Retinal Endovascular Surgery with Tissue Plasminogen Activator Injection for Central Retinal Artery Occlusion

Purpose: To report 2 cases of central retinal artery occlusion (CRAO) who underwent retinal endovascular surgery with injection of tissue plasminogen activator (tPA) into the retinal artery and showed a remarkable improvement in visual acuity and retinal circulation. Methods: Standard 25-G vitrectomy was performed under local anesthesia. Simultaneously, tPA (80,000 units/mL) solution was injected into the retinal artery of the optic disc for 2–3 min using a microneedle. Changes in visual acuity, fundus photography, optical coherence tomography (OCT), fluorescein angiography, and laser speckle flowgraphy (LSFG) results were examined. Results: Both cases could be treated within 12 h after the onset of CRAO. Case 1 was a 47-year-old woman. Her visual acuity improved from counting fingers before operation to 0.08 logMAR 1 month after the surgery. However, thinning of the retina at the macula was observed by OCT. Case 2 was a 70-year-old man. His visual acuity improved from counting fingers to 0.1 logMAR 2 months after the surgery. Both fluorescein angiography and LSFG showed improvement in retinal circulation after the surgery in case 2. Conclusions: Retinal endovascular surgery with injection of tPA into the retinal artery was feasible and may be a way to improve visual acuity and retinal circulation when performed in the acute phase of CRAO.
Case Rep Ophthalmol 2018;9:327–332

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Editorial Board

Publication date: July 2018
Source:Autoimmunity Reviews, Volume 17, Issue 7





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Response to C‐reactive protein as an individual prognostic marker in oral cancer: practical considerations

Clinical Otolaryngology, EarlyView.


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C‐reactive protein as an individual prognostic marker in oral cancer: Practical considerations

Clinical Otolaryngology, EarlyView.


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Epinephrine auto-injector carriage and use practices among US children, adolescents, and adults

Publication date: Available online 21 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Christopher M. Warren, Justin M Zaslavsky, Kristin Kan, Jonathan M Spergel, Ruchi S. Gupta




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Editorial Board

Publication date: August 2018
Source:Molecular Immunology, Volume 100





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Editorial

Publication date: August 2018
Source:Molecular Immunology, Volume 100





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Editorial Board/Reviewing Committee

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Caenorhabditis elegans in high-throughput screens for anti-infective compounds

Nicholas D Peterson | Read Pukkila-Worley

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Proximal-type epithelioid sarcoma of the oral cavity: a case report and literature review

Publication date: Available online 21 June 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Yutong Liu, Bincan Sun, Yaocheng Yang, Liang Zhong, Xifan He, Mengxue Wang, Kai Wang, Lin Chen
Proximal-type epithelioid sarcoma (PES) is an exceedingly rare malignant tumor of soft tissue; PES within the oral cavity is even rarer. Pathological examination is the primary diagnostic modality and surgical treatment is recommended as the preferred method for the treatment of PES. Currently, there is a paucity of literature that systematically reports on PES in the oral cavity. Here, we describe a 42-year-old man with PES in the oral cavity, which showed positivity for vimentin, cytokeratin, CD31, S-100, but did not express BCL-2, HMB-45, or desmin. We performed a wide excision and neck dissection, then used the free anterolateral thigh flap to reconstruct the defect in the soft tissue. Furthermore, we review the current literature with regard to diagnosis and treatment of PES.



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A Painful Infraorbital Mass

A man with recurrent sinus infections presented with progressive vertical diplopia, blurry vision, and medial right eye pain; test results revealed a soft-tissue mass expanding the bony margins of the infraorbital nerve canal. What is your diagnosis?

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Formal Idiographic Inference in Medicine

This Viewpoint proposes an alternate framework for evaluating patients that begins with inference from previous patients and ends with an idiographic model formed with data acquired from the current patient.

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Errors in Description of Suction Required by Patients

In the article titled "Association of Standardized Tracheostomy Care Protocol Implementation and Reinforcement With the Prevention of Life-Threatening Respiratory Events," the descriptions of suction in the second and third bullet points under the "Protocol guideline" heading have been corrected. The instances that previously read that patients will be suctioned 2 or 4 times have been corrected to read that the patients will be suctioned every 2 or 4 hours. The article was corrected online.

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Cystatin C and 20-Year Incidence of Hearing Impairment

This longitudinal, population-based study uses data from the Epidemiology of Hearing Loss Study to investigate the association between cystatin C, both as an independent biomarker and as a marker of kidney function, and the 20-year incidence of hearing impairment in a cohort of middle-aged and older adults.

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Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure

To the Editor The study by Schoppy et al provides information that furthers the dialogue about how surgical margins are assessed, both intraoperatively and on formalin-fixed specimens, and offers a seemingly attractive and clinically meaningful quality measure in head and neck surgery: a negative margin rate of 90%. The authors appropriately note a major limitation of this study—variation in margin sampling techniques across surgeons. By design, the authors could not define the source of negative margin: was margin status deduced from the actual resection specimen or tumor bed biopsies? How is the adequacy of margin revision determined? This limitation makes the proposed metric of a "90% or higher negative margin" rate a nonactionable one.

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Tobacco Cessation Attempts Among Smokers With Head and Neck Cancer

This cross-sectional study of smokers with head and neck squamous cell carcinoma (HNSCC) examines tobacco cessation attempts and symptoms experienced prior to development of HNSCC, as well as the correlation of these symptoms with number of cessation attempts and maximum quit days.

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Hearing Aid Use and Health Care Costs Among Older Adults

A number of studies have attempted to quantify the cost of hearing loss, including ones using the same data source but an earlier time. A systematic review that summarized many of these findings documented the financial results of hearing loss, but also highlighted the variability across studies and lack of standardization of how hearing loss is defined when using large data sets. Fewer data are available, however, on whether the use of hearing aids (HAs) mitigates, attenuates, or contributes to these costs. Given the lack of data, the increasing numbers of older adults who might benefit from the use of HAs and the current lack of health care coverage for hearing health care, Mahmoudi et al is exploring an important topic in this issue of JAMA Otolaryngology–Head and Neck Surgery. Elucidating the outcomes of HA use on health care costs could provide valuable data for those designing health care policy. The findings are interesting, yet raise a number of issues that could inform data interpretation as well as highlight additional research priorities.

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Proactive Swallowing Rehabilitation and Feeding Tube Placement in Pharyngeal Cancer Patients

This cohort study evaluates the initiation of a proactive speech and language pathology rehabilitation program and its association with rates of feeding tube placement and posttreatment oral intake in patients with head and neck squamous cell carcinoma.

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Increasing Age of Patients With Oropharyngeal Squamous Cell Carcinoma

This observational study evaluates the changes in age profile over time in patients with oropharyngeal squamous cell carcinoma.

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Association of Behavior With Noise-Induced Hearing Loss Among Attendees of an Outdoor Music Festival

This post hoc secondary analysis of a randomized clinical trial assesses which factors are associated with the occurrence of temporary noise-induced hearing loss among adult attendees of an outdoor music festival.

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Treatment of T3 Glottic Cancer

To the Editor We recently read the article "Survival Outcomes for Patients With T3N0M0 Squamous Cell Carcinoma of the Glottic Larynx" by Ko et al. We congratulate the authors; however, some potentially misleading details may be found in their article.

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Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss

This population-based cohort study of older adults with hearing loss evaluates the association of hearing aid use and health care use and cost.

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June 2018 Issue Highlights

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Response Time to Nurse Triage Phone Calls in a Tertiary Care Pediatric Otolaryngology Practice

This quality-improvement study analyzes a collaborative team approach to determine the optimal time for triage callback to families and attempts to define an optimal process that would allow more rapid response time for calls needed to escalate to the patient's managing surgeon.

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Human Papillomavirus in the Mouth and Throat

In this issue of JAMA Otolaryngology—Head & Neck Surgery, Li et al shows that human papillomavirus–positive squamous cell carcinoma (SCC) may be associated with improved overall survival not only in the oropharynx but also possibly in the upper aerodigestive tract subsites—oral cavity, larynx, and hypopharynx. This finding is persuasive given the large sample size used, which was obtained from the National Cancer Database (NCDB), and the multivariate analysis performed. Previous studies with smaller sample sizes have similarly suggested the favorable prognostic role of HPV in cancer in nonoropharyngeal head and neck sites, although other studies have refuted this possibility.

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Association of Obstructive Sleep Apnea With Calvarial and Skull Base Thinning

This cohort study examines the association of obstructive sleep apnea in adults with intracranial bone (calvaria and skull base) thickness.

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Auricular Swelling After Mild Trauma

A woman in her 50s presented with left auricular pain and malaise after treatment with a series of antibiotics had failed; pain and edema acutely worsened with new onset of drainage and crusting despite ciprofloxacin treatment. What is your diagnosis?

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Association of HPV Status at Head and Neck Carcinoma Subsites With Overall Survival

This cohort study examines the association of human papillomavirus (HPV) in head and neck carcinoma subsites with overall survival in patients with HPV-positive and HPV-negative status.

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Thyroidosis Mistaken for Thyroid Cancer

This is the report of a case of a woman in her 30s who underwent a left thyroid lobectomy and isthmusectomy for a thyroid nodule and presented 16 years later with a neck mass.

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Standardized Tracheostomy Care and Life-Threatening Respiratory Events

This cohort study examines the medical records of adults patients who had a tracheostomy placed before and after implementation of a standardized tracheostomy care protocol and assesses the occurrence of acute life-threatening respiratory events before and after protocol implementation.

