Head and Neck Medicine by Alexandros G.Sfakianakis: 05/06/18

Κυριακή 6 Μαΐου 2018

The relationship between masticatory ability, age, and dental and prosthodontic status in an institutionalized elderly dentate population in Qingdao, China

Abstract

Objectives

To identify relationships between masticatory ability and age, and dental and prosthodontic status amongst an institutionalized elderly dentate population in China.

Materials and methods

A sample of 512 elders living in eight nursing homes in Qingdao was categorized based on a hierarchical dental functional classification system with and without tooth replacements. Masticatory disability scores (MDSs) were analyzed using multiple regression models with only age, and age and dentition variables for participants having ≥ 10 natural and those having < 10 natural teeth in each jaw.

Results

Overall, associations between MDS and age, number of teeth, and number of teeth replaced by dental prostheses were identified. For participants having ≥ 10 natural teeth in each jaw, no significant associations between MDS and age and dental and prosthodontic status were found. Participants having < 10 natural teeth in each jaw had higher MDS (increasing chewing difficulties) at higher ages. However, when "premolar region sufficient" and "molar region sufficient" were included, MDS was not associated with age, but with these dentition variables. For participants having ≥ 10 teeth including prosthodontically replaced teeth in each jaw, age was the only variable associated with MDS. For participants having < 10 teeth including teeth replaced in each jaw, the significant factor was "premolar region sufficient." Overall, lower MDS was associated with increasing number of teeth, as well as with increasing number of teeth replaced by dental prostheses.

Conclusions

In this population of institutionalized dentate elderly, masticatory ability was significantly associated with dental and prosthodontic status.

Clinical relevance

For institutionalized elderly, having less than ten natural teeth in each jaw is associated with chewing problems. Most important dentition factor is the presence of three to four premolar pairs. Teeth added by partial removable dental prostheses compensate impaired masticatory ability due to tooth loss for 50% compared to natural teeth.

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Treatment outcome and prognostic factors of tonsillectomy for palmoplantar pustulosis and pustulotic arthro‐osteitis: A retrospective subjective and objective quantitative analysis of 138 patients

The Journal of Dermatology, EarlyView.

https://ift.tt/2HX0wOc

β-catenin ( CTNNB1 ) mutation and LEF1 expression in sinonasal glomangiopericytoma (sinonasal-type hemangiopericytoma)

Abstract

Sinonasal glomangiopericytoma (SN-GPC) is an uncommon mesenchymal tumor with myoid differentiation. Recently, mutations in exon 3 of the gene coding for β-catenin (CTNNB1) and its nuclear expression were discovered in SN-GPC. β-catenin protein is a key regulatory molecule of the canonical Wnt signaling pathway. The expression of β-catenin target proteins is not well characterized in SN-GPC. We examined three SN-GPCs by immunohistochemistry and CTNNB1 mutation analysis. All cases expressed nuclear β-catenin. We identified CTNNB1 exon 3 mutations in two analyzable cases. Lymphoid enhancer-binding factor 1 (LEF1), a protein downstream from β-catenin, was also expressed in all cases. Our results further characterized the activation of the Wnt signaling pathway caused by CTNNB1 exon 3 mutation and suggest the utility of LEF1 immunohistochemistry in the differential diagnosis of SN-GPC.

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Notalgia paresthetica: cryolipolysis as a novel potential treatment

International Journal of Dermatology, EarlyView.

https://ift.tt/2jzhFyM

Violence targeting children or violent society? Craniofacial injuries among the pre‐Hispanic subadult population of Gran Canaria (Canary Islands)

International Journal of Osteoarchaeology, EarlyView.

https://ift.tt/2wjdRej

Acquired idiopathic generalised anhidrosis: A rare cause of sweating deficiency

Australasian Journal of Dermatology, EarlyView.

https://ift.tt/2wj4Mlt

Ten-year follow-up after combined coronary artery bypass grafting and transmyocardial laser revascularization in patients with disseminated coronary atherosclerosis

