Head and Neck Medicine by Alexandros G.Sfakianakis: 10/14/18

Κυριακή 14 Οκτωβρίου 2018

The Use of Dynamic Contrast-Enhanced Perfusion MRI in Differentiating Benign and Malignant Thyroid Nodules

Abstract

To investigate the efficacy of perfusion magnetic resonance imaging (MRI) in benign-malignant differentiation of thyroid nodules. Images from 24 patients with thyroid masses were obtained using dynamic contrast enhanced MRI (DCE-MRI) at 3-T MR. DCE-MRI images were evaluated by post-processing of selected regions of interest (ROIs) on software, thus eliciting quantitative data for each voxel within the ROI. Ktrans, Ve, Kep, iAUC and chi² were calculated automatically. The DCE-MRI values of benign and malignant lesions were then compared. Mean Ktrans and iAUC values in malignant lesions were significantly lower than those in benign lesions (p = 0.028 and 0.049). Ktrans, Kep, and iAUC values in malignant lesions were statistically significantly lower than normal parenchyma values. In contrast to other tissues, the perfusion MRI findings of thyroid masses exhibit a decrease in Ktrans and iAUC values as malignancy increases. Perfusion MRI may be useful in differentiating benign and malignant thyroid nodules once a cut-off value has been determined by other studies.

https://ift.tt/2pV6HH7

Outcomes of Surgical Repair of Skull Base Defects Following Endonasal Pituitary Surgery: A Retrospective Observational Study

Abstract

Skull base defects following endonasal surgery for pituitary macroadenoma need to be addressed during the surgery to prevent serious postoperative complications like cerebrospinal fluid (CSF) leak. The objective of this study is to assess the incidence of CSF leak following pituitary surgery and the methods of effective skull base repair. This is a retrospective observational study conducted in a tertiary care hospital after obtaining due clearance from the Institutional ethics committee. The charts of patients who underwent endonasal pituitary surgery between 2013 and 2018 were studied and details noted. Patients undergoing revision surgery or with history of preoperative radiotherapy were excluded from the study. 52 patients were included in the study. Based on the type of CSF leak, the patients were grouped into four. 19 patients (36.5%) had an intraoperative CSF leak. 3 patients developed a postoperative CSF leak. Based on the histopathology, 4 patients had ACTH secreting tumor. 8 patients had growth hormone secreting tumor, 22 had gonadotropin secreting tumor, 9 patients had a non-functioning tumour and 9 patients had prolactinoma. The type of skull base repair performed in these patients were grouped into 4.18 patients underwent type I repair, 21 patients underwent type II repair, 8 patients underwent type III repair and 5 patients underwent type IV repair. We have observed that the pedicled nasoseptal flap is particularly advantageous over other repair techniques, especially in low pressure leaks. The strategy for skull base repair should be tailored to suit each patient to minimise the occurrence of morbidity and the duration of hospital stay.

https://ift.tt/2NIYAqJ

The illness experience of an undocumented immigrant in the USA

Approximately 11 million people living and working in the USA do so without documentation. This group represents a disenfranchised minority with adverse experiences and unique comorbidities that faces significant obstacles to receiving healthcare, including fear of deportation, language barriers, financial barriers and difficulty navigating an inconsistent and fragmented system. Healthcare is therefore often sought once symptoms have become critical, which can lead to more severe disease processes and multiple new diagnoses at presentation even in previously healthy patients. Here we present the case of a previously healthy 32-year-old undocumented immigrant who presented to a South Florida hospital with abdominal pain, diarrhoea and leg pain. He was diagnosed with both diabetes mellitus and chronic myelogenous leukaemia after a prolonged 20-day hospital stay. Culturally sensitive providers and dedicated staff play a major role in connecting patients to outpatient care after an acute illness, which most often occurs at charity clinics.

