This article addresses several facelift challenges involving anatomic conditions, including platysma banding, endomorphic facial habitus, and midface hypoplasia. In addition, patient counseling and conveying realistic expectations about limitations of facelift alone, with and without adjunctive procedures, are presented. In addition, a few technical modifications of the facelift procedure contributing to more uniform success and longevity are discussed.
https://ift.tt/2HjcC0u
Σάββατο 7 Απριλίου 2018
The Superficial Musculoaponeurotic System and Other Considerations in Rejuvenation of the Lower Face and Neck
Controversies in Facial Plastic Surgery
FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA
https://ift.tt/2HhSGLf
Controversies in Facial Plastic Surgery
Over the last 50+ years, the field of facial plastic surgery has evolved into a prominent subspecialty in surgery. This discipline encompasses the care of the entire region of the face, scalp, and neck. With the professional evolution of the field, there has also been an evolution and growth of the knowledge base of facial plastic surgery. The field lends expertise, understanding, and direction in all facets of the regional reconstructive, corrective, and cosmetic concerns.
https://ift.tt/2Hi6B43
Management of the Prominent Ear
This article incorporates the opinions and preferred surgical options in managing patients of 3 prominent facial plastic surgeons who have large otoplasty practices. Six different questions covering the management of prominent ears are answered by the 3 practitioners. Nonsurgical options for the treatment of prominent ears are discussed. The role of cartilage-cutting and cartilage-sparing techniques as well as individual preferred otoplasty techniques are thoroughly covered. Postoperative management of these patients is presented by the individual surgeons.
https://ift.tt/2GN9CbO
Orbital Fractures
Anatomic, rather than volumetric, reconstruction leads to improved outcomes in orbital reconstruction. Endoscopic visualization improves lighting and magnification of the surgical site and allows the entire operative team to understand and participate in the procedure. Mirror-image overlay display with navigation-guided surgery allows in situ fine adjustment of the implant contours to match the contralateral uninjured orbit. Precise exophthalmometry is important before, during, and after surgery to provide optimal surgical results.
https://ift.tt/2Hi6C87
Evaluating New Technology
There are multiple complex issues to consider when evaluating any new technology. First evaluate the efficacy of the device. Then considering your patient population decide whether this technology brings an added benefit to your patients. If it meets these 2 criteria, then proceed to the financial analysis of acquiring this technology. The complete financial analysis has several important components that include but are not limited to cost, value, alternatives, return on investment, and associated marketing expense.
https://ift.tt/2EsKzc1
Injectable Fillers
Injectable products are now being designed to treat specific areas of the face, including the lower lid/cheek region, the midface, and circumoral rhytids. Expert injectors from 3 core disciplines (facial plastic surgery, oculoplastic surgery, and dermatology) were asked to discuss their approaches to the midface, lower lid, and cheek region and their opinions about using cannulas versus needles. The authors describe their techniques for avoiding and managing filler complications. They give insight into how their techniques have changed over the past few years and their use of new products that have been developed.
https://ift.tt/2Hij4VD
Grafting Techniques in Primary and Revision Rhinoplasty
With the adoption of open structure techniques, rhinoplasty has become more reliant on the use of structural grafts to resist change that occurs over time owing to both gravity and the aging process. As surgical procedures have become more technically complex, the type of grafts use for both primary and secondary rhinoplasty have undergone significant evolution. This article provides a case approach focused on the use of structural grafting in rhinoplasty.
https://ift.tt/2GJVi3J
Lip Augmentation
This article examines 6 questions about lip augmentation answered by 3 experts in their field of facial plastic surgery. The topics covered include high-yield areas such as injection, surgical enhancement, rhytid resurfacing, implants, complications, and technique changes over the years. All the authors answered these questions in a "How I do it" manner to provide the reader with a true understanding of their thoughts and techniques. This article provides a practical resource to all physicians and practitioners performing lip augmentation on some of the most common questions and issues.
https://ift.tt/2HlTTl2
Facial Paralysis Discussion and Debate
This article examines 6 questions about facial paralysis answered by 3 experts in their field of facial plastic surgery. The topics covered include routine assessment, neuromuscular training, nonsurgical management, and the future of this field. All the authors answered these questions in a "How I do it" manner to provide the reader with a true understanding of their thoughts and techniques. This article provides a practical resource to all physicians and practitioners treating patients with facial paralysis on some of the most common questions and issues.
https://ift.tt/2EwKzry
Contemporary Laser and Light-Based Rejuvenation Techniques
Laser and light skin rejuvenation have changed dramatically in the last 10 years. CO2 and erbium:YAG remain the main wavelengths, but fractional, nonablative, and combination devices have been added. For those patients with lighter skin types and extensive photodamage and rhytids, full-field ablative laser resurfacing remains the procedure of choice. For those seeking less downtime and risks, fractional devices offer an excellent and growing alternative, although multiple treatments may be required for optimal results. A new generation of hybrid and nonablative devices offers many advantages, yet many of these results may be duplicated with well-proven intense pulsed light.
https://ift.tt/2Hgu9WX
Facial Plastic Surgery Controversies
There are more than 11 million people in the world affected with keloids. Nevertheless, there is a lack of agreement in keloid management. Moreover, keloid research has left gaps in the understanding of its pathogenesis. Six questions are answered by 3 clinical scientists in an attempt to address common keloid controversies.
https://ift.tt/2GKAxVu
Monoclonal Antibody L1Mab-13 Detected Human PD-L1 in Lung Cancers
Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.
https://ift.tt/2EtMVqN
Epitope Mapping of Monoclonal Antibody PMab-48 Against Dog Podoplanin
Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.
https://ift.tt/2Hi0exF
A novel digital workflow to manufacture personalized three-dimensional-printed hollow surgical obturators after maxillectomy
Partial or complete resection of the maxilla during tumour surgery causes oronasal defects, leading to oral-maxillofacial dysfunction, for which the surgical obturator (SO) is an important treatment option. Traditional manufacturing of SOs is complex, time-consuming, and often results in inadequate fit and function. This technical note describes a novel digital workflow to design and manufacture a three-dimensional (3D)-printed hollow SO. Registered computed tomography and magnetic resonance imaging images are used for gross tumour delineation.
https://ift.tt/2Jr0XNS
DOES fixation METHOD EFFECTS temporomandibular joints after mandibular advancement?
