Cystic fibrosis is an autosomal recessive disorder characterized by chronic progressive multisystem involvement. AH1N1 virus infections caused classic influenza symptoms in the majority of cystic fibrosis pati...
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Σάββατο 30 Σεπτεμβρίου 2017
Incidental late diagnosis of cystic fibrosis following AH1N1 influenza virus pneumonia: a case report
Clinical Thyroidology for the Public – Highlighted Article
From Clinical Thyroidology for the Public: In 2016, the encapsulated follicular variant of papillary thyroid cancer with no evidence of spread into the thyroid capsule or into the blood vessels seen under the microscope was renamed as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), and was suggested that it was a non-cancer diagnosis. Read More….
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Le partage des données au service de l’éthique, de la transparence et de la reproductibilité de la science médicale
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): O. Laccourreye, P. Bonfils, R. Garrel, R. Jankowski, A. Karkas, N. Leboulanger, M. Makeieff, C. Righini, C. Vincent, C. Martin
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Chirurgie de l’hyperparathyroïdie primaire en ambulatoire : à propos d’une série de 67 cas
Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): D. Culié, B. Pescetto, O. Dassonville, N. Guevara, D. Benisvy, J. Santini
IntroductionLa chirurgie de l'hyperparathyroïdie primaire, ciblée par l'imagerie morphologique et fonctionnelle, remplit les conditions théoriques d'une réalisation ambulatoire. L'objectif de notre étude était de valider ce type de prise en charge sur une série homogène de patients.Patients et méthodesL'ensemble des patients chez qui a été réalisée une chirurgie d'hyperparathyroïdie primaire en ambulatoire dans notre institution entre janvier 2013 et avril 2015 a été inclus dans cette étude rétrospective. Les critères habituels d'évaluation de la chirurgie ambulatoire ont été étudiés.RésultatsDurant la période étudiée, 144 patients ont été opérés d'une hyperparathyroïdie primaire. Dans 67 cas une chirurgie ambulatoire a pu être réalisée, avec un diagnostic préopératoire d'adénome parathyroïdien en imagerie. La recherche de la glande pathologique a été réalisée par une échographie chez tous les patients, et chez 66 d'entre eux par une scintigraphie. Cela a permis une chirurgie unilatérale, ciblée, dans 98,5 % des cas. Deux patients ont dû être hospitalisés pour la nuit en lien avec des complications mineures.ConclusionLa chirurgie de l'adénome parathyroïdien peut, dans une population de patients bien sélectionnée, être réalisée sur des durées opératoires courtes et avec un minimum de complications permettant ainsi sa réalisation en ambulatoire.
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Connaissances concernant le syndrome d’apnées-hypopnées obstructives du sommeil par la population générale de Lorraine
Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): F. Arous, J.-M. Boivin, A. Chaouat, C. Rumeau, R. Jankowski, D.T. Nguyen
ObjectifLe syndrome d'apnées-hypopnées obstructives du sommeil (SAHOS) semble être sous-diagnostiqué. L'objectif de cette étude était d'évaluer les connaissances du SAHOS par la population générale de Lorraine.MéthodesUne enquête à l'aide d'un questionnaire anonyme portant sur les connaissances des symptômes et des complications du SAHOS a été menée de juillet 2015 à novembre 2015, en région Lorraine. Le questionnaire a également été diffusé sur Internet à l'aide de réseaux sociaux. Les critères d'exclusion étaient les personnes de moins de 18 ans, le refus de remplir le questionnaire et la barrière linguistique.RésultatsAu total, 1307 personnes ont répondu à l'enquête : 1020 sous format papier et 287 via Internet. La plupart des symptômes étaient connus par environ deux tiers de la population. Les complications notamment cardiovasculaires et neurologiques étaient en revanche mal connues. Être atteint du SAHOS, avoir fait des études supérieures et avoir moins de 40 ans étaient des facteurs associés à une meilleure connaissance de la maladie. Les répondeurs sur Internet connaissaient aussi mieux cette pathologie.ConclusionMalgré des résultats concernant les symptômes du SAHOS plutôt encourageants, les connaissances du grand public concernant ses complications sont limitées. De nouvelles campagnes d'informations auprès des médecins ainsi qu'auprès du grand public devraient être réalisées afin d'informer la population de cette pathologie et de la sensibiliser sur ses complications.
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Résultats fonctionnels de la chirurgie endoscopique du diverticule de Zenker
Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): A. Dissard, L. Gilain, R. Pastourel, T. Mom, N. Saroul
But du travailL'objectif principal de cette étude rétrospective était l'évaluation des résultats fonctionnels de la chirurgie endoscopique du diverticule de Zenker. Les objectifs secondaires étaient d'évaluer la sécurité de la procédure, d'identifier les facteurs de risque de récidive et d'en déterminer leur conduite en cas de récidive.Patients et méthodesDe 2000 à 2014, 50 patients ont bénéficié d'une chirurgie endoscopique avec marsupialisation d'un diverticule de Zenker. Les symptômes de régurgitations et de dysphagie ont été évalués par l'échelle FOIS avant et après chirurgie. Le taux de récidives et le taux de complications ont été déterminés de manière rétrospective avec un suivi minimal de 18 mois.RésultatsLes régurgitations et la dysphagie ont été améliorées respectivement chez 96 % et 86 % des patients. Le taux de complications était de 12 %, complications le plus souvent mineures. Les temps moyens d'hospitalisation et de reprise alimentaire orale étaient respectivement de 2,0 et 1,3jours. Neuf patients (18 %) ont présenté une récidive de leur symptomatologie initiale et ont nécessité une reprise chirurgicale dans un délai moyen de 2,7 années. Elle a pu être réalisée dans la majorité des cas par voie endoscopique. Un seul facteur de risque de récidive a été identifié : la petite taille du diverticule.ConclusionLa chirurgie endoscopique du diverticule de Zenker permet une amélioration fonctionnelle dans la majorité de cas. Associant sécurité et efficacité, elle est actuellement la procédure de choix dans le traitement du diverticule de Zenker.
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Données étiologiques des sous-maxillites aiguës et prise en charge étiologique
Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): C. Bignet, J. Carvalho, E. Lemaire, A. Charpiot
ButL'objectif de notre étude est de vérifier l'hypothèse que les sous-maxillites aiguës sont liées à un obstacle sur les voies salivaires. Notre étude évalue les caractéristiques de ces obstacles et leurs prises en charge.Matériel et méthodesOnt été inclus de façon rétrospective les patients ayant fait un épisode de sous-maxillite aiguë entre 2009 et 2015. Tous les patients ont bénéficié d'une exploration des voies salivaires par imagerie et/ou par sialendoscopie, et un examen anatomopathologique en cas d'ablation de la glande pour le diagnostic étiologique. Concernant le traitement étiologique : si la lésion causale n'était pas traitable par sialendoscopie uniquement, l'opérateur pouvait avoir recours à une voie combinée aidée par sialendoscope. En cas d'échec de ces procédures, l'indication d'une sous-maxillectomie était posée.RésultatsVingt-neuf patients ont été inclus dans l'étude et 28 patients présentaient une anomalie des voies salivaires. Au moins un calcul était retrouvé chez 27 patients, ceux-ci étaient majoritairement uniques (n=20), dans le tiers moyen (n=21) et volumineux (7,7mm de moyenne). Une sténose était retrouvée chez 10 patients et pour 9 patients, associée à un calcul salivaire. Vingt-cinq patients avec un obstacle ont bénéficié d'une sialendoscopie. La prise en charge par sialendoscopie uniquement a été possible dans 5 cas et par voie combinée dans 13 cas.ConclusionUn épisode de sous-maxillite impose un examen des voies salivaires par sialendoscopie pour une prise en charge précoce en raison de la fréquence de calculs associés et du taux élevé de traitement conservateur guidé par sialendoscopie.
