The effectiveness of topical therapy combined with 308‐nm excimer laser on vitiligo compared to excimer laser monotherapy in pediatric patients

Abstract

We evaluated the efficiency of using a 308‐nm excimer laser with either tacrolimus, pimecrolimus, or halometasone for the treatment of childhood vitiligo. Patients who received combined treatments had significantly higher rates of repigmentation in comparison with individuals who underwent excimer laser alone therapy. Moreover, patients who received treatment with excimer laser and halometasone had significantly higher rates of repigmentation, even higher than individuals who were treated with tacrolimus combined or pimecrolimus combined. This regimen was more effective on the face, neck, and limbs. We conclude that the use of a combined excimer laser and halometasone cream has a greater therapeutic effect than laser alone.

https://ift.tt/2QES7CC

Pain therapy for the elderly patient: is opioid-free an option?

Purpose of review Chronic noncancer pain is an increasing problem in elderly because of rising life expectancy together with an increase of potentially painful medical conditions. Concomitantly, adequate treatment of elderly is often limited by coexisting diseases and polypharmacy.This review summarizes the most important specifics presented by elderly patients and discusses the pharmacological and nonpharmacological options of pain management. Recent findings A comprehensive pain assessment is a prerequisite for effective pain management. However, this can be a major challenge in patients who are unable to communicate adequately, that is, in patients with dementia. A recently developed electronic tool assessing automated facial expression and clinical behavioral indicators may help to solve this problem. The discussion about benefits and harms of opioids in elderly goes on. Although some authors underline the lack of efficacy together with the potential problems, such as, abuse, others report a beneficial effect in terms of pain relief, functional activities and disability. In addition, opioids have become an important treatment option in patients with restless legs syndrome. Various topical treatment options (i.e. capsaicin patch) and nonpharmacological interventions have been proven to be beneficial in elderly. Summary Adequate pain management of elderly patients constitutes numerous pharmacological options including nonopioids, opioids, coanalgesics and topical agents. Due to age-related characteristics, all systemic analgesics have to be given very cautiously ('start low, go slow'). Whenever possible, treatment should be performed as a multimodal approach based on the biopsychosocial model of chronic pain. Correspondence to Shahnaz Christina Azad, MD, PhD, Department of Anesthesiology and Pain Medicine, Ludwig-Maximilians University Munich, Marchioninistr. 15, 81377 Munich, Germany. Tel: +49 89440074464; fax: +49 89440074469; e-mail: shahnaz.azad@med.uni-muenchen.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Ergonomics in endoscopic sinus surgery

Purpose of review Awareness of ergonomics is growing into surgical specialties including otolaryngology. Most otolaryngologists experience occupational physical discomfort, and daily incorporation of standard ergonomic principles may alleviate some of this pain. Recent findings Further demonstration of surgery-related physical discomfort has been documented based on surveys of general otolaryngologists and subspecialty rhinologists. One study utilized surface electromyography to document physical findings directly associated with the endoscopic sinus surgery procedure. However, relatively little work has been published on interventions to relieve task-related pain and body discomfort in rhinology. Summary Surgeon fatigue and bodily injury is a surprisingly frequent occurrence and is more likely to occur in procedures that are mentally challenging, prolonged, and require the surgeon to operate in a fixed position. Endoscopic sinus and skull base surgeons appear particularly susceptible to task-related physical discomfort, and incorporation of ergonomic principles should be a priority. Correspondence to Vijay R. Ramakrishnan, MD, Department of Otolaryngology, University of Colorado School of Medicine, 12631 E 17th Ave, B205, Aurora, CO 80045, USA. Tel: +1 303 724 1950; fax: +1 303 724 1961; e-mail: Vijay.ramakrishnan@ucdenver.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Dermoscopic follow‐up of therapeutic response in mantle cell lymphoma with secondary involvement of the scalp

Summary

The scalp is a potential location for both benign and malignant tumors. Lymphoproliferative diseases can involve the skin as a primary or secondary manifestation. Dermoscopy is a noninvasive diagnostic tool for rapid diagnosis, screening, and follow‐up of the majority of skin tumors. Mantle cell lymphoma (MCL), a rare type of aggressive systemic lymphoma, usually occurs as a generalized lymphadenopathy, commonly with infiltration of the bone marrow, spleen, gastrointestinal tract, and Waldeyer's ring. In rare cases, it can also involve other structures, such as the lungs, central nervous system, liver, or skin. We report the case of a 74‐year‐old male patient suffering from MCL since 2015. Complete remission was obtained after R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) treatment. During maintenance therapy with rituximab, a solitary tumor occurred on the scalp. Dermoscopy of the lesion suggested relapse because of the presence of multiple chaotically distributed short linear vessels with multiple red dots within the hair follicles. Histological examination confirmed the diagnosis of MCL. After second‐line therapy with rituximab and bendamustine (R‐B), the tumor of the scalp completely disappeared and dermoscopy showed no abnormalities.

https://ift.tt/2EfX2Ei

Improvements in the perception of facial attractiveness following surgical aesthetic treatment; study based on online before and after photos

Summary

Background

Aesthetic surgery procedures such as lip augmentation, eyelid correction, face‐lifting, or Botox treatment for lines and wrinkles are an important part of cosmetic surgery.

Objectives

The aim of the study was to estimate improvement in appearance following plastic surgery using modern collective intelligence methods of validation.

Methods

A total of 108 photographs showing 54 patients prior to and following cosmetic surgery were downloaded from Internet web presentations of several unnamed plastic surgeons. The same number of photographs depicted each of the four investigated areas of treatment—26 lip enhancement, 26 blepharoplasty, 26 face‐lift, 26 botulinum toxin injection. Attractiveness of depicted individuals was assessed by 167 observers. Each photograph was judged separately.

Results

Blepharoplasty produced the most remarkable improvement in attractiveness amounting to 32.79 (SD ± 26.35). Improvement following Botox treatment stood at 30.29 (SD ± 24.55), whereas face‐lifting produces improvement of 28.70 (SD ± 22.76). Improvement following lip augmentation was estimated at 12.70 (SD ± 29.8). Highest Spearman's rank correlation coefficient was obtained for face‐lift and Botox (0.24 and 0.22, respectively).

Conclusions

Blepharoplasty, face‐lifting, and Botox deliver a significant improvement in facial attractiveness. Additionally, face‐lifting and Botox are distinguished by a high level of reproducibility. Our results indicate that lip augmentation is a treatment with a statistically significant, but less marked improvement in attractiveness.

https://ift.tt/2Su2iXK

A new approach to lower eyelid‐cheek junction rejuvenation

Summary

Background

Anti‐aging in lower eyelid‐cheek junction area has always been the upmost widely sought of cosmetic surgery. Removal of orbital fat from inside or outside, removal of part of the skin or even the orbicularis muscle, superficial pull and deep fill and a series of surgical procedures like these have been or are becoming the mainstream of clinical practice. However, aging involves a variety of tissues and causes, which is a dynamic and continuous process. Conventional or a single method cannot fundamentally solve all of the problems of the aging in lower eyelid‐cheek junction area. Therefore, we propose a better‐organized surgical approach based on the whole anatomy of lower eyelid‐cheek junction area.

Methods

A total of 103 patients received lower eyelid‐cheek junction rejuvenation surgery from September 2014 to September 2017 in our department. Efficacy of surgeries was delineated and scored by both patients and surgeons.

Results

All patients of different ages, genders were relatively satisfied with the lower eyelid‐cheek junction rejuvenation surgery in our department. Patients with different past histories of cosmetic surgeries could all benefit from the lower eyelid‐cheek junction rejuvenation surgery.

Conclusion

Rejuvenation of lower eyelid‐cheek junction area should be based on a thorough understanding of periorbital anatomy, age‐related changes of the lid‐cheek junction, and the variables controlling lower lid tone and position. The surgical strategies are best used in a graded fashion.

https://ift.tt/2EeXJh3

The relation between androgenetic thin hair diagnosed by trichoscope and benign prostatic hyperplasia

Summary

Background

Androgenetic alopecia carries a major cosmetic disfigurement and benign prostatic hyperplasia is associated with many urinary tract symptoms and both diseases are mediated by dihydrotestosterone.

Objectives

The study aimed to determine the relationship between hair diameter in androgenetic alopecia diagnosed, by trichoscope, to benign prostatic hyperplasia symptoms and signs.

Methods

Fifty androgenetic alopecia males and 50 normal males as control were included. We used trichoscope for hair examination, transrectal ultrasound for prostate volume, and urodynamic inspectoscope for urinary symptoms, serum total testosterone, dihydrotestosterone, and total prostatic specific antigen were measured in blood samples. All participants answered the International prostate symptom score questionnaire and the International Index of Erectile Function score questionnaire.

Results

A significant difference between patient and control groups was detected as regards hair thickness (P = 0.001), prostatic volume (P = 0.013), urinary symptoms, prostatic specific antigen level (P = 0.015). A significant difference was detected between thin (<0.03 mm, n = 26) and medium to thick hair (>0.03, n = 24) subgroups of patients as regards age (P = 0.001), dihydrotestosterone level (P = 0.001), testosterone level (P = 0.001), and urinary symptoms (P = 0.001).

