Carcinoma Cuniculatum of the Alveolar Mucosa: A Rare Variant of Squamous Cell Carcinoma

Abstract

Carcinoma cuniculatum is one of the variants of squamous cell carcinoma. It is significantly rare with an incidence rate < 1% compared to other histological variants of squamous cell carcinoma. Various etiologic factors implicated are trauma, HPV, chronic inflammation and alcohol consumption but real causative agent still remains unclear. Initially it resembles plantar wart which slowly progress to bulky exophytic mass in the sole of the foot, where cases have been reported first. In the oral cavity it presents clinically as an exophytic growth and slowly invades the jaw and destroys the underlying bone. Microscopically it exhibits as both exophytic and endophytic epithelial masses along with well differentiated and pronounced hyperkeratosis. Treatment includes surgical resection alone unlike other variants which are treated by radiation with or without chemotherapy. Here we present a case of carcinoma cuniculatum occurred in alveolar mucosa of a 47 years old female. It presented as an exophytic growth in mandibular alveolar region, with histological features consistent with carcinoma cuniculatum.

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Genetic and nongenetic factors that may predispose individuals to allergic drug reactions

Purpose of review Defining predisposition to allergic drug reactions has largely focussed on HLA associations, but other genetic and nongenetic factors are also likely to be involved. Recent findings Polymorphic genetic variants in cytokine genes, including IL-10, and co-signalling pathways, including CTLA4, have been associated with allergic drug reactions, but the effect size is lower than with HLA alleles and most associations have not been replicated. Although TCR specificity seems to be important for CBZ-induced SJS/TEN in South East Asian patients, a distinct repertoire may not play a role in reactions to other drugs. New mass spectrometric techniques allowing for the identification of naturally eluted peptides from drug-exposed HLA alleles will allow for the antigenic source of T-cell activation to be defined and may shed light on the influence of disease. Indeed, preliminary data highlight the propensity of drug-responsive T cells to cross-react with T cells primed to viral antigens. Furthermore, the environment can epigenetically influence regulatory gene expression, suggesting that an individual's family exposure history may alter immune thresholds and tip the balance toward activation. Summary It is likely that predisposition to allergic drug reactions is multifaceted in most cases. This will require the study of large numbers of patients to detect genetic factors that have a lower effect size than HLA alleles. This should be accompanied by detailed clinical phenotyping of patients and the assessment of the immunological phenotype with respect to the presence and type of drug antigen-responsive T cells. Correspondence to Munir Pirmohamed, Institute of Translational Medicine, University of Liverpool, Block A: Waterhouse Building, 1–5 Brownlow Street, Liverpool L69 3GL, United Kingdom. E-mail: munirp@liverpool.ac.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Interaction between foods and nonsteroidal anti-inflammatory drugs and exercise in the induction of anaphylaxis

Purpose of review To assess the studies that focus on the study of food-dependent exercise-induced anaphylaxis (FDEIA) and food-dependent NSAID-induced anaphylaxis (FDNIA). Recent findings Cofactors, as exercise and nonsteroidal anti-inflammatory drugs (NSAIDs), are relevant in up to 30% of episodes of anaphylaxis. Gliadin and lipid transfer proteins are the main allergens involved. The attempts to reproduce FDEIA and FDNIA in a controlled setting have an important failure rate. The cyclooxigenase (COX) pathway could play an important role in the underlying mechanisms: NSAIDs and exercise increase the permeability of the intestinal barrier. This effect is stronger with NSAID that inhibit both isoforms than with preferential COX-2 inhibitor. Basophils obtained from FDNIA patients, showed an increase of its activation with the food allergen with lysine–aspirin compared with the food allergen alone. This potentiating effect was not observed when basophils were stimulated with the food allergen with selective COX-2 inhibitor. Other mechanisms including transient receptor potential superamily, reactive oxygen species, altered B-cell pathway and increased neutrophil activation markers have been speculated. Summary The frequent implication of cofactors, as exercise and NSAID, in food-induced anaphylaxis highlights the importance of recognizing and including them into diagnostic workup. The understanding of the underlying mechanisms would help in the development of diagnostic and therapeutic strategies. Correspondence to Joan Bartra, Allergy Section, Pneumology Department, Hospital Clinic, Villarroel 170, Barcelona 08036, Spain. Tel: +34 627902503; e-mail: jbartra@clinic.ub.es Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Advances in hypersensitivity drug reactions

No abstract available

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Comparative Study of Nasal Symptoms and Pulmonary Function Tests Post FESS in Ethmoidal Polyposis

Abstract

The objective of this study were to assess the pulmonary function in patients with ethmoidal polyposis who did not respond to medical treatment; to evaluate the effect of Functional Endoscopic Sinus Surgery on the lung function of these patients and to compare the total nasal symptom score in these patients. A prospective observational study was conducted in Department of ENT, KMC Manipal on 50 subjects with ethmoidal polyposis who were unresponsive to medical treatment and hence underwent FESS. Pulmonary function tests were assessed using spirometry and nasal symptoms were scored as per TNSS system prior to surgery and 3 months post-surgery and compared with the pre-operative values and analysed. Pre operatively majority (35 patients) had TNSS value of 6–9 whereas post operatively the score was reduced to 2–3 in many patients (38 patients). The mean TNSS was 7.24 before surgery which declined to 2.82 after surgery with a p value < 0.0001 indicating a statistically significant improvement in the nasal symptoms post FESS. The mean pre-operative FVC, FEV1, MEFR were 2.94, 2.41 and 2.51 L respectively whereas the mean post-operative values were 2.95, 2.39 and 2.49 L respectively. There was no statistically significant change in lung function tests following FESS. Our study shows that FESS benefits patients with nasal polyposis by improving the symptoms and there by the quality of life without any adverse effects on the lower airways.

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Classification of Naso Septal Deviation Angle and its Clinical Implications: A CT Scan Imaging Study of Palakkad Population, India

Abstract

Computerized tomographic imaging of the nasal and paranasal regions has become an indispensable tool for the endoscopic sinonasal surgery. The case control study was carried out on 120 patients for pilot study and 800 patients for the main study. The cases were selected with a clinical diagnosis of chronic rhino sinusitis. They were referred for a sinus CT scan by otolaryngologists and controls from the normal population. The patients were separated into males and females and anatomical variations were assessed. Increased prevalence of left sided nasal septal deviation and type II nasal septal deviation was seen in males belonging to cases group in our study. Knowledge about the nasal septum anatomical variations provides understanding about the upper limit of surgical dissection and aids in road mapping the confident direction for the functional endoscopic surgeons.

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Symptomatic polyautoimmunity at diagnosis of 1463 childhood-onset lupus: A Brazilian multicenter study

Publication date: Available online 7 June 2018
Source:Autoimmunity Reviews
Author(s): Debora N. Setoue, Ana C. Pitta, Fernanda J. Fiorot, Mariana M. Nastri, Glaucia V. Novak, Beatriz C. Molinari, Juliana C. Oliveira, Natali W. Gormezano, Ana P. Sakamoto, Maria T. Terreri, Rosa M. Pereira, Claudia Saad-Magalhães, Adriana M. Sallum, Katia Kozu, Melissa M. Fraga, Daniela P. Piotto, Gleice Clemente, Roberto Marini, Hugo R. Gomes, Carlos N. Rabelo-Junior, Marta M. Felix, Maria C. Ribeiro, Rozana G. Almeida, Ana P. Assad, Silvana B. Sacchetti, Leandra C. Barros, Eloisa Bonfá, Clovis A. Silva
ObjectiveTo evaluate symptomatic polyautoimmunity (PA) at childhood-onset systemic lupus erythematosus(cSLE) diagnosis, and its association with demographic data, disease activity, clinical manifestations and laboratorial abnormalities in a large Brazilian cSLE population.MethodsA multicenter retrospective study was performed in 1463 cSLE(ACR criteria) patients from 27 Pediatric Rheumatology services. Symptomatic PA was defined according to the presence of more than one concomitant autoimmune disease(AD) and symptomatic multiple autoimmune syndrome(MAS) was defined as three or more AD. An investigator meeting was held to define the protocol. Demographic data, SLICC classification criteria and SLEDAI-2K were evaluated.ResultsAt cSLE diagnosis symptomatic PA was observed in 144/1463(9.8%) and symptomatic MAS occurred in solely 10/1463(0.7%). In the former group the more frequently observed associated AD were Hashimoto thyroiditis n = 42/144(29%), antiphospholipid syndrome n = 42/144(29%), autoimmune hepatitis n = 26/144(18%) and type 1 diabetes mellitus n = 23/144(15.9%). Further comparisons between cSLE patients with and without PA showed a higher median age(p = 0.016) and lower mean SLICC criteria (p = 0.039) in those with PA. Additionally, these cSLE patients had less renal involvement(35% vs. 44%, p = 0.038) and red blood cell cast(6% vs. 12%, p = 0.042) and more antiphospholipid antibodies(29% vs. 15%, p < 0.0001).ConclusionsApproximately 10% of cSLE had symptomatic PA at diagnosis, particularly endocrine autoimmune disorders and antiphospholipid syndrome. Lupus was characterized by a mild disease onset and MAS was infrequently evidenced. Further studies are necessary to determine if this subgroup of cSLE patients have a distinct genetic background with a less severe disease and a better long-term outcome.



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Polyautoimmunity - The missing ingredient

Publication date: Available online 7 June 2018
Source:Autoimmunity Reviews
Author(s): Gabriel Samasca, Ramesh Ajay, Daniel Sur, Cornel Aldea, Lucia Sur, Emanuela Floca, Genel Sur, Iulia Lupan, Matthias Torsten, Lerner Aaron




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The combination of FK506 and an anti-CD147 mAb exerts potential therapeutic effects on a mouse model of collagen-induced arthritis

Publication date: September 2018
Source:Molecular Immunology, Volume 101
Author(s): Jing Luan, Kui Zhang, Peng Yang, Yang Zhang, Fei Feng, Yu-meng Zhu, Ping Zhu, Zhi-Nan Chen
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease, and excessive T lymphocyte activation plays a critical role in the development of inflammation. CD147 is an antigen related to T cell activation, CD147 blockade exerts beneficial effects on RA. FK506, also known as tacrolimus, exerts strong immunosuppressive effects by inhibiting T cell activation. In this study, RL73 (an anti-mouse CD147 functional-grade purified antibody) and FK506 were co-administered to mice with collagen-induced arthritis (CIA). As expected, the combination of these two drugs produced superior therapeutic effects than either drug alone and enabled the administration of each drug at a lower dose. Moreover, joint damage and destruction were significantly improved in mice injected with both FK506 and RL73 compared with mice injected with either agent alone. These effects might have been observed because the proportions of CD4 + T and CD8 + T cells in the mouse spleen of the combination regimen were clearly decreased compared with each monotherapy. In addition, the proportions of Th2 subsets in the mouse spleen and peripheral blood were clearly increased, and the serum levels of the cytokines interleukin 4 (IL-4) and IL-10 were markedly increased in mice treated with the combination therapy compared with the other groups of mice. The splenic total number of T lymphocytes also showed that the inhibition of T lymphocytes was the most obvious in the combined treatment group. Based on the results from the present study, combining FK506 and the anti-CD147 mAb might be a new practical therapeutic option for the treatment of RA.



