Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Παρασκευή 23 Μαρτίου 2018

Primary male factor infertility due to asthenospermia in maturity-onset diabetes of the young type 5 (MODY 5): uncommon presentation of an uncommon disease

Mutations in hepatocyte nuclear factor-1β gene result in a multisystemic syndrome where a monogenic form of diabetes (maturity-onset diabetes of young type 5; MODY 5) and renal anomalies, usually bilateral multiple cysts are the most characteristic findings. Many of them have pancreatic structural abnormalities as well. A plethora of extrapancreatic manifestations like altered liver function tests, hypomagnesaemia, hyperuricaemia with/without gout and urogenital malformations, particularly in females are also components of the syndrome. Structural malformation of male urogenital tract is rare in MODY 5, even rarer is asthenospermia. We encountered a young non-obese individual having insulin-requiring diabetes following secondary oral agent failure with primary male factor infertility secondary to asthenospermia. A suggestive family history, lack of acanthosis, negative pancreatic autoimmunity, hypomagnesaemia, bilateral renal and epididymal cysts, and absence of body and tail of pancreas pointed towards underlying MODY 5.



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Superficial temporal artery pseudoaneurysm following facial trauma

A 68-year-old man presented with rapid swelling of the right forehead 11 days after sustaining a laceration secondary to a fall. Presumed to be an abscess due to retained foreign body, needle aspiration was performed and arterial blood obtained. Doppler ultrasound revealed a 3 cm mixed echogenicity lesion with 'see-sawing' internal Doppler flow arising from the superficial temporal artery (STA), in keeping with a pseudoaneurysm. Treatment options including interventional radiology and open surgery were considered. Open operative intervention with direct surgical ligation provided an excellent outcome. Delayed pseudoaneurysm of the STA is a rare complication of trauma but should be considered in the differential of a traumatic lateral forehead swelling to prevent complications and inappropriate investigations and management.



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Septic presentation of a giant fibroepithelial polyp of the vulva

Fibroepithelial stromal polyps are mesenchymal lesions occurring typically in reproductive age women with a predilection for the vulvo-vaginal region. Malignancy may mimic this polyp in morphology, rendering further investigations including detailed histopathology mandatory. Histologically its characteristic features are stellate and multinucleate stromal cells identified near the epithelial–stromal interface. This case report discusses incidental finding of largest fibroepithelial polyp presented in a 31-year-old nulliparous woman. She was initially admitted with sepsis and detailed physical examination revealed a right-sided infected pedunculated labial mass measuring 20x21 cm. After initial resuscitation for sepsis, she was further investigated for the mass. Transabdominal ultrasound was essentially normal apart from a small fibroid 3x2 cm in the anterior wall of the uterus. The vulval mass was removed under local and regional anaesthesia and was confirmed to be a giant fibroepithelial stromal polyp on histopathology. The woman recovered well and was followed up until 1 year.



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Herpes zoster ophthalmicus evolving into headache characterised as hemicrania continua

Postherpetic neuralgia (PHN) is the most common chronic complication of herpes zoster infection. However, a few patients may develop different types of pain after herpetic lesions. We are reporting two patients who developed postherpetic hemicrania continua (HC). Case 1: a 54-year-old woman had a 10-month history of continuous left-sided pain with superimposed exacerbations. The pain started with the onset of herpetic lesions in the ophthalmic division. The lesions subsided in a few weeks. However, the pain persisted and it responded exclusively to indomethacin. Case 2: a 61-year-old woman developed clinical features pertinent to PHN. However, later on, the pattern and associated clinical features changed. The patient fulfilled the criteria of HC and showed a complete response to indomethacin. We suggest that every patient with PHN should be asked for cranial autonomic features and a trial of indomethacin should be given in refractory herpes zoster neuropathy.



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Thyrotoxic crisis as an acute clinical presentation in a child

A previously well, 4-year-old girl presented with a 4–6 weeks' history of increased appetite, weight loss, tiredness, sleep difficulty, excessive sweating, swelling in the neck and new-onset 'prominent, protruding eyes.' Family history revealed paternal grandmother receiving treatment for hyperthyroidism. Clinical assessment demonstrated features of thyrotoxicosis (tachycardia, warm peripheries, small smooth goitre with no nodules, exophthalmos). TFT (Free T4=101 pmol/L, thyroid-stimulating hormone <0.05 mIU/L) with raised thyroid peroxidase antibody levels (TPO=541 IU/mL) confirmed autoimmune hyperthyroidism. Observation on the ward showed features of thyrotoxic crisis with persistent severe tachycardia on ECG (sinus tachycardia with left ventricular hypertrophy (LVH)) and hypertension. Ultrasound thyroid showed diffuse thyroiditis with no focal lesion. Echocardiogram confirmed the above findings. A diagnosis of Graves' disease with thyrotoxic crisis was made. Antithyroid treatment (carbimazole) and beta-blocker (propranolol) was commenced. Thyrotoxic crisis resolved over 2 weeks and the child has continued to respond to carbimazole treatment at 1-year follow-up.



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Worm in anterior chamber of the eye

We report a case of a 42-year-old female patient who presented to the ophthalmology outpatient department with painful red eye for 1 month. Slit-lamp microscopy showed a live worm in the anterior chamber of left eye. The worm was surgically removed under topical anaesthesia. It was sent to the microbiology department for further identification and was found to be adult female Loaloa.



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Placenta accreta complicated with peripartum cardiomyopathy

A 33-year-old G2P1 was referred to our hospital due to placenta accreta. During perioperative preparations, the patient was diagnosed with having a peripartum cardiomyopathy. The patient underwent caesarean hysterectomy at 36 weeks with an associated 2 L blood loss. Haemodynamic maintenance and stabilisation during the operation were challenging, with the combinations of fluid therapy, blood transfusions as well as vasoactive, antifibrinolytic and haemostatic drug. Postoperatively, the patient was managed in the intensive care unit and was subsequently transferred to intermediate care after less than 24 hours' observation. She was stable enough to be moved to the obstetrics ward the next day.



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Concurrent Sweets syndrome and myopericarditis following mesalamine therapy

Mesalamine, or 5-aminosalicylic acid, is a frequently used medication for the treatment of inflammatory bowel disease (IBD). We report the case of a 40-year-old woman recently diagnosed with IBD and started on mesalamine, who presented with new onset tender skin lesions 3 days following medication administration. One day following the onset of skin lesions, the patient developed acute chest pain, shortness of breath, ECG changes, troponemia, C-reactive protein elevation and pericardial enhancement on cardiac MRI consistent with myopericarditis. Subsequent skin biopsy confirmed the diagnosis of Sweet's syndrome. On cessation of the drug, both the skin lesions and the cardiac symptoms resolved in combination with anti-inflammatory therapy. While mesalamine has been previously associated with myocarditis and pericarditis, to our knowledge this is the first case of coexisting Sweet's syndrome with myopericarditis in the context of mesalamine therapy.



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Rapidly expanding venous intracerebral haemorrhage with spot sign

A 79-year-old woman was brought to the hospital with an acute-onset left haemiparesis. On initial examination, she had a pure sensorimotor syndrome with left-sided weakness and sensory disturbance. Her mental status was normal. She had normal visual fields to confrontation and no neglect. Her initial CT and CT angiogram revealed cerebral venous thrombosis with associated haemorrhage. A 'spot sign' was visible on CT angiogram. Immediately following the CT scan, the patient had a rapidly progressive decline in level of consciousness, requiring endotracheal intubation. A follow-up CT scan 70 min later showed the haemorrhage had expanded dramatically, with mass effect, midline shift and herniation. After a discussion with the family, the patient was extubated and died the following day. This is the first case of a cerebral venous thrombosis with associated spot sign-positive haemorrhage and published clinical details that the authors are aware of.



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Autoimmune pancreatitis with concomitant autoimmune haemolytic anaemia

Autoimmune pancreatitis (AIP) is an infrequent cause of acute pancreatitis, being more commonly associated with chronic pancreatitis. AIP can be associated with other autoimmune manifestations, including Sjögren's, inflammatory bowel disease, primary biliary cirrhosis, rheumatoid arthritis, hypothyroidism and sarcoidosis. Rarely, concurrent autoimmune haemolytic anaemia (AIHA) is observed, as seen in our case report of a 33-year-old postpartum woman.



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Pneumatosis intestinalis in small bowel obstruction

Description

We present a case of a 42-year-old woman with a history of acute myeloid leukaemia treated with bone marrow transplant. Her case was complicated by graft versus host disease involving the gastrointestinal tract, necessitating partial colectomy with ileostomy. She presented to the hospital with recurrent partial small bowel obstruction (SBO). Abdominal CT scan was consistent with partial SBO, and the patient was admitted for conservative treatment. She was deemed a poor surgical candidate given her multiple comorbidities and immunosuppressed state. Her clinical condition waxed and waned over the next week, and on hospital day 10 the patient developed decreased ileostomy output, increased nausea and vomiting. Abdominal radiographs revealed dilated bowel with increased intramural radiolucency (figure 1), and subsequent CT scan was confirmatory for extensive pneumatosis intestinalis (PI) (figure 2). The patient was treated conservatively with bowel rest and nasogastric suction with favourable outcome.



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Delayed neurological deficits after endovascular placement of a pipeline embolisation device: clinical manifestation and treatment

Endovascular treatment has been the mainstay of therapy for repair of both ruptured and unruptured cerebral aneurysms. Flow diverter devices offer a new option for the treatment of complex aneurysms that were previously not amenable to coiling. Procedural adverse effects include intracranial haemorrhage and ischaemic stroke, which usually occur on the same day. Delayed complications are rare. We report a case of a patient who underwent placement of a pipeline embolisation device and developed delayed neurological deficits, which were thought to be an inflammatory reaction to the hydrophilic coating used in guidewires and microcatheters. Our patient was treated with a course of steroids, with improvement of her neurological deficits and resolution of MRI findings. As the use of flow diverter devices has increased, variable and delayed complications of such therapy are increasingly being reported in the literature.



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Inferior turbinectomy: what is the best technique?

