Levothyroxine Replacement Therapy and Overuse: A Timely Diagnostic Approach

Thyroid, Ahead of Print.


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Split-mouth evaluation of connective tissue graft with or without enamel matrix derivative for the treatment of isolated gingival recession defects in dogs

Abstract

Objectives

The potential additive effect of an enamel matrix derivative (EMD) to a subepithelial connective tissue graft (CTG) for recession coverage is still controversially discussed. Therefore, the aim of this study was to histologically evaluate the healing of gingival recessions treated with coronally advanced flap (CAF) and CTG with or without EMD in dogs.

Materials and methods

Gingival recession defects (5 mm wide and 7 mm deep) were surgically created on the labial side of bilateral maxillary canines in 7 dogs. After 8 weeks of plaque accumulation and subsequent 2 weeks of chemical plaque control, the 14 chronic defects were randomized to receive either CAF with CTG (CAF/CTG) or CAF with CTG and EMD (CAF/CTG/EMD). The animals were sacrificed 10 weeks after reconstructive surgery for histologic evaluation.

Results

Treatment with CAF/CTG/EMD demonstrated statistically significantly better results in terms of probing pocket depth reduction (P < 0.05) and clinical attachment level gain (P < 0.001). The length of the epithelium was statistically significantly shorter in the CAF/CTG/EMD group than in the CAF/CTG group (1.00 ± 0.75 mm vs. 2.38 ± 1.48 mm, respectively, P < 0.01). Cementum formation was statistically significantly greater in the CAF/CTG/EMD group than following treatment with the CAF/CTG group (3.20 ± 0.89 mm vs. 1.88 ± 1.58 mm, respectively, P < 0.01). The CAF/CTG/EMD group showed statistically significantly greater complete periodontal regeneration (i.e., new cementum, new periodontal ligament, and new bone) than treatment with CAF/CTG (0.54 ± 0.73 mm vs. 0.07 ± 0.27 mm, respectively, P < 0.05).

Conclusion

Within their limits, the present findings indicate that the additional use of EMD in conjunction with CAF + CTG favors periodontal regeneration in gingival recession defects.

Clinical relevance

The present findings support the use of EMD combined with CTG and CAF for promoting periodontal regeneration in isolated gingival recession defects.

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The South Asian Facial Anthropometric Profile: A Systematic Review

Craniofacial anatomy, as measured by facial anthropometric data, varies significantly between races. South Asia, comprised of eight countries, represents a large proportion of the global population and is the fastest-growing region of the world. This systematic review presents the facial anthropometric data collected for populations from this region.

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Semiautomatic device for in vitro/ experimental bone perforation in dental implant research

The present study presents a semiautomatic device developed to perform in vitro experiments using surgical drills for assisting dental implant research. It was built to perform tests independent of human direct contact, and contains an adjustable toolholder for engaging different types of implant contra angle hand pieces, in which different drills can be adapted. The researcher is able to make a range of adjustments on the machine, such as controlling the drilling force and depth.

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Distinct transcriptomic profiles of early-onset atopic dermatitis in blood and skin of pediatric patients

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. The pipeline of novel targeted treatments for AD is expanding, largely based on our growing knowledge of disease mechanisms, with new therapeutics particularly focused on immune modulation.1 Most of our understanding of AD is derived from profiling tissues and blood of longstanding AD in adults, due to the difficulty of obtaining samples from infants and young children. However, initiation of AD typically happens very early in life, and the disease is already chronically established in the majority of patients by 5yrs of age.

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Neutrophil to lymphocyte ratio is a novel independent predictor of severe exacerbation in asthma patients

Severe exacerbations are well-known complications of asthma, which increase the total and asthma-related health care costs1 and decrease the quality of life of patients2. Although some exacerbation predictors have been reported3,4, it is difficult to predict and prevent severe exacerbations in a large percentage of patients affected by asthma.

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Foreign bodies in the ear, nose, and throat in Japan: association with sociocultural and geographical conditions

Foreign bodies (FBs) in ear, nose, and throat (ENT) are common ENT emergencies but are sometimes life-threatening. However, FBs could be avoidable by the efficient announcement about the risk of these occurrence to the public. Fish bones are commonly found as throat FBs, and small toys are commonly found as pediatric ear and nose FBs. We hypothesized that there were relationships between the occurrence of FBs and sociocultural/geographical conditions. The purpose of this study is to clarify the risk factors of FBs in ENT regions related to eating customs and weather conditions.

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In Response to Accuracy and Reliability of the Flow Coupler in Postoperative Monitoring of Head and Neck Free Flaps

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IFAR 2018 Reviewers

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Changes in the clinical and histological characteristics of Chinese chronic rhinosinusitis with nasal polyps over 11 years

Background

Traditionally, it was believed that chronic rhinosinusitis with nasal polyps (CRSwNP) demonstrated less eosinophilic and more neutrophilic inflammation in China compared to North America and Europe. However, inflammatory patterns may change over time. The study aimed to analyze the changing trends in the clinical and histological characteristics of CRSwNP over time in China.

Methods

A total of 115 consecutive CRSwNP patients from 2003 to 2005 and 114 consecutive CRSwNP patients from 2014 to 2016 were enrolled in this retrospective study. The clinical and histological data were compared between patients from the 2 time periods.

Results

The percentage of eosinophils in nasal polyp tissue increased, and the percentage of neutrophils and total inflammatory cell count decreased, over 11 years. The proportion of eosinophilic CRSwNP significantly increased from 59.1% to 73.7% over 11 years. The proportion of neutrophils and the total inflammatory cell count in nasal polyps decreased, and the proportion of eosinophilic CRSwNP patients using intranasal corticosteroids 1 month before surgery increased remarkably over 11 years. Moreover, eosinophilic CRSwNP patients had better compliance with intranasal corticosteroid use than non‐eosinophilic CRSwNP patients, and patients with comorbid allergic rhinitis and asthma had better compliance with intranasal corticosteroid use than patients without those conditions.

