No abstract available
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Παρασκευή 12 Μαΐου 2017
Effect of Albumin in Combination With Mannitol on Whole-blood Coagulation In Vitro Assessed by Thromboelastometry.
Background: Albumin and mannitol may interfere with hemostasis, but their coinfluence is unclear. We aimed to determine the effects of albumin alone and in combination with mannitol or Ringer acetate (RAC) on hemostasis in crossover in vitro study. Materials and Methods: From citrated fresh whole blood withdrawn from 10 volunteers, we prepared 2.5, 5, 10, 15, and 20 vol% dilutions of 4% albumin (Alb group). Each sample was thereafter diluted by 15% mannitol (Alb/Man group) or RAC (Alb/RAC group) at a ratio of 9:1. Using thromboelastometry, FibTEM (fibrinogen ROTEM) and ExTEM (extrinsic ROTEM) tests were performed. Results: A 20 vol%, but not 2.5 to 15 vol% dilution of albumin caused a prolonged clot formation time, [alpha]-angle decrease, and maximum clot firmness (MCF) weakening compared with undiluted sample (P
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Acetaminophen and Asthma in Children: Association or Causality?
Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.
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MYH9, a Nonmuscle Myosin, Regulates FOXE1 and PTCSC2, Two Genes Involved in Thyroid Development, Function, and Risk of Papillary Thyroid Cancer
Clinical Thyroidology May 2017, Vol. 29, No. 5: 198-199.
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Pregnant Women of African Descent Have Lower TSH Concentrations and a Lower Risk of TPO-Antibody Positivity
Clinical Thyroidology May 2017, Vol. 29, No. 5: 192-194.
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How Often Does a Thyroid Cancer Patient Need to Undergo Surveillance with Cervical Ultrasound?
Clinical Thyroidology May 2017, Vol. 29, No. 5: 173-175.
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LETTER: Women with Gestational Thyroid Dysfunction May Be at Higher Risk for Thyroid Disease Developing Postpartum
Clinical Thyroidology May 2017, Vol. 29, No. 5: 204-205.
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Meta-Analysis Confirms the Deleterious Effects of Combined BRAFV600E and Telomerase Reverse Transcriptase Promoter Mutations on the Course and Mortality of Papillary Thyroid Carcinoma
Clinical Thyroidology May 2017, Vol. 29, No. 5: 176-179.
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First -Degree Family Members of Patients with Hypothyroidism Due to Hashimoto's Thyroiditis Are at a Ninefold Increased Risk for the Same
Clinical Thyroidology May 2017, Vol. 29, No. 5: 180-182.
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Surgery for Neck Recurrence of Thyroid Cancer Can Achieve Complete Remission in a Majority of Patients
Clinical Thyroidology May 2017, Vol. 29, No. 5: 169-172.
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Many Patients Who Become Hypothyroid After Lobectomy Will Recover Normal Thyroid Function Without Supplementation
Clinical Thyroidology May 2017, Vol. 29, No. 5: 183-185.
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124I PET–CT May Be Useful in Identifying Radioiodine-Avid Lesions in Differentiated Thyroid Cancer
Clinical Thyroidology May 2017, Vol. 29, No. 5: 195-197.
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A New Assessment of the Prevalence and Risk Factors of Liver Abnormalities in Hyperthyroidism
Clinical Thyroidology May 2017, Vol. 29, No. 5: 186-188.
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Case Report: The Utility of PTH Needle Washout in Distinguishing Recurrent Thyroid Bed Lesions in Thyroid Cancer Patients at Risk for Hyperparathyroidism
Clinical Thyroidology May 2017, Vol. 29, No. 5: 200-203.
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Higher Preconception TSH Values Are Associated With Adverse Obstetric Outcomes
Clinical Thyroidology May 2017, Vol. 29, No. 5: 189-191.
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Characterization of the Anti-Bovine Podoplanin Monoclonal Antibody PMab-44
Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.
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Acetaminophen and Asthma in Children: Association or Causality?
Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.
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Well-Differentiated Laryngeal/Hypopharyngeal Liposarcoma in the MDM2 Era Report of Three Cases and Literature Review
Abstract
Laryngeal/hypopharyngeal liposarcomas are very rare, fewer than 40 cases have been reported. These tumors are polypoid, with a male predisposition, and usually cause hoarseness and difficulty breathing. Their clinical course is characterized by multiple local recurrences. No distant metastasis has been reported, and dedifferentiation is extremely rare. In sum, the prognosis of these tumors is excellent; the 5-year survival rate is essentially 100 %. Pathologic diagnosis of these well-differentiated liposarcomas can be challenging. Many of them were initially diagnosed as benign lipoma, fibrovascular polyp, or "inflammatory polyp". The correct diagnosis is usually made after multiple recurrences. On the other hand, the literature bears out that these incorrect diagnoses do not impact disease-specific survival. Here, we report three patients with laryngeal/hypopharyngeal well-differentiated liposarcomas; this is the first documentation of MDM2 amplification in liposarcomas at this site.
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Orthokeratinized Odontogenic Cyst with an Associated Keratocystic Odontogenic Tumor Component and Ghost Cell Keratinization and Calcifications in a Patient with Gardner Syndrome
Abstract
Gardner syndrome (GS) is caused by mutations in the APC and besides adenomatous colorectal polyps includes such manifestations as osteomas, epidermoid cysts (ECs) and occasionally multiple pilomatricomas. More than 50 % of ECs in patients with GS exhibit pilomatricoma-like ghost cell keratinization. The latter may be explained by the fact that the development of both GS and pilomatricoma is driven by activation of the Wnt/β-catenin signaling pathway. A 62-year-old, Caucasian male with history of GS presented with a unilocular, mixed radiopaque/radiolucent mandibular lesion causing divergence and external root resorption of involved teeth. Histopathologically, the lesion was composed of two cystic components, an orthokeratinized odontogenic cyst (OOC) and a smaller one with characteristics of keratocystic odontogenic tumor (KCOT) featuring, focally, ghost cells and an epithelial morule-like structure. Dystrophic calcifications essentially similar to those seen in pilomatricomas were observed in the fibrous connective tissue wall. The KCOT and OOC epithelia revealed strong and diffuse cytokeratin (AE1/AE3) and β-catenin immunoreactivity. CD10 positive immunostaining was seen in the keratin and superficial spinous cell layers in both OOC and KCOT. The intraepithelial and mural ghost cells showed a cytokeratin (+), β-catenin and CD10 (−) immunophenotype. The diagnosis of OOC with ghost cell calcifications in association with KCOT was rendered. The patient was lost to follow-up. Although a coincidental co-existence cannot be excluded, ghost cell calcifications mimicking pilomatricoma-like changes in an unusual odontogenic cyst combining OOC and KCOT features as seen in this patient with GS may be explained by the common molecular mechanisms underlying the pathogenesis of cutaneous pilomatricomas and GS.
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Programmed Death-Ligand 1 Expression, Microsatellite Instability, Epstein–Barr Virus, and Human Papillomavirus in Nasopharyngeal Carcinomas of Patients from the Philippines
Abstract
Most nasopharyngeal carcinomas (NPCs) in a high-incidence population are driven by Epstein–Barr virus (EBV) infection. EBV-associated malignancies have increased expression of the programmed death-ligand 1 (PD-L1). Immunotherapy agents targeting the PD-1/PD-L1 pathway have achieved durable treatment effects in patients with various cancer types including EBV-associated malignancies. In this study, we sought to investigate PD-L1 expression in a cohort of patients with NPCs from the Philippines. Fifty-six NPCs were studied for PD-L1, p16, and DNA mismatch repair (MMR) deficiency by immunohistochemistry. One case with MMR deficiency was also assessed for microsatellite instability (MSI) by polymerase chain reaction. EBV and human papillomavirus (HPV) status were tested by in situ hybridization. All NPCs were p16 negative. Three of the 56 NPCs (5%) were EBV negative (EBV−) and HPV negative, while one NPC (1/56, 2%) was EBV positive and showed MSI (EBV+/MSI). Positive PD-L1 expression (PD-L1+), defined as membranous staining in ≥1% tumor cells, was seen in 64% (36/56) of NPCs. All three EBV− NPCs were PD-L1+ as was the EBV+/MSI NPC. PD-L1+ was seen significantly more often in NPCs from non-smokers than those from smokers (23/28, 82% vs 9/18, 50%; P = 0.047). PD-L1+ was not associated with pT, pN, distant metastasis, or clinical stage (P > 0.05). PD-L1+ was not associated with overall survival (P = 0.473). In summary, our results show frequent PD-L1 expression in NPCs regardless of EBV status and a preferential PD-L1 expression in non-smokers. MSI and HPV positivity are exceedingly rare in NPCs.
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Anaplastic Transformation of Papillary Thyroid Carcinoma Only Seen in Pleural Metastasis: A Case Report with Review of the Literature
Abstract
Anaplastic transformation of papillary thyroid carcinoma (PTC) at distant metastatic sites is extremely rare, and there have been fewer than 20 reported cases in the literature. A 61-year-old woman presented with 1-week history of dyspnea. Her past medical history was remarkable because, 19 years ago, she underwent nearly total thyroidectomy and radical neck dissection due to PTC. Computed tomography of the chest revealed a 1.7 cm nodule in the lung and diffuse pleural thickening. Gun biopsy of the lung nodule revealed metastatic PTC with typical histology. However, the pleural biopsy predominantly showed anaplastic pleomorphic and spindle sarcomatoid carcinoma with microscopic focus of PTC. Immunohistochemical results showed both anaplastic sarcomatoid and PTC components positive for TTF-1, galectin-3 and PAX-8, thus supporting anaplastic transformation of PTC at the metastatic site. Subsequently the patient received 1 cycle of cisplatin-based chemotherapy but died from the disease 4 months after diagnosis. Although it is rare, anaplastic transformation of PTC should be considered during differential diagnosis of patients who present with exclusive sarcomatoid morphology at metastatic sites and have a history of PTC. We report another case of anaplastic transformation of PTC, found at pleural metastasis, together with the immunohistochemical profile and a literature review.
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Mucinous Carcinoma with Neuroendocrine Differentiation of Salivary Gland Origin
Abstract
Primary mucinous adenocarcinomas of the salivary gland are rare malignancies defined by aggregates of epithelial cells suspended in large pools of extracellular mucin. We report a case of a giant mucinous adenocarcinoma of salivary gland origin, with low-grade cytoarchitectural features and neuroendocrine differentiation arising in the submental region. Grossly, the tumor measured 12.5 × 13.4 × 8.2 cm and replaced the bone and soft tissues of the anterior oral cavity. Microscopically, the neoplasm was composed of large extracellular pools of mucin, which contained papillary and acinar aggregates, and small nodules of ductal type epithelium with minimal nuclear enlargement, powdery chromatin and little pleomorphism. The nodules comprised 20 % of the tumor and showed morphologic and immunohistochemical evidence of neuroendocrine differentiation. Examination revealed histologic features comparable to mammary gland analogues in mucin predominance, ductal type morphology, expression of estrogen and progesterone receptors, and GATA-3 positivity. This is the first case reported of mucin-rich carcinoma of salivary gland origin exhibiting neuroendocrine differentiation.
