Background: The development of spontaneous kidney transplant tolerance has been associated with numerous B cell-related immune alterations. We have previously shown that tolerant recipients exhibit reduced B cell receptor (BCR) signalling and higher IL-10 production than healthy volunteers. However, it is unclear whether CD4+T cells from tolerant recipients also display an antiinflammatory profile that could contribute to graft maintenance. Methods: CD4+T cells were isolated from kidney transplant recipients who were identified as being tolerant recipients, patients with chronic-rejection or healthy volunteers. CD4+T cells from the 3 groups were compared in terms of their gene expression profile, phenotype and functionally upon activation. Results: Gene expression analysis of transcription factors and signalling proteins, in addition to surface proteins expression and cytokine production, revealed that tolerant recipients possessed fewer Th17 cells and exhibited reduced Th17 responses, relative to patients with chronic rejection or healthy volunteers. Furthermore, impaired TCR signalling and altered cytokine cooperation by monocytes contributed to the development of Th17 cells in tolerant recipients. Conclusions: These data suggest that defective proinflammatory Th17 responses may contribute to the prolonged graft survival and stable graft function, which is observed in tolerant recipients in the absence of immunosuppressive agents. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. Copyright (C) 2017 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
Τρίτη 12 Σεπτεμβρίου 2017
Urinary CXCL10 chemokine is associated with alloimmune and virus compartment-specific renal allograft inflammation.
Background: Urinary CXCL10 is a promising biomarker for subclinical tubulointerstitial inflammation, but limited data exists regarding its correlation with (micro)vascular inflammation. Furthermore, no study has evaluated whether concomitant serum CXCL10 improves the discrimination for (micro)vascular inflammation. Methods: We investigated whether serum/urinary CXCL10 reflect subclinical inflammation within different renal compartments. Patients (n=107) with 107 surveillance biopsies were classified as: normal histology (n=47), normal histology with BKV or CMV viremia (n=17), moderate-severe tubulointerstitial inflammation (tubulitis >=2, n=18), pure microvascular inflammation (n=15), and isolated v lesions (n=10). Serum and urinary CXCL10 ELISA was performed. An independent validation set was evaluated for urine CXCL10: normal histology (n=14), normal histology with BKV or CMV viremia (n=19), tubulitis >=2 (n=15), pure microvascular inflammation (n=41), and isolated v lesions (n=14). Results: Elevated urinary CXCL10 reflected inflammation within the tubulointerstitial (urinary CXCL10/creatinine 1.23ng/mmol vs. 0.46ng/mmol, p=0.02; AUC 0.69, p=0.001) and microvascular compartments (urinary CXCL10/creatinine 1.72ng/mmol vs. 0.46ng/mmol, p=0.03; AUC 0.69, p=0.02) compared to normal histology. Intriguingly, urinary CXCL10 was predominantly elevated with peritubular capillaritis, but not glomerulitis (p=0.04). Furthermore, urinary CXCL10 corresponded with BKV, but not CMV viremia (p=0.02). These urine CXCL10 findings were confirmed in the independent validation set. Finally, serum CXCL10 was elevated with BKV and CMV viremia but was not associated with microvascular or vascular inflammation (p>=0.19). Conclusions: Urinary CXCL10 reflects subclinical inflammation within the tubulointerstitial and peritubular capillary spaces, but not the vascular/systemic compartments; this was consistent with BKV (tubulointerstitial) and CMV viremia (systemic). Serum CXCL10 was not a useful marker for (micro)vascular inflammation. 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. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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http://ift.tt/2fi8C3q
Evaluation of the efficacy and safety of oral isotretinoin versus topical isotretinoin in the treatment of plane warts: a randomized open trial
Abstract
Background
Plane warts are a common therapeutic problem. Our aim was to assess the efficacy and safety of oral versus topical isotretinoin in the treatment of plane warts.
Methods
Forty patients with multiple plane warts were randomized into two groups. Group A was treated with oral isotretinoin capsules in the dose of 0.5 mg/kg/d and Group B with topical isotretinoin 0.05% in gel formulation once daily at night. Treatment was given to the patients for 3 months or until the complete clearance of lesions, whichever was earlier. Patients with complete response were followed up monthly for 4 months to record the relapse rate.
Results
Results were analyzed in 16 patients of Group A and 13 patients of Group B. At the end of 3 months of therapy, 11 (69%) patients in Group A had complete remission whereas five (31%) had partial remission. In Group B, at the end of study, five (38%) patients had complete remission and six (46%) had partial remission, whereas two patients had no remission. The difference was statistically significant between two groups; P < 0.0001. The most common side effect in Group A was cheilitis. In Group B, five patients had to be dropped because they developed severe erythema and scaling.
Conclusion
Oral isotretinoin showed better and earlier response than topical isotretinoin. Oral isotretinoin should definitely be given a trial particularly in cases of multiple facial warts before trying various destructive procedures.
http://ift.tt/2xYEdho
Cover Image
The cover image, by Miklos Perenyei et al., is based on the Operative Techniques Use of the self-retaining Alexis ring retractor in transoral robotic surgery, DOI: 10.1002/hed.24882.
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Noninvasive submental fat reduction using colder cryolipolysis
Summary
Background
Cryolipolysis has shown to significantly reduce localized subcutaneous fat, including submental fat. Temperatures below −11°C have not been used to treat the submental region.
Objective
The purpose of this study was to evaluate safety and efficacy of Cryolipolysis for noninvasive reduction of submental fat using lower temperatures and reduced treatment time.
Methods
A small volume applicator was used to treat 15 subjects, using a noninvasive tissue cooling device (CoolSculpting System, ZELTIQ Aesthetics, Pleasanton, CA, USA) during 45 and 30 minutes at −12 and −15°C, respectively, to induce reduction of submental fat. Two treatments with an interval of 10 weeks were performed. Adverse events were monitored to assess safety. Treated area was evaluated using digital photography, and caliper measurements prior treatment, 10 weeks after first treatment and 12 weeks after second treatment. All patients were also evaluated before and after 12-week postlast treatment by Magnetic Resonance Imaging (MRI).
Results
The mean (SD) reduction measured by skin fold caliper was 33% (3.2 mm [1.7 mm]), (95% CI, 0.2297-0.4236; P=.05), and by MRI, mean (SD) reduction was 1.78 mm (1.157 mm). Independent blinded panel was able to correctly identify 60% of before and after photographs; 12 of 15 subjects (80%) were satisfied or very satisfied with the treatment. Side effects were mild and resolved completely within 10 weeks, except for one hyperpigmentation, which resolved spontaneously within 6 months after last treatment.
Conclusion
Cryolipolysis with colder temperature and reduced treatment time continues to be effective and is safe for noninvasive reduction of the submental fat.
http://ift.tt/2jlHWmO
External Nasal Neuralgia: an Update
Abstract
Purpose of Review
External nasal neuralgia is a rare syndrome of atypical facial pain for which there is limited reports in the scientific literature. We aim to review diagnosis and provide an update on treatments for this rare condition.
Recent Findings
Etiology has been documented as post-traumatic due to direct trauma to the nose area and in few case reports, idiopathic. Sensory innervation of the nose arises from the ophthalmic and maxillary divisions of the trigeminal nerve. Direct injury to the nerve appears to be the etiology of post-traumatic external nasal neuralgia. Pathophysiology for idiopathic nasal neuralgia is poorly understood but it appears to be of a central etiology given lack of response to intranasal anesthetics. Pain can be episodic with episodes of tingling sensation lasting up to 30 min, two to three times per day, but for some patients it can be constant bruised sensation of mild to moderate pain. Diagnostic workup including magnetic resonance imaging of brain and computerized tomography of the sinuses are usually negative, but there have been few cases of a nasal contact point. Routine blood work including erythrocyte sedimentation rate is negative.
Summary
Treatment for this rare condition is varied with very few patients responding to tricyclic antidepressants, specifically amitriptyline. Another medication used as prevention is pregabalin with good results as well. Most patients respond to nerve blockade with local anesthetic to the external nasal nerve and sphenopalatine ganglion block and radiofrequency ablation. More reports of this condition need to be published in the scientific literature to assist with proper diagnosis and treatment of this condition.
