Πέμπτη 8 Νοεμβρίου 2018
Nueva alternativa para relleno y camuflaje de dorso nasal: Injerto mixto de L-PRF y cartílago
RESUMEN Introducción: Entre las alteraciones del dorso nasal puede encontrarse desde un rádix bajo hasta un aplastamiento severo del dorso nasal, siendo fundamental el uso de injertos y material de relleno. Objetivo: Proponer una nueva alternativa de relleno y camuflaje en rinoplastía mediante un injerto mixto de L-PRF más cartílago picado en una matriz de fibrina autóloga. Material y método: Evaluación de los pacientes operados de rinoseptoplastía en quienes se utilizó el injerto mixto entre febrero y septiembre del año 2016 en el Servicio de Otorrinolaringología del Hospital Regional de Concepción. Evaluación de resultados respecto a reabsorción e irregularidades del injerto y autoevaluación del grado de satisfacción. Resultados: Fueron operados 7 pacientes. Cuatro de ellos presentaban aplastamiento severo de dorso nasal y tres un rádix profundo. Se logró el relleno y camuflaje del área deseada en todos los casos. No se presentó desplazamiento ni reabsorción del injerto en ninguno de los casos. El uso de este injerto no significó mayor costo económico, y el grado de satisfacción fue alto en todos los casos. Conclusión: Primer estudio en utilizar un injerto mixto de cartílago más L-PRF en una matriz de fibrina autóloga en rinoplastía, demostrando ser una alternativa asequible, efectiva, reproducible y segura, particularmente útil en casos de revisión.
ABSTRACT Introduction: Among the alterations of the nasal dorsum there can be found from a low radix to a severe crushing of the nasal dorsum, being fundamental the use of grafts and filling materials. Aim: To propose a new filling and camouflage alternative in rhinoplasty by means of a mixed graft of L-PRF and chopped cartilage in an autologous fibrin matrix. Material and method: Evaluation of the operated patients of rhinoseptoplasty in whom the mixed graft was used between February and September 2016 in the Otorhinolaryngology unit of the Hospital Regional de Concepción. Evaluation of results regarding resorption and graft irregularities and self-assessment of degree of satisfaction. Results: Seven patients were operated. Four of them presented severe crushing of the nasal dorsum and three of them a deep radix. The filling and camouflage of desired area was achieved in all cases. There were no displacement or resorption of the graft in any case. The use of this graft did not mean greater economic cost, and the degree of satisfaction was high in all cases. Conclusions: First study to use a mixed graft of cartilage and L-PRF in an autologous fibrin matrix in rhinoplasty, proving to be an affordable, effective, reproducible and safe alternative, particularly useful in revision surgeries.
https://ift.tt/2PmUJ8b
Rinoseptoplastía: Experiencia de 3 años en la Pontificia Universidad Católica de Chile
ABSTRACT Introduction: Rhinoseptoplasty is a complex and challenging surgery. It addresses nasal aesthetics and functionality. Aim: To describe the experience in rhinoseptoplasty performed by the Nose Committee at our medical center. Material and method: Descriptive study, of the all rhinoseptoplasties performed by the Nose Committee between 2013 and 2015. Results: 265 patients underwent surgery in the 3-year period; 164 (61.8%) were women and the mean age was 29 years (range 13-73). Most were primary surgeries (secondary: 2.6%). An external approach was most commonly used (92.5%). Nasal tip surgery was performed in 253 (95.5%) patients; osteocartilaginous dorsum reduction in 252 (95,1%), and augmentation in only 5 (1,9%). Osteotomies were frequent: paramedian in 229 (86.4%), bilateral percutaneous lateral osteotomies in 217 (81.9%) and unilateral percutaneous lateral in 17 (6.4%). Regarding nasal tip grafts, columellar strut was most often used, in 241 (90,9%) patients, followed by the shield graft in 69 (26,0%). For the dorsum, autospreaders were used in 124 (46.7%), and spreader grafts in 109 (41.1%). Conclusions: Open rhinoseptoplasty was the most commonly used approach. This has shown favorable for residents due to better exposition of nasal anatomy. Only 2.6% were secondary rhinoseptoplasties. We emphasize the use of the columellar strut for nasal tip support as we frequently encounter hispanic noses at our center.
https://ift.tt/2QA9DEU
Evaluación del proceso de decanulación en pacientes traqueostomizados en el Hospital Carlos van Buren. Una cohorte retrospectiva
ABSTRACT Introduction: The decannulation process consist in the evaluation of the upper airways competences which carry the definite extraction of the traqueostomy cannula. The prediction of its success is difficult due to the high number of variables that affect it. In order to reach this goal, is fundamental to count with an adequate protocol of the health institution, which assumes the multidisciplinary management. Aim: The proposed goal was to evaluate the success of decannulation in adult patients of Carlos van Buren hospital who followed the institutional protocol. Material and method: The cohort retrospective study that developed during the first semester of 2016. The decannulation success was evaluated in adult patients tracheostomized who fulfilled the inclusion criteria. The final sample was of 18 patients, of which were obtained data of interest from the clinical histories and register of the Medicine and Rehabilitation Service. Results: Of the 18 patients in this study none of them met the entry criteria of the institutional decannulation protocol at the time of the initial evaluation by the Physical Medicine and Rehabilitation Service, requiring all training in order to apply the protocol. Finally, a total of 15 patients achieved a successful decannulation requiring a median of 22 days of phonoaudiological and kinesiological training. Conclusions: After the therapeutic training it was achieved a 83% of success in decannulation, which required a coordinated work between the different disciplines of the Physical Medicine and Rehabilitation Service and the support of the Otorhinolaryngology Service. The institutional protocol should be evaluated to adjust it to the local reality.
https://ift.tt/2PjQASn
Efectividad de cinco sesiones de rehabilitación vestibular en mujeres mayores de 60 años con hipofunción vestibular
ABSTRACT Introduction: Vestibular symptoms are frequent reason for consultation in medical care, the elderly and especially the female gender is exposed to fall risk from this cause. It is common for the treatment of this group of patients to be vestibular suppressors while vestibular rehabilitation therapy is indicated exceptionally, sometimes forgetting that the anatomic and functional elements involved in vestibular dysfunctions are the integration of the visual, vestibular, and somatosensory, pillars in those that are based on vestibular rehabilitation (VR). Aim: The objective of this study is to determine if five VR sessions are sufficient to provide concrete quantitative data on the decrease of disability and risk of falling in a group of patients with vestibular pathology. Material and method: This prospective study included 14 female patients over 61 years of age with diagnoses of peripheral vestibular pathology. Dizziness handicap inventory (DHI), timed up and go (TUG) and video head impulse test (vHIT) were performed and after the intervention of five sessions of vestibular rehabilitation. Results: The three variables studied (DHI, TUG and vHIT) showed statistically significant improvements in the group of patients. Conclusions: The results obtained in this study allow us to suggest that VR therapy in elderly patients with peripheral vestibular pathology and without vestibular suppressor medication is an adequate, efficient and promising therapeutic modality.
https://ift.tt/2QwgvD2
Confiabilidad interevaluador de la prueba video head impulse test en estudiantes de primer año de la generación 2016 de la Escuela de Fonoaudiología de la Universidad de Valparaíso Casa Central
ABSTRACT Introduction: The video head impulse test is a rapid, non-invasive and comfortable method for the evaluation of the vestibulo-ocular reflex that is being used more often in the evaluation of patients with balance disorders. In Chile there is a lack of studies related to the inter-rater reliability for this test. Aim: To determine the level of agreement on the results for the vestibulo-ocular reflex of the horizontal semicircular canals obtained by the execution of the video head impulse test by 3 raters. Material and method: Quantitative, correlational, non-experimental, cross-sectional descriptive study with a type of non-probability sampling with voluntary participation. The video head impulse test was applied by 3 raters to 30 students who fulfilled the inclusion criteria. Results: The Bland-Altman method demonstrated good agreement in the measurements made between the 3 raters. The inter-rater reliability for the gain of the left and right horizontal semicircular canals was 0.85 and 0.91 respectively and 0.75 for the asymmetry value. Conclusion: The study showed an adequate inter-rater reliability for the video head impulse test in the evaluation of the horizontal semicircular canals.
https://ift.tt/2PiywIs
Resultados del programa de implantes cocleares de Clínica Las Condes a 20 años de su inicio: Serie clínica 1994-2015
ABSTRACT Introduction: Sensorineural hearing loss is the third leading cause of disability in Chile, with incidence in infants 1 to 3 cases per 1,000 newborn and prevalence in adult up to 70%, with many cases that can be treated with cochlear implant. Aim: to describe outcomes of our series of patients undergoing cochlear implant surgery at Clinica Las Condes (CLC). Material and method: Retrospective longitudinal cohort study, 237 patients implanted in our center since 1994 to 2015 were analyzed. Results: 237 patients, 106 women (44.7%) and 131 men (55.3%) received a cochlear implant during this period. 65.5% of patients were implanted between 2-6 years of age. The most common etiologies were; non-syndromic congenital deafness (45.9%), late genetic onset (11.8%) and meningitis (11.4%). A significant association between the average pure tone average and presence of cochlear malformation (p =0.008) was demonstrated. Only 9.9% of patients had other disabilities associated with hearing loss. Re-implantation rate was 16.3% and only the variable cochlear malformation was associated to it (p =0.016) Conclusions: The cochlear implant provides clear benefits to patients with hearing impairment who do not benefit from other hearing devices offering the possibility of social and labor reintegrating, with low surgical risk and high success rate.
