Use of the superficial inferior epigastric vein as an unusual interpositional vein graft

Publication date: Available online 24 July 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): J. Higginson, K. McMillan, E.M. Mustafa, N. Grew

https://ift.tt/2NJrCXs

UTHealth/Memorial Hermann Conduct First Sinus Surgery in U.S. Using Augmented Reality Technology

Sinus surgeons with The University of Texas Health Science Center at Houston (UTHealth) and Memorial Hermann-Texas Medical Center were the...

https://ift.tt/2LMia58

Treating Esophageal Diverticula: Life-changing Surgeries for Two Patients

In most cases, Zenker's diverticula are spontaneous and occur in people over the age of 60. More complicated cases of...

https://ift.tt/2uOyImy

Dr. William Yao Serves as Guest Editor of Otolaryngology Journal

William C. Yao, MD, was guest editor of  "Surgical Techniques of Emergencies in Otolaryngology,"  in recent issue of Operative Techniques...

https://ift.tt/2LMQmNT

Idiopathic cervical tracheal stenosis in an 11-year-old male

Publication date: October 2018

Source: International Journal of Pediatric Otorhinolaryngology, Volume 113

Author(s): Matthew R. Hoffman, Katrina M. Thompson, Jessica Van Beek-King

Abstract

Idiopathic laryngotracheal stenosis is a fibroinflammatory stenosis in persons without alternative explanation such as trauma, intubation, or autoimmune disease. Patients are usually females of child-bearing age. We report on an 11-year-old male who developed progressive dyspnea and stridor. Bronchoscopy revealed 90% stenosis of the cervical trachea. He underwent serial balloon dilation with steroid injection; stenosis decreased to 20%. He had no history of intubation or trauma. Histologic and laboratory workup for autoimmune disease was negative. This report highlights occurrence of a well-known disease in an uncommon population, and alerts providers to consider this when seeing new pediatric patients with symptoms of progressive airway restriction.

https://ift.tt/2LDQNx6

Comparison of the histopathological characteristics of osteomyelitis, medication-related osteonecrosis of the jaw, and osteoradionecrosis

Publication date: Available online 24 July 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): A. Shuster, V. Reiser, L. Trejo, C. Ianculovici, S. Kleinman, I. Kaplan

Abstract

The purpose of this study was to compare the histopathological parameters of chronic/suppurative osteomyelitis, medication-related osteonecrosis of the jaw (MRONJ), and osteoradionecrosis (ORN), and to examine the hypothesis that distinct histological features can be related to a specific disease, allowing for diagnosis based on microscopic evaluation alone. One hundred and ten samples were reviewed by two examiners in a blinded fashion, and a semi-quantitative histomorphometric analysis was performed. The parameters evaluated included the presence or absence of necrotic bone, inflammation, reactive bone formation, bacteria, and osteoclasts. No statistically significant differences were found between groups for any parameter. Necrotic bone was common to all three diagnoses. Inflammation and reactive bone formation were present in all three diagnoses. The presence of bacteria was a prominent feature in all cases. Osteoclasts were scarce in MRONJ and osteomyelitis, and non-existent in ORN. The results of this study failed to identify distinctive microscopic characteristics in any of the three entities that could be used to differentiate between them. Therefore, it is impossible to reach a specific final diagnosis based on microscopic findings alone. The role of microscopic analysis is to serve as an aid to diagnosis that must be complemented by the patient's history and imaging.

https://ift.tt/2JSmDkI

Do Different Modes of Delivering Postoperative Instructions to Patients Help Reduce the Side Effects of Tooth Extraction? A Randomized Clinical Trial

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Rasoul Gheisari, Fatemeh Resalati, Sattar Mahmoudi, Ali Golkari, Seyed Ali Mosaddad

Purpose

Postoperative instructions that are properly delivered can decrease postextraction side effects, such as stress, anxiety, and pain, in patients undergoing dental extraction. This study examined the role of the mode of delivering postoperative instructions in decreasing the side effects of dental extraction and increasing patient satisfaction after the procedure.

Materials and Methods

This randomized clinical trial was conducted on a population of 120 patients presenting to the oral and maxillofacial outpatient clinic affiliated with the Shiraz University of Medical Sciences (Shiraz, Iran) in 2015. The patients were randomly assigned to 3 groups of 40 per group. The first group received only verbal instructions after their surgical procedure. The second group received only written instructions. The third group received verbal and written instructions. Details on the patient's age, gender, and formal education were recorded before the operation using a questionnaire. The second part of the questionnaire was completed by patients 1 week after their tooth extraction and recorded their postoperative pain, bleeding, swelling, and satisfaction. Data were analyzed using the Mann-Whitney test, Kruskal-Wallis test, χ² test, and analysis of covariance at a significance level of 95%.

Results

Of the 120 participants, 77 were women and 43 were men; the participants' mean age was 36.45 ± 10.69 years. The results showed that the mode of delivering instructions had a marked relation with pain and patient satisfaction. Pain intensity was significantly higher in the verbal instructions group compared with the written instructions (P = .002) and verbal plus written instructions (P = .000) groups.

Conclusion

The mode of delivering postoperative instructions meaningfully affected pain intensity and general patient satisfaction. Patients who received verbal instructions reported the most intense pain and the least satisfaction, and patients who received verbal and written instructions were the most satisfied.

https://ift.tt/2A57Qnu

Comparison of the Regenerative Effects of Platelet-Rich Fibrin and Plasma Rich in Growth Factors on Injured Peripheral Nerve: An Experimental Study

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Damla Torul, Mehmet Cihan Bereket, Mehmet Emin Onger, Gamze Altun

Purpose

The aim of this study was to investigate the effects of platelet-rich fibrin (PRF) and plasma rich in growth factors (PRGF) on peripheral nerve injury in the early period of healing.

Material and Methods

Thirty Wistar albino rats were used in this study. Rats were divided into control (C), damaged (D), PRF, and PRGF groups. The left sciatic nerves of each group were identified as group C. Crush-type injury was performed on the right sciatic nerves of the D, PRF, and PRGF groups. In the PRF and PRGF groups, blood 2 mL was obtained to prepare the PRF and PRGF and the biomaterials were applied to the injured nerve area. After 8 weeks, functional, electrophysiologic, and stereological evaluations were performed.

Results

For the electrophysiologic evaluation, the latency and amplitude values in the D, PRF, and PRGF groups were significantly lower than those in the C group (P > .05). According to the sciatic functional index result, there were significant differences between groups D and PRF and between groups D and PRGF (P = .000). For the stereological evaluations, although no significant difference was observed between the PRGF and C groups (P > .05), a significant difference was observed among the D, PRF, and PRGF groups for myelinated axon number. There were significant differences between groups D and PRF and between groups D and PRGF for axon area (P = .021 and .001, respectively). No significant difference was observed among the D, PRF, and PRGF groups for myelin sheath thickness and ratio of axon area to myelin sheath thickness (P > .05).

Conclusions

The results of this study suggest that PRGF increases nerve regeneration in the early period of healing and that the limited early action of PRF should be re-evaluated in the late period.

https://ift.tt/2OhtVC7

A New Modified Method for Accurate Mandibular Reconstruction

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Chengshuai Yang, Shunyao Shen, Jinyang Wu, Shilei Zhang

Mandible plays a pivotal role for both function (mastication, swallowing, and phonation) and aesthetic. Traumas, osteomyelitis, osteoradionecrosis, and benign or malignant neoplasm can cause mandibular defect. Several techniques have been proposed for mandibular reconstruction along the past decades. In this article, we present and discuss a new modified method for accurate mandibular reconstruction. This method is mainly indicated in patients with benign mandibular tumors, where the resection margins can be more often anticipated prior to surgery. However, it is less useful for patients with malignant mandibular tumors, in whom resection margins are often finalized intraoperatively.

https://ift.tt/2Aa5zHw

Association of the Preoperative Body Mass Index With Postoperative Complications After Treatment of Oral Squamous Cell Carcinoma

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Susanne Wolfer, Tatjana Foos, Annika Kunzler, Cornelia Ernst, Stefan Schultze-Mosgau

Purpose

Nutritional status is believed to influence surgical outcome. Because of a lack of actual reports in the literature, this study evaluated the surgical outcome of patients after treatment for oral squamous cell carcinoma (OSCC), with special focus on the preoperative body mass index (BMI).

Patients and Methods

This retrospective cohort study investigated the association between preoperative BMI and surgical outcome for patients with OSCC, focusing on local and medical complications. This research also analyzed common clinical and demographic parameters, such as age, gender, TNM stage, tumor differentiation, risk behavior, Karnofsky Index, duration of operation, and length of hospital stay. Statistics were performed using the χ² test or Fisher exact test for categorical analysis and the t test or analysis of variance and Pearson correlation test for continuous variables. Multivariate analysis was computed for BMI with a multivariate linear regression model and for local and medical complications with multivariate Poisson regression.

Results

In the sample of 419 patients with OSCC, 8.6% were underweight, 54.7% were normal weight, and 36.8% were overweight (overall mean BMI, 24.28 kg/m²). BMI was significantly associated with age (P = .0017), consumption of nicotine (P = .0178) and alcohol (P = .0008), dental status (P = .0163), tumor differentiation (P = .0288), and tumor status (P = .0005). Underweight in particular was negatively correlated with local postoperative complications (P = .0047). Local complications were associated with the need for operative revisions (P < .0001) and an increase of hospital length of stay (P < .0001) using multivariable analysis.

Conclusion

These results indicate that evaluation of preoperative morbidity and nutritional status, especially in underweight patients, is worthwhile to improve medical and economic postoperative outcomes after surgical therapy of OSCC.

https://ift.tt/2OfyAo1

Nodal Stage: Is It a Prognostic Factor for Submandibular Gland Cancer?

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Yanbin Liu, Lizheng Qin, RunTao Zhuang, Xin Huang, Ming Su, Zhengxue Han

Purpose

Submandibular gland cancer is relatively rare. The purpose of this study was to estimate 5-year overall survival (OS) and disease-free survival (DFS) and to identify prognostic factors associated with OS and DFS for submandibular cancer.