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THE USE OF HUNTING AND HERDING SPACES: STABLE ISOTOPE ANALYSIS OF LATE ARCHAIC AND EARLY FORMATIVE CAMELIDS IN THE TULAN TRANSECT (PUNA DE ATACAMA, CHILE)
ABSTRACT
We present the results of analyzing stable carbon and nitrogen isotopes in camelid remains found at the Late Archaic site TU-52 (ca. 5000-3800 BP), the Tarajne Phase site TU-94 and the Early Formative sites TU-54, TU-85 and TU-122 (ca. 3100-2400 BP). All of the sites are located in the Puna de Atacama (Northern Chile) along the 14 km Tulan transect, between the head of Tulan ravine (ca. 3000 m.a.s.l.) and the border of the Salar de Atacama (2317 m.a.s.l.). Our aim is to understand how the space was used by hunter-gatherers and early herders from the beginning of camelid domestication to the consolidation of herding practices. Isotopic analyses were complemented with osteometric data in order to correlate changes in animal size and isotopic values with the initiation of animal husbandry. Isotopic and ostemetric results show less variability of δ13C and δ15N values during the Late Archaic and Tarajne Phase, whereas variability is higher during the Early Formative. We postulate that during the latter period there was more widespread use of hunting and herding spaces along the Tulan ravine, including areas above 3000 m.a.s.l. as result of more consolidated herding practices, while the highlands were used as a complementary space to hold livestock near ritual sites and residential settlements.
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Predictors of epinephrine dispensing and allergy follow-up after emergency department visit for anaphylaxis
National guidelines recommend that patients with anaphylaxis be prescribed an epinephrine auto-injector (EAI) and referred to an allergy/immunology (A/I) specialist.
http://ift.tt/2h2V4sO
A rare tumour of the masseter muscle
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): C.A. Righini, H. Gil, I. Atallah
http://ift.tt/2wZd2FL
Data sharing to serve ethics, transparency and reproducibility of medical science
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): O. Laccourreye, P. Bonfils, R. Garrel, R. Jankowski, A. Karkas, N. Leboulanger, M. Makeieff, C. Righini, C. Vincent, C. Martin
http://ift.tt/2jmE7xO
Auxiliary activation of the complement system and its importance for the pathophysiology of clinical conditions
Abstract
Activation and regulation of the cascade systems of the blood (the complement system, the coagulation/contact activation/kallikrein system, and the fibrinolytic system) occurs via activation of zymogen molecules to specific active proteolytic enzymes. Despite the fact that the generated proteases are all present together in the blood, under physiological conditions, the activity of the generated proteases is controlled by endogenous protease inhibitors. Consequently, there is remarkable little crosstalk between the different systems in the fluid phase. This concept review article aims at identifying and describing conditions where the strict system-related control is circumvented. These include clinical settings where massive amounts of proteolytic enzymes are released from tissues, e.g., during pancreatitis or post-traumatic tissue damage, resulting in consumption of the natural substrates of the specific proteases and the available protease inhibitor. Another example of cascade system dysregulation is disseminated intravascular coagulation, with canonical activation of all cascade systems of the blood, also leading to specific substrate and protease inhibitor elimination. The present review explains basic concepts in protease biochemistry of importance to understand clinical conditions with extensive protease activation.
http://ift.tt/2xw18os
Complement activation, a threat to pregnancy
Abstract
Pregnancy poses a challenge for the immune systems of placental mammals. As fetal tissues are semi-allogeneic and alloantibodies that commonly develop in the mother, the fetus and the placenta might be subject to complement-mediated immune attack with the potential risk of adverse pregnancy outcomes. Here, I describe how the use of animal models was pivotal in demonstrating that complement inhibition at the fetomaternal interface is essential for a successful pregnancy. Studies in animals also helped the identification of uncontrolled complement activation as a crucial effector in the pathogenesis of recurrent miscarriages, intrauterine growth restriction, preeclampsia, and preterm birth. Clinical studies employing complement biomarkers in plasma and urine showed an association between dysregulation of the complement system and adverse pregnancy outcomes. A better understanding of the role of the complement system in pregnancy complications will allow a rational approach to manipulate its activation as a potential therapeutic strategy with the goal of protecting pregnancies and improving long-term outcomes for mother and child.
http://ift.tt/2ffhHdh
Unresolved and critical issues in autoimmune rheumatic diseases
Source:Autoimmunity Reviews
Author(s): Andrea Doria, Mariele Gatto, Luca Iaccarino, Piercarlo Sarzi-Puttini
http://ift.tt/2ffhGWG
In utero development of memory T cells
Abstract
Pathogen-specific immune memory develops subsequent to primary exposure to antigen, mainly in the context of infection or vaccination to provide protection. Although a safe fetal life requires a tolerogenic environment in order to circumvent unnecessary inflammatory responses, it needs to be prepared in utero to face the microbial environment outside the womb. The possibility of immune memory generation in the fetus would help such transition providing protection in early life. This requires fetal T cell exposure to foreign antigens presented by dendritic cells. There are evidences of fetal T cell priming in several cases of congenital infections or in uninfected children born of infected mothers. Fetal T cell memory seems to arise also without any reported infection during pregnancy. Such memory T cells display various effector functions, including Th1, Th2, or Th17 profiles, raising the issue of benefits and risks for postnatal life when considering maternal vaccination, susceptibility to infection, or environmental allergen sensitization.
http://ift.tt/2jlOPEM
DRESS et virus
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Barbaud, N. Dupin, J.-C. Roujeau
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Aims & Scope/Editorial board
Source:Archives of Oral Biology, Volume 82
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Predictors of epinephrine dispensing and allergy follow-up after emergency department visit for anaphylaxis
Source:Annals of Allergy, Asthma & Immunology
Author(s): Megan Motosue, M. Fernanda Bellolio, Holly K. Van Houten, Nilay D. Shah, Ronna L. Campbell
BackgroundNational guidelines recommend that patients with anaphylaxis be prescribed an epinephrine auto-injector (EAI) and referred to an allergy/immunology (A/I) specialist.ObjectiveTo evaluate guideline concordance and identify predictors of EAI dispensing and A/I follow-up in patients with anaphylaxis treated in the emergency department (ED).MethodsWe identified patients seen in the ED for anaphylaxis from 2010 through 2014 from an administrative claims database using an expanded International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm.ResultsOf 7,790 patients identified, 46.5% had an EAI dispensed and 28.8% had A/I follow-up within 1 year after discharge. On multivariable analysis, those 65 years or older (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.30–0.41) and with a medication trigger (OR 0.24, 95% CI 0.21–0.28) had a lower likelihood of EAI dispensing. Those younger than 5 years (OR 2.67, 95% CI 2.15–3.32) and with food (OR 1.40, 95% CI 1.24–1.59) or venom (OR 4.48, 95% CI 3.51–5.72) triggers had a higher likelihood of EAI dispensing. Similarly, for A/I follow-up, the likelihood was lower for age 65 years or older (OR 0.46, 95% CI 0.39–0.54) and medication trigger (OR 0.66, 95% CI 0.56–0.78) and higher for age younger than 5 years (OR 3.15, 95% CI 2.63–3.77) and food trigger (OR 1.39, 95% CI 1.22–1.58).ConclusionOverall, 46.5% of patients with anaphylaxis in the ED had EAI dispensing and 28.8% had A/I follow-up. Patient age and triggers were associated with likelihood of EAI dispensing and A/I follow-up. Post-ED visit anaphylaxis management can be improved, with the potential to decrease future morbidity and mortality risk.
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New Adjuvant Option for BRAF Melanoma
Combined targeting with BRAF and MEK inhibitors will soon move into the adjuvant setting for treating BRAF-V300-positive stage III melanoma, say experts.
Medscape Medical News
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Clear Benefit With Adjuvant Nivolumab in Resected Melanoma
Adjuvant nivolumab significant improves relapse-free survival and reduces toxicity in comparison with ipilimumab in stage III/IV resected melanoma for patients at risk for relapse, trial results reveal.
Medscape Medical News
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26th European Academy of Dermatology and Venereology (EADV) Congress
Read clinically focused news coverage of key developments from EADV 2017
Medscape Dermatology
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Proceeding report of the Symposium on Hidradenitis Suppurativa Advances (SHSA)
Abstract
The Symposium on Hidradenitis Suppurativa Advances (SHSA) took place on 22-23 October 2016 at Women's College Hospital in Toronto, Canada. This symposium was a joint meeting of the Canadian Hidradenitis Suppurativa Foundation (CHSF), and the Hidradenitis Suppurativa Foundation (HSF Inc.) founded in USA. The purpose of this meeting was to gather well-known researchers from different disciplines to discuss most recent innovations, practical challenges and potential solutions to issues related to management and care of HS patients.