https://ift.tt/2QtgX51
Abordaje endoscópico al cavum de Meckel: Resección endoscópica endonasal de Schwannoma del nervio trigémino
ABSTRACT The Meckel's cave (CM) is a diverticulum located in the middle fossa adjacent to the cavernous sinus. The neoplasms of this region are extremely rare and represent a challenge for the surgeon due to the neurovascular structures that occupy and surround the parasellar region. For tumors located in this area, several surgical approaches have been described, all of which do not achieve an adequate exposure to the anteromedial portion of CM. In the last decade, the extended endonasal endoscopic approach (EEA) has been postulated as an alternative for the surgical management of tumors located in this region. We present the case of a patient with a trigeminal schwannoma located in the right CM treated by EEA.
https://ift.tt/2PiywrW
Carcinoma papilar de tiroides no captante de radioyodo (I131): A propósito de un caso
ABSTRACT Papillary thyroid carcinoma (PTC) is a common cancer in the world and in our country. It is usually associated with good prognosis and high survival rates, due to the tumor's characteristics, precise diagnostic tools and effective therapies. Unusual varieties of PTC have more aggressive behaviors and partial responses to usual treatments, such as negative uptake to radioiodine PTC (5% of cases). There is few literature about this variety and its treatment. Diverse treatment options have been proposed, according to whether there is evidence of tumor tissue, such as the empirical use of I131, surgery, radiotherapy, embolization and inhibitors of thyrosine kinase, however an uncertain response remains.
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Fasceítis necrotizante cervical: Consideraciones para el manejo precoz
ABSTRACT Cervical necrotizing fasciitis (CNF) is an infection that affects the cervical fascia and subcutaneous tissue. It is characterized by a rapid dissemination trough the fascial planes, with a high rate of mortality. Even tough imaging results a fundamental diagnostic tool, it is still made by clinic signs with rapid progression of symptoms in few hours. Here, we identify worse prognostic factors in the precocious diagnosis of CNF, from five cases presented in our center. A descriptive case-series study was performed in patients with CNF in the last ten years in the Otolaryngology Department of Barros Luco Trudeau Hospital. Five patients were identified, between the clinical and laboratory parameters. A disproportional pain and rapid deterioration of the laboratory exams were the most highlighted features. In the cases with suggestive signs of CFN in the CT scan, allowed an aggressive surgical management, while in those that had no suggestive images the diagnosis was delayed and therefore their management ended in a fatal outcome. CFN constitutes a severe picture in wich clinical suspicion and a prompt initiation of treatment are fundamental in its prognosis.
https://ift.tt/2Pf6fT0
Tinnitus pulsátil: Caso clínico y revisión de la literatura
ABSTRACT Pulsatile tinnitus is an infrequent otologic symptom but requires a thorough study. A detailed history and physical examination are essential to guide the subsequent imaging study, with which the diagnosis is reached in a large number of cases. The treatment should be aimed at correcting the underlying cause. In this study, a clinical case of pulsatile tinnitus, review of the subject and orientation to the diagnostic approach is presented.
https://ift.tt/2Qwg9wc
Tumor triquilemal proliferante: Reporte de un caso y revisión de la literatura
ABSTRACT Trichilemmal proliferating tumor is an infrequent neoplasia, usually solid or partially cystic, originating in the external root sheath of hair follicle. It occurs mainly as a solitary lesion in the scalp in older women. We report the case of a 56 years old woman with a cervical tumor of nine years of growth. Histology of the resection specimen confirmed the diagnosis.
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Piomiositis primaria del músculo esternocleidomastoideo: Reporte de un caso y revisión de la literatura
ABSTRACT Pyomyositis is a bacterial infection of the striated muscle that may affect the cervical musculature in very few cases. In the occidental world it has been associated with chronic diseases as diabetes and immunosuppression. We present a 67 years old patient attended to the Emergency Department because of a laterocervical fast growth tumor, without an interesting clinical history with the exception of type II diabetes mellitus. A CT scan with contrast showed an increased volume in the left sternocleidomastoid muscle, so an empiric treatment with intravenous antibiotics was started. Because of a bad evolution we finally performed a surgical drainage of the abscess under general anesthesia with an improvement of symptoms and laboratory markers. The pyomyositis of cervical muscles is very rare (0.4-1% of all cases) and the sternocleidomastoid muscle is the most commonly affected cervical muscle. CT scan is the gold standard imaging technique, because it allows to diagnose this disease and rule out other similar entities. If we consider that many patients present with associated comorbidities and/ or immunosuppression, it's very important to perform a rapid diagnosis and to begin a correct treatment that depends on the grade and extension of the infection. Although polymyositis of the sternocleidomastoid muscle is rare, its incidence is increasing associated to HIV infection and other immunosuppressive conditions. We have to keep in mind this pathology in the differential diagnosis of laterocervical tumors because high clinical suspicion is necessary to make a rapid diagnosis and a correct treatment.
https://ift.tt/2QwfXgs
Anosmia congénita aislada: Reporte de un caso clínico
ABSTRACT Disorders of olfaction are common, however, anosmia and hyposmia are not frequently self-reported, and these symptoms can lead to a significant impairment in quality of life. Causes of anosmia can be acquired or congenital, and the prevalence of isolated congenital anosmia is estimated to be 1:10000 in the general population. In these cases, anosmia is the only symptom referred by the patient. We hereby present the case of a 23-year-old male patient, with no prior medical history, diagnosed with isolated congenital anosmia. The findings from the medical history and physical examination, neuroendocrine evaluation, and the use of magnetic resonance imaging of the brain helped reach a final diagnosis.
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Complicaciones de traqueostomía en pacientes pediátricos. Revisión de la literatura
RESUMEN Las indicaciones de traqueostomía en niños han cambiado considerablemente en los últimos años, así como el perfil epidemiológico de los pacientes y la morbimortalidad de este procedimiento. Las complicaciones de este procedimiento pueden ser clasificadas en intraoperatorias, inmediatas y tardías. La mortalidad global en pacientes pediátricos llevados a traqueostomía oscila entre el 13% y 19%. Sin embargo, menos del 5% es directamente atribuible a la cirugía. La presente revisión abarcará las complicaciones más frecuentes asociadas a traqueostomía pediátrica con recomendaciones en su prevención y manejo.
ABSTRACT Indications of tracheostomy in children have changed considerably in recent years, as well as the epidemiological profile of patients, and morbidity and mortality related to this procedure. Complications of pediatric tracheostomy can be classified into intraoperative, immediate and late. Overall mortality in pediatric patients with tracheostomy ranges from 13% to 19%. However, less than 5% is directly attributable to tracheostomy. This review will cover the most frequent complications associated with pediatric tracheostomy with recommendations for its prevention and management.
https://ift.tt/2Qsp3uA
Vacuna contra el virus papiloma humano como tratamiento para la papilomatosis respiratoria recurrente
RESUMEN Una de las manifestaciones clínicas del virus papiloma humano (VPH) es la papilomatosis respiratoria recurrente (PRR), que se caracteriza por la proliferación de lesiones epiteliales verrucosas recurrentes en la mucosa respiratoria, pudiendo progresar a obstrucción de vía aérea o presentar transformación maligna. El tratamiento de primera línea quirúrgico, pero dada su alta recurrencia ha tomado peso el tratamiento adyuvante, como la vacuna tetravalente contra VPH. Sin embargo, existe controversia respecto a su eficacia. El objetivo de esta revisión es analizar la efectividad de la vacuna contra VPH como tratamiento adyuvante de la PRR, para lo cual hicimos una revisión de la literatura sobre la efectividad de la vacuna tetravalente contra VPH para PRR, realizando una búsqueda en diversas fuentes: Pubmed, MEDLINE, EMBASE, Cochrane, Google Scholar y Epistemonikos. Se seleccionaron los estudios que responden a la pregunta y se analizaron los datos de los estudios primarios. Se encontraron cinco estudios primarios no aleatorizados, todos a favor de la vacuna como tratamiento. Concluimos con baja certeza de evidencia, que la vacuna es posiblemente efectiva para pacientes con PRR en disminuir el número de recurrencias, aumentar el intervalo entre cirugías, lograr remisión completa o parcial de la enfermedad y aumentar significativamente los títulos de anticuerpos anti-VPH.