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TNF-α induction of IL-6 in alveolar type II epithelial cells: Contributions of JNK/c-Jun/AP-1 element, C/EBPδ/C/EBP binding site and IKK/NF-κB p65/κB site

Publication date: Available online 7 June 2018
Source:Molecular Immunology
Author(s): Chunguang Yan, Chunmin Deng, Xiufang Liu, Yutong Chen, Jiawei Ye, Rentian Cai, Yanfei Shen, Huifang Tang
Although participation of IL-6 in lung inflammation has been widely elucidated, the transcriptional regulation of its generation in alveolar type II cells stimulated by TNF-α remain unclear. Here, we find that TNF-α significantly induces IL-6 production, and TNF-α induction of IL-6 is mainly regulated at transcriptional level. Upon stimulated by TNF-α, Activator Protein-1 (AP-1)-mediated transcriptional activity is apparently increased in alveolar type II epithelial cells, which might be derived from elevated phosphorylation of JNK and subsequent activation of c-Jun. Either down-regulation of c-Jun or the AP-1 site mutation leads to significant reduction of IL-6 expression. In contrast, ectopic expression of c-Jun notably increases IL-6 generation. So, c-Jun, one of the AP-1 family members, plays a pivotal role in TNF-α-induced IL-6 generation. CCAAT/enhancer binding protein δ (C/EBPδ) expression is significantly amplified by TNF-α, which may contribute to the rise of C/EBP activity in alveolar type II cells. C/EBPδ shRNA treatment results in attenuation of IL-6 expression in the cells, which is consistent with data by introduction of mutations into the C/EBP site in the promoter. However, overexpression of C/EBPδ greatly increases the IL-6 promoter activity. In addition, data regarding another transactivator in the family—C/EBPβ show that it does not affect IL-6 production. We also find that the IKK/NF-κB p65 pathway is activated in TNF-α-treated alveolar type II epithelial cells, and plays an essential role in positive regulation of IL-6 expression in TNF-α-treated alveolar type II epithelial cells via knockdown or forced expression of NF-κB p65, or elimination of κB sites in the IL-6 promoter. Notably, IL-6 promoter-driven luciferase production in primary alveolar type II epithelial cells can also be increased by the ectopic expression of c-Jun, C/EBPδ, and NF-κB p65, respectively. Collectively, our data provide insights into molecular mechanism involved in IL-6 expression in alveolar type II epithelial cells on TNF-α treatment, which provides a theoretical basis for specific inhibition of IL-6 production at the transcriptional level.



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CD8+CD28+ T cells might mediate injury of cardiomyocytes in acute myocardial infarction

Publication date: September 2018
Source:Molecular Immunology, Volume 101
Author(s): Lili Zhang, Zhiyan Wang, Di Wang, Jumo Zhu, Yi Wang
CD8⁺ T cells accumulate in the necrotic myocardium of acute myocardial infarction (AMI). It is unclear whether CD8⁺CD28⁺ T cells, a specific subset of CD8⁺ T cells, contribute to myocardial injury. In this study, 92 consecutive patients with AMI and 28 healthy control subjects were enrolled. The frequency of CD8⁺CD28⁺ T cells in peripheral blood samples was assayed by flow cytometry. Plasma cardiac troponin I (TNI) and left ventricular ejection fraction (LVEF) were determined. Long-term prognosis of the patients was evaluated by major adverse cardiac and cerebrovascular events (MACCE) over a 12-month follow-up period. Our findings indicated that patients with AMI who presented with high numbers of CD8⁺CD28⁺ T cells had an increased infarction size and aggravated ventricular function. We proposed that cytotoxic CD8⁺CD28⁺ T cell-mediated myocardial necrosis may act as a novel and alternative pathway of AMI.



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Editorial Board

Publication date: July 2018
Source:Molecular Immunology, Volume 99





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Novel potential inhibitors of complement system and their roles in complement regulation and beyond.

Publication date: Available online 7 June 2018
Source:Molecular Immunology





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Role of neutrophils in allergic asthma

Coraline Radermecker | Renaud Louis | Fabrice Bureau | Thomas Marichal

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Ischaemic cardiomyopathy and embolic stroke in a young adult with suspected synthetic cannabinoid use

The incidence of cardiovascular disease is increasing in young adults. We are reporting a case of acute stroke in a young patient with severe ischaemic cardiomyopathy in the absence of traditional risk factors. After ruling out atherosclerotic disease, his presentation was attributed to synthetic cannabinoid use. We then discussed the typical barriers in early diagnosis and limitations of laboratory testing in this condition. Due to the increase in abuse of these synthetic drugs among young adults, there is a need for high clinical suspicion which can help with early recognition and improve morbidity and mortality associated with these chemicals.

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Is imaging of the brain necessary at diagnosis for cutaneous head and neck melanomas?

To evaluate the frequency of brain metastasis at the time of diagnosis for patients with cutaneous head and neck melanoma (CHNM).

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Comprehensive approach to reestablishing form and function after radical parotidectomy

The reconstructive goals following radical parotidectomy include restoration of symmetry, reanimation of the face, and reestablishment of oral competence. We present our experience utilizing the anterolateral thigh (ALT) free flap, orthodromic temporalis tendon transfer (OTTT), and facial nerve cable grafting to reestablish form and function.

https://ift.tt/2sT6DsC

National trends in inpatient parotidectomy: A fourteen-year retrospective analysis

Operating room (OR) procedures represent one quarter of hospitalizations, yet OR-related stays account for nearly 50% of hospital costs. Understanding trends in inpatient parotidectomy, associated charges, and key outcomes including length of stay is imperative in the era of evolving health reform.

https://ift.tt/2MaT5Bc

Clinical phenotypes of bronchial hyperresponsiveness in school-aged children

Bronchial hyperresponsiveness (BHR), one of the key features of asthma, shows a diverse natural course in school-aged children, but, studies on BHR phenotypes are lacking.

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Microvascular Reconstruction in the Vessel Depleted Neck – a Systematic Review

Surgical therapy is the gold standard in head and neck cancer treatment, whereas adjuvant radiation and chemotherapy may be indicated in advanced cases. Frequently, neck dissections, former flap anastomoses and irradiated tissue leave a neck depleted of recipient vessels. If further surgery becomes inevitable the surgeon is faced with a heavily pretreated surgical field asking for highly reliable solutions for microsurgical reconstruction.From September 2017 until October 2017, a standardised review on the literature of the databases PubMed, Cochrane Library and Web of Science was performed.

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Corrigendum to “Automatic repositioning of jaw segments for three-dimensional virtual treatment planning of orthognathic surgery” [Journal of Cranio-Maxillofacial Surgery 45 (9) (2017) 1399–1407]

The authors regret a missing minus sign in equation (1) of the above reference paper. The equation is displayed correctly below:

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Craniomaxillofacial patient-specific CAD/CAM implants based on cone-beam tomography data – a feasibility study

Customized implants have simplified surgical procedures and have improved patient outcome in craniomaxillofacial surgery. Traditionally, patient-specific data is gathered by conventional computed tomography (CT). However, cone-beam CT (CBCT) can generate a 3D reconstruction of the area of interest with a lower dose of radiation at reduced cost. In this study, we investigated the feasibility of using CBCT data to design and generate customized implants for patients requiring craniomaxillofacial reconstruction.

https://ift.tt/2HsXfRL

Three-dimensional volumetric analysis of condylar head and glenoid cavity after mandibular advancement

The aim of this study was to assess condylar resorption, spatial change in glenoid cavity, and its risk factors after mandibular advancement by three-dimensional volumetric analysis. Subjects consisted of 30 condyles of 15 patients diagnosed with mandibular retrognathism who underwent Le Fort I and bilateral sagittal split ramus osteotomy advancement. CBCT images were taken before surgery (T0), immediately after surgery (T1), and postoperatively at 6 months (T2) and 1 year (T3). Condylar resorption was observed in 21 condyles.

https://ift.tt/2sGnsrf

Optimized 3D virtually planned intermediate splints for bimaxillary orthognathic surgery: a clinical validation study in 20 patients

Orthognathic surgery is indicated for the treatment of significant skeletal malocclusions and facial dysmorphosis. Recent technological developments allow surgeons to virtually plan the orthognathic jaw movements. When producing intermediate splints, overlap between the upper and lower dentitions can occur. Autorotation of the mandible is often used as a solution for this problem. The purpose of this study was to present an optimized approach to fabricate digital intermediate splints based on the use of a scanned thick wax bite to overcome dental overlap during planning.

https://ift.tt/2HtwNHs

Change in the posterior airway after mandibular distraction osteogenesis in patients with ankylosis of the temporomandibular joint: a retrospective study

Mandibular distraction osteogenesis (DO) has been shown to lead to considerable improvement in obstruction of the posterior airway space in patients with ankylosis of the temporomandibular joint (TMJ), and our objective was to find out if we could confirm these findings. Seventeen patients had spiral computed tomographic (CT) scans before and after DO. After treatment, the overall posterior airway space was enlarged in all three sections of the airway (oropharyngeal, glossopharyngeal, and laryngeal).

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Long-term quality of life measured by the University of Washington QoL questionnaire (version 4) in patients with oral cancer treated with or without reconstruction with a microvascular free flap

We used the University of Washington Quality of Life (UW-QoL) questionnaire (version 4) to assess the long-term quality of life (QoL) of patients with oral squamous cell carcinoma treated with or without reconstruction with a microvascular free flap, and all patients with T2–T4 oral squamous cell carcinoma (SCC) treated in this way were eligible for the study. A total of 139 patients' personal details, medical history, and QoL scores were collected and analysed. The mean (SD) overall QoL score was 73.09 (14.8) for patients with T2–T4 oral SCC.

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Divergent dislocation of the carpometacarpal joints: a case report

Divergent carpometacarpal joint dislocations of the fingers are very rare. Due to severe swelling and overlapping of bones on a radiograph of the wrist and hand, dislocations are missed. The purpose of this cl...

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Nasal septal abscess caused by anaerobic bacteria of oral flora

Although nasal septal abscess (NSA) was formerly common, it has become rare since the development of antibiotics. NSA, if left untreated, can lead to intracranial complications such as meningitis and eventually result in saddle-nose deformity. NSA often occurs after injury, and indigenous skin bacteria such as Staphylococcus aureus are frequently detected. We treated a patient who had injured the upper alveolus in a fall on the stairs and developed NSA two weeks later. Anaerobic bacteria, including Veillonella parvula and Peptostreptococcus sp., were detected.

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Use of a folded extended vertical lower trapezius island myocutaneous flap to repair large pharyngocutaneous fistulae developing after salvage total laryngectomy

The purpose of this study was to evaluate the outcomes of surgery involving the use of folded trapezius flaps to repair large pharyngocutaneous fistulae (PCFs) developing after salvage total laryngectomy. Folded extended vertical lower trapezius island myocutaneous flaps (TIMFs) were created to repair large PCFs that developed after salvage total laryngectomy in eight patients. The maximum fistula dimension was 4.5×3.0cm and the minimum was 2.0×1.8cm. The skin paddle of the extended vertical TIMF ranged from 5cm to 9cm in width and 10cm to 23cm in length.

