Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Ambulante Operationen bleiben für Vertragsärzte ein Wachstumsfeld: Die Fallzahlen steigen kontinuierlich, die Honorarumsätze etwas schneller. Anders sieht es bei belegärztlichen Operationen aus, wie der aktuelle Honorarbericht der KBV beweist.
Beim fortgeschrittenen, aber nicht metastasierten Nasopharynxkarzinom hat sich die zeitgleiche Gabe von Strahlen- und Chemotherapie (CRT) etabliert. Wäre eine zusätzliche adjuvante oder Induktions-CT hilfreich?
Begutachtungsfragen sind seit jeher immanenter Bestandteil der ärztlichen Tätigkeit. In der Musterweiterbildungsordnung und in der Musterberufsordnung der Bundesärztekammer (BÄK) [1] sind die Begutachtung bzw. Ärztliche Gutachten und Zeugnisse aufgeführt. Sowohl im Medizinstudium als auch in der Weiter- und Fortbildung wird dieses Thema bisher allerdings zu wenig berücksichtigt [2]. Der folgende Beitrag wendet sich vor allem an diejenigen Kolleginnen und Kollegen, die am Anfang einer gutachterlichen Tätigkeit stehen.
Für den möglichst günstigen Verlauf einer Tumorerkrankung ist es wichtig, häufig auftretende Ernährungsstörungen fortlaufend im Blick zu haben. Eine der jeweiligen Situation angepasste Ernährungstherapie gilt als Bestandteil der Supportivbetreuung jedes Krebspatienten.
Je höher der Bildungsabschluss, desto größer ist im Schnitt das Einkommen, so das Ergebnis einer kürzlich durchgeführten Analyse des Ifo-Institutes in Frankfurt. Wie hoch sind da heutzutage die Differenzen?
Kaum ein anderer Beruf lebt so sehr vom Vertrauen wie der Arztberuf. Vertrauen darauf, dass der Arzt alles weiß, alles gut kann und alles heilt. Wenn aber der Eindruck entsteht, dass die Erwartungen nicht erfüllt wurden, kann Vertrauen in Enttäuschung und Misstrauen umschlagen und die Situation sogar in einem Rechtsstreit enden. Wie kann man ein Verfahren vermeiden oder so vorbereitet sein, dass man ein Verfahren nicht fürchten muss?
Bei Patienten mit Globusgefühl, bei denen alle „gängigen" Differenzialdiagnosen ausgeschlossen sind, lohnt es sich, neue Therapieansätze in Betracht zu ziehen. Denn eine nach unserer Erfahrung häufige Ursache für das Globusgefühl ist eine vermehrte Anspannung der paralaryngealen Muskulatur mit nach-weisbarer Überanstrengung. Hier hilft das manuelle „Entspannen" und Dehnen der Muskulatur. Die bekannteste Technik ist die laryngeale osteopathische Manipulation nach Jacob Lieberman.
Bei Lärmschwerhörigkeitsverfahren ist es häufig strittig, ob Hörverluste im Tieftonbereich und Mitteltonbereich neben einer Hochtonsenke auf die berufliche Lärmbelastung zurückgeführt werden können oder nicht. Zur Beantwortung dieser Frage sind verschiedene Kriterien zu berücksichtigen, die im Folgenden erläutert werden.
Bei einer Fortbildungsveranstaltung der Deutschen Apotheker- und Ärztebank Anfang April in Magdeburg gab es für die Teilnehmer eine Orientierung, wie die Nutzung moderner Medien den Praxisalltag verändern könnte.
Unter den in der Berufskrankheiten-Verordnung insgesamt 77 gelisteten Krankheiten finden sich eine ganze Reihe von Gesundheitsstörungen, die in das Fachgebiet des HNO-Arztes fallen können. Kollegen zögern allerdings oft, den Verdacht auf eine Berufskrankheit anzuzeigen. Neben der Unsicherheit, ob es sich tatsächlich um eine Berufskrankheit handeln könnte, werden als Gründe Mehrarbeit, Verwaltungsaufwand und schlechte Vergütung genannt. Aber nichts davon trifft wirklich zu. Und: Die Anzeige bei Verdacht ist Pflicht!
Werden Kindern mit rezidivierenden Tonsillitiden die Rachenmandeln entfernt, erkranken sie offenbar im darauffolgenden Jahr seltener an Racheninfektionen als ohne Operation.
Wie reagieren Patienten auf eine Allergen-Immuntherapie im Praxisalltag? Wie oft ereignen sich systemische Reaktionen nach subkutaner oder sublingualer Immuntherapie? Wie oft kommt es zu anaphylaktischen Notfallsituationen? Ein europäisches Team aus Allergologen ist diesen Fragen nachgegangen.
Per Gesetz ist seit März 2017 der Einsatz von Cannabisarzneimitteln als Therapiealternative zugelassen. Autofahrer sollten ärztlicherseits auf die Eigenschaften des Cannabiswirkstoffs hingewiesen werden.
Beide Erfinder waren Ärzte, und von der technischen Seite der Erfindung stimmt alles überein: Eine scharfe Metallschneide wird in einem stabilen Rahmen geführt. Nur die Öffnung des Rahmens musste dem abzutrennenden Objekt angepasst sein: Bei Joseph-Ignace Guillotin (1738–1814 ) war es der ganze Kopf bei Greenfield Sluder (1865–1928) eben „nur" die Tonsille.
Was Sie gerade auf Papier gedruckt in den Händen halten, könnten Sie auch online auf Ihrem Tablet lesen, denn ab sofort gibt es Ihre „HNO-Nachrichten" auch als ePaper: Es steht auf SpringerMedizin.de, dem Fachportal für Ärzte, kostenlos zum Download bereit. Dort finden Sie auch das Archiv der Zeitschrift und noch vieles mehr ...
