Πέμπτη 10 Μαΐου 2018
The multidisciplinary tumor board for the management of cutaneous neoplasms: A national survey of academic medical centers
To the Editor: The multidisciplinary tumor board (MTB) is a meeting of various medical specialties to discuss the management of patients with cancer. In lung, esophageal, and head and neck cancers, tumor boards increase adherence to national treatment guidelines, decrease treatment delays, are educational, and instill the importance of multidisciplinary care early in training.1-4 However, little is known about the MTB for cutaneous neoplasms. This study assesses the structure, goals, and participation patterns of the MTB in a nationwide sample of academic dermatology centers.
https://ift.tt/2KV6dKm
Should medical students follow up on skin biopsy results? When education conflicts with patient privacy
With the increased availability of EHR across clinical medicine, medical trainees are increasingly using this technology as a learning tool. Although medical students are standardly given access to patient records to carry out clinical duties, one study found that 96% of students use EHRs to follow-up on outcomes after patients have left the student's direct care.1 Of these students, 93% found the practice to be educationally beneficial.1 However, what implications does this have for a patient's right to privacy, which reflects the ethical principle of respect for patient autonomy? Autonomy represents self-governance or self-rule whereby a person is free from the control or undue influence of others.
https://ift.tt/2ryKpvM
Author index∗∗January, pp. 1-236; February, pp. 237-432 and S1-S24; March, pp. 433-644 and S25-S84; April, pp. 645-838; May, pp. 839-1034; June, pp. 1035-1294.
Abanmi A (see Thiboutot et al). 2018;78:S1-23 (Supplement article)
https://ift.tt/2wA043a
In the blink of an eye
It seems like just the other day that I stood before the AAD Board of Directors to discuss my vision for the Journal of the American Academy of Dermatology (JAAD). That "other day" was actually in July 2007, and the presentation was to support my candidacy for Editor of the Journal. I simply cannot believe how quickly time has passed. As the old saying goes, "Time flies when you're having fun."
https://ift.tt/2rAtIAh
Langerhans cell histiocytosis in children
Langerhans cell histiocytosis (LCH) is an inflammatory neoplasia of myeloid precursor cells driven by mutations in the mitogen-activated protein kinase pathway. When disease involves the skin, LCH most commonly presents as a seborrheic dermatitis or eczematous eruption on the scalp and trunk. Evaluation for involvement of other organ systems is essential, because 9 of 10 patients presenting with cutaneous disease also have multisystem involvement. Clinical manifestations range from isolated disease with spontaneous resolution to life-threatening multisystem disease.
https://ift.tt/2Kb5IKP
Instagram and the dermatologist: An ethical analysis
Instagram, one of the most popular social media platforms, is a mobile media sharing app that allows users to share their content with a large, diverse audience. Among the 1 million advertisers1 on Instagram are business savvy physicians who are engaging with potential patients and customers on this platform. The growing application of Instagram as a tool to connect with an audience and build a personal brand presents unique ethical dilemmas to physician users of this platform. Dr M's moral obligations as a physician may conflict with the perceived need to adapt to the changing landscape of marketing in medicine.
https://ift.tt/2ryRNra
Generalized urticaria caused by ingestion of sweet potato cake
Publication date: Available online 10 May 2018
Source:Allergology International
Author(s): David El-Qutob, Fernando Pineda, Isabela Raducan, Miriam Castillo
https://ift.tt/2jPADkU
Acquisition of tolerance to egg allergy in a child with repeated egg-induced acute pancreatitis
Publication date: Available online 10 May 2018
Source:Allergology International
Author(s): Ken-ichi Nagakura, Noriyuki Yanagida, Sakura Sato, Kiyotake Ogura, Motohiro Ebisawa
https://ift.tt/2jN6DWM
Implication of fraction of exhaled nitric oxide and blood eosinophil count in severe asthma
Publication date: Available online 10 May 2018
Source:Allergology International
Author(s): Tomoyuki Soma, Hidetoshi Iemura, Erika Naito, Sachiko Miyauchi, Yoshitaka Uchida, Kazuyuki Nakagome, Makoto Nagata
BackgroundSevere asthma is a complex disease with heterogeneous features and involves type 2 airway inflammation, including eosinophil accumulation. Surrogate biomarkers, fraction of exhaled nitric oxide (FeNO) and blood eosinophil count (b-EOS), may predict eosinophilic airway inflammation. Here we investigated clinical characteristics of severe asthma phenotype using a combined analysis of FeNO and b-EOS.MethodsThis retrospective study examined clinical data of patients with severe asthma (N = 107; median age, 64 years) treated at Saitama Medical University Hospital from 2009 to 2016. Thresholds of FeNO and b-EOS for sputum eosinophil ratio ≥2% were determined using receiver operating characteristic curve (ROC) analysis. Clinical characteristics were analyzed after classifying patients into four subgroups according to these thresholds.ResultsOf 39 induced sputum samples examined, ROC area under the curve for predicting sputum eosinophilia was 82.0% (p = 0.001) for b-EOS and 77.0% (p = 0.006) for FeNO at optimal cut-off values of ≥300/μL and ≥25 ppb, respectively. The number of sensitized allergens was higher in the high FeNO/low b-EOS and high FeNO/high b-EOS subgroups (p < 0.05). The prevalence of chronic sinusitis was higher in the low FeNO/high b-EOS and high FeNO/high b-EOS subgroups (p = 0.04). The high FeNO/high b-EOS subgroup included the largest proportion (approximately 40%) of patients experiencing frequent severe exacerbations. Both low FeNO/low b-EOS and high FeNO/low b-EOS subgroups showed less severe exacerbations.ConclusionsCombined evaluation of FeNO and b-EOS can identify patients with frequent exacerbations and stratify the appropriate therapy for type 2 inflammation-predominant severe asthma.
https://ift.tt/2IeUQuS
World Thyroid Day Recognized Globally on May 25th
World Thyroid Day Recognized Globally
American Thyroid Association® collaborates with International Thyroid Societies
May 25, 2018
On May 25th the American Thyroid Association® (ATA) (www.thyroid.org), in cooperation with the European Thyroid Association (www.eurothyroid.com), will be making an extraordinary effort to promote its year-round goals —focus attention on that small butterfly-shaped gland at the base of the neck that causes approximately 20 million Americans to experience thyroid disease. In addition to the millions who have some form of thyroid disease, it is estimated that more than 12 percent of the U.S. population will develop a thyroid condition during their lifetime.
The important goal of the ATA® and our sister thyroid organizations is to get the word out about Thyroid! Perhaps the most stunning statistics are that up to 60 percent of those with thyroid disease are unaware of their condition and that women are five to eight times more likely than men to have thyroid problems. Almost everyone knows someone affected by thyroid disease or thyroid cancer and the ATA is proud to promote international awareness on World Thyroid Day so that symptoms, diagnosis, and treatment of conditions are available around the globe. If you or someone you know are experiencing thyroid symptoms, make an appointment to see a thyroid specialist – you can find one in your area (in the US and internationally) by using the ATA Physician Referral Tool and you can read up on the thyroid educational materials in the ATA Thyroid Information Library.
The ATA® is the leading organization devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health. Our mission assures that we communicate the importance of the thyroid gland, which produces hormones that influence every cell, tissue, and organ in the body. Thyroid hormones regulate the body's metabolism—the rate at which the body produces energy from nutrients and oxygen—and affects critical body functions, such as energy level and heart rate. Through its mission, the ATA® supports the clinicians and researchers who are at the frontlines of thyroid treatments and research. We also work with the public, patients, and their families to educate and increase awareness of thyroid diseases.
ATA® member of 30 years, Dr. Gregory Brent – Chair, Department of Medicine from the University of California-Los Angeles says that, "The ATA has been my professional home since my fellowship and it has been a privilege to serve with my many valued colleagues and with such a committed and talented staff. I am most grateful to my mentors, who have encouraged and guided me. The professional and personal growths I have experienced from my involvement with the ATA are immeasurable."
The ATA Patient Thyroid Information library is just a few clicks away on the ATA® website – http://www.thyroid.org/thyroid-information/ and we encourage you to check back regularly for updates and new materials. We are also pleased to offer many of our brochures in Spanish – http://www.thyroid.org/informacion-sobre-la-tiroides/ and provide a translator on the website for most languages. The ATA website provides easy-to-access, patient-friendly information on topics such as:
Hypothyroidism: One of the most common thyroid conditions that occurs when the thyroid gland does not produce enough thyroid hormone. Symptoms include fatigue, depression, forgetfulness, irregular menses and weight gain. Treatment of hypothyroidism is usually with a synthetic form of thyroid hormone called "levothyroxine." Hashimoto's Thyroiditis is an autoimmune disease affecting the thyroid is the most common cause of hypothyroidism in the US, affecting mostly women. Diagnosis is usually confirmed by symptoms suggesting thyroid underactivity, positive anti-thyroid antibodies, and small goiter (thyroid enlargement) on physical examination. Patients with an elevated blood level of TSH and/or goiter are treated with thyroxine (T4).
On the opposite side of the spectrum is Hyperthyroidism and this occurs when the thyroid gland produces too much thyroid hormone. Symptoms include irritability, nervousness, muscle weakness, unexplained weight loss, sleep disturbances, vision problems and eye irritation. One type of hyperthyroidism, Graves' disease, is an autoimmune disorder that is partly genetic.
In addition to these common thyroid conditions, we also know that Thyroid Cancer is the most rapidly increasing form of cancer in the United States. The American Cancer Society estimates 53,990 new cases of thyroid cancer will be diagnosed in 2018 resulting in over 2,000 deaths. When thyroid cancer is identified and treated early, the majority of patients can be completely cured.
Mary Catherine Petermann whose father was diagnosed with Anaplastic Thyroid Cancer in 2006 describes how the ATA impacted her search for help, "The ATA was a valuable resource for our family when my dad was diagnosed with Anaplastic Thyroid Cancer. When you are faced with a detrimental diagnosis where even a few days can make the difference in life or death, understanding your options quickly is critical. The ATA website offers a one-stop shop for patients and caregivers to find specialists, current clinical trials, general thyroid cancer information, and links to other patient support groups and information" Mary Catherine's father was treated by ATA member physicians at Mayo Clinic and has clean scans as of October 2016.
