Caffeinated coffee was associated with a significant reduction in risk of rosacea but other sources of caffeine, such as soda and tea, did not appear protective.
Medscape Medical News
https://ift.tt/2R1WQe9
Παρασκευή 19 Οκτωβρίου 2018
Coffee May Reduce Rosacea Risk
Oxeiptosis: a discreet way to respond to radicals
Pietro Scaturro | Andreas Pichlmair
https://ift.tt/2yO3tsU
Surgical technique and chylothorax following coronary artery bypass grafting
Annals of Cardiac Anaesthesia 2018 21(4):468-468
https://ift.tt/2yO3gG8
Predictors of acute kidney injury in patients undergoing adult cardiac surgery
Annals of Cardiac Anaesthesia 2018 21(4):448-454
Background: Acute kidney injury (AKI) after cardiac surgery (CS) is not uncommon and has serious effects on mortality and morbidity. A majority of patients suffer mild forms of AKI. There is a paucity of Indian data regarding this important complication after CS. Aims and Objectives: The primary objective was to study the incidence of AKI associated with CS in an Indian study population. Secondary objectives were to describe the risk factors associated with AKI-CS in our population and to generate outcome data in patients who suffer this complication. Methods: Serial patients (n = 400) presenting for adult CS (emergency/elective) at a tertiary referral care hospital in South India from August 2016 to November 2017 were included as the study individuals. The incidence of AKI-CS AKI network (AKIN criteria), risk factors associated with this condition and the outcomes following AKI-CS are described. Results: Out of 400, 37 (9.25%) patients developed AKI after CS. AKI associated with CS was associated with a mortality of 13.5% (no AKI group mortality 2.8%, P = 0.001 [P < 0.05]). When AKI was severe enough to need renal replacement therapy, the mortality increased to 75%. Patients with AKI had a mean hospital stay 16.92 ± 12.75 days which was comparatively longer than patients without AKI (14 ± 7.98 days). Recent acute coronary syndrome, postoperative atrial fibrillation, and systemic hypertension significantly predicted the onset of AKI-CS in our population. Conclusions: The overall incidence of AKI-CS was 9.25%. The incidence of AKI-CS requiring dialysis (Stage 3 AKIN) AKI-CS was lower (2%). However, mortality risks were disproportionately high in patients with AKIN Stage 3 AKI-CS (75%). There is a need for quality improvement in the care of patients with AKI-CS in its most severe forms since mortality risks posed by the development of Stage 3 AKIN AKI is higher than reported in other index populations from high resource settings.
https://ift.tt/2yrsdYN
Facilitating noncardiac surgery for the patient with left ventricular assist device: A guide for the anesthesiologist
Annals of Cardiac Anaesthesia 2018 21(4):351-362
The introduction of left ventricular assist device (LVAD) has improved survival rates for patients with end-stage heart failure. Two categories of VADs exist: one generates pulsatile flow and the other produces nonpulsatile continuous flow. Survival is better for patients with continuous-flow LVADs. With improved survival, more of such patients now present for noncardiac surgery (NCS). This review, written for the general anesthesiologists, addresses the perioperative considerations when the patient undergoes NCS. For best outcomes, a multidisciplinary approach is essential in perioperative management of the patient.
https://ift.tt/2yOqo7o
Unrecognized hyperlucent lesion on lateral film of chest X-Ray
Annals of Cardiac Anaesthesia 2018 21(4):440-441
We report an interesting case of bulla right lung, incidently found during CABG surgery.
https://ift.tt/2ypq4wu
The efficacy of different modes of analgesia in postoperative pain management and early mobilization in postoperative cardiac surgical patients: A systematic review
Annals of Cardiac Anaesthesia 2018 21(4):363-370
Cardiac surgery induces severe postoperative pain and impairment of pulmonary function, increases the length of stay (LOS) in hospital, and increases mortality and morbidity; therefore, evaluation of the evidence is needed to assess the comparative benefits of different techniques of pain management, to guide clinical practice, and to identify areas of further research. A systematic search of the Cochrane Central Register of Controlled Trials, DARE database, Joanna Briggs Institute, Google scholar, PUBMED, MEDLINE, EMBASE, Academic OneFile, SCOPUS, and Academic search premier was conducted retrieving 1875 articles. This was for pain management postcardiac surgery in intensive care. Four hundred and seventy-one article titles and 266 abstracts screened, 52 full text articles retrieved for critical appraisal, and ten studies were included including 511 patients. Postoperative pain (patient reported), complications, and LOS in intensive care and the hospital were evaluated. Anesthetic infiltrations and intercostal or parasternal blocks are recommended the immediate postoperative period (4–6 h), and patient-controlled analgesia (PCA) and local subcutaneous anesthetic infusions are recommended immediate postoperative and 24–72 h postcardiac surgery. However, the use of mixed techniques, that is, PCA with opioids and local anesthetic subcutaneous infusions might be the way to go in pain management postcardiac surgery to avoid oversedation and severe nausea and vomiting from the narcotics. Adequate studies in the use of ketamine for pain management postcardiac surgery need to be done and it should be used cautiously.
https://ift.tt/2yTkthk
Missing swan ganz catheter
Annals of Cardiac Anaesthesia 2018 21(4):462-463
https://ift.tt/2yquVxp
Tissue oximetry during cardiac surgery and in the cardiac intensive care unit: A prospective observational trial
Annals of Cardiac Anaesthesia 2018 21(4):371-375
Background: Cerebral oximetry using near-infrared spectroscopy (NIRS) has well-documented benefits during cardiac surgery. The authors tested the hypothesis that NIRS technology can be used at other sites as a tissue oximeter during cardiac surgery and in the Intensive Care Unit (ICU). Aims: To establish feasibility of monitoring tissue oximetry during and after cardiac surgery, to examine the correlations between tissue oximetry values and cerebral oximetry values, and to examine correlations between oximetry values and mean arterial pressure (MAP) in order to test whether cerebral oximetry can be used as an index organ. Settings and Designs: A large, single-center tertiary care university hospital prospective observational trial of 31 patients undergoing cardiac surgery with cardiopulmonary bypass was conducted. Materials and Methods: Oximetry stickers were applied to both sides of the forehead, the nonarterial line forearm, and the skin above one paraspinal muscle. Data were collected from before anesthesia induction until extubation or for at least 24 h in patients who remained intubated. Statistical Analysis: Categorical variables were evaluated with Chi-square or Fisher's exact tests, while Wilcoxon rank-sum tests or student's t-tests were used for continuous variables. Results: The correlation between cerebral oximetry values and back oximetry values ranged from r = 0.37 to 0.40. The correlation between cerebral oximetry values and forearm oximetry values ranged from r = 0.11 to 0.13. None of the sites correlated with MAP. Conclusions: Tissue oximetry at the paraspinal muscle correlates with cerebral oximetry values while at the arm does not. Further research is needed to evaluate the role of tissue oximetry on outcomes such as acute renal failure, prolonged need for mechanical ventilation, stroke, vascular ischemic complications, prolonged ICU and hospital length of stay, and mortality in cardiac surgery.
https://ift.tt/2yRuXh8
The value of institutional protocols and focused cardiac ultrasound during a case of ultramassive transfusion
Annals of Cardiac Anaesthesia 2018 21(4):433-436
A 53-year-old female was admitted to the emergency department with an exsanguinating bleed from the rectum which was of unclear origin. In what could be considered an ultramassive transfusion, 60 units packed red blood cells, 23 units fresh frozen plasma, 20 units platelets, 6 units cryoprecipitate, 30 L of crystalloids, 2 L of colloids, and 4 g of tranexamic acid were transfused over the course of 7 h. An arterio-enteric fistula was diagnosed and treated by an interventional radiologist. The patient recovered rapidly thereafter without any major neurologic, pulmonary, cardiac, or hematologic complications.
https://ift.tt/2yprS8O
Preoperative predictors of poor laryngoscope views in pediatric population undergoing cardiac catheterization
Annals of Cardiac Anaesthesia 2018 21(4):376-381
Background: The primary objective of this study was to identify pre-anesthetic airway assessment parameters that would predict Cormack and Lehane grade III and IV laryngoscopy views in pediatric patients undergoing cardiac catheterization procedures. The secondary end points were to identify factors that would contribute to difficult laryngoscope views in this subset of patients. Settings and Design: Prospective observational study performed at a single tertiary cardiac care center. Materials and Methods: 199 children below 5 years of age undergoing elective cardiac catheterization were included. Pre-anesthetic airway assessment was done by modified Mallampati grading, lower lip to chin distance [LCD], tragus to mouth angle [TMA], thyromental distance [TMD], neck circumference [NC], and the ratio of height to thyromental distance [RHTMD]. Demographic data including American Society of Anesthesiologists physical status [ASA PS] were recorded for each child. Receiver Operating Characteristic curves were plotted and Areas Under the Curve were measured to identify the best cut off values for each of the airway evaluation method that would predict poor laryngoscopy views as well as assess their accuracy in doing so. Results: LCD, TMD and low body mass index were found to have good sensitivity, specificity and accuracy in predicting Grade III and IV laryngoscope views. ASA PS grade III and above patients had a significantly higher incidence of poor laryngoscope visualization. Conclusions: LCD, TMA, TMD, NC, RHTMD and BMI could all be used combinedly as screening tools during pre-anesthetic airway evaluation for predicting difficult laryngoscope views in children. Among these, LCD, TMD along with low body mass index might have better accuracy.
https://ift.tt/2ySlohZ
Abdominal compartment syndrome after surgical repair of Type A aortic dissection
Annals of Cardiac Anaesthesia 2018 21(4):444-445
Abdominal compartment syndrome is associated with severe dysfunction of intra-abdominal and intrathoracic organs. Medical therapy, with the goal of reducing intra-abdominal pressure, leads to improvement in organ perfusion.
https://ift.tt/2yquVNV
Usefulness of ultrasound-guided measurement of minimal transverse diameter of subglottic airway in determining the endotracheal tube size in children with congenital heart disease: A prospective observational study
Annals of Cardiac Anaesthesia 2018 21(4):382-387
Introduction: The search for an accurate and predictable method to estimate the endotracheal tube (ETT) size in pediatric population had led to derivation of many formulae. Of this, age-based formulae are the most commonly used. Studies have shown that minimal transverse diameter of subglottic airway (MTDSA) measurements using a high-frequency probe improves the success rate of predicting the airway diameter to about 90%. We did a prospective observational study using MTDSA as the criteria to select the size of ETT in children with congenital heart disease. Methods: In this prospective observational study, 51 children aged from 1 day to 5 years, scheduled for cardiac surgery, were enrolled for this study. The ETT size was guided solely based on the MTDSA. Leak test was used to determine the best-fit ETT size. Results: Data from 49 patients were analyzed. Agreement between the ETT determined by MTDSA and that predicted by Cole's age-based formulas with the best-fit ETT size was analyzed using a Bland–Altman plot. Conclusion: Age-based formula showed poor correlation (27.5%) compared to MTDSA (87.8%) in predicting the best-fit ETT. We observed that pediatric patients with congenital heart disease need a larger sized ETT as compared to what was predicted by age-based formula. Using ultrasound MTDSA measurements to guide selection of ETT size is a safe and accurate method in pediatric cardiac population.
https://ift.tt/2yQ5Knx
Is routine preoperative chest X-ray: An underutilized tool in asymptomatic patients!