Anästhesiol Intensivmed Notfallmed Schmerzther
DOI: 10.1055/s-0043-111784
Die präoperative Anamnese und körperliche Untersuchung sind anerkannter Standard bei der Risikoevaluation von Patienten vor elektiven chirurgischen Eingriffen. Ob und unter welchen Umständen technische Voruntersuchungen dazu beitragen können, das perioperative Risiko zu reduzieren, ist bislang nur unzureichend untersucht. Auch besteht unter Anästhesisten, Chirurgen und Internisten vielfach Unsicherheit im perioperativen Umgang mit der Dauermedikation. Die deutschen wissenschaftlichen Fachgesellschaften für Anästhesiologie und Intensivmedizin (DGAI), Chirurgie (DGCH) und Innere Medizin (DGIM) haben daher eine gemeinsame Empfehlung zur präoperativen Evaluation erwachsener Patienten vor elektiven, nicht herz-thoraxchirurgischen Eingriffen erarbeitet und erstmals im Jahr 2010 publiziert. Die vorliegende Fassung ist eine Überarbeitung der Stellungnahme von 2010 unter Einbeziehung der seither publizierten Literatur sowie von aktuellen Leitlinien internationaler Fachgesellschaften. Zunächst werden die allgemeinen Prinzipien der präoperativen Evaluation dargestellt (Teil A). Das Vorgehen bei Patienten mit bekannten oder vermuteten kardiovaskulären Vorerkrankungen wird gesondert betrachtet (Teil B: „Erweiterte kardiale Diagnostik"). Abschließend wird der perioperative Umgang mit der Dauermedikation diskutiert (Teil C). Die vorgestellten Konzepte stellen fachübergreifende Empfehlungen dar, die ein strukturiertes und gemeinsames Vorgehen ermöglichen sollen. Ihr Ziel ist es, durch transparente und verbindliche Absprachen eine hohe Patientenorientierung unter Vermeidung unnötiger Voruntersuchungen zu gewährleisten, präoperative Untersuchungsabläufe zu verkürzen sowie letztlich Kosten zu reduzieren. Die gemeinsamen Empfehlungen von DGAI, DGCH und DGIM spiegeln den gegenwärtigen Kenntnisstand, aber auch die Meinungen von Experten wider, da nicht für jede Fragestellung wissenschaftliche Evidenz besteht. Daher werden eine regelmäßige Überprüfung und Aktualisierung der Empfehlungen erfolgen, sobald gesicherte neue Erkenntnisse vorliegen.
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Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
Analyze postoperative complications after free flap surgery based on PGY training level.
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Myoepitheliomas account for less than 1% of salivary gland tumors. They mostly affect the parotid glands of adults during the third to fifth decades.
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We present a report of a patient with blunt trauma and mandibular fractures who developed a significant cerebral infarction due to an initially unrecognized injury of her left internal carotid artery. We belie...
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by Xiaojian Chen, Kiyoko Oshima, Diane Schott, Hui Wu, William Hall, Yingqiu Song, Yalan Tao, Dingjie Li, Cheng Zheng, Paul Knechtges, Beth Erickson, X. Allen Li
PurposeIn an effort for early assessment of treatment response, we investigate radiation induced changes in quantitative CT features of tumor during the delivery of chemoradiation therapy (CRT) for pancreatic cancer.
MethodsDiagnostic-quality CT data acquired daily during routine CT-guided CRT using a CT-on-rails for 20 pancreatic head cancer patients were analyzed. On each daily CT, the pancreatic head, the spinal cord and the aorta were delineated and the histograms of CT number (CTN) in these contours were extracted. Eight histogram-based radiomic metrics including the mean CTN (MCTN), peak position, volume, standard deviation (SD), skewness, kurtosis, energy and entropy were calculated for each fraction. Paired t-test was used to check the significance of the change of specific metric at specific time. GEE model was used to test the association between changes of metrics over time for different pathology responses.
ResultsIn general, CTN histogram in the pancreatic head (but not in spinal cord) changed during the CRT delivery. Changes from the 1st to the 26th fraction in MCTN ranged from -15.8 to 3.9 HU with an average of -4.7 HU (p Conclusions
Significant changes in CT radiomic features, such as the MCTN, skewness, and kurtosis in tumor were observed during the course of CRT for pancreas cancer based on quantitative analysis of daily CTs. These changes may be potentially used for early assessment of treatment response and stratification for therapeutic intensification.
by Yu-Chen Hung, Ya-Jung Lee, Li-Chiun Tsai
In contrast with previous research focusing on cochlear implants, this study examined the speech performance of hearing aid users with conductive (n = 11), mixed (n = 10), and sensorineural hearing loss (n = 7) and compared it with the speech of hearing control. Speech intelligibility was evaluated by computing the vowel space area defined by the Mandarin Chinese corner vowels /a, u, i/. The acoustic differences between the vowels were assessed using the Euclidean distance. The results revealed that both the conductive and mixed hearing loss groups exhibited a reduced vowel working space, but no significant difference was found between the sensorineural hearing loss and normal hearing groups. An analysis using the Euclidean distance further showed that the compression of vowel space area in conductive hearing loss can be attributed to the substantial lowering of the second formant of /i/. The differences in vowel production between groups are discussed in terms of the occlusion effect and the signal transmission media of various hearing devices.Publication date: August 2017
Source:Molecular Immunology, Volume 88
Author(s): Lihua Shii, Li Song, Kelly Maurer, Zhe Zhang, Kathleen E. Sullivan
The SERPINB2 gene is strongly upregulated in inflammatory states. In monocytes, it can constitute up to 1% of total cellular protein. It functions in protection from proteotoxic stress and plays a role in angioedema. The purpose of this study was to define the roles of enhancer RNAs embedded in the SERPIN gene complex. We found that the upstream enhancer RNAs upregulated SERPINB2 and the enhancer RNAs were expressed prior to those of SERPINB2 mRNA. Studies of the SERPINB2 promoter demonstrated the presence of an RNA polymerase II pause-inducing protein, NELF. Stimulation with LPS led to recruitment of the pause-releasing kinase P-TEFb and departure of the pause-inducing protein NELF. RNA immunoprecipitation revealed that NELF and the CDK9 component of P-TEFb bound to the enhancer RNAs after stimulation with distinct kinetics. Knock-down of the enhancer RNAs compromised stimulus induction of promoter and enhancer chromatin changes. Conversely, over-expression was associated with enhanced recruitment of c-JUN and increased expression of SERPINB2 mRNA expression. This study is the first to associate enhancer RNAs with SERPINB2 and is the first demonstration of acquisition of NELF binding by enhancer RNAs on chromatin.