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Editorial Board
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
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Carcinome indifférencié de type nasopharyngé chez l’enfant : particularités cliniques et évolutives
Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): W.S. Zrafi, S. Tebra, S. Tbessi, S. Ouni, M. Jebsi, N. Bouaouina
ObjectifsParticularités épidémiologiques, cliniques et thérapeutiques du carcinome indifférencié de type nasopharyngé chez l'enfant.Matériel et méthodesÉtude rétrospective d'une série de 40 patients d'âge inférieur à 17 ans suivis pour un carcinome indifférencié du nasopharynx, dans les deux centres d'oncologie radiothérapie du centre tunisien entre 1995 et 2012.RésultatsL'âge médian était 14 ans, le sex-ratio 1,3. Le délai moyen de consultation était de 5 mois, la circonstance de découverte était l'apparition d'adénopathies cervicales dans 90 % des cas. Sur le plan thérapeutique, 37 patients ont reçu un traitement à visée curative. Le schéma thérapeutique était séquentiel dans 85 % des cas, commençant par une chimiothérapie puis une radiothérapie du cavum et des aires ganglionnaires cervicales. La dose médiane au niveau du cavum était de 70,4Gy. L'évolution a été marquée par la survenue de deux récidives locales, cinq rechutes métastatiques, toutes osseuses. Après un recul moyen de 80,5 mois (1–180), 29 patients (72,5 %) étaient en rémission complète, huit sont décédés et trois perdus de vue. La survie globale à 5 ans était de 77,7 %.ConclusionLe carcinome indifférencié du nasopharynx de l'enfant représente dans notre région 6 % des cas d'UCNT pris en charge dans nos institutions. Il est souvent découvert à un stade évolué. L'association séquentielle de chimiothérapie et de radiothérapie a permis un excellent taux de contrôle local.
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Exploration électrophysiologique de l’audition
Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): D. Bakhos, M. Marx, A. Villeneuve, E. Lescanne, S. Kim, A. Robier
Les examens audiométriques électrophysiologiques se sont développés depuis les années 1960 avec comme objectif la détermination objective des seuils auditifs. Ils sont maintenant utilisés pour le dépistage de la surdité néonatale. Si ces tests permettent de préciser les seuils auditifs, leur interprétation ne peut se faire qu'en complémentarité de l'audiométrie subjective que représente l'audiométrie tonale et vocale. En effet, si les tests objectifs permettent de préciser les seuils auditifs, ils ne peuvent généralement pas déterminer le type de surdité en cause. Chaque examen teste une région anatomique différente permettant l'exploration du système auditif de l'organe de Corti au cortex auditif. Ainsi, les examens d'audiométrie objective sont complémentaires.
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Le nez brûlé : une analyse en 4 dimensions
Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): J. Bouguila, C. Ho Quoc, R. Viard, A. Brun, D. Voulliaume, J.-P. Comparin, J.L. Foyatier
De part sa position et sa projection, le nez est exposé aux diverses agressions comme les brûlures. Ce type de lésion peut concerner le nez de façon isolée ou entrer dans un contexte plus large constituant les brûlures nasofaciales. La reconstruction du nez constitue un défi, car cette entité anatomique est formée d'un ensemble tridimensionnel complexe, auquel s'ajoute même une « quatrième dimension » : la fonction. La prise en charge du nez brûlé constitue un défi esthétique et fonctionnel. Le traitement des séquelles doit s'adapter au degré d'atteinte du nez et aux impératifs esthétiques et fonctionnels de cette structure anatomique. Ce n'est qu'au terme de multiples interventions chirurgicales et de longs mois de rééducation que le patient brûlé retrouvera une vie sociale satisfaisante.
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Thérapie cellulaire et cordes vocales cicatricielles
Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): A. Mattei, J. Magalon, B. Bertrand, C. Philandrianos, J. Veran, A. Giovanni
La microstructure des cordes vocales est complexe et peut être altérée par une microchirurgie laryngée. On peut alors observer un état cicatriciel n'autorisant plus le découplage mécanique entre épithélium et muscle, responsable de difficultés vibratoires à l'origine d'une dysphonie invalidante. Les possibilités thérapeutiques actuelles sont réduites et souvent inefficaces sur la vibration : elles n'apportent qu'un effet volumateur limitant la fuite glottique. L'objectif de cette revue de la littérature était double : i) décrire l'état actuel de la littérature quant à l'intérêt de la thérapie cellulaire dans la prise en charge des cordes vocales cicatricielles ; ii) analyser l'intérêt thérapeutique de la fraction vasculaire stromale d'origine adipeuse parmi l'arsenal thérapeutique préexistant. Notre recherche sur PubMed® en septembre 2016 a référencé les articles originaux de langue anglaise ou française traitant de l'usage des cellules souches dans la prise en charge des cordes vocales cicatricielles. Vingt-sept articles publiés entre 2003 et 2016 répondaient aux critères de sélection. Les cellules souches mésenchymateuses étaient les plus utilisées, majoritairement extraites de la moelle osseuse ou du tissu adipeux. Quatre études étaient réalisées in vitro sur fibroblastes et dix-huit in vivo chez l'animal. Les critères d'évaluation étaient : i) l'analyse de la cicatrisation (morphologie macroscopique et microscopique, propriétés viscoélastiques, matrice extracellulaire, fibroblastes) ; ii) l'évaluation de la survie et différenciation des cellules souches. Ces études démontrent l'action bénéfique des cellules souches mésenchymateuses, notamment d'origine adipeuse. Par ailleurs, la fraction vasculaire stromale possède des propriétés qui pourraient permettre d'améliorer ces résultats, en facilitant la logistique de production.
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La maladie de Kikuchi-Fujimoto, une cause rare d’adénopathie en Afrique. Description de la première observation au Sénégal et revue de la littérature
Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): C.-A. Lame, B. Loum, A.-K. Fall, J. Cucherousset, A.-R. Ndiaye
IntroductionLa maladie de Kikuchi-Fujimoto est une lymphadénite histiocytaire nécrosante. Cette pathologie bénigne atteint le plus souvent le sujet féminin d'âge mûr. Elle se manifeste généralement par des adénopathies cervicales fébriles. Elle doit être évoquée dans notre contexte d'exercice dominé par la fréquence des adénopathies tuberculeuses et des hémopathies malignes.ObservationNous rapportons le cas d'une femme sénégalaise âgée de 33 ans qui a présenté des adénopathies cervicales subaiguës dans un contexte fébrile. Il existait un syndrome inflammatoire biologique. Les bilans sérologique et tuberculeux étaient négatifs. L'analyse histopathologique d'une biopsie ganglionnaire, après échec d'un traitement antibiotique non spécifique, concluait à une maladie de Kikuchi-Fujimoto. L'évolution était favorable sous corticothérapie.ConclusionEn Afrique noire, l'association de polyadénopathies et de syndrome fébrile doit faire penser et rechercher, après la tuberculose et les lymphomes à des pathologies rares comme la maladie de Kikuchi-Fujimoto.
