SS is diagnostically challenging due to clinical and immunologic features which overlap with other connective tissue diseases, SS patients with cutaneous vasculitis, especially cryoglobulinemic vasculitis, have worse prognosis with increased risk of systemic vasculitis and lymphoma. SS patients with photosensitive annular erythema tend to have milder systemic and glandular involvement, Characteristic cutaneous features of SS are early diagnostic signs correlating with prognosis.
https://ift.tt/2rXYP8f
Σάββατο 19 Μαΐου 2018
Cutaneous Features and Diagnosis of Primary Sjogren’s Syndrome: An Update and Review
Undifferentiated Pleomorphic Sarcoma: Factors Predictive of Adverse Outcomes
Undifferentiated pleomorphic sarcoma (UPS) embodies various spindle cell tumors; we sought to identify those with aggressive behavior, Invasion beyond subcutaneous fat and tumor size >2 cm predicted more aggressive behavior, We propose subcategorization to superficial and deep UPS
https://ift.tt/2kbOHp9
Medical and Preoperative Evaluation of the Older Adult
Because of age, increased rates of multimorbidity, polypharmacy, functional changes, and cognitive impairment, older adults are at higher risk for perioperative complications. Identifying modifiable risk factors and educating patients and families about what to expect can improve surgical outcomes and satisfaction. Comprehensive preoperative evaluation assesses these potential factors and should include recommendations for risk reduction. The optimal preoperative evaluation for older adults should address medical conditions and other areas pertinent to the care of older adults including assessments of cognition, capacity, delirium risk, function, frailty, nutrition, medications, and treatment preferences.
https://ift.tt/2LeneiL
Corseting: a new technique for the management of diffuse venous malformations in the head and neck region
A new surgical technique of intra-tumoural ligation for the treatment of low-flow vascular malformations in the head and neck region is proposed. Ninety patients with diffuse low-flow vascular malformations diagnosed clinically and/or radiologically were treated surgically with the corset suturing technique. All patient records and clinical photographs were reviewed retrospectively. Significant clinical results were obtained: a reduction of the turnout tumour mass and a return of the regional facial outline was evident within 4 weeks after surgery.
https://ift.tt/2Iud6Vk
Fas/FasL interaction mediates imbalanced cytokine/cytotoxicity responses of iNKT cells against Jurkat cells
Publication date: July 2018
Source:Molecular Immunology, Volume 99
Author(s): Rui Dou, Zhenya Hong, Xiaosheng Tan, Fenfen Hu, Yajie Ding, Wei Wang, Zhihui Liang, Rongrong Zhong, Xiongwen Wu, Xiufang Weng
The rapid antitumor cytokine production and direct cytotoxicity confer invariant NKT (iNKT) cells ideal candidates for cancer therapy. However, the therapeutic potential of iNKT cells in T-cell malignant diseases remains elusive, as antigen presentation by T cells (T-T presentation) has been suggested to induce hyporesponsiveness of iNKT cells. In this study, we found discrepancies in iNKT cell responses against two T cell-origin cell lines (Jurkat and Molt-4). Human iNKT cells exhibited more intensive cytotoxicity and less efficient cytokine production in response to Fas-bearing Jurkat cells than those to the Fas-negative tumor cells (Molt-4 and myeloid-derived K562). The imbalanced cytokine/cytotoxicity responses of iNKT cells against Jurkat cells were CD1d-dependent and relied mostly on Fas/FasL interaction. The impairment in cytokine production could be overcome by Fas/FasL blocking antibodies and exogenous IL-2. Elevated CD1d levels as well as CD1d and Fas co-localization were found in T-cell lymphomas. However, defects in frequency and function of circulating iNKT cells were observed in the patients, which could be partly rescued by exogenous IL-2. Collectively, the Fas/FasL-dependent aberrant iNKT cell responses and the reversibility of the defects suggest the distinct iNKT cell manipulation in CD1d- and Fas-bearing T cell malignancies.
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Genome-wide analysis reveals TNFAIP8L2 as an immune checkpoint regulator of inflammation and metabolism
Publication date: July 2018
Source:Molecular Immunology, Volume 99
Author(s): Ting Li, Wei Wang, Shunyou Gong, Honghong Sun, Huqin Zhang, An-Gang Yang, Youhai H. Chen, Xinyuan Li
The interplay between inflammation and metabolism is widely recognized, yet the underlying molecular mechanisms remain poorly characterized. Using experimental database mining and genome-wide gene expression profiling methods, we found that in contrast to other TNFAIP8 family members, TNFAIP8L2 (TIPE2) was preferentially expressed in human myeloid cell types. In addition, Tnfaip8l2 expression drastically decreased in lipopolysaccharide (LPS)-stimulated macrophages. Consequently, Tnfaip8l2 deficiency led to heightened expression of genes that were enriched for leukocyte activation and lipid biosynthesis pathways. Furthermore, mitochondrial respiration rate was increased in Tnfaip8l2-deficient macrophages, as measured by Seahorse metabolic analyzer. Taken together, these results indicate that Tnfaip8l2 serves as a "brake" for immunometabolism, which needs to be released for optimized metabolic reprogramming as well as mounting effective inflammatory responses. The unique anti-inflammatory and metabolic-modulatory function of TNFAIP8L2 renders it a novel therapeutic target for cardiovascular diseases and cancer.
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Operative technique for benign submandibular gland mass without identifying the mandibular branch of the facial nerve
The marginal mandibular branch of the facial nerve must be protected during surgery for benign diseases of submandibular gland. Methods for protecting the marginal mandibular branch include the nerve identification method and the non-identification method.
https://ift.tt/2Iw7S7v
Steroid pulse therapy transiently destroys the discriminative histological structure of tonsils in IgA nephropathy: Tonsillectomy should be performed before or just after steroid pulse therapy
Tonsillectomy combined with steroid-pulse therapy is a widely accepted method for the treatment of IgA nephropathy (IgAN) in Japan. However, the indication of tonsillectomy for IgAN is still controversial, and the timing of tonsillectomy is not clearly defined for the protocol of this therapy. Based on the results of a randomized control trial in Japan, the Evidence-Based Clinical Practice Guidelines for IgA nephropathy 2014 (edited in Japan) recommended tonsillectomy combined with steroid-pulse therapy for Grade C1.
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Concurrence of symmetrical peripheral gangrene and venous limb gangrene following polytrauma: a case report
Symmetrical peripheral gangrene is characterized as acral (distal extremity) ischemic limb injury affecting two or more extremities, without large vessel obstruction, typically in a symmetrical fashion. Risk f...
