Cholesterol crystals embolise when an aortic atherosclerotic lesion ruptures and cholesterol crystals are scattered and obstruct small peripheral arterioles. Risk factors include both iatrogenic factors such as intravascular catheterisation, and spontaneous factors for atherosclerosis such as aging, hypertension, dyslipidaemia, and smoking. We describe the case of an 83-year-old Japanese man who developed unilateral, superficial necrosis of the tongue as a result of spontaneous embolisation of cholesterol crystals.
https://ift.tt/2GtfNEJ
Δευτέρα 26 Μαρτίου 2018
Unilateral necrosis of the tongue caused by embolisation of cholesterol crystals
Socioeconomic determinants as risk factors for squamous cell carcinoma of the head and neck: a case-control study in Iran
Our aim was to assess the association between different components of sociodemographic status and the risk of developing squamous cell carcinoma (SCC) of the head and neck after we had adjusted for the influence of the known behavioural risk factors of smoking and drinking alcohol. We selected 146 patients with histopathologically-confirmed SCC of the head and neck, and matched them for age and sex with 266 healthy controls for this case-control study. Personal details, occupation, socioeconomic status, smoking, and alcohol consumption were recorded.
https://ift.tt/2DXORYm
Cochlear implant function in a patient with Jervell and Lange-Nielsen syndrome after defibrillation by countershock
Jervell and Lange-Nielsen syndrome (JLNS), a rare autosomal recessive congenital QT prolongation syndrome, is characterized by cardiac arrhythmias, syncopal episodes, and profound deafness. A cochlear implant (CI) for patients with JLNS is expected to result in hearing improvement. Sometimes, defibrillation is required if a patient experiences lethal arrhythmia. In this paper, we report a pediatric patient with JLNS who received defibrillation after CI surgery in his right ear at the age of 2 years.
https://ift.tt/2I5i0n8
Barriers to medication adherence in asthma: the importance of culture and context
Significant disparities exist in asthma outcomes. Racial and ethnic minorities have lower controller medication adherence, which may contribute to differences in asthma morbidity between minority and non-minority groups. The objective of this review is to identify individual, patient-provider communication, and systems issues that contribute to this pattern of medication underuse and to discuss potential strategies for intervention.
https://ift.tt/2utWIOf
Stage IV Melanoma of Unknown Primary: A Population-Based Study in the United States from 1973 to 2014
Melanoma of unknown primary (MUP) is incompletely described on a population level.
https://ift.tt/2GeXLmo
Melanoma staging: Varying precision and terminal digit clustering in Breslow thickness data is evident in a population based study
Errors in Breslow thickness reporting can give misclassification of T category, an important classifier in melanoma staging.
https://ift.tt/2IVtJGe
Risk of skin cancer in HIV-infected patients: a Danish nationwide cohort study
The risk of skin cancer in HIV-infected patients has not been extensively studied.
https://ift.tt/2pMK3Am
Non-malignant late cutaneous changes after allogeneic hematopoietic stem cell transplant in children
There are limited pediatric data on non-malignant cutaneous changes, including autoimmune conditions and permanent alopecia, after hematopoietic stem cell transplantation (HSCT).
https://ift.tt/2GenjQK
Oncological and Functional Evaluation of Open Conservation Surgery for Hypopharyngeal Cancer with/without Reconstruction
Objectives. Oncological and functional results of open conservation surgery for hypopharyngeal cancer have been desired. Methods. We performed a chart review of 33 patients with hypopharyngeal cancer who underwent open conservation surgery. Oncological and functional results were evaluated in surgery with primary closure (Group A) and surgery with reconstruction (Group B). Postoperative functions were evaluated by interval to resumption of oral intake, Functional Outcome Swallowing Scale (FOSS) and Communication Scale (CS). Results. Five-year disease-specific and overall cumulative survival rates by Kaplan-Meier method for all cases were 95.7% and 82.3%, respectively. Duration from surgery to full oral intake was 12 days in Group A and 14 days in Group B. FOSS rates were 83.3 in Group A and 95.5 in Group B. CS was 0 in both groups. Conclusion. Oncological and functional results of open conservation surgery were comparable to those with transoral surgery and chemo/radiotherapy. Our technique represents a reliable treatment for hypopharyngeal cancer.
https://ift.tt/2G9vdij
Evaluation of gap filling skills and reading mistakes of cochlear implanted and normally hearing students
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Hülya Çizmeci, Ayça Çiprut
ObjectiveThis study aimed to (1) evaluate the gap filling skills and reading mistakes of students with cochlear implants, and to (2) compare their results with those of their normal-hearing peers. The effects of implantation age and total time of cochlear implant use were analyzed in relation to the subjects' reading skills development.MethodsThe study included 19 students who underwent cochlear implantation and 20 students with normal hearing, who were enrolled at the 6th to 8th grades. The subjects' ages ranged between 12 and 14 years old. Their reading skills were evaluated by using the Informal Reading Inventory.ResultsA significant relationship were found between implanted and normal-hearing students in terms of the percentages of reading error and the percentages of gap filling scores. The average order of the reading errors of students using cochlear implants was higher than that of normal-hearing students. As for the gap filling, the performances of implanted students in the passage are lower than those of their normal-hearing peers. No significant relationship was found between the variables tested in terms of age and duration of implantation on the reading performances of implanted students.ConclusionEven if they were early implanted, there were significant differences in the reading performances of implanted students compared with those of their normal-hearing peers in older classes.
https://ift.tt/2unwzAk
Tuberculosis induced autoimmune haemolytic anaemia: a systematic review to find out common clinical presentations, investigation findings and the treatment options
Tuberculosis induced autoimmune haemolytic anaemia is a rare entity. The aim of this study was to explore its common presentations, investigation findings and treatment options through a systematic review of p...
https://ift.tt/2GtrHhW
A Pediatric Case of Relapsing-Remitting Multiple Sclerosis Onset following Varicella Zoster Ophthalmicus with Optic Neuritis
Some epidemiological studies have implied a pathogenetic association between varicella zoster virus (VZV) and multiple sclerosis (MS); this, however, remains controversial. The present report describes a case involving an immunocompetent 10-year-old girl who developed relapsing-remitting MS following the prolonged reactivation of VZV inside the first branch of the trigeminal nerve, exhibiting herpes zoster ophthalmicus with severe optic neuritis. Symptoms related to herpes zoster ophthalmicus and MS appeared consecutively in the 10-week period after the appearance of vesicles. This suggests that the onset of MS was triggered by some mechanism involving VZV reactivation in the first branch of the trigeminal nerve. To the best of our knowledge, this report is the first to describe a relationship between the onset of MS and herpes zoster ophthalmicus. Early diagnosis and aggressive antiviral therapy are important in cases of herpes zoster ophthalmicus to prevent the possible development of MS as well as visual impairment as sequela.
https://ift.tt/2G8OZul
Airborne protein concentration: a key metric for type 1 allergy risk assessment—in home measurement challenges and considerations
Exposure to airborne proteins can be associated with the development of immediate, IgE-mediated respiratory allergies, with genetic, epigenetic and environmental factors also playing a role in determining the ...
https://ift.tt/2ukt4ux
Submental liposuction for the management of lymphedema following head and neck cancer treatment: a randomized controlled trial
Patients who have undergone treatment for head and neck cancer are at risk for neck lymphedema, which can severely affect quality of life. Liposuction has been used successfully in cancer patients who suffer f...
https://ift.tt/2G7Dnrj
Role of neurogenic inflammation in local communication in the visceral mucosa
Abstract
Intense research has focused on the involvement of the nervous system in regard to cellular mechanisms underlying neurogenic inflammation in the pelvic viscera. Evidence supports the neural release of inflammatory factors, trophic factors, and neuropeptides in the initiation of inflammation. However, more recently, non-neuronal cells including epithelia, endothelial, mast cells, and paraneurons are likely important participants in nervous system functions. For example, the urinary bladder urothelial cells are emerging as key elements in the detection and transmission of both physiological and nociceptive stimuli in the lower urinary tract. There is mounting evidence that these cells are involved in sensory mechanisms and can release mediators. Further, localization of afferent nerves next to the urothelium suggests these cells may be targets for transmitters released from bladder nerves and that chemicals released by urothelial cells may alter afferent excitability. Modifications of this type of communication in a number of pathological conditions can result in altered release of epithelial-derived mediators, which can activate local sensory nerves. Taken together, these and other findings highlighted in this review suggest that neurogenic inflammation involves complex anatomical and physiological interactions among a number of cell types in the bladder wall. The specific factors and pathways that mediate inflammatory responses in both acute and chronic conditions are not well understood and need to be further examined. Elucidation of mechanisms impacting on these pathways may provide insights into the pathology of various types of disorders involving the pelvic viscera.