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Dorsal Augmentation Using Autogenous Tissues

Autogenous materials used for Asian dorsal augmentation are temporal fascia, dermofat, solid block type of costal cartilage, and diced cartilage. The temporal fascia is used for radix augmentation or correction of minor focal depression. Dermofat, solid block costal cartilage, and diced cartilage are recommended for major dorsal augmentation. The vertically oriented folded dermal graft curtails use of the fat component. Diced cartilage wrapped in temporal fascia exhibits a lower resorption rate, and may easily fit into the contour of the dorsum. This graft is thought to have low predictability of final height, as opposed to that of block cartilage.

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Homologous Tissue for Dorsal Augmentation

Homologous graft materials for dorsal augmentation are safe and biocompatible with a low risk of complications. Acellular dermal matrix (ADM) provides natural appearance of the nose and long-term structural integrity without extrusion, showing favorable augmentation results. Tutoplast-processed fascia lata (TPFL) is soft and easy to manipulate, providing a smooth postoperative contour of the nasal dorsum with low risk of infection or extrusion. ADM and TPFL carry low risk of major complications, such as infection, foreign body reaction, and graft extrusion. ADM and TPFL are suitable graft materials that deliver proper dorsal augmentation and patient satisfaction in primary and revision rhinoplasty.

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Augmentation Rhinoplasty Using Silicone Implants

Augmentation rhinoplasty is one of the most common aesthetic procedures in Asian countries with silicone implant being the most widely used material for augmentation rhinoplasty. Despite potential advantages, use of alloplastic materials in rhinoplasty is often discouraged in Western countries because of concern for possible risk of infection and extrusion of the implant. The collective experience of long-term favorable outcomes in Asia makes the silicone augmentation rhinoplasty a common procedure. Complication rates for silicone implants vary significantly, depending on surgeon experience, surgical technique, and implant design. Silicone implants can be safely used for nasal dorsal augmentation if precautions are taken.

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Surgical Anatomy of the Asian Nose

Rhinoplasty for Asian noses is markedly different from that for white noses. As rhinoplasty becomes increasingly popular among Asian people, it is important that the rhinoplasty surgeons master relevant anatomy and become skilled in required techniques to serve this segment of population. In this article, distinct characteristics of Asian noses are briefly described. Noses in the Asia population exhibit broad phenotypic variations. There is no typical Asian nose. Therefore, the terms of Asian noses in this article are confined to noses of people from East Asian (eg, Korea, Japan, and China).

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Correction of Short Nose

To correct an Asian short nose with low dorsum, short columella, and poorly defined nose tip, augmentation rhinoplasty has been popularized. A simple augmentation no longer is considered an efficient rhinoplasty approach for Asians aesthetically; most surgeons simultaneously perform nasal elongation and augmentation during rhinoplasty. To extend the nose length successfully, important factors are cartilages, mucosal and skin conditions, and presence and degree of fibrotic changes. In addition, surgeons should consider preoperatively how much should be extended from an aesthetics perspective. This article introduces the current practice of surgical correction of the short nose in Asians.

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

Publication date: Available online 7 June 2018
Source:Auris Nasus Larynx
Author(s): Masahiro Okada, Koichiro Suemori, Daiki Takagi, Masato Teraoka, Hiroyuki Yamada, Jun Ishizaki, Takuya Matsumoto, Hitoshi Hasegawa, Naohito Hato
ObjectiveTo investigate treatment outcomes, hearing outcomes, and adverse effects of rituximab (RTX) for intractable otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV).MethodsTwenty-three patients who met the criteria proposed by the OMAAV study group were included. RTX was used for patients who had difficulty achieving induction of remission using glucocorticoids (GC) and intravenous cyclophosphamide (IVCY).ResultsSix patients were treated with RTX (RTX group), while 17 patients did not require RTX for induction of remission (non-RTX group). All six patients in the RTX group achieved remission. Age, sex, and months from onset to diagnosis did not differ significantly between the groups. The air-conduction hearing thresholds at diagnosis and remission were 71.7±6.3dB and 50.1±5.1dB in the RTX group, and 56.8±4.8dB and 35.8±4.8dB in the non-RTX group, respectively. Hearing level at remission was significantly better in the non-RTX group (p<0.05), while hearing gain did not differ significantly between the groups. Infectious complications were similar between the groups.ConclusionsOur findings suggest that RTX is effective and safe for intractable OMAAV patients who have a poor response to GC and IVCY.



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Multidisciplinary surgical management of an unusual penetrating foreign body of the face

Publication date: Available online 7 June 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Villarmé, C. Savoldelli, E. Jean-Baptiste, N. Guevara
IntroductionFacial injuries by penetrating foreign body are unusual and require specific multidisciplinary surgical management.Case reportThis case report concerns a 20-year-old man who experienced a penetrating injury by a piece of wood to the face and describes the surgical approach to remove the wood and repair the injury. The foreign body had penetrated the infratemporal fossa, with an entry wound situated below the right eye and an exit wound in the neck, in contact with the left internal carotid artery. An adapted surgical strategy was necessary in view of the site of the foreign body. The internal carotid artery was controlled in order to follow the foreign body as far as its entry into the base of the skull. The proximity of the eye and carotid and jugular vessels and the deep penetration of the foreign body required the participation of interventional radiologists, head and neck and vascular surgeons and ophthalmologists.DiscussionThe site of the foreign body, precisely determined preoperatively, justified management by a multidisciplinary team to ensure rapid extraction, while limiting the risk of additional lesions. With a follow-up of 6 months, the patient did not present any sequelae of his facial injury.



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Assessment of chronic sinonasal dysfunction and cross-cultural adaptation of the DyNaChron questionnaire

Publication date: Available online 7 June 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): K. Choukry, J. Hasnaoui, Z. Chafiki, M. Khdim, R. Abada, M. Mahtar
ObjectiveSinonasal pathologies generate six principal symptoms with major organic and psychosocial impact that can be studied on a self-administered questionnaire assessing chronic sinonasal dysfunction independently of etiology. The objective of the present study was to translate, culturally adapt and validate the DyNaChron questionnaire for Arabic-speaking Moroccan patients.MethodsThe translation and cross-cultural adaptation of DyNaChron followed international guidelines. 164 patients filled out the questionnaire at day 0 and day 7 (without treatment) and day 60 after treatment.A prospective multicenter study validated the questionnaire for internal consistency, test-retest reliability and sensitivity to change.ResultsMean age was 35 years, with male predominance (63%). Nasal obstruction was the most frequent symptom (97.6%). Internal consistency on Cronbach alpha was high (0.97). Reproducibility on intraclass correlation (ICC) was excellent (0.84). Sensitivity to change was excellent for the majority of patients (effect size=0.97–6.69; SRM=2.47–6.74).ConclusionThis study of a cross-cultural Moroccan adaptation of the DyNaChron questionnaire showed good validity, reproducibility and sensitivity to change, and better representation of all symptoms generated by chronic sinonasal dysfunction. It can be used to evaluate the psychosocial and organic impact of chronic sinonasal dysfunction and to assess treatment.



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Role of supracricoid partial laryngectomy with cricohyoidoepiglottopexy in glottic carcinoma with anterior commissure involvement

Publication date: Available online 7 June 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): B. Pescetto, J. Gal, E. Chamorey, O. Dassonville, G. Poissonnet, A. Bozec
ObjectivesTo analyze oncologic and functional outcomes after supracricoid laryngectomy with cricohyoidoepiglottopexy (SCL-CHEP) in glottic carcinoma with anterior commissure (AC) involvement, to determine predictive factors, and to compare results with those reported for other therapeutic strategies.Material and methodsA retrospective analysis included all patients who underwent SCL-CHEP for glottic squamous cell carcinoma with anterior commissure involvement in our institution, between 2000 and 2014. Swallowing function was evaluated on the DOSS (Dysphagia Outcomes and Severity Scale).ResultsFifty-three patients were included. Three-year overall, cause-specific and recurrence-free survival rates were 86, 95 and 80%, respectively. There were 5 cases of local recurrence (9%), all treated by total laryngectomy. Smoking was the only predictive factor of recurrence-free survival (P=0.02). Mean DOSS score was 5.5±0.9. DOSS scores≥6 (normal oral feeding) were recovered by 59% of patients. T-stage≥2 was the only predictive factor for DOSS score (P=0.04).ConclusionIn glottic carcinoma with anterior commissure involvement, SCL with CHEP provided a local control rate of more than 90%, which is higher than reported with endoscopic surgery or external radiotherapy. However, contrary to LSC, salvage of local recurrence can often be obtained by conservative treatments after endoscopic surgery. Therefore, total-laryngectomy-free survival rates after SCL-CHEP and endoscopic surgery are finally comparable.



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Effect of Stimulus Polarity on Detection Thresholds in Cochlear Implant Users: Relationships with Average Threshold, Gap Detection, and Rate Discrimination

Abstract

Previous psychophysical and modeling studies suggest that cathodic stimulation by a cochlear implant (CI) may preferentially activate the peripheral processes of the auditory nerve, whereas anodic stimulation may preferentially activate the central axons. Because neural degeneration typically starts with loss of the peripheral processes, lower thresholds for cathodic than for anodic stimulation may indicate good local neural survival. We measured thresholds for 99-pulse-per-second trains of triphasic (TP) pulses where the central high-amplitude phase was either anodic (TP-A) or cathodic (TP-C). Thresholds were obtained in monopolar mode from four or five electrodes and a total of eight ears from subjects implanted with the Advanced Bionics CI. When between-subject differences were removed, there was a modest but significant correlation between the polarity effect (TP-C threshold minus TP-A threshold) and the average of TP-C and TP-A thresholds, consistent with the hypothesis that a large polarity effect corresponds to good neural survival. When data were averaged across electrodes for each subject, relatively low thresholds for TP-C correlated with a high "upper limit" (the pulse rate up to which pitch continues to increase) from a previous study (Cosentino et al. J Assoc Otolaryngol 17:371–382). Overall, the results provide modest indirect support for the hypothesis that the polarity effect provides an estimate of local neural survival.

https://ift.tt/2LumzZL

Association of Iodine Deficiency With Hearing Impairment in US Adolescents

This analysis of data from NHANES 2007-2010 evaluates associations between urinary iodine concentrations and hearing impairment among US adolescents.

https://ift.tt/2xPjfGA

Effect of Budesonide Added to Saline Sinus Irrigation for Chronic Rhinosinusitis

This randomized clinical trial evaluates the effect of adding budesonide to large-volume, low-pressure saline sinus irrigation vs a lactose control intervention for treatment of chronic rhinosinusitis.

https://ift.tt/2kVMf6z

Building the Evidence for Corticosteroid Irrigation Therapy in Chronic Rhinosinusitis