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Sirolimus Gel vs Placebo for Facial Angiofibromas in Patients With Tuberous Sclerosis Complex
This randomized clinical trial assesses the efficacy and safety of sirolimus gel, 0.2% vs placebo for treatment of angiofibromas and skin lesions in adult and pediatric patients with tuberous sclerosis complex.
https://ift.tt/2k8001l
https://ift.tt/2k8001l
A comprehensive review on green nanomaterials using biological systems: Recent perception and their future applications
Publication date: Available online 19 May 2018
Source:Colloids and Surfaces B: Biointerfaces
Author(s): Rijuta Ganesh Saratale, Indira Karuppusamy, Ganesh Dattatraya Saratale, Arivalagan Pugazhendhi, Gopalakrishanan Kumar, Yooheon Park, Gajanan S. Ghodake, Ram Naresh Bhargava, J. Rajesh Banu, Han Seung Shin
Over the last few years, nanotechnology is increasingly developing in scientific sector, which has attracted a great deal of interest because of its abundant applications in almost all the areas. In recent times, green nanotechnology is a relative and multidisciplinary field that has emerged as a rapidly developing research area. This is serving as an important technique that spotlight on making the procedure which are clean, safe and in particular environtmentally friendly, in a gap with the currently employed methods such as chemical and physical methods for nanosynthesis. The present review recaps the existing knowledge on various biogenic synthesis methods relying on bacteria, fungi, yeast, algae, viruses and on using biomolecules. The green nanosynthesis refers to the employment of reducing and stabilizing agents from plants and other natural resources, to fabricate nanomaterials. The green synthesis method does not engage the use of exceedingly venomous chemicals or elevated energy inputs during the synthesis. Nanoparticles (NPs) with distinct shapes, sizes and bioactivity can be produced from the variations in the bio-reducing agents employed for nanosynthesis. Hence, this review article summarizes the present information regarding the biological methods which are employed to fabricate greener, safer, and environmentally sustainable nanosynthesis routes. This review mainly highlights the wide-scale fabrication of NPs via green synthesis for biomedical and agricultural applications.
Graphical abstract
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Randomized phase II trial of cixutumumab alone or with cetuximab for refractory recurrent/metastatic head and neck squamous cell carcinoma
Publication date: July 2018
Source:Oral Oncology, Volume 82
Author(s): Renata Ferrarotto, William N. William, Jennifer E. Tseng, Shanthi Marur, Dong M. Shin, Barbara Murphy, Ezra E.W. Cohen, Christopher Y. Thomas, Richard Willey, Jan Cosaert, Nusrat Harun, J. Jack Lee, Ignacio W. Wistuba, Robert I. Haddad, Bonnie S. Glisson
ObjectivesCixutumumab (CIX) and cetuximab (CET) monoclonal antibodies block ligand-binding to insulin-like growth factor-1 receptor (IGF-1R) and epidermal growth factor receptor (EGFR) respectively. The objective of this study was to assess the efficacy of CIX alone or combined with CET in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) patients.MethodsIn this open-label phase II trial, 91 R/M HNSCC patients who progressed within 90 days of platinum-based chemotherapy, were randomized to CIX 10 mg/kg alone or with CET 500 mg/m2 every 2 weeks. Patients were stratified by prior CET use. The primary endpoint was median progression-free survival (PFS). Exploratory biomarker assessments included relevant markers on archival tumor and serial cytokine/angiogenic-factor profiles in blood.ResultsForty-seven patients were treated with CIX monotherapy and 44 with combination. The median PFS was 1.9 and 2.0 months and clinical benefit rate (complete or partial responses and stable disease) was 5.9% and 15.3%, respectively. There was no exacerbation of CET toxicity by concurrent CIX exposure. Higher tumor expression of IGF-1 was associated with improved PFS in the CIX + CET arm while increased p-EGFR expression correlated with shorter PFS in patients receiving single agent CIX. Higher serum baseline levels of IGF-1 and IGFBP-3 correlated with improved PFS and overall survival (OS) in the CIX arm. Neither regimen resulted in improved PFS or OS compared to historical data with CET alone.ConclusionThe results of this study do not support the use of cixutumumab alone or with cetuximab in unselected patients with R/M HNSCC.
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Clinical Thyroidology®for the Public – Highlighted Article
From Clinical Thyroidology® for the Public: Radioactive iodine therapy is an important part of the treatment of advanced thyroid cancer. Read More…
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Development of a Novel Self-administered Cognitive Assessment Tool and Normative Data for Older Adults
Background: Preexisting cognitive impairment in surgical patients is one of the leading risk factors for adverse cognitive outcomes such as postoperative delirium and postoperative cognitive dysfunction. We developed a self-administered tablet computer application intended to assess the individual risk for adverse postoperative cognitive outcomes. This cross-sectional study aimed to establish normative data for the tool. Materials and Methods: Healthy volunteers aged 65 years and above were administered the Mini-Mental State Examination, Geriatric Depression Scale, and Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological Assessment Battery to assess cognitive health. All subjects completed the tablet computer application without assistance. Primary outcome measure was the test performance. Regression models were built for each cognitive domain score with the covariates age, sex, and education in cognitively healthy subjects. Demographically adjusted standard scores (z-scores) were computed for each subtest. Results: A total of 283 participants (155 women, 128 men) were included in the final analysis. Participants' age was 73.8±5.2 years (mean±SD) and their level of education was 13.6±2.9 years. Mini-Mental State Examination score was 29.2±0.9 points, Geriatric Depression Scale score was 0.4±0.7 points, and Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological Assessment Battery total score was 98.7±5.7 points. Older age was associated with poorer performance in the visual recognition task and in Trail Making Test B (P
https://ift.tt/2rPhGDl
https://ift.tt/2rPhGDl
Glasgow Coma Scale Score Fluctuations are Inversely Associated With a NIRS-based Index of Cerebral Autoregulation in Acutely Comatose Patients
Background: The Glasgow Coma Scale (GCS) is an essential coma scale in critical care for determining the neurological status of patients and for estimating their long-term prognosis. Similarly, cerebral autoregulation (CA) monitoring has shown to be an accurate technique for predicting clinical outcomes. However, little is known about the relationship between CA measurements and GCS scores among neurological critically ill patients. This study aimed to explore the association between noninvasive CA multimodal monitoring measurements and GCS scores. Methods: Acutely comatose patients with a variety of neurological injuries admitted to a neurocritical care unit were monitored using near-infrared spectroscopy–based multimodal monitoring for up to 72 hours. Regional cerebral oxygen saturation (rScO2), cerebral oximetry index (COx), GCS, and GCS motor data were measured hourly. COx was calculated as a Pearson correlation coefficient between low-frequency changes in rScO2 and mean arterial pressure. Mixed random effects models with random intercept was used to determine the relationship between hourly near-infrared spectroscopy–based measurements and GCS or GCS motor scores. Results: A total of 871 observations (h) were analyzed from 57 patients with a variety of neurological conditions. Mean age was 58.7±14.2 years and the male to female ratio was 1:1.3. After adjusting for hemoglobin and partial pressure of carbon dioxide in arterial blood, COx was inversely associated with GCS (β=−1.12, 95% confidence interval [CI], −1.94 to −0.31, P=0.007) and GCS motor score (β=−1.06, 95% CI, −2.10 to −0.04, P=0.04). In contrast rScO2 was not associated with GCS (β=−0.002, 95% CI, −0.01 to 0.01, P=0.76) or GCS motor score (β=−0.001, 95% CI, −0.01 to 0.01, P=0.84). Conclusions: This study showed that fluctuations in GCS scores are inversely associated with fluctuations in COx; as COx increases (impaired autoregulation), more severe neurological impairment is observed. However, the difference in COx between high and low GCS is small and warrants further studies investigating this association. CA multimodal monitoring with COx may have the potential to be used as a surrogate of neurological status when the neurological examination is not reliable (ie, sedation and paralytic drug administration). C.W.H. receives research funding from Medtronic/Covidien, Dublin, IR. C.W.H. is the PI on an NIH-sponsored clinical study (R01 HL 92259) and he serves as a consultant to Medtronic/Covidien and Ornim Medical Inc., Foxborough, MA. L.R.