Complex regional pain syndrome type II arising from a gunshot wound (GSW) associated with infective endocarditis and aortic valve replacement

A 34-year-old man with a history of gunshot wound (GSW) to the right upper chest developed secondary aortic valve endocarditis (AVE) and was treated with an artificial valve placement (AVP). Three months after, he presented to an outpatient pain management clinic right arm pain and was diagnosed with complex regional pain syndrome type II (CRPS II). The patient underwent a diagnostic sympathetic ganglion block, before undergoing endoscopic thoracic sympathectomy surgery. Successful outcomes revealed decreased pain, opioid utilisation and improved tolerance to therapy and activities of daily living. To our knowledge, this is the first case reporting CRPS II arising from a GSW complicated by AVE followed by AVP, which emphasises how unforeseen syndromes can arise from the management of seemingly unrelated pathology. This case demonstrates the importance of timely and proper diagnosis of uncharacterised residual pain status post-trauma and differential diagnosis and management of chronic pain syndromes.

https://ift.tt/2AdXaAI

Metropolitan W135 meningococcal compressive pericarditis treated with intrapericardial fibrinolysis

Meningococcal pericarditis is a rare but severe form of acute purulent pericarditis. It is a classic complication of Neisseria meningitidis of serotype W135, usually occurring in pilgrims to Mecca and their household contacts. This severe form of meningococcaemia is difficult to diagnose and evolves frequently and gradually towards a tamponade, requiring emergency drainage. We report a case of meningococcal pericarditis caused by N. meningitidis W135 in an immunocompetent patient, without any other organ involvement especially meningeal, requiring pericardium drainage in emergency and then intrapericardial fibrinolysis.

https://ift.tt/2QU39jO

Rare origin of left main coronary artery from non-coronary sinus with aortic coarctation

Anomalous origin of left main coronary artery from non-coronary sinus (LCANCS) is an extremely rare anomaly. Aortic coarctation in association with LCANCS has not been previously described in literature.

https://ift.tt/2AfiMgm

Fits, feet and HIV: lessons from a case of coexisting epilepsy and neuropathy in a patient with perinatally acquired HIV-1 infection

An 18-year-old black African man with well-controlled perinatally acquired HIV-1 was diagnosed in late adolescence with the unrelated diagnoses of Charcot-Marie-Tooth type 1A (CMT1A), epilepsy due to polymicrogyria and subsequently developed severe depression. The CMT1A diagnosis occurred after transfer of care from a local paediatric HIV service to a tertiary paediatric referral centre and was precipitated by recognition of a history and neurological signs not typically associated with perinatal HIV. The case resulted in the establishment of a quarterly combined paediatric HIV and paediatric neurology multidisciplinary team clinic to assess children and adolescents living with HIV with neurological symptoms.

https://ift.tt/2QUJQ9Z

A Rare case of recurrent Guillain-Barre syndrome without albuminocytological dissociation

Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy, often preceded by an illness. It is a self-limiting illness in most of the cases, but recurrence is rare and can be seen in about 1%–6% of patients. GBS is characterised by progressive, symmetrical, proximal and distal weakness. Areflexia and sensory disturbances are also common. Patients with GBS usually have albuminocytological dissociation on cerebrospinal fluid (CSF) analysis. This is a case of a 69-year-old woman with recurrent GBS and normal CSF findings.

https://ift.tt/2Aet3sS

Sinus arrest with prolonged asystole due to the trigeminocardiac reflex during application of local anaesthetic in the nasal mucosa

The trigeminocardiac reflex (TCR) is defined as a sudden onset of parasympathetic dysrhythmias during stimulation of the trigeminal nerve. We describe a peripheral variation of TCR during manipulation of the nasal mucosa. A 42-year-old patient suffering from severe obstructive sleep apnoea was scheduled for surgical treatment. After inducted anaesthesia, the surgeon infiltrated the nasal mucosa with a local anaesthetic. The patient immediately showed an asystole and was treated with ephedrine and five chest compressions, despite spontaneous sinus rhythm return after ceasing of manipulation. Treatment with atropine established this TCR episode and ensured an event-free surgery.

The authors present here, for the first time, a prolonged asystole caused by the TCR, triggered by minimal manipulation of the nasal mucosa. This severe manifestation of peripheral TCR demonstrates its importance in daily clinical business. This case was treated according to a modified treatment algorithm for all subtypes of TCR which is presented here.

https://ift.tt/2QXlf4w

Friedreichs sign

Description  

An 82-year-old man with chronic atrial fibrillation treated with anticoagulation was admitted to the hospital for subacute progressive exertional dyspnoea. On examination, the jugular venous waveform was elevated to the mandibular angle with the patient sitting upright. Heart sounds were muffled. Transthoracic echocardiography (TTE) revealed a large circumferential pericardial effusion with early tamponade physiology. Pericardiocentesis yielded a large volume of sanguineous fluid. Following the procedure, there was improvement in jugular venous pressure to 14 cm H₂O. The height of the waveform increased with inspiration (Kussmaul's sign) and there was a prominent y descent, known as Friedreich's sign (see video 1). Repeat TTE revealed thickened pericardium, early diastolic septal bounce and respirophasic changes in early diastolic filling consistent with constrictive pericardial physiology. Friedreich's sign is a physical finding of constrictive pericarditis. The normal jugular venous waveform contains two descents, x and y. The x descent, which corresponds...

https://ift.tt/2Aero6G

Fungal thyroiditis in a lung transplant recipient

Description  

A 59-year-old man was admitted with 3 weeks of worsening shortness of breath 18 months after receiving a bilateral lung transplant for idiopathic pulmonary fibrosis. His immunosuppression included tacrolimus, everolimus and low-dose prednisone with no antifungal prophylaxis at the time of admission. CT chest revealed multiple, bilateral pulmonary nodules (figure 1—red arrows). CT-guided biopsy revealed fungal hyphae (figure 2). The initial CT and ultrasound of the neck at the onset of sore throat was negative; however, repeat CT neck for evolving neck pain and dysphasia during hospital course showed a mass-like lesion in the right thyroid lobe with extensive surrounding inflammatory changes (figure 3—green arrow). The lesion was also visualised on ultrasound, where it appeared as a hypoechoic solitary nodule (figure 4). Laboratory evaluation revealed hyperthyroidism, with a Thyroid Stimulating Hormone (TSH) of <0.01 µIU/mL (normal: 0.35–4.94 µIU/mL) and a...

https://ift.tt/2CPWJ2b

Correction to: Cytokine release kinetics of concentrated growth factors in different scaffolds

Legend of fig. 1a and b was reversed in the original version of this article.

https://ift.tt/2pWiepv

Staphylococcus aureus from patients with chronic rhinosinusitis show minimal genetic association between polyp and non-polyp phenotypes

Abstract

Background

Staphylococcus aureus has a high prevalence in chronic rhinosinusitis (CRS) patients and is suggested to play a more etiopathogenic role in CRS patients with nasal polyps (CRSwNP), a severe form of the CRS spectrum with poorer surgical outcomes. We performed a microbial genome-wide association study (mGWAS) to investigate whether S. aureus isolates from CRS patients have particular genetic markers associated with CRS with nasal polyps (CRSwNP) or CRS without nasal polyps (CRSsNP).

Methods

Whole genome sequencing was performed on S. aureus isolates collected from 28 CRSsNP and 30 CRSwNP patients. A mGWAS approach was employed using large-scale comparative genomics to identify genetic variation within our dataset.

Results

Considerable genetic variation was observed, with > 90,000 single nucleotide polymorphisms (SNPs) sites identified. There was little correlation with CRS subtype based on SNPs and Insertion/Delection (Indels). One indel was found to significantly correlate with CRSwNP and occurred in the promoter region of a bacitracin transport system ATP-binding protein. Additionally, two variants of the highly variable superantigen-like (SSL) proteins were found to significantly correlate with each CRS phenotype. No significant association with other virulence or antibiotic resistance genes were observed, consistent with previous studies.

Conclusion

To our knowledge this study is the first to use mGWAS to investigate the contribution of microbial genetic variation to CRS presentations. Utilising the most comprehensive genome-wide analysis methods available, our results suggest that CRS phenotype may be influenced by genetic factors other than specific virulence mechanisms within the S. aureus genome.

https://ift.tt/2ClnsTc

Ipilimumab/Nivolumab-related Opsoclonus-Myoclonus-Ataxia Syndrome Variant in a Patient with Malignant Pleural Mesothelioma

Introduction: Ipilimumab and nivolumab are immune-checkpoint inhibitors commonly used for melanoma. The combination is being investigated for its efficacy against several types of cancer, including malignant pleural mesothelioma. Although immune-related adverse events have been reported in patients receiving immune-checkpoint inhibitors, opsoclonus-myoclonus-ataxia syndrome has never been previously described. Case Presentation: We describe a 74-year-old male with malignant pleural mesothelioma who presented with opsoclonus and marked truncal ataxia ∼10 weeks following immunotherapy with ipilimumab and nivolumab. No myoclonus was present. Oligoclonal bands were detected in cerebrospinal fluid. Treatment with methylprednisolone and intravenous immunoglobulin along with clonazepam and valproic acid resulted in a rapid clinical improvement. A follow-up visit 2 months afterward showed a resolution of opsoclonus and he was able to walk with cane. Conclusions: A variant of opsoclonus-myoclonus-ataxia syndrome may occur following treatment with ipilimumab and nivolumab.

https://ift.tt/2Eo5eD1

Utilizing T-cell Activation Signals 1, 2, and 3 for Tumor-infiltrating Lymphocytes (TIL) Expansion: The Advantage Over the Sole Use of Interleukin-2 in Cutaneous and Uveal Melanoma

In this study, we address one of the major critiques for tumor-infiltrating lymphocyte (TIL) therapy—the time needed for proper expansion of a suitable product. We postulated that T-cell receptor activation in the first phase of expansion combined with an agonistic stimulation of CD137/4-1BB and interleukin-2 would favor preferential expansion of CD8+ TIL. Indeed, this novel 3-signal approach for optimal T-cell activation resulted in faster and more consistent expansion of CD8+CD3+ TIL. This new method allowed for successful expansion of TIL from cutaneous and uveal melanoma tumors in 100% of the cultures in

https://ift.tt/2RSHRV3

The Hexavalent CD40 Agonist HERA-CD40L Induces T-Cell–mediated Antitumor Immune Response Through Activation of Antigen-presenting Cells

