Head and Neck Medicine by Alexandros G.Sfakianakis: 08/22/18

Τετάρτη 22 Αυγούστου 2018

Evidence for Multiple Applications of Monoclonal Antibody 5G10

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.

https://ift.tt/2w7mciN

Development and Characterization of Monoclonal Antibodies Against Nitro-166Tyrosine of High-Density Lipoprotein: Apolipoprotein A1

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.

https://ift.tt/2Ll0mgc

Estradiol Affects Epstein–Barr Virus Reactivation-Induced Thyrotropin Receptor Antibody and Immunoglobulin Production in Graves’ Disease Patients and Healthy Controls

Viral Immunology, Ahead of Print.

https://ift.tt/2o3iTo0

Reproductive Control Among Women with Violent Partners in Paraguay

Violence and Gender, Ahead of Print.

https://ift.tt/2MLcaxf

Do the Ages of Mass Shooters Matter? Analyzing the Differences Between Young and Older Offenders

Violence and Gender, Ahead of Print.

https://ift.tt/2Nf6b0M

New Textbooks of Interest

Pediatric Allergy, Immunology, and Pulmonology, Ahead of Print.

https://ift.tt/2N6QyYX

Seasonal Differences in the Occurrence of Exercise-Induced Bronchoconstriction in Healthy School Children: Dependence on Climatic Factors

Pediatric Allergy, Immunology, and Pulmonology, Ahead of Print.

https://ift.tt/2MMMDDC

Effect of Excess Iodine Intake from Iodized Salt and/or Groundwater Iodine on Thyroid Function in Nonpregnant and Pregnant Women, Infants, and Children: A Multicenter Study in East Africa

Thyroid, Ahead of Print.

https://ift.tt/2MMMqAk

New Textbooks of Interest

Pediatric Allergy, Immunology, and Pulmonology, Ahead of Print.

https://ift.tt/2OYsl7H

Seasonal Differences in the Occurrence of Exercise-Induced Bronchoconstriction in Healthy School Children: Dependence on Climatic Factors

Pediatric Allergy, Immunology, and Pulmonology, Ahead of Print.

https://ift.tt/2MtsVhb

Surgical management of a huge post-circumcision epidermoid cyst of the vulva presenting unusually in a postmenopausal woman: a case report

Epidermoid cysts of the external genitalia are one of the late complications of female genital mutilation. These cysts are usually small and painless. The presentation of a giant vulvar cyst in a postmenopausa...

https://ift.tt/2BC0cRZ

Does the Technique of Skin Closure Affect the Cosmesis of Cervical Thyroidectomy and Parathyroidectomy Scars? A Review of Literature

Facial plast Surg
DOI: 10.1055/s-0038-1660844

The cosmetic outcomes following thyroid and parathyroid surgery is a priority for patients as the surgical scar is in a visible area of the body. Although some have advocated the use of minimally invasive and robotic surgery, these are not without risks and it has been suggested that the scars are not necessarily more favorable. The three most common means of skin closure include the use of subcuticular sutures, clips, and tissue adhesive (with or without deeper subcutaneous sutures) and there are no previous reviews of the published evidence. In this study, the authors compare the cosmetic outcomes through a systematic review of literature. Three studies (n = 200) comparing subcuticular sutures and clips suggest superior cosmetic outcomes with sutures (with statistically significant differences in the immediate postoperative period). Three studies (n = 213) comparing sutures and tissue adhesive show superior outcomes with sutures in the early postoperative period with no differences thereafter. Two studies (n = 202) comparing tissue adhesive and clips do not show that one is superior to the other and show no significant differences. Overall the data are limited; however, the evidence suggests that subcuticular sutures may offer superior cosmetic outcomes than clips and tissue adhesive in conventional thyroid and parathyroid surgery.
[...]

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

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

https://ift.tt/2Lk4sFl

Structural comparison of hemifacial microsomia mandible in different age groups by three-dimensional skeletal unit analysis

The goal of this study was to understand the three-dimensional (3D) structural characteristics of hemifacial microsomia (HFM) mandible in terms of skeletal units, especially to locate the underdeveloped skeletal regions for treatment. Another goal was to compare the HFM structure of different age groups to understand growth potential relevant to treatment scheduling.

https://ift.tt/2w78vAi

Two cases of laryngeal fractures treated with titanium mesh fixation

The larynx plays a vital role in respiration, swallowing, and vocal function. Thus, laryngeal fractures that are not appropriately managed may lead to permanent dyspnea, dysphagia, and voice disorders. In cases of laryngeal fractures, surgical repair by internal fixation has been performed with materials such as thread, steel wire, and titanium miniplates. However, thyroid and cricoid cartilage have a complicated morphology, and ossification at each site in the cartilage is not uniform; thus, in some cases it is difficult to perform internal fixation with conventional methods.

https://ift.tt/2OUl1tM

Keratocystic odontogenic tumour (KCOT) has again been renamed odontogenic keratocyst (OKC)

In the recent World Health Organization classification of tumours of the head and neck1, the name keratocystic odontogenic tumour (KCOT) has been changed again to odontogenic keratocyst (OKC). This decision has caused some confusion and has undoubtedly lessened alertness regarding this potentially very aggressive lesion. Apart from the known tendency of OKCs to recur, their potential aggressiveness has been well documented by Emerson et al.2, who described the extension of two recurrent OKCs in the mediastinum, extended via the neck.

https://ift.tt/2o2Noe6

Condyle-preserved arthroplasty versus costochondral grafting in paediatric temporomandibular joint ankylosis: a retrospective investigation

We aimed to evaluate results of condyle-preserved arthroplasty and costochondral grafting in growing children with temporomandibular joint ankylosis through medium-term follow-up and three-dimensional metric analysis. We assessed 11 patients (14 sides) with type II ankylosis (group A) and 11 patients (13 sides) with type III/IV (group B) from January 2012 to December 2015. Group A patients received condyle-preserved arthroplasty and group B patients received costochondral grafting. Postoperative computed tomography was used to measure condylar height, condylar width, mandibular ramus height and mandibular body length.

https://ift.tt/2BEhVZi

Does the use of amoxicillin/amoxicillin–clavulanic acid in third molar surgery reduce the risk of postoperative infection? A systematic review with meta-analysis

The objectives of this systematic review were to investigate the efficacy of amoxicillin/amoxicillin–clavulanic acid for reducing the risk of postoperative infection after third molar surgery and to evaluate the adverse outcomes in these patients, as well as in healthy volunteers. A systematic search of four databases was performed on May 26, 2017. Eleven studies qualified for the qualitative analysis and eight were found suitable for meta-analysis. The results suggest that both amoxicillin–clavulanic acid and amoxicillin significantly reduce the risk of infection after third molar extraction (overall relative risk (RR) 0.25, P<0.001).

https://ift.tt/2nZSLKT

Preoperative Gabapentin Administration Improves Acute Postoperative Analgesia in Patients Undergoing Craniotomy: A Randomized Controlled Trial

Background: Gabapentin is an adjuvant antiepileptic agent and helps to reduce acute postoperative pain in several surgery settings. However, the effect of gabapentin on postoperative pain from suboccipital or subtemporal craniotomy is not clear. Methods: The study was a single-center, randomized, placebo-controlled, and double-blinded trial. A total of 122 patients undergoing elective craniotomy by a suboccipital or subtemporal approach were randomly allocated to a placebo group and gabapentin group. The patients received gabapentin (600 mg, orally) the night before surgery and 2 hours before anesthesia induction in the gabapentin group, and patients received vitamin B in the placebo group. The primary outcome was the postoperative pain score on movement at 24 hours. The secondary outcomes included the pain score at other time points, incidence of nausea and vomiting, sedation, and analgesic consumption. Results: Gabapentin significantly decreased the postoperative acute pain scores at rest (P=0.001) and on movement (P=0.000) within 24 hours; however, it did not have an effect at 48 hours. Gabapentin decreased postoperative vomiting (P=0.047) and rescue antiemetic use (P=0.033), whereas it increased the postoperative sedation score at 2 hours (P

https://ift.tt/2LhVl8m

Frequency and levels of regulated and emerging mycotoxins in silage in Poland

Abstract

In this study, 120 silage samples collected in 2015 from farms in Poland were analysed by a multimycotoxin method based on liquid chromatography coupled with tandem mass spectrometry. The study included toxins which are regulated within the European Union (aflatoxins, deoxynivalenol, fumonisins, T-2/HT-2 toxins, ochratoxin A and zearalenone) and non-regulated mycotoxins (enniatins, beauvericin, 8-ketotrichothecenes, sterigmatocystin, zearalenone derivatives). All silage samples were positive for at least one mycotoxin, and 61% of samples contained five or more mycotoxins simultaneously. The most frequently detected toxins were deoxynivalenol, nivalenol, zearalenone, enniatins and beauvericin, although the levels of these toxins were relatively low. The mean concentration of deoxynivalenol and zearalenon was 406 and 80.6 μg/kg, respectively, and two toxins were positive-correlated. This is the first study that provides information about emerging mycotoxins contaminating silage in Poland.

https://ift.tt/2OVfB1C

Handekzemregister: Hintergründe, Nutzen und Ausblick

Zusammenfassung

Hintergrund

Populationsbezogene Studien weisen für das Handekzem (HE) eine 1‑Jahres-Prävlenz von bis zu 10,0 % aus, bei 5–7 % davon handelt es sich um schwere chronische HE (CHE), die das Leben der Betroffenen stark beeinträchtigen. Registerdaten helfen, Krankheitslast und Versorgung des HE unter Alltagsbedingungen zu erforschen und zu optimieren.

