Publication date: May–June 2018
Source:Allergologia et Immunopathologia, Volume 46, Issue 3
Author(s): L. Garcia-Marcos
https://ift.tt/2GDsAkQ
Πέμπτη 5 Απριλίου 2018
Wheezing in infants: A pandemic condition that need to be treated with patience
An Online Survey of Hypothyroid Patients Demonstrates Prominent Dissatisfaction
Thyroid, Ahead of Print.
https://ift.tt/2GDpT6U
Food Protein-Induced Enterocolitis Syndrome (FPIES): Review of Recent Guidelines
Abstract
Purpose of Review
To increase understanding of food protein-induced enterocolitis syndrome (FPIES), a non-immunoglobulin E (IgE)-mediated reaction to food, by reviewing a growing body of literature, including recently published international consensus guidelines.
Recent Findings
FPIES primarily affects infants and young children and is characterized by the delayed onset of gastrointestinal symptoms, predominantly repetitive vomiting, in response to a trigger food. Symptoms are often severe and can lead to shock. Diagnosis can be challenging due to a wide differential diagnoses and lack of disease biomarkers. FPIES is a clinical diagnosis, with allergy testing playing a very limited role, if any. Medically supervised oral food challenges are used to monitor resolution of disease, which generally occurs in early childhood.
Summary
FPIES is an important condition presenting to clinicians in a variety of settings. Recent international consensus guidelines and a growing body of literature can better equip practitioners to care for these often-challenging patients.
https://ift.tt/2uOOUGG
Dentin sealing and antibacterial effects of silver-doped bioactive glass/mesoporous silica nanocomposite: an in vitro study
Abstract
Objectives
To synthesize a silver-doped bioactive glass/mesoporous silica nanoparticle (Ag-BGN@MSN), as well as to investigate its effects on dentinal tubule occlusion, microtensile bond strength (MTBS), and antibacterial activity.
Materials and methods
Ag-BGN@MSN was synthesized using a modified "quick alkali-mediated sol-gel" method. Demineralized tooth disc models were made and divided into four groups; the following treatments were then applied: group 1—no treatment, group 2—bioglass, group 3—MSN, group 4—Ag-BGN@MSN. Next, four discs were selected from each group and soaked into 6 wt% citric acid to test acid-resistant stability. Dentinal tubule occlusion, as well as the occlusion ratio, was observed using field-emission scanning electron microscopy. The MTBS was also measured to evaluate the desensitizing effect of the treatments. Cytotoxicity was examined using the MTT assay. Antibacterial activity was detected against Lactobacillus casei, and ion dissolution was evaluated using inductively coupled plasma optical emission spectrometry.
Results
Ag-BGN@MSN effectively occluded the dentinal tubule and formed a membrane-like layer. After the acid challenge, Ag-BGN@MSN had the highest rate of dentinal tubule occlusion. There were no significant differences in MTBS among the four groups (P > 0.05). All concentrations of Ag-BGN@MSN used had a relative cell viability above 72%.
Conclusions
Ag-BGN@MSN was successfully fabricated using a modified sol-gel method. The Ag-BGN@MSN biocomposite effectively occluded dentinal with acid-resistant stability, did not decrease bond strength in self-etch adhesive system, had low cytotoxicity, and antibacterial effect.
Clininal relevance
Dentinal tubule sealing induced by Ag-BGN@MSN biocomposite with antibacterial effect is likely to increase long-term stability in DH.
https://ift.tt/2GYxEUp
Comparison of Two Protocols of Misoprostol (PGE1) and the Rate of Cesarean Section Due to Failed Induction.
Condition: Induction of Labor
Interventions: Procedure: 6 misoprostol; Procedure: 3 misoprostol
Sponsors: Saint Thomas Hospital, Panama; Sistema Nacional de Investigadores de Panamá
Not yet recruiting
https://ift.tt/2JoUqmM
Interventions: Procedure: 6 misoprostol; Procedure: 3 misoprostol
Sponsors: Saint Thomas Hospital, Panama; Sistema Nacional de Investigadores de Panamá
Not yet recruiting
https://ift.tt/2JoUqmM
Remote Activity Monitored by Fitbit Charge 2 in Investigating Daily Step and Sleep Data in Participants With Head and Neck Cancer Undergoing Radiation Therapy
Condition: Head and Neck Carcinoma
Intervention: Device: Monitoring Device
Sponsor: Sidney Kimmel Cancer Center at Thomas Jefferson University
Not yet recruiting
https://ift.tt/2Ix9Mo4
Intervention: Device: Monitoring Device
Sponsor: Sidney Kimmel Cancer Center at Thomas Jefferson University
Not yet recruiting
https://ift.tt/2Ix9Mo4
Assessment of Histopathological Grade and Ki-67 Expression in Tobacco and Non-tobacco Habitual Buccal Mucosa Cancer
Abstract
Although there are various risk factors in the literature, the established primary risk factor for oral cancer is tobacco and betal-nut chewing habits. It is believed that pathogenesis of oral cancer depends on the aetiology. To assess the histopathological grade and Ki-67 expression in tobacco (smoking/smokeless) and non-tobacco (betal nut/pan masala) habitual buccal mucosa cancer. The cross-sectional study was carried out in Regional cancer centre, Tamilnadu. Proliferative marker, Ki-67 expression was determined by immunohistochemistry using biotin-streptavidin method. The study includes 117 buccal mucosa cancer patients (61 male and 56 female). According to WHO grading system, high frequency observed with well differentiated squamous cell carcinoma 48 (41%) followed by moderate 46 (39.3%) and poorly differentiated 23 (19.7%). The cut-off value 50% was used to categorize Ki-67 expression into low and high labelling index (LI); 96 (82%) buccal mucosa cancer and 4 (3.4%) adjacent normal mucosa patients showed high Ki-67 expression. The present study showed highly significant association of histopathological tumor grade and Ki-67 expression by Chi square and paired t test p < 0.05. All the patients were grouped as tobacco 87 (74.4%) and non-tobacco habitual 30 (25.6%) in 3:1, respectively. Further, the risk habits identified with significant differences of tumor grade (p = 0.028) and Ki-67 at p < 0.05. Thus, the study revealed that the nature of cell differentiation and proliferation was strongly related to consumption of carcinogen in both tobacco and non-tobacco form. Therefore, histopathological grade and Ki-67 could be used as a reliable biomarker to understand the biological behaviour of risk habits which might helpful for further treatment therapeutics.
https://ift.tt/2EkJeUx
Benralizumab efficacy by atopy status and serum immunoglobulin E for patients with severe, uncontrolled asthma
Patients with severe asthma can have eosinophilic inflammation and/or allergen sensitization. Benralizumab is an anti-eosinophilic monoclonal antibody being developed for patients with severe, uncontrolled asthma with eosinophilic inflammation.
https://ift.tt/2ItKvv2
Impact of a structured oculoplastic surgery rotation on specialist training in oral and maxillofacial surgery
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): K. Payne, N. Barnard, P. Earl, K. McVeigh, J. Sen
https://ift.tt/2uUeZo6
Preoperative assessment of the risk of postoperative death in patients with oral squamous cell carcinoma: a consideration beyond age, sex, and stage of cancer
Publication date: Available online 5 April 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A.K. Bartella, A.-K. Sander, M. Kamal, J. Steegmann, A. Kloss-Brandstätter, J. Teichmann, F. Hölzle, B. Lethaus
Despite improvements in the management of patients in critical care, about 3% patients who have an operation with curative intent for oral squamous cell carcinoma (SCC) do not survive their stay in hospital. Our aim was to assess the risk factors for postoperative death that were independent of the stage of the cancer, or the age and sex of the patients. We screened 4760 consecutive inpatients at a maxillofacial tertiary care centre from 2011 to 2016, and 34 of them had died within the first three months after operation. We matched them with a further 34 patients with the same TNM stage, age, and sex. General personal and clinical data and preoperative laboratory values were screened, and we applied a Charlson Comorbidity Score (for anaesthetic risk) for each group. Patients' mean (SD) age was 66 (12) years old. There was no significant difference in sex (p=1), age (p=0.718), or TNM classification. Those who died after operation had significantly more renal (p=0.027) and gastrointestinal (p=0.006) diseases, but cardiac diseases (p=0.468) and diabetes mellitus (p=1) were not significant risk factors in themselves. Patients who died postoperatively had significantly worse risk scores (p=0.001) overall. The most common causes of death were septic shock (n=10) and acute cardiac (n=9) or respiratory failure (n=7). Our findings suggested that general diseases were not intrinsically a contraindication for operation with curative intent. The Charlson Comorbidity Score helped to detect potentially fatal courses and could be useful in the preoperative assessment of patients whose general health is not good.
https://ift.tt/2GBsY7J
Transcription and microRNA Profiling of Cultured Human Tympanic Membrane Epidermal Keratinocytes
Abstract
The human tympanic membrane (TM) has a thin outer epidermal layer which plays an important role in TM homeostasis and ear health. The specialised cells of the TM epidermis have a different physiology compared to normal skin epidermal keratinocytes, displaying a dynamic and constitutive migration that maintains a clear TM surface and assists in regeneration. Here, we characterise and compare molecular phenotypes in keratinocyte cultures from TM and normal skin. TM keratinocytes were isolated by enzymatic digestion and cultured in vitro. We compared global mRNA and microRNA expression of the cultured cells with that of human epidermal keratinocyte cultures. Genes with either relatively higher or lower expression were analysed further using the biostatistical tools g:Profiler and Ingenuity Pathway Analysis. Approximately 500 genes were found differentially expressed. Gene ontology enrichment and Ingenuity analyses identified cellular migration and closely related biological processes to be the most significant functions of the genes highly expressed in the TM keratinocytes. The genes of low expression showed a marked difference in homeobox (HOX) genes of clusters A and C, giving the TM keratinocytes a strikingly low HOX gene expression profile. An in vitro scratch wound assay showed a more individualised cell movement in cells from the tympanic membrane than normal epidermal keratinocytes. We identified 10 microRNAs with differential expression, several of which can also be linked to regulation of cell migration and expression of HOX genes. Our data provides clues to understanding the specific physiological properties of TM keratinocytes, including candidate genes for constitutive migration, and may thus help focus further research.
https://ift.tt/2H17gco
Patient-specific pre-contouring of osteosynthesis plates for mandibular reconstruction: Using a three-dimensional key printed solution
In mandibular reconstructive surgery, the osteosynthesis plates require contouring according to the patients' individual anatomical situation. These plates are frequently contoured around a three-dimensional (3D) printed model. However, the translation to the actual patient can introduce inaccuracies and unwanted rotations in the condyles and mandibular ramus, due to malpositioning of the pre-contoured plate.