Annals of Cardiac Anaesthesia 2018 21(4):460-461
https://ift.tt/2ypMGNz
Dreams content and emotional load in cardiac rehabilitation patients and their relation to anxiety and depression
Annals of Cardiac Anaesthesia 2018 21(4):388-392
Background: The assessment of a dream and its mechanisms and functions may help us to percept cognitions, emotions, and complex behaviors of patients. Hence, the present study aimed to assess (i) the rate of perceived dream and its emotional load and content and (ii) the relationship between functions of dream with anxiety and depression. Methods: In this cross-sectional study, 167 cardiac patients who had undergone rehabilitation in the western part of Iran were assessed during May–October 2016. Research instrument included Beck depression inventory, Beck anxiety inventory, Schredl's dream emotions manual, and content analysis of dreams manual. The findings were analyzed through Pearson's correlative coefficient and multiple regression analysis. Results: The mean age of participants (66.5% men) was 59.1 ± 9 years. The results indicated that the emotional content of patients' dreams included happiness (49.1%), distress (43.1%), sad (13.8%), fear (13.2%), and anger (3%). Although women report more sad dreams than men (P = 0.026), there was no difference between them in terms of other components of dreams, anxiety, and depression. Regression models showed that anxiety and depression were significantly able to predict perceived dream rates (P = 0.030) and emotionally negative dreams (P = 0.019). Conclusion: The increased rates of depression, especially anxiety, are related to increasing perceived dreams with negative and harmful emotional load. Regarding severity and negative content of dreams are reflexes of stressful emotional daily experiences, the management of experienced psychological symptoms such as depression and anxiety is concerned as an undeniable necessity.
https://ift.tt/2yTku4S
Anesthesia considerations in neonate with tetralogy of fallot posted for laparotomy
Annals of Cardiac Anaesthesia 2018 21(4):465-466
https://ift.tt/2ym2AZh
Is elevated blood glucose a marker of occult tissue hypoperfusion in off-pump coronary artery bypass grafting?
Annals of Cardiac Anaesthesia 2018 21(4):393-401
Context: Hyperglycemia has been found to occur during myocardial infarction and cardiac surgery even in nondiabetic patients. These being essentially stressful processes associated with hypoperfusion, we decided to find a possible relationship between the occurrence of global tissue hypoperfusion (GTH) and elevated blood glucose level in adult nondiabetic patients undergoing elective off-pump coronary artery bypass grafting (CABG). Aims: This study aims to observe for the occurrence of global tissue hypoperfusion and its effect on blood glucose level and whether raised blood glucose level can be used as a marker for GTH. Design: Prospective, observational study. Settings: Cardiothoracic operation theater and intensive care unit of a tertiary care teaching hospital. Materials and Methods: The occurrence of global tissue hypoperfusion were detected with the help of combined markers of mixed venous oxygen saturation and arterial lactate level at various perioperative study points together with arterial blood glucose level. Blood glucose level compared between the patients with and without GTH. Statistical Analysis Used: Numerical variables were compared between groups by Student's t-test and categorical variables by Fisher's exact test. Two-tailed P ≤ 0.05 was considered for statistically significant. Results: The incidence of GTH was 67%. Blood glucose level was raised in patients with GTH at some study time points but with poor sensitivity and specificity values. Conclusions: Global tissue hypoperfusion is a common occurrence in even nondiabetic patients undergoing elective off-pump CABG. A relationship exists between rise in blood glucose level and global tissue hypoperfusion in such patients, although it cannot be viewed as marker of the same.
https://ift.tt/2yKA0Qs
Statistical literacy for healthcare professionals: Why is it important?
Annals of Cardiac Anaesthesia 2018 21(4):349-350
https://ift.tt/2ym2AIL
Predictors and outcome of early extubation in infants postcardiac surgery: A single-center observational study
Annals of Cardiac Anaesthesia 2018 21(4):402-406
Objective: The objective of the current study was to evaluate the timing of first extubation and compare the outcome of patient extubated early with others; we also evaluated the predictors of early extubation in our cohort. Materials and Methods: This prospective cohort study included children <1 year of age undergoing surgery for congenital heart disease. Timing of first extubation was noted, and patients were dichotomized in the group taking 6 h after completion of surgery as cutoff for early extubation. The outcome of the patients extubated early was compared with those who required prolonged ventilation. Variables were compared between the groups, and predictors of early extubation were evaluated using multivariate logistic regression analysis. Results: One hundred and ninety-four (33.8%) patients were extubated early including 2 extubation in operating room and 406 (70.7%) were extubated within 24 h. Four (0.7%) patients died without extubation. No significant difference in mortality and reintubation was observed between groups. Patient extubated early had a significant lower incidence of sepsis (P = 0.003) and duration of Intensive Care Unit (ICU) stay (P = 0.000). Age <6 months, risk adjustment for congenital heart surgery category ≥3, cardiopulmonary bypass time ≥80 min, aortic cross-clamp time ≥ 60 min, and vasoactive-inotropic score >10 were independently associated with prolonged ventilation. Conclusion: Early extubation in infants postcardiac surgery lowers pediatric ICU stay and sepsis without increasing the risk of mortality or reintubation. Age more than 6 months, less complex of procedure, shorter surgery time, and lower inotropic requirement are independent predictors of early extubation.
https://ift.tt/2yKA3M8
Right atrial myxoma: Unusual location; uncommon association
Annals of Cardiac Anaesthesia 2018 21(4):437-439
We are presenting a case of the right atrial myxoma found in a case of rheumatic heart disease. During transthoracic echocardiography for the evaluation of a suspected rheumatic valvular heart disease, a diagnosis of severe mitral stenosis with severe mitral regurgitation with the right atrial thrombus was made. On transesophageal echocardiography, a pedunculated mass in the right atrium was confirmed. In the course of surgery, it was found that there is a tumor originating from the right atrial appendage (RAA) which was confused with clot on echocardiography. Rheumatic heart disease and myxomas have different etiopathogenesis, and this coexistence has not been reported. Further, right atrial myxoma arising out of RAA is also being reported for the first time.
https://ift.tt/2yob0zq
Predictors and outcome of early extubation in infants postcardiac surgery: A single-center observational study
Annals of Cardiac Anaesthesia 2018 21(4):407-408
https://ift.tt/2yKzRMU
Aortic regurgitation after chemoport catheter insertion: Diagnostic dilemma
Annals of Cardiac Anaesthesia 2018 21(4):442-443
Catheter insertion in central vein can potentially cause accidental arterial injury. However it is very unusual to see such catheter in aorta causing aortic regurgitation. Pressure monitoring and Ultrasound guidance can reliably prevent accidental arterial puncture.
https://ift.tt/2yoXYRV
Mesenchymale Stammzellen: Tumorfördernde oder -hemmende Eigenschaften – Ein aktueller Überblick
Laryngo-Rhino-Otol 2018; 97: 678-687
DOI: 10.1055/a-0650-4673
Eine multimodale Tumortherapie richtet sich nicht nur gegen die Tumorzellen, sondern beeinflusst auch das tumorumgebende Stroma. Das Tumorstroma beherbergt verschiedene nicht-maligne Zellen, unter anderem Fibroblasten, Immunzellen, aber auch mesenchymalen Stammzellen (MSC). MSC haben die Fähigkeit der Migration in Richtung Tumorgewebe. Welche Einflüsse MSC auf Tumorzellen ausüben wird in der gängigen Literatur kontrovers diskutiert. Die meisten Publikationen berichten von tumorfördernden Eigenschaften der MSC, welche über vier Hauptmechanismen ermöglicht werden: Die Sekretion löslicher Mediatoren verbunden mit Zell-Zell-Kontakten, die Transdifferenzierung der MSC in tumorassoziierte Fibroblasten, die Verbesserung der Neoangiogenese und zuletzt die Einleitung einer Immunsuppression durch MSC. In dieser Übersicht wird über den aktuellen Stand der Literatur referiert.
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© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
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Ambulante Cochlea-Implantation: was führt zur stationären Aufnahme?
Laryngo-Rhino-Otol 2018; 97: 664-665
DOI: 10.1055/a-0651-3971
Patel TA et al. Clinical Indicators of Admission for Pediatric Cochlear Implant Procedures. Ann Otol Rhinol Laryngol 2018; 127: 470–474 Eine ambulante Cochlea-Implantation bei Kindern gilt als sicher. Allerdings wird eine Minderheit über Nacht stationär aufgenommen. In Studien wird nahezu ausschließlich über postoperative Komplikationen und Behandlungsergebnisse und kaum über prognostische Indikatoren des Outcomes berichtet. Daher suchten amerikanische HNO-Ärzte nach Parametern, die mit der stationären Aufnahme korrelieren und prüften die Auswirkungen auf das klinische Ergebnis.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
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Larynxpapillomatose
Laryngo-Rhino-Otol 2018; 97: 670-671
DOI: 10.1055/a-0652-6483
Humane Papillomviren verursachen den gutartigen Epitheltumor, der bei Kehlkopfbefall zu Heiserkeit und Atemnot führt. Die Larynxpapillomatose ist nicht heilbar, gegenwärtig ist die phonochirurgische Behandlung das Mittel der Wahl.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
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Komplikationen nach Septumplastik analysiert
Laryngo-Rhino-Otol 2018; 97: 665-666
DOI: 10.1055/a-0651-3994
Dąbrowska-Bień J et al. Complications in septoplasty based on a large group of 5639 patients. Eur Arch Otorhinolaryngol 2018; 275: 1789–1794 In der Literatur fehlen Angaben zu Komplikationen nach alleiniger Septumplastik sowie der Kombination von Septumplastik mit Nasenmuschelreduktion in großen Populationen. Eine Arbeitsgruppe aus Warschau versuchte Komplikationen bei der Septumplastik zu bestimmen und die Inzidenz in Abhängigkeit von der Operationstechnik zu analysieren.
