ORL 2018;80:221
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Τρίτη 27 Νοεμβρίου 2018
A family with PTEN mutations with malignancy and an unusually high number of offspring with autism spectrum disorder: a case report
Cowden's syndrome (OMIM:158350), a rare genetic disorder (incidence ~ 1:250,000), is caused by mutations of the tumor suppressor gene PTEN. In this report, we describe clinical manifestations of a 56-year-old pat...
https://ift.tt/2ztfkxE
Change in endolymphatic hydrops 2 years after endolymphatic sac surgery evaluated by MRI
This study was performed to determine whether endolymphatic sac surgery improves vestibular and cochlear endolymphatic hydrops 2 years after sac surgery and to elucidate the relationship between the degree of improvement of endolymphatic hydrops and the changes in vertigo symptoms, the hearing level, and the summating potential/action potential ratio (−SP/AP ratio) by electrocochleography (ECochG) in patients with Ménière's disease (MD).
https://ift.tt/2FKgiLs
Philtrum reconstruction in unilateral cleft lip repair
The philtrum is an important aesthetic structure in the midface. A number of philtrum reconstruction techniques have been advocated for secondary cleft lip revision procedures. Conventional surgical management involves end-to-end orbicularis oris muscle approximation during primary cleft lip repair, often resulting in a flat lip appearance that requires secondary revision surgery at a later stage. A novel modification of the approximation of the orbicularis oris muscle is described that may be implemented with any cleft lip technique in order to create an accentuated philtrum column for a natural looking philtrum.
https://ift.tt/2KAt3Hv
Mycotoxins in poultry feed and feed ingredients in Nigeria
Abstract
Mycotoxins are toxic secondary fungal metabolites that can negatively affect animal productivity when ingested through feed. In order to assess mycotoxin contamination of poultry feed and feed ingredients vis-a-vis source tracking of feed contamination in Nigeria, 102 samples of feed (n = 30) and feed ingredients (n = 72) were collected from in-house mills of poultry farms across 12 states of Nigeria and analyzed for multiple mycotoxins using LC/MS-MS. One hundred and forty microbial metabolites were detected in the feed and feed ingredients. The most frequent mycotoxin in the feed was fumonisin B1, occurring in 97% of the samples at mean concentration of 1014 μg kg−1. AFB1 occurred in 83% of the feed samples at mean concentration of 74 μg kg−1 and in all feed ingredients except fish meal and other cereals (millet and rice). Feed samples analyzed in this study were contaminated with at least four mycotoxins: aflatoxins and fumonisin co-occurring in 80% of the samples. Peanut cake and maize contributed the most to the levels of aflatoxin and fumonisin, respectively, in the feed. Consequently, there is a need to explore other cereal- and protein-based ingredients for compounding feeds in order to reduce the risk associated with high mycotoxin (e.g. aflatoxin) intake in poultry.
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Fluorescence imaging of invasive head and neck carcinoma cells with integrin αvβ6-targeting RGD-peptides: an approach to a fluorescence-assisted intraoperative cytological assessment of bony resection margins
We assessed the use of peptides containing arginylglycylaspartic acid (RGD) that target integrin αvβ6 as a potential approach for a fluorescence-assisted intraoperative cytological assessment of bony resection margins (F-AICAB) in patients who had bone-infiltrating squamous cell carcinoma (SCC) of the head and neck. This was assessed to demarcate invasive carcinoma cells that stained for αvβ6. Specimens from bony resection margins (n=362) were defined as either malignant or benign according to the results of cytological and histological examinations.
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A Systematic Review and Meta-Analysis of Subsequent Malignant Neoplasm Risk After Radioactive Iodine Treatment of Thyroid Cancer
Thyroid, Ahead of Print.
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Role of Leucine 341 in Thyroid Hormone Receptor Beta Revealed by a Novel Mutation Causing Thyroid Hormone Resistance
Thyroid, Ahead of Print.
https://ift.tt/2E0OWir
How Should Thyroid-Related Quality of Life Be Assessed? Recalled Patient-Reported Outcomes Compared to Here-and-Now Measures
Thyroid, Ahead of Print.
https://ift.tt/2SaIhVW
An Age-Specific Serum Thyrotropin Reference Range for the Diagnosis of Thyroid Diseases in Older Adults: A Cross-Sectional Survey in China
Thyroid, Ahead of Print.
https://ift.tt/2E0P2GP
Smartphone telemedical emergency department consults for screening of nonacute dizziness
Objectives/Hypothesis
Each year, the United States spends over $4 billion on emergency department visits for evaluation of dizziness. Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness that can easily be diagnosed by observing characteristic eye movements during the Dix‐Hallpike test (DHT). The DHT is easily performed; however, interpretation requires more advanced training. This may be part of the reason it is not commonly performed in emergency departments, and instead, patients undergo costly imaging tests. We evaluated whether smartphone‐based video recordings of DHT could be assessed telemedically for screening of nonacute dizziness.
Study Design
Feasibility study.
Methods
Dizzy patients underwent objective vestibular testing, but also had videos of their eye movements recorded via a smartphone during the DHT. The videos were remotely reviewed by two neuro‐otologists for BPPV screening and were compared to objective and in‐person exam findings.
Results
Overall, 30 dizzy patients were evaluated with seven cases of BPPV. The sensitivity for diagnosing BPPV via a smartphone‐recording of eye movements of the DHT was 92.86%, with a specificity of 100% and a negative predictive value of 97.87%.
Conclusions
Our initial proof‐of‐concept study shows that remote screening of BPPV is possible with high specificity. Because the DHT is easily taught, having a remote otolaryngologist interpret the resulting eye movements may increase usage of the test and may lead to cost savings.
Level of Evidence
4 Laryngoscope, 2018
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Antileukotrienes improve naso‐ocular symptoms and biomarkers in patients with NARES and asthma
Objective
The aim of our study was to analyze the montelukast effectiveness in improving oculonasal symptoms, patient‐reported outcomes (PROs), and eosinophilic biomarkers in patients with nonallergic rhinitis eosinophilic syndrome (NARES).
Methods
We enrolled prospectively 80 symptomatic patients treated with 10 mg once a day of montelukast in monotherapy for 2 months. All patients were investigated before and after treatment. Nasal symptoms (nasal obstruction, rhinorrhoea, sneezing, nasal itching), ocular symptoms (redness/puffiness, watery eyes), and other PROs (olfactory dysfunction, difficulty going to sleep, nighttime awakenings, and nasal congestion on awakening) were scored by visual analogic scale. The following clinical scores were assessed: Total Nasal Symptom Score (T4NSS), Total Ocular Symptom Score (T2OSS), Total Symptom Score of Patient‐Reported Outcomes (TSS‐PROs), and a Composite Symptoms Score (CSS). Patients were classified as responders when a reduction of at least 50% of the CSS was observed. Before and after treatment, the eosinophilic biomarkers in nasal lavage were analyzed: nasal eosinophilia (number of eosinophils per high power field), eotaxin‐1 and eotaxin‐2.
Results
After treatment, significant reductions were observed for all the symptom scores. Forty‐two of 78 patients were considered responders. A significant reduction of eosinophils in nasal mucosa and of levels of eotaxin‐1 and eotaxin‐2 in nasal lavage were observed after treatment in responder patients. Patients with asthma had an increased probability to be responders.
Conclusion
NARES patients may benefit from treatment with montelukast. In particular, the presence of concomitant asthma may be predictive of a greater efficacy.
Level of Evidence
2. Laryngoscope, 2018
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Automated Quantification of Vocal Fold Motion in a Recurrent Laryngeal Nerve Injury Mouse Model
Objectives/Hypothesis
The goal of this study was to objectively examine vocal fold (VF) motion dynamics after iatrogenic recurrent laryngeal nerve (RLN) injury in a mouse surgical model. Furthermore, we sought to identify a method of inducing injury with a consistent recovery pattern from which we can begin to evaluate spontaneous recovery and test therapeutic interventions.
Study Design
Animal model.
Methods
The right RLN in C57BL/6J mice was crushed for 30 seconds using an aneurysm clip with 1.3‐N closing force. Transoral laryngoscopy enabled visualization of VF movement prior to surgery, immediately post‐crush, and at two endpoints: 3 days (n = 5) and 2 weeks (n = 5). VF motion was quantified with our custom motion‐analysis software. At each endpoint, RLN samples were collected for transmission electron microscopy for correlation with VF motion dynamics.