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Suspicious Yersinia granulomatous enterocolitis mimicking appendicitis

We present the case of a fit and well 12-year-old boy who presented with signs and symptoms suggestive of appendicitis. On laparoscopy, he was found to have a sinister-looking right iliac fossa mass with associated mesenteric lymphadenopathy. He proceeded to have an oncological right hemicolectomy, while the subsequent histology returned an unexpected result. The aim of this report is to highlight an unusual and complex clinical presentation in a young patient presenting with right iliac fossa pain.

https://ift.tt/2RQX4FX

Bivalirudin fails to prevent atrial thrombus development in heparin-induced thrombocytopaenia and thrombosis syndrome

An 81-year-old woman presented with acute decompensated heart failure due to new-onset atrial fibrillation and a flail myxomatous mitral valve which necessitated surgical mitral valve repair. No atrial thrombi were noted on transoesophageal echocardiograms performed prior to surgery and intraoperatively. Immediately postoperatively, while treated with unfractionated heparin, the patient developed thrombocytopaenia with positive platelet factor 4 antibodies and an abnormal serotonin functional platelet assay, consistent with heparin-induced thrombocytopaenia. The anticoagulation therapy was changed to the direct thrombin inhibitor bivalirudin with an improvement in the platelet count. Despite bivalirudin therapy, a left atrial layering thrombus was revealed on transoesophageal echocardiogram performed in preparation for cardioversion of the symptomatic atrial fibrillation. Anticoagulation was changed to warfarin, and the patient was discharged without thromboembolic complications neither during her hospital stay nor the 3-year outpatient follow-up.

https://ift.tt/2EiTrGo

Disseminated tuberculosis caused by Mycobacterium bovis presenting as a tongue base mass

An 80-year-old woman presented with dysphagia, odynophagia and progressive weight loss. Initial investigations suggested a large base of tongue squamous cell carcinoma. At panendoscopy, biopsies were taken which revealed granulomatous inflammation with multinucleated giant cells and areas of caseous necrosis. Acid-fast bacilli were identified on Ziehl-Neelsen stain and the appearances were consistent with Mycobacterium bovis. Closer inspection of the patient's medical history revealed that she had previously undergone right hemicolectomy for an ascending colon stricture. The histology had shown granulomatous inflammation consistent with intestinal tuberculosis but no systemic treatment had been instigated at the time. This case highlights the importance of taking a detailed clinical history as well as the need to be cognisant of tuberculosis masquerading as cancer in the head and neck.

https://ift.tt/2RMyq9A

Brown spots: Whats the diagnosis?

Description

A 3-year-old boy presented to a paediatric consult with a rash consisting of reddish-brown non-pruritic spots. This rash initially appeared in his first months of age, with no identified triggers or associated symptoms and had been previously interpreted as eczema. Skin examination revealed irregularly bordered, hyperpigmented, cafe-au-lait macules on his trunk, neck and right forearm, the largest around 2 cm in diameter (figures 1 and 2). Rubbing one of the skin lesions elicited localised erythema—positive Darier's sign (figure 3).

Figure 1

Skin lesions on the trunk (back).

Figure 2

Skin lesions on the trunk (front).

Figure 3

Darier's sign.

Laboratory investigation showed both normal blood count and serum tryptase levels. He was diagnosed with urticaria pigmentosa (UP), a type of cutaneous mastocytosis. The patient...

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Preoperative embolisation of a hypervascular, calvarial paraganglioma metastasis via a combined percutaneous and transophthalmic arterial approach

Description

A 30-year-old male patient with a history of malignant, metastatic paraganglioma presented with a rapidly enlarging, expansile left calvarial mass. CT and ultrasound imaging demonstrated a 60x46x31 mm soft-tissue lesion centred on the left frontal bone which was markedly hypervascular (figure 1A,B).

