An Introduction to Pharmacovigilance, 2nd ed

No abstract available

https://ift.tt/2Lan1Rr

In Response

No abstract available

https://ift.tt/2LyN2pA

Preventing Adverse Events in Cataract Surgery: Sub-Tenon’s Block

No abstract available

https://ift.tt/2L9Ds0c

Survival Analysis and Interpretation of Time-to-Event Data: The Tortoise and the Hare

Survival analysis, or more generally, time-to-event analysis, refers to a set of methods for analyzing the length of time until the occurrence of a well-defined end point of interest. A unique feature of survival data is that typically not all patients experience the event (eg, death) by the end of the observation period, so the actual survival times for some patients are unknown. This phenomenon, referred to as censoring, must be accounted for in the analysis to allow for valid inferences. Moreover, survival times are usually skewed, limiting the usefulness of analysis methods that assume a normal data distribution. As part of the ongoing series in Anesthesia & Analgesia, this tutorial reviews statistical methods for the appropriate analysis of time-to-event data, including nonparametric and semiparametric methods—specifically the Kaplan-Meier estimator, log-rank test, and Cox proportional hazards model. These methods are by far the most commonly used techniques for such data in medical literature. Illustrative examples from studies published in Anesthesia & Analgesia demonstrate how these techniques are used in practice. Full parametric models and models to deal with special circumstances, such as recurrent events models, competing risks models, and frailty models, are briefly discussed. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Accepted for publication June 8, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Patrick Schober, MD, PhD, MMedStat, Department of Anesthesiology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands. Address e-mail to p.schober@vumc.nl. © 2018 International Anesthesia Research Society

https://ift.tt/2LxwRsq

Salivary adiponectin, but not adenosine deaminase, correlates with clinical signs in women with Sjögren’s syndrome: a pilot study

Abstract

Objectives

To evaluate salivary adiponectin and adenosine deaminase (ADA) in women suffering from Sjögren's syndrome (SS).

Methods

Salivary adiponectin and ADA were measured in patients with SS (n = 17) and compared to their values in healthy controls (n = 13) and patients suffering from drug-induced xerostomia (non-SS sicca group; n = 19). A clinical history was made for each patient, patients were examined clinically, and xerostomia inventory (XI) was performed.

Results

Salivary adiponectin corrected by total protein was higher in patients with SS than in healthy individuals (P < 0.05) or patients with non-SS sicca (P < 0.01) and correlated with XI (r = 0.555; P < 0.05). Salivary ADA was higher in patients with SS and non-SS sicca compared to controls (P < 0.05 in both cases).

Conclusion

The results of the present study indicate that adiponectin and ADA are increased in the saliva of patients with SS.

Clinical relevance

Salivary adiponectin corrected by total protein can be a potential biomarker of SS.

Trial registration

NCT03156569

https://ift.tt/2zRvkMM

Correction to: Effectiveness of adjunctive hyaluronic acid application in coronally advanced flap in Miller class I single gingival recession sites: a randomized controlled clinical trial

The figure 2 of the original version of this article was incorrect. Correct figure is presented below.

https://ift.tt/2uSkBfk

In silico study of Moxifloxacin derivatives with possible antibacterial activity against a resistant form of DNA gyrase from Porphyromonas gingivalis

Publication date: Available online 19 July 2018

Source: Archives of Oral Biology

Author(s): Cristian Rocha-Roa, Rodrigo Cossio-Pérez, Diego Molina, Jorge Patiño, Néstor Cardona

Abstract

We performed a homology modeling of the structure of a non-mutated and mutated Ser83→Phe DNA gyrase of Porphyromonas gingivalis. The model presented structural features conserved in type II topoisomerase proteins. We designed and evaluated in silico structural modifications to the core of Moxifloxacin by molecular docking, predicted toxicity and steered molecular dynamics simulations (SMD). Our results suggest that 8D derivative of Moxifloxacin could present a strong inhibitory activity in Porphyromonas gingivalis bacteria that exhibits resistance to some conventional fluoroquinolone drugs. Also, our results suggest that hydrophobic radicals in the hydroxyl group at position 3 of the quinolone core would increase the antibacterial activity of the compound when a reported mutation Ser83→Phe is present in the DNA gyrase protein. In addition, new candidates that could have a higher antibacterial activity compared to Moxifloxacin in non-resistant bacteria are proposed.

https://ift.tt/2LdsW8o

In silico study of Moxifloxacin derivatives with possible antibacterial activity against a resistant form of DNA gyrase from Porphyromonas gingivalis

Publication date: Available online 19 July 2018

Source: Archives of Oral Biology

Author(s): Cristian Rocha-Roa, Rodrigo Cossio-Pérez, Diego Molina, Jorge Patiño, Néstor Cardona

Abstract

We performed a homology modeling of the structure of a non-mutated and mutated Ser83→Phe DNA gyrase of Porphyromonas gingivalis. The model presented structural features conserved in type II topoisomerase proteins. We designed and evaluated in silico structural modifications to the core of Moxifloxacin by molecular docking, predicted toxicity and steered molecular dynamics simulations (SMD). Our results suggest that 8D derivative of Moxifloxacin could present a strong inhibitory activity in Porphyromonas gingivalis bacteria that exhibits resistance to some conventional fluoroquinolone drugs. Also, our results suggest that hydrophobic radicals in the hydroxyl group at position 3 of the quinolone core would increase the antibacterial activity of the compound when a reported mutation Ser83→Phe is present in the DNA gyrase protein. In addition, new candidates that could have a higher antibacterial activity compared to Moxifloxacin in non-resistant bacteria are proposed.

https://ift.tt/2LdsW8o

Core circadian clock gene expression in human dental pulp‐derived cells in response to L‐mimosine, hypoxia and echinomycin

European Journal of Oral Sciences, Volume 126, Issue 4, Page 263-271, August 2018.


https://ift.tt/2Ns8BJ6

Synergistic effects of ischemic preconditioning and immediate post‐conditioning in the protection against ischemia/reperfusion injury in rabbit submandibular glands

European Journal of Oral Sciences, Volume 126, Issue 4, Page 282-291, August 2018.


https://ift.tt/2Nw7hoy

Author Guidelines

European Journal of Oral Sciences, Volume 126, Issue 4, Page 344-344, August 2018.


https://ift.tt/2O35wAf

Issue Information

European Journal of Oral Sciences, Volume 126, Issue 4, Page i-iii, August 2018.


https://ift.tt/2O6TmGC

Correlating regional emergency epistaxis visits with internet search activity

Publication date: Available online 19 July 2018

Source: American Journal of Otolaryngology

Author(s): Shane Griffith, Robert Archbold, Stephen Schell

Abstract

Purpose

To investigate the correlation between internet search activity and epistaxis-related Emergency Department visits.

Materials and methods

Data from Google Trends were obtained (www.google.com/trends) for the search term "nosebleed" in Erie County, Pennsylvania during a five-year period. All epistaxis-related CPT code events were obtained from one hospital in this county during the same period. Google total counts were cross tabulated with the following month's ED visits. Graphical analysis and correlation were used to assess the relationship between ED visits and search engine activity.

Results

A strong positive correlation was observed between epistaxis-related ED visits and search engine activity for the term "nosebleed" (r = 0.655).

Conclusion

Search engine activities for the term "nosebleed" correlates strongly with epistaxis-related ED visits. This study demonstrates the usefulness of utilizing Google Trends search data to assess regional disease burdens, which may provide a means for epidemiological study that is quicker than conventional methods.

https://ift.tt/2JFpugT

Postoperative pain management after sinus surgery: a survey of the American Rhinologic Society

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2LdpLO0

Histone deacetylase 11 inhibits interleukin 10 in B cells of subjects with allergic rhinitis

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2Luazb5

The socioeconomic determinants for transsphenoidal pituitary surgery: a review of New York State from 1995 to 2015

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2L9NcaD

Quality indicators for the diagnosis and management of chronic rhinosinusitis

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2JCJnp5

Precision medicine: why surgeons deviate from “appropriateness criteria” in the management of chronic rhinosinusitis and effects on outcomes

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2LaQiLJ

Effects of early postoperative nasal decongestant on symptom relief after septoplasty

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2JAqWRD

Effects of PM2.5 on mucus secretion and tissue remodeling in a rabbit model of chronic rhinosinusitis

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2LbbJfq

Up‐regulation of IL‐6 expression in human salivary gland cell line by IL‐17 via activation of p38 MAPK, ERK, PI3K/Akt, and NF‐κB pathways

Journal of Oral Pathology &Medicine, Volume 0, Issue ja, -Not available-.


https://ift.tt/2JE6YWg

Effect of a botanical cleansing lotion on skin sebum and erythema of the face: A randomized controlled blinded half‐side comparison

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2L97Iby

Male‐pattern baldness, common latent viruses, and microcompetition

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2JEBIGD

Multipolydioxanone scaffold improves upper lip and forehead wrinkles: A 12‐month outcome

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2LaS9QD

Evaluation of the efficacy of transdermal drug delivery of calcipotriol plus betamethasone versus tacrolimus in the treatment of vitiligo

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2JDa1xO

Wrinkles, brown spots, and cancer: Relationship between appearance‐ and health‐based knowledge and sunscreen use

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2LaS6Er

Severe vision loss caused by cosmetic filler augmentation: Case series with review of cause and therapy

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2Lykht8

Identification of a novel PLCD1 mutation in Chinese Han pedigree with hereditary leukonychia and koilonychia

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2LaS0g3

Persistent pruritic rash, fever, and joint pains in a young female

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2L6t21n

Giant fibroepithelial polyp of the vulva

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2JEfx3n

New perspectives on the initiation of allergic immune responses at barrier sites

Mario Noti

https://ift.tt/2uPp2Y2

Congenital fibroblastic connective tissue nevi: Unusual and misleading presentations in three infantile cases

Pediatric Dermatology, EarlyView.


https://ift.tt/2O3ZLlV

Association between obesity and pediatric psoriasis

Pediatric Dermatology, EarlyView.


https://ift.tt/2NxE7p8

Orofacial granulomatosis and erythema multiforme in an adolescent with Crohn's disease

Pediatric Dermatology, EarlyView.


https://ift.tt/2O4kOES

Retrospective review of screening for Sturge‐Weber syndrome with brain magnetic resonance imaging and electroencephalography in infants with high‐risk port‐wine stains

Pediatric Dermatology, EarlyView.


https://ift.tt/2Nwg2Pc

Influence of infantile hemangioma severity and activity on QoL of patients and their parents: A cross‐sectional study

Pediatric Dermatology, EarlyView.


https://ift.tt/2NY4vJL

Topical rapamycin (sirolimus) for the treatment of uncomplicated tufted angiomas in two children and review of the literature

Pediatric Dermatology, EarlyView.


https://ift.tt/2NwQnGr

J Henk Sillevis Smitt—Obituary

Pediatric Dermatology, EarlyView.


https://ift.tt/2O4kO7Q

Clinical studies evaluating abametapir lotion, 0.74%, for the treatment of head louse infestation

Pediatric Dermatology, EarlyView.


https://ift.tt/2NrZckM

Survival of children and young adults with skin cancer: Analysis of a population‐based Florida cancer registry: 1981‐2013

Pediatric Dermatology, EarlyView.


https://ift.tt/2O2ZO1h

Sirolimus as initial therapy for kaposiform hemangioendothelioma and tufted angioma

Pediatric Dermatology, EarlyView.


https://ift.tt/2NuIilh

Aggressive melanoma in an infant with congenital melanocytic nevus syndrome and multiple, NRAS and BRAF mutation‐negative nodules

Pediatric Dermatology, EarlyView.


https://ift.tt/2NY4ci5

Congenital‐type juvenile xanthogranuloma: A case series and literature review

Pediatric Dermatology, EarlyView.


https://ift.tt/2NvBP9W

Diffuse erythema with ‘angel wings’ sign in Japanese patients with anti‐small ubiquitin‐like modifier activating enzyme antibody‐associated dermatomyositis

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2zST4jD

Mepacrine‐induced interstitial lung disease in discoid lupus erythematosus?

