Surgical management of chronic genital lymphoedema

A 44-year-old man with a spinal cord injury was referred to a specialist urology service with a 7-year history of significant genital swelling. His condition had eluded diagnosis and was refractory to all previous treatments. The considerable swelling both impacted his quality of life and prevented the patient from adequately managing his neurogenic bladder. He was diagnosed with chronic idiopathic genital lymphoedema and underwent total scrotectomy, wide penile skin excision and split skin graft to the penile shaft. The patient made an excellent recovery. We present this unusual case with preoperative, intraoperative and postoperative images.

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Case of hepatic portal venous gas in an infant with hypertrophic pyloric stenosis

Hepatic portal venous gas is the presence of gas within the portal vein and its branches. A 4-week-old male infant presented with 1-week history of non-bloody, non-bilious projectile emesis. Examination was significant for an olive-shaped mass in the abdomen. Bloodwork showed hypokalaemic metabolic alkalosis. Abdominal ultrasound and radiograph was significant for portal venous gas and did not meet radiographic criteria for pyloric stenosis. He underwent upper endoscopy, which showed a narrowed, hypertrophic pylorus. The child underwent pyloromyotomy with resolution of his emesis. Hepatic portal venous gas (HPVG) is very rare and can be seen in the setting of hypertrophic pyloric stenosis. It is believed that an increase in intraluminal dilation and pressure subsequently moves gas from the intestinal mucosa venous system and lymphatics into the portal veins. The presence of HPVG in a well-appearing patient can be benign and should not prompt further testing nor delay treatment.

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Renal cell carcinoma with level 2 IVC thrombus

Description

A 40-year-old male patient, a chronic smoker for the last 10 years, presented with oedema of the lower legs and gross painless haematuria of 2 months duration. He also gave history of weight loss and loss of appetite. Physical examination revealed a right abdominal mass. Complete blood haemogram was normal. A comprehensive metabolic evaluation including serum calcium levels, C-reactive protein, liver function and urinalysis was also found normal.

Multidetector CT scan showed a right renal tumour of size 8x8 cm involving upper and mid-pole with tumour thrombus extending from the renal vein (RV) into the infrahepatic inferior vena cava (IVC) (figure 1). CT angiography was further performed to confirm the vascularity and extent of RV thrombus as shown in figure 2.

Figure 1

Right renal cell carcinoma involving upper and mid-pole with tumour thrombus extending into infrahepatic inferior vena cava (IVC).

...

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CMV encephalitis in an immune-competent patient

After being admitted to hospital with atypical chest pain, a 61-year-old woman was noted to become lethargic and confused. She also developed global dysphasia. MRI was suggestive of encephalitis, and lumbar puncture was positive for cytomegalovirus (CMV) PCR. The patient was treated with intravenous ganciclovir and subsequent oral valganciclovir and she gradually made a reasonable recovery. While this infection is usually closely linked to immunosuppression, the patient was found to be HIV negative, and was not on any immunosuppressive therapy. Going through the patient's medical history revealed two possible risk factors which might have led to the development of CMV encephalitis: immunosuppression secondary to underlying poorly controlled diabetes mellitus; and previous admission to the intensive care unit which might have lead to CMV reactivation.

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Comparison of rabies virus protection by single chain and leucine zipper Fv fragments cocktail derived from a monoclonal antibody cocktail

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Hualong Xi, Xiangyu Meng, Tiejun Gu, Zhuang Li, Yue Cheng, Qing Sun, Kaixin Zhang, Wei Kong, Yongge Wu

Abstract

Monoclonal antibodies (MAbs) are a unique and attractive class of biologics and are potential substitutes for post-exposure rabies prophylaxis. The safety, tolerance, and broad neutralization efficiency of a MAb cocktail called CL184, composed of the antibodies CR4098 and CR57, was confirmed in a phase I clinical trial. We have prepared a series of single-chain Fv fragments (scFvs) and leucine zipper Fv fragments (zipFvs) from CR57 and CR4098. In this study, we selected and formed scFv and zipFv cocktails and compared their protective effects against the rabies virus. Mice and hamster challenge models demonstrated the improved protection of the zipFv cocktail compared with scFv cocktail, because of its stronger affinity. The results indicate that zipFv production is a promising novel method for the genetic engineering of antibody fragments and improving affinity through systematic screening may be important when designing small molecule antibodies against RV.

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A Case-only Genome-Wide Association Study on Gene-Sex Interaction in Allergic Rhinitis

Publication date: Available online 5 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Afsaneh Mohammadnejad, Charlotte Brasch-Andersen, Weilong Li, Annette Haagerup, Jan Baumbach, Qihua Tan

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Targeting IgE in allergic disease

Pascal Gasser | Alexander Eggel

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Impulse oscillometry in the assessment of children's lung function

Publication date: Available online 5 July 2018

Source: Allergologia et Immunopathologia

Author(s): P.P. de Oliveira Jorge, J.H.P. de Lima, D.C. Chong e Silva, D. Medeiros, D. Solé, G.F. Wandalsen

Abstract

Purpose

To review available evidence in the literature on impulse oscillometry in the assessment of lung function in children with respiratory diseases, especially asthma.

Data collection

Research in the Medline, PubMed, and Lilacs databases, with the keywords forced oscillation, impulse oscillometry, asthma and impulse oscillometry.

Results

The Impulse Oscillometry System (IOS) allows the measurement of resistance and reactance of airways and is used as a diagnostic resource. A significant association between the findings of the IOS and those of spirometry is observed. In asthma, the IOS has already been used to assess the bronchodilator response and the therapeutic response to different drugs and has shown to be a sensitive technique to evaluate disease control. There are limitations to this assessment, such as children with attention deficit and in some cases it is difficult to interpret the results from a clinical point of view.

Conclusion

The IOS is a useful tool for the measurement of the lung function of children. It is an easy test, although its interpretation is not straightforward.

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Anaphylaxis caused by lipid transfer proteins: an unpredictable clinical syndrome

Publication date: Available online 5 July 2018

Source: Allergologia et Immunopathologia

Author(s): Inês Mota, Ângela Gaspar, Filipe Benito-Garcia, Magna Correia, Cristina Arêde, Susana Piedade, Graça Sampaio, Graça Pires, Cristina Santa-Marta, Luís-Miguel Borrego, Mário Morais-Almeida

Abstract

Introduction

Lipid transfer proteins (LTPs) are panallergens found in many plant foods. They are a common cause of food-induced anaphylaxis (FIA) in adults living in the Mediterranean area. LTPs have also been proposed as a main cause of food-dependent exercise-induced anaphylaxis (FDEIA).

Objectives

Describe clinical characteristics and allergen sensitization profiles in patients with FIA related to LTP.

Materials and Methods

Forty-three patients were included, aged 3–52 years with a clinical history of FIA and proven sensitization to LTP. Patients were tested with a multiple plant food and pollen panel and specific IgE to LTP allergens. LTP sensitization was assessed by in vivo (Pru p 3, LTP extract) and/or by in vitro tests (specific IgE, ImmunoCAP/ISAC^®).

Results

Median age of first anaphylactic episode was 24 years (range 2–51), 44% had asthma, 74% were atopic and 42% had pollinosis (olive, mugwort, plane tree, wall pellitory and cypress). Co-sensitization to profilins was found in 22%. Overall in our center, LTP-induced anaphylaxis represents 17% of all causes of FIA. Foods implicated in anaphylactic reactions were: fresh fruits 51%, tree nuts 42%, vegetables (including peanut) 40% and seeds 14%. Seven patients had FDEIA.

Conclusions

LTPs are important allergens of FIA in Portugal. Clinical reactivity to several taxonomically unrelated plant foods may raise suspicion toward LTP sensitization. The association of LTP-induced anaphylaxis with pollinosis is relevant in our country. The unpredictable clinical expression depends on the effect of cofactors such as exercise. The management of avoidance plans can be challenging due to LTP being a widely cross-reacting allergen in plant foods.

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An Integrated model of Alopecia Areata biomarkers highlights both Th1/Th2 up-regulation

Publication date: Available online 5 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Teresa Song, Ana B. Pavel, Huei-Chi Wen, Kunal Malik, Yeriel Estrada, Juana Gonzalez, Peter Hashim, John Nia, Danielle Baum, Grace Kimmel, Giselle K. Singer, James G. Krueger, Emma Guttman-Yassky

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Treating insect bite hypersensitivity (IBH) in horses by active vaccination against Interleukin-5

Publication date: Available online 5 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Albert Y. Wu, Sanjiv Sur, J. Andrew Grant

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Urinary PGDM, a prostaglandin D2 metabolite, is a novel biomarker for objectively detecting allergic reactions of food allergy

Publication date: Available online 5 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Shinichiro Inagaki, Shingo Maeda, Masami Narita, Tatsuro Nakamura, Tatsuo Shimosawa, Takahisa Murata, Yukihiro Ohya

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Outcome of domino hematopoietic stem cell transplantation in humans – an international case series

Publication date: Available online 5 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Mirjam E. Belderbos, Andrew R. Gennery, Christopher C. Dvorak, Henric-Jan Blok, Dirk-Jan Eikema, Juliana M.F. Silva, Paul Veys, Bénédicte Neven, Rebecca Buckley, Theresa Cole, Morton J. Cowan, W. Scott Goebel, Manfred Hoenig, Caroline Y. Kuo, E. Richard Stiehm, Robert Wynn, Marc Bierings, Inborn Errors Working Party of the EBMT and the PIDTC

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A Case-only Genome-Wide Association Study on Gene-Sex Interaction in Allergic Rhinitis

Allergic rhinitis (AR) is a condition with a significant impact on patient's quality of life. Sex differences in the prevalence and clinical presentation of rhinitis have been reported in multiple studies. Additionally, it has comorbidities with asthma, atopic dermatitis, rhinosinusitis, otitis media, anosmia, nasal polyps and lower airway infection. As a complex phenotype, AR is affected by both genetic and environmental factors. Recent literature has focused on difference in the genomic architecture of asthma for the two sexes by considering gene-sex interaction, whereas AR has been neglected.

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Comment on “Guidelines of care for the management of basal cell carcinoma”

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Reply to Comment on “Guidelines of Care for the Management of Basal Cell Carcinoma”

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Skin Confident: A skin health and acne educational intervention to improve Acne Quality of Life measures in adolescents

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Atypical Fibroxanthoma: Systematic Review and Meta-analysis of Treatment with Mohs Micrographic Surgery or Excision

The two treatment modalities most commonly used for AFX are wide local excision (WLE) and Mohs micrographic surgery (MMS). Mohs micrographic surgery (MMS) is associated with a lower local recurrence rate than WLE. MMS should be considered for treatment of AFX, especially in anatomically sensitive areas and in immunosuppressed patients.