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Fibrose angiocentrique à éosinophiles ethmoïdo-orbitaire droite
Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): S. Gorostis, M. Bacha, S. Gravier, T. Raguin
IntroductionLa fibrose angiocentrique à éosinophiles (EAF) est une affection bénigne et lentement progressive, affectant la muqueuse des voies aériennes supérieures ou l'orbite plus rarement. Elle appartient au spectre de la maladie associée aux IgG4.Cas cliniqueNous rapportons le cas d'un homme de 61 ans présentant une atteinte orbitaire (baisse d'acuité visuelle, douleurs, exophtalmie, œdème palpébral), céphalées et obstruction nasale. L'imagerie révèle une masse ethmoïdo-orbitaire droite infiltrant la graisse périorbitaire et englobant le nerf optique. L'analyse anatomopathologique a posé le diagnostic d'EAF devant l'infiltration périvasculaire par des cellules inflammatoires – majoritairement des polynucléaires éosinophiles – et des zones de fibrose « en bulbe d'oignon ». L'immunohistochimie a permis d'apparenter les lésions aux maladies associées aux IgG4. La prise en charge initiale par corticothérapie, puis dapsone n'a pas suffi au contrôle des crises évolutives, avec une importante corticodépendance. Une ethmoïdectomie chirurgicale emportant la lame papyracée a été réalisée dans le but de permettre l'expansion du globe oculaire vers la fosse nasale en cas de nouvelle crise.DiscussionL'association du rituximab à la chirurgie a permis la régression durable des douleurs et de l'exophtalmie.
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Carcinome mucoépidermoïde sclérosant de la glande sublinguale
Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): D.H. Lee, J.H. Kim, J.K. Lee, S.C. Lim
IntroductionLe carcinome mucoépidermoïde sclérosant de la glande salivaire est un sous-type rare de carcinome mucoépidermoïde. Les sites les plus touchés par le carcinome mucoépidermoïde sclérosant des glandes salivaires sont par ordre de fréquence la glande parotide, la glande sous-mandibulaire et les glandes salivaires accessoires.ObservationNous rapportons ici le premier cas de carcinome mucoépidermoïde sclérosant de la glande sublinguale.DiscussionLes cliniciens doivent évoquer le carcinome mucoépidermoïde sclérosant dans le diagnostic différentiel du néoplasme de la glande salivaire. L'exérèse chirurgicale avec marges saines est une option thérapeutique initiale qui semble suffisante pour le carcinome mucoépidermoïde sclérosant de la glande salivaire.
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Démarche diagnostique devant un œdème labial diffus isolé d’apparition soudaine
Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): O. Laccourreye, F. Rubin, J. Delort, P. Bonfils
À partir d'un cas d'œdème labial diffus isolé de survenue soudaine, les auteurs précisent les points clefs de la démarche diagnostique ainsi que les principales données épidémiologiques et cliniques.
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Les corps étrangers nasaux chez les enfants dans un hôpital pédiatrique au Sénégal : une évaluation de 3 ans
Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): P.E.J. Regonne, M. Ndiaye, A. Sy, Y. Diandy, A.D. Diop, B.K. Diallo
ObjectifsLes corps étrangers nasaux (CEN) sont un accident domestique fréquent chez les enfants. L'objectif de ce travail était de présenter les particularités des CEN chez les enfants dans un hôpital pédiatrique sénégalais et décrire notre attitude thérapeutique.Matériel et méthodesÉtude rétrospective descriptive au service d'oto-rhino-laryngologie du Centre hospitalier national pour enfants de Diamniadio du 1er janvier 2013 au 31 décembre 2015 incluant tous les enfants de moins de 15 ans reçus pour CEN. Les variables étudiées étaient l'âge, le sexe, la provenance, le motif de consultation, le délai de consultation, la nature du CEN, la méthode d'extraction et les complications.RésultatsCinquante-huit CEN avaient été recensés. L'âge moyen était de 3 ans 4 mois. Parmi les patients, 93 % avaient moins de 5 ans. Il y avait une prédominance féminine (53,45 %), soit un sex-ratio de 0,87. Les CEN étaient localisés chez 43 patients (74,1 %) à droite. Le premier motif de consultation était la rhinorrhée purulente retrouvée chez 51,7 % ; parmi les patients, 17,24 % étaient amenés en consultation dans les 24 premières heures. La mousse était le premier CEN (29,3 %), suivie des graines (20,7 %). L'extraction a été réalisée en consultation chez 84,5 % et chez 15,5 % au bloc opératoire. La morbidité était de 22,41 %. Il s'agissait dans 17,24 % d'une épistaxis et dans 5,17 % d'une infection nasale.ConclusionLes CEN sont des accidents fréquents chez l'enfant de moins de 5 ans. Notre contexte est marqué par un retard à la consultation.
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Tuméfaction inflammatoire basicervicale
Publication date: October 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): H. Benkhatar, F. Scotte, O. Laccourreye, C. Benoit
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Masse fluctuante cervicale : lettre à l’éditeur et revue de la littérature de phlébectasie de la veine jugulaire antérieure
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 5
Author(s): M.Y. Abboud, A. de Lafontaine-Ruel, B. Riederer, D. Philippon
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Chairside molecular imaging of aberrant glycosylation in subjects with suspicious oral lesions using fluorescently labeled wheat germ agglutinin
Abstract
Background
Aberrant sialylation is accepted as a carcinogenic biomarker. In previous work, fluorescently labeled wheat germ agglutinin (WGA) distinguished between cancerous and normal oral biopsies. The purpose of this study was to investigate WGA-fluorescein isothiocyanate (FITC) as a point-of-care tool for detecting oral malignant and dysplastic lesions in vivo.
Methods
Subject recruitment was divided into two groups: (1) the clinically normal oral mucosa group; or (2) the presence of clinically suspicious oral lesion(s) group. A WGA-FITC solution was topically applied to observable lesions or to half the subject's mouth (sagittal plane) if lesions were absent. Fluorescent molecular imaging was used to evaluate WGA-FITC localization.
Results
Fluorescent imaging in 55 subjects demonstrated that WGA-FITC could detect histopathologically-confirmed cancerous and dysplastic lesions with high sensitivity (100% and 81%, respectively) and specificity (82%).
Conclusion
This study supports in vivo fluorescent molecular imaging of WGA-FITC to visualize aberrant sialic acid expression associated with carcinogenesis. This technique resulted in the immediate chairside detection of oral cancerous and dysplastic lesions.
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Predictors of contralateral-bilateral nodal disease in oropharyngeal cancer: A National Cancer Data Base Study
Abstract
Background
Oropharyngeal squamous cell carcinoma (SCC) frequently presents with cervical metastasis. Roles of human papillomavirus (HPV) status, among other factors, on laterality are elusive.
Methods
The National Cancer Database was reviewed for oropharyngeal SCC diagnosed from 2010-2014. Predictors of clinically evident contralateral or bilateral nodal disease were identified.