ABSTRACT A clinical manifestation of human papillomavirus (HPV) is recurrent respiratory papillomatosis (RRP), characterized by the proliferation of recurrent verrucous epithelial lesions in the respiratory mucosa, which may progress to airway obstruction or malignant transformation. First-line treatment is surgery, but given its high recurrence the use of adjuvant therapy, such as the quadrivalent vaccine, has gained importance. However, there is controversy regarding its effectiveness. To analyze the effectiveness of the HPV vaccine as an adjuvant treatment for RRP a review of the literature on the effectiveness of HPV tetravalent vaccine for RRP was performed by searching databases such as Pubmed, MEDLINE, EMBASE, Cochrane, Google Scholar and Epistemonikos. We selected the studies that answered the question and analyzed the data from all of which supported the vaccine as treatment. None were randomized controlled trials. We conclude, with low certainty of evidence, that the vaccine is possibly effective for RRP in decreasing the number of recurrences, increasing the intersurgical interval, achieving complete or partial remission of disease and significantly increasing anti-HPV antibodies.
https://ift.tt/2Pgxnkw
Entrenamiento olfatorio. Revisión de literatura
RESUMEN La disfunción olfatoria es una patología frecuente que trae consigo una disminución importante en la calidad de vida de los pacientes y que incluso conlleva una mortalidad aumentada respecto a la población general. Sin embargo, es una condición subdiagnosticada, ya sea por desconocimiento de los profesionales o por falta de un método diagnóstico adecuado. A la fecha no existe un tratamiento efectivo para estos pacientes y generalmente se les deja sin tratar. Una alternativa para este gran problema es el entrenamiento olfatorio, tratamiento propuesto recientemente con resultados promisorios.
ABSTRACT Olfactory dysfunction is a frequent pathology associated with an important decrease in the quality of life of patients and an increased mortality respect to the general population. However, it is an underdiagnosed condition, either due to lack of knowledge of the professionals or due to the lack of an adequate diagnostic method. To date there is no effective treatment for these patients and they are usually left untreated. An alternative to this problem is olfactory training, a treatment recently proposed with promising results.
https://ift.tt/2QA9npq
“Hanger” in Intubation and Laryngoscopy
Abstract
Achieving an adequate exposure in laryngoscopy is an extremely tedious task for the operating surgeon, especially for the anterior commissure lesions. Various maneuvers have been described to overcome this difficulty, but failed in providing an adequate exposure leading to a poor outcome. To create a device that can deliver uniform pressure over the laryngeal cartilage and succeed in providing an adequate exposure of the glottic lesion. A total of 44 patients were included in the study, divided into two groups containing 22 patients each. The distance at the level of anterior commissure from the superior border of the distal end of the laryngoscope was noted and compared. Group A subjected to digital cricoid pressure showed a mean distance of 9.09 of exposure with variance of 1.22 and Group B subjected to cricoid pressure with the cricoid catapult showed a mean distance of 11.76 with variance of 1.59. The groups were statistically analyzed using Anova Test and the test was found to be very significant (p < 0.0001). The catapult is made of a hanger defining its economics, which has a vital role in difficult intubations especially in anterior placed larynx, short neck and obese patients, also succeeds in providing an adequate exposure of the glottic lesion, (especially the anterior commissure) by delivering uniform pressure over the laryngeal cartilage, leading to a superior operative outcome.
https://ift.tt/2JdE8gr
Completely Endoscopic Approach Using a Skeeter Drill to Treat Bilateral Congenital Choanal Atresia in a 33 Week Born Pre-term Baby
Abstract
Choanal atresia (CA) is a relatively rare condition manifesting with respiratory distress. Endoscopic approaches have superseded transnasal and transpalatal approaches. We present a case of a premature baby of 1.10 kg, who developed respiratory distress and was diagnosed with bilateral CA. A nasal airway was created endoscopically using a skeeter drill.
https://ift.tt/2JaOuBc
Human Immunodeficiency Virus Infection: Does Highly Active Antiretroviral Therapy Influence Ear Nose Throat Manifestations?
Abstract
To study the change in trend of ear, nose and throat (ENT) manifestations in patients who were on treatment, before and after availability of highly active antiretroviral therapy (HAART). To find out the prevalence of ENT manifestations in human immunodeficiency virus (HIV) infected people who were on treatment, in the year of 2004 (before the availability of HAART) and in 2014 (after the availability of HAART). Design A combination of a retrospective and prospective study. Setting Anti Retroviral Therapy (ART) Center at Our Hospital. Subjects Patients with HIV infection on ART. Methods Retrospective review of case records of the patients visiting the center in the year 2004 and prospective study of the patients visiting in the year 2014 was conducted. Sample size was calculated as 200 in each group based on 95% confidence and 96% power. Convenience sampling was used in our study. The prevalence of ENT manifestations in HIV patients were found to be 86% in 2004 and 93% in 2014. Among ENT manifestations oropharyngeal manifestations were most common. Lesser the CD4 count more was the prevalence of disorders in oropharynx. Our study showed a high prevalence of ENT manifestations in HIV patients who were on treatment, irrespective of the gap of 10 years and introduction of HAART therapy. Most common ENT manifestation both in 2004 and 2014 was oropharyngeal candidiasis. Lesser the CD4 count more was the prevalence of disorders in oropharynx.
https://ift.tt/2sDMbfL
Aural Atresia with Cholesteotoma and Its Management Strategies
Abstract
The term congenital aural atresia is used to describe failure of external auditory canal to open. Thus it results in conductive hearing loss. There are ways to improve the transmission of sound to the healthy inner ear, we have performed surgery to open the ear canal and restore the natural sound-conducting mechanism to the inner ear. Thus avoiding multiple surgeries. The study was conducted among patients aged between 12 and 24 years, our study included 8 patients with aural atresia with cholesteotoma. After a detailed examination of patients were subjected to surgery. In our study with the sample size of eight patients Where, all our patients underwent canal wall down mastoidectomy with simultaneous single stage reconstruction of ossicular chain. All our patients were discharge free and Had subjective improvement in hearing with the post operative period was well accomplished to < 35 dB. In our study all eight patients who underwent canal wall down mastoidectomy had good hearing outcome. As to avoid unnecessary recurrence and complications which are usually seen in intact canal wall down mastoidectomies, we suggest canal wall down and single stage reconstruction.
https://ift.tt/2xo5qim
Functional Nasal Surgery and Use of CPAP in OSAS Patients: Our Experience
Abstract
The surgical correction of nasal obstruction is definitely effective and recommended in patients with poor CPAP compliance, often secondary to the high pressures that need to be given in patients with nasal sub stenosis. For this reason, the objective of this study is the evaluation of the effectiveness and effects of the functional nose surgery on adherence to CPAP- therapy in patients (with moderate to severe OSAS with indication of ventilation therapy) poorly compliant with CPAP. The study was performed on a sample of 52 patients, 40 male and 12 female, aged between 29 and 72 years followed by the Otolaryngology Unit of the University Palermo in the period between January 2015 and January 2017. All patients were subjected to the following s iter: anamnesis with Epworth Sleepiness Scale, NOSE scale, evaluation of "CPAP usage data." Upper airway optical fiber endoscopy with Müller's maneuver. We performed various type of nasal surgery (septoplasty, decongestion of the lower turbinates and FESS) 6 months after the surgery, CPAP usage was evaluated and the NOSE scale has been reapplied. All patients had a subjective degree of obstruction classified in severe or extreme by the NOSE scale before surgery. Almost all patients reported a mild degree of obstruction after the surgery. About CPAP usage, the average usage has passed by 2, 3 h at night to 6, 8 h after the surgery. The result is significant because it shows how the nasal functional surgery can make selected patients suitable to ventilation therapy. As our work shows, a better nasal function allows to reduce the CPAP pressure, Therefore, we believe that all patients with medium to severe obstructive apnea syndrome and for whom night-time ventilation therapy (CPAP) is advised should be evaluated with endoscopy and anamnesis oriented to evaluate nasal obstructive pathologies that may reduce effectiveness of CPAP.
https://ift.tt/2J7C5KA
The Basophil Activation Test reduces the need for a food challenge test in children suspected of IgE‐mediated cow's milk allergy
Abstract
Background
The gold standard for the diagnosis of cow's milk allergy is the Double‐Blind Placebo‐Controlled Food Challenge (DBPCFC) test. However, disadvantages of the DBPCFC are the potential risk of anaphylactic reactions, the time consuming procedure and high costs.
Objective
The aim of this study is to determine the reliability of the Basophil Activation Test (BAT) both for the initial diagnosis of cow's milk allergy in children and for determination of tolerance in children with cow's milk allergy.