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Measuring Nasal Obstruction Outcomes

Methods of measuring nasal obstruction outcomes include both objective anatomic and physiologic measurements, as well as subjective patient-reported measures. Anatomic measurements include acoustic rhinometry, imaging studies, and clinician-derived examination findings. Physiologic measures include rhinomanometry, nasal peak inspiratory flow, and computational fluid dynamics. Patient-reported outcome measures (PROMs) are self-reported assessments of disease-specific quality-of-life outcomes. Several studies attempted correlation of these outcome measures; however, few show strong correlation. Expert opinion favors determining successful surgical outcomes using PROMs. This review provides a summary of current nasal obstruction outcome measures.

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Surgical Management of Nonallergic Rhinitis

Nonallergic rhinitis (NAR) describes chronic symptoms of nasal congestion, obstruction, and rhinorrhea unrelated to a specific allergen based on skin or serum testing. Vasomotor rhinitis is the most frequent subtype of NAR. Although medical management is the first-line treatment of NAR, there is a role for surgical therapy when medications fail to improve symptoms. Surgical options for NAR include inferior turbinate reduction and botulinum toxin injection as well as more directed targeting of the autonomic nerve supply to the nasal cavity through vidian neurectomy, posterior nasal neurectomy, and cryoablation of the posterior nerve.

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Augmentation and eversion of lips without injections: the lip peel

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The Elite Facial Surgery Practice: Development and Management

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Normal vaginal delivery at term after expectant management of heterotopic caesarean scar pregnancy: a case report

Heterotopic pregnancy with a combination of a caesarean scar pregnancy and an intrauterine pregnancy is rare and has potentially life-threatening complications.

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Pronounced femur malunion after pathological bone fracture due to a simple bone cyst in the shaft of the femur, treated using Ilizarov fixation: a case report

Although a simple bone cyst carries the risk of pathological fractures, it rarely causes severe deformity. Here we report a case of severe femoral deformity after multiple pathological fractures due to simple ...

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Epinephrine auto-injector carriage and use practices among US children, adolescents, and adults

Daily management of allergies to food, medication, latex, and/or insect stings can adversely impact quality of life (QoL) 1,2 and impose considerable economic burden3 onto affected patients and their caregivers. Studies suggest that such allergies are remarkably common in the US,4,5 with food allergies (FA) in particular having substantially risen in prevalence over recent decades6 to affect an estimated 8% of children7 and 5% of adults.8 Clinically, there is substantial variation in how allergic reactions can present and reactions to the same food can vary in severity.

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Vertebral anomalies in craniofacial microsomia: a retrospective analysis of 991 patients

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A Decade's Experience: A Sound Framework as the Foundation to Nasal Reconstruction

The goal of nasal reconstruction surgery is to restore normal nasal shape and function, and its success begins with creating a stable framework. In this article the authors discuss the most advantageous materials for building such a framework and how to design this element to achieve better and more durable outcomes. This is a retrospective study including patients who underwent nasal reconstruction in our rhinoplasty and nasal reconstruction center at a tertiary referral hospital between 2006 and 2016. Data included patient characteristics, defect location, the reason for defect, use of supporting structure, flap, lining, and complications were recorded. The minimum postoperative follow-up was at least 6 months after the last operation. This study included 455 patients. Nasal defects treated most commonly involved zone 2 and an average defect of 4.2 subunits. Expanded forehead flap for cover with costal cartilage as a framework and turn-over flap combined with distal end of the flap for lining was the most common reconstruction method used in this study. The complication rate was 4.39% and nearly half of these complications were related to usage of an expander during reconstruction. Regardless of flap used, the supporting structure was the most critical element for the 3-dimensional shape of the reconstructed nose. As 1 of the 3 elements of nasal reconstruction, framework deserves adequate attention during such reconstruction. Address correspondence and reprint requests to Fei Fan, MD, Plastic Surgery Hospital, Chinese Academy of Medical Science, No 33, Badachu Road, Shijingshan, Beijing, China; E-mail: fanfei1962@gmail.com Received 7 March, 2018 Accepted 3 May, 2018 Accepted as scientific poster in The Aesthetic Meeting 2018, April 26 to May 1 in New York, NY. This study was funded by the following fund programs: Special Scientific Research on Health Development in Beijing (2016-2-4042), Graduate Innovation Fund of Peking Union Medical College (5201020104), The Foundation of the Chinese Academy of Medical Sciences-Plastic Surgery Hospital, Major Program (5201010414), and Young Scientists Program (5201010404). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Effect of Piezoelectric Technique on Auditory Function on Postoperative Day One in Septorhinoplasty Surgery

Aim: To examine the effect of the piezoelectric application used increasingly for osteotomy and correction of nasal dorsum in septorhinoplasty surgeries on early auditory functions. Methods: Our study was conducted after the decision of 10840098-604.01.01-E.9057 taken from Istanbul Medipol University Clinical Research Local Ethics Committee. This study was designed to be prospective, randomized and controlled. Twenty patients between 18 and 50 years of age that piezoelectric technique was used in the study group and 10 patients in the same age range who underwent nasal surgery (endoscopic sinus surgery, septoplasty, lower concha radiofrequency and nasal valve surgery) for any reason in the control group were included in the study. Audiologic functions of the patients in both the groups were assessed by pure audio audiometry, tympanometry and distortion product otoacoustic emission test before the surgery and 24 hours after the surgery. The data obtained were statistically compared using the SPSS 22.0 program and P  0.05) at 250, 500, 1000, 2000, 4000, 6000, and 8000 Hz. The results of distortion product otoacoustic emission results (signal/noise ratio) obtained postoperatively were not statistically significant (P > 0.05) with the results obtained preoperatively. Conclusion: The results of the study show that the piezoelectric technique used in septorhinoplasty does not cause a negative effect on auditory functions. This study is the first comparative study to investigate the effect of piezoelectric technique used in septorhinoplasty surgery on auditory functions. After further clinical studies performed with well-selected and large patient population, the piezoelectric techniques can be a preferred technique during septorhinoplasty operations. Address correspondence and reprint requests to Yusuf Muhammed Durna, MD, Luleburgaz State Hospital, ENT Clinic, Kasap Ilyas Mah Org Abdurrahman Nafiz Gurman Cad, Lüleburgaz, Kirklareli 39080, Turkey; E-mail: yusufmdkbb@gmail.com Received 10 October, 2017 Accepted 7 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Value of Visualization of the Intraparotid Facial Nerve and Parotid Duct Using a Micro Surface Coil and Three-Dimensional Reversed Fast Imaging With Steady-State Precession and Diffusion-Weighted Imaging Sequence

Objective: To explore the value of micro surface coil combined with three-dimensional reversed fast imaging with steady-state precession and diffusion-weighted imaging (3D-PSIF-DWI) in displaying intraparotid facial nerves and parotid ducts. Methods: In total 24 healthy volunteers with no parotid disease underwent scanning of head and neck coil and 4-cm micro surface coil combined with 3D-PSIF-DWI prospectively. The obtained original images were processed through maximum intensity projection, multiplanar reconstruction, and curved planar reconstruction. The magnetic resonance imaging (MRI) signal characteristics of intraparotid structure, the subjective score of image quality, the signal intensity ratio (SIR) of facial nerve/parotid tissues (SIRN), and SIR of parotid duct/parotid tissues (SIRD) were calculated, and the displaying rates of the facial nerves and parotid ducts were observed. The Wilcoxon matched-sample signed rank sum test was used to compare the scores of head and neck coil and micro surface coil 3D-PSIF-DWI sequence images; paired-t test was used to compare SIRN and SIRD of the 2 groups; χ2 test was used to compare the displaying rate of the facial nerves and parotid ducts in the 2 groups. Results: In total 24 volunteers successfully underwent MRI scan of parotid glands. On 3D-PSIF-DWI images, the parotid gland showed slightly low signal intensity, muscle tissues showed intermediate intensity, while the vessels showed slightly high or equal intensity; the parotid segment of facial nerves was displayed as a tortuous line-like high intensity, and the parotid duct showed curved high intensity, lymph nodes showed kidney-shaped, oval, or spindle-shaped high intensity. The subjective scores for head and neck coil and small coil images were (2.2 ± 0.7) and (1.5 ± 0.3) respectively, with significant difference (Z = −2.714, P = 0.007), and image quality of micro surface coils was better than that of head and neck coil. The SIRNs of head and neck coil and micro surface coil images were 1.6 ± 0.5 and 2.2 ± 1.1 respectively; the SIRDs were 2.0 ± 0.6 and 2.8 ± 1.4 respectively, which showed significant differences (t = 3.440, 3.639 respectively, P value was 0.001, 0.001 respectively). All facial nerve trunks could be displayed by head and neck coils and micro surface coils. On head and neck coil images, 46 sides of temporofacial division, 47 sides of cervicofacial division, 21 sides of temporal branches, 22 sides of zygomatic branches, 29 sides of buccal branches, 30 sides of marginal mandibular branches, 32 sides of cervical branches, and 28 sides of the parotid duct could be displayed. On micro coil images, 48 sides of temporofacial division, 48 sides of cervicofacial division, 37 sides of temporal branches, 39 sides of zygomatic branches, 42 sides of buccal branches, 35 sides of marginal mandibular branches, 46 sides of cervical branches, and 28 sides of the parotid duct could be displayed. The display number of first branches of the intraparotid facial nerve by these 2 methods had no significant difference, the number of the secondary branches and parotid duct had significant differences. Conclusion: Micro surface coil surpassed parotid MRI with 3D-PSIF-DWI sequence than neck coil, which can simultaneously clearly display the trunk and branches of the intraparotid facial nerves and parotid ducts. Address correspondence and reprint requests to Bin Yang, MS, Department of Radiology, the First Affiliated Hospital of Dali University, Dali 671000, China; E-mail: yangbinapple@163.com Received 7 August, 2017 Accepted 9 May, 2018 YZ and BY contributed equally to this work. This work was supported by Medical Imaging Department, the First Affiliated Hospital, Dali University, key subjects of medical imaging. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Intracranial Hypotension and Hypertension Associated With Reconstructive Cranioplasty After Decompressive Craniectomy: Report of a Lethal Complication With Recommended Strategies for Future Avoidance