Conclusion

Androgenetic alopecia patients with thin hair diagnosed by trichoscopy are more prone to prostatic enlargement and its related symptoms. Androgenetic alopecia severity can be diagnosed by trichoscopy in addition to Hamilton‐Norwood scale.

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Mutilating genital aphthous ulceration causing perforation in two women

https://ift.tt/2rlQtHF

Zosteriform lymphangitis carcinomatosis in the cervical area arising from pyriform fossa adenocarcinoma

https://ift.tt/2GeseFR

Lack of Sphenoid Pneumatization Does Not Affect Endoscopic Endonasal Pediatric Skull Base Surgery Outcomes

Objectives/Hypothesis

Currently, due to the rarity of pathology, there are limited data surrounding outcomes of pediatric skull base surgery. Traditionally, surgeons have proceeded with caution when electing endonasal endoscopic transsellar/transplanum approaches to the skull base in pediatric patients due to poor sphenoid pneumatization. In this study, we review outcomes of endoscopic pediatric skull base surgery based on sphenoid pneumatization patterns.

Study Design

Retrospective chart review.

Methods

A review of all cases of pediatric (age < 18 years) craniopharyngioma managed via an endoscopic endonasal approach at a tertiary academic medical center.

Results

A total of 27 patients were included in the analysis. The median age was 8 years. Nineteen (70%) patients were male. Presellar, sellar/postsellar, and conchal sphenoid pneumatizations were found in 6, 11, and 10 patients, respectively. There was no significant association between sphenoid pneumatization pattern and extent of resection (gross vs. subtotal, P = .414), postoperative cerebrospinal fluid (CSF) leak (P = .450), intraoperative estimated blood loss (P = .098), total operative time (P = .540), and length of stay (P = .336). On multivariate analysis, after accounting for age, sex, preoperative cranial nerve involvement, and cavernous sinus invasion, there remained no significant association between sphenoid pneumatization pattern and extent of resection (P = .999) and postoperative CSF leak (P = .959).

Conclusions

Sphenoid pneumatization pattern does not appear to affect outcomes in endoscopic skull base surgery in the pediatric population. Importantly, lack of sphenoid pneumatization does not impede gross total resection or increase complications. Thorough knowledge of the anatomy during the endoscopic approach is critical to optimize outcomes.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2E3QdET

Der Mini-Audio-Test (MAT) – eine Screeningmethode auf Schwerhörigkeit für Haus- und Fachärzte

Laryngo-Rhino-Otol
DOI: 10.1055/a-0805-5741

Hintergrund In Deutschland leiden etwa 15 Millionen Menschen an einer Schwerhörigkeit (SH), doch nur 16 % tragen Hörgeräte. Diese Unterversorgung kann für die Betroffenen zu schwerwiegenden Folgen (soziale Isolation, Depression, Förderung einer Demenz etc.) führen. Ein frühzeitiges und flächendeckendes Hörscreening ab dem 50. Lebensjahr kann dies verbessern. In dieser Studie wurde der Mini-Audio-Test (MAT), ein sechs Fragen zum subjektiven Hörverlust (HV) umfassender Test mit dreistufiger Antwortskala, an einem Normalkollektiv überprüft (Sensitivität (Se), Spezifität (Sp), positiver prädiktiver Wert (PPW)). Methode Es wurden 943 Patienten (älter als 50 Jahre) ohne bekannte Ohrenerkrankungen mittels MAT befragt, zum Vergleich die Hörschwellen tonaudiometrisch ermittelt und die Se, Sp und der PPW zur Detektion eines relevanten HV durch den MAT für die Altersklassen < 60 Jahre (AG1) und ≥ 60 Jahre (AG2) mittels binomialer Proportionen ermittelt. Ergebnisse Die Se lag für AG1 bei 0,66, die Sp bei 0,61, der PW bei 0,60, für die AG2 lag die Se bei 0,47, die Sp bei 0,80, der PPW bei 0,89. Schlussfolgerung Entsprechend der vorliegenden Ergebnisse wird der Einsatz des MAT als Screeningmethode für Nicht-HNO-Ärzte zur Detektion von schwerhörenden Patienten ab dem 50. Lebensjahr vorgeschlagen. Hierdurch ließen sich auch schwerwiegende Begleiterkrankungen wie Minderung der kognitiven Leistungsfähigkeit, Sturzrisiko, Depression und Demenz positiv beeinflussen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2rm7uBw

Computer-assisted surgery in therapeutic strategy distraction osteogenesis of hemifacial microsomia: accuracy and predictability

Distraction osteogenesis can be used to treat hemifacial microsomia in patients of any age group. Application of three-dimensional (3D) technology in the surgical planning of distraction osteogenesis allows the placement of an intraoral distractor to define the cutting line and help predict the outcome of surgery.

https://ift.tt/2QA0krx

Adaptive change in temporomandibular joint tissue and mandibular morphology following surgically induced anterior disc displacement by bFGF injection in a rabbit model

The purpose of this study was to examine the effect of injecting basic fibroblast growth factor following surgical induced anterior disc displacement in temporomandibular joints (TMJ).

https://ift.tt/2QyzIaw

Evaluation of stress distribution in critical anatomic regions following the Le Fort I osteotomy by three-dimensional finite element analysis

In this study, we aimed to measure the stresses both on the pterygoid plates and the cranial base during the down-fracture and at the time of pterygomaxillary osteotomy by using the finite element analysis method to have an idea about the possible causes of complications. Three different surgical approaches were applied to the obtained models. In the Model 1, Le Fort I cuts without pterygomaxillary separation was applied. In the Model 2, same standard Le Fort I cuts were applied with pterygomaxillary separation.

https://ift.tt/2E2uSLT

Condylar Head Remodeling compensating for Condylar Head Displacement by Orthognathic Surgery

The purpose of this study was to evaluate the association between kind of condylar displacement due to orthognathic surgery and the subsequent adaptive condylar head remodeling.The sample in this retrospective cohort study consisted of 30 patients (12 female and 18 male; mean age 22.7y) with skeletal Class III malocclusion who underwent bilateral sagittal split ramus osteotomy (SSRO). Three-dimensional superimpositions of cone-beam computed tomography (CBCT) scan derived images from immediately after and 6 months after surgery were to reveal the type of remodeling, while images from before and immediately after surgery were to identify the subsequent type of condylar displacement.

https://ift.tt/2E44LEh

Three-dimensional analyses of nasolabial forms and upper lip surface symmetry after primary lip repair in patients with complete unilateral cleft lip and palate

To analyze three-dimensional (3D) nasolabial forms and upper lip surface symmetry after primary lip repair in children with unilateral cleft lip and palate (UCLP).

https://ift.tt/2QBQDsG

Risk factors and distribution features of level IB lymph nodes metastasis in nasopharyngeal carcinoma

The objective of this study is to investigate the risk factors and distribution features for level IB metastasis in nasopharyngeal carcinoma (NPC) and provide clinical evidence for defining the indications and clinical target volume (CTV) of prophylactic level IB irradiation.

https://ift.tt/2SwcZJj

Chondrosarcoma of the jaw bones: a review of 224 cases reported to date and an analysis of prognostic factors

The objective was to integrate the available published data on chondrosarcoma (CHS) of the jaw bones into a comprehensive analysis of its clinical and histological features, treatment, and prognostic factors. An electronic search was undertaken in October 2017. To be eligible, the publication had to provide sufficient clinical/histological data to confirm the diagnosis. One hundred and ten publications (224 cases of CHS) were identified and included. There was a slightly higher prevalence of CHS in males than in females.

https://ift.tt/2G3mtdP

Increased risk of incident thyroid diseases in people with psoriatic disease: A cohort study

●Patients with psoriasis are associated with an increase in incident thyroid diseases including hyperthyroidism, Grave's disease, hypothyroidism, and Hashimoto's thyroiditis. This risk is further increased in those with psoriatic arthritis.●Our findings may serve as a guide for risk stratification for thyroid disease among patients with psoriatic disease.

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Segmental phenol-Croton oil chemical peels for treatment of periorbital or perioral rhytides

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Correction

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Correction

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Correction

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REPLY to JAAD-D-18-01922: ‘‘Folliculitis decalvans: Effectiveness of therapies and prognostic factors in a multicenter series of 60 patients with long-term follow-up’’

https://ift.tt/2KWfZMN

Correction

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Eosinophilic dermatosis of hematologic malignancy: a retrospective cohort of 37 patients from an Italian center

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Comment on ‘‘Folliculitis decalvans: Effectiveness of therapies and prognostic factors in a multicenter series of 60 patients with long-term follow-up’’

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Patient Comfort and Expectations for Total Body Skin Exams: A Cross-Sectional Study

https://ift.tt/2KZKBNk

“Vitiligo and major depressive disorder: a bidirectional population-based cohort study”

•It is known that patients with vitiligo are at risk for depression; however this study demonstrated an increased risk of vitiligo in patients with depression, which may be due to immune dysregulation.•Clinicians treating vitiligo patients should be aware of this bidirectional relationship and refer for mental health services accordingly.

https://ift.tt/2BTvGBw

Monte Carlo simulation of reasons for early failure of implants: effects of two risk factors

We have estimated the joint effects of two important risk factors on early failure of implants and then ranked all quoted risks by importance. We made a systematic search of published papers listed in PubMed, Web of Knowledge, Scopus, and Cochrane Central up to March 2018, and identified a total of 437 records. Eight studies met the inclusion criteria, in which seven significant risk factors for early failure were selected and used to build a conceptual simulation model. Selected risk factors were: "male sex", "smoking", "quality of bone", "short implants", "wide implants", "adjacent teeth", and "periodontitis".

https://ift.tt/2RAERft

Day-case bilateral sagittal split osteotomy

In the UK, patients who have bilateral sagittal split osteotomy (BSSO) have generally been thought to require inpatient admission and an overnight hospital stay. However, since the introduction of national standards on day case surgery in the UK in 2011, patients at the Royal Gwent Hospital, Newport, have been treated as day cases, and have been pleased with the results. The aim of this paper was to show that these procedures conform to current national standards, and can be done successfully and safely.

