e-learning: the anesthesiology media lab of Yale University School of Medicine. A review

No abstract available

https://ift.tt/2NgOeip

Evaluation of Mucociliary Activity in Maxillary Antra in Patients with Squamous Cell Carcinoma of Buccal Mucosa Undergoing Post Operative Radiotherapy

Abstract

A prospective longitudinal observational study was conducted on 24 patients of histopathologically confirmed squamous cell carcinoma of buccal mucosa upon whom bilateral 'middle meatal antrostomy was performed during the same sitting as the tumour resection with the main aim to assess the maxillary mucociliary clearance, pre-, during and post-irradiation; and compare the findings with the non-irradiated side in the same patient to avoid any confounding factors. All patients underwent methylene blue dye clearance and saccharine clearance tests before the commencement of radiation therapy, weekly during irradiation and again at first and sixth month of completion of irradiation. Pre-radiation there was statistically no difference (P > 0.05) in clearance times between both sides. But, there was a significant (P < 0.001) increase in saccharin and methylene blue clearance times on the irradiated side in comparison to contralateral non-irradiated side, during and post-radiation. It is concluded that external beam radiotherapy for oral cancers significantly affect ciliary activity in the adjacent maxillary antrum and has no effect on the opposite side. Recovery in mucociliary activity was not seen even after 6 months after radiation therapy.

https://ift.tt/2PA26Wd

Sinonasal Metastatic Renal Cell Carcinoma: A Report of Two Cases with Varied Presentation and a Review of Literature

Abstract

Renal cell carcinoma is usually slow growing with delayed vague symptoms and may not be detected until an advanced stage. In only 9% of the cases the classical triad of "haematuria, costovertebral pain and abdominal mass" is seen. Less commonly, sinonasal metastasis may also be the presenting feature of RCC. So, in any case of sinonasal mass, possibility of metastasis from renal malignancy should be considered. Sinonasal metastasis from renal malignancy can occur even several years after the primary is treated with nephrectomy. In sinonasal region maxillary sinus is the most commonly affected. Isolated metastasis to the nose is extremely rare. Malignancies from various other sites of the body can also metastasize to sinonasal region. Epistaxis is the most common symptom. This is because of vascular stroma of the metastatic deposit. A 45 year old male with history of right nephrectomy 1 year back presented with intractable epistaxis. A 66 year old male presented with profuse epistaxis without any history of previous malignancies. Both the cases were evaluated resulting to the diagnosis of sinonasal metastasis from Renal Cell carcinoma. In the first case, metastasis occurred 1 year post surgery whereas in second case sinonasal metastasis was the presenting feature of Renal Cell carcinoma. Epistaxis is the most common symptom. This is because of vascular stroma of this metastatic deposit. In renal cancer, symptoms of metastasis often precede the symptoms of primary tumor.

https://ift.tt/2wn97kE

Facial nerve decompression

Purpose of review Facial nerve paralysis is a debilitating condition. Bell's palsy and temporal bone trauma are common causes of acute facial palsy, with recurrent idiopathic paralysis and Melkersson–Rosenthal syndrome accounting for a smaller subset of cases. Properly selected patients may benefit from facial nerve decompression. This article will review the relevant literature on facial nerve decompression. Recent findings The middle cranial fossa approach provides access to the primary site of lesion in Bell's palsy while preserving hearing. Patients with complete facial paralysis secondary to Bell's palsy or temporal bone trauma, more than 90% degeneration on electroneurography testing, and absent voluntary electromyography within 14 days of onset may benefit from facial nerve decompression. Facial nerve decompression may prevent future occurrences of recurrent forms of facial nerve paralysis. The return of facial nerve function following decompression will occur over weeks to months. Summary Appropriately selected patients with facial paralysis secondary to Bell's palsy or temporal bone trauma may benefit from facial nerve decompression. Patients should be counseled regarding the risks of decompression and that the return of maximal facial nerve function may be delayed up to 12 months. Correspondence to Marlan R. Hansen, MD, Departments of Otolaryngology – Head and Neck Surgery and Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. Tel: +1 319 353 7151; fax: +1 319 356 3967; e-mail: marlan-hansen@uiowa.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2MKPmh2

Aktuelle Therapie der systemischen Sklerodermie

Zusammenfassung

Die systemische Sklerose (SSc, Sklerodermie) ist eine schwere chronisch entzündliche Bindegewebserkrankung der Haut, des muskuloskeletalen Systems und vieler innerer Organe. Der heterogene, langjährige Verlauf dieser Erkrankung mit dem Befall multipler Organe stellt eine besondere Herausforderung an den betreuenden Arzt dar. Die therapeutischen Möglichkeiten haben sich in den vergangenen Jahren in verschiedenen Bereichen entscheidend verbessert. Diese positiven Entwicklungen haben dazu geführt, dass in verschiedenen Arbeitsgruppen abgestimmte Empfehlungen zur Behandlung der SSc veröffentlicht wurden. Ziel dieser Übersicht ist es, die wesentlichen Empfehlungen vorzustellen und in ein Konzept einer modernen interdisziplinären Betreuung einzubetten.

https://ift.tt/2wrpInw

Evaluation of Mucociliary Activity in Maxillary Antra in Patients with Squamous Cell Carcinoma of Buccal Mucosa Undergoing Post Operative Radiotherapy

Abstract

A prospective longitudinal observational study was conducted on 24 patients of histopathologically confirmed squamous cell carcinoma of buccal mucosa upon whom bilateral 'middle meatal antrostomy was performed during the same sitting as the tumour resection with the main aim to assess the maxillary mucociliary clearance, pre-, during and post-irradiation; and compare the findings with the non-irradiated side in the same patient to avoid any confounding factors. All patients underwent methylene blue dye clearance and saccharine clearance tests before the commencement of radiation therapy, weekly during irradiation and again at first and sixth month of completion of irradiation. Pre-radiation there was statistically no difference (P > 0.05) in clearance times between both sides. But, there was a significant (P < 0.001) increase in saccharin and methylene blue clearance times on the irradiated side in comparison to contralateral non-irradiated side, during and post-radiation. It is concluded that external beam radiotherapy for oral cancers significantly affect ciliary activity in the adjacent maxillary antrum and has no effect on the opposite side. Recovery in mucociliary activity was not seen even after 6 months after radiation therapy.

https://ift.tt/2PA26Wd

Sinonasal Metastatic Renal Cell Carcinoma: A Report of Two Cases with Varied Presentation and a Review of Literature

Abstract

Renal cell carcinoma is usually slow growing with delayed vague symptoms and may not be detected until an advanced stage. In only 9% of the cases the classical triad of "haematuria, costovertebral pain and abdominal mass" is seen. Less commonly, sinonasal metastasis may also be the presenting feature of RCC. So, in any case of sinonasal mass, possibility of metastasis from renal malignancy should be considered. Sinonasal metastasis from renal malignancy can occur even several years after the primary is treated with nephrectomy. In sinonasal region maxillary sinus is the most commonly affected. Isolated metastasis to the nose is extremely rare. Malignancies from various other sites of the body can also metastasize to sinonasal region. Epistaxis is the most common symptom. This is because of vascular stroma of the metastatic deposit. A 45 year old male with history of right nephrectomy 1 year back presented with intractable epistaxis. A 66 year old male presented with profuse epistaxis without any history of previous malignancies. Both the cases were evaluated resulting to the diagnosis of sinonasal metastasis from Renal Cell carcinoma. In the first case, metastasis occurred 1 year post surgery whereas in second case sinonasal metastasis was the presenting feature of Renal Cell carcinoma. Epistaxis is the most common symptom. This is because of vascular stroma of this metastatic deposit. In renal cancer, symptoms of metastasis often precede the symptoms of primary tumor.

https://ift.tt/2wn97kE

Probiotic supplementation with Lactobacillus plantarum and Pediococcus acidilactici for Helicobacter pylori therapy: A randomized, double‐blind, placebo‐controlled trial

Helicobacter, EarlyView.


https://ift.tt/2w94lrt

Monitoring tumor progression by mapping skin microcirculation with laser Doppler flowmetry

Abstract

Laser Doppler flow meter is a safe, useful, and noninvasive tool to monitor microvascular blood flow. It measures the changes in flow either over time or differences in flow over an area of skin or other exposed tissue. The primary function of LDF is to produce blood perfusion output signal that is proportional to the red blood cell perfusion (or flux). A simple analog-based laser Doppler flow meter is used to record the biosignals arising from the microvascular network of a surface lesion in the face of a human being. An innovative technique is developed to overcome one of the major technical limitations that involved removing the continuous artifacts or noise generated by the movement of the cable, the probe as well as the operator or the patient. A color heat map in MATLAB is created to facilitate its easy analysis, interpretation, and understanding of the blood flow changes over a period of time across a cross-sectional area in an image format processed after acquiring the biosignals (flux) using LDF by the clinicians or by the technician who is performing the vascular assessment of the lesion.

https://ift.tt/2BNzV3c

Composite neuroendocrine carcinoma and squamous cell carcinoma with regional lymph node metastasis: a case report

Neuroendocrine cell carcinoma is a rare variant of esophageal carcinoma. The characteristic clinical features and diagnosis of superficial neuroendocrine cell carcinoma remain to be established. We report a ra...

https://ift.tt/2MvVw5d

Acute and chronic phagocyte determinants of cardiac allograft vasculopathy

Abstract

Post-transplant immunosuppression has reduced the incidence of T cell-mediated acute rejection, yet long-term cardiac graft survival rates remain a challenge. An important determinant of chronic solid organ allograft complication is accelerated vascular disease of the transplanted graft. In the case of cardiac allograft vasculopathy (CAV), the precise cellular etiology remains inadequately understood; however, histologic evidence hints at the accumulation and activation of innate phagocytes as a causal contributing factor. This includes monocytes, macrophages, and immature dendritic cell subsets. In addition to crosstalk with adaptive T and B immune cells, myeloid phagocytes secrete paracrine signals that directly activate fibroblasts and vascular smooth muscle cells, both of which contribute to fibrous intimal thickening. Though maladaptive phagocyte functions may promote CAV, directed modulation of myeloid cell function, at the molecular level, holds promise for tolerance and prolonged cardiac graft function.

