Cerebellar degeneration in primary Sjögren syndrome

Neurological manifestations are reported as a consequence of primary Sjögren syndrome (PSS). Any part of the brain and peripheral nervous system can be involved in PSS. However, cerebellar degeneration and atrophy associated with PSS have been rarely reported. Our report describes a 22-year-old woman who presented with cerebellar ataxia, arthritis and arthralgia. Evaluation of her symptoms, autoantibodies and salivary gland pathology was in favour of the diagnosis of Sjögren syndrome. Also, her brain MRI revealed cerebellar degeneration. There are only four patients reported to be affected by cerebellar atrophy associated with PSS. Administration of high doses of methylprednisolone and cyclophosphamide leads to substantial improvement in the cerebellar symptoms of this case. In addition, after 2 months of follow-up, the patient's ataxia recovered significantly. It could be concluded that in addition to neurological degenerative disorders, in some cases cerebellar atrophy could also be associated with autoimmune conditions such as PSS.

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Campylobacter jejuni and Pseudomonas coinfection in the setting of ulcerative colitis

A 66-year-old woman presented with 2 days of fever and severe diarrhoea. She has a history of ulcerative colitis (UC), well controlled with medication. She also has a history of Ehlers-Danlos syndrome, infective endocarditis following aortic valve replacement and pulmonary embolism. She had complained of passing stool with traces of blood about 30 times per day. Stool testing for Clostridium difficile, routine culture and microscopy was done. She was started on ceftriaxone. CT scan revealed thick-walled colon consistent with UC flare. Flexible sigmoidoscopy showed active continuous colitis extending from the rectum to the proximal descending colon. Campylobacter jejuni was isolated from the stool and blood cultures yielded Pseudomonas aeruginosa. The antibiotic was transitioned to intravenous piperacillin/tazobactam and azithromycin followed by 2 weeks of intravenous cefepime. Her diarrhoea was controlled, and she was discharged for follow-up in 2 months.

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Lupus of the larynx: when bamboo nodes lead to diagnosis...

Description 

An 18-year-old patient consulted complaining of dysphonia for 3 months associated with severe weakness, headache and diffuse articular pain, with haematoma at the slightest trauma.

Laryngoscopy showed a submucosal oval lesion in the middle third of the two vocal folds resembling bamboo joint nodes (figure 1). Laboratory analysis showed the presence of antinuclear antibodies, antidouble-stranded DNA, antinucleosome, anti-SSA (117), anti-SSB (115) and anti-Sm (25) antibodies associated with thrombocytopaenia, haemolytic anaemia and severe ADAMTS-13 deficiency (under 5%). The patient was admitted to the hospital for monitoring, plasma exchange and glucocorticoid therapy. The diagnosis of systemic lupus erythematosus was made. The laryngeal lesions were bamboo nodes. The patient received Solu-Medrol 500 mg/day and prednisone 60 mg/day combined with speech therapy. The bamboo nodes partially regressed under treatment with a marked improvement of the voice. A few months later, laryngeal injection of triamcinolone 40 mg under local anaesthesia was performed with a favourable...

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Small bowel obstruction caused by vas deferens: a first documented report

Small bowel obstruction (SBO) is one of the most common causes for an acute surgical admission. Most of the time SBO is a result of common causes such as postoperative adhesions. However, rare and unusual causes of SBO do exist which can be challenging for surgeons. We report a first documented case of SBO caused by a remnant of the vas deferens in a 24-year-old patient with a history of gastroschisis and left orchidectomy. Clinical presentation, investigations, imaging and management of this case are described. To summarise, clinicians should keep an open mind in dealing with patients with intestinal obstruction due to the rare and atypical causes.

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Avascular necrosis: a growing concern for the HIV population

A 33-year-old woman with history of HIV presented with 4 months of gradually progressing right hip pain and was found to have avascular necrosis (AVN) of both femoral heads. She had no other risk factors for AVN including sickle cell disease, systemic lupus erythematosus, prolonged steroid used or trauma. She initially failed conservative management and ultimately had bilateral hip core decompressions. After decompression therapy, the left femoral head collapsed and patient underwent a left total hip arthroplasty. Her postsurgical course was complicated by the left sciatic nerve neuropathy for which she is currently being managed with duloxetine. She has yet to follow-up with her orthopaedic surgeon for further evaluation.

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Radiological appearance of primary extracranial meningioma of the pelvis in a middle-aged woman

Description 

A 47-year-old woman came with the complaints of on-and-off constipation for 6 months with the inability to pass stool for 2 days. She also complained of poor urinary stream and increased urine frequency for 1 year and had a history of hysterectomy with bilateral salpingo-oophorectomy. Her general and systemic examinations were unremarkable. Abdominal radiograph revealed diffuse opacification of the pelvis with left lateral displacement and compression of the rectal shadow (figure 1A). CT of abdomen and pelvis (figure 1B–F) revealed a large, well-defined heterogeneously enhancing lobulated lesion in the presacral region and central pelvis showing multiple coarse calcifications within. The lesion was abutting the distal sigmoid colon and rectum causing their left lateral displacement with luminal compression and loss of intervening fat plane. There was resultant dilatation of the large and distal small bowel loops suggestive of intestinal obstruction. The fat plane between the lesion and the...

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Small intestinal bacterial overgrowth (SIBO) and vitamin K-responsive coagulopathy: a previously unrecorded association

A 17-year-old woman, with a history of three operations on the upper gut in early life and intermittent diarrhoea, presented with a history of epistaxis and leg ecchymosis for the previous 3 months. Initial investigation revealed mild anaemia, low serum albumin, moderately elevated aminotransferases and an exceedingly prolonged prothrombin time (PT) which was promptly shortened to normal by intravenous vitamin K. Additional investigations revealed a grossly abnormal glucose hydrogen breath test, a dilated duodenum and deficiencies of vitamins A, D and E. Repeated courses of antimicrobial agents caused prompt but transient shortening of PT and eventually a duodenal–jejunal anastomosis was performed. Since then, up to 36 months later, the patient has been in good general health and PT has been consistently normal with no vitamin K supplementation. Small intestinal bacterial overgrowth has previously been associated with several conditions but this is the first description of its association with vitamin K-responsive coagulopathy.

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Melanoma with rhabdomyosarcomatous differentiation

Melanoma with rhabdomyosarcomatous differentiation is an extremely rare observation with a review of the literature revealing fewer than 15 previously identified cases. The authors describe a case of a 72-year-old man with a cutaneous lesion of the left scalp that was diagnosed as malignant melanoma on biopsy and wide excision. One month later, a punch biopsy of the excisional area revealed rhabdomyosarcomatous proliferation. Re-examination of the wide-excision specimen with muscle markers revealed areas of neoplastic melanoma cells consistent with rhabdomyosarcomatous differentiation.

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Lipschütz ulcer and group A streptococcal tonsillitis

Lipschütz ulcers (LU) are non-sexually related genital ulcers, rarely reported. We describe a healthy 11-year-old girl, who presented with fever and a painful vulvar ulcer associated with erythematous tonsillitis. Throat swab test for Group A Streptococcus (GAS) was positive. She was treated with amoxicillin. Further investigation was negative, including Herpes Simplex virus DNA from ulcer swab and serology for Epstein-Barr virus, cytomegalovirus and Mycoplasma pneumoniae. Antistreptolysin O titre was high. The ulcer healed in 2 weeks, with no recurrence in a 1 year follow-up period. The association of LU with GAS tonsillitis is very rare.

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Ombitasvir/paritaprevir/ritonavir plus dasabuvir regimen may be used safely in combination with sirolimus for the treatment of chronic hepatitis C

The era of direct acting antivirals has revolutionised the management of chronic hepatitis C infection and improved patient outcomes. The optimal management of patients who require liver transplantation remains a matter of ongoing discussion. Treatment in the post-transplantation setting may be complicated by significant drug–drug interactions between antiviral agents and standard immune suppressive treatment regimens. We describe what we believe to be the first reported case of a patient successfully treated for CHC with ombitasvir/paritaprevir/ritonavir plus dasabuvir, while taking sirolimus following liver transplantation.

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Isolated hepatobiliary tuberculosis: a diagnostic challenge

Hepatobiliary system involvement is frequently seen as part of disseminated tubercular infection. But primary isolated hepatobiliary tuberculosis with no evidence of tuberculosis elsewhere in the body is extremely rare. Isolated hepatobiliary tuberculosis can cause diagnostic dilemma as the clinical, laboratory and imaging features are non-specific in majority of the cases. We report the case of a 50-year-old woman who presented with hepatobiliary tuberculosis with no pulmonary or extra hepatic involvement. Liver function tests were abnormal and ultrasonography (USG), CT and MR cholangiopancreatography showed multiple focal lesions in the liver. The diagnosis of tuberculosis was confirmed by a USG-guided biopsy of the liver lesions. In endemic regions with the presence of supportive imaging findings, in the appropriate clinical setting, the possibility of hepatic tuberculosis should be considered and diagnosis has to be confirmed with histopathological examination.

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IgG4-related periarteritis in the coronary artery and subclinical pericarditis assessed the presence and monitoring of therapy response by PET and CT scan

Description 

A 70-year-old woman suffered from bilateral lacrimal gland enlargement from 2 years ago (figure 1). Geranium-enhanced MRI disclosed diffuse enlargement of bilateral eyelids indicating IgG4-related disease (IgG4RD), especially Mikulicz's disease. Laboratory tests showed elevation of serum IgG4 concentration and histopathological findings of the lacrimal glands showed IgG4-positive cell infiltration and obliterated veins by inflammatory cells, which consist of lymphocytes and plasma cells (obliterative phlebitis).

Figure 1

Bilateral lacrimal gland enlargement with predominance of right ones observed as a representative pathophysiological finding in this patient with IgG4-related disease.

Then, she was diagnosed with IgG4RD. We performed chest CT as screening for comorbidities of Mikulicz's disease. Chest CT revealed left circumflex artery (LCX) wall thickening. Coronary CT showed thickening of the left anterior descending artery and LCX. For suppressing physiological myocardial uptake, the patient was asked to restrict carbohydrate intake 24 hours before...

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Unexpected early complication of implantable-cardioverter defibrillator

A 41-year-old woman was visiting Oxford, where she had a sudden cardiac arrest. Cardiopulmonary resuscitation was started by a bystander until the paramedics arrived, who found her in ventricular fibrillation, and delivered three shocks. After 28 min she had return of spontaneous circulation. Emergency coronary angiography revealed normal coronary arteries. Echocardiography followed by a cardiac MRI showed non-dilated left ventricles with no evidence of late gadolinium enhancement. She had a single-chamber implantable-cardioverter defibrillator (ICD). A chest CT showed sternal fracture and subsegmental pulmonary embolism, for which she was anticoagulated and was discharged.

Several days later, the patient presented to another hospital with atypical chest pain and dizziness. She had haemodynamic instability and echocardiography showed the ICD lead perforating through the right ventricle, with a large pericardial effusion and tamponade, for which pericardiocentesis was done. Afterwards, the patient had repositioning of the ICD lead safely.

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Human Immunodeficiency Virus Infection: Does Highly Active Antiretroviral Therapy Influence Ear Nose Throat Manifestations?

Abstract

To study the change in trend of ear, nose and throat (ENT) manifestations in patients who were on treatment, before and after availability of highly active antiretroviral therapy (HAART). To find out the prevalence of ENT manifestations in human immunodeficiency virus (HIV) infected people who were on treatment, in the year of 2004 (before the availability of HAART) and in 2014 (after the availability of HAART). Design A combination of a retrospective and prospective study. Setting Anti Retroviral Therapy (ART) Center at Our Hospital. Subjects Patients with HIV infection on ART. Methods Retrospective review of case records of the patients visiting the center in the year 2004 and prospective study of the patients visiting in the year 2014 was conducted. Sample size was calculated as 200 in each group based on 95% confidence and 96% power. Convenience sampling was used in our study. The prevalence of ENT manifestations in HIV patients were found to be 86% in 2004 and 93% in 2014. Among ENT manifestations oropharyngeal manifestations were most common. Lesser the CD4 count more was the prevalence of disorders in oropharynx. Our study showed a high prevalence of ENT manifestations in HIV patients who were on treatment, irrespective of the gap of 10 years and introduction of HAART therapy. Most common ENT manifestation both in 2004 and 2014 was oropharyngeal candidiasis. Lesser the CD4 count more was the prevalence of disorders in oropharynx.

