Medicine by Sfakianakis Alexandros: 10/20/16

Πέμπτη 20 Οκτωβρίου 2016

Deutscher Preis für Patientensicherheit ausgelobt

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 645-645
DOI: 10.1055/s-0042-117054

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

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Infiltrative Right Parotid Mass With Lymphadenopathy

A man had a right parotid mass infiltrating the overlying facial skin and a postauricular node; MRI showed infiltration into the cartilaginous tissue of the external auditory canal, ipsilateral cervical adenopathy, and possible perineural involvement of the facial nerve. What is your diagnosis?

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Improving the Quality of the Reporting of Research Results

In JAMA Otolaryngology–Head & Neck Surgery, we strive to present the highest quality clinical, translational, and population health research from an array of disciplines aligned with the clinical practice of otolaryngology–head and neck surgery. Many problems exist in the conduct and analysis of clinical research—such as faulty or incorrect study design to answer the chosen research question, bias in the selection of study participants and measurement, improper attention to the role of chance, and incorrect use of statistical tests—to undermine the validity of the published results. In this editorial it is not my intention to describe these problems in detail; instead, I will focus on the problems in results reporting and provide some solutions that we will foster in the journal. I believe results reporting has received too little attention given its enormous importance for evaluating the significance and effect of research results. Indeed, without accurate reporting, the whole research endeavor might be meaningless or even misleading. I will offer solutions to the problems of results reporting, some of which must be implemented during the planning process and well before the conduct of research. Other solutions to the problems in the conduct and analysis of clinical research address the challenges of data analysis, interpretation of results, and results reporting, all of which have been presented previously in different forums. To illustrate my main points, I will use a 2-group randomized trial study design, where average values for the experimental group are compared with the average values for the control group. The points are relevant to almost all other study designs and analytical approaches.

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October 2016 Issue Highlights

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Comparison of Surgical vs Nonsurgical Treatment of T3 Glottic Squamous Cell Carcinoma

This cohort study uses SEER data to compare survival and functional outcomes in patients with T3 glottic squamous cell carcinoma undergoing surgical vs nonsurgical treatment.

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An Unusual Laryngeal Mass

A man presented with positional shortness of breath and sensation of airway obstruction; flexible fiber-optic laryngoscopy revealed a large, irregular pedunculated mass on the left anterior false vocal that was was seen to ball-valve in and out of the glottis with respiration. What is your diagnosis?

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Imaging Techniques to Detect and Localize Middle Ear Cholesteatoma

This cross-sectional study compares temporal bone CT, PROPELLER diffusion-weighted MRI, and a fusion of the two for diagnosing and localizing middle ear cholesteatoma.

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Survivorship in Head and Neck Oncology

This article summarizes the American Head and Neck Society Committee on Survivorship's perspective on improving the care and experience of patients living with a history of successfully treated head and neck cancer.

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Gelatin-Thrombin Hemostatic Matrix for Posttonsillectomy Bleeding

This case series describes outcomes for children managed with an absorbable, flowable gelatin-thrombin hemostatic matrix sealant for posttonsillectomy bleeding..

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Destructive Hard Palate Mass

A woman presented with painful swelling along the roof of her mouth and cheek associated with new-onset malocclusion, ipsilateral upper lip numbness, and a submucosal growth on the mesial aspect of the left maxillary alveolus. What is your diagnosis?

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Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus

This cross-sectional study quantifies the prevalence of tinnitus and describes the epidemiologic features of tinnitus in a nationally representative sample of US adults.

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Updated Affiliation and Contact Information

In the Special Communication titled "Management of Persistent or Recurrent Structural Neck Disease in Differentiated Thyroid Carcinoma: Point and Counterpoint," published in the August issue of JAMA Otolaryngology–Head & Neck Surgery, the first author's affiliation and contact information require an update. The affiliation, which was given as "Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston (Clayman)" should be replaced with "Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston (Clayman); now with Clayman Thyroid Cancer Center, Tampa General Hospital, Wesley Chapel, Florida (Clayman)." In addition, the Corresponding Author information, which appeared as "Gary L. Clayman, DMD, MD, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX 77030-4009 (gclayman@mdancerson.org)" should be replaced with "Gary L. Clayman, DMD, MD, Clayman Thyroid Cancer Center, Tampa General Hospital, 1 Tampa General Cir, Box 1289, Tampa, FL 33606 (clayman@thyroidcancercenter.com)." This article was corrected online.