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2mwv10m

Transepidermal water loss in healthy adults: a systematic review and meta‐analysis update

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2zRtw6r

Mosaicism due to postzygotic mutations in women with focal dermal hypoplasia

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2mwVvig

胃造口用于大疱性表皮松解

British Journal of Dermatology, Volume 179, Issue 1, Page e85-e85, July 2018.


https://ift.tt/2uNPOQB

职业性手部湿疹和转职

British Journal of Dermatology, Volume 179, Issue 1, Page e82-e82, July 2018.


https://ift.tt/2mteWs3

Gastrostomy for epidermolysis bullosa

British Journal of Dermatology, Volume 179, Issue 1, Page e71-e71, July 2018.


https://ift.tt/2zRtnzV

Methotrexate injections for psoriasis

British Journal of Dermatology, Volume 179, Issue 1, Page e73-e73, July 2018.


https://ift.tt/2mtXMKQ

Transverse basilar cleft: two more probable familial cases in an archaeological context

International Journal of Osteoarchaeology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2zVw0kb

Survey of disease awareness, treatment behavior and treatment satisfaction in patients with atopic dermatitis in Korea: A multicenter study

The Journal of Dermatology, EarlyView.


https://ift.tt/2mxXqTr

Improvement in abnormal coronary arteries estimated by coronary computed tomography angiography after secukinumab treatment in a Japanese psoriatic patient

The Journal of Dermatology, EarlyView.


https://ift.tt/2zQ0PXe

Cutaneous lymphomatoid granulomatosis with long‐term absence of lung involvement

The Journal of Dermatology, EarlyView.


https://ift.tt/2mtId5Z

Pyoderma gangrenosum reproduced by an electric current flow

The Journal of Dermatology, EarlyView.


https://ift.tt/2uPq4Do

Negative‐pressure closure was superior to tie‐over technique for stabilization of split‐thickness skin graft in large or muscle‐exposing defects: A retrospective study

The Journal of Dermatology, EarlyView.


https://ift.tt/2mtIea3

Bullous pemphigoid with hyperkeratosis and palmoplantar keratoderma: Three cases

The Journal of Dermatology, EarlyView.


https://ift.tt/2uLnjTG

BeSMART2: What is the Best Supportive Management for Adults Referred with Tonsillopharyngitis? Our experience surveying the attitudes of 80 patients and professionals

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2uAHLra

Predicting Sequential Bilateral Cochlear Implantation Performance in Postlingually Deafened Adults; a Retrospective Cohort Study

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2zRq8bJ

Relationship of MR Imaging of Submandibular Glands to Hyposalivation in Sjögren's Syndrome

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


https://ift.tt/2NvblVM

Infiltration of abdominal striae distensae by Hodgkin's lymphoma

International Journal of Dermatology, EarlyView.


https://ift.tt/2mx39sU

Postherpetic abdominal pseudohernia. Presentation of a clinical case and literature review

International Journal of Dermatology, EarlyView.


https://ift.tt/2uKlHta

Induced linear dermatosis: Kӧh Kchӧl

International Journal of Dermatology, EarlyView.


https://ift.tt/2ms5CVw

Pemphigus herpetiformis in South Tunisia: a clinical expression of pemphigus foliaceus?

International Journal of Dermatology, EarlyView.


https://ift.tt/2zTvWRT

The hunt for the earliest cases of AIDS‐related Kaposi sarcoma: a retrospective outbreak investigation

International Journal of Dermatology, EarlyView.


https://ift.tt/2mxUshY

Clinical subtypes and molecular basis of epidermolysis bullosa in Kuwait

International Journal of Dermatology, EarlyView.


https://ift.tt/2uMRyK4

Issue Information ‐ TOC

Allergy, Volume 73, Issue 8, Page 1573-1574, August 2018.


https://ift.tt/2LubYhX

Issue Information ‐ Cover and Editorial Board

Allergy, Volume 73, Issue 8, Page 1571-1571, August 2018.


https://ift.tt/2uzJSLM

Chronic urticaria can be caused by cancer and resolves with its cure

Allergy, Volume 73, Issue 8, Page 1750-1751, August 2018.


https://ift.tt/2A3P1B9

The Atopic March

Allergy, Volume 73, Issue 8, Page 1753-1753, August 2018.


https://ift.tt/2uBQfOH

On the pathogenicity of the plasminogen K330E mutation for hereditary angioedema

Allergy, Volume 73, Issue 8, Page 1751-1753, August 2018.


https://ift.tt/2A3OWNR

Response to “The Atopic March”

Allergy, Volume 73, Issue 8, Page 1754-1754, August 2018.


https://ift.tt/2uAyy1O

Persistent regulatory T cell response 2 years after 3 years of grass tablet SLIT: links to reduced eosinophil counts, sIgE levels and clinical benefit

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


https://ift.tt/2A3OSh5

Accidental allergic reactions in food allergy: causes related to products and patient's management

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


https://ift.tt/2uy2o74

Provocative proposal for a revised nomenclature for Allergy and other hypersensitivity diseases

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


https://ift.tt/2A3ONdh

Neurootologisches Counseling bei chronischem Tinnitus

Laryngo-Rhino-Otol
DOI: 10.1055/a-0648-4856

Die Diagnostik und Behandlung des Tinnitus erfordert neurootologische Kompetenz und eine ebenso sachgerechte wie für den Tinnitus-Betroffenen verständliche Aufklärung.Leitliniengerecht entscheidend ist – entsprechend der Tinnitus-Leitlinien von 2015 – die „Beratung des Patienten durch den betreuenden Arzt hinsichtlich seiner persönlichen Ätiopathogenese, wie der persönlichen Verarbeitung des Tinnitus, der Prognose, tinnitusverstärkender Faktoren oder das Ohr schädigender Einflüsse".Dementsprechend ist das Ziel die „Entpathologisierung des Symptoms Tinnitus und die Erklärung sowie Einordnung in die heute anerkannten wissenschaftlichen Vorstellungen" 1.So richtig die Leitlinienvorgabe ist, so schwierig kann es im kassenärztlichen Alltag sein, diese Empfehlungen umzusetzen. Nachfolgend soll daher ein 4- bis 5-schrittiges Vorgehen geschildert werden, dass im ärztlichen Gespräch oder in einer Gruppe die wichtigsten Aspekte leitliniengerecht und verständlich vermittelt. Ergänzend dazu wird auch auf hilfreiche Aspekte seelischer Gesundheit eingegangen.Hilfreich dabei ist der reduzierte Tinnitus-Fragebogen (Mini-TF12) 2, der unter anderem über die Homepage der Deutschen Tinnitus-Liga (DTL) kostenfrei ausgefüllt und ausgewertet werden kann.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

https://ift.tt/2uzJOM2

Issue Information

Clinical and Experimental Dermatology, Volume 43, Issue 6, Page i‐ii, 651-652, August 2018.


https://ift.tt/2Lrmzxe

News and Notices

Clinical and Experimental Dermatology, Volume 43, Issue 6, Page 756-756, August 2018.


https://ift.tt/2JDQPQE

Asian children living in Australia have a different profile of allergy and anaphylaxis than Australian‐born children: a State‐wide survey

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


https://ift.tt/2O0ZMqC

Does allergy explain why some children have severe asthma?

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


https://ift.tt/2NwCHel

Lysozyme, a new allergen in donkey's milk

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


https://ift.tt/2O0iOxc

Electronic Clinical Decision Support System for allergic rhinitis management

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


https://ift.tt/2NvtMKg

Three-dimensional microarchitecture and local mineralization of human jaws affected by bisphosphonate-related osteonecrosis

Recently, we showed that osteocyte lacunar volume and distribution, as well as mineralized bone mass density, are dependent on the specific region of the jaw in patients suffering from bisphosphonate-related osteonecrosis of the jaw (BRONJ) [1]. Indeed, a significant heterogeneity was found in terms of osteocyte lacunar morphology, most likely due to the variety of mechanical loading in the different regions.

https://ift.tt/2LqdWTE

Do Implant Surgical Guides Allow an Adequate Zone of Keratinized Tissue for Flapless Surgery?

Publication date: Available online 19 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Janina Golob Deeb, Sompop Bencharit, Christopher A. Loschiavo, Matthew Yeung, Daniel Laskin, George R. Deeb

Abstract

Introduction

A major advantage of guided implant surgery using 3D printed guides is the ability to do accurate surgery flapless. A drawback of a flapless technique is the inability to manipulate soft tissue to ensure sufficient gingiva around the implant. The purpose of this study was to determine how often flapless surgery using surgical guides results in less than 2 mms of keratinized tissue surrounding the implant.

Materials and Methods

A retrospective analysis included 27 maxillary and 27 mandibular implant sites treatment planned for implant guided surgery using 3shape Implant Studio. Intraoral scan images were used to measure the width of the keratinized tissue on the buccal aspect of each implant site in both arches and the lingual aspect in the mandibular arch. Three examiners measured the amount of buccal and lingual keratinized tissue in millimeters at each implant site. ANOVA (p<0.05) and correlation coefficients were used to determine statistical difference in keratinized tissue among sites.

Results

There was no statistical difference either between the width in buccal keratinized tissue in the maxillary anterior (4.06+/-1.42mm) and posterior areas (4.93+/-2.54mm) (p=0.293) or between the amount of buccal and lingual keratinized tissue in the mandible, p=0.995. The keratinized tissue width in the maxillary buccal area was significantly different (4.48+/-2.04mm) from in the mandibular posterior buccal (1.98+/-1.41mm) and lingual areas (1.98+/-1.23mm), (p<0.001). Over 77% of maxillary implant sites had >3mm of gingiva and just over 20% had sufficient gingiva in the mandible.