https://ift.tt/2pEuZp0
A Very Rare Case of Hypereosinophilic Syndrome Secondary to Natural Killer/T-Cell Lymphoma
Hypereosinophilic syndrome (HES) is a systemic disease characterized by an increased peripheral blood eosinophil count accompanied by systemic organ dysfunction. HES is classified into idiopathic HES, primary (neoplastic) HES (HESN), and secondary (reactive) HES (HESR). In this case report, a patient who developed peripheral blood eosinophilia and granulation tissue in the pharynx and paranasal sinus, which was initially diagnosed as chronic eosinophilic leukemia (CEL), categorized as HESN, but was eventually identified after the patient had died as natural killer/T-cell (NK/T) lymphoma, nasal type (ENKL), categorized as HESR, is presented. ENKL-induced HES is very rare but must be considered.
https://ift.tt/2Gb3zkP
An exploratory study of the factors related to mouth breathing syndrome in primary school children
Source:Archives of Oral Biology
Author(s): Issei Saitoh, Emi Inada, Yasutaka Kaihara, Yukiko Nogami, Daisuke Murakami, Naoko Kubota, Kaoru Sakurai, Yoshito Shirazawa, Tadashi Sawami, Miyuki Goto, Maki Nosou, Katsuyuki Kozai, Haruaki Hayasaki, Youichi Yamasaki
ObjectiveMouth breathing syndrome (MBS) is defined as a set of signs and symptoms that may be completely or incompletely present in subjects who, for various reasons, replace the correct pattern of nasal breathing with an oral or mixed pattern. It is important to identify the relevant factors affecting MBS in order to diagnose its cause since breathing obstructions can result from multiple factors. The purpose of this study is to clarify the relevant factors and the interrelationships between factors affecting MBS among children.DesignWe surveyed 380 elementary school children from 6 to 12 years in age. The questionnaire consisted of 44 questions regarding their daily health conditions and lifestyle habits and was completed by the children's guardians. A factor analysis was performed to classify closely related questions into their respective factors and to examine the strength of the correlation between the newly revealed factors.ResultsTwenty-six out of the 44 questions were selected, and they were classified into seven factors. Factors 1 to 7 were defined as "incompetent lip seal", "diseases of the nose and throat", "eating and drinking habits", "bad breath", "problem with swallowing and chewing", "condition of teeth and gums", and "dry lips", respectively. There were also correlations between these factors themselves.ConclusionMBS was categorized according to 7 major factors. Because Factor 1 was defined as "incompetent lip seal", which was representative of the physical appearance of mouth breathers and correlated with other factors, we suggested that MBS should consist of 7 factors in total.
https://ift.tt/2pIuZEk
Spectral components in electromyograms from four regions of the human masseter, in natural dentate and edentulous subjects with removable prostheses and implants.
Source:Archives of Oral Biology
Author(s): Rodrigo A. Guzmán-Venegas, Felipe H. Palma, Jorge L. Biotti P, Francisco J. Berral de la Rosa
ObjectiveTo compare the frequency or spectral components between different regions of the superficial masseter in young natural dentate and total edentulous older adults rehabilitated with removable prostheses and fixed-implant support. A secondary objective was to compare these components between the three groups.Design21 young natural dentate and 28 edentulous (14 with removable prostheses and 14 with fixed-implant support) were assessed. High-density surface electromyography (sEMG) was recorded in four portions of the superficial masseter during submaximal isometric bites. Spectral components were obtained through a spectral analysis of the sEMG signals. An analysis of mixed models was used to compare the spectral components.ResultsIn all groups, the spectral components of the anterior portion were lower than in the posterior region (p < 0.05). Both edentulous groups showed lower spectral components and median frequency slope than the natural dentate group (p < 0.05). The removable prostheses group showed the greatest differences with natural dentate group.ConclusionsThere were significant differences in the spectral components recorded in the different regions of the superficial masseter. The lower spectral components and fatigability of older adults rehabilitated with prostheses could be a cause of a greater loss of type II fibers, especially in the removable prostheses group.
https://ift.tt/2pLEbY7
An exploratory study of the factors related to mouth breathing syndrome in primary school children
Source:Archives of Oral Biology
Author(s): Issei Saitoh, Emi Inada, Yasutaka Kaihara, Yukiko Nogami, Daisuke Murakami, Naoko Kubota, Kaoru Sakurai, Yoshito Shirazawa, Tadashi Sawami, Miyuki Goto, Maki Nosou, Katsuyuki Kozai, Haruaki Hayasaki, Youichi Yamasaki
ObjectiveMouth breathing syndrome (MBS) is defined as a set of signs and symptoms that may be completely or incompletely present in subjects who, for various reasons, replace the correct pattern of nasal breathing with an oral or mixed pattern. It is important to identify the relevant factors affecting MBS in order to diagnose its cause since breathing obstructions can result from multiple factors. The purpose of this study is to clarify the relevant factors and the interrelationships between factors affecting MBS among children.DesignWe surveyed 380 elementary school children from 6 to 12 years in age. The questionnaire consisted of 44 questions regarding their daily health conditions and lifestyle habits and was completed by the children's guardians. A factor analysis was performed to classify closely related questions into their respective factors and to examine the strength of the correlation between the newly revealed factors.ResultsTwenty-six out of the 44 questions were selected, and they were classified into seven factors. Factors 1 to 7 were defined as "incompetent lip seal", "diseases of the nose and throat", "eating and drinking habits", "bad breath", "problem with swallowing and chewing", "condition of teeth and gums", and "dry lips", respectively. There were also correlations between these factors themselves.ConclusionMBS was categorized according to 7 major factors. Because Factor 1 was defined as "incompetent lip seal", which was representative of the physical appearance of mouth breathers and correlated with other factors, we suggested that MBS should consist of 7 factors in total.
https://ift.tt/2pIuZEk
Spectral components in electromyograms from four regions of the human masseter, in natural dentate and edentulous subjects with removable prostheses and implants.
Source:Archives of Oral Biology
Author(s): Rodrigo A. Guzmán-Venegas, Felipe H. Palma, Jorge L. Biotti P, Francisco J. Berral de la Rosa
ObjectiveTo compare the frequency or spectral components between different regions of the superficial masseter in young natural dentate and total edentulous older adults rehabilitated with removable prostheses and fixed-implant support. A secondary objective was to compare these components between the three groups.Design21 young natural dentate and 28 edentulous (14 with removable prostheses and 14 with fixed-implant support) were assessed. High-density surface electromyography (sEMG) was recorded in four portions of the superficial masseter during submaximal isometric bites. Spectral components were obtained through a spectral analysis of the sEMG signals. An analysis of mixed models was used to compare the spectral components.ResultsIn all groups, the spectral components of the anterior portion were lower than in the posterior region (p < 0.05). Both edentulous groups showed lower spectral components and median frequency slope than the natural dentate group (p < 0.05). The removable prostheses group showed the greatest differences with natural dentate group.ConclusionsThere were significant differences in the spectral components recorded in the different regions of the superficial masseter. The lower spectral components and fatigability of older adults rehabilitated with prostheses could be a cause of a greater loss of type II fibers, especially in the removable prostheses group.
https://ift.tt/2pLEbY7
Diagnostic double strike in the emergency room - two cases of complete pancreatic ruptures due to bicycle handlebar injuries on two consecutive days
Pancreatic injuries are rare in cases of blunt abdominal trauma and therefore easily misdiagnosed at time of hospital admission. They are associated with a significantly elevated morbidity and lethality. Bicyc...
https://ift.tt/2GbvtZW
Management of a giant retroperitoneal leiomyoma: a case report
Leiomyomas are benign tumors observed mainly in adult women. The retroperitoneum is a rare location for leiomyomas; almost 100 cases have been reported. Because retroperitoneal leiomyomas are paucisymptomatic ...
https://ift.tt/2pG4y26
Acute Suppurative Thyroiditis in an Intravenous Drug User with a Preexisting Goiter
Acute suppurative thyroiditis (AST) is an uncommon, potentially life-threatening cause of a rapidly enlarging neck mass. It may present similarly to subacute thyroiditis, a relatively benign and self-limiting condition. We report a case of AST in an adult intravenous (IV) drug user with a preexisting goiter who presented with a left forearm abscess that grew methicillin-sensitive Staphylococcus aureus. In this particular case, clinical suspicion for AST was high. As a result, early IV antibiotic therapy was initiated, and this led to rapid clinical improvement furthermore preventing airway compromise. To our knowledge, this is the first case of AST in the literature resulting from likely hematogenous spread in the setting of IV drug use and a preexisting goiter. Overall, this case highlights the importance of assessing risk factors for AST in patients whose presentations may seem more typical of subacute thyroiditis. Such an approach will lead to timely diagnosis and treatment to avoid potentially devastating consequences.
