Head and Neck Medicine by Alexandros G.Sfakianakis: 07/26/18

Πέμπτη 26 Ιουλίου 2018

Elevated Risk of Cancer Following Solid Organ Transplant in Childhood: A Population-based Cohort Study

Background Cancer risk is elevated among adult transplant recipients, but there is limited data regarding long-term cancer risk and mortality in pediatric recipients. Methods We conducted a population-based retrospective cohort study in Ontario, Canada. We included pediatric recipients of solid organ transplants at the Hospital for Sick Children, Toronto from 1991 to 2014, and compared rates of new cancers and cancer-specific mortality to nontransplanted Ontario children born in the same year. We constructed standard and time-dependent Cox proportional hazards models accounting for competing risk of death. Results A total of 951 recipients (kidney n=400, liver n=283, heart n=218, lung n=36, multiorgan/small bowel n=14) were compared to 5.3 million general population children. Mean (SD) age was 8.2 (6.4) years; 50% were male. Over a mean (SD) follow-up of 10.8 (7.1) years, cumulative incidence of cancer was 20% in recipients and 1.2% in the general population (incidence rate ratio 32.9; 95% CI 26.6-40.8). Risk was highest in the first year posttransplant (aHR 176; 95% CI 117-264), but remained elevated beyond 10 years (aHR 10.8; 95% CI 6.3-18.6). Lymphoproliferative disorders were predominant (77%); however, solid cancers (renal, sarcomas, genital, thyroid) were seen. Recipients of lung or multiorgan transplants were at highest risk. Cancer-specific mortality was also higher among recipients (HR 93.1; 95% CI 59.6-145.2). Conclusions Childhood transplant recipients have a 30-times greater cancer incidence versus the general population. Further investigation is needed to guide screening strategies in this at-risk population. *Corresponding Author Contact Information: Rulan S. Parekh, MD, MS., FRCPC, Nephrologist, Division of Nephrology, Associate Chief, Clinical Research, Scientist, Child Health Evaluative Sciences, Research Institute, Professor, Faculty of Medicine, Institute of Medical Sciences and Dalla Lana School of Public Health, University of Toronto, Peter Gilgan Centre for Research & Learning, The Hospital for Sick Children (SickKids), 686 Bay Street, Child Health Evaluative Sciences, 11th floor, Toronto, ON, Canada, M5G 0A4, Phone: 416-813-7654 ext. 328042, Fax: 416-813-5979. Email: rulan.parekh@sickkids.ca AUTHORSHIP A.K., S.D., S.J.K., P.C.N., and R.S.P participated in the study design. A.K., S.D., S.G., and P.C.N. participated in the data analysis. A.K., S.D., J.S.D., P.C.N., and R.S.P drafted the manuscript. All authors read and approved the final manuscript. DISCLOSURES The authors declare no conflicts of interest. FUNDING Dr. Rulan S. Parekh received funding from the Transplant & Regenerative Medicine Centre (TRMC) Catalyst Grant at The Hospital for Sick Children, Ashley's Angels Catwalk and the Canadian Institutes of Health Research (CIHR) for the completion of this study. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2LEMMbT

Regional Variation in Utilization and Outcomes of Liver Allografts from Donors with High Body-Mass Index and Graft Macrosteatosis: A Role for Liver Biopsy

Background Obesity, defined as a body mass index ≥30 kg/m2 (hBMI), is a growing epidemic worldwide and is associated with multiple comorbidities. hBMI individuals account for an increasing portion of potential liver donors. Here we evaluate trends in the utilization and outcomes of hBMI donors on a national and regional level and the potential role of liver biopsy in donor evaluation. Methods UNOS STAR database was evaluated for deceased donor liver transplants between 2006 and 2016 across 11 OPTN regions. hBMI donors were compared to lower BMI counterparts and evaluated for biopsy rates, utilization rates and allograft outcomes. Univariate and multivariable analyses were performed. Results 77 050 potential donors were identified and 60 200 transplants were evaluated. Utilization rates for hBMI donors was 66.1% versus 78.1% for lower BMI donors (p

https://ift.tt/2NNHTe0

Renal Revival; the Hidden Benefit of Antirejection Medications

No abstract available

https://ift.tt/2LEMIJb

Reduced Risk of BK Polyomavirus Infection in HLA-B51 Positive Kidney Transplant Recipients

Background Identification of specific HLA alleles and T cell epitopes that influence the course of BK polyomavirus (BKPyV) infection after kidney transplantation (KTx), including development of BKPyV-associated nephropathy (BKPyVAN), can be useful for patient risk stratification and possibly vaccine development. Methods In a retrospective cohort of 407 living kidney donor-recipient pairs, donor and recipient HLA class I and II status were correlated with the occurrence of recipient BKPyV viremia and BKPyVAN in the first year after KTx. Relevant HLA alleles were systematically analyzed for candidate peptide epitopes in silico. Results While none of the 78 HLA alleles analyzed increased the risk of BKPyV viremia and BKPyVAN, a considerable reduction of BKPyV viremia and BKPyVAN cases was observed in HLA-B51 positive KTx recipients. Multivariate analysis showed that HLA-B51-positivity, found in 36 recipients (9%), reduced the risk of viremia approximately five-fold (HR 0.18, 95% CI: 0.04 – 0.73, p = 0.017). Four HLA-B51-restricted putative cytotoxic T lymphocyte epitopes were identified, including a previously described HLA-B supermotif-containing peptide (LPLMRKAYL), encoded by 2 relevant T-antigens (Small T and Large T) and previously shown to be highly immunogenic. Conclusions In conclusion, HLA-B51-positive kidney transplant recipients were less susceptible to BKPyV infection, which might be explained by efficient presentation of a particular BKPyV-derived immunogenic peptide. Authorship The author's specific contributions are as follows: HFW and MCWF initiated the study. HFW, ACMK, JWdF, JIR, FHJC and MCWF designed the study. HFW, CSdB, GWH and JIR collected the samples and gathered the data. CSdB performed the serological tests and the PCR assays. HFW analysed the data. EWvZ and GWH provided statistical support. HFW, ACMK, JWdF, JIR, FHJC, and MCWF interpreted the data. HFW and MCWF drafted the manuscript, and designed the figures and tables. All authors reviewed and approved the final report. Disclosure The authors declare no conflicts of interest Funding This study was supported by the Dutch Kidney Foundation, grant 13A1D302. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2LTz4ih

The Impact of Deceased Donor Liver Extraction Time on Early Allograft Function in Adult Liver Transplant Recipients

Background In liver transplantation, both cold- and warm ischemia time are known to impact early graft function. The extraction time is a period during the initial phase of organ cooling which occurs during deceased donor procurement. During this time, the organ is at risk of suboptimal cooling. Whether donor extraction time, the time from donor aortic cross-clamp to removal of the donor organ from the body cavity has an effect on early graft function is not known. Methods We investigated the effect of donor extraction time on early graft function in 292 recipients of liver grafts procured locally and transplanted at our center between June 2012 and December 2016. Early graft function was assessed using the model of early allograft function score in a multivariable regression model including donor extraction time, cold ischemia time, warm ischemia time and the donor risk index. Results Donor extraction time had an independent effect on early graft function measured by the model of early allograft function score. (Coefficient 0.018, 95%CI 0.004 to 0.03, P = 0.012; for each minute increase of donor extraction time). Besides donor extraction time, cold ischemia time, warm ischemia time and donor risk index had a significant effect on early graft function. Conclusions We demonstrate an independent effect of donor extraction time on graft function after liver transplantation. Efforts to minimize donor extraction time could improve early graft function in liver transplantation. Correspondence information: Dieter Adelmann, MD, PhD, Department of Anesthesia & Perioperative Care, University of California, San Francisco, 521 Parnassus Avenue, San Francisco, CA 94143, USA, dieter.adelmann@ucsf.edu Authorship: D.A., G.R.R., and C.U.N. drafted the study protocol. C.U.N. obtained Institutional Review Board approval D.A., M.T. and R.P.K. collected patients' data D.A. performed the statistical analysis D.A., G.R.R., S.S., L.J.B, R.P.K. and C.U.N. prepared the manuscript. Disclosures: The authors declare no conflicts of interest Funding: This study was supported by departmental funds. (Department of Anesthesia and Perioperative Care San Francisco, University of California, San Francisco, CA) Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2LImB4a

Cell Spray Transplantation of Stem Cells for Ischemic Cardiomyopathy – How effective are dispersed droplets?

No abstract available

https://ift.tt/2LSKH8Y

Cell Spray Transplantation of Adipose-Derived Mesenchymal Stem Cell Recovers Ischemic Cardiomyopathy in a Porcine Model

Background Allogeneic adipose-derived mesenchymal stem cells (ADSC) are promising cell sources for cell therapy to treat ischemic cardiomyopathy (ICM). We hypothesized that ADSC transplantation via the new cell spray method may be a feasible, safe, and effective treatment for ICM. Methods Human ADSCs were acquired from white adipose tissue. Porcine ICM models were established by constriction of the left anterior descending coronary artery. ADSCs were spread over the surface of the heart via cell spray in fibrinogen and thrombin solutions. The cardiac function was compared to that of the control group. Results ADSCs were successfully transplanted forming a graft-like gel film covering the infarct myocardium. Premature ventricular contractions were rarely detected in the first 3 days after transplantation. Echocardiography and magnetic resonance imaging revealed improved cardiac performance of the ADSC group at 4 and 8 weeks after transplantation. Systolic and diastolic parameters were significantly greater in the ADSC group at 8 weeks after transplantation. Histological examination showed significantly attenuated left ventricular remodeling and a greater vascular density in the infarct border area in the ADSC group. Moreover, the coronary flow reserve was maintained, and expression levels of angiogenesis-related factors in the infarct border and remote areas were significantly increased. Conclusion Spray method implantation of allogenic ADSCs can improve recovery of cardiac function in a porcine infarction model. This new allogenic cell delivery system may help to resolve current limitations of invasiveness and cost in stem cell therapy. Corresponding author: Yoshiki Sawa, MD, PhD, Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan, E-mail: sawa-p@surg1.med.osaka-u.ac.jp, TEL: +81-6-6879-3154/FAX: +81-6-6879-3163 Author contributions D.M. participated in research design performance of research, analyzed data, and wrote the article. S.Y., K.K., H.K., and H.N. performed research and analyzed data. K.I. and J.H. participated in performing PET.(helped with some experiments) S.S., S.F., T.U., and K.T. reviewed all data and article. S.M. and Y.S.participated in research design, writing of the article and reviewed all data and article. All authors have met the following criteria: drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Disclosure This study was supported by Rohto Pharmaceutical Co., Ltd. Dr. Sawa serves as an advisor for the sponsor. Dr. Sawa and Dr. Miyagawa received a speaking fee from the sponsor. Ms. Kawai, Mr. Kurata, and Mr. Nishida receive a salary from the sponsor where they are employees. The sponsor had no control over the interpretation, writing, or publication of this work. The terms of this arrangement have been reviewed and approved by Osaka University in accordance with its policy on objectivity in research. Funding This work was supported by the Department of Advanced Stem Cell Therapy (Rohto Pharmaceutical Co. Ltd.). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2LEMDoR

Vascularized Plexus Allotransplantation: A New Hope in Brachial Plexus Palsy?