Reconstructive cranioplasty can be associated with many complications and add to the not insignificant potential risks associated with decompressive craniectomy. In the setting of post-traumatic hydrocephalus, treatment with a ventriculoperitoneal (VP) shunt prior to reconstructive cranioplasty likely increases these risks even further. The authors report a case of a 17-year-old male with a history of a severe closed head injury who initially suffered a life-threatening complication associated with intracranial hypotension after cranioplasty only to succumb to malignant intracranial hypertension following a second cranioplasty attempt. To our knowledge, this is the first description of a single patient developing both these disparate complications after reconstructive cranioplasty and emphasizes the likely synergistic hazards involved with decompressive craniectomy in the setting of a VP shunt in particular and the overall myriad potential complications that may be associated with reconstructive cranioplasty in general. Address correspondence and reprint requests to Hal S. Meltzer, MD, FAANS, 7910 Frost Street, Suite 120, San Diego, CA 92123; E-mail: hsmeltzer@ucsd.edu Received 31 July, 2017 Accepted 10 May, 2018 Previously presented in part at: 39th Annual Meeting of the American Society of Pediatric Neurosurgeons, February 5, 2016, Aruba. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Closure of Oroantral Fistula With Buccal Fat Pad Flap and Endoscopic Drainage of the Maxillary Sinus

Oroantral fistula (OAF) is a pathologic communication between the oral cavity and the maxillary sinus. It is usually associated with maxillary sinusitis, where drainage of sinus infection is a mandatory step during closure of the fistula. The flap used for closure of OAF should be tension free, broadly based and well vascularized. The aim of this study was to assess the effectiveness of closure of OAF using buccal fat pad (BFP) flap with concomitant endoscopic middle meatal antrostomy for maxillary sinus drainage. Nineteen patients with chronic OAF were included in the study. Closure was performed using BFP with endoscopic middle meatal antrostomy. Preoperative and postoperative assessments were carried out. Patients were followed up for at least 1 year postoperatively. Complete closure of all OAFs was achieved with no recurrence or dehiscence. In conclusion, closure of OAF with BFP flap and concomitant endoscopic drainage of the maxillary sinus through the middle meatus is an effective, easy, and simple method. It has a high success rate with no effect on the vestibular depth or mouth opening. Address correspondence and reprint requests to Mosaad Abdel-Aziz, 2 El-Salam Street, King Faisal, Above El-Baraka Bank, Giza, Cairo, Egypt; E-mail: mosabeez@hotmail.com and mosabeez@yahoo.com Received 18 January, 2018 Accepted 10 May, 2018 The study was conducted as a multicenter study on the Departments of Otolaryngology of Cairo University, Beni Suef University, Fayoum University (Egypt) and Taibah University (Saudi Arabia). It was conducted in the period from March 2015 to November 2017. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Surgical-Based Classification for Microtia

The known classifications for microtia have been cumbersome and difficult to apply in daily consultation. The lack of a progressive surgical behavior according to each degree of affection also contributes to confusion and in a lower success rate in clinical application. The authors propose a progressive surgical classification that takes into consideration the principal anatomical defect and the corresponding correction with modern techniques, having eliminated from previous classifications, those elements that are now considered deformations of the ear, capable of conservative treatment in early stages of life. Address correspondence and reprint requests to Armando Apellaniz Campo, MD, Plastic and Reconstructive Surgery Division, Hospital General "Dr. Manuel Gea Gonzalez," Av. Calzada de Tlalpan 4800. Tlalpan, Sección XVI, 14080 Mexico City, Mexico; E-mail: dr.apellaniz@gmail.com Received 7 May, 2018 Accepted 26 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Custom-Made Ocular Prosthesis for Atrophic Anophthalmic Cavity

The ocular prosthesis is a modality of facial prosthesis that acts on the repair of loss or deformity of the ocular globe. Prosthetic rehabilitations destined to anophthalmic cavities that suffered cicatricial retraction represent a challenge during fabrication since they often need to be reduced due to atrophic of the cavity and simultaneously need to have a good esthetic appearance regarding the contour and artificial iris. This clinical report describes the ocular prosthetic rehabilitation of a 77-year-old man with anophthalmic atrophic cavity due to herpes zoster-induced loss. The treatment focused on comfort and adaptation during use, on satisfactory retention and esthetic appearance, and on care to achieve total eye closure while wearing the ocular prosthesis. This article shows an unusual prosthetic rehabilitation of atrophic anophthalmic cavity with 6 months of follow-up. Address correspondence and reprint requests to Amália Moreno, DDS, PhD, Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, CEP: 31.270-901, Pampulha, Belo Horizonte, MG, Brazil; E-mail: amalia_moreno@yahoo.com.br Received 7 May, 2018 Accepted 26 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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The U-Shaped Maxillary Osteotomy: A Novel Resource for the Treatment of the Middle Third Facial Hypoplasia

The purpose of orthognathic surgery procedures is to manipulate the elements of the facial skeleton to reestablish normal anatomy and function. These elements could be repositioned with the technique known as Le Fort I osteotomy. This technique can be modified to be adapted on each patient, depending on the anomaly presented and the planned objective. The versatility, offered by the modifications of the Le Fort I osteotomy, has taken us to design one that allows the capability to correct the malar region hypoplasia in the same surgical procedure. A total of 9 patients were included with malocclusion as indication for orthognathic surgery who also presented with malar hypoplasia diagnosed clinically and cephalometrically. A modified technique, the "U"-shaped maxillary osteotomy, was performed with excellent functional and aesthetics results, and none of the patients presented complications associated directly to the maxillary osteotomy. Some patients with maxillary zygomatic deficiency combined with malocclusion continue to present a special challenge to clinicians treating these deformities. This technique is useful in improving zygomatic projection in bloc with the Le Fort I advancement without the need to place a bone graft and the advantage of rigid fixation along with the one used in the Le Fort I osteotomy. The U-shaped maxillary osteotomy is a safe, trustworthy, and reproducible technique that allows the resolution of the maxillomalar hypoplasia in a single surgical time, providing satisfactory aesthetic results. Any surgeon with adequate training in orthognathic or craniofacial surgery could perform it and incorporate it to his technical armamentarium. Address correspondence and reprint requests to Héctor O. Malagón, MD, Hospital Angeles Lomas, Vialidad de la Barranca s/n, Consultorio 270, Huixquilucan, Mex 52763, Mexico; E-mail: hectormalagon@hotmail.com Received 29 December, 2017 Accepted 25 April, 2018 The authors report no conflicts of interest. Supplemental digital contents are 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 Web site (https://ift.tt/2iuFjMi). © 2018 by Mutaz B. Habal, MD.

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A Survey of In Situ Splitting Rib Harvesting Surgery for Orbital Deformity: Follow-Up

Background: Our previous study indicated that in situ splitting rib harvesting surgery clinically reduced in related complications compared with the traditional surgical approach in the early stage, but there are few studies pay close attention to long-term recovery of donor area after rib harvesting. In this study, the authors conducted a follow-up study on recovery condition of donor and graft site of patients after in situ rib splitting grafting or simple whole rib grafting surgery. Methods: Between 2013 and 2016, 8 Chinese patients with orbital deformity were corrected using autogenous rib, of which 3 patients received conventional rib harvesting surgery, 3 patients received in situ splitting harvesting surgery, and 2 patients underwent both. In all patients, 3-dimensional computed tomography study of donor site and graft site were performed before and after operation. The ribs of donor site and graft site volume measurement were assessed using computed tomography 7 days and 12 months postoperation. Results: After 12 months operation, the integrity of rib arch recovered 94.1 ± 2.2% after in situ splitting rib harvesting, compared with 41.4 ± 5.0% after whole rib harvesting. The volume of grafted rib in situ splitting rib harvesting group reduced 69.8 ± 10.0% after 12 months operation compared with the volume after 1 week operation, and the reduced volume of ribs in whole rib harvesting group was 73.62 ± 9.5%. Conclusion: Rib regeneration occurred more quickly by in situ rib splitting harvesting approach compared with the traditional surgical approach. Address correspondence and reprint requests to Yu-Guang Zhang, MD, PhD, and Lu Zhang, MD, PhD, Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai 200011, China; E-mail: zhangyg18@126.com; luzhangmd@163.com Received 21 October, 2017 Accepted 15 February, 2018 Xiao-Ming Sun and Ling-Xiao Ye contributed equally to this work. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2K6ElFB

Optimal Timing of Alveolar Cleft Bone Grafting for Maxillary Clefts in the Cleft Palate Population

