Effects of laser therapy on patients who underwent rapid maxillary expansion; a systematic review

Abstract

Rapid maxillary expansion (RME) is one of the common treatments of transverse maxillary deficiency, and low-level laser therapy (LLLT) is one of the recommended solutions to enhance biological wound or bone healing. This review article aims to answer the following question: "What are the effects of LLLT, on patients who underwent surgical or non-surgical RME, in improving clinical success, wound healing, and bone regeneration?" A search in PubMed, Scopus, Web of Science, and ProQuest databases was performed, with a focus on the appropriate key words. Related articles, up to May 2017, were screened, and the full text of the randomized controlled trials (RCT) were comprehensively read and subjected to quality assessments. A total of 1804 articles were included after the initial search. Four RCTs were eligible in randomization and methodology. The applied wavelength varied from 660 to 830 nm with an output range of 40–100 mW. Also, the highest exposed energy was 420 J/cm² and the lowest was 100 J/cm². The exposure time differed from 20 to 84 s in each defined point in the palate. Based on the RCTs available, LLLT is better to be used at initial phase of RME, because it has some benefits in increasing the rate of bone remodeling.

https://ift.tt/2LKIonV

Analyses of dermal innate lymphoid cells in mice lacking T-bet and STAT6

Publication date: Available online 11 June 2018
Source:Allergology International
Author(s): Sohei Makita, Hiroaki Takatori, Tomohiro Tamachi, Akira Suto, Kotaro Suzuki, Hiroshi Nakajima




https://ift.tt/2LJDUho

Fellatio-associated erythema of the soft palate: an incidental finding during a routine dental evaluation

Oral lesions can have widely variable aetiology, hence, the importance of a comprehensive history and oral examination. We describe the case of a 47-year-old man who presented with an incidental erythematous lesion of the soft palate. The diagnosis was established during a routine dental examination. We found the lesion to be associated with the practice of fellatio. Oral sex is a very common sexual practice, and as clinicians we should consider it as a potential cause of palatal lesions in our differential diagnosis. This should also raise our suspicion for sexually transmitted diseases in high-risk patients.

https://ift.tt/2l2DdVe

Recurrent meningitis caused by idiopathic cerebrospinal fluid rhinorrhoea from the sphenoid sinus

Description

A 41-year-old woman with 7 days of fever and headache had loss of consciousness 1 day prior to presentation. Despite the absence of trauma or other significant medical history, she had two episodes of meningitis in the previous 6 months. Physical examination showed no nuchal rigidity or abnormal findings on nasal endoscopy. Lumbar puncture showed a cerebrospinal fluid cell count of 750/μl. CT showed a bony defect of the posterior wall of the sphenoid sinus, which was filled with a soft tissue density. MRI showed fluid intensity in the same area (figure 1A, B). The diagnosis was recurrent meningitis due to possible idiopathic cerebrospinal fluid rhinorrhoea. Although a cisternogram is normally recommended, emergency drainage of the sphenoid sinus with antibiotic treatment was prioritised because of her deteriorating condition. With various possible diagnoses, an experienced surgeon operated on the patient. 

Figure 1

A bony defect of...

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Management of placenta percreta in a Jehovahs Witness patient

Placenta percreta is increasing in incidence and is associated with the risk of life-threatening haemorrhage. Patients who do not accept blood products present a unique challenge to obstetrician-gynaecologists. In this case report, we present the case of a 42-year-old pregnant Jehovah's Witness with a complete placenta previa and confirmed percreta at 26 weeks' gestation. Due to her religious beliefs against the use of blood products, she was managed with a stepwise surgical approach which involved caesarean delivery with internal iliac (hypogastric) artery ligation, weekly methotrexate and delayed hysterectomy 6 weeks later. Non-traditional, alternative approaches to the management of abnormal placentation in patients declining blood products warrant exploration.

https://ift.tt/2l5DOpe

Persistent elevation of carcinoembryonic antigen as first presentation of a medullary thyroid carcinoma

Carcinoembryonic antigen (CEA) is still the most widely used tumour marker for gastrointestinal cancer. CEA was originally thought to be a specific marker for colorectal cancer, but it turned out to be a non-specific marker for further studies. CEA levels can be elevated in breast, lung and liver cancers, among others, including medullary thyroid cancer. The authors report a case of a 73-year-old woman who had a right hemicolectomy for an ascending colon adenocarcinoma and showed a persistent elevation in the CEA marker during follow-up. After several imaging tests, recurrence of the colon cancer was not found, but the presence of thyroid nodules had been detected. The diagnosis of a medullary thyroid carcinoma was made after the finding of a high value of calcitonin. The patient had a total thyroidectomy with resection of the central and lateral lymph nodes.

https://ift.tt/2y4BUP4

Bronchogenic cyst infection presenting as pleuropericarditis

Description 

A 17-year-old woman was admitted to the emergency department with a 3-day history of dyspnoea (New York Heart Association Class II) and typical pleuritic pain following a 1-week history of cough and fever. Pneumonia was diagnosed based on a chest X-ray (figure 1A), and amoxicillin–clavulanate treatment was initiated. After 48 hours, the patient developed hypotension and tachycardia. Given hypotension, ongoing fever and rising C reactive protein despite antibiotic treatment, she was referred to the intensive care unit. On admission, an echocardiography was performed. A circumferential pericardial effusion with 14 mm maximum diameter adjacent to the right ventricle was detected, without haemodynamic compromise at the time. Besides, left pleural effusion was evidenced. An ultrasound-guided thoracentesis was conducted. Pleural fluid testing revealed the following findings: white blood cells (WBC) count 11.10⁹/Literwith 90% neutrophils, proteins 38 g/L, pH 7.36, glucose 6.3 mmol/L and lactate dehydrogenase (LDH) 492 IU/L. The culture exhibited no organism,...