Results
A total of 15 517 patients with oropharyngeal SCC met criteria. The majority was HPV-positive. Histologically poorly differentiated tumors were more frequent in the HPV-positive group (55.7% vs 37.6%; P < .001). By incidence, there was no statistical difference in contralateral or bilateral nodal disease between HPV-positive and HPV-negative patients (14.2% vs 14.5%, respectively; P = .769). On multivariable analysis, notable predictors of contralateral or bilateral nodal disease included HPV-positivity (odds ratio [OR] 1.26; 99% confidence interval [CI] 1.10-1.44), base of tongue (BOT) location (OR 2.15; 99% CI 1.88-2.45), poorly differentiated tumor (OR 1.72; 99% CI 1.20-2.46), and T4 classification (OR 6.65; 99% CI 5.34-8.28).
Conclusion
Patients with HPV-associated oropharyngeal SCC have increased likelihood of contralateral or bilateral nodal disease. Tumor grade, tumor location, and tumor size are also independent predictors.
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Cost analysis of a speech pathology synchronous telepractice service for patients with head and neck cancer
Abstract
Background
The purpose of this study is to report the economic outcomes of a new synchronous telepractice service providing speech pathology intervention to patients with head and neck cancer at nonmetropolitan facilities.
Methods
A multisite randomized controlled trial comparing standard care versus a new synchronous telepractice model was conducted within a large Australian public cancer service. Data pertaining to health service costs (staff wages, equipment, and patient travel reimbursement), patient +/- carer costs (travel and wages), and patient-reported quality of life (Assessment of Quality of Life questionnaire 4D) were collected.
Results
Eighty-two referrals (39 standard care and 43 synchronous telepractice care) were managed. The new telepractice service reported average cost savings of 12% (P < .0058) for the health service and $40.05 saving per patient per referral. An equivalent positive increase in quality of life (0.04) was reported for both groups.
Conclusion
The synchronous telepractice service provides cost efficiencies over standard care for providing remote specialist speech pathology head and neck cancer intervention.
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Comparison of outcomes with extensive segmental pectoralis major myocutaneous flap via the anterior axillary line and the conventional technique in oral and oropharyngeal cancer
Abstract
Background
This study compared the outcomes of an extensive segmental pectoralis major myocutaneous flap (esPMMF) and a conventional pectoralis major myocutaneous flap (PMMF).
Methods
The study enrolled 91 patients with primary oral and oropharyngeal squamous cell carcinoma (SCC) who underwent radical resection followed by reconstruction of the defect using either an esPMMF via the anterior axillary line or a PMMF. The pedicle lengths of the esPMMF and PMMF were 22-28 and 18-22 cm, respectively. The esPMMF and PMMF had skin paddle dimensions of 5 × 8 to 7 × 14 cm and 6 × 7 to 8 × 17 cm, respectively.
Results
The esPMMF pedicle was longer than that of the PMMF. The range of shoulder abduction was significantly greater in the esPMMF group and the donor-site aesthetic results were better.
Conclusion
The esPMMF has a longer pedicle flap, enables a greater range of shoulder abduction, and has a better aesthetic result than the conventional technique.
http://ift.tt/2yzBlIb
Serum parathyroid hormone and alkaline phosphatase as predictors of calcium requirements after total parathyroidectomy for hypocalcemia in secondary hyperparathyroidism
Abstract
Background
To prevent hypocalcemia, this study examined the efficiency of a calcium supplement formula guided by predicted calcium requirement in patients with renal failure after parathyroidectomy with autotransplantation.
Methods
In the first phase, a protocol was followed whereby intravenous calcium gluconate was repeatedly titrated based on serum calcium levels in 22 patients with parathyroidectomy with autotransplantation. In the second phase, the first equation protocol was applied in 74 patients with parathyroidectomy with autotransplantation and revised.
Results
There is a significant correlation between the postoperative amount of calcium requirement and preoperative serum alkaline phosphatase level (r = 0.442; P < .001) and parathyroid hormone level (PTH; r = 0.889; P < .001). For prediction of insufficient calcium supplement, the cutoff point of PTH and alkaline phosphatase level values were calculated by receiver operating characteristic (ROC) curve analysis and modified equations were developed by regression analysis.
Conclusion
The preoperative PTH and alkaline phosphatase levels can predict postoperative calcium requirements, such that equations of calcium supplement allow the management of hypocalcemia efficiently in patients on dialysis after parathyroidectomy with autotransplantation.
http://ift.tt/2fZ5t9c
Role of macrophage migration inhibitory factor in head and neck cancer and novel therapeutic targets: A systematic review
Abstract
Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine involved in systemic, autoimmune, and inflammatory diseases, such as obesity, rheumatoid arthritis, and systemic lupus erythematosus. For the 2 past decades, MIF has been reported to participate in carcinogenesis, disease prognosis, tumor cell proliferation, invasion, and tumor-induced angiogenesis in many cancers. The purpose of this article is to review published experimental and clinical data for MIF and its involvement in upper aerodigestive tract cancers. Based on the current literature, we propose a biomolecular model describing the mechanisms underlying the involvement of MIF in the initiation, progression, apoptosis, and proliferation of head and neck tumor cells. In reference to this model, potential therapeutic approaches based on the use of MIF antagonists and neutralizing antibodies are described. It is concluded that MIF is a promising target for future therapeutic strategies, both with and without chemoradiation strategies.
http://ift.tt/2yzBgUT
Phase I study of induction chemotherapy with afatinib, ribavirin, and weekly carboplatin and paclitaxel for stage IVA/IVB human papillomavirus-associated oropharyngeal squamous cell cancer
Abstract
Background
The human papillomavirus (HPV) E6 oncoprotein enhances the oncogenic potential of ErbB proteins in HPV-related malignancies. This phase I study evaluates the addition of afatinib, an ErbB family inhibitor, and ribavirin to paclitaxel and carboplatin induction chemotherapy in HPV-associated, locally advanced oropharyngeal squamous cell carcinoma (SCC).
Methods
This dose escalation study included 2 doses of oral afatinib: 30 and 40 mg daily. Ribavirin dosing was weight based. Paclitaxel (80 mg/m2) and carboplatin (area under the curve [AUC] 1.5) were administered on days 1 and 8 of each 21-day cycle. After 3 cycles, patients were removed from protocol to receive definitive treatment.
Results
Among 10 patients, there were no dose-limiting toxicities. Six patients (67%) had unconfirmed objective partial responses. The 2-year progression-free survival rate was 75%.
Conclusion
Afatinib, ribavirin, paclitaxel, and carboplatin induction chemotherapy is safe and well tolerated. The phase II recommended dose of afatinib is 40 mg oral daily in this combination regimen.
http://ift.tt/2fZq3WZ
Modified technique for preservation of inferior alveolar nerve during mandibulectomy
Abstract
Background
The purpose of this article is to introduce the modified technique of preservation of the inferior alveolar nerve (IAN) during mandibulectomy for a benign lesion.
Methods
Five cases of osteofibrous hyperplasia and 3 cases of centricity osteomyelitis were included. During surgery, the IAN was marked using a planned cutting guide. Using an oscillating saw, the depth of the osteotomy along the IAN was controlled until the bone cortex was cut through. After splitting, the bony section was removed, leaving the neurovascular bundle intact. The sensation of the lower lip was evaluated using current perceptive threshold testing during follow-up.
Results
After follow-up for 6-27 months, no recurrence or secondary deformity was found. One patient had severe sensory disturbance.