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A Perspective of Clinical Behaviour and Management of Deep Neck Space Infections (DNSI): The Clinical Conundrum

Abstract

The diagnosis and management of deep neck space infections remain a challenging task for otolaryngologists. A retrospective observational analysis of 137 cases of deep neck infections at a tertiary care centre was reviewed. We present 137 treated cases of DNSIs in a retrospective 5 years clinical study conducted in the department of otolaryngology at a tertiary care center from January 2012 to December 2016. Demographic information, Socio-economic data, etiopathogenesis, clinical presentation, spaces involved, diagnosis, and treatment strategies, associated morbidities, course and complications were analysed and compared with past experiences. Odontogenic and salivary gland infections causes were the most common source of DNIs. Major complication observed was skin defect. In this study, submandibular space infection was found to be the most common space involved in DNSI. Pain (100%) was the most common clinical complaint followed by neck swelling (65.69%). Staphylococcus aureus (38 cases) was the most common micro-organism isolated. Surgical intervention was the main modality of treatment and there was one mortality. DNSIs are fairly common challenging and potentially lethal entities which can lead to severe complications in a very short time, should there be delay in its prompt diagnosis and management. Computerized Tomography Scan (CT scan) with contrast is the investigation of choice in diagnosing DNSIs. Assessment of airway control must take precedence.

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Miringoplastia con injerto doble medial y lateral

Publication date: Available online 7 June 2018
Source:Acta Otorrinolaringológica Española
Author(s): Francisco Javier Olarieta Soto, Francisco Antolí-Candela Cano, Alejandro Harguindey Antolí-Candela
ObjetivosSe describe la técnica quirúrgica del injerto doble medial y lateral de fascia autóloga, sus indicaciones y resultados.Material y métodoSe estudian las características preoperatorias y al año de la intervención de 100 casos intervenidos de miringoplastia con la técnica de injerto doble medial y lateral de fascia autóloga. Se analizan los resultados anatómicos y funcionales.ResultadosLos resultados se valoran al año de la intervención. En el 95% de los casos conseguimos el cierre de la perforación. La incidencia de persistencia de las perforaciones es del 12,5% en los niños menores de 10 años y del 2,5% en niños mayores de 10 años y adultos. Las complicaciones son un 4% de perlas epiteliales con engrosamiento del neotímpano, un 1% de retracciones del neotímpano y un 3% de epitelitis que se resuelven con tratamiento médico tópico. La recuperación auditiva es del 85% de cierres del UDA medio a menos de 20dB (el 38% a menos de 10dB y el 47% entre 10 y 20dB). Se analizan las posibles causas del cierre incompleto del UDA, posiblemente relacionados con fibrosis y esclerosis de los restos timpánicos y/o la cadena osicular.ConclusionesSe concluye que esta metodología nos proporciona los mejores resultados en comparación con otras que hemos utilizado y hemos relegado a situaciones muy específicas atendiendo al tamaño y localización de la perforación.ObjectivesA surgical technique for a double medial and lateral overlay autologous fascia graft myringoplasty is described in this paper along with its indications and results.Material and methodThe presurgical and one year post surgery characteristics are analyzed for 100 cases with the double medial and lateral overlay autologous fascia graft technique. The anatomical and functional results are analyzed.ResultsThe results are analyzed one year post surgery. The probabilities of obtaining a graft take using this methodology are 95%. The incidence of persistence of the perforations is 12.5% in children under 10 and 2.5% in children over ten years of age and adults. The complications are 4% of epithelial pearls with blunting of the neo-tympanum, 1% of retractions and 3% of epithelitis which is resolved with a topical medical treatment. The average residual air/bone gap is less than 20dB in 85% of the cases. Less than 10dB in 38%, and between 10 and 20dB in 47%. The causes for incomplete closure of the gap are analyzed; possibly related to fibrosis and sclerosis of the tympanic remnants and/or the ossicular chain.ConclusionsIt is concluded that this methodology provides the best results in comparison with other methods we have used and have set aside for very specific situations related to the size and location of the perforation.



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MicroRNA-21 down-regulates inflammation and inhibits periodontitis

Publication date: Available online 6 June 2018
Source:Molecular Immunology
Author(s): Wei Zhou, Li Su, Xingyu Duan, Xi Chen, Aislinn Hays, Satya Upadhyayula, Juili Shivde, Huizhi Wang, Yong Li, Dingming Huang, Shuang Liang
Periodontitis is one of the most prevalent inflammatory diseases, characterized by gingival inflammation and alveolar bone loss. MicroRNAs (MiRNAs) are important regulators of inflammation and involved in periodontitis pathogenesis. In this work, we studied the roles of microRNA-21 (miR-21) in periodontitis. MiR-21 is up-regulated in both periodontitis patients and the mice that induced with periodontitis. We tested the roles of miR-21 in the macrophages challenged by periodontitis pathogen Porphyromonas gingivalis (P. gingivalis) lipopolysaccharide (LPS). MiR-21 expression is up-regulated in P. gingivalis LPS-stimulated macrophages. MiR-21 mimic inhibits the pro-inflammatory cytokine production by macrophages, while miR-21 deficiency elevates the production of pro-inflammatory cytokines. Moreover, absence of miR-21 promotes activation of nuclear factor-κB (NF-κB) in P. gingivalis LPS- stimulated cells. In a murine periodontitis model, ligation induced exacerbated gingival inflammation and alveolar bone loss in miR-21 deficient mice than their wild-type littermates. These results demonstrated the anti-inflammatory function of miR-21 in vitro and in vivo, indicating miR-21 could be an interventional target for the control of periodontitis.



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SERPING1 and F12 combined variants in a hereditary angioedema family,,✰✰✰,✰✰✰✰

Publication date: Available online 6 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Delphine Charignon, Denise Ponard, Christian De Gennes, Christian Drouet, Arije Ghannam




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Olfactory dysfunction out of season in seasonal allergic rhinitis

Publication date: Available online 6 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Motohiko Suzuki, Makoto Yokota, Shinya Ozaki, Yoshihisa Nakamura




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The prognostic relevance of lymph node ratio in patients with oral squamous cell carcinoma treated with neoadjuvant therapy regimen and radical surgery

This study aims at investigating the prognostic significance of lymph node ratio (LNR) in a cohort of patients with oral squamous cell carcinomas (OSCC), treated with neoadjuvant radiochemotherapy followed by radical surgery.

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Clinical evaluation of non-syndromic scaphocephaly surgically corrected with the procedure of total vertex craniectomy

The present investigation constitutes a retrospective evaluation of the outcome in children who received surgical correction of a scaphocephalic phenotype by median total vertex craniectomy. Between September 2009 and September 2015, a total of 35 infants with non-syndromic scaphocephaly were treated according to the same standardized operative technique of total vertex craniectomy by a single surgeon approach. At the time of surgery, the patients were between 3 and 12 months of age, with a median of 5 months.

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Pediatric facial injuries: Hitting close to home

The aims of this study were as follows: To determine the national incidence of facial fractures among infants, toddlers, and children; to evaluate the types of facial fractures; and to analyze common products/activities associated with the fractures.

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Maxillary stability following Le Fort I osteotomy using Prebent plates and wire fixation in patients undergoing surgery for OSAS

The purpose of this study was to analyze the stability of Le Fort I maxillary advancement in the vertical and horizontal directions using a combination of wire and rigid fixation in patients undergoing surgery to treat obstructive sleep apnea (OSA). Wire osteosynthesis can be performed quicker and at a reduced cost.The lateral cephalograms of 21 patients were evaluated preoperatively (T0), immediately postoperatively (T1), and at least 6 months postoperatively (T2). Four cephalometric points were used to measure movement in the horizontal and vertical directions.

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Dog Attack Causing Lip Wound

Animal bites are relatively common occurrences reaching about 4.5 millions of people every year. The main aggressor is the domesticated dog, responsible for around 90% of the patients, with children being the most affected, with 70% of the registered patients, while with adults that number is a lot lower (15%). Bites around the head and neck require special attention. Due to the presence of noble structures and the rich local vascularization, any wounds have been immediately addressed to stop bleeding and further complications. The present study shows a woman patient, victim of a dog bite in her face, where the dog is her own, a domesticated Weimaraner. The patient was attended to in the Unidade de Pronto Atendimento, the procedure was to first apply anesthesia, then clean up the wound, debris of borders, and the plane suturation. Two months after the surgery, the patient showed satisfactory healing, with no complaints about pain or esthetics. As final considerations, it has to be remembered that facial trauma has to be assessed and taken care of immediately, in a way that closing the wound in the first hours after the trauma increase the chances of obtaining a better esthetic as physiologic result for the patient, also preventing infections from the wound and external environment. Also, in the case of animal bites, it is important that the professional possess the knowledge to deal with each individual situation, employing the correct prophylactic vaccine and perform the correct notification. Address correspondence and reprint requests to Abrahão Cavalcante Gomes de Souza Carvalho, DDS, MSc, PhD, Unichristus, João Adolfo Gurgel Street, 133, Cocó, Fortaleza, Ceará 60192-345, Brazil; E-mail: abrahao_cav@yahoo.com.br Received 4 January, 2018 Accepted 5 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Changes in Cervical Lordosis After Orthognathic Surgery in Skeletal Class III Patients

The purpose of this study was to evaluate cervical lordosis and head posture changes using lateral cephalographs after bimaxillary orthognathic surgery for mandibular prognatism by null hypothesis. Twenty-five patients with skeletal class III dentofacial deformities (10 men, 15 women; mean age, 29.28 ± 8.23 years; range 18–48 years) were included in this prospective clinical study. Lateral cephalographs were taken in natural head position (NHP) 2 weeks before and 6 months after orthognathic surgery. The reproducibility of the radiographer's technique of taking radiographs in NHP was investigated using a photographic method and found to be acceptable. All measurements for cervical lordosis (CV1/CV2; CV3/CV7; CV1/CV7), head posture (NSL/OPT; NSL/VER), and other cephalometric values (NSL/Go-Gn; NSL/OCL; Overjet) were repeated 3 times by the same blinded investigator at 2-week intervals and the average values of the 3 measurements were calculated to use in statistical analysis. Intraclass correlation coefficients (ICC) ranged between 0.996 and 1.000, demonstrating a high reliability of the measures. Statistically significant differences were found for CV3/CV7 (P = 0.006) and CV1/CV7 (P = 0.005) and no significant differences were identified in head posture for both cranio-cervical and cranio-vertical angles. The null hypothesis was rejected. Orthognathic surgery resulted in significant cervical lordosis extension, and a tendency for head extension could also be observed. Address correspondence and reprint requests to Fernando de Oliveira Andriola, MSc, DDS, Av. Ipiranga, 6681, Building 6 (Dental School), Partenon, 90619-900, Porto Alegre, RS, Brazil; E-mail: fernandoandriola@gmail.com Received 31 January, 2018 Accepted 7 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Benign Paroxysmal Positional Vertigo After Piezosurgical Removal of Osseointegrated Implants

With the increasing popularity of dental implants, the explantation of fractured implants has become a major challenge for clinicians. Several tools can be used for the removal of osseointegrated implants; however, few of these have the characteristics of easy control, selective cutting, and rapid healing. We report a case of benign paroxysmal positional vertigo (BPPV) developed immediately after piezosurgical removal of osteointegrated implants. The BPPV may be an unpleasant complication of piezosurgical removal of osseointegrated implants and may cause considerable stress if not identified correctly and managed properly. Address correspondence and reprint requests to Antonello Maria Messina, DDS, Via Salaria 394/b, Rome 00199, Italy; E-mail: antonellomariamessina@gmail.com Received 19 February, 2018 Accepted 7 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Evaluating the National Surgical Quality Improvement Program-Pediatric Surgical Risk Calculator for Pediatric Craniosynostosis Surgery