Results
Our VF tracking software permitted automated quantification of several measures of VF dynamics, such as range and frequency of motion. By 2 weeks post‐injury, the frequency of VF movement on the right (injured) side equaled the left, yet range of motion only partially recovered. These objective outcome measures enabled detection of VF dysfunction that persisted at 2 weeks post‐crush. Transmission electron microscopy images revealed RLN degeneration 3 days post‐crush and partial regeneration at 2 weeks, consistent with functional results obtained with automated VF tracking.
Conclusions
Our motion‐analysis software provides novel objective, quantitative, and repeatable metrics to detect and describe subtle VF dysfunction in mice that corresponds with underlying RLN degeneration and recovery. Adaptation of our tracking software for use with human patients is underway.
Level of Evidence
NA Laryngoscope, 2018
https://ift.tt/2QjSzWI
Surgery of the major salivary glands and its impact on salivary flow—A review
Objective
The aim of this study was to bring attention to a rather unnoted side effect of salivary gland surgery–reduced salivary flow.
Methods
A systematic PubMed, Cochrane Library, LIVIVO, and Embase databases search was performed to identify relevant articles.
Results
Eight studies matched the inclusion criteria. All studies described an association between salivary gland surgery and reduced salivary flow. In five of the eight studies, patients reported on xerostomia after salivary gland surgery.
Conclusions
Head and neck surgeons should inform their patients more accurately about reduced salivary flow and possible xerostomia after salivary gland surgery, and focus more on conservative strategies and minimally invasive techniques. Laryngoscope, 2018
https://ift.tt/2DRvC6L
Patient reported outcome measures in forty‐three patients undergoing endoscopic middle ear surgery
Abstract
1.PROMs are a useful technique to assess patient experience of middle ear surgery
2.Endoscopic ear surgery patients report better scar discomfort score
3.Endoscopic and open ear surgery patients report equivalent pain scores
4.Endoscopic and open ear surgery patients report equivalent overall patient experience
This article is protected by copyright. All rights reserved.
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Induction of smell through transethmoid electrical stimulation of the olfactory bulb
Background
Anosmia has an estimated prevalence of 5% of the general population. Outside of inflammatory causes, therapeutic options are limited despite research advances. Bypassing peripheral neuronal damage through central stimulation is a potential therapeutic option that has shown success in other sensory systems, most notably with hearing. We performed a pilot study to determine the feasibility of inducing smell through artificial electrical stimulation of the olfactory bulbs in humans.
Methods
Subjects with a history of sinus surgery, including total ethmoidectomy, with intact ability to smell were enrolled. The ability to smell was confirmed with a 40‐item smell identification test. Awake subjects underwent nasal endoscopy and either a monopolar or bipolar electrode was positioned at 3 areas along the lateral lamella of the cribriform plate within the ethmoid sinus cavity. A graded stimulation current of 1–20 mA at 3.17 Hz was administered while cortical evoked potential (CEP) recordings were collected. Subjective responses of perceived smell along with reports of discomfort were recorded. Subjects with artificially induced smell underwent repeat stimulation after medically induced anosmia.
Results
Five subjects (age, 43–72 years) were enrolled. Three subjects reported smell perception smell with electrical stimulation. This was reproducible after inducing anosmia, but CEP recordings could not provide objective support. All subjects tolerated the study with minimal discomfort.
Conclusion
This is the first report of induced smell through transethmoid electrical stimulation of the olfactory bulb. These results provide a proof of concept for efforts in development of an olfactory implant system.
https://ift.tt/2BBIkEM
Therapeutic use of steroids in non–chronic rhinosinusitis olfactory dysfunction: a systematic evidence‐based review with recommendations
Background
Olfactory loss is a common and debilitating disease with limited treatment options, particularly for olfactory dysfunction not related to sinonasal inflammation. Both topical and systemic steroids have been used as treatments for olfactory loss. This study systematically reviews the literature on the efficacy of steroids for non–chronic rhinosinusitis (CRS)‐related olfactory loss and provides recommendations.
Methods
A literature search of PubMed, Ovid, EMBASE, and the Cochrane Database was performed according to Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA) guidelines. Inclusion criteria included original data, English‐language articles on steroid treatment (topical and systemic) for olfactory loss unrelated to sinonasal inflammation. Data was collected on study design, olfaction dysfunction etiology, clinical outcomes, and level of evidence. Two investigators reviewed all articles independently, with a third acting as a mediator for any disagreements in recommendation.
Results
Of 866 abstracts identified, only 15 studies met inclusion criteria and were systematically reviewed. Level 4 evidence suggests oral steroids can improve olfactory loss. Level 1B evidence demonstrates topical steroid rinses improve olfactory dysfunction in a select group of patients. Topical steroid sprays show no improvement across several levels of evidence.
Conclusion
There is a paucity of high‐quality studies demonstrating efficacy of either topical or oral steroids for olfactory dysfunction unrelated to sinonasal disease. The only level 1 evidence suggests using steroid rinses to improve olfactory outcomes in select patients, with weaker evidence supporting use of oral steroids. Topical steroid sprays do not improve olfactory dysfunction in this patient population and are not recommended.
https://ift.tt/2KDthgJ
Ivacaftor improves rhinologic, psychologic, and sleep‐related quality of life in G551D cystic fibrosis patients
Background
Ivacaftor is a cystic fibrosis transmembrane conductance regulator (CFTR) potentiator that improves pulmonary function in cystic fibrosis (CF) patients with at least 1 copy of the G551D CFTR mutation. The purpose of this study is to evaluate the impact of ivacaftor on chronic rhinosinusitis (CRS) symptoms in this population.
Methods
The G551D Observational (GOAL) study was a multicenter prospective cohort study enrolling CF patients ≥6 years with at least 1 G551D mutation. Subjects were provided 20‐item Sino‐Nasal Outcome Test (SNOT‐20) questionnaires prior to ivacaftor therapy and at 1, 3, and 6 months afterward. The impact on rhinologic (R), psychological (P), sleep (S), and ear/facial (E) quality of life (QOL) domains was evaluated separately.
Results
Of 153 subjects, 129 (84%) completed all questionnaires. Typical baseline symptom burden was low (75% with scores <1) and degree of improvement (ie, reduced scores) was greater with higher baseline scores. SNOT‐20 decreased, reflecting improvement, at all follow‐up intervals (1 month: [mean change ± standard deviation] –0.25 ± 0.53, p < 0.01; 3 months; –0.29 ± 0.58, p < 0.01; 6 months: –0.21 ± 0.58, p = 0.02), but less than the prespecified minimal clinically important difference (0.8). Significant improvement was observed at 1, 3, and 6 months in the R domain (1 month: –0.24, p < 0.01; 3 months: –0.34, p < 0.01; 6 months: –0.25, p < 0.01) and P domain (1 month: –0.25, p < 0.01; 3 months: –0.32, p < 0.01; 6 months: –0.26, p < 0.01), and 1 and 3 months in the S domain (1 months: –0.35, p < 0.01; 3 months: –0.32, p < 0.01; 6 months: –0.18, p = 0.07). There was no improvement in the E domain at any time point.
Conclusion
Ivacaftor improves QOL in the R, P, and S domains in G551D CF patients, although QOL instruments validated for CRS may not translate well to CF CRS patients because symptom burden was surprisingly low.
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Interleukin‐4‒induced posttranscriptional gene regulation of CCL26 by the RNA‐binding protein HuR in primary human nasal polyp‒derived epithelial cells
Background
Much attention on the pathophysiology of nasal polyp (NP) has focused on eosinophils. Interleukin (IL)‐4 and eotaxin‐3 (C‐C motif chemokine ligand 26, or CCL26) levels have been reported to be increased in eosinophilic nasal polyps. The aim of this study was to characterize CCL26 posttranscriptional regulation by the RNA‐binding protein HuR in primary human nasal polyp‒derived epithelial cells (hNPDECs) challenged with IL‐4.
Methods
A prospective, observational study was conducted. Nasal polyp tissues were obtained from eosinophilic (n = 12) and non‐eosinophilic (n = 10) NP patients, and inferior turbinate (IT) tissues were taken from control subjects (n = 9) and cultured into hNPDECs. Expression of HuR and CCL26 were measured by immunohistochemistry, Western blot analysis, enzyme‐linked immunoassay, and real‐time polymerase chain reaction (PCR). The nucleocytoplasmic shuttling of HuR in hNPDECs was detected by immunofluorescence. Posttranscriptional regulation of CCL26 by HuR was tested by ribonucleoprotein immunoprecipitation assay (RIP) and dual‐luciferase reporter assay. CCL26 mRNA stabilization was measured by quatititative PCR after treatment with actinomycin D. Student's t test and one‐way analysis of variance were used.