Conclusion

Eosinophilic CRSwNP, which was previously a minor subtype in East Asians, has increased remarkably in incidence to become the predominant CRSwNP subtype in Beijing, China, indicating that rhinologists should place greater emphasis on its diagnosis and treatment.

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Optic neuritis following diphtheria, tetanus, pertussis, and inactivated poliovirus combined vaccination: a case report

Diphtheria, tetanus, pertussis, and inactivated poliovirus combined vaccine is widely used in young children as part of a series of immunizations before they start attending school. Case studies of demyelinati...

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Efficacy and Safety of a Water-Based Head Lice Lotion: A Randomized, Controlled, Investigator-Blinded, Comparative, Bicentric Study

Abstract

Introduction

Silicones (e.g., dimethicone) are effective and safe alternatives to insecticides for the treatment of head lice. However, silicones are lipophilic substances and do not only leave the hair greasy but they are also difficult to wash out. We have evaluated the efficacy and safety of a potential solution to this problem: an aqueous dispersion of a novel silylated polyol that has the same mode of action as dimethicone (suffocation) without its negative impact on hair characteristics.

Methods

This was a randomized, controlled, investigator-blinded, bicentric study that was conducted at two locations in the state of Florida (USA) to compare the test product (medical device) to a pyrethrum-based pediculicide that is a first-line, prescription-free treatment against head lice in the USA. The subjects (n = 70) were randomly divided into two groups of 35 persons (test product group and reference product group), with each participant receiving two applications (day 0 and 7) of the product to be tested, according to the instructions for use. Efficacy and safety was evaluated at distinct time points. The primary objective was to establish a cure rate for the test product that was better than 70% at study end (day 10). Esthetic effects of the test product versus dimethicone were evaluated in a blinded, cross-over consumer study (n = 100).

Results

At study end, the cure rate (corrected for re-infestation) of 88.2% with the test product significantly surpassed the pre-defined target of 70%, and thus the superiority of the test product versus the reference product was confirmed. The number of subjects cured (free of head lice) after the first treatment was remarkably higher with the test product than with the reference product (57.1 vs. 2.9%, respectively). Both products were safe and well tolerated and both showed beneficial esthetical effects. The consumer test demonstrated that the test product had better washing-out properties than dimethicone, as reflected by a significantly lower average rinsing time and number of washings required to restore the visual aspect of the hair, especially in terms of greasiness.

Conclusion

Aqueous dispersions of silylated polyols are a promising new class of pediculicides that combine high cure rates with optimal user convenience (short treatment period, easy wash-out with positive effect on hair quality).

Trial Registration

ClinicalTrials.gov identifier, NCT03617926.

Funding

Oystershell Laboratories.

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A rare presentation of a paediatric sinonasal inverted papilloma

Abstract

Sinonasal inverted papilloma (IP) is a benign tumour with an extremely low incidence in children. We report the case of an 11-year-old Caucasian male presenting with recurrent right-sided epistaxis, nasal obstruction and a mass in the right nasal cavity. An initial diagnosis of a nasopharyngeal angiofibroma was considered; however, on detailed histological examination, the mass was found to be an inverted papilloma. This report aims to increase awareness of IP in the paediatric age group, as well as reinforcing the role of endoscopic surgery in the management of this condition.

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Brunner’s gland hyperplasia: an unusual duodenal submucosal lesion seen in four patients

Abstract

Brunner's gland hyperplasia is an extremely rare benign hamartomatous lesion seen in proximal duodenum. Difficulty in diagnosing the condition pre-operatively puts the surgeon in dilemma for deciding appropriate management. We retrieved details from prospectively maintained retrospective data from January 2014 to April 2018. Four patients were identified of which three were males and one was female. Symptoms ranged from 4 days to 4 years, with abdominal pain, vomiting and malena being predominant. No patients were identified with diagnosis pre-operatively. Diagnosis was made on histopathological examination of the resected specimen and none of them were having malignant features. At a median follow up of 11 months, no patient had recurrence and were symptom free. Brunner's gland hyperplasia is a rare elusive duodenal pathology, symptomatically mimicking alarming duodenal lesions and mostly diagnosed on histopathology of specimen. Patients may harbour the lesion for long periods with little symptoms and upon treatment have good outcomes.

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Minimally invasive drainage of a giant ovarian mucinous cystadenoma associated with a mature cystic teratoma

Abstract

A 26-year-old, otherwise healthy female presented to the Emergency Room for the evaluation of abdominal pain. It was immediately apparent that she had a massively distended abdomen. History revealed progressive abdominal distension over several years. Evaluation for pregnancy was negative and a computed tomography (CT) scan demonstrated a 38 × 32 × 23 cm septated cystic mass. Careful controlled partial needle decompression of the cyst, removing 18.5 l of fluid, was followed by a mini-laparotomy with complete removal of a multi-loculated cystic ovarian mass approximately 45 lb in weight. Pathology was consistent with mucinous cystadenoma of the ovary in association with a mature cystic teratoma. This surgical technique of percutaneous drainage of the cyst, followed by mini-laparotomy is a valuable example of a safe and effective minimally invasive treatment modality for giant ovarian mucinous cystadenomas.