For thyroid cancer, Endocrinologists can sometimes employ minimally invasive procedures to distinguish thyroid cancer from benign thyroid nodules, which are common in the population. The ATA produces management guidelines for thyroid diseases and thyroid cancer, which, are open to the public and can accessed on the ATA website here: https://www.thyroid.org/professionals/ata-professional-guidelines/
We invite and encourage you to take a moment on the 25th of May, World Thyroid Day, to help ATA® continue to serve patients, families, and the physicians to treat them by making a donation on the ATA® World Thyroid Day Donation Page: https://www.crowdrise.com/world-thyroid-day
Your donation will help ATA continue the important work of education, research, and awareness on this most important disease. No donation is too small and if you would like to make a recurring donation throughout the year, please visit this page: https://www.givedirect.org/donate/?cid=723 and select frequency that is good for you.
Your interest and support help make a positive impact on the lives of so many who struggle with thyroid conditions and thyroid cancer every day and we thank you for joining us and helping carry-out the ATA® mission!
###
The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis and treatment of thyroid disorders and thyroid cancer. ATA is an international individual membership organization for over 1,700 clinicians and researchers from 43 countries around the world, representing a broad diversity of medical disciplines. It also serves the public, patients and their family through education and awareness efforts
Celebrating its 95th anniversary, ATA delivers its mission through several key endeavors: the publication of highly regarded monthly journals, THYROID, Clinical Thyroidology, VideoEndocrinology and Clinical Thyroidology for the Public; annual scientific meetings; biennial clinical and research symposia; research grant programs for young investigators, support of online professional, public and patient educational programs; and the development of guidelines for clinical management of thyroid disease.
More information about ATA is found at www.thyroid.org.
The post <i>World Thyroid Day </i>Recognized Globally on May 25th appeared first on American Thyroid Association.
https://ift.tt/2G5iIzp
Nemolizumab in moderate-to-severe atopic dermatitis: Randomized, phase II, long-term extension study
Publication date: Available online 10 May 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Kenji Kabashima, Masutaka Furue, Jon M. Hanifin, Grazyna Pulka, Andreas Wollenberg, Ryszard Galus, Takafumi Etoh, Ryosuke Mihara, Miwa Nakano, Thomas Ruzicka
BackgroundNemolizumab, an anti–interleukin-31 receptor A monoclonal antibody, improved pruritus, dermatitis, and sleep in adults with moderate-to-severe atopic dermatitis inadequately controlled by topical treatments in a phase II, 12-week, randomized, double-blind, placebo-controlled study (Part A) (NCT01986933).ObjectiveTo assess long-term efficacy and safety of nemolizumab injected subcutaneously every 4 weeks (Q4W) or every 8 weeks (Q8W) in a 52-week double-blind extension (Part B).MethodsDuring Part B, patients continued previous nemolizumab dose (0.1, 0.5, or 2.0 mg/kg Q4W or 2.0 mg/kg Q8W). Part B endpoints included percentage improvement from baseline in pruritus visual analogue scale (VAS) and dermatitis scores (including Eczema Area and Severity Index [EASI]).ResultsOverall, 216/264 patients completed Part A and 191 entered Part B; 131 completed Part B. In 153 patients randomized to nemolizumab in Part A, improvement from baseline in pruritus VAS was maintained/increased from Week 12 to 64, with greatest improvement in the 0.5-mg/kg Q4W group (percentage change from baseline at Week 64: −73.0, −89.6, −74.7, and −79.1 in the 0.1-, 0.5-, and 2.0-mg/kg Q4W and 2.0-mg/kg Q8W groups, respectively). Improvement from baseline in dermatitis scores was also maintained/increased to Week 64 (percent change in EASI score: −68.5, −75.8, −78.9, and −69.3 in the 0.1-, 0.5-, and 2.0-mg/kg Q4W and 2.0-mg/kg Q8W groups, respectively). Over 64 weeks, 83–89% had ≥1 adverse event, with no new safety concerns identified.ConclusionNemolizumab for up to 64 weeks was efficacious and, overall, well tolerated in patients with moderate-to-severe atopic dermatitis inadequately controlled by topical therapy.
https://ift.tt/2KSw0Tf
Retrospective analysis of postoperative interventions in mandibular fractures: a shift towards outpatient day surgery care
The management of fractured mandibles typically involves admission and operation at the time of presentation. While this should involve only a short stay in hospital these patients are surgically stable, and so priority is often given to more urgent cases. We retrospectively evaluated the postoperative medical requirements of patients who were operated on at Fiona Stanley Hospital, Perth, Western Australia between 1 January 2015 and 31 December 2016. Patients were excluded if they had had multiple facial fractures, multiple injuries, had fractures that were comminuted or in edentulous mandibles, and those who had been in hospital for preoperative medical investigations and care.
https://ift.tt/2wx9ZpZ
Comparative evaluation of various low-level laser therapies on bone healing following tooth extraction: An experimental animal study
The aim of this study was to evaluate the effects of helium-neon and gallium-aluminum-arsenide lasers with various doses on bone healing following tooth extraction.
https://ift.tt/2wtGSnJ
Accuracy of CAD/CAM mandibular reconstruction: A three-dimensional, fully virtual outcome evaluation method
Computer-aided design/computer-aided manufacturing (CAD/CAM) methods for mandibular reconstruction have improved both functional and morphological results. We evaluated the accuracy of the CAD/CAM method for mandibular reconstruction and assessed the quantitative and qualitative reproducibility of virtual preoperative planning.
https://ift.tt/2IwqWFT
Medical and dietary management of eosinophilic esophagitis
Eosinophilic esophagitis (EoE) is a disease of chronic, allergen-driven, T-helper 2 (Th2) immune-mediated inflammation that progresses to fibrostenosis of the esophagus if left untreated. There are currently no FDA-approved drugs for the treatment of EoE. This review focuses on medical and dietary management of EoE.
https://ift.tt/2I7swib
Minimally-invasive biomarker studies in eosinophilic esophagitis: a systematic review
Eosinophilic esophagitis (EoE) is a chronic, inflammatory disease of the esophagus which currently requires repeated endoscopic biopsies for diagnosis and monitoring as no reliable non-invasive markers have been identified.
https://ift.tt/2rBZ88q
Efficacy of a single dose of omalizumab for the prevention of ethylene oxide intraoperative anaphylaxis
Ethylene oxide (EtO) is a highly reactive gas commonly used to sterilize pharmaceutical and biomedical thermo-sensitive products, such as infusion sets, cannulae, intubation materials, ventriculo-peritoneal shunts, dialysis catheters and stents 1.
https://ift.tt/2I7ssyX
An EAACI task force report: recognising the potential of the primary care physician in the diagnosis and management of drug hypersensitivity
Adverse drug reactions include drug hypersensitivity reactions (DHRs), which can be immunologically mediated (allergy) or non-immunologically mediated. The high number of DHRs that are unconfirmed and often se...
https://ift.tt/2rwUZDU
Septic arthritis of the sternoclavicular joint: A unique late complication after tracheostomy
Septic arthritis of the sternoclavicular joint is a rare infection associated with significant morbidity and mortality. Several risk factors for septic arthritis have been reported in the literature ranging from immunodeficiency to intravenous drug use.
https://ift.tt/2I8EcRO
Total mandibulectomy defect in the setting of chronic bisphosphonate use
Bisphosphonates are among several drugs known in modern medicine to have a potentially deleterious effect on the mandible with chronic use. While purportedly causing a necrotic reaction in the bone, the complete mechanism is not fully elucidated yet as cases are quite rare in the general public. Despite the esoteric nature of this entity, patients suffering from bisphosphonate induced necrosis have a complicated and prolonged course often involving varying degrees of mandibular debridement with severe cases requiring reconstruction.
https://ift.tt/2ryE4Qp
Editorial Board
Source:Autoimmunity Reviews, Volume 17, Issue 6
https://ift.tt/2G572fU
Sinonasal adenoid cystic carcinoma-role of on-site FNAC: a case report
Adenoid cystic carcinoma (ACC), a rare tumor of epithelial cell origin, commonly arises from the major salivary glands. Uncommonly it may be found outside the salivary glands and it's especially rare in the na...
https://ift.tt/2G4Dcbw
Loss of bronchoprotection to Salbutamol during sputum induction with hypertonic saline: implications for asthma therapy
Sputum induction with hypertonic saline in obstructive airway diseases is generally safe. However, saline induces bronchoconstriction in some patients despite pre-medication with Salbutamol. Our objectives wer...
https://ift.tt/2KOzhTI
Tone-Evoked Acoustic Change Complex (ACC) Recorded in a Sedated Animal Model
Abstract
The acoustic change complex (ACC) is a scalp-recorded cortical evoked potential complex generated in response to changes (e.g., frequency, amplitude) in an auditory stimulus. The ACC has been well studied in humans, but to our knowledge, no animal model has been evaluated. In particular, it was not known whether the ACC could be recorded under the conditions of sedation that likely would be necessary for recordings from animals. For that reason, we tested the feasibility of recording ACC from sedated cats in response to changes of frequency and amplitude of pure-tone stimuli. Cats were sedated with ketamine and acepromazine, and subdermal needle electrodes were used to record electroencephalographic (EEG) activity. Tones were presented from a small loudspeaker located near the right ear. Continuous tones alternated at 500-ms intervals between two frequencies or two levels. Neurometric functions were created by recording neural response amplitudes while systematically varying the magnitude of steps in frequency centered in octave frequency around 2, 4, 8, and 16 kHz, all at 75 dB SPL, or in decibel level around 75 dB SPL tested at 4 and 8 kHz. The ACC could be recorded readily under this ketamine/azepromazine sedation. In contrast, ACC could not be recorded reliably under any level of isoflurane anesthesia that was tested. The minimum frequency (expressed as Weber fractions (df/f)) or level steps (expressed in dB) needed to elicit ACC fell in the range of previous thresholds reported in animal psychophysical tests of discrimination. The success in recording ACC in sedated animals suggests that the ACC will be a useful tool for evaluation of other aspects of auditory acuity in normal hearing and, presumably, in electrical cochlear stimulation, especially for novel stimulation modes that are not yet feasible in humans.