Methods
97 BATs and cow's milk specific IgE (sIgE) tests were performed in 86 infants/young children, suspected of (persistent) cow's milk allergy, who were qualified for an in‐hospital DBPCFC. The BAT was performed with cow's milk extract and the purified major allergens casein, α‐lactalbumin, β‐lactoglubulin. Basophil activation was determined by CD63 up‐regulation measured by flow cytometry. The BAT results were compared to the DBPCFC outcomes.
Results
Based on unequivocal DBPCFC and BAT result combinations (80%), the BAT had a sensitivity and specificity of 100% (CI 86‐100% and 68‐100%, respectively) in IgE sensitized children (41% of the tested children). All non‐IgE sensitized children (59%) had a negative DBPCFC and BAT, except for five patients. These latter showed delayed and relatively mild symptoms in the DBPCFC with a negative BAT, supporting a non‐IgE mediated allergy in these children.
Conclusions and Clinical Relevance
The BAT seems reliable and cost‐effective to diagnose patients with an IgE‐mediated cow's milk allergy. In IgE sensitized patients a BAT might replace a DBPCFC. For non‐IgE sensitized patients presenting with mild symptoms we propose to consider a (double‐blind) extended (time) challenge test at home.
This article is protected by copyright. All rights reserved.
https://ift.tt/2DbuiLt
Klippel‐Feil syndrome with associated cervical rib in a human skeleton from Wągrowiec (Poland, 14th–17th centuries)
Abstract
This paper presents congenital anomalies characteristic of Klippel‐Feil syndrome, type II, diagnosed in the skeleton of a young to middle‐aged woman uncovered in a cemetery adjacent to the Church of St Jacob the Apostle in Wągrowiec (Poland), from a grave within an archaeological layer dated to the 14th–17th centuries. A rare type of fusion was identified between the sixth and seventh cervical vertebrae only, co‐occurring with a well‐developed right cervical rib fused to the shaft of the first thoracic rib and articulated via synovial joints with the seventh cervical vertebra. The fusion of the cervical vertebrae involved their bodies, right laminae, and parts of the right articular processes. The interpretation of the presence of Klippel‐Feil syndrome is additionally supported by the absence of any evidence of trauma in the cervical region of the spine or of pathological changes in the skeleton indicative of diffuse idiopathic skeletal hyperostosis or ankylosing spondylitis. The formation of Schmorl's nodes and degenerative changes in apophyseal joint surfaces diagnosed in the cervical vertebrae were probably secondary in relation to the observed congenital anomalies. Additionally, examinations revealed ossified insertions of the ligamentum flavum and degenerative changes of the vertebrae in the lower region of the spine as well as incomplete posterior bridge of the atlas, torus mandibularis, and humerus septal aperture.
https://ift.tt/2AWlTdl
Hydroxychloroquine sulphate therapy of erosive oral lichen planus
Abstract
Background/Objectives
Erosive oral lichen planus (LP) may be painful and debilitating. Symptomatic oral LP has been treated with a wide spectrum of topical and systemic therapies, but few have been evaluated in large series. Hydroxychloroquine is suggested to be effective in oral LP.
Methods
Twenty‐one consecutive patients with erosive, biopsy‐confirmed oral LP were prescribed. hydroxychloroquine sulphate 400 mg/day. Symptomatic improvement was evaluated by means of a visual analogue scale into three groups: no change, moderate to marked improvement and complete remission.
Results
Five (24%) patients obtained complete remission, 12 (57%) patients showed moderate to marked improvement, 3 (14%) patients did not improve at all and in one patient therapy was terminated after 1 month due to side effects. Response to therapy was observed after 2–4 months. Side effects which ultimately led to termination of therapy in three patients were elevated creatinine serum levels (after 1 month), visual field defects (after 8 months) and hyperpigmentation (after 24 months). Among six patients who responded to therapy, three flared on stopping.
Conclusions
Hydroxychloroquine sulphate may be effective and relatively safe treatment for erosive oral LP.
https://ift.tt/2qxDhz8
Efficacy of erbium glass laser in the treatment of Old World cutaneous leishmaniasis: A case series
Abstract
Background
Treatment of cutaneous leishmaniasis remains a challenge; new physical treatment modalities including laser systems are of interest in the treatment of localized lesions.
Method
Fourteen patients (10 females) with 20 lesions of Old World cutaneous leishmaniasis underwent weekly treatments of 1540 nm erbium glass fractional laser (Palomar) using 10 mm spot size hand piece in four passes of 50–70 mJ/cm2 fluence and 10 ms pulse duration.
Results
Twelve lesions were available for assessment: six (50%) improved at 6 weeks and eleven lesions (91.7%) at 12 weeks. There were no recurrences at 6‐ and 12‐month follow‐ups.
Conclusion
Erbium glass fractional laser may be an alternative treatment for localized cases of Old World cutaneous leishmaniasis.
https://ift.tt/2Fffb6l
Seltene Differenzialdiagnose einer Tonsillopharyngitis
Laryngo-Rhino-Otol
DOI: 10.1055/a-0762-4033
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
https://ift.tt/2OwLcpP
Nationwide survey of congenital cholesteatoma using staging and classification criteria for middle ear cholesteatoma proposed by the Japan Otological Society
This study was undertaken to determine the characteristics of congenital cholesteatoma (CC) in Japan, via a nationwide survey using staging and classification criteria for middle ear cholesteatoma, as proposed by the Japan Otological Society (JOS).
https://ift.tt/2OyXPRs
Resection versus preservation of the middle turbinate in surgery for chronic rhinosinusitis with nasal polyposis: a randomized controlled trial
Chronic rhinosinusitis (CRS) affects up to 16% of the population. When medical treatment fails, endoscopic sinus surgery (ESS) is considered. The value of resecting the middle turbinate to optimize surgical ou...
https://ift.tt/2PkoVkc
Prognostic Factors, Treatment, and Survival in Cutaneous Pleomorphic Sarcoma
Cutaneous pleomorphic sarcoma (CPS) is an aggressive tumor with local recurrence and potential for metastasis. This SEER database study male gender identifies white race, age >39, primary site in the head/neck, size >15mm, distant disease as negative prognostic factors and demonstrates that surgical treatment of high risk patients improves outcomes.
https://ift.tt/2qDcKjU
Star flap: new reconstructive technique for defects of the scalp
The scalp has unique challenges for surgeons, because the tissue is inelastic and thick, it is often hair bearing, and small defects can be hard to cover. We have developed a technique using four flaps for reconstruction after the excision of skin cancer, which to our knowledge has never been described before.
https://ift.tt/2Plbi4w
Retrospective comparison of the number of screws used for fixation of skeletal anchorage plates in orthodontics, and their failure rates
The aim of this study was to compare the failure rate of fixation of skeletal orthodontic anchorage plates (SAP) with two screws with that of three screws, and to find out if there is a relation between the number of screws used to fix the plates and the failure rate. We reviewed clinical records of 65 patients from five hospitals with 176 SAP, and took into account other factors that may have affected the failure. The overall failure rate was 15/176 (8.5%), and for with two-screw fixation it was 9/86 compared with 6/90 for those with three-screw fixation.
https://ift.tt/2Qqi9WU
Fumonisin B 1 -induced oxidative stress triggers Nrf2-mediated antioxidant response in human hepatocellular carcinoma (HepG2) cells
Abstract
Fumonisin B1 (FB1), a causative agent for animal-related mycotoxicoses, has been implicated in human and animal cancer. FB1 induces oxidative stress but the related survival responses are not well established. Central to this response is the transcription factor, nuclear factor erythroid 2 p45–related factor 2 (Nrf2). The effects of FB1 on Nrf2-related survival responses in human hepatoma (HepG2) cells were investigated. HepG2 cells were treated with 200 μmol/l FB1 (IC50–24 h). Cellular redox status was assessed via the quantification of intracellular reactive oxygen species (ROS), lipid peroxidation, protein oxidation and the antioxidant glutathione (GSH). The protein expression of oxidative stress and mitochondrial stress response proteins [Nrf2, phosphorylated-Nrf2 (pNrf2), superoxide dismutase 2 (SOD2), catalase (CAT), sirtuin 3 (Sirt 3) and Lon-protease 1 (Lon-P1)] were quantified by western blotting, while gene expression levels of SOD2, CAT and GPx were assessed using quantitative polymerase chain reaction (qPCR). Lastly, the fluorometric, JC-1 assay was used to determine mitochondrial polarisation. FB1 significantly increased ROS (p ≤ 0.001), and induced lipid peroxidation (p < 0.05) and protein carbonylation (p ≤ 0.001), which corresponded with the increase in GSH levels (p < 0.05). A significant increase in pNrf2, SOD2, SOD2, CAT (p < 0.05), CAT (p ≤ 0.01) and GPx (p ≤ 0.001) expression was observed; however, total Nrf2 (p > 0.05) was reduced. There was also a minor reduction in the mitochondrial membrane potential of HepG2 cells (p < 0.05); however, the expression of Sirt 3 and Lon-P1 (p ≤ 0.001) were upregulated. Exposure to FB1 induced oxidative stress in HepG2 cells and initiated Nrf2-regulated transcription of antioxidants.