https://ift.tt/2I3gDoS
Cochlear Implantation in Charcot-Marie-Tooth Disease: Case Report and Review of the Literature
Introduction. Charcot-Marie-Tooth (CMT) disease is a peripheral hereditary neuropathy associated with motor and sensory impairment and can result in profound sensorineural hearing loss (SNHL). Currently, the role of cochlear implantation in the setting of CMT and other progressive peripheral neurodegenerative disorders is not well established. Methods. Case report and review of the English literature. Results. A 70-year-old male with CMT was referred for evaluation of progressive asymmetric SNHL and reported a 15-year duration of deafness involving the left ear. Audiometric testing confirmed profound SNHL in the left ear, while the right ear exhibited moderate-to-severe SNHL. Left-sided cochlear implantation was performed using a conventional length lateral wall electrode. Intraoperative device testing found normal impedance levels throughout the array; however, electrically evoked auditory potentials were absent on all electrodes. Upon initial activation 3 weeks after surgery, the patient reported excellent access to sound in the cochlear implant-only condition. He has made good progress at each subsequent visit; speech perception testing after seven months showed improvement from 0% to 32% on AzBio sentence and 53% on CNC phoneme testing in the cochlear implant-only condition. Conclusion. We report the third case of cochlear implantation in a patient with CMT. SNHL in CMT is hypothesized to result from disruption of synchronous activity of the cochlear nerve. In patients with CMT, cochlear implantation may reconstitute synchronous neural activity by way of supraphysiological electrical stimulation. Our results corroborate two earlier reports that cochlear implantation is a viable option for rehabilitation of SNHL in this unique subset of patients.
https://ift.tt/2GuYB1C
Association of body mass index with chronic pain prevalence: a large population-based cross-sectional study in Japan
Abstract
Purpose
The aim of this study was to examine the association between body mass index and chronic pain.
Methods
The outcome was chronic pain prevalence by body mass index (BMI). BMIs of less than 18.5, 18.5–25.0, 25.0–30.0, and 30.0 or over kg/m2 were defined as underweight, normal weight, overweight, and obese.
Subjects
We used data from 4993 participants (2464 men and 2529 women aged 20–79 years) of the Pain Associated Cross-sectional Epidemiological survey in Japan. Sex-stratified multivariable-adjusted odds ratios were calculated with 95% confidence intervals using a logistic regression model including age, smoking, exercise, sleep time, monthly household expenditure, and presence of severe depression. We analyzed all ages and age subgroups, 20–49 and 50–79 years.
Results
The prevalence of chronic pain was higher among underweight, overweight, and obese male respondents than those reporting normal weight, with multivariable odds ratios of 1.52 (1.03–2.25), 1.55 (1.26–1.91), and 1.71 (1.12–2.60). According to underweight, only older men showed higher prevalence of chronic pain than normal weight men with odd ratios, 2.19 (1.14–4.20). Being overweight and obese were also associated with chronic pain in women; multivariable odds ratios were 1.48 (1.14–1.93) and 2.09 (1.20–3.64). Being underweight was not associated with chronic pain.
Conclusion
There was a U-shaped association between BMI and chronic pain prevalence among men ≥ 50 years, and a dose–response association among women. Our finding suggests that underweight should be considered in older men suffering chronic pain.
https://ift.tt/2pEZlb4
Epidemiological Features and Management of Oral Cancer Patients: Experience from a Single Private Comprehensive Cancer Care Center in the State of Odisha
Abstract
Oral cancer is the most common cancer in India. Challenges in the management of oral cancer patients in India include, delay in the presentation with high volume of advanced disease to be handled, affordability of patients and lack economical support especially in the non-governmental institutions and lack of awareness among patients and their relatives. Present study, a retrospective analysis of a prospectively maintained data, portrays the epidemiological features and management of patients with oral cancer presented to a private comprehensive cancer care hospital in the state of Odisha, India. A total of 1049 patients were considered for the analyses, managed between January 2014 and December 2016. Among 1049 patients, 20% (n, 215) were females and 80% (n, 834) were males. Mean age among the present cohort of patients was 50 years with age group 40–55 years being most common. All the patients underwent resection with curative intent and a 1 cm gross resection margins with or without bone and skin. Margin negative resection could be achieved in 82% of patients. Nodal involvement was seen in 36% of patients in the final histopathological assessment. Management of oral cancer patients is a major oncological and reconstructive challenge in India due to the advanced nature of disease at presentation. Inspite of socioeconomic constraints, these patients can be managed even in a private cancer centers with optimum outcomes. This is possible through coordinated team efforts.
https://ift.tt/2GbWXP7
Prevalence of Otitis Media with Effusion in Children with Hearing Loss
Abstract
Otitis media is an inflammation of the middle ear cleft, with or without intact tympanic membrane. Otitis media is known to be one of the most common childhood infections. Middle ear effusions have been recognized to grab increasing attention because of the problems they pose in both the diagnosis and the treatment, and because of the fear that effusion is the cause of learning difficulties, irreversible middle ear disease, or both. To study prevalence of otitis media with effusion in children with hearing loss. Materials and methods: This prospective study was conducted on children with hearing loss ageing between 3 and 15 years presenting to ENT OPD of GURU GOBIND SINGH MEDICAL COLLEGE FARIDKOT with complaint of hearing loss from January 2015 to June 2016. Total of 125 children were taken in study. Detailed history and complete ENT examination was done along with pure tone audiometery and impedence audiometery. Most common complaints of patient were otalgia on ototscopic examination majority of patients had congested tympanic membranes. Otitis media with effusion was most common cause of hearing loss. Majority of children diagnosed with otitis media with effusion were in age group of 6–8 years of age. Patients with mild hearing loss due to otitis media with effusion, on pure tone audiometery was more as compared to moderate hearing loss. B type of tympanogram was found in majority of cases. The potential of otitis media with effusion to cause a series of sequels and complications such as tympanosclerosis, retraction pockets, adhesive otitis media and hearing or speech impairment makes the disease an important public health problem. To prevent delayed diagnosis which leads to development of this disease, parents must be informed about the preventable risk factors and symptoms for the development of otitis media with effusion.
https://ift.tt/2IP6b5E
Assessment of Severity of Illness and Monitoring Response to Treatment of Odontogenic Space Infection Using Serum Prealbumin
Abstract
Purpose
To assess Serum Prealbumin in the severity of illness and monitor response to treatment in odontogenic space infection.
Patients and Methods
This was a prospective cohort study comprising patients being managed for odontogenic space infection at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. The calculated sample size was 69. Clinical parameters (Swelling Size, Visual Analogue Scale for pain intensity, and Maximal Interincisal Distance) were measured on day 0, day 4, and day 8. Other clinical parameters were Number of Anatomic Spaces Involved, setting of treatment, and Length of Hospital Stay. Serum Prealbumin levels were also serially measured. The relationship between Serum Prealbumin level and the clinical parameters was established using Spearman's correlation test, independent t test, Friedman's test, and linear regression. Significance level was set at .05.
Results
The mean Serum Prealbumin level at presentation (day 0) was 19.19 ± 4.61 mg/dl, which was significantly lower among inpatients (p = 0.001). On days 0, 4, and 8, Serum Prealbumin negatively correlated with Number of Anatomic Spaces Involved (p < 0.001). Serum Prealbumin levels on days 0, 4, and 8 and response in Serum Prealbumin negatively correlated with Length of Hospital Stay. On each day, Serum Prealbumin negatively correlated with pain intensity and Swelling Size and positively correlated with mouth opening. The response in Serum Prealbumin also positively correlated with response in each of the three clinical parameters.
Conclusion
This study suggests that Serum Prealbumin is a reliable tool for grading severity of illness and monitoring response to treatment in odontogenic space infection.
https://ift.tt/2Grfp9G
Rezidiviertes oder refraktäres klassisches Hodgkin-Lymphom
Zusammenfassung
Hintergrund
Das klassische Hodgkin-Lymphom ist mit risikoadaptierter Erstlinientherapie in den meisten Fällen heilbar. Neben der Reduktion möglicher therapieassoziierter Früh- und Langzeitschädigungen stellt v. a. die Therapie von Patienten mit rezidivierter oder primär refraktärer Erkrankung (r/r HL) eine klinische Herausforderung dar.
Methoden
Dieser Übersichtsartikel fasst die aktuell verfügbaren Daten zu Sicherheit und Effektivität verschiedener Therapieansätze beim r/r HL zusammen und gibt Handlungsempfehlungen für verschiedene klinische Situationen.