https://ift.tt/2N9LByz

Response to the Letter to the Editor on “Comparison between flapless and open-flap implant placement: a systematic review and meta-analysis”

Thank you for giving us the opportunity to reply to the Letter to the Editor in response to our manuscript "Comparison between flapless and open-flap implant placement: a systematic review and meta-analysis"1. We would like thank the authors of the letter for the time taken and care with which they verified the data tabulated in this work. However, the claims made are refuted in the points described below.

https://ift.tt/2o28RDM

Evaluation of routine magnetic resonance imaging of patients with chronic orofacial pain

The aim of this study was to evaluate the reported presence of magnetic resonance imaging (MRI) pathologies (demyelination, space-occupying lesions, or trigeminal neurovascular contact within the transition zone) in patients with orofacial pain. Patient histories, demographic characteristics, and clinical features were compared between those with and without a reported MRI pathology. A retrospective service evaluation of all patients who had undergone MRI scanning to aid the diagnosis of orofacial pain conditions between 2012 and 2016 was conducted.

https://ift.tt/2BHaJLV

Cone beam computed tomography evaluation of tooth injury after segmental Le Fort I osteotomy

The purpose of this study was to explore the incidence of injuries to the teeth at the vertical osteotomy line after segmental Le Fort I osteotomy by examination of postoperative cone beam computed tomography (CBCT) images. Data for this retrospective case study were collected using CBCT images of 132 patients with an indication for Le Fort I osteotomy with three-piece segmentation of the maxilla. Twenty-two patients (17%, 95% confidence interval 10–23%) had dental injuries. No patient had more than one dental injury.

https://ift.tt/2o5s6fV

The bacteria stroke: Leclercia adecarboxylata folliculitis in a healthy swimmer—an emerging aquatic pathogen?

A 12-year-old healthy boy presented with a 2-month painful acneiform eruption. On exam erythematous follicular papules and pustules were scattered over bilateral shoulders and back. These surfaces were moderately tender to light palpation; the patient even complained that clothing in contact with his skin elicited pain. Doxycycline 75 mg po qd × 10 days was prescribed to cover common Staphylococcus aureus folliculitis. Due to the atypical presentation of significant pain, a bacterial culture was collected.

https://ift.tt/2Mrhdn7

Secukinumab treatment of moderate to severe plaque psoriasis in routine clinical care: Baseline characteristics, previous therapies, and transition periods of the first 2,000 subjects in the PROSPECT study

Introduction: Secukinumab, a fully human monoclonal antibody that selectively neutralizes IL-17A, has demonstrated substantial efficacy in the treatment of moderate to severe psoriasis. The PROSPECT study was designed to assess previous and concomitant use of Pso treatments in 2,504 subjects receiving secukinumab and the duration of transition periods from previous treatments to secukinumab in real-life settings. Here we report the baseline characteristics and previous therapies in an interim analysis of the first 1,988 subjects.

https://ift.tt/2OVm7Fy

The prevalence of inflammatory bowel disease in patients with hidradenitis suppurativa

Background: Hidradenitis suppurativa is a chronic inflammatory skin disease associated with many other systemic manifestations including metabolic syndrome. Multiple other inflammatory disorders have been associated with inflammatory bowel disease including psoriasis and rosacea. IBD has been reported with HS however analysis have often utilized large data pulls which rely on International Classification of Diseases (ICD) coding. This leads to the possibility of overestimating prevalence.

https://ift.tt/2MsjHlc

Sun behaviors and quality of life after first cutaneous melanoma diagnosis

Background: There is a growing population of patients living with a history of cutaneous malignant melanomas (CMM) and recent studies indicate that sun-protective behaviors may not be maintained long term. These patients are at increased risk of developing a second primary melanoma and little is known regarding barriers to successful patient education and behavioral change.

https://ift.tt/2OVm7p2

Solid persistent facial edema (Morbihan syndrome) in a young Mexican-Mestizo woman

Introduction: Morbihan syndrome (MS) is a rare entity characterized by chronic erythematous edema of the upper portion of the face, believed to be a clinical complication of acne vulgaris and/or rosacea, that mostly affects Caucasian adults. There are no laboratory abnormalities or specific histopathologic findings described and thus, MS is mainly a diagnosis of exclusion.

https://ift.tt/2P2lwlE

Role of industry funding in academic dermatology

Since 2003, the NIH Budget for research grants has diminished. As a result more academic physicians are turning to pharmaceutical and medical device companies for funding. The aim of this project was to examine the relationship between private industry funding in dermatology and the relative scholarly impact created by investigators who received this funding. The objective of this study was to compare the impact of the h-index, a weighted index of academic productivity, to the amount of industry research funding received by colleagues.

https://ift.tt/2MrAPHE

The evolution of confocal microscopy in dermatology

Reflectance confocal microscopy (RCM) is a diagnostic imaging tool used to visualize the skin in vivo at the bedside with accuracy that parallels histology. For tissue examination, RCM uses lasers to produce optical sections by illuminating the specimen and by scanning focused beams of light across the tissue. The principle of point illumination in confocal microscopy was first proposed by Marvin Minsky in 1955, and serves as the basis for all subsequent developments for this technology. In the 1970s, lasers were introduced, and shortly after that photomicrographs of histologically recognizable cells were published.

https://ift.tt/2P2rWBf

Systemic lupus erythematosus with toxic epidermal necrolysis–like lesions: An infrequent variant of acute cutaneous erythematous lupus

Introduction: Skin manifestations in systemic lupus erythematosus (SLE) are very heterogeneous. Toxic epidermal necrolysis (TEN)–like lesions are an infrequent clinical presentation of SLE that are included as diagnostic criteria and a variant of acute cutaneous lupus. It presents with photodistributed exanthema and minimal mucositis and the onset of the rash is insidious. Differential diagnosis between "TEN-like" LE and classic TEN, could be difficult especially when LE has not been previously diagnosed.

https://ift.tt/2MvCPii

Steroid-assisted drug delivery with chemical peels for lichen amyloidosis: A case series

Cutaneous amyloidosis is a chronic dermatologic problem that can be extremely frustrating to patients and for which there are limited therapeutic options, often of inadequate efficacy. Patient quality of life is affected by the severe pruritus and cosmetic disfigurement of their lesions. First-line therapy for this condition is potent topical corticosteroids, but therapeutic efficacy is often limited by ineffective drug delivery to the target site. Intralesional kenalog can be a useful alternative for those with small, localized areas of disease involvement.

https://ift.tt/2OZOwKC

Simultaneous treatment of moderate-to-severe horizontal frontalis lines, glabellar lines, and lateral canthal lines with onabotulinumtoxinA, from the subject’s perspective: Patient-reported satisfaction and impact outcomes from a phase 3 double-blind study

Purpose: Safety and efficacy of onabotulinumtoxinA (onabotA) for simultaneous treatment of horizontal forehead lines (FHL) and glabellar complex and simultaneous treatment of upper facial lines (UFL) were assessed in a 12-month, placebo-controlled study. The primary end point was met. Secondary efficacy results (patient-reported satisfaction and treatment impacts) are presented here.

https://ift.tt/2MwsKRW

Scalp photodamage in balding men: An observational study combining a novel clinical scoring method with estimation of individual sun exposure history and risk factors

Background: Despite the fact that actinic damage is well documented, particularly in men due to balding, to our knowledge, the intensity of the relationship between scalp actinic damage and sun exposure remains to be fully elucidated.

https://ift.tt/2OZOvq2

Removal of skin tags with Erbium:YAG Laser: A simple, safe, quick, and effective technique requiring no local anesthesia

Background: Acrochordons are a one of the commonest type of benign cutaneous tumors. These are soft skin fibromas, and have been thought to represent as a cutaneous marker of metabolic syndrome. Treatments like snipping, cryotherapy, electrocautery, and radiofrequency ablation though effective, have there own limitations.

https://ift.tt/2Mw1x1Z

Pythriasis versicolor atypica: A difficult diagnosis

Introduction: Pityriasis versicolor is a superficial mycosis of the skin caused by Malassezia spp., a dimorphic, lipophilic yeast, which is part of the cutaneous microbiota. The most frequent topography is the trunk and is distinguished by showing plaques with fine scales on the surface, of varying shape and size that may be hypochromic, hyperchromic or erythematous, with a chronic and recurrent evolution, usually asymptomatic. The genus Malassezia, from its description, causes confusion and controversy.

https://ift.tt/2P2lv14

The thousand faces of the Sweet syndrome

Introduction: Sweet syndrome is an acute febrile neutrophilic dermatosis described in 1964 by Robert Douglas Sweet, that primarily affects individuals in their fifth to seventh decades. It can be classified into classic or idiopathic, parainflammatory, paraneoplastic, and pregnancy associated. Etiology is unknown, but many authors proposes an unusual hypersensitivity that may be mediated by cytokines, such as interleukin-1, followed by infiltration of neutrophils. Clinically, it is characterized by the abrupt onset of multiple tender, erythematous plaques or nodules.

https://ift.tt/2MujQoc

The importance of eyebrows in the treatment of alopecia areata: An online questionnaire

Background: Alopecia areata (AA) affects not only scalp hair, but often also involves the eyebrows. Most clinical studies focus on scalp hair regrowth as the primary outcome. Our study aims to assess the importance of eyebrows to AA patients.

https://ift.tt/2P0DCV0

The effectiveness of using 1% diclofenac gel and 20% azelaic acid cream for melasma: A single-blind, placebo-controlled, split-face study

Background: Nonsteroidal antiinflammatory drugs that inhibit the mediator of UV-induced melanogenesis (1-6) may be another alternate option for melasma as were azelaic acid.

https://ift.tt/2MxJEQr

Teledermatology: An updated overview of clinical applications and reimbursement policies

Telemedicine is an emerging field in health care that provides services from different medical specialties to patients all around the world. One of the specialties in telemedicine, teledermatology, has grown exponentially as a cost-effective way to implement dermatologic health care to underserved areas and populations. This article reviews the literature that pertains to the cost-effectiveness, reliability, public access, patient satisfaction, and reimbursement policies of teledermatology. Teledermatology has two established modalities: store-and-forward (asynchronous) and live interaction (synchronous).