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Preventing Complications of Pediatric Tracheostomy

This case series examines whether a standardized protocol for parent education and wound care decreases the rate of readmission and other complications after pediatric tracheostomy.

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Ability of Risk Calculator to Predict Laryngectomy Complications

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) started in the Veterans Affairs (VA) health care system when the US Congress mandated that the VA improve the surgical care provided at its facilities. To those charged with this task, it was evident that not all VA hospitals provided care to the same mix of patient acuity. To be able to fairly compare hospitals, they developed and validated statistical methods to risk-adjust outcomes, based on preoperative risk factors. By 1991, this program became operational in the VA system. As data were gathered on the performance of individual hospitals, this information was then confidentially reported to the individual VA hospitals in hopes that they would use it to improve quality. In 2001, the ACS received a grant to assess whether this program could be used in the non-VA facilities with a test of voluntary pilot hospitals. This proved to be feasible, and in 2004, the program was expanded to include any private and public (non-VA) hospital. As of June 2016, 767 hospitals now participate in ACS-NSQIP.

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Ability of Risk Calculator to Predict Laryngectomy Complications

This study assesses the accuracy of the American College of Surgeons National Surgical Quality Improvement Program risk calculator to predict complications in patients undergoing laryngectomy.

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Removing the Taboo on the Surgical Violation (Cut-Through) of Cancer

This narrative review analyzes treatment outcomes for piecemeal removal of sinonasal, laryngeal, oropharyngeal, and hypopharyngeal cancer and discusses when these techniques should be applied.

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Early vs Late Tracheostomy—A Cost-effectiveness Analysis

This cost-effectiveness analysis evaluates the incremental cost per tracheotomy avoided for strategies using the early tracheostomy vs the late tracheostomy.

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Isolated Sphenoid Lesion

A woman experienced dizziness and headache to the vertex with left retro-orbital irradiation; MRI revealed a concentric multistratified appearance of the sinus content, a hyperintense peripheral layer, crescent-shaped heterogeneous material, and a black oval area in the sinus. What is your diagnosis?

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Effects of Extracorporeal Septoplasty on Nasal Tip

This study evaluates the outcomes of open-approach extracorporeal septoplasty without simultaneous rhinoplasty in terms of nasal tip projection and rotation using objective measurements.

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Right-Sided Laryngeal Mass With Hoarseness

A young man had hoarseness and foreign body sensation in his throat; laryngoscopy revealed a large, right-sided, supraglottic, submucosal mass expanding the aryepiglottic fold and false vocal fold with hypomobility of the right vocal fold and extending to the aryepiglottic fold. What is your diagnosis?

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Intraoperative Neuromonitoring and Reduced RLN Injury in Total Thyroidectomy

This cohort study compares the incidence of recurrent laryngeal nerve injury in total thyroidectomy patients who had intraoperative neuromonitoring vs those who had nerve visualization alone.

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Threshold dose distribution and eliciting dose of cashew nut allergy

A previous study1 found that 137 of 179 cashew nut sensitized children (76.5%) suspected of having cashew nut allergy had a positive double-blind, placebo-controlled food challenge (DBPCFC result), with 63 of 137 children (46%) manifesting subjective and/or objective symptoms to the lowest dose (1 mg of cashew nut protein). The primary aim of this study was to determine the distribution of threshold doses and the eliciting doses (EDs) in this population. The secondary aim was to investigate whether children who reacted to 1 mg of cashew nut (n = 63) could react to even lower doses than 1 mg (low-dose follow-up study).