Owing to our limited understanding of the pathophysiology of chronic rhinosinusitis (CRS), expansion of the armamentarium of medical therapies for CRS has remained notably constrained for decades. Over the last 30 years, advances in medical treatment for CRS have not kept pace with innovations in surgical treatment. And yet, since many physicians believe that CRS remains a medical disease first and foremost, there is often a sense of frustration that we do not have more innovative medical therapies to offer our patients with CRS.

https://ift.tt/2xSib4P

Old Barbers, Young Doctors, and Tonsillectomy

When tonsillectomy was a right of childhood passage, choosing an experienced surgeon may have been the best way to avoid the uncommon, but occasionally fatal, hemorrhage associated with the procedure. Franklin's old adage "beware of the young doctor and the old barber" was sage advice for families seeking a surgeon, and what better place to find one than the Tonsil Hospital in New York city, where 50 experienced doctors operated on thousands of children annually for 3 decades. Yet even in this bygone era of surgical excess the hospital's director, Robert Fowler, wisely noted "…it is very likely that in the future [physicians] will be able to provide rational guides which will eventually be accepted by the public" (emphasis original).

https://ift.tt/2kTpAHK

Association of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils

This population-based cohort study examines the risk for respiratory, allergic, and infectious diseases following surgical removal of adenoids, tonsils, or both in children durring the first 9 years of life.

https://ift.tt/2sPkf7Y

Aggression directed towards members of the oral and maxillofacial surgical team

Publication date: Available online 7 June 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): C.J. Mannion, C. Gordon
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/2JyhwKv

Inorganic filler content of resin-based luting agents and the color of ceramic veneers

Abstract The influence of inorganic filler content of resin-based luting agents (RBLAs) on color change (ΔE00), CIEL*a*b* (individual color coordinates), and translucency parameters (TP) of simulated ceramic laminate veneer (CLV) was investigated. RBLAs with low, intermediate, and high inorganic filler content (55%, 65%, and 75% mass fractions, respectively) were prepared. Feldspar ceramic (Vitablocs Mark II) specimens (1.2 mm × 0.8 mm, A1C shade) were bonded to simulated composite resin substrates (1.6 mm × 1.2 mm, A2D shade) using three experimental and a commercial (RelyX Veneer) RBLA (translucent shade). The ΔE00 was calculated by CIEDE2000 color difference metric under three conditions (before, immediately after, and 24 h after luting). The TP was calculated using CIEL*a*b* color coordinates measured over white and black backgrounds. Surface morphology of the RBLAs was analyzed. One-way and two-way analyses of variance with a post-hoc Tukey's test were used respectively to calculate TP, CIEL*a*b* coordinates, and ΔE00 (α= 0.05). Overall, the tested RBLAs presented clinically visible ∆E00 values under the three conditions evaluated. For all RBLAs, higher ∆E00 values were observed between measurements obtained before and immediately after luting. Different inorganic filler content did not significantly increase the opacity of the ceramic-luting agents-resin composite set. The variation in inorganic filler content did not influence significantly the TP of simulated CLV; although all of the experimental RBLAs tested yielded ∆E00 above the perceptibility threshold. The L*, a*, and b* individual color coordinates were cementation-dependent.

https://ift.tt/2M65pTv

Pain and temporomandibular disorders in patients with eating disorders

Abstract Orofacial pain and temporomandibular dysfunction may cause chronic facial pain, which may interfere with the emotional state and food intake of patients with eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN). Sixty-four patients were assigned to four groups: Group A (AN – restricting subtype): 07; Group B (AN – purging subtype ): 19; Group C (BN): 16; and Group D (control): 22. Complaints of pain are more prevalent in individuals with eating disorders (p<0.004). There are differences between the presence of myofascial pain and the number of hospitalizations (p = 0.046) and the presence of sore throat (p=0.05). There was a higher prevalence of masticatory myofascial pain and complaints of pain in other parts of the body in ED patients; however, there was no difference between ED subgroups. There was no difference in the number of self-induced vomiting between ED patients with and without myofascial pain.

https://ift.tt/2JqxzH5

Dental caries in schoolchildren: influence of inattention, hyperactivity and executive functions

Abstract Attention-deficit/hyperactivity disorder (ADHD) is characterized by inappropriate levels of hyperactivity, impulsivity, and/or inattention. Individuals with ADHD may present limitations with regard to executive functions and performing activities that involve planning and/or attention/concentration. The aim of the study was to investigate the association between dental caries and signs of ADHD in a representative sample of schoolchildren. A representative sample of 851 schoolchildren aged seven to 12 years was randomly selected from public and private schools. Data acquisition involved a clinical dental examination for cavitated permanent and deciduous teeth using the DMFT/dmft indices. Neuropsychological evaluations, including the assessment of intelligence (Raven's Colored Progressive Matrix Test) and executive functions (Corsi Tapping Blocks tests and Digit Span test) were also performed. Parents/caregivers and teachers answered the SNAP-IV Questionnaire for the investigation of signs of inattention and hyperactivity in the family and school environment. Parents/caregivers also answered questionnaires addressing socioeconomic and socio-demographic characteristics. Descriptive analysis of the variables and Poisson regression with robust variance were performed. Parental reports of signs of inattention (PR: 1.28; p < 0.05) and hyperactivity (PR: 1.15; p < 0.05) were associated with a greater occurrence of caries. A better performance on the backward order of the Corsi Tapping Blocks tests (PR: 0.94; p < 0.05) and higher level of mother's schooling were associated with a lower frequency of caries. A better performance on executive function tasks was a protective factor against dental caries, whereas children considered inattentive and/or hyperactive by their parents had a higher prevalence rate of dental caries.

https://ift.tt/2JwW60v

Comparative study of oral and salivary parameters in patients with and without loss of bone mass

Abstract Osteoporosis is an insidious and increasingly prevalent disease that can cause fractures and affect patients' quality of life. The current study comparatively evaluates patients with and without loss of bone mass in terms of salivary calcium, viscosity, and pH. A controlled cross-sectional study was conducted in two groups of 32 postmenopausal women subjected to a bone densitometry scan and later referred for dental management at the Federal University of Minas Gerais, Brazil. The patients were assigned to two groups: Group 1 - patients with low bone mineral density (BMD) and Group 2 - patients without bone mineral changes. The following salivary parameters were evaluated: calcium concentration, flow rate, viscosity, pH, and average total protein. An oral examination was performed for assessment of DMFT variables and tongue coating. Data were analyzed using descriptive and inferential statistics, adopting a p-value < 0.05. The patients' mean age was 60 years (± 7.35). Salivary flow, pH, and viscosity were similar among the groups. Average total protein was 14.8 mg/mL and 19.0 mg/mL in Groups 1 and 2, respectively. Tongue coating and salivary calcium levels were significantly higher in Group 1 (p < 0.001). Salivary calcium is an important screening tool and may eventually be used for the diagnosis of bone mineral changes.

https://ift.tt/2Lx39TZ

Immediate laser-induced hemostasis in anticoagulated rats subjected to oral soft tissue surgery: a double-blind study

Abstract Given the growing trend towards medical indications for continuous use of anticoagulants, the number of patients on these medications continues to rise. The management of patients on oral anticoagulants requiring oral surgical procedures has aroused much controversy. Changes in an anticoagulation regimen are associated with an increased risk of thromboembolism. However, it seems logical and advantageous for the patients' health if surgery could be performed without any change to the anticoagulation therapy. In dentistry, high-power lasers have been poorly explored in this field. The hemostatic properties of high-power lasers could be helpful during oral soft tissue surgeries in anticoagulated patients. The aim of this study was to compare bleeding time in anticoagulated rats after lingual frenectomy performed with a scalpel or diode laser with bleeding time in healthy animals. Twenty-four male Wistar rats were assigned to four groups (n = 6): (CS) Control-Scalpel Surgery; (AS) Anticoagulated-Scalpel Surgery; (CL) Control-Laser (diode laser 810 nm/1.5 W) Surgery; and (AL) Anticoagulated-Laser Surgery (diode laser 810 nm/1.5 W). Warfarin administration was used to induce anticoagulation. Blood was blotted every 30 seconds with filter paper until bleeding stopped to verify bleeding time. Two blinded researchers performed the surgeries and collected the bleeding time data. Diode laser surgery led to complete hemostasis in rats during and after lingual frenectomy. Zero bleeding was assessed during surgeries and after diode laser surgeries in anticoagulated rats. Laser-induced hemostasis offered an alternative solution to the controversial issue of intraoperative and postoperative bleeding control in patients on anticoagulation therapy.

https://ift.tt/2JA911D

Complications with PMMA compared with other materials used in cranioplasty: a systematic review and meta-analysis

Abstract Polymethyl methacrylate (PMMA) has been considered a suitable material for cranioplasty. However, no consensus has been reached concerning the best material for cranioplasty with regard to minimizing complications. Thus, this systematic review and meta-analysis aimed to compare the complication rates of PMMA with those of autologous bone and titanium mesh. This review was registered with PROSPERO (CRD42016042725). Systematic searches were conducted on PubMed/MEDLINE, Scopus, and Web of Science. The focus question was, "Do PMMA prostheses used in cranioplasty have complications rates similar to those of autologous bone and titanium mesh?" A meta-analysis of complication rates was performed on the basis of dichotomous outcomes assessed by risk ratio (RR) with corresponding 95% confidence intervals (CI). From 1014 data sources, 11 articles were selected according to eligibility criteria. These articles involved 1,256 individuals and 1,278 cranioplasties using autologous bone (n = 408), PMMA (n = 379), or titanium (n = 151). The follow-up period ranged from 63 days to 54.3 months. No difference was observed between the complication rates of PMMA and autologous bone (p = 0.94; RR, 0.98; 95%CI, 0.54–1.75) or between PMMA and titanium (p = 0.38; RR, 1.59; 95%CI, 0.57–4.48). Sub-analysis of the reasons for craniotomy (trauma/non-trauma) was conducted, which revealed no significant difference (p = 0.91; RR, 0.95; 95%CI, 0.37–2.42). The meta-analysis indicated that the use of PMMA yields complication rates that are near those of autologous bone and titanium mesh.

https://ift.tt/2JsTQ6U

De-mucosalized pharyngeal flap: a modified technique for selected cases of velopharyngeal insufficiency

Abstract

Background and purpose

Superiorly based posterior pharyngeal flap is performed via rotation of tissues of the posterior pharyngeal wall anteriorly and anchoring it to the soft palate. Unfortunately, bad healing of the donor site defect might be a considerable cause of morbidity of the surgery. With some modifications of flap elevation we could achieve better surgical outcomes. The aim of this study was to present the new modification of the conventional maneuver and its surgical/functional outcomes.

Subjects and methods

The study design is a case series. 17 patients underwent the de-mucosalized superiorly based pharyngeal flap for the treatment of velopharyngeal insufficiency. A wide laterally based (mucosa-only) flap was elevated off the submucosa of the posterior pharyngeal wall and then a superiorly based posterior pharyngeal flap (bared of its covering mucosa) was elevated and sutured to the palate. The mucosal flap was draped over the bed and sutured.

Results

No significant complications as airway problems, infection and bleeding were reported. Also, the postoperative pain was tolerable and there were no reports of neck rigidity with early ambulation; VAS showed significant improvement. No patients showed flap dehiscence or palatal fistula. Speech assessment showed improvement.

