Head and Neck Medicine by Alexandros G.Sfakianakis: 04/19/18

Πέμπτη 19 Απριλίου 2018

Generation and characterization of hagfish variable lymphocyte receptor B against glycoprotein of viral hemorrhagic septicemia virus (VHSV)

Publication date: July 2018
Source:Molecular Immunology, Volume 99
Author(s): Jung Seok Lee, Jaesung Kim, Se Pyeong Im, Si Won Kim, Jassy Mary S. Lazarte, Jae Wook Jung, Tae Won Gong, Young Rim Kim, Jeong Ho Lee, Hyoung Jun Kim, Tae Sung Jung
Variable lymphocyte receptors B (VLRBs) are non-immunoglobulin components of the humoral immune system in jawless vertebrates including hagfish (Eptatretus burgeri) and lamprey (Petromyzon marinus). Hagfish VLRBs consist of leucine rich repeat (LRR) modules with a superhydrophobic C-terminal tail, the latter of which leads to extremely low expression levels in recombinant protein technology. Here, we present an artificially oligomerized VLRB (arVLRB) that conjugates via the C4bp oligomerization domain derived from human C4b-binding protein (hC4bp) rather than the superhydrophobic tail. The resulting arVLRB had a tightly multimerized form with seven monomeric VLRB arms and showed high expression and secretion levels in a mammalian expression system. To isolate antigen-specific arVLRB, we constructed large VLRB libraries from hagfish immunized with the fish pathogen, viral hemorrhagic septicemia virus (VHSV). The selected arVLRBs were found to recognize various types of antigens, including the recombinant target protein, purified viruses, and progeny viruses, with high antigen binding abilities and specificities. We also performed in vitro affinity maturation of the arVLRBs through LRRCT mutagenesis, and found that this enhanced their antigen-binding properties by at least 125-fold. Our epitope mapping analysis revealed that ³⁷DWDTPL⁴², which is located in a region conserved among the glycoproteins of all VHSV isolates, is the recognition epitope of the arVLRBs. Thus, our newly developed arVLRB could prove useful in the development of universal diagnostic tools and/or therapeutic agents for the virus. Together, our novel findings provide valuable insights into hagfish VLRB and its potential use as a novel alternative to conventional antibodies for biotechnological applications.

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Tree nut allergens

Publication date: Available online 19 April 2018
Source:Molecular Immunology
Author(s): Sabine Geiselhart, Karin Hoffmann-Sommergruber, Merima Bublin
Tree nuts are considered as part of a healthy diet due to their high nutritional quality. However, they are also a potent source of allergenic proteins inducing IgE mediated hypersensitivity often causing serious, life-threatening reactions. The reported prevalence of tree nut allergy is up to 4.9% worldwide. The general term "tree nuts" comprises a number of nuts, seeds, and drupes, derived from trees from different botanical families. For hazelnut and walnut several allergens have been identified which are already partly applied in component resolved diagnosis, while for other tree nuts such as macadamia, coconut, and Brazil nut only individual allergens were identified and data on additional allergenic proteins are missing. This review summarizes the current knowledge on tree nut allergens and describes their physicochemical and immunological characterization and clinical relevance.

https://ift.tt/2J9WAFL

Peanut allergens

Publication date: Available online 19 April 2018
Source:Molecular Immunology
Author(s): Chiara Palladino, Heimo Breiteneder
Peanut allergens have the potential to negatively impact on the health and quality of life of millions of consumers worldwide. The seeds of the peanut plant Arachis hypogaea contain an array of allergens that are able to induce the production of specific IgE antibodies in predisposed individuals. A lot of effort has been focused on obtaining the sequences and structures of these allergens due to the high health risk they represent. At present, 16 proteins present in peanuts are officially recognized as allergens. Research has also focused on their in-depth immunological characterization as well as on the design of modified hypoallergenic derivatives for potential use in clinical studies and the formulation of strategies for immunotherapy. Detailed research protocols are available for the purification of natural allergens as well as their recombinant production in bacterial, yeast, insect, and algal cells. Purified allergen molecules are now routinely used in diagnostic multiplex protein arrays for the detection of the presence of allergen-specific IgE. This review gives an overview on the wealth of knowledge that is available on individual peanut allergens.

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Belatacept and auto-immune adverse events

No abstract available

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More Than Just Wait Time? Regional Differences in Liver Transplant Outcomes for Hepatocellular Carcinoma

Background Regional allocation of deceased donor livers has led to variable wait times for HCC patients on the liver transplant list. The purpose of our study was to evaluate how regional differences in wait time affect outcomes for HCC patients. Methods A retrospective, observational study was performed using the OPTN database from 2/27/2002 to 9/25/2015. The cumulative incidences of transplant and waitlist death as well as intention-to-treat and posttransplant survival were evaluated for patients ≥ 18 years of age listed for DDLT with stage II HCC exception points in each UNOS region. A multivariable analysis of predictive factors for posttransplant survival was performed. Results Cumulative incidence of transplant decreased and cumulative incidence of waitlist death increased as regional wait time increased. Intention-to-treat survival decreased with increased regional wait time with long wait time regions 1, 5, and 9 having significantly lower intention-to-treat survival compared to many of the shorter wait time regions (p

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Unique glandular ex-vivo Th1 and Th17 receptor motifs in Sjögren's syndrome patients using single-cell analysis

Publication date: Available online 19 April 2018
Source:Clinical Immunology
Author(s): Alexandria Voigt, Katherine Bohn, Sukesh Sukumaran, Carol M. Stewart, Indraneel Bhattacharya, Cuong Q. Nguyen
Primary Sjögren's syndrome (pSS) is an autoimmune disease in which the underlying cause has yet to be elucidated. The main objective of this study was to determine the T cell receptor (TCR) repertoires of individual infiltrating T helper (Th)-1 and 17 cells of pSS patients using single-cell analysis. Single-cell analysis of ex-vivo infiltrating T cells demonstrated that pSS patients had higher frequencies of activated Th17 cells. Single-cell TCR sequencing revealed that TCRβ variable (TRBV)3-1/joint (J)1-2 (CLFLSMSACVW) and TRBV20-1/J1-1 (SVGSTAIPP*T) were expressed by activated Th1 and Th17 cells in both cohorts. Uniquely, TCRα variable (TRAV)8–2/J5 (VVSDTVLETAGE) was expressed by Th1 cells present only in patients and complementarity-determining region (CDR)3α-specific motif (LSTD*E) present in both Th1/Th17 cells. The study demonstrates that both activated Th1 and Th17 cells of pSS patients showed restricted clonal diversities of which two CDR3 motifs were present in controls and patients, with another two motifs unique to pSS.