CD40 ligand (TNFSF5/CD154/CD40L), a member of the tumor necrosis factor (TNF) superfamily is a key regulator of the immune system. The cognate receptor CD40 (TNFRSF5) is expressed broadly on antigen-presenting cells and many tumor types, and has emerged as an attractive target for immunologic cancer treatment. Most of the CD40 targeting drugs in clinical development are antibodies which display some disadvantages: their activity typically depends on Fcγ receptor–mediated crosslinking, and depletion of CD40-expressing immune cells by antibody-dependent cellular cytotoxicity compromises an efficient antitumor response. To overcome the inadequacies of antibodies, we have developed the hexavalent receptor agonist (HERA) Technology. HERA compounds are fusion proteins composed of 3 receptor binding domains in a single chain arrangement, linked to an Fc-silenced human IgG1 thereby generating a hexavalent molecule. HERA-CD40L provides efficient receptor agonism on CD40-expressing cells and, importantly, does not require FcγR-mediated crosslinking. Strong activation of NFκB signaling was observed upon treatment of B cells with HERA-CD40L. Monocyte treatment with HERA-CD40L promoted differentiation towards the M1 spectrum and repolarization of M2 spectrum macrophages towards the M1 spectrum phenotype. Treatment of in vitro co-cultures of T and B cells with HERA-CD40L–triggered robust antitumor activation of T cells, which depended upon direct interaction with B cells. In contrast, bivalent anti-CD40 antibodies and trivalent soluble CD40L displayed weak activity which critically depended on crosslinking. In vivo, a murine surrogate of HERA-CD40L–stimulated clonal expansion of OT-I–specific murine CD8+ T cells and showed single agent antitumor activity in the CD40− syngeneic MC38-CEA mouse model of colorectal cancer, suggesting an involvement of the immune system in controlling tumor growth. We conclude that HERA-CD40L is able to establish robust antitumor immune responses both in vitro and in vivo.

https://ift.tt/2EoTtMT

Hemofiltration Successfully Eliminates Severe Cytokine Release Syndrome Following CD19 CAR-T-Cell Therapy

Cytokine release syndrome (CRS) remains to be a major adverse effect of chimeric antigen receptor T (CAR-T) cell therapy in B-cell acute lymphoblastic leukemia (B-ALL) and lymphoma. It was urgent to explore novel strategy for managing severe CRS. We conducted a clinical trial to assess the safety and efficacy of CD19-targeting CAR-T-cells in the treatment of relapsed and chemotherapy-refractory B-ALL and lymphoma. A 10-year-old boy with B-ALL who never achieved minimal residual disease (MRD) negative status after 5 courses of chemotherapy was enrolled into our study and received a total of 3.19×106/kg autologous CD19 CAR-T-cells. Before CAR-T-cell infusion, naive lymphocytes made up 41.8% of bone marrow cells, which were reduced to 1% at the 14th day after transfusion, with MRD

https://ift.tt/2RUoDyf

Treatment With Tumor-infiltrating Lymphocytes in Advanced Melanoma: Evaluation of Early Clinical Implementation of an Advanced Therapy Medicinal Product

Tumor-infiltrating lymphocytes (TIL)-therapy in advanced melanoma is an advanced therapy medicinal product (ATMP) which, despite promising results, has not been implemented widely. In a European setting, TIL-therapy has been in use since 2011 and is currently being evaluated in a randomized controlled trial. As clinical implementation of ATMPs is challenging, this study aims to evaluate early application of TIL-therapy, through the application of a constructive technology assessment (CTA). First the literature on ATMP barriers and facilitators in clinical translation was summarized. Subsequently, application of TIL-therapy was evaluated through semistructured interviews with 26 stakeholders according to 6 CTA domains: clinical, economic, patient-related, organizational, technical, and future. In addition, treatment costs were estimated. A number of barriers to clinical translation were identified in the literature, including: inadequate financial support, lack of regulatory knowledge, risks in using live tissues, and the complex path to market approval. Innovative reimbursement procedures could particularly facilitate translation. The CTA survey of TIL-therapy acknowledged these barriers, and revealed the following facilitators: the expected effectiveness resulting in institutional support for an internal pilot, the results of which led to the inclusion of TIL-therapy in a national coverage with evidence development program, the availability of an in-house pharmacist, quality assurance expertise and a TIL-skilled technician. Institutional and national implementation of TIL-therapy remains complex. The promising clinical effectiveness is expected to facilitate the adoption of TIL-therapy, especially when validated through a randomized controlled trial. Innovative and conditional reimbursement procedures, together with the organization of knowledge transfer, could support and improve clinical translation of TIL and ATMPs.

https://ift.tt/2Esw2SO

Determinants of Fasting Hyperglucagonemia in Patients with Type 2 Diabetes and Nondiabetic Control Subjects

Metabolic Syndrome and Related Disorders, Ahead of Print.


https://ift.tt/2EqYJ2y

Acute Physical Effort Increases Sympathovagal Balance Responses to Autonomic Stimulation in Metabolic Syndrome

Metabolic Syndrome and Related Disorders, Ahead of Print.


https://ift.tt/2RUhSwv

c-Myc Is a Major Determinant for Antitumor Activity of Aurora A Kinase Inhibitor MLN8237 in Thyroid Cancer

Thyroid, Ahead of Print.


https://ift.tt/2P7XYPQ

Persistent/Recurrent Differentiated Thyroid Cancer: Clinical and Radiological Characteristics of Persistent Disease and Clinical Recurrence Based on Computed Tomography Analysis

Thyroid, Ahead of Print.


https://ift.tt/2PDo4qW

Pathological Interactions Between Mutant Thyroid Hormone Receptors and Corepressors and Their Modulation by a Thyroid Hormone Analogue with Therapeutic Potential

Thyroid, Ahead of Print.


https://ift.tt/2P22Xl3

Gasless Transaxillary Endoscopic Thyroidectomy with Robotic Assistance: A High-Volume Experience in North America

Thyroid, Ahead of Print.


https://ift.tt/2PDnXM2

Response to Lenvatinib in Children with Papillary Thyroid Carcinoma

Thyroid, Ahead of Print.


https://ift.tt/2P1b15F

Comprehensive Transcriptomic and Genomic Profiling of Subtypes of Follicular Variant of Papillary Thyroid Carcinoma

Thyroid, Ahead of Print.


https://ift.tt/2PDnTMi

Initial Ablation Ratio: Quantitative Value Predicting the Therapeutic Success of Thyroid Radiofrequency Ablation

Thyroid, Ahead of Print.


https://ift.tt/2P7XXeK

Staphylococcus aureus from patients with chronic rhinosinusitis show minimal genetic association between polyp and non-polyp phenotypes

Staphylococcus aureus has a high prevalence in chronic rhinosinusitis (CRS) patients and is suggested to play a more etiopathogenic role in CRS patients with nasal polyps (CRSwNP), a severe form of the CRS spectr...

https://ift.tt/2P14CYi

In vivo and in vitro assessment of the bleaching effectiveness of a brush-off patch containing 3.0% hydrogen peroxide

Abstract

Objectives

To evaluate the efficacy of a brush-off patch containing 3.0% hydrogen peroxide, which is a new over-the-counter (OTC) product for tooth whitening, and determine the optimal protocol for use.

Materials and methods

We performed an in vitro study using hydroxyapatite specimens and a clinical trial involving 140 volunteers. The brush-off patch was applied to the specimens (in vitro) or the maxillary anterior teeth (in vivo; 14 days) for 10 min twice daily (case 10 group) or 30 min once daily (case 30 group). We also included control groups in both experiments. Lightness (L*), redness (a*), and yellowness (b*) values were measured using a colorimeter. In the in vivo study, color changes were measured at baseline and 7 and 14 days after the start of patch application. The overall color change (ΔE) was statistically analyzed.

Results

In the in vitro study, the color change (ΔE*) after the experiment was significantly different between the two case groups and the control group (p < 0.001). In the in vivo study, the case groups showed color changes at both 7 and 14 days after patch application. In particular, the change in the case 30 group was significantly more prominent on day 14 than on day 7 (p < 0.05).

Conclusion

Our findings suggest that brush-off patches containing 3.0% hydrogen peroxide are effective OTC products for tooth whitening.

Clinical relevance

For best results, brush-off patches containing 3.0% hydrogen peroxide can be applied once daily for 30 min.

https://ift.tt/2RRvJ6G

Effect of adjuvant use of metformin on periodontal treatment: a systematic review and meta-analysis

Abstract

Objective

The aim of the study was to perform a systematic review of the literature regarding the adjuvant effects of metformin on the results of mechanical periodontal treatment.

Methods

First, a search on the PubMed, EMBASE, and Scopus databases was performed up to March 2018. Randomized clinical trials with at least 3 months of follow-up and using metformin associated with mechanical periodontal treatment were included in the review. As comparison group, mechanical or periodontal therapy alone or in combination with placebo. The studies should involve adults with at least 30 years of age diagnosed with chronic periodontitis. For the evaluation of the risk of bias of the articles, the Cochrane Collaboration tool was used.

Results

Studies (1912) were retrieved and 4 were included in the review. The articles are all from the same research center and used metformin in gel at concentrations of 0.5%, 1%, or 1.5%. The majority of included studies presented low risk of bias. A linear meta-analysis was conducted for probing depth and clinical attachment loss outcomes. The results showed a weighted mean difference of 2.12 mm (95% CI 1.83–2.42) and 2.29 mm (95% CI 1.72–2.86) for probing depth and clinical attachment level, respectively, favoring the group exposed to 1% adjunct metformin.

Conclusion

The adjuvant use of metformin may promote an additional benefit to the results of mechanical periodontal therapy.

Clinical significance

The metformin as an adjuvant on periodontal treatment shows potential to reduce needs of additional interventions and also reduces the inflammatory burden in patients.

https://ift.tt/2RXcAR1

Total mandibular reconstruction following diffuse sclerosing osteomyelitis

Abstract

Background

Diffuse sclerosing osteomyelitis (DSO) is a non-purulent chronic recurrent inflammation and affects the mandible in many cases. Belonging to the group of autoinflammatory diseases, in children and in cases with various additional symptoms including synovitis, acne, pustulosis, hyerostosis, and osteitis (SAPHO syndrome), therapy usually consists of non-surgical treatment. Against this background, we present an unusual course of DSO in an adult female patient.

Case report

A 50-year-old female suffering from DSO without SAPHO syndrome was pretreated for years with conservative drug regimens and local surgery. Previous therapy was not successful, and subsequently, multiple surgical procedures were carried out focused on recurrent acute exacerbations of DSO. Surgery resulted in a total resection and alloplastic and autoplastic reconstruction of the mandible including both temporomandibular joints. Prosthetic rehabilitation was possible after dental implant loading, and the final outcome was very satisfactory.

