Head and Neck Medicine by Alexandros G.Sfakianakis: 09/30/18

Κυριακή 30 Σεπτεμβρίου 2018

Primary amenorrhoea and clitoromegaly in a nulliparous woman: successful medical and surgical management

Clitoromegaly is an important sign of virilisation and poses difficulty in sex determination, when present since birth. The diagnosis and treatment in an adult is a major challenge to the treating gynaecologist. The primary reason for its development is androgen excess due to congenital adrenal hyperplasia, polycystic ovarian syndrome, ovarian virilising tumours, neurofibromas, adrenal neoplasm and prolonged intake of anabolic steroids. A case of young nulliparous married woman who presented with primary amenorrhoea and clitoromegaly and was managed successfully has been reported.

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Giant left breast hamartoma in a 45-year-old woman

This is a case of a woman in her fifth decade of life who presented with a lump in her left breast. The patient underwent extensive breast investigations which did not confirm one particular diagnosis. The lesion was excised, and histological findings confirmed the diagnosis of a giant breast hamartoma. This case is interesting due to the largeness. As well as this, giant breast hamartomas are uncommon, and this case highlights the difficulty in their diagnosis and frequent misdiagnoses, potentially contributing to their reported low incidence rates. Diagnosis is difficult due to the complex appearance of the mass on imaging, raising the possibility of malignancy. Core biopsy is unremarkable, with the final diagnosis only possible on histological examination of the resected mass.

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Hypoxic hepatitis and furosemide

Hypoxic hepatitis is a rather common complication of heart, circulatory or respiratory failure. We present the case of a patient with hypoxic hepatitis in the setting of heart failure and dehydration from furosemide as a reminder of an important clinical lesson. The pathogenesis of hypoxia (especially in the case of heart failure) is explained by a two-hit mechanism in which the liver at risk of hypoxic injury by passive hepatic congestion (right heart failure) is subsequently exposed to systemic hypoperfusion, which leads to a marked and transient elevation of aminotransferases. In the case presented, the use of furosemide (at least partially) promoted the second hit because it helped to generate hypotension and splanchnic hypovolaemia and favoured hepatic hypoxia.

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Red colour venous flow in the suprasternal view: a red flag sign

Description

A 3-day-old full-term neonate, born by normal vaginal delivery, was presented with respiratory distress and mild cyanosis. His room air saturation in all four limbs was 84%. The clinical examination was unremarkable. Chest X-ray showed cardiomegaly and increased pulmonary vascular markings. Transthoracic echocardiography revealed 8 mm ostium secundum atrial septal defect (ASD) with bidirectional shunt and dilated right atrium and right ventricle with absence of individual pulmonary veins (PV) draining into left atrium (LA). Suprasternal view showed vertical vein (VV) which was recognised as a vessel lateral to LA with red-coloured continuous flow on Doppler (figure 1). The PVs were draining into the venous confluence behind the LA which was draining into the VV. VV connects into the left innominate vein which finally forms the right superior vena cava (figure 1, video 1).

Figure 1

Suprasternal view demonstrating vertical vein....

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Use of long saphenous vein graft in acute on chronic mesenteric ischaemia

Acute mesenteric ischaemia is a relatively rare surgical emergency, but despite advances in diagnostic tests, the mortality of this condition remains stubbornly high (50%–80%). This is principally because of the non-specific nature of the presenting symptoms and subsequent delay in diagnosis. We report an unusual case of acute mesenteric ischaemia treated by emergency laparotomy, small bowel resection and revascularisation using reversed long saphenous vein graft.

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Primary undifferentiated pleomorphic cardiac sarcoma with MDM2 amplification presenting as acute left-sided heart failure

Primary cardiac tumours are a rare clinical entity that can present with myriad of non-specific cardiopulmonary symptoms. We describe a case of a 61-year-old previously healthy woman who presented with progressive dyspnoea and lower extremity swelling, suggestive of acute left-sided heart failure. Transthoracic echocardiogram revealed a large, 3.7x3.2 cm intracardiac mass resulting in severe mitral valvular dysfunction. The patient underwent surgical resection of the mass, however, negative margins were not obtained, and the tumour quickly returned. Histological and molecular analysis was consistent with the diagnosis of undifferentiated pleomorphic sarcoma with murine double minute 2 (MDM2) amplification. Given the overall grim prognosis, the patient chose to pursue comfort-based care. She died at home 9 months after the initial diagnosis. Here, we provide an updated review of the literature for the classification of undifferentiated pleomorphic cardiac sarcoma and potential treatment modalities.

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A delayed diagnosis: recurrent fever and beta thalassaemia

Familial Mediterranean fever and beta-thalassaemia are two genetic disorders, with a largely common geographical distribution. However, they have not much else in common, as the first is an autoinflammatory disorder, while the other is a haemoglobinopathy. We describe a patient with known beta-thalassaemia intermedia who presented with recurrent fevers and he was diagnosed with familial Mediterranean fever 2 years later. We discuss whether there is an association between the two disorders and the cognitive biases that lead to the delay in the diagnosis of familial Mediterranean fever.

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Imaging features of toxic megacolon

Description

A 27-year-old woman presents with vomiting and abdominal pain for 2 days. She had been diagnosed with ulcerative colitis (UC) 2 weeks prior and was started on oral sulfasalazine and prednisolone. Currently, she is afebrile and not tachycardic. On examination, the abdomen was distended and tender centrally. Serial abdominal radiographs showed persistently dilated transverse colon with loss of haustra (figure 1). CT abdomen revealed diffuse bowel thickening involving the ascending colon, caecum and terminal ileum with multiple pseudopolyps at the ascending colon (figure 2). The transverse colon is dilated up to 6.8 cm (figure 3). There are also multiple enlarged right-sided mesenteric nodes. A diagnosis of toxic megacolon (TM) was made. She deteriorated during admission due to acute pulmonary embolism. Blood investigations showed marked leucocytosis (32x10⁹/L) and raised C-reactive proteins (98.7 mg/L). Subtotal colectomy involving the caecum until splenic flexure was performed followed by ileostomy and mucous...

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Modified laparoscopic Janeway gastrostomy: a novel adjunct for the management of choledocholithiasis in Roux-en-Y patients

A 76-year-old woman with surgical history of Roux-en-Y gastric bypass presented with recurrent choledocholithiasis. Double balloon enteroscopy was unsuccessful in cannulating the biliary tree, thus, requiring surgically assisted endoscopic retrograde cholangiopancreaticogram (ERCP) access. Due to her stable clinical status, the non-urgent indication and multiple anticipated ERCPs for definitive biliary clearance, a more durable port of access to the ampulla was desired. A modified laparoscopic Janeway gastrostomy of the gastric remnant was performed and served as access for multiple subsequent endoscopic procedures with successful clearance of the biliary tree.

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DRESS syndrome due to vemurafenib treatment: switching BRAF inhibitor to solve a big problem

We present a case report of an early-onset drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) induced by vemurafenib (BRAF inhibitor) in a middle-age man affected by a metastatic, BRAF mutant melanoma who was started on first-line metastatic treatment with vemurafenib and cobimetinib.