Results
Immunohistochemical data show that both HuR and CCL26 were highly expressed in NP tissues, especially eosinophilic NP tissues (p < 0.05). IL‐4 stimulation increased CCL26 mRNA stability, and overexpression and knockdown of HuR affected CCL26 expression. Immunofluorescence data indicate that IL‐4 altered the subcellular distribution of HuR. The RIP and dual‐luciferase reporter assay results supply strong evidence for HuR binding to CCL26.
Conclusion
Our results provide strong support for the hypothesis that IL‐4‒induced expression of CCL26 in hNPDECs relies partly on CCL26 mRNA stabilization mediated by the interaction of HuR with CCL26 3'UTR.
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Squamous cell carcinoma of the nail unit: a retrospective review of 19 cases in Asia and comparative review of Western literature
Abstract
Background
Reports regarding squamous cell carcinoma of the nail unit (SCCnu) are rare in Asia.
Objectives
To investigate the features of SCCnu in the Asian population.
Method
We performed a retrospective review of patients diagnosed with SCCnu at our institution between 2012 and 2017.
Results
Nineteen cases were included. Thirteen patients were male (68.4%). The fingers were most frequently affected (73.7%). Mean delay to diagnosis was 62.4 months. Misdiagnosis rate was high (78.9%). Frequent clinical features were subungual tumor, subungual hyperkeratosis, nail dystrophy, ulcer, and nail loss. The majority of cases were invasive SCC in 15 cases (78.9%), while SCC in situ was found in four cases (21.1%). Local recurrence was detected in two cases (10.5%) following surgical resection. However, distant metastasis was not reported.
Conclusion
This study provides data of 19 SCCnu cases in Asia. Clinical characteristics of SCCnu in this study were similar to those of reports from Western countries. However, we found a higher frequency of more invasive cases and longer delay to diagnosis in our study; this advocates the need for greater attention on nail disorders among healthcare providers, particularly in Asia.
https://ift.tt/2BAz4RB
The use of electrochemotherapy in combination with immunotherapy in the treatment of metastatic melanoma: a focused review
Abstract
Electrochemotherapy (ECT) is a treatment modality that combines low‐dose chemotherapy with electroporation, thereby enhancing cytotoxicity. ECT was first utilized in the treatment of metastatic head and neck cancer. Today it is used as a local treatment for the cutaneous and subcutaneous metastases of a variety of cancers, including melanoma. In addition, recent evidence indicates that ECT in combination with immunotherapy can lead to a systemic tumor response. This review aims to summarize the efficacy of ECT in the treatment of metastatic melanoma, with a specific focus on the combination of ECT with immunotherapy.
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Skin disorders are prominent features in primary immunodeficiency diseases: a systematic overview of current data
Abstract
Primary immunodeficiency diseases (PIDs) are characterized by an increased risk of infections, autoimmunity, autoinflammation, malignancy and allergic disorders. Skin disorders are also common clinical features in PIDs and may be among the presenting manifestations. Recognition of specific PID‐associated skin conditions in combination with other clinical features as described in the currently used warning signs could raise suspicion of an underlying PID. We aimed to provide a systematically obtained overview of skin disorders and their prevalence in PIDs. Secondary, the prevalence of Staphylococcus (S.) aureus‐associated skin disorders and atopy were reviewed, as these are the most prominent skin features in PIDs. A systematic search was performed in Embase, Medline, Web of Science, Cochrane and Google Scholar (up to May 9th 2018). All original observational and experimental human studies that address the presence of skin disorders in PIDs were selected. We rated study quality using the Institute of Health Economics Quality Appraisal Checklist for Case Series Studies. Sixty‐seven articles (5030 patients) were included. Study quality ranged from 18.2‐88.5%. A broad spectrum of skin disorders was reported in 30 PIDs, mostly in single studies with a low number of included patients. An overview of associated PIDs per skin disorder was generated. Data on S. aureus‐associated skin disorders and atopy in PIDs were limited. In conclusion, skin disorders are prominent features in PIDs. Through clustering of PIDs per skin disorder, we provide a support tool to use in clinical practice that should raise awareness of PIDs based on presenting skin manifestations.
This article is protected by copyright. All rights reserved.
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Increased expression of L‐plastin in nasal polyp of patients with nonsteroidal anti‐inflammatory drug exacerbated respiratory disease
Abstract
Background
Most patients with nonsteroidal anti‐inflammatory drug exacerbated respiratory disease (NERD) suffer from recurrence of nasal polyps. However, little is known about the specific cellular and molecular mechanisms contributing to the pathogenesis of nasal polyp development in patients with NERD in particular, especially at baseline when cyclooxygenase 1 inhibitors are not present. The objectives of this study were to identify proteins involved in the pathogenesis of nasal polyps in patients with NERD.
Methods
We collected nasal polyp tissue from patients with NERD and from patients with aspirin‐tolerant chronic rhinosinusitis with nasal polyps (CRSwNP). Protein profiles were analyzed by 2‐dimensional electrophoresis and identified several proteins, including L‐plastin, as highly expressed. We examined L‐plastin and tissue factor (TF) expression by immunohistochemical and immunofluorescence analyses. To examine the role of L‐plastin in eosinophils, we knocked down L‐plastin expression in Eol‐1 cells by using siRNA transfection.
Results
L‐plastin protein levels in nasal polyp tissue were increased in patients with NERD relative to those in patients with aspirin tolerant CRSwNP. Immunofluorescence analysis revealed that L‐plastin was dominantly expressed in eosinophils and L‐plastin and TF were co‐expressed in eosinophils in NERD nasal polyp tissue. Knockdown of L‐plastin in Eol‐1 cells disrupted the cell surface distribution of TF by stimulation with granulocyte macrophage colony‐stimulating factor.
Conclusions
Increased expression of L‐plastin by eosinophils may contribute to abnormal fibrin deposition through TF translocation to the eosinophil cell surface in NERD nasal polyp tissue, which in turn may contribute to the pathogenesis of NERD.
This article is protected by copyright. All rights reserved.
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Membrane‐enriched solute carrier family 2 member 1 (SLC2A1/GLUT1) in psoriatic keratinocytes confers sensitivity to 2‐deoxy‐D‐glucose (2‐DG) treatment
Abstract
Psoriasis is a common chronic disease with accelerated epidermal cell growth. Solute carrier family 2 member 1 (SLC2A1), also named GLUT1, transports glucose and its analogues into cells. With elevated membrane‐bound GLUT1, psoriatic keratinocytes uptake more glucose with increased glucose metabolism. Competition between glucose and its analogues can serve as a strategy to inhibit glycolysis as well as proliferation. In this study, we investigated the expression patterns of GLUT1 in keratinocytes in the human psoriasis vulgaris and imiquimod‐induced psoriasis model, and determined that the glucose metabolism inhibitor 2‐deoxyglucose (2‐DG) can relieve the psoriatic lesions. We found membrane‐enriched GLUT1 in psoriasis keratinocytes, which suggested some potential for glucose metabolic target therapy based on the glycolytic microenvironment. Furthermore, 2‐DG was able to relieve the psoriatic lesions in an in vivo animal model which provides a new possible therapeutic strategy.
This article is protected by copyright. All rights reserved.
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Student Elective Competition 2018/19: A call for entries
We are now launching the 2018/19 competition for students and interns. Write up your experiences as a global health case report and you could be the winner of a position as a Global Health Associate Editor for BMJ Case Reports.
All authors must be students or interns at the time of submission.
Your entry will undergo the same treatment that all our journal submissions do, including the peer review process, so be sure to check out our Instructions for Authors for guidance before you start writing. If you've never written a global health case report before, you may find our Global Health section useful to help you get started.
Winners will be selected for interview to become a Global Health Associate Editor. We welcome submissions from all over the world. Patients may be anyone seen on the ward or at home, in medical school or on elective. Winners will be announced in September 2019.
Global Health Associate Editors will have the chance to contribute to our global health blog, help manage our social media presence and collaborate on special global health projects.
The post Student Elective Competition 2018/19: A call for entries appeared first on BMJ Case Reports blog.
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Guselkumab in the treatment of severe Hidradenitis suppurativa
Abstract
Hidradenitis suppurativa (HS) is a chronic skin disease characterized by auto‐inflammation resulting in abscesses, nodules, fistula and scaring in the affected areas. It is known as one of the most life restricting diseases in dermatology with highly negative effects regarding the DLQI.
Despite the uprising therapeutic approaches available for HS, there is still a need for more effective medications to treat this auto‐inflammational disease.