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Universal influenza virus vaccines and therapeutics: where do we stand with influenza B virus?

Jessica Tan | Guha Asthagiri Arunkumar | Florian Krammer

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Plasminogen Activator Inhibitor-1 polymorphisms as a risk factor for chronic periodontitis in North Indian population

Publication date: Available online 18 April 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Puja Debnath, Jayant Dewangan, Divya Tandon, Vivek Govila, Mona Sharma, Virendra Kumar, Smita Govila, Srikanta Kumar Rath
ObjectivesImpaired plasminogen activator inhibitor-1 (PAI-1), controlling coagulation and the fibrinolytic system is supposed to be involved in the pathogenesis of periodontitis. This study was performed to examine the association of PAI-1 gene polymorphisms with Chronic Periodontitis (CP) and alveolar bone loss severity involved with the disease and for understanding the role of genetic contributions in disease progression.Methods87 volunteers were included in the study. Genomic DNA was isolated from peripheral blood, subsequently, DNA samples were subjected to polymerase chain reaction and endonuclease digestion. Direct gene sequencing were performed for all the samples to identify genotype polymorphisms (rs 11560324) in the 3' untranslated region of PAI-1 gene. For bone loss assessment full mouth IOPA was taken.ResultsStatistical analysis showed that for SNP PAI-I in 3' UTR, genotype CC (homozygous mutant) and allele C (mutant) has a risk associated with CP, although statistically significant association was not found. An increased risk of association of disease severity with CG (heterozygous mutant) and CC (homozygous mutant) genotypes, i.e., an increased carriage rate of genotype CG and CC (homozygous mutant) was evident with the increase in the severity of CP, highlighting an increased susceptibility to CP due to this gene polymorphisms.ConclusionPAI-1 genotype has a risk association with CP and alveolar bone loss severity in North-Indian population.

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Malignant fibrous histiocytoma of the mandible- A case report and review of published case reports

Publication date: Available online 18 April 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Sachin C. Sarode, Gargi S. Sarode, Yashwant Ingale, Manjusha Ingale, A. Thirumal Raj, Shankargouda Patil
The natural history of malignant fibrous histiocytoma (MFH) is still heavily debated. It's anonymous natural history is precisely denoted by its new adapted terminology 'undifferentiated pleomorphic sarcoma (UPS)'. Thus to diagnose a lesion as UPS, it is vital to correlate its histopathological features along with its immunohistochemical (IHC) expressions to confirm the tumor cell lineage. MFH is extremely rare in mandible with the literature search in PubMed database revealing only 13 case reports of MFH involving the mandible. Among these, only 7 case reports provide IHC details of the case. Without IHC data it is not possible to determine the accuracy of the diagnosis in the remaining 6 cases. Here we report an additional 8^th case of MFH involving the ramus and angle of the mandible. Histopathology revealed proliferating malignant spindle cells interspersed with histiocyte-like cells. The tumor cells were strongly positive for vimentin and CD68 and were negative for S-100, epithelial membrane antigen (EMA) and cytokeratin (CK). The diagnosis was made by correlating the histopathological findings with the IHC profile. The report also provides the data (clinical, radiographic, histopathological, immunohistochemical features and treatment details) extracted from the 7 confirmed MFH case reports involving the mandible.

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JAMA Otolaryngology–Head & Neck Surgery Peer Reviewers in 2017

We sincerely thank the 645 peer reviewers who completed manuscript reviews for JAMA Otolaryngology–Head Neck Surgery in 2017.

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Soft-Tissue Augmentation for Tracheoesophageal Puncture Enlargement

This study reports on the use of injectable soft-tissue fillers for the treatment of tracheoesophageal prosthesis enlargement and periprosthetic leakage.

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April 2018 Issue Highlights

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A Painful Submandibular Mass in a Patient With Bruxism

A woman with a history of bruxism and long-term use of a bite guard presented with pain centering on left submandibular area; contrast-enhanced computed tomography demonstrated a mass adjacent to the left submandibular gland. What is your diagnosis?

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Brain-Derived Neurotrophic Factor Therapy and Cochlear Implantation

This Viewpoint cites several examples of how brain-derived neurotrophic factor therapy affects outcomes of cochlear implantation.

https://ift.tt/2Hh5ekW

Opsoclonus-Myoclonus Syndrome—Additional Clinical Considerations

To the Editor We read with interest the report by Hsu et al describing a 39-year-old woman with opsoclonus-myoclonus syndrome (OMS). Although an intriguing case, several aspects of the treatment should be addressed for others who may encounter this condition.

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Open Access—Is There a Predator at the Door?

Dear Readers,

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A Pediatric Nasopharyngeal Mass

An otherwise healthy 3-year-old boy presented with symptoms of sleep-disordered breathing, including gasping, apneic episodes at night, and nighttime nasal congestion; intraoperatively he was found to have a nasopharyngeal mass. What is your diagnosis?

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JAMA Otolaryngology–Head & Neck Surgery Year in Review

As I complete my second year as Editor of JAMA Otolaryngology–Head & Neck Surgery, I would like to take this opportunity to thank our authors, reviewers, members of the editorial board, and staff for the many contributions to the journal and to share our accomplishments. This past year, we received 822 submissions and published 94 Original Investigations, 35 Reviews, 34 opinion articles, and 11 Research Letters. In 2017, the acceptance rate for major submissions was 19%. The publication of opinion articles provides context to the original investigations and a forum for active dialogue in our specialty.

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Medical Student Knowledge of Human Papillomavirus–Positive Head and Neck Cancer

This survey examines knowledge of the association of human papillomavirus and head and neck cancer among students at 10 New York State medical schools.

https://ift.tt/2EcSOti

Onabotulinum Toxin A in Adductor Spasmodic Dysphonia and Laryngeal Tremor

This cohort study examines the outcomes of onabotulinum toxin A treatment in patients with adductor spasmodic dysphonia with or without lateral laryngeal tremor.

https://ift.tt/2ERh6tZ

Lymph Node Yield as Quality Metric for Clinically N0 Oral Cancer

To the Editor In their research letter, Tsai et al evaluated lymph node yield in a cohort of patients with clinically N0 oral cavity cancer from the National Cancer Database (NCDB). They found an association of lymph node yield with survival. With a median node count of 23, they used neck dissections with 24 or more nodes as a variable in a multivariable analysis and found 24 or more nodes to be associated with improved survival.

