Microanatomical Nerve Architecture of 6 Mammalian Species: Is Trans-Species Translational Anatomic Extrapolation Valid?

Background and Objectives Various animal models have historically been used to study iatrogenic nerve injury during performance of conduction nerve blocks. Our aims were to compare the microstructures of nerves in commonly used species to those of humans and to explore the validity of the extrapolating these findings to humans. Methods High-resolution, light-microscopic images were obtained from cross sections of sciatic nerves at their bifurcation from fresh rat, rabbit, pig, sheep, dog, and human cadavers. Various microanatomical characteristics were measured and compared between the species. P

https://ift.tt/2pSsIpB

Application of precision medicine to the treatment of anaphylaxis

Purpose of review Recognize the presentation of anaphylaxis for prompt management and treatment and to provide tools for the diagnosis of the underlying cause(s) and set up a long-term treatment to prevent recurrence of anaphylaxis. Recent findings The recent description of phenotypes provides new insight and understanding into the mechanisms and causes of anaphylaxis through a better understanding of endotypes and biomarkers for broad clinical use. Summary Anaphylaxis is the most severe hypersensitivity reaction and can lead to death. Epinephrine is the first-line treatment of anaphylaxis and it is life-saving. Patients with first-line therapy-induced anaphylaxis are candidates for desensitization to increase their quality of life and life expectancy. Desensitization is a breakthrough novel treatment for patients with anaphylaxis in need of first-line therapy, including chemotherapy, mAbs, aspirin and others. Ultrarush with venom immunotherapy should be considered in patients who present with life-threatening anaphylaxis after Hymenoptera sting with evidence of IgE-mediated mechanisms. Food desensitization is currently being expanded to provide increased safety to adults and children with food-induced anaphylaxis. Correspondence to Mariana Castells, MD, PhD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, The Building for Transformative Medicine, 5th floor, Room 5002N, 60 Fenwood Road, Boston, MA 02115, USA. Tel: +1 617 525 1265; fax: +1 617 525 1310; e-mail: mcastells@bwh.harvard.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2J6qegf

Avenues for research in food allergy prevention: unheeded ideas from the epidemiology

No abstract available

https://ift.tt/2pShPUN

How to diagnose food allergy

Purpose of review To assess the recent studies that focus on specific immunoglobulin E (sIgE) testing and basophil activation test (BAT) for diagnosing IgE-mediated food allergies. Recent findings The sIgE to allergen extract or component can predict reactivity to food. The cutoff value based on the positive predictive value (PPV) of sIgE can be considered whenever deciding whether oral food challenge (OFC) is required to diagnose hen's egg, cow's milk, wheat, peanut, and cashew nut allergy. However, PPV varies depending on the patients' background, OFC methodology, challenge foods, and assay methodology. Component-resolved diagnostics (CRD) has been used for food allergy diagnosis. Ovomucoid and omega-5 gliadin are good diagnostic markers for heated egg and wheat allergy. More recently, CRD of peanut, tree nuts, and seed have been investigated. Ara h 2 showed the best diagnostic accuracy for peanut allergy; other storage proteins, such as Jug r 1 for walnut, Ana o 3 for cashew nut, Ses i 1 for sesame, and Fag e 3 for buckwheat, are also better markers than allergen extracts. Some studies suggested that BAT has superior specificity than skin prick test and sIgE testing. Summary The sIgE testing and BAT can improve diagnostic accuracy. CRD provides additional information that can help determine whether OFCs should be performed to diagnose food allergy. Correspondence to Sakura Sato, MD, Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara, Kanagawa 252-0392, Japan. Tel: +81 42 742 8311; fax: +81 42 742 5314; e-mail: s-satou@sagamihara-hosp.gr.jp Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2J5vOz7

How to predict and improve prognosis of food allergy

Purpose of review The prevalence of food allergy is increasing. More children are being diagnosed with food allergies, and it is taking longer to outgrow them, among those who develop tolerance. The aim of this review is to draw the profile of the persistent food allergic, so that prevention strategies can be developed and active treatment set up. Recent findings Many determinants are involved in food allergy prognosis: ethnicity and sex, type of food, innate immune system, eliciting dose, sensitization status and other biomarkers determination, gut microbiome composition, and the presence of comorbidities. Once identified, a persistent food allergy could be conveyed to active treatments, such as oral immunotherapy or the use of biologics, always taking into account their experimental nature. Summary A better understanding of prognostic factors and phenotypes of food allergy is crucial in decision-making when it comes to food allergy prevention and management. A good classification of the allergic patient allows to determine the degree of exclusion diets and the timing of the reintroduction of avoided food when possible. In the cases of persistent and severe food allergy, many promising interventions are emerging which could improve prognosis and quality of care. Correspondence to Lamia Dahdah, MD, University Department of Pediatrics, Division of Allergy, Pediatric Hospital Bambino Gesù, Piazza di Sant'Onofrio 4, Rome 00100, Vatican City, Italy. Tel: +39 046 6859 4777; fax: +39 046 6859 2020; e-mail: lamiaantanios.dahdah@opbg.net Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2pShNMF

Phenotypes/endotypes-driven treatment in asthma

Purpose of review Target therapy is the necessary step towards personalized medicine. The definition of asthma phenotypes and underlying mechanisms (endotypes) represent a key point in the development of new asthma treatments. Big data analysis, biomarker research and the availability of monoclonal antibodies, targeting specific cytokines is leading to the rapid evolution of knowledge. In this review, we sought to outline many of the recent advances in the field. Recent findings Several attempts have been made to identify asthma phenotypes, sometimes with contrasting results. More success has been obtained concerning the pathogenetic mechanism of specific asthma patterns with the consequent identification of biomarkers and development of effective ad hoc treatment. Summary We are in the middle of an extraordinary revolution of our mode of thinking about and approaching asthma. All the effort in the identification of clusters of patients with different disease clinical patterns, prognosis and response to treatment is closely linked to the identification of endotypes (Th2-low and Th2-high). This approach has allowed the development of the specific treatments (anti IgE, Anti IL5 and IL5R) that are now available and is leading to new ones. Correspondence to Angelica Tiotiu, MD, PhD, Pulmonology Department, CHRU Nancy, EA 3450 DevAH – Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, University of Lorraine, 9 Avenue de la Forêt de Haye, F- 54505 – Vandoeuvre-les-Nancy, France. Tel: +33 3 83 15 43 72; fax: +33 3 83 15 35 41; e-mail: a.tiotiu@chru-nancy.fr Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2J6hyq2

How to prevent food allergy during infancy: what has changed since 2013?

Purpose of review The purpose of this review is to summarize recent studies and emerging consensus guidelines regarding food allergy prevention in infants of the past 5 years. Recent findings Prior to 2013, the general consensus regarding prevention of food allergy in infants was to recommend delayed introduction or complete avoidance of commonly allergenic foods, such as milk, egg and peanut. However, in the past 5 years, several landmark studies have been conducted, particularly with peanut. The results of these studies have led to a paradigm shift from recommending delayed introduction to early introduction and frequent feeding of highly allergenic foods such as peanut, with hopes of achieving primary and secondary prevention of food allergy in infants. Summary Recent clinical trials have demonstrated that early introduction and frequent feeding, rather than delayed introduction or complete avoidance, of commonly allergenic foods plays a critical role in preventing food allergy in infants. More studies are required to risk-stratify infants by personal and family atopic history to tailor guidelines for groups with inherently different risks. The universal acceptance of the guidelines and their application outcome are still to be determined. Correspondence to Amal Assa'ad, MD, Professor of Pediatrics, Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Mail Location 2000, Cincinnati, OH 45229, USA. Tel: +1 513 636 6771; fax: +1 513 636 5835; e-mail: amal.assaad@cchmc.org Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2pShGRf

Current opinion in allergy and clinical immunology: a change in leadership

No abstract available

https://ift.tt/2J6WKi8

Effect of Epley, Semont Maneuvers and Brandt–Daroff Exercise on Quality of Life in Patients with Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo (PSCBPPV)

Abstract

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause in patients with vertigo (Pereira et al. in Braz J Otorhinolaryngol (Impr) 76(6):704–708, 2010; Dix and Hallpike in Ann Otol Rhinol Laryngol 6:987–1016, 1952). Posterior Semicircular Canal BPPV (PSCBPPV) has more incidence and prevalence then Lateral, and Anterior Semicircular Canal BPPV (Alghwiri et al. in Arch Phys Med Rehabil 93:1822–1831, 2012). Quality of life (QoL) is significantly impaired by vertigo (Sargent et al. in Otol Neurotol 22:205–209, 2001; World Health Organization in International classification of functioning, disability and health, World Health Organization, Geneva, 2001). To study the effect and compare Epley, Semont maneuvers and Brandt–Daroff Exercise on QoL in patients with PSCBPPV. 90 individuals with unilateral PSCBPPV were selected based on positive Dix–Hallpike test. 3 groups Epley, Semont, and Brandt–Daroff were formed and 30 individuals were selected in each group randomly. Dix–Hallpike test and Vestibular Activities and Participation (VAP) Scale based on International Classification of Functioning were administered before and after Epley, Semont maneuvers, and Brandt–Daroff Exercise to fulfill the aim. VAP Scale results revealed significant difference between pre and post treatment score in all 3 groups, suggestive of positive effect on QoL in patients with PSCBPPV. Improvements in VAP Score between 3 groups were compared and significant difference was observed. Dix–Hallpike test results revealed that 90, 73.33, and 50% patients improved in Epely, Semont, and Brandt–Daroff group respectively. Epely maneuver found to be the best choice and then Semont and Brandt–Daroff should be least preferred in treatment of patients with PSCBPPV.

https://ift.tt/2GCZ41Y

Treatment of Radiation and Cisplatin Induced Toxicities With Tempol

Conditions:   Mucositis;   Nephrotoxicity;   Ototoxicity
Interventions:   Drug: Tempol;   Drug: Placebo Solution
Sponsors:   Matrix Biomed, Inc.;   University of Maryland
Not yet recruiting

https://ift.tt/2E58XA8

Postoperative aRCH With Cisplatin Versus aRCH With Cisplatin and Pembrolizumab in Locally Advanced Head and Neck Squamous Cell Carcinoma

Condition:   HNSCC
Interventions:   Drug: Pembrolizumab 25 MG/1 ML Intravenous Solution [KEYTRUDA];   Other: adjuvant radiochemotherapy
Sponsor:   University of Leipzig
Not yet recruiting

https://ift.tt/2GVMpVn

Proton Beam Therapy in the Treatment of Esophageal Cancer

Conditions:   Esophagus Cancer;   Esophageal Cancer;   Cancer of the Esophagus
Interventions:   Radiation: Proton beam therapy;   Other: Patient-Reported Outcome Measures
Sponsor:   Washington University School of Medicine
Not yet recruiting

https://ift.tt/2uw4YNH

Evaluation of an Oral Care Programme for Head and Neck Cancer Patients

Condition:   Head and Neck Cancer
Intervention:   Procedure: Oral care programme
Sponsors:   Göteborg University;   Ryhov County Hospital;   FUTURUM, Academy of Health and Science;   Swedish Cancer Foundation
Recruiting

https://ift.tt/2GXCO0D

The Inclined Position in Case of Respiratory Discomfort in the One Year Less Infant : Study on the Profits and the Risks in the Home