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Histologic Improvements in Irradiated Bone Through Pharmaceutical Intervention in Mandibular Distraction Osteogenesis

Publication date: December 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12

Author(s): Kevin M. Urlaub, Jeremy V. Lynn, Edward G. Carey, Noah S. Nelson, Yekaterina Polyatskaya, Alexis Donneys, Amanda C. Mazzoli, Steven R. Buchman

Purpose

Despite the relative surgical ease and reduced donor-site morbidity of distraction osteogenesis (DO) in comparison with free tissue transfer, DO is currently precluded as a reconstructive option for head and neck cancer (HNC) patients because of the destructive effects of radiotherapy (XRT). This study investigates the ability of a novel combined therapy (CT) of radioprotective amifostine (AMF) and angiogenic deferoxamine (DFO) to mitigate XRT-induced bone injury in a murine model of DO.

Materials and Methods

Thirty male Sprague-Dawley rats were divided into 5 groups: DO (primary control), XRT (secondary control), AMF, DFO, and CT. With the exclusion of the DO group, all rats were administered a fractionated, human-equivalent XRT dose of 35 Gy, comparable with 70 Gy administered to HNC patients clinically. All groups underwent mandibular osteotomy and distraction to 5.1 mm. After euthanasia administration on postoperative day 40, the mandibles were sectioned and stained with Gomori trichrome. Osteocyte number, bone volume, and osteoid volume were compared between all groups by analysis of variance (P < .05).

Results

All rats survived and were included in the final analysis. The XRT group exhibited substantial bone injury, evidenced by a decreased osteocyte number and bone volume, as well as an increase in immature osteoid volume, compared with DO controls. The AMF, DFO, and CT groups showed significant increases in osteocyte proliferation compared with the XRT group and were not statistically different from the DO group. Notably, the CT group showed remediation of XRT-induced impairment of bone maturation and exhibited significantly greater bone volume and reduced osteoid volume in comparison with all groups.

Conclusions

Combined AMF and DFO treatment showed the capacity to remediate the deleterious effects of XRT, restore cellularity to nonirradiated levels, and surpass all groups in mature bone formation. Although further investigations of AMF and DFO are warranted, this study provides preliminary support for the potential use of DO in HNC patients through pharmaceutical facilitation of irradiated bone healing.

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Is There a Difference in Orbital Volume Between Affected and Unaffected Sides in Patients With Unilateral Craniofacial Microsomia?

Publication date: December 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12

Author(s): Maria N. Gribova, Britt I. Pluijmers, Cory M. Resnick, Cornelia J.J.M. Caron, Alessandro Borghi, Maarten J. Koudstaal, Bonnie L. Padwa

Purpose

Craniofacial microsomia (CFM) is characterized by malformations of structures derived from the first and second pharyngeal arches. The orbit is variably affected. The purpose of this study was to determine whether there is a difference in orbital volume between affected and unaffected sides in patients with unilateral CFM. The specific aims were to 1) measure orbital volume, 2) compare affected and unaffected sides, 3) evaluate the correlation between clinical evaluation of orbital size and volumetric measurement, and 4) determine whether there is a correlation between orbital volume and severity of mandibular deformity.

Materials and Methods

This study is a retrospective case series of patients with unilateral CFM from Boston Children's Hospital (Boston, MA) who had a computed tomographic (CT) scan. Manual segmentation of the orbit using Mimics software (Materialise, Leuven, Belgium) was performed on CT images of the 2 orbits. The predictor variable was laterality (affected vs unaffected side) and the primary outcome variable was orbital volume. Wilcoxon signed rank test was used to compare these measurements and determine whether the affected side differed from the unaffected side. The correlation between orbital volume and Pruzansky-Kaban type of mandibular deformity, as documented in the medical record, was determined using the Spearman rank correlation coefficient.

Results

Thirty-nine patients were included. Orbital volume was 10% smaller on the affected side (P = .001) in 80% of patients. There was no correlation between orbital size and severity of mandibular involvement.

Conclusion

The results of this study showed a marked difference in orbital volume between affected and unaffected sides in patients with unilateral CFM. These differences were small and might not be clinically relevant. Orbital volume did not correlate with severity of mandibular deformity.

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Surgical Accuracy in Inferior Maxillary Reposition

Publication date: December 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12

Author(s): Kasper Stokbro, Torben Thygesen

Purpose

Inferior maxillary repositioning is among the least stable and least predictable orthognathic procedures. The purpose of this study was to investigate whether posterior movement occurred with inferior maxillary repositioning and to analyze potential causes.

Materials and Methods

This retrospective observational study evaluated all consecutive patients treated at the Department of Oral and Maxillofacial Surgery of the Odense University Hospital (Odense, Denmark) with inferior maxillary repositioning from 2011 to 2013. The obtained repositioning was compared with the virtual surgical plan to determine surgical accuracy. Measurements were performed at 3 dental reference points. Linear and rotational measurements were performed along and around the right, anterior, and superior axes. Measurements were compared by paired t tests. Internal correlations and confounding variables were analyzed by mixed model regression analysis.

Results

Twenty patients were included for analysis. On average, the maxilla was positioned 1 mm posterior and 0.4 mm superior to the planned position. The virtual surgically planned reposition was statistically correlated with surgical accuracy. No other confounding variable influenced the outcome.

Conclusion

The correlation between planned advancement and inferior repositioning suggests that inferior repositioning destabilizes the maxillary position and that a perioperative or early postoperative relapse occurs in response to the advancement. This immediate relapse of 1 mm should be considered in the virtual surgical plan to ensure that the maxilla is placed closer to the desired position. Thus, this procedure could still benefit from increased surgical precision and stability based on technologic advancements, such as positioning guides or printed patient-specific plates.

