Myxoma of the mandibular condyle: Report of a rare case and review of the literature

Publication date: Available online 9 March 2018
Source:Oral Oncology
Author(s): Everaldo Pinheiro de Andrade Lima, Flávia Maria de Moraes Ramos-Perez, Rômulo Oliveira de Hollanda Valente, Jorge Esquiche León, Paulo Rogério Ferreti Bonan, Danyel Elias da Cruz Perez
This report describes an extremely rare case of myxoma of the mandibular condyle. The tumor occurred in the left mandibular condyle of a 42-year-old woman, which was identified in a routine radiographic examination. The clinico-radiographic and histopathological features, and histogenesis of the lesion are discussed. A review of the literature and differential diagnosis of radiolucent condylar lesions are also presented.



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Treatment and frequency of follow-up of BCC patients in the Netherlands

Abstract

The incidence of Basal Cell Carcinoma (BCC) rises by 5% per decade in the Netherlands (1), representing an important burden on the health care system and dermatologists' workload (2,3). There is no evidence that intensive follow-up results in better outcomes (burden of disease, cosmetic results) in patients with low risk BCCs (4–6). According to the Dutch BCC guideline, follow-up after treatment is not indicated for patients with a low risk BCC (7), but patients may come for follow-up more frequently for various reasons (4,7,8). Considering the enormous amount of patients, extra follow-up visits represent a substantial workload and healthcare costs. Therefore, we studied follow-up of 482 BCC patients, diagnosed in 2010 from general hospitals (N=291 – random sample from a population-based cancer registry) and academic hospitals (N=191), who had a total of 578 BCC diagnosed in 2010. Information on medical history, tumor characteristics and the treatment and follow-up of all diagnosed BCCs was retrieved from the patient files until April 2015.

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Immunohistochemical identification of nail matrix melanocytes

Abstract

Background

No previous studies have been conducted to determine the normal number of nail matrix melanocytes in Latin American individuals. The objective of this work was to determine the number of melanocytes per linear millimeter present in the nail matrix and the nail bed in samples obtained from Colombian individuals.

Methods

Twenty-six unilateral biopsies were taken from 19 cadavers subjected to clinical and medico-legal autopsies. These biopsy samples were processed with conventional histotechnology and immunohistochemistry (IHC) with anti-HMB-45 and anti-MiTF. Three sets of photographs (HE, HMB-45 and MiTF) were taken of each biopsy sample and independently assessed by three pathologists. Each observer counted the number of melanocytes present in 1 linear mm of the nail matrix or bed.

Results

We found an average of 4.6 melanocytes x linear mm with H & E staining, 9.8 with HMB-45 and 12.4 with MiTF.

Conclusions

The use of IHC significantly increases and facilitates the identification of melanocytes in unilateral biopsies. Our IHC counts exceed the averages found in the literature. This finding warrants new studies to verify whether the Colombian population presents higher numbers of melanocytes in the nail matrix than other populations or whether the observed increase is a result of the use of MiTF.

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A case of subepidermal autoimmune bullous disease with autoantibodies against 200-kDa and 290-kDa antigens

Abstract

Epidermolysis bullosa acquisita (EBA) and anti-p200 pemphigoid are uncommon subepidermal autoimmune bullous diseases caused by autoantibodies against the 200-kDa protein and 290-kDa type VII collagen, respectively. Here we describe a patient with autoantibodies against both 200-kDa and 290-kDa antigens.A 63-year-old-man had itchy tense blisters and edematous erythemas scattered on his trunk, buttocks, extremities and soles (Fig. 1a). There were no ocular or mucosal lesions. Psoriatic skin lesions were not observed. There was no personal or family history of serious diseases.

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Patch Testing in Gastrointestinal Diseases – A Systematic Review of the Patch Test (PT) and Atopy Patch Test (APT)

Abstract

Food allergy is common and the prevalence is increasing. The pathogenesis of food allergy has been extensively reviewed. Immunologic and clinical tolerance to food requires production of regulatory T cells that are food-antigen specific. Loss of tolerance to food can lead to IgE-mediated reactions and non-IgE-mediated reactions.

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Contact hypersensitivity in rosacea – a report on 143 cases

Abstract

Rosacea is a chronic skin disease characterized by inflammatory processes affecting mainly the center of the face. The pathophysiology is complex, environmental factors seem to play an important role in the exacerbation and worsening of the lesions. The barrier-dysfunction theory in atopic dermatitis has been well described in the literature.

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Reply to: Kubiak K. And al. Endosymbiosis and its significance in dermatology

Abstract

We would like to begin by congratulating Kubiak K et al on their work[1], which has the potential to contribute to review the question of endosymbiosis and its significance.We would like to add some new data, notes and comments. Some data regarding viral endosymbiosis other than those discussed by the authors, showed the transmission of a Gemycircularvirus - Sclerotinia sclerotiorum hypovirulence-associated DNA1- like virus (SsHADV-1–LV)- via insect vectors - Lycoriella ingenua.

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The iris signal: blue periphery, tan collaret and freckles pattern – strong indicators for epidermal skin cancer in South-Eastern Europe

Abstract

Background

Eye and skin share the embryological origin. Both are established risk factors in epidermal skin cancer. There are few reports using iris colour classification scales, most of them analyse colour in general or are too complex to use in daily practice.

Objectives

To investigate which iris colour pattern is associated with epidermal skin cancer in a S-E European Caucasian population.

Methods

A case control study was conducted on 480 patients: 229 skin cancers patients and 251 controls (dermatological patients free of skin cancers), admitted in two medical clinics of Dermatology in Bucharest, between October 2011 and May 2014. High resolution iris photos were taken for each patient. Three parameters of the iris were analysed individually and in association for each patient: periphery, collaret and freckles.

Results

The most frequent iris colour pattern associated with epidermal skin cancer was blue periphery with light brown collaret and freckles present. In terms of individual parameters, the strongest indicators for skin cancer patients were blue periphery and blue collaret.

Conclusions

The results of this study sustain the hypothesis that blue periphery with light brown collaret and freckles iris pattern is a reliable phenotypic marker for epidermal skin cancer. The results of this study differ from previous reports in which skin cancer risk was associated with a homogenous blue iris. We account these differences to the characteristics of the recruited patients (S-E European, skin type II and III). The assessment of iris colour patterns is an easy and inexpensive detection tool in skin cancer risk assessment.

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5 alpha-reductase inhibitor treatment for frontal fibrosing alopecia: An evidence-based treatment update

Abstract

Background

Treatment for frontal fibrosing alopecia (FFA) is challenging and its treatment regimen often mirrors other lymphocytic-predominant cicatricial alopecia. 5 alpha-reductase inhibitor (5ARI) has been reported with some treatment success in severe cases of FFA.

Objective

To carry out evidence-based analysis of articles published on treatment efficacy and safety of 5 alpha-reductase inhibitor for the treatment of FFA.

Methods

Articles published on the use of 5ARI to treat FFA between 2005 to 2017 were reviewed, analysed and graded according to the American College of Physicians outcome study grading system.

Results

There were two studies with moderate-level of evidence that described the efficacy of 5ARI for treatment of FFA. 5ARI was commonly used as adjunctive therapy with positive results in recalcitrant disease. Mild to moderate hair regrowth was reported in one grade 2 and three lower grade (one grade 3 and two grade 4) studies. There is limited evidence on the safety aspects of this medication in most studies that were analysed.

Limitations

Database studies might not fully account for confounders and is subjected to variations in methodology and data collection.

Conclusion

This review demonstrated that FFA patients treated with 5ARI could achieve either disease stability or reduction in the rate of progression in selected cases. A well designed randomised, double-blind, controlled study would strengthen the role of 5ARI as part of treatment armamentarium for FFA.

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(Meth)acrylate allergy: frequently missed?

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Mutilating male genital Crohn's without gastrointestinal involvement

Abstract

A 58 year old gentleman developed multiple fissures and discharging sinuses in the groin and perineum. Skin biopsies showed non-caseating granulomas suggestive of Crohn's disease. The patient had no gastrointestinal symptoms and a radio-labelled white cell scan demonstrated no bowel involvement.

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Long-Term Optimization of Outcomes With Flexible Adalimumab Dosing in Patients With Moderate to Severe Plaque Psoriasis

Abstract

Background

The recently updated dosing recommendation for adalimumab for moderate to severe plaque psoriasis states that patients with inadequate response to adalimumab every other week (EOW) after 16 weeks may benefit from an increase in dosing frequency to 40 mg every week (EW).

Objective

To determine the long-term efficacy of adalimumab in patients with psoriasis with flexibility to escalate and de-escalate between EOW and EW dosing.

Methods

Data from an open-label study in patients with psoriasis who had received adalimumab in phase 2/3 studies and their extensions were included. Patients initially received 40 mg adalimumab EOW for 24 weeks. From weeks 24 to 252, patients whose Psoriasis Area and Severity Index response was <50% (PASI 50) could be dose-escalated to 40 mg EW and were re-evaluated at 6 and 12 weeks and then every 12 weeks thereafter. Patients who dose-escalated and achieved a PASI 75 response were de-escalated to EOW and could re-escalate to EW if response fell below PASI 50 again; no further de-escalation was allowed. Changes in PASI scores were reported at the last visit before dose escalation or de-escalation.

Results

By week 24, 64.1% of patients in the overall population (n=1256) achieved ≥PASI 75 response, 40.3% ≥PASI 90 response, and 21.7% PASI 100 response. Patients who had a <PASI 50 during weeks 24 to 252 (349/1256, 27.8%) were dose-escalated to EW; 182 (52.1%) remained on EW dosing and 167 (47.9%) achieved a PASI 75 response and were de-escalated to EOW; 83 patients were later re-escalated to EW dosing owing to a <PASI 50 response. Dose escalation was not associated with additional safety concerns.

Conclusion

Optimizing therapy by temporarily increasing the dosing of adalimumab to EW in patients with psoriasis and an inadequate response to adalimumab 40 mg EOW permitted the achievement and long-term maintenance of clinical improvement.

