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Κυριακή 16 Σεπτεμβρίου 2018
Temporal Changes in Ventilator Settings in Patients With Uninjured Lungs: A Systematic Review
In patients with uninjured lungs, increasing evidence indicates that tidal volume (VT) reduction improves outcomes in the intensive care unit (ICU) and in the operating room (OR). However, the degree to which this evidence has translated to clinical changes in ventilator settings for patients with uninjured lungs is unknown. To clarify whether ventilator settings have changed, we searched MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science for publications on invasive ventilation in ICUs or ORs, excluding those on patients 25% of patients with acute respiratory distress syndrome (ARDS). Our primary end point was temporal change in VT over time. Secondary end points were changes in maximum airway pressure, mean airway pressure, positive end-expiratory pressure, inspiratory oxygen fraction, development of ARDS (ICU studies only), and postoperative pulmonary complications (OR studies only) determined using correlation analysis and linear regression. We identified 96 ICU and 96 OR studies comprising 130,316 patients from 1975 to 2014 and observed that in the ICU, VT size decreased annually by 0.16 mL/kg (−0.19 to −0.12 mL/kg) (P
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Perioperative Outcomes and Surgical Case Volume in Pediatric Complex Cranial Vault Reconstruction: A Multicenter Observational Study From the Pediatric Craniofacial Collaborative Group
BACKGROUND: Complex cranial vault reconstruction (CCVR) performed to treat craniosynostosis can be associated with significant blood loss, transfusion, and perioperative complications. The aim of this study was to examine the effect of CCVR surgical case volume on perioperative outcomes. We hypothesized that surgical case volume is not associated with differences in perioperative outcomes. The study primary outcome was total perioperative blood donor exposures. Secondary outcomes included the total perioperative transfusion volume, major complications, and intensive care unit and hospital length of stay. METHODS: The multicenter Pediatric Surgery Perioperative Registry was queried for infants and children undergoing CCVR between June 2012 and September 2016. Institutions were categorized into low, middle, or high surgical case volume groups based on tertiles of the average number of cases performed per month. Primary and secondary outcomes were analyzed with respect to these groupings. RESULTS: The query yielded 1814 CCVR cases from 33 institutions. Demographics were similar among the 3 study groups. An inverse relationship between surgical case volume and total perioperative blood donor exposures was observed (P
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Point-of-Care Ultrasound Abnormalities in Late-Onset Severe Preeclampsia: Prevalence and Association With Serum Albumin and Brain Natriuretic Peptide
BACKGROUND: Pilot studies applying point-of-care ultrasound (POCUS) in preeclampsia indicate the presence of pulmonary interstitial edema, cerebral edema, and cardiac dysfunction. Laboratory markers of oncotic pressure (albumin) and cardiac dysfunction (brain natriuretic peptide [BNP]) may be abnormal, but the clinical application remains unclear. We investigated the prevalence of pulmonary interstitial syndrome (PIS), cardiac dysfunction, and increased optic nerve sheath diameter (ONSD) in late-onset preeclampsia with severe features. The primary aim was to examine the association between PIS or ONSD and maternal serum albumin level. The secondary aims were to explore the association between cardiac dysfunction and PIS, ONSD, BNP, and serum albumin level and between POCUS-derived parameters and a suspicious or pathological cardiotocograph. METHODS: Ninety-five women were enrolled in this prospective observational cohort study. A POCUS examination of lungs, heart, and ONSD was performed. PIS was defined as a bilateral B-line pattern on lung ultrasound and diastolic dysfunction according to an algorithm of the American Society of Echocardiography. ONSD >5.8 mm was interpreted as compatible with raised intracranial pressure (>20 mm Hg). Serum BNP and albumin levels were also measured. RESULTS: PIS, diastolic dysfunction, systolic dysfunction, and raised left ventricular end-diastolic pressure (LVEDP) were present in 23 (24%), 31 (33%), 9 (10%), and 20 (25%) women, respectively. ONSD was increased in 27 (28%) women. Concerning the primary outcome, there was no association between albumin level and PIS (P = .4) or ONSD (P = .63). With respect to secondary outcomes, there was no association between albumin level and systolic dysfunction (P = .21) or raised LVEDP (P = .44). PIS was associated with diastolic dysfunction (P = .02) and raised LVEDP (P = .009; negative predictive value, 85%). BNP level was associated with systolic (P
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Morphometric Analysis of the Facial Profile: Contour of the Side Face and its Variations
Much research has been conducted on the morphological characteristics of the Chinese. However, very few facial measurements have been documented, especially of the side face. This study uses geometirc morphometric method to analyze the contour and variations of the side face in Bai and Yi ethnic minorities from Yunnan province, China. The mark collection proves that for the Bai ethnicity, the variations of the nose are comparatively large, while the forehead variations are small. Variations around the lips and the chin are the largest. For the Yi ethnicity, the forehead also witnesses small variations and the nose again has large variations. The area around the glabella has large variations. Through the comparisons, the area around the glabella tends to extrude more in males both in Bai and Yi. The situation, however, is much more different when it comes to the trichion landmark collection where we see an apparent intrusion in males. For the trichion, Yi people are more intruded than the Bai. Similarities between Bai and Yi are demonstrated by principal component analysis: one can roughly set the males apart from the females using the vertical axis. Profile at the end of horizontal axis suggests that the female facial profile has the following features: the nose is not so prominent as the male, the forehead and the nose are linked by an noticeable arc, the forehead is comparatively steep and is almost in a vertical plane with the lips and the chin. By comparison, the male has a flatter forehead, a more prominent nose, an obvious sellion, and an intruded chin. The common morphologic features of the Chinese face may be reflected through these similarities. Address correspondence and reprint requests to Haijun Li, PhD, School of Ethnology and Sociology, Minzu University of China, Beijing 100081, China; E-mail: lindavy@163.com Received 5 July, 2018 Accepted 17 August, 2018 This work was supported by the National Social Science Foundation of China (18BKG040), and the State Key Laboratory of Palaeobiology and Stratigraphy (Nanjing Institute of Geology and Palaeontology, CAS) (No. 153106). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
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The Relation Between Morphometric Features and Susceptibility to Mandibular Angle Fractures