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Oral Lichen Sclerosus: A Rare Case Report and Review of the Literature
Abstract
Lichen sclerosus (LS) is a chronic inflammatory mucocutaneous disease that often affects the anogenital area and causes significant discomfort and morbidity. Oral mucosal lesions in LS are extremely rare and might be associated with genital and/or skin manifestations. As a unique manifestation of LS, oral lesions are even more rare, with only 20 cases reported in English-language literature. In reviewing that literature in this paper, we present the case of a 44-year-old white man who sought dental assistance with a complaint of a white spot on his upper lip. Extraoral clinical examination revealed a slight white macule on the left upper lip vermilion next to the labial commissure. Intraoral examination revealed that the macule was approximately 3.5 × 2.0 cm, extended to the upper left labial mucosa, and presented an ivory-white color. Following an incisional biopsy and microscopy, the lesion was shown to be covered by a stratified squamous epithelium showing hyperkeratosis and atrophy. The superficial lamina propria revealed a well-marked band of subepithelial hyalinization and, below it, a band-like mononuclear inflammatory infiltrate. Sections stained by Verhoeff's technique revealed a scantiness of elastic fibers in the superficial lamina propria. The diagnosis of LS was then established. The patient was referred for dermatologic evaluation, which identified no skin or genital lesions, and no treatment was employed. After 6 years, no significant changes in clinical features were observed. Altogether, this rare case makes an important contribution to knowledge on this uncommon condition.
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Continuous Regional Anesthesia and Inpatient Rehabilitation for Pediatric Complex Regional Pain Syndrome.
Background: Evidence supports treatment of pediatric complex regional pain syndromes (CRPS) with physical and occupational therapy and cognitive-behavioral therapy. Some patients have persistent pain and/or limb dysfunction despite these treatments. We performed a retrospective study of pediatric patients with CRPS treated by continuous epidural or peripheral perineural local anesthetic infusions along with inpatient rehabilitation at Boston Children's Hospital. Methods: After approval from the institutional review board, electronic medical records were reviewed for patients treated between September 2003 and September 2014. Primary outcomes were pain and functional scores. Data were collected at the first encounter, at follow-up visits between 4 months before and after admission, and daily while inpatient. Changes over time were assessed using Wilcoxon tests with Dunn corrections. Clinical significance of benefit or harm was assessed by the method of Jacobson and Truax. Response predictors were analyzed using linear mixed models and exploratory logarithmic regression analyses. Results: Pain, function, and disability scores improved during hospitalization and in follow-up over a 4-month period. Seventy percent of patients achieved clinically significant benefit (56% for pain reduction and 40% increased functionality, respectively). Univariate and adjusted predictors of favorable outcome included preadmission resting Numeric Pain Rating Scale score of less than 6 (odds ratio, 5.0; P = 0.0164 and subsequent attendance at the Pediatric Pain Rehabilitation Center at Boston Children's Hospital (odds ratio, 5.0; P = 0.0206). Mean pain scores greater than 3 during the regional anesthesia infusion predicted less favorable outcome. Conclusions: Continuous regional anesthesia may be an option to facilitate intensive rehabilitation for selected pediatric patients with CRPS. Further research should help clarify the role of regional anesthesia in a comprehensive management program. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.
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Continuous Intrathecal Infusion of Cannabinoid Receptor Agonists Attenuates Nerve Ligation-Induced Pain in Rats.
Background and Objectives: Cannabinoid receptors (CB1R/CB2R) are known to play important roles in pain transmission. In this study, we investigated the effects of continuous intrathecal infusion of CB1/2R agonists in the L5/6 spinal nerve ligation pain model. Methods: Under isoflurane anesthesia, rats received nerve ligation and intrathecal catheter connected to an infusion pump. After surgery, saline (1 [mu]L/h), CB1/2R agonist WIN55,212-2, CB1R agonist ACEA, or CB2R agonist AM1241 (1 [mu]mol/h) was given intrathecally for 7 days. The mechanical and thermal sensitivities of rat hindpaw were determined by von Frey hair and radiant heat tests. The expression of CB1/2R and protein levels of CB1/2R, Iba1, glial fibrillary acidic protein, and tumor necrosis factor [alpha] were examined by immunofluorescence study and Western blotting. Results: On postligation day 7, rats that received WIN55,212-2, ACEA or AM1241 had significantly higher mean withdrawal thresholds (6.8, 8.4, and 10.2 g) and latencies (6.3, 7.3, and 9.1 seconds) than did saline-treated rats (1.7 g, 2.2 seconds). Cannabinoid receptors were expressed not only in IB4+ (isolectin B4) and CGRP+ (calcitonin gene-related peptide) dorsal root ganglion neurons, their central terminals, and peripheral axons, but also in neurons, microglia, and astrocytes in spinal cord. Cannabinoid receptor agonists enhanced nerve ligation-induced up-regulation of cannabinoid receptor in spinal cord and dorsal root ganglion. Treatment with WIN55,212-2 or AM1241, but not ACEA, markedly reduced nerve ligation-induced up-regulation of Iba1, glial fibrillary acidic protein, and tumor necrosis factor [alpha] in spinal cord. Conclusions: Continuous intrathecal infusion of CB1/2R agonists elicits antinociception in the pain model. The mechanisms might involve their actions on neurons and glial cells. CB2R, but not CB1R, seems to play an important role in the regulation of nerve injury-induced neuroinflammation. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.
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Retrobulbar Block in Pediatric Vitreoretinal Surgery Eliminates the Need for Intraoperative Fentanyl and Postoperative Analgesia: A Randomized Controlled Study.
Background and Objectives: Pediatric ophthalmologic surgery is traditionally accomplished by general anesthesia with opioids, but respiratory depression remains a major concern. Our study compared the efficacy of retrobulbar block with systemic fentanyl on pain, hemodynamic, and stress response in pediatric vitreoretinal surgery. Methods: A prospective double-blind, randomized controlled study was performed comparing retrobulbar block with intravenously administered fentanyl in 28 children aged 1 to 6 years undergoing vitreoretinal surgery. After general anesthesia was induced, retrobulbar block with 0.5% ropivacaine was accomplished in group RB (general anesthesia plus retrobulbar block) (n = 13), and normal saline was injected into retrobulbar space in group F (general anesthesia alone) (n = 15). Fentanyl 0.5 [mu]g/kg was administered when signs of inadequate anesthesia were observed. Results: Respiratory depression (defined as a persistent respiratory rate
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Diskitis, Osteomyelitis, Spinal Epidural Abscess, Meningitis, and Endocarditis Following Sacroiliac Joint Injection for the Treatment of Low-Back Pain in a Patient on Therapy for Hepatitis C Virus.
Objective: Sacroiliac joint injections are frequently performed procedures in the management of acute and chronic low-back pain, including patients with various immunocompromised states. Infectious complications following these procedures along with other spinal injections are rarely reported, but the true incidence is unknown. The purpose of this report is to highlight the devastating neurologic sequela that can occur, and to discuss potential future management strategies. Case Report: We present a patient who developed diskitis, osteomyelitis, spinal epidural abscess, meningitis, and endocarditis from Staphylococcus aureus, all of which developed shortly after a sacroiliac joint injection. The patient was on treatment for hepatitis C virus, and the resulting immunocompromised state likely contributed to the outcome. Conclusions: Immunocompromised patients should be identified prior to treatment, and the small possibility of devastating complications should be thoughtfully weighed against the potential benefit of the procedure. Conservative management should be maximized initially, and if a procedure is done, strict asepsis must be maintained. Prophylaxis for S. aureus should be considered for immunocompromised patients undergoing interventional spine procedures. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.
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Residual Enoxaparin Activity, Anti-Xa Levels, and Concerns About the American Society of Regional Anesthesia and Pain Medicine Anticoagulation Guidelines.
Currently, the American Society of Regional Anesthesia and Pain Medicine (ASRA) anticoagulation guidelines recommend that before the performance of a neuraxial procedure a minimum of 24 hours should elapse following a treatment dose of enoxaparin (1 mg/kg twice daily or 1.5 mg/kg once daily). The guidelines have since their inception also consistently recommended against the routine use of anti-Xa level monitoring for patients receiving enoxaparin. However, we noted in our clinical practice that anti-Xa levels were frequently still elevated despite patients meeting the time-based recommendation for treatment dose enoxaparin. To further investigate the possibility that residual anticoagulant activity may persist longer than 24 hours after a treatment dose of enoxaparin, we assessed anti-Xa level activity in patients presenting for elective surgery. Despite nearly universal compliance with ASRA's anticoagulation guidelines (1 sample was drawn at 23.25 hours), anti-Xa activity was found to be elevated in 11 of 19 patients. While 10 patients had an anti-Xa level within the peak prophylactic range (0.2-0.5 IU/mL), 1 patient's level was found to still be in the peak therapeutic range (0.5-1.0 IU/mL). These findings suggest that significant anticoagulant activity may persist longer than previously appreciated after the last treatment dose of enoxaparin and that the current time-based ASRA recommendation may not be conservative enough. Further research is needed to delineate the level of anti-Xa activity below which it is likely safe to proceed with a neuraxial procedure, but it may be time to reconsider the utility of anti-Xa level monitoring when it is available. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.
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Guidelines for allergen immunotherapy in India: 2017-An update
Indian Journal of Allergy, Asthma and Immunology 2017 31(1):1-2
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Guidelines for practice of allergen immunotherapy in India: 2017-An update
Indian Journal of Allergy, Asthma and Immunology 2017 31(1):3-33
The practice of Allergy and Immunotherapy is not streamlined in our country and there were no guidelines till we published in 2009 in IJAAI. The guidelines are updated now incorporating the additional information after 2009. The purpose of bringing out these guidelines was to maintain the uniformity in the methods of diagnosis and management i.e. Immunotherapy in the country. Because of different soil conditions, temperature, different allergens, different seasonal variations etc, it was the felt the need to have separate guidelines for India, although such guidelines are available from other organisations. These guidelines are based on available guidelines with modifications/alterations at appropriate places keeping in mind the situation in our country.
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5 things to know about endotracheal intubation
If you've ever wondered why the little hole near the tip of an endotracheal tube is called the Murphy Eye, or who Macintosh was, or even who performed the first intubatio, this quick trip through the history of endotracheal tubes and laryngoscopy is for you. Here are five things to know about the invention, indications and use of an endotracheal tube. 1. Endotracheal tube history There is debate ...
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Thick tumor capsule is a valuable risk factor for distant metastasis in follicular thyroid carcinoma
Source:Auris Nasus Larynx
Author(s): Wataru Shimbashi, Iwao Sugitani, Kazuyoshi Kawabata, Hiroki Mitani, Kazuhisa Toda, Keiko Yamada, Yukiko Sato
ObjectiveWhile the biological behavior of follicular thyroid carcinoma (FTC) has been studied in great detail using clinical experience, few studies have investigated pre- or intraoperative factors related to the risk of distant metastasis (DM) among patients with FTC. The aim of this study was to analyze the characteristics of FTC with DM.MethodsThis study retrospectively investigated 102 patients with FTC who underwent surgery between 1988 and 2013. We compared clinicopathological characteristics between FTC with and without DM.ResultsUnivariate analysis revealed nodal metastasis (p=0.045), serum thyroglobulin (Tg) at initial operation (≥1000ng/ml; p<0.0001), widely invasive appearance according to macroscopic findings (p<0.0001), thick tumor capsule (≥1mm; p<0.0001), vascular invasion (p=0.0003), extrathyroidal invasion (p=0.047), and venous tumor embolism (p=0.045) as significant risk factors for DM. Multivariate analysis conducted using pre- and intraoperative factors identified thick tumor capsule (≥1mm), serum Tg at initial operation (≥1000ng/ml), and macroscopically widely invasive appearance as risk factors independently associated with development of DM.ConclusionPatients with these risk factors should undergo total thyroidectomy and radioactive iodine ablation.