Conclusion

The modified de-mucosalized, superiorly based pharyngeal flap technique ensured self-mucosal draping of the bed, thus it would enhance primary healing and decrease postoperative pain with the resultant early ambulation. We believe that the new modified technique could correct VPI, in addition to the improvement of patients' comfort and decrease the morbidity of the procedure.

https://ift.tt/2JCYwuv

P1 cortical auditory evoked potential in children with unilateral or bilateral cochlear implants; implication for the timing of second cochlear implantation

Abstract

Objective

To examine maturation of the central auditory pathway, using P1 cortical auditory evoked potential (CAEP), in children who had received unilateral or bilateral cochlear implantation (CI).

Study design

Prospective study.

Setting

Tertiary referral hospital.

Methods

Twenty children who had received CI due to congenital, or prelingual, deafness participated in the study. Participants had received the 1st implant at a mean age of 3.4 ± 0.7 years; 16 had also received a 2nd CI for the contralateral ear, at a mean age of 11.1 ± 2.1 years. P1 CAEP was recorded while using the 1st implant and, for those who received contralateral CI, within 2 weeks of switching on the 2nd implant. Relations between P1 latency and duration with the 1st implant, and between age at 1st CI and P1 latency, were investigated. Relations between P1 latency with the 1st and 2nd implants, and between the interstage interval and difference between P1 latencies with the 1st and 2nd implants, were also examined.

Results

P1 CAEP with the 1st implant was present in 16 of the 20 children. Mean P1 latency was shorter in the early CI group compared with the late CI group, but this difference was not statistically significant (p = 0.154). There was a significant negative correlation between the duration with the 1st implant and P1 latency (r = − 0.783, p < 0.001). Among the 16 children with sequential bilateral CI, P1 CAEP with the 2nd implant was present in 10. There was a significant negative correlation between the duration with the 1st implant before receiving the 2nd implant and P1 latency with the 2nd implant (r = − 0.710, p = 0.021); there was also a significant positive correlation between P1 latency with the 1st and 2nd implants (r = 0.722, p = 0.018). There was not a significant correlation between interstage interval and the difference between the two P1 latencies (r = − 0.430, p = 0.248).

Conclusion

Longer cochlear implant use is associated with shorter P1 latency. Unilateral hearing with the 1st implant may positively affect P1 latency with the 2nd CI ear. These findings imply that increased auditory experience may influence central auditory pathway maturation and that the degree of central auditory pathway maturation before the 2nd CI, rather than the timing when the surgery is received, may influence 2nd CI outcome in children with sequential bilateral cochlear implants.

https://ift.tt/2Lx2Ngp

Reliability and validity of the Eating Assessment Tool-10 (Greek adaptation) in neurogenic and head and neck cancer-related oropharyngeal dysphagia

Abstract

Purpose

Dysphagia is a symptom associated with significant morbidity and mortality, with profound impact on physical ability and quality of life. Many questionnaires have been used to assess patient-reported dysphagia, but issues related to developmental and measurement properties affect their wide applicability. The purpose of this study was to assess the validity and reliability of the Eating Assessment Tool-10 (EAT-10, Greek adaptation) in neurogenic and head and neck cancer-related dysphagia.

Methods

The study consisted of: item generation in the Greek language, internal consistency and reliability analysis, normative data generation, and validity analysis. Data were collected prospectively from 421 participants: 144 asymptomatic subjects, 146 patients with dysphagia, and 131 patients with dysphagia-related diagnoses. Validity was assessed by comparing scores of healthy and dysphagic participants, by comparing pre- and post-treatment scores, and by correlating the Greek-EAT-10 with fibreoptic endoscopic evaluation of swallowing (FEES).

Results

The mean participants' age was 52.85 years (ranging from 18 to 85 years). All questionnaires were completed in less than 3 min. The overall internal consistency (assessed with Cronbach's alpha) was 0.963. The test–retest reliability was excellent with Spearman's rho ranging from 0.937 to 1. Dysphagic patients had a significantly higher score compared to healthy participants (p < 0.001). The mean EAT-10 improved significantly after treatment (Wilcoxon signed rank, p < 0.001). The Greek-EAT-10 and FEES scores were significantly correlated (Spearman's rho = 0.69).

Conclusions

The EAT-10 is a valid, reliable, symptom-specific tool for the assessment of dysphagia, easily self-administered, and practical for clinical use.

https://ift.tt/2JEK2uh

Proposal of a form for the collection of videolaryngostroboscopy basic findings

Abstract

Videolaryngostroboscopy is a useful investigation required for a correct diagnosis of laryngeal diseases and voice disorders. We present a form for the collection of basic laryngostroboscopic findings, which provides for the evaluation of the classical six parameters codified by Hirano (symmetry and periodicity of glottic vibration, glottic closure, profile of vocal fold edge, amplitude of vocal fold vibration, mucosal wave) and six other parameters which we have included in the form for an essential and complete laryngostroboscopic evaluation (supraglottic framework behaviour, seat of phonatory vibration, vocal fold morphology and motility, level of the vocal fold, stops of vocal fold mucosa vibration). This form was created in 2002 during the elaboration of the protocol for the assessment of dysphonia of the Italian Society of Phoniatrics and Logopedics, which follows the guidelines of the European Laryngological Society published in 2001. We used this form for 15 years in our daily laryngological practice with great satisfaction. We propose a more detailed version of this form, which provides for drawings which show the various videolaryngostroboscopic findings, helping the laryngologist in the collection of videolaryngostroboscopic examination basic findings.

https://ift.tt/2LwOkkj

The lymphocyte-to-monocyte ratio as a prognostic indicator in head and neck cancer: a systematic review and meta-analysis

Abstract

Purpose

The aim of this systematic review and meta-analysis was to investigate the relationship between the pre-treatment lymphocyte-to-monocyte ratio (LMR) and prognosis in HNC.

Methods

PubMed (via the Web), Embase, Scopus, and the Cochrane Library were searched. A systematic review and meta-analysis was done to generate the pooled hazard ratios (HR) for overall survival (OS) and disease-free survival (DFS).

Results

Our analysis included the results of 4260 patients in seven cohorts. The pooled data demonstrated that an elevated LMR was associated with significantly improved OS (HR 0.5; 95% CI 0.44–0.57), and DFS (HR 0.70; 95% CI 0.62–0.80). Of note, there was no detectable heterogeneity in either OS (I² = 0%) or DFS (I² = 0%).

Conclusions

An elevated LMR may be an indicator of favorable prognosis in HNC. However, our results should be interpreted with some degree of caution due to the retrospective nature of cohort studies. Further research with high-quality prospective studies is needed to confirm the effect of LMR in HNC prognosis.

https://ift.tt/2M3Al6J

Patient-reported outcome: results of the multicenter German post-market study

Abstract

Purpose

Upper airway stimulation (UAS) is an alternative second-line treatment option for patients with obstructive sleep apnea (OSA). In our substudy of a previous multicentre study of patients implanted with UAS, we focused on patient-related outcomes like Epworth Sleepiness Scale (ESS), the Functional Outcomes of Sleep Questionnaire (FOSQ), snoring and personal satisfaction 6 and 12 months after the implantation.

Methods

60 patients, who were initially non-adherent to CPAP and implanted with UAS, were included in a prospective multicentre study. Data were collected preoperative, 6 and 12 months after implantation regarding FOSQ, ESS, snoring, and their experience with the UAS device.

Results

Besides relevant Apnoea–Hypopnea Index (AHI) reduction, we saw significant improvements in ESS (p < 0.001), FOSQ (p < 0.001) and snoring under UAS therapy. A strong correlation between AHI results postoperative and the personal satisfaction of the patients after implantation was found as well as between usage results and AHI compared to the preoperative results.

Conclusion

The more the patients benefit from UAS according to their self-reported outcome, the higher is the therapy use.

https://ift.tt/2Lw1RZA

Is the modified cupulolith repositioning maneuver effective for treatment of persistent geotropic direction-changing positional nystagmus?

Abstract

Objective

Clinicians sometimes see patients with relatively persistent geotropic direction-changing positional nystagmus (DCPN) as a variant of lateral semicircular canal-benign paroxysmal positional vertigo (LSCC-BPPV). Recently, the concept of a "light cupula" in the lateral semicircular canal, exhibiting persistent geotropic DCPN, has been introduced. However, the underlying pathogenesis of light cupula is not known. We investigated the efficacy of a modified cupulopathy repositioning maneuver (mCuRM), designed to reduce light debris attached to the cupula in patients with persistent geotropic DCPN.

Study design

Retrospective cohort study.

Methods

Participants included 65 patients with a persistent geotropic DCPN: 35 underwent treatment (mCuRM group), and 30 were followed-up but received no treatment (No CuRM group). We compared the therapeutic and survival rate of persistent geotropic DCPN between two groups.

Results

On Day 1, the persistent geotropic DCPN did not resolve in either group. On the first and second follow-up days, persistent geotropic DCPN was observed in 28 (80%) and 21 (60%) of patients, respectively, in the mCuRM group, and in 28 (93.3%) and 24 (80%) patients, respectively, in the no mCuRM group. The differences between groups were not statistically significant. Furthermore, no between-group differences were found in the time from diagnosis to resolution of nystagmus, or the time from symptom onset to resolution of nystagmus. Kaplan–Meier analysis of the time course of persistent geotropic DCPN resolution from the day of diagnosis and day of symptom onset revealed no significant differences between the groups.

Conclusion

Our findings indicate that mCuRM had no therapeutic benefit for a persistent geotropic DCPN and suggest that the pathophysiology of persistent geotropic DCPN is less likely to be a light debris attached to the cupula.

https://ift.tt/2M5QIzP

Expression of cancer stem cell markers CD44, ALDH1 and p75NTR in actinic cheilitis and lip cancer

Abstract

Purpose

The aim of this work was to evaluate the expression of the cancer stem cell (CSC) markers CD44, ALDH1 and p75NTR in the ultraviolet-induced lesions actinic cheilitis (AC) and lip squamous cell carcinoma (LSCC), and to correlate it with p53 expression.

Methods

Immunohistochemistry was performed in 4 cases of normal lip (NL), 43 of AC and 20 of LSCC.

Results

All cases were positive for CD44, showing a membranous staining without differences between the groups. ALDH1 showed cytoplasmic staining and it was invariable amongst the grades of epithelial dysplasia and between AC and LSCC. p75NTR presented membranous/cytoplasmic staining in the basal and parabasal layer of NL and AC, while LSCC presented cytoplasmic staining in the peripheral layers of the tumor islands. p75NTR showed different expression amongst the dysplasia grades (p < 0.001) but no differences between AC and LSCC. p53 expression was similar amongst the dysplasia grades and between AC and LSCC. CD44, ALDH1 and p75NTR were unrelated amongst themselves and to p53 expression.