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A rare case of seven siblings with Waardenburg syndrome: a case report

Waardenburg syndrome is a group of rare genetic conditions. It is determined by the absence of melanocytes from the eyes, hair, and skin. There are four types of Waardenburg syndrome with specific criteria to ...

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Bilateral septic arthritis of the sternoclavicular joint complicating infective endocarditis: a case report

Septic arthritis is an infectious disease that commonly affects weight-bearing or proximal joints such as the knee and the hip. The sternoclavicular joint is an unusual site of this entity. It usually occurs i...

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Frequency of CD4+ and CD8+ T cells in Iranian chronic rhinosinusitis patients

Chronic Rhinosinusitis (CRS) is a persistent inflammatory disease affecting paranasal sinuses. CRS is categorized into two distinct subgroups defined as CRS with nasal polyps (CRSwNP) and CRS without nasal pol...

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Anti-ADAM17 monoclonal antibody MEDI3622 increases IFNγ production by human NK cells in the presence of antibody-bound tumor cells

Abstract

Several clinically successful tumor-targeting mAbs induce NK cell effector functions. Human NK cells exclusively recognize tumor-bound IgG by the FcR CD16A (FcγRIIIA). Unlike other NK cell activating receptors, the cell surface density of CD16A can be rapidly downregulated in a cis manner by the metalloproteinase ADAM17 following NK cell stimulation in various manners. CD16A downregulation takes place in cancer patients and this may affect the efficacy of tumor-targeting mAbs. We examined the effects of MEDI3622, a human mAb and potent ADAM17 inhibitor, on NK cell activation by antibody-bound tumor cells. MEDI3622 effectively blocked ADAM17 function in NK cells and caused a marked increase in their production of IFNγ. This was observed for NK cells exposed to different tumor cell lines and therapeutic antibodies, and over a range of effector/target ratios. The augmented release of IFNγ by NK cells was reversed by a function-blocking CD16A mAb. In addition, NK92 cells, a human NK cell line that lacks endogenous FcγRs, expressing a recombinant non-cleavable version of CD16A released significantly higher levels of IFNγ than NK92 cells expressing equivalent levels of wildtype CD16A. Taken together, our data show that MEDI3622 enhances the release of IFNγ by NK cells engaging antibody-bound tumor cells by blocking the shedding of CD16A. These findings support ADAM17 as a dynamic inhibitory checkpoint of the potent activating receptor CD16A, which can be targeted by MEDI3622 to potentially increase the efficacy of anti-tumor therapeutic antibodies.

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Do Aesthetic Average Nasal Parameters Matter For Rhinoplasty in India?

Abstract

Nose morphology and facial features depend on ethnicity, gender and environmental conditions. Nasal parameters for rhinoplasty are well defined in the European and American population. Though rhinoplasty is a common cosmetic surgery in India, till now, there is no dedicated study delineating the parameters for the Indian Rhinoplasty. The aim of this study is to determine and delineate the anthropometric measurements of the Indian male and female noses and to propose the nasal parameters for Indian rhinoplasty. To determine the aesthetically pleasing nasal anthropometric parameters in Indian males and females and to put forth the parameters for Indian Rhinoplasty. This anthropometric study included a volunteer sample of 221 young, good-looking Indian males and females aged 18–25 years with Indian parents and no history of previous surgery or trauma to the nose. Standardized frontal, lateral and basal photographs of the noses along with the reference scale were taken, and 11 standard anthropometric measurements of the nose were determined. The sample size selected was such that it included representative population from the north south east and west zones of India. All the nasal measurements for the Indian women and men were found to be significantly different from the other European standards. In our study, we measured the nasal average values of the good looking, young Indian males and females and compared with the results of the nasal parameters of the other populations found in the literature. This study is the first one to propose the aesthetic average nasal parameters for corrective rhinoplasty in Indian population. Level of Evidence IV.

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Ectopic Cervical Thymus in an Infant with Normal Orthotopic Thymus: Role of Imaging in Diagnosis and Management

Abstract

Ectopic cervical thymus (ECT) is a rare cause of solid cervical mass in the pediatric age group. The location of the mass along the path of thymic descent (thymopharyngeal duct), sonographic echo pattern and MR signal intensity identical to that of normal orthotopic thymus in the anterior mediastinum help us in making a confident diagnosis. To the best of our knowledge only nine cases have been reported in infants in the literature. We present a case of ECT presenting as a right upper neck mass in a 2 month old child.

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Comparing the Establishment of Operation Space Between High Position and Low Position in Endoscopic Thyroid Surgery

Conditions:   Thyroid Cancer;   Endoscopy
Interventions:   Procedure: high position space group;   Procedure: low position space group
Sponsor:   Fujian Medical University
Recruiting

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Laryngeal chondrosarcoma

Norman J. Chan, MD; Christopher Fundakowski, MD; Ahmed M.S. Soliman, MD

About 80% of laryngeal chondrosarcomas have calcifications that can be seen on CT, but MRI can help to determine extralaryngeal extension.

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Antibiotics, steroids, and combination therapy in chronic rhinosinusitis without nasal polyps in adults

Yuan F. Liu, MD; Clare M. Richardson, MD; Stewart H. Bernard, MD; Christopher A. Church, MD; Kristin A. Seiberling, MD

Abstract

Despite a lack of robust data regarding their efficacy, oral antibiotics and steroids remain two of the most common treatments for chronic rhinosinusitis without nasal polyps (CRSsNP). We sought to objectively compare the efficacy of antibiotics and steroids, independently and in combination, for the initial treatment of CRSsNP. To that end, we conducted a retrospective chart review of 100 patients-51 men and 49 women, age 20 to 85 years (mean: 50)-who were treated for CRSsNP from January 2010 through January 2015. Of this group, 17 patients were treated with an antibiotic only, 28 with a steroid only, and 55 with both agents. All patients underwent computed tomography (CT) before and after treatment, and we compared the three groups' pre- and post-treatment Lund-Mackay CT scores, symptom scores, and rates of surgery. The average time between the pre- and post-treatment visits was 4.4 weeks. The mean Lund-Mackay CT score for the entire study population was significantly lower after treatment than at baseline (6.3 vs. 9.1; p < 0.001); however, there were no significant differences among the three groups in either pre- or post-treatment scores. Symptom scores were significantly better in the combination therapy group than in the two monotherapy groups (p < 0.001). In all, 40 of the 100 patients underwent surgery; the difference in surgery rates among the three groups was not statistically significant (p = 0.884). Surgery was performed on 9 of the 52 (17.3%) patients who either were followed for at least 1 year or who had had surgery within the first year postoperatively; again, there were no significant differences among the three groups (p = 0.578). We conclude that although the Lund-Mackay CT scores decreased significantly in the antibiotic, steroid, and combination therapy groups, no one regimen was superior to any other for treating CRSsNP in our study.

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Hemifacial spasm secondary to middle ear cholesteatoma

Maheep Sohal, MD; Nicholas Karter, MD; Marc Eisen, MD, PhD

Abstract

Hemifacial spasm is a peripheral myoclonus of the VIIth cranial nerve that is characterized by paroxysmal contraction of the muscles of facial expression. It exists in both primary and secondary forms. In rare cases, hemifacial spasm is caused by middle ear pathology. We describe the case of a 90-year-old man with recurrent cholesteatoma and tympanic segment fallopian canal dehiscence manifesting as right-sided hemifacial spasm. His history was significant for a right-sided tympanomastoidectomy for cholesteatoma 6 years earlier. Computed tomographic angiography performed to look for vascular compression of the facial nerve demonstrated a right middle ear opacification. Middle ear exploration revealed a completely dehiscent tympanic segment with cholesteatoma abutting the facial nerve. The overlying keratin debris and matrix were carefully dissected off, and facial nerve function was preserved. The final diagnosis was hemifacial spasm. During 14 months of postoperative follow-up, the patient experienced no further facial spasm.

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Histopathologic evaluation of Ecballium elaterium applied to nasal mucosa in a rat rhinosinusitis model

Can Mehmet Eti, MD; Yusuf Vayisoglu, MD; Berkan Kardas, MD; Rabia Bozdogan Arpaci, MD; Elif Sahin Horasan, MD; Arzu Kanik, PhD; Neslihan Eti, MD; Serap Yalin, BScPhm; Derya Umit Talas, MD

Abstract

This study aimed to evaluate the antimicrobial effects of the medicinal plant Ecballium elaterium, which is topically applied as a traditional medicine for the treatment of rhinosinusitis. Pure and extract forms of E elaterium were applied to the nasal cavity of rats for the treatment of Streptococcus-pneumoniae -induced rhinosinusitis. The nasal mucosa, soft palate, and trachea of the rats were harvested in the first hour, third day, and third week for histopathologic evaluation. This experiment revealed the anti-inflammatory effects of E elaterium and showed that it reduced fibrosis. The anti-inflammatory effect of all forms of E elaterium was found to reach its maximum level on the third day, decreasing by the third week. We also observed that the pure form of E elaterium caused severe epithelium loss in the first hour after application. The mechanism of the anti-inflammatory effect of different levels of extract forms needs to be further analyzed with different doses and duration of treatment.

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Balloon eustachian tuboplasty and the tragedy of the commons

Brian J. McKinnon, MD, MBA, MPH, FACS

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Intradermal nevus of external auditory canal revisited

Pei-Hsuan Wu, MD; Hsin-Chien Chen, MD, PhD

Intradermal nevus, a subtype of melanocytic nevus, occurs relatively rarely in the external auditory canal.

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An inverted papilloma arising from the middle turbinate and extending to the maxillary sinus ostium

Jae Hoon Lee, MD

Inverted papillomas have been reported to have a high propensity for recurrence, and they are associated with squamous cell carcinoma.

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The incidence of revision adenoidectomy: A comparison of four surgical techniques over a 10-year period

Nipun Bhandari, MPH; Debra M. Don, MD; Jeffrey A. Koempel, MD, MBA

Abstract

Approximately 130,000 adenoidectomies are performed each year in the United States. Few studies have examined adenoid regrowth and the incidence of revision surgery or have compared four different surgical instruments commonly used for adenoid surgery within the same institution. This study aimed to determine the incidence of revision adenoidectomy after the use of microdebrider, Coblation, suction cautery, and curette instruments over a 10-year period at a single major tertiary children's center in the United States. A retrospective chart review was performed for all patients who underwent primary and/or revision adenoidectomy at the Children's Hospital Los Angeles (CHLA) between August 2004 and August 2014. During the 10-year study period, a microdebrider was used in 212 cases, Coblation in 382, suction cautery in 1,926, and curette in 3,139 adenoidectomies. The percentages of revision adenoidectomy were 1.42% (3 patients) for microdebrider, 0.79% (3 patients) for Coblation, 0.36% (7 patients) for suction cautery, and 0.03% (1 patient) for curette. The cumulative incidence of revision adenoidectomy for initial surgeries performed at CHLA was 0.2% for the 10-year study period. Pearson chi-square analysis showed statistically significant differences between the surgical techniques (p < 0.0001). In conclusion, regrowth of adenoid tissue requiring revision surgery occurs very infrequently irrespective of the instrument used for the primary procedure, and the most common indication for revision adenoidectomy is to improve eustachian tube dysfunction rather than nasal obstruction due to adenoid hypertrophy.