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Postadenotonsillectomy Blood Pressure Changes in Children With Obstructive Sleep Apnea

This case series investigates disparities in blood pressure changes after adenotonsillectomy in hypertensive and nonhypertensive children with obstructive sleep apnea.

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Errors in Questionnaire Scoring Algorithm

In the Original Investigation titled "Development and Initial Validation of a Consumer Questionnaire to Predict the Presence of Ear Disease," published online on August 3, 2017, and in the October 2017 issue of JAMA Otolaryngology–Head & Neck Surgery, there were errors in the analysis code for 3 of the questionnaire items (questions 16, 18, and 19). For these 3 questions, the 4-item rating scales were dichotomized incorrectly. Using the corrected algorithm resulted in changed sensitivity and specificity, odds ratios, and 95% CIs, as detailed herein. The corrections are also explained in a Letter to the Editor. In the abstract Results, descriptions of the sensitivity and specificity have been corrected to 90% (95% CI, 84%-94%) and 72% (95% CI, 59%-82%), respectively, for the training sample and 76% (95% CI, 61%-87%) and 80% (95% CI, 51%-95%) for the test sample, respectively. In the Statistical Analysis paragraph of the Methods section, rating scale items should have been dichotomized as 0 for "never" and "occasionally" and as 1 for "sometimes" and "always" rather than scored on a scale of 0 to 4. In the Results section, the odds ratio and 95% CI for the association between CEDRA score and presence of disease changed. In addition, the probability, sensitivity, and specificity values changed. In the third paragraph of the Discussion, all percentages have changed. Figure 2 has been replaced with a graph incorporating a corrected receiver operating characteristic curve, and the figure caption has been updated. This article was corrected online.

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Association of Metabolic Syndrome With Sudden Sensorineural Hearing Loss

This medical record review evaluates the association of the metabolic syndrome with the rate of recovery among adult patients with sudden sensorineural hearing loss.

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Nonsurgical Treatment for Posttraumatic Complete Facial Nerve Paralysis

This cohort study documents the results of nonsurgical treatment for posttraumatic complete facial paralysis with undisplaced temporal bone fracture and unfavorable electrophysiologic features.

https://ift.tt/2EJ9clG

Hard Swelling on Inner Cheek

A man had a hard swelling of the left inner cheek, with increasing spontaneous pain and swelling; examination revealed an erythematous lesion of the buccal mucosa, adjacent to the maxillary first molar, which produced a small amount of bleeding with palpation. What is your diagnosis?

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Scope of Procedures Performed by Pediatric Otolaryngologists, 2006-2016

This survey study asks directors from 33 US and international pediatric otolaryngology departments to report the percentage of 59 procedures that were performed by their department vs other specialties from 2006 to 2016.

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An Uncommon Cutaneous Lesion

A male smoker in his 60s presented with a right supraclavicular cutaneous mass that had persisted for 2 years; a biopsy of a pulmonary nodule showed a well-differentiated adenocarcinoma with lepidic pattern, and further workup revealed an intestinal tumor as the primary source. What is your diagnosis?

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Association of Reduced Delay in Care With a Dedicated Operating Room in Pediatric Otolaryngology

This study evaluates an otolaryngology-specific operating room time block for unscheduled cases to determine time from initial consultation to surgery and utilization of the dedicated block of time.

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Pectoral I Block Does Not Improve Postoperative Analgesia After Breast Cancer Surgery: A Randomized, Double-Blind, Dual-Centered Controlled Trial

Background and Objectives General anesthesia for breast surgery may be supplemented by using a regional anesthetic technique. We evaluated the efficacy of the first pectoral nerve block (Pecs I) in treating postoperative pain after breast cancer surgery. Methods A randomized, double-blind, dual-centered, placebo-controlled trial was performed. One hundred twenty-eight patients scheduled for unilateral breast cancer surgery were recruited. A multimodal analgesic regimen and surgeon-administered local anesthetic infiltration were used for all patients. Ultrasound-guided Pecs I was performed using bupivacaine or saline. The primary outcome was the patient pain score (numerical rating scale [NRS]) in the recovery unit 30 minutes after admission or just before the morphine administration (NRS ≥4/10). The secondary outcomes were postoperative opioid consumption (ie, in the recovery unit and after 24 hours). Results During recovery, no significant difference in NRS was observed between the bupivacaine (n = 62, 3.0 [1.0–4.0]) and placebo (n = 65, 3.0 [1.0–5.0]) groups (P = 0.55). However, the NRS was statistically significantly different, although not clinically significant, for patients undergoing major surgeries (mastectomies or tumorectomies with axillary clearance) (n = 29, 3.0 [0.0–4.0] vs 4.0 [2.0–5.0], P = 0.04). Morphine consumption during recovery did not differ (1.5 mg [0.0–6.0 mg] vs 3.0 mg [0.0–6.0 mg], P = 0.20), except in the major surgery subgroup (1.5 mg [0.0–6.0 mg] vs 6.0 mg [0.0–12.0 mg], P = 0.016). Intraoperative sufentanil and cumulative morphine consumption up to 24 hours did not differ between the 2 groups. Three patients experienced complications related to the Pecs I. Conclusions Pecs I is not better than a saline placebo in the presence of multimodal analgesia for breast cancer surgery. However, its role in extended (major) breast surgery may warrant further investigation. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT01670448. Accepted for publication December 13, 2017. Address correspondence to: Jérôme Cros, MD, MSc, Département d'Anesthésie-Réanimation, Hôpital de la mère et de l'enfant, 8, avenue Dominique Larrey, 87000 Limoges, France (e-mail: jerome.cros@chu-limoges.fr). Funding was provided by Réseau Québécois de Recherche sur la Douleur, Québec, Canada; Fondation d'Anesthésiologie et Réanimation du Québec, Canada; Fonds de Développement du Département d'anesthésiologie de l'Université de Montréal, Québec, Canada; and Fondation de France, Paris, France. This work has been presented in part at Euroanesthesia 2016, London, United Kingdom, May 29, 2016 (presented by J.C., abstract no. 03AP04-3); at the French Society of Anesthesia & Intensive Care Medicine (SFAR) 2016 Annual Meeting, Paris, France, September 24, 2016 (presented by J.C., abstract no. R480 [in French]); and at the World Congress of Pain 2016, Yokohama, Japan, September 27, 2016 (presented by P.B., abstract no. 943). The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Metabolic Syndrome Diagnosis: The Sooner the Better

Metabolic Syndrome and Related Disorders, Ahead of Print.