Conditions:   Obstruction, Airway;   Sudden; Death, Infant
Intervention:   Other: Questionnaires
Sponsor:   Hospices Civils de Lyon
Not yet recruiting

https://ift.tt/2E3IToV

Effect of Epley, Semont Maneuvers and Brandt–Daroff Exercise on Quality of Life in Patients with Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo (PSCBPPV)

Abstract

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause in patients with vertigo (Pereira et al. in Braz J Otorhinolaryngol (Impr) 76(6):704–708, 2010; Dix and Hallpike in Ann Otol Rhinol Laryngol 6:987–1016, 1952). Posterior Semicircular Canal BPPV (PSCBPPV) has more incidence and prevalence then Lateral, and Anterior Semicircular Canal BPPV (Alghwiri et al. in Arch Phys Med Rehabil 93:1822–1831, 2012). Quality of life (QoL) is significantly impaired by vertigo (Sargent et al. in Otol Neurotol 22:205–209, 2001; World Health Organization in International classification of functioning, disability and health, World Health Organization, Geneva, 2001). To study the effect and compare Epley, Semont maneuvers and Brandt–Daroff Exercise on QoL in patients with PSCBPPV. 90 individuals with unilateral PSCBPPV were selected based on positive Dix–Hallpike test. 3 groups Epley, Semont, and Brandt–Daroff were formed and 30 individuals were selected in each group randomly. Dix–Hallpike test and Vestibular Activities and Participation (VAP) Scale based on International Classification of Functioning were administered before and after Epley, Semont maneuvers, and Brandt–Daroff Exercise to fulfill the aim. VAP Scale results revealed significant difference between pre and post treatment score in all 3 groups, suggestive of positive effect on QoL in patients with PSCBPPV. Improvements in VAP Score between 3 groups were compared and significant difference was observed. Dix–Hallpike test results revealed that 90, 73.33, and 50% patients improved in Epely, Semont, and Brandt–Daroff group respectively. Epely maneuver found to be the best choice and then Semont and Brandt–Daroff should be least preferred in treatment of patients with PSCBPPV.

https://ift.tt/2GCZ41Y

Patients with unilateral squamous cell carcinoma of the tongue and ipsilateral lymph node metastasis do not profit from bilateral neck dissection

Abstract

Objectives

The purpose of this study was to evaluate the necessity of elective bilateral neck dissection for treating strict unilateral squamous cell carcinoma (SCC) of the tongue.

Methods

A cohort of 169 patients with unilateral non-midline crossing SCCs of the tongue treated by local resection and neck dissection was investigated. Study endpoints were nodal relapse and overall survival. The mean follow-up was 7.4 years.

Results

A total of 146 (88.1%) patients were treated by neck dissection. Lymph node metastases were diagnosed in 50 (34.2%) patients. Only two (1.1%) had contralateral lymph node metastases. Risk factors for developing a primary lymph node metastasis were size of tumor (T2/T3, p = 0.03; OR = 2.2), lymphangiosis (p = 0.003; OR = 4.7), and higher-grade differentiation (p = 0.051; OR = 2.43). Metachronous lymph node metastases were detected in 23 (13.6%) patients (19 ipsilateral, one contralateral and three bilateral). The main risk factor for developing a metachronous lymph node metastasis was the presence of a primary lymph node metastasis (p = 0.004; HR = 4.65). Patients with initial neck dissection came up with lower 5-year recurrence rates (13.6%) compared to patients without neck dissection (27.3%; p = 0.014). Bilateral neck dissection showed no advantage regarding nodal relapse free and overall survival (p = 0.606) compared to unilateral neck dissection irrespective of initial N or T stage.

Conclusion

Patients with unilateral SCC of the tongue benefit from an ipsilateral neck dissection regarding nodal relapse. The value of elective bilateral neck dissection as standard treatment seems questionable even if positive lymph nodes were diagnosed ipsilateral at primary therapy.

https://ift.tt/2GUlgCo

Patients with unilateral squamous cell carcinoma of the tongue and ipsilateral lymph node metastasis do not profit from bilateral neck dissection

Abstract

Objectives

The purpose of this study was to evaluate the necessity of elective bilateral neck dissection for treating strict unilateral squamous cell carcinoma (SCC) of the tongue.

Methods

A cohort of 169 patients with unilateral non-midline crossing SCCs of the tongue treated by local resection and neck dissection was investigated. Study endpoints were nodal relapse and overall survival. The mean follow-up was 7.4 years.

Results

A total of 146 (88.1%) patients were treated by neck dissection. Lymph node metastases were diagnosed in 50 (34.2%) patients. Only two (1.1%) had contralateral lymph node metastases. Risk factors for developing a primary lymph node metastasis were size of tumor (T2/T3, p = 0.03; OR = 2.2), lymphangiosis (p = 0.003; OR = 4.7), and higher-grade differentiation (p = 0.051; OR = 2.43). Metachronous lymph node metastases were detected in 23 (13.6%) patients (19 ipsilateral, one contralateral and three bilateral). The main risk factor for developing a metachronous lymph node metastasis was the presence of a primary lymph node metastasis (p = 0.004; HR = 4.65). Patients with initial neck dissection came up with lower 5-year recurrence rates (13.6%) compared to patients without neck dissection (27.3%; p = 0.014). Bilateral neck dissection showed no advantage regarding nodal relapse free and overall survival (p = 0.606) compared to unilateral neck dissection irrespective of initial N or T stage.

Conclusion

Patients with unilateral SCC of the tongue benefit from an ipsilateral neck dissection regarding nodal relapse. The value of elective bilateral neck dissection as standard treatment seems questionable even if positive lymph nodes were diagnosed ipsilateral at primary therapy.

https://ift.tt/2GUlgCo

Toward universal influenza virus vaccines: from natural infection to vaccination strategy

Chen Zhao | Jianqing Xu

https://ift.tt/2GXlXLp

Evaluation of postoperative changes in vascularized iliac bone grafts used for mandibular reconstruction

Vascularized iliac bone grafts are used for mandibular reconstruction, but the factors affecting graft maintenance are unknown. This study explored the postsurgical changes in vascularized iliac bone grafts in patients who had undergone mandibular reconstruction after segmental resection. The study involved 24 patients (16 men and eight women) with oral tumours or osteoradionecrosis. Thirteen patients required bare bone grafting (BBG) and 11 patients required reconstruction with soft tissue coverage (six with a skin paddle and five with direct closure).

https://ift.tt/2pMgaRu

Prognostic value of lymph node count from selective neck dissection in oral squamous cell carcinoma

Unlike the levels of anatomical exploration, there is no consensus on the extent of lymph node dissection, or lymph node count (LNC), during selective neck dissection (SND). The aim of this study was to validate the prognostic impact of LNC on survival and to determine an optimal LNC cut-off value for SND. A retrospective investigation identified 78 patients with a diagnosis of oral squamous cell carcinoma (OSCC) who underwent SND (levels I–III or levels I–IV). LNC and clinicopathological variables were analyzed for any association with survival in Cox proportional hazards models.

https://ift.tt/2Go653l

Does two-dimensional vs. three-dimensional surgical simulation produce better surgical outcomes among patients with class III facial asymmetry?

The aim of this study was to compare the outcomes of traditional two-dimensional planning (2DP) and three-dimensional surgical simulation (3DS) in the surgical correction of skeletal class III with facial asymmetry. This retrospective cohort study included 37 consecutive adult Taiwanese patients. Preoperative and postoperative three-dimensional cephalometric measurements were obtained from cone beam computed tomography scans. The outcome variables were the differences in preoperative and postoperative linear and angular measurements and the differences between the two groups after surgery.

https://ift.tt/2pPtvbs

Butterfly cartilage tympanoplasty outcomes: A single-institution experience and literature review

In 1998, Dr. Eavey described the trans-canal inlay butterfly cartilage tympanoplasty technique, also known as cartilage button tympanoplasty. Many retrospective studies have since demonstrated its efficacy and decreased operative time when compared to underlay and overlay tympanoplasty techniques. The butterfly cartilage tympanoplasty approach uses only a cartilage graft to repair tympanic membrane perforations. The aim of this study was to review the literature for studies that examined butterfly cartilage tympanoplasty success rates and outcomes and compare them to outcomes from our cohort.

https://ift.tt/2GmYL81

Tube patency: Is there a difference following otic drop administration?

Many surgeons instill peri-operative otic drops to maintain tube patency. A post-hoc analysis of three randomized, controlled studies involving a one-time administration of ciprofloxacin (OTO-201) given instead of otic drops perioperatively was conducted to evaluate tube patency in patients who did and did not receive otic drops as defined within the study protocol.

https://ift.tt/2GEXrRb

Surgical indication of Furlow palatoplasty to treat submucous cleft palate

Publication date: Available online 29 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Joon Hyun Kwon, Jeong Woo Lee, Jung Dug Yang, Ho Yun Chung, Byung Chae Cho, Kang Young Choi
This study investigated the effects of Furlow palatoplasty on children with submucous cleft palate (SMCP) and identified surgical indications by comparing SMCP and control patients. Twenty-three SMCP children (average age 28.9 months) who were nonsyndromic and underwent surgery between April 2010 and December 2016 were included. Facial computed tomography (CT) was performed preoperatively and at least 1 year postoperatively after a language test. Facial CT measurements were taken for 140 children aged 0–6 years without deformities (control group). Later surgery was associated with more severe nasality. In the coronal view, the difference in the maxillary tuberosity before and after surgery was 3.8 mm (p < 0.05). The height and width of the palatal arch (HNP and WNP) were well maintained (p > 0.05), whereas the angle of the levator veli palatini muscle (ALM) increased (p < 0.05). The nasopharynx was close to normal postoperatively. The distance between the medial pterygoid plates, the HNP, and the WNP were larger in SMCP patients preoperatively (p < 0.05), but these differences disappeared after surgery (p > 0.05). The ALM in SMCP patients was narrower preoperatively, but became flatter postoperatively (p < 0.05), indicating the repositioning of the levator muscle, with improvement of the velopharyngeal function. Furlow palatoplasty is indicated if the HNP and WNP values are larger, and the ALM value is less, in patients with SMCP than in those without.



http://bit.ly/2E38cYd

Effect of head orthoses on skull deformities in positional plagiocephaly: Evaluation of a 3-dimensional approach