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Erythromelalgia: improvement in pain with transcranial magnetic stimulation

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The Efficacy of Touch Smear Cytology in the Diagnosis of Salivary Gland Cancers

Publication date: Available online 10 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Seiji Hosokawa, Satoru Takebayashi, Yutaka Sasaki, Hiroyuki Mineta
PurposeMethods for cytological diagnosis, such as fine-needle aspiration (FNA) and touch smear (TS) cytology, have been frequently used for malignant tumor screening; however, false-negative cases often result in misdiagnosis. The purpose of this study is to investigate the causes of false-negative cases and methods to reduce the false-negative rate in salivary gland tumor TS cytology.MethodsIn this cross-sectional study, we examined pathologically confirmed salivary gland tumors in 127 cases in which both FNA and TS cytology were performed before the operation or open biopsy at Numazu City Hospital from 2002–2016. We evaluated the false-negative rates of TS and FNA cytology separately and when used in combination and other variables such as age, sex, sensitivity, accuracy, specificity, and the overall pathological diagnosis by resection.ResultsThe overall false-negative rate of postoperative pathological diagnosis was lower when TS and FNA were combined (1/127 cases, 0.8%) compared to FNA cytology alone (10/127 cases, 7.9%), (p = 0.034). Suggested causes of a false-negative FNA (or/and TS) result include cytological difficulties present in certain malignancies, e.g., mucoepidermoid carcinoma, adenoid cystic carcinoma, and others.ConclusionFalse-negative cases were reduced when a combination of preoperative FNA and intraoperative TS cytology were performed. TS cytology appears to be a useful method to avoid misdiagnosis in salivary gland diseases.



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Major prognostic factors for recurrence and survival independent of the American Joint Committee on Cancer eighth edition staging system in patients with cutaneous squamous cell carcinoma treated with multimodality therapy

Abstract

Background

The purpose of this study was to assess changes resulting from the American Joint Committee on Cancer (AJCC) eighth edition for cutaneous squamous cell carcinoma (SCC) and evaluate pertinent excluded factors.

Methods

In 101 patients receiving surgery and postoperative radiation, recurrence and survival were estimated by cumulative incidence and Kaplan-Meier method. Time-to-event analysis was performed using Cox proportional hazards and Fine-Gray competing risks regression models.

Results

The 2-year locoregional recurrence, overall survival (OS), and cause-specific mortality rates were 25%, 72%, and 13%, respectively. The AJCC eighth edition upstaged T classification in 50% of patients and overall stage in 39%. In multivariate analysis, immunosuppression and in-transit metastasis were associated with locoregional recurrence. Older age and in-transit metastasis were associated with worse OS. In univariate analysis (limited by number of events), cause-specific mortality was associated with positive margin, in-transit metastasis, and the seventh edition dichotomized T classification and overall stage.

Conclusion

In-transit metastasis was significantly associated with locoregional recurrence, OS, and cause-specific mortality. Efforts should be made to define in-transit metastasis in the staging system.

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Blunt cannula subcision is more effective than Nokor needle subcision for acne scars treatment

Summary

Background and aim

A comprehensive study comparing two different modalities, Nokor needle subcision (NNS) and blunt cannula subcision (BCS), for treatment of acne scars, has not been reported previously. The aim was to compare the effectiveness of these two methods based on patient's and doctor's satisfaction measures, in addition to the late complications 3 months postsubcision.

Method of intervention

Patients had 18-65 years old, with acne scars on both malar sides. They were treated at one malar side with NNS and with BCS at another side. They were monitored during the first week, at one and 3 months postintervention. Patient's and two dermatologist's satisfactions were compared during 3 months, for each modality and between modalities.

Results

From 34 patients, 29.4%, 55.9%, and 14.7% had mild, moderate, and severe acne scars, respectively. Ecchymosis, nodule formation post-NNS, and edema after BCS were the complications. Patients were satisfied with BCS during 3-month monitoring (P = .021), but not with NNS (P = .353). Physician-1 was satisfied from the outcome of both BCS and NNS procedures (P = .044 and .006, respectively). However, physician-2 was only satisfied with NNS at the month 3 than the month 1 (P = .002). All patients and physicians were significantly more satisfied with BCS than NNS (P = .000). Anyway, at the month 3, physician-2 had no significant different points of view about applied methods (P = .25).

Discussion

Considering the complications and satisfaction rates, BCS was more efficient than NNS for acne scar treatment. Then, we suggest BCS as a good replacement for NNS.

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Clinical evaluation of simultaneously applied monopolar radiofrequency and targeted pressure energy as a new method for noninvasive treatment of cellulite in postpubertal women

Summary

Introduction

This study investigates noninvasive cellulite treatments based on simultaneous application of monopolar radiofrequency (RF) and targeted pressure energy to evaluate efficacy and safety and to see whether simultaneous application has any benefits in noninvasive cellulite treatments.

Methods

Thirty women with cellulite (fibrous/adipose/aqueous types) received 4 gluteofemoral treatments (~24 minutes; ~1000 cm²) using a simultaneous application of RF and targeted pressure energy. Clinical improvement was assessed using a pentile grading scale and satisfaction questionnaires. Hip/thigh circumference was measured. Ultrasonography and thermography observed changes in dermal/subcutaneous tissue composition and in gluteofemoral thermal profile. Evaluation at 3 months posttreatment was compared against the baseline.

Results

The clinical improvement averaged 2.17 ± 0.95 (54% improvement). Cellulite was reduced in 93% of cases, while 73% of patients showed good/very good/excellent improvement, with most significant improvement seen in patients with moderately severe cellulite. Hips and thigh circumference decreased on average by 2.31 cm and 2.13 cm, respectively (P < .001). Patient satisfaction was very high, averaging 4.47 ± 0.57 points (1-5 scale). Ultrasonography revealed smoothing and thickening (+0.28 ± 0.15 mm) of the dermis and an average reduction of 1.96 ± 1.60 mm in fat thickness (P < .05). Subjects with significant cellulite reduction had a more homogenous thermal profile at follow-up as a result of therapy-induced diminution of topographic skin defects. No adverse events were recorded.

Conclusion

The application is effective and safe for treating cellulite. The level of clinical improvement after 4 sessions is comparable to results reported after 6-20 sessions in studies on stand-alone RF/laser/targeted pressure energy devices. The technology is promising and deserves further attention and research.

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Antiaging and antioxidant effects of topical autophagy activator: A randomized, placebo-controlled, double-blinded study

Summary

Background

Recently, potential roles of autophagy in skin homeostasis received many interests. But, little has been reported for the potential antiaging effects of autophagy activator.

Objective

With the newly synthesized autophagy activator, heptasodium hexacarboxymethyl dipeptide-12 (Aquatide™) in vitro and clinical efficacy of the topical autophagy activator as an antiaging cosmeceutical ingredient was evaluated.

Methods

Antioxidant effect of Aquatide™ was evaluated by radical scavenging assay. In vitro effect was assessed by measuring the cytotoxicity of hydrogen peroxide in cultured normal human epidermal keratinocytes. Clinical evaluation was performed by a randomized, placebo-controlled, double-blinded study. Antioxidant efficacy was observed by measuring the carbonylated proteins in stratum corneum (SC) by fluorescein-5-thiosemicarbazide (FTZ) staining.

Results

Radical scavenging effects of Aquatide were observed with the ABTS assay, and significant reduction in hydrogen peroxide-induced cytotoxicity was observed in Aquatide™-treated cells. Autophagy inhibitor treatment abrogated cytoprotective effects of Aquatide™. In a clinical study, statistically significant increase in skin elasticity was observed after 4 and 8 weeks. Quantitative analysis of carbonylated proteins in SC also showed significant reduction in Aquatide™-treated group, which is consistent with the in vitro data.

Conclusion

These results suggest that autophagy plays important roles in antioxidant system and aging process in skin, and topical autophagy activators can be potential cosmeceutical ingredients for skin antiaging.

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Should all patients with hyperparathyroidism be screened for a CDC73 mutation?

Summary

Primary hyperparathyroidism (PH) is a common endocrine abnormality and may occur as part of a genetic syndrome. Inactivating mutations of the tumour suppressor gene CDC73 have been identified as accounting for a large percentage of hyperparathyroidism-jaw tumour syndrome (HPT-JT) cases and to a lesser degree account for familial isolated hyperparathyroidism (FIHP) cases. Reports of CDC73 whole gene deletions are exceedingly rare. We report the case of a 39 year-old woman with PH secondary to a parathyroid adenoma associated with a large chromosomal deletion (2.5 Mb) encompassing the entire CDC73 gene detected years after parathyroidectomy. This case highlights the necessity to screen young patients with hyperparathyroidism for an underlying genetic aetiology. It also demonstrates that molecular testing for this disorder should contain techniques that can detect large deletions.

Learning points:

Necessity of genetic screening for young people with hyperparathyroidism.

Importance of screening for large, including whole gene CDC73 deletions.

Surveillance for patients with CDC73 gene mutations includes regular calcium and parathyroid hormone levels, dental assessments and imaging for uterine and renal tumours.

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Interleukin-31 and interleukin-31 receptor–new therapeutic targets for atopic dermatitis

Abstract

Atopic dermatitis (AD) is characterized by chronic, eczematous, severe pruritic skin lesions caused by skin barrier dysfunction and T helper (Th)2 cell–mediated immunity. Interleukin (IL)-31 is a potent pruritogenic cytokine primarily produced by Th2 cells. Both IL-31 transgenic mice and wild-type mice treated with IL-31 exhibit AD-like skin lesions and scratching behaviour. IL-31 receptor α-chain (IL-31RA) are also expressed in peripheral nerves and epidermal keratinocytes, and the roles of IL-31 on pruritus and skin barrier have been investigated. Recently, an anti–IL-31 receptor antibody was shown to significantly improve pruritus in AD patients. This review focuses on IL-31 and IL-31RA in AD.