Conclusion

In the event that non-surgical options are not successful in DSO, an extended surgical therapy becomes necessary. Even if surgery results in complete resection of the mandible, a satisfactory rehabilitation can be achieved after complex reconstruction.

https://ift.tt/2QU6HCz

Complication rate in mandibular angle fractures—one vs. two plates: a 12-year retrospective analysis

Abstract

Purpose

Treatment of mandibular angle fractures using one or two osteosynthesis plates is still a controversial topic. Fracture, treatment, and patient-dependent influencing factors could affect the overall outcome. In the present retrospective study, complication rates of mandibular angle fractures treated by open reduction were assessed according to type of treatment.

Materials and methods

We analyzed retrospective medical records using the search terms "mandibular angle fracture." We included all patients presenting with a mandibular angle fracture treated by open reduction and internal fixation at our department between 2002 and 2012.

Results

We included 186 patients treated with open reduction and miniplate fixation (84 one plate; 102 two plates). The early complication rate was significantly higher for the double-plate group (72.5% vs. 47.6%, respectively; p = 0.001). Most common findings in the postoperative period were transient hypoesthesia and tissue swelling. In the two-plate group, a significantly increased operation time of 183 min versus 150 min in the one-plate group was found (p < 0.001). Late complications did not differ significantly between both groups (21.4% single-plate group; 30.4% two-plate fixation group; p = 0.32).

Conclusion

We found a significantly increased early complication rate in the two-plate group. Long-term complications did not differ between both groups.

https://ift.tt/2AdTGya

A preliminary study on plasma concentration achieved following intrapterygomandibular space injection of dexamethasone as a route of drug delivery with lignocaine inferior alveolar nerve block–correlation of clinical effects

Abstract

Purpose

To determine the quantity of dexamethasone plasma concentration achieved following intrapterygomandibular space injection of dexamethasone when co-administered with inferior alveolar nerve block correlating with the clinical effects in the postoperative phase.

Objective

A preliminary prospective study to evaluate the dexamethasone plasma concentration achieved following intrapterygomandibular space injection of dexamethasone with 2% lignocaine inferior alveolar nerve block to achieve hemi-mandibular anesthesia for minor oral surgical procedures and derive clinical correlations.

Background

Dexamethasone is a glucocorticoid, chiefly used for the management of postsurgical sequelae like trismus and swelling in maxillofacial surgical practice. Conventionally, parenteral dexamethasone is administered via intravenous or intramuscular route. Intrapterygomandibular space injection is a novel route of steroid delivery described in literature. For minor oral surgical procedures in maxillofacial surgical practice requiring inferior alveolar nerve block, dexamethasone can be administered along with local anesthetic through a single injection as a mixture (twin mix).

Methods

Prospective double-blind randomized clinical trial was designed to evaluative plasma concentration of dexamethasone achieved following injection of a freshly prepared mixture of 1.8 ml of 2% lignocaine with adrenaline (1:200000) and 1 ml (4 mg) dexamethasone [2.8 ml solution of twin mix] in the pterygomandibular space. The 30 candidates included for the trial were randomly split into three study groups (ten each)—(1) control group (C); (2) intramuscular group (IM); (3) intraspace group (IS).

Results

The mean plasma dexamethasone concentration at 30 min postinjection in group IM was 226.41 ± 48.67 ng/ml and for IS group it was 209.67 ± 88.13 ng/ml. Post hoc (Bonferroni-Holm test) intergroup comparison for plasma dexamethasone concentration (IM and IS) was found statistically insignificant (P = 0.605).

Conclusion

Intraspace route of drug administration can be utilized to deliver dexamethasonized local anesthetics safely with predictable clinical effects in the patients requiring mandibular minor oral surgery under local anesthesia.

https://ift.tt/2QXli0h

Total mandibular reconstruction following diffuse sclerosing osteomyelitis

Abstract

Background

Diffuse sclerosing osteomyelitis (DSO) is a non-purulent chronic recurrent inflammation and affects the mandible in many cases. Belonging to the group of autoinflammatory diseases, in children and in cases with various additional symptoms including synovitis, acne, pustulosis, hyerostosis, and osteitis (SAPHO syndrome), therapy usually consists of non-surgical treatment. Against this background, we present an unusual course of DSO in an adult female patient.

Case report

A 50-year-old female suffering from DSO without SAPHO syndrome was pretreated for years with conservative drug regimens and local surgery. Previous therapy was not successful, and subsequently, multiple surgical procedures were carried out focused on recurrent acute exacerbations of DSO. Surgery resulted in a total resection and alloplastic and autoplastic reconstruction of the mandible including both temporomandibular joints. Prosthetic rehabilitation was possible after dental implant loading, and the final outcome was very satisfactory.

Conclusion

In the event that non-surgical options are not successful in DSO, an extended surgical therapy becomes necessary. Even if surgery results in complete resection of the mandible, a satisfactory rehabilitation can be achieved after complex reconstruction.

https://ift.tt/2QU6HCz

Complication rate in mandibular angle fractures—one vs. two plates: a 12-year retrospective analysis

Abstract

Purpose

Treatment of mandibular angle fractures using one or two osteosynthesis plates is still a controversial topic. Fracture, treatment, and patient-dependent influencing factors could affect the overall outcome. In the present retrospective study, complication rates of mandibular angle fractures treated by open reduction were assessed according to type of treatment.

Materials and methods

We analyzed retrospective medical records using the search terms "mandibular angle fracture." We included all patients presenting with a mandibular angle fracture treated by open reduction and internal fixation at our department between 2002 and 2012.

Results

We included 186 patients treated with open reduction and miniplate fixation (84 one plate; 102 two plates). The early complication rate was significantly higher for the double-plate group (72.5% vs. 47.6%, respectively; p = 0.001). Most common findings in the postoperative period were transient hypoesthesia and tissue swelling. In the two-plate group, a significantly increased operation time of 183 min versus 150 min in the one-plate group was found (p < 0.001). Late complications did not differ significantly between both groups (21.4% single-plate group; 30.4% two-plate fixation group; p = 0.32).

Conclusion

We found a significantly increased early complication rate in the two-plate group. Long-term complications did not differ between both groups.

https://ift.tt/2AdTGya

A preliminary study on plasma concentration achieved following intrapterygomandibular space injection of dexamethasone as a route of drug delivery with lignocaine inferior alveolar nerve block–correlation of clinical effects

Abstract

Purpose

To determine the quantity of dexamethasone plasma concentration achieved following intrapterygomandibular space injection of dexamethasone when co-administered with inferior alveolar nerve block correlating with the clinical effects in the postoperative phase.

Objective

A preliminary prospective study to evaluate the dexamethasone plasma concentration achieved following intrapterygomandibular space injection of dexamethasone with 2% lignocaine inferior alveolar nerve block to achieve hemi-mandibular anesthesia for minor oral surgical procedures and derive clinical correlations.

Background

Dexamethasone is a glucocorticoid, chiefly used for the management of postsurgical sequelae like trismus and swelling in maxillofacial surgical practice. Conventionally, parenteral dexamethasone is administered via intravenous or intramuscular route. Intrapterygomandibular space injection is a novel route of steroid delivery described in literature. For minor oral surgical procedures in maxillofacial surgical practice requiring inferior alveolar nerve block, dexamethasone can be administered along with local anesthetic through a single injection as a mixture (twin mix).

Methods

Prospective double-blind randomized clinical trial was designed to evaluative plasma concentration of dexamethasone achieved following injection of a freshly prepared mixture of 1.8 ml of 2% lignocaine with adrenaline (1:200000) and 1 ml (4 mg) dexamethasone [2.8 ml solution of twin mix] in the pterygomandibular space. The 30 candidates included for the trial were randomly split into three study groups (ten each)—(1) control group (C); (2) intramuscular group (IM); (3) intraspace group (IS).

Results

The mean plasma dexamethasone concentration at 30 min postinjection in group IM was 226.41 ± 48.67 ng/ml and for IS group it was 209.67 ± 88.13 ng/ml. Post hoc (Bonferroni-Holm test) intergroup comparison for plasma dexamethasone concentration (IM and IS) was found statistically insignificant (P = 0.605).

Conclusion

Intraspace route of drug administration can be utilized to deliver dexamethasonized local anesthetics safely with predictable clinical effects in the patients requiring mandibular minor oral surgery under local anesthesia.

https://ift.tt/2QXli0h

Genomic mutations and proof of causation between dysplasia and squamous cell carcinoma in medicolegal cases: a useful approach or a waste of resources?

It has been suggested that oral stratified squamous epithelium may be implicated in field cancerisation.1,2 Several other studies have examined the clonal relations between dysplasia and oral squamous cell carcinoma (SCC),3,4 and it is now obvious that the relation between dysplasia at a specific site in the oral cavity, and a subsequent SCC that has arisen at the same site several years later, is a complex rather than a simple progression.5 Those of us who see patients with mucosal abnormalities often treat lesions with low-grade or high-grade dysplasia.

https://ift.tt/2Ck9ykg

Current approaches to instrumental assessment of swallowing in children

Purpose of the review This article reviews recent developments in the instrumental assessment of swallowing in children with a specific focus on research published between January 2017 and June 2018. Recent findings Instrumental swallowing assessments reported in the time period included: videofluoroscopic study of swallowing, digital cervical auscultation, dynamic ultrasound, high-resolution impedance manometry, nasal airflow thermistry and respiratory inductance plethysmography. Several studies were found exploring tools to objectively quantify videofluoroscopic study of swallowing data; swallowing from the mouth through to stomach was addressed including approaches to analysing mastication as well as evaluating oesophageal motility disorders. Summary Even though a vast range of instrumentation were studied, lack of clarity on clinical feasibility and objective measures that facilitate medical decision-making in practice mean further research is required to provide guidance on implementation. Promising novel approaches to aid the quantification of swallowing physiology from the mouth, pharynx and through to the oesophagus are emerging. Correspondence to Isuru Dharmarathna, BSc, Speech Science, School of Psychology, Tamaki Campus, The University of Auckland, Private Bag 92019, Auckland, New Zealand. Tel: +64 9 923 8177; fax: +64 9 373 7902; e-mail: pdha800@aucklanduni.ac.nz Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2Afqnvh

Current approaches to instrumental assessment of swallowing in children

Purpose of the review This article reviews recent developments in the instrumental assessment of swallowing in children with a specific focus on research published between January 2017 and June 2018. Recent findings Instrumental swallowing assessments reported in the time period included: videofluoroscopic study of swallowing, digital cervical auscultation, dynamic ultrasound, high-resolution impedance manometry, nasal airflow thermistry and respiratory inductance plethysmography. Several studies were found exploring tools to objectively quantify videofluoroscopic study of swallowing data; swallowing from the mouth through to stomach was addressed including approaches to analysing mastication as well as evaluating oesophageal motility disorders. Summary Even though a vast range of instrumentation were studied, lack of clarity on clinical feasibility and objective measures that facilitate medical decision-making in practice mean further research is required to provide guidance on implementation. Promising novel approaches to aid the quantification of swallowing physiology from the mouth, pharynx and through to the oesophagus are emerging. Correspondence to Isuru Dharmarathna, BSc, Speech Science, School of Psychology, Tamaki Campus, The University of Auckland, Private Bag 92019, Auckland, New Zealand. Tel: +64 9 923 8177; fax: +64 9 373 7902; e-mail: pdha800@aucklanduni.ac.nz Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2Afqnvh

The speech perception after cochlear implantation: The hearing gain difference according to the implant systems is important?

