Thyroid, Ahead of Print.
https://ift.tt/2pHhyVp
Τρίτη 27 Μαρτίου 2018
Maternal Thyroid Function in Early Pregnancy and Child Neurodevelopmental Disorders: A Danish Nationwide Case-Cohort Study
Study of Pre and Post Operative Videostroboscopic Evaluation of Benign Vocal Cord Lesions
Abstract
To determine pre and postoperative vocal fold vibratory changes using videostroboscopy (VS) and effect of surgery on functional, physical and emotional levels of voice using voice handicap index (VHI). To determine correlation between VHI and VS in patients with benign vocal fold pathology. This is a prospective study done at Pushpagiri Medical College. 40 patients in the age group of 14–75 years who presented with complaints of voice change were included. VS and VHI of patients done preoperatively in 40 patients. Patients were re-evaluated postoperatively at 1 month by VHI and VS. All patients underwent microlaryngoscopic excision of the benign vocal cord lesion with biopsy under GA in the conventional manner. One month postoperatively, these patients were evaluated by VS and VHI and the findings noted. There was statistically significant improvement in the stroboscopy ratings and VHI scores post operatively (p < 0.0001). The mucosal wave was diminished or absent in 100% of the studied TVC cysts and present in approximately 60% of vocal polyps. There was no significant correlation found between preoperative VHI scores and stroboscopy ratings except for mucosal waves. Whereas there was significant correlation noted between the VHI subscales and total scores with stroboscopic scores postoperatively except for symmetry. All but 6 patients in this study benefitted from surgery and 85% had a normal voice post-operatively. Pre and post operative assessment of patients with benign vocal fold lesions by stroboscopy and VHI is a useful way to determine the degree of improvement following surgery.
https://ift.tt/2I5hSUD
Study of Pre and Post Operative Videostroboscopic Evaluation of Benign Vocal Cord Lesions
Abstract
To determine pre and postoperative vocal fold vibratory changes using videostroboscopy (VS) and effect of surgery on functional, physical and emotional levels of voice using voice handicap index (VHI). To determine correlation between VHI and VS in patients with benign vocal fold pathology. This is a prospective study done at Pushpagiri Medical College. 40 patients in the age group of 14–75 years who presented with complaints of voice change were included. VS and VHI of patients done preoperatively in 40 patients. Patients were re-evaluated postoperatively at 1 month by VHI and VS. All patients underwent microlaryngoscopic excision of the benign vocal cord lesion with biopsy under GA in the conventional manner. One month postoperatively, these patients were evaluated by VS and VHI and the findings noted. There was statistically significant improvement in the stroboscopy ratings and VHI scores post operatively (p < 0.0001). The mucosal wave was diminished or absent in 100% of the studied TVC cysts and present in approximately 60% of vocal polyps. There was no significant correlation found between preoperative VHI scores and stroboscopy ratings except for mucosal waves. Whereas there was significant correlation noted between the VHI subscales and total scores with stroboscopic scores postoperatively except for symmetry. All but 6 patients in this study benefitted from surgery and 85% had a normal voice post-operatively. Pre and post operative assessment of patients with benign vocal fold lesions by stroboscopy and VHI is a useful way to determine the degree of improvement following surgery.
https://ift.tt/2I5hSUD
The purinergic P2X7 ion channel receptor—a ‘repair’ receptor in bone
Niklas Rye Jørgensen
https://ift.tt/2GckyTO
Anosmia and nasal obstruction
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): J.J. Braun, S. Riehm
https://ift.tt/2pKUDIV
Correlation between body mass index and obstructive sleep apnea severity indexes — A retrospective study
To evaluate if Body Mass Index (BMI) is correlated to Apnea-Hypopnea Index (AHI), mean arterial oxygen saturation (SaO2) and Nadir SaO2, which are all indexes defining the severity of the respiratory stress associated with Obstructive Sleep Apnea (OSA).
https://ift.tt/2GfetlA
Intra-alveolar epsilon-aminocaproic acid for the control of post-extraction bleeding in anticoagulated patients: randomized clinical trial
The aim of this study was to compare the effectiveness of the intra-alveolar administration of epsilon-aminocaproic acid (EACA) and daily gentle rinsing with EACA mouthwash with that of routine postoperative procedures for the control of bleeding after tooth extraction in anticoagulated patients. A randomized clinical trial was conducted involving 52 patients submitted to 140 tooth extractions, assigned randomly to two groups. The intervention group was treated with intra-alveolar administration of EACA immediately after surgery and gentle rinsing with EACA mouthwash during the postoperative period.
https://ift.tt/2GeIEgM
Microcystic adnexal carcinoma—diagnostic criteria and therapeutic methods: case report and review of the literature
Microcystic adnexal carcinoma (MAC) is a rare, infiltrating, locally aggressive cutaneous neoplasm of combined follicular and eccrine/apocrine histogenesis, usually presenting on the upper lip or face. Differentiation from other adnexal tumours is very important because the clinical management of these tumours is radically different, and misdiagnosis may lead to incorrect treatment. A case of recurrent MAC in the upper lip, treated with multiple excisions and postoperative radiation therapy (PORT), is presented herein.
https://ift.tt/2DZwySL
Trend in otolaryngological surgeries in an era of super-aging: Descriptive statistics using a Japanese inpatient database
To reveal the age distribution and capture the longitudinal trend in otolaryngological surgeries performed in Japan, where society is rapidly aging.
https://ift.tt/2IaJFmF
Dilemmas for the pathologist in the oncologic assessment of pancreatoduodenectomy specimens
Abstract
A pancreatoduodenectomy specimen is complex, and there is much debate on how it is best approached by the pathologist. In this review, we provide an overview of topics relevant for current clinical practice in terms of gross dissection, and macro- and microscopic assessment of the pancreatoduodenectomy specimen with a suspicion of suspected pancreatic cancer. Tumor origin, tumor size, degree of differentiation, lymph node status, and resection margin status are universally accepted as prognostic for survival. However, different guidelines diverge on important issues, such as the diagnostic criteria for evaluating the completeness of resection. The macroscopic assessment of the site of origin in periampullary tumors and cystic lesions is influenced by the grossing method. Bi-sectioning of the head of the pancreas may offer an advantage in this respect, as this method allows for optimal visualization of the periampullary area. However, a head-to-head comparison of the assessment of clinically relevant parameters, using axial slicing versus bi-sectioning, is not available yet and the gold standard to compare both techniques prospectively might be subject of debate. Further studies are required to validate the various dissection protocols used for pancreatoduodenectomy specimens and their specific value in the assessment of pathological parameters relevant for prognosis.