https://ift.tt/2G5FNSm
Tone-Evoked Acoustic Change Complex (ACC) Recorded in a Sedated Animal Model
Abstract
The acoustic change complex (ACC) is a scalp-recorded cortical evoked potential complex generated in response to changes (e.g., frequency, amplitude) in an auditory stimulus. The ACC has been well studied in humans, but to our knowledge, no animal model has been evaluated. In particular, it was not known whether the ACC could be recorded under the conditions of sedation that likely would be necessary for recordings from animals. For that reason, we tested the feasibility of recording ACC from sedated cats in response to changes of frequency and amplitude of pure-tone stimuli. Cats were sedated with ketamine and acepromazine, and subdermal needle electrodes were used to record electroencephalographic (EEG) activity. Tones were presented from a small loudspeaker located near the right ear. Continuous tones alternated at 500-ms intervals between two frequencies or two levels. Neurometric functions were created by recording neural response amplitudes while systematically varying the magnitude of steps in frequency centered in octave frequency around 2, 4, 8, and 16 kHz, all at 75 dB SPL, or in decibel level around 75 dB SPL tested at 4 and 8 kHz. The ACC could be recorded readily under this ketamine/azepromazine sedation. In contrast, ACC could not be recorded reliably under any level of isoflurane anesthesia that was tested. The minimum frequency (expressed as Weber fractions (df/f)) or level steps (expressed in dB) needed to elicit ACC fell in the range of previous thresholds reported in animal psychophysical tests of discrimination. The success in recording ACC in sedated animals suggests that the ACC will be a useful tool for evaluation of other aspects of auditory acuity in normal hearing and, presumably, in electrical cochlear stimulation, especially for novel stimulation modes that are not yet feasible in humans.
https://ift.tt/2G5FNSm
Roxithromycin monotherapy inducing a partial response in a patient with myeloma: a case report
Clarithromycin is an efficacious treatment for myeloma in combination with other anti-myeloma therapy but not as monotherapy. To date, all studies have focused on a clarithromycin-specific effect rather than a...
https://ift.tt/2wq61PY
Exploration of Patient Characteristics and Quality of Life in Patients with Lipoedema Using a Survey
Abstract
Introduction
Lipoedema is a chronic disorder in which excessive fat distribution occurs predominantly from the waist down, resulting in a disproportion between the lower extremities and upper torso. Lipoedema is often not recognized, while patients experience pain and easy bruising. As a long-term condition, lipoedema has a massive effect on patients' lives and mental health. The aim of this study is to explore patient characteristics, quality of life, physical complaints and comorbidities in patients with lipoedema.
Methods
A survey was conducted by email amongst lipoedema patients, consisting of informed consent and multiple questionnaires. The questionnaires included general patient characteristics, physical complaints, comorbidities, RAND-36 and EQ-5D-3L. Participants who responded to a message on the Dutch Lipoedema Association website were recruited.
Results
All lipoedema patients experience physical complaints, with pain (88.3 %) and easy bruising (85.9 %) as primary complaints. The diagnosis was mostly made by a dermatologist after visiting a mean of 2.8 doctors. Furthermore, mean time from onset until diagnosis was 18 years. Quality of life (59.3) was significantly lower than the Dutch female average (74.9; p < 0.001). Additionally, patients with comorbidities had significant lower quality of life (RAND 54.7, p < 0.001).
Conclusions
Lipoedema patients often have severe complaints and experience lower quality of life regarding physical, emotional and social functioning. Additionally, comorbidities have a large impact on quality of life.
https://ift.tt/2rwdg4e
A Novel Computer Algorithm for Printing a 3-Dimensional Nasal Prosthetic
This pilot study describes a novel computer algorithm for the creation of a 3-dimensional model of a nose and uses a survey to evaluate the similarity of appearance of the nasal prosthesis with that of the individual's nose.
https://ift.tt/2KStzQU
https://ift.tt/2KStzQU
Human Papillomavirus in the Mouth and Throat
In this issue of JAMA Otolaryngology—Head & Neck Surgery, Li et al shows that human papillomavirus–positive squamous cell carcinoma (SCC) may be associated with improved overall survival not only in the oropharynx but also possibly in the upper aerodigestive tract subsites—oral cavity, larynx, and hypopharynx. This finding is persuasive given the large sample size used, which was obtained from the National Cancer Database (NCDB), and the multivariate analysis performed. Previous studies with smaller sample sizes have similarly suggested the favorable prognostic role of HPV in cancer in nonoropharyngeal head and neck sites, although other studies have refuted this possibility.
https://ift.tt/2rzVHzl
https://ift.tt/2rzVHzl
Association of HPV Status at Head and Neck Carcinoma Subsites With Overall Survival
This cohort study examines the association of human papillomavirus (HPV) in head and neck carcinoma subsites with overall survival in patients with HPV-positive and HPV-negative status.
https://ift.tt/2KOaEGC
https://ift.tt/2KOaEGC
Three-Dimensional Printing of Nasal Prosthetics
Although the technology has existed for decades, craniofacial applications for 3-dimensional (3-D) printing remains in its infancy. Preoperative surgical planning, education, reconstruction, and implantation are among the current topics of investigation into craniofacial applications for 3-D printing. The implications for 3-D printing in soft tissue reconstruction have been thoroughly discussed in the setting of congenital anomalies and ablative or traumatic defects. The execution of this technology in routine reconstructive practice has suffered from technologic naivety as well as the requisite cost, time, and resources.
https://ift.tt/2rul1Xo
https://ift.tt/2rul1Xo
Microvessel density in head and neck squamous cell carcinoma
Abstract
Purpose
Microvessel density (MVD) corresponds to the intensity of neo-angiogenesis. MVD assessments are based on the expression levels of the vascular endothelium markers such as, e.g., CD34 or CD105. The goal of this study was to assess MVD among patients with head and neck squamous cell carcinoma (HNSCC), and to evaluate the predictive value of MVD in head and neck cancers.
Methods
The study included 49 patients treated for HNSCC and 11 patients with dysplasia of the upper respiratory tract epithelium. Control tissues consisted of 12 normal mucous membranes of the throat. Expression levels of MVD markers were assessed by immunohistochemistry (IHC) using tissue microarrays (TMA). Clinicopathological factors and patients' survival over the 5-year follow-up period were analyzed.
Results
The MVD/CD34 values were found to be significantly elevated in the HNSCCs compared to the non-malignant control tissues (p = 0.001) and to dysplastic tissues. (p = 0.02). Significantly higher MVD/CD105 values were also seen in the tumor compared to the control tissues (p = 0.001) or the dysplastic tissues (p = 0.001). Unexpectedly, significantly lower MVD/CD34 values were seen in the tumor tissues of patients with the T3–T4 tumors compared to those with T1–T2 tumors (p = 0.01).
Conclusions
HNSCCs have statistically higher MVD values compared to dysplasia of the upper respiratory tract epithelium. However, the MVD/CD34 values did not correlate with local invasiveness (the T feature) of HNSCCs. This counterintuitive observation suggests that assessments of MVD as performed on TMA by IHC using anti-CD34 or anti-CD105 antibodies considered to be specific for endothelial cell markers might underestimate the extent of the tumor vascularity in HNSCC.
https://ift.tt/2rwJ8oc
Incidence of akathisia after postoperative nausea and vomiting prophylaxis with droperidol and ondansetron in outpatient surgery: A multicentre controlled randomised trial
BACKGROUND Akathisia, a distressing movement disorder induced by butyrophenones, has been described with low doses of droperidol used for postoperative nausea and vomiting (PONV) prophylaxis, but the incidence remains unclear. OBJECTIVES To determine the incidence of akathisia after PONV prophylaxis with two doses of droperidol in comparison with ondansetron, in patients undergoing ambulatory surgery. We hypothesised that the incidence of akathisia is higher with droperidol than that with ondansetron. DESIGN Randomised controlled double blind trial. SETTING Two University Hospital Centres and two private Clinics from January to September 2014. PATIENTS Patients (n=297) undergoing general anaesthesia for ambulatory surgery were randomly allocated to receive PONV prophylaxis with droperidol (0.625 or 1.25 mg) or ondansetron 4 mg; patients of the three groups also received 4 mg of dexamethasone. Exclusion criteria were contraindication to droperidol and ondansetron, use of psychotropic medications or benzodiazepines or history of psychotic illness. INTERVENTIONS Participants received droperidol (0.625 or 1.25 mg) or ondansetron 4 mg during general anaesthesia. After discharge from the postanaesthesia care unit presence and severity of akathisia were assessed using the Barnes Akathisia Rating Scale at 4 h postoperatively. MAIN OUTCOME MEASURES Score of the Global Clinical Assessment of Akathisia of Barnes Akathisia Rating Scale. RESULTS The number of akathisia observed was 1/118 (0.8%) in the ondansetron group, 1/84 (1.2%) in droperidol 0.625 mg group (DRO 0.625), and 3/87 (3.4%) in droperidol 1.25 mg group (DRO 1.25). The akathisia rate difference among the three groups was not significant (P = 0.52). We could not demonstrate significant differences in the incidence of akathisia between the two doses of droperidol. The only case of marked akathisia treated with benzodiazepines was observed after droperidol 1.25 mg. CONCLUSION The use of droperidol or ondansetron for PONV prophylaxis is associated to a low incidence of akathisia (0.8 to 3.4%) after general anaesthesia for ambulatory surgery. TRIAL REGISTRATION Clinicaltrials.gov: NCT01942343. Correspondence to Antoine Charton, Service d'Anesthésie-Réanimation, Hôpital de Hautepierre, 1 Avenue Molière, CP 67000 Strasbourg, France Tel: +33 388127076; fax: +33 388127074; e-mail: Antoine.charton@chru-strasbourg.fr © 2018 European Society of Anaesthesiology
https://ift.tt/2rzk28u
https://ift.tt/2rzk28u
Lipomas of the Oral Cavity: Utility of MDM2 and CDK4 in Avoiding Overdiagnosis as Atypical Lipomatous Tumor
Abstract
Traumatized lipomas with degenerative change may demonstrate histopathologic features that mimic atypical lipomatous tumor (ALT). Previously reported series of ALT involving the oral cavity preceded routine use of MDM2 and CDK4 immunohistochemistry. Our aim is to evaluate MDM2 and CDK4 immunohistochemical expression in adipocytic tumors arising in this site, in conjunction with the histiocytic marker PU.1, to determine whether MDM2 and CDK4 impacts classification. 17 cases originally diagnosed as ALT were retrieved and immunohistochemical studies for MDM2, CDK4 and PU.1 were performed. FISH analysis for MDM2 amplification was performed in select cases. For this study group, the male:female ratio was 9:8 and the median age was 62 (range 41–88). All 17 cases presented as well- or predominantly well-circumscribed proliferations of variably sized, mature adipocytes exhibiting uni- or multi-vacuolation with occasional scalloped nuclei and mild nuclear atypia. Variable amounts of fibrous stroma with focal myxoid change and bland spindle cells were identified in 14/17 cases. Lipoblasts or atypical hyperchromatic stromal cells were not identified in any cases. 14 of 17 cases were negative for MDM2 and CDK4 in tumor cells and 11 of these 14 showed weak nuclear positivity for MDM2 in histiocytes. 3 of 17 cases showed weak, multifocal immunohistochemical expression of MDM2 and CDK4. PU.1 highlighted histiocytes in all 17 cases. FISH analysis for MDM2 amplification was negative in all 3 cases with weak MDM2/CDK4 expression. All cases were reclassified as lipoma with degenerative changes. ALT, in all likelihood, is less common than previously thought in this anatomic location and best diagnosed with ancillary studies. MDM2 expression in histiocytes is best interpreted in conjunction with CDK4 immunohistochemistry and confirmatory FISH for MDM2 amplification.
