Purpose of review: MRI is becoming an indispensable diagnostic tool. The need for prolonged motion-free periods has substantially increased the need for deep sedation or anesthesia in a challenging environment. This review summarises recent literature with respect to pharmacological sedative strategies, nonpharmacological alternative approaches, airway management and safety issues in the ambulatory setting. Recent findings: Most literature researches the pediatric patient population. The American Society of Pediatrics published guidelines for monitoring and management of pediatric patients during sedation for diagnostic procedures. Dexmedetomidine is the most researched agent for sedation. It remains uncertain what the clinical implications are of the potential neurotoxicity of repeat sedation or anesthesia in young children. Airway strategies highlight the use of end-tidal carbon dioxide monitoring. Technical imaging advancement and nonpharmacological sedation alternatives allow for shorter procedures with a lower need for sedation. Summary: The anesthetic management of ambulatory patients in the MRI environment has its specific challenges and safety issues. However, the implementation of safety guidelines, new pharmacological and alternative nonpharmacological sedation strategies offer interesting perspectives to tackle these challenges. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Πέμπτη 17 Αυγούστου 2017
Super pulse CO2 laser therapy for benign eyelid tumors
Summary
Background
Benign eyelid tumors occur commonly in daily outpatient services.
Objectives
The aim of this study was to evaluate the treatment of benign eyelid lesions with a super pulse CO2 laser as an alternative to surgical excision.
Methods
This retrospective clinical study included 80 patients with 99 benign eyelid lesions treated with super pulse CO2 laser photocoagulation. The following areas were involved: the upper eyelid in 38 cases, the lower eyelid in 39 cases, and the angulus oculi in seven cases (the eyelid margin was included in 18 cases). The laser spot size ranged from 120 to 200 μm and the super pulse CO2 laser power density varied between 0.6 and 21.1 W/mm2. The mean follow-up period was 14.0±7.1 months (range five to 30). Histological diagnoses were obtained in 62 of the 80 patients.
Results
The cosmetic outcomes of all of the patients were satisfactory after treatment, and the wounds formed dry scabs, with no infections. They were epithelialized within 2-4 weeks with normal-appearing epithelium. Temporarily, the treated area had less hyperpigmentation than the surrounding normal skin, showing no obvious scars or notches. No complications were observed, with no relapses during the follow-up.
Conclusions
The super pulse CO2 laser therapy of the benign eyelid tumors provided satisfactory cosmetic results in this study. It is a convenient, cheap, accessible, and well-tolerated alternative to traditional surgery, especially for diffuse tumors, or those positioned close to the lacrimal papillae.
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Myricetin protects keratinocyte damage induced by UV through IκB/NFκb signaling pathway
Summary
Objective
The aim of this study was to evaluate the potential molecular mechanism of myricetin that protecting cells from photodamage.
Methods
Myricetin had broadly chemopreventive effects and anti-inflammatory properties. The effect of myricetin was assessed on HaCaT cells. Cell viability assay was carried out. Reactive oxygen species (ROS) level was measured. The expression of pro-inflammatory factor COX2 was determined by real-time PCR and Western blot. The protein levels of p-IκBa and IκBa were determined by Western blot.
Results
Myricetin attenuated UV-induced keratinocyte death in a dose-dependent manner as determined by cell viability assay. Pretreatment with myricetin also reduced the UV-induced ROS levels. Myricetin suppresses the upregulation of COX2 induced by UV in keratinocyte as demonstrated by real-time PCR and Western blot. Furthermore, signal transduction studies confirmed that myricetin attenuates the upregulation of COX2 induced by UV via suppression of IκB/NFκB pathways.
Conclusion
These results showed that antioxidant property of myricetin can effectively attenuate UV-caused cell damage and suppress the expression of COX2 through the IκB/NFκB signaling pathways. Myricetin had potential protective effects on UV-induced skin cell damages, which might be used in cosmetic and pharmaceutical industries.
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Nationwide skin cancer screening in Germany: Evaluation of the training program
Abstract
Background
In July 2008, the German statutory health insurance introduced a nationwide skin cancer screening program. Before the introduction, eligible physicians had to qualify to perform the screening test and counsel their patients on skin cancer screening. To educate physicians, a curriculum and training materials were developed. Since 2015 a revised curriculum and training materials have been used. The purpose of this paper is to provide information about the curriculum and to evaluate the revised training program.
Methods
A total of 573 completed pre- and posttests were analyzed with regard to changes in the identification of skin cancer, diagnostic accuracy, knowledge, and physicians' self-assessed-confidence. For statistical analysis, Mann-Whitney U test, Cohen's d, and chi-square test were used.
Results
General practitioners (GPs) diagnosed 7.45 of 12 skin lesions correctly before and 9.26 after the training course (P < 0.001). Compared to GPs, dermatologists' accuracy was higher at pre- and posttest (pre: 10.03, post: 10.21, P = 0.160).
The mean of correctly answered questions increased significantly in knowledge on screening and early detection (4.46–5.14, P < 0.001) as well as skin cancer and skin cancer screening (5.51–6.39, P < 0.001).
Conclusion
Participating physicians got a comprehensive understanding of skin cancer screening and counseling through the training and increased their diagnostic skills. In particular, GPs identified and diagnosed significantly more skin lesions correctly after the training compared to before the training, while dermatologists' diagnostic skills were high at both times, before and after.
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Effect of Maternal Antibody Transfer on Antibody Dynamics and Control of Porcine Circovirus Type 2 Infection in Offspring
Viral Immunology , Vol. 0, No. 0.
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Effect of application sequence of fluoride and CPP-ACP on remineralization of white spot lesions in primary teeth: An in-vitro study
Source:Archives of Oral Biology, Volume 83
Author(s): Ola B. Al-Batayneh, Reem A. Jbarat, Susan N. Al-Khateeb
ObjectiveTo explore how application sequence of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride influences remineralization of enamel white spot lesions (WSL) in primary teeth.DesignIn this in-vitro study, artificial WSLs were created in 130 primary teeth. Teeth were divided into 4 groups (n=27) and a control group (n=22) and exposed to one of the following remineralization regimens for 10 weeks: Group-1; 500ppm fluoride dentifrice; Group-2; 10% w/v CPP-ACP; Group-3; fluoride applied first, then CPP-ACP; Group-4; CPP-ACP applied first, then fluoride, and Group-5 was control. All groups were kept in a remineralizing solution. Mineral changes (ΔF) were quantified weekly using quantitative light-induced fluorescence. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS version 20.0).ResultsRemineralization occurred in all groups to different degrees; changes from baseline were significant in groups 1–4 (P≤0.05). Group-4 showed the earliest significant remineralization (after 2 weeks) among groups, (P<0.001). Group-4 showed maximum changes in ΔF among groups; however, only differences with Groups 1 and 5 were significant (P<0.05 and P<0.01, respectively). Group-3 showed better remineralization than Groups 1, 2 and 5; however, the difference was only significant with Group-5 (P<0.001). There were no significant differences between Group 1and 2, however, only Group 2 showed better remineralization than Group 5, (P<0.01).ConclusionCombined treatment with CPP-ACP followed by fluoride exhibited the best remineralization of white spot lesions in primary teeth in this study. Combined treatment with fluoride followed by CPP-ACP showed a tendency towards better remineralization than fluoride or CPP-ACP alone.
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Amelogenin induces M2 macrophage polarisation via PGE2/cAMP signalling pathway
Source:Archives of Oral Biology, Volume 83
Author(s): Kensuke Yamamichi, Takao Fukuda, Terukazu Sanui, Kyosuke Toyoda, Urara Tanaka, Yuki Nakao, Karen Yotsumoto, Hiroaki Yamato, Takaharu Taketomi, Takeshi Uchiumi, Fusanori Nishimura
ObjectivesAmelogenin, the major component of the enamel matrix derivative (EMD), has been suggested as a bioactive candidate for periodontal regeneration. Apart from producing a regenerative effect on periodontal tissues, amelogenin has also been reported to have an anti-inflammatory effect. However, the precise molecular mechanisms underlying these effects remain unclear. In the present study, we examined the immunomodulatory effects of amelogenin on macrophages.DesignHuman phorbol 12-myristate 13-acetate (PMA)-differentiated U937 macrophages and CD14+ peripheral blood-derived monocytes (PBMC)-derived macrophages were stimulated with recombinant amelogenin (rM180). After performing a detailed microarray analysis, the effects of rM180 on macrophage phenotype and signal transduction pathways were evaluated by real-time polymerase chain reaction, enzyme-linked immunosorbent assay, confocal microscopy and flow cytometry.ResultsThe microarray analysis demonstrated that rM180 increased the expression of anti-inflammatory genes in lipopolysaccharide (LPS)-challenged macrophages after 24h, while it temporarily up-regulated inflammatory responses at 4h. rM180 significantly enhanced the expression of M2 macrophage markers (CD163 and CD206). rM180-induced M2 macrophage polarisation was associated with morphological changes as well as vascular endothelial growth factor (VEGF) production. rM180 enhanced prostaglandin E2 (PGE2) expression, and the activation of the cAMP/cAMP-responsive element binding (CREB) signaling pathway was involved in amelogenin-induced M2 macrophage polarisation. Blocking of PGE2 signaling by indomethacin specifically abrogated rM180 with or without LPS-induced M2 shift in PBMC-derived macrophages.ConclusionAmelogenin could reprogram macrophages into the anti-inflammatory M2 phenotype. It could therefore contribute to the early resolution of inflammation in periodontal lesions and provide a suitable environment for remodeling-periodontal tissues.
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Omalizumab for hypersensitive reaction to seminal plasma: A case report
Publication date: Available online 15 August 2017
Source:Allergology International
Author(s): Maria Teresa Burguete-Cabanas, Oscar R. Fajardo-Ramirez, Roberta Yesaki, Raul Estrada-Maganas, Sandra Salazar-Meza, Olga Rios-Chavez, Irene Meester, Julio C. Salas-Alanis
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Association of STOP-Bang Questionnaire as a Screening Tool for Sleep Apnea and Postoperative Complications: A Systematic Review and Bayesian Meta-analysis of Prospective and Retrospective Cohort Studies.
