Education in neuroanesthesia and neurocritical care: trends, challenges and advancements

Purpose of review We summarize the latest evidence in neuroanesthesia and neurocritical care (NCC) training. In addition, we describe the newer advancements that clinical educators face in these subspecialties. Lastly, we highlight educational approaches that may lead to an enhanced learning experience and development of necessary skills for neurosciences trainees. Recent findings Current neuroanesthesia and NCC training requires acquisition of specific skills for increasing complex surgical cases, specialized neurosurgical practice and new perioperative technologies. Furthermore, there is increasing international interest for standardization and accreditation of neuroanesthesia fellowship programs. Recent evidence has demonstrated that well structured training using high-fidelity simulation improves cognitive and technical skills in acute neurological crises. Summary High-fidelity simulation in perioperative care of neurosurgical patients can be part of formal neuroanesthesia and NCC curricula, and potentially impact trainees' proficiency. A research agenda is needed to validate the assessment of most effective educational interventions in neurosciences trainees with diverse medical backgrounds. Creative combinations of cost-effective interventions including traditional teaching, specific technical skills workshops, low and high-fidelity simulation deserve to be assessed in future studies. Correspondence to Angela Builes-Aguilar, MD, MSc, MsEpi, Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine & Dentistry, Western University, 275 Regent Street, London, ON, Canada N6A2H3. Tel: +1 519 671 0313; e-mail: Angelitabuiles@gmail.com Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2N4Sgtr

Anesthesia for awake craniotomy

Purpose of review The current review reports on current trends in the anesthetic management of awake craniotomy, including preoperative preparation, sedation schemes, pain management, and prevention of intraoperative complications. Recent findings Both approaches for anesthesia for awake craniotomy, asleep–awake–asleep and monitored anesthesia care (MAC), have shown equal efficacy for performing intraoperative brain mapping. Choice of the appropriate scheme is currently based mainly on the preferences of the particular anesthesiologist. Dexmedetomidine has demonstrated high efficacy and safety in MAC for awake craniotomy and has become a rational alternative to propofol. Despite the high efficacy of scalp block and opioids, pain remains a common compliant in awake craniotomy. Appropriate surgical tactics can reduce pain and even prevent postoperative neurological complications. Although the efficacy of prophylaxis of intraoperative seizures with anticonvulsants remains doubtful, levetiracetam can be superior to other drugs for this purpose. Summary Following a great deal of progress in anesthetic management, awake craniotomy, which had been a relatively rare approach, is now a commonly performed procedure for neurosurgical intervention. Modern anesthesia techniques can provide for successful brain mapping in almost any patient. Management of awake craniotomy in high-risk patients is a central task for future research. Correspondence to Alexander Kulikov, MD, PhD, Department of Anesthesiology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia. Tel: +7 903 963 73 64; e-mail: akulikov@nsi.ru Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2KKGzeI

Opioid-free anesthesia: a different regard to anesthesia practice

Purpose of review In the past two decades, opioids have been prescribed increasingly for the treatment of various chronic pain conditions and during the perioperative period. Perioperative opioid administration is associated with well known adverse effects and recently to long-term use and poor surgical outcomes. In this context, the anesthesiologists have to face their responsibilities. The review discusses the neurophysiological basis of opioid-free anesthesia (OFA), the rational supporting its use in perioperative medicine as well as barriers and future challenges in the field. Recent findings OFA has gained in popularity as a way to enhance early recovery and to spare opioids for the postoperative period. Whether it is possible to deliver safe and stable anesthesia without intraoperative opioids to many patients undergoing various surgical procedures, OFA still raises questions. Accurate monitoring to measure intraoperative nociception and guide the use of adjuvants are not available. There is a need for the development of procedure-specific strategies as well as indications and contraindications to the technique. Finally, objective assessment of OFA use on patient outcomes should be recorded in large multicenter studies. Summary OFA stands as a new paradigm, which questions anesthesiology practice and might help to rationalize perioperative opioids use. Correspondence to Patricia Lavand'homme, MD, PhD, Department of Anesthesiology, Cliniques Universitaires St Luc - University Catholic of Louvain, Av Hippocrate 10, B-1200 Brussels, Belgium. Tel: +32 2 764 18 21; fax: +32 2 764 36 99; e-mail: patricia.lavandhomme@uclouvain.be Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2N5zRN5

Genetics and genomics in postoperative pain and analgesia

Purpose of review The review describes recent advances in genetics and genomics of postoperative pain, the association between genetic variants and the efficacy of analgesics, and the role of pharmacogenomics in the selection of appropriate analgesic treatments for postoperative pain. Recent findings Recent genetic studies have reported associations of genetic variants in catechol-O-methyltransferase (COMT), brain-derived neurotrophic factor (BDNF), voltage-gated channel alpha subunit 11 (SCN11A) and μ-opioid receptor (OPRM1) genes with postoperative pain. The recent pharmacogenetics studies revealed an association of the organic cation transporter 1 (OCT1) and ATP-binding cassette C3 (ABCC3) polymorphisms with morphine-related adverse effects, an effect of polymorphisms in cytochrome P450 gene CYP2D6 on the analgesic efficacy of tramadol and no effect of CYP2C8 and CYP2C9 variants on efficacy of piroxicam. Summary Genetic variants associate with inter-individual variability in drug responses and they can affect pain sensitivity and intensity of postoperative pain. Despite the recent progress in genetics and genomics of postoperative pain, it is still not possible to precisely predict the patients who are genetically predisposed to have severe postoperative pain or who develop chronic postoperative pain. Correspondence to Eija Kalso, MD, PhD, Pain Clinic, PB 140, 00029 HUS, Finland. Tel: +358 9 47175885; e-mail: eija.kalso@helsinki.fi Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2KMTwVu

Is epidural analgesia still a viable option for enhanced recovery after abdominal surgery

Purpose of review Although thoracic epidural analgesia (TEA) is considered often as gold standard in multimodal analgesia with regard to major abdominal surgery, there is an ongoing debate if it is still a viable option for enhanced recovery because of its potential severe complications. Recent findings In addition to the unsurpassed analgesic quality, a TEA offers several advantages. Studies have shown that a TEA does have a positive effect on perioperative morbidity and mortality, bowel function, the occurrence of ileus and patient mobility. Furthermore, TEA can reduce opioid-induced side effects, cardiac arrhythmias and pneumonia. When it is embedded into a multimodal fast-track program, it also shortens intensive care and hospital stay. Summary TEA provides superior pain control with a handful of important advantages if used sensibly and with caution. Because of associated risks for severe neurological complications, clear contraindications should be ruled out. Special attention needs be paid to potential hypotension in the setting of epidural analgesia. If these key points are considered, a TEA still represents a viable option for enhanced recovery after major abdominal surgery. Correspondence to Raphael Weiss, MD, University Hospital Münster, Departement of Anesthesiology and Intensive Care Medicine, Albert-Schweitzer-Campus 1, 48149 Münster, NRW, Germany. Tel: +49 251 83 47266; fax: +49 251 83 47257; e-mail: r_weiss@anit.uni-muenster.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2N8oXpN

The road to accreditation for fellowship training in regional anesthesiology and acute pain medicine

Purpose of review The purpose of this review is to provide the background and rationale for pursuing accreditation of regional anesthesiology and acute pain medicine (RAAPM) fellowships, explain specific steps and challenges in the process, and forecast the future of fellowship training. Recent findings In 2016, the first fellowship program in RAAPM was able to apply for accreditation from the Accreditation Council for Graduate Medical Education (ACGME). The establishment of this newly accredited subspecialty fellowship and the announcement of the first accredited programs represented a tremendous achievement in anesthesiology training and medical education in general and was the culmination of nearly 4 years of dedicated effort. Summary Programs with initial ACGME accreditation are on a 2-year term and will be reviewed to evaluate adherence to the program requirements and the quality of fellowship training. Deficiencies identified will need to be resolved or face loss of accreditation. However, a program's maintenance of accreditation represents a commitment to its fellows to provide a training experience that can be held as a benchmark for all programs. Correspondence to Edward R. Mariano, MD, MAS, Anesthesiology and Perioperative Care Service; VA Palo Alto Health care System; 3801 Miranda Avenue (112A), Palo Alto, CA 94304, USA. Tel: +650 849 0254; fax: +650 852 3423; e-mail: emariano@stanford.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2KPYqB2

Anesthesia for electroconvulsive therapy

Purpose of review Electroconvulsive therapy (ECT) is a well established and effective therapy in treatment-resistant depression. It is performed under general anesthesia, but no consensus exists regarding the optimal anesthetic drugs. A growing interest in optimizing adjunctive medication regimes in ECT anesthesia has emerged in recent years. Moreover different methods of seizure induction have been evaluated. Recent findings Pretreatment with dexmedetomidine eased the propofol injection pain and reduced the hyperdynamic response to ECT, but prolonged recovery. Remifentanil exhibited no proconvulsive effect and had no effect on seizure quality. Ketamine showed an antidepressive effect but was associated with cardiovascular side effects and an increased recovery time. A bispectral index-guided anesthesia or a time delay between anesthesia and seizure induction resulted in a better seizure quality presumably by avoiding high concentrations of (anticonvulsive) hypnotics. Seizure induction by magnetism seems to be an alternative to ECT, as the former is associated with less cognitive side effects but comparable antidepressive efficacy. Summary The current practice of anesthesia for ECT should not be modified, as the evidence of studies is either too low or the results are inconsistent. Some approaches are promising but require validation in further studies with a higher number of participants. Correspondence to Prof Dr Martin Soehle, Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany. Tel: +49 228 28714127; e-mail: martin.soehle@ukbonn.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2N6VA7A

Recent developments in ultrasound imaging for neuraxial blockade

Purpose of review Recent research has shed further light on the place of ultrasound imaging in neuraxial blockade in routine clinical practice, its use in thoracic epidurals, and real-time ultrasound-guided techniques. Recent findings Compared with the conventional technique of surface landmark palpation, preprocedural ultrasound imaging minimizes technical difficulty associated with lumbar neuraxial blockade in patients with poor-quality surface landmarks. Novice practitioners are able to learn to employ the technique effectively. Safety benefits include a reduction in postprocedural back pain associated with fewer needle passes and a lower risk of procedure-associated bleeding. The advantage of ultrasound is minimal however in patients with easily discernible surface landmarks, especially if the practitioner is highly experienced. Recent trials show that preprocedural ultrasound scanning for thoracic epidural insertion reduces needle punctures and increases early analgesic efficacy compared with the palpation technique. Real-time ultrasound-guided techniques, while feasible, remain challenging and may not offer significant benefit over preprocedural imaging in lumbar neuraxial blockade. Their role in thoracic epidural insertion requires further investigation. Summary Ultrasound imaging of the spine is a valuable technique that, while not indicated for routine use, should be part of the skillset of any practitioner that regularly performs lumbar and thoracic neuraxial blockade. Correspondence to Ki Jinn Chin, MBBS, MMed, FRCPC, Department of Anesthesia, Toronto Western Hospital, 399 Bathurst St, McL 2–405, Toronto, Ontario M5T 2S8, Canada. Tel: +1 416 603 5118; fax: +1 416 603 6494; e-mail: gasgenie@gmail.com Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2KPYosU

Prediction of flap compromise by Preoperative Coagulation Parameters in head and neck cancer patients

Publication date: Available online 11 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Kun Wu, Jing-shi Lei, Yuan-yuan Mao, Wei Cao, Zhen-Hu Ren, Han-Jiang Wu

Abstract

Purpose

Studies on coagulation parameters (including activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), platelet (PLT) and D-dimer) in flap compromise are limited. The aim of the present study is to compare coagulation parameter variables in patients with and without flap compromise.

