Head and Neck Medicine by Alexandros G.Sfakianakis: 04/04/18

Τετάρτη 4 Απριλίου 2018

Ces « spins » qui twistent les articles

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): O. Laccourreye, H. Maisonneuve

https://ift.tt/2GBCtzA

Lésions de l’œsophage provoquées par l’ingestion de pile bouton chez l’enfant : analyse des causes et proposition de mesures préventives

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): J.J. Lahmar, C. Célérier, E.N. Garabédian, V. Couloigner, N. Leboulanger, F. Denoyelle
ButsÉtudier les cas récents de lésion œsophagienne chez l'enfant par ingestion de piles boutons pris en charge aux urgences ORL pédiatriques d'Île-de-France, pour proposer des mesures préventives adaptées.Matériel et méthodesNous avons réalisé une étude descriptive, rétrospective et monocentrique. Les patients inclus étaient tous les enfants, âgés de moins de 15 ans, pris en charge aux urgences d'ORL pédiatrique entre janvier 2008 et avril 2014 pour l'ingestion et le blocage dans l'œsophage de pile bouton ayant nécessité une extraction en urgence.RésultatsVingt-deux garçons et 4 filles ont été inclus. L'âge médian était de 25 mois. Vingt-cinq piles sur 26 avaient un diamètre de 20mm ou plus. La durée médiane de présence des piles dans l'œsophage était de 7 heures 30 (2 à 72h). Le taux de complications était de 23 %. Le coût d'hospitalisation allait de 10 260 à 110 520€, avec un coût moyen de 38 751€. La provenance des piles était connue dans 23 cas sur 26 : télécommande sans compartiment vissé (42,3 %), paquet neuf ouvert (15,4 %), jouet pour enfant (15,3 %), appareil photo (7,7 %), montre (un cas) et appareil auditif sans compartiment vissé (un cas).ConclusionLes lésions œsophagiennes par ingestion de piles bouton chez l'enfant sont dues presque toujours à des piles de plus de 20mm provenant en majorité d'appareils au compartiment mal protégé ou de piles non conditionnées individuellement. Ces lésions sont sources de complications graves une fois sur 4 et leur prise en charge a un coût de santé élevé. Une législation imposant des compartiments vissés pour les appareils concernés et des emballages blisters individuels des piles aurait évité plus de 76,9 % des ingestions.

https://ift.tt/2GUDV3r

Myringoplastie avec utilisation de colle au cyanoacrylate et sans comblement d’oreille moyenne par Gelfoam©

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): L. Yang, L. JianMin, C. Yan, Z. Qing, R. XiaoYong, S. Ying
ObjectifsBien que de nombreuses méthodes aient été décrites pour essayer de stabiliser le greffon lors d'une myringoplastie, on ne peut éviter de placer du Gelfoam^© dans la caisse ; ceci peut entraîner une obstruction tubaire voire une atteinte de l'oreille interne. L'usage d'une colle tissulaire lors d'une myringoplastie connaît un regain d'intérêt car elle permet de stabiliser le greffon et d'améliorer sa prise. Le but de cette étude prospective était d'étudier les résultats des myringoplasties réalisées pour perforation tympanique subtotale, avec utilisation de colle au cyanoacrylate et sans mise en place d'un produit de comblement dans l'oreille moyenne.MéthodesEntre mars 2014 et novembre 2015, 71 patients présentant une perforation tympanique subtotale ont été opérés, aléatoirement et prospectivement répartis en deux groupes : le groupe colle et le groupe témoin. Deux techniques de stabilisation du greffon ont été utilisées : soit par colle au cyanoacrylate (groupe colle), soit par comblement de l'oreille moyenne au Gelfoam^© (groupe témoin). Toutes les interventions ont été réalisées par le même opérateur.RésultatsÀ 6 mois de l'intervention, la prise de greffe était de 87 % dans le groupe colle et de 89 % dans le groupe témoin. Dans les deux groupes, une amélioration significative de l'audition par rapport au préopératoire a été mise en évidence (p<0,05 dans les deux cas). Il n'y avait pas de différence entre le taux de prise de greffe, celui de complications, et les résultats audiométriques entre les deux groupes.ConclusionLa colle au cyanoacrylate est un outil utile pour stabiliser le greffon dans les myringoplasties pour perforation subtotale, et peut se substituer au comblement de la caisse par Gelfoam^©.

https://ift.tt/2IwbTbL

Facteurs pronostiques des métastases intra-parotidiennes des carcinomes épidermoïdes cutanés de la face

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): C. Bobin, P. Ingrand, B. Dréno, E. Rio, O. Malard, F. Espitalier
ContexteLes carcinomes épidermoïdes cutanés (CEC) se développent sur l'extrémité céphalique dans 80 % des cas. Les métastases intra-parotidiennes (MIP) sont rares, mais leur traitement associant chirurgie et radiothérapie est lourd et leur pronostic est sombre.Matériel et méthodesLes cas de parotidectomies pour MIP d'un CEC de la face entre 2005 et 2015 ont été rétrospectivement étudiés. Les données épidémiologiques, carcinologiques et thérapeutiques ont été évaluées. Les survies globale et spécifique ont été calculées suivant la méthode de Kaplan–Meier. Le test du Logrank et le modèle de Cox ont été utilisés pour rechercher les facteurs pronostiques des MIP.ObjectifsL'objectif principal était d'identifier les facteurs influençant la survie des patients présentant une MIP d'un CEC de la face.RésultatsTrente-cinq patients ont été inclus. Le délai d'apparition des MIP était en moyenne de 13 mois. La survie globale à 1 an, 2 ans et 5 ans était respectivement de 57 %, 50 % et 35 %, la survie spécifique respectivement de 70 %, 66 % et 59 %. Les facteurs pronostiques indépendants des MIP étaient l'immunodépression, l'âge au traitement, les marges non saines de la tumeur cutanée, l'envahissement macroscopique du nerf facial et la présence d'adénopathies cervicales métastatiques.ConclusionCette étude confirme l'association de nombreux facteurs pronostiques indépendants au stade métastatique ganglionnaire intra-parotidien, liés à la population, à la tumeur cutanée primitive et à la MIP. L'obtention d'une exérèse complète de la tumeur cutanée initiale est une règle absolue, afin de diminuer le risque de survenue des MIP. Une surveillance radioclinique accrue doit permettre le diagnostic précoce de ces métastases.

https://ift.tt/2GSqTDD

Évaluation à moyen terme de la fonction de la trompe auditive après dilatation par ballonnet

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): D. Schmitt, M. Akkari, T. Mura, M. Mondain, A. Uziel, F. Venail
Il n'existe à ce jour aucun traitement consensuel des dysfonctions tubaires par obstruction. En cas d'échec de traitements médicamenteux et pressionnels bien conduits, certains auteurs proposent la dilatation tubaire par ballonnet comme alternative thérapeutique. Le but était d'évaluer l'efficacité et l'innocuité de la dilatation tubaire par ballonnet dans cette population.Materiels et méthodesCette étude rétrospective monocentrique rapporte les résultats évalués cliniquement et par tubomanométrie, ainsi que les complications et la satisfaction des sujets traités consécutivement par dilatation tubaire de juin 2012 à février 2015. L'indication opératoire était portée sur des signes cliniques et paracliniques de dysfonction tubaire obstructive en échec de traitement médical bien conduit.RésultatsQuarante-cinq gestes ont été réalisés chez 38 sujets. L'amélioration des symptômes cliniques a été évaluée à 88 %, 80 % et 80 % à respectivement 2 mois, 6 mois, et à plus d'un an. On observait également une amélioration de la fonction évaluée par tubomanométrie dans 81 % des cas. Le geste était bien toléré, et uniquement 4 % de complications mineures ont été retrouvées.ConclusionsL'efficacité, la tolérance et la sécurité retrouvées sont comparables à celles observées dans la littérature, bien qu'il s'agisse de patients étant tous en échec de 1^re ligne de traitement. On note une normalisation de la fonction tubaire dans un peu plus d'un tiers des cas. Malgré ces résultats encourageants, la place et l'efficacité réelle de ce traitement reste à évaluer dans le cadre d'études prospectives de plus fort niveau de preuve.