https://ift.tt/2zHiKMO
Exposure of human lymphoma cells (U-937) to the action of a single mycotoxin as well as in mixtures with the potential protectors 24-epibrassinolide and selenium ions
Abstract
The progressive contamination of food products by mycotoxins such as zearalenone (ZEN) has prompted the search for specific substances that can act as protectors against an accumulation of these toxins. This paper discusses the effect of selenium ions and 24-epibrassinolide (EBR) as non-organic and organic compounds that preserve human lymphoblastic cells U-937 under ZEN stressogenic conditions. Based on measurements of cell viability and a DAPI test, concentrations of ZEN at 30 μmol/l, Se at 2.5 μmol/l and EBR at 0.005 μmol/l were selected. The addition of both protectors resulted in an increase in the viability of ZEN-treated cells by about 16%. This effect was connected with a decrease in lipid peroxidation (a decrease in the malonyldialdehyde content) and the generation of reactive oxygen species, which were determined by a cellular ROS/superoxide detection assay and the SOD activity. The Se protection was observed as the blocking of the all excess ROS, while the EBR action was mainly concentrated on something other than the superoxide radical itself. The experiments on the model lipid membranes that mimic the environment of U-937 cells confirmed the affect of ZEN on the structure and physicochemical properties of human membranes. Although the presence of both Se and EBR reduced the effect of ZEN by blocking its interaction with a membrane, the action of Se was more evident.
https://ift.tt/2SSqDYi
Evidence for neurogenic inflammation in lichen planopilaris and frontal fibrosing alopecia pathogenic mechanism
Abstract
Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are lymphocytic scarring alopecias affecting primarily the scalp. Although both diseases may share some clinical and histopathological features, in the last decade, FFA has become an "epidemic" particularly in Europe, North and South America with unique clinical manifestations compared to LPP, thus, raising the idea that this disease may have a different pathogenesis. Symptoms such as scalp burning, pruritus, or pain are usually present in both diseases, suggesting a possible role for nerves and neuropeptides in the pathogenesis of both diseases. Based on some previous studies, neuropeptides, such as substance P (SP) and calcitonin gene‐related peptide (CGRP), have been associated with lipid metabolism and many chronic inflammatory disorders. In this study we asked if these neuropeptides are associated with LPP and FFA scalp lesions. Alteration in the expression of SP and CGRP in affected and unaffected scalp skin from patients with both diseases was found with examination of sections using immunohistochemical techniques and confocal microscopy. We then quantitatively assessed and compared SP and CGRP expression from control, LPP and FFA scalp biopsies. Although LPP and FFA share similar histopathologic findings, opposite results were found in affected and unaffected scalp in the ELISA tests, suggesting that these diseases may have different pathogenic mechanisms. We also found presence of histopathological inflammation irrespective of evident clinical lesions, which raises the possibility that both diseases may be more generalized processes affecting the scalp.
This article is protected by copyright. All rights reserved.
https://ift.tt/2FebbTP
Component resolved analysis of ash pollen allergy in Bavaria
Sensitization to ash pollen is underestimated in various regions. The prevalence in Germany is about 10%. However, allergy to ash pollen is widely overlooked by allergists, since the pollination period of ash ...
https://ift.tt/2F98PFK
Sweet syndrome: a rare feature of ANCA-associated vasculitis or unusual consequence of azathioprine-induced treatment
Sweet syndrome is a rare skin condition characterised by fever, neutrophilia, and tender erythematous skin lesions and has been reported to occur in association with anti-neutrophil cytoplasmic antibodies (ANC...
https://ift.tt/2qAN2wl
Aetiology of anaphylaxis in patients referred to an immunology clinic in Colombo, Sri Lanka
The aetiology of anaphylaxis differs according to types of foods consumed, fauna and foliage and cultural practices. Although the aetiology of anaphylaxis in Western countries are well known, the causes in Sou...
https://ift.tt/2FfiHxx
Impact of pharmacists’ counseling on caregiver's knowledge in the management of pediatric atopic dermatitis
Abstract
Background
Atopic dermatitis (AD) is a common skin condition in childhood. AD management can be complex, and caregivers may have inadequate information on the disease, aggravating factors, and management. Comprehensive therapeutic education has been closely associated with increased compliance and is recommended for all patients. There are, as yet, no studies on the impact of a pharmacist‐led eczema counseling service.
Objectives
The primary objective was to assess the impact of a pharmacist‐led eczema counseling service on improving caregivers' knowledge. The secondary objective was to evaluate caregivers' satisfaction of the service and their confidence in handling the patient's condition after counseling.
Methods
This was a prospective, questionnaire‐based observational study. After obtaining informed consent, caregivers were required to complete questionnaire A, containing items on demographics and knowledge assessment. Caregivers then underwent a counseling session by a dermatology‐trained pharmacist. After counseling, caregivers were required to complete questionnaire B containing items on satisfaction and confidence level. A follow‐up phone call was conducted after initial counseling session, during which knowledge‐based questionnaire C would be completed.
Results
Data from 32 participants were included in the analysis. There was a significant improvement in caregivers' knowledge score after receiving counseling, with mean precounseling score of 8.38 ± 3.92 and mean postcounseling score of 13.88 ± 3.65 (P < 0.001). Majority was satisfied with the service and was confident in handling their child's condition.
Conclusion
Pharmacist‐led eczema counseling has a positive impact on caregiver's knowledge and can lead to improved compliance. The service was well received, although more time could be spent during the counseling.
https://ift.tt/2yYuU4h
Severe Nasal Swelling
A 32-year-old Hispanic man presented with progressive nasal pain, swelling, and crusting extending to his upper lip, without fever or leukocytosis. What is your diagnosis?
https://ift.tt/2qzQyHd
https://ift.tt/2qzQyHd
Trends in Health Care Costs and Utilization Associated With Untreated Hearing Loss Over 10 Years
This cohort study assesses whether untreated hearing loss is associated with increased health care costs and utilization.
https://ift.tt/2Fl0v5U
https://ift.tt/2Fl0v5U
Association of Age-Related Hearing Loss With Multiple Adverse Health Outcomes
Age-related hearing loss (ARHL) has recently received much attention owing to its recognition as a potential modifiable risk factor for dementia. An increasing number of observational studies, mostly published in the last decade, have associated ARHL with cognitive decline, cognitive impairment, and dementia, igniting increasing interest in ARHL. Livingston et al reported that interventions for peripheral hearing loss may reduce the prevalence of dementia by 9% globally, which is a result higher than that for any other modifiable risk factor. Interestingly, ARHL has also been associated with a higher risk for other common age-related conditions, including depression and falls, suggesting that ARHL is connected with a broader decline in health. However, the association of ARHL with adverse health outcomes other than dementia has been less well studied, despite the prevalence of ARHL as a chronic malady in older age (more than half of US adults older than 60 years have clinically meaningful hearing loss).
https://ift.tt/2qBMLJO
https://ift.tt/2qBMLJO
Analysis of Clinical Features of Mammary Analog Secretory Carcinoma Using the SEER Database
This population-based study uses data from the Surveillance, Epidemiology, and End Results database to analyze the typical clinical characteristics of mammary analog secretory carcinoma.
https://ift.tt/2F8AshR
https://ift.tt/2F8AshR
The Invisible Costs of Hearing Loss
In this issue of JAMA Otolaryngology–Head & Neck Surgery, data from the administrative claims supplied by the OptumLabs database and analyzed by Reed et al indicate significantly longer inpatient stays, higher 30-day hospital readmission rates, and increased overall health care costs among persons with untreated hearing loss. The authors used data from this large, diverse medical claims database representing over 125 million individuals in the United States and found evidence that untreated hearing loss may be influencing health care in more ways than we previously imagined. The prevalence of hearing loss, which is strongly associated with age, is increasing as our population ages, with most US adults 75 years and older experiencing hearing loss. Coupled with the fact that hearing loss is not only common, but also connected with social isolation, reduced cognitive function, poorer physical and psychological health, increased risk of falls and hospitalization, and worse patient-clinician communication, the health care system should do more to improve screening and treatment of individuals with hearing loss.
https://ift.tt/2qzOpeT
https://ift.tt/2qzOpeT
Incident Hearing Loss and Comorbidity
This retrospective, propensity-matched cohort study assesses the association between hearing loss and medical comorbidities.
https://ift.tt/2FbWu3w
https://ift.tt/2FbWu3w
Issues and Findings in Common Cavity Deformity
This narrative review describes the various aspects of common cavity deformity and examines cochlear implant, the first-line option for achieving hearing function in patients with common cavity deformity.
https://ift.tt/2qCJM3K
https://ift.tt/2qCJM3K
Resection versus preservation of the middle turbinate in surgery for chronic rhinosinusitis with nasal polyposis: a randomized controlled trial
Abstract
Background
Chronic rhinosinusitis (CRS) affects up to 16% of the population. When medical treatment fails, endoscopic sinus surgery (ESS) is considered. The value of resecting the middle turbinate to optimize surgical outcomes has been hypothesized but remains controversial and unproven. Whether the middle turbinate should be left in place or resected is controversial. Our objective is to determine if middle turbinectomy improves objective surgical outcomes after ESS.
