Head and Neck Medicine by Alexandros G.Sfakianakis: 03/22/18

Πέμπτη 22 Μαρτίου 2018

Local Anesthetic Injection Speed and Common Peroneal Nerve Block Duration: A Randomized Controlled Trial in Healthy Volunteers

Background and Objectives The speed of local anesthetic (LA) injections in peripheral regional anesthesia ranges from slow continuous infusions (3–12 mL/h) to rapid manual injections (>7500 mL/h). Optimizing injection speed could augment the spread of LA toward the targeted nerves and influence nerve block characteristics. The objective of this study was to investigate whether injection speed of a single dose of LA affects peripheral nerve block duration. Methods After approval from the Danish Regional Scientific Ethics Committee, we enrolled 60 healthy adult volunteers. We used an ultrasound-guided catheter-based technique to perform a common peroneal nerve block. Participants were randomized to receive 4.0 mL of ropivacaine 0.2% with 1 of 5 injection speeds: 12, 60, 300, 600, or 1800 mL/h. Investigators and participants were blinded to group assignment and intervention. Primary outcome was duration of sensory nerve block defined by insensitivity toward cold. Secondary outcomes were duration of motor nerve block, time to onset of sensory nerve block, and grades of sensory and motor nerve block. Intergroup differences were tested by one-way analysis of variance. Results We found no differences in sensory block duration between the 5 groups. Durations were median [range]: 11 [6–14], 12 [9–14], 10.5 [2–15], 11 [8–17], and 12 [9–18] hours, respectively (P = 0.294). In addition, we found no differences in secondary outcomes. Conclusions Injection speed of LA in the range of 12 to 1800 mL/h did not affect common peroneal nerve block duration. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT02801799. Accepted for publication November 13, 2017. Address correspondence to: Mikkel Herold Madsen, MD, Department of Anesthesiology, Nordsjællands Hospital Hillerød, Dyrehavevej 29, Building 52B, 4th Floor, DK-3400 Hillerød, Denmark (e-mail: mhmadsen@gmail.com). This work was funded by Innovation Fund Denmark and by Nordsjællands Hospital Hillerød. This work was presented in part at the American Society of Regional Anesthesia and Pain Medicine 42nd Annual Regional Anesthesiology and Pain Medicine Meeting; San Francisco, CA; April 6 to 8, 2017. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Case of a fractured human bone fragment as an endobronchial foreign body following a traffic incident

Endobronchial foreign bodies (EFBs) are present in various settings, such as eating or dental procedure. Accidental aspiration of foreign bodies is more common in children; however, cases of adult foreign body aspiration exist. Traumatic incidents can precipitate endobronchial aspiration of foreign bodies. Loss of consciousness, such as in coma, can result in foreign bodies being easily inhaled into the airways. Teeth or vehicle parts have been reported as EFBs following traumatic incidents. We report on a patient with chronic, sustained cough following maxillofacial trauma. Chest CT revealed an abnormal calcified endobronchial opacity. Flexible bronchoscopy confirmed the presence of an endobronchial foreign body in the left main bronchus. Following removal by bronchial forceps, the body was identified as a human bone fragment. Successful removal of the endobronchial bone fragment resulted in complete symptom remission. We concluded that post-traumatic respiratory complaints should be comprehensively evaluated, even if mild.

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What does vanishing bone disease look like?

Description

A previously healthy 44-year-old female presented with an acute history of increasing pain and reduced range of movement in her left shoulder. MRI scan revealed an infiltrative lesion in the proximal humerus, with a degree of cortical thinning and soft tissue involvement; however, initial biopsy provided no definitive diagnosis. Due to the suspicion of underlying malignancy, additional biopsies were organised. A second biopsy provided no diagnosis; however, a third biopsy taken 2 months after presentation revealed a benign vascular lesion with callus formation. This was consistent with the suspicion of our radiologist that a pathological fracture of the proximal humerus had been sustained following a minor fall (figure 1).

Figure 1

Radiograph of left humerus and shoulder at presentation.

Twelve months after presentation, with continued pain and swelling in the arm, further investigations were carried out. Radiographs demonstrated a second...

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Klippel-Trenaunay-Weber syndrome as a cause of chronic thromboembolic pulmonary hypertension

Description

A 52-year-old man was referred to an adult cardiovascular genetic clinic for lifelong venous tortuosity of the left leg. His medical history included recurrent deep venous thromboses of the left leg and pulmonary embolism complicated by oxygen-dependent chronic thromboembolic pulmonary hypertension and right-sided heart failure. He was taking warfarin and reported no family history of similar conditions. On examination, crackles were noted at bibasilar lungs. The left leg was slightly longer than the right leg, and giant tortuous veins were observed on the left side (figure 1A). MRI and angiography of the lower extremities revealed diffuse muscular hypertrophy (figure 1B) and bone elongation of the femur, tibia and fibula, as well as multiple capillary-venous malformations and tortuous deep and superficial veins (figure 1C) on the left leg. Chest tomography angiography showed pulmonary artery dilatation and calcified eccentric thrombus in the right pulmonary...

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Testicular torsion in a patient with Ehlers-Danlos syndrome

We present a 19-year-old man with a diagnosis of Ehlers-Danlos syndrome (EDS) and a delayed presentation of testicular torsion. EDS is a rare and heterogeneous condition affecting collagen synthesis and presents multiple difficulties in a surgical setting. Management of this case of testicular torsion was complicated by impaired cognition of the patient, difficulty with intubation, a contralateral undescended testis and postoperative bleeding. We discuss the specific challenges faced in this case of testicular torsion with longstanding ischaemia and perioperative considerations of EDS.

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Two cases of hypokalaemic rhabdomyolysis: same but different

In this paper, we present two women with hypokalaemic rhabdomyolysis in the context of increased diuretic intake and gastroenteritis, respectively. While their clinical manifestations and laboratory results were strikingly similar, two different underlying disorders were subsequently unveiled. The first patient was diagnosed with Conn syndrome, and adrenalectomy led to significant improvement of hypertension and sustained normokalaemia. The diagnosis in the second patient was Gitelman syndrome. Electrolyte supplements improved long-term lassitude and the frequency of muscle cramps declined significantly. These case vignettes illustrate the importance of establishing the underlying cause of hypokalaemia.

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A rare presentation of haematuria: hip prosthesis in the bladder

An 80-year-old woman presented to our department with visible haematuria and stage II acute kidney injury (AKI). She had stage IIB cervical cancer, for which she received chemotherapy and external beam radiotherapy in 2003. Four years later, she had a left dynamic hip screw for an extracapsular neck of femur fracture following a fall. In 2010, she underwent a right total hip replacement owing to osteoarthritis, and it was subsequently revised in 2012 owing to a right acetabular component failure. In this admission, her AKI improved with intravenous fluid administration and her haematuria settled following catheterisation with a three-way catheter and bladder irrigation with saline. She underwent a flexible cystoscopy which revealed that a part of her right hip prosthesis was in the bladder, having eroded through the right bony pelvis. However, she declined any surgical interventions.

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Importance of source images of time-of-flight magnetic resonance angiography in the diagnosis of low-flow dural arteriovenous fistulae after traumatic brain injury

Three-dimensional time-of-flight (TOF) magnetic resonance angiography (MRA) can reliably detect dural arteriovenous fistula (dAVF); however, TOF source images should be checked in cases with low-flow dAVFs. A 69-year-old woman reported intractable pulsatile tinnitus after head trauma. It was difficult to diagnose dAVF using conventional MRA, but it was confirmed using a TOF source image. Cerebral angiography revealed a dAVF with a small shunted pouch draining into the sigmoid sinus, accompanying the arterial jet flow. Transarterial embolisation of the shunted pouch completely obliterated the dAVF. The patient's tinnitus immediately disappeared after embolisation. This case suggests that a low-flow Borden type I dAVF is undetectable using conventional MRA, and we emphasise the importance of evaluating TOF source images. Transarterial embolisation of the shunted pouch while preserving the normal sinus flow was safe and effective.

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Rhinofacialentomophthoromycosis

Entomopthoromycosis is a rare subcutaneous fungal infection caused by onidiobolus coronatus affecting mainly the upper respiratory mucosa in immunocompetent people.The manifestations of this disease masquerades other clinical entities.Hence, high index of suspicion is required for prompt diagnosis.Histopathological examination and culture are the gold standard diagnostic tools, however no standard treatment protocols ha been mentioned in literature.We present a case of rhinofacial entomopthoromycosis in a yearold ma with a leftsided rhinofacial swelling to highlight the presence of this unusual fungal infection and its treatment.

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Central congenital hypothyroidism caused by maternal thyrotoxicosis

Central congenital hypothyroidism (CCH) is a rare and underdiagnosed disease that sometimes is caused by maternal Graves' disease. We report a case of CCH caused by undiagnosed, initially antibody-negative maternal thyrotoxicosis with possible disruption of fetal hypothalamic-pituitary-thyroid axis maturation. In CCH, maternal thyroid disease should be considered.

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Tarsal buckle with conjunctival prolapse following levator plication for unilateral congenital ptosis

An 8-year-old child underwent uneventful levator plication surgery for unilateral congenital ptosis. Postoperative course for initial few days was uneventful but on day 7, the patient was brought with conjunctival prolapse from the undersurface of upper eyelid due to tarsal kinking and eversion. Early medical management was initiated with frequent surface lubrication to avoid conjunctiva dryness. Under general anaesthesia, right-sided conjunctival repositioning was performed with an eyelid spatula supplemented by three forniceal stay sutures to retain the conjunctiva in its anatomical place. To reverse the tarsal kinking, continued downward traction suture was placed for a period of 2 weeks. At the end of 4 weeks, the conjunctival prolapse was completely resolved with a well-formed superior fornix. At the end of 3 months, the symmetric eyelid position was maintained without any additional complications.

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Complication of intraprosthetic dislocation of dual-mobility hip implant following closed reduction

Total hip replacement is a successful operation for the management of hip pain but there are potential complications, of which dislocation is one of the most common. The management of recurrent dislocation is a challenging problem that requires a multimodal approach and the use of dual-mobility implants is one option. We present a patient who was previously revised with a dual-mobility implant for recurrent dislocation, who had a complication after closed reduction of a subsequent intraprosthetic dislocation. Following a missed radiographical diagnosis, the patient experienced mechanical symptoms on hip flexion caused by a disassociated dual-mobility implant. Subsequent surgical removal of the failed implant and revision was required. Careful study of radiographs revealed an eccentric femoral head and evidence of the disassociated implant within the surrounding soft tissues. Radiographs following closed reduction of intraprosthetic dislocations should be scrutinised closely to detect implant failure to prevent further complications.