Conclusion
With the use of a cutting guide and osteotomy tricks, mandibulectomy with preservation of the IAN can be accurately performed.
http://ift.tt/2yzBdIH
“Airborne” suture tying technique: Simple steps to make it easy
Abstract
A multitude of microsurgical suture techniques have been described. Although accurate apposition and eversion of the vessel ends is paramount for the patency of anastomosis, rapidity is usually of secondary importance. However, in situations in which either multiple anastomoses are required or timely revascularization is crucial, speed becomes a determinant factor for eventual success. "Airborne" suture tying is aimed at decreasing operative time by streamlining the microvascular anastomosis. Over the years, several considerations have emerged as key points for achieving mastery of this helpful maneuver. Herein, we simplify the technique by breaking the maneuver into 2 components: the "charioteer" loop and the "lasso" loop. Relevant literature, indications, and benefits are discussed followed by step-by-step descriptions. Both back table and in vivo video demonstrations are presented online.
http://ift.tt/2fZllbV
18F-Fluoromisonidazole positron emission tomography/CT-guided volumetric-modulated arc therapy-based dose escalation for hypoxic subvolume in nasopharyngeal carcinomas: A feasibility study
Abstract
Background
The purpose of this study is to investigate the feasibility of a simultaneously integrated boost to the hypoxic subvolume of nasopharyngeal carcinomas (NCPs) under the guidance of 18F-fluoromisonidazole (FMISO) positron emission tomography (PET)/CT using volumetric-modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) techniques.
Methods
Eight patients with NPC were treated with simultaneous integrated boost-IMRT (treatment plan named IMRT70) with dose prescriptions of 70 Gy, 66 Gy, 60 Gy, and 54 Gy to the gross tumor volume (GTV), positive neck nodes, the planning target volume (PTV), and the clinically negative neck, respectively. Based on the same datasets, experimental plans with the same dose prescription plus a dose boost of 14 Gy (an escalation of 20% of the prescription dose) to the hypoxic volume target contoured on the pretreatment 18F-FMISO PET/CT imaging were generated using IMRT and VMAT techniques, respectively (represented by IMRT84 and VMAT84). Two or more arcs (approximately 2-2.5 arcs, totally rotating angle <1000 degrees) were used in VMAT plans and 9 equally separated fields in IMRT plans. Dosimetric parameters, total monitor units, and delivery time were calculated for comparative study of plan quality and delivery efficiency between IMRT84 and VMAT84.
Results
In experimental plans, hypoxic target volumes successfully received the prescribed dose of 84 Gy in compliance with other dose constraints with either the IMRT technique or the VMAT technique. In terms of the target coverage, dose homogeneity, and organs at risk (OAR) sparing, there was no statistically significant difference between the actual treatment plan of IMRT70 and experimental plans. The total monitor unit of VMAT84 (525.7 ± 39.8) was significantly less than IMRT70 (1171.5 ± 167; P = .001) and IMRT84 (1388.3 ± 151.0; P = .001) per fraction, with 55.1% and 62.1% reduction. The average machine delivery time was 3.5 minutes for VMAT plans in comparison with approximately 8 minutes for IMRT plans, resulting in a reduction factor of 56.2%. For experimental plans, the 3D gamma index average was over 98.0% with no statistical significant difference when a 3%/3 mm gamma passing rate criteria was used.
Conclusion
With the guidance of 18F-FMISO PET/CT imaging, dose escalation to hypoxic zones within NPC could be achieved and delivered efficiently with the VMAT technique in comparison with the IMRT technique.
http://ift.tt/2yzB9sr
Justification of routine venous thromboembolism prophylaxis in head and neck cancer reconstructive surgery
Abstract
Background
Venous thromboembolism (VTE) is a preventable complication in which early ambulation is expected after head and neck surgery. Thus, the role of VTE prophylaxis is questionable and needs further assessment. The purpose of this study was to specify the relative contributing risk factors for patients who underwent head and neck cancer ablation with immediate reconstruction.
Methods
A retrospective analysis was conducted of consecutive head and neck cancer ablations with immediate reconstructions between 2008 and 2013. Dextran and prostaglandin E2 (PGE2) were routinely given as flap thromboprophylaxis. Logistic regression was applied to analyze the potentially significant risk factors.
Results
Of 1953 subjects, the incidence of symptomatic VTE was 2.2% with 0.1% mortality rate. Prolonged surgery (>592.5 minutes; P = .048), immobilization (>4 days; P = .019), and subjects without postoperative flap thromboprophylaxis (P = .002) are significant risk factors for VTE development.
Conclusion
Our flap thromboprophylaxis regime might have played a crucial role in keeping the incidence of VTE low. Despite prolonged immobilization in fibula flap reconstruction, the incidence of VTE remained low when flap thromboprophylaxis was given.
http://ift.tt/2fZpPz7
Surrogate for oropharyngeal cancer HPV status in cancer database studies
Abstract
Background
The utility of cancer databases for oropharyngeal cancer studies is limited by lack of information on human papillomavirus (HPV) status. The purpose of this study was to develop a surrogate that can be used to adjust for the effect of HPV status on survival.
Methods
The study cohort included 6419 patients diagnosed with oropharyngeal squamous cell carcinoma between 2004 and 2012, identified in the National Cancer Database (NCDB). The HPV surrogate score was developed using a logistic regression model predicting HPV-positive status.
Results
The HPV surrogate score was predictive of HPV status (area under the curve [AUC] 0.73; accuracy of 70.4%). Similar to HPV-positive tumors, HPV surrogate positive tumors were associated with improved overall survival (OS; hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.59-0.91; P = .005), after adjusting for important covariates.
Conclusion
The HPV surrogate score is useful for adjusting for the effect of HPV status on survival in studies utilizing cancer databases.
http://ift.tt/2yzB6gf
Therapeutic lateral neck dissection in well-differentiated thyroid cancer: Analysis on factors predicting distribution of positive nodes and prognosis
Abstract
Background
Neck dissection is considered the treatment of choice in patients with lateral neck metastases from well-differentiated thyroid cancer.
Methods
A multicenter, retrospective review of patients who underwent therapeutic lateral neck dissection for well-differentiated thyroid carcinoma was carried out.
Results
The study included a total of 405 lateral neck dissections performed in 352 patients; 197 women (56%) and 155 men (44%). When considering ipsilateral neck metastases, levels IIa, IIb, III, IV, Va, Vb, and V (not otherwise specified) were involved in 42%, 6%, 73%, 67%, 11%, 31%, and 35% of cases, respectively. Five-year and 10-year overall survival (OS) were 93% and 81%, respectively. Age >55 years, pathologic T (pT)4 category, tumor diameter >4 cm, aggressive variants of well-differentiated thyroid carcinoma, endovascular invasion, and number of positive nodes >5 turned out to be the most important prognostic factors.
Conclusion
Neck dissection is a valid treatment option in the presence of neck metastasis from well-differentiated thyroid carcinoma. Levels IIa, III, IV, and Vb should always be removed.
http://ift.tt/2fZpJHL
Correlation between the pathology and clinical presentations in patients with adenoid cystic carcinoma of the external auditory canal
Abstract
Background
The purpose of this study was to analyze the correlation between the pathology and clinical presentations in patients with adenoid cystic carcinoma (ACC) of the external auditory canal.