The outcome of cochlear implantation (CI) is affected by various factors, including the manufacturer of the device. We validated the factors contributing to postoperative performance and evaluated the influence of different company devices on pure tone thresholds and postoperative performance.

https://ift.tt/2P7IYl0

Pleuroparenchymal fibroelastosis as a histological background of autoimmune diseases

Abstract

Patients with autoimmune disease–related interstitial lung disease (AID-ILD) occasionally develop radiologic pleuroparenchymal fibroelastosis (PPFE)–like lesions. However, the significance of AID as an etiology of PPFE has not been fully elucidated. The aim of this study is to verify the increase of elastic fibers in AID-ILD patients and evaluate the prevalence of histological PPFE in patients with AID-ILD. We selected cases of clinically diagnosed AID-ILD and idiopathic pulmonary fibrosis (IPF), in which an autopsy had been performed or in which the patient had undergone pneumonectomy for lung transplantation. We quantified the collagen fibers and elastic fibers in each lobe as the percentage of the non-aerated lung area (collagen fiber score and elastic fiber score, respectively) in histological specimens from a total of 73 patients (AID-ILD, n = 24; IPF, n = 49). There were no significant differences in the collagen fiber scores of the AID-ILD and IPF groups. Meanwhile, the elastic fiber scores of the AID-ILD group were significantly greater than those of the IPF group in the whole lung (17.3 ± 7.70 vs 11.6 ± 4.55), and the upper (16.6 ± 8.11 vs 11.2 ± 5.18), and lower (18.0 ± 9.68 vs 12.0 ± 5.55) lobes (all p < 0.01). Histological PPFE pattern was found in 12 of 24 AID-ILD patients (50%), and histological PPFE pattern as a dominant pattern of fibrosis was found in 2 of the 24 patients (8%). Thus, PPFE can be a manifestation of AID-ILD.

https://ift.tt/2yGMqcc

The role of induction chemotherapy followed by surgery in unresectable stage IVb laryngeal and hypopharyngeal cancers: a case series

The purpose of this study was to evaluate the benefit of induction chemotherapy followed by surgery in locally advanced unresectable stage IVb laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC).

https://ift.tt/2J3lgRq

Green Light photoselective vaporization of the prostate: a safe and effective treatment for elderly high-risk benign prostate hyperplasia patients with gland over 80 ml

Abstract

To analyze the efficacy of Green Light photoselective vaporization of the prostate (PVP) in elderly high-risk benign prostatic hyperplasia (BPH) patients with glands over 80 ml. From December 2013 to February 2016, we allocated 84 elderly (age 71–97) high-risk patients who underwent preoperative transrectal ultrasound (TRUS) examination with glands over 80 ml and divided them into two groups to receive 120 W (n = 40) and 180 W (n = 44) PVP. All the patients have been observed at least one intraoperative comorbidity: hypertension, diabetes mellitus, NYHA II, or combined. They were followed up for 12 months. All the conventional parameters were compared in this study. All the patients received successful operations without severe complications, and no patient needed blood transfusion. The operation time and catheterization time of the 180 W patients were significantly shorter than that of the 120 W patients (p < 0.05). The International Prostate Symptom Scores (IPSS), quality of life (QoL) scores, maximum flow rate (Qmax), and residual urine volume (RUV) in both groups have been significantly improved. PVP is safe and effective for high-risk aging patients with gland over 80 ml. In addition, 180 W XPS system has a short operation time and catheterization time and less inflammatory response.

https://ift.tt/2RSi27u

Effects of low-level laser therapy on soft and hard tissue healing after endodontic surgery

Abstract

The aim of this prospective study was to examine possible benefits of low-level laser therapy (LLLT) on soft and hard tissue healing after endodontic surgery. Seventy-six endo-surgery cases on maxillary incisors were included. The patients were assigned randomly into control and laser groups. In the laser group, gallium-aluminum-arsenide (GaAlAs) diode laser irradiation (810 nm, 129 mW, 3.87 J/cm²) was performed immediately after surgery and daily for postoperative 7 days from buccal and palatal surfaces (5 min for each side). In the control group, patients were not subjected laser therapy. The patients were compared in terms of pain, clinical and radiological findings, and life quality indexes [Oral Health Impact Profile-14 (OHIP-14) and General Oral Health Assessment Index (GOHAI)]. Seventy-one patients completed the study (n = 37 for control group, n = 34 for laser group). The laser group showed better results in edema, wound healing, and the number of analgesic tablets used on the 1st, 3rd, and 7th postoperative days. Significant reduction in ecchymoses was observed in the laser group on the postop 3rd and 7th days. The patients had significantly lower pain on the 1st and 3rd postop days in laser group. The laser group showed significantly better results in OHIP-14 and GOHA indexes on postop days 1 and 3. The laser group showed significantly favorable results in terms of bone density, defect volume and area, and periapical index in the postop 3rd month. This study concluded that LLLT improved soft and hard tissue healing after endodontic surgery and also showed favorable effects on pain and life quality of patients especially in the early phase of healing period.

https://ift.tt/2ErxVz8

Correction to: Comparative study using fractional carbon dioxide laser versus glycolic acid peel in treatment of pseudo-acanthosis nigricans

The author found small mistakes in scientific content of article. Editor-in-Chief confirmed that mistakes do not change or invalidate conclusions of article.

https://ift.tt/2RPoufs

Appropriate laser wavelengths for photodynamic therapy with methylene blue

https://ift.tt/2ErxNzE

Resistance to vertical root fracture of apicoected teeth using different devices during two root canal irrigation procedures

Abstract

The aim of the present work was to measure the fracture resistance of endodontically treated teeth that were apicoected with different procedures. Seventy-two extracted human maxillary anterior teeth were included in this study. The specimens were randomly assigned to three main groups according to the apical surgery procedures and then two subgroups according to the irrigation protocols during root canal treatment and total of six groups were obtained (n = 12). Group 1: served as a control and apical surgery process was not performed in this group. Group 2: apical surgery process was performed with tungsten carbide fissure bur Group 3: apical surgery process was performed with Er:YAG laser. Subgroup a: In this group, the specimens were irrigated with %5 NaOCl. Subgroup b: 15% EDTA solution was filled into the root canal and then agitated using a 1.5 W/100 Hz diode laser. The specimens were filled and mounted in acrylic resin blocks and compression strength test was performed. Statistical analysis was performed using two-way ANOVA. The statistical analysis revealed that there were no statistical significant differences between apical surgery procedures (groups 1, 2, and 3) (p < 0.05). Apical resection procedures did not affect the fracture resistance Significant differences were determined between the subgroups (p < 0.05). Agitation of the EDTA with the diode laser reduced the fracture resistance of the specimens. The different canal irrigation techniques altered resistance to fracture; however, apical surgery procedures did not altered the resistance to fracture when compared with the control group.

https://ift.tt/2RUXcEp

The role of induction chemotherapy followed by surgery in unresectable stage IVb laryngeal and hypopharyngeal cancers: a case series

Abstract

Background

The purpose of this study was to evaluate the benefit of induction chemotherapy followed by surgery in locally advanced unresectable stage IVb laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC).

Methods

Data of patients with stage IVb LHSCC who received induction chemotherapy for the purpose of tumor resection between January 2007 and January 2016 were retrospectively collected. Definitive surgery with postoperative adjuvant therapy was performed in patients whose tumors became resectable (resectable group). Chemoradiotherapy, radiotherapy, or supportive care was considered in patients whose tumors remained unresectable (unresectable group).

Results

Thirty-two patients were identified; the tumor resectability rate after induction chemotherapy was approximately 56%. The median overall survival (OS) rates of the resectable and unresectable groups were 20.0 months (range, 16.0–35.5 months) and 9.5 months (range, 6.0–15.0 months), respectively (p = 0.008). The estimated 2-year OS rates of the resectable and unresectable groups were 59.5% (95% confidence interval [CI], 33.2–78.3%) and 10.7% (95% CI, 1.1–35.4%), respectively (p = 0.008). The estimated 2-year disease-free survival (DFS) rates of the resectable and unresectable groups were 53.5% (95% CI, 27.9–73.6%), and 14.3% (95% CI, 2.3–36.6%), respectively (p = 0.009). On multivariate analysis, factors positively impacting OS and DFS in all patients were surgical resection, a laryngeal primary site, and induction chemotherapy with docetaxel, cisplatin, and fluorouracil.

Conclusions

In advanced unresectable stage IVb LHSCC patients, surgical resection following induction chemotherapy appears to improve survival outcomes.

https://ift.tt/2Ad4kFw

Radiation Oncology Mobile Application

Conditions:   Head and Neck Cancer;   Radiation Toxicity
Intervention:  
Sponsor:   King Hussein Cancer Center
Not yet recruiting

https://ift.tt/2RUVnro

Phase III Study of Camrelizumab in Combination With Chemotherapy in Recurrent/Metastatic Nasopharyngeal Carcinoma

Condition:   Nasopharyngeal Carcinoma
Interventions:   Drug: Camrelizumab;   Drug: Placebos;   Drug: Gemcitabine;   Drug: Cisplatin
Sponsor:   Jiangsu HengRui Medicine Co., Ltd.
Not yet recruiting

https://ift.tt/2EmUpBn

The Effect of Functional Exercises on Balance With Postural Thoracic Kyphosis

Conditions:   Postural Kyphosis;   Balance
Interventions:   Behavioral: The Group I Postural Exercise;   Behavioral: The Group II Three-dimensional Exercise Therapy Program
Sponsor:   Istanbul Medipol University Hospital
Recruiting

https://ift.tt/2RMKS9r

Genetic Analysis of Blood and Tissue Samples From Participants With Advanced Cancer