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Three‐dimensional structure of the wheat β‐amylase Tri a 17, a clinically relevant food allergen

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The relationship of habitual diet with oesophageal inflammation and integrity in Eosinophilic Esophagitis

https://ift.tt/2Sty5rS

Smoking habits among adolescents with asthma – data from a population based birth cohort

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Long‐term outcomes in chronic hypersensitivity pneumonitis

Abstract

Introduction

The objective of this study was to analyze mortality, possible predictors of long‐term survival and health‐related quality of life of a large chronic hypersensitivity pneumonitis (CHP) patient sample.

Methods

Longitudinal study in patients diagnosed with CHP during 2004‐2013, followed for at least one year. Patients remaining alive and consenting to participate had a follow‐up visit during 2015, including a complete pulmonary function study and the EuroQol‐5D and Beck Depression and Anxiety Inventories.

Results

Out of the 160 patients finally included, 87 remained alive. Seventy‐three had died or underwent lung transplantation at the time of the study with a median survival of 7.0 (4.4‐14.5) years. A Cox proportional risk model showed that factors associated with lower survival were: increased age, a low percentage of lymphocytes in bronchoalveolar lavage (BAL), a decreased transfer factor of the lung for carbon monoxide (DLCO), presence of honeycomb in the high resolution chest scan (HRCT) and the usual interstitial pneumonia (UIP) histologic pattern. At follow‐up all patients presented an EuroQol‐5D score < 0.8 and 21(50%) and 9(28.6%) subjects presented a probable anxiety and depressive syndrome, respectively.

Conclusion

CHP is a severe disease with a bad mid‐term prognosis. Lymphocyte values in BAL and DLCO values at baseline, presence of honeycomb in HRCT and UIP histologic pattern were found to be predictors of survival. Early accurate diagnosis of the disease is fundamental for prompt initiation of antigen avoidance.

This article is protected by copyright. All rights reserved.

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The WHO/IUIS Allergen Nomenclature

Summary

The WHO/IUIS Allergen Nomenclature Sub‐Committee (http://www.allergen.org/), an international body of experts, has developed an allergen nomenclature system to provide a common language for unambiguous communications between researchers, clinicians, pharmaceutical companies and regulatory authorities regarding specific allergenic proteins. Official allergen names are only assigned by the WHO/IUIS Nomenclature Sub‐Committee once a new allergen has successfully undergone the submission and evaluation process. This article highlights the necessary steps to obtain an official allergen name and the high importance of having an official allergen nomenclature.

This article is protected by copyright. All rights reserved.

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Does isotretinoin cause depression and anxiety in acne patients?

Background

Acne is the most common skin disease, and isotretinoin is the most powerful drug amongst the various drugs used for its treatment. A causal relationship has not yet been established between isotretinoin use and depression.

Objectives

The aim of this study is to research the effect of isotretinoin treatment on depression in a group of patients undergoing isotretinoin therapy.

Methods

Behavioral tests measuring anxiety and depression, and the measures assessing acne severity and quality of life were applied to 112 acne patients consulted at Dermatology Clinic of Beyazit Medico Social Center of Istanbul University.

Results

In this study, 72 acne patients (61 female and 11 male) were evaluated. A significant decrease was observed in HAD‐D, GAGS and CADI scores at the end of the therapy. There was no significant relationship between patients' depression history and HAD‐D scores at the end of first month of therapy and at the end of treatment.

Conclusion

Although the psychiatrists are concerned about the potential psychiatric side effects of isotretinoin, our data support no causal relationship between isotretinoin use and depression in acne patients.

This article is protected by copyright. All rights reserved.

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Alitretinoin for palmoplantar keratodermas: a novel case and review of the literature

Papillon‐Lefèvre syndrome (PLS) is a rare, autosomal recessive disorder of keratinization, characterized by palmoplantar keratoderma (PPK) and severe chronic periodontitis which leads to an early loss of primary and permanent teeth. Oral retinoids, such as etretinate, isotretinoin and acitretin, represent the most important therapeutic options for keratoderma of PLS, with varying results in terms of efficacy. We report here the first case of 55‐year‐old woman diagnosed with PLS treated with alitretinoin.

This article is protected by copyright. All rights reserved.

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When IL‐17 inhibitors fail: real‐life evidence to switch from secukinumab to adalimumab or ustekinumab

Psoriasis is a chronic, systemic inflammatory disease that in the moderate to severe forms may benefit of biologics, namely TNF and IL‐12/23 and IL‐17 inhibitors. Loss of response, lack of response or discontinuation due to adverse events represent a concrete therapeutic challenge for dermatologists that have to switch patients to other treatments. Although some evidences already exist toward the switch from IL‐12/23 and TNF inhibitors to IL‐17 inhibitors, conversely nothing is present toward the switch from IL‐17 inhibitors to IL‐12/23 and TNF inhibitors. We performed a real‐life study enrolling 50 patients randomly switched to adalimuamb, a TNF inhibitor, or ustekinumab, an IL‐12/23 inhibitor. Our observational study suggests that switching from IL‐17i to TNFi and IL‐12/23i is a safe and effective therapeutic strategy.

This article is protected by copyright. All rights reserved.

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Clindamycin as Unique Antibiotic Choice in Hidradenitis Suppurativa

Background and Objective

The Rifampicin (RF) ‐ Clindamycin (CL) combination is recommended as first line therapy in moderate to severe Hidradenitis Suppurativa (HS) by European S1 guidelines. Although prolonged use of RF should be discouraged, there are currently few alternatives to this combination therapy.

The aim of this study was to assess retrospectively the efficacy of oral CL monotherapy in patients diagnosed with HS.

Methods

In the period January 2017 ‐ May 2018 31 HS patients who received a 300 mg b.i.d. oral dose of CL were studied retrospectively. Efficacy of the treatment was evaluated by comparing the main HS severity scores (Sartorius score modified by J.E. Revuz, Hidradenitis Suppurativa Physician Global Assessment/HS‐PGA and International Hidradenitis Suppurativa Severity Score System/IHS4) before (W0) and after (W12) CL oral therapy.

Results

CL efficacy was demonstrated by the extreme and significant reduction of all three disease severity parameters during the 12‐week period (p≤0.01). There was also a statistically significant change in the mean VAS for pain.

Conclusions

This study demonstrates the efficacy of oral CL monotherapy as RF‐sparing regimen alternative to RF‐CL combination in a selected group of patients.

This article is protected by copyright. All rights reserved.

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Dysphagia diagnosis with questionnaire, tongue strength measurement, and FEES in patients with childhood-onset muscular dystrophy

Publication date: Available online 5 December 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Athanasia Printza, Charalambos Goutsikas, Stefanos Triaridis, Athanasios Kyrgidis, Katerina Haidopoulou, Jannis Constantinidis, Evagelos Pavlou

https://ift.tt/2EhIzYz

Does suturing tonsil pillars post-tonsillectomy reduce postoperative hemorrhage?: A Literature Review

Publication date: Available online 4 December 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jacqueline A. Wulu, Melissa Chua, Jessica R. Levi

Abstract

Objective

Literature review comparing post-tonsillectomy hemorrhage in pediatric and adult patients with and without suturing tonsil pillars to investigate whether suturing tonsil pillars reduces the risk of post-tonsillectomy hemorrhage.

Review

methods; Online journal databases were searched using the key phrases "post tonsillectomy hemorrhage", "post tonsillectomy bleed", and "tonsil pillar suture". 10 published studies were found regarding tonsil pillar suturing, four directly related to postoperative bleeding and five focusing on postoperative pain reduction. There was one study that evaluated both pain and bleeding. The pain reduction studies were comprised of 225 patients while the postoperative bleeding studies included 3987 patients.

Conclusions

Suturing tonsil pillars after tonsillectomy may be beneficial after cold tonsillectomy.

Implications for practice; Post-operative bleeding is one of the most common complications that can result in increased patient distress and hospitalization. In this article, we provide literature review of tonsil pillar suturing and post-tonsillectomy hemorrhage. Our study suggests suturing the tonsil pillars immediately post-tonsillectomy may reduce the risk of severe post-operative bleeding requiring return to the operating room for certain patients.

https://ift.tt/2SwSFaH

Uncertain diagnosis and prognosis in advanced melanoma: A qualitative study of the experiences of bereaved carers in a time of immune and targeted therapies

Abstract

Background

Recent advances in advanced melanoma therapies are associated with improved survival for some patients. How patients with diagnoses of advanced disease and their carers experience this expanding treatment paradigm, however, is not well understood.

