No abstract available
http://ift.tt/2hoVee2
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Παρασκευή 22 Σεπτεμβρίου 2017
Safety and efficacy of epidural analgesia.
Purpose of review: Epidural analgesia remains a widely used analgesic technique. This article aims to assess the safety of epidural analgesia by balancing efficacy and complications, of epidural analgesia for acute, labor and chronic pain. Recent findings: Main indications for epidural analgesia include major open abdominal surgery, thoracotomy and labor analgesia. Past and current literature show that epidural analgesia leads to statistically significant, but possibly clinically less meaningful, reductions in pain scores compared with intravenous analgesia. The debate continues whether epidural analgesia leads to decreased complications and improved outcome. Noninferiority of alternative regional analgesic approaches, that is continuous-wound-infiltration, peripheral nerve blocks or surgical site infiltration, appears to be present and is promising for the future. Serious adverse events after epidural analgesia seem to occur more often than was previously thought and clinicians must realize that incidence rates differ in specific perioperative patient populations. Summary: Epidural analgesia for obstetric analgesic purposes is considered to be well tolerated in young, healthy women, since efficacy has been proven and complications leading to permanent neurological damage seldomly occur. Safety of epidural analgesia for perioperative and chronic pain treatment is more difficult to balance; careful selection of appropriate patients cannot be over-emphasized. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2hp6xqA
http://ift.tt/2hp6xqA
New advancements in spinal cord stimulation for chronic pain management.
Purpose of review: To update the recent development of spinal cord stimulation (SCS) technology in the management of chronic pain. Recent Findings: Efficacy of SCS therapy has been significantly improved by the recent development of high frequency (HF-10 kHz) stimulation, burst stimulation, and dorsal root ganglion (DRG) stimulation. A few latest SCS modalities are in clinical trial. New approaches to guide lead placement and advances in surgical lead are introduced. Summary: HF-10 SCS is free of paresthesia and associated with significantly better coverage of axial lower back pain. Burst stimulation invokes minimal paresthesia and provides better coverage of low back pain. DRG stimulation results in better outcomes in patients with complex regional pain syndrome. It requires less energy and delivers consistent stimulation regardless of postural variations. Clinical trials with new SCS modalities, such as Stimwaves, are under way to make SCS wireless. Intraoperative neuromonitoring and paresthesia atlas may be used to guide lead placement. Multicolumn surgical paddle leads enable a combination of independent current control with up to 32 contacts for better programming and better coverage. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2hpDHm5
http://ift.tt/2hpDHm5
Nonoperating room anesthesia for endoscopic procedures.
Purpose of review: The purpose of this review is to take a look on some practical aspects of anesthetic care in the endoscopy suite, concerning the general approach, safety, and monitoring issues. Recent findings: Concerning propofol popularity for sedation during endoscopic procedures new studies create doubt in the safety of higher doses of propofol used for sedation. Careful titration of propofol, addition of synergistic supplements like ketamine and dexmedetomidine, and monitoring of anesthetic depth may limit the dose of propofol given to the patients. Capnography has the potential to detect airway compromise earlier than pulse-oximetry and by this enhancing patient safety. Summary: Sedation or anesthesia in the endoscopy suite is not without risk. For complex and longer lasting procedures and in patients with significant comorbidities and risk factors, good clinical judgment, built on experience, is essential and to foster this, it seems prudent to build up a group of anesthesiologists dedicated to a special sedation service. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2hlNGg0
http://ift.tt/2hlNGg0
Enhancing the quality and safety of the perioperative patient.
Purpose of review: Many possible hazards bedevil the perioperative patient. This review focuses on a number of aspects of perioperative management where the patient's quality and safety can be enhanced. Recent findings: Our understanding of the relationship between preoperative preparation and postoperative outcomes has improved. There have also been recent developments in our understanding of how to construct useful cognitive aids and make the best use of checklists by understanding the cultural environment supporting their use. Postoperatively, the concept of 'failure to rescue' in the surgical patients has been explored. Summary: A clear vision of what postoperative recovery should mean for practitioner and patients; careful risk stratification and prophylactic measures to avoid postoperative complications; the judicious use of checklists and other cognitive aids to complement clinical expertise in promoting safety within each local context; and the prompt recognition and rescue of postoperative problems when they occur are all important aspects of a safe perioperative care. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2hpEEuJ
http://ift.tt/2hpEEuJ
Optimizing education in difficult airway management: meeting the challenge.
Purpose of review: The last 2 decades have seen a vast change in the science and technology of airway management. As a result, there is an increasing need to equip anesthesiologists with the new knowledge and skills for the safe management of a difficult airway. Recent findings: In addition to knowledge and expertise, human factors and nontechnical skills (NTS), including situational awareness, communication and team work, play an important role during difficult airway management and contribute to the outcome. Didactic sessions are useful to impart knowledge. Self-learning, interactive discussions, simulation and debriefing are important tools for teaching and training in difficult airway management. Manikin training and simulation enable development of technical as well as NTS without subjecting patients to risk and allow multiple training sessions of relatively uncommon scenarios. Guidelines are useful teaching tools, whereas cognitive tools such as the Vortex approach may be useful during a difficult airway. Summary: There is need for research on difficult airway management and optimized training methods. Research is also required to determine the barriers to adoption of guidelines and strategies to ensure widespread dissemination and implementation of guidelines and best practices for difficult airway management. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2hlNBso
http://ift.tt/2hlNBso
Are we fully utilizing the functionalities of modern operating room ventilators?.
Purpose of review: The modern operating room ventilators have become very sophisticated and many of their features are comparable with those of an ICU ventilator. To fully utilize the functionality of modern operating room ventilators, it is important for clinicians to understand in depth the working principle of these ventilators and their functionalities. Recent findings: Piston ventilators have the advantages of delivering accurate tidal volume and certain flow compensation functions. Turbine ventilators have great ability of flow compensation. Ventilation modes are mainly volume-based or pressure-based. Pressure-based ventilation modes provide better leak compensation than volume-based. The integration of advanced flow generation systems and ventilation modes of the modern operating room ventilators enables clinicians to provide both invasive and noninvasive ventilation in perioperative settings. Ventilator waveforms can be used for intraoperative neuromonitoring during cervical spine surgery. Summary: The increase in number of new features of modern operating room ventilators clearly creates the opportunity for clinicians to optimize ventilatory care. However, improving the quality of ventilator care relies on a complete understanding and correct use of these new features. Video abstract: http://ift.tt/2hpXORl. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2hlNzRi
http://ift.tt/2hlNzRi
Anesthesia information management: clinical decision support.
Purpose of review: Perioperative informatics tools continue to be developed at a rapid pace and offer clinicians the potential to greatly enhance clinical decision making. The goal of this review is to bring the reader updates on perioperative information management and discuss future research directions in the field. Recent findings: Clinical decision support tools become more timely, accurate, and, in some instances, have been shown to improve patient outcomes. When correctly implemented, they are critical tools for optimization of perioperative care. Summary: Perioperative informaticians continue to test new and innovative ways to enhance the delivery of anesthesia care, improving the safety and efficacy of perioperative management. Future work will continue to refine tools to ensure that perioperative informatics provides clinicians timely and accurate feedback, with demonstrable evidence that a decision support system improves patient outcomes. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2hpwe6G
http://ift.tt/2hpwe6G
Long Cold Ischemia Times in Same Hospital Deceased Donor Transplants.
Background: Recent changes in deceased donor organ allocation for livers (Share-35) and kidneys (KAS) have resulted in broader sharing of organs and increased cold ischemia time (CIT). Broader organ sharing however is not the only cause of increased CIT. Methods: This was a retrospective registry study of CIT in same-hospital liver transplants (SHLT, n=4,347) and kidney transplants (SHKT, n=9,707) between 2004 and 2014. Results: In SHLT, median (IQR) CIT was 5.0 (3.5-6.5) hours versus 6.6 (5.1-8.4) hours in other-hospital LT. DCD donors, donor biopsy, male recipient, recipient obesity, and previous transplant were associated with increased CIT. MELD at transplant of 29+ or status 1a was associated with decreased CIT. SHLT CIT varied by OPO and transplant-center (p
http://ift.tt/2wcjMgK
http://ift.tt/2wcjMgK
Feasibility of Monotherapy by Rituximab Without Additional Desensitization in ABO-incompatible Living Donor Liver Transplantation.