Background: The American College of Surgeons' National Surgical Quality Improvement Program-Pediatric (NSQIP-P) risk calculator was developed based on national data. There have been no studies assessing the risk calculator's performance in pediatric neurosurgery. The authors aimed to evaluate the predictions from the risk calculator compared to our single institution experience in craniosynostosis surgery. Methods: Outcomes from craniosynostosis surgeries performed between 2012 and 2016 at our academic pediatric hospital were evaluated using the NSQIP-P risk calculator. Descriptive statistics were performed comparing predicted 30-day postoperative events and clinically observed outcomes. The performance of the calculator was evaluated using the Brier score and receiver operating characteristic curve (ROC). Results: A total of 202 craniosynostosis surgeries were included. Median age was 0.74 years (range 0.15–6.32); 66% were males. Blood transfusion occurred in 162/202 patients (80%). The following clinical characteristics were statistically correlated with surgical complications: American Society of Anesthesiologists physical status classification >1 (P 

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Therapeutic Protocol for Orthosurgical Management of Class III Malocclusion in Patients With Cleidocranial Dysostosis

Cleidocranial dysostosis (CCD) is a congenital skeletal disorder with significant manifestations in facial and dental development. Patients are affected with CCD present maxillary deficiency, late dental eruption, and supernumerary teeth. Early and multidisciplinary approach is necessary to treat CCD patients, especially to manage dental eruption and Class III malocclusion with maxillary deficiency. Several orthodontic and surgical interventions are performed to enable traction and extraction of teeth. Yet the maxillary deficiency may be protracted followed by orthodontic dental compensation. On the other hand, it is important to note that CCD patients' treatment is closely related to the severity of transversal and sagittal deformities, as well as the discrepancies in the lower third of the face. In this context, patients with facial impairment highly affected by CCD may need ortho-surgical decompensation to reach more aesthetic outcomes. The present study reports a case of a 14-year-old young patient affected by CCD. Clinically, the patient presented Class III malocclusion, maxillary deficiency, short lower facial third, posterior crossbite, and anterior open bite leading to facial disharmony. The patient underwent treatment in 2 stages: the interceptive approach aimed to transversally expand the maxilla and promote its protraction; and the corrective phase combined with the orthognathic surgery treated the patients' main complains; the anterior open bite, unerupted teeth, and chin prominence. The treatment approach applied in the clinical report allowed the correction of the malocclusion and facial profile satisfying completely the patient's expectations. Address correspondence and reprint requests to Victor de Miranda Ladewig, DDS, MsC, Department of Orthodontics, Sagrado Coração University 10-50, Irma Arminda st. 17011-160 Bauru, Sa[Combining Tilde]o Paulo, Brazil; E-mail: victor@odontobaby.odo.br Received 31 July, 2017 Accepted 1 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Cephalometric Findings in Nine Individuals With Richieri-Costa-Pereira Syndrome

The Richieri-Costa-Pereira syndrome (RCPS) is an autosomal-recessive acrofacial dysostosis caused by mutations in EIF4A3, characterized by mandibular cleft comprising other craniofacial anomalies and limb defects such as cleft palate/Robin Sequence, microstomia, absence of mandibular central incisors, minor ear anomalies, clubfeet and first and 5 ray defects. The findings from this study are useful for better understanding the morphological consequences of disorders of EIF4A3, and having a better picture of the anatomic characteristics of the syndrome for a better therapeutic planning. Twenty-four angular and linear variables were measured to assess anteroposterior and vertical (superior-inferior) position of the cranial base, maxilla, mandible, and facial profile. The cephalometric radiographic analysis was performed on 9 individuals with RCPS, obtained at a mean age of 10.3 years, and compared with randomly selected age-matched 9 controls, without clefts and with well-balanced faces, with mean age of 10.6 years (both groups range 8.1 to 13.7 years). t test was used for analysis of means and Levene test for equality of variances. The syndrome group presented severe mandibular hypoplasia and retrognathism (P = 0.009, P = 0.001), greater facial convexity (N'PnPog and N'SnPog, P 

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Standardised pain management decreases expenses on analgesics: results from a 5-year programme at a university hospital

No abstract available

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Severe and persistent morphine-induced respiratory depression associated with ATP-Binding Cassette Subfamily B Member 1 and catechol-O-methyltransferase genetic defects: A case report

No abstract available

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Does goal-directed haemodynamic and fluid therapy improve peri-operative outcomes?: A systematic review and meta-analysis

BACKGROUND Much uncertainty exists as to whether peri-operative goal-directed therapy is of benefit. OBJECTIVES To discover if peri-operative goal-directed therapy decreases mortality and morbidity in adult surgical patients. DESIGN An updated systematic review and random effects meta-analysis of randomised controlled trials. DATA SOURCES Medline, Embase and the Cochrane Library were searched up to 31 December 2016. ELIGIBILITY CRITERIA Randomised controlled trials enrolling adult surgical patients allocated to receive goal-directed therapy or standard care were eligible for inclusion. Trauma patients and parturients were excluded. Goal-directed therapy was defined as fluid and/or vasopressor therapy titrated to haemodynamic goals [e.g. cardiac output (CO)]. Outcomes included mortality, morbidity and hospital length of stay. Risk of bias was assessed using Cochrane methodology. RESULTS Ninety-five randomised trials (11 659 patients) were included. Only four studies were at low risk of bias. Modern goal-directed therapy reduced mortality compared with standard care [odds ratio (OR) 0.66; 95% confidence interval (CI) 0.50 to 0.87; number needed to treat = 59; N = 52; I2 = 0.0%]. In subgroup analysis, there was no mortality benefit for fluid-only goal-directed therapy, cardiac surgery patients or nonelective surgery. Contemporary goal-directed therapy also reduced pneumonia (OR 0.69; 95% CI, 0.51 to 0. 92; number needed to treat = 38), acute kidney injury (OR 0. 73; 95% CI, 0.58 to 0.92; number needed to treat = 29), wound infection (OR 0.48; 95% CI, 0.37 to 0.63; number needed to treat = 19) and hospital length of stay (days) (−0.90; 95% CI, −1.32 to −0.48; I2 = 81. 2%). No important differences in outcomes were found for the pulmonary artery catheter studies, after accounting for advances in the standard of care. CONCLUSION Peri-operative modern goal-directed therapy reduces morbidity and mortality. Importantly, the quality of evidence was low to very low (e.g. Grading of Recommendations, Assessment, Development and Evaluation scoring), and there was much clinical heterogeneity among the goal-directed therapy devices and protocols. Additional well designed and adequately powered trials on peri-operative goal-directed therapy are necessary.

https://ift.tt/2sD6JoA

Low anaesthetic waste gas concentrations in postanaesthesia care unit: A prospective observational study

BACKGROUND Volatile anaesthetics are a potential hazard during occupational exposure, pregnancy or in individuals with existing disposition to malignant hyperthermia. Anaesthetic waste gas concentration in postanaesthesia care units (PACU) has rarely been investigated. OBJECTIVE(S) The current study aims to assess concentrations of volatile anaesthetics in relation to room size, number of patients and ventilator settings in different PACUs. DESIGN A prospective observational study. SETTING Two different PACUs of the Hannover Medical School (Hannover, Germany) were evaluated in this study. The rooms differed in dimensions, patient numbers and room ventilation settings. PATIENTS During the observation period, sevoflurane anaesthesia was performed in 65 of 140 patients monitored in postanaesthesia unit one and in 42 of 70 patients monitored in postanaesthesia unit two. MAIN OUTCOME MEASURES Absolute trace gas room concentrations of sevoflurane measured with a compact, closed gas loop high-resolution ion mobility spectrometer. RESULTS Traces of sevoflurane could be detected in 805 out of 970 samples. Maximum concentrations were 0.96 ± 0.20 ppm in postanaesthesia unit one, 0.82 ± 0.07 ppm in postanaesthesia unit two. Median concentration was 0.12 (0.34) ppm in postanaesthesia unit one and 0.11 (0.28) ppm in postanaesthesia unit two. CONCLUSION Low trace amounts of sevoflurane were detected in both PACUs equipped with controlled air exchange systems. Occupational exposure limits were not exceeded.

https://ift.tt/2JndMZ9

Safety and efficacy of peri-operative administration of hydroxyethyl starch in children undergoing surgery: A systematic review and meta-analysis

BACKGROUND Hydroxyethyl starch (HES) solutions have shown their efficiency for intravascular volume expansion. A safety recommendation limiting their use in adult patients has recently been made. OBJECTIVE To assess the efficacy and adverse effects of HES when administered intra-operatively to paediatric patients. DESIGN Systematic review with meta-analyses. Data were analysed using classical mean differences [and their 95% confidence intervals (CIs)] and trial sequential analysis. A Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification was performed for all outcomes. Reviewers extracted valid data, including perioperative total fluid intakes, mortality, renal function, coagulation tests, blood loss and length of hospital and ICU stay. DATA SOURCES Searches were performed in databases (Pubmed, Embase, Cochrane central register of controlled trials), clinical trials register, and open access journals not indexed in major databases. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) published before December 2016 involving paediatric patients who received 6% low molecular weight HES. RESULTS Nine RCTs involving 530 peri-operative paediatric patients were analysed. Compared with other fluids, HES did not significantly modify the amount of peri-operative fluid administered [mean difference 0.04; 95% CI (−1.76 to 1.84) ml kg−1], urine output [mean difference −33; 95% CI (−104 to 38) ml kg−1] or blood loss [mean difference −0.09; (−0.32 to 0.15) ml kg−1]. Trial sequential analysis determined that the outcomes for peri-operative fluid and urine output were underpowered. All results were graded as very low quality of evidence. CONCLUSION Intravascular volume expansion with low molecular weight 6% HES did not appear to modify renal function, blood loss or transfusion when administered to children during the peri-operative period. However, given the lack of statistical power and the very low GRADE quality of evidence, more high-quality RCTs are needed to explore these outcomes.

https://ift.tt/2sBvHVH

Anaesthesia and orphan diseases: anaesthetic management of a patient with X-linked Charcot–Marie–Tooth disease type 1

No abstract available

https://ift.tt/2JkgEpC

Opioid-related genetic polymorphisms do not influence postoperative opioid requirement: A prospective observational study

BACKGROUND Among the various factors that may influence the pharmacological response to opioids, genetic polymorphisms [single nucleotide polymorphisms (SNP)] have generated some interest. OBJECTIVES To examine the influence on morphine dose requirements and adverse events in the postoperative period of four SNP [opioid receptor mu1 (OPRM1), ATP-binding cassette subfamily B, member 1 (ABCB1) ex-21 and ex-26, catechol-o-methyltransferase (COMT)] in candidate genes involved in morphine pharmacodynamics and pharmacokinetics. DESIGN A single centre prospective study. SETTING University Hospital, Paris, France, from 2 January 2007 to 15 November 2011. PATIENTS A total of 438 white adults scheduled for major orthopaedic surgery (spine, hip and knee) under general anaesthesia. The main exclusion criteria were receiving opioids for chronic pain, nonopioid drugs within 2 days prior to surgery, pregnancy, renal insufficiency, sleep apnoea obstruction syndrome, morbid obesity, severe hepatic impairment, cognitive dysfunction. INTERVENTIONS Assays of plasma concentrations of morphine and metabolites (morphine 3-glucuronide and morphine 6-glucuronide) were performed and common polymorphisms in four candidate genes [OPRM1 A118G rs1799971; P-glycoprotein (ABCB1) T3435C (rs1045642) and G2677T/A (rs2032582); COMT Val 158 Met (rs4680)] were analysed. Morphine was titrated by staff in the postanaesthesia care unit (PACU) and in the ward patient-controlled intravenous analgesia was used for 24 h. MAIN OUTCOME MEASURES The dose of morphine required to achieve pain relief and the influence of SNP in genes involved in morphine pharmacodynamics and kinetics on morphine dose requirements. Secondary endpoints were the concentrations of morphine, morphine 6-glucuronide and morphine 3-gluguronide, the proportion of patients requiring a rescue analgesic and the proportion of morphine-related adverse events. RESULTS A total of 404 patients completed the study to final analysis. The mean ± SD morphine dose to achieve pain relief was 15.8 ± 8.8 mg in the PACU and 22.7 ± 18.6 mg during patient-controlled intravenous administration. Morphine-related adverse events were observed in 37%. There was no relationship between any genetic polymorphisms and morphine dose, morphine 3-gluguronide and morphine 6-glucuronide concentration, morphine-related adverse events or pain level. In the PACU only, P-glycoprotein polymorphisms (ex-21; ex-26) were significantly associated with morphine concentration but the prediction of the model was poor (R2 = 0.04) CONCLUSION No major relationship has been demonstrated between SNP of OPRM1, ABCB1, COMT and morphine requirement, pain level or adverse effects in the postoperative period. TRIAL REGISTRATION NCT00822549 (www.clinicaltrials.gov).