https://ift.tt/2GBREsm

Editorial Board

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2

https://ift.tt/2GVFyOk

La chirurgie de rattrapage dans les récidives de carcinomes épidermoïdes du larynx et de l’hypopharynx : étude rétrospective de 2005 à 2013

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): K. Pujo, P. Philouze, A. Scalabre, P. Céruse, M. Poupart, G. Buiret
ObjectifLa chirurgie en terrain irradié, dite de rattrapage, est l'option thérapeutique de référence en cas de récidive locorégionale des cancers du larynx et de l'hypopharynx. Néanmoins ses résultats carcinologiques et fonctionnels modérés nécessitent de pouvoir sélectionner les patients candidats à cette chirurgie. L'objectif principal de ce travail était de déterminer les facteurs pronostiques préopératoires associés à la survie. Les objectifs secondaires étaient l'étude de la survie globale et sans récidive à 5 ans, du taux de complications locorégionales et générales et des résultats fonctionnels en termes d'alimentation et de sevrage de trachéotomie.Patients et méthodeIl s'agit d'une étude rétrospective multicentrique sur 52 patients ayant présenté une récidive de carcinome épidermoïde laryngé ou hypopharyngé en terrain irradié et ayant eu une chirurgie de rattrapage entre 2005 et 2013.RésultatsLes facteurs associés à une meilleure survie globale à 3 ans en analyse univariée étaient la localisation laryngée de la tumeur initiale (p=0,001), la localisation laryngée de la récidive (p=0,026), les tumeurs classées rT1, rT2, rT3 par rapport aux tumeurs rT4 (p=0,007), un antécédent de chimiothérapie (p=0,036) et la réalisation d'un curage cervical au cours de la chirurgie de rattrapage (p=0,005). Ce dernier est confirmé à l'analyse multivariée. La survie globale à 5 ans était de 36,0 % [27,6 %–44,4 %]. La durée médiane de survie globale estimée était de 23,04 mois (IC 95 % [19,44–26,64]). La survie sans récidive à 5 ans était de 23,5 % [16,0 %–31,0 %]. La durée médiane de survie sans récidive estimée était de 8,04 mois (IC 95 % [2,04–14,04]).ConclusionLa chirurgie de rattrapage des cancers du larynx et de l'hypopharynx est difficile avec des survies modestes. La localisation laryngée de la tumeur initiale et de la récidive, son volume et son extension modérés (inférieure à T4), un traitement préalable par chimiothérapie, ainsi que la possibilité de réaliser un curage lors de la chirurgie de rattrapage sont corrélés à une meilleure survie globale et sans récidive, permettant une meilleure sélection des patients pouvant en bénéficier.

https://ift.tt/2IqbuHy

Facteurs de risque cardiovasculaire et facteurs de gravité chez les patients hospitalisés pour épistaxis spontanée

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): N. André, N. Klopp-Dutote, A. Biet-Hornstein, V. Strunski, C. Page
ObjectifsÉvaluer le rôle des facteurs de risque « cardiovasculaire », de la prise de médicaments altérant la crase sanguine et les signes de gravité chez des patients hospitalisés pour épistaxis spontanée.Matériel et méthodesIl s'agissait d'une étude monocentrique, rétrospective, réalisée sur 7 ans dans un centre hospitalier universitaire, ayant inclus 205 patients hospitalisés pour épistaxis spontanée. Ont été notés par patient : les facteurs de « risque cardiovasculaire » (maladie ou antécédent « cardiovasculaire » à risque hémorragique ou thromboembolique, hypertension artérielle, diabète sucré, dyslipidémie), la prise de médicaments modifiant la crase sanguine ; les mesure de la pression artérielle et le taux minimal d'hémoglobinémie au cours de l'hospitalisation. Les patients ont été séparés en deux groupes : épistaxis « graves » et « non graves ».RésultatsIl n'existait pas de différence significative entre les groupes de patients concernant l'âge moyen, le sex-ratio, la présence d'un antécédent d'hypertension artérielle et le nombre de facteurs de « risque cardiovasculaire ». Les patients avec une épistaxis grave avaient des mesures de pression artérielle significativement plus basse que dans le groupe non grave. L'hémoglobinémie était significativement inférieure dans le groupe des épistaxis graves. Il existait un lien entre le nombre de facteurs de risque « cardiovasculaire » par patient et la probabilité d'une transfusion sanguine.ConclusionsLes rôles réels de ces différents facteurs présumés dans la survenue d'une épistaxis spontanée restent encore à élucider, de même que les facteurs de gravité.

https://ift.tt/2GSqIbr

Localisation intra-labyrinthique d’une tumeur sporadique du sac endolymphatique

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): C. Lucas, J.-C. Leclère, E. Mornet, R. Marianowski
IntroductionLes tumeurs du sac endolymphatique sont des tumeurs bénignes, invasives d'évolution lente, envahissant l'os temporal, se manifestant par une surdité unilatérale. Elles peuvent être sporadiques ou s'intégrer dans un syndrome de von Hippel-Lindau (VHL).Résumé du casNous rapportons le cas d'une tumeur développée dans l'utricule dont l'aspect histologique et immunohistochimique correspond à une tumeur du sac endolymphatique, chez un patient indemne de VHL.DiscussionLes tumeurs du sac endolymphatique sont des lésions lysant l'os temporal, situées dans la partie postérieure de l'os pétreux. D'après deux études concernant des patients atteints de von Hippel-Lindau, les tumeurs du sac endolymphatique seraient développées aux dépens du canal endolymphatique. Notre observation d'un développement intra-labyrinthique d'une tumeur du sac endolymphatique sporadique est en faveur de cette hypothèse pour les formes sporadiques et plaide pour une labyrinthectomie associée au geste d'exérèse tumorale afin d'éviter les récidives.

https://ift.tt/2ItLdbw

La pharyngo-laryngoplastie par voie endoscopique : à propos d’un cas

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): A. Baguan, C.A. Righini, P.F. Castellanos, I. Atallah
IntroductionToute thérapeutique permettant la décanulation des malades trachéotomisés et dépendants de leur canule leur apporte un confort et permet pour ceux-ci et permet en outre de réduire les coûts de santé publique.Résumé du cas cliniqueNous exposons le cas d'un patient de 70 ans trachéotomisé dans les suites d'une radiothérapie pour un cancer du larynx en rémission depuis 13 ans avec des échecs de décanulation. Il présentait une sténose pharyngolaryngée. Une pharyngo-laryngoplastie par voie endoscopique a été réalisée en adoptant les techniques reconnues de la microchirurgie reconstructrice au laser par voie transorale. Des sutures par voie endoscopique ont été réalisées et sécurisées par des clips afin de remodeler le pharyngo-larynx et d'éviter la récidive des synéchies. La chirurgie a permis la décanulation définitive de ce patient.DiscussionLa chirurgie endoscopique pharyngo-laryngée a été initialement développée pour la résection des tumeurs à des stades localisés. Plus récemment, la microchirurgie reconstructrice au laser par voie transorale a été développée. Elle présente un intérêt fonctionnel permettant une reconstruction pharyngolaryngée destinée à traiter les séquelles de la chirurgie ou/et de la radiothérapie des cancers des voies aérodigestives supérieures. Elle permet de reconstruire les voies aériennes supérieures restaurant une respiration buccale chez les patients trachéotomisés favorisant leur décanulation.

https://ift.tt/2GX5Csr

Lymphome de la zone marginale de localisation méningée : le piège du méningiome

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): A. Villeneuve, F. Rubin, P. Bonfils
ObjectifPrésenter un cas de lymphome de la zone marginale de type MALT de la méninge temporale dans lequel un diagnostic initial de méningiome temporal avait été initialement porté.ObservationPatiente de 60 ans immunocompétente suivie depuis plus de 10 ans pour un méningiome en plaque temporal (ou ostéoméningiome) responsable de vertiges et d'hypoacousie mixte. L'apparition d'une adénopathie cervicale a conduit à mettre en évidence une progression importante de la lésion intracrânienne et à poser le diagnostic de lymphome de la zone marginale grâce à l'examen histologique de l'adénopathie cervicale. Le traitement par 6 cures de Rituximab et Bendamustine a permis une rémission complète de l'atteinte cervicale et de l'atteinte intracrânienne, confirmant qu'il s'agissait d'un lymphome dural temporal.ConclusionLe lymphome dural primitif doit faire partie du diagnostic différentiel du méningiome, la surveillance au long terme permettant de redresser le diagnostic.

https://ift.tt/2IubZAq

Comment utiliser à moindre coût l’impression 3D comme aide à la reconstruction mandibulaire ?