This article is protected by copyright. All rights reserved.
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Microvascular Capillary Plexus Findings of Commotio Retinae on Optical Coherence Tomography Angiography
Optical coherence tomography (OCT) and histopathology features of commotio retinae (CR) have been established, but alterations of the microvascular macular capillary plexus on OCT angiography (OCTA) has not been previously studied. We present a 46-year-old man who sustained a tennis ball injury to the right eye with visual acuity reduction to 20/30 and grey-white deep macular discoloration, suggestive of CR. Spectral-domain OCT (SD-OCT) showed increased reflectivity and thickness of the ellipsoid zone (junction of photoreceptor inner and outer segments). OCTA revealed no apparent microvascular alterations (right versus left eye) in the foveal avascular zone superficial (0.42 vs. 0.43 mm2) and deep (0.45 vs. 0.44 mm2), superficial foveal capillary density (34.1 vs. 32.6%), and superficial parafoveal capillary density (55.2 vs. 52.2%). Deep macular capillary plexus and choriocapillaris were qualitatively comparable between the two eyes. At 2 months' follow-up, SD-OCT had normalized. CR is characterized by disruption of the ellipsoid zone without detectable alteration of the capillary plexuses.
Case Rep Ophthalmol 2018;9:473–478
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Severe vemurafenib‐induced photosensitivity in a 6‐year‐old boy
Abstract
Vemurafenib, a selective BRAF kinase inhibitor, has been found to induce several cutaneous adverse effects, ranging from a keratosis pilaris‐like reaction to squamous cell carcinoma. While photosensitivity has been well described as one of these manifestations, we report a case of a 6‐year‐old boy on vemurafenib who developed a severe blistering sunburn after only two 30‐minute episodes of sun exposure. A brief review of other common cutaneous adverse effects of vemurafenib is also provided.
https://ift.tt/2AstZsN
Highlights and recent developments in airway diseases in EAACI journals (2017)
The European Academy of Allergy and Clinical Immunology (EAACI) owns three journals: Allergy, Pediatric Allergy and Immunology and Clinical and Translational Allergy. One of the major goals of EAACI is to supp...
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Erratum: Eingewachsene Zehennägel – Optionen für die tägliche Praxis
Erratum zu:
Hautarzt 2018
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Sehr geehrte Leserin, sehr geehrter Leser,
in der Abbildungslegende von Abb. 2 des oben genannten Beitrags fehlt leider der Copyrightverweis zu Abb. 2b.
Wir bitten Sie, den Fehler zu entschuldigen und zukünftig die korrigierte Version …
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Estrogen associated with UVB irradiation recapitulates the specific melanosome distribution observed in Caucasoid Melasma
Abstract
Melasma is characterized by light to dark brown macules that usually occur on the face. Melasma occurs in 10‐15% of pregnant women and in 10‐25% of women taking oral contraceptives. Fertile women are most likely to develop melasma. Histological examination of melasma lesional skin revealed mainly pigmentary disorders with an increased melanin deposition in all layers of the epidermis including the horny layer and a frequent presence of melanophages in the dermis. On the other hand in the upper dermis, a disruption of the basement membrane in 3.9% of cases, an abundance of elastotic material and an increased number of blood vessels and mast cells have been reported in melasma.
This article is protected by copyright. All rights reserved.
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Oral benign neoplasms: A retrospective study of 790 patients over a 14-year period
Publication date: Available online 27 November 2018
Source: Acta Otorrinolaringológica Española
Author(s): Luiz Arthur Barbosa da Silva, Eduardo Alonso Cruz Monroy, Marianna Sampaio Serpa, Lélia Batista de Souza
Abstract
Introduction and objective
Oral benign neoplasms (OBNs) exhibit some features that can guide the professionals to the correct diagnosis and best treatment. Through retrospective studies, medical records can be reviewed to better describe a given population and, furthermore, help clinicians in routine practice. In this context, the objective of this paper was to analyze the cases of OBNs of an oral pathology referral department, from 2003 to 2017, in order to better understand their epidemiological and clinicopathological characteristics.
Methods
A total of 8355 histopathological reports were analyzed. Lesions diagnosed as OBNs were selected and the following variables were recorded: gender, age, histological type of the lesion, anatomical location, rate and pattern of growth, type of base, color, symptomatology and diagnostic hypotheses on clinical examination.
Results
OBNs represented 9.4% of all lesions diagnosed. The most frequent histopathological types were fibroma (39.9%), papilloma (22%), fibroblastoma (13.1%), lipoma (10.2%) and hemangioma (6.1%). Overall, most cases affected females (n = 518; 65.6%) and in the fifth decade of life (n = 148; 18.7%). The oral mucosa was the most common site (n = 265; 33.5%). The most common features of each OBN were also highlighted.
Conclusion
The most common OBNs were fibroma, papilloma, fibroblastoma, lipoma and hemangioma. Overall, the OBN presented common clinical features; however, in particular cases, there are some characteristics that can lead the professionals to the correct diagnosis. Nevertheless, in general, histopathological analysis must be performed to confirm diagnosis. Intraosseous tumors and large lesions may require imaging tests to help diagnosis.
Resumen
Introducción y objetivos
Las neoplasias benignas orales (NBO) presentan características clínico-patológicas específicas que pueden guiar al profesional al diagnóstico correcto y a un mejor tratamiento. Los estudios retrospectivos son uno de los principales recursos utilizados para conocer la situación actual de una población determinada y estimar sus necesidades para la implementación y el mantenimiento de los servicios de salud. En este contexto, el objetivo de este trabajo fue analizar los casos de NBO de un servicio de referencia en patología oral, de 2003 a 2017, para comprender mejor sus características epidemiológicas y clínico-patológicas.
Métodos
se analizaron un total de 8355 informes histopatológicos. Se seleccionaron las lesiones diagnosticadas como NBO y se registraron las siguientes variables: sexo, edad, tipo histológico de la lesión, ubicación anatómica, índice y patrón de crecimiento, tipo de base, color, sintomatología e hipótesis diagnósticas en el examen clínico.
Resultados
Las NBO representaron el 9,4% de todas las lesiones diagnosticadas. Los tipos histopatológicos más frecuentes fueron fibroma (39,9%), papiloma (22%), fibroblastoma (13,1%), lipoma (10,2%) y hemangioma (6,1%). También fueron verificados el perfil de los pacientes y las presentaciones clínicas de estas lesiones.
Conclusiones
Las NBO más comunes fueron fibroma, papiloma, fibroblastoma, lipoma y hemangioma. En general, las NBO presentaron características clínicas comunes; sin embargo, en casos particulares, existen algunas características que pueden llevar al profesional al diagnóstico correcto. Sin embargo, de forma general, el análisis histopatológico debe hacerse para confirmar el diagnóstico. Los tumores intraóseos y las lesiones de gran tamaño pueden requerir exámenes de imagen para ayudar al diagnóstico.
https://ift.tt/2RfTB35
The lncRNA H19/miR-675 axis regulates myocardial ischemic and reperfusion injury by targeting PPARα
Publication date: January 2019
Source: Molecular Immunology, Volume 105
Author(s): Hong Luo, Jing Wang, Donghai Liu, Suhua Zang, Ning Ma, Lixuan Zhao, Liang Zhang, Xin Zhang, Chenhui Qiao
Abstract
Increasing evidence has indicated that lncRNAs and miRNAs play important roles in the pathogenesis of myocardial ischemic and reperfusion (I/R) injury. This study investigated the potential roles and underlying molecular mechanisms of lncRNA H19 and H19-derived miR-675 in regulating myocardial I/R injury in vitro and in vivo. The results showed that expression of H19 and H19-derived miR-675 was upregulated in cardiomyocytes exposed to oxygen-glucose deprivation and reperfusion. Knockdown of H19 increased cell viability, reduced cell apoptosis, decreased inflammatory cytokines (IL-1β, TNF-α and IL-6), inhibited oxidative stress, downregulated p-IκB-α and p-p65, and upregulated expression of Nrf2 and HO-1. All of these effects were partly reversed by overexpression of miR-675. Furthermore, we found that PPARα was a target gene of miR-675 and that H19 negatively regulated PPARα expression via miR-675. By inhibiting PPARα, the biological effects of miR-675 or H19 inhibition on cellular functions (apoptosis, inflammation and oxidative stress) were at least partially reversed. Moreover, knockdown of H19 significantly reduced infarct size, increased left ventricular systolic pressure, and decreased left ventricular end-diastolic pressure in a mouse model of myocardial I/R. Taken together, these data indicate that H19 inhibition protects the heart against myocardial I/R injury, which may be partly attributed to regulation of the miR-675/PPARα axis.