Background: Rituximab is a cornerstone in the regimens of desensitization for ABO-incompatible living donor liver transplantation (ABO-i LT) that makes this modality an acceptable option for liver transplantation. Plasmapheresis (PP) to reduce anti-ABO antibody titer and local infusion therapy (LI) were practiced as the strategies for desensitization before the application of rituximab and were reported as additional treatments. The aim of this study was to clarify the feasibility of monotherapy by rituximab without any additional desensitization treatments in ABO-i LT. Methods: Forty patients receiving ABO-i LDLT with Rituximab were enrolled in this retrospective study. The patients were divided into 2 groups: the rituximab with pretransplant PP and posttransplant LI (RPL) group (n=20) and the rituximab monotherapy without any additional treatment (RM) group (n=20). The groups were then compared in terms of the rates of patient survival, antibody-mediated rejection (AMR), and infection. Results: The 1-, 3-, and 5-year patient survival rates were 85%, 85%, and 85% in the RPL group and 89%, 80%, and 80% in the RM group, respectively. There was no significant difference in patient survival between the 2 groups. There were no episodes of AMR in either group. The RM group had a lower rate of fungal and viral infections than the RPL group. Conclusions: Pretransplant rituximab without additional treatments yielded satisfactory outcomes comparable to that with additional treatments such as PP and LI. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2fgNNF7
http://ift.tt/2fgNNF7
Comprehensive survey of vitiligo patients in the northeast of China using a predesigned questionnaire
Abstract
To assess the sociodemographic data and clinical information of outpatients affected by vitiligo in the northeast of China, vitiligo patients or guardians who presented to the clinic were invited to participate in an exploratory questionnaire. The questionnaire consisted of two sections related to vitiligo, including sociodemographic data and clinical information. A total of 983 vitiligo patients answered the questionnaire. The rates of female and male patients were comparable. The investigated patients were mostly young and middle-aged. Most patients suffered from vitiligo in childhood or young adulthood. Vitiligo vulgaris was the most common type of vitiligo in clinic and 53.0% of patients were categorized as body surface area (BSA) of 10% or less. In response to the latest treatment, 43.6% of patients achieved good response (completely stopped or almost disappeared). More patients at active stage showed good response than the patients at stable stage (χ2 = 7.866, P < 0.05). Chronic comorbid condition(s) were observed in 12.6% of patients with BSA of more than 10%, whereas those were seen in 6.0% of patients with BSA of 10% or less (χ2 = 12.969, P < 0.05). In conclusion, active vitiligo seems to respond better than stable vitiligo and complications with other autoimmune diseases more frequently observed in severe patients than mild patients. The current study presented a comprehensive understanding of vitiligo in the northeast of China.
http://ift.tt/2xmv5qf
Association between circulating prolactin levels and psoriasis and its correlation with disease severity: a meta-analysis
Summary
Background
Studies that have compared circulating prolactin (PRL) levels in patients with psoriasis and healthy controls (HCs) and determined the relation between PRL levels and psoriasis severity have shown mixed results.
Aim
To evaluate the association between circulating PRL levels and psoriasis, and between serum/plasma PRL levels and psoriasis severity.
Methods
We performed a meta-analysis comparing serum/plasma PRL levels in patients with psoriasis with those of HCs, and examined the correlation coefficients for circulating PRL levels and psoriasis severity based on Psoriasis Area and Severity Index (PASI).
Results
In total, 12 studies assessing 446 patients with psoriasis and 401 HCs were included. PRL levels were significantly higher in the psoriasis group than in the HC group [standardized mean difference (SMD) 0.54; 95% CI = 0.18–090; P < 0.01). Stratification by age and sex revealed a significantly higher PRL level in the psoriasis group (SMD = 0.53; 95% CI = 0.15–0.91; P < 0.01). Subgroup analysis by sample size showed a significantly higher PRL level with larger sample sizes (n ≥ 80) (SMD = 0.51, 95% CI = 0.07–0.95, P = 0.02), but not with smaller sample sizes (n < 80) in the psoriasis group. Stratification by sample type revealed a significantly higher level of PRL in the sera, but not plasma of the psoriasis group. Meta-analysis of the correlation coefficients showed a positive, although not statistically significant, correlation between circulating PRL levels and PASI (correlation coefficient = 0.48, 95% CI = −0.05 to 0.80, P = 0.08).
Conclusion
Circulating PRL levels are higher in patients with psoriasis, and PRL levels may correlate with psoriasis severity.
http://ift.tt/2xlNNOS
T-helper immune phenotype may underlie ‘paradoxical’ tumour necrosis factor-α inhibitor therapy-related psoriasiform dermatitis
Summary
Background
Therapeutics targeting tumour necrosis factor (TNF)-α are effective for psoriasis; however, in patients treated for other disorders, psoriasis may worsen and psoriasiform dermatitis (PsoD) may arise. T helper (Th) cytokines in psoriasis upregulate keratin (K)17, which modulates TNF-α transduction, leading to vascular adhesion molecule upregulation and lymphocytic extravasation.
Aim
We investigated Th phenotype and expression of K17, intercellular adhesion molecule (ICAM)-1 and vascular adhesion molecule (VCAM)-1 in psoriasis and anti-TNF-α-related PsoD.
Methods
Skin biopsies from patients with psoriasis unresponsive to TNF-α inhibitor therapy (n = 11), PsoD-related to TNF-α inhibition (n = 9), untreated psoriasis (n = 9) or atopic dermatitis (AD; n = 9) were immunohistochemically analysed for Th1, Th2, Th17 and Th22. Expression of K17, ICAM-1 and VCAM-1 was also examined.
Results
Anti-TNF-α-unresponsive psoriasis and anti-TNF-α-related PsoD showed decreased Th1 : Th2 raio and increased Th17 : Th1 ratio compared with untreated psoriasis. Anti-TNF-α-unresponsive psoriasis had significantly fewer Th1 (4% vs. 12%) and more Th17 (51% vs. 20%) cells than untreated psoriasis. No difference in Th22 cells was identified. K17 was present in all cases of untreated psoriasis and anti-TNF-α-related PsoD, 91% of anti-TNF-α-unresponsive psoriasis, and only 22% of AD. VCAM-1 and ICAM-1 in anti-TNF-α-related PsoD was akin to untreated psoriasis, but decreased in anti-TNF-α-unresponsive psoriasis.
Conclusions
These findings further the current understanding of the anti-TNF-α-related psoriasiform phenotype and support a rationale for therapeutic targeting of interleukin-17 and TNF-α in combination.
http://ift.tt/2fHtHoi
The clinicoaetiological, hormonal and histopathological characteristics of melasma in men
Summary
Background
Melasma is relatively uncommon in males, and there is a paucity of data on male melasma, including its clinical pattern, triggering factors, endocrine profile and histopathological findings.
Aim
To characterize the clinical findings and aetiological factors, including hormonal and histopathological features, of male melasma.
Methods
Male patients with melasma and age- and sex-matched healthy controls (HCs) were recruited. Demographic profile, risk factors, clinical pattern and Wood lamp findings of patients were recorded. Sera were obtained from patients and HCs to determine hormone levels. Biopsy specimens were obtained from lesional and adjacent nonlesional skin.
Results
In total, 50 male patients with melasma and 20 HCs were recruited into the study. Mean age of patients was 27.58 ± 4.51 years. The most common clinical pattern of melasma was malar, which occurred in 52% of cases. Positive family history was present in 16% of patients, while 34% had disease aggravation with sun exposure and 62% used mustard oil for hair growth and/or as an emollient. Wood lamp examination revealed epidermal-type melasma in 54% of patients. There were no significant differences in hormone levels between patients and HCs. Histologically, epidermal melanin, elastotic degeneration, vascular proliferation and mast cells were more pronounced in lesional compared with nonlesional skin. Absent to weak expression of oestrogen receptors, progesterone receptors and stem cell factor was observed in lesional skin.
Conclusion
Ultraviolet light and mustard oil are important causative factors in male melasma. Although stress and family history may contribute, hormonal factors possibly have no role. Quantitative analysis of immunohistochemical markers would provide insight in understanding the pathogenesis of melasma.
http://ift.tt/2xngBGZ
Systemic photodynamic therapy in folliculitis decalvans
Summary
Folliculitis decalvans (FD) is classified as a primary neutrophilic cicatricial alopecia, and is estimated to account for approximately 10% of all cases of primary cicatricial alopecia. The role of dysfunctional immune activity and the presence of bacteria, particularly Staphylococcus aureus, appear pivotal. We describe a 26-year-old man with a 4-year history of FD that was recalcitrant to numerous systemic and topical therapies, whose disease was virtually cleared during a follow-up of 25 months following a course of treatment with systemic photodynamic therapy (PDT) using ultraviolet light (100–140 J/cm2) with porfimer sodium 1 mg/kg as monotherapy. This is the first report of the use of systemic PDT as a treatment for FD. Systemic PDT has potent antibacterial effects with little or no resistance. In addition, systemic PDT provides local immunomodulation and improved scar healing. Significant adverse effects following systemic PDT with appropriate aftercare are rare. This case demonstrates that systemic PDT is a useful therapy option in the treatment of recalcitrant FD.
http://ift.tt/2fHlj89
Acral melanoma foot lesions. Part 1: epidemiology, aetiology, and molecular pathology
Summary
Acral melanoma (AM) is a rare subtype of cutaneous malignant melanoma (MM) found on acral skin, primarily on the soles of the feet. Although rare, it is the most common subtype of MM found in patients of African or East Asian ethnicity and has a poor prognosis, often because of the more advanced stage of presentation at diagnosis. The pathogenesis of AM is unclear, but genetic alterations, including mutations in BRAF, NRAS, and KIT have been implicated. Early diagnosis of AM is important for a better prognosis, but its identification is often challenging, leading to easy misdiagnosis. In the first of this two-part review, we review the history, epidemiology, aetiology and molecular pathology of AM; in part 2 we will review diagnosis and management.
http://ift.tt/2fGWs4i
MicroRNAs in cutaneous lichen planus
Summary
Lichen planus (LP) is a chronic, inflammatory, papulosquamous, autoimmune disease. The pathogenesis of LP appears to be complex, with interactions between genetic, environmental and lifestyle factors. MicroRNAs (miRNAs) are short RNAs encoded in both protein coding and noncoding areas of the genome, and have been found to be involved in the pathogenesis of some inflammatory skin diseases. The aim of this study was to map the levels of miRNA (miR-)-203 and miR-125b in cutaneous LP to evaluate their possible role in the pathogenesis of the disease. In total, 40 patients with classic cutaneous LP and 40 age- and sex- matched healthy controls (HCs) were enrolled in this study. Punch biopsies (4 mm) were taken from cutaneous LP lesions of patients and from normal skin of HCs. miRNA-203 and miRNA-125b mRNA expression was estimated by reverse transcription PCR. Our analysis revealed a significantly (P < 0.001 for both) lower expression of both miR-203 and miR-125b mRNA in the LP than in the HC biopsies. No relationship was found between expression of miR-203 or miR-125b and either age, sex, presence of mucosal lesions or positivity for HCV antibodies. miR-125b and miR-203 could be involved in the pathogenesis of cutaneous LP.
