Head and Neck Medicine by Alexandros G.Sfakianakis: 05/02/18

Τετάρτη 2 Μαΐου 2018

Texting atopic dermatitis patients to optimize learning and eczema area and severity index scores: A pilot randomized control trial

Pediatric Dermatology, EarlyView.

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Hydroxychloroquine retinal toxicity in two patients with dermatological conditions

Australasian Journal of Dermatology, EarlyView.

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https://ift.tt/2HPFTzi

Editorial Board w/barcode

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Pulsus alternans induced by spinal anesthesia

Pulsus alternans is attributed to an alteration of the stroke volume with every other cardiac cycle, and reduced venous return is considered an important causative factor. Tachycardia can exacerbate this process as diastolic filling becomes further impaired. During pulsus alternans, increased end-diastolic volume can increase wall stress, which further reduces systolic performance [1], making appropriate treatment essential, even if the patient shows no signs or symptoms of heart failure.

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Whether time of operation does not increase the mortality rate in emergency surgery?

In a retrospective analysis, Rodney AG and colleagues [1] claim that time of operation (after-hours versus day-time hours) was not associated with death in emergency surgery, and those patients who undergoing intrathoracic or intraabdominal surgery, older patients and patients with a higher ASA PS may be at a higher risk of intraoperative mortality. However, we think it is inappropriate to reach the conclusion that no association of perioperative mortality with time of day in emergency surgery.

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Airtraq® reduces the hemodynamic response to tracheal intubation using single-lumen tubes in adults compared with the Macintosh laryngoscope: A systematic review and meta-analysis of randomized control trials

To investigate whether Airtraq® attenuate the hemodynamic responses to tracheal intubation using single-lumen tubes in adults as compared with the Macintosh laryngoscope.

https://ift.tt/2HR3f7x

Ultrasound-guided erector spinae plane block elicits sensory loss around the lateral, but not the parasternal, portion of the thorax

Ultrasound-guided erector spinae plane block (US-ESPB) has been recently reported to be an effective technique for thoracic surgery [1,2]. US-ESPB is a type of fascial block requiring a sufficient dose of drug to adequately cover the interfascial plane [3]. We performed US-ESPB for 12 patients in cases of thoracoscopic lobectomy and assessed the anesthetized area from anterior to lateral thorax, as well as postoperative pain scores, to verify the analgesic features for thoracic surgery. After obtaining written informed consent from all patients and approval from the Institutional Review Board of Ehime Prefectural Central Hospital, patients with American Society of Anesthesiologists physical status 1–3, who were scheduled to undergo complete video-assisted lobectomy without rib spreading, underwent US-ESPB followed by the induction of general anesthesia.

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Bilateral continuous erector spinae plane blocks for sternotomy in a pediatric cardiac patient

Effectiveness of continuous erector spinae plane (ESP) block as an alternative to thoracic epidural anesthesia have been reported for pain management in pulmonary malignancy [1]. In fact, there are multiple reports [2–5] can provide good analgesia for selective major thoracic procedures when epidural anesthesia is contraindicated, or if there are other concerns about administering an epidural.

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Transnasal sphenopalatine nerve block for patients with headaches

Letter to the editor

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13th International Workshop on Resistance to Thyroid Hormone and Thyroid Hormone Action

Thyroid, Ahead of Print.

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The Association of Dietary Intakes of Total Polyphenol and Its Subclasses with the Risk of Metabolic Syndrome: Tehran Lipid and Glucose Study

Metabolic Syndrome and Related Disorders, Ahead of Print.

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Genetic and Environmental Influences on the Associations Between Uric Acid Levels and Metabolic Syndrome Over Time

Metabolic Syndrome and Related Disorders, Ahead of Print.

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Clinical and Body Compositional Factors Associated with Metabolic Syndrome in Obese Koreans: A Cross-Sectional Study

Metabolic Syndrome and Related Disorders, Ahead of Print.

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Relationship of Selected Adipokines with Markers of Vascular Damage in Patients with Type 2 Diabetes

Metabolic Syndrome and Related Disorders, Ahead of Print.

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Prevalence and Burden Related to Genital Warts in India

Viral Immunology, Ahead of Print.

https://ift.tt/2JJim3B

SPECTRUM OF FEATURES IN DARIER’S DISEASE: A CASE REPORT WITH EMPHASIS ON DIFFERENTIAL DIAGNOSIS

Publication date: Available online 2 May 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Shwetha V, Sujatha S, Yashoda Devi BK, Rakesh N, Pavan Kumar T, Priyadharshini R, Yashaswi Krishnamurthy
Oral genodermatoses includes a spectrum of inherited dermatological disorders with varying oral mucosal manifestations. Darier's disease is an autosomal dominant disorder with defect in desmosomal attachment. This case report presents oro cutaneous manifestations of Darier's disease in a 40 year old female patient with a detailed review on etiology, pathogenesis, differential diagnosis and management of the condition.

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„Expertise Plastische Chirurgie: Funktionelle Wiederherstellung der oberen Luft- und Speisewege“ von Stephan Remmert

Laryngo-Rhino-Otol 2018; 97: 305-305
DOI: 10.1055/a-0594-3542

Article in Thieme eJournals:
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Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2018; 97: 296-297
DOI: 10.1055/a-0553-1576

Article in Thieme eJournals:
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Kindliche Hörstörungen in der Logopädie

Laryngo-Rhino-Otol 2018; 97: 304-304
DOI: 10.1055/s-0043-125451

Article in Thieme eJournals:
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Morbus Menière – wie hilfreich ist die Magnetresonanztomografie?

Laryngo-Rhino-Otol 2018; 97: 300-301
DOI: 10.1055/s-0043-121843

Patel VA et al. Magnetic resonance imaging findings in Ménière's disease. J Laryngol Otol 2017; 131: 602–607 Ein amerikanisches Wissenschaftlerteam veranschaulichte MRT-Befunde, die im Zusammenhang mit der Menière-Krankheit stehen. Diese umfassten kongenitale Malformationen, Schädigung der weißen Substanz, Veränderungen der hinteren Zirkulation und temporäre Abweichungen der Knochenstruktur.
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Article in Thieme eJournals:
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Die neue Leitlinie Rhinosinusitis – eine Miniaturversion

Laryngo-Rhino-Otol 2018; 97: 309-312
DOI: 10.1055/s-0044-100795

Zu Beginn dieses Jahres wurde die neue Leitlinie „Rhinosinusitis" als gemeinsame Leitlinie der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V. (DGHNOKHC) und der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM) veröffentlicht. Die Zielgruppe der neuen Leitlinie sind erwachsene Patienten mit einer entzündlichen Erkrankung der Nasennebenhöhlen und sie richtet sich an alle ärztlichen Berufsgruppen, die mit der Diagnostik und Therapie dieser Patienten befasst sind. Die aktuelle Herausforderung besteht darin, die Inhalte der Leitlinie in die klinische Praxis zu implementieren. Hierzu wurde eine Miniaturversion für den Klinik- und Praxisalltag entwickelt, die eine schnelle Hilfe bei klinischen Fragestellungen bieten soll.
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Article in Thieme eJournals:
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Totale Laryngektomie: Wundinfektionen sind bei Diabetespatienten häufiger

Laryngo-Rhino-Otol 2018; 97: 301-302
DOI: 10.1055/s-0043-121849

Filimonov A et al. Postoperative Complications of Total Laryngectomy in Diabetic Patients. Laryngoscope 2017; 127: 2247–2251 Diabetes Mellitus gilt als Risikofaktor vieler Komorbiditäten und Komplikationen. Ob sich die Stoffwechselerkrankung ebenso negativ auf das Ergebnis einer totalen Laryngektomie auswirken kann, haben Filimonov und Kolleginnen/Kollegen jetzt anhand einer retrospektiven Datenanalyse genauer betrachtet.
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Article in Thieme eJournals:
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HNO-Operationslehre Mit allen wichtigen Eingriffen

Laryngo-Rhino-Otol 2018; 97: 304-304
DOI: 10.1055/s-0044-100817

Article in Thieme eJournals:
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EGFR im Speichel: neuer Tumormarker für Plattenepithelkarzinom im Mund?

Laryngo-Rhino-Otol 2018; 97: 302-303
DOI: 10.1055/s-0044-100283

Zanotti L et al. Epidermal growth factor receptor detection in serum and saliva as a diagnostic and prognostic tool in oral cancer. Laryngoscope 2017; 127: E408–E414 Der EGF-Rezeptor (EGFR) ist ein Transmembranrezeptor mit intrinsischer Tyrosinkinase-Aktivität, der in allen Zellarten vorkommt. Die Überexpression des EGFR ist bei verschiedenen Tumorarten nachweisbar, so auch beim Plattenepithelkarzinom im Mundraum (OSCC). Den diagnostischen und prognostischen Wert des EGFR beim OSCC aus Serum und Speichel bestimmten italienische Ärzte der Universität von Brescia.
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Article in Thieme eJournals:
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Der Video-Kopf-Impuls-Test

Laryngo-Rhino-Otol 2018; 97: 306-308
DOI: 10.1055/a-0553-1609

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Article in Thieme eJournals:
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Aus der Gutachtenpraxis: Gehörschäden durch Infraschall?