In these studies we examined the impact of environmental tobacco smoke (ETS) and active smoking on sinonasal dendritic cell (DC) subsets in controls or patients with chronic rhinosinusitis with nasal polyps (CRSwNP). In subsequent in-vitro investigations, we examined the influence of cigarette smoke extract (CSE) on human sinonasal epithelial cells' (HSNECs) ability to regulate DC functions.
Sinonasal tissue, blood, and hair were collected from patients undergoing sinus surgery. Smoking status and ETS exposure were determined by hair nicotine. DC subsets were examined by flow cytometric analysis. Monocyte-derived dendritic cells (moDCs) were treated with conditioned medium from non-smoked-exposed HSNECs (NS-HSNECs) or cigarette-smoke-extract-exposed HSNECs (CSE-HSNECs) to assess the impact of CSE exposure on HSNEC regulation of moDC functions.
Control subjects who were active smokers displayed increased sinonasal moDC and myeloid dendritic 1 (mDC1) cells and reduced mDC2 cells, whereas, in CRSwNP patients, only moDC and mDC2 cells were altered. ETS was found to increase only moDCs in the CRSwNP patients. In vitro, CSE stimulated HSNEC secretion of the moDC regulatory products chemokine (C-C motif) ligand 20, prostaglandin E2, and granulocyte-macrophage colony-stimulating factor. CSE exposure also promoted HSNECs to stimulate monocyte and moDC migration. moDCs treated with CSE-HSNEC media stimulated an increase in antigen uptake and expression of CD80 and CD86. Last, CSE-HSNEC-treated moDCs secreted increased levels of interleukin-10, interferon-γ, and thymic stromal lymphopoietin.
Active smoking, and to a lesser degree ETS, alters the sinonasal composition of DCs. A potential mechanism to account for this is that cigarette smoke stimulates HSNECs to induce moDC migration, maturation, and activation.
The endoplasmic reticulum (ER) stress is a cellular process that occurs as a consequence of several stress circumstances, such as the accumulation of unfolded proteins in the lumen of the ER or distinct insults that disturb the ER normal function. Different conditions in the tumor microenvironment (TME), including hypoxia, nutrient deprivation, and the elevated production of reactive oxygen and nitrogen species destabilize the loading and dispatching of the newly synthesized proteins, triggering ER stress in cancer cells and tumor-infiltrating leukocytes. In order to cope with TME-induced ER stress, tumor and stromal cells initiate an adaptive response process that aims to resolve ER stress and to restore cellular homeostasis, which is referred as the unfolded protein responses (UPR). Paradoxically, the UPR can also induce cell death under severe and/or permanent ER stress. The UPR is started through three mediators, the activation of the inositol-requiring enzyme-1α, the pancreatic ER kinase-like ER kinase, and the activating transcription factor 6. In this minireview, we will discuss the pro- and anti-tumorigenic role of the UPR in cancer cells. In addition, we will describe the effects of the TME-induced ER stress in the immunosuppressive activity of tumor-infiltrating myeloid cells. Also, we will review the results of emerging therapeutic interventions that target ER stress and the UPR mediators in cancer. We postulate that the inhibition of ER stress or the UPR-related elements could represent a significant approach to increase the efficacy of various forms of cancer immunotherapy.
Peanut nut and tree nut allergy are characterised by IgE mediated reactions to nut proteins. Nut allergy is a global disease. Limited epidemiological data suggest varying prevalence in different geographical areas. Primary nut allergy affects over 2% of children and 0.5% of adults in the UK. Infants with severe eczema and/or egg allergy have a higher risk of peanut allergy. Primary nut allergy presents most commonly in the first five years of life, often after the first known ingestion with typical rapid onset IgE-mediated symptoms. The clinical diagnosis of primary nut allergy can be made by the combination of a typical clinical presentation and evidence of nut specifc IgE shown by a positive skin prick test (SPT) or specific IgE (sIgE) test. Pollen food syndrome is a distinct disorder, usually mild, with oral/pharyngeal symptoms, in the context of hay fever or pollen sensitisation, which can be triggered by nuts. It can usually be distinguish clinically from primary nut allergy. The magnitude of a SPT or sIgE relates to the probability of clinical allergy, but does not relate to clinical severity. SPT of ≥ 8 mm or sIgE ≥ 15 KU/L to peanut is highly predictive of clinical allergy. Cut off values are not available for tree nuts. Test results must be interpreted in the context of the clinical history. Diagnostic food challenges are usually not necessary but may be used to confirm or refute a conflicting history and test result. As nut allergy is likely to be a long-lived disease, nut avoidance advice is the cornerstone of management. Patients should be provided with a comprehensive management plan including avoidance advice, patient specific emergency medication and an emergency treatment plan and training in administration of emergency medication. Regular re-training is required.