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Intestinal-type adenocarcinoma of the sinonasal tract: an update

Purpose of review Intestinal-type adenocarcinoma (ITAC) is one of the most frequent sinonasal tumors, especially in European countries. The purpose of this article is to review the most recent literature, with special emphasis on biological and genetic profile and treatment guidelines. Recent findings Results on large series support transnasal endoscopic surgery as the technique of choice in the large majority of patients with ITAC. Adjuvant radiotherapy is recommended in advanced-stage and high-grade lesions. More robust data are required to confirm that early-stage, low-grade lesions can be treated with exclusive surgery. The efficacy of new chemotherapy and biotherapy regimens and the added value of heavy particle radiotherapy are currently under evaluation. With a 5-year overall survival ranging between 53 and 83%, which is mainly impacted by local recurrences, ITAC requires a more detailed understanding of its biology. Genetic and biological studies have identified alterations in the molecular pathways of EGFR, MET, and H-RAS which might be considered as potential targets for biotherapy. Summary Surgery still plays a key role in the treatment of ITAC, but multidisciplinary management is mandatory. Although further validation is needed, the role of nonsurgical treatment strategies is rising, in agreement with the progresses made in the biological profiling of the disease.

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Reducing morbidity and complications after major head and neck cancer surgery: the (future) role of enhanced recovery after surgery protocols

Purpose of review To review the development and the benefits of enhanced recovery after surgery (ERAS) protocols in non-head and neck disciplines and to describe early implementation efforts in major head and neck surgeries. Recent findings Several groups have adopted ERAS protocols for major head and neck surgery and demonstrated its feasibility and effectiveness. Summary There is growing evidence that clinical and financial outcomes for patients undergoing major head and neck surgery rehabilitation can be significantly improved by standardizing preoperative, intraoperative, and postoperative treatment protocols. Current experience is limited to single centers. A future goal is to broaden the adoption of ERAS in head and neck surgical oncology to include national and international collaboration, data sharing, and learning.

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Salivary duct carcinoma

Purpose of review The review puts new information on geno- and phenotype of salivary duct carcinoma (SDC) in the perspective of the updated 2017 WHO classification. Recent findings The proportion of SDC is increasing. This may be because of a true rise in incidence, but certainly to better diagnostic tests and changed WHO definitions. In this light, a substantial proportion of carcinoma expleomorphic adenoma is now attributed to the category of SDC. 'Low-grade SDC' and 'SDC in-situ' of the former WHO classification, are now named low-grade and high-grade intraductal carcinoma (IDC), respectively. Recent series quantify biologic aggressiveness: perineural growth, vascular invasion, and extracapsular extension in lymph node metastasis are each observed in two out of three patients with SDC. Most patients die within 3 years, but once 5-year disease-free survival is reached, further disease activity is exceptional. The typical molecular biological profile with high human epidermal growth factor receptor 2 and androgen receptor expression is increasingly successfully exploited in clinical trials for advanced SDC. Summary The aggressive SDC is increasingly diagnosed. Despite intensive combined surgery and radiation therapy, many patients recur, for whom new bullets, targeting the molecular biological mechanisms, are the subject of ongoing clinical trials.

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Nature and role of surgical margins in transoral laser microsurgery for early and intermediate glottic cancer

Purpose of review Summarize recent findings regarding the impact of margin status on oncologic outcomes and organ preservation, as well as evaluate possible management policies of close and positive margins after transoral laser microsurgery (TLM) for Tis-T2 glottic carcinomas. Recent findings Impact of margin status on survival rates remains controversial, whereas some authors found close and positive margins to be independent risk factors for recurrence and poorer survival rates, others did not find any significant variations compared with negative ones. A common trend can be observed in performing a watchful waiting policy or second look TLM in patients with close-superficial and positive single-superficial margins. Further treatment seems preferable in case of deep and positive multiple superficial margins. Summary Positive margins are present in up to 50% of patients treated by TLM, even though a high rate of false positivity, reaching 80%, has been described. Close and positive single superficial margins seem to be linked to higher recurrence rates compared with negative margins, even though watchful wait and see policy, especially when performed by adjunctive visual aids like Narrow Band Imaging, maintains good final oncological and organ preservation outcomes. Further treatments are required in case of deep margin positivity.

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Free flaps for head and neck cancer in paediatric and neonatal patients

Purpose of review To review recent literature on the subject of free tissue transfer options in paediatric head and neck surgery, with a particular emphasis on highlighting the advantages and disadvantages of different reconstructions in the paediatric patient. Recent findings Free tissue transfer in paediatric patients is predictable and applicable for a wide range of congenital and acquired defects in the head and neck. The free fibula flap is a mainstay of mandibular reconstruction and allows excellent implant-supported prosthodontic rehabilitation and growth potential at the recipient site with little or no donor site morbidity. Other less commonly explored options include the deep circumflex iliac artery flap, scapula flap and medial femoral condyle flap. The gracilis mucle remains the mainstay for facial reanimation with other options including pectoralis minor, rectus abdominis, extensor digitorum brevis and latissimus dorsi. There are compelling arguments for centralization of services and creative strategies in postoperative rehabilitation (e.g. play therapy). Summary Free flaps in paediatric patients are a viable option and may even have advantages relative to adults because of the absence of atherosclerosis, purported lower risk of vasospasm and proportionally larger vessel size. Transfer earlier in life maximizes functional potential and 'normalizes' treatment.

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Oncologic and functional outcomes of patients treated with transoral CO2 laser microsurgery or radiotherapy for T2 glottic carcinoma: a systematic review of the literature

Purpose of review To give an overview of the laryngeal preservation and functional outcomes of patients treated with transoral CO2 laser microsurgery (TLM) or radiotherapy for T2 glottic carcinoma. This information supports physicians and patients in treatment counselling and choices. Recent findings A recent systematic review showed that local control rates at 5-year did not differ between radiotherapy and TLM for T2 glottic tumours. However, there is a lack of comparative data on laryngeal preservation as well as functional outcomes in T2 glottic carcinoma. Summary Laryngeal preservation for T2 tumours in this review is higher for patients treated primarily with TLM (88.8 vs. 79.0%). It is important to differentiate between tumours with normal and impaired mobility (T2a and T2b) because the latter showed poorer prognosis for both TLM and radiotherapy. Involvement of the anterior commissure does not result in significantly lower oncological results, if adequately staged and treated. More studies are needed to support these data and to compare the functional outcomes between TLM and radiotherapy for T2 glottic carcinoma.

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Editorial introduction

No abstract available

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Synovial sarcomas of the upper aero-digestive tract: is there a role for conservative surgery?

Purpose of review To present the current state of knowledge concerning the role of conservative surgery in the treatment of synovial sarcomas of the upper aero-digestive tract (UADT). Recent findings The wider experience on synovial sarcomas involving the extremities and the results of retrospective reports focused on head and neck synovial sarcomas tend to justify a conservative surgical approach when dealing with tumors involving the UADT. Summary UADT synovial sarcomas is an extremely rare clinical entity (only around 50 cases reported in the literature, with four more herein presented from our own surgical series), with no clear guidelines concerning its treatment. Resection should be aimed to an en-bloc removal of the tumor within uninvolved surgical margins. In fit patients, a conservative surgical approach should be preferred if it does not interfere with a complete resection and reasonable functional outcomes. Adjuvant treatments (radiotherapy and/or chemotherapy) are frequently needed in view of the aggressive behavior of such tumor, but they should be balanced according to patient's characteristics and tumor risk factors (grade, size, and previous treatments).

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Orbital exenteration for sinonasal malignancies: indications, rehabilitation and oncologic outcomes

Purpose of review Review the recent literature regarding the management of orbital invasion in sinonasal malignant tumors. Recent findings There is a recent trend in preserving the orbit in cases of minimal invasion of periosteum and limited periorbit involvement, as well as in presence of good response to neoadjuvant chemotherapy, mainly in squamous cell carcinoma and neuroendocrine histologies. Summary The decision about orbital exenteration in cases of sinonasal malignancies is facilitated if the patient already has clear clinical signs of intraconal invasion such as visual loss, restriction of ocular mobility or infiltration of the eyeglobe. However, in borderline situations, confirmation of orbital involvement should be performed intraoperatively. In selected cases with minimal orbital invasion without functional compromise, orbit sparing surgery can be done with acceptable oncological outcomes.

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Detection of surgical margins in oral cavity cancer: the role of dynamic optical contrast imaging

Purpose of review The quantity of tissue removed during an oncologic surgical procedure is not standardized and there are numerous reports of local recurrence despite histologically adequate resection margins. The oral cavity is one of the sites in the head and neck with high chances of recurrence following negative margins. To address this need, this article reviews the recent applications of Dynamic Optical Contrast Imaging (DOCI) towards both oral screening and the intraoperative evaluation of tumor margins in head and neck surgery. Recent findings Human ex-vivo and in-vivo trials suggest DOCI is well tolerated, low-cost, and sensitive for differentiating cancerous from normal tissues throughout the head and neck, in addition to the oral cavity. Ex-vivo imaging of OSCC specimens generated histologically verified image contrast. Furthermore, in-vivo intraoperative results demonstrate significant potential for image-guided detection and resection of oral cavity squamous cell carcinoma (OSCC). Summary DOCI augments tissue contrast and may enable surgeons to clinically screen patients for oral cancer, make histologic evaluations in vivo with fewer unnecessary biopsies, delineate clinical margins for tumor resection, provide guidance in the choice of biopsy sites, and preserve healthy tissue to increase the postoperative functionality and quality of life of the patient.

