Periprocedural management of patients with subarachnoid hemorrhage

Purpose of review Anesthesiologists and intensivists may be involved in the management of aneurysmal subarachnoid hemorrhage (aSAH) patients at various stages of care. This article will review the recent advances in the periprocedural management of aSAH patients. Recent findings New scoring systems to assess gravity and prognosis of aSAH patients have been evaluated and proposed. Rebleeding still remains, with early aneurysmal treatment, a major challenge in the first hours of aSAH management. In the last decades, the treatment of the aSAH has shifted from clipping to coiling and more recently, the use of flow diversion technique has been introduced in selected patients. Although these improvements allow treatment of more complex aneurysms, they have implications for the anesthesiologist, including requiring the management of anticoagulation with its inherent risks. Even though knowledge, monitoring, and management of postprocedural phase of aSAH patients has improved, vasospasm and cerebral-delayed ischemia still remain the major and devastating complications in the postoperative course of aSAH patients. Summary Despite recent progress in the scoring, diagnosis, and treatment of aSAH patients, the periprocedural management of these patients is still a major challenge for anesthesiologists and intensivists, who are involved from the first phase of the aneurysm rupture through the postoperative phases and vasospasm period. Correspondence to Dr Paolo Gritti, Department of Anaesthesia and Critical Care Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy. Tel: +39 035 2675160/+39 339 8707380; fax: +39 035 2674979; e-mail: Grittip@libero.it Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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An update on regional analgesia for rib fractures

Purpose of review To provide an update on new strategies for pain management after rib fractures utilizing regional analgesia. Recent findings Pain management for patients with rib fractures can be very challenging. Traditionally, intravenous patient-controlled analgesia (IVPCA) with opioids, epidural, and paravertebral blocks have been used. These techniques, however, may be contraindicated or have limited application in certain patient populations. Recently, ultrasound-guided myofascial plane blocks such as the erector spinae plane (ESP) block and the serratus anterior plane (SAP) block have emerged as alternatives; providing excellent analgesia with minimal side effects. These blocks have the flexibility to be employed in a wide variety of circumstances where epidural and paravertebral approaches may not be feasible such as in anticoagulated patients and in patients with vertebral fractures where positioning options are limited. Myofascial blocks are less invasive and allow for broader and earlier application (e.g. in the emergency department). Further research on myofascial plane blocks is a priority. Summary Until recently, epidural, paravertebral, and intercostal blocks have been advocated as primary management techniques for pain associated with rib fractures. Newer myofascial plane blocks may play a key role in the future as part of alternative pain management strategies. Correspondence to Sanjib Das Adhikary, Department of Anaesthesiology and Perioperative Medicine, Penn State Hershey Medical Center, Penn State College of Medicine, 500, Univ. Drive, Hershey, PA 17033, USA. Tel: +1 717 8294201; e-mail: sadhikary1@pennstatehealth.psu.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Anesthesia for stroke rescue

Purpose of review To highlight the potential implications of recent advances in the management of large vessel occlusions for intraprocedural anesthetic management. Recent findings Stroke remains the leading cause of disability in the United States and the second leading cause of death in the world. Several randomized control trials published within the past decade have helped to make endovascular thrombectomy the standard of care for all eligible patients. However, whether intraprocedural anesthesia care practices may significantly improve in-hospital and out-of-hospital morbidity and mortality outcomes are not clear. Summary Management strategies that shorten the time to intervention and maintain blood pressure to preserve penumbral tissue may be beneficial. Future well powered studies are necessary to enable inferences on what type of anesthetic management is harmless, neurotoxic, or neural plasticity promoting. Correspondence to Ayòtúndé B. Fadayomi, MBBS, MPH, Center for Epidemiology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. E-mail: ayofadayomi@mail.harvard.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Intraoperative neurophysiological monitoring in neuroanesthesia

Purpose of review The purpose of this review is to highlight the importance of making informed choices of anesthetics and evaluating the impact of depth of anesthesia, hemodynamic status and other factors capable of interfering with signal capture during intraoperative neurophysiological monitoring (IONM). Recent findings Over the last decades, neuromonitoring has advanced considerably, allowing for insights into neurological function during anesthesia and making it possible to assess intraoperative consciousness and neural integrity in real time. IONM is indicated in surgeries posing risk to targeted neural tissues and adjacent structures. The technique helps correlate surgical maneuvers with neurophysiological changes at high levels of sensitivity and specificity and can identify risk situations early enough to prevent postoperative neurological deficits. Summary Experience with IONM, the use of an adequate IONM modality, and knowledge of the effect of anesthetic techniques and agents on neurophysiological parameters are fundamental for reliable measurements. The current gold standard in IONM is total intravenous anesthesia without neuromuscular block. Correspondence to Rogean R. Nunes, MD, PhD, Rua Comendador Francisco d'Angelo 1185, De Lourdes, Fortaleza, Ceará, Brazil, CEP: 60.177-130. E-mail: rogean@yahoo.com Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Outcomes of regional anesthesia in cancer patients

Purpose of review To summarize the current evidence on the impact of regional anesthesia or analgesia on cancer recurrence. Recent findings Preclinical investigations suggest that regional anesthesia could have a positive impact on reducing cancer growth and progression. Regional anesthesia is also associated with better immunological and stress-related outcomes in patients undergoing major oncological surgery. Most recent retrospective studies do not show any benefit of regional anesthesia or analgesia on cancer recurrence or recurrence-free survival. Summary The available clinical evidence does not support the use of any anesthesia technique to improve the cancer-related survival after major oncological surgery. The results from four randomized controlled trials will shed light on this critical topic in perioperative medicine. Correspondence to Juan P. Cata, MD, Department of Anesthesiology and Perioperative Medicine, The University of Texas – MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77401, USA. Tel: +713 792 4582; e-mail: jcata@mdanderson.org Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Anti-IgE therapy for IgE-mediated allergic diseases: from neutralizing IgE antibodies to eliminating IgE+ B cells

Allergic diseases are inflammatory disorders that involve many types of cells and factors, including allergens, immunoglobulin (Ig)E, mast cells, basophils, cytokines and soluble mediators. Among them, IgE pla...

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Sinonasal organising haematoma – a little known entity

Publication date: Available online 17 July 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Lalee Varghese, Sramana Mukhopadhyay, Raghav Mehan, Regi Kurien, Meera Thomas, V. Rupa

Abstract

Introduction

Sinonasal organising haematoma is a recently described, rare, benign inflammatory condition, which closely resembles malignancy in its clinical presentation.

Objective

To describe the clinical features of organising haematoma and to review the evolution of surgical options successfully used.

Methods

A retrospective review of charts of all patients with a histopathological diagnosis of sinonasal organising haematoma was performed.

Results

Six (60%) of the 10 patients were male with a mean age of 47.4 years. All patients had unilateral disease with recurrent epistaxis as the presenting symptom. Maxillary sinus was the most commonly involved sinus. There was no history of trauma in any of the patients. Hypertension (80%) was the most commonly associated comorbidity. Contrast-enhanced CT scan of the paranasal sinuses showed heterogenous sinus opacification with/without bone erosion. Histopathological examination was diagnostic. Complete endoscopic excision was done in all patients resulting in resolution of the disease.

Conclusion

Awareness of this relatively new clinical entity and its evaluation and treatment is important for otolaryngologists, maxillofacial surgeons and pathologists alike. Despite the clinical picture of malignancy, histopathological features of benign disease can safely dispel such a diagnosis.

Resumo

Introdução

Haematoma nasossinusal em organização é uma condição inflamatória benigna rara, recentemente descrita, que se assemelha a lesões malignas em sua apresentação clínica.

Objetivo

Descrever as características clínicas do haematoma em organização e analisar a evolução das opções cirúrgicas utilizadas com sucesso.

Método

Foi realizada a revisão retrospectiva dos prontuários de todos os pacientes com diagnóstico histopatológico de haematoma nasossinusal em organização.

Resultados

Seis (60%) dos 10 pacientes eram do sexo masculino, com média de idade de 47,4 anos. Todos os pacientes apresentavam doença unilateral com epistaxe recorrente como sintoma de apresentação. O seio maxilar era o mais comumente afetado. Não havia histórico de trauma em nenhum dos pacientes. Hipertensão (80%) foi a comorbidade mais comumente associada. A tomografia computadorizada dos seios paranasais com contraste mostrou opacificação heterogênea do seio com/sem erosão óssea. O exame histopatológico foi diagnóstico. A excisão endoscópica completa foi realizada em todos os pacientes, resultando na resolução da doença.

Conclusão

A conscientização a respeito desta entidade clínica relativamente nova e sua avaliação e tratamento é importante para os otorrinolaringologistas, cirurgiões buco-maxilo-faciais e patologistas. Apesar do quadro clínico de malignidade, as características histopatológicas da doença benigna podem descartar com segurança esse diagnóstico.

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Short-term evaluation of tegumentary changes of the nose in oral breathers undergoing rapid maxillary expansion

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): Fauze Ramez Badreddine, Reginaldo Raimundo Fujita, Mario Cappellette

Abstract

Introduction

Rapid maxillary expansion is an orthodontic and orthopedic procedure that can change the form and function of the nose. The soft tissue of the nose and its changes can influence the esthetics and the stability of the results obtained by this procedure.

Objective

The objective of this study was to assess the changes in nose dimensions after rapid maxillary expansion in oral breathers with maxillary atresia, using a reliable and reproducible methodology through computed tomography.

Methods

A total of 30 mouth-breathing patients with maxillary atresia were analyzed and divided into a treatment group who underwent rapid maxillary expansion (20 patients, 10 of which were male and 10 female, with a MA of 8.9 years and a SD of 2.16, ranging from 6.5 to 12.5 years) and a Control Group (10 patients, 5 of which were male and 5 female, with a MA of 9.2 years, SD of 2.17, ranging from 6.11 to 13.7 years). In the treatment group, multislice computed tomography scans were obtained at the start of the treatment (T1) and 3 months after expansion (T2). The patients of the control group were submitted to the same exams at the same intervals of time. Four variables related to soft tissue structures of the nose were analyzed (alar base width, alar width, height of soft tissue of the nose and length of soft tissue of the nose), and the outcomes between T1 and T2 were compared using Osirix MD software.

Results

In the TG, the soft tissues of the nose exhibited significant increases in all variables studied (p < 0.05), whereas, changes did not occur in the control group (p > 0.05). In the treatment group, mean alar base width increased by 4.87% (p = 0.004), mean alar width increased by 4.04% (p = 0.004), mean height of the soft tissues of the nose increased by 4.84% (p = 0.003) and mean length of the soft tissues of the nose increased by 4.29% (p = 0.012).