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Peripheral nerve blocks in the management of postoperative pain: challenges and opportunities

Peripheral nerve blocks (PNBs) are increasingly used as a component of multimodal analgesia and may be administered as a single injection (sPNB) or continuous infusion via a perineural catheter (cPNB). We undertook a qualitative review focusing on sPNB and cPNB with regard to benefits, risks, and opportunities for optimizing patient care. Meta-analyses of randomized controlled trials have shown superior pain control and reductions in opioid consumption in patients receiving PNB compared with those receiving intravenous opioids in a variety of upper and lower extremity surgical procedures.

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Comparative effectiveness of epsilon-aminocaproic acid and tranexamic acid on postoperative bleeding following cardiac surgery during a national medication shortage

The aim of this study was to compare the effectiveness of epsilon-aminocaproic acid (εACA) and tranexamic acid (TXA) in contemporary clinical practice during a national medication shortage.

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Optimal epidural analgesia for patients diagnosed as having gynecologic cancer undergoing interstitial brachytherapy

To determine the optimal epidural analgesia for patients receiving interstitial brachytherapy (ISBT) for gynecologic cancers.

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Midbrain Synchrony to Envelope Structure Supports Behavioral Sensitivity to Single-Formant Vowel-Like Sounds in Noise

Abstract

Vowels make a strong contribution to speech perception under natural conditions. Vowels are encoded in the auditory nerve primarily through neural synchrony to temporal fine structure and to envelope fluctuations rather than through average discharge rate. Neural synchrony is thought to contribute less to vowel coding in central auditory nuclei, consistent with more limited synchronization to fine structure and the emergence of average-rate coding of envelope fluctuations. However, this hypothesis is largely unexplored, especially in background noise. The present study examined coding mechanisms at the level of the midbrain that support behavioral sensitivity to simple vowel-like sounds using neurophysiological recordings and matched behavioral experiments in the budgerigar. Stimuli were harmonic tone complexes with energy concentrated at one spectral peak, or formant frequency, presented in quiet and in noise. Behavioral thresholds for formant-frequency discrimination decreased with increasing amplitude of stimulus envelope fluctuations, increased in noise, and were similar between budgerigars and humans. Multiunit recordings in awake birds showed that the midbrain encodes vowel-like sounds both through response synchrony to envelope structure and through average rate. Whereas neural discrimination thresholds based on either coding scheme were sufficient to support behavioral thresholds in quiet, only synchrony-based neural thresholds could account for behavioral thresholds in background noise. These results reveal an incomplete transformation to average-rate coding of vowel-like sounds in the midbrain. Model simulations suggest that this transformation emerges due to modulation tuning, which is shared between birds and mammals. Furthermore, the results underscore the behavioral relevance of envelope synchrony in the midbrain for detection of small differences in vowel formant frequency under real-world listening conditions.

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A Case of Reactive Cervical Lymphadenopathy with Fat Necrosis Impinging on Adjacent Vascular Structures

A tender neck mass in adults can be a diagnostic challenge due to a wide differential diagnosis, which ranges from reactive lymphadenopathy to malignancy. In this report, we describe a case of a young female with an unusually large and tender reactive lymph node with fat necrosis. The diagnostic imaging findings alone mimicked that of scrofula and malignancy, which prompted a complete workup. Additionally, the enlarged lymph node was compressing the internal jugular vein in the setting of oral contraceptive use by the patient, raising concern for Lemierre's syndrome or internal jugular vein thrombosis. This report shows how, in the appropriate clinical context, and especially with the involvement of adjacent respiratory or neurovascular structures, aggressive diagnostic testing can be indicated.