Sagittal split ramus osteotomy (SSRO) is a standard procedure in which miniplates and screws are used to achieve stabilization. Although the titanium plate and screw fixation system is stable, resorbable fixation systems are also used. There is currently no consensus on the ideal fixation technique for SSRO procedures and its effect on the condyle. We aimed to evaluate the stress distribution on temporomandibular joints (TMJ).
https://ift.tt/2JuH8oY
The association of solid-phase assays to immunofluorescence increases the diagnostic accuracy for ANA screening in patients with autoimmune rheumatic diseases
Source:Autoimmunity Reviews
Author(s): Nicola Bizzaro, Ignazio Brusca, Giulia Previtali, Maria Grazia Alessio, Massimo Daves, Stefan Platzgummer, Luigi Cinquanta, Giusy Paura, Maria Infantino, Mariangela Manfredi, Raffaella Faricelli, Danila Bassetti, Maura Musso, Gaia Deleonardi, Maria Teresa Trevisan, Antonella Radice, Marco Liguori, Tiziana Imbastaro, Fiorenza Pesente, Martina Fabris, Elio Tonutti
https://ift.tt/2Jv4hYm
The role of ophthalmic imaging in central nervous system degeneration in systemic lupus erythematosus
Source:Autoimmunity Reviews
Author(s): Arnaldo Dias-Santos, Rita Pinto Proença, Joana Tavares Ferreira, Sofia Pinheiro, João Paulo Cunha, Rui Proença, Maria Francisca Moraes-Fontes
Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disorder that can involve any organ system. Central nervous system involvement can be a severe life threatening complication, ultimately resulting in severe neurodegenerative changes. Magnetic resonance imaging suggests that neurodegeneration, which may have deleterious effects on brain function, may occur early in SLE and experimental models suggest that neuroprotection may be feasible and beneficial.The retina is an extension of the brain. Recent ophthalmic imaging technologies are capable of identifying early changes in retinal and choroidal morphology and circulation that may reflect CNS degeneration. However, their utility in monitoring CNS involvement in SLE has been poorly studied as these have only been performed in small cohorts, in a cross-sectional design, non-quantitatively and without correlation to disease activity.The authors aim to review the current understanding of neurodegeneration associated with SLE, with particular focus on the visual pathway. We describe the neuropathology of the visual system in SLE and the evidence for retinal and choroidal neurodegenerative and microvascular changes using optical coherence tomography technology. We aim to describe the potential role of optical imaging modalities in NPSLE diagnosis and their likely impact on the study of neuronal function.
https://ift.tt/2EqYrn2
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome – Evidence for an autoimmune disease
Source:Autoimmunity Reviews
Author(s): Franziska Sotzny, Julià Blanco, Enrica Capelli, Jesús Castro-Marrero, Sophie Steiner, Modra Murovska, Carmen Scheibenbogen
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a frequent and severe chronic disease drastically impairing life quality. The underlying pathomechanism is incompletely understood yet but there is convincing evidence that in at least a subset of patients ME/CFS has an autoimmune etiology. In this review, we will discuss current autoimmune aspects for ME/CFS. Immune dysregulation in ME/CFS has been frequently described including changes in cytokine profiles and immunoglobulin levels, T- and B-cell phenotype and a decrease of natural killer cell cytotoxicity. Moreover, autoantibodies against various antigens including neurotransmitter receptors have been recently identified in ME/CFS individuals by several groups. Consistently, clinical trials from Norway have shown that B-cell depletion with rituximab results in clinical benefits in about half of ME/CFS patients. Furthermore, recent studies have provided evidence for severe metabolic disturbances presumably mediated by serum autoantibodies in ME/CFS. Therefore, further efforts are required to delineate the role of autoantibodies in the onset and pathomechanisms of ME/CFS in order to better understand and properly treat this disease.
https://ift.tt/2JudmjQ
Systemic lupus erythematosus and systemic sclerosis: All roads lead to platelets
Source:Autoimmunity Reviews
Author(s): Marc Scherlinger, Vivien Guillotin, Marie-Elise Truchetet, Cécile Contin-Bordes, Vanja Sisirak, Pierre Duffau, Estibaliz Lazaro, Christophe Richez, Patrick Blanco
Systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) are two phenotypically distincts inflammatory systemic diseases. However, SLE and SSc share pathogenic features such as interferon signature, loss of tolerance against self-nuclear antigens and increased tissue damage such as fibrosis. Recently, platelets have emerged as a major actor in immunity including auto-immune diseases. Both SLE and SSc are characterized by strong platelet system activation, which is likely to be both the witness and culprit in their pathogenesis. Platelet activation pathways are multiple and sometimes redundant. They include immune complexes, Toll-like receptors activation, antiphospholipid antibodies and ischemia-reperfusion associated with Raynaud phenomenon. Once activated, platelet promote immune dysregulation by priming interferon production by immune cells, providing CD40L supporting B lymphocyte functions and providing a source of autoantigens. Platelets are actively implicated in SLE and SSc end-organ damage such as cardiovascular and renal disease and in the promotion of tissue fibrosis. Finally, after understanding the main pathogenic implications of platelet activation in both diseases, we discuss potential therapeutics targeting platelets.
https://ift.tt/2Ix4d95
From HSV infection to erythema multiforme through autoimmune crossreactivity
Source:Autoimmunity Reviews
Author(s): Alberta Lucchese
Scientific and clinical data indicate that human herpes simplex virus 1 (HSV1) and, at a lesser extent, human herpes simplex virus 2 (HSV2) are factor(s) implicated in the development of erythema multiforme (EM). With a focus on oral EM, the present structured review of proteomic and epitope databases searched for the molecular basis that might link HSV1 and HSV2 infections to EM. It was found that a high number of peptides are shared between the two HSVs and human proteins related to the oral mucosa. Moreover, a great number of the shared peptides are also present in epitopes that have been experimentally validated as immunopositive in the human host. The results suggest the involvement of HSV infections in the induction of oral EM via a mechanism of autoimmune cross-reactivity and, in particular, highlight a potential major role for 180 kDa bullous pemphigoid antigen and HSV1 infection in the genesis of crossreactions potentially conducive to EM.
https://ift.tt/2qiJqzB
Autoimmune phenomena and disease in cancer patients treated with immune checkpoint inhibitors
Source:Autoimmunity Reviews
Author(s): Milena Tocut, Ronen Brenner, Gisele Zandman-Goddard
The discovery and approved treatment with immune checkpoint inhibitors (ICIs) for a variety of cancers has changed dramatically morbidity and mortality for these patients.Despite the obvious benefits, their use is associated with unique immune-related adverse effects (irAEs), including autoimmune conditions such as: inflammatory arthritis, myositis, vasculitis and Sicca syndrome.The appearance of ICIs-induced autoimmune irAE requires from oncologists and rheumatologists a different approach to the identification and treatment of these conditions, which may differ from the classic and traditional approach to rheumatologic diseases. It should be taken into consideration that ICIs therapy in patients with preexisting autoimmunity could be possible, but with a cost of causing disease exacerbation.In this extensive review, we present the autoimmune irAEs, mostly as phenomena, but also as classic autoimmune diseases as well as therapeutic options for the side effects.
https://ift.tt/2Etakss
Antinuclear antibodies: Is the indirect immunofluorescence still the gold standard or should be replaced by solid phase assays?