No abstract available

https://ift.tt/2LQzd5T

Vascularized Brachial Plexus Allotransplantation – An Experimental Study in Brown Norway and Lewis Rats

Background Brachial plexus injuries are devastating. Current reconstructive treatments achieve limited partial functionality. Vascularized brachial plexus allotransplantation could offer the best nerve graft fulfilling the like-with-like principle. In this experimental study, we assessed the feasibility of rat brachial plexus allotransplantation and analyzed its functional outcomes. Methods A free vascularized brachial plexus with a chimeric compound skin paddle flap based on the subclavian vessels was transplanted from a Brown Norway rat to a Lewis rat. This study has 2 parts. Protocol I aimed to develop the vascularized brachial plexus allotransplantation-model (VBP-allo). Four groups are compared: no reconstruction, VBP-allo with and without Cyclosporine-A (CsA) immunosuppression, VBP autotransplantation (VBP-auto). Protocol II compared the recovery of the biceps muscle and forearm flexors when using all 5, 2 (C5+C6) or 1 (isolated C6) spinal nerve as the donor nerves. The assessment was performed on week 16 and included muscle weight, functionality (grooming tests, muscle strength), electrophysiology and histomorphology of the targeted muscles. Results Protocol I showed, the VBP-allo with CsA immunosuppression was electrophysiologically and functionally comparable to VBP-auto and significantly superior to negative controls and absent immunosuppression. In Protocol II, all groups had a comparable functional recovery in the biceps muscle. Only with 5 donor nerves did the forearm show good results compared with only 1 or 2 donor nerves. Conclusions This study demonstrated a useful vascularized complete brachial plexus allotransplantation rodent model with successful forelimb function restoration under immunosuppression. Only the allotransplantation including all 5 roots as donor nerves achieved a forearm recovery. Corresponding Author: David Chwei-Chin Chuang, M.D., Professor, Department of Plastic Surgery, Chang Gung Memorial Hospital, No.5, Fu-Shing St., Taoyuan, Taiwan, Tel.: 886-3-3281200, Ext 3355, Fax: 886-3-3972681, E-mail: dccchuang@gmail.com Authorship Author's specific contributions 1. Participated in research design: David Chwei-Chin Chuang 2. Participated in the writing of the paper: Tommy Nai-Jen Chang, Bassem W Daniel, Kuang-Te Chen, Johhny Chuieng-Yi Lu 3. Participated in the performance of the operation and the sample collection: Tommy Nai-Jen Chang, Kuang-Te Chen, Catherine Hernon 4. Contributed new reagents or analytic tools: Bassem W Daniel, David Chwei-Chin Chuang 5. Participated in data analysis: Tommy Nai-Jen Chang, Catherine Hernon, Mark Shafarenko, Yen-Lin Huang Disclosure The authors hereby declare that they have no conflict of interest in any products used/tested in this study and have nothing to declare. Financial Disclosure: This study was supported by a grant from the Ministry of Science and Technology Taiwan (NSC94-2314-B-182A-176) and the Chang Gung Memorial Hospital, Linkou, Taiwan (CMRPG3A0441-3). None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this article. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2LEMdih

Is recipient HLA-B51 status protective for the risk of BK infection after kidney transplantation?

No abstract available

https://ift.tt/2NQUmhd

Factors influencing the long-term results of autologous microvascular submandibular gland transplantation for severe dry eye disease

Publication date: Available online 26 July 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): L. Zhang, J.-Z. Su, Z.-G. Cai, L. Lv, L.-H. Zou, X.-J. Liu, J. Wu, Z.-H. Zhu, C. Mao, Y. Wang, X. Peng, B. Song, X.-X. Li, G.-Y. Yu

Abstract

We assessed long-term outcomes of autologous microvascular submandibular gland (SMG) transplantation for severe dry eye disease and investigated factors influencing long-term results. From August 1999 to January 2015, 185 patients (200 eyes) with severe dry eye received SMG transplantation. Subjective assessments and ophthalmologic evaluations were performed before and after transplantation. Follow-up results showed successful transplantation in 180 of 200 eyes (success rate: 90%), resulting in marked symptomatic relief of xerophthalmia. Surgery failed due to vascular thrombosis (15 glands) and duct obstruction (5 glands). Follow-up data were available for 163 eyes. Epiphora occurred in 98 (60.1%) eyes and was effectively managed by surgical reduction of graft, topical atropine gel and botulinum toxin injection. Wharton's duct obstruction occurred in 16 (10.6%) eyes and was treated by duct reconstruction. Subjective satisfaction was achieved in 143 (87.7%) eyes. Mean score of fluorescent staining reduced from 11.25 ± 1.42 to 7.25 ± 3.37. Postoperative best-corrected visual acuity improved in 85 (56.3%) eyes. Our clinical experience proved that SMG transplantation is effective and grants long-term improvement in severe dry eye. Secretory function of transplanted SMGs remains active and stable. Blood vessel thrombosis, Wharton's duct obstruction, and epiphora are primary factors influencing results.

https://ift.tt/2uSVlWS

A novel variant of SLC26A4 and first report of the c.716T>A variant in Iranian pedigrees with non-syndromic sensorineural hearing loss

Publication date: Available online 27 July 2018

Source: American Journal of Otolaryngology

Author(s): Fatemeh Azadegan-Dehkordi, Reza Ahmadi, Tayyeb Bahrami, Nasrin Yazdanpanahi, Effat Farrokhi, Mohammad Amin Tabatabaiefar, Morteza Hashemzadeh-Chaleshtori

Abstract

The autosomal recessive non-syndromic hearing loss (ARNSHL) can be associated with variants in solute carrier family 26, member 4 (SLC26A4) gene and is the second most common cause of ARNSHL worldwide. Therefore, this study aims to determine the contribution of the SLC26A4 genotype in the hearing loss (HL) of 40 ARNSHL pedigrees in Iran. A cohort of the 40 Iranian pedigrees with ARNSHL, having no mutation in the GJB2 gene, was selected. The linkage analysis with five short tandem repeat (STR) markers linked to SLC26A4 was performed for the 40 ARNSHL pedigrees. Then, two out of the 40 pedigrees with ARNSHL that linked to DFNB4 locus were further screened to determine the variants in all exons of SLC26A4 gene by direct DNA sequencing. The 21 exons of SCL26A4 were analyzed for the two pedigrees. A known variant (c.716T>A homozygote), it is the first reported incidence in Iran, a novel variant (c.493A>C homozygote) were detected in the two pedigrees and pathogenesis of c.493A>C confirmed in this study with review 100 hearing ethnically matched controls by PCR-RFLP analysis. The present study suggests that the SLC26A4 gene plays a crucial role in the HL occurring in Iranian pedigrees. Also, the results probably support the specificity and unique spectrum of SLC26A4 variants among Iranian HL patients. Molecular study of SLC26A4 gene may lead to elucidation of the profile of the population-specific variants which has importance in diagnostics of HL.

https://ift.tt/2K0job1

Phenotypes, endotypes and biomarkers in anaphylaxis: current insights

Purpose of review The aim of the review is to describe the different clinical pictures of anaphylaxis (phenotypes), in relation to the underlying mechanisms and potential biomarkers, to describe anaphylaxis endotypes. This may aid in achieving a better understanding, management and outcomes of such severe reactions. Recent findings Different anaphylaxis phenotypes have been outlined, ranging from the classical type-I-like to those suggestive of cytokine-storm-like or complement-mediated reactions. Underlying mechanisms differ and biomarkers of cells and systems involved are being identified (tryptase, IL-6, bradykinin etc.) Summary Identifying specific phenotypes/endotypes will allow the application of precision medicine in patients with anaphylaxis, providing insights to the most appropriate approach in each case. Correspondence to Mar Guilarte, Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Ps. Vall d'Hebron 119-129, 08035 Barcelona, Spain. Tel: +34 932746169; e-mail: mguilarte@vhebron.net Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2vbfJ4L

Prevalence of an Intact Hyoid Bone at Revision Excision of a Thyroglossal Duct Remnant

Publication date: Available online 27 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jonathan Huang, Beth Osterbauer, Jeffrey Koempel

Abstract

Objective

To determine the prevalence of an intact hyoid bone at the time of revision thyroglossal duct cyst (TGDC) surgery in a pediatric population.

Methods

The operative reports of 44 patients under 18 years of age who underwent a revision TGDC surgery from March 1997 to October 2015 at Children's Hospital Los Angeles were reviewed to determine finding of an intact hyoid bone at the time of the revision procedure.

Results

At the time of the revision surgery, 75% of the patients had an intact hyoid bone and 25% did not.