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Myocarditis secondary to smallpox vaccination

The development of vaccines ushered in the most profound advancement in 20th century medicine, and have widely been regarded as the one of the most important scientific discovery in the history of mankind. However, vaccines are not without risk; reactions can range from injection site reactions to life-threatening anaphylaxis. Among the more serious vaccine-related sequela is myocarditis. Although myocarditis has been reported following many different vaccines, the smallpox vaccine has the strongest association. We report a case of a 36-year-old active duty service member presenting with progressive dyspnoea, substernal chest pain and lower extremity swelling 5 weeks after receiving the vaccinia vaccination. The aetiology of his acute decompensated heart failure was determined to be from myocarditis. Although the majority of cases of myocarditis resolve completely, some patients develop chronic heart failure and even death. Vaccine-associated myocarditis should always be on the differential for patients that exhibit cardiopulmonary symptoms after recent vaccinations.

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Parkinsons disease with hypocalcaemia: adult presentation of 22q11.2 deletion syndrome

A growing amount of evidence indicates that 22q11.2 deletion syndrome (22q11.2DS) increases the risk of early-onset Parkinson's disease (EOPD). Here, we describe a 36-year-old patient with EOPD. The patient presented with 22q11.2DS features, including associated cognitive disabilities, hypocalcaemia and facial dysmorphia that led us to screen for and confirm this deletion. In addition, hypocalcaemia and vitamin D deficiency were the main factors responsible for severe, painful muscle spasms that were non-levodopa (L-Dopa) responsive and remitted after calcium and vitamin D replacement therapy. Many patients with this deletion remain undiagnosed until adulthood due to the absence of 'major' phenotypic hallmarks, which usually present during early childhood. Later onset problems involving various medical subspecialties are increasingly recognised as important components of 22q11.2DS. Therefore, the multisystem nature and associated burden of morbidities demand a high degree of suspicion for this entity from all clinicians regardless of their medical subspecialty.

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Diffusion-weighted imaging is helpful in the accurate non-invasive diagnosis of breast abscess: correlation with necrotic breast cancer

Clinical differentiation of atypical breast abscesses from necrotic tumour in premenopausal women is challenging and may delay appropriate therapy. In this case report, we present a 36-year-old woman with signs, symptoms and conventional imaging features of malignancy who underwent breast MRI. On diffusion-weighted imaging (DWI), profoundly low apparent diffusion coefficient values were a distinguishing sign of breast abscess from necrotic breast cancer, and helped manage the patient conservatively. We present a companion case of necrotic breast tumour highlighting significant differences in DWI.

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Effect of Splenectomy on Serum Cytokine Profiles in Hepatitis B Virus-Related Cirrhosis Patients with Portal Hypertension

Viral Immunology, Ahead of Print.

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A brave new world

Abstract

Whereas up to 1950s the two major activities of academic Pathology—diagnostic and experimental—were both practiced by a single individual, thereafter, scientific, academic and economic factors created the conditions that favored monothematic practitioners. In this white paper, I argue that now, at the beginning of the 21^st century, this separation is detrimental to the discipline, and I propose changes that would reunite the two strands.

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Intracell Heat Shock Protein 70 Expression and Nasopharyngeal Carcinoma Stage

Abstract

Tumor growth and metastasis in nasopharyngeal carcinoma (NPC) patients recent research stated that intracellular Hsp70 is a stress protein as the main factor for the growth, invasion and metastasis of NPC. To analyze intracellular Hsp70 protein expression of NPC patients which correlate with staging of NPC as clinical manifestation. Formalin-fixed paraffin-embedded biopsy specimens from 20 NPCs histopathology and clinically. The expression of intracellular Hsp70 was obtained using monoclonal antibody of Anti Human Hsp70 from Santa Cruz Biotechnology, California, USA. The assessment of the staining was performed with Remmele methode by Histopathologies doctor Consultant. 20 NPC patients met the inclusion and exclusion criteria. The data showed a negative intracellular of Hsp70 expression by 15% for all sample that consist of 1 patient of stage I, II, III, and none for stage IV. Then, followed by 25% of mild positive intracellular Hsp70 expression which consisted of 0 patient of stage I and III, 2 patients of stage II, and 3 patients of stage IV. Followed by 50% of moderate positive intracellular Hsp70 expression which consisted of 0 patient of stage I and II, 1 patient of stage III, and 9 patients of stage IV. Spearman test results test scored p = 0.001 with a correlation coefficient of 0.671. The correlation of intracellular Hsp70 protein expression with stage (I, II, III, and IV) in NPC patients was significant (p < 0.05). There was a correlation between increased intracellular Hsp70 expression and the stage of patients with nasopharyngeal carcinoma.

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Post Parotidectomy Quality of Life in Patients with Benign Parotid Neoplasm: A Prospective Study

Abstract

Parotid tumours are not uncommon. The management is surgical for benign and malignant parotid neoplasm. Due to the location of parotid gland and its intricate relationship with facial nerve, cosmetic and functional outcomes after parotid surgery are extremely important. Objectives of the study were to analyse facial nerve functions with emphasis on the quality of life of patients undergoing surgery for parotid neoplasm. A prospective study was conducted on patients presented with parotid neoplasm and undergone parotid surgery. Patient with malignant neoplasm were excluded. 30 patients with benign parotid neoplasm in final histopathology were included in the study. Post operative assessment of facial nerve was done using postparotidectomy facial nerve grading system. Symptom-specific QOL was assessed with the parotidectomy outcome inventory-8. Aesthetic outcome was evaluated with an ordinal scale. Posterior belly of digastric muscle and tragal pointer were the commonest landmark used for facial nerve identification. Temporary facial nerve dysfunction was present in six (20%) patients with marginal mandibular branch most commonly involved. 96% of the female patients and 91% of the male patients rated the cosmetic result as good or very good. A statistically significant difference is noted between superficial parotidectomy and total Parotidectomy for cosmetic outcome and sensory impairment. We noted that changed appearance due to resection of the parotid gland and scar and sensory impairment in the area affect the quality of life of patients and such affect are more after total conservative parotidectomy.

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The Journal of Dermatology, Ahead of Print.

The Journal of Dermatology, Ahead of Print.

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The Journal of Dermatology, Ahead of Print.

The Journal of Dermatology, Ahead of Print.

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Intracell Heat Shock Protein 70 Expression and Nasopharyngeal Carcinoma Stage

Abstract

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Post Parotidectomy Quality of Life in Patients with Benign Parotid Neoplasm: A Prospective Study

Abstract

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Biologicals in der Rhinologie – Individualisierte Konzepte der Zukunft

Laryngo-Rhino-Otol 2018; 97: S1-S22
DOI: 10.1055/s-0043-123484

Sinunasale Erkrankungen zählen mit zu den häufigsten chronischen Erkrankungen und führen zu einer erheblichen Störung der Lebensqualität, ein komorbides Asthma ist häufig. Trotz leitliniengerechter Therapie ist anzunehmen, dass mind. 20% der Patienten ihre Erkrankungssymptome nicht adäquat kontrollieren können. Neben den etablierten chirurgischen und konservativen Therapieoptionen finden sich nun vielversprechende Therapieansätze, die bspw. mittels therapeutischer Antikörper mechanistisch gezielt in die Pathophysiologie der Erkrankungen eingreifen können. Die Auswahl der geeigneten Patienten durch geeignete Biomarker und die richtige Therapie zum richtigen Stadium der Erkrankung anbieten zu können, ist das Ziel stratifizierter Medizin und eine wichtige Perspektive für die HNO.
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Molekulares Verstehen des Hörens – Was ändert sich für den Patienten?

Laryngo-Rhino-Otol 2018; 97: S1-S9
DOI: 10.1055/s-0043-121595

Das Innenohr und die Hörbahn mit ihren vergleichsweise geringen Zellzahlen haben sich einigen molekularen Ansätzen bislang beharrlich entzogen. Gleichzeitig vollbringt das Hören Spitzenleistungen, die sehr spezialisierte biologische Mechanismen nahelegen. Dies bedeutet einerseits, dass Analogieschlüsse zur molekularen Anatomie und Physiologie der Zellen des Hörsystems auf der Grundlage von Erkenntnissen aus molekular besser zugänglichen Systemen von beschränktem Nutzen sind. Andererseits legt eine solche Spezialisierung Gendefekte nahe, die von der Evolution toleriert wurden, weil sie nicht zur Fehlfunktion von essentiellen Körperprozessen führen. Technologische Fortschritte in der Humangenetik und der molekularen Analyse des Innenohrs im Tier bestätigen beide Annahmen und beleuchten den faszinierenden Mikrokosmos der Cochlea. Auf kleinstem Raum werden hier in konsequenter Arbeitsteilung herausragende Leistungen im Ionentransport, der Mechanotransduktion, der aktiven Zellmotilität und der synaptischen Verarbeitung erbracht. Einige der zugrundeliegenden molekularen Maschinen, z. B. das Motorprotein Prestin und das an synaptischer Fusion beteiligte Otoferlin, sind ausschließlich im Ohr aktiv. Dementsprechend führen ihre Defekte zu spezifischen nicht-syndromalen Schwerhörigkeiten, wie etwa bei der auditorischen Synaptopathie durch autosomal rezessive Mutationen im Otoferlin-Gen. Andere Mutationen, wie die den cochleären Kalium-Zyklus betreffenden, bedingen einen globalen Funktionsverlust der Cochlea. Viele genetische Defekte führen schließlich zur Degeneration des Innenohrs. Letztlich führt die molekulare Analyse sowohl beim Menschen, als auch im Tier-Innenohr aber auch zu neuen Erkenntnissen für häufige Formen der Schwerhörigkeit. So wurde der immunhistochemische Nachweis des Verlusts von Bandsynapsen der inneren Haarzellen zum Biomarker für „hidden hearing loss" im Tiermodell. Die moderne Hochdurchsatz-Sequenzierung (sog. Next Generation Sequencing – NGS) bietet Zugang zu bislang nicht bekannten Taubheitsgenen, Mutationsspektren von bekannten Taubheitsgenen und zu einem genetischen Profil der individuellen Schwerhörigkeit, ihre Interpretation erfordert jedoch große humangenetische Expertise und umfangreiche tierexperimentelle Einsichten. Eine kausale Therapie etwa durch viralen Genersatz, der im Tier-Innenohr und bei einzelnen Formen der humanen Blindheit bereits erfolgreich ist, steht für die Schwerhörigkeit in der Klinik noch nicht zur Verfügung. Bereits jetzt ermöglichen molekulare Ansätze aber schon eine verbesserte Beratung von schwerhörigen Patienten.
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Das Mikrobiom – die unplanbare Größe zukünftiger Therapien