Conclusions

Adequate keratinized tissue was found in most of the planned maxillary implant sites whilethe majority of the mandibular posterior implant sites had inadequate keratinized tissue. Therefore, elevation of a flap to preserve and reposition existing keratinized tissue around implants should be considered when planning to use tooth-borne surgical guides in the posterior mandible.

https://ift.tt/2Nv1MX1

Nasal Airway Obstruction

Nasal airway obstruction has a significant impact on quality of life and is one of the most common complaints of patients seeking treatment from Otolaryngologist–Head and Neck Surgeons. While nasal airway obstruction is common, its causes can be multifactorial. Focused treatment can help alleviate obstruction while minimizing unnecessary interventions. This issue of Otolaryngologic Clinics of North America is designed to provide a comprehensive overview of the diagnosis, medical and surgical management options, and methods of measuring the extent of initial obstruction and response to nasal airway obstruction treatment.

https://ift.tt/2LqclgO

The role of oral anticoagulants in epistaxis

Abstract

Purpose

The purpose of this retrospective study was to identify the impact of oral anticoagulants on epistaxis with the focus on new oral anticoagulants.

Methods

The study was conducted at the Department  for Ear- Nose- and Throat (ENT), Head and Neck Surgery, Technical University Munich, Germany. All patients presenting in 2014 with the diagnosis of epistaxis to a specialized ENT accident and emergency department were identified and analyzed in clinical data and medication.

Results

600 adult cases, with a median age of 66.6 years were identified with active bleeding. 66.8% of all cases were anticoagulated. Classic oral anticoagulants (COAC) were three times more common in patients than new-generation oral anticoagulants (NOAC). Recurrent bleeding was significantly associated with oral anticoagulants (OAC) (p = 0.014) and bleeding location was most often anterior (p = 0.006). In contrast, severe cases, which required surgery or embolization were significantly more likely in non-anticoagulated middle-aged patients with posterior bleedings (p < 0.05). In our epistaxis cohort, OAC were highly overrepresented (40%) when compared to the general German population (1%) but COAC as well as NOAC played only a minor role in severe courses of epistaxis.

Conclusion

Oral anticoagulation, especially with new-generation drugs, is not associated with more complicated and severe courses of epistaxis, but rather with recurrent bleeding. One should keep this information in mind when triaging the patient in the emergency room and when planning further procedures.

https://ift.tt/2mqUrwa

Repair of bony lateral skull base defects equal to or larger than 10 mm by extracorporeally sewed unit-sandwich graft

Abstract

Objective

To see effectiveness of the senior author's repair technique for repair of large (equal to or larger than 10 mm) bony lateral skull base defects.

Study design

Retrospective.

Settings

Secondary/tertiary care center.

Methods

We performed retrospective review of 9 surgeries done in our institution between January 2010 and December 2013 for repair of large lateral bony skull base defects. We defined skull base defects extra-cranially and repaired them intra-cranially. We made an extracorporeal sandwich of autologous fascia-bone-fascia (fascia lata and nasal septal bone) and sewed it together to make it into a unit-sandwich graft. This extracorporeally sewed unit-sandwich graft was then inserted to close the large skull base defects either via (1) a cranial slit-window, or (2) the skull base defect itself. Since skull base is bony, bony repair is preferred. Bone plates that are easily available for skull base repair are calvarial and nasal septal bone. Occasionally, harvest of split calvarial bone carries risk of major complications. We preferred nasal septal bone. Harvesting of septal bone even in children using a posterior incision should not disturb the cartilage growth centers.

Results

All nine patients were operated by this technique. We had four patients with cerebrospinal fluid leak, and five patients with brain herniation. All these patients had complete reversal of herniation of cranial contents and cessation of cerebrospinal fluid leak. On imaging, in 6 cases the bone graft remained in original intended position after 12 months of surgery. The bone graft was not identifiable in 3 cases.

Conclusion

The senior author's technique using autologous multi-layered graft is simple to master, repeatable and very effective.

https://ift.tt/2uOyMlz

Polypoid change of middle turbinate is associated to an increased risk of polyp recurrence after surgery in patients with chronic rhinosinusitis with nasal polyps

Abstract

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) affects approximately 4% of general population. Patients with CRSwNP have greater burden of CRS symptoms and higher rate of relapse after either medical or surgical treatments. The aim of this study was to evaluate the association between polypoid change of anterior free border of middle turbinate and rate of relapse in patients with CRSwNP.

Methods

A controlled prospective cohort study was performed. Seventy-seven adult patients with CRSwNP in whom their MT polypoid change was proved and 77 patients without MT polypoid change were recruited. Allergy, asthma, aspirin hypersensitivity, Lund Kennedy and Lund Mackay scores and eosinophilic scores of polyp and middle turbinate were recorded. Patient's health-related quality of life was assessed using the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire. All patients were evaluated 12 months after ESS. Polyp relapse, Lund Kennedy scores and SNOT-22 scores were documented.

Results

The relapse rate in patients with MT polypoid change was significantly higher than the control group (37.14 vs. 20.58, p value = 0.03). Eosinophil score of nasal polyps and MT specimens were significantly higher in patients with MT polypoid change than patients without polypoid change. The postoperative Lund Kennedy and SNOT-22 scores in patients with MT polypoid change were significantly higher than the control group.

Conclusion

This study showed a significant association between polypoid change of anterior free border of middle turbinate and nasal polyp relapse. This new and simple criterion of severity of CRSwNP could have clinical implications.

https://ift.tt/2ms5dlT

Quality assurance in head and neck surgery: special considerations to catch up

Abstract

Purpose

Quality assurance is much more difficult to achieve in surgical oncology than in medical oncology and radiotherapy where doses are standardized and toxicities are well-classified. To better define what is required in surgery, we analyzed recent articles addressing the point in head and neck surgery.

Results

The surgical report should match with the pathological description of the resected specimen with accurate delineation of the margins, number and level(s) of lymph nodes (capsular rupture if any). Complications (minor and major) should be standardized and meticulously recorded; as well as comorbidities and patient status. The acuity of the procedure should be defined by metrics collected in check-lists. Age > 60 years, male gender, tumor site and T₄ stage, neck dissection(s), flap reconstruction, alcohol and tobacco consumption, are acknowledged risk factors for more complications and longer hospital stay (or readmission).

Needs

Randomized controlled trials should be designed adopting the consolidated standards of reporting trials (CONSORT). Training young head and neck surgeons should encompass formation in designing, conducting and interpreting clinical trials.

https://ift.tt/2zSbgto

The diagnostic value of TROP-2, SLP-2 and CD56 expression in papillary thyroid carcinoma

Abstract

Objective

The study aimed to explore some novel diagnostic biomarkers for papillary thyroid carcinoma (PTC) by identifying the different expression of TROP-2, SLP-2 and CD56 in benign and malignant thyroid lesions.

Methods

We evaluated the mRNA expressions of TROP-2 and SLP-2 in fine needle aspirates (FNAs) which contained 10 PTCs and 10 benign follicular adenomas (FAs) using quantitative real-time PCR (qRT-PCR). Immunohistochemical (IHC) staining of TROP-2, SLP-2 and CD56 was also performed on postoperative samples of 30 PTCs and 29 FAs. Membranous or cytoplasmic staining in > 10% of cells was considered as positive. Diagnostic sensitivity, specificity, positive predictive value, negative predictive value (NPV) and diagnostic accuracy of these three biomarkers were carried out. We further analyzed the associations between the clinical features and the expressions of markers in PTCs.

Results

The mRNA expressions of both TROP-2 and SLP-2 were increased substantially in PTCs in comparison with those in FAs (P < 0.05). Similarly, IHC for these two proteins demonstrated higher positive staining in PTCs than in FAs (96.5% vs. 12.5% for TROP-2, 83.3% vs. 20.7% for SLP-2, P < 0.05). Conversely, CD56 expression was lost with 86.7% of PTCs. In identifying malignancy, TROP-2 was the most sensitive marker and CD56 was the most specific one. When the markers were combined, the sensitivity and NPV increased to 100% and had better diagnostic accuracy. However, no association was found between biomarker expressions and clinicopathological factors in PTCs.

Conclusions

We found that TROP-2, SLP-2 and CD56 were effective diagnostic markers for PTC, especially when they were combined to use.

https://ift.tt/2uIxet8

Otogenic lateral sinus thrombosis in children: proposal of an experience-based treatment flowchart

Abstract

Purpose

To describe the prevalent clinical, laboratory, and radiological features of otogenic lateral sinus thrombosis (OLST) in children; to identify clinical predictors of outcome; to propose a management algorithm derived from experience.

Methods

A retrospective review was conducted of the clinical records of patients with OLST, treated in a single tertiary care referral center for pediatric disease from 2006 to 2017. The inclusion criteria were pediatric age (0–16 years) and OLST diagnosis confirmed by a pre- and post-contrast CT or venography–MRI scan. Primary outcome measures were early (1–2 months) and late (6 months) sinus recanalization assessed by means of neuroimaging.

Results

Twenty-five patients (8 females and 17 males; mean age = 6 ± 3 years) were included. A genetic abnormality associated with thrombophilia was found in 24 (96%) patients. At diagnosis, anticoagulant treatment with low-molecular-weight heparin (LMWH) was started in all subjects, while surgical treatment (mastoidectomy and tympanostomy tube insertion) was performed in 16/25 (64%) patients. Follow-up neuroimaging showed lateral sinus recanalization in 12/25 (48%) patients after 1–2 months and in 17/25 (68%) after 6 months. At multivariate logistic regression analysis, no significant predictors of the early and late neuroradiological outcome were found.

Conclusions

All children with OLST should be screened for thrombophilia to decide on treatment duration and to assess the need for future antithrombotic prophylaxis. Immediately after diagnosis, anticoagulant treatment with LMWH should be started according to the international guidelines. Instead, our experience suggests that surgical treatment should not be indicated in all patients, but decided on a case-to-case basis.

https://ift.tt/2uOYwhk

Role of asthma and intolerance to acetylsalicylic acid on the redox profile in nasal polyp tissue

Abstract

Purpose

Nasal polyposis is a chronic inflammatory disease of the mucosa of the nasal cavity and paranasal sinuses. The etiology of nasal polyposis is unclear; however, it may be associated with asthma and intolerance to acetylsalicylic acid, possibly altering the redox profile. The study intends to compare the redox profile in polyps surgically removed from three clinical groups of patients with nasal polyposis who were divided according to the presence of asthma and intolerance to acetylsalicylic acid.