Publication date: Available online 29 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Klaus W.W. Dörhage, Jörg Wiltfang, Vera von Grabe, Annalena Sonntag, Stephan T. Becker, Benedicta E. Beck-Broichsitter
PurposeThe positional non-synostotic plagiocephaly represents a cranial asymmetry affecting all 3 dimensions. The aim of this study was to evaluate volumetric indices to assess the efficiancy in improving non-synostotic cranial asymmetries in treatment with head orthoses.Material and MethodsA total of 96 infants were included in this observational retrospective study. The cohort was further divided into subgroups according to age of helmet supply (younger/older than 7.5 months) and duration of therapy (less/more than 150 days). With 3-dimensional photogrammetry data sets, the skull volume was separated into quadrants and set in relation to each other to create an Anterior Cranial Asymmetry Index (ACAI) and a Posterior Cranial Asymmetry Index (PCAI) as 3-dimensional parameters.ResultsTreatment with head orthoses led to a significant reduction of ACAI (p<0.0001) and PCAI (p=0.001). Cranial asymmetry was more severe in the occipital region and significantly improved mainly during the first 75 days with a 40.08% decrease of PCAI value in the short-term therapy in the younger treatment subgroup (p=0.003).ConclusionsThe introduced parameters sufficiently reproduce the improvement of asymmetry during helmet therapy, following the trend of already established parameters. Asymmetry was significantly improved in the occiput region, and helmet therapy was highly effective in younger infants and in the early treatment period.



http://bit.ly/2GUPzc4

Evaluation of bone resection margins of segmental mandibulectomy for oral squamous cell carcinoma

Publication date: Available online 28 March 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): R.W.H. Smits, Ivo ten Hove, E.A.C. Dronkers, T.C. Bakker Schut, H. Mast, R.J. Baatenburg de Jong, E.B. Wolvius, G.J. Puppels, S. Koljenović
Resection margins are frequently studied in patients with oral squamous cell carcinoma and are accepted as a constant prognostic factor. While most evidence is based on soft tissue margins, reported data for bone resection margins are scarce. The aim of this retrospective study was to evaluate and determine the utility of surgical margins in bone resections for oral cavity squamous cell carcinoma (OCSCC). The status of bone resection margins and their impact on survival was investigated in patients who had undergone segmental mandibulectomy for OCSCC. Medical records were retrieved for the years 2000–2012; 127 patients were identified and included in the study. Tumour-positive bone resection margins were found in 21% of the patients. The 5-year overall survival was significantly lower in this group (P<0.005). Therefore, there is a need for intraoperative feedback on the status of bone resection margins to enable immediate additional resection where necessary. Although the lack of intraoperative methods for the evaluation of bone tissue has been addressed by many authors, there is still no reliable method for widespread use. Future research should focus on an objective, accurate, and rapid method of intraoperative assessment for the entire bone resection margin to optimize patient outcomes.



http://bit.ly/2GmSBEV

Pre-diagnostic dynamic HPV16 IgG seropositivity and risk of oropharyngeal cancer: Methodologic issues

We thank Erfan Ayubi and Saeid Safiri for their comments on our manuscript, Pre-diagnostic dynamic HPV16 IgG seropositivity and risk of oropharyngeal cancer, published in Oral Oncology in October 2017. In particular, we appreciate their identification of a transcription error in the upper bound of the confidence interval for the adjusted odds ratio of seropositivity with years prior to diagnosis in the 0–2 years category. The reported result of OR = 85.2, CI = 13.7–68.5 should have been OR = 85.2, CI = 13.7–684.6.

http://bit.ly/2GjnWZ5

Differential diagnoses of diaper dermatitis

Pediatric Dermatology, Volume 35, Issue S1, Page s10-s18, March/April 2018.


http://bit.ly/2GW2avw

Introduction: Hot topics in neonatal skin care from the 13th World Congress of Pediatric Dermatology (Chicago, IL – July 6‐9, 2017)

Pediatric Dermatology, Volume 35, Issue S1, Page s3-s4, March/April 2018.


http://bit.ly/2E61Pn0

Issue Information ‐ Table of Contents

Pediatric Dermatology, Volume 35, Issue S1, Page s2-s2, March/April 2018.


http://bit.ly/2GW28Uq

Prevention and treatment of diaper dermatitis

Pediatric Dermatology, Volume 35, Issue S1, Page s19-s23, March/April 2018.


http://bit.ly/2E5eAy4

Issue Information ‐ Editorial Board

Pediatric Dermatology, Volume 35, Issue S1, Page s1-s1, March/April 2018.


http://bit.ly/2GUMKrE

Skin barrier in the neonate

Pediatric Dermatology, Volume 35, Issue S1, Page s5-s9, March/April 2018.


http://bit.ly/2uBoeJk

Subclassification of Bethesda Atypical and Follicular Neoplasm Categories According to Nuclear and Architectural Atypia Improves Discrimination of Thyroid Malignancy Risk

Thyroid, Ahead of Print.


http://bit.ly/2GZQGaJ

Butterfly cartilage tympanoplasty outcomes: A single-institution experience and literature review

Publication date: Available online 29 March 2018
Source:American Journal of Otolaryngology
Author(s): Mejd Jumaily, Joel Franco, Jim Gallogly, Joshua L. Hentzelman, Dary J. Costa, Alan P.K. Wild, Anthony A. Mikulec
PurposeIn 1998, Dr. Eavey described the trans-canal inlay butterfly cartilage tympanoplasty technique, also known as cartilage button tympanoplasty. Many retrospective studies have since demonstrated its efficacy and decreased operative time when compared to underlay and overlay tympanoplasty techniques. The butterfly cartilage tympanoplasty approach uses only a cartilage graft to repair tympanic membrane perforations. The aim of this study was to review the literature for studies that examined butterfly cartilage tympanoplasty success rates and outcomes and compare them to outcomes from our cohort.Materials and methodsButterfly cartilage tympanoplasties were performed in 23 pediatric patients and 7 adult patients. We evaluated the tympanic membrane perforation closure rate and hearing results measured by closure of the air-bone gap.ResultsThe reviewed studies evaluating butterfly cartilage tympanoplasties demonstrated perforation closure rates between 71%–100%. The hearing outcomes in the reviewed literature varied, although the majority reported improved hearing. In our cohort, 21 of the 32 repaired tympanic membrane perforations demonstrated complete perforation closure. The mean follow-up length was 13.4 months. The mean air-bone gap decreased from 13.4 dB to 6.9 dB.ConclusionsThe butterfly cartilage/cartilage button technique is effective in closing tympanic membrane perforations and decreasing the air-bone gap in both adults and children.



https://ift.tt/2GyTnlN

Tube patency: Is there a difference following otic drop administration?

Publication date: Available online 29 March 2018
Source:American Journal of Otolaryngology
Author(s): Joseph E. Dohar, Chung H. Lu
PurposeMany surgeons instill peri-operative otic drops to maintain tube patency. A post-hoc analysis of three randomized, controlled studies involving a one-time administration of ciprofloxacin (OTO-201) given instead of otic drops perioperatively was conducted to evaluate tube patency in patients who did and did not receive otic drops as defined within the study protocol.Materials and methodsPost-hoc, retrospective analysis from three prospective, randomized, double-blind trials, (Phase 1b study [n = 83] and two Phase 3 studies [n = 532]) which enrolled children with confirmed middle ear effusion on the day of tympanostomy tube surgery and then randomized to placebo/sham (tubes alone) or OTO-201 and studied over a 28-day observation period. Patients with observed otorrhea post-tube were provided otic drops in the studies. An analysis was performed on the combined studies to evaluate tube patency, determined by pneumatic otoscopy and tympanometry, at four defined study visits over 28 days after the initial tube placement.ResultsThe analysis included 591 total patients with similar baseline demographics across groups. Tube patency ranged from 87 to 95% for patients who received otic drops, and from 96 to 99% for patients who did not receive otic drops.ConclusionBased on a retrospective post-hoc analysis from three randomized controlled trials in nearly 600 patients, tympanostomy tube occlusion rates was not increased in patients who did not receive otic drops. From this analysis, occlusion is likely caused primarily by peri-operative otorrhea since patency rates approached 99% in the absence of this complication.



https://ift.tt/2pQJRjd

Editorial Board

Publication date: April 2018
Source:Autoimmunity Reviews, Volume 17, Issue 4





https://ift.tt/2If8X3b

The Impact of Postreperfusion Syndrome on Acute Kidney Injury in Living Donor Liver Transplantation: A Propensity Score Analysis

BACKGROUND: Postreperfusion syndrome (PRS) has been shown to be related to postoperative morbidity and graft failure in orthotopic liver transplantation. To date, little is known about the impact of PRS on the prevalence of postoperative acute kidney injury (AKI) and the postoperative outcomes after living donor liver transplantation (LDLT). The purpose of our study was to determine the impact of PRS on AKI and postoperative outcomes after LDLT surgery. METHODS: Between January 2008 and October 2015, we retrospectively collected and evaluated the records of 1865 patients who underwent LDLT surgery. We divided the patients into 2 groups according to the development of PRS: PRS group (n = 715) versus no PRS group (n = 1150). Risk factors for AKI and mortality were investigated by multivariable logistic and Cox proportional hazards regression model analysis. Propensity score (PS) analysis (PS matching and inverse probability of treatment weighting analysis) was designed to compare the outcomes between the 2 groups. RESULTS: The prevalence of PRS and the mortality rate were 38% and 7%, respectively. In unadjusted analyses, the PRS group showed more frequent development of AKI (P

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Anesthetics Influence Mortality in a Drosophila Model of Blunt Trauma With Traumatic Brain Injury

Background: Exposure to anesthetics is common in the majority of early survivors of life-threatening injuries. Whether and to what degree general anesthetics influence outcomes from major trauma is unknown. Potential confounding effects of general anesthetics on outcome measures are usually disregarded. We hypothesized that exposure to isoflurane or sevoflurane modulates the outcome from blunt trauma with traumatic brain injury (bTBI). Methods: We tested the hypothesis in a novel model of bTBI implemented in Drosophila melanogaster. Fruit flies of the standard laboratory strain w1118 were cultured under standard conditions. We titrated the severity of bTBI to a mortality index at 24 hours (MI24) of approximately 20% under control conditions. We administered standard doses of isoflurane and sevoflurane before, before and during, or after bTBI and measured the resulting MI24. We report the MI24 as mean ± standard deviation. Results: Isoflurane or sevoflurane administered for 2 hours before bTBI reduced the MI24 from 22.3 ± 2.6 to 10.4 ± 1.8 (P

https://ift.tt/2GET7S8

Database Quality and Access Issues Relevant to Research Using Anesthesia Information Management System Data