Laryngo-Rhino-Otol 2018; 97: 341-343
DOI: 10.1055/a-0553-1631

Article in Thieme eJournals:
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Beurteilung der chemosensorischen Funktion mit validierten Riech- und Schmecktests

Laryngo-Rhino-Otol 2018; 97: 344-356
DOI: 10.1055/s-0043-124025

Etwa 5 % der Bevölkerung leiden unter einer funktionellen Anosmie, bei weiteren 15 % ist die Riechfunktion eingeschränkt. Ein Grundpfeiler der Behandlung durch den HNO-Arzt ist die Beurteilung der chemosensorischen Funktion durch psychophysische Riech- und Schmecktests. Die Verwendung standardisierter validierter Instrumente ist zwingend erforderlich, um Patienten nach dem neuesten wissenschaftlichen Stand über Therapieverfahren beraten zu können.
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Article in Thieme eJournals:
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Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2018; 97: 357-358
DOI: 10.1055/a-0553-1642

Article in Thieme eJournals:
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Rhinoplastik

Laryngo-Rhino-Otol 2018; 97: 359-363
DOI: 10.1055/a-0553-1686

Article in Thieme eJournals:
Table of contents | Full text

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Das Orthopantomogramm in der Diagnostik von zervikalen Schwellungen, ein Fallbericht

Laryngo-Rhino-Otol
DOI: 10.1055/a-0601-6985

Article in Thieme eJournals:
Table of contents | Full text

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Adult acute rhinosinusitis guidelines worldwide: similarities and disparities

International Forum of Allergy &Rhinology, EarlyView.

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Activation of the rat olfactory bulb by direct ventral stimulation after nerve transection

International Forum of Allergy &Rhinology, EarlyView.

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Glucocorticoid receptor isoform expression in peripheral blood mononuclear leukocytes of patients with chronic rhinosinusitis

International Forum of Allergy &Rhinology, EarlyView.

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Establishing the minimal clinically important difference for the Questionnaire of Olfactory Disorders

International Forum of Allergy &Rhinology, EarlyView.

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Severe trismus and contraindicated exodontia in a patient with fibrodysplasia ossificans progressiva: case report

Fibrodysplasia ossificans progressiva is a rare genetic disease of connective tissue in which muscles, ligaments, and tendons ossify either spontaneously or after trauma. Patients can develop physical disabilities and restriction of respiratory function. A patient attended a maxillofacial surgery outpatient clinic with severe trismus and mouth opening limited to 2mm. The risks of intervention were many from both anaesthetic and surgical perspectives, which prevented the extraction of carious teeth.

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Aldolase: a new crustacea allergen

Crustacean allergy is one of the most frequent causes of food allergic reactions, not just by ingestion, but also by inhalation1. Tropomyosin is considered the major allergen and it would be responsible of most crustacean-allergic reactions. We present a near fatal case of anaphylaxis due to allergy to Crustacea with exclusive sensitization to an infrequent shellfish allergen: Aldolase.

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Anatomy of the Le Fort I segment: Are arterial variations a potential risk factor for avascular bone necrosis in Le Fort I osteotomies?

Osteotomies of the Le Fort I segment are routine operations with low complication rates. Ischemic complications are rare, but can have severe consequences that may lead to avascular bone necrosis of the Le Fort I segment. Therefore the aim of this study was to investigate the blood supply and special arterial variants of the Le Fort I segment responsible for arterial hypoperfusion or ischemic avascular necrosis after surgery.

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A Novel Anatomical Thin Titanium Mesh Plate with Patient-matched Bending Technique for Orbital Floor Reconstruction

This study developed an anatomical thin titanium mesh (ATTM) plate for Asian orbital floor fracture based on the medical image database. The computer aided stamping analysis was performed on four hole/slot patterns included the control type without hole design, circular hole pattern, slot pattern and hole/slot hybrid patterns within the ATTM plate with upper/lower dies of averaged orbital cavity reconstruction models. The curved-fan ATTM plate with 0.4mm thickness was manufactured and pre-bent using a patient matched stamping process to verify its feasibility and the interfacial fitness between the plate and bone on the orbital floor fracture model.

https://ift.tt/2reu2oa

Inhibition of Notch Signaling Pathway Temporally Postpones the Cartilage Degradation Progress of Temporomandibular Joint Arthritis in Mice

The aim of this study is to explore the role of Notch signaling pathway in the initiation and progression of temporomandibular joint osteoarthritis (TMJOA).

https://ift.tt/2rhPvMf

An unusual cause of thunderclap headache after eating the hottest pepper in the world - "The Carolina Reaper"

Satish Kumar Boddhula<br />Apr 9, 2018; 2018:bcr-2017-224085-bcr-2017-224085<br />Images in...

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Quality of life and neuropsychiatric disorders in patients with Graves' Orbitopathy: Current concepts

Publication date: Available online 2 May 2018
Source:Autoimmunity Reviews
Author(s): Alice Bruscolini, Marta Sacchetti, Maurizio La Cava, Marcella Nebbioso, Angela Iannitelli, Adele Quartini, Alessandro Lambiase, Massimo Ralli, Armando de Virgilio, Antonio Greco
Graves' disease (GD) is an autoimmune chronic thyroiditis frequently associated with development of Graves' orbitopathy (GO) characterized by proptosis, strabismus, impairment of visual function, ocular surface inflammation and dry eye. As consequence, patients with GO experience impairment of quality of life and social function and could develop a neurobehavioral syndrome, ranging from anxious to depressive or psychotic disorders. To date, the pathogenic mechanism underlying neuropsychiatric disorders in patients with GD has not been clearly understood. In fact, the development of neuropsychiatric disorders in patients with GO has been associated with both the detrimental effects of the altered circulating thyroid hormones on the nervous system, and with the psychological discomfort caused by poor quality of life, reduced social interactions and relapsing course of the disease. This paper summarizes current evidence on neuropsychiatric abnormalities in Graves' disease focusing on its impact on QoL and psychosocial function. We remark the importance of a multidisciplinary approach and we emphasize the potential benefit of neuropsychiatric approach on disease perception, patient compliance to medical and/or surgical treatment and clinical outcomes.

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New use for an old treatment: Hydroxychloroquine as a potential treatment for systemic vasculitis

Publication date: Available online 2 May 2018
Source:Autoimmunity Reviews
Author(s): Alina Casian, Shirish Sangle, David P. D'Cruz
Antimalarials have been an effective and safe treatment for autoimmune rheumatic diseases such as systemic lupus erythematosus for more than a hundred years. There are surprisingly few reports of hydroxychloroquine use in the systemic vasculitides. Hydroxychloroquine has antithrombotic, cardiovascular, antimicrobial and antineoplastic effects, making it a potentially valuable treatment for patients with systemic vasculitis who are at risk of infections, malignancy and thrombotic events. We report the successful use of hydroxychloroquine in patients with ANCA vasculitis, Henoch Schonlein purpura/IgA vasculitis, Takayasu's arteritis and polyarteritis nodosa. We review the immunomodulatory mechanisms of action of hydroxychloroquine and the existing evidence for its use in the treatment of vasculitis, with a particular focus on ANCA subtypes.

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Animal studies are mandatory to investigate the poorly understood fate and effects of aluminum adjuvants administered to billions of humans and animals worldwide

Publication date: Available online 2 May 2018
Source:Autoimmunity Reviews
Author(s): Romain K. Gherardi, Guillemette Crépeaux, François-Jerome Authier, Lluis Lujan

https://ift.tt/2rg4Iyf

Efficacy of postoperative pain management in head and neck cancer patients

Our study quantifies the effectiveness of perioperative pain control in a cohort of patients undergoing major head and neck surgery with free flap reconstruction. Our long-term goal is to improve pain control ...

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Predictors, costs, and causes of readmission after surgery for sinonasal cancer: a national perspective

International Forum of Allergy &Rhinology, EarlyView.

https://ift.tt/2jm6NUG

Randomized controlled trial comparing the supraglottic airway to use of an endotracheal tube in sinonasal surgery

International Forum of Allergy &Rhinology, EarlyView.

https://ift.tt/2HOdDx8

Management of hypersensitivity reactions to Tocilizumab

Clinical &Experimental Allergy, EarlyView.

https://ift.tt/2ribjrR

Barriers and facilitators to self‐management of asthma in adolescents: An interview study to inform development of a novel intervention

Clinical &Experimental Allergy, EarlyView.

https://ift.tt/2wfsRdh

Eosinophils on trial

Clinical &Experimental Allergy, Volume 48, Issue 5, Page 490-492, May 2018.

https://ift.tt/2rfKW5N

A complicated relationship between peanut environmental exposure and the development of allergic sensitization to peanuts

Clinical &Experimental Allergy, Volume 48, Issue 5, Page 488-489, May 2018.

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Issue Information

Clinical &Experimental Allergy, Volume 48, Issue 5, Page 485-487, May 2018.

https://ift.tt/2HPMUzZ

Cover Image

Clinical &Experimental Allergy, Volume 48, Issue 5, Page i-i, May 2018.

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Best of the other journals

Clinical &Experimental Allergy, Volume 48, Issue 5, Page 612-612, May 2018.

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Forthcoming Meetings

Clinical &Experimental Allergy, Volume 48, Issue 5, Page 611-611, May 2018.