Source:Autoimmunity Reviews
Author(s): Dolores Pérez, Boris Gilburd, Danielle Azoulay, Ora Shovman, Nicola Bizzaro, Yehuda Shoenfeld
https://ift.tt/2Ix4c51
Efficacy and safety of rituximab in systemic sclerosis: French retrospective study and literature review
Source:Autoimmunity Reviews
Author(s): Mathilde Thiebaut, David Launay, Sébastien Rivière, Thibaut Mahévas, Syrine Bellakhal, Eric Hachulla, Olivier Fain, Arsène Mekinian
ObjectiveTo describe safety and efficacy of rituximab in patients with systemic sclerosis.MethodsWe included 13 patients with systemic sclerosis treated with rituximab and pooled with 40 additional patients from the literature. SSc rituximab untreated patients were matched to rituximab treated ones.ResultsThirteen patients who received rituximab and 26 rituximab-untreated patients were included. In comparison to 26 patients who did not received rituximab, FVC changes were not significantly different, whereas DLCO improved in 13 patients who received rituximab (0 [−4; 4] vs loss of −7 [−19; 0]; p = 0.05). Considering 7 rituximab treated and 14 untreated diffuse SSc, FVC was improved during the 24 [12; 46] months of follow up in dSSc who received rituximab (gain of 12 [7.5:14] % vs loss of 1.5 [−16.8; 2.5], (p = 0.003)). Pooled analysis of 53 patients (40 literature patients and 13 from personal series) showed significant improvement of median mRSS from 18 [8; 32] at baseline to 9 [4; 18] at M6 (p = 0.007), 13 [8; 18] at M12 (p = 0.008) and 10 [4; 16] at the last follow-up (p = 0.0002). FVC increased from 71% [66; 80] at baseline to 84% [75; 90] at M12 (p = 0.001). DLCO increased from 58% [39; 65] at M0 to 63% [53; 78] at M12 (p = 0.04).ConclusionOur personal data and pooled literature analysis suggest the efficacy of rituximab in the subset of diffuse SSc in particular in skin and interstitial disease involvements. The safety of rituximab seems to be reasonable and similar to previous data in other autoimmune diseases.
https://ift.tt/2Jv4cnw
Behçet's disease: New insights into pathophysiology, clinical features and treatment options
Source:Autoimmunity Reviews
Author(s): Antonio Greco, Armando De Virgilio, Massimo Ralli, Andrea Ciofalo, Patrizia Mancini, Giuseppe Attanasio, Marco de Vincentiis, Alessandro Lambiase
Behçet's disease (BD) is a rare systemic vasculitis characterized by oral aphthous ulcers, genital ulcers, ocular lesions and other systemic manifestations. BD occurs most frequently in Eurasian populations along the ancient trading route known as the "Silk Road" which extends from eastern Asia to the Mediterranean basin. The causes of BD are unknown: it is believed to be due to an autoimmune process triggered by an infectious or environmental agent in a genetically predisposed individual. HLA-B51 allele located in the MHC locus, on chromosome 6p has been the most strongly associated risk factor for BD in areas along the Old Silk Route. Herpes simplex virus-1 and Streptococcus have been postulated as possible environmental triggers of BD. T cell homeostasis perturbation, especially Th1 and Th17 expansions and decrease regulation by Tregs are now supposed to be the cornerstone of BD pathogenesis. The histology shows vasculitis that involves both arteries and veins, and vessels of any size. BD is a systemic vasculitis with significant neutrophil infiltration, endothelial cell swelling, and fibrinoid necrosis. The diagnosis of BD is only supported by clinical criteria and requires the exclusion of other diagnoses based on clinical presentation. There are no pathognomonic laboratorial findings of BD. This rare disease often leads to blindness and fatal systemic involvement. Main causes of death include major vessel disease and central nervous system involvement (Neuro-Behcet). Corticosteroids are commonly used to treat clinical manifestations of BD in combination with immunosuppressant drugs. Tumor necrosis factor (TNF)-blocking agents such as Infliximab, Etanercept, and Adalimumab have been reported to have success in patients with BD.
https://ift.tt/2EsIPzs
Hemifacial microsomia (oculo-auriculo-vertebral spectrum) in an individual from the Teramo Sant’Anna archaeological site (7th–12th centuries of the Common Era, Italy)
Source:Archives of Oral Biology
Author(s): Joan Viciano, Ruggero D'Anastasio
BackgroundThis study is based in an analysis of the skeletal remains of an adult male from the Teramo Sant'Anna archaeological site (7th–12th centuries of the Common Era, Teramo, Italy).Results and DiscussionThe individual shows distinct abnormalities that principally involve asymmetric hypoplasia and dysmorphogenesis of the facial skeleton. The combination of these findings and the absence of abnormalities of the spine strongly suggest diagnosis of the congenital malformation known as hemifacial microsomia. This very heterogeneous syndrome affects primarily aural, ocular, oral and mandibular development. Despite the lack of clinical information and the absence of soft tissue, it was possible to perform a differential diagnosis for this palaeopathological case. Mastication was probably altered considering that the mandible is extremely asymmetric and lacks true condyles. The temporomandibular joints are present, but the right one is hypoplastic and abnormal in shape. There is evidence of bilateral dislocation, and the facial muscles are hypertrophic.ConclusionsThis case represents an important contribution to the palaeopathological literature because this is an uncommon condition that has not been widely documented in ancient skeletal remains.
https://ift.tt/2HhI0fS
Hydroalcoholic extracts of Myracrodruon urundeuva All. and Qualea grandiflora Mart. leaves on Streptococcus mutans biofilm and tooth demineralization
Source:Archives of Oral Biology
Author(s): Juliana Gonçalves Pires, Sara Salustiano Zabini, Aline Silva Braga, Rita de Cássia Fabris, Flaviana Bombarda de Andrade, Rodrigo Cardoso de Oliveira, Ana Carolina Magalhães
ObjectivesThis study evaluated the effect of the hydroalcoholic extracts of Myracrodruon urundeuva All. and Qualea grandiflora Mart. leaves (alone or combined) on the viability of Streptococcus mutans biofilm and on the prevention of enamel demineralization.MethodsStrain of S. mutans (ATCC 21175) was reactivated in BHI broth. Minimum inhibitory concentration, minimum bactericidal concentration, minimum inhibition biofilm concentration and minimum eradication biofilm concentration were determined in order to choose the concentrations to be tested under biofilm model. S. mutans biofilm (5 × 105 CFU/ml) was produced on bovine enamel, using McBain saliva under 0.2% sucrose exposure, for 3 days. The biofilm was daily treated with the extracts for 1 min. The biofilm viability was tested by fluorescence and the enamel demineralization was measured using TMR.ResultsMyracrodruon urundeuva All. (Isolated or combined) at the concentrations ≥ 0.625 mg/ml was able to reduce bacteria viability, while Qualea Grandflora Mart. alone had antimicrobial effect at 5 mg/ml only (p < 0.05). On the other hand, none of the extracts were able to reduce enamel demineralization.ConclusionsThe hydroalcoholic extracts of Myracrodruon urundeuva All. and Qualea grandiflora Mart. leaves (isolated or combined) have antimicrobial action; however, they do not prevent enamel caries under S. mutans biofilm model.