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© Georg Thieme Verlag KG Stuttgart · New York
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Diagnostik und operative Therapie der Otosklerose
Laryngo-Rhino-Otol 2018; 97: 717-734
DOI: 10.1055/a-0652-6494
Für die – oft in Diagnostik und Therapie anspruchsvolle – Otosklerose kann bei richtiger Diagnosestellung eine operative oder apparative Hörrehabilitation mit sehr hohen Erfolgschancen in Aussicht gestellt werden. Der erste Teil des Fortbildungsbeitrags umfasste Grundlagen, Diagnostik und Differenzialdiagnostik, im zweiten Teil soll auf therapeutische Aspekte und Nachsorge eingegangen werden.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
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Mundhöhlenkarzinom: Optionen zum Erhalt der Unterkieferspeicheldrüse
Laryngo-Rhino-Otol 2018; 97: 666-668
DOI: 10.1055/a-0651-4005
Cakir Cetin A et al. Submandibular gland invasion and feasibility of gland-sparing neck dissection in oral cavity carcinoma. J Laryngol Otol 2018; 132: 446–451 Ärzte der medizinischen Fakultät der Universität in Izmir untersuchten Inzidenz und relevante Faktoren die mit der Beteiligung Unterkieferspeicheldrüse am Mundhöhlenkarzinom assoziiert sind. Insbesondere deswegen, um herauszufinden, ob in einem frühen Stadium des Plattenepithelkarzinoms der Mundhöhle die Möglichkeit besteht, die Unterkieferspeicheldrüse zu erhalten.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
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Anmerkungen zur Minimal-invasiven Otoplastik (MIO)
Laryngo-Rhino-Otol 2018; 97: 672-677
DOI: 10.1055/a-0671-4010
Die minimal-invasive Otoplastik (MIO) ist nach unseren inzwischen sehr umfangreichen Erfahrungen eine zuverlässige Technik zur Korrektur abstehender Ohren. Sie bringt bei richtiger Indikation ästhetisch ansprechende natürliche und dauerhafte Ergebnisse. Die Grenzen der minimalinvasiven Technik müssen allerdings erkannt und berücksichtigt werden. Neue Instrumente erleichtern den Eingriff und verringern Komplikationsraten. V. a. Keloide und große hypertrophe Narben infolge ausgedehnter Hautinzisionen und -resektionen auf der Ohrmuschelrückseite sind mit der MIO fast ausgeschlossen.Wir stellen unser über zwei Jahrzehnte gewachsenes operatives Konzept vor.
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© Georg Thieme Verlag KG Stuttgart · New York
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Expertise Plastische Chirurgie
Laryngo-Rhino-Otol 2018; 97: 669-669
DOI: 10.1055/a-0674-8368
© Georg Thieme Verlag KG Stuttgart · New York
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Rechtliche Aspekte der Digitalisierung in der Medizin
Laryngo-Rhino-Otol 2018; 97: 713-716
DOI: 10.1055/a-0652-6505
© Georg Thieme Verlag KG Stuttgart · New York
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Fragen für die Facharztprüfung
Laryngo-Rhino-Otol 2018; 97: 735-736
DOI: 10.1055/a-0652-6516
© Georg Thieme Verlag KG Stuttgart · New York
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Fehlbildungschirurgie von Nase und Lippe
Laryngo-Rhino-Otol 2018; 97: 737-739
DOI: 10.1055/a-0652-6560
© Georg Thieme Verlag KG Stuttgart · New York
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Kommentar der Schriftleitung
Laryngo-Rhino-Otol 2018; 97: 660-661
DOI: 10.1055/a-0652-6450
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
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Protecting the Beans: Perioperative Acute Kidney injury
No abstract availablehttps://ift.tt/2CUYdZ5
Preoperative Intravenous Iron to Enhance a Blood Management Program: Is It All in “Vein”?
No abstract availablehttps://ift.tt/2CT0i7F
Multimodal General Anesthesia: A Principled Approach to Producing the Drug-Induced, Reversible Coma of Anesthesia
No abstract availablehttps://ift.tt/2CU6dt7
Implication of Major Adverse Postoperative Events and Myocardial Injury on Disability and Survival: A Planned Subanalysis of the ENIGMA-II Trial
BACKGROUND: Globally, >300 million patients have surgery annually, and ≤20% experience adverse postoperative events. We studied the impact of both cardiac and noncardiac adverse events on 1-year disability-free survival after noncardiac surgery. METHODS: We used the study cohort from the Evaluation of Nitrous oxide in Gas Mixture of Anesthesia (ENIGMA-II) trial, an international randomized trial of 6992 noncardiac surgical patients. All were ≥45 years of age and had moderate to high cardiac risk. The primary outcome was mortality within 1 postoperative year. We defined 4 separate types of postoperative adverse events. Major adverse cardiac events (MACEs) included myocardial infarction (MI), cardiac arrest, and myocardial revascularization with or without troponin elevation. MI was defined using the third Universal Definition and was blindly adjudicated. A second cohort consisted of patients with isolated troponin increases who did not meet the definition for MI. We also considered a cohort of patients who experienced major adverse postoperative events (MAPEs), including unplanned admission to intensive care, prolonged mechanical ventilation, wound infection, pulmonary embolism, and stroke. From this cohort, we identified a group without troponin elevation and another with troponin elevation that was not judged to be an MI. Multivariable Cox proportional hazard models for death at 1 year and assessments of proportionality of hazard functions were performed and expressed as an adjusted hazard ratio (aHR) and 95% confidence intervals (CIs). RESULTS: MACEs were observed in 469 patients, and another 754 patients had isolated troponin increases. MAPEs were observed in 631 patients. Compared with control patients, patients with a MACE were at increased risk of mortality (aHR, 3.36 [95% CI, 2.55–4.46]), similar to patients who suffered a MAPE without troponin elevation (n = 501) (aHR, 2.98 [95% CI, 2.26–3.92]). Patients who suffered a MAPE with troponin elevation but without MI had the highest risk of death (n = 116) (aHR, 4.29 [95% CI, 2.89–6.36]). These 4 types of adverse events similarly affected 1-year disability-free survival. CONCLUSIONS: MACEs and MAPEs occur at similar frequencies and affect survival to a similar degree. All 3 types of postoperative troponin elevation in this analysis were associated, to varying degrees, with increased risk of death and disability.https://ift.tt/2CV1JT4
Postoperative Hypotension and Surgical Site Infections After Colorectal Surgery: A Retrospective Cohort Study
BACKGROUND: Hypotension compromises local tissue perfusion, thereby reducing tissue oxygenation. Hypotension might thus be expected to promote infection. Hypotension on surgical wards, while usually less severe than intraoperative hypotension, is common and often prolonged. In this retrospective cohort study, we tested the hypotheses that there is an association between surgical site infections and low postoperative time-weighted average mean arterial pressure and/or postoperative minimum mean arterial pressure. METHODS: We considered patients who had colorectal surgery lasting ≥1 hour at the Cleveland Clinic between 2009 and 2013. We defined blood pressure exposures as time-weighted average (primary) and minimum mean arterial pressure (secondary) within 72 hours after surgery. We assessed associations between continuous blood pressure exposures with a composite of deep and superficial surgical site infection using separate severity-weighted average relative effect generalized estimating equations models, each using an unstructured correlation structure and adjusting for potentially confounding variables. RESULTS: A total of 5896 patients were eligible for analysis. Time-weighted mean arterial pressure and surgical site infection were not significantly associated, with an estimated odds ratio (95% CI) of 1.03 (0.99–1.08) for a 5-mm Hg decrease (P = .16). However, there was a significant inverse association between minimum postoperative mean arterial pressure and infection, with an estimated odds ratio of 1.08 (1.03–1.12) per 5-mm Hg decrease (P = .001). CONCLUSIONS: Postoperative time-weighted mean arterial pressure was not associated with surgical site infection, but lowest postoperative mean arterial pressure was. Whether the relationship is causal remains to be determined.https://ift.tt/2CU1ojD
Safety of Drilling 3-Dimensional-Printed Temporal Bones.
| Related Articles |
Safety of Drilling 3-Dimensional-Printed Temporal Bones.
JAMA Otolaryngol Head Neck Surg. 2018 Sep 01;144(9):797-801
Authors: Freiser ME, Ghodadra A, Hart L, Griffith C, Jabbour N
Abstract
Importance: Three-dimensional (3-D) printing of temporal bones is becoming more prevalent. However, there has been no measure of the safety of drilling these models to date. It is unknown whether the heat and sheer from the drill may create harmful volatile organic compounds (VOCs).
Objective: To determine the level of exposure to airborne contaminants when conducting high-speed drilling on 3-D-printed models and to explore whether there is a need for exposure control measures.
Design, Setting, and Participants: In this occupational safety assessment carried out in a temporal bone laboratory, 3 individual 3-D-printed temporal bones were made using 3 different materials commonly cited in the literature: polylactic acid (PLA), photoreactive acrylic resin (PAR), and acrylonitrile butadiene styrene (ABS). Each model was drilled for 40 minutes while the surgeon wore a sampling badge. Sampling was conducted for airborne concentrations of VOCs and total particulate (TP). Monitoring for VOCs was conducted using Assay Technology 521-25 organic vapor badge worn at the surgeon's neckline. Monitoring for TP was conducted using a polyvinyl chloride filter housed inside a cassette and coupled with an SKC AirChek 52 personal air-sampling pump. Samples were collected and analyzed in accordance with NIOSH Method 500.
Main Outcomes and Measures: Presence of VOCs and TP count exposures at Occupational Safety and Health Administration (OSHA) actionable levels.
Results: Results of the VOC sample were less than detection limits except for isopropyl alcohol at 0.24 ppm for PAR. The TP samples were less than the detection limit of 1.4 mg/m3. The results are below all applicable OSHA Action Levels and Permissible Exposure Limits for all contaminants sampled for.
