Efficacy of two plant extracts against acne vulgaris: Initial results of microbiological tests and cell culture studies

Summary

Background

Acne vulgaris is a common skin disease characterized by increased sebum production, inflammation, and colonization of Propionibacterium acnes (P. acnes) on pilosebaceous follicles.

Aims

To determine the efficacy of two different plant extracts against P. acnes and to analyze the gene expression levels of IL‐1α, SRD5A1, and TNFα in HaCaT cells treated with these plant extracts.

Methods

Anti‐acne extract 1 (AE1) consisted of Juglans regia (walnut husk), Myrtus communis (myrtle leaves), Matricaria chamomilla (chamomilla flowers), Urtica dioica (stinging nettle leaves), and Rosa damascena (rose flowers). Anti‐acne extract 2 (AE2) contained Brassica oleracea var. botrytis (broccoli) and B. oleracea var. italica (cauliflower). The antimicrobial activities of the extracts were tested on two different P. acnes strains: the reference strain of P. acnes (ATCC 51277) and the clinical isolate from a patient. The minimum inhibitory concentration (MIC) of the extracts was determined using the broth dilution method. Human keratinocyte cells were used for in vitro tests. Gene expression analyses were performed with RT‐qPCR.

Results

The MIC values of the extracts were below 1/2048 µg/mL. In the gene expression analysis, AE1 increased the expression level of TNFα (1.1719, P < 0.0001), suppressed the expression level of IL‐1α, SRD5A1 (0.0588, P = 0.0231; 0.3081, P = 0.0351), respectively. AE2 suppressed gene expression level of IL‐1α, SRD5A1, TNFα (0.3815, P = 0.0254; 0.3418, P = 0.0271; 0.1997, P = 0.0623).

Conclusions

Both herbal extracts demonstrated strong antibacterial and anti‐inflammatory activity in this preliminary trial. In conclusion, the topical application of these botanical extracts can be good candidates for local acne treatment.

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Reconstruction of the Nose

Nasal reconstructive techniques have advanced significantly over the past 50 years. Modern techniques in nasal reconstruction are based on the nasal aesthetic subunits. In order to achieve ideal outcomes, reconstructive surgeons must consider differences in tissue qualities across the nasal aesthetic subunits and formulate reconstructive plans based on these differences. Local flaps, skin grafts, and several types of interpolated flaps comprise the most commonly used techniques for nasal reconstruction. Defects that involve structural or internal lining defects require reconstruction of significantly higher complexity.

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Reconstruction of the Ear

Skin cancer is a common indication for reconstructive surgery of the ear. The unique anatomy of the external ear makes the restoration of form and function challenging for the reconstructive surgeon. This article reviews the relevant anatomy of the ear, defines the goals of reconstruction, outlines the assessment of defects based on location, and describes specific surgical techniques useful in auricular reconstruction.

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Reconstruction of the Cheek

The goal of cheek reconstruction is to restore an illusion of "normal." Attention must be directed toward the contralateral cheek skin color, texture, thickness, and contour, because this serves a template for reconstruction. The cheek is a peripheral facial subunit and largely frames the more central subunits (eyelids, nose, lips). As such, avoiding distortion or disfigurement of the central subunits is of paramount importance. The cheek possesses significant tissue laxity, elasticity, and mobility, thus allowing for the vast majority of cheek defects to be addressed with primary closure, local flaps, or locoregional flaps.

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Contents

Jeffrey S. Moyer

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Mohs Micrographic Surgery

Mohs micrographic surgery (MMS) is the gold standard for treating various cutaneous tumors. MMS has evolved into a single-day, outpatient procedure. The tumor is excised, mapped, and processed with frozen, horizontal sections for immediate histologic evaluation. The process is repeated as necessary until the tumor is completely removed, with maximal conservation of normal tissue. Evaluation of 100% of the surgical margin allows for exceptional cure rates. The Mohs surgeon is trained in tumor excision, histopathology interpretation, and surgical reconstruction. The use of MMS is often part of a multidisciplinary approach to treating cutaneous tumors.

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Contributors

J. REGAN THOMAS, MD

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Reconstruction of Defects Involving the Lip and Chin

Successful perioral reconstruction is the result of consideration of both functional and esthetic goals. The lips are complex esthetic units with multiple tissue layers and distinct anatomic landmarks. Reconstruction can be difficult due to variables affecting the defect, such as size, depth, location, and involvement of adjacent subunits. There are many local flaps that can be used to match the complex tissue layers and anatomic landmarks. Use of the same reconstructive principles can be applied to secondary reconstruction to attain a successful outcome. This article focuses on local reconstructive options for defects of the lip and chin.

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Copyright

ELSEVIER

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The Role of Sentinel Lymph Node Biopsy in the Management of Cutaneous Malignancies

Sentinel lymph node biopsy uses the concept of selective lymphatic drainage and the lymphatic microvasculature to identify first-echelon nodes draining a given malignancy. Although initially considered difficult and unreliable in the head and neck, experience with the technique has improved and evolved significantly over the last 3 decades. It is now recognized to be accurate and reliable for regional nodal staging and detection of occult nodal metastasis in the head and neck. Although initially described for nodal staging of melanoma, the usefulness of sentinel lymph node biopsy continues to expand and is now extended to other cutaneous malignancies.

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Skin Cancer Treatment

FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA

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Forthcoming Issues

Facial Gender Affirmation Surgery

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State-of-the-Art in Skin Cancer Surgery

Skin cancer remains the most common cancer in the United States, affecting approximately 20% of Americans during their lifetime. Despite major advances in care delivery, including targeted drug therapies and immunotherapy, the primary treatment for early nonmelanoma skin cancer (NMSC) and melanoma continues to be careful surgical extirpation with clear margins, along with meticulous reconstruction that optimally addresses functional and aesthetic deficits.

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Reconstruction of the Forehead and Scalp

Tissue inelasticity and the hair-bearing nature of the scalp and forehead pose unique challenges during reconstruction. A thorough understanding of the surgical anatomy of the scalp and forehead is paramount for optimal reconstructive outcomes. Primary wound closure is usually preferred over secondary intention healing and skin grafting. Use of dermal alternatives and tissue expansion are adjunctive therapies to facilitate scalp wound closure. Local skin and soft tissue flaps are commonly used for most small to medium defects; however, microsurgical free tissue transfer can be considered for large full-thickness skin defects of the forehead and scalp.

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Adjuvant and Neoadjuvant Treatment of Skin Cancer

Skin cancer represents a broad classification of malignancies, which can be further refined by histology, including basal cell carcinoma, squamous cell carcinoma and melanoma. As these three cancers are distinct entities, we review each one separately, with a focus on their epidemiology, etiology including relevant genomic data, and the current evidence-based recommendations for adjuvant and neoadjuvant therapy. We also discuss future directions and opportunities for continued therapeutic advances.

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Health Outcome Studies in Skin Cancer Surgery

As cutaneous cancers are the most common malignancies affecting US citizens, they represent a significant public health problem and health care cost burden. There are a variety of treatment options available to manage cutaneous malignancies, but limited data are available regarding outcomes, including quality of life, recurrence, and mortality. Here, we examine outcomes of skin cancer surgery as they relate to sociodemographic data and treatment factors.

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Radiotherapy for Skin Cancers of the Face, Head, and Neck

Radiotherapy plays a role in the definitive or adjuvant management of early and late stage skin cancers including nonmelanoma basal cell carcinoma and cutaneous squamous cell carcinoma, melanoma, and Merkel cell carcinoma. The role of radiotherapy in skin cancers of the head and neck is reviewed including early and advanced-stage nonmelanoma skin cancers, melanoma, and Merkel cell carcinoma. In particular, the indications, oncologic outcomes, and technical aspects of radiotherapy for these diseases are discussed.

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Tissue Engineering and 3-Dimensional Modeling for Facial Reconstruction

Three-dimensional (3D) printing has transformed craniofacial reconstruction over the last 2 decades. For cutaneous oncologic surgeons, several 3D printed technologies are available to assist with craniofacial bony reconstruction and preliminary soft tissue reconstructive efforts. With improved accessibility and simplified design software, 3D printing has opened the door for new techniques in anaplastology. Tissue engineering has more recently emerged as a promising concept for complex auricular and nasal reconstruction. Combined with 3D printing, several groups have demonstrated promising preclinical results with cartilage growth. This article highlights the applications and current state of 3D printing and tissue engineering in craniofacial reconstruction.

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Management of Early-Stage Melanoma

Melanoma is a potentially aggressive skin cancer with a steadily rising incidence. Most melanomas are diagnosed at an early stage and associated with an excellent prognosis when treated appropriately. Primary treatment for melanoma is surgical. Wider surgical margins and a variety of techniques for comprehensive histologic margin assessment may be considered for lentigo maligna type melanoma on the head and neck, due to characteristic broad subclinical extension. For invasive melanoma, sentinel lymph node biopsy may be indicated for staging, and to guide further management and follow-up. Appropriate treatment guidelines for early-stage melanoma are reviewed and discussed.

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Periocular Reconstruction

Options for periorbital reconstruction include primary wound closure, local flaps, regional/distant flaps, or full-thickness skin grafts. Optimal aesthetic and functional outcomes are achieved by assessing regional contours, skin type, and facial aesthetic units. Like tissue should replace like tissue; for example, skin with skin, tarsus with tarsus (or equivalent material, eg, hard palate, ear cartilage, or autologous substitute), and conjunctiva with mucous membrane or like substitute (buccal mucous membrane, amniotic membrane). Patient characteristics including wound care needs, transportation needs, smoking status, and history of radiation can influence the reconstruction plan. Techniques most commonly used in our practice are reviewed.

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Nonmelanoma Skin Cancer

This article reviews the most common nonmelanoma skin cancers affecting the head and neck region. Although the most common of these malignancies rarely result in mortality, local morbidity caused by the tumors and their extirpation cannot be underestimated. Complete tumor extirpation with pathologically confirmed negative margins is the gold standard. Regional and distant metastases are rare, but must be treated appropriately should they occur. Although reconstructive surgery can be life changing for the patients and rewarding for the clinicians, it behooves the treating surgeons to remain true to oncologic principles above all else.

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Identification of inflammatory response patterns in experimental gingivitis studies

We used novel analytical approaches to identify inflammatory response patterns to plaque accumulation in experimental gingivitis studies in humans. Data from two experimental gingivitis studies [Dataset I (n = 40) and Dataset II (n = 42)], which differed in design and recording methods, were used. Both studies comprised a three‐phase program as follows: pre‐induction period (oral hygiene as usual for Dataset I; professional tooth cleaning for Dataset II); induction period (plaque accumulation); and resolution period (oral hygiene as usual). Clinical recordings of plaque and gingival inflammation were made on days 0, 4, 9, and 14 for Dataset I and on days −14, 0, 7, 21, and 35 for Dataset II. Group‐based‐trajectory and growth curve modeling were used for data analysis. In Dataset I, gingival response to plaque accumulation was found to be lagged in time. Different group‐based response patterns for gingival inflammation were not identified. However, in Dataset II, 'fast' and 'slow' gingival inflammation responders were identified. 'Slow' responders had lagged inflammation responses, whereas 'fast' responders seemed to respond immediately to plaque. The findings show that analytical approaches which consider the data structure allow investigation of the dynamics of the relationship between plaque accumulation and gingival inflammation and facilitate the identification of differential patterns of gingival inflammation development.

