Parameters of skull vibration-induced nystagmus in normal subjects

Abstract

Hypothesis

The knowledge of vibration-induced nystagmus test (SVINT) values in the normal population is highly relevant to provide a rapid orientation on the diagnosis attitude in a patient with vertigo.

Background

Although mastoid bone vibration should only induce nystagmus in the presence of vestibular asymmetry, it has also been reported in normal individuals raising doubts as to how to interpret the SVINT. To date, no population studies involving the use of the SVINT and that establish normative values have been published.

Methods

This study was carried out at two tertiary healthcare centres on a total of 122 subjects. We stimulated at three frequencies (30, 60 and 100 Hz), in increasing order, first stimulating the right mastoid and then the left mastoid, and waiting for 30 s between each stimulus. The response was recorded with a videonystagmography system. The following variables were evaluated in each subject: the mean and maximum speed of the slow phase of nystagmus, the frequency of the nystagmatic response (NR) and the component and direction of the rapid phase of nystagmus.

Results

Only 26 subjects (20.5%) of the subjects studied here (122 subjects) developed any kind of nystagmatic response and 96 subjects (79.5%) did not display any response. Stimulation at 100 Hz provoked the largest number of responses (p = 0.04), while there was no difference in the number of responses induced by 30 and 60 Hz stimulations (p = 0.85). The frequency of nystagmus was ≤ 0.7 n/s in 80.8% of the positive responses. The mean velocity of the horizontal component of the NR was 2.2°/s (SD 1.6) and that of the vertical component was 1.3°/s (SD 1.2).

Conclusions

Healthy subjects do not generally develop to NR upon vibratory stimulation and only 20% of the subjects studied here developed any kind of NR, this being a slow and inconsistent response of low frequency. The establishment of normal values contributes to improve the orientation in clinical practice in the pathological population and this opens possibilities for tackling more reliable studies in this population.

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Effect of curcumin on bone tissue in the diabetic rat: repair of peri-implant and critical-sized defects

Publication date: Available online 29 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): F.R. Cirano, S.P. Pimentel, M.Z. Casati, M.G. Corrêa, D.S. Pino, M.R. Messora, P.H.F. Silva, F.V. Ribeiro
This study determined the effect of curcumin on bone healing in animals with diabetes mellitus (DM). One hundred rats were divided into five groups: DM+PLAC, DM+CURC, DM+INS, DM+CURC+INS, and non-DM (CURC, curcumin; PLAC, placebo; INS, insulin). Critical calvarial defects were created and titanium implants were inserted into the tibiae. Calvarial defects were analyzed histometrically, and BMP-2, OPN, OPG, RANKL, Runx2, Osx, β-catenin, Lrp-5, and Dkk1 mRNA levels were quantified by PCR. The implants were removed for a torque evaluation, the peri-implant tissue was collected for mRNA quantification of the same bone-related markers, and the tibiae were submitted to micro-computed tomography. The DM+CURC+INS and non-DM groups exhibited greater closure of the calvaria when compared to the DM+PLAC group (P<0.05). Increased retention of implants was observed in the DM+CURC, DM+CURC+INS, and non-DM groups when compared to the DM+PLAC group (P<0.05). CURC improved bone volume and increased bone–implant contact when compared to DM+PLAC (P<0.05). In calvarial samples, CURC favourably modulated RANKL/OPG and Dkk1 and improved β-catenin levels when compared to DM+PLAC (P<0.05). In peri-implant samples, Dkk1 and RANKL/OPG were down-regulated and BMP-2 up-regulated by CURC when compared to DM+PLAC (P<0.05). CURC reverses the harmful effects of DM in bone healing, contributing to the modulation of bone-related markers.



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Bi-modal radiofrequency treatment for coexisting neuralgia and neuropathy in adjacent divisions of the trigeminal nerve

Publication date: Available online 30 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M. Bhatjiwale, M. Bhatjiwale, L.D. Naik, P. Chopade
Trigeminal neuralgia and deafferentation neuropathic pain, or trigeminal neuropathy, are different symptomatologies, rarely reported to present together. The case of a 65-year-old gentleman suffering from trigeminal neuralgia of the maxillary and mandibular division is reported. He first underwent an infraorbital neurectomy that was complicated by deafferentation neuropathic pain, whilst his mandibular neuralgia continued. He was treated successfully for both the neuropathic and neuralgic symptoms in the same session using ultra-extended euthermic pulsed radiofrequency treatment for the maxillary division (V2) and radiofrequency thermocoagulation for the mandibular division (V3). This report is novel in describing the use of dual modalities in the same session for two distinct coexisting clinical entities in two different divisions of the same cranial nerve. The use of ultra-extended pulsed radiofrequency treatment for neuropathic pain in this case is also unique. Nearly 2years after the procedure, the patient continues to have complete pain relief.



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Editorial Board/Reviewing Committee

Publication date: July 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 7





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Comparison of two physiotherapy programmes for rehabilitation after temporomandibular joint arthroscopy

Publication date: June 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 6
Author(s): W.A. Abboud, N. Yarom, R. Yahalom, M. Joachim, S. Reiter, O. Koren, H. Elishoov
The purpose of this study was to compare two physiotherapy programmes for rehabilitation after temporomandibular joint (TMJ) arthroscopy. The medical files of 137 consecutive patients diagnosed with closed lock and treated by arthroscopic lysis and lavage were analyzed retrospectively. Sixty-eight patients were rehabilitated with gradually increasing range of motion self-exercises (gradual programme) and 69 patients were rehabilitated with immediate full range of motion self-exercises (immediate programme). The outcome variables were maximum mouth opening (MMO) and pain (on a visual analogue scale). The postoperative measurements taken at 1 month, 6 months, and last follow-up examination available (mean of 10 months postoperative) were analyzed and compared between the two groups. The results showed significantly better MMO and pain outcomes for the immediate group than for the gradual group at the 1-month and 6-month postoperative evaluations. The results of the two groups were comparable at the last follow-up examination available. It is concluded that after arthroscopic treatment of closed lock of the TMJ, a physiotherapy programme consisting of immediate postoperative full range of motion mobilizations achieves better results (in terms of pain and mouth opening) than a physiotherapy programme consisting of gradual and controlled increases in range of motion.