https://ift.tt/2JhERRu

Peri-operative goal-directed therapy: A definitive answer remains elusive

No abstract available

https://ift.tt/2xP0Gm7

Toll-like receptor 4 deficient mice do not develop remifentanil-induced mechanical hyperalgesia: An experimental randomised animal study

BACKGROUND Drugs with antagonistic actions on the Toll-like receptor 4 (Tlr4), such as naloxone at ultra low doses, have been used to inhibit opioid-induced hyperalgesia in rodents suggesting the involvement of this receptor and pathway on opioid-induced hyperalgesia. OBJECTIVE The aim of this study was to determine whether mice without the Tlr4 gene (Tlr4−/−) would not develop remifentanil-induced hyperalgesia. DESIGN An experimental randomised animal study. SETTING Experimental Unit, Complutense University of Madrid, Madrid, Spain. ANIMALS Twelve adult female wild-type mice and 12 adult Tlr4−/− mice. INTERVENTIONS Under sevoflurane anaesthesia, a 1-h, constant rate subcutaneous infusion of remifentanil (4 μg kg−1 min−1) or 0.9% saline. MAIN OUTCOME MEASURES Mechanical nociceptive thresholds were evaluated using a von Frey hair test before (baseline) and on days 5, 6 and 7 after treatment. Hyperalgesia was considered to be a decrease in the mechanical nociceptive threshold. Changes in mechanical nociceptive thresholds in the different groups were compared with one-sided paired t tests. RESULTS Baseline mechanical nociceptive thresholds were similar in all groups (2.2 ± 0.1 g). Remifentanil produced a 24% decrease in mechanical nociceptive thresholds in the wild-type mice (1.7 ± 0.0 g, averaged over 3 days, P = 0.00021), whereas the nociceptive thresholds were not changed in Tlr4−/− mice (2.2 ± 0.1 g, P = 0.857) or in mice receiving 0.9% saline (Tlr4−/−, 2.2 ± 0.1 g, P = 0.807; wild-type, 2.2 ± 0.1 g, P = 0.962). CONCLUSION Tlr4 receptor involvement is suggested in the development of remifentanil-induced hyperalgesia in mice. TRIAL REGISTRATION CEA-UCM 107/2012.

https://ift.tt/2JdZHBf

Fasting before elective surgery does not result in hypovolaemia: A prospective, observational study

No abstract available

https://ift.tt/2Jo6jsL

Patient factors and outcomes associated with the withdrawal or withholding of life-sustaining therapies in mechanically ventilated brain-injured patients: An observational multicentre study

BACKGROUND Knowledge of the factors associated with the decision to withdraw or withhold life support (WWLS) in brain-injured patients is limited. However, most deaths in these patients may involve such a decision. OBJECTIVES To identify factors associated with the decision to WWLS in brain-injured patients requiring mechanical ventilation who survive the first 24 h in the ICU, and to analyse the outcomes and time to death. DESIGN A retrospective observational multicentre study. SETTINGS Twenty French ICUs in 18 university hospitals. PATIENTS A total of 793 mechanically ventilated brain-injured adult patients. INTERVENTIONS None. MAIN OUTCOME MEASURES Decision to WWLS within 3 months of ICU admission, and death or Glasgow Outcome Scale (GOS) score at day 90. RESULTS A decision to WWLS was made in 171 patients (22%), of whom 89% were dead at day 90. Out of the 247 deaths recorded at day 90, 153 (62%) were observed after a decision to WWLS. The median time between admission and death when a decision to WWLS was made was 10 (5 to 20) days vs. 10 (5 to 26) days when no end-of-life decision was made (P 

https://ift.tt/2JesQMB

Anaesthesia and orphan diseases: difficult tracheal intubation in a child with Frank–ter Haar syndrome

No abstract available

https://ift.tt/2xNPFkR

Self-confidence and level of knowledge after cardiopulmonary resuscitation training in 14 to 18-year-old schoolchildren: A randomised-interventional controlled study in secondary schools in Germany

BACKGROUND Education of schoolchildren in cardiopulmonary resuscitation (CPR) is a strategic goal for improvement of bystander CPR in society. OBJECTIVE(S) The primary objective was to analyse the impact of CPR training on the resuscitation knowledge and self-confidence of secondary schoolchildren. In addition, independent predictors of improved CPR knowledge and self-confidence were investigated. DESIGN Randomised-interventional controlled study. SETTING Four secondary schools in Germany. PARTICIPANTS Four hundred and twenty-four schoolchildren aged from 14 to 18 years were included into the study. Fifty-one percent were female, and 33% had an immigrant background. INTERVENTION The intervention group received a 90-min CPR training session, whereas controls had no intervention. Levels of knowledge and self-confidence in initiating CPR were analysed by a study questionnaire before (t0), 90 min after (t1) and 6 months after training (t2). MAIN OUTCOME MEASURES Based on the evaluation of study questionnaires, the primary endpoint was to determine the development of resuscitation knowledge and self-confidence in initiating cardiopulmonary resuscitation at survey time-points t0, t1 and t2. RESULTS Schoolchildren in the intervention group (n=207) showed a significantly higher level of knowledge (P 

https://ift.tt/2Jcph9A

Evaluation of transversus abdominis plane block in open appendectomy in paediatrics: Comparison of ropivacaine in two different concentrations

No abstract available

https://ift.tt/2xOZNtN

For beginners in anaesthesia, self-training with an audiovisual checklist improves safety during anaesthesia induction: A randomised, controlled two-centre study

BACKGROUND Beginners in residency programmes in anaesthesia are challenged because working environment is complex, and they cannot rely on experience to meet challenges. During this early stage, residents need rules and structures to guide their actions and ensure patient safety. OBJECTIVE We investigated whether self-training with an electronic audiovisual checklist app on a mobile phone would produce a long-term improvement in the safety-relevant actions during induction of general anaesthesia. DESIGN, SETTING AND PARTICIPANTS During the first month of their anaesthesia residency, we randomised 26 residents to the intervention and control groups. The study was performed between August 2013 and December 2014 in two university hospitals in Germany. INTERVENTION In addition to normal training, the residents of the intervention group trained themselves on well tolerated induction using the electronic checklist for at least 60 consecutive general anaesthesia inductions. MAIN OUTCOME MEASURES After an initial learning phase, all residents were observed during one induction of general anaesthesia. The primary outcome was the number of safety items completed during this anaesthesia induction. Secondary outcomes were similar observations 4 and 8 weeks later. RESULTS Immediately, and 4 weeks after the first learning phase, residents in the intervention group completed a significantly greater number of safety checks than residents in the control group 2.8 [95% confidence interval (CI) 0.4 to 5.1, P = 0.021, Cohen's d = 0.47] and 3.7 (95% CI 1.3 to 6.1, P = 0.003, Cohen's d = 0.61), respectively. The difference between the groups had disappeared by 8 weeks: mean difference in the number of safety checks at 8 weeks was 0.4, 95% CI −2.0 to 2.8, P = 0.736, Cohen's d = 0.07). CONCLUSION The use of an audiovisual self-training checklists improves safety-relevant behaviour in the early stages of a residency training programme in anaesthesia.

https://ift.tt/2sCwXaT

Supraglottic airways: One size does not fit all

No abstract available

https://ift.tt/2xP0aEH

Novel use of video goggles during binocular microscopy in the otolaryngology clinic

The development of portable, high resolution video displays such as video glasses allows clinicians the opportunity to offer patients an increased ability to visualize aspects of their physical examination in an ergonomic and cost-effective manner. The objective of this pilot study is to trial the use of video glasses for patients undergoing binocular microscopy as well as to better understand some of the potential benefits of the enhanced display option.

https://ift.tt/2Hq2WQm

Shorter interval between radiation therapy and salvage laryngopharyngeal surgery increases complication rates following microvascular free tissue transfer

To evaluate how the interval between radiation and salvage surgery for advanced laryngeal cancer with free tissue transfer reconstruction influences complication rates.

https://ift.tt/2kR65zH

SERPING1 and F12 combined variants in a hereditary angioedema family,,✰✰✰,✰✰✰✰

Hereditary angioedema (HAE) is an autosomal dominant disorder characterized by recurrent swellings of the cutaneous and mucosal tissues. Associated complications include potentially life-threatening swellings, involving the tongue, pharynx and larynx. The well-known form of HAE is caused by autosomal dominant variants in the SERPING1 gene affecting an estimated 1 in 50,000 individuals in Europe (MIM #106100).1,2 These lead to a C1 Inhibitor (C1Inh) functional deficiency, resulting in uncontrolled activation of kallikrein-kinin system and high bradykinin formation, with a subsequent increase in vascular permeability causing angioedema.

https://ift.tt/2JwiZRE

Aggression directed towards members of the oral and maxillofacial surgical team

Oral and maxillofacial surgery (OMFS) is an acute surgical specialty, and members of the surgical team may be exposed to challenging incidents. We have evaluated the experiences of members of OMFS teams and their experiences of aggressive and abusive behaviour. Education and training in the resolution of such conflicts should be offered to all members of the team to allow a safe and secure working environment.

https://ift.tt/2M2nfXo

Differentiating among conductive hearing loss conditions with wideband tympanometry

This study was aimed to investigate whether wideband tympanometry (WBT) can distinguish among various kinds of conductive hearing loss and provide additional information.

https://ift.tt/2HrCA02

The treatment outcomes of rituximab for intractable otitis media with ANCA-associated vasculitis

To investigate treatment outcomes, hearing outcomes, and adverse effects of rituximab (RTX) for intractable otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV).

https://ift.tt/2kUuXXq

Differentiating among conductive hearing loss conditions with wideband tympanometry

Publication date: Available online 6 June 2018
Source:Auris Nasus Larynx
Author(s): So Young Kim, Jae Joon Han, Seung Ha Oh, Jun Ho Lee, Myung-whan Suh, Me Hee Kim, Moo Kyun Park
ObjectiveThis study was aimed to investigate whether wideband tympanometry (WBT) can distinguish among various kinds of conductive hearing loss and provide additional information.MethodsWe recruited normal subjects and patients with conductive hearing loss due to the following reasons: tympanic membrane perforation only, ossicular chain problem only, and one or other of those conditions combined with mastoid problems. Wideband absorbance at ambient pressure, peak pressure, resonance frequency, and averaged tympanogram data were measured by WBT and compared between the normal, tympanic membrane perforation only, ossicular chain problem only, and combined with mastoid problems groups.ResultsThe normal subjects showed an average peak pressure of −19.51daPa and an average resonance frequency of 965.94Hz. Tympanic membrane perforation only patients showed a very low peak pressure (−124.93daPa) and resonance frequency (73.12Hz). When patients have ossicular chain problems, they showed slightly low peak pressures (43.08daPa) without changes in the resonance frequency (1024.8Hz). Mastoid problem subjects showed slightly decreased resonance frequencies (787.71Hz). Tympanic membrane perforation subjects showed decreased absorbance at low frequencies and ossicular chain problem subjects showed decreases at high frequencies. When comparing the perforation only and ossicular chain subjects by absorbance at 707Hz, the area under the ROC curve was 0.719 (P<0.022). Mastoid problems subjects showed decreased absorbance at all frequencies.ConclusionWBT can help to distinguish tympanic membrane perforation only and ossicular chain problem patients. WBT may provide additional information on "combined with mastoid problems" patients.