Fragestellung

Welche Registerdaten werden in der Forschung zum HE bisher ausgewertet? Welche Erkenntnisse konnten bisher mit Registerdaten zum HE gewonnen werden, und wo liegen deren Limitationen?

Material und Methode

Dies ist eine Übersichtsarbeit über bisherige Publikationen, in denen Registerdaten in Forschungsarbeiten zum HE verwendet wurden. Die Arbeiten stammen überwiegend aus Deutschland, zum Teil aber auch aus Skandinavien und der Schweiz.

Ergebnisse

Das weltweit bisher einzige Krankheitsregister zum HE ist das Chronische Handekzem Register zum Patienten-Langzeitmanagement (CARPE), das in Deutschland und später auch in der Schweiz durchgeführt wurde. Mithilfe von CARPE konnten erstmals die Charakteristika des CHE sowie der Verlauf der Erkrankung im Versorgungsalltag beschrieben werden. In Dänemark wurden Daten aus öffentlichen Registern (z. B. Berufskrankheitenregister) genutzt, um Patienten mit (beruflichen) HE zu identifizieren und zu befragen. Register für berufsbedingte Hautkrankheiten wurden in den 1990er-Jahren in Nordbayern und dem Saarland etabliert, die dort registrierten Patienten weisen in über 90 % der Fälle ein HE auf.

Schlussfolgerung

Handekzemregister liefern wichtige Daten aus der Versorgungsrealität und geben damit einen wichtigen Einblick in die Versorgungssituation dieser Dermatose. In Krankheitsregistern lässt sich die Vollständigkeit der Daten erfassen, während dies bei der Nutzung von öffentlichen Melderegistern selten möglich ist.

https://ift.tt/2Pxkpf1

Skleromyxödem

Zusammenfassung

Das Skleromyxödem ist eine sehr seltene Erkrankung, die gewöhnlich in Verbindung mit einer monoklonalen Gammopathie auftritt und systemische Symptome aufweisen kann. Die Pathogenese des Skleromyxödems ist unbekannt. Der klinische Verlauf ist chronisch und progressiv und kann zu schwerer Morbidität bzw. zum Tod führen. Der Hautbefund besteht aus multiplen wachsartigen Papeln und verhärteten Plaques. Eine fortschreitende Hautbeteiligung kann zu einer verminderten Beweglichkeit von Mund und Gelenken führen. Extrakutane Manifestationen können im Nerven-, muskuloskeletalen oder kardiovaskulären System, im Gastrointestinal- oder Atemtrakt oder an den Nieren auftreten. Eine für das Skleromyxödem zugelassene oder evidenzbasierte Therapie gibt es nicht. Als Therapie der ersten Wahl gelten hoch dosierte Immunglobuline, gefolgt von Lenalidomid (bzw. Thalidomid) und systemischen Glukokortikosteroiden, bei schweren Verläufen auch eine autologe hämatopoetische Stammzelltransplantation. In der Regel treten nach Absetzen einer erfolgreichen Therapie Rezidive auf, sodass eine engmaschige interdisziplinäre Anbindung ratsam ist.

https://ift.tt/2N7fKhX

Combined Reflectance Confocal Microscopy–Optical Coherence Tomography for Basal Cell Carcinoma

This pilot study of 85 lesions from 55 patients assesses the accuracy of a handheld imaging device that combines reflective confocal microscopy (RCM) and optical coherence tomography (OCT) to detect, diagnose, and estimate the depth of basal cell carcinoma in adults.

https://ift.tt/2MvL1PG

Palatal Swelling in a Patient With Refractory Leukemia

A man in his 20s with acute myeloid leukemia presented with rapidly growing, severely painful oral lesions on the left hard palate. What is your diagnosis?

https://ift.tt/2LhjA6E

Association Between Autoantibody Phenotype and Cutaneous Adverse Reactions to Hydroxychloroquine

This cohort study examines myositis-specific autoantibodies observed during hydroxychloroquine therapy in patients with dermatomyositis to determine whether certain subsets of patients are more likely to experience a skin eruption.

https://ift.tt/2MpF5aK

Dupilumab for the Treatment of Recalcitrant Bullous Pemphigoid

This case report describes the use of dupilumab to treat recalcitrant bullous pemphigoid.

https://ift.tt/2Ljzf5a

Pathogenetic Characteristics of Mesenchymal Stem Cells in Hidradenitis Suppurativa

This case-control study investigates the mesenchymal stem cell profile in patients with hidradenitis suppurativa and in healthy controls, with punch biopsy samples from axillary skin analyzed for immunophenotypic profiles.

https://ift.tt/2MqES7k

How Should AI Screen for Skin Cancer and Deliver Diagnostic Predictions to Patients?

This Viewpoint describes the current state of deep learning algorithms used in artificial intelligence and discusses their potential use in dermatology screening and diagnosis, including mobile apps for patient use.

https://ift.tt/2LdnzRD

Human leukocyte antigen-G 3’ untranslated region polymorphisms are associated with asthma severity

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Cinthia C. Alves, Luísa K.P. Arruda, Fabíola R. Oliveira, Juliana D. Massaro, Beatriz J. Aquino, Michelle A. Paz, Erick C. Castelli, Celso T. Mendes-Junior, Eduardo A. Donadi

Abstract

Asthma is a genetically complex chronic inflammatory airway disorder, and according to disease pathogenesis, clinical manifestations may vary according to asthma severity. A gene region close to the human leukocyte antigen-G (HLA-G) gene was identified as an independent susceptibility marker for asthma. Considering that the HLA-G immune checkpoint molecule may modulate inflammation, we evaluated the diversity of the HLA-G 3′ untranslated region (3′UTR) in asthmatic patients stratified according to disease severity. We evaluate the entire HLA-G 3′UTR segment in 115 Brazilian patients stratified into mild (n=29), moderate (n=21) and severe asthmatics (n=65), and in 116 healthy individuals. HLA-G 3′UTR typing was performed using Sanger sequencing. The multiple comparisons among patients stratified according to disease severity revealed several associations; however, after Bonferroni's correction, the following results remained significant: i) the +3010C and +3142G alleles were overrepresented in mild asthma patients when compared to controls; ii) the +3010G and +3142C alleles were overrepresented in severe asthma patients in comparison to patients with mild asthma. In conclusion, the +3010C/G and +3142C/G HLA-G 3′UTR variation sites were differentially associated according to asthma severity.

https://ift.tt/2Na2Yzx

The Effect of the Word Cancer on Thyroid Cancer Treatment Decisions

"A rose by any other name would smell as sweet," but would papillary thyroid cancer with another name be treated as aggressively?

https://ift.tt/2PsMT9v

Association of Preferences for Papillary Thyroid Cancer Treatment With Disease Terminology

This discrete choice survey study examines factors that are associated with treatment preferences for patients with papillary thyroid cancers, the trade-offs in treatment factors people are willing to accept, and the association of terminology with treatment preferences and benefit-harm trade-offs.

https://ift.tt/2LhaK91

Editorial Board

https://ift.tt/2N9At4I

Dental anaesthesia for children – effects of a computer-controlled delivery system on pain and heart rate: a randomised clinical trial

Local anaesthesia in dentistry is usually given by conventional injection through a syringe. In this randomised, single-blind, split-mouth clinical study we evaluated the perception of pain and changes in heart rate in children being given dental local anaesthesia using a computer-controlled device compared with that given using a traditional syringe. Participants were in good general health with no contraindications to local anaesthetics. One half of each maxilla was anaesthetised using each technique, the order having been randomly selected according to a computer-generated sequence.

https://ift.tt/2MLllgU

Quality assessment of systematic reviews on vertical bone regeneration

The aim of this study was to evaluate and compare the quality of systematic reviews of vertical bone regeneration techniques, using two quality-assessment tools (AMSTAR and ROBIS). An electronic literature search was conducted to identify systematic reviews or meta-analyses that would evaluate at least one of the following outcomes: implant survival, success rates, complications or bone gain after vertical ridge augmentation. Methodological quality assessment was performed by two independent evaluators.

https://ift.tt/2LgD7nL

Patient expectations and satisfaction following orthognathic surgery

Orthognathic surgery aims to correct dentoskeletal and facial discrepancies. Treatment usually requires a minimum of 18 months, necessitating that patients are adequately satisfied with the treatment provided. This study aimed to assess the determinants of patient satisfaction following treatment. One hundred and eighteen patients who had undergone orthognathic surgery were included prospectively. All participants completed a questionnaire regarding their reasons for undergoing treatment, treatment logistics, treatment outcomes, and satisfaction throughout their journey.