https://ift.tt/2pNoaRd
Subungual Atypical Lentiginous Melanocytic Proliferations in Children and Adolescents: A Clinicopathologic Study
Most subungual melanocytic lesions in children are benign, but some are difficult to classify due to prominent lentiginous growth and high-grade cytologic atypia.
https://ift.tt/2IUwLu5
A healthy diet in women is associated with less facial wrinkles in a large Dutch population-based cohort
Little is known about the impact of nutrition on youthful appearance., Adherence to a recommended healthy diet associates with less wrinkling in women whereas an unhealthy population driven dietary pattern is associated with more facial wrinkling., Dietary recommendations for skin aging preventing strategies could additionally help improve overall health.
https://ift.tt/2IUsk2B
Correlation between body mass index and obstructive sleep apnea severity indexes — A retrospective study
Source:American Journal of Otolaryngology
Author(s): Domenico Ciavarella, Michele Tepedino, Claudio Chimenti, Giuseppe Troiano, Manuela Mazzotta, Maria Pia Foschino Barbaro, Lorenzo Lo Muzio, Michele Cassano
PurposeTo evaluate if Body Mass Index (BMI) is correlated to Apnea-Hypopnea Index (AHI), mean arterial oxygen saturation (SaO2) and Nadir SaO2, which are all indexes defining the severity of the respiratory stress associated with Obstructive Sleep Apnea (OSA).Materials and methodsSeventy-five adult patients (mean age 51.4) referred for polysomnography were retrospectively recruited. BMI was calculated for each patient, as well as AHI, SaO2, and Nadir SaO2 recorded during polysomnography. Spearman's Rho test was used to evaluate if OSA severity was correlated to BMI values. First type error was set as p < 0.025.ResultsNo correlation was observed between BMI and AHI, and between BMI and SaO2. A statistically significant negative correlation (r2 = 0.424; p < 0.001) was found between the BMI index and the Nadir SaO2.ConclusionsHigher BMI values were correlated with lower Nadir SaO2 during overnight polysomnography. Since hypoxia stress is a risk factor for cardiovascular diseases and alters the lipid metabolism, dietary consulting should be recommended in association with other treatment modalities for OSA.
https://ift.tt/2DXqLgA
Longitudinal Associations of Metabolic Syndrome Severity Between Childhood and Young Adulthood: The Bogalusa Heart Study
Metabolic Syndrome and Related Disorders, Ahead of Print.
https://ift.tt/2pPbl9g
Anthropometrics and Allometry: Beyond Body Mass Index
Metabolic Syndrome and Related Disorders, Ahead of Print.
https://ift.tt/2GcndNj
Comparative Study in Oral, Breast Approach and Open Thyroidectomy
Condition: Thyroid Neoplasms
Intervention: Procedure: Thyroid Surgical Methods
Sponsor: Second Affiliated Hospital, School of Medicine, Zhejiang University
Recruiting
https://ift.tt/2I7Llgx
Intervention: Procedure: Thyroid Surgical Methods
Sponsor: Second Affiliated Hospital, School of Medicine, Zhejiang University
Recruiting
https://ift.tt/2I7Llgx
Can Early Initiation of Rehabilitation With Wearable Sensor Technology Improve Outcomes in mTBI?
Conditions: Mild Traumatic Brain Injury; Balance; Distorted; Gait, Unsteady; Quality of Life; Veterans
Intervention: Behavioral: Rehabilitation
Sponsors: Oregon Health and Science University; United States Department of Defense
Not yet recruiting
https://ift.tt/2GfWJe0
Intervention: Behavioral: Rehabilitation
Sponsors: Oregon Health and Science University; United States Department of Defense
Not yet recruiting
https://ift.tt/2GfWJe0
The Impact of Natural Disasters on Domestic Violence: An Analysis of Reports of Simple Assault in Florida (1999–2007)
Violence and Gender, Ahead of Print.
https://ift.tt/2pOJ2sn
The Importance of the Saphenous Nerve Block for Analgesia Following Major Ankle Surgery: A Randomized, Controlled, Double-Blind Study
Background and Objectives Major ankle surgery causes intense postoperative pain, and whereas the importance of a sciatic nerve block is well established, the clinical significance of a supplemental saphenous nerve block has never been determined in a prospective, randomized, double-blind, placebo-controlled trial. We hypothesized that a saphenous nerve block reduces the proportion of patients experiencing significant clinical pain after major ankle surgery. Methods Eighteen patients were enrolled and received a popliteal sciatic nerve block. Patients were randomized to single-injection saphenous nerve block with 10 mL 0.5% bupivacaine with 1:200,000 epinephrine or 10 mL saline (Fig. 1). Primary outcome was the proportion of patients reporting significant clinical pain, defined as a score greater than 3 on the numerical rating scale. Secondary outcomes were maximal pain and analgesia of the cutaneous territory of the infrapatellar branch of the saphenous nerve. Results Eight of 9 patients in the placebo group reported significant clinical pain versus 1 of 9 patients in the bupivacaine-epinephrine group (P = 0.003). Maximal pain was significantly lower in the active compared with the placebo group (median, 0 [0–0] vs 5 [4–6]; P = 0.001). Breakthrough pain from the saphenous territory began within 30 minutes after surgery in all cases. Sensory testing of the cutaneous territory of the infrapatellar branch of the saphenous nerve showed correlation between pain reported in the anteromedial ankle region and the intensity of cutaneous sensory block in the anteromedial knee region. Conclusions The saphenous nerve is an important contributor to postoperative pain after major ankle surgery, with significant clinical pain appearing within 30 minutes after surgery. Clinical Trials Registration This study has been registered at ClinicalTrials.gov, identifier NCT02697955. Accepted for publication November 20, 2017. Address correspondence to: Thomas Fichtner Bendtsen, MD, PhD, Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Noerrebrogade 44, DK-8000 Aarhus, Denmark (e-mail: tfb@dadlnet.dk). Funding was received from the A. P. Møller and Chastine Mc-Kinney Møller Foundation. The content is solely the responsibility of the authors. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
https://ift.tt/2Gsy05B
https://ift.tt/2Gsy05B
Too Deep or Not Too Deep?: A Propensity-Matched Comparison of the Analgesic Effects of a Superficial Versus Deep Serratus Fascial Plane Block for Ambulatory Breast Cancer Surgery