The study was aimed to determine possible relations between skeletal morphologic parameters to mandibular angle fractures. Retrospective study of 100 patients suffering from mandibular fractures and treated in the Rambam Health Care Campus between the years 2013 and 2017 was conducted. Predictor variable was facial skeletal morphologic features as derived from the measurements. Outcome variable was mandibular angle fractures. About 42 patients suffered from angle fractures. Gonial angle (131.3° versus 118.1°), condylar neck width (8.3 mm versus 6.8 mm sagittaly and 7.1 mm versus 5.8 mm horizontally), and wisdom tooth prevalence and impaction were positively correlated to the fracture. Ramus height (48.3 mm versus 53.4 mm) was negatively correlated to angle fractures. Many reports in the literature show positive relations between impacted 3rd molars and angle fractures, yet only sporadic reports describe relations between facial fractures and facial features. Our results showed the predictable positive relation between angle fractures and 3rd molar prevalence and impaction. Yet surprisingly, we found unequivocal significant positive correlation between angle fractures to gonial angle and condylar neck width and negative correlation to ramus height. Based on the correlation to the gonial angle and ramal height, it is concluded that enlarged anterior vertical growth is a predictor for angle fractures, as are condylar neck width, and wisdom teeth. Address correspondence and reprint requests to Dekel Shilo, DMD, PhD, Rambam Health Care Campus, 8 Ha'Aliyah Street Haifa 35254, Israel; E-mail: dekelshi@yahoo.com Received 13 March, 2018 Accepted 15 May, 2018 Bereznyak Elias Yekaterina and Shilo Dekel contributed equally. This study was approved by ethical committee (approval no 0462-17-RMB). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
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The role of electrocardiogram in sex verification in a young adult with primary amenorrhea: a case report
The use of electrocardiogram for sex verification in adults is an emerging concept in medicine. It is feasible through the utilization of Ogunlade Sex Determination Electrocardiographic Score. The aim of this ...
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Palmoplantar keratoderma Bothnia type with acrokeratoelastoidosis‐like features due to AQP5 mutations
Clinical and Experimental Dermatology, EarlyView.
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Preliminary study on chronic granulomatous disease in Sri Lanka
Chronic granulomatous disease (CGD) is a rare primary immunodeficiency of the phagocytic cells, which results in absent or diminished levels of microbicidal reactive oxygen species. The disease occurs due to g...
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“AIR LEAK SYNDROME”: An Unusual Presentation of Foreign Body in the Airway
Abstract
Spontaneous onset pneumomediastinum, pneumothorax and subcutaneous emphysema are rare presentations of a foreign body in the airway. The possible mechanism for unexplainable and non traumatic subcutaneous emphysema can be attributed to "Air leak syndrome" following inhalation of foreign body in the airway.
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Role of Proton Pump Inhibitors in Laryngopharyngeal Reflux: Clinical Evaluation in a North Indian Population
Abstract
There has been an escalation of patients presenting with symptoms of Laryngopharyngeal reflux disease (LPRD) in the otorhinolaryngology clinics due to life style and dietary changes. This study was undertaken to evaluate the effect of various proton pump inhibitors in the treatment of LPRD using Reflux symptom index (RSI) and Reflux finding score (RFS). This was a prospective study conducted from June 2016 to February 2017 with a total of 240 patients with symptoms and signs of LPR. The patients were divided into 5 groups. Each group was subjected to particular proton pump inhibitor. There were 124 males 116 females with a mean age 34.3 and rural to urban ratio being 11. After 3 months, RFS and RSI score within each group, improved significantly with Proton pump inhibitor therapy. In our study patients who were treated with omeprazole 20 mg twice daily had the highest improvement in laryngeal symptoms and laryngeal findings. We conclude emphasizing the effectiveness of proton pump inhibitors with incorporation of lifestyle modification in the successful management of LPRD.
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The Prevalence and Causes of Auditory Neuropathy/Dys-synchrony (AN/AD) in Children with Hearing Impairment
Abstract
There are a wide variety of hearing impairments that part of it is auditory neuropathy/dys-synchrony (AN/AD). So, the object of this study was determination the prevalence and causes of AN/AD in children with hearing impairment. This study was a descriptive cross-sectional survey. The sample size consisted of 105 hearing impairment children. All them were under hearing screening tests (tympanometry), distortion and transient evoked otoacoustic emissions (DPOAEs + TEOAE) and automated auditory brainstem response (AABR). If they were suspected to AN/AD, for complete diagnostic measurements were referred to our hospital. Four cases (8 ears) with AN/AD were diagnosed, which had an average age 37 months (SD = 8.67). So, the prevalence of AN/AD was 3.8 % among hearing impaired children. The findings of this study showed that there are the relationships between AN/AD and fluctuating hearing loss, acoustic reflex, high bilirubin, blood exchange after birth, neonatal intensive (NICU) care unit (P < 0.05). The simultaneous use of both ABR and OAE tests in the birth screening provide much more useful information than when each of these tests is used alone.
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The First Report of Multicentric Carpotarsal Osteolysis Syndrome Caused by MAFB Mutation in Asian
Multicentric carpotarsal osteolysis syndrome (MCTO) is a rare skeletal disorder characterized by aggressive osteolysis associated with progressive nephropathy. The early clinical presentation can mimic polyarticular juvenile idiopathic arthritis. Since 2012, MAFB mutations have been discovered in all MCTO patients. Therefore, the early diagnosis can be made based on genetic confirmation. We report the clinical manifestation of mineral bone disease and the molecular genetic study of a Thai female adolescent with MCTO. She presented with end-stage renal disease, bilateral wrist and ankle joint deformities, and subtle facial dysmorphic features. We identified a heterozygous missense MAFB mutation at nucleotide 197 from C to G (NM_005461.4; c.197C>G), predicting the change of amino acid at codon 66 from serine to cysteine (p.Ser66Cys), and the mutation was absent in the parents, indicating a de novo mutation. This report confirms the previous link between MAFB mutation and MCTO. Her unexplained hypercalcemia after a regular dose of calcium and active vitamin D supported an important role of MafB in the negative regulation of RANKL-mediated osteoclast differentiation. Therefore, we would encourage the physicians who take care of MCTO patients to closely monitor serum calcium level and perform a genetic study as a part of the management and investigation.