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Utility of a multidisciplinary approach to pediatric hearing loss
Because management of hearing loss (HL) often requires multiple specialists, a multidisciplinary clinic, Pediatric Hearing Management Clinic, (PHMC) was established to coordinate care for children with newly diagnosed HL.
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Thick tumor capsule is a valuable risk factor for distant metastasis in follicular thyroid carcinoma
While the biological behavior of follicular thyroid carcinoma (FTC) has been studied in great detail using clinical experience, few studies have investigated pre- or intraoperative factors related to the risk of distant metastasis (DM) among patients with FTC. The aim of this study was to analyze the characteristics of FTC with DM.
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Retraction
The article, "Laryngeal Function After Radiation Therapy," by Mauricio Gamez, Kenneth Hu, and Louis B. Harrison, originally published in the August 2015 issue of Otolaryngologic Clinics (Volume 48, Issue 4, pp. 585–599), has been retracted. Please see the Elsevier Policy on Article Withdrawal (http://ift.tt/1poHqya).
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Technological Advances in Sinus and Skull Base Surgery
Technological advances have always played a major role in the field of Rhinology and Skull Base Surgery. As minimally invasive approaches to the sinuses, orbit, and skull base were developed, pioneering surgeons relied heavily on specialized tools to access and target different anatomic reaches of the head. Since then, technology has continued to evolve in pace with our techniques and areas of focus, with a major emphasis being on multifunctional design and ergonomics. There has been a refinement in foundational tools such as microdebriders that now permit more effective drilling and are cautery enabled; enhancement in our surgical navigation systems that are providing "multimodal" information; and an explosion of bioabsorbable packing materials, including the first ever drug-eluting stent for use in the sinuses.
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Harnessing Technology at the Edges of Otolaryngology
The first frontal sinus surgery was described in 1750 by Runge, who performed an obliteration procedure. An external and intracranial drainage procedure for a frontal sinus mucocele was described in 1870, and in 1884, the era of trephination was born (Ogston-Luc procedure), but abandoned due to the high rate of nasofrontal duct stenosis and surgical failure. Radical ablation procedures with removal of the anterior table and mucosal stripping were introduced in 1895, but because of the significant cosmetic deformity and high failure rates, conservative procedures became de rigeur from 1905 onward.
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The Operating Room of the Future Versus the Future of the Operating Room
Technological advancement in the operating room is evolving into a dynamic system mirroring that of the aeronautics industry. Through data visualization, information is continuously being captured, collected, and stored on a scalable informatics platform for rapid, intuitive, iterative learning. The authors believe this philosophy (paradigm) will feed into an intelligent informatics domain fully accessible to all and geared toward precision, cell-based therapy in which tissue can be targeted and interrogated in situ. In the future, the operating room will be a venue that facilitates this real-time tissue interrogation, which will guide in situ therapeutics to restore the state of health.
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Technological Advances in Sinus and Skull Base Surgery
OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA
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Cochlear Implant – State of the Art
Laryngo-Rhino-Otol 2017; 96: S123-S151
DOI: 10.1055/s-0043-101812
Cochlea-Implantate sind elektronische Reizprothesen zum funktionellen Ersatz des Innenohrs. Aufgrund der rasanten technischen Entwicklung und den dadurch erzielten guten Ergebnissen haben sie sich zur Standardtherapie bei sensorischer Taubheit etabliert.Die Cochlea-Implantat-Versorgung erfordert ein interdisziplinäres Team und ein qualitätsgesichertes Konzept, das von der Indikationsstellung bis zur lebenslangen Nachsorge reicht und das in der AWMF-Leitlinie Cochlea-Implantat niedergelegt ist (AWMF Leitlinie Cochlea-Implantate 1).Heutige Cochlea-Implantat-Systeme sind teilimplantierbar und mit einer Vielzahl von Zusatzfunktionen wie bei Hörgeräten zur Schallvorverarbeitung und Störschallunterdrückung ausgestattet. Die intracochleäre Elektrodenlage ermöglicht eine differentielle Stimulation des Hörnerven und damit die Vermittlung unterschiedlicher Tonhöheneindrücke. Durch diese Nachbildung der Frequenzorganisation des Innenohrs können komplexe Schallsignale wie Sprache in ein differenziertes neuronales Erregungsmuster des Hörnerven umgesetzt werden, welches Basis für das Sprachverstehen mit einem Cochlea-Implantat ist.Indikationen sind heute die beidseitige sensorische hochgradige Schwerhörigkeit und Taubheit sowohl bei Kindern als auch bei Erwachsenen, die einseitige Taubheit sowie die Hochtontaubheit. Cochlea-Implantate sind immer dann indiziert, wenn ein ausreichendes Sprach- und Kommunikationsvermögen (Gebrauch des Telefons) oder eine Sprachentwicklung mit alternativen Methoden nicht möglich oder zu erwarten sind.Die chirurgische Technik ist standardisiert und für alle Patienten anwendbar. In der Regel wird ein transmastoidales Vorgehen mit posteriorer Tympanotomie und Insertion der Elektrode durch die runde Fenstermembran präferiert. Die Befestigung des Implantatkörpers in einem Knochenbett stellen ebenso wie die sichere Elektrodenfixation nahe der Cochlea entscheidende Elemente für ein komplikationsarmes Verfahren dar. Die hörerhaltende Cochlea-Implantat-Chirurgie ist heute Standard und ermöglicht die Versorgung von Patienten auch mit Restgehör.Die intraoperativ erhobenen elektrophysiologischen Parameter erlauben neben der Funktionskontrolle des Implantates eine Anpassung der Systeme, insbesondere bei Kindern, auf der Basis objektiver Parameter. Das sich anschließende Hör-Sprach-Training zielt auf den Spracherwerb bzw. das Spracherkennen ab. Die lebenslange Nachsorge umfasst neben medizinischen und technischen Kontrollen auch technologische Upgrades und das Erkennen und Behandeln von Komplikationen.In der Regel erreichen postlingual ertaubte Patienten ein offenes Sprachverständnis und können telefonieren. Bei Kindern wird bei früher Implantation nach Eintritt der Ertaubung in der Regel eine nahezu normale Sprachentwicklung erreicht.Die Komplikationsrate ist gering. Implantatausfälle treten bei ca. 2–4% der Patienten, medizinische Komplikationen bei ca. 4% der Implantierten auf. Reimplantationen können in der Regel ohne Probleme durchgeführt werden. Die Patienten profitieren von einem technologischen Upgrade.Die zukünftigen Entwicklungen gehen in Richtung des bionischen Ohres, das die Wiederherstellung des Gehörs durch Nachbildung des physiologischen Hörvorgangs mithilfe der Technik anstrebt. Dazu werden Elektroden mit einer deutlich höheren Anzahl von elektrisch getrennten Kanälen entwickelt. Durch Oberflächenfunktionalisierung und zusätzliche biologische Therapie lassen sich die Regeneration des Hörnerven mit Aufwachsen der Dendriten auf die Elektrode sowie eine Verhinderung einer weiteren Spiralganglienzellendegeneration erreichen. Damit können deutlich bessere Sprachverarbeitungsstrategien zum Einsatz kommen, die auch ein tonales Gehör z. B. für Musik ermöglichen. Telemedizinische Konzepte erlauben neue Formen der Patientenversorgung mit aktiver Beteiligung des Patienten, automatisierte technische Implantatkontrolle, Remote Care, Selbstprogrammierung und technologische Upgrades. Durch multimodale Stimulation mit integrierten intracochleären mechanischen oder optoakustischen Aktuatoren werden universelle Hörimplantate möglich, die eine individuell optimale Hörrehabilitation erlauben und bei progredientem Hörverlust jederzeit nachjustiert werden können. Der Einsatz robotischer Systeme wird zu einer wesentlichen Erhöhung der Präzision und Verbesserung der Hörerhaltung führen. Sogenannte Closed-Loop-Systeme mit Messung des EEG-Signals ermöglichen eine automatisierte Adaptation des Implantatsystems an verschiedene Hörsituationen. Vollimplantierbare Hörsysteme sind in Entwicklung und erlauben das sogenannte Invisible Hearing zur Überwindung des Stigmas Schwerhörigkeit.Insgesamt darf das Cochlea-Implantat als Prototyp für den Sinnesersatz gelten. Zur Zeit sind weltweit ca. 500 000 Patienten mit einem Cochlea-Implantat versorgt.
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Aktuelle operative Therapie des vestibulären Schwindels
Laryngo-Rhino-Otol 2017; 96: S209-S229
DOI: 10.1055/s-0042-120050
Das Leitsymptom „Schwindel" ist keine klar abgrenzbare Krankheitsentität, sondern stellt ein sehr heterogenes Krankheitsbild dar, das hauptsächlich von HNO-Ärzten, Neurologen, Internisten sowie Allgemeinmedizinern diagnostiziert und therapiert wird. Die meisten Schwindelsyndrome haben eine gute Prognose und können meist konservativ (medikamentös, physikalisch und psychotherapeutisch) erfolgreich behandelt werden. Operative Therapieverfahren des peripher vestibulären Schwindels spielen in absoluten Zahlen nur eine untergeordnete Rolle, sie stellen aber für die betroffenen Patienten nach Ausschöpfen alternativer Therapieverfahren oft die einzig verbleibende Option dar. In dem vorgelegten Referat wird die Entwicklung der operativen Therapieverfahren für hydropische Innenohrerkrankungen, hierbei insbesondere des M. Menière, für Dehiszenzsyndrome, Perilymphfisteln und für den benignen paroxysmalen Lagerungsschwindel vorgestellt und diskutiert. Abschließend erfolgt mit der Diskussion der vestibulären Implantate ein Ausblick auf mögliche zukünftige Therapieoptionen. Die Anwendung der vorgestellten operativen Therapieverfahren für die einzelnen Krankheitsbilder ist nach Ausschöpfen von funktionserhaltenden, konservativen Alternativen bei Fortbestehen einer belastenden Symptomatik indiziert. Der Erfolg hängt hierbei vor allem von der richtigen Diagnose- und Indikationsstellung und damit von einer geeigneten Patientenselektion ab. Da es sich z. T. um irreversible, intrakranielle Eingriffe mit entsprechenden Risiken für den Patienten handelt, ist eine ausführliche individuelle Beratung des Patienten über die Chancen und Risiken des Eingriffs unabdingbar. Mit der oft erfolgreichen Schwindelkontrolle durch die destruierenden Verfahren steigen auch die operativen Risiken, insbesondere für eine Hörverschlechterung oder Ertaubung, weswegen das vorhandene Restgehör meist in den Entscheidungsprozess miteinfließt.
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Implantierbare Hörsysteme
Laryngo-Rhino-Otol 2017; 96: S84-S102
DOI: 10.1055/s-0042-118775
In den letzten Jahren hat sich die kombinierte Schwerhörigkeit als wesentliche Indikation für implantierbare Hörsysteme herauskristallisiert. In Abhängig von der Knochenleitungshörschwelle stehen verschiedene Optionen zur Verfügung: Patienten mit geringgradiger sensorineuraler Schwerhörigkeit profitieren in der Regel von transkutanen BCI, während die perkutanen BCI-Systeme ihre Vorteile im Übergangsbereich zu mittelgradigem Hörverlust ausspielen. Für kombinierte Hörverluste mit ausgeprägtem mittelgradigem und hochgradigem cochleärem Hörverlust schließlich bietet sich die Versorgung mit aktiven Mittelohrimplantaten an. Bei der Sekundärversorgung von Patienten mit Unverträglichkeiten oder Operationen des Mittelohrs sind diese Implantate eine wertvolle und bewährte Ergänzung des therapeutischen Arsenals.