http://ift.tt/2xmuS6r
An interpretation of the new international MAP guideline for the management of Milk Allergy in Primary Care
General Practitioners suffer from guideline fatigue. They come fast and furious in many complicated forms. Cow's milk allergy (CMA) is one of the most common presentations of food allergy seen in early childho...
http://ift.tt/2wIfjXd
Clozapine-induced acute gastrointestinal necrosis: a case report
Clozapine is known to cause fecal impaction and ileus with resultant colonic necrosis due to compression of colonic mucosa. There are rare reports of clozapine causing necrosis of other portions of the gastroi...
http://ift.tt/2fGL4p3
Extraskeletal osteosarcoma in the parotid gland: A case report
Extraskeletal osteosarcoma is a very rare tumor and accounts for 4–5% of all osteosarcomas. We describe a 47-year-old Japanese man who presented with a right parotid tumor. The patient underwent total resection with postoperative radiotherapy; however, the tumor recurred in the lung, whereupon he underwent chemotherapy and partial lung resection. After surgery, a hemorrhagic brain metastasis appeared; this tumor was extirpated to prevent bleeding into the brain, after which additional chemotherapy was administered.
http://ift.tt/2wIOwuc
3D-constructive interference into steady state (3D-CISS) labyrinth signal alteration in patients with vestibular schwannoma
To evaluate signal intensity of the inner ear using 3D-CISS imaging and correlated signal characteristics in patients with vestibular schwannoma to neuro-otological symptoms.
http://ift.tt/2ywwMz8
High-dose corticosteroids improve the prognosis of Bell’s palsy compared with low-dose corticosteroids: A propensity score analysis
The aim of this study was to evaluate the effectiveness of high-dose corticosteroid (120mg prednisolone equivalent daily) in Bell's palsy compared with low-dose corticosteroid (60mg PSL equivalent).
http://ift.tt/2wHTuqQ
An ecological study of skin biopsies and skin cancer treatment procedures in the United States Medicare population, 2000 to 2015
Analyses of skin cancer procedures adjusted for population changes are needed.
http://ift.tt/2yws4S8
Collision of subungual melanoma and subungual squamous cell carcinoma: a case series
Subungual squamous cell carcinoma (SSCC) and subungual melanoma (SUM) are rare tumors. Several case reports of collision of a SSCC with a SUM (SSCC-SUM) have been published.
http://ift.tt/2ywua4f
Risk of Developing Pyoderma Gangrenosum after Procedures in Patients with a Known History of Pyoderma Gangrenosum – A Retrospective Analysis
The risk of postoperative pyoderma gangrenosum (PG) in patients with a known history of PG is unknown.
http://ift.tt/2yxj92C
Application of endoscopy in otology: Changes over the last 8years in Korean Otological Society
Despite the worldwide availability of endoscope in otology, it still has not replaced the microscopic surgery as it has for nose surgery. In 2008, we administered a questionnaire on the preference of using otoscopes in Korea. In light of the worldwide availability of endoscopic ear surgery, we have now conducted a more detailed survey to determine if this preference has changed over 8years.
http://ift.tt/2ywQACD
Rhinophyma: Our experience based on a series of 12 cases
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): P. Clarós, M.-C. Sarr, F.-B. Nyada, A. Clarós
IntroductionRhinophyma is a rare, benign and unsightly disease of the skin of the nose that was first described a very long time ago, as illustrated by portrait of an old man with a bulbous nose holding his grandson, by Ghirlandaio in 1490. It was described for the first time by Ferdinando Hebra Von (1816–1880), as the third stage of rosacea. The objective of this study is to report the author's experience and propose a new treatment option in the management of rhinophyma.Material and methodsWe describe our experience of rhinophyma based on a retrospective case study.ResultsWe identified 12 cases over a 12-year period, with a marked male predominance. The therapeutic approach was the same in all patients, consisting of a combination of dermabrasion, decortication and application of fibrin glue, with a favourable outcome in every case with complete epithelialisation.ConclusionRhinophyma is a rare condition of uncertain pathophysiology. Management is surgical and, in view of the many techniques and procedures proposed, we advocate the slogan "to each his own technique", until a consensus has been reached. Our technique combining dermabrasion, decortication and application of fibrin glue has given very good results.
http://ift.tt/2jSPYUI
Modification of fasciocutaneous radial forearm free flap to achieve two-layer closure during reconstruction of circumferential hypopharyngeal defects
Publication date: Available online 22 September 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): M. Abu-Serriah, S. Loughran
Circumferential defects of the hypopharynx are a reconstructive challenge. Various local, regional and free flaps have been described with each having advantages and disadvantages in terms of functional outcomes. The fasciocutaneous radial forearm free flap (RFFF) is one of the most common free flaps used for reconstructing circumferential hypopharyngeal defects. The skin paddle is pliable and reasonably matches the native hypopharyngeal wall. It is easy to raise, has predictable vascular anatomy and a long pedicle. Unlike the anterior lateral thigh (ALT) flap, the RFFF is associated with higher rates of pharyngo-cutaneous fistula. This was thought to be due to the difficulty in achieving two-layer closure. However, in a post treatment neck or in patient with large body habitus, the use of ALT or other free flaps may not be possible leaving the RFFF as the only viable option. To aim to reduce the risk of fistula and wound dehiscence, we describe a novel design of RFFF, which provides two-layer closure. We believe that our design gives the reconstructive surgeon another reconstructive option, which should be considered in challenging circumferential hypopharyngeal defects.
http://ift.tt/2xYxecx
Insights into the Management of Papillary Microcarcinoma of the Thyroid
Thyroid , Vol. 0, No. 0.
http://ift.tt/2hpgDEc
Use of a fibrinogen-thrombin sponge in rhinoplasty
Abstract
Background
Although several methods have been described to address nasal dorsum augmentation and smoothing of irregularities in rhinoplasty, establishing the ideal method has proven controversial.
Objective
Here, we introduce a novel technique of cartilage grafting for nasal dorsum augmentation by wrapping cartilage in a fibrinogen- and thrombin-coated collagen patch called TachoSil®.
Material and methods
In a pilot study comprising ten cases, the use of the collagen patch was examined in various indications in rhinoplasty. Patients were clinically monitored for up to 8 months and photometric and sonographic documentation was performed pre- and postoperatively.
Results
In nine patients, the collagen patch was used for fixation of cartilage grafts in different indications: saddle nose deformities (n = 5), open roof (n = 1), nasal dorsum irregularities (n = 3). A diced cartilage graft enclosed by a bilayer of TachoSil® was applied in seven patients. Solid pieces of cartilage were either embedded in a bilayer of the collagen patch (n = 1) or covered by a monolayer (n = 1). Moreover, the collagen patch alone served as a soft tissue support in one patient with thin skin. Six patients were revision cases. All patients had uneventful healing without adverse events such as allergic reactions and infections.
Conclusion
The collagen patch TachoSil® is eligible for various indications in rhinoplasty. It is a useful material predominantly for nasal dorsum augmentation by sandwiching diced or solid cartilage in the collagen patch, leading to better graft fixation and precise profile shaping. At the same time, TachoSil® helps with blood control. Follow-up studies will be performed to assess the material's long-term behavior.
http://ift.tt/2fn38Id
Laryngeal and vocal alterations after thyroidectomy
Publication date: Available online 21 September 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Renata Mizusaki Iyomasa, José Vicente Tagliarini, Sérgio Augusto Rodrigues, Elaine Lara Mendes Tavares, Regina Helena Garcia Martins
IntroductionDysphonia is a common symptom after thyroidectomy.ObjectiveTo analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy.MethodsProspective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months).ResultsAmong the 151 patients (130 women; 21 men). Type of surgery: lobectomy+isthmectomy (LI) n=40, total thyroidectomy (TT) n=88, thyroidectomy+lymph node dissection (TT+LND) n=23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (LI n=6; TT n=17; TT+LND n=9) and 2 superior laryngeal nerve (LI n=1; TT+LND n=1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n=76; palsy n=13), thyroiditis (n=8; palsy n=0), and carcinoma (n=67; palsy n=21).ConclusionVocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months.
http://ift.tt/2xXU5oA
Effects of diabetes mellitus and systemic arterial hypertension on elderly patients’ hearing
Publication date: Available online 21 September 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Laurie Penha Rolim, Alessandra Giannella Samelli, Renata Rodrigues Moreira, Carla Gentile Matas, Itamar de Souza Santos, Isabela Martins Bensenor, Paulo Andrade Lotufo
IntroductionChronic diseases can act as an accelerating factor in the auditory system degeneration. Studies on the association between presbycusis and diabetes mellitus (DM) and systemic arterial hypertension (SAH) have shown controversial conclusions.ObjectiveTo compare the initial audiometry (A1) with a subsequent audiometry (A2) performed after a 3 to 4-year interval in a population of elderly patients with DM and/or SAH, to verify whether hearing loss in these groups is more accelerated when compared to controls without these clinical conditions.Methods100 elderly individuals participated in this study. For the auditory threshold assessment, a previous complete audiological evaluation (A1) and a new audiological evaluation (A2) performed 3–4 years after the first one was utilized. The participants were divided into four groups: 20 individuals in the DM group, 20 individuals in the AH group, 20 individuals in the DMAH and 40 individuals in the control group (CG), matching them with each study group, according to age and gender. ANOVA and Kruskal–Wallis statistical tests were used, with a significance level set at 0.05.ResultsWhen comparing the mean annual increase in the auditory thresholds of the A1 with the A2 assessment, considering each study group and its respective control, it can be observed that there was no statistically significant difference for any of the frequencies for the DM group; for the AH group, significant differences were observed after 4kHz. For the DMAH group, significant differences were observed at the frequencies of 500, 2kHz, 3kHz and 8kHz.ConclusionIt was observed that the AH group showed the greatest decrease in auditory thresholds in the studied segment when compared to the other groups, suggesting that among the three studied conditions, hypertension seems to have the greatest influence on hearing.