https://ift.tt/2P0Gnpu

Sweet syndrome induced by influenza vaccination

History: A 41-year-old Caucasian man with no significant medical history presented with a painful rash on his left neck and arm. His symptoms began one day after receiving an influenza vaccination and persisted for several months. Review of systems was positive for occasional fevers and arthralgias.

https://ift.tt/2MuCvAf

Subjective facial dynamics with the use of hyaluronic acid dermal fillers formulated for facial movement and expression

Background: Not only do patients want to look younger and more attractive, patients also want to maintain a natural look following rejuvenation treatments that don't alter their facial expressions. Hence, it becomes increasingly important to assess facial dynamics as results that appear natural at rest may appear unnatural with expression. An open-label clinical study was conducted to evaluate the perception of the naturalness of facial expressions in motion following correction of wrinkles and folds in the lower face.

https://ift.tt/2OZNY7w

Sporotrichoid chromoblastomycosis on right lower leg

Introduction: Chromoblastomycosis is a worldwide chronic fungal infection caused mainly by Fonsecaea pedrosoi or Cladophialophora carrionii affecting predominantly men in tropical and subtropical countries. Patients acquire the infection through a traumatic implantation of fungi from soil. Most common clinical manifestation is a verrucous plaque. Very few cases of sporotrichoid chromoblastomycosis have been described. We report a rare lymphangitic chromoblastomycosis on right lower leg in a young male patient.

https://ift.tt/2MxtdUc

Nomogram model to predict postoperative relapse after mandibular osteoradionecrosis surgery

Osteoradionecrosis of the mandible (ORNM) is one of the most devastating complications following radiotherapy. Postoperative relapse (POR) occurs with high incidence even if a radical resection is performed. The current investigation was designed to identify prognostic factors for POR and to establish a nomogram model to estimate the risk for the onset of POR of ORNM.

https://ift.tt/2o2CJ2V

Age-related changes affecting the cricoarytenoid joint seen on computed tomography

Georges Ziade, MD; Sahar Semaan, MD; Sarah Assaad, MPH; Abdul Latif Hamdan, MD, EMBA, MPH

Abstract

We conducted a retrospective chart review to compare four characteristics-cricoarytenoid joint ankylosis, narrowing, erosion, and density increases-in patients younger and older than 65 years. Our study population was made up of 100 patients, who were divided into two groups on the basis of age. The younger group (<65 yr) comprised 49 patients (27 men and 22 women), and the older group (≥65 yr) was made up of 51 patients (25 men and 26 women). Findings on computed tomography (CT) of the neck were used to determine whether each of the four characteristics was present or absent. Overall, we found only one statistically significant difference between the two groups: ankylosis was significantly more common in the older group (p = 0.036). When we looked further at the side of these anatomic changes, we found that the older group had significantly more right-sided and left-sided ankylosis than did the younger group (p = 0.026 for both), as well as significantly more left-sided narrowing (p = 0.028) (some patients had bilateral involvement). When we analyzed age as a continuous variable, older age was again associated with significantly more ankylosis (p = 0.047) and narrowing (p = 0.011). We conclude that CT can be useful for assessing radiologic changes in the cricoarytenoid joint in elderly patients during the workup of dysphonia and abnormal movement of the vocal folds.

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Hepatozelluläres Karzinom

https://ift.tt/2o25VqN

Psychisches Wohlbefinden bei Patienten mit Leberzellkarzinom

Zusammenfassung

Hintergrund

Krebserkrankungen sowie die daraus resultierenden Folgen und Behandlungen stellen für Betroffene meist eine starke Belastung dar. Bei einem hepatozellulären Karzinom (HCC) handelt es sich um eine Krebserkrankung mit sehr schlechter Prognose. Mögliche Risikofaktoren, ein HCC zu entwickeln, nehmen in der Bevölkerung seit Jahren zu. Dennoch ist nur wenig über die psychische Belastung der Betroffenen bekannt.

Ziel der Arbeit

Ziel dieser Untersuchung war es, die psychische Belastung und Unterstützungswünsche von HCC-Patienten darzustellen.

Patienten und Methoden

In einer prospektiven Studie wurden Leberzellkarzinompatienten untersucht. Sie wurden zu Beginn und während eines Krankenhausaufenthalts, kurz vor der Entlassung aus demselben sowie 1/2 und 1 Jahr später befragt. Die psychische Belastung wurde mittels „hospital anxiety and depression scale" (HADS) erhoben. Zusätzlich wurden die Patienten gefragt, durch wen sie sich zusätzliche Betreuung wünschen. Bei der Auswertung wurde Häufigkeitsvergleiche mittels χ²-Test und Korrelationen mittels Pearson-Korrelationskoeffizient berechnet.

Ergebnisse

Insgesamt nahmen 97 Patienten an der Studie teil. Bei mehr als der Hälfte (56 %) lag der HADS-Gesamtwert zu Beginn der stationären Aufnahmen über 13, was einer überdurchschnittlichen psychischen Belastung entspricht. Über 90 % der befragten Patienten wünschten sich zu diesem Zeitpunkt psychosoziale Betreuung, zumeist durch Ärzte, Pflegekräfte und/oder Psychologen. Vor der Entlassung erhofften sich alle befragten Personen Unterstützung von Ärzten sowie Pflegekräften. Nach 1/2 Jahr wünschten sich die Betroffenen v. a. Unterstützung von Ärzten und Selbsthilfegruppen.

Diskussion

HCC-Patienten sind psychisch erheblich belastet, mit erhöhtem Betreuungsbedarf.

https://ift.tt/2BDmiDZ

Schlafendoskopie und komplett konzentrischer Weichgaumenkollaps bei CPAP-Nutzungsproblemen

Zusammenfassung

Hintergrund

Mittel der ersten Wahl bei obstruktiver Schlafapnoe (OSA) ist die Überdrucktherapie (CPAP). Allerdings kann sie von vielen Patienten nicht ausreichend genutzt werden. Mit einer medikamenteninduzierten Schlafendoskopie (DISE) lässt sich das Kollapsmuster im oberen Atemweg gut beurteilen. Ziel der Arbeit war es, ein Patientenkollektiv mit CPAP-Nutzungsproblemen mittels DISE hinsichtlich von Nutzungsproblemen und Therapieempfehlungen auszuwerten.

Methode

Über einen Zeitraum von 5 Jahren wurden alle Patienten mit einem Apnoe-Hypopnoe-Index (AHI) ≥15/h mittels DISE retrospektiv ausgewertet und die empfohlenen Therapieoptionen erfasst.

Ergebnisse

Die Datenanalyse von 210 Patienten ergab, dass etwa zwei Drittel Maskenprobleme als ursächlich für die CPAP-Ablehnung angaben. Bei 75 % konnte ein komplett konzentrischer Kollaps (CCC) ausgeschlossen werden, diese Patienten wiesen niedrigere AHI-Werte auf und hatten häufiger eine Tonsillektomie (TE) als Patienten mit CCC. Patienten mit einem Body-Mass-Index (BMI) > 35 kg/m² hatten doppelt so oft einen CCC wie die mit einem BMI < 35 kg/m². Bei fast gleichem BMI und AHI war bei Patienten ohne vorangegangene TE knapp doppelt so oft ein CCC zu erkennen wie mit TE.

Schlussfolgerung

Die Reihung der Therapieempfehlungen verändert sich häufig bei der Berücksichtigung von CCC, BMI > 35 kg/m² und vorheriger TE.

https://ift.tt/2LmquaC

Safety of Drilling 3-Dimensional–Printed Temporal Bones

This occupational safety assessment evaluates a surgeon's exposure to volatile organic compounds when drilling 3 commonly used materials in 3-dimensional–printed temporal bone implants using a standard Office of Safety and Health Administration protocol.

https://ift.tt/2o23Eff

Evolving Nomenclature of Thyroid Cancer

"Cancer is a word, not a sentence," acknowledged John Diamond as he embarked on an ultimately losing fight with oral carcinoma. It reflects the fear that the word cancer has instilled in the public for millennia. To many, a cancer diagnosis was, and remains, akin to a death sentence or, at the very least, a jarring call to battle. This connotation is rooted in the long-established theory of linguistic relativism, which stipulates that thought and action are determined a priori by language itself. Even today, our nuanced understanding of cancer biology and the inherent diversity of malignant processes has not erased the stigma and terror that the word evokes in our patients.

https://ift.tt/2BHpUF3

Medical Practice Entrepreneurship

To the Editor Faucett et al, in their review of Accreditation Council for Graduate Medical Education (ACGME) core competencies, concluded that there should be an increased emphasis on nonclinical core competencies, such as professionalism and systems-based practice.

https://ift.tt/2o6j6XM

Medical Practice Entrepreneurship—Reply

In Reply We appreciate the comments made by Dr Meyers regarding the integration of business education into residency program curricula. As we all know, rising health care costs, decreasing reimbursement rates, and changes in American health care reform are forcing physicians to become more business-minded. However, a significant percentage of physicians indicate that their training did a fair or poor job of preparing them to manage the business aspects of medicine, which suggests that it would be useful for educators to reexamine residency training education to ensure that physicians are prepared for the practice environment.

https://ift.tt/2BHG3dy

Reversible Auricular Necrosis Secondary to Systemic Thrombosis

This report describes a woman diagnosed with a rare case of concomitant heparin-induced thrombocytopenia and antiphospholipid antibody syndrome that presented with auricular necrosis.

https://ift.tt/2o4vTtG

Evaluation of Social Media Presence of Otolaryngology Residency Programs in the United States

This cross-sectional study examines the presence and activity of otolaryngology residency programs on social media sites.

https://ift.tt/2BDQDlS

Effect of a Change in Papillary Thyroid Cancer Terminology on Anxiety Levels and Treatment Preferences

This randomized cross-over trial analyzes how use of the word cancer may affect adults' level of anxiety and choice to undergo surgery for small, low-risk papillary thyroid cancer.

https://ift.tt/2o52UpL

Castleman disease

Jason E. Cohn, DO; Jing Zhou, MD, PhD; Amanda Hu, MD

HIV-negative Castleman disease has been associated with autoimmune disease, collagen vascular disorders, pulmonary arterial hypertension, and glomerulopathy.