After initiating the treatment, the patient presented an extensive cutaneous rash with eosinophilia and renal impairment. Due the constellation of signs and symptoms, a diagnosis of DRESS syndrome was made which strongly contraindicated the reintroduction of vemurafenib due to its hypersensibility reaction. Thus, vemurafenib was stopped immediately, and we started corticoid treatment with clinical improvement.

Due to the contraindication to start vemurafenib again, after multidisciplinary view of the case and having balanced the risks and benefits, we successfully performed a switch to another BRAF inhibitor in a progressively ascending pattern, without any skin toxicity and with a good response of the metastatic melanoma.

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Duplicated middle cerebral artery associated with aneurysm at M1/M2 bifurcation: a case report

A duplicated middle cerebral artery arises from the internal carotid artery and supplies blood to the middle cerebral artery territory. A duplicated middle cerebral artery is sometimes associated with an intra...

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Head and Neck Cancer in Haiti: A Case Series from Hopital de L’Universite d’Etat d’Haiti

This manuscript characterizes the demographics, presenting symptoms and risk factors of patients diagnosed with head and neck cancer at Hopital de L'Universite d'Etat d'Haiti (HUEH), Haiti's single largest healthcare facility. We conducted a prospective study of patients who presented to HUEH between January and March of 2016 with a lesion of the head or neck suspicious for cancer. All patients who met eligibility criteria received a biopsy, which was interpreted by a Haitian pathologist and when the specimen was available was confirmed by a team of pathologists from Stanford University. A total of 34 participants were identified. The biopsy-confirmed diagnoses were squamous cell carcinoma (n=7), benign (n=7), large cell lymphoma (n=2), ameloblastoma (n=2), pleomorphic adenoma (n=1), and adenocarcinoma (n=1). Fourteen patients were unavailable for biopsy. Patients with head and neck cancer had a mean age of 63.4 years, were majority male (62.5%), waited on average 10.9 months to seek medical attention, and most commonly presented with T-stage 3 or higher disease (87.5%). By characterizing patterns of head and neck cancer at HUEH we hope to facilitate efforts to improve early detection, diagnosis, and management of this important public health condition.

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A bronchoprotective role for Rgs2 in a murine model of lipopolysaccharide-induced airways inflammation

Asthma exacerbations are associated with the recruitment of neutrophils to the lungs. These cells release proteases and mediators, many of which act at G protein-coupled receptors (GPCRs) that couple via Gq to...

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2018 Sidney H. Ingbar Distinguished Lectureship Award to Be Given to Anthony N. Hollenberg, MD, at American Thyroid Association’s Annual Meeting

October 1, 2018—The American Thyroid Association (ATA) is pleased to announce that the 2018 Sidney H. Ingbar Distinguished Lectureship Award recipient will be Dr. Anthony N. Hollenberg, currently Professor and Chief of the Division of Endocrinology, Metabolism, and Diabetes at Beth Israel Hospital, Boston, as well as Physician in Endocrinology at Beth Israel Deaconess Medical Center (BIDMC).

The Ingbar Award recognizes an established investigator who has made outstanding contributions to thyroid-related research over many years. The award honors the memory of Dr. Sidney H. Ingbar, a brilliant innovator who was once Chief of the Beth Israel Thyroid Unit, a position Dr. Hollenberg now holds. The medal is conferred at the ATA Annual Meeting, held this year from October 3 to 7 in Washington, DC. On Friday, October 5, at 1 pm, Dr. Hollenberg will deliver the Sidney H. Ingbar Distinguished Award Lecture, titled "New Insights into Thyroid Hormone Action."

Dr. Hollenberg is recognized internationally for his consistent research contributions in studies of the molecular action of thyroid hormones. He was among the first to identify that thyrotropin-releasing hormone (TRH) neurons in the hypothalamus serve as integrators of metabolic input, setting thyroid hormone levels within the context of body weight. He was also among the first to identify the role of specific co-repressors in negative regulation by the thyroid and helped to establish the idea that hormone sensitivity is due to the quantity of co-repressors present. He has had an independent research laboratory at Beth Israel Hospital since 1993 and been funded continuously by the NIH since 1995. In addition, he founded the Thyroid Nodule Clinic at BIDMC 16 years ago to enable clinicians, radiologist, and cytologist to practice together, enhancing clinical care for patients with nodules.

In addition to groundbreaking research in thyroid hormone receptor action and function, Dr. Hollenberg has more recently begun a new program in his laboratory focused on the development of functioning thyroid follicular cells from embryonic stem cells, working in conjunction with the Kotton lab at Boston University School of Medicine.

Dr. Hollenberg received his MD from the Faculty of Medicine at the University of Calgary, Alberta, after earning his AB degree cum laude in biochemical sciences from Harvard College. He spent his internship and residency at BIDMC, after which he was Chief Medical Resident there for one year. Overlapping that appointment and continuing after it, he was Clinical and Research Fellow in Endocrinology as Massachusetts General Hospital (MGH). At the same time, he has risen from Instructor to Professor of Medicine at Harvard Medical School and has held—and continues to hold—numerous administrative positions at the local, national, and international levels. He has been a welcomed speaker at symposia, seminars, society meetings, and medical schools around the world for almost 20 years.

In addition to his research and academic activities, Dr. Hollenberg has served in an editorial capacity for the New England Journal of Medicine, Proceedings of the National Academy of Sciences, Endocrinology, Journal of Biological Chemistry, and many other journals and been on the editorial boards of Endocrinology and Molecular Endocrinology. Over 100 publications and book chapters have Dr. Hollenberg's signature and he has mentored and trained well over 100 graduate students and laboratory trainees. He received the ATA's Van Meter Award and the British Endocrine Society's Pitt Rivers Award, among others.

Through his sophisticated research, innovations, public speaking, and publications, Dr. Hollenberg has contributed significantly and continuously to the well-being of those with thyroid disease. That commitment, combined with his dedication to his patients and students, makes him a very worthy recipient for the highly sought after and prestigious, Sidney H. Ingbar Distinguished Award.

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The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 95^th anniversary, the ATA continues to deliver its mission of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health. These efforts are carried out via several key endeavors:

The publication of the highly regarded professional journals Thyroid, Clinical Thyroidology, and VideoEndocrinology
Annual scientific meetings
Biennial clinical and research symposia
Research grant programs for young investigators
Support of online professional, public, and patient educational programs
Development of guidelines for clinical management of thyroid disease and thyroid cancer

The ATA promotes thyroid awareness and information online through Clinical Thyroidology for the Public and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet. Every fifth year, the American Thyroid Association joins with the Latin American Thyroid Society, the European Thyroid Association, and the Asia and Oceania Thyroid Association to cosponsor the International Thyroid Congress (ITC).

The post 2018 Sidney H. Ingbar Distinguished Lectureship Award to Be Given to Anthony N. Hollenberg, MD, at American Thyroid Association's Annual Meeting appeared first on American Thyroid Association.