Ergebnisse
Bis zu 50 % der für eine intensivierte Therapie geeigneten Patienten erreichen nach einer Hochdosischemotherapie mit autologer Stammzelltransplantation (ASZT) eine langfristige Remission. Mehrfach rezidivierte, refraktäre, ältere oder multimorbide Patienten hatten bis vor einigen Jahren bei größtenteils palliativen Therapieoptionen eine schlechte Prognose. Das Anti-CD30-Antikörper-Wirkstoffkonjugat Brentuximab Vedotin (BV) ermöglicht eine zielgerichtete Therapie mit hohen Ansprechraten sowie teilweise dauerhaften kompletten Remissionen und ist nach ASZT oder zwei vorangegangen Therapien für das r/r HL zugelassen. Zuletzt wurden die beiden Anti-PD-1-Antikörper Nivolumab und Pembrolizumab als Immuncheckpointinhibitoren auch bei Patienten mit intensiv vorbehandeltem r/r HL untersucht. Beide Substanzen zeigten bei sehr guter Verträglichkeit deutlich höhere Ansprechraten als bei anderen malignen Erkrankungen und lange Remissionen. Nivolumab und Pembrolizumab wurden daher kürzlich für das r/r HL nach vorausgegangener Therapie mit BV zugelassen. Zudem zeigten weitere zielgerichtete Substanzen wie AFM13, Everolimus, Panobinostat oder Mocetinostat sowie auch Lenalidomid oder Bendamustin Aktivität bei intensiv behandelten Patienten.
https://ift.tt/2up17lw
Tumorassoziierte Fatigue beim Hodgkin-Lymphom
Zusammenfassung
Hintergrund
Da heutzutage die meisten Hodgkin-Patienten geheilt werden können, ist die Nachsorge der überwiegend jungen Langzeitüberlebenden in den Mittelpunkt gerückt. Zu den häufigsten Beeinträchtigungen zählt die tumorassoziierte Fatigue („cancer-related fatigue", CrF).
Fragestellung
Dieser Artikel gibt einen Überblick über die Häufigkeit, Entwicklung und den Verlauf von CrF beim Hodgkin-Lymphom (HL), deren langfristige Folgen für die soziale Reintegration sowie über bestehende therapeutische Optionen.
Material und Methoden
Mittels systematischer und manueller Literaturrecherche wurden relevante Publikationen sowie im Rahmen aktueller Studien getestete neue Therapieansätze für CrF zusammengefasst.
Ergebnisse
CrF ist bereits zum Zeitpunkt der Diagnosestellung vorhanden, wobei das Ausmaß der Fatigue mit fortschreitendem Stadium zunimmt. Unter laufender Therapie kommt es unabhängig vom Stadium und der erhaltenen Therapie zu einem starken Anstieg der Fatigue auf ein nahezu identisch hohes Niveau. Wichtigster prognostischer Faktor für den Verlauf und den Schweregrad der Langzeit-Fatigue ist die Baseline-Fatigue. Die Therapieintensität hingegen nimmt auf das Ausmaß und den Verlauf der Fatigue keinen Einfluss. In allen Stadien konnten mehrere Subgruppen mit unterschiedlichen Fatigue-Verläufen identifiziert werden. Patienten mit schwerer Fatigue bei Diagnosestellung müssen auch mit dauerhafter, schwerer Fatigue rechnen. In den anderen Subgruppen konnten hingegen teils wesentliche Verbesserungen beobachtet werden. Neben der Einschränkung der Lebensqualität hat das Leiden an Fatigue auch relevante sozioökonomische Folgen. Die Zahl der Überlebenden mit Fatigue, die sich nach 5 Jahren in einem festen Beschäftigungsverhältnis oder in Ausbildung befinden, ist fast 30 % niedriger verglichen mit Überlebenden ohne Fatigue. Mit körperlichen Trainingsprogrammen sowie verhaltenstherapeutischen Maßnahmen konnten bislang gute Erfolge in der Therapie von CrF erzielt werden.
Schlussfolgerungen
Der Leidensdruck der Betroffenen ist hoch. Weitere randomisierte, klinische Studien sind erforderlich, um die Therapieoptionen und somit das Outcome der Patienten zu verbessern.
https://ift.tt/2G5QusZ
Positronenemissionstomographie beim Hodgkin-Lymphom
Zusammenfassung
Hintergrund
Die FDG-PET (Fluordesoxyglucose-Positronenemissionstomographie) ist eine Standarduntersuchung in der Bestimmung des Stadiums und des Therapieansprechens des Hodgkin-Lymphoms geworden.
Ergebnisse
Im initialen Staging erlaubt die PET eine sichere Stadienzuordnung und bei unauffälligem osteomedullärem Befund den Verzicht auf die Knochenmarkbiopsie. Der prädiktive Wert der FDG-PET während und nach der Chemotherapie bietet weiteren, deutlichen Zugewinn an Information. PET-gesteuerte Therapieregime wurden eingeführt, die die PET schon nach 2 Zyklen Chemotherapie zur weiteren Therapiestratifizierung einsetzen. Sowohl Protokolle, die eine Intensivierung der Therapie aufgrund einer positiven PET nutzen, als auch die Deeskalation der Therapie wegen einer unauffälligen, negativen PET haben Erfolge gezeigt. So kann z. B. bei negativer FDG-PET nach 2 Zyklen effektiver Chemotherapie für fortgeschrittene Stadien die Therapie von üblicherweise 6 auf insgesamt nur 4 Zyklen verkürzt werden. Nach Chemotherapie kann in fortgeschrittenen Stadien bei negativer FDG-PET außerdem ohne Verlust an Therapiesicherheit auf eine ergänzende Bestrahlung verzichtet werden.
Ausblick
Für frühe und mittlere Stadien ist die Möglichkeit des Verzichts auf die Bestrahlung noch nicht gezeigt, jedoch werden belastbare Daten erwartet. Robuste und reproduzierbare Beurteilungskriterien für die PET sind heute Standard bei der Interpretation der Untersuchung, sowohl in wissenschaftlichen Studien als auch in der täglichen klinischen Routine. Die sog. 5‑Punkte-Deauville-Skala ist derzeitiger Standard zur visuellen Analyse. Die Konsequenzen aus der jeweiligen Zuordnung berücksichtigen dabei sowohl die vorangegangene als auch die folgende Behandlung.
https://ift.tt/2umZrsF
Therapie des Hodgkin-Lymphoms in frühen und intermediären Stadien
Zusammenfassung
Hintergrund
In frühen und intermediären Stadien des Hodgkin-Lymphoms (HL) kann die überwiegende Zahl der Patienten durch eine risikoadaptierte Chemo- und Strahlentherapie (RT) geheilt werden. Allerdings trägt die therapieassoziierte Langzeittoxizität wesentlich zu Morbidität und Mortalität bei. Aktuelle Studien haben daher zum Ziel, die therapieassoziierte Toxizität unter Erhalt bzw. weiterer Verbesserung der erreichten Tumorkontrolle zu reduzieren.
Ziel
Ziel war die Entwicklung einer Therapieleitlinie für die frühen und intermediären Stadien des HL auf der Grundlage aktueller Studiendaten.
Methoden
Es erfolgte eine Analyse der Tumorkontrolle, des Gesamtüberlebens und der verfügbaren Toxizitätsdaten in aktuellen randomisierten Studien, Metaanalysen und relevanten retrospektiven Auswertungen.
Ergebnisse und Schlussfolgerung
In den frühen Stadien sind 2 Zyklen ABVD (Adriamycin, Bleomycin, Vinblastin, Dacarbazin) und 20 Gy Involved-Site-RT (IS-RT) aufgrund der hervorragenden Überlebensdaten (HD10) und der Etablierung des kleineres Bestrahlungsfelds der IS-RT Therapiestandard. In den intermediären Stadien kann mit 4 Zyklen ABVD und 30 Gy IF-RT (Involved-Field-RT) ein progressionsfreies Überleben (PFS) von bis zu 83 % erzielt werden. Eine signifikante Verbesserung der Tumorkontrolle wurde bei höherer Akuttoxizität mit 2 Zyklen BEACOPPeskaliert (Bleomycin, Etoposid, Doxorubicin, Cyclophosphamid, Vincristin, Procarbazin, Prednison) und 2 Zyklen ABVD („2 + 2"; HD14) erreicht. Die in H10 angewandte 18FFDG-PET-basierte Applikation von 2 Zyklen BEACOPPeskaliert bei nach 2 Zyklen ABVD PET-positiven Patienten könnte bei einem signifikanten Teil der Patienten bei vergleichsweise gutem PFS die Therapieintensität reduzieren. Es bedarf jedoch weiterer Daten zur Etablierung dieses Ansatzes. Daher werden aktuell „2 + 2" + 30 Gy IS-RT bei Patienten bis 60 Jahre als Standard empfohlen. Die verfügbaren Daten unterstützen die Rolle der RT in der erzielten Tumorkontrolle. Eine 18FFDG-PET-basierte RT kann als individueller Therapieansatz angewandt werden.
https://ift.tt/2uhlXTH
Neue Entwicklungen in der Therapie des fortgeschrittenen klassischen Hodgkin-Lymphoms
Zusammenfassung
Hintergrund
Das Gesamtüberleben von Patienten mit fortgeschrittenem Hodgkin-Lymphom (HL), die mit dem aktuellen Standard der Deutschen Hodgkin Studiengruppe (DHSG), bestehend aus der Interim-Positronen-Emissionstomographie(PET)-gesteuerten Gabe von 4 bis 6 Zyklen BEACOPPeskaliert (Bleomycin, Etoposid, Doxorubicin, Cyclophosphamid, Vincristin, Procarbazin und Prednison in eskalierter Dosierung) plus Bestrahlung Positronen-Emissionstomographie-positiver Reste, behandelt werden, liegt bei mehr als 95 %. Es ist dennoch nötig, die Toxizität der Therapie weiter zu minimieren, ohne dabei Einbußen in der Effektivität zu erleiden. Langfristiges Ziel ist also die Reduktion von Nebenwirkungen bei gleichbleibend gutem Therapieerfolg.