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Low-grade sinonasal sarcoma with neural and myogenic features

Neil G. Hockstein, MD; Peter E. Dross, MD; Shoheb Farooqui, MD; Ian N. Wilhelm, MD

The distinction between bony destruction versus erosion is important because they suggest different pathologic entities.

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Endoscopic surgery for primary sinonasal malignancies: Treatment outcomes and prognostic factors

Yan Huang, MD; Qian-hui Qiu, MD, PhD; Shui-xing Zhang, MD, PhD

Abstract

We retrospectively reviewed the cases of 85 patients with primary sinonasal malignancies who had undergone endoscopic surgery with curative intent achieved by "regional resection." Our goal was to assess the efficacy of endoscopic surgical treatment vis-à-vis traditional open surgery. Kaplan-Meier data analysis revealed that the 1-, 3-, and 5-year disease-specific survival rates were 82, 60, and 49%, respectively. Multivariate Cox model survival analysis revealed that male sex, certain pathologic types of cancer (i.e., undifferentiated carcinoma, olfactory neuroblastoma, and rhabdomyosarcoma), and T3/T4 category negatively impacted survival (adjusted hazard ratios: 3.601, 0.012, 0.287, 0.068, and 0.339, respectively; p < 0.05 for all). We also performed a separate analysis of 47 patients who had category T3 or T4 cancer to determine if the type of surgical approach is a prognostic factor. For this, we identified 20 new patients who had undergone open resection, and we compared them to 27 of our endoscopically treated patients who had similar clinical characteristics. We found that the type of surgical approach did not appear to be a prognostic factor (p > 0.10), although those patients who had undergone endoscopic resection had significantly shorter hospital stays (p < 0.001). We conclude that patients with primary sinonasal malignancies who are treated with endoscopic surgery have acceptable survival rates and therefore endoscopic surgery is justified in the hands of highly experienced surgeons in selected cases.

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Ultrasound-guided left lateral transversus abdominis plane block combined with rectus sheath block in peritoneal dialysis catheter placement

Abstract

This study assessed the utility of ultrasound-guided lateral transversus abdominis plane (TAP) block combined with rectus sheath (RS) block for peritoneal dialysis catheter placement surgery. Thirty consecutive patients with end-stage renal disease scheduled to have peritoneal dialysis catheter placement received a left lateral TAP block combined with RS block performed under ultrasound guidance. The TAP and RS blocks were, respectively, conducted with 15 ml of 0.5% ropivacaine and 10 ml of 0.5% ropivacaine. Pain intensity was evaluated by verbal rating scale during operation, and the degree of patient and surgeon satisfaction was qualified by a categorical scale. Twenty-nine patients received successful blocks without any other adjuvant anesthetic drugs. One patient required rescue analgesia with lidocaine infiltration. No complications related to regional anesthesia were noted. Ultrasound-guided left lateral TAP block combined with RS block can serve as the primary anesthetic modality for peritoneal dialysis catheter placement surgery.

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Close Margins and Adjuvant Radiotherapy in Acinic Cell Carcinoma of the Parotid Gland

This case series evaluates the oncologic outcomes of patients with acinic cell carcinoma of the parotid gland and the results of adjuvant therapy for those with close (≤1-mm) margins.

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Multiple-Flap Reconstruction of Head and Neck Defects

The goals of head and neck reconstruction of cancer-related defects are to restore speech, swallowing, and cosmesis and maximize patient quality of life. During the past 2 decades, our ability to achieve these goals with free, pedicled, and local tissue transfer alone or in combination has steadily improved. The reconstructive surgeon now has a robust armamentarium with an array of tissue choices, including bone, muscle, viscera, skin (thick, thin, hair bearing, and color match to facial skin). In addition, there has been an expansion of recipient vessels, which allows an increased range of options for patients in whom prior therapy has failed and who present for head and neck reconstruction. These advances have changed the way that we think about the various components of the head and neck and increased the number of creative choices to restore form and function and minimize morbidity.

https://ift.tt/2KLem6S

Trend Toward the Use of Transcutaneous Osseointegrated Hearing Devices in Pediatric Patients

Transcutaneous osseointegrated hearing implants, instead of percutaneous implants, are increasingly becoming the choice of surgeons when considering osseointegrated hearing aids in children. Transcutaneous implants use a magnet under the skin coupled with a magnet on the processor, whereas percutaneous implants have an abutment through the skin to which the processor connects. For aural atresia and maximum conductive hearing loss, surgeons and patients have multiple options for hearing rehabilitation, including canalplasty and an osseointegrated hearing aid. Pediatric otolaryngologists seem to be choosing the transcutaneous devices because they present fewer complications and less wound care, which is better tolerated by pediatric patients. Most studies into osseointegrated hearing aids have focused on adult outcomes, and data in the pediatric population are lacking, especially information related to newer transcutaneous, rather than percutaneous, devices. Previous studies have shown a complication rate of more than 50% for pediatric patients with percutaneous implants, with most of the complications related to soft-tissue infections or growth. These studies have shown high rates of parental satisfaction with percutaneous devices but low compliance rates, indicating that satisfaction scores may be misleading.

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Transcutaneous Osseointegrated Implants for Pediatric Patients With Atresia

This case series describes the processes, advantages, and outcomes of transcutaneous osseointegrated implantation for pediatric patients with aural atresia.

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Outcomes in Head and Neck Resections That Require Multiple-Flap Reconstructions

This systematic review characterizes the outcomes of large-scale head and neck resections that require multiple-flap reconstructions.

https://ift.tt/2IUIMyE

Analysis of dysphagia in advanced-stage head-and-neck cancer patients: impact on quality of life and development of a preventive swallowing treatment

Abstract

Objectives

Swallowing and voice dysfunctions are common side effects following head-and-neck squamous-cell carcinoma (HNSCC) treatment. Our aim was to analyze the relationships between quality of life, swallowing, and phonatory problems in patients with an advanced-stage HNSCC and to prospectively evaluate the effects of a prophylactic swallowing program.

Methods

First, we retrospectively studied 60 advanced HNSCC patients treated with exclusive or adjuvant radiotherapy/chemoradiotherapy (RT/CRT). Subjects were classified according to general and clinical–therapeutic features. Outcome measures included EORTC QLQ-C30, EORTC QLQ-H&N35, Dysphagia Handicap Index (DHI), M.D.Anderson Dysphagia Inventory (MDADI), and Voice Handicap Index (VHI). Then, we conducted a prospective evaluation of a prophylactic swallowing counselling in 12 consecutive advanced-stage HNSCC patients by a two-arm case–control analysis. These patients were treated with exclusive or adjuvant RT/CRT.

Results

71% of the retrospective population studied reported swallowing dysfunction as a major side effect. No differences were detected in the severity of dysphagia or dysphonia according to type of treatment or staging of the primary tumour, while hypopharyngeal and laryngeal cancer patients showed significantly better swallowing ability and better QoL compared to oral cavity and oropharyngeal localisation (p < 0.05). In addition, a relevant correlation between swallowing and voice problems emerged (p < 0.05). In the prospective part, while no statistical correlation was evident before the start of RT/CRT in the experimental group compared to the control one, the former showed better performances at MDADI (p = 0.006) and DHI (p = 0.002) test 3 months after its end.

Conclusion

Dysphagia is both an acute-and-long-term side effect which greatly affects QoL of HNSCC patients undergoing multimodality treatment. Our data show that a prophylactic swallowing program could actually produce a beneficial effect on patients' outcomes.

Level of evidence

1b and 2b.

https://ift.tt/2lUtYXv

Eficacia de las maniobras de reposicionamiento canalicular en el vértigo posicional paroxístico benigno: revisión de 176 casos tratados en un centro hospitalario de tercer nivel

Publication date: July–August 2018

Source: Acta Otorrinolaringológica Española, Volume 69, Issue 4

Author(s): Claudio Carnevale, Diego J. Arancibia-Tagle, Elena Rizzo-Riera, Guillermo Til-Perez, Pedro L. Sarría-Echegaray, Julio J. Rama-Lopez, Santiago Quer-Canut, German Fermin-Gamero, Manuel D. Tomas-Barberan

Resumen

Introducción y objetivos

El vértigo posicional paroxístico benigno es la entidad más frecuente dentro de los vértigos de origen periférico. El objetivo del siguiente trabajo es revisar los resultados obtenidos con las diferentes maniobras de reposicionamiento canalicular específicas para cada tipo de canal semicircular afectado, evaluando posibles factores de riesgo relacionados con un peor pronóstico.

Métodos

Se han revisado retrospectivamente 176 pacientes diagnosticados de vértigo posicional paroxístico benigno en nuestro centro, de los cuales 150 tenían vértigo del canal semicircular posterior, 20 del horizontal, 3 del superior y 3 multicanal. Se ha usado la maniobra de Epley para el tratamiento del canal posterior y del superior y la maniobra de Lempert para el tratamiento del horizontal. En los casos refractarios se ha realizado siempre un estudio de imagen cerebral con resonancia.

Resultados

La maniobra de Epley ha mostrado una eficacia al primer intento del 74,6% para el canal posterior y del 100% para el superior. La eficacia de la maniobra de Lempert para el canal horizontal ha sido del 72,72% en los casos de canalolitiasis y del 58,33% en los de cupulolitiasis. Más complicado ha sido el tratamiento de los pacientes con más de un canal afectado y con antecedente quirúrgico en el mes previo.

Conclusiones

Las maniobras de reposicionamiento canalicular permiten alcanzar una tasa de éxito muy alta, obteniendo mejores resultados en el tratamiento del canal posterior. Hacen falta más estudios para confirmar la sospecha de que la cirugía previa pueda ser un factor de peor pronóstico.

Abstract

Introduction and objectives

Benign paroxysmal positional vertigo is the most common peripheral vertigo disease. The aim of this paper is to review the results obtained with the different specific particle repositioning manoeuvres, evaluating the possible risk factors linked to a poorer prognosis.