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Is it worthy to treat hidradenitis suppurativa with adalimumab in patients with melanoma and other debilitating systemic diseases? A series of clinical dilemmas

Australasian Journal of Dermatology, EarlyView.

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Clinicopathological, immunohistochemical and embryological aspects of cutaneous ciliated Müllerian cyst

Australasian Journal of Dermatology, EarlyView.

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Licorice-induced apparent mineralocorticoid excess compounded by excessive use of terbutaline and high water intake

This case highlights the clinical course of a 54-year-old male patient presenting with hypertension and long-term refractory hypokalaemia. He reported long-term malaise, fatigue and physical discomfort. Diarrhoea, vomiting, over-the-counter drugs, dietary supplements and any kind of medical abuse were all denied. Physical examination was normal. Suppressed plasma renin activity along with a low aldosterone level and elevated urinary cortisone/cortisol metabolite excretion ratio raised the suspicion of apparent mineralocorticoid excess (AME). The patient started treatment with spironolactone, but serum potassium levels were persistently fluctuating and the patient was hospitalised for further evaluation. During hospitalisation, repeated medical history and diagnostic examinations revealed licorice-induced AME complicated by excessive use of terbutaline and massive water intake. Licorice discontinuation, reduction of terbutaline and normalisation of water intake led to fully normalised potassium levels. Despite careful clinical history and diagnostic work-up, hospitalisation may be necessary in selected patients with long-term hypokalaemia.

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Localised perforation of locally advanced transverse colon cancer with spontaneous colocutaneous fistula formation: a clinical challenge

Colon cancer can present with complications such as obstruction, perforation and bleeding. The clinical presentation has been recognised as an independent prognostic factor for morbidity and mortality.¹ We present a rare case of localised perforation of a locally advanced colon cancer arising from mid-transverse colon in an elderly woman in the absence of widely metastatic disease with eventual cutaneous involvement of the overlying skin by direct extension, resulting in formation of colocutaneous fistula. The management of such cases is complex as usually tailored to the situation encountered.² This case was a clinical challenge to choose between initial palliative resection and curative R0 resection following neoadjuvant chemotherapy.

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Massive haemoptysis secondary to mycotic pulmonary artery aneurysm in subacute invasive aspergillosis

A 68-year-old man, presented with 3 week history of infective symptoms and mild haemoptysis. Past medical history included severe emphysema and a chronic right upper lobe (RUL) cavity. He was discharged from follow-up a year ago in view of clinical and radiological stability; previous bronchoscopic examinations yielded no specific diagnosis. CT scan on admission confirmed complex cavitary consolidation of RUL. He developed massive haemoptysis requiring intubation and ventilation. CT pulmonary angiogram (CTPA) revealed 16 mm RUL pulmonary artery (PA) aneurysm which was successfully embolized. Sputum cultures, aspergillus antigen and rapidity of clinical progression suggested a diagnosis of subacute invasive aspergillosis (SAIA), prompting treatment with Voriconazole. Bronchoscopy showed blood ooze from RUL even after embolization. Unfortunately, patient continued to deteriorate and succumbed to profound septicaemia.

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Laparoscopic management of an internal hernia in a pregnant woman with Roux-en-Y gastric bypass

Management of abdominal pain in a pregnant patient with a history of Roux-en-Y gastric bypass presents unique challenges. A misdiagnosis or delay in management can result in lethal maternal–fetal outcomes. We present a 30-year-old woman at 21 weeks of pregnancy presented with abdominal pain. She had a history of laparoscopic Roux-en-Y gastric bypass performed 3 years earlier. The clinical examination was remarkable for epigastric pain and tenderness. The vital signs and laboratory examinations were unremarkable. The CT scan was suggestive of an internal hernia. On an exploratory laparoscopy, the distal common small bowel was found to be herniating through the jejunojejunostomy mesenteric defect, causing intestinal obstruction with dilatation of the Roux limb and the biliopancreatic limb. The internal hernia was reduced, and no bowel resection was required. The mesenteric defect was closed with 3-0 silk sutures in a continuous fashion. The patient was discharged after 3 days and delivered a healthy baby at 40 weeks of gestation.

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Unexpected case of pneumomediastinum and subcutaneous emphysema: primary or secondary aetiology?

A 77-year-old man was admitted with a relapse of antineutrophil cytoplasmic antibody-positive vasculitis with pulmonary involvement and acute kidney injury. There was a background of pulmonary fibrosis (non-specific interstitial pneumonia type pattern) and superadded pulmonary haemorrhage, acute pulmonary oedema and sepsis. The patient was intubated for 4 days and remained dependent on high flow oxygen and continuous positive airway pressure after extubation. A chest radiograph performed 2 weeks after extubation demonstrated unexpected, extensive pneumomediastinum and subcutaneous emphysema. This was confirmed on CT which raised the possibility of a tracheal defect at the level of the prior endotracheal tube cuff position. Tracheal injury was considered clinically unlikely due to the considerable interval since extubation and a short, uneventful intubation period. The cardiothoracic team recommended a diagnostic bronchoscopy but this was felt too high risk by the clinical team. The cause of pneumomediastinum and subcutaneous emphysema remained indeterminate.

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Recognition of supraduodenal artery from hepatic artery is essential to avoid untoward complications at HAIC: two cases

Description

Supraduodenal artery (SDA) supplies the proximal duodenum, which originates most commonly from gastroduodenal artery (GDA), followed by common and proper hepatic artery.1 2 Origination from left hepatic artery (LHA) is relatively rare and only few articles have addressed this anatomic variation.3 Recognition of such an aberrant artery and proper coiling before liver-directed therapy are essential to prevent non-target organ injury. Herein, we report two rare cases of SDA that originated from the LHA.