-L. is the PI on an American Academy of Neurology/American Brain Foundation, Covidien/Metronic, and Ornim grant. The remaining authors have no conflicts of interest to disclose. Address correspondence to: Ryan J. Healy, BSc, Departments of Neurology, Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, 600 N Wolfe Street, Phipps 455, Baltimore, MD 21287 (e-mail: ryanhealy@comcast.net). Received November 21, 2017 Accepted April 19, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved
https://ift.tt/2IzG81R
https://ift.tt/2IzG81R
Rehabilitación del paciente laringectomizado. Recomendaciones de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello
Publication date: Available online 18 May 2018
Source:Acta Otorrinolaringológica Española
Author(s): Pedro Díaz de Cerio Canduela, Ismael Arán González, Rafael Barberá Durban, Alexander Sistiaga Suárez, Marc Tobed Secall, Pablo L. Parente Arias
La laringectomía total permanece como tratamiento fundamental para el carcinoma de laringe localmente avanzado asociándose a una mayor supervivencia. Sin embargo, supone para el paciente una serie de cambios, como la incapacidad de comunicarse verbalmente, la respiración o el cambio estético, que inciden en su calidad de vida y obligan a su rehabilitación integral.El presente documento ha sido elaborado por el grupo de trabajo de rehabilitación del paciente laringectomizado de la Comisión de Cabeza y Cuello y Base de Cráneo de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello con el objeto de unificar las recomendaciones sobre materiales, técnicas y medidas que aúnen la rehabilitación integral del paciente sometido a una laringectomía total para la mejora de su calidad de vida y está destinado a especialistas en otorrinolaringología, a profesionales relacionados con el cuidado del paciente laringectomizado total y también a los propios pacientes.Las recomendaciones del documento tienen como objetivo mejorar la atención del paciente al cual se le ha realizado una laringectomía total teniendo en cuenta las necesidades de personal y material, las consideraciones sobre los procedimientos necesarios antes de la cirugía, durante el propio acto quirúrgico y tras el alta hospitalaria del paciente. Se dan también recomendaciones específicas sobre los tipos de rehabilitación y seguimiento de la misma, así como la necesidad de llevar un registro de dichas actividades.Las recomendaciones expuestas pretenden ayudar a los profesionales sanitarios relacionados con el tratamiento de los pacientes laringectomizados totales a llevar a cabo la tarea de hacer que la vida de estos pacientes sea lo más parecida posible a la vida que llevaban antes de realizarse una laringectomía total.Total laryngectomy remains essential treatment for locally advanced laryngeal carcinoma, related to better survival rates. However, it involves changes for the patient, such as the inability to communicate verbally, breathing or aesthetic changes, which affect their quality of life and require comprehensive rehabilitation.This paper was written by the total laryngectomy rehabilitation workgroup of the National Head and Neck and Skull Base working committee of the Spanish Society of Otolaryngology and Head and Neck Surgery. The purpose of the article is to combine materials, surgical procedures and means towards the comprehensive rehabilitation of total laryngectomy patients, so that they can achieve a good quality of life. This paper is aimed at all health care professionals caring for total laryngectomy patients. It is also aimed at the patients themselves, as well as ENT surgeons.We have considered staffing and material needs, all procedures before, during and after surgery and after hospital discharge. There are also detailed recommendations about types of rehabilitation and follow-up, and the need for recording these events.The comprehensive rehabilitation total laryngectomy patients is very important if we want to improve their quality of life. The recommendations we mention aim to help the healthcare professionals involved in the treatment of total laryngectomy patients to help them achieve a good quality of life, as similar as possible to the life they led before surgery.
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Resultados auditivos del sistema activo de conducción ósea Bonebridge® en hipoacusias conductivas o mixtas
Publication date: Available online 18 May 2018
Source:Acta Otorrinolaringológica Española
Author(s): Claudio Carnevale, Guillermo Til-Pérez, Diego J. Arancibia-Tagle, Manuel D. Tomás-Barberán, Pedro L. Sarría-Echegaray
ObjetivoEl implante activo de conducción ósea transcutáneo Bonebridge® está indicado en pacientes con hipoacusia conductiva/mixta bilateral o en casos de hipoacusia neurosensorial unilateral, mostrando resultados auditivos similares a otros dispositivos percutáneos de conducción ósea pero con menor tasa de complicaciones. El objetivo del siguiente trabajo ha sido analizar los resultados auditivos en una serie de 26 pacientes con hipoacusia conductiva/mixta tratados con Bonebridge®.MétodosVeintiséis de un total de 30 pacientes implantados con Bonebridge® entre octubre 2012 y mayo 2017 fueron incluidos en el estudio. Se compararon los umbrales de vía aérea a las frecuencias 500, 1.000, 2.000, 3.000 y 4.000Hz, umbral de reconocimiento verbal 50% y el porcentaje de aciertos a 50dB sin y con el implante.ResultadosEl umbral tonal medio en campo libre con el dispositivo en funcionamiento fue de 34,91dB, obteniendo unas ganancias medias de 33,46dB. La SRT 50% media con el implante fue de 34,33dB mientras que sin él nadie alcanzaba el 50% de aciertos a una intensidad de hasta 50dB. Con respecto al porcentaje de aciertos a 50dB, mejoró desde un 11% sin implante a un 85% con el mismo. Entre las complicaciones solo se observó un caso de extrusión del dispositivo en una paciente con antecedentes de 2 ritidoplastias previas.ConclusionesLos resultados audiológicos obtenidos en nuestro estudio son similares a los publicados en la literatura. Bonebridge® representa una excelente alternativa en el tratamiento de la hipoacusia conductiva/mixta, pero con una tasa menor de complicaciones.ObjectiveThe active transcutaneous bone conduction implant Bonebridge®, is indicated for patients affected by bilateral conductive/mixed hearing loss or unilateral sensorineural hearing loss, showing hearing outcomes similar to other percutaneous bone conduction implants, but with a lower rate of complications. The aim of this study was to analyze the hearing outcomes in a series of 26 patients affected by conductive or mixed hearing loss and treated with Bonebridge®.Methods26 of 30 patients implanted with Bonebridge® between October 2012 and May 2017, were included in the study. We compared the air conduction thresholds at the frequencies 500, 1000, 2000, 3000, 4000Hz, the SRT50% and the percentage of correct answers at an intensity of 50dB with and without the implant.Results"Pure tone average" with the implant was 34.91dB showing an average gain of 33.46dB. Average SRT 50% with the implant was 34.33dB, whereas before the surgery no patient achieved 50% of correct answers at a sound intensity of 50dB. The percentage of correct answers at 50dB changed from 11% without the implant to 85% with it. We only observed one complication consisting of an extrusion of the implant in a patient with a history of 2 previous rhytidectomies.ConclusionsThe hearing outcomes obtained in our study are similar to those published in the literature. Bonebridge® represents an excellent alternative in the treatment of conductive or mixed hearing loss, and with a lower rate of complications.