Methods

One hundred and seventy-six patients with a diagnosis of benign paroxysmal positional vertigo were reviewed retrospectively, of whom 150 had vertigo of the posterior canal, 20 had vertigo of the horizontal canal, 3 had vertigo of the superior canal, and 3 had a double vertigo. The Epley manoeuvre was used to treat the posterior and superior canals, and Lempert manoeuvre was used to treat the horizontal canal. An imaging study by nuclear magnetic resonance with gadolin was always used in refractory cases.

Results

The Epley manoeuvre showed an efficacy of 74.6 and 100% at first attempt for posterior and superior canals respectively. The efficacy of the Lempert manoeuvre for the horizontal canal was 72.72% in the patients with canalolithiasis, and 58.33% in the patients with cupulolithiasis. The treatment of patients with more than one affected canal and a history of surgery in the previous month was more difficult.

Conclusions

Particle repositioning manoeuvres show a very high success rate, allowing better results in the treatment of the posterior canal. We need more studies to confirm the suspicion that surgery may be a factor of poorer prognosis.

https://ift.tt/2MMR5if

Predictors of locoregional recurrence in early stage buccal cancer with pathologically clear surgical margins and negative neck

Publication date: July–August 2018

Source: Acta Otorrinolaringológica Española, Volume 69, Issue 4

Author(s): Shakeel Uz Zaman, Shakil Aqil, Mohammad Ahsan Sulaiman

Abstract

Objective

To identify the significant predictors of locoregional recurrence in early stage squamous cell carcinoma (SCC) of buccal mucosa with pathologically clear surgical margins and negative neck.

Method

Seventy-three patients who underwent per oral wide excision and supraomohyoid neck dissection for early stage buccal SCC with clear surgical margins (>5 mm margins each) and negative neck (N0) were included. None of the patients received postoperative radiotherapy or chemotherapy. Univariate and multivariate analyses were used to identify independent predictors of locoregional recurrence.

Results

Recurrence was observed in 22 of 73 (30%) cases. Twelve had local, seven had regional and three developed locoregional recurrences. Both univariate and multivariate analyses demonstrated that lymphovascular invasion (LVI) and non-T4 muscular invasion (non-T4MI) were independent predictors affecting locoregional control.

Conclusion

Lymphovascular invasion (LVI) and non-T4 muscular invasion (non-T4MI) significantly increased the locoregional recurrence rate in early stage buccal SCC with clear surgical margins and negative nodal status. Adjuvant treatment with either radiation or chemoradiation should be considered when one or both of these factors present.

Resumen

Objetivo

Identificar los predictores significativos de recidiva locorregional en el carcinoma de células escamosas (CCS) en estadios iniciales de la mucosa buccal, con los márgenes quirúrgicos patológico libres y el cuello negativo.

Método

Se incluyeron en el estudio 73 pacientes sometidos a extirpación tumoral y disección supraomoioidea de cuello con cáncer bucal en estadios iniciales con márgenes quirúrgicos libres (margen de 5 mm cada uno) y cuello negativo (N0). Ninguno de los pacientes recibió radioterapia postoperatoria o quimioterapia. Se utilizaron análisis univariantes y multivariantes para identificar los factores predictivos independientes de recidiva locorregional.

Resultados

La recidiva se observó en 22 de 73 casos (30%). Doce tenían recidivas locales, 7 regionales y 3 desarrollaron recidivas locorregionales. Tanto los análisis univariantes como multivariantes demostraron que la invasión linfovascular (LVI) y la invasión muscular no T4 (non-T4MI) fueron predictores independientes que afectaron al control locorregional.

Conclusión

La LVI y la non-T4MI aumentaron significativamente la tasa de recurrencia locorregional en el CCS bucal precoz con márgenes quirúrgicos libres y estado nodal negativo. El tratamiento adyuvante con radiación o quimiorradiación debe considerarse cuando se presentan uno o ambos de estos factores.

https://ift.tt/2MSpDjf

Análisis de supervivencia libre de recaída audiométrica en pacientes con hipoacusia inmunomediada tratados exclusivamente con corticoides

Publication date: July–August 2018

Source: Acta Otorrinolaringológica Española, Volume 69, Issue 4

Author(s): Nieves Mata-Castro, Raimon García-Chilleron, Javier Gavilanes-Plasencia, Rafael Ramírez-Camacho, Alfredo García-Fernández, José Ramón García-Berrocal

Resumen

Objetivo

Describir los resultados en términos de supervivencia libre de recaída audiométrica y el ritmo de recaída en pacientes con hipoacusia inmunomediada tratados exclusivamente con corticoides.

Método

Estudio retrospectivo de pacientes, con recaídas audiométricas, en seguimiento desde 1995 hasta 2014, en 2 centros de la Comunidad de Madrid.

Resultados

Se evaluaron 31 pacientes con una media de edad de 48,52 años (14,67 DE) de los cuales el 61,3% fueron mujeres. La mayoría de las hipoacusias fueron fluctuantes (48,4%). Solo el 16,1% de los pacientes presentaban enfermedad autoinmune sistémica. Existe una correlación positiva moderada entre ser mujer y presentar afectación sistémica (coeficiente de correlación de Spearman = 0,356). La tasa relativa de incidencia de recaída en el primer año en nuestra serie fue de 2,01 recaídas/año con un IC95% (1,32-2,92). El tiempo de supervivencia medio del evento (recaída audiométrica) fue de 5,25 meses (DE 0,756). Con el análisis multivariante, la única variable que consiguió significación estadística fue la edad, con una hazard ratio de 1,032 (IC95%; 1,001-1,063, p = 0,043)

Conclusiones

La enfermedad inmunomediada del oído interno es una enfermedad crónica con recaídas. La mitad de los pacientes tratados exclusivamente con corticoides recaen antes de los 6 meses de seguimiento. Además, si un paciente no ha presentado recaída, tiene más riesgo de recaer cada año que pasa. El análisis de la supervivencia libre de recaída audiométrica permitirá comparar el efecto de tratamientos futuros y su capacidad para reducir el ritmo de recaídas.

Abstract

Objective

To describe the results in terms of audiometric relapse-free survival and relapse rate in immunomediated hearing loss patients treated exclusively with corticosteroids.

Method

Retrospective study of patients with audiometric relapses, monitored from 1995 to 2014, in two centres of the Community of Madrid.

Results

We evaluated 31 patients with a mean age of 48.52 years (14.67 SD), of which 61.3% were women. Most hearing loss was fluctuating (48.4%). Only 16.1% of patients had systemic autoimmune disease. There is a moderate positive correlation between the sex variable and the systemic involvement variable (Spearman's correlation coefficient = 0.356): specifically, between being female and systemic disease. The relative incidence rate of relapse in the first year was 2.01 relapses/year with a 95% CI (1.32 to 2.92). The mean survival time of the event (audiometric relapse) was 5.25 months (SD 0.756). With multivariate analysis, the only variable that achieved statistical significance was age, with a hazard ratio of 1.032 (95% CI; 1.001-1.063, P = .043).

Conclusions

Immune-mediated disease of the inner ear is a chronic disease with relapses. Half of the patients with immunomediated hearing loss treated exclusively with corticosteroids relapse before 6 months of follow-up. In addition, if a patient has not relapsed, they are more likely to relapse as each year passes. Analysis of the of audiometric relapse- free survival will enable the effect of future treatments to be compared and their capacity to reduce the rhythm of relapses.

https://ift.tt/2u8IAWV

Recomendaciones sobre el uso de la neuromonitorización en cirugía de tiroides y paratiroides

Publication date: July–August 2018

Source: Acta Otorrinolaringológica Española, Volume 69, Issue 4

Author(s): José Luis Pardal-Refoyo, Pablo Parente-Arias, Marta María Arroyo-Domingo, Juan Manuel Maza-Solano, José Granell-Navarro, Jesús María Martínez-Salazar, Ramón Moreno-Luna, Elvylins Vargas-Yglesias

Resumen

Introducción

La cirugía de tiroides y paratiroides (CTPT) se asocia a riesgo de lesión del nervio laríngeo recurrente, nervio laríngeo superior y cambios en la voz. La neuromonitorización intraoperatoria (NMIO), intermitente o continua, en CTPT evalúa el estado funcional de los nervios laríngeos y se utiliza progresivamente con más frecuencia. Esto obliga a adoptar puntos de acuerdo en los aspectos más controvertidos.

Objetivo

Elaborar un documento de ayuda para orientar en la utilización de la NMIO en CTPT.

Método

Consenso en grupo de trabajo mediante revisión sistemática y método Delphi.

Resultados

Se identificaron 7 secciones sobre las que se establecieron puntos de acuerdo: indicaciones, equipo, técnica (parámetros de programación y registro), conducta en pérdida de señal, laringoscopia, voz e implicaciones legales.

Conclusiones

La NMIO ayuda en la localización e identificación del nervio laríngeo recurrente, ayuda durante su disección, informa sobre su estado funcional al finalizar la cirugía y permite tomar decisiones en caso de pérdida de señal en el primer lado operado en una tiroidectomía bilateral programada o si había parálisis contralateral previa. La precisión de la NMIO depende de variables como la técnica realizada, la tecnología utilizada y la formación para la correcta ejecución de la técnica e interpretación de la señal. El documento presentado es un punto de inicio para futuros acuerdos en CTPT en cada una de las secciones de consenso.

Abstract

Introduction

Thyroid and parathyroid surgery (TPTS) is associated with risk of injury to the recurrent laryngeal nerve, superior laryngeal nerve and voice changes. Intraoperative neuromonitoring (IONM), intermittent or continuous, evaluates the functional state of the laryngeal nerves and is being increasingly used. This means that points of consensus on the most controversial aspects are necessary.

Objective

To develop a support document for guidance on the use of IONM in TPTS.

Method

Work group consensus through systematic review and the Delphi method.

Results

Seven sections were identified on which points of consensus were identified: indications, equipment, technique (programming and registration parameters), behaviour on loss of signal, laryngoscopy, voice and legal implications.

Conclusions

IONM helps in the location and identification of the recurrent laryngeal nerve, helps during its dissection, reports on its functional status at the end of surgery and enables decision-making in the event of loss of signal in the first operated side in a scheduled bilateral thyroidectomy or previous contralateral paralysis. The accuracy of IONM depends on variables such as accomplished technique, technology and training in the correct execution of the technique and interpretation of the signal. This document is a starting point for future agreements on TPTS in each of the sections of consensus.

https://ift.tt/2zdIFP1

Evaluación de la capacidad formativa del libro del residente de Otorrinolaringología español (FORMIR) como portafolio electrónico

Publication date: July–August 2018

Source: Acta Otorrinolaringológica Española, Volume 69, Issue 4

Author(s): Juan Manuel Maza Solano, Gustavo Benavente Bermudo, Francisco José Estrada Molina, Jesús Ambrosiani Fernández, Serafín Sánchez Gómez

Resumen

Introducción y objetivos

Evaluar la capacidad formativa del libro del residente español como portafolio electrónico para alcanzar los objetivos de aprendizaje de los MIR de Otorrinolaringología (ORL).