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MMP-7 expression may influence the rate of distant recurrences and disease-specific survival in HPV-positive oropharyngeal squamous cell carcinoma

Abstract

The objective of this study was to determine if matrix metalloproteinase-7 (MMP-7) expression is related to human papilloma virus (HPV) status, clinical parameters, and outcome in oropharyngeal squamous cell carcinoma (OPSCC). Tumor tissue specimens from 201 OPSCC patients treated with curative intent were available for immunohistochemistry, and the samples were stained with monoclonal MMP-7 antibody. All the patients were followed up at least 3 years or until death. MMP-7 expression did not differ between HPV-positive and HPV-negative patients. MMP-7 was not prognostic among patients with HPV-negative OPSCC. In the HPV-positive subgroup, patients with moderate, high, or very high MMP-7 expression had significantly worse 5-year disease-specific survival (DSS) (56.6%) than patients with absent, or low MMP-7 expression (77.2%), and MMP-7 expression appeared as a prognostic factor in the multivariate analysis. In addition, among HPV-positive OPSCC with moderate, high, or very high MMP-7 expression, the 5-year distant recurrence-free survival was significantly lower (69.6%) than in those who had low or absent MMP-7 expression (97.5%). Our results suggest that among HPV-positive OPSCC patients, high MMP-7 expression is related to worse 5-year DSS and increased rate of distant recurrences.

https://ift.tt/2HKi5Ry

c-MYC amplification and c-myc protein expression in pancreatic acinar cell carcinomas. New insights into the molecular signature of these rare cancers

Abstract

The molecular alterations of pancreatic acinar cell carcinomas (ACCs) and mixed acinar-neuroendocrine carcinomas (MANECs) are not completely understood, and the possible role of c-MYC amplification in tumor development, progression, and prognosis is not known. We have investigated c-MYC gene amplification in a series of 35 ACCs and 4 MANECs to evaluate its frequency and a possible prognostic role. Gene amplification was investigated using interphasic fluorescence in situ hybridization analysis simultaneously hybridizing c-MYC and the centromere of chromosome 8 probes. Protein expression was immunohistochemically investigated using a specific monoclonal anti-c-myc antibody. Twenty cases had clones with different polysomies of chromosome 8 in absence of c-MYC amplification, and 5 cases had one amplified clone and other clones with chromosome 8 polysomy, while the remaining 14 cases were diploid for chromosome 8 and lacked c-MYC amplification. All MANECs showed c-MYC amplification and/or polysomy which were observed in 54% pure ACCs. Six cases (15.3%) showed nuclear immunoreactivity for c-myc, but only 4/39 cases showed simultaneous c-MYC amplification/polysomy and nuclear protein expression. c-myc immunoreactivity as well as c-MYC amplification and/or chromosome 8 polysomy was not statistically associated with prognosis. Our study demonstrates that a subset of ACCs shows c-MYC alterations including gene amplification and chromosome 8 polysomy. Although they are not associated with a different prognostic signature, the fact that these alterations are present in all MANECs suggests a role in the acinar-neuroendocrine differentiation possibly involved in the pathogenesis of MANECs.

https://ift.tt/2waYZP6

Macrostomia: The defining feature of the oculo-auriculo-vertebral spectrum

Publication date: Available online 1 May 2018
Source:Acta Otorrinolaringológica Española
Author(s): Mainak Dutta, Indranil Chatterjee

https://ift.tt/2FBzJAR

Individualprävention beruflicher Kontaktekzeme: Schutzhandschuhe und Hautschutzempfehlungen im berufsgenossenschaftlichen Heilverfahren

Zusammenfassung

Das Hautarztverfahren ist ein zentrales Instrument, um berufsbedingte Kontaktekzeme frühzeitig zu erkennen, den Unfallversicherungsträgern zu melden und die Erkrankungen zu behandeln. Wenngleich es die originäre Pflicht des Arbeitgebers ist, Hautschutzmaßnahmen am Arbeitsplatz umzusetzen, so kann es im berufsdermatologischen Einzelfall erforderlich sein, im Sinne der Individualprävention Hautschutzempfehlungen für den einzelnen Patienten auszusprechen bzw. anzupassen. Das patienteneigene Hautschutzverhalten trägt maßgeblich dazu bei, die Hautgesundheit wiederherzustellen und zu erhalten. Hierzu zählen die Anwendung von beruflichen Hautmitteln sowie insbesondere die richtige Verwendung von sachkundig ausgewählten Schutzhandschuhen. Diese stellen die wichtigste personenbezogene Schutzmaßnahme in der Prävention von Kontaktekzemen dar. Bei der Identifikation geeigneter Schutzmaßnahmen können Präventionsdienste, Fachkräfte für Arbeitssicherheit, Betriebsärzte und berufsdermatologische Schwerpunktzentren unterstützen. Mittlerweile existiert für (fast) jede berufliche Aufgabe und Exposition ein geeigneter Handschuhschutz. Gleichzeitig können Anwendungsfehler in der Praxis (z. B. falsch verwendete Handschuhe) zum Risikofaktor für die Haut werden. Daher ist es von großer Bedeutung, diese Anwendungsfehler zu identifizieren, Patienten zum Thema Hautschutz zu schulen und sie zu einem adäquaten Hautschutzverhalten zu motivieren. Mit besonderem Fokus auf den Bereich der Schutzhandschuhe wird in diesem Beitrag ein Überblick über verschiedene Handschuhtypen, -materialien sowie potenziell handschuhrelevante Allergene gegeben, es werden Strategien zur Minderung von Okklusionseffekten vorgestellt sowie einige typische Anwendungsfehler aus der Praxis und Lösungsstrategien diskutiert.

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Typ-IV-Kontaktallergien in Nahrungsmittelberufen: Eine aktuelle Übersicht

Zusammenfassung

Hintergrund

Der Nahrungsmittelsektor gehört zu den Hochrisikobereichen für berufsbedingte irritative und allergische Kontaktekzeme.

Ziele

Die vorliegende Arbeit gibt einen Überblick über Hauptallergene und Sensibilisierungshäufigkeiten sowie Sensibilisierungsrisiko in verschiedenen Berufen der Nahrungsmittelindustrie.

Methoden

Die Literatur zu Typ-IV-Sensibilisierungen im Nahrungsmittelsektor wird zusammenfassend dargestellt.

Ergebnisse

Das relative Risiko, ein berufsbedingtes Handekzem in der Lebensmittelverarbeitung zu entwickeln, ist mehr als 3‑fach erhöht. Die Vergleichsgruppe wurde auf der Basis des Anteils dokumentierter Fälle im IVDK(Informationsverbund Dermatologischer Kliniken)-Netzwerk pro 100.000 berufstätiger Personen bezogen auf den Durchschnitt der Jahre 2005 und 2010 berechnet. Hierfür wurde das mittlere Risiko aller Patienten als Referenz auf 1 gesetzt. Vor allem betroffen sind Bäcker, Konditoren, Köche sowie Fleisch- und Fischverarbeiter. Neben irritativen Kontaktekzemen treten häufig allergische Kontaktekzeme und Proteinkontaktdermatitis auf. Führende Haptene (Hauptallergene) sind in erster Linie Gummiinhaltsstoffe, aber auch Desinfektionsmittel und Kompositen (Korbblütler).

Schlussfolgerung

Auch in der Nahrungsmittelindustrie sind wenige Kontaktallergene für die Mehrzahl der berufsrelevanten Sensibilisierungen verantwortlich.

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Esophageal pulmonary fistula – a rare complication of radiation therapy: a case report

Esophageal respiratory fistulae are abnormal communications between the esophagus and the respiratory system. They are either congenital or acquired. Most acquired esophageal respiratory fistulae are of the es...

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Perineural invasion: Independent prognostic factor in oral cancer that warrants adjuvant treatment

Head &Neck, EarlyView.

https://ift.tt/2JMNFdI

A score for the differential diagnosis of bradykinin- and histamine-induced head and neck swellings

Abstract

Purpose

Acute edema of the head and neck region may lead to life-threatening dyspnea and require quick and targeted treatment. They can be subdivided in bradykinin- and histamine-mediated swellings, which require treatment with different classes of pharmaceuticals. Clinical pathways for differential diagnoses do not exist so far, although it is known that early treatment is decisive for faster symptom relief and reduced expression of the swellings. Aim of the study was the creation of a clinical algorithm for identification of bradykinin-mediated angioedema.

Methods

188 patients that presented to our outpatient department between 2010 and 2016 with an acute, non-inflammatory swelling of the head and neck region were included in our retrospective study. All available anamnestic and clinical parameters were obtained from patient files. Parameters showing significant differences between the two groups were included in our score. Utilization of the Youden's index allowed determination of an optimal cut-off value.

Results

76 patients could be assigned to the histamine and 112 patients to bradykinin group. The following parameters were included in our score: age, dyspnea, itching or erythema, glucocorticoid response and intake of ACEi/AT-II blockers. The cut-off value is set at three points. The proposed score yielded a sensitivity for identification of bradykinin-mediated angioedema of 96%, a specificity of 84%, a positive predictive value of 91% and a negative predictive value of 93%.

Conclusions

Utilization of the proposed score allows quick and reliable assignment of patients to the correct subgroup and thereby reduces time for treatment.

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A self‐controlled study of intralesional injection of diprospan combined with topical timolol cream for treatment of thick superficial infantile hemangiomas

Dermatologic Therapy, EarlyView.

https://ift.tt/2rfprBn

Alpha‐1 antitrypsin deficiency panniculitis: clinical and pathologic characteristics of 10 cases

International Journal of Dermatology, EarlyView.

https://ift.tt/2JKw327

Epitope spread in chronic mucosal GVHD: mucous membrane pemphigoid resolution with rituximab

International Journal of Dermatology, EarlyView.

https://ift.tt/2rfONzX

Wells syndrome: a case of successful treatment with omalizumab

International Journal of Dermatology, EarlyView.

https://ift.tt/2JNewGJ

Comorbidities of Japanese patients with palmoplantar pustulosis: a report from a single center

International Journal of Dermatology, EarlyView.

https://ift.tt/2I7mJbI

Cellular transplantation procedures in vitiligo: what is in a name?

International Journal of Dermatology, EarlyView.

https://ift.tt/2JMXsR8

Amyloidosis associated with skin popping: a case report and review of literature

International Journal of Dermatology, EarlyView.

https://ift.tt/2I6GZtL

Subungual exostosis and subungual osteochondromas: a description of 25 cases

International Journal of Dermatology, EarlyView.

https://ift.tt/2JMXiJw

Clinical and molecular characterization and response to Acitretin in three Families with Sjögren‐Larsson Syndrome

International Journal of Dermatology, EarlyView.

https://ift.tt/2rbs9Zt

Investigating the effectiveness of the Trigonella foenum-graecum L. (fenugreek) seeds in mild asthma: a randomized controlled trial

Asthma is one of the important chronic diseases. The asthma prevalence is increasing in last decades. Despite the presence of good controller drugs like corticosteroids, about 60% of asthmatic patients use alt...

https://ift.tt/2rh6AWn

Chronic oral lichenoid erosions revealing haematological malignancies

Journal of the European Academy of Dermatology and Venereology, EarlyView.

https://ift.tt/2HIQG27

Bedside reasoning on causes and mechanisms of diseases in the era of precision medicine: a timeless story?