Methods

In this retrospective cohort study, patients were recruited from the Department of Oral and Maxillofacial Surgery at the Second Xiangya Hospital between July 2016 and July 2017. The primary predictor variable was a set of coagulation parameters. The primary outcome variable was flap compromise. The other variables were age, gender, T stage, smoking and prior radiotherapy history. Descriptive, bivariate, receiver operating characteristic curves and regression statistics were computed. Statistical significance was set at less than 0.05 with 95% reliability.

Results

A total of 503 patients with 42 compromised flaps were identified in this study. Venous thrombosis, arterial thrombosis or no confirmed reason for compromise was observed in 28, 5, and 9 compromised flaps, respectively. Only FIB was associated with flap compromise or venous thrombosis on adjusted analyses, although the predictive values were low on ROC analysis. For patients with D-dimer＜0.4 (μg/mL), the likelihood of venous thrombosis was greater than that for patients with D-dimer≥0.4 (μg/mL) (P=0.0414). For patients with FIB＜3.5 (g/L), the likelihood of venous thrombosis was greater than that for patients with FIB≥3.5 (g/L) (P= 0.0336).

Conclusion

Decreased FIB was associated with a higher rate of flap compromise. In patients with D-dimer＜0.4 (μg/mL) or FIB＜3.5 (g/L), the risk of venous thrombosis was higher.

https://ift.tt/2NEanHI

Effect of Mandible and Maxilla Osteotomies on Velar, Oropharyngeal, and Hypopharyngeal Diameter

Publication date: Available online 11 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Christopher Vanderbeek, Yuan F. Liu, Zachary Reichert, Jayini Thakker, Tolbin Collett, Jared C. Inman

Abstract

Purpose

In the literature, there is a lack of anatomic comparisons among maxillomandibular advancement (MMA) and other bony surgical treatments of obstructive sleep apnea (OSA). Therefore, we simulated these surgical procedures in cadavers to evaluate their ability to expand the posterior airway space (PAS).

Materials and Methods

The following bony advancement surgeries were performed on each of nine cadavers: genioglossal advancement (GGA); genioplasty with advancement of the genioglossus, geniohyoid, and anterior digastric muscles (GPA); bilateral sagittal split osteotomy (BSSO); LeFort I maxillary advancement (LFMA); LeFort I maxillary anterior impaction osteotomy (LFAI); maxillomandibular advancement (MMA); maxillomandibular advancement with genioplasty (MMA+GPA); and maxillomandibular advancement with LeFort I anterior impaction osteotomy (MMA+LFAI). Bony advancements were performed at increasing distances and change in PAS anterior-posterior (AP) diameter was measured at the levels of the velum, oropharynx, and hypopharynx.

Results

Change in posterior airway spaces varied in a grossly linear fashion with advancement surgical maneuvers. GPA led to a greater increase in AP distance at the level of the oropharynx and hypopharynx compared to GGA. LFAI showed greater increase in AP distance at the velum compared to MMA. All maxillary movements showed greater AP expansion in the PAS at the velum compared to mandibular advancements.

Conclusions

Static AP expansion of the PAS at the level of the velum, oropharynx, and hypopharynx occurs in a roughly linear and predictable pattern with different bony surgical procedure used in OSA surgery. MMA alone and MMA+GPA had the overall greatest effect at all airway levels. GPA had greater effect on expansion of the oropharynx and hypopharynx when compared to GGA.

https://ift.tt/2J9LpfT

Effect of Measurement Technique on TMJ Mandibular Condyle and Articular Disc Morphometry: CBCT, MRI and Physical Measurements

Publication date: Available online 10 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Matthew C. Coombs, Daniel J. Bonthius, Xingju Nie, Michael K. Lecholop, Martin B. Steed, Hai Yao

Abstract

Purpose

Accurate description of temporomandibular size and shape (morphometry) is critical for clinical diagnosis and surgical planning, design and development of regenerative scaffolds and prosthetic devices, and to model the temporomandibular loading environment. The study objective was to determine the three-dimensional morphometry of the temporomandibular joint (TMJ) condyle and articular disc by CBCT, MRI and physical measurements on the same joints using a repeated measures design, to determine the effect of measurement technique on temporomandibular size and shape.

Materials and Methods

Human cadaveric heads underwent a multi-step protocol, acquiring physiologically meaningful measurements of the condyle and disc. Heads first underwent CBCT scanning and solid models were automatically generated. Superficial soft tissues were dissected and intact TMJs were excised and underwent MRI scanning, and solid models were generated following manual segmentation. Following MRI scanning, intact joints were dissected and physical measurements of the condyle and articular disc were made. CBCT-based model measurements, MRI-based model measurements and physical measurements were standardized, and a repeated measures study design determined the effect of measurement technique on morphometric parameters.

Results

Multivariate general linear mixed effects models showed significant effects for measurement technique for condylar morphometric outcomes (p<0.001) and articular disc morphometric outcomes (p<0.001). Physical measurements following dissection were larger than both CBCT-based and MRI-based measurements. Differences in imaging-based morphometric parameters followed a complex relationship between imaging modality resolution and contrast between tissue types.

Conclusion

Physical measurements following dissection are still considered the gold standard, however due to their inaccessibility in vivo, understanding how imaging technique impacts temporomandibular size and shape is critical towards the development of high-fidelity solid models, to be utilized in the design and development of regenerative scaffolds, surgical planning, prosthetic devices and for anatomical investigations.

https://ift.tt/2NJcjP9

Myositis Ossificans Traumatica of the Medial Pterygoid Muscle Following Third Molar Tooth Extraction: A Case Report and Review of Literature

Publication date: Available online 10 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Soner Karaali, Ufuk Emekli

Abstract

Myositis ossificans (MO) is a rare non-neoplastic disorder characterized by heterotopic ossification in soft tissues, mainly muscles. Myositis ossificans traumatica is characterized by ossification of soft tissues following acute or repetitive trauma, burns, or surgical intervention. Muscular or soft tissue trauma is usually present as the underlying etiology. Myositis ossificans traumatica usually involves extremity muscles. The number of reported cases involving masticatory muscles is extremely low. The most common clinical sign of this condition is progressive limitation of mouth opening. Surgical resection of ossified tissue is the most commonly used treatment for this disorder, with a high postoperative recurrence rate. This paper aimed to report a case of traumatic myositis ossificans of the medial pterygoid muscle to draw attention to the possibility of the condition in patients with limited mouth opening, and to review the literature about myositis ossificans traumatica involving medial pterygoid muscle.

https://ift.tt/2L8Cxcp

Dexmedetomidine-midazolam sedation reduces unexpected patient movement during dental surgery as compared with propofol-midazolam sedation.

Publication date: Available online 10 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Eriko Togawa, Hiroshi Hanamoto, Hiroharu Maegawa, Chizuko Yokoe, Hitoshi Niwa

Abstract

Purpose

Due to its unpredictability, unexpected patient movement is one of the most important problems during surgery while under monitored anesthesia care with sedation. The purpose of this study was to compare unexpected patient movement during dental surgery while under dexmedetomidine and propofol sedation.

Methods

We designed and implemented a prospective, randomized, controlled trial. Patients undergoing dental surgery requiring intravenous sedation were randomly assigned to dexmedetomidine-midazolam (dexmedetomidine group) or propofol-midazolam (propofol group) sedation groups. In each group, 0.02 mg/kg of midazolam was administered in conjunction with continuous administration of dexmedetomidine or propofol in order to maintain a bispectral index value of 70-80. Unexpected patient movement interfering with the procedure was defined as: acceptable, no body movement or only one controllable movement; or as unacceptable, two or more controllable movements or any uncontrollable movement. The primary outcome was unexpected patient movement, with the secondary outcome defined as snoring and cough reflex. Other variables included the demographic and procedural characteristics. Continuous or ordinal variables were analyzed using a Student's t-test or a Mann-Whitney test. Dichotomous or categorical variables were analyzed using a χ² test or a Fisher's exact test. A P value < 0.05 was considered to indicate statistical significance.

Results

The 88 patients enrolled in the study were grouped as follows: dexmedetomidine group (n = 44) and propofol group (n = 44). There were no significant differences between the groups for the demographics and baseline variables. Intraoperative unacceptable patient movement occurred more commonly in the propofol (n = 13, 30%) vs. dexmedetomidine group (n = 4, 9%), P = 0.015. Intraoperative snoring occurred more commonly in the dexmedetomidine vs. propofol group (P = 0.045). Incidence and number of cough reflexes were comparable between the groups.

Conclusion

Dexmedetomidine-midazolam sedation reduces unexpected patient movement during dental surgery as compared with propofol-midazolam sedation.

https://ift.tt/2NFN0O9

Influence of chronic alcoholism and estrogen deficiency on the immunohistochemical expression of regulatory proteins of the bone resorption process in the periodontium of Wistar rats

Publication date: Available online 10 July 2018

Source: Archives of Oral Biology

Author(s): Adriana Mathias Pereira da Silva Marchini, Gabriela de Fátima Santana-Melo, Miriane Carneiro Machado Salgado, Elis Andrade de Lima Zutin, Leonardo Marchini, Rosilene Fernandes da Rocha, Luana Marotta Reis de Vasconcellos

Abstract

OBJECTIVE

The aim of this study was to investigate possible changes in immunohistochemical expression of proteins regulating the bone resorption process in the periodontium of rats subjected to alcoholism and/or estrogen deficiency. The investigated proteins were receptor activator of nuclear factor-kappa β ligand (RANKL), a protein that stimulates bone resorption, and osteoprotegerin (OPG), a protein that inhibits bone resorption. At the molecular level, decreased OPG expression and/or increased RANKL expression are consistent with a greater predisposition to bone resorption.

DESIGN

Wistar female rats were divided into ovariectomized (ovx) and non-ovariectomized (sham) groups, and subdivided into ad libitum diet (free diet), alcoholic diet (20% solution), and isocaloric diet (diet with a similar amount of calories as compared with groups ingesting an alcoholic diet). The alveolar bone crest and adjacent tissues were evaluated by immunohistochemical analyses for detection of OPG and RANKL.