This article is protected by copyright. All rights reserved.
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Phase 3 Study of KHK7580 for the Treatment of Hypercalcemia in Patients With Parathyroid Carcinoma or Primary Hyperparathyroidism
Conditions: Parathyroid Carcinoma; Primary Hyperparathyroidism
Intervention: Drug: KHK7580
Sponsor: Kyowa Hakko Kirin Co., Ltd
Recruiting - verified September 2017
http://ift.tt/2vRcP4F
Intervention: Drug: KHK7580
Sponsor: Kyowa Hakko Kirin Co., Ltd
Recruiting - verified September 2017
http://ift.tt/2vRcP4F
Burden of chronic urticaria relative to psoriasis in five European countries
Abstract
Background
Quantification of burden of chronic spontaneous urticaria (CSU) versus psoriasis (PsO) is limited.
Objective
To evaluate the burden associated with CSU versus PsO of all severities (overall PsO), mild and moderate/severe PsO.
Methods
his retrospective cross-sectional analysis compared data from adult patients with chronic urticaria (CU), used as a proxy for CSU, and PsO from the National Health and Wellness Survey in France, Germany, Italy, Spain, and the United Kingdom. Outcomes included mental and physical component summary scores (MCS and PCS) calculated from the Short-Form (SF)-36v2 or SF-12v2, SF-6D health utility scores, self-reported psychological complaints (anxiety, depression, and sleep difficulties), work productivity and activity impairment, and self-reported health care resource utilisation. Bivariate and multivariate analyses for each outcome and comparative group were conducted.
Results
This analysis included 769 CU and 7857 PsO (26.9% moderate/severe) patients. Following adjustment for covariates, CU patients showed a greater health-related quality of life (HRQoL) impairment versus overall PsO (MCS:-2.4, PCS:-1.6, SF-6D:-0.03; all p< 0.001). CU patients showed a higher risk of anxiety, depression, and sleep difficulties (odds ratio [OR]: 1.63, 1.34, and 1.56, respectively; all P< 0.01) and greater healthcare resource use versus overall PsO. The overall activity impairment was significantly greater in CU patients than in overall PsO patients (P=0.001) while the impact on work was not-significantly different. The results vs. moderate/severe PsO group showed no significant differences on all outcomes.
Conclusion
Burden of illness in CU is higher than PsO of all severities but similar to that observed in moderate/severe PsO. Both diseases have a similar negative impact on work productivity.
This article is protected by copyright. All rights reserved.
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Biologics combined with conventional systemic agents or phototherapy for the treatment of psoriasis: real-life data from PSONET registries
Abstract
Background
Biologics have greatly improved psoriasis management. However, primary and secondary non-response to treatment requires innovative strategies to optimize outcomes.
Objective
To describe the use of combined treatment of biologics with conventional systemic agents or phototherapy in daily clinical practice.
Methods
We collected data on frequency of use, demographics, treatment characteristics and drug survival of biologics combined with conventional systemic agents or phototherapy in five PSONET registries.
Results
Of 9922 biologic treatment cycles, 982 (9.9%) were identified as combination treatment. 72.9% of treatment cycles concerned concomitant use of methotrexate, 25.3% concerned concomitant UVB therapy, acitretin or cyclosporin and 1.8% concerned combined treatment with PUVA, fumaric acids or a second biologic. Substantial variation was detected in type and frequency of combination treatments prescribed across registries. Patients initiated on combined treatment had generally severe disease and were affected with psoriasis for many years. The extent to which patients had been priory treated with biologic monotherapy and the proportion of patients affected with psoriatic arthritis differed between registries. Survival rates for etanercept, adalimumab, infliximab and ustekinumab with methotrexate ranged between 43-92%, 28-83%, 65-87% and 53-77% respectively across registries after one year with no consistent superior survival for a particular biologic. Longest survival on a biologic combined with methotrexate, acitretin or cyclosporin was 103, 78 and 34 months respectively.
Conclusion
Methotrexate was the most commonly used concomitant treatment for patients on a biologic. Wide geographical variations in treatment selection and persistence of combination treatment exist. Data derived from ongoing studies may help to determine whether combined treatment is superior to biologic monotherapy.
This article is protected by copyright. All rights reserved.
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Stridor is not always croup: infantile haemangioma in the airway
Description
A 12-month-old boy presented with a history of respiratory distress and stridor since the first month of life. He had been repeatedly misdiagnosed as recurrent croup. The stridor was biphasic, with a more pronounced inspiratory component, and was exacerbated by agitation and supine positioning. He had a large posterior cervical haemangioma, whose extension had never been studied by imaging methods, and delayed growth. Flexible bronchoscopy showed a multilobulated subglottic haemangioma (SGH), occupying more than 70% of the tracheal lumen. MRI showed an angiomatous malformation with the epicentre at the hind head that extended inferiorly to the cervical planes, reaching the median line in retropharyngeal planes with inferior extension (figures 1 and 2). He underwent systemic and intralesional tracheal steroids injections with partial improvement and laser therapy at 5 years of age. Today he is an asymptomatic 14-year-old adolescent with normal growth and development.
Figure 1
Cervical...
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Toxic multinodular goitre: a surprising finding
Description
A 16-year-old healthy adolescent boy was referred to the paediatric endocrinology clinic because of multiple thyroid nodules detected by cervical ultrasound, in the context of cervical lymphadenopathies. There was no family history of thyroid disease. He denied recent infections, asthenia, weight loss, sweating, palpitations, mood or sleep disturbances, dysphagia or dysphonia. At physical examination, an enlarged, irregular and fibroelastic thyroid, with a predominant right lobe, was identified. The remaining examination was normal.
The analytical profile was thyroid stimulating hormone (TSH) <0.01 uUI/mL (normal 0.5–4.8 uUI/mL), free triiodothyronine (FT3) 7.27 pg/mL (normal 2.3–4.2 pg/mL) and free thyroxine (FT4) 2.02 ng/dL (normal 0.8–2.3 ng/dL). Thyroid antibodies were negative. Cervical ultrasound revealed an enlarged right thyroid lobe due to the presence of multiple mixed nodules with similar characteristics: the biggest one, 5 cm diameter, predominantly cystic with a peripheral ring of solid isoechoic parenchyma (figure 1A); the second characteristically mixed nodule, 2.2 cm diameter (
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Fever, bone pain and erectile dysfunction. Where is the cat?
Cat-scratch disease is due to Bartonella henselae and commonly presents as a localised papular lesion with regional lymphadenopathy. We report the case of a young man suffering general symptoms and dysautonomy characterised by an erectile dysfunction due to an invasive cat-scratch disease. He was successfully treated by tetracyclines during 3 weeks.
http://ift.tt/2jlNrlr
Pulsus alternans: a visual clue to a grave disorder!
Description
A 15-year-old, previously healthy teenager who had fatigue, shortness of breath, vomiting, chest discomfort, lower extremity oedema and inability to lay flat for 3 weeks prior to her initial presentation. She was warm, well perfused with alternating strong and weak central as well as peripheral pulses and laterally displaced cardiac impulse. Her monitoring showed visual evidence of 'pulsus alternans'—alternating low and high amplitude waveforms on the arterial waveform and plethysmography (figure 1). Her echocardiography showed severely depressed left ventricular function with ejection fraction of 15%. In addition, sinus tachycardia and varying capnography waveform supported the diagnosis. She gradually worsened requiring intubation and mechanical ventilation. She was diagnosed with primary cardiomyopathy. She underwent the placement of ventricular assist device and now awaits heart transplant.
Figure 1
Monitor showing (A) sinus tachycardia on telemetry. (B) Plethysmography showing alternating low and high amplitude waves as indicated...