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The recurrent pleomorphic adenoma conundrum

Purpose of review Recurrent pleomorphic adenoma (RPA) is uncommon. Treatment selection is based on the likely possibility of minimizing the risk of tumour recurrence, avoiding local functional and cosmetic sequelae, and eradicates the possibility of metastatic or malignant transformation. Much has changed since the topic was reviewed in 2001, and this manuscript comments on clinical progress and discusses patient treatment options. Recent findings Surgery is the preferred treatment for head and neck pleomorphic adenoma. Over the recent decade the surgical radicality is favoured for parotid and submandibular gland pleomorphic adenoma, from total gland and tumour removal to endoscopic or minimal open extracapsular tumour excision. Currently molecular pathology and biomarker research has not identified any evidence that separates pleomorphic adenoma from RPA, thus supporting that tumour recurrence is likely associated with surgery. Revision surgery has been reported to be frequently noncurative depending on the extent of the primary surgery, with the added risk of local cosmetic and functional sequelae. Radiotherapy as a nonsurgical modality has advanced and has been shown to be effective in controlling, if not curing, high-risk patients who have identifiable prognostic factors of developing a recurrence and patients with RPA. Summary Current surgical management of pleomorphic adenoma is associated with improved quality of life and minimal disturbance to cosmetic and functional. The reported incidence of RPA has been reduced by 'expert surgeons' but with limited short-term follow-up following more recent surgical modifications. Patients with RPA should be offered treatment that includes surgery and/or radiotherapy and should be encouraged to partake of this decision making process.

http://ift.tt/2HmAjUe

Impact of 3D virtual planning on reconstruction of mandibular and maxillary surgical defects in head and neck oncology

Purpose of review This review describes the advances in 3D virtual planning for mandibular and maxillary reconstruction surgical defects with full prosthetic rehabilitation. The primary purpose is to provide an overview of various techniques that apply 3D technology safely in primary and secondary reconstructive cases of patients suffering from head and neck cancer. Recent findings Methods have been developed to overcome the problem of control over the margin during surgery while the crucial decision with regard to resection margin and planning of osteotomies were predetermined by virtual planning. The unlimited possibilities of designing patient-specific implants can result in creative uniquely applied solutions for single cases but should be applied wisely with knowledge of biomechanical engineering principles. Summary The high surgical accuracy of an executed 3D virtual plan provides tumor margin control during ablative surgery and the possibility of planned combined use of osseus free flaps and dental implants in the reconstruction in one surgical procedure. A thorough understanding of the effects of radiotherapy on the reconstruction, soft tissue management, and prosthetic rehabilitation is imperative in individual cases when deciding to use dental implants in patients who received radiotherapy.

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Immunotherapy for recurrent/metastatic head and neck cancer

Purpose of review In the last decade, after cetuximab (anti-epidermal growth factor receptor), none of the novel investigated compounds has demonstrated benefit in head and neck squamous cell cancers (HNSCC), both in advanced and curative settings. Therefore, prognosis of recurrent/metastatic (R/M) HNSCC patients remains dismal, especially in platinum-refractory cohort. In the last few years, a new important class of drugs has affirmed its role. HNSCC, even if less 'immunogenic' than other malignancies (e.g. melanoma), was field of application of several new immune agents. To date, the most important data regard drugs acting on PD-1 (programmed death-1)/PD-L1 (programmed death-ligand 1) axis that is a crucial checkpoint used by tumor for immune escape. Our purpose is to summarize the results of these PD-1/PD-L1 inhibitors, outlining some critical points and few practical suggestions. Recent findings Nivolumab was recently approved by main regulatory agencies as second-line treatment for platinum-refractory R/M HNSCC. In the same setting, pembrolizumab was approved by FDA. Atezolizumab and durvalumab have already showed similar benefit in phase Ia and II studies, respectively. Summary Anti-PD1/PD-L1 agents are new effective therapies in R/M HNSCC. Their combination with conventional/novel compounds, as well as a better selection of responding patients, could lead to improve current results.

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Managing Your Anesthesiology Practice for the Future

Publication date: Available online 9 March 2018
Source:Anesthesiology Clinics
Author(s): Amr E. Abouleish, Stanley W. Stead




http://ift.tt/2txy6Ue

Interdisciplinary Treatment Algorithm for Facial Arteriovenous High-flow Malformations and Review of the Literature

High-flow arteriovenous malformations (HF-AVMs) are congenital vascular malformations. Typical localizations include the face, oral cavity, and extremities.Due to the high recurrence rate of AVM after incomplete resection or embolization, a combination of both therapeutic modalities has become the preferred choice of treatment. Therefore, we have developed an interdisciplinary therapeutic treatment algorithm for facial HF-AVM and performed a systematic review of the literature.

http://ift.tt/2DfhBvv

Continuity defects of the mandible: Comparison of three techniques for osseous reconstruction and their impact on implant loading

Computer-aided design/manufacturing (CAD/CAM) is now widely used, but whether it can help to overcome complications in mandibular reconstruction and accelerate dental implantation is still a matter for debate. Therefore, we aimed to evaluate the benefits of this technique using vascularized iliac crest or fibula flaps in mandibular reconstruction, with respect to the time between reconstruction and implantation, and the ratio of planned to inserted implants. We reviewed retrospectively the records of 54 patients who underwent mandibular reconstructions between 2012 and 2016, and included in our study the last 10 cases representing each of the following groups: iliac crest flap with CAD/CAM (Group 1); fibula flap with CAD/CAM (Group 2); and fibula flap without CAD/CAM (Group 3).

http://ift.tt/2p08z0Y

Improvement of skin lesions and life quality in moderate-to-severe eczema patients by combined TCM therapy

Atopic Dermatitis (AD) is a common allergic inflammatory skin disorder exacting up to $3.8 billion health dollars annually for treatment.1 50.4% of AD patients report using complementary and alternative therapies, such as Traditional Chinese Medicine (TCM); but reports on TCM efficacy and safety remain inconclusive.2, 3 We were interested to learn if combined TCM therapy could suppress Th2 inflammation and benefit patients with AD. We report a case series of 14 AD patients treated with this approach and analysis of the TCM herbs in murine and in vitro models.

http://ift.tt/2oZxKA6

Erratum

In the CME Review article, "The atopic march: Critical evidence and clinical relevance" (Ann Allergy Asthma Immunol. 2018;120(2):131–137), on page 131, the incorrect Key Messages were incorporated. The Key Messages should read as follows:

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Myxoma of the mandibular condyle: Report of a rare case and review of the literature

This report describes an extremely rare case of myxoma of the mandibular condyle. The tumor occurred in the left mandibular condyle of a 42-year-old woman, which was identified in a routine radiographic examination. The clinico-radiographic and histopathological features, and histogenesis of the lesion are discussed. A review of the literature and differential diagnosis of radiolucent condylar lesions are also presented.

http://ift.tt/2Fukevl

Pediatric Anatomy: Nose and Sinus

Publication date: Available online 9 March 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Habib G. Zalzal, Daniel C. O′Brien, George H. Zalzal
The sinonasal anatomy of children differs significantly when compared to the sinonasal anatomy of adults. Even within the pediatric group, the anatomy varies depending on the age of the patient, as structures reach full maturation in the teenage years. Knowledge of pediatric anatomy is important for all otolaryngologists, particularly those planning to operate within the nose of a child. This chapter will present the pediatric nasal and sinonasal anatomy with reference to development and related operative planning.



http://ift.tt/2IgT0KG

Endoscopic Management of Congenital Dacryocystocele

Publication date: Available online 9 March 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Vijay A. Patel, Zachary C. Landis, Amanda L. Ely
Congenital dacryocystocele is a relatively rare oculonasal anomaly which can result in symptomatic obstruction of the nasolacrimal system. Techniques utilized in the management of this condition include nasolacrimal duct probing, endoscopic dacryocystorhinostomy, and transnasal marsupialization. Operative adjuncts include balloon dacryocystoplasty, bicanalicular silastic intubation, and intranasal stenting. Recurrence is relatively uncommon and can be addressed with the application of long-term nasolacrimal stenting.



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Surgical Management of Inferior Turbinate Hypertrophy

Publication date: Available online 9 March 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Withita Utainrat, Daniel C. O′Brien, Dhave Setabutr
Nasal obstruction remains a common complaint and is a frequent reason for children to see otolaryngologists. Due to its location, proximal to the internal nasal valve, enlargement of the inferior turbinate can cause significant nasal obstruction. Symptoms vary widely and treatment may include both medical and surgical options. Surgeons may utilize monopolar cautery, microdebriders, or coblation technology. This article describes techniques with specific reference to children with nasal symptoms.



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Transnasal Repair of Congenital Choanal Atresia

Publication date: Available online 9 March 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Vijay A. Patel, Michele M. Carr
Choanal atresia is a relatively rare congenital nasal anomaly that must be repaired to allow infants to adequately breathe and feed. Techniques used in repair have evolved with the development of high-quality optical equipment, such that an endoscopic approach is now most commonly employed. Operative adjuncts include lasers, topical steroids, and stenting. Restenosis is common in the first few years, but this can be improved with dilation.



http://ift.tt/2DgC5Uv

Pediatric Septoplasty

Publication date: Available online 9 March 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Sarah R. Akkina, Sanjay R. Parikh
While septoplasty is routinely performed in the adult population, concerns regarding nasal and facial growth have restricted use of this effective procedure in the pediatric population. As a growing number of studies have demonstrated the safety of this technique and its positive effect on quality of life outcomes, septoplasty is gaining greater acceptance as a central treatment for pediatric nasal obstruction. This article explores the controversies, indications, pre-operative evaluation, and techniques of pediatric septoplasty including closed and open approaches. It also describes post-operative care and possible complications of pediatric septoplasty.



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Introduction: The simple act of breathing

Publication date: Available online 9 March 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): M.M. Carr




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Columellar Reconstruction in Children

Publication date: Available online 9 March 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Kristen S. Pan, Brian S. Pan
Defects of the nasal complex can cause significant functional and psychosocial impairment. Nasal reconstruction aims to restore the normal trilaminar structure of the nose, which includes the internal lining, cartilaginous framework, and soft tissue envelope. Among the nasal subunits, the columella is especially challenging to reconstruct due to its unique contour and composite nature. Multiple techniques have been described, each carrying distinct advantages and disadvantages; however, the optimal procedure for an isolated defect of the columella remains elusive. The ideal reconstructive technique should recreate the contour of the columella, provide nasal tip projection, and maintain external valve patency. Additional considerations include matching the pigmentation and texture of the nasal skin while minimizing donor site morbidity. The authors recommend a two-stage reconstruction with bilateral nasal sill flaps and an auricular composite graft.