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Minimally invasive orthognathic surgery: a systematic review

Publication date: Available online 29 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): N. AlAsseri, G. Swennen
Minimally invasive techniques are currently applied in many oral and maxillofacial surgical procedures, including orthognathic surgery. A systematic review on the application of potentially minimally invasive procedures in orthognathic surgery was performed to provide a clear overview of the relevant published data. Articles in English on minimally invasive orthognathic procedures, published in the scientific literature, were obtained from the PubMed, Embase, and Cochrane Library databases, and an additional manual search (revised 31 December 2016). After screening the abstracts and applying the eligibility criteria, 403 articles were identified. All articles reporting the potential for minimally invasive orthognathic surgery were included (n=44). The full papers were evaluated in detail and categorized as articles on a minimally invasive surgical approach (n=4), endoscopically assisted orthognathic procedures (n=17), or the use of a piezoelectric device in orthognathic surgery (n=25); two articles were each included in two categories. Although a small incision and minimal dissection is the basic principle of a minimally invasive technique, most articles (90.9%) reported the endoscope and piezoelectric instrument as important tools in minimally invasive orthognathic surgery. Evidence from available studies suggests that patients undergoing minimally invasive orthognathic surgery have less morbidity and make a faster recovery. Further research should aim to obtain higher levels of evidence.



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Clinicopathological and prognostic significance of preoperative serum epidermal growth factor levels in patients with oral squamous cell carcinoma

Publication date: Available online 26 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J.-S. Lin, F.-J. Sun, P.-Y. Lin, K.-W. Chang, C.-C. Yang, C.-J. Liu
Epidermal growth factor (EGF) promotes tumourigenesis and tissue repair of epithelial and mesenchymal cells and has a role in chemotaxis, mitogenesis, cell motility, and cytoprotection. It also enhances the growth of cancers. EGF may therefore have a role in the initiation or promotion of oral carcinogenesis. The cases of 152 patients with oral squamous cell carcinoma whose preoperative serum EGF level was determined by enzyme-linked immunosorbent assay were analyzed retrospectively, along with those of 40 age- and sex-matched controls. Patients with higher levels of EGF were more likely to have neck lymph node metastasis (P=0.026), advanced stage cancer (P=0.04), and a worse survival status (P=0.0019). Multivariate analysis using the Cox proportional hazards model indicated that the EGF level was an independent predictor of poor survival (hazard ratio 1.99, P=0.018). Patients with higher preoperative serum EGF levels had significantly poorer cancer-specific survival by Kaplan–Meier analysis (P=0.032). This study indicates that a higher preoperative serum EGF level is associated with neck lymph node metastasis, more advanced stage, and poor survival. EGF should be considered as a potential prognostic biomarker and a therapeutic target for patients with oral cancer.



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Long-term outcomes of craniofacial implants for the restoration of facial defects

Publication date: June 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 6
Author(s): S.S. Subramaniam, O. Breik, B. Cadd, G. Peart, D. Wiesenfeld, A. Heggie, S.D. Gibbons, A. Nastri
The aim of this study was to evaluate the long-term survival of craniofacial implants and prostheses and to identify factors associated with failure in a cohort of patients. A 25-year retrospective analysis was conducted at Royal Melbourne Hospital. Data included demographic characteristics, age, site and cause of the deformity, and number and survival of implants. Odds ratios were calculated and event-to-time Kaplan–Meier analyses performed. One hundred and ten patients were included (341 implants); their mean age was 46.2 years. The overall implant survival rate was 79.5% (mean follow-up 10.6 years). Temporal implants had the highest success rate (97.0%), followed by nasal implants (87.5%) and orbital implants (63.3%); differences were statistically significant (P<0.0001 and P=0.033, respectively). Kaplan–Meier analyses to determine long-term implant and prosthesis survival found temporal implants had the highest prosthetic (P<0.0001) and implant survival (P<0.0001). Patients with congenital deformities demonstrated the highest success rate. Radiotherapy was found to increase the risk of implant failure (P=0.02). Craniofacial implant-retained prostheses are a reliable and effective option for the restoration of facial defects, with good long-term success rates. Orbital implants and those placed post oncological surgery have a higher failure rate.



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Influences of age and sex on the validity of bone scintigraphy for the diagnosis of temporomandibular joint osteoarthritis

Publication date: Available online 31 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J.-H. Kang, Y.-S. An, S.-H. Park, S.I. Song
Bone scintigraphy has been used for the diagnosis of early-stage temporomandibular joint (TMJ) osteoarthritis (OA) owing to its high sensitivity. However, the diagnostic value of bone scintigraphy may be compromised when applied to patients in an age range with high bone metabolism rates. The aim of this study was to investigate the validity of bone scintigraphy as an appropriate diagnostic modality for TMJ OA. A total of 406 subjects (145 male, 261 female; age range 14–87 years) were selected, and all subjects underwent both bone scintigraphy and computed tomography (CT). The diagnosis of TMJ OA was confirmed with CT. Images obtained with bone scintigraphy were analyzed by visual and quantitative methods using the TMJ-to-skull ratio. The TMJ-to-skull ratio was significantly higher during adolescence and elderly adulthood, but differences between the sexes were not significant. The diagnostic value of the TMJ-to-skull ratio was lower in elderly adulthood in both males and females. The diagnostic utility of visual assessment was also compromised during late adulthood in both males and females. Thus bone scintigraphy has little value in the detection of TMJ OA, because the results could be influenced by age-related bone metabolism rates.



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Editorial Board/Reviewing Committee

Publication date: June 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 6





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Upper airway morphologic changes after mandibular setback surgery in skeletal class III malocclusion patients measured using cone beam computed tomography superimposition

Publication date: Available online 30 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S. Jeong, J. Sung, S. Kim, Y. Kim, S. Shin, S.S. Kim
This study used the superimposition of cone beam computed tomography (CBCT) images to evaluate three-dimensional morphologic changes in the upper airway space of skeletal class III malocclusion patients with normally positioned maxilla who had undergone mandibular setback surgery.The upper airways of 18 subjects (10 males and eight females) who underwent mandibular setback surgery were assessed using CBCT superimposition at T0 (2weeks before surgery) and T1 (1year after surgery) according to the cervical vertebrae 1 (CV1), CV2, CV3 and CV4 reference planes on CBCT.The cross-sectional area and anteroposterior width (APW) in the CV1 and CV2 planes had significantly decreased at 1year after surgery. The largest decrease was observed in the oropharynx area. However, the APW/transverse width in the CV2 plane had increased at 1year after surgery.These findings suggest that mandibular setback surgery can cause a reduction in the upper airway space; physiologic deformation of the oropharynx occurs after mandibular setback surgery.



