Severe Rhabdomyolysis as Complication of Interaction between Atorvastatin and Fusidic Acid in a Patient in Lifelong Antibiotic Prophylaxis: A Dangerous Combination

Atorvastatin and HMG-CoA reductase inhibitors are the most frequently used medication in the world due to very few adverse toxic side effects. One potentially life threatening adverse effect is caused by clinically significant statin induced rhabdomyolysis, either independently or in combination with fusidic acid. The patient in our case who previously had cardiac insufficiency, atrial fibrillation, and thoracic aorta aneurysm and was treated with insertion of an endovascular metallic stent in the aorta is presented in the report. He had an inoperable aortitis with an infected stent and para-aortic abscesses with no identified microorganism. The patient responded well to empirical antibiotic treatment with combination therapy of fusidic acid and moxifloxacin. This treatment was planned as a lifelong prophylactic treatment. The patient had been treated with atorvastatin for several years. He developed severe rhabdomyolysis when he was started on fusidic acid and moxifloxacin. The patient made a fast recovery after termination of treatment with atorvastatin and fusidic acid. We here report a life threatening complication of rhabdomyolysis that physicians must be aware of. This can happen either in atorvastatin monotherapy or as a complication of pharmacokinetic interaction between atorvastatin and fusidic acid.

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Orthodontic camouflage versus orthognathic surgery for class III deformity: comparative cephalometric analysis

Publication date: Available online 26 December 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): P. Martinez, C. Bellot-Arcís, J.M. Llamas, R. Cibrian, J.L. Gandia, V. Paredes-Gallardo
The objective of this study was to compare different cephalometric variables in adult patients with class III malocclusions before and after treatment, in order to determine which variables are indicative of orthodontic camouflage or orthognathic surgery. The cases of 156 adult patients were assessed: 77 treated with orthodontic camouflage and 79 treated with orthodontics and orthognathic surgery. The following cephalometric variables were measured on pre-treatment (T1) and post-treatment (T2) lateral cephalograms: sella–nasion–A-point (SNA), sella–nasion–B-point (SNB), and A-point–nasion–B-point (ANB) angles, Wits appraisal, facial axis angle, mandibular plane angle, upper and lower incisor inclination, and inter-incisal angle. There were statistically significant differences in cephalometric variables before and after treatment between the two groups. The percentage of normal pre-treatment measurements in the camouflage orthodontics group was 30.7%, which worsened slightly to 28.4% post-treatment. However in the group receiving surgery, this was 24.5% pre-treatment, improving to 33.5% after surgery. SNA, SNB, Wits appraisal, lower incisor inclination, and inter-incisal angle showed differences between the two groups before and after treatment. Wits appraisal, lower incisor inclination, and inter-incisal angle were indicative of one or other treatment. Upper and lower incisor decompensation in both groups did not reach ideal values, which impeded complete skeletal correction in 52% of surgical cases.



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Day-case otological surgery

Publication date: Available online 27 December 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Uziel
The author reviews day-case otological surgery, which has become increasingly popular in France and all over the world over recent years. Ear surgery is particularly suitable for short-stay admission because of the rapidity of these procedures and possibilities of pain control. This article discusses the advantages of this mode of management (for the patient, the surgeon and the healthcare institution), organizational and safety constraints, and ineligibility criteria. Day-case otological surgery should now become the rule rather than an opportunity.



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Vagal and recurrent laryngeal nerves neuromonitoring during thyroidectomy and parathyroidectomy: A prospective study

Publication date: Available online 27 December 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): N. Julien, E. Ferrary, A. Sokoloff, G. Lamas, O. Sterkers, D. Bernadeschi
ObjectivesThe aim of the study was to stimulate the vagal and the recurrent laryngeal nerves during and after thyroidectomy or parathyroidectomy, to record muscle responses, interpret the electrophysiological modifications and identify prognostic factors for postoperative vocal fold mobility.Patients and methodsA prospective study monitored 151 vagal nerves and 144 recurrent laryngeal nerves in 114 patients. Seven patients (14 vagal nerves) underwent continuous monitoring via an automatic periodic stimulation (APS^®) electrode. In 15 patients (21 vagal nerves), the stimulation threshold was studied. Muscle response was recorded on direct vagal and/or recurrent laryngeal nerve stimulation by a monopolar electrode or direct repeated stimulation via an electrode on the vagal nerve. In case of signal attenuation on the first operated side, surgery was not extended to the contralateral side.ResultsThe vagal nerve stimulation checked inferior laryngeal nerve integrity and recurrent status, without risk of false negatives. The vagal nerve stimulation threshold, before and after dissection, that induced a muscle response of at least 100μV ranged from 0.1 to 0.8mA. Similarity between pre- and post-dissection responses to supramaximal stimulation, defined as 1mA, on the one hand, and between post-dissection vagal and laryngeal recurrent nerve responses on the other correlated with normal postoperative vocal cord mobility. Conversely, muscle response attenuation below 100μV and increased latency indicated a risk of vocal fold palsy.ConclusionVagal nerve stimulation allows suspicion or elimination of lesions on the inferior laryngeal nerve upstream of the stimulation point and detection of non-recurrent inferior laryngeal nerve. Intermittent monitoring assesses nerve function at the moment of stimulation, while continuous monitoring detects the first signs of nerve injury liable to induce postoperative recurrent nerve palsy. When total thyroidectomy is indicated, signal attenuation on the first operated side casts doubt on continuing surgery to the contralateral side in the same step.