Ziel
Ziel des vorliegenden Artikels ist es, eine Zusammenfassung über die gegenwärtigen Standardtherapien sowie neue Entwicklungen in der Behandlung des fortgeschrittenen HL zu geben.
Material und Methode
Mittels systematischer und manueller Literaturrecherche wurden relevante Publikationen sowie im Rahmen derzeit laufender Studien getestete neue Therapieansätze zusammengefasst.
Ergebnisse
Vergleiche von BEACOPPeskaliert und ABVD (Doxorubicin, Bleomycin, Vinblastin, Dacarbazin) zeigen einen signifikanten und klinisch bedeutenden Überlebensvorteil für BEACOPPeskaliert sowohl im Sinne des progressionsfreien Überlebens (PFS) als auch des Gesamtüberlebens (OS). Die Interim-PET-gesteuerte Gabe von 4−6 Zyklen BEACOPPeskaliert ist sicher und hoch effektiv. Dennoch ist eine weitere Optimierung der Therapie, z. B. durch die Implementierung zielgerichteter Substanzen wie Brentuximab Vedotin, möglich. Daher wird derzeit eine BEACOPP-Variante namens BrECADD (Brentuximab Vedotin, Etoposid, Cyclophosphamid, Doxorubicin, Dacarbazin, Dexamethason) im Rahmen der HD21-Studie randomisiert mit herkömmlichem BEACOPPeskaliert verglichen. Zuvor wurde im Rahmen einer Phase-II-Studie gezeigt, dass BrECADD bei Patienten mit fortgeschrittenem HL sicher angewendet werden kann.
Schlussfolgerungen
Langfristiges Ziel in der Behandlung des HL ist die Reduktion der Toxizität der Therapie ohne Verschlechterung der Tumorkontrolle und des lymphomspezifischen Outcomes. Dies kann möglicherweise durch die Implementierung zielgerichteter Substanzen in die Erstlinientherapie erreicht werden. Daher wird momentan die Brentuximab Vedotin enthaltende BEACOPP-Variante BrECADD im Rahmen der HD21-Studie randomisiert gegen konventionelles BEACOPPeskaliert getestet.
https://ift.tt/2G60wdL
Submental liposuction for the management of lymphedema following head and neck cancer treatment: a randomized controlled trial
Abstract
Background
Patients who have undergone treatment for head and neck cancer are at risk for neck lymphedema, which can severely affect quality of life. Liposuction has been used successfully in cancer patients who suffer from post-treatment limb lymphedema. The purpose of our study was to review the outcomes of head and neck cancer patients at our center who have undergone submental liposuction for post-treatment lymphedema and compare their subsequent results with a control group.
Methods
All head and neck cancer patients at an oncology center in tertiary hospital setting who complained to their attending surgeon or radiation oncologist regarding cervical lymphedema secondary to head and neck cancer treatment, and had been disease-free for a minimum of one year, with no previous facial plastic surgical procedures were eligible for inclusion into the study. Study design was a non-blinded randomized controlled trial. Twenty patients were randomized into a treatment arm (underwent submental liposuction n = 10) and control arm (n = 10). Both groups of patients completed two surveys (Modified Blepharoplasty Outcome Evaluation and the validated Derriford Appearance Scale) on initial office visit after consenting for the trial. The treatment group then completed the surveys 6 months post-operatively while the control group filled the surveys 6 months after the initial assessment but had no intervention. Mann-Whitney U tests were performed to compare the responses of those that did and did not receive liposuction.
Results
Our study demonstrated a statistically significant improvement in patients' self-perception of appearance and statistically significant subjective scoring of appearance following submental liposuction.
Conclusions
Submental liposuction is an effective and safe procedure to improves the quality of life for head and neck cancer patients suffering from post-treatment lymphedema.
https://ift.tt/2IOmtM1
Epidemiological Features and Management of Oral Cancer Patients: Experience from a Single Private Comprehensive Cancer Care Center in the State of Odisha
Abstract
Oral cancer is the most common cancer in India. Challenges in the management of oral cancer patients in India include, delay in the presentation with high volume of advanced disease to be handled, affordability of patients and lack economical support especially in the non-governmental institutions and lack of awareness among patients and their relatives. Present study, a retrospective analysis of a prospectively maintained data, portrays the epidemiological features and management of patients with oral cancer presented to a private comprehensive cancer care hospital in the state of Odisha, India. A total of 1049 patients were considered for the analyses, managed between January 2014 and December 2016. Among 1049 patients, 20% (n, 215) were females and 80% (n, 834) were males. Mean age among the present cohort of patients was 50 years with age group 40–55 years being most common. All the patients underwent resection with curative intent and a 1 cm gross resection margins with or without bone and skin. Margin negative resection could be achieved in 82% of patients. Nodal involvement was seen in 36% of patients in the final histopathological assessment. Management of oral cancer patients is a major oncological and reconstructive challenge in India due to the advanced nature of disease at presentation. Inspite of socioeconomic constraints, these patients can be managed even in a private cancer centers with optimum outcomes. This is possible through coordinated team efforts.
https://ift.tt/2GbWXP7
Prevalence of Otitis Media with Effusion in Children with Hearing Loss
Abstract
Otitis media is an inflammation of the middle ear cleft, with or without intact tympanic membrane. Otitis media is known to be one of the most common childhood infections. Middle ear effusions have been recognized to grab increasing attention because of the problems they pose in both the diagnosis and the treatment, and because of the fear that effusion is the cause of learning difficulties, irreversible middle ear disease, or both. To study prevalence of otitis media with effusion in children with hearing loss. Materials and methods: This prospective study was conducted on children with hearing loss ageing between 3 and 15 years presenting to ENT OPD of GURU GOBIND SINGH MEDICAL COLLEGE FARIDKOT with complaint of hearing loss from January 2015 to June 2016. Total of 125 children were taken in study. Detailed history and complete ENT examination was done along with pure tone audiometery and impedence audiometery. Most common complaints of patient were otalgia on ototscopic examination majority of patients had congested tympanic membranes. Otitis media with effusion was most common cause of hearing loss. Majority of children diagnosed with otitis media with effusion were in age group of 6–8 years of age. Patients with mild hearing loss due to otitis media with effusion, on pure tone audiometery was more as compared to moderate hearing loss. B type of tympanogram was found in majority of cases. The potential of otitis media with effusion to cause a series of sequels and complications such as tympanosclerosis, retraction pockets, adhesive otitis media and hearing or speech impairment makes the disease an important public health problem. To prevent delayed diagnosis which leads to development of this disease, parents must be informed about the preventable risk factors and symptoms for the development of otitis media with effusion.
https://ift.tt/2IP6b5E
Can Medullary Thyroid Carcinoma Arise in Thyroglossal Duct Cysts? A Search for Parafollicular C-cells in 41 Resected Cases
Abstract
Thyroglossal duct cysts (TGDCs) are present in ~7% of adults and develop from the midline migratory tract between the foramen cecum and anatomic location of the thyroid. Thyroid tissue can be identified in 2/3 of TGDCs, and up to 1% develop associated malignancy, 90% of which are papillary thyroid carcinoma. Cases of follicular and anaplastic carcinoma have been documented, but there are no reports of medullary thyroid carcinoma arising in a TGDC. This is presumably due to the distinct embryologic origin of parafollicular C-cells, from which medullary carcinoma arises. The goal of this study is to determine whether parafollicular C-cells are present in TGDCs. H&E sections from 41 TGDC cases were examined for thyroid tissue, thyroglossal duct remnants, ultimobranchial remnants, and parafollicular C-cells. Immunohistochemistry was performed for TTF-1 and calcitonin. Eighty three percent (34/41) of cases contained thyroid tissue on H&E and by TTF-1. No cases (0/41) had ultimobranchial remnants or parafollicular C-cells on H&E or with calcitonin. One case of papillary carcinoma in a TGDC was identified. These cases illustrate that although TGDCs often contain thyroid tissue, parafollicular C-cells are absent. Therefore, unlike other thyroid neoplasms, there is no evidence to support the possibility of medullary carcinoma arising in a TGDC.
