Although gastrointestinal involvement in patients with granulomatosis with polyangiitis is uncommon, it is associated with mild to severe life-threatening complications. We present a case of pneumatosis cystoi...
http://ift.tt/2x67tGg
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Σάββατο 16 Σεπτεμβρίου 2017
Successful treatment with hyperbaric oxygen therapy for pneumatosis cystoides intestinalis as a complication of granulomatosis with polyangiitis: a case report
TRPM8-Agonisten lindern Pruritus bei trockener Haut
Gegen chronischen Juckreiz infolge von trockener Haut könnte eine Kombination aus zwei TRPM8-Agonisten helfen. Eine Pilotstudie.
http://ift.tt/2h9uApD
Junge Ärzte kämpfen gegen Vorurteile älterer Kollegen
Dass Nachwuchsmediziner ihr Bedürfnis nach Freizeit über die Nöte ihrer Patienten stellen und zu hohe Anforderungen an Ausbilder und künftige Arbeitgeber haben, ist reines Schubladendenken, finden junge Ärzte — und fordern ein neues Arbeitsklima.
http://ift.tt/2hauVfu
Plattenepithelkarzinom: Symptomatische perineurale Invasion trübt die Prognose
Perineurale Invasion gilt als prognostisch ungünstiger Faktor bei Plattenepithelkarzinomen der Haut. Dabei gibt es aber offenbar Unterschiede, je nachdem ob sich die Invasion klinisch bemerkbar macht oder nicht.
http://ift.tt/2hatHNx
Lichttherapie bei Pruritus: UV-B nicht mit UV-A kombinieren!
Ein Schweizer Ärzteteam hat untersucht, ob sich aus der Kombination kurzwelliger UV-B- mit längerwelliger UV-A-Strahlung ein klinisch relevanter Effekt auf Juckreiz ergibt.
http://ift.tt/2h7DB5W
Ein Dermatopathologe, zwei Meinungen
Dermatopathologische Diagnosen von Gewebe melanozytärer Male differieren nicht nur, wenn verschiedene Pathologen die Schnitte begutachten. Auch wenn derselbe Pathologe ein zweites Mal die gleiche Probe beurteilt, weichen die erste und zweite Diagnose häufig voneinander ab.
http://ift.tt/2h9Jnka
Melanom: Sentinelbiopsie kann warten
Bisher war unklar, ob ein Verschieben der Lymphknotenbiopsie Patienten mit einem Melanom eher schadet oder nützt. Dieser Unsicherheit wollten US-Ärzte ein Ende bereiten.
http://ift.tt/2h9JmN8
Psoriasis: Reviews selten von hoher Qualität
Ein spanisches Forscherteam hat systematische Übersichtsarbeiten zum Thema Psoriasis einer Qualitätskontrolle unterzogen. Gute Noten erhielten die wenigsten.
http://ift.tt/2h89lIg
Die Haut als „Touchpad“
Shiatsu ist eine japanische Form der ganzheitlichen Körperbehandlung. Dabei werden direkt unter der Haut verlaufende Energiekanäle per Druckmassage stimuliert, um die körpereigenen Selbstheilungskräfte anzuregen.
http://ift.tt/2h9ynmF
MEK-Inhibition beim inoperablen NRAS-mutierten Melanom
Wenn eine Immuntherapie bei fortgeschrittenem inoperablem NRAS-mutiertem malignem Melanom versagt, ist guter Rat teuer. In einer Phase-III-Studie wurden die Effizienz und Sicherheit des MEK-Inhibitors Binimetinib im Vergleich zu Dacarbazin getestet.
http://ift.tt/2h89cVe
Hiobsbotschaften zu übermitteln, fällt Ärzten oft schwer
Chirurgen aus den USA haben ein Tool entwickelt, das dabei helfen soll, schwierige Therapieentscheidungen oder schlechte Nachrichten mit Patienten oder Angehörigen zu besprechen. Allerdings zeigte sich, dass selbst geschulte Ärzte sich immer noch schwertun, kritisch Kranken schlechte Nachrichten zu vermitteln.
http://ift.tt/2h9ttWJ
Atopische Dermatitis: Erkrankungsalter verrät Allergierisiko
Die atopische Dermatitis kann bei Kindern offenbar abhängig von Erkrankungsalter und des Symptomenverlauf in vier verschiedene Untergruppen unterteilt werden. Dabei zeigen sich vor allem hinsichtlich der Wahrscheinlichkeit eines Etagenwechsels große gruppenspezifische Unterschiede.
http://ift.tt/2h9Lckt
Bei Hautabszessen immer auch ein Antibiotikum?