Purpose: Timing of bone grafting for maxillary alveolar clefts is not standardized. Secondary bone grafting is often performed; however, consensus does not exist regarding use of chronologic versus dental age to guide treatment. Several authors suggest an early chronologic age is associated with greater success. Available literature was systematically reviewed for evidence for optimal timing for grafting maxillary alveolar clefts. Methods: PubMed, MEDLINE, and Cochrane Central Registrar of Controlled Trials databases were queried for manuscripts pertaining to maxillary alveolar cleft bone grafting. Inclusion criteria included manuscripts with level of evidence 4 or greater. Studies not using bone graft, lacking postoperative follow up, and clinical reports were excluded. Seventeen articles met criteria. Results: Nine manuscripts recommended grafting based on dental age prior to eruption of the permanent canines, while 8 recommended grafting between ages 7 to 12. The most commonly reported complication was wound dehiscence, followed by graft-site infection. Ten studies used perioperative treatment protocols, 8 of which included preoperative and/or postoperative orthodontia for maxillary expansion. Correlation between chronologic age and success was not significant, but trended towards greater success with increasing age. Conclusion: Success of secondary grafting is high, but significant variability exists in the timing of grafting. Evidence is lacking to support specific chronologic age; rather, perioperative protocols, systematic surgical technique, and a multidisciplinary discussion are likely more substantial in achieving success, and may be confounders in studies where an early age at grafting appears associated with success. The timing of bone grafting for maxillary alveolar clefts would benefit from a prospective randomized study. Address correspondence and reprint requests to Dhivya R. Srinivasa, MD, Department of General Surgery, Section of Plastic Surgery, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109; E-mail: srinivad@med.umich.edu Received 14 September, 2017 Accepted 22 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2K6qGeg

Acetyl-11-Keto-β-Boswellic Acid Promotes Osteoblast Differentiation by Inhibiting Tumor Necrosis Factor-α and Nuclear Factor-κB Activity

Tumor necrosis factor (TNF) -α plays a crucial role in rheumatoid arthritis (RA)-related bone loss disease. The main mechanism of action of RA induced bone loss is the significant inhibitory effect of TNF-α on osteoblast differentiation. TNF-α inhibits osteoblast differentiation mainly by activating nuclear factor (NF) -κB signaling pathway. Owing to the crucial role of TNF-α and NF-κB in the inhibition of osteoblast differentiation, they are considered as targets for the development of therapeutic drugs. In the present study, we evaluated the NF-κB inhibitor Boswellic acid (BA) and its derivatives in the regulation of osteoblast differentiation and the molecular mechanism. Based on the cell model of TNF-α induced inhibition of osteoblast differentiation of MC3T3-E1, the regulatory role of BAs was studied. The result of MTT assay indicated that bone morphogenetic protein (BMP) -2, TNF-α, or acetyl-11-keto-β-BA (AKBA) impact no significant effect for cell viability of MC3T3-E1. The results of alkaline phosphatase (ALP activity assay and real-time polymerase chain reaction indicated that AKBA blocked TNF-α-induced inhibition of the expression of osteoblast markers, suggesting that AKBA rescued osteoblast differentiation from TNF-α-induced inhibition. Additionally, AKBA stimulated the BMP-2-induced expression of osteoblast markers, suggesting that AKBA promotes osteoblast differentiation directly. The results of western blotting and luciferase assay indicated that N-κB signaling was activated by TNF-α. The overexpression of NF-κB component p65 in MC3T3-E1 was found to attenuate the positive effect of AKBA in osteoblast differentiation, suggesting that AKBA potentiates osteoblast differentiation by inhibiting NF-κB signaling. Collectively, AKBA promotes osteoblast differentiation by inhibiting TNF-α and NF-κB. Our study revealed a new discovery of AKBA in regulating osteoblast differentiation, and demonstrated that AKBA may be a potential anabolic agent in the treatment of RA-derived bone loss disease. Address correspondence and reprint requests to Prof. Hong-Guang Xu, PhD, Department of Orthopedic Surgery, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui 241001, China; E-mail: yijishanjizhuguke@126.com Received 20 December, 2017 Accepted 5 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Do fetuses need vasopressors just before their birth?

https://ift.tt/2IeZwjS

Destructive Thyroiditis Caused by Accidental Ingestion of a Press-Through-Package

Thyroid, Ahead of Print.


https://ift.tt/2IbyqtI

The influence of standardized dry ivy leaf extract on the proportion of nasal secretion after post-septoplasty nasal packing removal

Publication date: Available online 21 June 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Slobodan Savović, Milica Paut Kusturica, Vladimir Kljajić, Maja Buljčik Čupić, Ljiljana Jovančević, Vedrana Pavlović, Aleksandar Rašković
IntroductionAfter post-septoplasty nasal packing removal, a certain proportion of nasal secretion occurs, leading to local and sometimes systemic infections.ObjectiveThe aim was to determine if standardized dry ivy leaf extract application after nasal packing removal influences the reduction of nasal secretion and diminish the occurrence of local infections.MethodsThe study included 70 post-septoplasty patients (divided into two equal groups) whose nasal packing was removed on the third day after the procedure. Group I was treated with standardized dry ivy leaf extract syrup along with regular nasal irrigation for the five days after the nasal packing removal whereas the Group II had only nasal lavage. On the sixth day after nasal packing removal, the quantity of nasal secretion was determined using a visual analog scale and nasal endoscopic examination.ResultsThe group treated with standardized dry ivy leaf extract syrup had significantly lesser nasal secretion both by subjective patients' assessment (p<0.001) and by nasal endoscopic examination (p=0.003). The post-surgical follow up examination on the sixth day after nasal packing removal showed no development of local infection in the Group I, while in the Group II a local infection was evident in five patients (14.29%) and antibiotic therapy was required.ConclusionThe use of the standardized dry ivy leaf extract after nasal packing removal significantly lowers the proportion of nasal secretion.



https://ift.tt/2KaT6nH

Questionnaires and checklists for central auditory processing screening used in Brazil: a systematic review

Publication date: Available online 21 June 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Francielli Loss Volpatto, Inaê Costa Rechia, Alexandre Hundertmarck Lessa, Cristina Loureiro Chaves Soldera, Maria Inês Dornelles da Costa Ferreira, Márcia Salgado Machado
IntroductionThe action of listening involves a complex interaction between the peripheral and central auditory systems. Central auditory processing disorder can be described as any problem in one or more auditory abilities. Literature reports that behavioral questionnaires and checklists can be applied to screen individuals at risk for central auditory processing disorder.ObjectiveTo identify and analyze in the national literature questionnaires and checklists for the screening of central auditory processing available in Brazil for the Portuguese language.MethodsThe research was carried out in electronic databases and "gray literature". The search strategy was: "questionnaires OR surveys and questionnaires AND auditory OR hearing tests OR auditory perception AND Brazil". The research was carried out between June and August of 2017. Study selection followed inclusion and exclusion criteria. The criteria adopted included Brazilian studies, without date and design restriction, that were carried out, translated, adapted and/or validated to Brazilian Portuguese or European Portuguese, as tools for central auditory processing screening. International studies that were not adapted to the Portuguese language were excluded, as well as the ones that were not available in full.ResultsA total of 3664 publications were found and seven articles were selected for this systematic review, according to the established criteria.ConclusionsThere is scarce national literature for central auditory processing screening and the only tool validated to Brazilian Portuguese, published as a monograph, is the auditory processing domains questionnaire. It is suggested that new studies with greater methodological stringency related to the processes of tool adaptation and validation be developed and published in the usual scientific databases, aiming at greater diffusion and clinical applicability.



https://ift.tt/2KbqGwR

Different clinical presentation of intralabyrinthine schwannomas – a systematic review

Publication date: Available online 21 June 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Thaís Gomes Abrahão Elias, Adriana Perez Neto, Ana Tereza Silveira Zica, Marcos Luiz Antunes, Norma de Oliveira Penido
IntroductionIntralabyrinthine schwannoma is a rare, benign tumor that affects the most terminal portions of the vestibular and cochlear nerves. This tumor can be classified into 10 subtypes, according to its inner ear location.ObjectiveTo carry out a comprehensive review of the most frequent auditory manifestations secondary to the intralabyrinthine schwannoma, describing the possible underlying pathophysiological mechanisms.MethodsSystematic review of the literature until October 2017 using the PubMed, Web of Science and Scopus databases. The inclusion criteria were clinical manifestations of the intralabyrinthine schwannoma. Three researchers independently assessed the articles and extracted relevant information. The description of a case of an intravestibular subtype intralabyrinthine schwannoma with multiple forms of clinical presentations was used as an example.ResultsTwenty-seven studies met our inclusion criteria. The most common intralabyrinthine schwannoma subtype was the intracochlear, followed by the intravestibular type. All the cases demonstrated hearing loss, usually progressive hearing loss.ConclusionThe diagnosis of intralabyrinthine schwannomas is based on high-resolution magnetic resonance imaging and should be included in the differential diagnosis of patients with vestibulocochlear complaints. Although there are approximately 600 cases in the literature, we still lack a detailed description of the clinical evolution of the patients, correlating it with MRI findings of temporal bones and tumor subtype.



https://ift.tt/2Ibgq2H

Analysis of the relation among tinnitus handicap inventory, tinnitometry, and the analogical visual scale in the evaluation of tinnitus

Publication date: Available online 21 June 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Islan da Penha Nascimento, Anna Alice Figueirêdo de Almeida, José Diniz, Mariana Lopes Martins, Thaís Mendonça Maia Wanderley Cruz de Freitas, Marine Raquel Diniz da Rosa
IntroductionTinnitus is a subjective auditory symptom usually associated with a sound, even in the absence of external sound sources. It has complex diagnosis, with one of the forms of measurement being the use, alone or in combination, of self-assessment questionnaires, such as the tinnitus handicap inventory, the visual analog scale and/or tinnitometry.ObjectiveTo analyze the correlation among three tinnitus measurement methods: tinnitus handicap inventory, visual analog scale and tinnitometry.MethodsThe study consisted of 148 patients complaining of chronic tinnitus. An otorhinolaryngological evaluation, anamnesis directed to tinnitus, audiometry (pure tone and speech), imitanciometry, tinnitus handicap inventory, visual analog scale, and tinnitometry were performed. The study was registered in the Ethics Committee of the Institution with no. 0129/12.ResultsRegarding the frequency of tinnitus handicap inventory responses, a higher occurrence of the mild degree was observed. An average of 6 points was observed on the visual analog scale. The mean sensation of loudness measured in the tinnitometry in the right ear was 20dBNS, and in the left ear was 17dBNS. As for the type of stimulus, the most found was continuous pure tone. The frequency of the pitch sensation was 6000Hz in the largest number of cases. Regarding the measures of tinnitus handicap inventory and the visual analogical scale, a significant correlation was observed, and as one value increases the other also increases. Tinnitometry and the visual analogical scale results are also significant.ConclusionThere was a significant correlation between the values measured by the tinnitus handicap inventory, visual analogical scale (annoyance) and tinnitometry (loudness) in the evaluation of tinnitus. The selection of any one of the three evaluative methods for tinnitus investigation provides different dimensions of the tinnitus and complements the others.