http://ift.tt/2yuYYCF
Behavioural and objective vestibular assessment in persons with osteoporosis and osteopenia: a preliminary investigation
Publication date: Available online 21 September 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Aditi Gargeshwari, Raghav Hira Jha, Niraj Kumar Singh, Prawin Kumar
IntroductionCalcium is vital for the functioning of the inner ear hair cells as well as for the neurotransmitter release that triggers the generation of a nerve impulse. A reduction in calcium level could therefore impair the peripheric vestibular functioning. However, the outcome of balance assessment has rarely been explored in cases with osteopenia and osteoporosis, the medical conditions associated with reduction in calcium levels.ObjectiveThe present study aimed to investigate the impact of osteopenia and osteoporosis on the outcomes of behavioural and objective vestibular assessment tests.MethodsThe study included 12 individuals each in the healthy control group and osteopenia group, and 11 individuals were included in the osteoporosis group. The groups were divided based on the findings of bone mineral density. All the participants underwent behavioural tests (Fukuda stepping, tandem gait and subjective visual vertical) and objective assessment using cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP).ResultsA significantly higher proportion of the individuals in the two clinical groups' demonstrated abnormal results on the behavioural balance assessment tests (p<0.05) than the control group. However, there was no significant difference in latencies or amplitude of cVEMP and oVEMP between the groups. The proportion of individuals with absence of oVEMP was significantly higher in the osteoporosis group than the other two groups (p<0.05).ConclusionThe findings of the present study confirm the presence of balance-related deficits in individuals with osteopenia and osteoporosis. Hence the clinical evaluations should include balance assessment as a mandatory aspect of the overall audiological assessment of individuals with osteopenia and osteoporosis.
http://ift.tt/2xXzKjp
The impact of surgical wait time on patient reported outcomes in sinus surgery for chronic rhinosinusitis
Background
In many developed countries, wait times for elective surgery are increasing. Among these elective surgeries is endoscopic sinus surgery (ESS) performed for treatment of chronic rhinosinusitis (CRS). Little is known about the impact of wait times on patients' surgical outcomes. The purpose of this study was to evaluate the association between patients' wait times and postoperative patient-reported outcomes.
Methods
This study was based on a prospectively recruited longitudinal cohort of patients booked for ESS for the treatment of medically-refractory CRS in Vancouver, Canada. Patients were recruited between September 2012 and December 2016. All participants completed the Sino-Nasal Outcome Test (SNOT-22) preoperatively and 6 months postoperatively. The primary outcome measure was participants' change in SNOT-22 score. A regression model measured the association between patient-reported outcome, wait time, and potential confounders.
Results
The study included 150 participants. The mean surgical wait time was 32 weeks. The mean preoperative SNOT-22 score was 40.0. The improvement in SNOT-22 scores following ESS was 18 points. Regression analysis found no association between wait time for ESS and the change in SNOT-22 scores after surgery (p = 0.42). Only preoperative SNOT-22 score correlated with outcome scores.
Conclusion
There was no association between the gains in health-related quality of life and the length of time participants waited for surgery. The largest gains in health were concentrated among participants with the highest symptom burden, irrespective of wait time. This result suggests that it may be safe to triage patients based on symptom severity as an approach to maximizing the population's overall health.
http://ift.tt/2fml1Xh
Comparison of surgical outcomes between patients with unilateral and bilateral chronic rhinosinusitis
Background
Although the majority of patients with chronic rhinosinusitis without nasal polyposis (CRSsNP) suffer from bilateral disease, a subset suffer from unilateral disease. Currently, outcomes following endoscopic sinus surgery (ESS) for medically recalcitrant CRS are inferred from outcomes for patients with bilateral disease. This study compares outcomes of ESS between patients with unilateral and bilateral disease.
Methods
Patients with CRSsNP who failed appropriate medical therapy and elected ESS were enrolled between 2011 and 2015. Patients were dichotomized according to radiographic evidence of unilateral disease (Lund-Mackay [LM] score = 0 for 1 side) or bilateral disease (LM ≥ 1 for both sides). The primary outcome of interest was the 22-item Sino-Nasal Outcome Test (SNOT-22), with secondary outcomes including the Brief Smell Identification Test (BSIT) and the Lund-Kennedy (LK) endoscopy staging system.
Results
A total of 190 patients met inclusion criteria consisting of 19 with unilateral (10%) and 171 with bilateral CRSsNP (90%). Both groups were similar across all preoperative demographic factors, SNOT-22, and BSIT scores. Postoperatively, patients with bilateral disease reported greater improvement in mean SNOT-22 scores compared to unilateral disease, but this difference was not statistically or clinically significant (−24.3 ± 21.1 vs −21.5 ± 24.0, p = 0.582). Mean LK scores improved for patients with bilateral disease but not unilateral disease, without a difference between groups (−2.0 ± 3.5 vs −0.4 ± 2.4, p = 0.090).
Conclusion
Patients with unilateral CRSsNP experience improvement after ESS comparable to patients with bilateral disease on patient reported outcome measures.
http://ift.tt/2xzsyc4
Three-dimensional image analysis for staging chronic rhinosinusitis
Background
Traditional methods of staging chronic rhinosinusitis (CRS) through imaging do not differentiate between degrees of partial mucosal sinus inflammation, thus limiting their utility as imaging biomarkers. We hypothesized that software-aided, quantitative measurement of sinus inflammation would generate a metric of disease burden that would correlate with clinical parameters in patients with suspected sinus disease.
Methods
Adults with rhinologic complaints undergoing computed tomography imaging were recruited at an urban, academic, tertiary care center (n = 45 with Lund-Mackay [LM] scores ≥4). Three-dimensional (3D) volumetric image analysis was performed using a semiautomated method to obtain a "Chicago-modified Lund-Mackay" (Chicago MLM) score, which provides a continuous scale to quantify extent of opacification. Linear regression was used to test the association of the Chicago MLM score with concurrent symptoms (Total Nasal Symptom Score [TNSS]) and disease-specific quality of life, based on the Sinonasal Outcome Test-22 (SNOT-22).
Results
Chicago MLM scores were significantly associated with both symptoms (p = 0.037) and disease-specific quality of life (p = 0.007). Inflammation in the ethmoid and sphenoid sinuses appeared to influence these associations. These findings were even more robust when analysis was limited to patients with more severe disease (LM >6).
Conclusion
The quantitative measurement of sinus inflammation by computer-aided 3D analysis correlates modestly with both symptoms and disease-specific quality of life. Posterior sinuses appear to have the greatest impact on these findings, potentially providing an anatomic target for clinicians to base therapy. The Chicago MLM score is a promising imaging biomarker for clinical and research use.
http://ift.tt/2fmGlvR
Long-term follow-up on patients treated for abdominal fat using a selective contactless radiofrequency device
Summary
Background and objective
The aim of this study was to evaluate how abdominal circumferential reduction achieved after using a noninvasive radiofrequency device (BTL Vanquish, BTL Industries Inc., Boston, MA) evolves over a 4-year period.
Methods
This is a follow-up on patients who were treated in our practice for abdominal fat in an earlier published multicenter prospective study. Patients were recalled for biometric data collection 4 years (±60 days) after the last treatment. Body and weight measurements were compared to the historical data. Digital images of the treated area were taken. Independent panelists were asked to recognize the original baseline images from the 4-year follow-up images.
Results
The evaluation encompasses 13 subjects. In the original study, these patients lost on average 5.88 ± 4.14 cm of waist circumference (P < .001) while losing on average 1.29 kg. After 4 years, the same subjects had an average reduction of 4.42 ± 2.85 cm (P < .001) compared to the baseline, while gaining on average 0.50 kg. In both cases, the waist change was statistically independent of the weight change (P < .01). The patients preserved on average 75.2% of the original body contouring effect after 4 years as measured by circumference. None of the patients grew in circumference when compared to the baseline. Reviewers recognized the baseline patient images from the follow-up patient images in 82.1% cases. No long-term side effects were observed that would relate to the treatments.