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The grass pollen season 2015: a proof of concept multi-approach study in three different European cities
Grasses release the most widespread aeroallergens with considerable sensitization rates, while different species produce several pollen concentration peaks throughout the season. This study analyzed the preval...
http://ift.tt/2wmzxB7
Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip
Publication date: Available online 12 September 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Rafael Denadai, Anelise Sabbag, Cassio Eduardo Raposo Amaral, João Carlos Pereira Filho, Mirian Hideko Nagae, Cesar Augusto Raposo Amaral
IntroductionThe interpretation of the speech results obtained with the buccinator myomucosal flap in the treatment of velopharyngeal insufficiency in patients with cleft palate has been limited by the restriction in the number of patients and the time of postoperative follow-up.ObjectiveTo evaluate the effect of the buccinator myomucosal flap on speech hypernasality in the treatment of patients with cleft palate and velopharyngeal insufficiency.MethodsPatients with repaired cleft palate (± lip) who were submitted to surgical correction of velopharyngeal insufficiency using the bilateral buccinator myomucosal flap were assessed. Hypernasality (scores 0 [absent], 1 [mild], 2 [moderate], or 3 [severe]) was analyzed by three evaluators by measuring the audiovisual records collected in early and late preoperative and postoperative periods (3 and 12 months, respectively). The values were considered significant for a 95% Confidence Interval (p<0.05).ResultsThirty-seven patients with cleft palate (± lip) showing moderate (16.2%) or severe (83.8%) hypernasality in the preoperative period were included. Analyses of the late postoperative period showed that hypernasality (0.5±0.7) was significantly (p<0.05) lower than the hypernasality of the preoperative and recent postoperative periods (2.8±0.4 and 1.7±0.9, respectively).ConclusionThe buccinator myomucosal flap is effective in reducing/eliminating hypernasality in patients with cleft palate (± lip) and velopharyngeal insufficiency.
http://ift.tt/2f2ccSD
Caudal Regression and Encephalocele: Rare Manifestations of Expanded Goldenhar Complex
Oculoauriculovertebral spectrum, or Goldenhar Syndrome, is a condition characterized by variable degrees of uni- or bilateral involvement of craniofacial structures, ocular anomalies, and vertebral defects. Its expressivity is variable; therefore, the term "expanded Goldenhar complex" has been coined. The Goldenhar Syndrome usually involves anomalies in craniofacial structures, but it is known that nervous system anomalies, including encephalocele or caudal regression, may, rarely, occur in this condition. We report two rare cases of infants affected by Goldenhar Syndrome, associated with neural tube defects, specifically caudal regression syndrome and nasal encephaloceles, to underline the extremely complex and heterogeneous clinical features of this oculoauriculovertebral spectrum. These additional particular cases could increase the number of new variable spectrums to be included in the "expanded Goldenhar complex."
http://ift.tt/2f39Tyt
Kosten allergischer Erkrankungen und Einsparpotenziale durch die allergenspezifische Immuntherapie
Zusammenfassung
Einleitung
Allergien stellen eine erhebliche Belastung der Sozialsysteme und der gesamten Volkswirtschaft dar. Die allergische Rhinitis (AR) ist mit einer Lebenszeitprävalenz von ca. 30 % eine der häufigsten chronischen Erkrankungen überhaupt und verursacht volkswirtschaftlich enorme direkte, indirekte und intangible Kosten. Die vorliegende Arbeit prüft eine gängige Hypothese, nach der eine SIT auf längere Zeitdauer betrachtet im Vergleich zur Standardtherapie oder keiner Therapie bei AR volkswirtschaftlich Kosten einspart.
Methodik
Durchgeführt wurden selektiven Literaturrecherchen in Pubmed und Medline, zusätzlich wurden aktuelle Publikationen deutschsprachiger Zeitschriften analysiert. Anhand einer gesundheitsökonomischen Modellrechnung mit einer Extrapolation über 9 Jahre werden die Probleme dargestellt, die mit der Extrapolation von Erkenntnissen aus kurzzeitigen Studien über einen längeren Zeitraum und unter Kombination unterschiedlicher Datenquellen verbunden sind.
Ergebnisse
Bei Anwendung allgemein akzeptierter Variablen in einer gesundheitsökonomischen Modellrechnung zeigt sich die SIT gegenüber einer rein symptomatischen Behandlung als kosteneffektiv zur Therapie der AR. Allerdings werden viele Parameter aus Modelberechnungen anderer Studien angenommen (Therapieadhärenz/Abbrecherquote, Arzneimittelkosten, Effektstärke hinsichtlich Symptomen und symptomatischer Begleitmedikation, Wirkdauer, Effektivität hinsichtlich Asthmaprophylaxe u. a.), die bislang nicht ausreichend beherrschbar sind und daher die Ergebnisse in verschiedentlicher Weise beeinflussen können.
Diskussion
Die persönliche Bewertung der Autoren fasst die bisherigen Erkenntnisse, aber auch die Probleme in der gesundheitsökonomischen Bewertung der SIT zur Behandlung allergischer Erkrankungen zusammen.
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Mohs micrographic surgery in the elderly. Comparison of tumours, surgery, and first-year follow-up in patients younger and older than 80 years-old in REGESMOHS
Abstract
Background
The elderly population is increasing and more patients in this group undergo Mohs micrographic surgery. The few publications investigating MMS in elderly people conclude that it is a safe procedure; however, these are single centre studies without a comparison group.
Objective
To compare the characteristics of patients, tumours, MMS, and one-year follow-up in patients younger than 80 years, with patients older than 80 years at the time of surgery.
Methods
Data was analysed from REGESMOHS, a prospective cohort study of patients treated with MMS. The participating centres were 19 Spanish hospitals where at least one MMS is performed per week. Data on characteristics of the patient, tumour, and surgery were recorded. Follow-up data was collected from two visits; the first within one month post-surgery and the second within the first year.
Results
From July 2013 to October 2016, 2575 patients that underwent MMS were included in the registry. Of them, 1942 (75,4%) were aged < 80 years and 633 (24,6%) were ≥80 years-old. In the elderly, the tumour size was significantly higher with a higher proportion of squamous cell carcinoma. Regarding surgery, elderly more commonly had tumours with deeper invasion and required a higher number of Mohs surgery stages, leaving larger defects, and requiring more time in the operating room. Despite this, the incidence of post-operative complications was the same in both groups (7%) and there were no significant differences in proportion of relapses in the first-year follow-up.
Conclusion
The risk of short term complications and relapses were similar in elderly and younger groups. MMS is a safe procedure in the elderly.
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Quality of Life Measurement in Acne. Position Paper of the European Academy of Dermatology and Venereology (EADV) Task Forces on Quality of Life and Patient Oriented Outcomes (QoL and PO) and Acne, Rosacea and Hidradenitis Suppurativa (ARHS)
Abstract
Acne causes profound negative psychological and social effects on the quality of life (QoL) of patients. The European Dermatology Forum S3-Guideline for the Treatment of Acne recommended adopting a QoL measure as an integral part of acne management. Because of constantly growing interest in health-related QoL assessment in acne and because of the high impact of acne on patients' lives, the European Academy of Dermatology and Venereology Task Force on QoL and Patient Oriented Outcomes and the Task Force on Acne, Rosacea and Hidradenitis Suppurativa have documented the QoL instruments that have been used in acne patients, with information on validation, purposes of their usage, description of common limitations and mistakes in their usage and overall recommendations.
This article is protected by copyright. All rights reserved.
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Risks of different skin tumor combinations after a first melanoma, squamous cell carcinoma and basal cell carcinoma in Dutch population based cohorts: 1989 – 2009
Abstract
Background
Skin cancer patients are primarily at increased risk of developing subsequent skin cancers of the same type. Shared risk factors might also increase the occurrence of a different type of subsequent skin cancer.
Objective
To investigate risks of different skin tumor combinations after a first melanoma, squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).
Methods
All melanoma and SCC patients included in the national Netherlands Cancer Registry (NCR) and all BCC patients included in the regional Eindhoven Cancer Registry (ECR) between 1989 and 2009 were followed until diagnosis of a subsequent different skin cancer (melanoma, SCC or BCC), date of death or end of study. Cumulative risks, Standardized Incidence Ratios (SIR) and Absolute Excess Risks (AER) of subsequent skin cancers were calculated.
Results
A total of 50,510 melanoma patients and 64,054 patients with a SCC of the skin were included (national data NCR). The regional data of the ECR consisted of 5,776 melanoma patients, 5,749 SCC patients and 41,485 BCC patients. The 21-year cumulative risk for a subsequent melanoma after a first SCC or BCC was respectively 1.7% and 1.3% for males and 1.3% and 1.2% for females; SCC after melanoma or BCC was 4.6% and 9.3% (males) and 2.6% and 4.1% (females); BCC after melanoma or SCC was respectively 13.2% and 27.8% (males) and 14.9% and 21.1% (females). SIRs and AERs remained elevated up to 21 years after the first melanoma, SCC or BCC.