Figure 1

(A) non-contrast CT demonstrating the left-sided expansile calvarial lesion with osseous destruction and frontal lobe compression (black arrow). (B) Colour flow Doppler ultrasound of the lesion demonstrating pronounced hypervascularity (white arrows). (C) Lateral left external carotid artery DSA demonstrating extensive superficial scalp supply to the lesion from multiple, enlarged superficial temporal artery (black arrowheads) and occipital artery (white arrowheads) branches. (D) Lateral left internal carotid artery DSA demonstrating deep dural arterial supply to the lesion from the MMA (white arrowheads) originating from the ophthalmic artery (black arrowhead). DSA, digital subtraction angiogram; MMA, middle meningeal artery.

A cerebral digital...

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Rotational carotid insufficiency: an unusual cause of bow hunters syndrome

We report an unusual case in which physiologic neck rotation impeded perfusion through the internal carotid artery. The patient had a history of prior radical neck surgery and radiation for malignancy. He presented withbow hunter's-like symptoms with transient loss of consciousness and right-sided weakness with left lateral neck rotation. A self-expanding peripheral stent was successfully used to treat the patient by preventing rotatory carotid compression. In select patients with prior neck surgery and radiation, carotid injections should be part of a dynamic cerebral angiogram if the vertebral arteries are unremarkable.

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Jellyfish‐like sonographic pattern can help recognition of dermatofibrosarcoma protuberans. Report of 3 new cases and review of the literature

Australasian Journal of Dermatology, EarlyView.

https://ift.tt/2yhGRlh

Outcomes of Surgical Repair of Skull Base Defects Following Endonasal Pituitary Surgery: A Retrospective Observational Study

Abstract

https://ift.tt/2NIYAqJ

The Use of Dynamic Contrast-Enhanced Perfusion MRI in Differentiating Benign and Malignant Thyroid Nodules

Abstract

https://ift.tt/2pV6HH7

A non-interventional multicenter study to document the implants success and survival rates in daily dental practices of the CONELOG screw-line implant

Abstract

Objective

This multicenter prospective non-interventional study evaluated the success and survival of the CONELOG implants inserted according to the standard protocol with one- or two-step surgery in daily practice three years after loading. Changes of soft tissue and bone level over time, esthetical outcome, and patient satisfaction were assessed.

Materials and methods

The study included patients in six centers. The implants were used in accordance with standard practice of each particular center, and the use was documented systematically. Failure rate, implant success, bone level changes, different clinical parameters, and patients' satisfaction were assessed.

Results

In total, 130 dental implants were placed in 94 patients (64 female, 30 male). Mean age of patients was 50.4 ± 13.7. At 3-year post-loading, 108 implants in 78 patients were available for evaluation. Success and survival rate were 98.4% after placement and 100% 36 months post-loading. Bone loss from surgery to loading was 0.52 ± 0.55 mm. From loading to 36 months post-loading, the bone level change remained stable. Patient assessments were performed for function, ability to chew, speech, esthetics, and general satisfaction. Patients were very satisfied (82.3%) or satisfied (16.1%). None of the patients was dissatisfied.

Conclusion

The 3-year results of this non-interventional multicenter study indicate that the CONELOG implants are reliable and effective over the course of the observation while used in standard conditions of daily environment and confirm the results obtained in controlled clinical trials.

Clinical relevance

Performance of CONELOG implants under daily routine is similar to controlled clinical trials.

https://ift.tt/2J0j7q0

Management of atrophic mandibular fractures: An Italian multicentric retrospective study

The aim of this multicentric study was to retrospectively evaluate the surgical outcome of atrophic mandible fractures treated with open reduction and rigid fixation (ORIF), using load-bearing plates.

https://ift.tt/2Pzy5pd

Vestibular evoked myogenic potential in healthy adolescents

Publication date: Available online 13 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Gitte Stokvad Brix, Therese Ovesen, Louise Devantier

Abstract

Objective

Vestibular dysfunction, which may lead to delayed motor development and reduced quality of life, is an overlooked entity among children and adolescents. Vestibular evoked myogenic potential (VEMP) is a common, safe diagnostic tool in adults with vestibular disorders. No normative data exist for children and adolescents. Our objective was to collect and assess normative VEMP data for adolescents.