For this special article, we reviewed the computer code, used to extract the data, and the text of all 47 studies published between January 2006 and August 2017 using anesthesia information management system (AIMS) data from Thomas Jefferson University Hospital (TJUH). Data from this institution were used in the largest number (P = .0007) of papers describing the use of AIMS published in this time frame. The AIMS was replaced in April 2017, making this finite sample finite. The objective of the current article was to identify factors that made TJUH successful in publishing anesthesia informatics studies. We examined the structured query language used for each study to examine the extent to which databases outside of the AIMS were used. We examined data quality from the perspectives of completeness, correctness, concordance, plausibility, and currency. Our results were that most could not have been completed without external database sources (36/47, 76.6%; P = .0003 compared with 50%). The operating room management system was linked to the AIMS and was used significantly more frequently (26/36, 72%) than other external sources. Access to these external data sources was provided, allowing exploration of data quality. The TJUH AIMS used high-resolution timestamps (to the nearest 3 milliseconds) and created audit tables to track changes to clinical documentation. Automatic data were recorded at 1-minute intervals and were not editable; data cleaning occurred during analysis. Few paired events with an expected order were out of sequence. Although most data elements were of high quality, there were notable exceptions, such as frequent missing values for estimated blood loss, height, and weight. Some values were duplicated with different units, and others were stored in varying locations. Our conclusions are that linking the TJUH AIMS to the operating room management system was a critical step in enabling publication of multiple studies using AIMS data. Access to this and other external databases by analysts with a high degree of anesthesia domain knowledge was necessary to be able to assess the quality of the AIMS data and ensure that the data pulled for studies were appropriate. For anesthesia departments seeking to increase their academic productivity using their AIMS as a data source, our experiences may provide helpful guidance. Accepted for publication January 29, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Data from this study were presented, in part, at the 2017 Annual Meeting of the American Society of Anesthesiologists, October 21–25, 2017, Boston, MA. Reprints will not be available from the authors. Address correspondence to Richard H. Epstein, MD, Department of Anesthesiology, Perioperative Medicine & Pain Management, University of Miami, Miller School of Medicine, 1400 NW 12th Ave, Suite 3075, Miami, FL 33136. Address e-mail to repstein@med.miami.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2E5a42I

Dexamethasone as an Adjuvant for Caudal Blockade in Pediatric Surgical Patients: A Systematic Review and Meta-analysis

BACKGROUND: Caudal block is commonly used to provide postoperative analgesia after pediatric surgery in the lower abdomen. Typically administered as a single-shot technique, 1 limitation of this block is the short duration of analgesia. To overcome this, dexamethasone has been used as an adjuvant to prolong block duration. However, there are concerns about steroid-related morbidity and the optimal route of dexamethasone administration (eg, caudal or intravenous) is unknown. METHODS: We conducted a systematic review and random-effects meta-analysis of randomized controlled trials recruiting pediatric surgical patients receiving a caudal block for surgical anesthesia or postoperative analgesia. Included studies compared dexamethasone (caudal, intravenous, or both) to control. Duration of analgesia was the primary outcome. Database sources were Medline, Embase, the Cochrane Library, and Google Scholar searched up to August 18, 2017, without language restriction. Screening of studies, data extraction, and risk of bias assessment were performed independently and in duplicate by 2 authors. Risk of bias was assessed using Cochrane methodology and the strength of evidence was scored using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. RESULTS: The initial search retrieved 93 articles. Fourteen randomized controlled trials that comprised 1315 pediatric patients met the inclusion criteria. All but 1 study involved lower abdominal operations (orchidopexy, inguinal hernia repair, and hypospadias repair). The caudal and intravenous dose of dexamethasone ranged from 0.1 to 0.2 mg/kg and 0.5 to 1.5 mg/kg, respectively, and all studies were pooled in the main analysis. Dexamethasone prolonged the duration of analgesia by both the caudal route (5.43 hours, 95% confidence interval [CI], 3.52–7.35; P

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Time for a Fresh Approach to Examining Factors Associated With Red Blood Cell Transfusion Outcome

No abstract available

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Repeated Morphine Prolongs Postoperative Pain in Male Rats

BACKGROUND: Opioids are effective postoperative analgesics. Disturbingly, we have previously reported that opioids such as morphine can worsen inflammatory pain and peripheral and central neuropathic pain. These deleterious effects are mediated by immune mediators that promote neuronal hyperexcitability in the spinal dorsal horn. Herein, we tested whether perioperative morphine could similarly prolong postoperative pain in male rats. METHODS: Rats were treated with morphine for 7 days, beginning immediately after laparotomy, while the morphine was tapered in a second group. Expression of genes for inflammatory mediators was quantified in the spinal dorsal horn. In the final experiment, morphine was administered before laparotomy for 7 days. RESULTS: We found that morphine treatment after laparotomy extended postoperative pain by more than 3 weeks (time × treatment: P

https://ift.tt/2GDo9tD

A Dedicated Acute Pain Service Is Associated With Reduced Postoperative Opioid Requirements in Patients Undergoing Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy

BACKGROUND: The Acute Pain Service (APS) was initially introduced to optimize multimodal postoperative pain control. The aim of this study was to evaluate the association between the implementation of an APS and postoperative pain management and outcomes for patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). METHODS: In this propensity-matched retrospective cohort study, we performed a before-after study without a concurrent control group. Outcomes were compared among patients undergoing CRS-HIPEC when APS was implemented versus historical controls (non-APS). The primary objective was to determine if there was a decrease in median total opioid consumption during postoperative days 0–3 among patients managed by the APS. Secondary outcomes included opioid consumption on each postoperative day (0–6), time to ambulation, time to solid intake, and hospital length of stay. RESULTS: After exclusion, there were a total of 122 patients, of which 51 and 71 were in the APS and non-APS cohort, respectively. Between propensity-matched groups, the median (quartiles) total opioid consumption during postoperative days 0–3 was 27.5 mg intravenous morphine equivalents (MEQs) (7.6–106.3 mg MEQs) versus 144.0 mg MEQs (68.9–238.3 mg MEQs), respectively. The median difference was 80.8 mg MEQs (95% confidence interval, 46.1– 124.0; P 50%, as well as shorter time to ambulation and time to solid intake. Implementation of an APS may improve outcomes in CRS-HIPEC patients. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Accepted for publication February 2, 2018. E. T. Said and J. F. Sztain contributed equally to this manuscript. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. This work has been presented, in part, as an oral presentation at the Enhanced Recovery After Surgery US Conference, November 10, 2017, Dallas, TX. Reprints will not be available from the authors. Address correspondence to Engy T. Said, MD, Department of Anesthesiology, University of California, 200 W Arbor Dr, MC 8770, San Diego, CA 92103. Address e-mail to esaid@ucsd.edu. © 2018 International Anesthesia Research Society

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Evidence Basis for Regional Anesthesia in Ambulatory Anterior Cruciate Ligament Reconstruction: Part I—Femoral Nerve Block

The optimal management of pain after ambulatory anterior cruciate ligament reconstruction (ACLR) is unclear. Femoral nerve block (FNB) is purported to enhance postoperative analgesia, but its effectiveness in the setting of modern multimodal analgesia is unclear. This systematic review examines the effect of adding FNB to multimodal analgesia on analgesic outcomes after ACLR, whether or not the analgesic regimen used included local instillation analgesia (LIA). We retrieved randomized controlled trials evaluating the effects of adding FNB to multimodal analgesia on analgesic outcomes after ACLR, compared to multimodal analgesia alone (control). We designated postoperative opioid consumption at 24 hours as our primary outcome. Secondary outcomes included postoperative opioid consumption at 24–48 hours, rest, and dynamic pain severity between 0 and 48 hours, time to analgesic request, postanesthesia care unit and hospital stay durations, patient satisfaction, postoperative nausea and vomiting, functional outcomes, and long-term (>1 month) quadriceps strength. Eight randomized controlled trials (716 patients) were identified. Five trials compared FNB administration to control, and another 3 compared the combination of FNB and LIA to LIA alone. Compared to control, adding FNB resulted in modest reductions in 24-hour opioid consumption in 2 of 3 trials, and improvements in rest pain at 1 hour in 1 trial and up to 24 hours in another. In contrast, the combination of FNB and LIA, compared to LIA alone, did not reduce opioid consumption in any of the trials, but it did improve pain scores at 20 minutes only in 1 trial. The effect of FNB on long-term quadriceps strength or function after ACLR was not evaluated in the reviewed trials. Contemporary evidence suggests that the benefits of adding FNB to multimodal analgesia for ACLR are modest and conflicting, but there is no incremental analgesic benefit if the multimodal analgesic regimen included LIA. Our findings do not support the routine use of FNB for analgesia in patients having ACLR. Accepted for publication January 10, 2018. Funding: Departmental. Both F. W. Abdallah and R. Brull are supported by the Merit Award Program, Department of Anesthesia, University of Toronto. R. Brull receives research support from the Evelyn Bateman Cara Operations Endowed Chair in Ambulatory Anesthesia and Women's Health, Women's College Hospital, Toronto. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Faraj W. Abdallah, MD, Department of Anesthesia, St Michael's Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada. Address e-mail to abdallahf@smh.ca. © 2018 International Anesthesia Research Society

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Determination of Geolocations for Anesthesia Specialty Coverage and Standby Call Allowing Return to the Hospital Within a Specified Amount of Time

BACKGROUND: For emergent procedures, in-house teams are required for immediate patient care. However, for many procedures, there is time to bring in a call team from home without increasing patient morbidity. Anesthesia providers taking subspecialty or backup call from home are required to return to the hospital within a designated number of minutes. Driving times to the hospital during the hours of call need to be considered when deciding where to live or to visit during such calls. Distance alone is an insufficient criterion because of variable traffic congestion and differences in highway access. We desired to develop a simple, inexpensive method to determine postal codes surrounding hospitals allowing a timely return during the hours of standby call. METHODS: Pessimistic travel times and driving distances were calculated using the Google distance matrix application programming interface for all N= 136 postal codes within 60 great circle ("straight line") miles of the University of Miami Hospital (Miami, FL) during all 108 weekly standby call hours. A postal code was acceptable if the estimated longest driving time to return to the hospital was ≤60 minutes (the anesthesia department's service commitment to start an urgent case during standby call). Linear regression (with intercept = 0) minimizing the mean absolute percentage difference between the distances (great circle and driving) and the pessimistic driving times to return to the hospital was performed among all 136 postal codes. Implementation software written in Python is provided. RESULTS: Postal codes allowing return to the studied hospital within the specified interval were identified. The linear regression showed that driving distances correlated poorly with the longest driving time to return to the hospital among the 108 weekly call hours (mean absolute percentage error = 25.1% ± 1.7% standard error [SE]; N = 136 postal codes). Great circle distances also correlated poorly (mean absolute percentage error = 28.3% ± 1.9% SE; N = 136). Generalizability of the method was determined by successful application to a different hospital in a rural state (University of Iowa Hospital). CONCLUSIONS: The described method allows identification of postal codes surrounding a hospital in which personnel taking standby call could be located and be able to return to the hospital during call hours on every day of the week within any specified amount of time. For areas at the perimeter of the acceptability, online distance mapping applications can be used to check driving times during the hours of standby call. Accepted for publication January 9, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Richard H. Epstein, MD, Department of Anesthesiology, Perioperative Medicine & Pain Management, University of Miami, Miller School of Medicine, 1400 NW 12th Ave, Suite 3075, Miami, FL 33136. Address e-mail to repstein@med.miami.edu. © 2018 International Anesthesia Research Society

