Head and Neck Medicine by Alexandros G.Sfakianakis: 03/15/18

Πέμπτη 15 Μαρτίου 2018

Doble conducto auditivo interno

Publication date: Available online 15 March 2018
Source:Acta Otorrinolaringológica Española
Author(s): María Fernanda Vargas Gamarra, Carlos de Paula Vernetta, Miguel Mazón Momparler

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Predictors of locoregional recurrence in early stage buccal cancer with pathologically clear surgical margins and negative neck

Publication date: Available online 16 March 2018
Source:Acta Otorrinolaringológica Española
Author(s): Shakeel Uz Zaman, Shakil Aqil, Mohammad Ahsan Sulaiman
ObjectiveTo identify the significant predictors of locoregional recurrence in early stage squamous cell carcinoma (SCC) of buccal mucosa with pathologically clear surgical margins and negative neck.MethodSeventy-three patients who underwent per oral wide excision and supraomohyoid neck dissection for early stage buccal SCC with clear surgical margins (>5mm margins each) and negative neck (N0) were included. None of the patients received postoperative radiotherapy or chemotherapy. Univariate and multivariate analyses were used to identify independent predictors of locoregional recurrence.ResultsRecurrence was observed in 22 of 73 (30%) cases. Twelve had local, seven had regional and three developed locoregional recurrences. Both univariate and multivariate analyses demonstrated that lymphovascular invasion (LVI) and non-T4 muscular invasion (non-T4MI) were independent predictors affecting locoregional control.ConclusionLymphovascular invasion (LVI) and non-T4 muscular invasion (non-T4MI) significantly increased the locoregional recurrence rate in early stage buccal SCC with clear surgical margins and negative nodal status. Adjuvant treatment with either radiation or chemoradiation should be considered when one or both of these factors present.

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Incidental Histopathologic Finding of Sinonasal Inverted Papilloma Among Surgically Excised Polyps Increases the Risk of Tumor Recurrence

Abstract

Inverted papilloma (IP) is a benign tumor remarkable for its tendency toward recurrence. Local relapse implicates incomplete resection concerning the bone adjacent to tumor base. The high false negative rates on biopsies, mainly when nasal polyps coexist, may affect the surgical management and outcomes. Our objective was to study the impact of preoperative histologic diagnosis in IP recurrence, particularly in patients with pre-surgical diagnosis of inflammatory polyps. A retrospective analysis of 62 patients treated for IP was conducted. Demographic data and information about smoking status, alcohol intake, tumor location, histology, presence of nasal polyps, staging, malignancy, previous biopsies and surgical approach were evaluated to identify factors associated with recurrence. Prevalence of nasal polyps was higher in patients with recurrence. Smoking history, alcohol abuse, staging, histologic type, malignancy and surgical approach were not associated with recurrence. The presence of nasal polyps at endoscopy was inversely associated with the diagnosis of IP at incisional biopsy. Incidental histologic diagnosis of IP after surgery increased the risk of recurrence more than tenfold. Biopsy reporting the diagnosis of IP previous to surgery was inversely associated to recurrence. In patients with IP, coexistence of nasal polyps at initial endoscopy and lack of pathological IP diagnosis prior to surgery are strongly associated with a higher risk of recurrence. When excisional biopsy reports IP incidentally, an early revision surgery should be considered in order to avoid future aggressive surgeries because of tumor recurrence.

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Incidental Histopathologic Finding of Sinonasal Inverted Papilloma Among Surgically Excised Polyps Increases the Risk of Tumor Recurrence

Abstract

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Plasticity of myeloid-derived suppressor cells in cancer

Evgenii Tcyganov | Jerome Mastio | Eric Chen | Dmitry I Gabrilovich

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Systematic review of professional liability when prescribing beta-lactams for patients with a known penicillin allergy

To describe medical negligence and malpractice cases in which a patient with a known penicillin allergy received a beta-lactam and experienced an adverse reaction related to the beta-lactam.

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Paediatric asthma treatment: what to do when international guidelines' recommendations don't agree?

Authors' contributions

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Sound energy absorbance characteristics of cartilage grafts used in type 1 tympanoplasty

The purpose of this prospective case-control study is to evaluate the sound energy absorbance characteristics of cartilage grafts in patients, who have undergone type 1 cartilage tympanoplasty.

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Treating isotretinoin-associated cheilitis with hydrocortisone-containing lip balm

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A novel technique using Lidocaine 2% topical gel for peristomal dermatitis

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Are surgeons overdosing patients with lidocaine?

Publication date: Available online 14 March 2018
Source:American Journal of Otolaryngology
Author(s): Laura Garcia-Rodriguez, Jeffrey Spiegel

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Intravenous injection of artificial red cells and subsequent dye laser irradiation causes deep vessel impairment in an animal model of port-wine stain

Abstract

Our previous study proposed using artificial blood cells (hemoglobin vesicles, Hb-Vs) as photosensitizers in dye laser treatment for port-wine stains (PWSs). Dye laser photons are absorbed by red blood cells (RBCs) and hemoglobin (Hb) mixture, which potentially produce more heat and photocoagulation and effectively destroy endothelial cells. Hb-Vs combination therapy will improve clinical outcomes of dye laser treatment for PWSs because very small vessels do not contain sufficient RBCs and they are poor absorbers/heaters of lasers. In the present study, we analyzed the relationship between vessel depth from the skin surface and vessel distraction through dye laser irradiation following intravenous Hb-Vs injection using a chicken wattle model. Hb-Vs were administered and chicken wattles underwent high-energy irradiation at energy higher than in the previous experiments. Hb-Vs location in the vessel lumen was identified to explain its photosensitizer effect using human Hb immunostaining of the irradiated wattles. Laser irradiation with Hb-Vs can effectively destroy deep vessels in animal models. Hb-Vs tend to flow in the marginal zone of both small and large vessels. Increasing laser power combined with Hb-Vs injection contributed for deep vessel impairment because of the synergetic effect of both methods. Newly added Hb tended to flow near the target endothelial cells of the laser treatment. In Hb-Vs and RBC mixture, heat transfer to endothelial cells from absorbers/heater may increase. Hb-Vs function as photosensitizers to destroy deep vessels within a restricted distance that the photon can reach.

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LED session prior incremental step test enhance VO 2max in running

Abstract

This study aimed to investigate the effect of prior LED sessions on the responses of cardiorespiratory parameters during the running incremental step test. Twenty-six healthy, physically active, young men, aged between 20 and 30 years, took part in this study. Participants performed two incremental load tests after placebo (PLA) and light-emitting diode application (LED), and had their gas exchange, heart rate (HR), blood lactate, and rating of perceived exertion (RPE) monitored during all tests. The PLA and LED conditions were compared using the dependent Student t test with significance set at 5%. The T test showed higher maximum oxygen uptake (VO_2max) (PLA = 47.2 ± 5.7; LED = 48.0 ± 5.4 ml kg⁻¹ min⁻¹, trivial effect size), peak velocity (V_peak) (PLA = 13.4 ± 1.2; LED = 13.6 ± 1.2 km h⁻¹, trivial effect size), and lower maximum HR (PLA = 195.3 ± 3.4; LED = 193.3 ± 3.9 b min⁻¹, moderate effect size) for LED compared to PLA conditions. Furthermore, submaximal values of HR and RPE were lower, and submaximal VO₂ values were higher when LED sessions prior to the incremental step test were applied. A positive response of the previous LED application in the blood lactate disappearance was also demonstrated, especially 13 and 15 min after the test. It is concluded that LED sessions prior to exercise modify cardiorespiratory response by affecting running tolerance during the incremental step test, metabolite clearance, and RPE. Therefore, LED could be used as a prior exercise strategy to modulate oxidative response acutely in targeted muscle and enhance exercise tolerance.

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Has the time come to include low-level laser photobiomodulation as an adjuvant therapy in the treatment of impaired endometrial receptivity?

Abstract

Low-level laser therapy (LLLT) has been used in photobiomodulation to promote healing, regenerate, and restore tissue function. Women with persistent thin endometrium were assumed to encounter diminished activity in the regenerative and functional capacity of their endometrium. The aim of this study was to examine the ability of LLLT in 635 nm wavelength to enhance the proliferation and gene expression of in vitro cultured endometrial cells. Single (SE) versus multiple exposures (ME) to LLLT were examined in the study groups and compared to controls. A fluence dose of 4.27 J/cm² for 16 min was given once in the SE or divided in three equal sessions in days 2, 4, and 6 of the culture in ME. Cellular response was evaluated by measuring viable cell numbers and surface area. Pattern of MUC1, ITGA5, ITGB3, LIF, and PTEN gene expression was assessed using the qRT-PCR. Greater numbers of cells were found in both study groups (P < 0.001) as compared to controls. The surface area of cells at the end of culture phase was highly significant (P < 0.001) in ME when compared to SE and controls. A statistically significant difference was found in terms of gene expression in both irradiated groups (P < 0.001) as compared to controls, although greater difference in PTEN tumour suppressor gene (Phosphatase and tensin homolog) expression was toward ME. The introduction of LLLT to the armamentarium of infertility will serve as a new adjuvant therapy in this field. The current study proofed that LLLT was able to increase the proliferative and functional capacity of cultured endometrial cells.

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A novel universal device“LINGUAL RING Ri.P.A.Ra” for TMDs and cranio-cervico-mandibular pains: preliminary results of a randomized control clinical trial

OBJECTIVE: The aim of this study was to evaluate functionality and clinical application of a novel immediate device in the treatment of temporomandibular disorders (TMDs). To address the research purpose, authors developed and implemented a randomized control clinical trial.

PATIENTS AND METHODS: Eighty patients were enrolled in this study and were randomly divided into two subgroups based on the treatment applied: patient group (PG) and control group (CG). The CG was not subjected to any kind of treatment, even placebo, in order to be able to assess the spontaneous development of the pathology over time. The PG was treated applying the novel device for a maximum of three months. The following parameters were evaluated at baseline (T0) and at the end of therapy (T1): presence/absence of articular noises, painful symptomatology (articular pains, muscle pains, headache, cervicalgia), parafunctional habits and duration of symptoms. The x2-index of association was performed, with a p-value < 0.05 considered as statistically significant.

RESULTS: No patient in the PG worsened its symptomatology. Thirteen patients (33%) declared themselves cured from their symptoms and were included in a monitoring protocol. Twenty-seven patients (67%) improved their symptoms and were treated with other conservative conventional methods to complete the therapeutic cycle. Therefore, 100% of PG obtained benefits from the application of the new therapeutic approach. In contrast, among patients of CG, eighteen subjects (45%) worsened their symptoms, while eighteen (45%) were defined as stationaries compared to T0 and only four (10%) were defined as improved.

CONCLUSIONS: The device presented the following advantages: immediacy of use, reduction of waiting times for its application, good tolerability and comfort and specificity in the execution of tongue rehabilitation exercises.