https://ift.tt/2qaWypt
The importance of lymph node ratio for patients with mandibular infiltration of oral squamous cell carcinoma
Lymph node ratio (LNR) essentially improves assessment of prognosis and therapeutic decision making for patients with oral squamous cell carcinoma, as it considers both the number of positive lymph nodes and the number of dissected lymph nodes. Mandibular infiltration by oral squamous cell carcinoma is a vital clinicopathological feature, significantly worsens prognosis. However, to the best of our knowledge, data on the influence of LNR on prognosis for patients with OSCC and mandibular infiltration are not available.
https://ift.tt/2GFo1KM
The value of histological grading of biopsy and resection specimens in early stage oral squamous cell carcinomas
In oral squamous cell carcinoma (OSCC) the differentiation grade of the tumor is determined on the biopsy and the resection specimen. The relation between tumor grade, nodal metastasis and survival is debatable. The aims of this study were to determine the correlation between differentiation grade of the biopsy and the resection specimen. Furthermore, we wanted to correlate tumor differentiation grade with nodal stage and survival.
https://ift.tt/2GBGJ6l
Evaluation of nerve growth factor−treated mesenchymal stem cells for recovery in neurotmesis model of peripheral nerve injury
Peripheral nerve damages are a relatively common type of the nervous system injuries. Although peripheral nerves show some capacity of regeneration after injury, the extent of regeneration is not remarkable. The present study aimed to evaluate the effect of NGF treated mesenchymal stem cells on regeneration of transected sciatic nerve.
https://ift.tt/2qa1yKX
sAssessment of Regional Asymmetry of the Face Before and After Surgical Correction of Unilateral Cleft Lip
This study was carried out on 26 unilateral cleft lip and palate (UCLP) cases with mean age 3.6 ± 0.7 months.3D facial images were captured for each infant 2–3 days before the repair of cleft lip and at 4 months following surgery at a mean age of 8.2 ± 1.8 months, using a stereophotogrammetry imaging system. An iterative closest point (ICP) algorithm was used to superimpose the 3D facial model to its mirror image using VRMesh software. After the superimposition, the face model was divided into seven anatomical regions.
https://ift.tt/2GCRvZS
Facial nerve palsy and laryngospasm as a complication of local anaesthesia during adenotonsillectomy
Tonsil surgeries are the most frequently performed surgical procedures in ENT departments. We would like to present the case of a 5-year-old patient who suffered from unilateral peripheral facial nerve palsy and laryngeal spasm following adenotonsillectomy. Paresis was observed immediately after the transfer of the patient to the postoperative room. The activity of facial muscles was restored within 2 hours from the beginning of the surgery. We assume that this was the direct effect of an anaesthetic on the extracranial processes of the facial nerve.
https://ift.tt/2Iysvzl
“Run-through” training at specialist training year 1 and uncoupled core surgical training for oral and maxillofacial surgery in the United Kingdom: a snapshot survey
Training in oral and maxillofacial surgery (OMFS) in the UK has undergone considerable changes during the last 10years, and "core" surgical training has replaced "basic" surgical training. In 2014 a pilot "run-through" training programme from specialist training year one (ST1)-ST7 was introduced to facilitate early entry into the speciality. Run-through training guarantees that a trainee, after a single competitive selection process and satisfactory progress, will be given training that covers the entire curriculum of the speciality, whereas uncoupled training requires a second stage of competitive recruitment after the first one (for OMFS only) or two years of "core" training to progress to higher specialty training.
https://ift.tt/2HbJ44Q
Impact of a structured oculoplastic surgery rotation on specialist training in oral and maxillofacial surgery
Specialist training in oral and maxillofacial surgery (OMFS) lasts five years and during this time trainees are expected to gain exposure to a number of subspecialties.1 While oculoplastic surgery is not listed as a subspecialty module in the OMFS specialist training curriculum there is obvious overlap with skin and aesthetic surgery modules.2 In our unit we are fortunate to have a close relationship with the oculoplastic surgery team. During their four-month rotation in trauma, trainees attend a theatre session in oculoplastic surgery for one day/week (about three/month).
https://ift.tt/2uPw2HG
Preoperative assessment of the risk of postoperative death in patients with oral squamous cell carcinoma: a consideration beyond age, sex, and stage of cancer
Despite improvements in the management of patients in critical care, about 3% patients who have an operation with curative intent for oral squamous cell carcinoma (SCC) do not survive their stay in hospital. Our aim was to assess the risk factors for postoperative death that were independent of the stage of the cancer, or the age and sex of the patients. We screened 4760 consecutive inpatients at a maxillofacial tertiary care centre from 2011 to 2016, and 34 of them had died within the first three months after operation.
https://ift.tt/2HctvK8
Effect of a domiciliary facial cooling system on generic quality of life after removal of mandibular third molars
To evaluate quality of life (QoL) and patients' perceptions of a domiciliary facial cooling system (Hilotherm®, Hilotherapy UK Ltd, Coventry, UK), we asked 30 patients to complete a paper-based EQ-5D-3L QoL questionnaire (EuroQol Group 1990, Rotterdam, The Netherlands) each day for seven days after the removal of mandibular third molars. They were returned by 14 of the 20 patients who had not used the system and by all 10 who had. Patients aged between 18 and 25 who had their teeth removed in outpatients (in accordance with National Institute for Health and Care Excellence guidelines) under general anaesthesia (American Association of Anesthesiologists (ASA) class I or II) and did not smoke, were included.
https://ift.tt/2uShWFD
Clinicopathological features of squamous cell carcinoma of the oral cavity and oropharynx in young patients
Our aim was to examine the clinicopathological features of squamous cell carcinoma (SCC) of the oral cavity and oropharynx in a group of young patients who were dignosed during a 15-year period (2000–2014). Patients' clinical details, risk factors, and survival were obtained from medical records. Formalin-fixed, paraffin-embedded, tissue was tested for high-risk human papillomavirus (HPV). The results were compared with those of a matching group of older patients. We identified 91 patients who were younger than 45 years old, and the 50 youngest patients were studied in detail.
https://ift.tt/2Hctu92
Warthin’s tumour in oral and maxillofacial regions: an 18-year retrospective study of 1084 cases in an eastern-Chinese population
Publication date: Available online 5 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): W. Xu, H. Lu, Y. Zhu, M. Ruan, C. Zhang, W. Yang, S. Liu
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%). The favorite primary site of the tumour was the parotid gland (n=1055), followed by intra-/peri-parotid lymph nodes (n=13), upper neck (n=10), submandibular gland (n=4) and upper lip (n=1). Multifocal WTs arose in 9.5% (103 patients) of cases whereas bilateral multifocal WTs were found in 0.65% (seven patients). In 24 (2.2%) patients, WT were found to coexist with other different types of neoplasm synchronously. The most common subtype of metaplasia was the squamous metaplasia (166/250, 66.4%). The usual treatment measure is (bilateral) superficial parotidectomy and the patients should be followed long term, in view of possible metachronous WT, even after prolonged time intervals.
https://ift.tt/2GA6Bzm
Postoperative bleeding risk of direct oral anticoagulants after oral surgery procedures: a systematic review and meta-analysis
Publication date: Available online 5 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): C. Bensi, S. Belli, D. Paradiso, G. Lomurno
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. The risk ratio of postoperative bleeding in DOACs patients was significantly greater than in healthy patients (3.04; 95% confidence interval (CI)=1.31–7.04). This is especially true for rivaroxaban (4.13; 95% CI=1.25–13.69), and less so for dabigatran which presented a risk ratio similar to that of healthy patients (1.00; 95% CI=0.21–4.82). However, further research is required to support these results. Both apixaban and edoxaban were excluded from statistical analysis due to the lack of clinical studies.
https://ift.tt/2EkZkNL
Three-dimensional radiographic evaluation of root migration patterns 4–8.5 years after lower third molar coronectomy: a cone beam computed tomography study
Publication date: Available online 5 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): A.W.K. Yeung, N.S.M. Wong, M.M. Bornstein, Y.Y. Leung
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. A total of 57 coronectomized third molars from 44 patients were included. The distance of the mean root migration was 2.82mm, and they predominantly translated mesially (76.8%). Age negatively correlated with the distance of migration. Root remnants with a soft tissue coverage had less bone regenerated at the adjacent second molar (1.27mm vs. 2.95mm) in comparison to their impacted counterparts. Based on the present radiographic results and the absence of any pathological findings, coronectomy can be recommended for selected cases of third molar removal as a safe procedure with favourable long-term outcomes.
https://ift.tt/2GBBTGd
The value of histological grading of biopsy and resection specimens in early stage oral squamous cell carcinomas
Publication date: Available online 5 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Eric A. Dik, Norbertus A. Ipenburg, Peter A. Kessler, Robert J.J. van Es, Stefan M. Willems
IntroductionIn oral squamous cell carcinoma (OSCC) the differentiation grade of the tumor is determined on the biopsy and the resection specimen. The relation between tumor grade, nodal metastasis and survival is debatable. The aims of this study were to determine the correlation between differentiation grade of the biopsy and the resection specimen. Furthermore, we wanted to correlate tumor differentiation grade with nodal stage and survival.Patients and methodsOne-hundred and forty-five patients with OSCC staged as T1-2, N0 of the tongue, floor of mouth or cheek with primary resection of the tumor were examined. Biopsy and resection specimen were histologically re-assessed with regard to differentiation grade, as well as infiltrative, peri-neural and vascular invasive growth.ResultsThis study showed a poor correlation between differentiation grade in the incisional biopsy and the resection specimen of the same tumor. No significant relation between differentiation grade of the resection specimen and nodal involvement, as well as overall and disease-specific survival was found.ConclusionIn early OSCC the differentiation grade determined by biopsy is of little predictive value for the grading of the resection specimen. Poor differentiation grade could not be related to the presence of nodal metastasis or survival and seems not to have any prognostic value concerning outcome. Treatment planning must be related to these findings.