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Otological surgery in paediatric photosensitive patients
Publication date: Available online 15 September 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): James Bates, Andy Hall, Thushitha Kunanandam, Richard Hewitt
Abstract
There are a wide range of genetic and auto-immune conditions where UV light exposure poses a threat of UV irradiation to the external auditory canal, tympanic membrane and surrounding skin. Preoperative Ultraviolet Light (UV) measurements were taken in the operating theatre with standard operating microscope and an approved UV light meter prior to surgery on a patient with xeroderma pigmentosa. UV light meter readings of UV index 75 were taken at an operating distance of 290mm. Proceeding with otological surgery with a high UV index would result in a significant UV radiation burn. Utilising a Dermagard and a specific UV filter applied to the microscope resulted in acceptable UV light readings. We highlight the potential morbidity of otological surgery in paediatric photosensitive conditions. We also recommend a management plan to avoid damage by UV radiation in photosensitive patients.
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Comparison of extrusion and patency of silicon versus thermoplastic elastomer tympanostomy tubes
Publication date: Available online 15 September 2018
Source: Auris Nasus Larynx
Author(s): Dongwon Kim, Sung-Won Choi, Hyun-Min Lee, Soo-Keun Kong, Il-Woo Lee, Se-Joon Oh
Abstract
Objectives
This study aimed to assess the differences in the extrusion rate, patency and incidence of otorrhea according to the material properties of tubes in tympanostomy tube (TT) procedures.
Subjects and methods
A total of 75 children with bilateral chronic otitis media with effusion were randomized in this prospective trial to receive 1.02-mm-sized TTs (thermoplastic elastomer) in one ear and 1.14-mm-sized TTs (silicone) in the other ear. Data were obtained on ventilation tube type, time to extrusion, comorbidities, tube plugging, incidence of TT otorrhea during following up, and age of the patient. Postoperatively, follow-up by an otologist continued every two months to assess the incidence of otorrhea, plugging, and TT extrusion until all tubes were extruded.
Results
Out of the 75 children, 7 patients were excluded during surgery and 4 were lost during follow-up. The mean extrusion time of 1.02-mm-sized TTs (thermoplastic elastomer) was 10.28 months, whereas that of 1.14-mm-sized TTs (silicone) was 7.36 months, which showed a significant difference. However, thermoplastic elastomer TTs had more plugging events than silicone TTs.
Conclusions
There was a significant increase in the time to extrusion in ears with the 1.02-mm-sized thermoplastic elastomer TT, although, generally, the larger inner diameter of the tube last longer in the eardrum. This contrasting result is thought to be due to the different material properties of both TTs. This information may be helpful for TT selection in clinical practice depending on the patient's condition.
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When a Seemingly Harmless Prescription Turns into Toxicity
Valacyclovir neurotoxicity is commonly seen in the elderly and those with impaired renal function. Differential diagnosis can be challenging as a myriad of medical conditions, including herpes zoster virus associated encephalitis, may present in a similar fashion. We present a case of a 71-year-old male who presented with altered mental status in the setting of recent herpes zoster eruption. His condition was attributed to valacyclovir neurotoxicity, and initiation of appropriate supportive therapy was met with complete resolution of symptoms and normalization of cognitive function.
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Quantitative analysis of biofilm bacteria according to different stages of early childhood caries
Publication date: Available online 15 September 2018
Source: Archives of Oral Biology
Author(s): Beatriz Gonçalves Neves, Rafael Nóbrega Stipp, Daniela da Silva Bezerra, Sarah Florindo de Figueiredo Guedes, Lidiany Karla Azevedo Rodrigues, B.G. Neves, R.N. Stipp, D.S. Bezerra, S.F.F. Guedes, L.K.A. Rodrigues
ABSTRACT
Objective
Monitoring selected key species related to health or diseases may facilitate caries risk assessment and discovery of novel ecological preventive and therapeutic approaches. This study aimed at quantifyingActinomyces naeslundii, Bifidobacterium spp., Lactobacillus acidophilus, Lactobacillus casei group, Streptococcus gordonii, Mitis group and Streptococcus mutans by quantitative polymerase chain reaction (qPCR) in dental biofilm from Brazilian children with different stages of early childhood caries (ECC).
Design
Seventy-five preschool children were clinically evaluated by ICDAS criteria and divided into groups: caries-free (CF; n = 20), enamel caries lesions (ECL; n = 17) and dentine caries lesions (DCL; n = 38). Plaque sample from all children was collected for detection and quantification of the selected bacteria.
Results
L. acidophilus and L. casei group were absent in almost all plaque samples. No differences in relative proportions of A. naeslundii, Mitis group and S. gordonii were observed in any stage of caries. However, S. mutans and Bifidobacterium spp. were present at higher concentrations in the biofilm of children with DCL (p < 0.001). Multivariate analysis showed that S. mutans and Bifidobacterium spp. were strongly associated with biofilm in children with DCL.
Conclusion
Differences were observed in the proportion of acidogenic and aciduric bacteria with dental caries progression. The data indicate thatS. mutans and Bifidobacterium spp. in dental biofilm may be involved in some progression processes for ECC.
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Quantitative analysis of biofilm bacteria according to different stages of early childhood caries
Publication date: Available online 15 September 2018
Source: Archives of Oral Biology
Author(s): Beatriz Gonçalves Neves, Rafael Nóbrega Stipp, Daniela da Silva Bezerra, Sarah Florindo de Figueiredo Guedes, Lidiany Karla Azevedo Rodrigues, B.G. Neves, R.N. Stipp, D.S. Bezerra, S.F.F. Guedes, L.K.A. Rodrigues
ABSTRACT
Objective
Monitoring selected key species related to health or diseases may facilitate caries risk assessment and discovery of novel ecological preventive and therapeutic approaches. This study aimed at quantifyingActinomyces naeslundii, Bifidobacterium spp., Lactobacillus acidophilus, Lactobacillus casei group, Streptococcus gordonii, Mitis group and Streptococcus mutans by quantitative polymerase chain reaction (qPCR) in dental biofilm from Brazilian children with different stages of early childhood caries (ECC).