Laryngo-Rhino-Otol 2018; 97: S1-S17
DOI: 10.1055/s-0043-122301

Unter Mikrobiom versteht man die Gesamtheit der bakteriellen, parasitären, viralen oder anderen zellulären Mikroorganismen, die den menschlichen Körper oder ein anderes Lebewesen besiedeln. Das Mikrobiom zeigt in den anatomischen Bereichen der Hals-Nasen-Ohrenheilkunde eine deutliche regionale Varianz. Für die Bereiche von Ohr, Nase, Rachen, Larynx und Haut sind jeweils verschiedene Interaktionen des Mikrobiomes mit allgemeinen Faktoren wie Alter, Diät und Lebensstilfaktoren (z. B. Rauchen) in den letzten Jahren bekannt geworden. Zudem liegen eine Reihe von Erkenntnissen vor, dass das Mikrobiom an der Pathogenese verschiedener Erkrankungen auch im HNO-Bereich beteiligt ist. Der vorgestellte Übersichtsartikel fasst die wesentlichen Erkenntnisse dieses sich aktuell äußerst rasch entwickelnden Forschungsgebietes überblickartig zusammen.
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HPV – Das andere Kopf-Hals-Karzinom

Laryngo-Rhino-Otol 2018; 97: S1-S34
DOI: 10.1055/s-0043-121596

Kopf-Hals-Tumore sind die sechst-häufigste Krebsart mit über 500000 jährlich gemeldeten Fällen weltweit. Die Hauptrisikofaktoren sind Tabak- und Alkoholkonsum, wobei v. a. Oropharynxkarzinome (OSCC) vermehrt eine Assoziation mit humanen Papillomaviren (HPV) aufweisen. Bei HPV-assoziierten und HPV-negativen OSCC handelt es sich bezüglich biologischer Charakteristika, Therapieansprechen und Prognose der Patienten um 2 eigenständige Entitäten, die allerdings bisher identisch behandelt werden. Bei HPV OSCC spielen neben der Aktivität viraler Onkoproteine auch genetische (Mutationen und chromosomale Aberrationen) und epigenetische Veränderungen eine entscheidende Rolle bei der Krebsentstehung. Aufgrund des besseren Therapieansprechens wird aktuell über die Einführung einer De-Intensivierung der Therapie und über zielgerichtete Therapieoptionen für Patienten mit HPV OSCC diskutiert. Ein vielversprechendes zielgerichtetes Therapiekonzept ist bspw. die Immuntherapie. Besonders intensiv wird derzeit die Anwendung von Checkpoint-Inhibitoren (z. B. gegen PD1) erforscht. Mithilfe sogenannter Flüssigbiopsien sollen zukünftig weitere Biomarker, in Form von viraler DNA oder Tumor-Mutationen, zur Überwachung des Krankheitsverlaufs und frühzeitigen Erkennens von Therapieversagen eingesetzt werden. Zur primären Prophylaxe einer Tumorentstehung ist die HPV-Impfung von männlichen und weiblichen Jugendlichen empfehlenswert.
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Radiomics: Big Data statt Biopsie in der Zukunft?

Laryngo-Rhino-Otol 2018; 97: S1-S15
DOI: 10.1055/s-0043-121964

Die Präzisionsmedizin wird – auch mit Zunahme gezielter Therapieoptionen durch Biologicals – immer mehr vorangetrieben. Die individuelle Charakterisierung einer Erkrankung auf der Grundlage von Biomarkern im weitesten Sinne ist eine grundlegende Voraussetzung hierfür. Diese Biomarker können bisher klinisch, histologisch oder molekular bestimmt werden. Die Entwicklung breiter Screening Methoden und gleichzeitig die Möglichkeit, große Datenmengen („Omics" ) mit geeigneter Software immer besser zu analysieren, führen dazu, dass man sich nicht nur auf einzelne Biomarker beschränkt, sondern Biomarker-Signaturen darstellen kann. Die „Radiomics" finden neben „Genomics", „Proteomics" oder „Metabolomics" in den letzten Jahren zunehmendes Interesse und erweitern das Biomarkerfeld. Basierend auf radiologischen Bildern werden eine Vielzahl von Merkmalen mithilfe spezifischer Algorithmen extrahiert. Diese Merkmale werden mit klinischen, (immun-) histopathologischen und genomischen Daten korreliert. Erfasste Strukturunterschiede sind Bestandteil der den Bildern zugrundeliegenden unbearbeiteten Metadaten. Diese sind für das bloße Auge oft nicht sichtbar und insofern ohne spezifische Software für den Untersucher nicht zu erfassen. Sie lassen sich aber numerisch abbilden und grafisch visualisieren. Ein besonderer Reiz der „Radiomics" ist, dass bereits routinemäßig durchgeführte Bildgebungen einen Biomarker-Charakter zeigen. Dieser hat das Potenzial, Zusatzuntersuchungen oder Biopsien idealerweise durch eine „Radiomics" Analyse zu ersetzen. Alternativ könnten „Radiomics"-Signaturen andere Biomarker suffizient ergänzen und hierdurch eine präzisere, multimodale Aussage ermöglichen. Bisher finden Radiomics vor allem in der Onkologie solider Tumore Anwendung. Auch bei Kopf-Hals-Karzinomen wurden bereits erste vielversprechende Untersuchungen veröffentlicht.
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Robotische Chirurgie – operiert der Roboter?

Laryngo-Rhino-Otol 2018; 97: S1-S25
DOI: 10.1055/s-0043-121791

Der Roboter-assistierten Chirurgie (RAC) im Kopf-Hals-Bereich wird ein großes Potenzial zugeschrieben. Vor allem in der operativen Onkologie wird der Einsatz von Roboter-Systemen als besonders interessant erachtet. Bislang sind 2 Gerätetypen (DaVinci® und FLEX®) für die klinische Anwendung im Kopf-Hals-Bereich zugelassen, und multiple weitere Systeme befinden sich in der präklinischen Erprobungsphase. Auch wenn prinzipiell bestimmte Patientengruppen von der RAC profitieren könnten, finden sich keine systematischen randomisierten Studien. Ein möglicher Vorteil der RAC gegenüber den bisherigen Standardverfahren kann daher bisher nicht nachgewiesen werden. Der begrenzte klinische Nutzen und die finanzielle Zusatzbelastung scheinen aktuell der Hauptgrund zu sein, warum der flächendeckende Einsatz der RAC bislang ausgeblieben ist. Diese Übersichtsarbeit beschreibt die verschiedenen Anwendungsmöglichkeiten der RAC im Kopf-Hals-Bereich. Außerdem werden die finanziellen und technischen Herausforderungen, sowie anstehende Weiterentwicklungen der RAC beleuchtet. Besonderes Augenmerk wird auf spezielle Risiken der Roboter-Chirurgie und aktuell laufende klinische Studien gelegt. Mittelfristig wird davon ausgegangen, dass die RAC Einzug in die klinische Routine erhalten wird und sich das medizinische Personal zunehmend mit den technischen, wissenschaftlichen und auch ethischen Besonderheiten auseinandersetzen muss.
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Regeneration – eine neue therapeutische Dimension in der Hals-Nasen-Ohrenheilkunde

Laryngo-Rhino-Otol 2018; 97: S1-S15
DOI: 10.1055/s-0043-122309

Die Regeneration als therapeutisches Prinzip und damit die Regenerative Medizin ist ein vielversprechender Ansatz künftig die therapeutischen Optionen der Hals-Nasen-Ohrenheilkunde um eine weitere Dimension zu erweitern. Während heute rekonstruktive chirurgische Verfahren, Medikamente und Prothesen wie bspw. das Cochlea Implantat die Funktionen defekter Gewebe im Kopf-Hals-Bereich ersetzen, sollen durch die Regenerative Medizin die defekten Gewebe und deren Funktion selbst wiederhergestellt werden. In dieser Übersichtsarbeit werden neue Entwicklungen wie das 3D-Bioprinting und dezellularisierte, natürliche Biomaterialien für regenerative Ansätze vorgestellt und durch eine Zusammenstellung aktueller präklinischer und klinischer Studien im Bereich der Regenerativen Medizin in der Hals-Nasen-Ohrenheilkunde ergänzt.
[...]

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

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Editorial Referateband 2018

Laryngo-Rhino-Otol 2018; 97: S1-S1
DOI: 10.1055/s-0044-101376

Liebe Kolleginnen und Kollegen,mit großer Freude lege ich den Referateband zur 89. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie vor. Dem Kongressmotto „Forschung heute – Zukunft morgen" folgend werden einige der Themen im Detail beleuchtet, die in den nächsten Jahren das Potential haben, die Versorgung unserer Patienten grundlegend zu verändern.
[...]

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

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Immuntherapie – Die neue Ära in der Onkologie

Laryngo-Rhino-Otol 2018; 97: S1-S23
DOI: 10.1055/s-0043-121594

In den letzten Jahren wurden bedeutende Fortschritte auf dem Gebiet der Immuntherapie erreicht mit teils langanhaltendem Therapieansprechen bei unterschiedlichsten Tumorentitäten. Die Basis hierfür bildet ein verbessertes Verständnis der Interaktion zwischen Tumor und Immunsystem und der damit verbundenen Integration immuntherapeutischer Ansätze in die klinische Routine. Die hierbei eingesetzten immuntherapeutischen Strategien greifen auf unterschiedlichen Ebenen der Immunantwort ein, fördern direkt oder indirekt die Zerstörung der Tumorzellen durch die körpereigene Abwehr und reichen von Zytokintherapien über Vakzinierungen und den Einsatz onkolytischer Viren bis hin zu monoklonalen Antikörpertherapien und dem adoptiven Zelltransfer.
[...]

