using a Trimmed Anterolateral Thigh Free Flap as an Adipofascial Flap

A 21-year-old female patient underwent wide excision of the buccal mucosa and tongue as well as selective neck dissection due to squamous cell carcinoma on the left side of the tongue. She had a severe limitation in opening her mouth, owing to fibrosis of the mucosa and scar contracture after adjuvant radiation therapy. Reconstruction of the oral mucosa and tongue defect was performed after removal of the scar to improve mouth opening. An anterolateral thigh (ALT) flap was used, trimmed to an adipofascial flap for the reconstruction of the thin and pliable oral mucosa and tongue. The maximum mouth opening improved to 40 mm intraoperatively and was 30 mm after surgery. The adipofascial ALT flap had excellent viability and presented neomucosa after secondary healing. An adipofascial flap obtained by trimming an ALT flap could be a reliable option for the reconstruction of thin and pliable oral mucosa after wide excision of oral cancer. Address correspondence and reprint requests to Jee-Ho Lee, DDS, PhD, Assistant Professor, Department of Oral and Maxillofacial Surgery, Asan Medical Center, 88, Olympic-ro, Songpa-gu, Seoul 138-736, Korea; E-mail: jeehoman@naver.com Received 28 August, 2017 Accepted 5 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Removal of Maxillary Sinus Antrolith and Concomitant Intrasinus Augmentation

Maxillary sinus antrolithisis is a rare finding. Conservative surgical removal recommended. In the patients that need to maxillary intrasinus augmentation and antrolith is observed in preoperative radiography, 2 options remain. First, doing Caldwell-luc surgery to remove antrolith and delayed open sinus lift. Second way is removing antrolith and concomitant intrasinus augmentation. The first way has 2 disadvantages: prolonged waiting period and difficulty of open sinus lift in sinuses with scar and fibrosis. Coupling these 2 surgeries and using corticocancellous bone block as grafting material are recommended by us. Buccal fat pad is a good option to isolate this graft from maxillary sinus. Address correspondence and reprint requests to Saeedeh Khajehahmadi, DDS, Dental Research Center, Mashhad University of Medical Sciences, Vakilabad Blvd, Mashhad 91735, Iran; E-mail: khajehahmadis@mums.ac.ir Received 2 December, 2017 Accepted 9 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Review of “The Prevalence of Burnout Among US Neurosurgery Residents” by Shakir HJ, McPheeters MJ, Shallwani H, Pittari JE, Reynolds RM in Neurosurgery [published ahead of print October 27, 2017] doi: 10.1093/neuros/nyx494

No abstract available

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Does Pediatric Obstructive Sleep Apnea Syndrome Cause Systemic Microvascular Dysfunction?

The aim of this study was to evaluate whether pediatric obstructive sleep apnea syndrome (OSAS) secondary to adenoid hypertrophy causes systemic microvascular dysfunction. This is a prospective single-blinded case–control study. As the patient group, 81 patients diagnosed to have OSAS secondary to adenoid hypertrophy at our hospital between January 2016 and May 2016; as the control group, 26 healthy pediatric volunteers who presented to the hospital for health screening were included in this study. Three groups of OSAS patients were defined as mild, moderate, and severe respectively, according to the lateral nasopharynx x-ray. Patients with comorbid diseases were excluded from the study. For microvascular dysfunction, videocapillaroscopic evaluation was performed at the nailfold and capillary density (CD) and postocclusive reactive hyperemia (PORH) values were measured and statistical analysis between the groups was performed. The duration of complaints in all patients with OSAS was at least 6 months and 0.05). PORH measurement in the control group and mild, moderate, and severe OSAS group was 95.6 ± 8.6, 97.9 ± 10.1, 96 ± 8.7, and 93.9 ± 9.3, respectively, with no significant difference between the groups (P > 0.05). OSAS secondary to adenoid hypertrophy in pediatric patients was demonstrated to cause no dysfunction in microvascular circulation and carried no cardiovascular risk in the early period. Address correspondence and reprint requests to Hasan Emre Koçak, MD, Bakirköy Dr. Sadi Konuk Eğitim ve Araştirma Hastanesi, Zuhuratbaba Mah. Tevfik Sağlam Cad. No: 11, Bakirköy, Istanbul 34147, Türkiye; E-mail: drhekbb@gmail.com Received 29 June, 2017 Accepted 29 December, 2017 All the authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Anatomic Considerations for Temporomandibular Joint Vascularized Composite Allotransplantation

Concomitant temporomandibular joint (TMJ) transplantation is an obvious advancement in the reconstructive armamentarium for face transplantation in scenarios involving TMJ ankylosis. This study investigates the fidelity of mandibular morphology and explores the feasibility of bilateral mandibular condyle transfer in facial vascularized composite allotransplantation. Geometric analysis was performed on 100 skeletally mature maxillofacial computed tomography scans. Exclusion criteria included mandibular trauma and dentoalveolar disease. Parameters measured were posterior height, ramus tilt, anterior height, intercondylar widths, condyle height, coronoid height, interglenoid distances, symphyseal and gonial angles, condyle and glenoid volumes, and condyle shapes. Parameters were compared by gender and ethnicity using χ2, independent sample t tests, and one-way ANOVA. Correlation with age was assessed using Pearson correlation coefficients. Bilateral measurements were compared using paired-sample t tests. Mean intercondylar width was 102.5 mm (SD 7.0 mm), anterior height 21.5 mm (5.5), and posterior height 65.3 mm (7.7), Males demonstrate larger geometric parameters, for example, intercondylar width (4 mm mean difference, P = 0.005), anterior height (2.3 mm, P = 0.032), posterior height (5 mm, P = 0.001). Asians demonstrated statistically larger intercondylar width (8 mm difference to Caucasians, P 

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Eliminating bias and accelerating the clinical translation of oral microbiome research in oral oncology

Publication date: Available online 1 March 2018
Source:Oral Oncology
Author(s): Rohit Kunnath Menon, Divya Gopinath




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Impact of perioperative hyperglycemia in patients undergoing microvascular reconstruction

Abstract

Background

The effects of perioperative hyperglycemia on complications and outcomes in microvascular reconstruction have not been reported in the literature.

Methods

A retrospective cohort of 203 patients undergoing microvascular reconstruction was generated. Perioperative glucose levels and clinical factors were tested for associations with complications using simple and multivariate analyses.

Results

Hyperglycemia (blood glucose ≥ 180 mg/dL) occurred in 91 patients (44.8%) perioperatively, and was associated with increased rates of surgical complications, medical complications, surgical site infections, fistulas, and wound dehiscence. On univariate analysis, a more strict definition of hyperglycemia (blood glucose ≥ 165 mg/dL) was significantly associated with greater rates of venous thrombosis, although this lost statistical significance on multivariate analysis.

Conclusion

Perioperative hyperglycemia occurs commonly in patients undergoing microvascular reconstruction and is associated with higher rates of complications, independent of a preexisting diagnosis of diabetes mellitus. Further research is needed to define the ideal glycemic target in this population.

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Preimplantation Genetic Diagnosis of Multiple Endocrine Neoplasia Type 2A Using Informative Markers Identified by Targeted Sequencing

Thyroid , Vol. 0, No. 0.


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Issue Information

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Large number of cutaneous neurofibromas beyond age-appropriate incidence in a patient with a large deletion of NF1

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Preface to Journal of Dermatology special issue: Psoriasis

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Issue Information

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Correlating the Dermatology Life Quality Index and Skin Discoloration Impact Evaluation Questionnaire tools in disorders of hyperpigmentation

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Collagen type III and elastin genes polymorphism and the risk of nonsyndromic striae

Summary

Background

Striae have been reported to be one of the most common skin lesions and a commonly encountered esthetic problem.

Objectives

The aim of this research was to examine elastin gene polymorphism (rs7787362, ELN) and collagen type III alpha 1 polymorphism (rs1800255, COL3A1) among polish woman population with SD in comparison with women without the lesions and to verify these polymorphisms as risk factors for SD.

Methods

Seventy female students (35 with striae (the mean age 23.9 years, SD 1.2 years) and 35 without these lesions (22.9 years, SD 1.7 years)) were included in the study. The subjects were asked to fill out a questionnaire including questions concerning risk factors for SD and had a cheek swabbed for cells for DNA isolation.