BACKGROUND: The risk of postoperative complications increases with undiagnosed obstructive sleep apnea (OSA). The high-risk OSA (HR-OSA) patients can be easily identified using the STOP-Bang screening tool. The aim of this systematic review and meta-analysis is to determine the association of postoperative complications in patients screened as HR-OSA versus low-risk OSA (LR-OSA). METHODS: The following data bases were searched from January 1, 2008, to October 31, 2016, to identify the eligible articles: Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Cochrane Databases of Systematic Reviews, Medline-in-Process & other nonindexed citations, Google Scholar, Embase, Web of Sciences and Scopus. The search included studies with adult surgical patients screened for OSA with STOP-Bang questionnaire that reported at least 1 cardiopulmonary or any other complication requiring intensive care unit admission as diagnosis of outcome. We used a Bayesian random-effects analysis to evaluate the existing evidence of STOP-Bang in relation to OSA and to assess the association of postoperative complications with the identified HR-OSA patients by study design and methodologies. RESULTS: This systematic review and meta-analysis was conducted using 10 cohort studies: 23,609 patients (HR-OSA, 7877; LR-OSA, 15,732). The pooled odds of perioperative complications were higher in the HR-OSA versus LR-OSA patients (odds ratio 3.93, 95% credible interval, 1.85-7.77, P= .003; 6.86% vs 4.62%). The length of hospital stay was longer in HR-OSA by 2 days when compared with LR-OSA (5.0 +/- 4.2 vs 3.4 +/- 2.8 days; mean difference 2.01; 95% credible interval, 0.77-3.24; P= .005). Meta-regression to adjust for baseline confounding factors and subgroup analysis did not materially change the results. CONCLUSIONS: This systematic review and meta-analysis suggests that HR-OSA is related with higher risk of postoperative adverse events and longer length of hospital stay when compared with LR-OSA patients. Our findings support the implementation of the STOP-Bang screening tool for perioperative risk stratification. (C) 2017 International Anesthesia Research Society
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Impact of Simulator-Based Training in Focused Transesophageal Echocardiography: A Randomized Controlled Trial.
BACKGROUND: The aim of the study was to determine if training in transesophageal echocardiography (TEE) using a TEE simulator improves the ability of novice operators to perform and interpret a focused critical care TEE. METHODS: In this prospective, randomized, controlled study with blinded outcome assessment, 44 intensive care unit trainees were randomly assigned to a control group receiving 4 hours of lecture-based training only, or an intervention group which was additionally trained for 4 hours using a TEE simulator. After the training intervention, each participant performed 2 TEEs in intensive care unit patients which were evaluated by blinded assessors. The imaging quality of TEEs was measured using a predefined examination quality score ranging from 0 to 100 points. The correct quantification of pathologies and the interpretation of the TEEs were evaluated by blinded assessors using focused and comprehensive expert TEEs as comparators. RESULTS: A total of 114 TEEs were assessed. The mean examination quality score was 55.9 (95% confidence interval [CI], 50.3-61.5) for TEEs of the control group, 75.6 (95% CI, 70.1-81.0) for TEEs of the intervention group, and 88.5 (95% CI, 79.3-97.7) for TEEs in the expert group. The multiple comparisons revealed significant differences between all groups (19.7 [95% CI, 12.8-26.6], P
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Young Age and Male Sex Are Predictors of Large-Volume Central Neck Lymph Node Metastasis in Clinical N0 Papillary Thyroid Microcarcinomas
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A Systematic Review of the Methods of Diagnostic Accuracy Studies of the Afirma Gene Expression Classifier
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Morphoproteomics, E6/E7 in-situ hybridization, and biomedical analytics define the etiopathogenesis of HPV-associated oropharyngeal carcinoma and provide targeted therapeutic options
Human papillomavirus (HPV) has been identified as an etiopathogenetic factor in oropharyngeal squamous cell carcinoma. The HPV E6 and E7 oncogenes are instrumental in promoting proliferation and blocking differen...
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Measurements of ionic concentrations along with endocochlear potential in wild-type and claudin 14 knockout mice
Publication date: Available online 12 August 2017
Source:Auris Nasus Larynx
Author(s): Yuka Shiraiwa, Eriko Daikoku, Masahisa Saito, Yui Yamashita, Takaya Abe, Fumihito Ono, Takahiro Kubota
ObjectiveTo examine whether the changes in endolymphatic ion concentrations were involved in hair cells degeneration in claudin-14 knockout (KO) mice (Cldn14−/−), we measured the endocochlear potential (EP) along with concentrations of K+, Na+, H+, or Ca2+ ([K]e, [Na]e, pHe, [Ca]e) in Cldn14−/−, in which hair cells were selectively damaged, and compared with measurements in wild type mice (Wt).MethodsWe used the Cldn14−/− from 3 weeks of age, in which the auditory brain responses (ABR) was severely diminished. Using double-barreled ion-selective microelectrodes, we measured [K]e, [Na]e, pHe, and [Ca]e in both Wt and Cldn14−/− at 8–10 weeks of age.Results(1) In Wt, the EP was +92mV. [K]e, [Na]e, pHe, and [Ca]e were 169mM, ∼1.0mM, 7.50, and 395nM, respectively. In the Cldn14−/−, the EP was +96mV. [K]e, [Na]e, pHe, and [Ca]e were 167mM, ∼1.0mM, 7.73, and 179nM, respectively. No significant differences in the above values were observed between Wt and Cldn14−/−. (2) A significant linear correlation between EP and [Ca]e (R=0.93) was observed for both Wt and Cldn14−/−, but no correlation was observed between EP and K+, Na+, or H+.ConclusionThese findings suggest that (1) the changes in endolymphatic ion concentrations might not be involved in hair cells degeneration in Cldn14−/−, (2) [Ca]e might be regulated by EP in both Wt and Cldn14−/−.
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Does CT help in predicting preepiglottic space invasion in laryngeal carcinoma?
Source:Auris Nasus Larynx
Author(s): Gülpembe Bozkurt, Özlem Ünsal, İrfan Çelebi, Burak Ayhan, Umman Guliyev, Pınar Akova, Tülay Başak, Berna Uslu Coşkun
ObjectiveEvaluating preepiglottic space involvement in laryngeal cancer by CT may lead misinterpretation. We sought to understand the causes of misinterpretation in evaluating the preepiglottic space by CT and assessed the effects of misinterpretation in treatment plans of patients with laryngeal squamous cell carcinomas.MethodsSpecimen histopathology reports of 102 (99 male, 3 female) patients who underwent total or partial laryngectomy due to supraglottic and/or transglottic laryngeal carcinoma were reviewed. Neck CTs were also re‐assessed for preepiglottic space involvement by three radiologists. The initial surgical treatment choices were re-examined according to the current radiological evaluation in combination with pathological results of the specimens and physical examination findings in the patients. Interobserver agreement regarding image interpretation was based on a kappa analysis.ResultsThe interclass correlation coefficient in predicting preepiglottic space invasion was 0.74; this was considered 'good.' Among the three radiologists, sensitivity, specificity, accuracy of CT in detecting preepiglottic space involvement were 86–93%, 75–93%, and 77–93%, respectively, while the negative and positive predictive values were 97–98% and 38–50%, respectively. Given the previous treatments applied, false-positive diagnoses for PES involvement resulted in overtreatment in 2.9% of cases. False-negative diagnoses of PES involvement (1.9% of cases) did not result in any undertreatment.ConclusionsAlthough CT is a practical and inexpensive imaging tool for evaluating laryngeal carcinomas, the PPV of CT in assessing preepiglottic space invasion, especially in advanced tumors, is low and may lead to overtreatment.
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Clinical course of incidental parathyroidectomy: Single center experience
Source:Auris Nasus Larynx
Author(s): Sabri Özden, Ahmet Erdoğan, Besir Simsek, Baris Saylam, Baris Yıldız, Mesut Tez
ObjectiveThyroidectomy is a very common surgical procedure. Regardless of surgeon experience, incidental parathyroidectomy is a complication of thyroidectomy. The aim of this study was to identify the clinical course of incidental parathyroidectomies after thyroidectomy.MethodsPatients who underwent thyroidectomy between January 2010 and June 2014 were evaluated retrospectively. Pathology reports were reviewed for the presence of parathyroid tissue in the thyroidectomy pathology specimens. Information regarding demographic, laboratory variables, operative details, and postoperative complications were collected.ResultsIncidental parathyroidectomy was found in 178 out of 3022 patients who had thyroidectomy (5.8%). Types of surgeries performed for 178 patients were total thyroidectomy (TT) in 132(74.2%) cases, TT and central lymph node dissection(CLND) in 30 (16.9%) cases, lobectomy in seven cases (3.9%), completion thyroidectomy in five (2.8%) patients and modified cervical lymph node dissection in four (2.2%)patients. One and two parathyroid glands were accidentally removed in 152 (85.3%) and 26 (14.7%) patients, respectively.In the entire series, biochemical temporary postoperative hypocalcemia occurred in 75(42.1%) patients and permanent hypocalcemia occured in 12 (6.7%) patients with incidental parathyroidectomy. There was not a statistically significant difference regarding the occurrence of postoperative permanent hypocalcemia between the patients who had incidental parathyroidectomy of one gland and the patients with two incidental parathyroidectomies (p=0.114).ConclusionIncidental parathyroidectomy is not uncommon during thyroidectomy. No association between inadvertent parathyroidectomy and postoperative permanent hypocalcemia was found.
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Correlation of soft palate length with velum obstruction and severity of obstructive sleep apnea syndrome
Source:Auris Nasus Larynx
Author(s): Ju-Shin Lim, Jae Woo Lee, Chun Han, Jang-Woo Kwon
ObjectiveOur aim in this study was to analyze whether soft palate length and velum obstruction during sleep are correlated and to determine the effects of related parameters on obstructive sleep apnea syndrome (OSAS) severity. We used computed tomography to measure soft palate length and drug-induced sleep endoscopy (DISE) to evaluate velum obstruction severity. Patients also underwent polysomnography (PSG) for evaluation of OSAS severity.MethodsA retrospective cohort of 67 patients with OSAS treated between May 1st, 2013 and July 31st, 2016 was analyzed. Each patient underwent DISE, PSG, and computed tomography. Using DISE, velum obstruction was categorized by the VOTE classification method. Using computed tomography, soft palate length was measured as the length of the posterior nasal spine to the uvula. Correlations of velum obstruction in DISE and PSG parameters (obstructive apnea, hypopnea, apnea hypopnea index (AHI), respiratory effort related arousal (RERA), respiratory disturbance index (RDI), baseline SaO2, and minimum SaO2) with soft palate length were also analyzed.ResultsAmong the 67 patients, the average PNS-U length was 39.90±4.19mm. Length was significantly different by age but not by other demographic characteristics such as sex, past history, or BMI. DISE revealed a statistically significant difference of velum obstruction degree; the cutoff value for PNS-U was 39.47mm. The PSG results, obstructive apnea, AHI, RDI, baseline SaO2, and minimum SaO2 were correlated with PNS-U length, while other results such as hypopnea and RERA showed no correlation.ConclusionAnalysis of soft palate length showed that increased PNS-U length was associated with higher rates of obstructive apnea, AHI, and RDI as assessed by PSG. In contrast, lower baseline SaO2 and minimum SaO2 values were seen by PSG; more severe velum obstruction was seen by DISE. We propose that when a soft palate is suspected in OSAS, computed tomography measurement of soft palate length is a valid method for estimating the degree of velum obstruction and the severity of OSAS.
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Cervical mass as the first clinical manifestation of unsuspected metastatic seminoma
Source:Auris Nasus Larynx
Author(s): Emanuele Ferri, Barbara Pedruzzi, Pierpaola Gasparin, Marcello Lunghi
The authors reported a case of a 27‐year‐old man with a nontender left neck mass that had grown quite rapidly within few weeks. FNAB and CT were not consistent to establish the definite diagnosis. After excisional biopsy, the histopathological examination and the immunohistochemical study of the specimen revealed a cervical metastasis of seminoma. The patient was treated with chemotherapy with a complete clinical remission. This uncommon case-report can represent a great diagnostic and therapeutic challenge and should be considered in the differential diagnosis of every cervical masses occurring in young males patients. Diagnostic delays are unfortunately common and may lead to metastatic spread and worse prognosis.