Design
Seventy-five preschool children were clinically evaluated by ICDAS criteria and divided into groups: caries-free (CF; n = 20), enamel caries lesions (ECL; n = 17) and dentine caries lesions (DCL; n = 38). Plaque sample from all children was collected for detection and quantification of the selected bacteria.
Results
L. acidophilus and L. casei group were absent in almost all plaque samples. No differences in relative proportions of A. naeslundii, Mitis group and S. gordonii were observed in any stage of caries. However, S. mutans and Bifidobacterium spp. were present at higher concentrations in the biofilm of children with DCL (p < 0.001). Multivariate analysis showed that S. mutans and Bifidobacterium spp. were strongly associated with biofilm in children with DCL.
Conclusion
Differences were observed in the proportion of acidogenic and aciduric bacteria with dental caries progression. The data indicate thatS. mutans and Bifidobacterium spp. in dental biofilm may be involved in some progression processes for ECC.
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Utilization of Transoral Robotic Surgery (TORS) in patients with Oropharyngeal Squamous Cell Carcinoma and its impact on survival and use of chemotherapy
Publication date: November 2018
Source: Oral Oncology, Volume 86
Author(s): Sujith Baliga, Rafi Kabarriti, Julie Jiang, Vikas Mehta, Chandan Guha, Shalom Kalnicki, Richard V. Smith, Madhur K. Garg
Abstract
Objective
To determine whether patients with Oropharyngeal Squamous Cell Carcinoma (OPSCC) treated with Transoral Robotic Surgery (TORS) have similar survival to patients treated with definitive RT.
Materials and methods
Using the National Cancer Database (NCDB) registry, we identified patients with newly diagnosed clinical T1-T2, N0-N2b OPSCC between 2010 and 2014. A multivariable logistic regression was utilized to determine the association between chemotherapy use and primary treatment modality (TORS vs definitive RT). Kaplan Meier survival analysis was used to estimate overall survival. Propensity score matching was utilized to address selection bias.
Results
We identified 17,150 patients, of which 14,470 (84.4%) received primary RT and 2,680 (15.6%) underwent TORS. The median follow-up for the cohort was 31.4 months. Propensity score matching demonstrated similar 5-year OS for patients treated with either definitive RT or TORS (81% vs 84%, log rank p = 0.10). There was no difference in survival outcomes by treatment selection (TORS or definitive RT) in either HPV positive or HPV negative subtypes. Patients treated with TORS were less likely to receive chemotherapy compared to patients treated with definitive RT and this was also demonstrated in a propensity matched analysis (OR: 0.09, 95%CI 0.078–0.12, p < 0.001). Only 68.4% of TORS treated patients underwent adjuvant RT, compared to 100% of patients in the primary RT cohort (p < 0.001).
Conclusions and relevance
For patients with OPSCC, TORS results in similar OS outcomes and is associated with decreased chemotherapy and RT use compared to definitive RT. Our results demonstrate the feasibility of TORS in a select subgroup of OPSCC patients.
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HPV status predicts for improved survival following chemotherapy in metastatic squamous cell carcinoma of the oropharynx
Publication date: November 2018
Source: Oral Oncology, Volume 86
Author(s): Luke R.G. Pike, William L. Hwang, Trevor J. Royce, Nina N. Sanford, Brandon A. Mahal
Abstract
Objective
We sought to further define prognostic and predictive value of human papillomavirus (HPV) status in metastatic squamous cell carcinoma of the oropharynx (OPC).
Materials and methods
A Surveillance, Epidemiology, and End Results custom database identified 5940 adult patients, >18-years-old, with primary SCCHN and known HPV status, diagnosed from 2013 to 2014. Wilcoxon rank-sum and Mantel-Haenszel χ2 tests compared distributions of continuous and categorical covariates. Fine-Gray competing risks regressions estimated hazard ratios by HPV status, and predictive analyses were performed including the interaction term HPV status × Receipt of Chemotherapy.
Results
182 of 5940 patients (4.0%) had metastatic OPC at diagnosis (106/3925 [2.7%] HPV+ and 76/1894 [4.0%] HPV−). HPV+ disease was prognostic for improved 20-month cancer-specific mortality (CSM) (47.1% vs 72.5%, HR 0.43, 95% CI 0.26–0.74, p = 0.002) on univariable analysis. HPV status was predictive of response to chemotherapy—adjusted HRs for receipt of chemotherapy were 0.11 (95% CI 0.03–0.37) and 0.34 (95% CI 0.18–0.64) for HPV+ versus HPV− disease, respectively (PHPV status∗Chemotherapy = 0.036).
Conclusion
HPV status has known prognostic value in locally advanced OPC, but data on metastatic OPC are sparse. In this work, we demonstrate that HPV status is strongly prognostic for CSM in metastatic OPC and show for the first time that HPV status predicts for response to chemotherapy.
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Internal Auditory Canal Duplicity
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): María Fernanda Vargas Gamarra, Carlos de Paula Vernetta, Miguel Mazón
https://ift.tt/2MDtqjG
Mammary Analogue Secretory Carcinoma of Salivary Glands: Report of Clinical Case
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): Carlota Rovira, Xavier León, Celina P. Vásquez, Montserrat López
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Myopericytoma of the tongue base: A case report
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): Stefano Rubino, Rita De Berardinis, Daniele Colombo, Alessandro De Padova
https://ift.tt/2MDtlwo
Paediatric Bilateral Vocal Cord Paralysis: Our Experience
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): María Laura Scatolini, Hugo A. Rodriguez, Cinthia G. Pérez, Alejandro Cocciaglia, Hugo A. Botto, Mary Nieto, Lucas Bordino
Abstract
Bilateral vocal cord paralysis (BVCP) is the second most common cause of neonatal stridor. The aim of this study was to describe the demographic features, aetiology, comorbidities, and management of our patients with BVCP.