Results

Analysis of polymorphisms of elastin gene (rs7787362) and COL3A1 gene (rs1800255) showed that women with SD and without these lesions did not differ in these aspects. Polymorphism rs7787362 was also analyzed in relation to SD in different locations, and showed no differences.

Conclusion

In conclusion, we found that there are some clinical factors that reduced the risk of SD: history of intended weight loss, negative family history of SD, and lower BMI. Gene polymorphisms analysis in patients with SD may help to establish the etiology of these lesions and to target the therapy. Analysis of polymorphisms of elastin gene (rs7787362) did not show differences in allele distribution between women with and without SD. Polymorphisms of COL3A1 gene (rs1800255) also did not differ between the examined groups.

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IL1A (-889) gene polymorphism is associated with the effect of diet as a risk factor in Acne Vulgaris

Summary

Background

Despite the several studies suggesting the genetic basis of acne vulgaris, the exact genetic architecture of this very common condition is not yet clear.

Aim of the work

This study aimed to investigate the association between IL-1A (−889) gene polymorphism and acne vulgaris in a sample of patients.

Subjects and Method

Blood samples from 100 patients with acne vulgaris and 100 healthy age, sex, and BMI matched controls were obtained. DNA samples were isolated from blood cells, and the PCR-RFLP method was used for genotyping.

Results

The genotype distributions of IL-1A (−889) polymorphism were as expected under Hardy-Weinberg equilibrium. T allele was predominant in the patients, while C allele predominated in the control subjects (P value < .001). The frequency of TT genotype in patients was significantly higher than in the control subjects (P value < .001). CT genotype was significantly more frequent in the control subjects compared to patients (P value < .001). Among the 47 patients who reported diet as a risk factor for triggering or exacerbating their lesions, 62.5% had TT genotype (P value = .038).

Conclusion

IL-1A (−889) gene polymorphism has a role in the pathogenesis of acne vulgaris. We suggest that the triggering or exacerbating effect of diet on acne may be related to IL-1A (−889) gene polymorphism.

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CME Accreditation Page

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Forthcoming Issues

Global Health in Otolaryngology

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The Stapes Prosthesis

Since the original carved Teflon stapes over vein graft, stapedectomy prostheses have undergone evolution. Prostheses shapes, materials, and surgical techniques for placement have reflected advances in biomaterials and surgical tools. The variability in prostheses has reflected alternative techniques of stapedectomy and stapedotomy and differing strategies for attachment to the incus. Although many iterations of stapes prostheses have been proposed, excellent results can be achieved with various prostheses designed to rest on tissue grafts in stapedectomy techniques or pass through the footplate in stapedotomy techniques when used by surgeons experienced with technique details specific to the selected prosthesis.

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Controversies in the Evaluation and Management of Otosclerosis

Controversies have been associated with the etiology, diagnosis, evaluation, and management of otosclerosis since Valsalva first described stapes fixation as a cause of hearing loss. Although the exact mechanism of the bone remodeling associated with otosclerosis remains uncertain, stapedotomy has been accepted as the surgical treatment of most patients with stapedial otosclerosis. There remains a disparity of opinion, however, regarding the role of preoperative imaging, surgical technique, implant selection, and medical therapy for cochlear otosclerosis. In addition, opinions vary regarding the optimal postoperative care of patients undergoing stapedotomy and a patient's ability to participate in activities that may result in barotrauma.

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Copyright-Page

Elsevier

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Otosclerosis

Over the past several years, with the evolution of genetic and molecular research, several etiologic factors have been implicated in the pathogenesis of otosclerosis. Overall, current evidence suggests that otosclerosis is a complex disease with a variety of potential pathways contributing to the development of abnormal bone remodeling in the otic capsule. These pathways involved in the pathogenesis of otosclerosis are influenced by both genetic and environmental factors.

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History of Otosclerosis and Stapes Surgery

The current advancements in otosclerosis therapy cannot be fully appreciated without studying the history, rediscovery, and modification of a once-forgotten procedure. The evolution of stapes surgery can be best summarized into 4 noteworthy eras: the preantibiotic era (which was forgotten and then rediscovered), the fenestration era (mainstreamed by Julius Lempert), the mobilization era (led by Samuel Rosen), and the modern stapedectomy era (revived and revolutionized by John Shea). Each era is unique with its own challenges and ingenious techniques to overcome what used to be among the leading causes of deafness.

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Otosclerosis and Stapes Surgery

OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA

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Impact of Imaging in Management of Otosclerosis

The use of imaging in otosclerosis for diagnosis, preoperative assessment, and follow-up has the potential to give the clinician an additional tier of patient evaluation and validation of diagnosis. Before stapes surgery, imaging may help avoid unnecessary middle ear explorations in nonotosclerotic cases, prevent potential complications, and assist in appropriate patient counseling regarding management expectations. Postoperatively, following unsuccessful air-bone gap closure in stapes surgery or conductive hearing deterioration following initial successful closure of the air bone gap, imaging can be used to determine the prosthesis position in the middle ear.

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Advanced Otosclerosis

Diagnosis and treatment of advanced otosclerosis can be controversial. In 1961, House and Sheehy defined advanced otosclerosis as hearing loss in air conduction threshold by 85 dB with nonmeasurable bone conduction. Recently, the definition of advanced otosclerosis is mostly based on the decrease of speech recognition. There are some treatment modalities: stapes surgery and hearing aids, cochlear implantation, or direct acoustic cochlear implant. The authors propose a new algorithm for treatment. If the patient is treated with cochlear implantation, the surgeon should be cautious for facial nerve stimulation after surgery because it is the most prevalent complication.

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Medical Management of Otosclerosis

Otosclerosis/otospongiosis is a primary osteodystrophy of the otic capsule that affects genetically predisposed individuals and leads to progressive hearing loss. Diagnosis is usually clinical, based on the findings of anamnesis, physical examination, and audiometric evaluation. However, high-resolution computed tomography scan and MRI have played an important role in the diagnosis and therapeutic approach of otosclerosis and in assisting in the differential diagnosis. The therapeutic approach is aimed at preventing, or at least minimizing, disease progression while attempting to restore hearing. The use of sodium fluoride and bisphosphonates can be an important adjunct, perhaps even primary treatment, in managing active lesions.

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Potential of Robot-Based Surgery for Otosclerosis Surgery

Otosclerosis surgery is performed through a transcanal approach and requires long, thin instruments with submillimetric precision and precise amplitude of motion. The functional outcomes and complications of otosclerosis surgery depend on the experience of the surgeon. Thus, any technological assistance that can enhance the surgeon's dexterity and rapidly reduce the learning curve could yield an even safer surgical procedure. One of the options is to use robotic assistance to achieve this goal. An overview of different robots designed for otosclerosis surgery is presented focusing on the RobOtol system that we have designed as a multitask platform for ear surgery.

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Use of Lasers in Otosclerosis Surgery

Lasers were introduced as an atraumatic modality for accomplishing several of the crucial steps in otosclerosis surgery. Advances in laser technology have spurred coevolution of refinements in the technique of the operation. Several varieties of laser systems are available to suit individual preference and to augment a surgeon's armamentarium; however, a clear advantage in terms of surgical outcome or patient safety remains to be demonstrated.

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Otosclerosis and Stapes Surgery

The roots of our knowledge about otosclerosis go back to the early eighteenth century. Since then, countless numbers of scientists have studied the pathogenesis and therapy of the disease. The articles in this issue of Otolaryngologic Clinics of North America flow from history to pathophysiology, clinical evaluation, surgical and medical management to future perspectives. As concepts are constantly progressing, timely topics such as genetics and molecular biology, endoscopic ear surgery and robotic surgery are also included in this issue.

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Revision Surgery for Otosclerosis

This article is an overview of the care of patients requiring revision surgery for otosclerosis. Preoperative evaluation of the patient including surgical history, audiologic results, and physical findings is discussed, and the causes of failure of primary surgery are reviewed. A discussion of evidence-based surgical technique and postoperative care then follows.

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Contents

Sujana S. Chandrasekhar

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Contributors

SUJANA S. CHANDRASEKHAR, MD

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Open access: Is there a predator at the door?