Background and Objectives Serratus fascial plane block can reduce pain following breast surgery, but the question of whether to inject the local anesthetic superficial or deep to the serratus muscle has not been answered. This cohort study compares the analgesic benefits of superficial versus deep serratus plane blocks in ambulatory breast cancer surgery patients at Women's College Hospital between February 2014 and December 2016. We tested the joint hypothesis that deep serratus block is noninferior to superficial serratus block for postoperative in-hospital (pre-discharge) opioid consumption and pain severity. Methods One hundred sixty-six patients were propensity matched among 2 groups (83/group): superficial and deep serratus blocks. The cohort was used to evaluate the effect of blocks on postoperative oral morphine equivalent consumption and area under the curve for rest pain scores. We considered deep serratus block to be noninferior to superficial serratus block if it were noninferior for both outcomes, within 15 mg morphine and 4 cm·h units margins. Other outcomes included intraoperative fentanyl requirements, time to first analgesic request, recovery room stay, and incidence of postoperative nausea and vomiting. Results Deep serratus block was associated with postoperative morphine consumption and pain scores area under the curve that were noninferior to those of the superficial serratus block. Intraoperative fentanyl requirements, time to first analgesic request, recovery room stay, and postoperative nausea and vomiting were not different between blocks. Conclusions The postoperative in-hospital analgesia associated with deep serratus block is as effective (within an acceptable margin) as superficial serratus block following ambulatory breast cancer surgery. These new findings are important to inform both current clinical practices and future prospective studies. Accepted for publication November 27, 2017. Address correspondence to: Faraj W. Abdallah, MD, The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, Ontario, Canada K1H 8L6 (e-mail: FAbdallah@toh.ca). This work was supported by departmental funding. F.W.A. and R.B. are supported by the Merit Award Program, Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada. R.B. also receives research support from the Evelyn Bateman Cara Operations Endowed Chair in Ambulatory Anesthesia and Women's Health, Women's College Hospital, Toronto. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
https://ift.tt/2Ghk5M2
https://ift.tt/2Ghk5M2
Microcystic adnexal carcinoma—diagnostic criteria and therapeutic methods: case report and review of the literature
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M. Mamic, L. Manojlovic, P. Suton, I. Luksic
Microcystic adnexal carcinoma (MAC) is a rare, infiltrating, locally aggressive cutaneous neoplasm of combined follicular and eccrine/apocrine histogenesis, usually presenting on the upper lip or face. Differentiation from other adnexal tumours is very important because the clinical management of these tumours is radically different, and misdiagnosis may lead to incorrect treatment. A case of recurrent MAC in the upper lip, treated with multiple excisions and postoperative radiation therapy (PORT), is presented herein. There have been no signs or symptoms of recurrence since the subsequent reconstructive surgery and PORT. Based on reports in the literature it appears that although immunohistochemistry can be helpful in distinguishing between MAC and other adnexal tumours, careful histopathological examination is essential for an accurate diagnosis. Perineural and intramuscular invasion strongly suggest the diagnosis of MAC. Its predilection for the facial area often limits the width of surgical excision. In such cases, PORT may be considered.
https://ift.tt/2GcSQ9L
Intra-alveolar epsilon-aminocaproic acid for the control of post-extraction bleeding in anticoagulated patients: randomized clinical trial
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): R.V. da Silva, T.B. Gadelha, R.R. Luiz, S.R. Torres
The aim of this study was to compare the effectiveness of the intra-alveolar administration of epsilon-aminocaproic acid (EACA) and daily gentle rinsing with EACA mouthwash with that of routine postoperative procedures for the control of bleeding after tooth extraction in anticoagulated patients. A randomized clinical trial was conducted involving 52 patients submitted to 140 tooth extractions, assigned randomly to two groups. The intervention group was treated with intra-alveolar administration of EACA immediately after surgery and gentle rinsing with EACA mouthwash during the postoperative period. The control group received routine postoperative recommendations. A single episode of immediate bleeding occurred in the intervention group. Late bleeding episodes occurred in 23 procedures (16.4%): 11 (15.7%) in the intervention group and 12 (17.1%) in the control group. Among the patients with late bleeding, 18 (78.3%) events were classified as moderate and were controlled by the patient applying pressure to a gauze pack placed over the extraction socket. The remaining five cases (21.7%) required re-intervention. No statistically significant difference in the frequency of postoperative bleeding was observed between the groups. Thus, routine measures were as effective for the control of bleeding after simple tooth extractions in anticoagulated patients as the topical administration of EACA.
https://ift.tt/2I6MV2i
When a transfusion in an emergency service is not really urgent: hyperhaemolysis syndrome in a child with sickle cell disease
A 13-month-old boy with sickle cell disease (SCD) from Equatorial Guinea, who had recently arrived in Spain, presented with fever. He had suffered from malaria and had received a blood transfusion. Following physical examination and complementary tests, intravenous antibiotics and a red blood cell (RBC) transfusion were administered. Soon after a second transfusion 5 days later, the haemoglobin level fell below pretransfusion levels, together with reticulocytopenia, and haematuria—the so-called hyperhaemolysis syndrome—requiring intensive care and treatment with intravenous immunoglobulins and corticosteroids, with resolution of the complication. We want to emphasise the importance of suspecting this rare, though severe complication that can appear after any RBC transfusion especially in patients with SCD, as the clinical syndrome can simulate other more common complications of these patients and a further transfusion is contraindicated. There is no standardised treatment, but intravenous immunoglobulin and corticosteroids are usually effective.
https://ift.tt/2I4KCNl
Brucellosis accompanied by haemophagocytic lymphohistiocytosis and multiple splenic abscesses in a patient with depression
A 39-year-old woman was being treated for depression in our clinic. She subsequently developed a fever and was diagnosed with pancytopenia and moderate splenomegaly. Laboratory and bone marrow results, including markedly increased serum ferritin levels, suggested haemophagocytic lymphohistiocytosis. CT showed multiple splenic abscesses and ovarian vein thrombosis. All laboratory values returned to normal after treatment for culture-positive brucellosis.