Conclusion

In short-term, rapid maxillary expansion provided a statistically significant increase in the dimensions of the soft tissues of the nose.

Resumo

Introdução

A expansão rápida da maxila é um procedimento ortodôntico e ortopédico que pode alterar a forma e a função do nariz. Os tecidos moles do nariz e suas alterações podem influenciar na estética e na estabilidade dos resultados obtidos por esse procedimento.

Objetivo

O objetivo desse estudo foi avaliar as alterações nas dimensões do nariz após expansão rápida da maxila em respiradores orais com atresia maxilar, usando uma metodologia confiável e reprodutível com o auxílio de tomografia computadorizada.

Método

Um total de 30 pacientes respiradores orais com atresia maxilar foram avaliados e divididos em um grupo de tratamento, submetidos à expansão rápida da maxila (20 pacientes, 10 dos quais do sexo masculino e 10 do sexo feminino, com média de idade de 8,9 anos e DP de 2,16, variando de 6,5 a 12,5 anos) e um grupo controle (10 pacientes, sendo 5 do sexo masculino e 5 do sexo feminino, com média de idade de 9,2 anos, DP de 2,17, variando de 6,11 a 13,7 anos). No grupo tratado, foram realizados exames de tomografia computadorizada multislice no início do tratamento (T1) e 3 meses após a expansão (T2). Os pacientes do grupo controle foram submetidos aos mesmos exames nos mesmos intervalos de tempo. Foram analisadas quatro variáveis relacionadas às estruturas dos tecidos moles do nariz (largura da base alar, largura alar, altura do tecido mole do nariz e comprimento do tecido mole do nariz) e os resultados entre T1 e T2 foram comparados, utilizando-se o software Osirix MD.

Resultados

No grupo tratado (GT), os tecidos moles do nariz apresentaram aumentos significativos em todas as variáveis estudadas (p < 0,05), enquanto isso não ocorreu no GC (p > 0,05). No GT, a largura média da base alar aumentou 4,87% (p = 0,004), a largura média alar aumentou 4,04% (p = 0,004), a altura média dos tecidos moles do nariz aumentou 4,84% (p = 0,003) e o comprimento médio dos tecidos moles do nariz aumentou 4,29% (p = 0,012).

Conclusão

A curto prazo, a expansão rápida da maxila proporcionou um aumento estatisticamente significativo nas dimensões dos tecidos moles do nariz.

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IRF6 rs2235375 single nucleotide polymorphism is associated with isolated non-syndromic cleft palate but not with cleft lip with or without palate in South Indian population

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): Venkatesh Babu Gurramkonda, Altaf Hussain Syed, Jyotsna Murthy, Bhaskar V.K.S. Lakkakula

Abstract

Introduction

Transcription factors are very diverse family of proteins involved in activating or repressing the transcription of a gene at a given time. Several studies using animal models demonstrated the role of transcription factor genes in craniofacial development.

Objective

We aimed to investigate the association of IRF6 intron-6 polymorphism in the non-syndromic cleft lip with or without palate in a South Indian population.

Methods

173 unrelated nonsyndromic cleft lip with or without cleft palate patients and 176 controls without clefts patients were genotyped for IRF6 rs2235375 variant by allele-specific amplification using the KASPar single nucleotide polymorphism genotyping system. The association between interferon regulatory factor-6 gene intron-6 dbSNP208032210:g.G>C (rs2235375) single nucleotide polymorphism and non-syndromic cleft lip with or without palate risk was investigated by chi-square test.

Results

There were significant differences in genotype or allele frequencies of rs2235375 single nucleotide polymorphism between controls and cases with non-syndromic cleft lip with or without palate. IRF6 rs2235375 variant was significantly associated with increased risk of non-syndromic cleft lip with or without palate in co-dominant, dominant (OR: 1.19; 95% CI 1.03–2.51; p = 0.034) and allelic models (OR: 1.40; 95% CI 1.04–1.90; p = 0.028). When subset analysis was applied significantly increased risk was observed in cleft palate only group (OR dominant: 4.33; 95% CI 1.44–12.97; p = 0.005).

Conclusion

These results suggest that IRF6 rs2235375 SNP play a major role in the pathogenesis and risk of developing non-syndromic cleft lip with or without palate.

Resumo

Introdução

Fatores de transcrição constituem uma família de proteínas muito diversa envolvida na ativação ou repressão da transcrição de um gene, em um determinado momento. Vários estudos usando modelos animais demonstraram o papel dos genes do fator de transcrição no desenvolvimento craniofacial.

Objetivo

Nosso objetivo foi investigar a associação do polimorfismo IRF6 intron-6 na fenda labial não sindrômica com ou sem fenda palatina em uma população do sul da Índia.

Método

Um total de 173 pacientes com fenda labial não sindrômica com ou sem fenda palatina e 176 controles sem fendas foram genotipados para a variante IRF6 rs2235375 por amplificação alelo-específica utilizando o sistema KASPar de genotipagem de polimorfismo de nucleotídeo único. A associação entre o polimorfismo de nucleotídeo único Fator 6 Regulatório do Interferon(IRF6) intron-6 dbSNP208032210:g.G>C (rs2235375) e o risco de fenda labial não sindrômica com ou sem fenda palatina foi investigado pelo teste qui-quadrado.

Resultadoss

Houve diferenças significativas nas frequências de genótipos ou alelos do rs2235375 SNP entre controles e casos com fenda labial não sindrômica com ou sem fenda palatina. A variante IRF6 rs2235375 foi significativamente associada ao aumento do risco de fenda labial não sindrômica com ou sem fenda palatina em modelos codominantes, dominantes (OR: 1,19; IC 95%: 1,03-2,51; p = 0,034) e alélicos (OR: 1,40; IC 95%: 1,04-1,90; p = 0,028). Quando a análise do subgrupo foi realizada, um risco significativamente aumentado foi observado no grupo Fenda Palatina Isolada (OR dominante: 4,33; IC 95%: 1,44-12,97; p = 0,005).

Conclusões

Esses resultados sugerem que o polimorfismo de nucleotídeo único IRF6 rs2235375 desempenha um papel importante na patogênese e risco de desenvolvimento de fenda labial não sindrômica com ou sem fenda palatina.

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Performance of the phonatory deviation diagram in the evaluation of rough and breathy synthesized voices

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): Leonardo Wanderley Lopes, Jonas Almeida de Freitas, Anna Alice Almeida, Priscila Oliveira Costa Silva, Giorvan Ânderson dos Santos Alves

Abstract

Introduction

Voice disorders alter the sound signal in several ways, combining several types of vocal emission disturbances and noise. The phonatory deviation diagram is a two-dimensional chart that allows the evaluation of the vocal signal based on the combination of periodicity (jitter, shimmer, and correlation coefficient) and noise (Glottal to Noise Excitation) measurements. The use of synthesized signals, where one has a greater control and knowledge of the production conditions, may allow a better understanding of the physiological and acoustic mechanisms underlying the vocal emission and its main perceptual-auditory correlates regarding the intensity of the deviation and types of vocal quality.

Objective

To analyze the performance of the phonatory deviation diagram in the discrimination of the presence and degree of roughness and breathiness in synthesized voices.

Methods

871 synthesized vocal signals were used corresponding to the vowel /ɛ/. The perceptual-auditory analysis of the degree of roughness and breathiness of the synthesized signals was performed using visual analogue scale. Subsequently, the signals were categorized regarding the presence/absence of these parameters based on the visual analogue scale cutoff values. Acoustic analysis was performed by assessing the distribution of vocal signals according to the phonatory deviation diagram area, quadrant, shape, and density. The equality of proportions and the chi-square tests were performed to compare the variables.

Results

Rough and breathy vocal signals were located predominantly outside the normal range and in the lower right quadrant of the phonatory deviation diagram. Voices with higher degrees of roughness and breathiness were located outside the area of normality in the lower right quadrant and had concentrated density.

Conclusion

The normality area and the phonatory deviation diagram quadrant can discriminate healthy voices from rough and breathy ones. Voices with higher degrees of roughness and breathiness are proportionally located outside the area of normality, in the lower right quadrant and with concentrated density.

Resumo

Introdução

Os distúrbios de voz alteram o sinal sonoro de diversas formas, combinando variados tipos de perturbações e ruído na emissão vocal. O diagrama de desvio fonatório é um gráfico bidimensional que possibilita a avaliação do sinal vocal a partir da combinação de medidas de periodicidade (jitter, shimmer e coeficiente de correlação) e de ruído (Glottal to Noise Excitation). A utilização de sinais sintetizados, onde se tem um maior controle e conhecimento das condições de produção, pode possibilitar uma maior compreensão dos mecanismos fisiológicos e acústicos subjacentes à emissão vocal e seus principais correlatos perceptivo-auditivos quanto à intensidade do desvio e tipos de qualidade vocal.

Objetivo

Analisar o desempenho do diagrama de desvio fonatório na discriminação da presença e do grau de rugosidade e soprosidade em vozes sintetizadas.

Método

Foram utilizados 871 sinais vocais sintetizados correspondentes à vogal/ɛ/. Realizou-se a análise perceptivo-auditiva do grau de rugosidade e soprosidade dos sinais sintetizados, com uma escala visual analógica. Posteriormente, os sinais foram categorizados quanto à presença/ausência desses parâmetros a partir dos valores de corte da escala visual analógica. A análise acústica foi realizada por meio da avaliação da distribuição dos sinais vocais de acordo com a área, quadrante, forma e densidade do diagrama de desvio fonatório. Executou-se o teste de igualdade de proporções e o teste Qui-quadrado para comparar as variáveis.

Resultados

Sinais vocais rugosos e soprosos localizaram-se predominantemente fora da área de normalidade e no quadrante inferior direito do diagrama de desvio fonatório. Vozes com maiores graus de rugosidade e soprosidade localizaram-se fora da área de normalidade, no quadrante inferior direito e apresentaram densidade concentrada.

Conclusão

A área de normalidade e o quadrante do diagrama de desvio fonatório são capazes de discriminar vozes saudáveis de rugosas e soprosas. Vozes com maior grau de rugosidade e soprosidade localizam-se proporcionalmente fora da área de normalidade, no quadrante inferior-direito e com densidade concentrada.

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25 (OH) D3 levels, incidence and recurrence of different clinical forms of benig paroxysmal positional vertigo

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): Sinisa Maslovara, Silva Butkovic Soldo, Anamarija Sestak, Katarina Milinkovic, Jasna Rogic-Namacinski, Anamarija Soldo

Abstract

Introduction

Benign paroxysmal positional vertigo is the most common cause of dizziness in the general population. It is a condition with potential impact of reduced levels of vitamin D on its recurrent attacks.