RESULTS

A significant decrease in OPG expression and a significant increase in RANKL expression were observed in ovariectomized animals which received alcohol as compared with non-ovariectomized animals which received isocaloric diet (experimental control). When estrogen deficiency was evaluated independently of the diet type, a significant decrease in OPG expression and a significant increase in RANKL expression were observed in ovariectomized animals as compared with non-ovariectomized animals.

CONCLUSIONS

Estrogen deficiency associated with alcoholic diet, as well as estrogen deficiency (analyzed independently of diet type), decreased the immunostaining for OPG and increased the immunostaining for RANKL in the periodontium of rats.

https://ift.tt/2L3D2Er

Influence of chronic alcoholism and estrogen deficiency on the immunohistochemical expression of regulatory proteins of the bone resorption process in the periodontium of Wistar rats

Publication date: Available online 10 July 2018

Source: Archives of Oral Biology

Author(s): Adriana Mathias Pereira da Silva Marchini, Gabriela de Fátima Santana-Melo, Miriane Carneiro Machado Salgado, Elis Andrade de Lima Zutin, Leonardo Marchini, Rosilene Fernandes da Rocha, Luana Marotta Reis de Vasconcellos

Abstract

OBJECTIVE

The aim of this study was to investigate possible changes in immunohistochemical expression of proteins regulating the bone resorption process in the periodontium of rats subjected to alcoholism and/or estrogen deficiency. The investigated proteins were receptor activator of nuclear factor-kappa β ligand (RANKL), a protein that stimulates bone resorption, and osteoprotegerin (OPG), a protein that inhibits bone resorption. At the molecular level, decreased OPG expression and/or increased RANKL expression are consistent with a greater predisposition to bone resorption.

DESIGN

Wistar female rats were divided into ovariectomized (ovx) and non-ovariectomized (sham) groups, and subdivided into ad libitum diet (free diet), alcoholic diet (20% solution), and isocaloric diet (diet with a similar amount of calories as compared with groups ingesting an alcoholic diet). The alveolar bone crest and adjacent tissues were evaluated by immunohistochemical analyses for detection of OPG and RANKL.

RESULTS

A significant decrease in OPG expression and a significant increase in RANKL expression were observed in ovariectomized animals which received alcohol as compared with non-ovariectomized animals which received isocaloric diet (experimental control). When estrogen deficiency was evaluated independently of the diet type, a significant decrease in OPG expression and a significant increase in RANKL expression were observed in ovariectomized animals as compared with non-ovariectomized animals.

CONCLUSIONS

Estrogen deficiency associated with alcoholic diet, as well as estrogen deficiency (analyzed independently of diet type), decreased the immunostaining for OPG and increased the immunostaining for RANKL in the periodontium of rats.

https://ift.tt/2L3D2Er

Nature versus nurture in the spectrum of rheumatic diseases: Classification of spondyloarthritis as autoimmune or autoinflammatory

Publication date: Available online 11 July 2018

Source: Autoimmunity Reviews

Author(s): Elena Generali, Tanima Bose, Carlo Selmi, J. Willem Voncken, Jan G.M.C. Damoiseaux

Abstract

Spondyloarthritides (SpA) include inflammatory joint diseases with various clinical phenotypes that may also include the axial skeleton and/or entheses. SpA include psoriatic arthritis, reactive arthritis, enteropathic arthritis and ankylosing spondylitis; the latter is frequently associated with extra-articular manifestations, such as uveitis, psoriasis, and inflammatory bowel disease. SpA are associated with the HLA-B27 allele and recognize T cells as key pathogenetic players. In contrast to other rheumatic diseases, SpA affect women and men equally and are not associated with detectable serum autoantibodies. In addition, but opposite to rheumatoid arthritis, SpA are responsive to treatment regimens including IL-23 or IL-17-targeting biologics, yet are virtually unresponsive to steroid treatment. Based on these differences with prototypical autoimmune diseases, such as rheumatoid arthritis or connective tissue diseases, SpA may be better classified among autoinflammatory diseases, with a predominant innate immunity involvement. This would rank SpA closer to gouty arthritis and periodic fevers in the spectrum of rheumatic diseases, as opposed to autoimmune-predominant diseases. We herein provide available literature on risk factors associated with SpA in support of this hypothesis with a specific focus on genetic and environmental factors.

https://ift.tt/2unqSPE

Subclinical cardiovascular disease and Systemic Sclerosis: A comparison between risk charts, quantification of coronary calcium and carotid ultrasonography

Publication date: Available online 11 July 2018

Source: Autoimmunity Reviews

Author(s): I. Sanz Pérez, F. Martínez Valle, A. Guillén del Castillo, A. Roque Pérez, H. Cuéllar Calàbria, M.N. Pizzi, A. Fernández Codina, E. Callejas Moragas, O. Orozco Gálvez, V. Fonollosa Pla, C.P. Simeón Aznar

Abstract

Background and objectives

Recently published population-based cohort studies have shown a high prevalence of cardiovascular disease in Systemic Sclerosis (SSc) patients. The aim of this study is to compare three different methods to measure cardiovascular risk in patients with scleroderma.

Methods

Forty-three SSc patients were included. A prospective study was performed for evaluation of cardiovascular risk and subclinical atheromatosis using 3 non-invasive methods: cardiovascular risk tables, carotid Doppler ultrasonography and quantification of coronary calcium by computerized tomography (CT).

Results

The cardiovascular risk charts for the Spanish population did not identify patients at high cardiovascular risk. Framingham-REGICOR identified 13 intermediate-risk patients. Twenty-two patients (51.2%) had plaques on carotid ultrasonography. We performed a ROC curve to identify the best cutoff point for the quantification of coronary artery calcium (CACscore), the value of CACscore > 28 AU (Agatston Units) had the highest sensitivity (73%) and specificity (81%) for the diagnosis of subclinical atheromatosis. In the multiple regression study, age and decreased HDL cholesterol levels were identified as independent factors for subclinical atherosclerotic disease. No disease-related factors were associated with increased subclinical arteriosclerosis.

Conclusion

Carotid ultrasound and CACscore are useful for identifying subclinical atheromatosis in patients with SSc and are superior compared to risk charts used for general population. HDL cholesterol and age were independent factors for the presence of subclinical atherosclerotic disease. A carotid ultrasound or CT should be performed for early detection of subclinical atheromatosis if these factors are present.

https://ift.tt/2m845np

Inflammation and dementia: Using rheumatoid arthritis as a model to develop treatments?

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Alice Mason, Clive Holmes, Christopher J. Edwards

Abstract

Dementia is a major international public health problem which looks set to grow as the ageing population increases. Despite large amounts of investment there has been relatively little progress in developing new therapies to combat this. There is a growing body of evidence that both local and systemic inflammation are important in dementia; with cerebral inflammation occurring secondarily to beta-amyloid plaques, raised levels of serum inflammatory molecules and cytokines being present in Alzheimer's disease patients and systemic inflammation being associated with cerebral microvasculature disease in vascular dementia. Observational studies had suggested that non-steroidal anti-inflammatory drugs may reduce the risk of dementia, but subsequent interventional studies have been disappointing. More recently some observational studies have suggested a protective effect from conventional synthetic disease modifying anti-rheumatic drugs (csDMARDS) and tumour necrosis factor inhibiting (TNFi) biological therapies. Treatments for inflammatory rheumatic diseases have previously been repurposed and used successfully in other diseases, such as TNFi for inflammatory bowel disease. There are also studies looking at the use of csDMARDs such as methotrexate to improve outcomes after cardiovascular events. Ongoing interventional trials are currently looking at whether therapies designed to treat inflammatory and autoimmune diseases have the potential to be used to treat dementia.

https://ift.tt/2zuCm9O

Efficacy and patient satisfaction in the use of subcutaneous immunoglobulin immunotherapy for the treatment of auto-immune neuromuscular diseases

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Taylor Pindi Sala, Jean-Charles Crave, Martin Duracinsky, Lepira Bompeka, Abir Tadmouri, Olivier Chassany, Patrick Cherin

Abstract

We reviewed the efficacy of SCIg administration in terms of muscle strength maintenance and patient satisfaction comparing with IVIg in the treatment of auto-immune neuromuscular diseases. A systematic review was conducted, and identified studies from databases (PUBMED, EMBASE, EBSCO, Web of Science and Google Scholar) which were analyzed. The methodological quality of the selected publications was evaluated using the Newcastle-Ottawa Scale. Data were extracted from a total of 11 studies Fixed and random-effect model meta-analyses were performed. For the maintenance of muscle strength, Overall Neuropathy Limitations Scale (ONLS) data from 100 patients diagnosed with multifocal mononeuropathy (MMN) or chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) were pooled together. Switching to subcutaneous immunoglobulin administration led to a significant improvement (fixed effects model, p = 0.002). In data collected using the Medical Research Council Scale for Muscle Strength data from 140 patients with a wider range of disorders, a small but significant improvement in overall strength was observed in the SCIg group (p < 0.0001). In addition, the results of two studies measuring health-related quality of life and patient satisfaction were pooled. Data from 49 patients suffering from MMN, CIDP, and a variety of different myopathies demonstrated a small but significant increase in the mean 36-Item Short Form Survey (SF-36) scores (p < 0.0001). A highly significant difference was revealed when comparing data from 119 patients' responses to the Life Quality Index questionnaire (LQI) assessing patient satisfaction (p < 0.0001). This is the first analysis showing that SCIg is more effective than IVIg in improving Patient Reported Outcomes in auto-immune neuromuscular disease. These results should permit a broad range of patients to self-administer immunoglobulin treatments at home, potentially improving patient acceptability while reducing hospital visits and healthcare costs for the treatment of chronic auto-immune neuropathies.

https://ift.tt/2m7xZYQ

Therapy of scleroderma renal crisis: State of the art

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Elisabetta Zanatta, Pamela Polito, Mariangela Favaro, Maddalena Larosa, Piero Marson, Franco Cozzi, Andrea Doria

Abstract

Scleroderma renal crisis (SRC) is an uncommon but still life-threatening manifestation of systemic sclerosis (SSc). The incidence of SRC has decreased in the last few decades, probably due to a widespread use of vasodilators in SSc patients. It is well-recognized that exposure to different drugs can trigger SRC (corticosteroids, cyclosporine) or prevent its occurrence (iloprost, calcium channel blockers). The prognosis of this life-threatening manifestation has not substantially improved since 1980s, when ACE-inhibitors were introduced in its treatment. ACE-inhibitors remain the mainstay in the therapy of SRC due to their efficacy in controlling malignant hypertension; indeed, the prognosis largely depends on the rapid improvement of the ongoing renal ischemia. Calcium-channel blockers and in third line diuretics and alpha-blockers should be used as additional therapy if blood pressure control remains suboptimal despite maximum tolerated doses of ACE-inhibitors. Given the growing evidence on the role of complement activation and endothelin-1 in the pathogenesis of SRC, recent case-series and case reports have suggested the use of C5-inhibitors and endothelin receptor antagonists in the therapy of SRC, mainly in the refractory cases. Plasma-exchange seems to give some benefits in patients with SRC and microangiopathy or intolerant to ACE-inhibitors. Renal transplantation is the last treatment option and its outcome is similar to that reported in other connective tissue disorders, with a 5-year patient survival rate of about 82%. In this review we summarize the current knowledge in the treatment of SRC.