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2018 Paul Starr Award to Be Given to Scott A. Rivkees, MD, at American Thyroid Association’s Annual Meeting

October 1, 2018—The American Thyroid Association (ATA) is pleased to announce that the 2018 Paul Starr Award recipient and lecturer will be Dr. Scott A. Rivkees, Professor and Chair, as well as Nemours Eminent Scholar, at the University of Florida Department of Pediatrics. Dr. Rivkees is also Physician-in-Chief at Shands Children's Hospital in Gainesville, Academic Chair of Pediatrics at Arnold Palmer Hospital in Orlando, and University of Florida Chair of Pediatrics at Studer Family Children's Hospital at Sacred Heart in Pensacola.

The Starr Award is presented to an outstanding contributor to clinical thyroidology. At the ATA Annual Meeting in Washington, DC, Dr. Rivkees will deliver the Paul Starr Award Lecture at 1:00 pm on October 4, 2018, on "Unmasking the Problems With Antithyroid Medication Safety."

Dr. Rivkees earned his BS in biochemistry from Cook College at Rutgers University and his MD from New Jersey Medical School. Thereafter, he was a Resident in Pediatrics at Massachusetts General Hospital (MGH) and Clinical Fellow in Pediatrics at Harvard Medical School (HMS), then a Clinical Fellow in Pediatric Endocrinology at both locations. While working as a Postdoctoral Fellow in Neuroscience—again at both locations—Dr. Rivkees was also a Research Fellow at MGH. After his postdoc, he was appointed Instructor in Pediatrics at HMS and Assistant in Pediatrics at MGH, followed by Assistant Professor of Pediatrics at HMS and Associate Professor Pediatrics at Indiana University and Yale University. After receiving tenure at Yale, he became director of the Yale Child Health Research Center, Professor of Pediatrics, Chief of the Section of Developmental Endocrinology and Biology, and Associate Chair of Yale Pediatrics for Research, all at the same time. From there he moved to his current appointments in Florida.

Dr. Rivkees's important contributions have focused on pediatric thyroidology, but also on thyroidology more generally. He made public the dangers—especially the onset of liver failure—associated with the use of the medicine propylthiouracil, which resulted in worldwide changes in the treatment of hyperthyroidism. Through his research, clinical work, and publications, he was responsible for changing the way children with juvenile-acquired hypothyroidism are treated. He wrote many papers concerning the risks and benefits of using radioactive iodine in children with thyroid disease, predating the ATA's own guidelines on treating pediatric thyroid cancer. And he started the first Pediatric Thyroid Cancer Program in the US, at Yale University.

Another area of Dr. Rivkees's research evaluated the risks of antithyroid medications to both mother and fetus, which led to findings that are now incorporated into the ATA guidelines for managing hypothyroidism during pregnancy.

Dr. Rivkees has written over 230 articles, chapters, and editorials. He is Editor-in-Chief of the International Journal of Pediatric Endocrinology and a member of the American Society for Clinical Investigation. He has been named "One of America's Best Doctors" and "One of America's Top Pediatricians," as well as "Physician of the Year" by the CARES Foundation. Dr. Rivkees has served on numerous panels, advisory boards, editorial boards, and symposia and in 2012 was named a Fellow of the American Academy for the Advancement of Science. He holds one patent, with three more pending.

Over the past three-plus decades, Dr. Rivkees has demonstrated repeatedly his dedication to clinical thyroidology, improving the care of infants, children, and adolescents worldwide. That commitment, combined with his dedication to his patients and students, makes him a very worthy recipient for the highly sought after and prestigious, 2018 Paul Starr Award, the first ever given to a pediatric endocrinologist.

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The publication of the highly regarded professional journals Thyroid, Clinical Thyroidology, and VideoEndocrinology
Annual scientific meetings
Biennial clinical and research symposia
Research grant programs for young investigators
Support of online professional, public, and patient educational programs
Development of guidelines for clinical management of thyroid disease and thyroid cancer

The post 2018 Paul Starr Award to Be Given to Scott A. Rivkees, MD, at American Thyroid Association's Annual Meeting appeared first on American Thyroid Association.

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2018 Lewis E. Braverman Distinguished Award to Be Presented to R. Michael Tuttle, MD, at American Thyroid Association’s Annual Meeting

October 1, 2018—The American Thyroid Association (ATA) announces with pleasure that the 2018 Lewis E. Braverman Distinguished Award recipient will be Dr. R. Michael Tuttle, currently Clinical Director of the Endocrinology Service and Attending Physician at Memorial Hospital for Cancer and Allied Diseases in New York City. Academic positions include Member, at Memorial Sloan Kettering Cancer Center (MSKCC) and Professor of Medicine at Weill Medical College of Cornell University, both in New York City.

The Braverman Distinguished Award is presented annually to an individual who: demonstrates excellence and passion for mentoring fellows, students, and junior faculty; has a long history of productive thyroid research; and is devoted to the ATA. Dr. Tuttle will give the Braverman Lecture, entitled "Common Clinical Thyroid Cancer Questions in Need of Better Answers" on October 6 at 10:45 am, during the ATA Annual Meeting, which is held this year from October 3 to 7 in Washington, DC.

Dr. Tuttle has demonstrated his teaching and mentoring excellence in training medical students, interns, residents, and fellows during his entire career. Many of his past fellows have gone on to national and international prominence in thyroid cancer research, treatment, and education. To quote one of his fellows, now an assistant professor from Saudi Arabia, he learned from Dr. Tuttle that "it is OK to change my practice and admit to do so if studies proved new evidence…. I learned how to communicate with colleagues and other working staff in a delightful way. He was always considerate and open to new ideas." Another cancer physician writes that after his fellowship with Dr. Tuttle he "gave multiple lectures around the country [Israel] that helped change the 'one size fits all' approach to a more risk-adapted, personalized approach." Through hundreds of invited lectures, meetings, and grand rounds, as well as his almost 300 publications, Dr. Tuttle has reached even more medical students, fellows, and peers with his emphasis on minimalism in treatment.

Dr. Tuttle's research has had major clinical impact over the years on the care of thyroid cancer patients. His laboratory's work confirmed that a recurrence staging system effectively predicts the risks of recurrence and persistent disease and that these risk assessments can be used productively to tailor follow-up recommendations for individual patients on a case-by-case basis, rather than using generalized treatment methods. Another of his mentees comments, "Thanks to everything learned with Dr. Mike Tuttle…the quality of life of patients with diagnosis and thyroid cancer in Chile is significantly higher."

An active member of the ATA since 1997, Dr. Tuttle has served on multiple committees, such as Clinical Affairs, Standards of Care, and Membership, among others. He was Program Chair of the 2014 Annual Meeting and a member of the Board of Directors from 2007 to 2011. He was key in drafting the ATA Guidelines on the Management of Thyroid Nodules and Thyroid Cancer and continues to be active on that committee, and he currently is Chair of the ATA's Medullary Thyroid Cancer Registry Consortium. In addition, Dr. Tuttle has been a reviewer for the ATA's journal Thyroid (as well as many other journals) and was Associate Editor of Thyroid from 2013 through 2015. He has attracted many new members to the ATA with his great enthusiasm for the study of thyroid disease.