Conclusions
In the study group, patients with ordinary weight changes preserved most of the original waist reduction after 4 years.
http://ift.tt/2wLLbFP
Considerations for antibiotic prophylaxis in head and neck cancer surgery
Source:Oral Oncology
Author(s): Michael P. Veve, Susan L. Davis, Amy M. Williams, John E. McKinnon, Tamer A. Ghanem
Peri/post-operative antibiotic prophylaxis (POABP) has become standard practice for preventing surgical site infections (SSI) in head and neck cancer patients undergoing microvascular reconstruction, but few data exist on optimal POABP regimens. Current surgical prophylaxis guideline recommendations fail to account for the complexity of microvascular reconstruction relative to other head and neck procedures, specifically regarding wound classification and antibiotic duration. Selection of POABP spectrum is also controversial, and must balance the choice between too narrow, risking subsequent infection, or too broad, and possible unwanted effects (e.g. antibiotic resistance, Clostridium difficile-associated diarrhea). POABP regimens should retain activity against bacteria expected to colonize the upper respiratory/salivary tracts, which include Gram-positive organisms and facultative anaerobes. However, Gram-negative bacilli also contribute to SSI in this setting. POABP doses should be optimized in order to achieve therapeutic tissue concentrations at the surgical site. Antibiotics targeted towards methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa are not warranted for all patients. Prolonged POABP durations have shown no differences in SSI when compared to short POABP durations, but prolonged durations provide unnecessarily antibiotic exposure and risk for adverse effects. Given the lack of standardization behind antibiotic POABP in this setting and the potential for poor patient outcomes, this practice necessitates an additional focus of surgeons and antimicrobial stewardship programs. The purpose of this review is to provide an overview of POABP evidence and discuss pertinent clinical implications of appropriate use.
http://ift.tt/2wEYKeR
Standardized whole blood stimulation improves immunomonitoring of induced immune responses in multi-center study
Source:Clinical Immunology
Author(s): Darragh Duffy, Vincent Rouilly, Cecile Braudeau, Véronique Corbière, Raouf Djebali, Marie-Noelle Ungeheuer, Regis Josien, Sam LaBrie, Olivier Lantz, Delphine Louis, Eva Martinez-Caceres, Francoise Mascart, Jose G. Ruiz de Morales, Catherine Ottone, Lydia Redjah, Nina Salabert-Le Guen, Alain Savenay, Manfred Schmolz, Antoine Toubert, Matthew L. Albert
Functional immune responses are increasingly important for clinical studies, providing in depth biomarker information to assess immunotherapy or vaccination. Incorporating functional immune assays into routine clinical practice has remained limited due to challenges in standardizing sample preparation. We recently described the use of a whole blood syringe-based system, TruCulture®, which permits point-of-care standardized immune stimulation. Here, we report on a multi-center clinical study in seven FOCIS Centers of Excellence to directly compare TruCulture to conventional PBMC methods. Whole blood and PBMCs from healthy donors were exposed to LPS, anti-CD3 anti-CD28 antibodies, or media alone. 55 protein analytes were analyzed centrally by Luminex multi-analyte profiling in a CLIA-certified laboratory. TruCulture responses showed greater reproducibility and improved the statistical power for monitoring differential immune response activation. The use of TruCulture addresses a major unmet need through a robust and flexible method for immunomonitoring that can be reproducibly applied in multi-center clinical studies.One sentence summaryA multi-center study revealed greater reproducibility from whole blood stimulation systems as compared to PBMC stimulation for studying induced immune responses.
http://ift.tt/2wa7ZPR
Multiple sclerosis treatment effects on plasma cytokine receptor levels
Source:Clinical Immunology
Author(s): Sahl Khalid Bedri, Katharina Fink, Ali Manouchehrinia, Wangko Lundström, Ingrid Kockum, Tomas Olsson, Jan Hillert, Anna Glaser
Genetic variants within some cytokine receptor genes have been associated with MS susceptibility, including IL7RA and IL2RA. As these genes are expressed by cells targeted by immune-modulatory drugs, we explored the potential role of their gene products as biomarkers in monitoring MS treatment. We assessed the impact of natalizumab followed by fingolimod on the intra-individual changes of plasma protein levels of sIL-7Rα, sIL-2Rα and also sIL-6R and sgp130 in MS patients. During natalizumab treatment we observed a decline in sgp130 and sIL-7Rα levels, while subsequent fingolimod treatment lead to increased sgp130 and sIL-7Rα and decreased sIL-2Rα levels. In addition, during fingolimod treatment sIL-7Rα levels were increasing significantly more in patients homozygous for the MS risk genotype of rs6897932. We also observed an effect of the MS associated rs71624119 on sgp130 levels. These results may elucidate the pharmacodynamics of treatments and help identify biomarkers for MS outcomes.
http://ift.tt/2fgmD1a
Regionenübergreifendes Tracking im Neugeborenen-Hörscreening
Zusammenfassung
Hintergrund und Problemstellung
Bei einem Wechsel des Zuständigkeitsbereichs zwischen dem Screening und der fachärztlichen Nachuntersuchung kommt es zu „Lost-to-Follow-up-Fällen" in der primär zuständigen Hörscreening-Zentrale. Dargestellt werden das Konzept sowie die Referenzimplementierung und die Evaluierung eines Vorschlags für ein regionenübergreifendes Tracking in Kooperation mit dem Verband Deutscher Hörscreening-Zentralen (VDHZ e. V.) als Angebot an die Entwickler von Trackingsoftware.
Methoden
Ausgehend von der Fehleranalyse realer Screeningdaten werden Methoden der Vorverarbeitung der Daten sowie die technischen Hintergründe der Schnittstelle und deren Integration in den Dateneingang von Trackingsoftware vorgestellt. Daten eines Belastungstests werden präsentiert.
Ergebnisse
Beim einem Belastungstest (Simulation von 6 Hörscreening-Zentralen mit 54.551 Kindern) wurden alle Anfragen mit einer durchschnittlichen Antwortzeit von 637 ms (SD [„standard deviation", Standardabweichung] = 266 ms/Median 613 ms) verarbeitet. Anonymisierende Eintragungen im Namen (n = 675/1,24 %) sowie doppelte Eintragungen in der Datenbank (n = 49/0,01 %) wurden erkannt.
Schlussfolgerung
Ein regionenübergreifendes Tracking bei heterogener Trackingssoftware ist ohne Nutzung einer einheitlichen Screening-ID möglich. Der hier zur Diskussion gestellte Ansatz erscheint konzeptionell und technisch dazu geeignet.
http://ift.tt/2xshYTI
Infantiles Hämangioperizytom der Nasenhaupthöhle
Zusammenfassung
Ein infantiles sinunasales Hämangioperizytom als Variante eines Myofibroms ist eine Rarität. Die Beobachtung eines infantilen Hämangioperizytoms der Nasenhaupthöhle, des Siebbeins und der vorderen Schädelbasis bei einem weiblichen Säugling mit dem Nachweis chromosomaler Gewinne (6q14q16.2 und 18q22qter) sowie chromosomaler Verluste (5q33.3q35.2, 10p11.2p12.2, 10q24.3q26.1, 15q23q25, 17p12pter und 22q11.2q13.2) wird vorgestellt. Die Behandlung erfolgte in Form einer endonasalen chirurgischen Resektion.
http://ift.tt/2wLs3aR
Relationship between acne vulgaris and cosmetic usage in Sri Lankan urban adolescent females
Summary
Background
Acne vulgaris is one of the commonest skin disorders affecting up to 80% of the world population at least during adolescence. Significant psychosocial effects such as depression and poor personality development have been linked with acne, especially in female adolescents. Various causative factors, including cosmetic exposure, have been attributed toward acne.
Objective
To analyze the association between frequent exposure to cosmetics and severity of acne in adolescent females.
Method
A cross-sectional analytical study was performed on 140 girls from three schools in Colombo, Sri Lanka. A self-administered questionnaire was utilized to assess the patterns of cosmetic usage. Grading acne of the participants was performed by the researchers utilizing a standard acne grading scale.
Results
The overall prevalence of acne in our study population was 91.4% with a mean acne grade of 3.09. At least one cosmetic type was used by 126 (90%) of the population. A Pearson correlation coefficient (r) value of .452 (P < .001) was obtained between cosmetic exposure and acne grade, which indicates a statistically significant correlation. A chi-square value of 22.875 was obtained at a degree of freedom of 2 (P < .001), enabling us to reject the null hypothesis that there is no significant association between cosmetic usage and acne severity.
Conclusion
Our results convey a significant positive association between frequent exposure to cosmetics and severity of acne in adolescent females. Girls of this age group must be made aware that cosmetic usage may be a potential aggravating factor for their facial acne.
http://ift.tt/2hpa1p0
Our experience with 500 patients with benign paroxysmal positional vertigo: Reexploring aetiology and reevaluating MRI investigation
Source:Auris Nasus Larynx
Author(s): Fei Tan, Constantin Bartels, Rory McConn Walsh
ObjectiveTo explore the aetiology of and to evaluate the importance of MRI investigation on the posterior semicircular canal benign paroxysmal positional vertigo in an Irish population.MethodsA retrospective observational study of 500 patients with posterior semicircular canal benign paroxysmal positional vertigo, diagnosed and treated by the senior author over a 10-year period. Most patients underwent an MRI brain and inner ear, following the same scan protocol. This included T1 weighted sagittal IR-FSPGR volume, axial T2 weighted, gradient echo T2 weighted and FLAIR sequences plus time of flight cerebral angiography.ResultsThe average age of presentation was 56 years; with the overall female to male ratio was 1.6:1, which was largely the net results of 2 age groups. Over 30% of our patients recalled distinct aetiological triggers, of which the top 3 were trauma, infection, and surgery. These accounted for 16%, 6%, and 5%, respectively. More than 25% of the patients were discovered to have abnormal intracranial findings on MRI. The 2 most common non-infarct incidental findings were neoplasia and vascular abnormalities. Although fewer than 20 patients had acute intracranial haemorrhage or malignant tumours, most of them were urgently referred to neurosurgeon due to the life-threatening nature of the condition. One round of particle repositioning manoeuver was successful in treating 84% of the patients, and the 2-year recurrence rate was only 2.2%.ConclusionThe diagnosis of posterior semicircular canal benign paroxysmal positional vertigo is thought to be relatively easy to make, and the treatment is highly effective. Clinicians should be fully aware of and prepared for the diverse aetiology, and thus have no hesitation in requesting MRI scan as an important investigation.