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Physical exercise contributes to cisplatin-induced nephrotoxicity protection with decreased CD4+ T cells activation

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Mariana Yasue Saito Miyagi, Marcela Teatin Latancia, Leonardo Abreu Testagrossa, Vinicius de Andrade-Oliveira, Welbert Oliveira Pereira, Meire Ioshie Hiyane, Lucas Maceratesi Enjiu, Marcus Pisciottano, Marilia Cerqueira Leite Seelaender, Niels Olsen Saraiva Camara, Mariane Tami Amano

Abstract

Cisplatin is a chemotherapy used to treat different types of cancer, such as testicular, bladder and head and neck. Physical exercise has been shown to improve cancer therapy and recently, it was demonstrated to be able to diminish side effects such as acute kidney injury (AKI), a common side effect in cisplatin treatment. In both cases, the modulation of inflammatory cytokines seems to be one of the mechanisms, but little is known about the immune cells in this process. Here, we investigated the role of CD4 + T cells in the AKI protection by physical exercise. We subjected C57Bl6 mice to long-term physical exercise (EX) before cisplatin treatment. Sedentary groups were used as control (CT). We confirmed that physical exercise decreased AKI by evaluating creatinine and Kim-1 levels, in the serum and kidney respectively. Analyzing the organs weight, we noticed a decrease in sedentary (CIS) and exercised (CIS-EX) cisplatin treated groups. Epididymal and brown adipose tissue weight were decreased in cisplatin treated subjects in comparison to untreated groups, as well as liver and spleen. We then investigated the profile of CD4 + T cells in the spleen and we observed increased levels of Tregs and CD4+CD25+ cells in CIS group, while CIS-EX presented similar amounts as control groups. Analyzing the kidney lymph nodes, we noticed a decrease of CD4+ cells in both CIS and CIS-EX group. However, a more activated phenotype (CD69+ and CD25+) was observed in CIS groups in comparison to CIS-EX group, as well as the presence of Tregs. We then investigated the production of cytokines by these cells and no difference among the groups was observed in cytokines production in splenic CD4 + T cells. However, a clear increase in TNF and IL-10 production was observed in CD4 + T cells from lymph nodes, while CIS-EX group presented similar levels as the control groups. We confirmed that physical exercise was able to diminish cisplatin-induced AKI with concomitant decrease in CD4 + T cell activation.

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Generation of novel Id2 and E2-2, E2A and HEB antibodies reveals novel Id2 binding partners and species-specific expression of E-proteins in NK cells

Publication date: Available online 23 August 2018

Source: Molecular Immunology

Author(s): Jai Rautela, Laura F. Dagley, Tobias Kratina, Angaleena Anthony, Wilford Goh, Elliot Surgenor, Rebecca B. Delconte, Andrew I. Webb, Ngaire Elwood, Joanna R. Groom, Fernando Souza-Fonseca-Guimaraes, Lynn Corcoran, Nicholas D. Huntington

Abstract

NK cells are cytotoxic lymphocytes with a key role in limiting tumour metastases. In mice, the NK cell lineage continually expresses high levels of the Inhibitor of DNA-binding 2 (Id2) protein and loss of Id2 is incongruous with their survival due to aberrant E-protein target gene activity. Using novel Id2 and E-protein antibodies that detect both mouse and human proteins, we have extensively characterised Id2 and E-protein expression in murine and human NK cells. We detected clear expression of E2 A and HEB, and to a lesser extent E2-2 in murine NK cells. In contrast HEB appears to be the major E-protein expressed in human NK cells, with minor E2-2 expression and surprisingly, no E2 A detected in primary NK cells nor human NK cell lines. These novel antibodies are also functional in immunofluorescence and immunoprecipitation. Mass spectrometry analysis of Id2 immuno-precipitated from murine NK cells revealed a number of novel associated proteins including several members of the SWI/SNF-related matrix-associated actin-dependent regulator chromatin (SMARC) and Mediator complex (MED) families. Taken together, these data highlight the utility of novel Id2 and E-protein antibodies and caution against mouse models for understanding Id2/E-protein biology in NK cells given their clearly disparate expression patternbetween species.

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Ancillary medications and outcomes in post-tonsillectomy patients

Ashley P. O'Connell Ferster, MD; Eric Schaefer, MS; Jane R. Schubart, MBA, PhD; Michele M. Carr, DDS, MD, PhD

Abstract

To investigate the impact of medications on outcomes after tonsillectomy, a retrospective review using the MarketScan database was performed. A total of 306,536 privately insured children and adolescents (1 to 17 years old) who underwent tonsillectomy/adenoidectomy were identified from 2008 to 2012. Pharmaceutical claims identified patients who received outpatient prescriptions for ibuprofen, steroids, or topical anesthetics until discharge and for medications for the treatment of attention deficit hyperactivity disorder (ADHD) or montelukast up to 14 days postoperatively. Logistic regression compared prescription claims to outcomes, including postoperative bleeding, dehydration, emergency department visits, and readmissions. Ibuprofen was the only medication associated with increased odds of postoperative bleeding (odds ratio [OR]: 1.45, 95% confidence interval [CI]: 1.07 to 1.95). Patients receiving steroids had lower odds of dehydration (OR: 0.74, 95% CI: 0.65 to 0.84) and emergency department visits (OR: 0.82, 95% CI: 0.76 to 0.88). Odds of dehydration were highest in patients taking ADHD medications (OR: 1.38, 95% CI: 1.15 to 1.66) and topical anesthetics (OR: 1.32, 95% CI: 1.10 to 1.59). Although causality cannot be assumed in observational studies, steroids and ibuprofen should be used judiciously.

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Treatment outcomes in HPV-negative oropharyngeal cancer: Surgery plus radiotherapy vs. definitive chemoradiotherapy

Dominique Rash, MD; Megan E. Daly, MD; Blythe Durbin-Johnson, PhD; Andrew T. Vaughan, PhD; Allen M. Chen, MD

Abstract

We performed a retrospective study to compare clinical outcomes among 51 consecutively presenting patients-38 men and 13 women, aged 46 to 74 years (median: 57)-with locally advanced human papillomavirus (HPV)-negative oropharyngeal cancer who were treated with either primary surgery followed by postoperative radiotherapy (S/RT group; n = 22) or definitive chemoradiotherapy alone (CRT group; n = 29). Within the cohort, 45 patients reported a history of tobacco use, with a median intensity of 40 pack-years. In addition, 39 patients (76%) reported moderate to heavy alcohol use. At baseline, there were no statistically significant differences between the two cohorts in sex, median age, cancer stage, intensity of smoking history, and alcohol use (p > 0.05 for all). Radiation doses ranged from 40 to 70 Gy (median: 70). Follow-up ranged from 2 to 93 months (median: 29). After treatment, we found no difference between the S/RT group and the CRT group in the incidence of locoregional recurrence (36 vs. 24%; p = 0.43) or distant metastases (14 vs. 21%; p = 0.56). Likewise, the difference in 2-year estimates of progression-free survival in the two groups was not significant (66 vs. 62%; p = 0.64), nor was the difference in 2-year overall survival (75 vs. 76%; p = 0.83). We conclude that treatment with either (1) primary surgery followed by postoperative radiotherapy or (2) CRT for locally advanced HPV-negative oropharyngeal cancer results in similar outcomes. In view of the relatively poor prognosis for patients with HPV-negative disease compared with their HPV-positive counterparts, clinical trials to investigate intensifying treatment may be warranted.

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A rare case of odontoameloblastoma in a geriatric patient

Pratyusha Yalamanchi, MD, MBA; Orly Coblens, MD; Meejin Ahn, DO; Steven B. Cannady, MD; Jason G. Newman, MD

Abstract

Odontoameloblastoma is an extremely rare tumor derived from odontogenic epithelium and mesenchyme. In the fewer than 20 reported cases, odontoameloblastoma is described as occurring in the maxilla or mandible of young men with a history of unerupted teeth. Here we report a case of a 73-year-old woman who presented to the dentist for routine cleaning and x-rays, which displayed a mandibular lesion. After referral to multiple providers, a biopsy of two involved teeth was obtained and computed tomography of the neck was performed, revealing a large, destructive lesion of the mandible. Histology was consistent with odontoameloblastoma. The patient underwent wide segmental mandibular resection and scapula tip free flap reconstruction. She recovered uneventfully and continues to have close follow-up, given the risk of recurrence. To the best of our knowledge, this is the first reported case of odontoameloblastoma in a patient over age 50. The goal of the authors is to raise awareness of this rare pathology and its diagnostic and management modalities.

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Dacryocystorhinostomy with a thulium:YAG laser-a case series

Christopher Tang, MD; Scott Rickert, MD; Niv Mor, MD; Andrew Blitzer, MD, DDS; Martin Leib, MD

Abstract

We conducted a retrospective chart review of 27 patients-7 men and 20 women, aged 47 to 94 years (mean: 71.3)-with symptomatic epiphora secondary to dacryostenosis who had undergone thulium: YAG (Tm:YAG) laser dacryocystorhinostomy (DCR). Among them, dacryostenosis had been documented in 35 eyes by dacryocystography. The Tm:YAG procedure involved the administration of local anesthesia, after which a 600-μm laser fiber was inserted into the lacrimal canaliculi and then into the nasolacrimal duct. Under endoscopic visualization, the DCR was performed anterior and inferior to the middle turbinate, which created an opening. Silicone stents were then inserted and tied intranasally. In the immediate postoperative period, all 27 patients noted initial improvement. During a follow-up of 22 days to 25 months (mean: 11.3 mo), 24 of the 27 patients (89%) remained symptom-free, while the remaining 3 patients (11%) experienced a treatment failure and required revision surgery. To the best of our knowledge, only two articles on thulium laser therapy for DCR have been previously published, both approximately 25 years ago; both involved the use of a thulium along with holmium and chromium in cadavers. As far as we know, our case series is the largest in the English-language literature that has documented the use of the thulium in laser therapy for DCR, and it is the only in vivo study. We found that DCR with the Tm:YAG laser was an effective and affordable option for patients with symptomatic epiphora secondary to lacrimal obstruction.