Journal of the European Academy of Dermatology and Venereology, EarlyView.

https://ift.tt/2rhkI1U

Positive Jacquet's sign in traction alopecia

Journal of the European Academy of Dermatology and Venereology, EarlyView.

https://ift.tt/2KvYXnN

Association of serious infections with pemphigus and pemphigoid: analysis of the Nationwide Inpatient Sample

Journal of the European Academy of Dermatology and Venereology, EarlyView.

https://ift.tt/2rgsA3Y

Candida induces the expression of IL‐36γ in human keratinocytes: implications for a pathogen‐driven exacerbation of psoriasis?

Journal of the European Academy of Dermatology and Venereology, EarlyView.

https://ift.tt/2KxfurQ

Various cold plasma devices for the treatment of actinic keratosis

Journal of the European Academy of Dermatology and Venereology, EarlyView.

https://ift.tt/2rhhcEM

Anti‐inflammatory therapy with tumour necrosis factor inhibitors is associated with reduced risk of major adverse cardiovascular events in psoriasis

Journal of the European Academy of Dermatology and Venereology, EarlyView.

https://ift.tt/2Kun4DC

Medically unexplained dermatologic symptoms and psychodermatology

Journal of the European Academy of Dermatology and Venereology, EarlyView.

https://ift.tt/2rgsyZU

A case of hereditary fibrosing poikiloderma with tendon contractures, myopathy and pulmonary fibrosis (POIKTMP) with the emphasis on cutaneous histopathological findings

Journal of the European Academy of Dermatology and Venereology, EarlyView.

https://ift.tt/2Kt07k2

Both children and adult patients with difficult‐to‐treat atopic dermatitis have high prevalences of concomitant allergic contact dermatitis and are frequently polysensitized

Journal of the European Academy of Dermatology and Venereology, EarlyView.

https://ift.tt/2rfro0I

Deoxycholic Acid for Fibrofatty Residua of Infantile Hemangiomas

This case report describes a patient treated with intralesional deoxycholic acid for fibrofatty residua of involuted infantile hemangiomas.

https://ift.tt/2HIotbT

Good to Begin Well, Better to End Well

https://ift.tt/2rg5cU2

Autoimmune Diseases in Patients With Cutaneous Lupus Erythematosus

This cross-sectional study examines the prevalence and risk factors of having coexisting autoimmune conditions in patients with cutaneous lupus erythematosus.

https://ift.tt/2HK6y4D

Knowledge Removes Discomfort

To the Editor McDonald et al wrote an interesting piece regarding screening for depression among dermatology patients, raising pressing issues and questions that warrant discussion and may interest the readership of JAMA Dermatology.

https://ift.tt/2rgAGJN

Knowledge Removes Discomfort—Reply

In Reply We thank Dr Nwabudike for replying to our publication on the Patient Health Questionnaire-2 (PHQ-2) in Dermatology. We address his inquiries in chronological order:

https://ift.tt/2KumcP6

Association of Nodal Metastasis With Vermilion Lip Location in Cutaneous SCC of the Lip

This cohort study of patients with cutaneous squamous cell carcinomas of the lip evaluates the risk differences for recurrence, metastasis, and death in tumors of the vermilion vs cutaneous lip locations.

https://ift.tt/2rgAaeP

Peripheral T Cell Lymphoma of Parotid Gland: A Diagnostic Challenge

Abstract

Peripheral T-cell lymphoma of salivary gland is a rare clinical entity most commonly involving the parotid gland and mimics a salivary gland carcinoma. It has an aggressive clinical course with poor prognosis. Majority of the cases are diagnosed after surgical excision whereas the principal treatment is non-surgical (chemotherapy). Core biopsy is an excellent method of identifying these indeterminate lesions pre-operatively which would avoid unnecessary surgical intervention. We present a case report with diagnostic challenge in identifying peripheral T cell lymphoma of salivary gland with the review of literature.

https://ift.tt/2rgyeD9

Akute, lebensbedrohliche Medikamentenreaktionen der Haut

Zusammenfassung

Stevens-Johnson-Syndrom (SJS) und toxisch epidermale Nekrolyse (TEN) sind akut auftretende, nicht vorhersehbare, oftmals lebensbedrohliche Reaktionen, die im klinischen Alltag eine große Herausforderung darstellen. Sie sind durch z. T. ausgedehnte Blasenbildung der Haut und Schleimhaut gekennzeichnet und werden als eine Krankheitsentität von verschieden schwerer Ausprägung betrachtet, weshalb sie als SJS/TEN oder auch EN (für epidermale bzw. epitheliale Nekrolyse) zusammengefasst werden. In Zusammenschau von klinischem Bild und histologischem Befund kann die Diagnose bestätigt werden. Um die auslösenden Faktoren zu identifizieren, ist das Erheben einer sehr detaillierten und gründlichen Arzneimittel- und Infektanamnese notwendig. Unter Berücksichtigung der Ergebnisse großer pharmakoepidemiologischer Studien lassen sich die möglichen Auslöser auch bei Multimedikation und bestehenden Grundkrankheiten eingrenzen. Zu Arzneimitteln mit hohem Risiko für SJS/TEN gehören Allopurinol, antibakterielle Sulfonamide, nichtsteroidale Antirheumatika vom Oxicam-Typ, verschiedene Antiepileptika und Nevirapin. Sie allein erklären mehr als die Hälfte aller Fälle von SJS/TEN, wobei es sich typischerweise um den ersten Einnahmezyklus des Medikamentes handelt und der Einnahmebeginn meist innerhalb von 1 bis 4 Wochen vor Reaktionsbeginn liegt. Nicht immer ist ein Arzneimittel ursächlich, in ca. 70–75 % der Fälle aber sehr wahrscheinlich. In anderen Fällen kommen Infekte als Auslöser infrage. Wenn bestimmte Arzneimittel als ursächlich angesehen werden, sollten diese umgehend abgesetzt werden. Zudem sollten symptomatische Therapiemaßnahmen eingeleitet werden. Schreitet die Reaktion voran, sollte zusätzlich eine immunmodulierende Therapie erwogen werden. In diesem Zusammenhang haben systematische Reviews die besten Ergebnisse für Cyclosporin A und systemische Steroide gezeigt.

https://ift.tt/2jpbIUW

Identification of dizzy patients who will develop an acute cerebrovascular syndrome: a descriptive study among emergency department patients

Abstract

Purpose

To calculate the incidence of subsequent acute cerebrovascular syndrome in emergency department patients with vertigo or dizziness symptoms and to determine predictors of subsequent acute cerebrovascular syndrome in these patients.

Methods

Descriptive and retrospective hospital based-population study among emergency department patients with vertigo or dizziness symptoms in 1 year. One year follow-up since the medical visit was performed. Chi-square and Fisher tests were used for qualitative variables; Mann–Whitney U test for quantitative variables. A multivariate model was created.

Results

1243 dizzy patients who visited emergency department during 2015 were identified, finally 928 were included. 12 acute cerebrovascular syndromes were identified; 8 strokes and 4 transient ischemic attacks. Percentages over the sample size: 1.29% for acute cerebrovascular syndromes, 0.43% for transient ischemic attack and 0.86% for stroke. Odds ratio values to develop an event over the general population were 7.24 for acute cerebrovascular syndrome, 95% CI (3.98–13.12); 14.9 for transient ischemic attack, 95% CI (4.8–40.9) and 5.86 for stroke, 95% CI (2.72–12.0). Atrial fibrillation and diabetes mellitus were identified as significant risk factors to develop an acute cerebrovascular syndrome.

Conclusion

Emergency department patients with symptoms of vertigo or dizziness had sevenfold higher risk of acute cerebrovascular syndromes than the general population. Atrial fibrillation and diabetes mellitus are risk factors associated with high risk of acute cerebrovascular syndromes in these patients.

https://ift.tt/2rl8Oo3

Efficacy of postoperative pain management in head and neck cancer patients

Abstract

Background

Methods

A retrospective analysis was performed at a tertiary, academic head and neck surgical oncology program in Calgary, Alberta, Canada from January 1, 2015 – December 31, 2015. Pain scores were recorded prospectively. Primary outcomes were frequency of postoperative pain assessments and pain intensity using the numeric rating scale.

Results

The cohort included 41 patients. Analysis was limited to pain scores recorded from postoperative days 1–14. There was an average of 7.3 pain measurements per day (SD 4.6, range 1–24) with the most frequent monitoring on postoperative days 1–4.

Median pain scores ranged from 0 to 4.5 with the highest median score on postoperative day 6. The daily maximum pain scores recorded ranged from 8 to 10 with scores of 10 recorded on postoperative days 1, 2, 3, 5, 7, 8, and 10.

Patients most frequently had inadequate pain control on postoperative days 1, 2, 4, and 5 with the majority occurring on postoperative day 1.