https://ift.tt/2m77HWz

Drug-induced lupus: Traditional and new concepts

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Augusto Vaglio, Peter C. Grayson, Paride Fenaroli, Davide Gianfreda, Valeria Boccaletti, Gian Marco Ghiggeri, Gabriella Moroni

Abstract

Drug-induced lupus (DIL) includes a spectrum of drug-induced reactions often characterised by a clinical phenotype similar to that of idiopathic systemic lupus eruthematosus (SLE) but usually lacking major SLE complications. Different drugs may be associated with distinct clinical and serological profiles, and early recognition is crucial. Drugs traditionally associated with DIL include procainamide, hydralazine, quinidine and others, but strong associations with newer agents, such as TNF α (TNFα) inhibitors, are increasingly recognised. The pathogenic mechanisms explaining how drugs that have heterogeneous chemical structure and function lead to autoimmunity are only partially understood. However, it is likely that traditional DIL-associated agents can boost innate immune responses, particularly neutrophil responses, with neutrophil extracellular trap (NET) formation and exposure of autoantigens. Research in the field of DIL is evolving and may provide interesting models for the study of autoimmunity.

https://ift.tt/2zuuepU

Classification of primary antiphospholipid syndrome as systemic lupus erythematosus: Analysis of a cohort of 214 patients

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Romain Paule, Nathalie Morel, Véronique Le Guern, Micaela Fredi, Laetitia Coutte, Meriem Belhocine, Luc Mouthon, Claire le Jeunne, Anthony Chauvin, Jean-Charles Piette, Nathalie Costedoat-Chalumeau

Abstract

Objectives

To assess the limitations of the SLICC (Systemic Lupus International Collaborating Clinics) classification criteria for systemic lupus erythematosus (SLE), in patients with primary antiphospholipid syndrome (PAPS).

Methods

Retrospective study of a cohort of APS patients (Sydney criteria). We successively excluded patients with (1) at least one "SLE-specific" manifestation (biopsy-proven SLE nephropathy, arthritis, cutaneous, or neurologic SLE manifestations, pericarditis, autoimmune haemolytic anaemia, oral and nasal ulcers, non-scarring alopecia, anti-dsDNA, and anti-Sm antibodies), (2) any other autoimmune connective tissue disease, and/or (3) antinuclear antibodies >1/320. Careful file review confirmed PAPS among the remaining patients. We then assessed the number of SLICC criteria each patient met.

Results

Among these 214 APS patients, we excluded 85 with at least one SLE-specific manifestation, 8 with another connective tissue disease, and 21 with antinuclear antibodies >1/320, leaving 100 patients with primary APS. Among them, 28% met at least 4 SLICC classification criteria including one clinical and one immunological criterion (antiphospholipid antibodies, aPL, by definition) and could thus theoretically be classified with SLE. Fourteen had an arterial phenotype (50%), 9 a history of catastrophic APS (32%), and 18 a triple-positive profile for aPL (64%). None had developed SLE during a median follow-up of 12 [6.5–17] years.

Conclusion

Because 28% of our patients with longstanding and strictly defined PAPS could be mistakenly classified as SLE, they were at risk of deleterious therapeutic management. We therefore suggest that any future classification for SLE should specifically require at least one SLE-specific criterion for patients with aPL.

https://ift.tt/2mavbdC

Biomet stock temporomandibular joint prosthesis: long-term outcomes of the use of titanium condyles secured with four or five condylar fixation screws

Publication date: Available online 11 July 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Stefanos Kanatsios, Omar Breik, George Dimitroulis

Abstract

Purpose

The aim of this study was to determine the long-term outcomes following TMJ replacement using the stock Zimmer-Biomet TMJ device. In particular, investigated whether the titanium condylar implant and number of screws used to fixate it to the mandibular ramus had any impact on outcomes.

Methods

Subjects who underwent surgical implantation of a stock Zimmer-Biomet TMJ prosthesis were identified for this retrospective study. All patients received a titanium condylar component secured with four or five screws and ultra-high molecular weight polyethylene (UHMWPE) fossa with no metal reinforcement. Pre- and postoperative pain scores (VAS) and maximum interincisal opening (MIO) data were collected. Additional data included patient demographics, as well as operative, postoperative and follow-up details. Data were analysed with IBM SPSS 2.0 through the use of paired t-tests, and ANOVA and ANCOVA analysis.

Results

190 subjects were identified. Following exclusions, the remaining study population (n = 60) consisted of 58 females and two males with a mean age of 53.5 years at time of surgery. Preoperative VAS and MIO values were 6.08 (SD = 2.24) and 31.88 mm (SD = 7.38 mm), respectively. 90% of the cohort required four screws to fix the prosthetic condylar component in place. After a median follow up of 5.2 years (95% CI: 4.73–5.62 years), with a range of 2–9 years, the VAS was 0.91 (SD = 1.89; p < 0.001) and the MIO was 34.8 mm (SD = X; p = 0.015). Only one device failed over the 9-year study period.

Conclusion

The results of this study demonstrate good VAS and MIO outcomes following the implantation of a stock Zimmer-Biomet TMJ device. Additionally, good long-term outcomes were obtained with a titanium condylar component, fixed to the mandibular ramus with only four or five screws, and a UHMWPE fossa with no metal reinforcement.

https://ift.tt/2L7wIvQ

Health-Related Quality of Life in Cleft Lip and/or Palate Patients – a cross-sectional study from preschool age until adolescence

Publication date: Available online 11 July 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Andreas Naros, Annekathrin Brocks, Susanne Kluba, Siegmar Reinert, Michael Krimmel

Abstract

Purpose

Cleft lip and/or palate (CLP) is the most common congenital craniofacial anomaly. Multiple operations, long-lasting supplementary treatments, as well as impaired functional and esthetic outcome might have a negative impact on patients' social–emotional functioning and self-esteem, resulting in a lower health-related quality of life (HRQoL).

Patients and Methods

This cross-sectional study aimed to evaluated CLP patients' HRQoL from preschool age (4 years) until adolescence (18 years) using the age-specific German KINDL^R questionnaire. We compared self-reports and parent proxy-reports, as well as reference values from an age-matched German norm population. Multivariate analysis was applied to identify mediating factors, e.g. cleft type, age, and gender. Additionally, a KINDSCREEN-10 questionnaire was used to implement a screening tool in the clinical routine.

Results

In total, 134 participants (average age 9.0 ± 3.8 years; 47.8% female) were included. Compared with German normative data, the evaluation revealed a significantly higher 'total QoL' in all self-report groups (Kiddy-, Kid-, Kiddo-KINDL^R) and a significantly higher proxy rating for children aged 7–13 years. Multivariate analysis verified a significant disparity between self-reports and parents' conceptions of HRQoL, as well as a deterioration of the ratings with increasing age. No significant effects of other contributing factors, e.g. cleft type and gender, were found. The KIDSCREEN-10 questionnaire successfully confirmed these findings.

Conclusions

Surprisingly, our survey revealed a higher HRQoL in cleft patients compared with normative data from healthy controls. But because the return rate of the forwarded questionnaire was low, this may have contributed to bias. Keeping this in mind, we may conclude at least that the HRQoL in our cleft patients was not significantly lower than in healthy children. On the other hand, it can be assumed that the special attention of the parents and the support from speech therapy and other medical professionals may have contributed to a positive effect on family interaction, communication skills, and self-esteem.

https://ift.tt/2NIf43q

HLA-G protein expression in colorectal cancer evaluated by immunohistochemistry and western blot analysis: Its expression characteristics remain enigmatic

Publication date: Available online 10 July 2018

Source: Clinical Immunology

Author(s): Marloes Swets, Anne Wouters, Daniëlle Krijgsman, Ronald L.P. van Vlierberghe, Arnoud Boot, Jaap D. van Eendenburg, Tom van Wezel, Hans Gelderblom, Cornelis J.H. van de Velde, Peter J. van den Elsen, Peter J.K. Kuppen

Abstract

HLA-G protein expression could play a role in evasion of tumor immune surveillance. Accumulating evidence demonstrates that HLA-G is expressed in different types of malignancies, including colorectal cancer (CRC). The purpose of the current study was to further unravel whether HLA-G protein expression could play a role in immune evasion of CRC. Therefore, to firmly establish HLA-G protein expression, eight early passage human CRC cell lines and five human rectal cancer tissues were analyzed by western blot analysis. The results obtained by western blot analysis were compared with immunohistochemistry on tumor tissue sections of the same patient. Furthermore, multiple monoclonal antibodies (mAbs), 4H84, MEM-G/1 and 5A6G7, targeting HLA-G were used to unravel staining patterns. We showed that results obtained with immunohistochemistry did not correlate with protein expression detected by western blot analysis, using three different HLA-G targeting mAbs. Furthermore, with respect to the specificity of the mAbs employed, additional immune reactivity was detected using the mAbs MEM-G/1 and 5A6G7 in western blot analysis with K562 control cell lines overexpressing HLA-A2 or HLA-G, all tumor tissues and in two out of eight CRC cell lines. Based on the current study and our previously reported results, we conclude that claiming HLA-G plays a role in immune modulation of CRC seems premature, as results from anti-body based detection of HLA-G protein remain inconclusive. Until the time that detection of HLA-G is sensitive enough to detect all aspects of HLA-G expression in biological samples, rather than transfected cells or long time cultured cell lines, conclusions should be drawn with great care.

https://ift.tt/2NEkFaR

Oral Health Status of Children with Mouth Breathing Due to Adenotonsillar Hypertrophy

Publication date: Available online 11 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Elif Ballikaya, Bahar Guciz Dogan, Ovsen Onay, Meryem Tekcicek

Abstract

Objectives

Mouth breathing is an important health problem, commonly encountered in children. In children, adeno-tonsillar hypertrophy is the main reason causing partial or complete upper airway obstruction and reduction in airflow. This study aimed to determine the oral health status of children aged 3-15 years, with mouth breathing who were due to have surgery for adeno-tonsillar hypertrophy and referred to the Department of Otorhinolaryngology at Children's Hospital of a University in Ankara, Turkey between January-July 2015.

Methods

The approval of the Non-Interventional Clinical Researches Ethics Board of Hacettepe University and written informed consents from the parents were obtained. The parents completed a questionnaire before the surgery. The children were examined using dental mirror and explorer under dental unit lighting. Oral health status was evaluated with DMFT/S, dmft/s, ICDAS II, dental plaque and gingival indices. The chi-square test, Kruskal Wallis and Mann Whitney U tests were used to statistically analyse the results, with statistical significance p<0.05.