Renato Roithmann
Braz J Otorhinolaryngol.2018;84:133-4

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Tinnitus and sound intolerance: evidence and experience of a Brazilian group

Ektor Tsuneo Onishi, Cláudia Couto de Barros Coelho, Jeanne Oiticica, Ricardo Rodrigues Figueiredo, Rita de Cassia Cassou Guimarães, Tanit Ganz Sanchez, Adriana Lima Gürtler, Alessandra Ramos Venosa, André Luiz Lopes Sampaio, Andreia Aparecida Azevedo, Anna Paula Batista de Ávila Pires, Bruno Borges de Carvalho Barros, Carlos Augusto Costa Pires de Oliveira, Clarice Saba, Fernando Kaoru Yonamine, Ítalo Roberto Torres de Medeiros, Letícia Petersen Schmidt Rosito, Marcelo José Abras Rates, Márcia Akemi Kii, Mariana Lopes Fávero, Mônica Alcantara de Oliveira Santos, Osmar Clayton Person, Patrícia Ciminelli, Renata de Almeida Marcondes, Ronaldo Kennedy de Paula Moreira, Sandro de Menezes Santos Torres
Braz J Otorhinolaryngol.2018;84:135-49

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The maturation state of the auditory nerve and brainstem in rats exposed to lead acetate and supplemented with ferrous sulfate

Fernanda Zucki, Thais C. Morata, Josilene L. Duarte, Maria Cecília F. Ferreira, Manoel H. Salgado, Kátia F. Alvarenga
Braz J Otorhinolaryngol.2018;84:150-8

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Pinna synthetic mold for otoplasty techniques application

Mariah Guieiro Alves dos Reis, Ricardo Guimarães Marim, Luis Ricardo Martinhão Souto
Braz J Otorhinolaryngol.2018;84:159-65

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Functional results in airflow improvement using a “flip‐flap” alar technique: our experience

Arianna Di Stadio, Carlo Macro
Braz J Otorhinolaryngol.2018;84:166-72

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Role of preoperative air‐bone gap in tinnitus outcome after tympanoplasty for chronic otitis media with tinnitus

Hong Chan Kim, Chul Ho Jang, Young Yoon Kim, Jong Yuap Seong, Sung Hoon Kang, Yong Beom Cho
Braz J Otorhinolaryngol.2018;84:173-7

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Sleep disorders in children with moderate to severe persistent allergic rhinitis

Jessica Loekmanwidjaja, Ana Cláudia F. Carneiro, Maria Lúcia T. Nishinaka, Daniela A. Munhoes, Gabriela Benezoli, Gustavo F. Wandalsen, Dirceu Solé
Braz J Otorhinolaryngol.2018;84:178-84

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The effect of different nasal irrigation solutions following septoplasty and concha radiofrequency: a prospective randomized study

Hanifi Kurtaran, K. Serife Ugur, Ceyda Sel Yilmaz, Mesut Kaya, Alper Yuksel, Nebil Ark, Mehmet Gunduz
Braz J Otorhinolaryngol.2018;84:185-90

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Influence of dietary and physical activity restriction on pediatric adenotonsillectomy postoperative care in Brazil: a randomized clinical trial

Denise Manica, Leo Sekine, Larissa S. Abreu, Michelle Manzini, Luísi Rabaioli, Marcel M. Valério, Manoela P. Oliveira, João A. Bergamaschi, Luciano A. Fernandes, Gabriel Kuhl, Cláudia Schweiger
Braz J Otorhinolaryngol.2018;84:191-5

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Rapid maxillary expansion in mouth breathers: a short‐term skeletal and soft‐tissue effect on the nose

Fauze Ramez Badreddine, Reginaldo R. Fujita, Fabio Eduardo Maiello Monteiro Alves, Mario Cappellette Jr
Braz J Otorhinolaryngol.2018;84:196-205

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Anti‐inflammatory effects of hyperbaric oxygen on irradiated laryngeal tissues

Mitat Arıcıgil, Mehmet Akif Dündar, Abitter Yücel, Hamdi Arbağ, Abdullah Arslan, Meryem Aktan, Sıdıka Fındık, İbrahim Kılınç
Braz J Otorhinolaryngol.2018;84:206-11

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Digital design of functional surgery for odontogenic cyst intruding into maxillary sinus

Ying Kai Hu, Chi Yang, Guang Zhou Xu, Qian Yang Xie
Braz J Otorhinolaryngol.2018;84:212-9

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Impact of body mass index on survival outcome in patients with differentiated thyroid cancer

Yousif Al‐Ammar, Bader Al‐Mansour, Omar Al‐Rashood, Mutahir A. Tunio, Tahera Islam, Mushabbab Al‐Asiri, Khalid Hussain Al‐Qahtani
Braz J Otorhinolaryngol.2018;84:220-6

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A novel method to evaluate salivary flow rates of head and neck cancer patients after radiotherapy: a pilot study

Luiz Felipe Palma, Fernanda Aurora Stabile Gonnelli, Marcelo Marcucci, Adelmo José Giordani, Rodrigo Souza Dias, Roberto Araújo Segreto, Helena Regina Comodo Segreto
Braz J Otorhinolaryngol.2018;84:227-31

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Giant fronto‐ethmoidal osteoma – selection of an optimal surgical procedure

Maria Humeniuk‐Arasiewicz, Grażyna Stryjewska‐Makuch, Małgorzata A. Janik, Bogdan Kolebacz
Braz J Otorhinolaryngol.2018;84:232-9

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Biofeedback in dysphonia – progress and challenges

Geová Oliveira de Amorim, Patrícia Maria Mendes Balata, Laís Guimarães Vieira, Thaís Moura, Hilton Justino da Silva
Braz J Otorhinolaryngol.2018;84:240-8

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Acquired stenosis of external auditory canal secondary to paraneoplastic manifestation of renal cancer

Loraine Entringer Falqueto, Marcos Lyra Kaddoum, Marcio Maia Lamy de Miranda, Henrique Faria Ramos
Braz J Otorhinolaryngol.2018;84:249-51

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Chorda tympani schwannoma: one new case revealed during malignant otitis externa and review of the literature

Marion Montava, Sophie Giusiano, Marianne Jolibert, Jean‐Pierre Lavieille
Braz J Otorhinolaryngol.2018;84:252-6

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Prevention of neck infection by endoscopic suture closure of pyriform sinus fistulae: a report of two cases

Hiroumi Matsuzaki, Kiyoshi Makiyama, Hirotaka Suzuki, Takeshi Ohshima
Braz J Otorhinolaryngol.2018;84:257-9

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Endoscopic surgery of the frontoethmoidal osteomas

Tomasz Gotlib
Braz J Otorhinolaryngol.2018;84:260-1

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Highly Sensitive Thyroglobulin Assays Are Reliable Indicators of Persistent Disease in Thyroid Cancer Patients with Thyroglobulin Antibody

Clinical Thyroidology, Volume 30, Issue 3, Page 122-125, March 2018.


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Low Urinary Iodine Concentrations Predict Decreased Fertility

Clinical Thyroidology, Volume 30, Issue 3, Page 135-137, March 2018.


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Methimazole Has a Dose-Dependent Association With Congenital Malformations, but Switching to PTU in the First Trimester Seems Too Late

Clinical Thyroidology, Volume 30, Issue 3, Page 104-107, March 2018.


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Thyroid Status Has Measurable Effects on Gene Expression in Whole Blood

Clinical Thyroidology, Volume 30, Issue 3, Page 129-131, March 2018.


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Most “Recurrences” of Thyroid Cancer Represent Persistent Rather Than Recurrent Disease

Clinical Thyroidology, Volume 30, Issue 3, Page 108-111, March 2018.


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No Benefit of Levothyroxine Among Pregnant Hypothyroid and/or Hypothyroxinemic Women on Offspring IQ at Age 9 years

Clinical Thyroidology, Volume 30, Issue 3, Page 100-103, March 2018.


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Thyroseq v3 Molecular Test for Indeterminate Thyroid Nodules Has Improved Sensitivity and Specificity

Clinical Thyroidology, Volume 30, Issue 3, Page 112-114, March 2018.


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Tumor Size and Nodal Stage Predict Recurrence and Timing of Ultrasonography in Papillary Thyroid Carcinoma Patients

Clinical Thyroidology, Volume 30, Issue 3, Page 126-128, March 2018.


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The Baseline Survey of the 294,905 Fukushima Children and Adolescents Reveals a Panorama of Thyroid Ultrasound Features

Clinical Thyroidology, Volume 30, Issue 3, Page 115-118, March 2018.


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Patients with Advanced Lung Cancer in Whom Thyroid Dysfunction Develops During Programmed Death-1 Protein Blockade May Have a Good Prognosis

Clinical Thyroidology, Volume 30, Issue 3, Page 132-134, March 2018.


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Preoperative Ultrasonography Guides the Extent of Thyroidectomy for Papillary Thyroid Cancer

Clinical Thyroidology, Volume 30, Issue 3, Page 119-121, March 2018.


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TSH Has Effects on Peripheral Thyroid Hormone Metabolism That Are Mild but Run Counter to Its Direct Effects on Thyroid Hormone Secretion

Clinical Thyroidology, Volume 30, Issue 3, Page 138-141, March 2018.


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To Evaluate the Role of H. pylori in Patients with Chronic Recurrent Tonsillitis

Abstract

The usual indication for surgical resection of tonsils is chronic recurrent tonsillitis. Literature also does not indicate the reason behind the fact that only part of the population suffers from recurrent chronic tonsillitis in spite being exposed to similar conditions. This was a prospective study, in which 50 tonsil biopsy samples obtained from chronic tonsillitis patients. Specimens were analysed with rapid urease broth test, HelicotecUT PLUS assay and Toluidine blue staining for presence of Helicobacter pylori. The age ranged from 4 to 34 years. The median age for patients with chronic recurrent tonsillitis was 9.5, 23 (46%) patients were male while 27 (54%) were female, presence of H. pylori by rapid urease broth test, HelicotecUT PLUS assay and Histopathology was 4%. Our analysis revealed that H. pylori did not significantly colonize the tonsils and does not play a role in the pathogenesis or development of chronic tonsillitis. The heterogeneity in study population and methodology may have contributed to the non significant results.



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Reduction of Marek's Disease Virus Infection by Toll-Like Receptor Ligands in Chicken Embryo Fibroblast Cells

Viral Immunology, Ahead of Print.


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To Evaluate the Role of H. pylori in Patients with Chronic Recurrent Tonsillitis

Abstract

The usual indication for surgical resection of tonsils is chronic recurrent tonsillitis. Literature also does not indicate the reason behind the fact that only part of the population suffers from recurrent chronic tonsillitis in spite being exposed to similar conditions. This was a prospective study, in which 50 tonsil biopsy samples obtained from chronic tonsillitis patients. Specimens were analysed with rapid urease broth test, HelicotecUT PLUS assay and Toluidine blue staining for presence of Helicobacter pylori. The age ranged from 4 to 34 years. The median age for patients with chronic recurrent tonsillitis was 9.5, 23 (46%) patients were male while 27 (54%) were female, presence of H. pylori by rapid urease broth test, HelicotecUT PLUS assay and Histopathology was 4%. Our analysis revealed that H. pylori did not significantly colonize the tonsils and does not play a role in the pathogenesis or development of chronic tonsillitis. The heterogeneity in study population and methodology may have contributed to the non significant results.