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): A. Dupret-Bories, S. Vergez, T. Meresse, F. Brouillet, G. Bertrand
L'impression en 3 dimensions est en plein essor dans le domaine médical. Cette technologie accroît les possibilités de traitement personnalisé pour les patients tout en abaissant les coûts de fabrication. Dans le cadre des reconstructions de mandibule par lambeau libre de fibula, des sociétés proposent, à l'heure actuelle, des guides de coupe obtenus par moulage à partir de scanner. Outre les délais de réalisation importants i.e. minimum 21jours, ces guides sont vendus à des coûts prohibitifs (2000 à 6000 euros). Conjointement avec le CNRS, des étudiants ingénieurs, une société biomédicale, les auteurs ont mis au point des guides de coupe et des fantômes de mandibule imprimés en 3 dimensions, livrables en 7jours et à moindre coût. La nouveauté de ce projet réside dans la rapidité d'élaboration des produits et la réduction importante de leur prix. Les auteurs proposent de décrire dans cette note technique la chaîne logistique de réalisation des fantômes et des guides de coupe ainsi que les résultats apportés. L'objectif est de permettre dans un avenir proche l'accès à cette technologie pour tous les patients.

https://ift.tt/2GX5zgf

La chirurgie endoscopique de la fente olfactive

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): R. Jankowski, C. Rumeau, P. Gallet, D.T. Nguyen, A. Russel, B. Toussaint
La fente olfactive est le siège électif de tumeurs spécifiques (hamartome épithélial respiratoire adénomatoïde, adénocarcinome intestinal, neuroblastome olfactif, papillome inversé, glomangiopéricytome, …). Elle est aussi le site de rhinoliquorrhées particulières appelées cribri-liquorrhées. En conséquence la chirurgie de la fente olfactive se doit d'être pensée en tant que chirurgie spécifique, complémentaire de la chirurgie des masses latérales de l'ethmoïde et de celle de la fosse cérébrale antérieure. Les tumeurs développées à partir de la fente olfactive peuvent être réséquées selon cinq procédés chirurgicaux différents : mucosectomie de fente olfactive, résection partielle de fente olfactive, résection totale de fente olfactive, résection cranio-ethmoïdale endoscopique unilatérale, et résection cranio-ethmoïdale endoscopique bilatérale. Le diagnostic et la fermeture des cribri-liquorrhées (rhinoliquorrhée prouvée dont l'origine au niveau de la lame criblée est affirmée au cours d'une endoscopie des fentes olfactives sous anesthésie générale chez un patient dont l'imagerie n'a pas permis de localiser le site de la brèche) complète ce nouvel arsenal chirurgical.

https://ift.tt/2GCSQfr

L’organe oublié

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): L.-M. Roussel, C. Escalard, M. Hitier

https://ift.tt/2GS6rCK

Une tumeur cervicale inusitée

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): A. Gaudreau, A. Belisle, T. Ayad

https://ift.tt/2ItnyYB

Physiologie de l’ostium des sinus paranasaux : observations endoscopiques

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): R. Jankowski, C. Rumeau

https://ift.tt/2GX5oBB

The burden of allergic rhinitis and allergic rhinoconjunctivitis on adolescents: a literature review

To evaluate the literature regarding the burden of allergic rhinitis (AR) and allergic rhinoconjunctivitis (ARC) in adolescents (10-19 years).

https://ift.tt/2uN5nLM

CORRECTION

https://ift.tt/2Jluath

Effect of changing postoperative pain management on bleeding rates in tonsillectomy patients

To review rates of post-tonsillectomy hemorrhage (PTH) at a quaternary medical center, including the impact of narcotic versus nonsteroidal anti-inflammatory drug (NSAID) postoperative pain management.

https://ift.tt/2q6JGk7

A boy presenting with chronic ear drainage and associated middle ear mass

11-year old male presented to the clinic with a chronically draining ear and associated hearing loss. He was treated two months ago by his pediatrician for otitis media with amoxicillin but continued to have drainage. He underwent an audiogram which showed a left sided maximal conductive hearing loss. He had no history of ear tubes or surgery. He passed his newborn hearing screen and subsequent audiograms until recently.

https://ift.tt/2He8ZZO

In whom does horizontal canal BPPV recur?

The objective of this study is to examine the rate of horizontal canal BPPV recurrence of the same type and search for predisposing factors.

https://ift.tt/2q7cxEL

Warthin’s tumour in oral and maxillofacial regions: an 18-year retrospective study of 1084 cases in an eastern-Chinese population

There is little information in the English-language literature regarding Warthin's tumour (WT) in the eastern-Chinese population. A large retrospective study (1084 primary tumours over a period of 18years) was carried out to investigate the clinicopathological features (patients' gender, age and tumour location) of these tumours in this population. A total of 994 (91.7%) patients were male and 90 (8.3%) were female, with a male/female ratio of 11:1. The mean age was 56.48years (range 20–89years), with a peak incidence in the fifth to seventh decade (82.1%).

https://ift.tt/2Is5j5W

Three-dimensional radiographic evaluation of root migration patterns 4–8.5 years after lower third molar coronectomy: a cone beam computed tomography study

This prospective study in patients with a follow-up of 4–8.5years aimed to describe the long-term, three-dimensional changes of coronectomized lower third molar roots. Pre- and postoperative cone beam computed tomography (CBCT) scans were compared. The distance of root migration, the direction of root translation and rotation, and the amount of bone regeneration at the adjacent second molar and superficially to the third molar root were recorded. Age, gender, time elapsed following surgery, the status of the retained root including, impaction pattern and depth of impaction were tested to check if they were influencing factors for the above outcomes.

https://ift.tt/2JjkYpt

Postoperative bleeding risk of direct oral anticoagulants after oral surgery procedures: a systematic review and meta-analysis

Direct oral anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban; DOACs) have been introduced to improve safety and superior therapeutic value compared to their predecessors such as warfarin or enoxaparin. The aim of this systematic review and meta-analysis was to assess the postoperative bleeding risk of DOACs during oral surgery procedures. Systematic searches were performed in electronic databases including PubMed, Scopus, Web of Science and Cochrane Library. Thirteen studies were included in the qualitative synthesis: two retrospective case–control studies, five prospective case–control studies, three cross-sectional studies, two case series and a case report; while only six studies were statistically analysed.

https://ift.tt/2IurkBa

Combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps for the restoration of through-and-through defects of the mandible following salvage surgery for recurrent head and neck tumours

This study was performed to evaluate the outcomes of combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps for the restoration of through-and-through defects of the mandible. The subjects were six patients with recurrent malignant tumours who underwent salvage surgeries and reconstruction with combined flaps based on the transverse cervical vessels (TCVs). All patients had combined bone (four type H, one type LCL, and one type C) and extensive soft tissue defects (through-and-through defects) following salvage surgery.

https://ift.tt/2JhKg7z

Clinical features and presentation of oral potentially malignant disorders

Publication date: Available online 4 April 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Saman Warnakulasuriya
Oral potentially malignant disorders (OPMDs) are conditions that precede the appearance of invasive cancers of the oral cavity. The term embraces both precancerous lesions and conditions referred to in the earlier WHO definitions. Leukoplakia is the most common OPMD; erythroplakia though rare is more serious. Several variants of leukoplakia are recognized and clinical subtyping could help in predicting the prognosis to a limited extent. Biopsy is essential to confirm the provisional clinical diagnosis and timely referral to a specialist is indicated. Certain OPMDs such as oral submucous fibrosis are encountered particularly in population groups from Asia with specific life-style habits. This review provides clinical descriptions of the wide range of PMDs encountered in the oral cavity as a prelude to the topics discussed in this focus issue.