Materials and Methods

The authors implemented a retrospective cohort study and enrolled a sample of patients with submandibular gland cancer. The predictor variables were age, gender, tumor stage, nodal stage, margin status, and extracapsular spread. The outcome variables were 5-year OS and 5-year DFS. Kaplan-Meier methods were used to estimate survival and Cox hazards models were used to identify prognostic variables.

Results

The sample was composed of 52 patients with submandibular gland cancer (mean age, 47.4 yr; 51.9% men). The median follow-up was 81 months (range, 11 to 159 months). The 5-year OS and DFS rates were 76.9 and 67.3%, respectively. Fixed mass, positive neck node, and positive margin status were relevant predictors of OS and DFS. Nodal stage was the relevant independent predictor affecting the disease outcome of submandibular gland cancer.

Conclusion

These results identified several important prognostic factors associated with survival rate in patients with submandibular gland cancer. These prognostic variables include symptoms at presentation, pathologic nodal status, and margin status. These outcomes suggest that heightening vigilance of clinical characteristics for this disease might provide the impetus for improving the survival rate.

https://ift.tt/2AeStZo

Superficial Temporal Versus Cervical Recipient Vessels in Maxillary and Midface Free Vascularized Tissue Reconstruction: Our 14-Year Experience

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Jun Li, Yi Shen, Liang Wang, Jin-bing Wang, Jian Sun, Thorsen W. Haugen

Purpose

The aims of this study are to review our surgical experience in maxillary and midface reconstruction using free vascularized tissue and to compare the postoperative outcomes based on superficial temporal versus cervical recipient vessels.

Materials and Methods

We performed a retrospective review of patients who underwent maxillary and midface reconstruction with free vascularized tissue from March 2001 to July 2014. Two groups were analyzed: those in whom superficial temporal vessels were used as the recipient vessels and those in whom cervical vessels were used as the recipient vessels. Patient gender and age, cause and classification of the defect, flap choice for reconstruction, recipient vessels, postoperative course, and complications also were recorded and analyzed. A 2-tailed Fisher exact test was used to compare outcomes between the 2 groups.

Results

On the basis of the different recipient vessels, 94 patients were divided into 2 groups: those with superficial temporal recipient vessels (n = 44) and those with cervical recipient vessels (n = 50). The overall flap survival rate was 99.0%. The overall complication rate for vascular anastomoses was 5.3%. The complication rate in patients with cervical recipient vessels was higher than the complication rate in those with superficial temporal recipient vessels (8.0% vs 2.27%, P = .37). In addition, in patients in the group with superficial temporal recipient vessels, the postoperative scar in the pre-tragal region was rated as more satisfactory than the postsurgical scar in those in the cervical recipient vessel group.

Conclusions

We recommend that the superficial temporal vessels be the first option for recipient vessels in free vascularized tissue maxillary and midface reconstruction because of proximity, superficial positioning, and suitability for anastomosis and monitoring and because these vessels are rarely compromised by prior operations or radiotherapy.

https://ift.tt/2OfZXys

Hypertrophic Mental Tubercles of the Mandible

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Bonnie L. Padwa, Nicole Beck, Cory M. Resnick

Purpose

Enlarged mental tubercles are rare benign exostoses that occur in children. The purpose of this study was to report a case series of patients with hypertrophic mental tubercles and propose a theory for their etiopathogenesis.

Patients and Methods

In this retrospective case series of patients with hypertrophic mental tubercles, we reviewed patients' medical records for age, gender, clinical presentation, findings on physical examination and radiographic images, and management details. Descriptive data were summarized.

Results

The sample included 14 patients (71% of whom were male patients) who presented at a mean age of 12.9 ± 4.8 years (range, 6 to 21 years). Most patients had bilaterally enlarged mental tubercles (n = 8); unilateral cases were primarily on the left side (5 of 6 patients). On clinical examination, a bony prominence in the parasymphyseal region was noted on palpation and occasionally by visual inspection. No tenderness to palpation or overlying skin changes were noted. Typical radiographic features included asymmetry along the inferior border of the mandible in the parasymphyseal region on panoramic radiographs and prominence and/or enlargement of the mental tubercles on computed tomography scans. No evidence of cortical expansion, perforation, or periosteal reaction was found. Three patients requested contouring of the hypertrophied tubercles.

Conclusions

Hypertrophic mental tubercles are rare bony exostoses that occur in children in a region where a confluence of facial muscles attach to the mandible. The etiology likely involves bone deposition occurring in an area of muscle pull.

https://ift.tt/2AaXXoc

Are Portable Stereophotogrammetric Devices Reliable in Facial Imaging? A Validation Study of VECTRA H1 Device

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Daniele Gibelli, Valentina Pucciarelli, Annalisa Cappella, Claudia Dolci, Chiarella Sforza

Purpose

Modern 3-dimensional (3D) image acquisition systems represent a crucial technologic development in facial anatomy because of their accuracy and precision. The recently introduced portable devices can improve facial databases by increasing the number of applications. In the present study, the VECTRA H1 portable stereophotogrammetric device was validated to verify its applicability to 3D facial analysis.

Materials and Methods

Fifty volunteers underwent 4 facial scans using portable VECTRA H1 and static VECTRA M3 devices (2 for each instrument). Repeatability of linear, angular, surface area, and volume measurements was verified within the device and between devices using the Bland-Altman test and the calculation of absolute and relative technical errors of measurement (TEM and rTEM, respectively). In addition, the 2 scans obtained by the same device and the 2 scans obtained by different devices were registered and superimposed to calculate the root mean square (RMS; point-to-point) distance between the 2 surfaces.

Results

Most linear, angular, and surface area measurements had high repeatability in M3 versus M3, H1 versus H1, and M3 versus H1 comparisons (range, 82.2 to 98.7%; TEM range, 0.3 to 2.0 mm, 0.4° to 1.8°; rTEM range, 0.2 to 3.1%). In contrast, volumes and RMS distances showed evident differences in M3 versus M3 and H1 versus H1 comparisons and reached the maximum when scans from the 2 different devices were compared.

Conclusion

The portable VECTRA H1 device proved reliable for assessing linear measurements, angles, and surface areas; conversely, the influence of involuntary facial movements on volumes and RMS distances was more important compared with the static device.

Graphical abstract

https://ift.tt/2OceECu

Maxillary Interdental Osteotomies Have Low Morbidity for Alveolar Crestal Bone and Adjacent Teeth: A Cone Beam Computed Tomography-Based Study

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Daniel B. Rodrigues, Paulo S.F. Campos, Larry M. Wolford, Jaqueline Ignácio, João R. Gonçalves

Purpose

Maxillary segmentation involving interdental osteotomies can have an adverse effect on the interdental crestal bone and adjacent teeth. The purpose of the present study was to evaluate the effect of interdental osteotomies on surrounding osseous and dental structures, including adjacent teeth, using cone beam computed tomography (CBCT), in patients who underwent segmental maxillary osteotomies.

Patients and Methods

The present retrospective cohort study evaluated interdental osteotomy (IDO) sites between the lateral incisors and canines in patients treated with 3-piece Le Fort I osteotomies. CBCT scans were assessed using Kodac Dental Imaging software at specific intervals: T0 (before surgery), T1 (immediately after surgery), and T2 (a minimum of 11 months after surgery). The statistical analysis using a linear regression model was adjusted to compare the variables at the different intervals. Injury to the dental structures was assessed by radiological evidence of dental damage, the requirement for endodontic treatment, or tooth loss.

Results

We evaluated 94 IDO sites in 47 patients in the present study. The mean inter-radicular distance at T0 was 2.5 mm. A statistically significant increase was seen in the inter-radicular distance (between T1 and T0) of 0.72 mm, with a reduction of the alveolar bone crest height (between T2 and T0) of 0.19 mm (P < .001) for the group that underwent IDO. A weak correlation was found for this increase in the inter-radicular distance, with changes in the alveolar crest bone height. The potential complications associated with interdental osteotomies such as iatrogenic damage to the tooth structure, the need for endodontic treatment, and tooth loss were not encountered in any patients.

Conclusions

We found very low morbidity for the interdental alveolar crest and the integrity of teeth adjacent to interdental osteotomies for patients who underwent maxillary segmentation between the lateral incisors and canines.

https://ift.tt/2AaXTEY

Long-Term Stability of Pre-Orthodontic Orthognathic Bimaxillary Surgery Using Intraoral Vertical Ramus Osteotomy Versus Conventional Surgery

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Jeong-Hwa Jeong, Sung-Hwan Choi, Kee-Deog Kim, Chung-Ju Hwang, Sang-Hwy Lee, Hyung-Seog Yu

Purpose

The aim of the present study was to compare the long-term stability of bimaxillary surgery using an intraoral vertical ramus osteotomy (IVRO) with and without presurgical orthodontic treatment.

Materials and Methods

The present retrospective study included 31 consecutive patients with skeletal Class III malocclusions who had undergone bimaxillary surgery (Le Fort I osteotomy and bilateral IVRO). Patients were divided into 2 groups based on treatment type: pre-orthodontic orthognathic surgery (POGS; n = 17) and conventional surgery with presurgical orthodontic treatment (CS; n = 14). Lateral cephalograms were obtained before surgery, 1 day after surgery, 1 month after surgery, 1 year after surgery, and 2 years after surgery to evaluate skeletal and soft tissue changes between the 2 groups. Data were analyzed using χ² tests, Mann-Whitney U tests, repeated-measures analyses of variance, and independent t tests.

Results

There was no significant difference in skeletal or soft tissue measurements—with the exception of the angle between the sella-and-nasion plane and the occlusal plane (SN-OP; P < .001)—between the CS and POGS groups at 2 years after IVRO. The SN-OP had increased in the CS group but decreased in the POGS group at 2 years after surgery.

Conclusions

These findings suggest that POGS and CS have similar long-term stability in patients with skeletal Class III malocclusion.

https://ift.tt/2OgZnAj

Accuracy of Orthognathic Surgical Outcomes Using 2- and 3-Dimensional Landmarks—The Case for Apples and Oranges?

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Alexandre Meireles Borba, Everton José da Silva, André Luis Fernandes da Silva, Michael D. Han, Maria da Graça Naclério-Homem, Michael Miloro

Purpose

To verify predicted versus obtained surgical movements in 2-dimensional (2D) and 3-dimensional (3D) measurements and compare the equivalence between these methods.