https://ift.tt/2I8w67r
Update on complications in cleft orthognathic surgery
Purpose of review To give an update on recent publications and tendencies concerning complications in cleft orthognathic surgery. Recent findings Cleft-specific changes after orthognathic surgery and their impact on surgical outcomes are discussed. Focus lays on the causes and mechanisms of cleft-related surgical complications and strategies to prevent or minimize these complications. Bimaxillary surgery is seen as a safe procedure for cleft patients. Maxillary distraction, total or segmental, is pointed out as an alternative method to improve outcomes. Different techniques for osteotomies and maxillary mobilization could decrease adverse events. Summary Cleft patients are more susceptible to the occurrence of complications because of peculiar presurgical conditions. Different surgical approaches and techniques are presented to overcome these difficulties, to achieve better results and to increase patient safety. The importance of communication between patient, family and cleft team members is emphasized. Correspondence to Philip Kuo-Ting Chen, Craniofacial Center, Taipei Medical University Hospital, 252 Wu-Xing Street, Xinyi District 110, Taipei City, Taiwan. Tel: +886937062575; e-mail: philip.ktchen@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2jNL0Ws
https://ift.tt/2jNL0Ws
Blepharoptosis repair
Purpose of review To review recent advances on the mechanisms and management of acquired aponeurotic blepharoptosis. Recent findings Recent advances over the past year have focused on refining well known methods of ptosis repair, expanding and modifying techniques to treat difficult and more severe conditions, and uncovering the biomechanical and neurostimulatory mechanisms of ptosis and its repair. Summary Innovations in ptosis repair are discussed in the context of current treatment paradigms. Correspondence to Pete Setabutr, MD, Department of Ophthalmology, 1855 West Taylor Street, Chicago, IL 60612, USA. Tel: +1 312 996 9120; fax: +1 312 413 7895; e-mail: psetabut@uic.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2G2Nzwg
https://ift.tt/2G2Nzwg
Update on complications in cleft orthognathic surgery
Purpose of review To give an update on recent publications and tendencies concerning complications in cleft orthognathic surgery. Recent findings Cleft-specific changes after orthognathic surgery and their impact on surgical outcomes are discussed. Focus lays on the causes and mechanisms of cleft-related surgical complications and strategies to prevent or minimize these complications. Bimaxillary surgery is seen as a safe procedure for cleft patients. Maxillary distraction, total or segmental, is pointed out as an alternative method to improve outcomes. Different techniques for osteotomies and maxillary mobilization could decrease adverse events. Summary Cleft patients are more susceptible to the occurrence of complications because of peculiar presurgical conditions. Different surgical approaches and techniques are presented to overcome these difficulties, to achieve better results and to increase patient safety. The importance of communication between patient, family and cleft team members is emphasized. Correspondence to Philip Kuo-Ting Chen, Craniofacial Center, Taipei Medical University Hospital, 252 Wu-Xing Street, Xinyi District 110, Taipei City, Taiwan. Tel: +886937062575; e-mail: philip.ktchen@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2jNL0Ws
https://ift.tt/2jNL0Ws
Blepharoptosis repair
Purpose of review To review recent advances on the mechanisms and management of acquired aponeurotic blepharoptosis. Recent findings Recent advances over the past year have focused on refining well known methods of ptosis repair, expanding and modifying techniques to treat difficult and more severe conditions, and uncovering the biomechanical and neurostimulatory mechanisms of ptosis and its repair. Summary Innovations in ptosis repair are discussed in the context of current treatment paradigms. Correspondence to Pete Setabutr, MD, Department of Ophthalmology, 1855 West Taylor Street, Chicago, IL 60612, USA. Tel: +1 312 996 9120; fax: +1 312 413 7895; e-mail: psetabut@uic.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2G2Nzwg
https://ift.tt/2G2Nzwg
Lipomas of the Oral Cavity: Utility of MDM2 and CDK4 in Avoiding Overdiagnosis as Atypical Lipomatous Tumor
Abstract
Traumatized lipomas with degenerative change may demonstrate histopathologic features that mimic atypical lipomatous tumor (ALT). Previously reported series of ALT involving the oral cavity preceded routine use of MDM2 and CDK4 immunohistochemistry. Our aim is to evaluate MDM2 and CDK4 immunohistochemical expression in adipocytic tumors arising in this site, in conjunction with the histiocytic marker PU.1, to determine whether MDM2 and CDK4 impacts classification. 17 cases originally diagnosed as ALT were retrieved and immunohistochemical studies for MDM2, CDK4 and PU.1 were performed. FISH analysis for MDM2 amplification was performed in select cases. For this study group, the male:female ratio was 9:8 and the median age was 62 (range 41–88). All 17 cases presented as well- or predominantly well-circumscribed proliferations of variably sized, mature adipocytes exhibiting uni- or multi-vacuolation with occasional scalloped nuclei and mild nuclear atypia. Variable amounts of fibrous stroma with focal myxoid change and bland spindle cells were identified in 14/17 cases. Lipoblasts or atypical hyperchromatic stromal cells were not identified in any cases. 14 of 17 cases were negative for MDM2 and CDK4 in tumor cells and 11 of these 14 showed weak nuclear positivity for MDM2 in histiocytes. 3 of 17 cases showed weak, multifocal immunohistochemical expression of MDM2 and CDK4. PU.1 highlighted histiocytes in all 17 cases. FISH analysis for MDM2 amplification was negative in all 3 cases with weak MDM2/CDK4 expression. All cases were reclassified as lipoma with degenerative changes. ALT, in all likelihood, is less common than previously thought in this anatomic location and best diagnosed with ancillary studies. MDM2 expression in histiocytes is best interpreted in conjunction with CDK4 immunohistochemistry and confirmatory FISH for MDM2 amplification.
https://ift.tt/2I8w67r
Lipomas of the Oral Cavity: Utility of MDM2 and CDK4 in Avoiding Overdiagnosis as Atypical Lipomatous Tumor
Abstract
Traumatized lipomas with degenerative change may demonstrate histopathologic features that mimic atypical lipomatous tumor (ALT). Previously reported series of ALT involving the oral cavity preceded routine use of MDM2 and CDK4 immunohistochemistry. Our aim is to evaluate MDM2 and CDK4 immunohistochemical expression in adipocytic tumors arising in this site, in conjunction with the histiocytic marker PU.1, to determine whether MDM2 and CDK4 impacts classification. 17 cases originally diagnosed as ALT were retrieved and immunohistochemical studies for MDM2, CDK4 and PU.1 were performed. FISH analysis for MDM2 amplification was performed in select cases. For this study group, the male:female ratio was 9:8 and the median age was 62 (range 41–88). All 17 cases presented as well- or predominantly well-circumscribed proliferations of variably sized, mature adipocytes exhibiting uni- or multi-vacuolation with occasional scalloped nuclei and mild nuclear atypia. Variable amounts of fibrous stroma with focal myxoid change and bland spindle cells were identified in 14/17 cases. Lipoblasts or atypical hyperchromatic stromal cells were not identified in any cases. 14 of 17 cases were negative for MDM2 and CDK4 in tumor cells and 11 of these 14 showed weak nuclear positivity for MDM2 in histiocytes. 3 of 17 cases showed weak, multifocal immunohistochemical expression of MDM2 and CDK4. PU.1 highlighted histiocytes in all 17 cases. FISH analysis for MDM2 amplification was negative in all 3 cases with weak MDM2/CDK4 expression. All cases were reclassified as lipoma with degenerative changes. ALT, in all likelihood, is less common than previously thought in this anatomic location and best diagnosed with ancillary studies. MDM2 expression in histiocytes is best interpreted in conjunction with CDK4 immunohistochemistry and confirmatory FISH for MDM2 amplification.