Graphical abstract
https://ift.tt/2Axjap8
Genetic and environmental influences on third molar root mineralization
Publication date: Available online 26 November 2018
Source: Archives of Oral Biology
Author(s): Giedrė Trakinienė, Irena Andriuškevičiūtė, Loreta Šalomskienė, Arūnas Vasiliauskas, Tomas Trakinis, Antanas Šidlauskas
Abstract
Objective
To assess the genetic and environmental influences on the variability of human third molar (M3) root mineralization stages via a twin study.
Design
The study sample consisted of 162 same-sex twins (66 dizygotic and 96 monozygotic, mean age: 17.9 years) with normal growth and development. Panoramic radiographs were evaluated to assess root mineralization stages of the upper and lower third molars, using the method of Demirijian et al. (1973). Zygosity was established using 15 specific DNA markers.
Results
Females developed their third molar roots earlier in life than males. Monozygotic twins (MZ) demonstrated higher intra-pair correlations for M3 root development stages than did DZ twins. An ACE model with additive genes, as well as common and specific environmental factors, provided the best explanation of variation in M3 root development. The mineralization of M3 roots showed highly additive genetic determination, varying from 60 to 63%, whereas a common environment contributed from 25 to 27%, and a specific environment only accounted 14% of the total variation, at most.
Conclusions
A considerable proportion of the total variability of the third molar root mineralization rate can be attributed to additive genetic effects, while common and specific environmental effects have a smaller, yet significant, impact.
https://ift.tt/2Sit5q5
Genetic and environmental influences on third molar root mineralization
Publication date: Available online 26 November 2018
Source: Archives of Oral Biology
Author(s): Giedrė Trakinienė, Irena Andriuškevičiūtė, Loreta Šalomskienė, Arūnas Vasiliauskas, Tomas Trakinis, Antanas Šidlauskas
Abstract
Objective
To assess the genetic and environmental influences on the variability of human third molar (M3) root mineralization stages via a twin study.
Design
The study sample consisted of 162 same-sex twins (66 dizygotic and 96 monozygotic, mean age: 17.9 years) with normal growth and development. Panoramic radiographs were evaluated to assess root mineralization stages of the upper and lower third molars, using the method of Demirijian et al. (1973). Zygosity was established using 15 specific DNA markers.
Results
Females developed their third molar roots earlier in life than males. Monozygotic twins (MZ) demonstrated higher intra-pair correlations for M3 root development stages than did DZ twins. An ACE model with additive genes, as well as common and specific environmental factors, provided the best explanation of variation in M3 root development. The mineralization of M3 roots showed highly additive genetic determination, varying from 60 to 63%, whereas a common environment contributed from 25 to 27%, and a specific environment only accounted 14% of the total variation, at most.
Conclusions
A considerable proportion of the total variability of the third molar root mineralization rate can be attributed to additive genetic effects, while common and specific environmental effects have a smaller, yet significant, impact.
https://ift.tt/2Sit5q5
Intraoperative ultrasound control of zygomatic arch fractures: Does additional imaging improves reduction quality?
Publication date: Available online 27 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Johannes Buller, Matthias Zirk, Matthias Kreppel, Volker Maus, Joachim E. Zöller
Abstract
Purpose
Intraoperative navigation to assess anatomic reduction is the general trend in maxillofacial trauma surgery. Aim of this study was to evaluate closed reduction outcome of isolated zygomatic arch fractures using ultrasound compared to palpation control.
Methods
In this case-control study, we identified consecutive treated patients who underwent closed reduction of isolated zygomatic arch fractures via Volkmann's reposition hook with intraoperative ultrasound. Controls were patients with the equal diagnosis and surgical procedure without ultrasound imaging. Pre- and postoperative radiographic data sets were geometrically analyzed. We compared the outcome variables in both study groups that were postoperative cortical step, persistent postoperative displacement and overall grade of reduction. Subgroups of fracture patterns were classified as M-shaped or variable fractures. Statistical analysis was performed using t test for continuous variables and two-sided chi-square test for categorical variables with p-value <0.05 defined as significant.
Results
A total of 16 cases with intraoperative ultrasound and 60 controls were identified from the institution's database. The angle of postoperative displacement was significantly reduced in the ultrasound group regarding all fractures (2.4° vs. 5.3°; p=0.004) and the variable fracture type (1.6° vs. 8.1°; p=0.005). Overall grade of reduction was improved in the ultrasound group for all fractures (p=0.03) but with no difference solely for M-shaped fractures (p=0.37).
Conclusion
Although reduction control via palpation and probing using the Volkmann's hook showed satisfactory results for M-shaped fractures, the additional intraoperative ultrasound imaging promises increasing success rates for variable configured zygomatic arch fractures.
https://ift.tt/2zsRcLu
The role of salivary duct morphology in the etiology of chronic obstructive parotitis: statistical analysis of sialographic features and computational fluid dynamics analysis of salivary flow
Publication date: Available online 27 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Wangyong Zhu, Tianjun Lan, Peisheng Liang, Xin Liu, Qian Tao
Abstract
Purpose
The causes of some cases of chronic obstructive parotitis (COP) without obstructive factors are still unclear. We hypothesized that some morphological features of salivary ducts might contribute to development of COP. This study aims to investigate the role of salivary duct morphology in the etiology of COP.
Materials and Methods
The investigators designed and implemented a case-control study. Cases were defined as patients with COP, diagnosed from September 2014 to May 2017, in the Affiliated Hospital of Stomatology, Sun Yat-sen University, and controls were healthy. The primary predictor variables were the occurrence of an accessory duct (AD), the number of branches uniting to form Stensen's duct (SD), the angle between AD and SD, and the angle between branches identified on sialographic CT images. Data from two groups were compared to investigate the association between these variables and COP. Chi-square test, Student's t test and Logistic regression were computed with significance set at p<0.05. Fluid dynamics analysis was used to analyze the salivary flow field in models of salivary ducts with different morphological features reconstructed from the sialographic CT.
Results
The sample was composed of 39 subjects with COP and 18 subjects without COP. The two groups were not similar in terms of the incidences of AD (71.8 vs 38.9%) and the angle between branches (96.5 ± 26.0° vs 71.5 ± 21.2°). There was no significant difference between the groups in the number of branches and angle between AD and SD. The area of low velocity was larger in model with the wider angle between branches.
Conclusion
The results suggest that the presence of an AD and a wider angle between the duct branches are associated with COP.
https://ift.tt/2P3mHRp
Do vertical soft-tissue and actual bony landmarks correlate in Le Fort I orthognathic surgery?
Publication date: Available online 27 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Cynthia Tsay, Rajendra Sawh-Martinez, Anamika Veeramani, Derek Steinbacher
Abstract
Purpose
Vertical changes in LeFort I orthognathic surgery are critical to the overall aesthetic result. 3D planning enables vertical measurements from the rendered CT scan, but intraoperative points are ascribed partially from soft tissues landmarks. This study compares intraoperative soft tissue vertical measurements with pre- and postoperative CT-based values, and attempts to validate intraoperative soft tissue landmarks for vertical positioning.
Methods
In this retrospective, single cohort study, we examined orthognathic procedures performed by a single surgeon at our institution. Patients were excluded if measurements and/or pre- and postoperative CT scans were lacking. Demographic information and soft tissue perioperative data were tabulated. Clinical vertical measurements included: left medial canthus to central incisor, left medial canthus to left canine, and right medial canthus to right canine. Bone measurements were calculated using pre- and postoperative CBCT scans for the same clinical landmarks. Statistical analysis including paired Student's t-test was performed using SPSS.
Results
42 patients were identified with a mean age of 23 years, and 57% were female. The change in pre- and postoperative measures was analyzed. There was no significant difference between the absolute value pre-and postoperatively between the two modalities (p<0.2, 0.1, 0.1) but a significant difference between bony and soft-tissue measurements (p<0.01). Subset analysis showed differences in postoperative values between class II and III cases.
Conclusion
Our results demonstrate a non-linear but predictable relationship between intraoperative soft tissue (medial canthi-maxillary dentition) and CT-measured bony vertical measurements. Understanding this relationship enables effective use of intraoperative measures to reproducibly achieve the desired bony vertical position, while allowing adjustments to be made in order to optimize aesthetics.
https://ift.tt/2zspEGa
Medicare in Oral and Maxillofacial Surgery Part 2: Academic Surgeons and Cancer Surgeons are Reimbursed Less
Publication date: Available online 26 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Yisi D. Ji, Zachary S. Peacock, James R. Hupp
Abstract
Purpose
To evaluate predictors of reimbursement of oral and maxillofacial surgery services in the Medicare population.