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A polyp originating in the middle turbinate and extending to the maxillary sinus ostium

Jae Hoon Lee, MD

The clinical presentations of nasal polyps include nasal obstruction, rhinorrhea, postnasal drip, anosmia, hyposmia, and facial pain.

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Endoscopic view of postoperative maxillary sinus mucoceles separated by bony septum

Jae Hoon Lee, MD

Postoperative maxillary sinus mucocele usually presents 20 to 30 years after Caldwell-Luc surgery involving the maxillary sinus.

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Bilateral massive pharyngoceles

Norair Adjamian, DO; Lyndsay L. Madden, DO; Libby J. Smith, DO

The differential diagnosis of pharyngoceles can be vast, and misdiagnosis often can occur without proper imaging studies.

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Inflammatory myofibroblastic tumor of the epiglottis excised with a carbon dioxide laser: Case report and literature review

Blake Raggio, MD; Neil Chheda, MD

Abstract

Inflammatory myofibroblastic tumor (IMT) is a benign neoplasm of intermediate biologic potential. It rarely occurs in the larynx, and it has not been previously reported in the epiglottis. We treated a 66-year-old woman who presented with progressive dysphonia and a mass on her suprahyoid epiglottis. The tumor was completely excised with a CO2 laser; no adjuvant therapy was administered. Histopathology revealed that the mass was an IMT. No evidence of recurrence was noted after 6 months of follow-up. We present what we believe is the first case of an epiglottic IMT to be reported in the literature, and we propose CO2 laser excision without adjuvant therapy as an acceptable treatment.

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Persistent stapedial artery with ankylosis of the stapes footplate

Fiona C. Hill, MBBS; Bing Teh, MBBS; Michael Tykocinski, FRACS

Persistent stapedial artery may present as a pulsatile middle ear mass or may appear as an incidental finding during middle ear surgery.

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Applicability of the real ear measurement for audiological intervention of tinnitus

Publication date: Available online 23 August 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Andressa Vital Rocha, Maria Fernanda Capoani Garcia Mondelli

Abstract

Introduction

Tinnitus is present in a large part of chronic health complaints, and it is considered a public health problem injurious to the individual's quality of life. Considering the increase of the world population associated with an increase of life expectancy, tinnitus remains a cause for medical concern, since during aging the occurrence of auditory impairments due to the deterioration of the peripheral auditory structures and central impairs the quality of life.

Objective

The aim of the present study was to analyze the applicability of real ear measurements for audiological intervention of tinnitus through specific evaluation, selection, verification and validation of the hearing aids combined with the sound generator.

Methods

Forty individuals of both genders with hearing loss and tinnitus complaints were deemed eligible to compose the sample. They were enrolled according to clinical symptoms and submitted to the following procedures: anamnesis and previous complaint history, high frequency audiometry, immittanciometry and acuphenometry with the research of psychoacoustic thresholds of pitch, loudness and minimum masking threshold, sound generator, in addition to the application of the Tinnitus Handicap Inventory and Visual Analog Scale tools. The entire sample was adapted with Siemens hearing aids and a sound generator, participated in a counseling session with support of digital material and evaluated in two situations: Initial Assessment (before the hearing aids and sound generator adaptation) and Final Assessment (6 months, after adaptation). The statistical analyzes were descriptive and inferential, adopted a significance level of 5% and the T-Paired Test and the Spearman Correlation test were performed.

Results

The results showed that there was a benefit with the use of hearing aids combined with a sound generator from the statistically significant values and strong correlations between the sound generator verification data regarding acuphenometry and the nuisance/severity questionnaires. Regarding the verification of the sound generator, it is important to highlight that the entire sample selected the effective acoustic stimulation based on the comfort levels, which was proved in the present study to be a sufficient intensity for positive prognosis, whereas the users' noises were found below the psychoacoustic thresholds of acuphenometry.

Conclusion

The present study concluded that the audiological intervention with any level of sound stimulus is enough to obtain a positive prognosis in the medium term. Data that specifies that the verification of sound generator was effective at the real ear measurements are important in the evaluation and intervention of the complaint. In addition, it points out that the greater the tinnitus perception, the greater its severity, and the greater the nuisance, the higher the psychoacoustics thresholds of frequency and the minimum threshold of masking.

Resumo

Introdução

O zumbido está presente em grande parte das queixas crônicas de saúde, sendo considerado um problema de saúde pública, prejudicial à qualidade de vida do indivíduo. Considerando o aumento da população mundial associado ao aumento da expectativa de vida, a tendência é que o zumbido permaneça como um motivo de preocupação, uma vez que com a idade a ocorrência de prejuízos auditivos decorrentes da deterioração das estruturas auditivas periféricas e centrais, ocasionam grande impacto negativo na qualidade de vida.

Objetivo

O objetivo do presente estudo foi analisar a aplicabilidade das medidas da orelha real para a intervenção audiológica do zumbido através de avaliação específica, seleção, verificação e validação do aparelho de amplificação sonora individual combinado ao gerador de som.

Método

Quarenta indivíduos de ambos os sexos com perda auditiva e queixa de zumbido foram considerados elegíveis para compor a amostra. Eles foram atendidos conforme a demanda clínica e submetidos aos seguintes procedimentos: anamnese e histórico prévio de queixa, audiometria de alta frequência, imitanciometria e acufenometria com pesquisa dos limiares psicoacústicos de pitch, loudness e limiar mínimo de mascaramento, gerador de som, além da aplicação das ferramentas tinnitus handicap inventory e escala visual analógica. Toda a amostra recebeu aparelho de amplificação sonora individual e gerador de som, ambos da marca Siemens, participaram de uma sessão de aconselhamento com apoio de material digital e foram avaliados em duas situações: Avaliação inicial (antes da adaptação dos aparelhos de amplificação sonora individual e gerador de som) e Avaliação final (6 meses após a adaptação). As análises estatísticas foram descritivas e inferenciais, adotando um nível de significância de 5% com a realização do teste t-pareado e o teste de correlação de Spearman.

Resultados

Os resultados mostraram que houve benefício com o uso de aparelho de amplificação sonora individual combinado ao gerador de som com base nos valores estatisticamente significantes e fortes correlações entre os dados da verificação do gerador de som em relação à acufenometria e os questionários de incômodo/gravidade. Em relação à verificação do gerador de sons, é importante destacar que toda a amostra selecionou a estimulação acústica efetiva baseada nos níveis de conforto, e no presente estudo demonstraram ser de intensidade suficiente para o prognóstico positivo, enquanto que os ruídos dos usuários estavam abaixo dos limiares psicoacústicos da acufenometria.

Conclusão

O presente estudo concluiu que a intervenção audiológica com qualquer nível de estímulo sonoro é suficiente para obter um prognóstico positivo em médio prazo. Os dados que demonstram que a verificação do gerador de som foi efetiva nas medidas da orelha real são importantes na avaliação e intervenção da queixa. Além disso, mostram que quanto maior a percepção do zumbido, maior a sua gravidade; e quanto maior o incômodo, maiores os limiares de frequência psicoacústica e o limiar mínimo de mascaramento.

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Two cases of laryngeal fractures treated with titanium mesh fixation

Publication date: Available online 23 August 2018

Source: Auris Nasus Larynx

Author(s): Taku Sato, Takaharu Nito, Rumi Ueha, Takao Goto, Tatsuya Yamasoba

Abstract

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. In this case report, we describe two patients who underwent successful fixation of fractures in their laryngeal cartilage after trauma by using titanium mesh with thread and screws. Since optimal reduction and fixation of fractured laryngeal cartilage cannot be performed with conventional methods in patients with unossified cartilage, titanium mesh may be considered a safe and reliable alternative.

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

Publication date: Available online 23 August 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Bong Chul Kim, Helios Bertin, Hak-Jin Kim, Sang-Hoon Kang, Jacques Mercier, Jean-Philippe Perrin, Pierre Corre, Sang-Hwy Lee

Summary

Purpose

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.

Materials and Methods

We reconstructed 3D mandibles from computed tomographic images of French and Korean patients with HFM (N=28; group II) and normal subjects (N= 27; group I). Each mandible was classified by Pruzansky's HFM types I, II and III, and by age group (child, adolescent, and adult). The mandible was divided into skeletal units, and geometrical representation by skeletal unit line was performed, including the condylar, body, coronoid, and angular units. Their length and angulations were measured and statistically analyzed.

Results

The results showed that the affected condylar unit in type II HFM and the condylar/coronoid unit in type III were smaller in young age groups than were other units. The angulation between the skeletal units in type II, though not type III, tended toward normalcy with age, but not to the normal degree of angulations in group I.

Conclusion

Our study shows the major involvement of condylar unit and minor involvement of body unit for HFM, improving with age in type II. The mandibular skeletal unit analysis seems to be a useful tool for individualized diagnosis, allowing identification of the major etiopathogenic area and treatment planning, including a simulation to set up a regimen for successful reconstruction of HFM.

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A Multi-Center Clinical Trial in Individuals With Spinal Cord Injury

Condition:   Spinal Cord Injuries
Interventions:   Device: Acute Intermitted Hypoxia;   Procedure: Massed Practise;   Device: Rapael Glove
Sponsor:   Shirley Ryan AbilityLab
Recruiting

https://ift.tt/2o1ldvZ

Men and Women Offering Understanding of Throat HPV

Conditions:   Oropharyngeal Cancer;   Human Papilloma Virus
Intervention:  
Sponsors:   Johns Hopkins Bloomberg School of Public Health;   Icahn School of Medicine at Mount Sinai;   Oregon Health and Science University;   National Institute of Dental and Craniofacial Research (NIDCR)
Recruiting

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

Publication date: Available online 23 August 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): R.K. Menon, D. Gopinath, K.Y. Li, Y.Y. Leung, M.G. Botelho

Abstract

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). However, with the exclusion of randomized controlled trials with a split-mouth design (due to an inadequate crossover period after antibiotic treatment), only amoxicillin–clavulanic acid was found to be effective (RR 0.21, P < 0.001). The risk of adverse effects was significantly higher in the amoxicillin–clavulanic acid group (RR = 4.12, P = 0.023) than in the amoxicillin group (RR 1.57, P = 0.405). In conclusion, amoxicillin–clavulanic acid and amoxicillin may significantly reduce the risk of infection after third molar extraction. However, their use in third molar surgery should be viewed with caution, as recent clinical trials on healthy volunteers have shown evidence of the negative impact of amoxicillin use on bacterial diversity and antibiotic resistance.