https://ift.tt/2I8w67r
The prevalence and impact of otitis media with effusion in children admitted for adeno-tonsillectomy at Dr George Mukhari Academic Hospital, Pretoria, South Africa
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Timothy Els, Ian Paul Olwoch
IntroductionOtitis media with effusion (OME) is a leading cause of acquired hearing loss in children worldwide. However, previous South African studies have consistently reported the local paediatric OME prevalence to be lower than typically published in international literature. Furthermore, no South African studies have investigated OME in children with adenotonsillar hypertrophy. The objective of this study was to determine the prevalence of OME in children admitted for adeno-tonsillectomy at our institution in Pretoria, South Africa. In addition, the study sought to gauge the impact of OME on quality of life using a validated questionnaire (OM-6).MethodsA cross-sectional, observational study was conducted between July 2015 and May 2016 at the Otorhinolaryngology outpatient department at DGMAH. he study included 109 consecutively sampled children, aged 2–12 years (mean 6.1; 49.7% female). Pneumatic otoscopy and tympanometry were performed on all participants. Adenoid hypertrophy was quantified using he adenoid-nasopharyngeal ratio (ANR) on a lateral post-nasal space radiograph (Fujioka's method). The OM-6 questionnaire was completed for each participant. Pure tone audiometry was performed for participants diagnosed with OME.ResultsThe prevalence of bilateral OME was 11.9%. For unilateral OME, the prevalence was 22.9% and 16.5%, for the left and right ears, respectively (p > 0.05). The mean hearing loss (SD) was 19.8 dB (9.4). Clinically significant adenoid hypertrophy (ANR ≥ 0.71) was present in 43% of participants. There was no statistically significant (p > 0.05) correlation between the presence OME and adenoid hypertrophy. The mean total OM-6 survey score was 1.67 (SD ± 0.59) in children with OME, and 1.31 (SD ± 0.45) without OME, showing no statistically significant difference (p > 0.05). There was a significant (P < 0.05) correlation between OME and the presence of atopy.ConclusionAdeno-tonsillar pathology may play an aetio-pathological role in the development of OME. However, this may be due to the presence of biofilms rather than obstructive adenoid hypertrophy, given the lack of a significant (p > 0.05) correlation between adenoid hypertrophy and OME. Whilst OME was not found to impair quality of life in this population group, the validity of the OM-6 in the South African paediatric population requires further investigation.
https://ift.tt/2jLID6r
Reduced Hemidiaphragmatic Paresis With a “Corner Pocket” Technique for Supraclavicular Brachial Plexus Block: Single-Center, Observer-Blinded, Randomized Controlled Trial
Background and Objective Hemidiaphragmatic paresis is common after supraclavicular brachial plexus block (SCBPB). In this randomized trial, we compared the incidence of hemidiaphragmatic paresis in patients who had local anesthetic injected primarily in the corner pocket (defined as the intersection of the first rib and subclavian artery) during SCBPB with that of patients who underwent injection primarily inside the neural cluster. Methods Thirty-six patients scheduled for right elbow, forearm, wrist, or hand surgery under SCBPB (using 12.5 mL of 0.75% ropivacaine and 12.5 mL of 2% lidocaine with 1:200,000 epinephrine) were randomly assigned to 1 of 2 groups. In group CP, local anesthetic was injected primarily in the corner pocket (20 mL) and secondarily inside the neural cluster (5 mL). In group NC, local anesthetic was deposited primarily inside the neural cluster (20 mL) and secondarily in the corner pocket (5 mL). The primary outcome was the incidence of hemidiaphragmatic paresis, as measured by M-mode ultrasonography 30 minutes after SCBPB. Results The incidence of hemidiaphragmatic paresis was significantly lower in group CP than in group NC (27.8% vs 66.7%, P = 0.019). The median decreases in forced expiratory volume at 1 second (7.5% [interquartile range, 3.3%–17.1%] vs 24.4% [interquartile range, 10.2%–31.2%]; P = 0.010) and forced vital capacity (6.4% [interquartile range, 3.3%–11.1%] vs 19.3% [interquartile range, 13.7%–33.2%]; P = 0.001) were also lower in group CP than in group NC. Conclusions The incidence of hemidiaphragmatic paresis was effectively reduced when local anesthetic was injected primarily in the corner pocket during right-sided SCBPB. However, the 28% incidence of hemidiaphragmatic paresis associated with the corner pocket technique may still represent a prohibitive risk for patients with preexisting pulmonary compromise. Clinical Trial Registration This study was registered at Clinical Trial Registry of Korea, identifier KCT0001769. Accepted for publication January 15, 2018. Address correspondence to: Duck Hwan Choi, MD, PhD, Department of Anesthesiology and Pain Medicine, Samsung Medical Center, 81 Irwon ro, Gangnam gu, Seoul 06351, Korea (e-mail: duckhwanc@gmail.com). R.A.K. and Y.H.C. contributed equally as first authors. The authors have no sources of funding to declare for this article. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
https://ift.tt/2G3CnPX
https://ift.tt/2G3CnPX
A Cadaveric Study Investigating the Mechanism of Action of Erector Spinae Blockade
Background and Objectives Erector spinae block is an ultrasound-guided interfascial plane block first described in 2016. The objectives of this cadaveric dye injection and dissection study were to simulate an erector spinae block to determine if dye would spread anteriorly to the involve origins of the ventral and dorsal branches of the spinal nerves. Methods In 10 unembalmed human cadavers, 20 mL of 0.25% methylene blue dye was injected bilaterally into the plane between the fifth thoracic transverse process and erector spinae muscle. An in-plane ultrasound-guided technique with the transducer orientated longitudinally was used. During dissection, superficial and deep muscles were identified, and extent of dye spread was documented in cephalocaudal and lateral directions. The ventral and dorsal rami of spinal nerves and dorsal root ganglion at each level were examined to determine if they were stained by dye. Results There was extensive cephalocaudad and lateral spread of dye deep and superficial to the erector spinae muscles. Except for 1 injection (from 20), the ventral rami were not stained by the dye. In only 2 injections did the dye track posteriorly through the costotransverse foramen to the dorsal root ganglion. In all other cases, the dorsal root ganglia were not involved in the dye injection. The dye stained the dorsal rami posterior to the costotransverse foramen. Conclusions There was no spread of dye anteriorly to the paravertebral space to involve origins of the ventral and dorsal branches of the thoracic spinal nerves. Dorsal ramus involvement was posterior to the costotransverse foramen. Accepted for publication January 15, 2018. Address correspondence to: Michael J. Barrington, PhD, MBBS, FANZCA, Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Victoria Parade, PO Box 2900 Fitzroy, Victoria 3065, Australia (e-mail: Michael.Barrington@svha.org.au). Funding was from departmental resources only. Support was provided by the Imaging and Posters Unit at the Department of Anatomy and Neuroscience, University of Melbourne, and Anastasia Arsenoulis from FUJIFILM SonoSite, Inc, which provided an ultrasound machine. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
https://ift.tt/2KRLuXW
https://ift.tt/2KRLuXW
Study of Endonasal Endoscopic Dacryo-cystorhinostomy with Special Reference to Mitomycin-C
Abstract
The aim of this study was to evaluate long-term results in patients with nasolacrimal duct obstruction treated with intranasal endoscopic dacryo-cystorhinostomy (DCR) with intraoperative topical application of mitomycin-C. The procedure was carried out in 34 subjects (41eyes). Patients with post-saccal stenosis were divided into two groups, 21 patients were treated with intranasal endoscopic dacryo-cystorhinostomy with intraoperative application of Mitomycin-C (MMC) and the other 20 cases underwent procedure only without Mitomycin-C. Effectiveness of drug at rhinostomy site was assessed in relation to granulation formation, adhesions and ostium size. Outcomes were assessed on the basis of relief of subjective symptoms, patency of rhinostomy site confirmed via syringing and final ostium size at end of 6 months, 1 and 2 year. Success rate was 100% at 3 and 6 months follow-up in both the groups. At the end of 1 year, one failure was noted in control group which had to undergo revision endoscopic DCR with overall success rate decreasing to 97%. This was maintained at the end of second year. Results revealed that adjunctive use of Mitomycin-C was effective at 3 months when granulation tissue formation was significantly lesser in MMC group compared to no MMC group. Topical application of Mitomycin-C has been found to be beneficial in preventing adhesions and also resulted in larger neo-ostium. We concluded that results with intraoperative topical application of Mitomycin-C in endoscopic dacryo-cystorhinostomy are encouraging. It can favourably affect wound healing and result in larger rhinostomy size/ostium. Mitomycin-C is safe and effective adjunct in endoscopic dacryo-cystorhinostomy procedure.