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Effect of methacrylated chitosan incorporated in experimental composite and adhesive on mechanical properties and biofilm formation

The lifespan of a resin‐based restoration is limited, with the main reason for failure being secondary caries. Biofilm formation at the tooth–material interface is a necessary etiological agent for caries development. Dental materials with antimicrobial properties may reduce formation of biofilm and thus increase the longevity of restorations. This study aimed to investigate the effect of methacrylated chitosan (CH‐MA), incorporated into the polymeric network of an experimental dental composite and adhesive, on biofilm growth of Streptococcus mutans and to assess the mechanical properties of the modified materials. The methacrylation of low‐molecular‐weight chitosan was achieved and biofilm studies confirmed the antibacterial effect of the modified polymer in solution. Methacrylated chitosan was incorporated into an experimental composite and adhesive, and the modified materials reduced the formation of S. mutans biofilm. The incorporation of CH‐MA did not alter the bond strength of the adhesives. However, the amount of CH‐MA in composite that is required to elicit an antibacterial response challenges the mechanical properties of the material. The hardness and flexural strength of the composite decreased with increasing amounts of CH‐MA. However, flexural strength values still met the requirement in the ISO standard.

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Editorial Board

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Neuromodulatory treatment of recalcitrant plaque psoriasis with onabotulinumtoxinA

To the Editor: The role of neurocutaneous pathways in the pathogenesis of psoriasis has been suggested in cases of dermatomal improvement in psoriatic plaques following central or peripheral nerve damage1-3; however, few studies have assessed the effect of nerve-targeting treatments,4,5 especially in plaque psoriasis. This study investigated the effect of onabotulinumtoxinA injections on psoriasis severity, epidermal nerve fiber (ENF) density, and expression of the neuropeptides substance P (SP) and calcitonin gene–related peptide (CGRP).

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Author index∗∗July, pp. 1-182; August, pp. 183-406; September, pp. 407-598; October, pp. 599-788; November, pp. 789-986; December, pp. 987-1226.

Aaserud S (see Veierød et al). 2018;79:118-25 (Original article)

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JAAD Case Reports Article List

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Reply to: “Comment on ‘Oral diabetes medications other than dipeptidyl peptidase-4 inhibitors are not associated with bullous pemphigoid: A Finnish nationwide case control study’”

To the Editor: We thank Dr Kridin for his interest in our recent publications.1,2 The limitation that we may have not been able detect the association between newer diabetes drugs and bullous pemphigoid (BP) was already acknowledged in our previous article.1 The unpublished finding of Dr Kridin's group that the use of linagliptin is associated with BP is not surprising and further confirms the significance of the use of dipeptidyl peptidase 4 inhibitors (DPP4is) (or gliptins) as a risk factor for BP.

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Comment on “Oral diabetes medications other than dipeptidyl peptidase-4 inhibitors are not associated with bullous pemphigoid: A Finnish nationwide case control study”

To the Editor: We read with great interest the study performed by Varpuluoma et al.1 The authors conducted a nationwide case-control study aiming to estimate the prevalence of administration of oral antidiabetics among patients with bullous pemphigoid (BP) versus among matched control subjects. No association was found between exposure to any oral diabetes medications other than dipeptidyl peptidase-4 inhibitors (DPP4is) and the development of BP.1 DPP4is, particularly vildagliptin, have emerged as a risk factor for the development of BP.

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Subject index

Abortion

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December Iotaderma #298

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Table of Contents

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Anti-aging effects of ingenol mebutate for patients with actinic keratosis

To the Editor: Ingenol mebutate (IM) gel has been approved by the Food and Drug Administration as a topical field-directed therapy for actinic keratosis (AK) and has been shown to cure subclinical and clinically apparent AKs.1 Recently, there have been reports of improvements in skin elasticity, wrinkles, and mottled pigmentation after the application of IM gel in patients with multiple AK lesions.2,3 In this study, we aimed to investigate histologic and molecular alterations after field cancerization by using topical IM gel in patients with multiple AK lesions and elucidate the mechanism underlying the skin-rejuvenating effect of IM gel.

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Information for Readers

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November iotaderma (#297)

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Journal Based CME Instructions and Information

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Answers to CME examination

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JAAD Virtual Journal Club

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CME examination

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Answers to CME examination

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Cover Sheet for Index

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CME examination

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Dermatology Calendar

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Suture‐ligature technique for the closure of tracheocutaneous fistula in adults

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Magnetic resonance imaging with cochlear implants and auditory brainstem implants: Are we truly practicing MRI safety?

Objective

Our objective is to evaluate the safety in patients with cochlear implants (CIs) and auditory brainstem implants (ABI) undergoing 1.5 Tesla (T) magnetic resonance imaging (MRI). Secondly, we want to raise awareness on CI and MRI safety, and advocate for continued improvement and advancement to minimize morbidity for our CI patients.

Methods

Retrospective case series from 2006 to 2018 at a single tertiary academic center. Data was collected on patients with CI or auditory brainstem implants undergoing MRI. Outcomes collected include demographic data, age at time of MRI, MRI characteristics, complications, CI manufacturer, and image quality.

Results

Eighteen patients with CI or ABI collectively underwent a total of 62 MRI scans. Five of 15 (33%) CI patients with magnet had complications: five total of 24 MRI scans (21%). Two patients had magnet removal prior to 29 MRI scans without complications. Four of five MRI‐related complications were equipped with a U.S. Food and Drug Administration‐approved head wrap. Three of five required a trip to the operating room to explore and reposition the CI magnet; two could not complete MRI secondary to pain. Of the complications, two were Cochlear (Sydney, Australia), two Advanced Bionics (Valencia, CA), and one MED‐EL (Innsbruck, Austria). Synchrony model (MED‐EL) had 0 of seven complications, with a total of 19 MRI scans, which features a freely rotating and self‐aligning magnet.

Conclusion

Our series offers a diverse number of CI manufacturers and is in accordance with other literature that CI MRI‐related adverse events are occurring at an unacceptable frequency. We can promote CI MRI safety through our institutions' MRI CI patient protocols, raise awareness that diagnostic MRI benefits must outweigh CI‐related complications, and advocate for continued industry technological innovation.

Level of Evidence

4 Laryngoscope, 2018

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Continuous laryngoscopy during provocation in the assessment of inducible laryngeal obstruction

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Postoperative respiratory complications and racial disparities following inpatient pediatric tonsillectomy: A cross‐sectional study

Objectives/Hypothesis

To study rates of respiratory complications/interventions among inpatient tonsillectomy patients in the United States and identify risk factors for these events.

Study Design

Retrospective database review.

Methods

Children (age < 18 years) undergoing tonsillectomy with or without adenoidectomy in 2006, 2009, and 2012 were studied using the Kids Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Outcomes were analyzed for respiratory events (complications/interventions) and racial disparities. Pearson χ#lary27405-bib-0002 test was used to analyze categorical data and regression analysis was used for continuous variables. Respiratory events were analyzed by racial identity using logistic regression analysis. A P < .05 was considered significant.

Results

The study included 30,617 patients (41% female, 51% white, 24% African American, 23% Hispanic, 3.0% Asian). The mean age was 5.2 years, and mean length of stay 2.3 days. The overall complication rate was 6.0%, and overall intervention rate was 3.6%. Respiratory events were more common among African American children (odds ratio [OR]: 1.5, 95% confidence interval [CI]: 1.3‐1.6) and less common among white children (OR: 0.8, 95% CI: 0.8‐0.9). These differences were significant after controlling for age, gender, obesity, obstructive sleep apnea, and asthma. The mortality rate was 0.05% with no ethnic predilection.

Conclusions

Respiratory events after inpatient tonsillectomy included laryngo/bronchospasm, pneumonia, pulmonary edema, intubation, prolonged intubation, and ventilation. Although uncommon, these were more common among African American children. Further research is needed to understand the etiology of this disparity.

Level of Evidence

NA Laryngoscope, 2018

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Modified endoscopic endonasal approach with a minimally invasive transoral approach—an adjunct to infrapetrous approaches

Objectives/Hypothesis

To evaluate the potential of a minimally invasive transoral–transpalatal approach (MITA) to the retrocarotid petrous apex, as an adjunct to endoscopic endonasal approaches (EEAs).

Study Design

Cadaver study.

Methods

Five cadaveric specimens were dissected raising an inverted U‐shaped palatal mucoperiosteal flap, and drilling a rectangular palatotomy (between the greater palatine foramens, and just anterior to the palatine aponeurosis). This allowed a transpterygoid EEA with cross‐court access (contralateral line of sight), followed by an extradural clivectomy that exposed the petroclival junction bilaterally. Surgical targets were marked on the posterior and medial surface of the petrous internal carotid artery (ICA), at its anterior genu, midhorizontal portion, and posterior genu. For each target and approach, the surgical freedom and angles of approach (in the horizontal and vertical planes) were calculated and statistically compared.

Results

Compared to EEA, the MITA resulted in greater surgical freedom for all targets, with the highest values at the anterior genu (1,661.37 mm² vs. 312.76 mm², P <.001), and maintaining superiority in this regard all the way to the posterior genu (847.84 mm³ vs. 138.91 mm³, P < .005). MITA also offered greater angles of approach for all targets.

Conclusions

This study suggests that the MITA may be indicated to supplement the exposure provided by a transpterygoid EEA. This technique, associated with low potential morbidity, offers an alternative to internal carotid lateralization while managing extradural lesions that are adjacent to the petrous ICA.

Level of Evidence

NA Laryngoscope, 2018

https://ift.tt/2PPLIEd

Decision aid prototype for treatment of pediatric sleep disordered breathing: A randomized pilot study

Objectives

1) To examine the feasibility and usability of a decision aid prototype (DA) for pediatric obstructive sleep apnea (OSA). 2) to estimate parameters for a future randomized controlled trial.

Study Design

Multicenter randomized pilot trial.

Methods

Ninety‐nine parents of children ( < 6 years of age) undergoing consultation for adenotonsillectomy for sleep‐disordered breathing were prospectively enrolled. Families were randomly assigned to receive the DA or to follow standard care procedures. All consultations were video‐recorded and coded with the observing patient involvement in decision making (OPTION) instrument. Following the consultation, parents completed the Decisional Conflict Scale (DCS) and Shared Decision‐Making Questionnaire (SDM‐Q‐9), whereas otolaryngologists completed the physician version (SDM‐Q‐Doc). A subset of parents and surgeons were interviewed to assess the usability of the DA.

Results: Overall, a significantly negative correlation between DCS and SDM‐Q‐9 was observed (P < 0.001). Interviews showed that parents found the DA helpful but wanted more time to read and contemplate the information. Both parents and surgeons indicated that instructions on how to use the DA would be beneficial. For parents receiving the DA, the mean total OPTION score was 13.83 out of 40 (standard deviation 5.24), compared to 11.95 (standard deviation 5.21) in those not receiving the DA (P = 0.11). There were no significant differences in the decisional conflict or shared decision making when using the DA.