Conclusions

Postoperative pain control could be improved at our centre. The frequency of pain assessments is also highly variable. Ongoing measurement, audit, and feedback of analgesic protocol effectiveness is an excellent first step in improving perioperative pain management in patients undergoing major head and neck cancer surgery with free flap reconstruction.

https://ift.tt/2JMBf5I

Common and Not-so-Common Rashes in Kids

A family physician and a dermatologist talk through the differential diagnosis for two children presenting with a primary complaint of rash.
Medscape Family Medicine

https://ift.tt/2jmq6gI

Peripheral T Cell Lymphoma of Parotid Gland: A Diagnostic Challenge

Abstract

https://ift.tt/2rgyeD9

Determination of Serum IgE and Eosinophils as a Diagnostic Indicator in Allergic Rhinitis

Abstract

Allergic Rhinitis is a chronic, inflammatory disease induced by an IgE-mediated reaction and identified clinically by the presence of symptoms of nasal discharge, itching, sneezing and nasal congestion. The aim and objectives of the study was to determine serum IgE and eosinophil levels in patients with allergic rhinitis and healthy controls, men and women, different age groups and to establish a correlation between serum IgE and eosinophil. A retrospective study was conducted in the outpatient department of ENT in ICARE institute of medical sciences and research, Haldia during the time span of March 2016 to February 2017. A total of 155 subjects (113 cases and 42 controls, 74 men and 81 women) of age 1 month—75 years were selected for the study. Blood samples obtained were analyzed to determine serum IgE and eosinophil levels and the results were subjected to statistical analysis using STATA 12 software. The mean values and standard deviation of the serum log IgE and eosinophil levels in cases and healthy controls, men and women, various age groups were obtained and tabulated using paired t test and MV test. Pearson's correlation was performed to establish a relationship between serum log IgE and eosinophil levels. The mean values of serum log IgE and eosinophil levels were found to be higher in cases (log IgE—5.65, IgE—814.36 IU/ml, eosinophil—4.49%) when compared to controls (log IgE—4.43, IgE—96.62 IU/ml, eosinophil—2.36%). Men predominance was seen in mean serum log IgE levels (IgE—1018.5 IU/ml, log IgE—5.92) whereas women predominance in mean eosinophil counts (4.96%) in allergic rhinitis. A weakly positive correlation of 0.194 was established between serum log IgE and eosinophil levels. Estimation of serum IgE and eosinophil can serve as a simple, non-invasive and reliable investigative tool in the diagnosis of allergic rhinitis.

https://ift.tt/2jkI8Qu

Monitoring of Immunological Mechanisms and Biomarkers Underlying Efficacy and Toxicity of Cancer Immunotherapy

Condition: Solid Cancers
Intervention: Other: Patients treated with immune checkpoint blockade
Sponsor: Institut Claudius Regaud
Not yet recruiting

https://ift.tt/2HPdDNq

Study on Application of Suturing Parathyroid Markers in Thyroid Cancer Surgery

Conditions: Thyroid Cancer; Hypoparathyroidism; Marker; Structural; Complication of Surgical Procedure; Parathyroid Function Low Adverse Event
Intervention: Procedure: The suture marks the location of the parathyroid gland
Sponsor: Bo Wang,MD
Recruiting

https://ift.tt/2jogDpm

Determination of Serum IgE and Eosinophils as a Diagnostic Indicator in Allergic Rhinitis

Abstract

https://ift.tt/2jkI8Qu

Response to ‘The use of laryngeal mask airway for adenoidectomy’

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Lee P. Smith

https://ift.tt/2HJ6eyT

The use of laryngeal mask airway for adenoidectomy

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Fatma Caylakli

https://ift.tt/2rkYk91

How to quantify the ‘auditory gain’ of a bone-conduction device; comment to the systematic review by Bezdjian et al. (2017)

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Ad Snik

https://ift.tt/2HJwx8k

Have Laryngologists Found One More Disease to Treat With a Flexible Laryngoscope and a Needle?-Reply.

Have Laryngologists Found One More Disease to Treat With a Flexible Laryngoscope and a Needle?-Reply.

JAMA Otolaryngol Head Neck Surg. 2018 Apr 26;:

Authors: Reder L, Bertelsen C, O'Dell K

PMID: 29710281 [PubMed - as supplied by publisher]

https://ift.tt/2HOakFY

Association Between Cystatin C and 20-Year Cumulative Incidence of Hearing Impairment in the Epidemiology of Hearing Loss Study.

Association Between Cystatin C and 20-Year Cumulative Incidence of Hearing Impairment in the Epidemiology of Hearing Loss Study.

JAMA Otolaryngol Head Neck Surg. 2018 Apr 26;:

Authors: Schubert CR, Paulsen AJ, Nondahl DM, Dalton DS, Fischer ME, Klein BEK, Klein R, Tweed TS, Cruickshanks KJ

Abstract
Importance: Hearing impairment (HI) is one of the most common conditions affecting older adults. Identification of factors associated with the development of HI may lead to ways to reduce the incidence of this condition.
Objective: To investigate the association between cystatin C, both as an independent biomarker and as a marker of kidney function, and the 20-year incidence of HI.
Design, Setting, and Participants: Data were obtained from the Epidemiology of Hearing Loss Study (EHLS), a longitudinal, population-based study in Beaver Dam, Wisconsin. Baseline examinations began in 1993 and continued through 1995, and participants were examined approximately every 5 years, with the most recent examination phase completed in 2015. The EHLS participants with serum cystatin C concentration data and without HI at the baseline examination were included in this study.
Main Outcomes and Measures: Participants without HI were followed up for incident HI (pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz >25 dB hearing level in either ear) for 20 years. Cystatin C was analyzed as a biomarker (concentration) and used to determine estimated glomerular filtration rate (eGFRCysC). Discrete-time Cox proportional hazards regression models were used to analyze the association between cystatin C concentration and eGFRCysC and the 20-year cumulative incidence of HI.
Results: There were 863 participants aged 48 to 86 years with cystatin C data and without HI at baseline. Of these, 599 (69.4%) were women. In models adjusted for age and sex, cystatin C was associated with an increased risk of developing HI (hazard ratio [HR], 1.20; 95% CI, 1.07-1.34 per 0.2-mg/L increase in cystatin C concentration), but the estimate was attenuated after further adjusting for educational level, current smoking, waist circumference, and glycated hemoglobin (HR, 1.11; 95% CI, 0.98-1.27 per 0.2-mg/L increase in cystatin C concentration). Low eGFRCysC was significantly associated with the 20-year cumulative incidence of HI in both the age- and sex-adjusted model (HR, 1.70; 95% CI, 1.16-2.48; <60 vs ≥60 mL/min/1.73 m2) and the multivariable-adjusted model (HR, 1.50; 95% CI, 1.02-2.22; <60 vs ≥60 mL/min/1.73 m2).
Conclusions and Relevance: Reduced kidney function as estimated using cystatin C, but not cystatin C alone, was associated with the 20-year cumulative incidence of HI, suggesting that some age-related HI may occur in conjunction with or as the result of reduced kidney function.

PMID: 29710267 [PubMed - as supplied by publisher]

https://ift.tt/2rgqTUM

Association Between Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss.

Association Between Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss.

JAMA Otolaryngol Head Neck Surg. 2018 Apr 26;:

Authors: Mahmoudi E, Zazove P, Meade M, McKee MM

Abstract
Importance: Hearing loss (HL) is common among older adults and is associated with poorer health and impeded communication. Hearing aids (HAs), while helpful in addressing some of the outcomes of HL, are not covered by Medicare.
Objective: To determine whether HA use is associated with health care costs and utilization in older adults.
Design, Setting, and Participants: This retrospective cohort study used nationally representative 2013-2014 Medical Expenditure Panel Survey data to evaluate the use of HAs among 1336 adults aged 65 years or older with HL. An inverse propensity score weighting was applied to adjust for potential selection bias between older adults with and without HAs, all of whom reported having HL. The mean treatment outcomes of HA use on health care utilization and costs were estimated.
Exposures: Encounter with the US health care system.
Main Outcomes and Measures: (1) Total health care, Medicare, and out-of-pocket spending; (2) any emergency department (ED), inpatient, and office visit; and (3) number of ED visits, nights in hospital, and office visits.
Results: Of the 1336 individuals included in the study, 574 (43.0%) were women; mean (SD) age was 77 (7) years. Adults without HAs (n = 734) were less educated, had lower income, and were more likely to be from minority subpopulations. The mean treatment outcomes of using HAs per participant were (1) higher total annual health care spending by $1125 (95% CI, $1114 to $1137) and higher out-of-pocket spending by $325 (95% CI, $322 to $326) but lower Medicare spending by $71 (95% CI, -$81 to -$62); (2) lower probability of any ED visit by 2 percentage points (PPs) (24% vs 26%; 95% CI, -2% to -2%) and lower probability of any hospitalization by 2 PPs (20% vs 22%; 95% CI, -3% to -1%) but higher probability of any office visit by 4 PPs (96% vs 92%; 95% CI, 4% to 4%); and (3) 1.40 more office visits (95% CI, 1.39 to 1.41) but 0.46 (5%) fewer number of hospital nights (95% CI, -0.47 to -0.44), with no association with the number of ED visits, if any (95% CI, 0.01 to 0).
Conclusions and Relevance: This study demonstrates the beneficial outcomes of use of HAs in reducing the probability of any ED visits and any hospitalizations and in reducing the number of nights in the hospital. Although use of HAs reduced total Medicare costs, it significantly increased total and out-of-pocket health care spending. This information may have implications for Medicare regarding covering HAs for patients with HL.

PMID: 29710214 [PubMed - as supplied by publisher]

https://ift.tt/2HJODXK

Beyond "Pharyngocise" for Patients With Head and Neck Cancer: Does One Size Fit All?

Beyond "Pharyngocise" for Patients With Head and Neck Cancer: Does One Size Fit All?

JAMA Otolaryngol Head Neck Surg. 2018 Apr 19;:

Authors: Pryor JC

PMID: 29710249 [PubMed - as supplied by publisher]

https://ift.tt/2HOaflE

Association of Celecoxib Use With Decreased Opioid Requirements After Head and Neck Cancer Surgery With Free Tissue Reconstruction.

Association of Celecoxib Use With Decreased Opioid Requirements After Head and Neck Cancer Surgery With Free Tissue Reconstruction.