Objectives

We explored bereaved carers' accounts of the trajectory of advanced melanoma involving treatment by immune or targeted therapies to build an understanding of their experiences of care relating to diagnosis and prognosis.

Methods

A qualitative exploratory design, using methods drawn from grounded theory was adopted. Analyses drew on in‐depth interviews with 20 bereaved carers from three metropolitan melanoma treatment centres in Australia. A flexible interview guide and a structured approach of concurrent data collection and analysis were applied.

Results

Carers described qualities of the experience including the shock of diagnosis after a sometimes‐innocuous presentation with vague symptoms. They reported an unclear prognosis with complexity arising from interplay between an uncertain disease trajectory and often ambiguous expectations of outcomes of emerging immune and targeted therapies. Uncertainty dominated carers' experiences, increasing the complexity of care planning.

Conclusions

Effective communication of an advanced melanoma diagnosis and prognosis is critical. Recognition of the uncertainty inherent in the benefit of immune and targeted therapies in a constructive manner may facilitate more timely and effective care planning conversations between patients, carers and medical specialists.

This article is protected by copyright. All rights reserved.

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Notch dysregulation and HS: let's talk about Numb

Abstract

We read with great interest the article by J. W. Frew regarding Notch Dysregulation as an Epiphenomenon in Inflammatory Skin Diseases.¹ The paper pointed out some controversies among Notch activity and keratinocyte proliferation as well as maturation in Hidradenitis Suppurativa (HS), Psoriasis, Atopic Dermatitis and Lichen Planus. Because of a recognized involvement of Notch in HS, but at the same time still not clear, we also explored other components of the same signalling.

This article is protected by copyright. All rights reserved.

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The illusion of conventional histological resection margin control

Abstract

An advantage of surgical treatment for basal cell carcinoma (BCC) over other therapeutic options is the possibility of histological margin control. The general understanding is that only 1‐2% of the actual margins are checked histologically using the 'bread loaf' or step sectioning technique for conventional excision specimens, but the percentage of resection margins that are microscopically evaluated have not actually been quantified to date. [1, 2] This study's objective was to calculate the mean percentage of resection margins of BCC excision specimens that is histologically evaluated.

This article is protected by copyright. All rights reserved.

https://ift.tt/2BRkTYf

Diagnostic accuracy of ex vivo fluorescence confocal microscopy for Mohs surgery of basal cell carcinomas: a prospective study on 753 margins

Abstract

Background

Frozen histological sections are currently used for intra‐operative margin assessment during Mohs surgery. Fluorescence confocal microscopy (FCM) is a new tool, which offers a promising and faster alternative to frozen histology.

Objective

The aim of the present study is to prospectively evaluate in a clinical setting, the accuracy of FCM as compared to frozen sections in BCC's margin assessment.

Methods

Patients with BCC, scheduled for Mohs surgery were prospectively enrolled. Freshly‐excised surgical specimens were first examined through FCM and then frozen sections were evaluated. Permanent sections were finally obtained, in order to validate our sample technique.

A blind re‐evaluation was also performed for discordant cases between FCM and frozen sections.

Sensitivity and specificity levels, as well as positive and negative predicting values were calculated and ROC curves were generated.

Results

We enrolled 127 BCCs in as many patients (40.2% females). A total number of 753 sections were examined. All BCCs were located on the head and neck area. When evaluating the performance of FCM as compared to frozen sections 79.8% sensitivity, 95.8% specificity, 80.5% positive predicting and 95.7% negative predicting values were found (Area Under the Curve: .88, 95%CI .84‐.92; P<.001). A total of 49 discordant cases between FCM and frozen sections evaluations were blindly re‐evaluated, of which 24 were false positive and 25 false negative. The performance of FCM and frozen sections was also evaluated according to the final histopathological assessment.

Conclusions

We found high levels of accuracy for FCM as compared to frozen sections evaluation, in intra‐operative BCC's margin assessment during Mohs surgery. Some technical issues still prevent a wide use of this technique, but new upcoming devices promise to overcome these limitations.

This article is protected by copyright. All rights reserved.

https://ift.tt/2KVyVez

Correlation of the Refined Hurley Classification for Hidradenitis suppurativa with Patient Reported Quality of Life and Objective Disease Severity Assessment

Abstract

Background

Hidradenitis suppurativa (HS) is a chronic, debilitating, heterogeneous disease requiring different treatment approaches. Recently, we refined the classic Hurley classification into a seven‐stage classification in order to guide these treatment choices. This new classification subdivides Hurley stage I and II into three sub‐stages namely mild (A), moderate (B), and severe (C) HS disease. Hurley stage III is not sub‐categorised and always severe.

Aim

To investigate the correlation between the given severity grades of Hurley I and Hurley II in the refined Hurley classification, and the patient reported quality of life and physician‐assessed objective severity score.

Methods

In this cross‐sectional study, HS patients participating in the observational cohorts of two Dutch tertiary referral centres were included before June 2017. The patient reported Dermatology Life Quality Index (DLQI) and physician‐assessed International HS Severity Score System (IHS4) scores were compared between the refined Hurley stages.

Results

In total, 433 patients were analysed. DLQI and IHS4 scores increased within Hurley stage I and II from A through C. There was a significant positive correlation of DLQI and IHS4 with increasing refined Hurley sub‐stages (refined Hurley stage I (A, B, and C) to DLQI: r_s=0.259, p<0.001 and refined Hurley stage II (A, B, and C) to DLQI r_s=0.185, p=0.010; refined Hurley stage I (A, B, and C) to IHS4 r_s=0.603, p<0.001 and refined Hurley stage II (A, B, and C) to IHS4 r_s=0.532, p<0.001).

Conclusion

The refined Hurley classification accurately correlates with HS severity assessed by both patients and clinicians. Therefore, the refined Hurley classification is a useful tool for the quick assessment of severity in HS.

This article is protected by copyright. All rights reserved.

https://ift.tt/2BSiQU4

Dermoscopy of angioleiomyoma: A case report

https://ift.tt/2zLnbXL

A rare association of paraneoplastic pemphigus with gastric signet cell ring carcinoma

https://ift.tt/2PlIeF4

Generalized pustular psoriasis complicated with bullous pemphigoid

https://ift.tt/2ASQJCn

Aggressive Squamous Cell Carcinoma in Organ Transplant Recipients

This case series describes the clinicopathologic features of and identifies factors associated with aggressive squamous cell carcinoma in solid organ transplant recipients.

https://ift.tt/2UcyZe9

Comparison of Injuries From Sharps Among Residents Within Dermatology and Other Medical Specialties

This study assesses whether the nature of injuries from sharps among dermatology residents is demonstrably different compared with injuries from sharps among residents in other medical and surgical specialties.

https://ift.tt/2AS4f9t

Use of Big Data to Estimate Defective DNA Repair Variants in the US Population

This molecular epidemiologic study examinsd 3 large exome sequence databases totaling more than 200 000 alleles to correlate disease-associated allele frequencies with the expected and reported prevalence of clinical disease.

https://ift.tt/2UhA4Bh

Cyclosporine-Induced Gingival Hypertrophy

This case report describes cyclosporine-induced gingival hypertrophy in a child with aplastic anemia.

https://ift.tt/2AVhq9H

In reply: Use of low-molecular weight dextran as an LA adjuvant to extend LA action

https://ift.tt/2RyGme0

Die adaptive Messung des Freiburger Einsilbertests im Störschall

Zusammenfassung

Hintergrund

Während sich die adaptive Messweise unter den Satztests etabliert hat, ist sie bei dem Freiburger Einsilbertest (FBE) als wichtigstem Vertreter der Worttests noch nicht angewendet worden. Da sich die Ergebnisse von Wort- und Satztests wegen der unterschiedlichen Messweise nicht vergleichen lassen, haben wir in dieser Studie einen adaptiven Messalgorithmus auf den FBE im Störschall übertragen, der sich bei Satztests bewährt hat. Die Ergebnisse des neuen Messverfahrens haben wir mit denen des Standards unter den Satztests, dem Oldenburger Satztest (OLSA), verglichen.

Methoden

An 40 otologisch gesunden Probanden wurde in randomisierter Reihenfolge sowohl der adaptiv gemessene FBE als auch der OLSA durchgeführt. Die Ergebnisse wurden bezüglich ihres Zeitbedarfs, möglicher geschlechtsspezifischer Unterschiede und der Reihenfolge der Sprachverstehenstests ausgewertet und hinsichtlich der Korrelation mit dem neuen Test untersucht.

Ergebnisse

Der Zeitbedarf für den adaptiven FBE war signifikant größer als für den OLSA. Bezüglich möglicher geschlechtsspezifischer Unterschiede oder der Präsentationsreihenfolge ließen sich keine signifikanten Unterschiede der Testergebnisse nachweisen. Der mittlere Signal-Rausch-Abstand für das 50 %-Sprachverstehen des OLSA war signifikant kleiner als der des FBE. Zwischen den Ergebnissen beider Tests konnte keine Korrelation nachgewiesen werden.