Conclusion: The DA was feasible but used differently among surgeons. The need to improve SDM techniques was suggested by both surgeons and parents. Future studies training otolaryngologists on effective SDM techniques and how to appropriately utilize decision aids may improve SDM for pediatric OSA.

Level of Evidence

1B. Laryngoscope, 2018

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Do preoperative corticosteroids benefit patients with chronic rhinosinusitis with nasal polyposis?

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Subglottic stenosis: An evaluation of an elderly treatment‐seeking population

Objectives/Hypothesis

To evaluate the demographics, etiology, intraoperative findings, and treatment outcomes of patients with subglottic stenosis (SGS), comparing those patients aged <65 years to an elderly population aged ≥65 years.

Study Design

Retrospective cohort study.

Methods

Nine‐year retrospective review of patients with SGS. Forty‐eight adults presented for evaluation and treatment of SGS between January 2008 and December 2016. At the time of presentation, 41 were aged <65 years and seven were aged ≥65 years.

Results

Comparing the aged <65 years group to the aged ≥65 years group, the etiology was idiopathic SGS in 50.0% versus 42.8%, intubation‐related SGS in 22.5% versus 28.6%, and granulomatosis with polyangiitis in 27.5% versus 28.6%, respectively. No statistically significant difference was noted in the two groups when comparing the demographics, etiology, treatment, intraoperative findings, or intertreatment interval (ITI).

Conclusions

We sought to analyze an older patient population with SGS and found no statistically significant differences compared to a younger population. ITI trended toward older patients requiring surgery more frequently but was not significant.

Level of Evidence

4 Laryngoscope, 2018

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Interesting case of late Gore‐Tex extrusion following medialization laryngoplasty

A 65‐year‐old female presented with a foreign body sensation following an asthmatic attack associated with severe coughing. Six years earlier, the patient underwent medialization laryngoplasty (ML), which was complicated by a small tear (2 mm) in the right ventricle. One year following this, the patient developed Gore‐Tex extrusion but elected only for partial removal. Healing was complete until 5 years later; on examination, the patient had evidence of Gore‐Tex extrusion through the right ventricle. Implant extrusion is a recognized complication of ML. This case demonstrates several important surgical steps that can benefit otolaryngologists at all stages of their surgical career. Laryngoscope, 2018

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Aspiration in children with unilateral vocal fold paralysis

Objectives/Hypothesis

To describe the prevalence of aspiration in children with unilateral vocal fold paralysis who underwent objective assessment of swallow function.

Study Design

Retrospective chart review.

Methods

A study of patients presenting to our institution with unilateral vocal fold paralysis in 2015 was conducted. All patients were diagnosed using flexible laryngoscopy. Patients were included if they underwent at least one modified barium swallow (MBS) study for evaluation of their swallowing function due to recurrent respiratory issues and/or feeding difficulty.

Results

Twenty‐eight patients diagnosed with unilateral vocal fold paralysis underwent an MBS study at our institution in 2015. Median age at the time of MBS study was 1.7 years (interquartile range: 0.4–4.3). Twenty‐six patients (92.9%) had dysphagia. Sixteen patients were found to aspirate on MBS study. All patients who aspirated did so without overt signs (silent aspiration). Eighteen patients had congenital heart disease (64.3%) and nine had a history of prematurity (32.1%). Eight patients (28.6%) presented with developmental delays.

Conclusions

Patients who present with unilateral vocal fold paralysis and recurrent respiratory and/or feeding issues may be affected by prominent issues such as swallowing dysfunction and silent aspiration. Clinicians should be aware of this risk and evaluate patients for any signs of feeding or swallowing difficulties.

Level of Evidence

4 Laryngoscope, 2018

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The Prevalence of Cricopharyngeal Webs in Elderly Cadavers

Objective

Cricopharyngeal webs (CPW) are a frequent cause of solid food dysphagia. They are difficult to diagnose and are often missed on swallowing fluoroscopy. The prevalence of CPWs is uncertain. The purpose of this study was to determine the prevalence of CPWs in elderly cadavers.

Methods

Direct laryngoscopy and cervical esophagoscopy were performed in 19 embalmed cadavers by independent two‐clinician consensus. Cadaver demographics and the presence and laterality of a CPW were recorded. The prevalence of CPW was calculated, and the size of the cricopharyngeus muscle (CPM) was quantified.

Results

The mean age of the cohort was 83 ( ± 12) years. Fifty‐three percent were female, and the mean body mass index was 19.7 ( ± 3). The causes of death were cardiovascular disease (10 of 19), cancer (5 of 19), and respiratory failure (4 of 19). A CPW was present in 68% (13 of 19) of cadavers. Forty‐seven percent (9 of 19) had a unilateral web, and 21% (4 of 19) had a bilateral web. There was no laterality predominance (P > 0.05). Forty‐two percent (8 of 19) had no CPM prominence; 32% (6 of 19) had a small/moderate CPM prominence; and 26% (5 of 19) had a significant CPM prominence.

Conclusion

The prevalence of cricopharyngeal webs in elderly cadavers is high (68%). The clinician should maintain a high index of suspicion for CPWs in patients with no other identifiable etiology of solid food dysphagia.

Level of Evidence

3b. Laryngoscope, 2018

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Is a schirmer's test necessary before blepharoplasty?

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Does anatomic subsite influence oral cavity cancer mortality? A SEER database analysis

Objective

To determine if there are differences in mortality from oral cavity squamous cell carcinoma (OCSCC) based on oral cavity (OC) subsites.

Methods

Using the Surveillance, Epidemiology, and End Results Program (SEER) 9 database, patients with sequence number 0 or 1 squamous cell OCSCC were analyzed by OC subsite for 5‐year cause‐specific mortality (CSM) from OCSCC. Proportional hazards regression determined the association between 5‐year CSM and OC subsites while controlling for treatment modality, stage, and demographic characteristics using hazard ratios. Significance was set at alpha = 0.05.

Results

20,647 OC patients were included in the regression analysis. The most commonly diagnosed sites were floor of mouth (34.4%) and oral tongue (34.3%). Floor of mouth, upper gum, and retromolar trigone were associated with lower CSM compared to oral tongue. Not receiving surgery and receiving radiation were associated with increased CSM, and CSM increased with cancer staging when distant or regional disease was compared to localized disease. Also, patients diagnosed at 60 years or older and black patients had increased CSM.

Conclusion

Among OCSCC patients, those with oral tongue cancer are more likely to experience CSM than patients with floor of mouth, upper gum, and retromolar trigone cancer. It is important to understand these mortality related differences in the management of OCSCC patients. Understanding subsite‐specific mortality may benefit prognosis counseling of OCSCC patients and elicit subsite‐directed research as a means to improve outcomes.

Level of Evidence

NA. Laryngoscope, 2018

https://ift.tt/2PNj0nn

Topical Application of 5‐Aminolevulinic Acid Is Sufficient for Photodynamic Therapy on Vocal Folds

Objectives

To evaluate the feasibility of topical photodynamic therapy (PDT) using 5‐aminolevulinic acid (5‐ALA) for vocal fold leukoplakia.

Study Design

Ex vivo and in vivo.

Methods

5‐ALA was applied topically as a 20% solution to ex vivo canine vocal folds. The penetration depth and concentrations of 5‐ALA in tissue were quantified using frozen sectioning and fluorescamine derivatization after 5‐ALA contact incubation or topical spraying. Then, 5‐ALA solution was sprayed on leporine vocal folds once, twice, or given systemically in vivo. Protoporphyrin IX (PPIX) location was visualized using fluorescence microscopy, and PPIX concentrations were measured using a fluorescent quantitative method. Hematoxylin and eosin (H&E) staining was performed to visualize the histological changes of vocal folds after PDT for each group.

Results

Topical incubation of 15 minutes with 5‐ALA achieved a penetration depth of over 2 mm and similar concentrations within the superficial 500 μm of epithelium, compared with longer incubation times. Topical spraying of 5‐ALA produced sufficient concentrations in vocal folds, but the retention time is short. An in vivo leporine model showed that laryngeal spraying of 20% 5‐ALA induced similar penetration depth and concentrations of PPIX compared to systemic administration of 5‐ALA. Two sprays of 20% 5‐ALA solution with an interval of 30 minutes are needed to produce complete exfoliation of vocal fold epithelium.

Conclusion

Topical PDT with laryngeal spraying of 20% 5‐ALA solution achieves sufficient therapeutic effects and is potentially applicable for the treatment of vocal fold leukoplakia.

Level of Evidence

NA. Laryngoscope, 2018

https://ift.tt/2DbhpkC

Evaluation of early oral cavity cancer treatment quality at a single institution

Objective

To evaluate the adherence to oral cavity quality guidelines endorsed by the American Head and Neck Society (AHNS) at a large tertiary care hospital.

Methods

This retrospective study identified patients treated for early‐stage oral tongue squamous cell carcinoma at a tertiary care hospital from 1992 to 2013. Patient charts were reviewed for 26 process quality measures and four key indicator process quality measures as endorsed by the AHNS. Patients were then grouped by diagnosis date either before (historical group, 1992–2007) or after (current treatment group, 2008–2013) the published process quality measures from the AHNS. Descriptive statistics were used to evaluate the rates of adherence for each process quality measure within the 2 groups.

Results

Of the 57 patients identified, 29 were female (51%). The mean age was 62.3 years. A majority of the oral cavity cancers were stage I (59.6%), followed by stage II (35.1%) and stage III (5.3%). Compliance with the process quality measures was in the acceptable range in both cohorts. However, several areas demonstrated lower adherence in both cohorts. Statistically significant improvements were noted between the two cohorts, which showed a measurable improvement in adherence to process quality measures in several key areas over time.

Conclusion

Using the process quality measures proposed by the AHNS, adherence to the process quality measures for early‐stage oral cavity cancer care at a tertiary care center was successfully evaluated. In general, good compliance with the proposed process quality measures was found and several areas for improvement were identified.

Level of Evidence

2c. Laryngoscope, 2018

https://ift.tt/2PK8qxB

Canal wall up surgery with mastoid and epitympanic obliteration in acquired cholesteatoma

Objectives/Hypothesis

The objective of this study was to evaluate surgical outcome and residual and recurrence rates of canal wall up (CWU) surgery with obliteration of the mastoid and epitympanum.

Study Design

Retrospective cohort study in a tertiary referral center.

Methods

Patients with (sequelae of) acquired cholesteatoma treated with primary or revision CWU surgery with obliteration of the epitympanum and mastoid were identified retrospectively from 2010 to 2014. Obliteration was performed with cartilage chips or a periosteal midtemporal flap in combination with bone pâté and/or hydroxyapatite. Patients were followed up with micro‐otoscopy and magnetic resonance imaging (MRI) with diffusion‐weighted imaging (DWI).