https://ift.tt/2GzvJ9D

Molecular markers associated with development and progression of potentially premalignant oral epithelial lesions: current knowledge and future implications

Publication date: Available online 4 April 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Nikolaos G. Nikitakis, Monica Pentenero, Maria Georgaki, Catherine F. Poh, Douglas E. Peterson, Paul Edwards, Mark Lingen, John J. Sauk
Identification and management of potentially premalignant oral epithelial lesions (PPOELs) at highest risk of malignant transformation (MT) holds great promise for successful secondary prevention of oral squamous cell carcinoma (OSCC), potentially reducing oral cancer morbidity and mortality. However, to date, neither clinical nor histopathologic validated risk predictors have been identified that can reliably predict which PPOELs will definitively progress to malignancy. In addition, the management of PPOELs remains a major challenge. Arguably, progress in the prevention and treatment of oral premalignancy and cancer will require improved understanding of the underlying molecular mechanisms, facilitating the discovery of diagnostic, prognostic and predictive markers, as well as the identification of novel targeted therapeutics.This review provides a synopsis of the molecular biomarkers that have been studied in PPOELs and have been correlated with the presence and grade of dysplasia and/or their propensity to undergo MT to OSCC. The emphasis is on highlighting new emerging research fields, particularly epigenetic events, including methylation and miRNA regulation. Several promising biomarkers are highlighted. Current limitations and challenges are discussed. Recommendations for future focused research areas, in order to validate and promote clinically useful applications, are offered.

https://ift.tt/2GBhXiC

Septal anchoring suture: a key suture to improve the nasolabial symmetry in unilateral cheiloplasty

Publication date: Available online 4 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): T.-C. Lu, S. Filson, C.-F. Yao, P.K.-T. Chen
Since 2008, a septal anchoring suture has been used in unilateral cleft lip repair at Chang Gung Memorial Hospital in order to stabilize the lateral lip centrally. This study compared the symmetry of two groups of patients: those treated with and without an anchoring suture. Multiple standardized direct and photographic facial measurements were performed on the faces of all patients pre-cheiloplasty and at 5 years post-cheiloplasty. The degree of nasolabial symmetry was evaluated by comparing the ratios of measurements of the cleft vs. non-cleft sides. The ratio of change in these measurements was also compared postoperatively. The vertical lip length ratio approached 1 in the septal anchoring suture group, which differed significantly from the group without the suture (0.968 vs. 0.873, P<0.001). As expected, the horizontal lip length and central lip height ratios showed no statistically significant change. The ratio of change from pre- to postoperative also showed a significant improvement (P=0.028) in the vertical lip length of the group with the septal anchoring suture compared to the one without. The septal anchoring suture is a useful method to correct the tendency of the lip to shift to the cleft side.

https://ift.tt/2EkcKd1

Endocytoscopy for in situ real-time histology of oral mucosal lesions

Publication date: Available online 4 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): I. Miyamoto, N. Yada, K. Osawa, I. Yoshioka
This study investigated the utility of endocytoscopy, a novel emerging endoscopic system, for in situ real-time histology of oral mucosal lesions. Endocytoscopy involves the use of a contact light microscopy system with 380-fold magnification. With the development of endoscopic instruments, it has become possible to observe the abnormal microvascular and capillary patterns of tumour cells. The resolution of the endoscopic image is improved in situ, and a more detailed diagnosis is possible. In this study, endocytoscopy along with other diagnostic modalities was used in nine patients. Normal mucous membranes and oral malignant lesions were observed. Endocytoscopy enabled the pathological diagnosis of oral malignancies in situ and the observation of both structural and cytological atypia. In the future, it is expected that pathological diagnoses will be made in situ by direct viewing of living cells. This technique has the potential to allow an 'optical biopsy'.

https://ift.tt/2Gx6ILW

Combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps for the restoration of through-and-through defects of the mandible following salvage surgery for recurrent head and neck tumours

Publication date: Available online 4 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): W.-l. Chen, Z.-q. Huang, B. Zhou, Y. Wang, R. Chen
This study was performed to evaluate the outcomes of combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps for the restoration of through-and-through defects of the mandible. The subjects were six patients with recurrent malignant tumours who underwent salvage surgeries and reconstruction with combined flaps based on the transverse cervical vessels (TCVs). All patients had combined bone (four type H, one type LCL, and one type C) and extensive soft tissue defects (through-and-through defects) following salvage surgery. All tumours were removed and the complex defects restored successfully. Two patients experienced minor complications: one minor intraoral flap failure and one case of wound dehiscence at the donor site. The appearance of the face and neck was satisfactory or acceptable in all patients. No patient showed severely limited range of motion of the upper limb. The patients were followed up for 10 to 18months. One patient was living with no evidence of disease. The use of combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps based on the TCVs may be an effective approach for the restoration of through-and-through defects of the mandible and may provide satisfactory or acceptable functional and aesthetic outcomes following salvage surgery for advanced head and neck tumours.

https://ift.tt/2Ek8zOs

A boy presenting with chronic ear drainage and associated middle ear mass

Publication date: Available online 4 April 2018
Source:American Journal of Otolaryngology
Author(s): Kaelen Black, Jonathan Murnick, Brian K. Reilly

https://ift.tt/2GUrRyY

Pollen and spore monitoring in the world

Ambient air quality monitoring is a governmental duty that is widely carried out in order to detect non-biological ("chemical") components in ambient air, such as particles of

https://ift.tt/2GDK1SA

Comparison of the computer–aided articulation therapy application with printed material in children with speech sound disorders

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Rana Dural, Özlem Ünal–Logacev
ObjectivesThe aim of the present study was to develop an iPad application for computer–aided articulation therapy called the Turkish Articulation Therapy Application (TARTU), and make comparisons between the efficacy of TARTU and printed material.MethodA single subject research design, adapted alternating treatments model, was used for this purpose. The study was carried out with 2 children, at the age of 5; 1 and 5; 11, both of whom have a speech sound disorder. The comparison between TARTU and printed material effectiveness was compared for three target sounds (/k/, /ʃ/ and /l/). 12 therapy sessions were carried out three times a week using the behavioural approach. One participant received therapy targeting the sound /k/ using TARTU, while printed material used for the sound /ʃ/. The targeted sounds were switched for the second participant. Sound /l/ was left without any intervention.ResultThe target sound met the criterion with TARTU in one participant, and with printed material in the other participant.ConclusionThe presentation type of the materials did not play an important role in the success of the therapy on the participants.

https://ift.tt/2GALcSG

Association of Hidradenitis Suppurativa With T Helper 1/T Helper 17 Phenotypes

This case series uses semantic map analysis to assess the association of hidradenitis suppurativa with T helper 1/T helper 17 phenotypes.

https://ift.tt/2uKV0Id

Task Shifting in Dermatology—A Call to Action

To the Editor In response to the Evidence Synopsis by Brown et al on the practice of task shifting, we would like to highlight how task shifting is currently being successfully implemented in health programs in India, with emphasis on National Leprosy Eradication Program.

https://ift.tt/2q5q0Oq

Indoor Tanners as a Priority Population for Skin Cancer Screening

The study by Heckman et al published in this issue of JAMA Dermatology makes a significant contribution to our understanding of skin cancer screening for indoor tanners. The literature contains only a handful of studies that examined skin screening prevalence and factors that may be associated with this practice among indoor tanners. The National Health Interview Survey (NHIS), a national probability survey of the US adult population, collects data on skin screening and indoor tanning and provides a valuable opportunity to examine potential factors associated with these practices in a large sample. Results of previous studies of skin screening and indoor tanning using NHIS data have been mixed, possibly because of differences in methods and sampling. One study of 2010 NHIS data found a positive association between indoor tanning in the past year and ever having had a skin examination, whereas another study of a subsample of the 2015 NHIS data found no association.

https://ift.tt/2GxkEBH

Prevalence of Delusional Infestation—A Population-Based Study

This population-based study reports the prevalence of delusional infestation in Olmsted County, Minnesota.

https://ift.tt/2q3saOG

Atorvastatin in Combination With Narrowband UV-B in Adult Patients With Active Vitiligo