https://ift.tt/2EnBcds
The importance of lymph node ratio for patients with mandibular infiltration of oral squamous cell carcinoma
Publication date: Available online 5 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Ali-Farid Safi, Martin Kauke, Andrea Grandoch, Hans-Joachim Nickenig, Joachim Zöller, Matthias Kreppel
PurposeLymph node ratio (LNR) essentially improves assessment of prognosis and therapeutic decision making for patients with oral squamous cell carcinoma, as it considers both the number of positive lymph nodes and the number of dissected lymph nodes. Mandibular infiltration by oral squamous cell carcinoma is a vital clinicopathological feature, significantly worsens prognosis. However, to the best of our knowledge, data on the influence of LNR on prognosis for patients with OSCC and mandibular infiltration are not available.Materials and MethodsA retrospective chart review of 89 patients with treatment-naive oral squamous cell carcinoma and histopathologically proven mandibular infiltration (pT4a) was performed. Exclusion criteria were primarily curative intended surgery (radical tumor resection, neck dissection and segmental mandibulectomy) with negative resection margins. Exclusion criteria were neoadjuvant chemoradiotherapy, erosive infiltration of the mandible, T4b classification, perioperative death, unresectable disease, synchronous malignancy, follow-up < 3 months, and inadequate information to correctly determine clinicopathological characteristics.ResultsWe observed a significant correlation on univariate analysis between locoregional recurrence and pathologic N classification (p=0.004), perineural invasion (p=0.005) and lymph node ratio (p<0.001). On multivariate analysis, lymph node ratio (p=0.028) was shown to be an independent indicator for locoregional recurrence.ConclusionLNR predicted locoregional recurrence better than the conventional nodal staging system and therefore might serve as a more precise risk stratification tool. LNR > 7% led to a 11.419-fold higher risk for locoregional recurrence of patients with mandibular infiltration due to OSCC.
https://ift.tt/2EqVAdW
Evaluation of nerve growth factor−treated mesenchymal stem cells for recovery in neurotmesis model of peripheral nerve injury
Publication date: Available online 5 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Mehrnaz Moattari, Homa Mohseni Kouchesfehani, Gholamreza Kaka, Seyed Homayoon Sadraie, Majid Naghdi
BackgroundPeripheral nerve damages are a relatively common type of the nervous system injuries. Although peripheral nerves show some capacity of regeneration after injury, the extent of regeneration is not remarkable. The present study aimed to evaluate the effect of NGF treated mesenchymal stem cells on regeneration of transected sciatic nerve.Materials and methodsIn this experimental study, forty-two male Wistar.rats (180-200g) were randomly divided into 6 groups (n=7) including control, Membrane + Cell (Mem +Cell), NGF group, NGF + Cell group, NGF + Mem group and NGF + Mem + Cell group. Regeneration of sciatic nerve was evaluated using behavioral analysis, electrophysiological assessment and histological examination.ResultsThe rats in the NGF + Mem +Cell group showed significant decrease in sciatic functional index (SFI) and hot water paw immersion test during the 2nd to 8th weeks after surgery. (p<0.001). At 8 weeks after surgery, electrophysiological findings showed that amplitude increased and latency decreased significantly in NGF + Mem + Cell group (p<0.001). Measured histological parameters showed that number of nerve fibers, number of vessels and percent of vessel area also increased significantly in NGF + Mem + Cell group (p<0.05).ConclusionThe present study showed that NGF in accompany with mesenchymal stem cells improved electrophysiological and histological indices.
https://ift.tt/2GCuZR1
In whom does horizontal canal BPPV recur?
Source:American Journal of Otolaryngology
Author(s): L. Pollak, R. Huna-Baron, Michael Osherov, Milo Roni
PurposeThe 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/2Hc4Pl9
Effect of changing postoperative pain management on bleeding rates in tonsillectomy patients
Source:American Journal of Otolaryngology
Author(s): Alexandra C.G. Fonseca, Margaret I. Engelhardt, Zhen J. Huang, Zi Yang Jiang, Sancak Yuksel, Soham Roy
PurposeTo 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.Materials and methodsA retrospective review was performed of tonsillectomies conducted at a single institution between 1/1/2013 and 1/1/2017. The rates of PTH and subsequent intervention were calculated. These were categorized into patients having surgery pre- and post-July 1, 2015, the former group receiving narcotics and the latter ibuprofen with acetaminophen.ResultsOf 1351 total tonsillectomies, 3.04% had PTH requiring return to the hospital. 0.74% required no further surgical intervention, whereas 2.30% required secondary surgical control. The bleed rate prior to July 2015 was 3.15%, with 1.05% non-surgical bleeds and 2.10% requiring surgery. Post-July 2015, the bleed rate was 2.92%, with 0.44% non-surgical bleeds and 2.49% requiring surgery. There were no statistically significant differences between the two groups with respect to overall, non-surgical, and surgical hemorrhage rates (p > 0.05). Of the total bleeds, the need for secondary surgery in the narcotic group was 66.7% and 85% in the NSAID group (p = 0.18). During the study period, 36 patients with PTH had their initial tonsillectomy performed at outside institutions; 53% required surgical intervention.ConclusionsSecondary hemorrhage remains a significant cause of morbidity in post-tonsillectomy patients, often requiring surgical intervention. This review found no increased bleeding risk associated with use of ibuprofen and acetaminophen as opposed to narcotic pain relief.Level of evidence2b
https://ift.tt/2EmNaUH
Prognostic Implication of N1b Classification in the Eighth Edition of the Tumor-Node-Metastasis Staging System of Differentiated Thyroid Cancer
Thyroid, Ahead of Print.
https://ift.tt/2JoOOsu
Association Between Thyroid Function and Development of Different Obesity Phenotypes in Euthyroid Adults: A Nine-Year Follow-Up
Thyroid, Ahead of Print.
https://ift.tt/2Iwj2bV
Short Implants: Analysis of 69 Implants Loaded in Mandible Compared With Longer Implants
Objectives: In the last decade, several studies have reported that short implants achieve excellent results with a 2-stage technique. According to the literature, short dental implants have often been used for the replacement of teeth. Methods and Materials: A total of 69 short implants (Bone System) were inserted in the posterior mandibular area (41 in males, 28 in females, with a median age of 55 years and an age ranging from 41 to 70 years). Results: Mean loss of bone levels at 1 year was 0.20 ± 0.03 mm, mean changes in bone levels for periods longer than 1 year was 0.07 mm. Survival rate (SRR) of short implants was 98.5%. Conclusion: This study showed no complications in short implants and they could represent predictable solutions for the rehabilitation of atrophic posterior mandible to avoid complementary surgical procedures. Address correspondence and reprint requests to Antonio Scarano, MD, DDS, Via dei Vestini 31, 66100 Chieti, Italy; E-mail: ascarano@unich.it Received 7 November, 2017 Accepted 7 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2q8yx33
https://ift.tt/2q8yx33
Comparison of Incidence and Severity of Chronic Postsurgical Pain Following Ear Surgery
Objectives: Literature review shows a limited number of studies investigating chronic pain following ear surgeries. The effect of mastoidectomy on chronic postsurgical pain, however, has never been investigated. The present study investigates not only the incidence and severity of chronic pain following ear surgeries with and without mastoidectomy, but also predisposing diseases for pain. Patients and Methods: The study was performed in a total of 150 patients who underwent tympanoplasty or tympanomastoidectomy through a retroauricular incision in a single tertiary health care center. During the routine postoperative 3rd-month examination, the patients were questioned for the presence and severity of chronic pain, as well as the diseases that might predispose the pain. Results: The difference between the visual analog scale scores of the groups was not statistically significant. Comparison of pain character revealed that neuropathic pain is more prevalent in both the groups. Evaluating the relationship between concomitant diseases and chronic pain, it was observed that migraine, cervical pathology, and acute postsurgical pain were closely associated with chronic pain. Conclusion: It was demonstrated that mastoidectomy does not pose an additional risk for chronic postsurgical pain. However, patients with migraine, cervical pathology, and acute postsurgical pain are at risk for chronic postsurgical pain. Address correspondence and reprint requests to Ahmet Kara, MD, Sakarya University Training and Research Hospital, 54000, Korucuk, Sakarya, Turkey; E-mail: doktor.kbb@hotmail.com Received 9 January, 2018 Accepted 9 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2uLxgnn
https://ift.tt/2uLxgnn
Multiple Intracranial Cavernous Angiomas With a Trigonal Cavernous Angioma Mimicking Glioma
Intracranial cavernous angiomas (CAs) are hamartomatous vascular malformations consisting of thin-walled vascular channels located within the brain, but typically lacking intervening neural parenchyma, large feeding arteries, or draining veins. The CAs occurring in the ventricular system are rare, with an incidence of 2.5% to 10.3% of the intracranial CAs, and those arising from the trigone of the lateral ventricle are even rarer. Till now, there are
https://ift.tt/2q8lFKr
https://ift.tt/2q8lFKr
Modified Rotational Anterior Segmental Osteotomy for Prevention of Common Complication (Aged Appearance)
Although anterior segmental osteotomy (ASO) is powerful procedures in treating the patient who has bimaxillary dentoalveolar protrusion, there is significant change in all soft and hard tissue parameters. Soft tissue changes in response to ASO can have a deleterious effect of an aged appearance. To prevent this aged appearance, the authors tried to rotate the maxillary anterior segment rather than simply posteriorly translating the segments. The application of a clockwise pivot rotation method during ASO can prevent overcorrection by controlling the degree of setback of the piriform aperture, and it can also affect convexity of the facial profile. Address correspondence and reprint requests to Eun-Jung Yang, MD, PhD, Assistant Professor, Department of Plastic and Reconstructive Surgery, Cheil General Hospital and Woman's Healthcare Center, College of Medicine, Dankook University, 17 Seoero-1gil Jung-gu, South Korea; E-mail: enyang7@gmail.com Received 25 October, 2017 Accepted 14 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2GFvKol
https://ift.tt/2GFvKol
A Patient With Severe Lower Face Degloving Injury
Avulsions of mandible are among the most devastating lesions observed in cranio-maxillofacial traumas. They present an important health problem because of the high risk of morbidity related to deformities that cause functional limitations and esthetic changes. The avulsions commonly result from high-energy effects, which cause complete or partial separation of the mandibular bone of the face. As a result of the intense aggression, the skin and subcutaneous tissues of the bone are usually removed, affecting muscles, fascia, blood vessels, and the surrounding nerves. This article aimed to present a case of partial avulsion of mandible caused by car accident. Here, we emphasize the importance of correctly performing patient stabilization and maintenance of the airways, damage control, and facial reconstruction. Finally, we proceeded with a literature review to discuss standard protocols and controversies in the treatment of these lesions. Address correspondence and reprint requests to Jéferson Martins Pereira Lucena Franco, D.D.S., Department of Oral and Maxillofacial Surgery, Hospital Geral de Fortaleza – HGF – Fortaleza – Ceará, Brazil, Rua Paulo Morais, 321, Papicu – Fortaleza – Ceará – Brazil; E-mail: jefersonlucenaodonto@hotmail.com Received 22 January, 2018 Accepted 14 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2q7PKK1