http://ift.tt/2xjGDe0
A case of adult congenital laryngeal cleft asymptomatic until hypopharynx cancer treatment
Source:Auris Nasus Larynx
Author(s): Kotaro Shimizu, Atsuhiko Uno, Kazuya Takemura, Naoki Ashida, Ryohei Oya, Takahiro Kitamura, Yukinori Takenaka, Yoshifumi Yamamoto
Laryngeal cleft is an anomaly of failed posterior closure of the larynx. Most cases are diagnosed and need treatment early in life due to respiratory and swallowing problems. We report an unusual case of a 66-year-old man with an asymptomatic laryngeal cleft until treatment for hypopharyngeal cancer. During concurrent chemoradiotherapy (CCRT), despite reduced tumor volume, he presented severe dysphagia and dyspnea, followed by severe pneumonia twice. Because CCRT had to be discontinued, a pharyngolaryngectomy was performed for the cancer treatment. The resected specimen showed total removal of the tumor and a total longitudinal cleft of the cricoid cartilage, classified as a type III laryngeal cleft by the Benjamin and Inglis' classification. A review of computed tomography images indicated that the redundant mucosa from bilateral edges closed the separation of the posterior cricoid cartilage and narrowed the laryngeal airway during CCRT. Adult presentations of laryngeal cleft are quite rare with only ten reported cases in English literature; the present case is of the oldest patient. Undiagnosed cases with laryngeal cleft may exist asymptomatically or without severe symptoms. The awareness of this condition may increase its diagnosis as a cause of diseases such as aspiration and recurrent pneumonia even in adult patients.
http://ift.tt/2fEIyzK
Concomitant suppression of Th2 and Th17 cell responses in allergic asthma by targeting RORγt
Source:Journal of Allergy and Clinical Immunology
Author(s): Hyeongjin Na, Hoyong Lim, Garam Choi, Byung Keun Kim, Sae-Hoon Kim, Yoon-Seok Chang, Roza Nurieva, Chen Dong, Seon Hee Chang, Yeonseok Chung
BackgroundAllergic asthma is a heterogeneous chronic inflammatory disease in the airway with a massive infiltration of eosinophils or neutrophils mediated by allergen-specific Th2 cells and Th17 cells, respectively. Successful treatment of allergic asthma will therefore require suppression of both Th2 and Th17 cells.ObjectiveWe sought to investigate the role of Th17 cell pathway in regulating Th2 cell responses in allergic asthma.MethodsAllergic asthma was induced by intranasal challenges with proteinase allergens in C57BL/6, Il17a−/−Il17f− /−and RORγtgfp/gfp mice. Pharmacological RORγt inhibitor was used to evaluate its preventive and therapeutic effects in allergic asthma. Characteristics of allergic airway inflammation were analyzed by flow cytometry, histology, qRT-PCR and ELISA. Mixed bone marrow chimeric mice, fate mapping analysis, shRNA transduction and in vitro T cell differentiation were employed for mechanistic studies.ResultsMice deficient in IL-17A and IL-17F as well as in RORγt exhibited a significant reduction not only in Th17 cell responses, but also in Th2 cell responses in an animal model of allergic asthma. Similarly, mice treated with an RORγt inhibitor showed significantly diminished Th17 as well as Th2 cell responses, leading to reduced numbers of neutrophils and eosinophils in the airway. RORγt-deficient T cells were intrinsically defective in differentiating into Th2 cells and expressed increased level of Bcl6. Knock-down of Bcl6 resulted in a remarkable restoration of Th2 cell differentiation in RORγt-deficient T cells. Blockade of RORγt also significantly hampered the differentiation of human Th2 cells and Th17 cells from naïve CD4+ T cells.ConclusionRORγt in T cells is required for optimal Th2 cell differentiation by suppressing Bcl6 expression; this finding suggests that targeting RORγt might be a promising approach for the treatment of allergic asthma by concomitantly suppressing Th17 and Th2 cell responses in the airway.
Teaser
Inhibition of RORγt suppresses both Th2 and Th17 cell responses in the airway, and this can become a potential therapeutic target for the treatment of allergic asthma.http://ift.tt/2xngvws
Inhibition of IL-17–committed T cells in a murine psoriasis model by a vitamin D analogue
Source:Journal of Allergy and Clinical Immunology
Author(s): Nobuhiro Kusuba, Akihiko Kitoh, Teruki Dainichi, Tetsuya Honda, Atsushi Otsuka, Gyohei Egawa, Saeko Nakajima, Yoshiki Miyachi, Kenji Kabashima
BackgroundA better understanding of the means by which topical vitamin D analogues exert their therapeutic effect on psoriasis is of theoretical and practical importance.ObjectiveWe sought to clarify whether and how the topical vitamin D analogue calcipotriol (CAL) controls the IL-17A–mediated pathogenesis of murine psoriasis-like dermatitis in vivo.MethodsPsoriasis-like dermatitis was induced by the topical application of an imiquimod (IMQ)–containing cream on the murine ear for 4 to 6 consecutive days. For topical CAL treatment, mice were treated daily with CAL solution on the ear before IMQ application.ResultsMice treated topically with CAL exhibited much milder IMQ-induced psoriasis-like dermatitis compared with vehicle-treated mice, with impaired accumulation of IL-17A–committed T (T17) cells in the lesional skin. The IMQ-induced upregulation of Il12b and Il23a was marked in the epidermis and was abrogated by CAL application, suggesting CAL-mediated suppression of IL-23 expression. CAL inhibited Il12b and Il23a expression by Langerhans cells ex vivo stimulated with IMQ and CD40 cross-linking. Topical CAL also inhibited T17 cell expansion in the draining lymph nodes of IMQ-treated skin, implying a possible effect on T17 cell–mediated dermatitis at distant sites. In fact, topical CAL application on the IMQ-treated left ear resulted in amelioration of T17 cell accumulation and psoriasis-like dermatitis in the right ear subsequently treated with IMQ.ConclusionTopical CAL can exert its antipsoriatic effect on CAL-treated lesions and, concomitantly, distant lesions by attenuating the T17 cell accumulation in both CAL-treated lesions and draining lymph nodes.
http://ift.tt/2xWEyoS
Pre-Pregnancy Exposure to Diesel Exhaust Predisposes Offspring to Asthma through IL-1β and IL-17A
Source:Journal of Allergy and Clinical Immunology
Author(s): Jerica Lenberg, Qian Qian, Zehua Sun, Rafeul Alam, Magdalena M. Gorska
Teaser
Using a mouse model we provided evidence that pre-pregnancy exposure to diesel exhaust predisposes offspring to asthma. We identified immunological mechanisms of this predisposition to facilitate future development of asthma prevention strategies.http://ift.tt/2xWExkO
Eosinophils release extracellular DNA traps in response to Aspergillus fumigatus
Publication date: Available online 21 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Valdirene S. Muniz, Juliana C. Silva, Yasmim A.V. Braga, Rossana C.N. Melo, Shigeharu Ueki, Masahide Takeda, Akira Hebisawa, Koichiro Asano, Rodrigo T. Figueiredo, Josiane S. Neves
BackgroundEosinophils mediate the immune response in different infection conditions. The release of extracellular DNA traps (ETs) by leukocytes has been described as an innate immune response mechanism that is relevant in many disorders including fungal diseases. Different stimuli induce human eosinophil ETs (EETs) release. Aspergillus fumigatus (A. fumigatus) is an opportunistic fungus that may cause eosinophilic allergic bronchopulmonary aspergillosis (ABPA). It has been reported that eosinophils are important to the clearance of A. fumigatus in infected mice lungs. However, the immunological mechanisms that underlie the molecular interactions between A. fumigatus and eosinophils are poorly understood.ObjectiveHere, we investigated the presence of EETs in the bronchial mucus plugs of ABPA patients. We also determined whether A. fumigatus-induced human eosinophils EETs release in vitro.MethodsMucus samples of ABPA patients were analyzed by light and confocal fluorescence microscopy. The release of EETs by human blood eosinophils was evaluated using different pharmacological tools and neutralizing antibodies by fluorescence microscopy and a fluorimetric method.ResultsWe identified abundant nuclear histone-bearing EETs in the bronchial secretions obtained from ABPA patients. In vitro, we demonstrated that A. fumigatus induces EETs release through a mechanism independent of reactive oxygen species but associated to eosinophil death, histone citrullination, CD11b and the Syk tyrosine kinase pathway. EETs lack the killing or fungistatic activities against A. fumigatus.ConclusionOur findings may contribute to the understanding of how eosinophils recognize and act as immune cells in response to A. fumigatus, which may lead to novel insights regarding ABPA patient treatment.