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Septic arthritis of the temporomandibular joint leading to an epidural abscess

Septic arthritis of the temporomandibular joint (TMJ) is rare, but patients with this diagnosis are at high risk for significant morbidity. We present a case of a 15-year-old man who presented with increasing trismus for 3 days. He had only minimal discomfort and swelling of the right cheek and temporal region, and pericoronitis of an impacted wisdom tooth was suspected. Under intravenous antibiotics, pain subsided, but trismus and a slight swelling remained. CT scan showed septic arthritis of the TMJ with an abscess formation penetrating into the epidural space. Immediate drainage and craniotomy were performed. Under intravenous antibiotics, the patient made a full recovery. The source of infection remained undetermined. To our knowledge, this is the first reported case of septic arthritis of the TMJ spreading into the epidural space.

https://ift.tt/2t1YmSS

Dentin dysplasia: diagnostic challenges

Dentin dysplasia(DD) is a rare autosomal dominant disorder associated with disturbance of the dentin. While the crowns appear clinically normal, on radiography, the pulp spaces appear partially or completely obliterated, with short blunted roots, and multiple periapical radiolucencies affecting the apparently sound teeth. Clinical signs include spontaneous abscess formation or increased tooth mobility which can lead to exfoliation. DD can therefore have a significant impact on the patient's dentition, and treatment is often challenging. Shields' classification of dentin disorders has been recently criticised for failing to consider differential variations and expressions of these disorders. This paper describes a case of a 23-year-old woman with previously undiagnosed DD, who presented with clinical and histological features belonging to several of these diseases, thus highlighting the potential diagnostic challenges faced with Shields' classification.

https://ift.tt/2l2D9Vu

Osteoporosis and malignancy: a dicey combination

Osteoporosis is the most common metabolic bone disorder worldwide, especially in women. Postmenopausal status is the most common risk factor for osteoporosis in elderly women. The operational diagnosis of osteoporosis is usually made with the help of central dual energy X-ray absorptiometry scan. Clinically, osteoporosis is suspected in the background of one or more fractures of the hip, vertebra, proximal humerus or pelvis in the absence of local disease or high-energy trauma. Serious underlying illness can present with vertebral fractures and can be missed if other clues from clinical examination and investigations are overlooked. We report a case emphasising this aspect.

https://ift.tt/2y61BP8

Primary carnitine deficiency in a 57-year-old patient with recurrent exertional rhabdomyolysis

Rhabdomyolysis is an emergency requiring rapid diagnosis and suitable aetiological treatment. We describe the case of a 57-year-old man with recurrent exertional rhabdomyolysis who was diagnosed with systemic primary carnitine deficiency (SPCD). Clinical examination was normal, creatine kinase levels were elevated, plasma free carnitine concentration was mildly decreased, muscle biopsy demonstrated lipid accumulation, carnitine uptake in cultured fibroblasts was decreased and genetic analysis identified a homozygous pathologic c.1181_1183del in the SLC22A5 gene. Rhabdomyolysis did not recur after treatment with oral L-carnitine was introduced. SPCD is a rare autosomal recessive disorder of carnitine transportation usually manifesting as an infantile (hepatic) or a childhood myopathic (cardiac) condition and rarely affecting adults. Our case indicates that SPCD should be considered in the aetiological evaluation of adult patients with recurrent exertional rhabdomyolysis, even in the absence of myopathy and cardiomyopathy.

https://ift.tt/2l5DK8Y

Horseshoe kidney with unilateral single ectopic ureter

The horseshoe kidney (HSK) is not an uncommon entity with an incidence of about 1 in 400 or 0.25% of the general population. It is also more commonly found in men as compared with women in a ratio of 2:1.An increased association of genitourinary anomalies have been found with HSK.Duplication of ureters occurs in 10% of HSKs. However, the association of HSK with single-system ectopic ureter is extremely rare. To our knowledge, no case with similar presentation has been reported in literature. Most cases of HSK with bilateral single ectopic ureters have been described. The aim of this report is to highlight the radiological and surgical findings in a case of HSK with unilateral single ectopic ureter.

https://ift.tt/2y61Ae2

Traumatic corneal perforation with exteriorisation of Ahmed glaucoma valve tube

We report a rare case of traumatic corneal perforation with Ahmed glaucoma valve (AGV) tube. A 5-year-old female child, diagnosed with refractory glaucoma, had undergone AGV implantation, presented with the posterior migration of AGV tube after trauma to the eye. The detailed ocular history, ophthalmic findings, clinical course and surgical management are discussed.

https://ift.tt/2l2D6cg

Metachronous renal Ewing sarcoma/primitive neuroectodermal tumour in a survivor of Burkitt lymphoma

We present a case of a 14-year-old girl who was diagnosed with Burkitt lymphoma in 2014. She was managed with chemotherapy and remained in remission for 3 years. On her surveillance imaging in 2017, a left-sided renal neoplastic mass was incidentally discovered. She underwent nephrectomy and pathology of the resected specimen revealed small cell tumour of the kidney with features favouring renal Ewing sarcoma/primitive neuroectodermal tumour. Molecular genetic analysis by fluorescence in situ hybridisation was performed which showed translocation of 22q12, thereby confirming the diagnosis. This is a rare secondary malignancy and an unusual association. This case highlights the importance and diagnostic dilemmas of rare secondary tumours in patients with such haematological malignancies and discusses its possible pathogenetic aspects.

https://ift.tt/2y61yCW

Thank you list 2017

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Thyroid Hormone Receptors Regulate the Expression of microRNAs with Key Roles in Skin Homeostasis

Thyroid, Ahead of Print.