Objectives

The aim of this study was to measure the serum levels of 25-hydroxyvitamin D3 (25-OH D3) in patients with benign paroxysmal positional vertigo and determine whether there is a difference in the serum levels of vitamin D3 between patients with and without recurrence, as well as between the different clinical forms of benign paroxysmal positional vertigo.

Methods

The study included 40 patients who came to the regular medical examination, diagnosed with posterior canal-benign paroxysmal positional vertigo based on the positive Dix-Hallpike's test. All patients underwent Epley manoeuvre after the diagnosis. Patients were classified according to current guidelines for levels of vitamin D3 in the serum in three groups: the deficiency, insufficiency and adequate level.

Results

The average serum level of 25-OH D3 among respondents was 20.78 ng/mL, indicating a lack or insufficiency of the aforementioned 25-OH D3. According to the levels of 25-OH D3, most patients suffer from deficiency (47.5%). 7 (17.5%) respondents had adequate blood level of 25-OH D3, and 14 (35%) respondents suffer from insufficiency. A significant difference was not found in the serum level of 25-OH D3 between patients with and without benign paroxysmal positional vertigo recurrence. There was a significant difference in the serum levels of 25-OH D3 in comparison to the clinical form of the disease. Lower 25-OH D3 values were found in patients with canalithiasis compared to those with cupulolithiasis.

Conclusions

There were no significant differences in the vitamin D3 serum level in patients with and without recurrence. The study showed a low level of serum vitamin D3 in most patients, indicating the need for supplemental therapy.

Resumo

Introdução

Vertigem posicional paroxística benigna é a causa mais comum de tonturas na população em geral. É uma condição no qual níveis reduzidos de vitamina D podem ter um potencial impacto para o desenvolvimento de crises recorrentes.

Objetivos

O objetivo desse estudo foi medir os níveis séricos de 25-hidroxivitamina D3 (25-OH D3) em pacientes com vertigem posicional paroxística benigna e determinar se há diferença nos níveis séricos de vitamina D3 entre pacientes com e sem recorrência, bem como entre as diferentes formas clínicas de vertigem posicional paroxística benigna.

Método

O estudo incluiu 40 pacientes submetidos a exame médico regular, diagnosticados com vertigem posicional paroxística benigna de canal posterior baseado no resultado positivo do teste de Dix-Hallpike. Todos os pacientes foram submetidos à manobra de Epley após o diagnóstico. Os pacientes foram classificados de acordo com as diretrizes atuais para os níveis de vitamina D3 sérica em três grupos: deficiência, insuficiência e nível adequado.

Resultados

O nível sérico médio de 25-OH D3 entre os indivíduos avaliados foi de 20,78 ng/mL, indicando falta ou insuficiência desta vitamina. De acordo com os níveis de 25-OH D3, a maioria dos pacientes apresentou deficiência (47,5%). Sete indivíduos (17,5%) entrevistados tinham nível sanguíneo adequado de 25-OH D3 e 14 (35%) apresentavam insuficiência. Não foi encontrada diferença significativa no nível sérico de 25-OH D3 entre pacientes com e sem recidiva de vertigem posicional paroxística benigna. Houve uma diferença significativa nos níveis séricos de 25-OH D3 de acordo com a forma clínica da doença. Baixos níveis de 25-OH D3 foram mais encontrados em pacientes com canalitíase em comparação com aqueles com cupulolitíase.

Conclusões

Não houve diferenças significativas no nível sérico de vitamina D3 em pacientes com e sem recorrência. O estudo mostrou um baixo nível de vitamina D3 sérica na maioria dos pacientes, indicando a necessidade de terapia suplementar.

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Influence of chronic lymphocytic thyroiditis on the risk of persistent and recurrent disease in patients with papillary thyroid carcinoma and elevated antithyroglobulin antibodies after initial therapy

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): Marina Carvalho S. Côrtes, Pedro Weslley Rosario, Gabriela Franco Mourão, Maria Regina Calsolari

Abstract

Introduction

In patients with papillary thyroid carcinoma who have negative serum thyroglobulin after initial therapy, the risk of structural disease is higher among those with elevated antithyroglobulin antibodies compared to patients without antithyroglobulin antibodies. Other studies suggest that the presence of chronic lymphocytic thyroiditis is associated with a lower risk of persistence/recurrence of papillary thyroid carcinoma.

Objective

This prospective study evaluated the influence of chronic lymphocytic thyroiditis on the risk of persistence and recurrence of papillary thyroid carcinoma in patients with negative thyroglobulin but elevated antithyroglobulin antibodies after initial therapy.

Methods

This was a prospective study. Patients with clinical examination showing no anomalies, basal Tg < 1 ng/mL, and elevated antithyroglobulin antibodies 8–12 months after ablation were selected. The patients were divided into two groups: Group A, with chronic lymphocytic thyroiditis on histology; Group B, without histological chronic lymphocytic thyroiditis.

Results

The time of follow-up ranged from 60 to 140 months. Persistent disease was detected in 3 patients of Group A (6.6%) and in 6 of Group B (8.8%) (p = 1.0). During follow-up, recurrences were diagnosed in 2 patients of Group A (4.7%) and in 5 of Group B (8%) (p = 0.7). Considering both persistent and recurrent disease, structural disease was detected in 5 patients of Group A (11.1%) and in 11 of Group B (16.1%) (p = 0.58). There was no case of death related to the disease.

Conclusion

Our results do not support the hypothesis that chronic lymphocytic thyroiditis is associated with a lower risk of persistent or recurrent disease, at least in patients with persistently elevated antithyroglobulin antibodies after initial therapy for papillary thyroid carcinoma.

Resumo

Introdução

Em pacientes com carcinoma papilífero de tireoide e com tireoglobulina sérica negativa após a terapia inicial, o risco de doença estrutural é maior entre aqueles com anticorpos antitireoglobulina elevados em comparação com pacientes sem anticorpos antitireoglobulina. Outros estudos sugerem que a presença de tireoidite linfocítica crônica está associada a um menor risco de persistência/recorrência do carcinoma papilífero de teireoide.

Objetivo

Este estudo prospectivo avaliou a influência da tireoidite linfocítica crônica sobre o risco de persistência e recorrência do carcinoma papilífero de tireoide em pacientes com tireoglobulina negativa, mas com anticorpos antitireoglobulinas elevados após a terapia inicial.

Método

Esse foi um estudo prospectivo, no qual foram selecionados pacientes com exame clínico sem anomalias; tireoglobulina basal < 1 ng/mL e anticorpos antitireoglobulina elevados 8-12 meses após ablação. Os pacientes foram divididos em dois grupos: Grupo A, com tireoidite linfocítica crônica no exame histológico; Grupo B, histologicamente sem tireoidite linfocítica crônica.

Resultados

O tempo de seguimento variou de 60 a 140 meses. Doença persistente foi detectada em 3 pacientes do Grupo A (6,6%) e em 6 do Grupo B (8,8%) (p = 1,0). Durante o seguimento, as recidivas foram diagnosticadas em 2 pacientes do Grupo A (4,7%) e em 5 do Grupo B (8%) (p = 0,7). Considerando tanto a doença persistente quanto a recorrente, doença estrutural foi detectada em 5 pacientes do Grupo A (11,1%) e em 11 do Grupo B (16,1%) (p = 0,58). Não houve nenhum caso de óbito relacionado à doença.

Conclusão

Nossos resultados não apoiam a hipótese de que a tireoidite linfocítica crônica esteja associada a um menor risco de doença persistente ou recorrente, pelo menos em pacientes com anticorpos antitireoglobulina persistentemente elevados após a terapia inicial do carcinoma papilífero de tireoide.

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Evaluating the ototoxicity of an anti-MRSA peptide KR-12-a2

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): Chung Man Sung, Hong Chan Kim, Yong Beom Cho, Song Yub Shin, Chul Ho Jang

Abstract

Introduction

Methicillin-resistant staphylococcus aureus is an emerging problem for the treatment of chronic suppurative otitis media, and also for pediatric tympanostomy tube otorrhea. To date, there are no effective topical antibiotic drugs to treat methicillin-resistant staphylococcus aureus otorrhea.

Objective

In this study, we evaluated the ototoxicity of topical KR-12-a2 solution on the cochlea when it is applied topically in the middle ear of guinea pigs.

Methods

The antimicrobial activity of KR-12-a2 against methicillin-resistant staphylococcus aureus strains was examined by using the inhibition zone test. Topical application of KR-12-a2 solution, gentamicin and phosphate buffered saline were applied in the middle ear of the guinea pigs after inserting ventilation tubes. Ototoxicity was assessed by auditory brainstem evoked response and scanning electron microscope examination.

Results

KR-12-a2 produced an inhibition zone against methicillin-resistant staphylococcus aureus from 6.25 μg. Hearing threshold in the KR-12-a2 and PBS groups were similar to that before ventilation tube insertion. However, the gentamicin group showed elevation of the hearing threshold and there were statistically significant differences compared to the phosphate buffered saline or the KR-12-a2 group. In the scanning electron microscope findings, the KR-12-a2 group showed intact outer hair cells. However, the gentamicin group showed total loss of outer hair cells. In our experiment, topically applied KR-12-a2 solution did not cause hearing loss or cochlear damage in guinea pigs.

Conclusion

In our experiment, topically applied KR-12-a2 solution did not cause hearing loss or cochlear damage in guinea pigs. The KR-12-a2 solution can be used as ototopical drops for treating methicillin-resistant staphylococcus aureus otorrhea; however, further evaluations, such as the definition of optimal concentration and combination, are necessary.

Resumo

Introdução

O Staphylococcus aureus resistente à meticilina é um problema emergente não só para a otite média supurativa crônica, mas também para casos de otorreia crônica em crianças com tubo de ventilação. Até o momento, não há antibióticos tópicos efetivos para a otorreia causada por staphylococcus aureus resistente à meticilina.

Objetivo

Nesse estudo, avaliamos a ototoxicidade da solução tópica de KR-12-a2 na cóclea quando aplicada topicamente na orelha média de cobaias.

Método

A atividade antimicrobiana de KR-12-a2 contra cepas de staphylococcus aureus resistente à meticilina foi avaliada utilizando-se o teste de zona de inibição de crescimento. Foram aplicados na orelhas médias de 3 grupos de cobaias, ou solução tópica de KR-12-a2, ou gentamicina ou solução salina tamponada com fosfato após timpanostomia. A ototoxicidade foi avaliada através do exame auditivo de potencial evocado auditivo de tronco encefálico e por microscopia eletrônica de varredura.