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Use of Nasal Conformer After Birth Effectively Improves Nostril Symmetry in Patients With Unilateral Incomplete Cleft Lip

Publication date: December 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12

Author(s): Spencer C.H. Kuo, Jui-Pin Lai, Ching-Hua Hsieh, Tzu-Ying Chen, Yu-Jen Chang, Faye Huang

Purpose

To investigate the clinical effects of preoperative nasoalveolar molding (NAM) and nasal conformer use in patients with unilateral incomplete cleft lip on the basis of their medical records and images.

Patients and Methods

Data and images of 16 patients born with unilateral incomplete cleft lip who were hospitalized between January 2015 and August 2017 were retrieved from the medical records. The primary outcome was the extent of improvement in columella height (CH) before cheiloplasty. Other outcome measurements included the CH, nostril width, and nostril height, which were measured by ImageJ image processing software (version 1.4; National Institutes of Health, Bethesda, MD) and presented as ratios. Mann-Whitney U tests were used to compare the non–normally distributed data.

Results

Patients in the NAM group and those in the nasal conformer group showed significantly improved (P < .05) preoperative cleft-side CH–to–normal-side CH ratios compared with the corresponding ratios at birth. There was no significant difference in terms of the extent of improvement in CH between the groups.

Conclusions

Preoperative use of nasal conformers in patients with unilateral incomplete cleft lip not only corrects the deformed nasal cartilage but also increases the CH and improves the overall preoperative nasal symmetry. In addition, compared with NAM, this method costs less, is more straightforward, and requires fewer outpatient clinic visits.

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A History of Orthognathic Surgery in North America

Publication date: December 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12

Author(s): R. Bryan Bell

This review highlights the contributions of American oral and maxillofacial surgeons to the field of orthognathic surgery. The present state of the art and science of orthognathic surgery is the harvest of yesterday's innovation and research. An improved understanding of the biological and surgical principles and the routine involvement of orthodontics have fueled widespread adoption of a coordinated approach to the treatment of dentofacial problems. Technologic advances in rigid internal fixation, virtual surgical planning with computer-aided manufacturing of occlusal splints and cutting guides, custom implants, and worldwide interest in the correction of dentofacial and craniofacial deformities have resulted in highly predictable, efficient, and safe treatment, which scarcely resembles the situation 70 years ago.

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When Net Loss Threatens Safety Net Loss

Publication date: December 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12

Author(s): Thomas B. Dodson

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AAOMS Author Disclosure forms

Publication date: December 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12

Author(s):

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Table of Contents

Publication date: December 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12

Author(s):

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Editorial Board Page

Publication date: December 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12

Author(s):

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Journal of Oral and Maxillofacial Surgery

Publication date: December 2018

Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12

Author(s):

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Salvage laryngectomy following organ-preservation therapy – An evidence-based review

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): Dustin A. Silverman, Sidharth V. Puram, James W. Rocco, Matthew O. Old, Stephen Y. Kang

Abstract

Salvage total laryngectomy is often indicated in patients with recurrent or persistent laryngeal cancer after radiation or chemoradiation treatment. This article reviews and discusses key considerations regarding salvage laryngectomy. Within this article, a review of the salvage laryngectomy incidence in the major organ preservation trials, survival rates, predictors of outcomes, complication rates, and the roles of elective neck dissection and free tissue transfer for reconstruction in patients undergoing salvage laryngectomy is provided.

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Magnetic resonance-based volumetric measurement of the endolymphatic space in patients with Meniere’s disease and other endolymphatic hydrops-related diseases

Publication date: Available online 30 November 2018

Source: Auris Nasus Larynx

Author(s): Hiroshi Inui, Tsuyoshi Sakamoto, Taeko Ito, Tadashi Kitahara

Abstract

Objective

To employ magnetic resonance imaging (MRI) to measure the volume of the inner ear endolymphatic space (ELS) in patients with acute low-tone sensorineural hearing loss (ALHL), sudden deafness (SD), cochlear Meniere's disease (cMD), and unilateral MD (uMD) compared with control subjects (CS) with chronic rhinosinusitis.

Methods

Forty-one patients with ALHL, 82 with SD, 48 with cMD, 72 with uMD, and 47 CS participated in the study. With the exception of all uMD patients, none of the subjects had vertigo. Images of the inner ear fluid space, positive perilymph signal, and positive endolymph signal were acquired using a 3-T MRI scanner. Three-dimensional images were reconstructed semi-automatically by using anatomical and tissue information to fuse the inner ear fluid space images and the ELS images.

Results

The cochlear ELS/total fluid space (TFS) volume ratio was 10.2 ± 6.7% (mean ± standard deviation) in the CS group, 12.1 ± 5.7% in ALHL patients, 15.2 ± 8.7% in SD patients, 18.1 ± 8.2% in cMD patients, and 21.9 ± 16.4% in uMD patients. The vestibular ELS/TFS volume ratio was 17.7 ± 10.2% in the CS group, 18.9 ± 8.3% in ALHL patients, 19.9 ± 11.3% in SD patients, 22.5 ± 13.7% in cMD patients, and 35.7 ± 24.1% in uMD patients. The cochlear ELS/TFS volume ratio in patients with uMD was similar to that in the cMD group and significantly higher than that in the CS, ALHL, and SD groups (CS = ALHL < SD < cMD = uMD: p < 0.05 for CS vs. SD and p < 0.01 for CS vs. cMD). The vestibular ELS/TFS volume ratio in patients with uMD was significantly higher than that in the CS and all other patient groups (CS = ALHL = SD = cMD < uMD: p < 0.01 for uMD vs. all other groups).