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Leserbrief zu Ellies M. Aus der Gutachtenpraxis: Was ist eine Biopsie mit Inzision? Begutachtung der Kodierung im G-DRG-System in der HNO-Heilkunde. Laryngo-Rhino-Otol 2018; 97: 203–205

Laryngo-Rhino-Otol 2018; 97: 373-373
DOI: 10.1055/a-0612-9553

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Stapedotomie erfolgreich bei fortgeschrittener Otosklerose?

Laryngo-Rhino-Otol 2018; 97: 369-370
DOI: 10.1055/s-0044-100282

Heining et al. Audiological outcome of stapes surgery for far advanced cochlear otosklerosis. J Laryngol Otol 2017; 131: 961–964 Die cochleäre Otosklerose ist eine seltene Erkrankung des Innenohres, die zu einer Verknöcherung der Haarzellen führt und die Homöostase der Lymphströme negativ beeinflussen kann. Betroffene leiden unter Innenohrschwerhörigkeit, eine Therapie gilt als schwierig. Heining und Kolleginnen/Kollegen haben nun in einer retrospektiven Studie untersucht, ob Patienten mit fortgeschrittener Otosklerose von einer Stapedotomie profitieren können.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Fachsprache Medizin im Schnellkurs – Für Studium und Berufspraxis

Laryngo-Rhino-Otol 2018; 97: 376-376
DOI: 10.1055/a-0593-7276

© Georg Thieme Verlag KG Stuttgart · New York

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Spasmodische Dysphonie: Langzeitergebnisse mit Thyroplastik Typ 2

Laryngo-Rhino-Otol 2018; 97: 370-372
DOI: 10.1055/s-0043-121841

Sanuki T et al. Long-term Evaluation of Type 2 Thyroplasty with Titanium Bridges for Adductor Spasmodic Dysphonia. Otolaryngol Head Neck Surg 2017; 157: 80–84 Japanische Ärzte für Hals-, Nasen- und Ohrenheilkunde sowie Kopf- und Halschirurgie berichteten über stimmliche Langzeitergebnisse nach Durchführung einer Thyroplastik Typ 2 zur Behandlung der spasmodischen Dysphonie vom Adduktor Typ.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Antwort von Prof. Dr. med. Maik Ellies auf den Leserbrief von Jäckel M zu Ellies M. Aus der Gutachtenpraxis: Was ist eine Biopsie mit Inzision? Begutachtung der Kodierung im G-DRG-System in der HNO-Heilkunde. Laryngo-Rhino-Otol 2018; 97: 203–205

Laryngo-Rhino-Otol 2018; 97: 374-375
DOI: 10.1055/a-0612-9574

© Georg Thieme Verlag KG Stuttgart · New York

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Carcinoma in situ der Stimmlippe

Laryngo-Rhino-Otol 2018; 97: 377-378
DOI: 10.1055/a-0588-6611

© Georg Thieme Verlag KG Stuttgart · New York

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Wie würden Sie entscheiden?

Laryngo-Rhino-Otol 2018; 97: 415-418
DOI: 10.1055/a-0588-6633

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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https://ift.tt/2MkuD0w

Das Plattenepithelkarzinom des Naseneingangs – Eine Literaturübersicht

Laryngo-Rhino-Otol 2018; 97: 379-391
DOI: 10.1055/a-0592-7965

Hintergrund Das Plattenepithelkarzinom des Naseneingangs (Vestibulum nasi) ist eine sehr seltene Tumorentität. In der Konsequenz herrscht bezüglich der Ätiologie, des Stagings und der notwendigen Therapie dieser Tumoren nach wie vor Uneinigkeit. Insbesondere die Mitbehandlung regionaler Lymphknotenstationen ist Gegenstand wissenschaftlicher Diskussionen. Methode Alle via Pubmed gefundenen Artikel zum Thema wurden hinsichtlich folgender Themenschwerpunkte untersucht: Lymphatische Versorgung, Metastasierung, Inzidenz, Prognose, Risikofaktoren (Leder, Nickel, Nikotin, Humane Papillomaviren), Tumorklassifikationssystem (UICC-, AJCC-, Wang-Klassifikation), Therapie des Primärtumors, Therapie regionaler Lymphknoten und Immunhistochemie. Ergebnisse Im vorliegenden Übersichtsartikel wurden 55 Veröffentlichungen ausgewertet. Die Ergebnisse hinsichtlich der untersuchten Aspekte sind in sich inhomogen. Schlussfolgerungen Als Klassifikationssystem wird die Wang-Klassifikation empfohlen. Für die Behandlung kleinerer Tumoren (T1-T2-Wang) kommen operative Resektionen oder Bestrahlungen in Betracht. Größere Tumoren (T3-Wang) sollten reseziert und einer adjuvanten Bestrahlung zugeführt werden. Im Falle einer cT1-cT2cN0-Situation kann – eine dezidierte bildgebende Diagnostik vorausgesetzt – auf eine elektive Therapie der regionalen Lymphknoten verzichtet werden.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Chirurgie bei Läsionen des Nervus facialis