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Clinicopathological features of differentiated thyroid carcinoma referred to radioiodine therapy at Tripoli Medical Center

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Hawa Juma El-Shareif

Thyroid Research and Practice 2018 15(1):3-9

Objectives: The objective of this study is to study the demographic, clinicopathological features, and geographical distribution of differentiated thyroid cancer (DTC) among Libyan patients referred from all parts of the country to the nuclear medicine department, for radioactive iodine (RAI) therapy. Materials and Methods: Retrospective review of medical records of 265 patients with differentiated thyroid carcinoma (DTC) referred to RAI therapy in the Nuclear Medicine Branch-Tripoli Medical Center, in the period from May 2005 to October 2010. The data analyzed included sex, age at the time of diagnosis, the city of residence, pathological diagnosis, the extent of disease, and types of treatment. Results: There were 225 (84.9%) females and 40 (15.1%) males giving a sex ratio of 5.6:1. The mean age of males at diagnosis was 51.2 ± 14.8 (range 24–78) years and the mean age of the females was 44.6 ± 15.6 (range 10–95) years. Two hundred and twenty-three (84.2%) had papillary thyroid cancer (PTC), 31 (11.7%) had follicular thyroid cancer, 3 (1.1%) had Hurthle cell thyroid cancer, and 2 (0.8%) had follicular-insular thyroid cancer. About 43 (16.2%) had a history of multinodular goiter, and 3 (1.1%) Hashimoto's thyroiditis. From data collected, cervical lymph node metastases were found in 45 (17.0%), and distal metastases in 27 (10.2%). Conclusions: PTC was the most common type of DTC. DTC was more common among females. The current study showed that the disease tends to occur at an older age, and with less cervical lymph node metastases than previously reported.

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Clinicopathological study of medullary carcinoma of thyroid: A single institute experience

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Chaithra Gowthuvalli Venkataramana, Radha R Pai, Ranjitha Rao, M Nirupama, Flora D Lobo, Kausalya K Sahoo

Thyroid Research and Practice 2018 15(1):38-41

Context: Medullary thyroid carcinoma is one of the rare thyroid malignancies representing only about 5%–10%of total thyroid cancers. Aims: To study the age, sex distribution, and various histopathological features of medullary carcinoma of thyroid in our institute over a period of 5 years. Settings and Design: This is a retrospective descriptional study of the cases diagnosed as medullary carcinoma over a period of 5 years in our institute (i.e., from April 01, 2010, to March 31, 2015). Subjects and Methods: The study material obtained from departmental records, gross specimens, paraffin blocks or slides and case files from medical record sections. Histopathologically, tumor was identified according to the classical features as described in the World Health Organization of classification of tumors of endocrine organs. Results: We found 20 cases of medullary carcinoma which accounted for 12% of thyroid malignancies. There was female dominance, and the age group of patients ranged from 20 years to 66 years. Microscopically, tumor cell arrangement was classic in all the cases with some showing pseudopapillary and spindle cell areas. Apoptosis of the tumor cells were seen notably in three cases. Three cases had necrotic areas. One case of micro medullary carcinoma was found incidentally. We had one interesting case where the clinical and cytological features were more in favor of papillary carcinoma. Conclusions: Medullary carcinoma of the thyroid is rare. Identifying the histopathological features and its variations may show light into understanding of the tumor biology with its implications on patient management and prognosis.

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Vitamin D and primary hypothyroidism: Is there an association?

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Jyothi Idiculla, Pooja Prabhu, Rekha Pradeep, Kranti Khadilkar, Subramanian Kannan

Thyroid Research and Practice 2018 15(1):34-37

Background: Association studies between the vitamin D deficiency (VDD) and hypothyroidism have given mixed results. Because of this controvery and relatively common prevalence of these two conditions, we conducted a case-control study investigating the prevalence of VDD in patients with hypothyroidism (both TPO-Ab positive and negative) and compared it with euthyroid controls. Methodology: This is a single centre cross sectional study. Adults (aged 18 years or more) of both the sexes diagnosed with primary hypothyroidism (TSH >5.1 mIU/L) were included (n = 115) along with age and sex matched euthyroid (TSH <5 mIU/ml) controls (n = 120) chosen from the outpatients' department. Biochemical parameters like Thyroid stimulating hormone (TSH), free T4 (fT4), 25 hydroxy vitamin D (Vit D) and thyroid peroxidase antibody (TPO-Ab) were tested in both the groups. Results: Patients in the hypothyroid group [38 (males) and 77 (females)] had a mean (SD) age 46 (15) years, while the euthyroid control group [24 (males) and 96 (females) had a mean (SD) age of 45 (17) years. In the hypothyroid group, 96% (110/115) had VDD as compared to 90% (108/120) in the control group with a significantly lower mean Vit D level was observed in the hypothyroid group as compared to the euthyroid group (12+8.6 vs 17.49+11.89 ng/ml; P < 0.001). While 27 cases with hypothyroidism had severe VDD (Vit D levels <4.2 ng/ml) only 10 among the control group had severe VDD (OR 2.04, CI: 1.03-4.05, P < 0.05)). The mean level of Vit D in the TPO-Ab positive hypothyroid group was 10.4+7.2 ng/ml in comparison to the TPO-Ab negative group 15.3+10.3 (P = 0.004) (OR 3.39, CI:1.18-9.80; P < 0.05) 3.62). Conclusion: The vitamin D levels in patients with hypothyroidism were significantly lower compared to euthyroid controls.TPO-Ab positive patients had lower levels of vitamin D in comparison with negative

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Thyroid abscess: A rare case report and review of literature

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Balram Sharma, Vijay Kumar Bhavi, Hardeva Ram Nehra, Anshul Kumar, Sanjay Saran, Sandeep Kumar Mathur

Thyroid Research and Practice 2018 15(1):49-51

Acute suppurative thyroiditis (AST) leading to thyroid abscess is a quite uncommon clinical entity. Both thyroid abscess and AST represent only 0.1%–0.7% of thyroid pathologies which may require surgical management. AST especially affects patients with Hashimoto's thyroiditis or thyroid cancer. In children, AST is associated with the persistence of a canal originating from the 3rd or 4th bronchial pouch that may lead to recurrent thyroid abscess. The left lobe of thyroid gland is more frequently involved. AST can be life threatening if left untreated, resulting in mortality of 12% or higher.

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Cytodiagnosis of mucosa-associated lymphoid tissue lymphoma of thyroid gland: An extremely rare presentation in a young female

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Indranil Chakrabarti, Nirmalesh Mahata, Vaswati Das, Piyali Mitra

Thyroid Research and Practice 2018 15(1):42-45

Thyroid lymphoma, a rare tumor, constitutes about 1%–5% of all thyroid malignancies and 1%–2% of all extranodal lymphomas. The thyroid gland contains no native lymphoid tissue and is seen only in various pathological conditions such as primary thyroid lymphoma (PTL). PTL is more common in women than men (3:1 predominance) with a peak incidence in the sixth and seventh decades. Mucosa-associated lymphoid tissue (MALT) lymphoma of thyroid is one of the rare variants. Chronic autoimmune thyroiditis (Hashimoto's disease) has been associated with an increased risk of lymphoma, including MALT lymphoma. Here, we report a case of a 38-year-old female who presented with rapidly progressive swelling on the right side of the neck for previous 3 months. No history suggestive of hypothyroidism or hyperthyroidism was present. Ultrasonography showed enlarged thyroid gland with hypoechoic echotexture and multiple echogenic septations. Fine-needle aspiration cytology revealed features suggestive of MALT lymphoma. The swelling was operated, and subsequent histopathology and immunohistochemistry confirmed the diagnosis. Thereafter, the patient was treated by radiotherapy. However, after 6 months' follow-up, there was a recurrence of the tumor. Then, combination of cyclophosphamide, doxorubicin, vincristine, prednisone regime and rituximab was started, and the patient was free of recurrence at the next 12-month follow-up. Here, we report a very rare case of MALT lymphoma of Thyroid occurring in a young female with no known history of Hashimoto's thyroiditis. The tumor recurred after radiotherapy treatment and was successfully treated with subsequent chemotherapy.

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Depression, anxiety, and somatization in patients with clinical and subclinical hypothyroidism: An exploratory study

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Kavita Sanjiv Kale, Bharati Baviskar

Thyroid Research and Practice 2018 15(1):10-14

Background: Hypothyroidism and subclinical hypothyroidism (SCHT) are common disorders seen in clinical practice. A large proportion of patients with these disorders show psychiatric comorbidity. The current study was carried out to assess the prevalence and proportion of depression, anxiety, and somatization symptoms and compare the same between these two groups of patients. Methodology: Patients attending a medical outpatient department were screened for thyroid dysfunction using laboratory parameters, and patients detected with clinical and SCHT were included in the study. The sample consisted of 34 patients with CHT and 36 patients with SCHT. The patients were administered the Hamilton Rating Scale for Depression, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 Questionnaire, and PHQ-15 for somatization. The data were analyzed statistically using computerized software. Results: The study groups were well matched on sociodemographic profile and basic data. On assessing the severity of depression and anxiety, more cases of mild depression were reported in the subclinical hypothyroid group compared to moderate and severe depression being higher in the clinical hypothyroid group (P = 0.0001). Anxiety was well matched in both groups while somatization was higher in the subclinical hypothyroid group (P = 0.0001). Scores on depression scales were higher in the clinical group (P = 0.0001) and anxiety and somatization scores were higher in the subclinical group (P = 0.0001). Conclusions: Depression is usually seen in CHT while anxiety and somatization may be greater in SCHT. Further studies in larger populations are needed to validate the findings.

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The Bethesda system for reporting thyroid cytopathology: A relook

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Kaushik Pandit, Ipsita Ghosh

Thyroid Research and Practice 2018 15(1):1-2



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A cross-sectional survey to assess knowledge, attitude, and practices in patients with hypothyroidism in India

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Bipin Sethi, Deepak Khandelwal, Upal Vyas

Thyroid Research and Practice 2018 15(1):15-22

Objective: The objective of this study is to assess the knowledge, attitude, and practices (KAP) in patients with hypothyroidism in India. Methods: This was a questionnaire-based, cross-sectional KAP study conducted in patients with hypothyroidism across 16 centers in India. The questionnaire was validated initially by a panel of experts, followed by 120 patients with primary hypothyroidism. Results: Out of 500 patients enrolled, about three-fourths (72.4%) were women. Most patients had low levels of knowledge (66.6%), were quite concerned (46.6%), and practiced a moderate level of precaution (77.8%). Around 18.4%, 26.2%, 27.8%, and 37.6% of patients had incorrect/no knowledge that weight gain, fatigue, muscle aches/pain, and dry skin were effects of hypothyroidism, respectively. Patients had poor knowledge regarding various risks associated with hypothyroidism such as abnormal menstruation (41.6%), depression (47%), hypercholesterolemia (65.6%), and medications causing hypothyroidism (74.2%). Most patients (91.4%) affirmed the need to consult a physician for or seek medical advice before treatment initiation. However, a small percentage did not agree on testing pregnant women (20.2%) and family members (26.2%) for hypothyroidism. Most patients (93.2% and 92.6%) practiced compliance to frequency and timings for medications; however, one-thirds reported missing doses. There was lack of knowledge-seeking behavior both from online sources (57.4%) and treating doctors (24.2%). Significant associations were found between education and the levels of knowledge, concern, and precautions taken. Conclusion: This study identified significant gaps in the knowledge about the risks associated with hypothyroidism, importance of laboratory investigation, and dietary precautions.