This randomized clinical trial evaluates the use of atorvastatin combined with narrowband UV-B therapy vs narrowband UV-B therapy alone in adult patients with active vitiligo.

https://ift.tt/2uL4JhD

Task Shifting in Dermatology—A Call to Action—Reply

In Reply We greatly appreciate the response by Bishnoi et al to "Task Shifting in Dermatology: A Call to Action." Their group's use of task shifting for early diagnosis of leprosy throughout remote areas of India is highly commendable. They emphasize that the challenges of task shifting include both the need for well-resourced training centers and "meticulous strategies." As outlined in their letter, task shifting involves training of an available workforce to meet previously unmet needs in the health care system, which may include community and individual education, diagnosis, referral to tertiary care centers, or treatment. We propose task shifting as a potential means to meet dermatologic needs specifically in lower- and middle-income countries. Worldwide, there exists an inequitable dermatologic treatment gap, and dermatologic disease is the fourth leading cause of morbidity globally. What is lacking are large-scale trials assessing the efficacy of (1) training of these health care workers and (2) implementation of task-shifting interventions, specifically in areas of dermatology diagnosis, triage, and treatment. Assessment of efficacy in the dermatologic setting is necessary prior to scaling up task-shifting interventions. The field of psychiatry has demonstrated through large randomized clinical trials in lower- and middle-income countries that community health care providers can effectively implement psychological therapies for diseases such as depression and alcoholism, and we propose that task shifting in dermatology be similarly systematically assessed.

https://ift.tt/2q5q0ho

Skin Cancer Screening Among Indoor Tanners and Nontanners

This survey study of 30 352 participants investigates the association between indoor tanning and skin cancer screening.

https://ift.tt/2GDApY0

Tumour lysis in newborn: spontaneous or secondary to antenatal steroids?

Malignancies are rare in the early neonatal period. Common congenital tumours include malignant teratoma and neuroblastomas. Tumour lysis syndrome is a serious condition usually seen after commencement of chemotherapy for a malignancy. Rare case reports of spontaneous tumour lysis have been reported though not in the newborn period. We report here an instance of tumour lysis syndrome in a newborn with congenital rhabdoid tumour, where the cause was either spontaneous or related to antenatal steroid exposure.

https://ift.tt/2IpjwQY

Surprising cause of a hoarse voice

Description

A 78-year-old woman presented to our otorhinolaryngology clinic with a 5-year history of gradually progressive, worsening dysphonia, associated with some recent weight loss. She denied any dysphagia, odynophagia, otalgia, dyspnoea or neck lumps. She had a significant cardiovascular history and was a non-smoker with no alcohol intake. Using the grade–roughness–breathiness–asthenicity–strain scale, the patient scored a 2/3 for grade and breathiness, 1/3 for roughness and 3/3 for strain. On examination, there was a large left-sided posterior pharyngeal wall swelling occluding most of the oropharynx (figure 1). It was firm, non-pulsatile and non-tender, with a normal overlying mucosal appearance. Flexible nasoendoscopy demonstrated that this swelling extended from the level of the soft palate to just below the level of the epiglottis, with laryngeal displacement to the right. However, there was no airway compression, and the patient had normal, mobile true vocal cords bilaterally. Videolaryngostroboscopy was not possible with...

https://ift.tt/2H8lF47

The burden of allergic rhinitis and allergic rhinoconjunctivitis on adolescents: a literature review

Publication date: Available online 4 April 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Michael S. Blaiss, Eva Hammerby, Susan Robinson, Tessa Kennedy-Martin, Sarah Buchs
ObjectiveTo evaluate the literature regarding the burden of allergic rhinitis (AR) and allergic rhinoconjunctivitis (ARC) in adolescents (10-19 years).Data SourcesSearches were performed in MEDLINE, Embase, Health Technology Assessment Database, and National Health Service Economic Evaluation Database for studies evaluating concepts of symptoms, quality of life (QOL), daily activities, sleep, examination performance, school absenteeism and presenteeism, and treatment burden in adolescents with AR or ARC.Study SelectionsEnglish-language journal articles indexed in the last 15 years describing non-interventional population-based studies. Records were assessed by 2 independent reviewers.ResultsA total of 27 articles were identified; outcomes evaluated were: symptoms (n=6 studies), QOL (n=9), daily activities (n=5), emotional aspects (n=3), sleep (n=6), education (n=7), and treatment burden (n=2). AR symptoms rated most bothersome were rhinorrhea, nasal congestion, and itchy eyes. QOL was worse in adolescents with AR versus controls regardless of QOL instrument used. Nasal symptoms and nasal obstruction were more likely to be associated with poor QOL in adolescents than in adults or younger children, respectively. Daily functioning and sleep were also negatively impacted by AR. In addition, a detrimental effect on absenteeism, school productivity, and academic performance was reported.ConclusionAlthough AR and ARC are sometimes perceived as trivial conditions, this review indicates that their impact on adolescent life is negative and far-reaching. It is critical that clinicians gain a greater understanding of the unique burden of AR and ARC in adolescents to ensure they receive prompt and appropriate care and treatment in order to improve clinical and academic outcomes.

https://ift.tt/2EjY3Xn

Cementum Regeneration Using Stem Cells in the Dog Model: A Systematic Review

Publication date: Available online 3 April 2018
Source:Archives of Oral Biology
Author(s): Jacqueline Crossman, Maryam Elyasi, Tarek El-Bialy, Carlos Flores Mir
ObjectiveRestoring lost tissues of the periodontium, such as cementum, is essential in reducing the risk of tooth loss due to periodontitis and/or severe root resorption. Stem cell therapy is a regenerative strategy in cementum regeneration. This systematic review aimed to analyze the effect of various stem cells and their transplantation method on cementum regeneration in the dog model.MethodsElectronic databases were searched, in addition to performing hand searches and a gray literature search. Titles and abstracts were searched according to the inclusion criteria and full texts were selected to be included in this systematic review. Data was extracted from each article and risk of bias was assessed for individual studies.ResultsMost studies reported that the treatment using a variety of stem cells resulted in significantly greater cementum regeneration.ConclusionsBecause of variations in additional factors included in each study and varied risk of bias among those studies, the effect of each type of stem cell on cementum regeneration in dogs is difficult to clarify. Additional information needs to be obtained from each study in order to further analyze the individual effect of stem cells on cementum regeneration in dogs.

https://ift.tt/2GAQ6z5

Cementum Regeneration Using Stem Cells in the Dog Model: A Systematic Review

Esclerosis múltiple: ventaja izquierda para la lateralidad auditiva en pruebas dicóticas de procesamiento auditivo central y relación de pruebas psicoacústicas con examen de discapacidad-EDEM

Publication date: Available online 3 April 2018
Source:Acta Otorrinolaringológica Española
Author(s): Yolanda Rebeca Peñaloza López, Xóchitl Daisy Orozco Peña, Santiago Jesús Pérez Ruiz
ObjetivoEvaluar los trastornos en procesos centrales de la audición, en pacientes con esclerosis múltiple, enfatizando en lateralidad auditiva mediante la aplicación de pruebas psicoacústicas e identificar la relación de estas con funciones de la Escala de Discapacidad en Esclerosis Múltiple(EDEM).MétodoEn 26 individuos con esclerosis múltiple y 26 controles se aplicaron escala de depresión (HADS), EDEM y 9 pruebas psicoacústicas para estudiar trastornos en los procesos centrales de la audición. Se efectuaron pruebas de correlación entre EDEM y pruebas psicoacústicas.ResultadosSiete de 9 pruebas psicoacústicas fueron diferentes significativamente (p<0,05); derecha o izquierda (14/19 exploraciones) respecto al grupo control. En dígitos dicóticos la izquierda mostró ventaja de aciertos respecto al predominio usual de dígitos dicóticos en la derecha. Hubo correlación significativa en 5 pruebas psicoacústicas y funciones específicas de la Escala de Discapacidad en Esclerosis Múltiple.ConclusiónConviene investigar la ventaja del oído izquierdo detectada como expresión de influencias deficientes del cuerpo calloso y de atención en esclerosis múltiple. Hay correlación entre pruebas psicoacústicas con funciones específicas de EDEM.ObjectiveTo evaluate the central auditory processing disorders in patients with multiple sclerosis, emphasizing auditory laterality by applying psychoacoustic tests and to identify their relationship with the Multiple Sclerosis Disability Scale (EDSS) functions.MethodDepression scales (HADS), EDSS, and 9 psychoacoustic tests to study CAPD were applied to 26 individuals with multiple sclerosis and 26 controls. Correlation tests were performed between the EDSS and psychoacoustic tests.ResultsSeven out of 9 psychoacoustic tests were significantly different (P<.05); right or left (14/19 explorations) with respect to control. In dichotic digits there was a left-ear advantage compared to the usual predominance of RDD. There was significant correlation in five psychoacoustic tests and the specific functions of EDSS.ConclusionThe left-ear advantage detected and interpreted as an expression of deficient influences of the corpus callosum and attention in multiple sclerosis should be investigated. There was a correlation between psychoacoustic tests and specific EDSS functions.