Dr. Tuttle earned his BS in biology magna cum laude from Northern Kentucky University and his MD cum laude from the University of Louisville School of Medicine, KY. He spent his internship and residency in Internal Medicine at Dwight David Eisenhower Army Medical Center, Augusta, GA, where he was awarded "Outstanding Graduating Resident." He held a Clinical Fellowship in endocrinology, a Research Fellowship in endocrinology and molecular biology, and then was Staff Endocrinologist, all at Madigan Army Medical Center in Tacoma, WA. His hospital positions thereafter were at Walter Reed Army Medical Center and then the Department of Medicine, Memorial Hospital for Cancer and Allied Disease, NYC, where he is now Attending Physician and Clinical Director of the Endocrinology Service. At the same time, his teaching and research positions have led him through the professional ranks at Memorial Sloan Kettering Cancer Center and the Weill Medical College of Cornell University.

Dr. Tuttle continues to leave a significant impact in the thyroid cancer field through his valuable mentoring, research, and contributions to the ATA. That commitment, combined with his dedication to his patients and students, makes him a very worthy recipient for the highly sought after and prestigious, 2018 Lewis E. Braverman Distinguished Award.

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The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 70 countries around the world. Celebrating its 95^th anniversary, the ATA delivers its mission of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health.

These efforts are carried out via several key endeavors:

The publication of the highly regarded professional journals Thyroid^®, Clinical Thyroidology^®, and VideoEndocrinology
Annual scientific meetings
Biennial clinical and research symposia
Research grant programs for young investigators
Support of online professional, public, and patient educational programs
Development of guidelines for clinical management of thyroid disease and thyroid cancer

Further information about the ATA^® annual meeting can be found https://www.thyroid.org/88th-annual-meeting-ata/ and research grants program https://www.thyroid.org/media-main/ and patient information https://www.thyroid.org/thyroid-information/. The ATA promotes thyroid awareness and information online through Clinical Thyroidology^® for the Public and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet. Every fifth year, the American Thyroid Association joins with the Latin American Thyroid Society, the European Thyroid Association, and the Asia and Oceania Thyroid Association to cosponsor the International Thyroid Congress (ITC).

The post 2018 Lewis E. Braverman Distinguished Award to Be Presented to R. Michael Tuttle, MD, at American Thyroid Association's Annual Meeting appeared first on American Thyroid Association.

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The American Thyroid Association holds its 88th Annual Meeting at the Marriott Marquis, Washington DC from October 3-7, 2018

The 88^th Annual Meeting of the American Thyroid Association (ATA) is almost here!! On behalf of the program committee, we look forward to welcoming you and your guests to our ATA annual meeting to be held October 3-7, 2018 at the Marriott Marquis Washington DC. This year the program committee, comprised of experts of all thyroid disciplines, has worked tirelessly to develop a program featuring the latest advances in basic/ translational and clinical thyroidology (www.thyroid.org). Meeting registration is on track to generate the highest attendance we have ever had for an ATA meeting. Washington, DC is a world-class destination with many stellar cultural, musical and museum attractions (within walking distance of the headquarters' hotel) available to attendees and their families.

New Programs This Year

This year the program will feature a wide variety of primary lectures, symposia and discussion-debates/meet the professor workshops that have been highly rated in the past along with several new sessions we hope to be of great interest. The first is the very first ATA international symposium – the ATA Latin American Satellite Symposium from 1:00 PM to 4:00 PM on Wednesday, October 3. This will represent a gathering of Latin American and ATA leaders allowing for true international interaction, networking, collaboration, the renewal of old and hopefully the development of new friendships. The international representation of the annual meeting is reflected by the over 543 abstracts submitted representing more than 38 countries.

The other new addition to the 2018 program is the 1^st Annual Advanced Practice Providers (APP) Satellite Symposium from 1:00 to 6:00 PM on Saturday, October 6. This symposium reflects the growing membership within the ATA of advanced practice providers. Reflecting this, the APP symposium will bring together the spectrum of healthcare professionals comprising the clinical "thyroid team"; focusing on all aspects of clinical management of thyroid disease, including nurse practitioners, clinical nurse specialists, advanced degree nurses and physician assistants.

Opening Day

Of interest in our pre-meeting programming is the ATA Endocrine Neck Advanced Ultrasound Course co-chaired by Kevin Brumund and Susan Mandel on Wednesday, October 3 and the E. Chester Ridgway Trainee Conference, an extensive clinical and basic training program co-chaired by Jacqueline Kung and Jennifer Sipos (for both these pre-congress programs preregistration is required, and seating is limited). On the evening of October 3, the annual meeting will kick off with our traditional Year in Thyroidology review featuring three leaders to discuss and interpret the top recent literature published in basic, clinical and surgical thyroidology. Christine Spitzweg, Virginia Sarapura, and Amy Chen will present summaries of the most notable studies in each of their respective fields. This remains a highly anticipated opening session and will be followed by the

This year, we have two distinguished speakers who will be presenting timely and novel plenary lectures: Dr. Kevin Harold from Yale University speaking on The Role of the Microbiome in Thyroid Autoimmunity and Dr. Timothy Chan from MSKCC discussing Antitumor Immunology and Immune therapies for Advanced Thyroid Cancer. Notable symposia include: Clinical Symposium: Iodine and Health, chaired by Elizabeth Pearce with speakers Jonathan Gorstein, Sarah C. Bath and Angela M. Leung; Basic Symposium: Genetic Landscapes on Advanced Thyroid Cancers chaired by Laura Boucai, with speakers Mingzhao Xing, Matthew D. Ringel and James A. Fagin. The highly anticipated Arthur Bauman Clinical Symposium will focus on cytologically indeterminate thyroid nodules and the role (and controversies) of molecular markers in their management strategies.

Awards remain an important part of the meeting, with recognitions being held for the following:

The ATA will announce the recipient of the Van Meter Award on Thursday, October 4^th in recognition of outstanding contributions to thyroid research.
Scott A. Rivkees is the recipient of the Paul Starr Award, which recognizes outstanding contributions to clinical thyroidology, and will present Unmasking the Problems with Anti-Thyroid Medication Safety.
The ATA Distinguished Service Award will be presented to David H. Sarne for his outstanding contributions to the society.
The John B. Stanbury Thyroid Pathophysiology Medal will be awarded to Marvin C. Gershengorn.
The Clark T. Sawin Historical Presentation on the Treatment of Hypothyroidism – from Animal Extracts to Current Controversies will be moderated by Peter Kopp, with panelists to include John Morris, Valerie Anne Galton, Jacqueline Jonklaas and Stephen LaFranchi.
The Sidney H. Ingbar Distinguished Awardee, an established investigator who has made major contributions to thyroid-related research over many years, is Anthony Hollenberg who will speak on New Insights into Thyroid Hormone Action.
The Lewis E. Braverman Distinguished Lectureship Award established in 2011 to recognize an individual who has demonstrated excellence and passion for mentoring fellows, students and junior faculty is being presented by R. Michael Tuttle on Common Clinical Thyroid Cancer Questions in Need of Better Answers.