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

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Safety of a two-day ultra-rush immunotherapy in vespid allergic patients: focus on elevated serum tryptase.

Systemic mastocytosis (SM) is a disorder caused by the abnormal proliferation of mast cells (MCs) in one or more organs, leading to heterogeneous clinical presentations. SM patients are more at risk for hymenoptera-sting-induced anaphylaxis1 and in these patients indolent systemic mastocytosis (ISM) is the most frequent form of this disorder.

http://ift.tt/2G5Atzn

From the pages of allergywatch recent advances in our understanding of the environment's role in allergy

The indoor environment can have a major impact on asthma morbidity in children. Indoor exposures include not only allergens such as dust mite but also pollutants such as secondhand smoke. This report highlights the role of indoor environmental control practices in the management of childhood asthma. Environmental control measures should be tailored to the individual child, based on knowledge of allergic sensitivities and relevant indoor exposures. An environmental history can be performed, addressing key exposures known to trigger the child's asthma symptoms and exacerbations.

http://ift.tt/2px4IZx

Head &Neck, Ahead of Print.

Head &Neck, Ahead of Print.

http://ift.tt/2G3IeG6

Head &Neck, Ahead of Print.

Head &Neck, Ahead of Print.

http://ift.tt/2IKRwbN

Head &Neck, Ahead of Print.

Head &Neck, Ahead of Print.

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Head &Neck, Ahead of Print.

Head &Neck, Ahead of Print.

http://ift.tt/2ILrzsn

Head &Neck, Ahead of Print.

Head &Neck, Ahead of Print.

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Thyroid® High-Impact Articles

FREE ACCESS through April 5, 2018.
Read now:

Latest Impact Factor: 5.515
The Official Journal of: American Thyroid Association^®

Preimplantation Genetic Diagnosis of Multiple Endocrine Neoplasia Type 2A Using Informative Markers Identified by Targeted Sequencing
Songchang Chen, Shuyuan Li, Junyu Zhang, Lanlan Zhang, Yiyao Chen, Li Wang, Li Jin, Yuting Hu, Xiaoping Qi, Hefeng Huang, and Chenming Xu

Effect of Thyroglobulin Autoantibodies on the Metabolic Clearance of Serum Thyroglobulin
Francesco Latrofa, Debora Ricci, Sara Bottai, Federica Brozzi, Luca Chiovato, Paolo Piaggi, Michele Marinò, and Paolo Vitti

Discriminatory miRNAs for the Management of Papillary Thyroid Carcinoma and Noninvasive Follicular Thyroid Neoplasms with Papillary-Like Nuclear Features
Iman Jahanbani, Abeer Al-Abdallah, Rola H. Ali, Nabeel Al-Brahim, and Olusegun Mojiminiyi

Mild Maternal Hypothyroxinemia During Pregnancy Induces Persistent DNA Hypermethylation in the Hippocampal Brain-Derived Neurotrophic Factor Gene in Mouse Offspring
Kenichi Kawahori, Koshi Hashimoto, Xunmei Yuan, Kazutaka Tsujimoto, Nozomi Hanzawa, Miho Hamaguchi, Saori Kase, Kyota Fujita, Kazuhiko Tagawa, Hitoshi Okazawa, Yasuyo Nakajima, Nobuyuki Shibusawa, Masanobu Yamada, and Yoshihiro Ogawa

A Nomogram Based on the Characteristics of Metastatic Lymph Nodes to Predict Papillary Thyroid Carcinoma Recurrence
Lei Jianyong, Zhong Jinjing, Li Zhihui, Wei Tao, Gong Rixiang, and Zhu Jingqiang

The post <i>Thyroid<sup>®</sup></i> High-Impact Articles appeared first on American Thyroid Association.

http://ift.tt/2FWafmH

Discrepancy between clinical and pathological neck staging in oral cavity carcinomas

Publication date: March–April 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 2
Author(s): Vânia Henriques, Eduardo Breda, Eurico Monteiro
IntroductionThe presence of cervical lymph node metastases in patients with oral cavity squamous cell carcinoma reduces survival by up to 50%.ObjectiveThe aims of this study are to assess the accuracy of clinical N staging versus pathological N staging and its impact on survival in order to identify predictive factors associated with the presence of occult neck metastases.MethodsOutcomes of 105 patients with oral cavity squamous cell carcinoma who underwent surgical treatment of the primary tumor and neck were retrospectively evaluated.ResultsFor pN0 and pN+ patients 5-year overall survival was respectively 53% and 27%; disease specific survival was 66% for pN0 and 33% for pN+. Patients with clinical negative lymph nodes were pathologically upstaged in 62% of cases. Disease specific survival according to staging discrepancy had statistically significant impact on survival (p=0.009).ConclusionClinical staging usually underestimates the presence of nodal disease. Neck dissection should be performed in cN0 oral cavity squamous cell carcinoma.

http://ift.tt/2IK6FtL

Impact of Total Laryngectomy on Return to Work

Publication date: March–April 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 2
Author(s): Jose Miguel Costa, Montserrat López, Jacinto García, Xavier León, Miquel Quer
IntroductionTotal laryngectomy is one of the most mutilating oncological operations. There are no specific studies evaluating return to work after this surgery.Patients and methodsA cross-sectional study was performed on a sample of 116 laryngectomized patients who were disease-free and had a minimum follow-up of 2 years from total laryngectomy. A survey was conducted to find out their employment situation before and after surgery. At the time of surgery, 62 (53%) were working, 40 (35%) were retired and 14 (12%) were in a disability situation.Results60% had professions with low qualification requirements, the largest group being construction workers. Of the 62 patients active at the time of total laryngectomy, 29 became inactive and 33 (53%) maintained their work activity. The most important factors in maintaining work activity were the level of professional qualification and the method of vocal rehabilitation. Eighty percent of the patients with high-intermediate qualification maintained their jobs, compared to 35% of those with low professional qualifications (P<.001). Seventy percent of the patients with voice prostheses maintained their work activity, compared to 31% of the patients rehabilitated with oesophageal voice (P=.004). Logistic regression confirmed these as independent variables for continuing to work.ConclusionsThis is the first study that analyzes the impact of total laryngectomy on the work situation. The most important factors for a return to work were having a high-intermediate skilled job and the use of voice prosthesis as a method of vocal rehabilitation.

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Salivary Pepsin Test: Useful and Simple Tool for the Laryngopharyngeal Reflux Diagnosis

Publication date: March–April 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 2
Author(s): Luz Barona-Lleó, Claudia Duval, Rafael Barona-de Guzmán
Introduction and objectivesLaryngopharyngeal reflux (LPR) is a disease characterized by the presence of symptoms, signs and tissue damage caused by retrograde flow of gastric contents to the upper aerodigestive tract. It represents up to 10% of otolaryngology consultations.The aim of the study is to describe the findings obtained by applying the salivary pepsin test (PEP-test) in a sample of patients with the clinical suspicion of LPR.Material and methodsOur descriptive clinical study included 142 subjects with symptoms suggestive of LPR and a score above 13 on the RSI scale. The subjects underwent laryngeal endoscopy to rule out other pathologies that could justify the symptoms and the salivary pepsin test (PEP-test). The latter was carried out on fasting subjects and a second test one hour after eating, only on those with negative results.ResultsThe results obtained in the tests performed on the 142 patients included in the study were: 105 (73.94%) presented positive results in some of the salivary pepsin tests and the results of both tests were negative in 37 subjects (26.06%).ConclusionThe salivary pepsin test is a simple, low-cost, non-invasive and easily repeatable tool which could minimize empirical treatments and invasive tests for LPR diagnosis, although further research is needed for its validation.

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Radioguided Surgery in Primary Hyperparathyroidism: Results and Correlation With Intraoperative Histopathologic Diagnosis

Publication date: March–April 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 2
Author(s): Juan P. Suárez, María L. Domínguez, Francisco J. de Santos, José M. González, Nuria Fernández, Fidel J. Enciso
Introduction and objectivesRadioguided surgery is a minimally invasive surgical technique for the treatment of primary hyperparathyroidism. The goals of our study were to evaluate the rate of success and compare the results with intraoperative histological analysis.MethodsWe retrospectively studied 84 patients with primary parathyroidism who had undergone radioguided surgery. All the patients had a positive parathyroid scintigraphy prior to surgery. An intravenous injection of Tc-99m sestamibi was administered before surgery, and radioguided location of the pathologic parathyroid tissue was performed using an intraoperative gamma probe, applying the "20% rule". All resected specimens underwent intraoperative histologic analysis. All patients were followed up for at least 6 months. Positive predictive values of both parathyroid scintigraphy and cervical ultrasonography were also compared.ResultsRadioguided surgery success rate was 99%. Sensitivity, specificity, positive and negative predictive values for gamma probe were 99%, 73%, 97% and 89%, respectively. After surgery, 83 of 84 patients were eucalcaemic (99%) and parathyroid hormone normalised in 77 of 84 patients (92%). Ultrasonography showed low positive predictive value (41%) when compared with scintigraphy.ConclusionsRadioguided surgery is a minimally invasive surgical technique with excellent results for the treatment of primary hyperparathyroidism and could replace both intraoperative histological analysis and intraoperative parathyroid hormone assay. Further studies are needed to confirm these findings.