Conditions:   Advanced Melanoma;   Advanced Renal Cell Carcinoma;   Anatomic Stage III Breast Cancer AJCC v8;   Anatomic Stage IIIA Breast Cancer AJCC v8;   Anatomic Stage IIIB Breast Cancer AJCC v8;   Anatomic Stage IIIC Breast Cancer AJCC v8;   Anatomic Stage IV Breast Cancer AJCC v8;   Clinical Stage III Gastroesophageal Junction Adenocarcinoma AJCC v8;   Clinical Stage IV Gastroesophageal Junction Adenocarcinoma AJCC v8;   Clinical Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8;   Clinical Stage IVB Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage III Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IIIA Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IIIB Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IV Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8;   Pathologic Stage IVB Gastroesophageal Junction Adenocarcinoma AJCC v8;   Prognostic Stage III Breast Cancer AJCC v8;   Prognostic Stage IIIA Breast Cancer AJCC v8;   Prognostic Stage IIIB Breast Cancer AJCC v8;   Prognostic Stage IIIC Breast Cancer AJCC v8;   Prognostic Stage IV Breast Cancer AJCC v8;   Stage III Colorectal Cancer AJCC v8;   Stage III Lung Cancer AJCC v8;   Stage III Ovarian Cancer AJCC v8;   Stage III Prostate Cancer AJCC v8;   Stage IIIA Colorectal Cancer AJCC v8;   Stage IIIA Lung Cancer AJCC v8;   Stage IIIA Ovarian Cancer AJCC v8;   Stage IIIA Prostate Cancer AJCC v8;   Stage IIIA1 Ovarian Cancer AJCC v8;   Stage IIIA2 Ovarian Cancer AJCC v8;   Stage IIIB Colorectal Cancer AJCC v8;   Stage IIIB Lung Cancer AJCC v8;   Stage IIIB Ovarian Cancer AJCC v8;   Stage IIIB Prostate Cancer AJCC v8;   Stage IIIC Colorectal Cancer AJCC v8;   Stage IIIC Lung Cancer AJCC v8;   Stage IIIC Ovarian Cancer AJCC v8;   Stage IIIC Prostate Cancer AJCC v8;   Stage IV Colorectal Cancer AJCC v8;   Stage IV Lung Cancer AJCC v8;   Stage IV Ovarian Cancer AJCC v8;   Stage IV Prostate Cancer AJCC v8;   Stage IVA Colorectal Cancer AJCC v8;   Stage IVA Lung Cancer AJCC v8;   Stage IVA Ovarian Cancer AJCC v8;   Stage IVA Prostate Cancer AJCC v8;   Stage IVB Colorectal Cancer AJCC v8;   Stage IVB Lung Cancer AJCC v8;   Stage IVB Ovarian Cancer AJCC v8;   Stage IVB Prostate Cancer AJCC v8;   Stage IVC Colorectal Cancer AJCC v8
Intervention:   Procedure: Biospecimen Collection
Sponsor:   National Cancer Institute (NCI)
Not yet recruiting

https://ift.tt/2EnJmYH

Safety, Tolerability and Efficacy Profile of Rivoceranib With Paclitaxel in Advanced GC or GEJ Cancer.

Conditions:   Gastric Cancer;   Gastroesophageal Junction Adenocarcinoma
Interventions:   Drug: Rivoceranib;   Drug: Paclitaxel
Sponsor:   LSK BioPartners Inc.
Not yet recruiting

https://ift.tt/2RW9Sez

Back Pain in Medical Students at The University of the West Indies, Mona, Jamaica

Condition:   Back Pain
Intervention:   Other: Spine Exercise Program
Sponsor:   The University of The West Indies
Not yet recruiting

https://ift.tt/2EkHuQi

CAR T and PD-1 Knockout Engineered T Cells for Esophageal Cancer

Condition:   Advanced Esophageal Cancer
Interventions:   Biological: Anti-MUC1 CAR-T cells;   Biological: PD-1 knockout Engineered T cells;   Combination Product: CAR-T combined with PD-1 Knockout T cells
Sponsors:   The First Affiliated Hospital of Guangdong Pharmaceutical University;   Guangzhou Anjie Biomedical Technology Co;LTD
Recruiting

https://ift.tt/2RUNxxD

A Study to Compare Efficacy and Safety of DRT VS CRT Plus Surgery in Patients Who Achieved CCR for Esophageal Cancer

Conditions:   Stage II Esophageal Cancer;   Stage III Esophageal Cancer
Interventions:   Combination Product: Definitive Radiochemotherapy;   Combination Product: Neoadjuvant Radiochemotherapy
Sponsors:   Tianjin Medical University Cancer Institute and Hospital;   Cancer Institute and Hospital, Chinese Academy of Medical Sciences;   Sun Yat-sen University;   Beijing Cancer Hospital
Not yet recruiting

https://ift.tt/2EmU0yR

Environmental and Life-Style Related Risk Factors for Sinonasal and Nasopharyngeal Malignancies among a Prospective Cohort in Jos, Nigeria

Background. Worldwide evidence indicates that environmental and life-style related factors are associated with increased risk for cancers in the head and neck region. We aim to study the association between these risk factors and cancers in the sinonasal and nasopharyngeal regions in our environment. Methods. Longitudinal prospective cohort study at the Jos University Teaching Hospital, Jos, Nigeria. Risk exposures were classified based on the International Agency for the Research on Cancer (IARC) classification of suspected carcinogens. Associations between variables were analyzed using logistic regression. Results. We studied 44 patients with malignancies in nasopharynx (n= 24; 54.5%) and sinonasal regions (n= 20; 45.5%). Male to female ratio is 1.9:1 and mean age is 45.2 years. Alcohol was the commonest risk factor in males (n= 19; 43.2%) while cooking wood fumes were the commonest in females (n= 14; 31.8%) which was associated with increased risk for malignancies for all sites, showing ten times risk in nasal cancers (OR= 9.67; 95% CI 1.87- 9.88; p= 0.01). Tobacco was associated with elevated risk of malignancies in the nasomaxillary and nasal regions. Other risks were herbicides, pesticides, and chemical fertilizers in farmers. Conclusion. The significant risk exposures in females were cooking wood fumes and alcohol, tobacco, and exposure to agricultural chemicals in males. Life-style modification and environmental changes to ensure clean air in Nigeria are essential to reduce risks.

https://ift.tt/2EqmZlr

A literature review of perioperative antibiotic administration in surgery for medication-related osteonecrosis of the jaw

Abstract

Purpose

Few studies exist that focus on the details of perioperative antibiotic administration for surgery to treat medication-related osteonecrosis of the jaw (MRONJ). The regime and duration of perioperative antibiotics applied in published studies were reviewed to clarify appropriate perioperative antibiotic use in MRONJ surgery.

Methods

A literature search was conducted using the MEDLINE database via PubMed.

Results

The search resulted in 453 hits on PubMed. After reading the downloaded full-text articles, 17 articles met the inclusion and exclusion criteria. The most common perioperative antibiotic used for MRONJ surgery was a combination of penicillin-based antibiotics and β-lactamase inhibitor (52.9%), and the second most common regime was penicillin-based antibiotics with metronidazole (17.6%). The duration of administration was 2 weeks postoperatively in nine studies, whereas four studies applied long-term administration (2–6 weeks postoperatively).

Conclusions

Oral and maxillofacial surgeons mostly prefer penicillin-based antibiotics plus β-lactamase inhibitor or metronidazole for MRONJ surgery. The duration of administration of these medications may be based on empirical experience.

https://ift.tt/2AdBZih

A literature review of perioperative antibiotic administration in surgery for medication-related osteonecrosis of the jaw

Abstract

Purpose

Few studies exist that focus on the details of perioperative antibiotic administration for surgery to treat medication-related osteonecrosis of the jaw (MRONJ). The regime and duration of perioperative antibiotics applied in published studies were reviewed to clarify appropriate perioperative antibiotic use in MRONJ surgery.

Methods

A literature search was conducted using the MEDLINE database via PubMed.

Results

The search resulted in 453 hits on PubMed. After reading the downloaded full-text articles, 17 articles met the inclusion and exclusion criteria. The most common perioperative antibiotic used for MRONJ surgery was a combination of penicillin-based antibiotics and β-lactamase inhibitor (52.9%), and the second most common regime was penicillin-based antibiotics with metronidazole (17.6%). The duration of administration was 2 weeks postoperatively in nine studies, whereas four studies applied long-term administration (2–6 weeks postoperatively).

Conclusions

Oral and maxillofacial surgeons mostly prefer penicillin-based antibiotics plus β-lactamase inhibitor or metronidazole for MRONJ surgery. The duration of administration of these medications may be based on empirical experience.

https://ift.tt/2AdBZih

Bilateral subdural empyemas with meningitis secondary to acute barosinusitis

Publication date: Available online 15 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): J. Sung, O. Kwon, D. Kim, K. Kim

Abstract

Introduction

Intracranial complications of acute rhinosinusitis are rare, but may turn life-threatening.

Case summary

We report a healthy 30-year-old male who complained of frontal headache, which developed while on a plane. A brain CT showed a low-density lesion on the left frontal convexity with right maxillary and ethmoid sinusitis. Despite receiving intravenous antibiotics, a follow-up brain CT showed two lesions with adjacent dural and leptomeningeal enhancement. A paranasal sinus CT revealed aggravated left frontal sinusitis and right maxillary sinusitis. The patient underwent craniotomy and brain abscess removal along with endoscopic sinus surgery. Seventeen days after the surgery, the patient was discharged with no neurological sequelae.

Conclusion

To the best of our knowledge, this case is the first report regarding the association between barotrauma and intracranial complications of acute rhinosinusitis. A high index of suspicion and well-timed surgical evacuation may ensure a full recovery.

https://ift.tt/2yGll9c

Congenital bilateral dacryocystocele

Publication date: Available online 15 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): Pedro Carneiro de Sousa, Marta Neves, Delfim Duarte, Paula Azevedo

Abstract

Introduction

Newborns are obligatory nasal breathers. Therefore, nasal obstruction can lead to cyanosis and desaturation. In spite of being very rare, congenital bilateral dacryocystocele is a possible etiology for neonatal respiratory distress.

Case summary

Case report of a male newborn with respiratory distress caused by a bilateral polypoid and bluish lesion occupying almost the entire inferior nasal meatus. Imaging confirmed bilateral dacryocystocele. Treatment was conservative. There was spontaneous drainage, with relief of respiratory distress. Discussion The diagnosis of congenital dacryocystocele is clinical, although imaging exams may be requested to confirm it. Treatment is controversial, because the natural history is variable. An initial conservative management may be recommended, but, if there is a permanent respiratory obstruction without improvement, surgical management is mandatory.

https://ift.tt/2yl6stA

Rekonstruktive Orbitachirurgie

Zusammenfassung

Hintergrund

Komplexe Orbitarekonstruktionen erfordern die korrekte und sorgfältige Wiederherstellung der Hart- und Weichgewebe als Voraussetzung für ein ästhetisches und funktionelles Resultat. Der Einsatz der computerassistierten Chirurgie („computer-assisted surgery", CAS) kann den Operateur vor und während der Rekonstruktion sowie im Rahmen der Qualitätskontrolle maßgeblich unterstützen. Dies soll allgemein sowie mithilfe von 3 klinischen Beispielen erläutert werden.