Level of evidence Individual prospective cohort study, level 1b
https://ift.tt/2wqi5kl
Endoscope-assisted retrosigmoid approach in hemifacial spasm: our experience
Publication date: Available online 9 May 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Giampietro Ricci, Arianna Di Stadio, Luca D'Ascanio, Ruggero La Penna, Franco Trabalzini, Antonio Della Volpe, Jacques Magnan
IntroductionThe use of surgical decompression of facial hemispasm due to the loop in the internal auditory canal is not always accepted due to the risk related to the surgical procedure. Currently a new surgical technique allows surgeons to work in safer conditions.ObjectiveTo report the results with endoscope-assisted retrosigmoid approach for facial nerve microvascular decompression in hemifacial spasm due to neurovascular conflict. The surgical technique is described.MethodsWe made a prospective study in a tertiary referral center observing 12 (5 male, 7 female) patients, mean age 57.5 (range 49–71) years affected by hemifacial spasm, that were submitted to an endoscope assisted retrosigmoid approach for microvascular decompression. We evaluated intra-operative findings, postoperative HFS resolution and complication rates.ResultsHemifacial spasm resolution was noticed in 9/12 (75%) cases within 24h after surgery and in 12/12 (100%) subjects within 45 days. A significant (p<0.001) correlation between preoperative historical duration of hemifacial spasm and postoperative recovery timing was recorded. Only 1 patient had a complication (meningitis), which resolved after intravenous antibiotics with no sequelae. No case of cerebrospinal fluid leak, facial palsy or hearing impairment was recorded. Hemifacial spasm recurrence was noticed in the only subject where the neurovascular conflict was due to a vein within the internal auditory canal.ConclusionsThe endoscope assisted retrosigmoid approach technique offers an optimal visualization of the neurovascular conflict thorough a minimally invasive approach, thus allowing an accurate decompression of the facial nerve with low complication rates. Due to the less invasive nature, the procedure should be considered in functional surgery of the cerebellar pontine angle as hemifacial spasm treatment, specially when the procedure is performed by an otolaryngologist.
https://ift.tt/2Iqp29M
Comparison of the efficacy of vocal training and vocal microsurgery in patients with early vocal fold polyp
Publication date: Available online 9 May 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Hanqing Wang, Pan Zhuge, Huihua You, Yulan Zhang, Zhifeng Zhang
IntroductionVocal fold polyp is a benign proliferative disease in the superficial lamina propria of the vocal fold, and vocal microsurgery can improve the voice quality of patients with vocal fold polyp. In preliminary studies, we found that vocal training could improve the vocal quality of patients with early vocal fold polyp.ObjectiveThis study aimed to compare the efficacies of vocal training and vocal microsurgery in patients with early vocal fold polyp.MethodsA total of 38 patients with early vocal fold polyp underwent 3 months of vocal training (VT group); another 31 patients with early vocal fold polyp underwent vocal microsurgery (VM group); and 33 healthy volunteers were included as the control group. All subjects were assessed using laryngostroboscopy, voice handicap index, and dysphonia severity index, and the efficacies of vocal training and vocal microsurgery were compared.ResultsThe cure rates of vocal training and vocal microsurgery were 31.6% (12/38) and 100% (31/31), respectively. The intragroup paired-sample t-test showed that the post treatment vocal handicap index, maximum phonation time, highest frequency (F0-high), lowest intensity (I-low), and dysphonia severity index in both the VT and VM groups were better than those before treatment, except for the jitter value. The intergroup independent-sample t-test revealed that the emotional values of vocal handicap index (t=−2.22, p=0.03), maximum phonation time (t=2.54, p=0.013), jitter (t=−2.11, p=0.03), and dysphonia severity index (t=3.24, p=0.002) in the VT group were better than those in the VM group.ConclusionsBoth, vocal training and vocal microsurgery could improve the voice quality of patients with early vocal fold polyp, and these methods present different advantages.
https://ift.tt/2K9sWRy
Study of Endonasal Endoscopic Dacryo-cystorhinostomy with Special Reference to Mitomycin-C
Abstract
The aim of this study was to evaluate long-term results in patients with nasolacrimal duct obstruction treated with intranasal endoscopic dacryo-cystorhinostomy (DCR) with intraoperative topical application of mitomycin-C. The procedure was carried out in 34 subjects (41eyes). Patients with post-saccal stenosis were divided into two groups, 21 patients were treated with intranasal endoscopic dacryo-cystorhinostomy with intraoperative application of Mitomycin-C (MMC) and the other 20 cases underwent procedure only without Mitomycin-C. Effectiveness of drug at rhinostomy site was assessed in relation to granulation formation, adhesions and ostium size. Outcomes were assessed on the basis of relief of subjective symptoms, patency of rhinostomy site confirmed via syringing and final ostium size at end of 6 months, 1 and 2 year. Success rate was 100% at 3 and 6 months follow-up in both the groups. At the end of 1 year, one failure was noted in control group which had to undergo revision endoscopic DCR with overall success rate decreasing to 97%. This was maintained at the end of second year. Results revealed that adjunctive use of Mitomycin-C was effective at 3 months when granulation tissue formation was significantly lesser in MMC group compared to no MMC group. Topical application of Mitomycin-C has been found to be beneficial in preventing adhesions and also resulted in larger neo-ostium. We concluded that results with intraoperative topical application of Mitomycin-C in endoscopic dacryo-cystorhinostomy are encouraging. It can favourably affect wound healing and result in larger rhinostomy size/ostium. Mitomycin-C is safe and effective adjunct in endoscopic dacryo-cystorhinostomy procedure.
Level of evidence Individual prospective cohort study, level 1b
https://ift.tt/2wqi5kl
Efficacy of a shower cream and a lotion with skin‐identical lipids in healthy subjects with atopic dry skin
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2rzK1MQ
Principles of Reconstruction After Mohs Surgery
Abstract
Purpose of Review
Reconstruction of cutaneous defects is a key component following completion of extirpative surgery, with a primary aim of restoring form and function to sensitive regions of the face and scalp. We review flap physiology, defect analysis, and reconstructive options in the reconstructive ladder, and describe key principles in unit reconstruction.
Recent Findings
An overview of time-honored principles and techniques including healing by second intention, skin grafting, and local flaps is described. More contemporary techniques such as the use of perichondrium-cutaneous composite grafts, and multi-layered reconstruction of complex nasal defects including the use of forehead flaps are succinctly discussed.
Summary
This concise review hopes to highlight key nuances in defect analysis, decision-making processes in choice of reconstruction, and considerations when performing reconstruction on various aesthetic units of the face and scalp.
https://ift.tt/2Kc4TSf
Severe Atopic Dermatitis in Children
Abstract
Purpose of Review
Severe atopic dermatitis (AD) in childhood leads to significant morbidity including psychosocial problems and infectious complications. There are only a few approved treatment options for these patients. These include topical corticosteroids and tacrolimus ointment, which are associated with potential side effects.
Recent Findings
In order to find better and safer treatments, further understanding of AD mechanisms is needed. Primary skin barrier defects play an important role in the pathogenesis of AD. In addition, the suppression of skin barrier functions by Th2 inflammation also plays an important role in the persistence and recurrence of AD. Cytokines in the Th2 pathway, which includes IL-4, IL-13, TSLP, IL-25, IL-31, and IL-33, are potential therapeutic targets in AD. Other potential targets of AD are Janus kinase, phospholipase A2, aryl hydrocarbon receptor, and skin microbiota.
Summary
A better understanding of the pathogenesis of AD will provide future direction for treatment.
https://ift.tt/2K61nJ1
Newborn Screening for Severe Combined Immunodeficiency
Abstract
Purpose of Review
This review provides a brief history of newborn screening (NBS) for severe combined immunodeficiency (SCID), discusses the theoretical basis for the T cell receptor excision circle (TREC) assay, highlights the results of recent studies using the TREC, and provides practical advice for the evaluation of infants with an abnormal TREC assay.
Recent Findings
Currently, all but three states perform NBS for SCID in the USA. NBS using the TREC assay is highly sensitive in identifying infants with SCID and may also identify infants with T cell lymphopenia due to other causes such as congenital syndromes, multiple congenital anamolies, and some combined immunodeficiencies.
Summary
Regardless of the genetic etiology, all forms of SCID are characterized by a severe deficiency of naïve T cells. TRECs are a biomarker of newly formed, naïve T cells that have recently left the thymus. Consequently, the TREC assay identifies infants with SCID and other causes of severe T cell lymphopenia.
https://ift.tt/2rvtTwW
Severe Atopic Dermatitis in Children
Abstract
Purpose of Review
Severe atopic dermatitis (AD) in childhood leads to significant morbidity including psychosocial problems and infectious complications. There are only a few approved treatment options for these patients. These include topical corticosteroids and tacrolimus ointment, which are associated with potential side effects.
Recent Findings
In order to find better and safer treatments, further understanding of AD mechanisms is needed. Primary skin barrier defects play an important role in the pathogenesis of AD. In addition, the suppression of skin barrier functions by Th2 inflammation also plays an important role in the persistence and recurrence of AD. Cytokines in the Th2 pathway, which includes IL-4, IL-13, TSLP, IL-25, IL-31, and IL-33, are potential therapeutic targets in AD. Other potential targets of AD are Janus kinase, phospholipase A2, aryl hydrocarbon receptor, and skin microbiota.
Summary
A better understanding of the pathogenesis of AD will provide future direction for treatment.
https://ift.tt/2K61nJ1
Newborn Screening for Severe Combined Immunodeficiency
Abstract
Purpose of Review
This review provides a brief history of newborn screening (NBS) for severe combined immunodeficiency (SCID), discusses the theoretical basis for the T cell receptor excision circle (TREC) assay, highlights the results of recent studies using the TREC, and provides practical advice for the evaluation of infants with an abnormal TREC assay.
Recent Findings
Currently, all but three states perform NBS for SCID in the USA. NBS using the TREC assay is highly sensitive in identifying infants with SCID and may also identify infants with T cell lymphopenia due to other causes such as congenital syndromes, multiple congenital anamolies, and some combined immunodeficiencies.