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Correlation Between Measures of Perceptual Assessment of GRB and Contact Quotient (CQ)

Publication date: March–April 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 2
Author(s): Rodrigo Maximiliano Jerez
ObjectiveThe aim of the present work is to correlate the perceptual parameters grade, roughness, and breathiness of the GRB scale with the contact quotient (CQ) obtained by electroglotography.Material and method70 samples of normal and pathological voices were analysed by means of auditory-perceptual analysis and electroglotography. The perceptual analysis was carried out by two expert judges depending on the parameters grade, roughness, and breathiness. The CQ values were obtained through the VoceVista System Version 3.3.7.ResultsThe results show a strong correlation between CQ and breathiness (r=−0.869), whereas between grade of dysphonia and CQ (r=−0.567), and roughness and CQ (r=0.643) the correlation is average.ConclusionsIt is possible to establish relationships between the vibrational behaviour of the vocal folds and the resulting phenomenon that we perceive auditively. The most relevant parameter in this respect was breathiness. The correlation between grade, roughness and CQ was weaker.

http://ift.tt/2GfnkXB

Cleft Lip and Palate Subjects Prevalence of Abnormal Stylohyoid Complex and Tonsilloliths on Cone Beam Computed Tomography

Publication date: March–April 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 2
Author(s): Eymi Valery Cazas-Duran, Izabel Regina Fischer Rubira-Bullen, Otávio Pagin, Bruna Stuchi Centurion-Pagin
Introduction and objectivesTonsilloliths and abnormal stylohyoid complex may have similar symptoms to others of different aetiology. Individuals with cleft lip and palate describe similar symptoms because of the anatomical implications that are peculiar to this anomaly. The aim of this study was to determine the prevalence of abnormal stylohyoid complex and tonsilloliths on cone beam computed tomography in individuals with cleft lip and palate.MethodsAccording to the inclusion and exclusion criteria, 66 CT scans out of 2794 were analysed, on i-Cat^® vision software with 0.8 index Kappa intra-examiner.ResultsThe total prevalence of ossification of the incomplete stylohyoid complex in individuals with cleft lip and palate was 66.6%; the prevalence of these findings in females was 75% and 61.9% in males. The total prevalence of tonsilloliths was 7.5%.ConclusionIt is important to ascertain calcification of the stylohyoid complex and tonsilloliths in the radiological report, due to the anatomical proximity and similar symptomatology to other orofacial impairments in individuals with cleft lip and palate, focusing on females with oral cleft formation, patients with incisive trans foramen cleft and incisive post foramen cleft because they are more prevalent. Greater knowledge of the anatomical morphometry of individuals with cleft lip and palate greatly contributes towards the selection of clinical behaviours and the quality of life of these patients, since cleft lip and palates one of the most common anomalies.

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Efficacy of the Myofascial Pectoralis Major Flap in the Reduction of Salivary Fistulas After Salvage Total Laryngectomy

Publication date: March–April 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 2
Author(s): Carlos Miguel Chiesa Estomba, Jose Angel González García, Jon Alexander Sistiaga Suarez, Izaskun Thomas Arrizabalaga, Ekhiñe Larruscain Sarasola, Xabier Altuna Mariezcurrena
IntroductionPharyngocutaneous fistula is the most frequent complication after total laryngectomy. Its incidence varies between 9%–25% in post primary total laryngectomy patients, to 14%–57% in salvage laryngectomy post radiotherapy or post chemotherapy+radiotherapy. The pectoralis major myofascial flap (PMMF) is postulated as a useful tool to decrease the incidence of this complication.Materials and methodRetrospective analysis of a group of patients treated by salvage laryngectomy, associated or not with pharyngeal closure reinforcement with PMMF.ResultsTwenty patients were included, 18 males (90%) and 2 females (10%), in 10 of whom the PMMF was used. The average age was 66.65 years. Seventeen (85%) had a laryngeal tumour and 3 (15%) had a hypopharyngeal tumour. Eight (80%) patients in the non-PMMF group had postoperative fistula, whereas only 2 (20%) patients in the PMMF group had a fistula during the postoperative period (P=.005). The mean time for fistula closure was significantly shorter in the cases where PMMF flap was used (16±11 days vs. 76.8±67 days, P=.001), as was hospital stay (19.6±18 days vs. 83.9±77 days, P=.001).ConclusionThe use of PMMF in our series is associated with a lower rate of post salvage laryngectomy fistulas in patients treated primarily by organ preservation protocol for laryngeal/hypopharyngeal cancer. In turn, it promotes local healing by decreasing the mean duration of fistula closure and the mean hospital stay.

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Cochleotoxicity monitoring protocol

Publication date: March–April 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 2
Author(s): José Ferreira Penêda, Nuno Barros Lima, Leandro Ribeiro, Diamantino Helena, Bruno Domingues, Artur Condé
IntroductionCochlear damage is frequent in long-term aminoglycosides therapy or chemotherapeutic treatments with platinum-based agents. Despite its prevalence, it is currently underestimated and underdiagnosed. A monitoring protocol is vital to the early detection of cochleotoxicity and its implementation is widely encouraged in every hospital unit. Our aim was to elaborate a cochleotoxicity monitoring protocol for patients treated with platinum compounds or aminoglycosides antibiotics.MethodsPubMed® database was searched using terms relevant to drug cochleotoxicity in order to identify the most adequate protocol. Several articles and guidelines influenced our decision.ResultsThere is no consensus on a universal monitoring protocol. Its formulation and application rely heavily on available resources and personnel. High-frequency audiometry and otoacoustic emissions play an important role on early detection of cochleotoxicity caused by aminoglycoside antibiotics and platinum compounds.ConclusionA cochleotoxicity monitoring protocol consisting on an initial evaluation, treatment follow-up and post-treatment evaluation is proposed.

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Recurrent Respiratory Papillomatosis With Lung and Chest Wall Involvement: A Rare Complication in an Adolescent

Publication date: March–April 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 2
Author(s): Hugo Rodríguez, Giselle Cuestas, Mariana Álvarez, Maira Monaje

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Metastasis of Gallbladder Adenocarcinoma to the Skin of the External Auditory Canal, a Case Report

Publication date: March–April 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 2
Author(s): Valery Nuñez Carrasco, Jose Luis Serdio Arias, Juan Jose Artazkoz del Toro, Leticia Melgar Vilaplana

http://ift.tt/2G4Hoc3

Castleman's Disease in the Paediatric Neck

Publication date: March–April 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 2
Author(s): Cristina Marco Martin, Roberto Méndez Gallart, Carlos Aliste Santos, Máximo Francisco Fraga Rodriguez, Adolfo Bautista Casasnovas

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Arteria lusoria: A rare cause of tracheal compression

Publication date: March–April 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 2
Author(s): Ana Nóbrega-Pinto, Isabel Carvalho, Cecília Almeida-Sousa

http://ift.tt/2pzlO8v

Plummer Vinson syndrome

Publication date: March–April 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 2
Author(s): Satvinder Singh Bakshi, Thilagaraj Lokesh Kumar

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Comments on the Assessment of Nasal Obstruction With Rhinomanometry and Subjective Scales and Outcomes of Surgical and Medical Treatment

Publication date: March–April 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 2
Author(s): Francisco Larrosa, Isam Alobid

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A 10 Point Plan to Demonstrate the Value of Dermatology in the Health Care System

In May 2017, the American Academy of Dermatology (AAD) convened a Dermatology Specialty Summit, with representatives from 15 dermatology specialty societies, the American Board of Dermatology, and the Coalition of Skin Diseases in attendance. The Summit's goal was to identify opportunities to address and enhance the perception of dermatology in the House of Medicine, the role of data in the changing health care environment, and access to dermatologic care. Summit participants collectively identified a list of 10 action items that address opportunities in these areas of concern.

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Functional outcomes assessment following free muscle transfer for dynamic reconstruction of facial paralysis: a literature review

Facial reanimation provides patients affected by chronic facial paralysis a chance to regain basic human functions such as emotional expression, verbal communication, and oral competence for eating and swallowing, but there is still no consensus as to the best way to measure surgical outcomes. We performed a literature review to investigate the different functional outcomes that surgeons use to evaluate facial function after reanimation surgery, focusing on outcomes other than facial expressions such as speech, oral competence, and patient quality of life/satisfaction.

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Is the 8th edition of the Union for International Cancer Control staging of oral cancer good enough?

Depth of invasion is an important predictor of survival. A study by the International Consortium (ICOR) for Outcome Research proposed incorporation of it (together with the greatest surface dimension, or the anatomical criteria, or both) into the T stage. This has been adopted in part by the 8th edition of the Union for International Cancer Control (UICC) TNM 8 classification of malignant tumours for oral squamous cell carcinoma (SCC). Our aim was to verify depth of invasion as an independent prognostic factor, and to validate the staging by comparing it with that specified in the 7th edition (TNM 7) and the T-staging model proposed by the International Consortium.

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Reply to DR. De Cassai et al.

We appreciate Dr De Cassai and colleagues [1] for their interest in our recent publication on bilateral ultrasound-guided erector spinae plane (ESP) block in breast surgery [2].

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Is the 8th edition of the Union for International Cancer Control staging of oral cancer good enough?

Publication date: Available online 22 March 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): D. Vuity, J. McMahon, S. Takhiuddin, C. Slinger, D. McLellan, C. Wales, C. MacIver, E. Thomson, J. McCaul, S. Hislop, C. Lamb, E. Stalker, D. Young
Depth of invasion is an important predictor of survival. A study by the International Consortium (ICOR) for Outcome Research proposed incorporation of it (together with the greatest surface dimension, or the anatomical criteria, or both) into the T stage. This has been adopted in part by the 8th edition of the Union for International Cancer Control (UICC) TNM 8 classification of malignant tumours for oral squamous cell carcinoma (SCC). Our aim was to verify depth of invasion as an independent prognostic factor, and to validate the staging by comparing it with that specified in the 7th edition (TNM 7) and the T-staging model proposed by the International Consortium. We retrospectively studied 449 patients who had had operations for a previously untreated primary oral cancer between 2006 and 2014 at a single centre, and analysed the independent predictive value of depth of invasion for both disease-specific and overall survival. It was an independent predictor of disease-specific survival as were sex, perineural invasion, and N stage. It was also an independent predictor of overall survival together with sex and N status. Staging in TNM 8 gave a better balance of distribution than that in TNM 7, but did not discriminate between prognosis in patients with T3 and T4 disease. The proposed International Consortium rules for T-staging gave an improved balance in distribution and hazard discrimination. The incorporation of depth of invasion into the T-staging rules for oral SCC improved prognostic accuracy and is likely to influence the selection of patients for adjuvant treatment. Our findings suggest that the TNM 8 staging lacks hazard discrimination in patients with locally-advanced disease because its T4 staging is restricted to anatomical criteria.

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Australasian Journal of Dermatology, Ahead of Print.

Australasian Journal of Dermatology, Ahead of Print.

http://ift.tt/2IHZ66O

Asthma Guidelines from the National Asthma Education and Prevention Program: Where Are We Now?

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 1, Page 37-39, March 2018.

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Ataxia Telangiectasia: A Rare Neurodegenerative Disease with Variable Immunodeficiency and Recurrent Infections

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 1, Page 1-1, March 2018.

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Ataxia-Telangiectasia Clinical and Laboratory Features: Single Center Results

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 1, Page 9-14, March 2018.

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2017 Acknowledgment of Reviewers

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 1, Page 40-41, March 2018.