Material und Methoden

Anhand eines 3D-Datensatzes werden die zu rekonstruierenden Strukturen und deren Umgebung erfasst. Einen Anhalt für die erwünschte Rekonstruktion bietet meist die nichtbetroffene Gegenseite durch Spiegelung. Das erzeugte virtuelle Modell kann nun zur Herstellung patientenspezifischer Modelle und Implantate, intraoperativ per Navigation oder zur direkten Qualitätskontrolle mithilfe des intraoperativen Röntgens genutzt werden.

Ergebnisse

Zur Rekonstruktion primärer und sekundärer traumatologischer Defekte sowie im Rahmen angeborener Fehlbildungen oder neoplastischer Erkrankungen kann der beschriebene Arbeitsablauf zum Einsatz kommen. Virtuelle Visualisierung, patientenspezifische Rekonstruktionen und direkte Qualitätskontrolle mithilfe des intraoperativen Röntgens erzielen ein planungskonformes Ergebnis. Unter Einhaltung des Wechselspiels von Hart- und Weichgewebe werden bestmögliche Rekonstruktionen erreicht.

Schlussfolgerung

Die CAS hat sich in den letzten Jahren stetig weiterentwickelt und ist im klinischen Alltag im Einsatz. Patientenspezifische Implantate in Kombination mit der direkten intraoperativen Qualitätskontrolle erleichtern die Rekonstruktion komplexer Orbitaverletzungen und -defekte und ermöglichen die ideale Rekonstruktion sowohl aus ästhetischen als auch funktionellen Aspekten.

https://ift.tt/2ynXdsm

Treatment of early-stage laryngeal cancer: A comparison of treatment options

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Brandon Jackson Baird, C. Kwang Sung, Beth M. Beadle, Vasu Divi

Abstract

Over the course of the last several decades, the treatment options for early laryngeal cancers (T1 and T2) have evolved; however, simultaneously the mortality rate has increased. As larynx preservation approaches have become the standard of care, the selection of the proper treatment modality has become paramount. Radiation therapy or transoral laser microsurgery are the most common options for treatment of these early lesions. Oncologic and functional outcomes are considered equivalent between the two modalities for early glottic cancers; however, no direct comparisons exist for robust analysis. In terms of larynx preservation, there also is not compelling data favoring one treatment option or another. For early stage lesions, the goal for any larynx-sparing technique, either radiation or surgery, should be the intent to cure with single modality treatment and minimal short- and long-term toxicity. This article is designed to create a frame of reference for managing early stage disease with respect to lesions of the glottis and supraglottis while weighing treatment implications from an oncologic, functional, and cost perspective.

https://ift.tt/2IYduZ5

Endoscopic Management of Subperiosteal Orbital Abscesses

Publication date: Available online 16 October 2018

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Christopher Pool, Johnathan McGinn

Abstract

While the progression of acute rhinosinusitis to orbital infections has decreased in the modern antibiotic era, they still occur, particularly in the pediatric population. Infection may spread from the nasal cavity and sinuses via direct extension into the orbit through the thin lamina papyracea or through the valveless veins in the bony orbital wall.¹ Congenital dehiscence and trauma also allow for direct extension of the infection to the orbit.¹ Most of these orbital infections originate in the ethmoid sinuses and subperiosteal abscesses most commonly occur along the medial orbital wall. However, the frontal sinus is implicated in superior abscesses in older children and adults. Postseptal orbital infections require prompt diagnosis and treatment as they may impact vision and progress centrally, manifesting as cavernous sinus and intracranial infections associated with significant morbidity and mortality.2, 3

https://ift.tt/2AcQzXg

Quantitative and qualitative assessment of sensory changes induced by local anesthetics block of two different trigeminal nerve branches

Abstract

Objectives

The aims were to use different techniques to assess the degree of sensory changes and magnitude of perceived size changes in the facial region induced by nerve blocks of two different trigeminal nerve branches in healthy participants.

Materials and methods

This placebo-controlled study included 30 healthy volunteers. The participants underwent quantitative and qualitative sensory testing (QST and QualST) thrice: before, 10 min, and 2 h after mental (n = 15) and infraorbital (n = 15) nerve blocks and during control (saline) sessions. Perceived numbness, temperature changes, and perceptual distortion were also measured at all time points during the nerve block and control sessions. Differences in outcome parameters between the sessions and time points were analyzed using analyses of variance and McNemar's tests.

Results

There was a significant degree of sensory loss to most QST and all QualST parameters, with significant numbness and increased perceived size at the injection site 10 min and 2 h after the nerve blocks compared with saline (P < 0.030) and the baseline (P < 0.042). Two hours after the nerve blocks, the sensitivity was significantly closer to baseline than after 10 min to most of the QST parameters (P < 0.011).

Conclusions

QST and QualST revealed that the nerve blocks in the orofacial region resulted in complete or partial blockade of afferent nerve fibers mediating thermal and mechanical function for more than 2 h with significant numbness and perceptual distortion.

Clinical relevance

Both QST and QualST can provide information on the degree of blockade of afferent nerve fibers after nerve blocks in the orofacial region.

https://ift.tt/2PCh7q6

Effect of air-blowing time and long-term storage on bond strength of universal adhesives to dentin

Abstract

Objectives

To evaluate the effects of air-blowing time and storage time on microtensile bond strength (μTBS) of universal adhesives to dentin.

Materials and methods

Ninety flat dentin surfaces from extracted human third molars were bonded with three universal adhesives (Clearfil Universal Bond-CU; G-Premio Bond-GP; Scotchbond Universal Adhesives-SB). Bonded dentin surfaces were air-dried for 5 s, 15 s, or 30 s followed by resin composite built-up. Resin-dentin beams were tested with μTBS test after different storage time in distilled water (24 h and 1 year). Data were analyzed by three-way ANOVA and Duncan test at (α = 0.05). Failure mode and resin-dentin interfaces were observed using a scanning electron microscope (SEM). Specific features of fractured beams after μTBS were further observed using SEM at high magnification.

Results

Extension of air-blowing time from 5 s to 30 s increased the 24 h μTBS of CU only. Bond strength of all adhesives significantly decreased after 1-year storage except for CU at 5 s and 30 s of air-blowing time. One-year μTBS were significantly higher when air-blowing times were extended to 15 s for SB and 30 s for CU. Air-blowing time had no influence on GP.

Conclusion

The effect of air-blowing time and storage time on resin-dentin bond was material-dependent.

Clinical relevance

Extended air-blowing time increased the bond strength and bond durability of CU. Extension of air-blowing time to 15 s and 30 s improve the long-term bond strength of SB and CU, respectively.

https://ift.tt/2NHIw8s

Does endoscopic stapedotomy increase hearing restoration rates comparing to microscopic? A systematic review and meta-analysis

Abstract

Objective

To assess all available data regarding the comparative success rates of endoscopic and microscopic stapes surgery.

Methods

MEDLINE, the Cochrane Library and Web of Science databases as well as other sources were searched by two independent reviewers. Controlled studies comparing endoscopic and microscopic stapedotomy in patients with otosclerosis or congenital stapedial fixation were included. Achievement of a postoperative air-bone gap ≤ 10 decibel was the primary outcome. Secondary outcomes were postoperative dysgeusia, scutum drilling and operation time. In case of homogenous, processable data (I² < 60%) a meta-analysis was performed. Odds ratio (OR) and Chi-square test were used to compare the two methods.

Results

Seven studies met the inclusion criteria. The OR analysis showed no significant differences between the two methods (OR 1.41, 95%CI [0.84, 2.38]), but goodness-of-fit analysis showed a correlation of endoscopic stapedotomy with normal hearing restoration (p = 0.00). Dysgeusia and scutum drilling took place significantly less often in the endoscopy group (OR 0.31, 95%CI [0.14, 0.69], p = 0.00 and OR 0.01, 95%CI [0.00, 0.07], p = 0.00 respectively).

Conclusion

As of yet, endoscopic surgery does not seem to confer benefit on audiological improvement comparing to conventional microscopic, however, it leads to less scutum drilling and fewer postoperative dysgeusia cases. High-quality, large-sample studies need to be performed in the future.

https://ift.tt/2J0AMxF

The 8th edition AJCC/UICC TNM staging for p16-positive oropharyngeal carcinoma: is there space for improvement?

Abstract

The 8th edition of the AJCC/UICC TNM-staging system for p16[HPV]-positive OPSCC manages to improve prediction of prognosis and will essentially influence choice of therapy in future. Nonetheless, adjustments of the current version are needed. The surrogate marker p16 alone is inadequate for HPV detection, the role of ECS in HPV-positive OPSCC is not fully understood, and the patient's characteristics as well as molecular signatures and genetics have not been taken into consideration yet.

https://ift.tt/2OqlWGw

New method for retention of glasses while operating

Publication date: Available online 15 October 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): D.C. Laraway

https://ift.tt/2PwurfD

Vascularised fatty tissue: its role in prevention of the symptoms of Frey syndrome after parotidectomy

Publication date: Available online 15 October 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): A. Ghassemi, A. Modabber, P.O. Brzoska, M. Sababi

Abstract

We studied 37 consecutive patients who had parotidectomies between 2008 and 2017 and who had vascular fat flaps inserted to replace the excised parotid tissue and prevent Frey syndrome. They were followed up for 1–9 years to check for the relevant symptoms. We studied 17 female and 20 male patients, mean age 52 (range 19–78) years. The flaps took a maximum of 17 minutes to dissect. There was no donor site morbidity, the vascular fat flap was stable in all cases for up to nine years, and none of the patients complained of symptoms of Frey syndrome.

https://ift.tt/2P4ltcw

Complications and loss of free flaps after reconstructions for oral cancer

Publication date: Available online 15 October 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): E. Marttila, H. Thorén, J. Törnwall, A. Viitikko, T. Wilkman

Abstract

The aim of this retrospective study was to analyse the incidence of complications and loss of flaps after primary reconstructions for oral cancer in 191 patients at our hospital over the five years 2005–2010. The patients' clinical and personal details, characteristics of the tumours, types of microvascular flap, complications, and outcomes were recorded. The soft tissue flaps used most often were the fasciocutaneous radial forearm free flap (RFFF) (n = 86, 45%) and the anterolateral thigh free flap (ALTFF) (n = 48, 25%) while the most commonly used osseous flap was the deep circumflex iliac artery flap (DCIA) (n = 25, 13%). There were postoperative complications that required intervention in a quarter of the patients, most often in the age group 41–50 years (p = 0.018). Older age was not associated with the development of complications. The overall survival of all free flaps was 181/191 (95%), and the only significant individual predictor of loss of a flap was reconstruction with a DCIA (p = 0.016), five of the 25 of which were lost. We conclude therefore that DCIA free flaps are associated with an increased risk of failure; the method of osseous reconstruction for maxillofacial reconstruction should be selected carefully; and carefully chosen older patients do not seem to be at increased risk of morbidity.