L'articolo A novel universal device"LINGUAL RING Ri.P.A.Ra" for TMDs and cranio-cervico-mandibular pains: preliminary results of a randomized control clinical trial sembra essere il primo su European Review.

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Management of duct obstruction in transplanted submandibular glands

Publication date: Available online 14 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Jia-Zeng Su, Zhi-Gang Cai, Xiao-Jing Liu, Lan Lv, Guang-Yan Yu
BackgroundSubmandibular gland (SMG) transplantation is a successful treatment approach for patients with severe dry eye. However, duct obstruction can occur post-transplant.MethodsWe studied nineteen patients with duct obstruction of transplanted SMGs, including five interventional modalities: stone removal; secretory stimulation (to mimic "internal irrigation" with substantial secretory flow); irrigation; surgical opening of stenosis and orifice reconstruction; cephalic vein bypass and Wharton's duct reconstruction.ResultsA solitary stone was found and removed in one patient. Duct blockages like mucus plug were cleared by secretory stimulation in three patients, and by normal saline irrigation in two grafts. In the remaining 13 patients, irrigation failed and surgical opening was performed. Orifice reconstruction succeeded in six of the eight patients, whose stenosis was near the orifice. Wharton's duct reconstruction was successful in two of the five cases where stenosis was located in the middle segment of the duct.ConclusionTransplanted SMGs obstruct for various reasons. Stone, which is easy to diagnose and treat, should be excluded first. Non-organic blockage and stenosis were semblable in clinic. Therefore, subsequent steps should be a diagnostic/therapeutic trial of secretory stimulation, followed by irrigation; failure of these interventions suggests the diagnosis of duct stenosis, necessitating surgical recanalization.

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Development of a patient-specific temporomandibular joint prosthesis according to the Groningen principle through a cadaver test series

Publication date: Available online 14 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): J. Kraeima, B.J. Merema, M.J.H. Witjes, F.K.L. Spijkervet
ObjectivesPatients suffering from osteoarthritis, ankylosis (e.g. post-trauma or tumour) in the temporomandibular joint (TMJ) can present with symptoms such as severely restricted mouth opening, pain or other dynamic restrictions of the mandible. To alleviate the symptoms, a total joint prosthesis can be indicated, such as the Groningen TMJ prosthesis. This was developed as a stock device with a lowered centre of rotation for improved translational and opening capacity. This study aimed to improve the design of the prosthesis, and produce a workflow for a customized Groningen TMJ prosthesis, in order to make it more accurate and predictable.MethodsThe fossa and mandibular components of the Groningen TMJ prosthesis were customized. A series of five human cadavers was operated and bilateral TMJ prostheses were placed using custom cutting and drilling guides. Placement accuracy was evaluated based on post-operative CT data.ResultsA total of N=10 prostheses were placed and analysed. The average Euclidean distance deviation from planned to actual position was 0.81mm (SD 0.21). All prostheses were placed according to the routine surgical approaches and had an excellent alignment with the bony structures.ConclusionThe newly developed custom Groningen TMJ prosthesis can be placed with great accuracy and is the first step for improving TMJ total joint replacement surgery.

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Mixed facial reanimation technique to treat paralysis in medium-term cases

Publication date: Available online 14 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Federico Biglioli, Federico Bolognesi, Fabiana Allevi, Dimitri Rabbiosi, Silvia Cupello, Antonino Privitera, Alessandro Lozza, Valeria M.A. Battista, Claudio Marchetti
Recent facial paralyses, in which fibrillations of the mimetic muscles are still detectable by electromyography (EMG), allow facial reanimation based on giving new neural stimuli to musculature. However, if more time has elapsed, mimetic muscles can undergo irreversible atrophy, and providing a new neural stimulus is simply not effective. In these cases function is provided by transferring free flaps into the face or transposing masticatory muscles to reinstitute major movements, such as eyelid closure and smiling.In a small number of cases, patients affected by paralysis are referred late — more than 18 months after onset. In these cases, reinnervating the musculature carries a high risk of failure because some or all of the mimetic muscles may atrophy irreversibly while axonal ingrowth is taking place place. A mixed reanimation technique to address this involves a neurorrhaphy between the masseteric nerve and a facial nerve branch for the orbicularis oculi, to ensure a stronger innervation to that muscle, associated with the transposition of the temporalis muscle to the nasiolabial sulcus. This gives good symmetry in the rest of the midface, while smiling movement is achievable, but not guaranteed. This one-time facial reanimation is particularly indicated for those who refuse major free-flap surgery or when that may be risky, as in previously operated and irradiated fields. More extensive procedures based on utilizing a free flap to recover smiling, while adding a cross-face nerve graft to restore blinking, may be proposed for motivated patients.Between 2010 and 2015, five patients affected by complete unilateral facial palsy underwent this technique in the Maxillofacial Surgery Department, San Paolo Hospital (Milan, Italy).Symmetry of the middle-third of the face at rest and recovery of smiling was quite good. Complete voluntary eyelid closure was obtained in all cases.Combining temporalis flap rotation and a masseteric-to-orbicularis-oculi-facial-nerve branch neurorrhaphy seems to be a valid solution for those medium-term referred patients.

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Molecular alterations of newly formed mandibular bone caused by zoledronate

Publication date: Available online 15 March 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): Y. Yoshioka, E. Yamachika, M. Nakanishi, T. Ninomiya, K. Nakatsuji, M. Matsubara, N. Moritani, Y. Kobayashi, T. Fujii, S. Iida
Bone quality is defined by structural and material characteristics. Most studies on the mandible have focused on the analysis of structural characteristics, with insufficient investigation of material characteristics. This study tested whether zoledronate affects the material characteristics of newly formed mandibular bone. Thirty-six female Wistar rats were assigned to three groups: sham-ovariectomized rats (SHAM, n=12), ovariectomized rats (OVX, n=12), and ovariectomized rats treated with zoledronate (ZOL, n=12). The left side of the mandibular ramus of all rats was drilled bicortically. Twenty-eight days after surgery, all surviving rats were euthanized and all mandibles were removed. Raman microspectroscopy was performed, and five spectra per specimen of newly formed mandibular bone were analysed. Compared with OVX rats, the mineral/matrix ratio in ZOL rats was significantly increased (5.43±1.88 vs. 7.86±2.05), while crystallinity (0.055±0.002 vs. 0.050±0.002), relative proteoglycan content (0.43±0.10 vs. 0.31±0.05), and collagen structural integrity (1.16±0.21 vs. 0.72±0.06) were significantly decreased. These changes in material characteristics may explain why rats that received zoledronate exhibited peculiar biological phenomena such as bisphosphonate-related osteonecrosis of the jaw.

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JAMA Otolaryngology–Head & Neck Surgery Peer Reviewers in 2017

We sincerely thank the 645 peer reviewers who completed manuscript reviews for JAMA Otolaryngology–Head Neck Surgery in 2017.

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JAMA Otolaryngology–Head & Neck Surgery Year in Review

As I complete my second year as Editor of JAMA Otolaryngology–Head & Neck Surgery, I would like to take this opportunity to thank our authors, reviewers, members of the editorial board, and staff for the many contributions to the journal and to share our accomplishments. This past year, we received 822 submissions and published 94 Original Investigations, 35 Reviews, 34 opinion articles, and 11 Research Letters. In 2017, the acceptance rate for major submissions was 19%. The publication of opinion articles provides context to the original investigations and a forum for active dialogue in our specialty.

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Risk Factors for Complication After Pediatric Tonsillectomy

This cohort study examines the association between posttonsillectomy complication rate and the age and weight of the child at the time of surgery.

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Soft-Tissue Augmentation for Tracheoesophageal Puncture Enlargement

This study reports on the use of injectable soft-tissue fillers for the treatment of tracheoesophageal prosthesis enlargement and periprosthetic leakage.

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Multidisciplinary Clinical Treatment of Head and Neck Cancer—Reply

In Reply to the letter from Mark et al, we wish to thank the writers for recognizing our publication as well as for their shared dedication to improving cancer care. We find their results in the field of prostate cancer to be quite interesting, particularly their findings regarding a survival benefit in patients with access to a multidisciplinary clinic (MDC) treatment model. Likewise, we plan to investigate potential survival benefits in our own head and neck cancer MDC treatment model once we have accrued sufficient patient volumes and follow-up time. Recent retrospective studies in head and neck cancer have identified survival benefits in patients with access to multidisciplinary evaluations in particular subsites. It will be valuable to see if we also find this site-specific advantage in our own MDC population. Again, we thank the writers for their supportive response and for their efforts to optimize complex cancer care.

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Multidisciplinary Clinical Treatment of Head and Neck Cancer

To the Editor We commend the authors on their adoption of a multidisciplinary clinic (MDC) for the treatment of head and neck cancers and we agree with their conclusion that the cooperative treatment of cancer patients by relevant specialties is superior to a multiappointment approach. In their study, Townsend et al were able to show a significant decrease in treatment delays for patients from both the time of referral and following their first appointment with the team. We have had the same experience in our own MDC.

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Analysis of Vocal Fold Motion Impairment in Neonates Undergoing Congenital Heart Surgery

This cross-sectional analysis evaluates the cost, postprocedure length of stay, and outcomes for neonates with vocal fold motion impairment after congenital heart surgery.

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Single-Stage Mastoid Obliteration in Cholesteatoma Surgery

This systematic study analyzes the literature on recurrent and residual cholesteatoma rates after single-stage canal wall up and canal wall down tympanoplasty with mastoid obliteration.

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An Aggressive Sinonasal Mass With Parameningeal Extension

A woman in her 60s presented with sinus pressure progressing to dental pain; imaging revealed a mass arising from the skull base and nasopharynx and involvement of the right posterior orbit. What is your diagnosis?

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Generalized Radiopacities of the Craniofacial Skeleton

An adolescent girl presented with multiple, slowly growing masses of the face and head, significant bilateral exophthalmos, visual changes, and dental malocclusion, but no clinical signs of endocrinopathy. What is your diagnosis?

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Proposal for New Diagnosis for Cochlear Migraine

This Viewpoint examines the existence and features of cochlear migraine.

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Trustworthy Otolaryngology Clinical Practice Guidelines

Clinical practice guidelines (CPGs) are the cornerstone of the evidence-based practice of otolaryngology–head and neck surgery. The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) CPGs are widely distributed, as judged by frequency of downloads, webpage views, and CPG-related sessions at national meetings. Clinical practice guidelines are developed to reduce variation in care and to improve quality. They create debate and even controversy, with concerns expressed about restraints on clinician decision making as well as the medicolegal implications of recommendations. Clinical practice guidelines must be trustworthy, and the Institute of Medicine (IOM) and the Guideline International Network have provided standards for CPGs. A major threat to the creation of trustworthy guidelines is conflict of interest (COI) among the organizations and the committee members who create CPGs.