Laryngo-Rhino-Otol 2018; 97: 419-434
DOI: 10.1055/a-0588-6622

Ursachen für eine Läsion mit nachfolgender Lähmung des N. facialis sind vielfältig, von der idiopathischen Fazialisparese bis hin zur Destruktion des Nervs durch einen malignen Tumor. Eine Indikation zur chirurgischen Intervention besteht immer dann, wenn die Wahrscheinlichkeit einer spontanen Heilung mit gutem funktionellen Ergebnis gering oder gar nicht vorhanden ist, und eine medikamentöse Behandlung nicht möglich oder auch der chirurgischen Therapie unterlegen ist.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2018; 97: 435-436
DOI: 10.1055/a-0588-6664

© Georg Thieme Verlag KG Stuttgart · New York

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Rhinoplastik

Laryngo-Rhino-Otol 2018; 97: 437-440
DOI: 10.1055/a-0588-6708

© Georg Thieme Verlag KG Stuttgart · New York

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Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2018; 97: 367-368
DOI: 10.1055/a-0588-6578

© Georg Thieme Verlag KG Stuttgart · New York

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One-year clinical evaluation of bulk-fill flowable vs. regular nanofilled composite in non-carious cervical lesions

Abstract

Objective

The aim of this double-blind, randomized trial was to evaluate the 1-year clinical performance of a bulk-fill flowable and a regular nanofilled composite in non-carious cervical lesions (NCCLs).

Methods

Twenty-two subjects with at least two NCCLs were enrolled in the study. A total of 89 restorations were performed by a single operator using Filtek Supreme (FS) Ultra Universal or Filtek Bulk (FB) Fill Flowable. A universal adhesive (Scotchbond™ Universal Adhesive) was used with a self-etching approach in dentin. The restorations were evaluated by two independent and previously calibrated examiners at baseline (7 days), 6 months and 1 year, according to the USPHS modified criteria. Mann–Whitney U test was used to analyze the differences between composites and Wilcoxon signed rank test for comparisons between the baseline and follow-ups (α = 5%).

Results

One restoration was considered clinically unacceptable due to loss of retention after 6 months in the FS group. FS presented statistically high scores for surface roughness when compared to FB after 1 year (p < 0.05), but both were considered clinically acceptable. After 1 year, the frequency of clinically unacceptable rates was 3.3% for anatomical form in the FB group, 1.1% for retention in the FS group, and 2.2% for marginal adaptation in both groups. All restorations, in both groups, presented score 0 over the 1-year period for marginal staining, postoperative sensitivity, and secondary caries.

Conclusion

Both composite resins showed acceptable clinical performances for the restoration of NCCLs after 1 year.

Clinical relevance

Both bulk-fill flowable and regular nanofilled composites showed good clinical performances for the restoration of NCCLs after 1 year.

https://ift.tt/2Ju5m6e

Erratum: Periphere Regionalanästhesie ohne Komplikationen – Ein Traum wird wahr?!

Anästhesiol Intensivmed Notfallmed Schmerzther
DOI: 10.1055/a-0629-0254

Georg Thieme Verlag KG Stuttgart · New York

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Clinical pathologic conference case: An elderly woman with A painless, deep and indurated ulcer on her mandibular alveolar mucosa

Publication date: Available online 11 June 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Sharon J. Akrish, Adi Rachmiel, Imaad Abu El-Naaj, Ofer Ben-Izhak




https://ift.tt/2l2IRqh

Low drug survival of apremilast for psoriasis in a real-word-setting

https://ift.tt/2HJIzhe

Systematic Review of the Therapeutic Roles of Adipose Tissue in Dermatology

Adipose tissue is rich in stem cells that secrete trophic factors; Several studies have demonstrated improved outcomes in scarring, wound healing, and hair growth with adipose tissue treatments; The evidence on using adipose tissue to treat complex dermatologic conditions is not strong enough to justify changes to current clinical practice.

https://ift.tt/2sQ4Nt5

Epidemiology of Staphylococcal Scalded Skin Syndrome in United States Adults

https://ift.tt/2HExBJR

Review: Surgical Smoke: Risks Assessment and Mitigation Strategies

Dermatologists are repeatedly exposed to surgical smoke from lasers and electrosurgery.; There are relevant infectious, direct physical, chemical, and mutagenic risks of surgical smoke.; These risks can be minimized by use of respirator masks and smoke evacuation systems.

https://ift.tt/2JsVutv

12-hydroxyeicosatetraenoic acid (12-HETE) levels are increased in Actinic Keratoses (AK) and Squamous Cell Carcinoma (SCC)

https://ift.tt/2HFEf2x

Hypoglossal nerve stimulator generator migration: INSPIRE device reimplantation with parallels to cardiac implantable electronic devices

Implantation rates of hypoglossal nerve stimulators, such as INSPIRE, are increasing. The device is still in its early stages of complication reporting, which to date includes implant related infection requiring device removal, and stimulation lead cuff dislodgement requiring replacement. Here we present a 48-year-old female who experienced generator migration and stimulator lead tension requiring an additional operation in order to resecure the generator device. This proved unsuccessful and a second surgery was performed with complete relocation of the device generator to inhibit device migration.