https://ift.tt/2IVBFag
Re: “A Follow-Up Strategy for Patients with Excellent Response to Initial Therapy for Differentiated Thyroid Carcinoma” by Jeon et al. (Thyroid 2018;28:187–192)
Thyroid, Ahead of Print.
https://ift.tt/2pIHlfX
Natural saliva as an adjuvant in a secondary caries model based on Streptococcus mutans
Source:Archives of Oral Biology
Author(s): Franziska Hetrodt, Julian Lausch, Hendrik Meyer-Lueckel, Christian Apel, Georg Conrads
ObjectiveTwo factors for secondary caries formation were evaluated using an artificial biofilm model, saliva as additive in culture medium and bonding procedures of composite materials for artificial gap creation.DesignStandardized cavities were prepared in bovine tooth samples (n = 44), treated with two different bonding pretreatments, restored and after artificial ageing incubated with Streptococcus mutans in a Mueller-Hinton-Broth-Sugar medium with or without human saliva for seven days. Secondary caries formation was analyzed using confocal laser scanning microscopy and transversal microradiography.ResultsLesions were significantly pronounced in groups using saliva, but were not influenced by the bonding pretreatments.ConclusionsThe results indicate that the addition of saliva, but not the type of bonding procedure influences the outcome in the present biofilm-based secondary caries model.
https://ift.tt/2GukHS9
Natural saliva as an adjuvant in a secondary caries model based on Streptococcus mutans
Source:Archives of Oral Biology
Author(s): Franziska Hetrodt, Julian Lausch, Hendrik Meyer-Lueckel, Christian Apel, Georg Conrads
ObjectiveTwo factors for secondary caries formation were evaluated using an artificial biofilm model, saliva as additive in culture medium and bonding procedures of composite materials for artificial gap creation.DesignStandardized cavities were prepared in bovine tooth samples (n = 44), treated with two different bonding pretreatments, restored and after artificial ageing incubated with Streptococcus mutans in a Mueller-Hinton-Broth-Sugar medium with or without human saliva for seven days. Secondary caries formation was analyzed using confocal laser scanning microscopy and transversal microradiography.ResultsLesions were significantly pronounced in groups using saliva, but were not influenced by the bonding pretreatments.ConclusionsThe results indicate that the addition of saliva, but not the type of bonding procedure influences the outcome in the present biofilm-based secondary caries model.
https://ift.tt/2GukHS9
Bevacizumab-induced intestinal perforation in a patient with inoperable breast cancer: a case report and review of the literature
Gastrointestinal perforation is known as a serious adverse event, but, for breast cancer, there are very few reports of gastrointestinal perforation. This report highlights gastrointestinal perforation caused ...
https://ift.tt/2uohZZn
TARC expression in the circulation and cutaneous granulomas correlates with disease severity and indicates Th2-mediated progression in patients with sarcoidosis
Publication date: Available online 26 March 2018
Source:Allergology International
Author(s): Chuyen Thi Hong Nguyen, Naotomo Kambe, Ikuko Ueda-Hayakawa, Izumi Kishimoto, Nhung Thi My Ly, Kana Mizuno, Hiroyuki Okamoto
BackgroundSarcoidosis is a systemic disorder characterized by the accumulation of lymphocytes and monocyte/macrophage lineage cells that results in the formation of non-caseating granulomas. Thymus- and activation-regulated chemokine (TARC)/CCL17 is an important chemokine in the amplification of Th2 responses, which are achieved by recruiting CCR4-expressing CD4+ T lymphocytes. TARC concentrations are known to increase in the serum of sarcoidosis patients; however, its role in the assessment of severity and prognosis of sarcoidosis remains unknown. The objective of this study is to elucidate the role of TARC in sarcoidosis by investigating its expression in peripheral blood and at inflammatory sites. We also examined its relationship with clinical features.MethodsSerum levels of TARC, soluble interleukin 2 receptor, angiotensin-converting enzyme, and lysozyme were measured in 82 sarcoidosis patients. The Th1 and Th2 balance in circulating CD4+ T cells was evaluated by flow cytometry. The immunohistochemical staining of TARC and CCR4 was performed in order to identify the source of TARC in affected skin tissues.ResultsTARC serum levels were elevated in 78% of patients and correlated with disease severity. The percentage of CCR4+ cells and the CCR4+/CXCR3+ cell ratios were significantly higher in sarcoidosis patients than in normal subjects (P = 0.002 and P = 0.015, respectively). Moreover, TARC was expressed by monocyte/macrophage lineage cells within granulomas. The abundancy as well as distribution of TARC staining correlated with its serum levels.ConclusionsThe present results suggest that elevations in TARC drive an imbalanced Th2- weighted immune reaction and might facilitate prolonged inflammatory reactions in sarcoidosis.
https://ift.tt/2GsaGVB
Rolle des angeborenen Immunsystems bei Otitis media
Zusammenfassung
Die Otitis media (OM) gehört zu den häufigsten Krankheiten im Kindesalter und ist für mehr Arztbesuche, chirurgische Eingriffe und Medikamentenverordnungen verantwortlich als jede andere Infektionskrankheit. Neuesten Forschungsergebnissen zufolge nimmt das angeborene Immunsystem bei der Bekämpfung der Mittelohrentzündung eine entscheidende Rolle ein. Die Mukosa des Mittelohrs identifiziert das eindringende Pathogen, indem sie „pathogenassoziierte molekulare Muster" (PAMP) über Rezeptoren wie die Toll-like-Rezeptoren (TLR) erkennt. Diese generieren umgehend eine antimikrobielle Immunantwort sowie die Freisetzung von Zytokinen und führen somit zu einer Entzündungsreaktion, wie sie bei der akuten und chronischen OM zu beobachten ist. Durch Interaktion zwischen den verschiedenen TLR kann der Heilungsprozess im Mittelohr sowohl verstärkt als auch gehemmt werden. Um eine Überreaktion auf der einen Seite und eine mangelnde Immunantwort auf der anderen Seite zu verhindern, muss das Signalnetzwerk der Toll-like-Rezeptoren über positive und negative Feedbackschleifen kontrolliert und vernetzt sein. Nur dann kann eine angemessene Immunantwort auf die Infektion im Mittelohr garantiert werden. In der vorliegenden Literaturübersicht liegt das Augenmerk auf der Rolle des angeborenen Immunsystems und der TLR sowie deren Bedeutung bei der Entwicklung von neuen Impfstrategien bzw. Immuntherapien.