Case 1

A 56-year-old man had a massive type hepatocellular carcinoma (HCC) in right hepatic lobe with right portal vein tumour thrombosis (figure 1). He had one episode of massive upper gastrointestinal bleeding at 2nd hepatic arterial infusion chemotherapy (HAIC) and panendoscope revealed haemorrhagic duodenitis with duodenal bulb ulcer. In our hospital, a SDA that originated from the LHA was found at angiography, which was successfully embolised with a minicoil (

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Intestinal granulomatous disease: what is the first call

A 15-year-old girl presented with erythema nodosum and mild abdominal complaints. Her intestinal granulomatous disease was erroneously diagnosed as Crohn's disease despite the fact that the possibility of tuberculosis was considered. The final diagnosis of tuberculosis was made only when an anti-tumour necrosis factor therapy resulted in further deterioration. The patient was treated with isoniazid, rifampin, pyrazinamide and ethambutol, with slow and steady clinical improvement until complete recovery was achieved.

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Cutaneous lymphangitis carcinomatosa made cervicofacial oedema intractable in a patient with superior vena cava syndrome

Cutaneous lymphangitis carcinomatosa (CLC) is a rare form of cutaneous metastasis that causes lymphoedema and various eruptions. We report a case of lung cancer with CLC that caused both superior vena cava (SVC) stenosis and cervicofacial oedema, suggestive of SVC syndrome. A 64-year-old woman with lung adenocarcinoma presented with cervicofacial oedema and erythema, followed by severe dyspnoea 2 months after four cycles of carboplatin, pemetrexed and bevacizumab triplet therapy. Although chest CT indicated SVC stenosis, cervicofacial oedema remained despite treating the SVC stenosis via balloon dilation. A skin biopsy of the erythematic sample confirmed CLC as the cause of the patient's symptoms. CLC should be considered as a differential diagnosis of cervicofacial oedema in addition to SVC syndrome, especially when it is observed in combination with skin erythema and induration. Moreover, a skin biopsy should be performed promptly for accurate diagnosis of CLC and to decide on appropriate treatment.

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Liver chemistry abnormalities and leg oedema in rheumatoid arthritis

A 66-year-old man with seronegative, erosive rheumatoid arthritis for 12 years presented with malaise, elevated alkaline phosphatase and gamma-glutamyl transferase, and leg oedema. He subsequently developed ascites. No liver pathology was found, but cardiac analysis including right heart catheterisation revealed constrictive pericarditis. Rheumatoid constrictive pericarditis is a rare condition, but, despite current effective treatment for rheumatoid arthritis, still occurs. Diagnostic delay is frequent. Although mortality of the intervention is high, pericardiectomy is needed for most patients.

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Gas in the right hemiscrotum? Amyands hernia in a neonate

Description

A 10-day-old boy, born at 36 weeks' gestation, was brought to our emergency department (ED) with irritability. He was able to suck as usual, but his temperature was 37.9°C and his right inguinal region was slightly erythematous. Laboratory data showed leucocytosis with a total leucocyte count of 23x10⁹/L (neutrophils 72.5%), but a low C reactive protein (<0.10 mg/dL). Urinalysis showed no pyuria and no organisms. Abdominal X-ray was unremarkable. Initial inguinal ultrasonography by a paediatric surgeon revealed no suggestion of testicular torsion or incarcerated hernia. The neonate was discharged home with a tentative diagnosis of acute epididymitis.

Six hours after discharge, he returned to ED with high fever of 38.7°C and extreme redness of the scrotum (figure 1). Repeat abdominal X-ray demonstrated gas in the right hemiscrotum (figure 2) and abdominal sonography revealed what appeared to be a bright cord in the right hemiscrotum (figure 3),...

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Spontaneous rupture of seminoma in undescended testis with hemoperitoneum: a rare presentation

Cryptorchidism is associated with increased risk of malignancy and infertility. We present a case of a 30-year-old man who presented to the Emergency Department of our tertiary care hospital with spontaneous intra-abdominal rupture of the seminoma in undescended testis with hemoperitoneum. This is a rare presentation of seminoma and emphasises the importance of scrotal examination in young men presenting with acute abdomen. Surgical management is the definitive treatment and should be instituted as soon as possible, after appropriate resuscitation.

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Bilateral tension pneumothorax after acupuncture

Acupuncture is an ancient complementary medicine which is currently used worldwide. Many serious adverse events have been reported which include a spectrum of mild-to-fatal complications. However, the level of awareness with regard to complications is still low both to physicians and patients. We report a 63-year-old who presented with acute shortness of breath 2 hours after having had acupuncture. On examination, there was absent breath sound heard on the left lung and slightly reduced breath sound on the right lung. She had type 1 respiratory failure. Urgent chest radiograph confirmed bilateral pneumothorax which was more severe on the left with tension pneumothorax and mediastinal shift. Chest tubes were inserted bilaterally after failed needle aspiration attempts. Subsequently, the pneumothoraces resolved, and she was discharged well. The bilateral pneumothoraces caused by acupuncture were curable but could have been potentially fatal if diagnosis was delayed. This case report adds to the limited current literature on the complications of acupuncture leading to bilateral pneumothoraces.

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Wedge‐shaped polydioxanone threads in a folded configuration (“Solid fillers”): A treatment option for deep static wrinkles on the upper face

Journal of Cosmetic Dermatology, EarlyView.

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Sensitization to minor cat allergen components is associated with type‐2 biomarkers in young asthmatics

Clinical &Experimental Allergy, EarlyView.

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Variation in the association of Der p 1 and Der f 1 with asthma and rhinitis in 9‐11‐year‐old schoolchildren: The French six cities study

Clinical &Experimental Allergy, EarlyView.

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Association of Behavior With Noise-Induced Hearing Loss Among Attendees of an Outdoor Music Festival

This post hoc secondary analysis of a randomized clinical trial assesses which factors are associated with the occurrence of temporary noise-induced hearing loss among adult attendees of an outdoor music festival.

https://ift.tt/2qLODjt

Increasing Age of Patients With Oropharyngeal Squamous Cell Carcinoma

This observational study evaluates the changes in age profile over time in patients with oropharyngeal squamous cell carcinoma.

https://ift.tt/2J4ZYBV

Proactive Swallowing Rehabilitation and Feeding Tube Placement in Pharyngeal Cancer Patients

This cohort study evaluates the initiation of a proactive speech and language pathology rehabilitation program and its association with rates of feeding tube placement and posttreatment oral intake in patients with head and neck squamous cell carcinoma.