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Long-term safety of crisaborole ointment 2% in children and adults with mild to moderate atopic dermatitis
Long-term topical treatment is often required for atopic dermatitis (AD), a chronic inflammatory skin disease.
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Repigmentation in vitiligo using the Janus kinase inhibitor tofacitinib may require concomitant light exposure
Vitiligo is an autoimmune disease in which cutaneous depigmentation occurs. Existing therapies are often inadequate. Prior reports have shown benefit of the Janus kinase (JAK) inhibitors.
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A comparative study for the analgesic efficacy and safety profile of fentanyl versus clonidine as an adjuvant to epidural ropivacaine 0.75% in lower abdominal surgeries
Anesthesia: Essays and Researches 2017 11(3):692-696
Context: Different adjuvants are coadministered with local anesthetics to improve the speed of onset and duration of analgesia, and to reduce the dose, the selection of which is often left to the choice of an anesthesiologist. Aim: The aim of this study was to compare the analgesic efficacy and safety profile of fentanyl and clonidine as an adjuvant to epidural ropivacaine anesthesia. Setting and Design: With institutional ethical committee clearance, a prospective, randomized, placebo-controlled double-blind clinical study was conducted at Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow. Material and Methods: Two groups with thirty patients each were randomly allocated to receive 15–20 ml of 0.75% ropivacaine with 75 μg clonidine or 15–20 ml of 0.75% ropivacaine with 75 μg fentanyl, respectively. Block characteristics such as onset of analgesia, maximum level of sensory blockade, complete motor blockade, hemodynamic, time to two-segment regressions, time for rescue analgesia, time to complete motor recovery, and side effects were analyzed. Results: Results showed that the onset of blockade is faster when fentanyl is used as additives. Time for two-segment regression was earlier in fentanyl group but time for rescue analgesia was longer in clonidine group. Statistical Analysis: Two groups were compared by Student's t-test and Chi-square test; ANOVA and significance of mean difference bet were done by Newman–Keuls test. Conclusion: Addition of clonidine to epidural ropivacaine provides superior analgesia than the addition of fentanyl to epidural ropivacaine without much difference in side effect profile.
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Laparoscopic cholecystectomy under segmental thoracic spinal anesthesia: A feasible economical alternative
Anesthesia: Essays and Researches 2017 11(3):781-783
Laparoscopic surgery is normally performed under general anesthesia, but regional techniques like thoracic epidural and lumbar spinal have been emerging and found beneficial.We performed a clinical case study of segmental thoracic spinal anaesthesia in a healthy patient.We selected an ASA grade I patient undergoing elective laparoscopic cholecystectomy and gave spinal anesthetic in T10-11 interspace using 1 ml of bupivacaine 5 mg ml−1 mixed with 0.5 ml of fentanyl 50 μg ml−1. Other drugs were only given (systemically) to manage patient anxiety, pain, nausea, hypotension,or pruritus during or after surgery. The patient was reviewed 2 days postoperatively in ward.The thoracic spinal anesthetia was performed easily in the patient.Some discomfort which was readily treated with 1mg midazolam and 20 mg ketamine intravenously.There was no neurological deficit and hemodynamic parameters were in normal range intra and post-operatively and recovery was uneventful. We used a narrow gauze (26G) spinal needle which minimized the trauma to the patient and the chances of PDPH, which was more if 16 or 18G epidural needle had been used and could have increased further if there have been accidental dura puncture. Also using spinal anesthesia was economical although it should be done cautiously as we are giving spinal anesthesia above the level of termination of spinal cord.
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Role of anesthesiologist in the management of a child with cerebral palsy
Anesthesia: Essays and Researches 2017 11(3):544-549
Cerebral palsy (CP) refers to a spectrum of nonprogressive neurological disorders with disturbances in posture and movement, resulting from perinatal intrauterine insult to developing infant brain. Many conditions associated with CP require surgery. Such cases pose important gastrointestinal, respiratory, and other perioperative considerations. Anesthetic management in these cases is delicate. Intraoperative complications including hypovolemia, hypothermia, muscle spasms, seizures, and delayed recovery might complicate the anesthetic management. A thorough preanesthetic evaluation allows for a better intra- and post-operative care. Postoperative analgesia is important, particularly in orthopedic surgeries one for pain relief. This review highlights the clinical manifestations in CP and anesthetic considerations in such child presenting for various surgeries.
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A comparative study of intravenous esmolol, labetalol and lignocaine in low doses for attenuation of sympathomimetic responses to laryngoscopy and endotracheal intubation
Anesthesia: Essays and Researches 2017 11(3):745-750
Background: Direct layngoscopy and endotracheal intubation is a noxious stimuli and induces sympathomimetic responses. Although well tolerated in healthy subjects, it may impose life threatening arrhythmias, left ventricular failure or rupture of cerebral aneurysm in susceptible patients. Esmolol, Labetalol and Lignocaine attenuate these responses but are associated with side effects of bradycardia, hypotension etc. In lower doses, chances of these side effects are comparatively low. So we designed this prospective clinical trial to assess the efficacy of intravenous esmolol, labetalol and lignocaine in low doses for attenuation of sympathomimetic responses to endotracheal intubation. Materials and Methods: Seventy-five consenting patients of ASA physical status I or II of age range 20 to 60 years, scheduled for different general surgical procedures were randomly assigned to one of the three groups; group ES, group LB and group LG. Participants of group ES, group LB and group LG was given esmolol HCL 0.5 mg/Kg, labetalol HCL 0.25 mg/kg and lignocaine HCL 1 mg/Kg body weight respectively. Outcome variables were HR, SBP, DBP, MAP and RPP. These variables were recorded just after intubation and thereafter at 1,3,5, 7 and 10 minutes of intubation. Results: There was no statistically significant difference regarding the demographic characteristics of the groups. Heart rate and systolic blood pressure was lower throughout the study period in labetalol group. But the values of study parameters were always higher than the baseline in esmolol and lignocaine group. Values of mean arterial pressure was slightly higher in labetalol group but it was much higher in two other groups throughout the study period. Diastolic blood pressure was higher in all the groups. Values of rate pressure product was higher during intubation and at 1minute after intubation in labetalol group but thereafter it was always lower than baseline values. Conclusion: Labetalol 0.25 mg Kg-1 is an effective and safe drug to be used for attenuation of sympathomimetic responses to endotracheal intubation. Esmolol 0.5 mg Kg-1 and lignocaine 1 mg Kg-1 are also effective to some extent and are safe.
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Nasogastric tube insertion in anesthetized intubated patients undergoing laparoscopic hysterectomies: A comparative study of three techniques
Anesthesia: Essays and Researches 2017 11(3):550-553
Background: Insertion of a nasogastric tube (NGT) in an anesthetized, comatose intubated patient is not always as easy as in a conscious, cooperative patient. Various techniques have been tried with varying success. The aim of this randomized study was to compare and evaluate the two techniques of NGT insertion with the conventional technique of insertion with respect to success rate, time taken for insertion and adverse effects. Materials and Methods: Patients admitted for laparoscopic hysterectomy were chosen and then were divided into three equal groups of forty each, by randomized technique. Group C included patients in whom conventional method was used to insert NGT. Group R where reverse Sellick's technique was used. Group F where neck flexion with lateral pressure was used. Results: Both the techniques were better than the conventional method. Among both the techniques, reverse Sellick's technique was the best method but not without adverse effects. The required insertion time was very less and success in the first attempt was more in the group where reverse Sellick's was used. Conclusion: Modified techniques of NGT insertion were better than the conventional method. Further studies after eliminating major limitations are required to really find a superior technique.
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Hyperparathyroid crisis: It's not all about calcium!
Anesthesia: Essays and Researches 2017 11(3):804-806
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Influence of addition of dexmedetomidine or fentanyl to bupivacaine lumber spinal subarachnoid anesthesia for inguinal hernioplasty
Anesthesia: Essays and Researches 2017 11(3):554-557
Background: No drug, used as adjuvant to spinal bupivacaine, has yet been identified that specifically inhibits nociception without its associated side effects. Aim of the Work: The purpose of this study is to compare the efficacy of dexmedetomidine and fentanyl with spinal bupivacaine in inguinal hernioplasty. Patients and Methods: Sixty patients of inguinal hernioplasty were randomly allocated to one of three groups, Group C (n = 20) – the patients received 15 mg hyperbaric bupivacaine + 0.5 ml saline. Group D – (n = 20) the patients received 15 mg hyperbaric bupivacaine + 10 μg dexmedetomidine diluted with 0.5 ml saline. Group F (n = 20) – the patients received 15 mg hyperbaric bupivacaine + 25 μg fentanyl (0.5 ml). Onset, duration of anesthesia, degree of sedation, and side effects were recorded. Results: The onset of anesthesia was shorter in Groups D and F as compared with the control Group C, but it was shorter in Group D than in Group F. The duration of sensory and motor block was prolonged in Group D and F as compared with the control Group C, but it was longer in Group D than in Group F. The postoperative analgesic consumption in the first 24 h was lower in Groups D and F than in Group C, and it was lower in Group D than in Group F. Conclusion: Onset of anesthesia is more rapid and duration is longer with less need for postoperative analgesia in patients undergoing inguinal hernioplasty under spinal anesthesia with dexmedetomidine and fentanyl than those with spinal alone with tendency of dexmedetomidine to produce faster onset, longer duration, and less analgesic need than fentanyl with similar safety profile.
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A prospective, observational study to evaluate the role of gabapentin as preventive analgesic in thyroidectomy under general anesthesia
Anesthesia: Essays and Researches 2017 11(3):718-723
Background: Effective management of postoperative pain is a part of well-organized perioperative care, which helps in reduced morbidity and improved patient satisfaction. Preventive analgesia can reduce acute and chronic pain by blocking the noxious inputs to pain pathways, preventing sensitization. Studies have reported efficacy of gabapentin as a preventive analgesic in perioperative pain. In this study, we aimed to determine whether preoperative gabapentin reduced postoperative pain and tramadol consumption after thyroidectomy under general anesthesia. Materials and Methods: Sixty patients scheduled for thyroidectomy were allocated to two groups of thirty each for this prospective, observational study. Patients in Group A and Group B received oral gabapentin 600 mg (6 × 10−4 kg) and diazepam 10 mg (1 × 10−5 kg), respectively, 2 h prior to surgery. Tramadol was given as rescue analgesic for postoperative pain with a verbal rating score of two. The analgesic efficacy of preoperative gabapentin was assessed in terms of postoperative pain scores at rest or swallowing, time to first rescue analgesic, and total tramadol consumption for 24 h. Ramsay sedation score and side effects of drug were also looked into. Results: Postoperative pain scores and total tramadol consumption were significantly lower in Group A during 24 h (P = 0.00). Time to first rescue analgesic was significantly prolonged in Group A (P = 0.001). Side effects were comparable. Conclusion: Oral gabapentin is effective as a preventive analgesic in reducing postoperative pain and tramadol consumption after thyroidectomy under general anesthesia.