https://ift.tt/2q7PKK1
A Step-By-Step Technique for the Piezosurgical Removal of Fractured Implants
With the increasing popularity of dental implants, the removal of fractured implants has become a major challenge for clinicians. Several tools can be used for the removal of osseointegrated implants; however, few of these have the characteristics of easy control, selective cutting, and rapid healing. In this study, the authors describe a step-by-step technique for the removal of osseointegrated fractured implants via multiple peri-implant osteotomies performed using a piezoelectric device and appropriate inserts. All patients ended with primary wound closure without any soft tissue dehiscence and no healing problems during the postoperative period. As the use of ultrasonic inserts enables precise and selective cuts, piezosurgical implant removal is an attractive alternative to trephine burs or rotary drills. Address correspondence and reprint requests to Antonello Maria Messina, DDS, Via Salaria 394/b, Rome 00199, Italy; E-mail: antonellomariamessina@gmail.com Received 15 January, 2018 Accepted 14 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2GDgWGF
https://ift.tt/2GDgWGF
Odontogenic Keratocysts as First Manifestation of Nevoid Basal Cell Carcinoma Syndrome: Surgical Management and Immunohistochemical Analysis
Nevoid Basal Cell Carcinoma Syndrome (NBCCS), also known as Gorlin syndrome, is a rare autosomal dominant disorder, with no gender predilection. Individuals with NBCCS are commonly diagnosed between 17 and 35 years old and can present multiple basal cell carcinomas scattered throughout the body, presence of recurrent and early-onset odontogenic keratocysts (OKCs) and skeletal abnormalities. This article describes a case of a 13-year-old white boy who referred complaining of facial asymmetry. Extraoral examination revealed volumetric increase displacing the nasal ala from the right side and extended to the zygomatic bone. The intraoral evaluation showed mixed dentition with moderate degree of malocclusion. In addition, bilateral vestibular fornix swelling was observed in the upper canine region. An increase in volume was also detected on the hard palate on the right side. Computed tomography revealed multiple hypodense lesions with cystic appearance. The aspiration was positive, with a yellowish aspirate of serous consistency of all lesions. Given the numerous lesions, it was decided to decompress them for posterior enucleation procedures. In addition to other manifestations, the patient was diagnosed with NBCCS. Although common, the occurrence of OKCs in pediatric patients, especially in multiple lesions, is highly indicative of NBCCS, and its investigation should be considered, even in the absence of other signs of this syndrome. Synchronous decompression was satisfactory and can be used in similar cases of multiple cystic lesions. Address correspondence and reprint requests to Jessica Luana dos Santos, DDS, MsC, Ribeirão Preto Medical School (FMRP), University of São Paulo, Avenida do Café, S/N, 14040-904, Ribeirão Preto, São Paulo, Brazil; E-mail: jessica.luana.l@usp.br Received 25 January, 2018 Accepted 17 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2GA0JC3
https://ift.tt/2GA0JC3
Thornwaldt Cyst
Thornwaldt cyst (Tc) is a benign mass, usually localized in the median plan of the nasopharynx. It is generate from permanent notochord remainings. The pharyngeal bursa—being an embryological residual—occurs in 3% of healthy adults. Closing of the orifice of a nasopharyngeal bursa results in the occurrence of Tc. When the Tc become infected or inflamed, causing to signs. The general indications for radiologic study in patients are nasopharyngeal symptoms, headache, seizures, and dizziness. Computed tomography is less effective than magnetic resonance imaging in the detection and characterization of Tc. On histopathologic study, the walls of Tc are seen to be infiltrated vaguely by lymphocytes and absent lymph follicles. Asymptomatic patients do not necessitate surgery, whereas symptomatic cysts need surgical treatment by a transnasal or transoral access. Marsupialization is the method of option to avoid recurrence. This review provides fundamental knowledge on Tc from an objective perspective. Address correspondence and reprint requests to Dr Erdem Atalay Cetinkaya, MD, Ear Nose and Throat Department, Antalya Ataturk State Hospital, Antalya 07100, Turkey; E-mail: drerdemcetinkaya@gmail.com Received 19 November, 2017 Accepted 15 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2q6lFui
https://ift.tt/2q6lFui
Factors Associated With the Complexity of Facial Trauma
Introduction: Facial fractures have their incidence, etiology, clinical presentation, and features influenced by variables such as economic, cultural, and demographic factors. A large number of these fractures require simple or more complex approaches, and it becomes important to understand their clinical and epidemiological profile and factors associated with the fracture event and surgical indication. Objective: The objective of this research is to analyze the clinical and epidemiological profile of surgical fractures and their associations with causal factors such as alcohol consumption, day of the incident, and nonuse of helmet for motorcycle accidents. Method: A retrospective study was conducted with collection of data from medical records of patients operated for facial fractures at the Hospital Regional of Cariri, state of Ceara, the Northeast of Brazil. Records from 2012 to 2014 were acquired highlighting sex, age, occupation, etiology, anatomical sites of fractures, and surgeries of varying complexities for single or multiple fractures. The day of the event, report or signs of alcohol consumption, and the use of helmets in motorcycle accidents were named associated factors. Results: As a result the authors had a total of 624 cases of surgical facial fractures. Out of these, 546 (87.5%) were male and the majority of them presented between 20 and 30 years of age (40.5%). It was also observed that as an etiological factor motorcycle accidents led to more cases of surgical facial fractures, with 357 cases (62.1%), followed by physical aggression with 72 cases (12.5%). Conclusions: It can be concluded that there is a high prevalence of surgical facial fractures in male patients between 20 and 30 years of age, caused by motorcycle accidents, and that there was a strong association between the consumption of alcohol, failure to wear a helmet, and the presence of surgical facial multiple fractures. Address correspondence and reprint requests to Jéferson Martins Pereira Lucena Franco, DDS, Department of Oral and Maxillofacial Surgery, Hospital Geral de Fortaleza (HGF), Rua Paulo Morais, 321, Papicu, Fortaleza, Ceará 60175-175, Brazil; E-mail: jefersonlucenaodonto@hotmail.com Received 28 January, 2018 Accepted 18 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2GDUJZc
https://ift.tt/2GDUJZc
Primary and Secondary Stability of Single Short Implants
Purpose: This prospective cohort study assessed the effect of bone quality on the primary and secondary stability of single short implants placed in the posterior region. Materials and Methods: A total of 39 short implants (4.1 × 6-mm long) were placed in the posterior region of the maxilla or mandible in 18 patients. Bone quality was classified into type I, II, III, or IV as assessed intrasurgically. Primary implant stability was measured with insertion torque, damping capacity (PTV values), and resonance frequency analysis (ISQ values). Secondary stability was measured by ISQ and PTV at abutment installation. Data were analyzed by using repeated-measures ANOVA and Tukey's test, Kruskall–Wallis test, and Spearman correlation tests. Results: Implants placed in bone type IV had significant lower insertion torque and ISQ values as well as higher PTV values than in bone types I to II (P
https://ift.tt/2GDCKC6
https://ift.tt/2GDCKC6
Primary Alveolar Echinococcosis Presenting with Simultaneous Cerebral and Craniofacial Involvement
Alveolar echinococcosis (AE) is an important parasitic infestation caused by the larval stage of the Echinococcus multilocularis. Turkey is one of the countries occurred endemic of the disease. The disease primarily affects the liver. Cerebral and craniofacial involvements are very rare. Here the authors report a 46-year-old woman with simultaneous cerebral and craniofacial involvement of E. multilocularis. Although primary AE lesions with simultaneous cerebral and craniofacial involvement are exceedingly rare, radiologist must suspect from other unusual involvement such as craniofacial and muscular location in patients with cerebral AE. Address correspondence and reprint requests to Hayri Ogul, MD, Kazim Karabekir Mah, Terminal Cad, Site Polat Apt. B Blok, Kat 1, No. 2, Erzurum, Turkey; E-mail: drhogul@gmail.com Received 24 January, 2018 Accepted 14 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2q80F6y
https://ift.tt/2q80F6y
Comparison of Osseointegration of Five Different Surfaced Titanium Implants
The topography, chemical features, surface charge, and hydrophilic nature of titanium implant surfaces are crucial factors for successful osseointegration. This study aimed to investigate the bone implant contact (BIC) ratio of titanium dental implants with different surface modification techniques using the rat femoral bone model. Sandblasted and acid washed (SL-AW), sandblasted (SL), resorbable blast material (RBM), microarc (MA), and sandblasted and microarc (SL-MA) surfaces were compared in this study. Forty male Sprague–Dawley rats were used in this study. The rats were divided into 5 equal groups (n = 8), and totally 40 implants were integrated into the right femoral bones of the rats. The rats were sacrificed 12 weeks after the surgical integration of the implants. The implant surface–bone tissue interaction was directly observed by a light microscope, and BIC ratios were measured after the nondecalcified histological procedures. Bone implant contact ratios were determined as follows: SL-AW: 59.26 ± 14.36%, SL: 66.01 ± 9.63%, RBM: 63.53 ± 11.23%, MA: 65.51 ± 10.3%, and SL-MA: 68.62 ± 6.6%. No statistically significant differences were found among the 5 different surfaced titanium implant groups (P > 0.05). Our results show that various implant surface modification techniques can provide favorable bone responses to the BIC of dental implants. Address correspondence and reprint requests to Dr Serkan Dundar, DDS, PhD, Department of Periodontology, Faculty of Dentistry, Firat University, Postal Code: 23119, Campus, Elazig, Turkey; E-mail: dtserkandundar@gmail.com, sdundar@firat.edu.tr Received 12 November, 2017 Accepted 20 February, 2018 This study supported by the Firat University Scientific Research Project Foundation Department with the project number DHF.16.07. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2uOu1vl
https://ift.tt/2uOu1vl
Treatment of Facial Infantile Hemangioma: Comparative Study Between Propranolol and Ethanolamine Oleate
Background: Infantile hemangiomas (IH) are the most common benign vascular tumors in childhood. Approximately 10% to 15% of these tumors require drug or surgical intervention. There are many options for IH treatment, of which propranolol is currently considered the gold standard. This study aims to compare the therapeutic results of 2 distinct drugs (ethanolamine oleate and propranolol), in order to increase the available therapeutic arsenal for the treatment of IH, thereby benefiting a larger group of patients. Methods: A retrospective observational study was conducted to assess 16 patients with facial IH, allocated into 2 groups (n = 8). All patients met the same inclusion and exclusion criteria. The resulting evolution assessment was based on photographic documentation produced in a professional setting, and was performed before, during, and after treatment. Two measurement scales, photographic-based assessment of infantile hemangioma characteristics, and outcomes were used for comparison between the 2 therapeutic methods. Results: Both assessment methods did not present any significant statistical difference (P > 0.05) at 1 year of follow-up. Conclusion: Both therapeutic modalities are able to offer the patient similar and satisfactory final esthetic results. Address correspondence and reprint requests to Cassio Eduardo Raposo-Amaral, MD, PhD, Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil; E-mail: cassioraposo@hotmail.com Received 15 December, 2017 Accepted 20 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2q7PGKh