JAMA Otolaryngol Head Neck Surg. 2018 Apr 18;:

Authors: Carpenter PS, Shepherd HM, McCrary H, Torrecillas V, Kull A, Hunt JP, Monroe MM, Buchmann LO, Cannon RB

Abstract
Importance: Head and neck cancer (HNC) surgery with free tissue reconstruction is associated with considerable postoperative pain. Opioids are typically used but can have adverse effects, including respiratory depression and high rates of dependence and addiction. Safe alternative analgesics that minimize opioid requirements are beneficial in HNC surgery.
Objective: To investigate the association of celecoxib use with opioid requirements in the postoperative setting after HNC surgery with free tissue reconstruction.
Design, Setting, and Participants: A retrospective, matched-cohort study of 147 patients who had undergone HNC surgery with free tissue reconstruction between June 2015 and Sept 2017 in an academic cancer hospital. Patients were separated into groups based on whether celecoxib had been used perioperatively or not. These groups were then matched by stage and site resulting in 102 included participants (51 celecoxib, 51 control).
Main Outcomes and Measures: Oral, intravenous (IV), and total morphine equivalents used in the postoperative setting per patient per day.
Results: There were 51 patients in the celecoxib cohort (19 women and 32 men) and 51 patients in the control cohort (20 women and 31 men) who met inclusion criteria after clinicopathologic data were matched. The mean age of the celecoxib and control cohorts was 61.6 years and 66.1 years, respectively. Treatment with celecoxib in the postoperative setting was associated with decreased mean use of opioids in oral (mean difference, 9.9 mg/d; 95% CI, -1.2 to 21.1), IV (mean difference, 3.9 mg/d; 95% CI, 1.0-6.8), and total (mean difference, 14 mg/d; 95% CI, 2.6-25.4) amount of morphine equivalents per day. When patients were matched to surgical procedure, the effect was more significant. Patients who underwent composite oral resection and received celecoxib had decreased opioid use in oral (mean difference, 25 mg/d; 95% CI, 12.5-25.4), IV (mean difference, 3.4 mg/d; 95% CI, 1.5-5.5), and total (mean difference, 28.4 mg/d; 95% CI, 15.7-41.5) amounts compared with those in the control group. There was no significant difference in complication rates between the 2 cohorts.
Conclusions and Relevance: Use of celecoxib after head and neck cancer surgery and reconstruction with free tissue transfer was associated with a decrease in oral, IV, and total opioid requirements without increasing surgical or flap-related complications.

PMID: 29710229 [PubMed - as supplied by publisher]

https://ift.tt/2rkUoVN

Have Laryngologists Found One More Disease to Treat With a Flexible Laryngoscope and a Needle?

Have Laryngologists Found One More Disease to Treat With a Flexible Laryngoscope and a Needle?

JAMA Otolaryngol Head Neck Surg. 2018 Apr 26;:

Authors: Bradley JP

PMID: 29710223 [PubMed - as supplied by publisher]

https://ift.tt/2HLSumW

RNA Oncoimmune Phenotyping of HPV-Positive p16-Positive Oropharyngeal Squamous Cell Carcinomas by Nodal Status.

RNA Oncoimmune Phenotyping of HPV-Positive p16-Positive Oropharyngeal Squamous Cell Carcinomas by Nodal Status.

JAMA Otolaryngol Head Neck Surg. 2018 Apr 18;:

Authors: Stepp WH, Farquhar D, Sheth S, Mazul A, Mamdani M, Hackman TG, Hayes DN, Zevallos JP

Abstract
Importance: Clinical trials that deintensify treatment for patients with suspected human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) use p16 expression to identify HPV-mediated tumors and guide treatment. While p16 staining has a strong correlation with good outcomes, approximately 12% of p16-positive patients have recurrent disease. Biomarkers that reveal tumor-specific characteristics, such as nodal involvement, may change therapy decisions.
Objective: To assess whether if a tumor-specific genetic signature exists for node-negative vs node-positive HPV 16-positive/p16-positive OPSCCs.
Design, Setting, and Participants: This was a retrospective cohort study with randomized case selection for p16 OPSCCs undertaken at a university-based, tertiary care cancer center. Samples were collected from patients with p16-positive OPSCC. A total of 21 HPV 16/p16-positive tumors were used in this study.
Main Outcomes and Measures: Gene expression profiles of node-negative vs node-positive tumor samples were evaluated using a differential expression analysis approach and the sensitivity and specificity of a molecular signature was determined.
Results: Among the 21 patients in the study (3 women, 18 men; mean [SD] age, 54.6 [9.6] years), 6 had node-negative disease and 15 had node-positive disease. Using differential expression analysis, we found 146 genes that were significantly different in patients with node-negative disease vs those with node-positive disease, of which 15 genes were used to create a genetic signature that could distinguish node-negative-like from node-positive-like disease. The resultant molecular signature has a sensitivity of 88.2% (95% CI, 63.6%-98.5%) and specificity of 85.7% (95% CI, 42.1%-99.6%). The positive likelihood ratio of this signature was 6.1 (95% CI, 1.0-38.2) and the negative likelihood ratio was 0.1 (95% CI, 0.04-0.5). Given this population's prevalence of node-positive disease of 70.8%, the positive- and negative-predicative values for this gene signature were 93.7% (95% CI, 70.8%-98.9%) and 75.0% (95% CI, 44.1%-92.0%), respectively. In addition, we developed a gene signature using agnostic, machine learning software that identified a 40-gene profile that predicts node-negative disease from node-positive disease (area under the curve, 0.93; 95% CI, 0.63-1.00).
Conclusions and Relevance: Many HPV-16 and p16-positive tumors are treated as "lower-risk," but they do not have similar genetic compositions at the biological level. The identification of subgroups with unique expression patterns, such as those with nodal metastases, may guide physicians toward alternative or more aggressive therapies. In our study, unguided clustering suggested that that the larger biological characteristics of a tumor could be a better prognostic biomarker.

PMID: 29710215 [PubMed - as supplied by publisher]

https://ift.tt/2joZGLx

Comparison Between Patient-Perceived Voice Changes and Quantitative Voice Measures in the First Postoperative Year After Thyroidectomy: A Secondary Analysis of a Randomized Clinical Trial.

Comparison Between Patient-Perceived Voice Changes and Quantitative Voice Measures in the First Postoperative Year After Thyroidectomy: A Secondary Analysis of a Randomized Clinical Trial.

JAMA Otolaryngol Head Neck Surg. 2018 Apr 18;:

Authors: Kletzien H, Macdonald CL, Orne J, Francis DO, Leverson G, Wendt E, Sippel RS, Connor NP

Abstract
Importance: Voice changes after thyroidectomy are typically attributed to recurrent laryngeal nerve injury. However, most postoperative voice changes occur in the absence of clinically evident vocal fold paralysis. To date, no study has compared the prevalence, duration, and consequences of voice-related disability from the patient perspective with use of quantitative vocal measures.
Objectives: To assess the quality-of-life consequences of postthyroidectomy voice change from the perspective of patients with thyroid cancer and to compare patient-perceived voice changes with changes in quantitative vocal variables at 5 time points in the first postoperative year.
Design, Setting, and Participants: This prospective mixed methods observational study within a randomized clinical trial occurred at the University of Wisconsin Hospital and Clinics. Participants were 42 patients with clinically node-negative papillary thyroid cancer without a preexisting vocal cord paralysis who were recruited and enrolled from outpatient clinics between June 6, 2014, and March 6, 2017, as part of the ongoing randomized clinical trial.
Intervention: Total thyroidectomy.
Main Outcomes and Measures: Semistructured interviews, symptom prevalence, and instrumental voice evaluations (laryngoscopy, phonation threshold pressure, Dysphonia Severity Index, and Voice Handicap Index) occurred at baseline (n = 42) and 2-week (n = 42), 6-week (n = 39), 6-month (n = 35), and 1-year (n = 30) postoperative time points.
Results: Participants had a mean age of 48 years (interquartile range, 38-58 years; age range, 22-70 years) and were mostly female (74% [31 of 42]) and of white race/ethnicity (98% [41 of 42]). Impaired communication was the primary theme derived from patient interviews from before thyroidectomy to after thyroidectomy. Voice changes were perceived by 24 participants at 2 weeks after thyroidectomy. After surgery, voice symptoms were prevalent and persisted for 50% (21 of 42) of participants out to at least 1 year of follow-up. Quantitative vocal perturbations were detected in the Dysphonia Severity Index and Voice Handicap Index at the 2-week follow-up but returned to baseline levels by the 6-week follow-up visit.
Conclusions and Relevance: Voice changes are common after surgery for papillary thyroid cancer and affect quality of life for many patients out to 1 year of follow-up. Directly querying patients about postoperative voice changes and questioning whether commonly used aerodynamic and acoustic variables detect meaningful voice changes are important in identifying patients whose quality of life has been affected by postthyroidectomy dysphonia.
Trial Registration: ClinicalTrials.gov Identifier: NCT02138214.

PMID: 29710208 [PubMed - as supplied by publisher]

https://ift.tt/2FyMHQ3

Hearing Aid Use and Health Care Costs Among Older Adults.

Hearing Aid Use and Health Care Costs Among Older Adults.

JAMA Otolaryngol Head Neck Surg. 2018 Apr 26;:

Authors: Wallhagen MI

PMID: 29710191 [PubMed - as supplied by publisher]

https://ift.tt/2rcMy0m

Extending the Ear-Kidney Association to Presbycusis.

Extending the Ear-Kidney Association to Presbycusis.

JAMA Otolaryngol Head Neck Surg. 2018 Apr 26;:

Authors: Monsell EM

PMID: 29710133 [PubMed - as supplied by publisher]

https://ift.tt/2HOXDLm

Association of Behavior With Noise-Induced Hearing Loss Among Attendees of an Outdoor Music Festival: A Secondary Analysis of a Randomized Clinical Trial.