Conclusion
This large population based study investigating risks of developing a different subsequent cutaneous malignancy showed high cumulative risks of mainly KC and markedly increased relative and absolute risks of all tumor combinations. These estimates confirm a common carcinogenesis and can serve as a base for follow-up guidelines and patient education aiming for an early detection of the subsequent cancers.
This article is protected by copyright. All rights reserved.
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Hematologic neoplasms: Dendritic cells vaccines in motion
Source:Clinical Immunology, Volume 183
Author(s): Domenico Galati, Serena Zanotta
Dendritic cells (DCs) are bone-marrow-derived immune cells accounted for a key role in cancer vaccination as potent antigen-presenting cells within the immune system. Cancer microenvironment can modulate DCs maturation resulting in their accumulation into functional states associated with a reduced antitumor immune response. In this regard, a successful cancer vaccine needs to mount a potent antitumor immune response able to overcome the immunosuppressive tumor milieu. As a consequence, DCs-based approaches are a safe and promising strategy for improving the therapeutic efficacy in hematological malignancies, particularly in combinations with additional treatments. This review summarizes the most significant evidence about the immunotherapeutic strategies performed to target hematologic neoplasms including the tumoral associated antigens (TAA) pulsed on DCs, whole tumor cell vaccines or leukemia-derived DCs.
http://ift.tt/2wmMGKj
Two novel mutations in ZAP70 gene that result in human immunodeficiency
Source:Clinical Immunology
Author(s): Beatriz Adriana Llamas-Guillén, Nina Pastor, Gabriela López-Herrera, Maria Edith González-Serrano, Lucero Valenzuela-Vázquez, Maria Elena Bravo-Adame, Tania Maria Villanueva-Cabello, Paul Gaytán, Jorge Yañez, Ivan Martinez-Duncker, Miguel Ruiz-Fernández, André Veillette, Sara Elva Espinosa-Padilla, Mario Ernesto Cruz-Munoz
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Interleukin 17 regulates SHP-2 and IL-17RA/STAT-3 dependent Cyr61, IL-23 and GM-CSF expression and RANKL mediated osteoclastogenesis by fibroblast-like synoviocytes in rheumatoid arthritis
Publication date: November 2017
Source:Molecular Immunology, Volume 91
Author(s): Ramamoorthi Ganesan, Mahaboobkhan Rasool
Interleukin (IL)-17 predominately produced by the Th17 cells, plays a crucial role in the fibroblast-like synoviocytes (FLS) mediated disease process of rheumatoid arthritis (RA). IL-17 exerts its pathogenic effects in RA-FLS by IL-17/IL-17RA/STAT-3 signaling. Recent studies have shown that RA-FLS produces SHP-2, Cyr61, IL-23, GM-CSF and RANKL which results in worsening of the disease. However, whether IL-17/IL-17RA/STAT-3 signaling regulates SHP-2, Cyr61, IL-23, GM-CSF and RANKL expressions in RA-FLS remains unknown. In this study, IL-17 treatment dramatically induced the production of Cyr61, IL-23 and GM-CSF in FLS isolated from adjuvant induced arthritis (AA) rats. Conversely, IL-17 mediated production of Cyr61, IL-23 and GM-CSF was abrogated by knockdown of IL-17RA using a small interfering RNA or blockade of STAT-3 activation with S3I-201 in AA-FLS. Interestingly, IL-17 treatment noticeably increased the expression of IL-17RA and SHP-2 in AA-FLS. However, silencing of IL-17RA reversed the effect of IL-17 on the expression of IL-17RA and SHP-2 in AA-FLS. In addition, an increased number of TRAP-positive multinucleated cells were observed in a coculture system consisting of IL-17 treated AA-FLS and rat bone marrow derived monocytes/macrophages. Further, mechanistically we found that IL-17 upregulated RANKL expression in AA-FLS that was dependent on the IL-17/IL-17RA/STAT-3 signaling cascade. Knockdown of IL-17RA or inhibition of STAT-3 activation decreased the IL- 17 induced RANKL expression by AA-FLS and their osteoclastogenic potential. Taken together, our findings demonstrate that IL-17 regulates SHP-2 expression and IL-17RA/STAT-3 dependent production of Cyr61, IL-23, GM-CSF and RANKL in AA-FLS and may reveal a new insight into the pathogenesis of RA.
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The varying role of vertebrae in Pacific fishbone analysis; comparing tropical versus temperate midden assemblages
Abstract
Archaeologists working in the tropical Pacific have demonstrated the feasibility and value of including fish vertebrae in midden analyses, and recent New Zealand studies draw similar conclusions. This work provides an illustrated guide to the identification of vertebrae from key New Zealand fish taxa and shows the effects of including vertebrae on a large fishbone assemblage from southern New Zealand. We note major differences between New Zealand and tropical Pacific assemblages resulting from the inclusion of vertebrae. Unlike the Indo-Pacific taxa of the tropical Pacific, no New Zealand species have been shown to be sensitive to the inclusion of vertebrae. In both places including vertebrae results in changes in relative abundance and rank order but in New Zealand this is a function of processing practices, not fishing behaviours. This work serves to highlight changes in the Polynesian fishing adaption following the colonisation of New Zealand.
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Animal Remains from Ritual Sites: a Cautionary Tale from the Eastern Adriatic
Abstract
This article assesses the potential pitfalls of extant methods and criteria used for identifying of the ritual use and consumption of animals. Previous analysis of the Late Iron Age sanctuary assemblage from Spila Nakovana identified the ritual consumption of domestic animals in the sanctuary through comparison with a common set of criteria for the identification of ritual patterning in faunal assemblages. A recent analysis of a larger sample from Spila Nakovana has overturned this original determination, leading to a re-evaluation of the ranked importance of the common criteria utilised for ritual patterning identification. The importance of context is addressed in the determination of ritual patterning within archaeological faunal assemblages, with regard to both the direct and wider context of the sample.
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Role of imaging in the diagnosis of parotid infantile hemangiomas
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Fabiola C. Weber, Arin K. Greene, Denise M. Adams, Marilyn G. Liang, Mohammed H. Alomari, Stephan D. Voss, Gulraiz Chaudry
ObjectivesTo review the clinical presentation, imaging and follow-up of parotid infantile hemangiomas (IH).MethodsOver a 15-year period, all patients with a clinical diagnosis of parotid IH were evaluated. Imaging was available in 35. The medical records, photographs, and radiology studies of these patients were reviewed.ResultsAll patients presented at less than 4 months of age (M:F, 13:21). 19 (55)% of tumors were on the left and were bilateral in 2 patients. The majority (29 patients) presented due to localized swelling or palpable mass; the remainder had a cutaneous lesion, but no palpable mass at the time of presentation. The referring diagnosis was incomplete or incorrect in 9 patients (26%).The imaging studies all demonstrated a well-defined homogeneous mass, with no abnormality of the surrounding subcutaneous fat. Sonography showed a uniformly vascular lesion with pulsatile fast-flow seen on Doppler. On MRI, the lesion was hyperintense on T2-weighted images, isointense on T1, with intense enhancement post-contrast.Oral therapy (propranolol or corticosteroids) was prescribed in 15 (45%). Follow-up in 28 patients demonstrated stability of the lesion in 11, regression in size in 11 and complete involution in 6. After involution 2 patients underwent resection of residual tissue and/or excess skin.ConclusionsTypical clinical presentation alone may be adequate to establish a diagnosis of parotid infantile hemangioma. However, in patients with no overlying cutaneous lesion, imaging can play a critical role in confirming the diagnosis. The sonographic findings are sufficiently characteristic to allow for a definitive diagnosis, obviating the need for further investigations. If diagnostic uncertainty remains or the full extent of the lesion cannot be appreciated, then MRI should be preferred over CT to avoid ionizing radiation.