Conclusion

Patients who experience a recurrence of a TGDC are more likely than not to have an intact hyoid bone at revision surgery. These data indicate that some surgeons are not following the recommendation from Schlange and Sistrunk that removal of the mid-portion of the hyoid bone should be a routine part of any primary procedure for excision of a known or suspected TGDC in order to decrease the risk of recurrence. Despite the prevalent knowledge that the central portion of the hyoid bone be removed during a TGDC procedure, special attention should be given to the area of the midportion of the hyoid bone as a likely site of persistent disease in revision cases even if a previous operative report documents resection of a portion of the hyoid bone and/or cartilage.

https://ift.tt/2vbCtBN

A multifaceted programme to reduce the rate of tongue-tie release surgery in newborn infants: Observational study

Publication date: Available online 27 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Bronwyn Dixon, Juliet Gray, Nikki Elliot, Brett Shand, Adrienne Lynn

Abstract

Objectives

A programme was introduced in Canterbury, New Zealand to evaluate the diagnosis and treatment of frenulum releases in newborn infants with suspected tongue-tie (ankyloglossia). The primary goals were to support breastfeeding and ensure that unnecessary surgery was avoided.

Methods

Local healthcare professionals reached consensus on a pathway for improving management of infants with tongue-tie and breast-feeding difficulties. This embedded an expert breast-feeding review and assessment of lingual function used a validated method, the Bristol Tongue-tie Assessment Tool (BTAT). Infants with breastfeeding problems related to tongue-tie had a frenotomy at a hospital outpatient clinic. An education programme was developed to support introduction of the new clinical pathway and included seminars and online information for healthcare professionals and the general public.

Results

Frenotomy intervention rate reduced markedly from 11.3% in 2015 to 3.5% by mid-2017. Feeding methods were not different before or after surgery between infants who received a frenotomy and those who did not. Initially, the BTAT threshold for frenotomy was set at ≤5, however the final clinical pathway combined a breastfeeding assessment and a BTAT threshold of ≤4. The education programs assisted with the changes in practice, while increased use of the clinician guidance and public health information websites confirmed growing awareness of tongue-tie and community breastfeeding support.

Conclusions

Establishing consistent multidisciplinary assessment of tongue-tie in infants with feeding difficulties led to a marked reduction in frenotomy intervention rate. 23% of the frenotomy group in the 2016 audit showed a significant improvement in the ability to breastfeed, but overall there was no difference in the feeding pattern of infants who either received or were declined a frenotomy. The development of a supportive education programme and availability of online information about tongue-tie for health professionals and consumers contributed to successful uptake of the new clinical pathway.

https://ift.tt/2mLdOQE

Clinical management of quadriplegia in low and middle-income countries: a patients road to physiotherapy, prostheses and rehabilitation

Here we discuss the follow-up case of a 27-year-old male patient from rural Philippines, who was neglected by local health services after losing all four of his limbs as a result of a high-voltage electrical accident. The case follows the patient's road to accessing prostheses, rehabilitation health services and physiotherapy. Significant disparities were found between the government health services and the private sector with respect to quality, accessibility and affordability. Access to affordable healthcare is a basic human right that must be a priority for low-income and middle-income countries.

https://ift.tt/2AkDAEW

Successful management of persistent distressing neuropsychiatric symptoms by clozapine in a patient suffering from dementia with Lewy bodies

Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia associated with poor prognosis and high carers' burden. Neuropsychiatric symptoms worsen this prognosis and are a high source of distress for service users and their carers. However, there is currently insufficient evidence to support the pharmacological and non-pharmacological management of these symptoms. Acetylcholinesterase inhibitors are the first-line pharmacological option, but challenging risky behaviours may persist despite their use. Antipsychotic medications are indicated in such clinical scenarios, but there is very limited evidence to support the efficacy and safety of these medications for managing neuropsychiatric symptoms in DLB. Hence, we report an individual with DLB with severe distressing persistent visual hallucinations and agitation. After multiple treatment options had failed, clozapine was successfully initiated with substantial improvement in both clinical and functional outcomes. Further studies are warranted for evaluating the efficacy of clozapine in managing neuropsychiatric symptoms in DLB.

https://ift.tt/2mNvgny

Linezolid-induced pancytopenia

Linezolid is a bacteriostatic antibiotic of the Oxazolidinone class; it works by inhibiting the initiation of protein synthesis on bacterial ribosomes. Due to its excellent bioavailability after oral dosing, it has become an important tool in combating multi-drug-resistant bacteria including glycopeptide-resistant enterococci and methicillin-resistant Staphylococcus aureus. Side effects are multiple and potentially serious. We report the case of an 87-year-old man who developed pancytopenia secondary to a 6-week course of linezolid. Withdrawal of the antibiotic was decided as the treatment and resolution of the pancytopenia was evident within 2 weeks. Clinicians should be aware of this side effect of linezolid therapy and that weekly full blood count monitoring is paramount.

https://ift.tt/2AeJSWV

Calvarial osteomyelitis and intracranial extension post-Mohs micrographic surgery

Mohs micrographic surgery (MMS) is a specialised micrographic technique used for the treatment of locally invasive skin cancers. Despite being a relatively low risk surgery, the overall complication rates range between 1.6% and 3%. Common complications include postoperative haemorrhage, haematoma formation, wound infection, wound dehiscence and flap/graft necrosis. Osteomyelitis after dermatological cancer surgery is exceedingly rare. There have only been two cases of osteomyelitis in association with Mohs surgery reported in the literature to date. Here, we describe an epidemiologically atypical patient who initially presented with fever and altered mental status and later found to have calvarial osteomyelitis, intracranial abscess (empyema) and meningoencephalitis as a result of Mohs surgery. Although rare, it is a predictable side effect postsurgery, and prevention of such complications are critical to decrease morbidity and mortality in patients undergoing MMS.

https://ift.tt/2OiA2pL

Neurogenic pulmonary oedema complicating a lateral medullary infarct

Neurogenic pulmonary oedema (NPO) is a rare clinical syndrome of pulmonary oedema occurring secondary to an insult of the central nervous system (CNS). The exact aetiology of this disorder is unknown. NPO can be fatal and poor awareness and identification of this entity, particularly in terms of misdiagnosis as primary pulmonary or cardiac disease, can result in suboptimal management and outcomes. We describe the presentation and management of a 68-year-old woman with an acute left lateral medullary stroke complicated by pulmonary oedema. The likely aetiology is discussed, and important learning points are highlighted.

https://ift.tt/2AeJMi1

Symptomatic pulmonary restriction secondary to diaphragmatic eventration and megacolon in adult

Description

A 70-year-old woman with a medical history significant for toxic megacolon secondary to Clostridium difficile infection treated 40 years prior with partial colectomy and known diaphragmatic eventration presents with a 3-day history of progressive shortness of breath and dyspnoea on exertion. The patient had never previously been symptomatic nor suffered blunt trauma and had a strong personal conviction to avoid surgery. CT imaging revealed a massive left diaphragmatic displacement containing spleen, stomach and colon with mediastinal shift, compression of the left lung and a pericardial effusion (figure 1). Due to persistent tachycardia and presence of pericardial effusion on CT, a transthoracic echocardiogram was obtained, which demonstrated a large pericardial effusion concerning for tamponade physiology. The patient developed supraventricular tachycardia for which cardiology was consulted and two doses of adenosine were administered with resolution. The patient was upgraded to surgical intensive care and taken to the operating...

https://ift.tt/2mLPZIw

Vessel wall enhancement by gadolinium-enhanced MRI in a patient with delayed stenosis after mechanical thrombectomy

Description

Delayed stenosis of targeted vessels is a reported complication of stent retriever-based mechanical thrombectomy.1 We report a case of delayed stenosis with MRI findings that may be related to the underlying stenotic mechanism.

A 46-year-old woman was brought to our hospital with sudden left hemiparesis and unilateral spatial neglect. MRI revealed occlusion of the right middle cerebral artery (MCA) and acute cerebral infarction (figure 1A,B). Emergent mechanical thrombectomy was performed with one stent retriever pass following two aspiration catheter passes, and a red thrombus was retrieved (figure 1C,D). We thought that an embolism had caused the vessel occlusion as no abnormalities were visualised at the occluded site on day 2 (figure 1E). Despite detailed examinations, we could not determine the embolic source during the patient's hospitalisation, so we administered low-dose aspirin. She was discharged on day 46.

https://ift.tt/2AeK0pn

Indapamide-induced bilateral choroidal effusion in pseudophakic patient.

We describe a case of indapamide-induced bilateral choroidal effusion, first time reported in pseudophakic patient, associated with no change in visual acuity and stable refraction.

A 70-year-old man was referred for ophthalmic assessment, with binasal visual field defect for 2 days. He had been started on treatment with indapamide 3 weeks earlier. His ophthalmic history included bilateral cataract surgery and intraocular lens implant. Fundal examination revealed bilateral choroidal effusions; B-scan ultrasonography was used to measure the extent of the choroidal detachment and the anterior chamber depth. Discontinuation of indapamide resulted in spontaneous resolution of choroidal effusion after 3 days. Our case is the first in the literature that describes bilateral choroidal effusion induced by indapamide in a pseudophakic patient. The lack of myopic shift likely resulted in a later presentation, enhancing the theory that lens thickening and/or accommodative spasm may play a crucial role in pathophysiology.

https://ift.tt/2OjKm0R

Spontaneous disenclavation of phakic intraocular iris claw lens

Description

A 35-year-old male patient came to the outpatient department with sudden onset painless diminution of vision and diplopia in RE since last 3 days. The vision was 20/200 in the RE and 20/20 in the LE. The patient was a known case of myopia with history of phakic eye iris claw intraocular lens (IOL) of both eyes done 12 years back. There was no history of trauma. His best-corrected visual acuity in the right eye was 20/20 with –3DS, –0.50DC x 90 in the OD. The intraocular pressure in the OD was 13 mm Hg and 15 mm Hg in the OS. On slit lamp examination nasal disenclavation of the iris claw lens was noted, the edge of which was bisecting the non-dilated pupillary plane. The IOL was hanging inferiorly with the optic touching the corneal endothelium inferiorly and with the other end fixed at the 9 o'clock position (figure 1). The cornea...

https://ift.tt/2AaHalb

POEMS syndrome: diagnostic delay and successful treatment with lenalidomide, cyclophosphamide and prednisone followed by autologous peripheral stem cell transplantation

Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes (POEMS) syndrome is a rare systemic disease, often unrecognised in the primary care setting. POEMS syndrome is associated with plasma cell dyscrasias and upregulation of vascular endothelial growth factor leading to systemic oedema, papilloedema and pulmonary hypertension. A wide constellation of presenting symptoms often leads to late diagnosis. Unrecognised and untreated disease rapidly leads to death from neuropathic exhaustion or cardiopulmonary failure. Treatment is extrapolated from other plasma cell dyscrasias such as multiple myeloma. Autologous peripheral blood stem cell transplantation (PBSCT) is often an important component of treatment. There is no established standard of care for POEMS syndrome. Therapies include lenalidomide, bortezomib and targeted monoclonal antibodies. We present a patient with POEMS syndrome who achieved rapid complete response to triple therapy consisting of lenalidomide, cyclophosphamide and prednisone, followed by high-dose chemotherapy and PBSCT.

https://ift.tt/2OlMOnF

Predictors of Neck Reoperation and Mortality After Initial Total Thyroidectomy for Differentiated Thyroid Cancer

Thyroid, Ahead of Print.

https://ift.tt/2uUN8Bz

Book review—Rosai and Ackerman’s surgical pathology-2 volume set, 11th edition

https://ift.tt/2LqN5Yw

Acute Hyponasality (Closed Rhinolalia) and Craniomaxillofacial Fracture Suggest the Coexistence of Retropharyngeal Emphysema and Pneumomediastinum

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0038-1667017

Pneumomediastinum (PM) implies an abnormal condition where a collection of free air or gas is entrapped within the fascial planes of mediastinal cavity. It is considered as benign entity, but an uncommonly seen complication of craniofacial injuries. We report a case of a 63-year-old male patient with the presenting sign of closed rhinolalia who was diagnosed with retropharyngeal emphysema and PM due to a linear and nondisplaced fracture of midface. The patient cited multiple efforts of intense nasal blowing shortly after a facial injury by virtue of a motorcycle accident. He was admitted in our clinic for closer observation and further treatment. The use of a face mask for continuous positive airway pressure was temporarily interrupted, and high concentrations of oxygen were delivered via non-rebreather mask. Patient's course was uncomplicated and he was discharged few days later, with almost complete resolution of cervicofacial emphysema and absence of residual PM in follow-up imaging tests. Closed rhinolalia (or any acute alteration of voice) in maxillofacial trauma patients should be recognized, assessed, and considered within the algorithm for PM and retropharyngeal emphysema diagnosis and management. For every single case of cervicofacial emphysema secondary to facial injury, clinicians should maintain suspicion for retropharyngeal emphysema or PM development.
[...]

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

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

https://ift.tt/2uUK20h

Serum periostin levels following small bone fractures, long bone fractures and joint replacements: an observational study

In asthma, serum periostin may potentially be used as a biomarker in the management of patients with Type-2 eosinophilic airway inflammation. However, serum periostin may be influenced by factors other than Ty...

https://ift.tt/2OjiDgN

Comparison of aural rehabilitation outcomes in presence and absence of back ground noise in hearing impaired children with and without attention deficit hyperactivity disorder (ADHD)

Publication date: Available online 26 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Fariba Noori, Saeed Farahani, Hermin Mokrian, Mastoore Asadi, Helnaz Mokrian

https://ift.tt/2AnU5Av

The bacterial community and local lymphocyte response are markedly different in patients with recurrent tonsillitis compared to obstructive sleep apnoea

Publication date: Available online 26 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

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

Abstract

Introduction

Obstructive sleep apnea (OSA) is now a more common indication for tonsillectomy than recurrent tonsillitis (RT) [1,2]. Few studies have addressed possible differences in pathogenesis between these two conditions. Children with RT and OSA are often being treated in the community with multiple courses of antibiotics before surgery. Current understanding of the role of bacteria in disorders of the tonsils is mainly based on the culture of tonsil swabs. Swab cultures reflect only a very small fraction of the bacteria present on the mucosal surface and may not represent the bacterial communities within the tonsil crypts [3,4]. This study aimed to evaluate the local lymphocyte response and associations with bacterial community composition using molecular techniques of the tonsils removed from children for RT or OSA.

Method

The palatine tonsils were removed by extracapsular dissection from 24 patients with age range one to ten years, 14 of whom had RT and 10 had OSA. The fixed tonsil tissues were evaluated for bacteria by Gram-staining and presence of connective tissue by safranin staining. B lymphocytes and T lymphocytes were also measured immunohistochemically. Finally, previously published bacterial community data for this cohort were reassessed for associations with RT and OSA, and with the observed lymphocyte patterns.

Results

In tonsils from patients with RT, large micro-colonies of bacteria were observed in the tonsil crypts, and a large number of B and T lymphocytes were noted immediately adjacent to the tonsil crypt itself. In marked contrast, the tonsils from patients with OSA had no bacteria identified, and no significant skewing of lymphocytes based on site (such as follicles or crypts). We observed that the majority of lymphocytes surrounding the bacterial micro-colonies were B lymphocytes with a mean ratio of 109:55 (B lymphocytes: T lymphocytes). Bacterial community diversity was not different between the two cohorts; however, there were significant differences in bacterial community composition. Children with RT had a higher relative abundance of members from the genera Parvimonas, Prevotella, and Treponema. While children with OSA had a higher relative abundance of Haemophilus, and Capnocytophaga.

Conclusion

These results demonstrate significant differences in the local lymphocyte response and bacterial community composition in tonsil tissue between RT and OSA patients. It suggests that the response to antibiotics used in the treatment of these two conditions may be different. Furthermore, the presence of lymphocytes in RT within the tonsil crypt outside the tonsil epithelium is a unique observation of the location of these cells.

https://ift.tt/2mMWRFM

Geographic Health Disparities in the Los Angeles Pediatric Neck Abscess Population

Publication date: Available online 26 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Varun Angajala, Kevin Hur, Lia Jacobson, Christian Hochstim

Abstract

Objective

To assess geographical sociodemographic differences in neck abscesses that require surgical drainage in Los Angeles.

Study Design: retrospective review

Methods

We reviewed the medical records of 119 consecutive pediatric patients at Children's Hospital Los Angeles (CHLA) from 2014-2017 with a diagnosis of a neck abscess requiring incision and drainage. Sociodemographic information including zip code of residence was extracted and analyzed with Chi-square, Fisher's exact test, and multivariate logistic regression.

Results

The average age of patients with a neck abscess in this study was 3.4 years old, 53.8% were female, 54.6% were Hispanic, and 82.5% had public health insurance. 79% of patients had an abscess located in the superficial neck, and 10.1% had an abscess located in the retropharyngeal space. There were no significant differences in gender, race, type of health insurance, or income between patients that lived within 10 miles of CHLA versus those that lived farther than 10 miles. On multivariate analysis, zip codes with a high volume of neck abscesses were more likely to be lower income neighborhoods. Gender, race, type of health insurance, and distance from CHLA were not associated with zip codes with a high volume of neck abscesses.

Conclusion

Geographic areas in the greater Los Angeles community with a high volume of neck abscesses requiring incision and drainage at our institution were associated with lower income neighborhoods.

https://ift.tt/2AffKKQ

Toll-like receptor 9 ligands increase type I interferon induced B-cell activating factor expression in chronic rhinosinusitis with nasal polyposis

Publication date: Available online 26 July 2018

Source: Clinical Immunology

Author(s): Jun Xu, Jin-Woo Lee, Soo-Kyoung Park, Sung-Bok Lee, Young-Hoon Yoon, Sun-Hee Yeon, Ki-Sang Rha, Ji-Ae Choi, Chang-Hwa Song, Yong Min Kim

Abstract

B-cell activating factor (BAFF) has been proposed to play a crucial role in the pathogenesis of chronic rhinosinusitis with nasal polyp (CRSwNP). The aim of this study was to evaluate the role of toll-like receptor (TLR) 9-mediated BAFF activation on the pathogenesis of CRSwNP. NP and uncinate tissue (UT) were obtained from patients with CRSwNP or CRS without NP, and control subjects. The expression of TLR9, high mobility group box-1 protein (HMGB1), type I interferon (IFN), BAFF, and anti-double stranded DNA (dsDNA) antibody were examined in the tissues and the cultured dispersed NP cells (DNPCs). The expression of TLR9, HMGB1, type I IFN, BAFF, and anti-dsDNA antibody were elevated in NP tissue compared to the UTs. Exposure to TLR9 agonist increased the type I IFN expression in vitro, which further increased BAFF production. In conclusion, we provided a novel therapeutic potential of TLR9 agonist in CRSwNP.

https://ift.tt/2LHJ954

Bioactive glass 45S5 ceramic for alveolar cleft reconstruction, about 58 cases

Publication date: Available online 26 July 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Nicolas Graillon, Nathalie Degardin, Jean Marc Foletti, Magali Seiler, Marine Alessandrini, Audrey Gallucci

Abstract

Background

Secondary alveolar bone grafting in patients with clefts lip and palate is usually performed with iliac crest bone harvesting, however using bone substitute allow to avoid harvesting morbidity. The purpose of our study was to assess if the use of a bioactive glass ceramic is an acceptable alternative to iliac crest bone harvesting in alveolar clefts treatment.

Methods

A prospective study including all patients who have benefited of alveolar grafting by GlassBONE™ (Noraker, France), a synthetic resorbable bioactive glass 45S5 ceramic was conducted. The patients underwent clinical assessments and imaging check-up by dental panoramic radiography and CBCT.

Results

Fifty-eight graftings were performed. The mean age at the time of the graft was 7.6 years. Hospitalization, social eviction and antalgic consumption were reduced. Bone continuity was achieved in 63.8% of the cases. Bilateral cleft and dental agenesia increased grafting failure. In the subgroup of 25 patients with isolated unilateral cleft without dental agenesis, 80% had bone continuity at one year. We noted 10.3% of alveolar fistula recurrence.