Methods
This is a cross-sectional study of Medicare Physician and Other Supplier Aggregate Data from 2015. Those classified as 'maxillofacial surgery' were included if they were confirmed to be an oral and maxillofacial surgeon (OMS) by National Provider Identifier (NPI) data. The primary outcome variable of this study was the proportion reimbursed (actual payment amount divided by charge amount divided). Predictor variables included type of practice (private vs. academic), scope (cancer vs. non-cancer), number of Medicare beneficiaries seen, number of unique CPT codes billed, and total amount charged. Descriptive statistics and regression analyses were calculated with a p-value of <0.05 considered significant.
Results
The initial search revealed 952 providers categorized as 'maxillofacial surgery,' with 894 confirmed to be an OMS (144 academic and 750 private practice). Of 894 OMSs, 39 were cancer surgeons and 855 non-cancer surgeons. Academic OMSs saw more complex patients compared to those in private practice (p<0.0001). Academic surgeons (n=144) charged an average of $116,876.92 to Medicare, with a mean payment amount of $22,219.62. Private practice surgeons (n=750) submitted an average charge of $27,812.56, with average reimbursement of $9,472.76.
Multiple linear regression revealed academia, cancer surgeons, number of unique CPT codes, higher HCC scores, and total submitted charge amount were negative predictors of proportion reimbursement.
Conclusion
Roughly 10% of OMSs participate and bill for Medicare. Factors associated with lower reimbursement proportion include being in academia, treatment of head and neck cancer, billing more unique CPT codes, seeing sicker patients, and larger total submitted charges. As third-party private insurers often follow fee schedules and rates set by the Centers for Medicare and Medicaid Services, this observed effect should also be evaluated in claims data of other insurers.
https://ift.tt/2P5ALtw
In Reply to Letter to the Editor
Publication date: Available online 26 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Hossein E. Jazayeri, Sung-Kiang Chuang
https://ift.tt/2zwq5iG
Delayed Pharyngeal Migration of a Mandibular Fixation Screw 30 Years After Orthognathic Surgery
Publication date: Available online 26 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Esther Cheng, Edward Schaefer, Steven Charous
https://ift.tt/2P4TTrz
Remarkable short-term regression of a posterior mediastinum metastasis from primary intraosseous carcinoma treated with nivolumab: a case report
Publication date: Available online 26 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Masashi Kimura, Yukihiro Shiraki, Kenichiro Ishibashi, Masahiro Umemura
Abstract
Primary intraosseous carcinoma (PIOC, NOS) is a rare odontogenic malignancy that is thought to arise from the odontogenic epithelium. In addition, some cases arise in odontogenic cysts or other benign precursors. There are no established treatment protocols for PIOC because of its rarity. In particular, no standard therapy has been established for patients with recurrent or metastatic PIOC. Here we report a case in which the use of nivolumab showed a significant treatment response in metastatic PIOC. The patient was a 71-year-old male with PIOC. We performed segmental mandibulectomy with modified radical neck dissection following neoadjuvant chemotherapy, including two cycles of paclitaxel, cetuximab, and carboplatin and one cycle of docetaxel, cisplatin, and 5-fluorouracil. The lesion rapidly enlarged during neoadjuvant chemotherapy, and surgical specimens demonstrated no histological therapeutic effects of chemotherapy. Three months after the surgery, contrast-enhanced CT scans showed posterior mediastinal lymph node metastasis. Treatment with nivolumab was initiated, and significant clinical improvement was noted after two cycles. Although it was a short-term treatment, we observed remarkable effects and no adverse events during and after nivolumab treatment. Nivolumab may be an attractive treatment option for metastatic PIOC that is resistant to traditional chemotherapy and target therapy, including cetuximab. Further investigation of this treatment is warranted.
https://ift.tt/2zvZrGL
Piezosurgery vs. Conventional Osteotomy in Impacted Lower Third Molar Extraction: Evaluation of Perioperative Anxiety, Pain and Paresthesia
Publication date: Available online 26 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Serpil Irem Kirli Topcu, Alen Palancioglu, Mehmet Yaltirik, Meltem Koray
Abstract
Purpose
Piezoelectric surgery is a safe and effective osteotomy technique that can decrease the perioperative complications and morbidity in oral-maxillofacial surgery. In this study, we compare piezosurgery and conventional rotary technique in the removal of impacted lower third molars. Our primary end points were perioperative anxiety, pain and postoperative discomfort while avoiding the drilling sound of the conventional instrument.
Materials and Methods
Twenty one patients (14 female, 7 male) with bilateral symmetrical impacted lower third molars were included in our study. The two osteotomy techniques were randomly allocated to be performed on the right or the left impacted lower third molars. The parameters evaluated were perioperative anxiety (STAI), postoperative pain (VAS), operation time and paresthesia.
Results
No significant difference was seen between piezosurgery and conventional rotatory techniques in terms of pain, anxiety and nerve damage. Preoperative anxiety was significantly higher in the female group than in the male group. No correlation was found between preoperative anxiety and postoperative pain. Operation time was found to be significantly longer in the piezosurgery group.
Conclusion
Piezosurgery provides a precise, less agressive osteotomy compared to conventional rotary techniques. However, it has not been found to significantly reduce perioperative pain and anxiety.
https://ift.tt/2P7CGy5
The Optimal Timing of Secondary Alveolar Bone Grafting: A Literature Review
Publication date: Available online 26 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Artur Fahradyan, Michaela Tsuha, Erik M. Wolfswinkel, Kerry-Ann S. Mitchell, Jeffrey A. Hammoudeh, William Magee
Abstract
Background
Secondary alveolar bone grafting (SABG) during mixed dentition is the standard of care for alveolar clefts. However, early SABG at the age of 4-7 years before the eruption of lateral incisors versus late SABG at the age of 8-12 years before the eruption of maxillary permanent canines is still debated.
The purpose of this study is to perform a systematic review of the literature to evaluate the outcomes of early SABG in terms of residual bone volume or degree of bone resorption, maxillary canine movement or impaction rate, complications, aesthetic outcomes, and compare outcomes of early versus late SABG.
Methods
A comprehensive search of the PubMed database was performed following PRISMA guidelines. Keywords for alveolar cleft repair and inclusion criteria were used to screen articles for final review.
Results
The initial search yielded 6278 articles of which four retrospective and four prospective studies were chosen for final review. From these, seven studies compared outcome variables between early and late SABG while another looked at bone formation of patients who only underwent early SABG. In terms of outcome variables, three articles assessed bone volume with radiographic evaluation, two estimated maxillary permanent canine impaction rate, one evaluated surgical complications, operative time and length of hospital stay and the last looked at anterior incisor crown length. Overall, six studies concluded that early SABG provides a better outcome than late SABG and two found comparable results across the aforementioned variables.
Conclusion
This review suggests that the existing data may support the concept of early SABG, however, it is not sufficient for a definitive conclusion. A well-planned prospective study is needed to further investigate the rationale for early SABG.
https://ift.tt/2zs8msV
Are facial asymmetry and condylar displacement associated with ramus height and treatment outcomes in unilateral condylar fracture when managed by closed method?
Publication date: Available online 26 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Mohit Bindal, Abhijit Joshi, Adithi Bhat, Venkatesh Anehosur
Purpose
This study measures the mandibular ramal height in patients with unilateral condylar fracture managed by closed method using elastic intermaxillary fixation (IMF). It's co-relation with facial asymmetry and condylar displacement were assessed. This will determine whether the treatment outcome is in favour of closed or open method.
Methodology
A prospective cohort study was performed. Subjects included patients with unilateral condylar fracture who reported to SDM Craniofacial & Research Centre, Dharwad, India. All subjects in the study were managed by closed method (non-surgically, using arch bars and elastic IMF). Standardised orthopantomogram radiographs were used to assess ramal height and condylar displacement in sagittal plane. PA mandible and reverse Towne's radiographs were used to assess facial asymmetry and condylar displacement in coronal plane during pre-treatment, immediate post-treatment, 3rd, 6th and 12th month follow-up. Data was subjected to statistical analysis by using ANOVA test and Karl Pearson's correlation coefficient method.