https://ift.tt/2q7PGKh
Intense, Instantaneous, and Shooting Pain During Local Anesthesia for Implant Surgery
Administration of local anesthetics is daily routine for most dental practitioners. Normally, the effect is achieved, and no adverse effects are seen. In this article, the authors describe the complications of immediate, intense and shooting pain, numbness, and marked pallor of the cheek, which occurred during infiltration of a local anesthetic in buccal vestibule infiltration. The patients moved suddenly because of pain and marked pallor of the cheek near the root of the nose and lower eyelid pallor was observed. The pain was very short and the injection was performed again after a few minutes. Two patients also reported an alteration of vision or paralysis of the extra-ocular muscles and drooping eyelid due to paralysis of the levator palpebrae superioris muscle and signs of numbness in the infraorbital area on the same side as the anesthesia. While 3 patients were also apprehensive and started to scare with heart palpitations, as they did not understand what was happening. Probably the anesthetic solutions were injected into an intravascular artery and passed from the extraosseous branch of posterior superior alveolar artery through to the infraorbital artery, which could produce the clinical signs observed in the present study. At the same time, the inoculation of anesthetic in the artery could be grounds for legal disputes for the dentist. In fact, in the absence of vascular disease, anomalies documented by the dentist, they would, however, respond to professional liability and be liable for damages caused to the patient. In conclusion, despite the fact that this condition requires no treatment, it could lead to the recognition of clinical signs in patient with injection of local anesthesia into the artery. At the same time, the inoculation of anesthetic in the artery could be grounds for legal disputes for the dentist. Address correspondence and reprint requests to Antonio Scarano, DDS, MD, Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio," Via dei Vestini, 66100 Chieti, Italy; E-mail: ascarano@unich.it Received 22 November, 2017 Accepted 20 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2GEZ3qW
https://ift.tt/2GEZ3qW
Superficial Fascia in the Cheek and the Superficial Musculoaponeurotic System
The origins and validity of the term "superficial musculoaponeurotic system" (SMAS) is reviewed. Gray stated the superficial fascia connects the skin with the deep or aponeurotic fascia and consists of fibro-areolar tissue. Hollinshead wrote superficial fascia exists throughout the body and contains a variable amount of fat. In the head and neck, it encloses voluntary muscles in its deep portion. Skoog found superficial fascia was fixed to the dense, deep fascia by fibrous adhesions in the temporal, preauricular, and parotid area. Mitz stated "There is a 'superficial muscular and aponeurotic system' (SMAS) in the parotid and cheek areas." SMAS has an intimate relationship with the entire superficial fascia of the head and neck and divides the subcutaneous fat into 2 layers. Wassef found a continuous fibromuscular layer at the deep limit of the "subcutis," which corresponded to the "superficial fascia." Nakajima reported the subcutaneous adipofascial tissue was made up of 2 adipofascial layers. Macchi found 2 different fibroadipose connective layers bounded to the laminar connective tissue layer (SMAS). In the cheek, Hwang found horizontal fibrous connective tissues (membranous layer of superficial fascia) divided the superficial fascia into the superficial fatty layer and the deep fatty layer. Recently, Mitz explained the reason for the term SMAS. The "musculo+aponeurotic" component is based on histology of muscle cells, including the risorius, in the same structure to be surgically consistent. The aponeurotic cells belong to the same surgical layer. SMAS is not sufficient to replace the old term "superficial fascia" of the cheek area. Address correspondence and reprint requests to Kun Hwang, MD, PhD, Department of Plastic Surgery, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, Korea; E-mail: jokerhg@inha.ac.kr Received 13 September, 2017 Accepted 7 March, 2018 This study was supported by a grant from National Research Foundation of Korea (NRF-2017R1A2B4005787). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2q6Dolm
https://ift.tt/2q6Dolm
Impact of Nasal Septal Surgery on Sleep Quality and Attention-Deficit/Hyperactivity Disorder
Objective: To evaluate the effect of nasal septal surgery on quality of life. Methods: A total of 49 patients who underwent septoplasty and/or inferior turbinate radiofrequency operations for nasal septal deviation and inferior turbinate hypertrophy were prospectively enrolled in the study. All patients completed the adult attention-deficit/hyperactivity disorder scale (ADHD scale) and Pittsburgh sleep quality index (PSQI) before and after septoplasty. Acoustic rhinometric measurements were also recorded. Results: Acoustic rhinometric measurements and PSQI showed statistically significant improvement after nasal surgery (P 0.05). Conclusion: Besides the functional improvement of septoplasty, a long-lasting improvement in the quality of life is observed in patients with that undergo this surgery. Address correspondence and reprint requests to Ildem Deveci, MD, Department of Otolaryngology, Health Science University Umraniye Education and Research Hospital, Elmalikent Mahallesi, Adem Yavuz Cddesi 1, Umraniye, Istanbul 34766, Turkey; E-mail: ildemdeveci78@yahoo.com Received 16 January, 2018 Accepted 12 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2GDCGSS
https://ift.tt/2GDCGSS
Normalization of Speech Processing After Whole-Vault Cranioplasty in Sagittal Synostosis
Background: Neurocognitive studies have found impairments in language-related abilities in nonsyndromic craniosynostosis, highlighting clinical importance of early language processing. In this study, neural response to speech sounds in infants with nonsyndromic sagittal craniosynostosis (NSC) is compared, preoperatively and postoperatively, using event-related potentials (ERPs) to objectively characterize development in language processing. Methods: Electroencephalogram was recorded while 39 infants (12 NSC and 27 controls; ages 73–283 days) listened to the Hindi dental /da/ and retroflex /da/ phonemes (non-native phonemic discrimination task). The mismatch negativity (MMN) ERP was extracted as the peak amplitude of the largest negative deflection in the difference wave over 80 to 300 milliseconds poststimulus. Differences in MMN were analyzed using repeated measures analysis of variance. Results: The MMN amplitude was attenuated in the infants with NSC preoperatively compared with controls (P = 0.047). A significant region by group interaction (P = 0.045) was observed, and infants with NSC displayed attenuated MMN in the frontal electrodes compared with controls (P = 0.010). Comparing the preoperative and postoperative MMN, a time by group interaction trend (P = 0.070) was observed. Pair-wise comparisons showed a trend for increase in MMN amplitude from preoperatively to postoperatively in the infants with NSC (P = 0.059). At the postoperative time point, infants with NSC showed no significant difference in MMN from controls (P = 0.344). Conclusion: Infants with NSC demonstrated atypical neural response to language preoperatively. After undergoing surgery, infants with NSC showed increased MMN amplitude which was not significantly different from controls. These findings support the idea that whole vault cranioplasty may improve neurocognitive outcomes in sagittal craniosynostosis. Address correspondence and reprint requests to John A. Persing, MD, Yale School of Medicine, PO Box 208062, New Haven, CT 06520; E-mail: john.persing@yale.edu Received 24 November, 2017 Accepted 23 January, 2018 Presented at: Plastic Surgery the Meeting (ASPS) 2016 in Los Angeles, CA; and the Plastic Surgery Research Council 61st Annual Meeting (2016) in New York, NY. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2q4h4c7
https://ift.tt/2q4h4c7
High doses of laser phototherapy can increase proliferation in melanoma stromal connective tissue
Abstract
It is well established that laser phototherapy (LP) is contraindicated directly over cancer cells, due to its bio modulatory effects in cell and blood vessel proliferation. The aim of the present study was to analyze the influence of typical low-level laser therapy (LLLT) and high intensity laser therapy (HILT) and an in-between dose of 9 J on collagen fibers and blood vessels content in melanoma tumors (B16F10) implanted in mice. Melanoma tumor cells were injected in male Balb C mice which were distributed in four groups: control (no irradiated) or irradiated by 3, 9, or 21 J (150; 450, or 1050 J/cm2). LP was performed in daily sessions for 3 days with a InGaAlP—660 nm (mean output: 50 mW, spot size: 2 mm2). Tumor volume was analyzed using (1) picrosirius staining to quantify collagen fibers content and (2) Verhoeff's method to quantify blood vessels content. Tumor growth outcome measured in the 3-J group was not significantly different from controls. Nine and 21-J groups, presented significant and dose-dependent increases in tumor volume. Quantitative analysis of the intensity of collagen fibers and their organization in stroma and peri-tumoral microenvironment showed significant differences between irradiated and control group. Blood vessels count of 21-J group outnumbered the other groups. High doses (≥ 9 J) of LP showed a dose-dependent tumor growth, different collagen fibers characteristics, and eventually blood vessel growth, while a typical LLLT dose (3 J) appeared harmless on melanoma cell activity.
https://ift.tt/2GWkFm1
Treatment of T3 Glottic Cancer
To the Editor We recently read the article "Survival Outcomes for Patients With T3N0M0 Squamous Cell Carcinoma of the Glottic Larynx" by Ko et al. We congratulate the authors; however, some potentially misleading details may be found in their article.
https://ift.tt/2uLJufS
https://ift.tt/2uLJufS
Survival Outcomes for Patients With T3N0M0 Squamous Cell Carcinoma of the Glottic Larynx—Reply
In Reply We thank Drs D'Ascanio and Piazza for their comments regarding our study demonstrating similar overall survival outcomes for patients with T3N0M0 glottic carcinoma treated with surgery or radiotherapy. We fully agree that individual patients in the T3 category may exhibit distinct pathophysiologies, be more appropriately treated by particular therapy approaches, and demonstrate dissimilar clinical outcomes. Such staging granularity, however, does not exist in the National Cancer Database. The primary intent of our study was to evaluate whether overall survival for all T3N0M0-staged patients treated with primary radiotherapy-based approaches revealed a decrement in survival, as has been suggested by several smaller studies in contrast to the randomized clinical trial data supporting equipoise between these approaches. Equivalence in overall survival between surgery and radiation was supported by our analysis.
https://ift.tt/2q7ONl0
https://ift.tt/2q7ONl0
A Child’s Complaint of “Throat Freeze”—Not Brain Freeze—and Experiences With Zenker Diverticulum
To the Editor I have come to learn that a Zenker diverticulum is an outpouching esophagus, diagnosed usually in older men. Mine was diagnosed in 2000 at age 32. My symptoms were consistent with those described in the literature. When eating grapefruit, gurgling was so loud that others commented. Sneezing occasionally produced food.
https://ift.tt/2GB0w1C
https://ift.tt/2GB0w1C
Thyroidosis Mistaken for Thyroid Cancer
This is the report of a case of a woman in her 30s who underwent a left thyroid lobectomy and isthmusectomy for a thyroid nodule and presented 16 years later with a neck mass.
https://ift.tt/2q9XWtd
https://ift.tt/2q9XWtd
Life Experience of Patients With Unilateral Vocal Fold Paralysis
This mixed methods study (surveys and interviews) promotes patient-centered care by characterizing the patient experiences of living with unilateral vocal fold paralysis.