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Vitamin D levels in children with Hashimoto's thyroiditis: Before and after L-thyroxine therapy

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Navendu Chaudhary, Rakesh Kumar, Naresh Sachdeva, Devi Dayal

Thyroid Research and Practice 2018 15(1):23-28

Background: Vitamin D deficiency has been associated with Hashimoto's thyroiditis (HT). Hypothyroidism per se can cause poor absorption and metabolism of Vitamin D leading to Vitamin D deficiency. It is unknown that Vitamin D deficiency in HT is a cause or effect of HT. Objectives: To study Vitamin D level in children with newly diagnosed HT and to follow the changes in Vitamin D level after L-thyroxine therapy. Material and Methods: A prospective observational study was conducted on 35 children recently diagnosed with HT who had not received Vitamin D supplementation in the past 6 months. Serum 25 hydroxy Vitamin D levels along with serum calcium profile were estimated before starting L-thyroxine and on follow-up after 3 months. Results: The mean Vitamin D level at diagnosis of HT was significantly low as compared to controls (33.34 ± 16.93 nmol/L vs. 65.13 ± 30.57 nmol/L; P < 0.0001). Out of 22 Vitamin D-deficient patients who were treated, seven (31.8%) remained deficient at follow-up. Thirteen patients (sufficient/insufficient Vitamin D levels) who were not supplemented with Vitamin D had fall in Vitamin D levels in follow-up. Conclusions: Children with HT have low Vitamin D levels at diagnosis, and L-thyroxine therapy can further compromise Vitamin D status. Children with recent diagnosis of HT should be screened and treated or supplemented with Vitamin D.

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Case report: An unusual variation in the course of recurrent laryngeal nerve in relation to the thyroid gland

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Anjali Venugopal, Akanksha A Saberwal, Yogesh G Dabholkar

Thyroid Research and Practice 2018 15(1):46-48

A complete understanding of the anatomic variations of the thyroid gland is necessary for a safe thyroid surgery. Injury to recurrent laryngeal nerve during thyroid surgery remains a significant source of morbidity. We present an uncommon variation in the position of right recurrent laryngeal nerve with the Tubercle of Zuckerkandl in a 40-year-old female who underwent thyroidectomy for a benign multinodular goiter. Identification and meticulous dissection of the Tubercle of Zuckerkandl and recognition of its association with the recurrent laryngeal nerve are essential to maintain the integrity of the nerve and prevent complications during thyroid surgery.

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Spectrum of clinical symptomatology and its resolution following levothyroxine supplementation in primary and subclinical hypothyroidism: An Indian perspective

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Sachin Chittawar, Apeksha Nagdeote, Abhinav Nair, Krishna Kumar Kawre, Deep Dutta

Thyroid Research and Practice 2018 15(1):29-33

Background: Data are scant on the spectrum of features associated with subclinical hypothyroidism (ScH) and overt primary hypothyroidism (OPH). This study aimed was to determine the burden as well as predictors of the lack of resolution of symptoms of hypothyroidism in patients of ScH and OPH following levothyroxine supplementation. Methods: A total of 505 patients were screened, of which 411 consecutive patients with ScH and 94 with OPH were evaluated. Data from 347 patients with ScH and 76 patients with overt OPH, who completed the study, were analyzed. Thyroid symptomatology was evaluated using standardized questionnaire. Results: The median age of participants was 35 (28–41) years; 95.04% being females. Common symptoms in OPH were shortness of breath (72.36%), depression (57.89%), irritability (57.89%), periorbital edema (53.94%), "feeling tired" (51.31%), and swelling of limbs (48.68%). Common symptoms in ScH were "feeling tired" (62.82%), "unhappy with routine" (44.95%), depression (40.92%), irritability (38.90%), and "weight gain with a poor appetite" (36.31%). Goiter was documented in 31.58% OPH and 3.17% in ScH (P < 0.001). Hair loss was observed 31.57% OPH and 29.68% ScH. Median (interquartile range) dose of levothyroxine supplemented was 37.5 (12.5–50) and 100 (75–112.5) mcg, respectively. Resolution of hypothyroidism symptoms was lesser in ScH. Persisting features included goiter, irregular menstruation, "weight gain with poor appetite," irritability, depression, "feeling tired," body aches, and depression. Binary logistic regression revealed thyroid stimulating hormone (TSH) to be an independent predictor of symptoms resolution. Every unit increase in TSH was associated with 0.7% greater resolution. Conclusion: Symptoms associated with hypothyroidism are diverse and nonspecific. Resolution of symptoms following levothyroxine supplementation and achieving biochemical euthyroidism is more likely in OPH that ScH.

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Steroid-responsive encephalopathy in autoimmune thyroiditis: A diagnostic enigma?

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Balram Sharma, Vijay Kumar Bhavi, Hardeva Ram Nehra, Anshul Goyal, Sanjay Saran, Sandeep Kumar Mathur

Thyroid Research and Practice 2018 15(1):52-55

Hashimoto's encephalopathy or steroid-responsive encephalopathy associated with autoimmune thyroiditis is a neuroendocrine disorder of unknown cause associated with thyroid autoimmunity. We report case of a 61-year-old male, previously healthy, who developed a subacute onset of declining higher mental functions. Serologic studies demonstrated the high levels of antithyroid antibodies. Electroencephalographic, cerebrospinal fluid, and magnetic resonance image findings were normal, consistent with Hashimoto's encephalopathy. It is a diagnosis of exclusion once the detailed neurology evaluations were done. This unusual disorder is often underrecognized because of the multiple and protracted neurocognitive manifestations; therefore, it is important to be aware of this clinical manifestations to make a correct diagnosis and favorable outcome.

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Regulation of human dendritic cell immune functions by ion channels

Christophe Vandier | Florence Velge-Roussel

https://ift.tt/2DR7Fsf

Periodontal and endodontic infectious/inflammatory profile in primary periodontal lesions with secondary endodontic involvement after a calcium hydroxide-based intracanal medication

Abstract

Objective

The aim of the present study was to investigate the effects of a calcium hydroxide-based intracanal medication (ICM) on periodontal and endodontic infectious/inflammatory contents and on periodontal clinical parameters in teeth with primary periodontal lesion and secondary endodontic involvement.

Materials and methods

Ten patients with abnormal pulp test results and deep probing depth derived from primary periodontal disease with secondary endodontic involvement were included. Samples were collected from root canals (RC) and periodontal pockets (PP) in order to investigate the microbiological status, levels of endotoxin (LPS), cytokines, and matrix metalloproteinases (MMP), before and after ICM. PCR was used for microbiological assessment. The kinetic-chromogenic LAL assay was used for LPS quantification. Quantikine ELISA kits were used for measurement of IL-1 α, IL-1 β, TNF-α, PGE2, MMP-2, MMP-3, MMP-8, MMP-9, and MMP-13 levels. The statistical analyses were made using the Friedman and Wilcoxon tests (p < 0.05). T test was used to compare data on periodontal characteristics.

Results

ICM did not reduce the number of microorganisms in PP and RC, except for Fusobacterium nucleatum in RC. There was a significant reduction in LPS, MMPs, IL-1 β, and TNF-α levels in PP after ICM. In RC, LPS, MMP13, PGE2, and IL-1β levels remained unaltered (p > 0.05); however, the levels of the other MMPs and cytokines were reduced (p < 0.05). After 1 year of the root canal treatment, tooth mobility was significantly reduced (p ≤ 0.05).

Conclusions

The use of a calcium hydroxide-based ICM showed positive effects for periodontal treatment prognosis, as it reduced LPS, cytokine, and MMP levels in periodontal pockets.

Clinical significance

Patients presenting deep probing depth and undergoing periodontal treatment for at least 6 months, with no positive response to periodontal therapy, might benefit with the endodontic treatment.



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Vascular liver diseases on the clinical side: definitions and diagnosis, new concepts

Abstract

The components of the hepatic vascular system (hepatic arteries, portal and hepatic veins, sinusoids, and lymphatics) can be damaged by various types of injury. Each of the resulting conditions is rare, which has limited knowledge and awareness. In the last two decades, international collaborations have allowed to reach critical masses of data, which has driven significant progresses in understanding and management of vascular disorders of the liver. The present paper discusses definitions, denominations, and diagnosis of such vascular disorders with the exception of those affecting hepatic arteries. Evolving pathogenic or pathophysiologic views relevant to the clinical aspects are also overviewed.



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EMA Committee Backs Remicade Biosimilar Zessly

The committee favors marketing the infliximab biosimilar product Zessly for treatment of rheumatoid arthritis, Crohn's disease, ulcerative colitis, ankylosing spondylitis, psoriatic arthritis, and psoriasis.
International Approvals

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Training Groups

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Publication date: April 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 3





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Editorial Board

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Publication date: April 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 3





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Percutaneous treatment of orofacial vascular malformations

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Publication date: April 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 3
Author(s): A. Sindel, A. Sayan, Ö. Özgür, T. Sindel, V. Ilankovan
The aim of this study was to evaluate the efficacy of fluoroscopy-guided percutaneous injection of bleomycin as the primary treatment for low-flow vascular malformations. A total of 34 patients (mean (range) age 24 (8–51) years) with orofacial vascular lesions were treated in the Department of Interventional Radiology and Maxillofacial Surgery. There were 20 low-flow venous malformations, 11 lymphatic malformations, and three of mixed type. All patients were treated by fluoroscopy-guided percutaneous injection of a mixture of bleomycin (mean (range) 15 (5–15)mg) and a radio-opaque agent (Ultravist® (iopromide), Bayer)/session. The number of sessions ranged from one to six. The clinical response was complete in 21 patients, obvious in nine, and of clinical benefit in four. Patients were reviewed within the first week, third week, and at three-month periods until 24 months. There were no serious complications such as pulmonary fibrosis. Fluoroscopy-guided intralesional injection of bleomycin should be considered as the first-line treatment for lymphatic malformations because it is effective and reliable with few complications.