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Aktuelle audiologische Diagnostik
Laryngo-Rhino-Otol 2017; 96: S4-S42
DOI: 10.1055/s-0042-120339
Die audiologische Funktionsdiagnostik der Gegenwart fußt auf einem Bestand von Hörprüfungen, deren große Zahl der Vielfalt von Funktionsstörungen eines komplexen Sinnesorgansystems und den Anforderungen an die Durchführbarkeit in jedem Lebensalter Rechnung trägt. Das Ziel besteht darin, Natur und Ursprung der Hörstörung zu identifizieren und ihr Ausmaß quantitativ so weit zu bestimmen, dass für die Einleitung der angemessenen konservativen, operativen oder apparativen Therapie oder zur Veranlassung von Fördermaßnahmen ausreichend qualifizierte Information zur Verfügung steht. Darüber hinaus liefert die Audiometrie die Grundlage zur Einschätzung der Beeinträchtigung und zur Berechnung des Grades der Behinderung. In dieser Übersicht wird von der Basisdiagnostik bis zu aufwendigen Spezialtechniken der derzeitige Stand der für die praktische Anwendung verfügbaren Verfahren dargestellt, nach bewährter Systematik in subjektive (psychoakustische) und objektive, auf physikalischen Messungen beruhende Verfahren gruppiert: orientierende Hörprüfungen, Tonhörschwelle, überschwellige Verarbeitung der Schallintensität, Richtungsgehör, Sprachverstehen ohne und mit Störgeräusch, dichotisches Hören, Tympanogramm, Stapediusreflex, otoakustische Emissionen und akustisch evozierte Potenziale. Bis auf wenige noch bestehende Lücken deckt dieses Methodeninventar das Spektrum aller klinisch relevanten Funktionsdefizite des Hörsystems ab.
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Hörgeräte: Indikationen, Technologie, Anpassung und Qualitätskontrolle
Laryngo-Rhino-Otol 2017; 96: S43-S65
DOI: 10.1055/s-0042-120046
Da nach wie vor eine kausale Behandlung von Schwerhörigkeiten, die durch Schädigungen der Strukturen des Innenohres bedingt sind, nicht verfügbar ist, steht für die Therapie von Schwerhörigkeit die apparative Hörrehabilitation im Vordergrund. Gleichzeitig haben sich die Qualität und technische Möglichkeiten der Hörgeräteversorgung in den letzten 10–15 Jahren deutlich verbessert. Besonders die moderne „offene Anpassung" hat die Akzeptanz für Hörgeräte, vor allem aber die Rehabiltation von Hochtonhörschwerhörigkeiten entscheidend verbessert. Dennoch sind die Bereitschaft der Betroffenen, sich versorgen zu lassen, aber auch der HNO-Ärzte, möglichst frühzeitig zu versorgen, sicher noch verbesserungsfähig. Aktuelle Forschungen machen jedoch deutlich, dass es sinnvoll ist, Schwerhörige bereits sehr früh und auch bereits mittelgradige Hörverluste apparativ zu versorgen. Dies beugt einer kortikalen auditiven Deprivation und damit auch drohenden sozialen Isolationen bis hin zu Demenzentwicklungen und Intelligenzverlusten vor, ist aber auch zugleich eine sinnvolle Therapie, um Begleitsymptome wie Tinnitus und Geräuschüberempfindlichkeiten lindern zu können. Dieses Referat soll die Indikationen, die technischen Möglichkeiten und den aktuellen Forschungsstand zur Hörgerätetechnologie, -akzeptanz und zu Besonderheiten in der Versorgung Schwerhöriger aufzeigen.
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Diagnostik und Therapie des Hörsturzes
Laryngo-Rhino-Otol 2017; 96: S103-S122
DOI: 10.1055/s-0042-122385
Die Übersichtsarbeit behandelt aktuelle Aspekte der Diagnostik, der Differentialdiagnostik sowie der Evidenz im Bereich der systemischen und lokalen Therapie des Hörsturzes. Da vielfältige Erkrankungen existieren, die auch eine akute einseitige Schallempfindungsschwerhörigkeit als Symptom haben können, kommt der sinnvollen, gezielten Diagnostik bei der Abklärung dieses Symptomes eine besondere Rolle zu. Eine bisher wahrscheinlich relativ häufig übersehene Differentialdiagnose sind intralabyrinthäre Schwannome, da diese bisher wenig beachtet wurden und auf den häufig durchgeführten „Kopf-MRTs" mit groben Schichten leicht zu übersehen sind. Daher sollte bei der Anforderung einer Schläfenbein-MRT-Untersuchung zur Abklärung eines Hörsturzes explizit auch nach Vorhandensein oder Ausschluss eines intralabyrinthären Schwannoms gefragt werden. Mit geeigneten MRT-Untersuchungen lässt sich heutzutage auch ein endolymphatischer Hydrops visualisieren.Die Studienlage bei der Therapie des Hörsturzes ist – bezogen auf die Qualität, nicht auf die Anzahl der Studien – unbefriedigend. Der Wert von systemisch (niedrige Dosis) oder intratympanal applizierten Kortikosteroiden in der Primärtherapie des Hörsturzes ist unklar. Um die Frage der Wirksamkeit einer in der aktuell gültigen AWMF-Leitlinie empfohlenen primären, systemischen Hochdosis-Kortikosteroidtherapie beim Hörsturz zu beantworten, wird mit Unterstützung des Deutschen Studienzentrums HNO (DSZ-HNO) in Deutschland derzeit eine multizentrische, klinische Studie durchgeführt (http://ift.tt/2pZpq2Y). Bei ungenügender Erholung der Hörschwelle nach systemischer Therapie des Hörsturzes scheint nach derzeitiger Datenlage die intratympanale Kortikosteroidtherapie als Sekundärtherapie mit einer signifikant höheren Wahrscheinlichkeit der Hörschwellenverbesserung einherzugehen. Die Hörverbesserung scheint dabei jedoch unabhängig zu sein vom Behandlungsbeginn. Eine Empfehlung für ein Therapieprotokoll für die intratympanale Therapie kann auf der Basis der derzeitigen Datenlage nicht abgeleitet werden.
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Tympanoplastik – Neues und neu Beleuchtetes
Laryngo-Rhino-Otol 2017; 96: S66-S83
DOI: 10.1055/s-0042-120048
Seit Beginn der rekonstruktiven Mittelohrchirurgie wurden Techniken und Biomaterialien zum Wiederaufbau des zerstörten Schallleitungsapparates beständig weiterentwickelt. Gleichzeitig wurden von Beginn an die Operationsergebnisse ausgewertet, um Erfolg oder Misserfolg der Therapien zu identifizieren. In den letzten Jahren nehmen Qualitätsbewertung und -sicherung im medizinischen Alltag einen wachsenden Stellenwert ein, der auch Einzug in die Mittelohrchirurgie hält. Bei der differenzierten und umfassenden Qualitätsbewertung kommt der exakten Definition und Erfassung der Zielparameter eine entscheidende Rolle zu. Diese umfasst heute nicht nur audiologische Daten, die prä- und postoperativ miteinander verglichen werden, sondern auch Bewertungen der individuellen Faktoren, die einen Einfluss auf das postoperative Gesamtergebnis nach einer Tympanoplastik haben, wie bspw. die gesundheitsspezifische Lebensqualität. Die Patientenselektion und Beschreibung der klinischen Ausgangssituation, der intraoperativ identifizierte Schaden am Schallleitungsapparat und die Rekonstruktionstechnik, die Wahl des Frequenzbereiches in der Audiometrie und das Nachbeobachtungsintervall sind nur einige der Faktoren, die die Ergebnisaussage beeinflussen. Werden sie nicht dokumentiert oder das Patientenkollektiv danach stratifiziert, sind die Aussagen einer Studie oder im Vergleich verschiedener Arbeiten nur bedingt aussagekräftig. Das vorliegende Referat soll daher eine Übersicht und Bewertung der Einflussfaktoren und der Bewertungsinstrumente liefern, um valide Aussagen aus klinischen Studien ziehen zu können. Weitere Bewertungsinstrumente für die intra- und postoperative Qualitätskontrolle stehen heute bereits in Studien zur Verfügung und liefern Aussagen über die intraoperative Rekonstruktionsqualität bzw. postoperativ über mögliche Ursachen nicht optimaler Hörergebnisse mittels Bildgebung. Im Bereich der Implantatentwicklung wurden in den letzten Jahren zunehmend funktionelle Elemente in die Mittelohrprothesen integriert, die nicht nur den Anforderungen der Schallübertragung genügen, sondern zudem atmosphärische Luftdruckschwankungen kompensieren können. Gerade in Kombination mit weiteren Implantat-Bausteinen und der Umsetzung eines modularen Prothesenkonzepts können experimentell wie klinisch vielversprechende Ergebnisse in Aussicht gestellt werden.
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Moderne Schwindeldiagnostik
Laryngo-Rhino-Otol 2017; 96: S183-S208
DOI: 10.1055/s-0042-118763
„Schwindel" ist ein vieldeutiges Syndrom, mit dem der HNO-Arzt täglich konfrontiert wird. Im Hinblick auf die komplexen Funktionen des Orientierungssinnes bezeichnet man „Schwindel" heute als Orientierungsstörung, eine gestörte Wahrnehmung des Körpers im Raum. Neben den häufigen klassischen Schwindelsyndromen (z. B. Lagerungsschwindel, Neuritis vestibularis, Morbus Menière), bei dem „Schwindel" das Leitsymptom darstellt, tritt „Schwindel" als Haupt- oder Begleitsymptom bei einer Vielzahl von HNO-Erkrankungen mit Beteiligung des Innenohres auf. Das betrifft z. B. akute oder chronische virale oder bakteriell bedingte Infektionen des Ohres mit seröser oder bakterieller Labyrinthitis, verletzungsbedingten Störungen (z. B. Barotrauma, Otobasisfraktur, Labyrinthkontusion), chronisch-entzündliche Knochenprozesse sowie Innenohraffektionen im perioperativen Verlauf. Schwindeldiagnostik hat in den letzten Jahren durch neue diagnostische Möglichkeiten einen Paradigmenwechsel erfahren. In der Notfalldiagnostik lassen sich periphere und zentrale Störungen bei „Schwindel" (akutes vestibuläres Syndrom) mit einfachen Algorithmen differenzieren. Die Einführung moderner vestibulärer Testverfahren (Videokopfimpulstest, vestibulär evozierte myogene Potenziale) in die klinische Praxis hat zu neuen Diagnosemöglichkeiten geführt. Das erlaubt erstmals eine komplexe objektive Beurteilung aller Anteile des Gleichgewichtsorgans mit relativ geringem Aufwand. Gemeinsam mit etablierten Methoden ist eine frequenzspezifische Beurteilung der Funktionen vestibulärer Reflexe möglich. Mithilfe neuer Klassifikationen lassen sich Schwindelsyndrome klinisch besser einordnen. Moderne radiologische Verfahren, wie z. B. die intratympanale Gadoliniumapplikation beim Morbus Menière mit Visualisierung eines endolymphatischen Hydrops, beeinflussen ebenfalls die bisherigen medizinischen Standards. Moderne Methoden haben wesentlich dazu beigetragen, dass sich „Schwindel" vor allem in der HNO-Heilkunde heute besser und zügiger abklären lässt.