https://ift.tt/2JsVGZC

Female Eye Attractiveness – Where Beauty Meets Science

While periorbital and -ocular surgery ranks amongst the most frequently performed plastic surgical procedures, only scarce information exists regarding the contributing factors of ageing and its systematic anatomic assessment. The presented study, based on measuring distinct physical landmarks, aimed to gather data to provide a foundation of in-depth periorbital analysis in order to more clearly define female eye attractiveness.

https://ift.tt/2l45Rp7

Accuracy of soft tissue prediction in surgery-first treatment concept in orthognathic surgery: A prospective study

The purpose of this study was to provide a quantitative accuracy assessment of soft tissue predictions generated by a computer-aided maxillofacial planning system in patients undergoing orthognathic surgery following the "surgery-first" treatment.

https://ift.tt/2y1X1RN

Effect of artemisinin and neurectomy of pterygoid canal in ovalbumin-induced allergic rhinitis mouse model

Allergic rhinitis (AR), characterized by sneezing, nasal itching and rhinorrhea, affects a large number of population. This study aimed to explore the effects of artemisinin alone or combined with neurectomy o...

https://ift.tt/2y3kYrZ

Cytomegalovirus reactivation in a critically ill patient: a case report

The aim of this case report is to discuss diagnostic workup and clinical management of cytomegalovirus reactivation in a critically ill immunocompetent pediatric patient.

https://ift.tt/2sNUqWK

A morphological classification for vocal fold leukoplakia

Publication date: Available online 11 June 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Min Chen, Changjiang Li, Yue Yang, Lei Cheng, Haitao Wu
IntroductionThere is still no general method for discriminating between benign and malignant leukoplakia and identifying vocal fold leukoplakia.ObjectiveTo evaluate the reliability of a morphological classification and the correlation between morphological types and pathological grades of vocal fold leukoplakia.MethodsA total of 375 patients with vocal fold leukoplakia between 2009 and 2015 were retrospectively reviewed. Two observers divided the vocal fold leukoplakia into flat and smooth, elevated and smooth, and rough type on the basis of morphological appearance. The inter-observer reliability was evaluated and the results of classification from both observers were compared with final pathological grades. Clinical characteristics between low risk and high risk group were also analyzed.ResultsThe percentage inter-observer agreement of the morphological classification was 78.7% (κ=0.615, p<0.001). In the results from both observers, the morphological types were significantly correlated with the pathological grades (p1<0.001, p2<0.001, Kruskal–Wallis test; r1=0.646, p1<0.001, r2=0.539, p2<0.001, Spearman Correlation Analysis). Multivariate analysis showed patient's age (p=0.018), the size of lesion (p<0.001), and morphological type (p<0.001) were significantly different between low risk group and high risk group. Combined receiver operating characteristic curve analysis of significant parameters revealed an area under the receiver operating characteristic curve of 0.863 (95% CI 0.823–0.903, p<0.001).ConclusionsThe proposed morphological classification of vocal fold leukoplakia was consistent between observers and morphological types correlated with pathological grades. Patient's age, the size of lesion, and morphological type might enable risk stratification and provide treatment guidelines for vocal fold leukoplakia.



https://ift.tt/2MjxpD5

Is fine needle aspiration biopsy reliable in the diagnosis of parotid tumors? Comparison of preoperative and postoperative results and the factors affecting accuracy

Publication date: Available online 11 June 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Fazilet Altin, Yalcin Alimoglu, Resit Murat Acikalin, Husamettin Yasar
IntroductionFine needle aspiration biopsy is a valuable tool in preoperative evaluation of head and neck tumors. However, its accuracy in management of salivary gland tumors is debatable.ObjectiveWe aimed to investigate the efficacy and the accuracy of fine needle aspiration biopsy in parotid gland tumors.MethodsPatients who underwent parotidectomy between January 2008 and June 2017 due to parotid gland tumor were examined retrospectively. Patients with both preoperative fine needle aspiration biopsy and postoperative surgical pathologies were included. Preoperative fine needle aspiration biopsy was categorized as benign, malignant or suspicious for malignancy. Surgical pathology was grouped as benign or malignant. Surgical pathology was compared with fine needle aspiration biopsy, and sensitivity, specificity, accuracy and agreement between both tests were investigated.Results217 cases were evaluated and 23 cases were excluded because the fine needle aspiration biopsy diagnosis was non-diagnostic or unavailable. 194 cases were included. The mean age of the patients was 47.5±15.88 (7–82). There were 157 benign, 37 malignant cases in fine needle aspiration biopsy, 165 benign and 29 malignant cases in surgical pathology. The most common benign tumor was pleomorphic adenoma (43.3%), and malignant tumor was mucoepidermoid carcinoma (4.13%). The diagnostic accuracy for fine needle aspiration biopsy when detecting malignancy was 86.52%. Sensitivity and specificity were 68.96% and 89.63% respectively. Positive predictive value was 54.05% and negative predictive value was 94.23%. There was moderate agreement between fine needle aspiration biopsy and surgical pathology (κ=0.52). The sensitivity was 54.54% in tumors less than 2cm while 77.77% in larger tumors. In tumors extending to the deep lobe, sensitivity was 80%.ConclusionFine needle aspiration biopsy is an important diagnostic tool in evaluation of parotid gland tumors. It is more accurate in detecting benign tumors. In tumors greater than 2cm and extending to the deep lobe, the sensitivity of fine needle aspiration biopsy is high. The use of fine needle aspiration biopsy in conjunction with clinical and radiological evaluation may help to reduce false positive and false negative results.