Methods

Patients were divided into three groups: nasal polyposis only (n = 30); nasal polyposis and asthma (n = 19); and nasal polyposis, asthma and intolerance to acetylsalicylic acid (n = 10). The following redox evaluations were performed: enzymatic antioxidant activity of superoxide dismutase, glutathione peroxidase, hydrogen peroxide consumption and glutathione S-transferase; non-enzymatic antioxidant levels of vitamin C, vitamin E and glutathione; levels of the oxidative damage biomarkers carbonyl groups (measuring protein damage) and malondialdehyde (measuring lipid peroxidation); and nitrite and nitrate levels.

Results

Compared with the polyposis only group, hydrogen peroxide consumption, glutathione S-transferase, vitamin E and malondialdehyde were lower in the asthma group. Total glutathione (0.12 ± 0.01 vs. 33.34 ± 10.48 µmol/mg) and nitrite and nitrate (0.06 ± 0.01 vs. 15.95 ± 1.38 nmol/mg) levels were higher in the nasal polyposis, asthma and intolerance to acetylsalicylic acid group.

Conclusions

In patients with nasal polyposis, asthma may alter the redox profile associated with the hydrogen peroxide and lipid damage pathways, whereas asthma and intolerance to acetylsalicylic acid increase nitrite and nitrate and total glutathione levels.

https://ift.tt/2mty9da

Length of the ossified stylohyoid complex and Eagle syndrome

Abstract

Purpose

To assess radiographically the presence of an ossified stylohyoid complex (OSHC) with signs and symptoms of Eagle syndrome or other oro-facial painful diseases in patients attending our institution and to confirm that the important issue for study is to know the length of the ossificated portion of the stylohyoid complex only.

Methods

We separated 1000 consecutive files, and after selection, 922 panoramic radiographs were evaluated. Assessed parameters were gender and age of the patients, size, and location of the analyzed OSHCs. In addition, the length parameters of the studied OSHCs were also determined in 100 extra radiographs.

Results

Normal length of OSHCs was between 2.83 and 4.16 cm and OSHCs measuring more than 4.17 cm long comprising 23.2% of the sample. Any of the patients with OSHC presented signs or symptoms of the Eagle syndrome or any other orofacial painful disease.

Conclusions

This is the first study on OSHCs using the mandatory parameters of normal, short and elongated length in the studied population. Our results suggest that the presence of an OSHC is not an important feature for pain detection in the Eagle syndrome and is not an important risk factor for development of throat pain in this and other painful orofacial diseases. Our results are different from those previously published in other populations and suggest that the widely used lengths of 2 to 4 cm for measuring the OSHCs are not adequate parameter. It is desirable to define first the short, normal and abnormal parameters of OSHCs in each studied population.

https://ift.tt/2zVnj9s

SPECT/CT-guided lymph drainage mapping for the planning of unilateral elective nodal irradiation in head and neck squamous cell carcinoma

Abstract

Purpose

To investigate the feasibility of lymph drainage mapping (LDM) using SPECT/CT to help select head and neck cancer (HNSCC) patients for unilateral elective neck irradiation (ENI). Patients with lateralized HNSCC treated with radiotherapy routinely undergo bilateral ENI, despite the incidence of contralateral regional failure being relatively low even after unilateral ENI. We hypothesized that patients with a lateralized tumor without visible lymph drainage to the contralateral neck have an extremely low risk of contralateral involved nodes. Excluding the contralateral neck from elective irradiation will reduce radiation-induced toxicity and improve quality-of-life.

Methods

Fifty-five patients with lateralized cT1-3N0-2bM0 HNSCC not crossing the midline underwent LDM. Radiolabeled ^99mTc-nanocolloid was injected in 4–5 depots around and in the primary tumor. Lymph drainage patterns were visualized using planar scintigraphy and SPECT/CT after 4 h. We report on the incidence of contralateral drainage, the location of draining areas, and the size of underlying nodes.

Results

Lymphatic drainage was successfully visualized in 54 patients (98%). In 11 patients (20%) with visible contralateral drainage, 14 draining areas (16 nodes; median volume 0.50 cc, diameter 8.0 mm) were identified. Neck levels with contralateral drainage were level II (88%), III (25%), and IV (13%). Contralateral drainage was significantly higher in T3 compared to T1–2 tumors (45 and 14%, respectively, P = 0.035).

Conclusion

SPECT/CT-guided LDM is feasible and can be used to guide unilateral ENI in HNSCC patients in prospective studies. In addition, the anatomical confidence in visualization of contralateral drainage indicates a potential for ENI limited to draining levels alone.

https://ift.tt/2uRELWO

IgG4-related disease: association between chronic rhino-sinusitis and systemic symptoms

Abstract

Purpose

The objective of this study is to analyze the relationship between chronic rhino-sinusitis (CRS) and systemic symptoms in patients with IgG4-related disease (IgG4-RD).

Patients and methods

The patients with IgG4-RD, confirmed by restrict association with clinical and histopathological manifestations between March 2013 and July 2016, were enrolled and followed-up for 1 year at the Tongren Hospital, Capital Medical University. The patients were divided into two groups: the case group included IgG4-RD patients with CRS confirmed by clinical and imaging, while the control group included IgG4-RD patients without CRS confirmed by clinical and imaging. Age, gender, clinical manifestations, the percentage of eosinophils in peripheral blood, sedimentation (ESR), C-reaction protein, serum IgE and IgG4 levels, histopathology, and treatment drugs at the baseline and 1 year of follow-up were compared between the two groups.

Results

A total of 46 cases met the diagnostic criteria for IgG4-RD. A total of 30 patients (65.2%) had IgG4-RD complicated with CRS, and were aged 49.7 ± 13.4 years, with male:female ratio = 2:1. The disease duration in the case group was longer than that in the control group (3.0 versus 0.8, p = 0.009). The ratio of ocular involvement was higher (86.7 versus 60%, p < 0.001), and allergic manifestations including drug allergy, asthma, and allergic skin were more common (56.5 versus 20%, p = 0.004), with a higher percentage of eosinophils in peripheral blood (8.5 versus 3.3%, p = 0.018) and more sensitive to glucocorticoids (6.0 versus 3.5, p = 0.004) than those in the control group.

Conclusions

CRS in patients with IgG4-RD was closely associated with IgG4-related ocular lesions, which was more prone to allergic manifestations accompanied by raised percentage of eosinophils in peripheral blood. The treatment of patients with IgG4-RD complicated with CRS was more effective than those with IgG4-RD without CRS.

https://ift.tt/2muWuiZ

Subjective effects of the sleep position trainer on snoring outcomes in position-dependent non-apneic snorers

Abstract

Purpose

To evaluate the effect of a new-generation positional device, the sleep position trainer (SPT), in non-apneic position-dependent snorers.

Methods

Non-apneic position-dependent snorers with an apnea–hypopnea index (AHI) < 5 events/h were included between February 2015 and September 2016. After inclusion, study subjects used the SPT at home for 6 weeks. The Snore Outcome Survey (SOS) was filled out by the subjects at baseline and after 6 weeks, and at the same time, the Spouse/Bed Partner Survey (SBPS) was filled out by their bed partners.

Results

A total of 36 participants were included and 30 completed the study. SOS score improved significantly after 6 weeks from 35.0 ± 13.5 to 55.3 ± 18.6, p < 0.001. SBPS score also improved significantly after 6 weeks from 24.7 ± 16.0 versus 54.5 ± 25.2, p < 0.001. The severity of snoring assessed with a numeric visual analogue scale (VAS) by the bed partner decreased significantly from a median of 8.0 with an interquartile range (IQR) of [7.0–8.5] to 7.0 [3.8–8.0] after 6 weeks (p = 0.004).

Conclusions

Results of this study indicate that positional therapy with the SPT improved several snoring-related outcome measures in non-apneic position-dependent snorers. The results of this non-controlled study demonstrate that this SPT could be considered as an alternative therapeutic option to improve sleep-related health status of snorers and their bed partners.

https://ift.tt/2uREzqy

Pathology of Benign and Malignant Neoplasms of Salivary Glands

Publication date: Available online 19 July 2018

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Daniel Lubin, Sharon Song, Zubair Baloch, Virginia A. LiVolsi

Abstract

Tumors of the salivary gland represent relatively rare neoplasms. Still, in spite of their scarcity, they demonstrate a wide spectrum of disease across both benign and malignant lesions. The purpose of this review is to provide a practical overview of the pathology of the more common salivary gland neoplasms, covering the morphologic, immunophenotypic, and molecular profiles with an emphasis on unique diagnostic challenges and prognostic indicators.

https://ift.tt/2Nue8P5

Potential of web-resource on ‘oral dysplasia and precancer’!

Publication date: Available online 19 July 2018

Source: Oral Oncology

Author(s): Prashanth Panta, Sachin C. Sarode, Gargi S. Sarode, Shankargouda Patil

https://ift.tt/2LBbU04

Three-dimensional microarchitecture and local mineralization of human jaws affected by bisphosphonate-related osteonecrosis

Publication date: Available online 19 July 2018

Source: Oral Oncology

Author(s): Alessandra Giuliani, Giovanna Iezzi, Marco Mozzati, Giorgia Gallesio, Serena Mazzoni, Giuliana Tromba, Franco Zanini, Adriano Piattelli, Carmen Mortellaro

https://ift.tt/2LbBLPW

Angina bullosa haemorrhagica: a systematic review and proposal for diagnostic criteria

The aim of this study was to perform a critical review of published data on the epidemiological, aetiological, clinical, histological, biological, and therapeutic characteristics of patients with angina bullosa haemorrhagica (ABH). A literature search was conducted in the PubMed, Science Direct, Web of Science, and Cochrane Library databases. All publications fulfilling the selection criteria were included in the eligibility assessment according to the PRISMA statement. The full texts of 54 retrieved articles were screened.

https://ift.tt/2mr3yNo

SELF-ASSESSMENT

No abstract available

https://ift.tt/2uNnsWF

Allergic Contact Dermatitis and Food and Drug Administration Reporting: A Survey of Current Member Practices

No abstract available

https://ift.tt/2mvqv2b

Chemokine Signaling in Allergic Contact Dermatitis: Toward Targeted Therapies

Allergic contact dermatitis (ACD) is a common skin disease that results in significant cost and morbidity. Despite its high prevalence, therapeutic options are limited. Allergic contact dermatitis is regulated primarily by T cells within the adaptive immune system, but also by natural killer and innate lymphoid cells within the innate immune system. The chemokine receptor system, consisting of chemokine peptides and chemokine G protein–coupled receptors, is a critical regulator of inflammatory processes such as ACD. Specific chemokine signaling pathways are selectively up-regulated in ACD, most prominently CXCR3 and its endogenous chemokines CXCL9, CXCL10, and CXCL11. Recent research demonstrates that these 3 chemokines are not redundant and indeed activate distinct intracellular signaling profiles such as those activated by heterotrimeric G proteins and β-arrestin adapter proteins. Such differential signaling provides an attractive therapeutic target for novel therapies for ACD and other inflammatory diseases.