https://ift.tt/2Ghbrx8
Guía clínica sobre implantes cocleares
Publication date: Available online 26 March 2018
Source:Acta Otorrinolaringológica Española
Author(s): Manuel Manrique, Ángel Ramos, Carlos de Paula Vernetta, Elisa Gil-Carcedo, Luis Lassaleta, Isabel Sanchez-Cuadrado, Juan Manuel Espinosa, Ángel Batuecas, Carlos Cenjor, María José Lavilla, Faustino Núñez, Laura Cavalle, Alicia Huarte
IntroducciónEn la última década son numerosos los hospitales que han iniciado su actividad en pacientes candidatos a un implante coclear (IC), y se han producido numerosos y relevantes avances para el tratamiento de la hipoacusia neurosensorial que han desembocado en una ampliación de las indicaciones de los IC.ObjetivosOfrecer a los especialistas de otorrinolaringología, de otras especialidades médicas, autoridades sanitarias y a la sociedad en general una guía clínica sobre implantes cocleares.MétodosLas comisiones científicas de otología, otoneurología y audiología de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC), de manera coordinada y consensuada, han llevado a cabo una revisión del estado actual de los IC basándose en las reglamentaciones existentes y en las publicaciones científicas que se referencian en la bibliografía del documento elaborado.ResultadosLa guía clínica sobre implantes cocleares aporta información sobre: a) definición y descripción sobre IC; b) indicaciones de los IC; y c) requisitos organizativos para un programa de IC.ConclusionesSe ha elaborado por un comité de expertos de la SEORL-CCC una Guía clínica sobre implantes cocleares que aporta coordenadas de actuación para todos aquellos agentes de la sanidad en la toma de decisiones en el ámbito de los IC como forma de tratamiento de la discapacidad auditiva.IntroductionIn the last decade numerous hospitals have started to work with patients who are candidates for a cochlear implant (CI) and there have been numerous and relevant advances in the treatment of sensorineural hearing loss that extended the indications for cochlear implants.ObjectivesTo provide a guideline on cochlear implants to specialists in otorhinolaryngology, other medical specialities, health authorities and society in general.MethodsThe Scientific Committees of Otology, Otoneurology and Audiology from the Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), in a coordinated and agreed way, performed a review of the current state of CI based on the existing regulations and in the scientific publications referenced in the bibliography of the document drafted.ResultsThe clinical guideline on cochlear implants provides information on: a) Definition and description of Cochlear Implant; b) Indications for cochlear implants; c) Organizational requirements for a cochlear implant programme.ConclusionsA clinical guideline on cochlear implants has been developed by a Committee of Experts of the SEORL-CCC, to help and guide all the health professionals involved in this field of CI in decision-making to treathearing impairment.
https://ift.tt/2pHPMYD
Floating fifth metacarpal: give conservative management a try!
Abstract
We describe a case of double dislocation of fifth metacarpal (floating metacarpal) in a young adult presenting immediately after injury. He was treated conservatively by closed reduction and immobilization with a wrist brace for 3 weeks. Following above mentioned conservative management, he was pain free and he regained full range of motion and power comparable to contralateral side. Reports on floating metacarpal are rare till date and all of them have been managed surgically. We report a case of such dislocation which was managed successfully with conservative treatment. We advocate conservative management for floating metacarpal if it presents early and if reduction is stable.https://ift.tt/2Gb9c2y
Malignant transformation of a urachal cyst—a case report and literature review
Abstract
Urachal remnant diseases are very uncommon pathologies which are mostly benign. Rarely they can progress to a very aggressive form of Urachal cancer. The rarity of this condition has precluded large studies to help guide the diagnostic and therapeutic management of these potentially malignant lesions. In this case, a urachal cyst was discovered and conservative management was employed after a biopsy proved the lesion was benign. Unfortunately this patient represented several years later with a locally advanced urachal cancer. To date, this is the first clearly documented case of malignant transformation. The available literature surrounding these urachal cysts and cancers will be reviewed to determine if anything could have been done differently in this case and in the future should a similar case present.https://ift.tt/2I6Pp0x
Prostatic malakoplakia: a case report with review of the literature
Abstract
Prostatic malakoplakia is a rare benign tumor with few reported cases in the literature. A 61-year-old male with a history of Escherichia coli urinary tract infection (UTI) and gross hematuria presented for evaluation with prostate-specific antigen (PSA) level of 16.0 ng/mL and a 1.5 cm palpable prostatic nodule highly suggestive of prostate cancer. Cystoscopy was unremarkable. Transrectal ultrasound-guided biopsy was performed. Pathologic analysis demonstrated prostatic malakoplakia without evidence of associated malignancy. The patient remains on surveillance with regular physical examination and PSA serum testing. Prostatic malakoplakia is a rare diagnosis with clinical examination findings highly suggestive of prostate cancer and without known associated malignancy risk.https://ift.tt/2Gamnk8
Comparison of Local Anaesthetic Efficacy of Tramadol Versus Lignocaine for Extraction of Tooth Under Supraperiosteal Infiltration
Abstract
Background
Tramadol has been shown to have a local anaesthetic effect when used as infiltration anaesthesia.
Methods
The local anaesthetic efficacy of tramadol was compared with that of lignocaine for the extraction of teeth in terms of their onset of action, duration of action, intraoperative pain, post-operative analgesic effect and adverse reactions. Apart from this, incidence of allergic reaction was also recorded for both the drugs. A total of 100 patients were divided into two groups randomly. Each patient was assigned to receive either a maximum of 2 ml of 5% tramadol (Supridol 50 mg, Neon laboratories), Group T (n = 50), as a local anaesthetic solution for extraction of maxillary premolar for orthodontic reason under supraperiosteal infiltration following strict aseptic precaution or a maximum of 2 ml of 2% lignocaine (Lox 2%, Neon laboratories), Group L (n = 50), in a double-blinded fashion.