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Patient Concerns Inventory (at diagnosis) and intention to treat

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Publication date: April 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 3
Author(s): B. Rushworth, S. Milne, A. Kanatas




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Early removal of sequestrum in patients affected by medication-related osteonecrosis of the jaw

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Publication date: April 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 3
Author(s): M. Kharazmi, P. Hallberg




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Corrigendum to “Medial approach for minimally-invasive harvesting of a deep circumflex iliac artery flap for reconstruction of the jaw using virtual surgical planning and CAD/CAM technology” [Br J Oral Maxillofac Surg 2017;55(November (9)):946–51]

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Publication date: April 2018
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 3
Author(s): A. Modabber, N. Ayoub, A. Bock, S.C. Möhlhenrich, B. Lethaus, A. Ghassemi, D.A. Mitchell, F. Hölzle




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Blindness after facial trauma: epidemiology, incidence and risk factors. a 27-year cohort study of 5708 patients.

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Publication date: Available online 23 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Panagiotis Stathopoulos, Dimosthenis Igoumenakis, Michalis Mezitis, George Rallis
ObjectivesThis is a 27-year study of a cohort of 5708 patients who sustained maxillofacial fractures. Our purpose is to present the aetiology, mechanism of trauma, site and concomitant injuries that led to visual loss. We hypothesize that fractures caused by high energy impact of the midface may be associated with blindness. A discussion of the treatment approaches is also included.Study Design5708 patients sustained a maxillofacial fracture during the years from 1985 to 2012 and were included in this study. Patients' records were reviewed for gender, age, fracture site, aetiology of trauma, concomitant injuries, method of treatment, length of hospital stay and cause of blindness. The relation of the above variables to blindness was investigated.ResultsThe incidence of loss of vision was 0.34%. A very strong association between firearm injuries and blindness is demonstrated. (p<0.001) These patients spent much longer time in hospital (p<0.01) and suffered serious concomitant injuries involving the brain.ConclusionRetrobullbar haemorrhage should be treated with lateral canthotomy whereas in traumatic optic neuropathy, observation seems to be the safest thing to do. In patients with penetrating injuries of the globe the immediate involvement of an Ophthalmic Surgeon is of paramount importance.



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Demographics and referral patterns of a university-based oral maxillofacial radiology clinic over a 20 year period

Publication date: Available online 23 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Chen Nadler, Linda Lee
Objectives– The aim of this study was to review the referral patterns, distribution of interpretations, and type of diagnostic imaging used in a university based oral maxillofacial radiology clinic for patients referred for consultation from both dental and non-dental clinicians.Study Design– The database of the Special Procedures clinic in the Oral Radiology department of the University of Toronto, Faculty of Dentistry, containing over 5,000 entries, from 1993 to 2013, was queried. Using descriptive categorical analysis, the results were analyzed to describe patient demographics, the speciality of the referring clinicians, the imaging modalities used and the interpretation provided.Results– Most referrals were from oral and maxillofacial surgeons and general dentists. Approximately 25% of referrals were interpreted as variations of normal anatomic structures. The most common reasons for referral were intraosseous lesions (42%), temporomandibular joints (39%), and sialography. Ten per cent of all referrals were for recall examinations. The distribution of image modalities has changed through the years covered by this study.Conclusion– This study reflects a lower proportion of referrals reported as normal structures and their variations, than reported in a previous comparable study.



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

Publication date: Available online 22 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Anson Dong, Kevin J. Zuo, Georgina Papadopoulos-Nydam, Jaret Olson, Gordon Wilkes, Jana Rieger
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. A total of 37 articles were reviewed, with the majority reporting outcomes through subjective facial expression ratings and only 15 dealing with other functional outcomes. In particular, outcomes related to oral competence and speech were reported inconsistently. Facial reanimation patients would benefit from a unified movement to create and validate through consensus, an outcomes reporting system incorporating not only facial expression, but also oral competence, speech, and patient-reported quality of life, to enable global patient assessment.



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Long-term evaluation of the effect of middle ear effusion on the vestibular system in children

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Katarzyna Pazdro-Zastawny, Lucyna Pośpiech, Tomasz Zatoński
BackgroundOtitis media with effusion (OME) is one of the most common clinical conditions in childhood. Fluid accumulation in the middle ear may impact inner ear.ObjectivesThe purpose of this random sample cohort study was to investigate whether the past history of middle ear effusion has a long-term negative impact on the vestibular system in children.Material and methodsThe study was carried out on 22 children aged 7–15 years who had undergone drainage of the middle ear 5 years before evaluation. The control group consisted of 29 healthy children aged 4–17 years. Vestibular function was examined using sway posturography and electronystagmography (ENG).ResultsThe stabilogram parameters of the study group and the control group were compared. The field of developed area (FDA) and the average body sway velocity (ASV) were analyzed. Elevated stabilogram parameters of FDA and ASV, both with eyes open and eyes closed, were found in the study group. Statistically significant values (p < 0.05) were present for ASV with eyes open and with eyes closed. The ENG recordings were analyzed in both groups. In the study group, spontaneous nystagmus was observed in 40.9% of the children and positional nystagmus occurred in 63.6% of the children. According to tests, eye tracking test was impaired in 27.3% of cases. Rotatory chair testing revealed asymmetry in 18.2% of the children.ConclusionThe presence of effusion in the middle ear in the past has a negative impact on the vestibular part of the inner ear. Clinicians should be aware of the possible negative impact of middle ear effusion on the vestibular function in children with a history of otitis media with effusion. With seeimingly asymptomatic children clinicians should inquire parents about symptoms of dysequlibrium and imbalance.



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Congenital and iatrogenic laryngeal and vocal abnormalities in patients with 22q11.2 deletion

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Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Bridget Ebert, James Sidman, Noelle Morrell, Brianne Barnett Roby
BackgroundVoice abnormalities often go unrecognized in patients with 22q11.2 deletion because speech abnormalities become the focus of evaluation.ObjectiveTo analyze voice and vocal fold abnormalities in patients with 22q11.2 deletion by examining voice, not speech.MethodsThis is a case series with chart review from 2009 to 2016. Records of both a velocardiofacial syndrome (VCF) clinic and pediatric otolaryngology clinic at a tertiary pediatric hospital were reviewed. All patients with confirmed 22q11.2 deletion were identified. Cardiac, otolaryngological, speech, and voice characteristics were recorded along with surgical history. Main outcomes included voice characteristics based on speech therapy assessment, along with vocal fold or laryngeal abnormalities. Co-morbidities and surgical history were also recorded.Results109 patients were identified with 22q11.2 deletion by genetic testing. Eighteen percent (n = 20) displayed a vocal fold or laryngeal abnormality, either congenital or iatrogenic. The most common congenital abnormalities were laryngeal web (n = 10) and subglottic stenosis (n = 7). The most common iatrogenic abnormality was paralyzed left vocal fold (n = 4). Perceptual analysis by speech therapy showed 65% (n = 71) with a voice within normal limits while 17% (n = 19) were not within normal limits. Of the 20 patients with a vocal fold abnormality, 15% (n = 3) presented a voice within normal limits, while 65% (n = 13) were not within normal limits. Of the 19 patients with a voice outside normal limits, 68% (n = 13) had a diagnosed vocal fold abnormality. Sixteen percent (n = 3) of these patients had an abnormal voice as a result of other issues.ConclusionOut of 109 patients with 22q11.2 deletion, 18% displayed a laryngeal abnormality and 17% had abnormal vocal quality. This suggests that voice and vocal fold abnormalities are important to consider in this population. Distinguishing between speech and voice abnormalities in patients with 22q11.2 deletion can help ensure appropriate intervention.



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Marginal versus segmental mandibulectomy for pediatric desmoid fibromatosis of the mandible – Two case reports and review of the literature

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Janet W. Lee, Arnaud F. Bewley, Craig W. Senders
Desmoid fibromatosis (DF) is a rare, benign soft tissue neoplasm with high rate of local recurrence. Surgical management of DF in the head and neck can be challenging given the desire to balance the preservation of form and function with the need to minimize local recurrence by achieving complete resection. We present two contrasting cases which highlight the advantages of marginal mandibulectomy over segmental mandibulectomy in children with DF. We favor marginal mandibulectomy even with limited bone stock given the remarkable ability of children to generate new bone.



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Surgical management of children presenting with surgical-needed tracheal stenosis

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Publication date: May 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 108
Author(s): Marie-Eva Rossi, Eric Moreddu, Loïc Macé, Jean-Michel Triglia, Richard Nicollas
ObjectivesThe purpose of this work was to assess epidemiological aspects, surgical approach, morbidity and mortality rates of patients presenting with tracheal stenosis requiring surgery, and the evolution of surgical techniques over the last years.MethodsWe performed a retrospective observational study from 1990 to 2017 in a pediatric tertiary-care center with needing surgery for tracheal stenosis. We analyzed clinical patients' characteristics, type of stenosis, type of surgery and follow-up.ResultsTwenty-eight children presented with tracheal stenosis, half of them with congenital stenosis (complete tracheal rings) and the other half with acquired stenosis (neoplasic or post intubation injury). 39.3% of these stenoses were associated with a vascular ring (61.5% in case of congenital stenosis). Depending on the extent of the stenosis and its origin, the surgery could be performed endoscopically or by an external approach. Enlargement tracheoplasty with an autograft (14.3%) was replaced by slide tracheoplasty with Cardio Pulmonary By-Pass (CPBP, 28.6%) with improved results for the treatment of long segment tracheal stenosis, involving more than 30% of the tracheal length (all were congenital in our study). Slide tracheoplasty has been performed since the late 90's in our institution. 25% of children have had a resection and anastomosis of the trachea because they had a stenosis involving less than 30% of tracheal length. Endoscopic surgery was performed for membranous stenoses, which were often seen after intubation or tracheotomy (32.1% of patients).ConclusionEffective treatment of surgical tracheal stenosis was performed in 28 children between 1990 and 2015. Surgical techniques have evolved over time, leading to a better management of this rare and serious disease.



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Depleted polymorphonuclear leukocytes in human metastatic liver reflect an altered immune microenvironment associated with recurrent metastasis

Abstract

Background

Hepatic immunity, normally protective against neoplasia, is subverted in colorectal liver metastasis (CRLM). Here, we compare the inflammatory microenvironment of CRLM-bearing liver tissue to donor liver.

Methods

Twenty-five patients undergoing resection for CRLM were recruited, 13 of whom developed intrahepatic recurrence within 18 months. Biopsies were obtained from tumour and normal liver tissue adjacent to and distal from, the tumour. Donor liver biopsies were obtained during transplantation. Biopsies were cultured and conditioned media (CM) screened for 102 inflammatory mediators. Twelve of these were validated by Luminex assay. Transwell assays measured cancer cell chemotaxis. Polymorphonuclear leukocytes (PMN) and lymphocytes were quantified in H&E sections.