Conclusions

CSC markers are expressed in potentially malignant and malignant lesions of the lip. Their expressions were invariable between AC and LSCC and unrelated to p53. p75NTR expression increased with the worsening of epithelial dysplasia grade.

https://ift.tt/2kSRPGz

Comparison of narrow band imaging and the Storz Professional Image Enhancement System for detection of laryngeal and hypopharyngeal pathologies

Abstract

Objective

The aim of this study was to compare narrow band imaging (NBI) endoscopy and Storz Professional Image Enhancement System (SPIES) in observing epithelial and/or subepithelial microvascular irregularities and pathologies.

Methods

A total of 73 patients with laryngeal or hypopharyngeal lesions were investigated using high-definition NBI endoscopy preoperatively in local anesthesia and using SPIES system intraoperatively in general anesthesia from August 2016 to October 2017. Superficial vascular structures were classified preoperatively (NBI) and intraoperatively (SPIES) according to descriptive guidelines of vascular changes by Arens. All lesions were endoscopically evaluated and divided according to the histological examination into four groups (A—benign lesions, B—recurrent respiratory papillomatosis, C—low-grade dysplasia, D—high-grade dysplasia, carcinoma in situ or invasive squamous cell carcinoma), and results were compared with NBI and SPIES optical biopsy.

Results

Benign lesions (polyps, cysts, chronic inflammation, hyperkeratosis) were histologically confirmed in 26/73 (35.6%) cases and identified by NBI in 20/26 lesions (76.9%) and in 20/26 cases (76.9%) by SPIES, respectively. Recurrent respiratory papillomatosis was confirmed in 16/73 (21.9%) and detected in 15/16 cases (93.8%) by NBI and in 16/16 cases (100.0%) by SPIES. Low-grade dysplasia (mild and moderate dysplasia) was histologically detected in 7/73 patients (9.6%) and accurately identified by NBI in 6/7 (85.7%) and by SPIES in 6/7 (85.7%) cases, respectively. Histopathological features of severe dysplasia, carcinoma in situ or invasive squamous cell carcinoma were detected in 24/73 (32.9%) patients. According to the NBI endoscopy the suspected vascular neoangiogenesis was recognized in 19/24 cases (79.2%) and in 18/24 cases (75.0%) using SPIES endoscopy. Sensitivity and specificity of NBI endoscopy and SPIES system in correct prediction of histological diagnosis of already detected lesions were 83.0 and 98.0% and 86.0 and 96.0%, respectively. Results of NBI/SPIES endoscopy and histopathological features of laryngeal and hypopharyngeal lesions were compared and the level of agreement was 81.43%, kappa index κ = 0.7428 (95% CI 0.682–0.832) (p < 0.001) by NBI endoscopy and 81.16%, kappa index κ = 0.7379 (95% CI 0.638–0.880) (p < 0.001) by SPIES endoscopy, respectively. The agreement was confirmed as substantial and strong. Level of agreement of both endoscopic methods was 92.54%, kappa index κ = 0.8965 (95% CI 0.877–0.954) (p < 0.001), agreement was confirmed as almost perfect. Between NBI and SPIES endoscopic imaging methods is no significant differentiation.

Conclusion

Both methods, NBI endoscopy and SPIES system, are comparable in detection and analysis of superficial neoangiogenesis, typical for benign lesion and for precancerous or cancerous changes in larynx and hypopharynx.

https://ift.tt/2LwOkAP

Impact of residual frontal recess cells on frontal sinusitis after endoscopic sinus surgery

Abstract

Purpose

Endoscopic sinus surgery (ESS) is a well-established treatment for chronic rhinosinusitis (CRS). However, ESS for frontal sinusitis remains complicated and challenging. The aim of this study was to identify the relationship between residual frontal recess cells and primary ESS failure in the frontal sinus.

Methods

We prospectively collected information on 214 sides of 129 patients with CRS who underwent standard ESS from June 2010 to May 2011. To identify risk factors, we retrospectively analyzed clinical data and computed tomography (CT) images before and 3 months after surgery.

Results

The posterior side of the frontal recess cells remained relatively common: suprabullar cells (SBCs) were found in 12.2% (16 sides), suprabullar frontal cells (SBFCs) in 20.3% (12 sides), and supraorbital ethmoid cells in 23.7% (14 sides). In contrast, the anterior side of the frontal recess cells, agger nasi cells, supra agger cells, and supra agger frontal cells remained at < 10.0%. Frontal septal cells persisted in 25.0% (5 sides). The presence of residual frontal recess cells was an independent risk factor for postoperative frontal sinus opacification as were well-recognized risk factors such as nasal polyps, the peripheral eosinophil count, and the CT score. Among residual frontal recess cells, SBCs and SBFCs were independent risk factors for opacification.

Conclusions

Residual frontal recess cells, especially SBCs and SBFCs, were independent risk factors for postoperative opacification of the frontal sinus. Complete surgical excision of frontal recess cells may improve surgical outcomes.

https://ift.tt/2Jyl4fX

Percutaneous bone-anchored hearing implant surgery: linear incision technique with tissue preservation versus linear incision technique with tissue reduction

Abstract

Objectives

To identify differences in skin thickening and soft tissue reactions between the linear incision technique with tissue reduction (LITT-R) and the linear incision technique with tissue preservation (LITT-P).

Study design

Retrospective cohort study.

Methods

All adult patients who underwent the LITT-R or LITT-P between August 2005 and December 2016 at a large general teaching hospital with a minimum follow-up of 6 months were included.

Results

A total of 83 implants were included using the LITT-R with a median follow-up of 74.0 months. In the LITT-P cohort 58 implants were included with a median follow-up of 16.5 months. Skin thickening was seen in seven implants (8.4%) in LITT-R cohort and 11 implants (19.0%) in the LITT-P cohort in the first 2 years of follow-up (p = 0.024). Skin thickening in need of treatment was registered in 5 (6.0%), respectively, 6 (10.3%) implants (p = 0.100). Moreover, treatment was successful in all cases. A soft tissue reaction (Holgers ≥ 1) was noticed in 28 (33.7%) implants in the LITT-R group compared to 16 implants (27.6%) in the LITT-P group (p = 0.679). An adverse soft tissue reaction (Holgers ≥ 2) was registered in 16 (19.2%), respectively, 2 (3.4%) implants. This difference was significant (p = 0.040).

Conclusion

LITT-P has a significantly higher rate of skin thickening and LITT-R has a significantly higher proportion of adverse soft tissue reactions. Nevertheless, combined with the advantages of LITT-P described in other studies, this can be advocated as the preferred technique.

https://ift.tt/2LuJGmY

Laser debulking or tracheotomy in airway management prior to total laryngectomy for T4a laryngeal cancer

Abstract

Purpose

Retrospective studies have shown that tracheotomy prior to total laryngectomy (TL) is associated with decreased survival. We sought to investigate whether this is due to higher local invasiveness associated with obstructive disease or whether it is the result of tracheotomy itself.

Methods

We reviewed patients with a T4a (AJCC 7th edition) laryngeal squamous-cell carcinoma treated with a primary TL followed by adjuvant radiotherapy between 2001 and 2013. We compared patients who had obstructive lesions with those who had non-obstructive lesions in terms of preoperative data, pathological features, and treatment outcomes. Second, we compared tracheotomized patients with patients who underwent endoscopic laser debulking (ELD).

Results

One hundred patients were reviewed. Thirty-seven of them required an airway intervention prior to a TL (tracheotomy n = 24/ELD n = 13). Patients with obstructive tumors had more frequently subglottic extension (p = 0.0066) and a shorter disease-free survival (DFS) (p = 0.046), due to a higher incidence of additional distant metastases. Tracheotomy was associated with a shorter DFS (p = 0.035) and more frequent perineural invasion (p = 0.0272) as compared to ELD, but not with a higher incidence of stomal recurrence.

Conclusions

A tracheotomy prior to a total laryngectomy is associated with decreased survival. We recommend laser debulking as the preferred treatment whenever management of an obstructive airway is required prior to a total laryngectomy.

https://ift.tt/2M7nwZm

Malleostapedotomy with the self-fixing and articulated titanium piston

Abstract

Objective

To analyze the results of malleostapedotomy performed by applying the self-fixing and articulated titanium piston according to Häusler.

Study design

Retrospective case review.

Setting

Tertiary referral center.

Patients and interventions

This study concerns a retrospective analysis of the results of malleostapedotomy with the use of a self-fixing articulated titanium piston in 16 ears of 16 consecutively treated patients between 2005 and 2009. The medical files were used for the acquisition of data on medical and surgical history and to obtain pre- and postoperative audiometry. Diagnosis and outcomes of mainly revision surgeries are presented and compared to the literature.

Main outcome measures

Effect of (revision) malleostapedotomy by evaluating postoperative audiometry and air–bone gap closure.

Results

The postoperative air–bone gap closure was ≤ 10 dB in 9/16 (56%) ears and within ≤ 20 dB in 13/16 (81%) ears. The mean postoperative air–bone gap was 14.3 dB HL (0.5–2.0 kHz) and 17.3 dB HL (0.5–4.0 kHz). Postoperatively, there was no increase in bone conduction thresholds larger than 3 dB (0.5–2.0 kHz) and postoperative dizziness was absent or very limited and transient.

Conclusions

The malleostapedotomy procedure has become surgically less demanding over time by the technical improvements present in the nowadays available pistons. The design of the self-fixing and articulated titanium piston used in the present group of patients allows a safe and straight-forward malleostapedotomy procedure. Present hearing outcomes match with results presented in the literature.

https://ift.tt/2Lthjpi

Provox 2 ® and Provox Vega ® device life-time: a case-crossover study with multivariate analysis of possible influential factors and duration

Abstract

Introduction

Tracheoesophageal speech is considered the gold standard for rehabilitation following total laryngectomy. Current literature is limited and contradictory about the possible causes of device failure. The aim of the study is to compare the device life-time between the Provox 2 and Provox Vega and to examine possible related factors that influence their duration.

Methods

Retrospective case-crossover study in 34 laryngectomized patients who had undergone tracheoesophageal voice rehabilitation using indwelling Provox 2 and Provox Vega voice prostheses between 2010 and 2016 in a tertiary care centre.

Results

A total of 440 prostheses were evaluated. The most frequent reason for replacement was due to an endoprosthesis leakage (n = 221, 64.2%) in both models. Radiotherapy increases the risk of prosthesis replacement (IRR = 1.88, p = 0.007) as well as bilateral neck dissection (IRR = 1.56, p = 0.017) in Provox 2. Age and unilateral neck dissection do not seem to influence the duration of the prosthesis. Mean life-time of Provox 2 was 106.64 days and 124.19 days for Provox Vega (p = 0.261). Complementary treatment with radiotherapy demonstrated a lower device survival (p < 0.001).