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Cancer-related hypercalcemia in oral cancer

Publication date: June 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 6
Author(s): T.-C. Lin, K.-L. Liang, L.-C. Lee, C.-Y. Hsu, T.-T. Yen
Cancer-related hypercalcemia (CRH) is a critical paraneoplastic disorder in advanced cancer patients. In clinical practice, patients with CRH have a poor prognosis. The medical records of 3198 oral cancer patients with CRH diagnosed at Taichung Veterans General Hospital from 1 January 2003 to 31 December 2015 were reviewed. The criteria for patient enrolment were a diagnosis of hypercalcemia or the use of antihypercalcemia medication. Patients who met any of the following criteria were excluded: use of total parenteral nutrition, incomplete serum calcium data, and unknown date of death. The total incidence of CRH was 6.95‰ per year. A total of 91 patients were enrolled; their median survival time was 28 days. The patients were divided into two groups by survival time, with a cut-off point of 30 days. Reduced serum albumin, leucocytosis, and clodronate use had a statistically significant effect on survival in the univariate analysis (all P<0.05). Forty-five patients (49.5%) had recurrence of CRH, of whom nine died within 30days. These nine patients had a shorter interval to the first episode of CRH recurrence (median 13 days) than those who survived ≥30days (median 28 days) (P<0.001). It was observed that a short interval to the first episode of CRH recurrence is a poor prognostic factor.



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Response to the Letter to the Editor regarding “Quantitative assessment of the learning curve for cleft lip repair using LC-CUSUM”

Publication date: Available online 29 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): E. Segna, R.H. Khonsari




https://ift.tt/2Jh2MzL

Accuracy of Le Fort I osteotomy in bimaxillary splint-based orthognathic surgery: focus on posterior maxillary movements

Publication date: Available online 29 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): D. Govaerts, E. Shaheen, R. Coopman, A. De Mol, Y. Sun, C. Politis
This retrospective study was performed to verify the accuracy of horizontal and vertical repositioning of the maxilla in bimaxillary osteotomy with a focus on posterior vertical displacement. Data from 39 orthognathic patients undergoing bimaxillary surgery including a one-piece Le Fort I osteotomy with pitch rotation and advancement at the University Hospitals of Leuven (Belgium), between January 2015 and April 2016, were included in the study. Preoperative and 1-week postoperative lateral cephalograms were digitized and imported into cephalometric software. Horizontal and vertical measurements of dental landmarks were used to assess the accuracy of maxillary repositioning, and errors were reported in terms of the mean and absolute mean. The horizontal advancements were randomly under- and over-corrected an average of 1.4mm±1.2mm. Vertical repositioning of the anterior maxilla followed the planning. A tendency for under-correction was found for posterior vertical intrusion of the maxilla. The same tendency towards under-correction of posterior maxillary inferior repositioning was detected when planned movements were greater than 3mm. For all studied groups, no significant difference was found between the planning and the results achieved, validating the use of intermediate splints.



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Evaluation of saliva and plasma cytokine biomarkers in patients with oral squamous cell carcinoma

Publication date: June 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 6
Author(s): L.T. Lee, Y.K. Wong, H.Y. Hsiao, Y.W. Wang, M.Y. Chan, K.W. Chang
The aim of this study was to investigate potential biomarkers in human saliva and plasma to aid in the early diagnosis of oral squamous cell carcinoma (OSCC). Saliva and plasma samples obtained from OSCC patients (n=41) and non-oral cancer patients (n=24) were analyzed by Luminex Bead-based Multiplex Assay. Data were analyzed using the non-parametric Mann–Whitney U-test, Kruskal–Wallis test, and receiver operating characteristics curve (ROC) to evaluate the predictive power of 14 biomarkers individually for OSCC diagnosis. The plasma level of IP-10 in early OSCC differed significantly from that in controls. Among the salivary biomarkers, IL-1β, IL-6, IL-8, MIP-1β, eotaxin and IFN-γ and TNF-α showed significant differences between OSCC patients and controls. With respect to carcinogenesis, significant differences in plasma levels of eotaxin, G-CSF, and IL-6 were found between OSCC stages III/IV and OSCC stages I/II. The area under the curve (AUC) for OSCC vs. control was greater than 0.7 for plasma IP-10 and saliva IL-1β, IL-6, IL-8, and TNF-α. The study findings indicate that salivary biomarkers may serve a useful role as a complementary adjunct for the early detection of oral OSCC. With regard to the evaluation of tumour progression, plasma eotaxin, G-CSF, and IL-6 may help in the detection of advanced OSCC. However, the correlation between saliva and plasma biomarkers in OSCC was weak.



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Comparison of osseous healing after sagittal split ramus osteotomy and intraoral vertical ramus osteotomy

Publication date: Available online 26 May 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S. Rokutanda, S. Yamada, S. Yanamoto, K. Omori, Y. Fujimura, Y. Morita, H. Rokutanda, H. Kohara, A. Fujishita, T. Nakamura, T. Yoshimi, N. Yoshida, M. Umeda
The sagittal split ramus osteotomy (SSRO) is generally associated with greater postoperative stability than the intraoral vertical ramus osteotomy (IVRO); however, it entails a risk of inferior alveolar nerve damage. In contrast, IVRO has the disadvantages of slow postoperative osseous healing and projection of the antegonial notch, but inferior alveolar nerve damage is believed to be less likely. The purposes of this study were to compare the osseous healing processes associated with SSRO and IVRO and to investigate changes in mandibular width after IVRO in 29 patients undergoing mandibular setback. On computed tomography images, osseous healing was similar in patients undergoing SSRO and IVRO at 1year after surgery. Projection of the antegonial notch occurred after IVRO, but returned to the preoperative state within 1year. The results of the study indicate that IVRO is equivalent to SSRO with regard to both bone healing and morphological recovery of the mandible.