Materials and Methods

A retrospective observational study of bimaxillary orthognathic surgeries was performed. Postoperative cone-beam computed tomographic (CBCT) scans were superimposed on preoperative scans and a lateral cephalometric radiograph was generated from each CBCT scan. After identification of the sella, nasion, and upper central incisor tip landmarks on 2D and 3D images, actual and planned movements were compared by cephalometric measurements. One-sample t test was used to statistically evaluate results, with expected mean discrepancy values ranging from 0 to 2 mm. Equivalence of 2D and 3D values was compared using paired t test.

Results

The final sample of 46 cases showed by 2D cephalometry that differences between actual and planned movements in the horizontal axis were statistically relevant for expected means of 0, 0.5, and 2 mm without relevance for expected means of 1 and 1.5 mm; vertical movements were statistically relevant for expected means of 0 and 0.5 mm without relevance for expected means of 1, 1.5, and 2 mm. For 3D cephalometry in the horizontal axis, there were statistically relevant differences for expected means of 0, 1.5, and 2 mm without relevance for expected means of 0.5 and 1 mm; vertical movements showed statistically relevant differences for expected means of 0, 0.5, 1.5 and 2 mm without relevance for the expected mean of 1 mm. Comparison of 2D and 3D values displayed statistical differences for the horizontal and vertical axes.

Conclusions

Comparison of 2D and 3D surgical outcome assessments should be performed with caution because there seems to be a difference in acceptable levels of accuracy between these 2 methods of evaluation. Moreover, 3D accuracy studies should no longer rely on a 2-mm level of discrepancy but on a 1-mm level.

https://ift.tt/2AaXRNm

Total Avulsed Ear Management With Radial Forearm Free Flap

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Uzair Luqman, Zahid Qayyum, Zahid Furqan, Kaleem Ullah

Avulsive injuries to the ear are extremely challenging to treat. The literature documents numerous ways to manage such injuries. This report describes a case of total auricular cartilaginous avulsion that occurred during a motor vehicle accident. The avulsed segment had an ischemia time longer than 8 hours by the time of presentation at the authors' tertiary care facility. The avulsed segment was de-epithelialized and embedded into the volar forearm. After a healing period of 6 months, a radial forearm free flap was harvested and the ear was reconstructed. After ensuring good flap uptake and adequate primary healing, the flap was debulked and reshaped at 4 months after inset.

https://ift.tt/2OdWq3H

Fractures of the Stylomandibular Complex: A Prospective Study Proposing a Classification and Clinical Protocol

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Elavenil Panneerselvam, Sasikala Balasubramaniam, Aditi Rajendra Sharma, Pathumai Murugadoss, Saravanan Chellappazham, V.B. Krishnakumar Raja

Purpose

Mandibular trauma can result in stylomandibular complex (SMC) fractures with clinical symptoms including glossopharyngeal neuralgia, globus pharyngeus, otalgia, and dysphonia. Fracture of the styloid process is noteworthy because of its proximity to numerous vital structures. The study objectives were 1) to determine the incidence of SMC fractures and develop a clinical grading system and 2) to institute and assess a treatment protocol.

Materials and Methods

This prospective clinical trial involved 206 patients with mandibular trauma based on a set of inclusion and exclusion criteria. On the basis of the clinical presentation of symptoms, patients were categorized as mild, moderate, or severe, and the radiographic features were characterized as type 1, 2, or 3. Patients were treated by an institutional protocol, and outcome was evaluated. A grading system was developed by correlating clinical features with imaging. Data were analyzed using SPSS software (version 22; IBM, Armonk, NY). Descriptive and analytic statistics were computed.

Results

The incidence of styloid fracture was 11.17%. The most common concomitant mandibular fractures were condyle (13 patients) and angle (7 patients) fractures. Dysphagia and restricted mouth opening were the most common symptoms. The distribution of radiographic types 1, 2, and 3 was 26.1%, 69.6%, and 4.3%, respectively. A significant correlation (P < .001) was found between clinical symptoms and radiographic types using the Fisher exact test.

Conclusions

This study proposes a clinical grading system for SMC fractures and a symptom-based management algorithm.

https://ift.tt/2AeShcC

Factors Influencing Postsurgical Diplopia in Orbital Floor Fractures and Prevalence of Other Complications in a Series of Cases

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Marina Alexandra Gavin Clavero, María Victoria Simón Sanz, Andrea Mur Til, Úrsula María Jariod Ferrer

Purpose

We conducted a review of orbital fractures treated in our hospital over a period of 4 years. We reviewed several complications of such fractures, especially the relationship of postsurgical diplopia with different presurgical variables: age, gender, type of fracture, fracture area, coronal and sagittal diameter of fracture, fractured floor area, time to surgery, presence of muscle herniation, and presence of muscle entrapment.

Patients and Methods

Fractures involving the orbital floor remain a controversial issue in terms of surgical treatment and the time from trauma to surgery. Surgical indications are divided into esthetic and functional, and they greatly differ from one medical center to another. We observed that the variables that influence postoperative complications varied in the different studies reviewed. Postsurgical diplopia is one of the most important complications, and its relationship with presurgical variables was the focus of this study. For the purpose of this study, we performed bivariate and multivariate analyses, accepting P < .05 as significant.

Results

According to the multivariate analysis, postsurgical diplopia was only associated with trapdoor fractures, regardless of all other variables, especially if these fractures were operated on after 48 hours. In addition, the bivariate analysis showed that fractures involving muscle herniation resulted in less diplopia and a better prognosis if operated on before 48 hours. However, these results were not statistically significant.

Conclusions

Surgery performed within 48 hours of trauma statistically improves fractures with true muscle entrapment and also, fractures with muscle hernation (although in this fractures, the improvement is not statistically significant).

https://ift.tt/2OcOPSW

Foreign Body Giant Cell Reaction to a Proplast/Teflon Interpositional Implant: A Case Report and Literature Review

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Kevin C. Lee, Sidney B. Eisig, Michael A. Perrino

After discectomy, interpositional implants (IPIs) are believed to provide temporomandibular joint stability and protect against degenerative joint space remodeling. Alloplastic IPIs gained popularity in the late 1970s because the practice showed early success without donor site morbidity. Unfortunately, these implants were subject to substantial fragmentation resulting in an exuberant foreign body giant cell response that progressively eroded adjacent structures. Most of these alloplastic implants were removed in the years following their recall by the US Food and Drug Administration in 1991, however some remained in circulation. This report describes a case of a failed Proplast/Teflon IPI 27 years after its placement. This case highlights the considerations for managing a patient with a Proplast/Teflon IPI and serves to remind providers that, although increasingly rare, these implants are still present and subject to delayed failure.

https://ift.tt/2AeSaOe

The CCL5/CCR5 Chemotactic Pathway Promotes Perineural Invasion in Salivary Adenoid Cystic Carcinoma

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Tao Gao, Zhiyuan Shen, Chao Ma, Yun Li, Xiangfeng Kang, Moyi Sun

Purpose

Perineural invasion (PNI) is a hallmark of salivary adenoid cystic carcinoma (SACC) and represents an important risk factor for local recurrence and poor survival. However, the mechanism of PNI has yet to be explored. We sought to examine the CCL5-CCR5 ligand–receptor interaction between nerves and SACC cells.

Materials and Methods

CCL5/CCR5 expression was determined by immunohistochemistry in SACC tissue specimens. The correlations between CCL5/CCR5 expression and clinicopathologic features were investigated. Dorsal root ganglia (DRG) and SACC cells cocultured in vitro were used to evaluate the effects of CCL5/CCR5 on PNI progression and pathogenesis.

Results

CCR5 expression was significantly elevated in SACC tissues and associated with distant metastasis, PNI, and TNM grade (P < .05). DRG and SACC cells cocultured in vitro showed that the activation of the CCL5/CCR5 axis significantly increased SACC cell invasion and promoted the outgrowth of the DRG. SACC cell lines expressing CCR5 migrated in response to CCL5 derived from DRG, eventually leading to PNI. More importantly, further study showed that blocking of CCL5 or CCR5 effectively inhibited the invasive capacity and PNI activity of SACC cells (P < .05).

Conclusions

Our results suggest a pivotal role of CCL5/CCR5 axis in tumor–nerve interactions during PNI of SACC. The CCL5/CCR5 pathway might prove to be an attractive new target for the treatment of SACC with PNI.

https://ift.tt/2OcuDRj

Embolization as the Primary Treatment for Mandibular Arteriovenous Malformations: An Analysis of 50 Literature Reports and of an Illustrative Case

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): João Luiz Gomes Carneiro Monteiro, José Alcides Almeida de Arruda, Jefferson Luiz Figueiredo Leal, Laécio Leitão Batista, Suzana Célia de Aguiar Soares Carneiro, Belmiro Cavalcanti do Egito Vasconcelos

Purpose

The aim of the present report is to describe 50 cases in the literature of mandibular arteriovenous malformations (AVMs) in which embolization was the primary treatment and to discuss details such as age, gender, materials used, outcome of embolization, time of follow-up, and intra- or postprocedure complications. An illustrative case in which reossification was noticed after embolization also is presented.

Patients and Methods

The study was carried out in 2 steps. In the first, an electronic search without time restriction for embolization as the primary treatment for mandibular AVMs was performed on Medline through PubMed. In the second, the case of a patient with mandibular AVM and massive oral bleeding episodes is described after a long-term follow-up.

Results

Clinical stability with the cessation of oral bleeding episodes was detected in 25 cases and 2 cases were planned for another embolization session. Clinical stability and reossification were detected in 23 of the 50 cases included. Complications were reported in 50% of cases, but most were minor and transient.