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Balloon Catheter Sinuplasty in Pediatric Chronic Rhinosinusitis

Publication date: Available online 9 March 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Chadi A Makary, Hassan H Ramadan
In this article, we review indications for balloon catheter sinuplasty in children with chronic rhinosinusitis who have failed medical therapy and adenoidectomy. We will discuss our surgical approach, complications, postoperative care, and share some tips and pearls about the procedure. Balloon sinuplasty is a safe procedure that can be used alone or concomitantly with other procedures such as adenoidectomy and/or endoscopic sinus surgery. Balloon catheter sinuplasty has been shown to be effective in selected cases, and in isolation or in combination with other procedures, has resulted in great outcomes for these children.



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Pyriform Aperture Stenosis Repair in Infants

Publication date: Available online 9 March 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Johnathan E. Castaño, David H. Chi
Congenital nasal pyriform aperture stenosis is a rare developmental anomaly, which is considered a variant of holoprosencephaly. It is characterized by a pyriform aperture width of 11mm or less on maxillofacial computed tomography, and is frequently associated with a solitary median maxillary central incisor. It presents with cyclical cyanosis, feeding difficulty, and respiratory distress. Conservative management includes nasal decongestant, saline and steroid drops, or a McGovern nipple. When conservative management fails, surgical intervention is indicated. Various methods of surgical repair have been described, two of which – nasal dilation and bone resection via a sublabial approach - are described in this article. The role of postoperative stenting is also discussed.



http://ift.tt/2IhjtYg

Pediatric Sinus Surgery for Chronic Rhinosinusitis

Publication date: Available online 9 March 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Chadi A. Makary, Hassan H. Ramadan
Pediatric chronic rhinosinusitis (CRS) is a common health problem. Pathophysiology is complicated which leads to different treatment options and approaches. Medical treatment with antibiotics and topical nasal sprays is first line treatment. Surgical intervention includes adenoidectomy and endoscopic sinus surgery (ESS). ESS has proven to be an effective and safe option when everything else fails. In this article, we review the indications, our surgical approach and techniques, and the safety considerations in pediatric ESS.



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Survival in patients with submandibular gland carcinoma — Results of a multi-institutional retrospective study

Publication date: Available online 7 February 2018
Source:Auris Nasus Larynx
Author(s): Koichiro Yamada, Keigo Honda, Hisanobu Tamaki, Shinzo Tanaka, Shogo Shinohara, Shinji Takebayashi, Ichiro Tateya, Morimasa Kitamura, Masanobu Mizuta, Toshiki Maetani, Tsuyoshi Kojima, Yoshiharu Kitani, Ryo Asato, Kazuyuki Ichimaru, Yohei Kumabe, Koji Ushiro, Koichi Omori
ObjectiveClinical studies demonstrating the prognostic factors in submandibular gland carcinoma are limited because the tumor is relatively rare. The aim of this study was to identify clinical outcomes and prognostic factors in submandibular gland carcinoma.MethodsThe study included 65 patients with submandibular gland carcinoma who underwent initial surgical treatment at the Kyoto University and its affiliated hospitals.ResultsThe 3-year overall survival (OS), disease specific survival, locoregional control (LRC), and no distant metastasis (NDM) rates were 74.2%, 74.2%, 90.0%, and 64.8%, respectively. In the current follow-up study, 16 patients died of the disease, 5 patients were alive with recurrence, 43 patients were alive without disease, and 1 patient died of unrelated disease without recurrence. All patients who died of the disease had developed distant metastasis. Based on univariate analysis, tumor grade (high grade) and lymph node metastases (≥N2) were significant prognostic factors for OS and LRC. It also revealed tumor grade (high grade), T classification (≥T3), and lymph node metastases (≥N2) were significant for distant metastasis. Multivariate analysis showed the following significant prognostic factors: lymph node metastases (≥N2) for OS, LRC, and NDM, and high tumor grade for NDM.ConclusionOur study suggested death of submandibular gland carcinoma occurred mainly due to distant metastasis. The significant predictors of distant metastasis were lymph node metastases (≥N2) and tumor grade (high grade).



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Tricyclic antidepressants and appropriate and inappropriate medications in the geriatric population comments.

Publication date: Available online 9 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Ronald S. Brown




http://ift.tt/2p1YSP6

Appropriateness of tricyclic antidepressants in the geriatric population: a critical interpretation of existing literature

Publication date: Available online 9 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Arwa M. Farag, Bhavik Desai




http://ift.tt/2IfiPdL

Non-invasive diagnostic adjuncts for the evaluation of potentially premalignant oral epithelial lesions: current limitations and future directions

Publication date: Available online 9 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Eric C. Yang, Melody T. Tan, Richard A. Schwarz, Rebecca R. Richards-Kortum, Ann M. Gillenwater, Nadarajah Vigneswaran
Potentially premalignant oral epithelial lesions (PPOELs) are a group of clinically suspicious conditions, of which a small percentage will undergo malignant transformation. PPOELs are suboptimally diagnosed and managed under the current standard of care. Dysplasia is the most well-established marker to distinguish high-risk PPOELs from low-risk PPOELs, and taking a biopsy to establish dysplasia is the diagnostic gold standard. However, biopsies are limited by high morbidity, resource requirements, and the potential for underdiagnosis. Diagnostic adjuncts could help clinicians better evaluate PPOELs before a definitive biopsy, but existing adjuncts such as toluidine blue, acetowhitening, and autofluorescence imaging have poor accuracy and are not generally recommended. Recently, in vivo microscopy technologies such as high-resolution microendoscopy, optical coherence tomography, reflectance confocal microscopy, and multiphoton imaging have shown promise for improving PPOEL patient care. These technologies allow clinicians to visualize many of the same microscopic features used for histopathological assessment at the point-of-care.



http://ift.tt/2p4ijGP

Matrix-associated chondrocyte transplantation for reconstruction of articulating surfaces in the temporomandibular joint: a pilot study covering medium- and long-term outcomes of 6 patients

Publication date: Available online 9 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Gerhard Undt, Michael Jahl, Sebastian Pohl, Stefan Marlovits, Doris Moser, Hyang-Hee Yoon, Jimmy Frank, Susanna Lang, Christian Czerny, Guenter Klima, Eileen Gentleman, Rolf Ewers
ObjectivesMatrix associated chondrocyte transplantation (MACT) is routinely used in joints of the extremities, but not in the temporomandibular joint (TMJ).Study designWe report the first case series in 7 patients of a tissue engineering approach to regenerate severely degraded articulating surfaces in the TMJ by simultaneously completely resurfacing both the mandibular condyle and the articular eminence/glenoid fossa with a commercially available collagen sponge seeded with autologous cells stabilised within a fibrin matrix. To facilitate healing, we temporarily employed a silicone membrane to protect the engineered tissues. The indications for surgery were post-traumatic fibro-osseous ankylosis, ankylosing osteoarthritis or late stage osteoarthritis.ResultsSix of the patients were recalled for follow-up after 3 years 6 months to 12 years 1 month. The maximum incisal opening was 18.2mm ± 9.2mm (min 9, max 33mm) before and 31.2mm ± 13.6mm (min 12, max 47mm) at the latest follow-up. Histological specimens taken at 4 months showed beginning differentiation of fibrocytes into chondrocytes, whereas at 3 and 11 years, mature hyaline cartilage – not typical for the TMJ - was present.ConclusionWe conclude that the reconstruction of TMJ surfaces by matrix associated chondrocyte transplantation may become a routine method for cartilage regeneration in the temporomandibular joint in the future.



http://ift.tt/2IcGuvo

Gingival ulceration in a 63-year-old lung transplant recipient

Publication date: Available online 8 February 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Brain M. Will, Scott M. Peters, Sidney B. Eisig, John T. Grbic, Michael A. McKenzie, Angela J. Yoon, Elizabeth M. Philipone




http://ift.tt/2oYTn3w

Combined human papillomavirus typing and TP53 mutation analysis in distinguishing second primary tumors from lung metastases in patients with head and neck squamous cell carcinoma

Abstract

Background

In head and neck squamous cell carcinoma (HNSCC), the occurrence of concurrent lung malignancies poses a significant diagnostic challenge because metastatic HNSCC is difficult to discern from second primary lung squamous cell carcinoma (SCC). However, this differentiation is crucial because the recommended treatments for metastatic HNSCC and second primary lung SCC differ profoundly.

Methods

We analyzed the origin of lung tumors in 32 patients with HNSCC using human papillomavirus (HPV) typing and targeted next generation sequencing of all coding exons of tumor protein 53 (TP53).

Results

Lung tumors were clearly identified as HNSCC metastases or second primary tumors in 29 patients, thus revealing that 16 patients had received incorrect diagnoses based on clinical and morphological data alone.

Conclusion

The HPV typing and mutation analysis of all TP53 coding exons is a valuable diagnostic tool in patients with HNSCC and concurrent lung SCC, which can help to ensure that patients receive the most suitable treatment.

http://ift.tt/2IgyN7u

Patterns of recurrence in oral tongue cancer with perineural invasion

Abstract

Background

Although perineural invasion (PNI) is recognized as an adverse prognostic factor in oral tongue squamous cell carcinoma (SCC), the patterns of failure are poorly defined.

Methods

Patients with oral tongue SCC who received primary surgical treatment were identified. Specimens were reviewed by head and neck pathologists. Disease-specific survival (DSS) and locoregional recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), and distant recurrence-free survival (DRFS) were calculated. The PNI and PNI characteristics were analyzed as predictors of outcome. The utility of grading the extent of PNI was assessed by quantifying the number of PNI foci per slide reviewed, nerve caliber, and percent circumference involved.

Results

Patients with PNI had a decreased DSS; however, PNI was not predictive of LRFS or RRFS. Patients with PNI were more likely to develop a distant recurrence and 19.40 (confidence interval [CI] 6.70-56.14; P < .001) were more likely to develop a distant recurrence if PNI foci density was >1.

Conclusion

The presence of PNI in oral tongue SCC predicts worse DSS, with distant recurrence as the most common pattern of failure. High PNI foci density is associated with worse DRFS.

http://ift.tt/2DeQIro

Polyethylene glycol fusion associated with antioxidants: A new promise in the treatment of traumatic facial paralysis

Abstract

Background

Recent studies in invertebrates have taught us that early cell membrane regeneration is determinant for axonal recovery and survival after trauma. Many authors obtained extraordinary results in neural regeneration using polyethylene glycol fusion protocols, which also involved microsutures and antioxidants.