Abstract

Coronary artery disease involving heavily calcified lesions has been associated with worse short- and long-term outcomes including increased mortality. This paper aims to evaluate long-term survival benefit when CABG + transmyocardial laser revascularization (TMLR) are performed on the hearts of patients with disseminated coronary atherosclerosis (DCA). This novel retrospective study was conducted between 1997 and 2002 and followed 86 patients with ischemic heart disease and severe DCA who underwent TMLR using a Holmium:YAG laser and/or CABG. There were 46 patients who had CABG plus TMLR on at least one heart wall ("combined therapy group") and 40 patients who had CABG or TMLR separately on at least one heart wall ("single therapy group"). For the whole group, actuarial survival at 10 years was 78.3% in the combined group compared to 72.5% in the single therapy group (p = 0.535). Ten-year survival in the combined vs. single therapy group for the anterior heart walls was 100 vs. 72.2% (p = 0.027). For the lateral and posterior heart walls were 73.7 vs. 73.3% (p = 0.97) and 84.2 vs. 72% (p = 0.27), respectively. Kaplan-Meier survival analysis showed benefit only for the anterior heart wall (F Cox test, p = 0.103). Single therapy procedures on all heart walls (odds ratio 1.736, p = 0.264) or on the anterior heart wall only (odds ratio 3.286, p = 0.279) were found to be predictors of 10-year late mortality. Combined therapy (TMLR + CABG) provides benefit for perioperative mortality and long-term survival only when provided on the anterior heart wall. For patients with disseminated coronary atherosclerosis, cardiac mortality was found to be increased when followed up 6 years later, regardless of the therapy applied.

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A split-face study: comparison of picosecond alexandrite laser and Q-switched Nd:YAG laser in the treatment of melasma in Asians

Abstract

To evaluate efficacy and safety of picosecond 755 nm alexandrite laser as compared to 1064 nm QS-Nd:YAG laser for melasma treatment in Asians. Twelve patients received 4 sessions of treatments at 1-month interval in a split-face manner. The right side of each patient's face received 755 nm picosecond laser, and the other side received 1064 nm QS-Nd:YAG laser. Zoom handpiece of 755 nm picosecond laser at fluence of 0.88–1.18 J/cm² was applied. The treatment protocol used for 1064 nm QS-Nd:YAG laser was 8 mm spot size at fluence of 2.0 J/cm² initially followed by 6 mm spot size at fluence of 3.5 J/cm², and finishing with 4 mm spot size at 3.2 J/cm². For both 755 nm picosecond laser and 1064 nm QS-Nd:YAG laser, the endpoint was mild erythema and swelling without petechiae. Objective evaluation with visual analogue score was conducted by two independent physicians. Subject self-assessment for each patient was conducted as well. Statistical results showed that higher pigmentation clearance rate was achieved at the 755 nm picosecond laser side after the second treatment. At the 3 months follow-up, greater clearance was observed at the 755 nm picosecond laser side compared to the 1064 nm QS-Nd:YAG side. 755 nm alexandrite picosecond laser has been observed to achieve a faster and better clearance rate for melasma compared to 1064 nm QS-Nd:YAG laser. We conclude that the 755 nm picosecond laser could be a safe and effective modality for melasma treatment in Asians.

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Lipids hide or step aside for CD1-autoreactive T cell receptors

Rachel N Cotton | Adam Shahine | Jamie Rossjohn | D Branch Moody

https://ift.tt/2HZOTSw

Complete response to orally administered melphalan in malignant pleural effusion from an occult female genital organ primary neoplasm with BRCA1/2 mutations: a case report

Definite diagnosis of metastasis from unknown primary depends on a comprehensive immunohistochemical investigation of tumor specimen. Accurate identification of the origin site usually helps a lot in choosing ...