Conclusion

Currently, owing to more sophisticated imaging techniques, the diagnosis of mandibular AVMs is quicker and new, less invasive techniques that avoid surgical resection have proved effective. It should be emphasized that these techniques are not without complications and that long-term monitoring is extremely important.

https://ift.tt/2AaXDWw

Toxic Epidermal Necrolysis: A Dermatologic Emergency and the Role of the Oral and Maxillofacial Surgeon

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Brian Wolf, Rory Sadoff, Victor Nannini

Toxic epidermal necrolysis (TEN) is a rare and severe mucocutaneous disorder characterized by mucosal and epidermal necrosis and sloughing. This potentially life-threatening condition, together with the less severe Stevens-Johnson syndrome, is commonly caused by an immunologic reaction to medications and can lead to many long-term complications. The disorder initially presents with fever, malaise, and painful mucosal ulcerations (most commonly oral) but progresses to widespread cutaneous lesions. A 14-year-old male patient was prescribed minocycline for treatment of his acne by his primary care doctor. Three weeks into the antibiotic treatment, he was admitted in distress, with a diagnosis of Stevens-Johnson syndrome that subsequently progressed to TEN. We present a discussion of the importance of early recognition and diagnosis of this condition by oral and maxillofacial surgeons and a description of our patient's treatment and management during his hospital stay.

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Effect of Obesity or Metabolic Syndrome and Diabetes on Osseointegration of Dental Implants in a Miniature Swine Model: A Pilot Study

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Paulo G. Coelho, Benjamin Pippenger, Nick Tovar, Sietse-Jan Koopmans, Natalie M. Plana, Dana T. Graves, Steve Engebretson, Heleen M.M. van Beusekom, Paula G.F.P. Oliveira, Michel Dard

Purpose

The increasing prevalence of obesity or metabolic syndrome (O/MS) and type 2 diabetes mellitus (DM) remains a global health concern. Clinically relevant and practical translational models mimicking human characteristics of these conditions are lacking. This study aimed to demonstrate proof of concept of the induction of stable O/MS and type 2 DM in a Göttingen minipig model and validate both of these disease-adjusted Göttingen minipig models as impaired healing models for the testing of dental implants.

Materials and Methods

Nine minipigs were split into 3 groups—control (normal diet), obese (cafeteria diet), and diabetic (cafeteria diet plus low-dosage streptozotocin)—followed by placement of dental implants. Inflammatory markers including tumor necrosis factor α, C-reactive protein, and cortisol were recorded for each study group. Removal torque was measured, and histomorphometric analysis (bone-to-implant contact and bone area fraction occupancy) was performed.

Results

O/MS pigs showed, on average, a 2-fold increase in plasma C-reactive protein (P < .05) and cortisol (P < .09) concentrations compared with controls; DM pigs showed, on average approximately, a 40-fold increase in plasma tumor necrosis factor α levels (P < .05) and a 2-fold increase in cortisol concentrations (P < .05) compared with controls. The impact of O/MS and DM on implants was determined. The torque to interface failure was highest in the control group (200 N-cm) and significantly lower in the O/MS (90 N-cm) and DM (60 N-cm) groups (P < .01). Bone formation around implants was significantly greater in the control group than in the O/MS and DM groups (P < .02).

Conclusions

Both O/MS and DM minipigs express a human-like disease phenotype, and both presented bone-healing impairment around dental implants. Our finding of no significant difference between type 2 DM and O/MS in bone formation around implants provides evidence that further investigation of the impact of O/MS is warranted.

https://ift.tt/2AaXv9u

Prevalence, Nature, and Management of Oral Stage Dysphagia in Adults With Temporomandibular Joint Disorders: Findings From an Irish Cohort

Publication date: August 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 8

Author(s): Órla Gilheaney, Leo FA Stassen, Margaret Walshe

Purpose

Temporomandibular disorders (TMDs) are caused by changes in the structure and/or function of the temporomandibular joint, masticatory muscles, and/or osseous components. TMDs can result in oral stage dysphagia (OD) with potential effects on function and patient well-being. Little is known about the prevalence, nature, and management of TMD-related OD. The aims of the present study were to estimate the prevalence and nature of OD in adult TMD patients and to identify the common management techniques used to manage the signs and symptoms of TMD-related OD.

Patients and Methods

An 18-item subjective questionnaire was adapted from existing tools and used to investigate TMD etiology, the symptoms and signs of TMD-related OD, and the intervention techniques used to manage these symptoms. This was disseminated to 178 TMD patients consecutively recruited over 6 months in 2016. Descriptive and statistical methods were used to analyze the data.

Results

Of the 178 TMD participants, 99% reported at least one symptom or sign of OD. Individuals presenting with subluxation of the jaw (80%), degenerative joint disorder (67%), and myofascial pain disorder (40%) reported OD most frequently. Common symptoms included painful mastication (90%), masticatory fatigue (78%), difficulties swallowing (33%), and difficulties drinking liquids (28%). The use of a broad range of management techniques was reported, with these including both OD-specific techniques (eg, diet modifications [81%]), and non-OD specific techniques (eg, analgesia [79%] and oral splints [75%]).

Conclusions

OD is prevalent, and difficulties with mastication are common in those with TMDs. The interventions used were diverse, with varying objectives and disparate levels of evidence supporting their efficacy within this cohort. Further research should address the epidemiology of TMD-related OD, evidence-based interventions, and the promotion of collaboration across the disciplines responsible for managing TMD-related OD (eg, speech and language therapy, oral and maxillofacial surgery, dentistry, restorative dentistry, orthodontics, oral medicine).

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Genome-wide analyses and functional profiling of human NK cell lines

Publication date: Available online 24 July 2018

Source: Molecular Immunology

Author(s): Justin T. Gunesch, Laura S. Angelo, Sanjana Mahapatra, Raquel P. Deering, Johanna E. Kowalko, Patrick Sleiman, John W. Tobias, Linda Monaco-Shawver, Jordan S. Orange, Emily M. Mace

Abstract

Natural killer (NK) cell lines, including YTS, NK92, NK3.3, and NKL, represent excellent models for the study of human natural killer cells. While phenotypic and functional differences between these cell lines have been reported, a multi-parametric study, encompassing genomic, phenotypic, and functional assays, has not been performed. Here, using a combination of techniques including microarray and copy number analyses, flow cytometry, and functional assays, we provide in-depth genetic, functional, and phenotypic comparison of YTS, NK92, NK3.3, and NKL cell lines. Specifically, we found that while the cell lines shared similarities in enrichment of growth and survival pathways, they had differential expression of 557 genes, including genes related to NK cell development, survival, and function. In addition, we provide genetic and phenotypic analyses that demonstrate distinct developmental origins of NK92, YTS, and NKL cell lines. Specifically, NK92 has a phenotype associated with the CD56^bright NK cell subset, while both YTS and NKL appear more CD56^dim-like. Finally, by classifying cell lines based on their lytic potential, we identified genes differentially expressed between NK cell lines with high and low lytic function. Taken together, these data provide the first comprehensive genetic, phenotypic, and functional analyses of these commonly used NK cell lines and provides deeper understanding into their origins and function. This will ultimately improve their use as models for human NK cell biology.

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Response to YAJOT_2018_288 “Letter to the Editor: T2-weighted MRI screening algorithm for patients with asymmetric sensorineural hearing loss”

Publication date: Available online 24 July 2018

Source: American Journal of Otolaryngology

Author(s): Matthew L. Carlson, Alex D. Sweeney, John I. Lane

https://ift.tt/2LjQb0q

Correction to: Correction to: The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the Management of Patients with Cervical Cancer

Regrettably, the author metadata used for the previous correction (doi: https://ift.tt/2LyZA3v) contained an error in the tagging of W. Glenn McCluggage's name; this has been corrected. No further adjustments have been made to the Correction, or the original Guideline paper (doi: https://ift.tt/2LM3IKq).

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The Nasal Width and Boxiness Index: Introduction and Pilot Study on Reliability and Validity of Sonographic Morphometry

Facial plast Surg 2018; 34: 373-380
DOI: 10.1055/s-0038-1667025

Both intended and unintended surgical modifications of nasal width and shape of the nasal tip continue to be of interest to the rhinoplasty surgeon. As validated instruments for quantifying width and boxiness are lacking, the objective of this study was to introduce a width index and a boxiness index for the nasal dorsum and the nasal tip. A width index and a boxiness index were defined within the methodological limits of noncontact sonography. The reliability of both indices was studied by comparing the measurements of two examiners on the noses of five volunteers. The validity of the indices was studied by correlating the sonographic width and boxiness with the 5-point Likert scale ratings of photographs of 5 noses by 21 lay persons. Nasal width was defined as the diameter at a distance of 5 mm from the skin surface on a sonographic cross-section perpendicular to the skin surface. Boxiness was defined as the quotient of width at a depth of 1 and 5 mm. Bland–Altmann analysis revealed negligible bias between both examiners and 95% of limits of agreement of 13, 7, and 13% for width at 1 mm, width at 5 mm, and boxiness, respectively. Corresponding Pearson's correlation coefficients were r = 0.93, r = 0.93, and r = 0.71. The correlation between the cumulative lay persons' scores and sonographic width and boxiness were r = 0.97, r = 0.66, and r = 0.81 for nasal tip width, dorsal width, and boxiness, respectively. Both the width at a depth of 5 mm as measured with sonography and the boxiness index that is defined as width at a depth of 1 mm divided by the width at a depth of 5 mm may prove to be acceptable surrogate parameters for width and boxiness of the nose in comparative morphometric studies.
[...]

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Rhinoplasty—Do Patients and Surgeons See the Same? A Double-Blind Study with 100 Randomized Patients

Facial plast Surg 2018; 34: 356-362
DOI: 10.1055/s-0038-1660823

One of the key points of a successful rhinoplasty is communication between the patient and surgeon. The surgeon needs to get a clear understanding of the patient's motivation for surgery and expectations of the procedure. This information is mandatory in formulating an optimal surgical plan and managing realistic expectations of the procedures. Ideally, surgeons and patients see, discuss, and quantify the same nasal defects. In reality, the subjective nature of perceiving aesthetics can cause variability of inter-rating nasal appearance. Therefore, one might question how well surgeons understand their patients. Do they see what patients see? The aim of this study is to assess the level of agreement on the evaluation of nasal appearance between patients, surgeons, and nonphysicians observers, and try to find predictive factors that cause high interobserver variability. This prospective, observational, and cross-sectional study was performed on a total of 100 randomized patients undergoing rhinoplasty. All patients were photographed before surgery and asked to rate the appearance of their nose on a 10 cm visual analogue scale (VAS) with 0 indicating very ugly and 10 indicating very nice. Subsequently, the photographs of each patient were, independently, rated by two panels: one constituted by two rhinoplasty surgeons and the other by four nonmedical raters. Both panels included European raters from the north (The Netherlands) and south (Portugal). Data regarding age, gender, skin type, and major nasal deformity were also collected. The authors found that there is no statistical agreement between the aesthetical evaluation of the nose between patients and surgeons or patients and nonmedical raters. Based exclusively on the VAS for subjective evaluation of nasal appearance, the authors' findings show that surgeons and patients do not "see the same" and generally, the score attributed by the surgeon is more favorable (almost 1 point higher) than the auto-assessment's score. This is important to realize when communicating about nasal appearance before rhinoplasty.
[...]