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Naive and effector B-cell subtypes are increased in chronic rhinosinusitis with polyps

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Role of group 2 innate lymphocytes in aspirin-exacerbated respiratory disease pathogenesis

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Headaches and facial pain in rhinology

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Assessing the onset of allergic rhinitis by nasal cytology and immunoglobulin E antibody levels in children

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Optimal cutoff values of allergen-specific immunoglobulin E to house dust mites and animal dander based on skin-prick test results: Analysis in 16,209 patients with allergic rhinitis

http://ift.tt/2HYxVV2

Oral allergy syndrome

http://ift.tt/2oHLvmU

Endoscopically assisted Crawford tube placement results in shorter general anesthesia times in pediatric patients

http://ift.tt/2HUksxk

How often is sinus surgery performed for chronic rhinosinusitis with versus without nasal polyps?

http://ift.tt/2oAPfY1

Management of odontogenic cysts by endonasal endoscopic techniques: A systematic review and case series

http://ift.tt/2F6P5xU

Comparison between endoscopic and external dacryocystorhinostomy by using the Lacrimal Symptom Questionnaire: A pilot study

http://ift.tt/2FgB044

Extent of surgery in endoscopic transsphenoidal skull base approaches and the effects on sinonasal morbidity

http://ift.tt/2F4YJRK

Use of intraoperative negative margins reduces inverted papilloma recurrence

http://ift.tt/2Fjbvz8

Using the nasoseptal flap for reconstruction after endoscopic debridement of radionecrosis in nasopharyngeal carcinoma

http://ift.tt/2F4YF4s

Esthetic nasolabial angle according to the degree of upper lip protrusion in an Asian population

http://ift.tt/2FhFSGo

Transnasal endoscopic resection of pediatric orbital cyst: “How I do it”

http://ift.tt/2GVKrU2

Superior turbinate eosinophilia correlates with olfactory deficit in chronic rhinosinusitis patients.

http://ift.tt/2oAkJh2

Comparative Study of Management of BPPV (Benign Paroxysmal Positional Vertigo) with only Drugs Versus Drugs Plus Epley Manoeuvre

Abstract

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, accounting for 20% of all vertigo cases. Idiopathic BPPV is most common between the ages of 50 and 70, although the condition is found in all age groups. The importance of early diagnosis and treatment can lead to a much improved quality of life for patients afflicted by this ailment. It is presently common for physicians to treat these patients mainly with benzodiazepines, antihistamines, and anticholinergic medications, especially if the history and physical is consistent with BPPV. This method of treatment has had questionable success. Several reviews of the management of vertigo have shown that no medication in current use has well established curative or prophylactic value or is suitable for long-term treatment. Epleys manoeuvre is also used in the treatment of BPPV. This manoeuvre relocates free floating particles from the affected semi-circular canals back into utricle, thus relieving the symptoms of vertigo. The purpose of this study is to compare the efficacy of Epleys manoeuvre with conventional drug therapy versus conventional therapy alone in patients who present with vertigo. The purpose of this study to evaluate and examine two methods of treatment.

http://ift.tt/2HYBPwX

Copyright

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1





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Contributors

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1





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Contents

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1





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Forthcoming Issues

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1





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Improving Perioperative Care: What Are the Tools That Lead to Sustainable Change?

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Lee A. Fleisher




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Quality Improvement and Implementation Science

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Meghan B. Lane-Fall, Lee A. Fleisher




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Quality Improvement and Implementation Science: Different Fields with Aligned Goals

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Meghan B. Lane-Fall, Lee A. Fleisher




http://ift.tt/2oJeWVL

Implementation Science in Perioperative Care

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Meghan B. Lane-Fall, Benjamin T. Cobb, Crystal Wiley Cené, Rinad S. Beidas

Teaser

There is a 17-year gap between the initial publication of scientific evidence and its uptake into widespread practice in health care. The field of implementation science (IS) emerged in the 1990s as an answer to this "evidence-to-practice gap." In this article, we present an overview of implementation science, focusing on the application of IS principles to perioperative care. We describe opportunities for additional training and discuss strategies for funding and publishing IS work. The objective is to demonstrate how IS can improve perioperative patient care, while highlighting perioperative IS studies and identifying areas in need of additional investigation.


http://ift.tt/2HWFCLB

Human Factors Applied to Perioperative Process Improvement

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Joseph R. Keebler, Elizabeth H. Lazzara, Elizabeth Blickensderfer, Thomas D. Looke

Teaser

This article discusses some of the major theories of the science of human factors/ergonomics (HF/E) in relation to perioperative medicine, with a focus on safety and errors within these systems. The discussion begins with human limitations based in cognition, decision making, stress, and fatigue. Given these limitations, the importance of measuring human performance is discussed. Finally, using the HF/E perspective on safety, high-level recommendations are provided for increasing safety within the perioperative environment.


http://ift.tt/2oJeRkV

Quality Improvement in Anesthesiology — Leveraging Data and Analytics to Optimize Outcomes

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Elizabeth A. Valentine, Scott A. Falk

Teaser

Quality improvement is at the heart of practice of anesthesiology. Objective data are critical for any quality improvement initiative; when possible, a combination of process, outcome, and balancing metrics should be evaluated to gauge the value of an intervention. Quality improvement is an ongoing process; iterative reevaluation of data is required to maintain interventions, ensure continued effectiveness, and continually improve. Dashboards can facilitate rapid analysis of data and drive decision making. Large data sets can be useful to establish benchmarks and compare performance against other providers, practices, or institutions. Audit and feedback strategies are effective in facilitating positive change.


http://ift.tt/2HZ0u4D

Emergency Manuals

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Sara N. Goldhaber-Fiebert, Carl Macrae

Teaser

How can teams manage critical events more effectively? There are commonly gaps in performance during perioperative crises, and emergency manuals are recently available tools that can improve team performance under stress, via multiple mechanisms. This article examines how the principles of implementation science and quality improvement were applied by multiple teams in the development, testing, and systematic implementations of emergency manuals in perioperative care. The core principles of implementation have relevance for future patient safety innovations perioperatively and beyond, and the concepts of emergency manuals and interprofessional teamwork are applicable for diverse fields throughout health care.


http://ift.tt/2oI6DcP

Use of Simulation in Performance Improvement

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Amanda Burden, Erin White Pukenas

Teaser

Human error and system failures continue to play a substantial role in preventable errors that lead to adverse patient outcomes or death. Many of these deaths are not the result of inadequate medical knowledge and skill, but occur because of problems involving communication and team management. Anesthesiologists pioneered the use of simulation for medical education in an effort to improve physician performance and patient safety. This article explores the use of simulation for performance improvement. Educational theories that underlie effective simulation programs are described as driving forces behind the advancement of simulation in performance improvement.


http://ift.tt/2HTh7ih

Developing Multicenter Registries to Advance Quality Science

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Laura E. Schleelein, Kathleen A. Harris, Elizabeth M. Elliott

Teaser

There are several benefits to clinical registries as an information repository tool, ultimately lending itself to the acquisition of new knowledge. Registries have the unique advantage of garnering much data quickly and are, therefore, especially helpful for niche populations or low-prevalence diseases. They can be used to inform on the ideal structure, process, or outcome involving an identified population. The data can be used in many ways, for example, as an observational tool to reveal associations or as a basis for framing future research studies or quality improvement projects.