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Editorial Board

https://ift.tt/2svOxfL

Training Groups

https://ift.tt/2IZNRKI

Pediatric Residents’ Assessment of Atopic Dermatitis Severity for Risk Assessment of Early Peanut Introduction,

Publication date: Available online 31 May 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): James Shea, Monika Martusiewicz, Lucy A Bilaver, Ozge N Aktas, Jialing Jiang, Anthony J Mancini, Ruchi S Gupta




https://ift.tt/2L73HQg

Development of Food Protein-Induced Enterocolitis Syndrome (FPIES) to egg following Immunoglobulin E (IgE)-mediated egg allergy,

Publication date: Available online 31 May 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Hannah Duffey, Maureen Egan




https://ift.tt/2JheLx1

Pilot study of the CAPS (Clinical extent, Area, Pruritus, Sleep) measure for atopic dermatitis severity,,✯✯✯,✯✯✯✯

Publication date: Available online 31 May 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Aaron M Drucker, Natalie H Matthews, Jennie Muglia, Abrar A Qureshi
Eczema; Atopic dermatitis; Outcome measures; Severity; Symptoms; ItchAbbreviations: AD, atopic dermatitis; BSA, body surface area; CAPS, Clinical extent, Area, Pruritus, Sleep; DLQI, Dermatology Life Quality Index; EASI, Eczema Area and Severity Index; IGA, Investigator Global Assessment; POEM, Patient-Oriented Eczema Measure



https://ift.tt/2Ld5rrd

Otolaryngology resident experience with supraclavicular, submental and other regional flaps in the United States

Despite the resurgence in regional flap use, otolaryngology resident regional flap experience has been incompletely studied. We sought to characterize United States (US) otolaryngology resident exposure to, and perceptions of, supraclavicular flaps (SCFs), submental flaps (SMFs), and other regional flaps.

https://ift.tt/2socB53

“Determination of the impact of melanoma surgical timing on survival using the National Cancer Database”

https://ift.tt/2J1Mrj1

Association of family structure with atopic dermatitis in United States children

The relationship between family structure and atopic dermatitis has not previously been elucidated., Children from family structures without two married, biological parents have increased odds of AD and poorer overall health outcomes., Children from family structures without two, married, biological parents may benefit from increased surveillance, closer follow-up and optimized treatment for incident AD.

https://ift.tt/2H9ApOz

Daily Oxymetazoline Cream Demonstrates High and Sustained Efficacy in Patients With Persistent Erythema of Rosacea Through 52 Weeks of Treatment

https://ift.tt/2J47CBb

Long-term adalimumab efficacy in patients with moderate-to-severe hidradenitis suppurativa/acne inversa: 3-year results of a phase 3 open-label extension study

Adalimumab is approved for moderate-to-severe hidradenitis suppurativa/acne inversa., A sustained response is seen through week 168 in 52.3% of patients treated with adalimumab 40 mg weekly, with no additional safety issues identified. Adalimumab can be considered for long term control of moderate-to-severe hidradenitis suppurativa.

https://ift.tt/2syXOnE

The readability of iPledge program patient education materials

https://ift.tt/2J43aC4

A cohort study of risk factors, clinical presentations and outcomes for dermatophyte, non-dermatophyte and mixed toenail infections

https://ift.tt/2H9sK2Q

Response to: Reply to:"Determination of the impact of melanoma surgical timing on survival using the National Cancer Database"

https://ift.tt/2kGf8DE

A review of syndromes associated with blue sclera, with inclusion of malformations of the head and neck

Publication date: Available online 31 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): John K. Brooks
Blue sclera is attributed to a diversity of mechanisms, mostly arising in genetic syndromes and to lesser extents to nongenetic disorders and from medication intake. A literature search was conducted to establish a database of blue scleral associations. This article represents the most comprehensive assemblage of etiopathologies coincident with blue sclera, comprising 66 genetic syndromes, 8 disorders, and 4 pharmacologically-induced pigmentations. To increase the knowledge of the clinical significance of blue sclera, a summary of the systemic and oral maxillofacial comorbidities is provided. Recognition of the presence of blue sclera is important as it could prompt a timelier and more thorough diagnostic evaluation of possible systemic and dental malformations and may lead to improved clinical outcomes.



https://ift.tt/2xy9Ovc

Osteonecrosis of the jaw in patients treated with denosumab: A multicenter case series

Osteonecrosis of the jaw has been recently reported in patients receiving denosumab for the treatment of metastatic bone disease or osteoporosis. It is essential to investigate this disease as a new osteonecrosis entity in order to recognize its optimal management strategies.

https://ift.tt/2so8aap

Enhanced radiographic visualization of resorbable foils for orbital floor reconstruction: A proof of principle

Despite the advantages and broad applications of alloplastic resorbable implants, postoperative radiological control is challenging due to its radiolucency. The aim of the present study was to evaluate the radiographic visibility of newly developed materials for orbital floor reconstruction.

https://ift.tt/2H9S5tz

Three-Dimensional Accuracy of Mandibular Reconstruction by Patient-Specific Pre-Bent Reconstruction Plates using an “In-House” 3D-Printer

The purpose of this study was to compare the three-dimensional accuracy of mandibular reconstruction following mandible continuity resection in patients treated with patient-specific, pre-bent reconstruction plates, using an 'in-house' 3D printer, with that in patients treated with conventional, intraoperatively bent plates.

https://ift.tt/2soNRJW

Influences of age and sex on the validity of bone scintigraphy for the diagnosis of temporomandibular joint osteoarthritis

Bone scintigraphy has been used for the diagnosis of early-stage temporomandibular joint (TMJ) osteoarthritis (OA) owing to its high sensitivity. However, the diagnostic value of bone scintigraphy may be compromised when applied to patients in an age range with high bone metabolism rates. The aim of this study was to investigate the validity of bone scintigraphy as an appropriate diagnostic modality for TMJ OA. A total of 406 subjects (145 male, 261 female; age range 14–87 years) were selected, and all subjects underwent both bone scintigraphy and computed tomography (CT).

https://ift.tt/2kEq18X

Changes in chronic rhinosinusitis symptoms differentially associate with improvement in general health-related quality of life

Chronic rhinosinusitis (CRS) is an inflammatory disease of the paranasal sinus mucosa.1 CRS is characterized by nasal as well as extra-nasal symptoms related to poor sleep, ear/facial discomfort and emotional disturbance.2 Due to these associated symptoms as well as other clinical manifestations—such as acute exacerbations of CRS and exacerbation of comorbid pulmonary disease—CRS causes a significant quality of life (QOL) detriment.3–5 The clinical manifestations of CRS are also associated with significant productivity losses.