Métodos

Se realizó una investigación cualitativa multimétodo de características tranversal, temporal y de orientación retrospectiva sobre los MIR de ORL mediante un cuestionario estructurado y una entrevista semiestructurada, sobre la aplicación informática web FORMIR.

Resultados

Participaron el 56,5% de los MIR de ORL de alguno de los 63 hospitales españoles acreditados para impartir formación en ORL entre 2009 y 2012. Los resultados obtenidos demostraron que los MIR de ORL que utilizaban el portafolio electrónico eran capaces de autoguiar mejor su aprendizaje, conocían mejor sus objetivos de aprendizaje, cumplían más eficientemente el programa de formación, identificaban más claramente las causas de sus carencias en el aprendizaje y consideraban que FORMIR como portafolio electrónico constituía una herramienta formativa idónea para sustituir al libro del residente en formato papel.

Conclusiones

Los MIR de ORL apreciaban de forma muy relevante las prestaciones formativas de FORMIR como portafolio electrónico, especialmente su interfaz, el feedback numérico y automático sobre la adquisición de competencias, su capacidad de almacenamiento de evidencias y su capacidad de visualizarse como logbook de la Unión Europea de Médicos Especialistas o como un curriculum vitae estándar. Este feedback automático facilita el aprendizaje autoguiado. Todo esto hace de FORMIR una herramienta formativa y evaluativa que supera las prestaciones y aceptación de instrumentos similares puestos a disposición de los residentes, que no dudan en proponerlo como el libro del residente más idóneo para facilitar su formación especializada.

Abstract

Background

and objectives We have evaluated the training capacity of the Spanish resident training book as an electronic portfolio to achieve the learning objectives of otorhinolaryngology (ENT) residents.

Methods

A multi-method qualitative investigation with transversal characteristics, temporal and retrospective guidance was performed on Spanish ENT residents using a structured questionnaire, a semi-structured interview, and a computer application on the FORMIR website.

Results

A 56.5% of ENT-residents specialising in one of the 63 accredited Spanish hospitals between 2009-2012 participated in the study. The results obtained show that the ENT residents who used the e-portfolio were better able to implement self-guided study, were more aware of their learning objectives, fulfilled the training programme more efficiently, identified the causes of learning gaps more clearly, and considered FORMIR in e-portfolio format to be an ideal training tool to replace the resident training book in paper format.

Conclusions

The ENT residents greatly appreciated the training benefits of FORMIR as an e-portfolio, especially its simple and intuitive interface, the ease and comfort with which they could record their activities, the automatic and numeric feedback on the acquisition of their competencies (which facilitates self-guided learning), its storage capacity for evidence, and its ability to be used as UEMS logbook as well as a standard curriculum vitae. All these features make FORMIR a training and evaluation tool that outperforms similar instruments available to ENT residents. They do not hesitate to identify it as the ideal resident training book for facilitating their specialised training.

https://ift.tt/2MRaqPv

Primary tuberculosis of the nasal septum: The non-ulcerated form presenting as septal thickening

Publication date: July–August 2018

Source: Acta Otorrinolaringológica Española, Volume 69, Issue 4

Author(s): Neeraj Aggarwal, Mainak Dutta, Ramanuj Sinha

https://ift.tt/2Ns7ABr

Recidiva de carcinoma nasosinusal relacionado con el virus del papiloma humano con características similares al adenoide quístico

Publication date: Available online 22 June 2018

Source: Acta Otorrinolaringológica Española

Author(s): Andrés Felipe Sáenz González, Eduardo Morera Serna, Adriana Marcela Quintero Duarte, Rafael Ramos Asensio

https://ift.tt/2MOrENq

Crisis epiléptica por neumoencéfalo como primera manifestación de un osteoma etmoido-frontal

Publication date: Available online 14 June 2018

Source: Acta Otorrinolaringológica Española

Author(s): Raquel Solavera, Martín Marcano, Marta Faubel, Miguel Armengot

https://ift.tt/2Kz7sSS

Manejo del absceso de la glándula tiroides

Publication date: Available online 9 June 2018

Source: Acta Otorrinolaringológica Española

Author(s): Javier García Callejo, Jaume Redondo Martínez, Miguel Civera, José Verdú Colomina, Verónica Pellicer Zoghbi, M. Paz Martínez Beneyto

Resumen

Introducción

La enfermedad supurativa de la glándula tiroides-absceso de tiroides o tiroiditis supurativa aguda– supone una infrecuente situación clínica. Presentamos nuestra experiencia en los casos asistidos durante 41 años.

Materiales y métodos

Estudio longitudinal retrospectivo anotando características epidemiológicas, conducta diagnóstico-terapéutica y resultado clínico, detectando 14 casos –9 varones y 5 mujeres, entre 19 y 68 años, con una media de edad de 40,6 ± 15,4 años– con 22 episodios. En 2 pacientes la condición se había reproducido hasta en 4 ocasiones.

Resultados

Supusieron el 0,29% de todos los abscesos cervicales atendidos. La punción-aspiración fue efectuada en 13 de ellos para su tratamiento e identificación del agente causal. Los agentes más habitualmente implicados fueron Mycobacterium tuberculosis y Staphylococcus aureus. Se realizó un estudio de imagen mediante ecografía en 9 casos y de tomografía computarizada en 7. En 10 pacientes el tratamiento definitivo fue quirúrgico, efectuándose drenaje del absceso en 7 de ellos, tiroidectomía total en 4 y hemitiroidectomía en 2. Otros tratamientos admitidos fueron la antibioterapia sistémica o mediante irrigación intralesional y la esclerosis. Aunque en un caso la fase aguda comenzó con hipertiroidismo y tirotoxicosis, a los 6 meses del alta existió hipotiroidismo definitivo en 5 casos. Las opciones terapéuticas adoptadas consiguieron la curación en el 100% de los casos.

Conclusión

La supuración de la glándula tiroidea es una circunstancia extremadamente rara en el contexto de la enfermedad cervical, variando las opciones terapéuticas desde alternativas conservadoras al drenaje con tiroidectomía según los hallazgos microbiológicos y radiológicos.

Abstract

Background

Thyroid abscess or acute suppurative thyroiditis is an unusual clinical condition. We present our experience with cases attended over 41 years.

Materials and methods

A retrospective study was performed on these patients reviewing their epidemiological characteristics and the diagnostic and therapeutic manoeuvres chosen for them all, as well as their clinical outcome. A group of 9 males and 5 females was studied, with ages ranging from 19 to 68 (mean of 40.6 ± 15.4). These patients suffered 22 acute episodes, and 2 patients each had 4 episodes.

Results

Suppurative thyroiditis comprised 0.29% of the neck abscesses. Fine needle aspiration was performed in 13 cases to evacuate the collection and isolate the aetiological agent. Mycobacterium tuberculosis and Staphylococcus aureus were the most frequently identified. Nine patients underwent ultrasound and 7 computed tomography imaging studies. Surgery was the option for 10 patients, including drainage for 7, thyroidectomy for 4 and hemithyroidectomy for the remaining 2. Systemic or intralesional antibiotics and sclerosis of the gland were also carried out. Although one case presented with hyperthyroidism and thyrotoxicosis in the acute phase, definitive hypothyroidism was observed in 5 patients at 6 months following discharge. The rate of success was 100%.

Conclusion

Thyroid gland suppuration is a very infrequent circumstance in neck pathology, and the options for its treatment are varied, from conservative to invasive techniques according to the microbial and radiologic findings.

https://ift.tt/2u73d5W

Estudio del daño otolítico en pacientes con vértigo posicional paroxístico benigno mediante potenciales vestibulares miogénicos evocados

Publication date: Available online 9 June 2018

Source: Acta Otorrinolaringológica Española

Author(s): Paula Martínez Pascual, Pedro Amaro Merino

Resumen

Introducción

La fisiopatología del vértigo posicional paroxístico benigno (VPPB) se explica por la migración de otoconias de la mácula del utrículo a los canales semicirculares; no obstante, el papel del sáculo en esta entidad continúa en estudio. Nuestro objetivo es estudiar el daño otolítico en estos pacientes con potenciales vestibulares miogénicos evocados (VEMP) y relacionarlo con los resultados de la posturografía dinámica computarizada (PDC).

Material y métodos

Presentamos 79 pacientes diagnosticados de VPPB de manera consecutiva entre marzo y junio de 2017 a quienes se les realizó un estudio con VEMP oculares y cervicales y PDC. Seleccionamos los 67 pacientes con VPPB del canal semicircular posterior y los comparamos con un grupo control de 60 pacientes.

Resultados

Los pacientes con VPPB presentaron VEMP cervicales alterados en el 49,25% de los casos, frente al 16,67% en el grupo control. La alteración en VEMP oculares fue del 61,19% en el grupo de VPPB, frente al 6,67% en el grupo control. La prevalencia de VEMP oculares anormales en pacientes con VPPB recurrentes fue estadísticamente significativa. No se halló correlación significativa con los resultados alterados de la PDC.

Conclusiones

La disfunción sacular y utricular en los pacientes con VPPB medida mediante VEMP es mayor que en la población sana. Esta alteración puede estar relacionada con la inestabilidad residual que a veces experimentan estos pacientes.

Abstract

Introduction

Benign paroxysmal positional vertigo (BPPV) pathophysiology is based on otoconia migration from the utricle and saccule to the semicircular canals, however, the role of the saccule is still under study. Our aim is to study the otolith damage in these patients with vestibular evoked myogenic potentials (VEMPS) and correlate the results with those of computerised dynamic posturography (CDP).

Material and methods

We present 79 patients diagnosed with BPPV between March and June 2017. VEMPS and CDP studies were performed. We selected 67 patients with posterior semi-circular canal BPPV and we compared them with 60 healthy subjects.

Results

BPPV group had abnormal cervical VEMPS in 49.25% of patients compared to 16.67% in the control group. Ocular VEMPS were altered in 61.19% of the patients and 6.67% of the healthy subjects. Abnormal ocular VEMPS in patients with recurrent BPPV was statistically significant. There was no significant correlation with CDP results.

Conclusions

Utricular and saccular dysfunction in BPPV patients proved by VEMPS is higher than in healthy individuals. This result may be related to symptoms of instability experienced by these patients occasionally.

https://ift.tt/2KHQ9yr

Immediate effects of a rhino-pharyngeal clearance protocol in nasal obstruction and middle ear condition of children under 3 years of age with upper respiratory infections: A randomized controlled trial

Publication date: Available online 8 June 2018

Source: Acta Otorrinolaringológica Española

Author(s): Ana Silva Alexandrino, Rita Santos, Cristina Melo, David Tomé, José Mesquita Bastos, Guy Postiaux

Abstract

Introduction and objectives

Children up to 2 years old are at high risk of respiratory infections and nasal irrigation is often prescribed. Yet, to date there is no sufficient knowledge about its immediate effects on the nasopharynx and middle ear. Therefore, this study aimed to analyze the effect of a rhino-pharyngeal clearance intervention protocol on nasal obstruction and middle ear condition in children under 3 years of age with URTI.