Results
In group T, the mean subjective onset of action was 33.66 s, while in group L it was 33.06 s (p = 0.881). In group T, the mean objective onset of action was 3.04 min, while in group L it was 3.18 min (p > 0.05). The mean duration of action in group T was 55.60 min, while in group L it was 57.50 min (p = 0.432). Only 2 patients in group T and 1 patient in group L had nausea (p = 0.245).
Conclusion
We conclude that 5% tramadol has a local anaesthetic efficacy similar to 2% lignocaine but is comparatively a weaker agent.
https://ift.tt/2I7dN2p
Prevalence and associated factors of preoperative functional disability in elective surgical patients over 55 years old: a prospective cohort study
Abstract
Purpose
In preoperative settings, patients may have functional disabilities due to the disease for which surgery is being performed or comorbidities, but the associated and predictive factors remain unknown. This study examined the prevalence of preoperative functional disability and clarified the associated factors.
Methods
Individuals aged ≥ 55 years who were scheduled to undergo surgery in a tertiary-care hospital in Japan between April 2016 and September 2016 were eligible for enrolment in the study. Patients with the diseases requiring psychiatric treatment and patients unable to complete the questionnaire without help were excluded. After obtaining informed consent, each patient was asked to complete the 12-item World Health Organization Disability Assessment Schedule-2.0, which is a standardized evaluation tool for assessing comprehensive living function. Data from these questionnaires and the patients' characteristics were evaluated. Multiple logistic regression analysis was conducted to determine independent factors associated with preoperative functional disability.
Results
Of 1201 recruited patients, 912 (75.9%) were included in our analysis. The prevalence of preoperative functional disability was 29.2%. Regression analysis identified six independent associated factors for preoperative functional disability: body mass index ≥ 30 kg m−2, mixed lung disease, serum albumin values, malnutrition, risk of malnutrition, and preoperative use of corticosteroids.
Conclusions
In total, 29.2% of preoperative patients had functional disability. Obesity, nutritional deficiency, respiratory complications, and low serum albumin values were determined as potentially modifiable factors.
https://ift.tt/2Ggg0b6
Intrathecal spinal abscesses due to Candida albicans in an immunocompetent man
Infections of the central nervous system due to Candida albicans are uncommon and are usually only observed in special circumstances, such as following neurosurgery or penetrating head trauma, in immunosuppressed patients, premature infants or in patients with ventriculoperitoneal shunts. The author reports a case of an immunocompetent man who presented with a thoracic intraspinal abscess due to C. albicans. Despite surgical drainage and 6 weeks of high-dose fluconazole therapy, the abscess extended and recurred in the cervical spine, requiring a second operation to arrest the infection.
https://ift.tt/2IY1lD0
Severe immune thrombocytopaenia in a patient taking benznidazole for chronic Chagas disease
Chagas disease is a parasitic disease that mostly affects Latin American countries, but it has currently become a worldwide epidemic due to migration. Both drugs marketed for its treatment (benznidazole and nifurtimox) are associated with a high rate of adverse reactions. Benznidazole is preferred initially because of its more favourable toxicity profile and perceived greater efficacy. Hypersensitivity dermatological reactions, gastrointestinal and neurological disturbances represent the most common drug-related adverse events. General symptoms such as fever, arthralgia, myalgia or bone marrow depression (leucopaenia) are seen less frequently. We describe the case of a 33-year-old woman with chronic Chagas disease who presented with acute gingival bleeding and severe thrombocytopaenia, probably related to benznidazole treatment. Temporal association with drug initiation and recovery after treatment withdrawal were demonstrated. Clinicians should be aware of the possible association between immune thrombocytopaenia and benznidazole, even though the pathogenesis remains unclear at present.
https://ift.tt/2uswrzs
Therapeutic plasma exchange for severe hyperlipidaemia in a patient with poorly controlled diabetes
Description
Hypertriglyceridaemia (HTG) is a common condition in the USA and is often caused or exacerbated by uncontrolled diabetes mellitus (DM), obesity and other metabolic disorders. It is usually asymptomatic until triglycerides exceed 1000 mg/dL. Signs include gastrointestinal pain, nausea, vomiting and dyspnoea. In type I DM, insulin deficiency leads to an inhibition of lipoprotein lipase (LpL).1 Control with insulin restores LpL function and reduces triglyceride levels. While initiating glucose control, therapeutic plasma exchange (TPE) can be used adjunctively, with intravenous insulin, to rapidly decrease triglyceride levels and prevent acute pancreatitis.
A man of 30 with poorly controlled type I DM, secondary to gallstone pancreatitis, presented for treatment of abdominal pain, nausea, vomiting and HTG. His father also has HTG, but no genetic testing for inherited lipid disorders has been pursued. The patient's initial glucose level was 335 mg/dL and his HbA1c was 14.2%. His lipid panel included...
https://ift.tt/2IY1eY6
Streptococcus pyogenes primary peritonitis
Streptococcus pyogenes, a Gram-positive bacterium, is a rare cause of primary peritonitis. Diagnosed on imaging and with positive growth in blood cultures, a case of primary peritonitis caused by S. pyogenes is discussed here, with a brief literature review, and used to discuss several key principles of antibiotic use, including selection of antibiotic, investigations and non-pharmacological management of infection.
https://ift.tt/2uoinXJ
Leiomyosarcoma: a rare sinonasal malignancy
Leiomyosarcomas (LMS) are rare sinonasal malignant tumours with 20 cases of nasal LMS previously reported in the literature. An 81-year-old man presented with an incidental left nasal lesion associated with left nasal obstruction and occasional left-sided blood-stained rhinorrhoea. Nasendoscopic examination showed green coloured polyps filling the left nasal cavity with biopsies showing LMS. CT imaging did not show any bony erosion. No metastases were found on positron emission tomography imaging. The patient underwent endoscopic resection and all surgical margins were clear of disease. The patient was declined postoperative radiotherapy, and serial follow-up has not shown any recurrence to date. Nasal LMS are rare sinonasal smooth muscle tumours and symptoms and radiological findings are often non-specific. Therefore, diagnosis is made on histopathological and immunohistochemical analysis. Due to their invasive nature, the treatment of choice is complete surgical resection, with adjuvant therapy reserved for patients with locally advanced or metastatic disease.