Results

Fewer periportal tissue-resident PMN were present in metastatic liver compared to donor liver. Patients with the fewest PMN in liver tissue distal to their tumour had a shorter time to intrahepatic recurrence (P < 0.001). IL-6, CXCL1, CXCL5, G-CSF, GM-CSF, VEGF, LIF, and CCL3 were higher in liver-bearing CRLM compared to donor tissue. Consequently, cancer cells migrated equally towards CM of all regions of metastatic liver but not towards donor liver CM.

Conclusions

The local inflammatory environment may affect both immune cell infiltration and cancer cell migration contributing to recurrence following resection for CRLM.



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

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 dec...

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Tumor PD-L1 expression is associated with improved survival and lower recurrence risk in young women with oral cavity squamous cell carcinoma

Publication date: May 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 5
Author(s): G.J. Hanna, S.-B. Woo, Y.Y. Li, J.A. Barletta, P.S. Hammerman, J.H. Lorch
Young patients with oral cavity squamous cell carcinoma (OCSCC) are often recognized as a distinct epidemiological cohort. In this study, genomic and immune-based metrics were correlated with long-term outcomes for a young patient population treated at a single institution. A fully clinically annotated, retrospective cohort of 81 patients aged ≤45 years with OCSCC is described, and the impact of clinicopathological features on long-term survival outcomes is reported. Genomic and immune parameters were integrated utilizing a whole-exome sequencing and immunohistochemical approach among females in the cohort. It was found that young OCSCC patients had favorable outcomes (10-year disease-free survival 79.1%, overall survival 80.0%) regardless of sex, particularly if they presented with oral tongue primaries and early stage disease. While mutational analysis appeared similar to that of older patients with OCSCC who lack a smoking history, a comparatively high degree of PD-L1 expression and PD-1/L1 concordance (P=0.001) was found among young female OCSCC patients. Subjects with greater membranous PD-L1 positivity and the presence of tumor-infiltrating lymphocytes had a decreased risk of recurrence (P=0.01 and P=0.01, respectively) and improved survival (P=0.04 and P=0.03, respectively). These findings warrant further validation and support the investigation of immunotherapeutic approaches targeting PD-1/L1 interactions in young OCSCC patients.



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Editorial Board/Reviewing Committee

Publication date: May 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 5





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The effect of different dosage regimens of tranexamic acid on blood loss in bimaxillary osteotomy: a randomized, double-blind, placebo-controlled study

Publication date: May 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 5
Author(s): B. Apipan, D. Rummasak, T. Narainthonsaenee
The purpose of this study was to compare the effects of three dosage regimens of intravenous tranexamic acid and normal saline placebo on blood loss and the requirement for transfusion during bimaxillary osteotomy. A prospective, randomized, double-blind, placebo-controlled study was performed. Eighty patients scheduled for elective bimaxillary osteotomy were divided into four groups: a placebo group and three groups receiving a single dose of tranexamic acid 10, 15, or 20mg/kg body weight after the induction of anaesthesia. Demographic data, the anaesthetic time, the operative time, and the experience of the surgical team were similar in the four groups. Patients receiving placebo had increased blood loss compared to those receiving tranexamic acid. No significant difference in blood loss was found among those who received 10, 15, or 20mg/kg body weight of tranexamic acid. There was no significant difference in transfusion requirement, amount of 24-h postoperative vacuum drainage, length of hospital stay, or complications among the four groups. Prophylactic tranexamic acid decreased bleeding during bimaxillary osteotomy. Of the three dosages of tranexamic acid studied, the most efficacious and cost-effective dose to reduce bleeding was 10mg/kg body weight.



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Correlation between intraoperative proximal segment rotation and post-sagittal split ramus osteotomy relapse: a three-dimensional cone beam computed tomography study

Publication date: May 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 5
Author(s): B.-J. Choi, B.-S. Lee, Y.-D. Kwon, J.-W. Lee, S.-U. Yun, K.-S. Ryu, J.-Y. Ohe
This study evaluated the effects of proximal segment rotation and the extent of mandibular setback on post-sagittal split ramus osteotomy (SSRO) relapse using three-dimensional (3D) analysis. Thirty-one patients diagnosed with a skeletal class III malocclusion who underwent SSRO alone were enrolled in this study. The movements of the mandibular condyles were assessed using cone beam computed tomography (CBCT) and a 3D imaging program at ≤1 month before the operation (T0), 1 week after the operation (T1), and 6 months (T2) and 1year (T3) postoperative. Yaw and roll were increased at T1 as compared to T0. However, the proximal segments reverted to their original positions between T2 and T3. There was a positive correlation between the extent of the posterior movement of the mandible and relapse at 6 months and 1year postoperative. Although the proximal bone segments showed displacement in three dimensions at T1, they reverted to their original positions over time. In addition, although there was a positive correlation between the extent of the posterior movement of the mandible and the occurrence of post-surgical relapse at 6 months and 1year post-surgery, the rotation of the proximal bone segment during surgery had no relationship with postoperative relapse.



https://ift.tt/2pBn4Ii

Three-dimensional changes to the upper airway after maxillomandibular advancement with counterclockwise rotation: a systematic review and meta-analysis

Publication date: May 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 5
Author(s): R.S. Louro, J.A. Calasans-Maia, C.T. Mattos, D. Masterson, M.D. Calasans-Maia, L.C. Maia
The aim of this study was to evaluate the effect of counterclockwise (CCW) rotation and maxillomandibular advancement (MMA) on the upper airway space using three-dimensional images. An electronic search was performed in the PubMed, Cochrane Library, Scopus, Virtual Health Library, Web of Science, and OpenGrey databases (end date July 2016); a hand-search of primary study reference lists was also conducted. The inclusion criteria encompassed computed tomography evaluations of the upper airway spaces of adult patients undergoing orthognathic surgery with CCW rotation and MMA. The articles were evaluated for risk of bias with a tool for before-and-after studies. A meta-analysis was performed with the mean differences using a random-effects model. Heterogeneity was assessed with the Q-test and the I2 index. The meta-analysis revealed significant (P<0.001) increases in both the total airway volume (effect size of 6832mm3 and confidence interval of 5554–8109mm3) and the minimum axial area (effect size of 92mm2 and confidence interval of 70–113mm2). The heterogeneity was low in both comparisons (I2=38% and 7%, respectively). The technique of mandibular advancement with CCW rotation produced significant increases in the volumes and areas of the upper airway spaces.



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Genioglossus muscle advancement and simultaneous sliding genioplasty in the management of sleep apnoea

Publication date: May 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 5
Author(s): R. Rojas, R. Chateau, C. Gaete, C. Muñoz
Genioglossus muscle advancement (GMA) was reported in 1993 as an option for the surgical treatment of obstructive sleep apnoea syndrome (OSAS), in the context of phase I of the Stanford University (Powell–Riley) protocol. The rationale for this technique is the placement of tension on the base of the tongue, thus preventing the tongue from falling back into the posterior airway space. However, in retrognathic patients undergoing phase I of the Stanford University protocol, an additional genioplasty will provide a better aesthetic outcome. Furthermore, genioplasty is one of the most common and versatile techniques used for the correction of dentofacial deformities. The aim of this article is to describe a technique that allows a combination of genioglossus muscle advancement (GMA) and a simultaneous sliding genioplasty. This technique can be used in patients undergoing phase I surgery, or in patients in whom a sliding genioplasty could be complemented by GMA. The advantage of this procedure is the aesthetic enhancement obtained in GMA patients. The indications, contraindications, complications, and outcomes of surgery in the first 15 patients treated with this technique are reported herein.



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Effect of implant loading protocols on failure and marginal bone loss with unsplinted two-implant-supported mandibular overdentures: systematic review and meta-analysis

Publication date: May 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 5
Author(s): M.H.E.-D. Helmy, A.Y. Alqutaibi, A.A. El-Ella, A.F. Shawky
The aim of this study was to compare implant failure and radiographic bone level changes with different loading protocols for unsplinted two-implant-supported mandibular overdentures. An electronic search of two databases (PubMed, Cochrane Library) was performed, without language restriction, to identify randomized controlled trials (RCTs) comparing immediate or early versus conventional dental implant loading protocols for unsplinted two-implant-supported mandibular overdentures. Data were extracted independently by two reviewers. The Cochrane tool was used to assess the quality of included studies. A meta-analysis was performed. Eight RCTs were identified, seven of which were included; one trial was excluded because related outcomes were not measured. Four of the seven studies were considered to have a high risk of bias and three an unclear risk. Meta-analysis revealed no difference between immediate versus conventional or early versus conventional implant loading protocols regarding implant failure (risk difference (RD) −0.02, 95% confidence interval (CI) −0.13 to 0.10; RD 0.09, 95% CI −0.03 to 0.20) or marginal bone loss (mean difference (MD) 0.09, 95% CI −0.10 to 0.28; MD −0.05, 95% CI −0.12 to 0.02) for implants supporting mandibular overdentures. These findings should be interpreted with great caution given the serious numerical limitations of the studies included.



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The impact of different torques for the insertion of immediately loaded implants on the peri-implant levels of angiogenesis- and bone-related markers

Publication date: May 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 5
Author(s): A. Verrastro Neto, R. Andrade, M.G. Corrêa, R.C.V. Casarin, M.Z. Casati, S.P. Pimentel, F.V. Ribeiro, F.R. Cirano
The aim of this split-mouth, randomized, double-blind, controlled clinical trial was to evaluate the influence of different insertion torque values for dental implants on bone- and angiogenesis-related marker profiles. Eighteen edentulous patients received dental implants and fixed complete-arch mandibular prostheses. The implants (n=36) were assigned randomly to two groups: reduced torque (n=18), with insertion torque <30Ncm; and conventional torque (n=18), with insertion torque ≥30Ncm. Levels of vascular endothelial growth factor (VEGF), placental growth factor, bone morphogenetic protein 9 (BMP-9), periostin, osteoprotegerin (OPG), and tartrate-resistant acid phosphatase (TRAP) in the peri-implant fluid were quantified at 7, 14, 30, and 120days after implant placement. Inter-group comparisons showed that VEGF and OPG levels were higher in the low-level torque group than in the conventional torque group on days 7 and 30, respectively (P<0.05). BMP-9 and periostin levels were higher in the conventional group than in the low-level torque group on day 120, and TRAP was up-regulated around implants inserted with conventional torque when compared to those inserted with lower-level torque at all time points evaluated (P<0.05). In conclusion, the use of different levels of torque for implantation of immediately loaded implants significantly influenced the levels of bone- and angiogenesis-related markers during early peri-implant repair.