https://ift.tt/2DVIViK
Nasopharyngeal Angiofibroma: A Clinical, Histopathological and Immunohistochemical Study of 42 Cases with Emphasis on Stromal Features
Abstract
Nasopharyngeal angiofibroma is a benign but aggressive tumor of unknown etiology, typically occurring in adolescent males. It is described as a rare neoplasm; however, the prevalence seems to have geographic differences. All cases referred to our head and neck clinical and pathology service were reviewed. Most of the patients presented at an advanced stage. The clinical and radiographic features are presented and discussed. Histologically, the tumor shows a highly vascular fibrous proliferation with characteristic plump, angulated and stellate cells, categorized as fibroblasts. Immunohistochemistry was performed on 42 cases to further elucidate the nature of these cells. The stromal cells expressed vimentin and factor XIIIa, the latter expressed most commonly in the giant stellate cells. Inflammation was almost exclusively present in peripheral subepithelial areas. Mast cells were abundant, even in the absence of other inflammatory cells. Lymphatics were observed principally in peripheral regions. Proliferating cells (Ki-67 reactive) were restricted to endothelial cells.
https://ift.tt/2Gry4SN
Can Medullary Thyroid Carcinoma Arise in Thyroglossal Duct Cysts? A Search for Parafollicular C-cells in 41 Resected Cases
Abstract
Thyroglossal duct cysts (TGDCs) are present in ~7% of adults and develop from the midline migratory tract between the foramen cecum and anatomic location of the thyroid. Thyroid tissue can be identified in 2/3 of TGDCs, and up to 1% develop associated malignancy, 90% of which are papillary thyroid carcinoma. Cases of follicular and anaplastic carcinoma have been documented, but there are no reports of medullary thyroid carcinoma arising in a TGDC. This is presumably due to the distinct embryologic origin of parafollicular C-cells, from which medullary carcinoma arises. The goal of this study is to determine whether parafollicular C-cells are present in TGDCs. H&E sections from 41 TGDC cases were examined for thyroid tissue, thyroglossal duct remnants, ultimobranchial remnants, and parafollicular C-cells. Immunohistochemistry was performed for TTF-1 and calcitonin. Eighty three percent (34/41) of cases contained thyroid tissue on H&E and by TTF-1. No cases (0/41) had ultimobranchial remnants or parafollicular C-cells on H&E or with calcitonin. One case of papillary carcinoma in a TGDC was identified. These cases illustrate that although TGDCs often contain thyroid tissue, parafollicular C-cells are absent. Therefore, unlike other thyroid neoplasms, there is no evidence to support the possibility of medullary carcinoma arising in a TGDC.
https://ift.tt/2DVIViK
Nasopharyngeal Angiofibroma: A Clinical, Histopathological and Immunohistochemical Study of 42 Cases with Emphasis on Stromal Features
Abstract
Nasopharyngeal angiofibroma is a benign but aggressive tumor of unknown etiology, typically occurring in adolescent males. It is described as a rare neoplasm; however, the prevalence seems to have geographic differences. All cases referred to our head and neck clinical and pathology service were reviewed. Most of the patients presented at an advanced stage. The clinical and radiographic features are presented and discussed. Histologically, the tumor shows a highly vascular fibrous proliferation with characteristic plump, angulated and stellate cells, categorized as fibroblasts. Immunohistochemistry was performed on 42 cases to further elucidate the nature of these cells. The stromal cells expressed vimentin and factor XIIIa, the latter expressed most commonly in the giant stellate cells. Inflammation was almost exclusively present in peripheral subepithelial areas. Mast cells were abundant, even in the absence of other inflammatory cells. Lymphatics were observed principally in peripheral regions. Proliferating cells (Ki-67 reactive) were restricted to endothelial cells.
https://ift.tt/2Gry4SN
Idiopathic omental infarction: One for conservative or surgical management?
Abstract
Idiopathic omental infarction (IOI) is a rare cause of right-sided abdominal pain, mimicking serious surgical pathology. It occurs in <4 in 1000 cases of appendicitis. IOI can be a challenge to diagnose, as features may mimic appendicitis, and therefore in young patients, may only be discovered on laparoscopy. CT features can be diagnostic, but due to its rarity the diagnosis may be unclear. The literature supports both conservative management and surgical management (to expedite symptom resolution). We present a case of IOI and discuss our management and learning from the case. We discuss the utility of CT radiology, conservative management and the benefits of non-resection management, even at laparoscopy.https://ift.tt/2DVs9jG
Laparoscopic resection of a giant retroperitoneal melanotic schwannoma
Abstract
Background
Retroperitoneal schwannomas are extremely rare, as they account for only 3% of retroperitoneal tumors. Clinical symptoms are nonspecific and of late onset, meaning that these tumors are diagnosed at an advanced stage. Surgical resection is required for histological diagnosis and to prevent possible malignant transformation. Celioscopy offers numerous benefits, reducing postoperative pain and speeding up the patient's return to autonomy, but it can pose a real challenge due to the size of these lesions. Case presentation
We report a case of laparoscopic resection of a very large right-sided retroperitoneal schwannoma, with a particular histological form. Conclusion
Surgical resection in a single unit remains the golden rule, and a laparoscopy can be proposed when the diagnosis is beyond doubt. The large size of the retroperitoneal melanotic schwannomas, a common feature, increases surgical difficulties but is not a contraindication to this approach.https://ift.tt/2Gsp1Be
Brown bowel syndrome, an unusual cause of sigmoid volvulus
Abstract
We report a case of a 79-year-old gentleman who presented to the emergency department with a 5-day history of abdominal pain, constipation, a progressively distending abdomen and new onset feculent vomiting on a background of a recent endoscopic decompression of a sigmoid volvulus. Investigations confirmed the presence of a recurrent sigmoid volvulus. Attempts to reduce this endoscopically failed and laparotomy with sub-total colectomy and ileostomy formation was performed. Histology from the resected specimen identified a distinct pathology, namely intestinal lipofuscinosis also known as brown bowel syndrome. Brown bowel syndrome is a recognized but rare complication of chronic long term malnutrition. It may present in a myriad of ways including atonia and, rarely, massive colonic dilatation, as in our case.https://ift.tt/2I2vMqw
Can Medullary Thyroid Carcinoma Arise in Thyroglossal Duct Cysts? A Search for Parafollicular C-cells in 41 Resected Cases
Abstract
Thyroglossal duct cysts (TGDCs) are present in ~7% of adults and develop from the midline migratory tract between the foramen cecum and anatomic location of the thyroid. Thyroid tissue can be identified in 2/3 of TGDCs, and up to 1% develop associated malignancy, 90% of which are papillary thyroid carcinoma. Cases of follicular and anaplastic carcinoma have been documented, but there are no reports of medullary thyroid carcinoma arising in a TGDC. This is presumably due to the distinct embryologic origin of parafollicular C-cells, from which medullary carcinoma arises. The goal of this study is to determine whether parafollicular C-cells are present in TGDCs. H&E sections from 41 TGDC cases were examined for thyroid tissue, thyroglossal duct remnants, ultimobranchial remnants, and parafollicular C-cells. Immunohistochemistry was performed for TTF-1 and calcitonin. Eighty three percent (34/41) of cases contained thyroid tissue on H&E and by TTF-1. No cases (0/41) had ultimobranchial remnants or parafollicular C-cells on H&E or with calcitonin. One case of papillary carcinoma in a TGDC was identified. These cases illustrate that although TGDCs often contain thyroid tissue, parafollicular C-cells are absent. Therefore, unlike other thyroid neoplasms, there is no evidence to support the possibility of medullary carcinoma arising in a TGDC.
https://ift.tt/2DVIViK
Nasopharyngeal Angiofibroma: A Clinical, Histopathological and Immunohistochemical Study of 42 Cases with Emphasis on Stromal Features
Abstract
Nasopharyngeal angiofibroma is a benign but aggressive tumor of unknown etiology, typically occurring in adolescent males. It is described as a rare neoplasm; however, the prevalence seems to have geographic differences. All cases referred to our head and neck clinical and pathology service were reviewed. Most of the patients presented at an advanced stage. The clinical and radiographic features are presented and discussed. Histologically, the tumor shows a highly vascular fibrous proliferation with characteristic plump, angulated and stellate cells, categorized as fibroblasts. Immunohistochemistry was performed on 42 cases to further elucidate the nature of these cells. The stromal cells expressed vimentin and factor XIIIa, the latter expressed most commonly in the giant stellate cells. Inflammation was almost exclusively present in peripheral subepithelial areas. Mast cells were abundant, even in the absence of other inflammatory cells. Lymphatics were observed principally in peripheral regions. Proliferating cells (Ki-67 reactive) were restricted to endothelial cells.