https://ift.tt/2MIx93O

18F-Fluorocholine PET/CT in Medullary Thyroid Cancer

Condition: Medullary Thyroid Cancer
Intervention: Diagnostic Test: 18F-fluorocholine PET/CT
Sponsors: University Medical Centre Ljubljana; Institute of Oncology Ljubljana
Recruiting

https://ift.tt/2w5AOz8

M6620 Plus Standard Treatment in Oesophageal and Other Cancer

Conditions: Oesophageal Adenocarcinoma; Squamous Cell Carcinoma; Solid Tumor
Interventions: Drug: M6620; Drug: Cisplatin; Drug: Capecitabine; Radiation: Radiotherapy
Sponsors: University of Oxford; Merck KGaA
Not yet recruiting

https://ift.tt/2Lkq8RT

ATR Kinase Inhibitor M6620 and Irinotecan in Treating Patients With Progressive, Metastatic, or Unresectable TP53 Mutant Gastric or Gastroesophageal Junction Cancer

Conditions: Clinical Stage III Gastric Cancer AJCC v8; Clinical Stage III Gastroesophageal Junction Adenocarcinoma AJCC v8; Clinical Stage IV Gastric Cancer AJCC v8; Clinical Stage IV Gastroesophageal Junction Adenocarcinoma AJCC v8; Clinical Stage IVA Gastric Cancer AJCC v8; Clinical Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8; Clinical Stage IVB Gastric Cancer AJCC v8; Clinical Stage IVB Gastroesophageal Junction Adenocarcinoma AJCC v8; Metastatic Gastric Adenocarcinoma; Metastatic Gastroesophageal Junction Adenocarcinoma; Pathologic Stage III Gastric Cancer AJCC v8; Pathologic Stage III Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage IIIA Gastric Cancer AJCC v8; Pathologic Stage IIIA Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage IIIB Gastric Cancer AJCC v8; Pathologic Stage IIIB Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage IIIC Gastric Cancer AJCC v8; Pathologic Stage IV Gastric Cancer AJCC v8; Pathologic Stage IV Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage IVB Gastroesophageal Junction Adenocarcinoma AJCC v8; Postneoadjuvant Therapy Stage III Gastric Cancer AJCC v8; Postneoadjuvant Therapy Stage III Gastroesophageal Junction Adenocarcinoma AJCC v8; Postneoadjuvant Therapy Stage IIIA Gastroesophageal Junction Adenocarcinoma AJCC v8; Postneoadjuvant Therapy Stage IIIB Gastroesophageal Junction Adenocarcinoma AJCC v8; Postneoadjuvant Therapy Stage IV Gastric Cancer AJCC v8; Postneoadjuvant Therapy Stage IV Gastroesophageal Junction Adenocarcinoma AJCC v8; Postneoadjuvant Therapy Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8; Postneoadjuvant Therapy Stage IVB Gastroesophageal Junction Adenocarcinoma AJCC v8; TP53 Gene Mutation; Unresectable Gastroesophageal Junction Adenocarcinoma
Interventions: Drug: ATR Kinase Inhibitor M6620; Drug: Irinotecan
Sponsor: National Cancer Institute (NCI)
Not yet recruiting

https://ift.tt/2w4IvW3

Long-term survival of teeth in the posterior region after apical surgery

Oftentimes the discussion of long-term success rates and treatment modalities becomes a central issue in consultations with patients. The aim of this study was to retrospectively evaluate survival rates of teeth after apicoectomy in an established private practice for Oral and Maxillofacial Surgery in Kiel, Germany.All teeth treated with apicoectomy between 2001 and 2006 were included. Treatment success was previously defined as preservation of the tooth. Putative influence factors on success as kind and quality of endodontic treatment, additional intraoperative endodontic filling, inflammatory status, tooth mobility, and pre- and postoperative X-rays were further evaluated.

https://ift.tt/2MOMfVy

Surgical findings and technical knacks to performing living donor liver transplantation for hepatocellular carcinoma recurrence after carbon ion radiotherapy

m_rjy228f01.png?Expires=2147483647&Signa

Abstract

Although carbon-ion radiotherapy (CIRT) has been reported to achieve good local control of hepatocellular carcinoma (HCC), liver transplantation is still required in patients with tumor recurrence. However, few cases of living donor liver transplantation (LDLT) after curative CIRT for HCC has been reported. It would be of great interest to ascertain the true situation of the irradiated region as well as to clarify the surgical points. We herein report the surgical findings and our experience along with technical difficulties and knacks concerning two cases of LDLT for HCC after CIRT. Both patients suffered tumor recurrence after curative CIRT for HCC. Severe adhesions were found between the irradiated region and the surrounding tissues, which resulted in surgical difficulties. Histological findings showed severe tissue fibrosis in the CIRT area. We should pay attention to adhesions in the irradiated area caused by CIRT including the vascular reconstruction during surgery.

https://ift.tt/2BAiuDi

Primary gastric volvulus: a report of two cases

m_rjy227f01.png?Expires=2147483647&Signa

Abstract

Gastric volvulus is an uncommon cause of gastric obstruction. It can be classified as primary when no underlying condition is identified as the cause for the rotation. An acute presentation includes typical symptoms and is frequently detected by imaging studies. Chronic cases present with intermittent vague symptoms and imaging studies may be normal during the symptomatic interval. The lack of specific symptoms and signs delays the diagnosis of chronic volvulus. However, appropriate treatment demands prompt diagnosis. We report two cases of primary gastric volvulus, with chronic or subacute symptoms and normal imaging studies during the asymptomatic periods. Both were treated surgically and had an uneventful follow-up.

https://ift.tt/2o0YFLC

Traumatic cerebrospinal fluid oculorrhea managed with an external ventricular drain

$3D reconstruction of fractured skull.$

Abstract

Cerebrospinal fluid (CSF) leaks following head injuries are rare complications with significant morbidity and mortality if left untreated. CSF oculorrhea secondary to a cranio-orbital fistula is a rare presentation of this complication. Standard treatment for a CSF leak involves management of intracranial pressure, CSF diversion and surgical repair of any dural defect. Lumbar drains have commonly been inserted to aid in diverting CSF. We describe a case of a 16-year-old male who presented with an open comminuted depressed skull fracture and CSF oculorrhea. Following a bifrontal decompressive craniectomy, he was successfully treated with CSF diversion following a conservative trial using an external ventricular drain. The use of an external ventricular drain for this purpose has not been described in the literature to date. We report this case as a method of demonstrating the use of an external ventricular drain to adequately divert CSF.

https://ift.tt/2BAdluT

Lateral intermuscular septum as cause of radial nerve compression: case report and review of the literature

$Plain films, AP/lateral showing appropriate alignment of fracture.$

Abstract

Multiple sites of compression of the radial nerve have been described, some more commonly than others. In this case report we describe a case of radial nerve compression at the lateral intermuscular septum in a patient with a history of open reduction and internal fixation of a mid-shaft humerus fracture 10 years prior. To our knowledge, only one previous case of chronic radial nerve compression by the lateral intermuscular septum associated with a humeral shaft fracture has been described. Our patient's clinical presentation with specific electrodiagnostic abnormalities, operative findings and post-operative symptom relief point towards the rare diagnosis of compression of the radial nerve at the level of the lateral intermuscular septum as the cause of his symptoms.

https://ift.tt/2nZWfx7

An Unusual Case of DMEK Graft Loss into the Vitreous and Its Successful Retrieval and Survival

Purpose: The aim of this article is to report an unusual case of postoperative graft loss into the vitreous cavity after Descemet membrane endothelial keratoplasty (DMEK) in a patient with an unstable iris-lens diaphragm (scleral-fixated intraocular lens [sf-IOL]) and its successful retrieval with a favourable outcome. Methods: This is a retrospective case report. Results: DMEK procedure was performed in a vitrectomized eye of an 80-year-old woman with pre-existing sf-IOL due to pseudophakic bullous keratopathy. In the setting of an inadvertently created oversized Ando iridectomy and unstable iris-lens diaphragm due to sf-IOL, repeated loss of an anterior chamber gas tamponade occurred. At the 3rd postoperative day, the patient noticed a change in visual perception, and we could detect a loss of the graft into the vitreous via B-scan ultrasound. A 23-G vitrectomy was performed promptly to recover the graft using a bimanual hand-over-hand technique. Six months after DMEK, the patient had a clear cornea without dehiscences with a central corneal thickness of 533 µm and endothelial cell count of 1,219 cells/mm². Conclusions: This case demonstrates the possibility of graft recovery from the vitreous after DMEK and subsequent corneal clearing despite unstable iris-lens diaphragm and vitrectomized eye.
Case Rep Ophthalmol 2018;9:381–387

https://ift.tt/2BAMCOX

Multiethnic comparison of facial skin aging

Overt signs of skin aging can differ in type, onset and magnitude across individuals of different races. To understand the molecular basis for these differences, we conducted a study with women of four races/ethnicities spanning in age from 20 to mid-70s; we named this study the MultiDecades and Ethnic (MDE) Study. U.S. women volunteers were African-American, Hispanic and Chinese with ∼25 women in the age groups of 20-24, 40-44, and 60-64 years, and European-descended Caucasian women across each decade from 20-24 to 70-74 years.

https://ift.tt/2w4mcQj

The use of EpiPen for urticaria pigmentosa: Beneficial or burdensome?