https://ift.tt/2qLOywb

Beyond “Pharyngocise” for Patients With Head and Neck Cancer

Advances in technology have improved survival rates for patients with head and neck cancer; however, the medical profession continues to pursue opportunities to improve quality of life for survivors. Advances in organ preservation therapies, such as intensity-modulated radiation therapy and proton therapy, are encouraging. However, preservation of swallowing-related quality of life remains challenging. For the past decade, speech-language pathologists (SLPs) have applied neuroplasticity principles to exercise-based swallowing treatment for patients undergoing chemoradiation therapy for head and neck cancer. This intensive daily exercise regimen, termed by some pharyngocise, also includes encouragement to eat and drink throughout radiation treatment. This treatment protocol flipped the traditional swallowing treatment paradigm by using a proactive vs a reactive ("wait and see") approach to treatment. Since approximately 2006, a growing body of research has largely supported better outcomes for patients who either completed the proactive exercises or ate and drank during treatment compared with those who did neither.

https://ift.tt/2Jay2wi

RNA Oncoimmune Phenotyping of HPV-Positive Oropharyngeal Cancer by Nodal Status

This cohort study explores whether a tumor-specific genetic signature exists for node-negative vs node-positive HPV 16–positive/p16-positive oropharyngeal squamous cell carcinomas.

https://ift.tt/2qILv7M

Baseline Cognition Assessment Among Patients With Oropharyngeal Cancer

This cohort study assesses the baseline cognition of patients with oropharyngeal cancer using the Patient-Reported Outcomes Measurement Information System and National Institutes of Health (NIH) Toolbox Cognitive Battery instrument.

https://ift.tt/2J6rJtV

Gene Expression Profiling in p16-Positive Oropharyngeal Squamous Cell Carcinomas

Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is associated with p16 overexpression and a better prognosis than HPV-negative OPSCC. Concurrent treatment with standard-dose radiation therapy (RT) (66-70 Gy) and platinum-based chemotherapy is highly effective for most patients with p16-positive OPSCC, but more than 40% of patients experience severe late toxic effects when treated with concurrent chemoradiation therapy (CRT). The advent of transoral minimally invasive surgical approaches to the oropharynx, such as transoral robotic surgery (TORS) and transoral laser microsurgery (TLM), has provided an opportunity to treat patients with OPSCC while potentially minimizing long term sequelae of CRT. Treatment choice (ie, surgery with or without adjuvant therapy vs primary RT-CRT) and deintensification are areas of current investigation. However, given heterogeneity among patients with p16-positive OPSCC, optimal treatment paradigms remain unclear.

https://ift.tt/2Hwfc5V

Patient-Perceived Voice Changes and Quantitative Voice Measures in the Year After Thyroidectomy

This mixed methods study assesses the quality-of-life consequences of postthyroidectomy voice change from the perspective of patients with thyroid cancer and compares patient-perceived voice changes with changes in quantitative vocal variables at 5 time points in the first postoperative year.

https://ift.tt/2JcgboL

Notfälle in der Dermatologie

https://ift.tt/2J9pA0m

Cerebral vasculitis and lateral rectus palsy – two rare central nervous system complications of dengue fever: two case reports and review of the literature

Dengue fever is a common mosquito-borne viral illness with a clinical spectrum ranging from a simple febrile illness to potentially life-threatening complications such as dengue hemorrhagic fever and dengue sh...

https://ift.tt/2HxQ6Ud

The prognostic impact of CDX2 correlates with the underlying mismatch repair status and BRAF mutational status but not with distant metastasis in colorectal cancer

Abstract

Loss of CDX2 expression has been proposed to be a prognostic biomarker in colorectal cancer (CRC) correlating with shorter overall (OS) and progression-free survival (PFS). Since metastatic disease, mismatch repair (MMR) deficiency, and the mutational status of BRAF are considered to be important prognostic determinants in CRC, the present study aimed to analyze CDX2 expression in correlation with these parameters. Immunohistochemistry for CDX2, hMLH1, and hMSH2 was applied to a study cohort of 503 CRC specimens (FIRE-3) and a matched case-control collection of 50 right-sided CRC specimens with synchronous distant metastases and 50 right-sided CRCs without distant metastases. Furthermore, the mutational status of BRAF gene was analyzed utilizing pyrosequencing. CDX2 expression significantly correlates with reduced OS (p = 0.008) within the study population. In both cohorts, a significant correlation of CDX2 expression and MMR deficiency as well as the presence of a BRAF mutation (each p > 0.001) was observed, whereas no correlation of CDX2 expression and synchronous metastasis could be obtained. In the case-control study, only patients with proficient MMR status showed a correlation of CDX2 loss and synchronous metastasis, whereas in patients with deficient MMR status and CDX2 loss, no distant metastases at the time of diagnosis were found (p = 0.003). We could demonstrate that the reduced OS of CDX2-negative CRC patients is not caused by higher rates of distant metastases. Furthermore, our data indicate that the prognostic impact of CDX2 depends on the MMR status and the BRAF mutational status of the tumors. Thus, it could be concluded that CDX2 is not an independent prognostic biomarker in CRC.

https://ift.tt/2JbBlmX

Induction TNX Plus Concurrent Nedaplatin-RT Versus Induction TPF Plus Concurrent Cisplatin-RT in NPC

Condition: Nasopharyngeal Carcinoma
Interventions: Drug: docetaxel, nedaplatin, and capecitabine; Drug: concurrent chemoradiotherapy with nedaplatin; Drug: docetaxel, cisplatin, and fluorouracil; Drug: concurrent chemoradiotherapy with cisplatin
Sponsors: Sun Yat-sen University; Tongji Hospital; Wuhan Union Hospital, China; Peking University; Fourth Military Medical University; Second Affiliated Hospital of Soochow University; The First Affiliated Hospital of Guangdong Pharmaceutical University; First People's Hospital of Foshan; Fifth Affiliated Hospital, Sun Yat-Sen University; Cancer Hospital of Guizhou Province; Xiangya Hospital of Central South University; Jilin Provincial Tumor Hospital; Henan Cancer Hospital; Hunan Cancer Hospital; Cancer Hospital of Guangxi Medical University
Not yet recruiting

https://ift.tt/2HCIVKg

A Comparative Study of Various Office Procedures for the Management of Small to Medium Size Tympanic Membrane Perforations

Abstract

A hospital based prospective study to compare and evaluate the efficacy and convenience of various office procedures like chemical cauterization, fat plug myringoplasty and butterfly cartilage tympanoplasty. This interventional, prospective, longitudinal study carried out on 300 patients in the ENT department of a tertiary care medical college hospital in central India between January 2009 and January 2015. The success rate was found to be 94.54, 91.12 and 97% in chemical cauterization, fat plug and butterfly cartilage tympanoplasty respectively (p value 0.246). In all the groups there were significant improvement in terms of hearing in decibels and AB gap postoperatively. No statistically significant association was found in between the failure rates in all the groups. From this study we conclude that all the procedures were simple, rapid, reliable, cost effective, takes less time and minimum hospital stay (day care) than conventional tympanoplasty. We strongly recommend these procedures in place of tympanoplasty in small to medium size central tympanic membrane perforations according to condition and convenience of the patients.