Die Frage, ob sich bei Hautabszessen an Inzision und Drainage eine Antibiose anschließen sollte, ist auch heute noch nicht ganz geklärt. Dies herauszufinden, hat sich ein Forscherteam aus den USA zur Aufgabe gestellt.
http://ift.tt/2jzUWpc
AllergoOncology: Opposite Outcomes of Immune Tolerance in Allergy and Cancer
Abstract
While desired for the cure of allergy, regulatory immune cell subsets and non-classical Th2-biased inflammatory mediators in the tumour microenvironment can contribute to immune suppression and escape of tumours from immunological detection and clearance. A key aim in the cancer field is therefore to design interventions that can break immunological tolerance and halt cancer progression, whereas on the contrary allergen immunotherapy exactly aims to induce tolerance. In this position paper, we review insights on immune tolerance derived from allergy and from cancer inflammation, focusing on what is known about the roles of key immune cells and mediators. We propose that research in the field of AllergoOncology that aims to delineate these immunological mechanisms with juxtaposed clinical consequences in allergy and cancer may point to novel avenues for therapeutic interventions that stand to benefit both disciplines.
This article is protected by copyright. All rights reserved.
http://ift.tt/2yfDGsJ
Tonsillectomy in adults: Analysis of indications and complications
Tonsillectomy is one of the surgical techniques most practiced by otolaryngologists, and despite being a relatively simple technique; it presents a considerable percentage of complications, such as postoperative bleeding. The aim of this study is to describe the surgical indications and most frequent complications, analyze whether surgical suture of the tonsillar pillars has an influence on bleeding, and study the data of hospital stay and its importance for the control of complications.
http://ift.tt/2xbxnaV
Developing biomarkers for predicting clinical relapse in pemphigus patients treated with rituximab
Rituximab is an effective therapy for pemphigus, although relapses are common.
http://ift.tt/2jxQebo
HLA class I expression predicts prognosis and therapeutic benefits from tyrosine kinase inhibitors in metastatic renal-cell carcinoma patients
Abstract
Purpose
Classical HLA class I antigen is highly involved in antigen presentation and adaptive immune response against tumor. In this study, we explored its predictive value for treatment response and survival in metastatic renal-cell carcinoma (mRCC) patients.
Experimental design
A TKI cohort of 111 mRCC patients treated with sunitinib or sorafenib and a non-TKI cohort of 160 mRCC patients treated with interleukin-2 or interferon-α-based immunotherapy at a single institution were retrospectively enrolled. HLA class I expression and cytotoxic T lymphocyte (CTL) density was assessed by immunohistochemistry on tissue microarrays. Association between HLA class I and CTL was also assessed in the TCGA KIRC cohort.
Results
In the TKI cohort, down-regulated HLA class I was associated with lower objective response rate of TKI therapy (P = 0.004), shorter overall survival (OS) (P = 0.001), and shorter progression free survival (PFS) (P < 0.001). Multivariate Cox regression model defined HLA expression as an independent prognostic factor for both OS [hazard ratio 1.687 (95% CI 1.045–2.724), P = 0.032] and PFS [hazard ratio 2.139 (95% CI 1.376–3.326), P = 0.001]. In the non-TKI cohort, HLA class I was not significantly associated with survival. HLA class I expression was associated with CTL infiltration and function, and its prognostic value was more predominant in CTL high-density tumors (P < 0.001) rather than CTL low-density tumors (P = 0.294).