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Intravenous Acetaminophen Does Not Reduce Inpatient Opioid Prescription or Opioid-Related Adverse Events Among Patients Undergoing Spine Surgery

BACKGROUND: Having entered the US market relatively recently, the perioperative role of intravenous acetaminophen (ivAPAP) remains to be established for several surgeries. Using national data, we therefore assessed current utilization and whether it reduces inpatient opioid prescription and opioid-related side effects in a procedure with relatively high opioid utilization. METHODS: Patients undergoing a lumbar/lumbosacral spinal fusion (n = 117,269; 2011–2014) were retrospectively identified in a nationwide database and categorized by the amount and timing of ivAPAP administration (1 or >1 dose on postoperative day [POD] 0, 1, or 1+). Multivariable models measured associations between ivAPAP utilization categories and opioid prescription and perioperative complications; odds ratios (or % change) and 95% confidence intervals are reported. RESULTS: Overall, ivAPAP was used in 18.9% (n = 22,208) of cases of which 1 dose on POD 0 was the most common (73.6%; n = 16,335). After covariate adjustment, use of ivAPAP on POD 0 and 1 was associated with minimal changes in opioid prescription, length and cost of hospitalization particularly favoring >1 ivAPAP dose with a modestly (-5.2%, confidence interval, -7.2% to -3.1%; P

https://ift.tt/2Gn5v5Z

Clonidine Effect on Pain After Cesarean Delivery: A Randomized Controlled Trial of Different Routes of Administration

BACKGROUND: Intrathecal clonidine prolongs spinal anesthesia. We evaluated the effects of the addition of intrathecal or intravenous clonidine (75 µg) to standard cesarean delivery spinal anesthesia on postoperative pain and neonatal outcomes. METHODS: In a randomized, placebo-controlled, double-blind trial, 64 women scheduled for elective cesarean delivery under spinal anesthesia were randomly allocated and compared among 3 groups: intrathecal clonidine 75 µg, intravenous clonidine 75 µg, and placebo. The primary outcome was acute postoperative pain. A sample size of 26 individuals per group (N = 78) was planned. RESULTS: From April 2015 to April 2016, 64 women were analyzed (14 excluded). No differences in postoperative pain scores were found (Numerical Verbal Scale for pain at movement at 24 hours of postcesarean delivery: 4.53 ± 3.0 vs 4.45 ± 2.73 vs 3.93 ± 3.07 for control, intrathecal, and intravenous, respectively, P = .771). Intrathecal and intravenous clonidine led to more sedation, in comparison to the control group, during the intraoperative period (Richmond Agitation and Sedation Scale: −0.3 ± 0.47 vs −1 ± 0.53 vs −0.73 ± 0.45 for control, intrathecal, and intravenous, respectively, overall P

https://ift.tt/2GBahA9

Changes in International Normalized Ratios After Plasma Transfusion of Varying Doses in Unique Clinical Environments

BACKGROUND: Plasma transfusion is commonly performed for the correction of abnormal coagulation screening tests. The goal of this investigation was to assess the relationship between the dose of plasma administered and changes in coagulation test results in a large and diverse cohort of patients with varying levels of coagulation abnormalities and comorbid disease and in a variety of clinical settings. METHODS: In this single-center historical cohort study, all plasma transfusion episodes in adult patients with abnormal coagulation screening tests were extracted between 2011 and 2015. The primary outcome was the proportion of patients attaining normal posttransfusion international normalized ratio (INR ≤1.1) with secondary outcomes including the proportion of patients attaining partial normalization of INR (INR ≤1.5) or at least 50% normalization in pretransfusion values with respect to an INR of 1.1. RESULTS: In total, 6779 unique patients received plasma with a median (quartiles) pretransfusion INR of 1.9 (1.6–2.5) and a median transfusion volume of 2 (2–3) units. The majority (85%) of transfusions occurred perioperatively, with 20% of transfusions administered prophylactically before a procedure. The median decrease in INR was 0.4 (0.2–0.8). Complete INR normalization was obtained in 12%. Reductions in INR were modest with pretransfusion INR values

https://ift.tt/2E4Nnvq

A Novel Approach to the National Resident Matching Program

This Viewpoint details a star system for matching otolaryngology–head and neck surgery applicants with programs.

https://ift.tt/2uvZjam

Tubular Neck Mass

A man in his 60s had right-sided lateral neck pain; palpation demonstrated a mass running along the lateral border of the sternocleidomastoid (SCM) muscle and imaging showed an elongated enhancing tubular structure along the lateral surface of the right SCM muscle. What is your diagnosis?

https://ift.tt/2GiNR7x

Pulsatile Tinnitus With Imaging

A woman in her 40s presented with right pulsatile tinnitus with a whooshing quality for 4 years; the external auditory canals were clear bilaterally, tympanic membranes were intact and mobile bilaterally, and there was no evidence of any vascular masses in the middle ear space. What is your diagnosis?

https://ift.tt/2uxnLIk

Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure

To the Editor The study by Schoppy et al provides information that furthers the dialogue about how surgical margins are assessed, both intraoperatively and on formalin-fixed specimens, and offers a seemingly attractive and clinically meaningful quality measure in head and neck surgery: a negative margin rate of 90%. The authors appropriately note a major limitation of this study—variation in margin sampling techniques across surgeons. By design, the authors could not define the source of negative margin: was margin status deduced from the actual resection specimen or tumor bed biopsies? How is the adequacy of margin revision determined? This limitation makes the proposed metric of a "90% or higher negative margin" rate a nonactionable one.

https://ift.tt/2GjLDVp

Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure—Reply

In Reply We appreciate the letter by Dr Duvvuri and colleagues regarding our recent study and the opportunity to further discuss our work. We agree that a lack of standardization in margin assessment in the National Cancer Database (NCDB) is a meaningful limitation. As we mentioned in the Discussion section of our article, variation in what constitutes a positive margin across pathologists and margin harvesting techniques may differ across surgeons and institutions. The NCDB likely groups patients with negative margins on the primary specimen and negative margins from repeated resections or tumor bed biopsies together, and we were unable to make these distinctions based on the available data. It is therefore possible that the survival advantage of having high institutional rates of negative margins would be even greater if margin assessment was standardized.

https://ift.tt/2uxny80

Postoperative Facial Baroparesis While Flying

This case report describes a unique iatrogenic mechanism of baroparesis in a patient who underwent surgical treatment of a facial nerve schwannoma.

https://ift.tt/2GkiQjm

Preoperative Facial Nerve Mapping and Pediatric Facial Vascular Anomaly Resection

This historically controlled study investigates if preoperative facial nerve mapping is associated with intraoperative facial nerve injury risk and safe surgical approach options compared with standard nerve integrity monitoring.

https://ift.tt/2uxnrcA

Thyroidectomy Practice After Implementation of 2015 American Thyroid Association Guidelines for Thyroid Carcinoma

This cohort study assesses surgical practice changes regarding lobectomy, up-front thyroidectomy, and completion thyroidectomy in a tertiary medical center before and after the implementation of the 2015 American Thyroid Association guidelines for well-differentiated thyroid carcinoma.

https://ift.tt/2GkiERa

Possible involvement of acetylcholine-mediated inflammation in airway diseases

Publication date: Available online 28 March 2018
Source:Allergology International
Author(s): Akira Koarai, Masakazu Ichinose
Inhaled bronchodilator treatment with a long acting muscarinic antagonist (LAMA) reduces symptoms and the risk of exacerbations in COPD and asthma. However, increasing evidence from cell culture and animal studies suggests that anti-muscarinic drugs could also possess anti-inflammatory effects. Recent studies have revealed that acetylcholine (ACh) can be synthesized and released from both neuronal and non-neuronal cells, and the released ACh can potentiate airway inflammation and remodeling in airway diseases. However, these anti-inflammatory effects of anti-muscarinic drugs have not yet been confirmed in COPD and asthma patients. This review will focus on recent findings about the possible involvement of ACh in airway inflammation and remodeling, and the anti-inflammatory effect of anti-muscarinic drugs in airway diseases. Clarifying the acetylcholine-mediated inflammation could provide insights into the mechanisms of airway diseases, which could lead to future therapeutic strategies for inhibiting the disease progression and exacerbations.



https://ift.tt/2GkwtuT

Mast cell disorders: Protean manifestations and treatment responses

Publication date: Available online 28 March 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Meng Chen, Alexander Kim, Bruce Zuraw, Taylor A. Doherty, Sandra Christiansen




https://ift.tt/2GAsP3z

MULTIPLE SOLID ORGAN TRANSPLANTATION IN TELOMEROPATHY: CASE SERIES AND LITERATURE REVIEW

Background Solid organ transplantation is a valid treatment option for selected patients with organ failure due to an underlying telomeropathy, however, feasibility of multiple-organ transplantation if several organs are compromised is unclear. Methods We describe 2 patients with telomeropathy due to heterozygous TERC or TERT mutation, who successfully underwent serial or combined liver and lung transplantation for concurrent liver fibrosis/cirrhosis and pulmonary fibrosis. Results Despite a challenging posttransplant course, long-term outcomes were favorable, with both patients doing fine now respectively 12/20 and 24 months after multiple-organ transplantation. Conclusions To our knowledge, this is the first report of multiple solid organ transplantation in documented telomeropathy. These cases highlight current difficulties of timely diagnosis, therapeutic approach and postoperative complications in telomeropathy-patients in whom several organs are affected. Address for correspondence: Prof. Dr. Robin Vos, Dept. of Respiratory Diseases, Lung Transplantation Unit, Herestraat 49, B-3000 Leuven, Belgium. Tel: + 32 16 341548 Fax: + 32 16 346803. E-mail: robin.vos@uzleuven.be AUTHORSHIP Author's specific contributions: • MLV: performed data collection, wrote the paper; and helped with critical appraisal of the manuscript • WAW: is responsible ILD physician of the patients and helped with critical appraisal of the manuscript • DC and WL: are responsible liver physicians, performed ERCPs and helped with critical appraisal of the manuscript • FN: is responsible liver physician of the patients and helped with critical appraisal of the manuscript • JP and DM: are responsible liver surgeons and helped with critical appraisal of the manuscript • TR and EKV: are responsible histopathologists of our liver and lung transplant program and helped with critical appraisal of the manuscript APN: is responsible anesthesiologist of the patients and helped with critical appraisal of the manuscript • DVR: is responsible thoracic surgeon and helped with critical appraisal of the manuscript • GMV: is medical director of the transplant program, is responsible lung transplant physician during pr- and posttransplant period; and helped with critical appraisal of the manuscript • RV: is responsible lung transplant physician during pre and posttransplant period; wrote the paper and helped with critical appraisal of the manuscript Disclosures: None of the authors of this manuscript have conflicts of interest to disclose regarding the presented data. The authors confirm that that the work described has not been published previously, that it is not under consideration for publication elsewhere, that its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form in English or in any other language, without the written consent of the copyright holder. Funding: • RV is senior clinical research fellow of the Research Foundation Flanders (FWO), Belgium. • RV is supported by a research grant of UZ Leuven, Belgium (STG15/023) Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid Organ Transplantation