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Handovers in Perioperative Care

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Atilio Barbeito, Aalok V. Agarwala, Amanda Lorinc

Teaser

Handovers around the time of surgery are common, yet complex and error prone. Interventions aimed at improving handovers have shown increased provider satisfaction and teamwork, improved efficiency, and improved communication and have been shown to reduce errors and improve clinical outcomes in some studies. Common recommendations in the literature include a standardized institutional process that allows flexibility among different units and settings, the completion of urgent tasks before information transfer, the presence of all members of the team for the duration of the handover, a structured conversation that uses a cognitive aid, and education in team skills and communication.


http://ift.tt/2HUXKoS

Rethinking Clinical Workflow

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Joseph J. Schlesinger, Kendall Burdick, Sarah Baum, Melissa Bellomy, Dorothee Mueller, Alistair MacDonald, Alex Chern, Kristin Chrouser, Christie Burger

Teaser

The concept of clinical workflow borrows from management and leadership principles outside of medicine. The only way to rethink clinical workflow is to understand the neuroscience principles that underlie attention and vigilance. With any implementation to improve practice, there are human factors that can promote or impede progress. Modulating the environment and working as a team to take care of patients is paramount. Clinicians must continually rethink clinical workflow, evaluate progress, and understand that other industries have something to offer. Then, novel approaches can be implemented to take the best care of patients.


http://ift.tt/2oHvz3S

Developing Capacity to Do Improvement Science Work

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Irene McGhee, Yehoshua Gleicher

Teaser

Developing capacity to do improvement science starts with prioritizing quality improvement training in all health professions curricula so that a common knowledge base and understanding are created. Educational programs should include opportunities for colearning with patients, health professionals, and leaders. In this way, knowledge translation (also called implementation) is more effective and better coordinated when applied across organizations. Key factors that enable and drive behavior change are reviewed, as is the importance of influence and leadership. A comprehensive approach that accounts for these factors hardwires quality improvement into the health care systems and creates a culture that enables its ongoing development.


http://ift.tt/2HVsfLq

Diffusing Innovation and Best Practice in Health Care

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Philip E. Greilich, Mary Eleanor Phelps, William Daniel

Teaser

Diffusing innovation and best practices in healthcare are among the most challenging aspects of advancing patient safety and quality improvement. Recommendations from the Baldrige Foundation, Institute for Healthcare Improvement, and The Joint Commission provide guidance on the principles for successful diffusion. Perioperative leaders are encouraged to applying these principles to high priority areas such as handovers, enhanced recovery and patient blood management. Completing a successful pilot project can be exciting, however, effective diffusion is essential to achieving meaningful and lasting impact on the service line and health system.


http://ift.tt/2oJeDKB

Assessment of focal laser photocoagulations’ early effect on polypoidal choroidal vasculopathy with optical coherence tomography angiography

Abstract

Polypoidal choroidal vasculopathy (PCV) is seen with polypoidal lesions and branching vascular networks (BVNs) (Spaide et al. in Retina 15(2):100–110, 1995; Yannuzzi et al. in Retina 10(1):1–8, 1990). There are reports about laser photocoagulation for PCV (Yuzawa et al. in Japan J Ophthalmol 47(4):379–384, 2003; Lee et al. in Eye 23(1):145–148, 2009); however, all these reports are about final vision and frequent relapses. Therefore, this treatment merits rigorous scrutiny using optical coherence tomography angiography (OCTA).

http://ift.tt/2t8NyWt

Rhinoplastik

Laryngo-Rhino-Otol 2018; 97: 217-220
DOI: 10.1055/s-0044-100738

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Durch das Cochlea-Implantat zum CODA?

Laryngo-Rhino-Otol 2018; 97: 176-180
DOI: 10.1055/s-0044-100741

Die Cochlea-Implantat-Versorgung gehörloser Kinder mit gehörlosen bzw. hochgradig hörgeschädigten Eltern ist möglich. Bereits vor der Operation muss ein tragfähiges (Re-)Habilitationskonzept zur Entwicklung und Förderung des Hör-Sprachprozesses erarbeitet werden. Der Erfolg der Kinder hängt von Vermittlern ab, die die Eltern unterstützen. Die Kinder wachsen zweisprachig auf: Gebärdensprache und Lautsprache. Sie können Schulen für Hörgeschädigte oder allgemeine Schulen für Hörende besuchen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Dank an die Gutachter

Laryngo-Rhino-Otol 2018; 97: 154-154
DOI: 10.1055/s-0044-101394

Die Laryngo-Rhino-Otologie legt die online eingereichten wissenschaftlichen Manuskripte Experten zur Begutachtung vor. Überwiegend kommen diese Gutachter aus dem Gebiet der Hals-Nasen-Ohrenheilkunde, aber auch aus dem naturwissenschaftlichen Bereich und den klinischen Nachbarfächern. Die Schriftleitung und der Verlag möchten daher den neuen Jahrgang der Zeitschrift nicht beginnen, ohne zuvor allen Gutachtern des letzten Jahres und den Experten, die mit ihren sachkundigen Kommentaren die Rubrik „Referiert und diskutiert" aufwerten, den herzlichsten Dank für ihre Tätigkeit auszusprechen. Zunächst genannt seien die Gutachter, die für ihr besonderes Engagement ausgezeichnet wurden:
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Neues Verfahren zur Liposuktion und Fettaugmentation nach Chordektomie

Laryngo-Rhino-Otol 2018; 97: 163-165
DOI: 10.1055/s-0044-101380

Fettaugmentationen der Stimmlippen sind ein etabliertes Verfahren in der Hals-Nasen-Ohrenheilkunde. Aktuell wird dieses Verfahren auch bei Patienten mit endolaryngealen Defekten nach Laser-Chordektomie diskutiert. Der Artikel beschreibt diesbezüglich ein minimal-invasives Verfahren zur primären Liposuktion und Fettaugmentation bei Patienten nach der Resektion eines pT1a Stimmlippenkarzinoms. Dieses neue Verfahren erwies sich als sichere und technisch einfache Methode zur Rekonstruktion von Stimmlippendefekten. Relevante Komplikationen wurden nicht beobachtet.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Laryngektomie: Rekonstruktion mit dauerhaftem Speichel-Bypass-Tubus effektiver

Laryngo-Rhino-Otol 2018; 97: 155-156
DOI: 10.1055/s-0044-100271

Piazza C et al. Fasciocutaneous free flaps for reconstruction of hypopharyngeal defects. Laryngoscope 2017; 127: 2731–2737 Pharynxdefekte nach totaler Laryngektomie und zirkumferenzieller oder partieller Pharyngektomie können verschiedenartig rekonstruiert werden. In einer Vergleichsstudie untersuchten Ärzte des Zentrums für Kopf-Hals-Chirurgie der Universität von Brescia verschiedene Rekonstruktionsstrategien nach totaler Laryngektomie. Bestimmt wurden der Erfolg der Lappenrekonstruktionen, das Auftreten pharyngokutaner Fisteln sowie die pharyngo-ösophageale Stenose-Rate.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Kopf-Hals-MRT: Was HNO-Ärzte wissen sollten

Laryngo-Rhino-Otol 2018; 97: 206-214
DOI: 10.1055/s-0044-101726

Die Magnetresonanztomografie (MRT) hat sich für die HNO-Heilkunde zu einem wichtigen bildgebenden Verfahren entwickelt. Ziel des vorliegenden CME-Beitrags für HNO-Ärzte ist es, einen Überblick über die Vor- und Nachteile sowie die Möglichkeiten der Kopf-Hals-MRT zu bieten und die wichtigsten klinischen Anwendungsgebiete der verschiedenen MRT-Sequenzen zusammenzufassen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Polysomnographie bei Kindern: nicht nur an obstruktive Schlafapnoe denken

Laryngo-Rhino-Otol 2018; 97: 156-157
DOI: 10.1055/s-0044-100281

Heubi CH et al. Polysomnography in Pediatric Otolaryngology: If Not Obstructive Sleep Apnea, What Is It? Otolaryngol Head Neck Surg 2017; 157: 1053–1059 Ärzte der Abteilung für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie der Universität von Cincinnati überprüften die Polysomnographie- Diagnosen von Kindern mit Verdacht auf schlafbezogene Atmungsstörungen (SBAS) und obstruktiver Schlafapnoe (OSA).
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Durchführung und Interpretation der FEES (Fiberoptic Endoscopic Evaluation of Swallowing)

Laryngo-Rhino-Otol 2018; 97: 160-162
DOI: 10.1055/s-0043-125008

© Georg Thieme Verlag KG Stuttgart · New York

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Präoperative Strahlentherapie bei therapeutischer Neck Dissection vielversprechend

Laryngo-Rhino-Otol 2018; 97: 157-158
DOI: 10.1055/s-0044-100284

Lippert D et al. Lymph Node Yield in Therapeutic Neck Dissection: Impact of Dissection Levels and Prior Radiotherapy. Ann Otol Rhinol Laryngol 2017; 126: 762–767
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Gastroösophageale Refluxkrankheit – was tun, wenn PPI nicht ausreichend wirksam, verträglich oder erwünscht sind?