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Langzeitergebnisse und Patientenzufriedenheit nach Tympanoplastik mit Titan-Clip-Prothesen
Laryngo-Rhino-Otol
DOI: 10.1055/s-0042-124509
Ziel der vorliegenden Arbeit ist die Evaluation der Langzeitergebnisse nach Ossikelkettenrekonstruktion mittels Titan-Clip Prothesen. Hierzu wurde eine retrospektive Analyse mit prospektivem Follow-up bei allen Patienten durchgeführt, bei denen in den Jahren 2002–2013 ein Clip-PORP implantiert wurde. Es erfolgten audiologische Messungen, otoskopische Untersuchungen sowie die Evaluation der Lebensqualität mittels Glasgow Benefit Inventory. 48 Patienten (51 Ohren, 29 Männer, 19 Frauen, Durchschnittsalter 44,1 Jahre) konnten für das Follow-up rekrutiert werden, der Nachbeobachtungszeitraum lag im Mittel bei 6,3 Jahren. Die Schallleitungskomponente wurde insgesamt (0,5–4 kHz) von präoperativ 22,8 dB auf 14,6 dB postoperativ reduziert (p≤0,001). Häufigste Operationsindikation waren Cholesteatome und -Rezidive (52%), gefolgt von chronischen Otitiden (12%), Radikalhöhlenrevisionen (8%) und Schallleitungsstörungen nach Voroperation (14%). In 47 Fällen war das Trommelfell verschlossen (92,2%), 4x (7,8%) bestand ein Defekt. Die Prothese war 39 Mal (75%) in situ, 6x (11,8%) lag eine Protrusion bzw. 2x (4%) eine Verkippung vor, 1x (2%) war die Prothese fehlend und 3x (5,9%) konnte es nicht beurteilt werden. Die postinterventionelle Patientenzufriedenheit wurde insgesamt positiv bewertet (8,4 Punkte), ebenso die allgemeine Unterskala während bei den Unterskalen soziale Unterstützung und körperliche Gesundheit keine Veränderung auftraten. Zusammenfassend ist die Ossikuloplastik mittels Titan-Clip Prothesen ein sicheres und etabliertes Verfahren. Auch langfristig werden gute und stabile audiologische Messresultate durch Reduktion der Schallleitungskomponente aufgezeigt. Die subjektive Lebensqualität ist insgesamt nachhaltig verbessert.
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Virtuelle Planung bei der epithetischen Orbitaversorgung
Laryngo-Rhino-Otol
DOI: 10.1055/s-0042-124508
Die optimale epithetische Versorgung von Patienten mit orbitalen Defekten stellt eine Herausforderung dar. Sowohl das Wählen des Implantations-Winkels als auch die Positionierung der Einzelimplantate kann bei inkorrekter Ausführung bei der Abformung, der Herstellung und dem Tragen der Epithese zu Problemen führen. Wir führten eine virtuelle Planung der enossalen Implantation an einem 3D-CT-Datensatz mit der Software CoDiagnostiX ™(DentalWings, Montréal, Kanada) durch. Mittels 3D-Druckverfahren erfolgte die Herstellung einer plastischen-Insertionsschablone (Med-610™, Stratasys, Rehovot, Israel). Bei einem 41-jährigen Patienten wurde bei Schrumpfung des Lidapparates nach Enukleation und Radiatio der linken Orbita vor 20 Jahren, nun eine Exenteratio orbitae durchgeführt. Im Anschluss erfolgte das Einbringen von 4 Vistafix-3 Implantaten (Cochlear™ Centennial, USA) mittels 3D-Schablone. Die Abformung und Epithesenanpassung im Verlauf war problemlos möglich und ergab eine sehr gute funktionelle und ästhetische Rehabilitation des Patienten. Die virtuelle 3D-Planung der knochenverankerten epithetischen Versorgung von Orbitadefekten ist gut durchführbar und führt zu einer optimalen Platzierung der Implantate insbesondere bei posttherapeutisch veränderten anatomischen Verhältnissen der Orbitaregion.
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Validierung der deutschen Version des Tinnitus Functional Index (TFI)
Laryngo-Rhino-Otol
DOI: 10.1055/s-0042-122342
Tinnitus ist eine Dysfunktion im Hörsystem mit deutlicher Beeinträchtigung der Patienten durch assoziierte Komorbidität wie Hörstörungen, Schlaf- und Konzentrationsprobleme oder affektive Verstimmungen. Mind. 5% der Bevölkerung sind von Tinnitus betroffen, mind. 2% Prozent leiden unter einem behandlungsbedürftigen Ohrgeräusch. Im englischsprachigen Raum wurde ein neuer Fragebogen zur Diagnostik und zur Messung von Therapieeffekten entwickelt, der Tinnitus-Functional Index (TFI). Die vorliegende Validierung einer deutschsprachigen Version des Tinnitus-Functional Index (TFI) wurde an 229 Patienten mit chronischem Tinnitus durchgeführt. Als Referenzskala diente der Tinnitusfragebogen von Goebel u. Hiller und die „Hamburger Allgemeine Depressionsskala" (HADS). Eine Messwiederholung nach 7 Tagen Therapie diente zur Messung der Veränderungssensitivität. Die faktorenanalytische Überprüfung resultiert in 8 Subskalen wie von Meikle et al. [2012] für das Original beschrieben. Die deutsche Fassung des TFI erreicht eine exzellente Reliabilität (Cronbach's α=0,93) und die interne Skalenkonsistenz entsprach der TFI-Originalversion. Die Korrelation des TFI mit dem Tinnitusfragebogen betrug r=0,83, und mit dem HADS r=0,49 für die Depressionsitems und r=0,51 für die Angstitems. Die Ergebnisse sprechen für die Validität des deutschsprachigen TFI. Er erweist sich als ein schnelles und statistisch belastbares Instrument zur Bestimmung der Tinnitusbeeinträchtigung und zur Messung von Veränderungseffekten durch Therapie.
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Vorwort für den Referateband 2017
Laryngo-Rhino-Otol 2017; 96: S3-S3
DOI: 10.1055/s-0042-120585
Liebe Kolleginnen und Kollegen!Ich freue mich sehr, Ihnen heute den Referateband der 88. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V. vorlegen zu können. Die 9 Referate sind von anerkannten Experten inhaltlich an das Kongressmotto „Gut hörend und schwindelfrei durch den Alltag – aber wie?" angepasst worden.
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Utility of a multidisciplinary approach to pediatric hearing loss
Source:American Journal of Otolaryngology
Author(s): Karen Hawley, Donald Goldberg, Samantha Anne
IntroductionBecause management of hearing loss (HL) often requires multiple specialists, a multidisciplinary clinic, Pediatric Hearing Management Clinic, (PHMC) was established to coordinate care for children with newly diagnosed HL.MethodsRetrospective review of patients seen in PHMC from February 2009 to April 2010.ResultsClinic information was available for 40/41 of the patients and was included in the study. 37/41 had confirmed HL. HL was categorized into bilateral/symmetric [15], bilateral/asymmetric [12] and unilateral [10]. Sixteen patients subsequently received hearing amplification after PHMC visit. Follow up was successfully established with otolaryngology in 23/32 (72%) patients, audiology in 29/40 (73%) patients, speech pathology in 11/12 (92%) patients, and ophthalmology in 15/30 (50%) patients. Twenty-nine patients completed evaluations of PHMC. The mean score in six total categories was 3.8/4.0 (4.0 as the highest satisfaction).ConclusionA multidisciplinary clinic approach provides a convenient and effective way to coordinate care for children with HL.
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Dermatoses cutanées et muqueuses des musiciens
Publication date: Available online 6 April 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): N. Kluger
Les musiciens, qu'ils soient professionnels ou simples amateurs passionnés, sont exposés à une large variété de complications en lien avec la pratique de la musique. Les complications dermatologiques sont souvent asymptomatiques et constituent de simples stigmates, source de fierté pour le musicien. En revanche, si elles perturbent le jeu du musicien, elles doivent être traitées et prévenues. Nous avons revu ici ces lésions occupationnelles particulières qui ne sont pas toujours bien connues des dermatologues.Whether they are professional or amateur, musicians are exposed to a various number of complications in relation to their practice, including cutaneous ones. The latter are often a simple musical stigma and a reason for pride for the musician. If they are symptomatic and disturb the musician, they have to be treated and prevented. We reviewed here those occupational and peculiar lesions that are often not that well known to the dermatologist.
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Évaluation des pratiques dans la prise en charge de la gale chez les enfants
Publication date: May 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 5
Author(s): M.-S. Lê, M.-A. Richard, K. Baumstarck, S. Hesse, C. Gaudy-Marqueste, J.-J. Grob, S. Mallet
IntroductionLa gale, en recrudescence ces dernières années, a posé des problèmes thérapeutiques, principalement lors des retraits répétés du benzoate de benzyle. L'objectif de cette étude était de décrire les pratiques de prescription d'experts du traitement de la gale chez l'enfant.Matériel et méthodesUne enquête nationale a été réalisée, entre décembre 2014 et mars 2015, au moyen d'un questionnaire standardisé reprenant différentes situations cliniques de gale et les molécules utilisées préférentiellement selon les âges. Le questionnaire a été diffusé aux membres du groupe de recherche clinique de la Société française de dermatologie pédiatrique.RésultatsSur 38 experts interrogés, 20 ont répondu. Pour une gale typique, l'ivermectine per os était prescrite en première intention par 55 % des experts chez les enfants de 6 ans, par 15 % chez les enfants de 2 ans et par 5 % chez un nourrisson de 3 mois. L'ivermectine était davantage prescrite après échec de traitements antérieurs, en cas de peau lésée ou impétiginisée, en cas de précarité, et surtout en cas de gale profuse hyperkératosique. Trente-cinq pour cent des dermatologues ne posaient pas de restriction à sa prescription en fonction du poids ou de l'âge. Des variations étaient également observées dans ses modalités d'administration. L'esdépalléthrine restait le traitement local préférentiellement prescrit (38 % de l'ensemble des topiques prescrits), sauf chez l'enfant asthmatique, alors que la perméthrine était le topique le moins prescrit.DiscussionCe travail confirme l'hétérogénéité de nos pratiques. Des recommandations formalisées d'experts sont attendues, notamment concernant la place de l'ivermectine chez le nourrisson.BackgroundScabies has been on the rise in France in recent years and has posed therapeutic problems, mainly due to the withdrawal of benzyl benzoate. The objective of this study was to describe prescribing practices for scabies in children.MethodsA national survey was conducted by means of a standardized questionnaire covering various clinical situations of scabies and the drugs used preferentially according to age, which was sent out between December 2014 and March 2015 to members of the clinical research group of the French Society of Paediatric Dermatology.ResultsOf the 38 experts contacted, 20 replied. For a typical case of scabies, 55% of the experts initially prescribed oral ivermectin for children aged 6 years, 15% prescribed ivermectin in children aged 2 years, and 5% in infants aged 3 months. Ivermectin was more widely prescribed after failure of prior treatment or recurrence of scabies, on skin lesions or impetigo, if precarious, especially for profuse hyperkeratotic scabies. A total of 35% of the experts reported no prescribing restrictions with regard to patient age or weight. Discrepancies were observed concerning the mode of administration and the time between consecutive doses. Esdepallethrin remained the preferred local treatment among the experts (38% of all topical prescriptions) except in asthmatic children, while permethrin was the least-prescribed topical agent.DiscussionThis study confirms the heterogeneity of our practices. Formal expert recommendations are awaited, particularly concerning the use of ivermectin in infants.