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Food-induced Anaphylaxis in Infants and Children

Recent recommendations to introduce peanut products to infants for peanut allergy prevention requires a focused assessment of infant anaphylaxis.

https://ift.tt/2L8MUN2

Bedroom Exposure to Airborne Allergens in the Chicago Area Using a Patient-Operated Sampling Device

Background: In current practice, allergens in vacuum collected dust are used as surrogates for inhalable allergens. We developed an airsampling device that can be used by patients themselves for direct measurement of airborne allergen concentrations in their own homes.Objective: To demonstrate the use of this device to establish allergen concentration reference ranges in a target population. To evaluate relationships of patient-reported information to measured allergen concentrations.Methods: Patients from 5 allergist's practices in the Chicagoland region were provided with instructions, questionnaire, informed consent forms and samplers to run for 5 days in their bedrooms.

https://ift.tt/2JjVqLB

Are there different subtypes of eosinophilic esophagitis?

Currently, eosinophilic esophagitis (EoE) is defined by the combination of clinical symptoms and pathologic findings. Patients should have symptoms of esophageal dysmotility as well as a defined (albeit somewhat arbitrarily so) level of esophageal eosinophilia. Thus, using this definition, the diagnosis of EoE is purely a phenotype, possibly allowing for multiple different etiologies to funnel into this diagnosis. In this manner, EoE is similar to other conditions that we treat, such as asthma, in which treatment strategies are evolving in an era of precision medicine.

https://ift.tt/2Ldda8Z

Dehiscencia de la lámina papirácea del etmoides

Publication date: Available online 30 May 2018
Source:Acta Otorrinolaringológica Española
Author(s): Gabriel Huguet Llull, Marta Mesalles Ruiz, Xavier González Compta




https://ift.tt/2xvQ0Zt

Extranodal involvement of diffuse large B-cell lymphoma in the head and neck: An indicator of good prognosis

In this study, we analyzed clinicopathological characteristics and survival outcomes according to extranodal involvement of diffuse large B-cell lymphoma (DLBCL) in the head and neck.

https://ift.tt/2xwLh9Y

Pediatric cochlear reimplantation: Decision-tree efficacy

Publication date: Available online 31 May 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): L. Distinguin, M. Blanchard, I. Rouillon, M. Parodi, N. Loundon
ObjectivesThe context leading to pediatric cochlear reimplantation (CreI) can be complex. The objectives of this study were to define initial CreI indications, analyze final diagnosis and draw up a decision-tree.MethodsA retrospective study included patients undergoing CreI between 2005 and 2015. Demographic characteristics, CreI circumstances and technical reports were collected. Circumstances indicating CreI were classified in 3 groups: performance decrement, suspected device failure, or medical. After CreI, final diagnoses were classified in 2 groups: confirmed failure (DFail) or medical (DMed).Results69 out of 734 cochlear implantation surgeries were for CreI (8%). Manufacturers' reports were available in 64 cases (93%). Two principal causes were found: trauma and infection. Initial indications were: performance decrement: 27%; device failure: 56%; and medical: 17%. Final diagnoses were: DFail: 72%; and DMed: 28%. Initial indication and final diagnosis were similar in 86% of cases. The majority of the 14% initial indication errors belonged to the "performance decrement" group. Traumatic causes correlated with risk of initial indication error (P=0.039).ConclusionApart from spontaneous device failure, the two causes of CreI were infection and trauma. Using the present decision algorithm, half of the complex cases were resolved after CreI.



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Tonsillectomy in children and in adults: changes in practice following the opening of a day-surgery unit with dedicated operating room

Publication date: Available online 30 May 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): S. Bartier, I. Gharzouli, N. Kiblut, H. Bendimered, L. Cloutier, D. Salvan
ObjectivesTo study the impact of the opening of a day-surgery unit on the practice of tonsillectomy in adults and children in the light of the experience of our department, and to compare complications between day-surgery and conventional admission.Material and methodsA retrospective review was conducted of all tonsillectomies performed since the opening of a dedicated day-surgery room, using the ENT and emergency department data-bases.ResultsBetween October 2013 and December 2014, 179 tonsillectomies were performed (51 in adults, 128 in children), including 108 day-surgeries. Between 2012 and 2014, the number of tonsillectomies increased by 12.7%, with an 18.27% increase in children and stable adult rate. Within 1 year, day-surgery became predominant for children (73.19%) and equaled conventional admission for adults (47.22%). For almost all patients without same-day discharge, the reasons were organizational or due to malorientation (comorbidity, or unsuitable home environment). Day-case tonsillectomy in children showed a 30-day complications rate comparable to those reported in the literature (8.3% postoperative hemorrhage), with a higher rate in adults (35.3%). Onset of complications was at a mean 6 days in adults and 9 days in children; only 2 patients developed complications between 6 and 24hours postoperatively.ConclusionThe present study showed that opening a day-surgery unit led to changes in practice, with most tonsillectomies now performed on an outpatient basis, without increased complications, and notably immediate complications. Outpatient tonsillectomy thus seems to be a solution of choice compared to conventional admission, in terms of cost saving and of patient comfort, without sacrificing safety. The dedicated operating room facilitates scheduling and thereby increasing turnover by reducing wait time.