Laryngo-Rhino-Otol 2018; 97: 166-175
DOI: 10.1055/s-0044-100740

Die Standardtherapie der GERD mit PPI ist weniger wirksam als gedacht: Mindestens 30 % der Patienten haben persistierende Symptome und Läsionen (Therapielücke). Bei persistierender Symptomatik oder Wunsch einer alternativen Behandlung ist eine stratifizierte Diagnostik erforderlich. Alginate und neue Operationsverfahren erweitern die Therapieoptionen
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Stephan Remmert - Funktionelle Wiederherstellung der oberen Luft- und Speisewege

Laryngo-Rhino-Otol 2018; 97: 158-159
DOI: 10.1055/s-0043-125338

© Georg Thieme Verlag KG Stuttgart · New York

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Aus der Gutachtenpraxis: Was ist eine Biopsie mit Inzision? Begutachtung der Kodierung im G-DRG-System in der HNO-Heilkunde

Laryngo-Rhino-Otol 2018; 97: 203-205
DOI: 10.1055/s-0044-100737

© Georg Thieme Verlag KG Stuttgart · New York

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Axel Trautmann, Jörg Kleine-Tebbe – Allergologie in Klinik und Praxis

Laryngo-Rhino-Otol 2018; 97: 159-159
DOI: 10.1055/s-0043-125365

© Georg Thieme Verlag KG Stuttgart · New York

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Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2018; 97: 215-216
DOI: 10.1055/s-0044-102258

© Georg Thieme Verlag KG Stuttgart · New York

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Deutschlandweite Umfrage zur Wertigkeit der Ultraschalldiagnostik im Kopf-Hals-Bereich

Laryngo-Rhino-Otol
DOI: 10.1055/a-0573-1785

2013–2014 wurde eine deutschlandweite Umfrage zur aktuellen Anwendung und Wertigkeit der Ultraschalldiagnostik im Kopf-Hals-Bereich durchgeführt. Hier war das Augenmerk insbesondere auf die Integration der Ultraschalldiagnostik im praktischen Alltag des HNO-Arztes im klinischen und im niedergelassenen Bereich gerichtet. Analysiert wurden ferner die aktuell geltenden Standardisierungsprozesse und Ausbildungsrichtlinien.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2018; 97: 151-152
DOI: 10.1055/a-0547-4493

© Georg Thieme Verlag KG Stuttgart · New York

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Eingeschränkte Schlafqualität als indirekte psychosoziale Folge einer Fazialisparese

Laryngo-Rhino-Otol
DOI: 10.1055/a-0573-2119

Hintergrund Fazialisparese (FP) ist eine Lähmung der Gesichtsmuskulatur und zählt zu den häufigsten motorischen Ausfällen. Sie geht mit einer starken Beeinträchtigung der Lebensqualität und depressiven Symptomen einher. Schlafstörungen in Folge einer FP werden oft auf krankheitsbedingte Beeinträchtigungen zurückgeführt, obwohl auch psychosoziale Belastungen als Ursache in Frage kämen. Diese Studie untersuchte direkte und indirekte Effekte der FP auf die Schlafqualität. Methoden Die Stichprobe der Querschnittsstudie umfasste N = 81 FP-Patienten. Es wurden Symptome der Gesichtsnervenlähmung (FACE), Schlafqualität (PSQI), Lebensqualität (SF36), Depressivität (PHQ9), soziale Ängste (LSAS) und soziodemographische Daten erfasst. Mit Mediationsmodellen wurden Zusammenhänge zwischen Symptomen der FP, sozialen Ängsten, Depressivität und Schlafqualität untersucht. Ergebnisse Die Schlafqualität war bei 33,3 % der Patienten verringert. Die subjektiv eingeschätzte Schwere der FP korrelierte mit der Schlafqualität. Mediationsanalysen legen eine Kausalkette zwischen der Schwere der FP, sozialen Ängsten, depressiven Symptomen und einer eingeschränkten Schlafqualität nahe. Wurden soziale Ängste und Depressivität als Mediatoren in das Modell aufgenommen, gab es keine direkten Effekte der FP auf die Schlafqualität. Schlussfolgerung Schlafprobleme im Kontext einer FP scheinen weniger durch die krankheitsbedingten Beeinträchtigung verursacht, als vielmehr eine indirekte Folge: Die mit einer FP eingehergehende Veränderung des Gesichtes verursacht psychische Beschwerden welche wiederum zu verminderter Schlafqualität führen. Die medizinische Versorgung von FP-Patienten sollte deshalb auch die psychosozialen Folgen in den Blick nehmen, um der Entstehung psychischer Störungen (z. B. Depressionen) und Schlafstörungen vorzubeugen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Mundgesundheitsbezogene Lebensqualität bei Krebspatienten

Laryngo-Rhino-Otol
DOI: 10.1055/a-0573-9741

Hintergrund Bis dato existieren wenige Studien über die mundgesundheitsbezogene Lebensqualität (MLQ) bei Patienten mit Krebserkrankungen. Die European Organisation for Research and Treatment of Cancer (EORTC) hat kürzlich einen Fragebogen zur Erfassung der MLQ erstellt, den Quality of Life Questionnaire – Oral Health Module 15 (EORTC QLQ-OH15). Ziel dieser Arbeit war die Identifizierung möglicher Einschränkungen von MLQ bei Krebspatienten im klinischen Alltag. Patienten und Methoden Die MLQ wurde zu einem nicht näher definierten Zeitpunkt während der Akutbehandlung (t1), 2 Wochen (t2) und 3 Monate (t3) nach dem ersten Befragungszeitpunkt mit dem EORTC QLQ-OH15 gemessen. Als mögliche Prädiktoren der MLQ wurden zu t2 Alter, Geschlecht, Bildung, Krebsentität und Therapie explorativ untersucht. Ergebnisse 40 Patienten nahmen initial an der Studie teil. Im Vergleich zu t1 litten die Patienten zu t2 mehr an klebrigem Speichel und Empfindlichkeit bei Essen und Trinken. Außerdem trugen weniger Patienten eine Zahnprothese. Zu t3 zeigte sich eine Verschlechterung hinsichtlich der Zufriedenheit über die Aufklärung von Problemen im Mundbereich. Über 50-Jährige, Frauen, Patienten mit geringer Bildung, Tumor im Kopf- und Halsbereich, palliativer Therapie, Operation oder zielgerichteter Krebstherapie gaben eine schlechtere MLQ zu t2 an als andere Patienten.Die MLQ ist bei Krebspatienten von klinischer Relevanz. Sie scheint vor allem nach Ende der Therapie eingeschränkt zu sein, und dies nicht nur bei Patienten mit Kopf-Hals-Tumoren. Der EORTC QLQ-OH15 ist trotz seiner Kürze in der Lage, diese Unterschiede abzubilden und wird von den Patienten gut akzeptiert, sodass er für zukünftige Studien in dem Bereich empfohlen werden kann.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Transoral robotic surgery for the treatment of laryngeal chondrosarcoma: A case report

Transoral robotic surgery has revolutionized the practice of head and neck surgery over the past decade, with indications now expanding to include laryngeal pathology. Although laryngeal chondrosarcoma is a rare entity, trends in otolaryngology literature suggest that it can frequently be managed with conservative approaches. We hope to inspire other head and neck surgeons to consider transoral robotic surgery for the treatment of such tumors so that outcomes data can be collected and studied.