The cover image, by S. El-Heis et al., is based on the Original Article Maternal stress and psychological distress preconception: association with offspring atopic eczema at age 12 months, DOI 10.1111/cea.12910
Topical solutions to the sinus cavity are primarily administered via a transnasal route with inherent limitations of distribution. Here we describe an alternate method of sinus access via lacrimal sinus diversion using a novel lacrimal diversion device (LDD).
A cadaveric study was performed using 12 disarticulated fresh heads. The LDD was implanted in 23 sides meeting insertion criteria. Time to placement was recorded and patency was assessed via nasal endoscopy. Methylene blue was administered via the LDD and 16 sides underwent surgical ethmoidectomy to assess distribution of mucosal staining. Four cadavers underwent computed tomography (CT) imaging to demonstrate stent position.
Mean time of placement was 3.66 ± 2.37 minutes (mean ± standard deviation [SD]). Patency rate was 100%. Six sides (37.5%) had anterior ethmoid staining, 6 sides (37.5%) had posterior ethmoid staining, and the remaining 4 sides (25%) had mixed anterior and posterior ethmoid staining. Stents placed optimally resulted in anterior ethmoid staining without complication. Malpositioned stents resulted in posterior ethmoid staining and some inadvertent ethmoid vertical lamella trauma in 2 instances.
Sinus irrigation can be delivered to the ethmoid sinuses directly via a lacrimal diversion stent. Technique modification or image guidance may be helpful in ensuring optimal placement.
Description
A 30-year-old primigravida was referred to our institution due to an isolated fetal ascites (IFA). The gestation was uneventful until the 32nd week when the mother was hospitalised due to refractory hypertension. An ultrasound revealed a fetal abdominal circumference above percentile 99. Fetal parameters and amniotic fluid volume were normal.and
The investigation of IFA was started on the mother: blood type was ARh+, indirect Coombs test and infectious serology (toxoplasmosis, syphilis, varicella-zoster, parvovirus B19, rubella, cytomegalovirus and herpes (TORCH)) were negative.
A spontaneous vaginal delivery occurred at 34 weeks. As the ascites compromised ventilation, the neonate was intubated and an urgent paracentesis was performed evacuating 175 mL of a transudate, and thereafter, the caucasian female neonate with 2235 g was stable with spontaneous breathing.
As the ascites persisted, the investigation continued on the neonate: blood group ARh+, negative direct Coombs test and normal echocardiography. Abdominal ultrasound showed dilated bowel loops. The abdominal X-ray...
This study aimed to review important hidden causes of anaphylaxis in ingestants, non-ingestants, and uncommon settings.
Multiple new and elusive causes of anaphylaxis have been described over the past 35 years.
Further research is required to identify the epidemiology, pathophysiology, and clinical impact of these hidden causes. Although these culprits should be considered in the appropriate clinical scenarios, many remain exceedingly rare.
Publication date: Available online 1 June 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Jennifer A. Vaughn
Congenital neck lesions are a common indication for imaging in the pediatric population. While the clinical history and physical examination can narrow the differential diagnosis, imaging is often obtained to distinguish among possible entities and provide additional information needed to guide appropriate treatment. In this review, congenital cystic neck masses including thyroglossal duct cysts, dermoid/epidermoids, branchial apparatus anomalies, thymic cysts, and cervical teratomas will be discussed, with a focus on characteristic imaging features and locations that define these lesions.
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Publication date: Available online 1 June 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Octavio Garaycochea, Raquel Manrique-Huarte, Manuel Manrique
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Publication date: Available online 1 June 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Yupeng Zhu, Dapeng Hao, Xiaoyan Tang, Lei Sun
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Medical case reports provide new and often important information about diseases, pathogeneses, adverse effects, or treatments. [1] However, they have been shown to favor positive results and can lead to publication bias. [2, 3] Some leading journals have been reducing space for case reports or even declining them because of concerns about impact factor. [4]
This article is protected by copyright. All rights reserved.
This study aimed to review important hidden causes of anaphylaxis in ingestants, non-ingestants, and uncommon settings.
Multiple new and elusive causes of anaphylaxis have been described over the past 35 years.
Further research is required to identify the epidemiology, pathophysiology, and clinical impact of these hidden causes. Although these culprits should be considered in the appropriate clinical scenarios, many remain exceedingly rare.
Facial filling with hyaluronic acid (HA) is a dermatological procedure that has been emerging today. There are not many references regarding safety of reusing the remaining product for later touch-up in the same patient.
To determine the microbiological safety of reusing hyaluronic acid that is remnant from syringes used for facial filling, stored at room temperature or cooled in a refrigerator at 4°C.
In culture medium, small aliquots of leftovers from 31 hyaluronic acid fillers, previously used for facial filling, were inoculated. The fillers were stored in their original syringes at room temperature or cooled in a standard refrigerator at 4°C for a period ranging from 1 week to 12 months after initial use.
The small number of samples limits extrapolation of the results obtained.
After 42 days of inoculation in culture medium, none of the samples showed any aerobic or anaerobic bacterial or fungal growth.
Hyaluronic acid fillers did not show any fungal or bacterial contamination after being opened and stored at room temperature in nonaseptic conditions. The possibility of reusing the remaining portion of the material in the syringe can be safe and economically viable.
Although microneedles are one of the best transdermal drug delivery systems for active compounds, few clinical trials have examined the safety and efficacy of brightening microneedle patches.
To determine the efficacy and safety of a newly developed whitening microneedle patch.
A split-face study was designed for efficacy assessment with 34 Korean women applying the tested product (a whitening microneedle patch) on one cheek and a control whitening essence on the other. We objectively measured changes in melanin index values and skin brightness by mexameter and chromameter. Each participant also used global assessment to determine skin whitening. In addition, 55 participants were selected for primary skin irritation tests and repeated insult patch tests for safety assessments.