Methods
Sixteen patients (15 men, 15 primary surgery) undergoing bilateral complete ESS for CRS with nasal polyposis were recruited. Nasal cavities were randomized so that middle turbinectomy was performed on one side while the middle turbinate was preserved on the other. Each participant acted as their own control. Nasal cavities were compared using Perioperative Sinus Endoscopy (POSE) and Lund-Kennedy (LKES) scores pre-operatively, and at 1, 3 and 6 months after ESS. Results were analyzed using Wilcoxon signed-rank test.
Results
Pre-operatively, the POSE (12.4 ± 2.9 vs 12.8 ± 2.6, p = 0.33, for the preserved side and the resected side, respectively) and LKES (5.0 ± 1.0 vs 4.8 ± 1.2, p = 0.33) scores were similar between sides. During follow up, resection was associated with more crusting at 1 month following ESS (1.0 ± 0.7 vs 0.4 ± 0.6, p = 0.02). There was a small, but statistically significant, difference between the nasal cavities at 3 months, where the resected side showed better endoscopic appearance (2.0 ± 2.2 vs 3.4 ± 2.8, p = 0.01). No difference was found at 6 months. Frontal sinus scores were similar between sides at 6 months (0.7 ± 0.5 vs 0.7 ± 0.5, p = 1.00).
Conclusion
Our results show no sustained objective endoscopic benefit of routine middle turbinectomy, at least within the first six postoperative months, in patients undergoing primary ESS for CRS with polyposis.
Trial registration
NCT, NCT02855931. Registered 16 August 2016.
https://ift.tt/2RIqpSd
Low dose provocation and skin tests in patients with hypersensitivity to Gadolinium‐based contrast agents
Abstract
Reported reactions rates with gadolinium‐based contrast agents (GBCA) ranged from 0.07 to 2.4%, the rate of hypersensitivity reaction (HS) is around 0.1% (1) and immediate and delayed HS have been reported (1–4). The diagnosis of HS to GBCA is challenging, based on clinical history and skin tests. Although little data is available on the performances of the GBCA skin tests, its negative predictive value appears to be of interest (5).
This article is protected by copyright. All rights reserved.
https://ift.tt/2qBqb40
Transdisciplinary Oral/Oropharyngeal Cancer Research & Care in Head and Neck Cancer (TORCH)
Condition: Head and Neck Cancer
Intervention: Other: Ancillary/Correlative
Sponsor: Medical University of South Carolina
Not yet recruiting
https://ift.tt/2QuMYtA
Intervention: Other: Ancillary/Correlative
Sponsor: Medical University of South Carolina
Not yet recruiting
https://ift.tt/2QuMYtA
An Phase 1 Study of ZSP1241 in Participants With Advanced Solid Tumors
Conditions: Hepatocellular Carcinoma; Cholangiocarcinoma; Gastric Cancer; Esophageal Cancer; Colorectal Cancer
Intervention: Drug: ZSP1241
Sponsor: Guangdong Zhongsheng Pharmaceutical Co., Ltd.
Not yet recruiting
https://ift.tt/2PjtEmu
Intervention: Drug: ZSP1241
Sponsor: Guangdong Zhongsheng Pharmaceutical Co., Ltd.
Not yet recruiting
https://ift.tt/2PjtEmu
NEO-SPACE Trial: Pembrolizumab and Chemoradiation in Nasopharyngeal Cancer
Condition: NPC
Intervention: Drug: Pembrolizumab Injection
Sponsor: CCTU
Not yet recruiting
https://ift.tt/2QuL4sM
Intervention: Drug: Pembrolizumab Injection
Sponsor: CCTU
Not yet recruiting
https://ift.tt/2QuL4sM
An Study to Evaluate the Safety and Efficacy of Copanlisib in Combination With Nivolumab in Patients With Advanced Solid Tumors
Condition: Non-small Cell Lung Cancer (NSCLC), Head and Neck Squamous Cell Carcinoma (HNSCC), Colorectal Cancer (CRC), Hepatocellular Carcinoma (HCC)
Interventions: Drug: Copanlisib; Drug: Nivolumab
Sponsor: Bayer
Not yet recruiting
https://ift.tt/2Pgz29P
Interventions: Drug: Copanlisib; Drug: Nivolumab
Sponsor: Bayer
Not yet recruiting
https://ift.tt/2Pgz29P
Postoperative Radiotherapy in Thoracic Esophageal Squamous Cell Carcinoma With Neoadjuvant Chemoradiotherapy
Condition: Radiation Oncology
Interventions: Radiation: Neoadjuvant Radiotherapy Program:; Drug: Neoadjuvant chemotherapy Program; Procedure: Esophagectomy program:; Radiation: Postoperative radiotherapy program
Sponsor: Fujian Medical University Union Hospital
Not yet recruiting
https://ift.tt/2QyKx9q
Interventions: Radiation: Neoadjuvant Radiotherapy Program:; Drug: Neoadjuvant chemotherapy Program; Procedure: Esophagectomy program:; Radiation: Postoperative radiotherapy program
Sponsor: Fujian Medical University Union Hospital
Not yet recruiting
https://ift.tt/2QyKx9q
A Study to Evaluate the Safety and Effectiveness of ILIxadencel Administered Into Tumors in Combination With Checkpoint Inhibitor (CPI) in Patients With ADvanced Cancer
Conditions: Carcinoma, Squamous Cell of Head and Neck; Carcinoma, Non-Small-Cell Lung; Gastric Adenocarcinoma; Gastroesophageal Junction Adenocarcinoma; Non-small Cell Lung Cancer; Human Papilloma Virus
Interventions: Biological: ilixadencel; Drug: Pembrolizumab
Sponsors: Immunicum AB; PPD
Not yet recruiting
https://ift.tt/2Pe8cz4
Interventions: Biological: ilixadencel; Drug: Pembrolizumab
Sponsors: Immunicum AB; PPD
Not yet recruiting
https://ift.tt/2Pe8cz4
A Study to Evaluate ONM-100, an Intraoperative Fluorescence Imaging Agent for the Detection of Cancer
Conditions: Breast Cancer; Head and Neck Squamous Cell Carcinoma; Colorectal Cancer; Bladder Cancer; Prostate Cancer; Ovarian Cancer
Intervention: Drug: ONM-100
Sponsor: OncoNano Medicine, Inc.
Not yet recruiting
https://ift.tt/2QsoWiF
Intervention: Drug: ONM-100
Sponsor: OncoNano Medicine, Inc.
Not yet recruiting
https://ift.tt/2QsoWiF
An evaluation of the effects of makeup on perceived age based on skin color in Korean women
Summary
Background
Makeup has been shown to increase women's attractiveness, perceived femininity, and self‐confidence and reduce their perceived age. Some of these results were caused by facial contrast and visible skin color. However, they did not investigate makeup benefit by focusing skin color change.
Objectives
We investigated the benefit of makeup in reducing perceived age by focusing on only skin color, based on the age‐related changes in several skin color parameters (mean, standard deviation, skewness, and kurtosis), and attempted to discover the indications for youthful‐looking skin color.
Methods
A total of 174 Korean women aged 20‐69 years participated in this study. Their digital facial images were cropped on the cheek area, standard Red green Blue data were transformed to Quasi‐L*a*b*, and the statistical parameters of individual Quasi‐L*a*b* data were calculated. Fourteen volunteers aged 30‐45 years wore liquid‐type makeup. The perceived age was assessed by 11 clinical evaluation researchers with a LCD monitor. The statistical analysis was performed using SPSS version 23.0, with a significance level of P < 0.05.
Results
According to a multiple regression analysis, unevenness in skin color, skin lightness, and skewness in skin yellowness significantly affected the participants' perceived age; the most important factor was the unevenness in skin yellowness in Korean women. The evaluated and calculated with the regression equation perceived age were decreased after makeup was applied.
Conclusions
The makeup can reduce women's perceived age by correcting the skin's color, and it can show youthful skin properties such as a lighter and more homogenous color with less chroma.
https://ift.tt/2DtCDLq
Chitinase 3‐like 1 protein plays a critical role in RSV‐induced airway inflammation
Abstract
Background
Chitinase 3‐like 1 protein (CHI3L1) (YKL‐40 in humans and breast regression protein [BRP]‐39 in mice) is required for optimal allergen sensitization and Th2 inflammation in various chronic inflammatory diseases including asthma. However, the role of CHI3L1 in airway inflammation induced by respiratory viruses has not been investigated. The aim of this study is to investigate the relationship between CHI3L1 and airway inflammation caused by respiratory syncytial virus (RSV) infection.