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Immediate Effects of External Vibration Therapy vs Placebo in Singers

This randomized clinical trial evaluates the immediate effects of external vibration therapy vs placebo on vocal function in trained singers using acoustic and self-assessment parameters.

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Diagnostic Accuracy of Parallel vs Perpendicular Orientation of the Tuning Fork in the Identification of Conductive Hearing Loss

This study compares patients' responses to the Rinne test when performed with the tuning fork positioned parallel vs perpendicular to the external auditory meatus.

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Industry Relationships Among Authors of Otolaryngology Clinical Practice Guidelines

This cross-sectional analysis examines the nature of industry payments to physicians who author otolaryngology clinical practice guidelines.

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Otorhinolaryngological Fitness for Compressed Gas Scuba Diving—Part 2

This review aims to provide a comprehensive overview of existing otorhinolaryngological fitness guidelines for diving recreationally.

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Serial In-Office Intralesional Steroid Injections in Airway Stenosis

This case-series study examines the association of serial in-office intralesional steroid injection after endoscopic dilation with surgery-free interval in adults with subglottic and proximal tracheal stenosis.

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Facial Pain and Diplopia in a Young Boy

A young boy presented with left facial and eye pain with intermittent diplopia on upward and lateral gaze; imaging showed a well-circumscribed posterior-medial extraconal mass extending into the orbital apex with dorsal extension into the left cavernous sinus. What is your diagnosis?

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Histopathological and Inflammatory Features of Open Mastoid Cavities

This study of tissue samples from a cohort of patients with chronically discharging open radical mastoid cavities investigates the histopathological and inflammatory features of these cavities and association of different types with treatment outcome.

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March 2018 Issue Highlights

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Status of Radiology Training in Otolaryngology Residency Programs

This survey study of program directors assesses the current state of radiology training in US otolaryngology residency programs.

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Otorhinolaryngological Hazards Related to Diving—Part 1: Compressed Gas Scuba Diving

This review provides an overview of otorhinolaryngological complications during scuba diving.

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Angiolytic Laser With or Without Polypectomy for Vocal Fold Polyps

This cohort study examines the outcomes and incidence rates of adverse events associated with in-office angiolytic laser procedures with or without concurrent polypectomy as an alternative treatment for vocal fold polyps.

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Adult-Onset Giant Cervical Mass

A man in his 40s presented with a giant, left-sided neck mass; magnetic resonance imaging revealed a homogenous ovoid bilobulated cystic mass in the left lateral region of the neck with displacement of the surrounding musculature and vascular structures but no sign of invasion. What is your diagnosis?

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Prevalence of High-Risk Human Papillomavirus in Tonsil Tissue in Healthy Adults

This retrospective, cross-sectional study examines the prevalence of oropharyngeal human papillomavirus and the spatial relationship between the virus and crypt biofilm in tonsil tissue of otherwise healthy adults.

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Nasopharyngeal Swelling After Sinus Surgery for Cystic Fibrosis

A woman in her 20s with cystic fibrosis underwent bilateral endoscopic sinus surgery and medial maxillectomy 4 months after bilateral lung transplantation; at 6-week follow-up, she presented with throat pain, and 2 weeks later, with nasal obstruction. What is your diagnosis?

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Otolaryngologic Manifestations of Klippel-Feil Syndrome in Children

This review examines a series of children with Klippel-Feil syndrome to define the otolaryngologic diagnoses made and procedures performed in this challenging patient population.

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Heart Failure and Hearing Loss Among Older Adults in the United States

This secondary analysis of the National Health and Nutrition Examination Survey examines the prevalence and correlates of hearing loss among older adults with and without heart failure in the United States.

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Primary Palate Trauma in Patients Presenting to US Emergency Departments

This database analysis uses the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample to measure the incidence of primary palate trauma visits to US emergency departments and to determine frequency and factors associated with head and neck imaging.

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Hereditary angioedema education in otolaryngology residencies: survey of program directors

Background

The objective of this work was to assess resident education regarding contemporary management of hereditary angioedema using a web-based survey.

Methods

An 11-item, multiple-choice, electronic questionnaire was sent to all 106 accredited otolaryngology training programs in November 2016. Questions focused on resident education, management principles, and formalized assessment.

Results

A total of 34 program directors responded, representing 32% of otolaryngology residences. Ninety-seven percent believed otolaryngology residents should be knowledgeable in the management of hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE). Specifically, 38% and 26% of program directors felt their residents were comfortable and very comfortable in C1-INH-HAE management, respectively. Of those surveyed, 18% have educational simulation activities and a protocol in place for C1-INH-HAE management. Forty-seven percent of respondents felt their training program provided adequate education and exposure to C1-INH-HAE. Over the last 5 years, 45% felt residents were exposed to 1 to 5 cases of C1-INH-HAE. Sixty-seven percent of residents were trained in the management of C1-INH-HAE through in-person lectures. Seventy-one percent of programs had no formal assessment of resident competency in C1-INH-HAE management.

Conclusion

This study is the first to offer insight into C1-INH-HAE education and management principles in otolaryngology training programs. Surveyed program directors believe residents need a strong knowledge base in the management of C1-INH-HAE but less than half feel their trainees acquire the necessary exposure to this emergent disease process. Future research efforts in this area should aim to determine optimal educational activities as well as how to best incorporate this into otolaryngology residency curricula.

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Liposomal nanoparticle armed with bivalent bispecific single-domain antibodies, novel weapon in HER2 positive cancerous cell lines targeting

Publication date: April 2018
Source:Molecular Immunology, Volume 96
Author(s): Shahryar Khoshtinat Nikkhoi, Fatemeh Rahbarizadeh, Saeed Ranjbar, Sepideh Khaleghi, Alireza Farasat
Breast cancer is the leading cause of mortality among all cancers. HER2, human epidermal growth factor receptors type 2, a receptor tyrosine kinase that induces interminable cell proliferation, is overexpressed in 20–25 percent of breast cancers. In spite of significant progress in nanomedicine in the past decade, being subjected to genetic drift that hides many paramount epitopes has rendered targeting HER2 as a big challenge. In the present study, we developed monovalent and bivalent monospecific along with bivalent bispecific VHH targeting different epitopes on HER2, and showed that bivalent bispecific VHH has the highest affinity among other tested modalities. Then we covalently coupled VHHs to the fluorescent labeled liposomal nanoparticle to produce targeted liposomes. Based on flow cytometry results, bivalent bispecific VHH targeted liposomes showed the highest fluorescent intensity, on HER2 breast cancer cells. Liposomes conjugated to bivalent monospecific VHH exhibited enhanced affinity toward HER2 positive cell lines compared to monovalent targeted liposomes, with bivalent bispecific liposomes appearing as the most robust probe.

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Molecular regulation of dendritic cell development and function in homeostasis, inflammation, and cancer

Publication date: Available online 15 March 2018
Source:Molecular Immunology
Author(s): Taylor T. Chrisikos, Yifan Zhou, Natalie Slone, Rachel Babcock, Stephanie S. Watowich, Haiyan S. Li
Dendritic cells (DCs) are the principal antigen-presenting cells of the immune system and play key roles in controlling immune tolerance and activation. As such, DCs are chief mediators of tumor immunity. DCs can regulate tolerogenic immune responses that facilitate unchecked tumor growth. Importantly, however, DCs also mediate immune-stimulatory activity that restrains tumor progression. For instance, emerging evidence indicates the cDC1 subset has important functions in delivering tumor antigens to lymph nodes and inducing antigen-specific lymphocyte responses to tumors. Moreover, DCs control specific therapeutic responses in cancer including those resulting from immune checkpoint blockade. DC generation and function is influenced profoundly by cytokines, as well as their intracellular signaling proteins including STAT transcription factors. Regardless, our understanding of DC regulation in the cytokine-rich tumor microenvironment is still developing and must be better defined to advance cancer treatment. Here, we review literature focused on the molecular control of DCs, with a particular emphasis on cytokine- and STAT-mediated DC regulation. In addition, we highlight recent studies that delineate the importance of DCs in anti-tumor immunity and immune therapy, with the overall goal of improving knowledge of tumor-associated factors and intrinsic DC signaling cascades that influence DC function in cancer.

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Primary failure of eruption (PFE): a systematic review

Abstract

Background

Primary failure of eruption (PFE) is a rare disease defined as incomplete tooth eruption despite the presence of a clear eruption pathway. Orthodontic extrusion is not feasible in this case because it results in ankylosis of teeth. To the best of our knowledge, besides the study of Ahmad et al. (Eur J Orthod 28:535-540, 2006), no study has systematically analysed the clinical features of and factors associated with PFE. Therefore, the aim of this study was to systematically evaluate the current literature (from 2006 to 2017) for new insights and developments on the aetiology, diagnosis, genetics, and treatment options of PFE.

Methods

Following the PRISMA guidelines, a systematic search was performed using the PubMed/Medline database for studies reporting on PFE. The following terms were used: "primary failure of tooth eruption", "primary failure of eruption", "tooth eruption failure", and "PFE".

Results

Overall, 17 articles reporting clinical data of 314 patients were identified. In all patients, the molars were affected. In 81 reported cases, both the molars and the premolars were affected by PFE. Further, 38 patients' primary teeth were also affected. In 27 patients, no family members were affected. Additional dental anomalies were observed in 39 patients. A total of 51 different variants of the PTH1R gene associated with PFE were recorded.

Conclusions

Infraocclusion of the posterior teeth, especially if both sides are affected, is the hallmark of PFE. If a patient is affected by PFE, all teeth distal to the most mesial tooth are also affected by PFE. Primary teeth can also be impacted; however, this may not necessarily occur. If a patient is suspected of having PFE, a genetic test for mutation in the PTH1R gene should be recommended prior to any orthodontic treatment to avoid ankylosis. Treatment options depend on the patient's age and the clinical situation, and they must be evaluated individually.

http://ift.tt/2IqBGCQ

Semi-automatic tumour volume measurements on MR-imaging using Smartbrush® in oropharyngeal carcinomas; our experience in 5 patients

Abstract

Head and neck cancer is worldwide the sixth most common cancer. Prognosis is linked to tumour (primary tumours, nodal stage and distant metastasis) and general patients' characteristics. Currently, the TNM-staging system is the most used staging system in the world. Beside this TNM-staging system, other prognostic factors are used to select the best treatment for each individual patient.

http://ift.tt/2Gus615

Transoral endoscopic base of tongue mucosectomy for investigation of unknown primary cancers of head and neck

Abstract

Cancer of the unknown primary (CUP) makes up 2-4% of new head and neck squamous cell carcinoma (SCC) diagnoses. This scenario is recognised as a diagnostic challenge for head and neck surgeons. For all patients with proven cervical lymph node metastatic SCC without a clinically apparent primary site, the current UK guidelines recommends PET-CT, panendoscopy with directed biopsies and bilateral tonsillectomy as a standard of care.

http://ift.tt/2DvqYHu

A web-based prediction score for head and neck cancer referrals

Abstract

Objective

Following the announcement of the NHS Cancer Plan in 2000, anyone suspected of having cancer has to be seen by a specialist within two weeks of referral. Since this introduction, studies have shown that only 6.3-14.6% of 2-week referrals were diagnosed with a head and neck cancer and that majority of the cancer diagnoses were via other referral routes. These studies suggest that the referral scheme is not currently cost effective. Our aim is to develop a scoring system that determines the risk of head and neck cancer in a patient, which can then be used to aid GP referrals.