Mean skin brightness and melanin indexes improved (P<.05) 4 weeks and 8 weeks after product use in both the whitening patch and whitening essence groups. Significant differences (P<.05) were observed between the whitening patch and whitening essence groups 8 weeks after use. Global assessment by participants showed moderate cosmetic outcomes for both the whitening patch and whitening essence groups. No adverse effects were reported, and primary irritation and human repeated insult patch tests revealed no irritation from the test product.
A newly developed microneedle patch was effective and safe for skin brightening and would be a promising functional cosmetic product.
Association of Gender With Financial Relationships Between Industry and Academic Otolaryngologists.
JAMA Otolaryngol Head Neck Surg. 2017 Jun 01;:
Authors: Eloy JA, Bobian M, Svider PF, Culver A, Siegel B, Gray ST, Baredes S, Chandrasekhar SS, Folbe AJ
Abstract
Importance: Gender disparities continue to exist in the medical profession, including potential disparities in industry-supported financial contributions. Although there are potential drawbacks to industry relationships, such industry ties have the potential to promote scholarly discourse and increase understanding and accessibility of novel technologies and drugs.
Objectives: To evaluate whether gender disparities exist in relationships between pharmaceutical and/or medical device industries and academic otolaryngologists.
Design, Setting, and Participants: An analysis of bibliometric data and industry funding of academic otolaryngologists.
Main Outcomes and Measures: Industry payments as reported within the CMS Open Payment Database.
Methods: Online faculty listings were used to determine academic rank, fellowship training, and gender of full-time faculty otolaryngologists in the 100 civilian training programs in the United States. Industry contributions to these individuals were evaluated using the CMS Open Payment Database, which was created by the Physician Payments Sunshine Act in response to increasing public and regulatory interest in industry relationships and aimed to increase the transparency of such relationships. The Scopus database was used to determine bibliometric indices and publication experience (in years) for all academic otolaryngologists.
Results: Of 1514 academic otolaryngologists included in this analysis, 1202 (79.4%) were men and 312 (20.6%) were women. In 2014, industry contributed a total of $4.9 million to academic otolaryngologists. $4.3 million (88.5%) of that went to men, in a population in which 79.4% are male. Male otolaryngologists received greater median contributions than did female otolaryngologists (median [interquartile range (IQR)], $211 [$86-$1245] vs $133 [$51-$316]). Median contributions were greater to men than women at assistant and associate professor academic ranks (median [IQR], $168 [$77-$492] vs $114 [$55-$290] and $240 [$87-$1314] vs $166 [$58-$328], respectively). Overall, a greater proportion of men received industry contributions than women (68.0% vs 56.1%,). By subspecialty, men had greater median contribution levels among otologists and rhinologists (median [IQR], $609 [$166-$6015] vs $153 [$56-$336] and $1134 [$286-$5276] vs $425 [$188-$721], respectively).
Conclusions and Relevance: A greater proportion of male vs female academic otolaryngologists receive contributions from industry. These differences persist after controlling for academic rank and experience. The gender disparities we have identified may be owing to men publishing earlier in their careers, with women often surpassing men later in their academic lives, or as a result of previously described gender disparities in scholarly impact and academic advancement.
PMID: 28570741 [PubMed - as supplied by publisher]
An HIV-Positive Child With a Gingival Mass.
JAMA Otolaryngol Head Neck Surg. 2017 Jun 01;:
Authors: Kane AC, Stark M, Kanotra SP
PMID: 28570725 [PubMed - as supplied by publisher]
Opsoclonus Recorded by a Smartphone.
JAMA Otolaryngol Head Neck Surg. 2017 Jun 01;:
Authors: Hsu SY, Young YH
PMID: 28570724 [PubMed - as supplied by publisher]
Assumptions of Quality Medicine: The Role of Uncertainty.
JAMA Otolaryngol Head Neck Surg. 2017 Jun 01;:
Authors: Scott-Wittenborn N, Schneider JS
PMID: 28570721 [PubMed - as supplied by publisher]
Free Flap Reconstruction Monitoring Techniques and Frequency in the Era of Restricted Resident Work Hours.
JAMA Otolaryngol Head Neck Surg. 2017 Jun 01;:
Authors: Patel UA, Hernandez D, Shnayder Y, Wax MK, Hanasono MM, Hornig J, Ghanem TA, Old M, Jackson RS, Ledgerwood LG, Pipkorn P, Lin L, Ong A, Greene JB, Bekeny J, Yiu Y, Noureldine S, Li DX, Fontanarosa J, Greenbaum E, Richmon JM
Abstract
Importance: Free flap reconstruction of the head and neck is routinely performed with success rates around 94% to 99% at most institutions. Despite experience and meticulous technique, there is a small but recognized risk of partial or total flap loss in the postoperative setting. Historically, most microvascular surgeons involve resident house staff in flap monitoring protocols, and programs relied heavily on in-house resident physicians to assure timely intervention for compromised flaps. In 2003, the Accreditation Council for Graduate Medical Education mandated the reduction in the hours a resident could work within a given week. At many institutions this new era of restricted resident duty hours reshaped the protocols used for flap monitoring to adapt to a system with reduced resident labor.
Objectives: To characterize various techniques and frequencies of free flap monitoring by nurses and resident physicians; and to determine if adapted resident monitoring frequency is associated with flap compromise and outcome.
Design, Setting, and Participants: This multi-institutional retrospective review included patients undergoing free flap reconstruction to the head and/or neck between January 2005 and January 2015. Consecutive patients were included from different academic institutions or tertiary referral centers to reflect evolving practices.