Objective: To evaluate the frequency of EpiPen prescription in children diagnosed with urticaria pigmentosa (UP) and the utility of prophylactic EpiPen prescription for potential anaphylactic reactions in children with UP.

https://ift.tt/2OXSiV6

JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngol Head Neck Surg. 2018 Aug 01;144(8):654

Authors:

PMID: 30128562 [PubMed - in process]

https://ift.tt/2OXiqiR

Comparison of Artificial Saliva vs Saline Solution on Rate of Suture Degradation in Oropharyngeal Surgery.

Comparison of Artificial Saliva vs Saline Solution on Rate of Suture Degradation in Oropharyngeal Surgery.

JAMA Otolaryngol Head Neck Surg. 2018 Aug 16;:

Authors: Briddell JW, Riexinger LE, Graham J, Ebenstein DM

Abstract
Importance: Absorbable sutures are designed to degrade and lose strength over time. Manufacturers warn that exposure to various body fluids can change the estimated degradation rate of these sutures, but few studies have been conducted to quantify the degree of change associated with saliva.
Objective: To quantify the association of increased loss of strength of sutures over time after exposure to artificial saliva (hereinafter referred to as "saliva").
Design, Setting, and Participants: This experimental in vitro study was conducted at Bucknell University (Lewisburg, Pennsylvania) from June 19, 2015, to July 4, 2015. No participants were involved. The loss of strength over time of sutures submerged in physiological saline and artificial saliva solutions was compared. Three types of absorbable sutures commonly used in oral surgery were tested: chromic, poliglecaprone 25, and polyglactin 910. Data analysis was conducted from July 15, 2016, to August 16, 2016.
Main Outcomes and Measures: The primary outcome measure was 50% strength reduction. To measure breaking strength, 6 knotted sutures of each type were pulled to failure at regular time intervals after immersion in either saline or synthetic saliva at 37°C. Regression analysis was used to interpret strength degradation profiles and to estimate the time to reach 50% of the original breaking strength.
Results: Of the 3 suture types submerged in the 2 solutions, all 3 degraded to 50% strength faster (by 2 to 13 days) in saliva than in saline. The differences in the degradation profiles varied by suture type. Poliglecaprone 25 sutures demonstrated a sudden decrease in failure strength between day 5 and day 8 in both solutions, but the decrease was greater in saliva (-10.2 N; 95% CI, -15.5 to -4.9 N) than in saline (-6.1 N; 95% CI, -11.2 to -0.9 N). The polyglactin 910 and chromic sutures share a similar degradation profile when implanted in tissue, but saliva was associated with more degradation of chromic sutures. Differences in degradation rate were seen in polyglactin 910 sutures after day 6 (saline: -0.9 N/d; 95% CI, -1.0 to -0.7 vs saliva: -1.2 N/d; 95% CI, -1.4 to -1.1). After day 2, chromic sutures had a degradation rate of -0.3 N/d (95% CI, -0.5 to -0.2) in saline and -0.5 N/d (95% CI, -0.6 to -0.3) in saliva.
Conclusions and Relevance: Knowing the association of saliva with suture degradation rates of various suture types may enable oropharyngeal surgeons to select sutures that retain their strength and degrade at an appropriate rate to allow for the effective healing of the wound.

PMID: 30128560 [PubMed - as supplied by publisher]

https://ift.tt/2Pu4Pk4

Association Between Catastrophizing and Dizziness-Related Disability Assessed With the Dizziness Catastrophizing Scale.

Association Between Catastrophizing and Dizziness-Related Disability Assessed With the Dizziness Catastrophizing Scale.

JAMA Otolaryngol Head Neck Surg. 2018 Aug 16;:

Authors: Pothier DD, Shah P, Quilty L, Ozzoude M, Dillon WA, Rutka JA, Gerretsen P

Abstract
Importance: Catastrophizing is a maladaptive thought process that involves irrational fear and worry about anticipated or actual symptoms. Although clinically relevant, the role of catastrophizing in patients with chronic dizziness or imbalance has not yet been explored to our knowledge.
Objectives: To validate a measure of dizziness catastrophizing and to assess its association with dizziness-related disability compared with other negative affect constructs (eg, anxiety and depression).
Design, Setting, and Participants: For this retrospective medical record review, the Dizziness Catastrophizing Scale (DCS), a dizziness-specific catastrophizing assessment tool, was adapted from the previously validated Pain Catastrophizing Scale. Psychometric evaluation of the DCS was performed. In addition, the associations of dizziness catastrophizing and positive and negative affectivity with dizziness-related disability were assessed using structural equation modeling and regression analyses. Data were collected using a retrospective medical record review from April 27, 2010, to June 25, 2014. The dates of analysis were June 3 to August 15, 2017. The setting was the Multidisciplinary Neurotology Clinic at the Toronto General Hospital (Toronto, Ontario, Canada). Participants were 457 adult outpatients with dizziness or imbalance who were referred to the clinic.
Main Outcomes and Measures: Psychometric properties of the DCS and its association with dizziness-related disability, as measured with the Dizziness Handicap Inventory.
Results: Among 457 patients (mean [SD] age, 53.4 [15.4] years; 154 [33.7%] male), the DCS demonstrated good convergent (r = 0.78, P < .001) and discriminant validity (r = -0.40, P < .001) with the negative and positive affectivity, respectively; internal consistency (α = .95); and test-retest reliability (intraclass correlation coefficient, 0.92; P < .001 at the 95% CI). An exploratory dimension reduction analysis revealed a single latent component of the DCS. The results of the structural equation modeling and regression analyses revealed that dizziness catastrophizing, although associated with negative affectivity (eg, symptoms of anxiety and depression), was independently associated with dizziness-related disability (standardized β = 0.378; P < .001). Furthermore, a strong association was found between catastrophizing and dizziness-related disability across different dizziness-related diagnoses (r ≥ 0.6; P < .001).
Conclusions and Relevance: In this study, the DCS was a valid and reliable measure for evaluating catastrophic thinking in patients with dizziness, which was independently associated with dizziness-related disability. Future studies should investigate the influence of alleviating symptoms of catastrophizing on functional outcomes in patients with dizziness or imbalance, the results of which will help guide novel approaches to the clinical care of patients with chronic dizziness.

PMID: 30128545 [PubMed - as supplied by publisher]

https://ift.tt/2LhWAUW

Factors Associated With Phantom Odor Perception Among US Adults: Findings From the National Health and Nutrition Examination Survey.

Factors Associated With Phantom Odor Perception Among US Adults: Findings From the National Health and Nutrition Examination Survey.

JAMA Otolaryngol Head Neck Surg. 2018 Aug 16;:

Authors: Bainbridge KE, Byrd-Clark D, Leopold D

Abstract
Importance: Phantom odor perception can be a debilitating condition. Factors associated with phantom odor perception have not been reported using population-based epidemiologic data.
Objective: To estimate the prevalence of phantom odor perception among US adults 40 years and older and identify factors associated with this condition.
Design, Setting, and Participants: In this cross-sectional study with complex sampling design, 7417 adults 40 years and older made up a nationally representative sample from data collected in 2011 through 2014 as part of the National Health and Nutrition Examination Survey.
Exposures: Sociodemographic characteristics, cigarette and alcohol use, head injury, persistent dry mouth, smell function, and general health status.
Main Outcomes and Measures: Phantom odor perception ascertained as report of unpleasant, bad, or burning odor when no actual odor exists.
Results: Of the 7417 participants in the study, 52.8% (3862) were women, the mean (SD) age was 58 (12) years, and the prevalence of phantom odor perception occurred in 534 participants, which was 6.5% of the population (95% CI, 5.7%-7.5%). Phantom odor prevalence varied considerably by age and sex. Women 60 years and older reported phantom odors less commonly (7.5% [n = 935] and 5.5% [n = 937] among women aged 60-69 years and 70 years and older, respectively) than younger women (9.6% [n = 1028] and 10.1% [n = 962] among those aged 40-49 years and 50-59 years, respectively). The prevalence among men varied from 2.5% (n = 846) among men 70 years and older to 5.3% (n = 913) among men 60 to 69 years old. Phantom odor perception was 60% (n = 1602) to 65% (n = 2521) more likely among those with an income-to-poverty ratio of less than 3 compared with those in the highest income-to-poverty ratio group (odds ratio [OR], 1.65; 95% CI, 1.06-2.56; and OR, 1.60; 95% CI, 1.01-2.54 for income-to-poverty ratio <1.5 and 1.5-2.9, respectively). Health conditions associated with phantom odor perception included persistent dry mouth (OR, 3.03; 95% CI, 2.17-4.24) and history of head injury (OR, 1.74; 95% CI, 1.20-2.51).
Conclusions and Relevance: An age-related decline in the prevalence of phantom odor perception is observed in women but not in men. Only 11% (n = 64) of people who report phantom odor perception have discussed a taste or smell problem with a clinician. Associations of phantom odor perception with poorer health and persistent dry mouth point to medication use as a potential explanation. Prevention of serious head injuries could have the added benefit of reducing phantom odor perception.