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

Publication date: Available online 23 August 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): P. J.W. Stoelinga

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

Publication date: Available online 23 August 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): L. Xia, Y. He, J. An, S. Chen, Y. Zhang

Abstract

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. Changes in maximum mouth opening were evaluated >1 year postoperatively.

Postoperative follow-up showed similar average maximum mouth opening and one case of recurrence in each group. Computed tomography measurements showed that condylar width and mandibular ramus height increased in both groups A and B (P < 0.05). Moreover, in group A, condylar angulation of medially displaced malformation decreased by 13.2° (P < 0.05), and mandibular body length increased by 5.7 mm (P < 0.05). Thus, both condyle-preserved arthroplasty and costochondral grafting were effective surgical methods for treatment of temporomandibular joint ankylosis. Moreover, compared with group B, group A patients manifested more remarkable mandibular growth, at least in the anteroposterior direction of the mandibular body.

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Patient expectations and satisfaction following orthognathic surgery

Publication date: Available online 22 August 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): N. Al-Hadi, S. Chegini, M.E. Klontzas, J. McKenny, M. Heliotis

Abstract

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. Most patients were 'very satisfied' (71.2%) or 'satisfied' (19.5%) with the overall treatment. The majority wished to improve their smile (78.0%); post-treatment, 89.0% of patients reported an improved smile. Almost half of the patients (46.6%) stayed in hospital for only one night, and 41.5% took over 4 weeks off work or school post-surgery. People with postoperative breathing difficulties spent more days in hospital (P = 0.021), but importantly, the duration of hospital stay did not differ between maxillary advancement, bilateral sagittal split osteotomy, and bimaxillary surgery (P = 0.78). In conclusion, patient satisfaction was high following orthognathic treatment. The results highlight areas for improvement, such as information delivery to the patient throughout the treatment journey, and show that the presence of ongoing problems is an important predictor of patient satisfaction.

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Global Professional Behaviours and Networking Preferences of Young Otolaryngologists – An International Survey

Publication date: Available online 22 August 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): K.A. Stephenson, D. Ramdhani, I. Fournier, T. Ayad

Abstract

Aims

An international survey was conducted to explore the professional and regional spread of "young" otolaryngologists, their society membership and networking preferences, with relevance to global health and future initiatives.

Material and methods

Otolaryngologists under the age of 45 years who had attended the 2017 International Federation of Otorhinolaryngological Societies (IFOS) meeting were invited by e-mail to participate in an online survey. Basic demographic data and information regarding career geography and networking preferences was requested.

Results

A total of 928 responses (including 635 certified otolaryngologists and 268 trainees) were received from 2787 individuals invited to complete the survey. The overall response rate was 33.3%. Most otolaryngologists were based in an academic hospital. The spread of respondents likely reflects the European location of the meeting from which participants were identified; 61.2% of all respondents were based in Europe. International movement between career stages was evident. The principal preferred networking methods involved face-to-face contact whilst social media use was the method of choice for 13%.

Conclusion

This survey offers a present-day snapshot and is hoped to serve as a platform for further work. Little is known on a global scale regarding the professional behaviours and networking preferences of otolaryngologists. A greater understanding will facilitate not only education and research but also enable networking and global health work.

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What is the availability of services for paediatric ENT surgery and paediatric surgery in Africa?

Publication date: Available online 22 August 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): S. Peer, I. Vial, A. Numanoglu, J.J. Fagan

Abstract

Background

Children constitute 50% of Africa's population. Sub-Saharan Africa has the highest under-five mortality rates in the world. This study is the first to document the availability of paediatric ENT and paediatric surgery services in Africa.

Objective

To determine the availability of paediatric ENT services in Africa, as well as that of paediatric surgery that would complement paediatric ENT.

Method

A descriptive observational study in the form of an online questionnaire was distributed by email to known ENT and paediatric surgeons based in Africa.

Results

Surgeons from twelve of 23 African countries responded to the survey. Seven countries had both ENT and paediatric surgery responses. In 8 of the 11 countries, the number of ENT surgeons per country was < 6% of that of the UK, with 1 ENT surgeon per 414,000 people and 1 paediatric surgeon per 1,181,151 people. Ten of 11 countries reported hearing assessments in schools were poor/unavailable. Seventy-three percent responded positively for access to rigid laryngoscopes, bronchoscopes, cameras and fibre optic cables, tracheostomy, anaesthesia and nurse practitioners. Access was reported as poor/unavailable for balloon dilators 73% (8/11 countries); CPAP machines 73% (8/11) and sleep studies 82% (9/11 countries). Flexible endoscopes were available in 50% (4/8 countries), 75% (6/8 countries) had access to a camera, monitor and stack. Thirty-eight percent (3/9 countries) reported no ENT specialists with paediatric training.

Conclusions

There is a great shortage of paediatric ENT and paediatric surgery services in Africa. More regional training opportunities and health infrastructure for these surgical specialties are needed. Collaborative development of paediatric ENT, surgery and anaesthesia should be considered to improve ENT-related child health in Africa.

https://ift.tt/2wjU37b

Barriers to research among residents in Otolaryngology - Head & Neck Surgery around the world

Publication date: Available online 22 August 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): I. Fournier, K. Stephenson, N. Fakhry, H. Jia, R. Sampathkumar, J.R. Lechien, A.E. Melkane, A.Y. Bahgat, K. De Carvalho Lopes, T. Kennel, N. Teissier, T. Ayad

Abstract

Objectives

To document the challenges faced by residents in Otolaryngology - Head & Neck Surgery (OTL-HNS) around the world to successfully complete research projects. The second objective is to assess if the challenges are uniform worldwide.

Methods

A survey was sent to all OTL-HNS under 45 years old from the 2017 IFOS meeting. This survey was conducted by the YO-IFOS group (Young Otolaryngologists of the International Federation of Otolaryngological Societies). Data was collected for a period of 1 month. Demographic characteristics, information regarding research projects conducted and data concerning perceived barriers to completion of research projects were collected.

Results

Among the 2787 attendees, 928 responded to the survey (response rate = 33.3%). Of these 928 answers, 267 responses were from residents/interns in OTL-HNS, while 635 responses were from certified otolaryngologists. The three most frequent obstacles to conducting research projects for trainees were limited dedicated time (64%), insufficient financial resources (55%) and lack of education in research (45%). There was no statistical difference in these barriers among the different countries (P > 0.05).

Conclusion

This is the first international study that provides insight on trainee's challenges to conduct research projects during residency. Despite the notion that research is essential for generating new knowledge to guide patient care, many residents fail to successfully incorporate research in their surgical curriculum. These obstacles must be addressed by Otolaryngology - Head & Neck Surgery programs in order to facilitate and support resident's research.

https://ift.tt/2PxrHPO

Functional mandibular reconstruction with double-barrel fibular flap and primary osseointegrated dental implants improve facial aesthetic outcome

Publication date: Available online 22 August 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Jie Chen, Ping Yin, Ning Li, Limeng Wu, Xinchun Jian, Canhua Jiang

Abstract

Introduction

Osseo-integrated dental implants in fibula free flaps can be used to reconstruct segmental mandibular defects resulting from head and neck resections. Double-barrel fibula flap (DBFF) has been applied as a modified method to overcome the insufficient width of fibula. This article describes DBFF with simultaneous dental implants placement as a superior method for esthetic mandibular reconstruction.

Methods

From 2012 to 2015, 26 patients underwent mandibular reconstruction with free fibula flap and immediate dental implant placement after segmental mandibulectomies. Among them 12 patients used DBFF while the other 14 patients used the conventional single barrel fibula flaps (SBFF). Palatal mucosal graft was performed if necessary. Functional and esthetic outcome was evaluated after 31 to 45 months' follow-up.

Results

All microvascular fibula transplantation were successful. All patients completed prosthodontic rehabilitation. The mean follow-up of patients after the reconstruction was 36.3 months (range: 31-45 months). The facial esthetic score was significantly higher in patients treated with DBFF than SBFF after 24 and 30 months (p<.05). No significant difference of marginal bone resorption between DBFF and SBFF (p>.05).

Conclusions

The one-stage surgical method is safe and reliable. DBFF significantly reduced the height discrepancy between the naïve and neomandible and achieve a better lower face esthetic outcome than SBFF. Osseointegrative dental implantation was adequate to achieve satisfactory dental rehabilitation in DBFF.

https://ift.tt/2LmsRtZ

What is the most effective rehabilitation method for posterior maxillae with 4 to 8 mm of residual alveolar bone height below the maxillary sinus with implant-supported prostheses? A frequentist network meta-analysis

Publication date: Available online 22 August 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Essam Ahmed Al-Moraissi, Nashwan Hamid Altairi, Bassam Abotaleb, Ghassan Al-Iryani, Essam Helboub, Mohammed Sultan Alakhali‬‏

Abstract

Purpose

The most effective rehabilitation method for patients with edentulous posterior maxillae having an intermediate (4 to 8 mm) residual bone height (RBH) below maxillary sinus is unclear. Evidence derived from conventional meta-analysis is limited due to the lack of head to head studies. We performed this network meta-analysis (NMA) to identify the most effective method to treat patients with intermediate posterior RBH.