Conclusions and Relevance: Drilling 3-D-printed models made from PLA, ABS, and PAR was safe by OSHA standards. Continued monitoring and safety testing are needed as 3-D-printed technologies are introduced to our specialty.
PMID: 30335883 [PubMed - in process]
https://ift.tt/2PJKnLG
Evaluation of Social Media Presence of Otolaryngology Residency Programs in the United States.
| Related Articles |
Evaluation of Social Media Presence of Otolaryngology Residency Programs in the United States.
JAMA Otolaryngol Head Neck Surg. 2018 Sep 01;144(9):802-806
Authors: Xie DX, Dedmon MM, O'Connell BP, Yawn RJ, Haynes DS
Abstract
Importance: Over two-thirds of the adult population in the United States use Facebook. Despite the high interest in and use of social media by the general public, the presence and accessibility of health care organizations on social media has not yet been fully evaluated.
Objective: To determine the use and popularity of social media among otolaryngology residency programs in the United States.
Design, Setting, and Participants: A cross-sectional study of the presence of accredited otolaryngology residency programs in the United States in an internet data repository was conducted. Programs were stratified by Doximity Residency Navigator reputation rankings (dividing programs into quartiles) and US News & World Report (comparing programs affiliated with hospitals ranked in the top 50 vs programs affiliated with unranked hospitals). Social media sites and activity for each program were assessed using internet searches. The study was conducted in April 2017.
Results: Among 101 otolaryngology residency programs, 30 were found to have social media sites (29.7%). Facebook and Twitter were the most commonly used services, with 25 (24.8%) and 14 (13.9%) accounts, respectively. Based on Doximity Residency Navigator rankings, programs in the first quartile were more likely to have Facebook profiles than programs in the fourth quartile (42.3% vs 12.0%; absolute difference, 30%; 95% CI, 2.9% to 52.6%). First- and second-quartile programs showed increased Facebook activity. There was greater Twitter presence in first- vs fourth-quartile programs (19.2% vs 8.0%; absolute difference, 11.2%; 95% CI, -11.6% to 33.0%). Higher-quartile programs were more active on Twitter and exhibited increased numbers of likes and followers. Analysis of US News & World Report rankings revealed that ranked programs had higher rates of presence, activity, and popularity on both Facebook and Twitter. However, these were smaller differences than seen when comparing Doximity Residency Navigator rankings. Correlation between the 2 ranking systems was indicated (Spearman ρ = 0.59; 95% CI, 0.34 to 0.76).
Conclusions and Relevance: This study suggests that otolaryngology residency programs with higher Doximity Residency Navigator reputation rankings have a stronger presence on social media. Smaller trends were observed for programs in the top 50 US News & World Report rankings. Overall, social media use among otolaryngology programs seems relatively low, and this may present an opportunity to increase communication with the public via these technologies.
PMID: 30335882 [PubMed - in process]
https://ift.tt/2PcOQtn
Reversible Auricular Necrosis Secondary to Systemic Thrombosis.
| Related Articles |
Reversible Auricular Necrosis Secondary to Systemic Thrombosis.
JAMA Otolaryngol Head Neck Surg. 2018 Sep 01;144(9):848-849
Authors: Merati M, Manzoor NF, Ahadizadeh EN, Mowry SE, Semaan M, Buethe DJ, Honda K
PMID: 30335881 [PubMed - in process]
https://ift.tt/2PHs6yD
Effect of a Change in Papillary Thyroid Cancer Terminology on Anxiety Levels and Treatment Preferences: A Randomized Crossover Trial.
| Related Articles |
Effect of a Change in Papillary Thyroid Cancer Terminology on Anxiety Levels and Treatment Preferences: A Randomized Crossover Trial.
JAMA Otolaryngol Head Neck Surg. 2018 Oct 01;144(10):867-874
Authors: Nickel B, Barratt A, McGeechan K, Brito JP, Moynihan R, Howard K, McCaffery K
Abstract
Importance: Given evidence of overdiagnosis and overtreatment of small papillary thyroid cancers (PTCs), strategies are needed to promote the consideration of less invasive treatment options for patients with low-risk PTC.
Objective: To determine the association of treatment preferences and anxiety levels for PTC with the terminology used to describe the condition.
Design, Setting, and Participants: This randomized crossover study involved a community sample of 550 Australian men and women 18 years or older without a history of thyroid cancer. Between March 16, 2016, and July 26, 2016, participants accessed an online study that presented 3 hypothetical but clinically realistic scenarios, each of which described PTC as papillary thyroid cancer, papillary lesion, or abnormal cells. Participants were exposed to all 3 scenarios with the different terminologies, and participants were randomized by the order (first, second, or third) in which they viewed the terminologies. Data analysis was conducted from September 1, 2016, to May 15, 2017.
Main Outcomes and Measures: Treatment choice (total thyroidectomy, hemithyroidectomy, or active surveillance), diagnosis anxiety, and treatment choice anxiety.
Results: Of the 550 participants who completed the online study and were included in the analysis, 279 (50.7%) were female and the mean (SD) age was 49.9 (15.2) years. A higher proportion of participants (108 [19.6%]) chose total thyroidectomy when papillary thyroid cancer was used to describe the condition compared with the percentage of participants who chose total thyroidectomy when papillary lesion (58 [10.5%]) or abnormal cells (60 [10.9%]) terminology was used. At first exposure, the papillary thyroid cancer terminology led 60 of 186 participants (32.3%) to choose surgery compared with 46 of 191 participants (24.1%) who chose surgery after being exposed to papillary lesion terminology first (risk ratio [RR], 0.73; 95% CI, 0.53-1.02) and 47 of 173 participants (27.2%) after being exposed to abnormal cells (RR, 0.82; 95% CI, 0.60-1.14) terminology first. After the first exposure, participants who viewed papillary thyroid cancer terminology reported significantly higher levels of anxiety (mean, 7.8 of 11 points) compared with those who viewed the papillary lesion (mean, 7.0 of 11 points; mean difference, -0.8; 95% CI, -1.3 to -0.3) or abnormal cells (mean, 7.3 of 11 points; mean difference, -0.5; 95% CI, -1.0 to 0.01). Overall, interest in active surveillance was high and higher levels of anxiety were reported by those who chose surgery, regardless of which terminology was viewed first (mean difference, 1.5; 95% CI, 1.0-1.9).
Conclusions and Relevance: Changing the terminology of small PTCs may be one strategy to reduce patients' anxiety levels and help them consider less invasive management options. To curtail overdiagnosis and overtreatment in PTC, other strategies may include providing balanced information about the risks and advantages of alternative treatments.
Trial Registration: anzctr.org.au Identifier: ACTRN12616000271404.
PMID: 30335875 [PubMed - in process]
https://ift.tt/2yKKTls
Medical Practice Entrepreneurship-Reply.
| Related Articles |
Medical Practice Entrepreneurship-Reply.
JAMA Otolaryngol Head Neck Surg. 2018 Oct 01;144(10):950-951
Authors: Faucett EA, Ishman SL
PMID: 30335874 [PubMed - in process]
https://ift.tt/2P7gRCN
Medical Practice Entrepreneurship.
| Related Articles |
Medical Practice Entrepreneurship.
JAMA Otolaryngol Head Neck Surg. 2018 Oct 01;144(10):949-950
Authors: Meyers A
PMID: 30335873 [PubMed - in process]
https://ift.tt/2PJKmY8
The Evolving Nomenclature of Thyroid Cancer: What's in a Name?
| Related Articles |
The Evolving Nomenclature of Thyroid Cancer: What's in a Name?
JAMA Otolaryngol Head Neck Surg. 2018 Oct 01;144(10):874-875
Authors: Shuman AG
PMID: 30335872 [PubMed - in process]
https://ift.tt/2S0PvwF
Contribution Of Cone-Beam Computed Tomography In The Decision Of Surgical Management For Bone Lesions Of The Maxillofacial Region
The aim of this study was to evaluate the contribution of cone-beam computed tomography (CBCT) in the decision of surgical management for bone lesions of the maxillofacial region. It is a retrospective cross-sectional observational study that includes a sample of panoramic radiography (PR) and CBCT from patients with some type of bone lesion in the maxillofacial region. PR and CBCT images were evaluated by three previously assessed examiners, specialists in oral and maxillofacial surgery. Each image was evaluated randomly, and a surgical procedure was suggested, initially in PR and then in CBCT.
https://ift.tt/2q9lBtz
Mandibular subcondylar fracture accessibility with transparotid approach by rhytidectomy and modified Risdon approach: an anatomical comparative study
The purpose of our anatomical study was to compare the accessibility of the area at the level of the neck of the condyle and the condylar head by two different approaches: the modified Risdon approach and a transparotid approach by rhytidectomy (TPAR).
https://ift.tt/2NKU0rT
The Role of C-Reactive Protein and White Blood Cell Count in the Prediction of Length of Stay in Hospital and Severity of Odontogenic Abscess
There are no financial disclosures or commercial interests from any authors.
https://ift.tt/2q3FEcJ
Quantification of the mandibular defect healing by micro-CT morphometric analysis in rats
The goal of this study was the evaluation of the bone tissue structural characteristics over the time course of mandibular defect healing using micro-CT technique, as well as determination of the inter-relationships between different micro-CT parameters used for assessment of the bone regeneration process and the patterns of their dynamic changes.
https://ift.tt/2S0dOL7
A novel treatment of temporomandibular joint arthritis as a complication in familial Mediterranean fever—literature review and a case report
Abstract
Objectives
Articular involvement in familial Mediterranean fever (FMF) ranges between 40 and 70% of the patients. Involvement of temporomandibular joint (TMJ) in FMF is very rare, and only a few cases have been reported in the literature. There are no specific guidelines for treatment. We hereby present a new treatment for TMJ inflammation in FMF.
Materials and methods
A literature search was performed using PubMed according to the following criteria: key terms included in the search were FMF arthritis, TMJ involvement in FMF patients, and arthroscopy in FMF patients. All keywords were included both as medical subject headings (MeSH) terms and text words. Selections were limited to the English language.
Results
Literature search yielded four reported cases of TMJ involvement in FMF patients. The four cases were treated differently, with no clear guidelines for management of TMJ involvement. Our patient suffered from painful swelling and redness over the involved TMJ area and severe trismus. She was treated by arthroscopic lysis and lavage of her TMJ followed by aggressive physiotherapy resulting to improvement of her mouth opening.