https://ift.tt/2zTLOUy

Skin Ceramide Profile in Children With Atopic Dermatitis

Background Atopic dermatitis (AD) is a common disease, which involves a disruption of the skin barrier function. Skin ceramide (CER) composition, which plays crucial roles in maintaining the barrier function of the stratum corneum, is changed in patients with AD. Objective The aim of this study was to identify and quantify skin CER subclasses in association with disease severity in pediatric patients with AD. Methods Two hundred thirteen patients were entered into the observational study. We compared their CER profiles using normal-phase high-performance liquid chromatography coupled with dynamic multiple reaction monitoring mass spectrometry. Results In total, 12 subclasses of CERs were identified. We found that 2 subclasses, that is, CER[AS] and CER[NS], were elevated (P = 0.007 and 0.012, respectively) and correlated with Severity Scoring of Atopic Dermatitis (P = 0.004 and 0.004, respectively). Conclusions Skin CER abundances are changed in children with AD compared with control subjects.

https://ift.tt/2mvqn2H

Electrochemical Screening Spot Test Method for Detection of Nickel and Cobalt Ion Release From Metal Surfaces

Background Present screening methods to rapidly detect release of nickel and cobalt ions from metallic surfaces involve colorimetric dimethylglyoxime (DMG)- and disodium-1-nitroso-2-naphthol-3,6-disulfonate–based spot tests with a cotton bud. There is a risk of false-negative test reactions because test outcomes are dependent on the pressure, area, and duration of surface wiping. Objective The aim of the study was to develop a miniaturized electrochemical device that uses a voltage to accelerate nickel and cobalt release from the tested item and perform an initial validation. Methods and Results A device was built in plastic, and its performance was investigated using 0.5 mL of test solutions of, respectively, DMG and disodium-1-nitroso-2-naphthol-3,6-disulfonate. Cotton buds that had been wetted in test solution were pressed against different metal surfaces at various voltages (0–9 V) and a range of test durations (0–120 seconds). Duplicate testing for nickel and cobalt release was also performed on a sample of 163 jewelry items. Conclusions This novel electrochemical device makes it possible to perform nickel and cobalt ion release testing without rubbing, thereby reducing interindividual differences in testing technique. The nickel testing with the device seemed to be superior to conventional DMG spot testing.

https://ift.tt/2zSuoI1

Piercing Metal Contact Allergy: Nothing Gold Can Stay

No abstract available

https://ift.tt/2mt32yp

A Retrospective Study of Aimed Patch Testing With Aqueous Nickel Sulfate Hexahydrate at 30% and 15% in Patients With Dermatitis

Background Sometimes, patients with a history of metal intolerance react negatively or doubtfully to nickel at patch testing. Objective The aim of the study was to investigate whether aqueous nickel sulfate hexahydrate at 15% and 30% traces more contact allergy than the nickel preparation in the baseline series at 5%. Methods In the period 1995–2015, more than 800 of 16,059 patients with a negative or doubtful patch test reaction to the petrolatum preparation of nickel at 5% on the day 3 reading were additionally tested with aqueous nickel at 15% and/or 30%. Conclusions In this retrospective study with aimed patch testing with aqueous nickel solutions, significantly more (P

https://ift.tt/2zSrfro

Steroid Withdrawal Effects Following Long-term Topical Corticosteroid Use

Background Concerns about topical steroid withdrawal (TSW) are leading some patients to cease long-term topical corticosteroid (TCS) therapy. Diagnostic criteria for this condition do not exist. Objective The aim of this study was to examine the demographics and outcomes in adult patients who believe they are experiencing TSW following discontinuation of chronic TCS overuse. Methods This was a retrospective cohort study of patients in an Australian general practice presenting with this clinical scenario between January 2015 and February 2018. Results Women represented 56% of the 55 patients seen, and ages ranged from 20 to 66 years (mean, 32.9 years; median, 30.0 years). Seventy-six percent had an original diagnosis of atopic dermatitis. Sixty percent had used potent TCSs on the face, and 42% had a history of oral corticosteroid use for skin symptoms. Burning pain was reported in 65%; all had widespread areas of red skin; and so-called "elephant wrinkles," "red sleeve," and the headlight sign were seen in 56%, 40%, and 29%, respectively. Conclusions Patients with a history of long-term TCS overuse may experience symptoms and signs described in TSW on stopping TCSs. Diagnostic criteria, reflecting the histories and examination findings of the patients studied, are suggested in this article with the aim to advance discussion and research into TSW.

https://ift.tt/2msEWDV

Textile and Shoe Allergic Contact Dermatitis in Military Personnel

Background and Objectives Allergic contact dermatitis is a common dermatosis among military personnel. Given the unique military demands, it is not surprising that shoe dermatitis and textile dermatitis are common. Our study aimed to compare the clinical and demographic parameters between military personnel and civilians evaluated for the suspicion of shoe and textile dermatitis in a tertiary clinic in Israel. Methods This retrospective cross-sectional study included 295 patients who were referred to a tertiary clinic for evaluation because of suspected shoe or textile dermatitis. Eighty-eight of the patients were soldiers. The patch tests were tailored according to the clinical presentation and relevant exposures. Results The 2 populations differed in several parameters. The duration of the dermatitis was longer in the civilian group. The atopy rate was significantly higher among military conscripts. The patch test reactivity and multiple patch test reactivity were lower in the army group. Dermatitis seen in the military group tended to be more widely distributed. Conclusions Distinctive demographic and exposure patterns explain the differences observed between the 2 study groups. It is not surprising that irritant dermatitis is more common among military personnel, given the extreme military demands and higher atopy rate among soldiers.

https://ift.tt/2zSu1ND

Contact Buzz: Allergic Contact Dermatitis to Cannabis

No abstract available

https://ift.tt/2mxy48d

Patch Testing to Propylene Glycol: The Mayo Clinic Experience

Background Propylene glycol (PG) is a solvent, vehicle, and humectant being used increasingly in a wide array of personal care products, cosmetics, and topical medicaments. Propylene glycol is a recognized source of both allergic and irritant contact dermatitis. Objective The aim of the study was to report incidence of positive patch tests to PG at Mayo Clinic. Methods We retrospectively reviewed records of all patients patch tested to PG from January 1997 to December 2016. Results A total of 11,738 patients underwent patch testing to 5%, 10%, or 20% PG. Of these, 100 (0.85%) tested positive and 41 (0.35%) had irritant reactions. Patients also tested to a mean of 5.6 concomitant positive allergens. The positive reaction rates were 0%, 0.26%, and 1.86% for 5%, 10%, and 20% PG, respectively, increasing with each concentration increase. The irritant reaction rates were 0.95%, 0.24%, and 0.5% for 5%, 10%, and 20% PG, respectively. Conclusions Propylene glycol is common in skin care products and is associated with both allergic and irritant patch test reactions. Increased concentrations were associated with increased reactions.

https://ift.tt/2zT3Fe7

Shellac: A Tertiary Care Center Experience

No abstract available

https://ift.tt/2mwDgJK

Pediatric Baseline Patch Test Series: Pediatric Contact Dermatitis Workgroup

Background Allergic contact dermatitis is a challenging diagnostic problem in children. Although epicutaneous patch testing is the diagnostic standard for confirmation of contact sensitization, it is less used in children by dermatologists treating children, pediatric dermatologists, and pediatricians, when compared with adult practitioners. Objective The aim of the study was to create and evaluate standardization of a pediatric patch test series for children older than 6 years. Methods We surveyed dermatologists and allergists conducting epicutaneous patch testing in children attending the 2017 American Contact Dermatitis Society meeting held in Washington, DC. This was followed by discussion of collected data and consensus review by a pediatric contact dermatitis working group at the conference. Conclusions A baseline pediatric patch test panel was established through working group consensus.

https://ift.tt/2zTBJad

T Cells Expressing the Chemokine Receptor CXCR3 Localize to Positive Patch Test Reaction Sites

No abstract available

https://ift.tt/2mvoYsG

Angina bullosa haemorrhagica: a systematic review and proposal for diagnostic criteria

Publication date: Available online 19 July 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): U. Ordioni, M. Hadj Saïd, G. Thiery, F. Campana, J.-H. Catherine, R. Lan

Abstract

The aim of this study was to perform a critical review of published data on the epidemiological, aetiological, clinical, histological, biological, and therapeutic characteristics of patients with angina bullosa haemorrhagica (ABH). A literature search was conducted in the PubMed, Science Direct, Web of Science, and Cochrane Library databases. All publications fulfilling the selection criteria were included in the eligibility assessment according to the PRISMA statement. The full texts of 54 retrieved articles were screened. Forty articles published between 1985 and 2016 describing 225 cases of ABH were finally selected. The mean age of the patients was 55.4 years; the male to female ratio was 0.7. The predominant localization was the palate (66%). A third of patients had no medical history. When specified, a triggering event or promoting factor was frequently found (82%). Biological tests were normal. A biopsy was performed on 35% of the patients. Treatment was symptomatic with a favourable outcome. Recurrences were frequent (62%). In conclusion, ABH is poorly documented and only by studies of low-level evidence. This review did not allow any aetiopathogenic association to be made with a general pathology or treatment. On the basis of this systematic review of the literature, diagnostic criteria aiming to improve the care of patients presenting with ABH are proposed.

https://ift.tt/2uAhDwA

Transoral approach to Type 1 Laryngeal Cleft Repair: A novel, non-endoscopic technique

Publication date: Available online 19 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Austin N. DeHart, Jonathan R. Korpon, Rajanya S. Petersson

Abstract

Endoscopic type 1 laryngeal cleft repair under spontaneous ventilation can be difficult in patients with poor pulmonary reserve. Intubation makes visualization of the interarytenoid area challenging during an endoscopic repair. As an alternative technique, we utilized a transoral, non-endoscopic approach with a McIvor mouth gag in two such patients. This provided adequate visualization and a larger working field with readily available instrumentation. The ability to intubate the patient obviated the need to intermittently place an endotracheal tube and allowed for uninterrupted working time. This technique does require favorable patient anatomy for adequate exposure, but is worth considering in certain patients.

https://ift.tt/2O4C4tp

The OSA-5: Development and validation of a brief questionnaire screening tool for obstructive sleep apnea in children

Publication date: Available online 19 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Han Jie Soh, Katherine Rowe, Margot J. Davey, Rosemary S.C. Horne, Gillian M. Nixon

Abstract

Objective

To develop and test a screening tool based on the OSA-18 questionnaire for triage of referrals for sleep-disordered breathing (SDB) in children.