http://ift.tt/2HVGpfF

Cytomorphological Spectrum of Thyroiditis: A Review of 110 Cases

Introduction. Different types of thyroiditis may share some parallel clinical and biochemical features. Timely intervention can significantly reduce morbidity and mortality. Aim. Aim of this study is to find the frequency of various thyroiditis, study the cytomorphological features and correlate with clinical findings including radiological findings, thyroid function test, and anti-thyroid peroxidase antibodies (Anti-TPO antibodies). Materials and Methods. The study included consecutive 110 cases of thyroiditis. Detailed cytomorphological features were studied and correlated with ultrasonography findings, thyroid function test, anti-thyroid peroxidase antibodies (anti-TPO) and histopathological features where thyroidectomy specimens were received for histopathological examination. Results. The majority were Hashimoto's thyroiditis () and females (). Other forms of thyroiditis were Hashimoto's thyroiditis with colloid goiter (), De Quervain's thyroiditis (), and one case each of postpartum thyroiditis and Hashimoto's thyroiditis with associated malignancy. The majority of patients were in the age group of 21–40 () and the majority () had diffuse enlargement of thyroid. The majority of patients were hypothyroid (). The serum anti-TPO antibodies were elevated in 47 patients out of 71 patients. In the 48 patients who underwent ultrasonography, 38 were diagnosed as having thyroiditis. The most consistent cytomorphological features seen in fine-needle aspiration smears of Hashimoto's thyroiditis were increased background lymphocytes, lymphocytic infiltration of thyroid follicular cell clusters, and Hurthle cells. Conclusion. The diagnostic cytological features in Hashimoto's thyroiditis are increased background lymphocytes, lymphocytic infiltration of thyroid follicular cell clusters, and Hurthle cells. FNAC remains the "Gold Standard" for diagnosing Hashimoto's thyroiditis. Clinical history, thyroid function, and biochemical parameters are the key for diagnosis of other forms of thyroiditis.

http://ift.tt/2t91ccc

Book Review: Dermatology: Visual Recognition and Case Reviews by Christine J. Ko

http://ift.tt/2F7mhFu

A study on etiopathogenesis and clinical features of multi-headed (bifid and trifid) mandibular condyles and review of the literature

The formations of second or more condylar heads are considered as rare anomalies. Fourteen multi-headed condyles (MHC) were presented; 13 of these were bifid mandibular condyles (BMC), whereas one exceptionally rare case was a trifid mandibular condyle (TMC). The TMC presented in this paper is the eighth case reported in the literature. In this paper, etiopathogenesis, types, and treatments are discussed.

http://ift.tt/2FJQPhB

Eliminating bias and accelerating the clinical translation of oral microbiome research in oral oncology

Dear Sirs,

http://ift.tt/2FH11Yd

Short dental implants in patients with oral lichen planus: a long-term follow-up

Oral lichen planus is associated with the Koebner phenomenon, and trauma may exacerbate oral lesions. Short dental implants, as alternatives to bony augmentation, would reduce the number of interventions and their morbidity. However, we know of no studies that have analysed the long-term outcomes of short implants in patients with oral lichen planus. We have therefore designed a retrospective study of such patients treated with short implants (≤8.5mm long), with survival of implants as the main outcome.

http://ift.tt/2FiIKma

So-called “bad split” may not be “bad” when the split is on the buccal side: technical note

In a sagittal split ramus osteotomy, the split in the ramus on the buccal side is generally called a "bad split". However, we think that it is "good" rather than "bad" when it refers to a case with asymmetry or a transverse cant, because there is no bony interference on the most posterior aspect.

http://ift.tt/2F7drYv

The C-MAC® Video-assisted Nasoendoscopy vs Traditional Direct Flexible Nasoendoscopy: A Pilot Randomised controlled study

Abstract

The C-MAC^® video monitor attachment is suitable for all otolaryngological scenarios, including post-operative follow up and difficult airway examination.

Currently, there are no studies looking at the effectiveness of C-MAC^® portable monitor with portable flexible nasoendoscopy.

Our study demonstrates that the C-MAC^® monitor with portable flexible nasoendoscopy is an excellent tool in terms of medical education, improving patient-doctor communication, efficiency of ward rounds and for medico-legal documentation, with distinct advantages over traditional direct flexible nasoendoscopy.

This article is protected by copyright. All rights reserved.

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Does otitis media in early childhood affect later behavioural development? Results from the Western Australian Pregnancy Cohort (Raine) Study

Abstract

Objectives

To examine the relationship between early life episodes of otitis media and later behavioural development with adjustment for confounders.

Design

Longitudinal cohort study.

Setting: The Western Australian Pregnancy Cohort (Raine) Study recruited 2900 pregnant women from King Edward Memorial Hospital (KEMH) in Perth, Western Australia, between 1989 and 1991.

Participants

Data from the children born were collected at both the Year 3 and Year 5 follow up. At Year 3, n = 611 were diagnosed with recurrent otitis media through parent-report and clinical examination. At Year 5, n = 299 were considered exposed to otitis media based upon tympanometry results.

Main Outcome Measures

Performance in the Child Behaviour Checklist (CBCL), a questionnaire completed by the primary caregiver at Year 10.

Results

Significant associations were found between recurrent otitis media at Year 3 and internalising behaviours (P = 0.011), and the somatic (P = 0.011), withdrawn (P = 0.014), attention (P = 0.003) and thought problems domains (P = 0.021), and the total CBCL score (P = 0.010). A significant association was also found between exposure to otitis media at Year 5 and externalising behaviours (P = 0.026).

Conclusions

A modest association was seen between recurrent otitis media at Year 3 and exposure to otitis media at Year 5 and a number of behaviour domains at Year 10.

This article is protected by copyright. All rights reserved.

http://ift.tt/2GS2Q48

Decreasing cytokeratin 17 expression in head and neck cancer predicts nodal metastasis and poor prognosis: the first evidence

Abstract

Objectives

Cytokeratins (CKs) are mainly expressed in epithelial carcinomas and are valuable for making diagnoses and identifying metastatic status. Changes in the expression of individual CKs in certain carcinoma may be relevant to establishing a prognosis. However, the prognostic significance of CKs in head and neck squamous cell carcinoma (HNSCC) remains elusive. Herein, we investigated the diverse and unique expression patterns of Cytokeratin 13 (CK13) and Cytokeratin 17 (CK17) and assessed the role of CK17 as a predictor for HNSCC metastasis and prognosis.

Methods

CK13 and CK17 expressions were evaluated by using immunohistochemical tissue microarray (TMA) analysis with 106 patients of HNSCC. To clarify the characterization of CK17 expression with respect to its ability in predicting metastatic disease, an in-vitro study of cells migration/invasion assays was conducted. Furthermore, the correlation of CK17 expression to clinicopathologic variables and prognosis was analyzed by using a serial statistical method.

Results

CK13 was predominately expressed in noncancerous tissues and was lost in HNSCC. Decreasing expression of CK17 correlated with cancerous cell migration and invasion (P<0.0001) in an in-vitro study. CK17 expression was lower in the N1 and N2 nodal metastases category compared to the N0 stage. Moreover, Kaplan-Meier survival analyses showed that a lower CK17 expression was associated with a poorer survival connotation in HNSCC patients (P<0.05) with 10-year follow-up.

Conclusion

Our findings provide the first evidence that CK17 under-expression might be a potential predictor of nodal metastasis and adverse prognosis.

This article is protected by copyright. All rights reserved.

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Effects of sumatriptan nasal spray (Imigran) on human nasal mucosa

Abstract

Objectives

Sumatriptan (Imigran) is a potent and highly selective 5-HT₁ receptor agonist often used in treating acute migraine. Intranasal sumatriptan is well absorbed and is generally effective in relieving headache. However, the effects of Imigran on human nasal mucosa have rarely been well explored. To verify the effect of Imigran, which act on human nasal mucosa directly in vitro.

Design and participants

We examined the effectiveness of Imigran on human nasal mucosa by testing: 1) effect on human nasal mucosa resting tension; 2) effect on contraction caused by 10^-6 M methoxamine as a sympathetic mimetic; 3) effect of the drugs on electrically induced on human nasal mucosa contractions.

Results

The results indicated that addition of methoxamine to the incubation medium caused the nasal mucosa to contract in a dose-dependent manner. Addition of Imigran at doses of 10 ⁻⁴ M elicited a significant relaxation response to 10^–6 M methoxamine -induced contraction. Imigran couldn't inhibit electrical field stimulation-induced spike contraction. It also had a minimal effect on the basal tension of nasal mucosa as the concentration increased.

Conclusions

The study indicated that high concentrations of Imigran had a significant spasmolytic effect by antagonizing α-adreoceptors and nasal obstruction couldn't be released in the patient combined with acute migraine and stuffy nose by concomitant α-adrenergic agonist nasal spray plus Imigran nasal spray.