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Evaluation of the diagnostic value of immunoglobulin clonal gene rearrangements in patients with parotid gland MALT lymphoma using BIOMED-2 protocol

Publication date: Available online 21 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Yamin Zhang, Dan Yu, Ke Huang, Chongshang Huang, Hangfei Liu, Xiafei Sun, Jiaxiong Wang, Huiyong Zhu
ObjectivesTo evaluate the diagnostic value of immunoglobulin (Ig) clonal gene rearrangements for mucosa-associated lymphoid tissue (MALT) lymphoma of the parotid gland.MethodsWe collected and retrospectively analyzed clinical data of 21 patients referred to our institution between 2009 and 2017. Eight patients were primarily diagnosed MALT lymphoma of the parotid gland, the remaining patients diagnosed lymphoepithelial lesion (LEL). The paraffin-embedded tissues were chosen for extracting genomic DNA and multiplex primer PCR amplification using BIOMED-2 primers. PCR amplification products were analyzed by heteroduplex analysis (HA).ResultsGenerally, seventeen patients were identified to be parotid gland MALT lymphoma; 47.06% of them had Sjögren's syndrome (SS). The sensitivity of IGH VH-JH FR1, FR2, FR3, IGK Vκ-Jκ and IGK (Vκ-Kde and intron-Kde) as targets was 76.47%, 82.35%, 88.24%, 29.41% and 35.29% respectively. The sensitivity of combined application of the above three IGH primers as targets was 100%. The sensitivity of combined application of the above two IGK primers as targets was 58.82%.ConclusionIg clonal gene rearrangements assays using BIOMED-2 protocol, could be a highly-reliable diagnostic method for parotid gland MALT lymphoma. For patients with SS, along with histologically benign lymphoepithelial lesion (BLL), Ig clonal gene rearrangements is important for routine differential diagnosis.

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The severity of denture stomatitis as related to risk factors and different candida spp.

Publication date: Available online 22 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Mirjana Perić, Rade Živković, Aleksandra Milić Lemić, Milena Radunović, Biljana Miličić, Valentina Arsić Arsenijević
Objectivesi) to select patients with Candida denture related stomatitis (DS) and to study possible risk factors associated with DS; ii) to evaluated the severity of DS according to Newton's Classification; iii) to investigated the association between the presence of Candida non-albicans spp. (NAC) or mixed Candida spp. and the severity of DS.Study design82 subjects with Candida positive DS have undergone: i) filling in the questionnaire-interview, ii) clinical examination and iii) microbiological examination.ResultsA total number of 113 Candida spp. isolates were obtained from Candida positive DS patients: C. albicans (as a single species) in 47/82 (57%) (SG_A patients) and NAC/mixed Candida spp. in 35/82 (43%) (SG_B patients). Univariate logistic regression analysis showed that older age, age of the mandibular denture, and ex-smokers associated with SG_A. Multivariate model revealed no significant predictor of DS severity. Patients from SG_A group were 3 times more likely to have DS type I, while patients from SG_B group were 4.9 times more likely to have DS type III.ConclusionOur results showed the association between type III of DS (by Newton's Classification) and presents of NAC or mixed Candida spp. in denture wearers.

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Alterations in the expression of DNA damage response-related molecules in potentially preneoplastic oral epithelial lesions

Publication date: Available online 22 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Nikolaos G. Nikitakis, George Z. Rassidakis, Jason Tasoulas, Ioannis Gkouveris, Georgios Kamperos, Argyrios Daskalopoulos, Alexandra Sklavounou
ObjectivesTo evaluate the expression levels of DNA damage response (DDR) markers in potentially preneoplastic oral epithelial lesions (PPOELs).Study designImmunohistochemical expression of DDR markers (γΗ2ΑΧ, pChk2, 53BP1, p53 and phosphorylated at Ser 15 p53) was assessed in 41 oral leukoplakias ranging from hyperplasia (H) to dysplasia (D), and compared with oral squamous cell carcinoma (OSCC) and normal mucosa (NM). Statistical and ROC curve analysis were performed.ResultsγH2AX immunoexpression demonstrated a gradual increase and upper layer extension from NM to H to higher D degrees to OSCC. pChk2 expression was minimal in NM, relatively low in PPOELs with an increasing tendency from H to D, and higher in OSCC. 53BP1 demonstrated higher levels in OSCC than NM, while its expression in PPOELs was heterogeneous, gradually increasing according to D. p53 demonstrated progressively higher levels and upper layer extension from H to D to OSCC. Phosphorylated p53 was absent in NM and relatively low in PPOELs and OSCC.ConclusionsDDR markers' expression is variable in PPOELs showing a tendency to increase along with dysplasia. Activated DDR mechanisms may play an important protective role at early stages of oral carcinogenesis, but probably suffer progressive deregulation, eventually failing to suppress malignant transformation.

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Dr. Herbert H. Frommer, 1933-2018

Publication date: Available online 22 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): James R. Geist

http://ift.tt/2IHCAuQ

Australasian Journal of Dermatology, Ahead of Print.

Australasian Journal of Dermatology, Ahead of Print.

http://ift.tt/2ueDbRH

Procedures for central auditory processing screening in schoolchildren

Publication date: Available online 22 March 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Nádia Giulian de Carvalho, Thalita Ubiali, Maria Isabel Ramos do Amaral, Maria Francisca Colella Santos
IntroductionCentral auditory processing (CAP) screening in schoolchildren has led to debates in literature, both regarding the protocol to be used and the importance of actions aimed at prevention and promotion of auditory health. Defining effective screening procedures for central auditory processing is a challenge in Audiology.ObjectiveThis study aimed to analyze the scientific research on central auditory processing screening and discuss the effectiveness of the procedures utilized.MethodsA search was performed in the SciELO and PUBMed databases by two researchers. The descriptors used in Portuguese and English were: auditory processing, screening, hearing, auditory perception, children, auditory tests and their respective terms in Portuguese. Inclusion criteria: original articles involving schoolchildren, auditory screening of central auditory skills and articles in Portuguese or English. Exclusion criteria: studies with adult and/or neonatal populations, peripheral auditory screening only, and duplicate articles. After applying the described criteria, 11 articles were included.ResultsAt the international level, central auditory processing screening methods used were: Screening Test for Auditory Processing Disorder (SCAN) and its revised version (SCAN-C), Screening Test for Auditory Processing (STAP), Scale of Auditory Behaviors (SAB), Children's Auditory Performance Scale (CHAPS) and Feather Squadron. In the Brazilian scenario, the procedures used were the Simplified Auditory Processing Assessment (ASPA) and Zaidan's battery of tests.ConclusionAt the international level, the STAP and Feather Squadron batteries stand out as the most comprehensive evaluation of hearing skills. At the national level, there is a paucity of studies that use methods evaluating more than four skills, and are normalized by age group. The use of ASPA and questionnaires can be complementary in the search for an easy access and low-cost alternative in the auditory screening of Brazilian schoolchildren. Interactive tools should be proposed, that allow the selection of as many hearing skills as possible, validated by comparison with the battery of tests used in the diagnosis.

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Separation Patterns of Orbital Wall and Risk of Optic Canal Injury in Le Fort 3 Osteotomy

Publication date: Available online 21 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Niyazi Aizezi, Tomohisa Nagasao, Tadaaki Morotomi, Motoki Tamai, Koji Imajo
PurposeThe authors hypothesized that the risks of optic canal injury in down-fracturing after Le Fort 3 osteotomy vary depending on the separation patterns of the orbital walls. This study verifies this hypothesis using biomechanical simulation.MethodsTen finite-element skull models were produced using computer tomography data from ten persons. These models were modified to simulate Le Fort 3 osteotomy models by removing junctions between the neurocranium and facial cranium. The separation of the orbital wall was performed in four differing ways. In Type 1, all walls were completely separated. In Type 2, only the lateral wall was separated. In Type 3, the inferior wall was left unseparated. In Type 4, the lateral wall was left unseparated. Biomechanical simulation of down-fracturing was performed on the resulting 40 models. By observing irregular fractures occurring inside the orbit, the rate of optic canal involvement was evaluated for each of the four orbital-wall separation patterns.ResultsThe rates of optic canal involvement were: Type 1 (0/10), Type 2 (0/10), Type 3 (0/10), and Type 4 (4/10).ConclusionWhen the lateral wall is incompletely separated in Le Fort 3 osteotomy, irregular fracture can develop inside the orbit and involve the optic canal during the down-fracturing process. Hence, the lateral orbital wall should be completely separated to avoid potential blindness due to optic canal injury.

http://ift.tt/2IFi9P7

Modified Le Fort III osteotomy: A simple solution to severe midfacial hypoplasia

Publication date: Available online 21 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Rodrigo Fariña, Salvador Valladares, Araceli Raposo, Francisco Silva
PurposeThere are multiple conditions that may affect the development of the middle third of the face and with varying degrees of severity. The surgical treatment alternatives for major midfacial sagittal deficiencies consist in Le Fort I, II, or III with conventional osteotomies or with distraction osteogenesis (DO). Both techniques have advantages and disadvantages that should be evaluated specifically in each case. The aim of this report is to present a group of patients with severe hypoplasia of the middle third of the face, with different origins, and their treatment with a Modified Le Fort III osteotomy and distraction osteogenesis, using a minimally invasive surgical approach.Materials and MethodsThe surgical technique was performed in a group of patients with severe hypoplasia of the middle third of the face, through a transconjunctival approach with lateral canthotomy and a trans-oral approach. The osteotomy consisted of a Le Fort III without the nasofrontal component. A rigid external distractor (RED) type II or internal distractor was installed. The amount of distraction, surgical time, blood loss, and complications were evaluated.ResultsA total of 7 patients underwent operation, 5 men and 2 women with an average age of 20.8 (range 11-41) years; 3 patients with Crouzon syndrome, 2 with Pfeiffer syndrome, 1 patient with cleft lip and palate sequel, and 1 with a severe non-syndromic class III. The average follow-up was 3.14 years. All patients achieved stable occlusion without postoperative changes, positive overbite and overjet, without relapse in the skeletal position. The average advancement was 14.7 (±4.07) mm, in 1.1 incisors, and 15.2 (±3.19) in point A. The average time of surgery was 2.78 (±0.64) hours, with an average blood loss of 240 (±48.6) ml. Four patients required a rhinoplasty in a secondary surgery.ConclusionThis technique shows a surgical approach with low morbidity, short surgery time, and low blood loss. It allows optimal resolution of severe hypoplasia of the middle third of the face with long-term stability. It avoids the use of grafts and osteosynthesis material. By not including the nasal pyramid in the osteotomy design, the size, position, and nasofrontal angle in patients with adequate facial balance is maintained. If nasal correction is necessary, a second surgery may be done. In cases of asymmetrical hypoplasia of the middle third, this osteotomy shows great versatility and can be done unilaterally and/or simultaneously combined with other distractions.