Results

Of the 170 children who had adenotonsillar hypertrophy with mouth breathing, 150 the parents agreed to participate the study. 77 of the children (51.3%) were male; the mean age was 5.9±2.6. Mean dmft was 3.8±3.6, dmfs 9.7±1.1, DMFT 0.4±1.0 and DMFS 0.6±1.5 respectively. Among the children, 101 (67.3%) had cavitated dental caries, and according to ICDAS II, none had healthy teeth, 15 (10.0%) had initial, 42 (28.0%) had moderate and 93 (62.0%) had advanced caries. Of the children, 89.3% had gingivitis and the proportion of gingivitis in posterior region was found to be significantly higher than anterior region (p<0,001).

Conclusions

The oral health status of mouth breathing in children with adeno-tonsillar hypertrophy was poor. To reduce the risk of dental caries and periodontal disease among these children, regular dental follow-up and preventive programmes for oral health are needed.

https://ift.tt/2NFOM1H

A novel rat model for assessment of laryngotracheal injury following transoral intubation

Publication date: Available online 10 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jahshan F, Ertracht O, A. Abu-Amar, Ronen O, Srouji S, L. Apel-Sarid, Eisenbach N, Atar S, Sela E, Gruber M

Abstract

Objective

Laryngotracheal damage is a well-described complication of endotracheal intubation and animal models are essential for studying the underlying cellular injury cascade. This novel rat model is based on transoral intubation and aims to simulate the common clinical scenario of tube-related airway damage.

Methods

Prospective randomized control pilot study. 28 male Sprague-Dawley were randomly assigned into three groups: control, 3-h' intubation and 6-h' intubation. The animals were then euthanized and their laryngotracheal complexes sent for histological analysis. Epithelial damage, mucosal thickness and mucosal gland hypertrophy were reviewed.

Results

Total of 13 control animals and 15 intubated animals. 10 intubated animals survived the study protocol. Loss of epithelial surface architecture including damage to the microscopic ciliary mechanism was a common feature amongst all intubated animals. Average mucosal thickness of the larynx (including vocal cords and subglottic area) was 143±88 μm for control rats, 315±101 μm for rats intubated 3 h and 574±174 μm for rats intubated 6 h .This was a statistically significant difference. Average mucosal gland hypertrophy in the laryngeal subsite was 0.41±0.5 in control rats, 1.4±0.5 in rats intubated 3 h and 2.0±0.0 for rats intubated 6 h (statistically significant difference). There was a clear difference between three and 6 h of intubation with poorer mucosal injury parameters for longer intubation.

Conclusions

We describe a novel rat-based animal model for simulating airway mucosal damage following transoral intubation. This animal model is easy to carry out, reproducible and involves containable animal mortality rates.

https://ift.tt/2JgTqQe

Accuracy of Chest X-Ray Measurements of Pediatric Esophageal Coins

Publication date: Available online 10 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Phillip Huyett, Amber Shaffer, Linda Flom, Jeffrey P. Simons, Noel Jabbour

Abstract

Objective

To determine the accuracy of chest x-ray measurements in children using ingested radiopaque foreign bodies of known size.

Methods

A database of foreign body ingestions at a tertiary care children's hospital was queried from 2013-2016 for children who had ingested a US coin, had a pre-operative chest x-ray and documentation of coin type at the time of endoscopic removal. Four blinded research subjects measured the coin diameter on chest x-ray using iSite PACS software and based on the measurement, predicted the coin type. Measurements were compared to the known coin diameters published by the US Mint.

Results

A total of 51 patients with sixteen esophageal quarters (diameter 24.26 mm), fourteen nickels (21.21 mm), fourteen pennies (19.05 mm) and seven dimes (17.91 mm) were included in the study. The four subjects had a mean accuracy of 60.3% (range 49.0%-72.5%) in predicting the correct coin type. Across all raters, there was poor agreement for pennies (kappa=0.161) and dimes (kappa=0.131), fair agreement for nickels (kappa=0.259), good agreement for quarters (kappa=0.687), and fair agreement overall (kappa=0.371). The study measurements overestimated the coin size in 203 of the 204 measurements by a mean of 1.84 mm (range -0.31 to 3.85 mm). The mean size discrepancy was larger (2.40 vs. 1.30 mm, p<0.001) and accuracy of coin type identification was worse (44.6% vs. 74.1%, p=0.001) in children <4 years old.

Conclusions

Measurement of esophageal coins on chest x-ray is relatively inaccurate and overestimates the size in the majority of cases. Clinicians should use caution when performing fine measurements on chest x-rays, especially in children younger than 4 years old.

https://ift.tt/2NFJCmk

Urinary Iodine Concentration and Mortality Among U.S. Adults

Thyroid, Volume 28, Issue 7, Page 913-920, July 2018.


https://ift.tt/2uuB895

Changing Trend of Thyroglobulin Antibodies in Patients With Differentiated Thyroid Cancer Treated With Total Thyroidectomy Without 131I Ablation

Thyroid, Volume 28, Issue 7, Page 871-879, July 2018.


https://ift.tt/2zuvDN6

Thyroid Hypoplasia in Congenital Hypothyroidism Associated with Thyroid Peroxidase Mutations

Thyroid, Volume 28, Issue 7, Page 941-944, July 2018.


https://ift.tt/2ubHF8Z

Comparative Histopathologic Analysis of “Radiogenic” and “Sporadic” Papillary Thyroid Carcinoma: Patients Born Before and After the Chernobyl Accident

Thyroid, Volume 28, Issue 7, Page 880-890, July 2018.


https://ift.tt/2umFFu9

Future Meetings

Thyroid, Volume 28, Issue 7, Page 955-956, July 2018.


https://ift.tt/2zuvmd2

Low-Activity Radioactive Iodine Therapy for Thyroid Carcinomas Exhibiting Nodal Metastases and Extrathyroidal Extension May Lead to Early Disease Recurrence

Thyroid, Volume 28, Issue 7, Page 902-912, July 2018.


https://ift.tt/2ugPI4L

Gly m 5/Gly m 8 fusion component as a potential novel candidate molecule for diagnosing soybean allergy in Japanese children

Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2uoZnFm

Association Between Serum CK-18 Levels and the Degree of Liver Damage in Fructose-Induced Metabolic Syndrome

Metabolic Syndrome and Related Disorders, Ahead of Print.


https://ift.tt/2N3Swcc

Contributors

J. REGAN THOMAS, MD

https://ift.tt/2m9QOL9

Copyright

ELSEVIER

https://ift.tt/2ugPSIm

Injection Rhinoplasty Using Filler

Rhinoplasty is a commonly performed cosmetic surgery in Asia. Rhinoplasty using filler is preferred because has fewer side effects and shorter down time. The part of external nose between the skin and bone or cartilages consists of 4 layers. To prevent vascular compromise, the injection should be into deep fatty layer, preventing embolization. Filler is usually injected in the order of radix, rhinion, tip, and the supratip area. To minimize asymmetry, the surgeon should always mark the midline on the nasal bridge and perform the procedure without deviating from it.

https://ift.tt/2m58Gqi

Alar Base Reduction and Alar-Columellar Relationship

Nasal base modification can improve nostril shape and orientation, reduce alar flaring, improve nasal base width, correct nasal hooding, improve symmetry, and create overall facial harmony. For the correction of alar rim deformities, careful examination, consultation, and analysis and consideration of the condition of the skin are essential. Understanding the ala and surrounding tissue, supporting the lower lateral cartilage, and selecting the proper technique produce functionally and aesthetically good results.

https://ift.tt/2umBrTg

Septal Extension Graft in Asian Rhinoplasty

A septal extension graft (SEG) can control nasal tip projection, shape, and rotation. SEG and dorsal alloplastic implants have predominated in Asian rhinoplasty, leading to iatrogenic complications such as a foreshortened nose and destruction of remaining septum. The lower nasal two-thirds can be enhanced anteriorly and caudally using the septal L-strut extension graft in Asians with relatively small noses. The septal L-strut extension graft is indicated in primary cases in which the bony dorsum is acceptable but the cartilaginous dorsum is relatively hypoplastic, and in secondary cases with an iatrogenic short-nose deformity due to alloplastic implants.

https://ift.tt/2m58CXA

Rhinoplasty for the Asian Nose

FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA

https://ift.tt/2undPh8

Tip Grafting for the Asian Nose

Tip surgery during rhinoplasty is particularly difficult in Asians. Tip grafting is the best approach. Conchal cartilage with perichondrium and costal cartilage are powerful grafting materials. The most important grafting techniques are tip-onlay grafting, shield grafting, and multilayer tip grafting. Tip-onlay grafts are useful for dorsal convexity. Shield grafts require sufficient support to prevent bending. Multilayer tip grafts (usually 2 layers) are versatile. Asians vary in cartilage configuration, skin thickness, and aesthetic desires: tip-grafting strategies must be tailored to meet the aesthetic goals of individuals. Tip-grafting complications (eg, visible graft contour and infection) are not uncommon and should be considered.

https://ift.tt/2m58yXQ

Contents

Yong Ju Jang

https://ift.tt/2umycLD

Hump Nose Correction in Asians

Nasal hump surgery is frequently regarded as a reduction surgery in most Western rhinoplasty textbooks and referred to as reduction rhinoplasty. Most Asian hump noses have a small hump frequently associated with a low nasal dorsum and underprojection of the nasal tip. Correcting a hump nose in Asians has distinct differences in concept and technique. A small hump and additional need for augmentation of the dorsum and the tip often minimizes the amount of hump removal or obviates resection itself. Characteristics of the Asian hump nose with emphasis on surgical techniques commonly used to obtain reliable results are presented.

https://ift.tt/2m9PBmO

Hybrid Approach for Asian Rhinoplasty

The hybrid approach delivers unlimited exposure and technical access, enabling all the procedures of the open approach. In addition, the hybrid approach is flexible in its extent of "dissection/ exposure" It can be more of a classic endonasal or limited access approach in some cases or open structural rhinoplasty and reconstruction in others. The benefits of the nonopen approach deserve equal attention among Asian rhinoplasty surgeons and residents-in-training courses. The difference is not merely that it spares an incision, it is an opportunity to fine-tune minor millimeters of changes in every step of rhinoplasty, a real and significant benefit.

https://ift.tt/2zup6C4

Forthcoming Issues

Current Utilization of Biologicals

https://ift.tt/2m58qrk

Truly Asian Rhinoplasty

It is a well-recognized fact that there is a distinctive quality to Asian Rhinoplasty when compared with rhinoplasty for patients from other regions. For Asian patients, especially from East and Southeast Asia, the relatively smaller sized noses have made simple augmentation of the nose using alloplastic implant stand in for the term "Rhinoplasty." However, with growing understanding of the diverse anatomical features of Asian noses and an increased sophistication in patients' aesthetic demands, Asian surgeons came to realize that "Asian Rhinoplasty" can be far more complex.

https://ift.tt/2zziCCe

Clinical Thyroidology®for the Public – Highlighted Article

From Clinical Thyroidology^® for the Public: The aim of this study was to determine whether selenium supplementation given to patients with Graves' disease who were starting treatment with methimazole resulted in improved response or remission rates Read More…

We welcome your feedback and suggestions. Let us know what you want to see in this publication.