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Shrinkage in oral squamous cell carcinoma: An analysis of tumor and margin measurements in vivo, post-resection, and post-formalin fixation
Source:American Journal of Otolaryngology
Author(s): Lauren A. Umstattd, Jonathan C. Mills, William A. Critchlow, Gregory J. Renner, Robert P. Zitsch
PurposeTo quantify changes in tumor size and tumor-free margins following surgical resection and formalin fixation of oral cavity squamous cell carcinoma.Materials and methodsNineteen patients were studied via cohort design. Between May and December 2011, measurements of tumor size and tumor-free margin were made in patients with squamous cell carcinoma of the oral cavity. Mucosal reference points were marked with sutures, representing tumor diameter and two separate resection margins. Measurements were recorded immediately before resection, after resection, and following fixation in formalin.ResultsThe overall mean shrinkage in tumor size was 10.7% (95% CI 3.4–18.0, p=0.006). When comparing mean tumor measurements, most of the tumor size decrease (6.4%, 95% CI 0.4–12.4, p=0.039) occurred between pre- and post-excision measurements. To a lesser extent, tumor size decreased following formalin fixation. Comparison of tumor-free margin measurements revealed a pre-excision to post-fixation mean decrease of 11.3% (95% CI 2.9–19.6%, p=0.011), with a statistically significant decrease of 14.9% (95% CI 8.5–21.3%, p<0.001) occurring between pre- and post-excision, and no significant decrease from post-excision to post-formalin fixation.ConclusionMucosal dimensions of both tumor and tumor-free margins in oral cavity squamous cell carcinoma specimens decrease between surgical resection and pathologic analysis. Most of this decrease occurs prior to fixation, especially for margins, and may be due to intrinsic tissue properties rather than formalin effects.
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Focal hyperkeratosis overlying the palmar faces of interphalangeal and metacarpophalangeal joints revealing a juvenile dermatomyositis
Abstract
Dermatomyositis (DM) is an idiopathic inflammatory myopathy characterized by an inflammatory infiltrate primarily affecting the skeletal muscle and skin [1]. It is the commonest of the idiopathic inflammatory myopathies of childhood, comprising 85% of cases. It has an annual incidence estimated to range between 1.9 and 4.1 per million children [2, 3].
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Clinical predictors of multiple tympanostomy tube placements in Ontario children
Objectives
To characterize risk factors that predict the need for multiple tympanostomy tube (TT) procedures.
Study Design
Retrospective population-based cohort study of children aged 18 years and younger in Ontario, Canada, who underwent at least one TT placement between January 1, 1994, and October 31, 2013.
Methods
The relative risk (RR) of need for multiple TT procedures was determined using log-binomial regression.
Results
There were 193,880 children who underwent TT insertion included in this cohort. Of these, 28.58% underwent at least two separate TT procedures. Over time, the RR of undergoing multiple TT procedures is decreasing for all children. In general, the younger the child was at the first TT procedure, the more likely the child was to undergo multiple TT procedures. Significantly higher RR for multiple TT procedures also was associated with male sex, the second-highest neighborhood income quintile, asthma or reactive airways, gastrointestinal disease, prematurity, or cleft lip and/or palate. Significantly lower RR for multiple TT procedures was associated with adenoidectomy or tonsillectomy (with or without adenoidectomy) at first TT placement or within 3 years prior. Furthermore, the benefit of adjuvant adenoidectomy or tonsillectomy was present for children aged under 4 years, in addition to those aged 4 years and older.
Conclusion
Among Ontario children who have had TT placement, more than one in four will have multiple sets placed. These identified risk factors permit improved preoperative counseling and enable identification of children who need closer follow-up.
Level of Evidence
2b. Laryngoscope, 2017
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Preliminary results of tissue-engineered injection laryngoplasty material in a rabbit model
Objectives/Hypothesis
Design and test a novel biomaterial for injection laryngoplasty aimed to increase the duration of effectiveness of micronized acellular dermis.
Study Design
Animal model.
Methods
Injection laryngoplasty was performed in three groups (n = 5) of New Zealand White rabbits. Acellular dermis was either used alone as a control (group 1), was combined with undifferentiated stem cells (group 2), or with predifferentiated chondrocytic cells (group 3). Groups 2 and 3 were supplemented with growth factors. Animals were sacrificed 4 and 12 weeks after laryngoplasty and histologic analysis was completed. The major outcome measure was volume of tissue remaining.
Results
After 4 weeks, the mean volume of tissue remaining was 341 ± 89 mm3, 295 ± 102 mm3, and 133 ± 15 mm3, for groups 1 to 3, respectively. At the 12-week time point, volumes were 62 ± 62 mm3, 235 ± 35 mm3, and 107 ± 99 mm3. After 12 weeks, there was a significantly higher volume in group 2 compared to group 1 or 3 (P = .01, P = .04). Volumes between week 4 and week 12 were significantly lower in group 1 (P = .02), but not significantly different for groups 2 and 3 (P = .38, P = .74). Histologic evaluation revealed a robust lymphocytic infiltration in all cases as well as morphologic and immunophenotypic features suggestive of chondrogenic differentiation in a single animal.
Conclusions
Micronized acellular dermis combined with stem cells and growth factors showed significantly less resorption 12 weeks after injection laryngoplasty compared to micronized acellular dermis alone. Groups using novel tissue-engineered biomaterial showed a lower resorption rate over time compared with acellular dermis alone.
Level of Evidence
NA Laryngoscope, 2017
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Chemosensory function before and after multimodal treatment in chronic rhinosinusitis patients
Objectives/Hypothesis
Olfactory dysfunction is common among the general population, with chronic rhinosinusitis (CRS) as one of the leading causes. Patients affected by CRS often report changes in taste sensations; however, quantitative measurements have not been performed to date. Therefore, the present study aimed to investigate gustatory and olfactory function in CRS patients prior to and after multimodal treatment.
Study Design
Prospective cohort study.
Methods
Twenty-one patients suffering from CRS with nasal polyps (14 male, seven female) with a mean age of 48 ± 15 years were included in the study. Chemosensory function was assessed prior to and approximately 190 days after multimodal treatment, which included endoscopic sinus surgery, oral antibiotics for 5 days, oral steroids for 12 days, and at least 6 weeks of topical nasal steroids. Olfactory function was tested with the Sniffin' Sticks test battery, whereas gustatory function was measured with taste strips. A clinically relevant change in olfactory function was defined as a change of ≥5 points in the threshold, discrimination, and identification scores.
Results
Compared to normative data, patients baseline gustatory and olfactory function was impaired. After multimodal treatment, improvements were seen in olfactory function for eight patients (42%), remained stable in 10 patients (53%), and deteriorated in one patient (5%). Taste function remained unchanged following sinus surgery.
Conclusions
Patients suffering from CRS with polyps exhibit olfactory and taste dysfunctions. Multimodal treatment leads to an improvement in olfactory, but not gustatory functionality.
Level of Evidence
4. Laryngoscope, 2017
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Effect of aging and direction of impulse in video head impulse test
Objective
The aim of this study was to identify the difference of gain value in the video head impulse test (vHIT) according to the age of the patient and the direction of the impulse.
Method
All participants were subjected to vHIT with horizontal semicircular canal (HSCC). vHIT with vertical canal (posterior and anterior semicircular canal [PSCC and ASCC]) additionally was performed in 434 participants.
Results
The mean vestibulo-ocular reflex (VOR) gain was maintained in patients in the HSCC at below 70 years (1.025 ± 0.08) and in the vertical canal at below 80 years (PSCC: 0.965 ± 0.12, ASCC: 0.975 ± 0.14). However, the decrease of VOR gain was significant in patients over 70 years in the HSCC (0.978 ± 0.35, P < .001) and in patients over 80 years in the vertical canal (PSCC: 0.828 ± 0.16, ASCC: 0.851 ± 0.13, P < .001). In addition, a VOR gain of rightward impulse was higher than the leftward impulse, but there was no difference based on the direction of impulse in the vertical impulse test.
Conclusion
VOR gain declines with increasing age, over 70 years on the horizontal canal, and over 80 years on the vertical canal. Additionally, horizontal VOR gain of rightward impulse was higher than the leftward impulse in right-eye recordings only, but the vertical canal showed no difference of gain according to the direction of impulse.
Level of Evidence
2b. Laryngoscope, 2017
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Efficacy of dexmedetomidine for perioperative morbidities in pediatric tonsillectomy: A metaanalysis
Objectives
This study aimed to assess the effects of perioperative dexmedetomidine as an adjuvant to tonsillectomy compared with opioid or sham in children.
Data Source
Five databases (PubMed, SCOPUS, Embase, Web of Science, and Cochrane Central Register of Controlled Trials) were searched from inception of article collections to April 2017.