https://ift.tt/2LuEMGP

Muscle Mass and Mortality After Cardiac Transplantation

Background Frailty assessment is recommended to evaluate the candidacy of adults referred for orthotopic heart transplantation (OHT). Psoas muscle area (PMA) is an easily measured biomarker for frailty. There has yet to be a study examining the prognostic impact of PMA in OHT patients. Methods In this retrospective study, pre and postoperative CT scans were retrieved for adults transplanted between 2000-2015 at a tertiary care hospital. PMA was measured on a single axial image. Outcomes of interest were all-cause mortality over 6 years and a composite of in-hospital mortality or major morbidity (prolonged ventilation, stroke, dialysis, mediastinitis, or reoperation). Results Of 161 adult patients transplanted, 82 had at least 1 abdominal CT scan. At baseline, mean PMA was 25.7±5.8 cm2 in men and 16.0±3.6 cm2 in women, and decreased by 8% from the first to the last available CT scan. Adjusting for age, sex, body mass index, and cardiomyopathy etiology, every 1 cm2 increase in PMA was found to be associated with a 9% reduction in long-term mortality (HR 0.91; 95% CI 0.83, 0.99; p=0.031) and a 17% reduction in in-hospital mortality or major morbidity (OR 0.83; 95% CI 0.72, 0.96; p=0.014). When PMA was smaller than the sex-specific median, the risk of mortality or major morbidity increased 4-fold (OR 4.29; 95% 1.19, 15.46; p=0.026). Conclusion Muscle mass is an independent predictor of mortality and major morbidity after OHT. Further research is needed to determine whether frail OHT patients with low PMA may benefit from muscle-building interventions to improve outcomes.fa Cosenior authors, Nadia Giannetti MD, Jonathan Afilalo MD, MSc ADDRESS FOR CORRESPONDENCE: Jonathan Afilalo, MD, MSc, FACC, FRCPC, Jewish General Hospital, 3755 Cote Ste Catherine Rd, E-222, Montreal, QC H3T 1E2, E-mail: jonathan.afilalo@mcgill.ca Author Contributions Lior Bibas: conception and design of study, collection of data, interpretation of data, primary authorship of manuscript. Eli Saleh, Samah Al-Kharji, Jessica Chetrit: collection of data, interpretation of data, coauthorship and revision of manuscript. Louis Mullie: software development for collection of data, coauthorship and revision of manuscript. Marcelo Cantarovich, Renzo Cecere: interpretation of data, coauthorship and revision of manuscript. Nadia Giannetti: conception and design of study, collection of data, interpretation of data, cosenior authorship of manuscript. Jonathan Afilalo: conception and design of study, software development for collection of data, statistical analysis, interpretation of data, cosenior authorship of manuscript. Author Disclosures Drs. Afilalo and Mullie developed the CoreSlicer.com software but do not hold any patents or financial incentives relating to its use. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding The costs related to data retrieval and extraction were funded by Dr. Nadia Giannetti's Heart Failure Research Fund. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2M3SpOm

Therapeutic Human IgG Preparations Contain Mixture of HLA Antibodies to Native HLA Antigens and Cryptic Epitopes with Little Clinical Significance

Background Human immunoglobulins (H-Ig) are widely used in solid organ transplantation for IgG replacement and for desensitization and treatment of antibody mediated rejection. They are obtained from plasma pools and may contain HLA antibodies that can be detrimental to transplant recipients. The goal of this study was to evaluate HLA antibodies in multiple lots of 2 commercial H-Ig preparations by. Luminex single antigen bead (SAB) and cell-based crossmatch assays. Methods Thirty lots of 2 commercial H-Ig products (CSL Behring, King of Prussia, PA.) were evaluated: 6 Hizentra® and 24 Privigen®. All were adsorbed and diluted 1:10 prior to testing. HLA immunoglobulin G (IgG) antibodies were determined by 2 Luminex SAB kits and C1q screen for complement binding capability. Lots were tested for the presence of antibody to denatured vs. intact Class I HLA alleles using acid-treated SAB. Surrogate T and B cell flow cytometry crossmatches (FCXM) were performed with peripheral blood lymphocytes from 2 healthy donors. Results Twenty-two lots (73%) at 1:10 showed SAB reactivity with MFI ≥2000 for HLA Class I, 67% (20/30 lots) for Class II. The reactivity pattern was similar using both SAB kits. Acid treatment revealed antibodies to denatured class I: the majority of HLA-C, half of HLA-B and few HLA-A alleles. No C1q reactivity was observed. Surrogate FCXM results were positive (>150 MCS), but were 4-8 fold lower than expected. Conclusions The H-Ig products tested consisted of low titer, noncomplement binding HLA Class I and Class II antibodies; most of the observed Class I HLA reactivity was towards denatured HLA antigens. Authorship Participated in research design: Massimo Mangiola, PhD Marilyn Marrari, BA Adriana Zeevi, PhD Participated in writing the paper: Massimo Mangiola, PhD Marilyn Marrari, BA Christopher Ensor, PharmD Martin O. Spycher, PhD Mel Berger, MD Adriana Zeevi, PhD Participated in the performance of the research: Massimo Mangiola, PhD Marilyn Marrari, BA Adriana Zeevi, PhD Contributed new reagents or analytic tools: Martin O. Spycher, PhD Mel Berger, MD Participated in the data analysis: Massimo Mangiola, PhD Marilyn Marrari, BA Adriana Zeevi, PhD CONFLICT OF INTEREST DISCLOSURE: Massimo Mangiola, PhD received support from CSL Behring LLC in form of reagents and supplies to conduct research Marilyn Marrari, BA received support from CSL Behring LLC in form of reagents and supplies to conduct research Christopher Ensor, PharmD received support from CSL Behring LLC in form of reagents and supplies to conduct research Martin O. Spycher, PhD Amployed by CSL Behring AG Mel Berger, MD Amployed by CSL Behring LLC Adriana Zeevi, PhD received support from CSL Behring LLC in form of reagents and supplies to conduct research Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2JjTtM5

Two potentially lethal conditions of probable immune origin occurring in a pregnant woman: a case report

Thrombotic thrombocytopenic purpura and peripartum cardiomyopathy are potentially lethal complications of pregnancy. We describe a case in which both of these developed in the same patient. The etiologies of b...

https://ift.tt/2sMF046

Tobacco smoking decreases clinical symptoms of gingivitis in patients with type 1 diabetes—a cross‐sectional study

Oral Diseases, EarlyView.


https://ift.tt/2M5bMGL

Stress‐related salivary proteins affect the production of volatile sulfur compounds by oral bacteria

Oral Diseases, EarlyView.


https://ift.tt/2xV9vei

Depth of invasion on pathological outcomes in clinical low‐stage oral tongue cancer patients

Oral Diseases, EarlyView.


https://ift.tt/2M6LV0X

Development and validation of oral health‐related quality of life measure in oral submucous fibrosis

Oral Diseases, EarlyView.


https://ift.tt/2Jotx22

Influence of cortical bone anchorage on the primary stability of dental implants

Abstract

Purpose

This retrospective chart review study assessed patient records to determine implant insertion torque (IT) and implant stability quotient (ISQ) values during implant placement to evaluate the correlation with cortical bone anchorage (mono- or bicortical).

Methods

Primary stability data (IT during implant placement surgery and ISQ values immediately after implant placement) and cone beam computed tomography of 33 patients (165 implants) were assessed. Patients were divided into the following groups: G1, implants with apical cortical bone contact; G2, implants with bicortical bone contact (apical and cervical regions); and G3, implants with cervical cortical bone contact.

Results

Sixty-eight implants were excluded due to cortical bone contact on regions other than implant apical or cervical. Ninety-seven implants were therefore assessed for this study. No implant failure was found after a mean 70.42-month follow-up time. Implants with bicortical anchorage (G2) showed higher IT (64.1 Ncm) during implant placement and higher ISQ values (76) (p < 0.05). Monocortical implants (G1, apical, and G3, cervical) showed similar IT (G1 52.3 and G3 54.3) and ISQ values (G1 71.9 and G3 73) (p > 0.05). No correlation (Pearson correlation coefficient) was found between the two stability measurement devices for the different cortical bone anchorages that were analyzed (G1 0.190, G2 0.039, and G3 − 0.027) (p > 0.05).

Conclusions

Insertion torque values and implant stability quotients were influenced by cortical bone contact. No significant correlation was found between IT and ISQ values—higher insertion torque values do not necessarily lead to higher implant stability quotients.

https://ift.tt/2xUkdBo

Genetic profiles of transcriptomic clusters of childhood asthma determine specific severe subtype

Clinical &Experimental Allergy, EarlyView.


https://ift.tt/2Hpocpk

Low incidence of heparin‐induced skin lesions in orthopedic surgery patients with low‐molecular‐weight heparins

Clinical &Experimental Allergy, EarlyView.


https://ift.tt/2kQGbfr

Prospective predictors of exacerbation status in severe asthma over a 3‐year follow‐up

Clinical &Experimental Allergy, EarlyView.


https://ift.tt/2HqK9UL

Tree nut allergies: Allergen homology, cross‐reactivity, and implications for therapy

Clinical &Experimental Allergy, EarlyView.


https://ift.tt/2Jh2DNx

Nasopharyngeal CCL5 in infants with severe bronchiolitis and risk of recurrent wheezing: A multi‐center prospective cohort study

Clinical &Experimental Allergy, EarlyView.


https://ift.tt/2Httj84

Src‐type tyrosine kinase p56lck is critical for thymic stromal lymphopoietin‐induced allergic rhinitis

Clinical &Experimental Allergy, EarlyView.


https://ift.tt/2JeMuIu

Peanut gastrointestinal delivery oral immunotherapy in adolescents: Results of the build‐up phase of a randomized, double‐blind, placebo‐controlled trial (PITA study)

Clinical &Experimental Allergy, EarlyView.


https://ift.tt/2sKStJP

Oral immunotherapy with omalizumab reverses the Th2 cell‐like programme of regulatory T cells and restores their function

Clinical &Experimental Allergy, EarlyView.


https://ift.tt/2JhNg7m

The national perioperative anaphylaxis audit project

Clinical &Experimental Allergy, Volume 48, Issue 6, Page 616-617, June 2018.


https://ift.tt/2sLBya3

Cover Image

Clinical &Experimental Allergy, Volume 48, Issue 6, Page i-i, June 2018.


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Best of the Other Journals

Clinical &Experimental Allergy, Volume 48, Issue 6, Page 754-754, June 2018.


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Selective nut‐eating in peanut or tree nut allergic children—How can molecular allergology help?

Clinical &Experimental Allergy, Volume 48, Issue 6, Page 618-619, June 2018.


https://ift.tt/2JhjHmw

Forthcoming meetings

Clinical &Experimental Allergy, Volume 48, Issue 6, Page 753-753, June 2018.


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Issue Information

Clinical &Experimental Allergy, Volume 48, Issue 6, Page 613-615, June 2018.


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Lysophosphatidylserine receptor P2Y10: A G protein‐coupled receptor that mediates eosinophil degranulation

Clinical &Experimental Allergy, EarlyView.


https://ift.tt/2sM1rGP

Low‐dose weekly methotrexate used to treat cutaneous Rosai–Dorfman disease

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2HptMrD

An unusual case of multiple nodules on the lower legs

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2JeKxeV

Cutaneous metastasis in a patient with multiple malignancies

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2sMgRur

Rickets re‐emerging: a cautionary tale

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2kRrrgj

Bilirubin oxidation derived from oxidative stress is associated with disease severity of atopic dermatitis in adults

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2HqEPkp

Elevated serum eosinophil cationic protein and transforming growth factor‐α levels in a patient with pemphigus vegetans

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2JgC1Mz

Subclinical atherosclerosis in psoriasis: a clue to aortic abnormalities?