Materials and methods

Randomized controlled trial in a day-care centre of Porto, including 44 children randomized to Intervention Group (IG) and Control Group (CG). Nasal auscultation and tympanometry were performed at baseline (M0) as well as after the intervention (M1), which consisted of nasal irrigation (NaCl .9%) followed by a forced nasal inspiration in the IG, and after 30 min of normal activities, in the CG.

Results

In M1 there was a lower frequency of children classified as having an obstructed nasal sound in the IG when compared to the CG (IG = 33.3%; CG = 68.4%; p = 0.042). We also observed an improvement of mean peak pressure (PP) in the IG (Left ear: M0 = −124daPa; M1 = −92daPa; p = 0.022. Right ear: M0 = −102daPa; M1 = −77daPa; p = 0.021), which was not observed in the CG (Left ear: M0 = −105daPa; M1 = −115daPa; p = 0.485. Right ear: M0 = −105daPa; M1 = −131daPa; p = 0.105). There were no significant results concerning the compliance of the tympanic membrane.

Conclusions

The rhino-pharyngeal clearance improved the nasal obstruction and PP of the middle ear of children under 3 years of age with URTI.

Resumen

Introducción y objetivos

Los niños corren un alto riesgo de infecciones respiratorias superiores (IRS) y con frecuencia se prescriben irrigaciones nasales. Hasta hoy no hay suficiente conocimiento sobre sus efectos inmediatos en la nasofaringe y el oído medio. Por lo tanto, este estudio tuvo como objetivo analizar el efecto de un protocolo de intervención de limpieza nasal en la obstrucción y en el estado del oído medio de niños menores de 3 años con IRS.

Material y métodos

Ensayo controlado aleatorizado en una guardería de Oporto, incluidos 44 niños asignados al Grupo de intervención (IG) y al Grupo de control (CG). La auscultación nasal y la timpanometría se realizaron al inicio (M0) y después de la intervención (M1), que consistió en irrigación nasal (NaCl 0,9%) seguido de una inspiración nasal forzada en IG, y después de 30 min de actividades normales en CG.

Resultados

En M1 hubo una menor frecuencia de niños clasificados como con un sonido nasal obstruido en IG en comparación con CG (IG = 33,3%; CG = 68,4%; p = 0,042). También se observó una mejora de la presión máxima media (PP) en IG (oído izquierdo: M0 = −124 daPa; M1 = −92 daPa; p = 0,022; oído derecho: M0 = −102 daPa; M1 = −77 daPa; p = 0,021), que no se observó en CG (oído izquierdo: M0 = −105 daPa; M1 = −115 daPa; p = 0,485; oído derecho: M0 = −105 daPa; M1 = −131 daPa; p = 0,105). No hubo resultados significativos con respecto al cumplimiento de la membrana timpánica.

Conclusiones

La limpieza nasal mejoró la obstrucción y la PP del oído medio de niños menores de 3 años con IRS.

https://ift.tt/2zfxk0S

Miringoplastia con injerto doble medial y lateral

Publication date: Available online 7 June 2018

Source: Acta Otorrinolaringológica Española

Author(s): Francisco Javier Olarieta Soto, Francisco Antolí-Candela Cano, Alejandro Harguindey Antolí-Candela

Resumen

Objetivos

Se describe la técnica quirúrgica del injerto doble medial y lateral de fascia autóloga, sus indicaciones y resultados.

Material y método

Se estudian las características preoperatorias y al año de la intervención de 100 casos intervenidos de miringoplastia con la técnica de injerto doble medial y lateral de fascia autóloga. Se analizan los resultados anatómicos y funcionales.

Resultados

Los resultados se valoran al año de la intervención. En el 95% de los casos conseguimos el cierre de la perforación. La incidencia de persistencia de las perforaciones es del 12,5% en los niños menores de 10 años y del 2,5% en niños mayores de 10 años y adultos. Las complicaciones son un 4% de perlas epiteliales con engrosamiento del neotímpano, un 1% de retracciones del neotímpano y un 3% de epitelitis que se resuelven con tratamiento médico tópico. La recuperación auditiva es del 85% de cierres del UDA medio a menos de 20 dB (el 38% a menos de 10 dB y el 47% entre 10 y 20 dB). Se analizan las posibles causas del cierre incompleto del UDA, posiblemente relacionados con fibrosis y esclerosis de los restos timpánicos y/o la cadena osicular.

Conclusiones

Se concluye que esta metodología nos proporciona los mejores resultados en comparación con otras que hemos utilizado y hemos relegado a situaciones muy específicas atendiendo al tamaño y localización de la perforación.

Abstract

Objectives

A surgical technique for a double medial and lateral overlay autologous fascia graft myringoplasty is described in this paper along with its indications and results.

Material and method

The presurgical and one year post surgery characteristics are analyzed for 100 cases with the double medial and lateral overlay autologous fascia graft technique. The anatomical and functional results are analyzed.

Results

The results are analyzed one year post surgery. The probabilities of obtaining a graft take using this methodology are 95%. The incidence of persistence of the perforations is 12.5% in children under 10 and 2.5% in children over ten years of age and adults. The complications are 4% of epithelial pearls with blunting of the neo-tympanum, 1% of retractions and 3% of epithelitis which is resolved with a topical medical treatment. The average residual air/bone gap is less than 20 dB in 85% of the cases. Less than 10 dB in 38%, and between 10 and 20 dB in 47%. The causes for incomplete closure of the gap are analyzed; possibly related to fibrosis and sclerosis of the tympanic remnants and/or the ossicular chain.

Conclusions

It is concluded that this methodology provides the best results in comparison with other methods we have used and have set aside for very specific situations related to the size and location of the perforation.

https://ift.tt/2tYSACZ

Dehiscencia de la lámina papirácea del etmoides

Publication date: Available online 30 May 2018

Source: Acta Otorrinolaringológica Española

Author(s): Gabriel Huguet Llull, Marta Mesalles Ruiz, Xavier González Compta

https://ift.tt/2zcSNHB

Reconstrucción de defectos orofaríngeos tras cirugía transoral robótica. Revisión y recomendaciones de la Comisión de Cirugía de Cabeza y Cuello de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello

Publication date: Available online 30 May 2018

Source: Acta Otorrinolaringológica Española

Author(s): José Ángel González García, Carlos Pollán Guisasola, Carlos Miguel Chiesa Estomba, Constanza Viña Soria, David Virós Porcuna

Resumen

La cirugía transoral de la orofaringe ha presentado una importante evolución en los últimos años, al ampliarse las opciones quirúrgicas disponibles (TORS, TOUSS, TOLS), la capacidad de resecar lesiones cada vez más extensas y el número de pacientes que se beneficia de ellas. Este hecho ha provocado una evolución en la reconstrucción de los defectos quirúrgicos tras cirugía transoral. Este artículo tiene como objetivo la revisión de las posibles técnicas reconstructivas, las indicaciones y factores que tener en cuenta previamente a la cirugía, además de proponer un protocolo para valorar la necesidad de reconstrucción transoral sobre la base de la profundidad del defecto, la estadificación y el tratamiento previamente recibido.

Abstract

Transoral surgery of the oropharynx has seen an important evolution in recent years, expanding the surgical options available (TORS, TOUSS, TOLS). The capacity to resect increasingly extensive lesions and the number of patients who benefit from them. This fact has led to an evolution in the reconstruction of surgical defects after transoral surgery. This article aims to review the possible reconstructive techniques, indications and factors to be taken into account prior to surgery, proposing a protocol to assess the need for transoral reconstruction based on the depth of the defect, the staging, and previous treatment.

https://ift.tt/2tV2yW8

Investigation on the relationship of dimensions of the maxillary sinus drainage system with the presence of sinusopathies: a cone beam computed tomography study

Publication date: October 2018

Source: Archives of Oral Biology, Volume 94

Author(s): Ana Beatriz Gomes de Carvalho, Andre Luiz Ferreira Costa, Acácio Fuziy, Afonso Celso Souza de Assis, José Ribamar Castro Veloso, Luiz Roberto Coutinho Manhães, Mauro Pedrine Santamaria, Sérgio Lucio Pereira de Castro Lopes

Abstract

Objective

This study sought to assess the relationship between the dimensions of the maxillary sinus drainage system with the content of sinuses.

Design

Three-hundred cone beam computed tomography images were selected from a database (105 males and 195 females). The images were assessed by a single investigator, trained and calibrated, performing image analysis. The length of the infundibulum and the ostium height in both maxillary sinuses were measured. The data were analyzed using Minitab 1, using 5% as a critical p-value.

Results

A significant gender difference was also found for presence in the normal content of sinus for females and presence of antral pseudocyst for males (p < 0.05). Subjects with normal content in the maxillary sinus present lower ostium height values. There were statistically significant with presence of and higher ostium height values and antral pseudocyst (p < 0.01).

Conclusion

The current study results demonstrated that some sinusopathies were significantly related to dimensions of maxillary sinus drainage.

https://ift.tt/2IWEbvX

Effects of far infrared radiation by isotropic high-density carbon on the human oral mucosa

Publication date: October 2018

Source: Archives of Oral Biology, Volume 94

Author(s): Isao Kimura, Toshiro Yamamoto, Koya Nakamura, Toshihiro Uenishi, Taku Asai, Masakazu Kita, Narisato Kanamura

Abstract

Objectives

Wound healing of the oral mucosal epithelium through the application of far infrared radiation emitted by isotropic high-density carbon was investigated in order to clarify the preventive and therapeutic effects of isotropic high-density carbon on oral mucosal injury.

Materials and methods

A carbon massager with an isotropic high-density carbon tip was used. Far infrared radiation was applied to the human buccal mucosal squamous cell carcinoma cell line, HO-1-N-1 using a carbon massager, and cell growth factors and heat shock protein levels were measured using real-time RT-PCR and ELISA. Far infrared radiation was applied to oral mucosal injury in SD rats over time using the carbon massager, and its effects were examined by HE staining and immunostaining. The immunostaining positive rate was measured and analyzed using image analysis software.

Results

Far infrared radiation induced stronger mRNA expression and higher HSP27 and HSP70 protein levels on real-time RT-PCR and ELISA than in the control group. The far infrared radiation of oral mucosal injury in rats induced strong positive reactions, and positive rates for Ki67, HSP27, and HSP70 were higher than those in the control group.