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Demand for Medical Specialists Increasing in US

Demand for primary care physicians remains strong, but organizations are increasingly looking for medical specialists, a new Merritt Hawkins report finds.
Medscape Medical News

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Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial

Publication date: Available online 20 June 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): T.F. Putters, D.E. Wortmann, J. Schortinghuis, B. van Minnen, G.C. Boven, A. Vissink, G.M. Raghoebar
Autogenous bone graft harvesting is still commonly considered the gold standard for the reconstruction of a severely resorbed maxillary alveolar ridge; however, the preferred donor site remains a subject of debate. This study compared the morbidity of calvarial and iliac crest donor sites after harvesting. Twenty edentulous patients with an insufficient volume of maxillary bone for reliable implant placement were assigned randomly to either calvarial (n=10) or anterior iliac crest (n=10) bone harvesting groups. All patients underwent a maxillary sinus floor elevation procedure combined with widening of the alveolar process using buccal bone blocks. Donor site morbidity was assessed before, during, and at 1year after the surgery through patient questionnaires, physical examination, and medical records. No perioperative complications occurred. The anterior iliac crest group reported minor postoperative pain after harvesting. The scars after calvaria harvesting were significantly longer (P=0.003), but this was not bothersome for the group of patients. Long-term pain was negligible and satisfaction was high in both groups. Both the calvaria and anterior iliac crest are associated with low long-term donor site morbidity and high patient satisfaction. Thus, patient-centred decision-making is appropriate when selecting the preferred harvesting method for that patient.



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Staphylococcus aureus impairs sinonasal epithelial repair: effects in CRSwNP and control subjects

Publication date: Available online 20 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Fabiana CP. Valera, Manon Ruffin, Damien Adam, Émilie Maillé, Badr Ibrahim, Julie Berube, Simon Rousseau, Emmanuelle Brochiero, Martin Y. Desrosiers
BackgroundThe impact of Staphylococcus aureus (SA) on nasal epithelial repair has never been assessed in chronic rhinosinusitis with nasal polyps (CRSwNP).ObjectiveThis study aimed to determine whether: i) nasal epithelial cell cultures from patients with CRSwNP and control subjects repair differently; ii) SA exoproducts compromise nasal epithelial repair; iii) SA alters lamellipodial dynamics; and iv) deleterious effects could be counteracted by the ROCK inhibitor Y-27632.MethodsPrimary nasal epithelial cells (pNECs), collected during surgeries, were cultured and injured under three conditions: i) basal, ii) exposed to SA exoproducts, and iii) exposed to SA exoproducts and Y-27632. Epithelial repair, lamellipodial dynamics and cytoskeletal organization were assessed.ResultsUnder basal condition, pNECs cultures from CRSwNP presented significantly lower repair rates, and reduced lamellipodial protrusion length and velocity than controls. SA exoproducts significantly decreased repair rates and protrusion dynamics in both controls and CRSwNP, however, the effect of SA on cell protrusions was more sustained over time in CRSwNP. Under basal conditions, immunofluorescence assays showed significantly reduced percentage of cells with lamellipodia at the wound edge in CRSwNP as compared to controls. SA altered cell polarity and decreased the percentage of cells with lamellipodia in both groups. Finally, Y-27632 prevented the deleterious effects of SA exoproducts on CRSwNP repair rates as well as on lamellipodial dynamics and formation.ConclusionsSA exoproducts significantly alter epithelial repair and lamellipodial dynamics on pNECs, this impairment was more pronounced in CRSwNP. Importantly, Y-27632 restored epithelial repair and lamellipodial dynamics in the presence of SA exoproducts.Clinical ImplicationsSinonasal epithelia from CRSwNP exhibit a defect in wound healing compared to controls, which is worsened by exposure to S. aureus. This phenomenon may be prevented by ROCK targeted therapies.

Graphical abstract

Teaser

Cells from CRSwNP show a slower repair pattern than controls, both under baseline conditions and following exposure to S. aureus exoproducts. The ROCK inhibitor Y-27632 significantly improves epithelial repair in CRSwNP cells, preventing the deleterious effect of S. aureus.


https://ift.tt/2lmRQmk

CVID patients with autoimmune cytopenias exhibit hyperplastic yet inefficient germinal center responses

Publication date: Available online 20 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Neil Romberg, Carole Le Coz, Salomé Glauzy, Jean-Nicolas Schickel, Melissa Trofa, Brian E. Nolan, Michele Paessler, Mina LuQing Xu, Michele Lambert, Saquib A. Lakhani, Mustafa K. Khokha, Soma Jyonouchi, Jennifer Heimall, Patricia Takach, Paul J. Maglione, Jason Catanzaro, F. Ida Hsu, Kathleen E. Sullivan, Charlotte Cunningham-Rundles, Eric Meffre
BackgroundThe lack of pathogen-protective, isotype-switched antibodies in common variable immunodeficiency (CVID) suggests germinal center hypoplasia, yet a subset of CVID patients is paradoxically affected by autoantibody-mediated autoimmune cytopenias (AICs) and lymphadenopathy.ObjectiveWe sought to compare the physical characteristics and immunological output of germinal center responses in CVID patients with AICs (CVID+AIC) and without AICs (CVID-AICs).MethodsWe analyzed germinal center size and shape in excisional lymph node biopsies from 14 CVID+AIC and 4 CVID-AIC patients. Using paired peripheral blood samples, we determined how AICs specifically impacted B and T cell compartments and antibody responses in CVID patients.ResultsWe found that CVID+AIC patients displayed irregularly-shaped, hyperplastic germinal centers (GCs), whereas GCs were scarce and small in CVID-AIC patients. GC hyperplasia was also evidenced by an increase in circulating T follicular helper cells, which correlated with decreased regulatory T cell frequencies and function. In addition, CVID+AIC patients showed serum endotoxemia associated with a dearth of isotype-switched memory B cells that displayed significantly lower somatic hypermutation frequencies than CVID-AIC counterparts. Moreover, IgG⁺ B cells from CVID+AIC patients expressed VH4-34 antibodies with unmutated AVY and NHS motifs which recognize both erythrocyte I/i self-antigens and commensal bacteria.ConclusionsCVID patients with autoimmune cytopenias fail to contain mucosal microbiota and exhibit hyperplastic yet inefficient germinal center responses that favor the production of untolerized IgG+ B cell clones that recognize both commensal bacteria and hematopoietic I/i self-antigens.

Teaser

Common variable immunodeficiency patients with autoimmune cytopenias exhibit hyperplastic germinal center reactions that fail to generate isotype-switched, somatically-mutated, immune-protective antibodies and instead produce poorly mutated, non-tolerized antibodies that recognize commensal bacteria and hematopoietic self-antigens.


https://ift.tt/2yCc0T8

G-quadruplex DNA targeting alters class switch recombination in B cells and attenuates allergic inflammation

Publication date: Available online 20 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Zeinab Dalloul, Pauline Chenuet, Iman Dalloul, François Boyer, Jean-Claude Aldigier, Brice Laffleur, Yolla El Makhour, Bernhard Ryffel, Valerie FJ. Quesniaux, Dieudonnée Togbé, Jean-Louis Mergny, Jeanne Cook-Moreau, Michel Cogné

Teaser

Targeting immunoglobulin switch regions with a G4-DNA binding drug offers a novel immunomodulatory strategy reducing class-switched antibody secretion.


https://ift.tt/2lmRMmA

T cell-intrinsic prostaglandin E2-EP2/EP4 signaling is critical in pathogenic Th17 cell-driven inflammation

Publication date: Available online 20 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Jinju Lee, Tomohiro Aoki, Dean Thumkeo, Ratklao Siriwach, Chengcan Yao, Shuh Narumiya
BackgroundInterleukin-23 (IL-23) is the key cytokine for generation of pathogenic IL-17-producing helper T (Th17) cells that critically contribute to autoimmune diseases. However, how IL-23 generates pathogenic Th17 cells remains to be elucidated.ObjectivesTo examine the involvement, molecular mechanisms and clinical implications of prostaglandin (PG) E2-EP2/EP4 signaling in induction of IL-23-driven pathogenic Th17 cells.MethodsThe role of PGE2 in induction of pathogenic Th17 cells was investigated in mouse Th17 cells in culture in vitro and in IL-23-induced psoriasis mouse model in vivo. Clinical relevance of findings in mice was examined by gene expression profiling of IL-23 and PGE2-EP2/EP4 signaling in psoriatic skin from patients.ResultsIL-23 induces ptgs2 encoding cyclooxygenase 2 in Th17 cells and produces PGE2, which acts back on PGE receptors EP2 and EP4 in these cells and enhances IL-23-induced expression of an IL-23 receptor subunit gene, Il23r, by activating STAT3, CREB1 and NF-κB through cAMP-protein kinase A signaling. This PGE2 signaling also induces expression of various inflammation-related genes, which possibly function in Th17 cell-mediated pathology. Combined deletion of EP2 and EP4 selectively in T cells suppressed accumulation of IL-17A⁺ and IL-17A⁺IFN-γ⁺ pathogenic Th17 cells and abolished skin inflammation in IL-23-induced psoriasis mouse model. Analysis of human psoriatic skin biopsies shows positive correlation between PGE2 signaling and the IL-23/Th17 pathway.ConclusionsThe T cell-intrinsic EP2/EP4 signaling is critical in IL-23-driven generation of pathogenic Th17 cells and consequent pathogenesis in the skin.