Results

Ninety‐nine ears in 96 patients were managed with obliteration of the epitympanum and mastoid following CWU surgery. Mean postoperative follow‐up was 39.6 (standard deviation [SD] = 16.3). Mean follow‐up until the last MRI‐DWI was 29.7 months (SD = 16.0). In total, 74 ears in 72 adult patients (mean age = 46.8 years) were operated and 25 ears in 24 pediatric patients (mean age = 12.8 years). The overall recurrence rate was 7.1%, and the residual rate was 7.1%. In comparison, before the introduction of obliteration, the residual rate in our clinic was 24.4% and the recurrence rate 39.7%. After CWU surgery with obliteration, recurrence in pediatric patients (16.0%) was more frequent than in adults (4.1%). Although this difference was not statistically significant, a trend was observed (P = .066).

Conclusions

Obliteration of the epitympanum and mastoid is a reliable and safe technique following CWU surgery for cholesteatoma, resulting in low residual and recurrence rates.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2Dev5eL

Measurement reliability of phonation threshold pressure in pediatric subjects

Objectives/Hypothesis

Phonation threshold pressure (PTP), the minimum subglottal pressure (P_s) required for phonation, is sensitive to changes in laryngeal biomechanics and is often elevated with pathology. Little is reported on PTP in children; challenges with task performance and measurement reliability represent barriers to routine clinical assessment.

Study Design

Pilot study evaluating PTP and P_s measurement reliability in children using labial and mechanical interruption.

Methods

Twenty‐two subjects aged 4 to 17 years (10.7 ± 3.9 years) participated. Ten trials were performed for each method; task order was randomized. For labial interruption, subjects produced /pα/ five times at softest (onset PTP) and comfortable amplitude. For mechanical interruption, subjects produced a sustained /α/ while a balloon valve interrupted phonation five times for 250 ms each; mechanical interruption was performed with a mouthpiece and mask. PTP was recorded as the difference between P_s and supraglottal pressure at phonation cessation (offset PTP). Mean PTP and P_s and intrasubject coefficients of variation were compared. Correlations with age were evaluated.

Results

Mean PTP (P < .001) and P_s (P = .005) were higher for labial interruption. Intrasubject coefficients of variation for PTP (P = .554) and P_s (P = .305) were similar across methods. Coefficient of variation was related to age for mechanical‐mask trials only (r = −0.628, P = .00175).

Conclusions

Differences in means are likely related to differences in task and PTP hysteresis effect. Reliability is comparable with all methods; using a mouthpiece may be preferable to a mask for mechanical interruption. Measurement of PTP is noninvasive, reliable, and may be a useful adjunct in pediatric voice assessment.

Level of Evidence

3b Laryngoscope, 2018

https://ift.tt/2POgpth

Real steak knives of cincinnati: Repeated foreign body ingestion with novel endoscopic removal

Repeated ingestion of foreign objects presents a multidisciplinary endoscopic dilemma. We report a 32‐year‐old female patient with history of multiple previous foreign body ingestions requiring several past exploratory laparotomies, who presents with a knife blade in the esophagus. We present a novel method of using a rigid cervical esophagoscope with a salivary bypass tube. The tip of the knife was isolated into the cervical esophagoscope, and the salivary bypass tube advanced off the cervical esophagoscope over the knife, shielding the serrated edge during removal preventing laceration to the esophagus.

https://ift.tt/2DdqQ32

I dream of Gini: Quantifying inequality in otolaryngology residency interviews

Objectives

Otolaryngology applicants routinely decry conflicting interview dates because this limits the number of interviews that one can attend, despite being offered an interview. Conversely, applicants also perceive that a large number of interviews are offered to a minority of applicants. We sought to verify and quantify the inequality in distribution of interviews attended.

Study Design

Retrospective analysis of the National Resident Matching Program (NRMP) 2016 Charting Outcomes in the Match and Electronic Residency Application Service (ERAS) historic specialty data.

Methods

The Gini coefficient, a commonly used indicator of economic inequality, was calculated using data from the 2016 Charting Outcomes in the Match to estimate the distribution of interviews attended. This data was compared to nine other specialties, comprising a wide range of competitiveness and specialty size.

Results

26% (110 of 416) of otolaryngology applicants accounted for half (1,721 of 3,426) of all possible interview positions. The Gini coefficient ranged from 0.43 to 0.84 across 10 specialties, with a higher coefficient indicating higher inequality. The Gini coefficient among otolaryngology applicants was 0.43, indicating lower inequality than most other specialties. When including only applicants who interviewed, the Gini coefficient was 0.23.

Conclusion

There is an unequal distribution of interview invitations, which likely reflects the reality of asymmetry in applicant competitiveness. Otolaryngology demonstrates the greatest equality in distribution, which may stem from a greater burden of hoarding. The specialty's perceived competitiveness mitigates factors such as cost and time, essentially encouraging more people to take as many interviews as they can.

Level of Evidence

NA. Laryngoscope, 2018

https://ift.tt/2PRIUq3

What defines asymmetric sensorineural hearing loss?

https://ift.tt/2D98tw9

Primavera: A new therapeutical approach to vulvo‐vaginal atrophy

Abstract

Vulvovaginal atrophy is a condition that affects women, although it is mainly associated with the onset of menopause mainly due to hormonal changes vulvovaginal laxity and mucosal atrophy can also affect women at different life stages such as after pregnancy or for cancer patients who have undergone chemo or endocrine therapy. This condition negatively influence quality of life, sexual desire, and self‐confidence. Many therapies have been considered mainly with inconclusive or transient results in terms of benefit factor. Recently, a new non‐invasive product, containing hyaluronic acid, oligopeptides, and antioxidants was introduced to the market. Its name is "Primavera," by Renaissance, Italy. The aim of this product is to allow a vulvo‐vaginal biostimulation and considered simple, safe, and satisfactory.

https://ift.tt/2RLVWTc

Cost‐of‐illness of Melanoma in Europe – a systematic review of the published literature

Abstract

Malignant melanoma accounts for the vast majority of skin cancer deaths. Primary prevention is used to increase knowledge about skin cancer and set incentives for a change in behaviour, which leads to a decrease in cases. Primary prevention may be cost‐effective or even cost saving. Cost‐of‐illness studies provide information on such potential savings.

The purpose of this study is to give an overview on cost‐of‐illness studies in European countries and to compare the cost‐of‐illness in total and by cost categories. The results can be used to model potential cost savings from prevention.

We conducted a systematic literature research in PubMed using the PRISMA checklist. All costs were converted into Euro and adjusted for the reference year 2012. For the ranking of countries according to their cost‐of‐illness, all costs were adjusted for the purchasing power parity.

Studies focusing on stage III–IV melanoma all include information on hospital, hospice, and outpatient treatment. Costs for the treatment of advanced melanoma range between € 2,972 in Italy and € 17,408 in Sweden after adjusting for PPP.

Most studies on stage I–IV melanoma include costs of hospitalisation, outpatient treatment and GP consultation. Direct costs range from € 923 in Sweden to € 9,829 in Denmark. Three articles also include information on indirect costs. Mortality costs vary between € 3,511 in Sweden and € 20,408 in England, morbidity costs between € 103 in Sweden and € 4,550 in England.

We showed that costs for the treatment of skin cancer are moderately high in the included countries. Since after publication of the articles new costly drugs were approved in Europe, treatment costs of melanoma in Europe may be expected to have risen in the last few years, which means that there is a high expectable potential for prevention programmes to become cost‐effective or even cost saving.

This article is protected by copyright. All rights reserved.

https://ift.tt/2PjQDh3

Decreasing sunbed use in the German population between 2001–2015: survey in 155,679 working persons

Abstract

Background

UV radiation is a proven cause of skin cancer. Use of sunbeds has been shown to provide an attributable risk.

Objective

To evaluate the proportion of regular sunbed use in Germany based on large‐scale population‐based surveys over 15 years.

Methods

Skin cancer screenings by dermatologists were conducted between 2001 and 2015 in more than 500 German companies, including a clinical examination and interviews on the risk behavior related to sunburns and sunbeds.

Results

Among 155,679 persons included regular sunbed use significantly declined from 11.0% in 2001 to 1.6% in 2015 (p < 0.001). There were significantly higher rates of sunbed use in women (12.5% / 2.0%) versus men (7.3% / 1.3%; p < 0.001), in younger persons and in participants with darker skin (type II and III) versus fair skin (type I). Individuals with sunburns in childhood were significantly more often sunbed users (5.1% vs. 4.6%; p = 0.002). A remarkable decline of sunbed use was observed after 2009 (7.0% in 2001–2008 and 2.2% in 2009–2015). This reduction occurred in the time of a legal ban of sunbed use for minors but also with the start of the national skin cancer screening program.

Conclusion

Use of sunbeds in the German adult population has dropped by more than 85% in the past decade. Primary prevention, including the large public awareness following the legal ban of sunbed use for young people and the effects of the statutory skin cancer screening program may have contributed to this.

This article is protected by copyright. All rights reserved.

https://ift.tt/2QwQhAo

A novel role of angiotensin II in epidermal cell lineage determination: Angiotensin II promotes the differentiation of mesenchymal stem cells into keratinocytes through the p38 MAPK, JNK and JAK2 signalling pathways

Summary

Background

Recent evidence suggests that angiotensin II (Ang II) plays a role in cutaneous wound healing. Mesenchymal stem cells (MSCs) are known as a rich source of cells that re‐establish healed skin. However, the potential impact of Ang II on MSC differentiation into keratinocytes is still unknown.

Objective

The present study was conducted to explore the effect of Ang II on differentiation of bone marrow‐derived MSCs (BM‐MSCs) into keratinocytes.

Methods

BM‐MSCs were isolated from rat bone marrow and cultured. The expression of Ang II type 1 (AT₁) and type 2 (AT₂) receptors was examined by immunofluorescence staining. The differentiation of BM‐MSCs into keratinocytes was investigated by flow cytometry or/and histological observation.

Results

The BM‐MSCs constitutively expressed both AT₁ and AT₂ receptors. The differentiation of BM‐MSCs into keratinocytes was successfully induced. Interestingly, incubation of BM‐MSCs with Ang II further promoted the differentiation of BM‐MSCs into keratinocyte, which was abolished by pre‐treatment with losartan, an AT₁ receptor antagonist, but not by PD123319, an AT₂ receptor antagonist. Moreover, the p38 mitogen‐activated protein kinase (MAPK) inhibitor SB203580, the c‐Jun N‐terminal kinase (JNK) inhibitor SP600125 and the Janus‐activated kinase (JAK)2 inhibitor AG490 suppressed Ang II‐induced differentiation of BM‐MSCs into keratinocytes. The phosphoinositide‐3 kinase (PI3K) inhibitor wortmannin and MEK1/2 inhibitor U0126 had no effect on BM‐MSC differentiation into keratinocytes.

Conclusions

Our data demonstrated for the first time that Ang II plays a promotive role in the differentiation of BM‐MSC into keratinocytes through the AT₁ receptor, and that the p38 MAPK, JNK and JAK2 signalling pathways are involved in this process.