https://ift.tt/2GFc5oA
Hemifacial microsomia (oculo-auriculo-vertebral spectrum) in an individual from the Teramo Sant’Anna archaeological site (7th–12th centuries of the Common Era, Italy)
Source:Archives of Oral Biology
Author(s): Joan Viciano, Ruggero D'Anastasio
BackgroundThis study is based in an analysis of the skeletal remains of an adult male from the Teramo Sant'Anna archaeological site (7th–12th centuries of the Common Era, Teramo, Italy).Results and DiscussionThe individual shows distinct abnormalities that principally involve asymmetric hypoplasia and dysmorphogenesis of the facial skeleton. The combination of these findings and the absence of abnormalities of the spine strongly suggest diagnosis of the congenital malformation known as hemifacial microsomia. This very heterogeneous syndrome affects primarily aural, ocular, oral and mandibular development. Despite the lack of clinical information and the absence of soft tissue, it was possible to perform a differential diagnosis for this palaeopathological case. Mastication was probably altered considering that the mandible is extremely asymmetric and lacks true condyles. The temporomandibular joints are present, but the right one is hypoplastic and abnormal in shape. There is evidence of bilateral dislocation, and the facial muscles are hypertrophic.ConclusionsThis case represents an important contribution to the palaeopathological literature because this is an uncommon condition that has not been widely documented in ancient skeletal remains.
https://ift.tt/2HhI0fS
Hydroalcoholic extracts of Myracrodruon urundeuva All. and Qualea grandiflora Mart. leaves on Streptococcus mutans biofilm and tooth demineralization
Source:Archives of Oral Biology
Author(s): Juliana Gonçalves Pires, Sara Salustiano Zabini, Aline Silva Braga, Rita de Cássia Fabris, Flaviana Bombarda de Andrade, Rodrigo Cardoso de Oliveira, Ana Carolina Magalhães
ObjectivesThis study evaluated the effect of the hydroalcoholic extracts of Myracrodruon urundeuva All. and Qualea grandiflora Mart. leaves (alone or combined) on the viability of Streptococcus mutans biofilm and on the prevention of enamel demineralization.MethodsStrain of S. mutans (ATCC 21175) was reactivated in BHI broth. Minimum inhibitory concentration, minimum bactericidal concentration, minimum inhibition biofilm concentration and minimum eradication biofilm concentration were determined in order to choose the concentrations to be tested under biofilm model. S. mutans biofilm (5 × 105 CFU/ml) was produced on bovine enamel, using McBain saliva under 0.2% sucrose exposure, for 3 days. The biofilm was daily treated with the extracts for 1 min. The biofilm viability was tested by fluorescence and the enamel demineralization was measured using TMR.ResultsMyracrodruon urundeuva All. (Isolated or combined) at the concentrations ≥ 0.625 mg/ml was able to reduce bacteria viability, while Qualea Grandflora Mart. alone had antimicrobial effect at 5 mg/ml only (p < 0.05). On the other hand, none of the extracts were able to reduce enamel demineralization.ConclusionsThe hydroalcoholic extracts of Myracrodruon urundeuva All. and Qualea grandiflora Mart. leaves (isolated or combined) have antimicrobial action; however, they do not prevent enamel caries under S. mutans biofilm model.
https://ift.tt/2GFc5oA
Bilateral pneumothorax, surgical emphysema and pneumomediastinum in a young male patient following MDMA intake
MDMA (3,4-methylenedioxymethamphetamine) or 'Ecstasy' is an illicit drug frequently used by young people at parties and 'raves'. It is readily available in spite of the fact that it is illegal.1 It is perceived by a lot of young people as being 'harmless', but there have been a few high-profile deaths associated with its use.2 Known side effects of MDMA include hyperthermia, rhabdomyolysis, coagulopathy and cardiac arrhythmias.3 Rarer side effects include surgical emphysema and pneumomediastinum, which have been better described with cocaine abuse.4–6 We present a case of bilateral pneumothorax, surgical emphysema and pneumomediastinum in a young man after taking ecstasy.
https://ift.tt/2Esatwc
Low-dose warfarin maternal anticoagulation and fetal warfarin syndrome
Fetuses exposed to warfarin during pregnancy are at an increased risk of developing an embryopathy known as fetal warfarin syndrome or warfarin embryopathy. The most consistent anomalies are nasal hypoplasia and stippling of vertebrae or bony epiphyses. Management of pregnant patients on anticoagulation is challenging. Current guidelines suggest the use of warfarin if the therapeutic dose is ≤5 mg/day. We report the case of a newborn with signs of warfarin embryopathy born from a mother anticoagulated with warfarin due to mechanical mitral and aortic heart valves. Warfarin was required at the dose of 5 mg/day and was withheld without medical advice between weeks 8 and 10 with no other anticoagulation. The newborn presented with skeletal abnormalities and a ventricular septal defect that have not required specific treatment during the first year of life. Low-dose warfarin is associated with a lower risk of warfarin-related fetopathy but the risk of embryopathy seems unchanged.
https://ift.tt/2Hfvg9l
Pemphigoid gestationis successfully treated with intravenous immunoglobulin
Pemphigoid gestationis (PG), also known as herpes gestationis, is a rare autoimmune blistering disease specific to pregnancy, which usually presents in the second or third trimesters and, in 15%–25% of cases, during the immediate postpartum period.1Although the ethiopathogeny of PG is not fully clarified, most patients develop antibodies against a 180 kDa transmembrane hemidesmosomal protein (BP180; BPAG2; collagen XVII).2 PG has a strong association with human leucocyte antigens DR3 and DR4.3
We report a case of a 29-year-old female patient with PG successfully treated with intravenous immunoglobulin.
https://ift.tt/2GIVUGP
Novel MRI of mediastinal masses: internal differentiation of a thymoma and lymphoma with T1 and T2 mapping
Routine imaging for mediastinal malignancies includes chest X-ray, CT or MRI. T1 and T2 mapping are novel MRI techniques which may have a role in expanding the assessment of internal tumour characteristics. This case report details two middle-aged women who had similar clinical presentations of mediastinal masses of comparable size and appearance when assessed with routine imaging. T1 and T2 maps were acquired on MRI to investigate whether these tumours could be further differentiated prior to surgery. T1 and T2 mapping supported suspicion for which tumour components were solid and cystic, as subsequently confirmed histologically. Furthermore, comparison between the two tumours showed native T1 values differed within the solid components by 37%, correlating to differences in proteinaceous material within the tumour types. This radiological–pathological correlation provides evidence that T1 and T2 mapping has clinical utility in the assessment and differentiation of mediastinal masses.
https://ift.tt/2HkVk3a
Anti-N-methyl-D-aspartate receptor encephalitis relapse in the brainstem
Description
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder involving IgG antibody reaction against NMDAR. It typically develops in women with ovarian teratoma, and its characteristic clinical symptoms include acute behavioural change, psychosis, movement disorder, seizure and autonomic dysfunction. Long-term management in an intensive care unit and immunosuppressive therapy are necessary in most cases, but good prognosis is achieved with appropriate treatment.1 Here, we report a case of anti-NMDAR encephalitis that improved without treatment, but relapsed involving a different brainstem lesion without any symptoms.