Conclusions
The adverse effect of TMJ arthritis in FMF patients can be avascular necrosis and destruction of the mandibular condylar head. TMJ arthroscopy allows lysis and lavage of the joint with minimal operative and postoperative complication, resulting with satisfactory results. Thus, in case of TMJ arthritis in FMF, we recommend TMJ arthroscopy as soon as possible, following aggressive physiotherapy in order to gain normal mouth opening.
Clinical relevance
FMF rates have been described among the Mediterranean and Middle Eastern population ranging from 1:5 to 1:3; thus, TMJ involvement due to the disease is not so rare in this region, and a clear treatment protocol is needed.
https://ift.tt/2J5UfwM
A novel treatment of temporomandibular joint arthritis as a complication in familial Mediterranean fever—literature review and a case report
Abstract
Objectives
Articular involvement in familial Mediterranean fever (FMF) ranges between 40 and 70% of the patients. Involvement of temporomandibular joint (TMJ) in FMF is very rare, and only a few cases have been reported in the literature. There are no specific guidelines for treatment. We hereby present a new treatment for TMJ inflammation in FMF.
Materials and methods
A literature search was performed using PubMed according to the following criteria: key terms included in the search were FMF arthritis, TMJ involvement in FMF patients, and arthroscopy in FMF patients. All keywords were included both as medical subject headings (MeSH) terms and text words. Selections were limited to the English language.
Results
Literature search yielded four reported cases of TMJ involvement in FMF patients. The four cases were treated differently, with no clear guidelines for management of TMJ involvement. Our patient suffered from painful swelling and redness over the involved TMJ area and severe trismus. She was treated by arthroscopic lysis and lavage of her TMJ followed by aggressive physiotherapy resulting to improvement of her mouth opening.
Conclusions
The adverse effect of TMJ arthritis in FMF patients can be avascular necrosis and destruction of the mandibular condylar head. TMJ arthroscopy allows lysis and lavage of the joint with minimal operative and postoperative complication, resulting with satisfactory results. Thus, in case of TMJ arthritis in FMF, we recommend TMJ arthroscopy as soon as possible, following aggressive physiotherapy in order to gain normal mouth opening.
Clinical relevance
FMF rates have been described among the Mediterranean and Middle Eastern population ranging from 1:5 to 1:3; thus, TMJ involvement due to the disease is not so rare in this region, and a clear treatment protocol is needed.
https://ift.tt/2J5UfwM
Anaphylactic shock to bacitracin irrigation during breast implant surgery
We report on a case of severe intra-operative anaphylactic shock immediately following irrigation of breast tissue with bacitracin solution. Sequential skin testing with dilutions of bacitracin ointment was used to confirm IgE-mediated drug allergy to bacitracin.
https://ift.tt/2AiBIL9
Functional variant of CHI3L1 gene is associated with neck metastasis in oral cancer
Abstract
Objectives
Oral cancer is the most common head and neck malignancy, and it is associated with a high recurrence rate and lymph node metastasis potential. YKL-40, also known as chitinase-3-like protein 1 (CHI3L1), is a secreted glycoprotein that serves as a biomarker in several diseases. It also plays a crucial role in regulating many characteristics of cancer, such as cell growth, migration, anti-apoptosis, and angiogenesis. Accumulating evidence supports the link between single-nucleotide polymorphisms (SNPs) and oral cancer, but no report on the association between CHI3L1 polymorphisms and oral cancer is available. Thus, the present study evaluated the contribution of CHI3L1 SNPs to oral cancer susceptibility and clinicopathology.
Materials and methods
This study recruited a total of 2362 subjects, comprising 1190 healthy male controls and 1172 male patients with oral cancer. Allelic discrimination of the CHI3L1 polymorphisms − 1371 G>A (rs6691378), − 247 G>A (rs10399805), − 131 C>G (rs4950928), and + 2950 T>C (rs880633) was assessed through real-time polymerase chain reaction.
Results
We detected a significant association of rs10399805 and rs6691378 with the risk of oral cancer (AOR, 1.537; 95% CI, 1.089–2.168; p = 0.014; AOR, 1.561; 95% CI, 1.131–2.156; p = 0.007, respectively) after adjustment for three potential confounders, smoking, betel nut chewing, and alcohol consumption. Moreover, we found that oral cancer patients carrying the homozygous A/A genotype of the rs10399805 (p = 0.035) or rs6691378 polymorphism (p = 0.023) showed a significantly lower risk of lymph node metastasis. Moreover, according to the Genotype-Tissue Expression database, the rs10399805 and rs6691378 polymorphisms in the promoter region were associated with decreased levels of CHI3L1 mRNA.
Conclusions
In conclusion, we found that the homozygous mutant allele of rs10399805 and rs6691378 appeared to have significantly lower risk of lymph node metastasis and associated with its mRNA levels in oral cancer.
Clinical relevance
The CHI3L1 polymorphisms rs10399805 and rs6691378 may act as biomarkers for predicting lymph node metastasis in oral cancer patients.
https://ift.tt/2NOBvTm
Evaluation of PACE4 isoforms as biomarkers in thyroid cancer
To date, no single molecular marker has been demonstrated as clinically useful in differentiating malignant from benign thyroid nodules when a fine needle aspiration falls in the "unknown significance" categor...
https://ift.tt/2NQyhij
Microglia Are Derived from Peripheral Blood Mononuclear Cells After Pseudorabies Infection in Mice
Viral Immunology, Ahead of Print.
https://ift.tt/2R1X6tE
INT-HA induces M2-like macrophage differentiation of human monocytes via TLR4-miR-935 pathway
Abstract
As a major component of the microenvironment of solid tumors, tumor-associated macrophages (TAMs) facilitate tumor progression. Intermediate-sized hyaluronan (INT-HA) fragments have an immunological function in cell differentiation; however, their role in promoting the polarization of non-activated macrophages to an M2-like TAM phenotype has not been characterized, and the underlying mechanisms remain unclear. Here, we used a miRNA microarray to find that some miRNAs (especially miR-935) were differentially regulated in INT-HA-induced M2-like macrophages. According to RT-qPCR and Western blot, there was an association between miR-935 and C/EBPβ, that control the polarization of macrophages. Moreover, we found that INT-HA induced an M2-like phenotype via the TLR4 receptor. In our study, there was a negative correlation between plasma HA and miR-935 in monocytes from the peripheral blood of patients with solid tumors. There was also a negative correlation between miR-935 and M2-like macrophage markers in monocytes. These findings suggest that HA fragments interact with TLR4 and educate macrophage polarization to an M2-like phenotype via miR-935. Therefore, this study provides new insight into the role of miR-935 in INT-HA-induced M2-like polarization, and suggests a potential therapeutic target for antitumor treatment.
https://ift.tt/2Ex6pAj
A comparison of conventional and diffusion-weighted magnetic resonance imaging in the diagnosis of sialadenitis and pleomorphic adenoma
Publication date: Available online 18 October 2018
Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Juliane P Araujo, Guilherme TC Terra, Arthur RG Cortes, Adalsa Hernandez, Jefferson X Oliveira
ABSTRACT
Objectives: To compare the efficacy of conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in helping observers correctly identify the presence of disease in the major salivary glands and correctly distinguish sialadenitis from pleomorphic adenoma.
Study design: Twenty-one patients diagnosed with unilateral sialadenitis or pleomorphic adenoma were selected. The non-affected contralateral glands were also analyzed. T1- and T2-weighted MRI and DWI were obtained using spin-echo (SE) pulse sequences with a 1.5 Tesla MRI device. The diagnostic performance of three observers was evaluated for detection of salivary gland alterations and differentiation between sialadenitis and pleomorphic adenoma based on evaluation of MRI compared to DWI.
Results: Intra-and interobserver reliability ranged from 0.86 to 0.94. DWI resulted in greater sensitivity and accuracy values than MRI for both detection of disease and differentiation of sialadenitis from pleomorphic adenoma, with specificity values that were greater than or equal to MRI. DWI yielded significantly higher diagnostic odds ratios than MRI for both identification of disease and for differentiation between lesions.
Conclusion: DWI resulted in better diagnostic performance for detection of alterations in the salivary glands and for the differentiation between sialadenitis and pleomorphic adenoma compared to conventional T1 and T2-weighted MRI.