This article is protected by copyright. All rights reserved.

https://ift.tt/2Qs1LVI

Mannosylerythritol lipids inhibit melanogenesis via suppressing ERK‐CREB‐MiTF‐tyrosinase signaling in normal human melanocytes and a three‐dimensional human skin equivalent

Abstract

Hyperpigmentation is caused by excessive production of melanin in melanocytes. Mannosylerythritol lipids (MELs) are glycolipid biosurfactants that are abundantly produced by yeasts and used commercially in cosmetics. However, the potential depigmenting efficacy of MELs has not been evaluated. In this study, the depigmentary effect of MELs was tested in primary normal human melanocytes (NHMs), α‐melanocyte‐stimulating hormone (MSH)‐stimulated B16 cells (murine melanoma cells) and a human skin equivalent (MelanoDerm) using photography, Fontana‐Masson (F&M) staining, and two‐photon microscopy. MELs significantly decreased the melanin contents in NHMs and α‐MSH‐stimulated B16 cells. Consistent with these findings, MELs treatment had a clear whitening effect in a human skin equivalent, brightening the tissue color and reducing the melanin content. The molecular mechanism underlying the anti‐melanogenic effect of MELs treatment was examined by real‐time PCR and Western blotting. Mechanistically, MELs clearly suppressed the gene expression levels of representative melanogenic enzymes, including tyrosinase, Tyrp‐1, and Tyrp‐2, by inhibiting the ERK/CREB/MiTF signaling pathway in NHMs. This work demonstrates for the first time that MELs exert whitening effects on human melanocytes and skin equivalent. Thus, we suggest that MELs could be developed as a potent anti‐melanogenic agent for effective whitening, beyond their use as a biosurfactant in cosmetics.

This article is protected by copyright. All rights reserved.

https://ift.tt/2PkiLk5

Three strategies for displaying the postcricoid space and pyriform sinus: a matched case‐controlled study of 50 patients

Abstract

The postcricoid space and pyriform sinus are difficult to completely display under routine laryngoscopy examination.

We present the results obtained from 50 patients who were randomly recruited to receive a laryngoscopy examination via a routine, Valsalva manoeuvre combined with anterior cervical skin traction (V‐ACST), followed by a Valsalva manoeuvre combined with the modified Killian method (V‐MK).

The routine method is not suitable for displaying the postcricoid space.

In general, both the V‐ACST and V‐MK displayed the postcricoid space and pyriform sinus very well.

The V‐ACST displayed significantly more of the postcricoid space, whilst the V‐MK was clear better at exposing the pyriform sinus.

This article is protected by copyright. All rights reserved.

https://ift.tt/2FfekTe

Design of Skin Islands for a Myocutaneous Serratus Anterior Free Flap ‐ An Anatomical Study and Clinical Implication for Pharyngeal Reconstruction after Laryngopharyngectomy

Abstract

Objectives

The main purpose of this study was to evaluate flap size and flap design of skin islands in myocutaneous serratus anterior free flaps (SAFFs) in fresh cadavers and to further investigate whether myocutaneous SAFFs are suitable flaps for pharyngeal reconstruction after laryngopharyngectomy.

Methods

Dissection and injection of methylene blue was performed in 20 hemithoraces of 13 fresh cadavers to evaluate flap size and location of skin islands. Based on these preclinical data, we performed pharyngeal reconstruction with myocutaneous SAFF in 5 patients after laryngopharyngectomy.

Results

Perfused skin paddles were found in all specimens with a mean size of perfused skin islands of 85.6 ± 49.8 cm². Lengths and widths of skin islands ranged from 10‐21 cm and 6‐20.5 cm, respectively. Flap size did not significantly differ between males and females (p=0.998), left compared to right hemithoraces (p=0.468) and between paired specimens (p=0.915). All skin islands were found within the upper 29.3% to 51.7% of hemithorax (calculated from axilla to costal arch), and between latissimus dorsi muscle posteriorly and anterior axillary line anteriorly. Accordingly, myocutaneous SAFFs were used for pharyngeal reconstruction after laryngopharyngectomy in 5 patients with advanced hypopharyngeal carcinomas. Three patients had uneventful courses, while one patient developed immediate intraoperative flap loss and another patient developed partial necrosis of SAFF on postoperative day 7.

Conclusion

Skin islands of SAFF have reliable blood supply, which allow harvest of large myocutaneous SAFFs that can be used also for pharyngeal reconstruction after laryngopharyngectomy.

This article is protected by copyright. All rights reserved.

https://ift.tt/2qBGIoe

The influences of age, gender and geometric pattern of visual image on the verticality perception: a subjective visual vertical (SVV) study among Malaysian adults

Abstract

Objectives

Subjective visual vertical (SVV) is a simple, quick and reliable test for measuring utricular function. The literature on the effects of fundamental demographic variables such as age and gender on SVV is inconclusive and should be supported by research with larger samples. The aim of the present study was to determine the influences of age, gender and geometric pattern of visual image on SVV among healthy adults.

Study Design

This study employed a repeated measures design.

Settings

Otorhinolaryngology Clinic, Hospital Universiti Sains Malaysia, Malaysia.

Participants

Eligible Malaysian adults (N=187, aged 21‐75 years) were recruited and categorized into young (N=60), middle‐aged (N=66) and older (N=61) groups. Most of them were Malay and 51.3% were men.

Main outcome measures

SVV angles (in degrees) were determined from each participant in a static upright condition using a computerized SVV device. They were asked to indicate their verticality perception for three types of visual images (solid line, dotted line and arrow pattern).

Results

Three‐way mixed ANOVA revealed insignificant influences of age and gender on SVV results (P>.05). In contrast, mean SVV angles were significantly higher for the arrow pattern than for other visual images (P=.004).

Conclusion

While the insignificant influences of age and gender on static SVV are further ascertained with larger samples, the perception of verticality is less accurate when aligning a more geometrically complex visual image (i.e. arrow pattern). Further SVV research on vestibular‐disordered patients is beneficial, particularly to verify the normative data obtained with this complex visual image.

This article is protected by copyright. All rights reserved.

https://ift.tt/2FeLjXT

The use of video‐laryngoscopy in head and neck surgery

Abstract

Direct visualisation of the upper aerodigestive tract is a fundamental skill for ENT surgeons. Rigid endoscopes themselves have seen little transformation since they were first developed for gastroscopy by Kussmaul in 1868¹. In an era of ultra high definition and 3D technology, a straight, rigid metal tube with adjoining light source carrier to inspect mucosal surfaces up to 40cm from the surgeon's eye could benefit from updating. In our department, we favour the use of the video‐laryngoscope, specifically the C‐MAC system from Karl Storz.

This article is protected by copyright. All rights reserved.

https://ift.tt/2qCOvCx

Identification of Pen m 4 as a potential cause of occupational asthma to Gammarus shrimp

We present the case of a 34-year-old male patient employed for 8 years in a company manufacturing and packaging animal feed. The patient developed occupational asthma to dry Gammarus powder. The diagnosis was ...

https://ift.tt/2PmgmWm

Prognostic significance of bone morphogenetic protein 6 (BMP6) expression, clinical and pathological factors in clinically node-negative oral squamous cell carcinoma (OSCC)

Bone morphogenetic protein 6 (BMP6) has unique properties regarding structure and function in supporting bone formation during development and adult life. Despite its known role in various malignant tumors, the prognostic significance of BMP6 expression in oral squamous cell carcinoma (OSCC) remains unknown. The aim of the study was to investigate immunohistochemical expression of BMP6 in OSCC in correlation with clinical and pathological parameters, disease recurrence and survival. In addition, we investigated other parameters in order to identify prognosticators of neck metastases and final outcome.

https://ift.tt/2RKoBIe

A simple method to estimate the linear length of the orbital floor in complex orbital surgery

The orbital floor (OrF) and infraorbital rim (IOR) repair in cases of complete destruction is challenging mainly due to the fact that the defect length cannot be measured. The aim of the current study is to develop a method of calculating the Orf length by using the gender and the lengths of the medial, superior and lateral orbital walls (OrW) of the same orbit.

https://ift.tt/2Dwlil9

The feasibility of rib grafts in long span mandibular defects reconstruction: a long term follow up

To evaluate the efficiency of reconstruction of long span mandibular defects using split rib bundle bone graft.

https://ift.tt/2ROHYjH

The antifungal agent of silver nanoparticles activated by diode laser as light source to reduce C. albicans biofilms: an in vitro study

Abstract

Candida albicans is a normal flora caused fungal infections and has the ability to form biofilms. The aim of this study was to improve the antifungal effect of silver nanoparticles (AgNPs) and the light source for reducing the biofilm survival of C. albicans. AgNPs were prepared by silver nitrate (AgNO₃) and trisodium citrate (Na₃C₆H₅O₇). To determine the antifungal effect of treatments on C. albicans biofilm, samples were distributed into four groups; L + P+ was treatment with laser irradiation and AgNPs; L + P− was treatment with laser irradiation only; L − P+ was treatment with AgNPs only (control positive); L − P− was no treatment with laser irradiation or AgNPs (control negative). The growth of fungi had been monitored by measuring the optical density at 405 nm with ELISA reader. The particle size of AgNPs was measured by using (particle size analyzer) and the zeta potential of AgNPs was measured by using Malvern zetasizer. The PSA test showed that the particle size of AgNPs was distributed between 7.531–5559.644 nm. The zeta potentials were found lower than − 30 mV with pH of 7, 9 or 11. The reduction percentage was analyzed by ANOVA test. The highest reduction difference was given at a lower level irradiation because irradiation with a density energy of 6.13 ± 0.002 J/cm² resulted in the biofilm reduction of 7.07 ± 0.23% for the sample without AgNPs compared to the sample with AgNPs that increased the biofilm reduction of 64.48 ± 0.07%. The irradiation with a 450-nm light source had a significant fungicidal effect on C. albicans biofilm. The combination of light source and AgNPs provides an increase of biofilm reduction compared to the light source itself.

https://ift.tt/2FeWxvh

Study of Anti-PD-1 Antibody SHR-1210 Plus Apatinib as Second-Line Treatment of Advanced Esophageal Squamous Cell

Condition:   Esophageal Cancer
Intervention:   Drug: Apatinib+SHR-1210
Sponsor:   The First Affiliated Hospital of Zhengzhou University
Not yet recruiting

https://ift.tt/2SXY77L

Alpha Radiation Emitters Device for the Treatment of Cutaneous, Mucosal or Superficial Soft Tissue Neoplasia (DaRT)

