IgE deficiency and prior malignancy: results of the 2005-2006 National Health and Nutrition Examination Survey (NHANES)

The role of immunoglobulin E (IgE) in type I hypersensitivity reactions and protection against helminthic parasites is well known.1 However, clinical observations and several epidemiological studies have also suggested a potential association between a history of atopy, total serum IgE level and risk of developing malignancy. 2-5 There are also studies that suggest a role of IgE in cancer immune surveillance, although the exact mechanisms are not completely understood. For instance, IgE antibodies have been found to be involved in antibody-dependent cytotoxicity against tumor antigens in pancreatic6 and ovarian7 cancers.

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The Coexistence of Growth Hormone-Producing Pituitary Adenoma and Rathke Cleft Cyst: How Can We Diagnosis Preoperation?

Pituitary adenoma (PA) rarely coexists with Rathke's cleft cyst (RCC). Previously, only 13 cases of patients with growth hormone (GH)-producing PA and concomitant RCC have been reported. Here, the authors report a 54-year-old female patient with a GH-secreting PA coexisting with an RCC. Acromegaly was diagnosed according to the physical examination and endocrine data. Preoperatively, the coronal magnetic resonance imaging (MRI) contained 2 different signal intensities, these unusually MRI findings for the intrasellar mass were rarely. According to our clinical experience for diagnosis of PA and RCC, besides GH-producing PA in this case, but the possibility of concomitant RCC should be considered. One-and-a-half nostril endoscopic transsphenoidal approach was performed. Intraoperatively, the adenoma was successfully removed and a large amount of grayish fluid from the cyst was released. The endocrine testing was normal soon after the operation and the patient remained well for a follow-up period of 3 months. The postoperative MRI (obtained 3 months after surgery) showed no intrasellar and suprasellar mass. The authors retrospectively analyzed the all 14 cases of concomitant GH-secreting PAs and RCCs and summarized MRI characteristics. When preoperative MRI contained 2 different signal intensities, one mass lesion showed low or isointense signal on the T1-weighted and T2-weighted images, whereas the other lesion showed low signal on the T1-weighted images and hyperintense on the T2-weighted images, the collision MRI features may be helpful for the preoperative diagnosis of concomitant PAs and RCCs. Address correspondence and reprint requests to Chiyuan Ma, MD, Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu 210002, China; E-mail: machiyuan_nju@126.com Received 2 May, 2018 Accepted 28 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Review of “A Statewide Surgical Coaching Program Provides Opportunity for Continuous Professional Development” by Greenberg CC, Ghousseini HN, Pavuluri Quamme SR, Beasley HL, Frasier LL, Brys NA, Dombrowski JC, Wiegmann DA, Wisconsin Surgical Coaching Program in Ann Surg 2018;267: 868–873

No abstract available

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Considerations for Temporomandibular Joint Procurement in Vascularized Composite Allotransplantation

Methods for harvest of the temporomandibular joint (TMJ) for transplantation may involve several anatomic levels. The authors aim to assess the feasibility and identify challenges with 2 such methods, resuspending the donor condyles from the recipient glenoid fossae and en bloc harvest of the joint and surrounding temporal bone with plate-fixation to the recipient skull base. Two mock face transplantations were carried out using 4 fresh cadavers. Computed tomography imaging was obtained before and after the procedures to assess the technical success of each method. Both techniques were technically successful, allowing for full passive jaw range of motion following graft transfer and appropriate condyle positioning as assessed by computed tomography. En bloc TMJ harvest allowed for transfer of the entire joint without violating its capsule or altering its biomechanics. The authors found this technique better able to avoid issues with size mismatch between the donor mandible and recipient skull base width. When no such mismatch exists, graft harvest at the level of the mandibular condyle is technically easier and less time consuming. Although both methods of TMJ harvest are technically feasible with acceptable immediate postoperative jaw position and range of motion, the en bloc technique allows for more natural jaw function with less risk of postoperative joint immobility by preserving the joint capsule and its ligamentous support. Address correspondence and reprint requests to Amir H. Dorafshar, MBChB, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 North, Caroline Street, JHOC 8th Floor, 512, Baltimore, MD 21287; E-mail: adorafshar@gmail.com Received 23 March, 2018 Accepted 10 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Leitlinie „Implantierbare Hörgeräte“ – Kurzversion

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The Value of Clinical Practice Guidelines in Otolaryngology

Abstract

Purpose of Review

To assess the value of clinical practice guidelines in otolaryngology.

Recent Findings

The value of a clinical practice guideline can best be assessed by comparing the value of care delivered as a result of following guideline recommendations vs. standard care. A limited number of studies show improved patients outcomes and cost reduction as a result of adherence to clinical practice guidelines. However, existing studies that evaluate awareness and adherence to clinical practice guidelines tend to demonstrate a lack of adherence to and dissemination of practice guidelines.

Summary

Quantifying the value of clinical practice guidelines in otolaryngology is a challenging task. There are strong arguments to support the value of clinical practice guidelines in terms of optimizing patients outcomes and reducing costs, but the evidence is currently limited. While clinical practice guidelines alone cannot resolve the challenges in our health care system, they can serve as a valuable tool to help achieve this goal.

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Should patients with NAFLD/NASH be surveyed for HCC?

Background Patients with nonalcoholic fatty liver disease (NAFLD) are at risk of developing hepatocellular carcinoma (HCC), but the magnitude of the association still needs to be determined in order to define the need for a specific surveillance strategy. Methods We based our assessment on a previously published review by White et al (1992-2011) and on a systematic review (2012-2017). Results The new search identified 328 abstracts. Combining both eras (1992-2011 and 2012-2017), 25 studies were included in the analysis. Four were prospective, 2 described a retrospective analysis of a prospective database, and the others were retrospective. All studies were published after 2004, but the inclusion period of half of them ended before the year 2000. Studies showed variation in the definition of NAFLD, in the incidence of fibrosis/cirrhosis, in the presence of comorbidities (potentially affecting HCC incidence), and in the type and duration of screening. Considering only studies strictly including patients with or without cirrhosis, the reported incidence of HCC in NAFLD patients with cirrhosis was between 6.7 and 15% at 5-10 years, while the incidence in NAFLD patients without cirrhosis was 2.7% at 10 years and 23 per 100 000 person-years. Conclusions HCC screening in NAFLD patients with cirrhosis is mandatory. However, the currently observed low (and insufficiently documented) incidence of HCC in NAFLD-patients without cirrhosis does not justify a systematic surveillance. Research efforts should focus on developing a score, which could aid the clinician in identifying NAFLD patients without cirrhosis who are at higher risk of developing HCC. Corresponding authors: María Reig, BCLC group. Liver Unit. IMDiM. CIBEREHD. IDIBAPS. Hospital Clínic. c/ Villarroel, 170. Escala 11, 4ª planta. 08036. Barcelona. Spain. Phone: +34 932279803; Fax: +34 932275792. Email: mreig1@clinic.ub.es; Christian Toso, Geneva University Hospitals, Department of Surgery, Rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland, Phone: +41 223723311, Fax : +41 223727755. E-mail : christian.toso@hcuge.ch Authorship: María Reig and Christian Toso, participated in the research design, and all authors participated in the writing of the paper, performance of the research, and/or participated in data analysis. Disclosure: The authors declare no conflict of interest. Funding: CT was supported by the Swiss National Science Foundation (PP00P3_165837). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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