Based on the success of last year's meeting, we are pleased to again offer the ATA Pediatric Thyroid Forum Satellite Symposium – Current state and Future Directions, co-chaired by Andrew Bauer and Catherine Dinauer taking place Saturday, October 6.

Mainstays of the Annual meeting, Discussion-Debates/Meet The Professor Workshops have shown high registration numbers thus far, including Locally Advanced Thyroid Cancer in the Era of TKIs, Endocrine and Nuclear Medicine – Controversies, Consensus and Collaboration in the use of RAI therapy in DTC, Understanding of Thyroid Pathology and Cytology for Endocrinologists and Surgeons, Thyroid Disease and Pregnancy, Medullary Thyroid Cancer – Updates on Detection, Management and Postoperative follow-up, RET translational symposium – 25 year anniversary of RET and Precision Medicine in Thyroid Cancer 2018.

Surgical programming

The surgical component of this year's annual meeting will be strong with participation of our many surgeon members representing numerous thyroid surgical societies. Sessions of interest to surgeons include the Role of molecular markers and evaluation of thyroid nodules chaired by Jennifer Sipos, a session on Medullary Thyroid Cancer chaired by Rich Wong, a session on Patient Reported Outcomes in Thyroid Cancer Treatment chaired by Megan Haymart and Jeffrey Garber and a special Surgical Symposium on Multidisciplinary Management of Graves' Disease 2018 chaired by Rosemary Metzger as well as a Thyroid Cancer Tumor Board session chaired by Catherine Sinclair and a session on Locally Advanced Thyroid Cancer Management in the Era of TKIs moderated by Wendy Sacks. We will again have a VideoEndocrinology session on Risk stratification of thyroid cancer chaired by William Barry Inabnet and David Terris.

ATA Governance and Constituency-building

The ATA annual meeting is a great time to work for the ATA within its committee structure and to get time to engage directly with colleagues and trainees over a poster or by discussion of an oral abstract presentation. Meet presenters and attendees with backgrounds in basic and clinical thyroid research, general endocrinology, otolaryngology, endocrine surgery, pediatric endocrinology, medical oncology, nuclear medicine, laboratory sciences, industry, pathology, cytology, advanced practice providers and allied health disciplines. Meet with pharmaceutical, device and technology sponsors and our patient support groups at the 2018 ATA Thyroid EXPO. ATA committee meetings will be held Wednesday, October 3, the Women in Thyroidology Networking Reception also Wednesday, October 3 the annual ATA Business Meeting will be held Thursday, October 4.

CME and MOC credits available

This year through meeting attendance one may earn a maximum of 23.50 AMA PRA Category 1 Credits™ and in addition through a new Maintenance of Certification (MOC) program attendees may earn up to 23.50 medical knowledge MOC points in the American Board of Internal Medicine MOC program through their program and activity reporting system and ACCME.

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2018 Distinguished Service Award to Be Given to David H. Sarne, MD, at American Thyroid Association’s Annual Meeting

October 1, 2018—The American Thyroid Association (ATA) is pleased to announce that the 2018 Distinguished Service Award recipient will be Dr. David H. Sarne, currently Clinical Associate in the Department of Medicine at the University of Chicago.

The Distinguished Service Award recognizes an ATA member who has made important and continuing contributions to the Association. The award will be conferred during the Presentation of Awards, beginning at 4:00 pm on October 4 during the ATA Annual Meeting, held this year from October 3 to 7 in Washington, DC.

Dr. Sarne received his MD with honors from the University of Michigan Medical School, after receiving his BS with highest distinction in Psychology and Zoology from the University of Michigan. He spent his internship and residency with the University of California Hospitals and Clinics in San Francisco and then became a Fellow in the Section of Endocrinology, Department of Medicine, at the University of Chicago. After three years as an Assistant Professor of Medicine at the University of Chicago, he moved to the University of Illinois Medical Center, where he rose to Professor. In 2012 he returned to the University of Chicago in his current position.

He has specialized in thyroid disorders, including hyperthyroidism, nodules, and thyroid cancer. As such, he has received regular funding for research efforts and has been an invited speaker at universities, association meetings, and conferences. Dr. Sarne has been the primary or a significant contributor to over 50 articles, book chapters, and other publications and has served as a manuscript reviewer for numerous medical journals, including JAMA, the New England Journal of Medicine, Thyroid, and Endocrinology, among others. He has repeatedly been named one of the "Best Doctors in America" and received scholarships, prizes, and awards throughout his academic and practice years.

Most important for the Distinguished Service Award, Dr. Sarne served on a variety of committees for the ATA between 1987 and 2017, including the Education Committee, the Distinguished Service Committee, the Awards Committee, the Annual Meeting Organizing Committee, and the Finance and Audit Committee—for the last of which he was Chair for 13 years. And he has twice served on the ATA's Board of Directors as Treasurer and member of the Executive Committee, first for a period of 7 years and most recently for 2 more years.

Dr. Sarne's tremendous commitment of time and energy to the Association over the past 30 years has helped to maintain our successful operation, particularly our financial health and stability. That commitment, combined with his dedication to his patients and students, makes him a very worthy recipient for the highly sought after and prestigious Distinguished Service Award.

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The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 70 countries around the world. Celebrating its 95^th anniversary, the ATA delivers its mission of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health.

These efforts are carried out via several key endeavors:

The publication of the highly regarded professional journals Thyroid^®, Clinical Thyroidology^®, and VideoEndocrinology
Annual scientific meetings
Biennial clinical and research symposia
Research grant programs for young investigators
Support of online professional, public, and patient educational programs
Development of guidelines for clinical management of thyroid disease and thyroid cancer

The post 2018 Distinguished Service Award to Be Given to David H. Sarne, MD, at American Thyroid Association's Annual Meeting appeared first on American Thyroid Association.

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2018 John B. Stanbury Thyroid Pathophysiology Medal to Be Awarded to Marvin C. Gershengorn, MD, at American Thyroid Association’s Annual Meeting

October 1, 2018—The American Thyroid Association (ATA) announces with pleasure that the 2018 John B. Stanbury Thyroid Pathophysiology Medal will be awarded to Dr. Marvin C. Gershengorn at the ATA Annual Meeting this week. Dr. Gershengorn is Chief of the Clinical Endocrinology Branch (formerly the Laboratory of Endocrinology and Receptor Biology) at the National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland.

The Stanbury Medal recognizes outstanding research contributions, either conceptual or technical, to the understanding of thyroid physiology or the pathophysiology of thyroid disease, that have had a major impact on research or clinical practice. The medal is traditionally conferred at the ATA Annual Meeting, held this year from October 3 to 7 in Washington, DC.