https://ift.tt/2uLjrW1
https://ift.tt/2uLjrW1
Auricular Swelling After Mild Trauma
A woman in her 50s presented with left auricular pain and malaise after treatment with a series of antibiotics had failed; pain and edema acutely worsened with new onset of drainage and crusting despite ciprofloxacin treatment. What is your diagnosis?
https://ift.tt/2q85Y61
https://ift.tt/2q85Y61
An Atypical Case of Bartonella henselae Osteomyelitis and Hepatic Disease
Bartonella henselae is a Gram-negative bacterium and the causative agent of cat scratch disease (CSD). Atypical presentations of B. henselae that involve the musculoskeletal, hepatosplenic, cardiac, or neurologic systems are rare. In this case report, we describe a case of B. henselae osteomyelitis involving bilateral iliac bones complicated by hepatic lesions in a 12-year-old immunocompetent female patient. Although B. henselae is a rare cause of osteomyelitis, it should be considered when patients who present with fever, pain, and lymphadenopathy do not respond to routine osteomyelitis therapy.
https://ift.tt/2uRCgH4
Horizontal Bone Reconstruction on sites with different amounts of native bone: a retrospective study
https://ift.tt/2q61xbI
Risk factors and comorbidities in Brazilian patients with orofacial clefts
Abstract: Considering that environmental risk factors substantially contribute to the etiology of orofacial clefts and that knowledge about the characteristics and comorbidities associated with oral clefts is fundamental to promoting better quality of life, this study aimed to describe the risk factors, main characteristics, and comorbidities of a group of patients with cleft lip and/or cleft palate (CL/P) from Rio Grande do Norte (RN), Brazil. Data were obtained from 173 patients with CL/P using a form from the Brazilian database on Orofacial Clefts. Most patients were male with cleft lip and palate and had a normal size and weight at birth; presented few neonatal intercurrent events; and had anemia and respiratory and cardiovascular diseases as main associated comorbidities. They also required timely surgical rehabilitation and multidisciplinary care to stimulate their neuropsychomotor development. In addition, a high frequency of familial recurrence and of parental consanguinity was evidenced in the studied population, especially for the cleft lip and cleft palate type. Other relevant findings were the considerable maternal exposure to alcohol, infections, smoking, and hypertension, as well as low supplementation with vitamins and minerals and deliberate consumption of analgesics, antibiotics, and antihypertensives during pregnancy. Characterization of the CL/P patient profile is essential for the planning of health services and integration among the health professionals involved in the diagnosis and treatment of these malformations. Our results reinforce the need for additional research to confirm the association between environmental factors and the development of orofacial clefts.
https://ift.tt/2uN0vX1
Is the fluoride intake by diet and toothpaste in children living in tropical semi-arid city safe?
https://ift.tt/2q7HWbg
Bond strength between a polymer-infiltrated ceramic network and a composite for repair: effect of several ceramic surface treatments
Abstract: The effects of several ceramic surface treatments on bond strength of a polymer-infiltrated ceramic network and resin composite as repair material were evaluated. CAD-CAM blocks of a polymer-infiltrated ceramic network (Vita Enamic) were sliced and subjected to aging process, followed by embedding in acrylic resin. The bonding/repair area was treated as follows (n = 30): C– without treatment; UA– universal adhesive application; FM– 10% hydrofluoric acid and silane application; OM–airborne-particle abrasion with aluminum oxide and silane application; RP– tribochemical silica coating; and CA– surface grinding and application of universal adhesive. Composite resin cylinders were made on the treated surface. Specimens from each group were assigned randomly to two subgroups (n = 15) considering storage condition: Baseline (shear tests after 48 hours) or Storage (tests after 6 months under distilled water). The treated surfaces were analyzed by goniometry, roughness, and SEM. Two-way ANOVA and 1-way ANOVA were applied to analyze the bond data and roughness / contact angle data, respectively, followed by Tukey's test (α = 5%). Surface treatments and storage conditions affected bond strengths (p < 0.01). Surface grinding (CA) followed by universal adhesive promoted the highest value of bond strength (14.5 ± 4.8 MPa for baseline, 8.5 ± 3.4 MPa for storage) and the roughest ceramic surface. Grinding with silicon carbide paper (simulating diamond bur) followed by the application of a universal adhesive system is the best option for repairing fractures of the polymer-infiltrated ceramic network.
https://ift.tt/2uP1kyh
Accuracy of two-dimensional pharyngeal airway space prediction for bimaxillary orthognathic surgery
Abstract
Purpose
The aim of this retrospective study was to evaluate the accuracy of two-dimensional (2D) virtual surgical planning (VSP) of pharyngeal airway space (PAS) in patients submitted to bimaxillary orthognathic surgery.
Methods
This study was conducted with lateral cephalograms acquired through cone-beam computed tomography records of 33 patients, divided into group 1—patients submitted to maxillary advancement and mandibular setback (n = 17) and group 2—patients submitted to maxillomandibular advancement (n = 16). Records were taken 1 to 2 months prior to surgery, which was used to perform the 2D VSP (Tp), and 6 to 8 months after surgery (T1). In Dolphin Imaging software, the anteroposterior size of the PAS was calculated at the level of four craniometric points: A, occlusal plane (Mx), B, and pogonion (Pog). Two previously calibrated examiners performed these measurements. Statistical analyses were conducted using Kendall and t tests at a 5% level of significance.
Results
There was a concordance between the two examiners at all points and times. In group 1, points A and B have statistically significant differences between the PAS measurements performed in Tp and T1, while in group 2, none of the PAS points showed statistically significant differences when comparing Tp to T1.
Conclusions
2D computer-based cephalometric prediction in Dolphin Imaging software offers a good orientation to professionals during the surgical procedure of bimaxillary surgeries since its use is considered clinically relevant in daily practice.
https://ift.tt/2uNo7dX
How do you prevent pimples?
Several factors can cause acne, but simple hygiene techniques and lifestyle changes can often prevent pimples from forming. Washing regularly and reducing stress are some of the best ways to ward off this common skin issue. Here, learn more about effective methods of prevention and treatment.
https://ift.tt/2HaQ6Xs
Presence of hepatitis B surface antibody in addition to hepatitis B core antibody confers protection against hepatitis B virus infection in hepatitis B surface antigen–negative patients undergoing kidney transplantation
Background The American Gastroenterological Association (AGA) and European Association for the Study of the Liver (EASL) recommend that hepatitis B surface antigen (HBsAg)-negative and hepatitis B core antibody (anti-HBc)-positive patients who receive immunosuppression should be monitored for hepatitis B virus (HBV) infection regardless of hepatitis B surface antibody (anti-HBs) status. However, anti-HBs may provide protection against infection. To investigate whether the presence of anti-HBs in addition to anti-HBc confers protection, we classified HBsAg(-) kidney transplantation (KT) patients into 4 groups according to anti-HBc and anti-HBs status, and compared the HBV infection rate between the anti-HBc(+)anti-HBs(+) group and the other 3 groups. Methods In this single-center retrospective study, we classified 1,959 patients into 4 groups: anti-HBc(-)anti-HBs(-) (n=356), anti-HBc(-)anti-HBs(+) (n=652), anti-HBc(+)anti-HBs(-) (n=142), and anti-HBc(+)anti-HBs(+) (n=809). Results HBV infection was noted in 31 patients (1.6%) after KT. There was a significant difference in HBV infection rate between anti-HBc(+)anti-HBs(+) (1.2%) and anti-HBc(+)anti-HBs(-) (5.6%) (p
https://ift.tt/2q7r3NU
https://ift.tt/2q7r3NU
Prediction of the Development of Persistent Massive Ascites after Living Donor Liver Transplantation Using a Perioperative Risk Score
Background Persistent massive ascites (PMAS) >14 days after living donor liver transplantation (LDLT) is not uncommon and associated with worse outcome. A predictive risk scoring system was constructed after analysis of recipient, graft and surgery related factors. Methods We retrospectively reviewed adult LDLT recipients from 2005 to 2011 after excluding cases that experienced any intervention for perioperative vascular-related events. Two groups were identified; PMAS and non-PMAS. The score was constructed from significant factors using weighted odds ratios (OR). Results The study population included 439 recipients. PMAS was evident in 74 cases (17%). Five significant risk predictors were identified in multivariate analysis; pretransplant serum creatinine > 1.5 mg/dl (OR: 5.693, weighted OR=2), recipient spleen to graft volume ratio > 1.3 (OR: 4.466, weighted OR=2), left lobe graft (OR: 3.196, weighted OR=1), more than 1000 mL ascites at laparotomy (OR: 2.541, weighted OR=1), and graft recipient weight ratio
https://ift.tt/2uTTqUi
https://ift.tt/2uTTqUi
Aripiprazole-induced sleep-related eating disorder: a case report
Sleep-related eating disorder is characterized by parasomnia with recurrent episodes of nocturnal eating or drinking during the main sleep period. Several drugs, including atypical antipsychotics, induce sleep...
https://ift.tt/2HaDX4O
Severe inflammatory ileitis resulting in ileal perforation in association with combination immune checkpoint blockade for metastatic malignant melanoma
Immune checkpoint inhibitors have become standard of care in metastatic malignant melanoma management. Despite superior effectiveness to chemotherapy, significant immune-related adverse events (irAE) may occur, particularly if used in combination. Gastrointestinal irAEs were reported with different patterns of involvement. Here, we report the case of a patient who had ileal perforation as a complication of terminal ileitis, without colitis, induced by combination immune checkpoint blockade.
https://ift.tt/2q91RWu
More than meets the eye: infant presenting with hypoxic ischaemic encephalopathy
We report a newborn infant who presented with poor Apgar scores and umbilical artery acidosis leading to the diagnosis of hypoxic ischaemic encephalopathy. During the course of the infant's hospitalisation, subsequent workup revealed an underlying genetic cause that masqueraded as hypoxic ischaemic encephalopathy.
https://ift.tt/2JmmzLo
Paediatric non-ketotic hyperglycaemic hemichorea-hemiballismus
Non-ketotic hyperglycaemic hemichorea–hemiballismus (NHHH) is commonly seen among elderly Asian women with type 2 diabetes mellitus. Here, we present a case of a 16-year-old Filipina with type 1 diabetes mellitus who is poorly compliant to her medications and subsequently developed right hemichorea–hemiballismus (HH). She was initially admitted with hyperglycaemia but was negative for ketonuria or metabolic acidosis. Neuroimaging showed bilateral lentiform nuclei and left caudate hyperdensities on CT and T1-weighted hyperintensity on MRI. Blood glucose was controlled with insulin. Haloperidol and clonazepam were started for the HH with gradual resolution of symptoms in 6 weeks. This is the fifth reported case of NHHH seen among the paediatric age group. NHHH in the paediatric population is clinically and radiographically similar to NHHH seen among adults. Correction of hyperglycaemia results in clinical improvement and radiographic resolution of lesions but persistent cases may necessitate specific treatment targeted towards the abnormal movements.