Summary
Regardless of the genetic etiology, all forms of SCID are characterized by a severe deficiency of naïve T cells. TRECs are a biomarker of newly formed, naïve T cells that have recently left the thymus. Consequently, the TREC assay identifies infants with SCID and other causes of severe T cell lymphopenia.
https://ift.tt/2rvtTwW
Cystatin F as a regulator of immune cell cytotoxicity
Abstract
Cysteine cathepsins are lysosomal peptidases involved in the regulation of innate and adaptive immune responses. Among the diverse processes, regulation of granule-dependent cytotoxicity of cytotoxic T-lymphocytes (CTLs) and natural killer (NK) cells during cancer progression has recently gained significant attention. The function of cysteine cathepsins is regulated by endogenous cysteine protease inhibitors—cystatins. Whereas other cystatins are generally cytosolic or extracellular proteins, cystatin F is present in endosomes and lysosomes and is thus able to regulate the activity of its target directly. It is delivered to endosomal/lysosomal vesicles as an inactive, disulphide-linked dimer. Proteolytic cleavage of its N-terminal part leads to the monomer, the only form that is a potent inhibitor of cathepsins C, H and L, involved in the activation of granzymes and perforin. In NK cells and CTLs the levels of active cathepsin C and of granzyme B are dependent on the concentration of monomeric, active cystatin F. In tumour microenvironment, inactive dimeric cystatin F can be secreted from tumour cells or immune cells and further taken up by the cytotoxic cells. Subsequent monomerization and inhibition of cysteine cathepsins within the endosomal/lysosomal vesicles impairs granzyme and perforin activation, and provokes cell anergy. Further, the glycosylation pattern has been shown to be important in controlling secretion of cystatin F from target cells, as well as internalization by cytotoxic cells and trafficking to endosomal/lysosomal vesicles. Cystatin F is therefore an important mediator used by bystander cells to reduce NK and T-cell cytotoxicity.
https://ift.tt/2G2GvzZ
Myeloid-derived suppressor cells (MDSCs) in patients with solid tumors: considerations for granulocyte colony-stimulating factor treatment
Abstract
Myeloid-derived suppressor cells (MDSCs) have been shown to contribute to tumor escape from host immune surveillance and to cancer progression by production of tumor-promoting soluble factors. Granulocyte colony-stimulating factor (G-CSF) is a principle cytokine controlling granulocyte number. Recombinant human G-CSF (rhG-CSF) has become the main therapeutic agent for the treatment of neutropenia and prophylaxis of febrile neutropenia in cancer patients. However, we show here that rhG-CSF triggers accumulation of granulocytic and monocytic subsets. Consequently, we discuss the pharmacological use of granulopoiesis stimulating factors not only in the context of febrile neutropenia but also from the perspective of MDSC-dependent and MDSC-independent mechanisms of immunosuppression and cancer angiogenesis.
https://ift.tt/2jNbMxY
Case 14-2018: A 68-Year-Old Woman with a Rash, Hyponatremia, and Uveitis
Presentation of Case. Dr. AbdulRasheed A. Alabi (Medicine): A 68-year-old woman was admitted to this hospital during the winter because of a rash, hyponatremia, and anterior uveitis. One month before admission, the patient traveled abroad. She spent a week in Sweden visiting family members,…
https://ift.tt/2jKlotn
Erbium Yttrium–Aluminum–Garnet Laser Versus Traditional Bur in the Extraction of Impacted Mandibular Third Molars: Analysis of Intra- and Postoperative Differences
Introduction: Different osteotomy techniques have been proposed in order to improve postoperative course of impacted third molar extraction. The aim is to evaluate the possible advantages achieved with erbium yttrium–aluminum–garnet (Er:YAG) laser osteotomy compared with traditional burs. Materials and Methods: Seventy-six extractions were randomly classified into 2 groups according to osteotomy instrument: group 1 (G1)—Er:YAG laser: 35 patients; group 2 (G2)—traditional bur: 41 patients. Intraoperative parameters: total time, stitches number, and patient compliance. Postoperative: pain, health-related quality of life (HR-QoL), need for analgesics, edema, trismus, intra- and extraoral hematoma, and postoperative complications. Results: Mean time for G1 resulted 1069.4 seconds; for G2 1913.5 seconds (P
https://ift.tt/2KbP91z
https://ift.tt/2KbP91z
The Effect of Different Doses of Extracorporeal Shock Waves on Experimental Model Mandibular Distraction
Objective: Distraction osteogenesis (DO) is widely used treatment for the bone deformities. In addition extracorporeal shock wave therapy (ESWT) is a new perspective on noninvasive modalities of management of the bone regeneration. We examined the effects of 2 different single doses of ESWT on the consolidation period of DO of the rabbit mandible using stereological, radiological and immunohistochemical methods in the present study. Methods: DO was performed unilaterally in the mandible of 18 New Zealand rabbits (6 months' old, weighing between 2.5 and 3 kg). The distraction zone of the mandible has received no treatment as controls. Group 2 (ESWT 500) received ESWT (single dose of 500 impulses 0.19 mJ/mm2 energy flux intensity and 2155 mJ totally) were applied on the first day of the consolidation. Group 3 (ESWT 1000) treated with ESWT (single dose of 1000 impulses0.19 mJ/mm2 energy flux intensity and 4310 mJ totally) were applied on the first day of the consolidation period. After the sacrification, radiologically bone mineral density, new bone formation, new fibrous tissue, and new vessel formation were analyzed using unbiased stereological methods. Results: It was found a statistically significant difference between the study groups and control group in the bone mineral density measurements and the highest values were in the ESWT1000 group. In terms of stereological analysis, there was a significant difference between the study groups and control group (P = 0.00). The new capillary volume was highest in the E1000 group. Additionally, significant differences were found in point of the capillary volumes between the groups control and ESWT500 (P = 0.001), control and ESWT1000 (P = 0.000), ESWT500 and ESWT1000 (P = 0.040), respectively. Conclusions: A total of 1000 impulses ESWT may induce the growth factors to enhance the newly formed bone regeneration. Address correspondence and reprint requests to Nilüfer Çakir-Özkan, DDS, PhD, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayis University, 55139 Samsun, Turkey; E-mail: nfozkan@hotmail.com Received 14 September, 2017 Accepted 20 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2IpOyw1
https://ift.tt/2IpOyw1
Endoscopically Assisted Transoral Gap Arthroplasty of the Temporomandibular Joint Ankylosis in a Pediatric Patient
Surgical management of temporomandibular joint (TMJ) ankylosis in children is often challenging and may result in various complications such as facial nerve injury and visible scar. In this clinical report, the authors present minimally invasive management of a 9-year-old boy with bilateral post-traumatic TMJ ankylosis. The ankylotic TMJs were addressed and gap arthoplasties were performed by endoscopically assisted transoral approach. The risk of facial nerve injury is minimized and facial scar was prevented by avoiding extraoral incision. Mandibular movements in 3 directions were satisfactory at 3rd postoperative month. Address correspondence and reprint requests to Özgür Erdogan, DDS, PhD, Department of Oral and Maxillofacial Surgery, Okan University, Gulbahar Mh. Oya Sokak 23/A 34394, Sisli, Istanbul, Turkey; E-mail: ozgerdogan@yahoo.com Received 5 December, 2017 Accepted 26 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2wuJSzZ
https://ift.tt/2wuJSzZ
Simple Bone Cyst Mimicking Stafne Bone Defect
Stafne bone defects (SBDs) are asymptomatic lingual bony defects in mandible, which are usually detected as an incidental finding in plain radiographs. Similarly, simple bone cysts (SBCs) are most frequently found in posterior region of the mandible and also are asymptomatic. However, due to anatomical structures overlap in plain radiographs, there is a possibility of misdiagnosing SBD that often is diagnosed by presumptive diagnosis observed in plain radiograph. This report shows an unusual case that a SBC resembles a SBD. Address correspondence and reprint requests to Eduardo Massaharu Aoki, DDS, MS, Department of Stomatology, School of Dentistry, University of São Paulo, Av. Lineu Prestes 2227, São Paulo, SP 05508-000, Brazil; E-mail: edumaoki@gmail.com Received 13 February, 2018 Accepted 9 March, 2018 A doctoral scholarship was granted to EMA and CPN by the National Council for Scientific and Technological Development (CNPq). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2wx8U1C
https://ift.tt/2wx8U1C
Development of Human Face Literature Database Using Text Mining Approach: Phase I
The face is an important part of the human body by which an individual communicates in the society. Its importance can be highlighted by the fact that a person deprived of face cannot sustain in the living world. The amount of experiments being performed and the number of research papers being published under the domain of human face have surged in the past few decades. Several scientific disciplines, which are conducting research on human face include: Medical Science, Anthropology, Information Technology (Biometrics, Robotics, and Artificial Intelligence, etc.), Psychology, Forensic Science, Neuroscience, etc. This alarms the need of collecting and managing the data concerning human face so that the public and free access of it can be provided to the scientific community. This can be attained by developing databases and tools on human face using bioinformatics approach. The current research emphasizes on creating a database concerning literature data of human face. The database can be accessed on the basis of specific keywords, journal name, date of publication, author's name, etc. The collected research papers will be stored in the form of a database. Hence, the database will be beneficial to the research community as the comprehensive information dedicated to the human face could be found at one place. The information related to facial morphologic features, facial disorders, facial asymmetry, facial abnormalities, and many other parameters can be extracted from this database. The front end has been developed using Hyper Text Mark-up Language and Cascading Style Sheets. The back end has been developed using hypertext preprocessor (PHP). The JAVA Script has used as scripting language. MySQL (Structured Query Language) is used for database development as it is most widely used Relational Database Management System. XAMPP (X (cross platform), Apache, MySQL, PHP, Perl) open source web application software has been used as the server. The database is still under the developmental phase and discusses the initial steps of its creation. The current paper throws light on the work done till date. Address correspondence and reprint requests to Dr Kewal Krishan, PhD, FRAI, Associate Professor and Chairperson, Department of Anthropology, Panjab University, Sector 14, Chandigarh 160 014, India; E-mails: gargkk@yahoo.com, kewalkrishan@pu.ac.in Received 11 February, 2018 Accepted 5 March, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2IrUeWk
https://ift.tt/2IrUeWk
Cervical Tracheal Resection and Anastomosis for Postintubation Tracheal Stenosis