Dr. Gershengorn received his MD with honors in Biochemistry in 1971 from New York University School of Medicine after completing his BS magna cum laude at City College of the City University of New York (CUNY). He completed his internship and residency in Medicine at Strong Memorial Hospital of the University of Rochester School of Medicine and Dentistry. He became a Clinical Associate in the Clinical Endocrinology Branch of the National Institute of Arthritis, Metabolism, and Digestive Diseases at NIH, then returned to the NYU School of Medicine as Assistant Professor, then Director of the Honors Program, Associate Professor of Medicine, and Associate Professor in the Graduate School of Arts and Sciences. Moving to Cornell University Medical College and the New York Hospital, he was appointed in turn Professor of Medicine and Chief of the Division of Endocrinology and Metabolism, Professor of Physiology and Biophysics, the Abby Rockefeller Mauze Distinguished Professor of Endocrinology in Medicine, Professor of Cell Biology and Genetics, Professor of Medicine and Director of the Division of Molecular Medicine, and Director of the Molecular Medicine Training Program. At Weill Graduate School of Medical Sciences of Cornell University, Dr. Gershengorn was appointed Chair of the Program in Physiology, Biophysics, and Molecular Medicine. He joined the NIDDK in 2001 as Director of the Division of Intramural Research (Scientific Director) before his current appointment in 2008.

During his various research positions, Dr. Gershengorn has made groundbreaking scientific contributions that have increased our understanding of thyroid physiology, from the development of the first assays to measure T3 in human serum, to using lithium as an adjunct to radioiodine therapy in thyroid cancer, to fine-needle aspiration biopsy for the diagnosing thyroid nodules, to determining the gene sequence of the TRH receptor, among many others. His laboratory has been the leader in developing small-molecule, drug-like compounds that target the TSH receptors of the thyroid.

Dr. Gershengorn has received numerous awards, honors, and fellowships during his career, including both the Van Meter Award and the Sidney Ingbar Distinguished Lectureship for Outstanding Thyroid Research from the ATA, two awards from the Endocrine Society, and the NIDDK Director's Award for Translational Research. He has served on the editorial boards of journals dedicated to endocrinology, biological chemistry, and physiology and on advisory boards, review committees, and as a board director. From 1999 to 2001, Dr. Gershengorn was a Director of the ATA Board.

In addition to holding five patents, Dr. Gershengorn has shared in writing 280 journal articles since 1968.

His four decades of very productive research, teaching, writing, and continuous contributions to our understanding of the pathophysiology of thyroid disease make Dr. Gershengorn an extremely appropriate recipient of the 2018 John B. Stanbury Pathophysiology Medal.

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The publication of the highly regarded professional journals Thyroid^®, Clinical Thyroidology^®, and VideoEndocrinology
Annual scientific meetings
Biennial clinical and research symposia
Research grant programs for young investigators
Support of online professional, public, and patient educational programs
Development of guidelines for clinical management of thyroid disease and thyroid cancer

The ATA promotes thyroid awareness and information online through Clinical Thyroidology for the Public and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet. Every fifth year, the American Thyroid Association joins with the Latin American Thyroid Society, the European Thyroid Association, and the Asia and Oceania Thyroid Association to cosponsor the International Thyroid Congress (ITC).

The post 2018 John B. Stanbury Thyroid Pathophysiology Medal to Be Awarded to Marvin C. Gershengorn, MD, at American Thyroid Association's Annual Meeting appeared first on American Thyroid Association.

https://ift.tt/2OlIbwK

Erratum zu: Monolokuläres Erythema elevatum et diutinum am Handrücken

Erratum zu:

Hautarzt 2018, Suppl 1

https://ift.tt/2xPnvDQ

Sehr geehrte Leserin, sehr geehrter Leser,

im oben genannten Beitrag ist es leider zu einem Fehler im Titel gekommen. Wir bitten Sie, den aktualisierten Beitragstitel zu berücksichtigen und den Fehler zu …

https://ift.tt/2NhuASA

Phenotyping and long-term follow up of patients with hyper IgE syndrome

Publication date: Available online 29 September 2018

Source: Allergologia et Immunopathologia

Author(s): S. Alyasin, H. Esmaeilzadeh, N. Ebrahimi, S.H. Nabavizadeh, S. Kashef, E. Esmaeilzadeh, M. Babaei, R. Amin

Abstract

Introduction and objectives

Long-term follow up of patients with hyper IgE syndrome (HIES), as a primary immunodeficiency disorder, has been poorly investigated. This study describes common clinical and immunological features of patients with HIES in the last 10 years in Shiraz University of Medical Sciences, Shiraz, Iran.

Methods and patients

In this cross-sectional study, the symptoms and medical records of 18 patients, who were diagnosed with HIES, were observed. Genetic and immunologic study was also performed.

Results

Eighteen patients with the mean age of 13 years old were investigated. Ten patients were detected to have mutations in DOCK8 gene and autosomal recessive HIES (AR-HIES); and four patients were found with STAT3 mutation and autosomal dominant HIES (AD-HIES). So, 14 patients with known genetic results were considered for further data analysis. Food allergy, eczema, viral and skin infections were the major complications of AR-HIES patients. The major clinical complications of AD-HIES patients were pneumonia, skin infections and eczema. Food allergy and viral infection were significantly higher in DOCK8 deficient patients. The most common causes of hospitalization in both AR-HIES and AD-HIES patients were pneumonia, skin infections and sepsis. The most common cause of death was found to be sepsis.

Conclusions

AD-HIES and AR-HIES cannot be differentiated only based on the clinical presentations. Genetic features are also necessary for better diagnosis. This study, summarizing the clinical, immunological and genetic information of the patients with AD-HIES and AR-HIES, may open a way for better diagnosis and management of HIES.

https://ift.tt/2NOWVol

Sublingual gland flap for soft tissue reconstruction of oral defects

Publication date: Available online 29 September 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): T. Eguchi, A. Basugi, I. Kanai, Y. Miyata, Y. Hamada

https://ift.tt/2N8sAM5

Classification of craniofacial osteoradionecrosis: the addition of “end stage disease”

Publication date: Available online 29 September 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): A. Kanatas, S. Doumas

https://ift.tt/2OqafyI

Immune response and evasion mechanisms in lip carcinogenesis: an immunohistochemical study

Publication date: Available online 29 September 2018

Source: Archives of Oral Biology

Author(s): Maria Luiza Diniz de Sousa Lopes, Amanda Katarinny Goes Gonzaga, Carla Mosconi, Gustavo Martelli Palomino, Elismauro Francisco Mendonça, Aline Carvalho Batista, Éricka Janine Dantas da Silveira

Abstract

Objectives

Programmed death ligand-1 (PD-L1) and human leukocyte antigen-G (HLA-G) are considered immune checkpoint molecules that inhibit T-cell effectiveness, contributing to tumor immune escape. This study investigated PD-L1, HLA-G, CD8, and granzyme B (GrB) expression at different stages of lip carcinogenesis.

