Outcomes Following Cordotomy by Coblation for Bilateral Vocal Fold Immobility.

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Outcomes Following Cordotomy by Coblation for Bilateral Vocal Fold Immobility.

JAMA Otolaryngol Head Neck Surg. 2017 Dec 14;:

Authors: Benninger MS, Xiao R, Osborne K, Bryson PC

Abstract
Importance: Bilateral vocal fold immobility (BVFI) can result in considerable voice and airway impairment. Although the carbon dioxide (CO2) laser is commonly used in transverse cordotomy, the coblator, a minimally invasive, low-thermal technology, has been increasingly used in otolaryngology.
Objective: To investigate outcomes associated with coblation to treat BVFI.
Design, Setting, and Participants: A retrospective case series was conducted between January 2012 and June 2017 including 19 patients with BVFI who underwent cordotomy by coblation in a single tertiary care institution.
Main Outcomes and Measures: Clinical, operative, and health status data for all patients were reviewed. Quality of life was measured by the EuroQol 5-Dimensions (EQ-5D), and the Voice Handicap Index (VHI) was used to measure vocal cord function.
Results: Nineteen patients were eligible for inclusion, 15 of which underwent cordotomy by coblation for BVFI without stenosis. Mean age was 57 years with 13 (68%) women. The etiology of BVFI included thyroidectomy in 8 (42%) patients and prolonged intubation in 7 (37%). Mean length of surgery for BVFI without stenosis was 17 minutes; mean operating room (OR) time was 63 minutes compared with 88 scheduled OR minutes (effect size, 25 minutes; 95% CI, 9 to 40 minutes). During follow-up, 4 (27%) of these patients developed granulation tissue postoperatively. Following surgery, patient-reported shortness of breath significantly improved, with 10 of 14 (71%; 95% CI, 45% to 88%) patients with some level of preoperative breathing difficulty experiencing improvement in their breathing. Stridor also significantly improved, with 10 of 12 (83%; 95% CI, 55% to 95%) patients with some level of preoperative stridor improved after surgery. The EQ-5D results trended toward improvement postoperatively (0.67 to 0.80; effect size, 0.13; 95% CI, -0.10 to 0.34). The functional (22 to 12; effect size, -10; 95% CI, -19 to -2), emotional (23 to 11; effect size, -12; 95% CI, -23 to -3), and total VHI all significantly improved (68 to 39; effect size, -29; 95% CI, -49 to -8).
Conclusions and Relevance: Initial outcomes of cordotomy by coblation revealed that this technique was a safe and efficient approach to treating BVFI. Coblation was associated with significant reduction in OR time compared with scheduled time, and patients experienced significant improvement in shortness of breath, stridor, and vocal cord function.

PMID: 29242922 [PubMed - as supplied by publisher]

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Cerebrospinal Fluid Rhinorrhea and a Lytic-Appearing Lesion of the Posterior Cranial Fossa.

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Cerebrospinal Fluid Rhinorrhea and a Lytic-Appearing Lesion of the Posterior Cranial Fossa.

JAMA Otolaryngol Head Neck Surg. 2017 Dec 14;:

Authors: Mehta K, Naples J, Eisen M

PMID: 29242910 [PubMed - as supplied by publisher]

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Fever with lymphadenopathy – Kikuchi Fujimoto disease, a great masquerader: a case report

Kikuchi Fujimoto disease is an uncommon benign condition of necrotizing histiocytic lymphadenitis commonly seen in East Asian and Japanese populations. It commonly presents with fever, cervical lymphadenopathy...

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Biologic treatment sequences for plaque psoriasis: a cost-utility analysis based on 10 years of Dutch real-world evidence from BioCAPTURE

Abstract

Background

Treatment with biologics may be indicated for patients with moderate to severe plaque psoriasis, but comparative evidence on cost-effectiveness is limited. Switching of biologics is common, but it is unclear what the effect is of differences in sequences of biologics.

Objective

Evaluate the cost-effectiveness of different biologic treatment sequences for psoriasis based on real-world evidence.