Methods

Cervical VEMP (cVEMP) with air-conducted sound. Endpoints were peak latencies after 13 and 23 ms (P13 and N23) and amplitude. Ocular VEMP (oVEMP) with bone-conducted vibration on the mastoid. Endpoints were latencies (N10 and P15) and amplitude. A meta-analysis of existing cVEMP data in children.

Results

cVEMP response rate (RR) was 85%, mean P13 and N23 latencies were 15.44 and 25.55 ms, respectively, and the asymmetry ratio (AR) was 14%.

oVEMP RR was 100%, mean N10 and P15 were 10.61 and 16.58 ms, respectively, and the AR was 12%.

In the meta-analysis, the pooled mean P13 and N23 were 12.75 and 21.8 ms, respectively. Head elevation (HE) gave shorter latencies than head rotation (HR).

Conclusion

The oVEMP data represents normal values for adolescents aged 13-16 years. Height should be considered more important than age when interpreting cVEMP in adolescents. Separate normative cVEMP data should be established for HE and HR.

https://ift.tt/2IXH9lk

Congenital Infantile Fibrosarcoma of the Glabella: Nuances of Achieving Surgical Cure without Cosmetic or Functional Deformity

Publication date: Available online 13 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Robert G. Nicholas, Tara E. Brennan

Abstract

Congenital Infantile Fibrosarcoma is a rare neoplasm that typically presents during the first year of life, but uncommonly in the head and neck. We report a six-day old male presenting with an expanding mass of the right glabella associated with visual field obstruction. The patient underwent a two-staged procedure for surgical removal of the tumor due to the initial unclear pathologic diagnosis of the tumor, combined with the desire to close the defect while incurring minimal aesthetic deformity. We describe this patient's postnatal presentation and curative surgical management and review the relevant literature to date.

https://ift.tt/2OpXpSa

The Arabic translation, cultural adaptation, and validation of the pediatric voice-related quality of life survey

Publication date: Available online 13 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Tamer A. Mesallam, Badr Alabdulkarim, AlMaha A. AlQabbani, Nawaf A. Bin Suhaym, Sulaiman AlAjlan

Abstract

Objective

The aim of this study was to develop an Arabic version of the pediatric voice-related quality of life (PVRQOL) and test its validity and reliability.

Subjects

and methods: Fifty-one children with voice problems were included in the study along with 60 control children without any voice disorders. The translated Arabic PVRQOL and the Arabic pediatric voice handicap index (PVHI) have been distributed to the study subjects. The Arabic PVRQOL was tested for its internal consistency, test-retest reliability, and clinical validity.

Results: the Arabic PVRQOL showed strong internal consistency and excellent test-retest reliability (Cronbach α = 0.9 and ICC = 0.92 respectively). There was a significant difference between the patients and control group regarding Arabic PVRQOL scores (P < 0.0001). Also, significant correlation was demonstrated between the Arabic PVRQOL and Arabic PVHI.

Conclusion

The Arabic version of PVRQOL maintained its validity and reliability and may be considered in the assessment of voice disorders for Arabic speaking children.

https://ift.tt/2IZjLUI

Conservative three-quarter versus subtotal seven-eighths parathyroidectomy in secondary hyperparathyroidism

Publication date: Available online 13 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): M. Veyrat, H. Fessi, J.-P. Haymann, P. Ronco, J. Lacau St Guily, S. Périé

Abstract

Objective

There is at present no consensus concerning surgical techniques for secondary hyperparathyroidism (SHPT) in end-stage renal disease (ESRD). Although both subtotal and total parathyroidectomy provide low rates of recurrence, they may induce hypoparathyroidism, damaging the bone and cardiovascular systems. The aim of our study was to compare 3/4 and 7/8 parathyroidectomy in this population and to discuss the potential benefit of more conservative treatment.

Study design

Prospective observational study in a university teaching hospital between 2010 and 2014.