https://ift.tt/2Gry4SN
Development of a droplet digital PCR assay for population analysis of aflatoxigenic and atoxigenic Aspergillus flavus mixtures in soil
Abstract
Aflatoxin B1 is a potent hepatotoxin and carcinogen that poses a serious safety hazard to both humans and animals. Aspergillus flavus is the most common aflatoxin-producing species on corn, cotton, peanuts, and tree nuts. Application of atoxigenic strains to compete against aflatoxigenic strains of A. flavus has emerged as one of the most practical strategies for ameliorating aflatoxin contamination in food. Genes directly involved in aflatoxin biosynthesis are clustered on an 82-kb region of the genome. Three atoxigenic strains (CA12, M34, and AF123) were each paired with each of four aflatoxigenic strains (CA28, CA42, CA90, and M52), inoculated into soil and incubated at 28 °C for 2 weeks and 1 month. TaqMan probes, omtA-FAM, and norA-HEX were designed for developing a droplet digital PCR (ddPCR) assay to analyze the soil population of mixtures of A. flavus strains. DNA was extracted from each soil sample and used for ddPCR assays. The data indicated that competition between atoxigenic and aflatoxigenic was strain dependent. Variation in competitive ability among different strains of A. flavus influenced the population reduction of the aflatoxigenic strain by the atoxigenic strain. Higher ratios of atoxigenic to aflatoxigenic strains increased soil population of atoxigenic strains. This is the first study to demonstrate the utility of ddPCR to quantify mixtures of both atoxigenic and aflatoxigenic A. flavus strains in soil and allows for rapid and accurate determination of population sizes of atoxigenic and aflatoxigenic strains. This method eliminates the need for isolation and identification of individual fungal isolates from experimental soil samples.
https://ift.tt/2Gc021I
Editorial Board Page
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 4
https://ift.tt/2DUUE0Z
2017 Reviewer Acknowledgement
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 4
https://ift.tt/2G6kVQ3
Re: African Americans in Oral and Maxillofacial Surgery: Factors Affecting Career Choice, Satisfaction and Practice Patterns
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 4
Author(s): Arthur H. Friedlander, Urie K. Lee, Earl Freymiller
https://ift.tt/2G8gGPL
Table of Contents
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 4
https://ift.tt/2GbOUSu
AAOMS Author Disclosure forms
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 4
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Our Educators—Celebrating a Century of the AAOMS
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 4
Author(s): James R. Hupp
https://ift.tt/2DUGL2Y
Masthead
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 4
https://ift.tt/2G3c0P4
The Evolution of Microvascular and Microneurosurgical Maxillofacial Reconstruction
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 4
Author(s): Michael R. Markiewicz, Michael Miloro
https://ift.tt/2G5Md8Z
Management of the Maxillary Diastema by Various Dental Specialties
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 4
Author(s): Bryan Wheeler, Caroline K. Carrico, Bhavna Shroff, Tegman Brickhouse, Daniel M. Laskin
PurposeThere is considerable controversy in the literature concerning the indications for frenectomy for treating a maxillary diastema and for timing of the procedure. The purpose of this study was to survey pediatric dentists, orthodontists, and oral and maxillofacial surgeons on their opinion of this matter to develop a consensus.Materials and MethodsAn anonymous 7-item electronic questionnaire was sent to members of the American Academy of Pediatric Dentists, the American Association of Orthodontists, and the American Association of Oral and Maxillofacial Surgeons asking about the etiology of the maxillary diastema, its diagnosis, and treatment.ResultsAlthough there was no agreement among the oral and maxillofacial surgeons for the timing of frenectomy and when the diastema should be closed, the pediatric dentists and orthodontists generally agreed that frenectomy should not be performed before the permanent canines are erupted and that the operation should follow orthodontic closure of the space.ConclusionAlthough there was no complete consensus among the 3 groups, a logical treatment approach for the maxillary diastema is proposed.
https://ift.tt/2Gc1Asm
Facial Nerve Injury and Other Complications Following Retromandibular Subparotid Approach for the Management of Condylar Fractures
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 4
Author(s): Stéphane Bruneau, Delphine S. Courvoisier, Paolo Scolozzi
PurposeTo estimate the prevalence and identify risk factors for facial nerve paralysis (FNP) and other postoperative complications after the use of the retromandibular subparotid approach (RMSA) for the treatment of condylar fractures.Materials and MethodsRadiologic and clinical data from all patients who underwent an RMSA from 2007 through 2015 at the University Hospital of Geneva (Geneva, Switzerland) were retrospectively reviewed. The primary and secondary outcome variables were, respectively, FNP and other complications (unesthetic scars, infection, nonunion, malocclusion, salivary fistula, Frey syndrome, and loosening or breaking of plates and screws). Predictor variables included age, gender, mechanism of injury, delay from injury to surgery, surgeon's experience, location of fracture, side and pattern of fracture, concomitant facial fractures, and status of healing. Univariable logistic regression statistics were computed.ResultsForty-eight subcondylar fractures in 43 consecutive patients were treated using the RMSA. Six fracture sites (12.5%) developed a temporary FNP that completely resolved within 4 months. Fractures at the neck level and with the comminution pattern were significant risk factors of postoperative FNP (P = .04 and P < .001, respectively; odds ratio = 82). Eight patients (18.6%) developed a slight transient malocclusion that was completely corrected within 3 to 4 weeks using guiding elastics and 1 patient (2.3%) had a wound dehiscence that resolved with a visible but thin and linear scar.ConclusionThe present study showed that 1) the FNP rate after the RMSA to surgery for condylar fractures was similar to that reported after the transparotid variant; 2) the FNP was transient and completely resolved in all patients; 3) neck and comminuted condylar fractures were statistically associated with increased risk of developing a postoperative temporary FNP; and 4) the final outcome was favorable with no major complications in any of the patients.
https://ift.tt/2G74JOj
Juxta-Apical Radiolucency: Prevalence, Characterization, and Association With the Third Molar Status
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 4
Author(s): Eduarda Helena Leandro Nascimento, Anne Caroline Costa Oenning, Mariana Rocha Nadaes, Gláucia Maria Bovi Ambrosano, Francisco Haiter-Neto, Deborah Queiroz Freitas
PurposeThis study aimed to investigate the prevalence of juxta-apical radiolucency (JAR), assessing its association with third molar status and describing its radiologic features through panoramic radiography.Materials and MethodsWe evaluated 1,050 radiographs (1,830 third molars) for the presence of JAR. The JAR and control groups were classified according to the third molar's angulation, impaction, and root development. The presence of radiographic signs of proximity between the mandibular canal and third molar and the imaging features of JAR also were recorded.ResultsJAR was identified in 116 patients (11%) and 130 third molars (7.1%), being significantly associated with female patients and with the second and third decades of life. There also was an association with teeth with a vertical angulation and complete root formation. Radiographic signs of proximity to the mandibular canal were absent in 66.2% of JAR cases. In most cases, there was lamina dura in the juxta-apical area that appeared to overlap the mandibular canal and to have a cortical outline.ConclusionsJAR is not a rare imaging finding. Given its possible relationship with nerve injuries and its differential diagnostic possibilities, knowing the characteristics of JAR is important to assist professionals in treatment planning and making the correct diagnosis.
https://ift.tt/2DRNZol
Bilateral Traumatic Caroticocavernous Fistulas: A Case Report and Review of the Literature
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 4
Author(s): Lorna Leandro, Giovanni Dolci, Satheesh Prabhu, Rufus Corkill
A traumatic caroticocavernous fistula (CCF) is an acquired, abnormal communication between the internal carotid artery and the cavernous sinus, secondary to trauma. This rare condition can initially be misdiagnosed, because its presentation shares features common to those of facial trauma, which can result in serious complications. We describe a case of bilateral CCF in an adult patient after a road traffic accident.