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Comparative study of oral gabapentin, pregabalin, and clonidine as premedication for anxiolysis, sedation, and attenuation of pressor response to endotracheal intubation
Anesthesia: Essays and Researches 2017 11(3):558-560
Introduction: The aim of the present study was to evaluate and compare the effect of clonidine 200 μg and gabapentin 900 mg and pregabalin 150 mg in attenuation of the hemodynamic response to laryngoscopy and intubation in normotensive patients undergoing elective surgery. Methods: Ninety adult patients between 18 and 60 years are enrolled in the study. Patients with American Society of Anesthesiologists Grade-I and Grade-II are included which are posted for elective surgery under general anesthesia. Patients were divided into three groups: A, B, and C and received oral drugs 90 min before induction of general anesthesia, pregabalin 150, gabapentin 900mg, and clonidine 200 μg, respectively. Hemodynamic parameters such as heart rate and blood pressure were noted just before the (basal) administration of the drug, and in operation room, readings were recorded before intubation (T0) and after intubation at 1, 3, 5, and 10 min. Sedation and anxiety score were noted after 1 h of oral administration of the drug. Results: Mean arterial pressure was well attenuated by pregabalin than others, and mean heart rate following laryngoscopy and intubation was attenuated by clonidine group significantly. Conclusion: We conclude that oral pregabalin and gabapentin attenuate blood pressure response fairly well and heart rate significantly attenuated by clonidine. All three drugs are very effective for relieving anxiety and improving sedation.
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Postoperative analgesic efficacy of bilateral transversus abdominis plane block in patients undergoing midline colorectal surgeries using ropivacaine: A randomized, double-blind, placebo-controlled trial
Anesthesia: Essays and Researches 2017 11(3):767-772
Background: Ultrasound-guided transversus abdominis plane (TAP) block is done as a part of multimodal analgesia for pain relief after abdominal surgeries. This prospective randomized, double-blind, placebo-controlled trial was conducted to evaluate the postoperative analgesic efficacy of bilateral TAP block in patients undergoing midline colorectal surgeries using ropivacaine. Materials and Methods: Eighty patients scheduled for elective colorectal surgeries involving midline abdominal wall incision under general anesthesia were enrolled in this prospective randomized controlled trial. Group A received TAP block with 20 ml of 0.2% ropivacaine on either side of the abdominal wall, and Group B received 20 ml of normal saline. The time to request for rescue analgesia, total analgesic consumption in 24 h, and satisfaction with the anesthetic technique were assessed. Results: The mean visual analog scale scores at rest and on coughing were higher in control group (P > 0.05). Time (min) to request for the first rescue analgesia was prolonged in study group compared to control group (P < 0.001). The total tramadol consumption in 24 h postoperatively was significantly high in control group (P < 0.001). Nausea/vomiting was more common in control group (P > 0.05). The level of satisfaction concerning postoperative pain control/anesthetic technique was higher in study group (P < 0.001). Conclusion: TAP block produces effective and prolonged postoperative analgesia in patients undergoing midline colorectal surgery. It is a technically simple block to perform with a high margin of safety. It produces a considerable reduction in mean intravenous postoperative tramadol requirements, reduction in postoperative pain scores, and increased time to first request for further analgesia, both at rest and on movement.
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A prospective comparative observational study of clinical efficacy of isobaric ropivacaine 0.75% with of isobaric bupivacaine 0.5% intrathecally in elective inguinal hernia repair surgeries
Anesthesia: Essays and Researches 2017 11(3):561-566
Aims: To evaluate the efficacy of intrathecal isobaric Ropivacaine and its comparison with intrathecal isobaric Bupivacaine in elective inguinal hernia repair surgeries. Settings and Design: A prospective, randomized study was conducted in a tertiary care hospital with 80 patients of ASA grade I-III undergoing elective inguinal hernia repair surgery under spinal anaesthesia .Ethical committee clearance and written consent taken. The patients were randomly divided into two equal groups to the Ropivicaine group (Group R) and to theBupivicaine group (Group B). Parameters observed were onset and duration of sensory and motor block, maximum sensory level achieved degree of motor blockade, two segment regression, and haemodynamic changes. Results: The development of sensory block was faster with Isobaric Ropivicaine (12.1 ± 4.9 minutes) as than isobaric Bupivicaine (13.94 ± 4.52 minutes) but the difference was not statistically significant. Onset of Grade III Motor block was longer with Isobaric Ropivicaine (8.51 ± 3.39 minutes) as compared to isobaric Bupivicaine ( 8.51 ± 3.39 minutes), but the difference was not statistically significant. Time of Complete Sensory Regression was significantly shorter with Isobaric Ropivicaine (212.69 ± 27.31 minutes) with statistical significance. Time to complete motor recovery was significantly shorter in Ropivacaine group (253.38 ± 27.13 minutes)as compared to Bupivacaine group (258.55 ± 35.81min), with statistical significance.Time to achieve discharge criteria was relatively shorter with Isobaric Ropivicaine. Haemodynamic Parameters did not differ significantly in both the groups during the entire study period. Conclusion: Intrathecal administration of isobaric Ropivacaine (0.75%) 15 mg provides similar quality of spinal anaesthesia but of significantly shorter duration, maintaining similar hemodynamic stability and discharge criteria without significant adverse effects when compared to isobaric Bupivicaine (0.5%) 10 mg.
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A complication after percutaneous nephrolithotomy: Anesthesia mumps
Anesthesia: Essays and Researches 2017 11(3):794-796
Some surgical procedures performed under moderate and sometimes extreme positions expose patients to nonphysiological changes. Especially, the manipulations of a patient in prone and lateral decubitus position might increase complications. Anesthesia mumps has been reported as one of these complications. It has been found to be rare but known entity associated with patients of all age groups and all surgical positions. We herein describe an early noticed acute case of unilateral anesthesia mumps that developed after endotracheal intubation in prone position in a 54-year-old female. Anesthesia mumps may occur in the immediate postoperative period with no suspicious predisposing factor. The reports of such cases would increase the awareness among anesthesiologists and postoperative caregivers regarding this benign complication.
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Efficacy of tramadol or dexamethasone as an adjuvant to levobupivacaine in ultrasound-guided supraclavicular plexus block for upper limb surgery: A randomized double-blinded controlled study
Anesthesia: Essays and Researches 2017 11(3):567-571
Aims and Objectives: To evaluate the efficacy of tramadol or dexamethasone as an adjuvant to levobupivacaine in ultrasound-guided supraclavicular brachial plexus block in terms of onset time of complete sensory and motor blockade, duration of motor blockade, duration of analgesia, and any complication. Settings and Design: This was a randomized controlled trial conducted in the Department of Anesthesiology, a tertiary care hospital. Materials and Methods: Sixty consecutive patients of the American Society of Anesthesiologists physical status Class I and II who were posted for upper limb surgeries were recruited. Patients were divided into two groups of thirty patients each. Group T (tramadol) received 20 ml of 0.5% levobupivacaine with 100 mg tramadol, and Group D (dexamethasone) received 20 ml of 0.5% levobupivacaine with 8 mg dexamethasone under ultrasound guidance. Sensory and motor block assessment was done every 2 min until the development of complete sensory and motor block till 45 min. Verbal numerical rating scale score was assessed in postoperative ward at regular intervals. Patients were followed up to check for any residual neurological deficits. Results: There was no statistical difference in demographic data between the two groups. The onset time of sensory and motor blockade shows no significant difference between groups. The mean time duration of motor blockade in Group T was 764.63 min and for Group D was 1150.27 min which was statistically significant (P < 0.05). The duration of analgesia in Group D was 1300.83 min and in Group T was 820.47 min which was statistically significant (P < 0.05). Side effects such as nausea, vomiting, pruritis, hypoxemia, and long-term neurological deficits were not reported in any of the patients in either group. Conclusion: Dexamethasone 8 mg as an adjuvant to 0.5% levobupivacaine for supraclavicular brachial plexus block using ultrasound guidance increases the duration of analgesia in comparison to 100 mg tramadol and provides excellent postoperative pain-free period without any neurological deficits.
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Glucose for children during surgery: Pros, cons, and protocols: A postgraduate educational review
Anesthesia: Essays and Researches 2017 11(3):539-543
The question of whether glucose supplementation is required in children during surgery is still under debate. The impact of perioperative glucose supplementation, or its restriction, on their metabolism remains unclear. We discuss the findings of various studies that have addressed this question and the rationale for current recommendations.
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Evaluating the efficacy of tramadol as an adjuvant to intrathecal isobaric levobupivacaine for elective infraumbilical surgeries
Anesthesia: Essays and Researches 2017 11(3):572-577
Background: Long-acting local anesthetics are used in subarachnoid block to increase the duration of anesthesia. Adjuvants are added to improve the duration of analgesia. Settings: Randomized controlled trial was conducted in the Department of Anesthesiology in a tertiary care hospital.Aims and Objectives: The objective of this study was to evaluate the efficacy of low-dose tramadol as an intrathecal adjuvant to levobupivacaine in terms of duration of analgesia, onset of sensory blockade, onset of motor blockade, and duration of motor blockade. Methodology: After obtaining the Institutional Ethics Committee approval and informed consent, sixty patients posted for infraumbilical surgeries were recruited. Randomization was done using a sealed envelope technique. Patients were divided into two groups: LT received 3 ml of 0.5% isobaric levobupivacaine with tramadol 10 mg (0.2 ml) and LS received 3 ml of 0.5% isobaric levobupivacaine with 0.2 ml of normal saline. Duration of analgesia, onset of sensory blockade, and onset and duration of motor blockade were recorded. Results: There was no statistical difference in demographic data between the two groups. The mean onset time of sensory blockade in Group LS was 12.7 ± 9.81 min and for Group LT was 12.9 ± 0.81 min, which was not statistically significant between two groups (P = 0.93). The mean onset time of motor blockade in Group LS was 13.4 ± 10 min and for Group LT was 14.4 ± 10 min, which was no statistically significant between the two groups (P = 0.71). The mean time duration of analgesia in Group LS was 170.3 ± 59 min and for LT was 198.9 ± 57.33 min. There was mild prolongation of analgesia in Group LT, but it was not statistically significant (P = 0.0615). The mean duration of motor blockade in Group LS was 170.23 ± 58 min and Group LT was 190.76 ± 4 min, which was not statistically significant between the two groups (P = 0.14). Conclusion: Low-dose tramadol as an adjuvant to isobaric intrathecal levobupivacaine does not prolong analgesia significantly.