Discussion

Results confirmed the non-significant differences on device life between Provox Vega and Provox 2, as well as the relevant role of radiotherapy treatment in the increase of replacements and diminution of the device duration.

https://ift.tt/2M63Q83

ENT audit and research in the era of trainee collaboratives

Abstract

Large surgical audits and research projects are complex and costly to deliver, but increasingly surgical trainees are delivering these projects within formal collaboratives and research networks. Surgical trainee collaboratives are now recognised as a valuable part of the research infrastructure, with many perceived benefits for both the trainees and the wider surgical speciality. In this article, we describe the activity of ENT trainee research collaboratives within the UK, and summarise how INTEGRATE, the UK National ENT Trainee Research Network, successfully delivered a national audit of epistaxis management. The prospective audit collected high-quality data from 1826 individuals, representing 94% of all cases that met the inclusion criteria at the 113 participating sites over the 30-day audit period. It is hoped that the audit has provided a template for subsequent high-quality and cost-effective national studies, and we discuss the future possibilities for ENT trainee research collaboratives.

https://ift.tt/2JovATB

Stereotactic Ablative Radiotherapy for Early-stage Glottic Larynx Cancer

Condition:   Glottic Carcinoma
Intervention:   Radiation: Radiation therapy
Sponsor:   University of Texas Southwestern Medical Center
Not yet recruiting

https://ift.tt/2LuVplC

Pseudo-Simultaneous Imaging of Tumor Hypoxia and Proliferation in HNC Patients Using PET/CT

Condition:   Head and Neck Cancer
Intervention:   Diagnostic Test: PET/CT Imaging
Sponsor:   Weill Medical College of Cornell University
Not yet recruiting

https://ift.tt/2JG7NBQ

A Study to Evaluate Safety, Feasibility, Efficacy of Multiple Dosing With VB10.NEO Immunotherapy in Patients With Locally Advanced or Metastatic Cancer

Condition:   Locally Advanced or Metastatic Solid Tumours
Intervention:   Drug: VB10.NEO
Sponsor:   Vaccibody AS
Recruiting

https://ift.tt/2Jo5BeY

Anatomical Look Into OnabotulinumtoxinA Injection for Chronic Migraine Headache

Background and Objectives While existing studies about onabotulinumtoxinA for chronic migraines have focused on injection location and appropriate dosing, little consideration has been given to patient body habitus and its potential impact on efficacy. We hypothesized that with increasing patient body mass index (BMI) there would be more subcutaneous fat separating targeted muscle groups from the skin surface, such that standard 0.5-inch needles used in existing protocols may not allow intramuscular injection. This may have implications for treatment planning. Methods Anatomically normal computed tomography scans of the head, neck, and face were randomly selected. Subjects were stratified into 4 groups based on BMI, with 30 patients in each group. Four standardized locations were chosen to obtain measurements from the skin surface to the underlying muscle fascia, including (1) frontalis, (2) temporalis, (3) semispinalis capitis, and (4) trapezius. Results Median depth for the temporalis was 12.65 mm (Q1 = 9.32 mm, Q3 = 15.08 mm) for the BMI greater than 35 kg/m2 group. Median depth for the semispinalis capitis was 13.77 mm (Q1 = 10.3 mm, Q3 = 15.7 mm) for the BMI 30 to 35 kg/m2 group, and 14.75 mm (Q1 = 11.00, Q3 = 17.00 mm) for the BMI greater than 35 kg/m2 group. Median depth for the trapezius was 13.95 mm (Q1 = 10.18 mm, Q3 = 19.00 mm) for the BMI greater than 35 kg/m2 group. These medians exceeded the length of the standard 0.5-inch (12.-mm) needle used in existing protocols. Conclusions Our study demonstrates that with increasing BMI there is a greater distance between the skin surface and the muscle fascia of muscles that are targeted for injection in standard chronic migraine botulinum toxin injection protocols. Because of this, patient body habitus may be an important factor in injection technique. Accepted for publication February 12, 2018. Address correspondence to: Ali Totonchi, MD, Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44106 (e-mail: totonchia@yahoo.com). The authors declare no conflict of interest. Interim data from this work were presented at the 2017 Annual Meeting of the Ohio Valley Society of Plastic Surgeons in Pittsburgh, PA, on May 2 to 4, 2017. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

https://ift.tt/2JgGQ8t

Personalized Versus Protocolized Fluid Management Using Noninvasive Hemodynamic Monitoring (Clearsight System) in Patients Undergoing Moderate-Risk Abdominal Surgery

Advances in noninvasive hemodynamic monitoring systems allow delivery of goal-directed fluid therapy and could therefore be used in less-invasive surgical procedures. In this randomized controlled trial, we compared closed-loop–assisted goal-directed fluid therapy using a noninvasive cardiac output (Clearsight system) monitor (personalized approach) to a protocolized fluid therapy approach in 40 patients undergoing moderate-risk laparoscopic abdominal surgery. Cardiac output and stroke volume variations were not significantly different in both groups and remained within predefined target values >90% of the study time. Personalized fluid therapy does not seem to offer any hemodynamic advantage over a protocolized approach in this population. Accepted for publication May 8, 2018. Funding: Departmental. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Trial Registry number: ClinicalTrials.gov (NCT03039946). Reprints will not be available from the authors. Address correspondence to Alexandre Joosten, MD, Department of Anesthesiology, Hospital Erasme, 808 Rt de Lennik, 1070 Brussels, Belgium. Address e-mail to Alexandre.Joosten@erasme.ulb.ac.be or joosten-alexandre@hottmail.com. © 2018 International Anesthesia Research Society

https://ift.tt/2HsQKy4

More on Fatigue Mitigation for Anesthesiology Residents

No abstract available

https://ift.tt/2sDjCiN

Estimating the Risk of a Rare But Plausible Complication That Has Not Occurred After n Trials

No abstract available

https://ift.tt/2Jyc6iK

Barash’s Clinical Anesthesia, 8th ed

No abstract available

https://ift.tt/2Hs9DkK

Propofol and Remote Ischemic Preconditioning: Possible Implications for Studies of Clinical Myocardial Protection Using Volatile Anesthetics in Cardiac Surgery Patients?

No abstract available

https://ift.tt/2Hra4fa

Intraoperative Hemodynamic and Echocardiographic Measurements Associated With Severe Right Ventricular Failure After Left Ventricular Assist Device Implantation

BACKGROUND: Severe right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation increases morbidity and mortality. We investigated the association between intraoperative right heart hemodynamic data, echocardiographic parameters, and severe versus nonsevere RVF. METHODS: A review of LVAD patients between March 2013 and March 2016 was performed. Severe RVF was defined by the need for a right ventricular mechanical support device, inotropic, and/or inhaled pulmonary vasodilator requirements for >14 days. From a chart review, the right ventricular failure risk score was calculated and right heart hemodynamic data were collected. Pulmonary artery pulsatility index (PAPi) [(pulmonary artery systolic pressure − pulmonary artery diastolic pressure)/central venous pressure (CVP)] was calculated for 2 periods: (1) 30 minutes before cardiopulmonary bypass (CPB) and (2) after chest closure. Echocardiographic data were recorded pre-CPB and post-CPB by a blinded reviewer. Univariate logistic regression models were used to examine the performance of hemodynamic and echocardiographic metrics. RESULTS: A total of 110 LVAD patients were identified. Twenty-five did not meet criteria for RVF. Of the remaining 85 patients, 28 (33%) met criteria for severe RVF. Hemodynamic factors associated with severe RVF included: higher CVP values after chest closure (18 ± 9 vs 13 ± 5 mm Hg; P = .0008) in addition to lower PAPi pre-CPB (1.2 ± 0.6 vs 1.7 ± 1.0; P = .04) and after chest closure (0.9 ± 0.5 vs 1.5 ± 0.8; P = .0008). Post-CPB echocardiographic findings associated with severe RVF included: larger right atrial diameter major axis (5.4 ± 0.9 vs 4.9 ± 1.0 cm; P = .03), larger right ventricle end-systolic area (22.6 ± 8.4 vs 18.5 ± 7.9 cm2; P = .03), lower fractional area of change (20.2 ± 10.8 vs 25.9 ± 12.6; P = .04), and lower tricuspid annular plane systolic excursion (0.9 ± 0.2 vs 1.1 ± 0.3 cm; P = .008). Right ventricular failure risk score was not a significant predictor of severe RVF. Post-chest closure CVP and post-chest closure PAPi discriminated severe from nonsevere RVF better than other variables measured, each with an area under the curve of 0.75 (95% CI, 0.64–0.86). CONCLUSIONS: Post-chest closure values of CVP and PAPi were significantly associated with severe RVF. Echocardiographic assessment of RV function post-CPB was weakly associated with severe RVF. Accepted for publication April 30, 2018. Funding: This study was supported in part by the National Center for Advancing Translational Sciences, National Institutes of Health, Award Number UL1TR001064. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). M. D. Gudejko and B. R. Gebhardt contributed equally and share first authorship. Reprints will not be available from the authors. Address correspondence to Frederick C. Cobey, MD, MPH, FASE, Department of Anesthesiology, Tufts Medical Center, 800 Washington St, Boston, MA 02111. Address e-mail to FCobey@tuftsmedicalcenter.org. © 2018 International Anesthesia Research Society

https://ift.tt/2Hs9uOe

Decision Support Tool Improves Real and Perceived Anesthesiology Resident Relief Equity

BACKGROUND: The Accreditation Council of Graduate Medical Education requires monitoring of resident clinical and educational hours but does not require tracking daily work patterns or duty hour equity. Lack of such monitoring may allow for inequity that affects resident morale. No defined system for resident relief of weekday operating room (OR) clinical duties existed at our institution, leaving on-call residents to independently decide daily relief order. We developed an automated decision support tool (DST) to improve equitable decision making for clinical relief and assessed its impact on real and perceived relief equity. METHODS: The DST sent a daily e-mail to the senior resident responsible for relief decisions. It contained a prioritized relief list of noncall residents who worked in the OR beyond 5 PM the prior clinical day. We assessed actual relief equity using the number of times a resident worked in the OR past 5:30 PM on 2 consecutive weekdays as our outcome, adjusting for the mean number of open ORs each day between 5:00 PM and 6:59 PM in our main OR areas. We analyzed 14 months of data before implementation and 16 months of data after implementation. We assessed perceived relief equity before and after implementation using a questionnaire. RESULTS: After implementing the DST, the percentage of residents held 2 consecutive weekdays over the total of resident days worked decreased from 1.33% to 0.43%. The percentage of residents held beyond 5:30 PM on any given day decreased from 18.09% to 12.64%. Segmented regression analysis indicated that implementation of the DST was associated with a reduction in biweekly time series of residents kept late 2 days in a row, independent of the mean number of ORs in use. Surveyed residents reported the DST aided their ability to make equitable relief decisions (pre 60% vs post 94%; P = .0003). Eighty-five percent of residents strongly agreed that a prioritized relief list based on prior day work hours after 5 PM aided their decision making. After implementation, residents reported fewer instances of working past 5 PM within the past month (P

https://ift.tt/2JybJom

Risks and Benefits of Ultrasound, Nerve Stimulation, and Their Combination for Guiding Peripheral Nerve Blocks: A Retrospective Registry Analysis