Conclusions
Classical HLA class I expression can serve as a potential predictive biomarker for TKI therapy in mRCC patients. Its predictive value was restricted in CTL high-density tumors. However, further external validations and functional investigations are still required.
http://ift.tt/2x7d4Kd
Depressed serum IgM levels in SLE are restricted to defined subgroups
Source:Clinical Immunology
Author(s): Caroline Grönwall, Uta Hardt, Johanna T. Gustafsson, Kerstin Elvin, Kerstin Jensen-Urstad, Marika Kvarnström, Giorgia Grosso, Johan Rönnelid, Leonid Padykov, Iva Gunnarsson, Gregg J. Silverman, Elisabet Svenungsson
Natural IgM autoantibodies have been proposed to convey protection from autoimmune pathogenesis. Herein, we investigated the IgM responses in 396 systemic lupus erythematosus (SLE) patients, divided into subgroups based on distinct autoantibody profiles. Depressed IgM levels were more common in SLE than in matched population controls. Strikingly, an autoreactivity profile defined by IgG anti-Ro/La was associated with reduced levels of specific natural IgM anti-phosphorylcholine (PC) antigens and anti-malondialdehyde (MDA) modified-protein, as well total IgM, while no differences were detected in SLE patients with an autoreactivity profile defined by anti-cardiolipin/β2glycoprotein-I. We also observed an association of reduced IgM levels with the HLA-DRB1*03 allelic variant among SLE patients and controls. Associations of low IgM anti-PC with cardiovascular disease were primarily found in patients without antiphospholipid antibodies. These studies further highlight the clinical relevance of depressed IgM, and suggest that low IgM levels in a SLE patient may reflect underlying immunological differences.
http://ift.tt/2x5566O
Targeting immune modulatory pathways in cancer
Source:Clinical Immunology
Author(s): Philipp Beckhove
http://ift.tt/2fpFCqr
Clinical update regarding general anesthesia-associated neurotoxicity in infants and children.
Purpose of review: The U.S. Federal Drug Administration (FDA) recently released a warning stating that 'repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures in children younger than 3 years or in pregnant women during their third trimester may affect the development of children's brains' ( http://ift.tt/2x7Abo0). The goal of this article is to review the most recent clinical studies which provide evidence that these concerns may be overstated for the majority of healthy young children who require surgery and anesthesia. Recent findings: Three large retrospective matched cohort studies published within the past year provide data on a total of 59 814 children exposed to general anesthesia before age 4 (including 30 021
http://ift.tt/2y5r1rb
http://ift.tt/2y5r1rb
Complications and unplanned admissions in nonoperating room procedures.
Purpose of review: The purpose of this article is to review complications and unplanned hospital admissions in patients presenting for ambulatory procedures requiring anesthesia care in the gastrointestinal endoscopy, bronchoscopy, and radiology suites. Recent findings: The range of ambulatory diagnostic and therapeutic procedures being undertaken in the gastrointestinal endoscopy, bronchoscopy, and radiology suites is expanding rapidly. Recent observational studies in gastrointestinal endoscopy confirm low incidences of complications and unplanned admissions. Deep propofol-based sedation is associated with more complications than lighter sedation. Older patients suffer more complications but obstructive sleep apnea does not appear to increase risk. Sedation improves patient comfort during bronchoscopy. Propofol-based sedation is associated with fewer complications than benzodiazepine-based sedation, but all combinations are associated with high patient satisfaction. Obesity and obstructive sleep apnea are not associated with worse outcomes in bronchoscopy patients. Sedation is increasingly required for interventions in the radiology suite. When patients are involved in choosing sedation depth, there is a trend to lighter sedation and high patient satisfaction. Summary: Sedation and anesthesia are required for the increasing number of increasingly complex procedures being undertaken outside the operating suite. Large randomized trials are required to define the optimum sedation drugs, sedation depth and sedation provider. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2x6MqkE
http://ift.tt/2x6MqkE
The relationship between the GJB3 c.538C>T variant and hearing phenotype in the Chinese population