Design

Retrospective data was collected from 1075 patients with 2-week head and neck cancer referrals from general practitioners. The retrospective data collected included patients' demographics, risk factors and relevant investigations. The data was used as input into a logistic regression to arrive at our model. Our approach included data analysis, machine learning techniques, statistical inference and model validation metrics to arrive at the best performing model. The model was then tested with more data from 235 prospective patients.

Results

Using our results from the logistic regression, we created a web-based tool that GPs can use to calculate their patient's probability of cancer and use this result to assist in their decision regarding referral. Our prototype can be seen in Figure 2.

Conclusion

We have created a prototype scoring system that can be hosted online to assist GPs with their referrals with a sensitivity of 31% and specificity of 92%. While we acknowledge that there are several limitations to our model, we believe we have created a novel preliminary scoring system that has the potential to be improved dramatically with further data and be very helpful for GPs in a long run.

http://ift.tt/2Guqd4H

Skin microneedling for acne scars associated with pigmentation in patients with dark skin

Summary

Background

Acne is very common skin condition. Most patients with acne will have a degree of scarring as a result of their acne. In patients with darker skin color the scarring can be further complicated by hyperpigmentation. Several treatment options can be used to improve acne scarring, however the problem of post acne hyperpigmentation is not often addressed. This study especially focus on the treatment of pigmented post acne scarring using skin microneedling.

Aims

The primary objective is to assess the improvement of pigmentation of acne scarring in patients with dark skin using microneedling. Secondary objectives include evaluation of post acne scarring improvement and the safety of microneedling in pigmented skin.

Materials & Methods

39 Patients with darker skin colors (types 3, 4 and 5) completed study. Baseline evaluation for both acne scars and pigmentation scores performed using "post acne hyperpigmentation index" (PAHPI) and Goodman-Baron scales (GB scale). Microneedling treatment done and subsequently patients reviewed at 2 weeks for initial assessment and then after at least 4 weeks from date of initial assessment using same scoring methods for both scars and pigmentation. Baseline photographs were taken and again at final assessment.

Results

Both PAHPI and Goodman-Baron scales showed statistically significant improvement from baseline following microneedling treatment. Side effects were minor and of transient nature. None of our patients showed worsening of pigmentation.

Conclusion

Microneedling is an effective treatment for both acne scars and associated pigmentation in patients with dark skin color. The treatment appears to be safe apart from transient redness, mild dryness, and small hematomas, however additional treatments may be needed in some patients to achieve more improvement in pigmentation.

http://ift.tt/2FLcS6W

Improvement of skin barrier dysfunction by Scutellaria baicalensis GEOGI extracts through lactic acid fermentation

Summary

Background

The development of an alternative medicine to treat atopic dermatitis (AD) from natural sources is necessary.

Aims

To improve skin barrier dysfunction by enhancing the differentiation of human keratinocytes with the fermented Scutellaria baicalensis.

Methods

Scutellaria baicalensis was fermented with Lactobacillus plantarum and extracted with 70% ethanol (FE). Antioxidant activities and the regulation of the gene expression related to keratinocyte differentiation were measured as well as its proliferation.

Result

This work first proved that the FE had multiple activities, both increasing keratinocyte differentiation and proliferation: The FE greatly up-regulated expression of the genes of keratinocyte differentiation such as involucrin, keratin 10, and transglutaminase-1 (TG-1) up to 4.06-fold, which was 3 times higher than the 2 other extracts. The effect of baicalein on keratinocyte differentiation was also first found; however, its efficacy was lower than that of the fermented extract. The FE proved to effectively accelerate keratinocyte differentiation, rather than to initiate the differentiation, and also showed an ability of stimulating keratinocyte proliferation up to 2.8 × 10⁶ viable cells/mL as well as 70.24 ng/mL of collagen production in fibroblasts. High efficacy of the FE was confirmed by synergistic effects of large amounts of various bioactive substances in the extracts as baicalein alone did not show remarkable effects and even positive controls had not much better activities than the FE.

Conclusion

The fermented extract was able to improve skin barrier dysfunction, and the ointment with 1%-5% (v/v) of the extract be directly used for skin clinical trials to treat AD.

http://ift.tt/2ph29Ld

Clinical characteristics from co-infection with avian influenza A H7N9 and Mycoplasma pneumoniae: a case report

More and more cases of human infections with avian influenza A H7N9 have been reported since it was first mentioned in 2013 in China, but concurrence of influenza A H7N9 with Mycoplasma pneumoniae, however, has n...

http://ift.tt/2FRCUsz

Novel compound heterozygote mutations in the ATP7B gene in an Iranian family with Wilson disease: a case report

Wilson disease is an autosomal recessive disorder of copper transport and is characterized by excessive accumulation of cellular copper in the liver and other tissues because of impaired biliary copper excreti...

http://ift.tt/2DtN5hI

A multicenter study of biopsied oral and maxillofacial lesions in a Brazilian pediatric population

Abstract The aim of this study was to investigate the prevalence of oral and maxillofacial lesions among children from representative regions of Brazil. A retrospective descriptive study was conducted. Biopsy records comprising the period from 2000 to 2015 were obtained from the archives of three Brazilian oral pathology referral centers. A total of 32,506 biopsy specimens were analyzed, and specimens from 1,706 children aged 0–12 years were selected. Gender, age, anatomical location and histopathological diagnosis were evaluated. Descriptive statistics was carried out. Likelihood ratio tests were used to evaluate the association between the categorical variables. The level of significance was set at 0.05. The post-hoc test was used to identify the subgroups that significantly differed from one another, and the Bonferroni correction was applied. A total of 1,706 oral and maxillofacial lesions were diagnosed in pediatric patients, including 51.9% girls. Oral mucocele was the most prevalent reactive/inflammatory lesion (64%). The most commonly affected sites were the lips (34.5%) and mandible (19.9%). A significant association was observed between age and the group of lesions of the oral cavity (p < 0.001), and between age and anatomical location (p < 0.001). Pediatric oral and maxillofacial lesions were frequent and showed wide diversity, with the prevalence of mucocele. Knowledge of oral lesions is important for pediatric dentists worldwide, since it provides accurate data for the diagnosis and oral health of children.

http://ift.tt/2FCWLMP

In vitro effects of alcohol-containing mouthwashes on human enamel and restorative materials

Abstract The objective of this study was to evaluate the in vitro effects, including surface morphological characteristics and chemical elemental properties, of different mouthwash formulations on enamel and dental restorative materials, simulating up to 6 months of daily use. Human enamel samples, hydroxyapatite, composite resin, and ceramic surfaces were exposed to 3 different mouthwashes according to label directions — Listerine® Cool Mint®, Listerine® Total Care, and Listerine® Whitening — versus control (hydroalcohol solution) to simulate daily use for up to 6 months. The samples were analyzed using scanning electron microscopy (SEM), infrared spectrophotometry (µ-Fourier transform infrared microscopy), energy-dispersive X-ray (EDX) spectroscopy, and color analysis before and after exposure. No relevant changes were observed in the morphological characteristics of the surfaces using SEM techniques. The physical and chemical aspects of the enamel surfaces were evaluated using mid-infrared spectroscopy, and EDX fluorescence was used to evaluate the elemental aspects of each surface. There was no variation in the relative concentrations of calcium and phosphorus in enamel, silicon and barium in composite resin, and silicon and aluminum in the ceramic material before and after treatment. No relevant changes were detected in the biochemical and color properties of any specimen, except with Listerine® Whitening mouthwash, which demonstrated a whitening effect on enamel surfaces. Long-term exposure to low pH, alcohol-containing, and peroxide-containing mouthwash formulations caused no ultra-structural or chemical elemental changes in human enamel or dental restorative materials in vitro.

http://ift.tt/2FJlpHm

Can intra-radicular cleaning protocols increase the retention of fiberglass posts? A systematic review

Abstract The presence of residues within the root canal after post-space preparation can influence the bond strength between resin cement and root dentin when using fiberglass posts (FGPs). Currently, there is no consensus in the literature regarding what is the best solution for the removal of debris after post-space preparation. This systematic review involved "in vitro" studies to investigate if cleaning methods of the root canal after post-space preparation can increase the retention of FGPs evaluated by the push-out test. Searches were carried out in PubMed (MEDLINE) and Scopus databases up to July2017. English language studies published from 2007 to July 2017 were selected. 475 studies were found, and 9 were included in this review. Information from the 9 studies were collected regarding the number of samples, storage method after extraction, root canal preparation, method of post-space preparation, endodontic sealer, resin cement, cleaning methods after post-space and presence of irrigant activation. Five studies presented the best results for the association of sodium hypochlorite (NaOCl) and ethylenediamine tetra-acetic acid (EDTA), while in the other 4 studies, the solutions that showed improved retention of FGPs were photon-induced photoacoustic streaming (PIPS), Qmix, Sikko and EDTA. The results showed heterogeneity in all comparisons due to a high variety of information about cleaning methods, different concentrations, application time, type of adhesive system and resin cements used. In conclusion, this review suggests that the use of NaOCl/EDTA results in the retention of FGPs and may thus be recommended as a post-space cleaning method influencing the luting procedure.

http://ift.tt/2FBQMHL

Assessment by the CANS Score Versus Anthropometry and Impact on Early Neonatal Morbidities

Condition: Fetal Malnutrition
Interventions: Diagnostic Test: Clinical assessment of nutritional status (CANS) score; Diagnostic Test: Anthropometric indices; Diagnostic Test: Proportionality indices
Sponsor: Cairo University
Recruiting

http://ift.tt/2Gw8aLA

Plasmablast Detection From IgG4-Related Disease Patients

Condition: IgG4-related Disease
Intervention:
Sponsor: Meir Medical Center
Not yet recruiting

http://ift.tt/2DuU2ii

Resilience and Quality of Life Among Cancer Survivors

Condition: Mental Health Wellness 1
Intervention: Other: Non applicable
Sponsor: Aga Khan University
Not yet recruiting

http://ift.tt/2FEVTHi

Management of tumour lysis syndrome during first-line palliative chemotherapy for high-volume colorectal cancer