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The Denominator in Value-Based Health Care: Porter’s Hidden Costs

No abstract available

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In Response

No abstract available

https://ift.tt/2HSElIM

Brown’s Atlas of Regional Anesthesia, 5th ed

No abstract available

https://ift.tt/2roRyOC

Incidence and Risk Factors for Perioperative Cardiovascular and Respiratory Adverse Events in Pediatric Patients With Congenital Heart Disease Undergoing Noncardiac Procedures

BACKGROUND: While mortality and adverse perioperative events after noncardiac surgery in children with a broad range of congenital cardiac lesions have been investigated using large multiinstitutional databases, to date single-center studies addressing adverse outcomes in children with congenital heart disease (CHD) undergoing noncardiac surgery have only included small numbers of patients with significant heart disease. The primary objective of this study was to determine the incidences of perioperative cardiovascular and respiratory events in a large cohort of patients from a single institution with a broad range of congenital cardiac lesions undergoing noncardiac procedures and to determine risk factors for these events. METHODS: We identified 3010 CHD patients presenting for noncardiac procedures in our institution over a 5-year period. We collected demographic information, including procedure performed, cardiac diagnosis, ventricular function as assessed by echocardiogram within 6 months of the procedure, and classification of CHD into 3 groups (minor, major, or severe CHD) based on residual lesion burden and cardiovascular functional status. Characteristics related to conduct of anesthesia care were also collected. The primary outcome variables for our analysis were the incidences of intraoperative cardiovascular and respiratory events. Univariable and multivariable logistic regressions were used to determine risk factors for these 2 outcomes. RESULTS: The incidence of cardiovascular events was 11.5% and of respiratory events was 4.7%. Univariate analysis and multivariable analysis demonstrated that American Society of Anesthesiologists (≥3), emergency cases, major and severe CHD, single-ventricle physiology, ventricular dysfunction, orthopedic surgery, general surgery, neurosurgery, and pulmonary procedures were associated with perioperative cardiovascular events. Respiratory events were associated with American Society of Anesthesiologists (≥4) and otolaryngology, gastrointestinal, general surgery, and maxillofacial procedures. CONCLUSIONS: Intraoperative cardiovascular events and respiratory events in patients with CHD were relatively common. While cardiovascular events were highly associated with cardiovascular status, respiratory events were not associated with cardiovascular status. Accepted for publication March 5, 2018. Funding: None. J. A. DiNardo and K. Yuki contributed equally and share senior authorship. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Koichi Yuki, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Cardiac Anesthesia Division, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115. Address e-mail to koichi.yuki@childrens.harvard.edu. © 2018 International Anesthesia Research Society

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Pediatrics and Beyond

No abstract available

https://ift.tt/2HSE5JO

In Response

No abstract available

https://ift.tt/2rqiTzO

World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia

The International Standards for a Safe Practice of Anesthesia were developed on behalf of the World Federation of Societies of Anaesthesiologists (WFSA), a nonprofit organization representing anesthesiologists in 150 countries, and the World Health Organization (WHO). The recommendations have been approved by WHO and the membership of WFSA. These Standards are applicable to all anesthesia providers throughout the world. They are intended to provide guidance and assistance to anesthesia providers, their professional organizations, hospital and facility administrators, and governments for maintaining and improving the quality and safety of anesthesia care. The Standards cover professional aspects; facilities and equipment; medications and intravenous fluids; monitoring; and the conduct of anesthesia. HIGHLY RECOMMENDED standards, the functional equivalent of mandatory standards, include (amongst other things): the continuous presence of a trained and vigilant anesthesia provider; continuous monitoring of tissue oxygenation and perfusion by clinical observation and a pulse oximeter; intermittent monitoring of blood pressure; confirmation of correct placement of an endotracheal tube (if used) by auscultation and carbon dioxide detection; the use of the WHO Safe Surgery Checklist; and a system for transfer of care at the end of an anesthetic. The International Standards represent minimum standards and the goal should always be to practice to the highest possible standards, preferably exceeding the standards outlined in this document. Accepted for publication March 22, 2018. WHO ePub clearance: WHO ePub-IP-00090890-EC. This article is jointly published in the Canadian Journal of Anesthesia and Anesthesia & Analgesia. Address correspondence to Adrian W. Gelb, Department of Anesthesia & Perioperative Care, University of California San Francisco, 500 Parnassus Ave, MUE 404, San Francisco, CA 94143. Address e-mail to adrian.gelb@ucsf.edu. © 2018 International Anesthesia Research Society