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Titanium and polyether ether ketone (PEEK) patient-specific sub-periosteal implants: two novel approaches for rehabilitation of the severely atrophic anterior maxillary ridge

Publication date: May 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 5
Author(s): M. Mounir, M. Atef, A. Abou-Elfetouh, M.M. Hakam
The aim of this study was to assess two new protocols for single-stage rehabilitation of the severely atrophic maxillary ridge using customized porous titanium or polyether ether ketone (PEEK) sub-periosteal implants. Ten patients with a severely atrophic anterior maxillary alveolar ridge were divided randomly into two groups (five patients in each) to receive customized sub-periosteal implants fabricated via CAD/CAM technology: group 1, porous titanium implants; group 2, PEEK implants. Prosthetic loading with fixed acrylic bridges was performed 1 month postoperative. The implants were followed-up for 12 months and evaluated for the presence of any sign of radiographic bone resorption, mobility, infection, prosthetic fracture, or implant exposure. The immediate postoperative period was uneventful except for one case complicated by wound dehiscence in group 1. At 12 months, all implants were functionally stable and the patients were comfortable with the prostheses. No signs of radiographic bone resorption, mobility, infection, or prosthetic fracture were observed. Within the limitations of this study, the application of customized porous titanium and PEEK sub-periosteal implants produced through CAD/CAM technology appears to be an acceptable method for single-stage prosthetic rehabilitation of the severely atrophic edentulous anterior maxilla.This study was awarded the best case study at the academy of osseintegration annual meeting 2017, Orlando, Florida.



https://ift.tt/2IMKGm7

Effectiveness of icatibant for treatment of hereditary angioedema attacks is not affected by body weight: findings from the Icatibant Outcome Survey, a cohort observational study

Icatibant is a bradykinin B2-receptor antagonist used for the treatment of hereditary angioedema attacks resulting from C1-inhibitor deficiency. Treatment is not adjusted by body weight however the impact of b...

https://ift.tt/2G6e8ll

The Laryngoscope, Ahead of Print.

The Laryngoscope, Ahead of Print.


http://ift.tt/2G1wU1a

Clinical and Experimental Dermatology, Ahead of Print.

Clinical and Experimental Dermatology, Ahead of Print.


http://ift.tt/2pAgPEB

Head &Neck, Ahead of Print.

Head &Neck, Ahead of Print.


http://ift.tt/2FWdZVv

Biocompatibility and biomineralization assessment of mineral trioxide aggregate flow

Abstract

Objective

Evaluate, in vivo, the biocompatibility via subcutaneous inflammatory tissue response and mineralization ability of the new MTA Flow compared to MTA Angelus and ProRoot MTA.

Materials and methods

Forty male Wistar rats were assigned and received subcutaneous polyethylene tube implants containing the test materials and a control group with empty tube (n = 10 animals/group). After days 7, 15, 30, and 60, the animals were euthanized and the polyethylene tubes were removed with the surrounding tissues. Inflammatory infiltrate and thickness of the fibrous capsule were histologically evaluated. Mineralization was analyzed by Von Kossa staining and under polarized light. Data were analyzed via Kruskal-Wallis and Dunn's test with a significance level of 5%.

Results

MTA Angelus induced the mildest reaction after 7 (P > .05) and 15 days (P < .05) followed by MTA Flow, both cements achieving mild inflammatory reaction after 15 days. ProRoot MTA induced a severe inflammation on day 7 and was reducing after day 15 (P > .05). No difference was observed after days 30 or 60 (P > .05). Von Kossa staining and birefringent structures were positive to all materials.

Conclusions

At the end of the experiment, the novel MTA Flow showed biocompatibility and induced biomineralization in all time periods.

Clinical relevance

The final consistence obtained in MTA Flow may facilitate several procedures, indicating that the MTA Flow has a promising application in endodontics.



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

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Publication date: Available online 22 March 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Chitra Dinakar, Stanley M. Fineman, Bradley E. Chipps, David A. Khan, Stephen A. Tilles




http://ift.tt/2G2aRmV

Effects of Remote Ischemic Preconditioning During Free Flap Reconstruction

Condition:   Remote Ischemic Conditioning
Interventions:   Procedure: remote ischemic preconditioning (RIPC);   Procedure: sham-RIPC
Sponsor:   Seoul National University Hospital
Recruiting

http://ift.tt/2ILBqOQ

Anatomical locations in the oral cavity where surgical resections of oral squamous cell carcinomas are associated with a close or positive margin—a retrospective study

Abstract

Objectives

This study aimed to identify anatomical areas where resections of oral squamous cell carcinomas (OSCC) are significantly associated with close or positive margins.

Materials and methods

This retrospective study included 330 patients with a primary OSCC from 2010 to 2015. Patient and tumour data were categorised into three groups by R-status (R0 [clear], ≥ 5 mm, 185 patients [56.06%]; R1 [positive], < 1 mm, 24 patients [7.27%]; and R0 [close], 1–5 mm, 121 patients [36.67%]).

Results

Areas where resections were significantly associated with close or positive margins were the hard palate (p < 0.001), buccal mucosa (p = 0.03), floor of the mouth (p = 0.004), lower alveolar ridge (p = 0.01), retromolar triangle (p = 0.005), and dorsal tongue (p = 0.02).

Conclusions

Anatomical areas were identified in the oral cavity where it is challenging to resect OSCCs with an adequate safety margin.

Clinical relevance

These results may enable surgeons to achieve a postulated safe distance during tumour resection, leading to a survival benefit for patients.



http://ift.tt/2G4PMZc

Deep vein thrombosis and pulmonary embolism secondary to urinary retention: a case report

Pulmonary embolism occurs when a blood thrombus forms and travels from a vein in the body to an artery in the lung. Thrombi often develop in one of the deep veins of the legs, thighs, or pelvis, a condition kn...

http://ift.tt/2I0FbPx

Hypercoagulability, Obstructive Sleep Apnea, and Pulmonary Embolism.

Hypercoagulability, Obstructive Sleep Apnea, and Pulmonary Embolism.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 22;:

Authors: Alonso-Fernández A, Toledo-Pons N, García-Río F

PMID: 29566245 [PubMed - as supplied by publisher]



http://ift.tt/2HXv5ii

Hypercoagulability, Obstructive Sleep Apnea, and Pulmonary Embolism-Reply.

Hypercoagulability, Obstructive Sleep Apnea, and Pulmonary Embolism-Reply.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 22;:

Authors: Hong SN, Lee SH

PMID: 29566146 [PubMed - as supplied by publisher]



http://ift.tt/2DPx7hT

A Rare Cause of Oropharyngeal and Supraglottic Airway Narrowing.

A Rare Cause of Oropharyngeal and Supraglottic Airway Narrowing.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 22;:

Authors: Razvi MA, Leo M, Sabat S

PMID: 29566120 [PubMed - as supplied by publisher]



http://ift.tt/2GeWmj0

Self-reported Hearing Difficulty and Risk of Accidental Injury in US Adults, 2007 to 2015.

Self-reported Hearing Difficulty and Risk of Accidental Injury in US Adults, 2007 to 2015.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 22;:

Authors: Lin HW, Mahboubi H, Bhattacharyya N

Abstract
Importance: Accidental injuries are a leading cause of morbidity and mortality in the United States. Hearing problems may be associated with an increased risk for such injuries.
Objective: To investigate associations between hearing difficulty and risk of accidental injuries among US adults.
Design, Setting, and Participants: Cross-sectional analysis of responses of a nationally representative sample of 232.2 million individuals 18 years or older who participated in the National Health Interview Survey from 2007 to 2015 and responded to the questions related to the hearing and injury modules.
Main Outcomes and Measures: The main outcome variable was accidental injury in the preceding 3 months. Hearing status was self-reported as "excellent," "good," "a little trouble," "moderate trouble," "a lot of trouble," and "deaf." Prevalence of accidental injuries was analyzed based on demographic characteristics and hearing status. Odds ratios (ORs) and 95% CIs for injuries adjusted for demographics were calculated for degrees of hearing difficulty. A secondary outcome was association of hearing status with type of injury and was classified as driving related, work related, or leisure/sport related.
Results: Of 232.2 million US adults, 120.2 million (51.7%) were female, and 116.3 million (50.1%) considered their hearing to be less than excellent. Accidental injuries occurred in 2.8% of survey respondents. In comparison with normal-hearing adults (those with self-rated excellent or good hearing), the odds of accidental injury were higher in those with a little trouble hearing (4.1%; OR, 1.6; 95% CI, 1.5-1.8), moderate trouble hearing (4.2%; OR, 1.7; 95% CI, 1.4-1.9), and a lot of trouble hearing (4.8%; OR, 1.9; 95% CI, 1.6-2.3). Work- and leisure-related injuries were more prevalent among those with self-perceived hearing difficulty. Multivariate analysis, adjusted for age and sex, revealed leisure-related injuries was most consistently associated with various degrees of hearing difficulty. Odds ratios were 1.2 (95% CI, 1.0-1.4) in those with a little trouble hearing, 1.4 (95% CI, 1.1-1.9) in those with moderate trouble hearing, and 1.5 (95% CI, 1.1-2.2) in those with a lot of trouble hearing.
Conclusions and Relevance: Hearing difficulty is significantly associated with accidental injury, especially injury related to work or leisure. Increased awareness about hearing difficulty and its proper screening and management may assist in decreasing accidental injury.

PMID: 29566111 [PubMed - as supplied by publisher]



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Making a Difference Through Advocacy

By Nathan Douthit

At the annual meeting for the Consortium of Universities for Global Health this year, the theme was Health Disparities: A Time for Action. The keynote address was delivered by Stephen Lewis, former UN special envoy for HIV/AIDS, Canada's Ambassador to the UN, humanitarian and broadcaster. He spoke about, "The drama of disparities," as viewed through the three-part lens of climate change, tuberculosis and conflict and sexual violence.

Stephen Lewis delivering the keynote address for CUGH 2018

Lewis spoke passionately about how the consequences of climate change for human health "fall far more heavily on the poorest country". He described tuberculosis as "the exemplar of disparity and inequality," affecting more people than HIV and malaria combined; the sufferers are the marginalized, who are, "always beleaguered, mostly without voice." He also spoke about the epidemic of conflict and sexual violence, quoting statistics from the recent conflicts in Syria; he especially emphasized the "explosion of rape that strangles credulity." He also mentioned that as the Rohingya are suffering attempted genocide in Myanmar, no UN Security Council resolution has been issued on their behalf.