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Case 32-2016: A 20-Year-Old Man with Gynecomastia

Presentation of Case. Dr. Laura E. Dichtel (Endocrinology): A 20-year-old man was evaluated at this hospital because of gynecomastia. The patient came to the hospital for a routine annual examination to establish adult care. He reported a 3-year history of bilateral breast enlargement, with no…

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Inconceivable Hypokalemia: A Case Report of Acute Severe Barium Chloride Poisoning

Barium is a heavy divalent alkaline earth metal that has been known as a muscle poison. Barium can cause human toxicity, which may lead to significant hypokalemia and have serious consequences. This paper reports a case of unprecedented barium intoxication in which the patient, who suffered from depression, swallowed at least 3.0 g barium chloride to commit suicide. On admission, the patient presented with nausea, vomiting, stomach burning feeling, dizziness, and weakness. Emergency biochemical testing showed that the patient was suffering from severe hypokalemia (K+ 1.7 mmol/L). His electrocardiogram (ECG) prompted atrioventricular blocking, ventricular tachycardia, prolongation of PR interval, ST segment depression with U waves, and T wave inversion. Intravenous potassium supplements were given immediately to correct hypokalemia and regular monitoring of vital signs and fluid balance was arranged. After all-out rescue of our hospital personnel, the condition of the patient is currently stable and he is gradually recovering. This case exemplifies the weaknesses of the management of toxic substances and the lack of mental health education for young people. We hope to get more attention for the supervision of toxic substances and the healthy development of young people.

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A Rare Case of an Irreducible Patella Dislocation

Reports of irreducible patellar dislocations are exceedingly sparse throughout the literature. Obvious radiographic or physical exam findings including fracture or inversion of the patella are often present to explain the block to reduction. Not described previously in the literature is the instance of an irreducible patella dislocation in the setting of innocuous appearing injury imaging. We present a case of a healthy thirty-two-year-old female who sustained an irreducible lateral patella dislocation while participating in a dance aerobics class. Closed means of reduction were unsuccessful, necessitating open reduction. Intraoperative findings suggest incarceration of a nondisplaced fracture and a chondral defect as the block to reduction. Following open reduction, the patient has had no further episodes of pain or instability related to the patella at one-year follow-up. Irreducible patellar dislocations are exceedingly rare injuries, where associated osseous or chondral lesions may necessitate open reduction despite innocuous appearing initial imaging. A high index of suspicion to proceed with open reduction may limit repeated attempts at closed reduction and further injury.

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Adalimumab Induced or Provoked MS in Patient with Autoimmune Uveitis: A Case Report and Review of the Literature

Anti-tumor necrosis factor α (anti-TNF-α) agents have been widely used in the field of autoimmune diseases and have proved decisive efficacy and relative safety. Data concerning their adverse effects has been lately describing central nervous system (CNS) demyelination process at escalating basis. Case Presentation. A 23-year-old male with autoimmune uveitis and a family history of multiple sclerosis (MS) developed two neurological attacks, after Adalimumab infusion, simultaneously with several cerebral lesions on magnetic resonance imaging (MRI). Hence the diagnosis of Adalimumab induced MS was suspected. Conclusion. This case is reported to tell physicians to be cautious when using anti-TNF-α in patients with family history of MS and to reconsider the risk of MS in patients with autoimmune diseases.

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Bowel Ischemia from Heat Stroke: A Rare Presentation of an Uncommon Complication

A healthy 27-year-old female presented to the hospital after she collapsed an hour into her first marathon run on a hot humid day. On presentation, she was hyperthermic, encephalopathic, tachycardic, and hypotensive. On admission, she was found to have lactic acidosis, rhabdomyolysis, and acute kidney injury and was treated with cold normal saline and cooling blankets. She subsequently started having abdominal pain and bloody bowel movements. Computed tomography of the abdomen revealed ascending colon thickening. Furthermore, her lab findings showed transaminitis and elevated coagulation parameters. Due to the acute hypotensive state from the heat stroke, patient had developed bowel ischemia, ischemic hepatitis, and disseminated intravascular coagulation, all of which are uncommon complications of heat stroke. She was managed aggressively with intravenous fluid hydration with resolution of her symptoms over the course of 4 days. In addition to the uncommon complications, early presentation of this bowel ischemia despite adequate hydration in such a healthy individual is another unique aspect of the case.