PMID: 30128498 [PubMed - as supplied by publisher]

https://ift.tt/2OSFZJw

Prevalence and Risk Factors for Olfactory Hallucinations: The Phantom Menace.

Prevalence and Risk Factors for Olfactory Hallucinations: The Phantom Menace.

JAMA Otolaryngol Head Neck Surg. 2018 Aug 16;:

Authors: Hsu DW, Suh JD

PMID: 30128479 [PubMed - as supplied by publisher]

https://ift.tt/2MK76Jn

Assessment of Physician Adherence to Guidelines for the Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo in Ambulatory Care Settings.

Assessment of Physician Adherence to Guidelines for the Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo in Ambulatory Care Settings.

JAMA Otolaryngol Head Neck Surg. 2018 Aug 16;:

Authors: Dunlap PM, Khoja SS, Whitney SL, Freburger JK

PMID: 30128474 [PubMed - as supplied by publisher]

https://ift.tt/2OWuHnG

Successful treatment switch from lenvatinib to sorafenib in a patient with radioactive iodine-refractory differentiated thyroid cancer intolerant to lenvatinib due to severe proteinuria

Publication date: December 2018

Source: Auris Nasus Larynx, Volume 45, Issue 6

Author(s): Hideaki Goto, Naomi Kiyota, Naoki Otsuki, Yoshinori Imamura, Naoko Chayahara, Hirotaka Suto, Yoshiaki Nagatani, Masanori Toyoda, Toru Mukohara, Ken-ichi Nibu, Toshihiko Kasahara, Yasuhiro Ito, Akihiro Miya, Mitsuyoshi Hirokawa, Akira Miyauchi, Hironobu Minami

Abstract

Sorafenib and lenvatinib showed efficacy for patients with radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC) in pivotal phase 3 clinical trials. Although the efficacy of lenvatinib in patients who received previous treatment with multi-target kinase inhibitors (m-TKIs), including sorafenib, was reported, the efficacy of sorafenib in patients who previously received lenvatinib remains unknown. A 75-year-old woman diagnosed as RAI-refractory poorly differentiated carcinoma with multiple lung metastases and started treatment with lenvatinib. She continued to receive lenvatinib but with repeated dose interruptions and reductions due to continuous proteinuria. Because of severe and persistent proteinuria as well as newly developed renal impairment, lenvatinib was suspended after two years of treatment. After the 7-month suspension, her proteinuria and renal impairment were partially improved, but her lung metastases progressed. Because she was unable to tolerate previous treatment with lenvatinib, sorafenib was started. At 7 months of treatment with sorafenib, her lung metastases shrank and she could continue sorafenib without exacerbation of proteinuria or renal impairment. This case may suggest that sorafenib does not exacerbate the proteinuria or renal impairment induced by lenvatinib, and may be an effective treatment option for RAI-refractory DTC patients who are unable to tolerate lenvatinib.

https://ift.tt/2Li0woG

Postoperative hypoparathyroidism after total thyroidectomy for thyroid cancer

Publication date: December 2018

Source: Auris Nasus Larynx, Volume 45, Issue 6

Author(s): Masanori Teshima, Naoki Otsuki, Naruhiko Morita, Tatsuya Furukawa, Hitomi Shinomiya, Hirotaka Shinomiya, Ken-ichi Nibu

Abstract

Objectives

Postoperative hypoparathyroidism (HPT) is one of the most common complications in total thyroidectomy for thyroid carcinoma. Parathyroid glands (PTGs) are at risk of being damaged during total thyroidectomy and central neck dissection mainly due to inadvertent removal, interruption of the blood supply or hematoma formation. The purpose of this study was to evaluate the efficacy of our surgical procedure to preserve for parathyroid function retrospectively and to clarify the risk factors of HPT after total thyroidectomy for thyroid cancer.

Patients and methods

Sixty-five patients undergoing total thyroidectomy with central neck dissection for thyroid cancer were enrolled in this retrospective study. Cancers were diagnosed as stage I in 15 patients, stage II in 24 patients, stage III in 19 patients, and stage IV in 7 patients. Lateral neck dissection and upper mediastinal dissection were simultaneously performed in 47 patients and one patient, respectively. Parathyroid glands (PTGs) were preserved in situ in 34 patients. Among 31 patients in whom PTG could not be preserved in situ, two or more PTGs were autotransplanted in 9 patients and one PTG was autotransplanted in 18 patients. PTG was not autotransplanted in 4 patients, since it could not be identified during the surgery.

Results

Postoperative transient HPT and permanent HPT were observed in 44 (68%) patients and in 12 (18%) patients, respectively. Among 34 patients in whom PTGs were preserved in situ, transient HPT and permanent HPT were observed in 17 (50%) patients and in 6 (2%) patients, respectively. Among 31 patients in whom PTG were not preserved in situ, postoperative permanent HPT was observed in all 4 patients without PTG autotransplantation, and 6 (33%) out of the 18 patients who had one PTG autotransplantation. On the other hand, none of the 9 patients who had two or more PTG autotransplantation at the time of thyroidectomy developed permanent HPT (P = 0.04). The patients with large tumor (≥40 mm) and/or gross extra glandular invasion had a significantly higher risk of permanent postoperative HPT compared with the patients without these pathological features (P < 0.01).

Conclusions

Two or more PTG should be autotransplanted in case where PTG is not preserved in situ to prevent postoperative HPT after total thyroidectomy with central neck dissection, especially in cases of large tumor and/or gross extrathyroidal extension.

https://ift.tt/2w3Fl4P

The influence of marital status on survival for patients aged 65 years and younger with oral cavity cancer

Publication date: December 2018

Source: Auris Nasus Larynx, Volume 45, Issue 6

Author(s): Pei-Hsun Liao, Ching-Chih Lee

Abstract

Objective

In Taiwan, the median age of diagnosis for oral cavity cancer is 51 year old, which is about 10 years earlier than that in Western countries. A recent study assessing the effect of marriage on outcomes for elderly oral cavity cancer patients (≥66 years old) showed that marriage was associated with better survival. However, little is known about the prognostic significance of marital status in oral cavity cancer patients aged 65 years and younger.

Methods

Data from 2007 to 2014 were collected from the Cancer Registry Dataset of the Kaohsiung Veterans General Hospital. We reviewed the records of all newly diagnosed patients with oral cavity cancer who were aged 65 years and younger and being treated by primary surgery with or without neck dissection or adjuvant therapy. None of the included patients had distant metastasis upon diagnosis. In total, 457 patients were indentified. We used multivariate Cox regression model to evaluate the effect of marriage on disease-specific survival rates after adjusting for demographic variables and treatments.

Results

There was no significant difference between the married and unmarried groups in stage at diagnosis or treatment. The 5-year disease-specific survival was 70.9% in the married group and 51.2% in the unmarried group (P = 0.001). Multivariate analysis with Cox regression showed that unmarried patients had worse disease-specific survival (unmarried, adjusted hazard ratio [aHR] 1.51, 95% CI: 1.06–2.16). Subgroup analysis among patients stratified by the independent factors in multivariate analysis revealed that being unmarried was associated with a trend of worse survival in most stratified groups.

Conclusion

Marriage was associated with better disease-specific survival for oral cavity cancer patients aged 65 years and younger.

https://ift.tt/2Li0qxk

Predictive value of the Hyodo score in endoscopic evaluation of aspiration during swallowing

Publication date: December 2018

Source: Auris Nasus Larynx, Volume 45, Issue 6

Author(s): Yoshihiro Chiba, Daisuke Sano, Yukiko Ikui, Goshi Nishimura, Kenichiro Yabuki, Yasuhiro Arai, Teruhiko Tanabe, Hidetaka Ikemiyagi, Hiroshi Hyakusoku, Nobuhiko Oridate

Abstract

Objective

The Hyodo scoring system during the endoscopic procedure has been proposed as a new tool for evaluating oral intake feasibility. However, the effectiveness of the information obtained from this procedure in predicting aspiration is not fully elucidated. The aim of this study was to assess the significance of clinical factors, including Hyodo scores, for predicting the risk of aspiration.

Methods

Five hundred and twenty-eight endoscopic swallowing examinations were performed. Clinical factors, including age, sex, disease type, history of aspiration pneumonia, cognitive function, presence of tracheostomy, presence of vocal cord paralysis, consciousness level on the Japan Coma Scale, ECOG Performance Status, serum albumin level and Hyodo score, were obtained for each examination. The relationship between each of these factors and the presence of aspiration during endoscopic procedure was evaluated.

Results

Three hundred and thirty-two patients (62.9%) were scored less than 5, 153 (29.0%) were scored between 5 and 8, and 43 (8.1%) were scored above 8. The number of patients with aspiration was 133 (25.2%). ROC analysis revealed that a cut-off point of 6 for Hyodo score was effective for predicting aspiration, with a sensitivity of 0.65 and a specificity of 0.86. History of aspiration pneumonia (OR 1.87, P < 0.001), vocal cord paralysis (OR 2.23, P < 0.001), PS ≥ 3 (OR 2.47, P < 0.001) and Hyodo score > 6 (OR 9.08, P < 0.001) were found to be independent predictive factors for aspiration.

