Tumor programmed cell death ligand 1 expression correlates with nodal metastasis in patients with cutaneous squamous cell carcinoma of the head and neck

Binding of tumor-expressed programmed cell death ligand 1 (PD-L1) to the programmed cell death 1 (PD-1) surface receptor blocks T-cell activation thereby leading to immune evasion. Tumor PD-L1 expression has been associated with poor outcome in a wide variety of cancers; however, data in cutaneous squamous cell carcinoma (cSCC) are scarce and conflicting.

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Frontal fibrosing alopecia among men: A clinicopathologic study of 7 cases

Frontal fibrosing alopecia (FFA) is a lichen planopilaris–variant scarring alopecia that has rarely been described in men.

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Reference values for skin microanatomy: A systematic review and meta-analysis of ex vivo studies

Few studies have characterized reference values of normal human skin microanatomy parameters.

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Thyroid Surgery: To Drain or Not to Drain, That Is the Problem - A Randomized Clinical Trial

Purpose: We conducted a prospective, randomized study to evaluate the necessity of drainage after thyroid surgery. Methods: The patients (n = 215) were randomly assigned to be treated with suction drains (group 1; n = 108) or not (group 2; n = 107). Results: The postoperative pain scores were significantly lower in the non-drained group than in the drained group of patients at postoperative days 0 and at 1. Hematomas, seromas, wound infections, transient biochemical hypoparathyroidism, and transient damage of the recurrent laryngeal nerve occurred more frequently in the drained group than in the non-drained group. The mean hospital stay was significantly shorter in the non-drained group than in the drained group. Conclusions: Routine drain emplacement after thyroidectomy is unnecessary.
ORL 2017;79:202-211

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The reliability of flexible nasolaryngoscopy in the identification of vocal fold movement impairment in young infants

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Yi-Chun Carol Liu, Tyler McElwee, Mary Musso, Tara L. Rosenberg, Julina Ongkasuwan
ObjectiveFlexible nasolaryngoscopy (FNL) is considered the gold standard for evaluation of vocal fold mobility but there has been no data on the reliability of interpretation in the infant population. Visualization may be limited by excessive movement, secretions, or floppy supraglottic structures that prevent accurate diagnosis of vocal fold movement impairment (VFMI). We sought to evaluate the inter- and intra-rater reliability of FNL for the evaluation of VFMI in young infants.Study typeCase-control.MethodsTwenty infants were identified: 10 with VFMI and 10 normal as seen on FNL. Three pediatric otolaryngologists reviewed the video without sound and rated the presence and/or degree of vocal fold mobility. Twelve videos were repeated to assess intra-rater reliability.ResultsThere was substantial agreement between the reviewers regarding the identification normal vs. any type of VFMI (kappa = 0.67) but only moderate agreement regarding the degree of vocal fold movement (kappa = 0.49). Intra-rater reliability ranges from moderate to perfect agreement (kappa = 0.48–1).ConclusionFNL in infants is an extremely challenging procedure. Clinically, physicians frequently use the quality of the cry and the past medical and surgical history to help make a judgment of vocal fold movement when the view is suboptimal. These other factors, however, may bias the interpretation of the FNL. Without sound, there is only moderate inter-rater and variable intra-rater reliability for the identification of degree of movement on FNL. Otolaryngologists must be cognizant of the limitations of FNL when using it as a clinical tool or as a "gold standard" against which other modalities are measured.



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Formula for the prediction of apnea / hypopnea index in children with obstructive sleep apnea without polysomnography according to the clinical parameters: Is it reliable?

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Zlatko Kljajić, Željka Roje, Kristijan Bečić, Vesna Čapkun, K. Vilović, Petar Ivanišević, Eugenija Marušić
Purpose of the studyThe aim of the study was to propose "the risk formula" for obstructive sleep apnea in children according to the general and local clinical parameters and findings relevant for obstructive sleep apnea (OSA) severity. The unmet need for this formula arises from the economic burden of polysomnography (device, staff, training, special sleep centers, etc) as the golden standard for the diagnostics.Materials and methods usedThe study was performed from January 2013 until January 2016 in the Sleep Center, Department for Neuroscience, School of Medicine of the University of Split, Department of Pediatrics, University Hospital Split, Croatia and ENT Dept. University Hospital in Split, Croatia. Inclusion criteria were: age > two years, AHI >1 diagnosed by polysomnography. Exclusion criteria were: chronic lung disease, active tonsillitis/pharyngitis at the time of the physical exam and syndromes that affect breathing. All polysomnograms were scored by a qualified sleep technologist and interpreted by two board certified sleep physicians independently. Age, sex, BMI, Mallampati score, tonsillar size and adenoids size were recorded. All statistical calculations were performed using SPSS 20.ResultsIn total 60 children were included in the study. The median of age was 5 years (range 2–9). There were 19 (32%) girls and 41 (68%) boys.Of all evaluated predictors, there were statistically significant differences in the values of AHI among children with different modified Mallampati score (χ2 = 28.2; p < 0.001), different size of tonsils (χ2 = 25.3; p < 0.001) and different size of adenoids (z = 2.7; p = 0,006) in univariate regression analysis. Strong positive association of AHI with modified Mallampati score (standardized B = 0.51; partial correlation = 0.542, r = 0.631) was found, as well as positive correlation of AHI with tonsillar size (standardized B = 0.246; partial correlation = 0.295,R = 0.489) in the multivariate forward stepwise regression analysis.ConclusionEven though we are aware that PSG is the gold standard for diagnostics of SDB there is a significant financial burden for this diagnostic procedure. That is why there is a necessity for establishing good clinical standards and possible formula for OSA severity evaluation. We propose formula which includes Mallampati score and tonsillar size for OSA -risk calculation in order to perform early therapeutic intervention thereby reducing the risk of long-term negative consequences. We recommend this formula as the screening formula in circumstances where PSG is not available, in cases when the "waiting list" is too long or when a child can not cooperate to perform it.In developing countries like Croatia on time intervention with reduced procedure–associated costs is of the utmost importance.



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Physical Models and Virtual Reality Simulators in Otolaryngology

The increasing role of simulation in the medical education of future otolaryngologists has followed suit with other surgical disciplines. Simulators make it possible for the resident to explore and learn in a safe and less stressful environment. The various subspecialties in otolaryngology use physical simulators and virtual-reality simulators. Although physical simulators allow the operator to make direct contact with its components, virtual-reality simulators allow the operator to interact with an environment that is computer generated. This article gives an overview of the various types of physical simulators and virtual-reality simulators used in otolaryngology that have been reported in the literature.

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