Material and methods
We conducted a retrospective review of the clinical charts of all patients diagnosed with BVCP seen at the Department of Respiratory Endoscopy between 2011 and 2015.
Results
47 patients were included. Mean age at diagnosis was 1 month and male sex predominated (63%). The aetiology was congenital in 59% and acquired in 41% of the infants. The cause was most frequently idiopathic in the former group and secondary to postoperative injury in the latter. Overall, 42 patients (89%) required tracheostomy, without statistically significant differences between the causes. Of all the patients, 39% regained vocal-cord mobility; 44% of those with congenital BVCP, 31% of those with acquired BVCP and 62.5% with idiopathic BVCP. In five patients a laryngotracheoplasty was performed with a posterior costal cartilage graft and one underwent posterior cordectomy. All were decannulated. In one patient vocal-cord lateralisation was performed, avoiding tracheostomy.
Conclusion
BVCP was most commonly of congenital cause and was mainly idiopathic within this group of patients, with a slight male preponderance. A high percentage of patients required tracheostomy. A higher recovery rate of vocal-cord mobility was observed in idiopathic BVCP, which allowed for successful decannulation. In this series, decannulation was possible in all patients that underwent surgery; however, further studies with comparison of techniques and objective assessment of swallowing and phonation are necessary.
Resumen
La parálisis bilateral de cuerdas vocales (PBCV) es la segunda causa más frecuente de estridor neonatal. Nuestro objetivo es describir la demografía, etiología, comorbilidades y tratamientos instaurados.
Materiales y métodos
Revisión retrospectiva de las historias clínicas de pacientes con diagnóstico de PBCV de 2011 a 2015.
Resultados
Se incluyeron 47 pacientes. La edad media de diagnóstico fue un mes de vida, con predominio de sexo masculino (63%). El 59% fue por causa congénita y el 41% adquirida, por lo general idiopática y postoperatoria, respectivamente. Se realizó traqueostomía (TQT) en 42 pacientes (89%), sin diferencias significativas en relación con la causa. La recuperación de la movilidad cordal fue del 39% en toda la muestra, 44% en la congénita, 31% en la adquirida y 62,5% en la idiopática. A 5 pacientes se les realizó laringotraqueoplastia con injerto costal posterior y a un paciente cordectomía posterior. Todos fueron decanulados. A un paciente se le realizó lateralización cordal, evitando la TQT.
Conclusión
Las causas congénitas fueron las más frecuentes, en su mayoría idiopáticas. Se registró una leve predilección por el sexo masculino. Un alto porcentaje de pacientes requirieron de TQT. La tasa de recuperación de la movilidad es mayor en causas idiopáticas. Se decanularon todos los pacientes operados, pero se requieren trabajos con mayor número de participantes, comparación de técnicas y evaluación de la deglución y la fonación de forma objetiva.
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Otoacoustic Emissions in Children Treated With Gentamicin in a Secondary Hospital
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): Jose Miguel Sequi Canet, Carlos Miguel Angelats Romero, Jose Miguel Sequi Sabater, Ana Miralles Torres, Miguel Boronat Garcia, Marta Gomez Delgado
Abstract
Introduction
The National Commission for the Early Detection of Hearing Loss (CODEPEH) recommends the re-evaluation of hearing in children who have suffered any potentially harmful event, such as the prescription of ototoxic antibiotics such as gentamicin. The evoked otoacoustic emissions (EOAE) are a good method for assessing the integrity of cochlear functionality.
Material and method
A prospective study is presented, including 92 children who were treated with intravenous gentamicin for septic risk/sepsis or urinary tract infection. The children underwent serial EOAE: on admission, at the end of treatment and one month later (if altered on discharge).
Results
In the end, none of the subjects were affected by the treatment.
Conclusion
Gentamicin appears to be a safe antibiotic in treatments lasting <10 days and at the doses described. EOAE are an inexpensive, fast, non-invasive and reliable method to check for gentamicin ototoxicity. This could save in the determination of drug levels.
Resumen
Introducción
Las recomendaciones de la Comisión Nacional para la Detección Precoz de la Hipoacusia (CODEPEH) aconsejan re-valorar la audición de aquellos niños que hayan sufrido algún evento potencialmente dañino para la audición como es la utilización de antibióticos ototóxicos como la gentamicina. Las otoemisiones evocadas son un buen método de evaluación de la integridad de la función coclear.
Material y método
Se presenta un estudio prospectivo que incluye a 92 niños, sin otros factores de riesgo auditivo, en los que se pautó tratamiento con gentamicina intravenosa por riesgo séptico/sepsis o infección urinaria y en los que se realizaron otoemisiones seriadas: al ingreso, al finalizar el tratamiento y al mes del alta (si estaban alteradas).
Resultados
Ningún sujeto presentó otoemisiones alteradas al final del seguimiento.
Conclusión
La gentamicina parece un antibiótico seguro en tratamientos con una duración <10 días y a las dosis descritas. Las otoemisiones son un método barato, rápido, incruento y fiable para comprobar la posible ototoxicidad por gentamicina. Su realización podría ahorrar la determinación de niveles del fármaco.
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Emotional Reaction Evaluation Provoked by the Vestibular Caloric Test Through Physiological Variables Monitoring
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): Rafael Barona-de-Guzmán, Claudio Krstulovic-Roa, Elena Donderis-Malea, Luz Barona-Lleó
Abstract
Introduction and objectives
The emotional evaluation of the causes of vertigo is made using the clinical records and several subjective questionnaires. The aim of the present study is to evaluate the emotional response objectively, in normal subjects, during an induced vertigo crisis.
Material and method
A caloric vestibular test with cold water was performed on 30 healthy subjects. The following physiological parameters were monitored during the 60 s prior to and the 60 s after the stimulation: Skin Conductivity, Peripheral Pulse Volume, Body Temperature, Muscle Contraction, Heart Rate, and Respiratory Rate. The maximum angular speed of the nystagmus slow phase at each stimulation was assessed.