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Real-life efficacy of volumetric modulated arc therapy in head and neck squamous cell carcinoma

Publication date: Available online 27 December 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): C. Moncharmont, A. Vallard, J.-B. Guy, J.-M. Prades, C. Rancoule, N. Magné
ObjectivesThere is paucity of data on the efficacy of volumetric modulated arc therapy (VMAT) in head and neck squamous cell carcinoma (HNSCC). The objective of the present study was to investigate outcomes and patterns of recurrence in locally advanced HNSCC treated by VMAT.MethodsA retrospective study included all patients with stage III or IV HNSCC undergoing curative VMAT.ResultsFrom 2010 to 2013, 130 patients were treated for locally advanced oropharynx (n=55; 42%), hypopharynx (n=38; 29%), larynx (n=22; 17%) or oral cavity (n=15; 12%) SCC. Median age was 60 years (range, 39–85). Median follow-up was 18.1 months (range, 0–43.7). By end of follow-up, 60 patients (46%) had died. Two-year progression-free and overall survival were respectively 63.6% and 77.3% for laryngeal tumors, 60% and 60% for oral cavity tumors, 52.6% and 57.6% for oropharyngeal tumors, and 38.8% and 54.7% for hypopharyngeal tumors. Most recurrences were located within or marginal to radiation therapy fields.ConclusionThis retrospective analysis is, to our knowledge, the largest study of the efficacy of VMAT in HNSCC. Recurrence patterns and outcomes were consistent with those previously reported for intensity-modulated radiotherapy.



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Preclinical evaluation of Luffa operculata Cogn. and its main active principle in the treatment of bacterial rhinosinusitis

Publication date: Available online 26 December 2016
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Leonardo Silva, Henrique Olival Costa, Flávia Coelho de Souza, Elaine Monteiro Cardoso Lopes, Suely Mitoi Ykko Ueda
IntroductionThe prevalence of rhino sinusitis is quite high. Despite the widespread use of antibiotics for rhino sinusitis, there are other forms of treatment, including phytotherapy. One of the most widely used herbal medicines for treatment of rhino sinusitis is Luffa operculata.ObjectiveThis study aimed to evaluate the efficacy of topical nasal solution of the aqueous extract of L. operculata, determining the toxicity to its use and identifying the active principles presented in the aqueous extract. The secondary objective was to evaluate the action of active principles on bacteria commonly involved in acute rhino sinusitis.MethodsThe study was conducted in experimental model of sinusitis. Three different concentrations of L. operculata were used as local treatment of rhino sinusitis. The results were compared with those observed in control groups that received nasal saline solution. Histological examination of the liver, kidney, spleen, myocardium, brain and lungs of all animals evaluated the toxicity of L. operculata. The aqueous extract used was subjected to chromatographic analysis and an active principle was isolated and tested for in vitro inhibition of bacterial colonies usually found in rhino sinusitis.ResultsIntranasal treatment of sinusitis with L. operculata showed better clinical evolution than control group. Statistically significant difference (p>0.10) between the treated group and the control group was observed in the histologic evaluation for inflammatory pattern. The aqueous extract of L. operculata used presented a predominance of 2,3-dicafeoilglicaric acid, a substance not yet described in the literature. There was a significant difference in bacterial growth of Streptococcus pyogenes on blood-agar plates when under the influence of both the aqueous extract and the active substance.ConclusionTopical nasal solution of the aqueous extract of L. operculata is effective compared to the application of saline solution for the treatment of bacterial rhino sinusitis in an experimental model. L. operculata determined in vitro inhibition of growth of S. pyogenes.



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Response to Letter to the Editor

Publication date: Available online 27 December 2016
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Elizabeth Cedars, Dylan Chan, Anna Meyer, Kristina Rosbe




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