Schlussfolgerungen

Der FBE kann nicht nur den Diskriminationsverlust als Hörverlust in Prozent, sondern mit einem adaptiven Algorithmus auch die 50 %-Sprachverstehensschwelle messen. Der adaptive FBE ist zeitaufwendiger als der OLSA. Hinsichtlich einer möglichen fehlenden Korrelation der Ergebnisse für das 50 %-Sprachverstehen beider Tests sollten weitere Studien mit Schwerhörenden durchgeführt werden.

https://ift.tt/2PlHAYm

Comparison of microbiota and allergen profile in house dust from homes of allergic and non-allergic subjects- results from the GUSTO study

The prevalence of allergic diseases, such as asthma, allergic rhinitis, eczema and food allergy, has been increasing worldwide, as shown in a large number of studies, including the International Study of Asthm...

https://ift.tt/2Uhcpkz

Urticaria control test might misevaluate disease control in particular patients treated with omalizumab

Publication date: Available online 4 December 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Murat Türk, İnsu Yılmaz

https://ift.tt/2G0ZPTu

Immunadsorption in der Dermatologie

Zusammenfassung

Den blasenbildenden Autoimmundermatosen liegen pathogenetisch relevante Autoantikörper gegen Bestandteile der Epidermis und/oder oberflächennahen Schleimhäute (beim Pemphigus) bzw. gegen Strukturproteine der dermoepidermalen Junktionszone (bei den Pemphigoiderkrankungen) zugrunde. Mittels Immunadsorption (IA) können Antikörper aus dem Plasma entfernt werden. Daten zum adjuvanten Einsatz dieser Therapie in der Dermatologie liegen insbesondere für Patienten mit einem therapierefraktären oder schweren Pemphigus vulgaris und Pemphigus foliaceus, aber auch mit Pemphigoiderkrankungen vor. In den letzten Jahren wurden zudem verschiedene Therapieprotokolle für den Einsatz der IA bei Patienten mit schwerem atopischem Ekzem und erhöhten IgE-Spiegeln publiziert. Während hauptsächlich Panimmunglobulinadsorber bzw. bei der atopischen Dermatitis auch ein spezifischer Ig(Immunglobulin)E-Adsorber eingesetzt wurden, sind in Zukunft antigenspezifische Adsorber zu erwarten, die eine gezielte Reduktion der Autoantikörper ermöglichen.

https://ift.tt/2EftFSw

Liposomal iRInotecan, Carboplatin or oXaliplatin for Esophagogastric Cancer

Condition:   Esophageal Cancer
Interventions:   Drug: Liposomal Irinotecan;   Drug: Carboplatin;   Drug: Capecitabine;   Drug: Oxaliplatin;   Drug: 5-fluorouracil;   Drug: Leucovorin
Sponsors:   Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA);   Servier
Not yet recruiting

https://ift.tt/2RCIykD

Study on the Effect of Sound Therapy on Chronic Primary Tinnitus

Condition:   Tinnitus
Interventions:   Device: CAABT;   Device: TMT
Sponsor:   Beijing Friendship Hospital
Recruiting

https://ift.tt/2QdkpVi

Study of Pembrolizumab Given Prior to Surgery and in Combination With Radiotherapy Given Post-surgery for Advanced Head and Neck Squamous Cell Carcinoma (MK-3475-689)

Condition:   Head and Neck Neoplasms
Interventions:   Biological: Pembrolizumab 200 mg;   Radiation: Radiotherapy 60 Gray/day;   Radiation: Radiotherapy 66 Gray/day;   Radiation: Radiotherapy 70 Gray/day;   Drug: Cisplatin 100 mg/m^2
Sponsor:   Merck Sharp & Dohme Corp.
Not yet recruiting

https://ift.tt/2RAjVoN

GETNE Registration of Thyroid Cancer

Condition:   Thyroid Cancer
Intervention:  
Sponsor:   Grupo Espanol de Tumores Neuroendocrinos
Not yet recruiting

https://ift.tt/2QcaAXD

Perindopril-induced angioedema of the lips and tongue: a case report

Ace inhibitor-induced angioedema, characterized by sudden-onset swelling of the mucous membrane, skin, or both, is a rare occurrence in the Kingdom of Saudi Arabia. Because of its safety and efficacy, perindop...

https://ift.tt/2SvPyQu

The fate of root canals obturated with Thermafil: 10-year data for patients treated in a master’s program

Abstract

Objectives

Retrospective description of the 10-year success rate of endodontic treatments with Thermafil (TF).

Materials and methods

Patients treated by postgraduate students in an Endodontics Master's Program (2006–2008) were enrolled. All treated root canals were filled with TF and AH Plus. Teeth satisfying the inclusion criteria (206 teeth in 89 patients) were reexamined clinically and radiographically to estimate a 10-year survival and periapical health. Demographic and medical data were registered; collected information included pre-, intra-, and postoperative variables. Teeth were classified as "healthy" (PAI ≤ 2 in absence of signs/symptoms), "endodontically diseased" (presenting at least one of the following: PAI ≥ 3, signs/symptoms, retreated in the course of the follow-up, or extracted for endodontic reasons), or "non-endodontically diseased" (extracted for non-restorable fractures or periodontal disease). For teeth lost during the 10-year follow-up, details and reason of extraction were analyzed. Two PAI-calibrated examiners assessed outcomes blinded to preoperative status. Bivariate and multilevel analyses were performed (α level set at 0.05).

Results

At 10 years, 179 (87%) teeth survived and 27 were extracted: 20 for non-endodontic reasons (excluded from success analysis) and 7 for endodontic reasons (considered "endodontically diseased"). Multilevel analysis revealed that the probability of extraction was increased by the presence of preoperative pain (odds ratio = 6.720; 95% confidence interval, 1.483–30.448) and by maxillary location (odds ratio = 2.950; 95% confidence interval, 1.043–8.347). Concerning periapical status, 159/186 teeth (85%) were assessed as "healthy." Multilevel analysis confirmed that maxillary location (odds ratio = 3.908; 95% confidence interval, 1.370–11.146), presence of flare up (odds ratio = 9.914; 95% confidence interval, 2.388–41.163), and fracture occurrence (odds ratio = 35.412; 95% confidence interval, 3.366–372.555) decreased the odds of healing, respectively.

Conclusions

After 10 years, teeth filled with Thermafil in a specialist master's program presented a survival and a periapical health comparable to cohorts where root canals were filled with other obturation techniques.

Clinical relevance

Carrier-based techniques provide time savings for clinicians while satisfying clinical quality criteria for the root filling and consequently the clinical outcome.

https://ift.tt/2rnLar8

Environmental exposure to agrochemicals and allergic diseases in preschool children in high grown tea plantations of Sri Lanka

Exposure to agrochemicals is one of the many aetiological agents, postulated to cause allergic diseases. In this study, we have compared the prevalence of allergic diseases among preschool children growing in ...

https://ift.tt/2PkdXq1

Comparison of clinical outcomes of treatment of dysfunction of the temporomandibular joint between conventional and ultrasound-guided arthrocentesis

Publication date: Available online 4 December 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): P.G. Antony, Aneesh Sebastian, Annapoorani D., K. George Varghese, Mohan S., Jayakumar N., Shiney Dominic, Bobby John

Abstract

Patients with disorders of the temporomandibular joint (TMJ) who do not respond to non-operative treatment may require invasive procedures such as arthrocentesis and arthroscopy. We divided 80 patients with dysfunction of the TMJ into two groups: a control group who were treated by conventional arthrocentesis, and an experimental group who were treated by ultrasound-guided arthrocentesis. Both groups were monitored three days, one week, and one month postoperatively and the clinical outcomes compared. The experimental group had a significant reduction in the degree of pain in the immediate postoperative period (p = 0.015). However, ultrasound-guided arthrocentesis showed no significant improvement in symptoms overall compared with conventional arthrocentesis. Both techniques seem to be effective in the management of dysfunction of the TMJ.

https://ift.tt/2Pm2kPF

L’acne conglobata existe-t-elle ?

Publication date: Available online 5 December 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): J. Revuz, F. Poli

https://ift.tt/2E19kzm

Condylar Head Remodeling compensating for Condylar Head Displacement by Orthognathic Surgery

Publication date: Available online 5 December 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Hyeon-Shik Hwang, Tingting Jiang, Lijun Sun, Kyung-Min Lee, Min-Hee Oh, Yan Biao, Hee-Kyun Oh, Till Edward Bechtold

Abstract

The purpose of this study was to evaluate the association between kind of condylar displacement due to orthognathic surgery and the subsequent adaptive condylar head remodeling.

The sample in this retrospective cohort study consisted of 30 patients (12 female and 18 male; mean age 22.7y) with skeletal Class III malocclusion who underwent bilateral sagittal split ramus osteotomy (SSRO). Three-dimensional superimpositions of cone-beam computed tomography (CBCT) scan derived images from immediately after and 6 months after surgery were to reveal the type of remodeling, while images from before and immediately after surgery were to identify the subsequent type of condylar displacement.

Laterally displaced condyles showed bone resorption on the lateral surfaces and deposition on the medial surfaces, whereas the contrary was found in medially displaced condyles. Anteriorly displaced condyles showed resorption on the anterior surfaces and deposition on the posterior surfaces, whereas the contrary was found in posteriorly displaced condyles. Superior surfaces of the condyles showed bone resorption regardless of displacement direction.