Conclusions

The treatment of oral mucosal injury with far infrared radiation emitted by isotropic high-density carbon appears to have promoted heat shock protein production and induced regenerative reactions more strongly than in the control group.

https://ift.tt/2KJmOmZ

The in vitro effects of CCN2 on odontoblast-like cells

Publication date: October 2018

Source: Archives of Oral Biology, Volume 94

Author(s): Youjing Qiu, Jia Tang, Takashi Saito

Abstract

Objective

To investigate the in vitro effects of CCN2 on odontoblast-like cells proliferation and differentiation.

Design

MDPC-23 cells were cultured in DMEM supplemented with 5% FBS. CCN2 was either added to culture media or coated onto culture polystyrene, addition or coating of dH2O was served as control. In the addition group, CCN2 (100 ng/mL) was added into culture media. In the coating group, CCN2 at the concentration of 1000 ng/mL was employed. Cell proliferation was performed using CCK-8 assay. Cell differentiation and mineralization were analyzed by ALPase activity assay, real time RT-PCR and alizarin red staining. One-way ANOVA with post-hoc tukey HSD test was used for statistical analysis.

Results

MDPC-23 cells exhibited robust proliferative activity upon exposure to either soluble or immobilized CCN2. ALP activity of cells cultured on CCN2-modified surface was continuously strengthened from day six (0.831 ± 0.024 units/μg protein versus 0.563 ± 0.006 units/μg protein of control) till day eight (1.035 ± 0.139 units/μg protein versus 0.704 ± 0.061 units/μg protein of control). Gene expression of BSP, OCN and OPN were promoted by soluble CCN2 after 48 h exposure. Moreover, gene expression of BSP, OCN, OPN, ALP, COL1 A1, Runx-2, DSPP and DMP-1 was significantly enhanced by immobilized CCN2. Finally, mineralization of MDPC-23 cells was accelerated by both soluble and immobilized CCN2 to different extent.

Conclusions

The findings indicate that CCN2 promoted proliferation, odontogenic gene expression and mineralization of MDPC-23 cells. It is proposed that CCN2 may be a promising adjunctive formula for dentin regeneration.

https://ift.tt/2IWMJCF

Effects of anterior tooth crown inclination on occlusal relationship—A study in three-dimensional reconstruction

Publication date: October 2018

Source: Archives of Oral Biology, Volume 94

Author(s): Feng Feng, Yifan Liu, Jingwen Chi, Yuqiao Wang, Bin Xing, Yucheng Wang, Wen Liu

Abstract

Objective

This study aims to analyze the relationship between the central incisor crown inclination and occlusal relationship via three-dimensional study.

Methods

Ten Chinese volunteers with normal occlusion were selected from physical examination of college students. Lateral cephalograms and CT scans were taken, and the CT data were imported into Simplant pro 11.04 to reconstruct three-dimensional model. In the three-dimensional model, every tooth was separated independently. The upper and lower central incisors were moved labial inclination(up) or lingual inclination(down) and then the upper and lower tooth were aligned based on the central incisor's position according to the principles of Andrew's six keys. Four groups were set up with different changes of central incisors. The upper and the lower arch were aligned again based on the moved central incisors. After every motion, the mesio-distal distances of upper and lower canines and first molars were recorded. All data were analyzed using t-test via SPSS19.0, and the significance level was set at 5%.

Results

The results showed that the mesio-distal distances of occlusal relationship were different from normal occlusal relations, when either upper incisor crown inclination or lower incisor crown inclination was changed, and both upper and lower incisor crown inclination were moved in same or opposite direction. According to the statistical analysis, there was no significant difference when the changes of U1-L1 were no more than 10° (P > 0.05). But there was statistically significant difference (P < 0.05) when changes of U1-L1 were more than 20°.

Conclusions

The incisor crown inclination has influence on the establishment of occlusal relationships. The bigger difference upper and lower incisor crown inclination has, the more deviations from the normal occlusal relationship exist.

https://ift.tt/2KJmGUx

The impact of dietary consistency on structural craniofacial components: Temporomandibular joint/condyle, condylar cartilage, alveolar bone and periodontal ligament. A systematic review and meta-analysis in experimental in vivo research

Publication date: October 2018

Source: Archives of Oral Biology, Volume 94

Author(s): Rolf Scheidegger, Despina Koletsi, Theodore Eliades

Abstract

Objective

The aim of this systematic review was to provide a comprehensive synthesis of available evidence evaluating the effect of dietary loading on temporomandibular joint/condyle, condylar cartilage, alveolar bone of the mandible and the periodontal ligament in healthy mice and rats.

Design

Medline via PubMed, EMBASE and Open Grey databases were searched for published and unpublished literature. Search terms included "mandiblular condyle", "alveolar bone", "temporomandibular joint", "condylar cartilage", "periodontal ligament", "rat", "mice". After data extraction, risk of bias (SYRCLE) and reporting quality (ARRIVE) were assessed. Random effects meta-analyses were performed for the outcomes of interest where applicable.

Results

A total of 33 relevant articles were considered in the systematic review, while only 6 studies were included in the quantitative synthesis. Risk of Bias in all studies was judged to be unclear to high overall, while reporting quality was suboptimal. Comparing soft to hard diet animals, significantly reduced anteroposterior condylar length (4 studies, weighted mean difference: −0.40 mm; 95% CI: −0.47, −0.32; p < 0.001) and width (4 studies, weighted mean difference: −0.043 mm; 95% CI: −0.51, −0.36; p < 0.001) were found in rats. Decreased anteroposterior condylar dimensions were detected for mice as well (2 studies, weighted mean difference: −0.049; 95% CI: −0.56, −0.43; p < 0.001).

Conclusions

Overall, there was strong evidence to suggest a significant effect of soft diet on reduced condylar dimensions in rodents; however, there is need for further high quality experimental studies to inform current knowledge on condylar cartilage, alveolar bone and periodontal ligament related outcomes.

https://ift.tt/2KUiRsr

Epigallocatechin-3-gallate reduces damage to osteoblast-like cells treated with Zoledronic acid

Publication date: October 2018

Source: Archives of Oral Biology, Volume 94

Author(s): Eduardo Pons-Fuster López, Juan Seoane Leston, Pia López Jornet

Abstract

Objective

analyze the effect of zoledronic acid (ZA) alone and in combination with epigallocatechin-3-gallate (EGCG) on human osteoblast cells.

Methods

SAOS-2 osteoblastic phenotype cell line treated with different doses (0.01–10 μM) of ZA or ZA + EGCG underwent cell viability, mineralization, collagen synthesis and cell migration tests.

Results

Micromolar (1 and 5 μM) doses of ZA reduced cell viability (p < 0.001), mineralization (p < 0.001), and collagen synthesis (p < 0.001), while nanomolar doses (0.1 μM) did not produce any effect. EGCG application partly reversed the inhibition produced by ZA, and even increased mineralization (p < 0.001).

Conclusions

the data obtained shows that ZA at micromolar doses produces negative effects on osteoblast at all parameters measured, while at nanomolar levels ZA only affected cell migration and had no other effects on osteoblasts. The addition of EGCG partly reversed the effects produced by ZA, suggesting that this might be a promising preventative measure against BRONJ.

https://ift.tt/2KJmBAd

A novel electron-microscopic method for measurement of mineral content in enamel lesions

Publication date: October 2018

Source: Archives of Oral Biology, Volume 94

Author(s): C. Fowler, R.J.M. Lynch, D. Shingler, D. Walsh, C. Carson, A. Neale, R.J. Willson, A. Brown

Abstract

Objective

To assess Scanning Electron Microscopy in Back-Scattered Emission mode (BSE-SEM) for measurement of lesion mineral content as a function of depth. Direct comparison is made with Transverse Micro-Radiography (TMR) and Surface Micro-Hardness (SMH) on carious and erosive lesions.

Design

Caries lesions prepared from sound bovine enamel at 37 °C and pH 4.6 in unsaturated (7d) or part-saturated (8d, 4.1 mM Ca²⁺, 8 mM Pi) lactic acid /methyl cellulose gel system, followed by TMR analysis. Erosive lesions prepared from sound bovine enamel (1% citric acid, pH3.8, room temperature) for 5, 10, 15 or 20 min at n = 10 per treatment group. SMH readings (Vickers diamond, 1.9 N, 20 s) were taken from acid-treated and reference areas of each sample. BSE-SEM performed on polished cross-sections of lesioned samples (Jeol JSM6490LV SEM; high vacuum, 10 keV beam voltage, magnification x500 with constant working distance of 10 mm). Under identical SEM conditions, polished standards i.e. MgF₂, alumina, Mg, Al and Si provided a calibration plot of BSE-SEM signal vs. atomic number (z¯). Mineral content vs. depth plots were derived from the cross-sectional BSE-SEM data.

Results

Cross-sectional BSE-SEM images clearly differentiate between caries and erosive lesions. Comparison of caries lesion mineral loss from BSE-SEM with TMR data showed good correlation (R² = 0.98). Similarly, comparison of BSE-SEM data from erosive lesions showed good correlation (R² = 0.99) with hardness loss data from SMH.

Conclusion

BSE-SEM provides a relatively rapid and cost-effective method for the assessment of mineral content in demineralised tooth enamel and is applicable to both caries and erosive lesions.

https://ift.tt/2KHPnBx

Are Hertwig’s epithelial root sheath cells necessary for periodontal formation by dental follicle cells?

Publication date: October 2018

Source: Archives of Oral Biology, Volume 94

Author(s): Yongwen Guo, Weihua Guo, Jie Chen, Guoqing Chen, Weidong Tian, Ding Bai

Abstract

Objective

The role of Hertwig's epithelial root sheath (HERS) cells in periodontal formation has been controversial. This study aimed to further clarify whether HERS cells participate in formation of the periodontium, and the necessity of HERS cells in differentiation of dental follicle cells (DFCs) for periodontal regeneration.

Design

HERS cells and DFCs were isolated and identified from post-natal 7-day Sprauge-Dawley rats. In vitro, direct co-culture of HERS cells and DFCs as well as the individual culture of HERS and DFCs were performed and followed by alizarin red staining and the quantitative real-time polymerase chain reaction analysis. For in vivo evaluation, the inactivated dentin matrix (iTDM) was fabricated. HERS cells and DFCs were seeded in combination or alone on iTDM and then transplanted into the rat omentum. Scanning electron microscope and further histological analysis were carried out.