Material and Methods

We conducted NMA of randomized controlled clinical trials (RCTs) assessing various rehabilitation methods using implant supported prostheses for patients having intermediate posterior maxillary RBH (4-8 mm). The publications from 1970 to March 2018 in three major databases were searched. Both parallel and split mouth RCTs that reported the outcomes of interest with follow up of at least six months from initial loading were included. The predictor variables were short implants (SI) (≤8 mm) alone, SI in conjunction with osteotome sinus floor elevation (OSFE) with or without bone grafting, long implants (LI) in conjunction with OSFE with and without bone grafting, and LI combined with lateral sinus floor elevations (LSFE) with bone grafting. The outcome variables were implants and prostheses failure rates, marginal bone loss and complications. Frequentist NMA was performed using STATA software.

Results

We included a total of 20 RCTs involving 770 patients with intermediate posterior maxillary RBH and 837 concerned maxillary sinuses who received 1486 implants using any of the 4 rehabilitation methods. There were no statistical significant differences between the four groups in terms of implants and prosthesis failure rates and marginal bone loss at follow-up time which ranged from 6 months to 5 years after loading. There was a significant reduction in complications for SI alone compared to LI combined with LSFE. For implants and prosthesis survival rates, SI in conjunction with OSFE w/o bone grafting ranked first as the most effective option (77.1%) followed by LI+OSFE w/o bone grafting (62%), LI+LSFE with bone grafting (43.9%), and finally SI alone (24.8%).

Conclusion

There is a moderate quality evidence derived from this NMA showing that OSFE combined with short or long implants either with or without bone grafting or SI alone are superior to long implants combined with LSFE and bone grafting when used for patients with intermediate maxillary RBH (4 –8 mm). Furthermore, the results of this study are showing that LSFE for patients with intermediate RBH is not a suitable treatment option because of unjustified high cost and rate of complications.

https://ift.tt/2w5mpD2

Covering the PDMP gap: Using Shared Decision Making to Reduce Dental Opioid Prescriptions

Publication date: Available online 22 August 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Tim T. Wang, Elliot V. Hersh, Neeraj Panchal

https://ift.tt/2Llb1HV

Elective neck dissection versus observation in squamous cell carcinoma of oral cavity with clinically N0 neck: A systematic review and meta-analysis of prospective studies

Publication date: Available online 22 August 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Zhangfan Ding, Tingying Xiao, Jie Huang, Yihang Yuan, Qingsong Ye, Ming Xuan, Huixu Xie, Xiaoyi Wang

Abstract

Purpose

To assess the possible benefits of elective neck dissection (END) in patients with squamous cell carcinoma (SCC) of oral cavity and clinically N0 neck.

Methods

MEDLINE, Embase, China National Knowledge Infrastructure, and Wan Fang Database were systematically searched. A meta-analysis was performed to evaluate the possible benefits of END to such patients.

Results

A total of 6 prospective studies involving 865 subjects fulfilled the inclusion criteria. The meta-analysis of all included studies revealed that END reduced the risk of regional recurrences significantly (RR 0.27; 95% CI 0.21-0.36) in the fixed effect model compared with the control, observation only. Three of the 6 included studies showed that the specific death rate related to regional recurrences was lower in END group than the observation group in the fixed effect model (RR 0.35; 95% CI 0.19-0.65). The mean metastasis rate of occult cervical lymph node was 30.27% with the standard deviation (SD) of 9.42. When fixed effect model was applied, four of the 6 included studies showed a less recurrence in END group compared with the observation group(RR 0.53; 95% CI 0.44-0.64).

Conclusions

END significantly reduces the recurrences and the death related to regional recurrences in early-stage SCC of oral cavity with clinically N0 neck, especially SCC of oral tongue and floor of mouth, which is necessary for such patients.

https://ift.tt/2w5mlmM

Development of Medication Related Osteonecrosis of the Jaw (MRONJ) after extraction of teeth with experimental periapical disease

Publication date: Available online 22 August 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Danny Hadaya, Akrivoula Soundia, Ioannis Gkouveris, Sarah Dry, Tara Aghaloo, Sotirios Tetradis

Abstract

Objectives

Medication related osteonecrosis of the jaw (MRONJ) is a rare, but severe side effect of antiresorptive medications. Most animal models utilize tooth extraction as an instigating local factor to induce MRONJ, with varied results. However, these teeth are healthy, absent of dental disease, a rare finding that does not reflect clinical practices. We hypothesize that extraction of teeth with periapical inflammation leads to MRONJ in rats treated with high-dose bisphosphonates.

Materials and Methods

Rats were pre-treated with zoledronic acid (ZA) for 1-week. Pulp Exposure (PE) was established by exposing the pulpal chamber of the first and second molars. Experimental Periapical Disease (EPD) was induced by pulp exposure and bacterial inoculation into pulp chambers of the first and second mandibular molars. The mandibular molars were extracted 4-weeks following PE or EPD, and animals euthanized 4-weeks after tooth extraction. Extraction sockets were assessed clinically, radiographically, and histologically.

Results

Clinically, radiographically and histologically, socket healing was observed in all Veh animals, and in ZA animals after extraction of healthy teeth or teeth with PE. In contrast, bone exposure, lack of socket healing and osteonecrosis were present in the majority of the ZA animals after extraction of teeth with EPD. Bacterial presence was noted in areas of osteonecrotic alveolar bone.

Conclusion

Our data support a synergistic contribution of severe dental disease and tooth extraction for MRONJ pathogenesis. Importantly, this model is amenable to manipulation of methodological conditions for the dissection of parameters involved in MRONJ pathogenesis.

https://ift.tt/2LlAqB3

Sleep Disorders and Atopic Dermatitis : a Two-Way Street?

Publication date: Available online 23 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Yung-Sen Chang, Bor-Luen Chiang

Abstract

Sleep disturbance is very common in patients with atopic dermatitis (AD), and is a major factor leading to impaired quality of life. Sleep disturbance is often viewed as one of the symptoms of AD and one of the measures of disease severity. In this review, we describe a variety of sleep disorders associated with AD and a wide range of impact that sleep disorders have on patients with AD. We also discuss our current understanding of the mechanism of sleep disturbance in AD. The relationship between sleep disorders and AD might be bi-directional and could form a vicious cycle. Therefore, we suggest viewing sleep disorders as a comorbidity of AD for which regular screening and bidirectional management strategies are indicated, with equal focus on maintaining disease control and implementing specific strategies to improve sleep.

https://ift.tt/2w4of72

Personalized omalizumab treatment improves clinical benefit in patients with chronic spontaneous urticaria

Publication date: Available online 23 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Tessa van der Kolk, Maurits S. van Maaren, Martijn B.A. van Doorn

https://ift.tt/2LlFohk

Diagnosis of dog allergy: beware of the dog

Publication date: Available online 23 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Roy Gerth van Wijk

https://ift.tt/2w5kTkk

A novel allergen-specific therapy with CD40-silenced B cells and dendritic cells

Publication date: Available online 23 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Motohiko Suzuki, Makoto Yokota, Yoshihisa Nakamura, Shinya Ozaki, Shingo Murakami

Summary

CD40-silenced B cells, induced by siRNA, inhibited allergic responses and symptoms antigen-specifically even after allergic rhinitis had been established. CD40-silenced B cells and CD40-silenced dendritic cells also have independent mechanisms with a synergic effect.

https://ift.tt/2LlAAJ0

Structured care to improve outcomes in primary single stage laryngotracheal reconstruction

Publication date: Available online 23 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Prasad John Thottam, Matthew Georg, Jeffrey P. Simons, Ryota Kashiwazaski, Deepak K. Mehta

Abstract

Purpose

To examine single stage laryngotracheal reconstruction (SSLTR) care to reduce complication and failure rate.

Methods

Forty-five patients that underwent primary SSLTR were examined retrospectively. All had pre-operative direct laryngoscopy and bronchoscopy, esophagoscopy with biopsy and MRSA screening. Pre-operative subglottic stenosis (SGS) grade and associated comorbidities were recorded. Intraoperative graft location and type was documented. Hospital course and results were evaluated and compared to cited literature.

Results

The median age at reconstruction was 2 years (0-15 years). 42.2% were male. 66.7% had gastroesophageal disease and 24.4% a MRSA history. Grade 2 SGS was noted pre-operatively in 37.8% and grade 3 or 4 in 57.7% of patients. Post-surgical hospital course was examined. 77.8% of patients were extubated on planned date. 95.6% of patients had operation specific successful decannulation. Graft type and variations of graft placement as well as MRSA and GERD status didn't affect procedure success rate. Active GERD was related to failure of extubation on planned day (p=0.02). An abnormal pre-operative swallowing examination was associated with higher complication rates (p=0.03).

Conclusion

Utilizing a more structured approach to SSLTR work-up and addressing potential SSLTR pitfalls may result in higher operation specific decannulation rates. Pre-operative GERD and swallowing dysfunction were associated with higher rates of adverse events.

https://ift.tt/2BFroQ6

Diagnosis and management of pediatric cervical vagal schwannoma

Publication date: Available online 23 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Józef Mierzwiński, Iwona Wrukowska, Justyna Tyra, Dariusz Paczkowski, Tomasz Szcześniak, Karolina Haber

Abstract

Schwannomas arising from the vagus nerve are extremely rare in children, with only 15 cases reported in the world literature.

We describe a pediatric case of cervical vagal nerve schwannoma successfully treated with cranial nerve-sparing surgery. Our patient presented extensive mass in the right side of the neck with ipsilateral Horner's syndrome. Her first sign, anisocoria, was diagnosed at the age of 1.5 y, making her the youngest vagal schwannoma case ever reported. Using an ultrasonic surgical aspirator and nerve monitoring, a multidisciplinary team successfully removed the mass with no recurrence after 2 years of follow-up.

https://ift.tt/2o3ltdX

A review of adenotonsillar hypertrophy and adenotonsillectomy in children after solid organ transplantation

Publication date: Available online 23 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jessica Roberts, Jason Powel, Michael Mather, Steven Powell, Malcolm Brodlie

Abstract

Objective

Paediatric solid organ transplantation is an increasingly successful treatment. Improved survival is paralleled by increased secondary complications of immunosuppression, including post-transplant lymphoproliferative disease (PTLD). PTLD frequently presents in Waldeyer's lymphatic ring. Adenotonsillar hypertrophy (ATH) is common in children, however in children after transplant, ATH may indicate PTLD. We review the literature on ATH and the role of adenotonsillectomy in children after transplantation.