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Mitochondrial Disorder Aggravated by Metoprolol

Beta-adrenergic blocking agents or beta-blockers are a class of medications used to treat cardiac arrhythmias and systemic hypertension. In therapeutic dosages, they have known adverse outcomes that can include muscular fatigue and cramping, dizziness, and dyspnea. In patients with mitochondrial disease, these effects can be amplified. Previous case reports have been published in the adult population; however, their impact in pediatric patients has not been reported. We describe a pediatric patient with a mitochondrial disorder who developed respiratory distress after metoprolol was prescribed for hypertension. As the patient improved with discontinuation of medication and no alternative etiology was found for symptoms, we surmise that administration of metoprolol aggravated his mitochondrial dysfunction, thus worsening underlying chest wall weakness.

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Treatment of erythematotelangiectatic rosacea with the fractionation of high-fluence, long-pulsed 595-nm pulsed dye laser

Summary

Various lasers have been used for the treatment of erythematotelangiectatic rosacea (ETR) that does not respond to systemic or topical therapy. The pulsed dye lasers (PDLs) are an effective option for ETR, and the purpuragenic fluence proved to be superior until now. Given that purpura and subsequent possible postinflammatory hyperpigmentation (PIH) are occasionally unbearable in some patients, and several studies using the low nonpurpuragenic fluence were reported. To deliver the sufficient high fluence of a PDL without generating purpura, we designed the fractionation of high fluence using five passes and longer pulse duration (6 milliseconds) of a PDL in succession. A total of eight patients with ETR were enrolled in this study; all patients were treated with PDL 10 times at 2-week intervals. Erythema and telangiectasia scores, as well as improvement, were assessed by two physicians using the digital photographs. Moderate-to-marked improvement was achieved in most of the patients, and erythema and telangiectasia scores were significantly decreased. Purpura and PIH were not reported in all patients. The fractionation of high-fluence, long-pulsed 595 nm PDL is a very safe and effective treatment for ETR.

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Comparison of the therapeutic efficacy and safety of combined oral tranexamic acid and topical hydroquinone 4% treatment vs. topical hydroquinone 4% alone in melasma: a parallel-group, assessor- and analyst-blinded, randomized controlled trial with a short-term follow-up

Summary

Background

Melasma's high prevalence and profound psychological impact on patients necessitate efficacious, economical, and safe therapeutic interventions. Adjunctive therapies such as tranexamic acid (TA) can enhance the therapeutic effect of standard treatments like hydroquinone 4% cream (HQ).

Objective

To conduct an assessor- and analyst-blinded, parallel, superiority, randomized controlled trial to compare the clinical efficacy and safety of oral TA plus HQ vs. HQ alone in melasma treatment.

Materials and Methods

A total of 100 eligible patients with symmetric facial melasma were assigned to the intervention (250 mg thrice daily oral TA plus HQ 4% cream nightly) or the control group (HQ 4% cream only). Following 3 months of treatment, MASI (melasma area and severity index) score reduction was calculated as the primary outcome measure. After a 3-month follow-up, relapse was also assessed.

Results

A total of 88 patients completed the study. At the end of the 6-month period, the overall mean of the MASI score in the intervention group was 1.8 points lower than in the controls (95% confidence interval, 0.36–3.24, P = 0.015) but the relapse rate was not significantly different (30% vs. 26% in the treatment vs. control group, respectively). Side effect occurrence was also similar, but treatment satisfaction was higher in the intervention group than the controls, with 82.2% vs. 34.95 of patients reporting moderate-to-complete satisfaction, respectively (P < 0.001).

Conclusions

Oral TA can enhance the efficacy of hydroquinone 4% cream in melasma treatment, but the high incidence of relapse suggests that treatment effects may be temporary, warranting more investigation.

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Are fingernails are a key to unlocking the puzzle of mammalian limb regeneration?