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Improved lung recruitment and oxygenation during mandatory ventilation with a new expiratory ventilation assistance device: A controlled interventional trial in healthy pigs

BACKGROUND In contrast to conventional mandatory ventilation, a new ventilation mode, expiratory ventilation assistance (EVA), linearises the expiratory tracheal pressure decline. OBJECTIVE We hypothesised that due to a recruiting effect, linearised expiration oxygenates better than volume controlled ventilation (VCV). We compared the EVA with VCV mode with regard to gas exchange, ventilation volumes and pressures and lung aeration in a model of peri-operative mandatory ventilation in healthy pigs. DESIGN Controlled interventional trial. SETTING Animal operating facility at a university medical centre. ANIMALS A total of 16 German Landrace hybrid pigs. INTERVENTION The lungs of anaesthetised pigs were ventilated with the EVA mode (n=9) or VCV (control, n=7) for 5 h with positive end-expiratory pressure of 5 cmH2O and tidal volume of 8 ml kg−1. The respiratory rate was adjusted for a target end-tidal CO2 of 4.7 to 6 kPa. MAIN OUTCOME MEASURES Tracheal pressure, minute volume and arterial blood gases were recorded repeatedly. Computed thoracic tomography was performed to quantify the percentages of normally and poorly aerated lung tissue. RESULTS Two animals in the EVA group were excluded due to unstable ventilation (n=1) or unstable FiO2 delivery (n=1). Mean tracheal pressure and PaO2 were higher in the EVA group compared with control (mean tracheal pressure: 11.6 ± 0.4 versus 9.0 ± 0.3 cmH2O, P 0.99). Minute volume was lower in the EVA group compared with control (5.5 ± 0.2 versus 7.0 ± 1.0 l min−1, P = 0.02) with normoventilation in both groups (PaCO2 5.4 ± 0.3 versus 5.5 ± 0.3 kPa, P > 0.99). In the EVA group, the percentage of normally aerated lung tissue was higher (81.0 ± 3.6 versus 75.8 ± 3.0%, P = 0.017) and of poorly aerated lung tissue lower (9.5 ± 3.3 versus 15.7 ± 3.5%, P = 0.002) compared with control. CONCLUSION EVA ventilation improves lung aeration via elevated mean tracheal pressure and consequently improves arterial oxygenation at unaltered positive end-expiratory pressure (PEEP) and peak inspiratory pressure (PIP). These findings suggest the EVA mode is a new approach for protective lung ventilation. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. https://ift.tt/OBJ4xP Correspondence to Johannes Schmidt, MD, Department of Anesthesiology and Critical Care, Medical Centre – University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany Tel: +49 761 270 26390; fax: +49 761 270 23280; e-mail: johannes.schmidt@uniklinik-freiburg.de Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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General Anesthetic Use in Fragile X Spectrum Disorders

The fragile X premutation is characterized by a repeat expansion mutation (between 55 to 200 CGG repeats) in the fragile X mental retardation 1 (FMR1) gene, which leads to RNA toxicity at the cellular level. This may cause patients with the premutation to be particularly susceptible to environmental toxins, which could manifest clinically as new or worsening ataxia and memory loss. Multiple published case reports have also suggested general anesthetics as a potential toxin leading to negative side effects when used in patients with fragile X- associated disorders. However, at this time, there have been no formal research studies regarding cellular changes or long-term clinical manifestations after general anesthetic use in this population. This review aims to highlight previous case reports regarding sequelae related to general anesthetic use in fragile X-associated disorders. New case reports related to this phenomenon are also included. Supported through NICHD grant HD036071, the MIND Institute Intellectual and Developmental Disabilities Research Center (grant U54 HD079125) and the National Center for Advancing Translational Sciences and National Institutes of Health (grant UL1 TR001860). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. R.H. has received support from Novartis, Alcobra, Neuren, and Marinus for studies in fragile X syndrome. She has also consulted with Zynerba, Fulcrum, and Ovid regarding studies in fragile X syndrome. The remaining authors have no conflicts of interest to disclose. Address correspondence to: Randi Hagerman, MD, MIND Institute, UCDMC, 2825 50th Street, Sacramento, CA 95817 (e-mail: rjhagerman@ucdavis.edu). Received August 23, 2017 Accepted April 10, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Safety of Sodium Bicarbonate for Control of ICP (Letter)