Methods

The study included 34 consecutive ESRD patients with SHPT: 19 underwent 3/4 parathyroidectomy (group A*3/4) and 15 underwent 7/8 parathyroidectomy (group B*7/8). Serum intact 1-84 PTH levels (before and 6 months after surgery) and hospital stay were compared between the two groups.

Results

Before surgery, PTH levels were similar between the two groups. At month 6 following surgery, median PTH levels were significantly higher in group A*3/4 than in group B*7/8 (109 versus 24 pg/mL, respectively; P < 0.0006). Hospital stay was shorter in group A*3/4 (4.79 versus 6.80 days, respectively; P = 0.008). Postoperative hypoparathyroidism requiring long-term calcium and 1alpha(OH) D3 treatment was reported in 5% of patients in group A*3/4 and 26% of patients in group B*7/8 (P = 0.04).

Conclusions

In this preliminary study, 3/4 conservative parathyroidectomy seemed effective and safe, with less reported morbidity than 7/8 parathyroidectomy, as assessed by lower rates of irreversible hypoparathyroidism and shorter hospital stay.

Level of evidence

3b, individual case-control study.

https://ift.tt/2AapPH8

Avocado: An Emerging Culprit in Food Protein-Induced Enterocolitis Syndrome?

Publication date: Available online 14 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Mera Goodman, Elizabeth Feuille

https://ift.tt/2QRzPdU

ORAL FOOD CHALLENGE FAILURES AMONG FOODS RESTRICTED DUE TO ATOPIC DERMATITIS

Publication date: Available online 14 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): AA Eapen, KM Kloepfer, FE Leickly, JE Slaven, G Vitalpur

Abstract

BACKGROUND

Recent studies have suggested that removing foods from the diet to manage atopic dermatitis (AD), based on positive allergy tests, may lead to immediate allergic reactions on reintroduction of that food.

OBJECTIVE

The purpose of this study was to examine the frequency of oral food challenge (OFC) failures among foods removed from the diet as suspected AD triggers, focusing on the five major food allergens in the US.

METHODS

OFCs to egg, milk, peanut, soy, and wheat, performed from 2008-14, at a children's hospital's allergy clinics, were reviewed. OFCs were offered based on history and laboratory values. Reasons for food avoidance were classified as food allergy (IgE-mediated reaction occurring within two hours); sensitization only (lack of introduction due to positive test results); and removal due to test results during AD evaluation.

RESULTS

There were 442 OFCs performed, with 89 failures (20.1%). Reasons for OFCs included a history of food allergy (320/442; 72.4%); food sensitization without any introduction (77/442; 17.4%); and AD (45/442; 10.2%). OFC failures among those who had food allergy (70/320; 21.9%); sensitization only (13/77; 16.9%); and suspected AD trigger (6/45; 13.3%) did not significantly differ (p=0.63). Wheat was more likely to be avoided than the other four foods for AD concerns (p<0.0001).

CONCLUSION

The frequency of OFC failure among those who removed foods suspected as AD triggers was 13.3%, indicating a loss of tolerance. Restriction of foods to manage AD must be done with caution and close monitoring.

https://ift.tt/2A9p0OJ

Within-tester repeatability and between-tester reproducibility of skin test endpoint titration: A quality assurance study

Publication date: Available online 14 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Christianne M Blais, Beth E Davis, Donald W. Cockcroft

https://ift.tt/2QKxSQa

Pathophysiologic mechanisms of chronic rhinosinusitis and their roles in emerging disease endotypes

Publication date: Available online 13 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Ping-Ping Cao, Zhi-Chao Wang, Robert. P. Schleimer, Zheng Liu