Publication date: November 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Shasha Huang, Bangqing Huang, Guojian Wang, Dong Yang Kang, Xin Zhang, Xiaoxiao Meng, Pu Dai
BackgroundMutations in GJB3 were originally shown to underlie an autosomal dominant form of non-syndromic deafness in Chinese patients and the c.538C>T (p.R180*) variants caused high-frequency hearing loss. But after that, few reports have reported this mutation. This study investigated the relationship between the GJB3 c.538C>T variant and hearing phenotype in Chinese to assist with risk assessment and genetic counseling for hearing loss patients and their families.MethodThe study enrolled 5700 patients with hearing loss and 4600 normal subjects. Deafness gene mutations were distinguished using a gene chip. The GJB3 c.538C>T variant rate was calculated from the results.ResultOf the 5700 patients, 23 (0.40%) carried a GJB3 c.538C>T heterozygous variant; of these, 11 patients had other gene (GJB2/SLC26A4) mutations simultaneously. Most patients had moderate to profound hearing loss. All 23 patients were sporadic cases and had no family history of deafness. Of the 4600 normal individuals, 11 (0.24%) had GJB3 c.538C>T heterozygous variant. There was no statistical difference in incidence between the two groups.ConclusionsOur results showed that the GJB3 c.538C>T variant has a very low incidence in the Chinese population, and there was no clear evidence to support a role of the GJB3 c.538C>T variant in the autosomal dominant form of non-syndromic deafness. Our findings suggested that GJB3 c.538C>T does not contribute to hearing loss, and this conclusion will assist with genetic counseling and risk prediction for deafness related to the GJB3 c.538C>T variant.
http://ift.tt/2h7rYfk
Utility of screening questionnaire and polysomnography to predict postoperative outcomes in children
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Hiromi Kako, Jennifer Tripi, Hina Walia, Dmitry Tumin, Mark Splaingard, Kris R. Jatana, Joseph D. Tobias, Vidya T. Raman
IntroductionThe prevalence of pediatric obstructive sleep apnea (OSA) has increased concurrently with the increasing prevalence of obesity. We have previously validated a short questionnaire predicting the occurrence of OSA on polysomnography (PSG). This follow-up study assessed the utility of the questionnaire in predicting postoperative outcomes.MethodsChildren undergoing surgery and completing a sleep study were prospectively screened for OSA using a short questionnaire. Procedures within 1 year of PSG were included in the analysis. Questionnaires were scored according to a cutoff previously deemed optimal for predicting OSA (apnea-hypopnea index ≥ 5) on the sleep study. Postoperative outcomes included prolonged (>60 min) length of stay (LOS) in the post-anesthesia care unit (PACU) and oxygen requirement in the PACU.ResultsThe study cohort included 185 patients (100/85 male/female) age 8 ± 4 years, undergoing adenotonsillectomy (n = 109), other ear, nose, and throat (ENT) procedures (n = 18), or non-ENT procedures (n = 58). There were 45 patients with OSA documented by PSG and 122 patients identified as likely to have OSA according to questionnaire responses (89% sensitivity, 41% specificity). PACU LOS was prolonged in 55/181 (30%) cases and supplemental oxygen was used in the PACU in 29/181 (16%) cases. In separate multivariable models, supplemental oxygen use in the PACU was more common if a patient scored ≥2/6 points on the short questionnaire scale (OR = 5.0; 95% CI: 1.3, 19.9; p = 0.023) or if the patient was diagnosed with OSA on PSG (OR = 4.6; 95% CI: 1.6, 13.5; p = 0.005). Neither OSA on PSG nor questionnaire score ≥2/6 were associated with prolonged PACU stay.ConclusionBoth OSA diagnosis based on the AHI and the questionnaire scale achieved comparable predictive value for the need for oxygen use in the PACU. The utility of the questionnaire in predicting rare adverse events (e.g., unplanned admission or rapid response team activation) remains to be determined. Our preliminary results support using a brief questionnaire scale for preoperative risk stratification among children with suspected OSA who have not had a formal sleep study.
http://ift.tt/2h9Uidp
Effects of pregabalin on postoperative pain after hysterectomy under spinal anesthesia with intrathecal morphine: a randomized controlled trial
Abstract
Purpose
To determine if preoperative pregabalin could decrease 24-h postoperative morphine consumption after spinal anesthesia with intrathecal morphine compared with placebo.