https://ift.tt/2PFL2hv

Anterior convex lateral orbital wall: distinctive morphology in Apert syndrome

Publication date: Available online 15 October 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): X. Lu, A.J. Forte, R. Sawh-Martinez, R. Wu, R. Cabrejo, D.M. Steinbacher, M. Alperovich, N. Alonso, J.A. Persing

Abstract

Bony malformations of the orbit and alterations to the soft tissue in Apert syndrome contribute to ophthalmic dysfunction. Recognised structural malformation of the sphenoid and ethmoid sinuses, together with corresponding deformities in the anterior and middle cranial base, are characteristic. Our aim was to explore the underlying structural components of disfigurement and the consequent development of the orbit in patients with Apert syndrome over time by studying 18 preoperative computed tomographic (CT) scans of affected patients and 36 scans from controls. Cephalometric measurements related to the orbit were collected, and analysed with Materialise software. The patients with Apert syndrome had larger than normal external orbital horizontal angles between the ages of 6 months and 2 years. The inside horizontal angle was narrower at 16.36° before 6 months, and continued to decrease into adulthood. The ethmoid and sphenoid side angles in affected patients consistently increased, starting at 7.93% and 14.68% of the external horizontal angle, respectively, during the first 6 months of age, and becoming 20.55% and 11.69%, respectively, in adulthood. In unaffected patients, both angles were less than 3% of the external horizontal angle overall. The orbital vertical angle also changed synchronously, with increasingly wide lateral orbits and shortened anteroposterior orbits. The anterior protrusion of the lateral orbital wall resulted from superior and posterior rotation of a curved, greater wing of the sphenoid, while the widened median orbital wall was caused by the widened ethmoid sinus. These resulted in bony deformities of the orbit, which predisposed to the visual impairments of Apert syndrome.

https://ift.tt/2P6GuDO

Retrospective Comparison of Velcro® and Twill Tie Outcomes Following Pediatric Tracheotomy

Publication date: Available online 16 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Anna C. Bitners, William B. Burton, Christina J. Yang

Abstract

Objectives

To compare the rates of skin-related complications and accidental decannulation in pediatric patients who received Velcro^® ties versus twill ties during the early postoperative period following tracheotomy. The rates of skin-related complications and accidental decannulation in patients with Velcro^® ties was hypothesized to differ from those in patients with twill ties.

Methods

Medical records of 109 patients ≤18 years old who underwent elective tracheotomy were reviewed: 70 received twill ties and 39 received Velcro^® ties. Patients were followed for the first seven postoperative days. The primary outcome was skin-related complications, which were further categorized into mild (irritation) and severe (breakdown). The secondary outcome was accidental decannulation. Rates of skin-related complication and accidental decannulation were compared across the two groups using chi-square analysis.

Results

Skin irritation occurred in 32 patients (45.7%) with twill ties and 10 patients (25.6%) with Velcro^®. Skin breakdown occurred in 20 patients (28.6%) with twill ties and 6 patients (15.4%) with Velcro^®. There were no accidental decannulation events. The use of Velcro^® ties was associated with a decreased rate of skin irritation (OR: 0.41; 95% CI: 0.17 – 0.97; P = 0.039).

Conclusions

The use of Velcro^® ties was associated with a decrease in the rate of skin irritation. There were no accidental decannulation events. These findings support the use of Velcro^® ties at the time of pediatric tracheotomy placement.

https://ift.tt/2OYhj6h

Non-atopic eczema in elderly women – Impact of air pollution and genes

Publication date: Available online 16 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Anke Hüls, Michael J. Abramson, Dorothea Sugiri, Kateryna Fuks, Ursula Krämer, Jean Krutmann, Tamara Schikowski

Abstract

Background

Whilst many risk factors have been described for atopic eczema in children, little is known about the eczema phenotype in middle aged or elderly adults.

Objective

To examine the association between air pollution, atopy and eczema in adulthood.

Methods

This analysis was based on 834 women from the Study on the influence of Air pollution on Lung Function, Inflammation and Ageing (SALIA) cohort in Germany. Incident symptoms of eczema after the age of 55 years and prevalent symptoms of eczema ≤12 months before investigation were assessed by questionnaire at second follow-up (2007-2010). Total serum Immunoglobulin E (IgE) was measured at baseline (1985-1994) and in 2007-2010. Exposure to air pollution was assessed using land use regression. Adjusted logistic regression models were applied to estimate the association between air pollution and incident and prevalent symptoms of eczema. Weighted genetic risk scores were used to investigate the impact of atopic eczema related risk alleles on this association.

Results

Exposures to oxides of nitrogen (NO₂ and NO_x) and particulate matter (PM_2.5 and PM₁₀) were significantly associated with increased odds of incident eczema (e.g. with PM_2.5 per 4.7μg/m³: OR=1.45, 95%CI: 1.06,1.99). These associations were slightly more pronounced with non-atopic eczema (e.g. with PM_2.5 OR=1.65, 95%CI: 1.15, 2.34 for participants without hay fever or elevated IgE levels). Associations with air pollution were stronger in carriers of fewer risk alleles for atopic eczema.

Conclusion

Non-atopic eczema in the elderly is associated with traffic related air pollutants and this phenotype differs from genetically driven atopic eczema.

https://ift.tt/2Adxdl7

Human primary immunodeficiency caused by expression of a kinase-dead p110δ mutant

Publication date: Available online 16 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Sarah Beaussant Cohen, Wayne Bainter, Jared L. Johnson, Ting-Yu Lin, Jenny C.Y. Wong, Jacqueline Wallace, Jennifer Jones, Fatima Mir, Farah Qamar, Lewis C. Cantley, Raif S. Geha, Janet Chou

https://ift.tt/2OXbPsr

Imatinib stimulates PGE2 and attenuates cytokine release via EP4 receptor activation

Publication date: Available online 16 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Thomas Bärnthaler, Katharina Jandl, Heinz Sill, Barbara Uhl, Yannick Schreiber, Magdalena Grill, Dominique Thomas, Rudolf Schicho, Gunther Marsche, Saša Frank, Akos Heinemann, Rufina Schuligoi

https://ift.tt/2yQk5R1

A comparison of panoramic radiography and cone beam CT in the detection of osteosynthesis complications in sheep mandibular angle fractures

Publication date: Available online 16 October 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Yigit Sirin, Senem Yildirimturk, Emre Aytugar, Sirmahan Cakarer, Sinan Horasan, Koray Guven

Abstract

Objective

To compare the diagnostic efficacy of panoramic radiography (PANO) and cone beam computed tomography (CBCT) in detecting simulated complications of plate osteosynthesis applied to mandibular angle fractures (MAFs).

Study Design

Unfavorable MAFs were created in 100 fresh sheep hemimandibles. Fractures were fixed with 4-hole titanium miniplates and screws. Bone necrosis around the screws, penetration of the screw into the inferior alveolar canal, screw loosening, and plate breakage were simulated. Diagnostic efficacy of the imaging techniques was compared by intra- and inter-observer agreement scores and area under the receiver operating characteristic curve (AUC) values. Examination time (ET), confidence scores (CS) and planar preference (PP) in CBCT evaluation were assessed.

Results

Intra- and inter-observer agreement scores varied between 0.61 and 0.91. AUCs for screw penetration into the IAC and screw loosening were significantly higher in CBCT than PANO (p < .05). CBCT presented significantly higher ET and CS values than PANO (p < .05). PP showed significant differences among types of complications (p < .05).

Conclusions

PANO provided acceptable outcomes in the detection of bone necrosis and broken plates around the screw, but CBCT was more likely to enable detection of all simulated types of complications with higher confidence.

https://ift.tt/2CM8fvj

Accuracy and Reliability of Mandibular Digital Model Registration Using the Mucogingival Junction as a Reference

Publication date: Available online 16 October 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Marcos Ioshida, Brian Andres Muñoz, Hector Rios, Lucia Cevidanes, Juan Fernando Aristizabal, Diego Rey, Hera Kim-Berman, Marilia Yatabe, Erika Benavides, Maria Antonia Alvarez, Sarah Volk, Antonio C. Ruellas

Abstract

Objective

To validate a method of mandibular digital model (DM) registration, acquired from an intraoral scanner, compared to high-resolution voxel-based cone beam computed tomography (CBCT) registration using the mucogingival junction as a reference.

Materials and Methods

Pre- and post-treatment CBCTs and DMs of 12 adults were randomly selected from an initial sample of 40 patients who underwent orthodontic treatment. The DM registration was performed in six steps: (1) construction of 3D volumetric label maps of CBCT scans; (2) voxel-based registration of CBCT scans; (3) pre-labeling of CBCT; (4) approximation and registration of DM to the corresponding CBCT models; (5) mucogingival-junction registration between pre-treatment and post-treatment DM; and (6) measurements. The Mann-Whitney U test was used to calculate the significance of differences between the CBCT and DM registrations. The intraclass correlation coefficient (ICC) was performed to assess reproducibility of the registration method.

Results

When registered CBCT models and registered DM models were compared, no statistically significant differences in the measurements were found (right-left p=0.267; anterior-posterior p=0.238; superior-inferior p=0.384; and 3D p=0.076). ICC showed excellent intra- and inter-rater correlation (ICC>0.90).

Conclusion

The method of digital model registration of the mandible using the mucogingival junction as a reference is accurate, reliable, and reproducible.

https://ift.tt/2CgNBmd

Contrast-enhanced CT image assessment of cervical lymph node metastasis in oral cancer patients using a deep learning system of artificial intelligence

Publication date: Available online 15 October 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Yoshiko Ariji, Motoki Fukuda, Yoshitaka Kise, Michihito Nozawa, Yudai Yanashita, Hiroshi Fujita, Akitoshi Katsumata, Eiichiro Ariji

Abstract

Objective

Although deep learning has been applied to medical images, its application to the diagnosis of cervical lymph nodes in patients with oral cancer has not yet been reported. The purpose of this study was to evaluate the performance of deep-learning image classification for diagnosis of lymph node metastasis.

Study Design

The imaging data used for evaluation consisted of CT images of 127 histologically proven positive cervical lymph nodes and 314 histologically proven negative lymph nodes from 45 patients with oral squamous cell carcinoma. The performance of a deep-learning image classification system for the diagnosis of lymph node metastasis on CT images was compared with the diagnostic outcomes of two experienced radiologists, using the Mann-Whitney U Test and chi-squared analysis.

Results

The performance of the deep-learning image classification system resulted in accuracy of 78.2%, sensitivity of 75.4%, specificity of 81.0%, positive predictive value of 79.9, negative predictive value of 77.1%, and area under the receiver operating characteristic curve of 0.80. These values were not significantly different from the radiologists' performance.