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Revisiting Correlation Between Pre Operative High Resolution Computed Tomography and Operative Findings in Attico Antral Disease

Abstract

(1) To correlate the findings of high resolution computed tomography (HRCT) scans with operative findings in chronic otitis media (attico antral disease). (2) To assess the role of HRCT in chronic otitis media (attico antral disease). This prospective observational study undertaken at a tertiary level teaching hospital included 50 patients of chronic otitis media (attico antral disease) who underwent pre-operative HRCT scanning and the findings were compared with the operative findings and correlation between the two was assessed with appropriate statistical methods. HRCT findings correlated well for the status of malleus and incus, facial nerve canal, lateral semicircular canal, and sinus plate but were less accurate for stapes and tegmen plate. As for disease extent and prediction of cholesteatoma the degree of correlation was site dependent being greater in mastoid air cell system and epitympanum and lesser in mesotympanum and hypotympanum. HRCT despite of its value in management of chronic otitis media has its drawbacks and limitations. CT's accuracy of prediction in some aspects of the disease varies with the site of pathology and this point must always be kept in mind by the operating surgeon. We suggest that each health care centre should establish their own correlative indices for HRCT temporal bone imaging in COM. HRCT cannot be entirely relied upon in management of chronic otitis media patients. However against the backdrop of improved radiological skills in interpreting temporal bone ct images, improved CT machines and importantly the growing concern over medicolegal issues, the role of pre operative CT scan in COM is much more than what was thought previously. Undoubtedly, it is a very useful 'aid' to management BUT a well-trained, experienced and alert surgeon is the key for an accurate diagnosis and successful management of chronic otitis media (attico-antral disease).

https://ift.tt/2snPXd3

Parotid Gland Tumours: Our Experience

Abstract

Salivary gland tumor comprises of approximately 3 to 10% of neoplasms of the head and neck region. Parotid gland is the most commonly involved salivary gland with an incidence of 62% followed by submandibular gland and other minor salivary gland tumors. However clinical course of benign and malignant tumors resemble each other in clinical findings, we require histopatholocal or cytological diagnosis for planning of management. To analyze parotid tumors retrospectively with following objectives. (1) Demographic distribution of parotid tumors. (2) To evaluate cytological and histopathological findings of parotid tumors. (3) Correlation of cytological and histopathological findings of parotid tumors. It was a retrospective observational study involving 31 patients who presented with parotid region swelling. Pre operative FNAC (fine needle aspiration cytology) and post operative histopathology were correlated. Surgical management depended on nature of disease. Correlation of FNAC and Histopathology: among 27 cases pre operative FNAC and post operative histopathology was same and in only 3 cases reports differed. One FNAC was inconclusive. In present study, Sensitivity of FNAC is 81.81%, Specificity is 94.73% and accuracy is 90%. FNAC is usually the first investigative modality, as it is a minimally invasive, cheap, OPD procedure that can differentiate benign from malignant tumors. Knowing preoperative pathological nature of disease can help in planning of surgical process.

https://ift.tt/2supiL7

Anaplastic carcinoma of the pancreas diagnosed by endoscopic ultrasound-guided fine-needle aspiration: a case report and review of the literature

Anaplastic carcinoma of the pancreas is a rare pancreatic neoplasm with a poor prognosis. It is classified as a variant of ductal adenocarcinoma, but the clinical features and treatment of it remain unknown be...

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Gallbladder metastasis of renal clear cell carcinoma 15 years after primary cancer excision: a case report

Renal cell carcinoma is well-known for its propensity to metastasize to unusual sites. However, metastasis to the gallbladder has been rarely reported in the literature.

https://ift.tt/2IZg1FM

Differential regulation of human monocytes and NK cells by antibody-opsonized tumors

Abstract

The monocyte network is important for therapeutic efficacy of antibody therapies against cancer. One mechanism which monocytes/macrophages use to kill cancer cells is phagocytosis. Using trastuzumab and human breast cancer cell lines as a model, we used flow cytometry to evaluate the importance of avidity, antigen density, Fcγ receptor (FcγR) expression, and FcγR polymorphisms in human monocyte phagocytosis. By increasing avidity for the tumor through the addition of pertuzumab to trastuzumab, there was a two-to-threefold increase in phagocytosis potency against the HCC1419 cell line compared to antibodies alone, while NK cell-mediated antibody-dependent cellular cytotoxicity (ADCC) failed to increase tumor cell death. Consistent with increasing the avidity through multiple antibodies, antigen density significantly enhanced phagocytosis with breast cancer cell lines that were HER2 gene-amplified compared to non-amplified tumor cells. Confirmation that high antigen density enhanced phagocytosis was obtained when HER2 was overexpressed in HER2 non-amplified cell lines. In contrast, NK cell ADCC failed to distinguish differences in tumor cell death when comparing gene-amplified and non-amplified breast cancer cell lines. The level of phagocytosis was influenced by FcγRIIa and FcγRIIIa expression. Most monocytes are FcγRIIIa⁻, and the induction of the receptor significantly enhances antibody-dependent phagocytosis. Although both receptors are involved, when blocked FcγRIIIa had a greater influence on phagocytosis. Furthermore, the polymorphism FcγRIIIa 158V significantly enhanced phagocytosis; whereas FcγRIIa 131H polymorphism appeared to improve phagocytosis but was not statistically significant. Targeting of monocytes for enhanced phagocytosis may improve the effectiveness of therapeutic antibodies to improve clinical outcomes.

https://ift.tt/2H7tu8S

Adenopharyngoplasty vs Adenotonsillectomy in Children With Severe Obstructive Sleep Apnea

This randomized clinical trial compares the outcomes of adenotonsillectomy vs adenopharyngoplasty in children with severe obstructive sleep apnea.

https://ift.tt/2J2mCva

Association of Idiopathic Sudden Sensorineural Hearing Loss With Affective Disorders

This cohort study uses a Korean nationwide database to investigate whether idiopathic sudden sensorineural hearing loss is associated with the development of affective disorders such as anxiety, depression, and bipolar disorder.

https://ift.tt/2LMmVfe

The Unrecognized Dangers of Sudden Hearing Loss

The impact of an idiopathic sudden sensorineural hearing loss (ISSNHL) on a patient can be devastating. Practitioners who treat this malady are always worried about potential life-threatening issues, such as an intracranial complication or a tumor. However, practitioners need to be aware of other life-altering consequences of a sudden hearing loss. The study by Kim et al reveals that an often-overlooked sequela is the onset of affective disorders such as depression and anxiety.