Study Design

Consecutive children aged >2y without major comorbidities referred for polysomnography (PSG) or overnight oximetry for suspected obstructive sleep apnea (OSA) between 11 January and 31 May 2017 were included. OSA was defined by an obstructive apnea/hypopnea index (OAHI) >1event/h on PSG or an abnormal overnight oximetry (McGill Oximetry Score 2-4). An 11-item questionnaire derived from a previous validation study of the OSA-18 underwent exploratory factor analysis (EFA) with varimax rotation. ANOVA identified questions associated with the presence of OSA. This informed a 5-question, 4-category instrument, scored 0-15 (the OSA-5), that was tested prospectively on 112 children having PSG.

Results

420 children (2.0-17.9y, 43% female) met the inclusion criteria, including 366 complete questionnaires. EFA resulted in a 3-factor structure. ANOVA identified 5 questions from one factor that were independently associated with a diagnosis of OSA: snoring, breath holding, choking, mouth breathing and parental concern. Mean OSA-5 scores with and without OSA were 7.7 vs 4.5 (p<0.001). Thirty-four percent (60/178) had a total score <5/15, with a sensitivity at this threshold for OSA of 82% and negative predictive value (NPV) of 70%. Similar results were obtained when tested prospectively, including a sensitivity of 82% and NPV of 81% for the presence of moderate/severe OSA (OAHI>5/h).

Conclusion

The OSA-5 is a simple questionnaire that performs well as a triage screening tool to identify those children at risk of OSA among large numbers of referrals for SDB.

https://ift.tt/2NwoRZh

Paired analysis of the microbiota between surface tissue swabs and biopsies from pediatric patients undergoing adenotonsillectomy

Publication date: Available online 19 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): James Johnston, Michael Hoggard, Kristi Biswas, Carmen Astudillo-García, Fiona J. Radcliff, Murali Mahadevan, Richard G. Douglas

Abstract

Introduction

Culture-independent methods, based on bacterial 16 S rRNA gene sequencing, have been used previously to investigate the adenotonsillar microbiota. However, these studies have focused on a single sampling site (usually a surface swab). We aimed to investigate potential differences in adenotonsillar microbiota according to sampling location, both on and within the adenoids and palatine tonsils.

Methods

Pediatric patients (n=28, mean age five years) undergoing adenotonsillectomy were recruited for this study. At the time of surgery, a mucosal adenoid surface swab and an adenoid tissue biopsy was collected. Immediately following surgery, the crypts of the right and left tonsils were swabbed, and a surface and core tissue sample from the right tonsil were also collected. Bacterial 16 S rRNA gene-targeted amplicon sequencing was used to determine the bacterial composition of the collected samples.

Results

There was no significant difference in diversity or composition of the adenoid microbiota based on sampling site. However, the Shannon–Wiener and Inverse-Simpson diversity indices differed significantly (p<0.05) between the microbial communities of the three different tonsil sampling sites. There was a higher average relative abundance of members from the genera Streptococcus, Actinobacillus, and Neisseria in the tonsil crypts when compared with surface and core tonsil tissue samples.

Conclusion

Our results indicate that there is variation in bacterial diversity and composition based on sampling sites in the tonsils but not the adenoids. The difference in microbiota between the surface and the tissue may have implications for our understanding of the pathogenesis of recurrent tonsillitis and have treatment implications.

https://ift.tt/2NZPS8B

Renal Ultrasound Abnormalities in Children with Syndromic and Non-Syndromic Microtia

Publication date: Available online 19 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Julie L. Koenig, Misha Amoils, Madeline M. Grade, Kay W. Chang, Mai Thy Truong

Abstract

Objective

Renal abnormalities are commonly considered in the work up of pediatric patients with external ear malformations. However, there is little consensus regarding an appropriate renal screening protocol for patients with microtia. We sought to characterize renal abnormalities detected on ultrasonography in pediatric patients with microtia.

Methods

We conducted a retrospective cohort study of pediatric patients diagnosed with microtia who underwent renal ultrasound from 1991 to 2014 at a single tertiary academic institution. Renal ultrasound reports and medical records were reviewed to assess for renal abnormalities and to determine whether patients required specialist follow-up or interventions. Audiograms and otolaryngology notes were used to determine patterns of hearing loss. The following additional information was recorded from the electronic medical records: patient sex, microtia grade (I-IV), microtia laterality, and known associated syndromes. Characteristics were compared between those who did and did not have renal ultrasound findings using Fisher's exact test. Univariate logistic regression analysis was performed to determine factors associated with renal ultrasound findings.

Results

The majority of patients in this cohort were syndromic (n=51, 64%) with grade III microtia (n=46, 58%) and conductive hearing loss (n=58, 72%). Syndromic children with microtia demonstrated a higher crude rate of renal ultrasound abnormalities (22%) than children with isolated microtia (7%). Of these patients, 69% required specialist follow-up. Univariate logistic regression analysis did not identify predictors that were significantly associated with renal ultrasound findings.

Conclusion

Fairly high rates of abnormalities in syndromic and non-syndromic patients may warrant screening renal ultrasound in all patients with microtia, especially given the high percentage of findings requiring renal follow-up. A prospective study to formally evaluate screening efficacy is needed.

https://ift.tt/2NtWFGt

Simultaneous auricular reconstruction combined with bone bridge implantation-optimal surgical techniques in bilateral microtia with severe hearing impairment

Publication date: Available online 19 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Yue Wang, Wenshan Xing, Tun Liu, Xu Zhou, Jin Qian, Bingqing Wang, Shouqin Zhao, Qingguo Zhang

Abstract

Background

Congenital bilateral microtia with external ear canal (EAC)/middle ear malformation lead to severe appearance defects, hearing impairment and language barrier. Here we report an optimal integrated surgical technique for BoneBridge implantation and auricular reconstruction, which reduce time span of operation, total cost and patients' suffering as well.

Method

Seven patients with bilateral external and middle ear malformation received 2-stage auricular reconstruction (age from 7 to 11 years old). In the 1st stage, 6th, 7th, and part of 8th autologous costal cartilage were used to make main body and C-shaped base part of the framework. In 2nd stage of the operation, dissect and lift the framework, isolate postauricular fascia and periosteum, put the BoneBridge subperiosteally and fixed with titanium screw. The C-shaped cartilage base was further attached to the framework and retroauricular fascial flaps and a full-thickness skin graft obtained from the donor site was used to cover posterior raw surface.

Results

Patients were followed up for about 8 months post operation, all of them satisfied with the outcomes and symmetric shape on both sides about desirable 3D detail without adverse complications. Hearing test indicated the mean improvement of auditory threshold of 34.8 dB HL 3 weeks after BoneBridge implantation, with mean scores of speech recognition test ranging from 26%∼62%.

Conclusion

The combined 2-stage surgical techniques of simultaneous auricular reconstruction and BoneBridge implantation is safe and efficient for bilateral microtia with significant advantages in decreasing operation difficuties, shortening treatment span and relieving suffering for patients.

https://ift.tt/2O1pf3f

T2-weighted MRI screening algorithm for patients with asymmetric sensorineural hearing loss

Publication date: Available online 19 July 2018

Source: American Journal of Otolaryngology

Author(s): Michael W. O'Bryant, Benjamin K.P. Woo

https://ift.tt/2mtEF3C

Temporary olfactory improvement in chronic rhinosinusitis with nasal polyps after treatment

Abstract

Purpose

Olfactory dysfunction in chronic rhinosinusitis with nasal polyps (CRSwNP) is a severe type of inflammatory olfactory disorders which greatly impair quality of life. The aim of this review is to summarize the current literature and to provide a comprehensive guide to the key metrics of the olfactory dysfunction, evaluations, treatment responses, and pathophysiological mechanisms in CRSwNP patients with olfactory dysfunction.

Methods

A review of the literature for olfaction in CRSwNP was conducted. The key terms ("chronic rhinosinusitis", "nasal polyps", and "olfaction") were used to search relevant articles in Pubmed.

Results

Inflammation within the olfactory cleft is a well-recognized cause of the olfactory loss in patients with CRSwNP. Although the current treatment could significantly improve the olfactory function, olfaction in patients with CRSwNP tends to deteriorate after temporary improvement. Recent research has focused on the change of olfactory cleft and its association with the olfactory function which shed light on the mechanisms of both conductive and sensorineural olfactory dysfunctions in patients with CRSwNP. The state of the olfaction in patients with CRSwNP is directly associated with the degree of inflammation control and disturbed normal turnover of the olfactory sensory neurons induced by chronic inflammation, especially the eosinophilic inflammation contributes to the olfactory dysfunction. Refractory factors contributing to the olfactory deterioration are the promising therapeutic target to maintain the olfactory function in patients with CRSwNP.

Conclusions

The current evidence supports temporary olfactory improvement in CRSwNP patients which accords with the refractory nature of CRSwNP. Future treatment should aim to the continuous elimination of inflammation and promote the normal turnover of the olfactory epithelium.

https://ift.tt/2mv5kgH

Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO 2 laser microsurgery, on local control

Abstract

Purpose

To assess the impact of surgical margins status on local control in patients with primary early glottic (Tis-T2) squamous cell carcinoma after treatment with transoral CO₂ laser microsurgery (TLM) and to assess the significance of additional wound bed biopsies.

Methods

Patients with Tis-T2 tumours treated with TLM type I–III resections according to the European Laryngological Society classification between 2009 and 2013 were included in retrospective analysis. Recurrence rate was determined in patients with free versus non-free specimen margins and wound biopsies. Five-year survival rates were determined using the Kaplan–Meier method. Prognostic impact of pT-category, resection margin status, tumour differentiation, wound bed biopsy status, and number of biopsies on local control (LC) were tested with the log-rank test.

Results

Eighty-four patients were included in the analysis. Positive margins were seen in 68 patients (81.0%). Margin status after TLM did not significantly influence LC (p = 0.489), however, additional wound bed biopsies were significantly associated with lower LC (p = 0.009). Five-year LC, disease-specific survival, overall survival and laryngeal preservation were 78.6, 78.0, 98.6 and 100%, respectively.

Conclusions

Additional wound bed biopsies can help predict local recurrence in patients treated with TLM for early glottic carcinoma. We propose that there is enough evidence to support a wait-and-see policy in patients with positive specimen margins and negative wound bed biopsies. For patients with positive wound bed biopsies, further treatment is warranted.

https://ift.tt/2zS1B6p

Early corrected serum calcium value can predict definitive calcium serum level after total thyroidectomy in asymptomatic patients

Abstract

Introduction

Hypocalcemia is the most common complication of thyroidectomy, requiring supplementation as well as prolonged hospitalization. Our study's objective was to determine a corrected calcium (CCa) level on day 1 after thyroidectomy predictive of no calcium and vitamin supplementation.

Materials and methods

A single-center prospective study conducted between January 2012 and July 2015 in 396 patients, consisting of 331 cases of total thyroidectomy, with seven completion surgeries. The data collected were age, sex, type of thyroid surgery, etiology, anatomical pathological analysis, and the need for calcium and vitamin supplementation therapy as well as its duration. CCa levels were analyzed 20 and 30 h after surgery then on days 2 and 3. To determine a cut-off value for CCa, a ROC curve analysis was performed. The population was described in terms of numbers and associated percentages for categorical variables, and mean.