A 36-year-old woman was admitted with headache and a single partial seizure 2 weeks after influenza-like fever. At admission, her physical and neurological examination findings as well as routine blood examination results were normal. Cerebrospinal fluid (CSF) analysis revealed a cell count of 163/μL (neutrophil-to-lymphocyte ratio, 15:1) and protein level of 47 mg/dL. MRI showed slight swelling in the limbic system. Meningitis was suspected;...
https://ift.tt/2GJz01W
Double venous compression due to duplicated inferior vena cava-induced right common iliac vein thrombosis
Venous compression syndromes are caused by extrinsic venous compression of anatomical structures, such as the adjacent arteries and bones. Chronic venous compression and pulsative vibratory arterial pressure accelerate the development of deep vein thrombosis. Herein, we report the first case of double venous compressions due to a duplicated inferior vena cava-induced right-sided common iliac vein thrombosis. The thrombus was induced by left-sided inferior vena cava entrapment and right-sided common iliac vein compression, resembling nutcracker syndrome and May-Thurner syndrome, respectively. Bypass flow of the right inferior vena cava rendered the right lower extremity asymptomatic. Once daily anticoagulation edoxaban was effective. Congenital venous anomalies and bypass formations should be considered when a common iliac vein thrombus without symptoms in the lower extremities is observed, and a lifelong periodical follow-up is mandatory, even after remission.
https://ift.tt/2HiMPFu
Good clinical history scores over extensive workup in unmasking a case of galactorrhoea
The clinical presentation of a young woman with galactorrhoea is described in detail including the history and clinical examination findings. While the patient and her family members feared a serious medical condition which had so far been an obscurity despite a number of investigations, we tried to diagnose the patient starting from the basics, which after a proper history revealed a levosulpiride-induced galactorrhoea. This again lays emphasis on the old adage in medical field that 'a proper history and examination are the key to diagnosis'. There are few reports pertaining to levosulpiride-induced galactorrhoea making it a rare side effect of this drug. We further try to discuss the different causes of galactorrhoea in a young non-pregnant woman which can be encountered in clinical practice.
https://ift.tt/2GIFKwU
Acute lower limb ischaemia secondary to intestinal occlusion
In general, acute lower limb ischaemia is caused by embolic, thrombotic or traumatic phenomena. Here, we describe the case of a 67-year-old woman in an emergency room setting who was initially assessed for paralysis and numbness of her lower left limb. On physical examination, the abdomen was distended and non-compressible. An abdominal AngioScan showed complete occlusion of the left iliac artery by extrinsic compression of the dilated small intestine. After a review of the literature, no case was found describing a lower limb ischaemia by extrinsic vascular compression secondary to a compartment syndrome caused by small bowel obstruction. The treatment of this case required surgical decompression of the abdomen which led to an instantaneous reperfusion of the left leg. Unfortunately, the patient deceased a few hours after the surgery due to haemodynamic deterioration.
https://ift.tt/2HhJKFI
Atypical mycobacteriosis in a poorly compliant patient
Description
Non-tuberculous mycobacteriosis most frequently presents as chronic lung disease.1 Delayed diagnosis or even misdiagnosis occurs due to a great similarity in its clinical presentation to tuberculosis.2 Treatment often seems unprofitable since it is complex and prolonged, poorly tolerated and frequently ineffective in the elimination of the disease.3
The authors present a 68-year-old woman with a history of pulmonary tuberculosis 1 year before, for which she only completed 6 weeks of treatment as well as follow-up, having abandoned both as she believed they went against her culture and religion. She was admitted with productive cough, weakness and weight loss. Blood tests revealed anaemia, thrombocytosis, elevated inflammatory markers, severe hypoalbuminaemia and negative HIV serology. The chest X-ray (figure 1) showed two cavities in the right lung and a consolidation in the left lower lobe. The chest CT scan (figures 2 and 3
https://ift.tt/2GGyh1t
Acute mucocutaneous methotrexate toxicity with marked tissue eosinophilia
Methotrexate toxicity in mucocutaneous areas is usually not associated with tissue eosinophilia. We describe a case of acute methotrexate-induced mucocutaneous erosions with interface dermatitis and eosinophils. A 76-year-old African-American woman with a history of bullous pemphigoid on methotrexate therapy presented with lower extremity cellulitis, developing oral and cutaneous erosions during hospitalization after daily dosage of methotrexate. Shallow circular cutaneous erosions were found on chest, abdomen and limbs. Laboratory results showed pancytopaenia and elevated liver function tests. Skin biopsy revealed irregular acanthotic epidermis with interface dermatitis, individual dyskeratotic cells and superficial perivascular lymphocytic infiltrate with numerous eosinophils. Methotrexate was stopped and leucovorin was administered, leading to improvement. The histopathological changes in acute mucocutaneous toxicity range from pauci-inflammatory erosions with dyskeratotic keratinocytes to interface dermatitis and infrequently seen eosinophils. This case exemplifies that interface dermatitis with a marked eosinophilic infiltrate can be found in the setting of acute mucocutaneous methotrexate toxicity.