https://ift.tt/2xr7KVI

Functional Nasal Surgery and Use of CPAP in OSAS Patients: Our Experience

Abstract

The surgical correction of nasal obstruction is definitely effective and recommended in patients with poor CPAP compliance, often secondary to the high pressures that need to be given in patients with nasal sub stenosis. For this reason, the objective of this study is the evaluation of the effectiveness and effects of the functional nose surgery on adherence to CPAP- therapy in patients (with moderate to severe OSAS with indication of ventilation therapy) poorly compliant with CPAP. The study was performed on a sample of 52 patients, 40 male and 12 female, aged between 29 and 72 years followed by the Otolaryngology Unit of the University Palermo in the period between January 2015 and January 2017. All patients were subjected to the following s iter: anamnesis with Epworth Sleepiness Scale, NOSE scale, evaluation of "CPAP usage data." Upper airway optical fiber endoscopy with Müller's maneuver. We performed various type of nasal surgery (septoplasty, decongestion of the lower turbinates and FESS) 6 months after the surgery, CPAP usage was evaluated and the NOSE scale has been reapplied. All patients had a subjective degree of obstruction classified in severe or extreme by the NOSE scale before surgery. Almost all patients reported a mild degree of obstruction after the surgery. About CPAP usage, the average usage has passed by 2, 3 h at night to 6, 8 h after the surgery. The result is significant because it shows how the nasal functional surgery can make selected patients suitable to ventilation therapy. As our work shows, a better nasal function allows to reduce the CPAP pressure, Therefore, we believe that all patients with medium to severe obstructive apnea syndrome and for whom night-time ventilation therapy (CPAP) is advised should be evaluated with endoscopy and anamnesis oriented to evaluate nasal obstructive pathologies that may reduce effectiveness of CPAP.

https://ift.tt/2J7C5KA

Nrf2 pathway modulates Substance P-induced human mast cell activation and degranulation in the hair follicle

Publication date: Available online 31 May 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Laura Jadkauskaite, Rajia Bahri, Nilofer Farjo, Bessam Farjo, Gail Jenkins, Ranjit Bhogal, Iain Haslam, Silvia Bulfone-Paus, Ralf Paus

Teaser

Activation of Nrf2 in primary human mast cells exposed to oxidative stress induced by substance P suppresses pro-inflammatory gene transcription, activation and degranulation.


https://ift.tt/2JoZ1bg

Paradoxical psoriasis following anti-TNF therapy in ankylosing spondylitis: A population-based cohort study

Publication date: Available online 31 May 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Jung Min Bae, Hyuck Sun Kwon, Gyong Moon Kim, Kyung-Su Park, Ki-Jo Kim

Teaser

The risks of psoriasis and palmoplantar pustulosis were significantly increased in patients with ankylosing spondylitis (AS) treated with anti-TNF agents compared to AS patients treated without anti-TNF agents in the population-based cohort study.


https://ift.tt/2LcPYI2

Biological Therapies for Eosinophilic Gastrointestinal Diseases

Publication date: Available online 31 May 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Joshua B. Wechsler, Ikuo Hirano
The scientific basis and the clinical application of monoclonal antibody therapies that target specific immunologic pathways for eosinophilic gastrointestinal diseases (EGIDs) are areas of active interest. There is a growing recognition of a subset of patients with eosinophilic esophagitis, or EoE, whose disease does not respond well to topical steroids or elimination diets. In addition, long-term use of corticosteroids presents risks. Systemic therapy with a biologic agent offers potential advantages as a global approach that could limit the need for multiple, locally active medical therapies and allergen avoidance. The identification of novel biologic strategies is ongoing, and the recent validation of instruments and outcome measures to assess disease activity has proved essential in demonstrating efficacy. Studies using biologics that target IL-13 pathways in the treatment of EoE have demonstrated substantial promise.



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Massive Silicone Oil Migration into the Subconjunctival Space: A Leakage Mechanism Dilemma

Purpose: To report a case in which an early, massive silicone oil migration into the subconjunctival space occurred in a patient after sutureless vitrectomy with the presence of a previously implanted pars plana glaucoma drainage device. Case Report: An 80-year-old man presented with neovascular glaucoma secondary to a proliferative diabetic retinopathy in his left eye. After an intracamerular bevacizumab injection and panretinal photocoagulation, a 23-gauge pars plana vitrectomy (PPV) combined with a superotemporal Ahmed pars plana glaucoma valve implantation was performed. Afterwards, the patient underwent a new 23-gauge PPV for a dense vitreous hemorrhage. Intravitreal 1,000 centistokes silicone oil was placed to prevent recurrent intraocular bleeding. No sutures were performed. In the first postoperative month, a massive migration of silicone oil into the 360° subconjunctival space was noted until no intraocular silicone oil was observed. Conclusions: We discuss the possible leakage mechanisms in this particular case.
Case Rep Ophthalmol 2018;9:310–314

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Apatinib for Esophagus Cancer

Condition:   Esophagus Cancer
Intervention:   Drug: Apatinib
Sponsor:   Affiliated Hospital of North Sichuan Medical College
Not yet recruiting

https://ift.tt/2JiACnT

Prof. dr. MirkoToš: Obituary

Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Janez Rebol




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Could fetal reduction induce facial cleft? Report of a case

Publication date: Available online 30 May 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J. Chauvel-Picard, J. Massardier, A. Gleizal
We describe a paramedian cleft of the lower lip that cannot be explained by embryological development in a child with only one predisposing factor, which was fetal reduction for a multiple pregnancy. To the best of our knowledge, there has been no report of a cleft that has been induced by the reduction of a multifetal pregnancy.



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Is there an ideal way to close the donor site of radial forearm free flaps?

Publication date: Available online 30 May 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A.M. Pabst, R. Werkmeister, J. Steegmann, F. Hölzle, A. Bartella
Radial forearm free flaps (RFFF) are the "workhorse" of reconstructive head and neck surgery, but have considerable morbidity at the donor site. The aim of this study was to review current publications about the incidence and type of morbidity and the different techniques used for closure of the site. We screened the MEDLINE database to find relevant papers using the terms "RFFF head and neck" and "RFFF donor site". Abstracts were filtered, and the full texts studied carefully. We found 1056 publications during the period 1982–2017 of which 389 were studied in full, and 39 studies were finally included in the review. We found four main methods of closure of the donor site: full-thickness skin grafts (FTSG); split-thickness skin grafts (STSG); modified techniques for raising the flap and closure of the wound by local flaps; and others (such as allografts, expanders, and vacuum bandages). For STSG and FTSG the preparation of the donor site seems to be a relevant factor. Special attention should be paid to the coverage of the flexor tendons. FTSG give better aesthetic results than STSG. Closure by local flaps may achieve primary closure of the donor site without a third surgical site, but the techniques are limited by the amount of tissue required at the site of the defect. The most common side effects are disorders of wound healing such as exposed tendons. To avoid exposure of the tendons, flexor tendons should be covered with muscle bellies when STSG are used. It is still not clear whether many other reported side effects (such as impairment of sensitivity) are induced by raising the flap or closing the donor site. There is an argument for closure of individual donor sites independently, but there is no one method of closure for all donor sites, because each has its specific disadvantages and complications.