Methods

A sequence model was developed to evaluate the costs and health effects of three consecutive lines of biologic treatments (for example adalimumab-etanercept-ustekinumab versus etanercept-ustekinumab-adalimumab) over a 10-year time horizon in the Netherlands. The model was populated with data from the Dutch BioCAPTURE registry and scientific literature. Analyses were conducted of cost per quality-adjusted life year (QALY) and uncertainty was addressed by probabilistic as well as scenario analyses.

Results

Treatment of psoriasis with biologics for a 10-year period was estimated to be associated with a cost of € 141,962 to € 148,442 per patient depending on the treatment sequence used. Cumulative health effects ranged from 7.79 to 8.03 QALYs. Starting with adalimumab or ustekinumab seems favourable concerning cost and utilities compared to strategies starting with etanercept, though credible intervals were partly overlapping.

Conclusions

The order in which biologics are used influences treatment cost-effectiveness, both in terms of costs and health effects. Initiation of a biologic treatment sequence for psoriasis may best be done with adalimumab or ustekinumab; etanercept seems less optimal from a health-economic perspective.

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The prevalence of antibody responses against Staphylococcus aureus antigens in patients with atopic dermatitis: a systematic review and meta-analysis

Abstract

Staphylococcus (S.) aureus plays a role in the pathogenesis of atopic dermatitis (AD), possibly via the expression of various virulence antigens. An altered antibody response towards these antigens might contribute to inflammation. We aimed to provide an overview of the varying prevalences and odds of antibody responses against S. aureus antigens in AD patients. Data were systematically obtained from Embase, Medline, Web of Science, Scopus, Cochrane, PubMed and Google Scholar (up to February 12^th 2016). We selected all original observational and experimental studies assessing anti-staphylococcal antibodies in serum of AD patients. Prevalences and odds ratios (ORs) of immunoglobulin (Ig) E, IgG, IgM, IgA against S. aureus in AD patients versus healthy controls were pooled using the random-effects model. We calculated I² statistics to assess heterogeneity and rated study quality using the Newcastle-Ottawa Scale. Twenty-six articles (2369 patients) were included of which 10 controlled studies. Study quality was fair to poor. AD patients had higher prevalences of IgE against staphylococcal enterotoxin (SE) A (OR 8.37, 95% CI 2.93-23.92) and SEB (OR 9.34, 95% CI 3.54-24.93) compared to controls. Prevalences of anti-staphylococcal IgE were 33% for SEA, 35% for SEB and 16% for toxic shock syndrome toxin (TSST)-1. However, study heterogeneity and imprecision should be taken into consideration when interpreting the results. Data on IgG, IgM and IgA as well as other antigens are limited. In conclusion, AD patients more often show an IgE antibody response directed against S. aureus superantigens compared to healthy controls supporting a role for S. aureus in the AD pathogenesis.

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La spongiose à éosinophiles

Publication date: Available online 15 December 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Lepelletier, M.-D. Vignon-Pennamen, M. Battistella




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Role of Bcl-2 and Bax in parotid gland atrophy

OBJECTIVE: To investigate the expression and correlation of B-cell lymphoma-2 (Bcl-2) and Bax in the parotid gland after leading duct ligation in rat.

MATERIALS AND METHODS: Atrophy of the right parotid was induced by ligating the right Stensen's duct of rats. Immunohistochemical labeling was performed to study the changes in number and distribution of Bcl-2 and Bax in each step of glandular atrophy, and every group at 1, 3, 5, 7, 14, 21, 30, 60, 90, 150, 180 days after ligation.

RESULTS: Bcl-2 and Bax showed a low level of expression in normal glandular tissues. At different time points after the ligation of the main duct, Bcl-2 was highly expressed in the duct cells, and the absorbance value reached a peak value at 21-day (3.02+0.10). The 1 D expression of Bax was found in some of the cells in the 3 D, and the expression of Bax reached the peak (1.99+0.10), and the expression of Bcl-2 and Bax were decreased in some cells. Bcl-2/Bax ratio increased at 1 day-21 day, and then decreased and stabilized.

CONCLUSIONS: The expression of Bax and Bcl-2 after ligation of the parotid gland is closely related to the process of the parotid gland atrophy.

L'articolo Role of Bcl-2 and Bax in parotid gland atrophy sembra essere il primo su European Review.

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