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Teaching Facial Plastic Surgery

Facial plast Surg 2018; 34: 341-342
DOI: 10.1055/s-0038-1667136

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

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Introducing Hair Transplantation into a Facial Plastic Surgery Practice

Facial plast Surg 2018; 34: 384-388
DOI: 10.1055/s-0038-1666785

Hair restoration can be an integral addition to the facial plastic surgery practice. As surgeons dedicated to reconstructive and aesthetic surgery of the head and neck, hair restoration is a natural complement to a facial plastic surgeon's practice. This article presents the keys to adding and starting hair restoration to one's facial plastic surgery practice.
[...]

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

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A Plea for Ethics: Suggestions for Implementation in the Medical Curriculum

Facial plast Surg 2018; 34: 343-349
DOI: 10.1055/s-0038-1667026

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

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Refinements in Saddle Nose Reconstruction

Facial plast Surg 2018; 34: 363-372
DOI: 10.1055/s-0038-1660824

Saddle nose correction remains a challenging procedure for rhinoplasty surgeons due to both aesthetic and functional issues. The most common causes of saddle nose are nasal trauma and prior septal surgery, and a defective relationship between the caudal septum and the anterior septal spine is the principal postoperative pathology. The authors propose their own classification system for saddle nose with one new category and several approaches to deal with this condition in accordance with the level of severity. They strongly advocate major septal reconstruction for most cases of saddle nose, either by placing extended spreader grafts, caudal extension grafts, or a new extracorporeally made L strut. For extreme cases, integrated dorsal implant with columellar strut can successfully bypass the saddled nasal dorsum without dissecting the septal mucoperichondrial pocket and achieve adequate dorsal height. Further dorsal augmentation can be achieved by applying side/gap grafts or dorsal onlay grafts in different forms. In cases with retracted columella, a premaxillary plumping graft is another useful technique. Finally, in autoimmune-related saddling patients, the evidence indicates that their aesthetic problems can be managed safely with surgery as long as the disease is well under control.
[...]

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Development and Validation of a Brief Four-Component Questionnaire to Identify Patient's Motivation to Undergo Functional Rhinoplasty

Facial plast Surg 2018; 34: 350-355
DOI: 10.1055/s-0038-1660835

Outcome of functional rhinoplasty depends on different domains such as functional and aesthetic improvement. The aim of this study was to develop a brief and comprehensible questionnaire to identify patient motivation to undergo rhinoplasty and to measure the outcome of an intervention within a short time during outpatient consultation. Patients undergoing rhinoplasty were asked to complete the Rhinoplasty Outcome Evaluation (ROE) questionnaire, the Nasal Obstruction Symptom Evaluation (NOSE) scale, and the Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty (OAR) preoperatively, as well as one, three, and twelve months postoperatively. Patient satisfaction after surgery was assessed at postoperative consultations using a five-point Likert scale. Principle component analysis was performed to reveal the main domains, which were detected by the different questionnaires. Items with the strongest loading on a factor were identified by correlation matrix. Influence of the nasal appearance on the quality of life, troubles with nasal breathing, subjective perception of nasal appearance, and the wish for modification or alteration were found to be the four important domains of the questionnaires. The questions with the strongest loading on these domains were compiled and the four-component questionnaire (4CQ) was developed. The 4CQ is a very effective instrument to obtain a comprehensive impression of the varied determinants representing the major motifs to undergo functional rhinoplasty within a short time. The preoperative assessment of the 4CQ allows an estimation concerning the expected outcome.
[...]

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Facial Asymmetry Index: Validation and Applications in Various Smile Restoration Techniques

Facial plast Surg 2018; 34: 381-383
DOI: 10.1055/s-0038-1660836

Consistent and objective evaluation of the paralyzed face is imperative for documenting preoperative findings and assessing postoperative outcomes of reanimation techniques. Static and dynamic facial asymmetry are the key features of the paralyzed face. To date, there is no consensus among surgeons on how best to document facial asymmetry. The authors propose a Facial Asymmetry Index (FAI) as an objective measure of facial asymmetry and validate its use and reliability across numerous reanimation techniques. Frontal photographs of patients with unilateral facial nerve paralysis were analyzed. The length from the medial canthus to the ipsilateral oral commissure was compared between affected and nonaffected sides. The FAI is the difference between the two values, with a higher value reflecting poorer facial symmetry. Validation and reliability testing was then performed. There was a consistent decrease in the FAI with procedural intervention (FAI pre = 10.1, FAI post = 3.17; p < 0.0001). Furthermore, there was excellent inter- and intrarater reliability among independent judges. The FAI is a powerful and accessible tool to quantify operative outcomes for many lower facial nerve reanimation techniques.
[...]

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Tip-on-Tip Scapular (TOTS) Flap for Reconstruction of Combined Palatectomy and Rhinectomy Defects

Facial plast Surg 2018; 34: 389-393
DOI: 10.1055/s-0038-1666784

Combination anterior palatectomy and rhinectomy defects result in complete loss of midface and nasal support and present a significant reconstructive challenge. A novel use of the scapular tip free flap—the tip-on-tip scapula flap—was developed to provide both palatal repair and restoration of intrinsic nasal support. The scapular tip bone is split into a large proximal segment for the anterior palate and a smaller distal bone segment for nasal framework reconstruction. Two patients undergoing reconstruction of both total palatectomy and partial rhinectomy defects at a single academic tertiary care center were reviewed. In both cases, the larger proximal segment of the scapular tip flap, used for the palatal defect, was based on the angular artery. The distal bone segment, used for nasal framework repair, was vascularized in one of two ways. In the osteomyogenous serratus-scapular tip variant, the serratus arterial branch provided periosteal blood supply to the bone through a cuff of attached serratus muscle. In the split-scapular tip variant, the periosteum of the scapular tip was kept in continuity with the distal bone segment and fed through the periosteal vascular arcade from the angular branch. In both patients, the distal bone segment demonstrated robust intraoperative vascularity and both flaps healed without complication. Both patients were able to resume oral diets and had good nasal breathing.
[...]

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Erratum: Failure of Synthetic Implants: Strategies and Management

Facial plast Surg 2018; 34: 429-430
DOI: 10.1055/s-0038-1667174

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

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EACMFS Prizes & Awards

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Announcements

Dear Colleagues,

https://ift.tt/2JQWiDX

Recent Molecular Profiling Studies in Papillary and Follicular Thyroid Carcinoma Provide Clinical and Basic Insights

Clinical Thyroidology, Volume 30, Issue 7, Page 319-323, July 2018.


https://ift.tt/2v33bwB

A High Proportion of Serum rT3 Tests Are Ordered by a Relatively Small Number of Providers in a U.S.-Wide Sample

Clinical Thyroidology, Volume 30, Issue 7, Page 337-339, July 2018.


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New Genomic Sequencing Classifier in Cytologically Indeterminate Thyroid Nodules Shows Improved Results

Clinical Thyroidology, Volume 30, Issue 7, Page 328-331, July 2018.


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Higher Preconception Maternal Iodine Intakes Are Associated with Higher Child IQ

Clinical Thyroidology, Volume 30, Issue 7, Page 302-304, July 2018.


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Some Advanced Thyroid Cancer Patients Have a Prolonged Response to Lenvatinib

Clinical Thyroidology, Volume 30, Issue 7, Page 305-308, July 2018.


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Editorial: Will the EUGOGO Predictive Score for Graves’ Orbitopathy Be Useful for Management?

Clinical Thyroidology, Volume 30, Issue 7, Page 300-301, July 2018.


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Analysis of Clinical Factors 1 Year After Surgery for Thyroid Cancer Enables Prediction of Treatment-free Survival

Clinical Thyroidology, Volume 30, Issue 7, Page 309-311, July 2018.


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Residual Lymph Node Metastases after Initial Surgery—What Are the Implications for the Approach to Initial Surgery and Postoperative Therapy?

Clinical Thyroidology, Volume 30, Issue 7, Page 324-327, July 2018.


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Thyroglobulin Levels Do Not Predict Recurrence After Lobectomy for Low-Risk Papillary Thyroid Cancer

Clinical Thyroidology, Volume 30, Issue 7, Page 312-314, July 2018.


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Automated Analysis of Gray-Scale Ultrasound Images of Thyroid Nodules (“Radiomics”) May Outperform Image Interpretation by Less Experienced Thyroid Radiologists

Clinical Thyroidology, Volume 30, Issue 7, Page 332-336, July 2018.


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What Factors Contribute to the Development of Central Hypothyroidism When Adult Patients with GH Deficiency Are Treated with rhGH?

Clinical Thyroidology, Volume 30, Issue 7, Page 315-318, July 2018.


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Letter to the Editor: Molecular Analysis Should Be Incorporated Into the Definition of NIFTP

Clinical Thyroidology, Volume 30, Issue 7, Page 340-341, July 2018.


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Effect of Runx2 silencing on autophagy and RANKL expression in osteoblasts

Publication date: Available online 24 July 2018

Source: Archives of Oral Biology

Author(s): Han Qin, Jun Cai

Abstract

Objective

This study aimed to investigate the effect of Runx2 silencing on autophagy and RANKL expression in mouse osteoblasts, and provide an experimental basis to assess obstacles in dental eruption.