https://ift.tt/2EvCkRC
TraceIT Tissue Marker to Mark the Primary Resection Bed Margins of Oropharyngeal Cancers
Condition: Oropharyngeal Cancer
Intervention: Device: TraceIT Tissue Marker
Sponsor: Washington University School of Medicine
Not yet recruiting
https://ift.tt/2CrA9fo
Intervention: Device: TraceIT Tissue Marker
Sponsor: Washington University School of Medicine
Not yet recruiting
https://ift.tt/2CrA9fo
Behavior of the Upper Cervical Spine in Rugby Players
Condition: Cervical Spine Destabilization
Intervention: Other: Destabilization of the upper cervical spine by Cervistab
Sponsor: University Hospital, Montpellier
Recruiting
https://ift.tt/2CXtdaO
Intervention: Other: Destabilization of the upper cervical spine by Cervistab
Sponsor: University Hospital, Montpellier
Recruiting
https://ift.tt/2CXtdaO
Nanoliposomal Irinotecan in Head & Neck and Esophagus After Prior Platinum-based Chemotherapy or Chemoradiotherapy
Condition: Head & Neck Cancer
Intervention: Drug: nanoliposomal irinotecan
Sponsors: National Health Research Institutes, Taiwan; China Medical University Hospital; Tri-Service General Hospital; Taipei Veterans General Hospital, Taiwan; National Cheng-Kung University Hospital
Not yet recruiting
https://ift.tt/2CsErmC
Intervention: Drug: nanoliposomal irinotecan
Sponsors: National Health Research Institutes, Taiwan; China Medical University Hospital; Tri-Service General Hospital; Taipei Veterans General Hospital, Taiwan; National Cheng-Kung University Hospital
Not yet recruiting
https://ift.tt/2CsErmC
Safety and Efficacy of SCT200 in Head and Neck Squamous Cell Carcinoma
Condition: Head and Neck Cancer
Intervention: Drug: Anti-EGFR monoclonal antibody
Sponsors: Sinocelltech Ltd.; Cancer Institute and Hospital, Chinese Academy of Medical Sciences
Not yet recruiting
https://ift.tt/2CSmjUh
Intervention: Drug: Anti-EGFR monoclonal antibody
Sponsors: Sinocelltech Ltd.; Cancer Institute and Hospital, Chinese Academy of Medical Sciences
Not yet recruiting
https://ift.tt/2CSmjUh
Prospective Observational Trial to Evaluate Quality of Life After Neoadjuvant or Definitive Chemoradiation in Patients With Esophageal Cancer
Conditions: Quality of Life; Chemoradiation; Esophageal Cancer
Interventions: Other: EORTC QLQ C30; Other: EORTC QLQ OES-18; Other: EORTC OG-25
Sponsor: Ludwig-Maximilians - University of Munich
Recruiting
https://ift.tt/2CtES03
Interventions: Other: EORTC QLQ C30; Other: EORTC QLQ OES-18; Other: EORTC OG-25
Sponsor: Ludwig-Maximilians - University of Munich
Recruiting
https://ift.tt/2CtES03
Multi-Omic Assessment of Squamous Cell Cancers Receiving Systemic Therapy
Conditions: Cancer; Esophagus Squamous Cell Carcinoma; Squamous Cell Carcinoma of the Head and Neck; Anal Canal Squamous Cell Carcinoma; Metastatic Cancer
Intervention:
Sponsor: University Health Network, Toronto
Not yet recruiting
https://ift.tt/2CUnMtg
Intervention:
Sponsor: University Health Network, Toronto
Not yet recruiting
https://ift.tt/2CUnMtg
Study of the Mechanisms by Which Aminoglycoside Damage Is Prevented in Chick Embryonic Hair Cells
Abstract
A major side effect of aminoglycoside antibiotics is mammalian hair cell death. It is thus intriguing that embryonic chick hair cells treated with aminoglycosides at embryonic day (E) 12 are insensitive to ototoxicity. To exclude some unknown factors in vivo that might be involved in preventing aminoglycoside damage to embryonic hair cells, we first cultured chick embryonic basilar papilla (BP) with an aminoglycoside antibiotic in vitro. The results indicated that the hair cells were almost intact at E12 and E14 and were only moderately damaged in most parts of the BP at E16 and E18. Generally, hair cells residing in the approximate and abneural regions were more susceptible to streptomycin damage. After incubation with gentamicin-conjugated Texas Red (GTTR), which is typically used to trace the entry route of aminoglycosides, GTTR fluorescence was not remarkable in hair cells at E12, was weak at E14, but was relatively strong in the proximal part of BP at E18. This result indicates that the amounts of GTTR that entered the hair cells are related to the degrees of aminoglycoside damage. The study further showed that the fluorescence intensity of GTTR decreased to a low level at E14 to E18 after disruption of mechanotransduction machinery, suggesting that the aminoglycoside entry into hair cells was mainly through mechanotransduction channels. In addition, most of the entered GTTR was not found to be colocalized with mitochondria even at E18. This finding provides another reason to explain why embryonic chick hair cells are insensitive to aminoglycoside damage.
https://ift.tt/2Pcw1qc
Amplitude Modulation Detection in Children with a History of Temporary Conductive Hearing Loss Remains Impaired for Years After Restoration of Normal Hearing
Abstract
Otitis media with effusion (OME) is considered a form of relative sensory deprivation that often occurs during a critical period of language acquisition in children. Animal studies have demonstrated that hearing loss during early development can impair behavioral sensitivity to amplitude modulation (AM), critical for speech understanding, even after restoration of normal hearing thresholds. AM detection in humans with a history of OME-associated conductive hearing loss (CHL) has not been previously investigated. Our objective was to determine whether OME-associated CHL in children ages 6 months to 3 years results in deficits in AM detection in later childhood, after restoration of normal audiometric thresholds. Children ages 4 to 7 years with and without a history of OME-associated CHL participated in an AM detection two-alternative forced-choice task at 8 and 64 Hz modulation frequencies using a noise carrier signal and an interactive touch screen interface. Thirty-four subjects were studied (17 with a history of OME-related CHL and 17 without). Modulation detection thresholds improved with age and were slightly lower (more sensitive) for the 64 Hz modulation frequency for both groups. Modulation detection thresholds of children with a history of OME-associated CHL were higher than control thresholds at 5 years, but corrected to expected levels between ages 6–7. OME-associated CHL results in impaired AM detection, even when measured years after restoration of normal audiometric thresholds. Future studies may shed light on implications for speech and language development and academic success for children affected by OME and associated conductive hearing loss.
https://ift.tt/2PIGXZC
Three- dimensional analysis of transverse width of hard tissue and soft tissue after mandibular setback surgery using intraoral vertical ramus osteotomy : a retrospective study
Publication date: Available online 18 October 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Sang Hyun Song, Jun-Young Kim, Sung Hwa Lee, Jin Hoo Park, Hwi-Dong Jung, Young-Soo Jung
Abstract
Purpose
Some clinicians are concerned that if an intraoral vertical ramus osteotomy (IVRO) is used to position the mandible posteriorly, the proximal segments should be positioned laterally to the distal segment, which could increase the transverse mandibular width (TMW), leading to esthetically-unfavorable results. This study investigated short- and long-term postoperative TMW changes in soft and hard tissue following IVRO for mandibular prognathism .
Methods
The subjects were 44 patients who were treated with mandibular setback surgery using an IVRO. They were categorized into either of a "facial symmetry" or "facial asymmetry" group based on their preoperative levels of chin top deviation. Three dimensional cone-beam computed tomography images were obtained at the preoperative, 1 and 12-month postoperative stages as T1, T2, and T3, respectively. We set the hard tissue-1 (HW1) and HW2 as the sum of distance at the bilateral ends of the angle and ramus; soft tissue-1 (SW1) and SW2 as the sum of distance at the bilateral ends of the soft tissue angle and ramus.
Results
Compared to the value at T1, the HW1 value increased by 8.16% (P<0.05) and HW2 increased by 4.39% (P>0.05) at T2; HW1 increased by 4.35% (P<0.05) and HW2 by 2.95% (P>0.05) at T3.
Compared to the value at T1, the SW1 value increased by 2.49% and SW2 increased by 2.50% at T2; however, SW1 decreased by 0.85% and SW2 increased by 0.37% at T3. The soft-tissue variations between T1 and T2, as well as between T2 and T3, were statistically significant. However, no significant difference was found between T1 and T3 (P>0.05) There was no difference between the facially symmetric and asymmetric groups over time for soft and hard tissues (P>0.05).
Conclusion
Notably, IVRO does not seem to impact the transverse facial profile and enables reliable prediction of the esthetic results of surgery.
https://ift.tt/2EB5y1t
Ankylosis of the Coronoid Process to the Zygomatic Bone : A Case Report and Review of the Literature
Publication date: Available online 18 October 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Sang Min Lee, Jin-A. Baek, Yongsoo Kim
Abstract
Purpose
Extra-articular temporomandibular bony ankylosis between the zygomatic bone and coronoid process is a rare condition. Currently, there are <40 cases reported in the English literature. The aim of this study was to report a case of zygomatico-coronoid ankylosis with surgical intervention and a literature review.
Method
Through a PubMed search from 1946 to February 2018, using the terms ("extra-capsular" OR "zygomatico-coronoid" OR "extra-articular") AND ("ankylosis"), 61 articles were initially identified. After screening, manual reviewing, and including additional articles through reviews of the reference lists, 26 reports (33 patients) were finally included in the analysis.
Result
The age of the patients ranged from 12 to 71 years (mean, 36.62 years; S.D., ± 16.24). The gender composition of the patients was as follows: males (n = 20; 60.6%), females (n = 12; 36.4%), and unknown (n = 1; 0.3%), with a clear predominance of male patients. The etiologies were trauma (n = 25; 75.8%), infection (n = 3; 9.1%), surgical complication (n = 4; 12.1%), and radiotherapy for maxillary cancer (SCC; n = 1; 3.0%). The treatment options were surgical intervention via intraoral approach (n = 19; 57.6%), via extraoral approach (n = 10; 30.3%), and via both intraoral and extraoral approach (n = 2; 6.1%), as well as non-surgical intervention (n = 2; 6.1%)
Conclusion
Zygomatico-coronoid ankylosis is one of the possible causes of mouth-opening limitation, particularly in relation to facial trauma. However, it can be easily overlooked because of the rarity of zygomatico-coronoid ankylosis and the attention focused on the joint. Surgical intervention is regarded as a good treatment to improve mouth-opening limitation.
https://ift.tt/2S2ONyN
Long Term Stability of Condylectomy and Costochondral Graft Reconstruction for Treatment of Idiopathic Condylar Resorption
Publication date: Available online 18 October 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Zachary S. Peacock, Cameron C.Y. Lee, Maria J. Troulis, Leonard B. Kaban
Abstract
Purpose
To assess and update long-term outcomes of endoscopic condylectomy and costochondral graft (CCG) reconstruction for treatment of active idiopathic condylar resorption (ICR).
Methods
This is a continuation of a retrospective cohort study of patients with active ICR who underwent bilateral condylectomies and CCG reconstruction from 1999-2016. Predictor variables were demographic and operative factors. Primary outcome variable was occlusal stability, as defined by normal overbite(1-4 mm) at latest follow-up. Overbite, overjet, SNB, mandibular plane angle, and ramus/condyle unit height were measured. Time points were: preoperative(T0), immediate(T1), 1(T2), 2(T3), 3-5(T4), and 5+ years(T5) postoperative. Descriptive and bivariate statistics were computed. A Firth logistic regression model was utilized to identify variables associated with occlusal instability.
Results
A total of 26 subjects (25 female, mean age 23.1 years) who underwent bilateral endoscopic condylectomies and CCGs were included: 14 from the original cohort and 12 additional for the current analysis. The median follow-up was 3.65 years(range 1.11-17.1). Preoperatively, all subjects had Class II malocclusion with mean overjet of 6.89mm(range 1.2-17.1) and mean anterior open bite of -2.12 mm(range -0.4 to -7.9). Normal overbite(1-4mm) and overjet(2-4mm) was achieved postoperatively in all subjects. There were no significant changes in overjet, overbite, SNB, mandibular plane angle, and ramus/condyle unit height between T1-T4. At latest follow-up, 88.5% of subjects had a normal overbite. Three subjects developed an anterior open bite postoperatively, one at 2 years(0.1 mm; pre-op -3.4) one at 9 years(-0.8 mm; pre-op -7.9), one at 11 years postoperatively (-1.3 mm; pre-op -1.1). In subjects with more than 5-year follow-up (T5, n=9/26), the mean overjet and overbite were 3.48 and 1.56, respectively. Non-white race and follow-up time were significant predictors of occlusal instability in the regression model.