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Cervical paragangliomas: experience of 114 cases in 14 years

Publication date: Available online 11 June 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Halil Basel, Nazim Bozan
Introduction and objectiveTo report a single center experience with carotid body paraganglioma cases that were treated by the same surgeon in a city with high prevalence of paragangliomas due to high altitude.MethodsWe retrospectively investigated the demographic, clinicopathological and radiological data of 104 patients diagnosed with cervical paragangliomas between 2003 and 2017. The patients were classified according to the Shamblin classification.ResultsIn this study a total of 104 patients (33 male and 71 female, with a mean age of 54.6±13 years) diagnosed with cervical paragangliomas located on carotid bifurcation between 2003 and 2017 were included. Among those patients, 10 presented with bilateral tumors and in total, 114 paragangliomas were managed in this period. The mean diameter of the tumors was 5.12±1.45cm. Malignant tumor was determined in only one (0.9%) patient. All patients were operated. In 12 patients with the tumor diameter larger than 5cm, preoperative coil embolization was achieved. In 14 patients, preoperative angiographic embolization was employed and in 4 patients intraoperative sclerosing agent injections were performed. Facial paralysis was observed in 2 patients and dysphagia was present in 1 patient, Horner syndrome was seen in 1 patient and hoarseness was reported in 7 patients after operation. All those complications improved during follow-up. Mortality was not reported in any cases.ConclusionSurgery is the definitive treatment for patients with cervical paragangliomas. Although, it may be difficult in patients with the advanced Shamblin types, in experienced hands, complication rates are very low.



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Solitary plasmacytoma of the jaws: therapeutical considerations and prognosis based on a case reports systematic survey

Publication date: Available online 11 June 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Eduardo Madruga Lombardo, Fábio Luiz Dal Moro Maito, Cláiton Heitz
IntroductionSolitary plasmacytoma is a rare malignant tumor of plasma cells with no evidence of systemic proliferation. There are two known subtypes: extramedullary solitary plasmacytoma and solitary bone plasmacytoma. The etiology is still unknown. Both lesions present a risk of progression to multiple myeloma. A number of approaches have been used for treatment of solitary plasmacytoma.ObjectiveTo carry out a systematic review of the case reports described in the literature, focusing on therapeutic and prognostic aspects.MethodsA search of clinical case reports was performed in the PubMed database using Mesh Terms related to "plasmacytoma" under the following criteria: type of study (case report), articles in English language, conducted in humans, with no publication date limits.ResultsOf the 216 articles found, only 21 articles met the pre-established inclusion criteria.ConclusionThe occurrence of solitary bone plasmacytoma in the bones of the face is a rare condition prevalent between the 4th and 6th decades of life, located in the posterior region of the mandible in most cases. Histopathological examination and systemic investigation are mandatory for confirmation of diagnosis.



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Effects of concentrated growth factors on the angiogenic properties of dental pulp cells and endothelial cells: an in vitro study

Abstract The aim was to investigate the angiogenic effects of concentrated growth factors on human dental pulp cells and human umbilical vein endothelial cells. Cells were treated with concentrated growth factor extracts. The CCK-8 assay and cell cycle assay were conducted to evaluate cell growth. Cell migration was evaluated by the Transwell migration assay. Angiogenesis-associated mRNA and protein expression levels were determined using quantitative real-time PCR and Western blotting, respectively. A tube formation assay was conducted to evaluate the angiogenic capacity in vitro. The data showed that compared with the control, concentrated growth factor extracts significantly promoted dental pulp cell proliferation and differentiation and endothelial cell proliferation and migration in a dose-dependent manner (p < 0.05). Concentrated growth factor extracts also promoted the tube-like structure formation of endothelial cells in vitro. The RT-PCR and Western blot results showed that concentrated growth factor extracts upregulated the expression of angiogenesis-related genes – chemokine receptor-4, platelet-derived growth factor, and vascular endothelial growth factor – in dental pulp cells. In conclusion, concentrated growth factors showed proangiogenic effects on dental pulp cells and endothelial cells and have good application potential for dental pulp revascularization.

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Fatigue strength of several dental ceramics indicated for CAD-CAM monolithic restorations

Abstract This in vitro study evaluated the fatigue strength of different ceramic materials indicated for monolithic restorations. Disc-shaped specimens were made according to ISO 6872 from five different ceramic materials: feldspathic ceramic (FC), polymer-infiltrated ceramic network (PIC), lithium disilicate glass-ceramic (LD), zirconia-reinforced lithium silicate glass-ceramic (ZLS), and high translucent tetragonal zirconia polycrystals doped by yttrium (YZ-HT). After obtaining the mean of each material (n = 5) from monotonic load-to-failure tests, specimens (n = 20) were subjected to fatigue tests (staircase method) using a biaxial flexural setup (piston-on-three-balls), to determine the fatigue strength. The parameters used for fatigue tests were: 100,000 cycles at 10 Hz, initial load of ~ 60% of mean load-to-failure, and step size of 5% of the initial load (specific for each ceramic material). Kruskal-Wallis and Bonferroni's test (α = 0.05) were used to analyze the fatigue strength data. Fatigue strength (MPa) of the materials was statistically different among each other as follows: YZ-HT (370.2 ± 38.7) > LD (175.2 ± 7.5) > ZLS (152.1 ± 7.5) > PIC (81.8 ± 3.9) > FC (50.8 ± 1.9). Thus, it can be concluded that, in terms of fatigue, high translucent polycrystalline zirconia is the best choice for monolithic restorations as it bears the highest load before cracking/fracturing.