Resultados

O KR-12-a2 produziu uma zona de inibição contra o staphylococcus aureus resistente à meticilina a partir de 6,25 μg. Alterações do limiar de audição no grupo KR-12-a2 e no grupo com solução salina foram semelhantes aos observados antes da inserção do tubo de ventilação. No entanto, o grupo gentamicina apresentou um limiar auditivo mais elevado, estatisticamente significativo em comparação ao grupo solução salina ou ao grupo KR-12-a2. Nos achados da microscopia eletrônica, o grupo KR-12-a2 apresentou células ciliadas externas intactas. No entanto, o grupo gentamicina apresentou perda total das células ciliadas externas. Em nosso experimento, a solução de KR-12-a2 aplicada topicamente não causou perda auditiva ou dano coclear em cobaias.

Conclusão

Em nosso experimento, a solução de KR-12-a2 aplicada topicamente não causou perda auditiva ou dano coclear em cobaias. A solução de KR-12-a2 pode ser utilizada como gotas otológicas para o tratamento da otorreia causada por staphylococcus aureus resistente à meticilina; no entanto, são necessárias outras avaliações, para a definição da concentração e das associações ideais.

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Turkish validity and reliability of Eustachian tube dysfunction questionnaire-7

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): Erdoğan Özgür, Cem Bilgen, Beyhan Cengiz Özyurt

Abstract

Introduction

During clinical evaluations, in order to interpret patients' complaints caused by Eustachian tube dysfunction and to monitor the success of the treatment, standardized and disease-related scales are necessary.

Objective

The aim of this study was to investigate the validity and reliability of the Turkish version of Eustachian tube dysfunction questionnaire-7.

Methods

Forty patients diagnosed with Eustachian tube dysfunction and 40 healthy individuals were enrolled for the study. After language validation of the Eustachian tube dysfunction questionnaire-7 for Turkish, a scale was completed by the both Eustachian tube dysfunction and control groups. Two weeks after the first evaluation, 15 of the cases filled out the scale again without any treatment intervention. Known-groups method was used in validity analysis. Floor-ceiling effect, test–retest method, item-total score correlation and internal consistency analysis were used in reliability analyses.

Results

Cronbach's alpha coefficient was 0.714 for the entire questionnaire. The test–retest reliability coefficient for the total scale was determined as 0.792, indicating correlation between the two questionnaires completed by the same patient over time. In the Eustachian tube dysfunction group, total and each item scores were found significantly higher than the control group (p < 0.001).

Conclusion

The Turkish version of Eustachian tube dysfunction questionnaire-7 was found to be highly valid and reliable. This scale is recommended to use for screening of Eustachian tube dysfunction and evaluating treatment outcome.

Resumo

Introdução

No intuito de interpretar as queixas dos pacientes causadas por disfunções na tuba auditiva durante uma avaliação clínica, e para monitorar o sucesso do tratamento, há necessidade de escalas padronizadas relacionadas à doença.

Objetivo

Investigar a validade e a confiabilidade da versão turca do Eustachian tube dysfunction questionnaire-7.

Método

Quarenta pacientes diagnosticados com disfunção da tuba auditiva e 40 indivíduos saudáveis foram incluídos no estudo. Após a validação do Eustachian tube dysfunction questionnaire-7 para o idioma turco, o questionário foi aplicada aos grupos disfunção da tuba auditiva e controle. Duas semanas após a primeira avaliação, 15 pacientes preencheram o questionário novamente sem qualquer tratamento. O método de grupos conhecidos foi utilizado na análise de validade. Os efeitos teto e chão, o método teste-reteste, a correlação se escore de item-total e a análise de consistência interna foram utilizados nas análises de confiabilidade.

Resultados

O coeficiente alfa de Cronbach foi de 0,714 para todo o questionário. O coeficiente de confiabilidade teste-reteste para a escala total foi determinado como 0,792, indicando correlação entre os dois questionários preenchidos pelo mesmo paciente ao longo do tempo. No grupo disfunções da tuba auditiva, foi observado que os escores total e de cada item foram significativamente maiores do que no grupo controle (p < 0,001).

Conclusão

A versão no idioma turco do Eustachian tube dysfunction questionnaire-7 foi considerada altamente válida e confiável. Recomenda-se a utilização dessa escala para a triagem de disfunções da tuba auditiva e avaliação do resultado do tratamento.

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Outcomes of external septorhinoplasty in a Turkish male population

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): Gamze Didem Kilci, Engin Başer, Ayşegül Verim, Ömer Faruk Çalim, Bayram Veyseller, Orhan Özturan, Ahmet Altintaş, Mustafa Çelik

Abstract

Introduction

The first and one of the most important steps in facial plastic surgery is accurate preoperative facial analysis and recording of data that may help the surgeon to check the outcomes of his/her techniques, promoting a surgeon's professional development.

Objective

To evaluate the esthetic outcomes of external septorhinoplasty relevant to ethnic facial harmony and to investigate the relationship of the columellar incision scar with the type of skin and columellar incision type in a Turkish population.

Methods

In total, 28 consecutive adult male patients with a mean age of 32.14 ± 10.66 years (range: 18–61 years) were included the study. Primary outcomes were preoperative and postoperative photogrammetric facial analyses of the patients including measurement of nasofrontal angle, nasolabial angle and nasal projection ratios (Gode) assessed according to the data derived from the Rhinobase program. Results were compared to facial proportions of the Turkish population. Columellar incision scar scores related to the Fitzpatrick skin type classification of the patients and columellar incision types used for the external approach were secondary outcomes of the study.

Results

Mean preoperative and postoperative nasofrontal angles were 148.04° ± 8.18° and 144.50° ± 7.15°, respectively, while mean preoperative and postoperative nasolabial angles were 87.59° ± 14.01° and 98.50° ± 9.71°, respectively. Mean preoperative and postoperative nasal tip projection ratios were 0.56 ± 0.05 and 0.60 ± 0.06, respectively. The differences between pre- and postoperative measurements were all significantly different and were in accordance with Turkish nasal harmony. Columellar inverted "V" incisions were performed in 15 (53.6%) patients while "V" incisions were used in 13 (46.4%) patients. Fitzpatrick skin Type 4 was seen in 46.42% of the patients, Fitzpatrick Type 3 in 46.42% and Fitzpatrick Type 2 in 7.14% of the patients. No significant difference was seen between columellar scar scores according to skin type and columellar incision type used for external septorhinoplasty.

Conclusions

This study demonstrated that outcomes for nasofrontal angle, nasolabial angle and nasal tip projection ratios analyzed using the Rhinobase program in patients who underwent external septorhinoplasty were similar to reference values for the Turkish population.

Resumo

Introdução

O primeiro e um dos mais importantes passos na cirurgia plástica facial é a análise pré-operatória facial precisa e registro de dados que podem ajudar o cirurgião a verificar os resultados de suas técnicas, promovendo seu desenvolvimento profissional.

Objetivo

Avaliar os resultados estéticos da rinosseptoplastia externa relevantes para a harmonia étnica facial e investigar a associação da cicatriz de incisão columelar com o tipo de pele e tipo de incisão columelar em uma população turca.

Método

No total, 28 pacientes adultos consecutivos com média de idade de 32,14 ± 10,66 anos (intervalo: 18-61 anos) foram incluídos no estudo. Os desfechos primários foram as análises faciais fotogramétricas pré-operatórias e pós-operatórias dos pacientes, incluindo a medida do ângulo nasofrontal, ângulo nasolabial e razões da projeção nasal (Gode), avaliados de acordo com os dados derivados do programa Rhinobase. Os resultados foram comparados às proporções faciais da população turca. Os escores de cicatriz de incisão columelar relacionados com a classificação de Fitzpatrick do tipo de pele dos pacientes e os tipos de incisão columelar usados para a abordagem externa foram os desfechos secundários do estudo.

Resultados

Os ângulos nasofrontais pré- e pós-operatórios médios foram 148,04 ± 8,18° e 144,50 ± 7,15°, respectivamente, enquanto os ângulos nasolabiais pré- e pós-operatórios médios foram 87,59 ± 14,01° e 98,50 ± 9,71°, respectivamente. As razões médias da projeção nasal pré- e pós-operatória foram de 0,56 ± 0,05 e 0,60 ± 0,06, respectivamente. As diferenças entre as medidas pré- e pós-operatórias foram todas significativamente diferentes e estavam de acordo com a harmonia nasal turca. A incisão columelar em "V" invertido foi utilizada em 15 (53,6%) pacientes e a incisão em "V" foi utilizada em 13 (46,4%) pacientes. Pele Fitzpatrick tipo 4 foi observada em 46,42% dos pacientes, Fitzpatrick Tipo 3 em 46,42% e Fitzpatrick Tipo 2 em 7,14% dos pacientes. Não foi observada diferença significativa entre os escores de cicatriz columelar de acordo com o tipo de pele e o tipo de incisão columelar utilizados na rinosseptoplastia externa.

Conclusões

Este estudo demonstrou que os desfechos para ângulo nasofrontal, ângulo nasolabial e razões de projeção nasal analisados pelo programa Rhinobase em pacientes submetidos à rinosseptoplastia externa foram semelhantes aos valores de referência para a população turca.

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Free tissue flaps in head and neck reconstruction: clinical application and analysis of 93 patients of a single institution

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): Jiwang Liang, Tao Yu, Xu Wang, Yuejiao Zhao, Fengqin Fang, Wei Zeng, Zhendong Li

Abstract

Introduction

Reconstruction with a free flap is routine in head and neck surgery because of better functional outcomes, improved esthetics, and generally higher success rates.

Objective

To evaluate the clinical outcomes in patients undergoing different microvascular free flap reconstructions.

Methods

This was a retrospective study of 93 patients undergoing reconstructions with free flaps from 2007 to 2015. Four types of free flap were performed: anterolateral thigh (76.3%), radial forearm (16.1%), fibula (4.3%) and jejunum (3.3%). Patients' demographic data were collected, and the outcomes measured included flap survival and complications. Postoperative functional and oncological outcome were also analyzed.

Results

The patients included 73 men and 20 women, with a mean age of 56.1 years. The most common tumor location was the tongue. Squamous cell carcinoma represented the vast majority of the diagnosed tumors (89.2%). The most common recipient vessels were the superior thyroid artery (77.4%) and the internal jugular vein (91.4%). Nine patients required emergency surgical re-exploration and the overall flap success rate was 90.3%. Venous thrombosis was the most common cause for re-exploration. Other complications included wound infection (5.4%), wound dehiscence (1.1%), partial flap necrosis (9.7%), fistula formation (10.8%), and 1 bleeding (1.1%). The majority of patients had satisfactory cosmetic and functional results of both donor site and recipient site after 46.7 months of mean follow-up.

Conclusion

Microsurgical free flap is shown to be a valuable and reliable method in head and neck surgery. It can be used safely and effectively with minimal morbidity in selected patients. The reconstruction can be performed by appropriately skilled surgeons with acceptable outcomes. Success rate appears to increase as clinical experience is gained.