Despite recent advances, cytomegalovirus infections remain one of the most common complications affecting solid organ transplant recipients, conveying higher risks of complications, graft loss, morbidity, and mortality. Research in the field and development of prior consensus guidelines supported by The Transplantation Society has allowed a more standardized approach to cytomegalovirus management. An international multidisciplinary panel of experts was convened to expand and revise evidence and expert opinion-based consensus guidelines on CMV management including prevention, treatment, diagnostics, immunology, drug resistance, and pediatric issues. Highlights include advances in molecular and immunologic diagnostics, improved understanding of diagnostic thresholds, optimized methods of prevention, advances in the use of novel antiviral therapies and certain immunosuppressive agents, and more savvy approaches to treatment resistant/refractory disease. The following report summarizes the updated recommendations. The CMV Consensus Conference was organized by the Infectious Diseases Section of The Transplantation Society. Independent, nonrestricted grants from Hoffman LaRoche, Merck, Oxford Immunotec, Qiagen, Shire, CSL Behring, Lophius Biosciences, Chimerix, Roche Molecular Systems, and Abbott Laboratories made this conference possible. At no time did the funding sources have input into the list of attendees, discussion, or content. Terminology: Antigenemia – measuring CMV specific antigen in peripheral blood leukocytes, for example pp65 assay Viremia – culture-based detection of infectious CMV DNAemia – measuring CMV-DNA by QNAT (whole blood and plasma) CMV-specific IgG is a marker of previous exposure (positive serology does not define "active infection") Surveillance – patient at risk, but no evidence of an event or biomarker Monitoring – patient has event or biomarker positive Conflicts of interest Dr. Kotton received funding for serving on scientific advisory boards for Roche Molecular and Merck; adjudication boards for Astellas, Merck, and Shire; and consultancy fees from Qiagen and Oxford Immunotec. Dr. Caliendo received funding for serving on a scientific advisory board for Roche Molecular. Dr. Kumar has received research grants from Roche, Shire, Qiagen, Oxford Immunotec as well as consultancy fees from Qiagen and Oxford Immunotec. Dr. Chou performed contracted CMV phenotyping research for Merck and Shire Dr. Huprikar and Dr. Danziger-Isakov have no conflicts to declare. Dr. Humar received research support from Qiagen, Astellas and Roche. Authorship: All authors participated in the consensus meeting, review and summary of available data, and in the writing of the paper. Leaders: Camille N. Kotton (USA) and Atul Humar (Canada) Diagnostics: Angela M. Caliendo (leader, USA), Randall Hayden (USA), Hans Hirsch (Switzerland), Tiziana Lazzarotto (Italy), Jutta Preiksaitis (Canada) Immunology: Deepali Kumar (leader, Canada), Davide Abate (Italy), Oriol Bestard (Spain), Javier Carbone (Spain), Hannah Kaminski (France), Rajiv Khanna (Australia), Martina Sester (Germany) Prevention: Atul Humar (coleader, Canada) and Camille N. Kotton (coleader, USA), Laura Barcan (Argentina), Emily Blumberg (USA), Jennifer Harrison (Canada), Nassim Kamar (France), Nicolas Mueller (Switzerland), Tomas Reischig (Czech Republic), Nina Singh (USA), David Snydman (USA), Helio Tedesco-Silva (Brazil), David Thomson (South Africa), Marty Zamora (USA) Treatment: Shirish Huprikar (leader, USA), Jay Fishman (USA), Shahid Husain (Canada), Michele Morris (USA), Claudia Nagel (Argentina), William Rawlinson (Australia) Resistance: Sunwen Chou (leader, USA), Sophie Alain (France), Guy Boivin (Canada), Klaus Hamprecht (Germany), Ajit P. Limaye (USA) Pediatrics: Lara Danziger-Isakov (leader, USA), Upton Allen (Canada), Michael Green (USA), Britta Hoecker (Germany), Rebecca Madan (USA), Gustavo Varela-Fascinetto (Mexico) Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Unusual Case of Vogt-Koyanagi-Harada Disease Associated with SAPHO Syndrome: A Case Report

A 66-year-old Japanese woman who was diagnosed with synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome presented with bilateral blurred vision 4 months prior to visiting our hospital. She had visited a local ophthalmology clinic first. She was diagnosed with conjunctivitis and was prescribed antibacterial eye drops. The symptoms persisted in spite of treatment. She was then referred to our hospital. At her initial visit, the visual acuities were 0.6 in both eyes. A slit-lamp examination revealed bilateral shallow anterior chamber, and intraocular pressures of 18 mm Hg in the right eye and 16 mm Hg in the left eye. There were no cells in the anterior chamber. Fundus examination revealed bilateral annular choroidal detachment and serous retinal detachment. Fluorescein angiography showed leakage of dye from the retinal pigment epithelium (RPE) and indocyanine green angiography showed focal choroidal hypoperfusion. Optical coherence tomography showed wavy RPE line and blurry thick choroid. Systemic investigation by the physician demonstrated bilateral pleural effusions of unknown origin. The patient had a past history of breast cancer; however, no metastasis was identified via malignant cells through cytology, laboratory findings, radiographs, CT, and MRI. After the diagnosis of Vogt-Koyanagi-Harada (VKH) disease was made, the patient was treated with local and systemic steroid including high-dose intravenous corticosteroids, and 150 mg of cyclosporine per day. Seventy days after the second high-dose of intravenous corticosteroids, these medications brought a complete resolution of both choroidal and retinal detachment. VKH disease associated with SAPHO syndrome is rare. The combination of immunosuppressive drug and steroid might be helpful for severe cases of VKH disease.
Case Rep Ophthalmol 2018;9:202–208

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Reduction of bilateral dislocation of TMJ and Rendu Osler Weber syndrome: case report and physiopathological model

Abstract

Temporomandibular joint dislocation (TMJ) is an infrequent clinical situation, representing 3% of all the human body's dislocations. The etiological factors reported are associated to alterations typical of the joint or of the muscular-ligament apparatus, or to clinical conditions that may cause dislocation. We present the case of a 46-year-old patient with hereditary hemorrhagic telangiectasia with bilateral dislocation of the TMJ. There are several potential causes (antipsychotics, intubation, etc.) although the deposit of manganese in the basal ganglia that produce extrapyramidal symptoms could be the most consistent cause.

https://ift.tt/2pOo4K4

Use of sternal plate for pectus excavatum repair in adults leads to minimal postoperative pain

Abstract

Pectus excavatum is a chest wall deformity that results in caved-in or sunken appearance of lower half of anterior chest. Surgical treatment is favored when functional or cosmetic concerns arise. We present a case and series of six patients (mean haller index: 4.28) who had repair with minimal pleural disruption and sternal plate. After a broad bilateral inframammary skin incision, the anterior aspect of sternum is identified and incised. Next, the surgeon hyperextends and fixates the bone in its desired position by applying manual dorsal pressure through a small intercostal incision. Superior and inferior fasciocutaneous flaps are raised and then advanced to reconstruct the soft tissue defect. All patients had durable repair of the chest wall abnormalities and they had minimal pain during the postoperative period. No analgesia medication was necessary 1 month post-operatively. This may provide significantly less pain compared to the Nuss or Ravitch procedures to fix Pectus excavatum.

https://ift.tt/2GoGgQs

Laparoscopic choledochoscopy with Ambu® aScope 3™ in the treatment of coledocholithiasis: a series of cases

Abstract

The progresses made in minimally invasive surgery, make it not only possible to perform isolated cholecystectomy, but also to provide a totally laparoscopic treatment of common bile duct lithiasis. In this approach, the use of choledochoscopy is indispensable for diagnostic and therapeutic success. This study describes the use of a disposable endoscope for choledochoscopy in the laparoscopic treatment of choledocholithiasis. We have analyzed the use of the Ambu^® aScope 3^™ disposable endoscope, normally used for bronchoscopy, in nine consecutive patients needing choledochoscopy in our Hospital. The patient average age was 78 years. Total clearance of the bile duct was obtained in seven patients. Bile duct vacuity was not obtained in two patients, but this is not attributed to equipment failure. There was one case of hemoperitoneum not related to equipment usage. This device is easy to use and looks promising for choledochoscopy in laparoscopic treatment of coledocholithiasis.

https://ift.tt/2pOrv3n

Case 10-2018: An 84-Year-Old Man with Painless Unilateral Testicular Swelling

Presentation of Case. Dr. Michael S. Abers (Medicine): An 84-year-old man was evaluated at this hospital because of painless right testicular swelling. The patient had been in his usual state of health until 6 weeks before this evaluation, when he noted while showering that the right testicle was…

https://ift.tt/2GR5JmJ

Light on fumaric acid esters therapy for psoriasis

British Journal of Dermatology, Volume 178, Issue 3, Page 586-587, March 2018.


https://ift.tt/2pO1gdg

Interleukin‐36 in hidradenitis suppurativa: evidence for a distinctive proinflammatory role and a key factor in the development of an inflammatory loop

British Journal of Dermatology, Volume 178, Issue 3, Page e241-e241, March 2018.


https://ift.tt/2IfRC9Z

Efficacy and safety of autologous haematopoietic stem cell transplantation in systemic sclerosis: a systematic review of the literature

British Journal of Dermatology, Volume 178, Issue 3, Page e239-e239, March 2018.


https://ift.tt/2pNwQrM

Ixekizumab treatment for psoriasis: integrated efficacy analysis of three double‐blinded, controlled studies (UNCOVER‐1, UNCOVER‐2, UNCOVER‐3)

British Journal of Dermatology, Volume 178, Issue 3, Page e242-e242, March 2018.


https://ift.tt/2Ie4X2C

Towards global consensus on core outcomes for hidradenitis suppurativa research: an update from the HISTORIC consensus meetings I and II

British Journal of Dermatology, Volume 178, Issue 3, Page e243-e243, March 2018.


https://ift.tt/2pP2HIF

Image Gallery: Symmetric reticular scarring of the cheeks

British Journal of Dermatology, Volume 178, Issue 3, Page e229-e229, March 2018.