Main Outcomes and Measures: Technique, frequency, and personnel for flap monitoring; flap complications; and flap success.
Results: Overall, 1085 patients (343 women [32%] and 742 men [78%]) from 9 institutions were included. Most patients were placed in the intensive care unit postoperatively (n = 790 [73%]), while the remaining were placed in intermediate care (n = 201 [19%]) or in the surgical ward (n = 94 [7%]). Nurses monitored flaps every hour (q1h) for all patients. Frequency of resident monitoring varied, with 635 patients monitored every 4 hours (q4h), 146 monitored every 8 hours (q8h), and 304 monitored every 12 hours (q12h). Monitoring techniques included physical examination (n = 949 [87%]), handheld external Doppler sonography (n = 739 [68%]), implanted Doppler sonography (n = 333 [31%]), and needle stick (n = 349 [32%]); 105 patients (10%) demonstrated flap compromise, prompting return to the operating room in 96 patients. Of these 96 patients, 46 had complete flap salvage, 22 had partial loss, and 37 had complete loss. The frequency of resident flap checks did not affect the total flap loss rate (q4h, 25 patients [4%]; q8h, 8 patients [6%]; and q12h, 8 patients [3%]). Flap salvage rates for compromised flaps were not statistically different.
Conclusions and Relevance: Academic centers rely primarily on q1h flap checks by intensive care unit nurses using physical examination and Doppler sonography. Reduced resident monitoring frequency did not alter flap salvage nor flap outcome. These findings suggest that institutions may successfully monitor free flaps with decreased resident burden.
PMID: 28570718 [PubMed - as supplied by publisher]
Retained rectal foreign bodies are increasingly reported in current clinical practice, and there is no clear consensus in the literature as to whether transanal extraction should be performed in the emergency or in the operating room. A 47-year-old presented to the hospital for a retained drinking glass in the rectum that was broken after an attempt at self-extraction. Physical examination showed no evidence of abdominal guarding nor bleeding from the rectum; abdominal and pelvic X-rays confirmed the presence of a broken glass, 8x6 cm in size and no signs of perforation. Initial anoscopy performed in the emergency room confirmed the partial fracture of the glass. The patient was transferred to the operating room and transanal extraction was carried out under general anaesthesia without complications.
Abciximab, the first approved glycoprotein (GP IIb/IIIa) inhibitor, is being widely used during acute coronary syndromes and offers the promising approach to antithrombotic therapy. We present a case of a young woman who initially received abciximab infusion for undergoing percutaneous coronary intervention of left anterior descending artery and was eventually diagnosed with abciximab-induced delayed thrombocytopaenia. This case outlines the importance of close follow-up of these patients to prevent serious adverse events.
Peptoniphilus asaccharolyticus, a Gram-positive obligatory anaerobic coccus, is a commensal of the human vagina and gut and can be an opportunistic pathogen in immunocompromised patients. It is usually part of polymicrobial anaerobic infections such as skin and soft tissue infections in diabetics, bone and joint infections and surgical site infections; however, infections caused by P. asaccharolyticus in pure culture have been reported as well. Herein, we describe a case of septic arthritis and osteomyelitis caused by P. asaccharolyticus in a woman with osteoarthritis and diabetes mellitus.
A 34-year-old male presented with an 8-month history of passing increasingly painful 'grit' in his ejaculate. Semen analysis was normal as were urinary and blood tests. T1-weighted MRI revealed several bilateral high-signal areas measuring up to 1 cm in diameter, located in the seminal vesicles. These were confirmed as calculi on T2-weighted imaging and a seminal vesiculogram, with no drainage from the left ejaculatory duct and only minimal from the right duct. He is currently awaiting a robot-assisted laparoscopic vesiculotomy after completion of family.
A 67-year-old man was referred with a history of a right-sided neck lump and dysphonia, secondary to a lesion in the thyroid gland. After undergoing a total thyroidectomy, he was found to have an exceedingly rare combination of follicular carcinoma, insular carcinoma, thyrolipomatosis and an amyloid goitre in his thyroid gland. He subsequently underwent further radioactive iodine ablation and has been in remission. He was also later incidentally diagnosed with systemic amyloidosis, which explained the amyloid deposition in his thyroid gland.
The authors present a case of a 57-year-old man, who presented to the surgical clinic with a mass in the suprapubic region. A CT scan revealed a well-circumscribed lobular, heterogeneous soft tissue mass measuring 12x8.6x7.8 cm. The final histopathological diagnosis from the resection of the lesion was a myxofibrosarcoma (MFS), grade 3. The management of MFS includes surgical and oncological options which are reviewed here. These are aimed at complete excision and reducing the risk of local occurrence.
We describe the case of a 62-year-old man with a history of bipolar disorder, previously stable on lithium for over 20 years, who presented with a manic relapse and signs of lithium toxicity in the form of a coarse tremor. Serum lithium levels were in the normal range, and the patient had stage 3 chronic kidney disease. He was admitted for treatment under Section 2 of the Mental Health Act, and after stopping lithium was started on olanzapine. Signs of lithium toxicity improved after withdrawal of lithium. This case highlights the need to treat normal serum lithium levels with caution in patients showing signs of clinical lithium toxicity.
Fabry's disease (FD) is a recognised mimic of multiple sclerosis (MS). It is an X-linked storage lysosomal disorder with deficiency of α-galactosidase A and enzyme replacement therapy is available. Patients with FD may satisfy modified McDonald criteria if the diagnosis of FD has not been pursued. We present a case of FD in a 65-year-old woman masquerading as benign MS for 40 years. She has recurrent posterior circulation stroke-like symptoms, hearing loss and acroparaesthesia, but typical radiological features of MS on MRI brain. Later she developed an ischaemic stroke, infiltrative cardiomyopathy and chronic renal failure. There was a missense mutation at p.R342Q in the galactodisdase alpha (GLA) gene. Neurologists need to consider FD and look for red flags in atypical MS cases and should not be over-reliant on MRI findings. Missed diagnosis of FD could lead to unnecessary immunosuppression, inappropriate disease counselling and missed treatment opportunity.