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Manejo de las epistaxis graves y/o refractarias
Publication date: Available online 19 May 2018
Source:Acta Otorrinolaringológica Española
Author(s): Patricia García-Cabo, Laura Fernández-Vañes, Daniel Pedregal, Marta Menéndez del Castro, Eduardo Murias, Pedro Vega, José Luis Llorente, Juan Pablo Rodrigo, Fernando López
Introducción y objetivosEl objetivo fue determinar los resultados del tratamiento de las epistaxis graves y/o refractarias que requirieron ingreso hospitalario. Además se compararon los resultados del tratamiento mediante ligadura arterial o embolización.Material y métodoSe incluyeron de forma prospectiva 63 pacientes con epistaxis grave y/o refractaria que requirieron ingreso hospitalario entre agosto de 2014 y diciembre de 2016.ResultadosEn 11 pacientes (17%) se realizó embolización, 5 (8%) fueron intervenidos mediante endoscopia y en los 47 restantes (75%) se realizó tratamiento conservador. La edad media de los pacientes en los que las medidas conservadoras fueron suficientes fue de 72 años, mientras que la edad de aquellos tratados con embolización fue de 71 años y de los que fueron intervenidos quirúrgicamente fue de 53 años. En los pacientes sometidos a tratamiento conservador o a cirugía la estancia media fue de 6 días, frente a 9 días en aquellos en los que se realizó embolización. Un paciente sufrió un ictus hemisférico tras la embolización. No se observaron complicaciones posquirúrgicas.ConclusionesLa mayoría de los pacientes con epistaxis graves y/o refractarias se resuelven mediante taponamiento convencional. El tratamiento mediante ligadura arterial está asociado a una disminución de la estancia hospitalaria, sin observarse complicaciones graves. Es aconsejable disponer de todas las opciones terapéuticas posibles para lo cual la presencia de radiólogos intervencionistas y cirujanos experimentados es fundamental para evitar complicaciones y decidir el tratamiento a realizar de forma individual en cada paciente.ObjectiveThe objective was to determine the results of the treatment of severe and/or refractory epistaxis requiring hospital admission. In addition, the results of arterial ligation versus embolization were compared.Material and methodSixty-three patients with severe and/or refractory epistaxis requiring hospital admission between August 2014 and December 2016 were included prospectively.ResultsEleven patients (17%) underwent embolization, 5 (8%) endoscopy ligation and the remaining 47 (75%) underwent conservative treatment with tamponade. The mean age of the patients in which conservative measures were sufficient was 72 years, while the age of those treated with embolization was 71 years and of those who underwent surgery was 53 years. For the patients who underwent conservative treatment or surgery, the average stay was 6 days, compared to 9 days for those who underwent embolization. One patient suffered a hemispheric stroke after embolization. No post-surgical complications were observed.ConclusionsMost cases of severe and/or refractory epistaxis are resolved by conventional tamponade. Endoscopy ligation is associated with a decrease in hospital stay, without serious complications. It is advisable to have all the possible therapeutic options available, for which the presence of interventional radiologists and experienced surgeons is essential to avoid complications and decide the treatment to be performed individually for each patient.
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Frozen in Time: A History of the Synthesis of Nitrous Oxide and How the Process Remained Unchanged for Over 2 Centuries
Three major factors have contributed to the unrivaled popularity of nitrous oxide (N2O) among anesthetists in the 20th century and beyond: its impressive safety profile, its affordability, and its rapid induction and emergence times. These 3 characteristics of N2O have been discussed and written about extensively throughout the medical literature. Nonetheless, the characteristic that contributed most to N2O's initial discovery—the elegance and simplicity of its synthesis—has received substantially less attention. Although N2O was first used as an anesthetic in Hartford, CT, in 1844, it had been identified and synthesized as a distinct gas in the late 18th century. In this article, we track the developments in the recognition and early synthesis of N2O, highlight the major players credited with its discovery, and examine its evolution from the late 1700s to today. The discovery and assimilation of N2O into common medical practice, alongside ether and chloroform, heralded a new paradigm in surgical medicine—one that no longer viewed pain as a fundamental component of surgical medicine. Its continued usage in modern medicine speaks to the brilliance and skill of the chemists and scientists involved in its initial discovery. Accepted for publication March 30, 2018. Funding: Intramural. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Manisha S. Desai, MD, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655. Address e-mail to manisha.desai@umassmemorial.org. © 2018 International Anesthesia Research Society
https://ift.tt/2ItL24h
https://ift.tt/2ItL24h
Understanding Conflict Management Styles in Anesthesiology Residents
BACKGROUND: Successful conflict resolution is vital for effective teamwork and is critical for safe patient care in the operating room. Being able to appreciate the differences in training backgrounds, individual knowledge and opinions, and task interdependency necessitates skilled conflict management styles when addressing various clinical and professional scenarios. The goal of this study was to assess conflict styles in anesthesiology residents via self- and counterpart assessment during participation in simulated conflict scenarios. METHODS: Twenty-two first-year anesthesiology residents (first postgraduate year) participated in this study, which aimed to assess and summarize conflict management styles by 3 separate metrics. One metric was self-assessment with the Thomas-Kilmann Conflict Mode Instrument (TKI), summarized as percentile scores (0%–99%) for 5 conflict styles: collaborating, competing, accommodating, avoiding, and compromising. Participants also completed self- and counterpart ratings after interactions in a simulated conflict scenario using the Dutch Test for Conflict Handling (DUTCH), with scores ranging from 5 to 25 points for each of 5 conflict styles: yielding, compromising, forcing, problem solving, and avoiding. Higher TKI and DUTCH scores would indicate a higher preference for a given conflict style. Sign tests were used to compare self- and counterpart ratings on the DUTCH scores, and Spearman correlations were used to assess associations between TKI and DUTCH scores. RESULTS: On the TKI, the anesthesiology residents had the highest median percentile scores (with first quartile [Q1] and third quartile [Q3]) in compromising (67th, Q1–Q3 = 27–87) and accommodating (69th, Q1–Q3 = 30–94) styles, and the lowest scores for competing (32nd, Q1–Q3 = 10–57). After each conflict scenario, residents and their counterparts on the DUTCH reported higher median scores for compromising (self: 16, Q1–Q3 = 14–16; counterpart: 16, Q1–Q3 = 15–16) and problem solving (self: 17, Q1–Q3 = 16–18; counterpart: 16, Q1–Q3 = 16–17), and lower scores for forcing (self: 13, Q1–Q3 = 10–15; counterpart: 13, Q1–Q3 = 13–15) and avoiding (self: 14, Q1–Q3 = 10–16; counterpart: 14.5, Q1–Q3 = 11–16). There were no significant differences (P > .05) between self- and counterpart ratings on the DUTCH. Overall, the correlations between TKI and DUTCH scores were not statistically significant (P > .05). CONCLUSIONS: Findings from our study demonstrate that our cohort of first postgraduate year anesthesiology residents predominantly take a more cooperative and problem-solving approach to handling conflict. By understanding one's dominant conflict management style through this type of analysis and appreciating the value of other styles, one may become better equipped to manage different conflicts as needed depending on the situations. Accepted for publication April 4, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Brenda G. Fahy, MD, MCCM, Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Rd, PO Box 100254, Gainesville, FL 32610. Address e-mail to bfahy@anest.ufl.edu. © 2018 International Anesthesia Research Society
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https://ift.tt/2wVuZqS
Evaluating Patient-Centered Outcomes in Clinical Trials of Procedural Sedation, Part 2 Safety: Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research Recommendations
The Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research, established by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks, a public–private partnership with the US Food and Drug Administration, convened a second meeting of sedation experts from a variety of clinical specialties and research backgrounds to develop recommendations for procedural sedation research. The previous meeting addressed efficacy and patient- and/or family-centered outcomes. This meeting addressed issues of safety, which was defined as "the avoidance of physical or psychological harm." A literature review identified 133 articles addressing safety measures in procedural sedation clinical trials. After basic reporting of vital signs, the most commonly measured safety parameter was oxygen saturation. Adverse events were inconsistently defined throughout the studies. Only 6 of the 133 studies used a previously validated measure of safety. The meeting identified methodological problems associated with measuring infrequent adverse events. With a consensus discussion, a set of core and supplemental measures were recommended to code for safety in future procedural clinical trials. When adopted, these measures should improve the integration of safety data across studies and facilitate comparisons in systematic reviews and meta-analyses. Accepted for publication March 5, 2018. Funding: None. 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). The views expressed in this article are those of the authors, none of whom has financial conflicts of interest specifically related to the issues discussed. At the time of the meeting (November 17–19, 2016) on which this article is based, several authors were employed by a pharmaceutical company or had received consulting fees or honoraria from 1 or more pharmaceutical or device companies. The authors of this article who were not employed by industry at the time of the meeting received (or their universities received) travel stipends, hotel accommodations, and meals during the meeting from the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public–private partnership. No official endorsement by the US Food and Drug Administration or the pharmaceutical and device companies that have provided unrestricted grants to support the activities of ACTTION should be inferred. Financial support for this project was provided by ACTTION, which has received research contracts, grants, or other revenue from the US Food and Drug Administration, multiple pharmaceutical and device companies, philanthropy, and other sources. Reprints will not be available from the authors. Address correspondence to Denham S. Ward, MD, PhD, Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 604, Rochester, NY 14642. Address e-mail to Denham_Ward@URMC.Rochester.edu. © 2018 International Anesthesia Research Society
https://ift.tt/2wTKVK5
https://ift.tt/2wTKVK5
The Impact of Anesthesia-Influenced Process Measure Compliance on Length of Stay: Results From an Enhanced Recovery After Surgery for Colorectal Surgery Cohort
BACKGROUND: Process measure compliance has been associated with improved outcomes in enhanced recovery after surgery (ERAS) programs. Herein, we sought to assess the impact of compliance with measures directly influenced by anesthesiology in an ERAS for colorectal surgery cohort. METHODS: From January 2013 to April 2015, data from 1140 consecutive patients were collected for all patients before (pre-ERAS) and after (ERAS) implementation of an ERAS program. Compliance with 9 specific process measures directly influenced by the anesthesiologist or acute pain service was analyzed to determine the impact on hospital length of stay (LOS). RESULTS: Process measure compliance was associated with a stepwise reduction in LOS. Patients who received >4 process measures (high compliance) had a significantly shorter LOS (incident rate ratio [IRR], 0.77; 95% CI, 0.70–0.85); P
https://ift.tt/2ItKtrb
https://ift.tt/2ItKtrb
Population Pharmacokinetics and Pharmacodynamics of Dexmedetomidine in Children Undergoing Ambulatory Surgery
BACKGROUND: Dexmedetomidine (DEX) is an α-2 adrenergic agonist with sedative and analgesic properties. Although not approved for pediatric use by the Food and Drug Administration, DEX is increasingly used in pediatric anesthesia and critical care. However, very limited information is available regarding the pharmacokinetics of DEX in children. The aim of this study was to investigate DEX pharmacokinetics and pharmacodynamics (PK–PD) in Mexican children 2–18 years of age who were undergoing outpatient surgical procedures. METHODS: Thirty children 2–18 years of age with American Society of Anesthesiologists physical status score of I/II were enrolled in this study. DEX (0.7 µg/kg) was administered as a single-dose intravenous infusion. Venous blood samples were collected, and plasma DEX concentrations were analyzed with a combination of high-performance liquid chromatography and electrospray ionization-tandem mass spectrometry. Population PK–PD models were constructed using the Monolix program. RESULTS: A 2-compartment model adequately described the concentration–time relationship. The parameters were standardized for a body weight of 70 kg by using an allometric model. Population parameters estimates were as follows: mean (between-subject variability): clearance (Cl) (L/h × 70 kg) = 20.8 (27%); central volume of distribution (V1) (L × 70 kg) = 21.9 (20%); peripheral volume of distribution (V2) (L × 70 kg) = 81.2 (21%); and intercompartmental clearance (Q) (L/h × 70 kg) = 75.8 (25%). The PK–PD model predicted a maximum mean arterial blood pressure reduction of 45% with an IC50 of 0.501 ng/ml, and a maximum heart rate reduction of 28.9% with an IC50 of 0.552 ng/ml. CONCLUSIONS: Our results suggest that in Mexican children 2–18 years of age with American Society of Anesthesiologists score of I/II, the DEX dose should be adjusted in accordance with lower DEX clearance. 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. Accepted for publication March 27, 2018. Funding: None. 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 Gustavo Lugo-Goytia, PhD, Departamento de Anestesiología y Medicina Crítica, Instituto Nacional de Ciencias Médicas y Nutrición, México; and Respiratory Intensive Care Unit, Instituto Nacional de Enfermedades Respiratorias, México. Address e-mail to lugogoy@yahoo.com.mx. © 2018 International Anesthesia Research Society
https://ift.tt/2wXObnG
https://ift.tt/2wXObnG
Benefit and Harm of Adding Epinephrine to a Local Anesthetic for Neuraxial and Locoregional Anesthesia: A Meta-analysis of Randomized Controlled Trials With Trial Sequential Analyses
BACKGROUND: This systematic review examines the benefit and harm of adding epinephrine to local anesthetics for epidural, intrathecal, or locoregional anesthesia. METHODS: We searched electronic databases to October 2017 for randomized trials comparing any local anesthetic regimen combined with epinephrine, with the same local anesthetic regimen without epinephrine, reporting on duration of analgesia, time to 2 segments regression, or any adverse effects. Trial quality was assessed using the Cochrane risk of bias tool and a random-effects model was used. Trial sequential analyses (TSA) were applied to identify the information size (IS; number of patients needed to reach a definite conclusion) and were set to detect an increase or decrease of effect of 30%–50%, depending on the end point considered. Alpha levels were adjusted (1%) for multiple outcome testing. RESULTS: We identified 70 trials (3644 patients, 17 countries, from 1970 to 2017). Median number of patients per trial was 44 (range, 9–174). Thirty-seven trials (1781 patients) tested epinephrine for epidural, 27 (1660) for intrathecal, and 6 (203) for locoregional anesthesia (sciatic, femoral, popliteal, axillary blocks). TSA enabled us to conclude that adding epinephrine to epidural local anesthetics could not decrease postoperative pain intensity by 30%, and did not impact the risk of intraoperative arterial hypotension. IS was insufficient to conclude on the impact of epinephrine on the risk of motor block (IS, 4%), arterial hypotension (20%), urinary retention (23%), or pain intensity at rest (27%) during labor. TSA confirmed that adding epinephrine to intrathecal local anesthetics increased the duration of motor block (weighted mean difference [WMD] 64 minutes; 99% CI, 37–91), analgesia (WMD 34 minutes; 99% CI, 6–62), and the time to 2 segments regression (WMD 20 minutes; 99% CI, 11–28). IS was insufficient to conclude on its impact on arterial hypotension (IS, 15%), or when administrated in a combined spinal-epidural, on motor block (IS, 11%) or arterial hypotension (IS, 11%). Adding epinephrine to local anesthetics for a locoregional block increased the duration of analgesia (WMD 66 minutes; 98% CI, 32–100]). CONCLUSIONS: Adding epinephrine to intrathecal or locoregional local anesthetics prolongs analgesia and motor block by no more than 60 minutes. The impact of adding epinephrine to epidural local anesthetics or to a combined spinal-epidural remains uncertain. Accepted for publication March 27, 2018. Funding: None. 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). Protocol registration: International prospective register of systematic reviews (PROSPERO) (CRD: 42015026148). Reprints will not be available from the authors. Address correspondence to Clément Tschopp, MD, MSc, Division of Anesthesiology, University Hospital of Zürich, Rämistrasse 100, Zürich CH-8091, Switzerland. Address e-mail to clement.tschopp@usz.ch. © 2018 International Anesthesia Research Society