Conclusion

The use of GlassBONE™ in alveolar grafts simplifies the surgery procedure and the postoperative management, and ensures satisfactory mucosal healing, tooth eruption and bone continuity in two thirds of the followed grafts.

https://ift.tt/2mKFrte

The allergic allergist behaves like a patient

Publication date: Available online 26 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Jean Bousquet, Ruth Murray, David Price, David Somekh, Lars Münter, Jim Phillips, Wienia Czarlewski

https://ift.tt/2NIwuMk

Combination Inhaled Glucocorticoid/Long-Acting Beta-Agonist Safety: The Long and Winding Road

Publication date: Available online 26 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Joseph D. Spahn

https://ift.tt/2LEf4mQ

A tough pill to swallow: Medicolegal liability and dysphagia

Publication date: Available online 26 July 2018

Source: American Journal of Otolaryngology

Author(s): Christopher Badger, Sunil P. Verma

Abstract

Level of evidence

Level 4 (Case Series).

Objective

Dysphagia is a debilitating condition that is associated with many etiologies. It can have a devastating effect on a patient's quality of life with long-term sequelae that make it a source of medical malpractice litigation. This study analyzed medical malpractice cases involving dysphagia and looked for factors determining legal liability.

Methods

The Westlaw Next legal database (Thomson Reuters, New York, NY) was searched for relevant malpractice cases and assessed for several factors including if the dysphagia was iatrogenic, the amount paid by the defendant, and the medical specialty of the defendants.

Results

A total of 45 cases of dysphagia were included. The majority of these cases were jury verdicts for the defendant (73.3%). Iatrogenic dysphagia was alleged in 55.5% of cases. Settlements and verdicts favoring the plaintiff resulted in awards ranging between $25,000 and $5,003,000 with a mean of $1,014,015. The most frequent physician specialists named were general surgeons (24.1), internists (11.1%), anesthesiologists (9.3%), gastroenterologists (7.4%), and otolaryngologists (5.6%). Iatrogenic dysphagia (OR 8.89 CI 1.02–77.32), medication-related iatrogenesis (OR 18.86 CI 1.82–195.41), and cases naming multiple specialties as a defendant (OR 5.90, CI 1.07–32.55) were factors associated with a verdict for the plaintiff or a settlement.

Conclusion

Dysphagia is a condition with medicolegal consequences for many specialties. While the majority of these cases are decided in favor of the defendant the cost of a negative outcome is considerable. Iatrogenic dysphagia and naming more than one defendant specialty were associated with increased odds of a plaintiff verdict or settlement.

https://ift.tt/2LOXIRa

Office-based retrograde transtracheal application of mitomycin C

Publication date: Available online 26 July 2018

Source: American Journal of Otolaryngology

Author(s): Valeria Silva Merea, Paul C. Bryson

Abstract

Objectives

The utility of topical mitomycin C (MMC) as an adjuvant treatment in the management of laryngeal and tracheal stenosis has been studied; however, the ideal timing of MMC application has not been fully elucidated. There is a paucity of studies evaluating the timing of MMC application after surgical airway intervention for stenosis. The purpose of this study is to describe a novel technique for MMC application that allows for delayed application in the unsedated, office-based setting, approximately one week following endoscopic airway dilation.

Methods

A technique for retrograde transtracheal application of MMC was developed and utilized in 3 tracheostomy-dependent patients with subglottic stenosis and glottic stenosis with bilateral vocal fold immobility. After administration of topical anesthesia, a MMC (0.4 mg/mL) coated pledget was advanced via a transtracheal approach and directed to the area of stenosis in retrograde fashion using endoscopic frontal sinus instruments. Appropriate positioning of the pledget was confirmed via transnasal flexible fiberoptic laryngoscopy.

Results

All 3 patients underwent successful in-office retrograde application of MMC onto the area of laryngeal stenosis 7–9 days after their preceding surgery. There were no complications. Two patients achieved decannulation while the third patient's management was interrupted due to cancer treatment.

Conclusions

We present a novel and well tolerated technique for delayed in-office application of MMC in tracheostomy-dependent patients with laryngeal stenosis. This approach can facilitate the study of the ideal timing of topical MMC use in airway stenosis.

https://ift.tt/2LBuk3Z

Combination Inhaled Glucocorticoid/Long-Acting Beta-Agonist Safety: The Long and Winding Road

This perspective seeks to address one of the major controversies that had plagued asthma management for over a decade. This controversy involves long-acting beta-agonist (LABA) safety, as it pertains to its use when combined with an inhaled glucocorticoid (GC). Unlike many controversies in medicine, this one can finally be put to rest. LABA's when used in combination with an inhaled GC are safe 1-4. On December 20, 2017 the FDA removed the black box warning in a Drug Safety Communication stating that there was no significant increase in risk of serious asthma outcomes with LABA's used in combination with inhaled GC's 5.

https://ift.tt/2JZvm4H

The allergic allergist behaves like a patient

There is a complete disconnection between physician's prescription and patient's behavior for the treatment of pollen-induced allergic rhinitis. The vast majority of allergists prescribe medications for the entire season recommending the patient to use them regularly even during days with few symptoms. On the other hand, the vast majority of patients use their medications on-demand when their AR is not well controlled and do not follow guidelines 1,2.

https://ift.tt/2mJNypP

Selecting the Right Biologic for Your Patients with Severe Asthma

Severe asthma affects 5-10% of the adult asthma population and is associated with increased morbidity, mortality, and consumption of health care resources. Recently, several biologic medications have been approved for use in severe asthma. These medications target the type-2 inflammatory pathway, which is characterized by activation of cytokines including interleukin (IL)-4, IL-5 and IL-13, which results in eosinophilia, high fractional exhaled nitric oxide (FeNO) and atopic features. The objective of this review is to provide clinicians with key points to assist in selecting the best biologic medication for each patient.

https://ift.tt/2K0e47H

Severe Asthma With Eosinophilic Gastroenteritis Effectively Managed by Mepolizumab and Omalizumab

Eosinophilic gastroenteritis and asthma are typically treated with systemic corticosteroids in the severe cases but chronic corticosteroid use often leads to serious long-term adverse effects.1 We herein report a unique case where eosinophilic gastroenteritis, esophagitis, and severe asthma refractory to systemic corticosteroids was and is being effectively managed by mepolizumab and omalizumab.

https://ift.tt/2Lr7TiJ

Long-Term Prophylaxis Therapy in Patients with Hereditary Angioedema with C1 Inhibitor Deficiency

Hereditary angioedema with C1 inhibitor (C1-INH) deficiency (C1-INH-HAE) is a rare condition that may have a profound effect on patients' lives, both physically and emotionally.1, 2 Swelling can occur in the abdomen, face, throat, genitalia, or extremities and may cause pain and disability. Abdominal swelling can cause severe pain and potentially intestinal obstruction, incapacitating the patient during the attack. Swelling of the extremities can impede patients from walking or using their hands, and swelling with airway involvement is potentially life-threatening.

https://ift.tt/2K0dUND

Bioactive glass 45S5 ceramic for alveolar cleft reconstruction, about 58 cases

Cone–beam computed tomographic analysis of maxillary and mandibular changes after high condylectomy combined with orthodontic treatment for active unilateral condylar hyperplasia

Factors influencing the long-term results of autologous microvascular submandibular gland transplantation for severe dry eye disease

Tongue reduction in Beckwith–Wiedemann syndrome: outcome and treatment algorithm

Insulin Resistance and Metabolic Syndrome: Clinical and Laboratory Associations in African Americans Without Diabetes in the Hemochromatosis and Iron Overload Screening Study

Metabolic Syndrome and Related Disorders, Volume 16, Issue 6, Page 267-273, August 2018.

https://ift.tt/2OkTkuU

Daily Application of an Aqueous, Acidifying, Peelable Nail Polish versus Weekly Amorolfine for Topical Onychomycosis Treatment: A Prospective, Randomized, Blinded Trial

Abstract

Introduction

Onychomycosis is a fungal nail infection, frequently caused by dermatophytes, which occurs in 2–14% of Western adults. The present study was set up to evaluate the efficacy and safety of a water-based, peelable nail polish (daily application), which acidifies the nail environment, versus a 5% amorolfine nail lacquer (weekly application) for topical treatment of mild-to-moderate onychomycosis.

Methods

One hundred two adults were randomized in this open, prospective, blinded trial. Clinical efficacy was evaluated at baseline and days 30, 60, 120, and 180, respectively. All patients underwent microbiological testing (at baseline and study end). The primary objective of this trial was the change in the percentage of healthy nail surface at day 180.

Results

The percentage of healthy surface between baseline and day 180 increased with 11.8% in the test product group and 13.2% in the amorolfine group, which were statistically comparable. Other onychomycosis-related parameters (dystrophy, discolouration, thickening, and healthy aspect, respectively) showed significant (p < 0.05) improvement after 180 days (versus baseline) with both treatments. Clinical performance was further confirmed by the frequency of patients showing onychomycosis improvement or success at the end of the study: 96.0% (test product) versus 79.6% (amorolfine). Microbiological results and improved quality of life confirmed clinical performance. Both treatments were well tolerated and appreciated for their properties and efficacy.

Conclusion

The present trial confirmed the clinical performance of daily acidification of the nail, as reflected by (1) a comparable increase of percentage of healthy nail surface following treatment with the test product versus amorolfine, (2) the overall improvement of other onychomycosis-related parameters, (3) user convenience, and (4) absence of side effects. These data indicate that daily application of an aqueous, acetic acid-based, peelable solution can be a convenient, safe, and equally effective alternative for the topical management of onychomycosis.

Trial Registration

ClinicalTrials.gov identifier; NCT03382717

Funding

Oystershell Laboratories.

https://ift.tt/2A9Gn44

Topical Application of 5-Fluorouracil Associated with Distant Seborrheic Dermatitis-like Eruption: Case Report and Review of Seborrheic Dermatitis Cutaneous Reactions after Systemic or Topical Treatment with 5-Fluorouracil

Abstract

Introduction

5-Fluorouracil is a fluoropyrimidine antineoplastic medication that is used to topically treat actinic keratoses. Although local adverse effects to the drug are common and anticipated, distant skin reactions are rare and unexpected. In this case report, we describe a patient who developed seborrheic dermatitis-like eruption at a distant site after topical application of 5-fluorouracil to his arms.