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Image Gallery: A hard ‘pebbly’ plaque stuck on the upper eyelid

British Journal of Dermatology, Volume 178, Issue 3, Page e226-e226, March 2018.


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Is new better than tried and tested? Topical atopic dermatitis treatment in context

British Journal of Dermatology, Volume 178, Issue 3, Page 583-584, March 2018.


https://ift.tt/2IfTIa9

黑素原生成的旁分泌调节

British Journal of Dermatology, Volume 178, Issue 3, Page e248-e248, March 2018.


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Image Gallery: Dermatophytic pseudomycetoma caused by Microsporum canis

British Journal of Dermatology, Volume 178, Issue 3, Page e228-e228, March 2018.


https://ift.tt/2pTCnx5

在系统性硬化病中进行自身造血干细胞移植的功效和安全性:文献的系统性评述

British Journal of Dermatology, Volume 178, Issue 3, Page e253-e253, March 2018.


https://ift.tt/2IcKawn

Corrigenda

British Journal of Dermatology, Volume 178, Issue 3, Page 814-814, March 2018.


https://ift.tt/2pTCyZh

Corrigenda

British Journal of Dermatology, Volume 178, Issue 3, Page 815-815, March 2018.


https://ift.tt/2GiAuA8

伊赛珠单抗对银屑病的治疗:三项双盲对照研究的综合药效分析(发现‐1、发现‐2、发现‐3)

British Journal of Dermatology, Volume 178, Issue 3, Page e256-e256, March 2018.


https://ift.tt/2pOHBtV

化脓性汗腺炎中的IL‐36:独特的促炎性作用的证据和炎症循环发展的关键因素

British Journal of Dermatology, Volume 178, Issue 3, Page e255-e255, March 2018.


https://ift.tt/2Id5xO5

化脓性汗腺炎研究的核心结果的全球共识:历史性共识会议I和II的更新

British Journal of Dermatology, Volume 178, Issue 3, Page e257-e257, March 2018.


https://ift.tt/2pTCpVJ

Corrigenda

British Journal of Dermatology, Volume 178, Issue 3, Page 815-816, March 2018.


https://ift.tt/2Ie3g5q

Cell delivery using microneedle devices: a new approach to treat depigmenting disorders

British Journal of Dermatology, Volume 178, Issue 3, Page 588-589, March 2018.


https://ift.tt/2pKFLKv

The heterogeneous mutational landscape of pustular psoriasis

British Journal of Dermatology, Volume 178, Issue 3, Page 589-590, March 2018.


https://ift.tt/2pO1LnD

Corrigenda

British Journal of Dermatology, Volume 178, Issue 3, Page 814-815, March 2018.


https://ift.tt/2Gk84FK

Buccal Fat Pad-Derived Stem Cells for Repair of Maxillofacial Bony Defects

Abstract

Aim

The purpose of this study was to evaluate the use of buccal fat pad-derived stem cells (BFPSCs) as a source for full thickness bone defect repair secondary to pathology in maxilla or mandible.

Methods

Fat-derived stem cells were isolated from buccal fat pad, differentiated into osteocytes in osteogenic medium, and seeded onto human bone defects. Autologous buccal fat pad was harvested and BFPSCs cultured within 4–6 weeks. Bone defects secondary to enucleation of pathologic cyst or tumors were reconstructed with osteogenically differentiated fat-derived stem cells. Hematoxylin and eosin staining, immunohistochemical staining for osteocalcin, alkaline phosphatase and genotypic and phenotypic marker analysis, and histomorphometric measurements of new bone were performed.

Results

Maxillofacial bone defects were successfully reconstructed by BFPSCs, which after implantation at an in vivo site yielded faster osseous regeneration. BFPSCs were associated with superior bone density formation, better blending of margins with enhanced bone trabecular formation, well-organized and well-vascularized lamellar bone with Haversian channels and osteocytes resulting in superior functional and cosmetic results with better quality of life and with significant decrease in secondary complications.

Conclusion

Buccal fat pad is an ideal tool in the hands of an oral and maxillofacial surgeon for tissue engineering and clinical use requiring bone tissue growth and repair, secondary to large osseous defects. This study demonstrates the feasibility of reconstructing bony defects with fat-derived stem cells.

https://ift.tt/2pLz9dY

Responses in patients receiving sequential paclitaxel post progression on PD1 inhibitors

Publication date: Available online 28 March 2018
Source:Oral Oncology
Author(s): Ammar Sukari, Misako Nagasaka, Nadine Abdallah
This report describes highlights the dramatic responses seen in patients who were given paclitaxel post progression on immunotherapy. There are multiple mechanisms by which synergistic effects of immunotherapy and chemotherapy occur. Further prospective studies on chemotherapy and immunotherapy are eagerly awaited.



https://ift.tt/2pNqvfY

Tumor lysate-based vaccines: on the road to immunotherapy for gallbladder cancer

Abstract

Immunotherapy based on checkpoint blockers has proven survival benefits in patients with melanoma and other malignancies. Nevertheless, a significant proportion of treated patients remains refractory, suggesting that in combination with active immunizations, such as cancer vaccines, they could be helpful to improve response rates. During the last decade, we have used dendritic cell (DC) based vaccines where DCs loaded with an allogeneic heat-conditioned melanoma cell lysate were tested in a series of clinical trials. In these studies, 60% of stage IV melanoma DC-treated patients showed immunological responses correlating with improved survival. Further studies showed that an essential part of the clinical efficacy was associated with the use of conditioned lysates. Gallbladder cancer (GBC) is a high-incidence malignancy in South America. Here, we evaluated the feasibility of producing effective DCs using heat-conditioned cell lysates derived from gallbladder cancer cell lines (GBCCL). By characterizing nine different GBCCLs and several fresh tumor tissues, we found that they expressed some tumor-associated antigens such as CEA, MUC-1, CA19-9, Erb2, Survivin, and several carcinoembryonic antigens. Moreover, heat-shock treatment of GBCCLs induced calreticulin translocation and release of HMGB1 and ATP, both known to act as danger signals. Monocytes stimulated with combinations of conditioned lysates exhibited a potent increase of DC-maturation markers. Furthermore, conditioned lysate-matured DCs were capable of strongly inducing CD4⁺ and CD8⁺ T cell activation, in both allogeneic and autologous cell co-cultures. Finally, in vitro stimulated CD8⁺ T cells recognize HLA-matched GBCCLs. In summary, GBC cell lysate-loaded DCs may be considered for future immunotherapy approaches.

https://ift.tt/2GSOqlg

Palatal Polymorphous Adenocarcinoma with High-Grade Transformation: A Case Report and Literature Review

Abstract

Polymorphous adenocarcinoma (PAC) is the second most common intraoral malignant neoplasm of the minor salivary glands. However, it is very rare for PAC to show high-grade transformation (HGT) and to our knowledge, the English literature only seven reported cases. HGT tends to be observed when PAC recurs, and it is extremely rare to be seen at initial presentation. Here we report a 43-year-old Japanese male patient with PAC of the right palate showing HGT at initial presentation. Histopathologically, the tumor was characterized by a prominent solid and papillary-cystic growth pattern, with nuclear atypia and necrosis in area of HGT. The immunohistochemical staining pattern was consistent with PAC, as the tumor cells showed diffuse positivity for cytokeratin, vimentin and S-100, and focal positivity for bcl-2, ɑ-SMA and EMA. The tumor cells in HGT areas were markedly positive for AR and Ki-67 (about 40%/HPF), and also focally positive for cyclin D1 and p53, whereas HER2/neu, ER, PgR, p63, D2-40, GCDFP-15, and mitochondria were negative. Here we present a very rare case of palatal PAC with HGT at initial presentation.

https://ift.tt/2Gk8JqV

Emergency Treatment of Blast, Shell Fragment and Bullet Injuries to the Central Midface Complex

Abstract

Purpose

Current ballistics and high-energy explosion possess unnoticed, new and significant biophysics and pathophysiology wounding effects that are unique in comparison with civilian trauma. The primary blast wave effects of compressed air due to explosion lead to tattered and crushed eggshell injuries to the upper central midface (UCM). High-energy shell fragments of various shapes and sizes cause extensive destruction and are different from assault rifle's bullets that cause high energy transfer to the tissue by creating a temporary cavitation.

Methods

Twenty-one patients with unquantifiable war injuries were selected. The emergency managment of lifesaving facial war injuries starts with life threatening hemorrahge or air compramise. This article describes immediate management of medial canthal tendon (MCT), intercanthal region and severe nasal war injuries.

Results

The utilized procedure obtained good results compared to the results of cases treated only by applying a classic approach of civilian fractures.

Conclusion

Treatments of UCM injuries are the most difficult since UCM includes the esthetic, physiologic, and anatomical regions of the face. The proposed technique provides immediate excellent stability for soft tissues, bone, and cartilage and is well tolerated in the long term by both the tissue and the patient. Most of the times, victims are treated with limited resources, deficient subspecialty, massive injuries, during mass casualties, and a single surgeon must have to handle all these within a short period of time. UCM injuries are really concerning since this region is the core of facial esthetic and function.

https://ift.tt/2If7pWN

Palatal Polymorphous Adenocarcinoma with High-Grade Transformation: A Case Report and Literature Review

Abstract

Polymorphous adenocarcinoma (PAC) is the second most common intraoral malignant neoplasm of the minor salivary glands. However, it is very rare for PAC to show high-grade transformation (HGT) and to our knowledge, the English literature only seven reported cases. HGT tends to be observed when PAC recurs, and it is extremely rare to be seen at initial presentation. Here we report a 43-year-old Japanese male patient with PAC of the right palate showing HGT at initial presentation. Histopathologically, the tumor was characterized by a prominent solid and papillary-cystic growth pattern, with nuclear atypia and necrosis in area of HGT. The immunohistochemical staining pattern was consistent with PAC, as the tumor cells showed diffuse positivity for cytokeratin, vimentin and S-100, and focal positivity for bcl-2, ɑ-SMA and EMA. The tumor cells in HGT areas were markedly positive for AR and Ki-67 (about 40%/HPF), and also focally positive for cyclin D1 and p53, whereas HER2/neu, ER, PgR, p63, D2-40, GCDFP-15, and mitochondria were negative. Here we present a very rare case of palatal PAC with HGT at initial presentation.

https://ift.tt/2Gk8JqV

Growth and development of craniofacial structures in patients at different ages with unrepaired submucous cleft palate