Graphical abstract

Teaser

IL-23 mobilizes T cell-intrinsic PGE2-EP2/EP4 signaling, which is critical in IL-23-induced pathogenic Th17 cell generation. Combined blockade of EP2 and EP4 suppressed IL-23-induced skin inflammation, suggesting this pathway as potential therapeutic target of Th17-mediated diseases.


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Tacrolimus ointment for the treatment of adult and pediatric atopic dermatitis: Review on safety and benefits

The Journal of Dermatology, EarlyView.


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Consensus-Based Attributes for Identifying Patients With Spasmodic Dysphonia and Other Voice Disorders

This study examines interrater agreement among clinicians who did not use standard guidelines to classify patients with adductor spasmodic dysphonia, abductor spasmodic dysphonia, voice tremor, and muscular tension dysphonia and develops expert consensus attributes for classifying patients for research.

https://ift.tt/2MK1mN2

Classifying and Diagnosing Laryngeal Dystonia

Laryngology is a relatively young subspecialty in otolaryngology. Although some practitioners focused on or limited their practices to laryngology in the late 1980s and early 1990s, the subspecialty began its more formal development near the turn of the century when laryngology programs began to produce the first fellowship-trained laryngologists, initially at about the rate of 10 per year.

https://ift.tt/2ts60pR

Spontaneous Recovery Rates in Patients With Idiopathic Sudden Sensorineural Hearing Loss

This Viewpoint discusses the literature surrounding the assessment of spontaneous complete recovery rates in patients with idiopathic sudden sensorineural hearing loss to help physicians better understand when treatment is warranted.

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Vertigo as a Prognostic Indicator of Outcome in Sudden Sensorineural Hearing Loss

In this issue of JAMA Otolaryngology–Head & Neck Surgery, Yu et al report results of their meta-analysis of sudden sensorineural hearing loss (SSHL) literature, addressing the association of vertigo with the hearing outcome. They screened 685 articles, of which 10 met inclusion criteria, including 4814 patients with SSHL, of whom 1709 (35.5%) had vertigo and 3105 (64.5%) did not. Overall, the rate of hearing recovery was 42.13% in the vertigo group and 60.29% in the nonvertigo group, suggesting that vertigo is negatively associated with the hearing outcome in SSHL. Subgroup analysis by treatment modality (systemic corticosteroid alone vs systemic corticosteroid and/or intratympanic corticosteroid) found that the difference in hearing outcome as a function of vertigo was present only in the systemic corticosteroid treatment subgroup; no difference in rates of hearing recovery were found between vertigo and nonvertigo groups in patients treated with intratympanic corticosteroids. The authors do not report the recovery rates of each subgroup. They conclude that use of intratympanic treatment might be preferable in patients with SSHL who present with vertigo, but methodologic limitations of the study preclude drawing a strong conclusion.

https://ift.tt/2tsjDFJ

Unilateral Otorrhea and Mastoid Erosion

A diabetic man in his 80s had a 4-month history of persistent otorrhea in the right ear and pain overlying the mastoid; a culture 3 months prior was positive for Pseudomonas, and he had been treated with ciprofloxacin-dexamethason ear drops. What is your diagnosis?

https://ift.tt/2MKdYDP

Association of Vertigo With Hearing Outcomes in Sudden Sensorineural Hearing Loss

This systematic review and meta-analysis investigates the association of vertigo with prognosis of hearing variables in patients with sudden sensorineural hearing loss with and without vertigo.

https://ift.tt/2yBW1V8

Rhabdomyolysis: An Unusual Presentation of Mycoplasma pneumoniae Infection in an Adult—A Case Report and Literature Review

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia, and many extrapulmonary manifestations have been described, but rhabdomyolysis is infrequently reported in adults. Of the few cases that have been reported in adults, it was almost exclusively seen when pneumonia was present. We report a case of a 30-year-old male who came in with complaints of fever and myalgia for three days. Immunoglobulin M antibodies for Mycoplasma pneumoniae were positive and trending up, despite having no radiographic evidence of pneumonia on chest X-ray or CT scan. He was treated successfully with levofloxacin and intravenous hydration. Later, his condition was clinically and biochemically improved, and he was discharged. Our patient did not present with typical respiratory tract symptoms of a mycoplasma infection. In addition, there was an absence of pneumonia on imaging, suggesting that rhabdomyolysis secondary to mycoplasma might be underdiagnosed and go untreated in the setting of low clinical suspicion. Upon review of the literature, there is only one other case of mycoplasma infection where rhabdomyolysis occurred in the absence of pneumonia. However, the degree of rhabdomyolysis in our case was much more severe. Although rare, when faced with rhabdomyolysis, Mycoplasma pneumoniae should be kept as a differential diagnosis even in the absence of pneumonia on radiological imaging.

https://ift.tt/2KeZy0d

Surgical re‐excision vs. observation for histologically dysplastic naevi: a systematic review of associated clinical outcomes

British Journal of Dermatology, EarlyView.


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A case of antiepiligrin cicatricial pemphigoid with extensive cutaneous erosions mimicking pemphigus vulgaris

Cicatricial pemphigoid (CP) is a chronic, autoimmune, subepidermal blistering disease with predominant mucosal involvement. In this article, we report a young patient with mucosal and extensive cutaneous involvement in the form of large erosions mimicking those of pemphigus vulgaris thus leading to diagnostic dilemma. We were unable to find any other previous reports with such extensive cutaneous erosions mimicking those of pemphigus vulgaris. Laminin 5 was the antigen found on knockout substrate testing. Antiepiligrin CP is a distinct subtype of CP with antibodies against laminin 5. This subtype is mostly associated with malignancy but no underlying malignancy was found in our case. Present report also highlights the importance of knockout substrate testing when immunoblot is not available.

https://ift.tt/2JXMFIs

Usual suspects: the foreign bodies of the aerodigestive tract

This case series is about four different foreign bodies lodged in different locations of the aerodigestive tract. All four cases had delayed diagnosis due to inconspicuous history. Radiology in the form of computed tomography aided the appropriate diagnosis in most of these cases. Though all four patients have been successfully managed by removal of foreign body, not all of them have identical outcomes. A brief discussion about predictive factors in the fish bone foreign body has been included. The authors also discuss certain critical aspects of the management, which may aid in reducing the morbidity. We emphasise on the high index of suspicion in peculiar cases and on the low threshold for radiological investigation in doubtful clinical scenarios.

https://ift.tt/2MbVyLa

Numb chin syndrome as a presenting symptom of diffuse large B-cell lymphoma with secondary myelofibrosis

Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin's lymphoma that classically presents with rapidly enlarging lymph nodes. We present a 59-year-old man with unusual clinical presentation of numb chin syndrome (NCS) as the first symptom of disease. On evaluation, he was found to have diffuse extranodal skeletal involvement in the form of lytic-sclerotic lesions and minimal lymphadenopathy. Bone marrow biopsy revealed a poorly differentiated tumour with infarction and extensive myelofibrosis. This was subsequently proven to be DLBCL of germinal centre type on immunohistochemical stain. NCS should alarm the clinician to investigate for an advanced underlying malignancy. Extensive myelofibrosis, though described in carcinomas and low grade lymphomas, may also be seen in high grade DLBCL.

https://ift.tt/2JSK8PA

Acute renal artery embolisation: role of local catheter-based intra-arterial thrombolysis

A 45-year-old man without previous comorbidity presented to us with acute onset right-sided flank pain for last 14 hours. His general physical and systemic examination was unremarkable, and there were no clinical signs of peritonitis. The ultrasonography did not reveal any evidence of nephrolithiasis or hydronephrosis. His contrast-enhanced CT scan revealed hypoattenuated areas of right kidney and evidence of right renal artery thrombosis. He was immediately shifted to cardiac catheterisation lab, and his renal angiography showed thrombotic occlusion of right renal artery. The bolus dose of streptokinase (250 000 IU) was given locally in renal artery by right judkins catheter followed by systemic infusion of streptokinase (100 000 IU/hour) for 24 hours. After that he was started on low molecular weight heparin. Repeat renal angiography done after 5 days showed completely normal right renal artery. His cardiac and thrombophilia work up was negative, and he was discharged on antiplatelets, oral anticoagulants and statins.