Methods
Twenty-nine patients with ACC of the external auditory canal who underwent surgery were retrospectively reviewed.
Results
Fifty percent of patients with solid pattern disease had recurrences, followed by those with cribriform (33%) and tubular (0%) pattern. Perineural invasion was common (55%), and occurred most frequently in the solid subtype (67%). The rate of otalgia was less in patients with perineural invasion (31% vs 46%). Most tumors (59%) involved the parotid gland, but it was not seen on preoperative MRI (35%).
Conclusion
The solid subtype presents the worst prognosis, and is prone to perineural invasion. Despite frequently occurring in ACC of the external auditory canal, perineural invasion may not be associated with otalgia. In ACC of the external auditory canal, high rates of occult parotid involvement support adjunctive superficial parotidectomy.
http://ift.tt/2yxSjH6
Genomic profiling of intestinal-type sinonasal adenocarcinoma reveals subgroups of patients with distinct clinical outcomes
Abstract
Background
Patients with intestinal-type sinonasal adenocarcinoma (ITAC) have an unfavorable prognosis and new therapeutic approaches are needed to improve clinical management.
Methods
Genetic analysis of 96 ITACs was performed by microarray comparative genomic hybridization and immunohistochemistry and correlated to previously obtained mutation, methylation, and protein expression data, and with pathological characteristics and clinical outcome.
Results
Seven copy number alterations (CNAs) were significantly associated with unfavorable clinical outcome: gains at 1q22-23, 3q28-29, 6p22, and 13q31-33, and losses at 4p15-16, 4q32-35, and 10q24. Unsupervised cluster analysis resulted in 5 subgroups of ITAC with significantly distinct genetic signatures and clinical outcomes, independently of disease stage or histological subtype.
Conclusion
These data may guide studies to identify driver genes and signaling pathways involved in ITAC. In addition, the subclassification of genetic subgroups of patients with distinct clinical behavior can aid therapeutic decision making and may ultimately lead to personalized therapy with targeted inhibitors.
http://ift.tt/2fZ3DVA
Predictors of survival after total laryngectomy for recurrent/persistent laryngeal squamous cell carcinoma
Abstract
Background
Total laryngectomy remains the treatment of choice for recurrent/persistent laryngeal squamous cell carcinoma (SCC) after radiotherapy (RT) or chemoradiotherapy (CRT). However, despite attempts at aggressive surgical salvage, survival in this cohort remains suboptimal.
Methods
A prospectively maintained single-institution database was queried for patients undergoing total laryngectomy for recurrent/persistent laryngeal SCC after initial RT/CRT between 1998 and 2015(n = 244). Demographic, clinical, and survival data were abstracted. The Kaplan-Meier survival curves and hazard ratios (HRs) were calculated.
Results
Five-year overall survival (OS) was 49%. Five-year disease-free survival (DFS) was 58%. Independent predictors of OS included severe comorbidity (Adult Comorbidity Evaluation-27 [ACE-27] scale; HR 3.76; 95% confidence interval [CI] 1.56-9.06), and positive recurrent clinical nodes (HR 2.91; 95% CI 1.74-4.88).
Conclusion
Severe comorbidity status is the strongest predictor of OS, suggesting that increased attention to mitigating competing risks to health is critical. These data may inform a risk prediction model to allow for focused shared decision making, preoperative health optimization, and patient selection for adjuvant therapies.
http://ift.tt/2yyqIp6
Risk of depressive disorder among patients with head and neck cancer: A nationwide population-based study
Abstract
Background
The purpose of this study was to assess the incidence and risk of depressive disorder among patients with head and neck cancer.
Methods
We identified 48 548 patients from the National Health Insurance Research Database (NHIRD) in Taiwan who were newly diagnosed with head and neck cancer between 2000 and 2010. Each patient was randomly frequency-matched with an individual without head and neck cancer, based on index year, sex, age, occupation category, urbanization level, monthly income, and comorbidities. The Cox proportional Registry of Catastrophic Illnesses Patient Database regression analysis was performed to estimate the effect of head and neck cancer on the risk of depressive disorder.
Results
Patients with head and neck cancer had a significantly higher risk of depressive disorder than the matched cohort (adjusted hazard ratio [HR] 3.32; 95% confidence interval [CI] 3.05-3.61), with the highest risk seen in the hypopharynx and oropharynx.
Conclusion
Patients with head and neck cancer had >3 times the incidence of depressive disorder, relative to the comparison group. Psychological evaluation and support are essential in head and neck cancer survivors.
http://ift.tt/2fZpEnr
Injury mechanisms and electromyographic changes after injury of the recurrent laryngeal nerve: Experiments in a porcine model
Abstract
Background
Recurrent laryngeal nerve (RLN) injury during surgery may reveal differences in electromyographic (EMG) changes after sustained compression or traction.
Methods
In 20 pigs with the NIM-FLEX EMG-endotracheal tube, EMG was recorded at baseline, during sustained RLN compression, or traction until 70% amplitude decrease and during 30 minutes of recovery.
Results
Seventy percent amplitude decrease from baseline was reached after 110 ± 98 seconds (compression group) and 2034 ± 2108 seconds (traction group). Traction induced a pronounced latency increase, peaking at 122 ± 8% in contrast to compression with 106 ± 5% (P < .001). The EMG amplitude recovery to ≥50% of baseline failed in 7 nerves after compression and 8 nerves after traction.
Conclusion
Compression caused a fast decrease of EMG amplitude with minor effects on latency. In contrast, RLN traction showed early and significant latency increase preceding a delayed amplitude decrease. Recovery rate of the EMG signals were similar in both groups.
http://ift.tt/2yz2fjm
Prognostic relevance of insulin resistance on disease-free survival in head and neck squamous cell carcinomas: Preliminary results
Abstract
Background
The primary purpose of this study was to investigate the significance of pretreatment glycemic parameters in the prognosis of head and neck squamous cell carcinoma (HNSCC).
Methods
Plasma samples of 71 patients with untreated HNSCC were obtained at the time of diagnosis. The prognostic value of fasting insulin, glucose, glycosylated hemoglobin levels, and the homeostatic model of risk assessment-insulin resistance (HOMA-IR) was evaluated toward disease-free survival.
Results
High HOMA-IR levels were associated with poor disease-free survival in intermediate-advanced stage tumors. Kaplan-Meier curves showed lower disease-free survival rates in patients with high HOMA-IR than in patients with low levels. In patients with intermediate-advanced stage tumors, multivariate analysis revealed that those with an HOMA-IR >2.974 presented a 2.7 times higher risk of poor outcome (95% confidence interval [CI] 1.023-7.341; P = .045).