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Predicting complications of major head and neck oncological surgery: an evaluation of the ACS NSQIP surgical risk calculator

Abstract

Background

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) universal surgical risk calculator is an online tool intended to improve the informed consent process and surgical decision-making. The risk calculator uses a database of information from 585 hospitals to predict a patient's risk of developing specific postoperative outcomes.

Methods

Patient records at a major Canadian tertiary care referral center between July 2015 and March 2017 were reviewed for surgical cases including one of six major head and neck oncologic surgeries: total thyroidectomy, total laryngectomy, hemiglossectomy, partial glossectomy, laryngopharyngectomy, and composite resection. Preoperative information for 107 patients was entered into the risk calculator and compared to observed postoperative outcomes. Statistical analysis of the risk calculator was completed for the entire study population, for stratification by procedure, and by utilization of microvascular reconstruction. Accuracy was assessed using the ratio of predicted to observed outcomes, Receiver Operating Characteristics (ROC), Brier score, and the Wilcoxon signed–ranked test.

Results

The risk calculator accurately predicted the incidences for 11 of 12 outcomes for patients that did not undergo free flap reconstruction (NFF group), but was less accurate for patients that underwent free flap reconstruction (FF group). Length of stay (LOS) analysis showed similar results, with predicted and observed LOS statistically different in the overall population and FF group analyses (p = 0.001 for both), but not for the NFF group analysis (p = 0.764). All outcomes in the NFF group, when analyzed for calibration, met the threshold value (Brier scores < 0.09). Risk predictions for 8 of 12, and 10 of 12 outcomes were adequately calibrated in the FF group and the overall study population, respectively. Analyses by procedure were excellent, with the risk calculator showing adequate calibration for 7 of 8 procedural categories and adequate discrimination for all calculable categories (6 of 6).

Conclusion

The NSQIP-RC demonstrated efficacy for predicting postoperative complications in head and neck oncology surgeries that do not require microvascular reconstruction. The predictive value of the metric can be improved by inclusion of several factors important for risk stratification in head and neck oncology.

http://ift.tt/2FYu0dy

Assessing oral health-related quality of life in children and adolescents: a systematic review and standardized comparison of available instruments

Abstract

Objectives

To obtain a systematic and standardized evaluation of the current evidence on development process, metric properties, and administration issues of oral health-related quality of life instruments available for children and adolescents.

Materials and methods

A systematic search until October 2016 was conducted in PubMed, Embase, Lilacs, SciELO, and Cochrane databases. Articles with information regarding the development process, metric properties, and administration issues of pediatric instruments measuring oral health-related quality of life were eligible for inclusion. Two researchers independently evaluated each instrument applying the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. An overall and seven attribute-specific EMPRO scores were calculated (range 0–100, worst to best): measurement model, reliability, validity, responsiveness, interpretability, burden, and alternative forms.

Results

We identified 18 instruments evaluated in 132 articles. From five instruments designed for preschoolers, the Early Childhood Oral Health Impact Scale (ECOHIS) obtained the highest overall EMPRO score (82.2). Of nine identified for schoolchildren and adolescents, the best rated instrument was the Child Perceptions Questionnaire 11–14 (82.1). Among the four instruments developed for any age, the Family Impact Scale (FIS) obtained the highest scores (80.3).

Conclusion

The evidence supports the use of the ECOHIS for preschoolers, while the age is a key factor when choosing among the four recommended instruments for schoolchildren and adolescents. Instruments for specific conditions, symptoms, or treatments need further research on metric properties.

Clinical relevance

Our results facilitate decision-making on the correct oral health-related quality of life instrument selection for any certain study purpose and population during the childhood and adolescence life cycle.

http://ift.tt/2IKL9oE

Asthma Guidelines from the National Asthma Education and Prevention Program: Where Are We Now?

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 1, Page 37-39, March 2018.

http://ift.tt/2pxxN6o

Ataxia Telangiectasia: A Rare Neurodegenerative Disease with Variable Immunodeficiency and Recurrent Infections

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 1, Page 1-1, March 2018.

http://ift.tt/2IFahgx

Ataxia-Telangiectasia Clinical and Laboratory Features: Single Center Results

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 1, Page 9-14, March 2018.

http://ift.tt/2G3wH9C

2017 Acknowledgment of Reviewers

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 1, Page 40-41, March 2018.

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What parents are reading about laryngomalacia: Quality and readability of internet resources on laryngomalacia

Publication date: May 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 108
Author(s): Erica Corredera, Kara S. Davis, Jeffrey P. Simons, Noel Jabbour
ObjectiveThe goal of this study is to measure the quality and readability of websites related to laryngomalacia, and to compare the quality and readability scores for the sites accessed through the most popular search engines.IntroductionLaryngomalacia is a common diagnosis in children but is often difficult for parents to comprehend. As information available on the internet is unregulated, the quality and readability of this information may vary.MethodsAn advanced search on Google, Yahoo, and Bing was conducted using the terms "laryngomalacia" OR "soft larynx" OR "floppy voice box." The first ten websites meeting inclusion and exclusion criteria were evaluated, for each search engine. Quality and readability were assessed using the DISCERN criteria and the Flesch reading ease scoring (FRES) and Flesch-Kincaid grade level (FKGL) tests, respectively.ResultsThe top 10 hits on each search engine yielded 15 unique web pages. The median DISCERN score (out of a possible high-score of 80) was 48.5 (SD 12.6). The median USA grade-level estimated by the FKGL was 11.3 (SD 1.4). Only one website (6.7%), had a readability score in the optimal range of 6th to 8th grade reading level. DISCERN scores did not correlate with FKGL scores (r = 0.10).ConclusionOnline information discussing laryngomalacia often varies in quality and may not be easily comprehensible to the public. It is important for healthcare professionals to understand the quality of health information accessible to patients as it may influence medical decision-making by patient families.

http://ift.tt/2HV8D9w

Auditory function and motor proficiency in type 1 diabetic children: A case-control study

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Jalali Mir Mohammad, Soleimani Robabeh, Koohmanai Shahin, Tizno Saeed, Akbari Maryam
ObjectivesThe aim of the study was to evaluate the auditory and motor functions in children with insulin dependent diabetes mellitus (IDDM).MethodsThis case-control study, 65 diabetic children, receiving care in Diabetes Center of 17 Sharivar Hospital, were enrolled. 130 controls were matched to cases by age and sex. The authors performed audio-vestibular tests, including pure tone audiometry (PTA), distortion product otoacoustic emission (DPOAE), auditory brainstem response (ABR), bedside head-impulse test and dynamic visual acuity test. Motor function was evaluated using of Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2).ResultsThe results showed higher thresholds of air conduction PTA and a prolonged peak latency of wave V (ABR) in diabetic children as compared to controls (all Ps < 0.001). The odds of normal response in DPOAE of cases decreased by 0.44–0.82 - fold. Although clinical vestibular outcomes were worse in cases, differences were not significant. In BOT-2, the cases had statistically significant lower scores (standard score = −0.58, P < 0.05) than the controls for the Total Motor Composite. Also diabetic girls had more skill motor impairment compared to boys with IDDM.ConclusionBased on our study, metabolic disturbances present in Type I diabetes cause disturbances in different parts of auditory and balance functions.

http://ift.tt/2FYiwXe

Nasal saline irrigation in pediatric rhinosinusitis: A systematic review

Publication date: May 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 108
Author(s): Jean-Nicolas Gallant, Jade I. Basem, Justin H. Turner, Chevis N. Shannon, Frank W. Virgin
ObjectiveTo determine the efficacy of nasal saline irrigation (NSI) in reducing symptoms and improving quality of life in pediatric patients with acute (ARS) or chronic (CRS) rhinosinusitis.Data sourcesWe searched the PubMed/MEDLINE and Embase electronic databases (indexed January, 1950 through April, 2017).Review methodsStudies assessing the efficacy of NSI in pediatric patients with ARS or CRS were selected for analysis. Outcome measures, including symptom scores and parental surveys, were analyzed. Two independent reviewers evaluated each abstract and article.ResultsOf the 272 articles identified using our search strategy, only 1 study, focusing on the use of NSI in pediatric ARS, met all inclusion criteria. No studies investigating NSI in pediatric CRS were included for analysis. In general, studies demonstrated significant improvement of symptom scores with the use of NSI in pediatric rhinosinusitis; but, the use of varied outcome measures, control treatments, and NSI delivery made including studies and drawing conclusions difficult. No quantitative meta-analysis could be performed.ConclusionNSI may provide benefit for ARS in children; however, additional high-quality studies with defined outcome measures are needed to determine the quantitative efficacy of this therapy in the pediatric patients with rhinosinusitis—especially in pediatric CRS.

http://ift.tt/2uglW2u

Development and validation of a quality of life instrument for patients with laryngeal cleft

Publication date: May 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 108
Author(s): Alexandria L. Irace, Ryan D. Walker, Kosuke Kawai, Meaghan Maddock, Natasha D. Dombrowski, Georgios Sideridis, Lynne Ferrari, Reza Rahbar
ObjectiveTo develop and validate a novel pediatric health-related quality of life (HR-QoL) instrument for patients with laryngeal cleft and their families.MethodsWe surveyed primary caregivers of patients that underwent endoscopic repair of Type I or II laryngeal cleft. The proposed HR-QoL instrument consists of 40 items representing four domains, assessing the patient's physical symptoms, the patient's and family's social functioning, and the family's emotions regarding the patient's illness pre- and post-operatively. Confirmatory factor analysis was employed to assess construct validity, dimensionality, and optimal simple structure.ResultsOf 78 eligible participants reached by phone, 40 (51%) of them completed the questionnaire. Confirmatory factor analysis suggested that all four measured constructs were well supported by the measured items in comparison to a unidimensional model. All factor loadings and factor correlations were significant and factor correlations ranged between 0.723 and 0.879. Indices of test-retest reliability and internal consistency reliability were well above recommended standards. There was a significant correlation between current instrument and PedsQL™ score. The overall QoL score significantly improved from 112.3 (±28.1) before surgery to 158.0 (±28.5) after surgery (mean difference 45.7; 95% CI: 37.3, 54.1; p < 0.001).ConclusionOur proposed pediatric HR-QoL instrument is a valid tool for measuring quality of life in patients with laryngeal cleft and their families. This instrument can provide insight into the effects of medical and surgical therapy and guide pre- and post-operative management of laryngeal cleft.