In this study the authors evaluated the outcomes of tracheal resection and anastomosis in postintubation tracheal stenosis. The authors also aimed to identify clinical and radiological factors associated with restenosis. Thirty-four consecutive patients were included in the study. Patients with subglottic stenosis who underwent procedures involving cricoid cartilage and patients with other etiologies were excluded from the study. Univariate analysis was performed to determine the risk factors for restenosis. Receiver operating characteristic (ROC) curves were generated for the diameter of the narrowest part of the trachea (Dst) and the distance between cricoid cartilage and stenosis (Dcs). Of the 34 patients, 31 (91.1%) patients were successfully decannulated. Nineteen (55.8%) patients had complications. After univariate analysis, Dst (P = 0.001), Dcs (P = 0.001), smoking (P = 0.007) and grade of the stenosis (P = 0.003) were significantly associated with restenosis. The sensitivity and specificity were 90.9% and 77.3%, respectively, when the cutoff value for Dst was 4 mm. Sensitivity and specificity were 72.7% and 100%, respectively, when the cutoff value for Dcs was 10 mm. Tracheal resection and anastomosis is an effective surgical method for treating postintubation tracheal stenosis. In our series, 91.1% of the patients with postintubation tracheal stenosis were successfully decannulated. Restenosis was the most common complication. The diameter of the narrowest part of the trachea (Dst), the distance between cricoid cartilage and stenosis (Dcs), smoking and grade of stenosis were significantly associated with restenosis. Address correspondence and reprint requests to Secaattin Gulsen, MD, Department of Otorhinolaryngology, Dr. Ersin Arslan Research and Training Hospital, Gaziantep, Turkey; E-mail: drsecaattingulsen@gmail.com Received 28 September, 2017 Accepted 11 March, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2wqfabu
https://ift.tt/2wqfabu
Deepening Fornix Technique Using Central Split-Medium Thickness Skin Graft to Treat Contracted Anophthalmic Sockets
Purpose: The aim of thhis study was to present the outcomes of postauricular split-medium thickness skin graft (SMTSG) to treat anophthalmic sockets with contracted fornices. Methods: This case series enrolled patients with grade 2 or 3 anophthalmic sockets between 2015 and 2016. Data were collected on patient demographics, objective and subjective parameters preoperatively and 180 days postoperatively. Success of the surgery was graded on the height of the graft, the depth of the superior and inferior fornices, and presence/abscence of lagophthalmos, entropion, and ability to retain an external prosthesis. Results: Eighteen patients were enrolled with a mean age of 35.9 ± 18 years. The median height of the graft was 22 mm (25% quartile = 18.75) when removed and 20 mm (25% quartile = 16) postoperatively. The median depth of the superior fornix was 6.5 mm (25% quartile = 4.5 mm) preoperatively and 10 mm (25% quartile = 8 mm) postoperatively (P = 0.5). The median inferior fornix depth was 7 mm (25% quartile = 3.5 mm) preoperatively and 8 mm (25% quartile = 5 mm) (P = 0.27) postoperatively. Preoperatively, there were 13 (72.2%) patients with lagophthalmos, 10 (44.4%) with entropion, 3 (37.5%) with poor prosthesis retention, and 5 (62.5%) who were unable to retain the prosthesis. Postoperatively, 7 (38.9%) patients had lagophthamos, 1 (5.6%) had entropion, and all the patients could retain the prosthesis. None of the sockets had a foul odor postoperatively. Conclusions: Postauricular SMTSG achieves successful outcomes for the treatment of contracted anophthalmic sockets, reshaping the anterior socket surface and deepening the fornices. Address correspondence and reprint requests to Alicia Galindo-Ferreiro, MD, PhD, Department of Ophthalmology, Rio Hortega University Hospital, Dulzaina St 2, Valladolid 47012, Spain; E-mail: ali_galindo@yahoo.es Received 6 December, 2017 Accepted 11 March, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2ItKZoo
https://ift.tt/2ItKZoo
Comparison of Piezosurgery and Hammer-Chisel in Endoscopic Dacryocystorhinostomy
Background: In this study, we compared the advantages and disadvantages of piezosurgery and hammer-chisel used in endoscopic dacryocystorhinostomy (EDCR). Material and Methods: Between January 2012 and January 2016, 10 women and 8 men in whom piezosurgery was used (group 1) and 11 women and 7 men in whom hammer-chisel was used (group 2) during EDCR operations were compared retrospectively. Recurrence, operation time, postoperative bleeding, and operative cost were evaluated in patients who were followed for an average of 11.8 months. In addition, visual analogue scale (VAS) was used to assess pain at 6 hours postoperatively. Results: No recurrence was observed in group 1, but recurrence was observed in 2 patients in group 2 (P = 0.685). There was no postoperative bleeding in both groups. The mean duration of operation was 30.6 ± 8.2 minutes in group 1 and 46.8 ± 9.5 minutes in group 2 (P = 0.038). The VAS score in group 1 was 2.7 ± 1.4 and the VAS score in group 2 was 5.8 ± 2.2 (P = 0.01). Piezosurgery costs an additional $325 for each patient while the use of the hammer-chisel does not incur additional costs. Conclusion: Piezosurgery causes shorter operation time, less recurrence, and less pain when compared with hammer-chisel. Address correspondence and reprint requests to Suphi Bulğurcu, MD, Sultan Abdülhamid Han Training and Research Hospital, Haydarpaşa, Istanbul 34500, Turkey; E-mail: suphibulg@yahoo.com Received 6 December, 2017 Accepted 11 March, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2IsijMB
https://ift.tt/2IsijMB
Surgical Management of the Recent Orbital War Injury
Maxillofacial trauma affects sensitive and essential functions for the human being such as smell, breathing, talking, and the most importantly the sight. Trauma to the orbit may cause a vision loss especially if this trauma yields a high kinetic energy like that encountered during wars. The purpose of the study was to evaluate the surgical outcomes of the orbital war trauma, enriching the literature with the experience of the authors in this field. A total of 16 patients were injured, evacuated, and managed, between June 2014 and June 2017, from the fight between the Iraqi army and the Islamic State of Iraq and Syria (ISIS) in different areas of Iraq. Two-stage protocol was adopted, that is debridement and reconstruction. There were 14 military patients and 2 civilians. The cause of trauma was either bullet or shrapnel from an explosion. In the battlefield, delayed evacuation of the casualties led to increase the morbidity and mortality. Wearing a protective shield over the eye during the war along with fast evacuation highly improved the survival rates. Address correspondence and reprint requests to Saif Saadedeen Abdulrazaq, BDS, FIBMS, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Baghdad, Bab-Almoadham, P.O. Box 1417, Baghdad, Iraq; E-mails: saifdento@gmail.com; drsaif.sa@codental.uobaghdad.edu.iq Received 9 November, 2017 Accepted 11 March, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2wCMNXJ
https://ift.tt/2wCMNXJ
Isolated Bilateral Macrostomia
Macrostomia (Tessier's 7 cleft) is a rare congenital lip deformity. Macrostomia can occur unilateral or bilateral, isolated or associated with other syndromes. Isolated bilateral macrostomia is exceedingly rare with only a few cases reported to date. The authors report 6 cases of isolated bilateral macrostomia surgically repaired in 4-layered approaches. The traditional method was improved and the result obtained was satisfactory after longest follow-up of 3 years. The technique is easy to imitate, simple in design, aesthetically and functionally corrects the deformity. Address correspondence and reprint requests to Guo-Qian Yin, PhD, Department of Plastic and Aesthetic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, People's Republic of China; E-mail: yinguoqian_007@hotmail.com Received 8 December, 2017 Accepted 16 March, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2IvyiJU
https://ift.tt/2IvyiJU
Congenital Calvarial Hemangioma
Objectives: The authors describe a case of congenital calvarial hemangioma successfully managed using propranolol therapy. Presenting symptoms, radiological and pathological features, differential diagnosis, and management of this rare congenital mass are described. Case Presentation: A 2-year-old boy presented with a 1-year history of a growing right parietal skull mass. No obvious etiology was apparent. No focal neurological deficits or associated craniofacial anomalies were identified. Plain film imaging demonstrated focal thickening of the right parietal bone with internal trabeculations in a sunburst appearance. Computed tomography (CT) scan showed bone thickening with coarsening of the bony trabeculae, minor irregularity of the outer table, unaffected inner table, and no evidence of aggressive features. A diagnostic biopsy of the lesion was performed in the operating room. Microscopic examination was consistent with hemangioma. Based on histological and radiological features of the lesion, it was identified as a cavernous hemangioma. Medical treatment utilizing propranolol was initiated for over 3 years with interval reduction in the lesion size. MRI head following treatment with propranolol demonstrated reduction of the mass compared to preoperative imaging. Conclusions: Although a rare entity, it is important to consider congenital calvarial hemangioma in the differential diagnosis of slow growing skull lesions due to the possibility of complications as a result of the hemangioma's intracranial extension, and the potential for treatment. En bloc resection has classically been described as a treatment for such lesions, although our case demonstrates that medical treatment with propranolol therapy may be appropriate in certain situations. Address correspondence and reprint requests to Adrianna Ranger, MD, FRCSC, Department of Paediatric Neurosurgery, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Rd. E, PO Box 5010, London, Ontario, Canada, N6A 5W9; E-mail: adrianna.ranger@lhsc.on.ca Received 27 August, 2017 Accepted 13 March, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2K8kzFT
https://ift.tt/2K8kzFT
Delayed Reduction of Zygomatic Arch Fracture: Effectiveness of the Rowe Zygoma Elevator
The zygomaticomaxillary complex fractures are common fractures among the all facial fractures, and the zygomatic arch fracture accounts for approximately 10% of all facial fractures. Various routes (Gillies app, Direct cutaneous app, Bicoronal, intraoral) and devices (Foley's ballon catheter, Rowe zygoma elevator, Langenbach, deschamps needle holder, Bone hook) for a surgical intervention of the zygomatic arch have been introduced. However, no study exists that has described an effective method of surgery for zygomatic arch fractures that have been left untreated for a long period, or for unstable reduction that have not been reduced >1 month after surgery. The authors describe the case of a 53-year-old female patient who was diagnosed an unstable reduction of the zygomatic arch, 6 weeks after undergone open reduction and internal fixation for a zygomaticomaxillary complex fracture. The authors had successful outcome for delayed reduction of a zygomatic arch fracture using a Rowe zygoma elevator. And the authors suggest that the Rowe zygoma elevator is an easy and effective method for delayed reduction of a zygomatic arch fracture. Address correspondence and reprint requests to Jinwoo Kim, PhD, Department of Reconstructive Surgery, Busan Paik Hospital, InJe University School of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea; E-mail: jinooda1971@naver.com Received 11 December, 2017 Accepted 16 March, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2IpOvAl
https://ift.tt/2IpOvAl
Εγγραφή σε:
Αναρτήσεις (Atom)