Results

Mean CCa on 20 h after surgery was 2.09 mmol/L (p < 0.001) and 30 h was 2.06 mmol/L p = 0.02. CCa of less than 2.13 mmol/L was predictive of calcium and vitamin supplementation with 56% sensitivity and 97% specificity. On the evening of day 1, the cut-off value for CCa was 2.06 mmol/L with 67% sensitivity and 65% specificity.

Conclusion

This prospective study confirms that CCa on the first morning after surgery is reliable when it is more than 2.13 mmol/L. In total, analyzing CCa on day 1 after total thyroidectomy allows the discharge of 70% of patients on the first day after surgery, with no risk of hypocalcemia.

https://ift.tt/2mtgiTR

Multimodal Analgesia Pathways in Outpatient Thyroid and Parathyroid Surgery and Opioid Prescriptions

This cohort study asseses the association of institutional availability of multimodal analgesia pathways with adoption and adherence to such pathways, and the frequency of opioid prescriptions at discharge among adults following thyroid and parathyroid surgery.

https://ift.tt/2LtuVVq

Bilateral Painless Cervical Lymphadenopathy in a Child

A child younger than 10 years presented with an 8-week history of bilateral cervical lymphadenopathy unresponsive to a 10-day course of drug treatment and no relevant medical history. What is your diagnosis?

https://ift.tt/2uOrwG1

Revisiting the 2015 American Thyroid Association Guidelines in the NIFTP Era

The incidence of thyroid cancer and subsequent thyroid surgery has increased significantly during the past decade in the United States. Mortality rates have remained unchanged, supporting the widely accepted hypothesis that this finding can, in part, be explained by increased detection of small, nonaggressive nodules, resulting in potential overdiagnosis and treatment.

https://ift.tt/2LtutGI

Risk of Second Primary Malignant Neoplasm After Head and Neck Squamous Cell Carcinoma

This population-based cohort study examines risk of second primary malignant neoplasms in adult patients diagnosed with HPV-associated vs non–HPV-associated head and neck squamous cell carcinoma.

https://ift.tt/2JBlvCb

Association of Cytologically Indeterminate Thyroid Nodule Size With Histologic and Clinical Outcomes

This study assesses the association of indeterminate thyroid nodule size among adults with histologic and clinical outcomes such as cancer rates and response to therapy in considering a surgical approach.

https://ift.tt/2LtulqI

Old Barbers, Young Doctors, and Tonsillectomy

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

https://ift.tt/2kTpAHK

Have Laryngologists Found One More Disease to Treat With a Flexible Laryngoscope and a Needle?—Reply

In Reply We thank Dr Bradley for his commentary regarding our recently published article, "Serial In-Office Intralesional Steroid Injections in Airway Stenosis." We agree with his comment highlighting how advances in one discipline can forward another, and that the treatment of scarring has been well studied. Applying proven treatments for scarring in other locations of the body is prudent, and we foresee the application of a number of newer treatments for scarring (ie, flourourocil) in airway stenosis. We acknowledge the lack of a true control group in this particular study. In addition, we appreciate that it is not clear how many total injections are required to effect positive changes for any given patient. With future evaluation of a larger cohort, we anticipate elucidating this more clearly and will likely be able to target different etiologic subgroups more specifically. Recognizing that intralesional steroid injections for airway stenosis will not be a panacea, patients with different etiologies of subglottic stenosis will need to be treated slightly differently, tailoring treatment to the patient's disease. We use intralesional steroid injections largely in 3 different ways. The first is as an adjuvant after an endoscopic procedure; this is done for patients in all etiologic subgroups. For patients in the traumatic subgroup for whom intralesional steroid injection is effective (ie, without significant cartilage collapse), ongoing intervention may not be required because they do not have a relapsing disorder. On the other hand, patients with inflammatory causes of stenosis, who have a high chance of recurrence, can benefit from adjuvant injections after surgery as well as maintenance injections for early recurrence. Recent reports aimed at identifying the etiology of idiopathic subglottic stenosis (iSGS), have suggested a local, inflammatory, immune response. The early stage of recurrence in both iSGS and rheumatologic-types of stenosis is granulation and erythema in the subglottis, followed by healing with fibrosis. Intervention with intralesional steroid injections (or potentially another immune modulator) at this early stage may alter wound healing, avoid scar formation, and therefore circumvent the need for surgical intervention. Several studies have shown efficacy, safety, and tolerance in patients with iSGS in addition to reducing the need for surgical treatment. Last, as previously observed, we have seen steroid injections dissolve scar tissue that has already formed, therefore obviating the need for surgical intervention in some patients when presenting without critical stenosis. Investigating alternative treatments for scarring is relevant in subglottic stenosis, but we also suggest exploring ways to pharmacologically modulate the inflammatory phase of the disease.

https://ift.tt/2r1hj8c

The Role of Otolaryngologists in Eradicating Human Papillomavirus

This Viewpoint discusses the low rates of vaccination for human papillomavirus in the United States and the role that otolaryngologists can play in improving public health policy about this vaccination.

https://ift.tt/2Ira7J3

A Man With a Midline Lesion Within the Oral Tongue

A man presented with tongue swelling; he denied any history of trauma, foreign body, or piercing. He returned several days later with worsening tongue swelling, voice change, and subjective fever. Computed tomography demonstrated a midline lesion within the oral tongue. What is your diagnosis?

https://ift.tt/2IKwxJC

Proton Pump Inhibitor Use and Outcomes in Children With Respiratory Symptoms

This Viewpoint discusses proton pump inhibitor use and outcomes among children without gastroesophageal reflux in light of the growing body of adult and pediatric literature highlighting the association of proton pump inhibitor use with the risk of fractures, infections, renal disease, cardiac disease, and even death.

https://ift.tt/2rgSzZM

July 2018 Issue Highlights

https://ift.tt/2mr8zFQ

A Novel Computer Algorithm for Printing a 3-Dimensional Nasal Prosthetic

This pilot study describes a novel computer algorithm for the creation of a 3-dimensional model of a nose and uses a survey to evaluate the similarity of appearance of the nasal prosthesis with that of the individual's nose.

https://ift.tt/2KStzQU

The Unrecognized Dangers of Sudden Hearing Loss

The impact of an idiopathic sudden sensorineural hearing loss (ISSNHL) on a patient can be devastating. Practitioners who treat this malady are always worried about potential life-threatening issues, such as an intracranial complication or a tumor. However, practitioners need to be aware of other life-altering consequences of a sudden hearing loss. The study by Kim et al reveals that an often-overlooked sequela is the onset of affective disorders such as depression and anxiety.

https://ift.tt/2xr7KVI

Clinical and Social Factors That Distinguish Presbylaryngis From Pathologic Presbyphonia

This cohort study determines what distinguishes pathologic presbyphonia from presbylaryngis in any adults older than 74 years.

https://ift.tt/2IwBWzJ

Association of Iodine Deficiency With Hearing Impairment in US Adolescents

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

https://ift.tt/2xPjfGA

Patient-Specific, 3-Dimensionally Printed Endoscopic Sinus and Skull Base Surgical Model

This study describes the development and assessment of 3-dimensionally printed sinus and skull base models for use in endoscopic skull base surgery.

https://ift.tt/2rONZlE

Blood Pressure Changes After Adenotonsillectomy in Children With Obstructive Sleep Apnea—Reply

In Reply We appreciate Dr Ghadami for his well advised comments. We are obliged for the keen interest taken in our study that compared the association of adenotonsillectomy with blood pressure (BP) in nonhypertensive vs hypertensive children with obstructive sleep apnea (OSA). We demonstrated that after adenotonsillectomy children with OSA showed improvement in diastolic BP, and our subgroup analysis revealed that hypertensive children with OSA had significant improvement in all BP measurements. Increasing evidence suggests that childhood OSA correlates with hypertension and sequential cardiovascular morbidities. Our results highlight the importance of screening children with OSA and appropriately treating these children to ease their OSA symptoms and potentially prevent future adverse cardiovascular outcomes.

https://ift.tt/2IaYhWN

Adenopharyngoplasty vs Adenotonsillectomy in Children With Severe Obstructive Sleep Apnea

This randomized clinical trial compares the outcomes of adenotonsillectomy vs adenopharyngoplasty in children with severe obstructive sleep apnea.

https://ift.tt/2J2mCva

The Voice and the Larynx in Older Adults—What’s Normal, and Who Decides?

Voice problems in older adults are common, with estimated prevalences of up to 30% across various samples and query methodologies. Age-related changes of laryngeal anatomy and physiology are thought to lead to both presbylaryngis and dysphonia, but many patients with findings of presbylaryngis are asymptomatic, and the incidence of presbylaryngis remains incompletely understood. A challenge in management of voice disorders in older adults is thus what to consider normal vs pathologic, particularly in the context of presbylaryngis.

https://ift.tt/2IM8U2C

Association of CPAP Use With Sexual Quality of Life in Patients With Sleep Apnea

This cohort study evaluates the association of sexual quality of life in patients with newly diagnosed obstructive sleep apnea who used continuous positive airway pressure (CPAP) for 12 months vs those who did not use CPAP.

https://ift.tt/2IEK6u2

Building the Evidence for Corticosteroid Irrigation Therapy in Chronic Rhinosinusitis

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

https://ift.tt/2xSib4P

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

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

https://ift.tt/2sPkf7Y

Identification of Pure-Tone Audiologic Thresholds for Pediatric Cochlear Implant Candidacy

This systematic review describes studies that have evaluated audiologic thresholds as a criterion for cochlear implantation in children with severe and profound hearing impairment.

https://ift.tt/2GOAt6e

Effect of Budesonide Added to Saline Sinus Irrigation for Chronic Rhinosinusitis

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

https://ift.tt/2kVMf6z

Unilateral Otorrhea and Mastoid Erosion

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

https://ift.tt/2MKdYDP

Is gender associated with success in academic oral and maxillofacial surgery?

Publication date: Available online 19 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Andrea B. Burke, Kristie L. Cheng, Jesse T. Han, Jasjit K. Dillon, Thomas B. Dodson, Srinivas M. Susarla

Abstract

Purpose

Several studies of surgical specialties have demonstrated disparities in measures of research productivity and academic rank between female and male surgeons. The purpose of this work was to measure the role of surgeon gender on academic success in oral and maxillofacial surgery.

Methods

This was a cross-sectional study of full-time academic oral and maxillofacial surgeons (OMSs) in the United States, as of June 2017. The primary study variable was surgeon gender (male or female). The primary outcome variable was research productivity assessed using two different parameters: 1) H-index (number of publications h with >h citations each) and 2) academic rank. Other study variables were demographic characteristics potentially related to the outcome measures. Descriptive, bivariate, and regression statistics were computed.