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2sMh8NZ

Leucoderma on the lips induced by neem (Azadirachta indica): case series

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2kR43zB

A simple, safe and cheap treatment of eccrine hidrocystomas: topical aluminium hexachloride

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2Hptb9n

Intravenous immunoglobulin is an effective treatment for refractory cutaneous dermatomyositis

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2JeRhcO

Association between climate, pollution and hospitalization for pemphigus in the USA

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2sJo2DZ

Malnutrition and skin disease in Far East prisoners‐of‐war in World War II

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2JjIOVW

Methotrexate‐associated lymphoproliferative disorder presenting as giant ulcers on the leg

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2sKLLn3

Cutaneous metastases of melanoma presenting as sudden haematomas: clinical, dermoscopic and sonographic features

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2kTGtCa

Intravascular basal cell carcinoma: what to do next?

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2HoJrHy

A small nodule on the auricle

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2kVct98

Acneiform follicular mucinosis: an indolent follicular mucinosis variant unrelated to mycosis fungoides?

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2sKMCEl

Pityriasis rubra pilaris‐like erythroderma secondary to phosphoinositide 3‐kinase inhibition

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2kR6kKY

Febrile ulceronecrotic Mucha–Habermann disease after levamisole‐adulterated cocaine use: an unusual case

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2HoXT2F

Perianal nodule in a young woman

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2JgZ5eb

Prevalence of oral potentially malignant disorders: A systematic review and meta‐analysis

Journal of Oral Pathology &Medicine, EarlyView.


https://ift.tt/2M2tRoI

CD44 and ALDH1 immunoexpression as prognostic indicators of invasion and metastasis in oral squamous cell carcinoma

Journal of Oral Pathology &Medicine, EarlyView.


https://ift.tt/2xNjty1

Homozygote C/C at rs12543318 was risk factor for non‐syndromic cleft lip only from Western Han Chinese population

Journal of Oral Pathology &Medicine, EarlyView.


https://ift.tt/2M347Ze

Immunohistochemical diagnosis of mucous membrane pemphigoid

Journal of Oral Pathology &Medicine, EarlyView.


https://ift.tt/2JmB41c

Central giant cell lesion of the jaws: An updated analysis of 2270 cases reported in the literature

Journal of Oral Pathology &Medicine, EarlyView.


https://ift.tt/2M33XkA

Keratin 4 regulates the development of human white sponge nevus

Journal of Oral Pathology &Medicine, EarlyView.


https://ift.tt/2JlAf8M

Perspectives on oral squamous cell carcinoma prevention—proliferation, position, progression and prediction

Journal of Oral Pathology &Medicine, EarlyView.


https://ift.tt/2M3fLDF

Treponema denticola chymotrypsin‐like proteinase is present in early‐stage mobile tongue squamous cell carcinoma and related to the clinicopathological features

Journal of Oral Pathology &Medicine, EarlyView.


https://ift.tt/2xKEvgR

Change of signs, symptoms and voice quality evaluations throughout a 3‐ to 6‐month empirical treatment for laryngopharyngeal reflux disease

Clinical Otolaryngology, EarlyView.


https://ift.tt/2xNhERQ

Role of local anaesthetic nerve block in endoscopic sinus surgery: A systematic review and meta‐analysis

Clinical Otolaryngology, EarlyView.


https://ift.tt/2M313wc

Impact of age on survival of locoregional nasopharyngeal carcinoma: An analysis of the Surveillance, Epidemiology, and End Results program database, 2004‐2013

Clinical Otolaryngology, EarlyView.


https://ift.tt/2xOl86D

A meta‐analysis on the surgical management of paraganglioma of the carotid body per Shamblin class

Clinical Otolaryngology, EarlyView.


https://ift.tt/2M5qLjS

A patient‐centred multidomain instrument for improving the clarity of outcomes reporting and documentation in complex airway surgery

Clinical Otolaryngology, EarlyView.


https://ift.tt/2JjPfEg

Primary versus secondary tracheoesophageal puncture for voice rehabilitation in laryngectomy patients: A systematic review

Clinical Otolaryngology, EarlyView.


https://ift.tt/2M3ftg1

Individual Funding Requests: A flawed process

Clinical Otolaryngology, EarlyView.


https://ift.tt/2xKBxcd

Oxford radiographic chart of foreign bodies

Clinical Otolaryngology, EarlyView.


https://ift.tt/2M5rX6H

Minimally invasive surgery for superior semicircular canal dehiscence: Results of a four fenestration technique in twenty‐one adults

Clinical Otolaryngology, EarlyView.


https://ift.tt/2xKOAuk

Nasopharyngeal versus hypopharyngeal packing during sino‐nasal surgeries: Randomised controlled trial

Clinical Otolaryngology, EarlyView.


https://ift.tt/2M6VQ6y

Trends in the prescribing of topical nasal agents Using an NHS England data base

Clinical Otolaryngology, EarlyView.


https://ift.tt/2xOOgKP

Ionizing radiation, but not ultraviolet radiation, induces mitotic catastrophe in mouse epidermal keratinocytes with aberrant cell cycle checkpoints

Experimental Dermatology, EarlyView.


https://ift.tt/2xOqgHN

Sun Protection Among Organ Transplant Recipients After Participation in a Skin Cancer Research Study

This study investigates the use of sun protection among organ transplant recipients after participation in a skin cancer research study.

https://ift.tt/2sCuTQ4

Polymorphic Erythematous Macules and Plaques With Dysesthesia

A woman in her 50s presented with a 2-year history of disseminated dermatosis involving the trunk and limbs; the dermatosis was characterized by polymorphic erythematous macules and plaques with elevated and indurated borders without evanescence to pressure. What is your diagnosis?

https://ift.tt/2sG2Lee

Hemophagocytic Lymphohistiocytosis in Cutaneous T-Cell Lymphoma

This case series examines the characteristics of cutaneous T-cell lymphoma associated with hemophagocytic lymphohistiocytosis and analyzes the presenting signs and symptoms, therapeutic options, and outcomes.

https://ift.tt/2sAx470

Core Outcome Sets for Psoriasis Clinical Trials

Standardized and relevant psoriasis-specific outcome measures would contribute to a better understanding of the benefits of a growing list of highly effective therapies. To this end, in this issue of JAMA Dermatology, Callis Duffin et al present the results of an effort to define core outcome sets (COSs) for clinical trials of psoriasis. Under the auspices of the International Dermatology Outcome Measures group, the authors conducted a Delphi survey and determined that the following 6 domains should be addressed in all psoriasis trials: (1) psoriatic skin manifestations (including location), (2) an investigator global assessment, (3) an evaluation of signs and symptoms of both psoriasis and psoriatic arthritis, (4) a patient global assessment of his or her condition, (5) an assessment of treatment satisfaction, and (6) a measure of health-related quality of life.

https://ift.tt/2HpmFzr

Identifying a Core Domain Set to Assess Psoriasis in Clinical Trials

This Delphi survey of patients, health care professionals, and other stakeholders identifies a core set of 6 domains that should be measured in all clinical trials for psoriasis therapies.

https://ift.tt/2sCuRrq

Dynamic Trichoscopy

This Viewpoint discusses how the dermoscope is a practical instrument for use in routine practice and describes how its shortcomings can be overcome with increasing familiarity with the use of dynamic vs static trichoscopy.

https://ift.tt/2Hp6sKN

Nivolumab versus ipilimumab in the treatment of advanced melanoma: a critical appraisal

British Journal of Dermatology, EarlyView.


https://ift.tt/2kWkhYp

Individuals with filaggrin‐related eczema and asthma have increased long‐term medication and hospital admission costs

British Journal of Dermatology, EarlyView.


https://ift.tt/2sMKbBj

Inherited pulmonary cylindromas: extending the phenotype of CYLD mutation carriers

British Journal of Dermatology, EarlyView.


https://ift.tt/2swKCAn

Accelerated barrier recovery and enhancement of the barrier integrity and properties by topical application of a pH 4 vs. a pH 5·8 water‐in‐oil emulsion in aged skin

British Journal of Dermatology, EarlyView.


https://ift.tt/2sLO35x

Bilateral striatal necrosis and dyschromatosis symmetrica hereditaria: A–I editing efficiency of ADAR1 mutants and phenotype expression

British Journal of Dermatology, EarlyView.


https://ift.tt/2kS25ik

Interleukin‐32 promotes detachment and activation of human Langerhans cells in a human skin explant model

British Journal of Dermatology, EarlyView.


https://ift.tt/2Ho9or5

Is depression screening in patients with acne critical?: reply from authors

British Journal of Dermatology, EarlyView.


https://ift.tt/2swKAsf

An important and overlooked parameter in platelet rich plasma preparation: The mean platelet volume

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2M2x3AV

Cutaneous acceptability of a moisturizing cream in subjects with sensitive skin

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2JmDQ6H

Platelet rich plasma for photodamaged skin: A pilot study

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2M4sAh6

Psoriasis Area and Severity Index response in moderate‐severe psoriatic patients switched to adalimumab: results from the OPPSA study

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


https://ift.tt/2JBsqiU

Silver absorption and toxicity evaluation of silver wound dressings in 40 patients with chronic wounds

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


https://ift.tt/2LsFnc0

The effects of season and weather on healthcare utilization among patients with atopic dermatitis

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


https://ift.tt/2JuhBz3

Trends in hospitalization rates for psoriasis flares since the introduction of biologics: a time series in France between 2005 and 2015

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


https://ift.tt/2LnlNxy

Prevalence and comorbidities associated with hidradenitis suppurativa in Korea: a nationwide population‐based study

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


https://ift.tt/2JxMvGI

The effect of autoimmune blistering diseases on work productivity

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


https://ift.tt/2LnlDpW

Genetic polymorphism of thymic stromal lymphopoietin in Korean patients with atopic dermatitis and allergic march

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


https://ift.tt/2Jxw2SY

Tattoo‐associated uveitis with or without systemic sarcoidosis: a comparative review of the literature

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


https://ift.tt/2LsquGG

Presence of SCF/CXCL12 double‐positive large blast‐like cells at the site of cutaneous extramedullary haematopoiesis

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


https://ift.tt/2JuWnAT

Beta‐adrenoceptor expression in pemphigus foliaceus

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


https://ift.tt/2LsqkPA

Problems and challenges of predatory journals

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


https://ift.tt/2JBsoHO

Outdoor environment, ozone, radionuclide‐associated aerosols and incidences of infantile eczema in Minsk, Belarus

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


https://ift.tt/2Lnldjm

Drug‐induced longitudinal melanonychia and transverse muehrcke's lines

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


https://ift.tt/2JuWbSb

Effectiveness of omalizumab in chronic spontaneous urticaria assessed with patient‐reported outcomes: a prospective study

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


https://ift.tt/2LoelCz

Ipilimumab more and more discussed: urgent need for predictive markers of response

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 6, Page 849-849, June 2018.


https://ift.tt/2Jz39Wl

Forthcoming Events

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 6, Page 1044-1044, June 2018.


https://ift.tt/2Lsq5UG

Issue Information

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 6, Page 843-848, June 2018.


https://ift.tt/2JzImls

Announcement

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 6, Page 1045-1045, June 2018.


https://ift.tt/2Loejur

Consensus‐based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 6, Page 850-878, June 2018.


https://ift.tt/2JuVRCX

Pseudo‐Kaposi sarcoma: report of a case investigated by dermoscopy, reflectance confocal microscopy and optical coherence tomography

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


https://ift.tt/2LsansB

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

Pediatric Dermatology, EarlyView.


https://ift.tt/2M5f0tK

Contact dermatitis to training toilet seat (potty seat dermatitis)

Pediatric Dermatology, EarlyView.


https://ift.tt/2JlEMbl

Segmental storiform collagenomas: Expanding the spectrum of PTEN hamartoma tumor syndrome in children

Pediatric Dermatology, EarlyView.


https://ift.tt/2M3pt91

Rhabdomyosarcoma and rhabdomyoma associated with nevoid basal cell carcinoma syndrome: Local treatment strategy

Pediatric Dermatology, EarlyView.


https://ift.tt/2xNh5Y2

Peanut lipids display potential adjuvanticity by triggering a pro‐inflammatory response in human keratinocytes

Allergy, EarlyView.


https://ift.tt/2sRS2O7

Allergen immunotherapy in people, dogs, cats and horses – differences, similarities and research needs

Allergy, EarlyView.


https://ift.tt/2sBKjEe

Human‐computer symbiosis: enhancing dermatologic care while preserving the art of healing

International Journal of Dermatology, EarlyView.


https://ift.tt/2M5zVwz

Climate change and atopic dermatitis: is there a link?