Graphical abstract
Teaser
Extracellular DNA traps, commonly found in mucus plugs of patients with allergic bronchopulmonary aspergillosis, are released by eosinophils in response to Aspergillus fumigatushttp://ift.tt/2xmrt5r
Farm Exposure in Early Childhood is Associated with a Lower Risk of Severe Respiratory Illnesses
Source:Journal of Allergy and Clinical Immunology
Author(s): Tiffany Ludka-Gaulke, Princy Ghera, Stephen C. Waring, Matthew Keifer, Christine Seroogy, James E. Gern, Steven Kirkhorn
http://ift.tt/2xmrqGN
Childhood Chronic Prurigo: interest of Patch tests and delayed reading Skin prick tests to environmental allergens
Source:Journal of Allergy and Clinical Immunology
Author(s): Claire Maridet, Martin Perromat, Juliette Miquel, Christine Chiaverini, Didier Bessis, Audrey Lasek, Maryam Piram, Anne-Claire Bursztejn, Claire Abasq, Alice Phan, Ludovic Martin, Bérénice Bréchat, Jin Ho Chong, Julien Seneschal, Alain Taïeb, Franck Boralevi
Teaser
Childhood chronic prurigo is rarely studied in particular for allergic components. We propose a clinical classification according to seasonality of prurigo in three groups to help identifying causal agents and guide allergy testing with delayed readings tests.http://ift.tt/2xWUmbo
Gene-environment interaction between an IL4R variant and school endotoxin exposure contributes to asthma symptoms in inner-city children
Source:Journal of Allergy and Clinical Immunology
Author(s): Peggy S. Lai, Amir H. Massoud, Mingcan Xia, Carter R. Petty, Amparito Cunningham, Talal A. Chatila, Wanda Phipatanakul
Teaser
An interleukin 4 receptor genetic variant (IL4Rα-Q576R) is common in children of African ancestry. There is a gene-environment interaction between this variant, school endotoxin exposure, and asthma symptoms.http://ift.tt/2xmmnWB
Long-term Benefits of Optimal Asthma Control in Pregnancy
Source:Journal of Allergy and Clinical Immunology
Author(s): Diane R. Gold, Augusto A. Litonjua
http://ift.tt/2xXVzz2
HLA-DRB1 and HLA-DQB1 alleles in Chinese Han patients with Juvenile-Onset recurrent respiratory papillomatosis
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Jing Zhao, Guoliang Wang, Guixiang Wang, Hua Wang, Shengcai Wang, Jun Tai, Lixing Tang, Jingang Gui, Jie Zhang, Xin Ni
Juvenile-Onset recurrent respiratory papillomatosis (JORRP) is a rare benign neoplasm of the respiratory mucosa caused by human papilloma virus. Previous studies on the possible associations between HLA alleles and JORRP have shown various results in different ethnic groups. The present study aims to investigate the association between JORRP and HLA class II DRB1and DQB1 alleles in Chinese Han children. We found that the frequencies of HLA-DRB1*03:01 (pc = 0.0378, OR = 4.8) and HLA-DQB1*02:01 (pc = 0.021, OR = 4.8) alleles were significantly higher in patients with JORRP than in controls. In addition, HLA-DRB1*03:01 allele significantly correlated with aggressive JORRP (r = 0.467, p = 0.009). This was the first study on the HLA alleles in Chinese Han patients with JORRP. Future studies are required to further elucidate the correlation of HLA class II alleles and susceptibility to JORRP.
http://ift.tt/2xsamAz
Satoyoshi syndrome—A case report from India
Abstract
Satoyoshi syndrome was first reported in Japan in 1967. It is a rare multisystem disorder of presumed autoimmune etiology that is characterized by alopecia, intermittent painful muscle spasms, diarrhea, and antinuclear antibody positivity. We report an 11-year-old girl with Satoyoshi syndrome who presented to the dermatology department for treatment of alopecia universalis. We present this case to emphasize the importance of recognizing Satoyoshi syndrome, which could go unnoticed if not suspected.
http://ift.tt/2fELa0H
Effect of biopsy site on detection of gastric cancer high-risk groups by OLGA and OLGIM stages
Abstract
Background/Aims
The operative link for gastritis assessment (OLGA) and operative link on gastric intestinal metaplasia assessment (OLGIM) staging systems are recommended to assess the severity of gastritis, but the optimal biopsy sites have not been clearly defined. We aimed to investigate whether the scoring of the OLGA and OLGIM stages was affected by the use of different biopsy sites.
Methods
Between 2014 and 2015, to determine OLGA and OLGIM stages, seven biopsy samples were obtained from the antrum (lesser and greater curvatures [LG] of the antrum and lesser curvature of the angle) and corpus (LG and anterior and posterior walls [AP]) in 247 patients diagnosed with gastritis, gastric adenoma, or adenocarcinoma. The OLGA and OLGIM stages were scored using four different protocols: antrum + angle + corpus LG, antrum + angle + corpus AP, antrum + corpus LG, and antrum + corpus AP. High-risk group included patients who had OLGA or OLGIM stages III and IV.
Results
For the OLGA stage, the angle + antrum + corpus LG protocol placed more patients in the high-risk group (64.4%) than the angle + antrum + corpus AP (55.5%, P < .001), antrum+corpus LG (59.5%, P = .031), and antrum + corpus AP (47.8%, P < .001) protocols. Likewise, for the OLGIM stage, the angle + antrum + corpus LG protocol placed more patients in the high-risk group (48.6%) than the angle + antrum + corpus AP (46.2%, P = .134), antrum + corpus LG (36.8%, P < .001), and antrum + corpus AP (37.2%, P < .001) protocols.
Conclusions
To prevent underestimation of OLGA and OLGIM stages, it is necessary to include an angle biopsy, and to obtain corpus biopsy specimens from lesser and greater curvature sites rather than from anterior and posterior wall sites.
http://ift.tt/2yu9pWY
Epidemiology of Helicobacter pylori infection in asymptomatic schoolchildren in Bhutan
Abstract
Aim
Bhutan is a small mountainous country between Tibet and India with relatively homogenous population. According to the World Health Organization, gastric cancer is the most frequent cause of cancer death in Bhutan. This study examined the prevalence of Helicobacter pylori among children in Bhutan with emphasis on water source and living conditions.
Methods
A cross-sectional sero-epidemiologic study was conducted among schoolchildren who attended public schools in Thimphu, Bhutan. Between 2015 and 2016, blood samples from schoolchildren were collected after obtaining an informed consent from the school management and the children's parents. Demographic information, parents' education, family size living in the same household, and aspects of household environment including type of latrines, boiling drinking water were collected. All serum samples were tested for H. pylori immunoglobulin G (IgG) by commercial ELISA kits.
Results
There were 327 children between 4 and 19 years of age participated, 44% boys, mean age = 13.6 ± 3 years. The overall prevalence of H. pylori was 66% with no difference between boys and girls (66 vs 64%, respectively), P = .42. H. pylori prevalence was 75% among both 4-7 and 15-19 years and not statically different from that of the 8-10 or 11-14 age groups (59% and 63%, respectively), P = .1. H. pylori prevalence was inversely correlated with the level of mother's education (70% vs 55%) for those without and with a college education, respectively (OR = 2.3; 95%CI = 0.9-1.7), P = .08. The total number of people living in the same household did not correlate with H. pylori sero-prevalence, but households had less than 3 children had lower prevalence than those with 3 or more children (62% vs 71%, respectively OR = 1.7, 95% CI = [1.0-2.6], P = .05).
Conclusions
H. pylori infection is prevalent among all age group children in Bhutan. The results suggest that transmission of H. pylori is related to personal care practices that directly correlate with the mothers' education and crowded living condition with children. Our results are important to developing prevention strategies for gastric cancer in Bhutan.
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Plain language summaries
Linked Comment: Wang et al. Br J Dermatol 2017; 177:656–665
Linked Comment: Langton et al. Br J Dermatol 2017; 177:818–827
Linked Comment: Lott et al. Br J Dermatol 2017; 177:845–853
Linked Comment: Smith et al. Br J Dermatol 2017; 177:628–636
Linked Comment: Smit et al. Br J Dermatol 2017; 177:779–790
Linked Comment: González-López et al. Br J Dermatol 2017; 177:688–695
Linked Comment: Xie et al. Br J Dermatol 2017; 177:809–817
Linked Comment: Ridd et al. Br J Dermatol 2017; 177:719–734
Linked Comment: Al-Jefri et al. Br J Dermatol 2017; 177:837–844
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The PD-1 and PD-L1 pathway in recurrent respiratory papillomatosis
Objectives/Hypothesis
Generation of an immunosuppressive microenvironment may enable a persistent human papillomavirus infection in the setting of an otherwise normal immune system. We hypothesized that expression of the T-lymphocyte co-inhibitory receptor programmed death 1 (PD-1) and its ligand PD-L1 would be increased in the recurrent respiratory papillomatosis (RRP) microenvironment compared to normal controls.
Study Design
Case-control study.
Methods
Formalin-fixed paraffin-embedded respiratory papilloma and normal controls were obtained under institutional review board approval, stained for CD4, CD8, FoxP3, and PD-1, and scored by automated cell count. PD-L1 staining was scored by a blinded pathologist using an adjusted inflammation score that accounted for epithelial and immune infiltrate.
Results
Thirty-nine RRP cases and seven controls were studied. All immunologic markers demonstrated significantly increased staining in RRP specimens compared to normal controls (all P < .01). PD-1 correlated with both CD4 (P < .0001) and CD8 (P < .001) cell counts. Epithelial staining for PD-L1 (68%) and PD-L1+ infiltrating immune cells (76%) were observed in the majority of papilloma samples. The strongest staining for PD-L1 was usually observed in the basal papilloma layer adjacent to the immunologic infiltrate in the vascular core. Disease severity inversely correlated with CD8 cell counts (P = .01). A correlation between disease severity and other immunologic markers was not observed.
Conclusions
Most RRP specimens demonstrate PD-1 T-lymphocyte infiltration and PD-L1 expression on both papilloma and infiltrating immune cells. This study suggests that this checkpoint pathway may be contributing to local immunosuppression in RRP, and opens the door for clinical trials utilizing PD-blocking monoclonal antibodies.
Level of Evidence
NA Laryngoscope, 2017
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Randomized controlled trial of steroid-soaked absorbable calcium alginate nasal packing following endoscopic sinus surgery
Objectives/Hypothesis
To evaluate the potential efficacy of steroid-soaked, absorbable calcium alginate nasal packing following endoscopic sinus surgery.
Study Design
Prospective, randomized, single-blinded, placebo-controlled trial.
Methods
Twenty-two patients (44 nostrils) who had chronic rhinosinusitis with polyps underwent bilateral endoscopic sinus surgery. Only those with an intersinus difference in Lund-Mackay severity score of 1 or less were included. In each patient, one randomly selected nostril was packed with calcium alginate soaked with 2 mL of triamcinolone (40 mg/mL) (triamcinolone group), whereas the contralateral nostril received an identical packing soaked in 2 mL of normal saline (saline group). Two independent investigators blinded to the packing allocation scored the surgical field using the validated Perioperative Sinus Endoscopy (POSE) scores 1, 4, and 8 weeks after surgery.