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Referrral systems development and survey of perioperative and critical care referral to anesthetists
Anesthesia: Essays and Researches 2017 11(3):702-712
Introduction: Anesthetists come in contact with more than two-third of hospital patients. Timely referral to anesthetists is vital in perioperative and remote site settings. Delayed referrals, improper referrals, and referrals at inappropriate levels can result in inadequate preparation, perioperative complications, and poor outcome. Methods: The self administered paper survey to delegates attending anesthesia conferences. Questions were asked on how high-risk, emergency surgical cases remote site and critical care patients were referred to anesthetists and presence of rapid response teams. Results: The response rate was 43.8%. Sixty percent (55.3–64.8, P - 0.001) reported high-risk elective cases were referred after admission. Sixty-eight percent (63.42–72.45, P - 0.001) opined preoperative resting echocardiographs were useful. Six percent (4.16–8.98, P - 0.001) reported emergency room referral before arrival of the patient. Twenty-five percent (20.92–29.42, P - 0.001) indicated high-risk obstetric cases were referred immediately after admission. Consultants practiced preoperative stabilization more commonly than residents (32% vs. 22%) (P - 0.004). For emergency surgery, resident referrals occurred after surgery time was fixed (40% vs. 28%) (P - 0.012). Residents dealt with more cases without full investigations in obstetrics (28% vs. 15) (P = 0.002). Remote site patients were commonly referred to residents after sedation attempts (32% vs. 20%) (P = 0.036). Only 34.8 said hosptals where tbey practiced had dedicated cardiac arrest team in place. Conclusions: Anesthetic departments must periodically assess whether subgroups of patients are being referred in line with current guidelines. Cancellations, critical incidents and complications arising out of referral delays, and improper referrals must be recorded as referral incidents and a separate referral incident registry must be maintained in each department. Regular referral audits must be encouraged.
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A survey of current practice of supraglottic airway devices in pediatric anesthesia from India
Anesthesia: Essays and Researches 2017 11(3):578-582
Background and Objectives: Supraglottic airway devices (SADs) have revolutionized the pediatric anesthetic practice and got a key role in difficult airway (DA) management. Several modifications of SADs design had come up to improve their safety. Aim: The aim of this survey was to determine the current usage of SADs in pediatric anesthetic practice, their availability, and to know any difficulties noted in practice. Methods: It was a questionnaire survey among the anesthesiologists who attended the National Pediatric Anesthesia Conference-2016. The questionnaire assessed the current practice preferences of SADs in routine pediatric cases and DA management, availability of various devices, and any difficulties noted in their usage. Results: First-generation SADs were widely available (97%), and 64% of respondents preferred to use it for pediatric short cases. 64% felt the use of SADs free their hands from holding the facemask and 58% found better airway maintenance with it. Intraoperative displacement (55%) was the common problem reported and only 11% felt aspiration as a problem. Most of the respondents (73%) accepted its use as rescue device in airway emergency, and 84% felt the need of further randomized controlled studies on safety of SADs in children. The majority were not confident to use SADs in neonates. Interpretation and Conclusions: The key role of SADs in DA management was well accepted, and aspiration was not a major problem with the use of SADs. Although many newer versions of SADs are available, classic laryngeal mask remains the preferred SAD for the current practitioner. Further, RCTs to ensure the safety of SADs in children are warranted.
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To evaluate the efficacy of fentanyl and dexmedetomidine as adjuvant to ropivacaine in brachial plexus block: A double-blind, prospective, randomized study
Anesthesia: Essays and Researches 2017 11(3):730-739
Context: Anesthesia and analgesia for surgeries to the upper extremity are commonly provided using brachial plexus anesthesia. There are limited or almost no studies comparing the use of ropivacaine with fentanyl to ropivacaine with dexmedetomidine. Aims: To compare the efficacy of fentanyl and dexmedetomidine as adjuvants to ropivacaine for brachial plexus block among patients undergoing upper limb orthopedic surgeries. Settings and Design: This was a prospective, randomized, double-blinded study. Subjects and Methods: The patients were randomly divided into three groups of 35 each using computerized randomization table. Group I patients received 3 mg/kg of 0.75% ropivacaine with 1 μg/kg of fentanyl diluted with normal saline (NS) to make a total volume of 35 ml. Group II patients received 3 mg/kg of 0.75% ropivacaine with 1 μg/kg of dexmedetomidine diluted with NS to make a total volume of 35 ml. Group III patients received 3 mg/kg of 0.75% ropivacaine with NS making a total volume of 35 ml. Statistical Analysis Used: Statistical analysis was performed using Statistical Package for Social Sciences, version 15.0. Analysis of variance followed by independent samples t-test was performed for parametric data, and Kruskal–Wallis test followed by Mann–Whitney U-test was performed for nonparametric data. Results: Mean motor and sensory block onset time was minimum in Group I and maximum in Group III while mean duration of sensory and motor block was maximum in Group I and minimum in Group III. Time taken for first rescue analgesic dose was also maximum in Group I and minimum in Group III. Conclusions: It can be concluded that 3 mg/kg of 0.75% ropivacaine along with 1 μg/kg of fentanyl diluted with NS to make a total volume of 35 ml was the most efficacious regimen for brachial plexus block among patients undergoing upper limb orthopedic surgeries.
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Comparative efficacy of minimal concentration of racemic bupivacaine (0.0625%) with fentanyl and ropivacaine (0.1%) with fentanyl for epidural labor analgesia
Anesthesia: Essays and Researches 2017 11(3):583-588
Background and Aims: This study aims to compare the minimum effective concentration of local anesthetic (LA) bupivacaine and ropivacaine with highly lipid soluble opioids fentanyl for providing optimal labor epidural analgesia. Settings and Design: The objective of this study was to evaluate the efficacy of racemic bupivacaine 0.0625% and 0.1% of ropivacaine both mixed with 2 μg/ml of fentanyl for epidural labor analgesia in parturients with spontaneous labor and normal fetal heart rate tracing. Methodology: Sixty parturients requesting for labor analgesia were divided into two groups. Group B (n = 30) received racemic bupivacaine (0.0625%) and fentanyl 2 μg/ml of 10 ml and Group R (n = 30) received ropivacaine (0.1%) and fentanyl 2 μg/ml. In both groups, the drug was given in 5 ml fractionated doses at 5 min interval. Parturients not experiencing analgesia within 15 min of initial bolus were supplemented with additional 5 ml of the same concentration of the solution. Epidural analgesia was maintained by timed top ups at the end of 90 min with the dosage equal to the initial dose of the drug. Duration of labor analgesia, motor block, visual analog scale, maternal hemodynamic parameters, mode of delivery, and maternal satisfaction was assessed. Statistical Analysis: Data were analyzed with odds variance, unpaired t-test, and Chi-square tests. P < 0.05 was considered statistically significant. Results: In our study, results indicate that both drugs were equally effective clinically. Maternal demographic characteristics were comparable. There were no statistically significant differences in visual analog pain score, highest sensory block, maternal satisfaction, mode of delivery, total dose of LAs during labor and motor block at delivery between the groups. Conclusions: In our study, both the drugs produced equivalent analgesia for labor at low concentration when used with highly lipid soluble opioid such as fentanyl.
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Single minute of positive end-expiratory pressure at the time of induction: Effect on arterial blood gases and hemodynamics in morbidly obese patients undergoing laparoscopic bariatric surgery
Anesthesia: Essays and Researches 2017 11(3):758-761
Background: The effect of positive end-expiratory pressure (PEEP) has been studied in detail after induction of general anesthesia especially in obese individuals. However, sparse information can be gathered from the literature regarding its effect when applied at the time of induction and the time of onset of its effect. Thus, this study was planned to assess the effect of PEEP when applied for a single minute in morbidly obese patients. Materials and Methods: This was a randomized prospective study comprising seven morbidly obese patients (body mass index ≥40 kg/m2). Control group included 30 patients who received no PEEP at the time of induction. The study group consisted of thirty patients who were given a PEEP of 10 cmH2O. Serial arterial blood gas samples were taken preoperatively, at the time of intubation, 5 min after intubation and 10 min after intubation. Results: PaO2was significantly higher in test group (242.0 ± 116.0 mmHg) than in control group (183.0 ± 107.0 mmHg) just after intubation. PaCO2was comparable in control group (43.73 ± 6.32 mmHg) and test group (44.52 ± 6.33 mmHg) just after intubation but was significantly less in test group than in control group at 5 and 10 min thereafter. Hemodynamic parameters were comparable in both groups at all time intervals. Conclusion: Application of even a single minute of PEEP at the time of induction improves oxygenation without any adverse effects on hemodynamics, in morbidly obese patients undergoing laparoscopic Bariatric surgery.
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Morphoproteomics, E6/E7 in-situ hybridization, and biomedical analytics define the etiopathogenesis of HPV-associated oropharyngeal carcinoma and provide targeted therapeutic options
Abstract
Background
Human papillomavirus (HPV) has been identified as an etiopathogenetic factor in oropharyngeal squamous cell carcinoma. The HPV E6 and E7 oncogenes are instrumental in promoting proliferation and blocking differentiation leading to tumorigenesis. Although surgical intervention can remove such tumors, the potential for an etiologic field effect with recurrent disease is real. A downstream effector of E7 oncoprotein, enhancer of zeste homolog 2 (EZH2), is known to promote proliferation and to pose a block in differentiation and in turn, could lead to HPV-induced malignant transformation. However, the EZH2 pathway is amenable to low toxicity therapies designed to promote differentiation to a more benign state and prevent recurrent disease by inhibiting the incorporation of HPV into the genome. This is the first study using clinical specimens to demonstrate EZH2 protein expression in oropharyngeal carcinoma (OPC).
Methods
The study included eight patients with oropharyngeal carcinoma, confirmed p16INK4a- positive by immunohistochemistry (IHC). The tissue expression of E6/E7 messenger RNA (mRNA) was measured by RNAscope® in-situ hybridization technology. Expression of EZH2, Ki-67, and mitotic indices were assessed by morphoproteomic analysis. Biomedical analytics expanded the results with data from Ingenuity Pathway Analysis (IPA) and KEGG databases to construct a molecular network pathway for further insights.
Results
Expression of E6 and E7 oncogenes in p16INK4a- positive oropharyngeal carcinoma was confirmed. EZH2 and its correlates, including elevated proliferation index (Ki-67) and mitotic progression were also present. Biomedical analytics validated the relationship between HPV- E6 and E7 and the expression of the EZH2 pathway.
Conclusion
There is morphoproteomic and mRNA evidence of the association of p16INK4a-HPV infection with the E6 and E7 oncogenes and the expression of EZH2, Ki-67 and mitotic progression in oropharyngeal carcinoma. The molecular network biology was confirmed by biomedical analytics as consistent with published literature. This is significant because the biology lends itself to targeted therapeutic options using metformin, curcumin, celecoxib and sulforaphane as therapeutic strategies to prevent progression or recurrence of disease.
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Adolescent Weapon Carrying and Use: Are the Correlates Gendered?
Violence and Gender , Vol. 0, No. 0.