https://ift.tt/2q6n2bL

Infectious complications in head and neck surgery: Porto Oncology Centre retrospective analysis

Publication date: Available online 3 April 2018
Source:Acta Otorrinolaringológica Española
Author(s): Miguel Sá Breda, Joaquim Castro Silva, Eurico Monteiro
ObjectiveTo analyze the impact of infectious complications and microbiology in the postoperative period after major oncologic neck surgeries.MethodsA retrospective study conducted in an oncology center, including all the consecutive patients who developed infectious complications after major neck cancer surgery, from October 2012 to May 2016 (44 months). Among other data, we collected TNM stage, ASA score, body mass index, comorbidities and habits, pre and postoperative hemoglobin levels, albumin serum levels, pre-surgical treatments, length of inpatient stay, isolated microbiological agents and the recorded complications and mortality rate.ResultsIn the studied period, 761 major neck surgeries were performed. Of these, 96 patients had complications (12.6%). Pharyngocutaneous fistula (PCF) was the most frequent complication (56%) and nosocomial pneumonia was the most common systemic complication (23%). Pseudomonas aeruginosa was the principal microorganism of the 26 species isolated (15%). 12 deaths were registered. Using multiple linear regression we concluded that flap/cutaneous necrosis and PCF were complications with statistical significance that prolonged inpatient stay. The same complications had significant relative risk for more than 30 days of hospitalization.ConclusionThe postoperative period is critical for the successful treatment of head and neck oncology patients. PCF and flap/cutaneous necrosis were the principal complications which worsened the outcomes during this critical period. The early recognition and treatment of these complications is crucial.

https://ift.tt/2H7Il4w

Cirugía de rescate en las recidivas locales del carcinoma de nasofaringe

Publication date: Available online 3 April 2018
Source:Acta Otorrinolaringológica Española
Author(s): María Cecilia Salom, Fernando López, Esteban Pacheco, Gabriela Muñoz, Patricia García-Cabo, Laura Fernández, Vanessa Suárez, José Luis Llorente
Introducción y objetivosLa quimiorradioterapia es el tratamiento de elección del carcinoma de nasofaringe. Las recurrencias locales son una de las principales causas de mortalidad en estos pacientes: el rescate quirúrgico o la reirradiación son el tratamiento de elección, según la disponibilidad. El objetivo fue evaluar y comparar los resultados de la cirugía de rescate en el tratamiento de las recidivas locales de los carcinomas nasofaríngeos mediante abordajes abiertos vs. endoscópicos.MétodosVeinte pacientes con recidivas locales de carcinomas nasofaríngeos fueron intervenidos quirúrgicamente: 12 pacientes fueron intervenidos mediante cirugía abierta y 8 mediante un abordaje endoscópico endonasal transpterigoideo. Un paciente fue estadiado como rT1; 3 como rT2; 2 como rT3 y 6 como rT4 en el grupo de abordajes abiertos; en la serie endoscópica, 2 pacientes fueron rT1, 5 fueron rT2 y uno fue rT3.ResultadosEn 3 de los pacientes (25%) intervenidos mediante cirugía abierta (un rT4, un rT3 y un rT2) no se logró una resección macroscópica completa). En el grupo endoscópico la resección fue completa en todos los pacientes. La tasa de complicaciones en el grupo intervenido mediante abordajes abiertos fue del 92% (5 complicaciones leves, 5 complicaciones moderadas y una complicación grave) y en el grupo intervenido mediante endoscopia fue del 100% (7 sufrieron complicaciones leves y un paciente una complicación grave). La supervivencia a los 3 y 5 años fue del 53 y del 42% en el abordaje abierto y del 100 y del 75% en el abordaje endoscópico, respectivamente.ConclusionesLos abordajes endoscópicos disminuyen la morbilidad asociada a los abordajes abiertos y permiten obtener un control oncológico favorable.Introduction and objectivesChemoradiotherapy is the treatment of choice for nasopharyngeal carcinoma. Local recurrences are one of the leading causes of death in these patients, and surgical salvage the treatment of choice. Our goal was to evaluate and compare the results of salvage surgery in the treatment of local recurrence of nasopharyngeal carcinomas comparing endoscopic to open approaches.MethodsTwenty patients with local recurrence of nasopharyngeal carcinomas underwent surgery: 12 patients underwent open surgery and 8 endoscopic endonasal transpterygoid nasopharyngectomy. One patient was classified as rT1; 3 as rT2;2 as rT3; and 6 as rT4 in the group of open approaches; in the endoscopic series, 2 patients were rT1, 5 rT2 and one rT3.ResultsIn 3 patients (25%) operated by an open approach (one rT4, one rT3 and one rT2) a complete gross resection was not achieved. Gross total resection was achieved in patients operated by endoscopic surgery. The complication rate in the group operated by an open approach was 92% (5 minor complications, 5 moderate complications, and one serious complication) and in the group that underwent endoscopic surgery all patients had some complication (7 had minor complications and one patient developed a severe complication). Survival at 3 and 5 years was 53% and 42% with the open approach and 100% and 50% with the endoscopic approach, respectively.ConclusionsEndoscopic approaches decrease the morbidity associated with open approaches and allow for favourable oncological control.

https://ift.tt/2EjlQGS

Fenómeno de vacío intervertebral: una causa de abombamiento de la pared faríngea

Publication date: Available online 4 April 2018
Source:Acta Otorrinolaringológica Española
Author(s): Luis Gorospe, Rosa María Gómez-García, Juan Martínez San Millán

https://ift.tt/2H8KVay

Effects of Branched-Chain Amino Acid Supplementation on Spontaneous Seizures and Neuronal Viability in a Model of Mesial Temporal Lobe Epilepsy

Background: The essential branched-chain amino acids (BCAAs) leucine, isoleucine, and valine have recently emerged as a potential novel treatment for medically refractory epilepsy. Blood-derived BCAAs can readily enter the brain, where they contribute to glutamate biosynthesis and may either suppress or trigger acute seizures. However, the effects of BCAAs on chronic (ie, spontaneous recurrent) seizures and epilepsy-associated neuron loss are incompletely understood. Materials and Methods: Sixteen rats with mesial temporal lobe epilepsy were randomized into 2 groups that could drink, ad libitum, either a 4% solution of BCAAs in water (n=8) or pure water (n=8). The frequency and relative percent of convulsive and nonconvulsive spontaneous seizures were monitored for a period of 21 days, and the brains were then harvested for immunohistochemical analysis. Results: Although the frequency of convulsive and nonconvulsive spontaneous recurrent seizures over a 3-week drinking/monitoring period were not different between the groups, there were differences in the relative percent of convulsive seizures in the first and third week of treatment. Moreover, the BCAA-treated rats had over 25% fewer neurons in the dentate hilus of the hippocampus compared with water-treated controls. Conclusions: Acute BCAA supplementation reduces seizure propagation, whereas chronic oral supplementation with BCAAs worsens seizure propagation and causes neuron loss in rodents with mesial temporal lobe epilepsy. These findings raise the question of whether such supplementation has a similar effect in humans. T.E. and R.D. are supported by grants from the National Institutes of Health (NIH): NINDS R01 NS070824. S.E.G. is supported by grants from the Foundation for Anesthesia Education and Research (FAER) and the NIH: T32 GM086287. This work was also made possible by a grant from the National Center for Advancing Translational Sciences (NCATS; UL1 TR000142), a component of the NIH and the NIH Roadmap for Medical Research. The authors have no conflicts of interest to disclose. Address correspondence to: Tore Eid, MD, PhD, Department of Laboratory Medicine, 330 Cedar St., P.O. Box 208035, Yale School of Medicine, New Haven, CT 06520 (e-mail: tore.eid@yale.edu). Received November 28, 2017 Accepted February 23, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

https://ift.tt/2uKFRXs

Endoscopic management of maxillary sinus inverted papilloma attachment sites to minimize disease recurrence