https://ift.tt/2HEuLs2

Correlation between Preoperative Auditory Steady-State Response and Postoperative Electrically Evoked Auditory Brainstem Response and T Level in Cochlear Implantation for Child Patients with Inner-Ear Malformations

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Objective: This study aims to investigate the correlation between thresholds of preoperative multiple auditory steady-state response (ASSR) and electrically evoked auditory brainstem response (EABR) and the behavioral threshold. Methods: A total of 72 patients were elected to receive a multichannel cochlear implant. According to the residual hearing determined in a preoperative test using high-, moderate-, and low-frequency ASSR, these patients were divided into the following 2 groups: residual hearing and hearing loss. The EABR and behavioral thresholds 1 year after implantation were assayed, and differences between these 2 parameters were compared. Results: Among the high-, moderate-, and low-frequency residual hearing groups, the EABR and behavioral thresholds of patients 1 year after implantation were significantly lower than those in the hearing loss group, and the differences were statistically significant (p #x3c; 0.01). Conclusion: Before the operation, ASSR results can be used to predict the efficacy of cochlear implantation in patients, and they serve as one of the reference conditions for choosing the ear for implantation. However, the threshold of ASSR is not equivalent to the actual auditory threshold of patients after implantation, and the deviation between these 2 thresholds is more significant at low frequencies.
ORL 2018;80:51–57

https://ift.tt/2J9fWLk

A Comparative Study of Various Office Procedures for the Management of Small to Medium Size Tympanic Membrane Perforations

Abstract

https://ift.tt/2HEuLs2

Penetrating Sacral Injury with a Wooden Foreign Body

Spinal penetrating trauma has a complex neurosurgical management. This study presents a 55-year-old male admitted in our center with a 1 × 1 centimeter laceration on the sacral area skin due to a wooden penetrating object. The computed tomography (CT) of the spine revealed a hypodense penetrating object that was introduced from the posterior aspect of the sacrum into dural space and then stopped in the S1 vertebral body. We performed a laminectomy of intact superior portion of the S1 lamina and released the wood from the surrounding bone, and finally, we pulled it out.

https://ift.tt/2qIWVse

Case 12-2018: A 30-Year-Old Woman with Cardiac Arrest

Presentation of Case. Dr. Emily C. Cleveland (Emergency Medicine): A 30-year-old woman was brought to the emergency department of this hospital because of cardiac arrest. On the morning of this presentation, the patient was found unresponsive in her bedroom. Her mother called emergency medical…

https://ift.tt/2EYz2Bt

Comparison of Ossiculoplasty Using Autograft Ossicle Versus Allograft (Teflon)

Abstract

Chronic suppurative otitis media in almost any form can disrupt the integrity of ossicular chain. Various materials have been used for ossicular substitution or reconstruction, including both biologic and alloplastic materials. Teflon piston is now the most widely used prosthesis for reconstruction of the ossicular chain in cases of otosclerosis. The oto-surgeons are still confronted with problems of ossicular reconstruction regarding the surgical procedure to be done, type of graft to be selected especially in low and poor socioeconomic population. Thus, there is a need felt to comprehensively and holistically evaluate the outcome of ossiculoplasty using Autograft ossicle versus Allograft ossicle (Teflon). Total 64 patients of chronic suppurative otitis media with no active ear infection and air–bone–gap of more than 15 dB were admitted for surgery and divided into two groups according to material used for ossiculoplasty as group A (Autograft) and group B (Allograft). Patients were evaluated at 3 and 6 months post-operatively using audiogram. In both Group A and B, the average pre-operative AC was 40.62 dB (SD 9.65) and 39.37 (SD 10.53) respectively. In 3 months there was a change of 8.83% from 40.62 dB to 37.03 dB in Group-A (p < 0.109, not statistically significant) and 13.10% change from 39.37 dB to 34.21 dB in Group-B (p < 0.049, statistically significant) whereas at 6 months, air conduction improved by 14.22% in Group-A (p < 0.01, statistically significant) and by 21.81% in Group-B (p < 0.001, highly statistically significant). Post-operatively at 3 months, improved AB gap was 62.5% in Group-A and 68.75% in Group-B patients. Post-operative AB gap at 6 months, improvement was seen in 78.12% in Group-A while it was 81.25% in Group-B patients. Alloplastic Teflon ossicle appears to be a good alternative for ossicular reconstruction where autologous incus is not available or disease precludes its use.

https://ift.tt/2J4Ka2c

Robot Assisted Trans Axillary Thyroidectomy: A Subcontinent Experience

Abstract

To evaluate the outcome and initial hurdles of transaxillary robotic thyroidectomy in the Indian subcontinent. A total of seven (n = 7) patients were operated from August 2016 to February 2017. Ultrasonography was used as a tool to decide the size of thyroid lobe and fine needle aspiration cytology for the type of lesion. All patients underwent ipsilateral brachial plexus nerve conduction studies preoperatively. Two arm positions were evaluated. The robot was docked at the contralateral side of the surgical field. Before discharge from hospital, all patients were given a questionnaire evaluate outcome. Set 1 was answered on the day of discharge and Set 2 at one-month follow up. The most common pathology in our case series was colloid goiter (n = 4) followed by follicular lesion (n = 3). The mean console time was 167 min, with initial two cases taking more than 200 min. The maximum and minimum length of the axillary tunnel was 16 and 27 cm respectively. There was no difference with regard to complication rate with either arm position. None of the patients developed brachial plexus injury and was confirmed by normal nerve conduction study done on postoperative day three. In our experience with transaxillary robotic thyroidectomy, the problems we faced in our population were unique considering the varied physical parameters. Use of malleable retractors comes handy in these situation and we recommend the use of these over the rigid ones. Though both the arm positions had similar outcomes, the one with sideways position was more favorable.

https://ift.tt/2qOofWn

Virtual Bronchoscopy: Highly Sensitive Time and Life Saving Investigation in the Diagnosis of Foreign Body Aspiration—Our Experience