https://ift.tt/2G5QOrP
The Anesthetic Efficacy of Articaine and Lidocaine in Equivalent Doses as Buccal and Non-Palatal Infiltration for Maxillary Molar Extraction: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 4
Author(s): Omer Waleed Majid, Aws Mahmood Ahmed
PurposeThe purpose of the present study was to evaluate the anesthetic adequacy of 4% articaine 1.8 mL versus 2% lidocaine 3.6 mL without palatal injection compared with the standard technique for the extraction of maxillary molar teeth.Materials and MethodsThis randomized, double-blinded, placebo-controlled clinical trial included patients requiring extraction of 1 maxillary molar under local anesthesia. Patients were randomly distributed into 1 of 3 groups: group A received 4% articaine 1.8 mL as a buccal injection and 0.2 mL as a palatal injection, group B received 4% articaine 1.8 mL plus normal saline 0.2 mL as a palatal injection, and group C received 2% lidocaine 3.6 mL plus normal saline 0.2 mL as a palatal injection. Pain was measured during injection, 8 minutes afterward, and during extraction using a visual analog scale. Initial palatal anesthesia and patients' satisfaction were measured using a 5-score verbal rating scale. Statistical analyses included descriptive statistics, analysis of variance, and Pearson χ2 test. Differences with a P value less than .05 were considered significant.ResultsEighty-four patients were included in the study. The average pain of injection was comparable among all study groups (P = .933). Pain during extraction in the articaine group was significantly less than that experienced in the placebo groups (P < .001), although the differences between placebo groups were insignificant. Satisfaction scores were significantly higher in the articaine group compared with the placebo groups (P < .001), with comparable results between placebo groups.ConclusionsAlthough the anesthetic effects of single placebo-controlled buccal injections of 4% articaine and 2% lidocaine were comparable, the level of anesthetic adequacy was statistically less than that achieved by 4% articaine given by the standard technique. These results do not justify the buccal and non-palatal infiltration of articaine or lidocaine as an effective alternative to the standard technique in the extraction of maxillary molar teeth.
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Comparison of Local Anesthetic Efficiency of Tramadol Hydrochloride and Lidocaine Hydrochloride
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 4
Author(s): Bilal Ege, Metin Calisir, Yahya Al-Haideri, Miray Ege, Metin Gungormus
PurposeThis study investigated the local anesthetic efficiency of tramadol versus lidocaine hydrochloride in maxillary infiltration anesthesia.Materials and MethodsThis study was a randomized double-blinded study involving 50 healthy volunteers. In the experimental part of this study, each volunteer received a buccal 0.5-mL injection of tramadol hydrochloride 25 mg on one side and a buccal 0.5-mL injection of vasoconstrictor-free lidocaine hydrochloride 20 mg on the other side. No other treatment was performed. After the injections, total duration of anesthesia, start and finish times of anesthesia, soft tissue (sensory) innervation, depth of anesthetic, possible side effects, and satisfaction levels were recorded from all volunteers.ResultsThere was no relevant difference between solutions for total anesthesia duration and peak values. However, statistically, the effect of lidocaine started and ended early. The efficacy of tramadol was markedly more effective in the gingiva and skin, especially at 15 and 20 minutes, compared with lidocaine. Both anesthetic agents were well tolerated by the volunteers.ConclusionTramadol hydrochloride can be a good alternative to local anesthetic agents and beneficial to support anesthesia during long operations.
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Close Resection Margins Do Not Influence Local Recurrence in Patients With Oral Squamous Cell Carcinoma: A Prospective Cohort Study
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 4
Author(s): Panagiotis Stathopoulos, William P. Smith
PurposeThis study investigated the clinical relevance of the distance between the resection margin and tumor cells of the primary sites for oral squamous cell carcinoma, with particular attention to local recurrence rate.Patients and MethodsAll patients diagnosed with oral squamous cell carcinoma from 1995 to 2006 and treated primarily with surgery formed the initial cohort of the study. Patient with various degrees of dysplasia in the margin, patients who received radiotherapy, and patients who died of causes other than oral cancer were excluded. Margins 1 to 5 mm were considered close. A margin of at least 5 mm was considered free of disease (clear). Local recurrence was defined as tumor development at the site of the primary tumor during the follow-up period (≥5 yr). The Fisher exact test was used to determine the relevance of the differences between the studied groups (free vs close margins) in relation to local recurrence.ResultsHistologic analysis of the specimens was performed. Of the 53 patients, 32 had free margins and 3 of the 32 had a local recurrence. In addition, 21 patients had close margins and 3 of the 21 had a local recurrence. The difference between the 2 groups was not statistically relevant.ConclusionsThe authors advocate that the strategy of using close resection margins as a generic indicator for local recurrence and adverse prognosis might have to be reassessed. The histopathologic evidence of tumor cells within a distance less than 0.5 cm from the surgical margins does not necessarily seem to offer a certain indication for additional treatment. Other prognostic factors, such as involvement of cervical lymph nodes and tumor depth, must be considered in the decision making for further treatment.
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Is Bone Morphogenetic Protein-2 as Effective as Alveolar Distraction Osteogenesis for Vertical Bone Regeneration?
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 4
Author(s): Jose M. Reuss, Joan Pi-Anfruns, Peter K. Moy
PurposeThe aim of this study was to assess the clinical effectiveness of alveolar distraction osteogenesis (ADO) versus recombinant human bone morphogenetic protein-2 (rh-BMP-2) for vertical ridge augmentation. Few data have been published on vertical bone regeneration using rh-BMP-2.Materials and MethodsThe authors implemented a retrospective cohort study and enrolled a sample composed of patients with deficient alveolar vertical bone height. The primary predictor variable was vertical augmentation with BMP-2 and a titanium mesh or ADO. The primary outcome variable was gain in vertical bone height (millimeters) measured using computed tomography. The secondary outcome variable was postoperative complications, namely need for further grafting before or simultaneous with implant placement, soft tissue dehiscence, paresthesia, infection, implant failure, and pain. Other outcomes included implant stability at time of placement and follow-up (implant stability quotient by resonance frequency analysis), surgical time (minutes), and total treatment time until implant placement (weeks). Other study variables included location of reconstruction (maxilla or mandible). Appropriate bivariate statistics were computed and statistical significance was set a P value less than .05.ResultsThe retrospective review yielded 21 patients in the BMP group and 19 in the ADO group. For the BMP-2 group, the average vertical bone gain was 2.96 ± 1.8 mm overall (maxilla, mean 3.6 ± 3.1 mm; mandible, mean 2.32 ± 1.8 mm). For the ADO group, this gain was 4 ± 1.69 mm overall (maxilla, mean 2.8 ± 1.94 mm; mandible, mean 5.2 ± 4.67 mm). For complications, group BMP showed a statistically minor tendency for more postoperative problems, such as wound dehiscence. For implant survival, group BMP showed a 92.2% survival rate versus 96.3% in group ADO at 3 to 45 months after delivery of the prosthesis (average, 22 months).ConclusionThe 2 techniques showed similar values in absolute vertical bone gain. Group ADO showed a slightly better outcome in outright vertical regenerative potential, albeit with a more frequent need for regrafting before and simultaneous with implant placement. Group BMP showed a lesser need for regrafting, despite having a higher postoperative complication rate.
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Does Graft Particle Type and Size Affect Ridge Dimensional Changes After Alveolar Ridge Split Procedure?
Source:Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 4
Author(s): Mohit G. Kheur, Supriya Kheur, Tabrez Lakha, Shantanu Jambhekar, Bach Le, Vinay Jain
PurposeThe absence of an adequate volume of bone at implant sites requires augmentation procedures before the placement of implants. The aim of the present study was to assess the ridge width gain with the use of allografts and biphasic β-tricalcium phosphate with hydroxyapatite (alloplast) in ridge split procedures, when each were used in small (0.25 to 1 mm) and large (1 to 2 mm) particle sizes.Patients and MethodsA randomized controlled trial of 23 subjects with severe atrophy of the mandible in the horizontal dimension was conducted in a private institute. The patients underwent placement of 49 dental implants after a staged ridge split procedure. The patients were randomly allocated to alloplast and allograft groups (predictor variable). In each group, the patients were randomly assigned to either small graft particle or large graft particle size (predictor variable). The gain in ridge width (outcome variable) was assessed before implant placement. A 2-way analysis of variance test and the Student unpaired t test were used for evaluation of the ridge width gain between the allograft and alloplast groups (predictor variable). Differences were considered significant if P values were < .05.ResultsThe sample included 23 patients (14 men and 9 women). The patients were randomly allocated to the alloplast (n = 11) or allograft (n = 12) group before the ridge split procedure. In each group, they were assigned to a small graft particle or large graft particle size (alloplast group, small particle in 5 and large particle size in 6 patients; allograft group, small particle in 6 and large particle size in 6). A statistically significant difference was observed between the 2 graft types. The average ridge width gain was significantly greater in the alloplast group (large, 4.40 ± 0.24 mm; small, 3.52 ± 0.59 mm) than in the allograft group (large, 3.82 ± 0.19 mm; small, 2.57 ± 0.16 mm). For both graft types (alloplast and allograft), the large particle size graft resulted in a greater ridge width gain compared with the small particle size graft (P < .05).ConclusionsWithin the limitations of the present study, we suggest the use of large particle alloplast as the graft material of choice for staged ridge split procedures in the posterior mandible.
https://ift.tt/2DV7dsZ
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