http://ift.tt/2FWG2Ep

A functional and anatomical comparison between two passive transcutaneous bone conduction implants in children

Publication date: May 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 108
Author(s): Sara Giannantonio, Alessandro Scorpecci, Concettina Pacifico, Pasquale Marsella
ObjectiveTo compare anatomical and functional outcomes of two passive transcutaneous bone conduction implant systems: Sophono™ and BAHA Attract™.Materials and methodsTwenty patients, affected by bilateral conductive hearing loss, underwent unilateral transcutaneous bone conduction implant surgery. Ten children received a Sophono™ implant (6 males, 4 females, mean age 11 years, mean unaided Pure Tone Average (PTA) 0.25-4kHz = 69.70dB HL) and 10 a BAHA Attract™ system (7 males, 3 females, mean age 19 years, mean unaided PTA0.25-4kHz = 66.40dB HL). The following outcomes were considered: incidence of local complications, hearing aid benefit, hearing aid gain and changes in quality of life (QOL), as measured by the Glasgow Children's Benefit Inventory (GCBI).ResultsOne patient in the Sophono group experienced magnet-related skin decubitus, while two patients (one per group) had skin hyperemia in the area overlying the magnet. The mean BAHA-aided threshold was 23.70dB, whereas the mean Sophono-aided threshold was 31.60dB. The mean gain was significantly different for lower frequencies, the BAHA having better functional outcomes. All patients reported an improvement in their QOL.ConclusionGiven the lower thickness of the internal magnet, the Sophono™ system might be more suitable for younger children, whereas BAHA offered better functional results. Both systems can be considered valid and safe options for the functional rehabilitation of conductive hearing loss in children, provided that precautions are observed, such as a gradual use of the device and use of the least powerful magnets in the first months after the activation.

http://ift.tt/2HYejj7

Three-dimensional development of the upper dental arch in unilateral cleft lip and palate patients after early neonatal cheiloplasty

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): E. Hoffmannova, V. Moslerová, J. Dupej, J. Borský, Š. Bejdová, J. Velemínská
ObjectivesThis prospective morphometric study evaluated the growth of the upper dental arch in UCLP patients after early neonatal cheiloplasty and compared the selected dimensions with published data on non-cleft controls and on later operation protocol patients.MethodsThe sample comprised 36 Czech children with nonsyndromic complete UCLP (cUCLP) and 20 Czech children with nonsyndromic incomplete UCLP (UCLP + b). 2-D and 3-D analyses of palatal casts were made at two time points: before neonatal cheiloplasty at the mean age of 3 days (±1 day), and 10 months after surgery at the mean age of 10 months (±1 month).ResultsThe upper dental arch of cUCLP and UCLP + b patients showed similar developmental changes, but the cleft type influenced growth significantly. The initial high shape variability in cUCLP patients diminished after 10 months, and approached the variability in UCLP + b patients. Both the width and length dimensions increased after surgery. Important growth concerned the anterior ends of both segments. The width and length dimensions illustrated similar growth trends with non-cleft controls and UCLP patients who underwent later cheiloplasty.ConclusionEarly neonatal cheiloplasty caused no reduction in the length or width dimensions during the first year of life. Our data suggest a reconstructed lip has a natural formative effect on the actively growing anterior parts of upper dental arch segments, which cause narrowing of the alveolar cleft.

http://ift.tt/2FWFRsJ

Diagnosis and management of pediatric sinusitis: A survey of primary care, otolaryngology and urgent care providers

Publication date: May 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 108
Author(s): Laurie Newton, Amanda Kotowski, Melissa Grinker, Robert Chun
ObjectivesThe aims of this project were two-fold: 1) To assess pediatric primary care (PCP), pediatric otolaryngology (ENT) and pediatric urgent care (UC) providers' perception of their adherence to the 2013 American Academy of Pediatrics (AAP) established guidelines for the diagnosis and management of acute bacterial rhinosinusitis (ABRS) in children 1–18 years old and 2) to assess the same providers' practice patterns in the diagnosis and management of pediatric chronic rhinosinusitis (PCRS).MethodA 21-item questionnaire (CVI .9) was designed by th investigators using Survey Monkey^®. The survey was emailed to pediatric providers (including physicians and advanced practice providers) in a Midwestern USA healthcare system (94 PCP, 25 UC, 19 ENT providers) from 20 pediatric primary care practices, 1 pediatric UC practice and 1 pediatric otolaryngology practice.ResultsDiagnosis: The following diagnostic criteria are utilized: persistent nasal congestion/cough lasting >10 days (95%), worsening of classic viral URI symptoms at days 5–7 (70%), severe onset and purulent nasal discharge for at least 3 consecutive days (45%). ENT will most commonly culture their patients. ENT providers (57%) approve of a nasal culture being obtained by PCPs. Management: Typically used antibiotics: amoxicillin (72%), Amoxicillin-clavulanic acid (98%), cefdinir (73%), azithromycin (15%). ENT providers will also use clarithromycin and Bactrim more often compared to PCPs. For PCN allergy patients, most providers choose cefdinir. Typical length of antibiotic therapy for providers is 10 days (70%) and 14 days (17%); ENT (21%) prescribes 7 days past any symptom compared to PCP (6%) and UC (5%). Use of adjuvant therapy is variable among the groups.ConclusionThis quality initiative project demonstrates that providers' diagnosis of ABRS is consistent with the 2013 AAP guidelines while variation in clinical management exists for both ABRS and PCRS. This survey demonstrates the need to educate all providers on the current 2013 AAP guidelines and define practice across all settings.

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Effect of early correction of nasal septal deformity in unilateral cleft lip and palate on inferior turbinate hypertrophy and nasal patency

Publication date: May 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 108
Author(s): Valentina Pinto, Ottavio Piccin, Luca Burgio, Valeria Summo, Elisa Antoniazzi, Paolo G. Morselli
ObjectivesA relatively neglected aspect of cleft lip nasal deformity is the effect of septal deviation and inferior turbinate hypertrophy (ITH) on the functional airway. In particular, ITH in the noncleft side can be especially problematic, because it reduces the healthy nasal area, creating bilateral nasal obstruction that might affect the growth of the maxillofacial skeleton. Although these anatomic and functional changes are documented, few recommendations have been developed regarding the proper approach to ITH. The aim of the present study was to asses the ITH severity and determine the degree of nasal airway patency in patients who have undergone primary correction of the nasal septum during lip repair compared to patients operated on without primary septal correction.MethodsThe study population included two groups. One group consisted of twenty unilateral cleft lip palate UCLP patients who have previously undergone primary rhinoseptoplasty as part of their treatment plan. The control group consisted of twenty UCLP patients operated on without rhinoseptal correction.The Nasal Obstructive Symptom Evaluation (NOSE) scale and nasal endoscopy were used to assess nasal obstruction.ResultsThe overall untreated group reported severe symptoms across all NOSE scale dimensions more frequently than children who have undergone primary rhinoseptoplasty. The difference was statistically significant for each dimensions (p < 0.05). The mean NOSE score for group A and group B was 21.4 ± 9.4 and 70.8 ± 17.2 respectively (p < 0.0001).In group A turbinate size decreased significantly (p < 0.05) compared to pre-operative data.Comparing the two groups a statistically significant difference in turbinate size was observed (p < 0.0001).ConclusionThe results of the present study confirm that there is a significant degree of ITH and nasal airway dysfunction in patients with UCLP. Early septal repositioning during primary cleft lip repair results in a statistically significant reduction in IT size and improvement of nasal patency.

http://ift.tt/2FUYmO1

Obstructive sleep apnea syndrome and growth failure

Publication date: May 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 108
Author(s): E. Esteller, J.C. Villatoro, A. Agüero, R. Lopez, E. Matiñó, J. Argemi, M. Girabent-Farrés
Obstructive sleep apnea syndrome is a common problem among children and is recognized as a cause of significant medical morbidity. Since the 1980s, it has been suggested that obstructive sleep apnea syndrome is a risk factor for growth failure in children. In many cases, it has been shown that growth failure is reversible once the obstructive sleep apnea syndrome is resolved. The objectives of this study were to analyze and compare growth failure prevalence in a Mediterranean population of children with obstructive sleep apnea syndrome and healthy children matched in age and sex, and to assess the effectiveness of tonsillectomy and adenoidectomy in resolving growth retardation. We compared 172 children with obstructive sleep apnea syndrome (apnea-hypopnea index ≥ 3) who had undergone tonsillectomy and adenoidectomy with 172 healthy controls in terms of key anthropometric parameters. Most of the criteria used for growth failure were higher to a statistically significant degree in the study group vs the control group: height-for-age ≤ 3rd percentile (7.56% vs 2.91%; p = 0.044), weight-for-age ≤ 5th percentile (9.30% vs 2.33%; p = 0.005), weight-for-age ≤ 3rd percentile (8.14% vs 2.33%; p = 0.013) and height and/or weight for-age ≤ 5th percentile (13.95% vs 5.81%; p = 0.009). The height-for-age ≤ 5th percentile was almost at the limit of statistical significance (8.72% for the study group vs 4.65% for the control group; p = 0.097).At one-year post-surgery follow-up, 10 of 15 children with height-for-age ≤ 5th percentile had achieved catch-up growth (66.6%), and 14 of 24 children with height- and/or weight-for-age ≤ 5th percentile had normalized growth (58.33%). For children with failure to thrive or who have growth failure, physicians should consider the possibility of obstructive sleep apnea. A significant number of children with obstructive sleep apnea concurrent with growth failure could benefit from tonsillectomy and adenoidectomy to recover and normalize their growth rate.

http://ift.tt/2uaEnFs

Αρχειοθήκη ιστολογίου

Πέμπτη 22 Μαρτίου 2018

Abstract

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Background

Methods

Results

Conclusion

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Objectives

Materials and methods

Results

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Clinical relevance