Methods

Sixty rats were evaluated with functional and histological protocol after facial nerve neurotmesis. Groups A and B had their stumps coapted with microsuture after 24 hours of neurotmesis and groups C and D after 72 hours. In addition to the microstructure, groups B and D used the polyethylene glycol-fusion protocol for the modulation of the Ca⁺².

Results

At the sixth week, the latency of group D and duration of group B was lower than groups A and C (P = .011). The axonal diameter of the groups that used polyethylene glycol-fusion was higher than those who did not use polyethylene glycol-fusion (P ≤ .001).

Conclusion

Although not providing a functional improvement, polyethylene glycol-fusion slowed down demyelination.

http://ift.tt/2If6AOt

Presence of lytic Epstein-Barr virus infection in nasopharyngeal carcinoma

Abstract

Background

Chromogenic Epstein-Barr virus-encoded RNA (EBER) in situ hybridization (EBER-ISH) is the gold standard to detect Epstein-Barr virus (EBV) but it is difficult to use in conjunction with immunohistochemistry (IHC). In this study, our purpose was to validate the sensitivity and specificity of RNAscope in detection of EBV infection in nasal epithelium and its stroma.

Methods

Fluorescence-based RNAscope EBER-ISH, BRLF1-ISH, and lineage marker-IHC were performed on archived formalin-fixed paraffin-embedded tissues from normal nasal cavity (n = 5), nasopharynx (n = 8), and nasopharyngeal carcinoma (NPC) specimens (n = 10).

Results

The EBERs were detected in 10 of 10 NPC samples but was absent in all normal tissues from the nasal cavity and nasopharynx. The EBERs were exclusively located in pan-cytokeratin (pan-CK)-positive tumor epithelial cells but not in CD45-positive leukocytes and vimentin-positive stromal fibroblasts. The level of EBER expression varied in tumor cells within patient and between patients as well. Additionally, 5 of 10 patients had positive BRLF-ISH.

Conclusion

We developed a simple and reproducible method to simultaneously detect mRNA and protein in formalin-fixed paraffin-embedded tissues of NPC. As a single staining, traditional EBER continues to be useful; however, for interpretation of the phenotype of EBV-infected cells, RNAscope is superior. Significantly, we showed that lytic EBV infection took place in NPC tumors.

http://ift.tt/2De4z1d

Second primary squamous cell carcinoma in patients with nasopharyngeal carcinoma after radiotherapy predictors and prognostic factors

Abstract

Background

We investigated risk and prognostic factors for second primary squamous cell carcinoma (SCC) in patients with nasopharyngeal carcinoma (NPC) after radiotherapy (RT).

Methods

A total of 49 021 patients with NPC were treated at Sun Yat-Sen Cancer Center between January 1970 and December 2009. The incidence and management of second primary SCCs were analyzed.

Results

A total of 142 patients (0.29%) developed second primary SCC, with 78.2% in the upper aerodigestive tract. Older age, smoking, and chemotherapy were associated with an increased rate of second primary SCC. The 3, 5, and 10-year overall survival (OS) rates for second primary SCC were 47.18%, 31.69%, and 11.97%, respectively. Advanced age, family history of cancer, and treatment modality were independent prognostic factors for survival.

Conclusion

Second primary tumors rarely develop in patients with NPC treated with RT, but when this occurs, second primary SCC comprises a majority of these. Intensity-modulated RT may shorten the latency to second primary SCC. Surgery as the first-line treatment may improve survival and prognosis.

http://ift.tt/2If6xlL

Treatment with anti-Sclerostin antibody to stimulate mandibular bone formation

Abstract

Background

Anti-Sclerostin antibody (Scl-Ab) is a promising new bone anabolic therapy. Although anti-Scl-Ab stimulates bone formation and repair in the appendicular and axial skeleton, its efficacy in the craniofacial skeleton is still poorly understood.

Methods

Using an established model of Down syndrome-dependent bone deficiency, 10 Ts65Dn mice and 10 wild-type mice were treated weekly via i.v. tail vein injection with vehicle or anti-Sclerostin for 3 weeks and euthanized 1 week after.

Results

Wild-type mice treated with the anti-Scl-Ab had increased mandibular bone, trabecular thickness, and alveolar height compared with controls. Anti-Scl-Ab increased Ts65Dn mandibular bone parameters such that they were statistically indistinguishable from those in vehicle-treated wild-type mandibles.

Conclusion

Treatment with anti-Scl-Ab significantly increased mandibular bone mass and alveolar height in wild type mice and normalized mandibular bone mass and alveolar height in Ts65Dn mice. The anti-Scl-Ab therapy represents a novel method for increasing mandibular bone formation.

http://ift.tt/2p216xS

Comparison of incidental versus palpable thyroid nodules presenting for fine-needle aspiration biopsy

Abstract

Background

Many attribute the rise in incidence of thyroid cancer to a deluge of radiologically identified incidental thyroid nodules. The clinical implications are unclear.

Methods

A review was performed of all patients who underwent fine-needle aspirations of thyroid nodules by our academic medical center's Endocrinology Division between 2006 and 2010. Medical records were reviewed to identify whether the thyroid nodule was discovered incidentally or by palpation.

Results

Of 1153 patients, 37.4% underwent a biopsy because of an incidental thyroid nodule. These patients were significantly more likely to be >45 years old, men, white race, and with a body mass index >30 kg/m². Of the 17.2% of incidentalomas that led to surgery, 8.5% were found to be thyroid cancer.

Conclusion

Thyroid nodules discovered incidentally are increasing the diagnosis of subclinical thyroid cancers. Not investigated previously, our study found that the mode of detection was not related to malignancy or surgery.

http://ift.tt/2If6uX7

Skeletal muscle cells actively shape (auto)immune responses

Publication date: Available online 9 March 2018
Source:Autoimmunity Reviews
Author(s): Ali Maisam Afzali, Thomas Müntefering, Heinz Wiendl, Sven G. Meuth, Tobias Ruck
Histopathological analyses of muscle specimens from myositis patients indicate that skeletal muscle cells play an active role in the interaction with immune cells. Research over the last few decades has shown that skeletal muscle cells exhibit immunobiological properties that perfectly define them as non-professional antigen presenting cells. They are able to present antigens via major histocompatibility complex molecules, exhibit costimulatory molecules and secrete soluble molecules that actively shape the immune response in an either pro- or anti-inflammatory manner. Skeletal muscle cells regulate both innate and adaptive immune responses and are essentially involved in the pathophysiological processes of idiopathic inflammatory myopathies. Understanding the role of skeletal muscle cells might help to identify new therapeutic targets for these devastating diseases. This review summarizes the immunobiological features of skeletal muscle cells, especially in the context of idiopathic inflammatory myopathies, and discusses shortcomings and limitations in skeletal muscle related research providing potential perspectives to overcome them in the future.



http://ift.tt/2IeZ8mH

Clinical and experimental evidence for targeting CD6 in immune-based disorders

Publication date: Available online 9 March 2018
Source:Autoimmunity Reviews
Author(s): Marta Consuegra-Fernández, Feng Lin, David A. Fox, Francisco Lozano
CD6 is a cell surface glycoprotein expressed by most T cells and a subset of B cells that has incompletely-defined roles in regulation of lymphocyte development, selection, activation and differentiation. The two main known mammalian CD6 ligands, CD166/ALCAM and the very recently reported CD318, are widely expressed by both immune cells and a wide range of other cell types, including various epithelial and mesenchymal cell types, as well as many neoplasms. Moreover, CD6 is also a receptor for several pathogen- and damage-associated molecular patterns. Further layers of complexity of CD6 function are implied by the existence of multiple CD6 isoforms generated by alternative splicing of CD6 transcripts and soluble forms of CD6 released by proteases from the lymphocyte surface. Multiple lines of evidence are now emerging to implicate CD6 and its ligands in the pathogenesis and potentially the treatment of human autoimmune diseases, such as multiple sclerosis and psoriasis. CD6 is an important multiple sclerosis risk gene, and mice genetically deficient in CD6 or CD318, or treated with antibodies or chimerical proteins that interfere with CD6-ligand interactions, are protected from experimental allergic encephalomyelitis, a mouse model of multiple sclerosis. CD6 deficient mice also show reduced TH17 differentiation and protection from disease in a moue model of psoriasis, providing a foundation for successful clinical trials of an anti-CD6 monoclonal antibody (Itolizumab) in psoriasis. Here we review current knowledge about CD6 and its ligands, and consider its potential value as a therapeutic target in a range of immune-mediated disorders.



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The role of capillaroscopy and thermography in the assessment and management of Raynaud's phenomenon

Publication date: Available online 9 March 2018
Source:Autoimmunity Reviews
Author(s): Ariane L. Herrick, Andrea Murray
Most patients with Raynaud's phenomenon (RP) have "benign" primary RP (PRP), but a minority have an underlying cause, for example a connective tissue disease such as systemic sclerosis (SSc). Secondary RP can be associated with structural as well as functional digital vascular changes and can be very severe, potentially progressing to digital ulceration or gangrene. The first step in management is to establish why the patient has RP. This short review discusses the role of nailfold capillaroscopy and thermography in the assessment of RP. Nailfold capillaroscopy examines microvascular structure, which is normal in PRP but abnormal in most patients with SSc: the inclusion of abnormal nailfold capillaries into the 2013 classification criteria for SSc behoves clinicians diagnosing connective tissue disease to be familiar with the technique. For those without access to the gold standard of high magnification videocapillaroscopy, a low magnification dermatoscope or USB microscope can be used. Thermography measures surface temperature and is therefore an indirect measure of blood blow, assessing digital vascular function (abnormal in both PRP and SSc). Until now, the use of thermography has been mainly confined to specialist centres and used mainly in research: this may change with development of mobile phone thermography.