Results
25 patients with unilateral condylar fracture managed by closed treatment had significant reduction in ramal height on the affected side by 1.15mm (p=0.0001) at 12th month follow-up. Change in facial asymmetry was reported as 1.05mm (p=0.0016) at 12th month follow-up. It was noted that its correlation with ramal height was insignificant (p=0.07). Only significant correlation noted between facial asymmetry and condylar displacement was in coronal plane at 12th month follow-up (p=0.04).
Conclusion
A weak positive co-relation was noted among the assessed values during the 12th month follow-up radiographs. Facial symmetry is not greatly affected when the ramal height at the time of injury on the fractured side is reduced by 3.25±0.6mm.
https://ift.tt/2P7CzTb
Segmental Maxillary Osteotomy to Close Wide Alveolar Clefts
Publication date: Available online 26 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Alexander T. Wilson, Robin T. Wu, Rajendra Sawh-Martinez, Derek M. Steinbacher
Abstract
Introduction: Wide alveolar clefts are challenging to treat and are often associated with a higher chance of failure requiring repeated bone grafts. Even if successful, an excessively large cleft leads to a wide edentulous space, and patients are faced with prolonged orthodontic treatment. We present a series of large alveolar clefts closed with the aid of segmental maxillary osteotomies. Cases of alveolar clefts treated by segmental maxillary osteotomy were reviewed from 2014-2016. Preoperative and postoperative CTs were analyzed to assess alveolar gap and bone fill. Demographics, diagnosis, and operative technique were reviewed and described. 10 alveolar fistulae were addressed, using 6 segmental osteotomies in 6 patients. 66% were bilateral cases. 4 were female and 2 were male with an average age of 12.6 years. Average preoperative cleft width was 14.2mm on CT scan. Postoperatively, all clefts were successfully closed and no adverse effects were observed. Segmental maxillary osteotomy with concurrent bone grafting and fistula closure is an effective approach to treat excessively wide alveolar clefts. This enables a prudent dental substitution/prosthodontic plan, while minimizing prolonged orthodontia, in addition to achieving the traditional goals of alveolar bone grafting (stabilizing the maxillary arch, closing fistulae, and permitting canine eruption).
https://ift.tt/2zstKyi
Tumor-infiltrating immune cell subpopulations and programmed death ligand 1 (PD-L1) expression associated with clinicopathological and prognostic parameters in ependymoma
Abstract
Ependymomas are biologically and clinically heterogeneous tumors of the central nervous system that have variable clinical outcomes. The status of the tumor immune microenvironment in ependymoma remains unclear. Immune cell subsets and programmed death ligand 1 (PD-L1) expression were measured in 178 classical ependymoma cases by immunohistochemistry using monoclonal antibodies that recognized tumor-infiltrating lymphocyte subsets (TILs; CD3, CD4, CD8, FOXP3, and CD20), tumor-associated macrophages (TAMs; CD68, CD163, AIF1), indoleamine 2,3-dioxygenase (IDO)+ cells and PD-L1-expressing tumor cells. Increases in CD3+ and CD8+ cell numbers were associated with a prolonged PFS. In contrast, increased numbers of FOXP3+ and CD68+ cells and a ratio of CD163/AIF1+ cells were significantly associated with a shorter PFS. An increase in the IDO+ cell number was associated with a significantly longer PFS. To consider the quantities of TILs, TAMs, and IDO+ cells together, the cases were clustered into 2 immune cell subgroups using a k-means clustering analysis. Immune cell subgroup A, which was defined by high CD3+, low CD68+ and high IDO+ cell counts, predicted a favorable PFS compared to subgroup B by univariate and multivariate analyses. We found six ependymoma cases expressing PD-L1. All these cases were supratentorial ependymoma, RELA fusion-positive (ST-RELA). PD-L1 expression showed no prognostic significance. This study showed that the analysis of tumor-infiltrating immune cells could aid in predicting the prognosis of ependymoma patients and in determining therapeutic strategies to target the tumor microenvironment. PD-L1 expression in the ST-RELA subgroup suggests that this marker has a potential added value for future immunotherapy treatments.
https://ift.tt/2PUosFM
Vocal cord immobility as a cause of aphonia in a child with 3p13p12 deletion syndrome encompassing FOXP1 gene
Publication date: Available online 27 November 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Hatice Mutlu-Albayrak, Kadri Karaer
Abstract
Congenital bilateral laryngeal paralysis/immobilization is an uncommon condition and has been described as isolated or accompanying to some recognizable syndromes. Heterozygous mutations in the FOXP1 gene (605515) are related with intellectual disability and, language impairment with or without autistic features. Expressive language is more affected than receptive language and more than half of the patients experience oromotor dysfunction and/or feeding difficulties. Here we report a child with severe developmental, speech delay and aphonia which was considered due to bilaterally abductor vocal cord immobility. Interstitial 8700 kbp deletion encompassing FOXP1 gene was detected on 3p13p12 chromosomal region. Although it is known that FOXP1 defects are related to abnormalities in vocal communication, FOXP1-associated laryngomalacia or vocal cord paralysis/immobilization cases have not been reported yet. The FOXP1 defects are considered to be a cause of delay in speech, and it is suggested that vocal cord evaluation should be conducted in suspicious cases.
https://ift.tt/2QpkG6K
Pediatric Ewing Sarcoma of the Head and Neck: A Retrospective Survival Analysis
Publication date: Available online 26 November 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Elaine Martin, Shannon Radomski, Earl Harley
Abstract
Objective
To determine the demographics, treatment modalities, and overall survival of pediatric Ewing sarcoma of the head and neck.
Methods
The National Cancer Institute's Surveillance, Epidemiology, and End Results database was used to identify cases of pediatric Ewing sarcoma of the head and neck between 1973 and 2015. Additional variables collected included age, gender, ethnicity, tumor grade, staging, treatment modality, and follow-up time. Kaplan-Meier survival curves were generated and overall survival was calculated.
Results
One hundred and twenty-seven cases of pediatric Ewing sarcoma were identified. The majority of patients were male (52.8%), white (88.2%), and non-Hispanic (75.6%), and the mean age at diagnosis was 10.5 years. The most common tumor sites were bones and joints of the skull and face (45.5%), followed by soft tissue of the head, face, and neck (25.2%), followed by the mandible (13.4%). Most patients (69.2%) had some type of surgery, 70.0% received radiation, and 92.1% received chemotherapy as part of their treatment. Overall 1-, 5-, and 10-year survival was 91.1%, 72.9%, and 68.2%, respectively. There was no significant difference in survival based on patient gender, age, tumor location, radiation, or chemotherapy treatment.
Conclusion
This study demonstrates that pediatric patients with Ewing sarcoma of the head and neck most commonly have stage II disease, no distant metastasis, and are treated with chemotherapy, with or without radiation. One, five, and ten-year survival are 91.1%, 72.9%, and 68.2%, respectively, and age, gender, and radiation do not seem to affect prognosis.
https://ift.tt/2DQTE1J
Are antithrombotic agents necessary for head and neck microvascular surgery?
Publication date: Available online 26 November 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): W. Zhou, W.-B. Zhang, Y. Yu, Y. Wang, C. Mao, C.-B. Guo, G.-Y. Yu, X. Peng
Abstract
The aim of this prospective study was to determine the effect of antithrombotic agents in preventing thrombosis after head and neck reconstructive surgery. A randomized clinical trial of referred patients undergoing free flap surgery between February 2015 and July 2017 was conducted. Four hundred and fifty-four patients were randomly assigned to group A (n = 153), administered aspirin and low molecular weight dextran; group B (n = 150), administered low molecular weight heparin; and group C (n = 151), not administered any antithrombotic agent. Patient demographic characteristics, donor site, thrombosis, haematoma, and flap failure were recorded. Coagulation values including platelet count, prothrombin time, and activated partial thromboplastin time were measured during the perioperative period. Repeated-measures ANOVA and the χ2 test were used for data comparisons. No significant inter-group differences were observed for postoperative microvascular thrombosis (P = 0.536) or flap failure (P = 0.615) among the three groups. There were more postoperative haematoma revisions in group B than in groups A and C (P = 0.032). It is concluded that postoperative antithrombotic agents neither provide a significant improvement in the free flap success rate nor decrease the risk of thrombosis and may increase the risk of haematoma.
https://ift.tt/2P20SBO
Pigmented villonodular synovitis occurring in the temporomandibular joint
Publication date: Available online 27 November 2018
Source: Auris Nasus Larynx
Author(s): Fuminori Nomura, Yosuke Ariizumi, Yusuke Kiyokawa, Akihisa Tasaki, Yumiko Tateishi, Nobuaki Koide, Hiroaki Kawabe, Takashi Sugawara, Kentaro Tanaka, Takahiro Asakage
Abstract
Objective
Pigmented villonodular synovitis occurring in the region of the temporomandibular joint is a rare disease, requiring a review of the treatment method, follow-up period.