Tumour lysis syndrome (TLS) is a rare oncological emergency in solid tumours. Because it is associated with bad short-term prognosis, early recognition and treatment are mandatory. This case refers to a middle-aged woman who presented with stage IV colon cancer, with massive hepatic involvement. After three cycles of first-line FOLFOX (folinic acid, 5-fluorouracil and oxaliplatin), she developed acute kidney injury and hyperkalaemia that did not respond to standard measures. High suspicion of TLS prompted further corroborating investigations and early intensive care unit admission. With vigorous hydration and allopurinol, TLS completely resolved and the patient was discharged. Prophylaxis of subsequent TLS recurrence was complicated by biopsy-proven neutrophilic vasculitis secondary to allopurinol. Prevention of TLS with hydration and rasburicase was performed prior to each subsequent cycle of chemotherapy. This case report is intended to highlight risk factors for TLS in solid tumours and focus on treatment and secondary prophylaxis of TLS.

http://ift.tt/2Gz9Hk5

Unusual case of a rectal tumour

A 48-year-old man presented as an emergency with a 3-week history of rectal bleeding. Examination of his rectum revealed a circumferential tumour, 2 cm from the anal verge. An MRI scan reported a locally infiltrative mid-lower rectal tumour staged as T3d/T4 N2 MX. A colonoscopy revealed appearances of severe proctitis and biopsies did not show any evidence of dysplasia or malignancy. The patient was discussed at the regional colorectal cancer multidisciplinary team meeting with a management plan for neoadjuvant chemoradiotherapy following repeat biopsies, which were again negative for malignancy. He tested positive for the HIV and was referred to genitourinary medicine. A positive Chlamydia trachomatis nucleic acid test from a rectal swab was serovar L2 consistent with a diagnosis of lymphogranuloma venereum. He was treated with doxycycline and subsequent MRI scans showed reduction in tumour size with eventual resolution. This case report highlights the importance of HIV testing in patients with newly diagnosed colorectal tumours.

http://ift.tt/2tQkBPn

Autopsy case of aortic dissection after transcatheter aortic valve implantation (TAVI)

Aortic dissection is one of the severe but rare vascular complications arising from transcatheter aortic valve implantation (TAVI). This paper presents an autopsy case of an 81-year-old male patient with delayed aortic dissection with underlying haemorrhages and acute inflammation 3 years after TAVI.

http://ift.tt/2FVAeKl

Gastric Dieulafoy lesion: a rare cause of massive haematemesis in an elderly woman

Description

A 78-year-old woman presented to her local accident and emergency department by ambulance, having collapsed following several episodes of voluminous fresh haematemesis with melaena. The patient had extensive medical comorbidities, suffering from type 2 diabetes mellitus, ischaemic heart disease, bronchiectasis and severe pulmonary hypertension. Three weeks previously she had undergone an uncomplicated total hip replacement for osteoarthritis and had been using non-steroidal anti-inflammatory drugs (NSAIDs) for analgesia. She had no history of gastroenterological disease.

The patient responded to initial resuscitative measures sufficiently to undergo oesophagogastroduodenoscopy. The gastroenterologist struggled to achieve any useful view of either stomach or duodenum due to the volume of haemorrhage, and aborted the procedure. The patient rapidly displayed signs of haemodynamic instability and deteriorated into a state of refractory hypovolaemic shock. She was intubated and ventilated.

The patient underwent laparotomy and antrotomy with duodenotomy, which showed no focal gastric or duodenal abnormality. Attempted...

http://ift.tt/2tUOL4g

Myelodysplastic syndrome presenting as a Behcets-like disease with aortitis

A 46-year-old Hispanic man presented with fever, genital ulcers, left eye redness and chest pain. Physical examination was notable for a healed oral ulcer and scrotal ulcers, and bilateral superficial thrombophlebitis. He was found to have new-onset pancytopenia. CT of the chest showed pericardial and pleural effusions and rapidly progressing inflammation of the aortic arch and ascending vessels. Although the patient had Behcet's disease (BD)-like symptoms, pancytopenia could not be explained by the diagnosis, prompting a bone marrow biopsy which showed myelodysplastic syndrome. This report highlights the importance of excluding alternate disorders before making a diagnosis of Behcet's disease if atypical, BD-incompatible or incomplete constellations of symptoms and findings are present.

http://ift.tt/2Gu9w9l

The 'wobbling pears in urine

Description

A 54-year-old female was admitted to the neurosurgery unit for excision of a non-functioning pituitary adenoma. Preoperative microscopic urinary examination revealed many motile pear- shaped organisms ranging in size from 17 to 23 µm (figure 1, red arrow) demonstrating characteristic wobbling to rotatory movement (video 1). These were conforming to the morphology of trophozoite form of Trichomonas vaginalis. Retrospectively, it was found that the patient had mild vaginal itching with passage of greenish discharge. Other laboratory investigations revealed that she was non-diabetic and HIV negative. Subsequently, she was given oral tinidazole 2 g single dose and was symptomatically better. She was taken up for surgery, and the follow-up urine sediment wet mount smears were negative for the parasite.

Trichomoniasis is the most common non-viral sexually transmitted infection worldwide. Vaginal/urethral/prostatic discharge and urine sediment wet mount smears offer rapid diagnosis with an excellent specificity owing to the...

http://ift.tt/2tUODBO

Disseminated tuberculous lymphadenitis presenting as cervical mass in patient with HIV infection, worsening after antiretroviral initiation: diagnosis and treatment challenges

Tuberculosis (TB) continues to represent an important public health challenge in the world and the USA, especially given its association with HIV infection and population migration. Cervical tuberculous lymphadenitis represents the most common extrapulmonary presentation of TB in the USA. Considerations for other causes of neck mass often contribute to delay in diagnosis. In this report, we describe the case of a 41-year-old man who presented with painful swelling of the neck and was diagnosed with tuberculous lymphadenitis, complicated by HIV therapy-associated immune reconstitution syndrome. Prior to this diagnosis, he presented with a chronic intermittent cough, repeatedly treated as bronchitis. Furthermore, TB is a recognised occupational risk for primary care physician, as they are often the first contact for patients. With the Patient Protection and Affordable Care Act in the USA, the risk is likely to increase with the influx of newly insured often poor,and/or immigrants.

http://ift.tt/2Gtj9Fi

Internal jugular vein aneurysm in an adult: diagnosis on non-invasive imaging

We report the case of a 48-year-old man with a right fusiform internal jugular venous aneurysm, presenting as a unilateral painless neck swelling on coughing or laughing. This is a rare condition, more commonly seen in the paediatric population and can be diagnosed using non-invasive modalities such as Doppler ultrasound and contrast-enhanced CT. This anomaly is frequently misdiagnosed or overlooked, and our case highlights the importance of considering venous aneurysm as a differential to prevent invasive imaging and inappropriate management.

http://ift.tt/2tQLOkX

Chronic myelogenous leukaemia with a p53 mutation demonstrated neutrophilic granulocytes with nuclear hypolobation (pseudo-Pelger-Hüet anomaly) and hypogranulation in the peripheral blood smear

A 70-year-old man visited our emergency department, whose laboratory test results revealed leucocytosis, anaemia, thrombocytopenia and high levels of serum lactate dehydrogenase. In addition, the peripheral blood smear revealed neutrophilic granulocytes with nuclear hypolobation (pseudo-Pelger-Hüet anomaly), hypogranulation and no myeloperoxidase reactivity. Genetic testing of the peripheral blood sample was as follows: G-band, 46XY,t(9;22)(q34;q11.2) (20/20); fluorescence in situ hybridisation BCR/ABL fusion signal, 97%; and analysis of exons 5–9 of the p53 gene, mutation (Pro72Arg) in exon 4 protein. On the basis of these findings, the patient was diagnosed with chronic myelogenous leukaemia (CML) in chronic phase with a p53 mutation and treated with hydroxyurea, dasatinib and nilotinib. Neutrophilic granulocytes with the anomalies were no longer observed after achieving cytogenetic remission. To the best of our knowledge, this is the first report of CML case with the anomalies, in which a p53 mutation without chromosome 17 abnormalities was identified.

http://ift.tt/2FSL3ga

Dilated tonic pupils with tabes dorsalis in neurosyphilis as first manifestation of HIV/AIDS: a video report

Description

A previously healthy 30-year-old bisexual African man was admitted with a 3-month history of weight loss, paroxysmal shooting pains and paraesthesia of both lower limbs and difficulty in walking. He denied progression of visual symptoms such as blurred vision with reading and near work, photophobia, anisocoria or visual loss. The Mini-Mental State Examination was normal (30/30). He was alert, oriented to time, person and place with a Glasgow Coma Scale of 15/15. His body mass index was 17 kg/m². There was generalised wasting syndrome, cervical lymphadenopathy and diffuse hair loss of the scalp and eyebrows. There was no urinary incontinence.

Visual acuity without correction (20/20), visual fields, intraocular pressures (14 mm Hg) and fundoscopy were normal in both eyes. Ocular motility was full bilaterally with no nystagmus. The pupils, however, were 6.0 mm in diameter on room light bilaterally, unreactive to light or accommodation (Video 1, segment 1)....

http://ift.tt/2tNeifD

Unilateral retinitis pigmentosa occurring in an individual with a mutation in the CLRN1 gene

This case report depicts the clinical course of a female patient with unilateral retinitis pigmentosa, who first presented at the age of 12 years. Fundus photography at the time revealed unilateral pigmentary retinopathy, which was associated with extinguished electroretinogram (ERG) signal. At 35 years of age, fundus examination revealed deterioration of pre-existing unilateral pigmentary retinopathy with progressive visual field defect detected on Goldmann visual field testing. ERG findings remained unchanged and multifocal ERG showed unilateral decrease in amplitude in the affected eye. The patient was referred for genetic counselling. Next-generation sequencing identified a deleterious heterozygous c.118T>G (p.Cys40Gly) mutation in the CLRN1 gene.

http://ift.tt/2GvwkFZ

Endovascular recanalisation with drug coated balloon for chronic symptomatic middle cerebral artery total occlusion

The optimal treatment for patients with chronic symptomatic middle cerebral artery (MCA) total occlusion is not well established. In addition to medical therapy, vessel recanalisation with stenting has shown much promise, especially for patients with recurrent ischemic symptoms. Nevertheless, the incidence of symptomatic in-stent restenosis (ISR) is high, and is associated with an unfavorable prognosis. Drug coated balloons (DCBs) have been proven to be effective in treating and preventing ISR. However, the feasibility of DCBs for de novo intracranial atherothrombotic stenosis has not been previously described, especially for total occlusion lesions. Here we reported a patient with chronic left MCA total occlusion successfully treated with DCBs, with a good outcome at the 1 year follow-up. More studies are warranted to further compare the efficacy of DCBs and stentings for intracranial revascularisation.