https://ift.tt/2KDZseY
https://ift.tt/2KDZseY
Laser-speckle imaging to measure tissue perfusion in free flaps in oral and maxillofacial surgery: a potentially exciting and easy to use monitoring method
Publication date: Available online 18 May 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): P.A. Brennan, M.T. Brands, R. Gush, P. Alam
https://ift.tt/2wTTW5P
New approach to the reconstruction of defects deep in the orbital roof
Publication date: Available online 18 May 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): N. Shah, S. Kassam, M. Perry, K. Tsang
https://ift.tt/2IOIFIX
Chromomycose cutanée étendue : efficacité de l’association terbinafine et cryothérapie
Publication date: Available online 17 May 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): Y. Elkhachine, J. Elbenaye, M. Er-Rami, A. Sakkah, A. Jakar, M. Elhaouri
IntroductionLa chromomycose est une infection cutanée fongique chronique touchant principalement les membres. Rarement décrite au Maroc, elle est responsable d'une morbidité lourde et son traitement est long et souvent décevant. Nous en rapportons un nouveau cas, remarquable par son évolution rapidement favorable sous un traitement de courte durée combinant terbinafine et cryothérapie.ObservationUn homme de 56 ans, immunocompétent, présentait sur le dos des deux avant-bras des placards érythémateux pustuleux et croûteux évoluant depuis une année. Le prélèvement mycologique objectivait des corps fumagoïdes et la biopsie cutanée des granulomes épithéloïdes avec cellules géantes et sans nécrose. Le diagnostic de chromomycose à Fonsecaea pedrosoi était confirmé par PCR. La sérologie VIH était négative. La terbinafine orale à la posologie de 250mg/j pendant 6 mois, associée à des séances de cryothérapie, permettait d'obtenir un début d'amélioration clinique après seulement 3 semaines et une rémission complète au terme du traitement.DiscussionLa survenue d'une chromomycose dans les régions non tropicales est de plus en plus souvent rapportée. Si les moyens diagnostiques deviennent plus performants dans l'identification des espèces en cause, la prise en charge reste difficile et mal codifiée. L'association terbinafine-cryothérapie s'est révélée chez notre patient très efficace et bien tolérée.ConclusionLe traitement combinant terbinafine et cryothérapie pourrait constituer une excellente alternative thérapeutique pour les chromomycoses cutanées à F. pedrosoi, du fait de son efficacité, sa faisabilité, son faible coût, son mode d'administration et son résultat esthétique.BackgroundChromomycosis is a chronic fungal skin infection, mainly affecting the limbs. It is responsible for severe morbidity and its treatment remains long and disappointing. Rarely described in Morocco, we report a new observation that has evolved very well under treatment combining terbinafine and cryotherapy over a short duration.Case reportA 56-year-old patient, immunocompetent, had a pustular and crusty placard on both forearms that had evolved for a year. Mycological examination showed fumagoid bodies and cutaneous biopsy showed epithelioid granulomas and giant cells without necrosis. The PCR confirmed a chromomycosis at Fonsecaea pedrosoi. HIV serology was negative. Treatment with terbinafine 250mg/d for 6months combined to cryotherapy resulted in complete remission with initial clinical improvement after only 3 weeks.DiscussionChromomycosis occurs increasingly in non-tropical areas. If diagnostic methods become more effective, management remains difficult and poorly codified. Terbinafine-cryotherapy combination would bring a lot of benefits with a little risk to bothpractitioner and patient.ConclusionThis combined treatment would constitute an excellent therapeutic alternative because of its efficiency, feasibility, low cost, method of administration and aesthetic result.
https://ift.tt/2rWA5NN
Carcinome épidermoïde de croissance rapide après traitement par mébutate d’ingénol
Publication date: Available online 17 May 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M. Ehret, C. Velter, M. Tebacher, C. Bruant-Rodier, B. Cribier
IntroductionLe mébutate d'ingénol est un traitement médical des kératoses actiniques (KA) qui agit par un double mécanisme : induction rapide de mort cellulaire et réaction inflammatoire intense.ObservationNous rapportons le cas d'un patient de 75 ans qui a développé une tumeur de croissance rapide 5 semaines après l'application de mébutate d'ingénol sur des KA. L'analyse histologique après exérèse chirurgicale révélait un carcinome épidermoïde (CE) invasif avec des signes d'agressivité (infiltration péri-nerveuse et perméation vasculaire).DiscussionLes effets secondaires constants du mébutate d'ingénol sont bénins et régressifs spontanément en 2 à 4 semaines : érythème, œdème, croûtes, ulcérations/érosions, pustules. La survenue d'un CE est rare. Nous avons cherché d'autres cas dans la littérature et dans les centres de pharmacovigilance français et européens. Trois observations ont été rapportées dans la littérature, 21 cas ont été signalés à l'agence européenne du médicament et l'interrogation des centres de pharmacovigilance français a permis de trouver cinq cas de CE après application de mébutate d'ingénol. Le rôle du mébutate d'ingénol dans le développement de CE n'est pas connu. L'inflammation induite par la molécule pourrait jouer un rôle dans le développement de ces tumeurs, par analogie à d'autres événements, de type traumatisme cutané (prise de greffe cutanée, incision chirurgicale). Le suivi au long cours de patients traités permettra de mieux connaître la fréquence des cas.IntroductionIngenol mebutate is an actinic keratosis treatment, which has a dual action mechanism. It allows a rapid cellular death and a severe inflammation.ObservationWe report the case of a 75 years old patient with a rapidly growing tumor 5 weeks after application of ingenol mebutate on typical actinic keratosis. Histological analysis after surgical excision showed an invasive squamous cell carcinoma (SCC); with aggressiveness signs: perineural infiltration and vascular permeation.DiscussionIngenol mebutate's common side effects are benign and regressive within 2 to 4 weeks. There are erythema, edema, crusts, and ulcerations/erosions. Squamous cell carcinoma development was rarely reported. We have tried to collect other cases in the literature and in pharmacovigilance centres: three similar cases were recently published in the literature, 21 cases were notified to the European Medicines Agency and we asked French pharmacovigilance centres and found 5 cases of SCC after ingenol mebutate application. The role of the molecule in SCC development is currently unknown. Induced inflammation could take part in the development of these tumors. We compare this case with other situations of inflammation, such skin graft donor site or surgical incision, complicated of rapidly growing SCC. Our case, literature's and pharmacovigilance's cases encourage us to follow ingenol mebutate's side effects. Careful follow-up and registration of such cases are important to gain further insight on this topic.
https://ift.tt/2kaMWbH
Animal Models of Chronic Migraine
Abstract
Purpose of Review
Chronic migraine (CM) is a recalcitrant subtype of migraine which causes high degrees of disability, poor treatment responses, and frequent recurrences in sufferers. However, the pathophysiological mechanisms underlying the development and chronification of migraine attacks remain incompletely understood. A validated animal model could help to decipher the pathogenic mechanism of the disease, facilitating the development of possible therapeutic strategies for CM. In this review, we aimed to summarize current animal models of CM and discuss the validity of these models.