Conclusion
Stable and predictable long-term outcomes can be achieved using endoscopic condylectomy and CCG reconstruction for treatment of active ICR.
https://ift.tt/2EJNW3N
Evaluation of PACE4 isoforms as biomarkers in thyroid cancer
Abstract
Background
To date, no single molecular marker has been demonstrated as clinically useful in differentiating malignant from benign thyroid nodules when a fine needle aspiration falls in the "unknown significance" categories of the Bethesda Classification. PACE4, a member of the proprotein convertase family of enzymes, has been shown to play a major role in the pathogenesis of prostate cancer, through the formation of an oncogenic isoform named PACE4-altCT. PACE4 isoforms have also been suggested to play a role in other cancers, including thyroid cancer, but have never been investigated in a detailed manner. Our objective is to compare the histochemical distribution of the two major PACE4 isoforms in benign and malignant thyroid nodules, in order to determine their potential usefulness as discriminatory biomarkers.
Methods
Thyroid tissues of patients who underwent thyroidectomy were classified according to final pathology. Corresponding tissue sections were immunostained, using two previously validated antibodies raised against the C-terminal end of the two PACE4 isoforms, namely the full-length PACE4 protein (PACE4-FL) and its alternative isoform (PACE4-altCT). Nodules were compared with adjacent normal parenchyma and immunostaining was rated as "low" or "high" by a head and neck pathologist.
Results
Non-lesional thyroid parenchyma did not express PACE4-FL (p = 0.002). As a group, malignant (n = 17) nodules expressed PACE4-FL significantly more than benign (n = 24) nodules (percentage of high immunostaining: 52.9% vs 4.2%; p = 0.001). Reciprocally, there was a statistically lower expression of PACE4-altCT in malignant nodules than in adjacent non-lesional parenchyma (p = 0.014). The specificity of a high PACE4-FL immunostaining in determining malignancy was 95.8% (95% CI, 78.9% to 99.9%).
Conclusion
This study supports the previously described relationship between PACE4-FL and PACE4-altCT through alternative splicing. It also suggests that PACE4-FL is a promising biomarker for thyroid malignancy. Its high specific expression for malignancy could make it an interesting "rule in" test for thyroid cancer. Further prospective, quantitative studies are currently being designed to address how measurements of PACE4 isoforms could be used in a clinical setting.
Trial registration
This study does not report the results of a health care intervention on human participants. It was nonetheless registered on ClinicalTrials.gov under reference number NCT03160482.
https://ift.tt/2ExEXm7
Ossicular chain reconstruction in chronic otitis media: hearing results and analysis of prognostic factors
Publication date: Available online 18 October 2018
Source: Brazilian Journal of Otorhinolaryngology
Author(s): Syriaco Atherino Kotzias, Mariana Manzoni Seerig, Maria Fernanda Piccoli Cardoso de Mello, Leticia Chueiri, Janaina Jacques, Martin Batista Coutinho, Daniel Buffon Zatt
Abstract
Objective
Analyze the hearing results in patients with chronic otitis media undergoing ossicular chain reconstruction, as well as predictive factors for successful surgery.
Methods
Charts of patients undergoing ossiculoplasty between 2006 and 2016 were reviewed. Sixty-eight patients were included, totaling 72 ears. The following data was analyzed: gender, age, smoking status, laterality, pathology, audiometric exams, type of surgery, previous surgery, characteristics of the middle ear, otorrhea and ossicular chain status. Patients were also classified according to two indices: middle ear risk index and ossiculoplasty outcome parameter staging. The results were evaluated by comparing the air-bone gap before and after surgery. The success of reconstruction was defined as air-bone gap ≤20 dB and the improvement of Speech Reception Thresholds, calculated through the mean frequencies 0.5, 1, 2 and 3 kHz.
Results
Reconstruction success rate was 61%. The mean preoperative air bone gap was 34.63 dB and decreased to 17.26 dB after surgery. There was a correlation between low risk in middle ear risk index and ossiculoplasty outcome parameter staging indices with postoperative success. The most frequently eroded ossicle was the incus and the type of prosthesis most used was tragal cartilage. In the patients without incus, we achieved success in 74.2% of the surgeries. In the absence of the stapes, the success rate decreased to 63.3%. In the absence of the malleus, 85% of the patients had and air bone gap ≤20 dB.
Significant improvement was observed in patients undergoing ossiculoplasty in our service, and the results are comparable to other centers. The best results were obtained using tragal cartilage. The use of indices to predict success in the reconstruction was valid.
Conclusion
We achieved improved audiometric outcomes using tragal cartilage in ossiculoplasty. Ossicle status influenced postoperative results, especially in the presence of the stapes. We also concluded that the indices analyzed may help to predict the success of the surgery.
Resumo
Objetivo
Analisar os resultados auditivos em pacientes com otite média crônica submetidos a reconstrução da cadeia ossicular, bem como os fatores preditivos de sucesso cirúrgico.
Método
Prontuários de pacientes submetidos a ossiculoplastia entre 2006 e 2016 foram revistos. Sessenta e oito pacientes foram incluídos, totalizando 72 orelhas. Os seguintes dados foram analisados: sexo, idade, tabagismo, lateralidade, doença, exames audiométricos, tipo de cirurgia, cirurgia prévia, características da orelha média, otorreia e estado da cadeia ossicular. Os pacientes também foram classificados de acordo com dois índices: índice de risco da orelha média e estadiamento do parâmetro de desfecho da ossiculoplastia. Os resultados foram avaliados comparando o gap aéreo-ósseo antes e após a cirurgia. O sucesso da reconstrução foi definido como gap aéreo-ósseo ≤ 20 dB e a melhora dos limiares de recepção de fala, calculados pelas frequências médias de 0,5, 1, 2 e 3 kHz.
Resultados
A taxa de sucesso da reconstrução foi de 61%. O gap aéreo-ósseo pré-operatório médio foi de 34,63 dB e diminuiu para 17,26 dB após a cirurgia. Houve correlação entre baixo risco no índice de risco para orelha média e os índices de estadiamento do parâmetro de desfecho da ossiculoplastia com sucesso pós-operatório. O ossículo com erosão mais frequente foi a bigorna e o tipo de prótese mais utilizada foi a cartilagem tragal. Nos pacientes sem bigorna o sucesso foi alcançado em 74,2% das cirurgias. Na ausência do estribo, a taxa de sucesso diminuiu para 63,3%. Na ausência do martelo, 85% dos pacientes apresentaram gap aéreo-ósseo ≤ 20 dB.
Melhora significativa foi observada em pacientes submetidos à ossiculoplastia em nosso serviço, e os resultados são comparáveis a outros centros. Os melhores resultados foram obtidos utilizando cartilagem tragal. O uso de índices para predizer o sucesso da reconstrução foi válido.
Conclusão
Obtivemos bons resultados audiométricos utilizando cartilagem tragal na ossiculoplastia. O estado dos ossículos influenciou os resultados pós-operatórios, principalmente na presença do estribo. Também concluímos que os índices analisados podem ajudar a prever o sucesso da cirurgia.
https://ift.tt/2AieqVH
Dramatic response after anti PD1 treatment failure in a squamous cell carcinoma of the maxillary sinus
Publication date: Available online 18 October 2018
Source: Oral Oncology
Author(s): Mathieu Larroquette, Charlotte Domblides, Sophie Cousin, Ludovic De Gabory, Charles Dupin, Alain Ravaud, Amaury Daste
https://ift.tt/2ypY5Nj
Study of the Mechanisms by Which Aminoglycoside Damage Is Prevented in Chick Embryonic Hair Cells
Abstract
A major side effect of aminoglycoside antibiotics is mammalian hair cell death. It is thus intriguing that embryonic chick hair cells treated with aminoglycosides at embryonic day (E) 12 are insensitive to ototoxicity. To exclude some unknown factors in vivo that might be involved in preventing aminoglycoside damage to embryonic hair cells, we first cultured chick embryonic basilar papilla (BP) with an aminoglycoside antibiotic in vitro. The results indicated that the hair cells were almost intact at E12 and E14 and were only moderately damaged in most parts of the BP at E16 and E18. Generally, hair cells residing in the approximate and abneural regions were more susceptible to streptomycin damage. After incubation with gentamicin-conjugated Texas Red (GTTR), which is typically used to trace the entry route of aminoglycosides, GTTR fluorescence was not remarkable in hair cells at E12, was weak at E14, but was relatively strong in the proximal part of BP at E18. This result indicates that the amounts of GTTR that entered the hair cells are related to the degrees of aminoglycoside damage. The study further showed that the fluorescence intensity of GTTR decreased to a low level at E14 to E18 after disruption of mechanotransduction machinery, suggesting that the aminoglycoside entry into hair cells was mainly through mechanotransduction channels. In addition, most of the entered GTTR was not found to be colocalized with mitochondria even at E18. This finding provides another reason to explain why embryonic chick hair cells are insensitive to aminoglycoside damage.
https://ift.tt/2Pcw1qc
Amplitude Modulation Detection in Children with a History of Temporary Conductive Hearing Loss Remains Impaired for Years After Restoration of Normal Hearing
Abstract
Otitis media with effusion (OME) is considered a form of relative sensory deprivation that often occurs during a critical period of language acquisition in children. Animal studies have demonstrated that hearing loss during early development can impair behavioral sensitivity to amplitude modulation (AM), critical for speech understanding, even after restoration of normal hearing thresholds. AM detection in humans with a history of OME-associated conductive hearing loss (CHL) has not been previously investigated. Our objective was to determine whether OME-associated CHL in children ages 6 months to 3 years results in deficits in AM detection in later childhood, after restoration of normal audiometric thresholds. Children ages 4 to 7 years with and without a history of OME-associated CHL participated in an AM detection two-alternative forced-choice task at 8 and 64 Hz modulation frequencies using a noise carrier signal and an interactive touch screen interface. Thirty-four subjects were studied (17 with a history of OME-related CHL and 17 without). Modulation detection thresholds improved with age and were slightly lower (more sensitive) for the 64 Hz modulation frequency for both groups. Modulation detection thresholds of children with a history of OME-associated CHL were higher than control thresholds at 5 years, but corrected to expected levels between ages 6–7. OME-associated CHL results in impaired AM detection, even when measured years after restoration of normal audiometric thresholds. Future studies may shed light on implications for speech and language development and academic success for children affected by OME and associated conductive hearing loss.