Feedback & Suggestions

The post Clinical Thyroidology^®for the Public – Highlighted Article appeared first on American Thyroid Association.

https://ift.tt/2znWPNw

Einfluss einer strukturierten Nachsorge auf die Therapietreue bei OSAS-Patienten unter CPAP-Therapie

Laryngo-Rhino-Otol
DOI: 10.1055/a-0640-9198

Hintergrund Die Therapie mit CPAP (continuous positive airway pressure therapy) ist die Referenztherapie beim mittel- und hochgradigen obstruktiven Schlafapnoesyndrom (OSAS). Die Therapietreue bei diesem Verfahren ist jedoch nicht zufriedenstellend. Ziel der Untersuchung war die Analyse der Einflussfaktoren auf die Therapietreue sowie die Evaluation, ob eine strukturierte Nachsorge die Therapietreue verbessert. Material und Methoden In dieser Studie wurden alle Patienten (n = 237) mit der Diagnose eines milden bis schweren OSAS und einer neu angepassten CPAP-Therapie im Zeitraum zwischen 2011 und 2013 untersucht. Die Nachsorgetermine fanden alle 1593,7 ± 77,4 CPAP-Betriebsstunden statt. Ergebnisse Unter Therapie nahm der AHI-Wert (Apnoe-Hypopnoe-Index) signifikant ab (5,6 ± 8,5/h; p < 0,001). 79 % erfüllten die Kriterien einer CPAP-Therapietreue (mindestens 4 Betriebsstunden an 7 Tagen pro Woche). Es gab keine signifikanten Einflüsse von demografischen, klinischen oder pharmakologischen Charakteristika der Patienten auf die Therapietreue. Die häufigsten Probleme unter CPAP-Therapie waren Trockenheit der Nasen- und Rachenschleimhäute (43,7 %) und Druckstellen (22,4 %). Die CPAP-Therapietreue korrelierte nicht mit den Werten der Epworth Sleepiness Scale. Die Zufriedenheit mit der Nachsorge korrelierte signifikant mit der Therapietreue (r = 0,185; p = 0,032), während der Therapiedruck keinen signifikanten Einfluss hierauf zeigte (r = −0,072; p = 0,383). Schlussfolgerungen Eine strukturierte, individuell angepasste Nachsorge ist wichtig für die Therapietreue. In Zukunft sollte im Rahmen der Nachsorge neben der Kontrolle des Therapieerfolges mehr Aufmerksamkeit auf Aspekte der Problemlösung, Rückkopplung, Schulung und Motivation gerichtet werden.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2L622hT

Erratum: Economic Analysis of Using Free Fat Graft or Acellular Dermis to Prevent Post-parotidectomy Frey Syndrome

Facial plast Surg
DOI: 10.1055/s-0038-1667294

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

https://ift.tt/2mdt60B

Regular follow-up visits reduce the risk for asthma exacerbation requiring admission in Korean adults with asthma

Asthma requires regular follow-up visits and sustained medication use. Although several studies have reported the importance of adherence to medication and compliance with the treatment, none to date have repo...

https://ift.tt/2N1tYkb

Does long-term success from endoscopic DCR correlate with early post-operative reduction in tearing?

The purpose of the study was to determine the association between early post-operative improvement in tearing and the long-term success rate of endoscopic dacryocystorhinostomy (eDCR).

https://ift.tt/2NGse0P

Biomet stock temporomandibular joint prosthesis: long-term outcomes of the use of titanium condyles secured with four or five condylar fixation screws

The aim of this study was to determine the long-term outcomes following TMJ replacement using the stock Zimmer-Biomet TMJ device. In particular, investigated whether the titanium condylar implant and number of screws used to fixate it to the mandibular ramus had any impact on outcomes.

https://ift.tt/2N02GKM

Health-Related Quality of Life in Cleft Lip and/or Palate Patients – a cross-sectional study from preschool age until adolescence

Cleft lip and/or palate (CLP) is the most common congenital craniofacial anomaly. Multiple operations, long-lasting supplementary treatments, as well as impaired functional and esthetic outcome might have a negative impact on patients' social–emotional functioning and self-esteem, resulting in a lower health-related quality of life (HRQoL).

https://ift.tt/2KPmKmA

Interleukin-18 as a diagnostic marker of adult-onset Still’s disease in older patients: a case report and review of the literature

Adult onset Still's disease is a systemic auto-inflammatory condition of unknown etiology characterized by intermittent spiking high fever, an evanescent salmon-pink or erythematous maculopapular skin rash, ar...

https://ift.tt/2KP8WZi

Remote partner assisted skin self‐examination skills training of melanoma survivors and their partners

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2L7dMNy

Alcohol‐induced respiratory symptoms improve after aspirin desensitization in patients with aspirin‐exacerbated respiratory disease

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2L7aXMs

PBMT and topical diclofenac as single and combined treatment on skeletal muscle injury in diabetic rats: effects on biochemical and functional aspects

Abstract

Physical exercise generates several benefits in a short time in patients with diabetes mellitus. However, it can increase the chances of muscle damage, a serious problem for diabetic patients. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to treat these injuries, despite the serious adverse effects. In this way, photobiomodulation therapy (PBMT) with low-level laser therapy (LLLT) and/or light emitting diode therapy (LEDT) can be used as an alternative in this case. However, its efficacy in tissue repair of trauma injuries in diabetes mellitus until now is unknown, as well as the combination between PBMT and NSAIDs. The objective of the present study was to evaluate the effects of NSAIDs and PBMT applied alone or combined on functional and biochemical aspects, in an experimental model of muscle injury through controlled trauma in diabetic rats. Muscle injury was induced by means of a single trauma to the animals' anterior tibialis muscle. After 1 h, the rats were treated with PBMT (830 nm; continuous mode, with a power output of 100 mW; 3.57 W/cm²; 3 J; 107.1 J/cm², 30 s), diclofenac sodium for topical use (1 g), or combination of them. Our results demonstrated that PBMT + diclofenac, and PBMT alone reduced the gene expression of cyclooxygenase-2 (COX-2) at all assessed times as compared to the injury and diclofenac groups (p < 0.05 and p < 0.01 respectively). The diclofenac alone showed reduced levels of COX-2 only in relation to the injury group (p < 0.05). Prostaglandin E₂ levels in blood plasma demonstrated similar results to COX2. In addition, we observed that PBMT + diclofenac and PBMT alone showed significant improvement compared with injury and diclofenac groups in functional analysis at all time points. The results indicate that PBMT alone or in combination with diclofenac reduces levels of inflammatory markers and improves gait of diabetic rats in the acute phase of muscle injury.

https://ift.tt/2m94NAN

Infratemporal fossa tumors: When to suspect a malignant tumor? A retrospective cohort study of 62 cases

Publication date: Available online 10 July 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): Q. Lisan, N. Leclerc, R. Kania, J.-P. Guichard, P. Herman, B. Verillaud

Abstract

Objectives

Infratemporal fossa (ITF) tumors are rare and little is known about their general epidemiology, making it sometimes difficult for clinicians, who seldom encounter them, to distinguish between benign and malignant forms on the basis of the initial clinical and radiological work-up alone. The objectives of this retrospective study were: (i) to determine the respective prevalences of the various histologic types of ITF tumor, and (ii) to assess associations between certain clinical and radiological features and malignancy.

Methods

A single-center observational study in a university hospital included all new consecutive cases of ITF tumor treated from January 2000 to December 2016. Histologic type, demographics, clinical presentation and imaging findings were analyzed.

Results

In total, 62 patients were included. 74% of tumors were benign (n = 46) and 26% malignant. Juvenile nasopharyngeal angiofibroma, adenoid cystic carcinoma and schwannoma were the most frequent histologic types, accounting for 47%, 16% and 10% of cases, respectively. The only clinical or imaging signs significantly associated with malignancy were trismus, facial pain, facial hypoesthesia and neural invasion on magnetic resonance imaging (all P-values < 0.05).

Conclusion

This study provides general epidemiological data on ITF tumors, and identified several clinical and radiologic signs to help clinicians suspect malignancy.

https://ift.tt/2uhXqdW

Comparative effectiveness of photobiomodulation and manual therapy alone or combined in TMD patients: a randomized clinical trial

Abstract The effectiveness of photobiomodulation (PBM) and manual therapy (MT), alone or combined (CT), were evaluated in pain intensity, mandibular movements, psychosocial aspects, and anxiety symptoms of temporomandibular disorder (TMD) patients. Fifty-one TMD patients were randomly assigned to three groups: the PBM group (n = 18), which received PBM with 808 nm, 100 mW, 13.3 J/cm2, and 4 J per point; the MT group (n=16) for 21 minutes each session on masticatory muscles and temporomandibular joint TMJ; and the CT group (n = 17), applied during twelve sessions. Seven evaluations were performed in different moments using visual analogue scale (VAS), Research Diagnosis Criteria for Temporomandibular Disorders (RDC/TMD) Axis I and II, and Beck anxiety inventory (BAI). All groups demonstrated reductions in pain and improvement in jaw movements during treatment and at follow-up (< 0.001). The assessment of psychosocial aspects of TMD, comparing baseline and follow-up in all treatment groups, revealed that treatment did not promote modification in the intensity of chronic pain (p > 0.05). However, depression symptoms showed a reduction in PBM and CT groups (p≤0.05). All treatments promoted reduction in physical symptoms with and without pain and enhancement of jaw disabilities (p ≤ 0.05). MT promotes improvement in 5 functions, PBM in 2, and CT in 1 (p < 0.001). BAI analysis revealed that all treatments lead to a reduction in anxiety symptoms (p≤0.05). All protocols tested were able to promote pain relief, improve mandibular function, and reduce the negative psychosocial aspects and levels of anxiety in TMD patients. However, the combination of PBM and MT did not promote an increase in the effectiveness of both therapies alone.

https://ift.tt/2Jc4huS

Stability and bone loss around submerged and non-submerged implants in diabetic and non-diabetic patients: a 7-year follow-up