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Lesión del conducto torácico a nivel cervical de forma espontánea: a propósito de un caso
Publication date: Available online 12 August 2017
Source:Acta Otorrinolaringológica Española
Author(s): Natalia Rodriguez, Maria Luisa Navarrete, Cesar Ortiz, Shelagh Dyer
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Miringoplastia con cartílago en alas de mariposa. Nuestra experiencia
Publication date: Available online 12 August 2017
Source:Acta Otorrinolaringológica Española
Author(s): Paula Cruz Toro, Ángela Callejo Castillo, Rafael Moya Martínez, Iván Domenech Juan
IntroducciónSe han propuesto múltiples técnicas quirúrgicas para cerrar perforaciones timpánicas. Eavey, hace dos décadas, describió una técnica destinada a cerrar perforaciones centrales en niños. Para ello diseñó un injerto de cartílago con forma de alas de mariposa que se colocaba entre la membrana timpánica. Dicha técnica demostró gran efectividad para el cierre de perforaciones así como baja morbilidad, rapidez y gran diferencia económica.MétodosSe realiza un estudio descriptivo de serie de casos analizando 32 intervenciones en niños y adultos con la técnica de Eavey modificada, durante el periodo de enero de 2012 a noviembre de 2016. Se evaluaron los resultados quirúrgicos y los resultados funcionales audiométricos.ResultadosEl éxito quirúrgico se logró en el 93% de los casos, incluyendo los cierres completos en 27 pacientes (84%) y 3 casos en los que se presentaron dehiscencias mínimas asintomáticas. Se presentó un rechazo del injerto y persistencia de la perforación y en un caso una perforación residual. No se describen complicaciones quirúrgicas o posquirúrgicas mayores asociadas al procedimiento. La mejoría de la media del gap audiométrico fue de 17dB preoperatorio a 7dB posterior a la intervención.ConclusionesLa técnica de Eavey modificada es un procedimiento con baja morbilidad, costo-efectiva, con facilidad técnica que demuestra ser eficaz para el cierre de perforaciones timpánicas en adultos y niños.IntroductionMultiple surgical techniques have been proposed to close tympanic perforations. Eavey, two decades ago, described a technique aimed at closing central perforations in children. For this, he designed a butterfly-shaped cartilage graft that was placed between the tympanic membrane in an inlay manner. This technique showed great effectiveness for the closure of perforations as well as low morbidity, rapidity and great economic difference.MethodsWe performed a descriptive study of a series of cases analysing 32 interventions in children and adults with the modified Eavey technique, during the period from January 2012 to November 2016. We evaluated the surgical and audiometric functional results.ResultsSurgical success was achieved in 93% of cases, including complete closures in 27 patients (84%) and 3 cases in which minimal asymptomatic dehiscences occurred. There was rejection of the graft and persistence of the perforation in only one case. No major surgical or postoperative complications associated with the procedure were described. The mean improvement in the audiometric gap was from 17dB preoperatively to 7dB after the intervention.ConclusionsThe modified Eavey technique is a low morbidity, cost-effective procedure with a technical facility that proves effective for the closure of tympanic perforations in adults and children.
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Aplicación de la biopsia por endoscopia flexible en el diagnóstico de la patología tumoral en otorrinolaringología
Publication date: Available online 14 August 2017
Source:Acta Otorrinolaringológica Española
Author(s): Carlos Saga, Manuel Olalde, Ekhiñe Larruskain, Leire Álvarez, Xabier Altuna
Introducción y objetivosLa endoscopia intervencionista nos permite actuar sobre la patología del paciente con mínimas molestias, bajos costes y alta eficiencia. Evaluamos la validez de la biopsia por endoscopia flexible en nuestro hospital, en las lesiones sospechosas de malignidad en el espacio rinofaringolaríngeo.Material y métodoEstudio retrospectivo de los pacientes con patología sospechosa de malignidad valorados en el periodo 2006-2016 en nuestro centro. Valoramos la eficacia, la tolerancia y número de complicaciones. Calculamos la reducción de costes frente a la laringoscopia directa en quirófano. Comparamos nuestra muestra con otras de características similares descritas en la bibliografía.ResultadosTreinta pacientes fueron estudiados mediante biopsia por endoscopia flexible en ese período. Diecinueve pacientes obtuvieron resultados positivos que permitieron iniciar el tratamiento de su patología. Siete casos, sin evidencia de malignidad, requirieron nueva biopsia bajo anestesia general que confirmó el diagnóstico de carcinoma. Dos muestras descartaron malignidad, dato que se confirmó tras microcirugía de laringe. Un caso mostró inflamación y la lesión se resolvió tras antibioterapia. En un caso la toma de muestra resultó imposible. Obtenemos de esta forma niveles de sensibilidad del 73% con una especificidad del 100%. No se produjeron complicaciones. La reducción de costes en nuestra muestra fue superior al 80%.ConclusionesLa biopsia por endoscopia flexible aporta ventajas sobre la laringoscopia directa que resultan de interés en el diagnóstico de patología oncológica en otorrinolaringología.Introduction and objectivesInterventional endoscopy allows us to act on the pathology of the patient with minimal discomfort, low costs and high efficiency. We assessed the validity of flexible endoscopic biopsies in our hospital, in lesions suspected of malignancy in the rhino-pharyngo-laryngeal space.Subjects and methodsRetrospective study of patients with a pathology suspected of malignancy assessed between 2006-2016 in our centre. We evaluated the effectiveness, the tolerance and the number of complications. We calculated the cost reduction in comparison with direct laryngoscopy in the operating room. We compared our sample with others of similar characteristics described in the literature.ResultsThirty patients were studied with a flexible endoscopic biopsy during that period. Nineteen patients obtained positive results which allowed them to start treatment for their pathology. Seven cases had no evidence of malignancy and required another biopsy under general anaesthesia, which confirmed the carcinoma diagnosis. Two samples ruled out malignancy which was confirmed by laryngeal microsurgery. One case showed inflammation and the lesion was cured after antibiotherapy. It was impossible to collect the sample in one case. Thus, we obtained sensitivity levels of 73% with a specificity of 100%. There were no complications. The cost reduction in our sample was above 80%.ConclusionsFlexible endoscopic biopsy has advantages over direct laryngoscopy that are relevant in the diagnosis of oncological pathology in otorhinolaryngology.
http://ift.tt/2v5Y3Wg
Summary of the British Transplantation Society UK Guidelines for Hepatitis E and Solid Organ Transplantation.
The incidence and prevalence of hepatitis E virus (HEV) infection has increased in many developed countries over the last decade, predominantly due to infection with genotype 3 (G3) HEV. Infection with HEV G3 is important in transplant recipients because it can persist in immunosuppressed individuals, leading if untreated to the development of chronic hepatitis and significant liver fibrosis. The British Transplantation Society (BTS) has developed Guidelines for "Hepatitis E & Solid Organ Transplantation" to inform clinical teams and patients about hepatitis E, to help increase the recognition of persistent hepatitis E infection, and to provide clear guidance on its management. This guideline was published on the BTS website in June 2017 and aims to review the evidence relating to the diagnosis and management of persistent hepatitis E in solid organ transplant recipients, and the methods of prevention of HEV infection. In line with previous guidelines published by the BTS, the guideline has used the GRADE system to rate the strength of evidence and recommendations. This article includes a summary overview of hepatitis E and transplantation with key references, and the statements of recommendation contained within the guideline. It is recommended that the full guideline document is consulted for complete details of the relevant references and evidence base. This may be accessed at http://ift.tt/2w6lROe Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2vNj0aG
http://ift.tt/2vNj0aG
Everolimus is Associated With Less Weight Gain Than Tacrolimus 2 Years Following Liver Transplantation: Results of a Randomized Multicenter Study.
Background: Weight gain early after transplant is a risk factor for posttransplant metabolic syndrome (PTMS), cardiovascular events, and renal insufficiency. The impact of mTOR inhibition on posttransplant weight gain and the development of PTMS components postliver transplantation were examined in a randomized, controlled study. Methods: Following a run-in period, patients (N = 719) were randomized at 30+/-5 days posttransplant in a 1:1:1 ratio to 3 treatment groups: (i) everolimus (EVR) + reduced tacrolimus (TAC)(n=245); (ii) TAC control (n=243) or (iii) TAC elimination (n=231). In this posthoc analysis, weight change at 12 and 24 months was compared between groups. Vital signs, lipids and laboratory parameters at 12 and 24 months and rates of PTMS were assessed. Results: Mean increase in weight from baseline was higher at month 12 in the TAC control arm (8.15 +/- 9.27 kg) than in the EVR + reduced TAC (5.88 +/- 12.60 kg, P=0.056) and the TAC elimination arms (4.76 +/- 9.94 kg, P=0.007). At month 24, the TAC control arm displayed a significantly greater weight increase (9.54 +/- 10.21 kg) than either the EVR + reduced TAC (6.69 +/- 8.37 kg, P=0.011) or the TAC elimination groups (6.01 +/- 9.98 kg, P=0.024). Rates of PTMS were similar for the EVR + reduced TAC (71.8%), TAC elimination (70.3%) and TAC control (67.4%) arms (P=NS). Conclusions: EVR with reduced-exposure TAC attenuated weight gain at 1 and 2 years posttransplant compared to a standard tacrolimus immunosuppression regimen. Rates of PTMS were comparable between EVR-containing and TAC control regimens. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2w6pcx4
http://ift.tt/2w6pcx4
Dermatological Evaluation in Patients With Skin of Colour
A new study examines the clinical challenges and gaps in detection of erythema in patients with heavily pigmented skin. Are commonly used outcome measures reliable in persons of color?
The British Journal of Dermatology
http://ift.tt/2w6k8ZA
Teens and Plastic Surgery: 10 Key Points to Consider
When are plastic surgery and other cosmetic procedures appropriate for adolescents? Here are key guidelines for ethical plastic surgery in teens.
Medscape Plastic Surgery
http://ift.tt/2wdkpdq
Novel molecular defects associated with very early-onset inflammatory bowel.
Purpose of review: Immune dysregulation disorders present with common clinical features of multiorgan autoimmunity. Gastrointestinal involvement is the hallmark of an impaired immune homeostasis. This review will give an overview on the novel phenotypes, highlighting the major points that will help to enable early diagnosis and treatment. Recent findings: The rapid progress on DNA sequencing technologies have led to the identification of monogenic defects that adversely impact the control of immune homeostasis. Lymphocytes may be present but dysfunctional, allowing for the development of excessive autoreactivity and resultant autoimmune disease. Regulatory T cells (Tregs) play an essential role in enforcing immune tolerance. Here we illustrate disorders caused by impairment of mechanisms ensuring Tregs function (Tregs related) in which autoimmunity is a hallmark of the clinical disease presentation and other disorders, affecting molecules more broadly involved in immune responses and indirectly causing immune dysregulation (Tregs unrelated). Clinical presentation is sometime mischievous and often symptoms are analogous in different diseases and can mislead diagnosis. Summary: The increasing comprehension of immunological concepts behind immune dysregulation diseases will allow better and in some cases possibly even targeted treatment. A genetic diagnosis therefore becomes important information in this group of patients, especially as some patients might require hematopoietic stem cell transplantation. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2vN1lj2
http://ift.tt/2vN1lj2
Topical ionic contra viral therapy comprised of digoxin and furosemide as a potential novel treatment approach for common warts
Abstract
Background
DNA viruses such as HPV rely on K+ influx for replication. Both digoxin and furosemide inhibit the K+ influx by interacting with cell membrane ion co-transporters (Na+/K+-ATPase and Na+-K+-2Cl- co-transporter-1, respectively). We therefore hypothesized that these two compounds in a topical formulation may be valuable in the treatment of HPV-induced warts. This new approach is called Ionic Contra-Viral Therapy (ICVT).
Objective
To evaluate systemic exposure, safety and tolerability of ICVT with a combination of furosemide and digoxin after repeated topical application in subjects with common warts. Furthermore, we aimed to evaluate pharmacodynamics effects of ICVT.