https://ift.tt/2IcbwCx

An unusual case of leptomeningeal carcinomatosis in a patient with primary adenocarcinoma of the lung

A 72-year-old man was brought to the emergency department with acute onset confusion and haemoptysis. Chest X-ray showed a possible lung mass, while CT head showed a fluid-filled, space-occupying lesion (SOL) in the right frontal lobe of the brain. MRI head indicated that this SOL had spilt its contents into the subarachnoid and intraventricular spaces. Due to a fluctuating Glasgow Coma Scale (GCS), the patient underwent emergency debulking. Macroscopically, a frail-walled cystic tumour filled with straw-coloured fluid was noted; histology confirmed metastasis from a primary lung adenocarcinoma. Whole brain radiotherapy was given, with a view to commence systemic therapy. The patient, however, deteriorated and unfortunately passed away a few weeks after completing radiotherapy. This patient presented with leptomeningeal metastasis as the first presentation of a lung adenocarcinoma, and had a highly unusual mechanism by which leptomeningeal spread had occurred, with metastatic brain tumour spilling its contents into the meningeal spaces.

https://ift.tt/2JYL6Kc

Necrotising fasciitis as a complication of primary varicella infection in an immunocompetent child

Necrotising fasciitis (NF) is an infrequent yet significant complication of primary varicella infection in immunocompetent children. We report a case of a 4-year-old girl who presented three days into her chicken pox illness, with a rapidly progressing, severely tender erythematous rash surrounding one chicken pox lesion on her thigh. She required intravenous antibiotics, two surgical debridements, a skin graft and a prolonged stay in the paediatric intensive care unit, but ultimately we were able to save her life and limb. NF is a rare complication of chicken pox that has high morbidity and mortality that requires prompt and specific treatment.

https://ift.tt/2IedpPi

Heart transplant recipient with mycophenolate mofetil-induced colitis: the great imitator

In this article, we report a case of a 55-year-old male heart transplant recipient who presented with diarrhoea. An extensive workup for infectious diseases was negative. The patient had a colonoscopy with biopsies showing colitis that mimicked graft-versus-host disease on histopathology. After excluding other potential causes and excluding acute cellular rejection, mycophenolate mofetil was discontinued, and the patient had significant clinical improvement with increased appetite and weight gain.

https://ift.tt/2JXZzWG

Abscess originating from osteomyelitis as a cause of lower urinary tract symptoms (LUTS) and acute urinary retention

Lower urinary tract symptoms (LUTS) are a common complaint in the general population with great impact on the quality of life. Besides the classical pathologies, there are less common causes that must be considered in the treatment approach for patients with LUTS. We present the case of a 30-year-old patient with multiple emergency department episodes with dysuria, urinary frequency, suprapubic pain and an episode of acute urinary retention. The blood and urine tests only revealed increased systemic inflammatory parameters. The ultrasound examination showed thickening of the bladder wall, and the CT scan revealed a retropubic abscess originating from a pubic symphysis osteomyelitis. A percutaneous drainage was performed and, after empirical antibiotic therapy, there was complete resolution of the clinical picture.

https://ift.tt/2I9XYqY

Unilateral pulmonary vein atresia: diagnostic dilemma unfolded on imaging

Unilateral pulmonary vein atresia is a rare entity, usually congenital in origin. It is thought to result from failure of incorporation of common pulmonary vein to left atrium. Patients often present with recurrent chest infections and haemoptysis during infancy or early childhood. Associated anomalies are commonly present in these cases. Pulmonary angiography is generally used for definitive diagnosis; however, characteristic imaging findings on latest multislice CT can be virtually diagnostic.

https://ift.tt/2thl76n

Influenza B-related meningoencephalitis in adults

We present a case involving an 85-year-old man with acute confusion and new onset seizure following a 1-week history of respiratory prodrome. This case report describes a case of influenza B-related meningoencephalitis supported by evidence of an influenza B infection and temporal relation of the neurological event and respiratory illness in the absence of other identifiable cause. Diagnosis is guided by cerebrospinal fluid profile and nasopharyngeal PCR. Treatment is largely supportive and the effect of vaccination on prevention of this neurological complication remains unclear.

https://ift.tt/2IcbdYp

Accidental aspiration of a solid tablet of sodium hydroxide

Sodium hydroxide is a corrosive, highly alkaline (PKa=14.8) household product. Ingestion of sodium hydroxide liquid is common, showing toxicity on the oesophagus and stomach. Nevertheless, cases of sodium hydroxide ingestions in pellet are rare and the management of them is unknown. We report the case of a 65-year-old man who accidentally swallowed a bleach tablet of 3.5 g. Six hours later, the patient developed an aphonia associated with dysponea stage IV, motivating a nasofibroscopy showing glottis and supraglottic necrosis and oedema for which the patient received intravenous steroids, was intubated and then underwent a tracheotomy. After 2 weeks under tracheotomy, local evolution was favourable allowing a removal of the cannula and a return back home.

https://ift.tt/2tdVe7k

Paraneoplastic cerebellar degeneration with bilateral facial palsy: a rare primary presentation of breast cancer

Paraneoplastic cerebellar degeneration is a rare dysfunction of the cerebellum associated with malignancy. Nevertheless, it is the most common paraneoplastic syndrome affecting the brain. A 50-year-old woman presented to the neurology outpatient department (OPD) with symptoms of cerebellar dysfunction since 4 months and complaints of a painless lump in the right breast and drooling from mouth since 1 month. Examination revealed classical signs of cerebellar dysfunction and a 5x5 cm lump in the right breast with a single right axillary lymph node. Serum anti-Yo antibody titre was strongly positive. The patient was referred to General Surgery OPD for opinion. After establishing the diagnosis of right breast carcinoma; she underwent a right modified radical mastectomy. She was referred to the oncologist for chemo/radiotherapy but because of poor performance status, only symptomatic treatment was pursued. Follow-up till now shows no improvement in the neurological dysfunction.

https://ift.tt/2MaZYSt

Oncocytoma of the adrenal gland in Birt-Hogg-Dube syndrome

A 32-year-old man was referred to our surgical unit with a left adrenal lesion. He was previously diagnosed with Birt-Hogg-Dube syndrome after presenting with a left pneumothorax and an incidental finding of a right apical lung mass. This syndrome is characterised commonly by benign skin hamartomas, recurrent pneumothoraces and an increased risk of renal tumours. He was unable to tolerate a biopsy of his lung lesion, however, this lung lesion was thought to be benign. Given the size of his adrenal lesion and radiological appearances, we performed a laparoscopic left adrenalectomy. Pathology confirmed that based on morphological appearances and immunohistochemical staining, this may represent an oncocytic tumour of the adrenal gland. This is only the third published case of an oncocytic tumour of the adrenal gland in a patient with Birt-Hogg-Dube syndrome.

https://ift.tt/2tgplv8

Wellens syndrome: a close call

We describe a case of a middle-aged man who presented to the emergency department with typical anginal chest pains and found to have new, deeply inverted T-waves on ECG consistent with Wellens' syndrome. Similar to the description by Wellens et al, a critical 99% stenosis of the proximal left anterior descending artery was indeed confirmed by coronary angiography and successfully treated with drug-eluting stent. It is very important that physicians recognise this ECG finding as a harbinger of a serious cardiovascular condition and the necessity for an early invasive cardiac catheterisation.

https://ift.tt/2IerZGe

Apprehension in patients mind: leading to myiasis

Description

A 65-year-old man had a history of acute urinary retention for which suprapubic catheterisation (SPC) was performed, following failed attempts at per urethral catheterisation by a local practitioner 3 months previously. He also had a history of hesitancy and intermittency for the past 1 year. He now presented with maggots discharging from the SPC site (figures 1 and 2). On taking a detailed history, he mentioned lack of local hygiene due to fear of dislodgement of SPC. There was no history of diabetes mellitus, surgical intervention or immune-compromised status.

Figure 1

Clinical photograph of the patient showing the suprapubic catheterisation site wound with maggots inside it.

Figure 2

Clinical photograph showing closer view of the suprapubic catheterisation site wound with maggots.

Per urethral catheterisation was attempted over a guide wire that was successful. Then his SPC was removed...