International Journal of Dermatology, EarlyView.


https://ift.tt/2JodGAi

JAK‐STAT signaling pathway inhibition: a role for treatment of discoid lupus erythematosus and dermatomyositis

International Journal of Dermatology, EarlyView.


https://ift.tt/2M3mZrd

Bazex‐Dupré‐Christol syndrome: review of clinical and molecular aspects

International Journal of Dermatology, EarlyView.


https://ift.tt/2Jl1lNf

Incidence of pemphigus vulgaris and pemphigus foliaceus in North‐East Poland (Podlaskie Province) – a 15‐year (2001–2015) bicentric retrospective study

International Journal of Dermatology, EarlyView.


https://ift.tt/2JjhLG8

Erratum

International Journal of Dermatology, EarlyView.


https://ift.tt/2M2rLp3

Acral nodule as a form of atypical presentation of a tufted angioma in adulthood

International Journal of Dermatology, EarlyView.


https://ift.tt/2JjhvqE

Psychosomatic factors of atopic dermatitis exacerbation

International Journal of Dermatology, EarlyView.


https://ift.tt/2M1yQpE

Hypohidrotic ectodermal dysplasia: clinical and molecular review

International Journal of Dermatology, EarlyView.


https://ift.tt/2JlSB9T

Disseminated tuberculosis following adalimumab treatment in psoriasis despite negative screening

International Journal of Dermatology, EarlyView.


https://ift.tt/2M3cC6W

First case of symmetrical drug‐related intertriginous and flexural exanthema (SDRIFE) due to Berberine, an over‐the‐counter herbal glycemic control agent

International Journal of Dermatology, EarlyView.


https://ift.tt/2JjgZcc

Vitamin D status in adult patients with nonmelanoma skin cancer in Cape Town, South Africa: a cross‐sectional study

International Journal of Dermatology, EarlyView.


https://ift.tt/2M3cqVg

Pigmented mammary Paget disease mimicking cutaneous melanoma

International Journal of Dermatology, EarlyView.


https://ift.tt/2M3cJzo

Comorbidities in vitiligo: comprehensive review

International Journal of Dermatology, EarlyView.


https://ift.tt/2JlBh4H

A prospective study to validate various clinical criteria used in classification of leprosy: a study from a tertiary care center in India

International Journal of Dermatology, EarlyView.


https://ift.tt/2LXHHJ7

Multiple red‐brown nodules and plaques on the face, trunk, and bilateral elbows

International Journal of Dermatology, EarlyView.


https://ift.tt/2JpGNmI

The rapidly evolving lesions of ulcerative pyoderma gangrenosum: a timeline

International Journal of Dermatology, EarlyView.


https://ift.tt/2M12hrY

Colloid milium: the expanding spectrum of orange color at dermoscopy

International Journal of Dermatology, EarlyView.


https://ift.tt/2JmieHw

Prurigo‐like herpes simplex

International Journal of Dermatology, EarlyView.


https://ift.tt/2M4oy8s

Multiple vegetating plaques on a Cesarean section scar

International Journal of Dermatology, EarlyView.


https://ift.tt/2JmidmW

Migratory, recurrent skin eruption in a returning traveller

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2JuS08X

Systemic contact dermatitis caused by inhalation of epoxy resin in industrial waste vapour

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2Ls5zn3

Immediate irritant dermatitis from the passionvine hopper (Scolypopa australis)

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2JvmXd7

Cervicofacial subcutaneous emphysema after facial cosmetic procedure in an 11‐year‐old girl

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2LszThq

Chemopreventive potential of nicotinamide in Gilmore's Bayesian analysis

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2JuRM1B

Treatment of giant vulvar syringomas with topical adelmidrol: The role of mast cells

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2Ls1Ohl

Eosinophilic fasciitis and lichen sclerosus in a patient treated with nivolumab

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2JuRGaf

Issue Information ‐ TOC

Australasian Journal of Dermatology, Volume 59, Issue 2, Page 79-81, May 2018.


https://ift.tt/2Ls5mjL

Corrigendum

Australasian Journal of Dermatology, Volume 59, Issue 2, Page 162-162, May 2018.


https://ift.tt/2Jxsr79

Issue Information ‐ JEB

Australasian Journal of Dermatology, Volume 59, Issue 2, Page 83-83, May 2018.


https://ift.tt/2Ls58cp

Porcine small intestine submucosal grafts improve remucosalization and progenitor cell recruitment to sites of upper airway tissue remodeling

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2sAULvM

EXHANCE‐12: 1‐year study of the exhalation delivery system with fluticasone (EDS‐FLU) in chronic rhinosinusitis

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2sLZiL1

Revision endoscopic sinus surgery rates by chronic rhinosinusitis subtype

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2kP7dUq

Incidence and predictive factors for additional opioid prescription after endoscopic sinus surgery

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2Hozfis

Issue Information

The Journal of Dermatology, Volume 45, Issue 6, Page i, 631-632, June 2018.


https://ift.tt/2JmzmwM

Corrigendum

The Journal of Dermatology, Volume 45, Issue 6, Page 751-751, June 2018.


https://ift.tt/2sB7ONZ

Issue Information

The Journal of Dermatology, Volume 45, Issue 6, Page 752-752, June 2018.


https://ift.tt/2xKkEOR

Epithelial–mesenchymal transition in Bowen's disease when arising de novo and acquiring invasive capacity

The Journal of Dermatology, Volume 45, Issue 6, Page 748-750, June 2018.


https://ift.tt/2sCpWH7

Epidermal barrier disruption by 9‐hydroxy‐10E,12Z‐octadecadienoic acid in human keratinocytes

The Journal of Dermatology, Volume 45, Issue 6, Page 746-747, June 2018.


https://ift.tt/2JmoxuK

Guidelines for the diagnosis and treatment of male‐pattern and female‐pattern hair loss, 2017 version

The Journal of Dermatology, EarlyView.


https://ift.tt/2JhuBZm

Two cases of conjunctival squamous cell carcinoma in the anophthalmic socket after treatment of retinoblastoma

The Journal of Dermatology, EarlyView.


https://ift.tt/2xKkqat

Scleroderma‐like syndrome associated with nivolumab treatment in malignant melanoma

The Journal of Dermatology, EarlyView.


https://ift.tt/2JiySfn

Localized scleroderma occurring after treatment of chronic hepatitis C with sofosbuvir and ribavirin

The Journal of Dermatology, EarlyView.


https://ift.tt/2xNc1Tw

Tubular apocrine adenoma: A rare and controversial tumor

The Journal of Dermatology, EarlyView.


https://ift.tt/2sCpGb7

pH in nature, humans and skin

The Journal of Dermatology, EarlyView.


https://ift.tt/2xNbLnw

Case of psoriasiform and pustular eruptions in addition to alopecia as a paradoxical reaction induced by infliximab

The Journal of Dermatology, EarlyView.


https://ift.tt/2sCpB7j

Nevus unius lateris: Electrofulguration as a therapeutic approach

The Journal of Dermatology, EarlyView.


https://ift.tt/2JpdkcZ

Case of late‐onset focal dermal elastosis

The Journal of Dermatology, EarlyView.


https://ift.tt/2JiYEjl

Mild hyperbaric oxygen activates the proliferation of epidermal basal cells in aged mice

The Journal of Dermatology, EarlyView.


https://ift.tt/2xJGnq2

From biologic to biologic: Ulcerative colitis in the setting of psoriasis treatment

The Journal of Dermatology, EarlyView.


https://ift.tt/2JiYrN5

H syndrome: Clinical, histological and genetic investigation in Tunisian patients

The Journal of Dermatology, EarlyView.


https://ift.tt/2Jm1Zdr

Four cases of acute infectious urticaria showing significant elevation of plasma D‐dimer level

The Journal of Dermatology, EarlyView.


https://ift.tt/2sCUsRd

Pigmented mammary Paget's disease without underlying carcinoma

The Journal of Dermatology, EarlyView.


https://ift.tt/2Jpdlxz

Key component of inflammasome, NLRC4, was identified in the lesional epidermis of psoriatic patients

The Journal of Dermatology, EarlyView.


https://ift.tt/2JbNsoC

The effect of Helicobacter pylori eradication on functional dyspepsia in Turkish children

Helicobacter, EarlyView.


https://ift.tt/2JdNufM

Retrospective study on outcome of salvage Helicobacter pylori eradication therapies based on molecular genetic susceptibility testing

Helicobacter, EarlyView.


https://ift.tt/2HpzVUK

Systematic review with meta‐analysis: Vonoprazan, a potent acid blocker, is superior to proton‐pump inhibitors for eradication of clarithromycin‐resistant strains of Helicobacter pylori

Helicobacter, EarlyView.


https://ift.tt/2kTLuLe

Eradication of Helicobacter pylori infection was associated with complete cure of resistant bleeding per gums

Helicobacter, EarlyView.


https://ift.tt/2HqZaWB

Issue Information

Helicobacter, Volume 23, Issue 3, June 2018.


https://ift.tt/2Jg7MoX

Posterior cricoid-graft mismatch in laryngotracheal reconstruction

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Derek Wu, Jordan Virbalas, Andrew Lee, John Bent
Introduction/ObjectiveIn laryngotracheal reconstruction (LTR) with sutureless posterior cricoid grafting (PCG), the inset graft's thickness may not precisely approximate the anterior-posterior depth of the divided posterior cricoid plate. This case series highlights this phenomenon and describes the clinical profiles and airway characteristics of children with similar subglottic stenosis grades undergoing LTR with PCG with varying degrees of graft-cricoid mismatch.MethodsThis is a case series with retrospective chart review of children who underwent LTR with PCG by a single surgeon at a tertiary care urban children's hospital from 2008 to 2014.ResultsTwenty-one patients with twenty-two operations were identified. Varying degrees of graft-cricoid mismatch were present. Of the 22 operations, 15 were classified as grade I (flush), 5 grade II (<3 mm), and 2 grade III (>3 mm). Median preoperative grade of stenosis was III in all groups. Mean one month granulation grade was 1.84, compared to 1.92 in grade I, 1.6 in grade II mismatch, 2 in grade III mismatch, and 1.7 in any mismatch (p = 0.65). Mean follow up was 24 months.ConclusionGraft-cricoid mismatch may occur at variable degrees during laryngotracheal reconstruction utilizing sutureless posterior cricoid grafting. Our preliminary data suggest several millimeters of graft-cricoid mismatch can be tolerated without significantly affecting postoperative granulation formation or adding to postoperative morbidity.



https://ift.tt/2kR612U

Molecular imaging assessment of periodontitis lesions in an experimental mouse model

Abstract

Objective

We aimed to evaluate molecular imaging as a novel diagnostic tool for mice periodontitis model induced by ligature and Porphyromonas gingivalis (Pg) inoculation.

Materials and methods

Twelve female mice were assigned to the following groups: no treatment as control group (n = 4); periodontitis group induced by ligature and Pg as Pg group (n = 4); and Pg group treated with glycyrrhizinic acid (GA) as Pg + GA group (n = 4). All mice were administered a myeloperoxidase (MPO) activity-specific luminescent probe and observed using a charge-coupled device camera on day 14. Image analysis on all mice was conducted using software to determine the signal intensity of inflammation. Additionally, histological and radiographic evaluation for periodontal inflammation and bone resorption at the site of periodontitis, and quantitative enzyme-linked immunosorbent assay (ELISA) were conducted on three mice for each group. Each experiment was performed three times.