This article is protected by copyright. All rights reserved.

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Punctate palmoplantar keratoderma: an unusual mutation causing an unusual phenotype

Abstract

Palmoplantar keratodermas (PPKs, OMIM #144200) refers to a large phenotypically and genetically heterogeneous group of keratinization disorders characterized by marked hyperkeratosis on the surface of palms and soles. Punctate PPK (PPKP) features multiple hyperkeratotic papules that develop in early adolescence or later and are irregularly distributed on the palms and soles. The disease is clinically classified into three autosomal dominant subtypes: PPKP1 (OMIM #148600, 614936) characterized by multiple tiny punctate keratoses and caused by mutations in the AAGAB or COL14A1 genes; PPKP2 (OMIM #175860) which features tiny hyperkeratotic spinous papules and PPKP3 or acrokeratoelastoidosis (AKE, OMIM # 101850) which manifests with small hyperkeratotic papules located over the peripheral margins of the palms and soles and is typically associated with degeneration of elastic fibers on histology. The molecular etiology of PPKP2 and AKE remains unknown.

This article is protected by copyright. All rights reserved.

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Evaluation of treatment results in multifocal primary cutaneous anaplastic large cell lymphoma: Report of the Dutch Cutaneous Lymphoma Group

Abstract

Background

There is no consensus on the treatment of multifocal primary cutaneous anaplastic large cell lymphoma (C-ALCL). Radiotherapy (RT) and methotrexate (MTX) are the current treatment options, but their efficacy is unknown. Recently, targeted therapies showed promising results in C-ALCL, and may therefore be an attractive first choice of treatment.

Objectives

To assess the efficacy of conventional treatment strategies for patients with multifocal C-ALCL, and to define which patients may require novel targeted therapies.

Methods

In this multicenter study, treatment was evaluated in patients initially presenting (n=24) or relapsing with multifocal C-ALCL (n=17; 23 relapses). Distinction was made between cases with ≤ 5 (n=36) and >5 lesions (n=11).

Results

Treatments most commonly used were radiotherapy (n=21), systemic chemotherapy (n=9) and low-dose methotrexate (MTX; n=7) with complete response rates of 100%, 78% and 43%, respectively, and an overall response rate of 100%, 100%, and 57%, respectively. Four patients showed a complete spontaneous regression. Sixteen of 24 patients (67%) first presenting with multifocal C-ALCL relapsed, including all five patients initially treated with CHOP. Compared with patients presenting with 2-5 skin lesions, patients presenting with >5 lesions had a higher chance of developing extracutaneous relapse (56 vs 20%) and more often died of lymphoma (44% vs 7%).

Conclusion

Patients with ≤5 lesions should be treated with low-dose RT (2x4 Gy). Maintenance low-dose MTX (20 mg/week) is a suitable option in patients with >5 lesions. Targeted therapies may be considered in rare patients refractory to MTX or patients developing extracutaneous disease.

This article is protected by copyright. All rights reserved.

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Genome-wide association study identifies three novel susceptibility loci for systemic lupus erythematosus in Han Chinese

Abstract

Systemic lupus erythematosus (SLE) is a common prototypic autoimmune disease with substantial genetic predispositions. It is more prevalent in Asians than in Caucasians. Genome wide association studies (GWAS) have discovered more than 80 genetic loci for the risk of SLE¹, which improve the understanding of SLE etiology and provide potential therapeutic targets. However, each GWAS finding only confers a relatively small effect, and they in total cannot fully explain SLE heritability, suggesting more genetic variants are yet to be discovered.

This article is protected by copyright. All rights reserved.

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Itch in dermatomyositis: the role of increased skin interleukin-31

Summary

Background

Interleukin-31 (IL-31) is implicated in pruritus associated with pruritic skin diseases like atopic dermatitis. Although pruritus is a prominent feature in dermatomyositis (DM), few studies have evaluated the pathogenesis of DM-associated itch.

Objectives

Our goals were to establish the prevalence of itch in DM, and to investigate the role of IL-31 in DM-related itch.

Methods

Pruritus and disease activity of DM were evaluated by a visual analog scale (VAS) and the Cutaneous Disease and Activity Severity Index (CDASI), respectively. Expression of IL-31 and IL-31 receptor alpha (IL-31RA) in lesional DM, non-lesional DM and healthy control (HC) skin was evaluated by qRT-PCR and immunofluorescence. Flow cytometry was performed on skin cells isolated from lesional DM skin to identify cellular sources of IL-31 in DM.

Results

Among 191 DM patients, 50.8% had moderate to severe itch, and itch was correlated with increased cutaneous severity (r= 0.34). In itchy DM patients, gene expression of IL-31 and IL-31RA in lesional skin was upregulated compared to non-lesional skin and HC skin. IL-31 mRNA expression positively correlated with VAS itch score (r= 0.67). On immunofluorescence, immunoreactivity for IL-31 and IL31RA was stronger in lesional skin. Flow cytometry showed lesional DM skin contained significantly more IL-31-producing cells and CD4+ cells were the most common cell type. Lenabasum, an emerging treatment for DM, significantly downregulated IL-31 from CpG-stimulated PBMCs.

Conclusion

Increased skin IL-31 may play a role in DM-associated itch, and ongoing trials will evaluate the effects of systemic treatment on IL-31 and itch in DM.

This article is protected by copyright. All rights reserved.

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A rare BRAF T599dup mutation conferring sensitivity to BRAF inhibitor in a patient with metastatic melanoma

Abstract

Treatment for patients with V600 mutation of the B-Raf protooncogene BRAF (BRAF-V600) and metastatic stage IV or unresectable stage III melanoma has greatly advanced with the introduction of selective BRAF inhibitors (BRAFi), such as vemurafenib and dabrafenib, combined with mitogen-activated protein kinase kinase inhibitors (MEKi), such as cobimetinib and trametinib, as first-line therapy [1,2]. Two mutations, V600E and V600K, are routinely searched in patients with stage IV and unresectable stage III cancer. The presence of the V600 mutation allows for prescribing BRAFi combined with MEKi according to the European Medicine Agency. Other non– BRAF-V600 mutations have been increasingly found by next-generation sequencing (NGS) and question the possible efficiency of BRAFi associated with MEKi with these mutations [3]. Here we report a case of metastatic melanoma in a patient with a non–BRAF-V600 mutation responding to combined BRAFi and MEKi treatment.

This article is protected by copyright. All rights reserved.

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Lymph Node Yield as Quality Metric for Clinically N0 Oral Cancer—Reply

In Reply We thank Dr Judson for his comments on our article. Dr Judson claimed that we selected the median number as our lymph node threshold and suggested that the cutoff was chosen arbitrarily. However, this was incorrect. As described in the article, we used restricted cubic spline, in particular, maximally selected rank statistics to choose the cutoff value. Therefore, the threshold 24 was selected objectively, not arbitrarily or based on the median lymph node count. We also examined model discriminative ability using bootstrapping bias-adjusted concordance probability (c-index) and calibration against the Kaplan-Meier estimated survival. Internal validation was performed using bootstrapping with 200 replications. The study by no means implied that half of the neck dissections in the cohort were inadequate; rather, it indicated that the cutoff of 24 could best differentiate the patient survival in the data set.