Methods

In accordance with previously reported methods, LVpFU-GW-016PSC60109-1 virus was used to transfect mouse osteoblasts (MOI = 40). Target gene expression was assessed via cytometer, and the effect of silencing Runx2 was assessed via a two-step quantitative real-time polymerase chain reaction (qRT-PCR)-based method. Western blotting was performed to assess LC3, Beclin-1 and RANKL expression.

Results

As confirmed via qRT-PCR analysis, Runx2 was efficiently silenced in the experimental group (>90% efficiency). Western blotting revealed that LC3 and RANKL proteins were significantly down -regulated in the experimental group (group KD), their expression levels being particularly lower than those in the control group (group NC). However, Beclin-1 protein expression was not significantly different from that of the control.

Conclusion

Upon Runx2 silencing, autophagy-related proteins and RANKL were repressed in osteoblasts, thereby potentially causing the tooth eruption disorder.

https://ift.tt/2LkKUWu

Effect of Runx2 silencing on autophagy and RANKL expression in osteoblasts

Publication date: Available online 24 July 2018

Source: Archives of Oral Biology

Author(s): Han Qin, Jun Cai

Abstract

Objective

This study aimed to investigate the effect of Runx2 silencing on autophagy and RANKL expression in mouse osteoblasts, and provide an experimental basis to assess obstacles in dental eruption.

Methods

In accordance with previously reported methods, LVpFU-GW-016PSC60109-1 virus was used to transfect mouse osteoblasts (MOI = 40). Target gene expression was assessed via cytometer, and the effect of silencing Runx2 was assessed via a two-step quantitative real-time polymerase chain reaction (qRT-PCR)-based method. Western blotting was performed to assess LC3, Beclin-1 and RANKL expression.

Results

As confirmed via qRT-PCR analysis, Runx2 was efficiently silenced in the experimental group (>90% efficiency). Western blotting revealed that LC3 and RANKL proteins were significantly down -regulated in the experimental group (group KD), their expression levels being particularly lower than those in the control group (group NC). However, Beclin-1 protein expression was not significantly different from that of the control.

Conclusion

Upon Runx2 silencing, autophagy-related proteins and RANKL were repressed in osteoblasts, thereby potentially causing the tooth eruption disorder.

https://ift.tt/2LkKUWu

Asthma Clinical Practice Guidelines: time for an update

Publication date: Available online 24 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Zuhair K. Ballas

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Fake Science: editorial

"… some men are born great, some achieve greatness, and some have greatness thrust upon them."1 To paraphrase, so it is also for journals and technical editors: some have them, and we like to think that they help in improving both the scientific veracity of the journal, and so the impact factor. However, a lot do not (and perhaps should have), and this can have a deleterious effect on standards of both science and language, as reported in a recent issue of The Times.2

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Anatomical analysis to establish the optimal positioning of an osteotomy for genioglossal advancement: a trial in cadavers

Genioglossal advancement, which is one of the treatments for obstructive sleep apnoea, can be effective only if it contains enough genial tubercle for an osteotomy. The aim of this study was to establish the position of the genial tubercle and of the optimal osteotomy during genioglossal advancement. Twenty-four adult cadavers with intact bony mandibular structures were included. Five variables were measured: the width and height of the genial tubercle (GTW); the distance from its inferior border to the inferior border of the mandible (IGT-IBM); the distance from the superior border of the genial tubercle to the inferior border of the mandible (SGT-IBM); and the width of the intermental foramen (IMFW).

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Use of the superficial inferior epigastric vein as an unusual interpositional vein graft

Where the first choice of flap is not available for reconstruction in the head and neck (often during salvage) the pedicle may not be long enough to allow tension-free anastomosis, which can lead to a greater risk of failure. Interpositional vein grafts are an accepted technique to provide a greater length of pedicle,1 and those most commonly used are the cephalic, external jugular, or long saphenous veins. We describe a patient in whom none of these were suitable and so the superficial inferior epigastric vein was used to good effect.

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Sclerosing polycystic adenosis of the oral cavity

Minor salivary glands are ubiquitous in the oral cavity, and related diseases are often indolent and asymptomatic. We describe the unusual features of sclerosing polycystic adenosis, and its similarities to more sinister conditions of the minor salivary glands. Its importance is currently uncertain and research points to a pathogenesis that is neoplastic, which can create ambiguity. Sclerosing polycystic adenosis is a newly-discovered condition that merits further discussion and research to evaluate its full impact.

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Morphometric analysis of Arcuate eminence: A Distinctive landmark for middle cranial fossa approach

The arcuate eminence (AE) is a bony prominence on the middle fossa plate of the temporal bone, hypothesized to be variably associated with superior semicircular canal (SSC) relief, temporal lobe sulcus, and subjacent air cells. We present various morphometric parameters of the AE, as seen using a middle fossa approach.

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The use of cranial resection templates with 3D virtual planning and PEEK patient-specific implants: A 3 year follow-up

The aim of this study was to evaluate the accuracy of resection templates in cranioplasties in order to facilitate a one-stage resection and cranial reconstruction. Patients and methods: In three cases, cranial resections were combined with direct reconstructions using the principles of computer-aided design, manufacturing, and surgery. The precision of the resection template was evaluated through a distance map, comparing the planned and final result.

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Three-dimensional facial anatomy evaluation: Reliability of laser scanner consecutive scans procedure in comparison with stereophotogrammetry

Laser scanner devices are acquiring a growing importance in facial anatomy. Most studies have analysed facial scans obtained through two simultaneous captures, whereas the same result can be obtained by consecutive three-dimensional (3D) scans. However, this latter procedure has not yet been validated.Fourteen volunteers underwent face image capture through stereophotogrammetry (VECTRA M3) and two consecutive facial scans through a laser scanner (Konica Minolta Vi910). The concordance between 14 linear distances, 12 angles, facial surface area and volume measurements was verified by the Bland-Altman test and calculation of absolute and relative technical errors of measurement (TEM/rTEM).

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Three-dimensional facial anatomy evaluation: Reliability of laser scanner consecutive scans procedure in comparison with stereophotogrammetry

Publication date: Available online 24 July 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Daniele Gibelli, Valentina Pucciarelli, Pasquale Poppa, Marco Cummaudo, Claudia Dolci, Cristina Cattaneo, Chiarella Sforza

Summary

Laser scanner devices are acquiring a growing importance in facial anatomy. Most studies have analysed facial scans obtained through two simultaneous captures, whereas the same result can be obtained by consecutive three-dimensional (3D) scans. However, this latter procedure has not yet been validated.

Fourteen volunteers underwent face image capture through stereophotogrammetry (VECTRA M3) and two consecutive facial scans through a laser scanner (Konica Minolta Vi910). The concordance between 14 linear distances, 12 angles, facial surface area and volume measurements was verified by the Bland-Altman test and calculation of absolute and relative technical errors of measurement (TEM/rTEM). The two facial images obtained by the different devices were then registered to calculate point-to-point distance.

Most of linear distances and angles showed a high agreement, with "very good" or "good" rTEMs, ranging between 1.1% and 6.4%. Surface area measurements agreed well between the devices (rTEM: 6.3%), while volumes were poorly comparable (rTEM: 25.8%); the root mean square point-to-point distance was 0.80 mm (SD: 0.41).

This study first tested the concordance of measurements on facial images obtained by stereophotogrammetry and consecutive laser scans. Results highlight the reliability of linear distances, angles and surface areas measurements, but discourage volume assessment and registration of surfaces acquired through different devices.

https://ift.tt/2Lks5T3

Allergic Contact Dermatitis To Personal Care Products And Topical Medications In Adults With Atopic Dermatitis

Atopic dermatitis (AD) is associated with skin-barrier disruption, immune dysregulation, and application of emollients and topical medications, which may predispose towards developing allergic contact dermatitis (ACD).

https://ift.tt/2A8rvCM

Pore Architecture Effects on Chondrogenic Potential of Patient-Specific 3-Dimensionally Printed Porous Tissue Bioscaffolds for Auricular Tissue Engineering

Publication date: Available online 24 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): David A. Zopf, Colleen L. Flanagan, Anna G. Mitsak, Julia R. Brennan, Scott J. Hollister

Abstract

Objective

This study aims to determine the effect of auricular scaffold microarchitecture on chondrogenic potential in an in vivo animal model.

Methods

DICOM computed tomography (CT) images of a human auricle were segmented to create an external anatomic envelope. Image-based design was used to generate 1) orthogonally interconnected spherical pores and 2) randomly interspersed pores, and each were repeated in three dimensions to fill the external auricular envelope. These auricular scaffolds were then 3D printed by laser sintering poly-L-caprolactone, seeded with primary porcine auricular chondrocytes in a hyaluronic acid/collagen hydrogel and cultured in a pro-chondrogenic medium. The auricular scaffolds were then implanted subcutaneously in rats and explanted after 4 weeks for analysis with Safranin O and Hematoxylin and Eosin staining.

Results

Auricular constructs with two micropore architectures were rapidly manufactured with high fidelity anatomic appearance. Subcutaneous implantation of the scaffolds resulted in excellent external appearance of both anterior and posterior auricular surfaces. Analysis on explantation showed that the defined, spherical micropore architecture yielded histologic evidence of more robust chondrogenic tissue formation as demonstrated by Safranin O and Hematoxylin and Eosin staining.

Conclusions

Image-based computer-aided design and 3D printing offers an exciting new avenue for the tissue-engineered auricle. In early pilot work, creation of spherical micropores within the scaffold architecture appears to impart greater chondrogenicity of the bioscaffold. This advantage could be related to differences in permeability allowing greater cell migration and nutrient flow, differences in surface area allowing different cell aggregation, or a combination of both factors. The ability to design an anatomically correct scaffold that maintains its structural integrity while also promoting auricular cartilage growth represents an important step towards clinical applicability of this new technology.

https://ift.tt/2A70i3l

Nodular fasciitis of the tongue: A case report in an infant

Publication date: Available online 24 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Raymond P. Shupak, Bruce B. Horswell, Marcus D. Shaffer, Milton J. Plata

Abstract

Nodular fasciitis is a benign lesion uncommonly found in the head and neck region. Although described previously in adults, there have been no reports of nodular fasciitis in a child's tongue. A 4 month old male infant was referred for evaluation of a rapidly growing tongue lesion. He underwent excisional biopsy of the lesion. Initial pathology suggested a spindle cell tumor. Subsequent outside facility molecular testing was obtained and Nodular Fasciitis was confirmed. Nodular fasciitis is a rare benign tumor that can be often mistaken for malignancy. Special histochemical and molecular testing is required to obtain final diagnosis.

https://ift.tt/2mHprIE

Spoken word recognition in noise in Mandarin-speaking pediatric cochlear implant users

Publication date: Available online 24 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Cuncun Ren, Jing Yang, Dingjun Zha, Ying Lin, Haihong Liu, Ying Kong, Sha Liu, Li Xu

Abstract

Objective

The purpose of the present study was to compare spoken word recognition performance in the presence of speech spectrum-shaped noise and four-talker babbles in Mandarin-speaking children with cochlear implants (CIs).