Inverted papillomas (IPs) are benign neoplasms, most commonly arising from the mucosal lining of the maxillary sinus. IPs can have single or multifocal sites of attachment. Although pedicle location is an impo...

https://ift.tt/2uQrYqS

In-office laryngeal procedures (IOLP) in Canada: current safety practices and procedural care

The advent of chip tip technology combined with advanced endoscopy has revolutionized the field of laryngology in the past decade. Procedures such as transnasal esophagoscopy, site-specific steroid injections,...

https://ift.tt/2JkoBLK

Critical view of anaphylaxis epidemiology: open questions and new perspectives

In contrast to the majority of allergic or hypersensitivity conditions, worldwide anaphylaxis epidemiological data remain sparse with low accuracy, which hampers comparable morbidity statistics. Data can diffe...

https://ift.tt/2GylttW

Interferon-α2b-induced STAT3 suppression in myeloid-derived suppressor cells in mycosis fungoides

https://ift.tt/2q5PdYl

A Prospective Study of Predicting Prognosis and Recurrence of Thyroid Cancer Via New Biomarkers, Urinary Exosomal Thyroglobulin and Galectin-3

Condition: Thyroid Cancer
Intervention:
Sponsor: National Taiwan University Hospital
Not yet recruiting

https://ift.tt/2q4unbA

Incidence, Risk Factors, and Outcomes of Clostridium difficile Infections in Kidney Transplant Recipients

Background Kidney transplant recipients (KTR) may be at increased risk for Clostridium difficile infections (CDI) but risk factors and outcomes in this population have not been well studied. Methods An observational cohort study was conducted to determine the incidence, risk factors, and outcomes of CDI in KTR. A total of 1,816 KTR transplanted between 2000 and 2013 at Toronto General Hospital were included. Sixty-eight patients developed CDI. Controls were selected at a 4:1 ratio using risk-set sampling and risk factors were explored using conditional logistic regression models. The impact of CDI on graft outcomes was evaluated using Cox proportional hazards models. Results The incidence rate of CDI was 0.64 cases/100 person-years. Independent predictors of CDI included antibiotic use (OR 2.88 [95%CI: 1.35, 6.15]), increased duration of hospitalization posttransplant (OR 1.04 [95%CI: 1.02, 1.06]), receiving a deceased donor kidney (OR 2.98 [95%CI: 1.47, 6.05]), and a history of biopsy-proven acute rejection (OR 5.82 [95%CI: 2.22, 15.26]). In the Cox proportional hazards model, CDI was found to be an independent risk factor for the subsequent development of biopsy-proven acute rejection (HR 2.18 [95% CI: 1.34, 3.55]). Conclusions Our results confirm that transplant-specific factors place KTR at a higher risk for CDI. CDI may increase the risk of adverse outcomes such as biopsy-proven acute rejection. These findings emphasize the importance of preventive strategies to reduce the morbidity associated with CDI in KTR. Address correspondence to: S. Joseph Kim, MD, PhD, MHS, FRCPC, Toronto General Hospital, University Health Network, 585 University Avenue, 11-PMB-129, Toronto, Ontario, Canada M5G 2N2. Email: joseph.kim@uhn.ca. Office: 416-340-3228. Fax: 416-340-4701 AUTHORSHIP Research design: G. Li, Trac, Husain, Famure, Y. Li, Kim Writing the paper: G. Li, Trac, Husain, Famure, Kim Performance of the research: G. Li, Trac, Husain, Famure, Kim Contributed analytic tools: G. Li, Trac, Y. Li, Kim Participated in data analysis: G. Li, Trac, Husain, Famure, Y. Li, Kim DISCLOSURE The authors have no conflicts of interest to disclose as it relates to this work. FUNDING No external funding was acquired to support this research. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2H9wfrA

Reduced access to liver transplantation in women: role of height, MELD exception scores and renal function underestimation

Background Sex-based disparities in liver transplantation (LT) are incompletely understood. We assessed the role of height, MELD, MELD-Na and exception points in the disparate access to LT. Methods Adults waitlisted for LT at Organ Procurement and Transplantation Network (OPTN) between 2002 and 2013 were included. Covariates associated with likelihood of LT were analyzed by Cox proportional model. In a separate cohort of waitlisted adults with glomerular filtration rate (GFR) measurement by iothalamate clearance (n=611), we determined the number of creatinine-derived MELD points in men vs women, across all ranges of GFR. The impact of correcting the MELD score deficit in women on LT was modeled. Results Among 90,720 OPTN registrants, women had higher mortality than men (4 years after listing: 22% vs 18%, p

https://ift.tt/2uKZGxN

Long-term outcomes of ABO-incompatible pediatric living donor liver transplantation

Background ABO-incompatible (ABOi) living donor liver transplantation (LDLT) have been performed to compensate for donor shortage. To date, few studies have reported detailed B cell desensitization protocols and long-term outcomes of ABOi pediatric LDLT. Methods Twenty-nine pediatric ABOi LDLT recipients were retrospectively analyzed. We compared the clinical outcomes between ABOi (n = 29) and non-ABOi (n = 131) pediatric LDLT recipients. Furthermore, we evaluated the safety and efficacy of our rituximab-based regimen for ABOi pediatric LDLT (2 ≤ age

https://ift.tt/2H8YWoR

Meeting Report of the 13th Congress of the International Society of Vascularized Composite Allotransplantation

The International Society of Vascularized Composite Allotransplantation (ISVCA) held its 13th congress "Defining Success" in October 2017 in Salzburg, Austria. A total of 122 delegates from 22 countries representing 5 continents attended the conference. The theme strived to provide pathways to accomplish best possible outcomes in this unique and multifaceted field of transplantation. 'Ignite talks', a new feature introduced for the first time at the Salzburg meeting served as key elements for productive discussions on both congress days. The "ignitors" had been selected as experts from Europe, the Americas and Asia in VCA and neighbouring disciplines and provided a global perspective of their topic. Posttransplant treatment regimens, including the most burdensome side effects of immunosuppressants in addition to novel and future therapeutic options were discussed in depth. An additional ethics symposium summarized and advanced topics that had been discussed during the first international workshop on bioethical challenges in reconstructive transplantation held earlier in 2017. Correspondence Annemarie Weissenbacher, MD, Oxford Transplant Centre, Nuffield Department of Surgical Sciences, University of Oxford, Old Road, Oxford, OX3 7LE, United Kingdom. Tel.: +447481147692. E-mail: annemarie.weissenbacher@nds.ox.ac.uk Authorship AW: local organising chair and chair of the SPC for the ISVCA congress, wrote the meeting report; LC, EM, PP, GB, PJF, VG, CK, JK, LSL, GV, SS: SPC members, participated in editing the meeting report Disclosure The authors declare no conflicts of interest. The authors have no funding to disclose. Funding No funding received. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2uLTZiZ