https://ift.tt/2smjF27

Volumetric comparison of autogenous bone and tissue-engineered bone replacement materials in alveolar cleft repair: a systematic review and meta-analysis

Publication date: Available online 30 May 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): M. Kamal, A.H. Ziyab, A. Bartella, D. Mitchell, A. Al-Asfour, F. Hölzle, P. Kessler, B. Lethaus
The goal of reconstruction of the alveolar cleft in patients with cleft lip and palate is to improve the quality of tissue, the structural stability, and increase the volume of bone. This study is a systematic review with meta-analysis of volumetric bony filling using autogenous bone and various tissue-engineered bone substitutes. We made an electronic search on MEDLINE, EMBASE, SCOPUS, WEB OF SCIENCE, "grey" publications (materials and research produced by organisations outside traditional channels for commercial or academic publishing and distribution), and relevant cross references according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that reported the outcomes of volumetric grafting were included in the meta-analysis. Of 1276 studies, 26 were included in the meta-analysis. Pooled analysis of 25 studies that used autogenous bone showed a significant reduction in the volume of the cleft equivalent to 62.0% bone fill (95% CI 54.3 to 69.6), in contrast to 10 studies that used a tissue-engineered material and reported bone filling of 68.7% (95% CI 54.5 to 82.8). The estimated sizes of pooled effects across studies showed that there was no significant difference between the two major intervention groups (p value 0.901). Our statistical analysis showed that autogenous bone grafts did not differ significantly from tissue-engineered materials in their ability to fill clefts.Systematic review registration: International Prospective Register of Systematic Reviews, PROSPERO (CRD42017065045).



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Undifferentiated Pleomorphic Sarcoma of Pancreas: A Case Report and Review of the Literature for the Last Updates

The most prevalent type of soft tissue sarcoma is undifferentiated pleomorphic sarcoma (UPS) or previously known as malignant fibrous histiocytoma. It accounts over 20% of all soft tissue sarcomas and occurs most frequently in the extremities, trunk, and retroperitoneum. However, it has been rarely observed in the digestive system. Pancreas sarcoma represents less than 1% of all pancreatic tumors, and primary UPS of the pancreas is even rarer. It exhibits high recurrence and poor prognosis. In this case, a 72-year-old woman with a UPS tumor which was located in the pancreas head and neck without adhesion to the retroperitoneum will be discussed.

https://ift.tt/2sjrRQW

Labeling Morphine Milligram Equivalents on Opioid Packaging: a Potential Patient Safety Intervention

Abstract

Purpose of Review

Given that the primary cause of overdose death in the USA is related to prescribed opioids, one potential strategy to improve awareness and decrease morbidity and/or mortality could include improved labeling. Specific patient populations which significantly struggle with adverse outcomes related to opioid abuse are seen in palliative care, chronic pain, and acute pain treatment settings.

Recent Findings

An unexplored option for improving the healthcare quality and safety for patients currently prescribed opioids would be to require pharmaceutical companies to provide a morphine milligram equivalent (MME) on opioid packaging. Some limitations to MME conversions include equianalgesic conversions being estimates at best and may not account for variations in genetics and pharmacokinetics. Changing opioid labeling requirements is feasible as it falls under the purview of the US Food and Drug Administration (FDA), which has been mandated to provide mechanisms to reduce or to minimize overdoses related to opioid prescriptions.

Summary

Labeling opioid packaging with MME per dose will promote clearer communication about opioid strength between patients and physicians. Labeling MME on packaging could help prevent prescriber errors.

https://ift.tt/2Lcohz4

Randomized controlled phase III trial of adjuvant chemoimmunotherapy with activated cytotoxic T cells and dendritic cells from regional lymph nodes of patients with lung cancer

Abstract

Randomized controlled trial of adjuvant chemoimmunotherapy for lung cancer indicated a significant advantage in patients receiving immunotherapy. Herein we report the final results and immunological analysis with a median follow-up of 59.6 months. Patients with post-surgical lung cancer were randomly designated to receive either chemoimmunotherapy (group A, immunotherapy arm) or chemotherapy (group B, control arm). The immunotherapy comprised the adoptive transfer of autologous activated killer T cells and dendritic cells (AKT–DC). The 2- and 5-year overall survival (OS) rates were 96.0 and 69.4% in group A and 64.7 and 45.1% in group B, respectively. Multivariate analysis results revealed that the hazard ratio was 0.439. The 2- and 5-year recurrence-free survival rates were 70.0 and 57.9% in group A and 43.1 and 31.4% in group B, respectively. Subgroup analysis for the OS between treatment groups indicated that younger patients (≤ 55 years: HR 0.098), males (HR 0.474), patients with adenocarcinoma (HR 0.479), patients with stage III cancer (HR 0.399), and those who did not receive preoperative chemotherapy (HR 0.483) had lower HRs than those in the other groups. Immunological analysis of cell surface markers in regional lymph nodes of subjects receiving immunotherapy indicated that the CD8⁺/CD4⁺ T-cell ratio was elevated in survivors. Patients with non-small-cell lung cancer benefited from adoptive cellular immunotherapy as an adjuvant to surgery. Patients with stage III cancer, those with adenocarcinoma, and those not receiving preoperative chemotherapy were good candidates. Lastly, cytotoxic T cells were important for a favorable chemoimmunotherapy outcome.

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Case 17-2018: A 40-Year-Old Woman with Leg Swelling and Abdominal Distention and Pain

Presentation of Case. Dr. Molly E. Wolf (Medicine): A 40-year-old woman was evaluated at this hospital because of progressive edema of the legs, as well as abdominal distention and pain. The patient had been in good health until approximately 10 months before this evaluation, when episodes of pain…

https://ift.tt/2H9rMUe