Methods

Participants included 33 children with unilateral CIs (with a mean age of 10.4 ± 2.9 years old and a mean length of CI use of 7.5 ± 3.0 years). The Standard Chinese version of Lexical Neighborhood Test was implemented in quiet, speech-spectrum-shaped noise (SSN), and four-talker babble (FTB). The signal-to-noise ratios (SNRs) were set at +5 and +10 dB for both types of maskers. Participants responded by verbally repeating each word they heard and the response was scored as the percentage accuracy of recognition performance. A Generalized Linear Model (GLM) fitting, correlational tests, and a two-way repeated-measures ANOVA were conducted on the percent-correct data.

Results

Word recognition in quiet was on average 74.5% correct but dropped to 57.3% and 48.8% correct for SSN and FTB at 10 dB SNR, respectively, and 44.4% and 32.6% correct for SSN and FTB at 5 dB SNR, respectively. In both quiet and noise conditions, the participants showed lower recognition accuracy for the hard words than for the easy words. Disyllabic words were recognized with higher accuracy rates than were the monosyllabic words. The GLM analysis revealed that all four tested factors (masker type, SNR, lexical neighborhood feature, and lexical type) showed significant impacts on word recognition in children with CIs. Word recognition scores in the two types of maskers were significantly correlated for the disyllabic words at both SNRs and monosyllabic words at 10 dB SNR.

Conclusions

The present study demonstrated that the lexical features such as the lexical neighborhood characteristics and lexical type had significant effects on speech recognition performance in both quiet and noise conditions in pediatric CI users. Children with years of experience of CI use still encountered remarkable difficulties in everyday listening environment although their speech recognition in quiet reached relatively desired level. Fluctuating noise, such as speech babbles, caused greater challenge than steady-state noise for speech recognition in children with CIs.

https://ift.tt/2A73nkd

PREDICTORS OF NATURE OF INGESTED FOREIGN BODIES IN CHILDREN & ASSESSMENT OF OPERATIVE OUTCOMES

Publication date: Available online 24 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Rubeena Arora, Sunil Kumar, Gautam Bir Singh

Abstract

OBJECTIVE

To examine sensitivity/specificity of history & radiology to identify ingested foreign body (FB) and develop a protocol for management of ingested FBs in paediatric patients; to assess outcomes of removal of lithium button battery foreign body (LBBFB).

METHODS

Retrospective review. Children presenting to ENT emergency with suspected FB ingestion underwent rigid esophagoscopy and FB removal. Average age, number of attempts, duration of ingestion, success rate, and complications were analysed.

RESULTS

Cases of coin/LBBFB ingestion: 916/70. Mean age: 5.8/2.03 years (p<0.001). Average duration of ingestion: 37/9.5 h (p<0.001). Patients below 3: 31.3/62.8% (p<0.001). Suggestive history/radiological signs: 100%/100%, 75.7%/98.6% (p<0.0001). Site of impaction cricopharynx: 60.3%/74.3% (p=0.02). LBBFB group: Successful removal in 1^st attempt: 66 (94.3%). Cases requiring multiple attempts due to impaction: 4 (5.7%). Parenteral steroids were administered before successful reattempt. No relation was found between duration of ingestion/impaction. Five (7.1%) cases developed complications. Average follow-up duration: 13.59 months.

CONCLUSIONS

Children <3 years with vague history of FB ingestion and suggestive chest x-ray should be sent urgently for FB removal. Parenteral pre-and postoperative short course steroid use may be considered to improve outcomes.

https://ift.tt/2OcRR9C

Comparison of the histopathological characteristics of osteomyelitis, medication-related osteonecrosis of the jaw, and osteoradionecrosis

The purpose of this study was to compare the histopathological parameters of chronic/suppurative osteomyelitis, medication-related osteonecrosis of the jaw (MRONJ), and osteoradionecrosis (ORN), and to examine the hypothesis that distinct histological features can be related to a specific disease, allowing for diagnosis based on microscopic evaluation alone. One hundred and ten samples were reviewed by two examiners in a blinded fashion, and a semi-quantitative histomorphometric analysis was performed.

https://ift.tt/2LhPDIp

Evaluating the Efficacy and Tolerability of Application of Metaderm Product for the Treatment of Psoriasis

Condition:   Psoriasis
Intervention:   Drug: Metaderm
Sponsor:   University of Alabama at Birmingham
Not yet recruiting

https://ift.tt/2uXDUna

Efficacy of Osteopathic Manual Therapy Combined With Myofunctional Exercise for Temporomandibular Chronic Disorders

Condition:   Temporomandibular Joint Dysfunction Syndrome
Interventions:   Procedure: Osteopathic Treatment;   Procedure: Myofunctional Motor control exercises
Sponsor:   Maxilofacial Institute Bara Gaseni
Not yet recruiting

https://ift.tt/2LnjUpi

Study Investigating a Single Oral Dose of Fenebrutinib in Healthy Volunteers

Condition:   Healthy Participants
Intervention:   Drug: Fenebrutinib
Sponsor:   Hoffmann-La Roche
Recruiting

https://ift.tt/2uXDNYM

Conformation of the N-Terminal Ectodomain Elicits Different Effects on DUOX Function: A Potential Impact on Congenital Hypothyroidism Caused by a H2O2 Production Defect

Thyroid, Ahead of Print.


https://ift.tt/2A8Xwea

Changes in Serum Thyroglobulin Levels After Lobectomy in Patients with Low-Risk Papillary Thyroid Cancer

Thyroid, Ahead of Print.


https://ift.tt/2mEBOVJ

Anatomical analysis to establish the optimal positioning of an osteotomy for genioglossal advancement: a trial in cadavers

Publication date: Available online 24 July 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): S.Y. Jung, Y.G. Eun, J.Y. Min, S.J. Kim, J. Jung, S.W. Kim

Abstract

Genioglossal advancement, which is one of the treatments for obstructive sleep apnoea, can be effective only if it contains enough genial tubercle for an osteotomy. The aim of this study was to establish the position of the genial tubercle and of the optimal osteotomy during genioglossal advancement. Twenty-four adult cadavers with intact bony mandibular structures were included. Five variables were measured: the width and height of the genial tubercle (GTW); the distance from its inferior border to the inferior border of the mandible (IGT-IBM); the distance from the superior border of the genial tubercle to the inferior border of the mandible (SGT-IBM); and the width of the intermental foramen (IMFW). The following mean (SD) (range) measurements were obtained: GTW 7.38 (1.43) (4.5–10.0); GTH 7.94 (1.45) (5.0–10.0); IGT-IBM 7.96 (2.29) (4.0–12.0); SGT-IBM 15.90 (2.29) (12.0–20.0); and IMFW 56.65 (6.44) (43.0–67.0) mm. Of the 24 cadavers, 22 showed evidence of optimal positioning when the osteotomy was placed 2 mm higher than the SGT-IBM measured on the inner table. This suggests that an optimal osteotomy, which includes the genial tubercle, may be possible in most patients when the osteotomy is positioned 2 mm higher at the SGT-IBM.

https://ift.tt/2A7cfpH

Fake Science: editorial

Publication date: Available online 24 July 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): M.E. Evans, C.D. Lester, A.J. Smith

https://ift.tt/2OcahY4

Sclerosing polycystic adenosis of the oral cavity

Publication date: Available online 24 July 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): S. Mumtaz, A. Ali, M. Singh

Abstract

Minor salivary glands are ubiquitous in the oral cavity, and related diseases are often indolent and asymptomatic. We describe the unusual features of sclerosing polycystic adenosis, and its similarities to more sinister conditions of the minor salivary glands. Its importance is currently uncertain and research points to a pathogenesis that is neoplastic, which can create ambiguity. Sclerosing polycystic adenosis is a newly-discovered condition that merits further discussion and research to evaluate its full impact.

https://ift.tt/2A7c65D

Congenital Cholesteatoma: The Silent Pathology

Background: Congenital cholesteatomas (CC) arise from epithelial remnants around the petrous bone. They enlarge gradually causing progressive destruction and functional damage to the ear and surrounding structures. Because of their insidious course, most patients are misdiagnosed and present late with complications. Methods: This is a retrospective study of 41 cases diagnosed as CC and followed up for 2 years. All patients underwent full audiological evaluation and a radiological study (CT, MRI). Results: The male:female ratio was 2.3: 1, and the mean age was 30.89 years. The mean delay before presentation was 13 months. The commonest presentations in order of frequency were: discharge (60.9%), hearing loss (51.2%), facial paralysis (31.7%) and intracranial complications (31.7%). Forty patients were treated surgically by a variety of approaches depending on the extensions and functional status. The facial nerve was decompressed in 9 cases and cable grafted in 4. Two cases underwent VII-XII anastomosis later on. Conclusion: CC present with a myriad of clinical manifestations and should be suspected in all patients with unexplained otological signs and symptoms. They must be completely excised and the functional status of the ear rehabilitated either immediately or later. Follow-up must be indefinite as they have a high recurrence rate.
ORL 2018;80:108–116

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In This Issue

https://ift.tt/2LHVK4S

Reprogramming of Th1 cells into regulatory T cells through rewiring of the metabolic status