Methods
We measured YKL‐40 levels in human nasopharyngeal aspirate (NPA) from hospitalized children presenting with acute respiratory symptoms. Wild‐type (WT) and BRP‐39 knockout (KO) C57BL/6 mice were inoculated with live RSV (A2 strain). Bronchoalveolar lavage fluid and lung tissue samples were obtained on day 7 after inoculation to assess lung inflammation, airway reactivity, and expression of cytokines and BRP‐39.
Results
In human subjects, YKL‐40 and IL‐13 levels in NPA were higher in children with RSV infection than in control subjects. Expression of BRP‐39 and Th2 cytokines, IL‐13 in particular, were increased following RSV infection in mice. Airway inflammation caused by RSV infection was reduced in BRP‐39 KO mice as compared to WT mice. Th2 cytokine levels were not increased in the lungs of RSV‐infected BRP‐39 KO mice. BRP‐39 regulated M2 macrophage activation in RSV‐infected mice. Additionally, treatment with anti‐CHI3L1 antibody attenuated airway inflammation and Th2 cytokine production in RSV‐infected WT mice.
Conclusions
These findings suggest that CHI3L1 could contribute to airway inflammation induced by RSV infection. CHI3L1 could be a potential therapeutic candidate for attenuating Th2‐associated immunopathology during RSV infection.
This article is protected by copyright. All rights reserved.
https://ift.tt/2ATCrmg
Sexuell übertragbare Infektionen und männliche Fertilität
Zusammenfassung
Hintergrund
Sexuell übertragbare Infektionen (STI) sind weltweit häufig und können Einschränkungen der Fertilität bewirken. Bei Frauen sind Entzündungen des kleinen Beckens mit hierdurch resultierender tubarer Sterilität hierdurch gut belegt; bei Männern wird der Einfluss von STI auf die Fertilität nach wie vor kontrovers diskutiert.
Fragestellung
Betrachtet werden die Auswirkungen verschiedener bakterieller und viraler STI auf die männliche Fertilität.
Material und Methode
Es erfolgte die Auswertung internationaler Literatur bis 30.04.2018, einschließlich Studien an größeren Kollektiven aus dem asiatischen Raum.
Ergebnisse
Zur Beeinflussung der männlichen Fertilität durch verschiedene bakterielle und virale STI ergibt sich weiterhin ein uneinheitliches Bild. Für den direkten oder indirekten Nachweis eines pathogenen Erregers allein konnte eine Auswirkung auf die Ejakulatqualität bisher nicht eindeutig gesichert werden; es bestehen jedoch Hinweise auf negative Auswirkungen durch Mykoplasmen und Ureaplasmen in großen asiatischen Kollektiven. Die Übertragung viraler Erreger (HPV [humanes Papillomavirus], HSV [Herpes-simplex-Virus], HBV [Hepatitis-B-Virus]) beeinträchtigt möglicherweise auch den Erfolg assistierter Reproduktionsmaßnahmen. Bei Betrachtung manifester, durch STI hervorgerufener entzündlicher Prozesse des männlichen Genitaltrakts (v. a. durch Chlamydien und Gonokokken) oder bei HIV(„human immunodeficiency virus")-Infektion finden sich dagegen häufiger Einschränkungen der Ejakulatqualität.
Schlussfolgerungen
Bei männlichen Fertilitätsstörungen ist eine mikrobiologische Abklärung sinnvoll. Weitere Studien zur Auswirkung von STI auf die männliche Fertilität an größeren Kollektiven, v. a. auch kaukasischer Patienten, sind notwendig. Die Inanspruchnahme existierender präventiver Maßnahmen wie das Chlamydienscreening für junge Frauen und die HPV-Impfung auch für Jungen sollte intensiv gefördert werden.
https://ift.tt/2QslCnO
A novel 450-nm blue laser system for surgical applications: efficacy of specific laser-tissue interactions in bladder soft tissue
Abstract
Low-power blue laser allows clean cutting with little bleeding and no undesired coagulations in adjacent tissues; however, studies on high-power blue laser soft tissue ablation properties, including vaporization and coagulation, have not been reported yet. The purpose of this study is to evaluate and analyze the ablation efficacy and coagulation properties of bladder epithelium tissues with a 30-W 450-nm wavelength blue laser. Well-designed ex vivo experiments compared blue laser and 532-nm LBO green laser, both with laser power up to 30 W, for porcine bladder tissue vaporization and coagulation at different experimental parameter settings. At working distance of 1 mm and sweeping speed of 1.5 mm/s, the vaporization efficiency of blue laser and green laser was 5.14mm3/s and 1.20mm3/s, while the depth of coagulation layer was 460 ± 70 μm and 470 ± 80 μm, respectively. We found both blue laser and green laser have excellent efficacy of tissue vaporization and similar tissue coagulation properties. Moreover, in a set of in vivo experiments simulated laser transurethral resection (TUR) surgery on dogs, we found both blue laser and green laser exhibited similar and satisfactory vaporization and coagulation outcomes. Taken together, our results demonstrate that a 450-nm wavelength high-power diode blue laser, like 532-nm wavelength green laser, is capable to produce high efficient tissue vaporization, low-laser tissue penetration, good tissue coagulation, and has low thermal damage to adjacent tissues. Therefore, a 30-W blue diode laser could be a new and safe alternative for surgeries of superficial bladder diseases.
https://ift.tt/2PNiypd
Overutilization of Computed Tomography for Odontogenic Infections
Publication date: Available online 7 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Ashleigh Weyh, Evan Busby, Salam O. Salman, Carmen Smotherman, Shiva Gautam
Abstract
Purpose
There is clear overutilization of computed tomography (CT) in the emergency setting, which is associated with a long-term potential for malignancy. This study aims to determine the rate of overutilization of CT for odontogenic infection work up, and determine the correlation of findings on the history and physical to diagnose moderate to high risk infections.
Methods
A retrospective cross-sectional study was implemented to determine the rate of overutilization of CT for odontogenic infections. Included subjects presented through the emergency department (ED) for evaluation of an odontogenic infection. A CT was determined to be unnecessary if the subjects presented without "red flag" signs on physical exam, which included voice change, elevated floor of mouth, signs of inflammation of deep fascial spaces, periorbital edema, non-palpable inferior border of the mandible, dyspnea, dysphagia/odynophagia, and trismus. Subjects could have no evidence of involvement of a moderate to high risk space or airway change on CT. Infection severity was either low, moderate, or high risk based on anatomical proximity to the airway and critical structures. Sensitivity, specificity, positive predictive, and negative predictive values of the history and physical (H&P) findings to predict moderate to high risk infections were calculated, with 95% confidence intervals.
Results
470 subjects were included, and 389 total CTs were performed, with 220 (56.6%) being unnecessary. Unnecessary scans were most prevalent in subjects with low risk infections, where out of 284 total CTs performed, 222 (78.2%) were unnecessary. There was high correlation of "red flag" signs with moderate to high risk infections.
Conclusion
There is overutilization of CT for odontogenic infections, most prevalent in low risk infections without significant findings in the work up. H&P findings can help accurately diagnose a higher risk infection prior to subjecting a patient to CT.
https://ift.tt/2DbtrdT
Exodontia for the Patient With a Left Ventricular Assist Device
Publication date: Available online 7 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Riccardo Ambrogio
https://ift.tt/2PMgX2S
No need to routinely remove titanium implants for maxillofacial fractures
Publication date: Available online 7 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Yongchun Yu, Weilong Liu, Jinlong Chen, Li Quan, Xiaohui Zheng, Lei Liu
Abstract
Purpose
Titanium implants are typically used to fix maxillofacial fractures and routine removal of them is a controversial topic in maxillofacial surgery. The study aims were to estimate the removal rate and risk factors associated with the removal.
Materials and Methods
The investigators designed and implemented a retrospective study. Adult patients who had open reduction and internal fixation with titanium implants for maxillofacial fractures were included and those who returned to theatre for implant removal were identified from January 2007 to December 2016. The predictor variables were sex, age, preoperative infection, injury time, trauma cause and fracture site. The primary outcome variable was the removal of titanium implants. Descriptive and bivariate statistics were computed. Kaplan-Meier survival methods were used to estimate rate of removal. Univariate and multivariate cox proportional hazards model were used to identify risk factors associated with the removal.
Results
Among the 2325 patients including 1890 males and 435 female, with an average age of approximately 35.49 years registered in this study, 163 (7.01%) patients had their titanium implants removed and one-,two- and ten-year removal rate were 3, 7, and 8% respectively. The risk factors most closely associated with the removal were preoperative infection, injury by blow from object, obsolete fracture and being female.
Conclusions
Routinely removing titanium implants in maxillofacial fracture patients is not necessary. When the risk factors mentioned above are present in maxillofacial fracture patients, follow-up should be scheduled more frequently.
https://ift.tt/2DbtmXD
What is the role of elective neck dissection in the management of patients with buccal squamous cell carcinoma and a clinically negative neck?