Design and results

Forty cases of lip squamous cell carcinoma (LSCC), 55 actinic cheilitis (AC), and 10 healthy lip mucosa (HLM) were submitted to immunohistochemistry. Semiquantitative (PD-L1, HLA-G), and quantitative (CD8, GrB) analysis were performed. PD-L1 and HLA-G expression in neoplastic cells/keratinocytes and stroma/connective tissue was significantly higher in LSCC and AC, compared to HLM (p<0.05). PD-L1 was not associated with clinicopathological features of the lesions. HLA-G expression by malignant cells was significantly higher in LSCCs with distant metastasis (p = 0.041).CD8⁺ and GrB⁺ cell numbers progressively increased from HLMs to LSCC, with AC exhibiting intermediate numbers (p<0.01). Most LSCCs showed coexistence of PD-L1⁺ and CD8⁺ cells (72.5%). PD-L1 was directly correlated to CD8⁺ and GrB⁺ lymphocytic infiltration in LSCCs (p<0.05). Low cytotoxic immune response was associated with lymph node metastasis in LSCC (p<0.05).

Conclusions

PD-L1 and HLA-G-mediated immune evasion mechanisms are likely to occur from early pre-malignant to advanced malignant stages of lip carcinogenesis, which might provide a rationale for therapeutic blockade of these pathways. PD-L1 expression in LSCCs was correlated with the cytotoxic markers, suggesting that that PD-L1 may appear as an escape mechanism in response to an active antitumor response.

https://ift.tt/2y4TSOe

Immune response and evasion mechanisms in lip carcinogenesis: an immunohistochemical study

Publication date: Available online 29 September 2018

Source: Archives of Oral Biology

Abstract

Objectives

Design and results

Conclusions

https://ift.tt/2y4TSOe

December 2018

Publication date: Available online 29 September 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Vivian Hernandez-Trujillo, John J. Oppenheimer, David A. Khan

https://ift.tt/2DI4V5U

Early versus late alveolar bone grafting in unilateral cleft lip and palate: dental arch relationships in pre-adolescent patients

Publication date: Available online 29 September 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Marina Siegenthaler, Lisa Bettelini, Andrzej Brudnicki, Martin Rachwalski, Piotr S. Fudalej

Summary

Objective

To evaluate the dental arch relationship in preadolescent children with complete unilateral cleft lip and palate after early secondary alveolar bone grafting (E-ABG) by comparing to late bone grafting (L-ABG).

Material and Methods

Two raters blindly assessed the dental arch relationship with the modified Huddart-Bodenham (HB) Index for 2 groups: E-ABG group (36 children, mean age 9.6 years) and L-ABG group (56 children, mean age 11.1 years). The groups differed with respect to age at which alveolar bone grafting was performed: between 1.4 and 4.1 years (mean 2.2 years, E-ABG group) and after 8 years (L-ABG group). T-test was run to compare scores between 2 groups. Regression analysis was carried out to evaluate gender, age at cleft repair, age at ABG, and age at assessment with the HB index.

Results

The overall HB scores were -6.77 and -4.25 in the E-ABG and L-ABG groups, respectively (p = 0.025). Regression analysis showed that only the age at cleft repair influenced the HB scores.

Conclusion

ABG carried out between 2 and 4 years of age does not seem to negatively affect the dental arch relationship at the age of 10 years in comparison to L-ABG.

https://ift.tt/2zGwad8

Individual Reliability of the Standard Clinical Method vs Patient-Centered Tinnitus Likeness Rating for Assessment of Tinnitus Pitch and Loudness Matching.

Individual Reliability of the Standard Clinical Method vs Patient-Centered Tinnitus Likeness Rating for Assessment of Tinnitus Pitch and Loudness Matching.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 27;:

Authors: Hébert S

Abstract
Importance: Current individualized sound therapies for tinnitus rely on tinnitus pitch assessment, which is commonly derived from the standard clinical 2-alternative forced-choice (2-AFC) approach driven by the examiner. However, this method is limited by lack of individual test-retest reliability and focuses on a single rather than multiple tinnitus frequencies.
Objective: To assess individual test-retest reliability of the 2-AFC, with a single final frequency (and corresponding loudness), and the tinnitus likeness rating (TLR), with the participant exposed to the entire audible frequency spectrum, from which 3 dominant frequencies and corresponding loudness were extracted.
Design, Setting, and Participants: In this case series, participants with tinnitus underwent testing twice with both methods at a 1-month interval by experienced clinicians from January 6 through March 17, 2017. Each clinician tested each patient only once at visit 1 or 2 in a university audiology training setting with standardized equipment and was blind to previous assessment. Participants with bilateral or unilateral chronic tinnitus for longer than 6 months, in good health, without total deafness in either ear, and without cerumen in the ear canal were recruited through advertisements (community and clinics) and word of mouth (volunteer sample). The audiologists were likewise participants in the planned comparison between TLR and 2-AFC in the test-retest measures.
Main Outcomes and Measures: Test-retest concordance with 95% CIs for each method, calculated as the proportion of participants with the same final frequency between the 2 visits (2-AFC) or with at least 1 concordant dominant frequency (TLR) as well as loudness differences of no greater than 10 dB.
Results: The study sample included 31 participants (55% men; mean [SD] age, 50.7 [13.7] years). For TLR, 26 of 31 participants had at least 1 concordant dominant frequency between the 2 visits (proportion, 0.84; 95% CI, 0.66-0.95), whereas for 2-AFC, 7 of 31 participants had a concordant final tinnitus pitch in either ear (proportion, 0.23; 95% CI, 0.10-0.41). Loudness reliability followed the same pattern, with more concordant loudness levels in the TLR (proportion, 0.73; 95% CI, 0.52-0.88) than in the 2-AFC (proportion, 0.40; 95% CI, 0.05-0.85). Mean time taken to complete the tests was less than 15 minutes, and general appreciation by participants with tinnitus and audiologists were overall similar for both.
Conclusions and Relevance: Superior test-retest concordance can be demonstrated at the individual level using the several dominant frequencies extracted from the patient-centered TLR.

PMID: 30267085 [PubMed - as supplied by publisher]

https://ift.tt/2NdqYAS

Understanding Risk Factors Associated With Unplanned Reoperation in Major Head and Neck Surgery.