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Editorial board
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 4
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Un nouveau cas de syndrome de Rowell
Publication date: April 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 4
Author(s): C. Schissler, S. Banea, M.-C. Tortel, A. Mahé
IntroductionNous souhaitons rapporter un nouveau cas de syndrome de Rowell, entité controversée associant un lupus érythémateux cutané et un érythème polymorphe.ObservationUn diagnostic de lupus érythémateux subaigu induit par l'ésoméprazole était porté chez une femme de 43 ans. En l'absence de régression après arrêt de ce médicament, de l'hydroxychloroquine était prescrite. Deux semaines plus tard, la patiente consultait pour de nouvelles lésions annulaires du décolleté et des bras, érosives et croûteuses, avec par endroits des cocardes, ainsi qu'une atteinte de la muqueuse buccale. L'histologie montrait un décollement bulleux sous-épidermique par nécrose kératinocytaire évocateur d'érythème polymorphe. La recherche d'autres causes d'érythème polymorphe était négative. L'évolution était favorable sous corticothérapie orale et maintien de l'hydroxychloroquine. Un an plus tard, la patiente était en rémission complète pour le lupus et l'érythème polymorphe.DiscussionL'association d'un lupus érythémateux et d'un érythème polymorphe correspond au syndrome décrit en 1963 par Rowell. Des critères diagnostiques précis ont ensuite été établis. Mais la réalité de cette entité est fortement discutée dans la littérature, qui soulève la question d'une confusion entre les lésions annulaires du lupus subaigu et un authentique érythème polymorphe. Certains auteurs considèrent néanmoins qu'il s'agit d'une entité propre, comme l'illustre notre observation. Notre patiente a en effet développé des lésions nettement distinctes de celles ayant conduit au diagnostic de lupus subaigu sur plusieurs plans : aspect des lésions élémentaires (cocardes érosives), présence d'une atteinte muqueuse, aspect histologique, évolution dissociée. Le débat reste donc ouvert.IntroductionThis article introduces a new case of Rowell's syndrome, a controversial entity defined by the association of lupus erythematosus and erythema multiforme.ObservationA 43-year-old woman was diagnosed with lupus erythematosus induced by esomeprazole. Because her eruption did not improve after withdrawal of the drug, hydroxychloroquine was administered. Two weeks later, the patient described new annular lesions on her chest and arms, both erosive and crusted, and some had a target-like appearance. The oral mucosa was also affected. Histology revealed sub-epidermal blistering with keratinocytic necrosis, strongly suggesting erythema multiforme. Screening for other causes of erythema multiforme proved negative. A positive outcome was achieved with corticosteroids and hydroxychloroquine. One year later, the patient was in complete remission for both lupus erythematosus and erythema multiforme.DiscussionThe association of lupus erythematosus and erythema multiforme first described in 1963 is known as Rowell's syndrome. While diagnostic criteria have been established in the literature, the reality of this entity is still contested. The annular lesions of subacute lupus erythematosus may be confused with the lesions of erythema multiforme. As suggested in the above section, other authors consider Rowell's syndrome to be a singular entity. Indeed, our patient developed lesions distinct from those initially suggesting subacute lupus erythematosus, in particular: the target-like aspect of the elementary lesions, mucosal involvement, a distinct histological aspect, and dissociated outcomes. Ultimately, the definition of Rowell's syndrome remains highly debated.
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Le dermatoscope peut-il remplacer le capillaroscope ?
Publication date: May 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 5
Author(s): P. Senet
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Évaluation comparative de la dermatoscopie et de la capillaroscopie dans le phénomène de Raynaud
Publication date: May 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 5
Author(s): J. Moreau, A.-S. Dupond, N. Dan, T. Untereiner, C. Vidal, F. Aubin
IntroductionLe phénomène de Raynaud (PR) est un motif fréquent de consultation. Une capillaroscopie est recommandée pour détecter des anomalies capillaires en faveur d'une maladie systémique, mais l'accès à cet examen est parfois difficile. Notre travail avait pour but de comparer dermatoscopie et capillaroscopie dans le bilan du PR.MéthodesIl s'agit d'une étude prospective monocentrique observationnelle menée chez les patients majeurs consultant pour un PR à l'hôpital Nord Franche-Comté entre janvier 2014 et juin 2015. Une dermatoscopie était réalisée lors de la consultation et une capillaroscopie était prescrite. Les variables suivantes étaient étudiées : aspect normal, présence de dystrophies capillaires, présence de mégacapillaires, présence de microhémorragies, raréfaction capillaire. Un coefficient kappa (κ) était calculé pour analyser la concordance entre les deux examens.RésultatsVingt-six patients ont été inclus. Le κ était de 0,76 pour le statut normal, 0,78 pour les dystrophies, 0,70 pour les mégacapillaires, 0,48 pour les microhémorragies et 0,62 pour la raréfaction ; la concordance globale était de 0,33. La présence des différentes anomalies en capillaroscopie était significativement corrélée à un statut « anormal » en dermatoscopie (p<0,05). La sensibilité de la dermatoscopie pour détecter un statut « anormal » en capillaroscopie était de 0,87.DiscussionLes concordances obtenues pour les variables étaient bonnes. La concordance globale était médiocre mais 80 % des analyses avaient le même statut normal/anormal avec les deux méthodes, l'attitude du clinicien restant alors identique au décours des deux examens.ConclusionLa dermatoscopie est un bon outil de dépistage des anomalies périunguéales et permet de renforcer l'examen clinique du dermatologue, même si la méthode de référence reste la capillaroscopie.ObjectiveRaynaud's phenomenon (RP) is a common cause for consultation. Capillaroscopy is a well-established technique to detect capillary abnormalities suggestive of a connective tissue disease, but it is sometimes unavailable. The aim of this study was to compare dermoscopy and capillaroscopy in the assessment of RP.MethodsThis was a prospective single-centre observational study in adult patients consulting for RP at the Hôpital Nord Franche-Comté between January 2014 and June 2015. Dermoscopy was performed at dermatological consultations and capillaroscopy was prescribed. For each capillaroscopy and dermoscopy, the following parameters were examined: normal appearance, giant capillaries, avascular areas, dystrophic capillaries or tortuosity and haemorrhages. Kappa coefficients were calculated.ResultsTwenty-six patients participated in this study. The kappa coefficient was 0.76 for "normal" status, 0.78 for tortuosity, 0.70 for giant capillaries, 0.48 for haemorrhage and 0.62 for avascular areas. The global kappa coefficient was 0.33. Detection of these abnormalities with capillaroscopy was significantly associated with abnormal dermoscopic status (P<0.05). The sensitivity of dermoscopy for the detection of "abnormal" capillaroscopic status was 0.87.ConclusionThe correlation coefficients were good. Despite poor global concordance, 80% of patients had the same status, normal or abnormal, for both capillaroscopy and dermoscopy, which resulted in the same clinical management. Dermoscopy is thus a valuable tool screening for periungual anomalies and provides support for clinical examination by the dermatologist, although the reference method continues to be capillaroscopy.
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Syndrome de Morel-Lavallée et cytostéatonécrose : deux complications post-traumatiques simulant une dermo-hypodermite infectieuse
Publication date: Available online 7 April 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Moulin, I. Barthélémy, C. Emering, M. D'Incan
IntroductionUne dermo-hypodermite inflammatoire au décours d'un traumatisme direct évoque en premier lieu une infection. Deux diagnostics différentiels sont importants : le syndrome de Morel-Lavallée et la cytostéatonécrose.ObservationsCas 1 : à la suite d'une chute à moto, une femme de 51 ans avait des abrasions dermiques en regard de la crête tibiale droite, évoluant rapidement vers une hypodermite inflammatoire persistant malgré une antibiothérapie. À la face interne du genou gauche, elle avait une tuméfaction non inflammatoire fluctuante. L'échographie montrait des collections sous-cutanées bilatérales. Le diagnostic de syndrome de Morel-Lavallée était confirmé par le chirurgien, qui réalisait un drainage des deux collections. L'évolution était rapidement favorable. Cas 2 : à la suite d'une glissade dans des escaliers, une femme de 40 ans présentait des abrasions dermiques de la jambe gauche et des hématomes. Une hypodermite de jambe apparaissait et progressait malgré une antibiothérapie. Un examen tomodensitométrique (TDM) étant en faveur d'une cytostéatonécrose, un débridement chirurgical était entrepris. Les prélèvements bactériologiques peropératoires étaient stériles. L'évolution était rapidement favorable.DiscussionCes observations montrent deux complications cutanées post-traumatiques, le syndrome de Morel-Lavallée et la cytostéatonécrose. Le syndrome de Morel-Lavallée correspond à une collection séro-hématique survenant à la suite d'un traumatisme tangentiel en regard d'un tissu richement vascularisé. La cytostéatonécrose est une nécrose adipocytaire. Dans les deux cas, le diagnostic est confirmé par l'imagerie. Surtout, nos observations montrent que la présentation sur un mode inflammatoire de ces deux complications conduit à des errements diagnostiques et thérapeutiques alors qu'un geste chirurgical s'impose, car des nécroses tégumentaires extensives peuvent survenir.BackgroundDermal and subcutaneous inflammation following direct trauma is initially evocative of soft-tissue infection. However, two differential diagnoses must be considered: Morel-Lavallée syndrome and post-traumatic nodular fat necrosis.Patients and methodsCase 1: a 51-year-old woman fell off her motorbike and had dermabrasions on her right and left tibial ridges that rapidly developed into dermo-hypodermitis of the entire limb. There was no improvement after 3 weeks of antibiotics. The patient was apyretic. She had a soft, non-inflammatory tumefaction on the inner aspect of her left knee. Ultrasound revealed subcutaneous collection in both legs. The surgeons confirmed a diagnosis of Morel-Lavallée syndrome and drained the two collections. Progress was good and the patient healed without major consequences. Case 2: following a fall on her stairs, a 40-year-old woman presented dermabrasions and haematomas on her left leg. Antibiotic therapy failed to prevent the progression of dermo-hypodermitis. The patient remained apyretic and there was no inflammatory syndrome. A CT scan showed thickening of a subcutaneous fat and fluid collection, resulting in diagnosis of post-traumatic nodular fat necrosis. Management was surgical and the outcome was good.DiscussionThese two cases show two post-traumatic cutaneous complications: Morel-Lavallée syndrome and post-traumatic nodular fat necrosis. Morel-Lavallée syndrome occurs after tangential trauma next to richly vascularized tissue. Post-traumatic nodular fat necrosis is defined as necrosis of adipocytes. In both cases, diagnosis is confirmed by imagery (Ultrasonography, tomography).ConclusionOur two case reports show that inflammatory presentation of both Morel-Lavallée syndrome and post-traumatic nodular fat necrosis can lead to diagnostic and therapeutic errors while a surgical procedure is necessary since tissue necrosis can occur.