Conclusion

The cochlear ELS volume of patients with MD and other endolymphatic hydrops-related diseases differed from that of CS. Our results suggest that ALHL may not be caused by endolymphatic hydrops. We confirmed the presence of extended ELS in patients with SD.

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Role of phosphorylcholine in Streptococcus pneumoniae and nontypeable Haemophilus influenzae adherence to epithelial cells

Publication date: Available online 29 November 2018

Source: Auris Nasus Larynx

Author(s): Hiroyuki Iuchi, Junichiro Ohori, Takayuki Kyutoku, Kotoko Ito, Yuichi Kurono

Abstract

Objective

Phosphorylcholine (PC) is a structural component of Streptococcus pneumoniae (Spn) and nontypeable Haemophilus influenzae (NTHi), and is known to be associated with adherence through the platelet activating factor receptor (PAF-R). Furthermore, high PC expression is considered to be involved in Spn and NTHi virulence. In this study, we examined the influence of PC expression on the adherence of Spn and NTHi to epithelial cells in order to clarify the potential effectiveness of a vaccine targeting PC.

Methods

Twenty-seven strains of Spn and twenty-two strains of NTHi were used, cultured overnight, and PC expression was evaluated by fluorescence activated cell sorting; the strains were divided into two groups: PC low expression (PC-low) and PC high expression (PC-high) groups. Bacterial adherence was then examined using Detroit 562 cells and BALB/c mice. Bacterial invasion was then examined in Detroit 562 cells.

Results

The adherence of Spn and NTHi and invasion of NTHi in the PC-high group was significantly reduced by pretreatment with a monoclonal anti-PC antibody (TEPC-15), PAF-R antagonist (ABT-491), and PC-keyhole limpet hemocyanin (PC-KLH). However, such findings were not observed in the PC-low group.

Conclusion

The present study suggests that PC is involved in the mucosal adhesion of Spn and NTHi, and the mucosal invasion of NTHi with PC-high strains, but not PC-low strains. These results suggest that a PC-targeting mucosal vaccine only affects PC-high Spn and NTHi strains and does not disturb commensal bacterial flora in the upper respiratory tract, which comprises nonpathogenic PC-low bacteria.

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Corrigendum to “Environmental factors associated with allergic rhinitis symptoms in Japanese university students: A cross-sectional study” [Auris Nasus Larynx 45 (2018) 1006–1013]

Publication date: Available online 29 November 2018

Source: Auris Nasus Larynx

Author(s): Hironobu Nishijima, Sayaka Suzuki, Kenji Kondo, Tatsuya Yamasoba, Shintaro Yanagimoto

https://ift.tt/2RuSehm

Klassifikation und Pathophysiologie von Angioödemen

Zusammenfassung

Hintergrund

Die differenzialdiagnostische Einordung von Angioödemen kann im klinischen Alltag eine Herausforderung darstellen.

Ziel der Arbeit

Ziel ist es, eine Übersicht über die aktuelle Klassifikation von Angioödemen zu geben und deren zugrunde liegende Pathophysiologie zu erläutern.

Material und Methoden

Es erfolgte die Auswertung aktueller Leitlinien und Forschungsarbeiten zur Pathophysiologie und Klassifikation von Angioödemen.

Ergebnisse

Angioödeme werden grundlegend in Mastzellmediator-induziert und Bradykinin-vermittelt unterschieden. Akute Angioödeme durch allergische Reaktionen oder im Rahmen einer akuten Urtikaria bzw. rezidivierende Angioödeme bei Patienten mit chronischer Urtikaria sind klassische Beispiele für Mastzellmediator-induzierte Angioödeme. Zu den Bradykinin-vermittelten Angioödemformen gehören das hereditäre Angioödem und das ACE(„angiotensin-converting enzyme")-Hemmer-induzierte Angioödem. Bradykinin-vermittelte Angioödeme kommen deutlich seltener vor als Mastzellmediator-induzierte Angioödeme und verlaufen of schwerer. Die Basis zur klinischen Unterscheidung beider Formen von Angioödemen ist die gezielte Anamneseerhebung und laborchemische Diagnostik.

Schlussfolgerungen

In den meisten Fällen lassen sich Angioödeme in Zusammenschau von Klinik und Diagnostik als Mastzellmediator-induziert oder Bradykinin-vermittelt unterscheiden. In sehr seltenen Fällen bleiben die Ursache und die verantwortlichen Mediatoren unklar.

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Large-Scale Otoscopic and Audiometric Population Assessment: A Pilot Study

Publication date: Available online 30 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Kenny H. Chan, Susan Dreith, Kristin M. Uhler, Veronica Tallo, Marilla Lucero, Joanne De Jesus, Eric AF. Simões

ABSTRACT

Objective

Large-scale otoscopic and audiometric assessment of populations is difficult due to logistic impracticalities, particularly in low- and middle-income countries (LMIC). We report a novel assessment methodology based on training local field workers, advances in audiometric testing equipment and cloud-based technology.

Methods

Prospective observational study in Bohol, Philippines. A U.S. otolaryngologist/audiologist team trained 5 local nurses on all procedures in a didactic and hands-on process. An operating otoscope (Welch-Allyn^R) was used to clear cerumen and view the tympanic membrane, images of which were recorded using a video otoscope (JedMed^R). Subjects underwent tympanometry and distortion product otoacoustic emission (DPOAE) (Path Sentiero^R), and underwent screening audiometry using noise cancelling headphones and a handheld Android device (HearScreen^R). Sound-booth audiometry was reserved for failed subjects. Data were uploaded to a REDCap database. Teenage children previously enrolled in a 2000-2004 Phase 3 pneumococcal conjugate vaccine trial, were the subjects of the trainees.