The results indicate that condylar remodeling patterns (resorption/deposition) are determined by the direction of condylar displacement during surgery. However, condylar displacement by surgery is not completely compensated by condylar head remodeling, especially in case of downward displacement.

https://ift.tt/2QD22IJ

Impact of Nasalis Muscle Repair in Unilateral Cleft Lip Patients

Publication date: Available online 5 December 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Sarah A. Attia, Hesham A. Helal, Amir S. El Barabary, Mostafa A. Awad, Mahmoud M. Sherif

Abstract

Background

Although the role of nasalis muscle in the establishment of nasal deformity is well recognized; its abnormal anatomy and role in the correction of alar deformity in cleft lip patients have not been adequately studied. This work aimed to study the effect of nasalis muscle repair on the postoperative nasal symmetry.

Patients and Methods

A controlled prospective randomized study was conducted on 45 cases of unilateral complete pre-alveolar cleft. Patients were divided into two groups; Group 1 (repair of the Orbicularis muscle only), Group 2 was further divided into 2 subgroups: Subgroup A (repair of the orbicularis oris muscle and dissection and repair the origin of the nasalis muscle). Subgroup B (repair of the orbicularis oris muscle and dissection of both origin and abnormal insertion of the nasalis and repair of the origin). Evaluation was conducted both subjectively and objectively through cleft lip evaluation profile and nostril angles measurement.

Results

Group 2B patients showed significantly better shape and symmetry of nasal tip, size and symmetry of nostrils and size, form and lateral displacement of the ala. Objective evaluation showed that group 2B had the closest results to the non-cleft side, with statistically significant difference, when compared to other groups.

Conclusion

Dissection and repair of both origin and insertion of nasalis muscle produced a nasal width, columellar height, and nasal tip projection close to the normal population of the same age.

https://ift.tt/2E2iprA

Evaluation of stress distribution in critical anatomic regions following the Le Fort I osteotomy by three-dimensional finite element analysis

Publication date: Available online 5 December 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Alparslan Esen, Elvan Dolanmaz, Dogan Dolanmaz

Summary

In this study, we aimed to measure the stresses both on the pterygoid plates and the cranial base during the down-fracture and at the time of pterygomaxillary osteotomy by using the finite element analysis method to have an idea about the possible causes of complications. Three different surgical approaches were applied to the obtained models. In the Model 1, Le Fort I cuts without pterygomaxillary separation was applied. In the Model 2, same standard Le Fort I cuts were applied with pterygomaxillary separation. Then both models were subjected to a force of 150 N over the anterior spina nasalis to simulate down-fracture. In the third model, same standard Le Fort I cuts were applied. Following this procedure, a force of 50 N was applied with a sharp osteotome to the pterygomaxillary junction to simulate osteotomy. According to the results of this experimental study, the cranial base stress values decreased during the down-fracture in the Model 2. Moreover, it was found that the force transmitted to the base of the skull is less when the height of the pterygomaxillary osteotome is limited to 1cm as we applied in Model 3.

https://ift.tt/2Qwj1wr

Does vertical incomitance predict the diplopia outcome in orbital fracture patients? A prospective study of 188 patients

Publication date: Available online 5 December 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): F. Bianchi, R. De Haller, H. Steffen, D.S. Courvoisier, P. Scolozzi

Abstract

Objective

To determine the predictive value of vertical incomitance for diplopia outcome in orbital fracture patients.

Patients and Methods

A prospective cohort study composed of patients with orbital fractures was designed. The predictor variable was vertical incomitance, and the primary outcome variable was diplopia. Incomitance was calculated in prism diopters (Δ) as the difference of the maximum absolute deviation between the upper and lower three gaze directions. Standard statistics for patient characteristics, the Fisher exact test for categorical variables and the Wilcoxon rank sum test for continuous variables were computed.

Results

The sample was composed of 188 patients grouped as follows: non-operated (n=124) and operated (n=64). Fifty-one patients showed vertical incomitance of whom10 (19.6%) had persistent diplopia at the 1-year follow-up. The mean incomitance was 9.6Δ in the diplopia group versus 2Δ in the non diplopia group (OR=1.13; p<0.001). There was a statistically significant association between vertical incomitance of >2Δ and persistent diplopia at 1 year after adjusting for the surgery variable (OR=1.07; p<0.04).

Conclusion

The present study has demonstrated that in orbital fracture patients, vertical incomitance was associated with (1) persistence of long-term diplopia, (2) the decision to perform surgery, and (3) the severity of the fracture.

https://ift.tt/2E11PIF

Political Preferences of Oral and Maxillofacial Surgeons: The Elephant (and Donkey) in the Room

Publication date: Available online 4 December 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Yisi D. Ji, Zachary S. Peacock, Thomas B. Dodson

https://ift.tt/2UeLZji

A New Technique for Reconstruction of Medium-Sized Eyelid Defects (A Modification of Tessier Nasojugal Flap)

Facial plast Surg
DOI: 10.1055/s-0038-1676050

Eyelid reconstructions are considered challenging surgical procedures, which are mostly performed due to trauma, tumor resections, and congenital defects. Several techniques can be used to reconstruct the lower eyelid defects. In this study, the authors aimed to introduce a new single-step technique for the reconstruction of medium-sized lower eyelid defects while preventing ectropion. A modified nasojugal flap was designed and harvested after making a complete incision. A dermal extension from the nasolabial area was added to the end of the nasojugal flap. A tunnel was created under the orbicularis oculi muscle, and the dermal tail was passed through this tunnel toward the lateral canthus. The flap was fixed in its new position by suturing. The defect in the nasojugal area was repaired by bilateral advancement of the surrounding tissue. The recovery of the patients was followed up for 6 months, which included assessment of the eyelid position and donor site morbidity. A total of four patients with an age range of 64 ± 8 years who suffered from basal cell carcinoma were treated using the technique introduced in this study. No ectropion or abnormal eyelid position nor donor site morbidity was observed during the follow-up period. Reconstruction of a medium-sized lower eyelid defect using nasolabial flap with local modification combined with orbital canthus fixation resulted in appropriate functional and cosmetic outcomes and limited the risk of complications and morbidity.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2PlQDIw

Deep Plane Facelift: An Evaluation of the High-SMAS versus Standard Incision Points

Facial plast Surg
DOI: 10.1055/s-0038-1675634

In surgery of the aging face, operative adjustments of the superficial musculoaponeurotic system (SMAS) enhance facial contours. The senior author has observed that the standard deep plane face lift entry points on the SMAS do not provide as much tissue movement in a vertical direction as high-SMAS deep plane face lift entry points. In this study, tissue movement was measured comparing the conventional SMAS entry point with a high-SMAS entry point for deep plane face lifts. Institutional review board approval was obtained. Fourteen facelift patients were enrolled, 10 female and 4 male. Average age was 63.4 (50–81) years. Tissue movement at three points along the jaw line was measured intraoperatively. Standard SMAS entry point suspension resulted in average vertical movements of 6.4, 10.3, and 13.8 mm and average horizontal movements of 3.5, 5.7, and 6.5 mm. High-SMAS entry point resulted in average vertical movements of 11.8, 17.9, and 24.1 mm and average horizontal movements of 5.8, 9.8, and 9.9 mm. This resulted in a 77.3% increase (p = 0.03) in vertical movement and a 61.4% increase (p = 0.02) in horizontal movement with a high-SMAS entry compared with standard SMAS entry. The high-SMAS entry point for a deep plane facelift resulted in a significant increase in lift for both the horizontal and vertical vector on the facial skin flap when compared with the conventional entry.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2zM2VoJ

Effects of Topical Mandelic Acid Treatment on Facial Skin Viscoelasticity

Facial plast Surg
DOI: 10.1055/s-0038-1676048

Mandelic acid is an α-hydroxy acid with reported benefit in treating acne and hyperpigmentation. The authors have developed a topical mandelic acid formulation that subjectively improves the quality of aged skin. Although the gold standard for assessing outcomes, photographic documentation is limited by subjective interpretation. Tools for measuring physical skin properties allow for an objective assessment of changes in skin quality. The authors sought to objectively study the viscoelastic changes to the skin following treatment with topical mandelic acid, using the Cutometer MPA 580. Twenty-four patients, twenty females and four males, aged 42 to 68 years, were studied over a four-week period. Mandelic acid was applied topically to the face twice a day for four weeks. The lower eyelid skin viscoelastic properties were assessed weekly using the Cutometer. After four weeks of topical mandelic acid treatment, the elasticity of lower eyelid skin increased 25.4% (P = .003). Skin firmness increased 23.8% (P = .029). Improvement in photographic appearance correlated with these findings. Mandelic acid is another topical treatment option for improving skin quality, and is well tolerated by patients. The authors feel that the Cutometer or similar device should be used routinely in facial plastic surgery to objectively assess outcomes of various treatment modalities.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2PkYaHH

Analysis of an in-house technique for temporary mandibulotomy and its impact on postoperative radiotherapy

Publication date: Available online 5 December 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): J. Hachleitner, C. Brandtner, A. Gaggl, M. Kopp, G. Fastner, G. Moser, S. Roesch