Results

Levels of serum IgG antibody against P. gingivalis were significantly higher in the Pg than in the Pg + GA group. Histological analyses indicated that the number of osteoclasts and neutrophils were significantly lower in the Pg + GA than in the Pg group. Micro-CT image analysis indicated no difference in bone resorption between the Pg and Pg + GA groups. The signal intensity of MPO activity was detected on the complete craniofacial image; moreover, strong signal intensity was localized specifically at the periodontitis site in the ex vivo palate, with group-wise differences.

Conclusions

Molecular imaging analysis based on MPO activity showed high sensitivity of detection of periodontal inflammation in mice.

Clinical relevance

Molecular imaging analysis based on MPO activity has potential as a diagnostic tool for periodontitis.

https://ift.tt/2xOgW6H

Influence of pH on osteoclasts treated with zoledronate and alendronate

Abstract

Objectives

The objectives of this study were to analyze the effect of pH on the growth and activity of osteoclasts treated with different doses of two nitrogen-containing BPs, zoledronate and alendronate.

Materials and Methods

Murine osteoclasts cultured on dentine disks were treated with zoledronate (50 or 500 nM) or alendronate (500 or 5 μM) at two different pH values (7.4 or 7.0). Osteoclasts were counted with transmitted light microscopy, apoptosis/necrosis was studied with flow cytometry and confocal microscopy, and resorption pit number and depth were calculated using reflected light and scanning electron microscopy.

Results

The osteoclast count on dentine disks was significantly (p < 0.001) reduced by zoledronate or alendronate treatment at pH 7.0 in comparison to treatment with the same doses at pH 7.4 and untreated disks (controls). The percentage of apoptotic cells was significantly increased by treatment with 500 nM zoledronate or 5 μM alendronate at pH 7.0 in comparison to the same doses at pH 7.4. The number and depth of resorption pits were significantly lower in disks treated at each BP dose studied than in untreated controls at pH 7.0.

Conclusions

Zoledronate and alendronate at therapeutic doses have an adverse effect on the viability and resorptive activity of osteoclasts when the local medium pH is reduced.

Clinical relevance

These findings suggest that periodontal or peri-implant oral cavity infection may be a key trigger of the cascade of events that lead to BRONJ.

https://ift.tt/2LXvCUh

Moderate Whole Body Hyperthermia for Patients Undergoing Re-irradiation for Head and Neck Cancer -Influence on the Tumor Microenvironment

Conditions:   Head and Neck Neoplasms;   Recurrence Tumor
Intervention:   Device: Moderate whole body hyperthermia using water-filtered IR-A-radiation
Sponsors:   Charite University, Berlin, Germany;   Erwin Braun foundation
Recruiting

https://ift.tt/2M0mSfU

Effect of Three Different Peak Airway Pressures on Determining Intraoperative Bleeding in Thryroidectomies

Conditions:   Thyroid Neoplasms;   Thyroid Nodule
Intervention:   Procedure: peak airway pressure
Sponsor:   Istanbul University
Not yet recruiting

https://ift.tt/2Jmd4LC

3M Cavilon Advanced Skin Protectant for the Prophylaxis of Radiation Dermatitis

Condition:   Radiation Dermatitis
Intervention:   Other: 3M™ Cavilon™ Advanced Skin Protectant
Sponsor:   Mayo Clinic
Recruiting

https://ift.tt/2M0mI8i

Awake Nasal Intubation in Oro and Hypo-pharynx Tumors

Condition:   Airway Management
Interventions:   Device: fiberoptic naso-tracheal intubation;   Drug: Topical anaesthesia;   Drug: Light sedation
Sponsor:   Iuliu Hatieganu University of Medicine and Pharmacy
Recruiting

https://ift.tt/2Jj8Nso

SBRT +/- Pembrolizumab in Patients With Local-Regionally Recurrent or Second Primary Head and Neck Carcinoma

Condition:   Head and Neck Squamous Cell Carcinoma (HNSCC)
Interventions:   Drug: Pembrolizumab;   Radiation: Stereotactic Body Radiation Therapy (SBRT)
Sponsors:   RTOG Foundation, Inc.;   Merck Sharp & Dohme Corp.
Not yet recruiting

https://ift.tt/2M19Wqa

Customized Registry Tool for Tracking Adherence to Clinical Guidelines for Head and Neck Cancers

Condition:   Head and Neck Neoplasms
Intervention:   Other: Registry
Sponsors:   University of California, San Francisco;   Agency for Healthcare Research and Quality (AHRQ)
Not yet recruiting

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Synchronous Parotid (Mammary Analog) Secretory Carcinoma and Acinic Cell Carcinoma: Report of a Case

Abstract

Mammary analogue secretory carcinoma (MASC) is a recently described low-grade salivary gland malignancy with histologic, immunohistochemical and molecular similarities to secretory carcinoma of the breast, including a specific t(12;15)(p13;q25) resulting in an ETV6–NTRK3 gene fusion. Ultrasound and magnetic resonance imaging frequently document a macrocystic structure. The main differential diagnosis of secretory carcinoma is with low grade acinic cell carcinoma (AciCC). The two can be differentiated with immunohistochemical stains for S100, mammaglobin, carbonic anhydrase VI and DOG-1; the identification of the specific translocation can help to characterize non-typical cases. We report a unique case of synchronous MASC and AciCC presenting in a parotid gland and discuss the implications of the correct identification of the two tumors.

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Sulfonamide Drug Allergy

Abstract

Purpose of Review

We sought to review past and current literature on sulfonamide drug allergy and distill it in a practical manner to assist the clinician, specifically focusing on cross-reactivity and desensitization.

Recent Findings

There do not appear to be consistent genetic markers to reliably predict features of or the presence hypersensitivity reactions. Recent evidence continues to alleviate early concerns cross-reactivity between sulfonamide antibiotics and non-antibiotics.

Summary

Sulfonamide drug allergy is frequently encountered by the practicing clinician. For sulfonamide antibiotics, delayed rash is the most common clinical manifestation. There is no current evidence to support avoidance of all non-antibiotic sulfonamides in those with a reported allergy to sulfonamide antibiotics, although certain scenarios require caution. Available evidence supports the cautious reintroduction of sulfonamide antibiotics via desensitization, which is usually well tolerated and should be considered in those with strong indications for trimethoprim-sulfamethoxazole and a reported sulfonamide allergy.

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Impact of obesity on outcomes for patients with head and neck cancer

Publication date: August 2018
Source:Oral Oncology, Volume 83
Author(s): Daniel F. Hicks, Richard Bakst, John Doucette, Benjamin H. Kann, Brett Miles, Eric Genden, Krzysztof Misiukiewicz, Marshall Posner, Vishal Gupta
ObjectivesThe prognostic role of obesity in head and neck squamous cell carcinoma (HNSCC) is not well defined. This study aims to determine its effect on disease-specific outcomes such as recurrence-free survival (RFS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) in addition to overall survival (OS).MethodsFor patients with newly diagnosed HNSCC undergoing radiation therapy (RT) at a single institution, body mass index (BMI) at diagnosis was categorized as normal (18.5 to 24.9 kg/m²), overweight (25 to 29.9 kg/m²) and obese (≥30 kg/m²). Outcomes were compared by BMI group using Cox regression.Results341 patients of median age 59 (range, 20–93) who underwent curative RT from 2010 to 2017 were included. 58% had oropharynx cancer, 17% larynx and 15% oral cavity. 72% had stage IVA/B disease and 28% stage I-III. At diagnosis, 33% had normal BMI, 40% overweight, and 28% obese. 59% had definitive RT and 41% had postoperative RT. Alcoholic/smoking status, advanced tumor stage, hypopharynx/larynx tumors, and feeding tube placement were more common in patients with lower BMI (P < .05 for each). Median follow-up was 30 months (range, 3–91). Higher BMI was associated with improved OS (P < .05) and obesity was associated with longer RFS (P < .05) and DMFS (P < .05), but not LRRFS (P = .07) after adjusting for confounding variables.ConclusionBeing overweight/obese at the time of HNSCC diagnosis is an independent prognostic factor conferring better survival, while obesity is independently associated with longer time to recurrence, primarily by improving distant control.



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Editorial Board/Aims & Scope

Publication date: June 2018
Source:Oral Oncology, Volume 81





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Nasopharyngeal carcinoma outcome with induction chemotherapy followed by concurrent chemoradiotherapy

Publication date: June 2018
Source:Oral Oncology, Volume 81
Author(s): Frank E. Mott, Renatta Ferrarotto, Theresa Nguyen, Jack Phan
Treatment of Nasopharyngeal Carcinoma (NPC) has been based on the Intergroup 0999 trial with chemoradiation (CRT) and consolidation chemotherapy (CT). While effective, toxicities are significant. As a result, many oncologists use induction chemotherapy (IC) followed by CRT, citing better tolerance with anecdotally no worse outcome. We reviewed 95 NPC patients treated between 2005 and 2015 at MDACC with IC followed by CRT. Median age was 49 years. Fifty-seven were T3/T4 and 62 were N2-3. The most common IC regimen was a platinum-taxane doublet (N = 72). 83 patients completed IC. Grade 3–4 toxicities with IC occurred in 10 patients. There were 15 primary site complete responses (CR), 68 partial responses (PR),6 stable disease (SD), and 2 progressed. There were 10 nodal CR, 73 PR, 4 SD, and 3 progressed. 92 patients received RT, 74 with CRT. At completion of treatment, there were 81 CR and 8 PR patients.Post radiation toxicities included mucositis and skin rash (37), oto- toxicity (25), PEG placement (12), and osteonecrosis (2). Three-year progression free survival (PFS) and distant metastasis free survival (DMFS) were 77.3% and 78%. CRT for advanced NPC is standard, but IC remains controversial. Early trials failed to show a benefit but used older chemotherapy and pre-intensity modulated radiation therapy (IMRT) methods. Modern trials with platinum-taxane regimens and IMRT have shown reasonable PFS and OS results with acceptable toxicity. This retrospective review of IC followed by CRT showed acceptable toxicity and good response and survival outcomes. This approach has, for many oncologists, become a standard.



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Magnitude of benefit for adjuvant radiotherapy following minimally invasive surgery in intermediate to high risk HPV-positive oropharyngeal squamous cell carcinoma

Publication date: July 2018
Source:Oral Oncology, Volume 82
Author(s): Dario Pasalic, Ryan K. Funk, Joaquín J. García, Daniel L. Price, Katharine A. Price, William S. Harmsen, Samir H. Patel, Geoffrey D. Young, Robert L. Foote, Eric J. Moore, Daniel J. Ma
ObjectiveTo determine the outcomes and toxicities of minimally-invasive surgery with adjuvant intensity-modulated radiotherapy +/− chemotherapy (AT) compared to definitive surgical therapy (ST) in a contemporary cohort of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC).MethodsFrom 2005 to 2013, a consecutive cohort of 190 HPV-positive OPSCC patients was retrospectively reviewed from multi-institutional databases maintained by the Departments of Otorhinolaryngology and Radiation Oncology. A total of 116 AT patients and 42 ST patients with intermediate or high risk pathologic features were included in the final analysis. All patients received minimally invasive surgery. Time to recurrence and time to death from the onset of surgery were evaluated. Toxicity data collected included dysphagia or xerostomia requiring feeding tube placement >6 months, or mandibular osteonecrosis requiring surgery or hyperbaric oxygen.ResultsAll AT patients received IMRT to a median dose of 60 Gy. Chemotherapy delivered to 67.2% of AT patients. AT group included more high-risk patients given higher nodal classification (p = 0.005) and extracapsular extension (p = 0.0005). AT improved disease-free survival (HR 2.77, CI 1.22–6.28; p = 0.02) and local-regional control (HR 14.83, CI 3.240–67.839; p = 0.001). Disease-free survival with AT and tumor extracapsular extension was improved when compared to ST (HR of 4.34, CI 1.540–12.213; p = 0.006). Dysphagia or mandibular osteonecrosis toxicity after AT vs. ST of 19.0% vs. 2.4%.ConclusionsAT improved local-regional control and disease-free survival but was associated with greater toxicity. The recurrence benefit was most pronounced in tumors with extracapsular extension.



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