Methods
Twelve healthy subjects with at least four common warts on their hands were included in the study and treated with a fixed dose of 980 mg topical gel containing 0.125% (w/w) digoxin and 0.125% (w/w) furosemide for 7 consecutive days on their lower back to assess safety and systemic exposure. Two warts were treated with 10 mg each and two served as negative controls to obtain preliminary evidence of treatment effect.
Results
ICVT was well tolerated topically, and there was no evidence of systemic exposure of digoxin or furosemide. There were no clinical relevant safety findings and no serious adverse events (SAEs). A rapid and statistically significant reduction of diameter, height and volume of the warts was already observed at day 14.
Conclusion
ICVT was found to be safe for administration to humans and 7 days of active treatment showed a statistical significant wart reduction compared to untreated control lesions, clearly indicating pharmacological activity.
This article is protected by copyright. All rights reserved.
http://ift.tt/2x8dJKb
Localized argyria: Troublesome side effect of acupuncture
Abstract
Acupuncture is among the most popular of all complementary or alternative therapies. In recent years, adverse effects of acupuncture have been discussed more intensively than ever before. Serious adverse events resulting from acupuncture have been identified in previous literature reviews.1 Localized argyria is an uncommon condition, which is a side effect of acupuncture.2
This article is protected by copyright. All rights reserved.
http://ift.tt/2fPuWod
Participation of cyclooxigenase-2 in lip carcinogenesis
Abstract
Inflammation is recognized as one of the earliest events of carcinogenesis. In the tumor microenvironment, cyclooxygenases (COX) act as mediators of the inflammatory pathomechanisms. COX-2 plays a role in the tumorigenic process through stimulation of cell proliferation, angiogenesis, inhibition of apoptosis, and modification of cell adhesion molecules.1,2 Despite its well-explored function in ultraviolet (UV)-induced skin cancer, little is known about COX-2 influence on lip carcinogenesis.
This article is protected by copyright. All rights reserved.
http://ift.tt/2i9Rwsn
Large nose angiosarcoma treated effectively with oral cyclophosphamide combined with propranolol
Abstract
Angiosarcomas are rare soft-tissue tumors of endothelial cell origin. They are associated with high rates of local recurrence and poor prognosis1. The standard of care for cutaneous angiosarcomas is surgical excision. In some cases, surgery is not possible because too mutilating. In these indications, only few chemotherapeutic drugs are available, i.e.paclitaxel or doxorubicin (with a progression-free survival (PFS) of 3.7-5.4 months for doxorubicin2).
This article is protected by copyright. All rights reserved.
http://ift.tt/2ialzAt
Morbihan Disease: Successful treatment with Slow-Releasing Doxycycline monohydrate
Abstract
Morbihan Disease (MD), designated so after the place of origin of the first ever reported patient by R. Degos in 1957, is a rare disorder of unknown etiology, characterized by a persistent, erythematous, non-pitting, solid edema of the middle and upper third of the face with a non-specific histology1. The hallmark of MD is its refractoriness to treatment, oral isotretinoin and tetracyclines being the most successful therapeutic approaches.
This article is protected by copyright. All rights reserved.
http://ift.tt/2fPuK8t
Langerhans Cell: Exciting Developments in Health and Disease
Abstract
Langerhans cells (LCs) have been the subject of much research since their discovery in 1868. LCs belong to the subset of leukocytes called dendritic cells. They are present in the epidermis and the pilosebaceous apparatus and monitor the cutaneous environment for changes in homeostasis. During embryogenesis, a wave of yolk-sac macrophages seed the fetal skin. Then, fetal liver monocytes largely replace the yolk-sac macrophages and comprise the majority of adult LCs. In the presence of skin irritation, LCs process antigen and travel to regional lymph nodes to present antigen to reactive T lymphocytes. Changes in LCs' surface markers during the journey occur under the influence of cytokines. The difference in expression of surface markers and the ability to resist radiation have allowed researchers to differentiate LCs from the murine Langerin-positive dermal dendritic cells. Exciting discoveries have been made recently regarding their role in inflammatory skin diseases, cancer, and HIV. New research has shown that antibodies blocking CD1a appear to mitigate inflammation in contact hypersensitivity reactions and psoriasis. While it has been established that LCs have the potential to induce effector cells of the adaptive immune system to counter oncogenesis, recent studies have demonstrated that LCs coordinate with natural killer cells to impair development of squamous cell carcinoma caused by chemical carcinogens. However, LCs may also physiologically suppress T cells and permit keratinocyte transformation and tumorigenesis. Although long known to play a primary role in the progression of HIV infection, it is now understood that LCs also possess the ability to restrict the progression of the disease. There is a pressing need to discover more about how these cells affect various aspects of health and disease; new information gathered thus far seems promising and exciting.
This article is protected by copyright. All rights reserved.
http://ift.tt/2i8v2Im
The impact of atopic dermatitis on work life – a systematic review
Abstract
Background
Atopic dermatitis (AD) has considerable multidimensional personal and societal costs. However, the extent to which the patient's work life is affected due to AD is more sparsely described in the literature.
Objective
To examine the impact on work life for patients with AD, with a specific focus on choice of education and occupation, sick leave, social compensations and change of job due to AD.
Methods
A systematic literature search was performed in PubMed, EMBASE and Web of Science up to 7th February 2017 for articles on the impact on work life for patients with atopic dermatitis. Results were summarized taking several measures of study quality into account.
Results
23 articles were found eligible. 5 studies assessed the influence of AD on educational or job choice, without any consistent conclusion, while 8 out of 9 studies with respect to sick leave and 2 on disability pensions found AD to have a negative impact. Studies of change or loss of job and AD showed more diverse results, as not all studies documented a negative effect of AD on work life.
Conclusions
AD imposes a burden extending beyond personal, emotional and financial costs. This review strongly implies that AD affects sick leave, and though not fully clarified, possible also job choice, change or loss of job and even disability pensions for the more severe cases.
This article is protected by copyright. All rights reserved.
http://ift.tt/2fPuuGx
Bateman purpura (dermatoporosis): a localized scurvy treated by topical vitamin C – Double blind randomized placebo-controlled clinical trial
Summary
Background
Bateman purpura is characterized by diffuse senile skin atrophy, senile purpura and spontaneous stellar pseudo-cicatrices. Cutaneous changes in the course of aging have been related to lower levels of ascorbic acid into the dermis of elderly people.
Objective
In the present study, we postulate that senile purpura could be linked to dermal vitamin C deficiency and could be corrected by topical administration of this vitamin.
Methods
A 12-weeks, hemi-member (forearm or leg), randomized double-blind comparative study, was conducted in 18 patients with Bateman purpura aged over than 60 years. At each visit, clinical assessment and biometrological measurements were performed. Clinical examination and scoring by experts showed a significant improvement on the vitamin C-treated side compared with the control, with reduction of hemorrhage areas, increase of dermal thickness.
Results
Twice-daily application of 5% topical vitamin C led to a clinically apparent improvement of the skin symptoms and allows beneficial effects on skin elasticity and thickness. Bateman purpura, a classical sign of photoaging whose origin has not clearly been recognized could be improved by vitamin C applied on to the skin.
Conclusion
These results confirm the hypothesis of underlying of role vitamin C deficiency in the determinism of Bateman purpura.
This article is protected by copyright. All rights reserved.
http://ift.tt/2fNqXZu
Diffuse Parotid Swelling From an Underlying Parotid Mass
A child presented with left jaw pain and symptoms of an upper respiratory infection; the swelling resolved leaving a firm, slightly mobile, subcentimeter mass palpable in the anterior parotid gland that enlarged and became painful. What is your diagnosis?
http://ift.tt/2qxPogB
http://ift.tt/2qxPogB
Assumptions of Quality Medicine
This Viewpoint discusses the increasing pressure on physicians to provide safe, effective, patient-centered, timely, efficient, and equitable care to all patients and the potentially incorrect assumptions of the economic policies influencing decision making.
http://ift.tt/2rfF4K6
http://ift.tt/2rfF4K6
Incorrect Middle Initial in Byline
In the article titled "Free Flap Reconstruction Monitoring Techniques and Frequency in the Era of Restricted Resident Work Hours," an author's middle initial was incorrect in the byline. Jeremy D. Richmon's middle initial previously and incorrectly read "M." This article was corrected online.
http://ift.tt/2w5GN84
http://ift.tt/2w5GN84
The USPSTF Recommendation on Thyroid Cancer Screening
This Editorial reviews thyroid cancer diagnosis and mortality in light of the latest USPSTF recommendation against screening for the disease.
http://ift.tt/2qYx2mX
http://ift.tt/2qYx2mX
Surgeon Volume in Parathyroid Surgery
This study examines the association between surgeon volume and 30-day rates of complications, mortality, and postdischarge utilization among patients undergoing parathyroidectomy.
http://ift.tt/2oqCwFb
http://ift.tt/2oqCwFb
Cholesteatoma Risk Among Patients With Chronic Rhinosinusitis
This population-based study evaluates the risk of cholesteatoma in patients with chronic rhinosinusitis.
http://ift.tt/2qYyI2u
http://ift.tt/2qYyI2u
Patient-Reported Outcome Measures in Upper Airway–Related Dyspnea
This systematic review of upper airway dyspnea–related patient-reported outcome measures evaluates each measure's developmental properties, validation, and applicability.
http://ift.tt/2rQvXOJ
http://ift.tt/2rQvXOJ
Automated Posttonsillectomy Bleed Capture vs Self-report
This medical record review evaluates the feasibility and accuracy of an algorithm to capture posttonsillectomy bleeding in a single health care system compared with traditional self-reported bleeding by the surgical team.
http://ift.tt/2qXZsjW
http://ift.tt/2qXZsjW
Unilateral Nasal Congestion in an Elderly Man
An elderly man had right-sided nasal congestion and intermittent epistaxis; CT imaging of the sinuses revealed opacification of the right nasal cavity with tissue protruding into the nasopharynx and complete opacification of the sinuses. What is your diagnosis?
http://ift.tt/2u2Jm79
http://ift.tt/2u2Jm79
Evaluation of Monitored Anesthesia Care in Sialendoscopy
This cohort study compares the outcomes of sialendoscopy procedures in patients who underwent general anesthesia with endotracheal intubation or monitored anesthesia care.
http://ift.tt/2rvLZfA
http://ift.tt/2rvLZfA
Cognitive Training Program to Treat Tinnitus
To the Editor The recent randomized clinical trial by Kallogjeri et al on the effect of the Brain Fitness Program-Tinnitus (BFP-T) to treat tinnitus was interesting, but several limitations made me question the conclusions drawn by the authors.
http://ift.tt/2r6wXBb
http://ift.tt/2r6wXBb
Indocyanine Green Dye Angiography to Predict Postoperative Fistulas After Laryngectomy
This study examines whether noninvasive angiography with indocyanine green dye can be used to evaluate native pharyngeal vascularity to anticipate pharyngocutaneous fistula development after salvage laryngectomy in patients with head and neck cancer.