ABSTRACT

Objective

Chronic rhinosinusitis (CRS) is a heterogeneous disorder with distinct pathophysiologic mechanisms. Based on the transcription factor expression and cytokine production patterns in different types of innate lymphoid cells (ILCs), in parallel with those of adaptive CD4⁺ T helper (Th) cells and CD8⁺ cytotoxic T (Tc) cells, new perspectives on endotypes of patients are emerging around the immune response deviation into type 1 (orchestrated by ILC1s, Tc1 and Th1 cells), type 2 (characterized by ILC2s, Tc2 and Th2 cells), and type 3 (mediated by ILC3s, Tc17 and Th17 cells) responses. Additionally, cluster analysis has been applied to the endotyping of CRS in recent years, which has provided additional novel insights into the CRS pathogenesis. This article aims to review pathological mechanisms of CRS on the basis of type 1, type 2, and type 3 immune responses and how they inform us to begin to understand CRS endotypes. This article also reviews the recent cluster analysis studies of CRS endotypes. Finally, the impact of endotype on therapeutic management of CRS is summarized.

Data Sources

Review of published literature.

Study Selections

Relevant literature concerning CRS endotypes and the possible underlying mechanisms were obtained from a PubMed search and summarized here.

Results and Conclusion

Both CRSwNP and CRSsNP are comprised of distinct endotypes with distinct deviated immune responses, pathogenic mechanisms, and different responses to medical and surgical treatment. An endotype of CRS with prominent type 2 immune responses is the most well studied endotype, and generally can benefit from treatment with steroids and specific type 2 disrupting biologics.

https://ift.tt/2AaWHiO

Author's Response to Hopp's Commentary

Publication date: Available online 13 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Jonathan M. Spergel, Evan S. Dellon, Chris A. Liacouras, Ikuo Hirano, Javier Molina-Infante, Albert J. Bredenoord, Glenn T. Furuta

https://ift.tt/2QPzWGz

Comment on “Streptococcus anginosus Dental Implant-Related Osteomyelitis of the Jaws: An Insidious and Calamitous Entity”

Publication date: Available online 14 October 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Romain Nicot, Matthias Schlund, Gwenael Raoul

https://ift.tt/2Ew9OQ3

Early onset oral tongue cancer in the United States: A literature review

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Benjamin R. Campbell, James L. Netterville, Robert J. Sinard, Kyle Mannion, Sarah L. Rohde, Alexander Langerman, Young J. Kim, James S. Lewis, Krystle A. Lang Kuhs

Abstract

The incidence of early onset oral tongue squamous cell carcinoma (OTC) has been increasing in the United States, and no clear etiology has been identified. Studies on this topic have generally been small and presented varied results. The goal of this review is to analyze and synthesize the literature regarding early onset OTC risk factors, outcomes, and molecular analyses within the US. To date, studies suggest that early onset OTC patients tend to have less heavy cigarette use than typical onset patients, but there may be an association between early onset OTC and smokeless tobacco (chewing tobacco and snuff) use. Early onset OTC is associated with similar or possibly improved survival compared to typical onset OTC. There has been no evidence to support a significant role for human papillomavirus in development of early onset OTC. Further research with larger cohorts of these patients is needed to better characterize this disease entity.

https://ift.tt/2A9I53b

Patterns of cervical node positivity, regional failure rates, and fistula rates for HPV+ oropharyngeal squamous cell carcinoma treated with transoral robotic surgery (TORS)

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Richard B. Cannon, Jeffrey J. Houlton, Sapna Patel, Sharat Raju, Anisha Noble, Neal D. Futran, Upendra Parvathaneni, Eduardo Méndez

Abstract

Objectives

(1) Report the patterns of cervical node positivity for HPV + oropharyngeal squamous cell carcinoma (OPSCC) treated with transoral robotic surgery (TORS) and a unilateral level II–IV node dissection. (2) Investigate the regional failure rate following this operation. (3) Report the rate of pharyngocutaneous fistula (PCF) formation intraoperatively and postoperatively following TORS/neck dissection.

Methods

Retrospective case series of 88 patients with HPV+ OPSCC treated with TORS and simultaneous neck dissection levels II–IV at the University of Washington from 2010 to 2016. Primary endpoints were PCF, regional recurrence, disease-free survival (DFS), and overall survival (OS).