https://ift.tt/2PIGXZC
Platelet‐rich plasma: Potential role in combined therapy for vitiligo
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2NQkiZB
Role of non-classical T cells in skin immunity
Publication date: November 2018
Source: Molecular Immunology, Volume 103
Author(s): Joon Seok Park, Ji Hyung Kim
Abstract
The immune network controls homeostasis and inflammation of the skin. Immune cells use their antigen receptors to respond to a wide range of insults originating from microbes and allergens. T cells, which are key effector cells in the immune system, engage their T cell receptors (TCRs) to recognize self and foreign antigens in the context of classical major histocompatibility complex (MHC) molecules, MHC-like CD1 proteins, or MHC class I-related molecules. Recently, increasing evidence has demonstrated that T cells activated by non-canonical antigens are important in skin diseases. This review focuses on recent studies examining the roles of non-classical antigen-presenting molecules and their reactive T cells in the skin immune system. Additionally, we describe the types of ligands that activate these unconventional T cells through the non-classical MHC pathway. Finally, we highlight recent advances in the understanding of the physiological functions of non-classical T cells in the skin. Further investigation may result in the development of new therapeutic strategies for treating immune-related skin diseases.
https://ift.tt/2NPzBSy
A Study of Use of Autologous Cartilage in Ossicular Reconstruction
Abstract
Ossiculoplasty is one of the commonly done and challenging surgery in otology and has been done using various graft materials. Materials such as autologous cartilage (tragal or conchal) or allograft (homograft) of the same tissue and synthetic materials like polyethylene TORP, ceramic and hydroxyapatite PORP or Titanium prosthesis have been used. But the latter synthetic materials are expensive and have high extrusion rates. Autologous cartilage grafts are selected for Ossiculoplasty as they are easy to harvest at the same site of operation, non-toxic, has less extrusion rate, minimum shrinkage and lateralization. The aim of this study is to know the efficacy of cartilage in ossicular reconstruction and to evaluate hearing outcome. It is a prospective study done on patients attending ENT outpatient department at hospitals attached to J.J.M Medical College, Davanagere. 50 patients were included in the study who underwent ossicular reconstruction either with canal wall up or down mastoidectomy with tympanoplasty. Pre-operative mean ABG was 39.3 db whereas 6 months post-operative mean ABG was 31.6 db with mean ABG improvement of 7.7 db which was statistically significant. Hearing improvement is better in cases where stapes suprastructure was present and also in canal wall up mastoidectomy procedures. This study suggests that cartilage graft (tragal and conchal) is effective in cases of ossicular reconstruction in patients of chronic otitis media and gives good hearing gain. It is also a economical option in developing countries.
https://ift.tt/2yNHYIF
A Study of Use of Autologous Cartilage in Ossicular Reconstruction
Abstract
Ossiculoplasty is one of the commonly done and challenging surgery in otology and has been done using various graft materials. Materials such as autologous cartilage (tragal or conchal) or allograft (homograft) of the same tissue and synthetic materials like polyethylene TORP, ceramic and hydroxyapatite PORP or Titanium prosthesis have been used. But the latter synthetic materials are expensive and have high extrusion rates. Autologous cartilage grafts are selected for Ossiculoplasty as they are easy to harvest at the same site of operation, non-toxic, has less extrusion rate, minimum shrinkage and lateralization. The aim of this study is to know the efficacy of cartilage in ossicular reconstruction and to evaluate hearing outcome. It is a prospective study done on patients attending ENT outpatient department at hospitals attached to J.J.M Medical College, Davanagere. 50 patients were included in the study who underwent ossicular reconstruction either with canal wall up or down mastoidectomy with tympanoplasty. Pre-operative mean ABG was 39.3 db whereas 6 months post-operative mean ABG was 31.6 db with mean ABG improvement of 7.7 db which was statistically significant. Hearing improvement is better in cases where stapes suprastructure was present and also in canal wall up mastoidectomy procedures. This study suggests that cartilage graft (tragal and conchal) is effective in cases of ossicular reconstruction in patients of chronic otitis media and gives good hearing gain. It is also a economical option in developing countries.
https://ift.tt/2yNHYIF
Mantle Cell Lymphoma of the Lacrimal Gland
The authors present 2 female patients of mantle cell lymphoma (MCL) involving the lacrimal gland. The patients include a 75-year-old female and a 59-year-old female. Both patients presented with palpable upper eyelid masses. The first patient was previously diagnosed with gastric and ileocecal MCLs and underwent chemotherapy with remission. The second patient had distant lesions in the muscular limbs that were confirmed to be MCL after the diagnosis of lacrimal gland MCL. Both patients underwent chemotherapy with complete remission. Address correspondence and reprint requests to Yasuhiro Takahashi, MD, PhD, Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195, Japan; E-mail: yasuhiro_tak@yahoo.co.jp Received 2 May, 2018 Accepted 28 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2Ew4BaB
https://ift.tt/2Ew4BaB
Reconstruction of a Calvarial Wound Complicated by Infection: Comparing the Effects of Biopatterned Bone Morphogenetic Protein 2 and Vascular Endothelial Growth Factor
Bone morphogenetic protein 2 (BMP2) bioprinted on biological matrix induces osseous regeneration in large calvarial defects in rabbits, both uncomplicated and scarred. Healing in unfavorable defects scarred from previous infection is decreased due in part to the lack of vascularity. This impedes the access of mesenchymal stem cells, key to osseous regeneration and the efficacy of BMP2, to the wound bed. The authors hypothesized that bioprinted vascular endothelial growth factor (VEGF) would augment the osseous regeneration achieved with low dose biopatterned BMP2 alone. Thirteen New Zealand white rabbits underwent subtotal calvariectomy using a dental cutting burr. Care was taken to preserve the underlying dura. A 15 mm × 15 mm flap of bone was cut away and incubated in a 1 × 108 cfu/mL planktonic solution of S aureus before reimplantation. After 2 weeks of subsequent infection the flap was removed and the surgical wound debrided followed by 10 days of antibiotic treatment. On postoperative day 42 the calvarial defects were treated with acellular dermal matrix bioprinted with nothing (control), VEGF, BMP2, BMP2/VEGF combined. Bone growth was analyzed with serial CT and postmortem histology. Defects treated with BMP2 (BMP2 alone and BMP2/VEGF combination) showed significantly greater healing than control and VEGF treated defect (P
https://ift.tt/2RWrlTU
https://ift.tt/2RWrlTU
Successful Treatment of a Subcutaneous Abscess Caused by Hyaluronic Acid Injection in Nasal Dorsum Augmentation Via a Scarless Incision
We report a successful treatment of a subcutaneous abscess in a 24-year-old woman caused by hyaluronic acid injection in nasal dorsum augmentation using negative pressure drainage via nasal mucosal approach. Address correspondence and reprint requests to Duo Zhang, MD, Department of Plastic and Reconstructive Surgery, The First Bethune Hospital of JiLin University, No.71, Xin Min Street, Chang Chun 130021, China; E-mail: zhangduo2002@hotmail.com Received 5 February, 2018 Accepted 30 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2Es5T6y
https://ift.tt/2Es5T6y
Genial Tubercle Fracture
Genial tubercle fracture is a rare mandibular fracture. It is classified into 2 different types based on the mechanism of injury, including type I, associated with an atrophied edentulous mandible or denture, and type II, associated with mandibular fracture. Although type I usually can be treated by only observation, type II may cause obstruction of the pharyngeal airway due to hematoma and edema of the floor of the mouth. In this report, genial tubercle fracture associated with mandibular fracture caused by a traffic accident was reported. Reconstructed 3-dimensional images of the pharyngeal airway indicated that there was almost no airway space around the intratracheal tube at the naso- and oropharynx. Address correspondence and reprint requests to Dr Ryo Sasaki, DDS, PhD, Department of Oral and Maxillofacial Surgery, Tokyo Women's Medical University, School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan; E-mail: sasaki.ryo@twmu.ac.jp Received 2 February, 2018 Accepted 3 June, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2S15E52
https://ift.tt/2S15E52
Repair of Cerebrospinal Fluid Leak in Cochlear Implantation
Objective: The aim of this study is to evaluate the treatment of cerebrospinal fluid (CSF) leaks from cochleostomy after cochlear implantation intraoperatively and postoperatively. Methods: Three hundred seven patients (age ranges 13 months to 18 years) were undergone cochlear implantation and 14 (4.56%) of them had CSF leakage intraoperatively (2 normal, 12 anomalous cochlea). Complete packing of the around electrode in cochleostomy with muscle had performed to control CSF leak intraoperatively for primary surgery in 10 patients. Cerebrospinal fluid leakage was observed in 3 patients after cochlear implantation postoperatively. Revision surgeries for CSF leakage with fat tissue sealing were performed for them also. Fat tissue packing was performed for the last 4 patients in primary surgery. Outcomes of management methods for sealing were evaluated. Results: Sealing the cochleostomy with muscle was performed for 10 patients. Fibrin glue applications were used for excessive leakage for 5 patients with cochlear anomalies and 3 of these patients had CSF leak from cochleostomy postoperatively (Patients I, II, III). Secondary surgeries with fat tissue sealing were performed. But CSF leakage also was occurred in Patient III. Subtotal petrosectomy and obliteration of cavity with fat tissue had been performed for Patient III. Cerebrospinal fluid leakage has not been seen in primary surgeries with fat tissue packing in other 5 patients. Conclusion: Cerebrospinal fluid leakage may occur in cochlear implantation patients with inner ear anomalies postoperatively. Sealing of the cochleostomy with fat tissue is more useful than muscle intraoperatively. Address correspondence and reprint requests to Erkan Karatas, MD, Professor, Turgut Ozal Medicine Center, Department of ORL HNS, Faculty of Medicine, Inonu University, Elazig Yolu 11. Km, 44280 Malatya, Turkey; E-mail: drerkankaratas@gmail.com Received 20 January, 2018 Accepted 11 June, 2018 The author reports no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2ExLz3O
https://ift.tt/2ExLz3O
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