Resumo

Introdução

Reconstrução com retalhos livres é um procedimento de rotina nas cirurgias de cabeça e pescoço devido aos melhores resultados funcionais e estéticos, e taxas de sucesso geralmente maiores.

Objetivo

Avaliar os desfechos clínicos de pacientes submetidos a diferentes reconstruções microvasculares com retalhos livres.

Método

Estudo retrospectivo de 93 pacientes submetidos à reconstruções com retalhos livres, de 2007 a 2015. Foram utilizados quatro tipos de retalho livre: coxa anterolateral (76,3%), antebraço radial (16,1%), fíbula (4,3%) e jejuno (3,3%). Os dados demográficos dos pacientes foram coletados e os parâmetros avaliados incluíram sobrevida e complicações. Os resultados funcionais e oncológicos pós-operatórios também foram analisados.

Resultados

Os pacientes incluíram 73 homens e 20 mulheres, com idade média de 56,1 anos. O local mais comum para o tumor foi a língua. O carcinoma de células escamosas representou a maioria dos tumores diagnosticados (89,2%). As artérias receptoras mais comuns foram a artéria tireóidea superior (77,4%) e a veia jugular interna (91,4%). Nove pacientes necessitaram de reexploração cirúrgica de emergência e a taxa de sucesso global do retalho foi de 90,3%. A trombose venosa foi a causa mais comum da reexploração. Outras complicações incluíram infecção da ferida cirúrgica (5,4%), deiscência da ferida (1,1%), necrose parcial do retalho (9,7%), formação de fístula (10,8%) e sangramento (1,1%). A maioria dos pacientes apresentou resultados estéticos e funcionais satisfatórios, tanto no local doador quanto no receptor, após 46,7 meses de seguimento médio.

Conclusão

O retalho livre microcirúrgico mostrou ser um método valioso e confiável na cirurgia de cabeça e pescoço. Pode ser utilizado de forma segura e eficaz, com morbidade mínima em pacientes selecionados. A reconstrução pode ser realizada por cirurgiões adequadamente qualificados com resultados aceitáveis. A taxa de sucesso parece aumentar à medida que a experiência clínica é adquirida.

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Comparison of the recovery rate of otomycosis using betadine and clotrimazole topical treatment

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): Mohammad Reza Mofatteh, Zahra Naseripour Yazdi, Masoud Yousefi, Mohammad Hasan Namaei

Abstract

Introduction

Otomycosis is a common diseases that can be associated with many complications including involvement of the inner ear and mortality in rare cases. Management of otomycosis can be challenging, and requires a close follow-up. Treatment options for otomycosis include local debridement, local and systemic antifungal agents and utilization of topical antiseptics.

Objective

This study was designed to compare the recovery rate of otomycosis using two therapeutic methods; topical betadine (Povidone-iodine) and clotrimazole.

Methods

In this single-blind clinical trial, 204 patients with otomycosis were selected using a non-probability convenient sampling method and were randomly assigned to two treatment groups of topical betadine and clotrimazole (102 patients in each group). Response to treatment was assessed at 4, 10 and 20 days after treatment. Data were analyzed using the independent t-test, Chi-Square and Fisher exact test in SPSS v.18 software, at a significance level of p < 0.05.

Results

The results showed that out of 204 patients with otomycosis, fungi type isolated included Aspergillus in 151 cases (74%), and Candida albicans in 53 patients (26%). On the fourth day after treatment, 13 patients (13.1%) in the group treated with betadine and 10 patients (9.8%) in the group treated with clotrimazole showed a good clinical response to treatment (p = 0.75). A good response to treatment was reported for 44 (43.1%) and 47 patients (46.1%) on the tenth day after the treatment (p = 0.85); and 70 (68.6%) and 68 patients (67.6%) on the twentieth day after treatment (p = 0.46) in the groups treated with betadine and clotrimazole, respectively. The response to treatment was thus not significantly different in the two groups.

Conclusion

In the present study the efficacy of betadine and clotrimazole was the same for the treatment of otomycosis. The result of this study supports the use of betadine as an effective antifungal in otomycosis treatment, helping to avoid the emergence of resistant organisms.

Resumo

Introdução

A otomicose é uma das doenças comuns associadas a muitas complicações, como envolvimento da orelha interna e mortalidade em casos raros. O tratamento da otomicose pode ser realmente desafiador e requer um acompanhamento rigoroso. As opções de tratamento para otomicose podem incluir desbridamento local, agentes antifúngicos locais e sistêmicos e uso de antissépticos tópicos, os medicamentos tópicos recomendados para o tratamento da otomicose.

Objetivo

Comparar a taxa de recuperação de otomicose utilizando dois métodos terapêuticos de betadina tópica (Povidona-iodo) e clotrimazol.

Método

Neste ensaio clínico simples cego, 204 pacientes com otomicose foram selecionados utilizando-se um método de amostragem de não probabilidade conveniente e randomizados para dois grupos de tratamento, com betadina tópica e com clotrimazol (102 pacientes em cada grupo). A resposta ao tratamento foi avaliada aos 4, 10 e 20 dias após o tratamento. Os dados foram analisados utilizando o teste t independente, qui-quadrado e teste exato de Fisher no software SPSS v.18, com nível de significância de p < 0,05.

Resultados

Os resultados mostraram que dos 204 pacientes com otomicose, os tipos de fungos isolados incluíram Aspergillus em 151 casos (74%) e Candida albicans em 53 pacientes (26%). No quarto dia após o tratamento, 13 pacientes (13,1%) no grupo tratado com betadina e 10 pacientes (9,8%) no grupo tratado com clotrimazol apresentaram boa resposta ao tratamento (p = 0,75). Uma boa resposta ao tratamento foi relatada para 44 (43,1%) e 47 pacientes (46,1%) no décimo dia após o tratamento (p = 0,85); e 70 (68,6%) e 68 pacientes (67,6%) no vigésimo dia após o tratamento (p = 0,46) no grupo tratado com betadina e clotrimazol, respectivamente. Assim, a resposta ao tratamento não foi significativamente diferente nos dois grupos.

Conclusão

No presente estudo, a eficácia da betadina e do clotrimazol foi a mesma no tratamento da otomicose. O resultado deste estudo apoia o uso de betadina como um antifúngico eficaz no tratamento da otomicose que pode ajudar a evitar o surgimento de organismos resistentes.

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Parotid Masson's tumor: case report

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): Filippo Carta, Sara Sionis, Valeria Ledda, Clara Gerosa, Roberto Puxeddu

https://ift.tt/2NZMjzx

A case of bilateral inferior concha bullosa connecting to maxillary sinus

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): Soo Kweon Koo, Ji Seung Moon, Sung Hoon Jung, Mi Jin Mun

https://ift.tt/2NpUVOI

Factors associated with voice disorders among the elderly: a systematic review

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): Amanda Cibelly Brito Gois, Leandro de Araújo Pernambuco, Kenio Costa de Lima

Abstract

Introduction

During the aging process, natural modifications occur in the larynx and the structures involved in phonation which explain the specific characteristics found in the voices of elderly persons. When, at any moment, a voice fails and there is interference with communication, a voice disorder has occurred. This can generate disadvantages in communicative efficiency and have a negative impact on quality of life, compromising mechanisms of socialization, the maintenance of autonomy, and the sense of well-being. Nevertheless, there appears to be little clarity about which factors are associated with voice disorders in this population, especially from an epidemiological perspective.

Objective

The present study is a literature review to identify factors associated with voice disorders among the elderly described in population-based studies.

Methods

A systematic review of electronic databases was carried out. The methodological quality of the studies was analyzed with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. The research was conducted independently by two researchers.

Results

Although two articles met the eligibility criteria, none fulfilled all the criteria for the evaluation of methodological quality. According to the two studies selected for this review, factors associated with voice disorders among the elderly included both physical and psychosocial aspects. However, the methodological discrepancies between the studies, particularly in relation to sample selection and the instruments used indicate great variability and compromise the reliability of the results.

Conclusion

Further prevalence studies and investigations of factors associated with voice disorders in the elderly from an epidemiological perspective, and which involve different cultures, should be carried out.

Resumo

Introdução

Durante o processo de envelhecimento, modificações naturais ocorrem na laringe e nas estruturas envolvidas na fonação que explicam as características específicas encontradas nas vozes de pessoas idosas. Quando, a qualquer momento, a voz falha e há interferência com a comunicação, ocorre um distúrbio de voz. Isso pode gerar desvantagens na eficiência de comunicação e um impacto negativo sobre a qualidade de vida, comprometendo os mecanismos de socialização, a manutenção da autonomia e o sentido de bem-estar. Entretanto, ainda não estão claros quais os fatores associados aos distúrbios de voz nesta população, especialmente considerando-se uma perspectiva epidemiológica.

Objetivo

O presente estudo é uma revisão da literatura para identificar fatores associados a distúrbios de voz em idosos descritos em estudos de base populacional.

Método

Foi realizada uma revisão sistemática das bases de dados eletrônicas. A qualidade metodológica dos estudos foi analisada utilizando-se as diretrizes Strengthening the Reporting of Observational Studies in Epidemiology. A pesquisa foi realizada de forma independente por dois pesquisadores.

Resultados

Embora dois artigos tenham preenchido os critérios de elegibilidade, nenhum deles preencheu todos os critérios para a avaliação da qualidade metodológica. De acordo com os dois estudos selecionados para esta revisão, os fatores associados aos distúrbios de voz em idosos incluíram aspectos físicos e psicossociais. Entretanto, as discrepâncias metodológicas entre os estudos, particularmente em relação à seleção da amostra e aos instrumentos utilizados, indicam grande variabilidade e comprometem a confiabilidade dos resultados.

Conclusão

Devem ser realizados estudos de prevalência e investigações de fatores associados a distúrbios de voz em idosos a partir de uma perspectiva epidemiológica e que levem em consideração diferentes culturas.

https://ift.tt/2NZ0FA7

Water protection after tympanostomy (Shepard) tubes does not decrease otorrhea incidence – retrospective cohort study

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): João Subtil, Ana Jardim, André Peralta Santos, João Araújo, José Saraiva, João Paço

Abstract

Introduction

Myringotomy for tube insertion is the most common otologic surgery. Otorrhea is a frequent complication of this procedure and, to prevent it, most surgeons strongly recommend avoiding contact with water as this is thought to adversely impact on post-operative quality of life.

Objective

To understand the benefit of this recommendation.