Recent Findings
Several methods have been available to induce recurrent headache-like behaviors or biochemical changes in rodents, including repeated dural application of inflammatory soup, chronic systemic infusion of nitroglycerin, repeated administration of acute migraine abortive treatment to simulate medication overuse headache, or genetic modification. These models exhibit some features that are believed to be associated with migraine; however, none of the model can recapitulate all the clinical phenotypes found in humans and each has its own weakness.
Summary
The complex features of CM increase the difficulty of constructing a proper animal model. Nonetheless, currently available models are valid to certain degrees. Future directions might consider simulating the spontaneity and chronicity of migraine by combining known genetic substrates and allostatic loads into the same model.
https://ift.tt/2KFvPtV
Benefit and predictive factors for speech perception outcomes in pediatric bilateral cochlear implant recipients
Publication date: Available online 18 May 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Young-Soo Chang, Sung Hwa Hong, Eun Yeon Kim, Ji Eun Choi, Won-Ho Chung, Yang-Sun Cho, Il Joon Moon
IntroductionDespite recent advancement in the prediction of cochlear implant outcome, the benefit of bilateral procedures compared to bimodal stimulation and how we predict speech perception outcomes of sequential bilateral cochlear implant based on bimodal auditory performance in children remain unclear.ObjectivesThis investigation was performed: (1) to determine the benefit of sequential bilateral cochlear implant and (2) to identify the associated factors for the outcome of sequential bilateral cochlear implant.MethodsObservational and retrospective study. We retrospectively analyzed 29 patients with sequential cochlear implant following bimodal-fitting condition. Audiological evaluations were performed; the categories of auditory performance scores, speech perception with monosyllable and disyllables words, and the Korean version of Ling. Audiological evaluations were performed before sequential cochlear implant with the bimodal fitting condition (CI1+HA) and one year after the sequential cochlear implant with bilateral cochlear implant condition (CI1+CI2). The good Performance Group (GP) was defined as follows; 90% or higher in monosyllable and bisyllable tests with auditory-only condition or 20% or higher improvement of the scores with CI1+CI2. Age at first implantation, inter-implant interval, categories of auditory performance score, and various comorbidities were analyzed by logistic regression analysis.ResultsCompared to the CI1+HA, CI1+CI2 provided significant benefit in categories of auditory performance, speech perception, and Korean version of Ling results. Preoperative categories of auditory performance scores were the only associated factor for being GP (odds ratio=4.38, 95% confidence interval – 95%=1.07–17.93, p=0.04).ConclusionsThe children with limited language development in bimodal condition should be considered as the sequential bilateral cochlear implant and preoperative categories of auditory performance score could be used as the predictor in speech perception after sequential cochlear implant.
https://ift.tt/2k9e7Dx
CT based analysis of the lamina papyracea variations and morphology of the orbit concerning endoscopic surgical approaches
Publication date: Available online 18 May 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Gülay Açar, Mustafa Büyükmumcu, İbrahim Güler
IntroductionRadiologic evaluation is mandatory to assess the type of endoscopic approach concerning sinonasal pathology and reconstruction of fractured defects before any treatment modalities are instituted related to medial wall of the orbit.ObjectiveThe goal was to provide improved understanding of the lamina papyracea variations and the relationship with the orbital morphometry.MethodsThis retrospective study was performed using computed tomography scans of 200 orbits and results were compared with respect to age, sex, laterality and LP variations.ResultsLP variations were categorized as type A, 80.5% (161/200); type B, 16% (32/200); type C, 3.5% (7/200). For medial wall the anterior and posterior lamina papyracea heights and angles were found as 17.14mm, 147.88° and 9.6mm, 152.72°, respectively. Also, the length of the lamina papyracea, the mean area of the orbital floor, medial wall, lamina papyracea and orbital entrance were 33.3mm, 7.2cm2, 6.89cm2, 4.51cm2 and 12.46cm2 respectively. The orbital height and width were measured as 35.9mm and 39.2mm respectively. The mean orbital cavity depth was 46.3mm from optic foramen to the orbital entrance and the orbital volume was 19.29cm3. We analyzed the morphometric measurements tending to increase with aging and greater in men and the relationship of them with lamina papyracea types.ConclusionPrecise knowledge of the lamina papyracea anatomy using computed tomography is essential for safer and more effective surgery and preforming the dimensions of an implant. In this way, the postoperative complications can be decreased and the best outcome can be provided.
https://ift.tt/2rX9u3b
Association of GRM7 polymorphisms and sensorineural hearing loss in adults of different age groups
Publication date: Available online 18 May 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Sanlin Xie, Jianzhong Li, Wentao Wang, Xianming Chen
IntroductionSensorineural hearing loss is a common challenge all over the world, including a section of the young population. While there have been many published reports associating glutamate metabotropic receptor 7 with sensorineural hearing loss, there is no report, till date, about the association of glutamate metabotropic receptor 7 polymorphisms with sensorineural hearing loss at different ages.ObjectiveTo test the association between the single nucleotide polymorphisms rs11928865 and rs11920109 of the glutamate metabotropic receptor 7 with sensorineural hearing loss in adults of different age groups.MethodsA total of 1661 subjects were studied. The individuals aged between 30 and 50, and between 51 and 70 years with sensorineural hearing loss comprised group A and group B, respectively. Individuals aged between 30 and 50; and between 51 and 70 years without hearing loss comprised control groups C and D, respectively. The MassARRAY method was used to analyze the genotypes.ResultsThe difference in genotypes for the glutamate metabotropic receptor 7 rs11928865 single nucleotide polymorphism between patients in the groups B and D was statistically significant (p=0.018). The distribution frequencies of genotypes in patients that were aged between 30 and 50 years were not significantly different. The difference in genotypes for the rs11920109 single nucleotide polymorphism between the sensorineural hearing loss groups and control groups showed no statistical significance.ConclusionThe rs11928865 single nucleotide polymorphism was associated with the susceptibility to hearing loss in patients in group B but not with those in group A.
https://ift.tt/2kaJca9
Effects of turbinoplasty versus outfracture and bipolar cautery on the compensatory inferior turbinate hypertrophy in septoplasty patients
Publication date: Available online 18 May 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Aykut Bozan, Hüseyin Naim Eriş, Denizhan Dizdar, Sercan Göde, Bahar Taşdelen, Hayrettin Cengiz Alpay
IntroductionThe most common cause of septoplasty failure is inferior turbinate hypertrophy that is not treated properly. Several techniques have been described to date: total or partial turbinectomy, submucosal resection (surgical or with a microdebrider), with turbinate outfracture being some of those.ObjectiveIn this study, we compared the pre- and postoperative lower turbinate volumes using computed tomography in patients who had undergone septoplasty and compensatory lower turbinate turbinoplasty with those treated with outfracture and bipolar cauterization.MethodsThis retrospective study enrolled 66 patients (37 men, 29 women) who were admitted to our otorhinolaryngology clinic between 2010 and 2017 because of nasal obstruction and who were operated on for nasal septum deviation. The patients who underwent turbinoplasty due to compensatory lower turbinate hypertrophy were the turbinoplasty group; Outfracture and bipolar cauterization were separated as the out fracture group. Compensatory lower turbinate volumes of all patients participating in the study (mean age 34.0±12.4 years, range 17–61 years) were assessed by preoperative and postoperative 2 month coronal and axial plane paranasal computed tomography.ResultsThe transverse and longitudinal dimensions of the postoperative turbinoplasty group were significantly lower than those of the out-fracture group (p=0.004). In both groups the lower turbinate volumes were significantly decreased (p=0.002, p<0.001 in order). The postoperative volume of the turbinate on the deviated side of the patients was significantly increased: tubinoplasty group (p=0.033).ConclusionBoth turbinoplasty and outfracture are effective volume-reduction techniques. However, the turbinoplasty method results in more reduction of the lower turbinate volume than outfracture and bipolar cauterization.