Association of Behavior With Noise-Induced Hearing Loss Among Attendees of an Outdoor Music Festival: A Secondary Analysis of a Randomized Clinical Trial.

JAMA Otolaryngol Head Neck Surg. 2018 Apr 19;:

Authors: Kraaijenga VJC, van Munster JJCM, van Zanten GA

Abstract
Importance: To date, factors associated with noise-induced hearing loss at music festivals have not yet been analyzed in a single comprehensive data set. In addition, little is known about the hearing loss-associated behavior of music festival attendees.
Objectives: To assess which factors are associated with the occurrence of a temporary threshold shift (TTS) after music exposure and to investigate the behavior of music festival attendees.
Design, Setting, and Participants: This prospective post hoc analysis gathered data from a randomized, single-blind clinical trial conducted on September 5, 2015, at an outdoor music festival in Amsterdam, the Netherlands. Adult volunteers with normal hearing were recruited via social media from August 26 through September 3, 2015. Intention to use earplugs was an exclusion criterion. Of 86 volunteers assessed, 51 were included. This post hoc analysis was performed from October 3, 2016, through February 27, 2017.
Interventions: Music festival visit for 4.5 hours.
Main Outcomes and Measures: The primary outcome was a TTS on a standard audiogram for the frequencies 3.0- and 4.0-kHz. Multivariable linear regression was performed to determine which factors are associated with a TTS. A questionnaire on behavior, hearing, and tinnitus was distributed to the participants before and after the festival visit.
Results: A total of 51 participants were included (18 men [35%] and 33 women [65%]) with a mean (SD) age of 27 (6) years. Mean (SD) threshold change across 3.0 and 4.0 kHz was 5.4 (5.7) dB for the right ear and 4.0 (6.1) dB for the left ear. Earplug use (absolute difference in the left ear, -6.0 dB [95% CI, -8.7 to -3.2 dB]; in the right ear, -6.4 dB [95% CI, -8.8 to -4.1 dB]), quantity of alcohol use (absolute difference per unit in the left ear, 1.1 dB [95% CI, 0.5 to 1.7 dB]; in the right ear, 0.7 dB [95% CI, 0.1 to 1.4 dB]), drug use (absolute difference in the right ear, 6.0 dB [95% CI, 0.9 to 11.1 dB]), and male sex (absolute difference in the right ear, 4.1 dB [95% CI, 0.3 to 5.9 dB]) were independently associated with hearing loss, with earplug use being the most important factor. Unprotected participants reported significantly worse subjective hearing performance and tinnitus after the festival visit than did participants using earplugs (Cramer V, 0.62 [95% CI, 0.47-0.79] and 0.39 [95% CI, 0.16-0.62], respectively). In the earplug group, the perceived loudness (r = -0.72; 95% CI, -1.00 to -0.43) and appreciation (r = 0.53; 95% CI, 0.29 to 0.78) of music and speech perception (r = 0.21; 95% CI, 0.09 to 0.35) were correlated with the duration of earplug use.
Conclusions and Relevance: The present study identified nonuse of earplugs, use of alcohol and drugs, and male sex as associated with a TTS at an outdoor music festival. Physicians should consider these factors to raise awareness about the combined risk of attending music festivals without using earplugs while consuming alcohol and/or drugs. The intention to use earplugs was correlated with the loudness and appreciation of music with earplugs, which may advocate for the use of personalized earplugs.
Trial Registration: trialregister.nl Identifier: NTR5401.

PMID: 29710132 [PubMed - as supplied by publisher]

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Baseline Cognition Assessment Among Patients With Oropharyngeal Cancer Using PROMIS and NIH Toolbox.

Baseline Cognition Assessment Among Patients With Oropharyngeal Cancer Using PROMIS and NIH Toolbox.

JAMA Otolaryngol Head Neck Surg. 2018 Apr 18;:

Authors: Sinha P, Wong AWK, Kallogjeri D, Piccirillo JF

Abstract
Importance: Cognitive dysfunction (CD) is recognized by the American Cancer Society as a treatment effect in head and neck cancer, but the extent of this problem at baseline in oropharyngeal cancer (OPC), the most common subsite in current practice, to our knowledge has never been studied.
Objective: To assess the baseline cognition of patients with OPC using National Institutes of Health (NIH)-sponsored instruments of Patient-Reported Outcomes Measurement Information System (PROMIS) and NIH Toolbox Cognitive Battery (NIHTB-CB).
Design, Setting, and Participants: This was a prospective cohort study conducted at a tertiary academic center. Of 83 consecutive patients, newly diagnosed as having OPC from September 2016 to May 2017, 16 were ineligible, 8 refused to participate, and 3 were lost to follow-up after screening, resulting in 56 study participants.
Main Outcomes and Measures: Self-perceived and objective cognition with PROMIS and NIHTB-CB standardized T scores, respectively, were main outcomes. Impairment was defined as (1) T scores less than 0.5 SD for PROMIS; (2) T score less than 1.5 SD in at least 1 cognitive domain or less than 1 SD in 2 or more domains for NIHTB-CB total cognition; and (3) T score per previously published criteria for NIHTB-CB intelligence-stratified cognition.
Results: Of the 56 study participants (52 men, 4 women; median age, 59 years [range, 42-77 years]), 19 (34%) had a college degree, and 20 (36%) had a professional or technical occupation. Thirty (about 53%) were never-smokers, 26 (46%) were never-drinkers, 29 (52%) were obese, 13 (23%) had a moderate to severe comorbidity, 3 (5%) used antidepressants, and 25 (52%) had hearing loss. Impaired self-reported, NIHTB-CB total, and intelligence-stratified cognition scores were observed in 6 (11%), 18 (32%), and 12 (21%), respectively. Among all variables, objective impairment was more common in men (23% vs 0%) and those with p16-negative OPC (33% vs 20%), moderate to severe comorbidity (31% vs 18%), and hearing loss (31% vs 12%).
Conclusions and Relevance: Impaired objective cognition was more common at baseline than self-reported, and was more frequent in men, participants with p16-negative OPC, moderate to severe comorbidity, and hearing loss. NIHTB-CB allowed immediate scoring of demographically adjusted cognitive function. In clinical practice, these scores can be used to identify patients with impaired cognition at baseline who may be susceptible to developing further impairment after treatment. Identification of impairment at baseline will help to institute early cognitive interventions, which may lead to an improved posttreatment quality of life.

PMID: 29710116 [PubMed - as supplied by publisher]

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Association of a Proactive Swallowing Rehabilitation Program With Feeding Tube Placement in Patients Treated for Pharyngeal Cancer.

Association of a Proactive Swallowing Rehabilitation Program With Feeding Tube Placement in Patients Treated for Pharyngeal Cancer.

JAMA Otolaryngol Head Neck Surg. 2018 Apr 19;:

Authors: Ajmani GS, Nocon CC, Brockstein BE, Campbell NP, Kelly AB, Allison J, Bhayani MK

Abstract
Importance: A proactive speech and language pathology (SLP) program is an important component of the multidisciplinary care of patients with head and neck squamous cell carcinoma (HNSCC). Swallowing rehabilitation can reduce the rate of feeding tube placement, thereby significantly improving quality of life.
Objective: To evaluate the initiation of a proactive SLP rehabilitation program at a single institution and its association with rates of feeding tube placement and dietary intake in patients with HNSCC.
Design, Setting, and Participants: Cohort study at a tertiary care and referral center for patients with HNSCC serving the northern Chicago region. Patients were treated for squamous cell carcinomas of the hypopharynx, oropharynx, and nasopharynx from 2004 to 2015 with radiation or chemoradiation therapy in the definitive or adjuvant setting. Patients who received less than 5000 cGy radiation or underwent reirradiation were excluded.
Interventions: A proactive SLP program for patients with HNSCC was initiated in 2011. Study cohorts were divided into 2 groups: 2004 through 2010 and 2011 through 2015.
Main Outcomes and Measures: Primary outcome variables were SLP referral placement and timing of the referral. Secondary outcomes were feeding tube placement and ability to tolerate any oral intake.
Results: A total of 254 patients met inclusion criteria (135 before and 119 after implementation of SLP program; median age, 60 years [range, 14-94 years]; 77% male). With the initiation of a proactive SLP program, pretreatment evaluations increased from 29 (21.5%) to 70 (58.8%; risk ratio [RR], 2.74; 95% CI, 1.92-3.91), and rate of referral overall at any time increased from 60.0% to 79.8% (RR, 1.33; 95% CI, 1.13-1.57). Feeding tube placement rates decreased from 45.9% (n = 62) to 29.4% (n = 35; RR, 0.64; 95% CI, 0.46-0.89). Among patients receiving a swallow evaluation, feeding tube requirements were less frequent for those receiving a pretreatment evaluation (31 of 99 [31%]) than for those referred during (11 of 18 [61%]) or after (38 of 59 [64%]) treatment. The rate of tolerating any oral intake at the end of treatment improved from 71.1% (n = 96) in the preimplementation period to 82.4% (n = 98; RR, 1.16; 95% CI, 1.01-1.33).
Conclusions and Relevance: A proactive SLP program can be successfully established as part of the multidisciplinary care of patients with HNSCC and improve patient quality of life.

PMID: 29710108 [PubMed - as supplied by publisher]

https://ift.tt/2I4CqQH

Gene Expression Profiling in HPV-Positive p16-Positive Oropharyngeal Squamous Cell Carcinomas: A Path to Deintensification?

Gene Expression Profiling in HPV-Positive p16-Positive Oropharyngeal Squamous Cell Carcinomas: A Path to Deintensification?

JAMA Otolaryngol Head Neck Surg. 2018 Apr 18;:

Authors: Sharma A

PMID: 29710080 [PubMed - as supplied by publisher]

https://ift.tt/2JGK8Ob

Effect of Perioperative Gabapentin Use on Postsurgical Pain in Patients Undergoing Head and Neck Mucosal Surgery: A Randomized Clinical Trial.