Introduction
Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction resulting from vascular compression of the third part of the duodenum in the angle between the abdominal aorta and SMA.
Case presentationA 19-year-old woman with anorexia nervosa with upper gastrointestinal obstruction symptoms resorted to the emergency department. A diagnosis of SMA syndrome was made. Symptoms were solved with conservative treatment aimed at increase body weight.
DiscussionSMA syndrome is most commonly associated with debilitating illnesses. Patients present with acute or insidious upper gastrointestinal obstruction symptoms. Aortomesenteric artery angle of ≤25° is the most sensitive measure of diagnosis. Advances in both enteral and parenteral nutrition led to a shift towards conservative treatment.
ConclusionsLow threshold of suspicion is important to make a timely diagnosis and treatment. A conservative treatment aimed at increasing body weight is the first-line approach, leaving surgical intervention for failure cases.
Chronic spontaneous/idiopathic urticaria (CSU/CIU) has substantial detrimental effects on health-related quality of life (HRQoL) with an effect comparable to or worse than many other skin diseases.
To assess the effect of omalizumab on CSU patients' HRQoL, measured by the Dermatology Life Quality Index (DLQI) in three phase III studies ASTERIA I, ASTERIA II, and GLACIAL.
A post-hoc analysis examined changes in DLQI scores, distribution of patients across DLQI bands and the proportion reaching minimal clinically important difference (MCID) following omalizumab vs placebo.
Omalizumab 300 mg significantly improved total DLQI scores vs placebo, with a mean decrease from baseline to week 12 of -10.3 vs -6.1 (P<.0001) in ASTERIA I, -10.2 vs -6.1 (P=.0004) in ASTERIA II and -9.7 vs -5.1 (P<.0001) in GLACIAL. A significant shift from high disease impact on life at baseline towards less impact at week 12 was seen with omalizumab 300 mg vs placebo (P<.001; all studies). The proportion of patients where change in mean total DLQI score from baseline to week 12 reached an MCID of ≥4 was 74.1%, 76.0% and 77.2% in ASTERIA I, II and GLACIAL, respectively (P<.01; all studies).
Maximum duration of omalizumab treatment was 24 weeks.
This additional analysis assessed the impact of CSU and benefit of treatment with omalizumab by exploring different facets of DLQI data by treatment arm at multiple assessment points. The original aspects of analysis included applying the concept of the recently validated score for the MCID of the DLQI, changes in DLQI domain scores and in the distribution of subjects based on validated total DLQI score bands. It showed consistently that omalizumab provides significant and clinically relevant improvements in many aspects of HRQoL that are important to patients with CSU. These results contribute to a better understanding of the impact of CSU and its treatment on patients and can support clinical decision making in routine medical practice.
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Although most skin tumors are known to be asymptomatic, patients frequently complain of pruritus. However, only few studies have investigated pruritus developing in skin tumors. The aim of this study was to assess the prevalence and characteristics of pruritus in skin tumors.
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The incidence rate of melanoma in the Caucasian population is rising worldwide. One of the major environmental risk factors for melanoma is the exposure to ultraviolet (UV) radiation. To prevent skin damage caused by UV exposure, several organizations recommend wearing protective clothing, staying in the shade, avoiding the outdoors during midday, and using sunscreen.
to provide representative data on factors associated with sun-protective behaviors and intentional sun exposure during summertime in the German population.
A population-based sample of 3,000 German residents aged 14 to 45 years (response: 32.1%) was interviewed via telephone from October to December 2015. Survey participants provided data on the use of recommended sun-protective measures on a sunny summer day and their intentional sun exposure during summertime. Data were weighted by age, sex, educational level, and federal state to ensure the national representativeness of the sample.
Wearing long-sleeved clothes was the most frequently reported protective measure (53.9%), while wearing headgear was the least common (17.9%). Significantly lower frequencies of almost all recommended sun-protective measures were identified for males, participants between 14 and 25 years, those with an immigrant background, and those with low levels of education. Using sun protection was positively associated with female gender (OR=1.62), higher levels of education (ORhigh=1.27), sunburn during childhood (OR=1.33), and paying attention to healthy nutrition (OR=1.64; all p<0.05). Sun tanning behavior was associated with female gender (OR=1.42), younger age, lower level of education, sunbed use (OR=5.24), and smoking status (OR=1.50; all p<0.001).
Since individual sun-protective measures are easy to implement and provide effective protection against high-risk UV exposure, campaigns on skin cancer prevention in Germany should put a stronger focus on young adults, men, less educated individuals, and those with immigration background.
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Desmoplastic melanoma (DM) is frequently misdiagnosed clinically and often associated with melanoma in situ (MIS).
To improve the detection of DM using dermoscopy and reflectance confocal microscopy (RCM).
A descriptive analysis of DM dermoscopy features and a case-control study within a melanoma population for RCM feature evaluation, performed blindly, using data obtained between 2005 and 2015. After retrospectively identifying all DM cases with RCM data over the study period (n=16), a control group of non-DM melanoma patients with RCM data, in a ratio of at least 3:1, was selected. The control group was matched by age and primary tumor site location, divided into non-DM invasive melanomas (n=27) and MIS (n=27). Invasive melanomas were selected according to the melanoma subtypes associated with the DM cases. The main outcomes were the frequency of melanoma-specific features on dermoscopy for DM; and the odds ratios of RCM features to distinguish DM from MIS and/or other invasive melanomas; or MIS from the combined invasive melanoma group.