Conditions:   Skin Cancer;   Mucosal Neoplasm of Oral Cavity;   Soft Tissue Neoplasm
Intervention:   Device: Radiation: Diffusing Alpha Radiation Emitters Therapy (DaRT)
Sponsor:   Alpha Tau Medical LTD.
Not yet recruiting

https://ift.tt/2zEwLL8

Treatment of alopecia areata: An Australian expert consensus statement

Abstract

Alopecia areata (AA) severity varies from a single small patch to complete loss of scalp hair, body hair, eyelashes and eyebrows. While 40% of all affected individuals only ever get one patch and will achieve a spontaneous complete durable remission within 6 months, 27% will develop additional patches but still achieve complete durable remission within 12 months and 33% will develop chronic AA. Without systemic treatment, 55% of individuals with chronic AA will have persistent multifocal relapsing and remitting disease, 30% will ultimately develop alopecia totalis and 15% will develop alopecia universalis. The unpredictable course and psychological distress attributable to AA contributes to the illness associated with AA. Numerous topical, intralesional and systemic agents are currently used to treat AA; however, there is a paucity of data evaluating their use, effectiveness and tolerability. Topical therapy, including topical glucocorticosteroids, minoxidil and immunotherapy, can be used in cases of limited disease. There are no universally agreed indications for initiating systemic treatment for AA. Possible indications for systemic treatment include rapid hair loss, extensive disease (≥50% hair loss), chronic disease, severe distress or a combination of these factors. Currently available systemic treatments include glucocorticosteroids, methotrexate, ciclosporin, azathioprine, dapsone, mycophenolate mofetil, tacrolimus and sulfasalazine. The optimal treatment algorithm has not yet been described. The purpose of this consensus statement is to outline a treatment algorithm for AA, including the indications for systemic treatment, appropriate choice of systemic treatment, satisfactory outcome measures and when to discontinue successful or unsuccessful treatment.

https://ift.tt/2qCKs92

Acrodermatitis continua of Hallopeau with dense infiltration of IgG4‐positive cells in the lesional dermis

Abstract

Acrodermatitis continua of Hallopeau (ACH) is a rare acropustular subtype of psoriasis. The characteristic feature of ACH is chronic, painful and destructive disease affecting the hands and feet, especially the fingertips and toes. The pathogenic mechanisms of ACH have not been fully elucidated. We report a case of ACH whose skin lesions showed dense infiltration of IgG₄‐positive cells in the dermis.

This article is protected by copyright. All rights reserved.

https://ift.tt/2qDxoQN

Multiple cutaneous reticulohistiocytomas after haematopoietic cell transplantation: contribution of donor and host‐derived cells

Abstract

Reticulohistiocytoma or reticulohistiocytosis of the skin is a histiocytic disorder which is histologically characterized by the presence of numerous reticulohistiocytes: large histiocytes with an abundant eosinophilic cytoplasm. The aetiology of reticulohistiocytosis and the origin of reticulohistiocytes are unknown. Multiple cutaneous reticulohistiocytomas (MCR) is a reticulohistiocytosis of the skin that is characterized by generalized eruptions and an absence of articular symptoms or internal malignancies. Around 20 MCR cases have been reported in the literature, but the association between reticulohistiocytosis and haematopoietic cell transplantation (HCT) has not been described.

This article is protected by copyright. All rights reserved.

https://ift.tt/2FarH6X

Recruitment of CCR6+ Foxp3+ regulatory gastric infiltrating lymphocytes in Helicobacter pylori gastritis

Abstract

Helicobacter pylori (H. pylori) infection is associated with an inflammatory response in the gastric mucosa, leading to chronic gastritis, peptic ulcers, and gastric cancer. Increased T‐cell infiltration is found at sites of H. pylori infection. The CCR6⁺ subset of CD4⁺ regulatory T cells (Tregs), a newly characterized subset of Tregs, has been reported to contribute to local immune inhibition. However, whether CCR6⁺ Tregs are present in H. pylori gastritis, and what their relationship is to disease prognosis, remains to be elucidated. In this study, gastric infiltrating lymphocytes were isolated from endoscopic biopsy specimens of H. pylori gastritis patients and analyzed. We found that in gastric infiltrating lymphocytes, CCR6⁺ CD4⁺ CD25^high Tregs, which express high levels of CD45RO, are positively associated with more severe inflammation in gastric mucosa during H. pylori infection. Furthermore, the frequency of CCR6⁺ Tregs in gastric infiltrating lymphocytes, but not CCR6⁻ Tregs, is significantly increased in inflamed gastric tissues, which is inversely correlated with significantly lower expression of IFN‐γ⁺ CD8⁺ T cells. We also found that the frequency of CCR6⁺ Tregs is positively correlated with the frequency of CD4⁺ IFN‐γ⁺ T cells. In addition, the frequency of CCR6⁺ Tregs, but not that of CCR6⁻ Tregs, is significantly correlated with increased inflammation in H. pylori gastritis. This study demonstrates that immunosuppression in H. pylori gastritis might be related to the activity of CCR6⁺ Tregs, which could influence disease prognosis.

https://ift.tt/2PNftVX

Hydroxyurea‐induced dermatomyositis koebnerizing at the site of previous shingles

https://ift.tt/2QrgYWV

Association of adjuvant radioactive iodine therapy with survival in node-positive papillary thyroid cancer

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Yungang Sun, Jian Gong, Bin Guo, Jingjie Shang, Yong Cheng, Hao Xu

Abstract

Purpose

To assess the effect of adding radioactive iodine (RAI) therapy to total thyroidectomy (TT) on overall survival (OS) in patients presenting with papillary thyroid cancer (PTC) and cervical pathologically proven LN metastases (pN1).

Methods and materials

We identified a cohort of patients with PTC and nodal metastases treated with TT alone or TT plus RAI in the Surveillance, Epidemiology and End Results database between 2004 and 2013. Propensity score 1-to-1 matching was used to balance baseline characteristics. Cox proportional hazards regression models and Kaplan-Meier survival analysis were used to test the relationship between RAI and OS.

Results

In all, 15,953 patients were identified. After propensity score matching, 12,128 patients remained in each group. Based on multivariate Cox analysis, patients treated with TT + RAI had a statistically significant improvement in OS compared with those treated with TT alone [hazard ratio (HR) = 0.54, P < 0.001)], and significance persisted in the matched cohort (HR = 0.41, P < 0.001). In a subgroup analysis, the survival benefit was observed among patients ≥55 years but not among those <55 years (age < 55: HR = 1.06, P = 0.72; age ≥ 55: HR = 0.33, P < 0.001). Patients with stage T4 benefited most from RAI treatment (HR = 0.29, P < 0.001).

Conclusion

This propensity-matched analysis suggests that RAI therapy after TT was associated with improved OS in PTC patients with pN1 disease. Adjuvant RAI therapy needs to be considered in this patient group.

https://ift.tt/2T4ey2u

The genomic landscape of UM-SCC oral cavity squamous cell carcinoma cell lines

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Megan L. Ludwig, Aditi Kulkarni, Andrew C. Birkeland, Nicole L. Michmerhuizen, Susan K. Foltin, Jacqueline E. Mann, Rebecca C. Hoesli, Samantha N. Devenport, Brittany M. Jewell, Andrew G. Shuman, Matthew E. Spector, Thomas E. Carey, Hui Jiang, J. Chad Brenner

Abstract

Objectives

We sought to describe the genetic complexity of 14 UM-SCC oral cavity cancer cell lines that have remained uncharacterized despite being used as model systems for decades.

Materials and Methods

We performed exome sequencing on 14 oral cavity UM-SCC cell lines and denote the mutational profile of each line. We used a SNP array to profile the multiple copy number variations of each cell line and use immunoblotting to compare alterations to protein expression of commonly amplified genes (EGFR, PIK3CA, etc.). RNA sequencing was performed to characterize the expression of genes with copy number alterations.

Results

The cell lines displayed a highly complex network of genetic aberrations that was consistent with alterations identified in the HNSCC TCGA project including PIK3CA amplification, CDKN2A deletion, as well as TP53 and CASP8 mutations, enabling genetic stratification of each cell line in the panel. Copy number FISH and spectral karyotyping analysis demonstrate that cell lines retain chromosomal heterogeneity.

Conclusions

Collectively, we developed an important resource for future oral cavity HNSCC cell line studies and highlight the complexity of genomic aberrations in cell lines.

https://ift.tt/2zB7rW4

Prevalence of hepatitis C virus infection and its impact on the prognosis of head and neck cancer patients

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Juliana de Brito Rangel, Luiz Claudio Santos Thuler, Jorge Francisco da Cunha Pinto

Abstract

Objective

Several studies have shown a higher prevalence of hepatitis C virus (HCV) infection among patients with head and neck cancer (HNC) compared to the general population. In Brazil, the prevalence of HCV infection is considered low (1.38%). The aim of this study was to determine HCV prevalence and how this can modify outcomes of patients with HNC.

Study design

Retrospective cohort.

Methods

Patients with a diagnosis of malignant neoplasm in the head and neck (HN) region and who had serology performed for HCV were included. Patients were classified into two groups: head and neck squamous cell carcinoma (HNSCC) and other head and neck malignant neoplasms (OHNMN). Descriptive statistics were performed for all variables of interest. Means were compared using ANOVA and proportions using chi-square tests. Survival data were compared by Kaplan-Meier curves and log-rank test.

Results

Global HCV prevalence in patients with HNC was 7.8%, reaching 12.8% in HNSCC and 3.4% in OHNMN (p = 0.003). There was a higher risk of developing a second primary neoplasm in HNSCC compared to OHNMN patients (20.6% versus 4.6%; p = 0.001). The mean survival was not different between HCV-positive and HCV-negative patients (6.0 years versus 6.6 years, respectively, p = 0.516).

Conclusion

The prevalence of HCV infection was higher in HNC patients compared to the general Brazilian population. It seems reasonable to consider that HCV infection is associated with an increased risk of HNC, but HCV infection does not worsens the prognosis of HNC patients.

https://ift.tt/2SZ0EOX

Star flap: new reconstructive technique for defects of the scalp

Publication date: Available online 8 November 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): Marco Pedrazzoli, Giacomo Colletti, Federico Biglioli

https://ift.tt/2Phxf4q

Retrospective comparison of the number of screws used for fixation of skeletal anchorage plates in orthodontics, and their failure rates

Publication date: Available online 8 November 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): D. Thean, D. Gebauer, K. Wan, N. Vujcich, M. Goonewardene

Abstract

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. Age, sex, and coexisting medical conditions did not affect the failure rate. There was a higher failure rate for those placed in the mandible (11/105) than for those placed in the maxilla (4/71). SAP provide a stable source of skeletal anchorage for orthodontic treatment. Our results show that those fixed with two screws may be marginally more likely to fail than those fixed with three, but further studies are needed to investigate the association between failure and the number of screws used.

https://ift.tt/2Qu2xBx

Programme des Communications Orales

Publication date: Available online 9 November 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s):

https://ift.tt/2PTXbTm

Présentations rares d’hémangiomes infantiles : 4 cas

Publication date: Available online 9 November 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): V. Babic, A. Schoeffler, S. Moawad, L. Mainard, J.-L. Schmutz, A.-C. Bursztejn

Résumé

Introduction

L'hémangiome infantile (HI) est une tumeur vasculaire fréquente et bénigne de l'enfant. Dans la majorité des cas, son diagnostic est clinique. L'examen complémentaire de première intention est l'échographie-doppler quand il existe un doute diagnostique. Nous rapportons quatre cas d'hémangiomes infantiles dont la présentation atypique était responsable d'un retard diagnostique et pour lesquels l'imagerie n'a pas été contributive.