https://ift.tt/2rWrACj
Nasal NK/T-cell Lymphoma Presenting as Acute Inflammation of Nasal Vestibule
Abstract
Extra nodal nasal NK/T cell lymphoma is relatively a rare type of non-Hodgkin lymphoma. Variable clinical presentation with rapidly progressive necrosis of the cartilaginous and bony wall of the nose and upper respiratory passages leads to delayed diagnosis and treatment. A 43-years-old patient presented with right nasal pain and furuncle-like swelling. The swelling progressed rapidly to cellulitis to the face up to the right eye. Within 2 months, it had advanced to necrosis of the lateral vestibular cartilage, medial maxillary wall, turbinate and nasal septal cartilage. Biopsy reported as non-Hodgkin diffuse T cell (angiocentric T cell) lymphoma.
https://ift.tt/2IBIBJj
Nasal NK/T-cell Lymphoma Presenting as Acute Inflammation of Nasal Vestibule
Abstract
Extra nodal nasal NK/T cell lymphoma is relatively a rare type of non-Hodgkin lymphoma. Variable clinical presentation with rapidly progressive necrosis of the cartilaginous and bony wall of the nose and upper respiratory passages leads to delayed diagnosis and treatment. A 43-years-old patient presented with right nasal pain and furuncle-like swelling. The swelling progressed rapidly to cellulitis to the face up to the right eye. Within 2 months, it had advanced to necrosis of the lateral vestibular cartilage, medial maxillary wall, turbinate and nasal septal cartilage. Biopsy reported as non-Hodgkin diffuse T cell (angiocentric T cell) lymphoma.
https://ift.tt/2IBIBJj
Characterization of human decidual mast cells and establishment of a culture system
Publication date: Available online 18 May 2018
Source:Allergology International
Author(s): Takayuki Matsuno, Shota Toyoshima, Tomomi Sakamoto-Sasaki, Jun-ichi Kashiwakura, Akira Matsuda, Yasuo Watanabe, Hiromitsu Azuma, Kei Kawana, Tatsuo Yamamoto, Yoshimichi Okayama
BackgroundAlthough rodent decidual mast cells (MCs) reportedly play an important role in implantation and placenta formation, the characterization of human decidual MCs has been not well clarified. The aims of this study were to investigate the distribution and characteristics of MCs in human decidua and to establish a culture system for decidua-derived MCs.MethodsDecidual tissues were obtained from patients who underwent a legal elective abortion (6th week to 9th week of pregnancy), and decidual MCs were enzymatically dispersed. Cultured decidua-derived MCs were generated by culturing decidual cells with stem cell factor. An ultrastructural analysis of primary decidual MCs and cultured decidua-derived MCs was performed using a transmission electron microscope. Receptor and protease expression was analyzed using FACS. Histamine released from MCs was measured using enzyme immune assays.ResultsA larger proportion of tryptase positive(+) MCs in decidua was present on the maternal side. Both enzymatically dispersed decidual MCs and cultured decidua-derived MCs showed an FcεRIα+Kit+tryptase+chymase+ phenotype. Their granules contenting particles exhibited variable amounts of electron-lucent space separating electron-dense particles. Both enzymatically dispersed decidual MCs and cultured decidua-derived MCs released comparable amounts of histamine following FcεRI aggregation.ConclusionsThe isolation method for MCs from decidua during early pregnancy and the culture system for decidua-derived MCs may enable the roles of decidual MC during pregnancy to be explored.
https://ift.tt/2Isyjz3
Pure low-grade DCIS in a male patient: a case report
Abstract
Breast cancer in males represents a small proportion of all cancers diagnosed. Pure ductal carcinoma in situ (DCIS), a low-grade form of breast cancer, is even more rare in male patients. We present a case of a 47-year-old male patient with a tender breast lump that was noted for 6 months. He was subsequently found to have a low grade, pure micropapillary and cribriform type DCIS with no evidence of invasive disease. Current literature does not provide distinct guidelines regarding management of male breast cancer, and it is currently managed in a similar fashion to female breast cancer.https://ift.tt/2KBw2xV
Splenic myoid angioendothelioma mimicking metastatic disease in an 8-year-old with Stage IV Wilms tumour
Myoid angioendothelioma are rare and benign vascular tumours of the spleen. Radiographic evaluation and diagnosis is often challenging and subjecting tissue samples to immuhistochemical analysis is often required to make a definitive diagnosis. Myoidangioendotheliomas can be managed with open or laparoscopic splenectomy with minimal risk of recurrent disease. Herein, we present a case of a myoid angioendothelioma in a patient with stage IV Wilms' tumour.
https://ift.tt/2IwQD5T
Coexisting squamous cell carcinoma and high-grade neuroendocrine carcinoma, small cell type: a rare collision in cervix
Collision tumours of the uterine cervix are extremely uncommon with exact incidence not known. Unlike squamous cell carcinoma (SCC) and adenocarcinoma that are known to coexist, small cell neuroendocrine carcinoma (SCNEC) is rarely documented with other histological types in the cervix. We report such rare case of a collision tumour in cervix displaying dual histological component of SCNEC and SCC in a 36-year-old woman. The case is being presented because of its rarity and represents a unique and hitherto seldom-reported combination of two malignant tumours with distinct and often contrasting epidemiology, histology and prognosis coexisting in the same patient.
https://ift.tt/2LfbQDq
Case of unilateral leg swelling: a DVT mimic
A 68-year-old woman with known metastatic renal cell carcinoma presented with an acutely swollen right leg. In between the two sessions of palliative radiotherapy to the right hip, she also had right hip modified Harrington procedure for tumour resection with hip replacement. Initial clinical evaluation raised the suspicion of right leg deep vein thrombosis (DVT). However, DVT was excluded and further investigations revealed stenosis of the right external and common iliac veins, likely secondary to radiotherapy.
https://ift.tt/2KEKTrF
Idiopathic nodular glomerulosclerosis (ING) in an African American (AA) man with hepatitis C
Idiopathic nodular glomerulosclerosis (ING) in a non-diabetic patient is uncommon. Nodular glomerulosclerosis is hallmark sign of diabetic nephropathy. ING is a very rare clinicopathological disease associated with smoking, obesity and hypertension, chronic obstructive pulmonary disease and metabolic syndrome. A 68-year-old non-obese African American man with hypertension, smoking and history of hepatitis C presented to the clinic with progressive worsening of lower extremity oedema and declining renal function over few months. Renal biopsy demonstrated nodular glomerulosclerosis. In this case, ING is hypothesised to be associated with hepatitis C along with smoking and hypertension (HTN). We present this case to speculate the existence of yet unknown aetiologies of ING.
https://ift.tt/2La2Pv7
Everyone is valuable
This case highlights the therapeutic value of valuing our patients as people. It starts with a common challenge we can all face as doctors both in primary and in secondary care. It is the challenge of facing a situation where both patient and doctor are 'stuck' where no progress is being made in patient care. A different approach was made to the situation and both patient and doctor could move on. It highlights an issue that is relevant for 'stuck' patients and all of our patients.
https://ift.tt/2IvvIA5
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