Case report

A 63-year-old man with actinic keratoses on his arms developed a facial seborrheic dermatitis-like reaction after topically applying 5-fluorouracil 5% cream twice daily to actinic keratoses on his forearms for 7 days. The facial dermatosis resolved shortly after discontinuation of the 5-fluorouracil; upon rechallenge of topical 5-fluorouracil on his arms, the facial seborrheic dermatitis recurred.

Discussion

Several case reports have been published which describe exacerbations of preexisting seborrheic dermatitis with local topical 5-fluorouracil. Additionally, one case series describes the development of scrotal dermatitis in two patients after distant treatment with 5-fluorouracil. The pathogenesis that causes this distant reaction is unclear.

Conclusion

We describe a patient with a seborrheic dermatitis eruption after topical application of 5-fluorouracil at a distant site. The etiologic association between the drug and adverse effect was confirmed with multiple cycles of application and discontinuation of the offending agent.

https://ift.tt/2OlKoVV

Mature dendritic cell density is affected by smoking habit, lesion size, and epithelial dysplasia in oral leukoplakia samples

Publication date: November 2018

Source: Archives of Oral Biology, Volume 95

Author(s): Giovanna Ribeiro Souto, Michelle Danielle Porto Matias, Laiz Fernandes Mendes Nunes, Raquel Conceição Ferreira, Ricardo Alves Mesquita

Abstract

Objective

To compare the densities of CD1a + immature and CD83+ mature dendritic cells, and inflammatory infiltrate cells between smokers and non-smokers with oral leukoplakia. Parameters associated with malignant transformation were also evaluated.

Design

21 smokers and 23 non-smokers diagnosed with oral leukoplakia were obtained. Densities of inflammatory infiltrate cells were calculated in H&E sections. Immunohistochemistry using anti-CD1a and anti-CD83 was performed and densities were calculated. Comparisons and statistical analyses were performed among the groups and parameters as gender, lesion size, site, and presence of cell dysplasia were analyzed.

Results

A lower density of CD83+ cells was observed in smokers compared to non-smokers (P < 0.05). For samples of smokers, a lower density of CD1a + cells, CD83+ cells, and inflammatory infiltrate cells was observed in samples with <10 mm compared to samples ≥10 mm of diameter (P < 0.05), and a lower density of CD83+ cells was also observed between samples without dysplasia compared to samples with dysplasia (P < 0.05).

Conclusion

In oral leukoplakia samples, dendritic cell density decreases in the presence of smoking habit, and increases in larger lesions and with epithelial dysplasia. Smoking habit is an external factor that contribute to alteration of the anti-tumoral immune defense system in lesions of oral leucoplakia, reinforcing that smoking elimination is important to control the development of this disease.

https://ift.tt/2NKqvXA

Tongue reduction in Beckwith–Wiedemann syndrome: outcome and treatment algorithm

Publication date: Available online 26 July 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): H. Naujokat, B. Möller, H. Terheyden, F. Birkenfeld, D. Caliebe, M.F. Krause, H. Fischer-Brandies, J. Wiltfang

Abstract

Beckwith–Wiedemann syndrome is a rare congenital overgrowth disorder with macroglossia being one of the cardinal symptoms. In pronounced cases, macroglossia can lead to airway obstruction, musculoskeletal alterations and functional deficits. Surgical tongue reduction is performed at varying ages and with different techniques. This study evaluated perioperative complications, as well as long-term aesthetic and functional outcomes, in a large cohort. A total of 68 patients, treated either surgically or conservatively, were included. Depending on the severity of macroglossia, patients were divided into three groups to determine the treatment algorithm. Complications after surgical tongue reduction were prolonged intubation and revision due to dehiscence or haematoma. In the long term, no patient suffered from impaired sense of taste or paresthesia, although the shape of the tongue was disproportional in 85%. With the present treatment algorithm, operative tongue reduction exerts a positive influence on skeletal, dentoalveolar and functional development with sufficient long-term outcome and high grade of satisfaction of the patients. Supportive therapy in an interdisciplinary centre is of fundamental importance for both surgical and conservative treatment.

https://ift.tt/2LDThvD

Mature dendritic cell density is affected by smoking habit, lesion size, and epithelial dysplasia in oral leukoplakia samples

Publication date: November 2018

Source: Archives of Oral Biology, Volume 95

Author(s): Giovanna Ribeiro Souto, Michelle Danielle Porto Matias, Laiz Fernandes Mendes Nunes, Raquel Conceição Ferreira, Ricardo Alves Mesquita

Abstract

Objective

Design

Results

Conclusion

https://ift.tt/2NKqvXA

Pleomorphic Adenoma of the Nasolacrimal Duct

This study describes the case of a man in his 60s with a 2-year medical history of right epiphora with recent 6-week onset of hemolacrima who presented with an incidental soft tissue lesion along the left inferior turbinate with associated nasolacrimal duct dilatation above the mass.

https://ift.tt/2LtQRAA

Nodular Mass in the Upper Lip

A man presents with a firm, painless, slow-growing mass in his upper lip. What is your diagnosis?

https://ift.tt/2v7nB7v

Management of Hoarseness

This guideline summary presents American Academy of Otolaryngology–Head and Neck Surgery recommendations for assessing and treating patients with hoarseness (dysphonia).

https://ift.tt/2Ln04ul

Association of the Anterolateral Thigh Osteomyocutaneous Flap With Femur Structural Integrity

This laboroatory analysis of synthetic femurs investigates the association of anterolateral thigh osteomyocutaneous flap harvest, with and without prophylactic fixation, with femur structural integrity as measured by 4-point bend and torsional biomechanical testing.

https://ift.tt/2vfHBVN

Positive Initial Margins and Survival Among Patients With SCC Treated With Total Laryngectomy

This cohort study investigates the association between positive initial margins and survival among patients with squamous cell carcinoma who underwent total laryngectomy and had negative final margins.

https://ift.tt/2LrhqWX

Quoi de neuf dans les malformations capillaires ?

Publication date: Available online 26 July 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): A. Dompmartin

https://ift.tt/2LBUcwp

Cone–beam computed tomographic analysis of maxillary and mandibular changes after high condylectomy combined with orthodontic treatment for active unilateral condylar hyperplasia

Publication date: Available online 26 July 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): C. Wu, Q. Meng, M. Deng, H. Cai, J. Ke, X. Long

Abstract

Our aim was to evaluate the efficacy of high condylectomy combined with orthodontic treatment for active unilateral condylar hyperplasia in 25 affected patients, by an analysis of the maxillary and mandibular changes on cone–beam computed tomography (CT). High condylectomy was the sole operative treatment. Variables that reflected the canting of the occlusal plane, the height of the maxillary complex, the buccolingual angulation of the maxillary first molar, the height of the ramus, the total length of the mandible, and the deviation of the chin were measured and compared between the two sides and between time intervals: preoperatively (T1) and the end of treatment (T2). The differences between time intervals in the deviation of the chin (p < 0.001) and the canting of the occlusal plane (p < 0.001) were significant, but there were no significant differences in the height of the ramus (p = 0.476) and the total length of the mandible (p = 0.838) between the affected and unaffected sides at T2. There were significant differences between time intervals in the buccolingual angulation on the unaffected side and the height of the maxillary complex on the affected side (p < 0.001). Facial asymmetry was corrected and the occlusal plane was improved. In conclusion, high condylectomy as the sole operative treatment combined with orthodontic treatment can provide an alternative method for correction of facial asymmetry associated with active unilateral condylar hyperplasia.

https://ift.tt/2mJEQYM

Supportive Therapieansätze beim hepatozellulären Karzinom

Zusammenfassung

Hintergrund

Die Therapieoptionen bei Patienten mit hepatozellulärem Karzinom (HCC) nach Versagen einer Therapie mit Sorafenib sind derzeit weiterhin eingeschränkt. Insbesondere bei Verschlechterung der Leberfunktion, der häufigsten HCC-bedingten Todesursache, erfolgt eine supportive Behandlung als akzeptierter Standard.

Methoden

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed zum Thema supportive Behandlung bei HCC.

Ergebnisse

Was genau eine supportive Behandlung bei HCC beinhaltet, ist in aktuellen Leitlinien und der Literatur jedoch unzureichend definiert. Außer zum Pruritus liegen kaum validierte Daten vor. Die meisten Patienten entwickeln im weiteren Krankheitsverlauf Symptome der Leberinsuffizienz (Aszites, Syntheseeinbruch mit Gerinnungsstörungen und Blutungen, Ödeme, u. a.). Klassische tumorassoziierte Beschwerden wie Schmerzen und Mangelernährung treten im weiteren Krankheitsverlauf auf. Eine Schmerztherapie erfolgt bevorzugt mit Paracetamol, ggf. mit Opiaten. Eine typische HCC-assoziierte Komplikation ist die maligne Pfortaderthrombose, über deren Therapie Uneinigkeit besteht. Als relativ seltene Komplikationen treten Cholestase/Cholangitis sowie symptomatische Knochen- und Lungenmetastasen auf.