Methods
A randomized, double-blind, controlled trial was performed in the tertiary care center. Patients aged between 18 and 65 years who were American Society of Anesthesiologists class I–II and scheduled for abdominal hysterectomy with or without salpingo-oophorectomy were randomly allocated to a placebo or a pregabalin group. Patients received pregabalin 150 mg or placebo 1 h prior to anesthesia. Spinal anesthesia was achieved with 0.5% hyperbaric bupivacaine with morphine 0.2 mg. Intravenous patient-controlled analgesia morphine was provided postoperatively. Postoperative morphine consumption at 6, 12, and 24 h, time to first analgesic rescue, pain scores, adverse effects, and patient satisfaction were evaluated at 24 h after the operation.
Results
One hundred twenty-five patients were recruited and 119 patients (placebo N = 58, pregabalin N = 61) were included in the analysis. Forty-seven (81.0%) patients in the placebo group and 53 (86.9%) patients in the pregabalin group required morphine in the first 24 h. Median [IQR] 24-h morphine consumption was 4.0 [1.8, 10.0] mg in the placebo group and 5.0 [2.0, 11.0] mg in the prebagalin group, p = 0.60. There were no differences in cumulative morphine consumption at 6, 12, and 24 h postoperatively. The two groups also did not differ in time to first analgesic rescue, pain scores at rest and on movement, and side effects.
Conclusion
A single preoperative dose of pregabalin 150 mg did not reduce 24-h postoperative morphine consumption or pain scores or prolong the time to first analgesic rescue in spinal anesthesia with intrathecal morphine.
http://ift.tt/2yfhRcA
Tumor regression grading of gastrointestinal cancers after neoadjuvant therapy
Abstract
Neoadjuvant therapy has been successfully introduced in the treatment of locally advanced gastrointestinal malignancies, particularly esophageal, gastric, and rectal cancers. The effects of preoperative chemo- or radiochemotherapy can be determined by histopathological investigation of the resection specimen following this treatment. Frequent histological findings after neoadjuvant therapy include various amounts of residual tumor, inflammation, resorptive changes with infiltrates of foamy histiocytes, foreign body reactions, and scarry fibrosis. Several tumor regression grading (TRG) systems, which aim to categorize the amount of regressive changes after cytotoxic treatment in primary tumor sites, have been proposed for gastroesophageal and rectal carcinomas. These systems primarily refer to the amount of therapy-induced fibrosis in relation to the residual tumor (e.g., the Mandard, Dworak, or AJCC systems) or the estimated percentage of residual tumor in relation to the previous tumor site (e.g., the Becker, Rödel, or Rectal Cancer Regression Grading systems). TRGs provide valuable prognostic information, as in most cases, complete or subtotal tumor regression after neoadjuvant treatment is associated with better patient outcomes. This review describes the typical histopathological findings after neoadjuvant treatment, discusses the most commonly used TRG systems for gastroesophageal and rectal carcinomas, addresses the limitations and critical issues of tumor regression grading in these tumors, and describes the clinical impact of TRG.
http://ift.tt/2xH47ui
Growing evidence of the beneficial effects of a marine protein-based dietary supplement for treating hair loss
Summary
Background
Hair loss is a common condition among women with a range of causes including nutritional deficiencies.
Aims
To review the clinical data supporting the use of an oral marine supplement designed to promote hair growth.
Patients/Methods
Adult women with temporary thinning hair. Following an initial pilot study, five randomized, double-blind studies assessed the effectiveness of the oral marine supplement for promoting hair growth. Each study was approved by one or more institutional review boards.
Results
Together, these studies demonstrated the ability of oral marine supplements to increase the growth of terminal and vellus hairs, increase the diameter of terminal and vellus hairs, and decrease hair loss. This product is beneficial for men as well as women.