Results

The overall frequency of cervical node positivity was 93%, with 84% in level IIa, 7% in IIb, 23% in III, and 13% in IV. Two patients developed PCF intraoperatively, repaired with a local digastric flap, and no postoperative PCF occurred. Sixteen patients (18%) received surgery alone, 49 patients (56%) received adjuvant radiation, and 23 patients (26%) underwent adjuvant chemoradiation. DFS at 2 years was 95% and OS at 2 years was 100%. No concerning level Ib nodes were identified preoperatively or during surgery, and no regional failures occurred in this location.

Conclusion

Our data suggests, in TORS for HPV+ OPSCC, neck dissection of levels II–IV accurately stages the neck pathologically and prevents regional recurrences, with adjuvant therapy when indicated, and survival outcomes are excellent. Single-staged operations did not result in any postoperative PCF. Avoiding dissection of level Ib with TORS oropharyngectomy limits morbidity to the marginal mandibular nerve and salivary function, and resulted in no postoperative fistulas with minimal reconstruction interventions.

https://ift.tt/2QMweh1

Organ preservation for advanced larynx cancer: A review of chemotherapy and radiation combination strategies

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Marcelo R. Bonomi, Adriana Blakaj, Dukagjin Blakaj

Abstract

The larynx is an organ of the upper aerodigestive tract that is involved in many critical functions such as breathing, speaking, and swallowing. As a result, both larynx cancer and its treatment may significantly affect quality of life. The management of laryngeal cancer has focused on improving survival while preserving the function of the organ. This manuscript focuses on the use of chemotherapy and radiation therapy as a non-surgical approach and potential organ preservation strategy for patients with advanced larynx cancer. We review the key clinical data on the following treatment courses: (1) induction chemotherapy followed by definitive radiation therapy, (2) concurrent chemotherapy and radiation, and (3) induction chemotherapy followed by concurrent chemo-radiation. We also review the clinical data on organ preservation for patients with hypopharynx cancers. Results from phase III studies suggest that patients with advanced T4 cancers have better outcomes with a primary surgical approach, while for patients with T2N+ and T3 tumors, definitive concurrent chemotherapy and radiation or induction chemotherapy followed by definitive radiation therapy are acceptable options. Choosing the optimal treatment strategy depends on patients' desires, tumor extent, and adequate follow-up to detect early recurrences in cases of larynx preservation treatments. To proceed with an organ preservation strategy, the patient should have a good pre-treatment larynx function, and there must be a high level of skill and cooperation among various disciplines.

https://ift.tt/2A9zZYp

Intramuscular injection of dexamethasone for the control of pain, swelling, and trismus after third molar surgery: a systematic review and meta-analysis

Publication date: Available online 14 October 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): I.A. Fernandes, G.M. de Souza, M.L.P. Pinheiro, S.G.M. Falci

Abstract

This systematic review aimed to answer the following PICO question: Does the intramuscular injection of dexamethasone result in less pain, swelling, and trismus after mandibular third molar removal when compared to other routes of administration or a control group (saline solution injection or no treatment)? An electronic search was conducted in Virtual Health Library, PubMed, and Web of Science, through March 2018. Eligibility criteria included clinical trials. The search strategy resulted in 331 studies. Following the selection process, 15 articles were included in the systematic review; eight of these were included in the meta-analysis. Most of the studies had an unclear risk of bias (Cochrane Handbook assessment). Pain (mean difference (MD) −1.58, 95% confidence interval (CI) −1.99 to −1.16) and oedema (MD −1.76, 95% CI −2.38 to −1.14) were lower in the intramuscular dexamethasone group when compared to the control group. When compared to the submucosal route, the intramuscular route was more effective only for pain on the third postoperative day (MD −0.79, 95% CI −1.38 to −0.20). The results suggest that the intramuscular injection of dexamethasone may be an alternative route of administration, since it is effective at reducing pain and oedema when compared to non-steroidal treatment and has similar results to the submucosal route.

https://ift.tt/2RTuxjk

A de novo monoallelic CTLA-4 deletion causing pediatric onset CVID with recurrent autoimmune cytopenias and severe enteropathy