Conclusion

The Hyodo scoring method was easy for otolaryngologists to perform and the scores were useful for predicting aspiration with moderate sensitivity and high specificity. Hyodo score > 6, history of aspiration pneumonia, vocal cord paralysis, and PS ≥ 3 were independent predictive factors for aspiration and that a Hyodo score above 6 was the statistically strongest predictor for aspiration.

https://ift.tt/2w3INwu

The palatal septal cartilage implantation for snoring and obstructive sleep apnea

Publication date: December 2018

Source: Auris Nasus Larynx, Volume 45, Issue 6

Author(s): Yi-Chan Lee, Li-Ang Lee, Hsueh-Yu Li

Abstract

Objective

Patients with snoring and obstructive sleep apnea frequently have nasal and palatal obstruction. The objective of this study was to investigate the safety and feasibility of a palatal septal cartilage implant (SCI) for snoring and obstructive sleep apnea.

Methods

This was a preliminary study of 10 consecutive patients who were enrolled retrospectively from electronic charts. The patients had undergone a single-stage operation including septoturbinoplasty and palatal SCI at a tertiary referral hospital. After nasal surgery, the harvested cartilage was prepared and trimmed into strips for palatal implantation. Key procedures of palatal SCI include vertical tunneling of the midline and paramedian soft palate, insertion of the septal cartilage strips, and fixation suture of the implants. The primary outcome measures were adverse events, including implant extrusion, infection, bleeding, velopharyngeal insufficiency and globus symptoms, assessed by the Glasgow–Edinburgh Throat Scale (GETS) questionnaire (10-item, 8-grade [0–7] Likert scale). Secondary outcomes were subjective snoring loudness (visual analogue scale, VAS), excessive daytime sleepiness (Epworth sleepiness scale, ESS) and objective apnea-hypopnea index. All patients were followed up for at least 1 year.

Results

None of the aforementioned adverse events were noted during the one-year follow-up. Among the ten items of the GETS, the median score of nine items was 0, and the median score of the total GETS was 2.0, which was classified as "asymptomatic". The snoring loudness improved significantly from 8.0 points (IQR 8.0–9.0) preoperation to 4.0 points (IQR 2.5–6.0) at 3 months postoperation and 4.5 points (IQR 3.3–6.0) at 1 year postoperation (P = 0.002 and P = 0.002, respectively). The ESS score improved significantly from 11.5 points (IQR 8.3–18.5) preoperation to 8.0 points (IQR 6.3–10.8) at 3 months postoperation and 8.5 points (IQR 6.3–10.8) at 1 year postoperation (P = 0.004 and P = 0.004, respectively). The apnea-hypopnea index significantly decreased from 54.7 (IQR 23.4–62.8) to 20.5 (IQR 14.7–45.6) (P = 0.047) in patients with a lower tongue position (modified Mallampati class ≤ II; n = 7).

Conclusion

Palatal SCI is a safe and feasible procedure. The advantages include providing implants of tailor-made length, biocompatible autologous cartilage and no need for extra-payment for the implant material. By using the SCI procedure, both nasal obstruction and sleep-disordered breathing can be managed in a single-stage operation. The long-term effectiveness of SCI deserves further research.

https://ift.tt/2Li0ld0

The safety and risk factors of revision adenoidectomy in children and adolescents: A nationwide retrospective population-based cohort study

Publication date: December 2018

Source: Auris Nasus Larynx, Volume 45, Issue 6

Author(s): Dai-Lou Lin, Chuan-Song Wu, Chao-Hsiun Tang, Ting-Yu Kuo, Tzong-Yang Tu

Abstract

Objective

To investigate the safety of adenoidectomy and risk factors of re-adenoidectomy, and intend to provide evidence-based information to clinicians for further consideration.

Methods and materials

This study was based on data obtained from Taiwan's National Health Insurance Research Database from the period 2002–2011. We utilized that data from the hospitalization group and collected information regarding those individuals who accepted adenoidectomy with or without tonsillectomy and post-adenoidectomy bleeding. Thereafter, we performed univariate and multi-variate analysis to explore the possible risk factors of re-adenoidectomy.

Results

A total of 5435 individuals who accepted a first adenoidectomy with or without tonsillectomy were collected. After further tracing treatment of these individuals, 107 (1.97%) accepted the revision adenoidectomy until 2011. Post-op bleeding was approximately 0.28%. The revision rate associated with patient age showed the following: 0–4 years (0.61%), 4–12 years (2.06%) and 12–18 years (2.56%). The revision rate associated with surgeon age showed: 28–41 years (1.42%), 41–50 years (2.96%), 50–65 years (2.74%); the surgeons' surgery volume showed low (4.34%), medium (0.71%), and higher (1.02%). There are 4 diseases (otitis media with effusion, sinusitis, chronic pharyngitis, and sleep disorder) that showed a significant relationship with the revision rate when subject to univariate and multivariate analysis. The revision rate incorporating hospital locations, volumes and levels revealed no significant difference with each other.

Conclusions

Adenoidectomy is a generally safe surgical procedure, with low complication and low revision rate. Our study indicated that the revision rate of adenoidectomy might be lower when performed by young visiting staff with medium to higher surgical volume in the medium to higher volume hospital. If patients had diseases such as otitis media with effusion, sinusitis, chronic pharyngitis, and sleep disorder, they would be subject to higher rate of re-adenoidectomy. Surgeons should be aware and sufficiently explain this information to the parents before surgery.

https://ift.tt/2w0YyV8

Trend in otolaryngological surgeries in an era of super-aging: Descriptive statistics using a Japanese inpatient database

Publication date: December 2018

Source: Auris Nasus Larynx, Volume 45, Issue 6

Author(s): Sayaka Suzuki, Hideo Yasunaga, Hiroki Matsui, Kiyohide Fushimi, Tatsuya Yamasoba

Abstract

Objective

To reveal the age distribution and capture the longitudinal trend in otolaryngological surgeries performed in Japan, where society is rapidly aging.

Methods

Using the Diagnosis Procedure Combination database, we extracted data on patients who were hospitalized and underwent any type of otolaryngological surgery in departments of otolaryngology or head and neck surgery from fiscal year 2007 to fiscal year 2013. Type of surgery, patient's age, and fiscal year were compared. We categorized >200 types of surgeries into eight specialties: ear surgery, functional endoscopic sinus surgery (FESS), other types of paranasal surgery (except for malignancy), head and neck cancer surgery, benign tumor surgery, upper airway surgery (including pharynx and larynx), removal of foreign body, and other.

Results

In total, 558,732 patients were included. The proportions of patients in each age category formed two peaks in middle age and in children aged ≤9 years. The proportion of all surgeries made up by FESS, other paranasal surgery, benign tumor surgery, and head and neck cancer surgery gradually increased with age, forming a peak in patients in their 60s. The proportion of ear surgery was highest in patients aged ≤9 years (34.0% of all surgeries, mostly myringotomy and transtympanic ventilation tube insertion) and formed a gradual peak in patients in their 60s (mostly tympanoplasty). The proportion of upper airway surgery (tonsillectomy and adenoidectomy) was highest in patients aged ≤9 years (25.3% of all surgeries). The proportion of foreign body removal was highest in patients aged ≤9 years (52.2% of all surgeries) and increased slightly with age. In 2013, compared with 2007, those aged 65–74 years and ≥75 years made up a larger percentage of patients undergoing each specific surgery, including tympanoplasty, stapedectomy/stapedotomy, FESS, head and neck cancer surgery, pharyngolaryngectomy, total/subtotal glossectomy, thyroid lobectomy, parotidectomy (for a benign tumor), submandibular gland resection, tonsillectomy, and vocal fold polypectomy.

Conclusion

The age distribution of otolaryngological surgeries varied by specialty. We found an increased proportion of patients aged 65–74 and ≥75 years in most specific surgeries.

https://ift.tt/2LgkCjg

Stapes surgery preserving the superstructure of stapes (Takagi’s stapedotomy) in otosclerosis: A retrospective study of 24 consecutive cases

Publication date: December 2018

Source: Auris Nasus Larynx, Volume 45, Issue 6

Author(s): Shin-ichi Sato, Akira Takagi, Takashi Fujiwara

Abstract

Objective

The aim of this study was to evaluate the hearing outcomes and complications of stapedotomy in which the stapes superstructure was preserved (Takagi's stapedotomy). In this surgical approach, the lenticular process of the incus rather is removed, than the superstructure of the stapes.

Methods

A single-center retrospective observational study was performed. We included all patients having Takagi's stapedotomy for otosclerosis between January 2005 and April 2016. Both primary and revision stapes surgery were included. We evaluated audiometric outcomes and surgical complications.

Results

Twenty-four patients who underwent stapedotomy preserving superstructure were included in this study. The postoperative air-bone gap at 1 year postoperatively was ≤10 dB in 66.7% of patients and ≤20 dB in all cases. In longer follow-up period, elevation of the air-bone gap was not observed over the 5 postoperative years in available cases. The postoperative air-bone gap was ≤10 dB in 72.2% at 3 years and 81.8% at 5 years postoperatively.