Results
All 44 nostrils were analyzed; the Lund-Mackay scores did not differ significantly between the groups before surgery. Eight weeks after surgery, the total POSE scores were significantly lower in the triamcinolone group (P = .014). The POSE scoring parameters were then compared between groups, and the following variables were significantly different: middle turbinate synechiae with the lateral wall (P = .037), polypoid degeneration of the ethmoid cavity (P = .006), and sphenoid sinus severity (P = .036).
Conclusions
This study demonstrated that steroid-soaked, absorbable nasal packing can be used to enhance wound healing after endoscopic sinus surgery and to prevent polypoid changes in the nasal mucosa.
Level of Evidence
1b. Laryngoscope, 2017
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Thirty-day morbidity and mortality following otologic/neurotologic surgery: Analysis of the national surgical quality improvement program
Objectives/Hypothesis
To determine the rate and timing of, as well as risk factors for, postoperative morbidity and mortality following otologic and neurotologic surgery.
Study Design
Retrospective cohort study.
Methods
A total of 1,381 patients were identified in the American College of Surgeons National Surgical Quality Improvement Program for the years 2005 to 2010. Simple summary statistics, χ2, and multivariable logistic regression were performed.
Results
Lateral skull base/neurotologic tumor resection (LSB) was done in 35.9%, and middle ear/mastoid procedures (MEM) were performed in 63.5%. The overall adverse event rate was 10.4%, although it was significantly higher for LSB (24.2%) and lower for MEM (2.6%). The overall mortality rate was 1.4%. Complications occurred postdischarge in 40.4% of cases. The outpatient setting (odds ratio [OR]: 0.31, 95% confidence interval [CI]: 0.15-0.65) and undergoing MEM (OR: 0.23, 95% CI: 0.12-0.47) were associated with lower risk of experiencing a complication. Impaired functional status (OR: 10.45, 95% CI: 3.65-29.89) was associated with postoperative mortality. An open wound preoperatively was associated with multiple causes of postoperative morbidity.
Conclusions
Patients undergoing approaches to the skull base and neurotologic tumor resections had the higher adverse event rate. Open wounds were predictive of several postoperative complications, and poor functional status was associated with mortality. Patients with significant comorbidities should be evaluated early on in their postoperative course to prevent readmission as well as major morbidity and mortality.
Level of Evidence
2b. Laryngoscope, 2017
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Cervical and middle dorsal actinomycetomas from Guerrero State, Mexico
Abstract
Background
Mycetomas are frequent subcutaneous mycoses with typical clinical characteristics such as sinuses, blood-stained, serous, or purulent exudates as well as local swelling. Even though the most commonly affected areas are the lower limbs, we report four cases affecting the neck and midback regions, of which three were young females. We draw attention to the importance of early identification of these cases for prevention and specific treatment in order to avoid severe consequences or irreversible complications such as quadriplegia.
Objective
To document the occurrence of cervical spine and middle dorsal thoracic mycetomas, as well as their severity, clinical manifestations, and secondary complications.
Material and Methods
This was an observational and descriptive study in which we reviewed cases with neck and middle dorsal thoracic mycetomas diagnosed at the Acapulco General Hospital of Guerrero State, Mexico. We describe the cases including the mechanism of inoculation, neurological symptoms, and severity.
Conclusions
We describe three cases initially diagnosed clinically as cervical mycetomas and one in the middle dorsal thoracic region. All the cases were diagnosed at the Acapulco General Hospital of Guerrero State in Mexico.
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Benign vocal fold lesions: update on nomenclature, cause, diagnosis, and treatment.
Purpose of review: The management of benign vocal fold lesions (BVFLs) continues to evolve. This article will review the recent literature surrounding the nomenclature, cause, diagnosis, and treatment of BVFLs, including polyps, nodules, cysts, and reactive lesions. Recent findings: The taxonomy of vocal fold lesions has been refined, and it serves as a common descriptive language for diagnosis, treatment algorithms, and reporting of outcomes. Though these lesions are known to be the result of phonotrauma, investigation into inflammatory mediators, apoptosis, and laryngopharyngeal reflux provide further elucidation of their underlying pathophysiology. The future of diagnosis, for which direct fiberoptic visualization and stroboscopy are the current gold standard, may utilize narrow-band imaging and videokymography; the clinical utility of ultrasound and optical coherence tomography is more remote. Angiolytic laser therapy and intralesional steroid injection are acceptable options for treatment of BVFLs. Voice therapy and microsurgical excision are mainstays of treatment. Summary: Recent clinical and basic science research has expanded upon an extensive literature surrounding the nomenclature, cause, diagnosis, and treatment of benign subepithelial vocal fold lesions. There remains a strong need for the advancement of rigorous diagnostic principles, evaluation of therapeutic interventions, and development of best practices guidelines. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Update on pediatric sinus surgery: indications and outcomes.
Purpose of review: To review the recent literature of pediatric endoscopic sinus surgery (ESS). Recent findings: Sinus balloon catheter dilation is an important addition to the surgical treatment tools for pediatric chronic rhinosinusitis (PCRS). ESS is a safe and effective therapeutic modality for uncomplicated PCRS. For PCRS complicated by comorbidities including cystic fibrosis and primary ciliary dyskinesia, ESS and adjuvant medical therapy confers significant sinus, pulmonary, and quality of life benefits to pediatric patients. Summary: ESS is a safe and effective treatment modality in the management of pediatric acute and chronic sinus disorders. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Effects of propofol on wound closure and barrier function of cultured endothelial cells: An in vitro experimental study.
BACKGROUND: Propofol is widely used in routine clinical practice for the induction and maintenance of anaesthesia. Although propofol is regarded as a well tolerated anaesthetic, its effect on intact or damaged endothelial cells has not yet been elucidated. OBJECTIVE: The aim of this study was to investigate the effects of different concentrations of propofol on cell damage, metabolic activity, barrier function and wound healing capacity of human endothelial cells. DESIGN: An in vitro investigation. SETTING: Research Laboratory of the Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany. MATERIALS: In vitro cultures of primary human umbilical vein endothelial cells (HUVECs). INTERVENTIONS: Intact HUVEC or wounded HUVEC monolayers were incubated with or without different concentrations of propofol (10, 30 and 100 [mu]mol l-1). MAIN OUTCOME MEASURES: Cell damage, metabolic activity, monolayer permeability, wound healing capacity, protein phosphorylation. RESULTS: Propofol did not alter the morphology, induce cell damage or influence metabolic activity of intact HUVEC cells. Permeability of a HUVEC monolayer was increased by propofol 100 [mu]mol l-1 (P
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Effects of magnesium chloride on rocuronium-induced neuromuscular blockade and sugammadex reversal in an isolated rat phrenic nerve-hemidiaphragm preparation: An in-vitro study.
BACKGROUND: Magnesium potentiates the effects of nondepolarising muscle relaxants. However, few studies have used magnesium chloride (MgCl2). Sugammadex reverses neuromuscular block by steroidal nondepolarising muscle relaxants. OBJECTIVES: To assess the effects of MgCl2 on rocuronium-induced neuromuscular blockade and its reversal by sugammadex. DESIGN: In-vitro experimental study. SETTING: Animal laboratory, Asan Medical Center, Seoul, South Korea, from 20 March 2016 to 3 April 2016. ANIMALS: Forty male Sprague Dawley rats. INTERVENTION: Left phrenic nerve-hemidiaphragms from 40 Sprague Dawley rats were allocated randomly to four groups (1, 2, 3 and 4 mmol l-1 MgCl2 group, n = 10 each). Rocuronium was administered cumulatively until the first twitch of train-of-four (TOF) disappeared completely. Then, equimolar sugammadex was administered. MAIN OUTCOME MEASURES: The effective concentration (EC) of rocuronium was obtained in each group. After administering sugammadex, recovery of the first twitch height and the TOF ratio were measured for 30 min. RESULTS: EC50, EC90 and EC95 significantly decreased as the concentration of MgCl2 increased (all P
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Median effective dose of intranasal dexmedetomidine sedation for transthoracic echocardiography examination in postcardiac surgery and normal children: An up-and-down sequential allocation trial.
BACKGROUND: Dexmedetomidine (DEX) has been used for sedation in young infants and children undergoing transthoracic echocardiography (TTE). The median effective dose of intranasal DEX has not been described for postcardiac surgery children. Postcardiac surgery children could require more DEX to achieve satisfactory sedation for TTE examination than children suspected of congenital heart disease. OBJECTIVES: To study whether postcardiac surgery children need a larger dose of DEX for TTE than normal children. DESIGN: A double-blind sequential allocation trial with doses determined by the Dixon and Massey up-and-down method. SETTING: A tertiary care teaching hospital from 25 October to 30 November 2016. PATIENTS: Children under the age of 3 years requiring intranasal DEX for TTE. INTERVENTIONS: Children were allocated to a postcardiac surgery group (n = 20) or a normal group (n = 19). The first patient in both groups received intranasal DEX (2 [mu]g kg-1): using the up-and-down method of Dixon and Massey, the next dose was dependent on the previous patient's response. MAIN OUTCOME MEASURES: Median effective dose was estimated from the up-and-down method of Dixon and Massey and probit regression. A second objective was to study haemodynamic stability and adverse events with these doses. RESULTS: The median effective dose (95% confidence interval) of intranasal DEX was higher in postcardiac surgery children than in normal children, 3.3 (2.72 to 3.78) [mu]g kg-1 versus 1.8 (1.71 to 2.04) ([mu]g kg-1), respectively (P
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