https://ift.tt/2Hfh4x6
Microsatellite instability associated with durable complete response to PD-L1 inhibitor in head and neck squamous cell carcinoma
Source:Oral Oncology
Author(s): Magalie P. Tardy, Ilaria Di Mauro, Nathalie Ebran, Sadal Refae, Alexandre Bozec, Karen Benezery, Frédéric Peyrade, Joel Guigay, Anne Sudaka-Bahadoran, Cécile Badoual, Florence Pedeutour, Esma Saada-Bouzid
https://ift.tt/2H0e8Xx
Comprehensive Acute Pain Management in the Perioperative Surgical Home
Source:Anesthesiology Clinics
Author(s): John-Paul J. Pozek, Martin De Ruyter, Talal W. Khan
Teaser
The careful coordination of care throughout the perioperative continuum offered by the perioperative surgical home (PSH) is important in the treatment of postoperative pain. Physician anesthesiologists have expertise in acute pain management, pharmacology, and regional and neuraxial anesthetic techniques, making them ideal leaders for managing perioperative analgesia within the PSH. Severe postoperative pain is one of many patient- and surgery-specific factors in the development of chronic postsurgical pain. Delivering adequate perioperative analgesia is important to avoid this development, to decrease perioperative morbidity, and to improve patient satisfaction.https://ift.tt/2uYFaJY
Quality and the Health System
Source:Anesthesiology Clinics
Author(s): Monaliza Gaw, Frank Rosina, Thomas Diller
Teaser
Since the publication of "To Err is Human" in 1999, substantial efforts have been made within the health care industry to improve quality and patient safety. Although improvements have been made, recent estimates continue to indicate the need for a marked change in approach. In this article, the authors discuss the concepts and characteristics of high reliability organizations, safety culture, and clinical microsystems. The health care delivery system must move beyond current quality and patient safety approaches and fully engage in these new concepts to transform health care system performance.https://ift.tt/2H70X7v
The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: a randomized clinical trial
Abstract
We aimed to compare the efficacy of low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) in the treatment of plantar fasciitis (PF). Seventy patients were randomized into either the LLLT (8 men, 27 women; mean age 48.65 ± 10.81 years) or HILT (7 men, 28 women; mean age 48.73 ± 11.41 years) groups. LLLT (904 nm) and HILT (1064 nm) were performed three times per week, over a period of 3 weeks. Each treatment combined with silicone insole and stretching exercises. Patients' pain and functional status were evaluated with Visual Analog Scale, Heel Tenderness Index, and Foot and Ankle Outcome Score before and after treatment. A chi-square test was performed to compare demographic and clinical characteristics. Within-group and between-group differences were also investigated. Paired samples t test was used to analyze the differences between baseline and after treatment values, while independent samples t test was used to compare the two groups. Both groups contained similar demographic characteristics including age, sex, and body mass index (all p > 0.05). Three and two patients in the HILT and LLLT group, respectively, were lost to follow-up. At the study onset, there were no statistically significant differences between the two groups in the Visual Analog Scale, Heel Tenderness Index, and Foot And Ankle Outcome Scores. Three weeks later, both groups showed significant improvement in all parameters (p < 0.05). The HILT group demonstrated better improvement in all parameters than the LLLT group. Although both treatments improved the pain levels, function, and quality of life in patients with PF, HILT had a more significant effect than LLLT.
https://ift.tt/2Hiq0SI
Unusual presentation of pheochromocytoma: thirteen years of anxiety requiring psychiatric treatment
Pheochromocytoma is a rare tumor of the adrenal gland. It often presents with the classic triad of headache, palpitations and generalized sweating. Although not described as a typical symptom of pheochromocytoma, anxiety is the fourth most common symptom reported by patients suffering of pheochromocytoma. We report the case of a 64 year old man who had severe anxiety and panic disorder as presenting symptoms of pheochromocytoma. After 13 years of psychiatric follow-up, the patient was diagnosed with malignant pheochromocytoma. After surgical resection of his pheochromocytoma and his hepatic metastases, the major panic attacks completely disappeared, the anxiety symptoms improved significantly and the psychiatric medications were stopped except for a very low maintenance dose of venlafaxine. We found in our cohort of 160 patients with pheochromocytoma 2 others cases of apparently benign tumors with severe anxiety that resolved after pheochromocytoma resection. These cases highlight that pheochromocytoma should be included in the differential diagnosis of refractory anxiety disorder.
Learning points:Anxiety and panic disorder may be the main presenting symptoms of pheochromocytoma.
The diagnosis of pheochromocytoma should be excluded in cases of long-term panic disorder refractory to medications since the anxiety may be secondary to a catecholamine-secreting tumor.
Surgical treatment of pheochromocytoma leads to significant improvement of anxiety disorders.
https://ift.tt/2H19CIq
A randomized control trial comparing between titanium osteosynthesis and biodegradable osteosynthesis in access mandibulotomy for oral malignancy
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jian Nan Liu, Ming Yi Wang, Kenneth Wan, Jing Han, Shi Jian Zhang, Xing Zhou Qu, Hui Shan Ong
BackgroundPrevious studies have shown that biodegradable implants can be used in mandibular fixation with optimal result. The effect of post-operative radiotherapy(PORT) on its degradation rate, strength and by-product secretion is not yet known.MethodsA prospective randomized control trial including 40 consecutive mandibulotomy patients randomly divided into either titanium or biodegradable osteofixation cohorts. All patients received PORT. The following parameters were recorded and compared: maximal mouth opening, occlusal force, centre of force trajectory, occlusal status, radiographic evidence of bony union, Mandibular Function Impairment Questionnaire(MFIQ), overall satisfaction score and complication rates.ResultsThere were no statistically significant differences between the biodegradable and the titanium osteosynthesis groups in term of mandibular function or occlusal status. MFIQ scores (p=0.0.089) and overall satisfaction scores (p=0.642) were higher in the biodegradable cohort but the differences were not statistically significant. 40% of patients in the titanium cohort complained of plate palpability/cold intolerance and required plate removal (p=0.028). 10% of patients in the titanium cohort developed osteoradionecrosis. The overall cost of management was higher in the titanium group (p=0.033).ConclusionBiodegradable osteosynthesis is as reliable as titanium osteofixation for access mandibulotomy and yet cost-effective. Post-operative radiotherapy did not increase the complication rate in the biodegradable osteosynthesis group.
https://ift.tt/2Es1F9M
Multiple Endocrine Neoplasia Type 2b (MEN2B) in a 9 Years Old Female
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Solon T. Kao, Christopher J. Capua, Rafik A. Abdelsayed
https://ift.tt/2Jsh5if
Evaluation of staff satisfaction after implementation of a surgical safety checklist in the ambulatory of an oral- and maxillofacial surgery department and its impact on patient safety
Publication date: Available online 6 April 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Schmitt Christian Martin, Buchbender Mayte, Musazada Saida, Bergauer Bastian, Neukam Friedrich- Wilhelm
PurposeSafety checklists in medicine have been shown to be effective in the prevention of complications and adverse events in patients undergoing surgery. Such checklists are not as common in dentistry. The aims of this study were to propose a safety checklist for the ambulatory treatment of patients undergoing oral and implant surgery and to assess its impact on patient safety and staff satisfaction.MethodsAfter implementation of a surgical safety checklist in the ambulatory treatment of patients undergoing oral and implant surgeries, a questionnaire regarding staff satisfaction and safety-related parameters was randomly administered. Incidents, complications and adverse events were documented. Outcomes with (n= 40 surgeries) and without (n= 40 surgeries) use of the checklist were analyzed and compared.ResultsStaff reported high satisfaction with the use of the checklist, which demonstrably improved team communication and reduced stress levels during surgery. There was a statistically significantly higher frequency of reported incidents without the use of the checklist (n=43) than with the use of the checklist (n=10, P= 0.000). Most incidents were reported in the context of pre- and post- procedural processes.ConclusionsSafety checklists help to improve work processes, optimize communication and reduce stress levels. Their use in clinical dental practice is recommended.