Conclusion

Takagi's stapedotomy restore ossicular conduction without the removal of superstructure of stapes. The air-bone gap did not get worse in long-term follow-up, although audiometric results would be unsatisfactory. Further larger studies are needed to evaluate the efficacy and safety of Takagi's stapedotomy.

https://ift.tt/2Pvbnie

Fracture probability assessed using FRAX® in elderly women with benign paroxysmal positional vertigo

Publication date: December 2018

Source: Auris Nasus Larynx, Volume 45, Issue 6

Author(s): Takafumi Nakada, Masaaki Teranishi, Yukio Ueda, Michihiko Sone

Abstract

Objective

Patients with benign paroxysmal positional vertigo (BPPV) can have vitamin D deficiency, which is a cause of abnormal bone turnover. Several studies have established a relationship between osteoporosis and BPPV. The World Health Organization Fracture Risk Assessment Tool, widely known as FRAX^® (http://www.shef.ac.uk/FRAX), is a computer-based algorithm for assessing fracture risk. No direct comparison has been made between the FRAX scores of patients with BPPV and controls. The purpose of this study was to determine whether women with BPPV are at high risk of fracture as assessed using FRAX.

Methods

The study involved 40 postmenopausal women diagnosed with BPPV between July 2015 and April 2016, and 40 postmenopausal women as controls. The 10-year major osteoporotic and hip fracture risks were calculated using FRAX and were compared between BPPV patients and controls using Welch's t test and a general linear model.

Results

The 10-year major osteoporotic fracture risk was 20.4% ± 12.1% for BPPV patients (aged 72.4 ± 8.6 years) and 14.3% ± 6.5% for controls (aged 71.2 ± 6.3 years). The 10-year hip fracture risk was 9.0% ± 9.8% for BPPV patients and 5.0% ± 3.9% for controls. The BPPV group had significantly higher 10-year major risks of osteoporotic fracture (p = 0.0069) and hip fracture (p = 0.0202) compared with controls. Similarly, after adjustment for age, the BPPV group had significantly higher 10-year risks of major osteoporotic fracture (p = 0.0007) and hip fracture (p = 0.0092) compared with controls.

Conclusion

Fracture risk calculated using FRAX was significantly higher in the BPPV group than in controls. Women with BPPV may need early intervention to prevent future fractures.

https://ift.tt/2Li0aym

The possible effect of human menopausal gonadotropin on the audio-vestibular system

Publication date: December 2018

Source: Auris Nasus Larynx, Volume 45, Issue 6

Author(s): Montaser Abdel-Salam, Osama G. Abdel-Naby Awad, Mohamed El-Badry, Ahmed Ibrahim, Mahmoud Hosny Ibrahiem

Abstract

Objective

Human menopausal gonadotropin (HMG) is one of the commonest drugs used for ovarian stimulation with no reports on the audio-vestibular system. This study aims to examine HMG on the hearing profile of patients planning intracytoplasmic sperm injection (ICSI).

Methods

This prospective study was conducted from June 2016 to June 2017 in a tertiary referral hospital. The audio-vestibular system of a total of 30 patients was evaluated using pure tone audiometry, distortion product otoacoustic emissions (DPOAEs in the form of a DP-gram) and Vestibular-evoked myogenic potential (VEMP) immediately before therapy and at the day 10 after therapy. Audio-vestibular adverse effects including hearing loss, tinnitus, vertigo, and otalgia were also considered.

Results

Significant elevations in hearing thresholds were found on comparing thresholds at the day 10 at the onset of the study. The elevations were mostly at frequencies (1000, 2000 and 8000 Hz) and did not affect speech perception. For DPOAE, significant differences were observed at all F2 frequencies on comparing both amplitudes and signal to noise ratios. Otologic complaints were significant for tinnitus and hearing loss.

Conclusion

Significant auditory and vestibular adverse effects may result from HMG therapy, indicating the importance of prompt monitoring of auditory functions in these patients.

https://ift.tt/2w3F9T9

Comparison of VEMPs, VHIT and caloric test outcomes after vestibular neurectomy in Menière’s disease

Publication date: December 2018

Source: Auris Nasus Larynx, Volume 45, Issue 6

Author(s): Andrea Canale, Federico Caranzano, Michele Lanotte, Alessandro Ducati, Francesco Calamo, Andrea Albera, Michelangelo Lacilla, Marco Boldreghini, Sergio Lucisano, Roberto Albera

Abstract

Objective

Selective unilateral vestibular neurectomy (VN) is considered a reliable surgical treatment in case of recurrent vertigo in Menière's disease (MD) because of hearing preservation and a minimally invasive posterior fossa retrosigmoid approach. The present study aimed to assess the quality of life and the long-term vestibular function in patients submitted to yearly follow-up after VN because of intractable MD.

Methods

Retrospective series of 15 MD patients undergoing retrosigmoid VN for recurrent vertigo. Outcome measures included cVEMPs and oVEMPs (cervical and ocular vestibular evoked myogenic potentials), VHIT (Video Head Impulse Test) and caloric test, besides to DHI (Dizziness Handicap Inventory) and PTA (Pure Tone Audiometry).

Results

Mean DHI score resulted within normal values in 74% of patients, significantly correlated to the duration of the follow-up. In the operated side, cVEMPs and oVEMPs have not been elicited respectively in 11 patients (73%) and 13 patients (87%), whereas it was not possible to evoke any response at bithermal caloric test in 4 cases. The gain of VOR from VHIT resulted always below normal values after VN except in one patient, who has also undergone an episode of posterior BBPV. The difference between average PTA threshold before and after VN resulted not significant.

Conclusion

The vestibular outcomes prove VN to be an effective and safe surgery in MD; furthermore, the unexpected occurrence of BPPV after VN can justify the presence of neural anastomosis between the inferior vestibular nerve and the cochlear nerve, allowing to still perceive vestibular symptomatology despite of a proper neurectomy.

https://ift.tt/2Lgc2kD

Characteristics of tinnitus found in anemia patients and analysis of population-based survey

Publication date: December 2018

Source: Auris Nasus Larynx, Volume 45, Issue 6

Author(s): Woongsang Sunwoo, Doh Young Lee, Ji Young Lee, Minhyung Lee, Young Kang, Min-Hyun Park, Young Ho Kim

Abstract

Objective

This study analyzed the characteristics of tinnitus identified in anemia patients with cohort- and population-based studies in a single institute and suggests a management algorithm.

Methods

Fifty patients who were treated for anemia and referred for tinnitus treatment were included in a single institute retrospective study. Characteristics of tinnitus were investigated in a correlation analysis with demographic and audiologic parameters. For the population-based study, data from the Korea National Health and Nutrition Examination Survey collected between 2010 and 2011 were analyzed. The study population consisted of 11,402 individuals aged 20–97 years with complete tinnitus-related data. The prevalence of tinnitus in anemia patients was investigated using the questionnaire, and associations between tinnitus and blood/urine parameters were evaluated by binary logistic regression analysis.

Results

In a single-institute study, patients with non-pulsatile tinnitus were significantly older and their initial hemoglobin was higher than those with pulsatile tinnitus (p = 0.001, 0.008, respectively). In pulsatile tinnitus, age and difference between initial and post-treatment hemoglobin were significantly associated with a subjective improvement in tinnitus (p = 0.002, 0.016, respectively). There were no significant audiologic or hematologic parameters associated with the improvement of non-pulsatile tinnitus. In the population-based study, there was no significant correlation between anemia and tinnitus (p = 0.064). In a multivariate analysis, age was the only parameter associated with tinnitus in participants with anemia.

Conclusion

The therapeutic strategy and prognosis of tinnitus in anemia patients differ according to the characteristics of tinnitus and the severity of anemia.

https://ift.tt/2Pvbbzw

Middle-ear disease in children with cleft palate

Publication date: December 2018

Source: Auris Nasus Larynx, Volume 45, Issue 6

Author(s): Tulasi Kota Karanth, Kenneth R. Whittemore

Abstract

Objective

The objective of this review is to summarize all aspects of middle ear diseases in children with cleft palate (CP).

Methods

PubMed, Scopus, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and The Cochrane Library were searched for English-language randomized control trials (RCTs), meta-analyses, systematic reviews and observational studies published through 31st July 2017.

Results

Epidemiology and pathogenesis of middle ear diseases in children with cleft palate have been discussed in this review. Methods of Evaluation, CP surgeries, complications and follow up have been detailed for the same.

Conclusion

Evaluation of middle-ear disease in children with CP begins at birth by a newborn hearing screen. Tympanometry and otoscopy helps screen for middle-ear disease during follow-up visits. Ventilation tube may be placed when indicated based on the patient's clinical course and presentation. Long-term follow up should be provided to look for the development of cholesteatoma.

https://ift.tt/2Lgke4i

Overcoming wound complications in head and neck salvage surgery

Publication date: December 2018

Source: Auris Nasus Larynx, Volume 45, Issue 6

Author(s): Daniel Kwon, Eric M. Genden, Remco de Bree, Juan P. Rodrigo, Alessandra Rinaldo, Alvaro Sanabria, Alexander D. Rapidis, Robert P. Takes, Alfio Ferlito

Abstract

Background

Loco-regional treatment failure after radiotherapy with or without chemotherapy and/or prior surgery represents a significant portion of head and neck cancer patients. Due to a wide array of biological interactions, these patients have a significantly increased risk of complications related to wound healing.