Effect of Perioperative Gabapentin Use on Postsurgical Pain in Patients Undergoing Head and Neck Mucosal Surgery: A Randomized Clinical Trial.

JAMA Otolaryngol Head Neck Surg. 2018 Apr 19;:

Authors: Townsend M, Liou T, Kallogjeri D, Schoer M, Scott-Wittenborn N, Lindburg M, Bottros M, Jackson RS, Nussenbaum B, Piccirillo JF

Abstract
Importance: Effective postoperative pain management increases patient satisfaction, reduces cost, reduces morbidity, and shortens hospitalizations. Previous studies investigating multimodal pain therapy in otolaryngology patients focused on homogenous patient groups with short postoperative follow-up times.
Objective: To investigate the effect of perioperative gabapentin treatment on postsurgical pain in patients undergoing head and neck mucosal surgery.
Design, Setting, and Participants: Adults undergoing head and neck mucosal surgery from July 25, 2016, through June 19, 2017, were included in this double-blinded, placebo-controlled randomized clinical trial and randomized to receive gabapentin, 300 mg twice daily, or placebo before surgery and up to 72 hours after surgery.
Main Outcomes: Primary outcome was hourly narcotic use calculated in morphine equivalents. Secondary outcomes included subjective visual analog scale pain scores captured for resting, coughing, and swallowing using a 0- to 100-mm scale (a 100-mm line anchored with no pain on the left end and worst possible pain on the right end). A change of 10 mm or more was deemed to be clinically meaningful. Additional secondary outcome measures included degree of pain control, patient satisfaction, and adverse effects.
Results: Of the 110 patients randomized to receive gabapentin or placebo, 11 and 10 withdrew from each group, respectively. Ninety patients were then analyzed: 44 in the gabapentin group (mean [SD] age, 61.1 [10.0] years; 33 [75%] male; 40 [91%] white) and 46 in the placebo group (mean [SD] age, 60.9 [11.3] years; 35 [78%] male; 43 [94%] white). Both groups had similar self-reported levels of preoperative pain and narcotic effectiveness. A median difference of 0.26 mg/h of morphine (95% CI, -0.27 to 0.94 mg/h) was found between groups. After controlling for comorbidity and self-reported baseline pain levels, mixed model analysis found the difference in marginal means of visual analog scale scores between groups to be lower in the gabapentin group compared with the placebo group for all categories (rest difference, 7.9 mm; 95% CI, -0.4 to 16.2 mm; cough difference, 8.9 mm; 95% CI, -0.5 to 18.3 mm; swallow difference, 9.4 mm; 95% CI, -1.2 to 20.0 mm). More patients in the gabapentin group reported that pain was always well controlled than in the placebo group (difference, 9.2%; 95% CI, -21% to 3%). Gabapentin and placebo groups reported similar levels of satisfaction with pain control (difference, 2%; 95% CI, -11% to 15%). There was no clinically meaningful difference in reported nausea between the 2 groups (difference, 6%; 95% CI, -14% to 26%).
Conclusion and Relevance: Perioperative gabapentin given 300 mg twice daily did not result in reduced narcotic use, but results were compatible with clinically meaningful reductions in pain scores. Satisfaction with pain control and adverse effects were similar between groups.
Trial Registration: ClinicalTrials.gov Identifier: NCT02926573.

PMID: 29710075 [PubMed - as supplied by publisher]

https://ift.tt/2rdGAvQ

Age Profile of Patients With Oropharyngeal Squamous Cell Carcinoma.

Age Profile of Patients With Oropharyngeal Squamous Cell Carcinoma.

JAMA Otolaryngol Head Neck Surg. 2018 Apr 19;:

Authors: Rettig EM, Fakhry C, Khararjian A, Westra WH

PMID: 29710071 [PubMed - as supplied by publisher]

https://ift.tt/2I7gWTb

Analysis of Age-Related Differences of Risk Factors and Comorbidities in Laryngotracheal Stenosis Patients

Abstract

Laryngotracheal stenosis (LTS) is a life threatening airway problem that is mainly caused by prolonged intubation. The authors intend to assess whether there was variability in the risk factors depending on age, and to determine which risk factors and comorbidities were more important in the development of LTS at older or younger ages. Fifty-two LTS patients were evaluated for comorbidities and risk factors retrospectively. The LTS etiologies, demographics, and medical and surgical histories of the patients were determined by the medical records. The patients under 40 years old were defined as group 1, and the patients 40 years of age or older were defined as group 2. Our study revealed that with regard to GERD, hypertension, DM2, and pulmonary infection, there was a statistically significant difference between group 1 and group 2 (p = 0.025, p = 0.0005, p = 0.002, and p = 0.000, respectively). Those patients ≥ 40 years old exhibited higher rates of GERD, hypertension, DM2, and pulmonary infection. However, there were no statistically significant differences between the groups with regard to smoking, alcohol consumption, COPD/asthma, immunological disease, and obesity (BMI > 30). There was a statistically significant difference between the groups for all the risk factors except a previous tracheotomy (p = 0.115). The risk factors and comorbidities thought to be involved in the development of LTS could show age-related variability. Therefore, in patients over 40 years of age with comorbidities (GERD, hypertension, DM2, and pulmonary infection), it is necessary to take precautions before the development of LTS. Prolonged intubation and tracheotomy history are the main risk factors for all patients, regardless of age.

https://ift.tt/2w3qtG6

Analysis of Age-Related Differences of Risk Factors and Comorbidities in Laryngotracheal Stenosis Patients

Abstract

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Efficacy of toothpastes in the prevention of erosive tooth wear in permanent and deciduous teeth

Abstract

Aim

To evaluate the erosive preventive effect of toothpastes in permanent (PT) and deciduous teeth (dt).

Design

Enamel samples were divided into five groups (n = 20): G1: placebo toothpaste; G2: NaF toothpaste; G3: AmF-NaF-SnCl₂ anti-erosion toothpaste; G4: SnF₂₋toothpaste; and G5: NaF anti-erosion toothpaste for children. The samples were exposed to five erosion-abrasion cycles (artificial saliva incubation; 3 min in 1% citric acid; 2 min in slurry, toothbrush abrasion, 50 strokes, 200 g). Surface microhardness (SMH), surface specular reflection intensity (SRI), and cumulative surface loss (CSL) were measured. Comparisons among toothpastes were evaluated using Kruskal-Wallis tests and comparisons between PT and dt were evaluated using Wilcoxon's rank sum test.

Results

G1 exhibited significantly lower SMH values in PT than the other toothpastes (p < 0.05), with no significant differences among the others groups. In dt, G1 and G4 exhibited significantly different values than the other groups (p < 0.05). G4 exhibited lower values of SRI in both types of teeth. Deciduous teeth presented significantly higher SRI than PT (p < 0.05), except for G3. Deciduous teeth generally presented higher CSL than PT, except for G3.

Conclusions

Deciduous teeth were more prone to mineral loss than permanent teeth. G5 exhibited better efficacy for both teeth, while G3 exhibited a better preventive effect only for deciduous teeth.

Clinical relevance

Erosive tooth wear prevalence in children is growing and deciduous teeth are more susceptible than permanent teeth. Considering this, it is important to know the preventive effect of different toothpastes in an initial erosion-abrasion model.

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Authors' response

We read the correspondence by Andersen et al1 with great interest. They made a number of important comments on our study of skin pain in atopic dermatitis (AD)2 that we would like to address. Severe pain and itch were found to exist concomitantly in a significant proportion of patients with AD. To clarify this point, we re-evaluated the data and found that most patients had some itch in the past 24 hours (98.4%). Interestingly, there were numerically lower rates of skin pain in those with vs without itch in the past 24 hours (46.2% vs 75.0%).

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Editorial Board

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Looking into the seeds of time

Peanut allergy affects 1.4% to 4.5% of children and fewer than 25% are anticipated to outgrow peanut allergy naturally, with many sufferers having severe reactions.1–3 Although no approved therapy is currently available, 2 products are in phase III trials, and multiple centers and offices already engage in off-label clinical oral immunotherapy (OIT) programs.4 Such for-profit programs boast good success but, because of their "unregulated" status, data are sparse (or possibly not even collected), making it difficult to compare such programs with formally regulated and Good Clinical Practices–compliant clinical trials for OIT, despite it already being evident that more patients have undergone "off-label" OIT than have completed formal clinical trials.

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Information for Readers

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Information for Authors

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Pain inhibits itch, but not in atopic dermatitis?

We read with great interest the article by Vakharia et al1 in a recent issue of the Annals. The prospective study comprehensively addresses an overlooked aspect of the sensory symptoms associated with atopic dermatitis (AD). In 305 patients with AD, the study reported that pain was found in 42.7% and that 30.2% rated the cutaneous pain intensity as being moderate to very severe. This pain incidence is aligned with a previous study on the AD itch characteristics.2 Vakharia et al1 consistently found cutaneous pain to be associated with reduced quality of life (including: Patient-Oriented Eczema Measure, ItchyQOL, and Dermatology Life Quality Index) and to a lesser extent with objective disease severity.

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For those individuals interested in basic and translational immunology, then the book Immunology edited...

For those individuals interested in basic and translational immunology, then the book Immunology edited by M.A. Hayat is one to obtain for your library. This book touches on many aspects of immunology that most allergists and clinical immunologists do not readily encounter in the care of their patients. This volume is to be the first of many to be published that discuss different aspects of immunology. Volume 1 focuses on better understanding immune responses pertaining to infection and cancer immunology, which together account for the sixth leading cause of death in the United States and cost our health care system billions of dollars annually to treat.

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School exposure and asthma

To provide a comprehensive overview of common school exposures and the association between school exposures and pediatric asthma morbidity.

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Αρχειοθήκη ιστολογίου

Τετάρτη 2 Μαΐου 2018

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