Abstract

Some mammalian digit tips, including those of mice and human children, can regenerate following amputation, whereas mammalian limb regeneration does not occur. One major difference between the digit tip and the rest of the limb is the presence of the nail, which is necessary for this type of regeneration. This couples well with the finding that canonical Wnt signaling and Lgr6, an agonist of Wnt signaling that marks nail stem cells, are necessary for digit tip regeneration. This viewpoint essay discusses the role of the nail in digit tip regeneration, and explores whether nail stem cells and their presumptive niche can be solely accountable for why regeneration is possible in the digit tip, but not the rest of the limb.

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Wy14643, an agonist for PPARα, down-regulates expression of TARC and RANTES in cultured human keratinocytes

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Melanoma risk alleles are associated with down-regulation of the MTAP gene and hyper-methylation of a CpG Island upstream of the gene in dermal fibroblasts

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TLR4-induced B7-H1 on keratinocytes negatively regulates CD4+ T cells and CD8+ T cells responses in oral lichen planus

Abstract

Oral lichen planus (OLP) is a T-cell-mediated autoimmune mucocutaneous disease affected by the interactions among the keratinocytes, CD4⁺ T cells and CD8⁺ T cells. B7-H1 induced by Toll-like receptors (TLRs), can suppress T cell immune reaction, thereby resulting in immune tolerance. However, the role of TLRs-mediated B7-H1 on keratinocytes in the immune response of OLP is still unknown. The present study showed that TLR4 could induce time-coursed B7-H1 expression on oral keratinocytes, and blocking NF-κB or PI3K/mTOR pathway down-regulated B7-H1 transcriptional expression. Moreover, TLR4-stimulated oral keratinocytes inhibited the proliferation of OLP CD4⁺ T cells and OLP CD8⁺ T cells, and simultaneously prompted their apoptosis. Blockade of keratinocytes-associated B7-H1 restored the declined proliferation of OLP CD4⁺ T cells and OLP CD8⁺ T cells, and prevented their increased apoptosis. Therefore, TLR4-upregulated B7-H1 on keratinocytes could decelerate immune responses of CD4⁺ T cells and CD8⁺ T cells in OLP.

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Hypercalcaemia-induced kidney injury caused by the vitamin D analogue calcitriol for psoriasis: a note of caution when prescribing topical treatment

Summary

A 55-year-old man with severe plaque psoriasis presented with a 2-week history of feeling generally unwell with lethargy and thirst. His symptoms had developed 6 weeks after commencement of the topical vitamin D3 analogue calcitriol. Investigations revealed hypercalcaemia and acute-on-chronic kidney injury, probably directly induced by systemic absorption of vitamin D3 following extensive topical use. Topical calcitriol had been started as a steroid-sparing agent to reduce the patient's liberal potent corticosteroid usage during anti-tumour necrosis factor-alfa therapy. Topical vitamin D analogues are commonly prescribed in dermatological and general practice, with hypercalcaemia being a rare but potentially serious adverse effect. This case serves to outline key factors that may predispose to hypercalcaemia, such as disease extent, quantity of drug applied, comorbidities and concurrent medications, and it highlights the importance of considering these factors when prescribing topical therapies.

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Urticarial exanthema due to hepatitis B in a pregnant woman, mimicking a polymorphic eruption of pregnancy

Summary

Hepatitis B virus (HBV) infection in pregnant women is very rare in western countries, thus, cutaneous manifestation of HBV infection may be confused with a dermatosis specific of pregnancy. We report a 39-year-old woman who presented in her 20th week of pregnancy with a pruritic rash, which consisted of generalized erythematous plaques, some of them with a purple centre. Serology testing showed acute HBV infection, and a biopsy revealed a superficial and interstitial perivascular inflammatory infiltrate of lymphocytes and eosinophils. A diagnosis of exanthema due to acute hepatitis B infection was established. The patient delivered a clinically healthy boy, who was given the first dose of the HBV vaccine and intravenous specific immunoglobulin, followed by the second dose 2 months later, and did not get infected with HBV. To our knowledge, this is the first case describing HBV exanthema in a pregnant woman, which led to early action for the newborn, avoiding vertical transmission and its high prevalence of cirrhosis and hepatocellular carcinoma.