He explained that disparities in education, income, economic advancement have profound effects on human health. He made it clear that while attempts to raise awareness and to advocate for work to improve poverty, nutrition, sanitation, and education have had limited success in bringing about meaningful change, highlighting the consequences these issues have for human health may be what is necessary to generate the political will and innovation needed for change. "When you concentrate on health you touch the mind and the heart." He criticized the tendency of Medicine to do objectively analyze but not go on to see change implemented. He encouraged an indefatigable and constant pressure on the powers that be in order to see health equity achieved in our generation.


BMJ Case Reports was also at the conference.

We are an enormous repository for case reports. Our global health case reports analyze the literature on environmental health, tuberculosis, conflict and sexual violence, as well as a range of social determinants that profoundly impact the health of the patients the case reports are about. These case reports have an important role to play in advocacy for justice in our local societies and around the world. The patients are encouraged to add to the case reports in their own words. Writing and publishing these patient stories can make a difference in our world today.

BMJ Case Reports invites authors to publish cases that can be used to advocate for individual patients as we all work toward a more just society. Global health case reports can emphasize any social determinant of health, including:
-The effects of climate change on patient and population health
-How infectious disease afflicts the vulnerable and marginalized in society and what interventions increase resilience
-The disproportionate burden of conflict and sexual violence on individuals in economically and political unstable regions of the world – including the effects of migration and people trafficking

Manuscripts may be submitted by students, physicians, nurses and allied health professionals to BMJ Case Reports at http://casereports.bmj.com/. For more information, review our guidance on how to write a global health case report and look through our online collection.

Competing Interests

None Declared



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Journal of Cosmetic Dermatology, Ahead of Print.

Journal of Cosmetic Dermatology, Ahead of Print.


http://ift.tt/2u9rlZ6

Journal of Cosmetic Dermatology, Ahead of Print.

Journal of Cosmetic Dermatology, Ahead of Print.


http://ift.tt/2FUW0i2

The evaluation of the effect of venous diameter measurement by ultrasonography on pain and withdrawal response

Abstract

Purpose

Rocuronium and propofol are used in the induction of anesthesia give discomfort to the patients. We aimed to investigate the relationship between venous diameter measured using ultrasonography, and pain and withdrawal movements after propofol and rocuronium applied with intravenous (IV).

Methods

This prospective-observational study was performed on 142 voluntary patients undergoing surgical operation under general anesthesia. An ultrasonography was used to measure the vein transverse diameter. Patients with a venous transverse diameter of ≤2 mm were classified as group 1 (n = 50), while patients with a diameter of > 2 mm were classified as group 2 (n = 92). The propofol pain was assessed according to the verbal rating scale (VRS). In addition, the withdrawal movements of the rocuronium injection were evaluated using the four-point scale.

Results

There was no difference between the two groups in terms of the demographic data. The patients have pain after propofol 38.2% and withdrawal movements after rocuronium 42.4% were detected. The maximum number of patients without pain after propofol injection (78.2%) and without withdrawal movements after rocuronium (76%) was found to be higher in group 2 (p = 0.001).

Conclusion

In this study, we found a reduction in the incidence and severity of pain and withdrawal movements in intravenous propofol and rocuronium administration through peripheral venous vessels of large diameter. We believe that the clinical drug injection through vessels with large venous diameter with the help of USG may be a non-invasive, simple, and reliable method to reduce pain and withdrawal movements in propofol and rocuronium injections.



http://ift.tt/2IKLQOT

Island cartilage vs temporalis fascia in type 1 tympanoplasty: A prospective study

Publication date: Available online 22 March 2018
Source:Acta Otorrinolaringológica Española
Author(s): Avani Jain, Sunil Samdani, Man Prakash Sharma, Vinod Meena
Objective(1) To compare the results of graft take-up and audiological outcome of temporalis fascia versus island cartilage graft in type 1 tympanoplasty. (2) To compare the rate of postoperative retraction of neotympanum in both.MethodsA prospective study was conducted on 70 patients of ages ranging from 11 to 50 years with dry subtotal perforation. 35 underwent island cartilage tympanoplasty and 35 underwent type 1 tympanoplasty using temporalis fascia graft. Graft acceptance rates and post-operative audiograms were compared.ResultsAt one year follow up, the graft take-up rate for temporalis fascia and island cartilage graft were found to be 82.9% and 97.1% respectively, which was found to be statistically significant (p<0.05). In the temporalis fascia group, two out of 35 patients (5.7%) had retraction of the neo tympanum. There was no incidence of retraction using island cartilage graft. There was no significant difference in the postoperative air-bone gap gain between temporalis fascia graft and island cartilage graft.ConclusionIsland cartilage tympanoplasty shows a high degree of reliability in high risk cases. It has a higher graft take-up rate with no incidence of retraction of neotympanum. Moreover, it provided significant hearing improvement in our patients.



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International Forum of Allergy &Rhinology, Ahead of Print.

International Forum of Allergy &Rhinology, Ahead of Print.


http://ift.tt/2INcJ4y

International Forum of Allergy &Rhinology, Ahead of Print.

International Forum of Allergy &Rhinology, Ahead of Print.


http://ift.tt/2pAQFBs

Diacylglycerol kinase α inactivation is an integral component of the costimulatory pathway that amplifies TCR signals

Abstract

The arsenal of cancer therapies has evolved to target T lymphocytes and restore their capacity to destroy tumor cells. T cells rely on diacylglycerol (DAG) to carry out their functions. DAG availability and signaling are regulated by the enzymes diacylglycerol kinase (DGK) α and ζ, whose excess function drives T cells into hyporesponsive states. Targeting DGKα is a promising strategy for coping with cancer; its blockade could reinstate T-cell attack on tumors while limiting tumor growth, due to positive DGKα functions in several oncogenic pathways. Here, we made a side-by-side comparison of the effects of commercial pharmacological DGK inhibitors on T-cell responses with those promoted by DGKα and DGKζ genetic deletion or silencing. We show the specificity for DGKα of DGK inhibitors I and II and the structurally similar compound ritanserin. Inhibitor treatment promoted Ras/ERK (extracellular signal-regulated kinase) signaling and AP-1 (Activator protein-1) transcription, facilitated DGKα membrane localization, reduced the requirement for costimulation, and cooperated with enhanced activation following DGKζ silencing/deletion. DGKiII and ritanserin had similar effects on TCR proximal signaling, but ritanserin counteracted long-term T-cell activation, an effect that was potentiated in DGKα−/− cells. In contrast with enhanced activation triggered by pharmacological inhibition, DGKα silencing/genetic deletion led to impaired Lck (lymphocyte-specific protein tyrosine kinase) activation and limited costimulation responses. Our results demonstrate that pharmacological inhibition of DGKα downstream of the TCR provides a gain-of-function effect that amplifies the DAG-dependent signaling cascade, an ability that could be exploited therapeutically to reinvigorate T cells to attack tumors.



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Coincidence of Concha Bullosa with Nasal Septal Deviation; Radiological Study

Abstract

Introduction Concha bullosa (CB) is the most common sinonasal anatomical variation reported in literature, it occurs most often in the middle turbinate. Causes of development are not clearly identified but coincident prevalence with deviated nasal septum (DS) is common. Objective To study the relationship between DS and development of CB. Methods A prospective study including 40 patients with DS, CT scans were thoroughly analyzed to detect the presence of CB, its type, and laterality. Effect of degree of septal deviation from the midline and level of deviation in the axial plane were also addressed. Results The study included 40 patients with DS; 15 of them had associated CB; the lamellar type of CB was the most prevalent followed by the true type. Conclusion Incidence of CB was higher in patients with increased angle of septal deviation and with lower level of deviation in the axial plane.



http://ift.tt/2GkN2u9

Coincidence of Concha Bullosa with Nasal Septal Deviation; Radiological Study

Abstract

Introduction Concha bullosa (CB) is the most common sinonasal anatomical variation reported in literature, it occurs most often in the middle turbinate. Causes of development are not clearly identified but coincident prevalence with deviated nasal septum (DS) is common. Objective To study the relationship between DS and development of CB. Methods A prospective study including 40 patients with DS, CT scans were thoroughly analyzed to detect the presence of CB, its type, and laterality. Effect of degree of septal deviation from the midline and level of deviation in the axial plane were also addressed. Results The study included 40 patients with DS; 15 of them had associated CB; the lamellar type of CB was the most prevalent followed by the true type. Conclusion Incidence of CB was higher in patients with increased angle of septal deviation and with lower level of deviation in the axial plane.



http://ift.tt/2GkN2u9

Pediatric Dermatology, Ahead of Print.

Pediatric Dermatology, Ahead of Print.


http://ift.tt/2IIOWTo

Australasian Journal of Dermatology, Ahead of Print.

Australasian Journal of Dermatology, Ahead of Print.


http://ift.tt/2FXVyzF

Evaluation of Andrews’ analysis as a predictor of ideal sagittal maxillary positioning in orthognathic surgery

Publication date: Available online 22 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Cory M. Resnick, Somi Kim, Rachel R. Yorlets, Carly E. Calabrese, Zachary S. Peacock, Leonard B. Kaban
PurposeThere is no universally accepted method for determining the ideal sagittal position of the maxilla in orthognathic surgery. In "Element II" of "The Six Elements of Orofacial Harmony", Andrews used the forehead to define the goal maxillary position. The purpose of this study was to compare how well this analysis correlated with postoperative findings in patients who underwent bimaxillary orthognathic surgery planned using other guidelines. We hypothesized that the Andrews analysis would more consistently reflect clinical outcomes than standard angular and linear measurements.MethodsThis is a retrospective cohort study of patients who had bimaxillary orthognathic surgery and achieved an acceptable aesthetic outcome. Patients with no maxillary sagittal movement, obstructive sleep apnea, cleft or craniofacial diagnoses or who were non-Caucasian were excluded. Treatment plans were developed using photographs, radiographs and standard cephalometric measurements. The Andrews analysis, measuring the distance from the maxillary incisor to the Goal Anterior Limit Line, and standard measurements were applied to end-treatment records. The Andrews analysis was statistically compared to standard methods.ResultsThere were 493 patients who had orthognathic surgery from 2007-2014, and 60 (62% female), with mean age 22.1±6.8 years, met the criteria for inclusion in this study. The mean Andrews distances were -4.8±2.9mm for females and -8.6±4.6mm for males preoperatively, and -0.6±2.1mm for females and -1.9±3.4mm for males postoperatively. For females, the Andrews analysis was closer to the goal value (0mm) postoperatively than any standard measurement (p<0.001). For males, A-N Vert performed best (p<0.001), followed by the Andrews analysis.ConclusionThe Andrews analysis correlated well with the final aesthetic sagittal maxillary position in our sample, particularly for females, and may be a useful tool for orthognathic surgical planning.



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