http://ift.tt/2tPETsu

Coinfection of leprosy and tuberculosis

Leprosy and tuberculosis (TB) are endemic to India, however, their coinfection is not frequently encountered in clinical practice. Here, we report a 32-year-old female patient who presented with a history of high-grade intermittent fever, cough and painless skin lesions since a month, along with bilateral claw hand (on examination). The haematological profile was suggestive of anaemia of chronic disease, chest radiograph showed consolidation, sputum smears were positive for Mycobacterium tuberculosis, and skin slit smear confirmed leprosy. The patient was prescribed WHO recommended multidrug therapy for multibacillary leprosy with three drugs. Additionally, prednisolone was added to her regimen for 2 weeks to treat the type 2 lepra reaction. For treatment of TB, she was placed on the standard 6-month short course chemotherapy. She was lost to follow-up, and attempts were made to contact her. Later, it came to our notice that she had discontinued medications and passed away 3 months after diagnosis.

http://ift.tt/2FXMES8

Recurrence of eosinophilic oesophagitis with subcutaneous grass pollen immunotherapy

Case reports have described an association between oral food/aeroallergen immunotherapy with the development of eosinophilic oesophagitis (EoE). The underlying mechanism of this is poorly understood, as is the role that both food/aeroallergen sensitisation plays in the pathogenesis of EoE. Specific immunotherapy has a long-standing history of use in the management of moderate/severe seasonal allergic rhinitis (AR), caused by tree/grass pollens. Subcutaneous immunotherapy (SCIT) to grass pollen is less commonly used in children than sublingual immunotherapy (SLIT) or oral immunotherapy for practical reasons. We describe a case of a child with severe grass-pollen related AR and known, but quiescent, EoE, who developed recurrence of oesophageal symptoms on two separate occasions, coincident with the commencement of SLIT to grass pollen. He was subsequently started on SCIT to grass pollen and developed recurrence of symptoms of EoE—a phenomenon that has yet to be reported in the medical literature.

http://ift.tt/2tPEQgi

Supraventricular tachycardia as a complication of severe diabetic ketoacidosis in an adolescent with new-onset type 1 diabetes

Diabetic ketoacidosis (DKA) is one of the most common causes of morbidity and mortality in new-onset type 1 diabetes (T1D). Supraventricular tachycardia (SVT), however, is a very rare complication of DKA. We present the case of a patient with new-onset T1D who presented with DKA. He received intravenous fluid resuscitation, insulin and potassium supplementation and subsequently developed SVT, confirmed on a 12-lead electrocardiograph despite a structurally normal heart. Vagal manoeuvres and adenosine failed to restore sinus rhythm, but flecainide was successful. We conclude that SVT can occur as a complication of DKA, including in new-onset T1D. Our case is the first of this phenomenon occurring in new-onset childhood diabetes, as the few prior documented cases had established diabetes. Furthermore, a combination of potassium derangement, hypophosphataemia and falling magnesium levels may have precipitated the event.

http://ift.tt/2FSKDGC

More than 40 years follow-up of an unconstrained metal lunate replacement for the treatment of Kienböcks disease

Kienböck's disease is characterised by avascular necrosis of the lunate bone, and over the years it has been a challenging disease to manage, with differing opinions on the best intervention. We present an interesting case of a metallic unconstrained lunate replacement that is still functioning well in a patient 40 years after surgery. This case report represents the longest follow-up of any such prosthesis.

http://ift.tt/2tUOcYc

Metastatic primary pulmonary melanoma successfully treated with checkpoint inhibitors

Our patient is a 69-year-old man who presented to the emergency department with left-sided hemiparesis that started 4 hours prior to presentation. Brain CT showed right basal ganglia and internal capsule haemorrhagic strokes. MRI revealed multiple brain lesions suspicious for metastases. Further workup revealed a 5 cm lung mass and a 1 cm pancreatic nodule. Biopsy of both pulmonary and pancreatic lesions was consistent with melanoma and was similar histologically. The patient underwent cyberknife stereotactic radiosurgery to the brain metastases followed by immunotherapy with pembrolizumab, and then by nivolumab and ipilimumab. The patient remains free of disease progression 2 years after treatment.

http://ift.tt/2GvwYD8

Infected symptomatic carotid artery atheroma concurrent with bacterial endocarditis

Optimal management of patients with stroke due to symptomatic carotid artery disease coexistent with bacterial endocarditis is still not well established. We report the case of a patient who presented with multifocal left middle cerebral artery stroke in the setting of Enterococcus faecalis endocarditis and was found to have near-occlusive ipsilateral carotid artery stenosis in stroke workup. Carotid artery endarterectomy was performed, and atheroma material demonstrated complicated plaque with cultures positive for E. faecalis. This report demonstrates that patients with cardioembolic disorders such as bacterial endocarditis with vegetations who present with stroke may benefit from evaluation for extracranial vessel stenosis. Also, additional consideration should be given to the possibility of infected atheroma in patients with symptomatic carotid stenosis with recent or active endocarditis or bacteraemia.

http://ift.tt/2tUNDO4

Methacrylate dressing on refractory venous leg ulcers

Chronic leg ulcers can have a major impact on the quality of life of patients. These wounds can be complex and hard to heal, as several factors may affect the outcome. Underlying conditions, bacterial growth and excess moisture may prevent wounds from healing. We describe the case of a patient with known chronic venous disease, who was admitted to our hospital for several complex, irregular and infected chronic venous ulcers in his lower legs. The management was frustrating for several months, until we began to use methacrylate powder dressing for his hard-to-heal wounds.

http://ift.tt/2GvQMGz

Unusual association between erythema nodosum and autoimmune atrophic gastritis

We report a case of a 46-year-old woman with a history of autoimmune atrophic gastritis and recurrent erythema nodosum (EN). Laboratory results showed iron-deficiency anaemia, positive antiparietal cell antibodies and marginal deficiency of vitamin B12. Although EN was refractory to general measures (rest and non-steroidal anti-inflammatory drugs) and corticosteroid therapy, it was successfully treated with vitamin B12 supplementation.

http://ift.tt/2pcxRt0

Myocarditis Secondary to Mesalamine-Induced Cardiotoxicity in a Patient with Ulcerative Colitis

Development of cardiac manifestations in patients diagnosed with inflammatory bowel disease undergoing treatment with mesalamine is a rare. When this occurs, it can be difficult to tease out the primary etiology, as both IBD and mesalamine can cause cardiac manifestations independently of each other. The exact mechanism of mesalamine-induced cardiotoxicity is yet to be determined although several mechanisms have been described. We present the case of a gentleman with nonexertional chest pain in the setting of ulcerative colitis exacerbation believed to have occurred secondary to mesalamine.

http://ift.tt/2DvnBQL

Acute Parotitis after Lower Limb Amputation: A Case Report of a Rare Complication

Background. Postoperative parotitis is a rare complication that occurs usually after abdominal surgery. Parotitis has never been described as a complication of vascular operations, in literature. In the present article, we describe a case of a postamputation parotitis along with its management and its possible pathogenesis. Case Report. An 83-year-old diabetic man was emergently admitted to hospital because of gangrene below the right ankle and sepsis. The patient underwent a lower limb amputation above the knee. On the 5th postoperative day, he was diagnosed with right parotitis probably because of dehydration, general anesthesia, and immunocompromisation. A CT scan confirmed the diagnosis. He received treatment with antibiotics and fluids. His condition gradually improved, and he was finally discharged on 15th postoperative day. Conclusions. Postoperative parotitis can possibly occur after any type of surgery including vascular. Clinicians should be aware of this complication although it is rare. Several risk factors such as dehydration, general anesthesia, drugs, immunocompromisation, head tilt during surgery, and stones in Stensen's duct may predispose to postoperative parotitis. Treatment consists of antibiotics and hydration.

http://ift.tt/2perZQ9

Molecular defects in BRAF wild-type ameloblastomas and craniopharyngiomas—differences in mutation profiles in epithelial-derived oropharyngeal neoplasms

Abstract

The aim of this study was to evaluate the mutation profile of BRAF wild-type craniopharyngiomas and ameloblastomas. Pre-screening by immunohistochemistry and pyrosequencing for identifying BRAF wild-type tumors was performed on archived specimens of ameloblastic tumors (n = 20) and craniopharyngiomas (n = 62). Subsequently, 19 BRAF wild-type tumors (nine ameloblastic tumors and ten craniopharyngiomas) were analyzed further using next-generation sequencing (NGS) targeting hot spot mutations of 22 cancer-related genes. Thereby, we found craniopharyngiomas mainly CTNNB1 mutated (8/10), including two FGFR3/CTNNB1-double mutated tumors. Ameloblastic tumors were often FGFR2 mutated (4/9; including one FGFR2/TP53/PTEN-triple mutated case) and rarely CTNNB1/TP53-double mutated (1/9) and KRAS-mutated (1/9). In the remaining samples, no mutation could be detected in the 22 genes under investigation. In conclusion, mutation profiles of BRAF wild-type craniopharyngiomas and ameloblastomas share mutations of FGFR genes and have additional mutations with potential for targeted therapy.

http://ift.tt/2GsAL48

Enhanced expression of PD-1 and other activation markers by CD4+ T cells of young but not old patients with metastatic melanoma

Abstract

The biological behavior of melanoma is unfavorable in the elderly when compared to young subjects. We hypothesized that differences in T-cell responses might underlie the distinct behavior of melanoma in young and old melanoma patients. Therefore, we investigated the circulating T-cell compartment of 34 patients with metastatic melanoma and 42 controls, which were classified as either young or old. Absolute numbers of CD4+ T cells were decreased in young and old melanoma patients when compared to the age-matched control groups. Percentages of naive and memory CD4+ T cells were not different when comparing old melanoma patients to age-matched controls. Percentages of memory CD4+ T cells tended to be increased in young melanoma patients compared to young controls. Proportions of naive CD4+ T cells were lower in young patients than in age-matched controls, and actually comparable to those in old patients and controls. This was accompanied with increased percentages of memory CD4+ T cells expressing HLA-DR, Ki-67, and PD-1 in young melanoma patients in comparison to the age-matched controls, but not in old patients. Proportions of CD45RA−FOXP3^high memory regulatory T cells were increased in young and old melanoma patients when compared to their age-matched controls, whereas those of CD45RA+FOXP3^low naive regulatory T cells were similar. We observed no clear modulation of the circulating CD8+ T-cell repertoire in melanoma patients. In conclusion, we show that CD4+ T cells of young melanoma patients show signs of activation, whereas these signs are less clear in CD4+ T cells of old patients.