Abstract To evaluate peri-implant bone loss (PIBL) and stability around submerged and non-submerged dental implants in patients with and without type 2 diabetes mellitus (T2DM). Thirty-five T2DM and non-diabetic (NT2DM) patients were included in this study. Demographic data were recorded using a questionnaire and PIBL was measured on digital radiographs. Resonance frequency analysis (RFA) was carried out for each implant at the time of fixture placement and at 3 months in both groups. P values less than 0.05 were considered statistically significant. One hundred and eighteen dental implants with a mean height of 10 to 12 mm and 3.3 to 4.1 mm in diameter were placed. The comparison of the mean RFA values at baseline and at 3 months was statistically significant (p = 0.008) in T2DM patients. The inter-group mean RFA values at baseline and at 3 months were not significant (p > 0.05). PIBL was significantly high in T2DM as compared to NT2DM patients at each follow-up (p < 0.05). At 2, 3, and 7 years, non-submerged dental implants showed significantly high PIBL in T2DM patients as compared to NT2DM individuals (p<0.05). The results of the present clinical study demonstrate increased PIBL around non-submerged single-tooth implant-supported restorations in T2DM patients, which may be due to the immune inflammatory status.

https://ift.tt/2L4iMWq

A comparison of different bone graft materials in peri-implant guided bone regeneration

Abstract The aim of this study was to compare the effects of hydroxyapatite (HA), deproteinized bovine bone (DPB), human-derived allogenic bone (HALG), and calcium sulfate (CAP) graft biomaterials used with titanium barriers for bone augmentation to treat peri-implant defects in rat calvarium treated by guided bone regeneration (GBR). Thirty-two female Sprague-Dawley rats were divided into four groups: DPB, HALG, HA, and CAP. One titanium barrier was fixed to each rat's calvarium after the titanium implants had been fixed. In total, 32 titanium implants and barriers were used. Ninety days after the surgical procedure, all the barriers were removed. After decalcification of bone tissue, the titanium implants were removed gently, and new bone regeneration in the peri-implant area was analyzed histologically. Immunohistochemical staining of vascular endothelial growth factor (VEGF) was also performed. There were no statistically significant between-group differences in new bone regeneration or VEGF expression after 3 months. According to the results of the histological and immunohistochemical analyses, none of the grafts used in this study showed superiority with respect to new bone formation.

https://ift.tt/2J9Y6aN

Accuracy of visual and image-based ICDAS criteria compared with a micro-CT gold standard for caries detection on occlusal surfaces

Abstract The aim of this study was to check the in vitro accuracy of ICDAS criteria on digital images compared to visual examination for the diagnosis of occlusal caries against a micro-CT gold standard. ICDAS was scored in 40 extracted permanent molars by means of visual inspection and stereomicroscopic images. Visual examinations were performed in duplicate and at a one-week interval by three different calibrated examiners. The analysis of digital images by ICDAS criteria was also performed in duplicate, 1 month after visual examinations. The detection methods were compared by means of sensitivity, specificity, area under the curve, predictive positive and negative values, and accuracy for two different thresholds (1- sound vs. carious teeth; 2- tooth requiring operative vs. non-operative treatment). Sensitivity and accuracy values for threshold 1 in the visual ICDAS and image-based ICDAS methods were high for sensitivity (0.93 and 0.97) and for accuracy (0.83 and 0.85), but low for specificity (0.55 for both methods). Specificity values for threshold 2 were 0.77 and 0.82, while sensitivity was 0.33 and 0.28 for each method. Spearman's rank correlation coefficient was 0.53 and 0.43 (p<0.05) for visual and image-based ICDAS compared to the gold standard scores. Both visual and image-based ICDAS scores were similar to each other in terms of diagnostic accuracy when compared to the micro-CT gold standard. Low specificity for the presence of caries and sensitivity for the detection of caries requiring operative treatment were found.

https://ift.tt/2L4iC1g

The role of contextual and individual factors on periodontal disease in Uruguayan adults

Abstract The present study aimed at understanding the relationship between periodontitis and socio-contextual and individual determinants of health. Data from "The First Uruguayan Oral Health Survey, 2011", which included 223 and 455 individuals with 35–44 and 65–74 years old respectively, were used. A stratified, multistage cluster sampling design was adopted (cities with ≥ 20.000 residents). Periodontitis was assessed using the modified Community Periodontal Index (CPI) and clinical attachment loss (CAL) (periodontal pocket and CAL ≥ 4 mm). Independent variables included contextual socioeconomic status (SES) measured by proportion of houses with Unsatisfied Basic Needs (UBN) and individual demographic and behavioral factors. Logistic regression multilevel models were generated. Living in contexts with a higher UBN was associated with higher odds for periodontitis in both age groups, even when adjusting for individual level variables (odds ratio [OR] = 1.51, 95%CI = 1.42–1.60 and 1.31, 95%CI = 1.21–1.42, respectively). Being male or heavy smoker increased the odds of periodontitis in this population for both age groups. Social structure impacts periodontal disease by modifying individual socioeconomic situations: in better socioeconomic context, UBN acts increasing the protector role of socioeconomic situation but in a poverty context the role is attenuated. Conclusions for this study are that periodontitis varies across contextual socio-demographic groups being higher in the population with a lower SES, challenging health authorities to integrate oral health into national non-communicable diseases programs.

https://ift.tt/2L8BAk7

School environment and individual factors influence oral health related quality of life in Brazilian children

Abstract The aim of this study was to verify the influence of school environment and individual factors on oral health related quality of life (OHRQoL) in a representative sample of Brazilian schoolchildren. A cross-sectional study was conducted with 1,134 12-year-old schoolchildren from Santa Maria, Southern Brazil. Clinical variables were obtained from examinations carried out by calibrated individuals. In addition, parents/guardians answered a semi-structured questionnaire about sociodemographic characteristics. Contextual variables were obtained from the city's official database, including the mean income of the neighborhood in which the school was located and the Basic School's Development Index (IDEB) of the school. The Brazilian version of the Child Perception Questionnaire (CPQ11–14) was used to access OHRQoL. Data analysis was conducted using multilevel Poisson regression. Children studying in schools with a higher classification on the IDEB presented a lower CPQ11–14 mean score (rate ratio 0.80, 95%CI 0.74–0.88) than those studying in schools with a lower IDEB. Regarding individual variables, children with carious cavities, malocclusion, and gingival bleeding presented higher CPQ11-14 mean values than their counterparts. The same was observed in children from families with low socioeconomic status. School environment, and individual clinical and socioeconomic factors were associated with schoolchildren's OHRQoL.

https://ift.tt/2L4irD8

Erratum: Active compounds and derivatives of camellia sinensis responding to erosive attacks on dentin. Braz Oral Res. 2018;32:e40.

Abstract The aim of the present study was to evaluate the association between metabolic syndrome (MS) and periodontitis (PD), through a systematic review and meta-analysis. Original observational studies assessing the association between MS and PD in adults, published before May 11th (2017), were identified through electronic searches of MEDLINE, EMBASE and Cochrane Library databases. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used. For studies to be included, they had to mention the criteria used to diagnose MS and to have used at least one clinical measure to diagnose PD. There was no language restriction. Three reviewers independently identified eligible studies for possible inclusion in the systematic review and meta-analysis. The quality of the studies was evaluated by the Newcastle-Ottawa scale for observational studies. A random model meta-analysis was conducted. The strategies used to investigate heterogeneity were sequential analysis, subgroup analysis, univariate meta-regression and sensitivity analysis. Thirty-three studies met the inclusion criteria for the systematic review, and 26 had enough information to be included in the meta-analysis, totaling 52,504 patients. MS and PD were associated with an odds ratio of 1.38 (95%CI 1.26–1.51; I2 = 92.7%; p < 0.001). Subgroup analysis showed that complete periodontal examination (I2 = 70.6%; p < 0.001) partially explained the variability between studies. The present findings suggest an association between MS and PD. Individuals with MS are 38% more likely to present PD than individuals without this condition. Prospective studies should be conducted to establish cause and effect relations between MS and PD.

https://ift.tt/2Jc3Roi

Multisystem amyloidosis as the unifying diagnosis for constipation, collapse and cardiomyopathy

Amyloidosis a rare disorder characterised by the deposition of amyloid protein aggregates in different organ systems throughout the body with resulting functional impairment of affected organs. It can present with localised or multisystemic deposits. Diagnosis is often delayed due to the non-specific nature of the symptoms. We present the case of a 59-year-old man with a 12-month history of non-specific symptoms. Investigations revealed Helicobacter pylori positive gastritis. Blood tests showed only a normocytic anaemia and thrombocytopaenia. CT scan showed proximal sigmoid thickening. Biopsies were unremarkable. Echocardiogram and cardiac MRI scan showed restrictive cardiomyopathy. Congo red staining of gastric biopsies showed amyloid deposition. The patient had elevated serum kappa light chains and a bone marrow biopsy confirmed multiple myeloma and he was subsequently diagnosed with systemic light chain (AL) amyloidosis secondary to this. He was started on chemotherapy and parenteral nutrition; however, he deteriorated rapidly and so was started on palliative treatment and discharged home.

https://ift.tt/2ufg4Dc

A case of posterior reversible encephalopathy syndrome associated with sepsis

Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterised by parieto-occipital vasogenic oedema seen on MRI. Infection and sepsis has been reported as a possible cause for this disorder.

We present a 19-year-old immunocompetent Caucasian man with known type 1 diabetes mellitus who presented to the emergency department with acute onset of bilateral visual loss, headaches and hypertension; he had been discharged 2 weeks ago for severe diabetic ketoacidosis and Staphylococcus aureus bacteraemia. Initial CT scan of the head was negative, but MRI showed findings suggestive of PRES. He was treated with nicardipine drip for strict blood pressure management and symptoms resolved within 4 days. PRES is a rare disease that has been increasingly reported as MRI becomes more commonplace. Usually associated with immunological disease, pre-eclampsia and cytotoxic therapies but an association with sepsis due to gram-positive bacteria.

https://ift.tt/2ukOzbz

Gluten-free diet: a possible treatment for chronic diarrhoea in common variable immunodeficiency

Gastrointestinal disorders are frequent in common variable immunodeficiency (CVID). Clinical symptoms and histological alterations in CIVD can resemble celiac disease. Usually, patients with chronic diarrhoea associated with CVID do not improve with a gluten-free diet. The authors present a case of a male patient who was diagnosed with CVID at age 33 and had chronic diarrhoea which resolved after initiating a gluten-free diet. Clinical relapse occurred after gluten reintroduction. The main objective of this case report is to alert clinicians to implement a gluten-free diet in patients with CVID with chronic diarrhoea.

https://ift.tt/2u7o3TC

Unusual surgical emergency in a patient of dengue haemorrhagic fever: spontaneous rectus sheath haematoma leading to abdominal compartment syndrome

Abdominal compartment syndrome (ACS) is an uncommon complication of dengue haemorrhagic fever (DHF), described so far only in association with fluid refractory shock and high-volume resuscitation. We describe an unusual case of ACS in a patient of DHF where raised intra-abdominal pressure was due to spontaneous rectus sheath haematoma causing external compression. Early recognition of the haematoma, constant vigilance and timely decision for surgical intervention could salvage the patient with complete recovery of organ function.