https://ift.tt/2IY19DM
Episodes of extreme lower leg pain caused by intraosseous varicose veins
We present a case of a 67-year-old man with episodes of extreme pain of the right lower extremity that prevented him from walking and sleeping. The patient had a history of varices in both legs. Physical examination showed a pretibial varix of the right leg inferiorly from a painful spot. X-ray of the right lower leg showed a cortex disruption at this spot. MRIs confirmed the disruption of the cortex of the right tibia and demonstrated an intraosseous vessel. The diagnosis intraosseous varices was made and the vein was surgically resected. Follow-up took place after 3 years and the patient was free from any symptoms related to the intraosseous varicose vein. The pathophysiology causing the pain symptoms is hard to understand, partly due to the limited cases presented with such anomalies. We demonstrate our case in the hope to generate more knowledge about this disorder.
https://ift.tt/2un1LQh
Alveolar rhabdomyosarcoma presenting as a lung mass: an uncommon presentation of a less common tumor
Description
Case: a male in his early 20s presented to the emergency department with back pain and abdominal pain for 1 month. The patient also complained of progressively worsening cough and shortness of breath. CT of the chest showed a very large enhancing destructive right lung mass with massive right pleural effusion, which caused a shift of mediastinal structures to the left as well as the significant mass effect on organs in the upper abdomen (figures 1 and 2). CT-guided biopsy of the mass and thoracocentesis was then performed. Histopathology showed nests of small round cells with hyperchromatic nuclei and surrounded by fibrous trabeculae. The tissue had areas of loss of cellular cohesion forming spaces suggestive of an alveolar pattern (figures 3 and 4). It containedPeriodic Acid-Schiff (PAS)positive glycogen as well. According to the TNM Classification of malignant tumours (TNM), it...
https://ift.tt/2IWzeED
Regression of human cirrhosis: an update, 18 years after the pioneering article by Wanless et al.
Abstract
Cirrhosis has been traditionally viewed as an irreversible, end-stage condition. Eighteen years ago, Wanless, Nakashima, and Sherman published a study that was based on the concept that hepatic architecture is under constant remodeling in the course of chronic liver diseases, even during their most advanced stages; depending on the balance between injury and repair, the histologic changes might be progressing or regressing. These authors described in detail the morphologic features of regressing cirrhosis, identified a set of histologic features of regression that they called the "hepatic repair complex," and provided convincing morphologic evidence that incomplete septal cirrhosis represents regressed cirrhosis. In the years that followed publication of this pioneering article, a number of clinical studies with performance of pre- and post-treatment liver biopsies provided abundant evidence that cirrhosis can regress after successful therapy of chronic hepatitis B, chronic hepatitis C, autoimmune hepatitis, and genetic hemochromatosis. Evidence for other chronic liver diseases may also be provided in the future, pending ongoing studies. Successful therapy allows resorption of fibrous septa, which can be followed by loss of nodularity and architectural improvement; however, many vascular lesions of cirrhotic livers are not thought to regress. Cases of cirrhosis that are considered more likely to improve than others include those of recent onset, with relatively thin fibrous septa and mild vascular changes. Histologic examination of liver biopsy specimens from patients with chronic liver diseases provides the opportunity to appreciate the features of the hepatic repair complex on a routine diagnostic basis; however, interpretation is often difficult, and can be aided by immunohistochemical stains. Clinicopathologic correlation is essential for a meaningful assessment of such cases. For many patients, cirrhosis is not an end-stage condition anymore; therefore, use of the term "cirrhosis" has been challenged, almost 200 years after its invention. However, regression of cirrhosis does not imply regression of molecular changes involved in hepatocarcinogenesis; therefore, surveillance for hepatocellular carcinoma should be continued in these patients.
https://ift.tt/2IVjmBW
Tinea capitis und Onychomykose durch Trichophyton soudanense
Zusammenfassung
Zwei afrikanische Mädchen, die erst vor ca. 4 Wochen nach Deutschland gezogen waren, stellten sich mit juckenden und schuppenden Hautveränderungen an der behaarten Kopfhaut vor. Das gesamte Kapillitium war mit einer weißen, trockenen, schuppenden Kruste überzogen. An den Oberschenkeln sah man trockene, kreisrunde, randbetonte, erythematosquamöse Läsionen. Der linke Daumennagel des jüngeren Mädchens war oberflächlich weißlich verfärbt. Das unter dem Verdacht auf eine Tinea capitis et corporis sowie Onychomykose durchgeführte Blankophor-Präparat aus Kopfschuppen, Hautschuppen vom Oberschenkel und Nagelspänen vom Daumen war positiv. Kulturell ließ sich aus 3 Haut- und Nagelproben Trichophyton (T.) soudanense isolieren. Die Pilzisolate wurden zur Bestätigung der Identifizierung einer Sequenzierung der Internal-Transcribed-Spacer(ITS)-Region der ribosomalen Desoxyribonukleinsäure (rDNA) sowie des TEF1α(„translation elongation factor 1α")-Gens unterzogen. Die Speziesidentifizierung T. soudanense wurde bestätigt. Im phylogenetischen Stammbaum – Dendrogramm – unterschieden sich die T.-soudanense-Stämme genetisch klar von T. rubrum. Dagegen erlaubte die Sequenzierung des TEF1α-Gens keine Unterscheidung zwischen T. soudanense und T. rubrum. Beide Mädchen wurden systemisch antimykotisch mit Fluconazol behandelt. Topisch kamen bei beiden Mädchen Ciclopiroxolamin und Terbinafin (jeweils 1‑mal täglich) als Lösung bzw. Creme zur Anwendung. Nach 8 Wochen oraler Fluconazol-Therapie war die Dermatomykose der Haut, Haare und des Daumennagels bei beiden Kindern komplett geheilt. T. soudanense ist ein aus Afrika stammender anthropophiler Dermatophyt, mit dem in Deutschland und Europa zunehmend gerechnet werden muss. Die kulturelle Identifizierung des Erregers ist relativ einfach. Molekulare Methoden erlauben zudem die genaue Unterscheidung von T. violaceum und T. rubrum.