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Effect of Topical Erythropoietin (EPO) on palatal wound healing subsequent to Free Gingival Grafting (FGG)

Abstract Free gingival grafting, the most predictable technique to increase the keratinized gingiva, leaves an open wound on the palate and the resulting discomfort during the healing phase is a significant concern. This study was intended to evaluate the effect of topical erythropoietin on healing of the donor site. Twelve patients lacking an attached gingiva at two sites in the mandible were included. In the test group, 1 mL of gel containing erythropoietin at a concentration of 4,000 IU mL-1 was applied to the donor site, whereas the control group was treated with 2 mL of the gel alone. On the second day after surgery, the same procedure was repeated. H2O2 was used to evaluate the amount of epithelialization. Clinical healing was compared using photographs and direct examination. The EPO group showed significantly better keratinization only on day 21. Comparison of clinical healing based on direct examination revealed significantly better healing in the test group on day 28. Furthermore, inflammation in the test group was lower than in the control group on the same day. Topical application of EPO improves palatal wound healing during the third and fourth weeks after free gingival graft procedures.

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Effect of different bonding protocols on degree of monomer conversion and bond strength between orthodontic brackets and enamel

Abstract The objective of the present study was to evaluate the effect of different surface treatments and polymerization protocols on the bond strength of brackets to enamel, and the degree of conversion of the bonding agents. 120 bovine crowns were embedded in acrylic resin blocks and sanded. Next, the blocks were randomly assigned into 12 groups. Metal brackets were bonded to enamel according to the "surface treatment" factor (A: Phosphoric Acid; ATxt: Phosphoric Acid + Transbond XT Primer®; Tse: Transbond Plus Self Etching Primer®; and SBU: Scotchbond Universal®) and "polymerization" factor (R20: Radii-Cal®/20 seconds; V20: Valo Cordless®/20 seconds; and V3: Valo Cordless®/3 seconds). All samples were stored for 6 months (water, 37ºC) and then subjected to a shear bond strength test (SBS). Bond failures were classified according to the Adhesive Remnant Index (ARI) and analyzed with the Kruskal-Wallis and Mann-Whitney tests (5%). Using the same factors, 120 resin discs were made to assess the degree of conversion (DC) of the monomer. Data from the SBS (MPa) and DC (%) were analyzed by analysis of variance (2 factors) and Tukey's test (5%). For the SBS, the factors "polymerization" (R20 = 8.1B; V20 = 13.2A; V3 = 5.2C, p = 0.0001) and "surface treatment" (A = 3.1C; ATxt = 13.6A; Tse = 12.3A; SBU = 6.3B, p = 0.0001) were statistically significant among groups. The highest adhesion value were found for the ATxt/V20 group (22.2A) and the lowest value for the A/R20 group (1.2E). Regarding ARI, score 2 was the most prevalent in groups A, ATxt, V20 and V3, while score 4 was the most prevalent in the Tse, SBU and R20 groups, with no significant difference between them (p = 1.0). Regarding DC, the factors "polymerization" (R20 = 66.6A; V20 = 58.4B; V3 = 45.1C, p = 0.0001) and "surface treatment" (A = 52B, ATxt = 59.7A, Tse = 51.4B, SBU = 63.8A, p = 0.0001) were statistically significant. Tse was more sensitive to the variations in polymerization protocols than the other surface treatments. Treatment A did not present suitable bond strength or degree of conversion.

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Study of ISU104, Targeting ERBB3 in Patients With Advanced Solid Tumors

Condition:   Solid Tumor
Intervention:   Biological: ISU104
Sponsor:   ISU Abxis Co., Ltd.
Recruiting

https://ift.tt/2JJwHRa

Effects of Probiotics in Preventing Oral Mucositis

Condition:   Head-and-neck Cancer
Interventions:   Drug: Lactobacillus Reuteri Oral Solution [BioGaia];   Drug: Placebos
Sponsor:   National University Hospital, Singapore
Not yet recruiting

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Study to Evaluate the Safety, Tolerate, Pharmacokinetics and Preliminary Efficacy of CYH33

Conditions:   Advanced Solid Tumors;   Advanced Esophagus Cancer and Squamous Cell Carcinoma of the Esophageal Junction
Intervention:   Drug: CYH33 for tablet
Sponsor:   ShangHai HaiHe Pharmaceutical
Recruiting

https://ift.tt/2MgsO4F

Gastrointestinal CMV Disease and Tuberculosis in an AIDS Patient: Synergistic Interaction between Opportunistic Coinfections

The AIDS pandemic has made diseases such as tuberculosis, CMV disease, and other opportunistic infections more prevalent; these diseases may even be found to be associated among themselves, and the natural history of each disease may present in an unusual manner. We report the case of a 41-year-old man with HIV (CD4 of 144 cells/dL) and HCV with hematochezia due to tuberculosis in the ileocecal valve and descending colon and CMV tissue invasive disease in the esophagus and descending colon. Coinfection among tuberculosis and cytomegalovirus in the gastrointestinal tract was described only once in a patient with a recent diagnosis of HIV that affected the distal ileum and ascending colon. We will discuss the peculiarities of the case and the behavior of the immune system in the face of simultaneous opportunistic infections. This is a challenging scenario that has scarce publications and is of great clinical importance.