https://ift.tt/2qd6IWL
Mucinous adenocarcinoma arising from chronic perianal fistula mimicking horseshoe abscess
Perianal fistulae are commonly seen clinical entity. Development of malignancy within a perianal fistula is rare. Even rarer is the development of mucinous adenocarcinoma in a chronic fistula-in-ano. Only a handful of such cases have been reported in the past. A case of mucinous adenocarcinoma arising in chronic perianal fistula in a 34-year-old woman is being described. She presented with complaints of perineal fullness, pain and recurrent pus discharge from perianal fistula for 4 years. On radiological workup, a large solid-cystic pelvic mass was seen in relation to the fistula. On MRI, the lesion was mimicking a large horseshoe abscess. Transrectal ultrasound-guided biopsy and subsequent histopathological examination confirmed the presence of mucinous adenocarcinoma with tumour cells immunopositive for CK7 and CK20.
https://ift.tt/2JmZDLK
Klebsiella endophthalmitis as the herald of occult colorectal cancer
A 67-year-old Chinese man presented with acute loss of vision and pain in the left eye with hypopyon in the anterior chamber. The patient was afebrile with no systemic symptoms at presentation. Diagnosis of endogenous endophthalmitis was made with vitreous tap yielding Klebsiella pneumoniae. Pars plana vitrectomy was performed twice to clear the infection. Thorough investigations showed no septic foci. Whole body positron emission tomography CT revealed a rectal tumour and biopsy showed adenocarcinoma. He was treated with neoadjuvant chemoirradiation followed by surgery to resect the tumour. Vision in the left eye was hand movement at 12 months postoperatively. This case illustrates Klebsiella endogenous endophthalmitis might be a herald of occult colorectal cancer. Bacteria might gain access into bloodstream via mucosal defect in the tumour.
https://ift.tt/2q8f29T
Native valve endocarditis, fusarium and end-stage renal disease
We would like to report a case of invasive Fusariosis involving the native mitral valve and complicated by septic thromboembolism. The patient was a known case of end-stage renal disease on maintenance haemodialysis and did not have any of the known risk factors for invasive Fusariosis like neutropaenia, severe T cell immunodeficiency, postsolid organ transplant recipients, posthaematopoietic stem cell transplant recipients and patients who received cytotoxic and/or high-dose corticosteroid therapy.
https://ift.tt/2JmPvmk
Epidermoid cyst within an intrapancreatic accessory spleen
This is a case of an epidermoid cyst in an intrapancreatic accessory spleen at the tail of the pancreas. Concurrent epidermoid cyst within the accessory spleen is an exceedingly rare entity. The patient initially presented with abdominal pain, nausea and vomiting. Imaging studies revealed a 3.6 cm cystic mass in the tail of the pancreas that was concerning for a mucinous cystic neoplasm (MCN). The patient underwent a robotic distal pancreatectomy for a suspected diagnosis of MCN, which following histologically examination was found to be an epidermoid cyst of an intrapancreatic accessory spleen. Further imaging characteristics are needed to characterise and differentiate these lesions from those of malignant potential. Robotic distal pancreatectomy is a safe alternative with many benefits including decreased length of stay and decreased blood loss.
https://ift.tt/2GA5orF
Infectious causes of Addisons disease: 1 organ--2 organisms!
Background
Infectious aetiologies are the most common causes of primary adrenal failure (Addison's disease) in low/middle-income countries while in the western world autoimmune causes predominate. The infections attributed to cause Addison's include disseminated gonococcal infection, tuberculosis, histoplasmosis, cryptococcosis and cytomegalovirus (CMV) infection. Here, we describe two classical cases of Addison's due to infections of the adrenal gland.
Case presentationCase 1A 55-year-old woman from North India was admitted with history of multiple episodes of vomiting. She had history of severe loss of appetite and loss of weight. There was also history of increased body pigmentation for the last 6 months. At admission, she was drowsy with tachycardia of 116 beats per minute and her blood pressure was 80/50 mm Hg in supine position associated with a significant postural drop. There was hyperpigmentation of fingers, face, oral mucosa and flexures. The rest of the system examination did not reveal any significant...
https://ift.tt/2qa5LOD
Uncommon presentation, rare complication and previously undescribed oncologic association of pheochromocytoma; the great masquerader
We describe the case of a 67-year-old man presenting with ventricular tachycardia (VT) and systolic heart failure secondary to a left adrenal phaeochromocytoma. After treatment with amiodarone, the patient's VT resolved. However, his course was complicated by femoral deep venous thrombosis secondary to an incidentally discovered dedifferentiated liposarcoma of the thigh, for which he was prescribed a course of enoxaparin. The patient was discharged with plans for adrenalectomy following achievement of sufficient preoperative heart rate and blood pressure control with alpha-adrenergic receptor blockade, but re-presented to an outside facility in haemorrhagic shock, where he ultimately expired. Autopsy determined his death to be caused by spontaneous haemorrhage of the phaeochromocytoma. Cardiac manifestations, complications and oncological associations of phaeochromocytoma are discussed.
https://ift.tt/2JnPlLC
Varicella-zoster virus necrotising retinitis, retinal vasculitis and panuveitis following uncomplicated chickenpox in an immunocompetent child
A 4-year-old girl presented with acute left visual loss 4 weeks after uneventful chickenpox. She was found to have left necrotising retinitis and profound retinal vasculitis and vitritis. Aqueous humour was PCR positive for varicella-zoster virus. Combined intravenous and intravitreal antiviral treatment led to rapid improvement with settled retinitis, no vascular occlusion and good recovery of vision. Her recent coinfection with Epstein-Barr virus may have acted to provoke the retinitis.
https://ift.tt/2EmnhUU
Isolated cystic lymphangiomatosis of spleen in an adult: a diagnostic conundrum
Lymphangiomatosis is a rare developmental disorder characterised by diffuse proliferation of anastomosing lymphatic channels (lymphangiomas). It is believed to result from anomalous lymphatic development and usually presents in childhood. It typically occurs as a part of systemic lymphangiomatosis and isolated organ involvement is rare. Only nine cases of isolated cystic lymphangiomatosis of spleen have been reported between 1990 and 2010. Tuberculosis is a significant health problem in India and varied forms of this disease are seen in clinical practice. Isolated splenic tuberculosis, though a rare entity, has been described in the Indian population. We present a case of isolated splenic lymphangiomatosis in a 42-year-old woman that was initially misdiagnosed as splenic tuberculosis and was treated accordingly. Unresponsive to medical treatment, the patient underwent splenectomy and on histopathological examination, cystic lymphangiomatosis was diagnosed. The patient's symptoms resolved after surgery and she is doing well at a follow-up of 3 months.
https://ift.tt/2Jld9PX
Hypocalcaemia in an adult: the importance of not overlooking the cause
A 58-year-old male patient was admitted at the São Bernardos's Hospital (Setúbal, Portugal) with generalised muscle spasms, dyspnoea, laryngospasm and bronchospasm in the context of severe hypocalcaemia. Despite efforts to correct serum calcium, it remained below average, leading to question the true cause of hypocalcaemia. Low parathyroid hormone and 25-hydroxyvitamin D, along with facial anomalies, palate defect and cognitive impairment with concomitant psychiatric disorder led to a suspicion of a DiGeorge/velocardiofacial/22q11.2 deletion syndrome (DS), which was confirmed through genetic testing. The 22q11.2 DS has a wide phenotypic expression and there are growing reports of diagnosis being made in adulthood. This case report highlights the importance of understanding the cause of refractory hypocalcaemia and alerts medical community to carefully access these patients, for this metabolic disorder may only present in later stages of life.
https://ift.tt/2qahCfF
Chiari malformation and tuberculous meningitis: aetiology and management
This is the first reported case of a Chiari 1 malformation in association with tuberculous (TB) meningitis. We present a case of a 23-year-old woman with a 2-week history nocturnal fever, vertigo, headache and projectile vomiting. She had nystagmus, scanning speech, bilateral papilloedema and ataxia. Cranial imaging showed a 10 mm tonsillar herniation. Posterior fossa decompression was done. Because the patient's gamut of symptoms was highly suspicious for a central nervous system infection, a lumbar tap was done which revealed TB meningitis. Four years later, after anti-TB medications and rehabilitation, all her symptoms except gait instability resolved.
https://ift.tt/2Gz3ism
Bilateral multifocal acute lobar nephronia caused by Enterococcus faecalis
An 8-year-old boy presented to our hospital with complaints of fever, epigastric pain and headache. Enterococcus faecalis were isolated from urine and blood culture, bacteraemic urinary tract infection was clinically diagnosed. Although vancomycin and ampicillin were administrated, fever did not subside. Contrast-enhanced CT (CECT) revealed bilateral and multiple wedge-shaped defects, thus prompting a diagnosis of acute lobar nephronia (ALN). After 7 days of antibiotic treatment, the patient's fever subsided. ALN can be classified into two subgroups based on features of CECT; simple and complicated ALN. The treatment response to antibiotics tends to be delayed in complicated ALN, it is important that we understand the natural course of complicated ALN and should not escalate antibiotics hastily. According to previous studies, ALN has a wide regional variety of causative organisms. Therefore, the physician should recognise a local pattern of microbiological aetiology of ALN.
https://ift.tt/2EmM1fM
Scorpion bite-induced unilateral pulmonary oedema
A 24-year-old woman came to the emergency room of our hospital, 6 hours after a sting to the pulp of her middle finger of her left upper limb by an Indian red scorpion. On examination, she had tachycardia, tachypnoea, hypotension and low oxygen saturation at room temperature. On auscultation, there was poor air entry in all areas of the right lung along with crackles. The left lung field was normal on auscultation. Chest X-ray showed unilateral haziness of right lung field. Two-dimensional echocardiography showed clinical findings of myocarditis. Arterial blood gas showed metabolic acidosis with severe hypoxaemia, suggestive of type 1 respiratory failure. After intubation and initiating ventillatory support, the patient was given intravenous analgesics, antihistaminic and infiltrated of site of bite with 2% xylocaine. The patient was started on inotropes, alpha receptor blocker, intravenous steroids, bronchodilators and diuretics support. The patient clinically improved over the course of treatment and was subsequently discharged.
https://ift.tt/2GzC30B
Rapunzel syndrome: a tail too long to tell!