Results

In vitro, mineral-like nodules were found in the culture of HERS cells alone or HERS + DFCs either by alizarin red staining or scanning electronic microscope. The mineralization and fiber-forming relevant mRNA expressions, such as bone sialoprotein, osteopontin, collagen I and collagen III in HERS + DFCs were significantly higher than that of the HERS or DFCs alone group. After transplantation in vivo, cementum and periodontal ligament-like tissues were formed in groups of HERS + DFCs and HERS alone, while no evident hard tissues and attached fibers were found in DFCs alone.

Conclusions

Hertwig's epithelial root sheath cells directly participate in the formation of the periodontium, and they are essential for the differentiation of dental follicle cells to form periodontal structures. The combination use of Hertwig's epithelial root sheath cells and dental follicle cells is a promising approach for periodontal regeneration.

https://ift.tt/2IU9Fmg

Inhibitory effects of tea catechin epigallocatechin-3-gallate against biofilms formed from Streptococcus mutans and a probiotic lactobacillus strain

Publication date: October 2018

Source: Archives of Oral Biology, Volume 94

Author(s): Ching-Yi Wu, Tzu-Yi Su, Mao-Yu Wang, Shue-Fen Yang, Kwei Mar, Shan-Ling Hung

Abstract

Objective

Effects of tea catechin epigallocatechin-3-gallate (EGCG) against biofilm formation by Streptococcus mutans and probiotic Lactobacillus casei in Yakult^® (LcY) were examined.

Design

Biofilms were formed by S. mutans alone (Sm) and co-culture of S. mutans and LcY (Sm + LcY) in the absence or presence of EGCG. The biomass of biofilms, which were sonicated or not, was measured by the crystal violet assay. Biofilm morphology was observed by scanning electron microscopy. Bacterial viability and extracellular polysaccharides were determined by SYTO9/propidium iodide and dextran-conjugated fluorescein staining, respectively, and confocal microscopy. Gene expression of glucosyltransferase was determined by quantitative polymerase chain reaction.

Results

While 250 μg/ml EGCG significantly decreased the biomass and acid production of Sm biofilms, 500 μg/ml EGCG was required to inhibit Sm + LcY biofilm formation and acid production. EGCG decreased the amount of live bacteria present in both Sm and Sm + LcY biofilms. The level of dead bacteria in Sm + LcY biofilms was higher than in Sm biofilms when formed in the presence of 250 μg/ml EGCG. EGCG decreased levels of extracellular polysaccharides in Sm and Sm + LcY biofilms. The extent of biofilm removal by sonication was not different between Sm and Sm+LcY biofilms formed in the absence or presence of 62.5 or 125 μg/ml EGCG. The level of Sm gtfB and gtfD expression in Sm + LcY biofilms was higher than those in the Sm biofilms when formed in the presence of EGCG at 250 μg/ml.

Conclusion

The results indicated that LcY might interfere the inhibitory effects of EGCG against biofilm formation by S. mutans.

https://ift.tt/2KHPcpR

Identification of major matrix metalloproteinase-20 proteolytic processing products of murine amelogenin and tyrosine-rich amelogenin peptide using a nuclear magnetic resonance spectroscopy based method

Publication date: September 2018

Source: Archives of Oral Biology, Volume 93

Author(s): Garry W. Buchko, Rajith Jayasinha Arachchige, Jinhui Tao, Barbara J. Tarasevich, Wendy J. Shaw

Abstract

Objective

The aim of this study was to identify major matrix metalloproteinase-20 (MMP20) proteolytic processing products of amelogenin over time and determine if the tyrosine-rich amelogenin peptide (TRAP) was a substrate of MMP20.

Design

Recombinant¹⁵N-labeled murine amelogenin and ¹³C,¹⁵N-labeled TRAP were incubated with MMP20 under conditions where amelogenin self-assembles into nanospheres. Digestion products were fractionated by reverse-phase high-performance liquid chromatography at various time points. Product identification took advantage of the intrinsic disorder property of amelogenin that results in little change to its fingerprint ¹H-¹⁵N heteronuclear single-quantum coherence nuclear magnetic resonance spectrum in 2% acetic acid upon removing parts of the protein, allowing cleavage site identification by observing which amide cross peaks disappear.

Results

The primary product in five out of the six major reverse-phase high-performance liquid chromatography bands generated after a 24 h incubation of murine amelogenin with MMP20 were: S55-L163, P2-L147, P2-E162, P2-A167, and P2-R176. After 72 h these products were replaced with five major reverse-phase high-performance liquid chromatography bands containing: L46-A170, P2-S152, P2-F151, P2-W45, and short N-terminal peptides. TRAP was completely digested by MMP20 into multiple small peptides with the initial primary site of cleavage between S16 and Y17.

Conclusions

Identification of the major MMP20 proteolytic products of amelogenin confirm a dynamic process, with sites towards the C-terminus more rapidly attacked than sites near the N-terminus. This observation is consistent with nanosphere models where the C-terminus is exposed and the N-terminus more protected. One previously reported end-product of the MMP20 proteolytic processing of amelogenin, TRAP, is shown to be an in vitro substrate for MMP20.

https://ift.tt/2KQl88h

Effects of citric acid modified with fluoride, nano-hydroxyapatite and casein on eroded enamel

Publication date: September 2018

Source: Archives of Oral Biology, Volume 93

Author(s): Ayşe Dündar, Abdulkadir Şengün, Canan Başlak, Mahmut Kuş

Abstract

Objectives

The aim of this in vitro study was to evaluate the effects of citric acid containing fluoride, nano-hydroxyapatite, and casein on eroded enamel.

Design

The crowns of 120 extracted bovine incisors were embedded in acrylic resin. An enamel window (2 × 3 mm) was created on the surface. Before in vitro pellicle formation samples were eroded in 1% citric acid (pH = 3.2) for 1 h at 36 °C and were randomly classified to eight groups (n = 15) as follows: Positive control: 1% citric acid, Negative control: Distilled water, F1: 0.047 mmol/L sodium fluoride, F2: 0.071 mmol/L sodium fluoride, NHA1: %0.05 Nano-Hydroxyapatite, NHA2: %0.1 Nano-Hydroxyapatite, C1: %0.02 Casein, C2: %0.2 Casein. Erosion cycling was performed three times daily for 3 days. In each cycle, the samples were immersed in 10 mL of control or modified solutions (10 min) and in 10 mL of artificial saliva (60 min). The surface roughness and enamel loss were analyzed by using profilometer, scanning electron microscopy (SEM) and atomic force microscopy techniques (AFM).

Results

Among the groups, the positive control group was found to be having the highest erosive wear. Erosive wear in the F2, NHA2, C1, and C2 groups was not significantly different from the negative control group (p > 0.05). The C1 and C2 groups showed that erosion terminated and minimal tissue recovery occurred on the enamel surface.

Conclusion

Although all modifications reduced further demineralization, the citric acid modification with casein was found to be having a greater impact on dental erosion than the others.

https://ift.tt/2KL6gLw

Responses to spaceflight of mouse mandibular bone and teeth

Publication date: September 2018

Source: Archives of Oral Biology, Volume 93

Author(s): Didem Dagdeviren, Zana Kalajzic, Douglas J. Adams, Ivo Kalajzic, Alan Lurie, Maija I. Mednieks, Arthur R. Hand

Abstract

Objective

To determine if spaceflight and microgravity affect non-weight bearing bones and development and mineralization of teeth, reasoning that combining an organ and a cellular level approach can lead to greater insights about these effects.

Design

Mandibles and incisors of mice flown on the US STS-135 space shuttle mission and the Russian Bion-M1 satellite were studied using micro-computed tomography and immunohistochemistry. Ground controls were mice housed in standard vivarium cages and flight habitats.

Results

Incisor length was greater in the 13-day STS-135 flight mice than in either control group. Initial incisor mineralization occurred more posteriorly, and incisor, enamel and dentin volumes and enamel and dentin thicknesses were greater in the 30-day Bion-M1 flight and habitat control mice than in vivarium control mice. Mandibular bone volume (BV) was increased in STS-135 flight and habitat groups and decreased in Bion-M1 flight and habitat groups compared to vivarium controls. No significant histological alterations occurred, but changes were seen in the bone and tooth proteins dentin sialoprotein, amelogenin and the type II regulatory subunit of protein kinase A. The percentage of sclerostin positive osteocytes was greatest in flight mice, and greater in STS-135 flight and habitat control mice than in the corresponding Bion-M1 groups. TRAP staining, representing osteoclastic bone remodeling, differed between the two flights and corresponded with changes in BV.

Interpretation of the findings was limited by a small number of flight mice, different sex and ages of the mice in the two missions, and different habitats and diets.

Conclusions

Microgravity has measurable effects on mandibular bone physiology and incisor development and mineralization. The results also showed that the habitat had an effect either in flight or ground control samples, as demonstrated by the changes in BV and apparent slowing of incisor eruption. Therefore, developing appropriate habitats is critical for future spaceflight missions.

https://ift.tt/2IXsAfY

Serotype a of Aggregatibacter actinomycetemcomitans down-regulates the increased serotype b-induced cytokine and chemokine production in dendritic cells

Publication date: September 2018

Source: Archives of Oral Biology, Volume 93

Author(s): Leticia Rojas, Samanta Melgar-Rodríguez, Jaime Díaz-Zúñiga, Carla Alvarez, Gustavo Monasterio, Carolina Rojas, Paola Carvajal, Rolando Vernal

Abstract

Objective

In Aggregatibacter actinomycetemcomitans, different serotypes have been described based on LPS antigenicity. Mixed infection with the different A. actinomycetemcomitans serotypes is frequent in periodontitis patients; accordingly, the role of this bacterial species in the pathogenesis of periodontitis may differ depending whether patients or periodontal lesions harbour one or more of the A. actinomycetemcomitans serotypes. We hypothesized that different combinations of these serotypes could be associated with distinct host responses and hence different inflammatory patterns. This investigation was aimed to assess whether the increased immuno-stimulatory potential attributed to the serotype b of A. actinomycetemcomitans on immune cells is able to be modified during co-infection with other A. actinomycetemcomitans serotypes.

Methods

Dendritic cells (DCs) were obtained from healthy subjects and stimulated with the different A. actinomycetemcomitans serotypes or their purified LPS using the following stimulatory conditions: serotype a, b, or c, and the combinations a+b, a+c, b+c, or a+b+c. The cytokine, CCR, and CCL levels were quantified by qPCR and ELISA.

Results

Higher levels of cytokines, CCRs, and CCLs were induced when DCs were stimulated with the serotype b of A. actinomycetemcomitans compared with the same cells stimulated with the other serotypes. When DCs were co-infected, these levels decreased in comparison with the serotype b-stimulation alone, in particular when the serotype a was present in the mixed infection.

Conclusions

The increased immuno-stimulatory potential attributed to the serotype b was modified when DCs were co-infected with other A. actinomycetemcomitans serotypes, in particular, when the serotype a was present, the DC response diminished.

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