Conclusions
A dietary supplement containing a marine complex and other natural ingredients can safely and effectively promote hair growth and decrease hair shedding in women and men with thinning hair.
http://ift.tt/2fblbRh
Unusually prolonged pemetrexed cytotoxicity in a patient with a lung adenocarcinoma: a case report
We describe a case of pemetrexed toxicities related to reabsorption by an ileal neobladder, which caused prolonged hematotoxicity and nephrotoxicity.
http://ift.tt/2x3QCny
Otolaryngologic management of Down syndrome patients: what is new?.
Purpose of review: The management of children with Down syndrome as it pertains to the otolaryngologist continues to evolve. Obstructive sleep apnea (OSA) has dominated the recent literature, but other topics including hearing loss, swallowing, and perioperative considerations are also reported. Recent findings: The prevalence of OSA in children with Down syndrome ranges from 57 to 73% in certain cohorts, and, whereas adentonsillectomy can decrease Apnea-Hypopnea Index, up to 80% may have persistent OSA. Surgical techniques involving reduction of the base of tongue are effective for those who fail adenotonsillectomy, and it is expected that drug-induced sleep endoscopy may improve outcomes. New technology is also on the horizon that can assist with diagnosis and treatment including computational modelling and upper airway stimulation. Children with Down syndrome may not respond to medical management of eustachian tube dysfunction as well as normally developing children. In addition, there is a high prevalence of inner ear anomalies, increasing the risk for sensorineural hearing loss. Summary: Questions remain pertinent to the otolaryngologist regarding the ideal management of children with Down syndrome. Additional studies are necessary, to optimize understanding and treatment of this complex population, in particular as opportunities develop with technological advances. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2xGqHTO
http://ift.tt/2xGqHTO
Extraluminal biodegradable splint to treat upper airway anterior malacia: A preclinical proof of principle
Objective
Upper airway malacia highly complicates the treatment of benign laryngotracheal stenosis, and no ideal option is available to date. We here explore the use of extraluminal biodegradable splints in an animal model of long-segment anterior tracheomalacia (TM). We show the efficacy, as well as the tissue tolerance, of a custom-made biodegradable extraluminal device surgically inserted around the trachea.
Study Design
Preclinical animal study.
Methods
Anterior TM was induced in rabbits through an anterior neck approach by removing eight consecutive anterior tracheal rings without damaging the underlying mucosa. Malacia was corrected during the same surgery by pexy sutures, suspending the tracheal mucosa to an experimental biodegradable device. Symptoms, survival, and tissue reaction were compared to healthy and sham surgery controls.
Results
The model induced death by respiratory failure within minutes. Ten animals received the experimental treatment, and those who survived the perioperative period remained asymptomatic with a maximum follow-up of 221 days. Histological studies at programmed euthanasia showed complete degradation of the prosthesis, with significant remnant fibrosis around the trachea. However, the tracheal stiffness of test segments was comparatively less than that of control segments.
Conclusion
Extraluminal biodegradable splints rescued animals with a condition otherwise incompatible with life. It was well tolerated, leaving peritracheal fibrosis that was not as stiff as normal trachea. The external tracheal stiffening was sufficient for the test animals to live through the phase of severe acute hypercollapsibility. This represents a valid option to help pediatric patients with laryngotracheal stenosis and associated cartilaginous airway malacia.
Level of Evidence
NA. Laryngoscope, 2017
http://ift.tt/2x3OCf7
A paradigm for evaluation and management of the maxillary sinus before dental implantation
Objectives
To determine a paradigm for evaluating and managing maxillary sinus conditions before dental implantation via preoperative sinonasal assessment.
Study Design
Prospective cohort study.
Methods
Eighty-four patients who underwent dental implantation with or without sinus augmentation were included. Maxillary sinus conditions were classified into groups 1 to 6 according to cone-beam computed tomography (CT) findings: 1) nonspecific findings, 2) solitary polyp or cyst, 3) mucosal thickening, 4) air–fluid level or fluid accumulation, 5) near-total opacification of the maxillary or other paranasal sinus, and 6) calcification spots in the maxillary sinus. Dental implantation with or without sinus augmentation was suggested with postoperative sinus observation (groups 1–3), after medication for acute sinusitis (group 4), and after comprehensive treatment of chronic or fungal sinusitis (groups 5–6). Intraoperative and postoperative sinus-related complications were recorded.