Results
Skin conductance presented a statistically significant increase during the vertigo crisis in relation to the prior period while the peripheral pulse volume presented a statistically significant decrease. There was no relationship between the slow phase of the provoked nystagmus angular speed and skin conductance and peripheral pulse volume changes. The decrease in peripheral pulse volume was significantly higher in the second vertigo crisis.
Conclusions
Skin conductance and peripheral pulse volume changed significantly during a vertigo crisis. There was no relation between the provoked vertiginous crisis intensity and the changes produced in those variables. The stress generated by the caloric stimulation is higher in the second crisis, when the subject has experience of the vertigo caused by the stimulation.
Resumen
Introducción y objetivos
La valoración emocional que provoca el vértigo se realiza mediante la historia clínica y diversos cuestionarios subjetivos. El objetivo del presente trabajo es valorar la respuesta emocional de forma objetiva, en sujetos normales, durante la crisis de vértigo inducida.
Material y método
Se realizó la prueba vestibular calórica con agua fría en 30 sujetos sanos. Durante los 60 s previos a la estimulación y los 60 s posteriores a la misma se monitorizaron las siguientes variables fisiológicas: Conductabilidad cutánea, Volumen de pulso periférico, Temperatura corporal, Contracción muscular, Frecuencia cardiaca y Frecuencia respiratoria. Se valoró la velocidad angular máxima de la fase lenta del nistagmo provocado en cada estimulación.
Resultados
Durante las crisis de vértigo, la conductabilidad cutánea presentó un aumento estadísticamente significativo con relación al periodo previo a las mismas, mientras que el volumen de pulso periférico presentó una disminución estadísticamente significativa. No hubo relación entre la velocidad angular de la fase lenta del nistagmo provocado y los cambios de la conductabilidad y el volumen de pulso periférico. La disminución provocada en el volumen de pulso periférico fue significativamente mayor en la segunda crisis de vértigo.
Conclusiones
La conductabilidad cutánea y el volumen de pulso periférico cambiaron de forma significativa durante las crisis de vértigo. No Hubo relación entre la intensidad de la crisis vertiginosa provocada y los cambios producidos en estas variables. El estrés generado por la estimulación calórica es mayor en la segunda crisis, cuando el sujeto tiene experiencia del vértigo que provoca la estimulación.
https://ift.tt/2xbDtYs
Analysis of Scientific Production in Otolaryngology in Spain in the Period 2011–2015
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): Jose A. Lopez-Escamez, Raquel Manrique-Huarte, Eduardo Martin-Sanz, Gabriel Trinidad, COMISIÓN DE INVESTIGACIÓN de la SEORL-CCC
Abstract
Introduction
Publishing in scientific journals is an indicator of hospital quality and has become a standard of excellence for medical doctors and institutions. The aim of the study is to identify the scientific publications performed by Otolaryngology Departments in Spain within the period 2011–2015 and to compare them to a previous period between 1998–2002.
Material and methods
Original papers published by Otolaryngology Departments in Spain in PubMed within 2011–2015 were retrieved. They were classified according to the type of journal published (international or Acta ORL Española) and the following subspecialty areas: Otology, Audiology and Neuro-Otology, Head and Neck Surgery (including Oncology), Rhinology and Paediatric ENT. Hospitals were ranked according to: number of original papers, accumulated impact factor and total number of publications.
Results
Between 2011 and 2015, 49 342 publications were included in PubMed, 1.44% from Otolaryngology Departments in Spain. Between 1998 and 2002, 3.80% publications were from Spanish ENT departments. Of the 712 papers published within the period 2011–2015, 389 were published in Acta ORL Española and 323 in international journals. From the latter, 20.7% belong to the Otology area, 19.2% to Audiology-Neuro-otology, 30.6% to Head and Neck Surgery, 15.2% to Rhinology and 3.4% to Paediatric ENT. Five tertiary centres published at least 10 original papers in the same period.
Conclusions
Spanish otolaryngology's contribution to international journals has decreased in the last 12 years. A few institutions are responsible for the majority of publications and they have notably increased the cumulative impact factor.
Resumen
Introducción
La publicación de artículos científicos es un indicador de calidad del hospital y se ha convertido en un criterio de excelencia entre los indicadores clínicos que acreditan a un profesional o a una institución. Se evaluaron las publicaciones científicas realizadas en los servicios de otorrinolaringología españoles durante el período 2011-2015 comparándolas con el periodo 1998-2002.
Material y métodos
Se extrajeron los artículos de Pubmed publicados por los servicios de ORL de España en el periodo 2011-2015, clasificándose según el tipo de revista (Acta Otorrinolaringológica Española o internacional) y el área de conocimiento: otología, audiología y otoneurología, cirugía de cabeza y cuello incluyendo oncología, rinología y ORL pediátrica. Se estableció un ranking de hospitales considerando el número total de originales, el factor de impacto acumulado y el número total de publicaciones.
Resultados
En el periodo 2011-2015 se han identificado 49.342 publicaciones, de las cuales el 1,44% proceden de España, mientras que entre 1998-2002 el 3,80% proceden de España. De los 712 artículos hay 389 publicados en Acta Otorrinolaringológica Española y 323 internacionales. De estas últimas el 20,7% pertenecen a la sección de otología, el 19,2% a audiología-otoneurología, el 30,6% a cirugía de cabeza y cuello, el 15,2% a rinología y el 3,4% ORL pediátrica. Cinco centros hospitalarios publicaron al menos 10 artículos originales en el período estudiado.
Conclusiones
La producción científica de la ORL española a nivel internacional ha descendido en los últimos 12 años. Se observa un fenómeno de concentración en determinados centros, asociado a un incremento considerable del factor de impacto acumulado.
https://ift.tt/2MzQS1v
Auditory steady-state response in cochlear implant patients
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): Alejandro Torres-Fortuny, Isabel Arnaiz-Marquez, Heivet Hernández-Pérez, Eduardo Eimil-Suárez
Abstract
Introduction and objective
Auditory steady state responses to continuous amplitude modulated tones at rates between 70 and 110 Hz, have been proposed as a feasible alternative to objective frequency specific audiometry in cochlear implant subjects. The aim of the present study is to obtain physiological thresholds by means of auditory steady-state response in cochlear implant patients (Clarion HiRes 90K), with acoustic stimulation, on free field conditions and to verify its biological origin.