At least 1 of the 14 melanoma-specific features evaluated on dermoscopy were found in 100% of DMs (n=15 DM with dermoscopy). Known RCM melanoma predictors were commonly found in the DMs, such as pagetoid cells (100%) and cell atypia (100%). The RCM feature of spindle cells in the superficial dermis was more common in DM compared with the entire melanoma control group (OR 3.82, 95% CI 1.01-14.90), and particularly compared to MIS (OR 5.48, 95% CI 1.11-32.36). Nucleated cells in the dermis and the RCM correlate of dermal inflammation were also significant RCM features favouring DM over MIS, as well as invasive melanoma over MIS.
Dermoscopy and RCM may be useful tools for the identification of DM. Certain RCM features may help distinguish DM from MIS and other invasive melanomas. Larger studies are warranted.
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Tufted angioma (TA) is a rare vascular lesion commonly occurring in infancy and early childhood. Presentation is usually a solitary violaceous macule or patch, frequently on the head, neck and upper trunk. It slowly progresses to a deep, indurated, often painful, red to purple plaque, with superimposed papules/nodules, then it stabilizes. Multiple and/or eruptive variants have been occasionally described. Its course varies, including persistence, complication with Kasabach-Merrit syndrome and complete or partial spontaneous regression.
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We read with great interest the landmark article by Gaul1 in which 16 individuals with positive patch test results to nickel received additional patch testing to inorganic and organic substances and more than half developed multiple sensitivities after the primary nickel sensitization. Notably, the patients with multiple sensitivities had developed more extensive dermatoses, had higher recurrence rates (characterized by decreased pain sensation, uncontrollable pruritus, and chronic eczema), and required multiple hospitalizations.
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Chronic spontaneous urticaria (CSU) is a common skin disease characterized by recurrent itchy wheals with or without angioedema that lasts longer than 6 weeks. Vascular endothelial (VE)-cadherin is an endothelial cell-specific adhesion molecule that plays critical roles in angiogenesis and endothelial permeability.
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A unified definition of asthma–chronic obstructive pulmonary disease overlap syndrome (ACOS) is not available, which makes it difficult to evaluate the prevalence and clinical features of patients with ACOS.
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Primary immunodeficiencies (PIDs), although rare, collectively occur in as many as 1 of 2,000 live births and can result in recurrent and/or severe infections, autoimmunity, or autoinflammation.1 Immunodeficiencies often present with overlapping signs and symptoms, making knowledge and application of available laboratory investigations critical to confirm a diagnosis or for direct additional testing. This article explores the indications, methodology, and interpretation of clinically available tests used in the evaluation of T and B cell number and function and provides an approach to using and understanding the tests performed by immunologists once a clinical suspicion of T and B cell immunodeficiencies exists (Fig 1 and Table 1).
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Brentuximab vedotin is a monoclonal antibody-drug conjugate directed against the protein CD301. Brentuximab vedotin is indicated for treating patients with CD30+ Hodgkin lymphoma (HL) for which treatment with autologous stem cell transplant (ASCT) or 2 previous chemotherapy treatments have failed and when ASCT or chemotherapy are contraindicated.1
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To provide an overview of studied cellular and noncellular blood-derived asthma biomarkers.
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To review the methods and materials used for collection, purification, commercial production, and clinical application of Hymenoptera venoms.
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Tea is one of the oldest produced beverages and has been consumed since 2700 BC.1 Green tea's popularity is increasing among consumers with its production expected to increase to 2.97 million tons a year by the year 2023.1 Anaphylaxis caused by tea produced from the Compositae family has been reported in the literature.2 To date, no cases of anaphylaxis from green tea, which is produced from Camellia sinensis, have been reported. We describe the first possible case of IgE-mediated anaphylaxis caused by imbibement of green tea.
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The pathogenesis of atopic dermatitis (AD) is complex and related to allergic responses and defects in skin barrier function. In common with many atopic diseases, the prevalence of AD has been increasing across the world.1 One of the theories for this increase is increased hygiene and urbanization-related changes in the environment, which can affect the human microbiome.2 Previous studies have found associations between the composition of the early gut microbiome and development of atopic conditions, including AD.
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To provide a clinical rationale for including impulse oscillometry (IOS) as a part of standard office-based asthma assessment.
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Understanding the molecular mechanisms that control effector and memory T-cell differentiation has been a central focus of T-cell biologists for many decades. As a result, powerful tools have been developed to analyze T cells down to the single-cell level. This textbook provides the experimental scientist a practical tool book for using updated laboratory techniques in the analysis of T-cell differentiation and effector cell function.
http://ift.tt/2riKUL5
Publication date: Available online 31 May 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Alexandria Irace, Eelam Adil
Knowledge of the embryogenesis of the head and neck is essential to the evaluation and management of congenital neck masses. In this article, we describe the embryology of the most common congenital neck masses, branchial apparatus and thyroglossal duct cysts. The anatomy of both branchial clefts and pouches is reviewed along with the histology and descent of the thyroid from its origin at the foramen cecum of the tongue. This article will serve as the foundation for understanding the anatomy surrounding surgical resection of these lesions, which will be discussed in later articles.
http://ift.tt/2rMnizE
Publication date: Available online 31 May 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Jaime Doody, Lindsay Sobin
Fourth branchial cleft and pouch anomalies are rare but clinically important entities that require a high index of suspicion. A missed diagnosis can prolong patient morbidity resulting in incorrect treatment and probable recurrence. These anomalies are secondary to errors in embryogenesis from incomplete involution of the fourth branchial cleft or pouch, resulting in the formation of a cyst, sinus, or fistula. They commonly present as a recurrent lateral neck swelling in the pediatric population. Surgery is the mainstay of treatment.
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