http://ift.tt/2qxF9Ja
http://ift.tt/2qxF9Ja
Perspectives on the Otolaryngology Residency Application Process
This survey study evaluates the perceptions of 2016 otolaryngology–head and neck surgery residency applicants regarding the application process and offers suggestions for reform.
http://ift.tt/2rZdWNd
http://ift.tt/2rZdWNd
An HIV-Positive Child With Gingival Mass
A young girl diagnosed as having varicella zoster encephalitis, cytomegalovirus retinitis, and HIV/AIDS had facial swelling and a violaceous, vascular-appearing lesion involving the left maxillary gingiva with numerous surrounding loose teeth.What is your diagnosis?
http://ift.tt/2qKJqWd
http://ift.tt/2qKJqWd
Analgesic Effects of Intravenous Acetaminophen vs Placebo for Endoscopic Sinus Surgery
This randomized clinical trial examines the use of intravenous acetaminophen vs placebo in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis.
http://ift.tt/2r11CyK
http://ift.tt/2r11CyK
A Supraclavicular Mass
A man presented with a 6-year history of a painless lump in the supraclavicular region; palpation detected a smooth, soft, and fluctuant mass, and computed tomography revealed a poorly circumscribed, heterogeneous, and cystic mass near the sternocleidomastoid muscle. What is your diagnosis?
http://ift.tt/2rl4ILf
http://ift.tt/2rl4ILf
Gender Disparities in Financial Relationships Between Industry and Academic Otolaryngologists
This study evaluates the existence of gender disparities in industry relationships with academic otolaryngologists.
http://ift.tt/2rfGpAD
http://ift.tt/2rfGpAD
Industry Sponsorship of Research in Otolaryngology
This cross-sectional analysis quantifies research payments made by the health care industry to otolaryngologists and compares the field of otolaryngology with other surgical specialties.
http://ift.tt/2o1vVSn
http://ift.tt/2o1vVSn
Gel-Forming Mucins and Aquaporin Gene Expression in Hearing Problems
This case-control study investigates the association of gel-forming mucins and aquaporin 5 gene expression with inflammation, effusion viscosity, and hearing loss in pediatric otitis media with effusion.
http://ift.tt/2rQ9ql3
http://ift.tt/2rQ9ql3
Rationale for neoadjuvant immunotherapy in head and neck squamous cell carcinoma
Source:Oral Oncology, Volume 73
Author(s): Glenn J. Hanna, Douglas R. Adkins, Paul Zolkind, Ravindra Uppaluri
The clinical benefit of immunotherapy in recurrent, metastatic head and neck squamous cell carcinoma has fueled interest in revisiting neoadjuvant approaches to complement definitive treatment. Neoadjuvant strategies incorporating immune checkpoint inhibitors and other novel immune-based therapies in head and neck cancer are reviewed here, with particular attention paid to the rationale for these approaches from both a clinical and biologic discovery standpoint. The potential benefits of neoadjuvant immunotherapy include reduction of extent of surgery and the intensity of adjuvant therapy by tumor downstaging, reduction of the risk of distant metastatic spread by early introduction of systemic therapy, conversion of unresectable to resectable disease, and early evaluation of biomarkers of tumor response. We await early trial results utilizing these approaches to confirm both safety and initial efficacy in head and neck cancer.
http://ift.tt/2w65EsF
Ossicular Chain Reconstruction: A Home Run for Leslie Horne After a Devastating Auto Accident
http://ift.tt/2i8ZGRK
Eulice Vial’s Christmas Miracle: A Singer Regains Her Voice
http://ift.tt/2i9Fy1Z
Three ORL Specialists Named to H Texas Magazine Top Doctors List for 2017
http://ift.tt/2i8m9hY
Samantha Wild: Making the Difference in Patient Care
http://ift.tt/2i8MWe1
Hörrehabilitation mit Cochleaimplantaten nach translabyrinthärer Vestibularisschwannomresektion
Zusammenfassung
Hintergrund
Die Hörrehabilitation nach translabyrinthärer Vestibularisschwannomresektion stellt eine Herausforderung dar. Da die Cochlea bereits einige Monate nach labyrinthärer oder cochleärer Eröffnung sklerosieren kann, ist die Hörrehabilitation mit Cochleaimplantaten (CI) ggf. zeitlich limitiert. Eine Option, um eine Komplettsklerosierung zu umgehen und das Intervall bis zur Cochleaimplantation zu prolongieren, ist es, bereits bei der translabyrinthären Resektion einen Platzhalter (Tiefenmesser) und das CI später („zweizeitig") einzusetzen.
Ziel
Ziel der retrospektiven Fallserie war es, den Hörerfolg aller Patienten (n = 6) im Verlauf darzustellen und den Einsatz des Tiefenmessers zu beurteilen.
Methodik
Der Hörerfolg aller Patienten mit (n = 3) und ohne (n = 3) Einlage eines Tiefenmessers wurde mittels Freiburger Einsilbertests ohne Störschall bei 65 dB gemessen. Die erste Messung wurde vor der translabyrinthären Vestibularisschwannomresektion, die letzte Messung bis zu 48 Monate nach der Cochleaimplantation durchgeführt.
Ergebnisse
Alle 6 Patienten erreichten auf dem erkrankten Ohr vor der translabyrinthären Vestibularisschwannomresektion 22,5 ± 36,57 % und 12 Monate nach Cochleaimplantation 41,3 ± 26 %. Die Verstehenswerte der Patienten mit Tiefenmesser liegen mit 25,8 ± 16 % nach 12 Monaten unter dem Wert der übrigen von 56,6 ± 25,0 %. Schwerwiegende intra- oder postoperative Komplikationen traten in beiden Gruppen nicht auf.
Schlussfolgerung
Der zweizeitige Ansatz der Cochleaimplantation mit Tiefenmessereinlage scheint nach labyrinthärer Eröffnung bei intaktem Nerv eine vielversprechende, sichere Variante der Hörrehabilitation darzustellen. Forschung zu diesem Ansatz zu intensivieren scheint gerechtfertigt und notwendig.
http://ift.tt/2vMynji
Thyroid Open Access Articles
FREE ACCESS through August 28, 2017
Read now:
Latest Impact Factor: 5.515
The Official Journal of: American Thyroid Association
Information for Clinicians: Approach to the Patient with Progressive Radioiodine-Refractory Thyroid Cancer—When to Use Systemic Therapy
Maria E. Cabanillas, David J. Terris, Mona M. Sabra, for the American Thyroid Association Clinical Affairs Committee
Hyperthyroidism, Hypothyroidism, and Cause-Specific Mortality in a Large Cohort of Women
Neige M.Y. Journy, Marie-Odile Bernier, Michele M. Doody, Bruce H. Alexander, Martha S. Linet, Cari M. Kitahara
Validation of American Thyroid Association Ultrasound Risk Assessment of Thyroid Nodules Selected for Ultrasound Fine-Needle Aspiration
Alice L. Tang, Mercedes Falciglia, Huaitao Yang, Jonathan R. Mark, David L. Steward
Is the Intrinsic Genomic Activity of Thyroxine Relevant In Vivo? Effects on Gene Expression in Primary Cerebrocortical and Neuroblastoma Cells
Pilar Gil-Ibáñez, Mónica M. Belinchón, Beatriz Morte, Maria Jesus Obregón, Juan Bernal
A Single 10 mg Oral Dose of Biotin Interferes with Thyroid Function Tests
Rosa Paula M. Biscolla, Maria Izabel Chiamolera, Ina Kanashiro, Rui M. B. Maciel, Jose G. H. Vieira
The post Thyroid Open Access Articles appeared first on American Thyroid Association.
http://ift.tt/2w5cK0w
“Surgeon on Service” Model in Academic Pediatric Otolaryngology
This review of pediatric otolaryngology medical records and physician trainee surveys compares time to tracheostomy and other factors before vs after implementation of a "surgeon on service" program at a large pediatric academic medical center.
http://ift.tt/2wjteSj
http://ift.tt/2wjteSj
Association Between Hypercoagulability and Severe Obstructive Sleep Apnea
This cohort study evaluates the association between obstructive sleep apnea and coagulation disorders in patients with snoring or sleep apnea.
http://ift.tt/2uTtYdv
http://ift.tt/2uTtYdv
Outpatient Percutaneous Radiologic Gastrostomy in Patients With Head and Neck Tumors
Conditions: Gastrostomy; Neoplasm Malignant; Head and Neck Neoplasms
Intervention: Procedure: Percutaneous radiologic gastrostomy
Sponsor: Instituto Nacional de Cancer, Brazil
Recruiting - verified August 2017
http://ift.tt/2wTbhYH
Intervention: Procedure: Percutaneous radiologic gastrostomy
Sponsor: Instituto Nacional de Cancer, Brazil
Recruiting - verified August 2017
http://ift.tt/2wTbhYH
Effects of High-intensity Training Compared to Resistance Training in Cancer Patients Undergoing Radiotherapy
Conditions: Prostate Cancer; Head and Neck Cancer; Rectum Cancer
Interventions: Behavioral: High-intensity interval training; Behavioral: Resistance training
Sponsor: Cliniques universitaires Saint-Luc- Université Catholique de Louvain
Not yet recruiting - verified July 2017
http://ift.tt/2vGVEoz
Interventions: Behavioral: High-intensity interval training; Behavioral: Resistance training
Sponsor: Cliniques universitaires Saint-Luc- Université Catholique de Louvain
Not yet recruiting - verified July 2017
http://ift.tt/2vGVEoz
Prognostic significance of CDX2 immunoexpression in poorly differentiated clusters of colorectal carcinoma
Abstract
CDX2 is a transcription factor that acts as a tumor suppressor in colorectal cancer (CRC). Its loss triggers metastatic process and tumor progression; however, its prognostic role in patients with CRC is still controversial. Poorly differentiated clusters (PDCs) are aggregates of neoplastic cells which likely have high metastatic potential in CRC. In this study, we analyzed and compared CDX2 expression in PDC (CDX2-PDC) and corresponding main tumor (CDX2 main tumor) in 42 CRCs showing at least 10 PDC (PDC G3). Five of 42 CRCs (12%) were classified as CDX2 main tumor negative (4/5 were also PDC-CDX2 negative); all had tumor recurrence and died of CRC. Twenty nine of 42 cases were CDX2-PDC negative. Among CRC CDX2 main tumor positive, 15 had recurrences and 13 died from CRC; 13 and 11 of them, respectively, were CDX2-PDC negative. By assigning one point to CDX2 main tumor or CDX2-PDC positivity, we assessed CDX2-staining score for each case. Twelve cases had CDX2-staining score 2 (CDX2 positive in main tumor and PDC); 26 had score 1 (CDX2 positive in main tumor or PDC), and 4 had CDX2 score 0 (CDX2 negative in main tumor and PDC). In our patients, CDX2-staining score had higher prognostic value compared to CDX2 main tumor or CDX2-PDC alone. In addition, it represented a significant and independent prognostic variable for disease-free survival (DFS) and cancer-specific survival (CSS). Our findings suggest that, although loss of CDX2 in the main tumor identifies high-risk patients with high specificity, CDX2-PDC should also be considered in CDX2 main tumor positive cases to predict prognosis.
http://ift.tt/2fO4Z8E
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