Methods
11 subjects comprised the sample. Four amplitude modulated tones of 500, 1000, 2000 and 4000 Hz were used as stimuli, using the multiple frequency technique. The recording of auditory steady-state response was also recorded at 0 dB HL of intensity, non-specific stimulus and using a masking technique.
Results
The study enabled the electrophysiological thresholds to be obtained for each subject of the explored sample. There were no auditory steady-state responses at either 0 dB or non-specific stimulus recordings. It was possible to obtain the masking thresholds. A difference was identified between behavioral and electrophysiological thresholds of −6 ± 16, −2 ± 13, 0 ± 22 and −8 ± 18 dB at frequencies of 500, 1000, 2000 and 4000 Hz respectively.
Conclusions
The auditory steady state response seems to be a suitable technique to evaluate the hearing threshold in cochlear implant subjects.
Resumen
Introducción y objetivos
Los potenciales evocados auditivos de estado estable (PEAEE) por estimulación con tonos modulados en amplitud entre 70 y 110 Hz han sido propuestos como una alternativa factible para realizar una audiometría objetiva en pacientes con implante coclear. El objetivo del presente estudio es verificar el origen biológico de los umbrales auditivos obtenidos mediante PEAEE por estimulación acústica y en condiciones de campo libre, en pacientes con implante coclear (Clarion HiRes 90K).
Métodos
La muestra constó de 11 pacientes. Cuatro tonos modulados en amplitud con frecuencias portadoras de 500, 1.000, 2.000 y 4.000 Hz y presentados simultáneamente fueron empleados como estímulo. Se registraron series de intensidad hasta alcanzar el umbral auditivo, así como registros a 0 dB HL, con estímulos no específicos y empleando técnicas de enmascaramiento.
Resultados
El estudio permitió obtener los umbrales electrofisiológicos par cada paciente de la muestra explorada. No hubo respuesta de estado estable ni a 0 dB ni al emplear estímulos no específicos. Fue posible obtener los umbrales de enmascaramiento. Se identificó una diferencia entre los umbrales conductuales y electrofisiológicos de −6 ± 16 dB, −2 ± 13 dB, 0 ± 22 dB y −8 ± 18 dB a las frecuencias de 500, 1.000, 2.000 y 4.000 Hz, respectivamente.
Conclusiones
Los PEAEE pueden constituir una técnica apropiada para evaluar el umbral auditivo en sujetos con implante coclear.
https://ift.tt/2xmpjUH
Azathioprine Reduces the Risk of Audiometric Relapse in Immune-mediated Hearing Loss
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): Nieves Mata-Castro, Javier Gavilanes-Plasencia, Rafael Ramírez-Camacho, Alfredo García-Fernández, José Ramón García-Berrocal
Abstract
Introduction
Current schemes for treatment of immune-mediated hearing loss with sporadic short-course, low-dose corticosteroids, are insufficient.
Methods
To determine the role of azathioprine in the control of auditory impairment, a longitudinal, observational, descriptive study was performed with 20 patients treated with azathioprine (1.5–2.5 mg/kg/day into two doses) for 1 year. The loss of 10 dB on two consecutive frequencies or 15 dB on an isolated frequency was considered as relapse.
Results
The mean age of the patients was 52.50 years (95% CI: 46.91–58.17), half were women. Bilateral affectation was 65%. 75% had organ specific disease and 25% had systemic autoimmune disease. The difference between baseline PTA (46.49 dB; DS 18.90) and PTA at 12 months (45.47 dB; DS 18.88) did not reach statistical significance (P=.799). There was a moderate positive correlation between female sex and the presence of systemic disease (R=.577). By applying Student's t for paired data, a significant difference (P=.042) was obtained between the PTA in frequencies up to 1000 Hz (PTA 125–1000 Hz). The relative incidence rate of relapse per year was .52 relapses/year (95% CI: .19–1.14]). The median time to audiometric relapse-free was 9.70 months (DS 1.03).
Conclusions
Azathioprine maintains the hearing threshold, decreases the risk of relapse, and slows down the rate at which patients relapse, altering the course of immune-mediated inner ear disease.
Resumen
Introducción
Los esquemas actuales de tratamiento de la hipoacusia inmunomediada con corticoides, a dosis baja y pauta corta, son insuficientes.
Métodos
Para determinar el papel de la azatioprina en el control del deterioro auditivo se ha llevado a cabo un estudio observacional descriptivo longitudinal con 20 pacientes tratados con azatioprina por vía oral (1,5-2,5 mg/kg/día en dos dosis) durante 1 año. Se consideró recaída la pérdida de 10 dB en dos frecuencias consecutivas o de 15 dB en una frecuencia aislada.
Resultados
La edad media de los pacientes fue de 5250 años (IC 95%: 46,91-58,17), y la mitad fueron mujeres. La afectación bilateral fue del 65%. Un 75% presentaban enfermedad organoespecífica y un 25%, enfermedad autoinmune sistémica. La diferencia entre la PTA basal (46,49 dB; DE 18,90) y la PTA a los 12 meses (45,47 dB; DE 18,88) no alcanzó significación estadística (p=0,799). Existía una correlación positiva moderada entre sexo femenino y presencia de enfermedad sistémica (R=0,577). Aplicando t de Student para datos apareados se obtuvo una diferencia significativa (p=0,042) entre el descenso de la PTA en frecuencias hasta 1.000 Hz (PTA 125-1.000 Hz). La tasa relativa de incidencia de recaída por año fue de 0,52 recaídas/año (IC 95%: 0,19-1,14). El tiempo medio de supervivencia libre de recaída audiométrica fue de 9,70 meses (DE 1,03).