Methods

Review of the current literature was performed for wound healing pathophysiology, head and neck salvage surgery, and wound therapy.

Results

The biology of altered wound healing in the face of previous surgery and chemoradiotherapy is well described in the literature. This is reflected in multiple clinical studies demonstrating increased rates of wound healing complications in salvage surgery, most commonly in the context of previous irradiation. Despite these disadvantages, multiple studies have described strategies to optimize healing outcomes. The literature supports preoperative optimization of known wound healing factors, adjunctive wound care modalities, and microvascular free tissue transfer for salvage surgery defects and wounds.

Conclusion

Previously treated head and neck patients requiring salvage surgery have had a variety of disadvantages related to wound healing. Recognition and treatment of these factors can help to reverse adverse tissue conditions. A well-informed approach to salvage surgery with utilization of free vascularized or pedicled tissue transfer as well as optimizing wound healing factors is essential to obtaining favorable outcomes.

https://ift.tt/2PvAodd

Editorial Board

Publication date: December 2018

Source: Auris Nasus Larynx, Volume 45, Issue 6

Author(s):

https://ift.tt/2LgjZGq

A rare cause of primary hyperparathyroidism: Parathyroid lipoadenoma

Publication date: December 2018

Source: Auris Nasus Larynx, Volume 45, Issue 6

Author(s): Sabri Özden, Servet Güreşci, Barış Saylam, Gül Dağlar

Abstract

Objective

The main cause of primary hyperparathyroidism is a single parathyroid adenoma. Parathyroid lipoadenomas contain abundance of fat cells. Because of these histological features, they can mimic normal parathyroid tissue at the histopathologic examination and radiological imaging could be difficult to localize lipoadenomas.

Clinical Presentation

In this case report, we present three cases of functional parathyroid lipoadenomas.

Conclusion

Preoperative imaging modalities often can't localize lipoadenoma. In our cases, SPECT has seen more successful than ultrasonography or CT. There may not be gender predominance at parathyroid lipoadenomas. Intraoperative pathology consultation and rapid biochemical workup can help the surgeon in difficult cases.

https://ift.tt/2PvaSom

A novel fluoroscopic method for multidimensional evaluation of swallowing function

Publication date: Available online 10 May 2018

Source: Auris Nasus Larynx

Author(s): Nobuyuki Arai, Kozo Hanayama, Takaharu Yamazaki, Tetsuya Tomita, Akio Tsubahara, Kazuomi Sugamoto

Abstract

Objective

Dynamic videofluoroscopic swallow study (VFSS) is used to investigate swallowing movements. However, it requires prolonged radiation exposure and mainly provides qualitative information. Herein, we present a multi-dimensional method for analyzing swallowing based on a pulsed, low-dose fluoroscopy technique that uses serial-shot images and evaluates the size, position, and temporal profile of the bolus to obtain a more comprehensive and realistic analysis of swallowing movements.

Methods

Fifteen healthy adults drank two liquids: 20 mL of pure water followed by 20 mL of contrast medium mixture in a fluoroscopic study. Data were recorded in serial-shot images (7.5 frames/second, 1024 × 1024-pixel resolution, DICOM format). The images from the water and contrast swallows were inverted, synchronized, and subtracted to visualize the bolus in each frame. The pathway of the bolus was divided into 15 parts traversing the oropharynx, hypopharynx, and upper esophagus, and the total gray value was measured in each section. The results were presented as contour graphs.

Results

The contour graphs allowed for information on the size, anatomical location, and temporal location of the bolus during swallowing to be displayed simultaneously. Two distinct swallowing patterns were observed in the subjects. The bolus showed two peaks—one in the hypopharynx and one in the upper esophagus—in all subjects. However, in nine of the 15 subjects, the two peaks were in different frames, whereas in six of the subjects, the two peaks were in the same frame.

Conclusion

We developed a new method for quantitatively evaluating swallowing. The technique allows for multidimensional assessment of the size, position, and temporal profile of the movement of the bolus across the pharynx. This method evaluates the swallowing movements using sharp, high-resolution images obtained by serial-shot, pulsed fluoroscopy with low radiation exposure. Additional studies are required to further clarify the variability of swallowing patterns and their clinical relevance in the evaluation of swallowing movements in healthy subjects and in patients with swallowing disorders.

https://ift.tt/2LceVCV

Comparison of functional outcomes after total thyroidectomy and completion thyroidectomy: Hypoparathyroidism and postoperative complications

Publication date: Available online 8 April 2018

Source: Auris Nasus Larynx

Author(s): Young Min Park, Jeong-Rok Kim, Kyung Ho Oh, Jae-Gu Cho, Seung-Kuk Baek, Soon-Young Kwon, Kwang-Yoon Jung, Jeong-Soo Woo

Abstract

Objective

This study aimed to investigate differences in functional outcomes of postoperative complications and hypoparathyroidism between patients who underwent completion thyroidectomy (CT) after thyroid lobectomy or total thyroidectomy (TT) as an initial treatment.

Materials and methods

We retrospectively analyzed the differences of functional outcomes after completion thyroidectomy and total thyroidectomy without lymph node dissection. We reviewed the medical records of 396 patients who underwent CT or TT for thyroid disease at Korea University Guro Hospital from March 2002 to August 2016.

Results

Of the 396 patients, 32 underwent CT and 364 underwent TT. There were 72 male patients and 324 female patients. Transient hypoparathyroidism was observed in 4 (9.4%) of the CT patients and 97 (26.6%) of the TT patients, with a statistically significant difference (p = 0.031). Permanent hypoparathyroidism was observed in 1 patient (3.1%) in the CT group and in 13 patients (3.6%) in the TT group, which was not significantly different. There were no significant differences in the postoperative complication of temporary recurrent laryngeal nerve injury, wound infection, and hematoma between two patients group.

Conclusion

The incidence of transient hypoparathyroidism in CT patients was significantly lower than in TT patients. These safety and functional superiority of CT should be considered when determining the scope and extent of operation in patients requiring surgery for thyroid disease.

https://ift.tt/2wb0MRV

Rehabilitation of Lost‐teeth Related to Maintenance of Cognitive Function

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

https://ift.tt/2LgfNGo

Science and policy collide in air quality regulations

International Forum of Allergy &Rhinology, EarlyView.

https://ift.tt/2OTZx04

Local vs. systemic pulmonary amyloidosis—impact on diagnostics and clinical management

Abstract

Immunoglobulin-derived light-chain (AL) amyloidosis of lungs and bronchi can appear as a systemic and a local form. While systemic AL amyloidosis may need haemato-oncological care, the localised form can be treated restrained. We re-evaluated 207 specimens of lungs and bronchi sent in for amyloid diagnostics. Amyloid was diagnosed by polarization microscopy using Congo red-stained tissue specimens and classified immunohistochemically. Histoanatomical amyloid distribution patterns were documented as well as additional histological findings. For 118 patients with AL amyloidosis, we retrieved clinical data. CT scan results were available from 59 patients. AL amyloidosis was the most common type (183 cases). ALλ was found in 141 and of ALκ in 27 cases. Fifteen cases were AL amyloid not otherwise specified. Twenty cases harboured transthyretin and three serum amyloid A derived amyloid. By correlation of histoanatomy, radiological and clinical data, amyloid was rarely in the initial differential diagnosis. Local AL amyloidosis often presented with a nodular pattern on CT scan and showed a significantly better disease-specific 10-year survival compared with systemic AL amyloidosis (96.0 vs. 51.9%). Localised and systemic pulmonary and bronchial AL amyloidosis are having a completely different prognosis. While CT scan might be indicative, histological and clinical assessment are mandatory to reach a proper diagnosis and guide patient care.

https://ift.tt/2vYrCMT

Αρχειοθήκη ιστολογίου

Τετάρτη 22 Αυγούστου 2018

Abstract

Zusammenfassung

Hintergrund

Fragestellung

Material und Methode

Ergebnisse

Schlussfolgerung

Zusammenfassung

Abstract

Abstract

Abstract

Objectives

Patients and methods

Results

Conclusions

Abstract

Objective

Methods

Results

Conclusion

Abstract

Objective

Methods

Results

Conclusion

Abstract

Objective

Methods

Results

Conclusion

Abstract

Objective

Methods and materials

Results

Conclusions

Abstract

Objective

Methods

Results

Conclusion

Abstract

Objective

Methods

Results

Conclusion

Abstract

Objective

Methods

Results

Conclusion

Abstract

Objective

Methods

Results

Conclusion

Abstract

Objective

Methods

Results

Conclusion

Abstract

Objective

Methods

Results

Conclusion

Abstract

Objective

Methods

Results

Conclusion

Abstract

Background

Methods

Results

Conclusion

Abstract

Objective

Clinical Presentation