Schlussfolgerung

Die vorliegende Übersicht fasst die derzeitige Datenlage zur supportiven Therapie inkl. der aktuellen Leitlinienempfehlungen zusammen.

https://ift.tt/2uP40tE

Gemcitabine and Cisplatin With/Without Anlotinib in Advanced Nasopharyngeal Carcinoma

Condition: Nasopharyngeal Carcinoma
Intervention: Drug: Gemcitabine/Cisplatin
Sponsor: Jiangsu Chia-tai Tianqing Pharmaceutical Co.,Ltd
Not yet recruiting

https://ift.tt/2AchOU2

Pilot Ph.II Study Evaluating The Role of ClO2 on Mucositis for Pt. Undergoing Head/Neck Radiotherapy

Condition: Head and Neck Carcinoma
Interventions: Drug: Chlorine Dioxide Sterilization; Other: Laboratory Biomarker Analysis; Other: Placebo
Sponsors: University of Arizona; National Cancer Institute (NCI)
Not yet recruiting

https://ift.tt/2mID3TH

Effects of Aqualief® in Patients With Xerostomia as Consequence of Radiotherapy for Head and Neck Cancer

Conditions: Xerostomia; Asialia; Hyposalivation; Mouth Dryness
Interventions: Dietary Supplement: Aqualief; Other: Placebo
Sponsors: Helsinn Healthcare SA; Latis S.r.l.
Recruiting

https://ift.tt/2A9YR4d

Alpelisib in Treating Participants With Transorally Resectable HPV-Associated Stage I-IVA Oropharyngeal Cancer

Conditions: CDKN2A-p16 Positive; Human Papillomavirus Positive Oropharyngeal Squamous Cell Carcinoma; Stage I Oropharyngeal Squamous Cell Carcinoma AJCC v6 and v7; Stage II Oropharyngeal Squamous Cell Carcinoma AJCC v6 and v7; Stage III Oropharyngeal Squamous Cell Carcinoma AJCC v7; Stage IVA Oropharyngeal Squamous Cell Carcinoma AJCC v7
Interventions: Drug: Alpelisib; Other: Laboratory Biomarker Analysis; Other: Pharmacodynamic Study; Procedure: Therapeutic Conventional Surgery
Sponsors: University of Arizona; National Cancer Institute (NCI)
Not yet recruiting

https://ift.tt/2mJ1HUf

Combining PET/CT and EBV DNA to Evaluate the Hazard of Progression in the Follow-up of Locally Advanced NPC

Condition: Nasopharyngeal Carcinoma
Intervention: Device: PET/CT and EBV DNA
Sponsor: Sun Yat-sen University
Not yet recruiting

https://ift.tt/2A9gkdi

Postoperative Concurrent Chemoradiotherapy Versus Radiotherapy Alone for Patients With Locoregionally Advanced Esophageal Squamous Cell Carcinoma

Condition: Esophageal Squamous Cell Carcinoma
Interventions: Drug: Docetaxel plus cisplatin; Radiation: radiotherapy
Sponsors: Huai'an First People's Hospital; Huai'an Second People's Hospital; lian shui county People's Hospital; xuyi People's Hospital; Chinese People's Liberation Army No. 82 Hospital
Recruiting

https://ift.tt/2Om4vDg

Phase 3 Trial of Donafenib in 131I-Refractory Differentiated Thyroid Cancer

Condition: Differentiated Thyroid Cancer
Interventions: Drug: Donafenib; Drug: Placebo
Sponsor: Suzhou Zelgen Biopharmaceuticals Co.,Ltd
Recruiting

https://ift.tt/2AmzX1F

Study of A166 in Patients With Relapsed/Refractory Cancers Expressing HER2 Antigen or Having Amplified HER2 Gene

Conditions: HER2-positive Breast Cancer; HER2 Gene Mutation; HER-2 Gene Amplification; HER2 Positive Gastric Cancer; Salivary Gland Cancer; Salivary Gland Tumor; Salivary Gland Carcinoma; Salivary Gland Neoplasms; Lung Cancer; Colo-rectal Cancer; Rare Diseases; Solid Tumor; Recurrent Gastric Cancer; Recurrent Colon Cancer; Recurrent Breast Cancer; Head and Neck Cancer; Head and Neck Carcinoma; Bladder Cancer; Cervical Cancer; Liver Cancer; Bile Duct Cancer; Urologic Cancer; Pancreatic Cancer; Prostate Cancer; Recurrent Prostate Cancer; Rectal Cancer; Recurrent Ovarian Carcinoma; Recurrent Renal Cell Cancer; Rectal Cancer Stage II; Rectal Cancer Stage I; Rectal Cancer Stage III; Skin Cancer; Mouth Cancer; Lip Cancer Stage I; Tongue Cancer; Breast Neoplasm Malignant Primary; Larynx Cancer; Tonsil Cancer; Palate Cancer; Mucoepidermoid Carcinoma; Primary Peritoneal Carcinoma; Mucinous Adenocarcinoma Gastric; Mucinous Breast Cancer Recurrent
Intervention: Drug: A166
Sponsor: Klus Pharma Inc.
Recruiting

https://ift.tt/2OiLuBK

Hypofractionated Versus Conventionally Fractionated Radiotherapy for Initial Distant Metastases Nasopharyngeal Carcinoma

Condition: Nasopharyngeal Carcinoma
Interventions: Radiation: Hypofraction radiation; Radiation: Standard dose IMRT
Sponsors: Wei Jiang; Wuzhou Red Cross Hospital; Guangxi Naxishan Hospital; Nanning Monority Hospital; Linshan pepole Hospital
Recruiting

https://ift.tt/2Ae4XRc

Randomized Controlled Trial for Vestibular Treatment in Concussion

Conditions: Vestibular Disorder; Mild Traumatic Brain Injury
Intervention: Behavioral: T-REV
Sponsors: University of Pittsburgh; United States Department of Defense
Not yet recruiting

https://ift.tt/2mJ1G2D

The effect of losing federal coverage through the Affordable Care Act on ear tube placements at an urban children's hospital

Publication date: Available online 26 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Madia C. Russillo, Thomas Chelius, Valerie Flanary

Abstract

Purpose

15-31% of the population in a large Mid-western city is between 100-400% of the Federal Poverty Level, thus qualifying for health care coverage under the Affordable Care Act (ACA). Coverage for their children would potentially be available under Children's Health Insurance Program (CHIP) or Medicaid programs. Loss of funding for these programs could be devastating for this community.

Methods

We retrospectively reviewed 1162 charts of pediatric patients with tympanostomy tube (TT) placement pre-ACA from November 2012 to December 2013 and 1606 charts post-ACA from January 2014 to July 2015. We filtered demographics by health insurance (Medicaid/CHIP/Other), residential zip codes, identified race/ethnicity within those zip codes as well as gender and age of patients getting TT during these periods.

Results

Bivariate analysis of these demographics between the two periods showed statistical significance (p=0.0098) between White Hispanic/Latino children receiving ear tubes (pre-ACA=3.8%, post-ACA=6.4%). However, there was no statistical significance for insurance enrollment (Medicaid or non-Medicaid) and other races (White-not Hispanic/Latino (nHL), African American, Other/Unknown/Refused) with respect to TT placement. Using pre-ACA period and White nHL females as arbitrary reference, a multivariate logistic regression showed that patients requiring TT surgery were equally likely to be covered on Medicaid either before or after ACA.

Conclusion

We demonstrated that the pre and post ACA Medicaid coverage for TT surgery did not change. Underserved children did not obtain other forms of insurance during this time. This demonstrates a potentially catastrophic loss of coverage for children should Medicaid/CHIP benefits be lost to sole coverage under the ACA.

https://ift.tt/2NLB4cU

The first 30 years of the American Academy of Dermatology skin cancer screening program: 1985-2014

The incidence of melanoma is rising faster than that of any other preventable cancer in the United States. The American Academy of Dermatology has sponsored free skin cancer education and screenings conducted by volunteer dermatologists in the United States since 1985.

https://ift.tt/2LR3HVF

Tumor der Nasenhaupthöhle und mittleren Schädelgrube

Laryngo-Rhino-Otol
DOI: 10.1055/a-0648-4897

Article in Thieme eJournals:
Table of contents | Full text

https://ift.tt/2NMsqea

Midfacial growth and dental arch relationships in bilateral cleft palate following secondary alveolar bone grafting and orthodontic intervention: Factors predicting a Le Fort I osteotomy at age 18

Publication date: Available online 26 July 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Gerhard Koendert Pieter Bittermann, Adrianus P. de Ruiter, Arnold JN. Bittermann, Aebele B. Mink van de Molen, Robert JJ. van Es, Ron Koole, Antoine JWP. Rosenberg

Summary

Objective

To evaluate midfacial growth and dental arch relationships in patients treated for bilateral cleft lip and palate (BCLP).

Materials and Methods

Data were collected from all patients with BCLP treated at our hospital between 2004 and 2014, with or without premaxillary osteotomy (PO). Dental casts for pre-secondary alveolar bone grafting with PO (SABG+PO) and end-point dental casts were analyzed using the Bauru yardstick scoring system. Pre-SABG+PO, post-SABG+PO, and end-point SABG+PO lateral cephalograms were analyzed. The correlation between both scoring systems was calculated.

Results

There were no significant differences between the Bauro scores for centers in a previous study and those collected here. A negative correlation was found between the pre-SABG+PO ANB angle and pre-SABG+PO Bauro scores (R = −0.58; p = 0.000), the long-term post-SABG+PO ANB and mean end-point Bauro (R = −0.50; p = 0.000), and the pre-SABG+PO ANB and mean end-point Bauro (R = −0.51; p = 0.000).

Conclusion

We found no significant difference between pre-SABG+PO and end-point Bauro scores. There was a decrease in the SNA and ANB angle over time, indicating delayed growth of the maxilla. We found a negative correlation between the pre-SABG ANB and end-point Bauro scores. Pre-SABG ANB can be used to predict the need for Le Fort I osteotomy at age 18.

https://ift.tt/2NNg3OZ

News and Announcements

Publication date: Available online 26 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s):

https://ift.tt/2uRLMHQ

Safety and immunogenicity of a potential checkpoint blockade vaccine for canine melanoma

Abstract

Human immunotherapy with checkpoint blockades has achieved significant breakthroughs in recent years. In this study, a checkpoint blockade vaccine for canine melanoma was tested for safety and immunogenicity. Five healthy adult dogs received a mixture of three replication-defective chimpanzee-derived adenoviral vectors, one expressing mouse fibroblast-associated protein (mFAP) and the others expressing canine melanoma-associated antigens Trp-1 or Trp-2 fused into Herpes Simplex-1 glycoprotein D, a checkpoint inhibitor of herpes virus entry mediator (HVEM) pathways. The vaccine mixture was shown to be well tolerated and increased frequencies of canineTrp-1-specific activated CD8⁺ and CD4⁺ T cells secreting interferon-(IFN)-γ, tumor necrosis factor (TNF)-α, or interleukin (IL)-2 alone or in combinations in four and five out of five dogs, respectively. To avoid excessive bleeds, responses to cTrp-2 were not analyzed. All dogs responded with increased frequencies of mFAP-specific activated CD8⁺ and CD4⁺ T cells. The results of this safety/immunogenicity trial invite further testing of this checkpoint blockade vaccine combination in dogs with melanoma.