Conclusion
The HOMA-IR is independently associated with disease-free survival in patients with HNSCC. We found an optimal HOMA-IR cutoff value for disease-free survival in patients with intermediate-advanced HNSCC.
http://ift.tt/2fZ2TzQ
Vaccination with a recombinant OprL fragment induces a Th17 response and confers serotype-independent protection against Pseudomonas aeruginosa infection in mice
Source:Clinical Immunology
Author(s): Chen Gao, Feng Yang, Ying Wang, Yaling Liao, Jinyong Zhang, Hao Zeng, Quanming Zou, Jiang Gu
Pseudomonas aeruginosa (PA) is the major causative agent of nosocomial infection. Despite of adequate use of antibiotics, it still represents a major challenge in controlling PA infection. The local pulmonary Th17 response plays an important protective role against PA infection. And the Th17-mediated protection is antibody independent, so we hypothesized that it would be an optimal strategy of a vaccine for PA control to induce an effective Th17 response. Herein we report the successful production of a recombinant fragment of the OprL (reOprL) of PA. Purified reOprL forms homogeneous monomers in solution and vaccination with reOprL elicited a remarkable Th17 response. In addition, reOprL vaccination conferred effective serotype-independent protection against PA infection, which relied on the Th17 response. Our data suggest that reOprL is a good candidate for the future development of Th17 immunity based PA vaccines.
http://ift.tt/2fHPEqp
The efficacy of oral and subcutaneous antigen-specific immunotherapy in murine cow’s milk- and peanut allergy models
Antigen-specific immunotherapy (AIT) is a promising therapeutic approach for both cow's milk allergy (CMA) and peanut allergy (PNA), but needs optimization in terms of efficacy and safety.
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Audio-visual speech perception in prelingually deafened Japanese children following sequential bilateral cochlear implantation
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Ryosuke Yamamoto, Yasushi Naito, Keizo Fujiwara, Shogo Shinohara, Shinji Takebayashi, Masahiro Kikuchi, Tetsuhiko Michida, Kazuki Hayashi, Koji Saida, Keisuke Mizuno
ObjectivesAn effect of audio-visual (AV) integration is observed when the auditory and visual stimuli are incongruent (the McGurk effect). In general, AV integration is helpful especially in subjects wearing hearing aids or cochlear implants (CIs). However, the influence of AV integration on spoken word recognition in individuals with bilateral CIs (Bi-CIs) has not been fully investigated so far. In this study, we investigated AV integration in children with Bi-CIs.MethodsThe study sample included thirty one prelingually deafened children who underwent sequential bilateral cochlear implantation. We assessed their responses to congruent and incongruent AV stimuli with three CI-listening modes: only the 1st CI, only the 2nd CI, and Bi-CIs. The responses were assessed in the whole group as well as in two sub-groups: a proficient group (syllable intelligibility ≥80% with the 1st CI) and a non-proficient group (syllable intelligibility < 80% with the 1st CI).ResultsWe found evidence of the McGurk effect in each of the three CI-listening modes. AV integration responses were observed in a subset of incongruent AV stimuli, and the patterns observed with the 1st CI and with Bi-CIs were similar. In the proficient group, the responses with the 2nd CI were not significantly different from those with the 1st CI whereas in the non-proficient group the responses with the 2nd CI were driven by visual stimuli more than those with the 1st CI.ConclusionOur results suggested that prelingually deafened Japanese children who underwent sequential bilateral cochlear implantation exhibit AV integration abilities, both in monaural listening as well as in binaural listening. We also observed a higher influence of visual stimuli on speech perception with the 2nd CI in the non-proficient group, suggesting that Bi-CIs listeners with poorer speech recognition rely on visual information more compared to the proficient subjects to compensate for poorer auditory input. Nevertheless, poorer quality auditory input with the 2nd CI did not interfere with AV integration with binaural listening (with Bi-CIs). Overall, the findings of this study might be used to inform future research to identify the best strategies for speech training using AV integration effectively in prelingually deafened children.
http://ift.tt/2fySTNb
Intratympanic Injection of Steroid for Treatment of Tinnitus
Abstract
Tinnitus has become one of the most challenging tasks faced by the medical field. It has a moderately negative impact on patient's quality of life. Different methods had been developed in medical science for managing tinnitus but none of these offered a permanent cure. In our study we used a simple procedure of intratympanic injection of dexamethasone in managing our tinnitus patients. Total number of patients involved in this study were 40, 26 females and 14 males with age spanned from 15 to 65 years. Out of 40 patients, 22 of them complained of tinnitus only while the other 18 of them complained of tinnitus with impaired hearing which was confirmed further by pure tone audiometry. Injection was given under otologic microscopic vision through posteroinferior quadrant of tympanic membrane in weekly interval. After receiving several number of injections, 24 patients (60%) reported complete disappearance of tinnitus, 10 of them (25%) still had residual tinnitus but comparatively less severe and 6 (15%) of them reported no improvement.
http://ift.tt/2yeuwQu
Clinical and hemodynamic risk factors associated with discrepancies in lower limb length with capillary malformations – data from the national paediatric French cohort CONAPE
Summary
Background
Genetics discoveries have allowed for better understanding capillary malformations (CMs) with overgrowth syndrome. However, molecular analyses are still not easy to perform or interpret. Other analytical methods are needed.
Objective
We aimed to identify clinical and hemodynamic factors associated with leg length discrepancy (LLD) in children with CM of lower limbs.
Methods
Data were obtained from the multicentre French national cohort CONAPE (COhorte Nationale d'enfants atteints d'Angiome Plan de membrE inférieur), including children from 2 to 12 years old with CM of lower limbs. Clinical characteristics were prospectively collected. Hemodynamic factors were measured by an echographer who calculated the arterial blood flow (ABF) in both lower limbs. An ABF difference ≥50% between the two lower limbs was considered relevant. LLD ≥ 2% was determined by the same radiologist on centralized radiographs.
Results
We analyzed data at baseline for 96 children. The mean (SD) age was 5.6 (3.1) years; 49 (51%) were male; and 14 (15%) showed LLD. Thirty-two patients (33%) had venous anomalies, 13 (14%) lymphatic anomalies, and in 1 child, diagnosis of Parkes Weber syndrome was made. Only increased circumference above the knee was more frequent with than without LLD (50% vs 13%, p=0.02). In all, 10/79 patients (13%) showed a difference in ABF ≥50%: 4 had LLD. The frequency of differences in ABF ≥50% was greater with than without LLD [33.3% (n=4/12) vs 9.0% (n=6/67), p=0.04].
Conclusions
ABF measured by Duplex ultrasonography is a simple, low-cost and non-invasive complementary examination for help in detecting LLD, with a difference ≥ 50% possibly associated.
This article is protected by copyright. All rights reserved.
http://ift.tt/2yf7kBs
Pirfenidone photosensitization in patients with idiopathic pulmonary fibrosis: a case series
Abstract
The oral antifibrotic agent, pirfenidone (PFD), 5-methyl-l-phenyl-[1H]-pyridine, is used to treat idiopathic pulmonary fibrosis (IPF), a chronic and fatal lung disease. In trials, PFD reduces disease progression and decreases mortality. The most common side events of PFD are skin manifestations (25%), described as a photosensitivity or rash, but they are not well characterised 1.
This article is protected by copyright. All rights reserved.
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Impact of Video Technology for Improving Success of Medial Canthus Episcleral Anesthesia in Ophthalmology.