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Burkitt’s lymphoma presenting as acute appendicitis: a case report

Abstract

Appendiceal lymphomas are exceedingly rare, constituting around 0.015% of all gastrointestinal lymphoma cases. Burkitt's lymphoma is the second most prevalent pathology, diagnosed in 25.9% of patients. We report a case of a 36-year-old male admitted with acute abdominal pain with 2 days of evolution, localized in the right lower quadrant associated with hyporexia, but no fever. On examination he presented abdominal tenderness on the right iliac fossa. A diagnosis of acute appendicitis was made clinically. At the post-operative follow up, 2 weeks later, he presented a low back pain of high intensity, associated with swelling of the abdomen, night sweats, daily fevers and weight loss. The histopathological exam of the appendix revealed diffuse and transmural lymphoid proliferation. Immunohistochemistry suggested high grade B-cell lymphoma indicative of Burkitt's lymphoma. This patient was staged as a IVxB lymphoma and was submitted into polychemotherapy with a complete clinical response in 8 months.

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Cecal ameboma mimicking obstructing colonic carcinoma

Abstract

Ameboma is a mass of granulation tissue with peripheral fibrosis and a core of inflammation related to amebic chronic infection. The initial presentations of colonic ameboma usually include obstruction and low gastrointestinal bleeding. It may mimic colon carcinoma or other granulomatous inflammatory conditions of the colon in both the clinical presentation and the endoscopic appearance. Here, we report a case of a 45-year-old male with a presentation of abdominal pain and constipation, as well as clinical, radiological and endoscopic presentation resembling colonic carcinoma, that was managed operatively with right hemicolectomy and post-operative histopathologic finding of cecal ameboma.

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Irreversible electroporation in borderline resectable pancreatic adenocarcinoma for margin accentuation

Abstract

Achieving clear microscopic resection margins following pancreaticoduodenectomy (PD) is challenging particularly in borderline resectable pancreatic carcinoma (BRPC). Positive resection margins has been identified as a major independent prognostic factor. Irreversible electroporation (IRE) has emerged as a promising non-thermal ablative method that could be used in the treatment of pancreatic cancer as an adjunct to chemotherapy and surgery. This case report describes the successful simultaneous intraoperative IRE and PD in a patient with BRPC, achieving clear microscopic resection margins. Technical aspects and histology showing the effect of IRE are presented. The role of IRE in the treatment of pancreatic adenocarcinoma should be further evaluated in prospective studies.

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Spontaneous adrenal hemorrhage. Report of two cases and review of pathogenesis, diagnosis and management

Abstract

Adrenal hemorrhage represents a relatively rare condition, usually associated with meningococcal septicemia. It is an underestimated cause of acute decompensation, multiorgan failure and death, usually diagnosed post-mortem. Depending on its etiology adrenal hemorrhage is categorized as traumatic and non-traumatic. The technical advancement of imaging modalities, has made diagnosis and management more efficient. Assessment of hemodynamic stability, exclusion of a hormonal active adrenal tumor and assessment for adrenal insuffi¬ciency, are of cardinal importance. Angiographic embolization has contributed significantly in better outcomes as emergency laparotomy is associated with high morbidity and mortality rates. Hereby we present two cases of spontaneous adrenal hemorrhage associated with extensive retroperitoneal bleeding and hemodynamic instability. Both underwent angiography with one requiring embolization with favorable outcome. Investigation for exclusion of underlying adrenal tumor, adrenal insufficiency and follow-up imaging are presented in detail for both cases.

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A Rare Presentation of Clozapine-Induced DRESS Syndrome

Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) is an uncommon side effect of certain medications. It causes a skin reaction, with eosinophilia and other organ involvement. This case describes a presentation of a 32-year-old female with a past medical history significant for schizophrenia and bipolar disorder who presented for a rash. She had been started on clozapine 10 days prior to admission. After extensive workup she was found to have DRESS syndrome secondary to clozapine use. This is the second reported case in the literature of clozapine-induced DRESS syndrome. This case is unique because it is the first case to present with the common manifestations of DRESS syndrome including eosinophilia, rash, lymphadenopathy, and organ involvement after clozapine use.

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Odontogenic Cutaneous Fistula: A Cause of Persistent Cervical Discharge

Odontogenic cutaneous fistulas often lead to intense levels of patient discomfort and suffering. Due to its rarity and the absence of dental symptoms, a considerable number of patients are usually misdiagnosed which results in inappropriate management. This case report presents a 16-year-old patient with a 2-year history of a nonhealing, persistently discharging lesion in the left submandibular region of the neck. The patient underwent exploration of the left submandibular region, and a fistulous tract directed superomedially to the ipsilateral lower molar teeth was excised. A subsequent panoramic orthopantomogram performed one week postoperatively demonstrated radiolucency is the distal root of tooth 37. A final diagnosis of odontogenic cutaneous fistula was made, and the patient was referred to the Maxillofacial Department for treatment of the offending tooth.

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