Results
Two patients (groups 1 and 3) developed acute rhinosinusitis after sinus augmentation; both recovered completely with medical treatment. Schneiderian membrane perforation occurred during sinus lift surgery in six patients (group 1): five recovered after conservative medical therapy and close observation, whereas one required endoscopic sinus surgery and recovered well. No chronic rhinosinusitis developed after dental implantation.
Conclusion
Craniofacial CT is crucial for pre-dental implantation sinonasal evaluation. The risk of dental implant-related chronic rhinosinusitis is low for patients with cysts, polyps, or mucosal thickening in the maxillary sinus. However, preventive endoscopic sinus surgery is recommended for patients with incurable chronic rhinosinusitis, fungal sinusitis, and large polyps or cysts.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2x66QdB
Evolution of the endoscopic modified Lothrop procedure: A systematic review and meta-analysis
Objective
Since first described in the 1990s, the endoscopic modified Lothrop procedure (EMLP) has been the subject of a growing body of literature. We performed a review to compare indications and outcomes of EMLP in an early cohort of publications (1990–2008) versus a contemporary cohort (2009–2016) and compare outcomes associated with follow-up ≥2 years versus <2 years.
Data Sources
PubMed, SCOPUS and Cochrane databases.
Review Methods
An English-language search of the PubMed and Ovid databases was conducted to identify publications from 1990 to 2016 reporting clinical outcomes of EMLP. Meta-analysis was performed using Statistical Analysis System 9.4.
Results
A total of 1,205 patients were abstracted from 29 articles with a mean follow-up of 29.1 ± 10.3 months. The overall rate of significant or complete symptom improvement was 86.5% (95% confidence interval [CI]: 84.2%-88.7%). The overall patency rate was 90.7% (95% CI: 89.1%-92.3%), with a revision rate of 12.6% (95% CI: 10.6%-14.3%). Compared to the early cohort, patients in the contemporary cohort underwent EMLP more often for tumors (P < .001), had higher rates of complete or significant symptom improvement (90.0% vs. 82.6 %, P < .001); and trended toward greater patency rates (92.1% vs. 88.6%, P = .052). Compared to the short-term follow-up cohort, the long-term cohort showed no differences in symptom improvement or patency, but the revision rate was higher (14.5% vs. 9.2%, P = .016).
Conclusions
In the last decade, EMLP has been performed more frequently for tumors. Recent studies have demonstrated improved symptom outcomes and a trend toward improved patency rates. The revision rate increased significantly when follow-up exceeded 2 years. Laryngoscope, 2017
http://ift.tt/2x48GOp
Otolaryngologic management of Down syndrome patients: what is new?.
Purpose of review: The management of children with Down syndrome as it pertains to the otolaryngologist continues to evolve. Obstructive sleep apnea (OSA) has dominated the recent literature, but other topics including hearing loss, swallowing, and perioperative considerations are also reported. Recent findings: The prevalence of OSA in children with Down syndrome ranges from 57 to 73% in certain cohorts, and, whereas adentonsillectomy can decrease Apnea-Hypopnea Index, up to 80% may have persistent OSA. Surgical techniques involving reduction of the base of tongue are effective for those who fail adenotonsillectomy, and it is expected that drug-induced sleep endoscopy may improve outcomes. New technology is also on the horizon that can assist with diagnosis and treatment including computational modelling and upper airway stimulation. Children with Down syndrome may not respond to medical management of eustachian tube dysfunction as well as normally developing children. In addition, there is a high prevalence of inner ear anomalies, increasing the risk for sensorineural hearing loss. Summary: Questions remain pertinent to the otolaryngologist regarding the ideal management of children with Down syndrome. Additional studies are necessary, to optimize understanding and treatment of this complex population, in particular as opportunities develop with technological advances. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2xGqHTO
http://ift.tt/2xGqHTO
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