Background and Objectives: Efficient learning of regional anesthesia in ophthalmology remains challenging because trainees are afforded limited opportunity to practice ocular anesthesia. The aim of this prospective, randomized, blinded study was to determine whether teaching with video improves regional anesthesia skills of residents in ophthalmology. Methods: From January to October 2016, 32 novice anesthesiology residents were evaluated while performing medial canthus episcleral procedures during a 5-day rotation. Residents were randomly assigned to either receive or not receive a video review of their performance at day 3. The primary outcome was a comparison of akinesia using a 12-point scale before incision assessed by the blinded surgeon. Results: A total of 288 blocks were performed by 32 residents and were assessed by 3 surgeons before the intervention (144 blocks) and after the intervention (144 blocks). Residents in the review group improved to a greater degree compared with residents in the no-review group. The median overall akinesia scores for the review and no-review groups were similarly low (6; interquartile range [IQR], 2-11; and 6 [IQR, 2-9], respectively) on day 1 of the rotation, whereas anesthesia performed by residents in the video group provided a better akinesia score (12 [IQR, 10-12] vs 8 [IQR, 6-10]; P
http://ift.tt/2xNbnUa
http://ift.tt/2xNbnUa
The Technology of Video Laryngoscopy.
Tracheal intubation via laryngeal exposure has evolved over the past 150 years and has greatly expanded in the last decade with the introduction and development of newer, more sophisticated optical airway devices. The introduction of indirect and video-assisted laryngoscopes has significantly impacted airway management as evidenced by the presence of these devices in the majority of published difficult airway algorithms. However, it is quite possible that many airway managers do not have a thorough comprehension of how these devices actually function, an understanding that is vital not only for their use but also for assessing the devices' limitations. This article discusses the development of video laryngoscopy, how the video laryngoscope works, and the impact of video laryngoscopy on difficult airway management. (C) 2017 International Anesthesia Research Society
http://ift.tt/2x4kZGv
http://ift.tt/2x4kZGv
General Anesthesia Imposes Negative Effects on Heart Rate and Blood Pressure Regulation in Patients With a History of Head and Neck Radiation Therapy.
BACKGROUND: Head and neck radiation therapy (HNRT) impairs baroreflex sensitivity, and it may potentiate the effects of anesthetics on heart rate (HR) and blood pressure (BP) regulation. Currently, the impacts of HNRT on HR and BP under anesthesia remain unclear. METHODS: In this study, 472 patients with primary oral cavity or oropharyngeal cancer at all stages were examined. Half of the patients underwent HNRT plus surgery. The other half underwent surgery only and was matched with the treatment patients according to age, sex, and body mass index at a 1:1 ratio. The HRs and BPs in the 2 groups during anesthetic induction, skin incision, and emergence were compared retrospectively. A multivariable model of repeated measures with unstructured covariance structure was used to examine the associations of HNRT with intraoperative HRs and BPs after adjusting for baseline HR and BP, time, use of [beta]-blockers, history of chemotherapy, and American Society of Anesthesiologists physical status score. BPs and HRs were collected every 5 minutes. The baseline HR and BP measurements were not included in the outcome vector and were only used as adjustment for baselines. RESULTS: Compared with corresponding baseline values in controls, the baseline HR was significantly higher (P = .0012) and the baseline systolic BP was lower (P
http://ift.tt/2wqM86S
http://ift.tt/2wqM86S
Maternal Death Due to Amniotic Fluid Embolism: A National Study in France.
BACKGROUND: A structured definition of amniotic fluid embolism (AFE) based on 4 criteria was recently proposed for use in research by the Society for Maternal-Fetal Medicine (SMFM) and the Amniotic Fluid Embolism Foundation. The main objective of this study was to review all AFE-related maternal deaths in France during 2007-2011 according to the presence or not of all these 4 diagnostic criteria. METHODS: Maternal deaths due to AFE were identified by the national experts committee of the French Confidential Enquiry into Maternal Deaths during 2007-2011 (n = 39). The maternal mortality ratio for AFE was calculated. We applied the structured definition proposed by the Society for Maternal-Fetal Medicine and the Amniotic Fluid Embolism Foundation to AFE-related maternal deaths identified by the national experts committee. Characteristics of women, pregnancies and deliveries; clinical and biological features of AFE; and specific laboratory tests used were described by the presence or not of all 4 diagnostic criteria. Management of obstetric hemorrhage and quality of care according to the experts were also described. RESULTS: The maternal mortality ratio from AFE was 0.95/100,000 live births (95% confidence interval, 0.67-1.3). Detailed clinical data were collected for 36 women who died from AFE: 21 (58%) had all 4 proposed diagnostic criteria and 15 (42%) had 1 or more missing criterion. Documented early disseminated intravascular coagulopathy was missing for 14 women, and 2 women exhibited more than 1 missing criterion. Ten of the 15 women with missing criteria had clinical coagulopathy, with standard hemostasis tests performed in only 3. Specific diagnostic examinations for AFE were performed in similar proportions by the presence or not of all diagnostic criteria. Opportunities to improve care included timely performance of indicated hysterectomy (n = 13) and improved transfusion practices (n = 9). In the context of maternal cardiac arrest, for 5 of 13 women, fetal extraction was performed within 5 minutes. CONCLUSIONS: The structured definition of AFE for research studies would exclude more than one-third of AFE-related maternal deaths identified by the national experts committee. Inclusion of clinical coagulopathy as a diagnostic criterion for AFE would reduce this proportion to 14%. There is still room for improvement in the management of obstetric hemorrhage and timely fetal extraction in the context of maternal cardiac arrest, frequently observed in AFE-related maternal death. (C) 2017 International Anesthesia Research Society
http://ift.tt/2x4As9j
http://ift.tt/2x4As9j
Monte Carlo Simulations Comparing Fisher Exact Test and Unequal Variances t Test for Analysis of Differences Between Groups in Brief Hospital Lengths of Stay.
BACKGROUND: We examined type I and II error rates for analysis of (1) mean hospital length of stay (LOS) versus (2) percentage of hospital LOS that are overnight. These 2 end points are suitable for when LOS is treated as a secondary economic end point. METHODS: We repeatedly resampled LOS for 5052 discharges of thoracoscopic wedge resections and lung lobectomy at 26 hospitals. RESULTS: Unequal variances t test (Welch method) and Fisher exact test both were conservative (ie, type I error rate less than nominal level). The Wilcoxon rank sum test was included as a comparator; the type I error rates did not differ from the nominal level of 0.05 or 0.01. Fisher exact test was more powerful than the unequal variances t test at detecting differences among hospitals; estimated odds ratio for obtaining P
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http://ift.tt/2wq1IzQ
Research Productivity and Rankings of Anesthesiology Departments in Canada and the United States: The Relationship Between the h-Index and Other Common Metrics.
BACKGROUND: To evaluate the relative research productivity and ranking of anesthesiology departments in Canada and the United States, using the Hirsch index (h-index) and 4 other previously validated metrics. METHODS: We identified 150 anesthesiology departments in Canada and the United States with an accredited residency program. Publications for each of the 150 departments were identified using Thomson's Institute for Scientific Information Web of Science, and the citation report for each department was exported. The bibliometric data were used to calculate publication metrics for 3 time periods: cumulative (1945-2014), 10 years (2005-2014), and 5 years (2010-2014). The following group metrics were then used to determine the publication impact and relative ranking of all 150 departments: h-index, m-index, total number of publications, sum of citations, and average number of citations per article. Ranking for each metric were also stratified by using a proxy for departmental size. The most common journals in which US and Canadian anesthesiology departments publish their work were identified. RESULTS: The majority (23 of the top 25) of top-ranked anesthesiology departments are in the United States, and 2 of the top 25 departments (University of Toronto; McGill University) are in Canada. There was a strong positive relationship between each of h-index, total number of publications, and the sum of citations (0.91-0.97; P
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http://ift.tt/2woB4an
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