Observations

Un enfant avait des papules et des nodules violacés congénitaux sur le dos du pied, le second une ulcération inaugurale du siège et les deux derniers des télangiectasies isolées ou surmontant une tache érythémateuse. Dans deux cas, l'échographie ne mettait en évidence aucune lésion vasculaire et dans les deux autres cas, l'absence d'hyperhémie ne permettait pas de conclure au diagnostic d'HI. Chez un patient, le diagnostic a été établi par biopsie cutanée, et chez les trois autres, par l'évolution clinique.

Discussion

Nous rapportons quatre formes rares d'hémangiomes infantiles responsables d'une errance diagnostique initiale. Le caractère atypique de certains HI oriente le clinicien et le radiologue vers d'autres lésions, qui n'ont parfois aucun contingent vasculaire. Il est important pour le dermatologue de connaître ces formes rares d'HI afin de raccourcir le délai diagnostique et de permettre une prise en charge précoce et adaptée.

Summary

Background

Infantile hemangioma (IH) is a common benign vascular tumor in children. In most cases, diagnosis is based entirely on clinical examination. When the diagnosis is uncertain, the first-line complementary examination is Doppler ultrasound. We report 4 cases of atypical infantile hemangiomas with delayed diagnosis and non-contributory imaging.

Patients and methods

One child had congenital purple papules and nodules on the back of the foot, the second had inaugural ulceration of the buttocks, and the last two presented telangiectasia, either isolated or on an erythematous macula. In two cases, ultrasound showed no vascular lesions, and in the other two cases, the absence of hyperemia did not allow a diagnosis of IH to be made. For one patient, diagnosis was made on the basis of cutaneous biopsy, and for the other three, on the basis of clinical course.

Discussion

We report 4 rare forms of infantile hemangioma resulting in initial diagnostic error. The atypical nature of some IHs may direct the clinician and the radiologist toward other diagnoses that in some cases have no vascular contingent. It is important for the dermatologist to be aware of these rare forms of IH in order to reduce the time to diagnosis and allow early initiation of appropriate management.

https://ift.tt/2Dfqnxp

Maladie de Grover sous anti PD-1 pour mélanome métastatique

Publication date: Available online 9 November 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): M. Amini-Adle, B. Balme, S. Dalle

https://ift.tt/2PQPLjs

Granulomes pyogéniques récidivants

Publication date: Available online 8 November 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): M. Roberge, M. Levavasseur, S. Darras, C. Capelle, C. Becquart, M. Vonarx, E. Martin de Lassalle, E. Delaporte, D. Staumont-Salle

https://ift.tt/2DfqbhF

Le syndrome de Huriez enfin déchiffré : haplo-insuffisance d’un gène impliqué dans la réparation de l’ADN par recombinaison homologue

Publication date: Available online 8 November 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): O. Dereure

https://ift.tt/2PQHhsw

Allergen‐specific IgE over time in women before, during and after pregnancy

https://ift.tt/2yZlfdK

Hypnotherapeutische Interventionen zur Behandlung von Schmerzen

Zusammenfassung

Hintergrund

Schmerzen sind ein häufiges Problem bei Tumorerkrankungen. Die ressourcenorientierte Nutzung subjektiver Trancephänome bietet sich zu deren Behandlung in besonderer Weise an.

Ziel der Arbeit

Ziel dieser Übersichtsarbeit ist die Darstellung der Vorgehensweise, der Evidenz für die klinische Wirksamkeit und des Interventionsspektrums der Hypnotherapie bei Schmerzen

Material und Methoden

Es wurde eine Literaturrecherche zu den einzelnen Anwendungsbereichen durchgeführt und klinisches Erfahrungswissen gesammelt.

Ergebnisse

Hypnose und Hypnotherapie erlauben die Behandlung und erfolgreiche Kontrolle eines breiten Spektrums von akuten und chronischen Schmerzen. Es gibt ein wirksames empirisch belegtes Interventionsspektrum, von dem die Mehrzahl aller Patienten zu profitieren vermag. Die Unterweisung in Selbsthypnose bildet eine wertvolle Basisfertigkeit zur Rückerlangung von Kontrolle und zur Steigerung der Selbstwirksamkeit und sollte frühzeitig im Behandlungsverlauf erfolgen. Die verschiedenen zur Verfügung stehenden Techniken sollten möglichst kombiniert zum Einsatz kommen und auf die individuellen subjektiven Ressourcenerfahrungen der Patienten zurückgreifen. Erkenntnisse der Neurowissenschaften über die zentralnervöse Schmerzverarbeitung legen die Verwendung verarbeitungsspezifischer Suggestionen nahe, die die jeweiligen Schmerzkomponenten systematisch ansprechen.

Schlussfolgerung

Hypnotherapeutische Interventionen zur Behandlung von Schmerzen bieten sich aufgrund ihrer raschen Wirksamkeit sowie des permissiven Vorgehens bei Tumorpatienten an. Besondere Stärken dieser Interventionen sind die ressourcenorientierte Nutzung der subjektiven Trancephänomene sowie die gleichzeitige Berücksichtigung verschiedener Komponenten des Schmerzkomplexes.

https://ift.tt/2RFycjE

The business model of oral medicine – disrupting the practice of dental medicine

Publication date: Available online 8 November 2018

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

Author(s): Andres Pinto, Rui Amaral Mendes

https://ift.tt/2qBTnI5

Role of induction chemotherapy in sinonasal malignancies: a systematic review

Background

Cancers of the paranasal sinuses are rare tumors that tend to be aggressive and usually are diagnosed at an advanced stage. Despite being rare, these tumors include a wide spectrum of histological subtypes with different biological behaviors. Choosing the optimal treatment modalities and analyzing the different oncological outcomes is therefore challenging. This study aims to evaluate the role of induction chemotherapy prior to definitive local therapy for sinonasal malignancies.

Methods

A systematic review of the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines was conducted. With the assistance of a medical librarian, data sources including MEDLINE, PubMed, Cochrane library, EMBASE, NCBI Bookshelf, National Guideline Clearinghouse, and Clinicaltrials.gov were searched using a customized search strategy that yielded 1758 articles. Inclusion criteria used were as follows: (1) the study has a patient population with 3 or more patients with previously untreated sinonasal malignancies; (2) patients underwent induction chemotherapy prior to definitive local therapy; (3) pretreatment staging information was documented; (4) overall survival was reported by histology type either in table or Kaplan‐Meier format. Nine studies with 220 patients ultimately met inclusion criteria and were analyzed in groups based on tumor histology.

Results

For squamous cell carcinoma (SCC), the 5‐year overall survival was 51%. For neuroendocrine tumors, the 5‐year overall survival was 78%. Eighteen percent (18%) of patients with pretreatment orbital involvement ultimately underwent orbital exenteration.

Conclusion

Induction chemotherapy in the management of sinonasal malignancies has similar overall survival outcomes as other standard treatment modalities and can be offered as an option to patients as part of multimodality therapy.

https://ift.tt/2yZDyzv

Signaling lymphocyte activation molecule family in systemic lupus erythematosus

Publication date: Available online 8 November 2018

Source: Clinical Immunology

Author(s): Denis Comte, Maria P. Karampetsou, Morgane Humbel, George C. Tsokos

Abstract

Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease characterized by a breakdown in immune tolerance leading to the development of auto-reactive lymphocytes and autoantibodies. Recent findings have provided new insight on the role of the signaling lymphocytic activation molecule family (SLAMF) receptors, a group of nine co-regulatory molecules involved in the activation of hematopoietic cells, and their downstream protein SLAM-associated protein (SAP), into the pathogenesis of SLE. This review summarizes the current knowledge on SLAMF in human SLE immunopathogenesis, and the importance of SLAMF molecules as new therapeutic targets.

https://ift.tt/2PfNrmC

The Importance of Technical Skills Assessment during an Airway Foreign Body Removal Course

Publication date: Available online 9 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Mason Hinchcliff, Michael Kao, Kaalan Johnson

Abstract

Purpose

Surgical simulation has proven useful in training for high-acuity, lowfrequency events such as airway foreign body removal (AWFBR). Studies have supported the role of simulation to improve trainee confidence and technical proficiency, but rigorous methodology is often lacking.

Through a pilot study, we sought to evaluate the feasibility and utility of two-view video capture for rigorous assessment of trainee skill in an educational course setting.

Methods

Participants were asked to perform 1) self-assessment surveys using 5- point Likert scale questions and 2) rigid bronchoscopy with AWFBR on intubation trainers, at the beginning and end of a multi-institution airway course. Video was collected from endoscopic and wide-angle body cameras. The videos were blinded and evaluated in random order by two expert reviewers using a 5-point pediatric airway endoscopy specific objective structured assessment of technical skills(OSATS) instrument.

Results

Fourteen trainees submitted pre- and post-course surveys, and eight of these also had complete video data. Faculty feedback indicated the importance of pre- and post-course AWFBR recordings for real-time trainee feedback and post-course curricular refinement. Survey data showed an increase in confidence for AWFBR from 2.0 to 3.3(p=0.05). Average OSATS scores increased from 1.84 to 2.58 but this did not reach significance(p=0.51). Paired improvements in confidence exceeded improvements in OSATS scores(1.29 vs. 0.18, p=0.058).

Conclusions

Rigorously evaluated two-view video capture was feasible in an educational course setting. The course resulted in improvements in confidence to a greater degree than OSATS scores. This supports the importance of assessing course impact and refining curricula using all available data including objectively assessing technical skills.

https://ift.tt/2DcWAp1

Causes and prevention of revision surgery for preauricular sinus: A histopathological analysis

Publication date: Available online 9 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Woo Jin Kim, Yeo Myeong Lee, Do Hun Kim, Sihong Choe, Donghoo Lee, Sung Yool Park, MiSeon Kang, Hwa Jin Cho, Kyung Wook Heo

Abstract

Objective

Recurrence rates following preauricular sinus (PAS) surgery vary. Few studies have investigated recurrence after primary PAS surgery in histopathological terms. We performed a histopathological analysis of the causes of revision surgery for PAS, with a view to reducing the recurrence rate after primary surgery.

Methods

We reviewed the medical records of patients who underwent revision surgery after primary excision of a PAS between 2002 and 2017. A pathologist reviewed the histopathology slides.

Results

In total, 24 patients underwent revision surgery; of those, histopathology slides were available for 18 patients (19 revisions). The mean interval between primary and revision surgery was 50.4 months. We detected lumen with stratified squamous epithelium in 14 of the 19(73.7%) revisions. Cartilage tissue was attached to the epithelial lining of the lumen in 14 of the 17(82.4%) slides containing lumen. Inflammatory changes were found in all slides, and granulation tissue was detected in 10 of 19 revision surgery slides.