Publication date: Available online 13 October 2018

Source: Clinical Immunology

Author(s): Vassilios Lougaris, Manuela Baronio, Luisa Gazzurelli, Tiziana Lorenzini, Maurizio Fuoti, Daniele Moratto, Anna Bozzola, Chiara Ricci, Maria Pia Bondioni, Alberto Ravelli, Vincenzo Villanacci, Alessandro Plebani

https://ift.tt/2CMXuci

The role of surface molecule CD229 in Multiple Myeloma

Publication date: Available online 13 October 2018

Source: Clinical Immunology

Author(s): Michael Olson, Sabari Radhakrishnan, Tim Luetkens, Djordje Atanackovic

Abstract

The outcome of Multiple Myeloma (MM) patients has dramatically improved, however, most patients will still succumb to their disease. Additional therapeutic options are urgently needed and novel immunotherapies are enormously promising in the therapeutic armamentarium against MM. The first step in the development of any immunotherapy needs to be the identification of an appropriate target structure. In this review we present the current knowledge on surface molecule CD229, a member of the Signaling Lymphocyte Activation (SLAM) family of immune receptors. We believe that based on its characteristics, including (1) strong and homogenous expression on all myeloma cells, (2) expression on myeloma precursors, (3) absence from most normal tissues, (4) a central function in the biology of MM, CD229 (SLAMF3) represents a promising target for anti-MM immunotherapies. The introduction of novel anti-CD229 approaches into the clinic will hopefully lead to more durable responses, or maybe even cures, in MM.

https://ift.tt/2CcDpee

Hirschsprung’s Associated Enterocolitis (HAEC) Personalized Treatment with Probiotics Based on Gene Sequencing Analysis of the Fecal Microbiome

Approximately 40% of children with Hirschsprung's disease (HD) suffer from Hirschsprung's associated enterocolitis (HAEC) despite correct surgery. Disturbances of the intestinal microbiome may play a role. Treatment with probiotics based on individual analyses of the fecal microbiome has not been published for HD patients with recurrent HAEC yet. A boy with trisomy 21 received transanal pull-through at the age of 6 months for rectosigmoid HD. With four years, he suffered from recurrent episodes of HAEC. The fecal microbiome was measured during three healthy and three HAEC episodes by next-generation sequencing. The patient was started on daily probiotics for 3 months; the fecal microbiome was measured weekly. The fecal microbiome differed significantly between healthy and HAEC episodes. HAEC episodes were associated with significant decreases of Actinobacteria and significant increases of Bacteroidetes and Proteobacteria. Probiotic treatment led to a significant increase of alpha diversity and a significant increase of Bifidobacterium and Streptococcus as well as decreases of Rikenellaceae, Pseudobutyrivibrio, Blautia, and Lachnospiraceae. A longitudinal observation of the microbiome has never been performed following correction of Hirschsprung's disease. Probiotic treatment significantly changed the fecal microbiome; the alterations were not limited to strains contained in the administered probiotics.

https://ift.tt/2ROQkbW

Normal human skin is superior to monkey esophagus substrate for detection of circulating BP180‐NC16A‐specific immunoglobulin G antibodies in bullous pemphigoid

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

https://ift.tt/2QSpdeL

Prediction of Disease Relapse in a Cohort of Juvenile Localized Scleroderma Patients

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

https://ift.tt/2CJR6Cz

Αρχειοθήκη ιστολογίου

Κυριακή 14 Οκτωβρίου 2018

Abstract

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Materials and methods

Results

Conclusion

Clinical relevance

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Subjects

Conclusion

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Study design

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Level of evidence

Abstract

BACKGROUND

OBJECTIVE

METHODS

RESULTS

CONCLUSION

ABSTRACT

Objective

Data Sources

Study Selections

Results and Conclusion

Abstract

Abstract

Objectives

Methods

Results

Conclusion

Abstract

Abstract

Abstract