https://ift.tt/2qeyUIJ
Minimization of radial forearm flap donor site scars using endoscopy and an allogenic dermal matrix
Publication date: Available online 6 April 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jae-Young Kim, Young-Kwan Kim, Sanghoon Lee, Woong Nam
Radial forearm free flaps are widely used for soft tissue reconstruction in the oral cavity. However, preparation of the vascular pedicle leaves long undesirable scars. Extensive scar formation also occurs at the skin defect site. Over recent years, endoscopic surgery has been increasingly used for minimally-invasive procedures. Here, we report four cases involving the formation of radial forearm free flaps using endoscopy and an alloplastic skin graft, resulting in minimal scar formation and favorable results.
https://ift.tt/2GGcYRX
Superficial parotidectomy versus partial superficial parotidectomy: A comparison of complication rates, operative time, and hospital stay
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Ahmet Erdem Kilavuz, Murat Songu, Ercan Pinar, Yilmaz Ozkul, Sedat Ozturkcan, Ibrahim Aladag
PurposeThe type and extent of surgery for benign parotid tumors is a subject of debate. The investigators aimed to measure and compare hospital stay, operative time, and complications rates associated with superficial parotidectomy (SP) and partial superficial parotidectomy (PSP).MethodsThis retrospective cohort study included all patients who underwent surgery for benign parotid gland tumors in our tertiary center between January 2006 and March 2014, and were followed up for at least 3 years. The predictor variable was the type of parotidectomy, and the main outcome parameters were operative time, hospital stay, and postoperative complications. The demographic characteristics (age, sex), clinical history, and preoperative findings were obtained from patient records. The Kolmogorov–Smirnov, Mann–Whitney U test and chi-square test were used to analyze the data. P values <0.05 were considered statistically significant.ResultsThe sample was composed of 321 patients (184 males and 137 females) with a mean age of 54.0±14.7 years (range, 18–87 years). Of those, 190 underwent SP and 131 patients underwent PSP. Pleomorphic adenoma was the most common tumor (83 patients, 53%), followed by Warthin's tumor (50 patients, 32%). The mean hospital stay was 6.7±2.3 days in the SP group and 4.8±2.4 days in the PSP group (p=0.000). The mean operative times in the SP and PSP groups were 134.0±24.6 and 92.1±21.9 min, respectively (p = 0.000). The overall complication rates were 21.6 and 12.2% in the SP and PSP groups, respectively (p = 0.031). No tumor recurrence was observed in either group.ConclusionCompared to the SP group, the PSP group had shorter operative and hospital stay durations and fewer postoperative complications with a comparable recurrence rate. Therefore, PSP should be considered in suitable cases.
https://ift.tt/2qahvBQ
Prevalence of Oral Candidiasis in Indian HIV Sero-Positive Patients with CD4 + Cell Count Correlation
Abstract
The objective of this study was to investigate the prevalence of oral candidiasis in human immunodeficiency virus/acquired immunodeficiency syndrome patients in India. A descriptive cross-sectional study. To compare the occurrence of candidiasis with the levels of CD4+ (cluster of differentiation) cell counts. A total of 100 patients infected with HIV were included. Oral lesions were observed, only patients with oral candidiasis were studied and classified. Standard methods were used for collection of oral specimens, culturing and identifying Candida species. Potential correlations between the presence and severity of oral lesions and CD4+ cells counts were analysed. Candidiasis was detected in 20% of the patients with an mean CD4+ count being 188. All the patients were on highly active antiretroviral therapy except one. There was pseudomembranous candidiasis in 9, erythematous type in 3, angular chelitis in 2, chronic hyperplastic in 4, and median rhomboid glossitis in 2. Candidiasis is an indicator of low CD4+ cell count but may be seen at different levels of the disease. In HIV sero-positive patients it is an indicator of falling CD4+ cell count generally below 200, indicating onset of AIDS. Many a times the patient does not have specific complaints but, it is picked up only on examination. Hence oral cavity examination should be a must in seropositive patients at every clinical follow up.
https://ift.tt/2uY5O60
Microscopic Versus Endoscopic Myringoplasty: A comparative study
Abstract
To compare the results of myringoplasty by using operating microscope (postaural) with that of myringoplasty by using endoscope (permeatal). Our study was conducted in Department of ENT of in Chirayu Medical College and Hospital. Total 60 patients of age group 18–60 were taken for study having chronic otitis media or trauma with central perforation. Patients were randomly selected microscopic or endoscopic myringoplasty. 30 patients for Microscopic Myringoplasty and 30 patients for endoscopic Myringoplasty were selected. Out of total 60 patients 35 were females and the 25 were males, 27 were in the age group 15–30 and 23 were in age group 31–45 and only 10 in the age group of 46–60. 18–30 age group cohort was predominant. The average time taken for endoscopic myringoplasty was 65.5 ± 3.45 min and for microscopic myringoplasty 85.7 ± 3.42 min. 26 were having Large central perforation (LCP), of which 13 underwent microscopic and 13 underwent endoscopic myringoplasty. The graft was taken up in situ in 22 patients while 4 patients had small residual central perforation. Out of these four residual perforations 3 were done by endoscopy and 1 by microscopy. 19 (of 60) were having Medium size central perforation (MCP), 10 were operated with endoscope and 9 with microscope. 15 (60) were having Small central perforation (SCP), 7 done with endoscope and 8 with microscope. In all patient graft take up was well. Large central perforation present in maximum patient and had least graft uptake as compared to MCP and SCP. Out of the 30 these endoscopic myringoplasty 27 patients had good graft uptake and 3 had small central residual perforation after 3 months. Out of the 30 microscopic myringoplasty 29 patients had good graft uptake and 1 patient had small central residual perforation after 3 months. In our study pre operative and post operative Air Bone Gaps (ABGs) were 22.05 ± 2.04 and 9.05 ± 1.36 db respectively in endoscopic myringoplasty and 21.81 ± 1.85 and 8.55 ± 1.44 db respectively in microscopic myringoplasty. Microscopic myringoplasty has greater success rate in larger perforations that is LCP and MCP and equal result in SCP. Advantage of microscope is depth perception and both hands are free for procedure which is limitation of endoscopic myringoplasty (need to use endoscope holder). Advantage of endoscopic permeatal myringoplasty is superior visualization, least tissue trauma and better cosmetic outcome, almost equal graft uptake and hearing outcome with less operative time. Endoscope system is portable, so convenient for surgeon where microscope is not available. Also endoscope is a less costly armamentarium. Our study shows better result in myringoplasty can be achieved if both methods of surgery are used in combination.