Understanding Risk Factors Associated With Unplanned Reoperation in Major Head and Neck Surgery.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 27;:

Authors: Sangal NR, Nishimori K, Zhao E, Siddiqui SH, Baredes S, Chan Woo Park R

Abstract
Importance: Understanding the preoperative, intraoperative, and postoperative risk factors of reoperation is the optimal way to approach decreasing its incidence.
Objective: To identify risk factors of unplanned reoperation following major operations of the head and neck.
Design, Setting, and Participants: This retrospective cohort study queried the American College of Surgeons National Surgical Quality Improvement Program database and identified 2475 cases of major operations of the head and neck performed between 2005 and 2014. Specific operations analyzed were glossectomy, mandibulectomy, laryngectomy, and pharyngectomy. Univariate and multivariate analyses were performed to compare demographic and clinical characteristics of patients with or without unplanned reoperation. Data were analyzed between September and November 2017.
Main Outcomes and Measures: The primary outcome was incidence of unplanned reoperation in patients with major operations in the head and neck region. An additional aim was to assess the risk factors associated with an increased likelihood of reoperation.
Results: In total, 1941 patients were included in this study (1298 [66.9%] males), with most patients (961 [49.5%]) between 61 and 80 years of age. The overall unplanned reoperation rate within 30 days after the principal operative procedure was 14.2% (275 patients). The operative procedure with the highest reoperation rate was pharyngectomy (8 of 46 [17.4%]), followed by glossectomy (95 of 632 [15.0%]), laryngectomy (53 of 399 [13.3%]), and mandibulectomy (25 of 240 [10.4%]). Among the unplanned reoperation patients, 516 patients (76.8%) underwent reoperation during their initial hospital admission and 156 patients (23.2%) after readmission. The mean (SD) number of days from the principal operative procedure to unplanned reoperation was 8.5 (3.6) days for initial-admission reoperations and 16.0 (4.8) days for readmission reoperations. The most common unplanned reoperation procedures overall included repair, surgical exploration, and revision procedures on arteries and veins (47 of 2475 [1.9%]), incision procedures on the soft tissue of the neck and thorax (37 of 1941 [1.9%]), and incision and drainage procedures on the skin, subcutaneous, and accessory structures (21 of 1941 [1.1%]). Multivariate analysis results indicated that the independent risk factors for unplanned reoperation following a major cancer operation of the head or neck included black race (odds ratio [OR], 1.72; 95% CI, 1.09-2.74), disseminated cancer (OR, 1.85; 95% CI, 1.14-3.00), greater total operation time (OR, 2.05; 95% CI, 1.49-2.82), superficial (OR, 2.56; 95% CI, 1.55-4.24) or deep (OR, 4.83; 95% CI, 2.60-8.95) surgical site infection, wound dehiscence (OR, 8.36; 95% CI, 5.10-13.69), and ventilator dependence up to 48 hours after surgery (OR, 2.95; 95% CI, 1.79-4.87).
Conclusions and Relevance: The identification of a significant association of black race, disseminated cancer, total operation time, surgical site infection in either the superficial or deep spaces, wound dehiscence, or ventilator dependence for more than 48 hours after surgery with increased risk of reoperation in major head and neck surgery may guide the modification and adaptation of these risk factors to decrease the burden that unplanned reoperation places on patients, surgeons, and the health care system.

PMID: 30267078 [PubMed - as supplied by publisher]

https://ift.tt/2zFQf37

Patient Concerns About Nasal Reconstruction After Mohs Surgery and Implications for Shared Decision Making.

Patient Concerns About Nasal Reconstruction After Mohs Surgery and Implications for Shared Decision Making.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 27;:

Authors: Chi JJ, Rosenberg A, Hahn S, Piccirillo JF, Politi M, Kallogjeri D, Kukuljan S

PMID: 30267057 [PubMed - as supplied by publisher]

https://ift.tt/2QozH5p

Rapidly Enlarging Parapharyngeal Mass.

Rapidly Enlarging Parapharyngeal Mass.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 27;:

Authors: Kim-Orden N, Chambers T, Sinha U

PMID: 30267038 [PubMed - as supplied by publisher]

https://ift.tt/2zGaQ7l

Addition of Hyperbaric Oxygen Therapy vs Medical Therapy Alone for Idiopathic Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis.

Addition of Hyperbaric Oxygen Therapy vs Medical Therapy Alone for Idiopathic Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 27;:

Authors: Rhee TM, Hwang D, Lee JS, Park J, Lee JM

Abstract
Importance: Sudden sensorineural hearing loss (SSNHL) causes substantial disease burden for both individuals and socioeconomic aspects. The benefit of hyperbaric oxygen therapy (HBOT) in addition to standard medical therapy (MT) for idiopathic SSNHL has been unclear.
Objective: To perform a systematic review and meta-analysis to compare HBOT + MT with MT alone as a treatment for patients with SSNHL.
Data Sources: PubMed, Embase, and the Cochrane Database of Systematic Reviews were systematically searched up to February 2018.
Study Selection: Randomized clinical trials and nonrandomized studies comparing HBOT + MT with MT alone for SSNHL treatment.
Data Extraction and Synthesis: Two investigators independently screened the eligible studies, established data, and assessed quality and risk of bias. A systematic review and meta-analysis using random-effects models was conducted.
Main Outcomes and Measures: The primary outcome was complete hearing recovery, and secondary outcomes were any hearing recovery and absolute hearing gain.
Results: Three randomized clinical trials and 16 nonrandomized studies comparing outcomes after HBOT + MT vs MT alone in 2401 patients with SSNHL (mean age, 45.4 years; 55.3% female) were included. Pooled odds ratios (ORs) for complete hearing recovery and any hearing recovery were significantly higher in the HBOT + MT group than in the MT alone group (complete hearing recovery OR, 1.61; 95% CI, 1.05-2.44 and any hearing recovery OR, 1.43; 95% CI, 1.20-1.67). Absolute hearing gain was also significantly greater in the HBOT + MT group than in the MT alone group. The benefit of HBOT was greater in groups with severe to profound hearing loss at baseline, HBOT as a salvage treatment, and a total HBOT duration of at least 1200 minutes.
Conclusions and Relevance: The addition of HBOT to standard MT is a reasonable treatment option for SSNHL, particularly for those patients with severe to profound hearing loss at baseline and those who undergo HBOT as a salvage treatment with a prolonged duration. Optimal criteria for patient selection and a standardized regimen for HBOT should be applied in routine practice, with future trials to investigate maximal treatment benefit.

PMID: 30267033 [PubMed - as supplied by publisher]

https://ift.tt/2OmPSCx

Sensitization to Api m 1, Api m 2, and Api m 4 in Japanese beekeepers who had experienced systemic reactions to honeybee stings

Publication date: Available online 29 September 2018

Source: Allergology International

Author(s): Hirokuni Hirata, Kozo Sato, Takeshi Ogasawara, Tatsuo Funakoshi, Daisuke Shima, Masamitsu Tatewaki, Sadaaki Shiromori, Ryosuke Souma, Hideyuki Satoh, Kumiya Sugiyama, Masafumi Arima, Kazuhiro Kurasawa, Takeshi Fukuda, Yasutsugu Fukushima

https://ift.tt/2DIHxVY

Tight junction, mucin and inflammasome‐related molecules are differentially expressed in eosinophilic, mixed and neutrophilic experimental asthma in mice

Allergy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2zFEGc0

The PROCLIPI international registry of early stage Mycosis Fungoides identifies substantial diagnostic delay in most patients

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2OmlpVn

Αρχειοθήκη ιστολογίου

Κυριακή 30 Σεπτεμβρίου 2018

Abstract

Introduction and objectives

Methods and patients

Results

Conclusions

Abstract

Objectives

Design and results

Conclusions

Abstract

Objectives

Design and results

Conclusions

Summary

Objective

Material and Methods

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Conclusion