Conclusion

The deep learning system produced diagnostic outcomes similar to those of the radiologists, which suggests that it may be valuable for diagnostic support.

https://ift.tt/2CM8oyR

Orthognathic Surgery Has a Significant Positive Effect on Perceived Personality Traits and Perceived Emotional Expressions in Long Face Subjects

Publication date: Available online 16 October 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Jeffrey C. Posnick, Brian E. Kinard

Abstract:

Purpose

Crowdsourcing is increasingly being used in medical research to obtain the opinion and perception of laypeople. The investigators hypothesized that a layperson's perception of a long-face dentofacial deformity (DFD) patient is more favorable after orthognathic surgery than before surgery with regard to perceived personality traits and emotional facial expressions.

Methods

The investigators implemented a survey, distributed through Amazon.com's Mechanical Turk crowdsourcing platform, to compare 6 perceived personality traits and 6 perceived emotional traits before and after (> 6 months) orthognathic surgery in subjects through standardized photographs (3 facial views). The sample was composed of 20 subjects randomly selected from our long-face DFD database, treated by one surgeon all having undergone bimaxillary and chin orthognathic surgery. The outcome variable was change in each of the 12 perceived personality and emotional traits studied. Descriptive and bivariate statistics were computed. P value less than 0.05 was considered significant.

Results

500 respondents (raters) completed the survey in less than 10 hours. The respondents were male (60%), 25 to 34 year of age (57%), Caucasian (71%), college graduates (53%) with an annual income between $20,000 and $50,000 (48%). After jaw reconstruction and completion of orthodontic treatment, long-face subjects as a group were perceived to be significantly more trustworthy, more friendly, more intelligent, more attractive and more dominant and also as happier and less angry, sad, afraid, or disgusted than they were prior to surgery (p < 0.05).

Conclusion

We confirmed that laypeople consistently report positive changes in a long-face subject's perceived personality traits and perceived emotional expressions after bimaxillary and chin orthognathic surgery.

https://ift.tt/2J0dVSL

Unilateral and Bilateral PNIF in Quality Control of Nasal Septal Surgery

The aim of this study was to explore the usefulness of unilateral, combined unilateral (left + right), and bilateral peak nasal inspiratory flow (PNIF) measurements in assessing the results of nasal septal surgery. Nasal obstruction was recorded subjectively and objectively before and 4 months after nasal septoplasty using a visual analogue scale (VAS) and a PNIF meter. Nasal septoplasty (58 patients) and septoplasty with turbinoplasty (68 patients) were performed on 126 patients (85 males; 41 females) with a mean age of 32.8 years. The results showed a significant improvement in VAS scores, as well as unilateral, combined unilateral, and bilateral PNIF values after both septoplasty and septoplasty with turbinoplasty. Septoplasty with turbinoplasty showed better improvement in VAS and PNIF scores than septoplasty alone and this was significant for bilateral PNIF scores. The best unilateral pre- and postoperative correlations between VAS and PNIF measurements were found using the lower of the two unilateral PNIF scores, irrespective of side. In the total material, VAS/PNIF correlations were mostly significant, but weak (all r

https://ift.tt/2pU820L

A retrospective comparative study of mandibular fracture treatment with internal fixation using reconstruction plate versus miniplates

Publication date: Available online 15 October 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Shintaro Sukegawa, Takahiro Kanno, Masanori Masui, Yuka Sukegawa-Takahashi, Tsukasa Kishimoto, Ai Sato, Yoshihiko Furuki

Summary

Purpose

This study compared the clinical success rates of mandibular fracture treatment using reconstruction plates or miniplates and clarified the selection criteria for reconstruction plates.

Methods

All patients who had surgically treated mandible fractures from 2008 to 2017 with sufficient follow-up were retrospectively analyzed for information about the fracture condition, treatment, and outcomes.

Results

A total of 126 surgically treated mandible fractures without mandibular condylar fracture in 105 patients (76 male, 29 female) were included. Reconstruction plates were used in 32 fractures with very good postoperative occlusal function. Four cases with complications requiring reoperation were treated using only miniplates. Variables that were statistically associated with follow-up surgery included simple versus comminuted mandible fracture, and the absence of teeth that could be used for intermaxillary fixation (P < 0.05). In the miniplates treatment for comminuted fracture, there was a significant difference in the treatment outcome depending on the number of free bone fragments and the presence of bone fragments requiring removal within 1 cm (P < 0.05).

Conclusion

Reconstruction plates provided better treatment outcomes for comminuted fractures and fractures without teeth. Selecting a reconstruction plate that is capable of sufficiently overloading is important in comminuted fractures with multiple free bone fragments and bone fragments requiring removal.

https://ift.tt/2CM2Rbz

Effect of a structured plaque control on MMP-1 and MMP-9 crevicular levels in patients with desquamative gingivitis associated with oral lichen planus

Abstract

Objectives

No data are available in the literature on the extent to which the immune host-response and bacterial-elicited inflammation separately contributes to the increase in gingival crevicular fluid (GCF) levels of inflammatory biomarkers in patients affected by desquamative gingivitis (DG) secondary to oral lichen planus (OLP). The aim of this study was to investigate the effect of a structured plaque control intervention on GCF levels of MMP-1 and MMP-9 in OLP patients with DG and to compare them with those of non-OLP patients.

Materials and methods

The study population consisted of 18 unrelated Caucasian patients with DG, while 18 periodontally healthy subjects were recruited for the control group. Periodontal parameters and GCF biomarker amounts were evaluated at baseline and 2 months after a structured plaque control intervention, comprising professional oral hygiene sessions, manual toothbrushing, and interdental cleaning advice, only for DG patients. Determination of MMP-1 and MMP-9 levels was carried out by means of an enzyme-linked immunosorbent assay.

Results

Plaque control program led to improvement in all examined clinical parameters and resulted in significant decrease in GCF total amount and concentration of MMP-1 and MMP-9 in comparison to baseline (p < 0.001). However, MMP-1 and MMP-9 levels in DG patients were still significantly higher than those in the healthy control group (p < 0.01).

Conclusions

These findings would seem to support an intrinsic upregulated expression of MMPs in DG patients that is exacerbated by bacterial plaque.

Clinical relevance

The present outcomes provide further scientific grounds for the importance of strict professional oral hygiene sessions in DG patients.

https://ift.tt/2QQitOr

Dynamics of antimicrobial resistance of Helicobacter pylori isolates in the Smolensk region of Russian Federation

Helicobacter, EarlyView.


https://ift.tt/2CMRCjs

Successful Helicobacter pylori eradication therapy improves symptoms of chronic constipation

Helicobacter, EarlyView.


https://ift.tt/2Cl344r

Normative data for static balance testing in healthy individuals using open source computerized posturography

Abstract

Purpose

Computerized posturography is the gold standard for balance assessment. Because of the great cost and dimensions of commercial equipments, low-cost and portable devices have been developed and validated, such as RombergLab, a software in open source term which works connected with a low-cost force platform. The objective of this study was to obtain normative posturography data using this software.

Methods

A multicentric prospective and descriptive study, with 350 healthy participants, was designed. Static postural stability (measured using the modified clinical test of sensory interaction on balance) was evaluated using the software connected to the force platform. Using the confidence ellipse area (CEA) in each condition, global equilibrium score (GES) was calculated and adjusted for significant variable factors using cluster analysis.

Results

Mean (SD) GES was 0.72 (0.22). Age (p < 0.01), height (p < 0.01) and recruitment center (p < 0.05) were found as influence factors for GES. Cluster analysis obtained 16 groups stratified by age and height. GES decreases with age and height (p < 0.005). No significant interaction of age nor height was found with GES in these clusters (p > 0.05). After correction for height and age, GES was no longer influenced by the recruitment center (p > 0.05).

Conclusions

With the introduction of the global equilibrium score values of the present study into the software, we consider RombergLab v1.3 a reference posturography tool for healthy individuals. Further studies are needed for validating it as a suitable instrumented test for screening between healthy and pathologic subjects and its reliability over time for the follow-up of patients.

https://ift.tt/2IYfctC

Neuromuscular blocking agents induced anaphylaxis: Results and trends of a French pharmacovigilance survey from 2000 to 2012

Allergy, EarlyView.


https://ift.tt/2ROcRW6

Issue Information

Dermatologic Therapy, Volume 31, Issue 5, September/October 2018.


https://ift.tt/2EqwUrf

Allergic contact dermatitis to slime: The epidemic of isothiazolinone allergy encompasses school glue

Pediatric Dermatology, EarlyView.


https://ift.tt/2J0nOzZ

Multifocal congenital pyogenic granuloma successfully treated with oral propranolol

Pediatric Dermatology, EarlyView.


https://ift.tt/2OvDAch

Solitary plaque on the leg of a child: A report of two cases and a brief review of acral pseudolymphomatous angiokeratoma of children and unilesional mycosis fungoides

Pediatric Dermatology, EarlyView.


https://ift.tt/2IZCOhj

Infantile hemangiomas with minimal or arrested growth: A retrospective case series

Pediatric Dermatology, EarlyView.


https://ift.tt/2Ow0oID

Prescribing isotretinoin for transgender youth: A pledge for more inclusive care

Pediatric Dermatology, EarlyView.


https://ift.tt/2IZ6cEB

The readability, suitability, and content features of eczema action plans in the United States

Pediatric Dermatology, EarlyView.


https://ift.tt/2Oqec7q

Congenital tufted angioma: A multicenter retrospective study of 30 cases

Pediatric Dermatology, EarlyView.


https://ift.tt/2IZDKTc

Pediatric dermatology workforce in the United States

Pediatric Dermatology, EarlyView.


https://ift.tt/2OoBDhs

Recalcitrant alopecia areata responsive to leflunomide and anthralin—Potentially undiscovered JAK/STAT inhibitors?

Pediatric Dermatology, EarlyView.


https://ift.tt/2J0nKQL

Oral Candida carriage among cigarette‐ and waterpipe‐smokers, and electronic cigarette users

Oral Diseases, EarlyView.


https://ift.tt/2PCrPNt

Incidence and death rate of pemphigus vulgaris and pemphigus foliaceus in Korea: A nationwide, population‐based study (2006–2015)

The Journal of Dermatology, EarlyView.


https://ift.tt/2yG9Cr0

Sinonasal cancer in The Netherlands: Follow‐up of a population‐based study 1989‐2014 and incidence of occupation‐related adenocarcinoma

Head &Neck, EarlyView.


https://ift.tt/2Enfo6Z

Scabies herpeticum, an emerging clinical form of crusted scabies in AIDS patient: case report and literature review

International Journal of Dermatology, EarlyView.


https://ift.tt/2CMGtz8