Pancreas Transplantation from pediatric donors: a single center experience

Background Pancreas allografts from pediatric donors are considered less suitable due to the increased risk of surgical complications and reduced islet cell mass that may compromise function. Methods All pancreatic transplants, procured from donors 60kg. Analysis of patient and graft survival was done between the groups, and subsequently between the pediatric cohort and the adult-donor control group. Results Sixty-three pediatric-donor pancreas transplants were performed. The mean donor age and weight were of 12.10±4.13 years and 47.8±21.3kg. Excellent metabolic control was achieved in 59 (93.65%) patients at the time of discharge and at a mean 5 year follow up, with the average hemoglobin A1c of 5.30 ±0.61% and blood glucose level of 102.75±20.70 mg/dL in those with a functioning graft. Nine graft losses were registered, of which one (1.6%) was due to arterial thrombosis. Eight (12.7%) patients experienced rejection. Overall graft survival and patient survival were of 85.7% and 92.1%, respectively, at a median follow up of 37.07 months (min 0.19 – max 119.57). No differences amongst the 3 groups were identified. Long term patient and allograft survival was comparable to that of the adult-donor pancreatic transplants. Conclusion Pediatric-donor pancreas demonstrated excellent short-term outcomes with no surgical complications and promising long-term outcomes despite the smaller islet mass. Pancreata from pediatric donors should not be marginalized and can offset worsening organ shortage. Corresponding Author: Mario Spaggiari, MD, Department of Surgery, University of Illinois at Chicago, 840 South Wood Street, Clinical Sciences Building, Suite 522, Chicago, Illinois 60612. Telephone: 312-996-6771. Fax: 312-413-3483. mspaggia@uic.edu Authorship: Mario Spaggiari participated in study design, statistical analysis, and writing. The author declares no conflict of interest. Caterina Di Bella participated in study design, statistical analysis, and writing. The author declares no conflict of interest. Pierpaolo Di Cocco participated in study design, statistical analysis and writing. The author declares no conflict of interest. Maya Campara participated in writing and critical review. The author declares no conflict of interest. Kelly Galen participated in writing and critical review. The author declares no conflict of interest Federico Gheza participated in data analysis and critical review. The author declares no conflict of interest. Jose Oberholzer participated in critical review and study design. The author declares no conflict of interest. Enrico Benedetti participated in critical review and study design. The author declares no conflict of interest. Ivo G. Tzvetanov participated in critical review and study design. The author declares no conflict of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2H9wbrQ

Tofacitinib halts progression of graft dysfunction in a rat model of mixed cellular and humoral rejection

Background The progression from acute to chronic antibody-mediated rejection in kidney transplant recipients is usually not prevented by current therapeutic options. Here, we investigated whether the use of tofacinitib, a Janus kinase 3 inhibitor, was capable of preventing the progression of allograft dysfunction in a Fisher-to-Lewis rat model of kidney transplantation. Methods Rats were treated from the third week after transplantation in order to allow the development of rejection. Treatment was based on cyclosporin A, rapamycin or tofacitinib. Renal function was assessed at 1, 4, 8 and 12 weeks after transplantation while rat survival, histological lesions and infiltrating lymphocytes were analyzed at 12 weeks. Results Tofacitinib prolonged graft survival, preserved tubular and glomerular structures and reduced humoral damage characterized by C4d deposition. Tofacitinib was able to reduce donor-specific antibodies. In addition, T and NK cell graft infiltration was reduced in tofacitinib treated rats. Although rapamycin treated rats also showed prolonged graft survival, glomerular structures were more affected. Moreover, only tofacitinib treatment reduced the presence of T, B and NK cells in splenic parenchyma. Conclusions Tofacitinib is able to reduce the immune response generated in a rat model of kidney graft rejection, providing prolonged graft and recipient survival, better graft function and less histological lesions. CORRESPONDING AUTHOR Fritz Diekmann, MD, Hospital Clínic de Barcelona, Department of Nephrology and Renal Transplantation, Villarroel 170 (Escala 12 – Planta 5). E-08036 Barcelona, Spain. Tel.: +34-932275444. Fax: +34-934546033. fdiekman@clinic.ub.es Authorship Jordi Rovira: participated in research design, performance of research, data analysis and writing of the paper. María J Ramírez-Bajo: participated in data analysis, performance of research. Elisenda Banon-Maneus: participated in data analysis, performance of research. Marta Lazo-Rodríguez: participated in data analysis, performance of research. Daniel Moya-Rull: participated in data analysis, performance of research. Natalia Hierro-Garcia: participated in data analysis, performance of research. Valeria Tubita: participated in data analysis, performance of research. Gastón J Piñeiro: participated in data analysis, performance of research. Ignacio Revuelta: participated in data analysis, performance of research. Pedro Ventura-Aguiar: participated in data analysis, performance of research. David Cucchiari: participated in data analysis, critical revision of the manuscript for important intellectual content. Federico Oppenheimer: critical revision of the manuscript for important intellectual content. Mercè Brunet: participated in data analysis, critical revision of the manuscript for important intellectual content. Josep M Campistol: critical revision of the manuscript for important intellectual content. Fritz Diekmann: participated in research design, data analysis and writing of the paper. Disclosure The authors declare no conflicts of interest. Funding This study has been funded by the project PI11/01112 and Redes Tematicas De Investigacion Cooperativa En Salud, REDINREN (RD12/0021/0028 and RD16/0009/0023) both co-funded by ISCIII-Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER) "Una manera de hacer Europa". CERCA Programme/Generalitat de Catalunya. This work was developed at the Centre de Recerca Biomèdica Cellex, Barcelona, Spain. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2IsMQGy

IL-17-producing-ST2+ILC2 plays a pathogenic role in lung inflammation

Publication date: Available online 3 April 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Ting Cai, Jinxin Qiu, Yan Ji, Wenjing Li, Zhaoyun Ding, Caixia Suo, Jiali Chang, Jingjing Wang, Rui He, Youcun Qian, Xiaohuan Guo, Liang Zhou, Huiming Sheng, Lei Shen, Ju Qiu
BackgroundIL-17 plays a pathogenic role in asthma. ST2⁻iILC2s (inflammatory group 2 innate lymphoid cells) driven by IL-25 can produce IL-17, while ST2⁺nILC2s (natural ILC2s) produce few IL-17.ObjectiveWe characterized the ST2⁺IL-17⁺ILC2s during lung inflammation and determined the pathogenesis and molecular regulation of ST2⁺IL-17⁺ILC2s.MethodsLung inflammation was induced by papain or IL-33. IL-17 production by lung ILC2s from wild-type, Rag1^−/−, Rorc^gfp/gfp and Ahr^−/− mice was examined by flow cytometry. Bone marrow transfer experiment was performed to evaluate hematopoietic MyD88 signaling in regulating IL-17 production by ILC2s. mRNA expression of IL-17 was analyzed in purified naïve ILC2s treated with IL-33, leukotrienes and inhibitors for NFAT, p38, JNK or NF-κB. The pathogenesis of IL-17⁺ILC2s was determined by transferring wild-type or Il17^−/−ILC2s to Rag2^−/−Il2rg^−/− mice which were further induced lung inflammation. Finally, the expression of 106 ILC2 signature genes was compared between ST2⁺IL-17⁺ILC2s and ST2⁺IL-17⁻ILC2s.ResultsPapain or IL-33 treatment boosted IL-17 production from ST2⁺ILC2s (we name them as ILC217), but not ST2⁻ILC2s. Ahr, but not RORγt, facilitated the production of IL-17 by ILC217s. Hematopoietic compartment of MyD88 signaling is essential for the induction of ILC217s. IL-33 works in synergy with leukotrienes, which signal through NFAT activation, to promote IL-17 in ILC217s. Il17^−/− ILC2s were less pathogenic in lung inflammation. ILC217s concomitantly expressed IL-5 and IL-13 but expressed few GM-CSF.ConclusionDuring lung inflammation, IL-33 and leukotrienes synergistically induce ILC217s. ILC217s are highly pathogenic and unexpected source for IL-17 in lung inflammation.

In the era of opioid epidemic, several lines of evidence have emerged to support non-opioid-based drugs and approaches along with a few newer opioid formulations for postoperative pain management, although more research is needed to find the right balance of efficacy and safety.

https://ift.tt/2GUJIWC

Αρχειοθήκη ιστολογίου

Τετάρτη 4 Απριλίου 2018

Teaser

Abstract

Purpose of Review

Recent Findings

Summary

Abstract

Purpose of Review

Recent Findings

Summary

Abstract

Purpose of Review

Recent Findings

Summary

Abstract

Purpose of the Review

Recent Findings

Summary

Abstract

Purpose of Review

Recent Findings

Summary

Abstract

Purpose of Review

Recent Findings

Summary