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Chronic spontaneous urticaria in an 8-year-old girl treated with omalizumab

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The value of direct audiology access for magnetic resonance imaging: an audit of 40 cases

Abstract

Audiologists can provide an effective and safe service through direct referral for magnetic resonance imaging screening in selected cases

Direct audiology referral for magnetic resonance imaging reduces need for new ENT clinic appointments as well as reducing the inconvenience of repeated visits to hospital for patients

Our experiences following the change of practice audit support the adoption of a more stream-lined audiology-led service

Good practice areas that were highlighted should be emphasised: good two-way communication between audiology and ENT leads and the value of educational feedback from radiology

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Immunohistochemical Studies and FDG Uptake on PET in Pharyngeal Cancer for Predicting Radiotherapy-based Treatment Outcomes

Abstract

Objectives

This study correlated immunohistochemical studies with fluorodeoxyglucose (FDG) uptake on positron emission tomography–computed tomography (PET–CT) and identified prognostic factors for radiotherapy (RT)-based treatment outcomes in patients with squamous cell carcinoma of the oropharynx and hypopharynx.

Methods

Genomic data from pretreatment biopsy specimens (Glut1, CAIX, VEGF, HIF-1α, EGFR, Ki-67, Bcl-2, CLAUDIN-4, YAP-1, c-Met, and p16) of 76 patients were analyzed using tissue microarrays. FDG uptake was evaluated using the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG).

Results

The overexpression of Glut1 positively associated with increased values of the SUVmax, MTV, and TLG, whereas VEGF and HIF-1α expression with the MTV and TLG, respectively. A VEGF immunoreactive score (IRS) >2 (P = .001, hazard ratio [HR] = 3.94) and an MTV defined by an SUV of 2.5 (MTV2.5) >14.5 mL (P = .004, HR = 3.31) were prognostic factors for low cause-specific survival, whereas a VEGF IRS >2 (P = .02, HR = 2.83) for low primary-relapse free survival.

Conclusion

The overexpression of Glut1, VEGF, and HIF-1α associated with increased FDG uptake. For patients with pharyngeal cancer requiring RT, the treatment outcome can be stratified by VEGF and MTV2.5.

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A novel computer algorithm for modeling and treating mandibular fractures: A pilot study

Objectives/Hypothesis

To describe a novel computer algorithm that can model mandibular fracture repair. To evaluate the algorithm as a tool to model mandibular fracture reduction and hardware selection.

Study Design

Retrospective pilot study combined with cross-sectional survey.

Methods

A computer algorithm utilizing Aquarius Net (TeraRecon, Inc, Foster City, CA) and Adobe Photoshop CS6 (Adobe Systems, Inc, San Jose, CA) was developed to model mandibular fracture repair. Ten different fracture patterns were selected from nine patients who had already undergone mandibular fracture repair. The preoperative computed tomography (CT) images were processed with the computer algorithm to create virtual images that matched the actual postoperative three-dimensional CT images. A survey comparing the true postoperative image with the virtual postoperative images was created and administered to otolaryngology resident and attending physicians. They were asked to rate on a scale from 0 to 10 (0 = completely different; 10 = identical) the similarity between the two images in terms of the fracture reduction and fixation hardware.

Results

Ten mandible fracture cases were analyzed and processed. There were 15 survey respondents. The mean score for overall similarity between the images was 8.41 ± 0.91; the mean score for similarity of fracture reduction was 8.61 ± 0.98; and the mean score for hardware appearance was 8.27 ± 0.97. There were no significant differences between attending and resident responses. There were no significant differences based on fracture location.

Conclusion

This computer algorithm can accurately model mandibular fracture repair. Images created by the algorithm are highly similar to true postoperative images. The algorithm can potentially assist a surgeon planning mandibular fracture repair.

Level of Evidence

Level IV. Laryngoscope, 2016

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Πέμπτη 20 Οκτωβρίου 2016

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