Abstract

The purpose of this study was to describe a newly developed procedure for temporary mandibulotomy and subsequent osteosynthesis. Clinical outcomes were evaluated, including complications and the impact on postoperative treatment, particularly postoperative radiotherapy. Twenty-four patients underwent temporary mandibulotomies for the surgical resection of malignancies located in the posterior oral or oropharyngeal region. All were treated with postoperative radiotherapy. An angulated median mandibulotomy was followed by osteosynthesis with three anchor screws directed towards the inferior aspect of the mandible. Anchor screws are modified conventional lag screws that include an additional biconcave washer. This modification prevents the screw heads from cracking into the cancellous bone during tightening, improving their biomechanical qualities considerably. Insertion of screws at any angle to the bony surface therefore becomes possible, which is a precondition for this technique. Minor complications occurred in two patients in the early postoperative period. However, complications causing bony non-union, leading to postponed postoperative radiotherapy were not noted in this cohort.

https://ift.tt/2SxO7kF

Comparison of retroauricular and small transcervical approaches for endoscopic-assisted selective neck dissection: a cadaveric study

Publication date: Available online 4 December 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): S. Lee, W. Nam

Abstract

Advances in endoscopic-assisted neck surgery have allowed surgeons to conceal the scars via various approaches. However, studies comparing the approaches are still rare. The aim of this study was to comparatively analyze the feasibility and oncological outcomes of the retroauricular approach (RA) and the small transcervical approach (STC) for endoscopic-assisted selective neck dissection (EASND). Five fresh cadavers were recruited. EASND was performed via RA on one side and via STC on the contralateral side of each of the cadavers. The duration of the procedure was subdivided into preparation and EASND, and was recorded during the operation. The preserved vital structures were inspected by another surgeon after the cadaver dissection. The total number of lymph nodes retrieved was assessed by a pathologist. There was no significant difference in lymph node count between the RA group (mean 21, range 9–38) and the STC group (mean 23, range 7–34) (P > 0.05). The operation time was significantly longer in the RA group than in the STC group (preparation, P = 0.042; EASND, P = 0.043). In terms of surgical feasibility, STC can be chosen as the approach of choice for EASND. In spite of a long learning curve, RA might be an alternative option in particular cases to minimize scarring.

https://ift.tt/2Efd94Y

Epiglottopexy by external puncture for epiglottic prolapse in severe laryngomalacia. A novel technique

Publication date: Available online 5 December 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): H. Álvarez-Neri, P. Villamor, E. Ortiz Hernandez, J. Penchyna Grub

Abstract

Introduction

Laryngomalacia (LM) is the first cause of stridor in infants. 10 to 20% of patients with LM may require surgery due to the development of severe symptoms. Supraglottoplasty is the most commonly performed surgery for severe LM. However, it is insufficient for the rostrocaudal displacement of the epiglottis against the posterior pharyngeal wall.

Case summary

We report a case of a 2-month-old infant with severe laryngomalacia with a remarkable collapse of the epiglottis towards the glottis with secondary obstruction of the airway, alteration in swallowing and failure to thrive. The patient was treated satisfactorily through epiglottopexy by an external puncture. During a follow-up of 2 years, the patient has been asymptomatic, without any adverse event.

Discussion

Glottic obstruction from posterior epiglottic collapse is the most severe type of laryngomalacia, generating severe respiratory symptoms and failure to thrive. Epiglottopexy by external puncture is a new technique, certainly affordable since it does not require special instruments and it can be performed in medical centers through suspension laryngoscopy. It can be achieved alone or in combination with traditional supraglottoplasty.

https://ift.tt/2PjZgn5

A vicious enemy in head and neck oncology: Delay!

Publication date: Available online 5 December 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): O. Laccourreye, G. Marret, P. Giraud

https://ift.tt/2zFRBu7

Scedosporium apiospermum invasive sinusitis presenting as extradural abscess

Publication date: Available online 4 December 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): N. Khoueir, B. Verillaud, P. Herman

Abstract

Introduction

Chronic invasive fungal rhinosinusitis (CIFR) is a rare entity generally observed in immunodepressed subjects. The pathogen most frequently identified is Aspergillus spp. Imaging generally reveals invasive pseudoneoplastic features. We report a case of Scedosporium apiospermum (S. apiospermum) CIFR with an atypical clinical and radiological presentation.

Case report

A 72-year-old immunocompetent man presented with chronic headache, neck pain and bilateral limitation of lateral gaze. Imaging revealed an isolated left sphenoidal lesion with marked bone changes and an extradural abscess over the clivus. Large endoscopic sphenoidotomy with type II rhinopharyngectomy was performed and the diagnosis of S. apiospermum CIFR was based on histological examination and fungal culture. The patient refused all medical treatment and did not present any signs of recurrence after 1 year of follow-up.

Discussion

S. apiospermum is a fungal species rarely isolated in CIFR. The present case was revealed by an atypical clinical presentation including isolated sphenoidal infection complicated by bilateral abducens nerve paralysis and extradural abscess. Imaging was also unusual, revealing features of fibrous dysplasia or bacterial osteomyelitis rather than the typical pseudoneoplastic appearance. The patient was successfully treated by surgery alone, which may therefore be sufficient treatment in immunocompetent subjects.

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Computational Fluid Dynamics in the assessment of nasal obstruction in children

Publication date: Available online 4 December 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): E. Moreddu, L. Meister, C. Philip-Alliez, J.-M. Triglia, M. Medale, R. Nicollas

Abstract

Objectives

Nasal obstruction is a highly subjective symptom. It can be evaluated by combining clinical examination, imaging and functional measurements such as active anterior rhinomanometry (AAR). In pediatrics, AAR is often impossible because it requires the participation of the child. Airflow modeling by Computational Fluid Dynamics (CFD) has been developed since the early 1990s, mostly in adults. This study is the first to describe a methodology of "numerical rhinomanometry" in children using CFD and to evaluate the feasibility and the clinical interest of this new tool.

Materials and methods

Five children aged from 8 to 15 years, complaining of nasal obstruction, underwent routine management including clinical evaluation, AAR, and CT-scanning. CT acquisitions were used for CFD calculations and numerical rhinomanometry.

Results and conclusions

In the 5 children, the results of CFD were concordant with clinical complaints and examination. In 3 children, AAR and CFD were concordant. In one patient, CFD corrected the results of AAR. In one patient, AAR was not feasible, unlike CFD, which contributed to diagnosis. This study highlighted the feasibility of CFD in children and that it can support or refute diagnosis of nasal obstruction with good reliability. These results indicate that CFD modeling could be widely used for functional exploration in pediatric rhinology.

https://ift.tt/2zFRA9x

Nasal nitric oxide in the inferior turbinate surface decreases with intranasal steroids in allergic rhinitis: A prospective study

Publication date: Available online 4 December 2018

Source: Auris Nasus Larynx

Author(s): Daisuke Takahara, Takashi Kono, Sachio Takeno, Takashi Ishino, Takao Hamamoto, Kazunori Kubota, Tsutomu Ueda

Abstract

Objective

It remains controversial whether nasal nitric oxide (NO) serves as a reliable parameter to evaluate treatment efficacy in patients with allergic rhinitis (AR). The measurement of local nasal NO levels has been shown to be a sensitive marker for the diagnosis of symptomatic AR patients. Here we assessed the applicability of nasal NO to evaluations of the efficacy of intranasal steroids (INS) in a prospective design.

Methods

We enrolled 25 patients with perennial AR and 10 age-matched healthy participants. The AR patients received fluticasone furoate (FF) once daily for 2 months. Fractional exhaled NO and nasal NO measurements were carried out using an electrochemical analyzer at pretreatment and at 2 weeks and 2 months after treatment. Nasal NO levels were directly measured at two different areas of the nasal cavity: the surface of the inferior turbinate (IT area) and the front of the middle meatus (MM area). Subjective nasal symptoms were also recorded at each visit.

Results

The mean total nasal symptom score in the AR patients decreased significantly after FF treatment (p < 0.0001). The mean nasal NO levels in the IT area in the AR patients were significantly higher at pretreatment than those of the healthy participants (109 vs. 62.5 ppb, respectively; p < 0.001). After FF administration, the nasal NO levels in the IT area of the AR group showed a significant reduction at both 2 weeks and 2 months (79.1 and 71.9 ppb, respectively; p < 0.05 and p < 0.01). There was no significant difference in nasal NO levels in the MM area between the controls and the AR group at any visit timepoint. When the ratio of the MM area to the IT area (MM/IT ratio) was plotted for each subject, the untreated AR patients showed a marked decrease in the ratio, whereas after the FF treatment, the AR patients' mean MM/IT ratios showed a significant increase. No significant difference compared to the control group existed at 2 months.