Results

During 4 days of training, 47 Filipino children (M/F = 28/19; mean/median age = 14.6/14.6 years) were the subjects of the trainee nurses. After the training, all nurses could perform all procedures independently. Otoscopic findings by ears included: normal (N=77), otitis media with effusion (N=2), myringosclerosis (N=5), healed perforation (N=6), perforation (N=2) and retraction pocket/cholesteatoma (N=2). Abnormal audiometric findings included: tympanogram (N=4), DPOAE (N=4) and screening audiometry (N=0).

Conclusion

Training of local nurses has been shown to be robust and this methodology overcomes challenges of distant large-scale population otologic/audiometric assessment.

https://ift.tt/2BHfVgO

Dog Bite Injuries to the Face: Is there Risk with Breed Ownership? A Systematic Review with Meta-Analysis

Publication date: Available online 29 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Garth Essig, Cameron Sheehan, Shefali Rikhi, Charles Elmaraghy, J. Jared Christophel

Abstract

Introduction

Dog bite injuries to the face are a serious, yet modifiable public health concern. This study explores the relationship between dog breed and the risk of biting and injury. The objective of this study is to determine the relative risk and severity of dog bite injuries to the face by breed.

Methods

Retrospective chart review of facial dog bite injuries presenting to the University of Virginia Health System and Nationwide Children's Hospital. Additionally, descriptive data was collected from 240 patients over the last 15 years. Bite risk by breed was assessed by a literature search from 1970 to current. A composite measure was used to determine the severity of injury, and characterize each patient into an ordinal scale of bite severity. An average of each breed bite rate within each study was calculated and combined to create an empiric bite risk by breed. Dog breeds were also further characterized morphologically.

Results

Bite risk by breed from the literature review and bite severity by breed from our case series were combined to create a total bite risk plot. Injuries from Pitbull's and mixed breed dogs were both more frequent and more severe. This data is well-suited for a bubble plot showing bite risk on the x-axis, bite severity on the y-axis, and size of the bubble by number of cases. This creates a "risk to own" graphic for potential dog owners.

Conclusions

Breeds vary in both rates of biting and severity. The highest risk breeds had both a high rate of biting and caused significant tissue injury. Physical characteristics can also help determine risk for unknown or mixed dog breeds. Potential dog owners can utilize this data when assessing which breed to own.

https://ift.tt/2KHFKjy

Surgical ablation of lingual tonsils in the treatment of obstructive sleep apnea

Publication date: Available online 30 November 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): C. Mure, M. Blumen, A. Alali, L. Page, F. Chabolle

Abstract

Objectives/Hypothesis

The retrolingual space is one of the potential sites of obstruction identified in patients with obstructive sleep apnea syndrome (OSAS). Hypertrophied lingual tonsils (LT) can obstruct the airway at this level. The goal of this study was to measure the tolerance and efficacy of lingual tonsillectomy in patients with OSAS.

Study design

A retrospective chart review was conducted recruiting all patients with OSAS confirmed on sleep recording, who either had failed or refused medical treatment and who underwent lingual tonsillectomy.

Materials and methods

Diagnosis of LT hypertrophy was made by full ENT clinical examination using a flexible endoscopy, completed by MRI and followed by drug-induced sleep endoscopy. The surgical intervention was carried out endoscopically by diode laser or coblation. The primary endpoint to measure efficacy was drop in apnea-hypopnea index (AHI) on sleep recording at 6 months. Secondary endpoints comprised reduced snoring and Epworth Sleepiness Scale (ESS) and postoperative symptom tolerance.

Results

Eleven patients aged 44.3 ± 12.6 years were included. AHI dropped from 29.5 ± 21.7/h to 11.6 ± 9.6/h: i.e., by 60% (P = 0.005). Five patients had AHI < 10/h: i.e., cure rate of 45%. ESS dropped from 13 ± 3.4 to 8.1 ± 4.9 (P = 0.012). No complications were observed.

Conclusions

LT ablation seemed effective in OSAS with retrolingual obstruction in failure of medical treatment.

Level of evidence

4.

https://ift.tt/2BHd0EK

Risk factors for severity of juvenile-onset recurrent respiratory papillomatosis at first endoscopy

Publication date: Available online 29 November 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): E. Moreddu, E. Lambert, D. Kacmarynski, R. Nicollas, J.-M. Triglia, R.J. Smith

Abstract

Objective

The study objective was to determine risk factors for severity of juvenile-onset recurrent respiratory papillomatosis (RRP) at first endoscopic evaluation.

Methods

Based on a review of all cases undergoing surgery for juvenile-onset RRP in two pediatric otolaryngology departments in the USA and France, the following severity risk factors were analyzed: number of laryngeal levels involved, extension to the subglottis, and bilateral involvement.

Results

Thirty-two patients were included, with 571 endoscopic procedures. Number of endoscopies per patient varied according to initial extension: 30.67 procedures when all three levels were involved, 15.57 procedures when two and 14.08 procedures when only one (P = 0.03). The odds ratio for risk of > 14 procedures in 3-level involvement was 20.43 (P = 0.047). Initial subglottic extension tended to be associated with more endoscopic procedures (23.67 vs 15.56, P = 0.16).

Conclusions

RRP severity correlated with initial laryngeal extension of papillomatous lesions at first endoscopy. This finding allowed a short 3-item assessment scale to be created for routine use, complementary to Derkay's assessment scale.

https://ift.tt/2KJ9wVf

Tramadol hydrochloride: An alternative to conventional local anaesthetics for intraoral procedures- a preliminary study

Publication date: Available online 30 November 2018

Source: Journal of Oral Biology and Craniofacial Research

Author(s): Shoeb Kasim Jendi, Abhishek Talathi

Abstract

Purpose

To evaluate and compare the soft tissue anaesthesia produced by tramadol hydrochloride on gingival tissues in maxilla.