Abstract

Foreign body airway is a common cause of morbidity and mortality in children. Virtual bronchoscopy is a new investigative technique useful in locating non radiopaque FB missed on plain radiography. The aim of the study was to study the clinical profile of patients with suspected foreign body aspiration and to evaluate the changing trends in the diagnosis and quicker management of foreign body aspiration as a way of virtual bronchoscopy. This was a retrospective and prospective cross sectional study conducted in the Department of Otorhinolaryngology M.G.M.M.C. and M.Y. Hospital Indore for a period of 10 years. The medical records of patients with foreign body aspiration, from August 2006 to September 2016 were reviewed. Data was collected regarding their clinical presentation, examination and chest X-ray, virtual bronchoscopy, rigid bronchoscopy findings. Patients with suspected foreign body aspiration were subjected to virtual bronchoscopy and rigid bronchoscopy was performed. The techniques and methods to extract different types of foreign bodies has been elaborated in this study. In the 150 subjects, we observed mean age group of presentation was 2.1 years, male is to female ratio was 4.1, 70% of the cases came from the rural areas, 86% were vegetative foreign bodies, and remaining non vegetative were aspirated mostly during the winter season. Betel nut was the most common aspirated foreign body 0.63% had a positive history of foreign body aspiration, where as 37% had a negative history. Right main bronchus was the most common site of lodgement. Breathlessness and reduced air entry were the most common symptoms and signs. We also observed, that chest radiograph were normal in as many as 40% cases. Hence negative chest radiographs does not rule out FB. In 150 patients with foreign body aspiration, which was detected by virtual bronchoscopy, 148 patients were diagnosed to have foreign body on rigid bronchoscopy. This amounts to a positive predictive value of 97.3% which was similar to the positive predictive value of rigid bronchoscopy which was 99%. Virtual bronchoscopy is the only imaging modality which gives 99.9% reassurance about the presence or absence of a foreign body, because of its high sensitivity and specificity, hence proves to be a life saving tool.

https://ift.tt/2voIiPL

Comparison of Ossiculoplasty Using Autograft Ossicle Versus Allograft (Teflon)

Abstract

https://ift.tt/2J4Ka2c

Robot Assisted Trans Axillary Thyroidectomy: A Subcontinent Experience

Abstract

https://ift.tt/2qOofWn

Virtual Bronchoscopy: Highly Sensitive Time and Life Saving Investigation in the Diagnosis of Foreign Body Aspiration—Our Experience

Abstract

https://ift.tt/2voIiPL

Diagnosis and Surgical Management of Congenital Intranasal Teratoma in a Newborn: A Rare Case Report

Teratomas are the most common germ cell tumors of childhood. Head and neck teratomas, however, account for less than five percent of all teratomas. Considered rare at an incidence of 1 in 20,000 to 40,000 live births, they may occur in the cervical region, nasopharynx, brain, orbit, or oropharynx. Teratoma presenting as an isolated intranasal mass is extremely rare. In this report, we describe a case of a mature teratoma arising from the roof of the nasal cavity presenting as an isolated intranasal mass, the first of its kind from our literature review. The tumor was resected endoscopically with no recurrence detected.

https://ift.tt/2qKaJlI

Initial-Stage Primary Intraosseous Squamous Cell Carcinoma Derived from Odontogenic Keratocyst with Unusual Keratoameloblastomatous Change of the Maxilla: A Case Report and Literature Discussion

Primary intraosseous squamous cell carcinoma (PIOSCC) is a rare malignant neoplasm derived from odontogenic epithelial remnants in the central jaw bone. Most PIOSCCs originate from odontogenic cysts with a nonkeratinized epithelial lining, especially from radicular/residual and dentigerous cysts. There have been few reports of PIOSCCs derived from the odontogenic keratocyst (OKC), particularly those describing pathological features at the initial stage. The diagnosis of PIOSCC is difficult and based on exclusion of other carcinomas, including metastatic tumors from other primary sites. Here, we report an extremely rare case of initial-stage PIOSCC derived from the OKC with unusual keratoameloblastomatous change of the maxilla.

https://ift.tt/2qIlIvS

A Rare Case of Adenoid Cystic Carcinoma of the Sphenoid Sinus Presenting with Lateral Rectus Palsy

Abstract

A rare case of adenoid cystic carcinoma arising from the sphenoid sinus causing lateral rectus palsy is presented here. Adenoid cystic carcinoma of the paranasal sinuses is an aggressive neoplasm which needs early diagnosis and treatment. Ideal treatment paradigm for paranasal sinus tumors is yet to be established. A combination of surgery and radiotherapy offers a better disease control and survival.

https://ift.tt/2HNidw4

Post Temporal Bone Fracture Facial Paralysis: Strategies in Decision Making and Analysis of Efficacy of Surgical Treatment

Abstract

Management of traumatic facial nerve injuries after temporal bone fractures is both challenging and controversial. The dilemma is whether to operate or not and if operating, when to operate and how much of the nerve to decompress. The aim of this study is to review our criteria for decision making in management of patients with temporal bone fracture induced facial nerve palsy, and analyze outcome of patients selected for surgical management. Review of 28 cases of temporal bone fracture between 2012 and 2016 was carried out. Patient assessment included clinical, audiological, computer tomography scans and electromyography (EMG) examinations. All 28 cases were initially started on conservative medical treatment. Based on criteria of complete clinical paralysis at onset, no improvement with conservative treatment and fibrillation potential in EMG, 10 cases underwent surgical decompression through the transmastoid approach. Among the 10 surgically-treated patients, lesions were predominantly found in geniculate ganglion area. Analysis of results after 12 months revealed 70% of cases who underwent surgery had House Brackmann (HB) Grade I–II recovery. Good recovery was achieved in all 18 medically treated patients (HB Grade I–II). Candidate selection based on accurate clinical judgment and judicious use of electrodiagnostic tests plays a vital role in outcomes in the treatment of post traumatic facial injury. Early surgical intervention gave better results in our study.

https://ift.tt/2voIrCU

A Rare Case of Adenoid Cystic Carcinoma of the Sphenoid Sinus Presenting with Lateral Rectus Palsy

Abstract

https://ift.tt/2HNidw4

Post Temporal Bone Fracture Facial Paralysis: Strategies in Decision Making and Analysis of Efficacy of Surgical Treatment

Abstract

https://ift.tt/2voIrCU

Αρχειοθήκη ιστολογίου

Πέμπτη 19 Απριλίου 2018

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