Results

The study sample was comprised of 306 full-time academic OMSs, 53 (17.3%) of whom were female. On average, female OMSs had shorter academic careers (mean time since completion of training (11.0 + 8.2 years versus 22.0 + 14.1 years for male OMSs, p < 0.001). There were no other significant differences between male and female OMSs with regard to the secondary measures (p > 0.23). Male OMSs had a higher mean H-index compared to female OMS (7.1 + 8.6 versus 5.1 + 7.9, p = 0.01). Academic rank was statistically significantly different between female and male OMSs, with a greater proportion of higher ranks seen in male OMSs (p = 0.001). After adjusting for career length and other confounders/effect modifiers, gender was not an independent predictor of the H-index or academic rank (p > 0.22).

Conclusion

While female surgeons represent a minority of full-time academic OMSs, academic success measured using research productivity and academic rank was not associated with gender.

https://ift.tt/2LnMhCL

Postoperative alopecia following oral surgery

Publication date: Available online 19 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Masanori Tsukamoto, Takashi Hitosugi, Hitoshi Yamanaka, Takeshi Yokoyama

https://ift.tt/2uOYdmX

Oral Cysticercosis: A case series and review of literature

Publication date: Available online 19 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): A. Singh, P. Gautam, A.C. Handa, K.K. Handa

Abstract

Cysticercus is the larval form of the adult pork tapeworm. Oral cavity involvement with cysticercosis is rare but are frequently reported from developing countries. We present three cases of oral cysticercosis involving tongue and buccal mucosa in isolation. All three patients were treated with surgical excision and had an uneventful postoperative course. A brief review of Pubmed English language literature search is presented. Oral cavity involvement with cysticercosis presents a diagnostic dilemma. The management is primarily surgical and carries an excellent prognosis.

https://ift.tt/2LnH3ac

Malignant Hyperthermia: A case report in a trauma patient

Publication date: Available online 19 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Ian C. Gibbs, Oluwole Fadahunsi, Natoya Reid, Andrea M. Bonnick

Abstract

Malignant hyperthermia is a rare condition that occurs in susceptible patients exposed to triggering anesthetic agents. It is associated with a high mortality if not recognized immediately and treated appropriately.

A 52 year old male presented to our clinic two days status post assault for management of jaw pain. A minimally displaced right parasymphyseal fracture and moderately displaced left body fracture of mandible were diagnosed.

There were no known drug allergies. He reported no previous difficulty with anesthesia as well as no known prior adverse reactions to anesthesia in any relatives.

Planned surgical intervention was open reduction internal fixation of bilateral mandible fractures. The patient received succinylcholine and desflurane during the procedure. A full 70 minutes elapsed before initial signs of hypermetabolism were noted, namely a rise in EtCO₂. The patient received dantrolene sodium approximately 120 minutes after induction of anesthesia. Signs of hypermetabolism began to abate within 45 minutes of commencing malignant hyperthermia treatment protocol. He was subsequently transferred to the surgical intensive care unit for continued management and had a favorable postoperative course.

This case underscores the importance of awareness of malignant hyperthermia and its presentation. This condition carries a potential high risk for complications following exposure to triggering anesthetic agents. Taking a complete and detailed history may help to identify potential cases. In this case, it was subsequently discovered that patient's biological sister had a near fatal reaction with general anesthesia several years prior to this incident. Intra-operative vigilance to the monitoring of vital signs cannot be overemphasized. An increase in end tidal carbon dioxide values, in addition to other clinical signs that cannot be easily attributed to other causes, should increase the clinical index of suspicion for a diagnosis.

https://ift.tt/2JCLNE2

Atypical metastasis of p16(+) tonsillar squamous cell carcinoma to the pleura: A case report

Publication date: Available online 19 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Claude Charles LeRose, Carlos Antonio Ramirez

Abstract

Incidence rates and patterns of distant metastasis of head and neck malignancies are well documented in the literature, such that focused management strategies are routinely practiced in anticipation of their likely behavior. Head and neck tumors are known to most commonly metastasize to the lungs, skeletal system, and liver, generally within two years of definitive treatment and in the context of poor locoregional control of the primary lesion. Recent studies have shown, however, that HPV(+) oropharyngeal squamous cell carcinoma (SCCa) tumors display different patterns of distant metastases than those traditionally described for head and neck HPV(-) SCCa tumors. This finding has significant implications for how patients treated for these cancers should be surveilled after therapy. This report describes a case of p16(+) tonsillar SCCa with metastasis to a highly unusual secondary site in the pleura to demonstrate an example of the unconventional patterns of distant metastases reported for HPV(+) oropharyngeal SCCa in the recent literature. The report aims to provide a more thorough understanding of this case by discussing the pathogenesis of metastatic spread to the pleura and the clinical progression generally observed in patients with secondary pleural malignancy. The report goes on to then investigate how behaviors of distant metastases exhibited by HPV(+) oropharyngeal SCCa differ from those of more conventionally described head and neck HPV(-) SCCa and the implications this has for strategies of post-treatment surveillance of these tumors going forward.

https://ift.tt/2LtdtAo

What factors are associated with regional recurrence following operative treatment of oral squamous cell carcinoma?

Publication date: Available online 19 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Matthias Troeltzsch, Selgai Haidari, Sophie Boser, Markus Troeltzsch, Florian A. Probst, Michael Ehrenfeld, Sven Otto

Abstract

Purpose

A considerable proportion of OSCC recurrences involve the neck which has a significant impact on prognosis and is poorly understood. The purpose of this study was to analyze clinical and pathological characteristics of regional recurrence of OSCC and to identify possible risk factors.

Materials and Methods

A single – center retrospective cohort study was designed to address the study purpose. All the patients who were treated surgically for primary OSCC with or without adjuvant therapy between 2010 and 2015 were considered for the inclusion with respect to predefined criteria and demographical, clinical and pathological variables were collected. The lymph node status after primary OSCC treatment ("pN") was defined as the predictor variable and the occurrence regional recurrence served as the primary outcome variable. Further variables of special interest were the histologic differentiation (G – status) of the primary OSCC and the values lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS). Descriptive, inferential and appropriate time – dependent (Kaplan – Meier analysis, cox regression model) statistics were computed. The level of statistical significance was set at p ≤ 0.05.

Results

The study sample was composed of 171 patients (female: 70; male: 101; average age 62.4 years). Neck failure occurred in 18 patients (11%) either in combination with local recurrence (15 patients) or in isolation (3 patients). Poor histologic differentiation of the primary tumor was identified as an independent risk factor for regional recurrence. The majority of neck recurrences manifested in previously unaddressed levels (IV and V).

Conclusion

Regional recurrence of OSCC might be associated with specific clinicopathological parameters of the primary tumor. Their importance for OSCC prognosis assessment and recurrence prediction should be elucidated in further studies.

https://ift.tt/2JBEooo

Therapeutic efficacy of cranioplasty post decompressive craniectomy for traumatic brain injury: A retrospective study

Publication date: Available online 19 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Rohit Sharma, Lalit Janjani, Vishal Kulkarni, Seema Patrikar, Shailey Singh

Abstract

Purpose

Autologous bone as removed at the time of decompressive craniectomy (DC) is always the first choice for cranioplasty. The aim of the present study was to evaluate the therapeutic efficacy of cranioplasty post-DC by measuring the changes in functional independence measure (FIM) score, to draw a comparison with pre-cranioplasty and the difference in outcome of cases managed among the 2 groups (group-I: Autologous bone, group-II: Titanuim mesh).

Materials & Methods

Forty seven patients (36 males /11 females) who underwent unilateral cranioplasty post DC for traumatic brain injury (TBI) at our institute from 2008 to 2017 were included in this analytical single institutional retrospective study design. The primary binary predictor variable was cranioplasty (autologous bone/mesh). The primary outcome variables of interest were increased/ decreased/ unchanged FIM scores. The secondary outcome variables included evaluation of immediate complications. Mann-Whitney U test was used to evaluate the difference between the scores.

Results

Group-I (n=26) had undergone cranioplasty using autologous bone flap. Group-II (n=21) cases had undergone cranioplasty using dynamic titanium mesh. Increase in FIM score (motor) for group-I (p=.01278) and group-II (p=.00112) were statistically significant. Increase in FIM score (cognition) for group-I (p=.17384) and group-II (p=.9492) were statistically insignificant. Evaluation of primary outcome variable (i.e. increased/decreased/unchanged FIM scores) and secondary outcome variables (i.e. immediate complications) revealed statistically insignificant difference between the two groups with respect to improvement (p=0.51).

Conclusion

The present study demonstrated that cranioplasty, irrespective of the material, after DC in patients with TBI results in a significant functional improvement apart from form and esthetics.

https://ift.tt/2LhFhYn

Idiopathic Condylar Resorption: A Survey and Review of the Literature

Publication date: Available online 19 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Lena Alsabban, Felix Jose Amarista, Louis G. Mercuri, Daniel Perez

Abstract

PURPOSE

Idiopathic condylar resorption (ICR) is a relatively uncommon condition. Its diagnosis, etiology and management options are also controversial. Further, it is difficult for one provider to collect a large cohort of ICR patients to develop a statistically significant study of these concerns. Therefore, the purpose of the present study was to survey experienced temporomandibular joint (TMJ) surgeons with ICR cases relative to these concerns, as well as review the management outcomes literature.

MATERIALS AND METHODS

Survey Monkey® (SurveyMonkey.com, LLC Palo Alto, CA) was used to canvas the 88 international TMJ surgeons on the TMJ Concepts (Ventura, CA) InterNetwork, this network connects a group of surgeon across the world that consistently do TMJ surgery, the intent was to provide a global snapshot of the demographic, epidemiologic, diagnostic work-up, and outcomes related to the management of ICR cases.

RESULTS

The surveys from surgeons who did not respond to all 12 questions were not included in the results. After applying the exclusion criteria, complete data on a cohort of 100 patients were obtained and utilized for the study. History of hormonal imbalance was only reported in 10% of the patients; however, 42 of 94 women were reportedly taking BCPs presumably affecting their menstrual cycles. The most common reason for consultation was Class II malocclusion (98% of the patients). Treatment modalities varied and included orthodontics, orthotics, TMJ total joint replacement (TMJ TJR), orthognathic surgery, and disc repositioning.

CONCLUSION

ICR management proved to be controversial amongst the surveyed surgeons, multiple treatment options have been described in the literature including: medical management, orthognathic surgery only, TMJ and orthognathic surgery or total joint prostheses (TJP) reconstruction.

Long-term controlled multi-center clinical studies should be developed to evaluate outcomes with all non-surgical and surgical management options for the ICR patient.

https://ift.tt/2JCLglw