Methods

A total of 50 ASA physical status I subjects between 18 and 35 years of age, both male and female were included in the study. Each individual received 0.5 ml of 50 mg tramadol in the soft tissues over maxillary canine tooth as local infiltration on one and 0.5 ml of 20 mg lignocaine on the contralateral side in a double-blinded fashion. After completing the injection, the author recorded pain on injection, the onset of action, duration of anaesthesia, side effects, and feedback from patient.

Results

The mean onset of anaesthesia for tramadol was 172.00 s (standard deviation 39.898) while for lignocaine it was 162.60 s (standard deviation 35.098) and there was no statistically significant difference between the two groups (p = 0.214). The mean duration of anaesthesia for tramadol group was 45.70 min with a standard deviation of 8.512 min whereas for lignocaine group it was 44.70 min with a standard deviation of 8.107 min. There was no statistical relevant difference between the two groups in duration of anaesthesia (p = 0.549). None of the subjects reported any side effect in both the groups. There was no significant difference in pain on injection between the two groups.

Conclusions

Tramadol has a local anaesthetic effect similar to lignocaine when injected as infiltration in oral soft tissues.

https://ift.tt/2FQPz02

Die Konzentration überschreitend

https://ift.tt/2zwEkE6

Erratum

Publication date: December 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 6

Author(s):

https://ift.tt/2KLOQvC

Anti-microbial Resistance In Atopic Dermatitis: Need for an Urgent Rethink

Publication date: Available online 29 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): C.P. Harkins, M.T.G. Holden, A.D. Irvine

https://ift.tt/2BJbyBW

Challenges in allergy immunology practice: Solutions needed for persistent patient problems

Publication date: December 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 6

Author(s): Gailen D. Marshall

https://ift.tt/2So2d89

Author Index

Publication date: December 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 6

Author(s):

https://ift.tt/2E5OVdl

A new acronym for PPI-REE?

Publication date: December 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 6

Author(s): Russell Hopp

https://ift.tt/2SmBYil

Editorial Board

Publication date: December 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 6

Author(s):

https://ift.tt/2E6hdUR

Information for Authors

Publication date: December 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 6

Author(s):

https://ift.tt/2SmBRTX

Table of Contents

Publication date: December 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 6

Author(s):

https://ift.tt/2E44KkB

Increased IRF4 expression in isolated B cells from common variable immunodeficiency (CVID) patients

Publication date: Available online 30 November 2018

Source: Allergologia et Immunopathologia

Author(s): S. Afshar-Ghasemlou, N. Esmaeil, R. Sherkat, R. Yazdani, F. Abbasi-Rad, M. Ganjalikhani-Hakemi, A. Rezaei

Abstract

Background

Common variable immunodeficiency (CVID) is a heterogeneous disorder characterized by low serum levels of immunoglobulins (Igs) and recurrent infection. In most CVID patients, a defect in the differentiation of B cells into plasma cells has been observed. Several factors play an important role in the proliferation and differentiation of B cells, including IRF4 and XBP1 transcription factors.

Methods

In the present study we investigated the expression of IRF4 and XBP1 in the B-cells of CVID and healthy controls (HCs). For this purpose, we assessed the expression of IRF4 and XBP1 at both mRNA and protein levels by real time-PCR and flow cytometry, respectively.

Results

We found that IRF4 expression was significantly increased in CVID patients compared with controls. Although the XBP1 protein level was lower in patients in comparison to controls, this difference was not significant.

Conclusion

Taken together, increased IRF4 expression could be involved in defective functions of B cells in CVID patients.

https://ift.tt/2SfHIKK

Development of a tool for screening adverse food reactions and food allergy in Portuguese children

Publication date: Available online 30 November 2018

Source: Allergologia et Immunopathologia

Author(s): A. Jorge, M. Santos Silva, C. Lozoya-Ibánez, F. Lorente, E. Sarinho, R.M. Afonso, H. Pereira, L. Taborda-Barata

Abstract

Introduction and objectives

A standardised questionnaire may be an excellent tool for epidemiological studies aiming at screening children with suspected food allergies. Thus, the aim of the present study was to develop a screening questionnaire for assessing children with suspected food allergy and to analyse its reproducibility.

Materials and methods

A questionnaire of adverse food reactions was developed by literary review of similar questionnaires validated in other countries as well as less well defined, non-validated Portuguese questionnaires. Peer review of the questionnaire by a panel of specialists and subsequent exploratory analysis was carried out by applying the questionnaire in children with confirmed food allergy. Test–retest analysis was performed by giving a face-to-face questionnaire to 159 children with suspected adverse food reactions, aged between three and 11 years. Temporal stability using Spearman Rho correlation test and reproducibility was studied using Cohen's Kappa index.

Results

115 children confirmed adverse food reactions that occurred with one or more foods. Retest was given about three weeks after the test, to 50 of these children who were randomly selected. The questionnaire showed good temporal stability (Spearman correlation coefficient of 0.834), and good reproducibility (only two of the 27 items had a Kappa index <0.60).

Conclusions

This questionnaire showed good temporal stability and reproducibility. Its validation for screening children with suspected food allergy will allow a standardised approach to diagnosis and comparison of results obtained in different centres.

https://ift.tt/2E3Si4z

Changes in the prevalence of asthma and related risk factors in adolescents: Three surveys between 1994 and 2015

Publication date: Available online 30 November 2018

Source: Allergologia et Immunopathologia

Author(s): J. Mallol, V. Aguirre, M. Mallol-Simmonds, A. Matamala- Bezmalinovic, L. Calderón-Rodriguez, F. Osses-Vergara

Abstract

Methods

This study assesses the temporal trend of current asthma symptoms prevalence and associated factors in Chilean adolescents from South-Santiago, considering surveys performed in 1994, 2002 and 2015.