Method
Refer to the past literature, along with a retrospective search.
Results
An excision, including the skull base bone, was performed in all cases; however, recurrence was found in one case on which fractional excision was performed. Past reports have also indicated that en bloc resection was considered desirable.
Conclusion
It is necessary to perform en bloc resection on patients with pigmented villonodular synovitis occurring in the region of the temporomandibular joint. Furthermore, due to reported cases of recurrence after a long period of time, follow-up observations of about 10 years are considered necessary.
https://ift.tt/2Sh1mWS
What to know about hyperpigmentation
Hyperpigmentation occurs when a person develops darker patches on the skin, such as age spots or melasma. Learn about the causes, types, and treatments for hyperpigmentation here.
https://ift.tt/2P3abBp
Gender Disparities in Trauma Care: How Sex Determines Treatment, Behavior, and Outcome
Publication date: Available online 27 November 2018
Source: Anesthesiology Clinics
Author(s): Evie G. Marcolini, Jennifer S. Albrecht, Kinjal N. Sethuraman, Lena M. Napolitano
https://ift.tt/2QkeXzi
Evaluating a shortened interpretation criterion for intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism: A 5‐minutes criterion in primary hyperparathyroidism and intraoperative algorithm
Abstract
Background
Most criteria require a parathyroid hormone (PTH) decline of ≥50% within 10 minutes after excision of the gland during surgery for primary hyperparathyroidism. The aim was to evaluate a model allowing earlier prediction of cure.
Methods
One thousand eighteen patients with primary hyperparathyroidism were included. A ≥50% decline from baseline within 10 minutes after excision intraoperatively predicted complete removal of hypersecreting tissue. The data were reanalyzed regarding a criterion, requiring a ≥50% decline after 5 minutes. Based on the data and the present literature, an algorithm was created.
Results
Assay predicted cure in 854 patients (true‐positive; 83.89%) after 10 minutes (false‐positive [FP] in 13 patients; 1.52%). Nevertheless, only 14 (1.83%) showed persisting disease. According to the "5 minutes" criterion, 723 patients (71.02%) showed a ≥50% decline from baseline within 5 minutes and 10 (1.38%) patients had a FP decline (sensitivity 0.75, specificity 0.86).
Conclusion
Using a modified criterion, surgery can be discontinued 5 minutes earlier in 71%.
https://ift.tt/2P2Xu9J
Diagnosis and treatment of oropharyngeal dysphagia after total laryngectomy with or without pharyngoesophageal reconstruction: A systematic review
Abstract
Background
This systematic review qualitatively summarizes the current literature on diagnosis and treatment of oropharyngeal dysphagia (OD) after total laryngectomy (TLE).
Methods
Electronic databases PubMed, Embase, and the Cochrane Library were used. Two independent reviewers carried out the literature search and assessed the methodological quality of the included studies using a critical appraisal tool.
Results
Forty‐four articles met the inclusion criteria. Of these, 35 studies were on diagnosis, four on therapy, and five on both diagnosis and treatment of OD following TLE. Study aims, swallowing‐assessment methods, and main findings of the included studies were summarized and presented.
Conclusions
The reviewers found heterogeneous outcomes and serious methodological limitations, which prevented us from pooling data to identify trends that would assist in designing best clinical practice protocols for OD following TLE. Further research should focus on several remaining gaps in our knowledge on diagnosis and treatment interventions for OD following TLE.
https://ift.tt/2zsSJ4h
Exceptional responses to pertuzumab, trastuzumab, and docetaxel in human epidermal growth factor receptor‐2 high expressing salivary duct carcinomas
Background
Alterations in the human epidermal growth factor receptor‐2 (HER2) pathway have been identified in a subset of salivary duct carcinomas. Dual HER2 inhibition with trastuzumab and pertuzumab has superior antitumor efficacy to trastuzumab monotherapy in HER2‐positive breast cancer, yet its efficacy in HER2‐positive salivary duct carcinoma is unknown.
Methods
We report 2 cases of exceptional responses of HER2‐positive salivary duct carcinomas to dual HER2 blockade and docetaxel combination and their molecular characteristics.
Results
A 54‐year‐old man with recurrent metastatic HER2 expressing salivary duct carcinoma of the parotid gland after definitive concurrent chemoradiation achieved a complete response (CR) after 6 cycles of trastuzumab, pertuzumab, and docetaxel (TPH). A 42‐year‐old woman with HER2‐positive salivary duct carcinoma of the parotid gland with bone and liver metastases had CR with TPH and remains in remission on maintenance trastuzumab and pertuzumab.
Conclusion
Dual HER2 blockage resulted in CR in patients with HER expressing salivary duct carcinoma and warrants further evaluation in this patient population.
https://ift.tt/2P52BpX
Massive aneurysmal bone cyst of the skull base treated with denosumab
Abstract
Background
Aneurysmal bone cysts are rare, benign expansile tumors most commonly involving long bones and vertebrae in patients younger than age 20. Skull base involvement is rare. Aneurysmal bone cysts shares radiological and histological features with other bone tumors, posing a diagnostic challenge.
Methods/Results
We report the case of a 32‐year‐old man who presented with facial pain, epistaxis, and cranial neuropathies secondary to a massive tumor of the maxillary sinus and anterior skull base. The tumor was originally misdiagnosed as osteosarcoma. However, genomic analysis revealed a rearrangement in the USP6 gene, elucidating a diagnosis of primary aneurysmal bone cysts. The patient was treated with denosumab. Within 5 months, the patient was asymptomatic with CT showing ossification of the tumor.
Conclusions
This case highlights (1) the utility of genomic analysis in aggressive bone tumors when the diagnosis is unclear and (2) the effectiveness of denosumab as a treatment for aneurysmal bone cysts when surgical resection is unfavorable.
https://ift.tt/2zsSFl3
Novel HAX1 Gene Mutation in a Vietnamese Boy with Severe Congenital Neutropenia
Severe congenital neutropenia (SCN) is a rare disease that involves a heterogeneous group of hereditary diseases. Mutations in the HAX1 gene can cause an autosomal recessive form of SCN-characterized low blood neutrophil count from birth, increased susceptibility to recurrent and life-threatening infections, and preleukemia predisposition. A 7-year-old boy was admitted due to life-threatening infections, mental retardation, and severe neutropenia. He had early-onset bacterial infections, and his serial complete blood count showed persistent severe neutropenia. One older sister and one older brother of the patient died at the age of 6 months and 5 months, respectively, because of severe infection. Bone marrow analysis revealed a maturation arrest at the promyelocyte/myelocyte stage with few mature neutrophils. In direct DNA sequencing analysis, we found a novel homozygous frameshift mutation (c.423_424insG, p.Gly143fs) in the HAX1 gene, confirming the diagnosis of SCN. The patient was successfully treated with granulocyte colony-stimulating factor (G-CSF) and antibiotics. A child with early-onset recurrent infections and neutropenia should be considered to be affected with SCN. Genetic analysis is useful to confirm diagnosis. Timely diagnosis and suitable treatment with G-CSF and antibiotics are important to prevent further complication.
https://ift.tt/2Shi0FK
Dermoscopy of lipidised dermatofibroma: A morphological study of 13 cases
Abstract
Background/Objectives
The aim of this study was to evaluate the morphological findings of lipidised dermatofibromas under dermoscopic observation.
Methods
Dermoscopic examination of 13 cases of lipidised dermatofibromas was performed to evaluate specific dermoscopic criteria and patterns.
Results
The most frequently occurring dermoscopic features were as follows: (i) A yellowish homogenous pigmentation in all cases (100%); this pigmentation was total in 30.7%; (ii) White structures were seen in 46.1%, most of them were central white networks (38.4%); (iii) Pigment network was observed in 53.8%, most of them were peripheral delicate pigment networks (38.4%), but two cases showed an atypical pigment network; (iv) The presence of vascular structures was common (10 cases, 77%); (v) Regarding to dermoscopic patterns, five lipidised dermatofibromas (38.4%) showed a total yellowish homogeneous pattern; 38.4% an atypical pattern and 23.2% a 'central white network + peripheral delicate pigment network' pattern.
Conclusions
The dermoscopic recognition of a total yellowish homogeneous area or a yellowish colouration in the context of a dermatofibroma can be proposed to help suspecting a lipidised dermatofibroma.
https://ift.tt/2FSaMqu
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