https://ift.tt/2HgFZ3D
Correlation Between Objective Evaluation Result of Nasal Congestion and Life Quality in Patients with Acute Rhinosinusitis
Abstract
Rhinosinusitis is an inflammatory process involving the nasal mucosa and paranasal sinuses. Rhinitis and sinusitis generally occur simultaneously and thus the current terminology used is rhinosinusitis. The blind nose can negatively affect the overall quality of life including the physical or emotional condition of the sufferer and disruption to work or school (reduced productivity and difficulty in concentrating). To analyse correlation between objective evaluation results of nasal congestion through NIPF and life quality based on sinonasal outcome Test-20 score in patients with acute rhinosinusitis. The study was conducted at Otolaryngology Outpatient Clinic at Dr. Soetomo General Hospital Surabaya. The time of study began in July 2011 until the minimum sample size was met. The sample of the study was patients diagnosed with acute rhinosinusitis treated at Otolaryngology Outpatient Clinic at Dr. Soetomo General Hospital Surabaya and meet the research criteria. Based on statistical analysis with Spearman rank correlation test, correlation between NIPF value and SNOT-20 score on 16 samples got correlation coefficient—0.310 and p = 0.243. The scatter diagram showed the NIPF value variables and the SNOT-20 scores being scattered in uneven spots and erratic patterns. This indicated that an objective evaluation of nasal congestion based on NIPF and subjective assessment of quality of life based on SNOT-20 score was not obtained correlation (p > 0.05). The results of the objective nasal obstruction examination based on Nasal Inspiratory Peak Flow have no correlation with subjective subjective assessment of quality of life based on Sino-Nasal Outcome Test-20 score in patients with acute rhinosinusitis.
https://ift.tt/2uSgRxp
Glossopharyngeal Nerve Block with Long Acting Local Anaesthetic Agent (Bupivacaine) and It’s Effect on Early Post-operative Period in Adult Tonsillectomy: A Prospective Study
Abstract
We evaluated the benefit of glossopharyngeal nerve block with long acting local anaesthetic like bupivacaine. It was a randomized prospective study. Sixty-four patients were selected and divided into two groups. Group A received bilateral nerve block and Group B received no block. Pain score using Visual Analog Scale (0–100 mm) was assessed at 30 min, 2, 6 and 12 h. In the immediate post operative period pain scores of Group A at rest and swallowing was significantly lower than Group B (p < 0.001 and p < 0.01). Glossopharyngeal nerve block is an important method of reducing post-tonsillectomy pain.
https://ift.tt/2Hg332p
Xanthelasma Palpebrarum: More than Meets the Eye
Abstract
Xanthelasma palpebrarum (XP) is the most common form of cutaneous xanthomata, and is important aesthetically, because of its close relation to the eyes, as well as medically for its association with cardiovascular disease (CVD). To provide avant-garde review discussing the various aspects of XP, including its aetio-pathogenesis and various treatment modalities. A structured Pubmed and Medline were searched for relevant articles. The finding of recent research has strongly espoused the link between XP and CVD, and mechanisms have been suggested for its formation. The new technologies have led to a multitude of treatment options for XP. XP is a multi-faceted entity; other than simple treatment of the cosmetic aspect of the disease, one must be cognizant of its cardiovascular implications.
https://ift.tt/2Es1eMG
Vagal Paragangliomas: From Reducing Morbidity to Improving Quality of Life
Abstract
Vagal paragangliomas are rare tumors. Advances in the imaging have aided the diagnosis and assessment of this disease. Surgery is the mainstay of the treatment however radiotherapy has been tried in the selected cases. Surgery is associated with some mortality but with a lot of morbidity in view of cranial nerve deficit. The necessity to prevent additional cranial nerve deficits needs thorough preoperative evaluation and influences the therapeutic approach. This study involves the retrograde evaluation of five patients of vagal paraganglioma histopathologically confirmed, all the patients were operated via trancervical approach. Preoperatively three of five had 9, 11 and 12th cranial nerve involvement, one had horner's syndrome. Postoperative vocal rehabilitation was done in all the patient by medialisation thyroplasty Issiki type 1. Though vagal paragangliomas are associated with mortality and morbidity. Surgical treatment should aim at reducing mortality. Vagal nerve morbidity can be taken care as a planned and staged procedure mainly involving restoring voice as rest of concerns are taken care by compensation from opposite nerves.
https://ift.tt/2HfQKD6
Transcutaneous Columellar Strut for Correcting Caudal Nasal Septal Deviation
Abstract
Correction of caudal septal deviation is a challenging issue because of its significant role in tip support mechanisms. Some interventions especially aggressive resection of caudal septum to correct deviation, may compromise external nasal valve, tip ptosis and persistence of nasal obstruction. Many surgical techniques have been suggested to correct this type of nasal septal deviation. This study presents a technique to correct caudal septal deviation without weakening of tip support mechanisms. To evaluate the efficacy of insertion of a transcutaneous columellar strut during correction of caudal septal deviation. The study was performed in patients complaining from nasal obstruction with caudal septal deviation. After intranasal incision and elevation of mucoperichondrial flap, Caudal septum released from anterior nasal spine (ANS) and a band of cartilage removed from inferior and caudal part of septum and septum again fixed to ANS. Through a vertical transcutaneous incision, a cartilaginous strut is placed in columella, between medial crurae. Preoperative and postoperative NOSE score determined and photographs were taken. In 14 patients we performed this technique, the postoperative NOSE score showed significant improvement, (p = 0.001). Nasal breathing improved in all patients without any complication or tip ptosis or worsening of nasal appearance. This septoplasty technique along with placement of transcolumellar strut, is an easy, efficient and complication free method for simultaneously correction of caudal deviation of nasal septum, reinforcing external nasal valve and prevents tip ptosis.
https://ift.tt/2Es1fQK
Clinical application of multicolour scanning laser imaging in diabetic retinopathy
Abstract
To compare the visualization of the lesions of diabetic retinopathy (DR) using multicolour scanning laser imaging (MSLI) and conventional colour fundus photography (CFP). The paired images of diabetic patients who underwent same-day MSLI and CFP examinations were reviewed. Combined multicolour (MC) images were acquired simultaneously using three laser wavelengths: blue reflectance (BR, λ = 488 nm), green reflectance (GR, λ = 518 nm) and infrared reflectance (IR, λ = 820 nm). The number of positive DR lesions was calculated using fundus fluorescein angiography as the reference standard. The visibility of the microaneurysms (Mas) was graded using a scale, and the number of Mas for each method was counted by two masked readers. Eighty eyes of 42 diabetic patients were included. The average grading score for Mas visualization was significantly higher with MC (1.50 ± 0.71) and GR (1.55 ± 0.69) than with CFP (0.95 ± 0.81). The average number of Mas was also significantly higher with MC (11.41 ± 14.02) and GR (11.93 ± 13.43) than with CFP (6.43 ± 9.39). The number of positive Mas, diabetic macular edema (DME) and epiretinal membranes (ERM) were significantly higher with MC than CFP (P < 0.05), while the numbers of cotton wool spots, haemorrhages, hard exudates, venous beading and abnormal new vessels were not significantly different (P > 0.05). Mas and ERM were most effectively detected on GR images, and an elevated greenish shift was clearly visualized in patients with DME on the MC images. MSLI can effectively visualize Mas and other pathological lesions of DR compared with CFP. MSLI with superior resolution may be a useful complement for DME and ERM detection.
https://ift.tt/2qe5pXw
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