BACKGROUND: Ultrasound, nerve stimulation, and their combination are all considered acceptable ways to guide peripheral nerve blocks. Which approach is most effective and associated with the fewest complications is unknown. We therefore used a large registry to analyze whether there are differences in vascular punctures, multiple skin punctures, and unintended paresthesia. METHODS: Twenty-six thousand seven hundred and thirty-three cases were extracted from the 25-center German Network for Regional Anesthesia registry between 2007 and 2016 and grouped into ultrasound-guided puncture (n = 10,380), ultrasound combined with nerve stimulation (n=8173), and nerve stimulation alone (n = 8180). The primary outcomes of vascular puncture, multiple skin punctures, and unintended paresthesia during insertion were compared with conditional logistic regression after 1:1:1 propensity score matching. Results are presented as odds ratios and 95% CIs. RESULTS: Propensity matching successfully paired 2508 patients with ultrasound alone (24% of 10,380 patients), 2508 patients with a combination of ultrasound/nerve stimulation (31% of 8173 patients), and 2508 patients with nerve stimulation alone (31% of 8180 patients). After matching, no variable was imbalanced (standardized differences

https://ift.tt/2JBVV3K

Stoelting’s Anesthesia and Co-Existing Disease, 7th ed

No abstract available

https://ift.tt/2HsMRcn

Cardiac Structure and Function in Morbidly Obese Parturients: An Echocardiographic Study

BACKGROUND: The increasing prevalence of obesity worldwide is a major threat to global health. Cardiac structural and functional changes are well documented for obesity as well as for pregnancy, but there is limited literature on morbidly obese parturients. We hypothesized that there are both cardiac structural and functional differences between morbidly obese pregnant women and pregnant women of normal body mass index (BMI). METHODS: This prospective cross-sectional study was performed in 2 referral maternity units in Cape Town, South Africa, over a 3-month period. Forty morbidly obese pregnant women of BMI ≥40 kg·m−2 (group O) were compared to 45 pregnant women of BMI ≤30 kg·m−2 (group N). Cardiac structure and function were assessed by transthoracic echocardiography, according to the recommendations of the British Society of Echocardiography. The 2-sample t-test with unequal variances was used for the comparison of the mean values between the groups. RESULTS: Acceptable echocardiographic images were obtained in all obese women. Statistical significance was defined as P

https://ift.tt/2Hu5pcj

Deep neuromuscular blockade and surgical conditions during laparoscopic ventral hernia repair: A randomised, blinded study

BACKGROUND Laparoscopic ventral hernia repair is a common surgical procedure. However, muscle contractions and general muscle tension may impair the surgical view and cause difficulties suturing the hernial defect. Deep neuromuscular blockade (NMB) paralyses the abdominal wall muscles and may help to create better surgical conditions. OBJECTIVES The current study investigated if deep compared with no NMB improved the surgical view during laparoscopic ventral hernia repair. DESIGN Crossover study. SETTING The study was carried out at Herlev and Gentofte Hospital, University of Copenhagen, Denmark and conducted from May 2015 until February 2017. PARTICIPANTS A total of 34 patients were randomised in an investigator-initiated, assessor-blinded crossover design of deep vs. no NMB during laparoscopic ventral hernia repair. INCLUSION CRITERIA Adults scheduled for elective laparoscopic ventral hernia repair. EXCLUSION CRITERIA Known allergy to any study medication, known homozygous variants in the butyrylcholinesterase gene, severe renal disease, neuromuscular disease, lactating or pregnant women, any indication for rapid sequence induction. INTERVENTIONS Deep NMB was established with rocuronium and reversed with sugammadex. Anaesthesia was conducted with propofol and remifentanil. MAIN OUTCOME MEASURES The primary outcome was evaluation of surgical view assessed on a five-point rating scale. Other outcomes included the surgical conditions during laparoscopic suturing of the hernia defect. RESULTS We found no difference in ratings for the surgical view when comparing deep with no NMB: mean −0.1 (95% confidence interval −0.4 to 0.2) (P = 0.521, paired t test). However, deep compared with no NMB improved the rating score for surgical conditions while suturing the hernia defect (P = 0.012, Mann–Whitney U test). No differences were found in either total length of surgery (P = 0.76) or hernia suturing time (P = 0.81). CONCLUSION Deep compared with no NMB did not change the rating score of the surgical view immediately after introduction of trocars during laparoscopic ventral hernia repair, but the surgical condition were improved during suturing of the hernia. TRIAL REGISTRATION ClinicalTrials.gov, NCT02247466. Correspondence to Matias V. Madsen, Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, Herlev, DK-2730, Denmark E-mail: matias.vested.madsen@regionh.dk © 2018 European Society of Anaesthesiology

https://ift.tt/2xWtZ62

Anesthetic efficacy of mental/incisive nerve block compared to inferior alveolar nerve block using 4% articaine in mandibular premolars with symptomatic irreversible pulpitis: a randomized clinical trial

Abstract

Objectives

The aim of this study was to compare the onset, success rate, injection pain, and post-injection pain of mental/incisive nerve block (MINB) with that of inferior alveolar nerve block (IANB) using 4% articaine in mandibular premolars with symptomatic irreversible pulpitis. The accuracy of electrical pulp test (EPT) in determining pulpal anesthesia was also examined.

Materials and methods

The study was designed as a randomized clinical trial with two study arms—MINB and IANB. Injections were performed using a standardized technique. Root canal treatment was initiated 10 min after the injection. Success was defined as no pain or mild pain during access cavity preparation and instrumentation. Injection pain and post-injection pain (up to 7 days) were recorded. All pain ratings were done using Heft-Parker Visual Analog Scale (HP VAS).

Results

Sixty-four patients were enrolled. The success rate of MINB (93.8%) was higher than IANB (81.2%) but the difference was not significant (p > 0.05). The onset of anesthesia with MINB was significantly quicker, and injection pain was significantly less (p < 0.05), but post-injection pain was significantly higher during the first 4 days (p < 0.001). The accuracy of EPT in determining pulpal anesthesia was 96.88%.

Conclusions

MINB and IANB with 4% articaine had similar efficacy in anesthetizing mandibular premolars with irreversible pulpitis. Post-injection pain with MINB was higher than with IANB.

Clinical relevance

MINB and IANB with 4% articaine can be used interchangeably to anesthetize mandibular premolars with irreversible pulpitis.

https://ift.tt/2kRTGeW

NSAIDs hypersensitivity: questions not resolved

Purpose of review NSAIDs are the drugs most frequently involved in hypersensitivity reactions (HSR). These are frequently prescribed at all ages. HSR are of great concern and can affect people at any age. These drugs can induce reactions by stimulating the adaptive immune system (IgE or T cell), known as selective responders or more frequently by abnormalities in biochemical pathways related with prostaglandin metabolism. These are known as cross-intolerant. With some exceptions, skin testing and in-vitro studies are of little value in selective responders. Recent findings In the last years, several classifications have been provided based on clinical symptoms, time interval between drug intake and appearance of symptoms, response to other nonchemically related NSAIDs and the diseases. Based on this classification, several well differentiated categories within each group of entities cross-intolerant and selective responders are now recognized. The most complex groups for evaluation are cross-intolerant in which three major groups exist: NSAIDs exacerbated respiratory disease, NSAIDs exacerbated cutaneous disease and NSAIDs-induced urticaria/angioedema in the absence of chronic spontaneous urticaria. Within the selective responders, there are two mechanisms involved: drug-specific IgE or T-cell effector responses. New entities have been added to this classification like mixed reactions within the cross-intolerant category, that must manifest as anaphylaxis and multiple immediate selective reactions. Summary The precise evaluation of patients with NSAIDs hypersensitivity following established guidelines will improve not only our understanding but also the management of these entices. As the number of patients affected with NSAIDs is important, further studies are warranted. Correspondence to Natalia Blanca-Lopez, Allergy Service, Infanta Leonor University Hospital, Avda Gran Via del Este 80, 28031 Madrid, Spain. E-mail: natalia.blanca@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2M50VMY

The comparative evaluation of 1% A lendronate gel as local drug delivery system in chronic Periodontitis in smokers nad non smokers: Randomized Clinical Trial

Publication date: Available online 6 June 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Vidushi Sheokand, Vandana Srikrishna Chadha, Pooja Palwankar
IntroductionPeriodontitis is a progressive disease of microbial origin involving the loss of supporting tissues of the teeth resulting from host inflammatory and immunologic reactions. The standard approach to the prevention and treatment of periodontal diseases for a number of years has been mechanical therapy and if required surgical intervention Researcher thought of creating a treatment modality where by altering the host response, the destructive host mechanisms could be interfered affecting the final outcome of the disease process.AimThe present study aims to explore the efficacy of local delivery of a 1% Alendronate (ALN) gel as an adjunct to scaling and root planing (SRP) for the treatment of infrabony periodontal pockets in smokers and non-smoker with Chronic Periodontitis.Materials and method60 infrabony periodontal pockets in patients with chronic periodontitis between the age group of 30 - 50 years were selected. The study consisted of 2 groups smoker and nonsmoker. A gel based drug delivery system of Alendronate was formulated. 0.1 ml alendronate gel and 0.1 ml placebo gel was placed at the experimental and control sites respectively following root planing. Clinical and radiographic parameters were recorded at baseline, three months and six months.ResultsAlendronate was effective in improving clinical and radiographic parameters compared to placebo. Alendronate showed better result in non smoker group when compared with smoker group.ConclusionThis Study showed improvements in clinical parameters both at the control and experimental sites. However, the experimental sites (Alendronate) showed greater improvement as compared to the control sites (Placebo). A significant gain in alveolar crest height and defect fill was measured radiographically at non smoker Alendronate group.



https://ift.tt/2xMF2il

Overexpression of nicotinamide N -methyltransferase in HSC-2 OSCC cell line: effect on apoptosis and cell proliferation

Abstract

Objectives

Oral squamous cell carcinoma (OSCC) is the most common malignancy of oral cavity. Despite advances in therapeutic approaches, the 5-year survival rate for oral cancer has not improved in the last three decades. Therefore, new molecular targets for early diagnosis and treatment of OSCC are needed. In the present study, we focused on the enzyme nicotinamide N-methyltransferase (NNMT). We have previously shown that enzyme expression is upregulated in OSCC and NNMT knockdown in PE/CA PJ-15 cells significantly decreased cell growth in vitro and tumorigenicity in vivo.

Material and methods

To further explore the role of the enzyme in oral cancer cell metabolism, HSC-2 cells were transfected with the NNMT expression vector (pcDNA3-NNMT) and the effect of enzyme upregulation on cell proliferation was evaluated by MTT assay. Subsequently, we investigated at molecular level the role of NNMT on apoptosis and cell proliferation, by exploring the expression of β-catenin, survivin, and Ki-67 by real-time PCR. Moreover, we performed immunohistochemistry on 20 OSCC tissue samples to explore the expression level of NNMT and survivin ΔEx3 isoform.

Results

Enzyme upregulation significantly increased cell growth in vitro. Moreover, a positive correlation between NNMT and survivin ΔEx3 isoform expression levels was found both in HSC-2 cells and in OSCC tissue samples.

Conclusion

Taken together, our results indicate a possible involvement of NNMT in the proliferation and tumorigenic capacity of OSCC cells and seem to suggest that the enzyme could represent a potential target for the treatment of oral cancer.

Clinical relevance

The involvement of NNMT in cell growth and anti-apoptotic mechanisms seems to suggest that this enzyme could be a new therapeutic target to improve the survival of OSCC patients.

https://ift.tt/2M3233s