Methods

Observational study – retrospective cohort study comparing the incidence of post-operative otorrhea and its impact on patients' quality of life, in two groups of patients comprising children under 10 years of age who underwent bilateral myringotomy and tube placement for chronic otitis media with effusion between May 2011 and May 2012. One group received water protection care after surgery, the other did not. Data was collected through telephonic interview, after one year of follow up (one year after the procedure). Water exposure without protection was considered the exposure event. Incidence of otorrhea and perceived impact on quality of life were the outcome measures. Results were compared after logistic regression.

Results

We included 143 children: 116 were not exposed to water without protection and 27 were exposed. In the not exposed group 36.2% had at least one episode of otorrhea, compared to 40.0% of the exposed group. Odds ratio for otorrhea on exposed was 1.21 (95% CI 0.51–2.85, p = 0.6). Negative impact on quality of life was reported by parents of 48.2% on the not exposed children, compared to 40.7% on the exposed group. This difference was not significant (p = 0.5).

Conclusion

We found that recommending water protection did not have beneficial effect on the incidence of otorrhea after myringotomy with tubes on chronic otitis media with effusion. However, such measures did not appear to have a negative impact on quality of life. This is a populational observational study with few cases (143 cases); these final statements would be better stated by a very large populational study with another large control group.

Resumo

Introdução

A miringotomia para inserção de tubo de ventilação é a cirurgia otológica mais comum. Otorreia é uma complicação frequente deste procedimento e, para evita-la, a maioria dos cirurgiões recomenda evitar o contato com a água, pois acredita-se que isso possa afetar negativamente a qualidade de vida pós-operatória.

Objetivo

Verificar o benefício dessa recomendação.

Método

Estudo observacional - estudo de coorte retrospectivo, comparando a incidência de otorreia pós-operatória e seu impacto na qualidade de vida dos pacientes, em dois grupos de pacientes com crianças menores de 10 anos submetidas à miringotomia bilateral e colocação de tubo de ventilação para o tratamento de otite média crônica com efusão, entre maio de 2011 e maio de 2012. Um grupo recebeu cuidados de proteção contra a água após a cirurgia, o outro não. Os dados foram coletados através de entrevista telefônica, após um ano de seguimento (um ano após o procedimento). A exposição à água sem proteção foi considerada o evento de exposição. A incidência de otorreia e o impacto percebido na qualidade de vida foram as medidas de resultado. Os resultados foram comparados após a regressão logística.

Resultados

Incluímos 143 crianças: 116 não foram expostas à água sem proteção e 27 foram expostas. No grupo não exposto, 36,2% apresentaram pelo menos um episódio de otorreia, em comparação com 40,0% do grupo exposto. A razão de chances (odds ratio) para otorreia no grupo exposto foi de 1,21 (IC 95%: 0,51-2,85, p = 0,6). O impacto negativo na qualidade de vida foi relatado pelos pais de 48,2% nas crianças não expostas, em comparação com 40,7% no grupo exposto. Essa diferença não foi significante (p = 0,5).

Conclusão

Não verificamos um efeito benéfico sobre a incidência de otorreia ao recomendar a proteção contra a água após colocação de tubos de ventilação para otite média com efusão. Entretanto, tais medidas não parecem ter tido um impacto negativo na qualidade de vida.

https://ift.tt/2NoVgRv

Quality of life and cochlear implant: results in adults with postlingual hearing loss

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): Aline Faria de Sousa, Maria Inês Vieira Couto, Ana Claudia Martinho-Carvalho

Abstract

Introduction

Considering the variability of results found in the clinical population using a cochlear implant, researchers in the area have been interested in the inclusion of quality of life measures to subjectively assess the benefits of the implantation.

Objective

To assess the quality of life of adult users of cochlear implant.

Methods

A cross-sectional and clinical study in a group of 26 adults of both genders, with mean duration of cochlear implant use of 6.6 years. The Nijmegen Cochlear Implantation Questionnaire and the generic World Health Organization Quality of Life questionnaire were sent electronically.

Results

The best assessed domain in the quality of life assessment for the cochlear implantation questionnaire was the social domain, whereas for the quality of life questionnaire it was the psychological domain. The variables, gender, time of cochlear implant use and auditory modality did not influence the results of both questionnaires. Only the variable level of education was correlated with the environment domain of the quality of life questionnaire. The variable telephone speech comprehension was associated with a better perception of quality of life for all the domains of the specific questionnaire and for the self-assessment of quality of life in general.

Conclusion

From the users' perspective, both questionnaires showed that cochlear implant brought benefits to different aspects related to quality of life.

Resumo

Introdução

Diante da variabilidade de resultados clínicos encontrada na população usuária de implante coclear, pesquisadores da área têm se interessado pela inclusão de medidas de qualidade de vida para avaliar de maneira subjetiva os benefícios do implante coclear.

Objetivo

Avaliar a qualidade de vida de adultos usuários de implante coclear.

Método

Estudo transversal e clínico em um grupo de 26 adultos, de ambos os gêneros, com tempo de uso médio do implante coclear de 6,6 anos. Foram utilizados o questionário específico Nijmegen de Implantes Cocleares e o questionário genérico World Health Organization Quality of Life, enviados via mídia eletrônica.

Resultados

O domínio melhor pontuado na avaliação da qualidade de vida para o questionário Nijmegen foi o social e para o questionário World Health Organization Quality of Life foi o psicológico. As variáveis, gênero, tempo de uso do implante coclear e modalidade auditiva não influenciaram os resultados de ambos os questionários. Apenas a variável nível de instrução correlacionou-se com o domínio meio ambiente do questionário sobre qualidade de vida. A variável compreensão de fala ao telefone associou-se a uma melhor percepção da qualidade de vida para todos os domínios do questionário específico e para a autoavaliação da qualidade de vida em geral.

Conclusão

Na perspectiva dos usuários, o implante coclear trouxe benefícios para os diversos aspectos relacionados à qualidade de vida em ambos os questionários.

https://ift.tt/2O0bEsL

A rare laryngeal tumor in a patient with thyroid papillary cancer: granular cell tumor

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): Sheng-Yao Cheng, Li-Hsiang Cheng, Yi-Shu Liao, Wen-Sen Lai

https://ift.tt/2NkpTHK

Anthropometric study of the caucasian nose in the city of Curitiba: relevance of population evaluation

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): Annelyse Cristine Ballin, Bettina Carvalho, José Eduardo Lutaif Dolci, Renata Becker, Cezar Berger, Marcos Mocellin

Abstract

Introduction

Norms and patterns of nasal esthetics are essential for an adequate preoperative evaluation and surgical programming. The esthetic nasal patterns used are a blend of artistic beauty ideals and tracings in models and celebrities. Because they do not consider population measures, they vary according to the period, and allow a discrepancy between the surgeon's preference and the patient's real desire for rhinoplasty. Not all populations wish to obtain an esthetic result according to these values, but prefer a natural result, that is, one with some of the nasal characteristics of the population to which they belong to. The Brazilian population lacks population studies to evaluate its nose measurements.

Objective

(1) To evaluate the anthropometric measures of Caucasian noses of people living in the city of Curitiba (state of Paraná), and to compare them to the ideal esthetic pattern of the literature; (2) To compare them between genders.

Methods

This is a prospective cohort study involving 100 Caucasian volunteers at a tertiary hospital in Southern Brazil. Through the frontal and lateral view photos, intercanthal distance, alar distance, nasal dorsum length, nasofrontal angle, nasolabial angle, and nasal tip projection (Goode's method) were obtained. A statistical analysis was performed to compare the measures obtained between genders and with the ideal patterns.

Results

Comparing the results obtained with those predicted by the esthetic ideals, the sample presented: similar nasolabial angle (p = 0.07), alar width greater than intercanthal distance (p < 0.001), higher nasal tip projection (p < 0.001), larger width–length ratio (p < 0.001), and more obtuse nasofrontal angle (p < 0.001). The nasofrontal angle (p = 0.0008) and the tip projection (p = 0.032) were statistically different between the genders. Men had a smaller nasofrontal angle, and a larger Goode's ratio.

Conclusion

Except for the nasolabial angle, the measures obtained in the population sample differed from the published esthetic ideals. Comparing the genders, men had a sharper nasofrontal angle, and higher tip projection than women.

Resumo

Introdução

Normas e padrões de estética nasal são essenciais para uma adequada avaliação pré-operatória e programação cirúrgica. Os padrões estéticos nasais usados são uma mistura dos ideais artísticos de beleza e traçados em modelos e celebridades. Por não considerar medidas populacionais, variam conforme o período e permitem uma discrepância entre o desejo do cirurgião e o real desejo do paciente com a rinoplastia. Nem todas as populações desejam obter um resultado estético conforme esses valores, mas um resultado natural, ou seja, com algumas das características nasais da população a que pertencem. A população brasileira carece de estudos populacionais que avaliam as suas medidas nasais.

Objetivo

1) Avaliar as médidas antropométricas de narizes caucasianos da cidade de Curitiba (Paraná) e compará-los com o padrão estético ideal da literatura; 2) Compará-los entre os sexos.

Método

Estudo prospectivo, coorte, envolvendo 100 voluntários caucasianos em um Hospital terciário no Sul do Brasil. Através de fotografias na vista frontal e lateral, foram obtidas: distância intercantal, distância alar, comprimento do dorso nasal, ângulo nasofrontal, ângulo nasolabial e projeção da ponta nasal (método do Goode). Análise estatística foi realizada para comparar as medidas obtidas: entre os gêneros e com os padrões ideais.

Resultados

Comparando os resultados obtidos com o apregoado pelos ideais estéticos, a amostra apresentou: ângulo nasolabial similar (p = 0,07), largura alar maior que distância intercantal (p < 0,001), maior projeção da ponta nasal (p < 0,001), relação largura-comprimento maior (p < 0,001) e ângulo nasofrontal mais obtuso (p < 0,001). Diferiram estatisticamente entre os sexos o ângulo nasofrontal (p = 0,0008) e a projeção da ponta (p = 0,032). Homens apresentaram o ângulo nasofrontal menor e a razão de Goode maior.

Conclusão

Com exceção do ângulo nasolabial, as medidas obtidas na amostra populacional diferiram dos ideais estéticos publicados. Comparando os sexos, homens apresentaram um ângulo nasofrontal mais agudo e uma projeção da ponta maior que as mulheres.

https://ift.tt/2NWXTeo

Body mass index and acoustic voice parameters: is there a relationship?

Publication date: July–August 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 4

Author(s): Lourdes Bernadete Rocha de Souza, Marquiony Marques dos Santos

Abstract

Introduction

Specific elements such as weight and body volume can interfere in voice production and consequently in its acoustic parameters, which is why it is important for the clinician to be aware of these relationships.

Objective

To investigate the relationship between body mass index and the average acoustic voice parameters.