Description
Trichobezoar leading to Rapunzel syndrome (RS) is an extremely rare entity with about 90 cases reported in literature.1 RS derives its name from the fairy tale 'Rapunzel', where the German princess let her long golden hair down from her tower to facilitate a tryst with her lover akin to the long and shiny tail of hair seen in RS.2 Hair being slippery gets trapped in gastric mucosal folds, eluding peristalsis. More and more hair conglomerate to form a stomach-shaped mass coated with mucus called trichobezoar. This provides it a shiny glistening surface, and the acid secreted in stomach denatures the hair protein which gives it the typical black colour.3 When the tail of hair extends beyond the stomach into the small intestine, it is called RS.
A 6-year-old girl presented to our emergency department with history of abdominal pain and recurrent vomiting for...
https://ift.tt/2Ely3uV
Immune stromal keratitis: a rare ocular presentation of tuberculosis
An 11-year-old female patient presented with diminution of vision in both the eyes for the last 4 days. She had redness, watering and photophobia for the past 11 days. Slit lamp examination revealed multiple disc-shaped corneal stromal infiltrates with an overlying epithelial defect and hypopyon in both the eyes. A provisional diagnosis of infective keratitis was made. The patient was started on empirical antimicrobial therapy. However, no improvement was noted over the next 72 hours. Microbiological examination of the corneal scraping from both the eyes was negative. Considering the above, provisional diagnosis was changed to immune stromal keratouveitis and the patient was started on topical steroids. Further evaluation revealed a positive Mantoux test (30x20 mm) and contrast enhanced CT chest showing pulmonary nodules, suggestive of tuberculosis. The patient was subsequently started on antitubercular treatment. The infiltrates along with the ulcer and anterior uveitis responded dramatically to the revised treatment and resolved completely within 7 days of therapy.
https://ift.tt/2GzBXpL
Perforated gastric remnant ulcer after laparoscopic gastric bypass
Ulcer perforation in the excluded stomach and duodenum is a rare complication after Roux-en-Y gastric bypass (RYGB). Pathogenesis of these ulcers are multifactorial. We report a case of perforated gastric remnant ulcer in a 54-year-old woman who had undergone a laparoscopic RYGB 5 years previously. The perforation was successfully repaired with an omental patch. We also present a review of the literature of similar cases.
https://ift.tt/2ElGbLy
Risk factors for salivary gland cancers in France: Results from a case-control study, the ICARE study
Source:Oral Oncology, Volume 80
Author(s): Loredana Radoï, Christine Barul, Gwenn Menvielle, Matthieu Carton, Mireille Matrat, Marie Sanchez, Corinne Pilorget, Michel Velten, Isabelle Stücker, Danièle Luce
ObjectivesEpidemiological studies on the risk factors for salivary gland cancers (SGC) are rare, concern a small sample size, and show inconsistent results. The aim of the present work was to analyze several risk factors for SGC, using the data from the ICARE study, a multicenter, population-based case-control study.Materials and methodsData from 73 SGC cases and 3555 controls were collected using a standardized questionnaire on lifestyle habits, personal and family medical history, and lifetime occupational history. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using unconditional logistic regressions.ResultsTobacco use and alcohol consumption were not associated with the risk of SGC. A history of head and neck cancer or that of cervicofacial radiotherapy was associated with a higher risk of SGC (OR = 17.06, 95% CI: 4.34–67.05, and OR = 31.74, 2.48–405.25, respectively). Significantly increased risks were observed for some occupations: waiter (OR = 2.94, 1.11–7.78), charworker (OR = 3.02, 1.38–6.60), electrical and electronic equipment assembler (OR = 7.16, 2.02–25.38), plumber (OR = 3.95, 1.33–11.67), electric arc welder (OR = 6.15, 1.76–21.48), sheet-metal worker (OR = 2.89, 1.01–8.32), building painter (OR = 3.42, 1.01–11.49), and material handling equipment operator (OR = 5.05, 1.71–14.84). Results for industries were consistent with those observed for occupations.ConclusionOur results showed that a history of head and neck cancer, cervicofacial radiotherapy, and several occupations and industries, were associated with an increased risk of SGC. Further studies with larger sample sizes are indicated to confirm our results.
https://ift.tt/2GzMrFR
Hypoxia modulates CCR7 expression in head and neck cancers
Source:Oral Oncology, Volume 80
Author(s): Haneen A. Basheer, Edvinas Pakanavicius, Patricia A. Cooper, Steven D. Shnyder, Lisette Martin, Keith D. Hunter, Victoria Vinader, Kamyar Afarinkia
BackgroundThe chemokine receptor CCR7 is expressed on lymphocytes and dendritic cells and is responsible for trafficking of these cells in and out of secondary lymphoid organs. It has recently been shown that CCR7 expression is elevated in a number of cancers, including head and neck cancers, and that its expression correlates to lymph node (LN) metastasis. However, little is known about the factors that can induce CCR7 expression in head and neck cancers.MethodWe compared the protein expression and functional responses of CCR7 under normoxia and hypoxia in head and neck cancer cell lines OSC-19, FaDu, SCC-4, A-253 and Detroit-562 cultured as monolayers, spheroids, and grown in vivo as xenografts in balb/c mice. In addition, we analysed the correlation between hypoxia marker HIF-1α and CCR7 expression in a tissue microarray comprising 80 clinical samples with various stages and grades of malignant tumour and normal tissue.ResultsUnder hypoxia, the expression of CCR7 is elevated in both in vitro and in vivo models. Furthermore, in malignant tissue, a correlation is observed between hypoxia marker HIF-1α and CCR7 across all clinical stages. This correlation is also strong in early histological grade of tumours.ConclusionHypoxia plays a role in the regulation of the expression of CCR7 and it may contribute to the development of a metastatic phenotype in head and neck cancers through this axis.
https://ift.tt/2Em4s4h
Multi-criteria optimization achieves superior normal tissue sparing in intensity-modulated radiation therapy for oropharyngeal cancer patients
Publication date: May 2018
Source:Oral Oncology, Volume 80
Author(s): Jianghong Xiao, Yan Li, Huashan Shi, Tangel Chang, Yong Luo, Xuetao Wang, Yang He, Nianyong Chen
ObjectivesTo evaluate the benefit of intensity-modulated radiation therapy (IMRT) with multi-criteria optimization (MCO) in patients with oropharyngeal cancer (OPC) and compare the dose difference between the MCO plans navigated by physicians and dosimetrists.Materials and methodsThe conventional IMRT plans (nonMCO) and MCO IMRT plans navigated by physicians and dosimetrists (MCOp and MCOd) were created for 30patients with OPC. All the plans were reviewed, and the planning time and dose-volume parameters were compared.ResultsThe difference of D95 among three kinds of plans was not significant (p > 0.05). The maximum dose and D2 of spinal cord, brain stem, the mean dose of bilateral parotids, cochlea, oral cavity and glottic larynx were lower in MCO plans than those in nonMCO plans (p < 0.017). Furthermore, MCOp showed better bilateral parotids, oral cavity and glottic larynx sparing compared to MCOd (p < 0.017), in which the magnitude was related to the overlapping volume of the corresponding organ at risk (OAR) and targets. The active planning time was reduced by a median of 94.3 min (MCOd vs. nonMCO) or 91.6 min (MCOp vs. nonMCO).ConclusionMCO IMRT plans significantly reduced the dose of OARs and the active planning time, without compromising the target coverage in OPC patients; navigations by physicians could be beneficial to the dose sparing of the OARs with high complication rate and those overlapping with targets; the constraints could be the predominant factor affecting the results of optimization in the MCO IMRT planning.
Graphical abstract
https://ift.tt/2JlbkTj
A predictive model for recurrence in patients with glottic cancer implemented in a mobile application for Android
Source:Oral Oncology, Volume 80
Author(s): Ana Gabriela Jover-Esplá, Antonio Palazón-Bru, David Manuel Folgado-de la Rosa, Guillermo Severá-Ferrándiz, Manuela Sancho-Mestre, Joaquín de Juan-Herrero, Vicente Francisco Gil-Guillén
ObjectivesThe existing predictive models of laryngeal cancer recurrence present limitations for clinical practice. Therefore, we constructed, internally validated and implemented in a mobile application (Android) a new model based on a points system taking into account the internationally recommended statistical methodology.Materials and methodsThis longitudinal prospective study included 189 patients with glottic cancer in 2004–2016 in a Spanish region. The main variable was time-to-recurrence, and its potential predictors were: age, gender, TNM classification, stage, smoking, alcohol consumption, and histology. A points system was developed to predict five-year risk of recurrence based on a Cox model. This was validated internally by bootstrapping, determining discrimination (C-statistics) and calibration (smooth curves).ResultsA total of 77 patients presented recurrence (40.7%) in a mean follow-up period of 3.4 ± 3.0 years. The factors in the model were: age, lymph node stage, alcohol consumption and stage. Discrimination and calibration were satisfactory.ConclusionA points system was developed to obtain the probability of recurrence of laryngeal glottic cancer in five years, using five clinical variables. Our system should be validated externally in other geographical areas.
https://ift.tt/2Em4rxf
The clinical outcome and microbiological profile of bone-anchored hearing systems (BAHS) with different abutment topographies: a prospective pilot study
Abstract
Purpose
In this prospective clinical pilot study, abutments with different topologies (machined versus polished) were compared with respect to the clinical outcome and the microbiological profile. Furthermore, three different sampling methods (retrieval of abutment, collection of peri-abutment exudate using paper-points, and a small peri-abutment soft-tissue biopsy) were evaluated for the identification and quantification of colonising bacteria.
Methods
Twelve patients, seven with machined abutment and five with polished abutment, were included in the analysis. Three different sampling procedures were employed for the identification and quantification of colonising bacteria from baseline up to 12 months, using quantitative culturing. Clinical outcome measures (Holgers score, hygiene, pain, numbness and implant stability) were investigated.
Results
The clinical parameters, and total viable bacteria per abutment or in tissue biopsies did not differ significantly between the polished and machined abutments. The total CFU/mm2 abutment and CFU/peri-abutment fluid space of anaerobes, aerobes and staphylococci were significantly higher for the polished abutment. Anaerobic bacteria were detected in the tissue biopsies before BAHS implantation. Anaerobes and Staphylococcus spp. were detected in all three compartments after BAHS installation. For most patients (10/12), the same staphylococcal species were found in at least two of the three compartments at the same time-point. The common skin coloniser Staphylococcus epidermidis was identified in all patients but one (11/12), whereas the pathogen Staphylococcus aureus was isolated in five of the patients. Several associations between clinical and microbiological parameters were found.
Conclusions
There was no difference in the clinical outcome with the use of polished versus machined abutment at 3 and 12 months after implantation. The present pilot trial largely confirmed a suitable study design, sampling and analytical methodology to determine the effects of modified BAHS abutment properties.
Level of evidence
2. Controlled prospective comparative study.
https://ift.tt/2GCpW2P
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