http://ift.tt/2tTHFwC

Case 8-2018: A 55-Year-Old Woman with Shock and Labile Blood Pressure

Presentation of Case. Dr. Nathalie Roy: A 55-year-old woman was transferred to this hospital for evaluation and treatment of cardiogenic shock. Approximately 4 months before presentation, the patient was admitted to a hospital in her home state for "pounding" in her chest, nausea, and diaphoresis…

http://ift.tt/2pbE6gS

Repair of Large Full-Thickness Scalp Defects Using Biomaterial and Skin Grafting

The reconstruction of large full-thickness scalp defects remains a surgical challenge, especially when the skull is exposed completely without periosteum. Surgical technique options for wound coverage have included tissue expansion, skin grafting, local or regional flaps, and microvascular free tissue transfer. In recent years, some authors have reported to use biological material as an alternative for repairing complex wounds. The authors report the successful reconstruction of a large defect with bare skull in bilateral temporal regions of a 3-year-old child. The patient was treated with artificial biomaterial followed by skin grafting, without making multiple cranial burr holes or burring out the outer bony cortex. The relevant literatures were reviewed and the vascular anatomy evidence of the blood supply at temporal region was also demonstrated on cadaver. This case suggests that artificial biomaterial followed by skin grafting is a potential alternative for the treatment of large full-thickness scalp defects in pediatric patients. Address correspondence and reprint requests to Sufan Wu, MD, PhD, Department of Plastic Surgery and Reconstructive Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China; E-mail: sufanwu@163.com Received 4 January, 2017 Accepted 7 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

http://ift.tt/2FSQ9sJ

Anatomical Examination of Mandibular Condyle Protrusion Into the Middle Cranial Fossa: Cadaveric Dissection

Trauma to the mandible can occasionally be a life-threatening event. Although extremely rare with only 56 reported patients in the English language, fracture of the floor of the middle cranial fossa with protrusion of the mandibular condyle into the middle cranial fossa was first reported in 1963 by Dingman. The authors review the anatomy of the temporomandibular joint in relation to the middle cranial fossa and demonstrate the possible complications due to condylar intrusion with anatomical dissection. Address correspondence and reprint requests to Joe Iwanaga, DDS, PhD, Seattle Science Foundation, 550 17th Ave, James Tower, Suite 600, Seattle, WA 98122; E-mail: joei@seattlesciencefoundation.org Received 13 December, 2017 Accepted 7 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

http://ift.tt/2HxkhXK

Anatomic Study on Sphenoidal Emissary Foramen by Using Cone-Beam Computed Tomography

Objectives: The goal of this retrospective study is to evaluate the radiologic anatomy of sphenoidal emissary foramen (SEF) by using cone-beam computed tomography (CBCT) scans. Methods: Three hundred seventeen (189 female and 128 male) full-head CBCT images were evaluated in this study. Incidence, diameter, shape, confluence to foramen ovale, and distance to anatomic structures of SEF were noted. Results: In the 317 analyzed images, the SEF was identified in 89 (28.1%) images. Of these, 67 (21.1%) were unilateral, 22 were (6.9%) bilateral. The maximum mean diameter of SEF was measured 2.66 mm on the right side and 2.82 mm on the left side (P = 0.16). The most observed SEF shape was oval with the incidence of 68.5% (P ≤ 0.05). Confluence was observed in 23.4% of SEF whereof 84.6% were in the left side (P ≤ 0.05). Conclusion: Observations in this study tender new anatomic parameters regarding SEF incidence, characteristics, and distances to proximate anatomic structures. Knowledge related to SEF variations will be helpful for neurosurgeons and radiologist. Address correspondence and reprint requests to Dr Seval Bayrak, PhD, Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Abant Izzet Baysal University, Bolu, Turkey; E-mail: dtseval@hotmail.com Received 1 November, 2017 Accepted 1 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

http://ift.tt/2FVdE4w

Open Rhinoplasty Using Concealing Incisions for Mild Bifid Nose With Unilateral Mini-Microform Cleft Lip

Bifid nose, an indicator of Tessier No.0, is a rare congenital malformation. Because of its rarity, few cases were reported and the optimal surgical procedure and the best time for surgery have not been widely acknowledged. In this brief report, a 9-year-old girl with mild bifid nose and unilateral mini-microform cleft lip, and its surgical management, is presented. We focused our attention on modifying the shape of the nose through open rhinoplasty without excising the surplus skin on the nasal dorsum and achieved good results. Address correspondence and reprint requests to Jian Li, DDS, Hospital and School of Stomatology Wuhan University, Wuhan 430079, China; E-mail: lijian_hubei@whu.edu.cn Received 25 July, 2017 Accepted 2 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

http://ift.tt/2HAC28K

Eyebrow Shapes of Chinese Empresses of the Ming and Qing Dynasties

The aim of this study was to analyze eyebrow shapes in portraits of Chinese empresses of Ming and Qing dynasties. The frontal portraits of 20 Ming empresses and 24 of Qing in which the eye and eyebrows were identifiable were measured and analyzed. The arch shape did not differ significantly (P > 0.05) between Ming and Qing. The head-up type (66.6%) was significantly more common (P

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Association of overexpressed karyopherin alpha 2 with poor survival and its contribution to interleukin-1β-induced matrix metalloproteinase expression in oral cancer

Abstract

Background

The purpose of this study was to elucidate the clinicopathological associations and molecular mechanisms of karyopherin alpha 2 (KPNA2) in oral cavity squamous cell carcinoma (SCC) progression.

Methods

The KPNA2 expressions were analyzed by immunohistochemistry and enzyme-linked immunosorbent assay in 209 tissues and 181 saliva samples, respectively. The functions of KPNA2 in migration and invasion were examined in KPNA2-knowdown cells. The matrix metalloproteinase (MMP) levels were determined by real-time quantitative polymerase chain reaction (qPCR). The subcellular fraction was used to obtain the nuclear distribution of nuclear factor-kappa B (NF-κB).

Results

The KPNA2 overexpression was associated with extranodal extension (P < .05) and poor disease-specific survival in patients with oral cavity SCC (P < .05). The salivary KPNA2 levels were elevated in patients with oral cavity SCC (P < .05). The KPNA2 knockdown reduced cell migration and invasion. This knockdown also suppressed the interleukin (IL)-1β-induced nuclear import of NF-κB and MMP (MMP-1, MMP-3, and MMP-9) transcription.

Conclusion

The KPNA2 overexpression is an independent biomarker for poor prognosis of oral cavity SCC and is required for MMP-mediated metastasis.

http://ift.tt/2FV5I3m

Circulating tumor DNA as a biomarker and liquid biopsy in head and neck squamous cell carcinoma

Abstract

The use of circulating biochemical molecular markers in head and neck cancer holds the promise of improved diagnostics, treatment planning, and posttreatment surveillance. In this review, we provide an introduction for the head and neck surgeon of the basic science, current evidence, and future applications of circulating tumor DNA (ctDNA) as a biomarker and liquid biopsy to detect tumor genetic heterogeneity in patients with head and neck squamous cell carcinoma (HNSCC).

http://ift.tt/2Hzlpu4

Pilot randomized controlled trial of a comprehensive smoking cessation intervention for patients with upper aerodigestive cancer undergoing radiotherapy

Abstract

Background

Smoking among patients with cancer is associated with poor outcomes, however, smoking cessation interventions have had limited success.

Methods

This randomized controlled trial compared a novel smoking cessation intervention ("intervention") with enhanced usual care ("control"). Participants were smokers with head and neck or thoracic malignancies undergoing radiation. Controls received brief counseling. Intervention participants received intensive counseling, pharmacotherapy, text-messaging, and financial incentives. Biochemically confirmed 7-day abstinence at 8 weeks was compared using Fisher's exact t test. Smoking abstinence and intensity were also analyzed using time-series panel regression.

Results

The study population comprised 19 intervention and 10 control participants. More intervention (74%) than control (30%) participants abstained from smoking at 8 weeks (P = .05). Intervention participants were significantly more likely to abstain (adjusted odds ratio [OR] 14.70; 95% confidence interval [CI] 3.56-60.76) and smoked fewer cigarettes (adjusted incidence rate ratio [IRR], 0.16; 95% CI 0.06-0.40) during weeks 1 to 8.

Conclusion

This intervention decreased smoking among patients with upper aerodigestive cancers during radiotherapy.

http://ift.tt/2FRf5kz

“Hemimandibular Hyperplasia Correction by Simultaneous Orthognathic Surgery and Condylectomy under Digital Guidance”

Publication date: Available online 15 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Bing Han, Xing Wang, Zili Li, Biao Yi, Cheng Liang, Xiaoxia Wang
BackgroundSimultaneous orthognathic surgery and condylectomy under digital guidance has been proven to be a feasible method to treat hemimandibular hyperplasia (HH). The objective of this study was to evaluate effects and precision of correction of HH by use of this method.MethodsThis was a case-series study. Fourteen patients with HH who had undergone simultaneous bimaxillary orthognathic surgery and condylectomy from January 2016 to April 2017 were included in this study. Presurgical virtual treatment planning was performed, transferred to the operation room, and realized with assistance of surgical navigation and 3 dimensionally printed occlusion splints. Postoperative CT data were used to analyze improvement of facial symmetry and verify accuracy of the surgical procedure.ResultsAll patients exhibited satisfactory clinical effects: facial asymmetry was corrected as expected. Postoperative validation revealed that the presurgical planning had been achieved more precisely on the unaffected side than on the affected side. Moreover, bilateral mandibular proximal segments revealed a tendency of outward rotation compared with the presurgical planning model. Furthermore, when assessing facial symmetry compared with the presurgical model, deviation of all midline landmarks was <2 mm, occlusal plane inclination was <1 mm, and asymmetry index of paired landmarks remarkably decreased after surgery (p<0.01).ConclusionSimultaneous orthognathic surgery and condylectomy under digital guidance is a realistic and precise method for treatment of HH. Surgical results can be validated during surgery by virtual navigation. However, movement of each bone segment cannot be accurately controlled as planned before surgery.

http://ift.tt/2Ir9CPZ

Is Counterclockwise rotation With Double Jaw Orthognathic Surgery Stable Long Term in Hyperdivergent Class iii Patients?