Methods

Observational, cross-sectional descriptive study. The sample consisted of 84 women, aged between 18 and 40 years, an average of 26.83 (±6.88). The subjects were grouped according to body mass index: 19 underweight; 23 normal ranges, 20 overweight and 22 obese and evaluated the fundamental frequency of the sustained vowel [a] and the maximum phonation time of the vowels [a], [i], [u], using PRAAT software. The data were submitted to the Kruskal–Wallis test to verify if there were differences between the groups regarding the study variables. All variables showed statistically significant results and were subjected to non-parametric test Mann–Whitney.

Results

Regarding to the average of the fundamental frequency, there was statistically significant difference between groups with underweight and overweight and obese; normal range and overweight and obese. The average maximum phonation time revealed statistically significant difference between underweight and obese individuals; normal range and obese; overweight and obese.

Conclusion

Body mass index influenced the average fundamental frequency of overweight and obese individuals evaluated in this study. Obesity influenced in reducing maximum phonation time average.

Resumo

Introdução

Elementos específicos como peso e volume corporal podem interferir na produção da voz e, consequentemente, em seus parâmetros acústicos, razão pela qual é importante que o médico esteja ciente dessas relações.

Objetivo

Investigar a relação entre o índice de massa corporal e os parâmetros acústicos médios da voz.

Método

Estudo observacional, transversal, descritivo. A amostra foi composta por 84 mulheres, com idade entre 18 e 40 anos, média de 26,83 (±6,88). As participantes foram agrupadas de acordo com o índice de massa corporal: 19 abaixo do peso; 23 com intervalos normais, 20 com sobrepeso e 22 obesos e avaliadas quanto a frequência fundamental da vogal sustentada [a] e o tempo máximo de fonação das vogais [a], [i], [u], utilizando o software PRAAT. Os dados obtidos foram submetidos ao teste de Kruskal-Wallis para verificar se houve diferença entre os grupos com relação as variáveis do estudo. Todas as variáveis apresentaram resultados estatisticamente significativos e foram submetidas ao teste não paramétrico de Mann-Whitney.

Resultados

Com relação à média da frequência fundamental, houve diferença estatisticamente significativa entre os grupos com peso normal e sobrepeso e entre os grupos com peso normal e obesidade. A média do tempo máximo de fonação revelou diferença estatisticamente significativa entre indivíduos com baixo peso e obesidade; peso normal e obesidade; sobrepeso e obesidade.

Conclusão

O índice de massa corporal influenciou na média da frequência fundamental dos indivíduos com sobrepeso e obesos avaliados neste estudo. A obesidade mórbida influiu na redução da média do tempo máximo de fonação.

https://ift.tt/2NqI5zw

Beef Jerky and Other Processed Meats Associated with Manic Episodes

An analysis of more than 1,000 people with and without psychiatric disorders has shown that nitrates—chemicals used to cure meats such as beef jerky, salami, hot dogs and other processed meat snacks—may contribute to mania, an abnormal mood state. Mania is characterized by hyperactivity, euphoria and insomnia.

https://ift.tt/2NqpQui

Matrix Metalloproteinase-9 Expression and Status of Cervical Lymph Nodes in Patients with Nasopharyngeal Carcinoma

Abstract

Tumor growth and metastasis in nasopharyngeal carcinoma (NPC) patients was suspected as a role of several molecular biomarkers that have been identified in tumor specimens of patients with NPC. Invasion and metastasis process was a complex mechanism which involved some proteolytic enzymes, such as matrix metalloproteinase-9 (MMP-9). To analyze the association of MMP-9 expression of NPC patients with cervical lymph node metastasis. The study was conducted in oncology unit of ORL-HNS at Dr. Soetomo General Hospital Surabaya from May to July 2015. Formalin-fixed paraffin-embedded biopsy specimens from NPC patients with WHO type II and III of histopathology and clinically were divided into four state of cervical enlargement (N0. N1. N2 and N3). The expression of MMP-9 was obtained with immunohistochemistry using rabbit polyclonal antibody Anti-MMP9 ab7299 from abcam^®. Cambridge-UK. Thirty-two NPC patients were enrolled in this study. The study found a negative expression of MMP-9 in 3.12% of samples. Spearman rho test result was p = 0.001 with correlation coefficient of 0.754. Spearman test resulted p value of 0.001 with a correlation coefficient of 0.754. Correlation of matrix metalloproteinase-9 expression with cervical lymph node metastasis (N0, N1, N2, and N3) in patients with NPC showed a significant result (p < 0.05). There was a strong positive correlation between MMP-9 expressions with cervical lymph node status in NPC patients.

https://ift.tt/2mraYAr

Correlation Between Superoxide Dismutase Serum Level Alteration with Neck Metastatic Tumor Post Cisplatin–Paclitaxel Chemotherapy Response in Nasopharyngeal Carcinoma Patients

Abstract

Nasopharyngeal carcinoma (NPC) is a malignant tumor in the nasopharynx. The patients treated with neoadjuvan combination chemotherapy cisplatin–paclitaxel while waiting a radiotherapy. This combination can produce a very high reactive oxygen species (ROS) level. Our body has a protective mechanism against oxidant through superoxide dismutase (SOD) that can inhibit DNA chain damage from ROS induction produced by chemotherapy in NPC patients. This study aimed to analyze the correlation between SOD level alteration with neck metastatic tumor response after cisplatin–paclitaxel chemotherapy. This was a cohort study. Thirty samples examined for neck metastasis tumor volume (VTM) and serum SOD were examined with ELISA pre- and postchemotherapy. Statistical significance was defined as p < 0.05. Mean SOD serum level pre-chemotherapy and post-chemotherapy were was 179.5 and 209.1, respectively. Mean tumor metastaic volume pre and post chemotherapy were 127.3 and 62.7, respectively. The correlation test with the result (r) 0.180 and p = 0.340. There was no correlation between SOD serum level alteration with VTM volume post cisplatin–paclitaxel chemotherapy in NPC patients.

https://ift.tt/2uII0zL

Nasal Framework Reconstruction in Patient with Eosinophilic Angiocentric Fibrosis

Abstract

Eosinophilic angiocentric Fibrosis (EAF) is a rare condition involving the sinonasal tract and nasal septum which is mostly considered as a benign condition. EAF could present with progressive nasal obstruction as its most common symptom. In this case report, we try to report a case of middle aged man with nasal septum tumor-link lesion which was diagnosed with EAF. A 45 years old man presented with complete nasal obstruction who described a growing nasal cavity mass for over 6 months. Anterior rhinoscopy revealed bilateral mass with a smooth surface on the nasal septum and mass protruded into both nasal cavities. CT scan showed a 28 × 18 mm soft tissue mass in nasal cavity mostly in right side with erosion of right maxillary alveolar ridge. Microscopic examination of a biopsy taken from the mass showed dense infiltration of inflammatory cells rich in eosinophils as well as perivascular condensation of fibrotic bundles creating onion-skin appearance was noted. The patient went under surgical ablation of the tumor and has been followed up every 2–3 month for about 1 year and there was no evidence of recurrent disease. The complete surgical excision may eradicate the allergic manifestations in the EAF patients and cartilage graft such as rib graft seems to be safe if the reconstruction is needed. It is important to prevent tumor from recurrence by totally resecting the involved tissues.

https://ift.tt/2mnyMF0

Matrix Metalloproteinase-9 Expression and Status of Cervical Lymph Nodes in Patients with Nasopharyngeal Carcinoma

Abstract

Tumor growth and metastasis in nasopharyngeal carcinoma (NPC) patients was suspected as a role of several molecular biomarkers that have been identified in tumor specimens of patients with NPC. Invasion and metastasis process was a complex mechanism which involved some proteolytic enzymes, such as matrix metalloproteinase-9 (MMP-9). To analyze the association of MMP-9 expression of NPC patients with cervical lymph node metastasis. The study was conducted in oncology unit of ORL-HNS at Dr. Soetomo General Hospital Surabaya from May to July 2015. Formalin-fixed paraffin-embedded biopsy specimens from NPC patients with WHO type II and III of histopathology and clinically were divided into four state of cervical enlargement (N0. N1. N2 and N3). The expression of MMP-9 was obtained with immunohistochemistry using rabbit polyclonal antibody Anti-MMP9 ab7299 from abcam^®. Cambridge-UK. Thirty-two NPC patients were enrolled in this study. The study found a negative expression of MMP-9 in 3.12% of samples. Spearman rho test result was p = 0.001 with correlation coefficient of 0.754. Spearman test resulted p value of 0.001 with a correlation coefficient of 0.754. Correlation of matrix metalloproteinase-9 expression with cervical lymph node metastasis (N0, N1, N2, and N3) in patients with NPC showed a significant result (p < 0.05). There was a strong positive correlation between MMP-9 expressions with cervical lymph node status in NPC patients.

https://ift.tt/2mraYAr

Correlation Between Superoxide Dismutase Serum Level Alteration with Neck Metastatic Tumor Post Cisplatin–Paclitaxel Chemotherapy Response in Nasopharyngeal Carcinoma Patients

Abstract

Nasopharyngeal carcinoma (NPC) is a malignant tumor in the nasopharynx. The patients treated with neoadjuvan combination chemotherapy cisplatin–paclitaxel while waiting a radiotherapy. This combination can produce a very high reactive oxygen species (ROS) level. Our body has a protective mechanism against oxidant through superoxide dismutase (SOD) that can inhibit DNA chain damage from ROS induction produced by chemotherapy in NPC patients. This study aimed to analyze the correlation between SOD level alteration with neck metastatic tumor response after cisplatin–paclitaxel chemotherapy. This was a cohort study. Thirty samples examined for neck metastasis tumor volume (VTM) and serum SOD were examined with ELISA pre- and postchemotherapy. Statistical significance was defined as p < 0.05. Mean SOD serum level pre-chemotherapy and post-chemotherapy were was 179.5 and 209.1, respectively. Mean tumor metastaic volume pre and post chemotherapy were 127.3 and 62.7, respectively. The correlation test with the result (r) 0.180 and p = 0.340. There was no correlation between SOD serum level alteration with VTM volume post cisplatin–paclitaxel chemotherapy in NPC patients.

https://ift.tt/2uII0zL

Nasal Framework Reconstruction in Patient with Eosinophilic Angiocentric Fibrosis

Abstract

Eosinophilic angiocentric Fibrosis (EAF) is a rare condition involving the sinonasal tract and nasal septum which is mostly considered as a benign condition. EAF could present with progressive nasal obstruction as its most common symptom. In this case report, we try to report a case of middle aged man with nasal septum tumor-link lesion which was diagnosed with EAF. A 45 years old man presented with complete nasal obstruction who described a growing nasal cavity mass for over 6 months. Anterior rhinoscopy revealed bilateral mass with a smooth surface on the nasal septum and mass protruded into both nasal cavities. CT scan showed a 28 × 18 mm soft tissue mass in nasal cavity mostly in right side with erosion of right maxillary alveolar ridge. Microscopic examination of a biopsy taken from the mass showed dense infiltration of inflammatory cells rich in eosinophils as well as perivascular condensation of fibrotic bundles creating onion-skin appearance was noted. The patient went under surgical ablation of the tumor and has been followed up every 2–3 month for about 1 year and there was no evidence of recurrent disease. The complete surgical excision may eradicate the allergic manifestations in the EAF patients and cartilage graft such as rib graft seems to be safe if the reconstruction is needed. It is important to prevent tumor from recurrence by totally resecting the involved tissues.

https://ift.tt/2mnyMF0

New approaches to allergen immunotherapy

Publication date: Available online 17 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Natasha C. Gunawardana, Stephen R. Durham

Abstract

Objective

New insights into mechanisms should enable strategic improvement of allergen immunotherapy, aiming to make it safer, faster, more effective and able to induce long-term tolerance. We review novel approaches with potential to translate into clinical use.