Review Methods
Prospective, randomized controlled studies that compared outcomes between children who underwent tonsillectomy plus dexmedetomidine administration (intervention) and children who underwent tonsillectomy with placebo or opioid (control) were systemically and independently reviewed by two researchers. The outcomes of interest were emergence agitation, postoperative pain intensity, rescue analgesic consumption, and other morbidities (nausea and vomiting and agitation).
Results
Fifteen studies with n = 1,552 met the inclusion criteria. Postoperative pain scores and the need for analgesics in the postanesthesia care unit (PACU) were significantly decreased in the dexmedetomidine group versus the control group. The incidence and degree of agitation and desaturation incidence in the PACU also were significantly lower in the dexmedetomidine group than in the control group. Additionally, there was no significant difference in the duration of staying PACU between both groups. In subgroup analyses by administration method (bolus injection or continuous injection), dexmedetomidine was shown to be effective at reducing postoperative morbidities regardless of administration method.
Conclusion
Perioperative administration of dexmedetomidine can provide pain and agitation relief without side effects in children undergoing adenotonsillectomy. Considering the high heterogeneity of results within some parameters; however, further clinical trials with robust research methodology should be conducted to confirm the results of this study. Laryngoscope, 2017
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Oncologic outcomes of KTP laser surgery versus radiation for T1 glottic carcinoma
Objectives/Hypothesis
To characterize outcomes for patients who underwent transoral microsurgery with potassium titanyl phosphate (KTP) laser resection of early glottic cancers and to compare outcomes with patients who received external beam radiation therapy.
Study Design
Retrospective cohort study.
Methods
The history of patients with T1 glottic carcinoma treated with curative primary radiation or transoral KTP laser resection was reviewed. Oncologic outcomes for both radiation and surgery cohorts including disease-free and overall survival were calculated.
Results
Eighty-seven patients met inclusion criteria from 2011 to 2016; 47 patients (54%) received primary KTP laser ablation, and 40 patients (46%) received primary external beam radiotherapy. The average length of follow-up was 924 ± 529 days in the KTP laser group and 994 ± 603 days in the radiation group (P = .26). There were no significant differences between the two treatment groups in terms of medical or demographic variables. There were six recurrences in the KTP laser group (13%), versus six in the radiotherapy group (15%) (P = .77). The laryngeal preservation rate for the cohort of patients who initially received KTP laser treatment was 46 out of 47 patients (98%). Of the cohort that received primary radiation therapy, the laryngeal preservation rate was 36 out of 40 patients (90%, P = .18). Disease-free and overall survival were 88% and 98% in the KTP laser cohort and 85% and 95% in the radiation cohort (P = .78, P = .56), respectively.
Conclusions
KTP laser ablation is a modality equivalent to primary radiation therapy in oncologic outcomes for T1 glottic squamous cell carcinoma.
Level of Evidence
4 Laryngoscope, 2017
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Perceptions of pain of laryngeal electromyography
Objective
To evaluate pain associated with laryngeal electromyography (LEMG).
Study Design
A prospective case series.
Methods
Adult patients scheduled for LEMG in a tertiary care laryngology practice were recruited between July 20, 2016, and March 1, 2017. Demographic and clinical data were extracted from the charts. Study participants reported their anticipated pain level using a visual analog scale (VAS) prior to the procedure. VAS was administered again within 10 minutes after the procedure, along with the validated McGill Pain Questionnaire, to gauge patient's pain perception after undergoing LEMG.
Results
Results were reviewed for 80 patients (mean age 48.2 ± 16.6 years, 37.5% male). Preprocedure VAS pain scores (4.59 ± 2.3 out of 10) were not significantly different than postprocedure VAS pain scores (4.61 ± 2.4) (P = 0.95). The McGill Pain Questionnaire reported a moderate pain level (32.1 ± 12.7 out of 78). Females anticipated a higher preprocedure VAS pain score (5.04 ± 2.3) than males (3.85 ± 2.2) (P = 0.02); however, postprocedure scores were not significantly different between genders. The following factors did not influence the pain scores: age, professional voice use, history of previous EMG, chronic pain diagnosis, psychiatric diagnosis, or current treatment with pain/psychiatric medications. All LEMGs were completed without any complications.
Conclusion
Patients appropriately anticipated their pain levels for the LEMG, which may be attributed to proper patient education and counselling before the procedure. Overall pain levels were mild to moderate, and all LEMGs were completed; thus, LEMG was well tolerated.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2f0Olm2
Laryngeal exposure and margin status in glottic cancer treated by transoral laser microsurgery
Objective
Laryngeal exposure is one of the most limiting factors in transoral laser microsurgery (TLM) for glottic cancer. We evaluated the correlation between the degree of laryngeal exposure, as assessed by an easy previously described scoring tool (Laryngoscore), and histopathologic surgical margin status after TLM.
Study Design
Prospective evaluation of 147 patients affected by Tis–T2 glottic cancer treated by TLM with curative intent between January 2012 and April 2016.
Methods
All patients were preoperatively assessed and classified as having good (group A including Laryngoscore class 0–I) or suboptimal laryngeal exposure (group B including class II–III). Margins were classified as negative (more than 1 mm margin between healthy tissue and tumor) or positive (one/multiple superficial or deep margins involved by invasive or in situ carcinoma). Patients with multiple superficial or deep margin positivity were scheduled for TLM re-excision, open partial laryngectomy, or postoperative radiotherapy.
Results
Twenty-one type I, 54 type II, 19 type III, 7 type IV, 41 type V, and 5 type VI cordectomies (according to the European Laryngological Society classification) were performed with an en-bloc or multi-bloc technique according to the size, site, and exposure of the lesion. Group A included 109 (74%) and group B included 38 (26%) patients. Positive surgical margins were overall observed in 39 (26.5%) cases: 21 (19.2%) in group A versus 18 (47.4%) in group B (P = 0.001).
Conclusion
Laryngeal exposure is one of the most important factors influencing TLM resection of glottic cancer within safe surgical margins. The importance of its adequate preoperative assessment cannot be overemphasized.
Level of Evidence
2b. Laryngoscope, 2017
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Laryngeal EMG: Preferential damage of the posterior cricoarytenoid muscle branches especially in iatrogenic recurrent laryngeal nerve lesions
Objective
Laryngeal electromyography (LEMG) of the thyroarytenoid (TA) muscle alone may not be sufficient in all patients to characterize or prove a recurrent laryngeal nerve (RLN) lesion in cases of vocal fold immobility. LEMG of the posterior cricoarytenoid (PCA) muscle may provide additional information.
Study Design
Retrospective review.
Method
Between 2008 and 2016, 339 patients in our laryngeal paralysis clinic were examined by transcutaneous needle TA-LEMG and, if tolerated, by PCA-LEMG. LEMGs were rated and compared according to criteria of the European Laryngological Society. Etiology was categorized as iatrogenic, noniatrogenic, or malignancy related.
Results
A total of 282 out of 339 patients had a partial or complete RLN or vagal nerve lesion: 178 iatrogenic, 74 noniatrogenic, and 30 because of nerve involvement by malignancies. Of paralytic vocal folds, 35.7% had normal or near-normal TA innervation, whereas corresponding PCA traces (if present) were pathologic in 94.6%. Comparing pairs of TA and PCA-LEMGs in paralysis of less than 4 months duration showed a predominance of PCA branch injuries in iatrogenic lesions (71.7 %), while in noniatrogenic lesions this was less pronounced (44.4%). In the few malignancy cases, there was an almost even distribution. Synkinetic reinnervation was earlier in iatrogenic RLN lesions.
Conclusion
PCA-LEMG was better in proving an RLN lesion than TA-EMG alone. Our findings suggest etiology-dependent differences in the TA/PCA lesion pattern. To confirm this, larger sample sizes are needed. A preferential damage to PCA innervation in iatrogenic lesions could be relevant for further improvements of intraoperative neuromonitoring.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2jkaYTS
Work-related musculoskeletal symptoms among otolaryngologists by subspecialty: A national survey
Objective
Given the high prevalence of work-related musculoskeletal symptoms, increased appreciation for workplace ergonomics is critical. The purpose of this study is to assess work-related musculoskeletal symptoms and injury among otolaryngologists across subspecialties, as well as to quantify the understanding and application of ergonomic principles in the operating room.