Abstract

T helper type 1 (T_h1) cells form one of the most stable CD4 T-cell subsets, and direct conversion of fully differentiated T_h1 to regulatory T (T_reg) cells has been poorly investigated. Here, we established a culture method for inducing Foxp3 from T_h1 cells of mice and humans. This is achieved simply by resting T_h1 cells without T-cell receptor ligation before stimulation in the presence of transforming growth factor-beta (TGF-β). We named the resulting T_h1-derived Foxp3⁺ cells T_h1_reg cells. Mouse T_h1_reg cells showed an inducible T_reg-like phenotype and suppressive ability both in vitro and in vivo. T_h1_reg cells could also be induced from in vivo-developed mouse T_h1 cells. Unexpectedly, the resting process enabled Foxp3 expression not through epigenetic changes at the locus, but through metabolic change resulting from reduced mammalian target of rapamycin complex 1 (mTORC1) activity. mTORC1 suppressed TGF-β-induced phosphorylation of Smad2/3 in T_h1 cells, which was restored in rested cells. Our study warrants future research aiming at development of immunotherapy with T_h1_reg cells.

https://ift.tt/2OhMWVc

STAT4 is required for the generation of Th1 and Th2, but not Th17 immune responses during monophosphoryl lipid A adjuvant activity

International Immunology, Volume 28, Issue 11, 1 November 2016, Pages 565–570, https://doi.org/10.1093/intimm/dxw038

https://ift.tt/2ND3ANN

Molekulare Netzwerke von Hypoxie und neuronaler Apoptose in der Cochlea

Zusammenfassung

Hintergrund

In organotypischen Kulturen zeigt die Region des Modiolus (MOD) von neugeborenen Ratten eine 4‑fach höhere Rate des Zelltods als die Region des Corti-Organs (OC). Die unterschiedliche Vulnerabilität geht mit einer differenziellen Expression zahlreicher Gene einher.

Methodik

Organotypische Kulturen von OC und MOD von 3–5 Tage alten Ratten wurden einer norm- bzw. hypoxischen (pO₂: 10–20 mmHg; 5 h) Atmosphäre ausgesetzt. 24 h nach Anlegen der Kultur wurde die Zelltodrate bestimmt und die Expression mittels c‑DNA-Microarray untersucht. Mithilfe der DAVID-Datenbank wurden aus einer Liste von 60 Genen mit veränderter Expression biologische Prozesse entsprechend der Gene-Ontology-Datenbank (GO) zugeordnet. Molekulare Netzwerke wurden mithilfe der Datenbanken STRING und ConsensusPathDB erstellt.

Ergebnisse

Das Netzwerk der GO-Annotationen „Hypoxie", „Entzündung" und „mechanischer Stimulus" deutet auf das Vorliegen von 2 Gen-Clustern, einem Cluster mit proinflammatorischen Genen (Ccl3, Cxcl2, Cxcr4, Ccl20) und einem Cluster mit hypoxieassoziierten Genen (c-Jun, Hif1a und Vegfa). Das Netzwerk der GO-Annotationen „positive und negative neuronale Apoptose" lässt vermuten, dass die unterschiedliche Expression der Gene c-Jun, Ngfr und Casp3 von entscheidender Bedeutung für die Regulation des programmierten Zelltods von neuronalen Zellen des OC und MOD ist.

Schlussfolgerung

Während c‑JUN als ein wichtiger Modulator des Gleichgewichts zwischen Zelltod und Überleben wirkt, scheinen die Assoziationen von NGFR und CASP3 bedeutsam für die Einleitung des Zelltods zu sein. Die Auswertung und Anwendung von Erkenntnissen aus biostatistischen Datenbanken sind ein wichtiges Mittel für das Verständnis der Funktion von einzelnen Genen und Gen-Clustern in medizinisch relevanten biologischen Prozessen.

https://ift.tt/2uO48cx

Small intestine polypoid arteriovenous malformation: a stepwise approach to diagnosis in a paediatric case

We report a case of acute gastrointestinal haemorrhage due to a small intestine polypoid arteriovenous malformation (AVM) in a patient with a remote history of obscure gastrointestinal bleeding (OGIB) 8 years earlier. The diagnosis of a small intestine AVM was made using video capsule endoscopy (VCE) and confirmed using single-balloon push enteroscopy. The lesion was marked with submucosal tattoo to aid in subsequent surgical resection of the lesion with primary duodenoduodenostomy. Since our patient's initial bleeding episode, a variety of advanced tools have become widely available to aid in the localisation of OGIB. This case illustrates the use of a stepwise approach using new medical technology to identify and manage OGIB in children. VCE and push enteroscopy proved to be important diagnostic modalities in this paediatric case.

https://ift.tt/2mDGxH7

Acute peritonsillar swelling: a unique presentation for Kawasaki disease in adolescence

We report the case of a 14-year-old man with unilateral peritonsillar swelling, airway compromise and fever. On physical examination, the patient was pyrexic with trismus, dysphonia, uvula deviation, exudative unilateral peritonsillar swelling and unilateral cervical lymphadenopathy. Attempts at aspirating the prominent peritonsillar region were unsuccessful. CT head and neck identified a large inflammatory mass arising from the left palatine tonsil. The patient was treated for presumptive peritonsillar abscess. After failing to respond to intravenous antimicrobials, he progressively developed the classical sequale of Kawasaki's Disease. Echocardiogram identified coronary arteritis. Intravenous immunoglobulin and high-dose aspirin were initiated and his clinical picture improved. Kawasaki's disease mimicking an acute infective process can pose a diagnostic dilemma. It is an uncommon differential in the adolescent population. Prompt recognition and initiation of appropriate therapy are imperative to minimise morbidity.

https://ift.tt/2A6dlCi

Multiple cranial nerve injuries and neck abscesses caused by a transorally penetrating organic stick

Foreign bodies cause a remarkable number of otolaryngological emergency visits and occasionally result in life-threatening conditions and later-emerging complications. Patient recovery depends on the detection and proper extraction of all foreign materials. Despite various obtainable diagnostic tools, adequate anamnesis forms the basis of clinical reasoning and should direct later examinations and radiological imaging. This case report describes a challenging patient with a unique trauma mechanism: many pieces of a fragmented organic foreign body emerged within 1 year of the initial injury, leading to repeated operations, a long period in an intensive care unit and a long-term swallowing and speech dysfunction.

https://ift.tt/2OgGGwC

Sporadic Burkitts lymphoma masquerading as an intussuscepted Meckels diverticulum in a 9-year-old child

We report the case of a 9-year-old boy who presented with abdominal pain and was found to have an intussusception with a sporadic Burkitt's lymphoma (BL) lead point. Our case was unusual in that the patient did not present with the typical clinical features of BL, nor was he in a high-risk demographic for this uncommon disease.

https://ift.tt/2A6d7uW

Acinic cell carcinoma of the parotid gland in pregnancy: an approach to cancer in pregnancy

A 27-year-old woman presented with an enlarging painless right preauricular mass at 28 weeks' pregnant. The mass had been stable for more than 10 years, but showed rapid growth during pregnancy. Imaging and biopsy were consistent with parotid gland malignancy, with surgical resection undertaken at 33+4 weeks' gestation. Histopathology confirmed acinic cell carcinoma. Labour was induced without complication at 36+6 weeks' gestation and adjuvant radiotherapy commenced 2 weeks postpartum. At 9 months follow-up, both mother and baby were well, with no signs of disease recurrence. Rapid progression in pregnancy, of a previously stable salivary gland mass, is a common feature among reported cases and was also observed in the current case. This suggests an aetiological link between pregnancy and salivary gland tumour progression. We demonstrate successful management of a parotid gland malignancy in pregnancy and review guiding principles for cancer management in pregnancy.

https://ift.tt/2Oea9aP

Double-positive with positive anti-glomerular basement membrane antibody and ANCA-positive disease in a patient with dermatomyositis

Approximately one in four patients (23.3%) with inflammatory myositis including dermatomyositis can require evaluation for acute kidney injury. The main cause of kidney injury is acute tubular necrosis from medications or myoglobinuria, though clinicians should be aware of a wide variety of possible aetiologies. We present the case of a 44-year-old woman with stable anti-Jo1 dermatomyositis, who presented with acute kidney injury. During her hospital course, she was diagnosed with double-positive disease characterised by circulating anti-glomerular basement membrane antibody and myeloperoxidase antineutrophil cytoplasmic antibody and renal biopsy revealing crescentic glomerulonephritis with linear staining of capillary wall for IgG.

https://ift.tt/2A7MPs7

Transabdominal ultrasound-guided Gartners abscess drainage, a rare cause of acute urinary retention in second trimester of pregnancy

Acute retention of urine in pregnancy is an emergency, since it can lead to loss of pregnancy besides other dire complications. Gartner's abscess is an extremely rare cause for this condition. We present a case of a 23-year-old primigravida woman who presented to us at 24 weeks of pregnancy with acute retention of urine. After clinical and radiological evaluation, a large Gartner's abscess was found to be the cause. Per vaginal drainage of the abscess was not attempted because insertion of transvaginal probe was extremely painful for the patient, and the abscess was located high up in the anterior fornix. Transabdominal approach under sonographic guidance was used for the drainage of the abscess. Careful aspiration of the abscess, avoiding injury to the placenta, fetus and maternal bladder, revealed 60 cc of frank pus. The patient was given injection hydroxyprogesterone caproate and antibiotics in the preprocedure period. Antibiotics were continued in the postprocedure period, and she was discharged at 26 weeks of pregnancy in satisfactory condition.

https://ift.tt/2mDCZVh

Allopurinol-induced DRESS syndrome presented as a cholecystitis-like acute abdomen and aggravated by antibiotics

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening adverse drug reaction characterised by generalised skin rash, fever, lymph node enlargement and haematological abnormalities, in addition to multiorgan involvement. However, diagnosis can be challenging, with rare cases presenting as an acute abdomen.

Its aetiopathogenesis is not fully understood but inefficient drug detoxification, deregulated immune responses, reactivation of host viruses and genetic predisposition appear to be important. Furthermore, it has been recently recognised that antibiotics may act as promoters of DRESS syndrome caused by another drug. We report the case of a 48-year-old man, receiving allopurinol, who developed DRESS syndrome, initially presenting with a cholecystitis-like acute abdomen that was triggered by antibiotics. This report also emphasises the utility of performing patch skin tests to establish drug imputability.

https://ift.tt/2A5NnyJ