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Femoral nerve paralysis complicating a post-traumatic iliopsoas haematoma

Paralysis of the femoral nerve secondary to iliopsoas haematoma is a rare post-traumatic complication. Because of the large differential diagnosis, a high level of suspicion is required for its early recognition. Treatment modalities are controversial due to the rarity of this entity. An 18-year-old student presented with complete paralysis of the knee extensors and a sensory deficit on the anterior side of the thigh 5 weeks after a sport accident. MRI of the lesser pelvis showed an iliopsoas haematoma. Surgical decompression was performed and recovery was complete at 6 months of follow-up.

https://ift.tt/2IaiI23

A Study of ASP1948, Targeting an Immune Modulatory Receptor, in Subjects With Advanced Solid Tumors

Condition:   Advanced Solid Tumors
Intervention:   Drug: ASP1948
Sponsors:   Astellas Pharma Global Development, Inc.;   Potenza Therapeutics
Not yet recruiting

https://ift.tt/2MFojAZ

A First-in-Human,Dose Escalation,Open-Label Study of JAB-3068 in Adult Patients With Advanced Solid Tumors in China

Conditions:   Non-small Cell Lung Cancer;   Head and Neck Cancer;   Esophageal Cancer;   Other Metastatic Solid Tumors
Intervention:   Drug: JAB-3068
Sponsor:   Jacobio Pharmaceuticals Co., Ltd.
Not yet recruiting

https://ift.tt/2tp42XB

Nexavar for Neoadjuvant Treatment of Anaplastic Thyroid Cancer

Condition:   Thyroid Cancer, Anaplastic
Interventions:   Drug: Nexavar;   Procedure: operation;   Radiation: External radiation therapy
Sponsor:   Fujian Medical University
Recruiting

https://ift.tt/2MLsOKo

Study of REGN2810 Prior to Surgery in Patients With Advanced-Stage, Resectable Cutaneous Squamous Cell Carcinoma of the Head and Neck

Condition:   Melanoma and Other Malignant Neoplasms of Skin
Intervention:   Drug: REGN2810
Sponsors:   M.D. Anderson Cancer Center;   Regeneron Pharmaceuticals
Not yet recruiting

https://ift.tt/2trFsoW

Happiness among second year MBBS students and its correlates using Oxford Happiness Questionnaire

Publication date: Available online 20 June 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Shivam Kamthan, Saurabh Sharma, Rahul Bansal, Bhawna Pant, Parul Saxena, Shivakshi Chansoria, Arvind Shukla
ObjectivesInner happiness and the ability to fully receive joy is the utmost necessity to be healthy, to mature in professional life and eventually serving the mankind. Medical students are less ecstatic compared to other students in university because of concrete inculcation and work conditions. The aim of the present study was to evaluate happiness among medical students& its correlates.Materials and methodologyThe study was conducted among 115 medical students of MBBS (2nd year) of Subharti Medical College, Meerut. The information was gathered by using the Oxford Happiness Questionnaire which was distributed among the MBBS second year students present during the study at Subharti Medical College, Meerut. Descriptive statistics and chi-square test were used for the analysis.ResultsThe happiness distribution in regards to baseline characteristic showed that 60.8% of the selected medical students were in happy group. It was found that male students (51.4%) were happier than females (48.6%). It was seen that 85.7 % of medical students who were happy, had never consumed drugs and this association was found to be statistically significant. It was observed that comparatively younger siblings were happier. Those who believed in higher power or universal consciousness were found to be more contented and happier.ConclusionOverall the medical students were found to be happy. To make a conducive environment for internal happiness, a belief in superpower was very helpful. All kind of drugs (alcohol and tobacco) should be discouraged as these may cause a temporary feeling of elation but not internal happiness.



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Vocal cord paralysis appears to be an acquired lesion in children with repaired esophageal atresia/tracheoesophageal fistula

Publication date: September 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): Thomas Kovesi, Federica Porcaro, Francesca Petreschi, Marilena Trozzi, Sergio Bottero, Renato Cutrera
ObjectivesDetermine whether vocal cord paresis or paralysis (VCP/P) following surgical repair of congenital esophageal atresia/tracheoesophageal fistula (EA/TEF) is generally a primary anomaly, or is secondary to EA/TEF repair.MethodsWe carried out a retrospective study based on a recently published protocol, which included the systematic performance of a laryngo-tracheo-bronchoscopy before and after EA/TEF repair.ResultsThere were 105 patients with EA/TEF referred for multidisciplinary follow-up, between 2010 and 2015. Sixty-four of the 105 patients included in the study underwent EA/TEF repair at the referral center and had pre-operative bronchoscopy; the others had their initial surgery elsewhere. No included patient had VCP/P detected pre-operatively. Six patients (4 initially managed at the referral center) were diagnosed with VCP/P during the follow-up period (6/105, 5.7%).ConclusionVCP appears to be an acquired lesion in this population.



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Hydroa vacciniforme‐like lymphoproliferative disorder in an elderly Chinese patient and a literature review of adult cases

International Journal of Dermatology, EarlyView.


https://ift.tt/2K5NWfF

Necrotic cheek ulcer in a liver transplant patient

International Journal of Dermatology, EarlyView.


https://ift.tt/2K6mBGU

Chronic atypical first bite syndrome and primary squamous cell carcinoma of the parotid

Head &Neck, EarlyView.


https://ift.tt/2tr0FPX

Differences in cancer gene copy number alterations between Epstein‐Barr virus‐positive and Epstein‐Barr virus‐negative nasopharyngeal carcinoma

Head &Neck, EarlyView.


https://ift.tt/2lnRJXV

A prospective analysis of prevalence of metastasis in levels IIB and V neck nodes in patients with operable oral squamous cell carcinoma

Publication date: August 2018
Source:Oral Oncology, Volume 83
Author(s): Sriharsha Haranadh, Rukmangadha Nandyala, Vijayalakshmidevi Bodagala, Narendra Hulikal
ObjectivesThe present study was designed to know and analyze the prevalence of pathological involvement of level IIB and V neck nodes in operable oral cavity squamous cell carcinomas.Materials and methodsAll treatment naïve, willing biopsy proven patients of age group 18–70 years with oral cavity squamous cell carcinomas undergoing surgery from May 2015 to December 2016 in a single tertiary care Institute were prospectively analyzed for level IIb and V involvement.ResultsA total of 199 patients met the selection criteria of the study. Most common site was buccal mucosa, majority were cT2 lesions and 90% underwent Modified neck dissection. 63% of patients had pN0 disease. The rate of involvement of level II b and V nodes was 3% and was associated with higher T size, disease burden in proximal basin and lymphovascular invasion. There was no skip metastasis to level IV. Only one patient had skip metastasis to levels V and IIB each.ConclusionTo conclude our data strongly supports omission of level IIb and level V nodal dissection routinely in patients with cT1 and T2 buccal cancers. However, a randomized controlled study to evaluate the morbidity as well as recurrence pattern between the selective and super-selective approach is warranted.



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Interaction between anesthetic conditioning and ischemic preconditioning on metabolic function after hepatic ischemia–reperfusion in rabbits

Abstract

Background

Both anesthetic-induced and ischemic preconditioning are protective against hepatic ischemia–reperfusion injury. However, the effects of these preventive methods on the metabolic function remain to be elucidated. We investigated the anesthetic conditioning and ischemic preconditioning on the metabolic function of the rabbit model of hepatic ischemia–reperfusion.

Methods

After approval by the institutional animal care and use committee, 36 Japanese White rabbits underwent partial hepatic ischemia for 90 min either under sevoflurane or propofol anesthesia. All the rabbits underwent 90 min of hepatic ischemia, and half of the rabbits in each group underwent additional 10-min ischemia and 10-min reperfusion before index ischemia. Hepatic microvascular blood flow was intermittently measured during reperfusion period, and galactose clearance, serum aminotransferase activities, and lactate concentrations were determined 180 min after reperfusion.

Results

Neither anesthetic conditioning with sevoflurane nor ischemic preconditioning altered hepatic microvascular blood flow during reperfusion and serum transaminase activities after reperfusion. However, galactose clearance of reperfused liver was significantly higher under sevoflurane anesthesia than propofol (0.016 ± 0.005/min vs. 0.011 ± 0.004/min). Statistically significant interaction between anesthetic choice and application of ischemic preconditioning suggests that the ischemic preconditioning is selectively protective under propofol anesthesia. Increase of blood lactate concentration was significantly suppressed under sevoflurane anesthesia compared to propofol (1.5 ± 0.8 vs. 3.9 ± 1.4 mmol/l) without any statistically significant interaction with the application of ischemic preconditioning.

Conclusion

Sevoflurane attenuated the decrease of galactose clearance and increase of the blood lactate after reperfusion compared to propofol. Application of ischemic preconditioning was significantly protective under propofol anesthesia.

https://ift.tt/2M9nrmU

Multiple lentigines arising on resolving psoriatic plaques after treatment with apremilast

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2K3kljJ

Management of posterior glottic stenosis using the Combined Glottic Reconstruction procedure

Clinical Otolaryngology, EarlyView.


https://ift.tt/2lmJZoY

Characteristics and pathogenesis of facial nerve stimulation after cochlear implant surgeries: A single‐centre retrospective analysis from 1151 patients

Clinical Otolaryngology, EarlyView.


https://ift.tt/2yu9bTY

Demographic, Clinical and Histopathological Features of Oral Neural Neoplasms: A Retrospective Study

Abstract

Intraoral neural neoplasms though unusual may be clinically significant. The aim of this study was to categorize and evaluate oral neural tumors in a large oral pathology biopsy service. With IRB approval, a retrospective search of all neural neoplasms of the oral cavity in the archives of the University of Florida Oral Pathology Biopsy Service spanning from 1994 to 2015 was performed. Extraoral cases as well as cases with insufficient patient information were excluded. A total of 340 out of 164,578 submitted specimens in a 22 year period (0.2%) were included with a mean age of 43.3 years (range: 6–89), and 44% male and 56% female. The most commonly affected locations were: tongue (37.5%), palate (22%), lip (19%), and gingiva (14%). The microscopic diagnoses rendered, in descending order of frequency were: neurofibromas (NFs): 123 (36%), granular cell tumor (GCT): 108 (32%), schwannomas: 61 (17%), palisaded encapsulated neuromas: 39 (11%), benign neural lesion not otherwise specified: 8 (2%), and mucosal neuroma c/w multiple endocrine neoplasia type 2B (MEN 2B): 1 (< 0.5%). Six cases of NF reported a history of neurofibromatosis Type 1 (NF 1). Four cases showed multifocal lesions. Immunohistochemical staining was performed on equivocal cases (25% of the lesions) and all were confirmed by their S-100 positivity. Intraoral neural neoplasms, though uncommon should be in the differential diagnosis of oral soft tissue entities and specific consideration to syndromal linkage is paramount as this may impact patient management.

https://ift.tt/2McxcB1