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Scabietic vasculitis: Report of 2 cases
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 5
Author(s): C. Clevy, D. Brajon, E. Combes, M. Benzaquen, J.-P. Dales, M.-C. Koeppel, P. Berbis
BackgroundThe infectious causes of cutaneous vasculitis are well known and include streptococcal infections among others. Cases resulting from parasitic infection are less frequent. Scabies, which is currently on the increase, has only been reported in a few isolated cases. Herein, we report two noteworthy cases of profuse scabies complicated by cutaneous vasculitis.Patients and methodsCase 1: a 90-year-old woman, residing in a nursing home, was admitted to our dermatology department complaining of pruritus, present for one month, predominantly on the inside of the thighs and on the buttocks, associated with purpuric lesions on the lower limbs. A skin biopsy revealed leukocytoclastic vasculitis. A diagnosis of scabies was based on severe pruritus and hypereosinophilia and was confirmed by microscopic examination of the parasitology sample and the skin biopsy sample. Despite thorough investigation, no other cause of vasculitis could be found. Complete regression of the skin lesions was achieved with scabies treatment only, without any specific treatment for the vasculitis. Case 2: a 74-year-old man, living in a nursing home, was hospitalized for purpuric papules on the lower limbs, present for one month. Physical examination revealed linear patterns in the interdigital spaces associated with scabies evident on dermoscopic examination. The skin biopsy revealed signs of vasculitis. As in our first case, no aetiology of vasculitis was found and a favorable outcome was achieved by means of scabies treatment alone with no specific treatment for vasculitis.DiscussionBoth of our patients presented scabies and vasculitis. In view of the absence of other causes of vasculitis and of the complete regression of lesions due to vasculitis without recurrence achieved with the scabies treatment alone, a diagnosis was made of scabietic vasculitis, probably as a result of cutaneous hypersensitivity reaction to humeral mediators.
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Editorial board
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 5
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L’éthique, enfin
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Petit, D. Penso-Assathiany
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Intérêt de la microscopie confocale par réflectance in vivo pour la détection des Demodex
Source:Annales de Dermatologie et de Vénéréologie
Author(s): Y. Harmelin, F. Le Duff, T. Passeron, J.-P. Lacour, P. Bahadoran
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Une chromomycose contractée en zone non tropicale
Publication date: Available online 7 April 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M.S. Ouédraogo, M.-D. Vignon-Pennamen, M. Battistella, A. Levy, M. Feuilhade de Chauvin, A. Petit
IntroductionLa chromomycose, ou chromoblastomycose, est due à l'inoculation cutanée de champignons dématiés d'origine tellurique ou végétale. Elle est habituellement rencontrée dans des zones tropicales ou sub-tropicales. Son traitement est réputé difficile. Nous rapportons une observation de chromomycose contractée en région tempérée d'Europe de l'Est ou d'Asie centrale, traitée efficacement par itraconazole et terbinafine orales associées à une cryothérapie.ObservationUn homme de 44 ans, immunocompétent, consultait pour une lésion de la fesse évoluant depuis 16 ans, jamais traitée, devenue gênante depuis quelques mois. L'examen montrait un vaste placard érythémato-squameux infiltré hétérogène. La biopsie permettait le diagnostic en montrant des corps fumagoïdes à l'examen histologique ; la mise en culture d'un second prélèvement mettait en évidence l'agent responsable, Fonsecaea pedrosoi. Après 30 mois de traitement par terbinafine orale à très forte dose (1000mg/j), terbinafine locale et cryothérapie adjuvante, on constatait une amélioration considérable mais incomplète. L'association de terbinafine (500mg/j) et d'itraconazole (200mg/j) entraînait finalement une guérison clinique et histologique.DiscussionLa possibilité d'acquisition d'une chromomycose en dehors d'une zone tropicale est rare, mais décrite depuis longtemps, notamment en Europe de l'Est. Chez notre patient, la source exacte de la contamination est inconnue ; la pratique fréquente de l'équitation ou du sauna pourrait être en cause. Cette observation confirme que l'association d'itraconazole et de terbinafine peut être efficace sur cette affection de traitement habituellement difficile.BackgroundChromomycosis, or chromoblastomycosis, is caused by cutaneous inoculation of dematiaceous fungi of telluric or plant origin. It is generally seen in tropical or subtropical zones. Treatment of the condition is known to be complex. Herein we report a case of chromomycosis contracted in a temperate region of Eastern Europe/Central Asia that was effectively treated with oral itraconazole and terbinafine in combination with cryotherapy.Patients and methodsA 44-year-old immunocompetent male subject consulted for a lesion on the buttocks that he had sustained 16 years earlier, and which, although never previously treated, had only become troublesome within the last few months. The examination revealed a large erythemato-squamous plaque containing a heterogeneous infiltrate. The diagnosis was based upon biopsy, with histological examination revealing sooty mould ; culture of a second sample showed the causative agent to be Fonsecaea pedrosoi. After 30 months of treatment combining oral terbinafine at a very high dose (1000mg/day), topical terbinafine and adjuvant cryotherapy, considerable, though incomplete, improvement was obtained. Finally, combined use of terbinafine (500mg/day) and itraconazole (200mg/day) led to clinical and histological cure.DiscussionThe possibility of acquiring chromomycosis other than in a tropical zone is slight but has nevertheless been described, particularly in Eastern Europe. In our patient, the exact source of contamination is unknown, although it may have been acquired through frequent horse-riding or use of saunas. This case confirms the efficacy of combined itraconazole and terbinafine against this condition, which is usually difficult to treat.
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Mycosis fongoïde chalazodermique associé à un séminome testiculaire métastatique
Publication date: Available online 7 April 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): D. Carton de Tournai, L. Deschamps, P. Laly, C. Zeboulon, J.-D. Bouaziz, C. Ram-Wolff, J.-M. Doumecq-Lacoste, N. Ortonne, J. Rivet, M. Battistella, M. Bagot
IntroductionLe mycosis fongoïde (MF) chalazodermique est un sous-type très rare de lymphome T cutané, variante du MF. Nous décrivons le premier cas de MF chalazodermique associé à un séminome métastatique.ObservationUn patient de 28 ans consultait pour de volumineuses tuméfactions violacées avec relâchement progressif de la peau prédominant aux grands plis et évoluant depuis 4 ans. L'examen histologique trouvait des lésions granulomateuses avec élastophagie et un infiltrat lymphocytaire CD4+ atypique épidermotrope et dermohypodermique permettant de conclure à un diagnostic de MF chalazodermique. La biopsie d'une adénopathie rétropéritonéale montrait un séminome testiculaire métastatique.DiscussionLe MF chalazodermique est fréquemment associé à une hémopathie ou un cancer solide, particulièrement une maladie de Hodgkin. Cette association entre MF chalazodermique et pathologie maligne, lymphoproliférative ou autre, impose un suivi à long terme et conditionne le pronostic des patients.ConclusionBien qu'il soit impossible de démontrer un lien de causalité entre le MF chalazodermique et le séminome testiculaire de notre patient, cette observation illustre qu'en cas d'évolution dissociée sous traitement d'un MF chalazodermique, la recherche d'un second cancer est souhaitable. Une biopsie ganglionnaire doit être réalisée avant de traiter un MF chalazodermique suspect d'atteinte ganglionnaire.BackgroundGranulomatous slack skin (GSS) is an extremely rare subtype of T-cell lymphoma, a variant of mycosis fungoides (MF). Herein, we describe the first reported case of GSS associated with metastatic testicular seminoma.Patients and methodsA 28-year-old male patient presented with circumscribed erythematous loose skin masses, especially in the body folds and which had been relapsing for 4years. Skin biopsy showed a loss of elastic fibers and an atypical granulomatous T-cell infiltrate with epidermotropism, enabling a diagnosis of GSS to be made. A biopsy of a retroperitoneal lymphadenopathy showed testicular seminoma metastasis.DiscussionPatients suffering from GSS have a statistically higher risk of developing a second primary cancer, especially Hodgkin's lymphoma. The association found between GSS and a lymphoproliferative malignancy requires long-term follow-up and determines the patient's prognosis.ConclusionIt is not possible to prove a formal link between GSS and testicular seminoma. However, this case illustrates the value of screening for a second cancer, particularly where extra-cutaneous lesions appear during GSS treatment. Lymph node biopsy should be performed routinely in the event of GSS with possible lymph node involvement.
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Malformations lymphatiques kystiques superficielles. Réponses au pré-test
Publication date: May 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 5
Author(s): R. Gabeff, G. Lorette, D. Herbreteau, A. le Touze, D. Goga, A. Maruani
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L’absence de preuve n’est pas la preuve de l’absence. Du mésusage de « l’evidence based medicine »
Publication date: Available online 6 April 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J. Revuz
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Alopécie frontale fibrosante : rôle des écrans solaires
Publication date: Available online 6 April 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J.-L. Schmutz
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Encore un « dernier mot » sur le syndrome de Rowell
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 4
Author(s): J.-C. Roujeau, J. Revuz
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Tumeurs cutanées vasculaires infantiles : encore des protéines G…
Publication date: May 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 5
Author(s): O. Dereure
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Calendrier
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 5
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Lésions linéaires ecchymotiques du dos chez une patiente asiatique
Source:Annales de Dermatologie et de Vénéréologie
Author(s): N. Kluger, J.-J. Fraslin
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Gender Differences in Patterns and Trends in U.S. Homicide, 1976–2015
Violence and Gender , Vol. 0, No. 0.
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Considerations for the successful decannulation of the pediatric patient: A single surgeon's experience
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Jonathan T. Maslan, Kenneth R. Feehs, Daniel J. Kirse
ObjectiveTo characterize the steps and interventions necessary for successful decannulation of the chronic pediatric tracheostomy patient.MethodsThis retrospective review analyzed one surgeon's (DJK) pediatric tracheostomy decannulation methods and results at a tertiary academic medical center over a thirteen-year period, from October 2002 through November 2015. It also examined which tests and procedures were conducted on patients prior to their successful decannulation.ResultsOver the period of study, 46 patients met inclusion criteria for analysis and underwent decannulation after being followed in the clinic or the hospital. One of these patients had to have the tracheostomy tube replaced. In nearly all cases, these patients underwent a systematic progression from tolerance of daytime tracheostomy capping to a capped sleep study, and endoscopic airway evaluation. In recent years, a subset of patients also underwent sleep endoscopy. In nearly all cases, patients spent a single night in the hospital in a non-acute bed at the time of decannulation. Ninety-eight percent (n = 45) of patients were successfully and safely decannulated after having met the milestones that we employ at our institution.ConclusionsThis study serves as a safe, efficient, and resource-prudent protocol for otolaryngologists to follow when considering tracheostomy decannulation in the pediatric population. Sleep endoscopy can play a helpful role in guiding decannulation decisions. Since it is impossible to employ a single rigid protocol of testing prior to decannulating all patients, clinical judgment must always be exercised in individual circumstances.
http://ift.tt/2qBxCtR
Non-invasive methods to maintain cervical spine position after pediatric tracheal resections
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Kahren K. Aydinyan, Jonathan D. Day, Gina M. Troiano, G. Paul Digoy
ObjectivesTo present our experience with two methods of neck stabilization after pediatric tracheal resection with primary anastomosis as possible alternatives to the traditional chest-chin suture.MethodsChildren undergoing tracheal resection and/or cricotracheal resection with anastomosis under tension were placed in cervical spine flexion postoperatively with either a chest-chin (Grillo) suture, an Aspen cervical collar or Trulife Johnson cervical-thoracic orthosis (CTO). A retrospective chart review of tracheal resections performed between 2005 and 2016 was completed to evaluate the positive and negative factors associated with each neck flexion technique.ResultsOf the 20 patients, there were 13 patients with the Grillo suture, 4 with the Aspen collar and 3 patients with the Johnson CTO. There were 13 tracheal resection procedures and 7 cricotracheal resections, all of which had anastomosis under tension. One major anastomosis dehiscence was noted with the Grillo suture technique which required reoperation. Two patients with the Grillo suture experienced skin breakdown at the suture site. The Aspen cervical collar, which fixed the cervical spine and prevented lateral and rotational motion, was limited in several cases in that it placed the spine in slight hyperextension. The Johnson CTO provided the most support in a flexed position and prevented cervical spine motion in all directions. No anastomosis complications were noted with the Aspen collar or the Johnson CTO, however, several patients sustained minor cutaneous wounds.ConclusionIn this series the Aspen cervical collar and Johnson CTO were used successfully as non-Grillo alternatives to postoperative neck stabilization in pediatric tracheal resections. Modifications to both devices are proposed to minimize cutaneous injuries and increase immobilization of the cervical spine in the desired flexed position. Although these devices appear to be safe and may be better tolerated, further innovation is needed to improve the design and fit of these devices.