https://ift.tt/2GwRSo0
The relationship between intracapsular fracture patterns and arthroscopic findings
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Ko Ito, Fumie Yamazaki, Kosuke Takahashi, Shinnosuke Nogami, Toshirou Kondoh, Alastair Goss
PurposeTo observe the superior joint compartment (SJC) using ultra-thin arthroscopy in intracapsular condylar fracture (ICF) of the temporomandibular joint (TMJ) and describe the changes: To evaluate the relations between the fracture pattern, arthroscopic findings, and clinical outcome.Patients and methodsTwenty patients with 27 ICF were the subject group. Thirteen patients had unilateral ICF, seven patients had bilateral ICF. The fracture patterns were classified into nine categories, and all the patients had arthroscopic examination of the traumatized joint at the time of definitive treatment. At 4 months after treatment of the injury, all the patients had a secondary arthroscopy of the ICF joint. In all the patients, the range of motion (ROM) was measured as interincisal distance (mm) at the first visit to 12 months after first treatment, and the data was statistically evaluated.ResultsThere was intra articular hyperemia, hyper-vascularity, and temporal bone damage, and four had disc perforations at the first examination. At second arthroscopy 4 months later, normal healing occurred in 11 joints all of which had minimally displaced fractures. Fifteen joints showed complete filling of the SJC, all of these had a displaced minor fragment from the fossa. Comparison on ROM of the effect of the presence or absence of SJC fibrosis showed significant differences from 1 to 12 months. The effect of early or delayed definitive treatment showed significant differences at 4 and 12 months.ConclusionThe intra-articular condition at 4 months post-ICF as demonstrated arthroscopically related to the minor fragment position. If the minor fragment is undisplaced it will heal back to a normal state; however, if the minor fragment is displaced from the fossa, then the SJC shows disc damage and fibrosis. This may potentially lead to fibrous ankylosis.
https://ift.tt/2GtoUFA
Medico-legal considerations involving iatrogenic lingual nerve damage
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Roberto Pippi, Andrea Spota, Marcello Santoro
The aim of this review is to improve risk management strategies through analysis of the anatomical, semeiotic and medico-legal aspects that characterize iatrogenic lingual nerve damage (LND) and its legal consequences in case of legal proceedings for a claim for compensation.In dental practice, LND can be caused by local or general anesthesia, or by mechanical, chemical, or thermal mechanisms. A certain post-operative identification of LND etiopathogenesis is often very challenging since it can be difficult to demonstrate at what time and which mechanism actually caused the damage. Clinical tests assessing lingual nerve sensory capabilities have a low sensitivity and moderate specificity, while instrumental tests have the advantage of not being affected by data interpretation subjectivity by both the operator and the patient. The quantification of permanent LND is not uniformly established and there are no specific standard worldwide indications. From a medico-legal point of view, LND is a complication that may or may not be caused by surgical error. The two different concepts of expectability and avoidability or preventability allow to discriminate between professional liability and fate and therefore to determine the surgeon's imputability in LND. Despite clinical competence and practice in performing the medical/surgical procedure, the clinician risks a lawsuit for negligence if he/she does not warn the patient about all relevant risks regardless of their frequency. Informed consent plays an essential role in minimizing litigation; the patient must be informed, taking into consideration both his/her level of culture and ability to understand, of diagnosis, prognosis, therapeutic perspectives and their consequences, in addition to all other viable alternative therapies and the risks of non-treatment as well.
https://ift.tt/2DWKeOo
News and Announcements
Source:Journal of Oral and Maxillofacial Surgery
https://ift.tt/2GvsmPR
The microsurgical approach in primary cleft rhinoplasty - an anthropometric analysis
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Frizzi Bschorer, Daniel Schneider, Gerhard Schön, Max Heiland, Reinhard Bschorer
PurposeOral and maxillofacial surgeons use a variety of approaches to repair the nasal deformity of cleft lip patients, differing in both technique and timing. The aim of this longitudinal study was to analyze a new surgical technique to treat the nose deformity of cleft patients at four to six weeks of life using a microscope.Methods27 newborn cleft patients were treated by means of a primary repair of the nasal deformity using a microscope at four to six weeks of life. The procedure includes a columellar incision, alar cartilage plication sutures according to Daniel's and transcolumellar sutures. All patients were photographed at specific time points up to one year after the surgery. Established angles and distances were analyzed and compared to normal values of age-matched children by Farkas.1ResultsAll parameters improved through surgery and showed stable values at follow-up assessments. Almost ideal values concerning symmetry, as indicated by columellar deviation and nostril comparison, were obtained. Measurements of nasal morphology were similar to established norm values.ConclusionWe recommend the early treatment of the cleft nasal deformity involving microscopic surgery as it showed stable and symmetrical results at least up to one year after surgery. Clinical observations up to adolescence suggest no growth disturbance or deterioration of nasal shape.
https://ift.tt/2DXEHr3
Selection of Submucosal Steroids to Minimize Postsurgical Pain
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Mark C. Kendall, Lucas J. Castro-Alves
https://ift.tt/2GymTYC
In reply
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Daniel Lim, Wei Cheong Ngeow
https://ift.tt/2I5DQ9Y
Antiphospholipid syndrome presenting as acute mesenteric venous thrombosis involving a variant inferior mesenteric vein and successful treatment with rivaroxaban
Acute mesenteric venous thrombosis (MVT) is the rarest cause of acute mesenteric ischaemia, so thrombosis of a variant inferior mesenteric vein (IMV) is especially uncommon in the setting of antiphospholipid syndrome (APS). Here, we present such a case of seronegative APS initially manifesting as an anomalous IMV thrombosis in a 76-year-old woman. Although guidelines support anticoagulation with vitamin K antagonists in these patients, we anticoagulated with rivaroxaban (a direct oral anticoagulant (DOAC)) due to patient preference, which resulted in complete clinical and endoscopic resolution. IMV thrombosis is a rare form of MVT, only two case reports describe successful anticoagulation with DOACs in the setting of MVT and none report APS as an underlying aetiology. Therefore, this case provides the opportunity to review the pathophysiology of MVT, APS and their medical management including current trends in anticoagulation.
https://ift.tt/2GbaPgK
Εγγραφή σε:
Αναρτήσεις (Atom)