Publication date: Available online 7 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Jasjit K. Dillon, Akashdeep S. Villing, Richard S. Jones, Neal D. Futran, Hans C. Brockhoff, Eric R. Carlson, Thomas Schlieve, Deepak Kademani, Ketan Patel, Scott T. Claiborne, Eric J. Dierks, Yedeh P. Ying, Brent B. Ward
Abstract
Purpose
Buccal squamous cell carcinoma (BSCC) is rare in the United States. Given its location, few anatomical barriers to spread exist and it has been found to have a high loco-regional recurrence rate1,2. The role of the elective neck dissection (END) in the clinically negative neck (N0) is not clear. This study aims to answer the research question: Among patients with N0 BSCC does END improve loco-regional control, distant metastatic rates, and 2 and 5 year survival rates?
Methods
A retrospective cohort study was conducted. The sample included subjects diagnosed with BSCC. The primary predictor variable was END status (yes/no). 5 institutions participated: The Universities of Washington, Michigan, Tennessee, North Memorial Oral and Maxillofacial Surgery in Minnesota and Head and Neck Surgical Associates (Portland, OR) between June 2001 and June 2011. The primary outcome variable was loco-regional recurrence. Secondary outcome variables were distant metastasis, 2 and 5 year survival rates. Other variables collected were demographics, initial operation, adjuvant therapy, clinical and pathology data and staging. Kaplan-Meier and Cox proportional hazards statistics were computed.
Results
The sample was composed of 98 subjects with clinically N0 BSCC. The mean age was 66 (30-88), and 54% were male. 74 (76%) underwent END. Loco-regional recurrence-free rates were 61% for END versus 38% for no END (p=0.042). Distant metastatic rates were 4% for END versus 9% for no END. The 2- and 5-year disease-free survival rates were 91 and 75% (p=0.042),respectively, for END and 85 and 63% (p= 0.019), respectively,for no END.
Conclusion
END had a therapeutic effect, evidenced by lower loco-regional recurrence, distant metastatic rates and improved 2 and 5 year survival.
https://ift.tt/2PNgZHR
Human and computational models of atopic dermatitis: a review and perspectives by an expert panel of the International Eczema Council
Publication date: Available online 7 November 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Kilian Eyerich, Sara J. Brown, Bethany E. Perez White, Reiko J. Tanaka, Robert Bissonette, Sandipan Dhar, Thomas Bieber, Dirk J. Hijnen, Emma Guttman-Yassky, Alan Irvine, Jacob P. Thyssen, Christian Vestergaard, Thomas Werfel, Andreas Wollenberg, Amy S. Paller, Nick J. Reynolds
Abstract
Atopic dermatitis (AD) is a prevalent disease worldwide associated with systemic co-morbidities, representing a significant burden on individuals, their families and society. Therapeutic options for AD remain limited, in part due to lack of well-characterised animal models. To better define pathophysiological mechanisms and to identify novel therapeutic targets and biomarkers that predict therapeutic response, there has been increasing interest in developing experimental approaches to study the pathogenesis of human AD in vivo, in vitro, and in silico. This review critically appraises a range of models including: genetic mutations relevant to AD; experimental challenge of human skin in vivo; tissue culture models; integration of "omic" datasets; and the development of predictive computational models. Whilst no one individual model recapitulates the complex AD pathophysiology, our review highlights insights gained into key elements of cutaneous biology, molecular pathways and therapeutic target identification through each approach. Recent developments in computational analysis, including the application of machine learning and a systems approach to data integration and predictive modelling, highlight the applicability of these methods to AD subclassification (endotyping), therapy development and precision medicine. Such predictive modelling will highlight knowledge gaps, further inform refinement of biological models, and support new experimental and systems approaches to AD.
https://ift.tt/2qBNCtW
Mechanical impairment on alveolar bone graft: a literature review
Publication date: Available online 7 November 2018
Source: Journal of Cranio-Maxillofacial Surgery
Author(s): Caroline Dissaux, Delphine Wagner, Daniel George, Camille Spingarn, Yves Rémond
https://ift.tt/2yXp4Ab
Immunology of the Ancestral Differences in Eosinophilic Esophagitis
Publication date: Available online 7 November 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Leah Kottyan, Jonathan M. Spergel, Antonella Cianferoni
https://ift.tt/2D6VA5H
Review of 400 Consecutive Oral Food Challenges to Almond
Publication date: Available online 7 November 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Mary Grace Baker, Jacob Kattan
Abstract
Background
Diagnosis of almond allergy is complicated by a high rate of false positive test results. Accurate diagnosis of almond allergy is critical as almond is a source of nutrition and milk products for children with other food allergies.
Objectives
We reviewed the outpatient almond oral food challenges (OFCs) performed at our institution to analyze the pass rate and identify variables that predict OFC outcome.
Methods
We reviewed all almond OFCs performed at our pediatric, university-based outpatient practice between October 2015 and July 2017. OFC details, including dosing, reactions, and treatments, as well as demographic, clinical, and laboratory data were compiled. Statistical analysis was performed using the Fisher's exact and student t-tests.
Results
We identified 400 patients who underwent consecutive almond OFCs. Of these, 375 passed (93.8%, median sIgE 1.41 kUA/L, mean SPT wheal 3.23 mm), 16 failed (4.0%, sIgE 2.54 kUA/L, SPT 5.0 mm), and 9 were indeterminate (2.3%, sIgE 3.33 kUA/L, SPT 5.0 mm). Among children who reacted, pruritus was the most common symptom. Only two children had reactions that required epinephrine. There was no difference in demographics or allergic comorbidities between those who passed and failed.
Conclusions
Among patients in our cohort, the probability of passing an almond OFC was 94%. Although higher almond sIgE level and SPT wheal size correlated with OFC failure, the pass rate remained >95% for patients with sIgE up to 10 kUA/L and SPT wheal size up to 5 mm. Among the patients who had a reaction to almond, anaphylaxis was uncommon. Our data support that performing outpatient OFCs to almond is safe for select patients.
https://ift.tt/2PJYVON
Andrologische Beratung bei neuen onkologischen Systemtherapien mit „small molecules“
Zusammenfassung
Die sog. „small molecules" erweitern das Spektrum onkologischer Systemtherapien rasant. Zielproteine dieser Medikamentengruppe sind u. a. die Tyrosinkinasen VEGF(„vascular endothelial growth factor")-R, EGF(„epidermal-growth-factor")-R, Bcr-Abl, c‑kit, JAK („just another-kinase", Januskinase), CDK („cycline dependent kinases"/cyclinabhängige Kinasen) u. a. In der Dermatologie gehören die Serin-Threonin-Kinasen BRAF und MEK beim Melanom und der Transmembranrezeptor SMO („smoothened") beim Basalzellkarzinom dazu. Die Auswirkungen dieser zielgerichteten Therapien auf die männliche Fertilität sind z. T. nur unzureichend untersucht. Klinische Daten gibt es meist nur für die älteren Präparate. Darüber hinaus handelt es sich häufig um Multikinaseinhibitoren, sodass selbst „small molecules" mit gleichem (Haupt‑)Target nicht vollständig vergleichbar sind. Bei unzureichender Datenlage sollte vor einer Therapie unter Berücksichtigung individueller Suszeptibilitätsunterschiede und andrologischer Vorerkrankungen eine Spermienkryokonservierung angeboten werden.
https://ift.tt/2z0YLsH
Natural and modified IL-2 for the treatment of cancer and autoimmune diseases
Publication date: Available online 8 November 2018
Source: Clinical Immunology
Author(s): Masayuki Mizui
Abstract
Interleukin-2 (IL-2) is a pleiotropic cytokine required for both effector lymphocyte proliferation/differentiation and regulatory T cell expansion/survival. Ability to receive IL-2 signals is defined by the affinity to distinct IL-2-receptor-complexes on each subset of cells. While IL-2 targets anti-tumor cytotoxic lymphocytes (CTLs) for the treatment of patients with melanoma or renal cell carcinoma, IL-2 directed at regulatory T (Treg) cells has value in several immune-related diseases including chronic graft-versus-host disease (cGVHD), type 1 diabetes (T1D) and systemic lupus erythematosus (SLE). A variety of IL-2 alteration has been made to deliver IL-2 to the proper target, including mutant IL-2, IL-2-fusion proteins and anti-IL-2 antibodies. Experimental and clinical trials with IL-2 are spreading for diverse group of diseases. Although the sustainability and efficiency of IL-2-responding cells in controlling disease activity are still not fully understood, the results of clinical trials will provide a basis of the most effective regimen for each disease.
https://ift.tt/2Qszkal
Reversible dilative cardiomyopathy after electrical injury: a case report
Dilative cardiomyopathy is an uncommon cardiac complication of electric shock.
https://ift.tt/2qxtV6o
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