Publication date: Available online 28 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Congcong Cao, Xue Xu, Qian Zheng, Bing Shi, Jingtao Li, Yan Wang
ObjectiveSubmucous cleft palate (SMCP) is a particular subtype of cleft palate deformities; research related to craniofacial features of patients with SMCP is comparatively rare. The study objective was cephalometric comparison of craniofacial features of patients with SMCP to non-cleft controls at different ages.Materal and methodsThe sample in this cross-sectional study was composed of two groups, SMCP patients and non-cleft controls. The primary predictor variables were study group (cleft and non-cleft) and age. Age was divided into three groups. The outcome variables of interest were craniofacial measurements. Measurements used reflect cranial length, cranial angle, maxilla sagittal length and protrusion, maxilla vertical height, pharyngeal depth, facial height, mandible length and protrusion, mandibular plane angle and intermaxillary relation. Adjusted cephalometric craniofacial measurements between the groups were compared in three age groups using generalized linear models after being adjusted for age and gender.ResultsSixty SMCP patients and sixty normal controls were included. SMCP patients and normal controls were assigned into three subgroups: T1 -, ranging from 5 to 7 years, T2 -, ranging from 9 to 11 years, and T3 -, ranging from 18 to 30 years. Patients with SMCP at 5-7 years showed shortened cranial base length, maxillary sagittal length and height, and bony pharynx depth. Patients with SMCP at 9-11 years showed smaller maxillary sagittal length, bony pharynx depth and inharmonious jaw relationship. Patients with SMCP at 18-30 years showed smaller maxillary sagittal length, height and inharmonious jaw relationship.ConclusionSMCP is associated with progressive maxillary retrognathism and reduced profile convexity from childhood to adulthood.



https://ift.tt/2GT2CuA

The Millimeter Mindset: The Dental Underpinnings of an Inborn Surgical Advantage

Publication date: Available online 28 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Christopher. A. Fanelli, Yoh. Sawatari




https://ift.tt/2IcERx4

Dental and maxillofacial signs in Aarskog syndrome: A review of three siblings and literature

Publication date: Available online 29 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Arnaud Depeyre, Matthias Schlund, Rémi Gryseleyn, Joel Ferri




https://ift.tt/2GXwWo4

Preservation of Salivary Function Following Extracapsular Dissection for Tumors of the Parotid Gland

Publication date: Available online 28 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Sung Joon Park, Sungjun Han, Hyo-Jung Lee, Soon-Hyun Ahn, Woo-Jin Jeong
PurposeWe sought to evaluate salivary function following extracapsular dissection (ECD), compared to partial superficial parotidectomy (PSP) and classic superficial parotidectomy (CSP), of benign parotid gland tumors. The investigators hypothesized that ECD would be superior in preserving post-operative salivary function than PSP and CSP.MethodsRetrospective analyses were performed for 43 consecutive patients undergoing parotidectomies, by a single experienced surgeon, of benign parotid tumors. Clinical data and pre- and post- operative whole salivary flow rates were compared between the operative procedures. Pearson's chi-square, Fisher's exact test was used to compare categorical variables. Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed rank tests were used to compare means. P value under 0.05 was considered as significant throughout the study.ResultsTumor sizes did not differ between the groups. Operative times, amounts of drainage, and hospital days for ECD were significantly less than for CSP, and tended to be less than PSP. Resection margins were exposed in 0, 12.5, and 6.7% of ECD, PSP, and CSP patients, respectively. Post-operative complications occurred less (but not significantly) following ECD. Post-operative basal salivary flow rates in the ECD, PSP, and CSP groups were 0.39, 0.32, and 0.14 mL/min, respectively (P =.05). Stimulated salivary flow rates remained stable for the ECD and PSP groups, but decreased in the CSP group.ConclusionExtracapsular dissection is a safe and time-efficient surgical approach, offering early recovery for parotid tumors and better preservation of salivary function. ECD should be considered as a surgical approach for parotid tumors, especially those in the parotid tail region, such as for Warthin's tumors.



https://ift.tt/2E4suAz

Orbital Floor Reconstruction: Three-Dimensional Analysis Demonstrates Comparable Morphology of Scapular and Iliac Crest Bone Grafts

Publication date: Available online 28 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Joel C. Davies, Harley HL. Chan, Jonathan M. Bernstein, David P. Goldstein, Jonathan C. Irish, Ralph W. Gilbert
PurposeCurrent non-vascular osseous reconstructive options for reconstruction of the orbital floor following maxillectomy include options such as the scapular tip and iliac crest bone grafts. The aim of this study was to determine whether these donor sites were morphologically comparable to the orbital floor.MethodsA retrospective cross-sectional study design was selected. Using a pre-existing melanoma database (January 1, 2005-September 20, 2015), CT scans of the head, neck, thorax and pelvis were obtained from patients without evidence of bony metastases. Using 3D software (Mimics, Materialise, Leuven, Belgium), grafts from the scapulae and iliac crests, the predictor variables, were digitally harvested, co-registered with the orbital floors bilaterally and analyzed. The primary outcome was conformance. Data were analyzed using descriptive statistics and tests of statistical significance. The significance level was set at a P value less than or equal to .05.ResultsThe study sample included 10 patients (6 males, 4 females; mean age 55±18). A close conformance was observed when analyzing the morphology of the orbital floor to the scapular (2.23±0.31mm) and iliac crest (2.13±0.30mm) bone grafts with no significant difference between sites. Conformance mapping demonstrated maximal conformance centrally (scapula:1x10-3±1x10-3mm;iliac crest: 1x10-3±1x10-3mm) with decreased morphologic similarity peripherally (scapula:6.09±0.94mm;iliac crest: 5.74±0.88mm). There was no significant difference in conformance between sides of graft harvest.ConclusionWhen considering non-vascularized bone grafts for reconstruction of the orbital floor, both the scapula and iliac crest offer near complete conformance to the orbital floor structure and represent reasonable reconstructive options.



https://ift.tt/2GUq9eD

Impact of bone volume upon condylar activity in patients with unilateral condylar hyperplasia

Publication date: Available online 28 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Luc H.E. Karssemakers, Jitske W. Nolte, D.Bram Tuinzing, Geerling E.J. Langenbach, Alfred G. Becking, Pieter G. Raijmakers
PurposeUnilateral condylar hyperplasia/ hyperactivity (UCH) is a bone overgrowth disorder affecting the mandible. The purpose of this study is to determine the relationships between age, condylar bone structure, condylar bone volume and condylar bone activity on SPECT scans in UCH patients.MethodsThis study included 20 patients with a clinical presentation of progressive mandibular asymmetry and a positive bone SPECT scan. A bone SPECT derived standardized uptake value (bSUV) for the condylar region was determined. All patients underwent condylectomy to arrest further progression of the disease. The resected condyles were scanned with a microCT scanner (18 μm resolution). Bone architectural parameters were calculated with routine morphometric software.ResultsThe mean bSUV of the condyle on the affected side was 15.32 (SD ±8,98) compared to 9.85 (SD ±4.40) on the non-affected side (p=0.0007). For the trabecular bone structure there was a non-significant correlation between the SUV of the affected condyle and the measured bone volume fraction (r=0.13, p=0.58), trabecular thickness (r=0.03, p=0.90).ConclusionNo significant relation was found between condylar bone volume fraction and the condylar activity in a bone scan; therefore, the impact of bone volume fraction on the results of bone scans is limited. The measured condylar activity on the SPECT scan seems primarily a reflection of the remodeling rate of bone.



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Remember the vessels! Craniofacial fracture predicts risk for blunt cerebrovascular injury

Publication date: Available online 28 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Elina Varjonen, Frank Bensch, Tuomo Pyhältö, Mika Koivikko, Johanna Snäll
PurposeThe risk factors for blunt cerebrovascular injuries (BCVI) are currently under intensive research, yet it is still controversial who should be screened. This study aimed to determine if craniofacial fractures are associated with BCVI.MethodsThis retrospective cohort study focused on suspected polytrauma patients after whole body computed tomography including angiography of the cervical arteries. Patients were reviewed for BCVI and craniofacial fractures. Exclusion criteria were hanging injury, gunshot injury, or other penetrating injury to the neck, and a cervical fracture on any level. The outcome variable was BCVI, and the main predictor variable was a craniofacial fracture. A secondary predictor variable was a type of craniofacial fracture classified as a facial fracture, skull fracture, or a combination of a facial and skull fracture. Other predictor variables were gender, age, and mechanism of injury. In addition, specific craniofacial fractures were analyzed in more detail. The significance of associations between BCVI and the predictors underwent a chi-squared test. Significance was set at .01.Results428 patients aged 13 to 90 during a period of 12 months were included in the analysis. Craniofacial fractures occurred in 75 (17.5%). BCVI occurred significantly more frequently in those with than in those without a craniofacial fracture (18.6 vs. 7.4%, P = .002). Craniofacial fracture patients had a 4-fold increased risk for BCVI, whereas those in the age group 31–50 years had 3.4-fold increased risk. Type of craniofacial fracture, gender, and the mechanism of injury were not associated with BCVI.ConclusionCraniofacial fractures are a significant risk factor for BCVI. This research suggests that in patients with any craniofacial fracture and suspected polytrauma, rigorous imaging of cervical arteries in search of BCVI is essential.



https://ift.tt/2GXwLco

Effective post-operative analgesia using intravenous flurbiprofen and acetaminophen.

Publication date: Available online 28 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Mitsuhiro Yoshida, Yoshitaka Shimizu, Keita Yoshida, Akari Mukai, Mitsuru Doi, Masahiro Irifune
PurposeManagement of postoperative pain is one of the most important components in postoperative care, because most patients suffer from pain after dental surgery. The aim of this study was to evaluate whether acetaminophen can be an alternative to fentanyl in combination with a nonsteroidal anti-inflammatory drug (NSAID) as an analgesic after dental surgery, in cases where narcotic drugs are contraindicated.MethodsThe subjects were 24- to 54-year-old male patients who underwent enucleation of a mandibular cyst under general anesthesia. We measured time from discontinuation of anesthetic administration until discharge from the operating room and postoperative pain during four hours after discharge. We compared the above parameters between patients who were intravenously administered an NSAID such as flurbiprofen with fentanyl (NSAID/fentanyl group) and those administered an NSAID with acetaminophen (NSAID/acetaminophen group). Parametric data of time were analyzed using Student's t-test. Non-parametric data of the analgesic effect were analyzed using Mann–Whitney U-test.ResultsTime until discharge from the operating room after discontinuation of anesthetics in the NSAID/fentanyl group was significantly longer than that in the NSAID/acetaminophen group (P < 0.05). In contrast, there was no significant difference in analgesic effect between the NSAID/acetaminophen and NSAID/fentanyl groups (P > 0.05).ConclusionAlthough the recovery time in the operating room of flurbiprofen and acetaminophen administered group was significantly shorter than that of flurbiprofen and fentanyl group, the postoperative analgesic effects of both drugs were equipotent. Therefore, acetaminophen can be an alternative to fentanyl in cases where narcotic drugs are contraindicated.



https://ift.tt/2E4ezdO