Methods

A comprehensive literature search was performed on 26 t h September 2017 of Ovid Medline (1996 – September 2017), Embase (1996 -2017) and EBM reviews (Cochrane database of systematic reviews 2005 – September 20 t h 2017). Results were limited to English language publications within the last 20 years. Abstracts were screened for relevance to PTLD and ATH in the paediatric solid organ transplantation population. Screening of the bibliographies identified further articles.

Results

85 unique articles were screened to yield 18 relevant articles. 10 were retrospective studies and 8 were prospective studies.

Conclusion

In children, we report a PTLD incidence of up to 15% with up to 63% of cases presenting in the head and neck. Histological examination of adenotonsillectomy specimens found PTLD in a mean 5.7% (range 0 – 39%). We found a lack of prospective studies into this topic and further high quality research is needed. Clinical assessment of ATH in children after transplantation and when to perform a diagnostic adenotonsillectomy remains challenging. Children with ATH warrant prompt further investigation and support from colleagues in transplantation and oncology is required. 

https://ift.tt/2BFrhnE

Side-related differences in sudden sensorineural hearing loss in children

Publication date: Available online 22 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Kaitian Chen, Hongyan Jiang, Ling Zong, Xuan Wu

Abstract

Objective

Most studies on sudden sensorineural hearing loss (SSNHL) do not differentiate the outcomes within varied affected ears in children. The present study was designed to determine the clinical differences between unilateral and bilateral SSNHL in children.

Methods

The clinical data, from a total of 101 pediatric patients with SSNHL, was retrospectively analyzed from January 2003 to December 2016. The main outcome measures included basic characteristics, etiology, clinical symptoms and treatment courses.

Results

When the bilateral group (n = 28) was compared to the unilateral group (n = 73), neither gender nor onset of SSNHL was significantly different (p > 0.05 each); However, bilateral SSNHL tended to occur in younger ages (8.1 ± 4.0 yrs), with higher percentages of suspected etiologies (50%) and proportion of profound deafness (55.4%, p < 0.05 each). The short-term recovery rate was superior in the unilateral cases over the bilateral cases (37.0% vs. 12.5%, p < 0.05). Milder initial hearing threshold, early onset of treatment (5.6 ± 4.8 days) with unilateral involvement and an older age (11.3 ± 3.0 yrs) in bilaterally affected cases were associated with a better prognosis in this cohort. In addition, the unilateral group showed comparable outcomes, when sub-analyzed by comparison to that in either left- (n = 42) or right-sided (n = 31) SSNHL.

Conclusion

Although bilateral and unilateral pediatric SSNHL could cause partial to complete cochlear lesion, they may be relevant to distinct backgrounds. Our data also provides valuable information about demographics and outcomes of SSNHL in children.

https://ift.tt/2o3ljDn

L1CAM expression in uterine carcinosarcoma is limited to the epithelial component and may be involved in epithelial–mesenchymal transition

Abstract

Uterine carcinosarcoma (UCS) has been proposed as a model for epithelial–mesenchymal transition (EMT), a process characterized by a functional change facilitating migration and metastasis in many types of cancer. L1CAM is an adhesion molecule that has been involved in EMT as a marker for mesenchymal phenotype. We examined expression of L1CAM in UCS in a cohort of 90 cases from four different centers. Slides were immunohistochemically stained for L1CAM and scored in four categories (0%, < 10%, 10–50%, and > 50%). A score of more than 10% was considered positive for L1CAM. The median age at presentation was 68.6 years, and half of the patients (53.3%) presented with FIGO stage 1 disease. Membranous L1CAM expression was positive in the epithelial component in 65.4% of cases. Remarkably, expression was negative in the mesenchymal component. In cases where both components were intermingled, expression limited to the epithelial component was confirmed by a double stain for L1CAM and keratin. Expression of L1CAM did not relate to overall or disease-free survival. Our findings suggest L1CAM is either not a marker for the mesenchymal phenotype in EMT, or UCS is not a good model for EMT.

https://ift.tt/2w6EJLN

A 27-Month-Old Boy with Polyuria and Polydipsia

Psychogenic polydipsia is a well-described phenomenon in those with a diagnosed psychiatric disorder such as schizophrenia and anxiety disorders. Primary polydipsia is differentiated from psychogenic polydipsia by the lack of a clear psychotic disturbance. We present a case of a 27-month-old boy who presented with polyuria and polydipsia. Laboratory studies, imaging, and an observed water deprivation test were consistent with primary polydipsia. Polydipsia resolved after family limited his fluid intake and began replacing water drinking with other transition objects and behaviors for self-soothing. This case highlights the importance of water deprivation testing to differentiate between causes of polyuria, thereby avoiding misdiagnosis and iatrogenic hyponatremia. Secondly, primary polydipsia can result during the normal stages of child development without overt psychiatric disturbances.

https://ift.tt/2LjIzpU

Immunohistochemical classification of gastric cancer based on new molecular biomarkers: a potential predictor of survival

Abstract

Several classification systems have been described for stratifying patients with gastric carcinoma (GC). However, their prognostic value is low, and there is an urgent need for identification of molecular markers and development of new classifications. Retrospective study of 206 cases of GC diagnosed and surgically resected in our hospital between 2000 and 2017. Clinicopathological features of all cases were assessed and tissue microarrays were constructed for immunohistochemical (IHC) study. Patients were stratified based on IHC results. Mean patient age was 71 years and most patients were male (54.6%). Most tumors were located in the gastric antrum and body, and they were mostly fungoid or ulcerative lesions. GC were mainly intestinal-type tumors and 60.3% were diagnosed at pT3. 56.2% of patients showed recurrences and 29.4% died due to GC. According to our IHC classification, 23.5% of tumors showed microsatellite instability, 6% were E-cadherin negative, 53.5% were stable-p53 not overexpressed, and 17% were stable with p53 overexpression. IHC classification was significantly correlated with patient gender, gross morphology, Laurén classification, tumor necrosis, perineural infiltration, type of leading edge, and patient outcome. Multivariate analysis showed that IHC subtype was significantly and independently associated with overall survival, together with clinical symptoms, signet cell phenotype, tumor grade and vessel invasion. The application of IHC classifications based on molecular biomarkers in clinical practice can aid in the stratification of GC patients. More studies are needed to evaluate the reproducibility and clinical significance of these classifications.

https://ift.tt/2Lk1ZL2

Case of acute paraspinal pyomyositis in an elderly diabetic secondary to spread from urinary tract infection

A 73-year-old woman with medical history of diabetes and hypertension presented with right-sided back pain and night sweats of 1 month duration. On physical examination, there was costovertebral angle tenderness and her urinalysis was indicative for urinary tract infection. She was admitted and managed with intravenous antibiotics. On initial imaging, there was a right-sided retroperitoneal mass adjacent to right kidney. This was investigated further with MRI, which showed diffuse inflammation of right paraspinal muscles with two loculated abscesses. The abscesses were aspirated and the culture sent grew Streptococcus agalactiae (Group B Streptococcus) and the patient was treated with 6-week course of intravenous antibiotics.

https://ift.tt/2BEgrhB

Scrotal oedema: a misadventure of direct vision internal urethrotomy

Description 

A 30-year-old man presented with voiding lower urinary tract symptoms for 2 years due to bulbar urethral stricture. He had a history of appendectomy two and a half years ago during which he was catheterised. His retrograde urethrogram was suggestive of a short (<1 cm) bulbar urethral stricture (figure 1). After proper counselling, he was posted for direct vision internal urethrotomy (DVIU) under spinal anaesthesia. Immediately following the procedure, he developed scrotal oedema (figure 2). Perineal compression was given along with scrotal support. The patient was observed for 2 days in the ward; there was no increase in the oedema. He was subsequently discharged with an advice to keep a scrotal support and called on the 10th postoperative day. His oedema had completely resolved and his catheter was removed. He voided with a good flow rate of 27 mL/s and had a normal bell-shaped curve on uroflow...

https://ift.tt/2o1QkaI

A deceptive presentation of Tuberculosis hip as Staphylococcal infection, its successful management and literature review

A 71-year-old man presented with septic arthritis of the hip with an initial culture growth of methicillin-sensitive Staphylococcus aureus (MSSA) masking the diagnosis of tuberculosis (TB). Based on joint aspirate culture and sensitivity results, the patient was first diagnosed with MSSA arthritis. He was started on intravenous antibiotics and underwent washout and debridement of hip. During the procedure, the surgeons observed characteristic tubercular changes and samples were sent for tubercular testing. The reports of cultures for acid-fast bacilli and synovial biopsies confirmed our intraoperative suspicion of TB. Antitubercular medication was started and it helped patient to improve quickly. He completed 9 months of tubercular treatment regimen and at completion total hip replacement was offered. At 8-year follow-up, the patient was doing fine with no recurrence of infection in his hip. High index of suspicion for skeletal TB was raised based on clinical and radiological signs especially if there was a delay or absence of response to appropriate therapy.

https://ift.tt/2BEgp9t

Port site hernias following robotic colorectal surgery in people with obesity

Port site hernias are a rare complication following robotic surgery that can result in disastrous outcomes. We describe incarcerated port site hernias in two patients with obesity. Both patients required laparoscopic reduction. Following laparoscopic reduction, one patient's postoperative course was complicated by pneumatosis intestinalis, requiring exploratory laparotomy and subsequent small bowel resection. It is standard practice to not close the fascia of port sites less than 12 mm in robotic surgery. However, this allows for the rare possibility of small bowel herniation through the port site. We suggest that our patients' history of obesity and metabolic dysfunction contributed to difficult port retention during the case, and longer operating times which caused an increased amount of torque at the port site. Additionally, compared with laparoscopic surgery, robotic surgery is associated with increased torque at port sites. The combination of these risk factors extended the fascial defect, ultimately leading to the incarceration of small bowel in the port site.

https://ift.tt/2o3mkeF