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Optimizing conventional DMARD therapy for Sjögren's syndrome

Publication date: Available online 9 March 2018
Source:Autoimmunity Reviews
Author(s): E.H.M. van der Heijden, A.A. Kruize, T.R.D.J. Radstake, J.A.G. van Roon




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The value of Autoimmune Syndrome Induced by Adjuvant (ASIA) - Shedding light on orphan diseases in autoimmunity

Publication date: Available online 9 March 2018
Source:Autoimmunity Reviews
Author(s): Yahel Segal, Shani Dahan, Kassem Sharif, Nicola Luigi Bragazzi, Abdulla Watad, Howard Amital
Autoimmune Syndrome Induced by Adjuvant (ASIA) is a definition aimed to describe the common etiological process at the root of five clinical entities sharing similar symptomatology: macrophagic myofasciitis syndrome (MMF), Gulf War Syndrome (GWS), sick building syndrome (SBS), siliconosis, and post vaccination autoimmune phenomena. ASIA illustrates the role of environmental immune stimulating agents, or adjuvants, in the instigation of complex autoimmune reactions among individuals bearing a genetic preponderance for autoimmunity. The value of ASIA lies first in the acknowledgment it provides for patients suffering from these as yet ill-defined medical conditions. Equally important is the spotlight it sheds for further research of these poorly understood conditions sharing a common pathogenesis.In this article we elaborate on the significance of ASIA, review the current evidence in support of the syndrome, and address recent reservations raised regarding its validity.



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Contribution of sex steroids and prolactin to the modulation of T and B cells during autoimmunity

Publication date: Available online 9 March 2018
Source:Autoimmunity Reviews
Author(s): Gabriela Recalde, Tamara Moreno-Sosa, Florencia Yudica, Cristian A. Quintero, Belén Sanchez, Graciela A. Jahn, Alexis M. Kalergis, Juan Pablo Mackern-Oberti
In this review we discuss how sex steroids and prolactin affect regulation and responsiveness of B and T cells. Sex hormones exert profound effects on several physiological processes of non- reproductive tissues. In the immune system, several studies with experimental models for SLE have shown a noticeable pro-inflammatory role for ERα, contributing to disease development reflected in proteinuria and renal pathology. On the other hand, ERβ appears to have an anti- inflammatory and immunosuppressive effect. Estrogen/ERα signaling induced an increase of Th17 cells in lymph nodes as well as the expression of its correspondent chemokine receptor CCR6 during collagen induced arthritis acute phase. High levels of anti- DNA antibodies and increased mortality was observed when given high E and prolactin doses to NZB/NZW mice, as compared with mice receiving low E and prolactin doses, or high E and low prolactin doses. Intracellular progesterone receptors have been detected in TCD4⁺ cells but in contrast as observed with ERs, it suppresses T cell dependent responses. Progestagen administration on female NZB/NZW mice decreased anti DNA IgG, improved survival, decreased glomerulonephritis and proteinuria.



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A methodological review of induced animal models of autoimmune diseases

Publication date: Available online 8 March 2018
Source:Autoimmunity Reviews
Author(s): Xinhua Yu, Frank Petersen
Autoimmune disorders are characterized by a loss of immune tolerance and consequent autoimmunity-mediated disease manifestation. Experimental models are invaluable research tools helping us to understand disease pathogenesis and to search for novel therapeutics. Animal models of autoimmune diseases consist of two groups, spontaneous and induced models. In this review article, we focus on the induced models of autoimmune diseases. Due to the complex nature of autoimmune disorders, many strategies have been applied for the induction of corresponding experimental models in animals like monkeys, rabbits, rats, and mice. Methodologically, these strategies can be categorized into three categories, namely immunization with autoantigen, transfer of autoimmunity, and induction by environmental factors. In this review article, we aim to provide a comprehensive overview of the field of induced experimental autoimmune diseases. On the one hand, we describe and summarize the different strategies used for induction of experimental autoimmune disease. On the other hand, we discuss how to select a strategy for modeling human disease, including the choice of an appropriate species and method for such an approach.



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Letter to the editor: Autoimmune pathogenic mechanisms in amyotrophic lateral sclerosis

Publication date: Available online 8 March 2018
Source:Autoimmunity Reviews
Author(s): Antonio Greco, Massimo Ralli, Maurizio Inghilleri, Armando De Virgilio, Andrea Gallo, Marco de Vincentiis




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Solid phase assays versus automated indirect immunofluorescence for detection of antinuclear antibodies

Publication date: Available online 8 March 2018
Source:Autoimmunity Reviews
Author(s): Jolien Claessens, Thibaut Belmondo, Ellen De Langhe, Rene Westhovens, Koen Poesen, Sophie Hüe, Daniel Blockmans, Michael Mahler, Marvin J. Fritzler, Xavier Bossuyt
Solid phase assays (SPAs) and automated microscope systems are increasingly used to screen for antinuclear antibodies (ANAs). The goal of this study was to evaluate the performance of three automated ANA screening assays; NOVA Lite HEp-2 using NOVA View® (NV, Inova Diagnostics), an automated indirect immunofluorescence method, EliA™ CTD Screen (Fluorescence Enzyme Immunoassay, FEIA; Thermo Fisher) and QUANTA Flash® CTD Screen Plus (Chemiluminescence immunoassay, CIA; Inova Diagnostics).The assays were performed on 480 diagnostic samples from patients with an ANA-associated rheumatic disease (AARD; systemic lupus erythematosus, primary Sjögren's syndrome, systemic sclerosis, inflammatory myopathy, mixed connective tissue disease) and on 767 samples from diseased and healthy controls.Using cut-offs proposed by the manufacturers, the sensitivity was 95%, 80.5% and 86% for NV, FEIA and CIA, respectively. The corresponding specificity was 61% (NV), 97.5% (FEIA) and 88% (CIA). The sensitivity associated with a specificity of ~95% was 79%, 82% and 78% for NV, FEIA, and CIA, respectively. Receiver operating characteristics (ROC) curve analysis revealed no differences in area under the curve (AUC) between the 3 assays when all diseases were grouped. For Sjögren's syndrome, the AUC was higher for SPAs than for NV, whereas for systemic sclerosis, the AUC was higher for NV than for CIA. For all assays, the likelihood ratio for AARD increased with increasing antibody levels and for double positivity of NV with SPA.In conclusion, the performance of automated SPA and IIF was assay- and disease-dependent. Taking into account antibody levels and combining IIF with SPA adds value.



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Perspective: Scientific and ethical concerns pertaining to animal models of autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA)

Publication date: Available online 8 March 2018
Source:Autoimmunity Reviews
Author(s): Rohan Ameratunga, Daman Langguth, David Hawkes
The autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA) was first described in 2011. The aluminium containing adjuvants of vaccines were stated to be one of the main causes of the condition. Other disorders associated with ASIA include siliconosis, Gulf war syndrome, sick building syndrome and the macrophagic myositis syndrome. We have recently reviewed ASIA as defined by its authors. We have shown that the definition of ASIA is imprecise and includes all patients with an autoimmune disorder as well as potentially the entire population. Application of the Bradford Hill criteria for causality does not support ASIA as an outcome of exposure to aluminium containing adjuvants in vaccines. The advocates of ASIA highlight animal models as evidence for the existence of the disorder. However, as this review will demonstrate, animal models purporting to support the existence of ASIA have methodological, analytical and ethical flaws which, in our view refute the existence of the condition. Three publications by the advocates of ASIA were recently retracted from peer-reviewed journals. We call for a moratorium on animal experiments of ASIA until an independent inquiry has been conducted to determine the existence of a clinically relevant syndrome, identifiable as ASIA in humans.



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Cryoglobulins: An update on detection, mechanisms and clinical contribution

Publication date: Available online 8 March 2018
Source:Autoimmunity Reviews
Author(s): Marie-Nathalie Kolopp-Sarda, Pierre Miossec
Cryoglobulins are immunoglobulins precipitating in cold condition. They are classified in 3 types according to the Brouet classification and may lead to vasculitis of small and medium size vessels. Vasculitis is related to vessel obstruction by monoclonal cryoglobulin aggregates in type I cryoglobulins and immune complex deposition in type II and III mixed cryoglobulins. This phenomenon is favored by low temperature, especially in skin, joints, and peripheral nerves, or increased cryoglobulin concentration in kidneys. For their detection, collection and clotting at 37 °C are critical pre-analytical conditions. Cryoglobulin characterization and quantification are important to identify the underlying disease. Since detection and identification of cryoglobulins lack standardization, a protocol for such detection, characterization and quantification is proposed.



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Association between allelic variants of the human glucocorticoid receptor gene and autoimmune diseases: A systematic review and meta-analysis

Publication date: Available online 8 March 2018
Source:Autoimmunity Reviews
Author(s): Cristian Herrera, Miguel Marcos, Cristina Carbonell, José Antonio Mirón-Canelo, Gerard Espinosa, Ricard Cervera, Antonio-Javier Chamorro
IntroductionThe human glucocorticoid receptor gene (NR3C1) is considered to play a role in the differences and sensitivities of the glucocorticoid response in individuals with autoimmune diseases. The objective of this study was to examine by means of a systematic review previous findings regarding allelic variants of NR3C1 in relation to the risk of developing systemic autoimmune diseases.MethodsStudies that analysed the genotype distribution of NR3C1 allelic variants among patients with systemic autoimmune diseases were retrieved. A meta-analysis was conducted with a random effects model. Odds ratios (ORs) and their confidence intervals (CIs) were calculated. In addition, sub-analysis by ethnicity, sensitivity analysis and tests for heterogeneity of the results were performed.ResultsEleven studies met the inclusion criteria for meta-analysis. We found no evidence that the analysed NR3C1 polymorphisms, rs6198, rs56149945, and rs6189/rs6190, modulate the risk of developing a systemic autoimmune disease. Nonetheless, a protective role for the minor allele of rs41423247 was found among Caucasians (OR = 0.78; 95% CI: 0.65, 0.92; P = 0.004). A subgroup analysis according to underlying diseases revealed no significant association either for Behçet's disease or rheumatoid arthritis, while correlations between NR3C1 polymorphisms and disease activity or response to glucocorticoids could not be evaluated due to insufficient data.ConclusionsThere is no clear evidence that the analysed NR3C1 allelic variants confer a risk for developing systemic autoimmune diseases although the minor G allele of rs41423247 may be protective among Caucasians.