Conclusiones
La azatioprina mantiene el umbral de audición, disminuye el riesgo de recaída y frena la velocidad con la que los pacientes recaen, alterando el curso de la enfermedad inmunomediada del oído interno.
https://ift.tt/2MASDeT
Survey on the Knowledge of Cochlear Implant Indication in the Treatment of Hearing Loss in Spain
Publication date: September–October 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 5
Author(s): Manuel Manrique, Ángel Ramos, Beatriz Pradel, Carlos Cenjor, Diego Calavia, Constantino Morera
Abstract
Introduction
This study aims to analyse the knowledge of cochlear implant (CI) candidacy criteria of otorhinolaryngology specialists in Spain, and from the results, consider whether it is necessary to implement training measures aimed at improving knowledge in this area.
Material and methods
A questionnaire was designed for measuring the level of knowledge of cochlear implant candidacy criteria (CI) in people with hearing loss. The questionnaire collected the demographic data of the respondents and their knowledge on the conventional and emergency indications for CI, technical characteristics of CI and results in the implanted population.
Results
A total of 222 Spanish specialists in otorhinolaryngology answered the questionnaire (10.29% of the sample surveyed).
Conclusions
The 50% of all respondents showed a medium-high knowledge about CI. Epidemiological data suggest that a high percentage of adults with postlocutive deafness and candidates for a CI are not referred for treatment. The lack of knowledge about the criteria for the indication of CI by otorhinolaryngology specialists may contribute to inadequate guidance of patients who are potential candidates for CI. The greatest shortcomings are found in the most emergency indications for a CI. Among otorhinolaryngology professionals, the greatest knowledge about CI is found in those who work in tertiary hospitals in the areas of otology and otoneurology, either in the public or private sector. This study suggests that training on CI should be increased for otorhinolaryngology professionals, especially for general otorhinolaryngologists.
Resumen
Introducción
Este trabajo pretende analizar el conocimiento del especialista en Otorrinolaringología en España sobre los criterios de indicación de los implantes cocleares (IC) y, según los resultados, considerar si es necesario implementar medidas de formación dirigidas a mejorar el conocimiento en esta área.
Material y métodos
Se diseña un cuestionario dirigido a conocer el nivel de conocimiento sobre la indicación de IC en personas con hipoacusia. Este cuestionario recogía información demográfica de los encuestados y conocimientos sobre aspectos como indicaciones convencionales y emergentes de los IC, características técnicas de los IC y resultados en la población implantada.
Resultados
Un total de 222 especialistas españoles en Otorrinolaringología respondieron el cuestionario (10,29% de la muestra encuestada).
Conclusiones
Un 50% de los encuestados mostraron unos conocimientos medios-altos sobre IC. Datos epidemiológicos sugieren que un alto porcentaje de adultos con sorderas poslocutivas candidatos a un IC no son referidos para tratamiento. El desconocimiento de los criterios para la indicación de IC por parte de los especialistas en Otorrinolaringología puede contribuir a una inadecuada orientación de los pacientes potencialmente candidatos a un IC. Las mayores deficiencias se encontraron en las indicaciones más emergentes de un IC. Dentro de los profesionales de la Otorrinolaringología los mayores conocimientos sobre IC se concentraron en aquellos que trabajaban en hospitales terciarios, especializados en Otología y Otoneurología, y desempeñaban su actividad laboral en el sector público y privado. Este estudio sugiere la conveniencia de incrementar acciones formativas sobre IC en los profesionales de la Otorrinolaringología, especialmente para otorrinolaringólogos generales.
https://ift.tt/2xetqSB
Describing the mandible in patients with craniofacial microsomia based on principal component analysis and thin plate spline video analysis
Publication date: Available online 15 September 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): O. Kaya, B.I. Pluijmers, F. Staal, C. Ruff, B.L. Padwa, M.J. Koudstaal, D.J. Dunaway
Abstract
Craniofacial microsomia (CFM) is most often described as a unilateral malformation of derivatives of the first and second branchial arches. The mandible has been classified using several classification systems. However, all are based on two-dimensional imaging. The aim of this study was to mathematically describe the deformed mandible based on principal component analysis (PCA) in a three-dimensional way. This may aid in defining the flaws in existing surgical corrections of the mandible through the identification of the differences in shape compared with a normal mandible in a holistic view with the help of videos. Forty-three homologous landmarks were defined to describe a mandible with CFM. Computed tomography scans of 22 patients and 30 controls were marked manually. The changes in shape between the mandibles were visualized using videos. A lateral rotation with increase in posterior rotation of the condyle due to shortening of the condyle–gonial height and a longitudinal rotation with outward bending of the mandibular angle were noted on the affected side, as well as an inward bending of the angle on the unaffected side. Due to the compensatory remodelling of the mandible on the unaffected side, one could suggest that CFM is never truly unilateral.
https://ift.tt/2D3f78R
Postoperative pain management for tracheoesophageal fistula repair using transverse, in-plane, ultrasound guided paravertebral technique in a 2 kg neonate
We read with interest the recent paper discussing an ultrasound guided oblique intercostal approach for paravertebral catheters placement in 2 neonates scheduled for tracheoesophageal fistula repair [1]. While we applaud the author's choice of using for paravertebral catheters (PVBCs) in such small neonates, we question the technique used; an ultrasound image was not presented, and the figure and block details do not seem to be in concordance with the approach used. The depth of paravertebral space with intercostal approach is only few millimiters, making this approach extremely challenging, with a high risk of pneumothorax and intrapleural catheter placement.
https://ift.tt/2D1ciVz
Attenuation of murine allergic airway inflammation with a CXCR1/CXCR2 chemokine receptor inhibitor
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Op2LJ7
Precision and reproducibility of automated computer‐guided PASI measurements in comparison to trained physicians
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Qzgmz9
The vascular morphology of melanoma is related to Breslow index: an in vivo study with dynamic optical coherence tomography
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Qy2Prz
Mechanisms of Pathogenic Effects of Eosinophil Cationic Protein and Eosinophil Derived Neurotoxin on Human Keratinocytes
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Oo5OkP
Associations among two vitamin D receptor (VDR) gene polymorphisms (ApaI and TaqI) in acne vulgaris: A pilot susceptibility study
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2xgDjiq
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