Conclusions

To prevent PAS recurrence after primary surgery, we recommend a wide local excision including the inflammatory soft tissue, with concomitant partial removal of the cartilage of the ascending helix adjacent to the PAS.

https://ift.tt/2PLT0Zz

Computer-assisted reading intervention for children with sensorineural hearing loss using hearing aids: Effects on auditory event-related potentials and mismatch negativity

Publication date: Available online 8 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Elisabet Engström, Petter Kallioinen, Cecilia Nakeva von Mentzer, Magnus Lindgren, Marianne Ors, Birgitta Sahlén, Björn Lyxell, Inger Uhlén

Abstract

Objectives

The primary aim was to investigate whether computer-assisted reading intervention somehow can affect event-related potentials (ERP) and mismatch negativity (MMN) in hearing impaired (HI) children with hearing aids (HAs) and normal hearing (NH) children.

Methods

The study included 15 HI children with sensorineural hearing loss (SNHL) using bilateral HAs and 14 NH children as a reference group; all children between the ages of 5 and 8. A multi-feature MMN-paradigm, Optimum-1, with a standard stimulus alternating with 5 different deviants was used. ERPs were recorded pre and post intervention, i.e. one month of repeatedly computer-assisted training (GraphoGame). MMN was calculated from the average ERP of each deviant minus standard. Data were based on samples within a specific time interval, 80 - 224 ms, and repeated measures ANOVA was used to analyze possible interactions.

Results

There was a significant difference between groups before training, though, the mean obligatory responses or MMN was not statistically significantly different before versus after training, neither among the NH nor the HI children. Further, the HI children did generally achieve lower levels in GraphoGame compared to the NH children. Altogether, our findings indicate differences between the groups and that training may affect the neurophysiological processing in the brain, gaining the HI children. Both MMN and pMMR were seen among both the HA and NH children, irrespective to deviant type. Individually, changes of the MMN and pMMR after training seem unpredictable.

Conclusion

There are statistically significant differences in both the obligatory responses in ERP and the MMNs between the NH and HI groups before the computer-assisted training. Though, these differences disappear after the intervention. This suggests possible training effects regarding the central auditory processing among the HI children.

https://ift.tt/2DcWuxF

Phase 1 study of everolimus and low-dose oral cyclophosphamide in patients with metastatic renal cell carcinoma

Abstract

mTOR inhibitors are frequently used in the treatment of metastatic renal cell cancer (mRCC). mTOR regulates cell growth, proliferation, angiogenesis, and survival, and additionally plays an important role in immune regulation. Since mTOR inhibitors were shown to benefit immunosuppressive regulatory T-cell (Treg) expansion, this might suppress antitumor immune responses. Metronomic cyclophosphamide (CTX) was shown to selectively deplete Tregs. This study was, therefore, designed to determine the optimal dosage and schedule of CTX when combined with everolimus to prevent this potentially detrimental Treg expansion. In this national multi-center phase I study, patients with mRCC progressive on first line anti-angiogenic therapy received 10 mg everolimus once daily and were enrolled into cohorts with different CTX dosages and schedules. Besides immune monitoring, adverse events and survival data were monitored. 40 patients, 39 evaluable, were treated with different doses and schedules of CTX. Combined with 10 mg everolimus once daily, the optimal Treg depleting dose and schedule of CTX was 50 mg CTX once daily. 23 (59%) patients experienced one or more treatment-related ≥ grade 3 toxicity, mostly fatigue, laboratory abnormalities and pneumonitis. The majority of the patients achieved stable disease, two patients a partial response. Median PFS of all cohorts was 3.5 months. In conclusion, the optimal Treg depleting dose and schedule of CTX, when combined with everolimus, is 50 mg once daily. This combination leads to acceptable adverse events in comparison with everolimus alone. Currently, the here selected combination is being evaluated in a phase II clinical trial.

Trial registration

NCT01462214.

https://ift.tt/2Qxbzh5

Local anesthetic spread into the paravertebral space with two types of quadratus lumborum blocks: a crossover volunteer study

Abstract

Purpose

Previous work showed that 20 mL of local anesthetic (LA) did not spread into the paravertebral space (PVS) via the intramuscular quadratus lumborum block (QLBi). If spread of LA into the PVS can be achieved by increasing the total LA volume, QLBi can be more effective. We hypothesized that a larger volume of LA for the QLBi would spread into the PVS.

Methods

This crossover volunteer study included five healthy men. For comparison, both the ultrasound-guided QLB type 2 (QLB2) and QLBi were employed on opposite sides of each volunteer, and the spread of LA solution (0.7 mL/kg) mixed with contrast media in the PVS was assessed 1 h after the first injection using magnetic resonance imaging. Sensory loss was evaluated by pinprick 90 min post-injection. Each volunteer underwent both QLB types, and the same procedures were administered on opposite sides 7 days after the first experiment.

Results

In total, 20 QLB blocks (10 QLB2 and 10 QLBi) were performed. LA did not spread into the PVS after the QLBi. The sensory block area included the lower abdomen after the QLB2, but not after the QLBi. The sensory block area did not extend to the upper abdominal region or the midline of the lower abdomen with either block method.

Conclusion

LA administered by the QLB2 spreads into the PVS of T10–T12, resulting in lower and lateral abdominal sensory loss. In contrast, LA administered by the QLBi does not spread into the PVS and results in only lateral abdominal sensory loss.

https://ift.tt/2AVpoRj

Efficacy of Chitosan in promoting wound healing in extraction socket: A prospective study

Publication date: Available online 9 November 2018

Source: Journal of Oral Biology and Craniofacial Research

Author(s): Akshat Gupta, Vidya Rattan, Sachin Rai

Abstract

Purpose

Chitosan has been shown to promote wound healing and induce bone formation. The aim of this split-mouth study was to evaluate the effectiveness of chitosan based dressing in wound healing after lower third molar extraction.

Method

Asymptomatic symmetrical mandibular third molars were extracted simultaneously in 27 patients and Chitosan dressing was placed into the extraction socket in the test side. Pain scores were recorded on VAS using a 0 to 10 pain score. Wound healing was compared between right and left side. Radiographic findings were evaluated by observing lamina dura and density of extraction socket.

Results

Test group had more pain than control at all time intervals and unerupted tooth sites showed mean pain score significantly more than erupted tooth sites. Test group was superior to control in event of wound healing. Healing was significantly better in erupted tooth than unerupted tooth. At second week 12 sites showed better radiographic findings in chitosan treated group compared to 3 sites in the control group. At third month, 14 sites showed improved bone formation in chitosan treated group compared to 4 in control group. None of the unerupted teeth group showed better radiographic finding in test side at 2 week and 3 month compared to erupted teeth group.

Conclusion

Chitosan is effective in promoting wound healing and early osteogenesis in erupted tooth socket after extraction. We recommend that chitosan dressing should be used in the sockets of erupted tooth after extraction but should be avoided in unerupted or impacted teeth cases.

https://ift.tt/2qE4ksE

Firm digital papulonodules in a young boy

https://ift.tt/2PlnB0s

Cutaneous sarcoidosis after Hodgkin lymphoma

https://ift.tt/2Qxi9nN

Comment on: teaching and learning tips 7: small‐group discussion

https://ift.tt/2QtMSSJ

A call for mentorship in otolaryngology

Publication date: Available online 8 November 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Peter H. Hwang

https://ift.tt/2JRkckf

Erratum of “Laryngeal electromyography in dysphonic patients with incomplete glottic closure”

Publication date: November–December 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 6

Author(s): Noemi Grigoletto de Biase, Gustavo Polacow Korn, Grazzia Guglielmino, Paulo Pontes

https://ift.tt/2AUS9xy

Side effects of intraoral devices for OSAS treatment

Publication date: November–December 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 6

Author(s): Andressa Otranto de Britto Teixeira, Ana Luiza Ladeia Andrade, Rhita Cristina da Cunha Almeida, Marco Antonio de Oliveira Almeida

Abstract

Introduction

Intraoral devices have increasingly assumed a key role in the treatment of obstructive sleep apnea syndrome, but there are limitations to their indication and side effects that result from their continuous use, as well as the use of the continuous positive airway pressure device.

Objectives

To evaluate the changes in dental positioning caused by the continuous use of mandibular advancement devices.

Methods

A prospective longitudinal study with a sample of 15 patients, with evaluation of complete documentation after a mean time of 6.47 months, assessed changes in dental positioning due to the use of the Twin Block oral device for the treatment of patients with apnea. The following variables were evaluated: overjet, overbite, upper and lower intermolar distances, upper and lower intercanine distances, Little's irregularity index and the incisor mandibular plane angle. An intraclass correlation test was performed and a correlation index > 0.08 was accepted. After verifying the normal sample distribution (Shapiro-Wilks), a parametric test was used (t test), with a significance level set at 5%.

Results

There was a decrease in the values of overjet, overbite and Little's irregularity index, whereas there was an increase in the lower intercanine distance and IMPA values. All these variables are influenced, at different levels, by the forward inclination of the lower incisors, an action that can be expected due to the force applied by the device on the dentition. The other variables did not show statistically significant differences.

Conclusion

After a mean time of 6.47 months of use of the mandibular advancement device, there were statistically significant changes in the dental positioning, but they were not clinically relevant. However, it is relevant that this device is commonly in use over long periods of time, making the monitoring of these patients of the utmost importance for the duration of their therapy.

Resumo

Introdução

Os aparelhos intraorais têm assumido cada vez mais um papel importante no tratamento da síndrome da apneia obstrutiva do sono, mas existem limitações a sua indicação e efeitos colaterais com o seu uso contínuo, assim como com o uso do aparelho de pressão aérea positiva contínua.

Objetivos

Avaliar as alterações no posicionamento dentário produzido pelo uso contínuo do aparelho de projeção mandibular.

Método

Através de estudo longitudinal prospectivo com amostra de 15 pacientes, com avaliação de documentações completas após um tempo médio 6,47 meses do uso do aparelho oral de Twin Block para tratamento de pacientes com apneia, foram avaliadas as alterações do posicionamento dos dentes decorrentes do seu uso. As seguintes variáveis foram avaliadas: overjet, overbite, distâncias intermolares superior e inferior, distâncias intercaninos superior e inferior, índice de irregularidade de Little e ângulo do plano incisivo mandibular. Foi feito teste de correlação intraclasse e foram aceitos índices de correlação acima de 0,08. Após atestada a distribuição normal da amostra (Shapiro-Wilks), foi usado um teste paramétrico (teste t), com nível de significância de 5%.

Resultados

Houve diminuição nos valores de overjet, overbite e irregularidade de Little e aumento nos valores da distância intercanino inferior e do ângulo do plano incisivo mandibular. Todas essas variáveis sofrem influência, com diferentes expressividades, da inclinação para frente dos incisivos inferiores, uma ação que pode ser esperada devido à força aplicada pelo aparelho sobre a dentição. As demais variáveis não demostraram diferenças estatisticamente significativas.

Conclusão

Houve mudanças estatisticamente significativas no posicionamento dos dentes, porém clinicamente sem relevância, com um tempo médio de uso de 6,47 meses do aparelho de avanço mandibular. Contudo, deve-se considerar que o uso desta aparelhagem, é comum durante longos períodos, fazendo com que seja de suma importância o acompanhamento desses pacientes a longo prazo.

https://ift.tt/2JRsVD9