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Podoplanin expression as a predictive marker of dysplasia in oral leukoplakia

Publication date: Available online 9 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Davide Bartolomeo Gissi, Andrea Gabusi, Achille Tarsitano, Laura Luccarini, Luca Morandi, Lucio Montebugnoli
PurposeRecent studies have emphasized the role of podoplanin in oral lesions at risk of malignant transformation. We investigated a group of oral leukoplakias (OLs) to determine a possible relation between altered podoplanin expression and dysplasia, and to compare the results with those obtained by other, widely used biomarkers.Materials and MethodsThe population consisted of 40 consecutive patients with a clinical and histological diagnosis of OL. Thirty-two OLs did not show dysplasia, whereas eight lesions presented with dysplasia. Immunohistochemical expression of podoplanin, p53 and Ki67 was analyzed in all samples.ResultsAll three biomarkers were positive in seven of eight dysplastic OLs. Among the 32 OLs without dysplasia, Ki67 and p53 showed positive values in 21 and 10 samples respectively, whereas podoplanin was positive in only one case. Multiple logistic regression showed that podoplanin was the most powerful variable (Chi square 9.77; p<.01) statistically related to the presence of dysplasia. In addition, podoplanin showed a higher specificity value (96.87%) than Ki67 (34.37%) and p53 (68.75%).ConclusionPodoplanin seems to be a reliable means of discriminating lesions with epithelial dysplasia and could be introduced in routine practice as a marker to discriminate OLs at risk of developing cancer.



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Evaluating Hearing Loss in Patients Undergoing Second Line Anti Tubercular Treatment

Abstract

To estimate the prevalence of Sensorineural hearing loss and evaluate the severity of hearing impairment in patients undergoing second line injectable antitubercular treatment. To study the effects of duration of treatment, dose schedule and demographic factors which aggravates anti TB drug induced ototoxicity. Design–prospective and retrospective study Setting-ENT & TB clinic at our hospital and TB Hospital of Subject-18–50 year age , diagnosed MDR or XDR TB Method–baseline puretone audiometry was done of all patients. all patients divided in 3 group depending on aminoacid (amikacin , kanamycin, capreomycin). Follow up PTA was done at 3rd month, 6th month and 6 month after stopping treatment 35.48% of Group 1 (kanamycin) patients show High frequency hearing loss and 16% of patient have both high and low frequency hearing loss High frequency hearing loss 21% of Group 2 (amikacin) patients show High frequency hearing loss and 5% of patient have both high and low frequency hearing loss 20% of Group 3 (capreomycin) patients show High frequency hearing loss with no patient resulted low frequency loss Patients treated FOR MDR-TB develop significant adverse effects. Clinicians must consider risk benefit analysis during treatment as ototoxicity of injectable aminoglycoside ATT is permanent. Early detection of hearing loss through pure tone audiometry helps preventing and progression of hearing loss without compromising the treatment.

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New-onset atrial fibrillation: an update

Abstract

New-onset atrial fibrillation (NOAF) is the most common perioperative complication of heart surgery, typically occurring in the perioperative period. NOAF commonly occurs in patients who are elderly, or have left atrial enlargement, or left ventricular hypertrophy. Various factors have been identified as being involved in the development of NOAF, and numerous approaches have been proposed for its prevention and treatment. Risk factors include diabetes, obesity, and metabolic syndrome. For prevention of NOAF, β-blockers and amiodarone are particularly effective and are recommended by guidelines. NOAF can be treated by rhythm/rate control, and antithrombotic therapy. Treatment is required in patients with decreased cardiac function, a heart rate exceeding 130 beats/min, or persistent NOAF lasting for ≥ 48 h. It is anticipated that anticoagulant therapies, as well as hemodynamic management, will also play a major role in the management of NOAF. When using warfarin as an anticoagulant, its dose should be adjusted based on PT-INR. PT-INR should be controlled between 2.0 and 3.0 in patients aged < 70 years and between 1.6 and 2.6 in those aged ≥ 70 years. Rate control combined with antithrombotic therapies for NOAF is expected to contribute to further advances in treatment and improvement of survival.

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Occurrence of deoxynivalenol and zearalenone in brewing barley grains from Brazil

Abstract

Barley (Hordeum vulgare L.) is an important cereal crop for food and represents one of the main ingredients in beer production. Considering the importance of barley and its derived products, the knowledge about the mycotoxin contamination in the barley production is essential in order to assess its safety. In this study, the levels of deoxynivalenol (DON) and zearalenone (ZEN) in brewing barley were determined using a LC-MS/MS method. A survey was conducted in 2015 to estimate the mycotoxin levels in these products (n = 76) from four crop regions in Brazil. The results showed high levels of DON and ZEN in the analyzed samples, with contamination levels of 94 and 73.6%, respectively. The mean levels of DON and ZEN ranged from 1700 to 7500 μg/kg and from 300 to 630 μg/kg, respectively. Barley samples from regions 1 and 2 presented higher levels of ZEN and DON, respectively, and those from region 4 presented lower levels of both. Co-occurrence of DON and ZEN was seen in the majority of the barley grain samples, and the mycotoxin content was above the maximum levels established by the Brazilian and European regulations.

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Randomised feasibility study to compare the use of Therabite® with wooden spatulas to relieve and prevent trismus in patients with cancer of the head and neck

Publication date: Available online 9 March 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): R. Lee, S.T. Yeo, S.N. Rogers, A.L. Caress, A. Molassiotis, D. Ryder, P. Sanghera, C. Lunt, B. Scott, P. Keeley, R.T. Edwards, N. Slevin
Our aim was to compare the efficacy of the Therabite^® jaw motion rehabilitation system (Atos Medical) with that of wooden spatulas to relieve and prevent trismus in patients who have had radiotherapy for stage three and four oral and oropharyngeal cancer. Secondary aims were to assess the feasibility and the impact of exercise on health-related quality of life (QoL), and the use of health services after treatment. We designed a randomised, open-label, controlled, three-centre feasibility study to compare the effectiveness and cost of the Therabite^® and wooden spatulas. We studied compliance with exercises and health-related QoL, assessed cost using three health economics measures, and conducted semistructured interviews with patients. Patients were randomised into two groups: the Therabite^® group (n=37) and the wooden spatula group (n=34). All patients had some sense of jaw tightening before the study started. Mean mouth opening after six months increased in both groups, but the difference between the groups was not significant (p=0.39). Completion rates for the three economic measures were good. There was no significant difference between the two groups in frequency of contact with care services or in QoL. Exercises during and after radiotherapy can ameliorate trismus in patients with stage three and four oral and oropharygeal cancers, but differences between groups in efficacy, compliance, QoL, or use of hospital or community health services, were not significant.



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Hodgkins Lymphoma presenting as an obstructing endobronchial mass--A rare presentation

We report a case of Hodgkin's lymphoma presenting as an endobronchial mass in a 40-year-old man with history of 8 months of non-specific symptoms like cough, fatigue and weight loss. Initially he was treated with broad-spectrum antibiotics for suspicion of pneumonia without recovery. Radiographic work-up showed cavitary consolidation of the upper lobe of the left lung, followed by bronchoscopy which showed obstructing mass of the upper lobe of the left lung mimicking primary lung carcinoma. Immunohistochemical staining of the specimen was suggestive of Hodgkin's lymphoma. The patient responded well to the chemotherapy regimen.

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Acute glomerulonephritis secondary to Streptococcus anginosus

Streptococcus anginosus is a clinically important pathogen that is emerging globally but remains poorly investigated. Here, we report the first case of acute glomerulonephritis resulting from infection with S. anginosus. Glomerulonephritis is typically caused by S. pyogenes and reports secondary to other strains including S. zooepidemicus and S. constellatus exist. Infection with S. anginosus in this patient was associated with acute nephritis (haematuria, oedema and hypertension), nephrotic syndrome and progressive azotemia. There was activation of the complement system. The presence of low C1q and elevated anti-C1q binding complexes points to a potential pathogenic role. Testing for streptococcal antigens was strongly positive. Emerging nephritogenic strains of S. anginosus present a significant health concern for both developed and developing countries.

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Use of Irradiated Homologous Costal Cartilage in Rhinoplasty: Complications in Relation to Graft Location

Background: Nasal septal cartilage and conchal cartilages are preferred sources of grafts in augmentation rhinoplasty. Rib cartilage can also be used, but it may evoke a patient's concerns about a scar and an extensive surgery. In such cases, irradiated homologous costal cartilage (IHCC) can be a useful alternative. However, controversy still exists in many literatures regarding complications with use of IHCC. Therefore, the authors reviewed our experiences with IHCC in rhinoplasty and analyzed the complications in relation to graft location. Methods: A retrospective chart review was made of all patients who underwent rhinoplasty with IHCC between 2007 and 2015. A total of 323 patients were included. The authors considered the cases that required revision surgery for external aesthetic changes as complications. The authors defined major complications, including resorption, infection, fracture, or warping. Results: The total complication rate was 8%. Two fractures (0.6%), 4 fragmentation (1.2%), 4 resorptions (1.2%), 4 infections (1.2%), and 2 warpings (0.6%) were noted. Most of these complications occurred for the septal extension graft. Other complications, including 1 nasal obstruction, 2 visible contours, 3 caudal septal deviations, and 4 cases of unfavorable results (patient unsatisfactions), were noted. Conclusions: Based on the outcomes of this study, the authors concluded that IHCC is a useful and reliable source of cartilage graft and can serve as an alternative graft material for rhinoplasty. However, care must be taken in use of IHCC graft in areas under tension such as septal extension graft, though its complication rate is low. Address correspondence and reprint requests to Yeon-Jun Kim, MD, JW Plastic Surgery Center, Samsin Building, 836 Nonhyeon-ro, Gangnam-gu, Seoul 135-893, Korea; E-mail: kimyj.md@gmail.com Received 18 April, 2017 Accepted 10 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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