Publication date: Available online 15 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Yasemin Bahar Acar, Necip Fazıl Erdem, Ahmet Hüseyin Acar, Ahmet Nejat Erverdi, Kemal Ugurlu
PurposeTo evaluate long-term post-surgical stability of counterclockwise rotation of occlusal plane (OP) with double-jaw orthognathic surgery in hyperdivergent Class III patients.MethodsThis retrospective cohort study evaluated postsurgical stability of orthognathic surgery in patients with skeletal Class III malocclusion and counterclockwise rotation of the maxillomandibular complex with an occlusal plane change of ≥ -2°. Patients were evaluated with lateral cephalometric analysis at pre-surgery (T0), immediately post-surgery (T1) and at longest follow-up (T2). Primary predictor variable was the change in OP-Frankfurt horizontal angle post-surgery. Primary outcome variable was stability of occlusal plane at longest follow-up. Other study variables were age, sex and the following cephalometric measurements: mandibular plane angle, gonial angle, SNB, maxillary height, angle of palatal plane to sella-nasion, distances of posterior nasal spine and A-point to FH, and A-point to the vertical line passing from nasion. The Mann-Whitney U test was used to compare stability groups since variables were not normally distributed. The Bonferroni correction was used to evaluate p values. Chi-Square and Fisher's exact test, where appopriate, was used to compare proportions of the groups. P<0.05 was accepted as statistically significant.ResultsThe sample was composed of 15 adult patients, mean age at surgery was 23.5 years, and 40% were male. The median duration of follow-up was 48 months (IQR: 36-60). The groups had similar demographic properties and similar surgical changes. 10 patients showed very stable results with OP-FH change ≤1°. 4 patients were considered unstable with an 2.25±0.5° change of OP-FH in the follow-up period. Change in mandibular plane angle was significant between stable and unstable subjects, being the variable that was affected the most from relapse of the OP.ConclusionThis study demonstrated long-term post-surgical skeletal stability of counterclockwise rotation of occlusal plane with double-jaw orthognathic surgery in high angle Class III patients with a median of 48 months follow-up.

http://ift.tt/2phbIJ9

Predictors of Failure in Infant Mandibular Distraction Osteogenesis

Publication date: Available online 15 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jeffrey A. Hammoudeh, Artur Fahradyan, Colin Brady, Michaela Tsuha, Beina Azadgoli, Sally Ward, Mark M. Urata
BackgroundMandibular distraction osteogenesis (MDO) has been shown to be successful in treating upper airway obstruction (UAO) caused by micrognathia in pediatric patients. The purpose of this study was to assess the success rate of MDO and possible predictors for failure.MethodsThe records of all neonates and infants who underwent MDO from 2008 to 2015 were retrospectively reviewed. Procedural failure was defined as patient mortality or need for tracheostomy post-operatively. Details of distraction, length of stay (LOS), and failures were captured and elucidated.ResultsOut of the 82 patients, 47 (57.3%) were males, 46 (56.1%) had sporadic Pierre Robin sequence (PRS), 33 (40.3%) had syndromic PRS, and three (3.7%) had micrognathia, not otherwise specified. The average distraction length was 27.5 (15-30, SD 4.4) mm, average age at operation was 63.3 (3-342, SD 71.4) days, and average length of post-MDO hospital stay was 43 (9-219, SD 35) days with a follow-up period of 4.3 (1.1-9.6, SD 2.6) years. There were seven (8.5%) failures (5 tracheostomies, 2 mortalities) resulting in a 91.5% success rate. Regression analysis showed that predicted probability of the need for tracheostomy was 45% (p-0.02) when the patient had a CNS anomaly. The predicted probability of the need for tracheostomy and mortality combined was 99.6 % when the patient had laryngomalacia, CNS anomaly and was pre-operatively intubated (p <0.05).ConclusionThis review confirms that MDO is an effective method of treating the UAO caused by micrognathia with a high success rate. In our sample, the presence of CNS abnormalities, laryngomalacia, and pre-operative intubation had significant impact on the failure rate.

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Effectiveness of drainage in mandibular third molar surgery:a systematic review and meta-analysis

Publication date: Available online 15 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Shaopeng Liu, Zhu You, Chuan Ma, Ye Wang, Huaqiang Zhao
ObjectiveThe purpose of this study was to provide an evidence-based evaluation of the impact of surgical drainage after the removal of the mandibular third molars.MethodThe Medline (PubMed), the Cochrane Library, and Web of Science databases were searched to identify randomized controlled trials (RCTs) up to September 1, 2017. The postoperative variables, including facial swelling, trismus, and pain, were calculated both early (2-3 days) and late (5-7 days) after the removal of impacted mandibular third molars. Weighted mean differences (WMD) for trismus and standardized mean differences (SMD) for swelling and pain were pooled for the included studies.ResultThe samples comprised 592 extractions (297 with surgical drainage and 295 controls) in 409 participants. The included studies were published from 1988 to 2016. Participants who received surgical drainage had significantly less facial swelling during both the early stage (SMD, -0.46; 95% CI: -0.67, -0.26; p<0.0001) and the late stage (SMD, -0.36; 95% CI: -0.55, -0.16; p=0.0004) after the removal of an impacted mandibular third molar. They also had better mouth opening than the controls during both the early and late stages (early MD, 5.55 mm; 95% CI: 2.31 mm, 8.79 mm; p=0.0008; late MD, 2.38 mm; 95% CI: 1.47 mm, 3.29 mm; p<0.0001). The level of pain was significantly different between the two groups in the early stage (SMD, -0.55; 95% CI: -1.00, -0.10; p=0.01), however, there were no significant differences in the late stage (SMD, -0.13; 95% CI: -0.38,0.12; p=0.30).ConclusionThe use of surgical drainage has an obviously positive effect on postoperation reactions after the removal of a mandibular third molar. Given the need for additional clinic visits time, surgical drainage presents an alternative for the perioperative management of impacted mandibular third molar surgery, especially in cases of a fully bony tooth with poor drainage.

http://ift.tt/2pjqwav

Zoledronic acid induces site-specific structural changes and decreases vascular area in the alveolar bone

Publication date: Available online 15 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Mariana Quirino Silveira Soares, Jeroen Van Dessel, Reinhilde Jacobs, Paulo Sérgio da Silva Santos, Tania Mary Cestari, Gustavo Pompermaier Garlet, Marco Antonio Hungaro Duarte, Thaís Sumie Nozu Imada, Ivo Lambrichts, Izabel Regina Fischer Rubira-Bullen
PurposeThe aim of this study was to assess the effect of a relevant regiment of zoledronic acid (ZA) treatment for the study of bisphosphonate-related osteonecrosis of the jaw (ONJ) on alveolar bone microstructure and vasculature. The subobjective was use three-dimensional imaging to describe site specific changes induced by ZA in the alveolar bone.MethodsFive Wistar rats received ZA (0.6 mg/kg) and five (controls) received saline solution in the same volume. The compounds were administrated intraperitoneally in five doses each 28 days. The rats were euthanized after 150 days of the therapy onset. Mandibles were scanned using a high-resolution (14μm) micro-computed tomography (Micro-CT); decalcified; cut into histological slices (5μm); and stained with Hematoxylin and Eosin. Bone quality parameters were calculated using CT-Analyser (Bruker, Belgium) in two different volumes of interest (VOI) (1.the region between the first molar roots and; 2.the periapical region under the first and second molars apex). Blood vessels density (VD) and bone histomorphometric parameters were only calculated for the region between the roots of the first molar using AxioVision Imaging 4.8 (Carl Zeiss, Germany).ResultsZA treated rats presented a significant increase in percentage of bone volume and density (p<0.05) with thicker and more connected trabeculae. Furthermore, the ZA group also presented a significant decrease in the size of the marrow spaces and nutritive canals and in the VD (p<0.05). In the Micro-CT evaluation, VOI-2 presented better outcomes in measuring ZA effect on alveolar bone.ConclusionZA treatment induced bone corticalization and decreased alveolar bone vascularization. VOI-2 should be preferred for Micro-CT evaluation of the effect of BP in the alveolar bone. The current analysis allows to characterize the effect of ZA on alveolar bone and its vascularization. Results of this analysis may add further knowledge to the understanding of ONJ physiopathology.

http://ift.tt/2ItvgCP

Neuraxial labor analgesia: a focused narrative review of the 2017 literature

Purpose of review Neuraxial labor analgesia remains the most effective and one of the most commonly utilized methods for pain relief during labor. This narrative review article is a summary of the literature published in 2017 on neuraxial analgesia for labor. Recent findings From a total of 41 identified articles, 13 were included in the review. The topics have been structured into three categories: initiation of neuraxial analgesia, maintenance of neuraxial analgesia, and neuraxial analgesia and obstetric outcomes. Maintenance regimens, such as program intermittent epidural bolus (PIEB) techniques, remain a focus of extensive research with the potential to optimize analgesia for each individual patient. In a similar way, the dural puncture epidural technique could improve the quality of labor analgesia with fewer side effects compared with standard epidural and combined spinal epidural (CSE) techniques. Finally, the increased use of modern technology using portable ultrasound devices with automated imaging software to facilitate epidural catheter placement may offer potential advantages to the obstetric anesthesiologist, especially when dealing with technically difficult cases. Summary Recent advances, as well as refinements, of current neuraxial analgesia techniques could improve women's experience of labor. Correspondence to Mitko Kocarev, Anesthesia Department, Hamad Medical Corporation, PO Box 3050, Doha, Qatar. E-mail: mkocarev@hamad.qa Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Paediatric anaesthesia: a rapidly evolving subspecialty

No abstract available

http://ift.tt/2FEcDOU

Wellness in anaesthesia

No abstract available

http://ift.tt/2HzJZLs

Peer support in anesthesia: turning war stories into wellness

Purpose of review Peer support, a method of providing for the well being of healthcare providers following adverse or stressful events, is garnering increased attention in light of the increased prevalence and awareness of burnout, depression and suicidality in physicians. In this review, we will summarize the evolution of the 'second victim,' explore methods of support and examine how new regulatory requirements are changing the peer support landscape. Recent findings As peer support and the second victim are investigated more, themes are emerging regarding the natural history of recovery. As these are delineated, more targeted peer support models are being developed. One major change in 2017 is the institution of new Accreditation Council for Graduate Medical Education's Common Program Requirements, now including topics targeted on well being. Summary Effective and accessible peer support is developing in many departments nationwide and can only be expected to continue, given new regulatory requirements. As these programs develop, and research on their effect continues, best practices will likely emerge. Correspondence to Amy E. Vinson, MD, Boston Children's Hospital, 300 Longwood Avenue - Bader 3, Boston, MA 02115, USA. Tel: +1 401 261 4642; e-mail: amy.vinson@childrens.harvard.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Protective Effect of Punica granatum Extract in Head and Neck Cancer Patients Undergoing Radiotherapy

Abstract

In India, head and neck cancers account for 30–40% cancers of all sites. Due to lack of screening program, wide variation in the availability of infrastructures and expertise, patients present at an advanced stage. The main stay of management of the head and neck tumours is surgery and chemoradiation. Radiation dermatitis and mucositis is one of the most common side effect encountered during the radiotherapy. Aim of our study was to study protective role of pomegranate extract on radiation induced dermatitis and mucositis in head and neck cancer patients. It was a prospective, clinical, double blind, case control study. 60 patients (30 active and controls) undergoing radiotherapy for head and neck cancer were studied for 12 months. Patients in study group were given whole fruit pomegranate extract. Each capsule contained 300 mg of whole fruit extract, each capsule contains 40% polyphenols and 27% punicalagin. Each patient were given 2 capsules every day for a period of 6–7 weeks. The skin and mucosal changes was graded according to the acute radiation morbidity scoring criteria (RTOG) for skin and mucous membrane. The results were statistically significant. Pomegranate extract proved to be radioprotective. Our study is one of the first study in humans to demonstrate the effectiveness of pomegranate extract in preventing radiation dermatitis and mucositis.

http://ift.tt/2FEUGQf

Αρχειοθήκη ιστολογίου

Πέμπτη 15 Μαρτίου 2018

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