Study Design
Cross-sectional study.
Methods
An online REDCap survey was distributed electronically to University of Kansas faculty, alumni, and residents; members of the American Academy of Facial Plastic and Reconstructive Surgery; and residency program coordinators for distribution to residents and faculty between August 2016 and March 2017. The survey assessed caseload, ergonomic practices, and associated musculoskeletal symptoms by type of procedure and impact of symptoms on surgeon practice.
Results
The survey was distributed to 3,006 individuals. We received 377 responses (12.5%), with 63.9% reporting symptoms. The majority of respondents began to experience symptoms in residency or fellowship. Neck and shoulder were the most affected body areas across all types of surgeries. One-third of surgeons were formally taught or actively sought information on ergonomics principles. Among those who applied ergonomics in practice, 69.6% observed improvement in their symptoms.
Conclusion
Although musculoskeletal issues are prevalent among otolaryngologists, awareness of surgical ergonomics principles among otolaryngologists remains limited. Early instruction in ergonomic principles is important because work-related musculoskeletal symptoms commonly present in residency. Most respondents reporting the application of ergonomic principles also acknowledge symptom improvement.
Level of Evidence
NA. Laryngoscope, 2017
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European guidelines on perioperative venous thromboembolism prophylaxis: Surgery in the elderly.
: The risk for postoperative venous thromboembolism (VTE) is increased in patients aged more than 70 years and in elderly patients presenting with co-morbidities, for example cardiovascular disorders, malignancy or renal insufficiency. Therefore, risk stratification, correction of modifiable risks and sustained perioperative thromboprophylaxis are essential in this patient population. Timing and dosing of pharmacoprophylaxis may be adopted from the non-aged population. Direct oral anti-coagulants are effective and well tolerated in the elderly; statins may not replace pharmacological thromboprophylaxis. Early mobilisation and use of non-pharmacological means of thromboprophylaxis should be exploited. In elderly patients, we suggest identification of co-morbidities increasing the risk for VTE (e.g. congestive heart failure, pulmonary circulation disorder, renal failure, lymphoma, metastatic cancer, obesity, arthritis, post-menopausal oestrogen therapy) and correction if present (e.g. anaemia, coagulopathy) (Grade 2C). We suggest against bilateral knee replacement in elderly and frail patients (Grade 2C). We suggest timing and dosing of pharmacological VTE prophylaxis as in the non-aged population (Grade 2C). In elderly patients with renal failure, low-dose unfractionated heparin (UFH) may be used or weight-adjusted dosing of low molecular weight heparin (Grade 2C). In the elderly, we recommend careful prescription of postoperative VTE prophylaxis and early postoperative mobilisation (Grade 1C). We recommend multi-faceted interventions for VTE prophylaxis in elderly and frail patients, including pneumatic compression devices, low molecular weight heparin (and/or direct oral anti-coagulants after knee or hip replacement) (Grade 1C). (C) 2017 European Society of Anaesthesiology
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http://ift.tt/2y2nDye
Risk Vessels of Retropharyngeal Hematoma During Stellate Ganglion Block.
Background and Objective: Bleeding into the retropharyngeal space is a potential complication in stellate ganglion block (SGB). Retropharyngeal hematoma formation is considered to be due to damage of small arteries in the region, although only scanty details of the region are available. The aim of this study was to map the risk blood vessels in the retropharyngeal space to avoid accidental damage during SGB. Methods: Contrast-enhanced 3-dimensional computed tomography images performed on 80 patients were reanalyzed retrospectively to construct detailed map of cervical blood vessels that are prone to damage and bleeding during SGB. Results: Of the 160 bilateral necks, 6 (3.8%) and 82 (51.3%) small arteries were identified in the medial portions of the ventral surface of the transverse processes of the sixth and seventh cervical vertebrae, respectively. In particular, 5 of the 6 small arteries detected in the medial portion of the ventral surface of the transverse process of the sixth cervical vertebra were the inferior thyroid artery (ITA). Of the 160 vertebral arteries, 2 arteries were missing, 4 (2.5%) entered the transverse foramen of the fifth cervical vertebra, whereas 1 artery (0.6%) entered the transverse foramen of the fourth cervical vertebra. Conclusions: Three-dimensional computed tomography identified the ITA in the medial portion of the ventral surface of the transverse process of the sixth cervical vertebra. The risk vessels of retropharyngeal hematoma during SGB could include the ITA. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.
http://ift.tt/2wWQIec
http://ift.tt/2wWQIec
Outcomes of Bone Anchored Hearing Aid Implant at Universiti Kebangsaan Malaysia Medical Centre (UKMMC)
Abstract
The cross sectional study was conducted in Universiti Kebangsaan Malaysia Medical Center (UKMMC), Malaysia from August 2012 to December 2013. All patients implanted with in UKMMC from December 2001 until December 2012 was included. Glasgow Benefit Inventory (GBI) questionnaires and UKMMC questionnaires were used as part of the assessment tool. The GBI is a scoring which measures the change in health status produced by surgical interventions. UKMMC questionnaires was invented by our department to assess questions related to social and life style of patients and also the cosmetic perspective Baha implant and other daily related activities. The audiological assessment was assessed using hearing aid gain threshold. Complication with regards to skin reaction was graded using Holger Skin Classification. A total of 40 patients underwent Baha implant were recruited but only 35 patients fulfilled the criteria and included in this study for analysis. Age of patients ranged from 5 year old to 38 year old, with median of 13 years old. There were 22 patients (62.8%) were male and 13 patients (37.1%) were females. Almost all cases were canal atresia except one adult patient was a case of bilateral chronic discharging ear with chronic irritation with ear mould. Majority of patients 21 (60%) have hearing level of moderate to severe hearing loss (40–89 dB) and 14 patients (40%) have mild to moderate hearing loss (20–39 dB). The level of hearing was retested post operatively. All of the patients have improvement in their aided hearing with the range of 10–25 dBL which is statistically significant at p value of <0.05. The GBI was scored positively in all subscales. Majority of patients (91.4%) used BAHA more than 4 h per day and 88.6% agreed that BAHA is cosmetically acceptable. All patients experienced some form of skin irritation (Holger grade 1–2) however only 20% required surgical intervention. All our patients have range of 10–25 dB improvement of their aided hearing which is statistically significant at p value of <0.05. BAHA has been proven to show significant benefit in audiological improvement and quality of life.
http://ift.tt/2xsxK25
Outcomes of Bone Anchored Hearing Aid Implant at Universiti Kebangsaan Malaysia Medical Centre (UKMMC)
Abstract
The cross sectional study was conducted in Universiti Kebangsaan Malaysia Medical Center (UKMMC), Malaysia from August 2012 to December 2013. All patients implanted with in UKMMC from December 2001 until December 2012 was included. Glasgow Benefit Inventory (GBI) questionnaires and UKMMC questionnaires were used as part of the assessment tool. The GBI is a scoring which measures the change in health status produced by surgical interventions. UKMMC questionnaires was invented by our department to assess questions related to social and life style of patients and also the cosmetic perspective Baha implant and other daily related activities. The audiological assessment was assessed using hearing aid gain threshold. Complication with regards to skin reaction was graded using Holger Skin Classification. A total of 40 patients underwent Baha implant were recruited but only 35 patients fulfilled the criteria and included in this study for analysis. Age of patients ranged from 5 year old to 38 year old, with median of 13 years old. There were 22 patients (62.8%) were male and 13 patients (37.1%) were females. Almost all cases were canal atresia except one adult patient was a case of bilateral chronic discharging ear with chronic irritation with ear mould. Majority of patients 21 (60%) have hearing level of moderate to severe hearing loss (40–89 dB) and 14 patients (40%) have mild to moderate hearing loss (20–39 dB). The level of hearing was retested post operatively. All of the patients have improvement in their aided hearing with the range of 10–25 dBL which is statistically significant at p value of <0.05. The GBI was scored positively in all subscales. Majority of patients (91.4%) used BAHA more than 4 h per day and 88.6% agreed that BAHA is cosmetically acceptable. All patients experienced some form of skin irritation (Holger grade 1–2) however only 20% required surgical intervention. All our patients have range of 10–25 dB improvement of their aided hearing which is statistically significant at p value of <0.05. BAHA has been proven to show significant benefit in audiological improvement and quality of life.
http://ift.tt/2xsxK25
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