Results

The prevalence of current asthma symptoms showed a trend to increase from 11.1% in 1994 to 13.4% in 2015 (p < 0.001); physician-diagnosed asthma increased from 11.5% to 13.8%, (p < 0.001) whereas severe asthma and asthma with exercise decreased (p < 0.001). Female adolescents had a higher prevalence of current asthma in the three surveys (p < 0.001), and was a risk factor for asthma in the three surveys. In 2002, frequent consumption of meat and potatoes were associated with current asthma while frequent vigorous exercise was protective. Frequent exercise and parental tobacco smoking were risk for asthma in 2015 (p < 0.001). Current active tobacco smoking showed a trend to increase reaching a prevalence of 28.9% in 2015 (p < 0.001). There was a consistently low proportion of adolescents with current wheezing and asthma diagnosis (32.1% in 2015) and 37.6% of them had no asthma treatment.

Conclusion

The prevalence of current asthma in adolescents from the studied area would be still increasing. As in other studies, female adolescents had a higher prevalence of current asthma. Current active tobacco smoking has strikingly increased in the studied children while indoor passive tobacco exposure remains inadmissibly high. Our findings suggest that asthma in children is underdiagnosed and undertreated. More attention should be given to female gender, tobacco exposure, air pollution and local diagnostic preferences when studying and interpreting trends of asthma prevalence in adolescents from developing localities.

https://ift.tt/2SfHGCC

Self-reported hypersensitivity and allergy to foods amongst Mexican adolescents: Prevalence and associated factors

Publication date: Available online 30 November 2018

Source: Allergologia et Immunopathologia

Author(s): T.R. Bedolla-Pulido, M. Bedolla-Barajas, J. Morales-Romero, T.I. Bedolla-Pulido, M.V. Domínguez-García, D.D. Hernández-Colín, M.V. Flores-Merino

Abstract

Background

The prevalence of food allergy is on the rise on a global scale.

Objective

To determine the prevalence of food hypersensitivity (FHS) and probable food allergy (PFA), as well as the foods and factors associated with these occurrences.

Methods

A cross-sectional study was carried out among 1992 adolescents (aged 15–18 years). Each adolescent answered a structured questionnaire. A multivariate analysis was used to identify the association between the variables.

Results

The prevalence of FHS was 10.6% (the most commonly associated foods were shrimp, cow's milk and avocado) and the PFA was 7.8% (shrimp, cow's milk and pecan). The prevalences of oral allergy syndrome, food-associated urticaria and systemic reaction were 4.9%, 3.6% and 1.5%, respectively. The following factors were associated with FHS: personal history of asthma (OR 1.63; 95% CI: 1.11–2.41), allergic rhinitis (OR 2.60; 95% CI: 1.75–3.87), atopic dermatitis (OR 2.07; 95% CI: 1.25–3.43), maternal history of asthma (OR 1.80; 95% CI: 1.02–3.16), atopic dermatitis (OR 6.11; 95% CI: 2.45–15.29), and female sex (OR 1.89; 95% CI: 1.38–2.59). PFA was associated with a personal history of asthma (OR 1.65; 95% CI: 1.06–2.56), allergic rhinitis (OR 2.46; 95% CI: 1.56–3.88), atopic dermatitis (OR 2.02; 95% CI: 1.15–3.54), paternal allergic rhinitis (OR 2.52; 95% CI: 1.15–5.51), maternal atopic dermatitis (OR 7.46; 95% CI: 2.93–19.00), and female sex (OR 1.89; 95% CI: 1.31–2.72).

Conclusion

The adverse reactions associated with foods among late adolescents are a frequent occurrence, and the most commonly associated factor is atopy.

https://ift.tt/2E5MJCn

Corrigendum to “National Wisdom Tooth Treatment Audit” [Br. J. Oral Maxillofac. Surg. 54 (10) (December 2016) e71]

Publication date: Available online 30 November 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): Christine Wanis, Katy Martin, Shrina Nathwani

https://ift.tt/2FYJMpk

Plasma CXCL13 is a predictive factor for HBsAg loss and clinical relapse after discontinuation of nucleos(t)ide analogue treatment

Publication date: Available online 30 November 2018

Source: Clinical Immunology

Author(s): Muye Xia, Guichan Liao, Hongjie Chen, Yin Wu, Rong Fan, Xiaoyong Zhang, Jie Peng

Abstract

In this study, we investigated whether plasma cytokine/chemokine levels could predict HBsAg loss or clinical relapse (CR) after stopping nucleos(t)ides analogue (NA) treatment. Theplasma cytokines/chemokines levels were measured at 0, 4, 8, 12, 24 and 48 weeks after NA discontinuation by using the enzyme-linked immunoassay (ELISA) kit. Cox regression analysis revealed that CXCL13 level at the end of treatment (EOT) was an independent predictor for CR (HR 0.26, p < 0.001) and HBsAg loss (HR 3.01, p = 0.008) after treatment cessation. Among the patients with EOT CXCL13 level < 80 pg/ml, the cumulative incidences of CR and HBsAg loss were 65% and 0% at 4 years, respectively. As for the patients with EOT CXCL13 level ≥ 1000 pg/ml, 47.5% cases had HBsAg loss. Our study showed that EOT CXCL13 level was associated with off-treatment response, which may be used to guide cessation of NA treatment in clinical practice.

https://ift.tt/2PaZooG