https://ift.tt/2LsFBV6

An Ultrasound-Guided Lateral Approach for Proximal Sciatic Nerve Block: A Randomized Comparison With the Anterior Approach and a Cadaveric Evaluation

Background and Objectives The lateral and anterior approaches for proximal sciatic nerve (SN) block can be used in patients lying supine. We assume that the posterior femoral cutaneous nerve (PFCN) is simultaneously blocked more often via the lateral approach than via the anterior approach, given the proximity of these 2 nerves at the injection level. However, locating the SN is difficult when using the original landmark-based lateral approach. We have introduced ultrasound guidance to alleviate the technical difficulty of the lateral approach and tested the hypothesis that an ultrasound-guided lateral approach would achieve PFCN block more often than the ultrasound-guided anterior approach for SN block. Methods Forty consecutive patients undergoing knee surgery were randomly allocated to receive an SN block using an ultrasound-guided lateral or anterior approach. The primary outcome was the frequency of PFCN block 30 minutes after SN block. Secondary outcomes included the frequency of SN block, nerve depth, needle depth, and time taken to perform the block. We also assessed the spread of injectate by the lateral approach in 4 cadaveric legs. Results The frequency of PFCN block 30 minutes after SN block was higher with the lateral approach than with the anterior approach (60% vs 15%, P = 0.008). The frequency of SN block was comparable between the groups. Dye reached the PFCN in all cadaveric specimens. Conclusions The ultrasound-guided lateral approach for proximal SN block can be performed as successfully as the anterior approach and provides PFCN block more often than the anterior approach. Clinical Trial Registration: This study was registered at UMIN Clinical Trials Registry, identifier UMIN000026748. Accepted for publication March 25, 2018. Address correspondence to: Takayuki Yoshida, MD, PhD, Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata-city, Osaka 573-1191, Japan (e-mail: ytaka@mac.com). The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

https://ift.tt/2LnAntA

Bimaxillary orthognathic surgery with a conventional saw compared with the piezoelectric technique: a longitudinal clinical study

Publication date: Available online 25 July 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): D. Rossi, M. Romano, L. Karanxha, C. Baserga, A. Russillo, S. Taschieri, M. Del Fabbro, A.B. Giannì, A. Baj

Abstract

The only cutting technique used for osteotomies in orthognathic surgery for many years has been a saw, but recently piezoelectric surgery has been introduced as a possible alternative. The aim of this study was to find out if piezoelectric surgery can be more comfortable for patients having orthognathic surgery. A total of 25 patients with dentofacial deformities (seven male and 18 female), were treated from January 2016 to September 2017. In 11 patients, osteotomies were made using a conventional saw, while in 14 a piezoelectric device was used. The variables assessed were: operating time, postoperative swelling, postoperative pain, and cutaneous sensitivity of the upper and lower lips. The duration of operation for the piezosurgery group was significantly longer than that for controls, but the patients had less swelling at all follow-up visits, and the difference was significant at the 30-day follow-up (p = 0.045). Those who had piezosurgery had significantly less pain at the three-day follow up (p = 0.035). There was a significant difference in cutaneous sensitivity only for the right side of the upper lip and only at the one-day follow-up. We conclude that piezoelectric surgery offers some advantages in lessening swelling and the perception of pain after orthognathic surgery, but further investigations are required.

https://ift.tt/2JWDt22

Combined petrosal approach

Purpose of review The combined petrosal approach to the lateral skull base merges a retrolabyrinthine-presigmoid posterior fossa craniotomy with an adjacent middle fossa craniotomy, which are rendered continuous by division of the tentorium. This is a hearing-preserving approach that affords wide access to the lateral aspect of the clivus, the prepontine space, and the cerebellopontine angle. Recent findings This article details the historical development of the combined petrosal approach alongside a description. In particular, the critically relevant anatomy is reviewed, including the course of the vein of Labbé, with a view toward avoiding the known complications associated with this approach. Outcomes for application of this approach as applied for various lesions are also reviewed as portrayed by the current literature. Summary The combined petrosal approach affords wide access to the lateral skull base in the middle and posterior fossa. The approach and the lesions addressed by this approach involve delicate and sensitive anatomy. We review the evolution of this approach and highlight advancements that have allowed the combined petrosal approach to be a safe addition to the surgeon's armamentarium. Correspondence to Michael B. Gluth, MD, Section of Otolaryngology – Head & Neck Surgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, 5841 S. Maryland, MC1035/E-103, Chicago, IL 60637, USA. Tel: +1 773 702 7117; fax: +1 773 702 6809; e-mail: mgluth1@surgery.bsd.uchicago.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2OiHnWh

Non-vascularised fibular bone graft after vascular crisis: compensation for the failure of vascularised fibular free flaps

Publication date: Available online 25 July 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): N. Xiao, L. Zhang, X. Peng, C. Mao, J. Zhang, Z.G. Cai

Abstract

After reconstruction of a segmental mandibular defect with a fibular free flap, a vascular crisis can be detected clinically and a "no-flow" phenomenon found during re-exploration. Traditional methods used to solve this include removal of the failed flap and delayed mandibular reconstruction, or restoration of the defect with a functional reconstruction plate or contralateral fibular free flap. Our aim therefore was to investigate under what circumstances it is feasible to use a non-vascularised fibular bone graft (NVFB) as a free bone graft after the failure of a vascularised fibular free flap. From 1 January 2010–31 December 2014, 10 patients who had NVFB after failure of a fibular free flap were included in the study. All patients were treated at the Peking University School and Hospital of Stomatology. NVFB were preserved successfully without infection in all 10 cases, and follow-up imaging showed that it had incorporated well with the residual mandible, the basic function and facial aesthetics of which were maintained. In conclusion we have identified that by precise selection of patients, detailed preoperative planning, and meticulous postoperative care, NVFB can be used as a "rescue" technique after failure of a fibular free flap, and can successfully restore the segmental mandibular defect and facial contour.

https://ift.tt/2mKWhIE

Molecular therapy for genetic and degenerative vestibular disorders

Purpose of review The primary purpose of this review is to summarize current literature in the field of vestibular regeneration with a focus on recent developments in molecular and gene therapies. Recent findings Since the discovery of limited vestibular hair cell regeneration in mammals in the 1990s, many elegant studies have improved our knowledge of mechanisms of development and regeneration of the vestibular system. A better understanding of the developmental pathways of the vestibular organs has fueled various biological strategies to enhance regeneration, including novel techniques in deriving vestibular hair cells from embryonic and induced pluripotent stem cells. In addition, the identification of specific genetic mutations responsible for vestibular disorders has opened various opportunities for gene replacement therapy. Summary Vestibular dysfunction is a significant clinical problem with limited therapeutic options, warranting research on biological strategies to repair/regenerate the vestibular organs to restore function. The use of gene therapy appears promising in animal models of vestibular dysfunction. Correspondence to Alan G. Cheng, MD, Department of Otolaryngology-Head and Neck Surgery, 801 Welch Road, Stanford, CA 94305, USA. Tel: +1 (650) 725-6500; fax: +1 (650) 721-2163; e-mail: aglcheng@stanford.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2LMy3bO

Combined petrosal approach

Molecular therapy for genetic and degenerative vestibular disorders

Dexamethasone concentration affecting rocuronium-induced neuromuscular blockade and sugammadex reversal in a rat phrenic nerve-hemidiaphragm model: An ex vivo study

BACKGROUND The concentration range of dexamethasone that inhibits neuromuscular blockade (NMB) and sugammadex reversal remains unclear. OBJECTIVE To evaluate the effects of dexamethasone on rocuronium-induced NMB and sugammadex reversal. DESIGN Ex vivo study. SETTING Asan Institute for Life Sciences, Asan Medical Center, Korea, from July 2015 to November 2015. ANIMALS One hundred sixty male Sprague–Dawley rats. INTERVENTIONS We assessed the effect of four concentrations of dexamethasone [0, 0.5, 5 (clinical concentrations) and 50 μg ml−1 (experimental concentration)] on partial NMB on 40 phrenic nerve–hemidiaphragm preparations (n=10 per concentration). Once the first twitch of train-of-four (TOF) had been depressed by 50% with rocuronium, dexamethasone was administered. To assess the effect of dexamethasone on sugammadex reversal, 120 phrenic nerve–hemidiaphragm preparations were used in three subexperiments (n=40 per experiment), using three administration regimens of rocuronium–equimolar sugammadex: a single dose, a split-dose (split 1/2 and 1/2) and a reduced split-dose (split 1/2 and 1/4). After complete NMB was achieved, dexamethasone and sugammadex were administered. MAIN OUTCOME MEASURES The change in the first twitch height, the recovery time to a TOF ratio at least 0.9, and the TOF ratio at 30 min were evaluated. RESULTS There were no significant differences in the first twitch height among groups (P = 0.532). With a single dose of sugammadex, dexamethasone did not affect the recovery time to a TOF ratio at least 0.9 (P = 0.070). After using a split-dose of sugammadex, the recovery time to a TOF ratio at least 0.9 was delayed only at a concentration of 50 μg ml−1 of dexamethasone. With a reduced split-dose of sugammadex, the TOF ratio at 30 min was lowered only by a concentration of 50 μg ml−1 of dexamethasone (P

https://ift.tt/2NICQM0

Αρχειοθήκη ιστολογίου

Πέμπτη 26 Ιουλίου 2018

Abstract

Abstract

Abstract

Objective

Methods

Results

Conclusion

Abstract

Objectives

Methods

Results

Conclusions

Abstract

Introduction

Method

Results

Conclusion

Abstract

Objective

Methods

Results

Conclusion

Abstract

Abstract

Background

Methods

Results

Conclusion

Abstract

Level of evidence

Objective

Methods

Results

Conclusion

Abstract

Objectives

Methods

Results

Conclusions

Abstract

Introduction

Methods

Results

Conclusion

Trial Registration

Funding

Abstract

Introduction

Case report

Discussion

Conclusion

Abstract

Objective

Design

Results

Conclusion

Abstract

Abstract

Objective

Design

Results

Conclusion

Abstract

Zusammenfassung

Hintergrund

Methoden

Ergebnisse

Schlussfolgerung

Abstract

Purpose

Methods

Results

Conclusion