http://ift.tt/2raU0HH
TLR4 supports the expansion of FasL+CD5+CD1dhi regulatory B cells, which decreases in contact hypersensitivity
Source:Molecular Immunology, Volume 87
Author(s): Keng Wang, Lei Tao, Jianbing Su, Yueyang Zhang, Binhua Zou, Yiyuan Wang, Min Zou, Nana Chen, Linsheng Lei, Xiaojuan Li
Certain B cells termed as "regulatory B cells" (Bregs) can suppress the ongoing immune responses and a splenic CD5+CD1dhi Breg subset identified earlier was shown to exert its regulatory functions through secretion of IL-10. Though FasL expression is an alternative mechanism of immune suppression used by B cells, little is known about the FasL expressing CD5+CD1dhi Bregs. In this study, we isolated splenocytes or splenic CD19+ B cells and compared the efficiency of toll-like receptor(TLR)4 ligand (lipopolysaccharide) with TLR9 ligand (CpG), anti-CD40 and TLR9 ligand (CpG) plus anti-CD40 on the FasL expression of splenic CD5+CD1dhi Bregs by flow cytometry. FasL expression in CD5+CD1dhi B cells was rapidly increased after TLR4 ligation. Intriguingly, anti-CD40 and CpG plus anti-CD40 combinations failed to stimulate FasL expression in CD5+CD1dhi B cells although the IL-10 production was up-regulated in this subset. In addition, LPS and other B10-cell inducers increased the expression of surface molecules like CD86 and CD25, which are correlated to the regulatory functions of B cells. Furthermore, NF-κB and NF-AT inhibitors decreased the TLR4-activated FasL expression in CD5+CD1dhi B cells. Then we sorted splenic CD5+CD1dhi Bregs using flow cytometry and found that TLR4-activated CD5+CD1dhi Bregs suppressed the proliferation of CFSE-labeled CD4+ T cells in vitro, which was partly blocked by anti-FasL antibody. In oxazolone-sensitized mice having contact hypersensitivity, FasL expression in splenic CD5+CD1dhi B cells was decreased compared to the control group after TLR4 ligation. Our findings suggest that the regulatory function of CD5+CD1dhi B cells could be partly mediated by Fas-FasL pathway and this FasL expressing CD5+CD1dhi Bregs might participate in the regulation of inflammatory diseases.
http://ift.tt/2qaT0Fh
RhoB induces the production of proinflammatory cytokines in TLR-triggered macrophages
Source:Molecular Immunology, Volume 87
Author(s): Shuyuan Liu, Lisong Huang, Zhusen Lin, Yuanqin Hu, Ruifeng Chen, Liqiu Wang, Yi Shan
Toll-like receptors (TLRs) are the primary sensors detecting conserved molecular patterns on microorganisms, thus acting as important components of innate immunity against invading pathogens. Many positive and negative regulators of TLR-triggered signaling have been identified. The Rho GTPase RhoB plays a key role in cell migration, division and polarity; however, the function and regulatory mechanisms of RhoB in TLR ligand-triggered innate immune responses remain to be investigated. Here, we report that the expression of RhoB is induced by TLR agonists (lipopolysaccharide (LPS), CpG, poly(I:C)) in macrophages. Knockdown of RhoB expression markedly decreased TLR ligand-induced activation of mitogen activated protein kinases and nuclear factor-κB (NF-κB), and the production of tumor necrosis factor α (TNFα), interleukin (IL)-6 and IL-1β in macrophages stimulated with TLR ligands. Furthermore, we demonstrated that RhoB interacts with major histocompatibility complex class II (MHCII) α chain, but not β chain, in endosomes of macrophages. Knockdown of MHCII expression greatly reduced the interaction of RhoB with Btk, and attenuated the induction of NF-κB and interferon β activity by RhoB upon LPS stimulation. These findings suggest that RhoB is a positive physiological regulator of TLRs signaling via binding to MHCII in macrophages, and therefore RhoB may be a potential therapeutic target in inflammatory diseases.
http://ift.tt/2r9uAtd
Clasificación de las resecciones transorales en la orofaringe: propuesta del grupo de trabajo de la Sociedad Catalana de Otorrinolaringología
Publication date: Available online 12 May 2017
Source:Acta Otorrinolaringológica Española
Author(s): David Virós Porcuna, Francisco Avilés Jurado, Carlos Pollán Guisasola, Rosa Delia Ramírez Ruiz, Jacinto García Lorenzo, Marc Tobed Secall, Isabel Vilaseca González, José Miguel Costa González, Josep Soteras Olle, Francesc Casamitjana Claramunt, Anna Sumarroca Trouboul, Rafael Hijano Esqué, Guillem Viscasillas Pallàs, Manel Mañós Pujol, Miquel Quer Agustí
Introducción y objetivosLa cirugía mínimamente invasiva ha presentado una expansión muy importante en la última década. Con el objetivo de aportar un lenguaje común tras cirugía transoral de la orofaringe, se ha creado un sistema de clasificación de las resecciones en esta zona, independientemente de la instrumentalización utilizada.MétodosDesde el Grupo de Trabajo en Oncología de la Sociedad Catalana de Otorrinolaringología, se presenta una propuesta de clasificación basada en una división topográfica de las diferentes zonas de la orofaringe, así como en la afectación de las estructuras anexas según las vías anatómicas de extensión de estos tumores.ResultadosLa clasificación se inicia utilizando la letra D o I según la lateralidad sea derecha (D) o izquierda (I). A continuación se coloca el número del área resecada. Esta numeración define las zonas iniciando a nivel craneal donde el área I sería el paladar blando, el área II lateral en la zona amigdalina, el área III en la base de lengua, el área IV en los repliegues glosoepiglóticos, la epiglotis y repliegues faringoepiglóticos, el área V pared orofaríngea posterior y VI el trígono retromolar.Se añade el sufijo p si la resección afecta profundamente al plano submucoso de la zona comprometida. Las diferentes áreas propuestas tendrían, de una forma teórica, diferentes implicaciones funcionales.ConclusionesPropuesta de sistema de clasificación por áreas que permite definir diferentes tipos de cirugía transoral de la orofaringe así como compartir los resultados y ayudar en la docencia de este tipo de técnicas.Introduction and goalsThere has been a very significant increase in the use of minimally invasive surgery has in the last decade. In order to provide a common language after transoral surgery of the oropharynx, a system for classifying resections has been created in this area, regardless of the instrumentation used.MethodsFrom the Oncology Working Group of the Catalan Society of Otorhinolaryngology, a proposal for classification based on a topographical division of the different areas of the oropharynx is presented, as also based on the invasion of the related structures according to the anatomical routes of extension of these tumours.ResultsThe classification starts using the letter D or I according to laterality either right (D) or left (I). The number of the resected area is then placed. This numbering defines the zones beginning at the cranial level where area I would be the soft palate, lateral area II in the tonsillar area, area III in the tongue base, area IV in the glossoepiglottic folds, epiglottis and pharyngoepiglottic folds, area V posterior oropharyngeal wall and VI the retromolar trigone.The suffix p is added if the resection deeply affects the submucosal plane of the compromised area. The different proposed areas would, in theory, have different functional implications.ConclusionsProposal for a system of classification by area to definedifferent types of transoral surgery of the oropharynx, and enable as sharing of results and helps in teaching this type of technique.
http://ift.tt/2qbO96a
Aprendiendo de la demanda asistencial en el síndrome de apnea del sueño infantil
Publication date: Available online 12 May 2017
Source:Acta Otorrinolaringológica Española
Author(s): Paz Martinez-Beneyto, Cristina E. Soria Checa, Paloma Botella-Rocamora, Inés Rincon-Piedrahita, Francisco J. Garcia Callejo, Jaime Marco Algarra
Introducción y objetivosEl síndrome de apnea-hipopnea del sueño (SAHS) pediátrico engloba alteraciones multisistémicas que afectan al estado general de salud, valorado indirectamente mediante el estudio de la demanda asistencial. Objetivo: cuantificar la frecuentación de consultas médicas en niños con SAHS durante 5 años y compararla con una población sana.MétodosEstudio casos-control longitudinal ambispectivo en un hospital del sistema nacional de salud. Reclutamos a 69 niños remitidos por SAHS sin otras patologías para que la demanda asistencial fuera predominantemente atribuida al SAHS. Se seleccionó a otros 69 niños sanos como grupo control. Obtuvimos datos de frecuentación durante 5 años: el año en el que se realizó el tratamiento del SAHS («año 0»), 1 y 2 años antes («año –1» y «año –2»), y 1 y 2 años tras el tratamiento («año+1» y «año+2»).ResultadosEl índice de frecuentación (IF), descrito como cociente entre demanda asistencial por los niños con SAHS y niños sanos, fue 1,89 durante el año –2 y 2,15 durante el año –1 (p<0,05). El tratamiento disminuyó la utilización, con IF de 1,59 durante el año+1 y 1,72 en el año+2 (p<0,05). Las principales causas de sobrefrecuentación fueron otorrinolaringológicas y neumológicas.ConclusionesLos niños con SAHS muestran mayor demanda asistencial, al menos 2 años antes del tratamiento, lo que implica un deterioro de la salud global que pudiera estar presente años antes de que la abordemos. El tratamiento repercute en una mejora, aunque permanece alta tras el tratamiento, sugiriendo enfermedad residual o secuelas.Introduction and objectivesPaediatric Obstructive Sleep Apnoea-Hypopnoea Syndrome (OSAS) is a multisystemic condition affecting child's health status that may be investigated analyzing demand for healthcare. Objective: to quantify the frequency of medical consultations in children with OSAS over a 5-year period, compared to a healthy population.MethodsA longitudinal, case-control, ambispective study was conducted at a hospital pertaining to the national public health system. 69 consecutive children referred for OSAS were recruited with no diseases other than OSAS so that healthcare demand was purely attributed to this condition. Matched healthy control children were selected to compare these data. Data regarding frequency of the medical consultations were obtained over 5 years: the year of the treatment ("Year0"), 1 and 2 years before ("Year -1" and "Year -2" respectively), and 1 and 2 years after treatment ("Year+1" and "Year+2")ResultsFrequentation Index (FI), as ratio between the use of health services by OSAS children and healthy controls was 1.89 during Year-2, and 2.15 during Year-1 (P<.05). Treatment diminishes utilization, with FI of 159 during year+1 and 1.72 during year+2 (P<.05). The main causes of attendance were otolaryngological and pneumological diseases, improving after treatment.ConclusionsChildren suffering from OSAS demand more healthcare services, at least 2 years before treatment, implying that the disease could be present years before we manage it. Therapeutic actions improve healthcare services utilization, although remain higher than for controls, which suggests OSAS sequelae or residual disease.
http://ift.tt/2pH16Sl
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