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Lymph Node Yield as Quality Metric for Clinically N0 Oral Cancer

To the Editor In their research letter, Tsai et al evaluated lymph node yield in a cohort of patients with clinically N0 oral cavity cancer from the National Cancer Database (NCDB). They found an association of lymph node yield with survival. With a median node count of 23, they used neck dissections with 24 or more nodes as a variable in a multivariable analysis and found 24 or more nodes to be associated with improved survival.

http://ift.tt/2oBEK6M

Fall With e-Cigarette Resulting in Pharyngeal and Esophageal Burns

This Observation describes the case of a man who presented to the emergency department with stridor, increased work of breathing, and supplement oxygen requirement after falling with an e-cigarette in his mouth several hours earlier.

http://ift.tt/2GWANAx

Association of Reduced Delay in Care With a Dedicated Operating Room in Pediatric Otolaryngology

This study evaluates an otolaryngology-specific operating room time block for unscheduled cases to determine time from initial consultation to surgery and utilization of the dedicated block of time.

http://ift.tt/2oCdyVq

Preoperative Aspirin Use and Bleeding Complications in Thyroid Surgery

This cohort study assesses whether continued preoperative aspirin use preoperatively is associated with increased bleeding complications among patients undergoing thyroid surgery.

http://ift.tt/2t9ulEa

The central venous pressure, and ‘a plea for some common-sense’

No abstract available

http://ift.tt/2FgGv2M

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

Obstructive sleep apnoea (OSA) is a common breathing disorder of sleep with a prevalence increasing in parallel with the worldwide rise in obesity. Alterations in sleep duration and architecture, hypersomnolence, abnormal gas exchange and also associated comorbidities may all feature in affected patients. The peri-operative period poses a special challenge for surgical patients with OSA who are often undiagnosed, and are at an increased risk for complications including pulmonary and cardiovascular, during that time. In order to ensure the best peri-operative management, anaesthetists caring for these patients should have a thorough understanding of the disorder, and be aware of the individual's peri-operative risk constellation, which depends on the severity and phenotype of OSA, the invasiveness of the surgical procedure, anaesthesia and also the requirement for postoperative opioids. The objective of this review is to educate clinicians in the epidemiology, pathogenesis and diagnosis of OSA in adults and also to highlight specific tasks in the preoperative assessment, namely to select a suitable intra-operative anaesthesia regimen, and manage the extent and duration of postoperative care to facilitate the best peri-operative outcome.

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Is the dose and mode of administration of dipyrone associated with acute kidney injury?

No abstract available

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Effect of various durations of smoking cessation on postoperative outcomes: A retrospective cohort analysis

BACKGROUND Preoperative smoking cessation is commonly advised in an effort to improve postoperative outcomes. However, it remains unclear for how long smoking cessation is necessary, and even whether a brief preoperative period of abstinence is helpful and well tolerated. OBJECTIVE We evaluated associations between various periods of preoperative smoking cessation and major morbidity and death. DESIGN Retrospective cohort analysis. SETTING Adults who had noncardiac surgery at the Cleveland Clinic Main Campus between May 2007 and December 2013. PATIENTS A total of 37 511 patients whose smoking history was identified from a preoperative Health Quest questionnaire. Of these patients, 26 269 (70%) were former smokers and 11 242 (30%) were current smokers. Of the current smokers, 9482 (84%) were propensity matched with 9482 former smokers (36%). We excluded patients with American Society of Anesthesiologists' physical status exceeding four, patients who did not have general anaesthesia, and patients with missing outcomes and/or covariables. When multiple procedures were performed within the study period, only the first operation for each patient was included in the analysis. MAIN OUTCOME MEASURES The relationship between smoking cessation and in-hospital morbidity/mortality. RESULTS The incidence of the primary composite of in-hospital morbidity/mortality was 6.9% (656/9482) for all former smokers; the incidence was 7.8% (152/1951) for patients who stopped smoking less than 1 year before surgery, 6.3% (118/1977) for 1 to 5 years, 7.2% (115/1596) for 5 to 10 years and 6.9% (271/3457) for more than 10 years. CONCLUSION Smoking cessation was associated with reduced in-hospital morbidity and mortality which was independent of cessation interval.

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About anaesthetists and artists

No abstract available

http://ift.tt/2F46yuV

Incidence and risk factors of anaesthesia-related perioperative cardiac arrest: A 6-year observational study from a tertiary care university hospital

BACKGROUND In recent decades, the incidences of anaesthesia-related perioperative mortality and adverse outcomes have decreased drastically. However, to date, data on perioperative cardiac arrest and risk factors of perioperative cardiac arrest from European countries are scarce. OBJECTIVES To determine the incidences of perioperative cardiac arrest and rates of anaesthesia-related and anaesthesia-contributory cardiac arrest. Identification of pre-existing risk factors leading to perioperative cardiac arrest. DESIGN Retrospective cohort study. SETTING Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany. INTERVENTIONS Perioperative critical incident reports between 2007 and 2012 were screened, and reports on cardiac arrest within 24 h postoperatively were identified. Cardiac arrests were classified as 'anaesthesia-related', 'anaesthesia-contributory' or 'anaesthesia-unrelated' by two reviewers independently. Univariate and multi-variate logistic regression analysis was used to identify risk factors associated with perioperative cardiac arrest. RESULTS Analysis of 318 critical incidents from 169 500 anaesthetics revealed 99 perioperative cardiac arrests. This is an overall incidence of perioperative cardiac arrest of 5.8/10 000 anaesthetics [95% confidence interval (CI), 4.7 to 7.0]. The rate of anaesthesia-related cardiac arrest was 0.7/10 000 (95% CI, 0.3 to 1.1), and the rate of anaesthesia-contributory cardiac arrest was 1.7/10 000 (95% CI, 1.1 to 2.3). Most cardiac arrests related to anaesthesia were due to respiratory events. From the multi-variate analysis, American Society of Anesthesiologists physical status grade at least 3 [P = 0.007, odds ratio (OR) 2.59 (95% CI, 1.29 to 5.19)], emergency surgery [P 

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Does the technique of two-hand mask ventilation matter?

No abstract available

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Intraoperative hypotension is associated with acute kidney injury in noncardiac surgery: An observational study

BACKGROUND Perioperative acute kidney injury (AKI) is common and increases the risk of morbidity and mortality. OBJECTIVES To determine the association between intraoperative hypotension, defined as an individual decrease from baseline and the risk of perioperative AKI. DESIGN Observational cohort study. SETTING Karolinska University Hospital, Stockholm, Sweden, from October 2012 to May 2013 and October 2015 and April 2016. PATIENTS All adult patients undergoing major elective noncardiac surgery who were scheduled for an overnight admission in the postoperative unit were included. Patients undergoing phaeochromocytoma surgery were excluded. DATA COLLECTION Preoperative risk factors (comorbidities), intraoperative events (hypotension defined as a more than 40 or 50% decrease in SBP relative to each patient's baseline and lasting more than 5 min) and postoperative data were collected from medical records. MAIN OUTCOME MEASURES AKI within the first two postoperative days. RESULTS Of the final cohort of 470 patients, 127 (27%) developed AKI in the perioperative period. AKI was associated with male sex [(66 vs. 48%) P 40%, 70 vs. 57%, P = 0.013; >50%, 20 vs. 12%, P = 0.024) and greater blood loss (800 vs. 400 ml, P 

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Is the Arné risk index a valid predictor for difficult intubation with indirect laryngoscopy?

No abstract available

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Comparing peri-operative complications of paediatric and adult anaesthesia: A retrospective cohort study of 81 267 cases

BACKGROUND Comparisons of peri-operative complications associated with paediatric (≤16 years) and adult anaesthesia are poorly available, especially in which cardiac surgery, organ transplantation and neurosurgery are involved. OBJECTIVE The aim of this study was to evaluate the nature and incidence of peri-operative complications that might be due to anaesthesia and to identify independent risk factors for complications in children and adults, including those undergoing cardiac surgery, organ transplantation and neurosurgery. DESIGN Retrospective cohort study. SETTING The study was performed at the University Medical Centre Groningen in the 4 years between 1 January 2010 and the 31 December 2013. MAIN OUTCOME MEASURES Complications and their severity were graded according to the standard complication score (20 items) of the Dutch Society of Anaesthesia. Univariate and multivariate regression analysis was used to identify independent risk factors for the reported complications. RESULTS A total of 81 267 anaesthetic cases were included. In the paediatric cohort, there were 410 (2.9%) complications and 1675 (2.5%) in the adults. In both cohorts age, American Society of Anaesthesiologists classification and emergency treatment were independent risk factors for complications. With respect to age, infants less than 1 year were at the highest risk, whereas in the adult cohort, increased age was related to a greater number of complications. The incidences of the specific complications were different between both cohorts. Upper airway obstruction was more frequently observed in paediatric patients (26%), whereas in the adults, complications with the highest incidence concerned conversion of regional-to-general anaesthesia (25%) and hypotension (17%). CONCLUSION Risk factors for all peri-operative complications were similar for paediatric and adult anaesthesia. However, the incidence of specific complications differed between both age categories.

http://ift.tt/2oEPGAT