No abstract available

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Minimally invasive approach to suppurated cervical lymphadenitis in children: Our experience on 60 patients

Clinical Otolaryngology, EarlyView.

https://ift.tt/2rq7hwI

Transcanal Approach for Type 2 Tympanoplasty with Incus Interposition Ossiculoplasty: Our Experience on 134 Patients

Clinical Otolaryngology, EarlyView.

https://ift.tt/2KGd2PY

Experimental butchery study investigating the influence of timing of access and butcher expertise on cut mark variables

International Journal of Osteoarchaeology, EarlyView.

https://ift.tt/2FOoBAK

Dyke–Davidoff–Masson syndrome in the Late Bronze and Early Iron Ages Armenia—a cause of trepanation?

International Journal of Osteoarchaeology, EarlyView.

https://ift.tt/2KAVFzL

Early salivary changes in multiple myeloma patients undergoing autologous HSCT

Oral Diseases, EarlyView.

https://ift.tt/2jz2Nk8

A case of generalized acquired cutis laxa

International Journal of Dermatology, EarlyView.

https://ift.tt/2FPnHUy

Stress and psoriasis

International Journal of Dermatology, EarlyView.

https://ift.tt/2KCokEG

Paraneoplastic arthritis in a patient with Sézary syndrome

International Journal of Dermatology, EarlyView.

https://ift.tt/2FNWuBQ

Is tonsillectomy mandatory for asymmetric tonsils in children? A review of our diagnostic tonsillectomy practice and the literature

Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Gareth Huw Jones, Girvan Burnside, Joanna McPartland, Anne Markey, Michael Fallon, Sujata De
IntroductionDiagnostic tonsillectomy is performed to exclude malignancy. It is associated with a post-operative hemorrhage rate of 3.5%, (1) which is more dangerous in small children. No previous case series for asymmetrical tonsils have detected tonsil lymphoma.(2–6) We aimed to review our local diagnostic tonsillectomy practice.MethodThe authors reviewed the clinical notes and histological results for all diagnostic tonsillectomies carried out from June 2013 to June 2016.ResultsWe recorded data for 168 patients. There were four post-operative bleeds and one return to theatre. Bilateral tonsillectomies accounted for 152 operations (90.5%). Lymphoid hyperplasia accounted for 95% of histological diagnosis with no malignancies found. Pre-operative tonsil grading demonstrated no statistically significant association with histological tonsil weight difference (ANOVA p = 0.10). Actinomyces colonisation had little affect on tonsil weight difference when we compared patients with bilateral colonisation and no colonisation (t-test p = 0.540) and between tonsils in patients with unilateral tonsil Actinomyces colonisation (paired t-test p = 0.448). Recurrent tonsillitis was more prevalent in patients with Actinomyces colonisation than OSA/sleep disordered breathing (39% vs 15%).ConclusionA literature search yielded five smaller case series of palatine tonsil asymmetry in children with no malignancy found.(2–6) Case-control studies report tonsillar asymmetry as the most common presenting symptom (73%) in tonsillar lymphoma.(7) This enlargement usually occurs rapidly within 6 weeks with new obstructive or systemic B-type symptoms.(3) A Turkish epidemiological study found asymmetrical tonsils in 1.7% of the healthy paediatric population.(8) We therefore estimate there to be over 210,000 children with asymmetrical tonsils in the UK. With an unreliable grading system, we believe asymmetrical tonsils in isolation, unchanged for over 6 weeks may not warrant tonsillectomy.

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