https://ift.tt/2zoj5XN

A novel mutation in Wiskott-Aldrich gene manifesting as macrothrombocytopenia and neutropenia

Wiskott-Aldrich syndrome (WAS) is a rare X-linked disorder, described as a clinical triad of microthrombocytopenia, eczema and recurrent infections. Different mutations in WAS gene have been identified, resulting in various phenotypes and a broad range of disease severity, ranging from classic WAS to X-linked thrombocytopenia and X-linked neutropenia. WAS in some cases can be fatal without haematopoietic stem cell transplantation early in life. In this particular case, we present a novel mutation with a unique presentation. An 18-year-old man incidentally found to have macrothrombocytopenia and neutropenia at 16 years of age later found to be hemizygous for c. 869T>C (p.Ile290Thr) mutation in WAS gene. The late presentation, absence of other manifestations of WAS and presence of macrothrombocytopenia, rather than microthrombocytopenia, which is usually a characteristic finding in WAS, misled the initial diagnosis. On review of literature, this mutation has not been reported as causing WAS.

https://ift.tt/2zpBKSO

Rectus sheath haematoma causing ureteric obstruction

Rectus sheath haematoma is an uncommon condition. However, its incidence is increasing, attributed to greater use of anticoagulant therapy. We present the case of an 83-year-old woman on therapeutic enoxaparin for a prior pulmonary embolus who underwent elective right hemicolectomy and developed a rectus sheath haematoma 13 days postoperatively. Her extensive haematoma compressed retroperitoneal structures including the right ureter. She was successfully managed conservatively.

https://ift.tt/2u7o220

Rare but life-threatening complication of fecalith

Description

A 78-year-old woman with history of Addison's disease, hypothyroidism, hypertension and recent hospital admission for asthma exacerbation requiring hospitalisation for steroid pulse presented to the emergency department with 1 day of significant epigastric and right lower quadrant pain. Her pain steadily worsened and was associated with nausea and clear emesis. She was on a steroid taper for her recent asthma exacerbation, and she is normally on baseline low-dose steroids for her Addison's disease.

On evaluation in the emergency department, the patient was noted to be tachycardic in the 100s but otherwise haemodynamically stable. Her abdomen was distended, and she endorsed moderate to severe tenderness over her right lower quadrant with guarding but no rebound. Her labs were notable for white cell count of 31.6x10⁹/L and a lactate of 4.5 mmol/L.

The patient was promptly fluid resuscitated, given intravenous antibiotics and analgesics. Given concern for bowel ischaemia, an abdominopelvic CT angiogram was...

https://ift.tt/2zoiRjp

Giant abdominal metastasis from cardiac liposarcoma

Description 

The patient was a 58-year-old man. His history began 6 years before the admission to our hospital because of a syncopal episode. MRI showed a 2 cm lesion at the confluence of the left pulmonary veins. It was surgically removed and the histopathological diagnosis was of 'pleomorphic liposarcoma'. The postoperative course was regular.

Since the patient lived in a rural area, he was not treated in a high-volume reference centre for sarcoma and follow-up was not managed by a dedicated multidisciplinary team. Three years later, for the onset of an intestinal occlusion, he underwent emergency laparotomy. An ileo-ileal invagination due to a little ileal lesion was treated with a 30 cm intestinal resection. The histopathological response was again of liposarcoma. Chemotherapy was not performed.

One year later, a thoracoabdominal CT scan showed a heart recurrence and an enormous abdominal mass involving many ileal loops with intestinal subocclusion. The patient...

https://ift.tt/2u6feJU

When a patient with depression is feeling sleepy, be aware of sleep apnoea

A 67-year-old man was referred to an outpatient clinic of geriatric psychiatry because of persistent symptoms of depression and anxiety, accompanied by sleepiness. The latter had been evaluated multiple times in the general practice over several years; each time it was considered to be a symptom of depression. After referral, the patient was diagnosed with severe obstructive sleep apnoea (OSA), comorbid to a depressive and anxiety disorder. Retrospectively, we conclude that affective symptoms accompanying OSA and sleepiness were wrongfully interpreted as depression, but after having led to problems at work, they have triggered psychiatric comorbidity. Treatment of OSA in addition to the psychiatric disorders resulted in a full recovery over time. The delayed diagnosis of OSA has certainly diminished the patient's quality of life and might have precipitated the depressive disorder. Moreover, OSA poses patients at an increased risk of cardiovascular disease, hypertension, stroke and traffic accidents.

https://ift.tt/2uffEg6

Mixed extragonadal germ cell tumour of the prostate

Extragonadal germ cell tumours (EGGCTs) originated in prostate are extremely rare, with <20 cases described in the literature. We report a case of a patient with a primary prostatic mixed EGGCT. A 47-year-old man presenting severe low urinary tract symptoms and signs of prostatic enlargement, with no malignancy suspicion, underwent transurethral resection of the prostate. The histopathological evaluation suggested the diagnosis of a retroperitoneal sarcoma. The patient underwent neoadjuvant chemotherapy and then was submitted to radical cystoprostatectomy. Histology revealed a mixed EGGCT of the prostate with yolk sac tumour and seminoma components. No testicular abnormalities were identified on the postoperative scrotal ultrasound. The patient went through four cycles of chemotherapy with bleomycin, etoposide and cisplatin. After 12 months of follow-up, the patient is alive and free of recurrence.

https://ift.tt/2u6dEYs

Recurrent minor strokes/TIA with a right to left shunt

A patient came to our institution for evaluation and closure of suspected patent foramen ovale actively manifesting as cerebrovascular accident. Through further studies, we found the presence of a pulmonary arteriovenous fistula, which was subsequently and successfully closed through non-invasive percutaneous selective segmental pulmonary artery embolisation.

https://ift.tt/2zoiJAr

Empirical treatment of tuberculosis: TB or not TB?

Of the 8.6 million new cases of tuberculosis (TB) that occur globally each year, a quarter occur in India. We describe the case of a 38-year-old Indian woman who presented with symptoms of hepatitis after being treated empirically with anti-TB therapy for five months. The patient was suspected to have TB after having recurrent episodes of coughing which would improve briefly before her respiratory symptoms returned, which led to her being treated at various healthcare clinics and hospitals. We highlight the challenges the patient faced due to the lack of centralised medical records which would have prevented unnecessary investigations and treatment.

https://ift.tt/2u6fdFQ

Cold agglutinin-mediated autoimmune haemolytic anaemia associated with diffuse large B cell lymphoma

Cold agglutinin-mediated autoimmune haemolytic anaemia is associated with the development of autoantibodies that can agglutinate red blood cells at cold temperatures. While primary cold agglutinin disease is an idiopathic lymphoproliferative disorder, secondary cold agglutinin syndrome (CAS) complicates other diseases such as infections, autoimmune diseases and cancers, mostly low-grade lymphomas. Early recognition, treatment of CAS and treatment of its associated underlying diseases are crucial to a successful outcome. We report a case of CAS in a setting of diffuse large B cell lymphoma, in which the treatment course was complicated by worsened anaemia due to chemotherapy-induced myelosuppression. We reviewed previously reported cases and discussed diagnosis and treatment strategies, including novel complement inhibitors, as potential future therapy.

https://ift.tt/2zsNyUo

Postoperative diffuse alveolar haemorrhage: insidious negative pressure or sevoflurane induced?

Negative pressure pulmonary oedema is well described in the literature as an uncommon but recognised complication of general anaesthe sia; negative pressure diffuse alveolar haemorrhage is a rarer consequence. We report a case of massive haemoptysis following elective general anaesthesia using a laryngeal mask airway device and sevoflurane anaesthetic maintenance. The patient had no obvious signs of laryngospasm or other cause of upper airway obstruction perioperatively. We explore the possibility that the haemoptysis was caused by clinically unapparent negative pressure generation, but also ask whether the anaesthetic agent should be considered as a culprit.

https://ift.tt/2u8P218

Lineäre, irregulär konfigurierte Pigmentierungen am gesamten Integument

https://ift.tt/2m57GCs

Traumatologie der Orbita

Zusammenfassung

Hintergrund

Bei einem Trauma des Gesichtsschädels ist eine begleitende Fraktur der Orbita wegen der anatomischen Gegebenheiten (Stützpfeilersystem des Mittelgesichts) häufig. Ätiologisch sind die Ursachen nach lokoregionalen Gegebenheiten vielfältig.

Material/Methoden

Es wird ein Überblick über die Traumatologie der Orbita einschließlich des diagnostischen Vorgehens, der Symptome und der Therapie gegeben. Darüber hinaus erfolgte eine prospektive Analyse am eigenen Patientenkollektiv eines Jahres inklusive eines 5‑Jahres-Follow-up.

Ergebnisse

Die möglichen Frakturen des Mittelgesichts mit Beteiligung der Orbita einschließlich ihrer Klassifikationen werden aufgeführt. Auch die entscheidenden klinischen Symptome und das diagnostische Vorgehen werden dargestellt. Im Rahmen des therapeutischen Vorgehens werden neben dem – meist erforderlichen – operativen Therapieansatz auch die konservativen Therapieoptionen und deren Voraussetzung zur konservativen Therapie aufgezeigt. Im eigenen Patientenkollektiv zeigten sich deutliche Unterschiede im Entstehungsmechanismus. Bei Rohheitsdelikten verletzten sich eher männliche, jüngere Patienten, während vermehrt weibliche, ältere Patienten stürzten. In 17 % der Fälle erfolgte eine konservative Therapie, in 83 % eine operative Versorgung.

Schlussfolgerung

Die Traumatologie der Orbita bedarf einer individuellen Therapieentscheidung. Auch ein konservatives Regime kann zu guten Ergebnissen führen. Die Therapie einer Fraktur der Orbita und des Mittelgesichts sollte aufgrund der fachlichen Kompetenz auch in Bezug auf die Nachbarstrukturen in den Händen erfahrener Mittelgesichtschirurgen liegen.

https://ift.tt/2zsjzvO

Lack of association between LTF gene polymorphisms and different caries status in primary dentition

Oral Diseases, Volume 0, Issue ja, -Not available-.


https://ift.tt/2m5bjs7

TIMP‐1 association with collagen type I overproduction in hereditary gingival fibromatosis

Oral Diseases, Volume 0, Issue ja, -Not available-.


https://ift.tt/2ujBT4w

Type 2/Th2‐driven inflammation impairs olfactory sensory neurogenesis in mouse chronic rhinosinusitis model

Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2KLWM3p

Neuromedin‐U directly induces degranulation of skin mast cells, presumably via MRGPRX2

Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2N6PfJo

A missense mutation of the plasminogen gene in hereditary angioedema with normal C1 inhibitor in Japan

Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2KHY3IG

Dietary assessment and the development of asthma in Korean adolescents and adults

Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2N6P8gW