Conclusion

Nasal NO measurement around the inferior turbinate is an objective measure to evaluate allergic conditions and is useful to monitor therapeutic effects of INS.

https://ift.tt/2Ef1fIa

Bird-egg syndrome induced by α-livetin sensitization in a budgerigar keeper: Successful induction of tolerance by avoiding exposure to avians

Publication date: Available online 4 December 2018

Source: Allergology International

Author(s): Naoko Inomata, Katsuyuki Kawano, Michiko Aihara

https://ift.tt/2FXThoB

The Urticaria Control Test and Urticaria Activity Score correlate with quality of life in adult Japanese patients with chronic spontaneous urticaria

Publication date: Available online 4 December 2018

Source: Allergology International

Author(s): Shoko Nakatani, Yoshiko Oda, Ken Washio, Atsushi Fukunaga, Chikako Nishigori

https://ift.tt/2riFnmM

Clinical features of Helicobacter pylori antibody‐positive junior high school students in Nagano Prefecture, Japan

Abstract

Background

Previously, we conducted an epidemiological study screening for Helicobacter pylori antibody positivity among Japanese junior high school students. In this study, we updated the epidemiological data and assessed the clinical features of H pylori antibody‐positive junior high school students.

Materials and methods

We assessed H pylori antibody‐positive subjects who were identified between 2012 and 2015 at four junior high schools in Nagano Prefecture, Japan. H pylori infection was confirmed by urea breath test (UBT) or endoscopic examination. Endoscopy was performed after obtaining consent from the subject and their guardians. Eradication therapy consisted of triple therapy with proton pump inhibitor (PPI), amoxicillin (AMPC), and clarithromycin (CAM) or metronidazole (MNZ) for seven days. Eradication of H pylori was confirmed by UBT. We reviewed subjects' characteristics, endoscopic findings, histological findings, eradication regimes, outcomes, and adverse effects.

Results

The overall prevalence of H pylori antibody positivity was 3.2% (42/1298). We assessed thirteen H pylori antibody‐positive subjects. Eight subjects had a family history of H pylori infection. Six subjects had abdominal pain, and two subjects had iron deficiency anemia (IDA). Twelve subjects underwent endoscopy; one subject had duodenal ulcer, eleven subjects had antral nodular gastritis, and six subjects showed grade 2 closed type atrophic border according to the Kimura‐Takemoto classification. All subjects received eradication therapy; CAM was used in five subjects with CAM susceptibility as well as in three subjects with unknown information on CAM susceptibility, and MNZ was used in five subjects with CAM resistance. Eradication was successful in twelve subjects (one unconfirmed). There were three mild adverse effects (abdominal pain or diarrhea).

Conclusions

Helicobacter pylori test for junior high school students represents an opportunity to diagnose the peptic ulcer, iron deficiency anemia, and gastric atrophy.

https://ift.tt/2StA5k4

The effect of poly‐p‐dioxanone plates on the protection and vitality of cartilage: An animal study

Objectives/Hypothesis

In septorhinoplasty, septal, auricular, and costal cartilage are often used as autologous graft. Autologous grafts are preferred in nasal reconstruction. The aim of this study was to histopathologically examine the tissue compatibility and the effect on the stability and cartilage vitality of poly‐p‐dioxanone (PDS) plates.

Study Design

Ten adult New Zealand rabbits were used.

Methods

Ten New Zealand rabbits were used. Septal and auricular cartilage sections were removed; one of the two cartilage grafts was left plain, and the other was sutured to a PDS plate. Grafts were placed into the back of the rabbits. After 12 weeks, the graft material was examined microscopically.

Results

The specimens did not cause any significant foreign body reaction. Within 3 months, a significant degree of color, stability, and stiffness was lost. Microscopically, inflammation, necrosis, and cartilage cell degeneration scores were statistically significantly lower in the grafts using PDS (P < .05), and the vascularization, collagen, and cartilage proliferation scores were found to be statistically significantly higher (P < .05). No statistically significant difference was determined in respect of the bone proliferation scores (P > .05).

Conclusions

The use of PDS plates together with cartilage provided mechanical support to the graft. Therefore, changes that disrupt the integrity of the graft, such as inflammation, necrosis, and cartilage cell degeneration, were reduced, and changes that provide greater stability, such as vascularization, collagen, and cartilage proliferation, were increased.

Level of Evidence

NA Laryngoscope, 2018

https://ift.tt/2zJeD3n

Use of bovine pericardium for the treatment of anterior iatrogenic glottic web

https://ift.tt/2PjeGb9

Vertical head impulse and caloric are complementary but react opposite to Meniere's disease hydrops

Objectives/Hypothesis

Meniere's disease (MD) patients can show normal head impulses despite poor caloric test results. This study aimed to investigate the discrepancy in the vestibulo‐ocular reflex (VOR) in MD patients and whether endolymphatic hydrops (EH) influence the VOR.

Study Design

Prospective, cross‐sectional observational study.

Methods

Ninety MD patients were enrolled. Neuro‐otological testing, including a video head impulse test (vHIT) of all semicircular canals (SCs), and gadolinium‐enhanced inner ear magnetic resonance imaging were performed. The vestibular EH volume was quantitatively evaluated by processing magnetic resonance images.

Results

Abnormal vHIT results in MD patients were found most frequently in the posterior (44.4%) SCs, followed by the horizontal (13.3%) and anterior (10%) SCs. Canal paresis (CP) was assessed using the vHIT and the caloric test, and results were not significant when vHIT responses were assessed as CP only using the horizontal SC. The difference in the vestibular EH between the presence and absence of CP was not significant if assessed using the vHIT (P = .5591), but it was statistically different if assessed using the caloric test (P = .0467).

Conclusions

The contradictory reaction of VOR in MD patients may result from the high specificity but low sensitivity of CP in the horizontal vHIT. EH volume in the vestibule affects the caloric response but does not affect the vHIT response.

Level of Evidence

2b Laryngoscope, 2018

https://ift.tt/2zKCC2f

Imaging predictors for malignant transformation of inverted papilloma

Objectives/Hypothesis

Inverted papillomas (IPs) are benign tumors of the sinonasal tract with a malignant transformation potential. Predicting the transformation propensity of IPs and corresponding risk factors has long been a challenge. In this study, we aimed to use radiographic findings on magnetic resonance imaging (MRI) and computed tomography (CT) to help differentiate IP from IP‐transformed squamous cell carcinomas (IP‐SCC).

Study Design

Retrospective cohort study.

Methods

A retrospective analysis was performed at two institutions comparing IP (n = 76) and IP‐SCC (n = 66) tumors, evaluating preoperative radiographic imaging with corresponding surgical pathology reports. The presence of a convoluted cerebriform pattern (CCP) using postcontrast T1‐weighted and T2‐weighted MRI was evaluated. Using MRI diffusion‐weighted imaging (DWI), we calculated the apparent diffusion coefficient (ADC) value of each tumor. We also determined the tumor origin, attachment sites, and presence of bony erosion using CT imaging.

Results

Benign IPs had a higher prevalence of CCP on MRI compared to IP‐transformed SCC (P = .0001. The mean value ADC of malignant IP‐SCC (ADC_b0,1000 = 1.12 × 10⁻³ mm²/s) was significantly lower than that of benign IPs (ADC_b0,1000 = 1.49 × 10⁻³ mm²/s, P = .002). IP‐SCC tumors were more likely to be have orbital wall attachment (P = .002) and bony erosion (P < .0001) compared to IPs.

Conclusions

Evaluation of CCP and DWI with ADC values on MRI are promising qualitative and quantitative methods to help differentiate benign IP tumors from their transformed malignant counterparts. Malignant IP‐SCCs are associated with a loss of CCP and lower ADC values. Findings of orbital wall involvement and bony erosion on CT may also help determine presence of malignancy.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2PfyCvD

Is acupuncture effective in reducing overall symptomatology in chronic rhinosinusitis?

https://ift.tt/2zEr4gU

Differences in video head impulse test gains from right versus left or outward versus inward head impulses

Objective

To investigate the effect of the right/left and outward/inward head impulses on video head impulse test (vHIT) gains.

Methods

Video head impulse test gains were calculated by recording the right eye movements with an infrared camera in a cohort of 24 healthy subjects (26–39 years old, 30 ± 9 years old). We compared the vHIT gains in four different situations in which the right and left lateral semicircular canals (LSCC) were stimulated through outward or inward head impulses.

Results

The vHIT gains from stimulating the right LSCC were significantly larger than those stimulating the left LSCC, regardless of whether the head impulse was outward or inward (1.06 ± 0.1 by right outward vs. 0.98 ± 0.08 by left outward, P = 0.003; 1.02 ± 0.1 by right inward vs. 0.92 ± 0.07 by left inward, P < 0.0001). The mean difference in vHIT gain between stimulating the right or left LSCC was 0.09. The gains from outward vHITs were significantly larger than those from the inward tests, regardless of the LSCC side stimulated (1.06 ± 0.1 from right outward vs. 1.02 ± 0.1 from right inward, both stimulating the right LSCC, P = 0.013; 0.98 ± 0.08 from left outward vs. 0.92 ± 0.07 from left inward, both stimulating the left LSCC, P = 0.001). The mean difference in the vHIT gains between the outward and inward tests was 0.05.

Conclusion

The right/left vHIT gain difference (0.09) is higher than the outward/inward vHIT gain difference (0.05). These are independently significant differences when using a vHIT system, which records movements in the right eye. An understanding of these differences may be helpful when interpreting vHIT results.

Level of Evidence

4. Laryngoscope, 2018

https://ift.tt/2PkyLOv

When Should Pediatric Septoplasty Be Performed for Nasal Airway Obstruction?

https://ift.tt/2zIseb6