Data Sources

Database searches were conducted in Pubmed, Scopus and Google Scholar.

Study Selections

Search terms were based on current and novel approaches in immunotherapy. Literature was selected primarily from recent randomised double-blind placebo-controlled trials and meta-analyses.

Results

Alum, microcrystalline tyrosine and calcium phosphate are adjuvants in current use. Toll-like receptor 4 agonists combined with allergen have potential to shorten duration of treatment. Other novel adjuvants, nano-particles and virus-like particles in combination with allergen have shown early promise. Omalizumab reduces systemic side effects, however does not improve efficacy. Intralymphatic immunotherapy for aeroallergens and epicutaneous immunotherapy for food allergens, use of modified allergens (allergoids), recombinant allergens (and hypoallergenic variants) and T and B cell peptide approaches have shown evidence of efficacy and permitted shortened courses but have only rarely been compared with conventional extracts.

Conclusion

Novel routes of immunotherapy, the use of modified allergens and the combination of allergens with immunostimulatory adjuvants, or immune modifiers have been developed to augment down-regulation of Th2 immunity and/or induce 'protective' blocking antibodies. Whereas these strategies have permitted shortened courses, confirmatory phase III trials are required to confirm efficacy and safety, and head-to-head trials for comparative efficacy. At present, subcutaneous and sublingual immunotherapy using in-house standardised crude extracts remain the only approaches proven to induce long-term tolerance.

https://ift.tt/2uvIMRl

An Economic Evaluation of Immediate Verses Non-immediate Activation of Emergency Medical Services After Epinephrine Use for Peanut-induced Anaphlaxis

Publication date: Available online 17 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Marcus Shaker, Tsuzumi Kanaoka, Lynn Feenan, Matthew Greenhawt

Abstract

Background

Layperson food allergy management plans commonly stipulate that if epinephrine is used to "immediately call 911 and seek care in the nearest medical facility" for observation. Objective: To evaluate the cost-effectiveness of this strategy, versus a watchful waiting approach before activating emergency medical services (EMS).

Methods

We performed a cost-effectiveness analysis using Markov modeling simulated over a 20-year horizon comparing activating EMS immediately after epinephrine use for allergic reactions to peanut vs. a "wait and see" approach in which EMS was only activated if symptoms of the reaction did not promptly resolve after treatment. The base-case model assumed a 10-fold increased fatality risk with delayed EMS activation.

Results

The fatality risk associated with early EMS use was minimal, with a per-patient fatality rate over a 20-year horizon of 1.2 × 10-6, vs. 1.9 × 10-6 for a "wait and see" approach. The incremental cost per life-year saved was $142,943,447 for early EMS vs "wait and see," with the cost per death prevented reaching $1,349,335,651 as the simulation concluded. Cost of early EMS activation rose to $321,625,534 per lifeyear saved ($3,035,454,848 per death prevented) if a 5-fold increase in fatality risk was assumed, and was $12,997,173 per life-year saved ($122,689,936 per death prevented) if a 100-fold increase in fatality risk was assumed.

Conclusion

Medical observation of a treated and promptly resolved peanut allergic reaction has minimal benefit and excessive costs. Immediately activating EMS after using epinephrine for a peanut allergic reaction in this context is not cost-effective.

https://ift.tt/2zN98mH

Evaluation of the manufacturer-dependent differences in sIgE results for indoor allergens

Publication date: Available online 17 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Nathalie Wojtalewicz, Kathrin Kabrodt, Sabine Goseberg, Ingo Schellenberg

Abstract

Background

Even though allergies are an important health issue, the detected amount of allergen-specific IgE (sIgE) has differed widely between manufacturers in the past, and even as recently as this year. These discrepancies hinder diagnostics and can even impact allergen immunotherapy.

Objective

The aim of this study was to evaluate the development and status quo of the quality of in vitro diagnostic testing for house dust mites (HDM) and cat epithelium, two important indoor allergen sources. Methods: We analyzed data on the allergen sources European HDM, American HDM and cat epithelium, which were collected by the Society for Promoting Quality Assurance in Medical Laboratories (INSTAND e.V.) during 7 years as part of External Quality Assessment schemes (EQAs). A pseudoanonymized comparison was made of the semi-quantitative data and allergen-class results of the four main suppliers of in vitro diagnostic sIgE tests. Coefficients of variation (CV) were determined in order to evaluate interlaboratory comparability.

Results

In vitro allergy diagnostic testing for the major allergen sources HDM and cat epithelium still reveals manufacturer-dependent differences. Despite this, there appears to be a cautious trend towards an alignment of the results and interlaboratory comparability with the exception of one supplier.

Conclusion

Even though these results are promising, future EQAs have to be closely monitored to ensure this positive trend is not just a snapshot.

https://ift.tt/2uvxfkI

Allergy to ginger with Cysteine proteinase GP-I as the relevant allergen

Publication date: Available online 17 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Patricia López-De-Los-Santos, David González-de-Olano, Ricardo Madrigal-Burgaleta, Borja Bartolomé, Carlos Pastor-Vargas

https://ift.tt/2zN93iT

Effects of HLA status and HER2 status on outcomes in breast cancer patients at risk for recurrence – Implications for vaccine trial design

Publication date: Available online 17 July 2018

Source: Clinical Immunology

Author(s): O. Jackson Doreen, Trappey A. Francois, Clifton G. Travis, J. Vreeland Timothy, M. Peace Kaitlin, F. Hale Diane, K. Litton Jennifer, L. Murray James, A. Perez Sonia, Papamichail Michael, A. Mittendorf Elizabeth, E. Peoples George

Abstract

Immunotherapy, using peptide-based cancer vaccines is being studied to assess its potential in breast cancer. Trials of HLA-restricted peptide vaccines have been difficult to enroll given HLA subtype restrictions. It is necessary to determine the prognostic significance of HLA-status in breast cancer if patients who are ineligible to receive a vaccine due to their HLA-status are used as controls. The impact of targeted tumor associated antigen expression, when it effects eligibility is also important. We examined control patients from two randomized phase II trials that tested HER2-peptide vaccines to determine the effect of HLA-A2 status and HER2 expression on disease-free survival. The analysis showed that HLA-A2-status does not affect disease-free survival, regardless of HER2 expression suggesting that HLA-A2 negative patients can be used as control patients. Additionally, HER2 over-expression was associated with a better disease-free survival in this population, underscoring the need for additional therapies in HER2 low-expressing breast cancer.

ClinicalTrials.gov Identifier: NCT00524277

https://ift.tt/2NmWDjK

Systemic lupus erythematosus-myasthenia gravis overlap syndrome: Presentation and treatment depend on prior thymectomy

Publication date: Available online 17 July 2018

Source: Clinical Immunology

Author(s): Scott Brian Minchenberg, Geeta Chaparala, Zachary Oaks, Katalin Banki, Andras Perl

Abstract

In this study, we investigated four patients who met the diagnostic criteria for overlapping systemic lupus erythematosus (SLE) and myasthenia gravis (MG) but responded differently to treatment. All patients were acetylcholine receptor (AChR) and antinuclear antibody positive at the time of SLE diagnosis. Two patients presented with SLE who have been effectively treated with cholinesterase inhibitors for MG. These patients developed SLE with photosensitivity, rash, and arthritis post thymectomy, which had been performed 29 years and 40 years earlier, respectively. Two other patients were found to have AChR antibodies and MG in the context on new-onset SLE. These subjects were responsive to hydroxychloroquine and immunosuppression but failed cholinesterase inhibitors. The evolution of these cases is relevant for the role of thymus in lupus pathogenesis during aging and for treatment selection in SLE-MG overlap patients.

https://ift.tt/2NZisag

Accidental food allergy reactions: Products and undeclared ingredients

Publication date: Available online 17 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): W. Marty Blom, Anouska D. Michelsen-Huisman, Harmieke van Os-Medendorp, Gert van Duijn, Mary-lène de Zeeuw-Brouwer, Astrid Versluis, Jacqueline J.M. Castenmiller, Hubert P.J.M. Noteborn, Astrid G. Kruizinga, André C. Knulst, Geert F. Houben

Background

Accidental allergic reactions to food are frequent and can be severe and even fatal.

Objective

We sought to analyze the culprit food products and levels of unexpected allergens in accidental reactions.

Methods

A prospective cohort study was conducted in adults (n = 157) with a physician-confirmed diagnosis of food allergy. During a 1-year follow-up, 73 patients reported accidental allergic reactions and the culprit food products. Food samples received (n = 51) were analyzed for a wide range of suspected noningredient allergens, and risk was quantified.

Results

A very diverse range of food products was responsible for the unexpected allergic reactions. Thirty-seven percent (19/51) of products analyzed had 1 to 4 culprit allergens identified that were not supposed to be present according to the ingredient declaration. Concentrations varied from 1 to 5000 mg of protein of the allergenic food per kilogram of food product and were greatest for peanut, milk, and sesame. Milk proteins posed the highest estimated risk for objective allergic reactions. The intake of culprit allergens by patients varied considerably. For those cases in which culprit allergens were detected, the intake of at least 1 allergen exceeded the reference dose or a culprit allergen with a yet unknown reference dose was present. Both patient neglect of precautionary allergen labeling statements and omission of using a precautionary allergen labeling statement by food manufacturers seem to contribute to accidental reactions.

Conclusion

A wide range of food products are causing accidental reactions in patients with food allergy. Eight different allergens not declared on the ingredient lists were detected in the culprit food products, all of which were representative of allergens regulated in the European Union.

Graphical abstract

https://ift.tt/2JwL9rq